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1.
World Neurosurg ; 187: e860-e869, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38734167

RESUMO

OBJECTIVE: Despite the growing acceptance of neuronavigation in the field of neurosurgery, there is limited comparative research with contradictory results. This study aimed to compare the effectiveness (tumor resection rate and survival) and safety (frequency of neurological complications) of surgery for brain gliomas with or without neuronavigation. METHODS: This retrospective cohort study evaluated data obtained from electronic records of patients who underwent surgery for gliomas at Dr. Alejandro Dávila Bolaños Military Hospital and the Clinic Hospital of Barcelona between July 2016 and September 2022. The preoperative and postoperative clinical and radiologic characteristics were analyzed and compared according to the use of neuronavigation. RESULTS: This study included 110 patients, of whom 79 underwent surgery with neuronavigation. Neuronavigation increased gross total resection by 57% in patients in whom it was used; gross total resection was performed in 56% of patients who underwent surgery with neuronavigation as compared with 35.5% in those who underwent surgery without neuronavigation (risk ratio [RR], 1.57; P=0.056). The incidence of postoperative neurologic deficits (transient and permanent) decreased by 79% with the use of neuronavigation, (12% vs. 33.3%; RR, 0.21; P=0.0003). Neuronavigation improved survival in patients with grade IV gliomas (15 months vs. 13.8 months), but it was not statistically significant (odds ratio (OR), 0.19; P=0.13). CONCLUSIONS: Neuronavigation improved the effectiveness (greater gross total resection of tumors) and safety (fewer neurological deficits) of brain glioma surgery. However, neuronavigation does not significantly influence the survival of patients with grade IV gliomas.


Assuntos
Glioma , Neuronavegação , Complicações Pós-Operatórias , Neoplasias Supratentoriais , Humanos , Neuronavegação/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Glioma/cirurgia , Estudos Retrospectivos , Adulto , Neoplasias Supratentoriais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Estudos de Coortes , Resultado do Tratamento , Procedimentos Neurocirúrgicos/métodos , Neoplasias Encefálicas/cirurgia
2.
Childs Nerv Syst ; 37(12): 3817-3826, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34319438

RESUMO

BACKGROUND: Stereo-electroencephalography (SEEG) is a well-known invasive diagnostic method for drug-resistant epilepsy (DRE). Its rate of complications is relatively low, being the intracranial hemorrhage (ICH) the most relevant. Most centers perform immediate imaging studies after SEEG to rule out complications. However, delayed intracranial hemorrhages (DIH) can occur despite normal imaging studies in the immediate postoperative period. METHODS: We performed a retrospective review of DRE pediatric patients operated on SEEG between April 2016 and December 2020 in our institution. After implantation, an immediate postoperative CT was performed to check electrode placement and rule out acute complications. An additional MRI was performed 24 h after surgery. We collected all postoperative hemorrhages and considered them as major or minor according to Wellmer´s classification. RESULTS: Overall, 25 DRE patients were operated on SEEG with 316 electrodes implanted. Three ICHs were diagnosed on postoperative imaging. Two of them were asymptomatic requiring no treatment, while the other needed surgical evacuation after clinical worsening. The total risk of hemorrhage per procedure was 12%, but just one third of them were clinically relevant. Two hemorrhages were not visible on immediate postoperative CT, being incidentally diagnosed in the 24 h MRI. We recorded them as DIH and are reported in detail. CONCLUSION: Few reports of DIH after SEEG exist in the literature. It remains unclear whether these cases are late occurring hemorrhages or immediate postoperative hemorrhages undiagnosed on initial imaging. According to our findings, we recommend to perform additional late postoperative imaging to diagnose these cases and manage them accurately.


Assuntos
Diagnóstico Tardio , Epilepsia Resistente a Medicamentos , Criança , Epilepsia Resistente a Medicamentos/cirurgia , Eletrodos Implantados , Eletroencefalografia , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Estudos Retrospectivos , Técnicas Estereotáxicas
3.
Neurocirugia (Astur) ; 23(1): 29-35, 2012 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-22520101

RESUMO

Our review of the literature is basically focused on the primary prophylaxis of early seizures after surgery of cerebral supratentorial tumors, with the aim of suggesting several recommendations in medical antiepileptic treatment to avoid this kind of seizures which occur immediately after surgery. In conclusion, it is recommended to provide criteria for prophylaxis of early seizures after surgery of cerebral supratentorial tumors. It́s recommended a one week treatment with antiepileptic drugs in patients who didnt have seizures jet, starting immediately after the surgical treatment. If seizures appear during progress of the disease, a large period treatment will be needed. Preferred antiepileptic treatment is intravenous and with a low interactions profile. Levetiracetam, followed by valproic acid seem to be most appropriated drugs due to their properties and protective effects, particularly for our patients requirements. These recommendations are considered a general proposal to effective clinical management of early seizures after surgery, not taking into account the single circumstances of our patients. Always, clinical features of the patients could modify even significantly these guides in the benefit of each patient.


Assuntos
Neurocirurgia , Convulsões , Anticonvulsivantes/uso terapêutico , Humanos , Espanha , Neoplasias Supratentoriais
4.
Acta Neurochir (Wien) ; 152(2): 355-60, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19997945

RESUMO

PURPOSE: Cranial nerve microvascular decompression is a habitual neurosurgical procedure. Authors describe a new application of the Dextroscope (Volume Interactions, Ltd.), a virtual reality environment, to plan and properly simulate this kind of procedures. METHODS: In three cases of hemifacial spasm refractory to drugs and botulinum toxin treatment, the authors used a virtual reality workstation (Dextroscope) to develop an interactive simulation of craniotomy, approach, and Gore-Tex implant optimal size and position in order to reach vascular decompression of facial nerve. RESULTS: Three-dimensional interactive environment allowed the authors to virtually carry out craniotomy, to visualize vascular and nerve relationship, and finally, to select and to simulate best Gore-Tex graft positioning in each case. During surgical procedures, facial nerve vascular compressions were exposed and Gore-Tex grafts were successfully placed as it was virtually planned. Patient outcomes were excellent, with an average improvement of two units (0-4 grades of severity scale). CONCLUSION: Virtual reality environment can help the neurosurgeon to plan and train vascular decompression procedures. Use of appropriate craniotomy, knowledge of vascular and nerve relationship, and selection of optimum paddy size and position are the main useful applications of the Dextroscope in these procedures.


Assuntos
Craniotomia/métodos , Descompressão Cirúrgica/métodos , Espasmo Hemifacial/cirurgia , Neuronavegação/métodos , Interface Usuário-Computador , Procedimentos Cirúrgicos Vasculares/métodos , Artéria Basilar/patologia , Artéria Basilar/fisiopatologia , Artéria Basilar/cirurgia , Transtornos Cerebrovasculares/patologia , Transtornos Cerebrovasculares/fisiopatologia , Transtornos Cerebrovasculares/cirurgia , Desenho Assistido por Computador/instrumentação , Craniotomia/instrumentação , Descompressão Cirúrgica/instrumentação , Nervo Facial/patologia , Nervo Facial/fisiopatologia , Nervo Facial/cirurgia , Feminino , Espasmo Hemifacial/patologia , Espasmo Hemifacial/fisiopatologia , Humanos , Processamento de Imagem Assistida por Computador/instrumentação , Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Microcirurgia/instrumentação , Microcirurgia/métodos , Microvasos/patologia , Microvasos/fisiopatologia , Microvasos/cirurgia , Neuronavegação/instrumentação , Cuidados Pré-Operatórios/instrumentação , Cuidados Pré-Operatórios/métodos , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Procedimentos Cirúrgicos Vasculares/instrumentação
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