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1.
Ann Plast Surg ; 2024 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-39356084

RESUMEN

BACKGROUND: This study aims to present lateral sacral artery perforator (LSAP) flaps as a new option for myelomeningocele reconstruction and to discuss their advantages and disadvantages. METHODS: Eleven patients were included in the study, and reconstruction was performed with 22 LSAP flaps. Patients were evaluated in age, gender, birth weight, kyphosis status, defect localization and size, flap size, operation time, amount of bleeding, and postoperative complications. RESULTS: Sixteen flaps were raised from the first and 6 from the second LSA. The average time for soft tissue reconstruction was 57 minutes. The mean blood loss was 11.1 mL/kg. No cerebrospinal fluid leakage was detected in any patient. In 1 of the 22 flaps, venous congestion did not completely resolved and resulted in partial necrosis secondary to venous insufficiency. In 2 patients, minimal wound dehiscence was detected in the distal part of the flap. No wound infections, hematomas, donor site complications, or seromas were observed in any patient. CONCLUSIONS: Considering that myelomeningoceles are often located in the lumbar region, we think that LSAP flaps will be a new option among other flaps. Additionally, if other flaps are used in the neonatal period, it may be a good alternative for pressure sore reconstruction in the kyphotic area.

2.
Childs Nerv Syst ; 35(3): 429-435, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30610485

RESUMEN

OBJECTIVE: To evaluate the feasibility and safety of sodium fluorescein (Na-Fl)-guided surgery with the use of the PENTERO 900 surgical microscope (Carl Zeiss, Meditec, Oberkochen, Germany) equipped with the YELLOW-560-nm filter and low-dose Na-Fl (2 mg/kg) in pediatric brain tumor surgery. METHODS: The study included 23 pediatric patients with various intracranial pathologies, who underwent Na-Fl-guided surgery between April 2015 and February 2018. Clinical features, surgical observations, extent of resection, and tumor histopathology were retrospectively analyzed. The use of YELLOW-560-nm filter was found "helpful" if the discrimination of the pinkish brain tissue and bright yellow stained tumor tissue was clear. Otherwise, it was described as "not helpful." RESULTS: There were 11 female and 12 male patients with a mean age of 9.4 years. There were 7 brain stem/tectal plate gliomas, 6 supratentorial tumors, 4 intraventricular tumors, 2 pineal tumors, 2 infratentorial tumors, 1 clivus tumor, and 1 tumor with supra- and infratentorial extensions in the current series. Na-Fl was found helpful by means of the tumor demarcation in 20 instances (87%). In 11 of these 20 operations (55%), a total resection was achieved regardless of the tumor pathology. A subtotal resection was achieved in the remaining 9 patients (45%). No adverse events or side effects were encountered with regard to Na-Fl use. CONCLUSION: Na-Fl guidance with the use of the YELLOW-560 filter is safe and effective during brain tumor surgery in pediatric age group.


Asunto(s)
Neoplasias Encefálicas/cirugía , Fluoresceína , Microscopía Fluorescente/métodos , Microcirugia/métodos , Procedimientos Neuroquirúrgicos/métodos , Niño , Estudios de Factibilidad , Femenino , Humanos , Masculino , Neuronavegación/métodos , Estudios Retrospectivos
3.
Neurocirugia (Astur) ; 28(5): 235-241, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28532963

RESUMEN

OBJECTIVE: To report perioperative complications in fully endoscopic lumbar discectomy (FELD). METHODS: From September 2010 to November 2016, 835 patients underwent FELD. In total, 865 disc levels were operated on. Of the 835 patients, the transforaminal (TF) approach was used in 174 patients, while 691 patients were operated on using the interlaminar (IL) approach. Surgical complications occurred in 47 patients, which were retrospectively analyzed. RESULTS: Neurological deficits occurred in six patients. In four of these six patients, deficits resolved spontaneously. In one patient, symptoms resolved after a laminectomy procedure. In only one case, the neurological deficit was permanent. Seven patients complained of dysesthesia, which resolved spontaneously with medical treatment in four patients. In the remaining two patients, dysesthesia symptoms improved after epidural and foraminal injections. Dural tears were encountered in 26 patients. Pudendal neuralgia occurred in three patients. Two cases showed wound infection. The other complications comprised one disc infection, one retroperitoneal hematoma and one wrong level surgery. CONCLUSION: The FELD procedure has a steep learning curve and it is a difficult procedure to master. Surgeons should be aware of complications that can occur with the FELD procedure, most of which resolve spontaneously.


Asunto(s)
Discectomía/efectos adversos , Discectomía/métodos , Endoscopía , Complicaciones Posoperatorias/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
4.
Turk Neurosurg ; 30(1): 112-118, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31573066

RESUMEN

AIM: To determine the feasibility and efficacy of full endoscopic interlaminar discectomy (FEID) for recurrent disc herniation. MATERIAL AND METHODS: This retrospective single-center study included 60 patients. Among them, 36 who previously had microdiscectomy underwent revisional FEID (MD group), and 24 who previously had FEID underwent revisional FEID (FEID group). In addition to general parameters, the following measurement tools were used: visual analog scale (VAS) and Oswestry disability index (ODI) questionnaire. RESULTS: No statistically significant difference was observed in length of hospitalization, time to return to work, complications, and recurrences between the two groups. Both the FEID and MD groups had a significant decrease in postoperative VAS and ODI scores. The mean operation time was shorter in the FEID group than in the MD group, and the result was significantly different (p < 0.05). During the 36-month follow-up, no significant differences were observed in postoperative VAS and ODI scores between the two groups. Moreover, none of the patients developed complications correlated to surgery. However, three patients with a previous history of microdiscectomy or endoscopic discectomy had recurrence despite revisional endoscopic surgery. CONCLUSION: Percutaneous revisional full endoscopic lumbar disc surgery is a safe and effective procedure that does not cause additional structural damage. Full endoscopic technique can be used safely for recurrent disc herniations regardless if a patient underwent microscopic or endoscopic surgery.


Asunto(s)
Discectomía/métodos , Endoscopía/métodos , Desplazamiento del Disco Intervertebral/cirugía , Reoperación/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Degeneración del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Región Lumbosacra/cirugía , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento
5.
Turk Neurosurg ; 30(2): 225-230, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31608977

RESUMEN

AIM: To evaluate the clinical characteristics of children who recently underwent decompressive craniectomy (DC) due to elevated intracranial pressure (ICP) correlated to head trauma or other causes, such as ischemic insult. MATERIAL AND METHODS: Twelve patients aged ≤17 years who underwent DC due to elevated ICP between 2013 and 2018 were included in the study. The clinical status of the participants, radiological characteristics, type and timing of surgery, and outcomes were recorded. RESULTS: Three female and nine male patients with a mean age of 10 years were included. The initial average Glasgow Coma Scale score was 6 (3-12). All patients presented with signs of diffuse cerebral edema and subdural hematoma of various sizes along with other intracranial pathologies. Only one patient required bilateral frontal craniectomy. In the postoperative period, three patients died, and three had severe disability. CONCLUSION: With the increasing use and success of DC in adults, this procedure can also be effective in children. Considering brain differences in children, large and well-structured clinical trials must be conducted to prevent complications and to identify the best technique, timing, and benefits of DC for children.


Asunto(s)
Lesiones Traumáticas del Encéfalo/complicaciones , Lesiones Traumáticas del Encéfalo/cirugía , Craniectomía Descompresiva , Hipertensión Intracraneal/cirugía , Adolescente , Edema Encefálico/complicaciones , Edema Encefálico/fisiopatología , Lesiones Traumáticas del Encéfalo/fisiopatología , Niño , Craniectomía Descompresiva/efectos adversos , Femenino , Hematoma Subdural/complicaciones , Hematoma Subdural/fisiopatología , Hematoma Subdural/cirugía , Humanos , Hipertensión Intracraneal/etiología , Masculino , Estudios Retrospectivos , Resultado del Tratamiento
6.
Neurocirugia (Astur : Engl Ed) ; 30(4): 159-166, 2019.
Artículo en Inglés, Español | MEDLINE | ID: mdl-30792109

RESUMEN

OBJECTIVE: Although meningiomas are the most common primary non-glial intracranial tumors, cystic meningiomas are quite rare. This study presents six cases in order to discuss the radiological and pathological features of cystic meningiomas. PATIENTS AND METHODS: Six patients with cystic meningiomas were included in the study. All patients underwent a cranial computed tomography scan and magnetic resonance imaging (MRI) evaluation, pre- and postoperatively. RESULTS: All patients presented with long standing headache dating back at least two years. There was no gender predominance in our series. Radiological evaluation revealed two parasagittal and two convexity meningiomas located at the frontal region. Two lesions were located at the tuberculum sellae and the foramen magnum. All of the tumors were totally excised (Simpson Grade I or II). Pathology results included meningothelial meningioma in three patients, angiomatous meningioma in two patients, and metaplastic meningioma in one patient. In two patients, the cystic meningiomas were resected with the use of sodium fluorescein (Na-Fl) under a YELLOW 560nm microscope filter. Na-Fl was found to be very useful in demonstrating the brain-tumor interface, and it was especially effective in resecting the cyst wall of the peritumoural cystic meningiomas. None of the patients had any complications, and no recurrences were noted in any of the patients within the mean follow-up period of 51 months (range: 16-102 months). CONCLUSION: It is important to note MRI changes specific to cystic meningioma and include meningiomas in the differential diagnosis of intracranial cystic lesions. The use of sodium fluorescein (Na-Fl) under a YELLOW 560nm microscope filter is a useful tool to differentiate the brain-tumor interface, as well as to identify the cyst wall in order to fully resect the tumor with the cystic component to avoid recurrence and achieve better clinical results.


Asunto(s)
Imagen por Resonancia Magnética , Neoplasias Meníngeas/diagnóstico por imagen , Meningioma/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Masculino , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/cirugía , Meningioma/patología , Meningioma/cirugía , Persona de Mediana Edad , Neuronavegación/métodos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
7.
World Neurosurg ; 107: 966-973, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28755915

RESUMEN

OBJECTIVE: To evaluate the feasibility of sodium fluorescein (Na-Fl)-guided surgery involving the use of the PENTERO 900 surgical microscope equipped with the YELLOW-560 nm filter and low-dose Na-FL (200 mg/2-4 mg/kg) in meningioma surgery. PATIENTS AND METHODS: The study included 30 patients with newly diagnosed or recurrent meningiomas who underwent Na-Fl-guided surgery between April 2015 and December 2016. Clinical features, surgical observations, extent of resection, and tumor histopathology were retrospectively analyzed. The Na-Fl enhancement pattern was assessed as "no enhancement," "diffuse homogenous enhancement," or "low heterogeneous enhancement." RESULTS: There were 30 meningiomas among the 30 patients. In 25 patients, Na-Fl was used for tumor demarcation, whereas in 5 patients, it was used for videoangiography. In this series, 88% of tumors showed diffuse homogeneous Na-Fl enhancement during the operation. The resection rate of the meningiomas was 87%. In 5 patients, in whom Na-Fl was used for videoangiography, the approach was useful to evaluate Na-Fl-stained vessels for patency and to understand their relationship with the tumor. No adverse events were encountered with regard to Na-Fl use. CONCLUSIONS: Na-Fl guidance with the use of the YELLOW-560 filter is safe and effective during meningioma surgery.


Asunto(s)
Fluoresceína/administración & dosificación , Colorantes Fluorescentes/administración & dosificación , Neoplasias Meníngeas/cirugía , Meningioma/cirugía , Microcirugia/métodos , Cirugía Asistida por Video/métodos , Adulto , Anciano , Preescolar , Estudios de Factibilidad , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Neoplasias Meníngeas/diagnóstico por imagen , Meningioma/diagnóstico por imagen , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Adulto Joven
8.
Ulus Travma Acil Cerrahi Derg ; 23(6): 452-458, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29115658

RESUMEN

BACKGROUND: We investigated the effects of an N-methyl-D-aspartate receptor antagonist, riluzole, and a pancaspase inhibitor and basic apoptosis mediator, Q-VD-OPh, in combination or alone in posttraumatic spinal cord injury. METHODS: In our study, 45 healthy male Sprague Dawley rats were used. Spinal trauma was induced by the clip compression technique via thoracal 7, 8, 9 laminectomies. After inducing the trauma, the drug was continuously administered intraperitoneally for 5 days. After inducing the trauma, the subjects were assessed using Tarlov's motor grading scale and inclined plane test. Five days after the trauma, the spinal cord specimens were harvested, and a histopathological examination was performed. RESULTS: Compared with the other groups, a statistically significant difference with regard to better results for necrosis, inflammation, and apoptosis was observed in the riluzole only and combination groups. Statistically better motor function scores were observed in the Q-VD-OPh only group than in the other groups. CONCLUSION: With regard to limiting secondary damage after trauma, statistically significant results were observed in the Q-VDOPh only and Q-VD-OPh-riluzole combination groups. More extensive laboratory studies are required to limit and control the effects of secondary damage after spinal cord trauma.


Asunto(s)
Clorometilcetonas de Aminoácidos , Fármacos Neuroprotectores , Quinolinas , Riluzol , Traumatismos de la Médula Espinal , Clorometilcetonas de Aminoácidos/administración & dosificación , Clorometilcetonas de Aminoácidos/farmacología , Clorometilcetonas de Aminoácidos/uso terapéutico , Animales , Apoptosis/efectos de los fármacos , Modelos Animales de Enfermedad , Masculino , Necrosis/tratamiento farmacológico , Necrosis/prevención & control , Fármacos Neuroprotectores/administración & dosificación , Fármacos Neuroprotectores/farmacología , Fármacos Neuroprotectores/uso terapéutico , Quinolinas/administración & dosificación , Quinolinas/farmacología , Quinolinas/uso terapéutico , Ratas , Ratas Sprague-Dawley , Riluzol/administración & dosificación , Riluzol/farmacología , Riluzol/uso terapéutico , Traumatismos de la Médula Espinal/tratamiento farmacológico , Traumatismos de la Médula Espinal/fisiopatología
9.
Clin Neurol Neurosurg ; 143: 39-45, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26895208

RESUMEN

OBJECTIVE: Sodium fluorescein (Na-Fl) is a fluorescent dye that accumulates in tumoral tissues via disrupted blood-brain barrier. It has been used in fluorescence-guided surgery for various brain tumors. Herein, we report our initial experience and preliminary results for the first 28 patients who were operated on under Na-Fl guidance with the use of a special filter on the surgical microscope. PATIENT AND METHODS: Between January and November 2015, 200 mg (2-4 mg/kg) of Na-Fl was administered in 28 patients (30 surgeries) after anesthesia induction. The clinical features, surgical observations, extent of resection on the postoperative magnetic resonance imaging (MRI) and histopathology of the tumors were retrospectively analyzed. The use of YELLOW 560 nm filter was found "helpful" if the discrimination of the pinkish brain tissue and bright yellow stained tumor tissue was clear. Otherwise, it was described as "not helpful. RESULTS: There were 23 high-grade and 7 metastatic tumors in our study group. Na-Fl was found helpful by means of the tumor demarcation in 29 of 30 operations (97%). In 23 of these 29 operations (79%), a total resection was achieved regardless of the tumor pathology. No adverse events were encountered regarding the use of Na-Fl. CONCLUSION: Na-Fl guidance with the use of a YELLOW 560 filter is safe and effective in high-grade glioma and metastatic tumor surgery. We think it is feasible for increasing the extent of resection in these tumors.


Asunto(s)
Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/cirugía , Fluoresceína/administración & dosificación , Colorantes Fluorescentes/administración & dosificación , Monitoreo Intraoperatorio/métodos , Procedimientos Neuroquirúrgicos/métodos , Adulto , Anciano , Niño , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Microscopía Fluorescente/métodos , Persona de Mediana Edad , Estudios Retrospectivos
10.
Clin Neurol Neurosurg ; 145: 74-8, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27101087

RESUMEN

OBJECTIVE: The aim of this study is to make a comparison between fully endoscopic lumbar discectomy (FELD) and conventional microdiscectomy (MD) by using pre- and postoperative serum creatine phosphokinase (CPK) levels in correlation with postoperative low-back pain. METHODS: Fortyfive consecutive patients who underwent surgery for lumbar disc herniation were allocated into three groups with 15 patients on each: (1) FELD with interlaminar approach (IL), (2) FELD with transforaminal approach (TF), (3) Conventional MD. Serum CPK levels pre- and 1, 6, 12 and 24h postoperatively, patients' body mass index (BMI), operation duration and hospital stays were recorded. The low-back pain pre- and postoperatively was assessed with the use of the 100mm visual analog scale (VAS) and the "Oswestry Disability Index" (ODI). RESULTS: There were 16 female (35.5%) and 29 male (64.5%) patients with a mean age of 44.1 years. CPK levels at 6th, 12th and 24th hours postoperatively were found significantly lower in TF and IL groups compared to MD group (p<0.004). Mean operation duration was significantly shorter in MD group (p: 0.014). There was a significant decrease in both the VAS and ODI scores after the surgery in all patient groups (p<0.001). Postoperative VAS scores were found significantly higher in MD group (p: 0.04). CONCLUSION: Minimal invasive nature of FELD procedures compared to the MD was substantiated by serum CPK levels in this study. To draw definitive conclusions regarding pain relief, larger patient samples should be evaluated, although postoperative VAS scores were found in favor of FELD.


Asunto(s)
Dolor de Espalda/etiología , Creatina Quinasa/sangre , Discectomía/efectos adversos , Discectomía/métodos , Evaluación de Resultado en la Atención de Salud , Adulto , Endoscopía , Femenino , Humanos , Masculino , Microcirugia , Persona de Mediana Edad
12.
J Neurosurg Pediatr ; 9(2): 139-43, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22295917

RESUMEN

OBJECT: Traumatic posterior fossa epidural hematoma (PFEDH) is rare, but among children it may have a slightly higher incidence. With the widespread use of CT scanning, the diagnosis of PFEDH can be established more accurately, leading to an increased incidence of the lesion and possibly to a better patient prognosis. This study presents 40 pediatric cases with PFEDH. METHODS: The authors assessed the type of trauma, clinical findings on admission, Glasgow Coma Scale scores, CT findings (thickness of the hematoma, bone fracture, compression of the fourth ventricle, and ventricle enlargement), type of treatment, clinical course, and prognosis. Early postoperative CT scans (within the first 6 hours) were obtained and reviewed in all surgical cases. RESULTS: Twenty-nine patients underwent surgery and 11 patients received conservative therapy and close follow-up. All patients fared well, and there was no surgical mortality or morbidity. CONCLUSIONS: Based on the data in this large series, the authors conclude that PFEDH in children can be treated in experienced centers with excellent outcome, and there is no need to avoid surgery when it is indicated.


Asunto(s)
Fosa Craneal Posterior/lesiones , Fosa Craneal Posterior/cirugía , Hematoma Epidural Craneal/cirugía , Hematoma Epidural Craneal/terapia , Accidentes por Caídas , Accidentes de Tránsito , Adolescente , Traumatismos en Atletas/diagnóstico por imagen , Traumatismos en Atletas/cirugía , Traumatismos en Atletas/terapia , Niño , Preescolar , Fosa Craneal Posterior/diagnóstico por imagen , Craneotomía , Femenino , Cuarto Ventrículo/diagnóstico por imagen , Cuarto Ventrículo/lesiones , Escala de Coma de Glasgow , Hematoma Epidural Craneal/diagnóstico por imagen , Humanos , Lactante , Masculino , Procedimientos Neuroquirúrgicos , Tomografía Computarizada por Rayos X
13.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(4): 159-166, jul.-ago. 2019. ilus, tab
Artículo en Inglés | IBECS (España) | ID: ibc-183581

RESUMEN

Objective: Although meningiomas are the most common primary non-glial intracranial tumors, cystic meningiomas are quite rare. This study presents six cases in order to discuss the radiological and pathological features of cystic meningiomas. Patients and methods: Six patients with cystic meningiomas were included in the study. All patients underwent a cranial computed tomography scan and magnetic resonance imaging (MRI) evaluation, pre- and postoperatively. Results: All patients presented with long standing headache dating back at least two years. There was no gender predominance in our series. Radiological evaluation revealed two parasagittal and two convexity meningiomas located at the frontal region. Two lesions were located at the tuberculum sellae and the foramen magnum. All of the tumors were totally excised (Simpson Grade I or II). Pathology results included meningothelial meningioma in three patients, angiomatous meningioma in two patients, and metaplastic meningioma in one patient. In two patients, the cystic meningiomas were resected with the use of sodium fluorescein (Na-Fl) under a YELLOW 560nm microscope filter. Na-Fl was found to be very useful in demonstrating the brain-tumor interface, and it was especially effective in resecting the cyst wall of the peritumoural cystic meningiomas. None of the patients had any complications, and no recurrences were noted in any of the patients within the mean follow-up period of 51 months (range: 16-102 months). Conclusion: It is important to note MRI changes specific to cystic meningioma and include meningiomas in the differential diagnosis of intracranial cystic lesions. The use of sodium fluorescein (Na-Fl) under a YELLOW 560nm microscope filter is a useful tool to differentiate the brain-tumor interface, as well as to identify the cyst wall in order to fully resect the tumor with the cystic component to avoid recurrence and achieve better clinical results


Objetivo: Aunque los meningiomas son los tumores intracraneales primarios no gliales más frecuentes, los meningiomas quísticos son bastante raros. Este estudio presenta 6 casos para discutir las características radiológicas y patológicas de los meningiomas quísticos. Pacientes y métodos: Se incluyeron 6 pacientes con meningiomas quísticos en el estudio. Todos los pacientes se sometieron a una tomografía computarizada craneal y a una evaluación por resonancia magnética, antes y después de la operación. Resultados: Todos los pacientes presentaron dolor de cabeza de larga duración de al menos 2 años. No hubo predominio de género. La evaluación radiológica reveló 2 meningiomas parasagitales y 2 de la convexidad ubicados en la región frontal. En los otros 2 pacientes las lesiones se ubicaron en el tubérculo selar y en el foramen magno respectivamente. Todos los tumores fueron totalmente extirpados (grado de Simpson I o II). En 2 pacientes, los meningiomas quísticos se resecaron con el uso de fluoresceína de sodio bajo un filtro de microscopio AMARILLO de 560nm. Se encontró que la fluoresceína de sodio era muy útil para demostrar la interfaz entre el cerebro y el tumor, y fue especialmente eficaz para resecar la pared de los quistes peritumorales. Los resultados de histopatología incluyeron meningioma meningotelial en 3 pacientes, meningioma angiomatoso en 2 y meningioma metaplásico en uno. Ninguno de los pacientes presentó ninguna complicación, y no se observaron recurrencias en ningún paciente dentro del período de seguimiento medio de 51 meses (rango: 16-102 meses). Conclusión: Es importante tener en cuenta los cambios en la resonancia magnética específicos de los meningiomas quísticos e incluir estos tumores en el diagnóstico diferencial de las lesiones quísticas intracraneales. El uso de fluoresceína de sodio bajo un filtro de microscopio AMARILLO de 560nm es una herramienta útil para diferenciar la interfaz cerebro-tumor, así como para identificar la pared del quiste y resecar completamente el tumor con el componente quístico para evitar la recidiva y conseguir mejores resultados clínicos


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Quistes/diagnóstico por imagen , Meningioma/diagnóstico , Neoplasias Meníngeas/diagnóstico por imagen , Craneotomía/métodos , Quistes/patología , Meningioma/patología , Neoplasias Meníngeas/patología , Cefalea/etiología , Tomografía Computarizada de Emisión/métodos , Fluoresceína , Estudios Retrospectivos , Procedimientos Neuroquirúrgicos/métodos
14.
Neurocir.-Soc. Luso-Esp. Neurocir ; 28(5): 235-241, sept.-oct. 2017. ilus, tab
Artículo en Inglés | IBECS (España) | ID: ibc-167470

RESUMEN

Objective: To report perioperative complications in fully endoscopic lumbar discectomy (FELD). Methods: From September 2010 to November 2016, 835 patients underwent FELD. In total, 865 disc levels were operated on. Of the 835 patients, the transforaminal (TF) approach was used in 174 patients, while 691 patients were operated on using the interlaminar (IL) approach. Surgical complications occurred in 47 patients, which were retrospectively analyzed. Results: Neurological deficits occurred in six patients. In four of these six patients, deficits resolved spontaneously. In one patient, symptoms resolved after a laminectomy procedure. In only one case, the neurological deficit was permanent. Seven patients complained of dysesthesia, which resolved spontaneously with medical treatment in four patients. In the remaining two patients, dysesthesia symptoms improved after epidural and foraminal injections. Dural tears were encountered in 26 patients. Pudendal neuralgia occurred in three patients. Two cases showed wound infection. The other complications comprised one disc infection, one retroperitoneal hematoma and one wrong level surgery. Conclusion: The FELD procedure has a steep learning curve and it is a difficult procedure to master. Surgeons should be aware of complications that can occur with the FELD procedure, most of which resolve spontaneously


Objetivo: Informar las complicaciones perioperatorias en la discectomía lumbar completamente endoscópica (FELD). Métodos: De septiembre del 2010 a noviembre del 2016, 835 pacientes fueron sometidos a FELD. Se utilizó un total de 865 niveles de disco. De los 835 pacientes, 174 pacientes fueron operados utilizando el enfoque transforaminal (TF) y 691 pacientes fueron operados en el método interlaminar (IL). Las complicaciones quirúrgicas ocurrieron en 47 pacientes que fueron analizados retrospectivamente. Resultados: Se presentaron déficits neurológicos en seis pacientes. En 4 de 6 de estos pacientes los déficits se resolvieron espontáneamente. En un paciente, los síntomas se resolvieron después de un procedimiento de laminectomía. En un solo caso, el déficit neurológico fue permanente. Siete pacientes se quejaron de la disestesia, que se resolvió espontáneamente con la terapia médica en 4 pacientes. En los 2 pacientes restantes, los síntomas de la disestesia mejoraron después de las inyecciones epidurales y foraminales. Se encontraron lágrimas dural en 26 pacientes. La neuralgia de Pudendal ocurrió en 3 pacientes. Dos casos mostraron infección de la herida. Una infección a nivel de disco, un hematoma retroperitoneal y una cirugía de nivel incorrecto fueron las otras complicaciones. Conclusión: El procedimiento FELD tiene una curva de aprendizaje abrupta y es un procedimiento difícil de dominar. Los cirujanos deben ser conscientes de las complicaciones que pueden ocurrir con el procedimiento FELD, la mayoría de los cuales se resuelven espontáneamente


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Discectomía/métodos , Endoscopía/métodos , Procedimientos Neuroquirúrgicos , Parestesia/tratamiento farmacológico , Discectomía/efectos adversos , Estudios Retrospectivos , Laminectomía/métodos , Neuralgia/complicaciones , Discitis/diagnóstico por imagen , Fluoroscopía/métodos , Periodo Perioperatorio/efectos adversos
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