RESUMO
BACKGROUND: Dural repair is a potential source of complications in neurosurgery. We make a comparison in pseudomeningocele and CSF leak incidence with the sealants Tisseel® and Hemopatch®. METHODS: We collected 147 patients from September 2017 to December 2018 in a prospective observational study. Inclusion criteria were adult patients with an intradural cranial or spinal surgery whose dura was closed with a fibrin sealant. Primary endpoints were the incidence of pseudo meningocele and CSF leak. Secondary endpoints were the surgical-site infection, epidural hematoma, and the influence of previous surgery. RESULTS: In 65 and 82 patients Tisseel® and Hemopatch® were used as sealants respectively. The incidence of CSF leak presented a significant statistical relation with the use of Tisseel® in a univariate and multivariate analysis. Infratentorial surgery presented a higher incidence of pseudomeningocele and CSF leak, but the approach used was not a significant factor in multivariate analysis. Patients who were operated previously had a higher risk present a postoperative complication. CONCLUSIONS: The incidence of pseudomeningocele and CSF leak was higher with Tisseel® compared with Hemopatch® with a statistic significant relation in case of CSF fistulae. The procedure done may be a confusion factor in our study. There was no report of adverse effects or a higher incidence of complications. However, it is recommended to plan randomized trials with larger samples to get stronger evidence.
Assuntos
Bandagens , Dura-Máter/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Vazamento de Líquido Cefalorraquidiano/prevenção & controle , Feminino , Adesivo Tecidual de Fibrina , Humanos , Incidência , Masculino , Meningocele/epidemiologia , Meningocele/prevenção & controle , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Centros de Atenção Terciária , Resultado do Tratamento , Adulto JovemRESUMO
Liposarcomas generally originate in the extremities or retroperitoneum, they are very unusual in the head and neck region, and extremely rare in the thorax. The mainstay of treatment for liposarcomas is surgical excision. We report a very unusual case, not reported before to our knowledge, of a well-differentiated liposarcoma arising from the supraclavicular fossa that produces a pathological clavicular fracture. The patient underwent complete resection of the lesion, without damage of the cervical nerves. Eight months after the surgery the patient is free of recurrence. We demonstrate that giant liposarcomas can be resected completely without morbidity.