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1.
Front Surg ; 11: 1386722, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38933651

RESUMO

Introduction: Infrared thermography (IT) is a non-invasive real-time imaging technique with potential application in different areas of neurosurgery. Despite technological advances in the field, intraoperative IT (IIT) has been an underestimated tool with scarce reports on its usefulness during intracranial tumor resection. We aimed to evaluate the usefulness of high-resolution IIT with static and dynamic thermographic maps for transdural lesion localization, and diagnosis, to assess the extent of resection, and the occurrence of perioperative acute ischemia. Methods: In a prospective study, 15 patients affected by intracranial tumors (six gliomas, four meningiomas, and five brain metastases) were examined with a high-resolution thermographic camera after craniotomy, after dural opening, and at the end of tumor resection. Results: Tumors were transdurally located with 93.3% sensitivity and 100% specificity (p < 0.00001), as well as cortical arteries and veins. Gliomas were consistently hypothermic, while metastases and meningiomas exhibited highly variable thermographic maps on static (p = 0.055) and dynamic (p = 0.015) imaging. Residual tumors revealed non-specific static but characteristic dynamic thermographic maps. Ischemic injuries were significantly hypothermic (p < 0.001). Conclusions: High-resolution IIT is a non-invasive alternative intraoperative imaging method for lesion localization, diagnosis, assessing the extent of tumor resection, and identifying acute ischemia changes with static and dynamic thermographic maps.

2.
J Clin Neurosci ; 124: 1-14, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38615371

RESUMO

BACKGROUND: Vestibular schwannomas (VS) are benign tumors arising from vestibular nerve's Schwann cells. Surgical resection via retrosigmoid (RS) or middle fossa (MF) is standard, but the optimal approach remains debated. This meta-analysis evaluated RS and MF approaches for VS management, emphasizing hearing preservation and Cranial nerve seven (CN VII) outcomes stratified by tumor size. METHODS: Systematic searches across PubMed, Cochrane, Web of Science, and Embase identified relevant studies. Hearing and CN VII outcomes were gauged using the American Academy of Otolaryngology-Head and Neck Surgery, Gardner Robertson, and House-Brackmann scores. RESULTS: Among 7228 patients, 56 % underwent RS and 44 % MF. For intracanalicular tumors, MF recorded 38 % hearing loss, compared to RS's 54 %. In small tumors (<1.5 cm), MF showed 41 % hearing loss, contrasting RS's lower 15 %. Medium-sized tumors (1.5 cm-2.9 cm) revealed 68 % hearing loss in MF and 55 % in RS. Large tumors (>3cm) were only reported in RS with a hearing loss rate of 62 %. CONCLUSION: Conclusively, while MF may be preferable for intracanalicular tumors, RS demonstrated superior hearing preservation for small to medium-sized tumors. This research underlines the significance of stratified outcomes by tumor size, guiding surgical decisions and enhancing patient outcomes.


Assuntos
Neuroma Acústico , Procedimentos Neurocirúrgicos , Humanos , Fossa Craniana Média/cirurgia , Nervo Facial/cirurgia , Audição/fisiologia , Perda Auditiva/etiologia , Perda Auditiva/prevenção & controle , Perda Auditiva/cirurgia , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos
3.
Arq. bras. neurocir ; 43(1): 48-56, 2024.
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1571306

RESUMO

With the advancement of technology in Neurosurgery, imaging guidance for surgical planning and intraoperative assessment has become relevant. Currently, two major methods of imaging guidance are generally explored in the literature, namely based on imaging and fluorescence. These techniques, however, are not without limitations. Thermal imaging has potentially broad applications in clinical practice, especially for intracranial diseases. Infrared thermography (IT) has been an underestimated tool with few reports on its usefulness during intracranial surgeries. In this article, we aim to provide a brief discussion on the limitations of current intraoperative imaging techniques for intracranial surgeries and to provide an in-depth state-of-the-art review on intraoperative IT (IIT) for intracranial lesions. High-resolution IIT is a non-invasive alternative imaging method that provides real-time estimation of regional cerebral blood flow. For brain tumors, the studies were mostly directed to diagnostic purposes and occasionally for lesion-localization. The use of IIT to address the extent of resection is a potential new application. Clinical data in this issue suggests that IIT might detect residual tumors, occasionally not assessed by other imaging technologies. Thermographic measurements during vascular and epilepsy surgeries comprise an interesting field for future research with potential clinical implications. Further experimental and clinical studies should be addressed to provide technical refinements and verify the usefulness of this noninvasive technology in neurosurgery.


Com o avanço da tecnologia em neurocirurgia, a orientação do planejamento cirúrgico e da avaliação intraoperatória por métodos de imagem se tornaram extremamente relevantes. Atualmente, dois métodos principais de cirurgia guiada por imagem são geralmente explorados na literatura, ou seja, baseados em imagens e em fluorescência. Essas técnicas, no entanto, apresentam limitações. A termografia infravermelha (TI) tem aplicações potencialmente amplas na prática clínica, especialmente para doenças intracranianas. A TI tem sido uma ferramenta subestimada, com poucos relatos sobre a sua utilidade durante cirurgias intracranianas. Neste artigo, pretendemos fornecer uma breve discussão sobre as limitações das atuais técnicas de imagem intraoperatória para cirurgias intracranianas e fornecer uma revisão aprofundada do estado da arte sobre a TI intraoperatória (TII) para lesões intracranianas. A TII de alta resolução é um método de imagem alternativo não invasivo que fornece estimativa em tempo real do fluxo sanguíneo cerebral regional. Para tumores cerebrais, os estudos foram direcionados principalmente para fins diagnósticos e, ocasionalmente, para localização das lesões. O uso da TII para avaliar a extensão da ressecção é uma nova aplicação em potencial. Os dados clínicos sugerem que a TII pode detectar tumores residuais, ocasionalmente não avaliados por outras tecnologias de imagem. Medidas termográficas durante cirurgias vasculares e de epilepsia constituem um campo interessante para pesquisas futuras com potenciais implicações clínicas. Novos estudos experimentais e clínicos devem ser realizados para fornecer refinamentos técnicos e verificar a utilidade dessa tecnologia não invasiva em neurocirurgia.

4.
Arq. bras. neurocir ; 43(3): 204-207, 2024.
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1571424

RESUMO

Introduction Infrared thermography (IRT) has demonstrated high diagnostic accuracy for carpal tunnel syndrome (CTS) diagnosis in previous studies. However, the recovery of the autonomic function after treatment for CTS is rarely addressed in the literature, especially on the long-term. Case Presentation A 59-year-old lady sought treatment for a long-term history of numbness, tingling, and hand and arm pain. CTS was diagnosed by clinical and electrophysiological means. After 6 months of conservative treatment, surgical treatment was offered. Preoperative IRT was performed by static and dynamic evaluations immediately and 5 minutes after the cold challenge test using the FLIR C2 camera with accuracy of 2°C or 2%. Fingers were consistently colder (mean of 3.76° C), which clearly represented an autonomic dysfunction in the patient's hand. The patient underwent mini-open carpal tunnel decompression and did great postoperatively. One year after surgery, the patient was fully recovered and completely asymptomatic. IRT imaging showed a remarkable improvement of fingers temperature (mean of 3.36°C). Conclusion Our long-term results confirmed that functional recovery occurred concomitantly to autonomic recovery, which was demonstrated by consistent improvement in fingers' temperature. IRT has a strong potential at the evaluation of patients with CTS for both diagnosis and follow-up.


Introdução A termografia infravermelha (IRT) demonstrou alta precisão diagnóstica para o diagnóstico da síndrome do túnel do carpo (STC) em estudos anteriores. No entanto, a recuperação da função autonômica após o tratamento para STC é raramente abordada na literatura, especialmente a longo prazo. Apresentação do caso Uma senhora de 59 anos procurou tratamento para um histórico de longo prazo de dormência, formigamento e dor nas mãos e braços. A STC foi diagnosticada por meios clínicos e eletrofisiológicos. Após 6 meses de tratamento conservador, o tratamento cirúrgico foi oferecido. A IRT pré-operatória foi realizada por avaliações estáticas e dinâmicas imediatamente e 5 minutos após o teste de provocação pelo frio usando a câmera FLIR C2 com precisão de 2 °C ou 2%. Os dedos estavam consistentemente mais frios (média de 3,76 °C), o que claramente representava uma disfunção autonômica na mão da paciente. A paciente foi submetida a uma mini descompressão aberta do túnel do carpo e teve um ótimo desempenho no pós-operatório. Um ano após a cirurgia, a paciente estava totalmente recuperada e completamente assintomática. A imagem IRT mostrou uma melhora notável na temperatura dos dedos (média de 3,36 °C). Conclusão Nossos resultados de longo prazo confirmaram que a recuperação funcional ocorreu concomitantemente à recuperação autonômica, o que foi demonstrado pela melhora consistente na temperatura dos dedos. A IRT tem um forte potencial na avaliação de pacientes com STC para diagnóstico e acompanhamento.

5.
BMJ Case Rep ; 16(8)2023 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-37553170

RESUMO

Hourglass-like constriction (HLC) is an uncommon spontaneous mononeuropathy that is typically characterised by a sudden onset of pain followed by palsy, affecting branches of the radial (posterior interosseous nerve) and median nerves (anterior interosseous nerve). HLC of the radial nerve (RN) is rare, with only a few reported cases. Here, we report a case of a man who presented with acute wrist and finger drop due to the HLC of the RN. Surgery was recommended 5 months after clinical observation, when the lesion was resected and primarily repaired, resulting in satisfactory recovery. There is still much that remains unknown about HLC, especially for RN. The current understanding points out an inflammatory disease that should be treated conservatively for 3-7 months. The surgical technique depends mostly on the severity and extent of constriction; however, considering only RN constrictions, primary repair by neurorrhaphy or nerve grafts resulted in better functional outcomes.


Assuntos
Neuropatia Radial , Masculino , Humanos , Neuropatia Radial/cirurgia , Constrição , Extremidade Superior/patologia , Nervo Radial/cirurgia , Antebraço/patologia , Constrição Patológica/cirurgia
6.
J Neurooncol ; 161(2): 235-243, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36058985

RESUMO

PURPOSE: To compare the accuracy of three volumetric methods in the radiological assessment of meningiomas: linear (ABC/2), planimetric, and multiparametric machine learning-based semiautomated voxel-based morphometry (VBM), and to investigate the relevance of tumor shape in volumetric error. METHODS: Retrospective imaging database analysis at the authors' institutions. We included patients with a confirmed diagnosis of meningioma and preoperative cranial magnetic resonance imaging eligible for volumetric analyses. After tumor segmentation, images underwent automated computation of shape properties such as sphericity, roundness, flatness, and elongation. RESULTS: Sixty-nine patients (85 tumors) were included. Tumor volumes were significantly different using linear (13.82 cm3 [range 0.13-163.74 cm3]), planimetric (11.66 cm3 [range 0.17-196.2 cm3]) and VBM methods (10.24 cm3 [range 0.17-190.32 cm3]) (p < 0.001). Median volume and percentage errors between the planimetric and linear methods and the VBM method were 1.08 cm3 and 11.61%, and 0.23 cm3 and 5.5%, respectively. Planimetry and linear methods overestimated the actual volume in 79% and 63% of the patients, respectively. Correlation studies showed excellent reliability and volumetric agreement between manual- and computer-based methods. Larger and flatter tumors had greater accuracy on planimetry, whereas less rounded tumors contributed negatively to the accuracy of the linear method. CONCLUSION: Semiautomated VBM volumetry for meningiomas is not influenced by tumor shape properties, whereas planimetry and linear methods tend to overestimate tumor volume. Furthermore, it is necessary to consider tumor roundness prior to linear measurement so as to choose the most appropriate method for each patient on an individual basis.


Assuntos
Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Estudos Retrospectivos , Reprodutibilidade dos Testes , Imageamento por Ressonância Magnética/métodos , Carga Tumoral , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Aprendizado de Máquina
7.
Acta Radiol ; 64(3): 1109-1115, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35876308

RESUMO

BACKGROUND: Magnetic resonance diffusion tensor imaging (MR-DTI) has been increasingly applied for carpal tunnel syndrome (CTS) diagnosis, but relatively little is known about the effect of CTS treatment on median nerve (MN) integrity and functional outcome prediction. PURPOSE: To assess how structural changes in MR-DTI of the MN correlates with symptom severity, functional status, and electrophysiological parameters in patients suffering from CTS before and after decompression surgery. MATERIAL AND METHODS: Nine wrists were prospectively enrolled to perform MR-DTI pre- and postoperatively. The apparent diffusion coefficients (ADC) and fractional anisotropy (FA) of the MN were examined in three different regions-distal radioulnar joint, pisiform bone, and hamate bone-and correlated with clinical and electrophysiological parameters. RESULTS: Postoperatively, mean Boston Carpal Tunnel Questionnaire scores decreased 1.55 points (range = 0.08-3; P = 0.0172) and 1.01 points (-0.13 to 1.88; P = 0.0381) in the symptomatic and functional domains, respectively. Postoperative clinical improvement was reflected in proximal FA elevation (P = 0.0078), but not in diffusivity in comparison to baseline examination. Preoperative electrophysiological parameters were correlated with a reduction in the pre- (sensory latencies [rho = -0.6826; P = 0.0312]) and postoperative (motor latencies [rho = -0.7488; P = 0.0325]) distal FA values. Higher sensory amplitudes indicated higher postoperative proximal FA values (rho = 0.7618; P = 0.0280) ​​and lower postoperative proximal ADC values (rho = -0.9047; P = 0.0020). CONCLUSION: Our study demonstrated that pre- and postoperative proximal FA values are useful biomarkers for the structural evaluation of the MN in patients with CTS. Symptomatic improvement can be better predicted by analyzing FA changes.


Assuntos
Síndrome do Túnel Carpal , Humanos , Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/cirurgia , Imagem de Tensor de Difusão/métodos , Prognóstico , Biomarcadores , Descompressão
8.
Rev. Bras. Neurol. (Online) ; 58(3): 29-34, jul.-set. 2022. ilus
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1400413

RESUMO

The history of the description and classification of the cranial nerves has paralleled the development of anatomy and its role in providing rationality to medicine. About five hundred years ago, the "Anatomical Notes by the Great Alexander Achillinus of Bologna" (1520) provided the first description of the trochlear nerve. In this article, we review the most important macroscopic achievements through different epochs and pioneers such as Herophilus of Chalcedon, Galen of Pergamon, Andreas Vesalius, Bartolomeo Eustachi, Realdo Colombo, Gabriele Falloppio, Antonio Molinetti, Caspar Bartholin, Thomas Willis and Samuel Thomas von Soemmerring. Each of them contributed to a better understanding of the cranial nerves as we know today. Galen's classification was enduring through his seven pairs of cranial nerves. Realdo Colombo coined the name pathetic nerve or nervus oculorum pateticos to the trochlear nerve in 1559, and Molinetti, nervus trochlearis, in 1669. The term trochlear nerve is derived from the Latin word pulley, trochlea, as it innervates the superior oblique muscle that ends in a tendon that bends through a pulley of connective tissue. Besides description and naming, the inclusion into current cranial nerve classification system and how such knowledge applies to current microsurgical understanding is also discussed.


A história da descrição e da classificação dos nervos cranianos acompanhou o desenvolvimento da anatomia e o seu papel na racionalidade da medicina. Cerca de quinhentos anos atrás, as "Notas Anatômicas do Grande Alexandre Achillini de Bolonha" (1520) forneceram a primeira descrição do nervo troclear. Neste artigo, revisamos as realizações macroscópicas mais importantes em diferentes épocas e damos crédito aos pioneiros como Herófilo de Calcedônia, Galeno de Pérgamo, Andreas Vesalius, Bartolomeo Eustachi, Realdo Colombo, Gabriele Falloppio, Antonio Molinetti, Caspar Bartholin, Thomas Willis e Samuel Thomas von Soemmerring. Cada um deles contribuiu para uma melhor compreensão dos nervos cranianos, como os conhecemos hoje. A classificação de Galeno perdurava através de seus sete pares de nervos cranianos. Realdo Colombo cunhou o nome nervo patético ou nervus oculorum pateticos para o nervo troclear em 1559, e Molinetti, nervus trochlearis, em 1669. O termo nervo troclear é derivado da palavra latina polia, tróclea, pois inerva o músculo oblíquo superior que termina em um tendão que se dobra através de uma polia de tecido conjuntivo. Além da descrição e da nomenclatura, também é discutida a inclusão do nervo troclear no atual sistema de classificação de nervos cranianos e como esse conhecimento se aplica à compreensão microcirúrgica atual.

9.
Asian J Neurosurg ; 17(2): 347-351, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36120628

RESUMO

Craniopharyngiomas (CPs) are benign tumors that are believed to arise from embryonic remnants of the Rathke pouch epithelium. Herein, we report a case of aseptic meningitis due to spontaneous rupture of multicystic CP, which contained an Ommaya catheter. A 19-year-old boy was admitted to the hospital with a 4-day history of acute severe headache after strenuous physical exercise followed by altered sensorium, fever, and neck stiffness. Cerebrospinal fluid (CSF) analysis revealed marked pleocytosis and elevated protein levels. CSF culture was otherwise negative. Cyst reduction on subsequent imaging confirmed the diagnosis. The patient received intravenous steroid therapy and was discharged asymptomatic. This is a rare evolution of a multicystic CP, which was previously treated with intracystic therapy and had an Ommaya catheter. Clinicians should be aware of spontaneous CP rupture and look actively for the occurrence of cholesterol crystals or elevated CSF levels of cholesterol as well as prompt follow-up imaging.

11.
Cureus ; 13(5): e14874, 2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-34104602

RESUMO

Anterior clinoidectomy (AC) is a key microsurgical step for the safe and successful management of parasellar pathologies that involve the anterior clinoid process (ACP) and the optic canal. Traditionally, extra and intradural ACs are performed separately according to the surgeon's experience or preference. The objective is to present and discuss the tailored AC concept through illustrative cases. We conducted a retrospective record review of three patients who underwent AC as a surgical step for the treatment of parasellar pathologies that involve the ACP and optic canal. A review of the relevant literature on AC was performed in the PubMed, LILACS, and SciELO databases. In all three cases, the pterional craniotomy was the preferred approach for AC. Case 1, a 47-year-old female patient with type III anterior clinoidal meningioma, underwent a tailored intradural technique (optic canal unroofing) with total tumor resection and complete visual recovery. Case 2, a 63-year-old female patient with a complex type II anterior clinoidal meningioma with extensive hyperostosis of the ACP, underwent a hybrid AC technique with complete removal of the tumor and visual improvement. Case 3, a 62-year-old female, underwent a tailored intradural AC for clipping an incidental carotid-ophthalmic aneurysm. Tailored AC aims to provide adequate exposure with less risk of neurovascular injury, allowing enough space to safely treat parasellar lesions. The type, size, and location of the lesion, as well as the surgeon's experience, should always be considered for surgical planning.

12.
World Neurosurg ; 146: e537-e543, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33130134

RESUMO

OBJECTIVE: The common fibular nerve (CFN) is the most frequently injured nerve in the lower limbs. Surgical management is necessary in approximately two thirds of patients and includes neurolysis, suture, graft repair, or nerve transfer. The distal sural nerve is the preferred donor for grafting, but it is not without complications and requires a second incision. We sought to study the surgical anatomy of the lateral sural cutaneous nerve (LSCN) with the aim of repairing CFN injuries through the same incision and as a potential source for grafting in other nerve injuries. METHODS: The popliteal fossa was dissected in 11 lower limbs of embalmed cadavers to study LSCN variations. Four patients with CFN injuries then underwent surgical repair by LSCN grafting using the same surgical approach. RESULTS: At the medial margin of the biceps femoris, the LSCN emerged from the CFN approximately 8.15 cm above the fibular head. The LSCN ran longitudinally to the long axis of the popliteal fossa, with an average of 3.2 cm medial to the fibular head. The mean LSCN length and diameter were 9.61 cm and 3.6 mm, respectively. The LSCN could be harvested in all patients for grafting. The mean graft length was 4.4 cm. Motor function was consistently recovered for foot eversion but was recovered to a lesser extent for dorsiflexion and toe extension. All patients recovered sensitive function (75% of S3). Hypoesthesia was recognized at the calf. CONCLUSIONS: LSCN harvest is a viable alternative for nerve grafting, especially for repairing short CFN injuries, thereby avoiding the need for a second incision.


Assuntos
Fíbula/cirurgia , Perna (Membro)/cirurgia , Transferência de Nervo , Nervo Fibular/cirurgia , Nervo Sural/cirurgia , Adolescente , Adulto , Estudos de Viabilidade , Fíbula/inervação , Humanos , Perna (Membro)/fisiopatologia , Extremidade Inferior/cirurgia , Masculino , Procedimentos Neurocirúrgicos , Neuropatias Fibulares/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adulto Jovem
13.
World Neurosurg ; 145: 557-566, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33348521

RESUMO

Extradural anterior clinoidectomy is an important tool for neurovascular and skull base surgery. This technique is cardinal for expanding access to the proximal carotid artery, optic nerve, sella, and the central skull base. The goal of anterior clinoidectomy is to reveal the more proximal ophthalmic and clinoidal segments of the internal carotid artery (ICA) while skeletonizing the proximal optic nerve. This maneuver expands the opticocarotid and carotid-oculomotor windows and therefore the operative corridor to the interpeduncular cisterns; both the carotid artery and optic nerve are partially untethered or liberated and can be more safely mobilized.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Procedimentos Neurocirúrgicos/métodos , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Artéria Carótida Interna/anatomia & histologia , Craniotomia/métodos , Humanos , Nervo Óptico , Cuidados Pré-Operatórios/métodos , Base do Crânio/anatomia & histologia
14.
J Neurol Surg A Cent Eur Neurosurg ; 81(6): 571-574, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32361980

RESUMO

High median nerve injuries (HMNIs) are rare lesions involving the upper extremities and affect the median nerve from its origin to the emergence of the anterior interosseous nerve (AIN). Proximal reconstruction has long been considered the gold standard in treating HMNI, but thumb and index flexion and pinch and grip weakness are consistently not recovered. We report the surgical results of a patient affected by an HMNI with partial spontaneous recovery after a gunshot wound. AIN function was successfully restored in a delayed fashion by transferring the radial nerve branch to the extensor carpi radialis brevis to the AIN.


Assuntos
Dedos/inervação , Dedos/cirurgia , Transferência de Nervo/métodos , Procedimentos Neurocirúrgicos/métodos , Nervo Radial/cirurgia , Polegar , Adulto , Humanos , Masculino , Nervo Mediano/lesões , Nervo Mediano/cirurgia , Amplitude de Movimento Articular , Resultado do Tratamento , Ferimentos por Arma de Fogo/cirurgia
15.
Stroke ; 51(6): 1703-1711, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32397934

RESUMO

Background and Purpose- The benefits of endovascular intervention over surgery in the treatment of ruptured aneurysms of anterior circulation remains uncertain. Recently, published studies did not find superiority of endovascular intervention, challenging earlier evidence from a clinical trial. The earlier evidence also had a higher than average proportion of patients in good clinical status, leading to uncertainty about external validity of earlier trials. Methods- We performed a systematic review of studies after 2005 under a protocol published in the International Prospective Register of Systematic Reviews. Primary outcomes were posttreatment rebleeding and adverse events (procedural complications). Secondary outcomes were dependency at 3 to 6 and 12 months, delayed cerebral ischemia, and seizures. Results- Rebleeding was more frequent after endovascular intervention (Peto OR, 2.18 [95% CI, 1.29-3.70]; 3104 participants; 15 studies; I2=0%, Grading of Recommendations, Assessment, Development and Evaluation: very low certainty of evidence). Fewer adverse events were reported with the endovascular intervention (RR, 0.71 [95% CI, 0.53-0.95]; 1661 participants; 11 studies; I2=14%, Grading of Recommendations, Assessment, Development and Evaluation: low certainty of evidence). Three to six months dependency (RR, 0.82 [95% CI, 0.73-0.93]; 4081 participants; 18 studies; I2=15%, Grading of Recommendations, Assessment, Development and Evaluation: low certainty of evidence) and 12-month dependency (RR, 0.76 [95% CI, 0.66-0.86]; 1981 participants; 10 studies; I2=0%, Grading of Recommendations, Assessment, Development and Evaluation: low certainty of evidence) were lower after endovascular intervention. Conclusions- This study found consistent results between recent studies and the earlier evidence, in that endovascular intervention results in lower chance of dependency compared with surgery for repair of ruptured anterior circulation aneurysms. A lower proportion of patients in good clinical status in this review supports the application of the earlier evidence. Registration- URL: https://www.crd.york.ac.uk/PROSPERO. Unique identifier: CRD42018090396.


Assuntos
Aneurisma Roto/cirurgia , Procedimentos Endovasculares , Aneurisma Intracraniano/cirurgia , Feminino , Humanos , Masculino , Equipolência Terapêutica
16.
J Clin Neurosci ; 70: 178-182, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31447366

RESUMO

Rhabdomyolysis is characterized by the rupture of skeletal muscles due to a lot of reasons such as exercise, drug addiction, toxins, infections, trauma and some medications. The etiology of postoperative rhabdomyolysis is potentially multifactorial and has been documented in several types of surgery. The lysis of cell membrane releases organic and inorganic intracellular components that can be toxic and life threatening. Creatinephosphokinase (CPK) is one of the components and it is the most sensitive indicator of myocyte injury. The classic triad of symptoms is characterized by myalgia, weakness and brown-red urine. There is not a clearly agreed level of serum CPK that is evident for diagnosis of rhabdomyolysis. However, a CPK level higher than 5 times of its normal value is accepted by many authors as diagnostic criteria. Acute kidney injury is the most serious complication of rhabdomyolysis in the days following initial presentation and develops in 33% of patients. The objective of this study was to perform a review of the literature, aiming at a better understanding about the changes in CPK levels and the frequency of rhabdomyolysis in spine surgery, with special attention in posterior lumbar fusion. Nineteen studies were selected for analysis. The studies had different characteristics considering patients age, body mass index, comorbidities and type of surgery. The best available evidence points out to the prognosis depend on the extension and clinical severity of rhabdomyolysis, as well as on the early and prompt medical intervention.


Assuntos
Complicações Pós-Operatórias/etiologia , Rabdomiólise/etiologia , Fusão Vertebral/efeitos adversos , Adulto , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Complicações Pós-Operatórias/epidemiologia , Rabdomiólise/epidemiologia , Fatores de Risco
17.
World Neurosurg ; 129: e514-e521, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31152890

RESUMO

OBJECTIVE: The aims of this study were to evaluate the risk factors for muscle injury in patients undergoing posterior lumbar spinal surgery and the clearance of postoperative biochemical changes following lumbar fusion and secondarily to evaluate the timing for monitoring postoperative biochemical serum levels and potential clinical correlation. METHODS: The study prospectively enrolled 39 patients with degenerative disease of the lumbar spine. Biochemical markers (creatine phosphokinase [CPK], creatinine, and hemoglobin) were analyzed in 5 predefined stages. All relevant clinical data were collected. Rhabdomyolysis (RML) was defined as a postoperative 5-fold increase of the baseline CPK value. RESULTS: Patients from the lumbar fusion group had the highest postoperative CPK ratio. Overall, the rate of RML was 43.6%. CPK and creatinine activity reached their maximum on the first postoperative day in 69.2% and 87.5% of patients, respectively. Lumbar fusion (P = 0.005), surgical time >270 minutes (P = 0.028), and fall in hemoglobin levels >3 g/dL (P = 0.034) were identified as independent factors associated with higher risk of RML. CONCLUSIONS: The risk of RML increases with prolonged and invasive surgery with higher bleeding potential. Knowing the clearance of postoperative biochemical changes permits a standardized strategy with measurements in precise intervals, thereby avoiding unnecessary costs. The clinical significance is still undetermined.


Assuntos
Discotomia/efeitos adversos , Laminectomia/efeitos adversos , Vértebras Lombares/cirurgia , Rabdomiólise/etiologia , Fusão Vertebral/efeitos adversos , Adolescente , Adulto , Idoso , Creatina Quinase/sangue , Creatinina/sangue , Feminino , Humanos , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Adulto Jovem
18.
World Neurosurg ; 122: e516-e529, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31108070

RESUMO

BACKGROUND: We performed a rigorous statistical analysis of the complications and outcomes of patients with ruptured or unruptured intracranial aneurysms. Our emphasis was on the potential predictive factors when both surgical and endovascular management are offered by a team with balanced microsurgical and endovascular expertise. METHODS: From January 2005 to December 2011, 1297 consecutive patients presenting with ruptured (n=829) or unruptured (n=468) aneurysms were prospectively enrolled in our vascular database. The treatment modality was determined by consensus of the endovascular and microsurgical teams. The patients' medical and neurological conditions and aneurysm characteristics were compared against the postintervention complication rates and outcomes using multivariate analyses. RESULTS: The patients mostly underwent clipping for ruptured (63.7%) or unruptured (56.6%) aneurysms. For ruptured aneurysms, higher Hunt and Hess and Fisher grades on admission were key predictors of increased neurological (P < 0.001 and P < 0.001, respectively) and medical (P < 0.001 and P=0.041, respectively) complication rates. No significant differences in the outcomes were observed between the coiling or clipping groups during the follow-up period. For the unruptured group, a family history of intracranial aneurysms was the most relevant predictor for reducing neurological complication rates and increasing survival at 6 months. Hypertension was, however, the strongest factor associated with complications negatively affecting the outcomes. CONCLUSIONS: For the ruptured and unruptured groups both, the outcomes were generally good, although neurological and medical complications were reasonably more frequent for the ruptured aneurysms. Coiling provided a sustained benefit in lowering the complication rates only in the short term for the unruptured aneurysms. Smoking was associated, paradoxically, with improved outcomes.


Assuntos
Aneurisma Roto/cirurgia , Procedimentos Endovasculares/estatística & dados numéricos , Aneurisma Intracraniano/cirurgia , Microcirurgia/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/estatística & dados numéricos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Hidrocefalia/etiologia , Hipertensão , Masculino , Microcirurgia/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Vasoespasmo Intracraniano/etiologia , Adulto Jovem
19.
BMJ Case Rep ; 12(4)2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30996066

RESUMO

Brainstem gliomas are rare tumours in adults, accounting for only 1%-2% of all intracranial gliomas. They are recognised as a heterogeneous group, in which most are malignant tumours. Brainstem gliomas are classified into four major groups according to the growth pattern on imaging, namely diffuse, focal, exophytic and cervicomedullary. Such a classification system is also useful for surgical decision making. The exophytic variant is extremely rare having anecdoctal reports in the literature. We report the case of an adult patient affected by an exophytic glioblastoma of the pons, which was submitted to subtotal resection followed by radiation therapy and chemotherapy with a longer overall survival. To the best of our knowledge, this is the seventh adult patient reported of an exophytic brainstem glioblastoma.


Assuntos
Neoplasias do Tronco Encefálico/patologia , Tronco Encefálico/patologia , Doenças dos Nervos Cranianos/diagnóstico por imagem , Glioblastoma/diagnóstico por imagem , Neuroimagem , Ponte/patologia , Tronco Encefálico/diagnóstico por imagem , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Neoplasias do Tronco Encefálico/terapia , Quimiorradioterapia , Doenças dos Nervos Cranianos/etiologia , Doenças dos Nervos Cranianos/fisiopatologia , Evolução Fatal , Glioblastoma/patologia , Glioblastoma/terapia , Humanos , Hidrocefalia/fisiopatologia , Hemorragias Intracranianas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Ponte/diagnóstico por imagem , Fatores de Tempo
20.
Cancer Med ; 8(3): 972-981, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30735009

RESUMO

Malignant peripheral nerve sheath tumors (MPNSTs) are rare and aggressive soft tissue sarcomas with a significant susceptibility to metastasize early in their course. Pathogenesis is yet to be fully elucidated. Recently, the essential role of mast cells in the tumor onset of neurofibromatosis type 1 (NF1)-associated neurofibromas and MPNSTs was confirmed in both experimental and human studies. In this study, we investigate mast cell density (MCD), microvascular density (MVD), and proliferation index (Ki-67) in MPNST. A secondary aim was to correlate histological staining to clinical data and survival in patients with and without NF1. In total, 34 formalin-fixed paraffin-embedded MPNST tissues from 29 patients were eligible. MCD, MVD, and Ki-67 labeling index (LI) were analyzed in all stained tissues by a computer-based quantitative algorithm (Aperio ImageScope). In addition, chart review was performed for clinical data and survival analysis. Overall, MCD, MVD, and Ki-67 LI were evenly distributed throughout tumor tissue. There was a negative correlation of NF1 status (affected, P = 0.037), tumor size (>10 cm, P = 0.023), and MVD in the tumor periphery (higher tercile, P = 0.002) to survival. Multivariate analysis confirmed the association of MVD in the tumor periphery (higher tercile, P = 0.019) with a decreased overall survival. Diverse mast cell and microvascular distributions suggest that angiogenesis in MPNST occurs independently. The role of mast cells in tumor progression is unclear and lacks prognostic value. Higher MVD has prognostic significance with possible therapeutic implications in MPNST.


Assuntos
Mastócitos/patologia , Neoplasias de Bainha Neural/irrigação sanguínea , Neoplasias de Bainha Neural/patologia , Neurofibromatose 1/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Microvasos/patologia , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Carga Tumoral , Adulto Jovem
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