RESUMO
BACKGROUND: Repairing bone defects generated by craniectomy is a major therapeutic challenge in terms of bone consolidation as well as functional and cognitive recovery. Furthermore, these surgical procedures are often grafted with complications such as infections, breaches, displacements and rejections leading to failure and thus explantation of the prosthesis. OBJECTIVE: To evaluate cumulative explantation and infection rates following the implantation of a tailored cranioplasty CUSTOMBONE prosthesis made of porous hydroxyapatite. One hundred and ten consecutive patients requiring cranial reconstruction for a bone defect were prospectively included in a multicenter study constituted of 21 centres between December 2012 and July 2014. Follow-up lasted 2 years. RESULTS: Mean age of patients included in the study was 42±15 years old (y.o), composed mainly by men (57.27%). Explantations of the CUSTOMBONE prosthesis were performed in 13/110 (11.8%) patients, significantly due to infections: 9/13 (69.2%) (p<0.0001), with 2 (15.4%) implant fracture, 1 (7.7%) skin defect and 1 (7.7%) following the mobilization of the implant. Cumulative explantation rates were successively 4.6% (SD 2.0), 7.4% (SD 2.5), 9.4% (SD 2.8) and 11.8% (SD 2.9%) at 2, 6, 12 and 24 months. Infections were identified in 16/110 (14.5%): 8/16 (50%) superficial and 8/16 (50%) deep. None of the following elements, whether demographic characteristics, indications, size, location of the implant, redo surgery, co-morbidities or medical history, were statistically identified as risk factors for prosthesis explantation or infection. CONCLUSION: Our study provides relevant clinical evidence on the performance and safety of CUSTOMBONE prosthesis in cranial procedures. Complications that are difficulty incompressible mainly occur during the first 6 months, but can appear at a later stage (>1 year). Thus assiduous, regular and long-term surveillances are necessary.
Assuntos
Craniotomia/normas , Durapatita/normas , Procedimentos de Cirurgia Plástica/métodos , Próteses e Implantes/normas , Implantação de Prótese/normas , Crânio/cirurgia , Adulto , Autoenxertos/transplante , Craniotomia/efeitos adversos , Craniotomia/métodos , Durapatita/administração & dosagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Próteses e Implantes/efeitos adversos , Implantação de Prótese/efeitos adversos , Procedimentos de Cirurgia Plástica/efeitos adversos , Reprodutibilidade dos TestesRESUMO
High levels of tissue-like plasminogen activator in cerebrospinal fluid reported in a patient with an intracerebral haemorrhage associated to cerebral metastasis of malignant melanoma could support the hypothesis of cerebral haemorrhage induced by tPA tumoral synthesis.
Assuntos
Neoplasias do Ventrículo Cerebral/patologia , Hemorragias Intracranianas/etiologia , Melanoma/patologia , Adulto , Neoplasias do Ventrículo Cerebral/metabolismo , Humanos , Hemorragias Intracranianas/metabolismo , Hemorragias Intracranianas/patologia , Masculino , Melanoma/metabolismo , Ativador de Plasminogênio Tecidual/biossíntese , Ativador de Plasminogênio Tecidual/líquido cefalorraquidianoRESUMO
Few cases of pituitary adenoma with metastases have been reported. We report a case with histologically benign intracranial and cauda equina metastases. We compare it to the others in the literature.
Assuntos
Adenoma/patologia , Neoplasias Encefálicas/secundário , Imageamento por Ressonância Magnética , Neoplasias Hipofisárias/patologia , Adenoma/diagnóstico , Neoplasias Encefálicas/diagnóstico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A patient with a mass lesion of Müllerian origin associated with a spinal dysraphism is reported. The mass lesion was a genuine uterine formation, and a hemorrhage arose from a functional endometrium. A spinal dysraphism was associated, including a low-lying conus medullaris, a subcutaneous lipoma, and a sinus between the cul-de-sac and the lipoma. This ectopic and mature tissue may be differentiated from teratoma and endometriosis.