Conciencia transoperatoria en personas operadas mediante craneotomía despierto / Intraoperative awareness in awake craniotomy patients

La craneotomía con paciente despierto (CPD) demanda un manejo multidisciplinario particular debido al componente de conciencia transoperatoria que aporta beneficios en la resección tumoral y preservación neurológica, pero también implica el manejo de los riesgos asociados a la necesidad de cooperación del paciente durante el procedimiento. En este trabajo se describen los beneficios y las complicaciones en pacientes operados bajo la modalidad de CPD. Además, se abordan los retos documentados tanto para el equipo profesional a cargo, como para los pacientes, los cuales tienen un rol activo durante la cirugía. En ese sentido, se exponen los criterios para la selección, preparación psicológica y neuropsicológica tanto previo como durante la cirugía. A su vez, se proponen las consideraciones para lograr un procedimiento exitoso y evitar las posibles secuelas psicológicas a largo plazo, como insumos para la protocolización de este tipo de procedimientos con base en nuestra experiencia.

Awake craniotomy (AC) requires a multidisciplinary management due to trans operative awareness, which benefits the tumor resection and neurologic preservation, but it also implies risks for the patient cooperation during the procedure. This article describes the benefits and complications in patients operated under AC. Besides, it approaches the documented challenges for both the professional team and patients, who have an active role during surgery. In this regard, the criteria for selection and psychological and neuropsychological preparation before and during surgery are set out. It suggests considerations to achieve a successful procedure and to avoid possible long- term psychological sequelae, as a resource for the protocol of this type of procedures based on our experience.

Estudio del líquido cefalorraquídeo en pacientes post-trauma y post-operados para el diagnóstico diferencial de meningitis en ellos / Analysis of the cerebrospinal fluid in post-trauma and post-surgery patients as a differential of meningitis in them

Determine the variants of the cerebrospinal fluid in patients post-trauma and post-surgery without sepsis, to differentiate them from th variations in patients with meningitis. It's a prospective study in which we made lumbar puncture to 50 patients that were admitted in the neurosurgery service with the diagnosis of moderate or severe head trauma, or were operated for different reasons. All the patients had red blood cells in the cerebrospinal fluid. In 30 patientsthe white blood cells were >10 the relation of glucose in CSF/blood was less than 60 por ciento in 31 patients, and proteins were >45 mg/dl in 39 cases. Twenty-six patients had a relations red blood cell/white blood cell altered. All the cultures were negative. There was no correlation between fever, leukocytosis and number of white blood cells in CSF. Twelve patients had proteins elevated, glucose diminished and a low relation red blood cell/white blood cell. In all of them the culture was negative. Trauma and surgery procedure a subarachnoid hemorrhage that originates an inflamatory not infectious response, and this is the cause of the alterations of the cerebrospinal fluid. We recomended don't use antibiotics in post-trauma and post-surgery patients with fever and alterations of CSF, but without signs of meningitis, in wich the diagnosis in not confirmed with a culture of CSF