Comparative study of complications after primary and revision transsphenoidal endoscopic surgeries.

A preferred treatment for residual/recurrent pituitary adenomas has not been established. The existence of higher complication rates for revision surgeries remains under debate. This study aimed to compare complication rates of primary and revision transsphenoidal endoscopic surgeries and to identify risk factors for complications. Data from 144 primary and 39 revision surgeries were analysed. The surgical complications evaluated were intraoperative and postoperative cerebrospinal fluid (CSF) leaks; meningitis; permanent diabetes insipidus (DI) and hypopituitarism; worsening visual acuity; ophthalmoplegias; visual field defects; otorhinolaryngological, systemic and vascular complications; and death. The variables that were potentially associated with surgical complications were gender, age, comorbidities, lumbar drain use, duration of lumbar drain use, invasion of the sphenoid and cavernous sinuses, presence and degree of suprasellar expansion, preoperative identification of the pituitary, CSF leaks and intraoperative pituitary identification. Intraoperative CSF leaks, visual field losses and worsening visual acuity were more common for revision surgeries. There were no between-group differences in the occurrence of postoperative CSF leaks; systemic, vascular and otorhinolaryngological complications; meningitis; DI and hypopituitarism; ophthalmoplegias; or death. Intraoperative identification of the pituitary was associated with lower rates of permanent DI and hypopituitarism, systemic complications, intraoperative CSF leaks and worsening visual acuity. Suprasellar expansion increased the risk of intraoperative CSF leaks but not endocrinological deficits or visual impairment. Intraoperative CSF leaks were associated with postoperative CSF leaks, meningitis, anterior hypopituitarism, DI and worsening visual acuity. Intraoperative CSF leaks, worsening visual acuity and visual field losses were more common in reoperated patients.

Choroid plexus cauterization on treatment of hydranencephaly and maximal hydrocephalus.

INTRODUCTION: The standard treatment for hydranencephaly and maximal hydrocephalus consists of inserting shunts, although complications frequently occur. Choroid plexus cauterization (CPC) is an alternative, but its long-term efficacy and the factors associated with the success and failure of controlling head circumference (HC) are not well defined. OBJECTIVE: This study aims to evaluate the long-term efficacy and factors related to the success rate of CPC in the treatment of hydranencephaly and maximal hydrocephalus. METHOD: Forty-two children with maximal hydrocephalus and hydranencephaly underwent CPC from 2006 to 2014 and were retrospectively evaluated. Children with less than 3 months of follow-up were excluded. The long-term efficacy and success rate of possible variables (i.e., sex, type of malformation, type of surgery performed, treatment hospital, age, and HC at the time of surgery and birth) were evaluated. RESULTS: Thirty-four children were considered for the effectiveness analysis. Treatment was successful in 24 children (70.6%), and failure occurred in 10 children (29.4%). Failure was detected soon after the endoscopic procedure (average 116 days). There was no difference in effectiveness when comparing the age at the moment of surgery (p = 0.473), type of malformation (p = 1), HC at birth (0.699), and HC at the time of surgery (p = 0.648). The surgical death rate was 7.14%. CONCLUSION: Endoscopic CPC was a valid procedure used to treat hydranencephaly and maximal hydrocephaly, and it was effective in 70.6% of cases, with an average follow-up period of 32 months. When failures occurred, they occurred early. None of the analyzed variables interfered with the success of the treatment.

Coagulação endoscópica do plexo coroide no tratamento primário da hidranencefalia e da hidrocefalia extrema / Endoscopic coagulation of the choroid plexus in the primary treatment of extremehydrocephalus and hydranencephaly

Objetivos: Descrever a técnica de coagulação neuroendoscópica do plexo coroide e divulgá-la como opção de tratamento primário da hidranencefalia e da hidrocefalia extrema. Mostrar a casuística de coagulação endoscópica de plexo coroide do Serviço de Neurocirurgia do Hospital da Baleia em BeloHorizonte, MG, Brasil. Métodos: Imagens tomográficas foram avaliadas por um neurocirurgião, sendo selecionadas crianças portadoras de hidranencefalia e hidrocefalia extrema com cavidade ventricular única. Os pacientes foram acompanhados por até três anos no pós-operatório. Resultados: Foram tratadas seis crianças com hidranencefalia e seis com hidrocefalia extrema. Um paciente faleceu na primeira semana de pós-operatório em função de choque hipovolêmico e hipernatremia graves e outro cursou com aumento progressivo do perímetro cefálico e necessidade de derivação ventriculoperitoneal. Um terceiro paciente apresentou óbito tardio não relacionado à cirurgia endoscópica. Os demais apresentaram evolução adequada no pós-operatório. Conclusão: A coagulação endoscópica do plexo coroide mostrou-se alternativa eficaz no tratamento da hidranencefalia e da hidrocefalia extrema.

Objectives: Describing the neuroendoscopic technique for coagulation of the choroid plexus and publicize it as an option for the primary treatment of extreme hydrocephalus and hydranencephaly. Display the series of endoscopic coagulation of the choroid plexus of the Neurosurgery Department of the Hospital da Baleia in Belo Horizonte, MG, Brazil. Methods: Tomographic images were used to select children with hydranencephaly and extreme hydrocephalus with single ventricular cavity. Patients were followed for up to three years postoperatively. Results: Six children with hydranencephaly and six with extreme hydrocephalus were treated. One patient died in the first week postoperatively due to hypovolemic shock and severe hypernatremia and another developed progressive increase in head circumference and the need for ventriculoperitoneal shunt. A third patient had late death unrelated to endoscopic surgery. The others had adequate postoperative evolution. Conclusion: The endoscopiccoagulation of the choroid plexus is an effective alternative in the treatment of extreme hydrocephalus and hydranencephaly

Tratamento cirúrgico da epilepsia refratária: análise de 34 casos atendidos no Hospital das Clínicas da UFMG / Surgical treatment of refractory epilepsy: analysis of 34 cases from the Hospital das Clínicas, Federal University of Minas Gerais

Objetivo: Apresentar dados estatísticos referentes a uma série de casos submetidos ao tratamento cirúrgico da epilepsia refratária no Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG), no período entre 23/11/2007 e 7/12/2010. Métodos: Estudo retrospectivo com análise de prontuários de 34 pacientes e classificação do controle de crises pós-operatório utilizando a Escala de Engel. Resultados: Dos pacientes, 70,5% apresentaram início das crises antes dos 15 anos, sendo o tipo de crise mais comum as crises parciais complexas com generalização secundária, presente em 55% dos casos. Esclerose mesial temporal foi o diagnóstico de base em 79,4% dos pacientes. Houve complicações cirúrgicas em 23,5% dos casos, sendo as mais frequentes as alterações de campo visual (8,8% dos casos). Conclusão: O controle de crises foi compatível com Engel menor ou igual a III em 64,7% dos casos. O tratamento cirúrgico revelou-se eficiente para melhorar o controle de crises em pacientes portadores de epilepsia refratária ao tratamento medicamentoso.

Objective: Presenting statistical data on a series of cases undergoing surgical treatment of epilepsy at the Hospital das Clínicas, Universidade Federal de Minas Gerais (HC-UFMG) in the period between 11/23/2007 and 12/7/2010. Methods: Retrospective analysis with charts of 34 patients and classification of seizure control postoperatively using the Engel Scale. Results: 70.5% of the patients had the onset of seizures before 15 years old and the most common type of seizure was complex partial seizure with secondary generalization, presented in 55% of cases. Mesial temporal sclerosis was the underlying diagnosis in 79.4% of patients. There were surgical complications in 23.5% of cases, the most frequent visual changes (8.8% of cases). Conclusion: Seizure control was consistent with Engel III or less in 64.7% of cases. Surgical treatment has proved effective in improving seizure control in patients with medically refractory epilepsy.

Impacto da terapia antirretroviral combinada no crescimento e nas taxas de hospitalização de crianças infectadas pelo HIV / Impact of HAART on growth and hospitalization rates among HIV-infected children

OBJETIVO: Avaliar mudanças em parâmetros de crescimento e hospitalização em crianças infectadas pelo vírus da imunodeficiência humana (human immunodeficiency virus, HIV) em uso de terapia antirretroviral combinada. MÉTODOS: As crianças foram avaliadas durante os primeiros 3 anos de terapia. A resposta clínica foi avaliada a cada 24 semanas com base em escores z de peso/idade e altura/idade. Modelos de regressão linear foram utilizados para identificar preditores de resposta clínica. Dados relevantes relativos à hospitalização dos pacientes foram obtidos retrospectivamente mediante revisão dos prontuários clínicos. RESULTADOS: Um total de 196 crianças foram avaliadas. A média do escore z aumentou de -1,62 (±1,32) no início do estudo para -1,14 (±1,12) na semana 24. A média do escore z de altura/idade aumentou de -1,88 (±1,45) para -1,66 (±1,18). Foi observada associação entre maiores escores z no início do estudo e maiores aumentos nos escores z de peso/idade ao longo do tempo. Cargas virais mais baixas e escores de altura/idade mais altos também estiveram associados com maior recuperação do crescimento. Oitenta e cinco crianças (43,3 por cento) foram hospitalizadas. A maioria das internações esteve associada a causas infecciosas, sendo apenas dois casos de infecções oportunistas. CONCLUSÃO: A terapia combinada resultou em aumentos significativos nos escores z de peso/idade e altura/idade. A menor idade, o uso de inibidores de protease e a classificação clínica em estágios avançados estiveram associados a uma maior efetividade do tratamento. Além disso, o estudo demonstrou a eficácia da terapia para a redução das taxas de hospitalização, morte e incidência de infecções oportunistas entre crianças portadoras do HIV.

OBJECTIVE: To evaluate HAART-associated changes in growth and hospitalization rates over time in a cohort of HIV-infected children. METHODS: Children starting HAART were assessed during the first 3 years of therapy. Clinical response was assessed every 24 weeks by z scores of weight-for-age and height-for-age. Linear regression models were used to detect predictors of clinical response. Pertinent information on hospitalizations was obtained retrospectively through review of medical records. RESULTS: A total of 196 children were assessed. Mean weight z score increased from -1.62 (±1.32) at baseline to -1.14 (±1.12) by week 24. Mean height z score increased from -1.88 (±1.45) at baseline to -1.66 (±1.18). Better z scores at baseline were associated with greater increases in weight z scores over time. Lower viral load and higher height z scores at baseline were also associated with improved height catch-up. Eighty-five children (43.3 percent) were hospitalized. Most hospitalizations were prompted by infectious disease, with only two due to opportunistic infections. CONCLUSION: HAART was associated with significant increases in weight and height z scores. Younger age, the use of protease inhibitors and advanced clinical disease were associated with better outcomes. The present study demonstrated the effectiveness of HAART in significantly reducing hospitalization, death, and incidence of opportunistic infections among HIV-infected children.

Impact of HAART on growth and hospitalization rates among HIV-infected children.

OBJECTIVE: To evaluate HAART-associated changes in growth and hospitalization rates over time in a cohort of HIV-infected children. METHODS: Children starting HAART were assessed during the first 3 years of therapy. Clinical response was assessed every 24 weeks by z scores of weight-for-age and height-for-age. Linear regression models were used to detect predictors of clinical response. Pertinent information on hospitalizations was obtained retrospectively through review of medical records. RESULTS: A total of 196 children were assessed. Mean weight z score increased from -1.62 (±1.32) at baseline to -1.14 (±1.12) by week 24. Mean height z score increased from -1.88 (±1.45) at baseline to -1.66 (±1.18). Better z scores at baseline were associated with greater increases in weight z scores over time. Lower viral load and higher height z scores at baseline were also associated with improved height catch-up. Eighty-five children (43.3%) were hospitalized. Most hospitalizations were prompted by infectious disease, with only two due to opportunistic infections. CONCLUSION: HAART was associated with significant increases in weight and height z scores. Younger age, the use of protease inhibitors and advanced clinical disease were associated with better outcomes. The present study demonstrated the effectiveness of HAART in significantly reducing hospitalization, death, and incidence of opportunistic infections among HIV-infected children.