Treatment of CSF leakage and infections of dural substitute in decompressive craniectomy using fascia lata implants and related anatomopathological findings.

PURPOSE: Decompressive craniectomy (DC) is widely used to treat raised intracranial pressure (ICP) in cranial trauma and stroke. It is accompanied by numerous complications. The aim of our study is to assess the surgical treatment of infections related to the use of a dural substitute with concurrent CSF leakage performed at our institution. MATERIAL AND METHODS: A retrospective analysis of a series of 72 patients who underwent DC between 2011 and 2017 was performed. Seven cases (9%) showed infection related to the use of xenograft (bovine pericardium) and coexisting CSF leakage. Epidural/subdural empyemas were observed in seven cases; three in conjunction with an intracerebral abscess. For reconstruction, free anterolateral thigh fascia lata flaps were used, based on the size of the defect. RESULTS: After removal of the dural substitute and the implant of free fascia lata, infection and CSF leaks resolved in all. An anatomopathological examination of the implant at the later time of cranioplasty (CP) showed the tissue had become vascularized exhibiting integration with the native dura. No complications related to the harvesting of the fascia lata were observed. CONCLUSIONS: Fascia lata is a validated source of autologous grafts; it is cost-free and would appear to be the biological material most similar to the dura mater. The implanted material appears to maintain a lasting vitality when covered over with a well-vascularized scalp, even after a period of months, achieving a successful suppression of infection. Subsequent skull reconstruction is performed safely and easily using artificial bone.

Minimally invasive spinal fixation in an aging population with osteoporosis: clinical and radiological outcomes and safety of expandable screws versus fenestrated screws augmented with polymethylmethacrylate.

OBJECTIVE: The goal of this study was to compare the clinical and radiological outcomes between fenestrated pedicle screws augmented with cement and expandable pedicle screws in percutaneous vertebral fixation surgical procedures for the treatment of degenerative and traumatic spinal diseases in aging patients with osteoporosis. METHODS: This was a prospective, single-center study. Twenty patients each in the expandable and cement-augmented screw groups were recruited. Clinical outcomes included visual analog scale (VAS), Oswestry Disability Index (ODI), and satisfaction rates. Radiographic outcomes comprised radiological measurements on the vertebral motion segment of the treated levels. Intraoperative data including complications were collected. All patients completed the clinical and radiological outcomes. Outcomes were compared preoperatively and postoperatively. RESULTS: An average shorter operative time was found in procedures in which expandable screws were used versus those in which cement-augmented screws were used (p < 0.001). No differences resulted in perioperative blood loss between the 2 groups. VAS and ODI scores were significantly improved in both groups after surgery. There was no significant difference between the 2 groups with respect to baseline VAS or ODI scores. The satisfaction rate of both groups was more than 85%. Radiographic outcomes also showed no significant difference in segment stability between the 2 groups. No major complications after surgery were seen. There were 4 cases (20%) of approach-related complications, all in fenestrated screw procedures in which asymptomatic cement extravasations were observed. In 1 case the authors detected a radiologically evident osteolysis around a cement-augmented screw 36 months after surgery. In another case they identified a minor loosening of an expandable screw causing local back discomfort at the 3-year follow-up. CONCLUSIONS: Expandable pedicle screws and polymethylmethacrylate augmentation of fenestrated screws are both safe and effective techniques to increase the pullout strength of screws placed in osteoporotic spine. In this series, clinical and radiological outcomes were equivalent between the 2 groups. To the authors' knowledge, this is the first report comparing the cement augmentation technique versus expandable screws in the treatment of aging patients with osteoporosis.

Clinical investigation of chronic subdural hematoma: Relationship between surgical approach, drainage location, use of antithrombotic drugs and postoperative recurrence.

OBJECTIVES: Chronic subdural hematoma (CSDH) is one of the most common diseases in the routine neurosurgical practice. The most usual procedures for CSDH treatment include single or multiple burr hole drainage craniectomy. There is still controversy, however, about the risks and benefits of the different surgical approaches and types of drainage. The aim of the current study is to evaluate the postoperative complications of the various surgical techniques of CSDH. PATIENTS AND METHODS: We conducted a single center retrospective analysis on 414 patients surgically treated for CSDH over a period of 6 years. Comparisons were made after dividing the patients into 4 groups based on the surgical technique and type of drainage: Single burr hole with subdural drainage (Group Ia), single burr hole with subgaleal drainage (Group Ib), craniotomy with subdural drainage (Group IIa), and craniotomy with subgaleal drainage (Group IIb). 238 cases underwent burr hole with irrigation, while 290 cases were treated with craniotomy. Of the analysed patients, subdural drainage was inserted in 382 cases, while subgaleal drain was used only in 146 patients, for a total of 528 procedures. RESULTS: Re-operation was performed in 9.47 % of cases. The frequency of re-intervention for recurrences appeared to be lower in the Group I a (5.06 %), while the frequency of the re-intervention was higher in the craniotomy with subdural drainage group (Group IIa, 11.6 %). 14 patients (2.65 %) developed acute subdural rebleeding in the immediate postoperative period with 6 of them on antiplatelets/anticoagulants in the preoperative period. CONCLUSION: Recurrence rate and functional outcome after surgical drainage of CSDH does not appear to be affected by surgical technique (craniotomy vs burrhole) and drainage location. To our opinion, surgeons may elect procedures on a case-by-case basis.

Interspinous spacer decompression (X-STOP) for lumbar spinal stenosis and degenerative disk disease: a multicenter study with a minimum 3-year follow-up.

Interspinous distraction devices provide an effective treatment for patients suffering from lumbar spinal stenosis and/or degenerative disk disease. The aim of this multicenter study was the prospective evaluation of patients treated for symptomatic lumbar spinal stenosis with interspinous process decompression (IPD) implants compared with a population of patients managed with conservative treatment. 542 patients affected by symptomatic lumbar spine degenerative disease were enrolled in a controlled trial. 422 patients underwent surgical treatment consisting of X-STOP device implantation, whereas 120 control cases were managed conservatively. Both patient groups underwent follow-up evaluations at 6, 12, 24, and 36 months using the Zurich Claudication Questionnaire, the Visual Analog Scale score and spinal lumbar X-rays, CT scans and MR imaging. One-year follow-up evaluation revealed positive good results in the 83.5% of patients treated with IPD with respect to 50% of the nonoperative group cases. During the first three years, in 38 out of the 120 control cases, a posterior decompression and/or spinal fixation was performed because of unsatisfactory results of the conservative therapy. In 24 of 422 patients, the IPD device had to be removed, and a decompression and/or pedicle screw fixation was performed because of the worsening of neurological symptoms. Our results support the effectiveness of surgery in patients with stenosis. IPD may offer an effective and less invasive alternative to classical microsurgical posterior decompression in selected patients with spinal stenosis and lumbar degenerative disk diseases.

Primary enlarged craniotomy in organized chronic subdural hematomas.

The aim of the study is to evaluate the efficacy of craniotomy and membranectomy as initial treatment of organized chronic subdural hematoma (OCSH). We retrospectively reviewed a series of 34 consecutive patients suffering from OCSH, diagnosed by magnetic resonance imaging (MRI) or contrast computer tomography (CCT) in order to establish the degree of organization and determine the intrahematomal architecture. The indication to perform a primary enlarged craniotomy as initial treatment for non-liquefied chronic subdural hematoma (CSDH) with multilayer loculations was based on the hematoma MRI appearance--mostly hyperintense in both T1- and T2-weighted images with a hypointense web- or net-like structure within the hematoma cavity. The reason why some hematomas evolve towards a complex and organized architecture remains unclear; the most common aspect to come to light was the "long standing" of the CSDHs which, in our series, had an average interval of 10 weeks between head injury and initial scan. Recurrence was found to have occurred in 2 patients (6% of cases) in the form of acute subdural hematoma. One patient died as the result of an intraventricular and subarachnoid haemorrhage, while 2 patients (6%) suffered an haemorrhagic stroke ipsilateral to the OCSH. Eighty-nine percent of cases had a good recovery, while 11% remained unchanged or worsened. In select cases, based on the MRI appearance, primary enlarged craniotomy seems to be the treatment of choice for achieving a complete recovery and a reduced recurrence rate in OCSH.

[Neuroendocrine carcinoma of the colon with metastasis to the brain: a case report and review of the literature]. / Carcinoma neuroendocrino del colon con metastasi cerebrale. Descrizione di un caso e revisione della letteratura.

The Authors report a case of a 71-year-old male with synchronous neuroendocrine colon carcinoma and a solitary brain metastasis. The patient was treated surgically with resection of both the cerebral and intestinal lesions followed by cerebral radiotherapy. A pulmonary metastasis was discovered after 3 months and treated with interferon and octreotide. No further cerebral or intestinal relapses were observed. The patient died of cardiac disease 11 months after the first operation. Central nervous system metastases from carcinoid tumours are rare. The reported survival in untreated cases or in cases treated by radiotherapy alone is 4 months. In the case reported, surgical resection of the cerebral and intestinal lesions followed by intracranial radiotherapy yielded complete local control of the disease and a slight improvement in survival.

Incidence of group A rotavirus in urban and rural areas of the city of Londrina-Brazil, from 1995 to 1997

Os rotavírus säo patógenos comuns e causam diarréia aguda em crianças e animais jovens. Neste trabalho avaliamos a participaçäo do vírus na diarréia de populaçäo humanas das áreas urbana e rural da cidade de Londrina, Paraná. Foram analisadas 905 amostras fecais de indivíduos com diarréia aguda, senso 686 e 219 amostras das zonas urbanas e rural, respectivamente. Trinta eoito amostras (4,2 por cento) foram consideradas positivas pelas técnicas de eletroforese em gel de poliacrilamida do RNA viral e aglutinaçäo passiva de látex, das quais 36 da área urbana e dois da área rural. Das amostras positivas, 17 foram genotipadas por RT-PCR tendo sido caracterizadas 16 cepas G1 e uma consideradas mistura dos gfenótipos G1 e G3

Hipertensäo arterial: análise da realidade da Unidade Básica de Saúde do Jardim Tókio / Hypertension: analysis of the Jardim Tokio's Health Basic Unit reality

A implantaçäo do Projeto Especial de Ensino Assistência Primária à Saúde: Práticas Multiprofissionais e Interdisciplinares (PEEPIN), no Centro de Ciências da Saúde da Universidade Estadual de Londrina, permitiu integrar o ensino das várias profissöes da saúde e desencadeou mudanças na estrutura acadêmica. Um dos grupos participantes (GIM 05), através de observaçöes da realidade e identificaçäo do problema da Unidade Básica de Saúde do Jardim Tókio, analisou a situaçäo dos hipertensos desta comunidade. Utilizou-se como instrumento para coleta dos dados um formulário com questöes fechadas. Foram entrevistados 74 pacientes hipertensos sendo 22 (30 por cento) do sexo masculino e 52 (70 por cento) do sexo feminino, com idade variando entre 28 e 82 anos (média-55 anos). Os resultados revelaram que 35 (47 por cento) apresentam antecedentes familiares de hipertensäo , 54 (73 por cento) usam medicaçäo com frequência, 40(54 por cento) mudaram seus hábitos alimentares e 36 pessoas estudadas (49 por cento) näo receberam informaçöes sobre a doença. Concluiu-se após análise e reflexäo dos resultados, a existência de um papel fundamental para cada profissional envolvido neste trabalho (medicina, fisioterapia, enfermagem odontologia e farmácia quanto à participaçäo na soluçäo desse problema e sugerimos a implantaçäo de um programa especial de atendimento para os hipertensos desta Unidade Básica de Saúde