Posterior fossa decompression with duraplasty in Chiari surgery: A technical note / Descompressão de fossa posterior com duroplastia no tratamento cirúrgico do Chiari: nota técnica

Summary Chiari malformation (CM) is the most common and prevalent symptomatic congenital craniocervical malformation. Radiological diagnosis is established when the cerebellar tonsils are located 5 mm or more below the level of the foramen magnum on magnetic resonance imaging (MRI). Surgical treatment is indicated whenever there is symptomatic tonsillar herniation or syringomyelia/hydrocephalus. The main surgical treatment for CM without craniocervical instability (such as atlantoaxial luxation) is posterior fossa decompression, with or without duraplasty. The authors describe in details and in a stepwise fashion the surgical approach of patients with CM as performed at the State University of Campinas, emphasizing technical nuances for minimizing the risks of the procedure and potentially improving patient outcome.

Resumo A malformação de Chiari (MC) é a malformação craniocervical congênita sintomática mais comum e prevalente. O diagnóstico radiológico é definido quando as tonsilas cerebelares estão localizadas pelo menos 5 mm abaixo do nível do forame magno na ressonância magnética (RM). Quando há hérnia tonsilar sintomática, siringomielia ou hidrocefalia, o tratamento cirúrgico é indicado. O principal tratamento cirúrgico para MC sem instabilidade craniocervical (como a luxação atlantoaxial) é a descompressão da fossa posterior com ou sem duroplastia. Os autores descrevem detalhadamente a abordagem cirúrgica de pacientes com MC realizada na Universidade Estadual de Campinas, enfatizando nuances técnicas para minimizar os riscos relacionados ao procedimento e melhorar os resultados pós-operatórios.

Posterior fossa decompression with duraplasty in Chiari surgery: A technical note.

Chiari malformation (CM) is the most common and prevalent symptomatic congenital craniocervical malformation. Radiological diagnosis is established when the cerebellar tonsils are located 5 mm or more below the level of the foramen magnum on magnetic resonance imaging (MRI). Surgical treatment is indicated whenever there is symptomatic tonsillar herniation or syringomyelia/hydrocephalus. The main surgical treatment for CM without craniocervical instability (such as atlantoaxial luxation) is posterior fossa decompression, with or without duraplasty. The authors describe in details and in a stepwise fashion the surgical approach of patients with CM as performed at the State University of Campinas, emphasizing technical nuances for minimizing the risks of the procedure and potentially improving patient outcome.

Evaluation of the reliability and validity of the newer AOSpine subaxial cervical injury classification (C-3 to C-7).

OBJECTIVE The authors evaluated a new classification for subaxial cervical spine trauma (SCST) recently proposed by the AOSpine group based on morphological criteria obtained using CT imaging. METHODS Patients with SCST treated at the authors' institution according to the Subaxial Cervical Spine Injury Classification system were included. Five different blinded researchers classified patients' injuries according to the new AOSpine system using CT imaging at 2 different times (4-week interval between each assessment). Reliability was assessed using the kappa index (κ), while validity was inferred by comparing the classification obtained with the treatment performed. RESULTS Fifty-one patients were included: 31 underwent surgical treatment, and 20 were managed nonsurgically. Intraobserver agreement for subgroups ranged from 0.61 to 0.93, and interobserver agreement was 0.51 (first assessment) and 0.6 (second assessment). Intraobserver agreement for groups ranged from 0.66 to 0.95, and interobserver agreement was 0.52 (first assessment) and 0.63 (second assessment). The kappa index in all evaluations was 0.67 for Type A, 0.08 for Type B, and 0.68 for Type C injuries, and for the facet modifier it was 0.33 (F1), 0.4 (F2), 0.56 (F3), and 0.75 (F4). Complete agreement for all components was attained in 25 cases (49%) (19 Type A and 6 Type C), and for subgroups it was attained in 22 cases (43.1%) (16 Type A0 and 6 Type C). Type A0 injuries were treated conservatively or surgically according to their neurological status and ligamentous status. Type C injuries were treated surgically in almost all cases, except one. CONCLUSIONS While the general reliability of the newer AOSpine system for SCST was acceptable for group classification, significant limitations were identified for subgroups. Type B injuries were rarely diagnosed, and only mild (Type A0) and extreme severe (Type C) injuries had a high rate of interobserver agreement. Facet modifiers and intermediate injury patterns require better descriptions to improve their low agreement in cases of SCST.

Immediate intra and post-surgery complications of the orthotopic liver transplantation in pigs

Objective: to analyze immediate organic modifications and complications subsequent to orthotopic liver transplantation in pigs. Method: fourteen female pigs, specie Sus domesticus, were utilized in this study, with body mass between 5 and 8 Kg, considering that we evaluated the main immediate intra and post-surgery complications of the liver transplantation. Results: in the donor, we highlighted as the main complication the occurrence of bleedings, considering that this was observed in all procedures. In addition, such situation occurred during surgery involving the receptor, in which the bleeding was also perceived as the most frequent complication. However, it is valid to highlight that the hemodynamic instability was present in 5 procedures involving the receptor. Conclusion: among trans surgery complications we may cite: difficulty of oro-tracheal intubation, intra surgery hemorrhages, hemodynamic and respiratory instability and anesthetic complications. In the immediate post-surgery, thus, we observed as the most frequent complications: hemodynamic instability and small anastomotic bleedings

Objetivo: analisar as modificações orgânicas e complicações imediatas subseqüentes ao transplante hepático ortotópico em suínos. Método: foram utilizados no estudo, 14 porcos fêmeas espécie Sus domesticus, com massa corporal entre 5 e 8 Kg, sendo que avaliou-se as principais complicações intra e pós-operatórias imediatas no transplante hepático. Resultados: no doador, destacou-se a ocorrência de sangramentos como principal complicação, tendo em vista que esta foi observada em todos os procedimentos. Tal situação também ocorreu no ato cirúrgico envolvendo o receptor, no qual se percebeu o sangramento como a complicação, também, mais freqüente. Entretanto é valido destacar a instabilidade hemodinâmica, que esteve presente em 5 procedimentos envolvendo o receptor. Conclusão: dentre as complicações trans operatórias podem ser citadas: dificuldade de intubação oro-traqueal, hemorragias intra operatórias, instabilidade hemodinâmica e respiratória e complicações anestésicas. Já no pós-operatório imediato observamos como complicações mais frequentes: instabilidade hemodinâmica e pequenos sangramentos anastomóticos.