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Acta Neurochir (Wien) ; 161(8): 1733-1741, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31187267


BACKGROUND: 5-Aminolevulinic acid (5-ALA) has become an important assistant in glioblastoma (GB) surgery. Unfortunately, its price affects its widespread use. OBJECTIVE: The aim of this study was to compare commercial 5-ALA with the pharmacy-compounded solution. METHODS: Using first an in vitro experimental approach, different concentrations of the pharmacy-compounded solution and commercial 5-ALA were tested in U87MG, LN229, U373, and T98G commercial glioblastoma cell lines. Fluorescence intensity was compared for each concentration by flow cytometry. Mean fluorescence of culture supernatant and lysate samples were analyzed. In a second phase, both preparations were used for surgical glioblastoma resection and tumor samples were analyzed by confocal microscopy. Mean fluorescence intensity was analyzed for each preparation and compared. RESULTS: There was a high variability of fluorescence intensity between cell lines, but each cell line showed similar fluorescence for both preparations (compounded preparation and commercial 5-ALA). In the same way, both preparations had similar fluorescence intensity in glioblastoma samples. CONCLUSION: Both, compounded and commercial 5-ALA preparations produce equivalent fluorescent responses in human glioblastoma cells. Fluorescence intensity is cell line specific, but fluorescent properties of both preparations are undistinguishable.

J Neurol Surg A Cent Eur Neurosurg ; 80(3): 149-161, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30654404


BACKGROUND AND STUDY AIMS: Stereotactic biopsy is a versatile, minimally invasive technique to obtain tissue safely from intracranial lesions for their histologic diagnosis and therapeutic management. Our objective was to determine the anatomical, radiologic, and technical factors that can affect the diagnostic yield of this technique. We suggest recommendations to improve its use in clinical practice. METHODS: This retrospective study evaluated 407 patients who underwent stereotactic biopsies in the past 34 years. The surgical methodology changed through time, distinguished by three distinct periods. Different stereotactic frames (Todd-Wells, CRW, Leksell), neuroimaging tests, and planning programs were used. Using SPSS software v.23, we analyzed a total of 50 variables for each case. RESULTS: The series included 265 men (65.1%) and 142 women (34.9%) (average age 53.8 years). The diagnostic yield was 90.4%, morbidity was 5.65% (n = 17), and mortality was 0.98% (n = 4). Intraoperative biopsy improved accuracy (p = 0.024). Biopsies of deep lesions (p = 0.043), without contrast enhancement (p = 0.004), edema (p = 0.036), extensive necrosis (p = 0.028), or a large cystic component (p = 0.023) resulted in a worse diagnostic yield. Neurosurgeons inexperienced in stereotactic techniques obtained more nondiagnostic biopsies (p = 0.043). Experience was the clearest predictive factor of diagnostic yield (odds ratio: 4.049). CONCLUSIONS: Increased experience in stereotactic techniques, use of the most suitable magnetic resonance imaging sequences during biopsy planning, and intraoperative evaluation of the sample before finalizing the collection are recommended features and ways to improve the diagnostic yield of this technique.

Encéfalo/cirurgia , Técnicas Estereotáxicas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/métodos , Encéfalo/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem , Estudos Retrospectivos , Adulto Jovem
World Neurosurg ; 2019 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-30684698


This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at

Int J Spine Surg ; 11: 6, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28377864


BACKGROUND: We describe the carrying out of our open door laminoplasty technique by reproducing a posterior vertebral arch using a local originating autologous bony graft and titanium plates. METHODS: We designed a prospective study and present our first 16 patients. The clinical results were evaluated with the JOA score, Nurick scale and the VAS. The functional and radiological evaluation was performed with radiographs, CT and MRI, and the measurements of the dimensions of the spinal canal were carried out with the MIPAV programme ( Johns Hopkins University). All the variables were statistically analysed by means of SPSS23.0. RESULTS: After following up the cases for two years, the clinical evaluation showed, amongst other findings, a 75% improvement in the JOA score, while the radiological controls showed an appropriate range of motion (ROM) along with the stability of the construction. The rate of complete arthrodesis of the cervical neo-arch reached was approximately 92%. CONCLUSIONS: Our results show that the modifications that we performed on the technique originally described have made it into a simpler, more efficacious and safer procedure, without lessening its essential objectives.

Int J Spine Surg ; 9: 22, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26196029


BACKGROUND: We present our experience in the treatment of patients with isthmic or degenerative spondylolisthesis, by means of a posterior lumbar interbody fusion (PLIF) and instrumented posterolateral fusion (IPLF), and we compare them with those published in the literature. We analyse whether there exists any statistical association between the clinical characteristics of the patient, radiological characteristics of the disease and our surgical technique, with the complications and the clinical-radiological prognosis of the cases. METHOD: We designed a prospective study. A total of 36 cases were operated. The patients included were 14 men and 22 women, with an average age of 57.17±27.32 years. Our technique consists of PLIF+IPLF, using local bone for the fusion. The clinical results were evaluated with the Visual Analogical Scale (VAS) and the Kirkaldy-Willis criteria. The radiological evaluation followed the Bratingan (PLIF) and Lenke (IPLF) methodology. A total of 42 variables were statistically analysed by means of SPSS18. We used the Paired Student's T-test, logistic regression and Pearson's Chi-square-test. RESULTS: The spondylolisthesis was isthmic in 15 cases and degenerative in 21 cases. The postoperative evaluations had excellent or good results in 94.5% (n = 34), with a statistically significant improvement in the back pain and sciatica (p < 0.01). The rate of circumferential fusion reached was approximately 92%. We had 13.88% of transitory morbility and 0% of mortality associated with our technique. A greater age, degree of listhesis or length of illness before the intervention, weakly correlated with worse clinical results (p< -0.2). In our series, the logistical regression showed that the clinical characteristics of the patient, radiological characteristics of the lesion and our surgical technique were not associated with greater postoperative complications. CONCLUSION: Although a higher level of training is necessary, we believe that the described technique is a very effective decision in cases of spondylolisthesis, isthmic or degenerative, refractory to conservative treatment, for the obtaining the best clinical results and rates of fusion, with similar risks to those of the other published techniques. Our statistical analysis could contribute to improve outcomes after surgery.