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2.
Asian J Neurosurg ; 16(2): 237-242, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34268145

RESUMO

Temporary clips are invaluable safety tools during the clipping of an aneurysm. Controversies regarding maximum permissible duration and safety, however, remain unanswered. This descriptive narrative attempts to review the literature to provide valuable insights on controversies clouding the use of temporary clips among neurosurgeons. Popular databases, including Pub Med, Medline/Medscape, Scopus, Cochrane, Embase, Google Scholar, were searched to find available literature on temporary clips. The searched MeSH terms were "Temporary Clip," "Temporary Clipping," "Cerebral Aneurysm," and "Aneurysm." Temporary clips have been in use since 1928 and have undergone considerable structural and technical modifications. A temporary clip's optimal safety limit is not yet defined with literature evidence ranging from immediate to 93 min. It is not yet definite whether temporary clips application aggravates vasospasm, but emergency temporary clips application, especially in poor-grade aneurysmal subarachnoid hemorrhage patients, is associated with poor outcomes. A temporary clip needs to be applied with caution in patients treated earlier by endovascular technique and having indwelling stents. Nitinol Stent is feasible, while a Cobalt-Chromium alloy stent does not get occluded and gets deformed under the closing pressure of a temporary clip. Although a temporary clip application is a fundamental strategy during the clipping of an aneurysm; the exact safe duration remains to be decided in randomized control trials. Their utility for the shorter duration is beneficial under un-conclusive evidence of neuroprotective agents and intraoperative monitoring. Neurosurgeons need to consider all aspects of their pros and cons for optimal use.

3.
Artigo em Inglês | MEDLINE | ID: mdl-34208596

RESUMO

Traumatic brain injury (TBI) occurs due to the disruption in the normal functioning of the brain by sudden external forces. The primary and secondary injuries due to TBI include intracranial hematoma (ICH), raised intracranial pressure (ICP), and midline shift (MLS), which can result in significant lifetime disabilities and death. Hence, early diagnosis of TBI is crucial to improve patient outcome. Computed tomography (CT) is the preferred modality of choice to assess the severity of TBI. However, manual visualization and inspection of hematoma and its complications from CT scans is a highly operator-dependent and time-consuming task, which can lead to an inappropriate or delayed prognosis. The development of computer aided diagnosis (CAD) systems could be helpful for accurate, early management of TBI. In this paper, a systematic review of prevailing CAD systems for the detection of hematoma, raised ICP, and MLS in non-contrast axial CT brain images is presented. We also suggest future research to enhance the performance of CAD for early and accurate TBI diagnosis.


Assuntos
Lesões Encefálicas Traumáticas , Lesões Encefálicas , Encéfalo , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Humanos , Pressão Intracraniana , Tomografia Computadorizada por Raios X
4.
World Neurosurg ; 145: e127-e130, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33010506

RESUMO

BACKGROUND: Achieving optimal brain relaxation is paramount in aneurysm surgery. Despite proper positioning and the use of newer anesthetic drugs and the administration of decongestants, it is often not possible to achieve satisfactory relaxation, which can lead to neurological deficits owing to excessive brain retraction. The present study aimed to provide detailed surgical notes regarding the novel technique of temporal horn tapping for intraoperative ventriculostomy. METHODS: The hospital records of anterior circulation aneurysm surgery performed during the previous 5 years were retrieved. Only those cases in which we had used temporal horn tapping were included. Ventriculostomy was performed only in those cases in which the brain was tense despite the administration of decongestants. A small corticectomy was performed over the middle temporal gyrus and deepened to access the temporal horn. RESULTS: This technique was used in 84 surgical cases. The mean patient age was 52.8 years. The male/female ratio was 1:1.4. Anterior communicating artery aneurysms were the most common. Adequate brain relaxation was satisfactorily achieved in all cases. Two patients had developed a small temporal hematoma attributable to the temporal corticectomy, both managed conservatively. CONCLUSIONS: We believe that this new trajectory through the middle temporal gyrus to access the temporal horn is very safe because of the lack of proximity to any blood vessel or critical structures. We recommend the use of this technique during pterional approaches for acute aneurysmal surgery in the tight, bulging brain to achieve relaxation and avoid secondary complications such as retraction contusions and resultant cerebral edema.


Assuntos
Aneurisma Intracraniano/cirurgia , Lobo Temporal/cirurgia , Ventriculostomia/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
Life Sci ; 264: 118673, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33130078

RESUMO

AIMS: The study focused on the expression and role of a recent potential cancer therapeutic target protein, MutT Homolog1 (MTH1). MTH1 gets activated in an increased reactive oxygen species (ROS) environment and removes the oxidized nucleotides from the cell. The study aimed to check the role of MTH1 in DNA damage and apoptosis, migration and angiogenesis and also to examine its regulation in glioma. MAIN METHODS: The experiments were carried out in human glioma tissue samples and brain tissues of epilepsy patients (non-tumor control). We used two human glioblastomas cell lines, U87MG and U251MG cells. In order to study the role of MTH1 in glioma and to analyze the relation of MTH1 with Hif1α, we have used MTH1 siRNA and Hif1α siRNA respectively. KEY FINDINGS: We found an increased expression of MTH1 in glioma tissues compared to the non-tumor brain tissues. Correlation analysis revealed that those samples showing reduced expression of MTH1 also had high levels of DNA damage and apoptotic markers, while diminished expression of angiogenesis regulators and levels of migration. MTH1 knockdown in vitro by siRNA in tumor cell lines corroborates the above observation. This justifies the emergence of MTH1 inhibitors as potential first-in-class drugs. Mechanistically, our observations suggest that Hif1α may modulate MTH1 expression. SIGNIFICANCE: We found elevated MTH1 expression in glioma irrespective of their grades, while its inhibition affects multiple tumor progression pathways, and that targeting Hif1α could simulate the same.


Assuntos
Neoplasias Encefálicas/metabolismo , Enzimas Reparadoras do DNA/biossíntese , Regulação Neoplásica da Expressão Gênica , Glioma/metabolismo , Subunidade alfa do Fator 1 Induzível por Hipóxia/biossíntese , Monoéster Fosfórico Hidrolases/biossíntese , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patologia , Linhagem Celular Tumoral , Enzimas Reparadoras do DNA/genética , Glioma/genética , Glioma/patologia , Humanos , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Gradação de Tumores/métodos , Monoéster Fosfórico Hidrolases/genética
6.
Clin Neurol Neurosurg ; 200: 106339, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33183885

RESUMO

BACKGROUND: Inflammation plays a role in secondary brain injury after intracerebral haemorrhage (ICH). Peripheral biomarkers of inflammation especially the neutrophil-to-lymphocyte ratio (NLR) have been shown to influence outcome following ischemic stroke and traumatic brain injury. Role of NLR in outcome prognostication following haemorrhagic stroke has not yet been conclusively established. This study analyses the prognostic significance of admission neutrophil to lymphocyte ratio on mortality and 90-day outcome in patients admitted with acute SICH. MATERIAL AND METHODS: A total of 851 patients with spontaneous ICH were retrospectively investigated. Admission haematological parameters were retrieved from our hospital laboratory systems and NLR was then calculated using the formula ANC/ALC. (Absolute neutrophil count/Absolute lymphocyte count) Clinical outcome was assessed by modified Rankin Scale at 90 days. Logistic regression was performed to identify independent risk factors of mortality and 90-day outcome. Receiver operator curve (ROC) test was used to determine the predictive value of NLR for 30-day death. RESULTS: A total of 851 patients enrolled in the study. Our 30 day and 90 day mortality were 125 (17.7 %) and 244 (28.7 %) respectively. The mean NLR in the entire cohort was 9.03 ±â€¯7.6. NLR was significantly higher in the mortality group compared to the survivors (11.98 ±â€¯9.91 vs 8.52 ±â€¯7.05) P < 0.001. NLR in patients with a good outcome at 90 days (7.21 ±â€¯6.06) was a lower in comparison to patients with poor outcome(10.66 ±â€¯8.48).(p=<0.001). NLR was dichotomised at 8.2 which was computed based on ROC curve. Mortality and poor outcome were higher in the NLR > 8.2 group at 140 (40.1 %) and 23 (67.8 %) respectively (p < 0.001). Age, GCS < 8, Volume of Hematoma, Intra ventricular extension of hematoma and NLR > 8.2 were found to be independent predictors of outcome. GCS < 8 had a greater predictive value (5.236) compared to NLR.8.2 (1.78). CONCLUSION: Elevated levels of admission NLR were independently related to poor mortality and 90-day outcome after ICH. NLR is a novel, easily available and cost effective prognostic biomarker following ICH.


Assuntos
Hemorragia Cerebral/sangue , Hemorragia Cerebral/diagnóstico , Linfócitos/metabolismo , Neutrófilos/metabolismo , Idoso , Biomarcadores/sangue , Biomarcadores/metabolismo , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos
10.
J Neurosci Rural Pract ; 11(4): 517-518, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33144784
11.
J Neurosci Rural Pract ; 11(4): 623-628, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33144801

RESUMO

Background Adult primary intraventricular hemorrhage (PIVH) is a rare type of hemorrhagic stroke that is poorly understood. The study attempts to define the clinical profile, yield of diagnostic cerebral angiography, and prognosis of patients with PIVH. Patients and Methods Retrospective data analysis of all patients with PIVH admitted between February 2015 and February 2019 at a tertiary care center. Outcome was assessed using the modified Rankin scale (mRS) at 6 months. Results and Discussion Our study group of 30 patients constituted 3.3% (30/905) of our spontaneous intracerebral hemorrhage (SICH) patients in the study period. The mean Glasgow Coma Score on admission was 11 ± 3.33 and the mean IVH Graeb score was 5.2±2.4. All patients underwent angiography. Angiography detected moyamoya disease in four patients (13.3%) and aneurysms in two patients (6.6%) and these patients were managed surgically. Extraventricular drainage with intraventricular instillation of Streptokinase was performed in five patients. The rest of the patients was managed conservatively. At 6-month follow-up, 25 patients (83.33%) achieved favorable outcome (mRS score of 0.1 or 2), whereas five (16.66%) patients had a poor outcome (mRS score of 3 or more. Three patients succumbed to the illness. IVH Graeb score and presence of hydrocephalus have significant correlation with poor outcome. Conclusion PIVH is an uncommon entity but carries a better long-term prognosis than SICH angiography helps in diagnosing surgically remediable underlying vascular anomalies and is indicated in all cases of PIVH.

12.
World Neurosurg ; 144: e622-e630, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32916353

RESUMO

BACKGROUND: Spontaneous intracerebral hemorrhage carries a poor prognosis with a 30-day mortality rate of 35%-52%. There is no standardized surgical technique for treatment of spontaneous intracerebral hemorrhage. While minimally invasive techniques are popular, there has been renewed interest in decompressive craniectomy (DC). We compared surgical and functional outcomes of standard craniotomy and DC, both with hematoma evacuation, in the surgical treatment of supratentorial spontaneous intracerebral hemorrhage. METHODS: This 4-year retrospective study compared outcomes of 2 surgical techniques: standard craniotomy in group A (n = 78) and DC in group B (n = 54). To minimize bias in case selection, propensity matching was performed to match preoperative Glasgow Coma Scale score and hematoma volume (group C). RESULTS: Hematoma evacuation was performed in 132 patients. Mean age of patients was 53.3 years, 50.5 years, and 52.06 years in groups A, B, and C, respectively. Median preoperative Glasgow Coma Scale score was 9, 7, and 8 (P = 0.01; P = 0.45), and mean hematoma volume was 46.21 mL, 50.91 mL, and 49.90 mL. Overall mortality was 26.5%; 62.9% (n = 22) of deaths were in group A, and 37.1% (n = 13) were in group B (P = 0.69). Median modified Rankin Scale score was similar in both groups, both at discharge and at 3 months. After determining propensity scores, mortality and outcomes of matched groups remained similar. CONCLUSIONS: DC with hematoma evacuation does not appear to provide a significant advantage over standard craniotomy with regard to functional outcomes and mortality. DC may overcome the need for subsequent surgery in accommodating postoperative mass effect in residual bleeds and rebleeds but is associated with greater blood loss and longer operative duration.


Assuntos
Hemorragia Cerebral/cirurgia , Craniectomia Descompressiva , Hemorragia Cerebral/epidemiologia , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
13.
J Neurosci Rural Pract ; 11(3): 385-394, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32753802

RESUMO

Background Spheno-orbital meningiomas (SOMs) constitute a rare cause for orbital proptosis and visual impairment. This study aims to share our outcome experience with regard to vision and exophthalmos following the surgical management of 17 patients with SOM. Methods Retrospective analysis of the case records of all surgically treated SOMs in the last 10 years. Exophthalmos index (EI) was calculated based on preoperative magnetic resonance imaging/computed tomography imaging. Vision was assessed using the Snellen's chart and Goldman's perimeter. Orbital volume was calculated using three-dimensional volume rendering assisted region-of-interest computation. Preoperative duration of symptoms and extent of surgery were the other predictors analyzed. Results Patients' age ranged from 17 to 72 years (mean, 50.57 y; median, 50.0 years). Women represented 13 (76.4%) of the entire study group. Proptosis (14/17; 82.4%) and visual impairment (14/17; 82.3%) were the two most common presenting complaints followed by headache (12/17; 70.1%). Gross total resection (GTR) was achieved in only 2 of the 17 patients (11.8%). Majority of the tumors were benign World Health Organization Grade I meningiomas (14/17; 84%). Mean follow-up time for the entire cohort was 56 months. Postoperatively, proptosis improved in nine (64.3%) and remained static in the rest five (35.7%) of patients. Four patients (28.6%) improved in vision following surgery. Vision remained static in eight patients (57.1%). Vision deteriorated in two (14.3%) patients who had severe preoperative visual deficits. New onset oculomotor palsy, trigeminal dysfunction, and mechanical ocular motility restriction were noticed in three (17.6%), two (11.2%), and six (35.3%) patients, respectively. The mean preoperative orbital volume was 21.68 ± 3.2 cm 3 and the mean postoperative orbital volume was 23.72 ± 3.4 cm 3 . Orbital volume was inversely related to EI. Optic canal (OC) deroofing and extensive orbital wall decompression facilitated visual improvement and proptosis reduction. None of the variables including orbital volume proved to be statistically significant in predicting outcome. Conclusion SOMs constitute a rare subgroup of skull base meningiomas that pose considerable surgical challenges. A surgical strategy aimed at safe maximal resection rather than aggressive GTR provides favorable outcome with less morbidity. Adequate bony decompression of the orbital walls and OC provides satisfactory improvements in proptosis and vision. Residual disease is common, but the risk of symptomatic recurrence is low especially when combined with adjuvant radiotherapy. Visual outcome is likely to be poor in patients presenting with severely compromised vision.

14.
Stroke Res Treat ; 2020: 2192709, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32411342

RESUMO

Background. This article attempts to evaluate the clinical profile and outcome determinants following hypertensive SICH in a South Indian population. The study represents the largest series of SICH reported from a single centre in India. Materials and Methods. Prospective data collection and analysis of patients with SICH admitted to our centre between 1st January 2015 and 31st December 2018. The variables analysed include: age, sex, comorbidities, Glasgow coma score (GCS) on admission, radiological features, treatment modality, and outcome at three months. Modified Rankin score (mRS) was used to assess the outcome at discharge and three months. Results. Our study group of 905 patients included 638 males and 267 females and the mean age at presentation was 58.10 ± 12.76 years. The study group included 523 patients (57.8%) previously diagnosed hypertensive, of whom 36.3% (n = 190) were on irregular medication. The most frequent locations of hematoma were basal ganglia (478), thalamus (202), lobar (106), cerebellar (61), brainstem (31), and primary intraventricular haemorrhage (27). Secondary intraventricular extension was seen in 425 (47%) patients on admission. The mean volume of the clot on admission was 23.45 ± 19.79 ml, and clot progression was seen in only 46 (5.08%) cases. Surgical evacuation through craniotomy was done in 147 (16.8%) patients, and external ventricular drainage (EVD) was placed in 56 (6.2%) patients. Overall 3-month mortality was 30.1% (266 patients). On the last follow up a favorable outcome (mRS 0-3) was observed in 412 (45.53%) patients and a poor outcome (mRS 4-5) in 207 patients (22.87%). Independent predictors of mortality are Age >70 (p = <0.001, OR 4.806, 95% CI 3.064-7.54), admission GCS <8 (p = <0.001, OR7.684, 95% CI 5.055#x2013;11.68), and Hematoma volume >30 ml (p = <0.001, OR 2.45, 95% CI 1.626-3.691). Intraventricular haemorrhage was an additional poor outcome predictor (p < 0.015, CI 1.105-2.585). Surgical evacuation reduced mortality in the group, but morbidity rates remained the same. Conclusions. SICH predominantly affects a younger population in India in comparison to the Western society. Elderly age, poor GCS on admission, clot volume above 30 ml and intraventricular extension remain the most consistent predictors of death and poor outcome. Further studies are needed to assess the risk of SICH among hypertensive patients and to prognosticate the outcome after SICH using novel predictors, including biomarkers.

15.
Pituitary ; 23(5): 515-525, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32451987

RESUMO

OBJECTIVE: Implication of the tumor size on oncological and functional outcomes of craniopharyngioma is inconsistently reported. The aim of this study is to assess the postoperative outcome of giant craniopharyngiomas (> 4 cm in diameter) and to elucidate the impact of tumor size on various outcome parameters and survival. MATERIAL AND METHODS: Forty-four patients (children aged ≤ 18 years: 25; adults: 16) with giant craniopharyngioma, operated between January 2001 and December 2015, were included in this study. Various outcomes, progression-free survival (PFS) and overall survival (OS) were calculated. RESULTS: Gross total resection (GTR) was achieved in 17 (39%) and subtotal resection (STR) in 27 (61%) patients. Eleven patients (25%) received radiotherapy (RT) after STR. Postoperatively, new cranial nerve and motor deficits were noted in 12 (27%) and 9 (20%) patients, respectively. Tumor recurrence following GTR and STR without adjuvant RT was diagnosed in 3 (17%), and 5 (38%) patients, respectively. Following STR with RT, one (9%) experienced recurrence. PFS at 5-, and 10- year following GTR, STR, and STR + RT was 80.8%, 45.4%, and 90%, respectively. At 5- and 10- year, OS was 86.5%, 77.9% and 100% following GTR, STR, and STR + RT, respectively. The rate of GTR was significantly lower in patients with giant tumors (39% vs. 62%; Chi-square test, p value 0.008). Postoperatively, neurological deficit (20%), hypopituitarism (95%) and hypothalamic dysfunction (26%) were significantly higher for giant craniopharyngiomas. Hazards of recurrence were not significant between giant and non-giant tumors (hazard ratio 1.86; 95% CI 0.94-3.68; p 0.07). There was no significant difference in OS between the patients with giant and non-giant tumors (log-rank test 2.1; p value 0.14). CONCLUSION: Tumor size should be considered as an important predictor of the postoperative functional outcome. Although the rate of GTR is less than that of small tumors, the recurrence rate, progression-free survival, and overall survival of the patients with giant tumor are comparable to non-giant tumors.


Assuntos
Craniofaringioma/patologia , Craniofaringioma/cirurgia , Craniofaringioma/mortalidade , Intervalo Livre de Doença , Feminino , Humanos , Hipopituitarismo/mortalidade , Hipopituitarismo/patologia , Hipopituitarismo/cirurgia , Doenças Hipotalâmicas/mortalidade , Doenças Hipotalâmicas/patologia , Doenças Hipotalâmicas/cirurgia , Masculino , Período Pós-Operatório , Intervalo Livre de Progressão , Estudos Retrospectivos , Resultado do Tratamento
16.
Neurol India ; 68(1): 63-70, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32129246

RESUMO

Introduction: Although cranioplasty (CP) is a straightforward procedure, it may result in a significant number of complications. These include infections, seizures, intracranial hematomas, and others. Many reports have stated that early CP is associated with higher complications; however, more recent articles have contradicted this opinion. We intend to share our experience and results on outcomes of CP from our university hospital. Materials and Methods: This is a 3-year retrospective analysis of patients undergoing CP. Demographic profile, etiology of decompressive craniectomy (DC), DC-CP interval, operative details, complications, and follow-up data were analyzed. Correlation of complications with timing of CP and other factors was studied to look for statistical significance. Results: A.total of 93 cases were analyzed. The majority were traumatic and ischemic stroke etiologies. There were eight open/compound head injuries (HIs). Eleven were bilateral and the rest unilateral cases. The mean and median CP interval were 8.5 weeks (range 4-28 weeks) and 8 weeks, respectively. All patients received 48 h to up to 5 days of postoperative antibiotics. Ten complications (10.7%) were noted (including one death). Poor Glasgow Outcome Scale at CP was the only statistically significant factor associated with higher complication rates. There was no statistical difference with respect to gender, CP material, and etiology; however, early CP had slightly fewer complications. Conclusion: Patients with poor neurological condition at the time of CP have a significantly higher risk of complications. Contrary to earlier reports, early CP (<12 weeks) was not associated with higher complications but rather fewer complications than delayed procedures. Adherence to a few simple steps may help reduce these complications.


Assuntos
Craniectomia Descompressiva , Complicações Pós-Operatórias/cirurgia , Crânio/cirurgia , Acidente Vascular Cerebral/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Craniectomia Descompressiva/métodos , Países em Desenvolvimento , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Convulsões/etiologia , Acidente Vascular Cerebral/etiologia , Centros de Atenção Terciária , Adulto Jovem
18.
Clin Neurol Neurosurg ; 192: 105711, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32036264

RESUMO

OBJECTIVE: The optimal therapeutic approach to craniopharyngioma has not been established conclusively. The surgical outcome following radical excision and conservative resection with adjuvant radiotherapy are comparable or even better with the later in pediatric or mixed populations. This study is aimed at reviewing the role of extent of resection in local tumor control and long-term outcome in adults with craniopharyngioma. PATIENTS AND METHODS: Ninety-five adults operated between 2001 and 2013 were included. Progression-free survival (PFS) and overall survival (OS) were calculated. Predictors of various outcome parameters were analyzed. RESULTS: The predominant presenting symptom was visual impairment (78 %) followed by symptoms of hypothalamic involvement (29 %). Total and subtotal excisions (TE, STE) were achieved in 63 %, and 47 % of patients, respectively. Vision improved in 62 % of patients in the early postoperative period. Thirteen patients (14 %) experienced vision deterioration postoperatively. On multivariate analysis, tumor >3 cm and optic atrophy predicted poor visual outcome. Hormonal replacement for hypopituitarism was required in 83 % during follow-up. Diabetes insipidus was seen in 73 %. Imaging evidence of 3rd ventricular floor destruction by tumor emerged as an independent predictor of postoperative hypothalamic morbidities. The recurrence rate following TE and STE was 11.6 % and 72 %, respectively. Unlike radical excision, PFS following STE was significantly shorter (p- 0.02). TE was not associated with increased visual impairment or hypothalamic-pituitary dysfunction postoperatively as compared to STE. Most of the patients (85 %) were independent and able to return to the premorbid occupation. CONCLUSION: Subtotal resection provides equally good long-term visual, endocrinological, and hypothalamic outcomes as radical surgery. When used with adjuvant radiotherapy, it also gives a better local control of the tumor. Hence, subtotal resection with adjuvant radiotherapy should be considered as an effective alternative strategy to radical excision.


Assuntos
Craniofaringioma/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/cirurgia , Insuficiência Adrenal/metabolismo , Insuficiência Adrenal/fisiopatologia , Adulto , Craniofaringioma/metabolismo , Craniofaringioma/fisiopatologia , Feminino , Estado Funcional , Hormônio do Crescimento/deficiência , Humanos , Hipogonadismo/metabolismo , Hipogonadismo/fisiopatologia , Hipopituitarismo/metabolismo , Hipopituitarismo/fisiopatologia , Hipotireoidismo/metabolismo , Hipotireoidismo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , Neoplasias Hipofisárias/metabolismo , Neoplasias Hipofisárias/fisiopatologia , Radioterapia Adjuvante , Resultado do Tratamento , Transtornos da Visão/fisiopatologia , Adulto Jovem
19.
Physiother Res Int ; 25(2): e1827, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31880059

RESUMO

OBJECTIVES: To develop an adherence questionnaire specific to stroke and measure the level of adherence to home-based exercises among community-dwelling stroke survivors. METHODS: We developed and validated the "Stroke-Specific Measure of Adherence to Home-based Exercises" (SS-MAHE). We measured the exercise adherence among 92 community-dwelling stroke survivors in a cross-sectional study. RESULTS: The SS-MAHE has two sections covering (a) the dosage of prescribed exercises and (b) dosage of actual exercises done by the participants. It was found to be reliable with ICC score of 0.81 (95% CI, 0.44, 0.94, p = .001.) Adherence was measured by comparing prescribed exercises to the actual exercises performed at home. We rated participants as "adherent" if they were following more than 70% of the prescribed exercise dosage. In our sample of 92 stroke survivors, only 28% of participants were adherent to prescribed home-based exercises. CONCLUSION: SS-MAHE is a practical and reliable tool to measure adherence to home-based exercises after a stroke. Exercise adherence among stroke survivors is less than ideal. There is a need for strategies to specifically target exercise adherence in stroke survivors.


Assuntos
Terapia por Exercício/psicologia , Cooperação do Paciente/psicologia , Autocuidado/psicologia , Reabilitação do Acidente Vascular Cerebral/psicologia , Sobreviventes/psicologia , Idoso , Estudos Transversais , Feminino , Humanos , Vida Independente , Índia , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/psicologia , Reabilitação do Acidente Vascular Cerebral/métodos , Inquéritos e Questionários
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