Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 73
Filtrar
Mais filtros










Intervalo de ano de publicação
2.
Acta Neurochir (Wien) ; 162(6): 1425-1429, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32040620

RESUMO

BACKGROUND: Usual management of peripheral nerve tumors is to avoid biopsy in those that are likely benign; the risk of biopsy outweighs the benefit of definitive tissue diagnosis. Biopsy of presumed malignant lesions is performed widely. There is a subset of peripheral nerve tumors that are not easily categorized as benign or malignant based on the clinical and/or radiological features alone. The role of biopsy in peripheral nerve tumors of uncertain character remains controversial and the risk of biopsy (and the potential risk/benefit ratio) for these lesions is not known. METHODS: Following approval by our institutional review board, we reviewed all notes of a single peripheral nerve surgeon from 2000 to 2018 with respect to image-guided percutaneous biopsy of nerve tumors. We divided these patients into 3 groups based on clinicoradiologic features. We determined the risk of complications and the "hit rate" for patients with peripheral nerve tumors of uncertain behavior, defined as the percentage of patients sent for percutaneous biopsy who had a malignancy on their final pathology. RESULTS: Of 82 patients with tumors of uncertain behavior, 9 had complications, and 23 had malignant final pathology (a "hit rate" of 27.7%). Neurosurgical referral for biopsy of tumors of uncertain behavior was made in 60 patients. Twenty-two had malignant final pathology ("hit rate"= 36.7%). Non-neurosurgical referral for biopsy was made in 22 patients with tumors of uncertain behavior. Two had malignant final pathology ("hit rate"= 4.55%). There was a statistically significant difference between the "hit rate" for the two groups (p = 0.021). CONCLUSIONS: The decision to biopsy a peripheral nerve tumor is largely based on the presumed behavior and prognosis, determined via clinicoradiologic characteristics. Patient care might be improved by delaying percutaneous biopsy of peripheral nerve lesions until after a neurosurgical evaluation.

4.
Eur Spine J ; 29(4): 754-760, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31993788

RESUMO

BACKGROUND: Traditionally, adolescent idiopathic scoliosis (AIS) has not been associated with back pain, but the increasing literature has linked varying factors between pain and AIS and suggested that it is likely underreported. PURPOSE: Our objective was to investigate factors associated with post-op pain in AIS. METHODS: A prospectively collected multicenter registry was retrospectively queried. Pediatric patients with AIS having undergone a fusion with at least 2 years of follow-up were divided into two groups: (1) patients with a postoperative SRS pain score ≤ 3 or patients having a reported complication specifically of pain, and (2) patients with no pain. Patients with other complications associated with pain were excluded. RESULTS: Of 1744 patients, 215 (12%) experienced back pain after postoperative recovery. A total of 1529 patients (88%) had no complaints of pain, and 171 patients (10%) had pain as a complication, with 44 (2%) having an SRS pain score ≤ 3. The mean time from date of surgery to the first complaint of back pain was 25.6 ± 21.6 months. In multivariate analysis, curve type (16% of Lenke 1 and 2 curves vs. 10% of Lenke 5 and 6, p = 0.002) and a low preoperative SRS pain score (no pain 4.15 ± 0.67 vs. pain 3.75 ± 0.79, p < 0.001) were significant. When comparing T2-4 as the upper instrumented vertebrae in a subgroup of Lenke 1 and 2 curves, 9% of patients had pain when fused to T2, 13% when fused to T3, and 18% when fused to T4 (p = 0.002). CONCLUSION: 12% of all AIS patients who underwent fusion had back pain after postoperative recovery. The most consistent predictive factor of increased postoperative pain across all curve types was a low preoperative SRS pain score. These slides can be retrieved under Electronic Supplementary Material.

5.
World Neurosurg ; 135: 171-172, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31870821

RESUMO

Benign peripheral nerve sheath tumors are well known to neurosurgeons and a relatively commonly seen pathology. Intraneural ganglion cysts, once thought to be rare and poorly understood, are increasingly recognized in clinical practice and better understood based on the advent of high-resolution imaging. There are few reports of different nerve lesions in the same anatomic location appearing concurrently. Herein we present a patient with 2 distinct pathologies explaining 2 distinct symptom complexes-sensory changes in the superficial peroneal distribution (from a schwannoma of the superficial peroneal nerve) and mild motor weakness in the tibialis anterior (from an intraneural ganglion cyst arising from the superior tibiofibular joint affecting this motor branch). Recognition of the 2 pathologies allowed targeted surgical approaches, which led to resolution of the symptoms.


Assuntos
Cistos Glanglionares/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neuropatias Fibulares/diagnóstico por imagem , Idoso , Feminino , Cistos Glanglionares/complicações , Cistos Glanglionares/cirurgia , Humanos , Imagem por Ressonância Magnética , Neurilemoma/complicações , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/cirurgia , Nervo Fibular/diagnóstico por imagem , Nervo Fibular/cirurgia , Neuropatias Fibulares/complicações , Neuropatias Fibulares/cirurgia
6.
J Neurosurg ; : 1-4, 2018 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-29652235

RESUMO

Harvey Cushing is widely regarded as one of the forefathers of neurosurgery, and is primarily associated with his work on intracranial pathology. However, he had a clinical and academic interest in peripheral nerve surgery. Through the courtesy of the Alan Mason Chesney Medical Archives, the surgical records of the Johns Hopkins Hospital from 1896 to 1912 were reviewed. The records of a single patient undergoing brachial plexus exploration and cervical rib resection were selected for detailed review. The operative report and accompanying illustrations demonstrate Cushing's interest in adding approaches to the pathology of the brachial plexus to his operative armamentarium.

8.
Ann Plast Surg ; 76(4): 406-10, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26101973

RESUMO

BACKGROUND: Postoperative fistulae and velopharyngeal insufficiency (VPI) are 2 important complications after cleft palate repair. The effects of preoperative cleft width on outcomes after cleft palate repair have been rarely studied. METHODS: A retrospective review of all patients undergoing primary cleft palatoplasty by a single surgeon between 2004 and 2011 was performed. Primary outcomes were palatal fistula and VPI, defined as the need for corrective surgery after failing conservative speech-language therapy. Logistic regression analysis was performed to identify factors associated with the primary outcomes. RESULTS: One hundred seventy-seven patients (84 men and 93 women) were identified. Median age at repair was 10 months with median follow-up of 3.80 years. Preoperative cleft width was 10 mm or less for 72 (41%) patients, 11 to 14 mm for 54 (30%) patients, and 15 mm or greater for 51 (29%) patients. Palatal fistula was observed in 8 (4.5%) patients, but required surgical repair in only 2 (1.1%). Fistula was overall associated with Veau IV classification (odds ratio, 8.13; P < 0.01) but not with cleft width. Velopharyngeal insufficiency needing surgical intervention occurred in 9 patients (7.38% of patients older than 4 years) and was associated with increasing cleft width (odds ratio, 1.29; P = 0.011). Outcomes were similar for patients undergoing surgery in the earlier and later halves of the study. CONCLUSIONS: This retrospective review is one of the first from the United States to explore the associations between measured cleft width and outcomes after palatoplasty. Overall rates of palatal fistula and VPI were low, corroborating previous studies showing good outcomes with the 2-flap palatoplasty. After adjusting for multiple variables including Veau type, cleft width was associated with higher VPI rates but not with fistula formation. Cleft width is a unique preoperative factor that should be considered and studied as a potential predictor of outcomes.


Assuntos
Fissura Palatina/patologia , Fissura Palatina/cirurgia , Fístula Bucal/etiologia , Procedimentos Cirúrgicos Ortognáticos , Complicações Pós-Operatórias/etiologia , Insuficiência Velofaríngea/etiologia , Feminino , Seguimentos , Humanos , Incidência , Lactente , Modelos Logísticos , Masculino , Fístula Bucal/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Insuficiência Velofaríngea/epidemiologia
9.
J Neurosurg Spine ; 23(4): 412-8, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26115026

RESUMO

Although Harvey Cushing was mostly known for his contributions to brain tumor surgery, he was also a pioneer in the development of spinal cord surgery. This lesser known facet of Cushing's career can provide a fresh and unique perspective into how the founders of neurosurgery surmounted early challenges in the field. The authors bring to light and examine for the first time Cushing's unpublished writing "Technique of Laminectomy" along with his first 3 documented intramedullary spinal cord tumor (IMSCT) cases at the Johns Hopkins Hospital. The authors draw lessons from the challenges in pathological classification, preoperative diagnosis, tumor localization, and surgical technique of that time. Although Cushing's attempts at exploration and resection of IMSCT as described here were of limited success, his ability to adapt his clinical and surgical technique to the challenges of the time, as well as develop skills to successfully manipulate the spinal cord during these exploratory procedures without the patients incurring neurological damage, postoperative infection, or complications, is a testament to his determination to advance the field and his meticulous operative technique. In spite of the limitations imposed on the pioneer neurosurgeons, Harvey Cushing and his contemporaries persevered through many of the challenges and built an essential part of neurosurgery's common story.


Assuntos
Neurocirurgia/história , Neoplasias da Medula Espinal/cirurgia , Descompressão Cirúrgica/história , História do Século XIX , História do Século XX , Humanos , Laminectomia/história , Maryland
10.
Ann Plast Surg ; 75(3): 302-5, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25046662

RESUMO

Most surgeons recommend cleft palate repair between 6 and 12 months of age. Internationally adopted patients often undergo delayed repair due to social circumstances. There are few outcomes studies on this population. We conducted a 13-year retrospective review of all patients undergoing primary cleft palate repair at a single tertiary-care academic medical center between 1993 and 2006. The primary outcome was velopharyngeal insufficiency, defined as the recommendation for corrective surgery after multiple formal speech assessments. Two hundred one patients (102 males and 99 females) were identified. One hundred eighty-three repairs were performed before 18 months of age (standard repair group). Eighteen repairs were performed after 18 months of age (delayed repair group), with international adoption being a circumstance in 16 cases. The delayed and standard repair groups were similar with regard to sex, presence of craniofacial syndrome, Veau class, cleft size and laterality, type of repair, and operating surgeon. Mean follow-up was 9.3 years, with minimum follow-up of 5.0 years. Six (33%) of 18 patients in the delayed repair group developed velopharyngeal insufficiency compared to 23 (13%) of 183 in the standard repair group (P = 0.03 by Fisher exact test). These data demonstrate that internationally adopted patients undergoing delayed palate repair suffer especially poor speech outcomes. Physiologic differences in patients undergoing late repair, as well as social factors including adaptation to a new language and culture, may be factors. Early repair should be performed when possible.


Assuntos
Adoção , Fissura Palatina/cirurgia , Procedimentos Cirúrgicos Ortognáticos , Insuficiência Velofaríngea/etiologia , Fatores Etários , Pré-Escolar , Fissura Palatina/complicações , Feminino , Seguimentos , Humanos , Lactente , Cooperação Internacional , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos , Insuficiência Velofaríngea/diagnóstico , Insuficiência Velofaríngea/epidemiologia
11.
Clin Pediatr (Phila) ; 53(12): 1149-57, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24920348

RESUMO

INTRODUCTION: This study investigates radiographically acquired normative ranges of anterior fontanelle closure (AFC) and surface area (SA) in healthy full-term infants. METHODS: High-resolution head computed tomography (CT) scans were retrospectively reviewed for AFC and AF dimensions to allow approximation of AF SA. RESULTS: Between 15 and 23 head CT scans per monthly age-group (0-24 months) were reviewed, totaling 464 scans. AFC frequency increased steadily from age 10 (16%) to 20 months (88%), reaching higher than 50% at age 16 months (53%). The AF was closed in 3% to 5% of infants at 5 to 6 months. AF median SA increased from 769.3 mm(2) (age 0 months) to 1022.2 mm(2) (2 months), then declined steadily. CONCLUSIONS: This study provides reference charts detailing AFC frequency and AF SA as a function of age. Wide variability of AFC timing and AF size among healthy infants suggest that early or delayed AFC may represent normal variants.


Assuntos
Fontanelas Cranianas/anatomia & histologia , Fontanelas Cranianas/fisiologia , Cabeça/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
12.
J Neurol Surg B Skull Base ; 75(1): 27-34, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24498586

RESUMO

Objectives To review Dr. Harvey Cushing's early surgical cases at the Johns Hopkins Hospital, revealing details of his operative approaches to fractures of the skull base. Design Following institutional review board approval and through the courtesy of the Alan Mason Chesney Archives, we reviewed the Johns Hopkins Hospital surgical files. Setting The Johns Hopkins Hospital, 1896 to 1912. Participants A total of 24 patients underwent operative treatment for suspected fractures of the skull base. Main Outcome Measures The main outcome measure was operative approach, postoperative mortality, and condition recorded at the time of discharge. Results Overall, 23 patients underwent operative treatment for suspected skull base fractures. The mechanisms of injury were known for 22 patients and included work-related injuries (41%), falls (23%), vehicle injuries (32%), and other trauma (5%). One patient had no mechanism of injury specified in the file. The outcome at the time of discharge from the hospital was "well" or "improved" in 12 patients (52%). The remaining 11 patients died during their admission. Conclusions Although Cushing's experience with selected skull base pathology has been previously reported, the breadth of his contributions to operative approaches to the skull base has been neglected.

13.
Cleft Palate Craniofac J ; 51(1): 105-9, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23551074

RESUMO

Harvey Cushing has been deemed by many as the neurosurgeon of the 20th century. Cushing's unknown contributions to the field of plastic and reconstructive surgery were only recently reported. Further review of his teaching and operative records, brought from Johns Hopkins to Yale University, revealed an unpublished case of bilateral cleft lip repair that he performed. In this article, we present in detail this comprehensive case and describe, with the help of his personal teaching notes and illustrations, how Cushing combined methods from world-renowned surgeons to approach bilateral cleft lip deformities.


Assuntos
Fenda Labial/história , Fenda Labial/cirurgia , Neurocirurgia/história , Cirurgia Plástica/história , História do Século XIX , História do Século XX , Humanos
14.
Neurocir. - Soc. Luso-Esp. Neurocir ; 24(5): 225-228, sept.-oct. 2013. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-127179

RESUMO

Aunque el déficit de origen traumático del séptimo par craneal es una entidad común en la práctica neuroquirúrgica, la parálisis facial bilateral asociada a fracturas temporales supone un episodio infrecuente. Describimos el caso de un paciente de 38 años que sufre un traumatismo craneoencefálico severo (Glasgow Coma Scale de 7). En la TC inicial se apreció una fractura de peñasco longitudinal derecha y transversal izquierda. El paciente ingresó en la unidad de cuidados intensivos y, tras la extubación, se comprobó la existencia de una diplejía facial bilateral. El déficit bilateral del séptimo par craneal posee una etiología distinta al déficit unilateral. En estos casos, la ausencia de asimetría facial puede dificultar el diagnóstico, por lo que la TC de alta resolución y el estudio electromiográfico son útiles para su detección (AU)


Although traumatic injury of the facial nerve is a relatively common condition in neurosurgical practice, bilateral lesions related to fracture of temporal bones are seldom seen. Were port the case of a 38-year-old patient admitted to Intensive Care Unit after severe head trauma requiring ventilatory support (Glasgow Coma Scale of 7 on admission). A computed tomography (CT) scan confirmed a longitudinal fracture of the right temporal bone and a transversal fracture of the left. After successful weaning from respirator, bilateral facial paralysis was observed. The possible aetiologies for facial diplegia differ from those of unilateral injury. Due to the lack of facial asymmetry, it can be easily missed in critically ill patients, and both the high-resolution CT scan and electromyography studies can be helpful for correct diagnosis (AU)


Assuntos
Humanos , Masculino , Adulto , Paralisia Facial/etiologia , Traumatismos Craniocerebrais/complicações , Fratura da Base do Crânio/complicações , Traumatismos do Nervo Facial/complicações , Cuidados Críticos/métodos
15.
J Clin Neurosci ; 20(10): 1422-6, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23928040

RESUMO

Glioblastoma is the most common and aggressive type of primary brain tumor in adults. Average survival is approximately 1 year, but individual survival is heterogeneous. Using a single institutional experience, we have previously identified preoperative factors associated with survival and devised a prognostic scoring system based on these factors. The aims of the present study are to validate these preoperative factors and verify the efficacy of this scoring system using a multi-institutional cohort. Of the 334 patients in this study from three different institutions, the preoperative factors found to be negatively associated with survival in a Cox analysis were age >60 years (p<0.0001), Karnofsky Performance Scale score ≤80 (p=0.03), motor deficit (p=0.02), language deficit (p=0.04), and periventricular tumor location (p=0.04). Patients possessing 0-1, 2, 3, and 4-5 of these variables were assigned a preoperative grade of 1, 2, 3, and 4, respectively. Patients with a preoperative grade of 1, 2, 3, and 4 had a median survival of 17.9, 12.3, 10, and 7.5 months, respectively. Survival of each of these grades was statistically significant (p<0.05) in log-rank analysis. This grading system, based only on preoperative variables, may provide patients and physicians with prognostic information that may guide medical and surgical therapy before any intervention is pursued.


Assuntos
Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/cirurgia , Glioblastoma/mortalidade , Glioblastoma/cirurgia , Idoso , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Prognóstico , Reprodutibilidade dos Testes , Resultado do Tratamento
16.
Neurocirugia (Astur) ; 24(5): 225-8, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23541180

RESUMO

Although traumatic injury of the facial nerve is a relatively common condition in neurosurgical practice, bilateral lesions related to fracture of temporal bones are seldom seen. We report the case of a 38-year-old patient admitted to Intensive Care Unit after severe head trauma requiring ventilatory support (Glasgow Coma Scale of 7 on admission). A computed tomography (CT) scan confirmed a longitudinal fracture of the right temporal bone and a transversal fracture of the left. After successful weaning from respirator, bilateral facial paralysis was observed. The possible aetiologies for facial diplegia differ from those of unilateral injury. Due to the lack of facial asymmetry, it can be easily missed in critically ill patients, and both the high resolution CT scan and electromyographic studies can be helpful for correct diagnosis.


Assuntos
Traumatismos Faciais/complicações , Paralisia Facial/etiologia , Adulto , Humanos , Masculino
17.
PLoS One ; 8(3): e58198, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23554877

RESUMO

INTRODUCTION: Glioblastoma is the most common primary malignant brain tumor, and is refractory to surgical resection, radiation, and chemotherapy. Human mesenchymal stem cells (hMSC) may be harvested from bone marrow (BMSC) and adipose (AMSC) tissue. These cells are a promising avenue of investigation for the delivery of adjuvant therapies. Despite extensive research into putative mechanisms for the tumor tropism of MSCs, there remains no direct comparison of the efficacy and specificity of AMSC and BMSC tropism towards glioma. METHODS: Under an IRB-approved protocol, intraoperative human Adipose MSCs (hAMSCs) were established and characterized for cell surface markers of mesenchymal stem cell origin in conjunction with the potential for tri-lineage differentiation (adipogenic, chondrogenic, and osteogenic). Validated experimental hAMSCs were compared to commercially derived hBMSCs (Lonza) and hAMSCs (Invitrogen) for growth responsiveness and glioma tropism in response to glioma conditioned media obtained from primary glioma neurosphere cultures. RESULTS: Commercial and primary culture AMSCs and commercial BMSCs demonstrated no statistically significant difference in their migration towards glioma conditioned media in vitro. There was statistically significant difference in the proliferation rate of both commercial AMSCs and BMSCs as compared to primary culture AMSCs, suggesting primary cultures have a slower growth rate than commercially available cell lines. CONCLUSIONS: Adipose- and bone marrow-derived mesenchymal stem cells have similar in vitro glioma tropism. Given the well-documented ability to harvest larger numbers of AMSCs under local anesthesia, adipose tissue may provide a more efficient source of MSCs for research and clinical applications, while minimizing patient morbidity during cell harvesting.


Assuntos
Tecido Adiposo/metabolismo , Células da Medula Óssea/metabolismo , Diferenciação Celular , Movimento Celular , Glioma/metabolismo , Células-Tronco Mesenquimais/metabolismo , Tecido Adiposo/patologia , Células da Medula Óssea/patologia , Linhagem Celular , Técnicas de Cocultura , Feminino , Glioma/patologia , Humanos , Masculino , Células-Tronco Mesenquimais/patologia , Especificidade de Órgãos
18.
J Hist Neurosci ; 22(1): 96-115, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23323535

RESUMO

The evolution of techniques to manage patients with head injuries has served as the basis for the treatment of other neurosurgical disorders, including brain tumors, intracranial infections, and cerebrovascular disease. In the nineteenth century, advances in anesthesia, asepsis, and cerebral localization slowly took hold and created the groundwork for modern neurosurgery. To better understand the advances in the treatment of brain injuries in the late 1800s and early 1900s, we examine relevant historical literature and, through the courtesy of the Alan Mason Chesney Medical Archives, we review Dr. Harvey Cushing's patient records (1898-1909) in the Johns Hopkins Hospital surgical archives. The original case histories of 10 patients (6 in detail) who suffered head injuries and underwent treatment by Cushing illustrate some of Cushing's early attempts at intracranial surgery. We also examine the influences on Cushing as he developed into a leader in the new era of modern neurosurgery.


Assuntos
Traumatismos Craniocerebrais/história , Medicina Militar/história , Neurocirurgia/história , Procedimentos Neurocirúrgicos/história , Baltimore , Traumatismos Craniocerebrais/cirurgia , Europa (Continente) , História do Século XVII , História do Século XVIII , Humanos , I Guerra Mundial
19.
Neurol Res ; 35(2): 206-11, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23336127

RESUMO

OBJECTIVE: The development of venothromboembolisms (VTEs), including deep vein thrombosis (DVT) and pulmonary emboli (PE), is common in brain tumor patients. Their development can be catastrophic. Studies evaluating pre-operative clinical factors that predispose patients to the development of VTE are few and limited. An understanding may help risk stratify patients and guide subsequent therapy aimed at reducing the risk of DVTs/PEs. METHODS: All adult patients who underwent surgery for an intracranial tumor at an academic tertiary care institution between 1998 and 2008 were retrospectively reviewed. Stepwise multivariate logistical regression analysis was used to identify pre-operative factors associated with the development of peri-operative (within 30 days of surgery) DVTs/PEs among patients who underwent surgery of their intracranial tumor. RESULTS: Of the 4293 patients in this study, 126 (3%) patients developed DVT and/or PE in the peri-operative period. The pre-operative factors independently associated with the development of DVTs/PEs were: poorer Karnofsky performance scale (KPS) [odds ratio (OR), 1·040; 95% confidence interval (CI), 1·026-1·052; P<0·0001], high grade glioma (OR, 1·702; 95% CI, 1·176-2·465; P = 0·005), older age (OR, 1·033; 95% CI, 1·020-1·046; P<0·0001), hypertension (OR, 1·785; 95% CI, 1·180-2·699; P = 0·006), and motor deficit (OR, 1·854; 95% CI, 1·244-2·763; P = 0·002). Eighty six per cent of the patients with DVTs/PEs were treated with either unfractionated or low molecular weight heparin, and 4% of these patients developed intracranial hemorrhage. DISCUSSION: The present study found that poorer functional status, older age, pre-operative motor deficit, high grade glioma, and hypertension each independently increased the risk of developing peri-operative DVTs/PEs. These findings may provide patients and physicians with prognostic information that may guide therapies aimed at minimizing the development of peri-operative DVTs/PEs.


Assuntos
Neoplasias Encefálicas/cirurgia , Craniotomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Embolia Pulmonar/epidemiologia , Trombose Venosa/epidemiologia , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Neoplasias Encefálicas/complicações , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Embolia Pulmonar/complicações , Embolia Pulmonar/tratamento farmacológico , Fatores de Risco , Trombose Venosa/complicações , Trombose Venosa/tratamento farmacológico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA