Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 18 de 18
Filtrar
1.
BMJ Case Rep ; 14(8)2021 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-34429290

RESUMO

Penetrating trauma due to nail gun is an uncommon yet important clinical entity. There are numerous case reports describing these injuries, yet few describe those resulting in cerebrovascular injury. Laceration of cerebral blood vessels may result in significant intracranial haemorrhage and cerebral ischaemia, with catastrophic consequences. In the present study, we report a female patient who was shot in the face with a nail gun in a domestic assault. The nail entered her right cavernous sinus and lacerated her right internal carotid artery causing a pseudoaneurysm and a caroticocavernous fistula. This report details the approach to, and pitfalls of, managing a cerebrovascular injury due to penetrating intracranial nail. Catheter cerebral angiography is essential in the diagnosis and treatment of these injuries. Best treatment and outcomes require clinicians with expertise in endovascular and surgical repair strategies.


Assuntos
Falso Aneurisma , Fístula Carotidocavernosa , Traumatismos Craniocerebrais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/etiologia , Fístula Carotidocavernosa/cirurgia , Angiografia Cerebral , Feminino , Humanos
2.
J Clin Neurosci ; 91: 243-248, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34373035

RESUMO

The study aimed to determine how much change in neurogenic claudication spinal surgeons expect in patients following lumbar decompression for lumbar spine stenosis (LSS), and radicular leg pain following microdiscectomy. Secondary aims were to identify surgeons' preferences regarding surgical techniques for lumbar decompression, and their rating of the quality of current evidence for lumbar decompression. All Australian spine surgeons were invited, of whom 71 completed the survey (31% response rate). Only registered spinal surgeons were included. The online survey, administered using REDCap, included 4 sections: demographics and background; expected change in symptoms on a +/- 100% scale (-100% worst, 0% no change and 100% best possible); surgical preference; and rating of current evidence for lumbar decompression compared with other treatments. There were 71 complete responses, 76% were neurosurgeons (N = 54), predominantly male (96%; N = 68). On average, surgeons expected an 86% (median: 87%, inter-quartile range (IQR): 80%, 91%) improvement in neurogenic claudication following lumbar decompression for LSS and 89% (median: 91%, IQR: 85%, 95%) improvement in radicular pain following microdiscectomy. A multiple linear regression found no surgeon characteristics were associated with expected change following surgery. The preferred surgical technique for LSS was full laminectomy (58%; N = 41). Thirty-five percent of surgeons accurately rated the evidence supporting the superiority of lumbar decompression compared with non-surgical care for LSS as low quality. Spine surgeons expect large symptom improvements following lumbar decompression and microdiscectomy. Understanding of the current evidence was higher for lumbar decompression with fusion, than for decompression alone for LSS.


Assuntos
Descompressão Cirúrgica , Estenose Espinal , Austrália , Dor nas Costas , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Neurocirurgiões , Procedimentos Neurocirúrgicos , Estenose Espinal/cirurgia , Resultado do Tratamento
4.
ANZ J Surg ; 91(6): 1226-1232, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33021022

RESUMO

BACKGROUND: To clinically evaluate 3D print-formed implant process, using cranioplasty as a proof of concept, to examine its effectiveness and utility as a method of intraoperative implant fabrication. METHODS: Twelve patients had a 3D print-formed template created for patient-specific implant manufacture. Of these patients, 10 received intraoperatively formed polymethylmethacrylate cranioplasty implants between 2013 and 2019. The 3D print-formed implant templates produced to manufacture these patient-specific implants were generated using patient computed tomography scans and 3D printed using fused deposition modelling technology. Cosmetic and functional results were determined by participating surgeons, in conjunction with a patient questionnaire. RESULTS: The functional results and stability of the implants were deemed to be favourable by participating surgeons. Three of the 10 patients completed a post-cranioplasty survey, all of whom judged their cosmetic results as good or excellent. At time of writing, the rate of surgical revision was zero and without clinically adverse outcomes. CONCLUSIONS: 3D print-formed implants are an effective method of patient-specific implant formation.


Assuntos
Impressão Tridimensional , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Polimetil Metacrilato , Próteses e Implantes , Crânio/diagnóstico por imagem , Crânio/cirurgia
5.
Spine J ; 21(3): 455-464, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33122056

RESUMO

OBJECTIVE: The aim of the review was to appraise clinical practice guidelines and their recommendations for the treatment of lumbar spinal stenosis. METHODS: PubMed, Medline, CINAHL, Embase, and Cochrane Central Register of Controlled Trials were searched up until 25/01/2020 for clinical practice guidelines on the management of lumbar spinal stenosis with a systematic process to generate recommendations and were publicly available. RESULTS: Ten guidelines were included, with a total of 76 recommendations for the treatment of lumbar spinal stenosis. Only 4 of the 10 guidelines were of satisfactory methodological quality according to the AGREE II instrument. Around three-quarters of recommendations (72.4%) were presented with poor evidence, with the remaining 21 presenting (27.6%) fair evidence. No recommendation presented good evidence. Recommendations were made on four types of interventions: surgery, injections, medications, and other nonsurgical treatments, with supporting evidence similar for all four treatment types. Positive recommendations were more common for injections (12/13=92.3%) and surgery (10/15=66%) than for nonsurgical treatments (6/21=28.6%) or medications (1/27=3.75%). CONCLUSIONS: Ten guidelines on the management of lumbar spinal stenosis were identified in the systematic review, but only four were of adequate methodological quality. While the evidence underpinning the various types of interventions was similar, guidelines tended to endorse surgery and injections but not nonsurgical interventions and medicines. These results support the need for greater rigor and inclusion of steps to minimize bias in the production of guidelines.

6.
Spine J ; 19(8): 1378-1396, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30986579

RESUMO

BACKGROUND CONTEXT: Selecting a walking outcome measure for neurogenic claudication requires knowledge of its measurement properties. PURPOSE: To systematically review and appraise the literature on the measurement properties of walking outcome measures for patients with neurogenic claudication. STUDY DESIGN: A systematic review and meta-analysis. METHODS: A systematic search was conducted on the following seven databases: PubMed, PsychINFO, Web of Science, Embase, CINAHL, MEDLINE, and Cochrane Central Register of Controlled Trials. Clinical studies that assessed a measurement property of a walking outcome measure for patients with neurogenic claudication were selected. The methodological quality of studies was assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. Measurement property results were assessed using the adapted criteria from Terwee et al. (2007). RESULTS: Twelve studies that evaluated 15 separate walking outcome measures were included. Out of the 12 studies included, half had poor methodological quality. Four measures had acceptable test-retest reliability: the self-paced walking test (intraclass correlation coefficient, or ICC was 0.98, 95% CI: 0.95-0.99), Physical Function Scale (PFS) (pooled analysis ICC = 0.79, 95% CI: 0.77-0.89), PFS walk item (ICC = 0.81, 95% CI: 0.68-0.89), and Oswestry Disability Index (ODI) walk item (ICC = 0.86, 95% CI: 0.76-0.92). Responsiveness was assessed on five walking outcome measures, and three had adequate responsiveness: the ODI walk item (Area under the Curve, or AUC, was 0.76, SD 0.15), Treadmill test (AUC = 0.70), and PFS (AUC = 0.77, SD 0.14). A meta-analysis demonstrated the PFS had adequate test retest reliability (pooled ICC = 0.79, 95% CI: 0.77-0.89) and internal consistency (pooled Cronbach's αlpha (α) = 0.84, 95% CI: 0.81-0.86), but not criterion validity (pooled correlation coefficient = -0.59, 95% CI: -0.71, -0.45). Measures that recorded adequate criterion validity were the ODI walk item (pooled correlation coefficient = -0.71, 95% CI: -0.80, -0.58), Treadmill test (pooled correlation coefficient = 0.86, 95% CI: 0.78-0.91), and self predicted walking item (pooled correlation coefficient = 0.74, 95% CI: 0.63-0.82). CONCLUSIONS: The results of our systematic review demonstrated that high-quality studies that asses the measurement properties of walking outcome measures for patients with neurogenic claudication are lacking. There was only limited evidence available for each walking measure, which prevented any single outcome from being confirmed as the gold standard measure of neurogenic claudication. Clinicians and researchers are recommended to use the self-paced walking test and ODI walk item until further evidence is available. Future research should focus on producing high-quality studies with excellent methodology and larger sample sizes.


Assuntos
Estenose Espinal/diagnóstico , Caminhada , Ensaios Clínicos Controlados como Assunto , Teste de Esforço/normas , Humanos , Avaliação de Resultados em Cuidados de Saúde , Reprodutibilidade dos Testes , Estenose Espinal/terapia
7.
J Neurosurg ; 115(6): 1236-41, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21888476

RESUMO

OBJECT: Routine postoperative admission to the intensive care unit (ICU) is often considered a necessity in the treatment of patients following elective craniotomy but may strain already limited resources and is of unproven benefit. In this study the authors investigated whether routine postoperative admission to a regular stepdown ward is a safe alternative. METHODS: Three hundred ninety-four consecutive patients who had undergone elective craniotomy over 54 months at a single institution were retrospectively analyzed. Indications for craniotomy included tumor (257 patients) and transsphenoidal (63 patients), vascular (31 patients), ventriculostomy (22 patients), developmental (13 patients), and base of skull conditions (8 patients). Recorded data included age, operation, reason for ICU admission, medical emergency team (MET) calls, in-hospital mortality, and postoperative duration of stay. RESULTS: Three hundred forty-three patients were admitted to the regular ward after elective craniotomy, whereas there were 43 planned and 8 unplanned ICU admissions. The most common reasons for planned ICU admissions were anticipated lengthy operations (42%) and anesthetic risks (40%); causes for unplanned ICU admissions were mainly unexpected slow neurological recovery and extensive intraoperative blood loss. Of the 343 regular ward admissions, 10 (3%) required a MET call; only 3 of these MET calls occurred within the first 48 postoperative hours and did not lead to an ICU admission. The overall mortality rate in the investigated cohort was 1%, with no fatalities in patients admitted to the normal ward postoperatively. CONCLUSIONS: Routine ward admission for patients undergoing elective craniotomies with selective ICU admission appears safe; however, approximately 2% of patients may require a direct postoperative unplanned ICU admission. Patients with anticipated long operation times, extensive blood loss, and high anesthetic risks should be selected for postoperative ICU admission, but further study is needed to determine the preoperative factors that can aid in identifying and caring for these groups of patients.


Assuntos
Craniotomia/mortalidade , Procedimentos Cirúrgicos Eletivos/mortalidade , Unidades de Terapia Intensiva/normas , Avaliação de Resultados em Cuidados de Saúde , Cuidados Pós-Operatórios/normas , Complicações Pós-Operatórias/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Clínicos/normas , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
8.
J Clin Neurosci ; 17(2): 163-7, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20056420

RESUMO

The recent increase in implementation of evidence-based medicine in neurosurgery has led to an increase in awareness of the importance of meta-analysis. An integral component of meta-analysis is the test of heterogeneity. This test examines whether the apparent differences between the studies are significant enough to bias the outcome and conclusion of the meta-analysis. The author has examined four different tests of heterogeneity available in the scientific literature for binary data. In the context of neurosurgical data, the author found that Pearson's test was the most accurate in terms of Type I and Type II errors, as well as "goodness-of-fit" between the empirical distribution and approximate chi-squared distribution. Moreover, its ease of computation made this test a highly favorable test to be used in neurosurgical data analysis.


Assuntos
Medicina Baseada em Evidências/métodos , Metanálise como Assunto , Neurocirurgia/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Interpretação Estatística de Dados , Humanos , Matemática/métodos , Neurocirurgia/estatística & dados numéricos , Complicações Pós-Operatórias , Reprodutibilidade dos Testes , Distribuições Estatísticas
9.
Neurosurgery ; 62 Suppl 2: 614-21, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18596443

RESUMO

OBJECTIVE: To describe the short-term operative success and the long-term reliability of endoscopic third ventriculostomy (ETV) for treatment of hydrocephalus and to examine the influence of diagnosis, age, and previous shunt history on these outcomes. METHODS: We retrospectively analyzed 203 consecutive patients from a single institution who had ETV as long as 22.6 years earlier. Patients with hydrocephalus from aqueduct stenosis, myelomeningocele, tumors, arachnoid cysts, previous infection, or hemorrhage were included. RESULTS: The overall probability of successfully performing an ETV was 89% (84-93%). There was support for an association between the surgical success and the individual operating surgeon (odds ratios for success, 0.44-1.47 relative to the mean of 1.0, P = 0.08). We observed infections in 4.9%, transient major complications in 7.2%, and major and permanent complications in 1.1% of 203 procedures. Age was strongly associated with long-term reliability. The longest observed reliability for the 13 patients 0 to 1 month old was 3.5 years. The statistical model predicted the following reliability at 1 year after insertion: at 0 to 1 month of age, 31% (14-53%); at 1 to 6 months of age, 50% (32-68%); at 6 to 24 months of age, 71% (55-85%); and more than 24 months of age, 84% (79-89%). There was no support for an association between reliability and the diagnostic group (n = 181, P = 0.168) or a previous shunt. Sixteen patients had ETV repeated, but only 9 were repeated after at least 6 months. Of these, 4 procedures failed within a few weeks, and 2 patients were available for long-term follow-up. CONCLUSION: Age was the only factor statistically associated with the long-term reliability of ETV. Patients less than 6 months old had poor reliability.

10.
J Clin Neurosci ; 13(7): 759-62, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16904895

RESUMO

We previously reported 52 patients with hydrocephalus who were followed up after insertion of low-pressure Novus valves. These valves have a normally open anti-siphon device (ASD) incorporated. There were no cases of subdural haematomas (SDH). Subsequently, three new patients suffered SDH after insertion of these valves. We investigated a simple method for intra-operative testing of the ASD. These new patients had their valves replaced. In the laboratory, flow rates through five valves were recorded as a function of proximal positive pressure and distal negative pressures (siphoning). The flow rates were influenced by both proximal positive and distal negative pressures. The ASD stopped flow at distal negative pressures between -40 and -60 cm H(2)O. Proximal positive pressures increased this threshold. The flow can be measured by counting drops per minute. Three valves removed from patients were functioning as expected, one had unexpectedly slow flow at very high siphoning pressure and one had unexpectedly slow flow rates. In three patients with SDH complicating low-pressure Novus valves, the valves and anti-siphon devices were functioning adequately. Using a simple device, measuring flow rates in drops per minute was reliable and reproducible.


Assuntos
Derivações do Líquido Cefalorraquidiano/instrumentação , Hematoma Subdural/fisiopatologia , Pressão Intracraniana/fisiologia , Procedimentos Neurocirúrgicos/instrumentação , Desenho de Equipamento , Hematoma Subdural/cirurgia , Humanos , Hidrocefalia/cirurgia , Procedimentos Neurocirúrgicos/métodos
12.
Neurosurgery ; 56(6): 1271-8; discussion 1278, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15918943

RESUMO

OBJECTIVE: To describe the short-term operative success and the long-term reliability of endoscopic third ventriculostomy (ETV) for treatment of hydrocephalus and to examine the influence of diagnosis, age, and previous shunt history on these outcomes. METHODS: We retrospectively analyzed 203 consecutive patients from a single institution who had ETV as long as 22.6 years earlier. Patients with hydrocephalus from aqueduct stenosis, myelomeningocele, tumors, arachnoid cysts, previous infection, or hemorrhage were included. RESULTS: The overall probability of successfully performing an ETV was 89% (84-93%). There was support for an association between the surgical success and the individual operating surgeon (odds ratios for success, 0.44-1.47 relative to the mean of 1.0, P = 0.08). We observed infections in 4.9%, transient major complications in 7.2%, and major and permanent complications in 1.1% of 203 procedures. Age was strongly associated with long-term reliability. The longest observed reliability for the 13 patients 0 to 1 month old was 3.5 years. The statistical model predicted the following reliability at 1 year after insertion: at 0 to 1 month of age, 31% (14-53%); at 1 to 6 months of age, 50% (32-68%); at 6 to 24 months of age, 71% (55-85%); and more than 24 months of age, 84% (79-89%). There was no support for an association between reliability and the diagnostic group (n = 181, P = 0.168) or a previous shunt. Sixteen patients had ETV repeated, but only 9 were repeated after at least 6 months. Of these, 4 procedures failed within a few weeks, and 2 patients were available for long-term follow-up. CONCLUSION: Age was the only factor statistically associated with the long-term reliability of ETV. Patients less than 6 months old had poor reliability.


Assuntos
Endoscopia , Hidrocefalia/cirurgia , Terceiro Ventrículo/cirurgia , Ventriculostomia/métodos , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/mortalidade , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Modelos Estatísticos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
13.
JAMA ; 293(13): 1644-52, 2005 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-15811984

RESUMO

CONTEXT: Compensation, whether through workers' compensation or through litigation, has been associated with poor outcome after surgery; however, this association has not been examined by meta-analysis. OBJECTIVE: To investigate the association between compensation status and outcome after surgery. DATA SOURCES: We searched MEDLINE (1966-2003), EMBASE (1980-2003), CINAHL, the Cochrane Controlled Trials Register, and reference lists of retrieved articles and textbooks, and we contacted experts in the field. STUDY SELECTION: The review included any trial of surgical intervention in which compensation status was reported and results were compared according to that status. No restrictions were placed on study design, language, or publication date. Studies were selected by 2 unblinded independent reviewers. DATA EXTRACTION: Two reviewers independently extracted data on study type, study quality, surgical procedure, outcome, country of origin, length and completeness of follow-up, and compensation type. DATA SYNTHESIS: Two hundred eleven studies satisfied the inclusion criteria. Of these, 175 stated that the presence of compensation (workers' compensation with or without litigation) was associated with a worse outcome, 35 found no difference or did not describe a difference, and 1 described a benefit associated with compensation. A meta-analysis of 129 studies with available data (n = 20,498 patients) revealed the summary odds ratio for an unsatisfactory outcome in compensated patients to be 3.79 (95% confidence interval, 3.28-4.37 by random-effects model). Grouping studies by country, procedure, length of follow-up, completeness of follow-up, study type, and type of compensation showed the association to be consistent for all subgroups. CONCLUSIONS: Compensation status is associated with poor outcome after surgery. This effect is significant, clinically important, and consistent. Because data were obtained from observational studies and were not homogeneous, the summary effect should be interpreted with caution. Compensation status should be considered a potential confounder in all studies of surgical intervention. Determination of the mechanism for this association requires further study.


Assuntos
Compensação e Reparação , Avaliação de Resultados em Cuidados de Saúde , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Indenização aos Trabalhadores , Humanos , Responsabilidade Legal
14.
Neurosurg Focus ; 17(5): E8, 2004 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-15633985

RESUMO

OBJECT: Individuals with unruptured intracranial aneurysms experience a higher rate of rupture if their history includes another aneurysm that has previously bled. The authors used systematic review and metaregression to estimate the annual rate of development of second de novo aneurysms after subarachnoid hemorrhage. METHODS: This investigation included studies in which more than 300 patients with intracranial aneurysms were described, and in which the age of the patients and the proportion with multiple aneurysms were documented. Studies describing delayed follow-up angiography that was performed after treatment of aneurysms were also reviewed. Twenty studies were included in a between-study analysis. The univariate odds ratio (OR) for multiple intracranial aneurysms per year of age was 1.085 (95% confidence interval [CI] 1.015-1.165); this value was calculated using a hierarchical model for between-study heterogeneity. Five studies were included that provided age stratification. The estimated OR for multiple intracranial aneurysms per year was 1.011 (95% CI 1.005-1.018). Four follow-up studies were available. CONCLUSIONS: According to the three different approaches (study-level, patient-level, and follow-up analyses), the estimated annual rates of development of de novo aneurysms were 1.62% (95% CI 0.28-3.59%), 0.28% (95% CI 0.12-0.49%), and 0.92% (95% CI 0.64-1.25%), respectively. The estimated annual rate of development of second de novo aneurysms ranged from 0.28 to 1.62%.


Assuntos
Angiografia Cerebral/estatística & dados numéricos , Aneurisma Intracraniano/epidemiologia , Intervalos de Confiança , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Razão de Chances , Análise de Regressão , Fatores de Risco , Estatística como Assunto
15.
Neurosurg Focus ; 17(5): E9, 2004 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-15633986

RESUMO

OBJECT: The goal in this study was to develop an interactive, probabilistic decision-analysis system for clinical use in the decision to treat or observe unruptured intracranial aneurysms. Further goals were to enable users of the system to adapt decision-analysis methods to individual patients and to provide a tool for interactive sensitivity analysis. METHODS: A computer program was designed to model the outcomes of treatment and observation of unruptured aneurysms. The user supplies probabilistic estimates of key parameters relating to a specific patient and nominates discount rate and quality of life adjustments. The program uses Monte Carlo discrete-event simulation methods to derive probability estimates of the outcomes of treatment and observation. Results are expressed as summary statistics and graphs. Discounted quality-adjusted life years are graphed using survival methods. Hierarchical simulations are used to enable investigators to perform probabilistic sensitivity analysis for one or multiple parameters simultaneously. The results of sensitivity analysis are expressed in graphs and as the expected value of perfect information. The system can be distributed and updated using the Internet. CONCLUSIONS: Further research is required into the benefits of clinical application of this system. Further research is also required into the optimum level of complexity of the model, into the user interface, and into how clinicians and patients are likely to interpret results. The system is easily adaptable to a range of medical decision analyses.


Assuntos
Técnicas de Apoio para a Decisão , Aneurisma Intracraniano , Intervalos de Confiança , Árvores de Decisões , Humanos , Aneurisma Intracraniano/epidemiologia , Aneurisma Intracraniano/terapia , Método de Monte Carlo
16.
Neurosurgery ; 53(3): 597-605; discussion 605-6, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12943576

RESUMO

OBJECTIVE: This study examined the efficacy of computed tomographic angiography (CTA) for detection of ruptured and unruptured aneurysms after adjustment for their size distributions under various conditions of aneurysm prevalence. METHODS: A systematic review was used to estimate 1) the aneurysm size-specific sensitivity and specificity of CTA, and 2) the size distributions of ruptured and unruptured aneurysms. Probabilistic computer simulation was used to estimate the efficacy of CTA in the detection of aneurysms. RESULTS: The sensitivity of CTA ranged from 53% (95% confidence interval [CI], 44-62%) for 2-mm aneurysms to 95% (95% CI, 92-97%) for 7-mm aneurysms. The overall specificity was 98.9% (95% CI, 91.5-99.99%), but there was between-study heterogeneity. The estimated negative likelihood ratios for ruptured, unruptured, and at least 6-mm unruptured aneurysms were 0.081, 0.18, and 0.012, respectively. The positive likelihood ratio for CTA was sensitive to the pretest probability, the size of the positive finding, and the clinical context. With a small pretest probability, the positive likelihood ratio for unruptured aneurysms ranged from 15 for 2-mm aneurysms to 61 for 5-mm aneurysms. The positive likelihood ratio for ruptured aneurysms with an intermediate pretest probability (50%) ranged from 3.9 to 56 for 2- to 5-mm aneurysms. CONCLUSION: Small aneurysms detected on CTA should be investigated further unless there is a high pretest probability of a ruptured aneurysm. During screening for ruptured aneurysms, a negative CTA should be investigated further. During screening for unruptured aneurysms, a negative CTA results in a very low probability of a clinically important aneurysm.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Angiografia Cerebral/estatística & dados numéricos , Aneurisma Intracraniano/diagnóstico por imagem , Funções Verossimilhança , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Estudos de Avaliação como Assunto , Humanos , Modelos Logísticos , Metanálise como Assunto , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
17.
Neurosurgery ; 51(5): 1101-5; discussion 1105-7, 2002 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-12383354

RESUMO

OBJECTIVE: To estimate the proportion of patients with aneurysmal subarachnoid hemorrhage (SAH) who die before receiving medical attention. METHODS: We performed a systematic literature review. RESULTS: Eighteen population-based studies between 1965 and 2001 described the incidence of death from SAH before the patients received medical attention. The combined overall risk of sudden death was 12.4% (95% confidence interval, 11-14%). Patient level analysis was possible for two studies. No significant association between age and sudden death was identified. Aneurysms in the posterior circulation had an estimated probability of sudden death of 44.7% (95% confidence interval, 7.4-86%). Statistical sensitivity analysis was performed to examine some possible causes for the heterogeneity between the studies. Study factors statistically associated with a higher rate of sudden death include origin in England, computed tomographic scans not available for diagnosis, inclusion of patients with SAH from arteriovenous malformations, lower or not stated rate of autopsy for deaths in the community, and a higher rate of patients with confirmed aneurysms. CONCLUSION: The combined overall estimated risk of sudden death was 12.4% for aneurysmal SAH and 44.7% for posterior circulation aneurysms. However, there are several sources of heterogeneity or possible bias in the reported studies. Further information on patient and aneurysm characteristics is required.


Assuntos
Aneurisma Roto/complicações , Morte Súbita/etiologia , Aneurisma Intracraniano/complicações , Morte Súbita/epidemiologia , Humanos , Incidência , Probabilidade
18.
J Clin Neurosci ; 9(5): 539-43, 2002 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12383411

RESUMO

PURPOSE: The low pressure Novus valve is a pressure differential valve with a normally open siphon control mechanism. This study evaluates our experience with this valve in adult hydrocephalus and is the first published clinical review of the Novus valve. PATIENTS AND METHODS: From June 1999, we prospectively inserted low pressure Novus valves in all patients requiring new ventriculoperitoneal and ventriculoatrial shunts and requiring shunt valve revision. In December 2000, 52 patients were retrospectively reviewed. RESULTS: The major causes of hydrocephalus were intracranial haemorrhage (18), tumour (10), normal pressure hydrocephalus (10) and trauma (9). Forty one procedures were first shunts and eleven were revisions. The Novus valve was revised once. Complications include one infection and one sudden death from cerebral haemorrhage. No patients developed overdrainage symptoms or subdural haematomas. There were large improvements in symptoms. Ninety-three percent of the patients reported an improvement in daily function and quality of life. The remaining 7% reported no change, despite improvements in symptoms. CONCLUSIONS: The Novus low pressure valve is an effective first choice of valve for adult hydrocephalus.


Assuntos
Derivações do Líquido Cefalorraquidiano/instrumentação , Hidrocefalia/cirurgia , Procedimentos Neurocirúrgicos/instrumentação , Atividades Cotidianas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ventrículos Cerebrais/cirurgia , Derivações do Líquido Cefalorraquidiano/efeitos adversos , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Hidrocefalia de Pressão Normal/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Qualidade de Vida , Radiografia , Reoperação , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...