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1.
BMC Pregnancy Childbirth ; 22(1): 14, 2022 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-34986833

RESUMO

BACKGROUND: Coronavirus Disease 2019 (COVID-19) is predominately known as a respiratory disease associated with pneumonia, acute respiratory distress syndrome and multiorgan failure. However, extra-pulmonary complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly being recognized. In this regard, some studies implied the hemostatic and vascular involvements in patients with SARS-CoV-2 infection. CASE PRESENTATION: We describe a case of spontaneous Intracerebral Hemorrhage (ICH) in a pregnant patient with COVID-19 and history of cesarean section a week before the occurrence of ICH. The patient underwent emergent craniotomy with acceptable outcome. Hemorrhagic events, including ICH, may happen during COVID-19 infection with several possible mechanisms. CONCLUSION: COVID-19 patients, especially high-risk groups, are at a risk of intracranial hemorrhage. Therefore, close follow-up must be maintained and hemorrhagic events must be kept in mind in these cases.


Assuntos
COVID-19/complicações , Hemorragia Cerebral/virologia , Complicações Cardiovasculares na Gravidez/virologia , Complicações Infecciosas na Gravidez , SARS-CoV-2 , Adulto , Hemorragia Cerebral/patologia , Hemorragia Cerebral/cirurgia , Craniotomia , Cuidados Críticos , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/patologia , Complicações Cardiovasculares na Gravidez/cirurgia , Complicações Infecciosas na Gravidez/virologia , Resultado do Tratamento
2.
J Craniofac Surg ; 33(1): 279-283, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34967525

RESUMO

OBJECTIVE: To explore the clinical value of bilateral balanced frontotemporoparietal decompressive craniectomy (bbDC) in severe diffuse traumatic brain injury by comparison to the unilateral frontotemporoparietal decompressive craniectomy (uDC). MATERIALS AND METHODS: Twenty three patients with severe diffuse traumatic brain injury from April 2015 to December 2019 were selected, including 10 cases underwent bbDC (bilateral group) and 13 cases underwent uDC (unilateral group). Compared with the postsurgical intracranial pressure (ICP), cerebral perfusion pressure, cerebral blood flow volume, postsurgical imaging score, the occurrence of complications as well as the 6 month outcome (Glasgow Outcome Scale, GOS) of two groups. RESULTS: 1. The postsurgical ICP was lower in the bbDC group than in the uDC group, while the postsurgical CCP and cerebral blood flow volume were higher in the bbDC group than in the uDC group. 2. Postsurgical imaging scores of the bbDC group were lower, indicating that the decompression effect of bbDC was more exhaustive than that of the uDC group. 3. The incidence of intraoperative acute cerebral bulging was lower in bbDC group than in uDC group. 4. The bbDC could effectively reduce the proportion of patients with the worst prognosis (dead+vegetative state). CONCLUSION: For patients with severe, diffuse traumatic brain injury combined with bilateral or unilateral pupil dilation, bilateral balanced decompression craniotomy is an effective method, which should be performed as soon as possible. As compared to unilateral decompression, the decompression effect on the brainstem is more thorough; the incidence of acute cerebral bulging, postoperative incisional hernia, and postoperative cerebral infarction involving a large area are reduced. ICP can be better controlled, cerebral perfusion pressure and cerebral blood flow increases, improving the patient's survival rate, quality of life, and prognosis.


Assuntos
Lesões Encefálicas Traumáticas , Lesões Encefálicas , Craniectomia Descompressiva , Hipertensão Intracraniana , Lesões Encefálicas/cirurgia , Lesões Encefálicas Traumáticas/cirurgia , Craniotomia , Humanos , Hipertensão Intracraniana/cirurgia , Pressão Intracraniana , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
4.
J Neurosurg Anesthesiol ; 34(1): e1-e13, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31972627

RESUMO

Awake craniotomy (AC) is the preferred surgical option for intractable epilepsy and resection of tumors adjacent to or within eloquent cortical areas. Monitored anesthesia care (MAC) or an asleep-awake-asleep (SAS) technique is most widely used during AC. We used a random-effects modeled meta-analysis to synthesize the most recent evidence to determine whether MAC or SAS is safer and more effective for AC. We included randomized controlled trials and observational studies that explored the incidence of AC failure, duration of surgery, and hospital length of stay in adult patients undergoing AC. Eighteen studies were included in the final analysis. MAC was associated with a lower risk of AC failure when compared with SAS (global pooled proportion MAC vs. SAS 1% vs. 4%; odds ratio [ORs]: 0.28; 95% confidence interval [CI]: 0.11-0.71; P=0.007) and shorter surgical procedure time (global pooled mean MAC vs. SAS 224.44 vs. 327.94 min; mean difference, -48.76 min; 95% CI: -61.55 to -35.97; P<0.00001). SAS was associated with fewer intraoperative seizures (global pooled proportion MAC vs. SAS 10% vs. 4%; OR: 2.38; 95% CI: 1.05-5.39; P=0.04). There were no differences in intraoperative nausea and vomiting between the techniques (global pooled proportion MAC vs. SAS: 4% vs. 8%; OR: 0.86; 95% CI: 0.30-2.45; P=0.78). Length of stay was shorter in the MAC group (MAC vs. SAS 3.96 vs. 6.75 days; mean difference, -1.30; 95% CI: -2.69 to 0.10; P=0.07). In summary, MAC was associated with lower AC failure rates and shorter procedure time compared with SAS, whereas SAS was associated with a lower incidence of intraoperative seizures. However, there was a high risk of bias and other limitations in the studies included in this review, so the superiority of 1 technique over the other needs to be confirmed in larger randomized studies.


Assuntos
Anestesia , Neoplasias Encefálicas , Adulto , Neoplasias Encefálicas/cirurgia , Craniotomia , Humanos , Monitorização Fisiológica , Duração da Cirurgia , Vigília
5.
J Neurosurg Anesthesiol ; 34(1): e46-e51, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32482989

RESUMO

BACKGROUND: The role of high-field 3-Tesla intraoperative magnetic resonance imaging (I-MRI) during awake craniotomy (AC) has not been extensively studied. We report the feasibility and safety of AC during 3-Tesla I-MRI. METHODS: This retrospective descriptive report compared 3 groups: AC with minimal sedation and I-MRI; I-MRI-guided craniotomy under general anesthesia (GA), and; AC without I-MRI. Perioperative factors, surgical, anesthetic and radiologic complications, and postoperative morbidity and mortality were recorded. RESULTS: Overall, 85 patients are included in this report. Five of 23 patients (22%) who underwent AC with I-MRI had anesthetic complications (nausea/vomiting and conversion to GA) compared with 3 of 40 (8%) who underwent I-MRI-guided craniotomy under GA (nausea/vomiting during extubation, and arrhythmia). Intraoperative surgical complications (seizures and speech deficits) occurred in 5 patients (22%) who underwent AC and I-MRI, excessive intraoperative bleeding occurred in 2 patients (5%) who had I-MRI-guided craniotomy under GA, and 4 of 22 (18%) patients who underwent AC without I-MRI experienced neurological complications (seizures, motor deficits, and transient loss of consciousness). Eight patients (20%) who had I-MRI with GA had postoperative complications, largely neurological. The duration of surgery and anesthesia were shortest in the group of patients receiving AC without I-MRI. Seventy-three percent of the patients in this group had residual tumor postoperatively compared with 44% and 38% in those having I-MRI with AC or GA, respectively. Patients who underwent I-MRI-guided craniotomy with GA had the highest morbidity (8%) at hospital discharge. CONCLUSIONS: Our institutional experience suggests that AC under 3-Tesla I-MRI could be an option for glioma resection, although firm conclusions cannot be drawn given the limited and heterogenous nature of our data. Future multicenter trials comparing anesthetic and imaging modalities for glioma resection are recommended.


Assuntos
Neoplasias Encefálicas , Vigília , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Canadá , Craniotomia , Humanos , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Estudos Retrospectivos
6.
J Neurosurg Anesthesiol ; 34(1): 74-78, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33060551

RESUMO

BACKGROUND: During awake craniotomy, securing the patient's airway might be necessary electively or emergently. The objective of this study was to compare the feasibility of airway management using a laryngeal mask airway (LMA) and 4 alternative airway management techniques in an awake craniotomy simulation. METHODS: After completing a questionnaire, 9 anesthesia providers attempted airway management in a cadaver positioned to simulate awake craniotomy conditions. Following the simulation, participants rated and ranked the devices in their order of preference. RESULTS: Only 3 approaches resulted in the successful securement of an airway device for 100% of participants: LMA (median; interquartile range time to secure the airway 6 s, 5 to 10 s), fiberoptic bronchoscopy through an LMA (41 s; 23 to 51 s), and video laryngoscopy (49 s; 43 to 127 s). In contrast, the oral and nasal fiberoptic approaches demonstrated only 44.4% (154.5 s; 134.25 to 182 s) and 55.6% (75 s; 50 to 117 s) success rates, respectively. The LMA was the fastest and most reliable primary method to secure the airway (P=0.001). After the simulation, 100% of participants reported that an LMA would be their first choice for emergency airway management, followed by fiberoptic intubation through the LMA (7 of 9 participants) if the LMA failed to properly seat. CONCLUSIONS: We demonstrated that an LMA was the fastest and most reliable primary method to secure an airway in a laterally positioned cadaver with 3-pin skull fixation. Fiberoptic and video laryngoscope airway equipment should be readily available during awake craniotomy procedures, and an attempt to visualize the vocal cords through the LMA should be attempted before removing it for alternative techniques.


Assuntos
Máscaras Laríngeas , Vigília , Manuseio das Vias Aéreas , Cadáver , Craniotomia , Humanos , Intubação Intratraqueal
7.
BMJ Case Rep ; 14(12)2021 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-34969805

RESUMO

We present a case of syringomyelia following retrosigmoid craniectomy and resection of vestibular schwannoma complicated by Cerebrospinal fluid (CSF) leak, multiple infections and CSF diversion procedures. We believe this is the first reported case of syrinx formation after this type of surgery. Potential mechanisms by which the syrinx may have developed are discussed.


Assuntos
Neuroma Acústico , Siringomielia , Vazamento de Líquido Cefalorraquidiano , Craniotomia/efeitos adversos , Humanos , Neuroma Acústico/cirurgia , Siringomielia/diagnóstico por imagem , Siringomielia/etiologia , Siringomielia/cirurgia
8.
J Int Med Res ; 49(12): 3000605211062789, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34898308

RESUMO

OBJECTIVE: To explore the effects of sedation and analgesia with dexmedetomidine and other drugs on the stress response in patients with cerebral hemorrhage after craniotomy hematoma removal and bone flap decompression and insertion of an indwelling endotracheal catheter. METHODS: A total of 180 patients with cerebral hemorrhage with consciousness disturbance who underwent emergency surgery were included in this study. They were divided into six groups treated with propofol, dexmedetomidine, lidocaine, sufentanil, dezocine, and remifentanil, respectively. Intravenous medication was given after recovery of spontaneous respiration, and stress responses were compared among the group. RESULTS: Serum concentrations of norepinephrine, epinephrine, and cortisol and systolic blood pressure were significantly correlated with drug treatment. Serum norepinephrine concentrations differed significantly among the groups, except between the sufentanil and propofol groups. There were significant differences in serum epinephrine concentrations among all groups, and significant differences in serum cortisol concentrations among all groups, except the propofol, dexmedetomidine, and lidocaine groups. CONCLUSION: Dexmedetomidine can reduce the stress response in patients with intracerebral hemorrhage undergoing emergency craniotomy and bone flap decompression, and can reduce adverse events from an indwelling endotracheal catheter 3 hours post-operation.


Assuntos
Dexmedetomidina , Propofol , Analgésicos , Craniotomia , Descompressão , Dexmedetomidina/uso terapêutico , Humanos , Hipnóticos e Sedativos/uso terapêutico
9.
Medicine (Baltimore) ; 100(51): e28400, 2021 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-34941178

RESUMO

BACKGROUND: The purpose of this study was to evaluate the efficacy and safety of sevoflurane-remifentanil (SR) vs propofol-remifentanil (PR) as inhalation anesthesia or total intravenous anesthesia in patients undergoing craniotomy, respectively. METHODS: Electronic databases included PubMed, ScienceDirect, Embase, Cochrane library, CNKI, and Wanfang data were searched using suitable search items. Randomized clinical controlled trials comparing the combination of SR and PR as anesthetics for neurosurgery were included. The outcomes included wake-up time, spontaneous respiration time, extubation time, and safety. RESULTS: Seventeen studies were included in this meta-analysis. There were no statistically significant differences in wake-up time (P = .25, standardized mean difference (SMD) = 0.29, 95% CI -0.20 to 0.77), extubation time (P = .1, SMD = 0.52, 95% CI -0.11 to 1.14) and spontaneous respiration time (P = .58, SMD = 0.43, 95% CI -1.07 to 1.93) when patients with SF and PF for anesthesia maintenance. Moreover, the changes of hemodynamic parameters are similar between the 2 groups. During anesthesia maintenance, SF could significantly increase the incidence of hypotension and brain edema than PF (P = .02, SMD = 1.68, 95% CI 1.07 to 2.62; P < .0001, SMD = 3.37, 95% CI 1.86 to 6.12), PF markedly promoted the incidence of hypertension (P = .001, SMD = 0.55, 95% CI 0.39 to 0.79). The postoperative adverse reactions were similar between the 2 groups (P > .05), but the incidence of postoperative nausea and vomiting proved to be higher in SF group (P < .0001, SMD = 2.12, 95% CI 1.47 to 3.07). CONCLUSIONS: SR and PR as anesthetics in patients underwent craniotomy had similar effects, but PR was superior to SR in terms of safety of intraoperation and postoperation.


Assuntos
Analgésicos Opioides/uso terapêutico , Craniotomia , Propofol/uso terapêutico , Remifentanil/uso terapêutico , Sevoflurano/uso terapêutico , Analgésicos Opioides/efeitos adversos , Anestesia por Inalação/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Humanos , Propofol/efeitos adversos , Remifentanil/efeitos adversos , Sevoflurano/efeitos adversos
10.
Neurocirugia (Astur : Engl Ed) ; 32(6): 268-277, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34743824

RESUMO

INTRODUCTION AND OBJECTIVES: To determine the safety and efficacy of endoscopic keyhole surgery in patients with cerebellopontine angle tumours. MATERIALS AND METHODS: This was a retrospective study of patients with cerebellopontine angled tumours treated by fully endoscopic retrosigmoid keyhole approach in a tertiary centre during a period of four years. Preoperative, transoperative and postoperative variables were analysed. RESULTS: A number of 40 patients were included. The age average was 49.4 years and male/female proportion was 0.4-1. We found 31 vestibular schwannomas (77.5%), five meningiomas (12.5%), two cholesteatomas (5.0%) and two metastases (5.0%). Vestibular schwannomas Hannover type IIIb, IVa and IVb predominated. The surgical resection was total or near-total 92.5% of patients. Hearing preservation rate was 62.5% and acceptable facial function nerve function rate was 80% after six months. Hospital stay was 7.5 days. The total or near total resection and functionally preservation rate was high. Complications were unusual. CONCLUSIONS: Endoscopic retrosigmoid keyhole approach represented a safe and efficient procedure in selected patients with cerebellopontine angle tumours.


Assuntos
Neoplasias Meníngeas , Neuroma Acústico , Craniotomia , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/cirurgia , Estudos Retrospectivos
11.
Am J Case Rep ; 22: e933862, 2021 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-34731159

RESUMO

BACKGROUND Head trauma, defined as damage to the brain, skull, or scalp when the head is hit by an external force, is a major cause of mortality in military personnel. Therefore, we report a novel case involving a naval helicopter pilot who sustained a helicopter propeller rotor blade injury. CASE REPORT We describe a case involving a pilot struck on the head by a helicopter rotor blade. He received care from medical staff shortly after the injury and was en route to the nearest trauma center. Cranial computed tomography (CT) scans revealed a comminuted fracture of the right occipital bone, with bone fragment retention in the right cerebral hemispheres. We performed an emergency right occipital craniotomy. The visual field patterns demonstrated right homonymous hemianopia when the patient was discharged. The patient underwent delayed titanium mesh cranioplasty about 3 months after the right occipital craniotomy. From discharge to 5 years, the patient had performed rehabilitation exercise for at least 3 days every week. The patient's continued recovery was confirmed at the 5-year follow-up in 2019. The bilateral visual acuity was 20/20, and the right homonymous hemianopia problem also disappeared. In the same year, after a physical and psychological assessment by an aviation doctor, he was able to resume flying. CONCLUSIONS This report has shown that despite safety regulations for military and civilian helicopter personnel, which include the wearing of helmets, helicopter rotor blade injuries still occur and can have long-term consequences due to the severity of head injury.


Assuntos
Traumatismos Craniocerebrais , Pilotos , Adulto , Aeronaves , Traumatismos Craniocerebrais/etiologia , Craniotomia , Humanos , Masculino
12.
J Craniofac Surg ; 32(8): 2615-2620, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34727466

RESUMO

OBJECTIVES: Spring-mediated cranial vault expansion (SMC) may enable less invasive treatment of sagittal craniosynostosis than conventional methods. The influence of spring characteristics such as force, length, and quantity on cranial vault outcomes are not well understood. Using in vivo and ex vivo models, we evaluate the interaction between spring force, length, and quantity on correction of scaphocephalic deformity in patients undergoing SMC. METHODS: The authors retrospectively studied subjects with isolated sagittal craniosynostosis who underwent SMC between 2011 and 2019. The primary outcome measure of in vivo analysis was head shape determined by cephalic index (CI). Ex vivo experimentation analyzed the impact of spring length, bend, and thickness on resultant force. RESULTS: Eighty-nine subjects underwent SMC at median 3.4 months with median preoperative CI 69% (interquartile range: 66, 71%). Twenty-six and 63 subjects underwent SMC with 2 and 3 springs, with mean total force 20.1 and 27.6 N, respectively (P < 0.001).Postoperative CI increased from 71% to 74% and 68% to 77% in subjects undergoing 2- and 3-spring cranioplasty at the 6-month timepoint, respectively (P < 0.001). Total spring force correlated to increased change in CI (P < 0.002). Spring length was inversely related to transverse cranial expansion at Postoperative day 1, however, directly related at 1 and 3 months (P < 0.001). Ex vivo modeling of spring length was inversely related to spring force regardless of spring number (P < 0.0001). Ex vivo analysis demonstrated greater resultant force when utilizing wider, thicker springs independent of spring arm length and degree of compression. CONCLUSIONS: A dynamic relationship among spring characteristics including length, bend, thickness, and quantity appear to influence SMC outcomes.


Assuntos
Craniossinostoses , Procedimentos Cirúrgicos Reconstrutivos , Craniossinostoses/cirurgia , Craniotomia , Humanos , Lactente , Estudos Retrospectivos , Crânio/cirurgia
13.
J Craniofac Surg ; 32(8): 2768-2770, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34727476

RESUMO

BACKGROUND: Metopic craniosynostosis is traditionally repaired with fronto-orbital advancement (FOA) or, alternatively, limited short scar strip craniectomy (LSSSC) followed by helmet therapy. There is controversy among surgeons regarding resultant head shape outcomes between the 2 methods. This study aims to assess how surgeons perceive the postoperative aesthetic results of the 2 metopic craniosynostosis repair methods. METHODS: A retrospective analysis was performed on 13 (n = 6 LSSSC; n = 7 FOA) patients who presented for surgical correction of isolated metopic craniosynostosis via either LSSSC (followed by helmet therapy) or FOA. Clinical photographs at 1 year postop were shown to 10 craniofacial surgeons who rated the aesthetic outcomes on a Likert scale of 1 (poor) to 5 (excellent) and guessed which surgical method was performed. RESULTS: Mean age at the time of the procedure was younger in LSSSC than FOA (3.1 ±â€Š1.0 versus 17.5 ±â€Š8.5 months; P < 0.001). Mean blood loss was significantly lower with LSSSC versus FOA (202.0 ±â€Š361.2 versus 371.43 ±â€Š122.9 mL; P < 0.001), as was mean blood transfusion requirement (92.5 ±â€Š49.9 versus 151.3 ±â€Š51.2 mL; P < 0.001) and mean duration of the operation (3:06 ±â€Š0:24 versus 7:53 ±â€Š0:31 hours; P < 0.001). Mean surgeon scores of aesthetic outcomes were similar between groups: LSSSC, 3.27 ±â€Š1.09; FOA, 3.51 ±â€Š0.95 (P = 0.171). When asked to identify which procedure patients had received, only 63.8% of responses were correct. CONCLUSIONS: Limited short scar strip craniectomy offers an important alternative to traditional open FOA and should be considered as an option for children diagnosed with metopic craniosynostosis.


Assuntos
Craniossinostoses , Procedimentos Cirúrgicos Reconstrutivos , Criança , Craniossinostoses/cirurgia , Craniotomia , Estética , Humanos , Lactente , Estudos Retrospectivos , Resultado do Tratamento
14.
J Craniofac Surg ; 32(8): 2774-2778, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34727478

RESUMO

BACKGROUND: Minimally-invasive endoscopic strip-craniectomy (or suturectomy) for the repair of craniosynostosis combined with postoperative cranial orthotic molding has been widely adopted in the past 2 decades, proving itself as a safe and effective procedure. Over time the authors transitioned from performing an endoscopic strip-craniectomy, to performing the same surgery without the endoscope. The authors here describe our technique and compare its results to those published in the literature for endoscopic suturectomies. METHODS: A retrospective chart review was performed for patients with nonsyndromic craniosynostosis who underwent minimally-invasive nonendoscopic suturectomy between 2019 and 2020 at our institution. RESULTS: Thirteen patients (11 males; 2 females) were operated including 5 Metopic, 5 Sagittal, 2 coronal, and 1 lambdoid craniosynostosis. The average age at surgery was 4.35 months. The average length of surgery was 71 minutes. Averaged intraoperative estimated blood loss was 31.54 mL. Eleven patients received a blood transfusion (most before performing the skin incision) with a mean amount of 94.62 mL of blood transfused during surgery. The mean hemoglobin at discharge was 10.38 mg/dL. There was only 1 intraoperative mild complication. The mean intrahospital length of stay was 1.77 days with no postoperative complications noted. All patients initiated remodeling orthotic treatment following surgery. Long-term follow-up scans were available for 8 patients (5 metopic, 2 sagittal, and 1 lambdoid) with an average follow-up of 9 months. In all cases, there was a significant improvement in the skull width at the synostosis location as well as in the skull proportions and symmetry. The above outcomes are similar to those published in the literature for endoscope-assisted strip-craniectomies. CONCLUSIONS: Suturectomies assisted with cranial orthosis remodeling for the treatment of all types of nonsyndromic craniosynostosis can be performed without an endoscope while maintaining minimal-invasiveness, good surgical results, and low complication rates.


Assuntos
Craniossinostoses , Suturas Cranianas/cirurgia , Craniossinostoses/cirurgia , Craniotomia , Endoscópios , Feminino , Humanos , Lactente , Masculino , Aparelhos Ortopédicos , Estudos Retrospectivos , Resultado do Tratamento
15.
J Craniofac Surg ; 32(8): 2859-2863, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34727486

RESUMO

BACKGROUND: Scaphocephaly is the commonest from of craniosynostosis. There are several surgical methods to correct this and is influenced by the areas affected. A common thread in any of these corrections is an attempt to increase the biparietal diameter by modifying the lateral vault panel (LVP). A simple and novel method is proposed. MATERIALS AND METHOD: The records of all patients undergoing scaphocephaly correction in the craniofacial unit at the institution were reviewed from 2003 to 2019. There were 106 patients, 57 males, and 49 females. The age ranged from 6 months to 5 years with a mean of 11 months. The method of vault remodeling was LVP only in 36 (34%), subtotal vault remodeling in 59 (56%), and total vault remodeling in 11 (10%). All 106 patients underwent LVP remodeling as part of the procedure. One or 2 wedge excisions was performed to increase the curvature of the LVP and this panel was fixed on the outside of the temporal squame bone. RESULTS: The patients were followed up for a minimum of 1 year. Satisfactory results were obtained. The mean preoperative cephalic index was 64% and the mean postoperative index was 75%. There were minor complications such as screw visibility in a few patients. CONCLUSIONS: Wedge excisions of the LVP is a simple and effective maneuver that can be used as strategy when performing scaphocephaly correction.


Assuntos
Craniossinostoses , Anormalidades Maxilomandibulares , Procedimentos Cirúrgicos Reconstrutivos , Craniossinostoses/cirurgia , Craniotomia , Feminino , Humanos , Lactente , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Crânio/cirurgia , Resultado do Tratamento
16.
Medicina (Kaunas) ; 57(11)2021 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-34833500

RESUMO

Background and Objectives: The landmark for neurosurgical approaches to access brain lesion is the pterion. The aim of the present study is to classify and examine the prevalence of all types of pterion variations and perform morphometric measurements from previously defined anthropological landmarks. Materials and methods: One-hundred and twenty-four Thai dried skulls were investigated. Classification and morphometric measurement of the pterion was performed. Machine learning models were also used to interpret the morphometric findings with respect to sex and age estimation. Results: Spheno-parietal type was the most common type (62.1%), followed by epipteric (11.7%), fronto-temporal (5.2%) and stellate (1.2%). Complete synostosis of the pterion suture was present in 18.5% and was only present in males. While most morphometric measurements were similar between males and females, the distances from the pterion center to the mastoid process and to the external occipital protuberance were longer in males. Random forest algorithm could predict sex with 80.7% accuracy (root mean square error = 0.38) when the pterion morphometric data were provided. Correlational analysis indicated that the distances from the pterion center to the anterior aspect of the frontozygomatic suture and to the zygomatic angle were positively correlated with age, which may serve as basis for age estimation in the future. Conclusions: Further studies are needed to explore the use of machine learning in anatomical studies and morphometry-based sex and age estimation. Thorough understanding of the anatomy of the pterion is clinically useful when planning pterional craniotomy, particularly when the position of the pterion may change with age.


Assuntos
Suturas Cranianas , Crânio , Craniotomia , Feminino , Humanos , Masculino , Procedimentos Neurocirúrgicos , Tailândia
17.
Cir Cir ; 89(S1): 66-69, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34762625

RESUMO

Meningiomas are the most frequent extra-axial tumors of the nervous system. Multiple meningiomas are defined as the presence of two or more lesions that appear simultaneously or not, in different intracranial location, without association to neurofibromatosis. Each lesion must be evaluated individually for treatment, which consists in microsurgical resection in most cases. A 59-year-old woman presented with neurological symptoms from different anatomical site. Two extra-axial tumors of different location, at right sphenoid wing and the other in the tuberculum sellae were identified. Microsurgical resection was decided in one-step surgery, using the same craniotomy for both lesions with complete resection.


Assuntos
Neoplasias Meníngeas , Meningioma , Craniotomia , Feminino , Humanos , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Resultado do Tratamento
18.
Trials ; 22(1): 800, 2021 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-34774098

RESUMO

BACKGROUND: Postoperative pain is a common problem that occurs in pediatric patients following neurosurgery which may lead to severe complications. Dexmedetomidine is a commonly used adjuvant medicine in craniotomy owing to its sedative, amnestic, analgesic, and neuroprotective properties. Besides, studies suggest that lidocaine has similar effects on sedation, analgesia, and neuroprotection. Both two adjuvants can reduce postoperative pain after neurosurgery in adults. However, it is still unknown whether dexmedetomidine or lidocaine can reduce postoperative pain in children undergoing craniotomy, and if yes, which is a better medicine choice. Therefore, we aimed to compare the effect of dexmedetomidine vs. lidocaine on postoperative pain in pediatric patients after craniotomy. METHODS/DESIGN: We will perform a randomized (1:1:1), double-blind, placebo-controlled, single-center trial. Children aged 1-12 years scheduled for craniotomy will be eligible for inclusion. The 255 recruited participants will be stratified by age in two strata (1-6 years and 7-12 years), and then each stratum will be equally randomized to three groups: group D (infusion of dexmedetomidine [intervention group]), group L (infusion of lidocaine [intervention group]), and group C (infusion of normal saline [control group]). Patients will be followed up at 1 h, 2 h, 4 h, 24 h, and 48 h after surgery. The primary outcome will be total sufentanil consumption within 24 h after surgery. DISCUSSION: In this clinical trial, we expect to clarify and compare the postoperative analgesic effect of dexmedetomidine vs. lidocaine infusion on pediatric patients undergoing craniotomy. We believe that the results of this trial will provide more choices for postoperative analgesia for the pediatric population. TRIAL REGISTRATION: Chinese ClinicalTrials.gov ChiCTR1800019411 . Registered on 10 November 2018.


Assuntos
Analgesia , Analgésicos não Narcóticos , Dexmedetomidina , Adulto , Analgésicos não Narcóticos/efeitos adversos , Criança , Pré-Escolar , Craniotomia/efeitos adversos , Dexmedetomidina/efeitos adversos , Método Duplo-Cego , Humanos , Lactente , Lidocaína/efeitos adversos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Minerva Anestesiol ; 87(9): 997-1005, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34612617

RESUMO

BACKGROUND: Research comparing 20% mannitol, 3% hypertonic saline and 8.4% sodium bicarbonate for intraoperative hyperosmolar therapy during supratentorial tumor excision is sparse. With the hypothesis that equiosmolar concentration of these agents will produce equivalent effects, this study was conducted to compare the effects on intraoperative brain relaxation and hemodynamics. METHODS: The prospective study was conducted over a period of one year. Ninety patients, aged 18-60 years, American Society of Anesthesiologists class Ι and ΙΙ with supratentorial tumor and scheduled for surgery were randomized into three groups to receive equiosmolar 20% mannitol (group 1), 3% hypertonic saline (group 2) and 8.4% sodium bicarbonate (group 3). Primary outcome assessed was the effect on intraoperative brain relaxation score while hemodynamic parameters, changes in arterial blood gas parameters, serum electrolytes, serum osmolarity, urine output, fluid intake, post-operative course, hospital stay were the secondary outcomes. RESULTS: Demographic characteristics, surgical and anesthetic variables, were comparable between the three groups. Brain relaxation scores were significantly better in group 3 compared to group 2 and group 1 respectively. Patients in group 1 had lower mean blood pressure and central venous pressure values, higher urine output, fluid intake compared to other groups. Patients of group 3 had significantly higher pH, bicarbonate, partial pressure of carbon dioxide, serum sodium and serum osmolarity values compared to groups 1 and 2. CONCLUSIONS: Eight point four percent sodium bicarbonate solution infusion is associated with superior intraoperative brain relaxation scores and improved haemodynamic stability compared to equiosmolar 3% hypertonic saline solution and 20% mannitol.


Assuntos
Bicarbonato de Sódio , Neoplasias Supratentoriais , Adolescente , Adulto , Encéfalo , Craniotomia , Hemodinâmica , Humanos , Manitol , Pessoa de Meia-Idade , Estudos Prospectivos , Solução Salina Hipertônica , Neoplasias Supratentoriais/cirurgia , Adulto Jovem
20.
J Clin Neurosci ; 93: 183-187, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34656245

RESUMO

There is no consensus on the management of post-craniotomy pain. Several randomized controlled trials have examined the use of a regional scalp block for post-craniotomy pain. We aim to investigate whether scalp block affected short or long-term pain levels and opioid use after craniotomy. This study prospectively administered selective scalp blocks (lesser occipital, preauricular nerve block + pin site block) in 20 consecutive patients undergoing craniotomy for semicircular canal dehiscence. Anesthesia, pain, and opioid outcomes in these patients were compared to 40 consecutive historic controls. There was no significant difference in patient demographics between the two groups and no complications related to selective scalp block. The time between the end of procedure and end of anesthesia decreased in the scalp block group (16 vs 21 min, P = 0.047). Pain scores were significantly less in the scalp block group for the first 4 h, after which there was no statistically significant difference. Time to opioid rescue was longer in the scalp block group (3.6 vs 1.8 h, HR 0.487, P = 0.0361) and opioid use in the first 7 h was significantly less in the scalp block group. Total opioid use, outpatient opioid use, and length of stay did not differ. Selective scalp block is a safe and effective tool for short-term management of postoperative pain after craniotomy and decreases the medication requirement during emergence and recovery. Selective scalp block can speed up OR turnover but is not efficacious in the treatment of postoperative pain beyond this point.


Assuntos
Analgésicos Opioides , Bloqueio Nervoso , Analgésicos Opioides/uso terapêutico , Anestésicos Locais , Craniotomia , Humanos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Couro Cabeludo
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