Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.529
Filtrar
1.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(4): 395-399, 2020 Apr 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32879063

RESUMO

OBJECTIVES: To analyze the risk factors for postoperative deep vein thrombosis (DVT) in neurosurgical patients to provide the basis for the prevention of postoperative DVT. METHODS: A total of 141 patients underwent neurosurgery were enrolled. Thrombelastography (TEG) test was performed before and at the end of surgery. According to whether there was DVT formation after operation, the patients were divided into a thrombosis group and a non-thrombosis group. T-test and rank sum test were used to compare the general clinical characteristics of the 2 groups, such as age, gender, intraoperative blood loss, D-dimer, intraoperative crystal input, colloid input, blood product transfusion, operation duration, length of postoperative hospitalization. The application of chi-square test and rank-sum test were used to compared TEG main test indicators such as R and K values between the 2 groups. Logistic regression was used to analyze the possible risk factors for postoperative DVT in neurosurgical patients. RESULTS: There were significant differences in postoperative TEG index R, clotting factor function, intraoperative blood loss, hypertension or not, length of postoperative hospital stay, and postoperative absolute bed time (all P<0.05). Logistic regression analysis showed hypercoagulability, more intraoperative blood loss and longer postoperative absolute bed time were risk factors for DVT formation after craniotomy. CONCLUSIONS: Hypercoagulability in postoperative TEG test of patients is an important risk factor for the formation of postoperative DVT after neurosurgery, which can predict the occurrence of postoperative DVT to some extent.


Assuntos
Trombofilia , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia , Craniotomia/efeitos adversos , Humanos , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Fatores de Risco
2.
PLoS One ; 15(9): e0235273, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941422

RESUMO

OBJECTIVES: Sepsis and septic shock are important quality and patient safety metrics. This study examines incidence of Sepsis and/or septic shock (S/SS) after craniotomy for tumor resection, one of the most common neurosurgical operations. METHODS: Multicenter, prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was used to identify patients undergoing craniotomy for tumor (CPT 61510, 61521, 61520, 61518, 61526, 61545, 61546, 61512, 61519, 61575) from 2012-2015. Univariate and multivariate logistic regression models were used to identify risk factors for S/SS. RESULTS: There were 18,642 patients that underwent craniotomy for tumor resection. The rate of sepsis was 1.35% with a mortality rate of 11.16% and the rate of septic shock was 0.65% with a 33.06% mortality rate versus an overall mortality rate of 2.46% in the craniotomy for tumor cohort. The 30-day readmission rate was 50.54% with S/SS vs 10.26% in those without S/SS. Multiple factors were identified as statistically significant (p <0.05) for S/SS including ascites (OR = 33.0), ventilator dependence (OR = 4.5), SIRS (OR = 2.8), functional status (OR = 2.3), bleeding disorders (OR = 1.7), severe COPD (OR = 1.6), steroid use (OR = 1.6), operative time >310 minutes (OR = 1.5), hypertension requiring medication (OR = 1.5), ASA class ≥ 3 (OR = 1.4), male sex (OR = 1.4), BMI >35 (OR = 1.4) and infratentorial location. CONCLUSIONS: The data indicate that sepsis and septic shock, although uncommon after craniotomy for tumor resection, carry a significant risk of 30-day unplanned reoperation (35.60%) and mortality (18.21%). The most significant risk factors are ventilator dependence, ascites, SIRS and poor functional status. By identifying the risk factors for S/SS, neurosurgeons can potentially improve outcomes. Further investigation should focus on the creation of a predictive score for S/SS with integration into the electronic health record for targeted protocol initiation in this unique neurosurgical patient population.


Assuntos
Neoplasias Encefálicas/cirurgia , Craniotomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Choque Séptico/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Craniotomia/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Choque Séptico/etiologia
3.
S Afr Med J ; 110(5): 403-408, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32657726

RESUMO

BACKGROUND: Despite progress in hospital care, infections continue to represent one of the major complications among hospitalised patients. OBJECTIVES: To determine the aetiology and incidence of hospital-acquired infections and their associated risk factors following neurosurgical procedures. METHODS: A retrospective study was conducted from October 2013 to September 2014. Data including demographics, hospitalisation period, type of operation and primary diagnosis were collected. Post-surgical infections were confirmed microbiologically. SPSS (Statistical Package for the Social Sciences) version 23 was used for statistical analysis. RESULTS: Among a total of 1 688 patients who underwent neurosurgical operations, the incidence of post-surgical infections was 4.2% per year. Post-surgical infections were significantly associated with craniotomy (p<0.0001), prolonged stay in hospital (≥30 days) (p=0.008), and patient age ≥35 years (p=0.05). Staphylococcus aureus was the most frequently isolated pathogen (19.7%), followed by Klebsiella pneumoniae (12.7%). A total of 42.9% of S. aureus isolates were methicillin-resistant S. aureus (MRSA), but all these isolates were susceptible to vancomycin; 44.4% of K. pneumoniae isolates were extended-spectrum beta-lactamase (ESBL)-positive, but were susceptible to carbapenems, piperacillin-tazobactam and amikacin. CONCLUSIONS: Post-surgical infections remain an important problem in neurosurgery. Increased resistance to causative pathogens is a major concern.


Assuntos
Infecção Hospitalar/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Adolescente , Fatores Etários , Antibacterianos/uso terapêutico , Craniotomia/efeitos adversos , Infecção Hospitalar/microbiologia , Estudos Transversais , Farmacorresistência Bacteriana , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Infecções por Klebsiella/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Fatores de Risco , África do Sul/epidemiologia , Infecções Estafilocócicas/epidemiologia , Infecção da Ferida Cirúrgica/microbiologia , Derivação Ventriculoperitoneal/efeitos adversos
4.
Forensic Sci Med Pathol ; 16(3): 477-480, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32500339

RESUMO

During a disease pandemic, there is still a requirement to perform postmortem examinations within the context of legal considerations. The management of the dead from COVID-19 should not impede the medicolegal investigation of the death where required by the authorities and legislation but additional health and safety precautions should be adopted for the necessary postmortem procedures. The authors have therefore used the craniotomy box in an innovative way to enable a safe alternative for skull and brain removal procedures on suspected or confirmed COVID-19 bodies. The craniotomy box technique was tested on a confirmed COVID-19 positive body where a full postmortem examination was performed by a team of highly trained personnel in a negative pressure Biosafety Level 3 (BSL-3) autopsy suite in the National Institute of Forensic Medicine (IPFN) Malaysia. This craniotomy box is a custom-made transparent plastic box with five walls but without a floor. Two circular holes were made in one wall for the placement of arms in order to perform the skull opening procedure. A swab to detect the presence of the SARS-CoV-2 virus was taken from the interior surface of the craniotomy box after the procedure. The result from the test using real-time reverse transcriptase polymerase chain reaction (rRT-PCR) proved that an additional barrier provided respiratory protection by containing the aerosols generated from the skull opening procedure. This innovation ensures procedures performed inside this craniotomy box are safe for postmortem personnel performing high risk autopsies during pandemics.


Assuntos
Betacoronavirus/patogenicidade , Encéfalo/virologia , Infecções por Coronavirus/prevenção & controle , Craniotomia/instrumentação , Controle de Infecções/instrumentação , Exposição Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Patologistas , Pneumonia Viral/prevenção & controle , Aerossóis , Autopsia , Betacoronavirus/isolamento & purificação , Encéfalo/patologia , Infecções por Coronavirus/patologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Craniotomia/efeitos adversos , Contaminação de Equipamentos , Desenho de Equipamento , Interações entre Hospedeiro e Microrganismos , Humanos , Exposição Ocupacional/efeitos adversos , Saúde do Trabalhador , Equipamento de Proteção Individual , Pneumonia Viral/patologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Roupa de Proteção , Dispositivos de Proteção Respiratória , Medição de Risco , Fatores de Risco
5.
Medicine (Baltimore) ; 99(26): e20836, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590774

RESUMO

INTRODUCTION: Postoperative pulmonary complications (PPCs) are common and associated with increased morbidity, mortality, and medical cost. They are gaining increasing concerns among patients receiving neurological surgery. Chronic obstructive pulmonary disease (COPD) affect a large section of whole population and is also one of the risk factors of PPCs in the perioperative setting. Ipratropium bromide is the inhalation solution for the treatment of COPD. Studies showed the perioperative nebulization of ipratropium bromide could increase the lung function and decrease the incidence of postoperative pneumonia in COPD patients underwent thoracic surgery. The purpose of this study is to investigate the effect of perioperative nebulization of ipratropium bromide on PPCs in COPD patients underwent neurosurgical surgery. METHODS AND ANALYSIS: This study is a multicenter retrospective study in China. Patients who meet the inclusion/exclusion criteria are selected from 7 neurosurgical centers in China. According to whether ipratropium bromide is used in perioperative period, the patients are divided into exposure group and control group. The primary outcome is the incidence of postoperative pneumonia. Secondary outcomes are unplanned intubation, postoperative mechanical ventilation ≥ 48 hours, respiratory failure, atelectasis, death, and length of stay. ETHICS AND DISSEMINATION: This study was approved by the ethics committee (EC) of the School of Public Health, Fudan University, Shanghai, China. Waived by the ethics committee, no written consent form was obtained since we used the registry data. The study results will be communicated via publication. TRIAL REGISTRATION NUMBER: ChiCTR1900022552.


Assuntos
Craniotomia/efeitos adversos , Dispneia/tratamento farmacológico , Ipratrópio/normas , Complicações Pós-Operatórias/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Broncodilatadores/normas , Broncodilatadores/uso terapêutico , Distribuição de Qui-Quadrado , China/epidemiologia , Craniotomia/métodos , Feminino , Humanos , Ipratrópio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/epidemiologia , Pontuação de Propensão , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos
6.
J Clin Neurosci ; 77: 148-156, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32376154

RESUMO

Spontaneous intracerebral hemorrhage (sICH) is associated with high rates of morbidity and mortality. Neurosurgical clot evacuation is controversial but often a life saving maneuver in the setting of severe mass effect and cerebral herniation. Outcomes from large multicenter databases are sparsely reported. Patients who underwent craniotomy for evacuation of a supratentorial sICH between 2006 and 2017 were systematically extracted from the American College of Surgeons National Surgical Quality Improvement Program Participant Use Files. Our primary outcomes of interest were 30-day mortality, non-routine discharge disposition, and extended length of stay ([eLOS], defined as the top quartile for the cohort). Individual binary logistic regression models were constructed to query the associations between pre- and perioperative variables and each outcome. A total of 751 patients met the inclusion criteria. The 30-day mortality rate was 23.3% and increased from 2011 to 2017 (pooled OR 2.060 [95% CI 1.437 - 2.953]). Older age, morbid obesity, preoperative mechanical ventilation, preoperative systemic inflammatory response syndrome (SIRS) or septic shock, and thrombocytopenia were associated with mortality. Older age, race, and preoperative mechanical ventilation were associated with non-routine discharge. Patients who were mechanically ventilated or were insulin-dependent diabetics had greater odds of experiencing eLOS. A formula for estimating 30-day mortality was developed and found to have a strong linear association with actual mortality rates (R2 = 0.777, p = 0.002). Preoperative mechanical ventilation is a consistent predictor of poor outcomes following surgery for supratentorial sICH. Mortality is also influenced by older age, body habitus, SIRS, septic shock, and thrombocytopenia.


Assuntos
Hemorragia Cerebral/cirurgia , Craniotomia/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Idoso , Hemorragia Cerebral/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Respiração Artificial/estatística & dados numéricos , Sepse/epidemiologia
7.
J Craniofac Surg ; 31(5): 1404-1407, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32310891

RESUMO

When craniotomy complicated by secondary infection requires debridement and craniectomy, the bony defect is typically not reconstructed immediately. Due to concerns about placing a prosthetic material in an infected field, cranioplasty has traditionally been delayed by weeks or months after craniectomy. However, surgeons have begun performing single-stage cranioplasty after craniectomy in an effort to reduce the morbidity associated with multiple procedures and reduce overall healthcare costs. The purpose of this systematic review is to analyze outcomes of immediate cranioplasty performed after bone flap debridement secondary to infection. A literature review from January 1, 1998 through January 1, 2019 was conducted, examining the data on immediate titanium cranioplasty and its complication and reoperation rates. A meta-analysis of these articles was then performed. Variables studied included incidence of infection post-cranioplasty, wound healing complications, need for unplanned reoperation, and mortality. In total, there were 40 patients who underwent immediate cranioplasty after bone flap debridement. Overall, there was a 5% rate of postoperative infection, a 12.5% rate of unplanned return to the operating room, 7.5% rate of CSF fistula or leak, a 2.5% rate of hematoma, and a 2.5% rate of mortality within the immediate post-op period. Although there are insufficient data in the literature to rigorously compare these immediate cranioplasties in a direct way with the more traditional delayed type; the outcomes of immediate cranioplasty procedures secondary to craniectomy for infection were similar to the outcomes of delayed cranioplasty after craniectomy for any reason. Given these results, immediate titanium cranioplasty should be considered in select patients.


Assuntos
Craniotomia/efeitos adversos , Crânio/cirurgia , Infecção da Ferida Cirúrgica , Feminino , Fístula/cirurgia , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Retalhos Cirúrgicos/cirurgia , Infecção da Ferida Cirúrgica/cirurgia , Titânio
8.
J Clin Neurosci ; 75: 218-220, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32249175

RESUMO

Pneumocephalus describes the presence of air within the cranial cavity and is often self-limiting. Tension pneumocephalus is a neurosurgical emergency manifested by headaches, seizures, reduced consciousness and even death resulting from raised intracranial pressure. Differentiating both entities clinically is often challenging but crucial. We present a case involving a sixty-year-old male who was transferred to our unit after he collapsed while undergoing rehabilitation. The patient had undergone a combined bifrontal craniotomy and transnasal endoscopic resection of recurrent sinonasal adenocarcinoma with anterior skull base involvement eight days prior. Imaging demonstrated the classic Mt. Fuji sign and a diagnosis of tension pneumocephalus was formed. The patient proceeded for definitive management which included a multi-layered repair of the anterior skull base. The three mechanisms that propose the development of tension pneumocephalus include the ball-valve mechanism, the inverted soda-bottle effect and rarely, infection from gas forming organisms. A review of current literature on PubMed/MEDLINE revealed tension pneumocephalus after skull base surgery to be a rare entity with only eleven cases reported. Most patients achieved complete recovery of symptoms post-treatment. Clinicians should recognise tension pneumocephalus as a potential complication after skull base surgery. Accurate diagnosis requires appreciation of imaging features and a high index of suspicion. Prompt management is imperative to prevent possible devastating outcomes.


Assuntos
Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Craniotomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos
9.
Cochrane Database Syst Rev ; 4: CD007286, 2020 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-32343399

RESUMO

BACKGROUND: This is an updated version of the Cochrane Review previously published in 2018. The incidence of seizures following supratentorial craniotomy for non-traumatic pathology has been estimated to be between 15% to 20%; however, the risk of experiencing a seizure appears to vary from 3% to 92% over a five-year period. Postoperative seizures can precipitate the development of epilepsy; seizures are most likely to occur within the first month of cranial surgery. The use of antiepileptic drugs (AEDs) administered pre- or postoperatively to prevent seizures following cranial surgery has been investigated in a number of randomised controlled trials (RCTs). OBJECTIVES: To determine the efficacy and safety of AEDs when used prophylactically in people undergoing craniotomy and to examine which AEDs are most effective. SEARCH METHODS: For the latest update we searched the following databases on 29 September 2019: Cochrane Epilepsy Group Specialized Register, CENTRAL, MEDLINE, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP). We did not apply any language restrictions. SELECTION CRITERIA: We included RCTs of people with no history of epilepsy who were undergoing craniotomy for either therapeutic or diagnostic reasons. We included trials with adequate randomisation methods and concealment; these could either be blinded or unblinded parallel trials. We did not stipulate a minimum treatment period, and we included trials using active drugs or placebo as a control group. DATA COLLECTION AND ANALYSIS: Three review authors (JW, JG, YD) independently selected trials for inclusion, extracted data and assessed risk of bias. We resolved any disagreements through discussion. Outcomes investigated included the number of participants experiencing seizures (early (occurring within first week following craniotomy), and late (occurring after first week following craniotomy)), the number of deaths and the number of people experiencing disability and adverse effects. Due to the heterogeneous nature of the trials, we did not combine data from the included trials in a meta-analysis; we presented the findings of the review in narrative format. Visual comparisons of outcomes are presented in forest plots. MAIN RESULTS: We included 10 RCTs (N = 1815), which were published between 1983 and 2015. Three trials compared a single AED (phenytoin) with placebo or no treatment. One, three-armed trial compared two AEDs (phenytoin, carbamazepine) with no treatment. A second three-armed trial compared phenytoin, phenobarbital with no treatment. Of these five trials comparing AEDs with placebo or no treatment, two trials reported a statistically significant advantage for AED treatment compared to controls for early seizure occurrence; all other comparisons showed no clear or statistically significant differences between AEDs and control treatment. None of the trials that were head-to-head comparisons of AEDs (phenytoin versus sodium valproate, phenytoin versus phenobarbital, levetiracetam versus phenytoin, zonisamide versus phenobarbital) reported any statistically significant differences between treatments for either early or late seizure occurrence. Only five trials reported incidences of death. One trial reported statistically significantly fewer deaths in the carbamazepine and no-treatment groups compared with the phenytoin group after 24 months of treatment, but not after six months of treatment. Incidences of adverse effects of treatment were poorly reported; however, three trials did show that significantly more adverse events occurred on phenytoin compared to valproate, placebo, or no treatment. No trials reported any results relating to functional outcomes such as disability. We considered the evidence to be of low certainty for all reported outcomes due to methodological issues and variability of comparisons made in the trials. AUTHORS' CONCLUSIONS: There is limited, low-certainly evidence to suggest that AED treatment administered prophylactically is either effective or not effective in the prevention of postcraniotomy (early or late) seizures. The current evidence base is limited due to the different methodologies employed in the trials and inconsistencies in the reporting of outcomes including deaths and adverse events. Further evidence from good-quality, contemporary trials is required in order to assess the clinical effectiveness of prophylactic AED treatment compared to placebo or no treatment, or other AEDs in preventing postcraniotomy seizures in this select group of patients.


Assuntos
Anticonvulsivantes/uso terapêutico , Craniotomia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Convulsões/prevenção & controle , Anticonvulsivantes/efeitos adversos , Carbamazepina/uso terapêutico , Humanos , Isoxazóis/uso terapêutico , Levetiracetam/uso terapêutico , Fenobarbital/uso terapêutico , Fenitoína/uso terapêutico , Piracetam/análogos & derivados , Piracetam/uso terapêutico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Convulsões/etiologia , Convulsões/mortalidade , Ácido Valproico/uso terapêutico , Zonisamida/uso terapêutico
10.
BMC Neurol ; 20(1): 150, 2020 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-32321451

RESUMO

BACKGROUND: Infratentorial craniotomy patients have a high incidence of postoperative nausea and vomiting (PONV). Enhanced Recovery After Surgery (ERAS) protocols have been shown in multiple surgical disciplines to improve outcomes, including reduced PONV. However, very few studies have described the application of ERAS to infratentorial craniotomy. The aim of this study was to examine whether our ERAS protocol for infratentorial craniotomy could improve PONV. METHODS: We implemented an evidence-based, multimodal ERAS protocol for patients undergoing infratentorial craniotomy. A total of 105 patients who underwent infratentorial craniotomy were randomized into either the ERAS group (n = 50) or the control group (n = 55). Primary outcomes were the incidence of vomiting, nausea score, and use of rescue antiemetic during the first 72 h after surgery. Secondary outcomes included postoperative anxiety level, sleep quality, and complications. RESULTS: Over the entire 72 h post-craniotomy observation period, the cumulative incidence of vomiting was significantly lower in the ERAS group than in the control group. Meanwhile, the incidence of vomiting was significantly lower in the ERAS group on postoperative days (PODs) 2 and 3. Notably, the proportion of patients with mild nausea (VAS 0-4) was higher in the ERAS group as compared to the control group on PODs 2 or 3. Additionally, the postoperative anxiety level and quality of sleep were significantly better in the ERAS group. CONCLUSION: Successful implementation of our ERAS protocol in infratentorial craniotomy patients could attenuate postoperative anxiety, improve sleep quality, and reduce the incidence of PONV, without increasing the rate of postoperative complications. TRIAL REGISTRATION: ChiCTR-INR-16009662, 27 Oct 2016, Clinical study on the development and efficacy evaluation of Enhanced Recovery After Surgery (ERAS) in Neurosurgery.


Assuntos
Craniotomia/efeitos adversos , Recuperação Pós-Cirúrgica Melhorada , Náusea e Vômito Pós-Operatórios , Neoplasias Encefálicas/cirurgia , Humanos , Náusea e Vômito Pós-Operatórios/epidemiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle
11.
Medicine (Baltimore) ; 99(11): e19071, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176032

RESUMO

BACKGROUND: It is important to manage inflammation after craniotomy. It may be prudent to reduce the excessive usage of antibiotics and to add supplementary treatments like acupuncture, which would be effective and safe. However, there are only a few studies available to date on the effects of acupuncture on anti-inflammatory response after craniotomy. The aim of this study was to explore the anti-inflammatory effects of acupuncture in patients after a craniotomy. METHODS: This study was a single-center, prospective, open-label, controlled trial. Forty-four subjects who underwent craniotomy for an unruptured aneurysm, facial spasm, or brain tumor were allocated to either an acupuncture group or a control group. Both groups received postoperative routine care in the Department of Neurosurgery. The subjects in the acupuncture group also received a total of 6 acupuncture treatments sessions within 8 days after craniotomy. Acupuncture treatments included acupuncture, electroacupuncture, and intradermal acupuncture. The serum interleukin (IL)-1ß and IL-6, tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and erythrocyte sedimentation rate levels were assessed four times within 7 days after surgery. The presence of fever, use of additional antibiotics, presence of infection including pneumonia or urinary tract infection, and safety were also reviewed. RESULTS: The IL-1ß levels of subjects who underwent aneurysmal clipping were significantly lower in the acupuncture group (P = .02). TNF-α levels of subjects who underwent aneurysmal clipping at the seventh postoperative day were also significantly lower in the acupuncture group (P = .03). Six cases of fever of unknown origin were observed in the control group, while none were seen in the acupuncture group, revealing that the incidence of fever was significantly lower in the acupuncture group (P = .02). No adverse events occurred during the trial. CONCLUSION: Acupuncture showed a possibility of alleviating inflammation by attenuating the levels of proinflammatory cytokines and significantly reduced the incidence of fever of unknown origin in patients after craniotomy. Acupuncture would be suitable as an adjunctive therapy to alleviate inflammation after craniotomy.


Assuntos
Terapia por Acupuntura/métodos , Craniotomia/efeitos adversos , Inflamação/terapia , Complicações Pós-Operatórias/terapia , Proteína C-Reativa/análise , Feminino , Humanos , Inflamação/sangue , Inflamação/etiologia , Interleucina-1beta/sangue , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fator de Necrose Tumoral alfa/sangue
12.
J Clin Neurosci ; 73: 37-41, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32035794

RESUMO

Patients undergoing surgical resection of a brain tumor have the potential risk for beingintubated post-operatively, which may be associated with significant morbidity and/or mortality after surgery. This study was analyzed various preoperative patient characteristics, postoperative outcomes, and complications to identify risk factors for unplanned intubation (UI) in adult patients undergoing craniotomy for a brain tumor and created a risk score framework for that cohort. Patients undergoing surgery for a brain tumor were identified according to primary Current Procedural Terminology codes, and information found in The American College of Surgeons (ACS) National Surgical Quality Improvement Project (NSQIP) database from 2012 to 2015 was reviewed. A total of 18,642 adult brain tumor patients were included in the ACS-NSQIP. The rate of unplanned intubation in this cohort was 2.30% (4 2 8). The mortality rate of patients who underwent UI after surgical resection of brain tumor was 24.78% compared to an overall mortality of 2.46%. During the first 30 days after surgery, 33% of patients who underwent UI had an unplanned reoperation, compared to 4.76% of patients who did not undergo unplanned intubation. Bivariate and multivariate analyses identified several predictors and computed a risk score for UI. A risk score based on patient factors for those undergoing a craniotomy for a brain tumor predicts the postoperative UI rate. This could aid in surgical decision-making by identify patients at a higher risk of UI, while modifying perioperative management may help prevent UI.


Assuntos
Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/cirurgia , Craniotomia/mortalidade , Intubação Intratraqueal/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/diagnóstico , Estudos de Coortes , Craniotomia/efeitos adversos , Craniotomia/tendências , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/tendências , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade/normas , Fatores de Risco , Adulto Jovem
13.
Turk Neurosurg ; 30(3): 407-415, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32020570

RESUMO

AIM: To analyze the impact of Tranexamic acid (TXA) on perioperative hemodynamics in craniosynostosis surgery. MATERIAL AND METHODS: Data of thirty-six children (operated between 2014-2017) were categorized into two groups depending on TXA delivery. Patient demographics, preoperative, intraoperative, postoperative data on hemostasis and metabolic outcomes were recorded. Blood loss from the drains, estimated blood loss (EBV loss), volume of blood transfusions, hemodynamic alerations and complications were extracted. Postoperative outcome involved variables at admission, 2 < sup > nd < /sup > , 6 < sup > th < /sup > , 12 < sup > th < /sup > , 24 < sup > th < /sup > hours. A multiple logistic regression analysis was also performed. RESULTS: Demographics presented mean age of 8.14 ± 3.53 months, male/female ratio:1.76/1, procedure length 3.98 ± 0.78 hours. Intraoperative analysis indicated TXA deliveries manifested fewer blood transfusion volumes (p=0.002) due to lower EBV loss (4.02 ± 1.19 ml/kg vs. 5.97 ± 1.61 ml/kg, p < 0.001) with better metabolic outcome. Postoperative outcomes presented all children manifested hematocrit decline after surgey. TXA did not influence postoperative hemodynamic alterations (p=0.090, p=0.112), despite reduced blood loss from the drains and transfusion necessity (p=0.015, p=0.0175). Intraoperative transfusion volumes and EBV loss were associated with postoperative hemodynamics (OR: 3.033, 95% CI: 1.286-7.154; p=0.011; OR: 0.280, 95% CI: 0.081-0.972; p=0.045, respectively). ROC analysis indicated 10.13 ml/kg of intraoperative blood transfusion requirement as the cut off value for hemodynamic instability with 91% sensitivity and 80% specificity. One unit increase in intraoperative transfused blood volume increased the odds of developing hemodynamic alterations by 3.033 times. CONCLUSION: Intraoperative TXA is crucial for successful surgical management; however postoperative period carries out paramount importance due to excessive bleeding after surgery. In case of severe intraoperative transfusion necessity, postoperative TXA utilization might be considered to minimize potential risks by balancing the pros and cons of the drug.


Assuntos
Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Craniossinostoses/cirurgia , Craniotomia/efeitos adversos , Ácido Tranexâmico/uso terapêutico , Feminino , Humanos , Recém-Nascido , Masculino , Resultado do Tratamento
14.
Acta Neurochir (Wien) ; 162(4): 923-928, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31997070

RESUMO

Extravasation of Onyx is a rare complication during embolization of arteriovenous malformations (AVM). We present a case of embolization that was complicated by leakage of Onyx into the cerebellum which was later encountered during surgical excision of the AVM. Our goal is to report this rare event and to outline successful treatment of this complication. The patient's records were reviewed for medical history, laboratory and radiologic workup, and outpatient clinical follow-up. A 62-year-old female presented with Hunt Hess grade 2 and modified Fisher grade 2 subarachnoid hemorrhage (SAH) secondary to ruptured left posterior inferior cerebellar artery (PICA) aneurysm associated with a superior cerebellar vermian AVM. Following endovascular intervention, the aneurysm was completely embolized; however, only 75% of the AVM could be safely obliterated. Extravasation of Onyx from the ruptured aneurysm was noted on her initial angiogram. Elective suboccipital craniectomy was subsequently planned for resection of the residual AVM where the extravasated Onyx posed an operative nuisance during resection. Post-op angiogram confirmed complete resection of the AVM, as well as the bulk of the extravasated Onyx. Patient did well post-operatively, remaining neurologically intact throughout her hospital course. Although infrequently reported in the literature, Onyx extravasation is a potential complication that neurosurgeons should be ready to face. Adherence of Onyx to surrounding parenchyma could hinder optimal surgical resection of AVM and increase complications. Therefore, careful surgical dissection should be performed with special care to delicate neurovasculature. In this case, complete resection of the AVM and Onyx mass was safely achieved.


Assuntos
Aneurisma Roto/cirurgia , Craniotomia/métodos , Dissecação/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Embolização Terapêutica/métodos , Malformações Arteriovenosas Intracranianas/cirurgia , Hemorragia Subaracnóidea/cirurgia , Aneurisma Roto/complicações , Aneurisma Roto/terapia , Craniotomia/efeitos adversos , Dissecação/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/terapia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Hemorragia Subaracnóidea/etiologia
15.
J Clin Neurophysiol ; 37(3): 271-273, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31977570

RESUMO

This case report will provide further evidence for the fact that breach rhythm is not the effect of a bone abnormality only. We present the case of an 84-year-old woman, who had a craniotomy 14 month before admission to our emergency department with a focal inhibitory status epilepticus. Even after clinical recovery, electroencephalography revealed frequent subclinical seizure patterns. When seizure activity was suppressed by anticonvulsive medication with levetiracetam, breach rhythm appeared. Breach rhythm develops usually some months after craniotomy and therefore should have been established in our patient at the time of admission. Therefore, it is reasonable to assume that it was in some way suppressed by the seizure activity in our primary EEG recordings. The appearance of the breach rhythm after the complete suppression of seizure activity by antiepileptic drug treatment shows that breach rhythm is not purely the result of a skull defect but is related to the functional state of the brain tissue beneath.


Assuntos
Craniotomia/efeitos adversos , Epilepsias Parciais/etiologia , Paralisia/fisiopatologia , Convulsões/tratamento farmacológico , Convulsões/etiologia , Idoso de 80 Anos ou mais , Anticonvulsivantes/uso terapêutico , Encéfalo/efeitos dos fármacos , Encéfalo/fisiopatologia , Eletroencefalografia , Feminino , Humanos , Levetiracetam/uso terapêutico
16.
World Neurosurg ; 135: e723-e730, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31899385

RESUMO

OBJECTIVE: The aim of the present study was to compare the outcomes of patients with chronic subdural hematoma after undergoing burr hole craniotomy with subperiosteal or subgaleal drainage (SPGD) with those of patients who have undergone burr hole craniotomy with subdural drainage. METHODS: We searched 4 databases (PubMed, Web of Science, Embase, and Cochrane Library) for relevant reports from January 1995 to September 2019. Two reviewers recorded the major outcomes data as follows: recurrence, mortality, postoperative seizures, postoperative bleeding events, surgical infection, pneumocephalus, modified Rankin scale scores, and Glasgow outcome scale scores. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: A total of 3149 patients from 10 studies were included in our analysis. Compared with the SSD group, the SPGD group had a lower recurrence rate (OR, 0.72; 95% CI, 0.57-0.91) and a smaller risk of postoperative bleeding (OR, 0.41; 95% CI, 0.22-0.78). Also, no significant differences were found in the incidence of mortality (OR, 0.79; 95% CI, 0.54-1.18), postoperative seizures (OR, 0.74; 95% CI, 0.39-1.40), surgical infection (OR, 0.98; 95% CI, 0.55-1.76), pneumocephalus (OR, 0.58; 95% CI, 0.28-1.20), modified Rankin scale score 0-3 (OR, 1.04 at discharge; OR, 1.33 at 6 months), and Glasgow outcome scale score 4-5 (OR, 1.48; 95% CI, 0.82-2.67). CONCLUSIONS: Burr hole craniotomy with SPGD can be recommended as an effective and safe surgical therapy for patients with chronic subdural hematoma owing to its lower recurrence rate and reduced incidence of postoperative brain injuries, in addition to no increase in the rate of some postoperative complications. However, more studies are necessary for further confirmation.


Assuntos
Drenagem/métodos , Hematoma Subdural Crônico/cirurgia , Craniotomia/efeitos adversos , Craniotomia/métodos , Craniotomia/mortalidade , Drenagem/efeitos adversos , Drenagem/mortalidade , Métodos Epidemiológicos , Hematoma Subdural Crônico/mortalidade , Humanos , Recidiva , Resultado do Tratamento
17.
J Craniofac Surg ; 31(1): e53-e57, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31609953

RESUMO

Postoperative remote intracranial hemorrhage (rICH) secondary to craniotomy surgery is an extremely rare but catastrophic complication. The present study aimed to investigate the incidence and the possible pathophysiological mechanism of rICH after brain tumor surgery. The clinical data from 9 rICH cases among 4588 patients undergoing brain tumor surgery were collected retrospectively. Remote intracranial hemorrhage occurred in 9 cases, including 6 cases of remote epidural hemorrhage (rEDH), 2 cases of remote subdural hemorrhage (rSDH), and 1 case of remote cerebellar hemorrhage (rCBH). Among the 9 cases, 2 were males and 7 were females, with an age range of 22 to 63 years (mean of 44.3 years). The incidence of rICH in the patients with ventricular system opening/drainage (4/258) was much higher than the patients without ventricular system opening/drainage (5/4330), and the difference was statistically significant (P < 0.01). Hematoma evacuation was performed in 7 patients with serious neurological status or massive hematoma. The outcome for most of the rICH cases was good, and the Glasgow outcome scale scores of 4-5 were found in 8 cases with a 3-month-long follow-up. Our results suggest that brain tumor surgery with ventricular system opening/drainage was more susceptible to rICH. Paying particlular attention to gradual reduction of intracranial pressure and avoiding excessive loss of cerebrospinal fluid may aid to prevent the occurrence of rICH. The authors suggest that a high index of suspicion, a prompt diagnosis, and emergent management is of vital importance to achieve good prognosis for rICH patients secondary to brain tumor surgery.


Assuntos
Neoplasias Encefálicas/cirurgia , Craniotomia/efeitos adversos , Hemorragias Intracranianas/etiologia , Adulto , Drenagem , Feminino , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Adulto Jovem
18.
World Neurosurg ; 133: 221-226, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606497

RESUMO

BACKGROUND: A rare but important complication related to otherwise uneventful brain and spine surgery is becoming more recognized and more frequently reported in the medical literature. This has been variably labeled as pseudohypoxic brain swelling or postoperative hypotension-associated venous congestion. This poorly understood condition occurs in the setting of surgical intervention and is thought to be related to cerebrospinal fluid leak or evacuation, decreased intracranial pressure, and subsequent development of deep venous congestion affecting the basal ganglia, thalami, and cerebellum. Clinically, patients may have global neurologic deficit and outcomes range from full recovery to vegetative state or death. The imaging correlate includes atypical edema, infarction, or hemorrhage and can overlap the appearance of diffuse hypoxic injury, for which this condition can be mistaken both clinically and radiologically. Although this deep brain tissue edema can be associated with other signs of cerebrospinal fluid hypotension such as dural thickening, brain sagging, and cerebellar herniation, it can be isolated, making the diagnosis challenging. CASE DESCRIPTION: We present 2 cases of unexpected clinical deterioration occurring in patients with otherwise uncomplicated neurosurgery, 1 with craniotomy and the other with lumbar spine intervention. Both patients exhibit similar appearing edema in the deep gray structures on postoperative magnetic resonance imaging scans. In addition to reviewing the prior literature and imaging findings, we evaluate the imaging findings to determine if there are unique features or signatures that might allow differentiation of PHBS from hypoxic-ischemic encephalopathy. CONCLUSIONS: The lentiform rim sign can be helpful for differentiation of pseudohypoxic brain swelling versus hypoxic-ischemic encephalopathy.


Assuntos
Edema Encefálico/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Hipotensão Intracraniana/diagnóstico por imagem , Procedimentos Neurocirúrgicos/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Edema Encefálico/etiologia , Craniotomia/efeitos adversos , Feminino , Humanos , Hipotensão Intracraniana/etiologia , Imagem por Ressonância Magnética , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia
19.
World Neurosurg ; 133: 278-282, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606510

RESUMO

BACKGROUND: Depression following resection of diffuse low-grade glioma has rarely been described. Location of the tumor and surgical route are potential causes. Lesion network mapping (LNM), leveraging high-quality resting-state functional magnetic resonance imaging data from large samples of healthy adults, has been used to explore the broader network connectivity for given lesions. However, LNM has not been applied to large intra-axial masses or surgical lesions. We used LNM to examine a potential cause of postoperative depression in a patient with a cingulate diffuse low-grade glioma (zones I-III). CASE DESCRIPTION: A 34-year-old woman underwent surgery for medically refractory seizures attributable to diffuse low-grade glioma. Near-total resection was attained via a single-stage, transcortical route through the medial prefrontal cortex. Despite freedom from seizure and lack of tumor growth at 42 months of follow-up, she developed symptoms of major depressive disorder soon after surgery that persisted. To identify functional networks potentially engaged by the surgical corridor and tumor resection cavity, both were segmented separately and used as seeds for normative resting-state functional magnetic resonance imaging connectivity mapping. To study depression specifically, networks associated with the tumor and surgical approach were compared with networks associated with subgenual cingulate deep brain stimulation. LNM results suggested that the surgical corridor, rather than the tumor, had greater overlap with deep brain stimulation-based depression networks (32% vs. 8%). CONCLUSIONS: Early postoperative development of major depressive disorder following resection of a cingulate region tumor, although likely multifactorial, should be considered and patients appropriately counseled preoperatively. Further validation of LNM as a viable methodology for correlating symptoms to lesions could make it a valuable tool in selection of surgical approach and patient counseling.


Assuntos
Neoplasias Encefálicas/cirurgia , Craniotomia/efeitos adversos , Transtorno Depressivo Maior/etiologia , Glioma/cirurgia , Giro do Cíngulo/cirurgia , Convulsões/cirurgia , Adulto , Neoplasias Encefálicas/complicações , Feminino , Glioma/complicações , Humanos , Complicações Pós-Operatórias/etiologia , Convulsões/etiologia
20.
World Neurosurg ; 133: 192-195, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31574328

RESUMO

BACKGROUND: The frontal aslant tract (FAT) is a white matter fiber pathway connecting the superior frontal gyrus to the Broca area. This tract in the dominant hemisphere has been shown to play a role in speech initiation and production, and direct subcortical stimulation can induce stuttering and speech arrest in a patient. However, controversy remains as to whether disruption of this pathway will lead to a permanent language deficit and if it is even necessary to map this tract during tumor resections of the dominant frontal lobe. CASE DESCRIPTION: Here, we report a case of a patient with a lower-grade diffuse glioma invading the dominant FAT that was removed with an asleep craniotomy. In the immediate postoperative state, the patient had a transcortical motor dysphasia and was unable to initiate speech. These immediate language deficits quickly recovered, and the patient was neurologically intact at the time of discharge a few days after surgery. CONCLUSIONS: Given the high likelihood for a complete neurologic recovery including transient aphasia, we propose that awake mapping for the purpose of identifying the dominant FAT is unnecessary during tumor resection and that disruption of this tract is not associated with any long-term language deficits.


Assuntos
Afasia/etiologia , Craniotomia/efeitos adversos , Glioma/cirurgia , Substância Branca/cirurgia , Afasia/diagnóstico por imagem , Afasia/patologia , Feminino , Glioma/diagnóstico por imagem , Glioma/patologia , Humanos , Imagem por Ressonância Magnética , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Substância Branca/diagnóstico por imagem , Substância Branca/patologia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA