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1.
Medicine (Baltimore) ; 99(31): e21434, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756153

RESUMO

RATIONALE: Intracranial aneurysm with the first manifestation of acute subdural hematoma (aSDH) is rare in the field of neurosurgery. Usually subarachnoid hemorrhage or intracranial hematoma happens after the rupture of an intracranial aneurysm, whereas trauma is the primary cause of aSDH. PATIENT CONCERNS: Here, we present the case of a 71-year-old woman who presented with spontaneous aSDH with progressive headache and vomiting. DIAGNOSIS: Urgent head computed tomography (CT) identified an aSHD, but the patient had no history of trauma. CT angiography (CTA) identified the cause of the aSDH as rupture of an intracranial aneurysm in the left middle cerebral artery. INTERVENTIONS: Emergent craniotomy with hematoma evacuation was performed. OUTCOMES: Due to prompt diagnosis and appropriate intervention, the patient recovered fully with no disability. LESSONS: This unique case demonstrates that aSDH caused by intracranial aneurysm rupture requires timely identification and appropriate action to prevent adverse outcomes. We performed a comprehensive systematic literature review to examine the etiology and pathogenesis of non-traumatic aSDH. Furthermore, digital subtraction angiography should be considered in patients diagnosed with an aSDH with no known cause.


Assuntos
Angiografia Digital/métodos , Hematoma Subdural Agudo/etiologia , Aneurisma Intracraniano/patologia , Artéria Cerebral Média/diagnóstico por imagem , Ruptura/complicações , Adulto , Idoso , Angiografia Digital/normas , Angiografia por Tomografia Computadorizada/métodos , Craniotomia/métodos , Feminino , Cefaleia/etiologia , Hematoma Subdural Agudo/diagnóstico por imagem , Hematoma Subdural Agudo/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/patologia , Resultado do Tratamento , Vômito/etiologia
2.
Medicine (Baltimore) ; 99(21): e20291, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481310

RESUMO

Burr-hole craniostomy (BHC) is a widely accepted treatment for chronic subdural hematomas (CSDHs). This study adopted siphon irrigation to evacuate CSDHs and investigated its efficacy and safety as compared with the traditional irrigation used in BHC.A retrospective cohort study was conducted at a center between January 2017 and December 2018. The data of 171 patients who underwent burr-hole craniostomy for CSDH were collected and analyzed. A total of 68 patients underwent siphon irrigation (siphon group) and 103 patients were treated by a traditional method (control group). A follow-up was conducted 6 months after the surgery.No significant difference was observed in the baseline characteristics and preoperative computed tomography (CT) features of the 2 groups (P > .05). The postoperative CT features of the siphon group, which included the volume of hematoma evacuation (P = .034), hematoma evacuation rate (P < .001), recovery rate of the midline shift (P = .017), and occurrence of pneumocephalus (P = .037) were significantly different and better than those of the control group. The length of hospital stay after surgery of the siphon group was significantly shorter than that of the control group (P = .015). The Markwalder score of the siphon group was significantly superior to that of the control group on postoperative day 1 (P = .006). Although the recurrence rate in the siphon group (2/68, 2.5%) was lower than that in the control group (11/103, 8.9%), no statistically significant difference was observed between them (P = .069). Moreover, no significant differences were observed in terms of complications and mortality rate between the 2 groups.There was no significant difference in the recurrence rate between the groups that underwent siphon irrigation and traditional irrigation. However, in comparison, siphon irrigation can better improve postoperative CT features, promote early recovery of neurological dysfunction after surgery, and shorten the length of hospital stay. This indicates that siphon irrigation may be a better therapeutic option in BHC for CSDH.


Assuntos
Craniotomia/métodos , Hematoma Subdural Crônico/cirurgia , Trepanação/instrumentação , Idoso , Drenagem/métodos , Desenho de Equipamento , Feminino , Seguimentos , Hematoma Subdural Crônico/diagnóstico , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Irrigação Terapêutica/instrumentação , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
Acta Cir Bras ; 35(4): e202000406, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32578724

RESUMO

PURPOSE: To investigate the role of Rosmarinic acid (RA) in the prevention of traumatic brain injury and the immunohistochemical analysis of IBA-1 and GFAP expressions. METHODS: Healthy male rats were randomly divided into 3 groups consisting of 10 rats. Groups were as follows; control group, traumatic brain injury (TBI) group, and TBI+RA group. After traumatic brain injury, blood samples were taken from the animals and analyzed with various biochemical markers. And then IBA-1 and GFAP expressions were evaluated immunohistochemically. RESULTS: Significant results were obtained in all biochemical parameters between groups. Immunohistochemical sections showed IBA-1 not only in microglia and macrophage activity but also in degenerative neurons in blood vessel endothelial cells. However, GFAP reaction and post-traumatic rosmarinic acid administration showed positive expression in astrocytes with regular structure around the blood vessel. CONCLUSION: Rosmarinic acid in blood vessel endothelial cells showed that preserving the integrity of astrocytic structure in the blood brain barrier may be an important antioxidant.


Assuntos
Lesões Encefálicas Traumáticas/prevenção & controle , Proteínas de Ligação ao Cálcio/análise , Cinamatos/farmacologia , Craniotomia/métodos , Depsídeos/farmacologia , Proteína Glial Fibrilar Ácida/análise , Proteínas dos Microfilamentos/análise , Fármacos Neuroprotetores/farmacologia , Animais , Astrócitos/efeitos dos fármacos , Lesões Encefálicas Traumáticas/patologia , Lesões Encefálicas Traumáticas/cirurgia , Glutationa Peroxidase/análise , Imuno-Histoquímica , Masculino , Malondialdeído/análise , Distribuição Aleatória , Ratos Sprague-Dawley , Valores de Referência , Reprodutibilidade dos Testes
4.
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.
Nat Protoc ; 15(6): 1992-2023, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32405052

RESUMO

Cranial microsurgery is an essential procedure for accessing the brain through the skull that can be used to introduce neural probes that measure and manipulate neural activity. Neuroscientists have typically used tools such as high-speed drills adapted from dentistry to perform these procedures. As the number of technologies available for neuroscientists has increased, the corresponding cranial microsurgery procedures to deploy them have become more complex. Using a robotic tool that automatically performs these procedures could standardize cranial microsurgeries across neuroscience laboratories and democratize the more challenging procedures. We have recently engineered a robotic surgery platform that utilizes principles of computer numerical control (CNC) machining to perform a wide variety of automated cranial procedures. Here, we describe how to adapt, configure and use an inexpensive desktop CNC mill equipped with a custom-built surface profiler for performing CNC-guided microsurgery on mice. Detailed instructions are provided to utilize this 'Craniobot' for performing circular craniotomies for coverslip implantation, large craniotomies for implanting transparent polymer skulls for cortex-wide imaging access and skull thinning for intact skull imaging. The Craniobot can be set up in <2 weeks using parts that cost <$1,500, and we anticipate that the Craniobot could be easily adapted for use in other small animals.


Assuntos
Craniotomia/instrumentação , Microcirurgia/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Crânio/cirurgia , Animais , Craniotomia/métodos , Desenho de Equipamento , Feminino , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Microcirurgia/métodos , Procedimentos Cirúrgicos Robóticos/métodos
7.
World Neurosurg ; 139: 603, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32360676

RESUMO

Cavernous malformations of the midbrain require careful consideration of the risks and benefits of intervention as well as the optimal surgical approach for these challenging lesions. Excellent results can be achieved with careful surgical planning and technique. We demonstrate a contralateral left pterional craniotomy for a translamina terminalis approach to carbon dioxide laser-assisted microsurgical resection of a thalamomesencephalic cavernoma in a 59-year-old woman with progressive debilitating diplopia secondary to partial third nerve palsy (Video 1). We performed a contralateral left modified pterional craniotomy in which we limited dissection of the temporalis muscle to approximately one third rather than extending the muscle split down to the zygoma. The cavernous malformation was resected with no complications, and the patient was discharged from the hospital on postoperative day 3. She noted immediate improvement and nearly complete resolution of symptoms over ensuing weeks. This approach offers a direct route to the lesion with minimal brain transgression, while avoiding the critical structures within the interpeduncular cistern, including the basilar artery and thalamomesencephalic perforating arteries, as well as bordering neural structures, including cerebral peduncles, oculomotor nerves, and mamillary bodies. Use of the carbon dioxide laser with its 0.55-mm tip offers a low surgical profile and allows for precise cutting, thus minimizing thermal damage to surrounding tissues. The translamina terminalis approach through a pterional craniotomy offers a safe and potentially less morbid alternative to select thalamomesencephalic lesions compared with exposure through the mesencephalic surface, which in our experience often necessitates an orbitozygomatic craniotomy.


Assuntos
Craniotomia/métodos , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Terapia a Laser/métodos , Tálamo/cirurgia , Feminino , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Tálamo/diagnóstico por imagem
8.
Medicine (Baltimore) ; 99(18): e19937, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358365

RESUMO

RATIONALE: We report a stroke patient who showed increased thalamocortical connectivity to the medial prefrontal cortex (mPFC) with recovery of impaired consciousness that was demonstrated on diffusion tensor tractography (DTT) of the ascending reticular activating system (ARAS). PATIENTS CONCERNS: A 48-year-old male patient underwent craniectomy and hematoma removal for spontaneous intracerebral hemorrhage in the right basal ganglia and thalamus. When he started rehabilitation at 5 weeks after onset he was in a vegetative state with a Coma Recovery Scale-Revised score of 6. DIAGNOSES: The patient was diagnosed spontaneous intracerebral hemorrhage in the right basal ganglia and thalamus. INTERVENTIONS: He underwent comprehensive rehabilitation including neurotropic durgs, transcranial direct current stimulation, and repetitive transcranial magnetic stimulation of the left prefrontal lobe (Brodmann area 10). OUTCOMES: After 5 weeks of rehabilitation, the patient had recovered to a nearly normal conscious state with a Coma Recovery Scale-Revised score of 22. On 10-week DTT, thickening of the lower dorsal ARAS was observed on both sides compared with 5-week DTT. Decreased neural connectivity to the left PFC was observed on 5-week DTT whereas decreased neural connectivity to the left PFC was increased on 10-week DTT, especially the mPFC. LESSONS: Increased thalamocortical connectivity to the mPFC was demonstrated in a stroke patient who showed concomitant recovery from a vegetative state to a nearly normal conscious state. The results suggest that the increased neural connectivity to the mPMC contributed to recovery of consciousness in this patient.


Assuntos
Coma/fisiopatologia , Imagem de Tensor de Difusão/métodos , Estado Vegetativo Persistente/fisiopatologia , Córtex Pré-Frontal/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Hemorragia Cerebral/complicações , Coma/diagnóstico por imagem , Coma/etiologia , Estado de Consciência , Craniotomia/métodos , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estado Vegetativo Persistente/diagnóstico por imagem , Estado Vegetativo Persistente/etiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Reabilitação do Acidente Vascular Cerebral/métodos
9.
J Clin Neurosci ; 77: 41-48, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32409219

RESUMO

Hypnosis could extend the time of Intraoperative Neuropsychological Testing and Brain Mapping in Awake Surgery. A clinical validation for the Hypnosis aided AS (HAs) is still ongoing and further evidences are required. The objective of the present study is to compare two homogeneous cohorts of patients undergoing AS, the first with the aid of the hypnosis and the second according to a standard AS (SAs) protocols. The clinical, radiological and surgical data of two comparable procedures cohorts were retrospectively examined for the present study. All surgeries in Group A were performed with a HAs protocol. Procedures belonging to Group B were performed with a SAs protocol. Endpoints: to compare 1. Incidence of complications in the immediate postoperative period, 2. Clinical and neurological status in the immediate postoperative period and 30 days after surgery, 3. Duration of surgical interventions, 4. Extent of Resection (EOR). The final cohort is composed of 15 procedures; 6 belonging to Group A and 9 to Group B. The different methods outline statistically comparable results from the clinical (Neurological outcomes) both in the postoperative period and one month after surgery and from the surgical point of view (comparable EOR). The incidence of complications is comparable either. The duration of the procedures was significantly longer in HAs group. Hypnosis is a promising approach to increasing the duration of intraoperative "testability" of patients at the price of a longer operative time. A specific professional is needed to induce hypnosis in the difficult intraoperative setting.


Assuntos
Neoplasias Encefálicas/cirurgia , Gerenciamento Clínico , Glioma/cirurgia , Hipnose/métodos , Monitorização Intraoperatória/métodos , Vigília , Adulto , Mapeamento Encefálico/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/psicologia , Estudos de Coortes , Craniotomia/métodos , Feminino , Glioma/diagnóstico por imagem , Glioma/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores/métodos , Testes Neuropsicológicos , Duração da Cirurgia , Estudos Retrospectivos
10.
World Neurosurg ; 138: e955-e960, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-274866

RESUMO

OBJECTIVE: The novel coronavirus disease 2019 (COVID-19) pandemic poses a substantial threat to the health of health care personnel on the front line of caring for patients with COVID-19. The Centers for Medicare and Medicaid Services have announced that all nonessential planned surgeries and procedures should be postponed until further notice and only urgent procedures should proceed. Neurologic surgeries and procedures should not be delayed under the circumstance in which it is essential at saving a life or preserving functioning of the central nervous system. METHODS: With the intent to advise the neurosurgery team on how to adequately prepare and safely perform neurosurgical procedures on confirmed and suspected patients with COVID-19, we discuss considerations and recommendations based on the lessons and experience shared by neurosurgeons in China. RESULTS: Perioperative and intraoperative strategies, considerations, as well as challenges arisen under the specific circumstance have been discussed. In addition, a case of a ruptured aneurysm in a suspected patient with COVID-19 is reported. It is advised that all health care personnel who immediately participate in neurosurgical surgeries and procedures for confirmed and suspected patients with COVID-19 should take airborne precautions and wear enhanced personal protective equipment. CONCLUSIONS: Following the proposed guidance, urgent neurosurgical surgeries and procedures can be safely performed for the benefit of critical patients with or suspected for COVID-19.


Assuntos
Aneurisma Roto/cirurgia , Infecções por Coronavirus/diagnóstico , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Pneumonia Viral/diagnóstico , Hemorragia Subaracnóidea/cirurgia , Filtros de Ar , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Betacoronavirus , China , Técnicas de Laboratório Clínico , Angiografia por Tomografia Computadorizada , Infecções por Coronavirus/complicações , Craniotomia/métodos , Drenagem , Emergências , Hematoma/complicações , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Pressão Intracraniana , Cuidados Intraoperatórios , Pulmão/diagnóstico por imagem , Monitorização Fisiológica , Salas Cirúrgicas , Pandemias , Assistência Perioperatória , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Estados Unidos
11.
World Neurosurg ; 138: e955-e960, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-124982

RESUMO

OBJECTIVE: The novel coronavirus disease 2019 (COVID-19) pandemic poses a substantial threat to the health of health care personnel on the front line of caring for patients with COVID-19. The Centers for Medicare and Medicaid Services have announced that all nonessential planned surgeries and procedures should be postponed until further notice and only urgent procedures should proceed. Neurologic surgeries and procedures should not be delayed under the circumstance in which it is essential at saving a life or preserving functioning of the central nervous system. METHODS: With the intent to advise the neurosurgery team on how to adequately prepare and safely perform neurosurgical procedures on confirmed and suspected patients with COVID-19, we discuss considerations and recommendations based on the lessons and experience shared by neurosurgeons in China. RESULTS: Perioperative and intraoperative strategies, considerations, as well as challenges arisen under the specific circumstance have been discussed. In addition, a case of a ruptured aneurysm in a suspected patient with COVID-19 is reported. It is advised that all health care personnel who immediately participate in neurosurgical surgeries and procedures for confirmed and suspected patients with COVID-19 should take airborne precautions and wear enhanced personal protective equipment. CONCLUSIONS: Following the proposed guidance, urgent neurosurgical surgeries and procedures can be safely performed for the benefit of critical patients with or suspected for COVID-19.


Assuntos
Aneurisma Roto/cirurgia , Infecções por Coronavirus/diagnóstico , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Pneumonia Viral/diagnóstico , Hemorragia Subaracnóidea/cirurgia , Filtros de Ar , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Betacoronavirus , China , Técnicas de Laboratório Clínico , Angiografia por Tomografia Computadorizada , Infecções por Coronavirus/complicações , Craniotomia/métodos , Drenagem , Emergências , Hematoma/complicações , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Pressão Intracraniana , Cuidados Intraoperatórios , Pulmão/diagnóstico por imagem , Monitorização Fisiológica , Salas Cirúrgicas , Pandemias , Assistência Perioperatória , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Estados Unidos
12.
World Neurosurg ; 138: 408-410, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32247791

RESUMO

Civilian gunshot wounds to the brain are associated with high overall mortality; however, outcomes can vary significantly depending on bullet trajectory. This report details the outcome of a patient who sustained a bifrontal gunshot wound with multiple associated calvarial and frontal sinus fractures. Although surgery for penetrating brain injury is most frequently employed for relief of mass effect and decompression of vital structures, this case report describes a more comprehensive technique involving duroplasty, obliteration of the frontal sinus, and cranial vault reconstruction with the aim of decreasing the rate of cerebrospinal fluid leak, infection, reoperation, and readmission.


Assuntos
Encéfalo/cirurgia , Craniotomia/métodos , Traumatismos Cranianos Penetrantes/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ferimentos por Arma de Fogo/cirurgia , Encéfalo/patologia , Drenagem , Feminino , Traumatismos Cranianos Penetrantes/etiologia , Traumatismos Cranianos Penetrantes/patologia , Humanos , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/cirurgia , Pessoa de Meia-Idade , Crânio/patologia , Crânio/cirurgia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/patologia
13.
World Neurosurg ; 138: e859-e866, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32251832

RESUMO

OBJECTIVE: The minipterional approach (MPTa) has been widely accepted as a minimally invasive technique in the treatment of anterior and middle cranial fossa lesions. However, this craniotomy does not facilitate exposure of the distal sylvian fissure or wide sylvian dissection. We have described a modification of the MPTa, the extended minipterional approach (eMPTa), which results in improved access to the distal sylvian fissure with minimal additional bony removal. We have defined the ideal posterior landmark for this craniotomy, the preauricular line, using an anatomic cadaveric study. METHODS: The insular and sylvian exposure offered by the MPTa and eMPTa were compared in 5 cadaveric heads. Anatomic exposure of the eMPTa and its anatomic relation to different landmarks were also evaluated. RESULTS: The eMPTA, extending posteriorly to the preauricular line, offers improved surgical exposure of the sylvian fissure (30.5 vs. 13 mm; P < 0.001) and insula (31 vs. 10 mm; P < 0.001) compared with the MPTa. The frontal precentral artery, an important landmark for performing distal-to-proximal sylvian dissection, is 17 ± 5.2 mm anterior to the preauricular line, the posterior limit of the eMPTa. In contrast, it is 6.5 ± 3.6 mm posterior to the traditional posterior limit of the MPTa. CONCLUSION: The eMPTA offers improved access to the sylvian fissure, allowing for wider fissure splitting and only requiring extension of the posterior limit of the MPT craniotomy up to the preauricular line. This could allow for improved freedom of movement deep in the sylvian cistern and potentially expand the indications of the MPTa.


Assuntos
Córtex Cerebral/cirurgia , Craniotomia/métodos , Dissecação/métodos , Córtex Cerebral/irrigação sanguínea , Fossa Craniana Anterior/cirurgia , Fossa Craniana Média/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
14.
World Neurosurg ; 138: e955-e960, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32344132

RESUMO

OBJECTIVE: The novel coronavirus disease 2019 (COVID-19) pandemic poses a substantial threat to the health of health care personnel on the front line of caring for patients with COVID-19. The Centers for Medicare and Medicaid Services have announced that all nonessential planned surgeries and procedures should be postponed until further notice and only urgent procedures should proceed. Neurologic surgeries and procedures should not be delayed under the circumstance in which it is essential at saving a life or preserving functioning of the central nervous system. METHODS: With the intent to advise the neurosurgery team on how to adequately prepare and safely perform neurosurgical procedures on confirmed and suspected patients with COVID-19, we discuss considerations and recommendations based on the lessons and experience shared by neurosurgeons in China. RESULTS: Perioperative and intraoperative strategies, considerations, as well as challenges arisen under the specific circumstance have been discussed. In addition, a case of a ruptured aneurysm in a suspected patient with COVID-19 is reported. It is advised that all health care personnel who immediately participate in neurosurgical surgeries and procedures for confirmed and suspected patients with COVID-19 should take airborne precautions and wear enhanced personal protective equipment. CONCLUSIONS: Following the proposed guidance, urgent neurosurgical surgeries and procedures can be safely performed for the benefit of critical patients with or suspected for COVID-19.


Assuntos
Aneurisma Roto/cirurgia , Infecções por Coronavirus/diagnóstico , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Pneumonia Viral/diagnóstico , Hemorragia Subaracnóidea/cirurgia , Filtros de Ar , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Betacoronavirus , China , Técnicas de Laboratório Clínico , Angiografia por Tomografia Computadorizada , Infecções por Coronavirus/complicações , Craniotomia/métodos , Drenagem , Emergências , Hematoma/complicações , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Pressão Intracraniana , Cuidados Intraoperatórios , Pulmão/diagnóstico por imagem , Monitorização Fisiológica , Salas Cirúrgicas , Pandemias , Assistência Perioperatória , Equipamento de Proteção Individual , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Estados Unidos
15.
World Neurosurg ; 139: 588-591, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32344145

RESUMO

BACKGROUND: Orbital compartment syndrome (OCS) is a rare post operative complication of Neurosurgery. It presents typically acutely with loss of vision, loss of pupillary reaction, and limitation of extraocular movement. The etiology of OCS is most typically associated with increased pressure from a mass lesion in the orbit compromising the blood supply of orbital structures. Emergent bedside decompression of the orbit by lateral canthotomy is indicated to quickly treat OCS in an attempt to save visual acuity and extraocular function. CASE DESCRIPTION: We report a 76-year-old male patient whose magnetic resonance imaging of the brain demonstrated an anterior right frontal broad dural-based homogenously enhancing mass measuring 6.0 × 3.1 × 6.3 cm after he presented with 1-year of progressive cognitive dysfunction. A right-sided pterional craniotomy and resection of mass was performed under general anesthesia, with an uncomplicated intraoperative course. Postoperatively, the right eye was noted to have an afferent pupillary defect, complete ophthalmoplegia, ptosis, and significant resistance to retropulsion. Emergent ophthalmologic consultation confirmed the ocular examination, and the diagnosis of right OCS was suspected. A right lateral canthotomy and cantholysis was performed by the ophthalmologist at the bedside. The fundoscopic retinal evaluation was normal. Noncontrast computed tomography of the head demonstrated expected postoperative changes and mild edema of the right frontal lobe without evidence of acute hemorrhage. There was no retro-orbital hematoma, but the right extra-ocular muscles appeared edematous compared to the left. No light perception and ophthalmoplegia continued in the right eye. CONCLUSIONS: This case demonstrates that although very rare, OCS can occur without compression of the eye or an intra-orbital mass. Visual loss is a devastating complication. Constant vigilance to ensure adequate arterial and venous supply to the orbit, with great care to prevent external compression on the eye, hopefully, will continue to make this complication rare.


Assuntos
Neoplasias Encefálicas/cirurgia , Síndromes Compartimentais/cirurgia , Craniotomia/métodos , Lobo Frontal/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Órbita/cirurgia , Idoso , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Síndromes Compartimentais/diagnóstico por imagem , Síndromes Compartimentais/etiologia , Descompressão Cirúrgica/métodos , Lobo Frontal/diagnóstico por imagem , Humanos , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/complicações , Meningioma/diagnóstico por imagem , Órbita/diagnóstico por imagem
16.
World Neurosurg ; 139: 7-11, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32278819

RESUMO

BACKGROUND: Awake craniotomy (AC) with brain mapping has been successfully used for the resection of lesions located in or near eloquent areas of the brain. The selection process includes a thorough presurgical evaluation to determine candidates suitable for the procedure. Psychiatric disorders including post-traumatic stress disorder (PTSD) are considered potential contraindications for this type of surgery because these patients may be less cooperative to tolerate AC. Here we present the management of a patient with PTSD who underwent an AC using a multidisciplinary team for removal of a dominant hemisphere low-grade insular glioma with speech, motor, and cognitive mapping. CASE DESCRIPTION: A 34-year-old right-handed male military veteran with a previous history of PTSD was scheduled for a left AC for resection of a low-grade insular glioma. He underwent preoperative neurocognitive assessment with a neuropsychologist and clinic visit with a neurosurgeon to characterize his PTSD and potential triggers, explain the procedure in a stepwise fashion, and address any concerns. The intraoperative environment was modified to minimize triggering stimuli, and an asleep-awake-asleep anesthetic protocol was followed. The patient tolerated the procedure well without any postoperative neurologic deficits including cognitive deficits. At 1-month follow-up, he denied any worsening of his PTSD symptoms and recalls the AC as a positive experience. CONCLUSIONS: With a multidisciplinary team, adequate preoperative education, detailed clinical interview to identify triggers, and a controlled intraoperative environment, awake surgery can be carried out safely in a patient with PTSD.


Assuntos
Neoplasias Encefálicas/cirurgia , Craniotomia/métodos , Glioma/cirurgia , Cuidados Intraoperatórios/métodos , Transtornos de Estresse Pós-Traumáticos/psicologia , Veteranos , Vigília , Adulto , Anestesia Geral , Mapeamento Encefálico/métodos , Mapeamento Encefálico/psicologia , Neoplasias Encefálicas/complicações , Craniotomia/psicologia , Glioma/complicações , Humanos , Cuidados Intraoperatórios/psicologia , Masculino , Neuropsicologia , Neurocirurgiões , Equipe de Assistência ao Paciente , Educação de Pacientes como Assunto , Transtornos de Estresse Pós-Traumáticos/complicações
17.
World Neurosurg ; 139: 200-207, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32311556

RESUMO

BACKGROUND: Awake craniotomy with brain mapping aims to maximize resection of gliomas located within eloquent regions while minimizing the risk of postoperative deficits. This technique is common practice in the developed world but has yet to be implemented in most low- and middle-income countries (LMICs). We assessed the feasibility, safety, and efficiency of functional-based glioma resection using minimal facilities in a limited-resource institution. METHODS: This is a retrospective review of patients harboring gliomas within eloquent regions who underwent awake craniotomy and tumor resection guided by cortico-subcortical mapping at a tertiary hospital of an LMIC. Patient characteristics, surgical results, and functional outcomes were studied. RESULTS: Twenty consecutive patients with a mean age of 37 years were enrolled in the study. Seizure, present in 70% of patients, was the major presenting symptom. Eighteen patients had diffuse low-grade gliomas and 2 patients had high-grade gliomas. Intraoperative events were dominated by seizures, occurring in 5 patients (25%). The average extent of tumor removal was 89.5% and the rate of total and subtotal removal was 85%. New postoperative deficits were observed in 5 patients (25%), and permanent deficits were found in 1 patient (5%). The main hurdles encountered were the difficulties in investigating patients and human resource availability. CONCLUSIONS: Awake craniotomy with brain mapping for functional-based resection of gliomas can be safely achieved in a limited-resource institution with good functional and oncologic results.


Assuntos
Mapeamento Encefálico/métodos , Neoplasias Encefálicas/cirurgia , Craniotomia/métodos , Glioma/cirurgia , Adulto , Neoplasias Encefálicas/patologia , Estudos de Viabilidade , Feminino , Glioma/patologia , Recursos em Saúde , Humanos , Tempo de Internação , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Marrocos , Gradação de Tumores , Neoplasia Residual , Duração da Cirurgia , Complicações Cognitivas Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Convulsões/epidemiologia , Vigília , Adulto Jovem
18.
World Neurosurg ; 138: 352-354, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32217178

RESUMO

BACKGROUND: Fetal trauma during pregnancy can have a significant impact on the developing brain. Fetal trauma can lead to several intracranial pathologies including hypoxic-ischemic injury, skull fractures, and intracranial hemorrhages. Blunt trauma to a fetus resulting in the need for neurosurgical intervention is a rare occurrence and seldom described in the literature. CASE DESCRIPTION: Here we present the case of a 28-year-old, 36-week pregnant woman who was brought to the hospital by ambulance following a high-speed motor vehicle collision as the restrained driver. On computed tomography of the abdomen, the fetus was found to have a left-sided skull fracture with intracranial hemorrhage. The fetus was emergently delivered by way of caesarean section for lack of fetal movement and indeterminate heart tracings. Postnatally, the neonate had a Glasgow Coma Scale of 7. A postnatal head computed tomography better defined the skull fractures and multiple areas of intracranial hemorrhage. The baby was taken to the operating room for evacuation of the hematomas. At 16 months of age, the baby was well with only mild developmental delay, although a ventriculoperitoneal shunt was needed in a delayed fashion at 3 months of age. CONCLUSIONS: We present a rare situation where emergent caesarean section delivery followed by neonatal craniotomy was necessary. Our case illustrates that good outcomes can be achieved with rapid identification of fetal intracranial injury and intervention.


Assuntos
Craniotomia/métodos , Hemorragias Intracranianas/cirurgia , Lesões Pré-Natais/cirurgia , Fraturas Cranianas/cirurgia , Acidentes de Trânsito , Adulto , Feminino , Humanos , Recém-Nascido , Hemorragias Intracranianas/etiologia , Gravidez , Lesões Pré-Natais/etiologia , Fraturas Cranianas/etiologia
19.
World Neurosurg ; 138: e289-e298, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32112942

RESUMO

BACKGROUND: Minimally invasive craniotomy (MIC) for ruptured aneurysm remains a debatable issue because of unclear information regarding its safety and efficacy compared with standard approaches. Here, we compared the outcomes between MIC and pterional craniotomy (PTC) for the treatment of ruptured anterior circulation aneurysms. METHODS: A database of patients with ruptured anterior circulation aneurysm who were treated with surgical clipping was reviewed. With the use of propensity score matching to balance the baseline characteristics of MIC and PTC groups, outcomes of the 2 groups were compared. Clinical predictors of favorable outcomes (modified Rankin scale score 0-2) were evaluated by using uni- and multivariate analyses. RESULTS: A total of 102 matched pairs were identified. MIC resulted in a significantly shorter operative time (2.8 ± 0.9 vs. 4.2 ± 0.7 hours; P = 0.004) and hospital stay (14.2 ± 5.9 vs. 19.2 ± 9.1 days; P < 0.001), respectively. Both MIC and PTC had similar mortality and complication rates except for the incidences of intracranial hemorrhage (2% vs. 9.8%; P = 0.039) and brain injury (9.8% vs. 27.5%; P = 0.036), respectively. Use of MIC instead of standard surgery and lower World Federation of Neurosurgical Societies (WFNS) grade and absence of hydrocephalus were significant predictors of favorable outcome at 1 month, whereas higher WFNS grade and higher Fisher grade were significantly associated with a poor outcome at 6 months. CONCLUSIONS: For the treatment of ruptured anterior circulation aneurysms, MIC was comparable with PTC and presented additional advantage in terms of earlier recovery. Therefore, MIC can be considered an alternative surgical treatment in this setting.


Assuntos
Aneurisma Roto/cirurgia , Craniotomia/métodos , Aneurisma Intracraniano/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
World Neurosurg ; 138: e381-e388, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32145412

RESUMO

BACKGROUND: The necessity and timing of early postoperative imaging (POI) are debated in many studies. Despite the consensus that early POI does not change patient management, these examinations are routinely performed. This is the first prospective study related to POI. Our aims were to assess the necessity of early POI in asymptomatic patients and to verify accuracy of the presented algorithm. METHODS: This was an algorithm-based prospective single-center study. The algorithm addressed preoperative, perioperative, and postoperative considerations, including estimated pathology type, device placement, and postoperative neurologic change. Early computed tomography scans were obtained in all patients, but if postoperative algorithm indications did not recommend a scan, the treating team was blinded to them, and patient management was conducted based on clinical examinations alone. A neuroradiologist and study-independent neurosurgeon reviewed all the scans. RESULTS: Of 103 enrolled patients, 88 remained asymptomatic, and 15 experienced symptoms postoperatively. Pathology was present on POI in 1% of the asymptomatic patients and 53% of the symptomatic patients (P < 0.001). In the asymptomatic group, no treatment modifications were made postoperatively. Blinding of the surgical team was not removed, and 20% of the symptomatic patients returned to the operating room because of imaging and neurologic findings. The goal of <5% algorithm failure was reached with statistical significance. CONCLUSIONS: In asymptomatic postoperative patients in whom early imaging is not performed for oncologic indications, device placement verification, or similar reasons, POI is unnecessary and does not change the management of these patients.


Assuntos
Encéfalo/diagnóstico por imagem , Craniotomia/métodos , Neuroimagem , Cuidados Pós-Operatórios , Adulto , Idoso , Algoritmos , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
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