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1.
Int J Nanomedicine ; 15: 3729-3740, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32547025

RESUMO

Background: Duraplasty is one of the most critical issues in neurosurgical procedures because the defect of dura matter will cause many complications. Electrospinning can mimic the 3D structure of the natural extracellular matrix whose structure is similar to that of dura matter. Poly(L-lactic acid) (PLLA) has been used to fabricate dura matter substitutes and showed compatibility to dural tissue. However, the mechanical properties of the PLLA substitute cannot match the mechanical properties of the human dura mater. Methods and Results: We prepared stereocomplex nanofiber membranes based on enantiomeric poly(lactic acid) and poly(D-lactic acid)-grafted tetracalcium phosphate via electrospinning. X-ray diffraction results showed the formation of stereocomplex crystallites (SC) in the composite nanofiber membranes. Scanning electron microscope observation images showed that composites nanofibers with higher SC formation can keep its original morphologies after heat treatment, suggesting the heat resistance of composite nanofiber membranes. Differential scanning calorimeter tests confirmed that the melting temperature of composite nanofiber membranes was approximately 222°C, higher than that of PLLA. Tensile testing indicated that the ultimate tensile strength and the elongation break of the stereocomplex nanofiber membranes were close to human dura matter. In vitro cytotoxicity studies proved that the stereocomplex nanofiber membranes were non-toxic. The neuron-like differentiation of marrow stem cells on the stereocomplex nanofiber membranes indicated its neuron compatibility. Conclusion: The stereocomplex nanofiber membranes have the potential to serve as a dura mater substitute.


Assuntos
Materiais Biomiméticos/química , Dura-Máter/fisiologia , Nanofibras/química , Poliésteres/química , Animais , Fosfatos de Cálcio/química , Varredura Diferencial de Calorimetria , Diferenciação Celular , Linhagem Celular , Cristalização , Humanos , Masculino , Células-Tronco Mesenquimais/citologia , Camundongos , Nanofibras/ultraestrutura , Neurônios/citologia , Ratos Sprague-Dawley , Estereoisomerismo , Temperatura , Difração de Raios X
3.
Zhonghua Shao Shang Za Zhi ; 36(3): 219-223, 2020 Mar 20.
Artigo em Chinês | MEDLINE | ID: mdl-32241048

RESUMO

Objective: To evaluate the clinical effects of anterolateral thigh free flap with fascia lata in the repair of dura mater defect after resection of head squamous cell carcinoma. Methods: From June 2016 to June 2018, Xijing Hospital of Air Force Medical University applied the free transplantation of anterolateral thigh flap with fascia lata to repair the dura mater defect of 12 patients with head squamous cell carcinoma, including 9 males and 3 females, aged from 35 to 74 years. The size of scalp soft tissue defects in patients after carcinoma resection ranged from 12 cm×10 cm to 24 cm×21 cm, and the size of dura mater defect of patients ranged from 7 cm×6 cm to 16 cm×14 cm. The size of flap of patients ranged from 14 cm×12 cm to 27 cm×24 cm, and the size of fascia lata ranged from 8 cm×7 cm to 17 cm×15 cm. The superficial temporal artery and middle temporal vein were connected by end to end anastomosis with the first musculocutaneous perforating branch of the descending branch of lateral femoral artery and its accompanying vein. The flap donor area was transplanted with autologous split-thickness skin graft from trunk and fixed with packing. Postoperative survival of flaps and skin grafts was observed. The patients were followed up regularly. The cranial magnetic resonance imaging was performed to observe the recurrence of intracranial tumors and dural integrity, shape of the flap and whether the donor site region was left with significant dysfunction were observed. Results: All the flaps and skin grafts survived well in 12 patients after surgery. Ten patients had primary healing at the edge of the flap suture; 2 patients had local sinus tract formation at the suture site of flap, with a small amount of cerebrospinal fluid leakage, and were recovered after outpatient dressing change. The patients were followed up for 10 to 36 months, and 3 patients with tumors involving in the dura mater sagittal sinus region had postoperative intracranial tumor recurrence. The tumor was resected again. All the patients had good dural integrity. The flaps of all patients were in good shape, and no obvious dysfunction remained in the flap donor site. Conclusions: Free transplantation of anterolateral thigh flap with fascia lata is an effective and reliable method to repair the dura mater defect following head squamous cell carcinoma resection. It can repair the scalp and dura mater defects caused by the invasion of squamous cell carcinoma and provide possibilities for skull reconstruction.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Dura-Máter , Fascia Lata/transplante , Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Adulto , Idoso , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Coxa da Perna , Resultado do Tratamento
4.
World Neurosurg ; 137: 415, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32058109

RESUMO

Trigeminal neuralgia is featured by episodic and severe unilateral facial pain triggered usually by innocuous cutaneous stimuli.1-4 Microvascular decompression (MVD) is a safe and effective treatment for cases refractory to medical treatment caused by neurovascular conflicts.1,5-7 This Video 1 demonstrates MVD using arachnoid membrane and petrosal dura to transpose dual offending arteries. Informed consent was obtained from the patient for publication of this operative video. The patient was a 64-year-old woman with refractory right trigeminal neuralgia (V2 territory). Preoperative magnetic resonance imaging demonstrated simultaneous conflict between the right trigeminal nerve (TN) and superior cerebellar (SCA) and anterior inferior cerebellar arteries (AICA). Due to progressive and refractory symptoms, MVD was indicated, with aid of neurophysiologic monitoring. A right retrosigmoid approach was employed and after exposure of the TN root, both AICA and SCA were identified conflicting with the nerve. The AICA was displaced inferolaterally and attached to the petrosal dura between the VII/VIII and IX cranial nerves using a USP #0 silk thread. The SCA was mobilized into a fissure created in the lateral pontomesencephalic arachnoid membrane and fixed with shredded Teflon (polytetrafluoroethylene). Another piece of Teflon was positioned between the TN and the proximal segment of AICA to lighten the pulling force from the thread. Postoperative imaging demonstrated no signs of cerebellar contusion or hemorrhage. The patient presented complete resolution of her pain, and no neurologic deficits were observed. We demonstrate MVD with 2 different transposition techniques that can be considered for trigeminal neuralgia with dual offending arteries (AICA, SCA).


Assuntos
Aracnoide-Máter/cirurgia , Cerebelo/irrigação sanguínea , Dura-Máter/cirurgia , Cirurgia de Descompressão Microvascular/métodos , Neuralgia do Trigêmeo/cirurgia , Cavidades Cranianas , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Vertebral
6.
J Clin Neurosci ; 72: 378-385, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31948884

RESUMO

INTRODUCTION: Spinal laminectomy is a common procedure performed to relieve neural compression in patients suffering from myelopathy or radiculopathy. However, up to 40% of patients suffer from persistent post-operative pain and disability, a condition known as Failed Back Surgery Syndrome (FBSS). Excessive scarring in the surgical bed is implicated as a cause. Hydrogels have been proposed to prevent adhesion formation post-laminectomy; however, their efficacy has not been proven. This study uses Chitogel complexed with the iron chelator Deferiprone (Def) to prevent adhesion formation in a sheep laminectomy model. MATERIAL & METHODS: Fifteen Adult Merino sheep (Ovis Aries, 1-5 yrs old) underwent laminectomy at lumbar levels 1-5 and had hydrated aluminum silicate (kaolin) applied to promote adhesion formation. Subjects were randomised to receive at each laminectomy level no-treatment control, Chitogel, Chitogel with Def at 20 mM or 40 mM or Carboxy-methyl-cellulose and Polyethylene oxide (CMC/PEO) gel. The animals were recovered for 3 months post-surgery, followed by assessment with Magnetic Resonance Imaging (MRI) and histopathology of the spinal tissues for evaluating the presence and extent of adhesions. RESULTS: MRI and Histology assessment indicated that Kaolin induced severe inflammation with adhesion formation. Chitogel with and without 20 mM Def decreased inflammation (p < 0.01) and trended to reduce adhesions (p < 0.1). Chitogel with Def 40 mM was not significantly dis-similar to CMC/PEO and did not reduce inflammation or adhesions compared to no-treatment control. CONCLUSION: Chitogel in combination with Def 20 mM is safe and effective in decreasing the inflammatory process and may possibly reduce post-operative adhesions following laminectomy.


Assuntos
Deferiprona/farmacologia , Laminectomia/efeitos adversos , Aderências Teciduais/prevenção & controle , Adulto , Animais , Cicatriz , Dura-Máter/patologia , Espaço Epidural/patologia , Síndrome Pós-Laminectomia , Feminino , Fibrose , Humanos , Vértebras Lombares/cirurgia , Masculino , Ovinos , Aderências Teciduais/patologia
7.
Nat Commun ; 11(1): 354, 2020 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-31953399

RESUMO

The mechanisms behind molecular transport from cerebrospinal fluid to dural lymphatic vessels remain unknown. This study utilized magnetic resonance imaging along with cerebrospinal fluid tracer to visualize clearance pathways to human dural lymphatics in vivo. In 18 subjects with suspicion of various types of cerebrospinal fluid disorders, 3D T2-Fluid Attenuated Inversion Recovery, T1-black-blood, and T1 gradient echo acquisitions were obtained prior to intrathecal administration of the contrast agent gadobutrol (0.5 ml, 1 mmol/ml), serving as a cerebrospinal fluid tracer. Propagation of tracer was followed with T1 sequences at 3, 6, 24 and 48 h after the injection. The tracer escaped from cerebrospinal fluid into parasagittal dura along the superior sagittal sinus at areas nearby entry of cortical cerebral veins. The findings demonstrate that trans-arachnoid molecular passage does occur and suggest that parasagittal dura may serve as a bridging link between human brain and dural lymphatic vessels.


Assuntos
Líquido Cefalorraquidiano/metabolismo , Dura-Máter/metabolismo , Vasos Linfáticos/metabolismo , Adulto , Idoso , Aracnoide-Máter/metabolismo , Transporte Biológico/fisiologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Líquido Cefalorraquidiano/diagnóstico por imagem , Meios de Contraste , Dura-Máter/diagnóstico por imagem , Dura-Máter/patologia , Humanos , Sistema Linfático/fisiologia , Vasos Linfáticos/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Compostos Organometálicos , Adulto Jovem
8.
World Neurosurg ; 136: 12-16, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31917311

RESUMO

BACKGROUND: Spinal cord herniation in the cervical spine is an exceptionally rare occurrence. It is most often cited in association with surgery and almost exclusively with a posterior approach. Herniation with an anterior approach has been reported in 3 cases after multilevel corpectomy, all of which involved herniation through a dural defect sustained during surgery. CASE DESCRIPTION: A 49-year-old man presented to the emergency room with generalized fatigue. He had a previous anterior C5 corpectomy and posterior cervical fusion from C2-T4 performed 17 years prior for a cervical kyphotic deformity that developed after a laminectomy. Magnetic resonance imaging of the cervical spine demonstrated a significant ventral cord herniation into the C5 ventral corpectomy site. The patient underwent a C4-6 vertebral corpectomy with C3-7 anterior reconstruction, fusion, and instrumentation with successful reduction and anatomic realignment of the spinal cord herniation. CONCLUSIONS: We present a case of cervical cord herniation that occurred into the ventral corpectomy site without obvious dural defect. We hypothesize that cerebral spinal pulsations over time degraded the corpectomy site and ultimately promoted herniation of the spinal cord. Here, we discuss the successful surgical management of this unique pathology and discuss a relevant review of the literature.


Assuntos
Vértebras Cervicais/cirurgia , Dura-Máter , Hérnia Ventral/etiologia , Doenças da Medula Espinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia
9.
World Neurosurg ; 136: 49-57, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31926358

RESUMO

BACKGROUND: At present, no consensus has been reached on the compartmental subdivision of the jugular foramen (JF), which can complicate surgical planning in this area and hinder understanding of foraminal tumor growth patterns. The extradural neural axis compartment (EDNAC) might aid in producing a standardized model in the future. In the present review, we have summarized the models of JF compartmentalization and analyzed how sound they are anatomically. METHODS: The present narrative review identified the key studies and supporting reports that had discussed, referenced, or first presented models of JF compartmentalization. RESULTS: Three intraforaminal components serve as the basis for JF compartmentalization: the fibro-osseous bridge, neurovascular contents, and EDNAC. A total of 4 models have been proposed to date. These include the 2-part (bipartite) models by Hovelacque (1934) and Shapiro (1972) and the 3-part (tripartite) subdivisions by Katsuta (1997) and Bernard (2018). CONCLUSIONS: The bipartite model has been criticized as being oversimplified and lacking surgical validity. However, support for this compartmentation has persisted despite the increasing popularity of the tripartite model. The 3-part subdivision of Bernard can be considered the most anatomically faithful model to date owing to the consideration of the dura and EDNAC. It is important that future studies consider the entire anatomy of the JF, which may generate an anatomically accurate and surgically applicable compartmental model.


Assuntos
Forâmen Jugular/anatomia & histologia , Nervo Acessório/anatomia & histologia , Cavidades Cranianas/anatomia & histologia , Dura-Máter/anatomia & histologia , Nervo Glossofaríngeo/anatomia & histologia , Humanos , Veias Jugulares/anatomia & histologia , Modelos Anatômicos , Osso Occipital/anatomia & histologia , Osso Petroso/anatomia & histologia , Nervo Vago/anatomia & histologia
10.
World Neurosurg ; 136: e578-e585, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31958589

RESUMO

OBJECTIVE: To determine the rate and anatomical location of dural tears associated with spinal surgery using a percutaneous biportal endoscopic surgery (PBES) technique. We investigated the relationship between dural tears and the type of procedure and type of instrument used. METHODS: We retrospectively analyzed 643 PBES cases by reviewing the medical records, operative records, and operative videos. Incidental durotomy was identified in 29 cases. We analyzed the size and anatomical location of the dural tears, the surgical instrument that caused the tear, and the technique used to seal the tear. RESULTS: The dural tear incidence was 4.5% (29 of 643 cases). Tears in the exiting nerve area (2 cases; 6.9%) had mainly been caused by curettage, tears in the thecal sac area (18 cases; 62.1%) were associated with electric drill and forceps use; and tears in the traversing nerve area were associated with the use of a Kerrison punch (9 cases; 31%). Of the 29 cases of dural tear, 12 were treated with in-hospital monitoring and bed rest, 14 were treated with a fibrin sealant, 2 were treated with a nonpenetrating titanium clip, and 1 was converted to microscopic surgery. One case of postoperative meningocele after conservative treatment required endoscopic revision surgery to close the dural tear. CONCLUSIONS: Most cases of incidental dural tear during PBES were treated with an endoscopic procedure. The incidence of dural tear was no greater than that associated with microscopic surgery. Our management strategy for incidental dural tears during PBES has been shown to be safe and effective.


Assuntos
Dura-Máter/lesões , Neuroendoscopia/efeitos adversos , Coluna Vertebral/cirurgia , Dura-Máter/cirurgia , Feminino , Adesivo Tecidual de Fibrina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/instrumentação , Duração da Cirurgia , Estudos Retrospectivos , Instrumentos Cirúrgicos , Adesivos Teciduais/uso terapêutico
11.
World Neurosurg ; 134: 540-543, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31786381

RESUMO

BACKGROUND: Intradural disk herniation (IDH) is defined as the displacement of the intervertebral disk nucleus pulposus into the dural sac. In this lumbar lesion, the affected level differs from that of a traditional extradural herniation: 55% of cases occur at the level of L4-5, 16% at L3-4, and 10% at L5-S1. Upper lumbar IDH is extremely rare. We present a case of an IDH at the level of L2-3 that was diagnosed during endoscopic surgery. CASE DESCRIPTION: A 65-year-old male patient presented with severe radiating pain in the anterior right thigh that was accompanied by a tingling sensation in the right calf and difficulty in walking. Physical examination showed normal strength. Bladder and bowel function was normal, but mild hypesthesia of the L3 sensory dermatome was observed. Magnetic resonance imaging revealed a herniated disk at the level of L2-L3 that was compressing the right side of the dura. A percutaneous transforaminal endoscopic lumbar diskectomy was planned. After foraminoplasty, no ruptured disk fragments could be found. During dissection of the adhesion between the dura and protruded disk, the dura was torn. Interestingly, through this dural opening, multiple fragmented disk portions were visualized among the nerve rootlets. We removed some of the soft disk material; however, complete removal of the disk fragments was predicted to damage the rootlets, and we decided to convert to microscopic surgery. The disk fragments were successfully removed via durotomy under microscopic assistance. The incised dorsal dura was primarily sutured with continuous stitches, and the defect on the ventrolateral side of the dura was patched and sealed using a harvested inner ligamentum flavum and Gelfoam (Pfizer, New York, New York, USA). After the operation, the patient's symptoms improved. There was no cerebrospinal fluid leakage. CONCLUSIONS: If there is any preoperative clinical or radiologic suspicion of IDH, a microscopic surgical approach should be considered to be the first-line option, as this is a safe and effective method for achieving IDH removal and dura repair without a postoperative neurologic deficit. Even during endoscopic surgery, if the surgeon expects even minor complications, we suggest converting to open surgery. In addition, the adequate sealing of the dura may be sufficient to prevent cerebrospinal fluid leakage, without the need for dural suture and lumbar drainage.


Assuntos
Dura-Máter/cirurgia , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Idoso , Discotomia Percutânea/métodos , Endoscopia/métodos , Humanos , Degeneração do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/diagnóstico , Região Lombossacral/cirurgia , Imagem por Ressonância Magnética , Masculino
12.
World Neurosurg ; 133: 256-259, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31629135

RESUMO

BACKGROUND: Endovascular embolization of the middle meningeal artery (MMA) is effective for recurrent chronic subdural hematoma (CSDH). CSDH associated with dural metastasis is generally refractory to burr hole surgery and has poor prognosis even if any interventions are applied. To the best of our knowledge, this study is the first to report a case of refractory CSDH associated with dural metastasis that was successfully treated with embolization of the MMA. CASE DESCRIPTION: A 66-year-old man with a 1-year history of lung adenocarcinoma had also undergone whole-brain irradiation for multiple brain metastases 5 months before presentation, surgical removal of relapse of brain metastases 3 months prior, and stereotactic radiotherapy for the relapses 1 month prior. He was admitted to our institution with speech disturbance, severe headache, and right-sided motor weakness. Head computed tomography on admission revealed left-sided CSDH, and emergency burr hole irrigation surgery was performed. However, CSDH recurred twice in a short period after hospitalization. Histological examination revealed adenocarcinoma cells in the dura mater and in hematoma samples during the first surgery; therefore, the patient was diagnosed with refractory CSDH associated with dural metastasis of lung adenocarcinoma. We performed endovascular embolization of the MMA, followed by systemic chemotherapy at 1 month after embolization, and no recurrence of the CSDH was observed. CONCLUSIONS: Embolization of the MMA has few surgical risks and could be a treatment option for refractory CSDH associated with dural metastasis because it might prolong the therapeutic time window until radical therapies are administered.


Assuntos
Adenocarcinoma de Pulmão/secundário , Dura-Máter/patologia , Embolização Terapêutica/métodos , Hematoma Subdural Crônico/terapia , Neoplasias Pulmonares/patologia , Artérias Meníngeas , Neoplasias Meníngeas/secundário , Adenocarcinoma de Pulmão/complicações , Idoso , Hematoma Subdural Crônico/complicações , Humanos , Neoplasias Pulmonares/complicações , Masculino , Neoplasias Meníngeas/complicações , Resultado do Tratamento
13.
World Neurosurg ; 134: e866-e873, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31715409

RESUMO

OBJECTIVE: To assess the dynamic change of the dural sac size in patients with lumbar spinal stenosis (LSS) from supine to standing position and their correlation with clinical symptoms. METHODS: A total of 110 patients with LSS were prospectively enrolled to undergo both supine (0°) and standing (78°) magnetic resonance imaging (MRI). Dural sac cross-sectional area (DCSA) and dural sac anteroposterior diameter (DAPD) at the most constricted spinal level in supine and standing MRI were measured and compared. Clinical symptoms were assessed by duration of disease, claudication distance, visual analog scale (VAS) score of leg pain, and Chinese Oswestry Disability Index score of low back pain. The correlation between the parameters and clinical symptoms was analyzed by Pearson correlation coefficient (r). RESULTS: Mean minimum DCSA and DAPD in the standing position were significantly smaller (both P < 0.01) than in the supine position. DCSA and DAPD in standing MRI and their changes had better correlation with the intermittent claudication distance and VAS score of leg pain than in the supine position. A more than 15 mm2 reduction of DSCA was observed in patients with shorter claudication distance and more severe VAS score of leg pain (both P < 0.01). CONCLUSIONS: Dural sac size on MRI was reduced significantly from supine to standing position. Standing MRI and the changes of DCSA significantly correlated with claudication distance and VAS score of leg pain in patients with LSS. Therefore, standing MRI provides more radiologic information correlating with clinical symptoms in patients with LSS than supine MRI.


Assuntos
Dura-Máter/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem , Posição Ortostática , Decúbito Dorsal , Adulto , Idoso , Dura-Máter/patologia , Feminino , Humanos , Perna (Membro) , Vértebras Lombares , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Dor/etiologia , Dor/fisiopatologia , Medição da Dor , Estenose Espinal/complicações , Estenose Espinal/fisiopatologia
14.
World Neurosurg ; 134: e624-e630, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31678318

RESUMO

BACKGROUND: Negative pressure wound therapy (NPWT) for deep spinal wound infections after exposure or opening of the dura can carry significant risks (i.e., cerebrospinal fluid infections and fistulas). In the present study, we reviewed a fairly large and recent experience with such patients. METHODS: We identified 25 patients with exposure and/or incision of the dura who had undergone NPWT from January 2014 to June 2018 for deep spinal wound infections. The demographic data, specifics of primary surgery and NPWT (i.e., dressing changes, duration, time required for wound healing), patients' clinical course, outcomes, and microbiological findings were studied. Application of a Granufoam vacuum dressing with a continuous negative pressure of 60 mm Hg was performed after proper debridement. RESULTS: Of the 25 patients, 13 were women and 12 were men (median age, 69 years). They had primarily undergone treatment for spinal tumors (n = 7), infections and degenerative disease (n = 8 each), or fractures (n = 2), with instrumentation in 18 patients (72%). The dura was exposed in all 25 patients and had been incised in 10 (40%) patients (intended incision, 3; accidental incision, 7). Most patients had been treated for a lumbar wound infection (64%). A microorganism was detected in 84% of the cases, with Staphylococcus aureus accounting for most of the infections (48%). NPWT was concluded after a median of 4 dressing changes (range, 2-14) and 19 days (range, 10-70), with no implant removal required in any patient. NPWT application was observed to be safe without cerebrospinal fluid-related complications. The presence of comorbidities (28% had diabetes) had no effect on the treatment results. CONCLUSIONS: NPWT can be safely applied for deep spinal wound infections after dura exposure or durotomy during previous spine surgery.


Assuntos
Dura-Máter/cirurgia , Tratamento de Ferimentos com Pressão Negativa , Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Reoperação , Estudos Retrospectivos , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/epidemiologia , Doenças da Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/microbiologia , Resultado do Tratamento , Adulto Jovem
15.
World Neurosurg ; 133: 29-33, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526887

RESUMO

BACKGROUND: Spinal dural arteriovenous fistula (DAVF) typically has a single intradural drainage vein, abnormally connecting with the radiculomeningeal artery at the dura root sleeve. Multiple intradural draining veins are extremely rare. To date, only 1 case of spinal DAVF with multiple draining veins has been reported. CASE DESCRIPTION: A 62-year-old woman presented with a 2-year history of progressive weakness and numbness in her lower extremities. Spinal magnetic resonance imaging showed extensive edema of the cord and prominent vascular flow voids. Spinal angiography demonstrated a right L3 DAVF with supply from the left L3 lumbar artery. The feeding artery was also thought to give rise to the artery of Adamkiewicz. The spinal DAVF was surgically treated, and the artery of Adamkiewicz was retained. Her postoperative symptoms gradually improved. Eight months after the surgery, her symptoms gradually worsened. Repeat spinal angiography revealed a right L3 DAVF at the same location of the first fistula. In retrospect, the draining vein identified on the second angiography was mistakenly considered as the artery of Adamkiewicz at the first angiography. Therefore the initial fistula was drained through double draining veins, 1 of them mimicking the artery of Adamkiewicz. The fistula was coagulated and divided. Postoperatively, the patient's symptoms gradually improved. Three months after the second surgery, she was able to walk independently. CONCLUSIONS: Spinal DAVF is a rare disease, but clinicians should be cautious of possible multiple drainage veins in diagnosis and treatment.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Dura-Máter/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Angiografia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Dura-Máter/irrigação sanguínea , Dura-Máter/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Doenças da Medula Espinal/cirurgia
16.
Forensic Sci Int ; 306: 110066, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31765884

RESUMO

In forensic evaluation of charred corpses, internal detrimental signs may result as more significant of those observed during external examination and is often arduous to state if a victim was exposed to fire before or after death. When the histological analysis of the remaining internal viscera is necessary, the massive destruction caused by the lesion, the charring and the coarctation of the samples don't allow to give further information or to determine the remaining organic components of the viscera. This limit is determined by the intrinsic characteristics of this thermal lesivity of self-maintenance even after the exitus of the subject, worsening the initial detrimental framework. The Authors, with the purpose of improving the microscopic visualization of the samples collected from cadavers with peculiar deterioration, as in case of carbonization, suggest the use of a specific technical protocol based on the use of Sandison's rehydrating solution since the samples treated with this solution showed, at microscopic examination, a substantial histological-morphological improvement.


Assuntos
Fogo , Patologia Legal/métodos , Soluções para Reidratação , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta/patologia , Encéfalo/patologia , Cadáver , Dura-Máter/patologia , Esôfago/patologia , Feminino , Humanos , Intestino Delgado/patologia , Rim/patologia , Fígado/patologia , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Pele/patologia , Baço/patologia , Adulto Jovem
17.
World Neurosurg ; 134: e951-e955, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31734429

RESUMO

OBJECTIVE: To evaluate the incidence and outcomes of incidental durotomy in transforaminal endoscopic spine surgery. METHODS: Transforaminal lumbar endoscopic procedures were performed by 2 surgeons in 907 patients over a period of 4 years from 2014 to 2018. Patient data were evaluated retrospectively in these patients with a minimum follow-up of 1 year. RESULTS: In 907 patients over 4 years there were 5 durotomies: 4 incidental and 1 intentional. The rate for incidental durotomy was therefore 0.4%. There were no adverse outcomes from the incidental durotomies, and only 1 patient noted a headache. CONCLUSIONS: Incidental durotomy is a rare complication of transforaminal lumbar endoscopic spine surgery and appears to occur more likely in patients who have undergone previous spine surgery at the site of the endoscopic procedure, not unexpectantly. Glues, patches, and bedrest were among the various methods used after durotomy. In this series there were no cases of symptomatic spinal fluid leakage or pseudomeningocele seen. Only 20% of patients who had durotomies noted a headache in the immediate postoperative period.


Assuntos
Vazamento de Líquido Cefalorraquidiano/epidemiologia , Dura-Máter/lesões , Cefaleia/epidemiologia , Complicações Intraoperatórias/epidemiologia , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adesivos , Adulto , Idoso de 80 Anos ou mais , Repouso em Cama , Vazamento de Líquido Cefalorraquidiano/etiologia , Discotomia/efeitos adversos , Feminino , Foraminotomia/efeitos adversos , Cefaleia/etiologia , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/terapia , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Fusão Vertebral/efeitos adversos
18.
World Neurosurg ; 134: e1115-e1120, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31785439

RESUMO

BACKGROUND: The suboccipital midline approach is common dealing with posterior fossa tumors but has a high risk of postoperative complications, such as pseudomeningocele, cerebrospinal fluid (CSF) leak, and meningitis. Neurosurgeons used various kinds of method to lower its rate. METHODS: A retrospective, single-center review of patients diagnosed with posterior fossa tumor underwent a suboccipital midline approach. Compare the rates of pseudomeningocele, CSF leak, and meningitis between 2 groups (artificial dura mater or cervical fascia autograft). We get the cervical fascia autograft from the superficial layer of deep cervical fascia just above the trapezius. RESULTS: Our retrospective review involved 123 patients matching the inclusion criteria between January 2009 and April 2019. The complication rate of pseudomeningocele, CSF leak and meningitis were 8.9%, 4.9%, and 17.9%, respectively. The presence of pseudomeningocele or CSF leak for group "artificial" was 11 of 75 (14.67%) and for group "autograft" it was 3 of 48 (6.25%). The rate of meningitis for group "artificial" (24.0%, 18 of 75) was significantly higher (P = 0.027) than the one for group "autograft" (8.33%, 4 of 48). Multivariate regression analysis suggested that the age was negatively correlated with postoperative pseudomeningocele or CSF leak (P = 0.006), with meningitis (P < 0.001). Using cervical fascia autograft decreased the rate of meningitis (P = 0.021) while showing no statistically significant clinical impact on pseudomeningocele or CSF leak. CONCLUSIONS: Applying the cervical fascia autograft to reconstruct the dura during posterior fossa surgery is a simple and effective method to reduce the rate of meningitis as compared with artificial dura mater.


Assuntos
Materiais Biocompatíveis/uso terapêutico , Dura-Máter/cirurgia , Fáscia/transplante , Neoplasias Infratentoriais/cirurgia , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Idoso , Astrocitoma/cirurgia , Neoplasias do Tronco Encefálico/cirurgia , Neoplasias Cerebelares/cirurgia , Neoplasias do Ventrículo Cerebral/cirurgia , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Criança , Pré-Escolar , Ependimoma/cirurgia , Feminino , Quarto Ventrículo , Hemangioblastoma/cirurgia , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Humanos , Lactente , Masculino , Meduloblastoma/cirurgia , Meningioma/cirurgia , Meningite/epidemiologia , Meningocele/epidemiologia , Pessoa de Meia-Idade , Pescoço , Estudos Retrospectivos , Transplante Autólogo , Adulto Jovem
19.
World Neurosurg ; 134: e892-e902, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31733380

RESUMO

BACKGROUND: The introduction of image-guided methods to bypass surgery has resulted in optimized preoperative identification of the recipients and excellent patency rates. However, the recently presented methods have also been resource-consuming. In the present study, we have reported a cost-efficient planning workflow for extracranial-intracranial (EC-IC) revascularization combined with transdural indocyanine green videoangiography (tICG-VA). METHODS: We performed a retrospective review at a single tertiary referral center from 2011 to 2018. A novel software-derived workflow was applied for 25 of 92 bypass procedures during the study period. The precision and accuracy were assessed using tICG-VA identification of the cortical recipients and a comparison of the virtual and actual data. The data from a control group of 25 traditionally planned procedures were also matched. RESULTS: The intraoperative transfer time of the calculated coordinates averaged 0.8 minute (range, 0.4-1.9 minutes). The definitive recipients matched the targeted branches in 80%, and a neighboring branch was used in 16%. Our workflow led to a significant craniotomy size reduction in the study group compared with that in the control group (P = 0.005). tICG-VA was successfully applied in 19 cases. An average of 2 potential recipient arteries were identified transdurally, resulting in tailored durotomy and 3 craniotomy adjustments. Follow-up patency results were available for 49 bypass surgeries, comprising 54 grafts. The overall patency rate was 91% at a median follow-up period of 26 months. No significant difference was found in the patency rate between the study and control groups (P = 0.317). CONCLUSIONS: Our clinical results have validated the presented planning and surgical workflow and support the routine implementation of tICG-VA for recipient identification before durotomy.


Assuntos
Revascularização Cerebral/métodos , Artéria Cerebral Média/cirurgia , Software , Cirurgia Assistida por Computador/métodos , Artérias Temporais/cirurgia , Fluxo de Trabalho , Adolescente , Adulto , Idoso , Dissecação da Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Angiografia Cerebral , Corantes , Craniotomia/métodos , Dura-Máter/cirurgia , Feminino , Humanos , Verde de Indocianina , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
World Neurosurg ; 135: 234-240, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863889

RESUMO

BACKGROUND: In our series, the gravity-assisted ipsilateral paramedian approach was shown to be safe and advantageous for the resection of parafalcine meningioma, because it does not result in contralateral brain impingement and does not require brain retraction. We have reported the technical details of this method and the outcomes of our patients. METHODS: From September 2018 to September 2019, 10 consecutive patients with parafalcine meningioma underwent microsurgery using the gravity-assisted ipsilateral paramedian approach. The clinical data, radiological images, and surgical outcomes were collected and analyzed. RESULTS: All 10 patients (5 men and 5 women, mean age, 55.8 ± 12.5 years) underwent safe tumor resection. Of the 10 tumors, 6 were located in the frontal area, 2 in the parietal area, and 2 in frontal and parietal area. The superior sagittal sinus wall had been affected in 6 patients. Obvious perilesional edema was observed in 60% of the patients. During surgery, bridging veins were encountered in 8 patients and were preserved, except for a small branch. Brain retraction or transgression was not required, and gross total resection was achieved in all 10 patients. No major postoperative complications occurred, except for an unexpected subacute subdural hematoma 1 month postoperatively. All 10 patients had achieved a favorable outcome (Glasgow outcome scale, ≥ 4) at discharge, which remained the same after a mean follow-up of 5.8 ± 3.7 months. CONCLUSIONS: The results from the present case series have demonstrated the safety of the gravity-assisted ipsilateral paramedian approach for parafalcine meningioma resection. The approach provides good tumor exposure and clear identification and preservation of bridging veins, does not result in contralateral brain impingement, and does not require excessive brain retraction.


Assuntos
Gravitação , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Posicionamento do Paciente/métodos , Adulto , Idoso , Dura-Máter , Feminino , Escala de Resultado de Glasgow , Hematoma Subdural/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia
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