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1.
No Shinkei Geka ; 49(2): 220-228, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33762441

RESUMO

Intracranial aneurysms or arterial dissections are major causes of subarachnoid hemorrhage(SAH). Early surgical or endovascular repair of the bleeding source is crucial because rebleeding mostly occurs within a few days after the initial attack. Radiological examination is an initial step for the appropriate diagnosis of ruptured intracranial aneurysms and arterial dissections. However, misdiagnosis may occur, especially in patients with minor bleeding or multiple aneurysms. In addition to computed tomography, magnetic resonance imaging, including FLAIR and SWI, and T2*WI are useful for detecting minor SAH. Vessel-wall imaging has recently been applied to diagnosing the site of rupture in patients with multiple cerebral aneurysms or microaneurysms, but not to assessing the instability of unruptured cerebral aneurysms or intracranial arterial dissections. In this article, we discuss the current radiological modalities and their usefulness for diagnosing SAH.


Assuntos
Aneurisma Roto , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Imagem por Ressonância Magnética , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/cirurgia , Tomografia Computadorizada por Raios X
2.
Artigo em Russo | MEDLINE | ID: mdl-33560620

RESUMO

Background. Brain aneurysms are found in 1-2% of population and cause subarachnoid hemorrhage (SAH) in 80-85% of cases. In recent decades, the incidence of unruptured aneurysms has increased due to widespread availability of CT and MRI. Microsurgery is still essential in the treatment of cerebral aneurysms. OBJECTIVE: To assess the effectiveness and safety of minimally invasive approaches in microsurgical treatment of brain aneurysms in comparison with traditional approaches, to clarify the indications and contraindications for minimally invasive approaches. MATERIAL AND METHODS: There were 394 patients with cerebral aneurysms for the period 2014-2019. All patients were divided into 2 groups depending on surgical approach: traditional approach (TrA) (n=171, 43.4%) and minimally invasive approach (MiniAp) (n=223, 56.6%). In the TrA group, pterional (n=85), orbitozygomatic (n=23) and lateral supraorbital approaches (n=63) were used. In the MiniAp group, transbrow supraorbital (n=88), mini-pterional (n=62), transbrow transorbital (n=37) and transpalpebral transorbital approaches (n=36) were used. Treatment outcomes were compared in both groups for patients with ruptured and unruptured aneurysms. We evaluated intra- and postoperative complications, surgery time and postoperative hospital-stay. Neurological outcomes were assessed using the Glasgow Outcome Scale (GOS) and the modified Rankin Scale (mRs). Cosmetic outcomes were compared using the visual analogue cosmetic scale. Unilateral hypesthesia and eyebrow movement were assessed separately after 3, 6 and 12 months. RESULTS: In acute period of SAH, surgery time was significantly less in the MiniAp group (p=0.001). There were no significant between-group differences in the incidence of intraoperative rupture, surgical and neurological complications (p>0.05). Postoperative hospital-stay was significantly less in the MiniAp group (p=0.006). In this group, neurological outcomes were slightly better (p<0.001), there was no mortality, adverse outcomes occurred in 5.3% of cases (n=5). In the TrA group, 1 patient died from postoperative hematoma, adverse outcomes were noted in 9 (8.7%) patients. Cosmetic outcomes were significantly better in the MiniAp group (p<0.001). In delayed period of SAH and unruptured aneurysms, surgery time was less in the MiniAp group (p=0.051). Incidence of intra- and postoperative complications was similar in both groups (p>0.05). Hospital-stay was significantly shorter in the MiniAp group (p<0.001). Functional outcomes were comparable in both groups. Cosmetic outcomes were significantly better in the MiniAp group (p<0.05). CONCLUSION: MiniAp and TrA are characterized by similar efficacy in microsurgical treatment of cerebral aneurysms. MiniAp is recommended only for experienced neurosurgeons in a specialized hospital. Safety and effectiveness of MiniAp are achieved by careful selection of patients, individual neuroimaging and preoperative planning.


Assuntos
Aneurisma Roto , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Aneurisma Roto/cirurgia , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Microcirurgia/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos , Hemorragia Subaracnóidea/cirurgia , Resultado do Tratamento
3.
World Neurosurg ; 148: e689-e694, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33540092

RESUMO

BACKGROUND: Cessation of elective procedures and lower bed capacity during the COVID-19 pandemic have led to a rise in the waiting lists for surgery, but it is unclear if workload has recovered sufficiently to account for this backlog. We describe the change in neurosurgical workload at a tertiary neurosciences center in the United Kingdom after the first pandemic wave in comparison with the months before and during the first wave. METHODS: A retrospective review of theatre records and electronic referrals-between December 1, 2019, and August 31, 2020-was performed. The months of December 2019-February 2020 were designated as pre-COVID months and March-May 2020 were designated as COVID months. The time period from June to August 2020 was designated as post-wave months. Statistical analyses were performed on SPSS v22 (IBM). RESULTS: Referrals declined from 572 in January to a nadir of 352 in April before a steady rise to August. Referral volumes for degenerative spinal disease and traumatic brain injuries showed a statistically significant change during the year. On average, 212 procedures per month were performed in the pre-COVID months, 167 procedures per month during COVID months, and 232 procedures per month in the post-wave months. The number of patients on the waiting list for scheduled operations rose from March (785 patients) onward to a peak of 997 patients in July. CONCLUSIONS: In the aftermath of COVID-19, higher referral volumes and operative procedures were apparent in the post-wave months as services returned to normal. With the expectation of a second wave of infections, it is unclear whether this will be sustainable.


Assuntos
/epidemiologia , Procedimentos Neurocirúrgicos/tendências , Carga de Trabalho , Lesões Encefálicas Traumáticas/cirurgia , Neoplasias Encefálicas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/tendências , Estudos Retrospectivos , Doenças da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Hemorragia Subaracnóidea/cirurgia , Centros de Atenção Terciária , Reino Unido/epidemiologia , Listas de Espera
4.
BMC Neurol ; 21(1): 27, 2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468099

RESUMO

BACKGROUND: This observational study was performed to show the impact of complications and interventions during neurocritical care on the outcome after aneurysmal subarachnoid hemorrhage (SAH). METHODS: We analyzed 203 cases treated for ruptured intracranial aneurysms, which were classified regarding clinical outcome after one year according to the modified Rankin Scale (mRS). We reviewed the data with reference to the occurrence of typical complications and interventions in neurocritical care units. RESULTS: Decompressive craniectomy (odds ratio 21.77 / 6.17 ; p < 0.0001 / p = 0.013), sepsis (odds ratio 14.67 / 6.08 ; p = 0.037 / 0.033) and hydrocephalus (odds ratio 3.71 / 6.46 ; p = 0.010 / 0.00095) were significant predictors for poor outcome and death after one year beside "World Federation of Neurosurgical Societies" (WFNS) grade (odds ratio 3.86 / 4.67 ; p < 0.0001 / p < 0.0001) and age (odds ratio 1.06 / 1.10 ; p = 0.0030 / p < 0.0001) in our multivariate analysis (binary logistic regression model). CONCLUSIONS: In summary, decompressive craniectomy, sepsis and hydrocephalus significantly influence the outcome and occurrence of death after aneurysmal SAH.


Assuntos
Craniotomia/métodos , Cuidados Críticos/métodos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/cirurgia , Resultado do Tratamento , Idoso , Craniotomia/mortalidade , Descompressão Cirúrgica/métodos , Descompressão Cirúrgica/mortalidade , Feminino , Humanos , Hidrocefalia/etiologia , Hidrocefalia/mortalidade , Masculino , Pessoa de Meia-Idade , Sepse/etiologia , Sepse/mortalidade , Hemorragia Subaracnóidea/mortalidade
5.
World Neurosurg ; 148: e209-e217, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33385596

RESUMO

BACKGROUND: The occurrence of coronavirus disease 2019 (COVID-19) has overwhelmed the blood supply chain worldwide and severely influenced clinical procedures with potential massive blood loss, such as clipping surgery for aneurysmal subarachnoid hemorrhage (aSAH). Whether acute normovolemic hemodilution (ANH) is safe and effective in aneurysm clipping remains largely unknown. METHODS: Patients with aSAH who underwent clipping surgery within 72 hours from bleeding were included. The patients in the ANH group received 400 mL autologous blood collection, and the blood was returned as needed during surgery. The relationships between ANH and perioperative allogeneic blood transfusion, postoperative outcome, and complications were analyzed. RESULTS: Sixty-two patients with aSAH were included between December 2019 and June 2020 (20 in the ANH group and 42 in the non-ANH group). ANH did not reduce the need of perioperative blood transfusion (3 [15%] vs. 5 [11.9%]; P = 0.734). However, ANH significantly increased serum hemoglobin levels on postoperative day 1 (11.5 ± 2.5 g/dL vs. 10.3 ± 2.0 g/dL; P = 0.045) and day 3 (12.1 ± 2.0 g/dL vs. 10.7 ± 1.3 g/dL; P = 0.002). Multivariable analysis indicated that serum hemoglobin level on postoperative day 1 (odds ratio, 0.895; 95% confidence interval, 0.822-0.973; P = 0.010) was an independent risk factor for unfavorable outcome, and receiver operating characteristic curve analysis showed that it had a comparable predictive power to World Federation of Neurosurgical Societies grade (Z = 0.275; P > 0.05). CONCLUSIONS: ANH significantly increased postoperative hemoglobin levels, and it may hold the potential to improve patients' outcomes. Routine use of ANH should be considered in aneurysm clipping surgery.


Assuntos
Aneurisma Roto/cirurgia , Transfusão de Sangue Autóloga/métodos , Procedimentos Médicos e Cirúrgicos de Sangue/métodos , Hemodiluição/métodos , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Hemorragia Subaracnóidea/cirurgia , Adulto , Idoso , Transfusão de Sangue/estatística & dados numéricos , Feminino , Hemoglobinas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Instrumentos Cirúrgicos
6.
Biomed Pharmacother ; 133: 111048, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33378955

RESUMO

Subarachnoid hemorrhage (SAH) is an acute and severe disease with high disability and mortality. Inflammatory reactions have been proven to occur throughout SAH. Extracellular vesicles derived from mesenchymal stem cells (MSCs-EVs) have shown broad potential for the treatment of brain dysfunction and neuroprotective effects through neurogenesis and angiogenesis after stroke. However, the mechanisms of EVs in neuroinflammation during the acute phase of SAH are not well known. Our present study was designed to investigate the effects of MSCs-EVs on neuroinflammation and the polarization regulation of microglia to the M2 phenotype and related signaling pathways after SAH in rats. The SAH model was induced by an improved method of intravascular perforation, and MSCs-EVs were injected via the tail vein. Post-SAH assessments included neurobehavioral tests as well as brain water content, immunohistochemistry, PCR and Western blot analyses. Our results showed that MSCs-EVs alleviated the expression of inflammatory cytokines in the parietal cortex and hippocampus 24 h and 48 h after SAH and that MSCs-EVs inhibited NF-κB and activated AMPK to reduce inflammation after SAH. Furthermore, MSC-EVs regulated the polarization of microglia toward the M2 phenotype by downregulating interleukin-1ß, cluster of differentiation 16, cluster of differentiation 11b, and inducible nitric oxide synthase and upregulating the expression of cluster of differentiation 206 and arginase-1. Additionally, MSCs-EVs inhibited the neuroinflammatory response and had neuroprotective effects in the brain tissues of rats after SAH. This study may support their use as a potential treatment strategy for early SAH in the future.


Assuntos
Proteínas Quinases Ativadas por AMP/metabolismo , Encéfalo/enzimologia , Vesículas Extracelulares/transplante , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais , Microglia/enzimologia , NF-kappa B/metabolismo , Hemorragia Subaracnóidea/cirurgia , Animais , Encéfalo/patologia , Células Cultivadas , Citocinas/genética , Citocinas/metabolismo , Modelos Animais de Doenças , Vesículas Extracelulares/enzimologia , Masculino , Células-Tronco Mesenquimais/enzimologia , Microglia/patologia , Fenótipo , Fosforilação , Ratos Sprague-Dawley , Transdução de Sinais , Hemorragia Subaracnóidea/enzimologia , Hemorragia Subaracnóidea/patologia
7.
No Shinkei Geka ; 48(11): 1073-1078, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33199666

RESUMO

Kissing aneurysms are defined as two adjacent aneurysms arising from identical or different arteries with separate origins and partially adherent walls. Mirror aneurysms are defined as intracranial aneurysms located in similar positions bilaterally on the parent arteries. Both kissing and mirror aneurysms at the anterior communicating artery(AcomA)are rare. We report a case of subarachnoid hemorrhage(SAH)due to ruptured kissing mirror aneurysms of the AcomA. An 80-year-old woman was admitted to our hospital with a sudden headache and vomiting. CT revealed diffuse SAH. Digital subtraction arteriography(DSA)revealed an aneurysm at the right A1-A2 junction of the AcomA. Hence, coil embolization was performed. On day 14 following embolization, rebleeding occurred. DSA revealed complete occlusion of the aneurysm at the right A1-A2 junction. However, left carotid angiography revealed an aneurysm at the left A1-A2 junction. We did not understand the anatomical construction of the aneurysms;therefore, we selected microsurgical treatment to clip the AcomA aneurysm using an interhemispheric approach. The left A1-A2 junctional aneurysm was anterior to the right A1-A2 junctional aneurysm, which was coil embolized. We detected the left A1-A2 junctional aneurysm as a ruptured aneurysm. The two aneurysms were adhered to each other. After dissection to expose the aneurysmal neck, the left A1-A2 junctional aneurysm was clipped. Kissing mirror aneurysms are difficult to diagnose before treatment. Knowledge and suspicion of the occurrence of kissing mirror aneurysms in the AcomA are important.


Assuntos
Aneurisma Roto , Embolização Terapêutica , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Idoso de 80 Anos ou mais , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/cirurgia , Angiografia Cerebral , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/cirurgia
8.
No Shinkei Geka ; 48(10): 949-955, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33071232

RESUMO

Cerebral aneurysms and arachnoid cysts are relatively common cerebral malformations and the use of recent modalities has increased their detection rates. However, cerebral aneurysms associated with arachnoid cysts are unusual. We describe two cases of ruptured cerebral aneurysms associated with arachnoid cysts. According to previous reports, clinical presentation may sometimes be unusual, as cysts can prevent subarachnoid hemorrhage. Moreover, in some cases, CT may reveal typical arachnoid cysts without subarachnoid hemorrhage, without intracystic hematoma, or with subdural hematoma alone. These clinical presentations and radiologic findings can lead to delayed diagnosis of subarachnoid hemorrhage. Therefore, we should consider the coexistence of arachnoid cyst in case of a warning sign of aneurysm rupture.


Assuntos
Aneurisma Roto , Cistos Aracnóideos , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Hematoma Subdural , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/cirurgia
9.
J Stroke Cerebrovasc Dis ; 29(10): 105069, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912497

RESUMO

Hemorrhagic stroke associated with essential thrombocythemia (ET) is very infrequent. Herein, we report a case of a 33-year-old woman with a 2-year history of ET who developed intracerebral and subarachnoid hemorrhage. Angiography demonstrated severe vessel irregularity in the bilateral cerebral arteries. Molecular genetic testing revealed a calreticulin mutation. To our knowledge, hemorrhagic stroke has been reported in only six other patients with ET, and this is the first report of hemorrhagic stroke in an ET patient with a calreticulin mutation. We review the current literature and discuss the possible underlying mechanisms.


Assuntos
Hemorragia Cerebral/etiologia , Acidente Vascular Cerebral/etiologia , Hemorragia Subaracnóidea/etiologia , Trombocitemia Essencial/complicações , Adulto , Calreticulina/genética , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Craniotomia , Feminino , Predisposição Genética para Doença , Humanos , Mutação , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/cirurgia , Trombocitemia Essencial/diagnóstico , Trombocitemia Essencial/genética , Resultado do Tratamento
10.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(9): 1353-1358, 2020 Sep 30.
Artigo em Chinês | MEDLINE | ID: mdl-32990220

RESUMO

OBJECTIVE: To investigate the clinical outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) after surgeries in Yunnan Province. METHODS: We retrospectively analyzed the demographic features, vascular risk factors, severity at admission, and aneurysm locations in 85 patients with aSAH receiving surgical interventions in Yunnan Province. All the patients were treated by aneurysm clipping or coiling and followed up for clinical outcomes and recovery of daily activities evaluated by modified Rankin Scale (mRS) and Activities of Daily Living (ADL) scale, respectively. RESULTS: Thirty-four of the patients (40.0%) underwent aneurysm clipping and 51 (60.0%) underwent aneurysm coiling. During a median follow- up period of 66.23 months (IOR, 12.03 months), 84.7% of the patients had low mRS scores, and 78.8% lived independently. The WFNS grade at admission was significantly correlated with the follow-up mRS scores (95%CI: 1.48-19.09, P=0.011) and ADL (95%CI: 2.55-28.77, P < 0.001). Multivariate analysis showed that age (95%CI: 1.02-1.23, P=0.017; 95%CI: 1.00-1.15, P=0.038) and a high WFNS grade at admission (95%CI: 2.19-141.48, P=0.007; 95%CI: 2.84-82.61, P=0.002) were independent predictors of both mRS and ADL scores at follow-up. There was no significant difference in clinical outcomes or the length of hospital stay between the two treatment strategies (P > 0.05), but the cost of hospitalization was significantly higher in coiling group than in the clipping group (P < 0.001). CONCLUSIONS: Both aging and a high WFNS grade at admission are associated with a poor prognosis of aSAH, for which aneurysm clipping and coiling have similar long- term outcomes, but for patients with a high WFNS score, aneurysm clipping is favored over coiling in terms of health economics.


Assuntos
Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea , Atividades Cotidianas , Idoso , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Hemorragia Subaracnóidea/cirurgia , Resultado do Tratamento
12.
J Nippon Med Sch ; 87(3): 162-165, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32655093

RESUMO

BACKGROUND: Aneurysmal subarachnoid hemorrhage is a rare but important cause of maternal death during pregnancy. CASE DESCRIPTION: A 34-year-old primigravida (31 weeks of pregnancy) with acute headache but no neurological deficits or neck stiffness was prescribed medication and returned home. Four weeks later she presented with severe headache and consciousness disturbance. She was admitted to our hospital, where she fell into a deep coma. Brain CT and three-dimensional CT angiography showed subarachnoid hemorrhage and a 5-mm right internal carotid-posterior communicating artery aneurysm. Fetal heart rate was 60 beats per minute. Emergent cesarean section and surgical clipping were performed. Intraoperative examination revealed that the aneurysm originated at the right posterior communicating artery. There were no postoperative neurological focal deficits. On postoperative day 13 she developed delayed cerebral ischemia of the right temporo-parieto-occipital lobe. She was discharged home 36 days after surgery with left hemianopsia. The infant was free of complications and was discharged at age 17 days. CONCLUSIONS: A pregnant woman with severe headache should undergo brain CT or magnetic resonance imaging to rule out subarachnoid hemorrhage.


Assuntos
Cefaleia/etiologia , Complicações na Gravidez , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Doença Aguda , Adulto , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Artérias Carótidas , Angiografia por Tomografia Computadorizada , Transtornos da Consciência/etiologia , Feminino , Humanos , Imageamento Tridimensional , Gravidez , Complicações na Gravidez/etiologia , Índice de Gravidade de Doença , Hemorragia Subaracnóidea/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
13.
Medicine (Baltimore) ; 99(28): e21057, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664119

RESUMO

Spontaneous subarachnoid hemorrhage (SAH) is a catastrophic event with high disability and fatality rates. Post-SAH survivors may require prolonged intubation with the assistance of mechanical ventilators, and some patients will undergo tracheostomy to facilitate their pulmonary hygiene and airway protection. The aim of this study is to identify the incidence and risk factors of the need for tracheostomy after spontaneous SAH. We used a retrospective approach and enrolled 838 adult patients with a primary diagnosis of spontaneous SAH who survived >7 days after hospitalization. Medical information was retrieved from the administrative database utilizing diagnostic and procedure codes by the International Classification of Diseases, Ninth Revision, Clinical Modification. Patients with first-ever SAH included 329 men and 509 women, and their average age was 56.9 ±â€Š14.4 years, ranging between 18 and 91 years. Fifty-eight of these 838 patients underwent tracheostomy procedures, and the overall incidence was 6.9%. In a multivariate logistic regression model, the independent risk factors of the need for tracheostomy were underlying diabetes mellitus (P = .02), hydrocephalus (P < .01), and pneumonia (P < .01). The mean duration of hospital stay was 26.0 ±â€Š15.3 and 16.8 ±â€Š12.2 days for patients with and without a tracheostomy, respectively (P < .01). In conclusion, a significant percentage of post-SAH survivors underwent tracheostomy during acute hospitalization. Attention to independent risk factors, including preexisting diabetes mellitus, concomitant hydrocephalus, and nosocomial pneumonia, is essential for timely patient selection for tracheostomy.


Assuntos
Hemorragia Subaracnóidea/cirurgia , Traqueostomia/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
14.
J Clin Neurosci ; 78: 108-113, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32600972

RESUMO

Subarachnoid hemorrhage (SAH) can trigger immune activation sufficient to induce systematic inflammatory response syndrome (SIRS). Serum inflammatory biomarkers and SIRS can predict a poor outcome. The relationship between surgical stress and inflammatory response is well known but described in few reports in the neurosurgical population. We aimed to ascertain whether postoperative SIRS and initial serum biomarkers were associated with outcomes and evaluate whether the postoperative SIRS score differed between those with clipping and coil embolization. We evaluated 87 patients hospitalized within 24 h from onset of nontraumatic SAH. Serum biomarkers, such as levels of C-reactive protein (CRP), white blood cells (WBC), and D-dimer, as well as stress index (SI: blood sugar/K ratio) were obtained at admission. SIRS scores 3 days after admission were derived by adding the number of variables meeting the standard criteria (heart rate [HR] >90, respiratory rate [RR] >20, temperature >38 °C or <36 °C, and WBC count <4000 or >12,000). Clinical variables were compared according to whether they were associated with poor outcomes. Coil embolization was performed in 30 patients and clipping in 57. WBC, SI, D-dimer levels, and SIRS scores were significantly higher in patients with poor-grade SAH and were associated with poor outcomes. SIRS scores were significantly higher with clipping than with coil embolization among patients with good-grade SAH without intracerebral hemorrhage. Acute SIRS and serum biomarkers predict outcomes after SAH. Moreover, our study suggests the influence of surgical invasion via clipping on SIRS after SAH.


Assuntos
Proteína C-Reativa/metabolismo , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Hemorragia Subaracnóidea/sangue , Hemorragia Subaracnóidea/cirurgia , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Humanos , Leucócitos/metabolismo , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Hemorragia Subaracnóidea/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Resultado do Tratamento
15.
Acta Neurochir (Wien) ; 162(8): 1795-1801, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32514620

RESUMO

BACKGROUND: To investigate whether patients with critical emergency conditions are seeking or receiving the medical care that they require, we characterized the reality of care for patients presenting with neuro-emergencies during the first phase of the COVID-19 pandemic. METHODS: In this observational, longitudinal cohort study, all neurosurgical admissions that presented to our department between February 1 and April 15 during the COVID-19 pandemic and during the same time period in 2019 were identified and categorized according to the presence of a neuro-emergency, the route of admission, management, and the category of disease. Further, the clinical course of patients with aneurysmal subarachnoid hemorrhage (aSAH) and chronic subdural hematoma (cSDH) was investigated representatively for severe vascular and semi-urgent traumatic conditions that present with a wide variety of symptoms. RESULTS: During the pandemic, the percentage of neuro-emergencies among all neurosurgical admissions remained similar but a larger proportion presented through the emergency department than through the outpatient clinic or by referral (*p = 0.009). The total number of neuro-emergencies was significantly reduced (*p = 0.0007) across all types of disease, particularly in vascular (*p = 0.036) but also in spinal (*p = 0.007) and hydrocephalus (*p = 0.048) emergencies. Patients with spinal emergencies presented 48 h later (*p = 0.001) despite comparable symptom severity. For aSAH, the number of cases, aSAH grade, aneurysm localization, and treatment modality did not change but strikingly, elderly patients with cSDH presented less frequently, with more severe symptoms (*p = 0.046), and were less likely to reach favorable outcome (*p = 0.003) at discharge compared with previous years. CONCLUSIONS: Despite pandemic-related restrictive measures and reallocation of resources, patients with neuro-emergencies should be encouraged to present regardless of the severity of symptoms because deferred presentation may result in adverse outcome. Thus, conservation of critical healthcare resources remains essential in spite of fighting COVID-19.


Assuntos
Encefalopatias/cirurgia , Infecções por Coronavirus/epidemiologia , Emergências , Procedimentos Neurocirúrgicos , Pneumonia Viral/epidemiologia , Doenças da Medula Espinal/cirurgia , Traumatismos da Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Estudos de Coortes , Feminino , Hematoma Subdural Crônico/cirurgia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pandemias , Hemorragia Subaracnóidea/cirurgia , Adulto Jovem
16.
World Neurosurg ; 139: 582, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32380340

RESUMO

A 49-year-old woman presented with sudden-onset headache and meningismus. Computed tomography scan revealed a posterior fossa subarachnoid hemorrhage extending from the foramen magnum to the ambient cistern. Angiography showed a pial extramedullary arteriovenous malformation (AVM) at the lateral ventral surface of the cervicomedullary junction with primary supply from the left posterior inferior cerebellar artery (PICA) and dominant drainage into the anterior median perimedullary vein. Embolization of the AVM was considered a high-risk procedure, as feeding arteries originated from the proximal lateral medullary segment of the left PICA. A far lateral approach with suboccipital craniotomy and C1-C2 laminectomy was performed (Video 1). The PICA was disconnected from the AVM, and multiple small feeders were interrupted with bipolar cautery and aneurysm clips to achieve an in situ occlusion of the pial AVM. Intraoperative indocyanine green video angiography was used to define the AVM and critical en passant vessels before disconnection and to demonstrate no residual early venous filling after the in situ occlusion. Postoperative angiography demonstrated no residual arteriovenous shunting or nidiform vessels, with preservation of patency of the left PICA. The patient had an uneventful postoperative course and was discharged with no significant neurologic deficits.


Assuntos
Transtornos Cerebrovasculares/cirurgia , Malformações Arteriovenosas Intracranianas/cirurgia , Bulbo/cirurgia , Hemorragia Subaracnóidea/cirurgia , Angiografia Cerebral/métodos , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Bulbo/diagnóstico por imagem , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia
18.
World Neurosurg ; 139: e580-e584, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32353538

RESUMO

BACKGROUND: Management of small unruptured aneurysms is controversial. Small aneurysms and those with low PHASES scores are often observed. The primary aim of this study was to assess whether the PHASES score classified the patients with subarachnoid hemorrhage as high risk for rupture. METHODS: We retrospectively reviewed a consecutive series of 628 aneurysmal subarachnoid hemorrhage neurosurgical cases over a 10-year period between 2008 and 2018. We collected patient and aneurysm characteristics and calculated PHASES scores. RESULTS: The median aneurysm size was 5.3 mm (interquartile range, 3.5-7). Of the aneurysms, 75% (473/628) were less than 7 mm in size. Nearly half of the aneurysms were less than 5 mm (48%, 302/628). The median PHASES score was 5 (interquartile range, 4-6), corresponding to a 5-year risk of rupture of only 1.3%. Most ruptured aneurysms in our series were small with low PHASES scores, suggesting a low risk of rupture. Many of these patients would have been conservatively managed. CONCLUSIONS: PHASES is inadequate in management of unruptured aneurysms because it fails to identify many patients at risk for subarachnoid hemorrhage. A more nuanced assessment of rupture risk should be undertaken.


Assuntos
Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/cirurgia , Adulto , Idoso , Aneurisma Roto/epidemiologia , Angiografia Cerebral , Tratamento Conservador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Medição de Risco
19.
Medicine (Baltimore) ; 99(19): e20013, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384459

RESUMO

INTRODUCTION: Clinically, anterior communicating artery complex fenestration combined with fenestration-related aneurysms is rare, and combination of this condition with tandem aneurysms is even rarer. PATIENT CONCERNS: A case of a 43-year-old man with spontaneous subarachnoid hemorrhage. DIAGNOSIS: A computed tomography angiography examination revealed a fenestrated anterior communicating artery complex combined with 2 aneurysms. Then, a digital subtraction angiography examination was performed to further determine the diagnosis, which showed a complex anatomical structure of the local tissue. After the aneurysms ruptured, they were partially wrapped by a hematoma and compressed, which increased the difficulty of surgery. INTERVENTIONS: An endovascular interventional therapy method was chosen, and a simple coil was successfully inserted through the blood vessel into the tandem aneurysms to maintain the integrity of the anatomical structure. OUTCOMES: The patient recovered well postoperatively. An imaging review after the operation did not show the aneurysms, and the upper and lower branches were patent. CONCLUSION: Therefore, endovascular treatment is an appropriate choice for arterial fenestration combined with tandem aneurysms, once the aneurysms have ruptured.


Assuntos
Aneurisma Roto , Angiografia Cerebral/métodos , Artérias Cerebrais , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Procedimentos Neurocirúrgicos/métodos , Hemorragia Subaracnóidea , Adulto , Aneurisma Roto/diagnóstico , Aneurisma Roto/fisiopatologia , Aneurisma Roto/cirurgia , Angiografia Digital/métodos , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/patologia , Artérias Cerebrais/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/cirurgia , Resultado do Tratamento
20.
World Neurosurg ; 139: 361-369, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32339735

RESUMO

BACKGROUND: It can sometimes be challenging to find a suitable clip to treat an unusual aneurysm, or when the surrounding anatomy is unusual, especially in resource-limited environments. We describe a method to modify aneurysm clips based on the method originated by Sugita et al in 1985. Herein clip modification (Clip-Mod) is used to treat anatomically difficult anterior communicating artery aneurysms. METHODS: The Department of Neurological Surgery database was reviewed to find aneurysm patients treated using modified aneurysm clips. Clip-Mod was performed during surgery by shortening the tines of titanium aneurysm clips by abrasion applied from the side of a standard 3-mm surgical diamond drill bit under constant irrigation. Note that the thickness of the tines and the clip spring were not modified or contacted by the drill. RESULTS: Four cases used modified aneurysm clips, from 648 total clip-treated aneurysms (0.6%) by 2 surgeons over a 14-year period. Three patients presented with subarachnoid hemorrhages that were determined to be due to anterior communicating artery aneurysms. One patient presented with an incidental unruptured anterior communicating artery aneurysm. All 4 patients were treated with 3-mm titanium clips shortened intraoperatively to 1- to 2-mm lengths, to achieve aneurysm obliteration without stenosing parent or perforating vessels. CONCLUSIONS: All 4 patients have done well clinically with no reoccurrences after 2-6 years' follow-up, which included angiographic evaluation. The use of this "Clip-Mod" technique thus appears useful for anterior communicating artery aneurysms. Clip-Mod could also be considered for treating other aneurysms when the "perfect" length clip is not available.


Assuntos
Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/instrumentação , Hemorragia Subaracnóidea/cirurgia , Instrumentos Cirúrgicos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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