Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.440
Filtrar
1.
Zhonghua Yi Xue Za Zhi ; 101(9): 620-623, 2021 Mar 09.
Artigo em Chinês | MEDLINE | ID: mdl-33685042

RESUMO

Objective: To explore the efficacy and safety of intraoperative ultrasound-assisted neuroendoscopy for treating hypertensive intracerebral hemorrhage (HICH) via lateral fissure and insula approach. Methods: The clinical data of 66 patients with HICH in basal ganglia who underwent intraoperative ultrasound-assisted neuroendoscopy via lateral fissure and insula approach for hematoma evacuation were retrospectively analyzed, including operative data and follow-up results. All patients had no brain hernia before operation. The hematoma was located by the ultrasound and then the path into the hematoma cavity was determined. Meanwhile, the residual hematoma was also detected by using the ultrasound. The clearance rate of hematoma was observed by CT. Barthel index was used to evaluate the activity of daily living. Results: The amount of residual hematoma was less than 10% in 63 ases and 10%-20% in 3 cases. There were 11 cases of postoperative pneumonia, of whom 9 cases underwent percutaneous tracheotomy. Rebleeding occurred in 2 cases, but the amount was small, and there was no need for reoperation. Meanwhile, there was 1 case of secondary intracranial infection and 1 case of secondary hydrocephalus. No case of cerebral contusion was reported. Half a year after the operation, Barthel Index grading showed that there were 3 cases of grade I, 25 cases of grade Ⅱ, 34 cases of grade Ⅲ, 3 cases of grade Ⅳ and 1 case of death, respectively. Conclusions: Intraoperative ultrasound-assisted neuroendoscopy via lateral fissure and insula approach can improve the efficacy and safety of treatment for HICH.


Assuntos
Hemorragia Intracraniana Hipertensiva , Neuroendoscopia , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Craniotomia , Hematoma , Humanos , Hemorragia Intracraniana Hipertensiva/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
2.
Zhonghua Yi Xue Za Zhi ; 101(4): 254-258, 2021 Jan 26.
Artigo em Chinês | MEDLINE | ID: mdl-33486933

RESUMO

Objective: To explore the value of neuroendoscopy combined with fluorescence angiography in anterior circulation aneurysm clipping. Methods: A total of 15 patients with anterior circulation aneurysm from Department of Neurosurgery, Zhongnan Hospital of Wuhan University between October 2018 and January 2019 were enrolled. Neuroendoscopy combined with indocyanine green fluorescence angiography (ICGA) was used to determine the shape of the aneurysm, the specific location of the aneurysm neck and its relationship with the aneurysm-bearing artery during anterior circulation aneurysm clipping. Meanwhile, Neuroendoscopy combined with ICGA can be employed to observe whether there was stenosis and incomplete clamping of the aneurysm-bearing artery after clipping the aneurysm, and whether there was misclamping of the perforating branches hidden under the posterior wall of the aneurysm. Results: The success rate of aneurysm clipping in 15 cases was 15/15. After aneurysm clipping, ICGA and neuroendoscopy were performed. The residual aneurysm neck was detected in 3 cases, and the position of aneurysm clip was adjusted or aneurysm clips were added. In one case, the anterior choroidal aneurysm was found to be mistakenly clipped. After adjusting the aneurysm clip, ICGA and neuroendoscopy showed that the anterior choroidal artery was normal. In another case, the A1 segment aneurysm was clipped. ICGA and neuroendoscopy found that the perforating branch blood vessels were mistakenly clipped. After the adjustment of the aneurysm clip, the blood vessels recovered their patency. There were no surgical-related deaths, disability and coma cases in the study. Conclusions: During aneurysm clipping, neuroendoscopy combined with ICGA can reduce cerebral vasospasm, decrease the misclipping rate of perforation of blood vessels, and avoid residual neck of aneurysm, stenosis or occlusion of aneurysm-bearing artery by using neuroendoscopy to observe whether misclipping of the perforating branch vessels exist and whether the aneurysm is clipped. Therefore, it can reduce postoperative complications.


Assuntos
Aneurisma Intracraniano , Neuroendoscopia , Angiografia Cerebral , Angiofluoresceinografia , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos , Instrumentos Cirúrgicos
3.
J Clin Neurosci ; 82(Pt A): 29-31, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33317734

RESUMO

PURPOSE: This technical note illustrates microscope integrated optical coherence tomography (iOCT) as an imaging technique to delineate concealed micro anatomical structures not displayable by conventional intraoperative imaging methods in the context of a cerebral arachnoid cyst. METHODS: iOCT was used for the first time to scan a cerebral arachnoid cyst in vivo. Scanning sites were defined at the outer membrane of the arachnoid cyst, the inner membrane at the temporal cortex as well as at the fenestration site to the basal cisterns - a point out of reach and resolution for conventional intraoperative imaging methods like e. g. ultrasound or neuroendoscopy. RESULTS: iOCT was feasible during microsurgical fenestration of an arachnoid cyst. A clear delineation of the arachnoid cyst membrane was possible. The differentiation of the arachnoid cyst membrane and underlying arachnoid barrier cell membrane was possible. Trans cystic scanning at the temporal cortex could delineate the content of the subarachnoid space like subarachnoid blood vessels, trabecular sytem and vessel wall morphology of a M4 middle cerebral artery branch. Scanning of the inner membrane of the arachnoid cyst at site of fenestration to the basal cisterns excluded underlying micro anatomical structures. CONCLUSION: This case demonstrates that iOCT achieved to delineate concealed micro anatomical structures which are occult to conventional intraoperative imaging methods. Further studies are necessary to value iOCT as a tool to improve intraoperative security.


Assuntos
Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Neuroendoscopia/métodos , Tomografia de Coerência Óptica/métodos , Adulto , Humanos , Masculino , Microscopia/métodos , Microcirurgia/métodos
4.
Pain Res Manag ; 2020: 7361691, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33354269

RESUMO

Background: Epiduroscopy, or spinal endoscopy, is the visualisation of the epidural space using a percutaneous and minimally invasive imaging fiberoptic device. Recently, as a result of some studies, it has been reported that laser therapy with epiduroscopic laser neural discectomy (ELND) was applied during multiple lesions. Methods: In this study, ELND performed between January 2012 and July 2016 at the Algology Clinic of the Department of Anesthesiology and Reanimation, Sakarya University Training and Research Hospital, was examined retrospectively. The Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) scores were recorded preoperatively, as well as after 2 weeks and 2, 6, and 12 months after the ELND. Results: According to the preoperative VAS and ODI scores, the decrease in postoperative 2nd week, 2nd, 6th, and 12th month VAS and ODI scores was significant (p=0.001). Similarly, according to the postoperative 2nd week VAS and ODI scores, decrease in postoperative 6th and 12th VAS and ODI scores was significant (p=0.001). Conclusions: As a result, ELND with Holmium: YAG laser, which is a new technique in patients with lumbar disc herniated low back and/or leg pain, can reduce VAS and ODI scores from 2 weeks without any complications that open surgery can bring with it. We believe that it is a useful and advanced technique in treatment of lumbar disc herniation and has low complication rates that provides maximum efficacy from the first year.


Assuntos
Discotomia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Terapia a Laser/métodos , Neuroendoscopia/métodos , Adulto , Idoso , Feminino , Humanos , Lasers de Estado Sólido , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 6062-6065, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019353

RESUMO

Electrosurgery is used in the operating room on a daily basis as a means to cut tissue and maintain hemostasis. The principle of this technology lies in the transfer of electricity from an electrosurgical unit to the operating site on a patient's body and modifying the waveform of that electricity to achieve the desired surgical effect. Bipolar cautery uses two electrodes, an active and a return, both at the surgical site to perform electrosurgery. Bipolar cautery can be very useful in helping surgeons to operate; however, current designs are not well suited to a 2.1 mm working channel in endoscopic procedures due to their rigid structure, limited range of motion, and bulky design. This paper describes a novel approach to designing a minimally- invasive bipolar cautery tool suitable for flexible neuroendoscopy. The system features 1.9 mm diameter bipolar tips which resemble grasping forceps, making it easier for surgeons to hold tissue while performing electrosurgery. The electrode wires also function as the actuating cables used to open and close the tips, which require 2.10 mm to open the tips to 30.9 °. The results show that the tool can safely cauterize a porcine brain specimen at various settings on the electrosurgical unit, and increasing the setting increases the area of tissue affected by the electricity. Repeatability was demonstrated and exhaustion was reached after the tool was opened and closed 73 times. Future work will involve improving the current design to increase the number of cycles the tool can survive before losing function.


Assuntos
Neuroendoscopia , Animais , Eletrocoagulação , Eletrocirurgia , Humanos , Neuroendoscópios , Instrumentos Cirúrgicos , Suínos
8.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(4): 165-72, jul.-ago. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-193897

RESUMO

INTRODUCCIÓN: La neuroendoscopia se ha posicionado como un tratamiento eficaz y seguro en los quistes aracnoideos en la edad pediátrica. Realizamos una revisión de los pacientes pediátricos con quistes aracnoideos tratados mediante neuroendoscopia en nuestro servicio y analizamos los resultados. MATERIAL Y MÉTODOS: Análisis retrospectivo de una serie de 20 pacientes intervenidos entre los años 2005 y 2018. Las variables recogidas son: género, edad, presentación clínica, localización del quiste, presencia de hidrocefalia o colecciones extraaxiales, maniobras endoscópicas realizadas y complicaciones. Se consideró éxito del procedimiento cuando se produjo mejoría de los síntomas y reducción del tamaño del quiste, manteniéndose esta situación hasta final de seguimiento. RESULTADOS: La serie consta de 13 varones y 7 mujeres (edad media: 64,6 meses; rango 4-172 meses). La localización más repetida fue supraselar/prepontina (7), seguida de intraventricular (6), después cuadrigeminales (3), interhemisféricos (2) y silvianos (2). Un 70% (14/20) de pacientes asociaba hidrocefalia en el momento del diagnóstico, elevándose hasta el 85% en quistes supraselares/prepontinos o el 100% en cuadrigeminales. Solo 4/14 pacientes precisaron un sistema de derivación ventriculoperitoneal (mediana de edad al diagnóstico: 12,5 meses). De estos 4, 3 desarrollaron un sobredrenaje valvular grave. Se consideró éxito del procedimiento en 12/20 pacientes (60%) de la serie. Diferenciando por localización: 4/7 en supraselares (57%), 1/3 en cuadrigeminales (33%), 4/6 en intraventriculares (66%), 2/2 en interhemisféricos (100%) y 1/2 en silvianos (50%). Por tanto, se registraron 8 fallos de tratamiento, con un tiempo medio hasta el fallo de 12,12 meses (rango: 0-45). De esos 8 pacientes, en 4 se realizó una nueva neuroendoscopia (éxito de 2/4), en 2 casos se optó por la colocación de derivación ventriculoperitoneal, en un caso por la colocación de derivación cistoperitoneal y en el restante se mantuvo una actitud conservadora. El seguimiento medio fue de 52,45 meses (rango 3-129 meses). CONCLUSIONES: El tratamiento neuroendoscópico es efectivo y seguro en el tratamiento de los quistes aracnoideos en edad pediátrica, permitiendo además en muchos casos el control de la hidrocefalia asociada. El tipo de procedimiento neuroendoscópico y el porcentaje de éxito dependen de la localización del quiste. Se observa una tendencia de mayor dependencia valvular en pacientes de menor edad. En esos casos, sería recomendable la aplicación de medidas de prevención de sobredrenaje


INTRODUCTION: Neuroendoscopy has become an effective and safe treatment for arachnoid cysts in the paediatric population. We review the paediatric patients with arachnoid cysts treated by neuroendoscopy in our hospital and analyse the results. MATERIAL AND METHODS: A retrospective analysis of 20 patients operated on from 2005 to 2018. The variables assessed are: gender, age, clinical presentation, cyst site, presence of hydrocephalus and/or extra-axial collections, endoscopic procedures and complications. Procedure success is defined as an improvement in symptoms and reduction in cyst size until end of follow-up. RESULTS: Our series comprised 13 males and 7 females (mean age: 64.6 months, range: 4-172 months). The most frequent site was suprasellar-prepontine (7), followed by intraventricular (6), quadrigeminal (3), interhemispheric (2) and Sylvian (2). A total of 70% (14/20) of patients had hydrocephalus at diagnosis, which increased to 85% in suprasellar-prepontine cysts and 100% in quadrigeminal cysts. Only 4/14 patients with required a ventriculoperitoneal shunt (median age at diagnosis: 12.5 months). Of these 4 patients, 3 developed severe shunt overdrainage. The procedure was successful in 60% (12/20) of the patients in the series. Success by location was 57% (4/7) in suprasellar cysts, 33% (1/3) in quadrigeminal cysts, 66% (4/6) in intraventricular cysts, 100% (2/2) in interhemispheric cysts and 50% (1/2) in Sylvian cysts. Treatment thus failed in 8 cases, with a mean time to failure of 12.12 months (range: 0-45 months). A new neuroendoscopic procedure was performed in 4 of these 8 cases (success in 2/4), a ventriculoperitoneal shunt was placed in 2 cases, a cystoperitoneal shunt was placed in 1 case and the remaining case was managed conservatively. Mean follow-up time was 52.45 months (range: 3-129 months). CONCLUSIONS: Neuroendoscopy is an effective and safe treatment for arachnoid cysts in paediatric patients that also enables managing associated hydrocephalus in most cases. The choice of neuroendoscopic procedure and success rate depend on cyst location. Younger patients have been found to have a higher shunt dependency rate. In these cases, measures to prevent shunt overdrainage are recommended


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Neuroendoscopia/instrumentação , Neuroendoscopia/métodos , Estudos Retrospectivos , Cistos Aracnóideos/complicações , Hidrocefalia/complicações , Procedimentos Neurocirúrgicos/métodos , Neoplasias do Ventrículo Cerebral/cirurgia
9.
World Neurosurg ; 142: 314-317, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32712405

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has infected more than 13 million people on a global scale and claimed more than half million deaths across 213 countries and territories. While the focus is currently on recovery from the pandemic, the disease has significantly changed the way we practice medicine and neurosurgery in New York City and the United States. Apart from the emergency cases, several health systems across the country have similarly started to perform elective surgeries. Although COVID-19 screening and testing guidelines have been proposed and adopted by many hospitals, these may not adequately protect the operating room personnel who are in proximity to the patient for prolonged periods. There are concerning reports of especially high transmission rates of COVID-19 in transmucosal head and neck procedures conducted by otolaryngologists and neurosurgeons, despite attempts at wearing what constitutes appropriate personal protective equipment. METHODS: Here, we describe a simple technique of additional draping that can be used for all cranial, endonasal, spinal, and neurointerventional cases to limit the transmission of coronavirus. RESULTS: The proposed technique offers a simple, commonly available, cost-effective alternative that avoids the use of additional retractor systems. Moreover, this technique can be used in all neurosurgical procedures. CONCLUSIONS: With the rising concerns regarding airborne spread of the virus, we expect that these precautions will prove highly useful as we enter the recovery phase of this pandemic and hospitals attempt to prevent a return to widespread infection. In addition, its availability and cost effectiveness make this technique especially attractive to practical use in centers with limited resources.


Assuntos
Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Procedimentos Neurocirúrgicos/instrumentação , Pneumonia Viral/transmissão , Campos Cirúrgicos , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Humanos , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural , Neuroendoscopia/instrumentação , Neuroendoscopia/métodos , Procedimentos Neurocirúrgicos/métodos , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle
10.
Zhonghua Wai Ke Za Zhi ; 58(8): 653-656, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727200

RESUMO

Trigeminal schwannomas(TSs) is the second most common intracranial schwannomas next to acoustic neuroma. These uncommon, slow-growing tumors, which prove to originated from Schwann cells of the fifth brain nerve, can achieve their development into various compartments.Previous to the era of microsurgery, the total tumor resection rate was low, and the postoperative neurological function was seriously damaged.With the development of microsurgery and skull base approach, the microsurgery effect of TSs has been improved. Besides, neuroendoscopy is also used in the operation of some types of trigeminal schwannomas. Radiation therapy can be performed to control tumor growth for the patients who cannot tolerate surgery, have small tumor volume, have residual tumor tissue or relapse.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Neurilemoma/cirurgia , Doenças do Nervo Trigêmeo/cirurgia , Neoplasias dos Nervos Cranianos/radioterapia , Humanos , Microcirurgia , Neurilemoma/radioterapia , Neuroendoscopia , Resultado do Tratamento , Doenças do Nervo Trigêmeo/radioterapia
11.
Neurol India ; 68(Supplement): S141-S145, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32611906

RESUMO

Background: The COVID-19 pandemic is currently an evolving situation. Operating rooms (OR) are high-risk areas for the transmission of any respiratory infection with multiple personnel involved, in close proximity. Of concern to neurosurgeons, is the high-risk of aerosol generating procedures (AGPs) like transsphenoidal and endonasal surgery. Endonasal AGPs theoretically present a higher risk of viral exposure due to the longer duration of exposure and aggressive disruption of potentially virus-containing mucosa. Objective: The current review discusses potential strategies to neuro-surgeons to avoid transmission of COVID 19 during endo-nasal and trans-sphenoidal surgeries. Materials and Methods: We searched PubMed using the search terms "COVID-19", "SARS-CoV-2", "coronavirus" in combination with "neurosurgery", and identified 13 relevant articles. A pre-surgical risk assessment score is proposed based on the risk of transmission. A flow chart of patient selection and care has been formulated. Conclusion: In all emergency patients, it is preferable to consider transcranial surgery or a sub-labial approach avoiding exposure to mucosa. Due to laboratory constraints routine swabs is not always available. Therefore, routine preoperative screening computed tomography (CT) chest is performed in all patients. Based on risk of transmission of infection to others, we propose a classification of patients for skull-based surgery into low, high and very high risk groups and suggest suitable personal protective equipment. Additionally, we discuss avoiding use of powered drills in or any AGP. However, cold procedures involving shavers and microdebriders generate lesser amounts of aerosol. Post-operatively, the length of stay could be reduced with a multidisciplinary approach.


Assuntos
Algoritmos , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Neurocirurgiões , Pneumonia Viral/transmissão , Base do Crânio/cirurgia , Betacoronavirus , Humanos , Neuroendoscopia , Pandemias
12.
Neurol India ; 68(Supplement): S134-S136, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32611904

RESUMO

Even in ideal circumstances, the performance of safe and effective endoscopic transsphenoidal pituitary surgery requires complicated orchestration of care amongst multiple medical and surgical teams in the preoperative, intraoperative, and postoperative settings. The current COVID-19 pandemic further complicates this highly orchestrated effort. Healthcare systems around the globe are working to adapt to the rapidly changing healthcare landscape as information about the SARS-CoV-2 virus is discovered and disseminated. The nature of the transsphenoidal corridor exposes the pituitary surgery team to increased risk of virus exposure.


Assuntos
Infecções por Coronavirus/transmissão , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Neurocirurgiões , Neoplasias Hipofisárias/cirurgia , Neoplasias Hipofisárias/virologia , Pneumonia Viral/transmissão , Betacoronavirus , Infecções por Coronavirus/complicações , Humanos , Controle de Infecções/normas , Neuroendoscopia , Pandemias , Pneumonia Viral/complicações
13.
Spine (Phila Pa 1976) ; 45(15): E967-E971, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675618

RESUMO

STUDY DESIGN: Technique note. OBJECTIVE: To evaluate the feasibility of endoscopy in various spinal pathologies. SUMMARY OF BACKGROUND DATA: Osteoporotic vertebral fractures are a common pathology in the elderly. These fractures are often accompanied by serious complications such as neurological deficits due to the compression of the spinal cord or nerve roots. METHODS: A 78-year-old female patient presented to our hospital with a severe pain in her left leg and back. Lumbar magnetic resonance imaging and computed tomography scan revealed an osteoporotic L3 burst fracture compressing the left L3 nerve root. A minimally invasive translaminar endoscopic approach was used to remove the fractured fragment and cement was injected into the L3 vertebra. The patient was mobilized the same evening and was relieved of her pain. CONCLUSION: Minimally invasive endoscopy is a safe and effective alternative to conventional major decompression with or without posterior stabilization, particularly in elderly patients with serious comorbidities. LEVEL OF EVIDENCE: 4.


Assuntos
Vértebras Lombares/cirurgia , Neuroendoscopia/métodos , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Cimentos para Ossos , Descompressão Cirúrgica/métodos , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem
14.
Pain Physician ; 23(4): E377-E388, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709184

RESUMO

BACKGROUND: Intraspinal cement leakage is a catastrophic complication of percutaneous vertebroplasty (PVP). Percutaneous endoscopic spinal surgery (PESS) for intraspinal cement leakage has rarely been reported. OBJECTIVES: To evaluate the therapeutic effectiveness of PESS for intraspinal cement leakage following PVP. STUDY DESIGN: This was a retrospective study approved by the ethics committee of our institution. SETTING: Department of Orthopedics from an affiliated hospital. METHODS: Twelve patients with neurologic impairments resulting from intraspinal cement leakage after PVP were treated with PESS for spinal decompression from May 2014 to June 2018. Computed tomography and 3-dimensional reconstruction were used to confirm the vertebral level of cement leakage. The surgical index, neurologic function, and clinical results were recorded in this study. RESULTS: The leaked cement of all patients was successfully removed under PESS, and no severe intraoperative complications were reported in our study. The operation time ranged from 43 to 119 minutes (mean, 65.5 minutes). The amount of intraoperative blood loss was 64.25 ± 9.62 mL. The lengths of postoperative hospital stays were 5.25 ± 2.53 days. The follow-up rate was 83.3% (10/12). The follow-up time ranged from 14 to 30 months (mean, 22 months). The Visual Analog Scale scores of foraminal leaks improved from 6.50 ± 0.93 preoperatively to 1.75 ± 0.71 at the last follow-up (P < 0.05). Neurologic function was evaluated by Japanese Orthopaedic Association 29 scores, which improved from 18.75 ± 1.06 to 22.70 ± 1.64 (P < 0.0001). The good and excellent rates were 80% according to the modified Macnab criteria. LIMITATIONS: This study is limited by the volume of patients and the deep learning curve needed for PESS. CONCLUSIONS: PESS, as a minimally invasive technique, can achieve targeted spinal cord decompression and may be a safe and effective alternative approach to conventional procedures for cement leakage after PVP. KEY WORDS: Endoscopes, cement leakage, minimally invasive surgery, percutaneous vertebroplasty.


Assuntos
Cimentos para Ossos/efeitos adversos , Neuroendoscopia/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Vertebroplastia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/métodos , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X/métodos , Vertebroplastia/métodos
16.
Medicine (Baltimore) ; 99(25): e20747, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569218

RESUMO

RATIONALE: Optic Schwannoma is rarely observed clinically as optic nerve had anatomically impossibility for the location of Schwannoma. However, several reports described the established cases of optic Schwannoma, of which the locations were in orbit or within optic canal. The occurrence of optic Schwannoma intracranially has been not reported. PATIENT CONCERNS: A 60-year-old female complained of visual impairment in the right eye and the frequent headache and the dizziness over 2 years with unknown reasons. The result of magnetic resonance imaging (MRI) showed a round, well-circumscribed, heterogeneously enhancing signal with cystic change displayed on the right suprasellar cistern. DIAGNOSES: Intracranial optic Schwannomas. INTERVENTIONS: The patient accepted microneurosurgery assisted by endoscopy. We observed a gray and yellow lesion located near the right anterior clinoid process with a mid-sized cyst. And there was a vague boundary between the tumor and the right optic nerve which was compressed by the tumor. Optic chiasm and left optic nerve were also compressed. Meanwhile, the tumor had also adhesion to the right anterior cerebral artery (ACA). OUTCOMES: After the tumor was totally resected, the patient had satisfactory recovery. LESSONS: We reported an intracranial optic Schwannoma removal with the lateral supraorbital keyhole approach assisted by neuroendoscopy. Intracranial optic Schwannoma was rarely seen clinically. Neuroendoscopy imaging suggested the close relationship between the tumor and ACA, supporting vasculature-origin hypothesis for the optic Schwannoma.


Assuntos
Microcirurgia/métodos , Neurilemoma/cirurgia , Neuroendoscopia/métodos , Neoplasias do Nervo Óptico/cirurgia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/cirurgia , Neoplasias do Nervo Óptico/diagnóstico por imagem
17.
Zhongguo Gu Shang ; 33(6): 519-23, 2020 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-32573155

RESUMO

OBJECTIVE: To investigate the efficacy and safety of total spine endoscopy in the treatment of lumbar disc herniation combined with posterior apophyseal ring separation. METHODS: From January 2015 to January 2018, a total of 21 patients with lumbar disc herniation complicated with posterior apophyseal ring separation were treated with total spine endoscopy via interlamina approach. There were 17 males and 4 females. The age ranged from 18 to 48 years old and the median age was 27 years old. All were single segment unilateral disc herniation, interlaminar approach was adopted, and the herniated disc was removed unilaterally at the symptomatic side under the microscope, and all or part of the broken bonewas removed. RESULTS: There were no complications such as incision infection, intervertebral space infection, intestinal injury, dural injury and cerebrospinal fluid leakage. The operation time ranged from 32 to 92 minutes and the median time was 57 minutes. Postoperative imaging examination showed that 2 patients had complete resection of osteotomy of posterior edge of vertebral body, 16 patients had partially resection and 3 patients had no resection. All intervertebral discs were completely removed. All 21 patients were followed up, and the duration ranged from 12 to 36 months, with a median of 15 months. The VAS of lumbago was 7.10±1.20 before surgery, 3.46±0.23 on the 3rd day after surgery, 2.36±0.19 on the 6th month after surgery; and the VAS of leg pain was 8.80±0.55 before surgery, 3.54±0.28 on the 3rd day after surgery, and 2.59±0.26 on the 6th month after surgery. The Oswestry Disability Index score was (69.71±9.37)% before surgery, (32.19±6.95)% on the 6th month after surgery, and (20.95± 6.16)% at the latest follow up. Onthe 1st year after operation, 16 patients got an excellent result, 4 good and 1 fair according to Macnab evaluation system. CONCLUSION: Total spine endoscopy via interlaminal approach can be used as an option in the treatment of lumbar disc herniation combined with vertebral posterior margin dissociation, which can reduce trauma and injury to the lumbar dorsal muscle and achieve similar decompression effect as open surgery. The long term efficacy needs to be further proved by prospective randomized controlled studies with larger sample size.


Assuntos
Discotomia Percutânea , Deslocamento do Disco Intervertebral , Adolescente , Adulto , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Neuroendoscopia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
18.
Pain Res Manag ; 2020: 1537875, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32566059

RESUMO

Objective: Nowadays, trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscopy and laser is one of the preferred options for minimally invasive treatment in lumbar disc diseases. However, SELD is still in the initial stages of the global field of spine surgery, and the clinical outcomes in patients with lumbar disc herniation are not established yet. Therefore, the authors investigated patients undergoing SELD to report the clinical results. Methods: Between November 2015 and November 2018, a total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. A retrospective review of clinical data was conducted. Clinical outcomes were evaluated using the visual analogue scale (VAS) for low back and leg pain and Odom's criteria. Also, surgical outcomes, including complications and symptom recurrences, and radiological outcomes were analyzed. Results: Low back pain and leg pain as determined by the VAS improved from an average of 5.43 ± 1.73 and 6.10 ± 1.67 to 2.80 ± 1.43 and 3.58 ± 2.08 at the final follow-up (p < 0.001). According to Odom's criteria, the success rate defined as excellent or good results at the final follow-up was 58.5%. There were no surgery-related complications such as neurologic deficits, infection, or epidural hematomas, except for transient mild paralysis in 3 patients and procedure-related nuchal pain in 2 patients. The rate of additional procedures was 17.0% (6 patients received revision surgery and 8 patients received an additional nerve block) during the follow-up. Conclusion: Our findings showed that SELD for lumbar herniated disc disease achieved less favorable clinical outcomes compared with those of previous studies. Further study is needed to clarify the influencing factors on the clinical outcomes of SELD.


Assuntos
Descompressão Cirúrgica/métodos , Deslocamento do Disco Intervertebral/cirurgia , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Neuroendoscopia/métodos , Adulto , Descompressão Cirúrgica/instrumentação , Feminino , Humanos , Terapia a Laser/instrumentação , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/instrumentação , Estudos Retrospectivos , Resultado do Tratamento
19.
Turk Neurosurg ; 30(4): 565-572, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32530475

RESUMO

AIM: To compare neuroendoscopy versus minimal puncture drainage for surgical treatment of supratentorial hypertensive intracerebral hemorrhage. MATERIAL AND METHODS: A total of 108 cases involving supratentorial intracerebral hemorrhage were retrospectively analyzed. In 30 cases, endoscopic surgery was performed, while 78 cases involved puncture surgery. We compared hematoma clearance rate, postoperative rebleeding rate, incidence of postoperative complications, operation duration, and Glasgow coma score seven days after surgery. Clinical data such as early postoperative rehabilitation time, Glasgow outcome score three months after surgery, and intensive care unit (ICU) stay were also compared between the two groups. RESULTS: The results showed that endoscopic surgery was associated with a superior clinical therapeutic effect in hematoma clearance rates, GCS scores on postoperative day 7, the average ICU stay, early postoperative rehabilitation time and intracranial infection outcomes than minimal puncture drainage surgery for the treatment of supratentorial intracerebral hemorrhage (p < 0.05). Three months after surgery, the favorable prognosis rate in the endoscopic treatment group was significantly higher than that in the craniotomy group [83.3% (28/34) vs. 61.5% (31/51), respectively; ? < sup > 2 < /sup > =4.698, p=0.030]. In contrast, no significant differences in rebleeding, pulmonary infection, tracheotomy, secondary epilepsy, gastrointestinal hemorrhage, death in late postoperative period, or in baseline parameters were observed between the two groups (p > 0.05). CONCLUSION: Endoscopic surgery potentially represents a beneficial surgical procedure for treatment of supratentorial spontaneous intracerebral hemorrhage.


Assuntos
Drenagem/métodos , Hemorragia Intracraniana Hipertensiva/diagnóstico por imagem , Hemorragia Intracraniana Hipertensiva/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neuroendoscopia/métodos , Punções/métodos , Adulto , Idoso , Craniotomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
20.
J Craniofac Surg ; 31(5): e503-e506, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32541266

RESUMO

Surgical management of spontaneous hypertensive brainstem hemorrhage remains a challenge for neurosurgeons, especially when the hemorrhage is located the ventral brainstem. Recently endoscopic endonasal approach has been applied for resection of ventral brainstem lesions, though no published literature has explored its utility in treating brainstem hemorrhage. Here we reported a successful evacuation of severe hypertensive brainstem hemorrhage through endoscopic endonasal transclival approach. A 37 years-old male with a 5-year history of uncontrolled hypertension was brought to the Emergency Department with sudden vomiting, limb convulsions, and loss of consciousness for 2 hours. Computed tomography demonstrated a hemorrhage measuring 2.5 × 2.2 cm in the ventral midbrain and pontine. He presented with a Glasgow coma scale (GCS) score of 3 and disrupted vitals, and was intubated in the Emergency Department. Considering the ventral location of the hemorrhage and the need for emergent surgical decompression, an endoscopic endonasal approach was applied. Evacuation of the brainstem hemorrhage was achieved and his spontaneous respiration improved immediately after surgery. He was weaned off the ventilator and extubated on postoperative day 1, along with an improved GCS score of 5 (E2V1M2). At 1 month postoperatively his GCS score improved to 11 (E4V2M5) and he is currently under rehabilitation. Endoscopic endonasal approach is a feasible alternative for emergent surgery of ventrally located brainstem hemorrhage in carefully selected cases by providing direct visualization of the area and a good working angle, which facilitate evacuation of the hemorrhage with minimal damage to the brainstem.


Assuntos
Hemorragia Cerebral/cirurgia , Hipertensão/complicações , Mesencéfalo/cirurgia , Nariz , Ponte/cirurgia , Adulto , Hemorragia Cerebral/etiologia , Escala de Coma de Glasgow , Humanos , Masculino , Neuroendoscopia , Convulsões/etiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...