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1.
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
2.
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
3.
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
4.
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
5.
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
6.
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
8.
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
9.
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
10.
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
11.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(3): 151-154, mayo-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-192419

RESUMO

El papiloma del plexo coroideo es un tumor poco frecuente del sistema nervioso central, que representa menos del 1% de todas las neoplasias intracraneales. Las ubicaciones habituales son el ventrículo lateral en bebés y niños y el cuarto ventrículo en adultos. El tercer ventrículo es una localización inhabitual, con pocos casos recogidos en la bibliografía. Describimos el caso de un niño de 3 meses que ingresó en nuestro centro con signos de aumento de la presión intracraneal. Los estudios de neuroimagen mostraron una lesión en el tercer ventrículo, con hidrocefalia asociada. Al paciente se le extirpó completamente el tumor mediante abordaje transfrontal y cirugía de derivación ventriculoperitoneal. El curso postoperatorio del niño transcurrió sin incidentes y la imagen de resonancia magnética de seguimiento no reveló tumor residual. La histopatología de la lesión resecada confirmó el diagnóstico de papiloma del plexo coroideo. Discutimos las características clínicas, radiológicas e histológicas de este tipo infrecuente de tumores


Choroid plexus papilloma is an uncommon tumour of the central nervous system, accounting for less than 1% of all intracranial neoplasm. The usual locations are the lateral ventricle in infants and children and the fourth ventricle in adults. The third ventricle is a rare location, with few cases reported in the literature. We describe the case of a 3-month-old boy who was admitted to our centre with signs of raised intracranial pressure. Neuroimaging studies showed a third ventricular mass with associated hydrocephalus. The patient underwent complete tumour removal through a transfrontal approach and ventriculo-peritoneal shunt surgery. Postoperative course of the child was uneventful and follow-up magnetic resonance imaging revealed no residual tumour. Histopathology of the resected lesion confirmed the diagnosis of choroid plexus papilloma. We discuss the clinical, radiological and histological features of this infrequent type of tumours


Assuntos
Humanos , Masculino , Lactente , Papiloma do Plexo Corióideo/diagnóstico por imagem , Papiloma do Plexo Corióideo/cirurgia , Terceiro Ventrículo/cirurgia , Neuroendoscopia/métodos , Terceiro Ventrículo/patologia , Derivação Ventriculoperitoneal/métodos , Ultrassonografia , Cérebro/diagnóstico por imagem , Cérebro/patologia
12.
World Neurosurg ; 139: 488-494, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32376381

RESUMO

BACKGROUND: Thoracic spinal stenosis (TSS), a common vertebral degenerative disease, is generally treated via surgical decompression. Percutaneous endoscopic thoracic decompression (PETD) under local anesthesia is considered a relatively safe, minimally invasive procedure. Few reports detail the success of endoscopic decompression for treatment of TSS caused by ossification of ligamentum flavum, the most common cause of TSS. This study investigated application of PETD for treatment of TSS caused by ossification of ligamentum flavum, ossification of posterior longitudinal ligament, or thoracic disc herniation. METHODS: From January 2017 to January 2019, 12 consecutive patients (6 men and 6 women) underwent PETD. TSS was caused by ossification of ligamentum flavum in 5 patients, thoracic disc herniation in 5 patients, and ossification of posterior longitudinal ligament in 2 patients. All cases were followed up for 1 year postoperatively. Preoperative and postoperative neurologic status was evaluated using the modified Japanese Orthopaedic Association score, and complications were documented. RESULTS: Average modified Japanese Orthopaedic Association score improved significantly from 6.25 ± 1.60 preoperatively to 9.75 ± 1.21 at final follow-up. Dural tear was observed in 1 case during the intervention, and 1 case had transient worsening of preoperative paralysis. Recovery at final follow-up was classified as excellent in 5 cases, good in 6 cases, and poor in 1 case. CONCLUSIONS: This retrospective analysis showed that PETD under local anesthesia may be a feasible alternative to treat TSS in elderly patients with other underlying complications for whom general anesthesia or major surgical trauma would be harmful.


Assuntos
Anestesia Local/métodos , Descompressão Cirúrgica/métodos , Neuroendoscopia/métodos , Estenose Espinal/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estenose Espinal/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem
13.
Pain Res Manag ; 2020: 5428170, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32399127

RESUMO

Epiduroscopy is a type of spinal intervention that visualizes the epidural space through the sacral hiatus using a fiberoptic scope. However, it is technically difficult to perform compared to conventional interventions and susceptible to complications. Surgery simulator has been shown to be a promising modality for medical education. To develop the epiduroscopy simulator and prove its usefulness for epiduroscopy training, we performed a case-control study including a total of 20 physicians. The participants were classified as the expert group with more than 30 epiduroscopy experiences and the beginner group with less experience. A virtual simulator (EpiduroSIM™, BioComputing Lab, KOREATECH, Cheonan, Republic of Korea) for epiduroscopy was developed by the authors. The performance of the participants was measured by three items: time to reach a virtual target, training score, and number of times the dura and nerve are violated. The training score was better in the expert group (75.00 vs. 67.50; P < 0.01). The number of violations was lower in the expert group (3.50 vs. 4.0; P < 0.01). The realism of the epidural simulator was evaluated to be acceptable in 40%. Participants improved their simulator skills through repeated attempts. The epiduroscopy simulator helped participants understand the anatomical structure and actual epiduroscopy.


Assuntos
Espaço Epidural/cirurgia , Neuroendoscopia/educação , Neuroendoscopia/métodos , Treinamento por Simulação/métodos , Interface Usuário-Computador , Estudos de Casos e Controles , Competência Clínica , Estudos de Viabilidade , Humanos , Masculino , Projetos Piloto , República da Coreia , Software
14.
World Neurosurg ; 139: 583-587, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32360672

RESUMO

BACKGROUND: Thermal coagulation is a central principle in surgery, particularly regarding hemostasis, as well as being an integral part of intracranial tumor removal. Traditionally, surgical hemostasis is achieved through application of unipolar or bipolar electrocautery. This method has been contemporized and specialized to treat intracranial tumors through a technique called stereotactic laser ablation (SLA), also known as laser interstitial thermal therapy. CASE DESCRIPTION: In this article, we present this technique as an additional option in the treatment of difficult intracranial tumors. Specifically, we report here a highly vascular and hemorrhagic pineocytoma found in a fragile, elderly patient who underwent a novel combination of procedures: SLA mediated devascularization followed by resection via an endoscopic approach. CONCLUSIONS: SLA-mediated thermal-coagulation is a potential strategy for minimizing hemorrhagic risks in brain tumor resection and may be used in conjunction with other approaches tailored to the patient and their disease.


Assuntos
Neoplasias Encefálicas/cirurgia , Hemorragia Cerebral/cirurgia , Terapia a Laser/métodos , Neuroendoscopia/métodos , Glândula Pineal/cirurgia , Pinealoma/cirurgia , Idoso , Neoplasias Encefálicas/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Feminino , Humanos , Glândula Pineal/diagnóstico por imagem , Pinealoma/diagnóstico por imagem , Estudo de Prova de Conceito
15.
J Clin Neurosci ; 76: 166-170, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32253144

RESUMO

The present prospective cohort study evaluates the effect of three-dimensional (3-D) endoscopy on outcome in transphenoidal endoscopic surgery of pituitary adenomas compared to conventional two-dimensional (2-D) endoscopy. Prospective data was collected from patients undergoing endoscopic surgery for pituitary adenomas before and after the introduction of 3-D endoscopy. Patients, grouped by having 2-D or 3-D endoscopic surgery, were compared in regard to procedure time, intraoperative blood loss, complications, hospital stay, grade of resection and quality of life (QoL). Twenty-six patients having surgery with 2-D endoscopy were compared with 29 patients having surgery with 3-D endoscope. Only primary procedures were included. There were no significant differences in baseline characteristics between the two groups. No statistically significant differences in outcome were noted with 3-D endoscopy. Procedure time, complication rate, hospital stay, rate of gross total resection and post-operative QoL were unaffected by surgical technique though there were non-significant increases in new pituitary insufficiency with 3-D endoscopy and diabetes insipidus with 2-D endoscopy. This prospective cohort study fails to show obvious outcome advantages with 3-D endoscopy in pituitary surgery using basic parameters including post-operative QoL. To our knowledge this is the first prospective study published on the matter, thus corroborating results from previous retrospective studies with similar results on 3-D neuroendoscopy and 3-D endoscopy in general. The main advantage of increased depth perception is more likely found in more complex extended transphenoidal skull base procedure.


Assuntos
Perda Sanguínea Cirúrgica , Endoscopia/métodos , Tempo de Internação , Neoplasias Hipofisárias/cirurgia , Qualidade de Vida , Adenoma/cirurgia , Adulto , Idoso , Diabetes Insípido/etiologia , Endoscopia/efeitos adversos , Endoscopia/normas , Feminino , Humanos , Hipopituitarismo/etiologia , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/métodos , Neoplasias Hipofisárias/complicações , Período Pós-Operatório , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
16.
Neural Netw ; 126: 384-394, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32311656

RESUMO

Convolutional neural networks (CNNs), a popular type of deep neural network, have been actively applied to image recognition, object detection, object localization, semantic segmentation, and object instance segmentation. Accordingly, the applicability of deep learning to the analysis of medical images has increased. This paper presents a novel application of state-of-the-art CNN models, such as DenseNet, to the automatic detection of the tympanic membrane (TM) and middle ear (ME) infection. We collected 2,484 oto-endoscopic images (OEIs) and classified them into one of three categories: normal, chronic otitis media (COM) with TM perforation, and otitis media with effusion (OME). Our results indicate that CNN models have significant potential for the automatic recognition of TM and ME infections, demonstrating a competitive accuracy of 95% in classifying TM and middle ear effusion (MEE) from OEIs. In addition to accuracy measurement, our approach achieves nearly perfect measures of 0.99 in terms of the average area under the receiver operating characteristics curve (AUROC). All these results indicate robust performance when recognizing TM and ME effusions in OEIs. Visualization through a class activation mapping (CAM) heatmap demonstrates that our proposed model performs prediction based on the correct region of OEIs. All these outcomes ensure the reliability of our method; hence, the study can aid otolaryngologists and primary care physicians in real-world scenarios.


Assuntos
Aprendizado Profundo , Redes Neurais de Computação , Neuroendoscopia/métodos , Otite Média/diagnóstico por imagem , Membrana Timpânica/diagnóstico por imagem , Bases de Dados Factuais , Humanos , Neuroendoscopia/instrumentação , Curva ROC , Reprodutibilidade dos Testes
17.
Neurosurgery ; 87(2): E140-E146, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32302399

RESUMO

BACKGROUND AND IMPORTANCE: A pituitary adenoma patient who underwent surgery in our department was diagnosed with COVID-19 and 14 medical staff were confirmed infected later. This case has been cited several times but without accuracy or entirety, we feel obligated to report it and share our thoughts on the epidemic among medical staff and performing endonasal endoscopic surgery during COVID-19 pandemic. CLINICAL PRESENTATION: The patient developed a fever 3 d post endonasal endoscopic surgery during which cerebrospinal leak occurred, and was confirmed with SARS-CoV-2 infection later. Several medical staff outside the operating room were diagnosed with COVID-19, while the ones who participated in the surgery were not. CONCLUSION: The deceptive nature of COVID-19 results from its most frequent onset symptom, fever, a cliché in neurosurgery, which makes it hard for surgeons to differentiate. The COVID-19 epidemic among medical staff in our department was deemed as postoperative rather than intraoperative transmission, and attributed to not applying sufficient personal airway protection. Proper personal protective equipment and social distancing between medical staff contributed to limiting epidemic since the initial outbreak. Emergency endonasal endoscopic surgeries are feasible since COVID-19 is still supposed to be containable when the surgeries are performed in negative pressure operating rooms with personal protective equipment and the patients are kept under quarantine postoperatively. However, we do not encourage elective surgeries during this pandemic, which might put patients in conditions vulnerable to COVID-19.


Assuntos
Adenoma/cirurgia , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Neuroendoscopia/métodos , Neoplasias Hipofisárias/cirurgia , Pneumonia Viral/transmissão , Adenoma/complicações , Idoso , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos , Epidemias , Humanos , Pulmão/diagnóstico por imagem , Masculino , Cavidade Nasal , Cirurgia Endoscópica por Orifício Natural , Procedimentos Neurocirúrgicos/métodos , Salas Cirúrgicas , Pandemias , Isolamento de Pacientes , Neoplasias Hipofisárias/complicações , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Cuidados Pós-Operatórios , Tomografia Computadorizada por Raios X
18.
World Neurosurg ; 139: 460-470, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32330621

RESUMO

OBJECTIVE: The influence of graft type (nonautologous vs. autologous) on surgical outcomes in endoscopic anterior skull base (EASB) reconstruction is not well understood. This review systematically evaluated rates of postoperative complications of EASB repairs that utilized autologous or nonautologous grafts. METHODS: Original studies reporting EASB reconstruction outcomes were extracted from PubMed, Ovid, and the Cochrane Library from database inception to 2019. Risk ratios, risk differences, χ2 tests, and multivariate logistic regression were used to evaluate outcome measures: postoperative cerebrospinal fluid (CSF) leaks, meningitis, and other major complications (OMCs). RESULTS: A total of 2275 patients from 29 studies were analyzed. Rates of postoperative CSF leaks, meningitis, and OMCs were 4.0%, 1.6%, and 2.3%, respectively, using autologous grafts, and 5.0%, 0.3%, and 1.0%, respectively, using nonautologous grafts. Multivariate analysis of 118 patients demonstrated no significant differences in age, CSF flow rate, single or multilayer reconstruction, and presence of intraoperative CSF leak or lumbar drain. Meta-analyses of 6 studies yielded a risk ratio of 0.64 (95% confidence interval [CI], 0.19-2.14; P = 0.47) for postoperative CSF leakage, and risk differences of -0.01 (95% CI, -0.06 to 0.05; P = 0.80) and -0.02 (95% CI, -0.09 to 0.05; P = 0.51) for postoperative meningitis and OMCs, respectively. There were no significant differences in postoperative CSF leakage (P = 0.95) and OMCs (P = 0.41) between graft types among cases with intraoperative CSF leaks. However, meningitis rates were lower (P = 0.04) in the nonautologous group. CONCLUSIONS: EASB reconstructions utilizing autologous and nonautologous grafts are associated with similar rates of postoperative CSF leakage and OMCs. In cases with intraoperative CSF leakage, nonautologous grafts were associated with reduced postoperative meningitis.


Assuntos
Neuroendoscopia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias da Base do Crânio/cirurgia , Base do Crânio/cirurgia , Transplantes/transplante , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Vazamento de Líquido Cefalorraquidiano/prevenção & controle , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/epidemiologia , Retalhos Cirúrgicos/transplante
20.
World Neurosurg ; 139: 268-273, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32278818

RESUMO

BACKGROUND: No formalized surgical treatment strategy exists for a thoracic epidural abscess. Although endoscopic approaches have been described for the treatment of spinal infections, this is the first report of an endoscopic transforaminal approach for the drainage of a thoracic/lumbar epidural abscess with placement of indwelling abscess drain. We present a novel use of a known endoscopic approach and describe a minimally invasive surgical option for ventrally located thoracic epidural abscesses. CASE DESCRIPTION: A patient with ventrally located T5-L5 epidural abscess with cord compression was taken for endoscopic transforaminal drainage at the right T9-10 level. A drain was left in the abscess cavity and tunneled subcutaneously for continued postoperative drainage. Immediate postoperative radiographic results showed significant reduction in the abscess size. The patient tolerated the procedure well with return to neurologic baseline. CONCLUSIONS: Endoscopic transforaminal drainage of ventrally located thoracic epidural abscess is a safe procedure that may be an option for patients with a purulent-filled abscess. This procedure should be considered an option to avoid more invasive procedures that would require decompression and possibly instrumented fusion.


Assuntos
Abscesso Epidural/cirurgia , Neuroendoscopia/métodos , Descompressão Cirúrgica/métodos , Drenagem/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Infecções Estafilocócicas/cirurgia , Vértebras Torácicas
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