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1.
Neurol India ; 69(4): 829-832, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507396

RESUMO

Background and Introduction: Unlocking of the frontotemporal dural fold (FTDF) and extradural removal of the anterior clinoid process (EACP) are challenging but mandatory skills for micro-neurosurgeons. Despite the presence of an extensive body of literature on this subject, the translation of this cadaveric and 3D simulation to a real patient turns out to be a very demanding and difficult task. Objective: This video is aimed to address the surgical nuances and major adjustments necessary in the unlocking of the FTDF and extradural ACP removal in an actual case for an early-career neurosurgeon. Surgical Technique: A 40-year lady presented with features of acromegaly with radiological evidence of significant component of the tumor in the right cavernous sinus along with sellar suprasellar component. To achieve a good hormonal control, a complete tumor excision was required, which was achieved with FTDF and EACP removal. The cavernous sinus was approached through the Parkinson's triangle. Results: The patient had uneventful recovery and good hormonal control at the 3-month follow-up. Conclusion: FTDF unlocking and EACP are elegant procedures and need to be learned by all neurosurgeons. This article will provide excellent teaching material for young neurosurgeons.


Assuntos
Seio Cavernoso , Base do Crânio , Cadáver , Humanos , Neurocirurgiões , Procedimentos Neurocirúrgicos , Osso Esfenoide
2.
Neurol India ; 69(4): 904-909, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507410

RESUMO

Background and Aims: Insular gliomas remain one of most challenging locations for aggressive resection. We report our experience and strategies we employed to avoid complications in immediate post-operative period of surgical resection of insular gliomas. Methods: Retrospective analysis of data collected in 61 consecutive patients who underwent surgical resection of insular gliomas between May 2013 and May 2016 was done. Primary outcome measures were neurological deficits and death in the immediate post-operative period to three months follow-up. Results: The average age of the study population was 42.57 ± 10.98 years with 41 (67.2%) men. Glioma was on the right side in 35 (57.3%) patients. Surgery for recurrent glioma was performed in three (4.9%) patients. The average MIB index of the entire group was 10.1 ± 13.9. While 23 (37.7%) patients underwent the TO approach, 38 (62.3%) underwent TS approach. In the immediate post-operative period, significantly higher number of patients under TS approach had post-surgical complications (8.6% vs 34.2%; P = 0.032). The surgical approaches did not differ significantly for outcome, mortality and complications at three month post-operatively (0.0% vs 10.5%; P = 0.287). However, a trend for lower complications at three months was observed with TO approach. Conclusion: We report that morbidity and mortality in immediate post-operative period can be reduced by: a) pre-surgical assessment of confinement of glioma in respect to lenticulo-striate arteries, b) Intra-operative use of functional-MRI, DTI tractography and ICG angiography, c) Application of Berger-Sinai classification to localize the glioma, d) selecting either TS or TO approach based on Berger-Sinai classification.


Assuntos
Neoplasias Encefálicas , Glioma , Cirurgiões , Adulto , Neoplasias Encefálicas/cirurgia , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/cirurgia , Glioma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
4.
Vestn Otorinolaringol ; 86(4): 111-115, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34499458

RESUMO

The article presents a clinical example of the course of posttraumatic acute purulent sinusitis with reactive soft tissue phenomena due to the previous injury of the orbit by a foreign body, the introduction of the latter into orbit and the maxillary sinus result in a fracture of the lower wall of the orbit. A feature of the injury is the penetration of a foreign body through the conjunctiva of the lower eyelid and lower conjunctival fornix, without damaging the skin. This case is professionally interesting for both young doctors and experienced specialists in otolaryngology, ophthalmology, maxillofacial surgery and neurosurgery. Experts, analyzing this clinical example, will be able to correctly diagnose, effectively eliminate the inflammatory process in the maxillary sinus.


Assuntos
Corpos Estranhos , Sinusite Maxilar , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Corpos Estranhos/cirurgia , Humanos , Seio Maxilar/cirurgia , Sinusite Maxilar/diagnóstico , Sinusite Maxilar/etiologia , Sinusite Maxilar/cirurgia , Procedimentos Neurocirúrgicos , Órbita/diagnóstico por imagem
5.
Niger J Clin Pract ; 24(8): 1170-1173, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34397026

RESUMO

Objective: In this study, we report the results of patients who underwent ulnar nerve submuscular anterior transposition surgery due to cubital tunnel syndrome. Methods: Data of 46 patients who underwent anterior submuscular transposition surgery due to cubital tunnel syndrome between January 2010 and December 2014 were retrospectively reviewed. Twenty-seven patients with preoperative and postoperative complete medical records available and who had completed at least 24 months follow-up were included in the study. Results: According to preoperative McGovan staging system, 1 patient was classified as stage 1, 8 were stage 2A, 3 were stage 2B, and 15 were stage 3. The mean follow-up time was 61.4 (35-88) months. The mean DASH score of the patients was calculated as 19 (0-81.81). Mayo elbow performance score was excellent in 13 patients, good in 7, fair in 6, and poor in 1. Conclusion: Anterior submuscular transposition of ulnar nerve had resolved symptoms 89% of our patients. The technique is a successful method with a low recurrence and complication rate.


Assuntos
Síndrome do Túnel Ulnar , Síndrome do Túnel Ulnar/cirurgia , Descompressão Cirúrgica , Seguimentos , Humanos , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Resultado do Tratamento , Nervo Ulnar/cirurgia
6.
Artigo em Russo | MEDLINE | ID: mdl-34463447

RESUMO

In recent years, fluorescence navigation has been increasingly used in surgery for gliomas. In most studies, 5-ALA derivatives are used as fluorescence inducers. However, there are few data regarding E6 chlorin for these purposes. OBJECTIVE: To evaluate an effectiveness and feasibility of fluorescence navigation with chlorin E6 in surgery of brain gliomas. MATERIAL AND METHODS: The study included 30 patients with glial brain tumors grade II-IV. All patients were operated at the Polenov Russian Neurosurgical Institute. We used surgical microscope (Leica OHS-1), D-Light AF System (Karl Storz, Germany), original fluorescence module (St. Petersburg LOMO, developed by G.V. Papayan) and special software RSS Cam - Endo 1.4.313 for visual analysis of fluorescence. Histological examination included hematoxylin-eosin staining of specimens and immunohistochemical studies. RESULTS: Fluorescence was weak in all patients with Grade II gliomas and strong in almost all patients with Grade III-IV gliomas. Sensitivity of fluorescence diagnosis with chlorin E6 was 72.2% for Grade II gliomas, 83.8% for Grade III gliomas and 87.7% for Grade IV. Specificity of this method was 60% for Grade II gliomas, 66.7% for Grade III gliomas and 85.2% for Grade IV. CONCLUSION: Certain method of fluorescence imaging ensured resection of glial brain tumors using chlorin E6. Intensity of tumor fluorescence correlated with glioma malignancy grade. These results indicate that chlorin E6 is an effective photosensitizer for intraoperative fluorescence diagnosis in surgery for glioma.


Assuntos
Neoplasias Encefálicas , Glioma , Ácido Aminolevulínico , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Fluorescência , Glioma/cirurgia , Humanos , Procedimentos Neurocirúrgicos , Porfirinas
7.
Zh Vopr Neirokhir Im N N Burdenko ; 85(4): 103-110, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34463457

RESUMO

This review is devoted to various techniques for reduction of brain damage during retraction. Searching for reports was carried out in Russian and English languages using the PubMed database (n=721) without restrictions on language, date and study design according to the following keywords: «brain retraction injury¼, «spatula brain retractors¼, «tubular brain retractors¼, «retractorless neurosurgery¼. Primary screening and exclusion of duplicate manuscripts allowed us to single out the main group of articles (n=121). Some reports were excluded due to non-compliance with inclusion criteria (no description of methods, few references and insufficient data). The final list included 32 studies which were represented by cohort studies, retrospective analyses of surgical interventions, as well as experimental and laboratory studies. Small number of publications did not allow us to obtain unambiguous conclusions. Further research is required to reduce brain retraction trauma.


Assuntos
Lesões Encefálicas , Procedimentos Neurocirúrgicos , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Humanos , Estudos Retrospectivos , Instrumentos Cirúrgicos
8.
Artigo em Russo | MEDLINE | ID: mdl-34460167

RESUMO

The review of publications on functional magnetic resonance imaging (fMRI) and its practical application in neurosurgery is presented. Advantages and disadvantages are selected taking pathogenesis into account. Results of surgical treatment with use of functional navigation are described. Separate attention is paid to fMRI precision by its comparing with direct cortical stimulation. New resting-state method of visualization is observed. Practical advices are given of fMRI application in neurooncology and surgery of arteriovenous malformations.


Assuntos
Neurocirurgia , Mapeamento Encefálico , Humanos , Imageamento por Ressonância Magnética , Procedimentos Neurocirúrgicos
9.
Ann Plast Surg ; 87(3): 310-315, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397519

RESUMO

ABSTRACT: Diaphragmatic paralysis due to phrenic nerve injury may cause orthopnea, exertional dyspnea, and sleep-disordered breathing. Phrenic nerve reconstruction may relieve symptoms and improve respiratory function. A retrospective review of 400 consecutive patients undergoing phrenic nerve reconstruction for diaphragmatic paralysis at 2 tertiary treatment centers was performed between 2007 and 2019. Symptomatic patients were identified, and the diagnosis was confirmed on radiographic evaluations. Assessment parameters included pulmonary spirometry (forced expiratory volume in 1 second and FVC), maximal inspiratory pressure, compound muscle action potentials, diaphragm thickness, chest fluoroscopy, and Short Form 36 Health Survey Questionnaire (SF-36) survey. There were 81 females and 319 males with an average age of 54 years (range, 19-79 years). The mean duration from diagnosis to surgery was 29 months (range, 1-320 months). The most common etiologies were acute or chronic injury (29%), interscalene nerve block (17%), and cardiothoracic surgery (15%). The mean improvements in forced expiratory volume in 1 second and FVC at 1 year were 10% (P < 0.01) and 8% (P < 0.05), respectively. At 2-year follow-up, the corresponding values were 22% (P < 0.05) and 18% (P < 0.05), respectively. Improvement on chest fluoroscopy was demonstrated in 63% and 71% of patients at 1 and 2-year follow-up, respectively. There was a 20% (P < 0.01) improvement in maximal inspiratory pressure, and compound muscle action potentials increased by 82% (P < 0.001). Diaphragm thickness demonstrated a 27% (P < 0.01) increase, and SF-36 revealed a 59% (P < 0.001) improvement in physical functioning. Symptomatic diaphragmatic paralysis should be considered for surgical treatment. Phrenic nerve reconstruction can achieve symptomatic relief and improve respiratory function. Increasing spirometry and improvements on Sniff from 1 to 2 years support incremental recovery with longer follow-up.


Assuntos
Paralisia Respiratória , Diafragma , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Nervo Frênico/cirurgia , Paralisia Respiratória/etiologia , Paralisia Respiratória/cirurgia , Estudos Retrospectivos
10.
Ann Plast Surg ; 87(3): 316-323, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397520

RESUMO

BACKGROUND: Neurolysis techniques have been adapted for decompression of peripheral nerves in multiple locations, including the common peroneal nerve (CPN) at the fibular neck. The aim of this study was to conduct a systematic review and meta-analysis to summarize the clinical outcomes of neurolysis for the management of peroneal nerve palsy (PNP). METHODS: Preferred Reporting Systems for Systematic Reviews and Meta-Analyses guidelines were followed for this meta-analysis. Four databases were queried, and randomized clinical trials, cohort studies, case-control studies, and case series with n > 10 published in English that evaluated clinical outcomes of neurolysis for the treatment of PNP and foot drop were included. Two reviewers completed screening and data extraction. Methodological quality was evaluated using the Newcastle-Ottawa Scale. RESULTS: A total of 493 articles were identified through literature search. Title and abstract screening identified 39 studies for full-text screening. Ten articles met the inclusion criteria for qualitative analysis, and 8 had complete data for meta-analysis.Overall, there were 368 patients (370 nerves) who had neurolysis of the CPN for PNP, of which 59.2% (n = 218) were men and 40.8% (n = 150) were women. The mean age of the patients was 47.1 years (SD, 10.0 years), mean time to surgery was 9.65 months (SD, 6.3 months), and mean follow-up time was 28 months (SD, 14.0 months). The median preoperative Medical Research Council (MRC) score was 1 (IQR 0, 3), with 42.2% (n = 156) having MRC score of 0. The median postoperative MRC score was 5 (IQR 4, 5), with 53.9% (n = 199) having MRC score of 5. Complications of neurolysis of the peroneal nerve for treatment of PNP included postoperative infection (0.54%, n = 2), wound dehiscence (0.27%, n = 1), hematoma (0.54%, n = 2), bleeding (0.27%, n = 1), relapse of PNP (0.27%, n = 1), and 1 case of mortality due to sepsis. CONCLUSIONS: Our meta-analysis shows that neurolysis of the CPN is safe and improves ankle dorsiflexion strength in patients with PNP. Future studies should use a standardized method of measuring sensory outcomes, and studies of higher levels of evidence are needed to better assess the clinical outcomes of neurolysis for treatment of PNP.


Assuntos
Neuropatias Fibulares , Feminino , Fíbula , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Paralisia , Nervo Fibular/cirurgia , Neuropatias Fibulares/cirurgia
12.
BMJ Case Rep ; 14(8)2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34417230

RESUMO

A 12-year-old girl underwent surgery for Lenke type 4 adolescent idiopathic scoliosis. After scoliosis correction, the transcranial motor-evoked potential (Tc-MEP) showed no alarm. However, the Tc-MEP amplitude had declined ~10 min after correction, with a normal blood pressure (BP) and body temperature and without any technical monitoring errors. Therefore, we suspected indirect spinal cord ischaemia because of the delayed true-positive Tc-MEP alarm. All the strong corrections made loss of Tc-MEP and all the correction releases made recovers of waveform. Finally, a weak correction was performed, and the Tc-MEP amplitude was recovered. Because transient spinal cord ischaemia due to correction of triple curves may cause a delayed monitoring alarm, the monitoring team should frequently check Tc-MEP after these manoeuvres. This patient had no neurological deficits and was considered to be a rescue case.


Assuntos
Cifose , Procedimentos Ortopédicos , Escoliose , Adolescente , Criança , Potencial Evocado Motor , Feminino , Humanos , Procedimentos Neurocirúrgicos , Escoliose/cirurgia
14.
Ann R Coll Surg Engl ; 103(8): 548-552, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34464556

RESUMO

INTRODUCTION: Medical malpractice litigation is a major concern for all spine surgeons. Our aim was to evaluate the incidence and burden of successful litigation relating to the management of spinal disorders over 12 years within a UK NHS tertiary-level spinal unit and compare these litigation costs with those of other specialties. METHODS: We obtained all data held by our claims department from its inception in January 2008 to December 2019. We also obtained costs for the total financial burden incurred by our Trust during this period. RESULTS: In total, there were 83 closed claims involving spinal pathologies. Over 80% of these comprised negligent surgery (n = 28, 34%), delay to diagnose/treat (n = 25, 30%) and negligent care (n = 18, 22%). The vast majority of claims were withdrawn without incurring any cost to the hospital (n = 59, 71%) and only 24 (29%) resulted in successful litigation for the claimant. The total cost of damages for these 24 successful claims was just over £8 million, including legal costs of £2.5 million, out of total litigation costs of £381 million over this period. DISCUSSION: Fewer than 30% of initial claims against a tertiary spinal surgical referral unit resulted in a successful financial outcome for the claimant. The total costs incurred were just over £8 million, with one-third apportioned to high legal costs, reflecting the complexity of resolving spinal litigation. Our entire legal expenses accounted for only 2% of the total legal bill paid by our hospital over a 12-year period.


Assuntos
Imperícia/economia , Procedimentos Neurocirúrgicos/legislação & jurisprudência , Doenças da Coluna Vertebral/cirurgia , Humanos , Imperícia/legislação & jurisprudência , Medicina Estatal/economia , Medicina Estatal/legislação & jurisprudência , Reino Unido
15.
BMJ Open ; 11(8): e049902, 2021 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-34426467

RESUMO

INTRODUCTION: The full-endoscopic spinal surgery (FESS) procedure is widely accepted and welcomed in China. With the continuous development of minimally invasive surgery, the further expansion of indications and the greater diversity of techniques, spinal endoscopic surgery currently accounts for more than 10% of spinal surgery in China, ranking among the top in the world. However, the admission system and standardised training system for spinal endoscopic surgery are not perfect, which presents a challenge and disadvantage for novices. METHODS AND ANALYSIS: Exploratory mixed methods are applied for designing this study. First, we will collect questions from novices by allowing them to openly list their concerns to those who have completed FESS. These qualitative questions will be categorised using NVivo software. To produce the qualitative results, a questionnaire for the sequential two-round Delphi approach will be developed to identify the 20 most important questions from novices. This study is planned to be started at April 2021, and completed at March 2022. ETHICS AND DISSEMINATION: The Research Ethics Committee of Peking University Third Hospital provided a waiver for this Delphi protocol. We expect that the findings will be published in a clinical journal and presented at conferences. Furthermore, we hope that the results can contribute to answering the questions raised by novices of spinal endoscopy in the form of books and to improving the training system for spinal endoscopy surgery.


Assuntos
Endoscopia , Projetos de Pesquisa , China , Humanos , Procedimentos Neurocirúrgicos , Inquéritos e Questionários
16.
No Shinkei Geka ; 49(4): 698-710, 2021 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-34376602

RESUMO

Stereotactic and functional neurosurgery(SFN)is one of the oldest subspecialties of neurosurgery. In Japan, functional epilepsy surgery was performed in the Meiji era, even before World War II, when general surgeons used to operate on patients with intractable cancer pain through open myelotomy or cordotomy. Knowledge gathered from such age-old procedures provided the basic understanding of neurophysiology and hence, functional neurosurgery used to be termed as "applied neurophysiology". Human stereotactic surgery was introduced in 1947 and many Japanese neurosurgeons, particularly Hirotaro Narabayashi, Keiji Sano and Chihiro Ohye, contributed to the development of this field. Additionally, we should remember that common procedures of neurosurgery practiced today such as neuroendoscopy, navigation surgery, intraoperative monitoring, and the concept of exo-scope, which are less invasive and involves high accuracy, emerged from the field of SFN. Young doctors should learn from history and understand where we started from, where we at present, and where we are heading in the future.


Assuntos
Epilepsia , Neurocirurgia , Epilepsia/cirurgia , Humanos , Imageamento Tridimensional , Japão , Procedimentos Neurocirúrgicos
17.
No Shinkei Geka ; 49(4): 858-872, 2021 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-34376618

RESUMO

The sequelae of neurosurgical diseases are an increasingly important component of neurologists' clinical practice. Moreover, spasticity is one of the most common of these effects. While spasticity may be useful in compensating for a loss in motor strength, it frequently becomes harmful and leads to further functional losses. When patients with harmful spasticity cannot be managed through physical therapy, neurosurgical treatment must be considered. We present the current state of knowledge relating to the assessment and treatment of spasticity, especially selective peripheral neurotomy and intrathecal baclofen therapy. To continue developing therapies for spasticity, we must be familiar with the characteristics of various treatment methods used to treat spasticity and create frameworks for regional alliances that focus primarily on education and rehabilitation programs targeting spasticity treatment that involve patients, patients' families, and medical staff.


Assuntos
Relaxantes Musculares Centrais , Neurocirurgia , Baclofeno/uso terapêutico , Humanos , Injeções Espinhais , Relaxantes Musculares Centrais/uso terapêutico , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/cirurgia , Procedimentos Neurocirúrgicos
18.
No Shinkei Geka ; 49(4): 873-881, 2021 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-34376619

RESUMO

Stereotactic and functional neurosurgery(deep brain stimulation[DBS]and radiofrequency coagulation)is an established method of treatment for patients with Parkinson's disease, tremor, and/or dystonia. The surgery involves many pitfalls and is similar to other surgeries, requiring experience and skills. Here, we have discussed three categories of DBS-related complications, including surgical procedure-related and device-related complications, and stimulation-induced side effects. In addition, we have discussed the prevention and coping methods, including those not listed in the guidelines for stereotactic and functional neurosurgery.


Assuntos
Estimulação Encefálica Profunda , Distonia , Neurocirurgia , Doença de Parkinson , Distonia/terapia , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Doença de Parkinson/cirurgia
20.
Curr Opin Anaesthesiol ; 34(5): 569-574, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34435600

RESUMO

PURPOSE OF REVIEW: Same-day protocols for craniotomy have been demonstrated to be feasible and safe. Its several benefits include decreased hospital costs, less nosocomial complications, fewer case cancellations, with a high degree of patient satisfaction. This paper reviews the most recent publications in the field of same-day discharge after craniotomy. RECENT FINDINGS: Since 2019, several studies on same-day neurosurgical procedures were published. Ambulatory craniotomy protocols for brain tumor were successfully implemented in more centers around the world, and for the first time, in a developing country. Additional information emerged on predictors for successful early discharge, and the barriers and enablers of same-day craniotomy programs. Moreover, the cost benefits of same-day craniotomy were reaffirmed. SUMMARY: Same- day discharge after craniotomy is feasible, safe and continues to expand to a wider variety of procedures, in new institutions and countries. There are several benefits to ambulatory surgery. Well-established protocols for perioperative management are essential to the success of early discharge programs. With continued research, these protocols can be refined and implemented in more institutions globally, ultimately to provide better, more efficient care for neurosurgical patients.


Assuntos
Neoplasias Encefálicas , Alta do Paciente , Procedimentos Cirúrgicos Ambulatórios , Neoplasias Encefálicas/cirurgia , Craniotomia , Humanos , Procedimentos Neurocirúrgicos
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