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1.
Rozhl Chir ; 99(7): 304-310, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32972148

RESUMO

INTRODUCTION: Vagus nerve stimulation is a palliative treatment for patients with refractory epilepsy to reduce the frequency and intensity of seizures. A bipolar helical electrode is placed around the left vagus nerve at the cervical level and is connected to the pulse generator placed in a subcutaneous pocket, most commonly in the subclavian region. METHODS: Between March 1998 and October 2019, we performed 196 procedures related to the vagal nerve stimulation at the Neurosurgery Department in Motol University Hospital. Of these, 126 patients were vagal nerve stimulator implantation surgeries for intractable epilepsy. The cases included 69 female and 57 male patients with mean age at the time of the implantation surgery 22±12.4 years (range 2.158.4 years). RESULTS: Nine patients (7.1%) were afflicted by complications related to implantation. Surgical complications included postoperative infection in 1.6%, VNS-associated arrhythmias in 1.6%, jugular vein bleeding in 0.8% and vocal cord paresis in 2.4%. One patient with vocal cord palsy also suffered from severe dysphagia. One patient (0.8%) did not tolerate extra stimulation with magnet due to a prolonged spasm in his throat. The extra added benefit of vagus stimulation in one patient was a significant reduction of previously regular severe headaches. CONCLUSION: Vagus nerve stimulation is an appropriate treatment for patients with drug-resistant epilepsy who are not candidates for focal resective surgery. Implantation of the vagus nerve stimulator is a relatively safe operative procedure.


Assuntos
Epilepsia/terapia , Estimulação do Nervo Vago/efeitos adversos , Pré-Escolar , Feminino , Humanos , Masculino , Procedimentos Neurocirúrgicos , Complicações Pós-Operatórias , Resultado do Tratamento , Nervo Vago
2.
Zhonghua Yi Xue Za Zhi ; 100(33): 2618-2621, 2020 Sep 08.
Artigo em Chinês | MEDLINE | ID: mdl-32892609

RESUMO

Objective: To introduce and evaluate a technique to precisely localize the transverse-sigmoid sinus junction (TSSJ) in retrosigmoid craniotomy. Methods: This was a single-center prospective randomized controlled study. Sixty-three patients, 29 male and 34 female, who would undergo retrosigmoid craniotomy admitted to Department of Neurosurgery, the First Affiliated Hospital of Xinjiang Medical Universityfrom March to October 2019 were enrolled in the study and were divided into trial group and control group according to the computer-generated random numbers. Preoperative venous computed tomographic angiography (CTA) combined with 3-dimensional computed tomography computed tomography (3D CT) was randomly given to the patients(n=32). Asterion was used for identification of the TSSJ in the controls (n=31). The main outcome measures as postoperative complications and relevant intraoperative indicators were compared. Results: Incision length, craniotomy time, bone window sizein trial group were shorter or smaller than those of the controls, as(6.8±0.5) cm vs (8.0±1.5) cm, (37±8) min vs (45±15) min, (8.7±1.2) cm(2) vs (10.2±2.4) cm(2) respectively, with statistical significance (all P<0.05). No statistical significance was found in bleeding amount, incidence of sinus injury and cerebrospinal fluid leakage. While incidence of neck pain was lower in case group (15.63% vs 38.71%; P=0.04) and the remission time of incisional pain in case group was shorter [(6±1) d vs (9±2) d; P=0.01]. Conclusion: While the technique is used, the center of the keyhole should be located at transitional place of the lateral part of the occipitomastoid suture, the retromastoid ridge and the superior nuchal line. Compared with the traditional craniotomy method marked by asterion, it has great advantages in reducing incidence of postoperative complications, craniotomy time, and the remission time of incisional pain.


Assuntos
Cavidades Cranianas , Tomografia Computadorizada por Raios X , Craniotomia , Feminino , Humanos , Masculino , Procedimentos Neurocirúrgicos , Estudos Prospectivos
6.
Medicine (Baltimore) ; 99(39): e22471, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991485

RESUMO

RATIONALE: Patients with long term bed rest in intensive care unit after neurosurgery could experience splanchnic hypoperfusion. These patients have several other medical conditions that exacerbate splanchnic hypoperfusion during treatment and the splanchnic hypoperfusion could result in "stress-induced intestinal necrosis", which could cause massive hematochezia. We report here the experience of life-threatening hematochezia in 3 patients who underwent brain surgery in our institution. PATIENTS CONCERNS: One female patient (72-year-old) and 2 male patients (58- and 35-year-old) were admitted to our institution because of traumatic intracerebral hemorrhage, subarachnoid hemorrhage due to a ruptured anterior communicating artery, and subarachnoid hemorrhage with unknown cause respectively. All patients underwent emergency brain surgery for diagnosis and treatment. After surgery, they all experienced long-term bed rest in intensive care unit. Hematochezia occurred on postoperative day 15, 17, and 49, respectively. DIAGNOSES: All of the patients were assessed by abdomen/pelvis computed tomography and underwent a colonoscopy. INTERVENTIONS: The female patient underwent embolization through pelvic arteriography and epinephrine injection through colonoscopy, but a total colectomy and ileostomy was performed due to refractory hematochezia. 58-year-old male patient had a laparoscopic ileostomy for the bowel rest. The other patient underwent nil per os and conservative treatment for 2 weeks. OUTCOMES: The female patient was discharged without further treatment plan, 58-year-old male patient survived after laparoscopic ileostomy, while the other patient survived after 2 weeks of nil per os. LESSON: Abdominal symptoms, such as hematochezia, should be actively managed in neurosurgical patients who are undergoing long-term bed rest in an intensive care unit under physiologically stressful medical conditions.


Assuntos
Repouso em Cama/efeitos adversos , Hemorragia Gastrointestinal/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Adulto , Idoso , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios X
9.
Orv Hetil ; 161(37): 1574-1578, 2020 09.
Artigo em Húngaro | MEDLINE | ID: mdl-32894737

RESUMO

Intracranial surgical interventions and spontaneous intracerebral hemorrhages challange neuroanesthesia and neurocritical care. First, the brain is the most sensitive organ to tissue hypoxia in the case of severe intraoperative bleedings and, second, a growing hemorrhage within the closed intracranial space may result in a ciritcal elevation of intracranial pressure resulting in an imminent life danger. The authors summerize the potential treatment strategies during neuroanesthesia and neurocritical care. Perioperative organ-specific optimalization of hemoglobin concentration, thrombocyte count and fibrinogen concentrations are key elements in elective neurosurgical interventions. Prior antithrombotic and anticoagulant treatment may indicate targeted pharmacological optimalization and treatment that should be based on laboratory diagnosis. In intracerebral hemorrhages, treatment strategy should be based on the etiology and laboratory diagnostics and targeted pharmacological treatment is preferable. Orv Hetil. 2020; 161(37): 1574-1578.


Assuntos
Anticoagulantes , Hemorragia Cerebral , Hemostáticos , Procedimentos Neurocirúrgicos , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/terapia , Humanos , Hemorragias Intracranianas , Procedimentos Neurocirúrgicos/efeitos adversos
10.
BMC Infect Dis ; 20(1): 669, 2020 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-32928130

RESUMO

BACKGROUND: The parasite Entamoeba histolytica is the causal agent of amoebiasis, a worldwide emerging disease. Amebic brain abscess is a form of invasive amebiasis that is both rare and frequently lethal. This condition always begins with the infection of the colon by E. histolytica trophozoites, which subsequently travel through the bloodstream to extraintestinal tissues. CASE PRESENTATION: We report a case of a 71-year-old female who reported an altered state of consciousness, disorientation, sleepiness and memory loss. She had no history of hepatic or intestinal amoebiasis. A preliminary diagnosis of colloidal vesicular phase neurocysticercosis was made based on nuclear magnetic resonance imaging (NMRI). A postsurgery immunofluorescence study was positive for the 140 kDa fibronectin receptor of E. histolytica, although a serum analysis by ELISA was negative for IgG antibodies against this parasite. A specific E. histolytica 128 bp rRNA gene was identified by PCR in biopsy tissue. The final diagnosis was cerebral amoebiasis. The patient underwent neurosurgery to eliminate amoebic abscesses and was then given a regimen of metronidazole, ceftriaxone and dexamethasone for 4 weeks after the neurosurgery. However, a rapid decline in her condition led to death. CONCLUSIONS: The present case of an individual with a rare form of cerebral amoebiasis highlights the importance of performing immunofluorescence, NMRI and PCR if a patient has brain abscess and a poorly defined diagnosis. Moreover, the administration of corticosteroids to such patients can often lead to a rapid decline in their condition.


Assuntos
Abscesso Encefálico/diagnóstico , Abscesso Encefálico/parasitologia , Infecções Parasitárias do Sistema Nervoso Central/diagnóstico , Entamebíase/diagnóstico , Idoso , Animais , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/cirurgia , Ceftriaxona/administração & dosagem , Infecções Parasitárias do Sistema Nervoso Central/tratamento farmacológico , Infecções Parasitárias do Sistema Nervoso Central/patologia , Infecções Parasitárias do Sistema Nervoso Central/cirurgia , Terapia Combinada , DNA de Protozoário/análise , Dexametasona/administração & dosagem , Quimioterapia Combinada , Entamoeba histolytica/genética , Entamoeba histolytica/imunologia , Entamoeba histolytica/isolamento & purificação , Entamebíase/tratamento farmacológico , Entamebíase/patologia , Entamebíase/cirurgia , Evolução Fatal , Feminino , Humanos , Metronidazol/administração & dosagem , Procedimentos Neurocirúrgicos , Testes Sorológicos
11.
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
12.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(4): 184-194, jul.-ago. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193899

RESUMO

INTRODUCCIÓN: La cirugía de los tumores cerebrales se ha implementado en los últimos años con nuevas técnicas de imagen intraoperatoria, que tratan de mejorar la resección tumoral, aunque conllevan un aumento de recursos. Con el fin de hacer una actualización de este tema, se ha elaborado este manuscrito desde el grupo de tumores de la Sociedad Española de Neurocirugía. MATERIAL Y MÉTODOS: Se ha propuesto a expertos en el uso de cada una de las técnicas intraoperatorias más empleadas en la cirugía de los tumores cerebrales, la descripción de la técnica y una breve revisión de la literatura. Se describirán indicaciones de uso, sus ventajas e inconvenientes basados en la experiencia clínica y en lo publicado en la literatura. RESULTADOS: La técnica de imagen intraoperatoria más consistente sería la resonancia de bajo y alto campo, pero a su vez es la que supone un mayor gasto de recursos. La ecografía intraoperatoria navegada es portátil y tiene un menor coste, aunque discrimina peor los tumores de alto grado y es observador-dependiente. Las técnicas de fluorescencia más empleadas son el 5-aminolevulínico para gliomas de alto grado y la fluoresceína, de utilidad en lesiones que rompen la barrera hematoencefálica. Por último, la TAC intraoperatoria es la más versátil en el quirófano de neurocirugía, pero tiene menos indicaciones en la cirugía neurooncológica. CONCLUSIONES: Las técnicas de imagen intraoperatoria se emplean cada vez con más frecuencia en la cirugía de los tumores cerebrales, y el neurocirujano debe valorar su posible uso en función de sus recursos y las necesidades de cada paciente


INTRODUCTION: New intraoperative imaging techniques, which aim to improve tumour resection, have been implemented in recent years in brain tumour surgery, although they lead to an increase in resources. In order to carry out an update on this topic, this manuscript has been drafted by a group from the Sociedad Española de Neurocirugía (Spanish Society of Neurosurgery). MATERIAL AND METHODS: Experts in the use of each one of the most-used intraoperative techniques in brain tumour surgery were presented with a description of the technique and a brief review of the literature. Indications for use, their advantages and disadvantages based on clinical experience and on what is published in the literature will be described. RESULTS: The most robust intraoperative imaging technique appears to be low- and high-field magnetic resonance imaging, but this is the technique which results in the greatest expenditure. Intraoperative ultrasound navigation is portable and less expensive, but it provides poorer differentiation of high-grade tumours and is observer-dependent. The most-used fluorescence techniques are 5-aminolevulinic acid for high-grade gliomas and fluorescein, useful in lesions which rupture the blood-brain barrier. Last of all, intraoperative CT is more versatile in the neurosurgery operating theatre, but it has fewer indications in neuro-oncology surgery. CONCLUSIONS: Intraoperative imaging techniques are used with increasingly greater frequency in brain tumour surgery, and the neurosurgeon should assess their possible use depending on their resources and the needs of each patient


Assuntos
Humanos , Neoplasias Encefálicas/cirurgia , Procedimentos Neurocirúrgicos , Processamento de Imagem Assistida por Computador , Monitorização Intraoperatória/instrumentação , Imagem por Ressonância Magnética/instrumentação , Monitorização Intraoperatória/normas , Imagem por Ressonância Magnética/normas
14.
Medicine (Baltimore) ; 99(31): e21474, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756170

RESUMO

RATIONALE: Tibial nerve injury is a sustainable but rare complication during total-ankle arthroplasty (TAA). We outlined 2 previously unreported cases of tibial nerve injury in TAA, including the prognoses and possible causes. PATIENT CONCERNS: First, a 63-year-old woman complained of a 5-month history of persistent tingling sensation and numbness on the medial and plantar aspects of her foot after TAA. Second, a 50-year-old woman complained of a 6-month history of tingling sensation and numbness on the plantar surface of her forefoot after TAA. DIAGNOSIS: Explorations were performed on suspicion of tarsal tunnel syndrome; however, both patients exhibited complete laceration of tibial nerve with neuroma formation. INTERVENTIONS: In both patients, we excised the neuroma and performed end-to-end nerve repair. OUTCOMES: The sensory disturbance of the sole considerably improved at long-term follow-up over 8 years after the neurorrhaphy procedures. LESSONS: Tibial nerve injury is rare following TAA, and is sometimes unrecognized or misdiagnosed. If tibial nerve injury is suspected, prompt surgical exploration should be performed; great precaution must also be taken to prevent injury of the tibial nerve during TAA.


Assuntos
Artroplastia de Substituição do Tornozelo/efeitos adversos , Neuroma/cirurgia , Parestesia/etiologia , Nervo Tibial/lesões , Assistência ao Convalescente , Feminino , Pé/fisiopatologia , Humanos , Hipestesia/etiologia , Doença Iatrogênica/epidemiologia , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Síndrome do Túnel do Tarso/diagnóstico , Nervo Tibial/patologia , Resultado do Tratamento
15.
Medicine (Baltimore) ; 99(32): e21579, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769906

RESUMO

Posterior vertebral column resection (PVCR) was the most powerful technique for treating severe rigid spinal deformity, but it has been plagued with high neurologic deficits risk. The fluctuations of spinal cord blood flow (SCBF) play an important role in secondary spinal cord injury during deformity correction surgery.The objective of this study was to first provide the characteristic of SCBF during PVCR with spinal column shortening in severe rigid spinal deformity.Severe rigid scoliokyphosis patients received PVCR above L1 level were included in this prospective study. Patients with simple kyphosis, intraspinal pathology and any degree of neurologic deficits were excluded. The deformity correction was based on spinal column shortening over the resected gap during PVCR. Laser Doppler flowmetry was used to monitor the SCBF at different surgical stages.There were 12 severe rigid scoliokyphosis patients in the study. The baseline SCBF was 316 ±â€Š86 perfusion unite (PU), and the SCBF decreased to 228 ±â€Š68 PU after VCR (P = .008). The SCBF increased to 296 ±â€Š102 PU after the middle shortening and correction which has a 121% increased comparison to the SCBF after VCR (P = .02). The SCBF will slightly decrease to 271 ±â€Š65 PU at final fixation. The postoperative neural physical examination of all patients was negative, and the MEP and SSEP of all patients did not reach the alarm value during surgery.These results indicate that PVCR is accompanied by a change in SCBF, a proper spinal cord shortening can protect the SCBF and can prevent a secondary spinal cord injury during the surgery.


Assuntos
Cifose/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Escoliose/cirurgia , Medula Espinal/irrigação sanguínea , Coluna Vertebral/cirurgia , Adolescente , Adulto , Feminino , Humanos , Cifose/complicações , Masculino , Procedimentos Neurocirúrgicos/métodos , Estudos Prospectivos , Escoliose/complicações , Medula Espinal/cirurgia , Coluna Vertebral/fisiopatologia , Resultado do Tratamento
16.
Medicine (Baltimore) ; 99(32): e21640, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769930

RESUMO

BACKGROUND: The best treatment option for patients with post-hemorrhagic hydrocephalus (PHH) remains controversial. The objective of the current meta-analysis is to systematically evaluate the long-term outcomes of patients with PHH treated by ventriculoperitoneal shunt (VPS) and lumboperitoneal shunt (LPS). METHODS: We search literatures through PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), the Chinese Science and Technology Periodical Database (VIP) and Wan fang databases, and Chinese Biomedical Literature Database (CBM) from its beginning to June 15, 2020. Randomized controlled trials (RCTs) and non-RCTs in English or Chinese studies will be considered. The primary outcome is the rate of shunt failure after shunt implantationThe secondary outcome is the rate of complications that are associated with shunt surgery. RESULTS AND CONCLUSION: The study will compare the 2 types of shunt surgery in the treatment of PHH, providing evidence for the treatment option for the patients with PHH. STUDY REGISTRATION NUMBER: The study is priorly registered through International Platform of Registered Systematic Review and Meta-analysis Protocols on June 17, 2020 (INPLASY202060063).


Assuntos
Protocolos Clínicos , Hidrocefalia/cirurgia , Procedimentos Neurocirúrgicos/normas , Derivação Ventriculoperitoneal/normas , Humanos , Metanálise como Assunto , Procedimentos Neurocirúrgicos/métodos , Revisões Sistemáticas como Assunto , Derivação Ventriculoperitoneal/métodos
17.
Medicine (Baltimore) ; 99(32): e21720, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769940

RESUMO

The surgical treatment of congenital scoliosis under 10 years is difficult as it involves resecting vertebrae. Moreover, patient follow-up after surgery is extremely important because the patient is a child whose growth has not been completed. However, there are very few long-term follow-up studies after surgical treatment of congenital scoliosis. Therefore, this study is designed to evaluate surgical outcomes after posterior hemivertebra resection in children under 10 years and its long-term effects.Twenty-one patients with congenital scoliosis who were younger than 10 years at the time of the surgery and received posterior hemivertebra resection and fusion using pedicle screw fixation were included in this study.There were significant improvements in the main curve, coronal balance, sagittal vertical axis, thoracic kyphosis, and lumbar lordosis after surgery (P < .001, .021, .047, .043, .006, respectively). Coronal balance, sagittal vertical axis, thoracic kyphosis, and lumbar lordosis remained within the normal range during the follow-up period; however, main curve deteriorated significantly (P = .005). Trunk appearance of perception scale improved significantly after surgery (P = .031) and was maintained during the follow-up period (P = .078).In conclusion, posterior hemivertebra resection and fusion using pedicle screw fixation in patients under 10 years old with congenital scoliosis is a safe and effective procedure that can achieve rigid fixation and deformity correction. Complete resection of the hemivertebra is important for deformity correction and prevention of curve progression, and careful long-term follow-up is necessary.


Assuntos
Escoliose/cirurgia , Coluna Vertebral/cirurgia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Fixadores Internos , Masculino , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Escoliose/complicações , Escoliose/fisiopatologia , Curvaturas da Coluna Vertebral/classificação , Curvaturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Resultado do Tratamento
18.
Crit Rev Oncol Hematol ; 154: 103073, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32827878

RESUMO

Although radiation therapy (RT) is a main treatment of brain tumors, delayed cerebral toxicity may lead to cognitive deteriorations with adverse effects on quality of life. Despite technological advances in RT, the concept of brain connectome has not yet been incorporated in the strategy of irradiation. Because white matter tracts represent the main limitation of neuroplasticity, tumor surgery is increasingly performed with awake cortical-subcortical mapping. Here, the purpose is to reinforce the link between cognitive neurosciences and neurooncology, which is critical for neurosurgeons but also for medical oncologists, especially brain radiation oncologists. The goal is to optimize RT planning by sparing individual critical neural networks. A redefinition of "organs at risk" should be proposed, beyond the few structures (such as brainstem, optic pathway, pituitary gland, hippocampi) which are classically preserved for brain radiation, by considering the structural and functional connectivity in order to evolve toward a RT "à la carte".


Assuntos
Neoplasias Encefálicas/radioterapia , Conectoma , Encéfalo/diagnóstico por imagem , Humanos , Procedimentos Neurocirúrgicos , Qualidade de Vida
19.
Neurol India ; 68(4): 774-791, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32859813

RESUMO

Introduction: Severe acute respiratory syndrome, coronavirus 2 (SARS-COV 2) has inexplicably and irreversibly changed the way of neurosurgery practice. There has been a substantial reduction in neurosurgical operations during the period of lockdown. The lockdown might be the most effective measure to curtail viral transmission. Once we return to the normalization of the lifestyle, there will be a backlog of unoperated pending cases along with the possibility of further spread of the coronavirus. Methods: We reviewed the available literature and protocols for neurosurgical practice in different geographic locations. We drafted a consensus statement based on the literature and protocols suggested by the World Health Organization (WHO) and various professional societies to prevent the spread of SARS-COV2 while streamlining the neurosurgical practice. Results: The consensus statement suggests the patient triage, workflow, resource distribution, and operational efficacy for care providers at different stages of management. The priority is set at personal protection while ensuring patients' safety, timely management, and capacity building. We performed a detailed subsection analysis for the management of trauma and set up for COVID-free hospitals for simultaneous management of routine neurosurgical indications. In this time of medicolegal upheaval, special consent from the patients should be taken in view of the chances of delay in management and the added risk of corona infection. The consensus statements are applicable to neurosurgical setups of all capacities. Conclusion: Along with the glaring problem of infection, there is another threat of neurosurgery emergency building up. This wave may overwhelm the already stretched systems to the hilt. We need to flatten this curve while avoiding contagion. These measures may guide neurosurgery practitioners to effectively manage patients ensuring the safety of caregivers and care seekers both.


Assuntos
Betacoronavirus/patogenicidade , Consenso , Infecções por Coronavirus/prevenção & controle , Neurocirurgia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Cuidadores , Infecções por Coronavirus/cirurgia , Humanos , Neurocirurgia/métodos , Procedimentos Neurocirúrgicos , Pneumonia Viral/cirurgia
20.
Plast Reconstr Surg ; 146(2): 381-388, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740591

RESUMO

BACKGROUND: Patients undergoing trigger-site deactivation surgery for headaches report a high prevalence (approximately 37 percent) of prior head or neck injury. Traditional medical treatment often fails to treat these posttraumatic patients. It is unclear whether surgery mirrors these poor outcomes. This study aims to describe the characteristics of posttraumatic headache surgery patients and compare their postoperative results to those of patients without a history of head or neck injury. METHODS: One hundred forty-two patients undergoing trigger-site deactivation surgery were prospectively enrolled. Patients were requested to complete a preoperative questionnaire on headache history, including the Migraine Headache Index and information on prior head or neck injury. Follow-up surveys were requested at approximately 12 months postoperatively. RESULTS: Seventy patients (49 percent) reported a history of head or neck injury, and 41 (29 percent) classified the injury as the precipitating event leading to their headache onset. Patients with a precipitating event were significantly less likely to report a family history of migraine. There was no significant difference in mean preoperative Migraine Headache Index between cohorts. At 12 months postoperatively, there was no significant difference in Migraine Headache Index reduction between groups. The proportion of patients who experienced at least a 50 and 80 percent improvement in Migraine Headache Index per group, respectively, was 83 and 67 percent (atraumatic), 76 and 68 percent (posttraumatic), and 71 and 63 percent (precipitating event). CONCLUSIONS: This study suggests that surgical outcomes in posttraumatic headache patients are comparable to those without injury. Trigger-site deactivation surgery candidates with a history of injury can therefore expect similar outcomes as reported for patients overall. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Traumatismos Craniocerebrais/complicações , Descompressão Cirúrgica/estatística & dados numéricos , Transtornos de Enxaqueca/cirurgia , Lesões do Pescoço/complicações , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/etiologia , Medição da Dor/estatística & dados numéricos , Resultado do Tratamento
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