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1.
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
2.
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
3.
Plast Reconstr Surg ; 146(2): 187e-195e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740592

RESUMO

BACKGROUND: Recent clinical experience with migraine surgery has demonstrated both the safety and the efficacy of operative decompression of the peripheral nerves in the face, head, and neck for the alleviation of migraine symptoms. Because of the perceived novelty of these procedures, and the paranoia surrounding a theoretical loss of clinical territory, neurologists have condemned the field of migraine surgery. The Patient Safety Subcommittee of the American Society of Plastic Surgeons ventured to investigate the published safety track record of migraine surgery in the existing body of literature. METHODS: A comprehensive review of the relevant published literature was performed. The relevant databases and literature libraries were reviewed from the date of their inception through early 2018. These articles were reviewed and their findings analyzed. RESULTS: Thirty-nine published articles were found that demonstrated a substantial, extensively replicated body of data that demonstrate a significant reduction in migraine headache symptoms and frequency (even complete elimination of headache pain) following trigger-site surgery. CONCLUSIONS: Migraine surgery is a valid method of treatment for migraine sufferers when performed by experienced plastic surgeons following a methodical protocol. These operations are associated with a high level of safety. The safety and efficacy of migraine surgery should be recognized by plastic surgeons, insurance companies, and the neurology societies.


Assuntos
Descompressão Cirúrgica/métodos , Transtornos de Enxaqueca/cirurgia , Procedimentos Neurocirúrgicos/métodos , Nervos Periféricos/fisiopatologia , Descompressão Cirúrgica/efeitos adversos , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/fisiopatologia , Procedimentos Neurocirúrgicos/efeitos adversos , Medição da Dor , Resultado do Tratamento
4.
Stroke ; 51(9): e215-e218, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32639861

RESUMO

BACKGROUND AND PURPOSE: Young patients with malignant cerebral edema have been shown to benefit from early decompressive hemicraniectomy. The impact of concomitant infection with coronavirus disease 2019 (COVID-19) and how this should weigh in on the decision for surgery is unclear. METHODS: We retrospectively reviewed all COVID-19-positive patients admitted to the neuroscience intensive care unit for malignant edema monitoring. Patients with >50% of middle cerebral artery involvement on computed tomography imaging were considered at risk for malignant edema. RESULTS: Seven patients were admitted for monitoring of whom 4 died. Cause of death was related to COVID-19 complications, and these were either seen both very early and several days into the intensive care unit course after the typical window of malignant cerebral swelling. Three cases underwent surgery, and 1 patient died postoperatively from cardiac failure. A good outcome was attained in the other 2 cases. CONCLUSIONS: COVID-19-positive patients with large hemispheric stroke can have a good outcome with decompressive hemicraniectomy. A positive test for COVID-19 should not be used in isolation to exclude patients from a potentially lifesaving procedure.


Assuntos
Isquemia Encefálica/complicações , Isquemia Encefálica/cirurgia , Infecções por Coronavirus/complicações , Craniectomia Descompressiva/métodos , Procedimentos Neurocirúrgicos/métodos , Pneumonia Viral/complicações , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/cirurgia , Adulto , Edema Encefálico/complicações , Edema Encefálico/cirurgia , Isquemia Encefálica/diagnóstico por imagem , Causas de Morte , Tomada de Decisão Clínica , Cuidados Críticos , Craniectomia Descompressiva/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Procedimentos Neurocirúrgicos/efeitos adversos , Pandemias , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
Medicine (Baltimore) ; 99(29): e20954, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702835

RESUMO

BACKGROUND: To investigate the risk factors for postoperative venous thromboembolism (VTE) in patients undergoing spinal surgery. METHODS: Literature published in PubMed, Embase, the Cochrane Library, and Web of Science was systematically reviewed to assess risk factors for VTE following spinal surgery. The data analysis was conducted with STATA 12.0. Data were pooled using fixed-effects or random-effects models according to the heterogeneity among the included studies. RESULTS: Twenty-six studies involving 3,216,187 patients were included in this meta-analysis, and the total incidence of VTE after spinal surgery was 0.35% (0.15-29.38%). The pooled analysis suggested that the incidence of VTE after spinal surgery was higher in such aspects as increasing age (weighted mean difference [WMD] 0.55 years, 95% confidence interval [CI] 0.33-0.78, P < .001), female sex (odds ratio [OR] 1.12, 95% CI 1.01-1.25; P = .034), diabetes (OR 1.34, 95% CI 1.29-1.44; P < .001), chronic kidney disease (OR = 8.31, 95% CI 1.98-34.93; P = .004), nonambulatory preoperative activity status (OR 3.67, 95% CI 2.75-4.83; P < .001), D-dimer level (WMD 1.023, 95% CI 0.162-1.884; P = .02), long duration of operation (WMD 0.73, 95% CI 0.21-1.24; P = .006), spine fusion (OR 1.54, 95% CI 1.31-1.82; P < .001), and blood transfusion (OR 2.31, 95% CI 1.73-3.07; P < .001), and the differences were statistically significant. However, there were no significant differences in body mass index, obesity, hypertension, coronary heart disease, spondylolisthesis, intraoperative blood loss, surgical procedures (anterior lumbar interbody fusion vs posterior intervertebral fusion /translaminar lumbar interbody fusion), or surgical site (lumbar vs thoracic) (all P > .05). CONCLUSION: Based on our meta-analysis, we identified several important factors that increased the risk of VTE after spinal surgery. We hope our study provides assistance to spine surgeons so that they can adequately analyze and assess risk factors in patients and then develop preventive measures to reduce the incidence of VTE.


Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Ortopédicos/efeitos adversos , Coluna Vertebral/cirurgia , Tromboembolia Venosa/etiologia , Fatores Etários , Transfusão de Sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Limitação da Mobilidade , Duração da Cirurgia , Complicações Pós-Operatórias , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco , Fatores Sexuais
6.
World Neurosurg ; 140: 374-377, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32479908

RESUMO

BACKGROUND: A novel viral strain known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created a worldwide pandemic known as coronavirus 2019 (COVID-19). Early reports from China have highlighted the risks associated with performing endoscopic endonasal skull base surgery in patients with SARS-CoV-2. We present a rare complication of nasoseptal flap (NSF) necrosis associated with COVID-19, further emphasizing the challenges of performing these procedures in this era. CASE DESCRIPTION: A 78-year-old man underwent an extended endoscopic endonasal transplanum resection of a pituitary macroadenoma for decompression of the optic chiasm. The resulting skull base defect was repaired using a pedicled NSF. The patient developed meningitis and cerebrospinal fluid (CSF) leak on postoperative day 13, requiring revision repair of the defect. Twelve days later, he developed persistent fever and rhinorrhea. The patient was reexplored endoscopically, and the NSF was noted to be necrotic and devitalized with evident CSF leakage. At that time, the patient tested positive for SARS-CoV-2. Postoperatively, he developed acute respiratory distress syndrome complicated by hypoxic respiratory failure and death. CONCLUSIONS: To our knowledge, this is the first reported case of NSF necrosis in a patient with COVID-19. We postulate that the thrombotic complications of COVID-19 may have contributed to vascular pedicle thrombosis and NSF necrosis. Although the pathophysiology of SARS-CoV-2 and its effect on the nasal tissues is still being elucidated, this case highlights some challenges of performing endoscopic skull base surgery in the era of COVID-19.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus , Procedimentos Neurocirúrgicos/efeitos adversos , Pandemias , Pneumonia Viral , Base do Crânio/cirurgia , Retalhos Cirúrgicos/cirurgia , Idoso , Vazamento de Líquido Cefalorraquidiano/etiologia , Humanos , Masculino , Necrose/etiologia , Complicações Pós-Operatórias/virologia , Retalhos Cirúrgicos/virologia
7.
Medicine (Baltimore) ; 99(21): e20127, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481281

RESUMO

BACKGROUND: Venous thromboembolism (VTE) is a serious, sometimes life-threatening complication that can occur following spine surgery. The incidence of VTE, and the optimal type and timing of thromboprophylaxis for this complication in elective spine surgery is a matter of debate. OBJECTIVE: To perform a systematic review with the aim of clarifying the efficacy and adverse effects of mechanical and chemical prophylaxis for preventing thromboembolic complications in elective spine surgery for conditions other than trauma and malignant disease. METHODS/DESIGN: A search strategy of related articles up to March 2018 was designed and executed in Medline and Embase. PATIENTS: adolescents (>10 years) and adults undergoing elective surgery for spinal deformity or degenerative disease (from C1 to S1). INTERVENTION: Perioperative mechanical and chemical thromboprophylaxis. Studies could be randomized controlled trials or observational studies that reported data on any relevant clinical outcomes. RESULTS: In total, 2451 uniquecitations were identified and 35 studies were ultimately included in the systematic review. The overall mean incidence of complications was 3.7% for deep venous thrombosis, 0.0% for pulmonary embolism, and 3.7% for bleeding in chemoprophylaxis group; 2.9% for deep venous thrombosis, 0.4% for pulmonary embolism and 0.0% for bleeding in mechanoprophylaxis; and 0.7% for deep venous thrombosis, 0.1% for pulmonary embolism and 0.2% for bleeding in mixed prophylaxis group with no specific data on these rates for the type of patient and type and location of surgery. None of the articles retrieved provided information on the adolescent population. DISCUSSION AND CONCLUSIONS: The poor design and high variability among the studies regarding characteristics of study population, details of interventions, and definitions of outcomes, determines a low quality of the available evidence and limits the interpretation of the results. We were unable to identify a clear advantage of one type of thromboprophylaxis over the other, although there was an increased risk of bleeding with chemoprophylaxis, which could favor the use of mechanoprophylaxis in this scenario.


Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Coluna Vertebral/cirurgia , Tromboembolia Venosa/prevenção & controle , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Humanos , Metanálise como Assunto , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Revisões Sistemáticas como Assunto , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/terapia
9.
J Neurointerv Surg ; 12(7): 643-647, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: covidwho-327010

RESUMO

BACKGROUND: Infection from the SARS-CoV-2 virus has led to the COVID-19 pandemic. Given the large number of patients affected, healthcare personnel and facility resources are stretched to the limit; however, the need for urgent and emergent neurosurgical care continues. This article describes best practices when performing neurosurgical procedures on patients with COVID-19 based on multi-institutional experiences. METHODS: We assembled neurosurgical practitioners from 13 different health systems from across the USA, including those in hot spots, to describe their practices in managing neurosurgical emergencies within the COVID-19 environment. RESULTS: Patients presenting with neurosurgical emergencies should be considered as persons under investigation (PUI) and thus maximal personal protective equipment (PPE) should be donned during interaction and transfer. Intubations and extubations should be done with only anesthesia staff donning maximal PPE in a negative pressure environment. Operating room (OR) staff should enter the room once the air has been cleared of particulate matter. Certain OR suites should be designated as covid ORs, thus allowing for all neurosurgical cases on covid/PUI patients to be performed in these rooms, which will require a terminal clean post procedure. Each COVID OR suite should be attached to an anteroom which is a negative pressure room with a HEPA filter, thus allowing for donning and doffing of PPE without risking contamination of clean areas. CONCLUSION: Based on a multi-institutional collaborative effort, we describe best practices when providing neurosurgical treatment for patients with COVID-19 in order to optimize clinical care and minimize the exposure of patients and staff.


Assuntos
Betacoronavirus , Infecções por Coronavirus/cirurgia , Infecções por Coronavirus/transmissão , Pessoal de Saúde/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Procedimentos Neurocirúrgicos/normas , Pneumonia Viral/cirurgia , Pneumonia Viral/transmissão , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Salas Cirúrgicas/métodos , Salas Cirúrgicas/normas , Pandemias , Equipamento de Proteção Individual/normas
10.
Stroke Vasc Neurol ; 5(1): 40-49, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32411407

RESUMO

Intracerebral haemorrhage (ICH) describes haemorrhage into the brain parenchyma that may result in a decline of the patient's neurological function. ICH is a common cause of morbidity and mortality worldwide. Aggressive surgical treatment for ICH has remained controversial as clinical trials have failed to demonstrate substantial improvement in patient outcome and mortality. Recently, promising mechanical and pharmacological minimally invasive surgery (MIS) techniques for the treatment of ICH have been described. MIS was designed with the objective of reducing morbidity due to complications of surgical manipulation. Mechanical MIS includes the use of tubular retractors and small diameter instruments for ICH removal. Pharmacological methods consist of catheter placement inside the haematoma cavity for the passive drainage of the haematoma over the course of several days. One of the most favourable approaches for MIS is the use of natural corridors for reaching the lesion, such as the transsulcal parafascicular approach. This approach provides an anatomical dissection of the subjacent white matter tracts, causing the least amount of damage while evacuating the haematoma. A detailed description of the currently known MIS techniques and devices is presented in this review. Special attention is given to the transsulcal parafascicular approach, which has particular benefits to provide a less traumatic MIS with promising overall patient outcome.


Assuntos
Hemorragia Cerebral/cirurgia , Drenagem , Procedimentos Neurocirúrgicos , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/mortalidade , Hemorragia Cerebral/fisiopatologia , Circulação Cerebrovascular , Tomada de Decisão Clínica , Drenagem/efeitos adversos , Drenagem/instrumentação , Drenagem/mortalidade , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/mortalidade , Medição de Risco , Fatores de Risco , Resultado do Tratamento
11.
Stroke Vasc Neurol ; 5(1): 50-58, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32411408

RESUMO

Dural arteriovenous fistula (dAVF) accounts for approximately 10% of all intracranial vascular malformations. While they can be benign lesions, the presence of retrograde venous drainage and cortical venous reflux makes the natural course of these lesions aggressive high risk of haemorrhage, neurological injury and mortality. Endovascular treatment is often the first line of treatment for dAVF. Both transarterial and transvenous approaches are used to cure dAVF. The selection of treatment approach depends on the angioarchitecture of the dAVF, the location, the direction of venous flow. Surgery and, to a lesser extent, stereotactic radiosurgery are used when endovascular approaches are impossible or unsuccessful.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/terapia , Embolização Terapêutica , Procedimentos Endovasculares , Procedimentos Neurocirúrgicos , Radiocirurgia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/mortalidade , Malformações Vasculares do Sistema Nervoso Central/fisiopatologia , Circulação Cerebrovascular , Tomada de Decisão Clínica , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/mortalidade , Radiocirurgia/efeitos adversos , Radiocirurgia/mortalidade , Medição de Risco , Fatores de Risco , Resultado do Tratamento
12.
Stroke Vasc Neurol ; 5(1): 59-64, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32411409

RESUMO

This review highlights the recent evolution of the imaging, medical management, surgical options and endovascular therapies for symptomatic intracranial atherosclerotic disease (ICAD). Recent imaging developments including optical coherence tomography and other modalities to assess the intracranial arteries for symptomatic ICAD are reviewed, not only to diagnose ICAD but to determine if ICAD plaques have any high-risk features for treatment. Potential future developments in the treatment of ICAD are discussed, including the development of trackable drug-coated balloons for the cerebral circulation to treat primary or restenotic arteries, new iterations of self-expanding intracranial stents with easier delivery systems, and the re-examination of indirect surgical bypass techniques for revascularisation. In addition to these important technological developments, however, is the evolving evidence regarding the best treatment window for these techniques and additional factors in medical management which can improve patient outcomes in this devastating pathology.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Procedimentos Endovasculares , Arteriosclerose Intracraniana/terapia , Procedimentos Neurocirúrgicos , Comportamento de Redução do Risco , Fármacos Cardiovasculares/efeitos adversos , Circulação Cerebrovascular , Tomada de Decisão Clínica , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/mortalidade , Arteriosclerose Intracraniana/fisiopatologia , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/mortalidade , Placa Aterosclerótica , Medição de Risco , Fatores de Risco , Stents , Resultado do Tratamento
13.
J Neurointerv Surg ; 12(7): 643-647, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32434798

RESUMO

BACKGROUND: Infection from the SARS-CoV-2 virus has led to the COVID-19 pandemic. Given the large number of patients affected, healthcare personnel and facility resources are stretched to the limit; however, the need for urgent and emergent neurosurgical care continues. This article describes best practices when performing neurosurgical procedures on patients with COVID-19 based on multi-institutional experiences. METHODS: We assembled neurosurgical practitioners from 13 different health systems from across the USA, including those in hot spots, to describe their practices in managing neurosurgical emergencies within the COVID-19 environment. RESULTS: Patients presenting with neurosurgical emergencies should be considered as persons under investigation (PUI) and thus maximal personal protective equipment (PPE) should be donned during interaction and transfer. Intubations and extubations should be done with only anesthesia staff donning maximal PPE in a negative pressure environment. Operating room (OR) staff should enter the room once the air has been cleared of particulate matter. Certain OR suites should be designated as covid ORs, thus allowing for all neurosurgical cases on covid/PUI patients to be performed in these rooms, which will require a terminal clean post procedure. Each COVID OR suite should be attached to an anteroom which is a negative pressure room with a HEPA filter, thus allowing for donning and doffing of PPE without risking contamination of clean areas. CONCLUSION: Based on a multi-institutional collaborative effort, we describe best practices when providing neurosurgical treatment for patients with COVID-19 in order to optimize clinical care and minimize the exposure of patients and staff.


Assuntos
Betacoronavirus , Infecções por Coronavirus/cirurgia , Infecções por Coronavirus/transmissão , Pessoal de Saúde/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Procedimentos Neurocirúrgicos/normas , Pneumonia Viral/cirurgia , Pneumonia Viral/transmissão , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Salas Cirúrgicas/métodos , Salas Cirúrgicas/normas , Pandemias , Equipamento de Proteção Individual/normas
15.
BMC Neurol ; 20(1): 203, 2020 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-32438899

RESUMO

BACKGROUND: To our knowledge, the exposed nerve roots in thoracic spine are usually sacrificed to facilitate osteotomy during posterior vertebral column resection (PVCR) for severe spinal deformity. Currently we report a case with severe spine deformity in which intraoperative neurological monitoring (IOM) loss after interrupting T8 nerve root finally led to spinal cord injury during PVCR surgery. CASE PRESENTATION: The patient was a 14-year-old female with severe congenital kyphoscoliosis (CKS) without preoperative neurologic deficits. The IOM events (MEP loss and SSEP latency prolong) were showed when T8 nerve root at concave side was interrupted. And then we reduce the scope of osteotomy to control bleeding, raised blood pressure (MAP, 65-80) to increase blood supply for spinal cord, placed the bilateral rod to stabilized the spinal cord, used the methylprednisolone, explored the presence or absence of spinal cord compression, and prepared to change the surgical plan from PVCR to PSO. After that the IOM signals partial recovered from the lowest point. Postoperatively the patients showed transient motor function deficits of left lower limbs weak without somatosensory deficits, and come back to preoperative status 6 months later. CONCLUSIONS: Interrupting the thoracic spine nerve root is danger to trigger the spinal cord injury during PVCR procedure of severe CKS. That probably because the increasing tension of contralateral anterior horn area of spinal cord via the nerve root pulling.


Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Traumatismos da Medula Espinal/etiologia , Raízes Nervosas Espinhais/cirurgia , Coluna Vertebral/cirurgia , Adolescente , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Cifose/complicações , Cifose/cirurgia , Monitorização Intraoperatória , Osteotomia/métodos , Estudos Retrospectivos , Escoliose/complicações , Escoliose/cirurgia , Resultado do Tratamento
16.
J Clin Neurosci ; 77: 168-174, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32360158

RESUMO

The objective of this study was to more fully understand the optimal neurosurgical strategy for spinal benign meningiomas from a medium to long-term perspective. This retrospective study included a cohort of 35 patients with a diagnosis of spinal meningioma who were first operated at our institute over the past 10 years and followed-up for at least 2 years after surgery. The inclusion criterion for the study was the pathological diagnosis finally verified as benign meningioma of World Health Organization (WHO) grade 1. The average follow-up duration after surgery was 61.0 months. The location of the spinal meningioma was classified into ventral or dorsal type based on the operative video record and the preoperative MR images. The extent of resection of the spinal meningioma was carefully determined based on the Simpson grade. The average neurological condition was significantly improved at the final follow-up. Simpson grade I or II resection was achieved in 31 of 35 cases (88.6%). No Simpson grade I or II cases showed local recurrence during follow-up. Tumor recurrence was noted in 2 of 4 cases of Simpson grade IV resection. One case has been followed-up without any re-operation because of no neurological deterioration, and the other case underwent stereotactic radiosurgery. This study suggested that meticulous Simpson grade II resection of spinal benign meningiomas of WHO grade 1 may be good enough from a medium to long-term follow-up perspective, though longer follow-up is absolutely necessary.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Neoplasias Meníngeas/patologia , Meningioma/patologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias/cirurgia , Reoperação/estatística & dados numéricos
17.
Brain Nerve ; 72(4): 437-443, 2020 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-32284468

RESUMO

Recent progress in understanding of iatrogenic Creutzfeldt-Jakob disease (CJD) has revealed pathological and biochemical features specific to patients with iatrogenic CJD Based on the pathological and biochemical characteristics, we have identified iatrogenic CJD cases among presumed sporadic cases; in a neurosurgeon and in a patient with a medical history of neurosurgery. In addition, incidents of suspected CJD exposure via contaminated neurosurgical instruments are occasionally noted. Therefore, improvement of CJD case recognition and tracking of neurosurgical instruments are necessary to prevent iatrogenic CJD transmission via neurosurgical instruments. Further, accumulating evidence suggests that certain misfolded proteins and amyloid proteins, as well as prion proteins, are transmissible between individuals. Evaluation of the potential risks of iatrogenic transmission and the development of preventative strategies for these infectious proteins are our future tasks.


Assuntos
Síndrome de Creutzfeldt-Jakob/etiologia , Procedimentos Neurocirúrgicos/efeitos adversos , Contaminação de Equipamentos , Humanos , Doença Iatrogênica , Proteínas Priônicas
18.
World Neurosurg ; 139: 151-157, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32305599

RESUMO

OBJECTIVE: Paralysis (paraplegia or quadriplegia) after posterior fossa surgery is a rare but devastating complication. We investigated previous reports of this complication to examine similarities among patients, risk factors, and methods by which it may be prevented. METHODS: A systematic review was completed according to PRISMA guidelines. Electronic databases were searched until November 2019 using keywords "paraplegia," "quadriplegia," or "spinal cord injury" added to "posterior fossa surgery." RESULTS: Thirteen case reports published between 1996 and 2019 were included. Five (38.5%) involved quadriplegia/quadriparesis and 8 (61.5%) involved paraplegia after surgery. Ten cases (76.9%) were tumor resections and 3 (23.1%) were posterior fossa decompressions (2 for Chiari malformations and 1 for Morquio syndrome). Seven surgeries (53.8%) were performed in the sitting position and 6 (46.2%) were prone. Proposed mechanisms of paralysis involved cervical hyperflexion yielding spinal cord ischemia in 8 patients (61.5%), arterial hypotension in 2 patients (15.4%), spinal cord compression from hematoma in 1 patient (7.7%), and decreased cardiac output in 1 patient (7.7%) (1 study did not propose a cause). Cervical hyperflexion was equally likely in the sitting and prone positions (4 patients each). Only 3 patients (23.1%) involved intraoperative complications (all cardiopulmonary in nature). CONCLUSIONS: Paralysis after posterior fossa surgery often involves spinal cord infarction apparently caused by cervical hyperflexion. Extreme care during patient positioning is needed in both the sitting or prone positions. Electrophysiologic monitoring might enable early identification of spinal cord dysfunction to minimize or avoid this complication.


Assuntos
Fossa Craniana Posterior/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Paraplegia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Quadriplegia/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Isquemia do Cordão Espinal/epidemiologia , Malformação de Arnold-Chiari/cirurgia , Neoplasias Encefálicas/cirurgia , Humanos , Neoplasias Infratentoriais/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Paraplegia/etiologia , Posicionamento do Paciente , Complicações Pós-Operatórias/etiologia , Decúbito Ventral , Quadriplegia/etiologia , Postura Sentada , Traumatismos da Medula Espinal/etiologia , Isquemia do Cordão Espinal/etiologia
19.
J Clin Neurosci ; 75: 218-220, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32249175

RESUMO

Pneumocephalus describes the presence of air within the cranial cavity and is often self-limiting. Tension pneumocephalus is a neurosurgical emergency manifested by headaches, seizures, reduced consciousness and even death resulting from raised intracranial pressure. Differentiating both entities clinically is often challenging but crucial. We present a case involving a sixty-year-old male who was transferred to our unit after he collapsed while undergoing rehabilitation. The patient had undergone a combined bifrontal craniotomy and transnasal endoscopic resection of recurrent sinonasal adenocarcinoma with anterior skull base involvement eight days prior. Imaging demonstrated the classic Mt. Fuji sign and a diagnosis of tension pneumocephalus was formed. The patient proceeded for definitive management which included a multi-layered repair of the anterior skull base. The three mechanisms that propose the development of tension pneumocephalus include the ball-valve mechanism, the inverted soda-bottle effect and rarely, infection from gas forming organisms. A review of current literature on PubMed/MEDLINE revealed tension pneumocephalus after skull base surgery to be a rare entity with only eleven cases reported. Most patients achieved complete recovery of symptoms post-treatment. Clinicians should recognise tension pneumocephalus as a potential complication after skull base surgery. Accurate diagnosis requires appreciation of imaging features and a high index of suspicion. Prompt management is imperative to prevent possible devastating outcomes.


Assuntos
Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Craniotomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos
20.
World Neurosurg ; 139: e308-e315, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32298819

RESUMO

OBJECTIVE: To identify rates, risks, and complications of red blood cell (RBC) transfusion in metastatic spinal tumor surgery. METHODS: The multicenter prospective American College of Surgeons National Quality Improvement Program database was queried for the years 2012-2016. Adult patients with disseminated cancer who underwent metastatic spinal tumor surgery were identified. Transfusion was defined as having received at least 1 intraoperative/postoperative RBC transfusion within the first 72 hours of surgery start time. A stepwise multiple logistic regression model with backward elimination was used. RESULTS: Of 1601 patients identified, 623 patients (38.9%) received a RBC transfusion. Independent predictors of RBC transfusion included higher American Society of Anesthesiologists class (odds ratio [OR] = 1.54), preoperative anemia (OR = 3.10), instrumentation (OR = 1.63), and longer operative time (OR = 1.52). The overall complication rate was significantly higher in patients who received a transfusion compared with patients who did not receive a transfusion (22.3% vs. 15.0%, P < 0.001). Individual complications that were more common in patients who received a transfusion were sepsis (3.5% vs. 1.9%, P = 0.050), deep vein thrombosis (6.1% vs. 3.3%, P = 0.007), and prolonged ventilation (3.9% vs. 1.3%, P = 0.001). RBC transfusion (OR = 1.65), hypoalbuminemia (OR = 1.53), and anterior/anterolateral approaches for corpectomy (OR = 2.11) were independent risk factors for developing a postoperative complication. CONCLUSIONS: RBC transfusion after metastatic spinal tumor surgery may increase the risk of early postoperative complications. Future research into preoperative patient optimization and decreasing intraoperative blood loss is needed.


Assuntos
Transfusão de Eritrócitos/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Idoso , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Coluna Vertebral/secundário , Resultado do Tratamento
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