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2.
BMC Neurol ; 20(1): 9, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914955

RESUMO

BACKGROUND: Venous sinus stenosis (VSS) is a type of cerebral venous vascular disease. Cerebral autoregulation is an indicator of cerebral arterial function. The cerebral circulatory system is composed of the venous system and arterial system. Impaired venous function may affect arterial function. Thus, cerebral venous stenosis may influence cerebral autoregulation. CASE PRESENTATION: In this case, a 50-year-old woman with transient blindness and headache was admitted to the hospital. The patient was diagnosed with VSS. A stent was placed at the stenosis. The stent released the intravenous pressure and remitted the patient's symptoms. Measurements of dynamic cerebral autoregulation (dCA) were performed at 3 time points: before stenting, after stenting, and 3 months later. The dCA gradually improved after stenting. CONCLUSION: VSS may have an influence on cerebral autoregulation, and effective treatment improves cerebral autoregulation in patients with VSS.


Assuntos
Cavidades Cranianas/patologia , Cavidades Cranianas/cirurgia , Homeostase , Procedimentos Neurocirúrgicos/métodos , Veias Cerebrais/patologia , Transtornos Cerebrovasculares/patologia , Transtornos Cerebrovasculares/fisiopatologia , Transtornos Cerebrovasculares/cirurgia , Constrição Patológica , Cavidades Cranianas/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/instrumentação , Stents , Resultado do Tratamento
3.
World Neurosurg ; 136: e300-e309, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31901493

RESUMO

OBJECTIVE: Although the risk of aneurysm remnants after microsurgical clipping is generally low, complete aneurysm occlusion is not always guaranteed. We performed a morphometric analysis of intracranial aneurysms to identify predictors for aneurysm remnants and to propose a novel risk score. METHODS: This is a retrospective, single-center analysis of consecutive patients with ruptured and unruptured aneurysms who underwent microsurgical clipping and postoperative digital subtraction angiography between 2010 and 2018. Based on preoperative rotational angiography, distinct morphologic aneurysm characteristics were determined and correlated with postoperative angiographic results. Factors predictive in the univariate and multivariate analyses were determined to establish a risk score for postoperative remnants after aneurysm clipping. RESULTS: Among 140 patients with 166 clipped aneurysms, aneurysm remnants were present in 19.9%. In the multivariate analysis, ruptured aneurysm status (odds ratio [OR], 7.8; 95% confidence interval [CI], 1.7-36; P < 0.01) and increased aspect ratio (OR, 1.9; 95% CI, 1.0-4.0; P = 0.07) were associated with postoperative aneurysm remnants. Anterior communicating artery location (P = 0.02), internal carotid artery location (P = 0.06), increased aneurysm inclination angle (P < 0.01), and irregular aneurysm shape (P = 0.07) were further predictors for aneurysm remnants in the univariate analysis. These factors were weighted and included into a risk sum score for postoperative aneurysm remnants (range, 0-8 points), which performed with good accuracy (area under the curve = 0.807). CONCLUSIONS: After external validation of the proposed risk score, it could help identify cases requiring angiographic control after aneurysm surgery.


Assuntos
Aneurisma Intracraniano/patologia , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adolescente , Adulto , Idoso , Aneurisma Roto/patologia , Aneurisma Roto/cirurgia , Feminino , Humanos , Masculino , Microcirurgia/instrumentação , Microcirurgia/métodos , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/instrumentação , Estudos Retrospectivos , Fatores de Risco , Instrumentos Cirúrgicos , Adulto Jovem
4.
World Neurosurg ; 136: e371-e379, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31931237

RESUMO

BACKGROUND: This study aimed to compare the functional outcome at discharge for unruptured cerebral aneurysms (UCAs) between surgical clipping and endovascular coiling in total, nonelderly (<65 years), and elderly (≥65 years) patients by nonbiased analysis based on a national database in Japan. METHODS: A total of 15,671 patients with UCA were registered in the Diagnosis Procedure Combination, the nationwide database, from 2010 to 2015 in Japan. The outcome of the Barthel Index (BI) at discharge was investigated, and propensity score-matched analysis was conducted in total, nonelderly, and elderly patient groups. RESULTS: Propensity score-matched analysis found no significant difference for in-hospital mortality between the 2 treatment methods in the total and both age-groups. The rate of morbidity of BI <90 at discharge was higher after surgical clipping than after endovascular coiling in the total (4.9% vs. 3.9%; P = 0.040; risk difference, -1.0%; 95% confidence interval, -3.6 to 2.3%) and the elderly age-group (8.1% vs. 5.0%; P < 0.001; risk difference, -3.1%; -4.8% to 1.5%), however, no significant association between the 2 treatment methods (2.4% vs. 2.6%; P = 0.67; risk difference, 0.22%; -0.79 to 1.22%) was found in the nonelderly group. CONCLUSIONS: In elderly patients with UCA, a better outcome at discharge after endovascular coiling was found. However, no significantly different functional outcome at discharge between surgical clipping and endovascular coiling for UCA in nonelderly patients was confirmed by propensity score-matched analysis from a nationwide database in Japan.


Assuntos
Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos , Idoso , Prótese Vascular , Bases de Dados Factuais , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Aneurisma Intracraniano/mortalidade , Japão , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Instrumentos Cirúrgicos , Resultado do Tratamento
5.
World Neurosurg ; 133: 60-65, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568903

RESUMO

BACKGROUND: Neurosurgical micropatties (also known as sponges or cottonoids) have been used in microsurgical procedures to protect the brain surface and aspirate cerebrospinal fluid and blood. We sought to describe unique applications of micropatties in neurosurgical interventions. METHODS: Various sizes of micropatties have been used in neurosurgical interventions including tumor, vascular, and skull base surgeries to enhance safe surgical procedures and clear the operative field. Their roles are divided into 3 types: tissue protectors, instrument assistants, and instruments in the microsurgical procedures. RESULTS: Appropriate use of micropatties provides a well-visualized operative field, easy identification of bleeding spots, effective tumor elevation from the cleavage layer, and precise procedures around critical structures. CONCLUSIONS: To achieve safe and successful neurovascular protective surgery, micropatties play an important role in any type of microsurgical procedure in their various applications.


Assuntos
Encéfalo/cirurgia , Microcirurgia/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Tampões de Gaze Cirúrgicos , Humanos
6.
World Neurosurg ; 133: 283-290, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31505282

RESUMO

BACKGROUND: Traditional manual retraction to access deep-seated brain lesions has been associated with complications related to vascular compromise of cerebral tissue. Various techniques have been developed over time to minimize injury, such as self-sustaining retractors, neuronavigation, and endoscopic approaches. Recently, tubular retractors, such as the ViewSite Brain Access System (VBAS), have been developed to reduce mechanical damage from retraction by dispersing the force of the retractor radially over the parenchyma. Therefore, we sought to review the current literature to accurately assess the indications, benefits, and complications associated with use of VBAS retractors. METHODS: A literature search for English articles published between 2005 and 2019 was performed using the MEDLINE database archive with the search terminology "Vycor OR ViewSite OR Brain-Access-System NOT glass." The VBAS website was also examined. Only articles detailing neurosurgical procedures using the VBAS tubular retractor system alone, or in combination with other retractors, were included. Postoperative morbidity and mortality were analyzed to estimate complications linked to using the retractor. RESULTS: Twelve publications (106 patients) met the inclusion criteria. The VBAS retractor was used for tumor resections, hematoma evacuations, cyst removal, foreign body extractions, and lesion resection in toxoplasmosis and multiple sclerosis. These cases were subdivided into groups based on lesion location, size, and resection volume for further analysis. Gross total resection was achieved in 63% of tumor excisions, and subtotal resection was achieved in 37%. Hematoma evacuation was successful in all cases. There were 3 short-term postoperative complications linked to the retractor, with an overall complication rate of 2.8%. CONCLUSIONS: This report is the first formal assessment of the VBAS, highlighting technical considerations of the retractor from the surgeon's perspective, patient outcomes, and complications. The retractor is a safe and efficacious tubular retraction system that can be used for tumor biopsy and resection, colloid cyst removal, hematoma evacuation, and removal of foreign bodies. However, further randomized controlled trials are indicated to accurately assess complication rates and outcomes.


Assuntos
Neoplasias Encefálicas/cirurgia , Microcirurgia/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Instrumentos Cirúrgicos , Humanos
7.
World Neurosurg ; 132: 99-102, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479785

RESUMO

BACKGROUND: Hemostasis valves are commonly used in neurointerventions. We propose a novel concept for fixing hemostasis valves to the operating table during procedures. Moreover, we report our preliminary in vitro experience using these new devices created using a 3-dimensional printer. METHODS: The hemostasis valve holder (HVH) comprises 2 components: an inner fixer and an outer socket. It was designed to be suitable for use with all rotational hemostasis valves commercially available. HVH contains magnets at the bottom that facilitate its attachment to a thin steel board beneath a sterilized drape on the working table. We evaluated the HVH's efficacy via in vitro experiments involving stent placement by a single operator. RESULTS: HVH allowed easy attachment to and detachment from the rotational hemostasis valve. Moreover, the use of multiple HVHs facilitated operators to concentrate on the procedure because they continuously prevented the unexpected movement of devices at several points. Use of HVHs enables stent placement to be performed even by a single operator. We observed that forming a loop of the stent delivery catheter between 2 HVHs enhanced the device control. CONCLUSIONS: HVHs should be more useful than conventional methods, particularly in cases requiring fine complementary control of both a microcatheter and microguidewire.


Assuntos
Procedimentos Endovasculares/instrumentação , Desenho de Equipamento , Hemostasia Cirúrgica/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Humanos , Impressão Tridimensional , Instrumentos Cirúrgicos
8.
World Neurosurg ; 132: 114-117, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476467

RESUMO

OBJECTIVE: Neurosurgical operating rooms are equipped with microscopes in order to provide a good standard of care. Nevertheless, in developing countries, microscopes are not always available. During a short period in a western Africa hospital, we adapted our smartphones as a valid alternative to the microscope. METHODS: Using a shaped tin can, a smartphone cover, and a rod fixed to the bed, we could make a support for a smartphone creating a simple "homemade" exoscope, which allowed us to have magnification and light in the surgical field. RESULTS: Among others, we performed 5 surgical interventions of both spinal and brain surgery using our smartphone as a magnifier. This allowed us to overcome the absence of a better magnification system. CONCLUSIONS: This simple "smartphone-based exoscope" allows surgeons to get an adequate magnification during surgery when microscopes or magnification goggles are not available. It can be a useful solution in developing countries where often nothing better is available.


Assuntos
Microscopia/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Smartphone , Equipamentos Cirúrgicos/provisão & distribução , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Países em Desenvolvimento , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Metastasectomia/métodos
9.
World Neurosurg ; 132: e696-e703, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31421297

RESUMO

OBJECTIVE: The authors used a micromirror under a microscope with an indocyanine green (ICG) imaging system to assess clipped aneurysms and the blood flow in hidden regions during aneurysm surgery. This study then investigated the usefulness of such mirroring with ICG angiography (MICGA). METHODS: A micromirror was used during aneurysm surgery on 25 patients, and MICGA was performed on 10 of these 25 patients to inspect the hidden region after clipping. The mirrored aneurysms were located at the posterior communicating artery (n = 4), anterior choroidal artery (n = 4), proximal A1 segment (n = 1), and middle cerebral artery (n = 1). RESULTS: In all 10 cases, MICGA was successful in assessing the state of the clipped aneurysm and blood flow of the vessels in the hidden region after clipping. This led to clip repositioning in 3 patients (30.0%) because of incomplete clipping of a hidden aneurysm or occlusion of a hidden perforator. Complete occlusion of the aneurysm was achieved in 8 patients, and the other 2 patients showed near complete occlusion because of an intentional residual aneurysm to avoid a small vessel adherent to the posterior wall of the aneurysm base. CONCLUSIONS: MICGA can provide useful and reliable information on the state of a clipped aneurysm and the blood flow of associated vessels and perforators in a hidden region after aneurysm clipping.


Assuntos
Angiografia Cerebral/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/instrumentação , Instrumentos Cirúrgicos , Procedimentos Cirúrgicos Vasculares/instrumentação , Adulto , Idoso , Angiografia Digital , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/cirurgia , Circulação Cerebrovascular , Corantes , Feminino , Humanos , Verde de Indocianina , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Posterior/diagnóstico por imagem , Artéria Cerebral Posterior/cirurgia , Resultado do Tratamento
10.
World Neurosurg ; 132: e869-e877, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31400528

RESUMO

OBJECTIVE: Treatment of cystic craniopharyngiomas can be challenging and recurrences are frequent, even after total resection. In selected cases, less-aggressive surgery with the sole drainage of the cyst reliefs symptoms caused by mass effect and represents a valid alternative option, notably in pediatric population. We herein analyze a series of adult cystic craniopharyngiomas, managed with Ommaya Reservoir implant, focusing on local tumor control and eventual complications. METHODS: In total, 11 nonconsecutive adult cystic craniopharyngiomas (7 recurrent lesions) were treated with Ommaya Reservoir System (ORS), in 2 neurosurgical centers. ORS was placed in 9 cases using minimally invasive procedures: 6 burr-hole endoscopic insertion and 3 navigated electromagnetic placement; in the remaining 2 patients, the Ommaya reservoir was used as a shunt to prevent cyst recollection during a transcranial approach. RESULTS: The main presenting symptoms were visual impairment (75%), cognitive and behavioral disorders (66.7%), hypopituitarism (38%), headache (30.8%), and hypothalamic obesity (8%). The median follow-up period was 41.4 months. In all patients, the visual function and intracranial hypertension improved after decompression. Local tumor control was accomplished in 8 patients (72.7%), without the need of adjuvant treatments. The endoscopic vision carried similar rates of tumor control than stereotaxy (75% vs. 66.7%). CONCLUSIONS: In selected patients, tailored procedures are required to achieve long-term tumor control and as well limit surgery-related morbidity. ORS could represent a safe and effective treatment option for cystic craniopharyngiomas, providing also reduced surgical-related morbidity, especially in recurrent lesions and in patients not suitable for radical surgery.


Assuntos
Craniofaringioma/cirurgia , Cistos/cirurgia , Drenagem/métodos , Procedimentos Neurocirúrgicos/instrumentação , Neoplasias Hipofisárias/cirurgia , Adolescente , Adulto , Idoso , Disfunção Cognitiva/etiologia , Craniofaringioma/complicações , Cistos/complicações , Drenagem/instrumentação , Campos Eletromagnéticos , Feminino , Cefaleia/etiologia , Humanos , Hipopituitarismo/etiologia , Hipertensão Intracraniana/etiologia , Masculino , Transtornos Mentais/etiologia , Pessoa de Meia-Idade , Neuroendoscopia , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/complicações , Estudos Retrospectivos , Técnicas Estereotáxicas , Transtornos da Visão/etiologia , Adulto Jovem
11.
World Neurosurg ; 131: 52, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376553

RESUMO

Brain retraction is crucial for adequate exposure during many intracranial procedures. It facilitates the access to the area of interest inside the brain and gives the surgeon the ability to create a corridor to visualize the deeply seated lesions. Retraction-related injury is a well-known complication. A minimally invasive retraction system has been invented and modified to improve the downside of retraction and overcome the complications. The syringe brain port system is a transtubular system composed of simple tools that are available in all medical facilities. It can help the neurosurgeons to achieve brain retraction in a safe, simple, and cost-effective technique. We are presenting a video of how to make this system. Also, we are demonstrating an intraoperative application of this system in a case of a 36-year-old male with deep-seated recurrent right frontal glioblastoma multiforme grade IV.


Assuntos
Neoplasias Encefálicas/cirurgia , Glioblastoma/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Recidiva Local de Neoplasia/cirurgia , Procedimentos Neurocirúrgicos/instrumentação , Seringas , Adulto , Humanos , Masculino
13.
J Clin Neurosci ; 68: 329-332, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31327587

RESUMO

Intrathalamic aneurysms are a cause of patient morbidity and mortality. Aneurysms in this location can be accessed microsurgically when they cannot be accessed endovascularly. Care must be taken to avoid critical white matter tracts when approaching the thalamus microsurgically. Use of a tubular retractor can offer safe brain retraction during the approach. A 53-year-old female with a history of hypertension and cerebrovascular accidents presented with slurred speech, altered mental status, and right-sided weakness. CT demonstrated an acute parenchymal hemorrhage within the left thalamus and the internal capsule. CT angiography demonstrated a left dorsal thalamic aneurysm. Following angiography with consideration for embolization, the patient was taken to the operating room for microsurgical clip ligation with the use of minimally invasive techniques. The aneurysm was accessed using a contralateral transventricular approach with a tubular retractor for microsurgical clip ligation. Postoperative imaging demonstrated successful interval clipping of the aneurysm within the thalamus. This is the first report using our described surgical approach for treatment of a dorsal intrathalamic aneurysm. We combined the use of diffusion tensor imaging with a tubular retractor to clip a dorsal thalamic aneurysm.


Assuntos
Aneurisma Roto/cirurgia , Aneurisma Intracraniano/cirurgia , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Feminino , Humanos , Ligadura/métodos , Microcirurgia/instrumentação , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/instrumentação , Instrumentos Cirúrgicos
14.
World Neurosurg ; 130: e98-e104, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31307931

RESUMO

BACKGROUND: Cortical bone trajectory (CBT) screw is an attractive technique in terms of fixation strength and less invasiveness. However, the insertion of a pedicle screw penetrating cortical bone on the ideal trajectory is technically demanding. The use of 3-dimensional (3D) patient-matched guides may facilitate the use of this technique. In this technical note and case series, the use of a patient-matched 3D targeting guide for a circumferential fixation with CBT screws is described. METHODS: Eleven patients with a mean age of 49 years were treated. The MySpine MC (Medacta International SA, Castel San Pietro, Switzerland) technology was used to place CBT screws. A computed tomography (CT) scan-derived 3D model of the patient vertebra was created after the surgeons planned the best custom CBT screw trajectory. Then, scaffolds were printed and used during surgery to guide the screw through the patient pedicle. An intersomatic arthrodesis was also performed. RESULTS: The images of the planned trajectory were superimposed on the postoperative CT scan, confirming the accuracy of the trajectory. The mean deviation from the planned pedicle midpoint was 0.91 mm; 85.2% of the screws were placed within 2° from the planned trajectory. There were 2 grade A (<2 mm) and no grade B or C perforations. The actual entry point was always within 2 mm from the planned entry point. CONCLUSIONS: This technical note and case series is the first clinical description on the use of a patient-matched guide for posterior CBT screw placement. The use of these devices could also improve placement accuracy and decrease the risk of nerve damage.


Assuntos
Osso Cortical/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos , Parafusos Pediculares , Impressão Tridimensional , Doenças da Coluna Vertebral/cirurgia , Adulto , Osso Cortical/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Vértebras Lombares/diagnóstico por imagem , Pessoa de Meia-Idade , Modelos Anatômicos , Fusão Vertebral/métodos , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
World Neurosurg ; 130: 523-529.e2, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31279111

RESUMO

BACKGROUND: Despite widespread use of flow diverters, wide-necked large and giant aneurysms are still treated with other techniques as well. A contemporary review of results from different endovascular treatments is timely. METHODS: A literature review of the English language literature since 2011 was conducted using PubMed and Science Direct. Keywords and Medical Subheadings included large and giant aneurysms, ruptured aneurysms, aneurysms located in posterior circulation, and aneurysm occlusion status. Case reports were excluded. A combined model was built including both flow diverter and coil treatments in addition to separate models. Efficacy and safety were pooled using random effects analysis and regression. RESULTS: The review comprised 29 studies. For coiling techniques, complete occlusion was 40.2%-82.8%, and adjusted regression resulted in 53% (95% confidence interval [CI] 22%-81%). Flow diverter complete occlusion rate was 40.5%-87.8%, and adjusted regression resulted in 87% (95% CI 76%-93%). Overall occlusion rate for both techniques combined was 62%-75%, and adjusted regression resulted in 81% (95% CI 68%-89%). Overall stroke and death regression rate was 5% (95% CI 3%-10%); flow diverters showed slightly higher rates than coiling (6% vs. 3%). CONCLUSIONS: All current treatments of large and giant wide-necked aneurysms have comparable safety and efficacy with a trend of superiority of efficacy toward flow diverters. Results of future treatment options and devices can be compared with current technology to evaluate feasibility.


Assuntos
Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos , Embolização Terapêutica/instrumentação , Embolização Terapêutica/métodos , Humanos , Stents , Resultado do Tratamento
16.
World Neurosurg ; 131: e271-e276, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31351208

RESUMO

OBJECTIVE: With the introduction of the 5-aminolevulinic acid (5-ALA) technique, surgical neuro-oncology has made a major advance. 5-ALA fluorescence-guided resection of malignant glioma results in more complete surgical resections and subsequently prolonged survival. However, it remains uncertain how light intensities of the blue light source and 5-ALA-derived fluorescence intensities of the illuminated tissue are connected. The aim of the present study was to compare light intensities of different blue light sources and protoporphyrin (PpIX) fluorescence intensities of PpIX solutions with defined concentrations after illumination with different light sources. MATERIAL AND METHODS: The light spectrum of 7 different blue light sources and the fluorescence intensity of 2 PpIX solutions (0.15 µg/mL and 5 µg/mL) were quantified after illumination. We compared the Zeiss OPMI Pentero microscope, the Zeiss OPMI Pentero 900 microscope, the Leica M530 OH6 microscope, an endoscope equipped with the 5-ALA technique, a mini-spectrometer equipped with a multi-channel light-emitting diode (LED) source emitting monochromatic light, a modified commercially available LED head lamp, and a commercially available unmodified UV-LED lamp. PpIX fluorescence was quantified in a standardized setup using a mini-spectrometer. RESULTS: Maximum light intensities of the evaluated light sources were reached at different wavelengths. All tested devices were able to detect PpIX-induced fluorescence. However, the intensity of PpIX fluorescence of the differently concentrated PpIX solutions (0.15 µg/mL and 5 µg/mL) was significantly dependent on the light source used. CONCLUSIONS: Intensity of the 5-ALA-derived fluorescence is related to the light source used.


Assuntos
Ácido Aminolevulínico , Neoplasias Encefálicas/cirurgia , Fluorescência , Glioma/cirurgia , Luz , Protoporfirinas , Humanos , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos
17.
World Neurosurg ; 131: e362-e370, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31362101

RESUMO

BACKGROUND: The benefits of the right transradial approach for anterior circulation lesions using a 6F Simmonds guiding sheath have been reported. However, this technique can be anatomically challenging in the type I aortic arch. Furthermore, to the best of our knowledge, no studies have reported on neurointervention using a Simmonds guiding sheath and the left transradial approach. We devised a novel technique using the contralateral subclavian artery as an "anchor" to reform the Simmonds curve, named the subclavian artery anchoring technique (SCAT). The purpose of the present study was to evaluate the feasibility, safety, and usefulness of neurointervention with the SCAT for patients with a type I aortic arch treated with the right transradial approach and patients treated with the left transradial approach. METHODS: Ten consecutive patients treated from June 2018 to January 2019 were included in the present study. We retrospectively analyzed: 1) the success rate for reforming the Simmonds curve using the SCAT; 2) the success rate for introducing the 6F Simmonds guiding sheath into the target common carotid artery; 3) the success rate for completing the procedure; 4) periprocedural complications; and 5) vascular access site complications. RESULTS: In all 10 patients, the Simmonds curve was reformed, and a 6F Simmonds guiding sheath was introduced into the target common carotid artery. The procedure was successfully achieved for all 10 patients without periprocedural or vascular access site complications. CONCLUSIONS: The results of the present study have shown that this technique is a feasible, safe, and useful method for patients with type I aortic arch treated with a right transradial approach or a left transradial approach. SCAT makes up for a deficiency in the transradial approach with a 6F Simmonds guiding sheath.


Assuntos
Doenças das Artérias Carótidas/cirurgia , Procedimentos Endovasculares/métodos , Procedimentos Neurocirúrgicos/métodos , Dispositivos de Acesso Vascular , Adulto , Idoso , Aorta Torácica/anatomia & histologia , Artéria Carótida Primitiva , Artéria Carótida Interna , Estenose das Carótidas/cirurgia , Procedimentos Endovasculares/instrumentação , Estudos de Viabilidade , Feminino , Humanos , Aneurisma Intracraniano/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/instrumentação , Artéria Radial , Estudos Retrospectivos , Stents , Artéria Subclávia
18.
World Neurosurg ; 130: e160-e165, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31203069

RESUMO

OBJECTIVE: Considerable effort has been made in order to reduce surgical invasiveness while maintaining optimal exploiting of the operative space in aneurysm surgery. One aspect of this evolution is represented by the Lazic (Peter Lazic GmbH, Tuttlingen, Germany) aneurysm clip system. The purpose of this study was to illustrate the new generation clip system in practiced aneurysm surgery. METHODS: A retrospective analysis of all aneurysm surgeries in our departments between December 2015 and January 2018 using the new D-Clip system was performed. Evaluation included standardized retrospective review of the main surgeon, the nursing staff, as well as an analysis of surgical video documentation by objective reviewers. RESULTS: Forty-five patients with 50 intracranial aneurysms underwent surgical clipping using the D-Clip system. A total of 64 permanent and 19 temporary D-Clips were applied. Nine clips needed to be replaced. All aneurysms could be occluded totally. Surgeons considered handling and manoeuvrability of clip application as feasible and good in all cases (100%), even under impaired visibility circumstances (14%). Objective video analysis revealed comparable results. Nursing staff scored handling and practicability of D-Clips equivalent to the preceding L-Clip generation. There were no intraoperative complications. Surgery-related postoperative morbidity was 6.7%. CONCLUSIONS: The new D-Clip system combines an attenuated design for minimally invasive clipping procedures with traditional mechanisms of common clip systems. It therefore appears to be highly versatile in the context of variable different aneurysm morphologies and locations while maintaining high standard surgical safety and efficacy.


Assuntos
Aneurisma Intracraniano/cirurgia , Microcirurgia/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Instrumentos Cirúrgicos , Procedimentos Cirúrgicos Vasculares/instrumentação , Feminino , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
19.
World Neurosurg ; 130: e62-e67, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31195129

RESUMO

BACKGROUND: Multimodality monitoring is used frequently to guide care of patients with severe acute brain injury. The aim of this study was to examine the safety and reliability of multimodality monitoring. METHODS: From a prospective observational database at a Level I trauma center, 501 patients, including 300 men and 201 women (mean age 58 ± 39 years) were identified retrospectively. Each patient received a triple-lumen bolt and 3 monitors: intracranial pressure, brain temperature, and brain oxygen. Intensive care unit and hospital records were examined to identify complications, reasons for device replacement, malfunction and infection. Head computed tomography (CT) scans performed before and after the monitors were inserted were examined for evidence of monitor-related adverse effects. RESULTS: A total of 696 triple-lumen bolts were placed. Median duration of monitoring was 78.88 hours (interquartile range, 33.0-133.2 hours). Bilateral monitors were inserted in 22 (3.16%) patients. Ten (1.43%) monitors were replaced to allow magnetic resonance imaging, and 40 (5.74%) monitors were replaced to facilitate additional cranial surgery. Of 35 (5.02%) monitors that were replaced because they were thought to not be functioning properly, 19 (54.29%) were subsequently found to be functioning normally. Follow-up CT scans were compared with CT scans obtained before insertion of monitors; 9 (2.13%) small contusions and 10 (2.36%) extra-axial hematomas associated with the devices were identified. Based on the CT findings, the hematomas were thought to be associated with the insertion technique rather than the device; 4 hematomas required treatment. Twenty-two (3.16%) devices were incorrectly placed (e.g., the probe was in an infarct or an already existing contusion). Only 1 associated infection was identified. CONCLUSIONS: Placement of intracranial monitors for multimodality neuromonitoring using a triple-lumen bolt appears to be safe. The complication rate is similar to published complication rates for single-lumen bolts and single monitors.


Assuntos
Lesões Encefálicas/diagnóstico , Monitorização Fisiológica/efeitos adversos , Monitorização Fisiológica/métodos , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Idoso , Lesões Encefálicas/cirurgia , Bases de Dados Factuais , Feminino , Humanos , Pressão Intracraniana , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/instrumentação , Estudos Retrospectivos , Segurança , Tomografia Computadorizada por Raios X
20.
World Neurosurg ; 130: e467-e474, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31247354

RESUMO

OBJECTIVE: The treatment of spinal metastasis carries significant surgical morbidity, and decompression and stabilization are often necessary. Less invasive techniques may reduce risks and postoperative pain. This study describes the differences between a mini-open (MO) procedure and a traditional open surgery (OS) for symptomatic spinal metastasis, and reports differences in outcome for similar patients undergoing each procedure. METHODS: We describe a MO technique and retrospective analysis of 20 OS patients who were matched to 20 MO patients by histology, spinal region, and levels instrumented. MO surgery combined a traditional midline exposure for tumor resection with transfascial pedicle screw fixation. Outcome measures included estimated blood loss (EBL), operative time (OT), length of stay (LOS), transfusion rate, complication rate, ASIA Impairment Scale motor score (AMS), and pain scores. Statistical analysis used unpaired t tests and Fisher exact test. RESULTS: Average age of the patients was 58.3 years. Forty-eight percent of patients were women. Average number of levels treated was 5.9. Both groups had similar LOS (P = 0.98), OT (P = 0.30), perioperative complication rates (P = 0.51), transfusion rates (P = 0.33), and AMS (P = 0.17). EBL was found to be significantly lower in the MO group than the open group (805 ± 138 mL vs. 1732 ± 359 mL, respectively; P = 0.019). The MO group had a significant reduction in postoperative pain (-1.71 ± 0.5 vs. 0.33 ± 0.7, P = 0.018). CONCLUSIONS: Although further studies are needed, the MO approach appears to result in decreased blood loss and postoperative pain, without compromising neural element decompression or spinal stability. These findings are consistent with the use of muscle sparing, minimally invasive pedicle screw fixation.


Assuntos
Procedimentos Neurocirúrgicos/métodos , Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Idoso , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Neurocirúrgicos/instrumentação , Dor Pós-Operatória/prevenção & controle , Parafusos Pediculares , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/secundário , Resultado do Tratamento
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