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1.
Plast Reconstr Surg ; 145(2): 401e-406e, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985655

RESUMO

BACKGROUND: Chronic migraines affect approximately 2 percent of the U.S. population and cost an estimated $17 billion per year. OnabotulinumtoxinA (botulinum toxin type A) is a U.S. Food and Drug Administration-approved prophylactic medication for chronic migraine headaches and is best injected in a targeted fashion into specific trigger sites. The purpose of this study was to determine the cost-effectiveness of long-term, targeted botulinum toxin type A versus peripheral trigger site deactivation surgery for the treatment of migraine headaches. METHODS: A Markov model was constructed to examine long-term, targeted botulinum toxin type A versus peripheral trigger site deactivation surgery. Costs, utilities, and other model inputs were identified from the literature. One-way and probabilistic sensitivity analyses were performed. An incremental cost-effectiveness ratio under $50,000 per quality-adjusted life-year was considered cost-effective. RESULTS: The mean cost of peripheral trigger site deactivation surgery was $10,303, with an effectiveness of 7.06; whereas the mean cost of long-term, targeted botulinum toxin type A was $36,071, with an effectiveness of 6.34. Trigger-site deactivation surgery is more effective and less costly over the time horizon of the model. One-way sensitivity analysis revealed that surgery is the most cost-effective treatment in patients requiring treatment for greater than 6.75 years. CONCLUSIONS: Based on this model, peripheral trigger site deactivation surgery is the more cost-effective option for treating refractory migraine headaches requiring treatment beyond 6.75 years. The model reveals that peripheral trigger-site deactivation surgery is more effective and less costly than long-term, targeted botulinum toxin type A over the course of a patient's lifetime.


Assuntos
Inibidores da Liberação da Acetilcolina , Toxinas Botulínicas Tipo A , Transtornos de Enxaqueca , Procedimentos Neurocirúrgicos , Inibidores da Liberação da Acetilcolina/economia , Inibidores da Liberação da Acetilcolina/uso terapêutico , Adulto , Toxinas Botulínicas Tipo A/economia , Toxinas Botulínicas Tipo A/uso terapêutico , Análise Custo-Benefício , Humanos , Cadeias de Markov , Pessoa de Meia-Idade , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/economia , Transtornos de Enxaqueca/cirurgia , Procedimentos Neurocirúrgicos/economia , Procedimentos Neurocirúrgicos/métodos
2.
World Neurosurg ; 133: e640-e645, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568907

RESUMO

BACKGROUND: Concomitant chemoradiation (CCRT) after surgical resection has been established as standard care for patients with newly diagnosed glioblastoma (GBM). However, the optimal time interval from surgery to starting CCRT (IST) remains controversial. METHODS: The electronic medical records of 160 patients with newly diagnosed GBM treated at our institution between 2009 and 2016 were examined retrospectively. The eligibility criteria were newly diagnosed GBM, pathology confirmed by craniotomy or stereotactic biopsy, and CCRT performed in our institution. Patients who received CCRT within 28 days after surgery were defined as the early group, and those who received CCRT at >28 days after surgery were defined as the delayed group. RESULTS: We included 138 patients who met our eligibility criteria. The median IST was 26 days (range, 10-55 days). In a Kaplan-Meier analysis, overall survival (OS) did not differ between groups (15.5 month for the early group vs. 14.5 months for the delayed group; P = 0.707). In the gross total resection (GTR) subgroup, OS did not differ significantly (20.0 months for the early vs. 21.0 months for the delayed group; P = 0.854). In the non-GTR subgroup, however, the early group had better OS than the delayed group (11.0 months vs. 5.0 months; P = 0.029). CONCLUSIONS: Performing CCRT within versus after 28 days after surgery did not result in a statistically significant difference in OS. However, a subgroup analysis showed that delayed CCRT may be associated with worse OS in the non-GTR group.


Assuntos
Neoplasias Encefálicas/terapia , Quimiorradioterapia/métodos , Glioblastoma/terapia , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/patologia , Quimiorradioterapia/mortalidade , Intervalo Livre de Doença , Feminino , Glioblastoma/mortalidade , Glioblastoma/patologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/mortalidade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
3.
World Neurosurg ; 133: e492-e497, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31542439

RESUMO

BACKGROUND: Colloid cysts are the most common third ventricular tumor and may present with symptoms related to obstructive hydrocephalus. Although definitive endoscopic or microsurgical resection is the standard of care, patients may receive temporizing ventriculoperitoneal shunts when definitive management is deferred. Subsequent definitive treatment can be challenging because of the ventricular collapse and narrowing of the operative corridor. There is currently no literature evaluating the feasibility of definitive colloid cyst resection in patients with preexisting ventriculoperitoneal shunts. METHODS: We retrospectively reviewed records for patients undergoing colloid cyst resection between 2009 and 2019 to identify patients with preexisting shunts prior to surgery. RESULTS: Three patients had preexisting ventriculoperitoneal shunts. Two patients had been shunted at outside institutions where microsurgical or endoscopic resection was not available. One patient received a shunt from an outside surgeon when she was deemed a poor surgical candidate because of cardiac instability. All 3 patients underwent successful gross total colloid cyst resection via the transcallosal approach without recurrences during a mean follow-up of 4.2 years. All patients had intact cognitive and memory function and returned to work. CONCLUSIONS: Surgical resection of colloid cysts is possible despite a preexisting ventriculoperitoneal shunt. Because the ventricular space may be collapsed postoperatively because of cerebrospinal fluid diversion, a transcortical route (either endoscopic or microscopic) can be complicated by a small operative corridor with reduced visibility. The transcallosal approach was safe and feasible in these cases for providing midline access with adequate visualization for complete resection despite ventricular collapse.


Assuntos
Cistos Coloides/cirurgia , Procedimentos Neurocirúrgicos/métodos , Derivação Ventriculoperitoneal , Adulto , Feminino , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Masculino , Microcirurgia/métodos , Estudos Retrospectivos
4.
World Neurosurg ; 133: e551-e557, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31562966

RESUMO

OBJECTIVE: Although external landmarks and trajectories for external ventricular drainage have been described for the freehand-guided method, no standard trajectory has been reported for deep-seated intracerebral hemorrhage (ICH). This article presents a freehand-guided catheter insertion technique for deep-seated spontaneous ICH using external landmarks. METHOD: Freehand-guided hematoma aspiration using Kocher's point and the external auditory canal as landmarks was performed in 32 patients with a diagnosis of spontaneous ICH in basal ganglia treated between May 2015 and July 2018 at the author's institute. RESULTS: In computed tomographic images, the mean actual to planned catheter tip distance was 16.1 ± 7.7 mm, the mean right-left deviation was 4.6 ± 5.2 mm, the mean anterior-posterior deviation was 11.1 ± 9.5 mm, and the mean superior-inferior deviation was 8.7 ± 4.4 mm. On largest hematoma slice, the mean distance from hematoma centers to inserted catheter was 9.8 ± 4.9 mm, and the mean horizontal and vertical distances were 4.0 ± 4.7 mm and 7.7 ± 4.8 mm, respectively. In 29 of the 32 patients, all the catheter holes contacted hematomas, whereas in the other 3 patients, 1 or more holes were in contact with brain parenchymal tissue. CONCLUSION: For patients with basal ganglia hemorrhage, freehand-guided catheter insertion and hematoma aspiration with subsequent fibrinolysis is a feasible procedure that shortens procedural times. The described technique could be used as an alternative method because it can be performed when the patient is in a critical state without additional equipment.


Assuntos
Hemorragia Cerebral/cirurgia , Procedimentos Neurocirúrgicos/métodos , Paracentese/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos
5.
World Neurosurg ; 133: e513-e521, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31550541

RESUMO

OBJECTIVE: Owing to technical development of specific fluorophore filters, the neurosurgical application of sodium fluorescein (SF) has regained value in brain tumor surgery. The aim of this study was to determine the usefulness of SF during nerve biopsies. METHODS: This single-center study included 5 cases of nerve biopsies performed under microscope-based fluorescence with SF performed between March 2016 and February 2017. SF was applied intravenously (1 mg/kg body weight). After microsurgical dissection of the involved nerve segment, fluorescence-guided fascicular biopsy was performed. Selection of target fascicles was at the surgeon's discretion and took into account nerve stimulation for preservation of motor function and fluorescence intensity. Correlation to histopathologic examination was examined. Video analysis of intraoperative images comparing target fascicles with intense fluorescent response to adjacent fascicles of the same nerve segment was performed using ImageJ. RESULTS: All patients had motor or sensory deficits. Magnetic resonance imaging findings were similar, depicting long segments of gadolinium enhancement (minimum 11.7 cm). Each biopsy sample was positive resulting in diverse histopathologic results. Digital image analysis revealed a statistically significant difference of the complementary color green (P = 0.0473). CONCLUSIONS: Magnetic resonance imaging is the gold standard in diagnostic work-up of peripheral nerve disorders. Longitudinal nerve thickening with positive contrast enhancement is an unspecific magnetic resonance imaging finding. Various pathologies, such as tumors and inflammatory lesions, may cause this morphologic phenomenon. Nerve biopsies may be needed for diagnostic work-up. Intraoperative SF may help to depict the most affected fascicles and identify target fascicles for biopsy and increase diagnostic certainty of nerve biopsies.


Assuntos
Biópsia/métodos , Meios de Contraste , Fluoresceína , Procedimentos Neurocirúrgicos/métodos , Doenças do Sistema Nervoso Periférico/diagnóstico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
Medicine (Baltimore) ; 98(50): e18231, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852084

RESUMO

Surgical decompression and antibiotic therapy are the treatments of choice for patients with spinal epidural abscess (SEA). Surgical treatment included decompression, evacuation of abscess, and debridement. Recently, minimal invasive surgery has been introduced more widely, and biportal endoscopic spinal surgery have shown satisfactory clinical outcomes compared with traditional open surgery. The purpose of this study was to evaluate the efficacy of biportal endoscopic spinal surgery for the treatment of SEA .From January 2016 to June 2017, 13 patients who underwent biportal endoscopic spinal surgery under the diagnosis of SEA were retrospectively enrolled in this study. The surgical indications of the enrolled patients included SEA with or without early stage spondylodiscitis who had neurological symptoms. Periopertaive data and clinical outcomes were assessed by regular serologic testing, imaging studies, physical examination, visual analog scale, Oswestry Disability Index and modified Macnab criteria.Offending pathogens were identified in seven (54%) of 13 biopsy specimens. Appropriate intravenous antibiotics for the identified pathogens isolated from infected tissue biopsy cultures were administrated to patients for at least 30 days. All patients reported satisfactory relief of pain and neurological symptoms after surgery. No surgery-related complications and recurrences were found after 2 years follow up.Biportal endoscopic spinal surgery may be an effective alternative to traditional open surgical decompression for the treatment of SEA.


Assuntos
Desbridamento/métodos , Descompressão Cirúrgica/métodos , Endoscopia/métodos , Abscesso Epidural/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Biópsia , Abscesso Epidural/diagnóstico , Feminino , Seguimentos , Humanos , Vértebras Lombares , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
8.
Medicine (Baltimore) ; 98(50): e18233, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852086

RESUMO

Percutaneous epidural neuroplasty (PEN) is an effective interventional treatment for radicular pain. However, in some cases, contrast runoff to the spinal nerve root does not occur. We investigated whether contrast runoff to the spinal nerve root affects the success rate of PEN and whether additional transforaminal epidural blocks for intentional contrast runoff affect the success rate of PEN in cases in which contrast runoff is absent.This study was registered at ClinicalTrials.gov (Identifier: NCT03867630) in March 2019. We reviewed the medical records of 112 patients who underwent PEN with a wire-type catheter from May 2016 to August 2018. Patients were divided in 3 groups (Runoff group, Non-runoff group, Transforaminal group).Patients with low back pain and leg radicular pain who did not respond to lumbar epidural steroid injectionsPEN was performed in 112 patients with a wire-type catheter in target segment. We compared the success rate of PEN betweenThe success rate was significantly different between the Runoff group and the Non-runoff group (P < .0007) and between the Non-runoff group and the Transforaminal group (P = .0047), but not between the Runoff group and the Transforaminal group (P = .57).Contrast runoff influenced the success rate of PEN. In cases without contrast runoff, additional transforaminal epidural blocks for intentional contrast runoff increased the success rate of PEN with a wire-type catheter.


Assuntos
Anestesia Epidural/instrumentação , Cateteres , Dor Lombar/terapia , Procedimentos Neurocirúrgicos/métodos , Manejo da Dor/métodos , Raízes Nervosas Espinhais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluoroscopia , Seguimentos , Humanos , Injeções Epidurais/métodos , Dor Lombar/diagnóstico , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
9.
Neurosurg Rev ; 42(4): 843-852, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31617125

RESUMO

To perform a systematic review of the techniques for transient circulatory arrest during intracerebral aneurysm surgery according to the PRISMA guidelines. Search of PubMed and Google Scholar using the following: ("heart arrest" OR "cardiac standstill"[All Fields]) AND ("intracranial aneurysm" OR "intracranial"[All Fields] AND "aneurysm"[All Fields]). A total of 41 original articles were retrieved, of which 17 were excluded (review articles, editorials and single-case reports). A total of 24 separate articles published between 1984 and 2018 were included in the final analysis, where the majority of patients harbored anterior circulation giant or large aneurysms. Adenosine-induced cardiac arrest gave a short, temporary asystole. The method had benefits in aneurysm with a broad neck, a thin wall, in specific localizations with narrow surgical corridors or in case of intraoperative rupture. Rapid ventricular pacing (RVP) allows a longer and more easily controlled hypotension. Its use is largely limited to elective cases. Deep hypothermic circulatory arrest required a complex infrastructure, and fatal procedure complications lead to a 11.5-30% 30-day mortality rate, limiting its application to giant or complex aneurysm of the basilar artery or to residual posterior circulation aneurysm after endovascular treatment. Adenosine and RVP are both effective options to facilitate clipping of complex aneurysms. However, their use in patient with ischemic heart disease and cardiac arrhythmias should be avoided, and their safety in the context of subarachnoid hemorrhage is yet to be determined. Today, deep hypothermic circulatory arrest is almost obsolete due to endovascular alternatives.


Assuntos
Parada Cardíaca Induzida/métodos , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adenosina/administração & dosagem , Estimulação Cardíaca Artificial/métodos , Fármacos Cardiovasculares/administração & dosagem , Parada Circulatória Induzida por Hipotermia Profunda , Humanos , Hipotensão/induzido quimicamente , Hipotensão/etiologia
10.
World Neurosurg ; 131: 328-338, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31658576

RESUMO

Glioblastomas are the most common malignant brain tumor and despite extensive research have a dismal prognosis. This review focuses on the current treatment paradigms of glioblastoma and highlights current advances in surgical approaches, imaging techniques, molecular diagnostics, and translational efforts. Several promising clinical trials in immunotherapy and personalized medicine are discussed and the importance of quality of life in the patients and their caregivers both during active treatment and survivorship is also commented on.


Assuntos
Neoplasias Encefálicas/terapia , Glioblastoma/terapia , Antineoplásicos/uso terapêutico , Neoplasias Encefálicas/diagnóstico , Ensaios Clínicos como Assunto , Fracionamento da Dose de Radiação , Feminino , Previsões , Glioblastoma/diagnóstico , Humanos , Imunoterapia/métodos , Imunoterapia/tendências , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/tendências , Masculino , Terapia de Alvo Molecular/tendências , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/tendências , Tomografia por Emissão de Pósitrons/métodos , Tomografia por Emissão de Pósitrons/tendências , Medicina de Precisão/métodos , Medicina de Precisão/tendências , Qualidade de Vida , Fatores de Risco
11.
World Neurosurg ; 131: 364-370, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31658579

RESUMO

In recent years, advances in cortical-subcortical mapping, intraoperative neurophysiology, and neuropsychology have increased the ability to remove intrinsic brain tumors, expanding indications and maximizing the extent of resection. This has provided a significant improvement in progression-free survival, time of malignant transformation (in low-grade gliomas), and overall survival. Although current techniques enable preservation of language and motor functions during surgery, the maintenance of a complex set of functions defined with the term cognition is not always achievable. Cognition is defined as every neural process underlying a high human function and includes motor haptic and visuospatial functions, memory, social interactions, empathy, and emotions. In this regard, an extensive preoperative and postoperative neuropsychological evaluation is strongly suggested to assess cognitive impairment due to tumor growth, to assess surgical result, and to plan cognitive rehabilitation. This article discusses the main recent innovations introduced for cognitive mapping with the aim to preserve cognitive functions, which are essential to maintain a high quality of life.


Assuntos
Mapeamento Encefálico/métodos , Neoplasias Encefálicas/terapia , Transtornos Cognitivos/prevenção & controle , Terapia por Estimulação Elétrica/métodos , Glioma/terapia , Procedimentos Neurocirúrgicos/métodos , Neoplasias Encefálicas/psicologia , Função Executiva/fisiologia , Glioma/psicologia , Humanos , Margens de Excisão , Testes Neuropsicológicos , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/prevenção & controle , Semântica , Processamento Espacial/fisiologia
12.
World Neurosurg ; 131: 385-390, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31658580

RESUMO

Traumatic brain injury (TBI) represents a major public health concern worldwide, with no significant change in its epidemiology over the last 30 years. After TBI, the primary injury induces irreversible brain damage, which is untreatable. The subsequent secondary injury plays a critical role in the clinical prognosis because without effective treatment it will provide additional tissue damage. The resulting scenario is the rise in intracranial pressure (ICP) with the development of progressive neurological deficits. Current optimal management is based on a progressive, target-driven approach combining both medical and surgical treatment strategies among which is decompressive hemicraniectomy. With the advent of technology, research in the glymphatic pathways, and advances in microscopic surgery, a novel surgical technique-the cisternostomy-has emerged that holds promise in managing rising ICP in TBI-affected patients. In this article we describe the rationale for cisternostomy, an emerging microneurosurgical approach for the management of moderate to severe TBI.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Procedimentos Neurocirúrgicos/métodos , Estomia/métodos , Contraindicações de Procedimentos , Craniectomia Descompressiva/métodos , Drenagem/métodos , Humanos , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/cirurgia , Ilustração Médica , Microcirurgia/métodos
13.
Spine (Phila Pa 1976) ; 44(21): 1492-1498, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31609917

RESUMO

STUDY DESIGN: A prospective, within-subject study was conducted. OBJECTIVE: We aimed to compare the influence of anesthetic fade under maximum stimulation conditions between constant-current and constant-voltage stimulation techniques. SUMMARY OF BACKGROUND DATA: The monitoring of muscle-evoked potentials after electrical stimulation to the brain [Br(E)-MSEP)] is useful for assessing the integrity of spinal cord motor tracts during major spine surgery. Nonetheless, Br(E)-MSEP responses are known to deteriorate over the duration of surgeries performed under general anesthesia. This phenomenon is known as anesthetic fade. METHODS: We recruited 117 patients undergoing various spinal surgeries from the cervical to the lumbar level. We excluded 29 cases with insufficient data. The decrease rate of the Br(E)-MSEP amplitude for each muscle was examined. Br(E)-MSEP monitoring with constant-current and constant-voltage stimulations at the C3 and C4 electrode positions was applied. Compound muscle action potentials (CMAPs) were bilaterally recorded from the abductor pollicis brevis, deltoid, abductor hallucis, tibialis anterior, gastrocnemius, and quadriceps muscles. We defined the decrease rate as follows: (initial CMAPs-final CMAPs)/initial CMAPs × 100. Differences in the decrease rate were evaluated between stimulators, limbs (upper vs. lower), and operative time group (lowest quartile vs. highest quartile). RESULTS: The overall decrease rate (across all muscles) increased as the operative time increased, and the rate was higher in the lower limbs than in the upper limbs. In addition, the overall decrease rate was lower with constant-voltage stimulation than with constant-current stimulation. Furthermore, the decrease rate for constant-current stimulation was significantly higher than that for constant-voltage stimulation, regardless of the operative time. CONCLUSION: The CMAP waveform with constant-voltage stimulation is less susceptible to anesthetic fade than that with constant-current stimulation, even during long surgeries. LEVEL OF EVIDENCE: 3.


Assuntos
Anestésicos/farmacologia , Encéfalo/efeitos dos fármacos , Potencial Evocado Motor/fisiologia , Músculo Esquelético/fisiologia , Procedimentos Neurocirúrgicos/métodos , Coluna Vertebral/cirurgia , Adulto , Anestesia Geral , Estimulação Elétrica , Eletrodos , Potenciais Evocados , Feminino , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
14.
Spine (Phila Pa 1976) ; 44(20): 1435-1440, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31589200

RESUMO

STUDY DESIGN: Prospective multicenter study. OBJECTIVE: The aim of this study was to study the incidence of nonneurologic adverse events related to transcranial electric stimulation (TES) for intraoperative spinal cord monitoring (IOM) with motor-evoked potentials (MEPs) (Tc(E)- MEPs) and determine the need for safety precautions. SUMMARY OF BACKGROUND DATA: Tc(E)-MEPs monitoring requires high-voltage multipulse TES that causes widespread muscle contraction and movement. Improved awareness of TES-induced movement-related adverse events is needed. METHODS: We analyzed data from 2643 patients who underwent high-risk spinal surgery with intraoperative Tc(E)-MEPs at 11 spinal centers from 2010 to 2016. Information about neurologic and non-neurologic postoperative complications was collected, including type of surgical procedure, operative time, estimated blood loss, and treatment for postoperative adverse events. RESULTS: A 70% drop in Tc(E)-MEPs amplitude, which was the alarm criterion to interrupt surgery, predicted postoperative motor deficits with 93.5% sensitivity, 91.0% specificity, a false-positive rate of 8.2%, and a false-negative rate of 0.3%. Non-neurologic adverse events developed in 17 (0.64%) patients and were most commonly because of bite injuries (0.57%), including 11 cases of tongue laceration, two cases of lip laceration, and two cases of tooth breakage. Four (0.15%) tongue lacerations required surgical repair with sutures and two tooth breakages required dental treatment. One patient had hair loss corresponding to the TES site. One patient, who underwent additional IOM with transpharyngeal stimulation, had severe nasal hemorrhage following electrode placement by nasal route, which resolved spontaneously. Non-neurologic adverse events did not significantly affect the accuracy of IOM assessment. Neither operative times nor blood loss significantly influenced the occurrence of adverse events. CONCLUSION: During TES-IOM, both the surgeon and monitoring team must consider the possibility-although rare-of non-neurologic adverse events, particularly bite injuries. Such complications can be minimized by using a soft bite-block and frequently evaluating the intraoral integrity of the anesthetized patient. LEVEL OF EVIDENCE: 4.


Assuntos
Potencial Evocado Motor/fisiologia , Monitorização Neurofisiológica Intraoperatória/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias , Estimulação Transcraniana por Corrente Contínua/efeitos adversos , Humanos , Estudos Prospectivos
15.
Medicine (Baltimore) ; 98(39): e17145, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574816

RESUMO

RATIONALE: Paragangliomas are rare neuroendocrine tumors that originate in specialized cells derived from the neural crest with metastasis to the thoracic spine being among the rarest forms. Here, we are presenting a detailed analysis of a case of malignant paraganglioma in the thoracic spinal region in a 14-year-old boy. Our focus is to emphasize the importance of considering malignant paraganglioma as a diagnosis and guiding the perioperative management upon surgical treatment. The management of these unique cases has yet to be well-documented. PATIENT CONCERNS: A 14-year-old boy presented with a 5-month history of continuous and progressive elevated blood pressure and back pain. The patient, who had been diagnosed of malignant paraganglioma in the left posterior mediastinum for 3 months, received surgical resection of paraganglioma in the left posterior mediastinum, which had involved the left intervertebral foramen of T4. However, the tumor was not completely resected during the first operation. DIAGNOSES: Magnetic resonance imaging of spine and positron emission tomography-computed tomography showed spinal cord compression secondary to the epidural component of the T4 mass, with increased marrow infiltration of the left T4 intervertebral foramen, which was difficult to be removed. Postoperative pathology confirmed the diagnosis of spinal involvement of malignant paraganglioma. INTERVENTIONS: The patient underwent biopsy and percutaneous vertebroplasty of T4 and paravertebral lesions, and needle-track cement augmentation via a posterior approach. OUTCOMES: The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 10-month follow-up visit. There were no other complications associated with the operation during the follow-up period. LESSONS: Combined efforts of specialists from orthopedics, neurosurgery, thoracic surgery, and medical oncology led to the successful diagnosis and management of this patient. Malignant paraganglioma of thoracic spine, although rare, should be part of the differential diagnosis when the patient has a history of paraganglioma and presents with back pain and radiculopathy. We recommend the posterior approach for spinal decompression of the malignant paraganglioma when the tumor has caused neurological deficits. Osteoplasty by cement augmentation is also a good choice for surgical treatment. However, we need to take the potential risk of complications in bone cement applications into full consideration.


Assuntos
Neoplasias do Mediastino/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Ortopédicos/métodos , Paraganglioma/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adolescente , Descompressão Cirúrgica , Humanos , Masculino , Neoplasias do Mediastino/patologia , Paraganglioma/patologia , Neoplasias da Coluna Vertebral/patologia , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Vertebroplastia/métodos
16.
Artigo em Russo | MEDLINE | ID: mdl-31577266

RESUMO

Aneurysms of vertebral (VA) and posterior inferior cerebellar arteries (PICA) are relatively rare pathologies and account for 3.4% of the total number of intracranial aneurysms. MATERIAL AND METHODS: The experience of microsurgical treatment of 67 patients with VA and PICA aneurysms in N.N. Burdenko National Medical Research Center for Neurosurgery of the RF Ministry of Health from 2012 to 2017 is presented. RESULTS: Most patients underwent reconstructive microsurgical interventions: clipping of the aneurysm neck in 42 (62.7%) patients and complex clipping with the formation of arterial opening - in 10 (14.9%). Exclusion of the aneurysm together with the carrier artery (trapping, proximal clipping) was performed on 10 (14.9%) patients. In 5 (7.5%) patients, deconstruction of the carrier artery of the aneurysm was performed after creating local anastomoses. The radical exclusion of aneurysms in the studied group was 95.5%. Postoperative dysfunction of the caudal group of cranial nerves was detected in 11 (16.4%) patients. There were no lethal outcomes, or cases with vegetative status outcomes. CONCLUSION: Microsurgical intervention is an effective way to treat VA and PICA aneurysms, subject to the principles of patient selection based on existing treatment algorithms as well as adherence to an interdisciplinary approach.


Assuntos
Artérias Cerebrais , Aneurisma Intracraniano , Microcirurgia , Procedimentos Neurocirúrgicos , Cerebelo , Artérias Cerebrais/cirurgia , Humanos , Aneurisma Intracraniano/cirurgia , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Resultado do Tratamento , Artéria Vertebral
17.
Orv Hetil ; 160(40): 1584-1590, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31565974

RESUMO

Introduction: Malignant tumours of the sinonasal region - including those with invasion of the skull base - necessitate surgical resection. The majority of the cases give an opportunity to perform the procedure via minimally invasive, endoscopic approach, without external, craniofacial surgery. Aim: To assess our clinical experience in treating anterior skull base malignancies, performing minimally invasive endoscopic transcribriform resection. Method: Between February 2015 and July 2017, four male and one female patient underwent minimally invasive, endoscopic skull base procedure. The mean age was 64.6 years (59-70, median: 66). Every surgery was performed via transnasal, endoscopic transcribriform approach. In two cases Kadish C esthesioneuroblastomas, while in one case a T3N0 sinonasal non-differentiated carcinoma, a T1N0 intestinal type adenocarcinoma and a T4N0 squamous cell carcinoma was the indication of surgery, respectively. Results: The mean follow-up time was 22.8 months, between 14 and 46 months. Intraoperative complications did not occur during the procedures. Regarding the postoperative period, liquorrhoea and pneumocephalus occurred in one case. Complications were solved with lumbar drainage. During follow-up, neither residual nor recurrent tumour was observed in our patients. Conclusion: Endoscopic transcribriform resection of the skull base malignancies is a safe and viable alternative to the traditional open approach. Orv Hetil. 2019; 160(40): 1584-1590.


Assuntos
Endoscopia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Neuroendoscopia/métodos , Procedimentos Neurocirúrgicos/métodos , Neoplasias dos Seios Paranasais/cirurgia , Neoplasias da Base do Crânio/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Recidiva Local de Neoplasia , Neuroendoscopia/efeitos adversos , Neoplasias dos Seios Paranasais/patologia , Base do Crânio/cirurgia , Neoplasias da Base do Crânio/patologia , Resultado do Tratamento
18.
Medicine (Baltimore) ; 98(42): e17558, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626120

RESUMO

BACKGROUND: Microsurgery is widely utilized for patients with cerebral hemorrhage (CH). The purpose of this study is to assess the efficacy and safety of microsurgery for the treatment of patients with CH secondary to gestational hypertension (GH). METHODS: Relevant randomized controlled trials in eight electronic databases of Cochrane Library, PUBMED, EMBASE, Web of Science, VIP, WANFANG, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure will be included. All electronic databases will be searched from inceptions to the present without language restriction. RevMan 5.3 software will be applied for statistical analysis. RESULTS: This study will summarize a high-quality synthesis of maternal mortality, severe maternal complications, maternal quality of life, limbs function, muscle strength, and muscle tone to evaluate the efficacy and safety of microsurgery for patients with CH secondary to GH. CONCLUSIONS: This study will provide evidence that microsurgery is an effective intervention in patients with CH secondary to GH. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019145750.


Assuntos
Hemorragia Cerebral/cirurgia , Hipertensão Induzida pela Gravidez/cirurgia , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Hemorragia Cerebral/etiologia , Feminino , Humanos , Gravidez , Resultado do Tratamento
19.
World Neurosurg ; 132: 398, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520755

RESUMO

Intracranial epidermoid cysts are developmental central nervous system abnormalities that arise from erroneous ectodermal inclusion during neural tube closure. Epidermoids are relatively common, representing 1% of all intracranial masses, and are particularly predominant in the cerebellopontine angle (CPA), where they are the third most prevalent diagnosis after schwannomas and meningiomas. Although small, asymptomatic, or incidental lesions may be safely observed, in the presence of symptomatic mass effect, epidermoid cysts typically require surgical resection. As shown in Video 1, we demonstrate the operating room setup and endoscopic resection of a left CPA epidermoid cyst through a retrosigmoid craniotomy. By use of a 2-surgeon 4-hands technique, the mass was dissected from the surrounding neurovascular structures, and a gross total removal was achieved with no postoperative neurologic deficits. Our video highlights the critical nuances pertinent to the fully endoscopic resection technique, with special attention to the relative restrictions of a small working corridor parallel to the tentorium and the petrous bone.


Assuntos
Doenças Cerebelares/cirurgia , Ângulo Cerebelopontino/cirurgia , Endoscopia/métodos , Cisto Epidérmico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias Cerebelares/cirurgia , Humanos , Meningioma/cirurgia , Neurocirurgiões
20.
World Neurosurg ; 132: e40-e52, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520759

RESUMO

BACKGROUND: Schwannomas encompassing the superior parapharyngeal space are challenging lesions because of the anatomical complexity of this region and the frequent involvement of the neurovascular structures of the jugular foramen. The purpose of this study is to report the technical aspects and the advantages of the anterolateral approach, here proposed for schwannomas of this complex area. METHODS: The main steps of the anterolateral approach are described in detail, along with the results of a consecutive series of 38 patients with a retrostyloid superior parapharyngeal schwannoma involving the jugular foramen operated on by means of this route between 1999 and 2019. RESULTS: The supine position is generally preferred. The medial border of the sternocleidomastoid muscle, mastoid tip, and superior nuchal line are the landmarks for the hockey-stick skin incision. The accessory nerve is retrieved and mobilized cranially. Detachment of the sternocleidomastoid, digastric, and nuchal muscles allows for a 180° exposure of the extracranial side of the jugular foramen. Three working corridors, namely the pre-carotid, pre-jugular, and retro-jugular, allow access to the deeper part of the jugular foramen area and the superior parapharyngeal space. In the present series, a gross total resection was achieved in 89.4% of the patients. Three recurrences occurred after an average follow-up of 80.5 ± 51 months. CONCLUSIONS: The anterolateral approach is highly effective in the treatment of retrostyloid superior parapharyngeal space schwannomas involving the jugular foramen. Its simplicity of execution, versatility, and very low morbidity are among its main strengths.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Faringe/cirurgia , Adulto , Idoso , Feminino , Humanos , Incidência , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/epidemiologia , Músculos Faríngeos/anatomia & histologia , Músculos Faríngeos/cirurgia , Faringe/diagnóstico por imagem , Decúbito Dorsal , Tomografia Computadorizada por Raios X , Adulto Jovem
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