Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 922
Filtrar
1.
Sci Rep ; 11(1): 6171, 2021 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-33731753

RESUMO

The world currently faces the novel severe acute respiratory syndrome coronavirus 2 pandemic. Little is known about the effects of a pandemic on non-elective neurosurgical practices, which have continued under modified conditions to reduce the spread of COVID-19. This knowledge might be critical for the ongoing second coronavirus wave and potential restrictions on health care. We aimed to determine the incidence and 30-day mortality rate of various non-elective neurosurgical procedures during the COVID-19 pandemic. A retrospective, multi-centre observational cohort study among neurosurgical centres within Austria, the Czech Republic, and Switzerland was performed. Incidence of neurosurgical emergencies and related 30-day mortality rates were determined for a period reflecting the peak pandemic of the first wave in all participating countries (i.e. March 16th-April 15th, 2020), and compared to the same period in prior years (2017, 2018, and 2019). A total of 4,752 emergency neurosurgical cases were reviewed over a 4-year period. In 2020, during the COVID-19 pandemic, there was a general decline in the incidence of non-elective neurosurgical cases, which was driven by a reduced number of traumatic brain injuries, spine conditions, and chronic subdural hematomas. Thirty-day mortality did not significantly increase overall or for any of the conditions examined during the peak of the pandemic. The neurosurgical community in these three European countries observed a decrease in the incidence of some neurosurgical emergencies with 30-day mortality rates comparable to previous years (2017-2019). Lower incidence of neurosurgical cases is likely related to restrictions placed on mobility within countries, but may also involve delayed patient presentation.


Assuntos
/mortalidade , Procedimentos Neurocirúrgicos/mortalidade , Procedimentos Neurocirúrgicos/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Europa (Continente) , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Neurocirurgia/métodos , Pandemias/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
2.
World Neurosurg ; 148: e689-e694, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33540092

RESUMO

BACKGROUND: Cessation of elective procedures and lower bed capacity during the COVID-19 pandemic have led to a rise in the waiting lists for surgery, but it is unclear if workload has recovered sufficiently to account for this backlog. We describe the change in neurosurgical workload at a tertiary neurosciences center in the United Kingdom after the first pandemic wave in comparison with the months before and during the first wave. METHODS: A retrospective review of theatre records and electronic referrals-between December 1, 2019, and August 31, 2020-was performed. The months of December 2019-February 2020 were designated as pre-COVID months and March-May 2020 were designated as COVID months. The time period from June to August 2020 was designated as post-wave months. Statistical analyses were performed on SPSS v22 (IBM). RESULTS: Referrals declined from 572 in January to a nadir of 352 in April before a steady rise to August. Referral volumes for degenerative spinal disease and traumatic brain injuries showed a statistically significant change during the year. On average, 212 procedures per month were performed in the pre-COVID months, 167 procedures per month during COVID months, and 232 procedures per month in the post-wave months. The number of patients on the waiting list for scheduled operations rose from March (785 patients) onward to a peak of 997 patients in July. CONCLUSIONS: In the aftermath of COVID-19, higher referral volumes and operative procedures were apparent in the post-wave months as services returned to normal. With the expectation of a second wave of infections, it is unclear whether this will be sustainable.


Assuntos
/epidemiologia , Procedimentos Neurocirúrgicos/tendências , Carga de Trabalho , Lesões Encefálicas Traumáticas/cirurgia , Neoplasias Encefálicas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/tendências , Estudos Retrospectivos , Doenças da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Hemorragia Subaracnóidea/cirurgia , Centros de Atenção Terciária , Reino Unido/epidemiologia , Listas de Espera
3.
World Neurosurg ; 148: e197-e208, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33385606

RESUMO

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) pandemic has been at its peak for the past 8 months and has affected more than 215 countries around the world. India is now the second most-affected nation with more than 48,000,000 cases and 79,000 deaths. Despite this, and the fact that it is a lower-middle-income nation, the number of deaths is almost one third that of the United States and one half that of Brazil. However, there has been no experience published from non-COVID-19-designated hospitals, where the aim is to manage noninfected cases with neurosurgical ailments while keeping the number of infected cases to a minimum. METHODS: We analyzed the number of neurosurgical cases (nontrauma) done in the past 5 months (March-July 2020) in our institute, which is the largest neurosurgical center by volume in southern India, and compared the same to the concurrent 5 months in 2019 and 5 months preceding the pandemic. We also reviewed the total number of cases infected with COVID-19 managed during this time. RESULTS: We operated a total of 630 cases (nontrauma) in these 5 months and had 9 COVID-19 infected cases operated during this time. There was a 57% (P = 0.002) reduction in the number of cases operated as compared with the same 5 months in the preceding year. We employed a dual strategy of rapid antigen testing and surgery for cases needing emergency intervention and reverse transcriptase-polymerase chain reaction test for elective cases. The hospital was divided into 3 zones (red, orange, and green) depending on infectivity level with minimal interaction. Separate teams were designated for each zone, and thus we were able to effectively manage even infected cases despite the absence of pulmonology/medical specialists. CONCLUSIONS: We present a patient management protocol for non-COVID-19-designated hospitals in high-volume centers with the constraints of a lower-middle-income nation and demonstrate its effectiveness. Strict zoning targeted testing and effective triage can help in management during the pandemic.


Assuntos
/epidemiologia , Procedimentos Neurocirúrgicos/tendências , Telemedicina/tendências , Centros de Atenção Terciária/organização & administração , Assistência Ambulatorial/tendências , Aneurisma Roto/cirurgia , Neoplasias Encefálicas/cirurgia , /prevenção & controle , Transtornos Cerebrovasculares/cirurgia , Humanos , Índia/epidemiologia , Controle de Infecções , Aneurisma Intracraniano/cirurgia , Defeitos do Tubo Neural/cirurgia , Seleção de Pacientes , Equipamento de Proteção Individual , Radiocirurgia , Doenças da Coluna Vertebral , Traumatismos da Coluna Vertebral
4.
Neurol Clin ; 39(1): 181-196, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33223082

RESUMO

Pharmacoresistant seizures occur in nearly one-third of people with epilepsy. Medial temporal lobe and lesional epilepsy are the most favorable surgically remediable epileptic syndromes. Successful surgery may render the patient seizure-free, reduce antiseizure drug(s) adverse effects, improve quality of life, and decrease mortality. Surgical management should not be considered a procedure of "last resort." Despite the results of randomized controlled trials, surgery remains an underutilized treatment modality for patients with drug-resistant epilepsy (DRE). Important disparities affect patient referral and selection for surgical treatment. This article discusses the advances in surgical treatment of DRE in adults with focal seizures.


Assuntos
Epilepsia Resistente a Medicamentos/cirurgia , Procedimentos Neurocirúrgicos/tendências , Adulto , Epilepsias Parciais/cirurgia , Humanos , Resultado do Tratamento
5.
Neurosurgery ; 88(3): E259-E264, 2021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33370820

RESUMO

BACKGROUND: Length of stay beyond medical readiness (LOS-BMR) leads to increased expenses and higher morbidity related to hospital-acquired conditions. OBJECTIVE: To determine the proportion of admitted neurosurgical patients who have LOS-BMR and associated risk factors and costs. METHODS: We performed a prospective, cohort analysis of all neurosurgical patients admitted to our institution over 5 mo. LOS-BMR was assessed daily by the attending neurosurgeon and neuro-intensivist with a standardized criterion. Univariate and multivariate logistic regressions were performed. RESULTS: Of the 884 patients admitted, 229 (25.9%) had a LOS-BMR. The average LOS-BMR was 2.7 ± 3.1 d at an average daily cost of $9 148.28 ± $12 983.10, which resulted in a total cost of $2 076 659.32 over the 5-mo period. Patients with LOS-BMR were significantly more likely to be older and to have hemiplegia, dementia, liver disease, renal disease, and diabetes mellitus. Patients with a LOS-BMR were significantly more likely to be discharged to a subacute rehabilitation/skilled nursing facility (40.2% vs 4.1%) or an acute/inpatient rehabilitation facility (22.7% vs 1.7%, P < .0001). Patients with Medicare insurance were more likely to have a LOS-BMR, whereas patients with private insurance were less likely (P = .048). CONCLUSION: The most common reason for LOS-BMR was inefficient discharge of patients to rehabilitation and nursing facilities secondary to unavailability of beds at discharge locations, insurance clearance delays, and family-related issues.


Assuntos
Continuidade da Assistência ao Paciente/tendências , Custos de Cuidados de Saúde/tendências , Tempo de Internação/tendências , Procedimentos Neurocirúrgicos/tendências , Alta do Paciente/tendências , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Instituições de Cuidados Especializados de Enfermagem/tendências , Estados Unidos
7.
Eur J Endocrinol ; 183(6): 597-606, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33075752

RESUMO

Objective: Neurosurgery is the first-line treatment for acromegaly. Whether metabolic disorders are reversible after neurosurgery is still debated. The meta-analysis aimed to address the following questions: (i) Does neurosurgery affect glycolipid metabolism? (ii) Are these effects related to disease control or follow-up length? Design: A meta-analysis and systematic review of the literature. Methods: Three reviewers searched databases until August 2019 for prospective trials reporting glycometabolic outcomes after neurosurgery. Three other extracted outcomes, all assessed the risk of bias. Results: Twenty studies were included. Neurosurgery significantly reduced fasting plasma glucose (FPG) (effect size (ES): -0.57 mmol/L, 95% CI: -0.82 to -0.31; P < 0.001), glucose load (ES: -1.10 mmol/L, 95% CI: -1.66 to -0.53; P < 0.001), glycosylated haemoglobin (HbA1c) (ES: -0.28%, 95% CI: -0.42 to -0.14; P < 0.001), fasting plasma insulin (FPI) (ES: -10.53 mU/L, 95% CI: -14.54 to -6.51; P < 0.001), homeostatic model assessment of insulin resistance (HOMA-IR) (ES: -1.98, 95% CI: -3.24 to -0.72; P = 0.002), triglycerides (TGDs) (ES: -0.28 mmol/L, 95% CI: -0.36 to -0.20; P < 0.001) and LDL-cholesterol (LDLC) (ES: -0.23 mmol/L, 95% CI: -0.45 to -0.02 mmol/L); P = 0.030) and increased HDL-cholesterol (HDLC) (ES: 0.21 mmol/L, 95% CI: 0.14 to 0.28; P < 0.001). Meta-regression analysis showed that follow-up length - not disease control - had a significant effect on FPG, with the greatest reduction in the shortest follow-up (beta = 0.012, s.e. = 0.003; P = 0.001). Conclusions: Neurosurgery improves metabolism with a significant decrease in FPG, glucose load, HbA1c, FPI, HOMA-IR, TGDs, and LDLC and increase in HDLC. The effect on FPG seems to be more related to follow-up length than to disease control.


Assuntos
Acromegalia/metabolismo , Acromegalia/cirurgia , Procedimentos Neurocirúrgicos/tendências , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Colesterol/sangue , Seguimentos , Glucose/metabolismo , Hemoglobina A Glicada/metabolismo , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Estudos Prospectivos
8.
Spine (Phila Pa 1976) ; 45(15): E933-E942, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675608

RESUMO

STUDY DESIGN: Retrospective study. OBJECTIVE: To analyze proximal junctional kyphosis (PJK) occurrence and surgical outcomes according to degree of lumbar lordosis (LL) correction relative to pelvic incidence (PI). In addition, risk factors of PJK including LL and sagittal vertical axis (SVA) correction were investigated. SUMMARY OF BACKGROUND DATA: PJK is a common complication after adult spinal deformity surgery, and many factors are known to be associated with PJK. However, the effect of degree of LL correction on PJK occurrence is not fully understood. METHODS: Eighty-three degenerative sagittal imbalance patients treated with deformity correction and long instrumented fusion to the sacrum with a minimum follow-up of 2 years were studied. Patients were divided into three groups according to their postoperative LL angle relative to PI using the SRS-Schwab classification: Group A (undercorrection, PI-LL> 10°), Group B (ideal correction, -10°

Assuntos
Cifose/diagnóstico por imagem , Lordose/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Doenças Neurodegenerativas/diagnóstico por imagem , Procedimentos Neurocirúrgicos/efeitos adversos , Adulto , Idoso , Animais , Feminino , Humanos , Cifose/etiologia , Lordose/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/etiologia , Procedimentos Neurocirúrgicos/tendências , Estudos Retrospectivos , Fatores de Risco
9.
Spine (Phila Pa 1976) ; 45(15): E950-E958, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675610

RESUMO

STUDY DESIGN: Case-control study from a continuous series. OBJECTIVES: To study the impact of perioperative sitting radiographs in adult spinal deformity (ASD) patients and determine whether proximal junctional kyphosis (PJK) can be prevented using preoperative sitting radiograph. SUMMARY OF BACKGROUND DATA: Radiographic analysis of ASD comprises standing whole-spine radiography which cannot evaluate the relaxed posture without head-to-foot compensation. METHODS: Preoperative and postoperative whole-spine standing and sitting radiographs and proximal mechanical complications in surgically treated spinal disorders with a minimum of 1-year follow-up were studied. Whole-spinal alignment was defined by cervical lordosis (CL), sagittal vertical axis (SVA), T1 slope (T1S), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and level of kyphotic apex (KA). Proximal mechanical complication was described as a PJK (proximal junctional angle >20°) or reoperation due to proximal junctional failure. RESULTS: Surgically treated 113 patients were prospectively investigated. Patients were divided into either the ASD (thoracic to ilium posterior corrective fusion), or non-ASD groups. In the ASD group, 10 patients had postoperative PJK, and three revision surgeries were carried out due to PJF with neurological deficit. Comparing standing with sitting positions, CL, TK, and PT became larger, SVA became frontal, LL and SS became smaller, and KA became caudal particularly in the ASD group. Logistic regression analysis demonstrated that the most influenced plumb line for PJK was the upper instrumented vertebra (UIV) to C2 plumb line distance, with a cutoff value of 115 mm for predicting PJK. CONCLUSION: Our findings highlight the usefulness of sitting spinal alignment evaluation, particularly in ASD patients, with maximum effort of thoracic spine and lower extremity compensation at standing. Mechanical complications such as PJK could be predicted using the distance from the planned UIV to the C2 plumb line in preoperative sitting radiographs. LEVEL OF EVIDENCE: 3.


Assuntos
Cifose/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Postura Sentada , Vértebras Torácicas/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Cifose/cirurgia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/tendências , Radiografia/métodos , Radiografia/tendências , Estudos Retrospectivos , Sacro/diagnóstico por imagem , Sacro/cirurgia , Vértebras Torácicas/cirurgia , Adulto Jovem
10.
World Neurosurg ; 142: e183-e194, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32599201

RESUMO

OBJECTIVE: In the present study, we quantified the effect of the coronavirus disease 2019 (COVID-19) on the volume of adult and pediatric neurosurgical procedures, inpatient consultations, and clinic visits at an academic medical center. METHODS: Neurosurgical procedures, inpatient consultations, and outpatient appointments at Vanderbilt University Medical Center were identified from March 23, 2020 through May 8, 2020 (during COVID-19) and March 25, 2019 through May 10, 2019 (before COVID-19). The neurosurgical volume was compared between the 2 periods. RESULTS: A 40% reduction in weekly procedural volume was demonstrated during COVID-19 (median before, 75; interquartile range [IQR], 72-80; median during, 45; IQR, 43-47; P < 0.001). A 42% reduction occurred in weekly adult procedures (median before, 62; IQR, 54-70; median during, 36; IQR, 34-39; P < 0.001), and a 31% reduction occurred in weekly pediatric procedures (median before, 13; IQR, 12-14; median during, 9; IQR, 8-10; P = 0.004). Among adult procedures, the most significant decreases were seen for spine (P < 0.001) and endovascular (P < 0.001) procedures and cranioplasty (P < 0.001). A significant change was not found in the adult open vascular (P = 0.291), functional (P = 0.263), cranial tumor (P = 0.143), or hydrocephalus (P = 0.173) procedural volume. Weekly inpatient consultations to neurosurgery decreased by 24% (median before, 99; IQR, 94-114; median during, 75; IQR, 68-84; P = 0.008) for adults. Weekly in-person adult and pediatric outpatient clinic visits witnessed a 91% decrease (median before, 329; IQR, 326-374; median during, 29; IQR, 26-39; P < 0.001). In contrast, weekly telehealth encounters increased from a median of 0 (IQR, 0-0) before to a median of 151 (IQR, 126-156) during COVID-19 (P < 0.001). CONCLUSIONS: Significant reductions occurred in neurosurgical operations, clinic visits, and inpatient consultations during COVID-19. Telehealth was increasingly used for assessments. The long-term effects of the reduced neurosurgical volume and increased telehealth usage on patient outcomes should be explored.


Assuntos
Assistência Ambulatorial/tendências , Infecções por Coronavirus , Neurocirurgia , Procedimentos Neurocirúrgicos/tendências , Pandemias , Pneumonia Viral , Encaminhamento e Consulta/tendências , Telemedicina/tendências , Centros Médicos Acadêmicos , Adolescente , Idoso , Betacoronavirus , Neoplasias Encefálicas/cirurgia , Criança , Pré-Escolar , Craniotomia/tendências , Remoção de Dispositivo , Procedimentos Endovasculares/tendências , Epilepsia/cirurgia , Feminino , Humanos , Hidrocefalia/cirurgia , Lactente , Masculino , Pessoa de Meia-Idade , Implantação de Prótese , Procedimentos Cirúrgicos Reconstrutivos/tendências , Doenças da Coluna Vertebral/cirurgia , Traumatismos da Coluna Vertebral/cirurgia , Tennessee , Procedimentos Cirúrgicos Vasculares/tendências
11.
Pain Physician ; 23(3S): S129-S147, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503360

RESUMO

BACKGROUND: The trends of the expenditures of facet joint interventions have not been specifically assessed in the fee-for-service (FFS) Medicare population since 2009. OBJECTIVE: The objective of this investigation is to assess trends of expenditures and utilization of facet joint interventions in FFS Medicare population from 2009 to 2018. STUDY DESIGN: The study was designed to analyze trends of expenditures and utilization of facet joint interventions in FFS Medicare population from 2009-2018 in the United States. In this manuscript: • A patient was considered as undergoing facet joint interventions throughout the year. • A visit included all regions treated during the visit. • An episode was considered as one per region utilizing primary codes only. • Services or procedures were considered all procedures (multiple levels). Data for the analysis was obtained from the standard 5% national sample of the Centers for Medicare & Medicaid Services (CMS) physician outpatient billing claims for those enrolled in the FFS Medicare program from 2009 to 2018. All the expenditures were presented with allowed costs and also were inflation adjusted to 2018 US dollars. RESULTS: This analysis showed expenditures increased by 79% from 2009 to 2018 in the form of total cost for facet joint interventions, at an annual rate of 6.7%. Cervical and lumbar radiofrequency neurotomy procedures increased 185% and 169%. However, inflation-adjusted expenditures with 2018 US dollars showed an overall increase of 53% with an annual increase of 4.9%. In addition, using inflation-adjusted expenditures per procedures increased, the overall 6% with an annual increase of 0.7%. Overall, per patient costs, with inflation adjustment, decreased from $1,925 to $1,785 with a decline of 7% and an annual decline of 0.8%. Allowed charges per visit also declined after inflation adjustment from $951.76 to $849.86 with an overall decline of 11% and an annual decline of 1.3%. Staged episodes of radiofrequency neurotomy were performed in 23.9% of patients and more than 2 episodes for radiofrequency neurotomy in 6.9%, in lumbar spine and 19.6% staged and 5.1% more than 2 episodes in cervical spine of patients in 2018. LIMITATIONS: This analysis is limited by inclusion of only the FFS Medicare population, without adding utilization patterns of Medicare Advantage plans, which constitutes almost 30% of the Medicare population. CONCLUSIONS: Even after adjusting for inflation, there was a significant increase for the expenditures of facet joint interventions with an overall 53% increase. Costs per patient and cost per visit declined. Inflation-adjusted cost per year declined 7% overall and 0.8% annually from $1,925 to $1,785, and inflation-adjusted cost per visit also declined 11% annually and 1.3% per year from $952 in 2009 to $850 in 2018. KEY WORDS: Facet joint interventions, facet joint nerve blocks, facet joint neurolysis, facet joint injections, Medicare expenditures.


Assuntos
Gastos em Saúde , Procedimentos Neurocirúrgicos/economia , Manejo da Dor/economia , Articulação Zigapofisária , Idoso , Centers for Medicare and Medicaid Services, U.S. , Dor Crônica/economia , Dor Crônica/terapia , Feminino , Humanos , Masculino , Medicare/economia , Procedimentos Neurocirúrgicos/tendências , Manejo da Dor/métodos , Manejo da Dor/tendências , Estados Unidos
12.
World Neurosurg ; 139: 512-518, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32380336

RESUMO

BACKGROUND: Six decades after birth, the path to sustainable neurosurgical education and care in West Africa remains slow paced. We highlight plain sailing local attributes and global interventions for accelerated progress. METHODS: This was a 20-year study of neurosurgical practice and training status from 1999 to 2018. We prospectively evaluated development of neurosurgical units between 2009 and 2018 and compared with retrospective data both from 1999 to 2018 and from the origin of West African neurosurgery in 1962. RESULTS: The number of neurosurgeons rose from 1 in 1962 to 221 in 2018 with a mean of 3.95 neurosurgeons per year. Between 1998 and 2018, the subregional annual neurosurgeon birthrate varied significantly between 0.72 and 3.95. In 1998, 7 countries contributed to a neurosurgeon population of 26. In 2018, 13 countries contributed to a total of 221 neurosurgeons. The period 2009-2018 recorded the highest growth of neurosurgeons with a neurosurgeon birthrate of 7.5. Nigeria accounts for 51.6% (200.9 million) of the West African population and has 57% (11) of the 19 fully accredited training centers, while Ghana and Senegal account for 7.7% and 4.3% of the West African population, respectively, and each has 11% of the training centers. The 10-year unit procreativity index for the period 2009-2018 was 1.3, with Nigeria accounting for 0.7 (53.8%). CONCLUSIONS: The low unit procreativity index across West Africa, a major cause of the low neurosurgeon birthrate, can be resolved using tailored kindling and procreative strategies.


Assuntos
Saúde Global/tendências , Colaboração Intersetorial , Neurocirurgiões/educação , Neurocirurgiões/tendências , Procedimentos Neurocirúrgicos/educação , Procedimentos Neurocirúrgicos/tendências , África Ocidental/epidemiologia , Humanos , Procedimentos Neurocirúrgicos/métodos , Estudos Prospectivos , Estudos Retrospectivos
13.
Spine (Phila Pa 1976) ; 45(10): 673-678, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32358305

RESUMO

STUDY DESIGN: Cohort. OBJECTIVE: To evaluate perioperative morbidity in patients undergoing minimally invasive spine surgery of the lumbar spine while continuing the antiplatelet drug (APD) perioperatively as compared with those not continuing these drugs and those not on these drugs. SUMMARY OF BACKGROUND DATA: While discontinuation of antiplatelet drugs carries with it the risk of thrombosis of the cardiac stents, myocardial infarction, peripheral vascular occlusion, cerebro-vascular events and other thrombotic complications, continuation of these drugs has the risk of intra spinal bleeding and the serious consequences of subsequent epidural hematoma with associated spinal cord compression. METHODS: This institutional review board approved study included 1587 patients from 2011 to 2018. Perioperative parameters were analyzed for 216 patients who underwent spinal surgery after the discontinuation of anticoagulation therapy, 240 patients who continued to take APD daily through the perioperative period and 1131 patients who were never exposed to APD therapy. The operative time, intraoperative estimated blood loss, length of hospital stay, incidence of clinically evident hematoma, and transfusion of blood products were also recorded and compared in three cohorts. RESULTS: The patients who continued taking APD in the perioperative period had a longer length of hospital stay on average (2.5 ±â€Š0.67 vs. 1.59 ±â€Š0.76 and 1.67 ±â€Š0.83, P < 0.05), whereas there was no significant difference in the operative time, estimated blood loss, the amount of blood products transfused, and overall intra and postoperative complication rate. There were no instances of postoperative wound soakage or neurological deficit suggestive of possible spinal epidural hematomas in either of the study groups. CONCLUSION: The current study has observed no appreciable increase in perioperative morbidities including bleeding related complication rates in patients undergoing lumbar minimally invasive spine surgery while continuing to take APD compared with patients who either discontinued APD prior to surgery or those not taking APD. LEVEL OF EVIDENCE: 4.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Assistência Perioperatória/métodos , Inibidores da Agregação de Plaquetas/administração & dosagem , Complicações Pós-Operatórias/diagnóstico , Adulto , Idoso , Perda Sanguínea Cirúrgica/prevenção & controle , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Morbidade , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/tendências , Assistência Perioperatória/efeitos adversos , Assistência Perioperatória/tendências , Inibidores da Agregação de Plaquetas/efeitos adversos , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos
14.
Childs Nerv Syst ; 36(7): 1347-1355, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32435890

RESUMO

SARS-CoV-2 COVID-19, coronavirus, has created unique challenges for the medical community after national guidelines called for the cancellation of all elective surgery. While there are clear cases of elective surgery (benign cranial cosmetic defect) and emergency surgery (hemorrhage, fracture, trauma, etc.), there is an unchartered middle ground in pediatric neurosurgery. Children, unlike adults, have dynamic anatomy and are still developing neural networks. Delaying seemingly elective surgery can affect a child's already vulnerable health state by further impacting their neurocognitive development, neurologic functioning, and potential long-term health states. The purpose of this paper is to demonstrate that "elective" pediatric neurosurgery should be risk-stratified, and multi-institutional informed guidelines established.


Assuntos
Betacoronavirus , Infecções por Coronavirus/cirurgia , Procedimentos Cirúrgicos Eletivos/tendências , Incidentes com Feridos em Massa , Procedimentos Neurocirúrgicos/tendências , Pneumonia Viral/cirurgia , Tempo para o Tratamento/tendências , Criança , Infecções por Coronavirus/epidemiologia , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Incidentes com Feridos em Massa/prevenção & controle , Pandemias , Pneumonia Viral/epidemiologia
16.
World Neurosurg ; 139: e872-e876, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32450314

RESUMO

BACKGROUND: Neurosurgical services have been affected by the 2019 novel coronavirus disease (COVID-19) pandemic, and several departments have reported their experiences and responses to the COVID-19 crisis in an attempt to provide insights from which other impacted departments can benefit. The goals of this study were to report the load and variety of emergent/urgent neurosurgical cases after implementing the "Battle Plan" at an academic tertiary referral center during the COVID-19 pandemic and to compare these variables with previous practice at the same institution. METHODS: The clinical data of all patients who underwent a neurosurgical intervention between March 23, 2020, and April 20, 2020, were obtained from a prospectively maintained database. Data of the control group were retrospectively collected from the medical records to compare the types of surgeries/interventions performed by the same neurosurgical service before the COVID-19 pandemic started. RESULTS: Over a 4-week period during the COVID-19 pandemic, 91 patients underwent emergent, urgent, and essential neurosurgical interventions. Patient screening at teleclinics identified 11 urgent surgical cases. The implementation of the Battle Plan led to a significant decrease in the caseload, and the variation of cases by subspecialty was evident when compared with a control group comprising 214 patients. CONCLUSIONS: Delivery of optimal care and safe practice and education at an academic neurosurgical department can be well maintained with proper execution of crisis protocols. Teleclinics proved to be efficient in screening patients for urgent neurosurgical conditions, but in-person clinic visits may still be necessary for some cases in the immediate postoperative period.


Assuntos
Centros Médicos Acadêmicos/tendências , Betacoronavirus , Infecções por Coronavirus/cirurgia , Procedimentos Neurocirúrgicos/tendências , Pandemias , Pneumonia Viral/cirurgia , Centros de Atenção Terciária/tendências , Centros Médicos Acadêmicos/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/normas , Pneumonia Viral/epidemiologia , Estudos Prospectivos , Centros de Atenção Terciária/normas , Adulto Jovem
17.
World Neurosurg ; 139: 549-557, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32426065

RESUMO

Despite the substantial growth of telemedicine and the evidence of its advantages, the use of telemedicine in neurosurgery has been limited. Barriers have included medicolegal issues surrounding provider reimbursement, interstate licensure, and malpractice liability as well as technological challenges. Recently, the coronavirus disease 2019 (COVID-19) pandemic has limited typical evaluation of patients with neurologic issues and resulted in a surge in demand for virtual medical visits. Meanwhile, federal and state governments took action to facilitate the rapid implementation of telehealth programs, placing a temporary lift on medicolegal barriers that had previously limited its expansion. This created a unique opportunity for widespread telehealth use to meet the surge in demand for remote medical care. After initial hurdles and challenges, our experience with telemedicine in neurosurgery at Penn Medicine has been overall positive from both the provider and the patients' perspective. One of the unique challenges we face is guiding patients to appropriately set up devices in a way that enables an effective neuroexamination. However, we argue that an accurate and comprehensive neurologic examination can be conducted through a telemedicine platform, despite minor weaknesses inherent to absence of physical presence. In addition, certain neurosurgical visits such as postoperative checks, vascular pathology, and brain tumors inherently lend themselves to easier evaluation through telehealth visits. In the era of COVID-19 and beyond, telemedicine remains a promising and effective approach to continue neurologic patient care.


Assuntos
Betacoronavirus , Infecções por Coronavirus/cirurgia , Exame Neurológico/métodos , Neurocirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Pneumonia Viral/cirurgia , Telemedicina/métodos , Infecções por Coronavirus/epidemiologia , Humanos , Exame Neurológico/tendências , Neurocirurgia/tendências , Procedimentos Neurocirúrgicos/tendências , Pandemias , Pneumonia Viral/epidemiologia , Telemedicina/tendências
19.
World Neurosurg ; 139: 732-733, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32446982

RESUMO

Never in history has the fabric of African neurosurgery been challenged as it is today with the advent of the novel coronavirus identified in 2019 (COVID-19). Even the most robust and resilient neurosurgical educational systems in the continent have been brought to their knees with neurosurgical trainees and young neurosurgeons bearing the brunt. In the face of this new reality, and in order to limit the impact of the current COVID-19 pandemic, multiple programs have implemented physical distancing to reduce in-person interactions. In some cases, residents have been asked to stay home at least until they are instructed otherwise. This unfortunate event presents an innovative opportunity for neurosurgical education in Africa. Herein, we detail the framework of an online neurosurgical education initiative to advance the education of African residents and young neurosurgeons during and after the COVID-19 pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Neurocirurgiões/educação , Procedimentos Neurocirúrgicos/educação , Pneumonia Viral/epidemiologia , África/epidemiologia , Infecções por Coronavirus/cirurgia , Humanos , Neurocirurgiões/tendências , Procedimentos Neurocirúrgicos/tendências , Pandemias , Pneumonia Viral/cirurgia , Inquéritos e Questionários
20.
J Clin Neurosci ; 77: 62-66, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32409209

RESUMO

OBJECTIVE: Space-occupying spinal meningiomas (SM), commonly diagnosed due to gradual neurological deterioration, are treated surgically by decompression and tumor resection. In this series of patients with surgically treated SM, we determined individual predictors of functional outcome in the context of intraoperative neuromonitoring (IOM). METHODS: This retrospective study included 45 patients (39 women, 6 men; mean age 63 years). We reviewed pre- and postoperative charts, surgical reports, radiographic data for demographics, use of IOM, duration of symptoms, histopathology, co-morbidities, radiographic extension, surgical strategy, neurological performance (Japanese Orthopedic Association Score [JOA score]. Median follow-up was 34 months (12-190 months). RESULTS: Most frequent surgical approaches were laminectomy (71.1%, n = 32) and hemi-laminectomy (28.9%, n = 13). Predominant SM site was the thoracic spine (55.6%, n = 25). Most common symptoms were sensory deficits (77.8%, n = 35), gait disorders (55.6%, n = 25), motor deficits (42.2%, n = 19), and radiating pain (37.8%, n = 17). Simpson grade 1 resection was achieved in 6 patients, most common type of resection was Simpson grade 2 in 36 patients. During follow-up, 80.0% of patients had fully recovered sensory deficits (p < 0.001), 76.0% of patients with preoperative gait disorders had been asymptomatic (p < 0.001), and motor deficits in 12/19 (63.1%). Pain had decreased significantly from admission to follow-up (p = 0.001). IOM was used in 20 (44.4%) patients. Postoperatively, 6(13.3%) patients had developed a new neurological deficit, 4 of them operated without IOM. CONCLUSION: Resection of SM with IOM showed good recovery, excellent functional results with low surgical morbidity.


Assuntos
Descompressão Cirúrgica/tendências , Laminectomia/tendências , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Recuperação de Função Fisiológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/métodos , Feminino , Seguimentos , Humanos , Laminectomia/métodos , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/tendências , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...