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1.
AJR Am J Roentgenol ; 212(4): 925-932, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30741561

RESUMO

OBJECTIVE: The purpose of this study was to assess the rate, type, and severity of complications related to 9-gauge stereotactic vacuum-assisted breast biopsy (SVAB) and to delineate associated factors that may contribute to a higher rate of complications. MATERIALS AND METHODS: This retrospective study included 4776 patients who underwent SVAB between 2003 and 2016. A total of 319 patients with documented postbiopsy complications were identified. Complications were subcategorized as bleeding, pain, lightheadedness, bruising, and other complications, and their severity was classified as minor, moderate, or severe. Hematoma volumes were correlated with biopsy location and complication severity. A group of control subjects who underwent SVAB but had no complications was compared with the group of study patients with regard to age, biopsy location, lesion type, and pathologic findings. Postbiopsy screening adherence was assessed. Statistical analyses were performed using the Fisher exact, Mann-Whitney, Kruskal-Wallis, and Spearman rank correlation tests. RESULTS: Of the 319 patients with complications who were identified (representing 6.7% of the 4776 patients who underwent SVAB), 307 (96.2%) had mild complications, 12 (3.8%) had moderate complications, and no patients had severe complications. The most common complication was bleeding or hematoma (89.3% of patients [285/319]), followed by pain (6.9% [22/319]), lightheadedness (0.9% [3/319]), bruising (0.9% [3/319]), and other complications (1.9% [6/319]). No significant differences were noted between the study group and the control group in terms of age (p = 0.474), biopsy location (p = 0.065), histologic findings (p = 0.056), or lesion type (p = 0.568). Hematoma volume (median, 7.5 cm3) did not correspond to the severity of complications. Larger hematoma volumes were associated with a posterior biopsy location (p = 0.008). The rate of return to annual screening after biopsy was not adversely affected by the presence of biopsy complications. CONCLUSION: Clinically significant complications associated with SVAB were exceedingly rare (0.3%) in this large study spanning 13 years.


Assuntos
Biópsia por Agulha/efeitos adversos , Neoplasias da Mama/patologia , Técnicas Estereotáxicas/efeitos adversos , Vácuo , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico por imagem , Detecção Precoce de Câncer , Feminino , Humanos , Mamografia , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
Acta Neurochir (Wien) ; 161(3): 545-552, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30675655

RESUMO

BACKGROUND: Frameless stereotactic biopsies, particularly robot-assisted procedures are increasing in neurosurgery centers. Results of these procedures should be at least equal to or greater than frame-based reference procedure. Evaluate robot-assisted technology is necessary in particular, when a team has chosen to switch from one to another method. OBJECTIVE: The objective of our prospective work was (i) to evaluate the success rate of contributive robotic-assisted biopsy in 60 patients, to report the morbidity and mortality associated with the procedure and (ii) to compare it with literature data. METHODS: We performed a prospective and descriptive study including 60 consecutive patients having had robotic-assisted stereotactic biopsy at the Rouen University Hospital, France. All patients had presurgical imaging before the procedure included Magnetic Resonance Imaging merged with Computed Tomography scan acquisition. Registration was mostly performed with a touch-free laser (57/60). A control Computed Tomography scan was always realized at day 0 or day 1 after surgery. Data collected were success rate, bleeding, clinical worsening, infection, and mortality. RESULTS: All the biopsies were considered as contributive and lead to the final diagnosis. In 41/60 patients (68%), the lesion was glial. Six in 60 patients (10%) had visible bleeding without clinical worsening related, 5/60 patients (8.5%) showed clinical impairment following surgery, which was permanent in 2 patients, and 1/60 patient presented generalized seizures. We did not report any infection and mortality. CONCLUSION: Robot-assisted frameless surgery is efficient and provides a reasonable alternative to frame-based procedure. The operating time can be reduced, without increasing morbidity and mortality rates.


Assuntos
Neoplasias Encefálicas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Robótica/métodos , Técnicas Estereotáxicas/efeitos adversos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia
3.
Neurosurgery ; 84(3): 569-580, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29982615

RESUMO

BACKGROUND: Surgical site infections (SSIs) after spine and brain surgery present a major burden to patients and hospitals by increasing morbidity, mortality, and healthcare costs. OBJECTIVE: To review available literature investigating the role of intrawound powdered vancomycin against SSIs after neurosurgical operations. METHODS: All randomized and observational English language studies of intrawound powdered vancomycin use in spinal and cranial surgery were included and analyzed using random-effects modeling. RESULTS: In spine surgery (25 studies with 16 369 patients), patients in the vancomycin group had a significantly lower risk for any SSI (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.30-0.57; P < .001; I2 = 47%). However, when separate analyses were conducted for superficial and deep SSIs, a significant difference was found only for deep (OR: 0.31; 95% CI: 0.22-0.45; P < .001; I2 = 29%). Subgroup analyses for different vancomycin powder dosages (1 g vs 2 g vs composite dose) did not point to any dose-related effect of vancomycin. In cranial surgery (6 studies with 1777 patients), use of vancomycin was associated with a significantly lower risk for SSIs (OR: 0.33; 95% CI: 0.18-0.60; P = .0003; I2 = 45%). In meta-regression analysis, trial-level variability of diabetes had no influence on the association of vancomycin powder use with SSIs. CONCLUSION: Use of vancomycin powder in spinal and cranial surgery might be protective against SSIs, especially against deep SSIs. No dose-related effect of vancomycin powder was identified. However, caution is needed in the clinical interpretation of these results, owing to the observational design of the included studies in this meta-analysis.


Assuntos
Antibacterianos/administração & dosagem , Procedimentos Neurocirúrgicos/efeitos adversos , Infecção da Ferida Cirúrgica/prevenção & controle , Vancomicina/administração & dosagem , Antibioticoprofilaxia/métodos , Humanos , Procedimentos Neurocirúrgicos/tendências , Estudos Observacionais como Assunto/métodos , Pós , Psicocirurgia/efeitos adversos , Psicocirurgia/tendências , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Coluna Vertebral/cirurgia , Técnicas Estereotáxicas/efeitos adversos , Técnicas Estereotáxicas/tendências , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/etiologia
4.
J Neurosurg Pediatr ; 23(3): 288-296, 2018 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-30544342

RESUMO

OBJECTIVEThe goal in the study was to describe the clinical outcomes associated with robot-assisted stereoelectroencephalography (SEEG) in children.METHODSThe authors performed a retrospective, single-center study in consecutive children with medically refractory epilepsy who were undergoing robot-assisted SEEG. Kaplan-Meier survival analysis was used to calculate the probability of seizure freedom. Both univariate and multivariate methods were used to analyze the preoperative and operative factors associated with seizure freedom.RESULTSFifty-seven children underwent a total of 64 robot-assisted procedures. The patients' mean age was 12 years, an average of 6.4 antiepileptic drugs (AEDs) per patient had failed prior to implantation, and in 56% of the patients the disease was considered nonlesional. On average, children had 12.4 electrodes placed per implantation, with an implantation time of 9.6 minutes per electrode and a 10-day postoperative stay. SEEG analysis yielded a definable epileptogenic zone in 51 (89%) patients; 42 (74%) patients underwent surgery, half of whom were seizure free at last follow-up, 19.6 months from resection. In a multivariate generalized linear model, resective surgery, older age, and shorter SEEG-related hospital length of stay were associated with seizure freedom. In a Cox proportional hazards model including only the children who underwent resective surgery, older age was the only significant factor associated with seizure freedom. Complications related to bleeding were the major contributors to morbidity. One patient (1.5%) had a symptomatic hemorrhage resulting in a permanent neurological deficit.CONCLUSIONSThe authors report one of the largest pediatric-specific SEEG series demonstrating that the modern surgical management of medically refractory epilepsy in children can lead to seizure freedom in many patients, while also highlighting the challenges posed by this difficult patient population.


Assuntos
Epilepsia Resistente a Medicamentos/cirurgia , Eletroencefalografia/métodos , Procedimentos Cirúrgicos Robóticos , Técnicas Estereotáxicas , Adolescente , Fatores Etários , Análise de Variância , Criança , Intervalo Livre de Doença , Epilepsia Resistente a Medicamentos/fisiopatologia , Eletrodos Implantados/estatística & dados numéricos , Eletroencefalografia/efeitos adversos , Feminino , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , Hemorragia Pós-Operatória/complicações , Recidiva , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Robótica , Técnicas Estereotáxicas/efeitos adversos , Resultado do Tratamento
5.
Acta Neurochir (Wien) ; 160(12): 2489-2500, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30413938

RESUMO

BACKGROUND: Stereoelectroencephalography (SEEG) is an effective technique to help to locate and to delimit the epileptogenic area and/or to define relationships with functional cortical areas. We intend to describe the surgical technique and verify the accuracy, safety, and effectiveness of robot-assisted SEEG in a newly created SEEG program in a pediatric center. We focus on the technical difficulties encountered at the early stages of this program. METHODS: We prospectively collected SEEG indication, intraoperative events, accuracy calculated by fusion of postoperative CT with preoperative planning, complications, and usefulness of SEEG in terms of answering preimplantation hypothesis. RESULTS: Fourteen patients between the ages of 5 and 18 years old (mean 10 years) with drug-resistant epilepsy were operated on between April 2016 and April 2018. One hundred sixty-four electrodes were implanted in total. The median entry point localization error (EPLE) was 1.57 mm (1-2.25 mm) and the median target point localization error (TPLE) was 1.77 mm (1.2-2.6 mm). We recorded seven intraoperative technical issues. Two patients suffered complications: meningitis without demonstrated germ in one patient and a right frontal hematoma in the other. In all cases, the SEEG was useful for the therapeutic decision-making. CONCLUSION: SEEG has been useful for decision-making in all our pediatric patients. The robotic arm is an accurate tool for the insertion of the deep electrodes. Nevertheless, it is an invasive technique not risk-free and many problems can appear at the beginning of a robotic arm-assisted SEEG program that must be taken into account beforehand.


Assuntos
Epilepsia Resistente a Medicamentos/cirurgia , Eletroencefalografia/métodos , Complicações Pós-Operatórias/epidemiologia , Robótica/métodos , Técnicas Estereotáxicas/efeitos adversos , Adolescente , Criança , Pré-Escolar , Tomada de Decisão Clínica , Epilepsia Resistente a Medicamentos/diagnóstico , Eletrodos Implantados/efeitos adversos , Eletrodos Implantados/normas , Eletroencefalografia/efeitos adversos , Eletroencefalografia/instrumentação , Eletroencefalografia/normas , Feminino , Humanos , Masculino , Robótica/instrumentação , Robótica/normas , Técnicas Estereotáxicas/instrumentação , Técnicas Estereotáxicas/normas
6.
PLoS One ; 13(10): e0205772, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30352066

RESUMO

BACKGROUND: Frame-based stereotactic biopsy (FBSB) is a minimally-invasive and effective procedure for the diagnosis of brain lesions and will likely gain clinical importance. Since FBSB procedures comprise a variety of imaging and sampling methods, it is necessary to compare the safety and effectiveness of individual techniques. OBJECTIVE: To assess the safety and effectiveness of FBSB using 1.5T iMRI as a one-stop procedure under general anesthesia without intraoperative histological examination. METHODS: In this single-center, retrospective analysis, 500 consecutive FBSBs using iMRI were compared to a historic control of 100 biopsies with traditional workflows (computed tomography (CT) with MRI image fusion). All procedures were performed under general anesthesia. Data on surgical procedures, pre- and postoperative neurologic patient status, complications and diagnostic yield were extracted from clinical records. RESULTS: Complication rates and diagnostic yield showed no significant differences between both groups. Mortality was 0.6%, 95% CI = [0.12%, 1.74%], in the iMRI and 0.0% [0.00%, 3.62%], in the control group with a morbidity of 5.4% [3.6%, 7.8%] and 6.0% [2.2%, 12.6%] and a diagnostic yield of 96.8% [94.9%, 98.2%] and 96.0% [90.1%, 98.9%]. Mean procedure duration was 124 [121, 127] minutes using iMRI and 112 [106, 118] minutes in the control group. CONCLUSION: FBSB using 1.5T iMRI under general anesthesia is a safe and effective procedure and is equivalent to traditional stereotactic workflows with respect to complication rate and diagnostic yield.


Assuntos
Neoplasias Encefálicas/diagnóstico , Encéfalo/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Técnicas Estereotáxicas/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/patologia , Neoplasias Encefálicas/patologia , Criança , Pré-Escolar , Feminino , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodos , Lactente , Período Intraoperatório , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/efeitos adversos , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
7.
Clin Neurol Neurosurg ; 174: 180-184, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30261475

RESUMO

OBJECTIVE: The risk of hemorrhages after stereotactic biopsy is known to be low. Nevertheless hemorrhages in eloquent areas result in neurological deficit for the patients. Since the basal ganglia resemble a particularily high vascularized and eloquent location, which is often the source of hypertensive hemorrhages, we aimed to analyse possible risk factors for hemorrhage after stereotactic biopsy in this region. PATIENTS AND METHODS: We performed a retrospective analysis including patients who underwent stereotactic biopsies of lesions in the basal ganglia between January 2012 and January 2017. 63 patients were included in this study. We accessed age, gender, histopathological diagnosis, hypertension, blood pressure intraoperative, anticoagulative medication and postoperative hemorrhage. RESULTS: Fishers exact test revealed no significant p-values concerning anticoagulative therapy, gender, smoking and hypertension concerning postoperative hemorrhage. Wilcoxon-Mann-Whitney-Test showed no significant correlation for systolic blood pressure intraoperative, number of tissue samples and age with hemorrhage. A trend for lymphoma in correlation with postoperative hemorrhage was in patients with Lymphoma (Wilcoxon-Mann-Whitney Test). CONCLUSION: Stereotactic biopsies even in eloquent areas as the basal ganglia are a safe procedure even if patients suffer under hypertension or are smoker. None of the here examined risk factors showed a significant correlation with postoperative hemorrhage. Accessing tumor tissue for histopathological diagnosis is mandatory for adequate therapy.


Assuntos
Gânglios da Base/diagnóstico por imagem , Gânglios da Base/cirurgia , Hemorragia Pós-Operatória/diagnóstico por imagem , Hemorragia Pós-Operatória/cirurgia , Técnicas Estereotáxicas/efeitos adversos , Idoso , Biópsia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco
8.
World Neurosurg ; 119: e1021-e1028, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30142433

RESUMO

OBJECTIVE: In percutaneous endoscopic transforaminal discectomy (PETD), surgeons are exposed to intraoperative radiographic radiation over a long-term career, which may be correlated with high risk of iatrogenic radiation hazards. The purpose of this prospective cohort study was to assess the impact of concentric stereotactic technique on radiation exposure to surgeons in PETD. METHODS: Patients who underwent conventional PETD were regarded as group A, whereas those undergoing PETD with concentric stereotactic technique were considered as group B. The primary outcomes were cumulative radiation dose to the surgeon's eye, thyroid gland, and breast. RESULTS: A total of 34 patients were treated in group A and 30 patients were treated in group B. The cumulative radiation dose of the eye per operation was 0.017 (0.58/34) mSv in group A and 0.010 (0.31/30) mSv in group B, which meant a reduction of 41.18%. The cumulative radiation dose of the thyroid gland per operation was 0.018 (0.60/34) mSv in group A and 0.011 (0.33/30) mSv in group B, which meant a reduction of 38.89%. The cumulative radiation dose of the chest per operation was 0.039 (1.33/34) mSv in group A and 0.023 (0.70/30) mSv in group B, which meant a reduction of 41.03%. There were no significant differences in hospital stay, visual analog scale score of waist and leg pain, Oswestry Disability Index score, MacNab satisfaction, and complications between the 2 groups (P > 0.05). CONCLUSIONS: The concentric stereotactic technique can effectively reduce radiation exposure to surgeons by about 40%.


Assuntos
Discotomia Percutânea , Endoscopia , Exposição Ocupacional/prevenção & controle , Exposição à Radiação/prevenção & controle , Técnicas Estereotáxicas , Cirurgiões , Adulto , Mama/efeitos da radiação , Discotomia Percutânea/efeitos adversos , Endoscopia/efeitos adversos , Olho/efeitos da radiação , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Estudos Prospectivos , Doses de Radiação , Sacro/diagnóstico por imagem , Sacro/cirurgia , Técnicas Estereotáxicas/efeitos adversos , Glândula Tireoide/efeitos da radiação , Resultado do Tratamento
9.
Prog Neurol Surg ; 32: 27-38, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29990971

RESUMO

Surgical resection of gliomas affecting functionally important brain structures is associated with high risk of permanent postoperative neurological deficit and deterioration of the patient's quality of life. The availability of modern neuroimaging and neuronavigation permits the application of minimally invasive stereotactic cryodestruction of the tumor in such cases. The authors used this treatment in 88 patients with supratentorial gliomas of various WHO histopathological grades not suitable for microsurgical resection. Postoperative mortality (1.1%) and rate of surgical complications (11.4%) were comparable to reported results of stereotactic brain tumor biopsy, whereas the rate of neurological morbidity (42%) was comparable to outcome after resection of gliomas within eloquent brain areas. The majority of complications were temporary, and permanent deterioration of neurological function was noted in 8% of cases only. The median survival after treatment in patients with glioblastoma and anaplastic astrocytoma was 12.4 and 46.9 months, respectively, and was not reached in cases of diffuse astrocytoma, which compared favorably both with historical controls and literature data. Therefore, it seems reasonable to consider stereotactic cryodestruction in multimodality management strategies of "unresectable" intracranial gliomas, and further studies directed at evaluation of its efficacy are definitely needed.


Assuntos
Neoplasias Encefálicas/cirurgia , Criocirurgia/métodos , Glioma/cirurgia , Técnicas Estereotáxicas , Neoplasias Supratentoriais/cirurgia , Adulto , Neoplasias Encefálicas/mortalidade , Criocirurgia/efeitos adversos , Feminino , Glioma/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas Estereotáxicas/efeitos adversos
10.
World Neurosurg ; 118: e245-e253, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29966784

RESUMO

BACKGROUND: Magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI), is an excellent tool for diagnosing intracranial infection, with limitations in previous neurosurgical intervention. This study aimed to evaluate the accuracy of DWI in the diagnosis of postoperative intracranial infection. METHODS: We retrospectively evaluated all consecutive patients with intracranial infection undergoing a neurosurgical intervention who had preoperative MRI, including DWI. Patients were divided into 2 groups: spontaneous intracranial infection (SI) and postoperative intracranial infection (PI). A control group (CG) of patients who had undergone brain surgery without any signs of subsequent infection was also included. Qualitatively, MRI data were evaluated for the presence of intracranial infection. Sensitivity, specificity, and positive and negative predictive values for PI as opposed to no infection were determined. Quantitatively, areas with diffusion restriction within the surgery/abscess cavity were identified for the 3 groups using semiautomated segmentation. Group differences regarding apparent diffusion coefficient (ADC) ratios were evaluated. Receiver operating characteristic curve analysis was used to identify a point in time beyond which ADC ratios might show reasonable discriminatory power between the PI and CG groups. RESULTS: A total of 78 patients were included (38 in the SI group, 20 in the PI group, 20 in the CG group). Sensitivity, specificity, and positive and negative predictive values in the diagnosis of PI were 80%, 95%, 4%, and 100%, respectively. Median ADC was significantly higher in the PI group compared with the SI group (0.98 vs. 0.69; P < 0.001) but lower compared with the CG group (1.24; P = 0.16). The analysis suggested a possible differentiation of PI and CG after a time interval of approximately 100 days/3 months. CONCLUSIONS: DWI is of limited value in evaluating postoperative brain infection. Our data show a trend toward DWI regaining its validity at approximately 3 months after surgery.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Drenagem/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Técnicas Estereotáxicas/efeitos adversos , Idoso , Abscesso Encefálico/etiologia , Drenagem/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Técnicas Estereotáxicas/tendências
11.
J Clin Neurosci ; 52: 71-73, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29602604

RESUMO

Pre-operative scalp shaving is conventionally thought to simplify postoperative cranial wound care, lower the rate of wound infections, and ease optimal incision localization. Over the past few decades, some neurosurgeons have refrained from scalp shaving in order to improve patient satisfaction with brain surgery. However, this hair-sparing approach has not yet been explored in the growing field of magnetic resonance-guided laser interstitial thermal therapy (MRgLITT). This study investigated the initial impact of a no-shave technique on post-operative wound infection rate as well as on entry and target accuracy in MRgLITT for mesial temporal epilepsy. Eighteen patients selected by the Stanford Comprehensive Epilepsy Program between November 2015 and August 2017 were included in the study. All patients underwent functional selective amygdalohippocampotomies using MRgLITT entirely within a diagnostic MRI suite. No hair was removed and no additional precautions were taken for hair or scalp care. Otherwise, routine protocols for surgical preparations and wound closure were followed. The study was performed under approval from Stanford University's Internal Review Board (IRB-37830). No post-operative wound infections or erosions occurred for any patient. The mean entry point error was 2.87 ±â€¯1.3 mm and the mean target error was 1.0 ±â€¯0.9 mm. There have been no other complications associated with this hair-sparing approach. The study's results suggest that hair sparing in MRgLITT surgery for temporal epilepsy does not increase the risk of wound complications or compromise accuracy. This preferred cosmetic approach may thus appeal to epilepsy patients considering such interventions.


Assuntos
Epilepsia do Lobo Temporal/cirurgia , Cabelo , Terapia a Laser/métodos , Couro Cabeludo/cirurgia , Técnicas Estereotáxicas/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Feminino , Humanos , Imagem Tridimensional/métodos , Terapia a Laser/efeitos adversos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Infecção da Ferida Cirúrgica/etiologia
12.
J Clin Neurosci ; 53: 112-116, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29685415

RESUMO

Parenchymal hemorrhage is considered a major risk factor for perioperative morbidity in patients undergoing stereotactic brain biopsy. Studies on patients undergoing surgical procedures have suggested that evaluation of prothrombin time (PT) and activated partial thromboplastin time (aPTT) is of limited value with regard to prevention of haemorrhagic complications. However, this issue has not yet been addressed in patients undergoing stereotactic biopsy of intracranial lesions. We retrospectively analysed the medical records of 159 consecutive patients undergoing stereotactic biopsy of supratentorial intracranial lesions during a three-year period. Laboratory values (PT, aPTT, platelet count) were reviewed as well as clinical characteristics, modalities of surgical treatment, histopathological results and the postoperative course of patients. The overall diagnostic yield was 93.7%. Histopathological examination revealed glioma (WHO°I: 5, WHO°II: 25, WHO°III: 23, WHO°IV: 65), lymphoma (n = 14), inflammation (n = 8) and other entities (n = 6). Surgery-associated neurological deficits occurred in 7 patients (4.4%) and completely resolved in 6 of these patients. CT-confirmed intracranial hemorrhage occurred in 2 patients (1.3%) and in both cases, histopathological examination revealed glioblastoma. Results of hemostatic parameters (PT: 99 ±â€¯13%, aPTT: 24 ±â€¯3s, platelet count: 274 ±â€¯87 103/µL) were within normal range values in all patients and did not correlate with postsurgical morbidity. Standard assessment of haemostasis seems to be of limited value in patients with intracranial lesions undergoing stereotactic biopsy. Further studies regarding the intratumoural vasculature's impact on the risk of biopsy-related bleeding are necessary.


Assuntos
Biópsia/efeitos adversos , Testes de Coagulação Sanguínea , Hemorragias Intracranianas/etiologia , Cuidados Pré-Operatórios/métodos , Técnicas Estereotáxicas/efeitos adversos , Neoplasias Supratentoriais/diagnóstico , Idoso , Biópsia/métodos , Feminino , Hemostasia , Humanos , Hemorragias Intracranianas/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
13.
Stereotact Funct Neurosurg ; 96(1): 40-45, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29495014

RESUMO

BACKGROUND/AIMS: Interventional MRI (iMRI) allows real-time confirmation of electrode and microcatheter location in anesthetized patients; however, MRI-compatible pneumatic compression devices (PCD) to reduce the periprocedural venous thromboembolism (VTE) risk are not commercially available. Given the paucity of literature on VTE following iMRI surgery, better characterizing patients suffering this complication and the incidence of this event following iMRI procedures is pivotal for defining best surgical practices. We aim to investigate the incidence of postoperative VTE in iMRI procedures without the use of PCD. METHODS: Medical records and operative times of patients were retrospectively reviewed. Patient demographics and mean surgical durations were reported with statistical comparisons via ANOVA and the 2-tailed Student t test, an α of 0.05, and the Bonferroni correction. Patients experiencing postoperative VTE underwent an in-depth chart review. RESULTS: Two out of two hundred ten (0.95%) iMRI procedures resulted in postoperative VTE events. There were statistically significant differences in procedure times between unilateral electrode (157.5 ± 5.7 min), bilateral electrode (193.6 ± 2.9 min), and bilateral gene therapy procedures (467.3 ± 26.5 min). Both patients had longer-than-average operative times for their respective procedures. CONCLUSIONS: The incidence of postoperative VTE is low following iMRI procedures, even without the use of PCD during surgery.


Assuntos
Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Imagem por Ressonância Magnética Intervencionista/efeitos adversos , Técnicas Estereotáxicas/efeitos adversos , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/etiologia , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Imagem Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
14.
J Neurosurg Pediatr ; 21(5): 523-527, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29451453

RESUMO

Magnetic resonance imaging-guided stereotactic laser ablation of intracranial targets, including brain tumors, has expanded dramatically over the past decade, but there have been few reports of complications, especially those occurring in a delayed fashion. Laser ablation of subependymal giant cell astrocytomas (SEGAs) is an attractive alternative to maintenance immunotherapy in some children with tuberous sclerosis complex (TSC); however, the effect of treatment on disease progression and the nature and frequency of potential complications remains largely unknown. The authors report the case of a 5-year-old boy with TSC who underwent stereotactic laser ablation of a SEGA at the right foramen of Monro on 2 separate occasions. After the second ablation, immediate posttreatment MRI revealed gadolinium extravasation from the tumor into the lateral ventricle. Nine months later, the patient presented with papilledema and delayed obstructive hydrocephalus secondary to intraventricular adhesions causing a trapped right lateral ventricle. This was successfully treated with endoscopic septostomy. The authors discuss the potential cause and clinical management of a delayed complication not previously reported after a relatively novel surgical therapy.


Assuntos
Astrocitoma/cirurgia , Neoplasias Encefálicas/cirurgia , Meios de Contraste , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Gadolínio , Terapia a Laser/efeitos adversos , Técnicas Estereotáxicas/efeitos adversos , Encefalopatias/etiologia , Pré-Escolar , Humanos , Hidrocefalia/etiologia , Ventrículos Laterais , Masculino , Complicações Pós-Operatórias/etiologia , Aderências Teciduais/complicações
15.
World Neurosurg ; 113: 366-372.e3, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29425986

RESUMO

BACKGROUND: A stereotactically placed laser fiber can deliver thermal energy to an epileptogenic focus in the brain. This procedure is done under intraoperative (thermography) magnetic resonance imaging (MRI) guidance. Thermoablation can lead to edema in the surrounding area and can cause a secondary insult. In this report of 3 cases, we have quantified the edema produced after laser ablation by sequential MRI in the immediate postoperative period. CASE DESCRIPTIONS: Three patients with intractable epilepsy underwent a detailed neurologic and neuroradiologic workup to localize the site of epileptogenic foci. Two of the patients had mesial temporal lobe sclerosis, and the other patient had hypothalamic hamartoma. A laser fiber was placed stereotactically in the epileptogenic zone, and MRI-guided thermoablation was done. Postoperatively, T1-weighted and fluid-attenuated inversion recovery (FLAIR)-based volumetric MRI sequences were performed on postoperative days 1, 3, and 5 to quantify the edema. I-Plan software was used for volumetric analysis. Targeted volumes were 0.22, 4.2, and 3.5 mL, and lesions were 0.3, 6.5, and 6 mL, respectively. FLAIR hyperintensity was 2.3, 11.8, and 8.4 mL on the first postoperative day and 1.5, 12.6, and 6.3 mL on postoperative day 8. All patients remained seizure-free during the postoperative period. No complications were observed. CONCLUSIONS: Laser ablation of epileptic focus is safe. FLAIR hyperintensity in the postoperative period is 3-5 times the targeted volume. However, no significant increase occurs during the first 8 days, and thus steroids can be stopped within 5 days of surgery.


Assuntos
Epilepsia Resistente a Medicamentos/diagnóstico por imagem , Epilepsia Resistente a Medicamentos/cirurgia , Edema/diagnóstico por imagem , Terapia a Laser/métodos , Técnicas Estereotáxicas , Adulto , Pré-Escolar , Edema/etiologia , Feminino , Humanos , Terapia a Laser/efeitos adversos , Imagem por Ressonância Magnética/métodos , Masculino , Técnicas Estereotáxicas/efeitos adversos , Adulto Jovem
16.
Br J Neurosurg ; 32(2): 210-213, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29069919

RESUMO

OBJECTIVE: Biospies of brain lesions with unknown entity are an everyday procedure among many neurosurgical departments. Biopsies can be performed frame-guided or frameless. However, cerebellar lesions are a special entity with a more complex approach. All biopsies in this study were performed stereotactically frame guided. Therefore, only biopsies of cerebellar lesions were included in this study. We compared whether the frame was attached straight versus oblique and we focused on diagnostic yield and complication rate. METHODS: We evaluated 20 patients who underwent the procedure between 2009 and 2017. Median age was 56.5 years. 12 (60%) Patients showed a left sided lesion, 6 (30%) showed a lesion in the right cerebellum and 2 (10%) patients showed a midline lesion. RESULTS: The stereotactic frame was mounted oblique in 12 (60%) patients and straight in 8 (40%) patients. Postoperative CT scan showed small, clinically silent blood collection in two (10%) of the patients, one (5%) patient showed haemorrhage, which caused a hydrocephalus. He received an external ventricular drain. In both patients with small haemorrhage the frame was positioned straight, while in the patient who showed a larger haemorrhage the frame was mounted oblique. In all patients a final histopathological diagnosis was established. CONCLUSION: Cerebellar lesions of unknown entity can be accessed transcerebellar either with the stereotactic frame mounted straight or oblique. Also for cerebellar lesions the procedure shows a high diagnostic yield with a low rate of severe complications, which need further treatment.


Assuntos
Biópsia/métodos , Doenças Cerebelares/patologia , Cerebelo/patologia , Posicionamento do Paciente/métodos , Técnicas Estereotáxicas , Adolescente , Adulto , Idoso , Biópsia/efeitos adversos , Doenças Cerebelares/diagnóstico por imagem , Neoplasias Cerebelares/diagnóstico por imagem , Neoplasias Cerebelares/patologia , Neoplasias Cerebelares/terapia , Cerebelo/diagnóstico por imagem , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Retrospectivos , Técnicas Estereotáxicas/efeitos adversos , Tomografia Computadorizada por Raios X
17.
Br J Neurosurg ; 32(4): 372-380, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29260585

RESUMO

BACKGROUND: For stereotactic brain biopsy involving motor eloquent regions, the surgical objective is to enhance diagnostic yield and preserve neurological function. To achieve this aim, we implemented functional neuro-navigation and intraoperative magnetic resonance imaging (iMRI) into the biopsy procedure. The impact of this integrated technique on the surgical outcome and postoperative neurological function was investigated and evaluated. METHOD: Thirty nine patients with lesions involving motor eloquent structures underwent frameless stereotactic biopsy assisted by functional neuro-navigation and iMRI. Intraoperative visualisation was realised by integrating anatomical and functional information into a navigation framework to improve biopsy trajectories and preserve eloquent structures. iMRI was conducted to guarantee the biopsy accuracy and detect intraoperative complications. The perioperative change of motor function and biopsy error before and after iMRI were recorded, and the role of functional information in trajectory selection and the relationship between the distance from sampling site to nearby eloquent structures and the neurological deterioration were further analyzed. RESULTS: Functional neuro-navigation helped modify the original trajectories and sampling sites in 35.90% (16/39) of cases to avoid the damage of eloquent structures. Even though all the lesions were high-risk of causing neurological deficits, no significant difference was found between preoperative and postoperative muscle strength. After data analysis, 3mm was supposed to be the safe distance for avoiding transient neurological deterioration. During surgery, the use of iMRI significantly reduced the biopsy errors (p = 0.042) and potentially increased the diagnostic yield from 84.62% (33/39) to 94.87% (37/39). Moreover, iMRI detected intraoperative haemorrhage in 5.13% (2/39) of patients, all of them benefited from the intraoperative strategies based on iMRI findings. CONCLUSIONS: Intraoperative visualisation of functional structures could be a feasible, safe and effective technique. Combined with intraoperative high-field MRI, it contributed to enhance the biopsy accuracy and lower neurological complications in stereotactic brain biopsy involving motor eloquent areas.


Assuntos
Biópsia/métodos , Encéfalo/patologia , Neuronavegação/métodos , Procedimentos Neurocirúrgicos/métodos , Técnicas Estereotáxicas/instrumentação , Adolescente , Adulto , Idoso , Astrocitoma/diagnóstico por imagem , Astrocitoma/cirurgia , Biópsia/efeitos adversos , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Período Intraoperatório , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Força Muscular , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/fisiopatologia , Neuronavegação/efeitos adversos , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Técnicas Estereotáxicas/efeitos adversos , Resultado do Tratamento , Adulto Jovem
18.
Turk Neurosurg ; 28(3): 483-489, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28770553

RESUMO

AIM: Deep brain stimulation (DBS) surgeries are multi-faceted and the various steps are interconnected. Since its first implementation, the method of DBS surgery has undergone changes. We have encountered several expected and also non-expected perioperative technical complications in the past seventeen years. Here, we describe the stereotactic frame, stereotactic localizer and planning station related complications and how we have managed them as much as possible. MATERIAL AND METHODS: This study is a retrospective qualitative analysis of the documented technical events encountered during DBS surgeries from 1999 onwards. We have collected these events from a cohort of approximately 921 DBS electrodes implantations from the centers of the authors. RESULTS: Stereotactic frame related complications included movement related fixation problems, head anatomy related problems, and lack of maintenance related issues. Localizer related complications were compatibility issues of the stereotactic localizer and planning station, field of view effect on fiducials, air bubbles in localizers using liquid solutions, and disengaged localizer effect. Planning station related complications included image fusion failures and cerebrospinal fluid signal effect on image fusion. CONCLUSION: The road to success in DBS therapy passes through the ability to cope with surgical and technical complications. Each step is unconditionally connected to the other, and detection of the problems that can be encountered in advance and preparations for these negative conditions are the key to success for the group responsible for executing the therapy. We are still learning from these events and advance our surgical approaches.


Assuntos
Estimulação Encefálica Profunda/efeitos adversos , Estimulação Encefálica Profunda/métodos , Complicações Intraoperatórias/diagnóstico por imagem , Movimento , Técnicas Estereotáxicas/efeitos adversos , Eletrodos Implantados/efeitos adversos , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Assistência Perioperatória/métodos , Estudos Retrospectivos
19.
Stereotact Funct Neurosurg ; 95(5): 325-329, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28910805

RESUMO

BACKGROUND/AIMS: The RNS® System utilizes a cranially implanted neurostimulator attached to leads placed at the seizure focus to provide brain responsive stimulation for the treatment of medically intractable partial onset epilepsy. Infection and erosion rates related to the cranial implant site were assessed overall and by neurostimulator procedure to determine whether rates increased with additional procedures. METHODS: Infection and erosion rates were calculated as (1) chance per neurostimulator procedure, (2) incidence per patient implant year, and (3) rates for initial and each subsequent neurostimulator implant (generalized estimating equation). RESULTS: In 256 patients followed for an average of 7 years, the infection rate was 3.7% per neurostimulator procedure (n = 31/840), and the rate of erosions was 0.8% per neurostimulator procedure (n = 7/840). Rates did not increase with subsequent neurostimulator procedures (p = 0.66, infection; p = 0.70, erosion). A prior infection or erosion at the implant site did not significantly increase the risk at a later procedure (p ≥ 0.05 for all combinations). CONCLUSION: These data indicate that the risk for infection compares favorably to other neurostimulation devices and suggest that rates of infection and erosion do not increase with subsequent neurostimulator replacements.


Assuntos
Epilepsia Resistente a Medicamentos/terapia , Contaminação de Equipamentos , Neuroestimuladores Implantáveis/efeitos adversos , Neuroestimuladores Implantáveis/tendências , Epilepsia Resistente a Medicamentos/epidemiologia , Contaminação de Equipamentos/prevenção & controle , Desenho de Equipamento/efeitos adversos , Desenho de Equipamento/instrumentação , Desenho de Equipamento/tendências , Feminino , Humanos , Neuroestimuladores Implantáveis/microbiologia , Masculino , Pessoa de Meia-Idade , Convulsões/epidemiologia , Convulsões/terapia , Técnicas Estereotáxicas/efeitos adversos , Técnicas Estereotáxicas/instrumentação , Técnicas Estereotáxicas/tendências , Adulto Jovem
20.
Neurodiagn J ; 57(3): 191-210, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28898173

RESUMO

BACKGROUND: Uncontrolled seizures in children can contribute to irreversible cognitive impairment and developmental delay, in addition to placing them at risk for sudden unexplained death in epileptic patients (SUDEP). Since its introduction at Saint Ann Hospital in Paris in the 1960s, stereoelectroencephalography (SEEG) is increasingly being utilized at epilepsy centers in the United States as an invasive tool to help localize the seizure focus in drug-resistant focal epilepsy. INDICATIONS: Children with symptomatic epilepsy, commonly due to cortical dysplasia and dysembryoplastic neuroepithelial tumor (DNET), may benefit from SEEG investigation. The arrangement of SEEG electrodes is individually tailored based on the suspected location of the epileptogenic zone (EZ). The implanted depth electrodes are used to electrically stimulate the corresponding cortices to obtain information about the topography of eloquent cortex and EZ. Morbidity: Surgical morbidity in these children undergoing SEEG investigation is low, but not negligible. The number of electrodes directly correlates with the risk of intraoperative complication. Thus a risk and benefit analysis needs to be carefully considered for each patient. Neurodiagnostic technology: Both during and after the SEEG electrode implantation, the intraoperative monitoring and EEG technologists play a vital role in the successful monitoring of the patient. CONCLUSION: SEEG is an important tool in the process of epilepsy surgery in children with symptomatic epilepsy, commonly due to cortical dysplasia and DNET.


Assuntos
Neoplasias Encefálicas , Estimulação Encefálica Profunda/instrumentação , Eletroencefalografia , Neoplasias Neuroepiteliomatosas , Técnicas Estereotáxicas , Teratoma , Adolescente , Mapeamento Encefálico , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Córtex Cerebral/anormalidades , Córtex Cerebral/diagnóstico por imagem , Criança , Pré-Escolar , Eletroencefalografia/efeitos adversos , Eletroencefalografia/métodos , Eletroencefalografia/estatística & dados numéricos , Humanos , Neoplasias Neuroepiteliomatosas/diagnóstico por imagem , Neoplasias Neuroepiteliomatosas/cirurgia , Técnicas Estereotáxicas/efeitos adversos , Técnicas Estereotáxicas/estatística & dados numéricos , Teratoma/diagnóstico por imagem , Teratoma/cirurgia
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