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1.
World Neurosurg ; 136: 198-204, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31927123

RESUMO

BACKGROUND: Pseudoaneurysms of the middle meningeal artery represent fewer than 1% of all intracranial aneurysms; it can be associated with different patterns of intracranial hemorrhages. A chronic epidural hematoma (CEDH) caused by post-traumatic pseudoaneurysm of the middle meningeal artery (MMA) has not yet been reported. CASE DESCRIPTION: A 17-year-old male patient was referred to our unit after a car accident, with head trauma and presented motor and language deficits. After a brain computed tomography scan that revealed a left temporal epidural hematoma, the patient underwent surgery with complete hematoma drainage and recovery. After 5 months, he developed a chronic epidural hematoma secondary to a pseudoaneurysm of the MMA, as shown by cerebral angiography. We also reviewed the literature to evaluate the state of the art concerning the diagnosis and management of patients affected by CEDH. CONCLUSIONS: Pseudoaneurysms are considered unstable because of the poor support of the aneurysmal wall. They tend to progressively increase in size and ultimately rupture, leading to delayed intracranial bleeding. A univocal definition of the interval of time between the acute head trauma and the diagnosis to classify the CEDH is still debated. To our knowledge, this is the first case described of a CEDH secondary to a pseudoaneurysm of the MMA. In our study we suggest defining CEDHs as extradural hematomas diagnosed and/or treated 21 days or more after a head injury.


Assuntos
Falso Aneurisma/complicações , Traumatismos Craniocerebrais/complicações , Hematoma Epidural Craniano/etiologia , Artérias Meníngeas , Acidentes de Trânsito , Adolescente , Falso Aneurisma/cirurgia , Traumatismos Craniocerebrais/cirurgia , Hematoma Epidural Craniano/diagnóstico por imagem , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem
2.
World Neurosurg ; 133: 127-134, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568909

RESUMO

Aulus Cornelius Celsus lived in Rome during the reigns of Augustus and Tiberius. He developed the scientific Latin, and his work De Medicina was the first medical textbook to be written in Latin, and subsequently the first medical treatise to be printed. He perhaps was a simple medical writer rather than a real physician, but his contributions to medical knowledge are outstanding. He described the tetrad of inflammation (dolor, rubor, calor, tumor), coined the term cancer, and reported several revolutionary surgical techniques. His eighth book, almost entirely dedicated to dislocations and fractures, provides an extensive description of head injuries such as extradural hematomas, lesions distant from the impact point, and intracranial damage in cases with no overlying fractures. He also provided the first description of brain swelling exceeding the level of the skull, described several surgical indications and craniotomy techniques, recommended treatment for depressed fractures (which had been previously considered untreatable), and detailed the surgical instruments employed. De Medicina was based on the previous Greek medical knowledge, but Celsus also provided original innovations, personal observations, and even comments and criticisms. Despite the fact that he was almost forgotten during the Middle Age, most of his concepts and surgical advices remained in the medical background of the following 2 millennia.


Assuntos
Traumatismos Craniocerebrais/cirurgia , Neurocirurgia/história , História Antiga , Humanos
4.
Georgian Med News ; (294): 10-16, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687941

RESUMO

Aim - to evaluate pathogens and their susceptibility to antibiotic therapy (ABT) in combat-related penetrating craniocerebral gunshot wound (PCGW) patients and develop recommendations for treatment of post-traumatic meningoencephalitis. We conducted a prospective analysis of examination and treatment results of 121 patients who were admitted to the Public Institution, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine, from 25 May 2014, to 31 December 2017, and were successively enrolled in the study. Intracranial purulent-septic complications were diagnosed in 14 (11.6%) patients including eight cases of isolated meningoencephalitis, three cases of meningoencephalitis combined with ventriculitis, two cases of meningoencephalitis combined with ventriculitis and subdural empyema and one case of multiple brain abscesses. In most cases of combat-related craniocerebral wounds, infections are considered nosocomial and typically related to medical procedures and devices. In most cases, the effectiveness of first-line antibiotics was low, and it was often necessary to prescribe broad-spectrum ABT, including those related to second-line antibiotics and reserve drugs, according to the World Health Organisation classification. The use of initial de-escalation of empiric ABT with the broadest-spectrum drugs, mainly as a part of combination therapy for expected gram-positive and gram-negative aerobic and anaerobic infection pathogens, is recommended.


Assuntos
Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Infecções Bacterianas/complicações , Abscesso Encefálico/tratamento farmacológico , Traumatismos Craniocerebrais/complicações , Infecção da Ferida Cirúrgica/complicações , Infecção dos Ferimentos/tratamento farmacológico , Ferimentos Penetrantes/complicações , Adulto , Bactérias/classificação , Bactérias/isolamento & purificação , Abscesso Encefálico/epidemiologia , Abscesso Encefálico/microbiologia , Traumatismos Craniocerebrais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/microbiologia , Ucrânia/epidemiologia , Infecção dos Ferimentos/diagnóstico , Infecção dos Ferimentos/epidemiologia , Infecção dos Ferimentos/microbiologia
6.
Cir Cir ; 87(S1): 1-7, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501621

RESUMO

Introduction: Thromboelastometry evaluates viscoelastic changes in the coagulation process. It offers a graphic representation of the formation of the coagulum, its stability and the presence of lysis. Objective: This first case of transfusion management guided by thromboelastography in Mexico and we conducted a review of the literature. Method: A metasearch search was performed (PubMed, Scielo, Medigraphic) with the words thromboelastometry, coagulopathy, transfusion medicine and the most influential works were included. Conclusions: The rotational thromboelastometry is a diagnostic tool that graphs the functionality of the clot, for a directed and individualized management of the coagulopathy associated with bleeding.


Assuntos
Transfusão de Componentes Sanguíneos/métodos , Choque/terapia , Tromboelastografia/métodos , Tempo de Coagulação do Sangue Total/métodos , Adolescente , Afibrinogenemia/tratamento farmacológico , Afibrinogenemia/etiologia , Plaquetas/fisiologia , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/cirurgia , Soluções Cristaloides/administração & dosagem , Emergências , Transfusão de Eritrócitos/métodos , Evolução Fatal , Feminino , Fibrinogênio/uso terapêutico , Humanos , México , Plasma , Choque/etiologia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/cirurgia
7.
Curr Opin Otolaryngol Head Neck Surg ; 27(5): 407-412, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31397694

RESUMO

PURPOSE OF REVIEW: The aim if this review is to provide an update on the existing literature of animal bite treatment strategies and provide a systematic approach to animal bites from presentation to reconstruction. RECENT FINDINGS: Dog bites cause 80-90% of animal bites with 26.8-56.5% occurring in the head and neck. Infection rates may be as low as 5.7-9.7%. Primary closure alone is sufficient in 69.8% of dog bites within the first 24 h. SUMMARY: Animal bite injuries to the head and neck are common, especially in the younger population. Dogs cause a majority of these bite injuries. Injuries can include simple lacerations or punctures, avulsions with tissue present, or avulsions with loss of tissue. The most common locations are the cheek, nose, and lips. It is important to gather the vaccination status of the animal and patient and to administer tetanus/rabies prophylaxis if indicated. Antibiotics are typically prescribed for 3-5 and 7-14 days for uninfected and infected wounds, respectively. These wounds require evaluation, irrigation, and occasionally debridement or repair in the operating room. The type of repair is determined based on the location and extent of injury and can range from primary closure to microsurgical replantation, skin grafts, flaps, or even facial transplantation.


Assuntos
Mordeduras e Picadas/cirurgia , Traumatismos Craniocerebrais/cirurgia , Cabeça/cirurgia , Lesões do Pescoço/cirurgia , Animais , Humanos , Procedimentos Cirúrgicos Reconstrutivos
8.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(4): 198-201, jul.-ago. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-183587

RESUMO

El Pott's puffy tumor (PPT) es una rara entidad que en la actualidad representa un abombamiento del cuero cabelludo asociado a un absceso subperióstico y a una osteomielitis craneal, pudiendo acompañarse o no de infección intracraneal. Suele asociarse a la sinusitis frontal, tratándose de una complicación típica, aunque poco frecuente de la misma. Por su parte las osteomielitis causadas por Actinomyces son raras y suelen tener lugar a nivel mandibular, no encontrándose apenas casos de osteomielitis craneal causada por este género bacteriano, en especial tras traumatismo craneoencefálico. Presentamos un caso especialmente poco usual al tratarse de un PPT frontal tras traumatismo cerrado, con componente intracraneal y en el que tras cirugía se aisló Actinomyces como copartícipe de dicha infección, junto con Fusobacterium y Propionibacterium


Pott's puffy tumour (PPT) is a rare entity that involves scalp swelling associated with subperiosteal abscess and cranial osteomyelitis, occasionally accompanied by intracranial infection. It is usually affiliated with frontal sinusitis, which is a typical but infrequent complication. On the contrary, Osteomyelitis by Actinomyces is rare and usually occurs at the mandibular level, with very few cases of cranial osteomyelitis caused by this bacterial specie, especially after traumatic brain injury. We report an exceptionally unusual case of a PPT frontal tumor after blunt trauma (closed head injury), with an intracranial lesion whereby Actinomyces was isolated after surgery, as a co-participant of the mentioned infection besides Fusobacterium and Propionibacterium


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/cirurgia , Osteomielite/complicações , Actinomyces/patogenicidade , Actinomyces/isolamento & purificação , Osso Frontal/diagnóstico por imagem , Osso Frontal/lesões , Dura-Máter/diagnóstico por imagem , Dura-Máter/cirurgia , Crânio/diagnóstico por imagem , Crânio/cirurgia , Antibacterianos/administração & dosagem
9.
World Neurosurg ; 130: 154-156, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31301440

RESUMO

BACKGROUND: Intracranial de novo arachnoid cysts in adults are rare, suggesting the involvement of head trauma and inflammatory diseases. We report a symptomatic adult case of nontraumatic de novo arachnoid cyst on the ventral medulla oblongata. CASE DESCRIPTION: A 56-year-old man came to our hospital complaining of dysphagia and writing difficult since 3 months ago. There was no history of head injury or inflammatory disease. A 25-mm cystic lesion was found on the ventral side of the medulla oblongata on brain magnetic resonance imaging, and the lower cranial nerve and medulla oblongata were highly compressed. The lesion did not exist on magnetic resonance imaging performed 9 years ago. Capsular resection was performed, and the histologic diagnosis was a typical arachnoid cyst. After the operation, all neurologic symptoms disappeared and no recurrence has been observed after 6 months. CONCLUSIONS: The pathophysiology of nontraumatic de novo arachnoid cysts has many unknown features, and it appears necessary to accumulate further case reports.


Assuntos
Cistos Aracnóideos/patologia , Cistos Aracnóideos/cirurgia , Traumatismos Craniocerebrais/cirurgia , Bulbo/cirurgia , Recidiva Local de Neoplasia/cirurgia , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/patologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Bulbo/patologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/patologia , Tomografia Computadorizada por Raios X/métodos
10.
Acta Chir Orthop Traumatol Cech ; 86(3): 220-222, 2019.
Artigo em Eslovaco | MEDLINE | ID: mdl-31333188

RESUMO

A 34-year-old worker suffered electrical burns on his head and right hand caused by the contact with a 380 V power source. He was unconscious, intubated, hospitalised at the ICU, and later he woke up. The entry wound was on the right hand and the exit wound on the head. These factors resulted in an extensive deep mutilating defect of the right fronto-orbital region. This article describes the management and surgical treatment of this interesting case of burn injury. Key words:electrical injury, surgical treatment.


Assuntos
Traumatismos Craniocerebrais/cirurgia , Traumatismos da Mão/cirurgia , Ferimentos e Lesões/cirurgia , Adulto , Queimaduras por Corrente Elétrica/complicações , Queimaduras por Corrente Elétrica/cirurgia , Traumatismos Craniocerebrais/etiologia , Traumatismos da Mão/etiologia , Humanos , Masculino , Ferimentos e Lesões/etiologia
11.
BMJ Case Rep ; 12(6)2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31189547

RESUMO

Decompressive craniectomy is a life-saving procedure performed to treat intracranial hypertension caused by a variety of conditions. Subsequent cranioplasty reconstruction is needed for brain protection. Different alloplastic materials with different advantages and disadvantages are available for cranial reconstruction. We present the first case of a deformed titanium cranioplasty mesh in a paediatric patient following head trauma. Children who have undergone cranioplasty reconstruction should be counselled to wear a protective helmet when involved in contact sports or activities that may put their implant at risk of trauma.


Assuntos
Traumatismos Craniocerebrais/cirurgia , Craniectomia Descompressiva/efeitos adversos , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Fraturas Cranianas/cirurgia , Retalhos Cirúrgicos/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Criança , Traumatismos Craniocerebrais/complicações , Humanos , Masculino , Falha de Prótese , Fraturas Cranianas/etiologia , Titânio
12.
World Neurosurg ; 128: e488-e494, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31048054

RESUMO

BACKGROUND: In situations in which posterior atlanto-occipital fixation might not be possible or might require supplemental fixation, anterior fixation might add stability in obtaining arthrodesis. The present study aimed to provide a radiographic evaluation of the safety and feasibility in the anterior approach. METHODS: The bilateral craniocervical computed tomography slices of 60 patients were examined. The anterior screw entry point was the lowest point at the middle anterior aspect of C1 (atlas) lateral mass. To avoid hypoglossal canal and craniocerebral injury, the height of the hypoglossal canal and occipital condyle and occipital condyle width were obtained. The mandible occlusion angle (MOA), anterior screw trajectory above, under, and distal to the hypoglossal canal (AHA, UHA, and DHA) relative to the tangent line of C1 front border were measured, together with the maximum screw length under each angle (AHL, UHL and DHL). An independent samples t test was used for statistical analysis. RESULTS: The height of the hypoglossal canal and occipital condyle and occipital condyle width were all larger in the men than in the women. The MOA, AHA, UHA, and DHA were 55.0°, 18.7°, 41.0°, and 55.0°, respectively, and were similar between genders. The AHL, UHL, and DHL were 34.5, 30.9, and 31.3 mm, with the measurements for the men generally longer than those for the women by 3-4 mm. A total of 10 of 120 bilateral measurements showed the possibility of mandible occlusion, and the potential success rate of the anterior approach could reach 91.7%. CONCLUSIONS: The ideal entry angle for anterior atlanto-occipital fixation ranges from 41.0° to 55.0°, with a safe screw length from 30.9 to 31.3 mm. The potential success rate could reach >90%.


Assuntos
Articulação Atlantoccipital/diagnóstico por imagem , Atlas Cervical/diagnóstico por imagem , Luxações Articulares/cirurgia , Osso Occipital/diagnóstico por imagem , Adulto , Idoso , Articulação Atlantoccipital/lesões , Articulação Atlantoccipital/cirurgia , Parafusos Ósseos , Atlas Cervical/cirurgia , Traumatismos Craniocerebrais/cirurgia , Feminino , Humanos , Nervo Hipoglosso , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/cirurgia , Osso Occipital/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
13.
J Clin Neurosci ; 64: 122-126, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30935750

RESUMO

The Royal Hobart Hospital (RHH) provides the only neurosurgical service in the state of Tasmania, Australia, with many patients requiring surgical treatment of intracranial injuries needing to be transferred from peripheral hospitals around the state to Hobart. This retrospective review analysed the medical records of all patients who underwent a neurosurgical intervention at RHH for an intracranial injury over a 10½ year period to ascertain if prolonged transfer times correlated with poorer patient outcomes. A total of 360 patients were included in the study, with 159 patients presenting initially to a peripheral hospital and subsequently transferred to RHH for surgery. A correlation analysis found no statistically significant relationship between transfer times from peripheral hospitals and patient Glasgow Outcome Scale (GOS) scores at 6 months post-surgery (r = 0.065, P = 0.434). There was also no correlation between transfer times and discharge destination (r = 0.088, P = 0.275). We concluded that patient transfers for head injury management in Tasmania are timely and meeting patient needs.


Assuntos
Traumatismos Craniocerebrais/cirurgia , Transferência de Pacientes/estatística & dados numéricos , Adulto , Austrália , Feminino , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Tasmânia
14.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936337

RESUMO

A 48-year-old woman presented with bilateral non-pulsatile proptosis and ophthalmoplegia after 3 days following blunt orbital trauma. It was associated with fever, malaise and loss of vision in right eye. She was provisionally diagnosed with cavernous sinus thrombosis and was treated with intravenous antibiotics with no improvement. A subtle bruit was present on examination, and digital subtraction angiography revealed a right direct (type A) carotid-cavernous fistula (CCF). The patient underwent right coil embolisation of direct CCF. On follow-up at 4 months, her proptosis resolved completely and extraocular movements improved.


Assuntos
Fístula Carotidocavernosa/cirurgia , Traumatismos Craniocerebrais/fisiopatologia , Embolização Terapêutica/métodos , Exoftalmia/fisiopatologia , Acidentes de Trânsito , Angiografia Digital , Fístula Carotidocavernosa/etiologia , Fístula Carotidocavernosa/fisiopatologia , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/cirurgia , Exoftalmia/etiologia , Exoftalmia/cirurgia , Olho/irrigação sanguínea , Olho/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Resultado do Tratamento
15.
J R Army Med Corps ; 165(6): e1, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30992341

RESUMO

The management of a craniocerebral wound (CCW) remains challenging, particularly in a severely injured patient. Considering the complexity of the multilayer insult and damage control care in an unstable patient, every procedure performed should promptly benefit the patient. We report an illustrative case of a patient with a gunshot wound to the head that resulted in a CCW for which we applied vacuum-assisted closure (VAC) therapy according to damage control principles. We describe the technical approach and discuss the indications, results and technique by considering the literature available. VAC can be used for CCWs, particularly for large defects in selected patients according to clinical and CT evaluations following immediate resuscitation. In severely injured and unstable patients, VAC aims to delay definitive reconstructive and time-consuming treatment. Interestingly, it appears to be a safe treatment based on the previously described-but not exclusively trauma-cases with no secondary cerebrospinal fluid leakage encountered.


Assuntos
Traumatismos Craniocerebrais/cirurgia , Tratamento de Ferimentos com Pressão Negativa , Ferimentos por Arma de Fogo/cirurgia , Acidentes , Humanos , Masculino , Pessoa de Meia-Idade
16.
Plast Reconstr Surg ; 143(5): 993e-1002e, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033820

RESUMO

BACKGROUND: Cell-seeded biomaterial scaffolds have been proposed as a future option for reconstruction of bone tissue. The ability to generate larger, functional volumes of bone has been a challenge that may be addressed through the use of perfusion bioreactors. In this study, the authors investigated use of a tubular perfusion bioreactor system for the growth and differentiation of bone marrow stromal (mesenchymal stem) cells seeded onto fibrin, a highly angiogenic biomaterial. METHODS: Cells were encapsulated within fibrin beads and cultured either within a tubular perfusion bioreactor system or statically for up to 14 days. Scaffolds were analyzed for osteogenic differentiation. A rodent cranial defect model (8-mm diameter) was used to assess the bone regeneration of scaffolds cultured in the bioreactor, statically, or used immediately after formation. Immunohistochemistry was used to visualize CD31 vessel density. Micro-computed tomographic imaging was used to visualize mineral formation within the defect volume. RESULTS: Tubular perfusion bioreactor system-cultured samples showed significantly greater osteodifferentiation, indicated by an increase in VEGF expression and mineral deposition, compared with statically cultured samples. Increased expression of OPN, RUNX2, VEGF, and CD90 was seen over time in both culture methods. After implantation, bioreactor samples exhibited greater bone formation and vessel density compared with all other groups. Analysis of micro-computed tomographic images showed full union formation through the greatest diameter of the defect in all bioreactor samples and the highest levels of mineralized volume after 8 weeks. CONCLUSION: Mesenchymal stem cells encapsulated in fibrin beads and cultured in the tubular perfusion bioreactor system resulted in increased vascularization and mineralized tissue formation in vivo relative to static culture.


Assuntos
Regeneração Óssea , Técnicas de Cultura de Células/métodos , Osteogênese/fisiologia , Crânio/lesões , Tecidos Suporte , Animais , Reatores Biológicos , Células da Medula Óssea/fisiologia , Técnicas de Cultura de Células/instrumentação , Diferenciação Celular/fisiologia , Células Cultivadas , Traumatismos Craniocerebrais/cirurgia , Modelos Animais de Doenças , Humanos , Masculino , Células-Tronco Mesenquimais/fisiologia , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/métodos , Perfusão/métodos , Ratos , Ratos Sprague-Dawley , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Crânio/cirurgia , Resultado do Tratamento
17.
Rev. medica electron ; 41(2): 368-381, mar.-abr. 2019. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1004274

RESUMO

RESUMEN Introducción: el traumatismo encefalocraneano es una causa frecuente de mortalidad y morbilidad. Según datos epidemiológicos aporta la mayor cantidad de fallecidos en menores de 45 años a nivel mundial. Objetivo: caracterizar el trauma craneoencefálico desde el punto de vista clínico-quirúrgico, neuroimagenológico y por neuromonitorización en los pacientes investigados. Materiales y métodos: estudio observacional, descriptivo, transversal, en el Servicio de Neurocirugía del Hospital Provincial Clínico Quirúrgico Docente José Ramón López Tabrane y Comandante Faustino Pérez Hernández, de Matanzas, durante el periodo comprendido entre enero del 2016 a enero del 2018. Resultados: predominó el sexo masculino con el 71,7% de los casos, la mayor prevalencia estuvo en edades inferiores a 48 años con el 80,1 %. La mayor cantidad presentaba un traumatismo encefalocraneano leve con el 56% de los casos seguido del traumatismo encefalocraneano moderado y severo con el 29% y 15% de los casos respectivamente. Predominaron las fracturas lineales (45,8%), seguido de las contusiones sin efecto de masa y los hematomas subdurales con el 24,2% y 23,3%. La mayoría de los pacientes presentó una escala de Marshall II con el 40,8%. Las cifras de presión intracraneal entre de 20-40 mmHg se presentó con mayor frecuencia (44,4 %). Conclusiones: la mitad de los pacientes neuromonitorizados presentaron una saturación del golfo de la vena yugular dentro de parámetros normales con el 50%. La operación más practicada fue la evacuación de hematomas subdurales con el 29,4%.


ABSTRACT Introduction: the encephalocranial trauma (ECT) is a frequent cause of mortality and morbidity. According to epidemiological data, it causes the highest number of deaths in people aged less than 45 years worldwide. Objective: to characterize the encephalocranial trauma from the clinical-surgical, neuroimaging and neuromonitoring point of view in the studied patients. Materials and methods: observational, descriptive, cross-sectional study carried out in the Neurosurgery Service of the Provincial Teaching Surgical Clinical Hospitals "Jose Ramon Lopez Tabrane" and "Comandante Faustino Perez Hernandez", of Matanzas, during the period from January 2016 to January 2018. Results: male sex predominated with 71.7% of the cases; the highest prevalence was in ages below 48 years with 80.1%. Most of them presented a mild encephalocranial trauma with 56% of the cases followed by moderate and severe encephalocranial trauma with 29% and 15% of the cases respectively. Linear fractures predominated (45.8%), followed by contusions without mass effect and subdural hematomas with 24.2% and 23.3%. Most of patients presented a Marshall II scale with 40.8%. The intracranial pressure between 20-40 mmHg occurred more frequently (44.4%). Conclusions: half of the neuromonitored patients presented jugular vein gulf saturation within normal parameters with 50%. The most practiced operation was the evacuation of subdural hematomas with 29.4%.


Assuntos
Humanos , Procedimentos Neurocirúrgicos , Tomografia Computadorizada Espiral , Traumatismos Craniocerebrais/cirurgia , Traumatismos Craniocerebrais/classificação , Traumatismos Craniocerebrais/mortalidade , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/diagnóstico por imagem , Epidemiologia Descritiva , Estudos Transversais , Estudo Observacional , Traumatismos Craniocerebrais/diagnóstico
18.
World Neurosurg ; 126: e944-e952, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30876998

RESUMO

BACKGROUND: Traumatic acute subdural hematomas (ASDHs) showed the highest mortality of intracranial hematomas. The aim of the current study was to identify predictive factors of poor prognosis among patients who were operated on. METHODS: This is a single-center retrospective cohort study of 82 patients who underwent surgical evacuation of a traumatic ASDH between January 2009 and December 2016. The epidemiologic, clinical, radiologic, and surgical features were recorded. Postoperative outcome were assessed by the Glasgow Outcome Scale (GOS) score at 6 months. Univariate and multivariate analysis and a classification and regression tree (CART) were performed. RESULTS: At 6 months, 76% of patients achieved an unfavorable outcome (GOS score 1-3). The context of polytrauma (P = 0.03) and ASDH thickness ≥20 mm (P = 0.02) were significantly associated with poor outcome in the multivariate analysis. The CART algorithm isolated 3 subgroups of patients with an unfavorable prognosis: polytrauma (91%), isolated head injury (HI) featuring an ASDH thickness ≥20 mm (89%), or isolated HI featuring a thickness <20 mm in a patient older than 54 years (71%). Isolated patients with HI younger than 54 years harboring an ASDH <20 mm thick had the most promising results, with 53% with a GOS score of 4 or 5. CONCLUSIONS: The context of polytrauma, ASDH thickness, and age were major predictive factors of poor prognosis in patients with surgically evacuated traumatic ASDH. The CART algorithm using these features isolated subgroups with decreasingly unfavorable outcome, providing a relevant statistical tool to apply to future studies of traumatic ASDH.


Assuntos
Traumatismos Craniocerebrais/cirurgia , Hematoma Subdural Agudo/cirurgia , Fatores Etários , Algoritmos , Traumatismos Craniocerebrais/complicações , Craniotomia , Feminino , Escala de Resultado de Glasgow , Hematoma Subdural Agudo/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Resultado do Tratamento , Trepanação
19.
J Plast Reconstr Aesthet Surg ; 72(6): 990-999, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30880047

RESUMO

BACKGROUND: The authors introduce an algorithm for preoperative planning of optimal lateral circumflex femoral artery system perforator flap (LCFAPF) supplied by the best quality and the easiest dissection of the perforators and the source vessels for simplified and customized strategies in head and neck reconstruction with perforator navigation using color Doppler ultrasound and three-dimensional reconstruction (3D-CDUS PN). METHODS: Between June 2011 and September 2015, a prospective cohort study was performed with an algorithm based on defect site, perforator type, and pedicle length using 3D-CDUS PN to select optimal perforators arising from the different branches of LCFA in 108 patients. The optimal perforator and flap were determined by perforator caliber and quality, difficulty in flap dissection, and length of the source vessels. Cause and classification of the defect, flap choice, recipient vessels, postoperative course, and complications were analyzed. RESULTS: The source vessels of the perforators were lateral descending branch in 73 cases and oblique branch in 17 cases with ALTPFs, medial descending branch in 12 cases with AMTPFs, and ascending branch in 6 cases with TFLPFs. Straightforward dissection of flaps with septocutaneous (n = 40) and semi-septocutaneous (n = 17) perforators was performed in 52.8% cases. Successful exploration rate and overall flap survival rate were both 100%. Satisfactory functional and esthetic results in both recipient and donor sites with no serious complications were observed in all patients. CONCLUSIONS: Our algorithm using 3D-CDUS PN facilitates selection of optimal flap with better caliber and quality of the perforators and sufficient pedicle length for easy dissection.


Assuntos
Traumatismos Craniocerebrais/cirurgia , Artéria Femoral , Neoplasias de Cabeça e Pescoço/cirurgia , Imageamento Tridimensional/métodos , Lesões do Pescoço/cirurgia , Retalho Perfurante , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Ultrassonografia Doppler em Cores/métodos , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/transplante , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos
20.
Br J Neurosurg ; 33(3): 360-364, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30773933

RESUMO

Purpose: We report a series of 29 pediatric patients who sustained head injuries due to metallic ceiling fans. They all were admitted to the Emergency Department of Neurosurgery Teaching Hospital in Baghdad, Iraq, during January 2015 to January 2017. Results: Pediatric ceiling fan head injuries are characterized by four traits which distinguish them from other types of head injuries; 1- Most of them were because of climbing on or jumping from furniture between the ages of two and five. 2- Most of them sustained compound depressed skull fracture which associated with intracranial lesions and pneumocephalus. 3- The most common indication for surgical intervention was because of dirty wound which mixed with hairs. 4- These variables were statistically significantly correlated with the outcome: Level of consciousness, neurologic deficit, fracture site (occipital fracture had worse outcome), intracranial hemorrhage and surgery. Conclusion: Pediatric metallic ceiling fan head injury should be seen as a distinct type of head injury because it has special presentations, managements, and outcomes. In addition, we should start applying preventive methods to minimize its occurrence.


Assuntos
Traumatismos Craniocerebrais/etiologia , Utensílios Domésticos , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/etiologia , Lesões Encefálicas Traumáticas/cirurgia , Criança , Pré-Escolar , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/cirurgia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Iraque/epidemiologia , Masculino , Metais , Estudos Retrospectivos , Fraturas Cranianas/cirurgia
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