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1.
Neurosurg Rev ; 46(1): 41, 2023 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-36703023

RESUMO

Different materials and techniques have been proposed for surgical repair of spontaneous middle cranial fossa (MCF) defects. However, conclusive evidence supporting their selection and impact on clinical outcomes is lacking. The study aims to conduct a systematic review and meta-analysis on materials and techniques employed to repair MCF defects and evaluate complications and rates of recurrent cerebrospinal fluid (CSF) leaks. A PRISMA-guided systematic review and meta-analysis were performed using MESH terms and specific keywords including studies published before May 2022. Primary outcomes included recurrence of CSF leak and complication rates by type of reconstructive material and technique utilized. Meta-analyses of proportions were performed using random effects and confidence intervals for individual proportions were calculated using the Clopper-Pearson method. Twenty-nine studies were included (n = 471 cases). Materials employed for repair were categorized according to defect size: 65% of defects were of unknown size, 24% were small (< 1 cm), and 11% were large (≥ 1 cm). Rigid reconstruction (RR) was significantly favored over soft reconstruction (SR) for larger defects (94% of cases, p < 0.05). Complications and recurrent CSF leak rates of SR and RR techniques were comparable for defects of all sizes (p > 0.05). Complication rates reported for these procedures are low regardless of technique and material. RR was universally preferred for larger defects and analysis of complication and recurrence rates did not reveal differences regardless of defect size. While RR was more frequently reported in smaller defects, SR was used by several centers, particularly for smaller MCF floor defects.


Assuntos
Vazamento de Líquido Cefalorraquidiano , Fossa Craniana Média , Humanos , Fossa Craniana Média/cirurgia , Estudos Retrospectivos , Vazamento de Líquido Cefalorraquidiano/cirurgia , Resultado do Tratamento
2.
BMC Neurol ; 23(1): 36, 2023 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-36690947

RESUMO

BACKGROUND: External ventricular drainage (EVD) is frequently used in neurosurgical procedures for cerebrospinal fluid (CSF) drainage. It is, however, associated with high infection rates, namely secondary meningitis and ventriculitis. Based on a previous high prevalence of these infections among patients with EVDs, we have proposed and implemented a protocol in an effort to decrease the infection rate. The aim of this study was to measure the effect of hospital-wide implementation of the EVD handling protocol on secondary EVD infections. PATIENTS AND METHODS: We included 409 consecutive patients who received a new EVD for other indications than infectious pathologies from January 2000 until June 2012. Patients above 18 years of age were divided into pre- (n = 228) and post-protocol (n = 181) groups. Patient and disease demographics, as well as EVD data together with confounders for secondary meningitis were recorded in a database. Propensity score matching was then performed to create groups matched for sex, age, reason for drainage, type of shunt, time in situ and duration of surgery to place the EVD. Binomial logistic regression for confounder adjustment and regression discontinuity analyses were then performed on the matched cohort. RESULTS: Infections occurred more frequently in the pre-protocol group (23% vs 9%, p <  0.001). The incidence of infection was 33/1000 drain-days pre-protocol and 9/1000 drain-days post-protocol. Regression analysis in a propensity score-matched cohort (n = 103 in the pre- and n = 178 in the post-protocol groups) showed that the pre-protocol period was independently associated with more infections (OR 2.69; 95%-CI 1.22-5.95, p = 0.01). CONCLUSIONS: The incidence of secondary EVD infections can be reduced significantly by the implementation of a strict hospital-wide EVD handling protocol.


Assuntos
Doença pelo Vírus Ebola , Meningite , Humanos , Estudos de Coortes , Pontuação de Propensão , Estudos Retrospectivos , Meningite/epidemiologia , Drenagem/métodos , Vazamento de Líquido Cefalorraquidiano
3.
Oper Neurosurg (Hagerstown) ; 24(2): 121-130, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36637296

RESUMO

BACKGROUND: There is controversy over the choice of optimal approach for olfactory groove meningiomas (OGM). The endoscopic endonasal approach (EEA) is one of the most recently described corridors, which provides direct access to the tumor base. OBJECTIVE: To detail the evolution of the endoscopic endonasal technique over the past 2 decades and demonstrate the impact of this evolution on patient outcomes. METHODS: This is a retrospective study based on a prospectively maintained database of consecutive cases of OGM operated on at our institution via EEA. For analysis, the whole cohort has been divided into 3 equal "eras" according to the time period during which the surgery happened, creating early, middle, and contemporary groups. RESULTS: Seventy-five patients were included, 25 in each group. The rate of postoperative cerebrospinal fluid leak significantly decreased over time (28%, 32%, and 8% in the early, middle, and contemporary groups, respectively, P = .020). The rate of postoperative encephalomalacia was significantly lower in more recent groups (24%, 16%, and 0% in the early, middle, and contemporary groups, respectively, P = .029), as was the time to resolution of postoperative brain edema (103.9 months, 87.3 months, and 16.8 months in the early, middle, and contemporary groups, respectively, P = .020). CONCLUSION: The endoscopic endonasal approach for OGM significantly evolved over time, achieving lower cerebrospinal fluid leak rates while providing a high rate of Simpson grade 1 resection. Technical improvements minimized the frontal lobe impact. Current data support EEA as a safe and effective corridor to treat OGM.


Assuntos
Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/cirurgia , Meningioma/patologia , Neoplasias Meníngeas/cirurgia , Neoplasias Meníngeas/patologia , Estudos Retrospectivos , Resultado do Tratamento , Vazamento de Líquido Cefalorraquidiano
4.
Oper Neurosurg (Hagerstown) ; 24(2): 162-167, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36637300

RESUMO

BACKGROUND: Grafts available for posterior fossa dural reconstruction after Chiari decompression surgery include synthetic, xenograft, allograft, and autograft materials. The reported rates of postoperative pseudomeningocele and cerebrospinal fluid leak vary, but so far, no dural patch material or technique has sufficiently eliminated these problems. OBJECTIVE: To compare the incidence of graft-related complications after posterior fossa surgery using AlloDerm alone vs AlloDerm with a DuraGen underlay. METHODS: We performed a retrospective single-center study of a cohort of 106 patients who underwent Chiari decompression surgery by a single surgeon from 2014 through 2021. Age, sex, body mass index, tonsillar descent, syrinx formation, type of dural graft, and follow-up data were analyzed using univariate and χ2 statistical tests. RESULTS: The AlloDerm-only group had a percutaneous cerebrospinal fluid (CSF) leak rate of 8.6% vs a 0% rate in the dual graft group (P = .037). At initial follow-up, there was a 15.5% combined rate of pseudomeningocele formation plus CSF leak in the AlloDerm-only group vs 18.8% in the AlloDerm + DuraGen group (P = .659). However, the pseudomeningoceles were larger in the AlloDerm-only cohort (45.5 vs 22.4 mm anteroposterior plane, P = .004), and 5 patients in this group required operative repair (56%). All pseudomeningoceles resolved without reoperation in the AlloDerm + DuraGen group (P = .003). CONCLUSION: The use of a DuraGen underlay with a sutured AlloDerm dural patch resulted in significantly fewer CSF-related complications and eliminated the need for reoperation compared with AlloDerm alone. This single-center study provides evidence that buttressing posterior fossa dural grafts with a DuraGen underlay may decrease the risk of postoperative complications.


Assuntos
Malformação de Arnold-Chiari , Rinorreia de Líquido Cefalorraquidiano , Humanos , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Estudos Retrospectivos , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Vazamento de Líquido Cefalorraquidiano/cirurgia , Vazamento de Líquido Cefalorraquidiano/complicações , Rinorreia de Líquido Cefalorraquidiano/etiologia , Malformação de Arnold-Chiari/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia
6.
Otol Neurotol ; 44(1): e22-e25, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36509438

RESUMO

OBJECTIVE: This report describes a case of a spontaneous cerebrospinal fluid leak at the jugular foramen that was surgically repaired via the infralabyrinthine approach with adjunct use of intrathecal fluorescein and stereotactic navigation. PATIENTS: A 39-year-old woman presenting with clear otorrhea confirmed to be cerebrospinal fluid (CSF) emanating from a defect in the jugular foramen. INTERVENTION: Surgical repair of the skull base defect using an infralabyrinthine approach to the jugular foramen. During surgery, intrathecal fluorescein and stereotactic navigation were used to localize the defect and confirm a successful repair. MAIN OUTCOME MEASURE: Recurrence of a CSF leak. RESULTS: The defect was successfully repaired using the techniques described, resulting in cessation of the patient's CSF leak. There was no recurrence of the CSF leak up to a 4-month postoperative outpatient follow-up. CONCLUSIONS: Diagnosis and repair of spontaneous otogenic CSF leaks in an uncommon location like the jugular foramen are challenging. This report demonstrates the successful use of the infralabyrinthine approach for control of a CSF from the jugular foramen. In addition, use of techniques, such as intrathecal fluorescein and stereotactic navigation that are not routinely used in otology and neurotology allowed for safe, effective repair of the leak in this case.


Assuntos
Vazamento de Líquido Cefalorraquidiano , Forâmen Jugular , Feminino , Humanos , Adulto , Fluoresceína , Estudos Retrospectivos , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/cirurgia , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia
7.
J Neurosurg Pediatr ; 30(6): 624-632, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36459394

RESUMO

OBJECTIVE: Wound healing can be challenging in children undergoing spine surgery for neurological conditions due to a high risk of cerebrospinal fluid (CSF) leakage and wound infection. In adults, use of the Dermabond Prineo (DP) skin closure system, which consists of both tissue adhesive glue and a self-adhesive mesh, for wound closure of medium-length surgical incisions has been reported. The aim of this study was to investigate the efficiency and cosmetic outcome of DP for wound closure in extra- and intradural pediatric neurological spine surgery. METHODS: In this prospective cohort study, 47 children underwent 50 spine procedures using DP for wound closure between 2018 and 2022 at a single institution. Patient demographic and surgical data were collected. The primary outcome was revision surgery for wound healing disorders, while secondary outcomes were infections, minor wound healing disorders, and both physician and parental satisfaction (parent-reported outcome measures [PROMs]) at last follow-up. RESULTS: Among 50 spinal (45 intra- and 5 extradural) interventions, 1 patient (2%) underwent revision surgery for a cutaneous CSF fistula and pseudomeningocele. Minor wound healing disorders occurred after 16 surgeries, which did not require surgical wound revision and resolved completely. No allergic reactions to DP or surgical site infections within 30 days were observed. The parents and the medical team described wound care as significantly facilitated since wound dressing changes were not needed. Three families (6.4%) encountered difficulties in wound care, and 46 (97.9%) were satisfied with DP. The cosmetic outcome based on PROMs was excellent, with a mean score of 8 (IQR 2) on a scale from 1 to 10. At long-term follow-up, a mean of 11.3 ± 10.7 months after surgery, physicians rated the cosmetic outcome on the visual analog scale (median score 9, IQR 1) and Hollander scale (median score 6, IQR 1). The outcomes were similar among the different pathologies and age groups and did not differ in patients with and without syndromic malformations. CONCLUSIONS: The application of DP is simple, enables good patient comfort, facilitates both professional and parental wound care, and leads to excellent cosmetic results. DP possibly aids in the reduction of postoperative CSF leakage and infections after pediatric neurological spine surgery.


Assuntos
Ferida Cirúrgica , Adesivos Teciduais , Adulto , Humanos , Criança , Adesivos Teciduais/uso terapêutico , Estudos Prospectivos , Estudos de Coortes , Telas Cirúrgicas , Infecção da Ferida Cirúrgica/etiologia , Vazamento de Líquido Cefalorraquidiano , Ferida Cirúrgica/cirurgia , Medidas de Resultados Relatados pelo Paciente
8.
Neurosurg Focus ; 53(6): E7, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36455277

RESUMO

OBJECTIVE: The transsphenoidal approach is the standard for most pituitary tumors. Despite low morbidity, postoperative CSF fistulas and meningitis are specific complications. Various surgical closure techniques for intraoperative CSF (iCSF) leak and sellar reconstruction have been described. For many years the authors have applied synthetic materials for iCSF leak repair and sellar closure in a standardized fashion in their department. Here they analyze the surgical outcome as well as risk factors for iCSF leak and meningitis. METHODS: All patients with transsphenoidal resection of a pituitary adenoma performed by the same surgeon between January 2013 and December 2019 were screened retrospectively. A small amount of iCSF flow without a diaphragmatic defect was classified as a minor leak, and obvious CSF flow with or without a diaphragmatic defect was classified as a major leak. In case of iCSF leak, a fibrin- and thrombin-coated sponge was used to cover the diaphragmatic defect and another one was used for the sellar opening. A gelatin sponge was placed in the sphenoid sinus as an abutment. The primary and secondary outcomes were the number of postoperative CSF (pCSF) leaks and meningitis, respectively. Clinical, histological, and perioperative data from medical records were collected to identify risk factors for CSF leak and meningitis. RESULTS: Of 417 transsphenoidal surgeries, 359 procedures in 348 patients with a median age of 54 years were included. There were 96 iCSF leaks (26.7%; 37.5% major, 62.5% minor). In 3 of 359 cases (0.8%) a pCSF fistula occurred, requiring revision surgery in 2 patients and a lumbar drain in 1 patient. Meningitis occurred in 3 of 359 cases (0.8%). All 3 patients recovered without sequelae after antibiotic therapy. According to univariate analysis, risk factors for iCSF leak were macroadenoma (p = 0.006) and recurrent adenoma (p = 0.032). An iCSF leak was found less often in functioning adenomas (p = 0.025). In multivariate analysis recurrent tumors remained as a risk factor (p = 0.021) for iCSF leak. Patients with iCSF leak were at increased risk for a pCSF leak (p = 0.005). A pCSF leak in turn represented the key risk factor for meningitis (p = 0.033). CONCLUSIONS: Patients with macroadenomas and recurrent adenomas are especially at risk for iCSF leak. An iCSF leak in turn increases the risk for a pCSF leak, which carries the risk for meningitis. The authors' surgical technique leads to a very low rate of pCSF leaks and meningitis without using autologous graft materials. Hence, this technique is safe and improves patient comfort by avoiding the disadvantages of autologous graft harvesting.


Assuntos
Adenoma , Meningite , Neoplasias Hipofisárias , Humanos , Pessoa de Meia-Idade , Neoplasias Hipofisárias/cirurgia , Estudos Retrospectivos , Adenoma/cirurgia , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/cirurgia , Meningite/etiologia , Fatores de Risco , Complicações Pós-Operatórias/etiologia
9.
Acta Med Okayama ; 76(6): 737-742, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36549777

RESUMO

Paraplegia after an operation for acute aortic dissection Stanford type A (AADA) is fairly uncommon, and there is no consensus about optimal treatment. We present a case in which cerebrospinal fluid drainage (CSFD) and permissive hypertension were used for treatment of paraplegia. When the patient showed complete bilateral paraplegia after operation for AADA, we immediately began CSFD and maintained mean arterial blood pressure at over 90 mmHg. His neurological deficit gradually recovered, and he was eventually able to walk without support. The combination of CSFD and permissive hypertension could be a first-line emergent treatment for postoperative paraplegia after AADA surgery.


Assuntos
Hipertensão , Masculino , Humanos , Aorta Torácica/cirurgia , Vazamento de Líquido Cefalorraquidiano , Hipertensão/complicações , Paraplegia/etiologia , Paraplegia/terapia , Resultado do Tratamento
10.
AJNR Am J Neuroradiol ; 43(10): 1539-1543, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36574327

RESUMO

CSF leaks, including CSF-venous fistulas, which cause spontaneous intracranial hypotension, remain difficult to diagnose, even on digital subtraction myelography and CT myelography. Dual-energy CT technology has been used to improve diagnostic utility within multiple organ systems. The capability of dual-energy CT to create virtual monoenergetic images can be leveraged to increase conspicuity of contrast in CSF-venous fistulas and direct epidural CSF leakage to improve the diagnostic utility of CT myelography. Six cases (in 5 patients) are shown in which virtual monoenergetic images demonstrate a leak location that was either occult or poorly visible on high- or low-kilovolt series. This clinical report describes the novel application of dual-energy CT for the detection of subtle CSF leaks including CSF-venous fistulas.


Assuntos
Fístula , Hipotensão Intracraniana , Humanos , Mielografia/métodos , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/complicações , Hipotensão Intracraniana/etiologia , Tomografia Computadorizada por Raios X/métodos , Fístula/complicações
11.
BMC Neurol ; 22(1): 421, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36368955

RESUMO

BACKGROUND: Meningoencephalocele is a rare malformation caused by congenital and acquired lesions. The association between recurrent bacterial meningitis and meningoencephaloceles with cerebrospinal fluid (CSF) leak is reported in the literature. We report a rare case of meningoencephalocele secondary to chronic idiopathic intracranial hypertension as a result of hospitalization repeatedly for meningitis due to the lack of CSF leak. CASE PRESENTATION: This study presents a case of a patient with a decade of recurrent meningitis. With clinical symptoms and imaging examination with chronic idiopathic intracranial hypertension, this patient was diagnosed with meningoencephalocele. With the treatment of acetazolamide to decrease CSF product, the patient had no recurrence of meningitis over the 6-months follow-up period. CONCLUSION: In patients with recurrent intracranial infections but no history of immunodeficiency, cranial trauma, or neurosurgery, the possibility of meningitis should be considered appropriately, even in the absence of CSF otorrhea or rhinorrhea.


Assuntos
Infecções do Sistema Nervoso Central , Rinorreia de Líquido Cefalorraquidiano , Hipertensão Intracraniana , Meningites Bacterianas , Meningocele , Pseudotumor Cerebral , Humanos , Pseudotumor Cerebral/complicações , Rinorreia de Líquido Cefalorraquidiano/diagnóstico , Rinorreia de Líquido Cefalorraquidiano/etiologia , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Meningocele/complicações , Meningocele/diagnóstico por imagem , Encefalocele/complicações , Encefalocele/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/complicações , Meningites Bacterianas/complicações , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/tratamento farmacológico
12.
J Craniofac Surg ; 33(8): 2581-2585, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36409876

RESUMO

OBJECTIVES: A defect in the skull base can result in leakage of cerebrospinal fluid (CSF) out of the subarachnoid space into the sinonasal cavities, termed CSF rhinorrhea. Patients presenting with CSF rhinorrhea often require surgical repair, typically performed endoscopically. Successful surgical intervention is highly reliant on accurate identification of the leak site. Identification can be enhanced by the administration of intrathecal fluorescein (IF) via a lumbar drain before surgery. The objective of this systematic review is to better characterize the benefits and limitations of IF administration. METHODS: A systematic search was conducted for literature documenting the use of IF for CSF leak localization. The results of this search were subjected to initial review, followed by full-text evaluation of selected texts, and final inclusion based on predetermined selection criteria. Primary outcomes were specificity and sensitivity of IF administration in identifying CSF leak sites. Secondary outcomes included administration technique and safety data. RESULTS: A total of 25 studies representing 3801 instances of IF administration met inclusion criteria. When injected slowly for up to 30 minutes at doses of <50 mg, IF administration results in minimal complications. A total of 25 mg doses (92.36%) of IF appear more sensitive than 10 mg (71.88%) doses of IF while maintaining a similar safety profile. Mixing fluorescein with double distilled water instead of CSF or saline may decrease waiting times before fluorescein can be identified and increase its safety profile. CONCLUSIONS: Intrathecal fluorescein may play an important role in the identification of CSF leak site during endoscopic repair.


Assuntos
Rinorreia de Líquido Cefalorraquidiano , Humanos , Rinorreia de Líquido Cefalorraquidiano/diagnóstico por imagem , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Fluoresceína , Base do Crânio/cirurgia , Endoscopia/métodos , Vazamento de Líquido Cefalorraquidiano/diagnóstico , Vazamento de Líquido Cefalorraquidiano/complicações
13.
Artigo em Chinês | MEDLINE | ID: mdl-36347580

RESUMO

Objective:To evaluate the accuracy of preoperative computed tomographic cisternography(CTC) and magnetic resonance hydrography(MRH)in the diagnosis of cerebrospinal fluid(CSF) rhinorrhea. Methods:Retrospective analysis was made on the data of 38 patients diagnosed as cerebrospinal rhinorrhea who completed preoperative HRCT, CTC and MRH examinations in the Department of Otolaryngology Head and Neck Surgery of Tianjin Huanhu Hospital from October 2016 to January 2022. The diagnostic accuracy of preoperative imaging examinations was compared according to the leak location found during operation. Results:Among all the 38 cases with CSF rhinorrhea, the detection rates of HRCT, CTC, and cranial MRH were 31.58%, 89.47%, and 60.53%, respectively. The accuracy of CTC was significantlyhigher than that of MRH ( χ²=8.49, P=0.007), and the accuracy of MRH was significantly higher than that of HRCT (χ²=6.41, P=0.01). Subgroup analyses were performed according to the precise positioning of cerebrospinal fluid rhinorrhea leakage. In patients with cerebrospinal fluid rhinorrhea located in ethmoid sinus, the accuracy of CTC(80.95% vs. 14.29%,P<0.01)and MRH(52.38% vs. 14.29%,P=0.02)were significantly higher than that of HRCT, but the accuracy but the difference between CTC and MRH between CTC and MRH was not statistically significant (P=0.10). The accuracy of CTC was significantly higher than that of MRH (100.00% vs. 61.54%, P=0.04) and HRCT (100.00% vs. 53.85%, P<0.01) in patients with CSF rhinorrhea located in sphenoid sinus. However, there was no significant difference in the accuracy between MRH and HRCT ( P=1.00). However, There was no significant difference in the accuracy of CTC, MRH and HRCT in patients with cerebrospinal fluid rhinorrhea located in frontal sinus. The accuracy of CTC and MRH was 84.62% and 57.69% respectively in 26 patients who failed to detect a CSF rhinorrhea by HRCT, and the difference was not statistically significant(χ²=4.59, P=0.06). Conclusion:The comprehensive application of the multiple imaging methods has important guiding significance for the accurate treatment and prognosis evaluation. CTC and MRH could improve the accuracy of the localization diagnosis of cerebrospinal fluid rhinorrhea.


Assuntos
Rinorreia de Líquido Cefalorraquidiano , Humanos , Rinorreia de Líquido Cefalorraquidiano/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Imageamento por Ressonância Magnética , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Espectroscopia de Ressonância Magnética
15.
Otol Neurotol ; 43(10): e1194-e1199, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36351231

RESUMO

OBJECTIVE: To determine the severity of symptoms and degree of obstructive sleep apnea (OSA) in patients with spontaneous cerebrospinal fluid (sCSF) leaks of the temporal bone given the known association between sCSF leaks and OSA. STUDY DESIGN: Retrospective case review. SETTING: Ambulatory clinics in tertiary referral centers. PATIENTS: Polysomnogram testing in 34 consecutive patients who had been diagnosed with sCSF leaks of the temporal bone was examined. Diagnosis of sCSF leak was defined as biochemically confirmed CSF from middle ear fluid with no other obvious source. INTERVENTION: Diagnostic. MAIN OUTCOMES MEASURES: Patient characteristics (age, sex, body mass index, Epworth Sleepiness Scale score, presence of hypoxia, overnight change in blood pressure, and apnea hypopnea index [AHI]) were recorded. Diagnosis of OSA was defined as mild when AHI ≥5 and <15/h, moderate when AHI ≥15 and <30/h, and severe when AHI ≥30/h. RESULTS: Of the 34 patients, 28 (82%) had a confirmed diagnosis of OSA. There was a male predisposition in those with OSA, and 17 of 28 (61%) were male. A majority were overweight, and the mean body mass index was 30.1 (SD, 4.8; range, 23.2-40) kg/m2. The mean severity of OSA was moderate, and the mean AHI was 28.7 (SD, 21.9; range, 5.4-92.8). Of the 28 patients, 13 with OSA (46%) had Epworth Sleepiness Scale scores higher than 8, suggesting that many were asymptomatic for excessive daytime sleepiness at the time of presentation. CONCLUSION: OSA is highly prevalent among patients with sCSF leaks of the temporal bone. Patients with sCSF leaks irrespective of symptoms of OSA should undergo formal polysomnogram testing.


Assuntos
Apneia Obstrutiva do Sono , Sonolência , Humanos , Masculino , Feminino , Estudos Retrospectivos , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Vazamento de Líquido Cefalorraquidiano , Osso Temporal/diagnóstico por imagem
16.
Artigo em Inglês | MEDLINE | ID: mdl-36360727

RESUMO

BACKGROUND: Cerebrospinal fluid (CSF) rhinorrhea requires proper management to avoid disastrous consequences. The objectives of this study were to ascertain the patient characteristics, etiologies, sites of defect, skull base configurations, methods of investigation, and management outcomes of CSF rhinorrhea. METHODS: A retrospective study was performed over 4 years involving three surgeons from Malaysia, Singapore, and Thailand. Hospital records were reviewed to determine the patients' characteristics, the causes and sites of leaks, methods of investigation, skull base configurations, choices of treatment, and outcomes. RESULTS: A total of 15 cases (7 traumatic and 8 non-traumatic) were included. Imaging was performed in all cases. The most common site of leakage was the cribriform plate (9/15 cases). The mean ± SD of the Keros heights were 4.43 ± 1.66 (right) and 4.21 ± 1.76 mm (left). Type II Keros was the most common (60%). The mean ± SD angles of the cribriform plate slope were 51.91 ± 13.43 degrees (right) and 63.54 ± 12.64 degrees (left). A class II Gera configuration was the most common (80%). All except two patients were treated with endonasal endoscopic surgical repair, with a success rate of 92.3%. A multilayered repair technique was used in all patients except one. The mean ± SD postoperative hospital stay was 9.07 ± 6.17 days. CONCLUSIONS: Non-traumatic CSF rhinorrhea outnumbered traumatic CSF rhinorrhea, with the most common site of leak at the cribriform plate. Imaging plays an important role in investigation, and Gera classification appears to be better than Keros classification for evaluating risk. Both conservative and surgical repairs are practiced with successful outcomes. Endonasal endoscopic CSF leak repair is the mainstay treatment.


Assuntos
Rinorreia de Líquido Cefalorraquidiano , Humanos , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Rinorreia de Líquido Cefalorraquidiano/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Base do Crânio/cirurgia , Vazamento de Líquido Cefalorraquidiano/complicações , Vazamento de Líquido Cefalorraquidiano/cirurgia
18.
Neurosurg Rev ; 45(6): 3779-3788, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36322203

RESUMO

Cerebrospinal fluid (CSF) leakage is a well-known complication of craniotomies and there are several dural closure techniques. One commonly used commercial product as adjunct for dural closure is the collagen-bound fibrin sealant TachoSil®. We analysed whether the addition of TachoSil has beneficial effects on postoperative complications and outcomes. Our prospective, institutional database was retrospectively queried, and 662 patients undergoing craniotomy were included. Three hundred fifty-two were treated with dural suture alone, and in 310, TachoSil was added after primary suture. Our primary endpoint was the rate of postoperative complications associated with CSF leakage. Secondary endpoints included functional, disability and neurological outcome. Systematic review according to PRISMA guidelines was performed to identify studies comparing primary dural closure with and without additional sealants. Postoperative complications associated with CSF leakage occurred in 24 (7.74%) and 28 (7.95%) procedures with or without TachoSil, respectively (p = 0.960). Multivariate analysis confirmed no significant differences in complication rate between the two groups (aOR 0.97, 95% CI 0.53-1.80, p = 0.930). There were no significant disparities in postoperative functional, disability or neurological scores. The systematic review identified 661 and included 8 studies in the qualitative synthesis. None showed a significant superiority of additional sealants over standard technique regarding complications, rates of revision surgery or outcome. According to our findings, we summarize that routinary use of TachoSil and similar products as adjuncts to primary dural sutures after intracranial surgical procedures is safe but without clear advantage in complication avoidance or outcome. Future studies should investigate whether their use is beneficial in high-risk settings.


Assuntos
Dura-Máter , Adesivo Tecidual de Fibrina , Humanos , Adesivo Tecidual de Fibrina/uso terapêutico , Dura-Máter/cirurgia , Estudos Retrospectivos , Estudos Prospectivos , Estudos de Coortes , Vazamento de Líquido Cefalorraquidiano/etiologia , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/etiologia , Colágeno/uso terapêutico
19.
No Shinkei Geka ; 50(6): 1150-1157, 2022 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-36426516

RESUMO

Childhood hydrocephalus is a highly diverse disease caused by various factors, and most surgical treatments are performed during infancy. Despite the diversity of hydrocephalus pathologies, treatment options are limited. It is difficult for pediatric neurosurgeons to select and perform appropriate surgical procedures for neonates and infants. Treatment options for hydrocephalus are broadly divided into permanent and temporary. Permanent treatments include cerebrospinal fluid shunt and endoscopic third ventriculostomy; temporary treatment entails cerebrospinal fluid drainage using lumbar puncture and intermittent cerebrospinal fluid drainage with an Ommaya reservoir, ventricular drainage, and ventriculosubgaleal shunt. This article describes in detail Ommaya reservoir placement and ventricular drainage as representative procedures for temporarily treating hydrocephalus.


Assuntos
Hemorragia Cerebral , Hidrocefalia , Recém-Nascido , Lactente , Humanos , Criança , Hemorragia Cerebral/cirurgia , Estudos Retrospectivos , Hidrocefalia/terapia , Drenagem/efeitos adversos , Drenagem/métodos , Vazamento de Líquido Cefalorraquidiano
20.
No Shinkei Geka ; 50(6): 1182-1194, 2022 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-36426519

RESUMO

Endoscopy is essential in less invasive surgery and its use has widely expanded in almost all surgical specialties. This procedure has also been adopted for neurosurgery. It is now introduced in skull base surgery, expanded from endoscopic transsphenoidal surgery, to remove pituitary tumors, assisting tumor removal or removing a tumor only with the endoscope; spine surgery; and endoscopic third ventriculostomy(ETV). ETV is now accepted as a standard technique for treating noncommunicating hydrocephalus. Currently, 1067 neurosurgeons are certified by the Japan Society for Neuroendoscopy, and endoscopic surgery is recognized as a typical treatment option. This article describes the surgical procedure for ETV, a basic procedure for pediatric hydrocephalus. It is important to master intraventricular manipulation using the endoscope. Also, certain tips must be implemented before and after the endoscopic procedure to avoid complications. It is also necessary to emphasize the difference between adult cases, such as high risk of cerebrospinal fluid leakage in child cases. So that every single effort must be done to avoid this leak.


Assuntos
Hidrocefalia , Neuroendoscopia , Adulto , Criança , Humanos , Ventriculostomia/métodos , Neuroendoscopia/métodos , Hidrocefalia/cirurgia , Hidrocefalia/etiologia , Procedimentos Neurocirúrgicos/efeitos adversos , Vazamento de Líquido Cefalorraquidiano/cirurgia
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