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1.
BMC Neurol ; 23(1): 49, 2023 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-36721255

RESUMO

BACKGROUND: Primary cerebral epithelioid angiosarcoma (PCEA) is a rare malignant tumor of the central nervous system. To the best of our knowledge, only three cases have been reported in the English language literature thus far. CASE PRESENTATION: Here, we report a fourth case in a 73-year-old man admitted for headache. Radiological examination revealed a mass in the right occipital lobe, which was removed by right occipital craniotomy. Histopathological examination revealed epithelioid angiosarcoma. The patient received radiotherapy after resection but survived for only nine months due to recurrence of the tumor and his declining further surgery. CONCLUSIONS: In this report, we add to the knowledge base on this exceedingly rare tumor, review the small number of relevant cases published previously, and analyze and summarize the clinical and pathological characteristics, treatment options and prognosis of this cancer.


Assuntos
Hemangiossarcoma , Masculino , Humanos , Idoso , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/cirurgia , Craniotomia , Cefaleia , Hospitalização , Idioma
2.
BMJ Open ; 13(1): e063976, 2023 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-36690404

RESUMO

INTRODUCTION: Postoperative delirium (POD) is a common surgical complication. The incidence is 19% in neurological procedures, and advanced age is a risk factor for neurological procedures. Many studies have shown that dexmedetomidine (DEX) reduced the incidence of delirium after non-cardiac surgery in elderly patients. However, there are few studies focus on the effect of DEX on POD in elderly patients undergoing neurosurgery. METHODS AND ANALYSIS: This is a randomised, double-blinded, paralleled-group and controlled trial. Patients older than 65 years and scheduled for elective craniotomy will be randomly assigned to the DEX group and the control group. After endotracheal intubation, patients in the DEX group will be administered with continuous DEX infusion at rate of 0.4 µg/kg/hour until the surgical haemostasis. In the control group, patients will receive the identical volume of normal saline in the same setting. The primary outcome is the incidence of POD during the first 5 days. Delirium will be evaluated through a combination of three methods, including the Richmond Agitation Sedation Scale (RASS), the confusion assessment method for ICU (CAM-ICU) and the 3 min diagnostic interview for CAM (3D-CAM). The RASS, CAM-ICU and 3D-CAM will be evaluated two times per day (08:00-10:00 and 18:00-20:00 hours) during the first postoperative 5 days. Secondary outcomes include pain severity score, quality of recovery, quality of sleep, cognitive function, psychological health state, intraoperative data, physiological status, length of stay in ICU and hospital, hospitalisation costs, non-delirium complications, and 30-day all-cause mortality. ETHICS AND DISSEMINATION: The protocol (V.4.0) has been approved by the medical ethics committee of Beijing Tiantan Hospital, Capital Medical University (KY2021-194-03). The findings of the study will be disseminated in a peer-reviewed journal and at a scientific conference. TRIAL REGISTRATION NUMBER: NCT05168280.


Assuntos
Dexmedetomidina , Delírio do Despertar , Humanos , Idoso , Dexmedetomidina/uso terapêutico , Delírio do Despertar/induzido quimicamente , Método Duplo-Cego , Unidades de Terapia Intensiva , Craniotomia , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
BMC Anesthesiol ; 23(1): 11, 2023 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-36624375

RESUMO

BACKGROUND: Goal-Directed Fluid Therapy (GDFT) is recommended to decrease major postoperative complications. However, data are lacking in intra-cranial neurosurgery. METHODS: We evaluated the efficacy of a GDFT protocol in a before/after multi-centre study in patients undergoing elective intra-cranial surgery for brain tumour. Data were collected during 6 months in each period (before/after). GDFT was performed in high-risk patients: ASA score III/IV and/or preoperative Glasgow Coma Score (GCS) < 15 and/or history of brain tumour surgery and/or tumour greater size ≥ 35 mm and/or mid-line shift ≥ 3 mm and/or significant haemorrhagic risk. Major postoperative complication was a composite endpoint: re-intubation after surgery, a new onset of GCS < 15 after surgery, focal motor deficit, agitation, seizures, intra-cranial haemorrhage, stroke, intra-cranial hypertension, hospital-acquired related pneumonia, surgical site infection, cardiac arrythmia, invasive mechanical ventilation ≥ 48 h and in-hospital mortality. RESULTS: From July 2018 to January 2021, 344 patients were included in 3 centers: 171 in the before and 173 in the after (GDFT) period. Thirty-six (21.1%) patients displayed a major postoperative complication in the Before period, and 50 (28.9%) in the After period (p = 0.1). In the propensity score analysis, we matched 48 patients in each period: 9 (18.8%) patients in the After period and 14 (29.2%) patients in the Before period displayed a major perioperative complication (p = 0.2). Sixty-two (35.8%) patients received GDFT in the After period, with great heterogeneity among centers (p < 0.05). CONCLUSIONS: In our before-after study, GDFT was not associated with a decrease in postoperative major complications in elective intra-cranial neurosurgery.


Assuntos
Hidratação , Objetivos , Humanos , Estudos Retrospectivos , Hidratação/métodos , Tempo de Internação , Craniotomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia
4.
BMC Anesthesiol ; 23(1): 15, 2023 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-36624384

RESUMO

BACKGROUND: Satisfactory brain relaxation is essential in neurosurgery. Desflurane anesthesia and propofol-based total intravenous anesthesia (TIVA) have different effects on cerebral hemodynamics, potentially contributing to discrepant brain relaxation. The purpose of this study was to compare the effects of desflurane and TIVA on brain relaxation in patients undergoing craniotomy for supratentorial tumors. METHODS: In this randomized, controlled study, we enrolled patients aged 18-60 years, with ASA I-III, who were scheduled to undergo elective craniotomy for supratentorial tumors. Patients were randomly assigned in a 1:1 ratio to receive desflurane anesthesia or TIVA. The primary outcome was the proportion of satisfactory brain relaxation. Secondary outcomes included emergence and extubation times, recovery of cognitive function and postoperative complications. RESULTS: Of 369 patients who were assessed for eligibility, 111 were randomized and 110 were included in the modified intention-to-treat analysis (55 in the desflurane group and 55 in the TIVA group). The proportion of satisfactory brain relaxation was similar between the two groups: 69% in the desflurane group and 73% in the TIVA group (RR: 0.950, 95% CI: 0.748-1.207; P = 0.675). Patients assigned to the desflurane group had shorter emergence (10 [8-13] min vs. 13 [10-20] min, P < 0.001) and extubation times (13 [10-18] min vs. 17 [13-23] min, P < 0.001), and better recovery of cognitive function at 15 min after extubation (16 [0-24] vs. 0 [0-20], P = 0.003), but experienced increased postoperative nausea and vomiting (PONV) (16 [29%] vs. 6 [11%] P = 0.017) and tachycardia (22 [40%] vs. 9 [16%], P = 0.006) during recovery. CONCLUSIONS: Desflurane anesthesia and TIVA provide similar brain relaxation in patients without intracranial hypertension undergoing elective craniotomy. Desflurane accelerates the recovery from anesthesia but is associated with increased PONV and tachycardia during the recovery period. TRIAL REGISTRATION: Clinicaltrial.gov (NCT04691128). Date of registration: December 31, 2020.


Assuntos
Anestésicos Inalatórios , Isoflurano , Propofol , Neoplasias Supratentoriais , Humanos , Desflurano , Anestésicos Inalatórios/efeitos adversos , Náusea e Vômito Pós-Operatórios/induzido quimicamente , Anestésicos Intravenosos/efeitos adversos , Isoflurano/efeitos adversos , Anestesia Intravenosa , Período de Recuperação da Anestesia , Propofol/efeitos adversos , Encéfalo/cirurgia , Neoplasias Supratentoriais/cirurgia , Craniotomia
5.
BMC Anesthesiol ; 23(1): 29, 2023 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-36650435

RESUMO

BACKGROUND: Endotracheal extubation under deep anesthesia (deep extubation) has been proved to present stable hemodynamics and steady intracranial pressure during emergence from anesthesia in patients undergoing craniotomy. This study aims to examine, in comparison with deep extubation, if a laryngeal mask airway (LMA) could provide a safer and smoother emergence from anesthesia in patients undergoing craniotomy. METHODS: This prospective randomized controlled study was conducted on patients undergoing elective craniotomy for brain tumors. After the complement of the surgical procedure, the patients had anesthesia maintained with end-tidal sevoflurane concentration 2.5% and also fully regained muscle power (Time Zero), they were randomly assigned to ETT Group (n = 29) for deep extubation or to LMA Group (n = 29), where the endotracheal tube was replaced by a laryngeal mask airway. The primary outcomes were respiratory complications, airway interventions and hemodynamic changes through emergence from anesthesia till 30 min following Time Zero. The secondary outcomes were re-operation incidence in 24 h, stay time in the intensive care unit and postoperative hospital days. RESULTS: At 5 min before Time Zero either oxygen partial pressures (PaO2) or carbon dioxide partial pressures (PaCO2) between the two groups were comparable. No significant PaCO2 change was noted in both groups in 5 min after Time Zero, yet there was a remarkably lower PaO2 in ETT Group at that time point, 188.9 (± 71.1) in ETT Group vs 264.4 (± 85.4) in LMA Group. In ETT Group, coughs and snores were considerably more frequent, and thus more interventions were needed to maintain adequate respiration. From Time Zero on, blood pressures (systolic, diastolic and mean) and heart rates in ETT Group were generally higher than those in LMA Group, but the differences were insignificant at all time points except heart rate at 10 min after Time Zero. The secondary outcomes between the two groups were similar. CONCLUSIONS: Compared with deep extubation, a LMA, as a temporary airway replacement, facilitates a safer and smoother emergence from anesthesia for patients undergoing craniotomy, in terms of better oxygen saturation, fewer respiratory complications and fewer airway interventions. TRIAL REGISTRATION: The study was conducted after receiving approval from Institutional Review Board of Chang Gung Memorial Hospital, Linkou Branch, Taiwan (registration number 202102115A3; January 27, 2022), and the clinicaltrials.gov (NCT05253404) on 23 February 2022.


Assuntos
Anestesia , Máscaras Laríngeas , Humanos , Máscaras Laríngeas/efeitos adversos , Estudos Prospectivos , Intubação Intratraqueal , Craniotomia/efeitos adversos , Anestesia Geral
6.
Neurosurg Rev ; 46(1): 38, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36662312

RESUMO

Awake craniotomy with direct electrical stimulation (DES) is the standard treatment for patients with eloquent area gliomas. DES detects speech and language errors, which indicate functional boundaries that must be maintained to preserve quality of life. During DES, traditional object naming or other linguistic tasks such as tasks from the Dutch Linguistic Intraoperative Protocol (DuLIP) can be used. It is not fully clear which speech and language errors occur in which brain locations. To provide an overview and to update DuLIP, a systematic review was conducted in which 102 studies were included, reporting on speech and language errors and the corresponding brain locations during awake craniotomy with DES in adult glioma patients up until 6 July 2020. The current findings provide a crude overview on language localization. Even though subcortical areas are in general less often investigated intraoperatively, still 40% out of all errors was reported at the subcortical level and almost 60% at the cortical level. Rudimentary localization patterns for different error types were observed and compared to the dual-stream model of language processing and the DuLIP model. While most patterns were similar compared to the models, additional locations were identified for articulation/motor speech, phonology, reading, and writing. Based on these patterns, we propose an updated DuLIP model. This model can be applied for a more adequate "location-to-function" language task selection to assess different linguistic functions during awake craniotomy, to possibly improve intraoperative language monitoring. This could result in a better postoperative language outcome in the future.


Assuntos
Neoplasias Encefálicas , Glioma , Adulto , Humanos , Neoplasias Encefálicas/cirurgia , Fala/fisiologia , Vigília/fisiologia , Qualidade de Vida , Imageamento por Ressonância Magnética , Mapeamento Encefálico/métodos , Glioma/cirurgia , Encéfalo/cirurgia , Craniotomia/métodos , Estimulação Elétrica
7.
Neurosurg Rev ; 46(1): 35, 2023 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-36629928

RESUMO

Cerebellar ischemic stroke (CIS) is a morbid neurological event, with potentially fatal consequences. There is currently no objective standard of care regarding when surgical procedures are required for this entity. We retrospectively reviewed 763 patients with CIS, 247 patients of which had a stroke larger than 1 cm in greatest dimension on cranial imaging. In this subgroup, 11% of patients received ventriculostomy, 12% suboccipital craniectomy, and 9% mechanical endovascular thrombectomy. Various clinical and radiographic variables were examined for relationship to surgical procedures, 30-day mortality rate, and modified Rankin scores. The smallest volume of stroke requiring a surgical procedure was 15.5 mL3 (BrainLab Software). Patients receiving surgical procedures had a higher incidence of multi-territory infarctions, hydrocephalus, cistern compression, 4th ventricular compression, as well as younger age, lower admission GCS, higher admission NIHSS, and higher 30-day mortality/disability. Patients deemed to require surgical procedures for CIS have a higher expected morbidity and mortality than those not requiring surgery. Various clinical and radiographic variables, including stroke volume, can be used to guide selection of patients requiring surgery.


Assuntos
AVC Isquêmico , Acidente Vascular Cerebral , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Craniotomia , Infarto
8.
Math Biosci Eng ; 20(1): 837-858, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36650791

RESUMO

Craniotomy is an invasive operation with great trauma and many complications, and patients undergoing craniotomy should enter the ICU for monitoring and treatment. Based on electronic medical records (EMR), the discovery of high-risk multi-biomarkers rather than a single biomarker that may affect the length of ICU stay (LoICUS) can provide better decision-making or intervention suggestions for clinicians in ICU to reduce the high medical expenses of these patients and the medical burden as much as possible. The multi-biomarkers or medical decision rules can be discovered according to some interpretable predictive models, such as tree-based methods. Our study aimed to develop an interpretable framework based on real-world EMRs to predict the LoICUS and discover some high-risk medical rules of patients undergoing craniotomy. The EMR datasets of patients undergoing craniotomy in ICU were separated into preoperative and postoperative features. The paper proposes a framework called Rules-TabNet (RTN) based on the datasets. RTN is a rule-based classification model. High-risk medical rules can be discovered from RTN, and a risk analysis process is implemented to validate the rules discovered by RTN. The performance of the postoperative model was considerably better than that of the preoperative model. The postoperative RTN model had a better performance compared with the baseline model and achieved an accuracy of 0.76 and an AUC of 0.85 for the task. Twenty-four key decision rules that may have impact on the LoICUS of patients undergoing craniotomy are discovered and validated by our framework. The proposed postoperative RTN model in our framework can precisely predict whether the patients undergoing craniotomy are hospitalized for too long (more than 15 days) in the ICU. We also discovered and validated some key medical decision rules from our framework.


Assuntos
Registros Eletrônicos de Saúde , Descoberta do Conhecimento , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Unidades de Terapia Intensiva , Craniotomia/efeitos adversos , Craniotomia/métodos
9.
Neurosurgery ; 92(2): 225-240, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36580643

RESUMO

BACKGROUND: Awake craniotomy (AC) enables real-time monitoring of cortical and subcortical functions when lesions are in eloquent brain areas. AC patients are exposed to various preoperative, intraoperative, and postoperative stressors, which might affect their mental health. OBJECTIVE: To conduct a systematic review to better understand stress, anxiety, and depression in AC patients. METHODS: PubMed, Scopus, and Web of Science databases were searched from January 1, 2000, to April 20, 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. RESULTS: Four hundred forty-seven records were identified that fit our inclusion and exclusion criteria for screening. Overall, 24 articles consisting of 1450 patients from 13 countries were included. Sixteen studies (66.7%) were prospective, whereas 8 articles (33.3%) were retrospective. Studies evaluated stress, anxiety, and depression during different phases of AC. Twenty-two studies (91.7%) were conducted on adults, and 2 studies were on pediatrics (8.3 %). Glioma was the most common AC treatment with 615 patients (42.4%). Awake-awake-awake and asleep-awake-asleep were the most common protocols, each used in 4 studies, respectively (16.7%). Anxiety was the most common psychological outcome evaluated in 19 studies (79.2%). The visual analog scale and self-developed questionnaire by the authors (each n = 5, 20.8%) were the most frequently tools used. Twenty-three studies (95.8%) concluded that AC does not increase stress, anxiety, and/or depression in AC patients. One study (4.2%) identified younger age associated with panic attack. CONCLUSION: In experienced hands, AC does not cause an increase in stress, anxiety, and depression; however, the psychiatric impact of AC should not be underestimated.


Assuntos
Neoplasias Encefálicas , Adulto , Humanos , Criança , Neoplasias Encefálicas/cirurgia , Depressão , Vigília , Estudos Retrospectivos , Estudos Prospectivos , Craniotomia/métodos , Ansiedade/etiologia
10.
Oper Neurosurg (Hagerstown) ; 24(1): 94-102, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36519883

RESUMO

BACKGROUND: Dynamic craniotomy provides cranial decompression without bone flap removal along with avoidance of cranioplasty and reduced risks for complications. OBJECTIVE: To report the first clinical cases using a novel dynamic craniotomy bone flap fixation system. The NeuroVention NuCrani reversibly expandable cranial bone flap fixation plates provide dynamic bone flap movement to accommodate changes in intracranial pressure (ICP) after a craniotomy. METHODS: The reversibly expandable cranial bone flap fixation plates were used for management of cerebral swelling in a patient with a subdural hemorrhage after severe traumatic brain injury and another patient with a hemorrhagic stroke. RESULTS: Both cases had high ICP's which normalized immediately after the dynamic craniotomy. Progressive postoperative cerebral swelling was noted which was compensated by progressive outward bone flap migration thereby maintaining a normal ICP, and with resolution of the cerebral swelling, the plates retracted the bone flaps to an anatomic flush position. CONCLUSION: The reversibly expandable plates provide an unhinged cranial bone flap outward migration with an increase in ICP and retract the bone flap after resolution of brain swelling while also preventing the bone flap from sinking inside the skull.


Assuntos
Edema Encefálico , Craniotomia , Humanos , Crânio/cirurgia , Placas Ósseas , Retalhos Cirúrgicos , Pressão Intracraniana , Edema Encefálico/cirurgia
11.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 33(6): 350-355, nov.-dic. 2022. ilus
Artigo em Inglês | IBECS | ID: ibc-212994

RESUMO

Central nervous system (CNS) involvement in the context of relapsed/refractory Hodgkin lymphoma (HL) is a quite rare, but well-known complication. Nevertheless, primary CNS–HL is an exceedingly rare condition, which diagnosis is based on well-defined morphological and immunohistochemical features, in addition to isolated involvement of the CNS. In spite of limited casuistry (just over twenty cases reported in the literature), available data agree that primary and isolated CNS–HL, when treated with a combination of surgery followed by some form of adjuvant therapy (radiotherapy±chemotherapy), carries a better prognosis than those cases with CNS involvement in the context of relapsed/refractory HL or those with CNS non-Hodgkin lymphoma. We herein report a case of a 55-year-old female patient who was diagnosed with primary CNS–HL. The patient was treated with complete surgical resection followed by intrathecal chemotherapy and whole brain radiotherapy (WBRT), showing fourteen months of disease-free survival at the time of this case report. A review of the available literature is also presented (AU)


La afectación del sistema nervioso central (SNC) en pacientes con diagnóstico de linfoma de Hodgkin (LH) sistémico es una complicación muy poco frecuente, aunque bien definida. Sin embargo, el LH primario del SNC es una entidad extremadamente rara, cuyo diagnóstico precisa la identificación de un patrón morfológico e inmunohistoquímico específico, así como la afectación aislada del SNC. Pese a contar con una casuística muy limitada (apenas una veintena de casos publicados en la literatura) la bibliografía disponible coincide en que el LH con afectación primaria y aislada del SNC, cuando es tratado con cirugía y tratamiento adyuvante (radioterapia±quimioterapia), parece tener un mejor pronóstico que aquellos casos en los que la afectación del SNC se produce en el contexto de un LH sistémico o en el contexto de un linfoma no Hodgkin. En este artículo se presenta el caso de una mujer de 55 años con diagnóstico histopatológico de LH primario del SNC. La paciente fue sometida a una exéresis completa de la lesión y a tratamiento adyuvante con quimioterapia intratecal y radioterapia holocraneal, con una supervivencia libre de enfermedad hasta la fecha de 14 meses. Se presenta asimismo, la revisión de la literatura disponible (AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Linfoma não Hodgkin/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Linfoma não Hodgkin/terapia , Neoplasias Encefálicas/terapia , Imageamento por Ressonância Magnética , Intervalo Livre de Doença , Terapia Combinada , Craniotomia
12.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 33(6): 361-365, nov.-dic. 2022. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-212996

RESUMO

La craneoplastia es un procedimiento habitual en la práctica neuroquirúrgica. Está asociada a una considerable morbilidad y a varios tipos de complicaciones posquirúrgicas, especialmente infecciones, reabsorción ósea y hematomas. La aparición de dolor facial neuropático no ha sido descrita como complicación posquirúrgica. Presentamos un caso de una paciente que, en el postoperatorio inmediato de una craneoplastia, desarrolló un dolor facial atípico resistente a tratamiento médico y al bloqueo del ganglio esfenopalatino. Finalmente, desapareció tras una revisión quirúrgica de la plastia (AU)


Cranioplasty is a procedure routinely performed in neurosurgery. It is associated with significant morbidity and several types of postsurgical complications. The most common are infections, bone flap resorption and hematomas. Atypical facial pain has not been documented yet as a potential postoperative complication. We present a case of atypical facial pain reported at immediate postoperative period after cranioplasty. The pain was refractory to medical treatment and sphenopalatine ganglion block. Eventually, the pain totally disappeared after surgical revision of the cranial implant (AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Dor Facial/etiologia , Craniotomia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Próteses e Implantes/efeitos adversos , Polietileno , Procedimentos Cirúrgicos Reconstrutivos/métodos , Craniotomia/métodos
13.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 33(6): 383-388, nov.-dic. 2022. ilus
Artigo em Espanhol | IBECS | ID: ibc-213000

RESUMO

El melanoma cerebral primario es un tumor muy infrecuente (0,07% de las neoplasias primarias del SNC). Generalmente muestra un abundante contenido en melanina, y solo en contadas ocasiones se han descrito variantes hipoamelanóticas. Presentamos el caso de una paciente con clínica de cefalea, paresia braquial izquierda y síndrome lobar frontal. La RM mostró una masa frontal derecha con captación homogénea de contraste. Como tratamiento, se realizó una resección quirúrgica completa. El estudio anatomopatológico fue diagnóstico para melanoma, con muy escaso contenido en melanina y alto índice proliferativo. Se realizó un estudio de extensión exhaustivo para descartar otra localización primaria. Debido a varias complicaciones intercurrentes, la paciente evolucionó desfavorablemente, sin llegar a recibir otros tratamientos. La variante amelanótica de los melanomas cerebrales primarios no ha sido descrita con detalle previamente. Repasamos la literatura al respecto y discutimos los detalles de manejo y diagnóstico de esta entidad clínica (AU)


Primary brain melanoma is a very rare tumour (only 0.07% of primary CNS neoplasms) which usually shows with abundant melanin content; whereas hypo/melanotic variants have been scarcely described. We introduce the case of a female patient with headache, left brachial paresis and frontal lobar syndrome. The MRI image showed a right frontal mass with homogeneous contrast uptake. As treatment, a complete surgical resection was performed. Pathology was diagnostic for melanoma, with very low melanin content and a high proliferative index. A thorough extension study was performed to rule out an extracranial primary origin. Due to several intercurrent complications, the patient evolved unfavorably, not being able to receive further treatment. The amelanotic variant of primary intracranial malignant melanomas has not been described in detail previously. We will review the literature, focusing on the particularities of management and diagnosis of this clinical entity (AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias Encefálicas/diagnóstico por imagem , Melanoma Amelanótico/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Imageamento por Ressonância Magnética , Neoplasias Encefálicas/cirurgia , Melanoma Amelanótico/cirurgia , Craniotomia
14.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 33(6): 398-401, nov.-dic. 2022. ilus
Artigo em Espanhol | IBECS | ID: ibc-213003

RESUMO

La neuralgia glosofaríngea es una enfermedad rara cuyo tratamiento inicial es farmacológico. Cuando la terapia médica no es eficaz, se encuentran disponibles diferentes opciones quirúrgicas, incluida la radiocirugía estereotáctica, la descompresión microvascular o la sección de nervios. Se presenta el caso de una mujer de 26 años con neuralgia glosofaríngea y malformación de Chiari. Este tipo raro de neuralgia a veces se asocia con una anomalía de la unión cráneo-cervical. Se realizó una expansión de fosa posterior con duraplastia y descompresión microvascular. La paciente mostró una completa desaparición del dolor, sin necesidad de llevar a cabo la resección de las amígdalas cerebelosas (AU)


Glossopharyngeal neuralgia is a rare disease whose initial treatment is pharmacological. When medical therapy is not effective, different surgical options are available including stereotactic radiosurgery, microvascular decompression or nerve section. It is reported a case of a 26-year-old female with glossopharyngeal neuralgia and Chiari malformation. This rare type of neuralgia sometimes is associated with an abnormality of the cranio-cervical junction. It was performed a posterior fossa expansion with duraplasty and microvascular decompression. The patient showed a complete disappearance of the pain, with no need of tonsil resection (AU)


Assuntos
Humanos , Feminino , Adulto , Malformação de Arnold-Chiari/diagnóstico por imagem , Doenças do Nervo Glossofaríngeo/diagnóstico por imagem , Malformação de Arnold-Chiari/cirurgia , Doenças do Nervo Glossofaríngeo/cirurgia , Imageamento por Ressonância Magnética , Craniotomia
15.
Neurosurg Rev ; 46(1): 19, 2022 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-36529827

RESUMO

Augmented and virtual reality (AR, VR) are becoming promising tools in neurosurgery. AR and VR can reduce challenges associated with conventional approaches via the simulation and mimicry of specific environments of choice for surgeons. Awake craniotomy (AC) enables the resection of lesions from eloquent brain areas while monitoring higher cortical and subcortical functions. Evidence suggests that both surgeons and patients benefit from the various applications of AR and VR in AC. This paper investigates the application of AR and VR in AC and assesses its prospective utility in neurosurgery. A systematic review of the literature was performed using PubMed, Scopus, and Web of Science databases in accordance with the PRISMA guidelines. Our search results yielded 220 articles. A total of six articles consisting of 118 patients have been included in this review. VR was used in four papers, and the other two used AR. Tumour was the most common pathology in 108 patients, followed by vascular lesions in eight patients. VR was used for intraoperative mapping of language, vision, and social cognition, while AR was incorporated in preoperative training of white matter dissection and intraoperative visualisation and navigation. Overall, patients and surgeons were satisfied with the applications of AR and VR in their cases. AR and VR can be safely incorporated during AC to supplement, augment, or even replace conventional approaches in neurosurgery. Future investigations are required to assess the feasibility of AR and VR in various phases of AC.


Assuntos
Realidade Aumentada , Realidade Virtual , Humanos , Vigília , Craniotomia , Procedimentos Neurocirúrgicos/métodos
16.
Trials ; 23(1): 996, 2022 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-36510271

RESUMO

BACKGROUND: Post-craniotomy pain is a common occurrence which is associated with poor outcomes. Pre-emptive scalp infiltration with dexamethasone and ropivacaine has been proven effective in previous studies but with limited clinical significance. Dexamethasone palmitate emulsion (D-PAL) is a pro-drug incorporating dexamethasone into lipid microspheres with greater anti-inflammatory activity and fewer side effects than free dexamethasone. However, its effects in post-craniotomy pain management remain unknown. This study hypothesizes that pre-emptive scalp infiltration with ropivacaine plus D-PAL emulsion can achieve superior analgesic effects to ropivacaine alone in adult patients undergoing craniotomy. METHODS/DESIGN: This is a single center, randomized controlled trial enrolling 130 patients scheduled for supratentorial craniotomy, which is expected to last longer than 4 h. We compare the efficacy and safety for postoperative pain relief of ropivacaine plus D-PAL group and ropivacaine alone group following pre-emptive scalp infiltration. Primary outcome will be pain Numerical Rating Scale at 24 h postoperatively. Secondary outcomes will include further analgesia evaluations and drug-related complications within a follow-up period of 3 months. DISCUSSION: This is the first randomized controlled trial aiming to assess the possible benefits or disadvantages of D-PAL emulsion for incisional pain in craniotomy. It may provide an alternative to optimize pain outcome for neurosurgical patients. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04488315). Registered on 19 July 2020.


Assuntos
Anestésicos Locais , Palmitatos , Adulto , Humanos , Ropivacaina/efeitos adversos , Anestésicos Locais/efeitos adversos , Estudos Prospectivos , Palmitatos/uso terapêutico , Método Duplo-Cego , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Craniotomia/efeitos adversos , Dexametasona/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
JAMA ; 328(22): 2211-2212, 2022 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-36511922

RESUMO

In this narrative medicine essay, a mother describes the process of diagnosis, craniotomy, and recovery her child experienced as a tribute to her child's courage.


Assuntos
Craniotomia
19.
Medicine (Baltimore) ; 101(50): e32214, 2022 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-36550878

RESUMO

Postcraniotomy fever is a common complication in patients undergoing infratentorial surgeries. There are few studies about it and the efficacy of intensive antibiotic regimens, which remain to be studied. We carried out a retrospective study in patients undergoing infratentorial surgeries to analyze the factors associated with postcraniotomy fever and further investigated the efficacy of different antibiotic regimens on fever and abnormal cerebrospinal fluid (CSF) results. Among the 115 patients, 74 (64.3%) had fever after craniotomy. Univariate analysis results showed that disease type, drainage tube placement, duration of drainage tube, and intraoperative bleeding volume were associated with postcraniotomy fever in patients undergoing infratentorial surgeries (P < .05). The multivariate analysis results showed that the duration of drainage tube (odds ratio = 1.010, 95% confidence interval: 1.232-6.178, P = .014) and duration of surgery (odds ratio = 1.010, 95% confidence interval: 1.002-1.017, P = .013) were associated with postcraniotomy fever in these patients. After treatment with different antibiotic regimens, the changes of white blood cells, sugar, chlorine and protein in CSF in patients with intensive antibiotic regimens were -638.48 × 106/L, 0.25 mmol/L, -0.76 mmol/L and -0.16 g/L respectively, which did not show significant differences when compared with ordinary antibiotic regimens (P > .05). Most cases of fever at the early stage after craniotomy in patients with infratentorial surgeries were nonintracranial infectious. Intensive antibiotic regimens did not show obvious advantages in improving the body temperature and CSF examination results. It is not necessary to use intensive antibiotic regimens too early, such as carbapenems or linezolids.


Assuntos
Antibacterianos , Craniotomia , Humanos , Estudos Retrospectivos , Antibacterianos/uso terapêutico , Craniotomia/efeitos adversos , Craniotomia/métodos , Complicações Pós-Operatórias/etiologia
20.
BMJ Case Rep ; 15(12)2022 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-36581354

RESUMO

A man in his 40s with a history of coronary artery disease previously treated with a drug-eluting stent presented for elective craniotomy and resection of an asymptomatic but enlarging meningioma. During his craniotomy, he received desmopressin and tranexamic acid for surgical bleeding. Postoperatively, the patient developed chest pain and was found to have an ST-elevation myocardial infarction (MI). Because of the patient's recent neurosurgery, standard post-MI care was contraindicated and he was instead managed symptomatically in the intensive care unit. Echocardiogram on postoperative day 1 demonstrated no regional wall motion abnormalities and an ejection fraction of 60%. His presentation was consistent with thrombosis of his diagonal stent. He was transferred out of the intensive care unit on postoperative day 1 and discharged home on postoperative day 3.


Assuntos
Stents Farmacológicos , Neoplasias Meníngeas , Meningioma , Infarto do Miocárdio , Masculino , Humanos , Stents Farmacológicos/efeitos adversos , Meningioma/cirurgia , Meningioma/complicações , Infarto do Miocárdio/etiologia , Neoplasias Meníngeas/cirurgia , Neoplasias Meníngeas/complicações , Craniotomia/efeitos adversos
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