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2.
Acta Neurochir (Wien) ; 166(1): 293, 2024 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-38985334

RESUMO

OBJECTIVE: Intraoperative rupture (IOR) is the most common adverse event encountered during surgical clip obliteration of ruptured intracranial aneurysms. Besides increasing surgeon experience and early proximal control, no methods exist to decrease IOR risk. Thus, our objective was to assess if partial endovascular coil embolization to protect the aneurysm before clipping decreases IOR. METHODS: We conducted a retrospective analysis of patients with ruptured intracranial aneurysms that were treated with surgical clipping at two tertiary academic centers. We compared patient characteristics and outcomes of those who underwent partial endovascular coil embolization to protect the aneurysm before clipping to those who did not. The primary outcome was IOR. Secondary outcomes were inpatient mortality and discharge destination. RESULTS: We analyzed 100 patients. Partial endovascular aneurysm protection was performed in 27 patients. Age, sex, subarachnoid hemorrhage severity, and aneurysm location were similar between the partially-embolized and non-embolized groups. The median size of the partially-embolized aneurysms was larger (7.0 mm [interquartile range 5.95-8.7] vs. 4.6 mm [3.3-6.0]; P < 0.001). During surgical clipping, IOR occurred less frequently in the partially-embolized aneurysms than non-embolized aneurysms (2/27, 7.4%, vs. 30/73, 41%; P = 0.001). Inpatient mortality was 14.8% (4/27) in patients with partially-embolized aneurysms and 28.8% (21/73) in patients without embolization (P = 0.20). Discharge to home or inpatient rehabilitation was 74.0% in patients with partially-embolized aneurysms and 56.2% in patients without embolization (P = 0.11). A complication from partial embolization occurred in 2/27 (7.4%) patients. CONCLUSIONS: Preoperative partial endovascular coil embolization of ruptured aneurysms is associated with a reduced frequency of IOR during definitive treatment with surgical clip obliteration. These results and the impact of preoperative partial endovascular coil embolization on functional outcomes should be confirmed with a randomized trial.


Assuntos
Aneurisma Roto , Embolização Terapêutica , Aneurisma Intracraniano , Humanos , Aneurisma Intracraniano/cirurgia , Aneurisma Intracraniano/terapia , Masculino , Feminino , Aneurisma Roto/cirurgia , Embolização Terapêutica/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , Resultado do Tratamento , Instrumentos Cirúrgicos , Adulto , Procedimentos Endovasculares/métodos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Procedimentos Neurocirúrgicos/métodos
3.
Neurocirugia (Astur : Engl Ed) ; 35(4): 205-209, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38964823

RESUMO

The anterior communicating artery (AcoA) aneurysms represent the most complex aneurysms of the anterior circulation. For years, surgical challenges including the intricate anatomy and narrow surgical corridor have been overcome using supplementary techniques including extended craniotomies, wide opening of the cisterns, gyrus rectus resection and special clips like fenestrated clips. However, imaginative solutions such as intraoperative clip modification may be inevitable in particular cases for safe clipping. We retrospectively analyzed clinical records of two patients who required clip modification intraoperatively. Case #1 underwent microsurgical clipping of a ruptured, 4-mm AcoA aneurysm. Unfortunately, given the short distance between the two A2s, it was not possible to clip the aneurysm without a compromise to the contralateral A2 with the available shortest 3mm-fenestrated clip. We then used the clip modification technique intraoperatively by shortening the clip tips with mesh-plaque cutter and smoothening the remaining sharp ends using cautery sanding. Eventually, the aneurysm was clipped successfully with the modified-fenestrated clip. Post-clipping imagings confirmed complete occlusion of the aneurysm and patency of parent arteries. Case 2# underwent microsurgical clipping for a ruptured, 1-mm AcoA aneurysm. Like Case 1#, the initial clipping attempt with the available shortest 4mm-fenestrated clip failed given the excessive length of the tips. The patient, thus, required clip modification as described above. The aneurysm was then clipped successfully using the modified-fenestrated clip, protecting bilateral A2s. Post-clipping imagings demonstrated patency of parent arteries with no residual aneurysm filling. Clip modification seems to be an effective option in clipping the AcoA aneurysms when available clips are too long to secure them safely.


Assuntos
Aneurisma Intracraniano , Instrumentos Cirúrgicos , Humanos , Aneurisma Intracraniano/cirurgia , Aneurisma Intracraniano/diagnóstico por imagem , Feminino , Pessoa de Meia-Idade , Masculino , Aneurisma Roto/cirurgia , Aneurisma Roto/diagnóstico por imagem , Estudos Retrospectivos , Microcirurgia/instrumentação , Microcirurgia/métodos , Desenho de Equipamento , Idoso , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/instrumentação
5.
Neurosurg Rev ; 47(1): 318, 2024 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-38995460

RESUMO

Studies comparing different treatment methods in patients with middle cerebral artery (MCA) aneurysms in different subgroups of onset symptoms are lacking. It is necessary to explore the safety and efficacy of open surgical treatment and endovascular therapy in patients with MCA aneurysms in a specific population. This study aimed to compare microsurgical clipping versus endovascular therapy regarding complication rates and outcomes in patients with MCA aneurysms presenting with neurological ischemic symptoms. This was a retrospective cohort study in which 9656 patients with intracranial aneurysms were screened between January 2014 and July 2022. Further, 130 eligible patients were enrolled. The primary outcome was the incidence of serious adverse events (SAEs) within 30 days of treatment, whereas secondary outcomes included postprocedural target vessel-related stroke, disabling stroke or death, mortality, and aneurysm occlusion rate. Among the 130 included patients, 45 were treated with endovascular therapy and 85 with microsurgical clipping. The primary outcome of the incidence of SAEs within 30 days of treatment was significantly higher in the clipping group [clipping: 23.5%(20/85) vs endovascular: 8.9%(4/45), adjusted OR:4.05, 95% CI:1.20-13.70; P = 0.024]. The incidence of any neurological complications related to the treatment was significantly higher in the clipping group [clipping:32.9%(28/85) vs endovascular:15.6%(7/45); adjusted OR:3.49, 95%CI:1.18-10.26; P = 0.023]. Postprocedural target vessel-related stroke, disabling stroke or death, mortality rate, and complete occlusion rate did not differ significantly between the two groups. Endovascular therapy seemed to be safer in treating patients with MCA aneurysms presenting with neurological ischemic symptoms compared with microsurgical clipping, with a significantly lower incidence of SAEs within 30 days of treatment and any neurological complications related to the treatment during follow-up.


Assuntos
Procedimentos Endovasculares , Aneurisma Intracraniano , Microcirurgia , Humanos , Aneurisma Intracraniano/cirurgia , Aneurisma Intracraniano/complicações , Masculino , Feminino , Procedimentos Endovasculares/métodos , Pessoa de Meia-Idade , Microcirurgia/métodos , Adulto , Estudos Retrospectivos , Idoso , Resultado do Tratamento , Isquemia Encefálica/cirurgia , Isquemia Encefálica/etiologia , Procedimentos Neurocirúrgicos/métodos , Instrumentos Cirúrgicos , Complicações Pós-Operatórias/epidemiologia , Artéria Cerebral Média/cirurgia
7.
Rev Col Bras Cir ; 51: e20243619, 2024.
Artigo em Inglês, Português | MEDLINE | ID: mdl-38896634

RESUMO

INTRODUCTION: 3-dimensional printing has enabled the development of unique and affordable additive manufacturing, including the prototyping and production of surgical forceps. Objective: demonstrate the development, 3D printing and mechanical-functional validation of a laparoscopic grasping forceps. METHODS: the clamp was designed using a computer program and printed in 3 dimensions with polylactic acid (PLA) filament and added 5 screws for better leverage. Size and weight measurements were carried out, as well as mechanicalfunctional grip and rotation tests in the laboratory with a validated simulator. RESULTS: Called "Easylap", the clamp weighed 48 grams, measured 43cm and was printed in 8 pieces, taking an average of 12 hours to produce. It allowed the simulation of the functional characteristics of laparoscopic pressure forceps, in addition to the rotation and rack locking mechanism. However, its strength is reduced due to the material used. CONCLUSION: It is possible to develop plastic laparoscopic grasping forceps through 3-dimensional printing.


Assuntos
Desenho de Equipamento , Laparoscopia , Impressão Tridimensional , Instrumentos Cirúrgicos , Laparoscopia/instrumentação , Laparoscopia/métodos
8.
Medicine (Baltimore) ; 103(23): e38451, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38847672

RESUMO

Although endoscopic forceps biopsy is the gold standard for early gastric cancer (EGC) diagnosis, the method can cause endoscopic resection of specimens and histological discrepancies. This study aims to examine the risk factors for histological discrepancies in EGC and long-term clinical outcomes. This retrospective study included patients diagnosed with differentiated-type EGC using forceps biopsy. Patients without histological discrepancies and with undifferentiated types in endoscopic resection histology were categorized into the concordant and discordant groups, respectively. Clinical characteristics and long-term outcomes related to histological discrepancies were analyzed. A total of 957 lesions from 936 patients were enrolled. An overall discrepancy rate of 8.7% was confirmed, with an undifferentiated-type discrepancy of 5.5%. The discordant group showed a higher tendency for lesions to be located in the upper third region, to have whitish discoloration, and to undergo a greater number of biopsies compared with the concordant group. Multivariate analysis confirmed that lesion location in the upper third region (odds ratio [OR]: 2.125; 95% confidence interval [CI]: 1.032-5.277; P = .041) and whitish surface discoloration (OR: 13.615; 95% CI: 6.028-28.728; P = .001) were significantly correlated with histologic discrepancy. Compared with the concordant group, the discordant group had a lower curative resection rate, but no differences were observed in complications, local recurrence, or survival rates. Upper third location and whitish discoloration were risk factors for the histologic discrepancy between differentiated and undifferentiated types in patients with EGC. For curative resections performed in patients with EGC and histologic discrepancies and without additional treatment, careful follow-up is possible.


Assuntos
Neoplasias Gástricas , Humanos , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/patologia , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Fatores de Risco , Idoso , Biópsia/métodos , Instrumentos Cirúrgicos , Gastroscopia/métodos , Detecção Precoce de Câncer/métodos , Ressecção Endoscópica de Mucosa/métodos
9.
PLoS One ; 19(6): e0304603, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38870196

RESUMO

Iatrogenic transmission of prions, the infectious agents of fatal Creutzfeldt-Jakob disease, through inefficiently decontaminated medical instruments remains a critical issue. Harsh chemical treatments are effective, but not suited for routine reprocessing of reusable surgical instruments in medical cleaning and disinfection processes due to material incompatibilities. The identification of mild detergents with activity against prions is therefore of high interest but laborious due to the low throughput of traditional assays measuring prion infectivity. Here, we report the establishment of TESSA (sTainlESs steel-bead Seed Amplification assay), a modified real-time quaking induced cyclic amplification (RT-QuIC) assay that explores the propagation activity of prions with stainless steel beads. TESSA was applied for the screening of about 70 different commercially available and novel formulations and conditions for their prion inactivation efficacy. One hypochlorite-based formulation, two commercially available alkaline formulations and a manual alkaline pre-cleaner were found to be highly effective in inactivating prions under conditions simulating automated washer-disinfector cleaning processes. The efficacy of these formulations was confirmed in vivo in a murine prion infectivity bioassay, yielding a reduction of the prion titer for bead surface adsorbed prions below detectability. Our data suggest that TESSA represents an effective method for a rapid screening of prion-inactivating detergents, and that alkaline and oxidative formulations are promising in reducing the risk of potential iatrogenic prion transmission through insufficiently decontaminated instrument surfaces.


Assuntos
Príons , Aço Inoxidável , Instrumentos Cirúrgicos , Animais , Camundongos , Aço Inoxidável/química , Descontaminação/métodos , Síndrome de Creutzfeldt-Jakob/transmissão , Síndrome de Creutzfeldt-Jakob/prevenção & controle , Desinfecção/métodos , Detergentes/química , Detergentes/farmacologia , Humanos , Desinfetantes/farmacologia , Oxirredução
10.
Zhonghua Yi Xue Za Zhi ; 104(21): 1979-1986, 2024 Jun 04.
Artigo em Chinês | MEDLINE | ID: mdl-38825941

RESUMO

Objective: To analyze the efficacy of alternate titanium clip closure in preventing postoperative complications for patients with gastric mucosal lesions after endoscopic submucosal dissection (ESD). Methods: Clinical data of patients with gastric mucosal lesions who underwent ESD in the Department of Gastroenterology, Zhongda Hospital, Southeast University, were retrospectively collected from January 1, 2013 to August 31, 2023. According to the postoperative wound closure status, the patients were divided into completely closed group (complete closure of ESD wounds using alternate titanium clip closure), partially closed group (partial closure of ESD wounds), and unclosed group (without use of clips for treatment of ESD wounds). The incidence of postoperative complications as well as wound healing at 1 month and 3 months after surgery were compared among three groups, and the factors related to delayed bleeding after ESD for gastric mucosal lesions were analyzed through multiple logistic regression analysis. Results: A total of 846 patients were included, 430 cases in the completely closed group, including 300 males and 130 females, age [M (Q1, Q3)] was 65(56, 72) years old; one hundred and nine cases in unclosed group, including 78 males and 31 females, aged 66 (60, 71) years; and 307 cases in the partially closed group, including 214 males and 93 females, aged 66 (59, 71) years. The difference in the rate of delayed postoperative bleeding between the completely closed group [2.1% (9/430)] and the unclosed group [5.5% (6/109)] was not statistically significant (P=0.072), but both were lower than that of the partially closed group [9.4% (29/307), P<0.05)]. Further stratified analysis showed that, for the lesions located in the lower 1/3 of the stomach, the rate of postoperative bleeding was lower in the completely closed group than in the partially closed and unclosed groups [0.9% (2/222) vs 11.4% (4/35) vs 9.5% (7/74), respectively, P<0.001]. For lesions≥50 mm in length, the rate of postoperative bleeding was lower in the completely closed group than that in the partially closed and unclosed group[0 vs 11.8% (2/17) vs 20.5% (15/73), respectively, P=0.004]. The incidence of postoperative abdominal pain in the completely closed group [84.2% (363/430)] was lower than that in the unclosed group [97.2% (106/109)] and the partially closed group [95.4% (293/307), both P<0.001)]. The score of postoperative abdominal pain in the completely closed group [0 (0, 1)], was lower than that in the unclosed group [3 (2, 3)], and that in the partially closed group [2 (1, 3)] (both P<0.001). The wound healing rate of the completely closed group [80% (176/220)] was higher than that of the unclosed group [52.3% (33/63)] and the partially closed group [52.2% (83/159)] at 1 month postoperatively (both P<0.001); the healing rate of all three groups reached 100% at 3 months postoperatively. Multiple logistic regression analysis showed that the presence of ulcers or scars on the surface of the lesion (OR=2.930, 95%CI:1.503-5.712, P=0.002), and the diameter (OR=1.031, 95%CI:1.015-1.047,P<0.001) were related factors for postoperative bleeding. Conclusions: The alternate titanium clip closure surgery can reduce postoperative abdominal pain and shorten wound healing time in patients with gastric mucosal lesions after ESD surgery. The risk of postoperative bleeding can be reduced for lesions with a diameter≥50 mm and located in the lower 1/3 of the stomach.


Assuntos
Ressecção Endoscópica de Mucosa , Mucosa Gástrica , Complicações Pós-Operatórias , Humanos , Ressecção Endoscópica de Mucosa/efeitos adversos , Ressecção Endoscópica de Mucosa/métodos , Masculino , Idoso , Feminino , Mucosa Gástrica/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Pessoa de Meia-Idade , Instrumentos Cirúrgicos , Neoplasias Gástricas/cirurgia , Titânio , Cicatrização , Gastroscopia
11.
PLoS One ; 19(6): e0305693, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38917181

RESUMO

This study developed and validated a surgical instrument motion measurement system for skill evaluation during practical laparoscopic surgery training. Owing to the various advantages of laparoscopic surgery including minimal invasiveness, this technique has been widely used. However, expert surgeons have insufficient time for providing training to beginners due to the shortage of surgeons and limited working hours. Skill transfer efficiency has to be improved for which there is an urgent need to develop objective surgical skill evaluation methods. Therefore, a simple motion capture-based surgical instrument motion measurement system that could be easily installed in an operating room for skill assessment during practical surgical training was developed. The tip positions and orientations of the instruments were calculated based on the marker positions attached to the root of the instrument. Because the patterns of these markers are individual, this system can track multiple instruments simultaneously and detect exchanges. However due to the many obstacles in the operating room, the measurement data included noise and outliers. In this study, the effect of this decrease in measurement accuracy on feature calculation was determined. Accuracy verification experiments were conducted during wet-lab training to demonstrate the capability of this system to measure the motion of surgical instruments with practical accuracy. A surgical training experiment on a cadaver was conducted, and the motions of six surgical instruments were measured in 36 cases of laparoscopic radical nephrectomy. Outlier removal and smoothing methods were also developed and applied to remove the noise and outliers in the obtained data. The questionnaire survey conducted during the experiment confirmed that the measurement system did not interfere with the surgical operation. Thus, the proposed system was capable of making reliable measurements with minimal impact on surgery. The system will facilitate surgical education by enabling the evaluation of skill transfer of surgical skills.


Assuntos
Competência Clínica , Laparoscopia , Laparoscopia/educação , Humanos , Instrumentos Cirúrgicos , Movimento (Física) , Cadáver , Nefrectomia/educação , Nefrectomia/métodos
12.
Acta Neurochir (Wien) ; 166(1): 253, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38847921

RESUMO

BACKGROUND/PURPOSE: Several periprocedural adjuncts for elective surgical aneurysm treatment have been introduced over the last 20 years to increase safety and efficacy. Besides the introduction of IONM in the late-1990s, ICG-videoangiography (ICG-VAG) since the mid-2000s and intraoperative CT-angiography/-perfusion (iCT-A/-P) since the mid-2010s are available. We aimed to clarify whether the introduction of ICG-VAG and iCT-A/-P resulted in our department in a stepwise improvement in the rate of radiologically detected postoperative ischemia, complete aneurysm occlusion and postoperative new deficits. METHODS: Patients undergoing microsurgical clip occlusion for unruptured anterior circulation aneurysms between 2000 and 2019 were included, with ICG-VAG since 2009 and iCT-A/-P (for selected cases) since 2016. Baseline characteristics and treatment-related morbidity/outcome focusing on differences between the three distinct cohorts (cohort-I: pre-ICG-VAG-era, cohort-II: ICG-VAG-era, cohort-III: ICG-VAG&iCT-A/-P-era) were analyzed. RESULTS: 1391 patients were enrolled (n = 74 were excluded), 779 patients were interventionally treated, 538 patients were surgically clipped by a specialized vascular team (cohort-I n = 167, cohort-II n = 284, cohort-III n = 87). Aneurysm size was larger in cohort-I (8.9 vs. 7.5/6.8 mm; p < 0.01) without differences concerning age (mean:55years), gender distribution (m: f = 1:2.6) and aneurysm location (MCA:61%, ICA:18%, ACA/AcomA:21%). There was a stepwise improvement in the rate of radiologically detected postoperative ischemia (16.2vs.12.0vs.8.0%; p = 0.161), complete aneurysm occlusion (68.3vs.83.6vs.91.0%; p < 0.01) and postoperative new deficits (10.8vs.7.7vs.5.7%; p = 0.335) from cohort-I to -III. After a mean follow-up of 12months, a median modified Rankin scale of 0 was achieved in all cohorts. DISCUSSION: Associated with periprocedural technical achievements, surgical outcome in elective anterior circulation aneurysm surgery has improved in our service during the past 20 years.


Assuntos
Isquemia Encefálica , Aneurisma Intracraniano , Complicações Pós-Operatórias , Humanos , Aneurisma Intracraniano/cirurgia , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Feminino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Idoso , Isquemia Encefálica/prevenção & controle , Isquemia Encefálica/etiologia , Isquemia Encefálica/diagnóstico por imagem , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Neurocirúrgicos/métodos , Instrumentos Cirúrgicos , Adulto , Resultado do Tratamento , Angiografia Cerebral/métodos , Estudos Retrospectivos , Microcirurgia/métodos , Angiografia por Tomografia Computadorizada/métodos
13.
Am J Case Rep ; 25: e943891, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38853402

RESUMO

BACKGROUND The Over-the-Scope-Clip (OTSC) System is a class of endoscopic clips intended to provide improved strength and tissue capture compared to conventional through-the-scope clips. These clips are generally safe and effective in managing many gastrointestinal conditions, with a low overall adverse event rate. Although the OTSC has been used to treat gastrointestinal bleeding and bowel perforations for many years, it often is relegated to second-line therapy and has only recently become a first-line hemostatic therapy for gastrointestinal bleeding. CASE REPORT Here, we present a unique adverse event of the OTSC causing iatrogenic ligation of the gastroduodenal artery (GDA). A 71-year-old man presented with 6 months of epigastric abdominal pain and 2 weeks of hematemesis, and was ultimately diagnosed with a bleeding duodenal ulcer. He underwent multiple endoscopic interventions to attempt to control the duodenal ulcer bleeding, including placement of the OTSC on a visible vessel. Soon after OTSC placement, he became hypotensive with recurrent hematochezia, and Interventional Radiology was consulted for endovascular management of the bleeding. Angiography showed the OTSC had been deployed across the midportion of the GDA from the duodenal lumen, effectively ligating the GDA, causing bleeding due to direct vascular injury. This bleeding was ultimately controlled with coil embolization. However, this iatrogenic ligation of the midportion of the GDA by the OTSC significantly complicated endovascular intervention to control the bleeding. CONCLUSIONS As the OTSC device becomes more commonly used in the endoscopy suite, it is important to share potential pitfalls that may be encountered in the clinical setting that impact not only endoscopists and patients, but other specialties as well.


Assuntos
Duodeno , Doença Iatrogênica , Humanos , Masculino , Idoso , Ligadura , Duodeno/lesões , Duodeno/irrigação sanguínea , Instrumentos Cirúrgicos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Úlcera Duodenal
16.
Obes Surg ; 34(7): 2730-2735, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38862751

RESUMO

INTRODUCTION: In minimally invasive upper gastrointestinal and bariatric surgery, proper organ retraction, especially liver retraction, is essential to achieve better per-operative precision and safety. Most currently used methods require specific material which might not be available in all hospitals. We introduce an easily reproducible low-cost trocar-less elastic intra-corporeal retractor (ICR). MATERIALS AND METHODS: ICR was created then used in two institutions where around 500 upper gastrointestinal and bariatric procedures are jointly performed yearly. Its design and application require an elastic rubber band, three staples, and a needle holder. For liver retraction, ICR is anchored to the right diaphragmatic crus and the anterior abdominal wall, creating a triangular shaped retractor. RESULTS: ICR requires around 2-3 min for application and can be easily repositioned for adequate exposure. Its trocar-less and intra-corporeal characteristics offer the advantage of decreasing the risk of bleeding, infection, and liver injury accompanying additional trocars, transcutaneous punctures and conventional retractors. CONCLUSION: ICR is a safe, effective, inexpensive, and easily reproducible intra-corporeal organ retractor which can be used in both laparoscopic and robotic bariatric surgery.


Assuntos
Cirurgia Bariátrica , Desenho de Equipamento , Laparoscopia , Obesidade Mórbida , Humanos , Cirurgia Bariátrica/instrumentação , Cirurgia Bariátrica/métodos , Laparoscopia/métodos , Laparoscopia/instrumentação , Obesidade Mórbida/cirurgia , Instrumentos Cirúrgicos , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos
20.
Turk Neurosurg ; 34(4): 716-727, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38874254

RESUMO

AIM: To compare microsurgical clipping and endovascular therapy (EVT) for the management of shunt-dependent hydrocephalus (SDH) in patients with subarachnoid hemorrhage (SAH) and hydrocephalus. MATERIAL AND METHODS: This retrospective study was conducted from July 2018 to December 2022 and included 67 patients with SAH accompanied by acute hydrocephalus. Patients' demographic, clinical, and radiological data, such as age, sex, Glasgow Coma Scale scores, Hunt and Hess scale, Fischer grade, external ventricular drain (EVD) duration, complications, Ommaya reservoir placement, cerebrospinal fluid drainage, and outcomes, were obtained. Statistical analyses, including univariate analysis and stepwise logistic regression, revealed significant risk factors for shunt dependence. RESULTS: Of the 67 patients, 33 underwent microsurgical clipping and 34 received EVT. Spasmolysis reduced shunt dependency, whereas early EVD placement correlated with reduced shunt dependence (p=0.002). The Ommaya reservoir helped in the management of meningitis but was found to be associated with shunt dependency (p=0.04). Multiple logistic regression analysis revealed that perioperative infarct was a significant risk factor for shunt dependence (p=0.05). No significant difference in patient outcomes was observed between the two treatment groups. However, patients who received EVT had shorter intensive care unit and hospital stays. CONCLUSION: This study shows that managing clinical vasospasm with spasmolysis may reduce shunt dependency. Overall, both microsurgical clipping and EVT offer similar long-term outcomes and efficacy in preventing shunt dependence, but the latter has the advantage of shorter hospital stay. These findings provide crucial insights for clinical decision-making and patient care in SDH after SAH.


Assuntos
Aneurisma Roto , Procedimentos Endovasculares , Hidrocefalia , Hemorragia Subaracnóidea , Humanos , Feminino , Masculino , Hidrocefalia/cirurgia , Hidrocefalia/etiologia , Procedimentos Endovasculares/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Aneurisma Roto/cirurgia , Aneurisma Roto/complicações , Hemorragia Subaracnóidea/cirurgia , Hemorragia Subaracnóidea/complicações , Idoso , Resultado do Tratamento , Adulto , Derivações do Líquido Cefalorraquidiano , Aneurisma Intracraniano/cirurgia , Aneurisma Intracraniano/complicações , Instrumentos Cirúrgicos , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos
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