RESUMO
BACKGROUND: Cerebral microdialysis enables assessment of regional metabolic physiology and provides biomarkers for clinical correlation in critical conditions, such as subarachnoid hemorrhage (SAH). The aim of our current study was to investigate the correlation between regional cerebral blood flow and microdialysis parameters (glucose, lactate, glycerol, pyruvate concentrations, and lactate/pyruvate metabolic ratio) in patients with SAH. MATERIALS AND METHODS: Twenty-one patients with SAH were enrolled in our retrospective study. Cerebral blood flow (CBF) based on thermal diffusion methodology, the thermal coefficient K, and microdialysis biochemical markers were recorded. The duration of the brain monitoring was 10 days. RESULTS: Microdialysis glucose concentration was inversely related to the cerebral temperature and to the L/P ratio. Furthermore, it was positively correlated to all other microdialysis parameters but glycerol. The K coefficient was strongly and positively correlated with the temperature and marginally with the CBF. The L/P ratio was positively correlated with glycerol, while it was inversely correlated with the CBF. Patients who died had elevated L/P ratio and K coefficient compared to the survivors in our series. CONCLUSIONS: Thermal conductivity coefficient may change over time as cerebral injury progresses and tissue properties alter. These alterations were found to be associated with the microdialysis metabolite concentrations and the CBF itself. The microdialysis biochemical indices of cell stress and death (glycerol, L/P ratio) were positively related to each other, while the measured L/P metabolic ratio was higher among patients who died.
Assuntos
Circulação Cerebrovascular , Fluxometria por Laser-Doppler/métodos , Microdiálise/métodos , Hemorragia Subaracnóidea/diagnóstico , Condutividade Térmica , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
PURPOSE: To evaluate the diagnostic value of 3T (1)H-MRS in grading cerebral gliomas using short and long echo times. METHODS: 1H-MRS was performed on 71 patients with untreated cerebral gliomas. Metabolite ratios of NAA/Cr, Cho/Cr, Cho/NAA, and mI/Cr were calculated for short and long TE and compared between low and high grade gliomas. Lipids were qualitatively evaluated. ROC analysis was performed to obtain the cut-off values for the metabolic ratios presenting statistical difference between the two glioma grades. RESULTS: Intratumoral Cho/Cr at both TEs and long TE Cho/NAA were significantly different between low and high grade gliomas. Peritumoral NAA/Cr of both TEs, as well as long TE Cho/Cr and Cho/NAA ratios, significantly differentiated the two tumor grades. Diagnostic sensitivity of peritumoral short TE NAA/Cr proved to be superior over the other metabolic ratios, whereas intratumoral short TE Cho/Cr reached the highest levels of specificity and accuracy. Overall, short TE 1H-MRS reached higher total sensitivity in predicting glioma grade, over long TE. CONCLUSION: An advantage was found in using short TE over long TE 1H-MRS in the discrimination of low versus high grade gliomas. Moreover, the results suggested that the peritumoral area of gliomas may be more valuable in predicting glioma grade than using only the intratumoral area.
Assuntos
Neoplasias Encefálicas/patologia , Glioma/patologia , Adolescente , Adulto , Idoso , Neoplasias Encefálicas/diagnóstico , Glioma/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Gradação de Tumores , Sensibilidade e Especificidade , Adulto JovemRESUMO
We present the results of a retrospective study employing intraoperative micro-Doppler ultrasonography (MDU) in verifying proper clip placement during cerebral aneurysmal surgery. One hundred and thirty-four patients surgically treated for 147 intracranial aneurysms were studied. Thirteen patients harboring 17 aneurysms were surgically treated on an elective basis, while 121 patients with 130 aneurysms, presented with subarachnoid hemorrhage (SAH). Blood flow velocities of the parent and adjacent vessels as well as the aneurysmal sac were measured using a Conforma Micro-Doppler (Cook Vascular Inc., Leechburg, PA, USA). Pre- and post-operative cerebral angiography was obtained in all our patients. In 23 aneurysms (15.6%) there was decreased or absent flow in the parent vessel or in one of the adjacent vessels after clipping. In another 19 aneurysms (12.9%), MDU demonstrated flow through the aneurysmal dome even though the aneurysmal neck appeared to be totally obliterated. Presence of SAH, anatomic location and size of the aneurysm were associated with improper clip placement in a statistically significant fashion. The false positive rate for MDU was 2% while there were no false negative findings in our study. MDU appears to be a non-invasive, reliable alternative methodology to intra-operative angiography. This inexpensive method may lend itself to routine usage in aneurysm surgery.
Assuntos
Aneurisma Intracraniano/diagnóstico por imagem , Instrumentos Cirúrgicos , Ultrassonografia Doppler em Cores/métodos , Adulto , Idoso , Feminino , Humanos , Aneurisma Intracraniano/patologia , Aneurisma Intracraniano/cirurgia , Complicações Intraoperatórias/patologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Instrumentos Cirúrgicos/estatística & dados numéricosRESUMO
Acute cranial subdural hematoma (SDH) represents a common consequence of traumatic brain injury. The vast majority of acute SDHs larger than 10mm in thickness require immediate surgical evacuation. In rare occasions, however, spontaneous resolution may occur. In our current communication, we present four cases of spontaneous resolution of acute cranial SDH. Further more, the proposed theories explaining spontaneous resolution of acute SDH, as well as, clinical parameters and imaging characteristics that might predict such phenomenon, are also reviewed. The possibility of spontaneous resolution of an acute SDH, although remote, may impact the decision making process regarding the management of these patients under certain conditions.
Assuntos
Hematoma Subdural Intracraniano/diagnóstico por imagem , Doença Aguda , Adulto , Lesões Encefálicas/complicações , Feminino , Escala de Coma de Glasgow , Hematoma Subdural Intracraniano/etiologia , Humanos , Masculino , Remissão Espontânea , Tomografia Computadorizada por Raios XRESUMO
The basal ganglia constitute parts of highly sophisticated and complex neuronal networks, which represent essential elements of functional circuits, actively involved in the control of movement. The physiologic properties of these networks and their interchange with different brain areas could serve as a model for the pathophysiologic explanation of various movement disorders, particularly Parkinson's disease. Stimulation of these networks and subsequent recording of the evoked Local Field Potentials is currently used not only for understanding the pathophysiology of movement disorders but also for the physiologic localization of the anatomical target during deep brain stimulation procedures. An overview of the currently available research and clinical data from the recording of Local Field Potentials as well as the advantages, the disadvantages and the limitations of this methodology are presented in this chapter.
Assuntos
Potenciais de Ação/fisiologia , Gânglios da Base/anatomia & histologia , Gânglios da Base/fisiologia , Rede Nervosa/fisiologia , Animais , Humanos , Transtornos dos Movimentos/patologia , Transtornos dos Movimentos/fisiopatologiaRESUMO
The concept of seizure abortion after prompt detection by employing stimulation is a very appealing one. Several investigators in previous experimental and clinical studies have used stimulation of various anatomical targets with promising results. In this chapter, the authors present their experience with a novel, implantable, local closed-loop responsive neuro-stimulation system (RNS) (Neuropace, Inc., Mountain View, CA, USA). This system consists of a cranially implanted pulse generator, one or two quadripolar subdural strip or depth leads and an external programmer. The system components and technical characteristics are presented. The criteria for selecting candidates for implantation as well as the preliminary results of a clinical trial are also presented. Closed-loop stimulation system appears to be a safe treatment option with promising results for the management of patients with well-localized, focal medically-refractory epilepsy, who are not candidates for surgical resection.
Assuntos
Estimulação Encefálica Profunda/instrumentação , Estimulação Encefálica Profunda/métodos , Epilepsias Parciais/terapia , Eletrodos Implantados , Eletroencefalografia/métodos , Epilepsias Parciais/patologia , Humanos , Imageamento por Ressonância MagnéticaRESUMO
STUDY DESIGN: One hundred two patients with symptoms of cervical radiculopathy, were retrospectively analyzed and their cervical spinal cord diameters obtained. OBJECTIVES: To measure the cervical spinal cord in vivo and to compare the findings with those previously reported in the literature. SUMMARY OF BACKGROUND DATA: Traditionally, autopsy data have served as the linchpin of cervical cord measurements. However, several studies obtained by realtime radiographic methods have failed to confirm such measurements. METHODS: The spinal cord was retrospectively measured in 102 patients. All patients underwent myelogram and postmyelogram computed tomographic scan. Anteroposterior and transverse diameters of the spinal cord were measured from C2 to T1 at the level of each intervertebral disc. The depth of the anterior median fissure and cross-sectional area were measured as well. Plain myelographic films were reviewed but demonstrated no findings contrary to postmyelogram computed tomographic measurements. RESULTS: There was no statistically significant difference in the spinal cord measurements in relation to age or sex. There was an increase in the transverse diameter but not in the anteroposterior diameter in the midcervical spinal enlargement. The anteroposterior diameter decreased linearly. The transverse diameter and the cross-sectional area increased to a maximum at C5, as did the depth of the anterior median fissure. The cervical spinal cord diameter was documented to be 15-20% smaller than has commonly been determined by autopsy data. CONCLUSIONS: Postmyelogram computed tomographic measurements are smaller than those obtained from autopsy data.
Assuntos
Medula Espinal/anatomia & histologia , Adulto , Idoso , Autopsia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mielografia , Pescoço/diagnóstico por imagem , Estudos Retrospectivos , Medula Espinal/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
STUDY DESIGN: Seventy patients undergoing de novo lumbar microdiscectomy were prospectively randomized into a control group and a group in which cold intraoperative wound irrigation along with postoperative wound cooling was used. Postoperative analgesia requirements and length of hospital stay were analyzed and correlated. OBJECTIVES: To evaluate the role of intraoperative cold irrigation and postsurgical cooling in minimizing postoperative lumbar discectomy pain. SUMMARY OF BACKGROUND DATA: Regulated hypothermia has been used frequently in pain reduction; however, the efficacy of such a strategy in lumbar disc procedures has not been established. METHODS: Seventy patients (43 men and 27 women), operated on the first time for lumbar disk herniation were prospectively randomized into two groups. A standard microdiscectomy was performed on all patients. In cohort A the wound site was irrigated with a cold (18 C) 5% bacitracin solution for 5 minutes. Additionally, a cooling microtemperature pump was placed on the wound site for 24 hours after surgery. The patients in the control group (cohort B) were treated in a standard fashion without additional hypothermic therapy. All patients received postoperative analgesia through a self-administered morphine pump. The amount of postoperative analgesia received was calculated in morphine equivalents per kilogram. The length of hospital stay was also noted. RESULTS: The total amount of pain medication was significantly smaller in cohort A than in the control group (cohort B). For the statistical analysis of the results, covariate analyses for both the length of hospital stay and the morphine dose were used, demonstrating a statistically significant difference with P = 0.0001. No postoperative wound infection was noted in either group. CONCLUSIONS: Intraoperative and postoperative wound site cooling is a safe, inexpensive, and efficient therapeutic method. It reduces the patients' postoperative pain, promotes earlier ambulation and decreases the length of hospital stay.
Assuntos
Discotomia , Hipotermia Induzida , Vértebras Lombares/cirurgia , Dor Pós-Operatória/prevenção & controle , Irrigação Terapêutica/métodos , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Período Intraoperatório , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Morfina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Período Pós-Operatório , Resultado do TratamentoRESUMO
Intracranial temperature and its normal variation, as well as its response to various pathologic conditions, has become a critical component of monitoring in neurosurgical intensive care. In a prospective clinical study of 54 neurosurgical patients, intracranial pressure, cerebral perfusion pressure, and intraventricular and systemic temperatures were monitored in a neurosurgical intensive care unit. All of our patients' intraventricular temperatures were initially higher than their systemic temperatures. In 11 patients, the intraventricular temperature became lower than the systemic temperature, in a median time of 4.43 hours (range, 4.21-5.18 hours), prior to any changes in intracranial and cerebral perfusion pressures. Reversal of the disassociation between intraventricular and systemic temperatures may be an early marker of patients with a poor prognosis.
Assuntos
Temperatura Corporal/fisiologia , Morte Encefálica/fisiopatologia , Encéfalo/fisiologia , Adulto , Idoso , Anestésicos Intravenosos , Pressão Sanguínea/fisiologia , Morte Encefálica/diagnóstico , Ventrículos Cerebrais/fisiologia , Feminino , Humanos , Pressão Intracraniana/fisiologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Prognóstico , Propofol , Estudos ProspectivosRESUMO
INTRODUCTION AND BACKGROUND: Traumatic epidural hematoma (EDH) represents a rare head injury complication in infants. Its diagnosis can be quite challenging because its clinical presentation is usually subtle and nonspecific. In our current communication, we present our data regarding the presentation of infants with EDH, their management, and their long-term outcome. MATERIALS AND METHODS: In a retrospective study, the hospital and outpatient clinic charts and imaging studies (head CT and skull X-rays) of 31 infants with pure, supratentorial EDH of traumatic origin were meticulously reviewed. Children Coma Scale score and Trauma Infant Neurologic Score (TINS) were also reviewed. The most common presenting symptom was irritability, which occurred in 18/31 (58.1%) of our patients. Pallor (in 30/31 patients) and cephalhematoma (in 21/31 patients) were the most commonly occurring clinical signs upon admission; both signs represent signs of significant clinical importance. Surgical evacuation via a craniotomy was required in 24/31 of our patients, while 7/31 patients were managed conservatively. The mortality rate in our series was 6.5% (2/31 patients), and our long-term morbidity rate was 3.2% (1/31 patients). CONCLUSIONS: EDH in infants represents a life-threatening complication of head injury, which requires early identification and prompt surgical or conservative management depending on the patient's clinical condition, size of EDH, and presence of midline structure shift on head CT scan. Mortality and long-term morbidity are low with early diagnosis and prompt treatment.
Assuntos
Descompressão Cirúrgica/métodos , Traumatismos Cranianos Fechados/complicações , Hematoma Epidural Craniano/diagnóstico por imagem , Fraturas Cranianas/complicações , Acidentes por Quedas , Cerebelo/irrigação sanguínea , Dura-Máter/irrigação sanguínea , Feminino , Seguimentos , Traumatismos Cranianos Fechados/diagnóstico por imagem , Traumatismos Cranianos Fechados/terapia , Hematoma Epidural Craniano/etiologia , Hematoma Epidural Craniano/terapia , Humanos , Lactente , Recém-Nascido , Masculino , Radiografia , Estudos Retrospectivos , Fraturas Cranianas/diagnóstico por imagem , Índices de Gravidade do TraumaRESUMO
INTRODUCTION: Anatomical hemispherectomy is frequently employed in the surgical management of pediatric patients with medically refractory epilepsy. MATERIALS AND METHODS: In this chapter, we review the historical evolution of this surgical procedure, outline the indications and the criteria for selecting surgical candidates and describe the important pre-operative evaluation of the surgical candidates. DISCUSSION: We provide a detailed description of our surgical technique, anesthesiological considerations, and post-operative care plan. Ultimately we analyze the most common complications associated with this procedure. CONCLUSION: Anatomical hemispherectomy performed in carefully selected pediatric patients with medically intractable epilepsy can be a safe and efficacious surgical procedure.
Assuntos
Epilepsia/patologia , Epilepsia/cirurgia , Hemisferectomia/métodos , Epilepsia/história , Hemisferectomia/história , História do Século XX , Humanos , Assistência Perioperatória/métodosRESUMO
Acute hydrocephalus is a well-documented complication of subarachnoid hemorrhage. The insertion of external ventricular drainage (EVD) has been the standard of care in the management of this complication, aiming primarily at immediate improvement of the clinical condition of these patients, making them more suitable candidates for surgical or endovascular intervention. In our current communication, we review the pertinent literature regarding the relationship of rebleeding and EVD. Several studies have implicated a significantly increased risk of rebleeding in patients with EVD, compared with patients without it. Abrupt lowering of the intracranial pressure could lead to rebleeding due to decreased transmural pressure or removal of the clot sealing the previously ruptured aneurysm. However, a variety of parameters that could affect the rebleeding rate, such as the timing of surgery, the timing and duration of drainage, the size of the aneurysm, as well as the severity of the initial hemorrhage, do not seem to have been adequately explored in the majority of these studies. In addition, a number of clinical trials have failed to provide evidence for the negative role of EVD in the development of rebleeding. Conclusively, further long-term multi-center studies are required in order to establish the exact nature of the relationship between EVD and rebleeding after aneurysmal subarachnoid hemorrhage.
Assuntos
Drenagem/efeitos adversos , Hidrocefalia/terapia , Hemorragia Subaracnóidea/fisiopatologia , Aneurisma Roto/etiologia , Aneurisma Roto/fisiopatologia , Pressão Sanguínea , Drenagem/métodos , Humanos , Hidrocefalia/etiologia , Hidrocefalia/fisiopatologia , Pressão Intracraniana/fisiologia , Recidiva , Fatores de Risco , Ruptura Espontânea/etiologia , Ruptura Espontânea/fisiopatologia , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/terapia , Resultado do TratamentoRESUMO
Hemangiopericytomas represent rare intracranial tumors that have a tendency to recur locally and have the unique characteristic of giving extracranial metastases. Our current communication reviews a series of patients diagnosed with hemangiopericytoma who were treated in our facility. Eleven patients with a mean age of 51.2 years underwent follow-up for a mean time of 7.1 years. Their neuroimaging preoperative evaluation included plain skull X-rays, head CT scans, brain MRI, angiograms, and (1)HMRS. Preoperative embolization of the tumor was employed in 6/11 patients. All patients underwent craniotomy for tumor resection and postoperative radiation treatment was employed on all but one. Grade I resection was accomplished in 6/11 (54.5%), grade III in 4/11 (36.4%), and grade IV in 1/11 (9.1%). Local recurrence was detected in 3/11 (27.3%) at a mean period of 5 (range 2-7.5) years. Extracranial metastatic disease was documented in 4/11 (36.4%) patients at a mean of 4.9 (range 2.5-7) years after the initial diagnosis. The GOS score was: 7/11 (63.6%) scored 5, while 4/11 (36.4%) died at a mean time of 5.5 (range 3-8) years after the initial diagnosis. Intracranial hemangiopericytomas management requires aggressive surgical resection, postoperative radiation treatment, and extensive follow-up to rule out local recurrences and delayed extracranial metastases.
Assuntos
Hemangiopericitoma/cirurgia , Neoplasias Meníngeas/cirurgia , Adulto , Idoso , Biomarcadores Tumorais/análise , Diagnóstico por Imagem , Feminino , Seguimentos , Escala de Resultado de Glasgow , Hemangiopericitoma/diagnóstico , Hemangiopericitoma/patologia , Humanos , Processamento de Imagem Assistida por Computador , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Espectroscopia de Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/patologia , Meninges/patologia , Meninges/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/patologia , Complicações Pós-Operatórias/diagnósticoRESUMO
BACKGROUND: Cerebral hydatid cysts account for up to 3.6% of all intracranial space-occupying lesions, in endemic countries. The vast majority of patients affected are children. Computed tomography (CT) and magnetic resonance imaging (MRI) have greatly contributed to a more accurate diagnosis of hydatids. However, correct pre-operative diagnosis still remains quite puzzling. Extirpation of the intact cyst is the treatment of choice, resulting in most cases to a complete recovery. METHOD: In our retrospective study, we have reviewed 76 cases of intra-cranial hydatid disease operated on in our hospital over a 22 year period. Presenting clinical symptoms and signs and the radiological findings on CT and MRI were documented. Albendazole was given preoperatively to patients with giant (>5 cm) or multiple cysts and postoperatively to all patients. The follow-up period ranged from 12 months to 22 years and the outcome was assessed using the Glasgow Outcome Scale (GOS). FINDINGS: Sixty seven (95.7%) of our patients were children. Increased intracranial pressure and papilledema were the predominant findings in this group, whereas focal neurological deficits were most prevalent in adults. CT and MRI revealed round cystic lesions, isodense and iso-intense respectively to cerebrospinal fluid (CSF), with no rim enhancement or perifocal edema. Multiple cysts were identified in 3 cases. Extirpation of the cyst without rupture was accomplished in 56 patients (73.7%). Recurrences occurred in 19 patients (25%). 4 patients (5.3%) died within 6 months after surgery; 3 of these patients had multiple cysts and one died shortly after the operation due to anaphylactic shock following intra-operative rupture of the cyst. CONCLUSION: Long-term follow-up confirms that intracranial hydatid cysts should always be surgically removed without rupture; the outcome remains excellent in these cases. Correct preoperative diagnosis is vital for the successful outcome of surgery. A high index of suspicion is therefore required in endemic areas despite the availability of advanced neuro-imaging. Medical treatment with albendazole seems to be beneficial both pre- and post-operatively. Newer diagnostic methodologies, such as MR spectroscopy and MR diffusion weighted imaging, might lend themselves to the diagnosis of intracranial hydatid cysts.
Assuntos
Encéfalo/parasitologia , Encéfalo/cirurgia , Equinococose/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Adulto , Albendazol/uso terapêutico , Anticestoides/uso terapêutico , Encéfalo/patologia , Criança , Diagnóstico Diferencial , Equinococose/diagnóstico , Equinococose/fisiopatologia , Feminino , Escala de Resultado de Glasgow , Humanos , Imageamento por Ressonância Magnética , Masculino , Procedimentos Neurocirúrgicos/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/normas , Recidiva , Estudos Retrospectivos , Irrigação Terapêutica/normas , Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
OBJECTIVE: Intraventricular hemorrhage (IVH) represents a clinicopathologic entity with a dismal prognosis. The associated mortality rate has been reported as high as 80%; the morbidity is also quite high. The use of various fibrinolytic agents (streptokinase, urokinase, and recombinant tissue-type plasminogen activator [rt-PA]) has been reported in a small number of clinical series with a very limited number of participants, yielding significant variability regarding inclusion criteria, treatment protocol, and outcome analysis. METHODS: In our prospective study, we report our experience using rt-PA in 21 patients with IVH. Patients with IVH of aneurysmal or arteriovenous malformation origin were excluded. Intraventricular administration of rt-PA was initiated within 24 hours after the ictal event (dose, 3 mg every 24 hours) through a ventricular catheter. The patients' intracranial and cerebral perfusion pressures, cerebrospinal fluid (CSF) cell count, and head CT scans with emphasis to frontal horn dimension and inner cranium diameter at the same level ratio were collected and analyzed. RESULTS: Good outcome was observed in 47.5% of our patients, whereas 28.5% died and 24.0% survived with severe disability. The development of rt-PA-associated complications was as follows: new hemorrhage in 19%, infection in 14.3%, and CSF pleocytosis in 100% of patients. Permanent CSF shunt was required in 40%. The intermediate (3-month) follow up of our survivors showed no significant outcome changes compared with the immediate (1-month) follow up. CONCLUSIONS: Intraventricular administration of rt-PA appears to be beneficial in cases of IVH even though it is occasionally associated with serious complications. Further multi-institutional studies are required for validating this treatment modality and standardizing its parameters.
Assuntos
Hemorragia Cerebral/tratamento farmacológico , Ventrículos Cerebrais , Ativadores de Plasminogênio/administração & dosagem , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/administração & dosagem , Adulto , Idoso , Hemorragia Cerebral/complicações , Feminino , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Injeções Intraventriculares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Proteínas Recombinantes , Estudos Retrospectivos , Estatísticas não Paramétricas , Ventriculostomia/métodosRESUMO
PURPOSE: To determine the factors influencing the outcome of cortical dysplasia resection for medically refractory epilepsy. MATERIAL AND METHODS: 13 patients underwent craniotomy for resection of epileptogenic foci using electrographic and MRI guidance. All patients had had seizures for more than 2 years and were on 3 or more antiepileptic medications. Their preoperative evaluation included MRI, neuropsychological evaluation including the WADA test, video EEG monitoring and intraoperative electrocorticography. Invasive preoperative monitoring was employed in 8 cases. The Engel outcome classification system was used. The mean follow-up time was 60.1 months with a minimum follow-up of 24 months. RESULTS: Postoperatively, all 6 patients younger than 18 years were seizure free. Among 7 patients older than 18 years, 6 were class II and 1 was class III. Based on their preoperative MRI studies, among the patients with abnormal studies, 2 were class I, 5 were class II and 1 was class III. Among patients with normal studies, 4 were class I and 1 class II. Regarding the ictal EEG findings, among patients with localizing findings, 4 were class I and 5 were class II. Among patients with no localization in their ictal EEG, 2 were class I, 1 class II and 1 class III. Regarding the invasive preoperative monitoring of the 7 patients with localizing findings, 5 were class I and 2 were class II. The only patient with nonlocalizing findings was class II. Finally, among the patients with no invasive preoperative monitoring, 3 were class I, 1 was class II and 1 was class III. CONCLUSION: Cortical resection is an effective treatment modality in patients with medically refractory epilepsy. In our series, the outcome was better in patients less than 18 years old and patients with normal preoperative MRI studies.
Assuntos
Córtex Cerebral/patologia , Córtex Cerebral/cirurgia , Epilepsia/patologia , Epilepsia/cirurgia , Adolescente , Adulto , Fatores Etários , Distribuição de Qui-Quadrado , Criança , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
We present a series of 21 patients, 12 males and 9 females, aged 41-76 years, with the preoperative diagnosis of a brain tumor. Both preoperatively and postoperatively, all of our patients underwent either a brain computed tomography (CT) or magnetic resonance imaging (MRI). All the radiographic studies were taped and loaded preoperatively in the Stereotactic Microscopic Navigator (SMN) workstation (Zeiss, Germany). The mean duration of this procedure was 25 +/- 6 min. All our patients were operated on in our institute with the use of the SMN system. The specificity of tumor localization using CT scan was 2.20 +/- 0.25 mm and for the MRI scan 2.6 +/- 0.25 mm. As assessed by postoperative radiographic studies, total gross tumor resection was possible in 20 patients (95.23%). No major intraoperative or early postoperative complications were noted in our series. We believe that the SMN system is a safe, well-tolerated by the patients and simple method with extremely high accuracy and specificity.
Assuntos
Neoplasias Encefálicas/cirurgia , Técnicas Estereotáxicas/instrumentação , Idoso , Astrocitoma/diagnóstico por imagem , Astrocitoma/patologia , Astrocitoma/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/patologia , Meningioma/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
The ability of magnetic resonance spectroscopy (MRS) to differentiate neoplastic brain cells and their metabolic and structural characteristics is evaluated. We examined 120 patients with brain tumors using a 1.5-tesla MRI unit and MRS. The peak areas of N-acetyl-aspartate (NAA), phosphocreatine-creatine (Pcr-Cr), choline-containing compounds (Cho), lactate, lipids, myoinositol, amino acids and the ratios of NAA/Pcr-Cr, NAA/Cho and Cho/Pcr-Cr were calculated by a standard integral algorithm. In normal brain tissue, the following metabolites were identified: NAA at 2.0 ppm, Pcr-Cr at 3.0 ppm and Cho at 3.2 ppm. The different concentrations of the metabolites examined and their role in the biochemical profile of different types of tumors are discussed. The confidence interval of the MRS versus pathology was between 0.9 and 0.954, while it was between 0.52 and 0.631 for MRI versus pathology. The Cho/Pcr-Cr ratio is a very important malignancy marker for histologic tumor grading of astrocytomas. The greater this ratio, the higher the grade of the astrocytoma. NAA/Pcr-Cr together with Cho/Pcr-Cr help specify the presence or absence of a neoplasm. Proton MRS is a useful and promising diagnostic modality not only in diagnosing but also in grading solid brain tumors.
Assuntos
Ácido Aspártico/análogos & derivados , Neoplasias Encefálicas/diagnóstico , Encéfalo/patologia , Espectroscopia de Ressonância Magnética , Adulto , Idoso , Aminoácidos/metabolismo , Ácido Aspártico/metabolismo , Astrocitoma/metabolismo , Encéfalo/metabolismo , Abscesso Encefálico/diagnóstico , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Colina/metabolismo , Creatina/metabolismo , Glioblastoma/diagnóstico , Humanos , Lactatos/metabolismo , Metabolismo dos Lipídeos , Meningioma/diagnóstico , Pessoa de Meia-Idade , Oligodendroglioma/diagnóstico , Fosfocreatina/metabolismo , Valores de ReferênciaRESUMO
OBJECTIVES: The atlantoaxial segment of the cervical spine is commonly destabilized in a variety of disorders. Transarticular screw fixation of the C1-C2 joint has been proposed as a biomechanically superior therapeutic modality. The authors present their experience with this technique. METHODS: A retrospective analysis of 23 patients treated with this technique was performed. The mean follow-up period was 39.5 +/- 0.1 months. RESULTS: Mean duration of hospitalization was 3.4 +/- 0.1 days (range, 2 to 11 days). No intraoperative or early postoperative complications were detected. Four patients (17.4%) had postoperative complications unrelated to the primary procedure. The position of the screw was judged as satisfactory in 21 patients (91.3%). Two patients (8.7%) with suboptimal positioning of the screws were neurologically intact but needed no reoperation. Solid osseous fusion was detected in 19 patients (82.6%). CONCLUSIONS: Transarticular C1-C2 screw fixation appears to be a safe and surgically reliable technique. Criteria for its application and refinements in its technical considerations continue to advance its clinically versatile therapeutic potential.