RESUMEN
ABSTRACT: Cervical spondylotic myelopathy (CSM) is a common disease with an increased anticipated burden to health systems worldwide. Methods to predict outcomes in these patients are needed so physicians can provide more effective care. Fractional anisotropy (FA) analysis is a promising technique used to quantify how preserved the diffusion is in neural pathways. A systematic review and meta-analysis were performed using the PRISMA guidelines. Full articles available online were searched for correlation coefficients between FA values and mJOA scores. Average FA values, preoperative mJOA, and postoperative mJOA scores were gathered to perform a correlation analysis. A total of 5 articles presented correlations between FA and mJOA change and were included in the correlation meta-analysis. Correlation coefficients varied from -0.42 and 0.55. The number of patients in each study varied from 15 to 95. The Random effects model resulted in a non-significant correlation coefficient of 0.1315 (95% CI: -0.2575 to 0.4839; p= 0.5124). Spearman's correlation analysis was significant for preoperative vs postoperative mJOA (r = 0.79, p = 0.02), while preoperative FA did not correlate significantly with preoperative or postoperative mJOA. At this point, the data available in the literature is insufficient to determine a real correlation between FA and mJOA scores. More studies are necessary for a better understanding of this matter. Level of Evidence III; Study Review.
RESUMO: A mielopatia espondilótica cervical (CSM, pelas suas siglas em inglês) é uma doença comum com elevados gastos para os sistemas de saúde em todo o mundo. Métodos para prever resultados nesses pacientes são necessários para que a atenção médica seja mais eficaz. A análise de anisotropia fracionada (FA) é uma técnica promissora usada para quantificar a preservação da difusão nas vias neurais. Uma revisão sistemática e meta-análise foi realizada usando as diretrizes PRISMA. Artigos completos disponíveis online foram avaliados em busca de coeficientes de correlação entre valores de FA e escores de mJOA. Valores médios de FA, escores de mJOA pré-operatórios e pós-operatórios foram coletados para realizar uma análise de correlação. Um total de 5 artigos apresentaram correlações entre alteração de FA e mJOA e foram incluídos na meta-análise de correlação. Os coeficientes de correlação variaram entre -0,42 e 0,55. O número de pacientes em cada estudo variou de 15 a 95. O modelo de efeitos aleatórios resultou em um coeficiente de correlação não significativo de 0,1315 (95% CI: -0,2575 a 0,4839; p= 0,5124). A análise de correlação de Spearman foi significativa para mJOA pré-operatório vs. pós-operatório (r = 0,79, p = 0,02), enquanto a FA pré-operatório não apresentou correlação significativa com o mJOA pré-operatório ou pós-operatório. Os dados disponíveis na literatura neste momento são insuficientes para determinar uma correlação real entre os escores FA e mJOA. Mais estudos são necessários para uma melhor compreensão deste assunto. Nível de Evidência III; Revisão de Estudos.
RESUMEN: La mielopatía cervical espondilótica (CSM, por sus siglas en inglés) es una enfermedad común con una mayor carga anticipada para los sistemas de salud en todo el mundo. Se necesitan métodos para predecir los resultados en estos pacientes para que los médicos puedan brindar una atención más eficaz. El análisis de anisotropía fraccional (FA) es una técnica prometedora que se utiliza para cuantificar cuán preservada está la difusión en las vías neurales. Se realizó una revisión sistemática y un metanálisis utilizando las pautas PRISMA. Se buscaron artículos completos disponibles en línea para encontrar coeficientes de correlación entre los valores de FA y las puntuaciones de mJOA. Se recopilaron los valores promedio de FA, mJOA preoperatorios y mJOA postoperatorios para realizar un análisis de correlación. Un total de 5 artículos presentaron correlaciones entre el cambio de FA y mJOA y se incluyeron en el metanálisis de correlación. Los coeficientes de correlación variaron entre -0,42 y 0,55. El número de pacientes en cada estudio varió de 15 a 95. El modelo de efectos aleatorios resultó en un coeficiente de correlación no significativo de 0,1315 (IC 95%: -0,2575 a 0,4839; p= 0,5124). El análisis de correlación de Spearman fue significativo para la mJOA preoperatoria frente a la posoperatoria (r = 0,79, p = 0,02), mientras que la FA preoperatoria no presentó una correlación significativa con la mJOA preoperatoria o posoperatoria. Los datos disponibles en la literatura en este momento son insuficientes para determinar una correlación real entre las puntuaciones de FA y mJOA. Son necesarios más estudios para una mejor comprensión de este asunto. Nivel de Evidencia III; Revisión de Estudios.
Asunto(s)
Enfermedades de la Médula EspinalRESUMEN
Introduction Endoscopic spine surgery enables the minimally invasive treatment of pathologies affecting the spinal cord and roots. Herein we describe an unprecedented technique of Ultrasound-Guided in-plane interlaminar lumbar endoscopic approach with a smartphone and portable light source. Methods The interlaminar approach was performed in a cadaveric specimen at L4 to 5 and L5 to S1 bilaterally. A curvilinear 2 to 5 MHz ultrasound probe was employed, the puncture was performed with the needle, a guide wire was inserted until the flavum ligament, followed by the dilator and working cannula. A 30° spinal endoscope, with an optical adapter of the endoscope camera for smartphone and portable endoscope lighting was inserted, the flavum ligament was visualized, and an opening in this site was performed with the scissors. Open dissection of the specimen was subsequently performed by identifying the puncture site in the interlaminar window. Results The four interlaminar punctures were successfully guided by ultrasound; the opening of the ligamentum flavum was performed in the most lateral part of the interlaminar space, near the junction of the superior and inferior articular processes of the corresponding vertebrae in all the punctures. Discussion The ultrasound makes possible to identify facets, foramina, transverse processes, and the interlaminar space. It is possible to minimize the use of radioscopy and its associated risks, both for patients and health professionals. Conclusions The ultrasound-guided, in-plane, interlaminar, lumbar endoscopic approach with smartphone-adapted endoscope and portable light source is feasible and practical, minimizing radiation risks and making it possible to perform endoscopic spinal surgery.
Introdução A cirurgia endoscópica da coluna possibilita o tratamento minimamente invasivo de patologias que acometem a medula espinhal e raízes. Aqui descrevemos uma técnica inédita de acesso endoscópica, interlaminar, lombar, em plano guiado por ultrassom com um smartphone e fonte de luz portátil. Métodos A abordagem interlaminar foi realizada em espécime cadavérico em L4 a 5 e L5 a S1 bilateralmente. Foi utilizado um transdutor de ultrassom curvilíneo de 2 a 5MHz, realizada a punção com a agulha, inserido um fio guia até o ligamento amarelo, seguido do dilatador e da cânula de trabalho. O endoscópio de coluna de 30° com adaptador óptico para smartphone e iluminação portátil foi inserido, visualizando o ligamento amarelo, que foi aberto com tesoura. A dissecção aberta do espécime foi realizada posteriormente, identificando o local da punção na janela interlaminar. Resultados As quatro punções interlaminares foram guiadas com sucesso por ultrassom; a abertura do ligamento amarelo realizada foi na parte mais lateral do espaço interlaminar, próximo à junção dos processos articulares superior e inferior das vértebras correspondentes em todas as punções. Discussão A ultrassonografia permite identificar facetas, forames, processos transversos e o espaço interlaminar. É possível minimizar o uso da radioscopia e seus riscos associados, tanto para pacientes quanto para profissionais de saúde. Conclusões A abordagem endoscópica, interlaminar, lombar, em plano guiada por ultrassom, com endoscópio adaptado à smartphone e fonte de luz portátil, é viável e prática, minimizando os riscos de radiação e possibilitando a realização de cirurgia endoscópica da coluna vertebral.
RESUMEN
BACKGROUND: Hemichorea may point to a structural lesion in the contralateral basal ganglia with a large list of possible causes. Cavernous angioma may be rarely a possible cause for acute appearance of this movement disorder. CASE DESCRIPTION: We present a rare case of a 32-year-old female patient with hemichorea caused by a cavernoma (or cavernous angioma) in the contralateral insula and putamen with complete improvement of symptoms with surgical resection of the lesion. CONCLUSIONS: We believe that surgical resection of basal ganglia cavernomas may be feasible with minor risks and resolution of clinical symptoms in the immediate postoperative period.
Asunto(s)
Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/cirugía , Hemangioma Cavernoso/complicaciones , Hemangioma Cavernoso/cirugía , Paresia/etiología , Paresia/cirugía , Adulto , Ganglios Basales/diagnóstico por imagen , Corteza Cerebral/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , Procedimientos Neuroquirúrgicos/métodos , Complicaciones Posoperatorias/terapia , Putamen/diagnóstico por imagenRESUMEN
BACKGROUND: Vestibular schwannoma (VS) is the most common benign tumor originating in the cerebellopontine angle. In most cases, tumors tend to grow and deserve proper treatment. Sometimes they stabilize, and rarely they decrease in size spontaneously. METHODS: We evaluated retrospectively the images of patients with spontaneous tumor regression. We describe the common neuroimage findings of patients with spontaneous tumoral regression. RESULTS: Four patients with diagnosis of VS were followed with magnetic resonance imaging (MRI). There were some relevant features in MRI: a heterogeneous contrast enhancement in the outer layer of the tumor and presence of a cerebrospinal fluid column between the tumor and the entrance of the internal auditory canal. The percentage of tumor diameter reduction ranged from 20% to 40%. CONCLUSIONS: Some MRI features may demonstrate a spontaneous involution of VS and may be closely followed in asymptomatic or oligosymptomatic patients.
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Neoplasias Cerebelosas/patología , Ángulo Pontocerebeloso/patología , Neuroma Acústico/patología , Adulto , Anciano , Neoplasias Cerebelosas/complicaciones , Femenino , Pérdida Auditiva/etiología , Pérdida Auditiva/patología , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Regresión Neoplásica Espontánea/patología , Neuroma Acústico/complicaciones , Estudios Retrospectivos , Acúfeno/etiología , Acúfeno/patologíaRESUMEN
INTRODUCTION: Chordoma is a malignant tumor that usually involves the axial skeleton. Intradural chordomas are even rarer and 37 cases have been reported to the best of our knowledge. We present a case of a patient with an atypical metastatic diffuse intradural spinal involvement. CASE DESCRIPTION: We present a 33-year-old woman previously submitted to five brain surgeries to treat a posterior fossa intradural chordoma since December 2012. Currently, she presented almost with right and left hemiplegia (grade 2 bilaterally) and also left oculomotor, adbucent and facial nerve paresis. We performed neuroaxis magnetic resonance MR which disclosed stability of posterior fossa tumor which was previously irradiated. However, there were new intradural lesions at the level of C3, T11/T12 and L4/L5/S1 vertebrae. DISCUSSION: With the advent of contemponaeous surgery, radiotherapy options and even available chemotherapy to treat Chordomas (Imatinib), patients may experience enlarged survival and thus face complications such as drop metastases along neuroaxis. Our case illustrates a late (6â¯years) follow-up presentation of an initial posterior fossa intradural chordoma. It suggests that whole neuraxis involvement may be the final presentation of all patients harbouring chordomas and surviving after adequate initial treatment.
Asunto(s)
Cordoma/patología , Neoplasias Infratentoriales/secundario , Neoplasias de la Médula Espinal/secundario , Adulto , Cordoma/cirugía , Femenino , Humanos , Neoplasias Infratentoriales/cirugía , Imagen por Resonancia MagnéticaRESUMEN
A 4-year-old girl was admitted to the emergency department after having been buried beneath a wall. A computed tomography scan revealed anterior grade V L5-S1 spondylolisthesis, and magnetic resonance imaging showed a traumatic rupture of the fibrous annulus of the L5-S1 intervertebral disc and lesion of the anterior longitudinal and yellow ligaments. The patient underwent anterior and posterior fixation. Four months later she was able to walk independently, despite a persistent left foot drop. Additionally, we conducted a literature review on lumbosacral spondyloptosis in the pediatric population published between 1990 and 2017. We found 16 cases, 86.6% of which were male, with a mean patient age of 16 ± 5.05 years. Most patients underwent spine instrumentation. Based on the data reviewed, the neurological status at admission might be a valid predictor of outcome. Pedicle screws are a safe and reliable procedure for stable fixation of the spine in these cases. The removal of screws is discouraged.
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Región Lumbosacra/lesiones , Región Lumbosacra/cirugía , Fusión Vertebral/métodos , Espondilolistesis/cirugía , Niño , Descompresión Quirúrgica/métodos , Femenino , HumanosRESUMEN
METHODS: Thirty cases, previously treated according to the new algorithm, were presented to four spine surgeons who were questioned about their personal suggestion for treatment, and the treatment suggested according to the application of the algorithm. After four weeks, the same questions were asked again to evaluate reliability (intra- and inter-observer) using the Kappa index. RESULTS: The reliability of the treatment suggested by applying the algorithm was superior to the reliability of the surgeons' personal suggestion for treatment. When applying the upper cervical spine injury treatment algorithm, an agreement with the treatment actually performed was obtained in more than 89% of the cases. CONCLUSION: The system is safe and reliable for treating traumatic upper cervical spine injuries. The algorithm can be used to help surgeons in the decision between conservative versus surgical treatment of these injuries.
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Algoritmos , Vértebras Cervicales/lesiones , Neurocirugia , Traumatismos Vertebrales/cirugía , Adolescente , Adulto , Anciano , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Traumatismos Vertebrales/clasificación , Adulto JovenRESUMEN
INTRODUCTION: Chiari malformation type I (CM) is the main congenital malformation disease of the craniovertebral junction. The ideal surgical treatment is still controversial. Invasive procedures inside the cerebrospinal fluid (CSF) space and associated with dural repair are considered the gold standard; however, less invasive surgery with isolated bone decompression without dural opening may be possible in selected patients. Our study evaluates the efficacy of intraoperative CSF flow measurement with ultrasonography (USG) as a determining parameter in the selection of these patients. METHODS: We analyzed prospectively 49 patients with CM operated on at the Hospital das Clínicas, College of Medicine, University of São Paulo. Patients underwent decompressive surgery with or without opening of the dura mater after intraoperative USG measuring flow rate. A value of 3 cm/second was considered a cutoff. Quality of life before and after surgery and the improvement of neck pain and headache were evaluated. RESULTS: Among 49 patients enrolled, 36 patients (73%) had CSF flow >3 cm/second and did not undergo duraplasty. In 13 patients (27%) with initial flow <3 cm/second, dural opening was performed together with duraplasty. All patients improved when preoperative and postoperative scores were compared, and all clinical parameters evaluated did not differ between both surgical groups. Patients submitted to bone decompression alone had a lower complication rate. CONCLUSIONS: Intraoperative USG with measurement of CSF allows the proper selection of patients with CM for less invasive surgery with bone decompression without duraplasty.
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Malformación de Arnold-Chiari/diagnóstico por imagen , Malformación de Arnold-Chiari/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Monitoreo Intraoperatorio/métodos , Ultrasonografía Intervencional/métodos , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Adulto JovenRESUMEN
ABSTRACT In the present study, we evaluated the reliability and safety of a new upper cervical spine injury treatment algorithm to help in the selection of the best treatment modality for these injuries. Methods Thirty cases, previously treated according to the new algorithm, were presented to four spine surgeons who were questioned about their personal suggestion for treatment, and the treatment suggested according to the application of the algorithm. After four weeks, the same questions were asked again to evaluate reliability (intra- and inter-observer) using the Kappa index. Results The reliability of the treatment suggested by applying the algorithm was superior to the reliability of the surgeons’ personal suggestion for treatment. When applying the upper cervical spine injury treatment algorithm, an agreement with the treatment actually performed was obtained in more than 89% of the cases. Conclusion The system is safe and reliable for treating traumatic upper cervical spine injuries. The algorithm can be used to help surgeons in the decision between conservative versus surgical treatment of these injuries.
RESUMO Avaliamos a reprodutibilidade e segurança do algoritmo Upper Cervical Spine Injuries Treatment Algorithm (UCITA) recém proposto para a escolha do tratamento das lesões traumáticas da junção crânio-cervical. Métodos Trinta casos previamente tratados de acordo com o algoritmo foram apresentados a quatro cirurgiões de coluna, sendo questionada a conduta pessoal dos mesmos e a conduta segundo a aplicação do algoritmo. Após 4 semanas, foram refeitas as mesmas perguntas para avaliar a reprodutibilidade (intra e interobservador) do algoritmo, através do índice estatístico “Kappa”. Resultados A reprodutibilidade da conduta com o uso do algoritmo foi superior a reprodutibilidade da conduta pessoal dos cirurgiões. Com o uso do UCITA, a concordância do tratamento realmente efetivado foi encontrada em mais de 89% dos casos. Conclusão O uso do UCITA foi seguro e reprodutível, podendo ser usado como ferramenta auxiliar na tomada de decisão entre tratamento cirúrgico versus conservador dos traumatismos da junção crâniocervical.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Traumatismos Vertebrales/cirugía , Algoritmos , Vértebras Cervicales/lesiones , Neurocirugia , Traumatismos Vertebrales/clasificación , Puntaje de Gravedad del Traumatismo , Variaciones Dependientes del Observador , Reproducibilidad de los ResultadosRESUMEN
UNLABELLED: Paraclinoid aneurysms are lesions located adjacent to the clinoid and ophthalmic segments of the internal carotid artery. In recent years, flow diverter stents have been introduced as a better endovascular technique for treatment of these aneurysms. METHOD: From 2009 to 2014, a total of 43 paraclinoid aneurysms in 43 patients were surgically clipped. We retrospectively reviewed the records of these patients to analyze clinical outcomes. RESULTS: Twenty-six aneurysms (60.5%) were ophthalmic artery aneurysms, while 17 were superior hypophyseal artery aneurysms (39.5%). The extradural approach to the clinoid process was used to clip these aneurysms. One hundred percent of aneurysms were clipped (complete exclusion in 100% on follow-up angiography). The length of follow-up ranged from 1 to 60 months (mean, 29.82 months). CONCLUSION: Surgical clipping continues to be a good option for the treatment of paraclinoid aneurysms.
Asunto(s)
Enfermedades de las Arterias Carótidas/cirugía , Aneurisma Intracraneal/cirugía , Microcirugia/métodos , Arteria Oftálmica/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Adulto , Anciano , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/cirugía , Angiografía Cerebral , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Microcirugia/instrumentación , Persona de Mediana Edad , Arteria Oftálmica/diagnóstico por imagen , Complicaciones Posoperatorias , Estudios Retrospectivos , Factores de Riesgo , Estadísticas no Paramétricas , Instrumentos Quirúrgicos , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/instrumentaciónRESUMEN
ABSTRACT Paraclinoid aneurysms are lesions located adjacent to the clinoid and ophthalmic segments of the internal carotid artery. In recent years, flow diverter stents have been introduced as a better endovascular technique for treatment of these aneurysms. Method From 2009 to 2014, a total of 43 paraclinoid aneurysms in 43 patients were surgically clipped. We retrospectively reviewed the records of these patients to analyze clinical outcomes. Results Twenty-six aneurysms (60.5%) were ophthalmic artery aneurysms, while 17 were superior hypophyseal artery aneurysms (39.5%). The extradural approach to the clinoid process was used to clip these aneurysms. One hundred percent of aneurysms were clipped (complete exclusion in 100% on follow-up angiography). The length of follow-up ranged from 1 to 60 months (mean, 29.82 months). Conclusion Surgical clipping continues to be a good option for the treatment of paraclinoid aneurysms.
RESUMO Aneurismas paraclinóideos são lesões localizadas adjacentes aos segmentos clinóideos e oftálmicos da artéria carótia interna. Os stents desviadores de fluxo tem sido crescentemente aplicados com sucesso. Métodos De 2009 a 2014, um total de 43 aneurismas paraclinóideos foram clipados em 43 pacientes. Analisamos retrospectivamente os dados dos pacientes e desfechos clínicos. Resultados Vinte seis aneurismas (60,5%) foram de artéria oftálmica e 17 de artéria hipofisária superior (39,5%). O acesso extradural à clinóide foi utilizado para todos aneurismas. Cem por cento dos aneurismas foram clipados com oclusão de 100% na angiografia controle. O tempo de follow-up oscilou de 1 a 60 meses, com media de 29 meses. Conclusão A clipagem cirúrgica é uma opção boa e segura para o tratamento de aneurismas paraclinóideos.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de las Arterias Carótidas/cirugía , Aneurisma Intracraneal/cirugía , Microcirugia/métodos , Arteria Oftálmica/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Angiografía Cerebral , Arteria Carótida Interna , Arteria Carótida Interna/cirugía , Aneurisma Intracraneal , Microcirugia/instrumentación , Arteria Oftálmica , Complicaciones Posoperatorias , Estudios Retrospectivos , Factores de Riesgo , Estadísticas no Paramétricas , Instrumentos Quirúrgicos , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/instrumentaciónRESUMEN
ABSTRACT Spinal cord epidural metastasis (SEM) is a common complication of systemic cancer. Predicting these patient’s survival is a key factor to select the proper treatment modality, but the three most used score scales to predict their survival (Tokuhashi revised score, Tomita score and Bauer modified score) were designed in single institutions and their reliability to predict correctly the patient’s survival were first tested only in those specific populations. This prognostication issue is addressed in this article, evaluating retrospectively the survival of 17 patients with SEM from a Brazilian general hospital with these score scales. Our results show that the actual survival of those patients were worse than the predicted of all three score scales, suggesting that differences between the different populations might have affected their reliability and alert that their usage as a major factor to select the most appropriate treatment have to be done with caution.
RESUMO Metástases vertebrais são uma complicação comum em pacientes com câncer sistêmico. Avaliar o prognóstico e a sobrevida desses pacientes é um fator de grande importância para escolher o tratamento mais adequado, porém as três escalas mais usadas atualmente para prever a sobrevida deles (Tokuhashi revisada, Tomita e Bauer modificada) foram desenhadas em instituições isoladas, e sua habilidade em estimar corretamente a sobrevida desses pacientes foram testadas primeiramente apenas nessas populações específicas. Essa questão de estimar o prognóstico é abordada nesse artigo, analisando retrospectivamente a sobrevida de 17 pacientes com metástase vertebral provenientes de um hospital geral no Brasil com essas escalas. Nossos resultados apontam que a sobrevida real desses pacientes foi menor que a prevista pelas três escalas, sugerindo que as diferenças entres as diferentes populações podem ter afetado a aplicabilidade delas. Assim, alertamos que o uso dessas escalas em populações diferentes das estudadas originalmente deve ser feito com cuidado.
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Epidurales/mortalidad , Neoplasias Epidurales/secundario , Esperanza de Vida , Neoplasias de la Próstata/patología , Índice de Severidad de la Enfermedad , Compresión de la Médula Espinal/cirugía , Neoplasias de la Tiroides/patología , Escala Resumida de Traumatismos , Brasil/epidemiología , Toma de Decisiones Clínicas , Neoplasias Epidurales/complicaciones , Neoplasias Epidurales/cirugía , Valor Predictivo de las Pruebas , Pronóstico , Reproducibilidad de los Resultados , Estudios Retrospectivos , Tasa de Supervivencia , Compresión de la Médula Espinal/etiología , Resultado del TratamientoRESUMEN
Spinal cord epidural metastasis (SEM) is a common complication of systemic cancer. Predicting these patient's survival is a key factor to select the proper treatment modality, but the three most used score scales to predict their survival (Tokuhashi revised score, Tomita score and Bauer modified score) were designed in single institutions and their reliability to predict correctly the patient's survival were first tested only in those specific populations. This prognostication issue is addressed in this article, evaluating retrospectively the survival of 17 patients with SEM from a Brazilian general hospital with these score scales. Our results show that the actual survival of those patients were worse than the predicted of all three score scales, suggesting that differences between the different populations might have affected their reliability and alert that their usage as a major factor to select the most appropriate treatment have to be done with caution.
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Neoplasias Epidurales/mortalidad , Neoplasias Epidurales/secundario , Esperanza de Vida , Neoplasias de la Próstata/patología , Índice de Severidad de la Enfermedad , Compresión de la Médula Espinal/cirugía , Neoplasias de la Tiroides/patología , Escala Resumida de Traumatismos , Adulto , Anciano , Brasil/epidemiología , Toma de Decisiones Clínicas , Neoplasias Epidurales/complicaciones , Neoplasias Epidurales/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Reproducibilidad de los Resultados , Estudios Retrospectivos , Compresión de la Médula Espinal/etiología , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Indocyanine green (ICG) video angiography has been used for several medical indications in the last decades. It allows a real time evaluation of vascular structures during the surgery. This study describes the surgical results of a senior vascular neurosurgeon. We retrospectively searched our database for all aneurysm cases treated with the aid of intraoperative ICG from 2009 to 2014. A total of 61 aneurysms in 56 patients were surgically clipped using intraoperative ICG. Clip reposition after ICG happened in 2 patients (3.2%). Generally, highly variable clip adjustment rates of 2%-38% following ICG have been reported since the introduction of this imaging technique. The application of ICG in vascular neurosurgery is still an emerging challenge. It is an adjunctive strategy which facilitates aneurismal evaluation and treatment in experienced hands. Nevertheless, a qualified vascular neurosurgeon is still the most important component of a high quality work.
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Angiografía Cerebral/métodos , Colorantes , Verde de Indocianina , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Monitoreo Intraoperatorio/métodos , Angiografía de Substracción Digital/métodos , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Procedimientos Neuroquirúrgicos/métodos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Instrumentos Quirúrgicos , Resultado del Tratamiento , Cirugía Asistida por Video/métodosRESUMEN
BACKGROUND: Lumbar discectomy is still one of the most common spinal surgeries performed today. Nevertheless, there are few publications considering severe complications. CASE DESCRIPTION: We report a case with severe complication, without any previous report, a brain empyema after cerebrospinal fluid leak with good outcome afterword. A 45 years old man, returned six days after surgery, presenting cerebrospinal fluid leak, which after clinical and laboratory deterioration was reoperated. In the 14th postoperative facing worsening level of consciousness was diagnosed empyema in cerebellopontine angle and hydrocephalus underwent emergency surgery. Evolved with hemiplegia in the first postoperative attributed to vasculitis, completely recovered after 5 days. CONCLUSIONS: Although infrequent, lumbar discectomy is subject to severe complications, which as the case presented, can be dramatic. In surgeries must be careful to avoid cerebrospinal fluid leak e infectious complications.
RESUMEN
Indocyanine green (ICG) video angiography has been used for several medical indications in the last decades. It allows a real time evaluation of vascular structures during the surgery. This study describes the surgical results of a senior vascular neurosurgeon. We retrospectively searched our database for all aneurysm cases treated with the aid of intraoperative ICG from 2009 to 2014. A total of 61 aneurysms in 56 patients were surgically clipped using intraoperative ICG. Clip reposition after ICG happened in 2 patients (3.2%). Generally, highly variable clip adjustment rates of 2%–38% following ICG have been reported since the introduction of this imaging technique. The application of ICG in vascular neurosurgery is still an emerging challenge. It is an adjunctive strategy which facilitates aneurismal evaluation and treatment in experienced hands. Nevertheless, a qualified vascular neurosurgeon is still the most important component of a high quality work.
A angiografia intraoperatória com indocianina verde (ICG) já foi aplicada em diversas situações clínicas por vários anos. O ICG permite avaliação em tempo real de estruturas vasculares durante a cirurgia. Este artigo descreve os resultados cirúrgicos do autor sênior. Avaliamos retrospectivamente os casos de aneurismas intracranianos operados de 2009 a 2014. Um total de 61 aneurismas em 56 pacientes foram operados com ICG. O reposicionamento do clip ocorreu em 2 casos (3.2%). Geralmente, taxas variáveis de reposicionamento do clip têm sido descritas (2%–38%). A aplicação de ICG na neurocirurgia vascular ainda é um desafio crescente. É um artifício que auxilia na avaliação e tratamento de aneurismas intracranianos em mãos experientes. No entanto, um neurocirurgião vascular continua sendo o principal componente de um resultado cirúrgico de alto nível.
Asunto(s)
Femenino , Humanos , Masculino , Colorantes , Angiografía Cerebral/métodos , Verde de Indocianina , Aneurisma Intracraneal , Aneurisma Intracraneal/cirugía , Monitoreo Intraoperatorio/métodos , Angiografía de Substracción Digital/métodos , Periodo Intraoperatorio , Procedimientos Neuroquirúrgicos/métodos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Instrumentos Quirúrgicos , Resultado del Tratamiento , Cirugía Asistida por Video/métodosRESUMEN
Cisternal spinal accessory schwannoma are still a rare condition without neurofibromatosis with only 32 cases reported so far. We describe a cisternal accessory schwannoma presented in a 36-year-old woman with posterior cervical pain and cervical mieolopaty, defined by grade IV tetraparesia. A suboccipital craniectomy with C1 posterior arch resection was performed. During microsurgical dissection together with electrophysiological monitoring and nerve stimulation tumor was identified as having the spinal accessory root as its origins. Carefully intraneural dissection was then performed with complete lesion removal, histopatological examination confirmed the hypothesis of schwannoma. The patient was free from pain and improved her neurological status with no accessory nerve palsy. Complete surgical resection is indicated for such lesions and can be achieved with good outcome.
O schwannoma do ramo espinhal do nervo acessório em sua porção cisternal, quando não associado à neurofibromatose, é uma condição rara, com apenas 32 relatos de caso na literatura. O diagnóstico diferencial da lesão deve ser atentado, principalmente no que diz respeito à preservação da função motora do nervo acessório. Este é um relato de caso de uma paciente do sexo feminino de 36 anos com queixa de cervicalgia associada à mielopatia cervical compressiva secundária à lesão expansiva intradural, extramedular, estendendo-se do forame magno até a porção superior da lâmina de C2. A paciente foi submetida a uma craniectomia de fossa posterior e ressecção do arco posterior de C1. Durante exploração cirúrgica, auxiliada por monitoração eletrofisiológica e estimulação neural, foi identificado que a lesão tinha origem no ramo espinhal do nervo acessório direito. Foi então ressecada de forma completa com preservação dos fascículos íntegros do nervo de origem. O exame anatomopatológico confirmou a hipótese de schwannoma. A paciente evoluiu sem dor e com melhora do quadro neurológico, sendo preservada a função do nervo acessório. O schwannoma do ramo espinhal do nervo acessório é uma condição rara. A ressecção cirúrgica total é o tratamento de escolha para esses pacientes e pode ser alcançada sem lesões neurológicas significativas secundárias ao ato cirúrgico.
Asunto(s)
Humanos , Femenino , Adulto , Enfermedades del Nervio Accesorio , Microcirugia , NeurilemomaRESUMEN
Gunshot wounds (GSW) to the cervical spine leading to instability are rare. Also, the presence of vital vascular and neurological structures in the surround area lead to death or severe disability in the vast majority of cases. In this brief report, we present a rare case of C1 fracture due to GSW leading to instability of the atlanto-occipital joint in a neurologically intact patient.