RESUMEN
BACKGROUND/AIMS: Internal pulse generator (IPG) replacement is considered a relatively minor surgery but exposes the deep brain stimulation system to the risk of infectious and mechanical adverse events. We retrospectively reviewed complications associated with IPG replacement surgery in our center and reviewed the most relevant publications on the issue. METHODS: A retrospective analysis of all the IPG replacements performed in our center from January 2003 until March 2018 was performed. A logistic regression model was used to analyze the risk factors associated with IPG infections at our center. RESULTS: A total of 171 IPG replacements in 93 patients were analyzed. The overall rate of replacement complications was 8.8%, whereas the rate of infection was 5.8%. IPG removal was required in 8 out of 10 infected cases. An increased risk of infection was found in patients with subcutaneous thoracic placement of the IPG (OR 5.3, p = 0.016). The most commonly isolated germ was Staphylococcus coagulase negative (60%). We found a non-significant trend towards increased risk of infection in patients with more than 3 replacements (p = 0.07). CONCLUSIONS: Infection is the most frequent complication related to IPG replacement. Staphylococcus coagulase negative is the most commonly isolated bacteria causing the infection. According to our results, the subcutaneous thoracic placement represents a greater risk of infection compared to subcutaneous abdominal placement.
Asunto(s)
Estimulación Encefálica Profunda/efectos adversos , Estimulación Encefálica Profunda/instrumentación , Electrodos Implantados/efectos adversos , Neuroestimuladores Implantables/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Adulto , Anciano , Estimulación Encefálica Profunda/métodos , Temblor Esencial/diagnóstico , Temblor Esencial/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/diagnóstico , Enfermedad de Parkinson/cirugía , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Una masa intramedular pigmentada es un hallazgo muy raro en la práctica diaria, y supone un reto diagnóstico. Se deben considerar tumores que contienen melanina (ependimoma melanótico y schwannoma melanótico) y los tumores que contienen melanocitos (melanocitoma, melanoma primario, melanoma metastásico). Describimos el caso de un hombre de 47 años con una lesión intramedular a nivel de T7-T8. Las imágenes de resonancia magnética (RM) revelaban una lesión hiperintensa en T1 e hipointensa en T2. El tumor fue resecado parcialmente y tratado con radioterapia adyuvante. La histología y la ausencia de lesiones fuera del sistema nervioso central (SNC) permitieron establecer el diagnóstico de melanoma primario intramedular (MPI). Se realizó una revisión de la literatura de los 26 casos de MPI reportados. Los MPI son tumores extremadamente raros, pero son la causa más frecuente de tumores intramedulares pigmentados. La primera opción de tratamiento es la resección quirúrgica completa, seguida de radioterapia complementaria
A dark pigmented intramedullary mass is very rarely encountered in daily practice, and poses a diagnostic challenge. Several entities have to be considered, including melanin-containing tumours (melanotic ependymoma and melanotic schwannoma) and melanocyte-containing tumours (melanocytoma, primary melanoma and melanoma metastases). The case is presented of a 47 year-old male with a pigmented intramedullary tumour located at T7-T8 level. Magnetic resonance images (MRI) revealed a tumour with hyperintensity on T1 and hypointensity on T2. The tumour was resected partially and treated with adjuvant radiotherapy. The diagnosis of primary intramedullary melanoma (PIM) was established based on histology and the absence of other lesions outside of the CNS. A literature review is presented on the other 26 PIM cases reported. PIM are extremely rare tumours, but are the most frequent cause of pigmented intramedullary tumour. Complete surgical resection is the treatment of choice whenever possible, followed by radiotherapy
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Melanoma/cirugía , Neoplasias de la Médula Espinal/cirugía , Melanocitos/patología , Metástasis de la Neoplasia/patología , Neoplasias Encefálicas/secundario , Imagen por Resonancia MagnéticaRESUMEN
A dark pigmented intramedullary mass is very rarely encountered in daily practice, and poses a diagnostic challenge. Several entities have to be considered, including melanin-containing tumours (melanotic ependymoma and melanotic schwannoma) and melanocyte-containing tumours (melanocytoma, primary melanoma and melanoma metastases). The case is presented of a 47 year-old male with a pigmented intramedullary tumour located at T7-T8 level. Magnetic resonance images (MRI) revealed a tumour with hyperintensity on T1 and hypointensity on T2. The tumour was resected partially and treated with adjuvant radiotherapy. The diagnosis of primary intramedullary melanoma (PIM) was established based on histology and the absence of other lesions outside of the CNS. A literature review is presented on the other 26 PIM cases reported. PIM are extremely rare tumours, but are the most frequent cause of pigmented intramedullary tumour. Complete surgical resection is the treatment of choice whenever possible, followed by radiotherapy.
Asunto(s)
Melanoma/diagnóstico , Neoplasias de la Médula Espinal/diagnóstico , Dolor de Espalda/etiología , Terapia Combinada , Incontinencia Fecal/etiología , Humanos , Hipoestesia/etiología , Laminectomía , Imagen por Resonancia Magnética , Masculino , Melanoma/diagnóstico por imagen , Melanoma/patología , Melanoma/terapia , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Radioterapia Adyuvante , Compresión de la Médula Espinal/etiología , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/patología , Neoplasias de la Médula Espinal/terapia , Vértebras Torácicas , Incontinencia Urinaria/etiologíaRESUMEN
Objetivo: Presentar una técnica novedosa, precisa y segura para la implantación de electrodos profundos destinados al registro de la actividad eléctrica cerebral o SEEG, sin marco estereotáctico, mediante la asistencia de neuronavegación, TC intraoperatorio O-Arm(R), y el uso del brazo articulado pasivo Vertek(R). Material y métodos: Todos los pacientes a los que se les implantaron electrodos profundos para SEEG mediante está técnica en el Hospital Clínic de Barcelona fueron incluidos. De forma prospectiva evaluamos la precisión de la técnica, las complicaciones posquirúrgicas, el tiempo quirúrgico, la estancia media y los resultados a corto plazo. Resultados: Un total de 10 pacientes fueron intervenidos mediante está técnica. La media de edad fue de 38 años, 60% de los casos fueron mujeres. La media de electrodos por paciente fue de 6,9 (3-10), con un total de 69 electrodos implantados. El tiempo medio quirúrgico fue de 34,7 min por electrodo. La distancia media entre la diana planificada y la definitiva fue de 1,39mm (0,95-1,7). No se presentaron complicaciones posquirúrgicas. Se detectó foco epileptógeno en 6 casos (60%). Se realizó cirugía resectiva en 5 casos (50%), en 3 casos (30%) se realizó termocoagulación y en 2 casos (20%) no se realizó ningún tratamiento. A los 6 meses de seguimiento, de los 8 casos tratados, 37,5% presentan ELAI I, 12,5% ELAI III, 25% ELAI IV y 25% ELAI V. Conclusiones: La colocación de electrodos profundos para SEEG realizada mediante la utilización de brazo articulado pasivo Vertek(R) y TC intraoperatorio O-Arm(R) es una técnica segura, efectiva y con una adecuada precisión
Objective: To report a novel, accurate, and safe technique for deep brain electrode implantation to register brain electrical activity or SEEG, using frameless stereotaxy, neuronavigation assisted, and intraoperative CT-guided O-Arm® and the Vertek(R) articulated passive arm. Material and methods: All patients implanted by this technique in Barcelona Hospital Clinic were included. A prospective evaluation was made of the accuracy of the technique, as well as complications, surgical time, length of stay, and short-term outcomes. Results: The study included 10 patients that underwent this procedure. The mean age was 38 years, and 60% were women. A mean of 6.9 (3-10) electrodes/patient, with a total of 69 electrodes, were implanted. The mean time for implantation was 34.7minutes per electrode. The mean distance between the planned target and the final target was 1.39 millimetres (0.95-1.7). There were no surgically derived complications. The epileptogenic zone was determined in 6 cases (60%). Surgical resection was performed in 5 cases (50%), with thermocoagulation in 3 (30%) cases, and in 2 cases (20%) there was no treatment. At a six-month follow-up of the 8 treated cases, 37.5% were ELAI I, 12.5% ELAI III, 25% ELAI IV, and 25% ELAI V. Conclusions: The implantation of deep brain electrodes for SEEG by using intraoperative CT O-Arm(R) and the Vertek(R) articulated passive arm is a safe and effective technique with adequate accuracy
Asunto(s)
Humanos , Electroencefalografía/métodos , Epilepsia/diagnóstico , Técnicas Estereotáxicas , Electrodos Implantados , Procedimientos Neuroquirúrgicos/métodos , Neuronavegación/métodos , Cirugía Asistida por Video/métodosRESUMEN
OBJECTIVE: To report a novel, accurate, and safe technique for deep brain electrode implantation to register brain electrical activity or SEEG, using frameless stereotaxy, neuronavigation assisted, and intraoperative CT-guided O-Arm® and the Vertek® articulated passive arm. MATERIAL AND METHODS: All patients implanted by this technique in Barcelona Hospital Clinic were included. A prospective evaluation was made of the accuracy of the technique, as well as complications, surgical time, length of stay, and short-term outcomes. RESULTS: The study included 10 patients that underwent this procedure. The mean age was 38 years, and 60% were women. A mean of 6.9 (3-10) electrodes/patient, with a total of 69 electrodes, were implanted. The mean time for implantation was 34.7minutes per electrode. The mean distance between the planned target and the final target was 1.39 millimetres (0.95-1.7). There were no surgically derived complications. The epileptogenic zone was determined in 6 cases (60%). Surgical resection was performed in 5 cases (50%), with thermocoagulation in 3 (30%) cases, and in 2 cases (20%) there was no treatment. At a six-month follow-up of the 8 treated cases, 37.5% were ELAI I, 12.5% ELAI III, 25% ELAI IV, and 25% ELAI V. CONCLUSIONS: The implantation of deep brain electrodes for SEEG by using intraoperative CT O-Arm® and the Vertek® articulated passive arm is a safe and effective technique with adequate accuracy.
Asunto(s)
Epilepsia/cirugía , Neuronavegación , Técnicas Estereotáxicas , Cirugía Asistida por Computador , Adulto , Electrodos Implantados , Electroencefalografía , Femenino , Humanos , Imagenología Tridimensional , Masculino , Estudios Prospectivos , Derivación y Consulta , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Decompressive craniectomy (DC) has been sporadically used in cases of infectious encephalitis with brain herniation. Like for other indications of DC, evidence is lacking regarding the beneficial or detrimental effects for this pathology. METHODS: We reviewed all the cases of viral and bacterial encephalitis treated with decompressive craniectomy reported in the literature. We also present one case from our institution. These data were analyzed to determine the relation between clinical and epidemiological variables and outcome in surgically treated patients. RESULTS: Of 48 patients, 39 (81.25 %) had a favorable functional recovery and 9 (18.75 %) had a negative course. Only two patients (4 %) died after surgical treatment. A statistically significant association was found between diagnosis (viral and bacterial encephalitis) and outcome (GOS) in surgically treated patients. Viral encephalitis, usually caused by herpes simplex virus (HSV), has a more favorable outcome (92.3 % with GOS 4 or 5) than bacterial encephalitis (56.2 % with GOS 4 or 5). CONCLUSIONS: Based on this literature review, we consider that, due to the specific characteristics of infectious encephalitis, especially in case of viral infection, decompressive craniectomy is probably an effective treatment when brain stem compression threatens the course of the disease. In patients with viral encephalitis, better prognosis can be expected when surgical decompression is used than when only medical treatment is provided.