RESUMEN

BACKGROUND: Infection is a serious complication in neurosurgical patients who undergo external ventricular drain (EVD) insertion. METHODS: We conducted a quasi-experimental study in patients who underwent EVD insertion to evaluate the impact of a multi-modal strategy to reduce the incidence of external ventricular drain associated infections (EVDAIs). The study was divided into 2 periods; (1) the pre-intervention period when techniques for EVD insertion and maintenance were up to the discretion of the neurosurgeons and (2) the post-intervention after implementation of a multi-modal strategy (cefazolin antibiotic prophylaxis, preoperative chlorhexidine showers, application of postoperative chlorhexidine-impregnated dressing, limited manipulation of the EVD, and meticulous EVD management). The primary outcome was the incidence rate of EVDAIs; secondary outcomes included in-hospital mortality rate, the hospital length of stay. RESULTS: In total, 135 patients were included. The incidence rate of EVDAIs was significantly reduced in the post-intervention period (5.6 cases/1,000 EVD-days) compared with the pre-intervention period (18.2 cases/1,000 EVD-days; P=0.026). There were no differences in all secondary outcomes analyzed. This multi-modal strategy was associated with high satisfaction among health care personnel. CONCLUSIONS: Implementation of a multi-modal strategy was associated with a reduction in the incidence of EVDAIs. This was in line with our goal of promoting a new culture of safety despite being in a resource-limited setting.

RESUMEN

BACKGROUND: Hydrocephalus remains a common sequela of intraventricular hemorrhage (IVH) despite adequate drainage of the hematoma, including endoscopic surgery, intraventricular fibrinolysis, and external ventricular drainage (EVD). Moreover, the appropriate timing for conversion from EVD to ventriculoperitoneal shunt (VPS) is uncertain. This study aimed to evaluate the predictors of shunt dependency in patients with IVH based on the early EVD weaning protocol in our institution. METHODS: We retrospectively reviewed medical records of patients who were diagnosed with primary IVH and secondary IVH from spontaneous intracerebral hemorrhage during the period 2018-2021. Predictors associated with shunt dependency were identified using a logistic regression model. The cutoff point of each variable was selected by receiver operating characteristic curve analysis. Furthermore, shunt complications were reported as a safety measure of our early EVD weaning protocol. RESULTS: The analysis included 106 patients. After IVH treatment, 15 (14%) patients required ventriculoperitoneal shunt, whereas 91 (86%) patients were shunt-free. The diameter of posttreatment temporal horn and the degree of IVH reduction were the significant predictors of shunt dependency. Moreover, patients with IVH reduction of >45% and temporal horn diameter of <9 mm had a lower probability of shunt dependency. Shunt failure was found in 2 (13.3%) patients. CONCLUSIONS: This study showed that a large temporal horn diameter and a lower degree of IVH removal were predictors of shunt dependency in patients with IVH. In addition, early conversion from EVD to ventriculoperitoneal shunt is safe and feasible.

Asunto(s)

RESUMEN

OBJECTIVES: To highlight the feasibility and evaluate the outcomes of the transorbital endoscopic approach (TOEA) in the management of frontal sinus cerebrospinal fluid (CSF) leaks. STUDY DESIGN: Retrospective case series. METHODS: The database of patients with frontal sinus CSF leaks managed with TOEA from January 2017 through December 2019 at our institution was reviewed. Two videos of clinical case examples are presented. RESULTS: Sixteen patients (10 males, 6 females, mean age 53; range 21-61 years) underwent TOEA through the superior eyelid corridor for the repair of frontal sinus CSF leak. The most common etiology of the CSF leak was trauma (nine cases; 56.3%), followed by injury from iatrogenic causes in six cases (37.5%), and spontaneous leak in one case (6.2%). Average defect size was 8.8 mm (range 2.0-20.8 mm). Ten patients were revision cases who had undergone prior nontransorbital CSF leak repair at outside institutions. All patients underwent successful repair via TOEA without postoperative complications. Complete resolution was maintained in all cases. Mean follow-up period was 11 months (range 6-22 months). CONCLUSIONS: TOEA is a safe minimally disruptive alternative for definitive management of frontal sinus CSF leak in well-selected primary or revision cases. Further studies are necessary to define its indications and outcomes. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1753-1757, 2021.

Asunto(s)

RESUMEN

OBJECTIVE: Several techniques of minimal invasive spinal surgery are now becoming common roles in the treatment of spinal diseases in many spinal centers. In the present report, the authors present a retrospective, cohort evaluation of 46 consecutive patients who underwent full endoscopic lumbar discectomy. The purpose of the present report was to present outcomes in this initial series of patients and to present outlines of the operative technique; the full endoscopic uniportal lumbar discectomy. The present research is the first preliminary report in Thailand to analyze and evaluate this new surgical technique. MATERIAL AND METHOD: Forty-six lumbar disc herniation operations were performed in two spinal centers between February and June 2008, using the full endoscopic uniportal with Vertebris instrumentation system. The operations were carried out by interlaminar and transforaminal approach using an 8 mm-diameter uniportal endoscopy of Vertebris instrumentation. The outcome was clinically assessed, on immediate post-operation and one month after surgery, by using Visual Analogue Scale (VAS), the Thai Version of the modified Oswestry disability index (ODI) questionnaire (version 1.0), and modified McNab criteria. RESULTS: Excellent and good outcome was achieved in 87.4% of patients from Modified McNab criteria. Forty-three patients (93.5%) had significant improvement of sciatic pain immediately after the operation. Eight postoperative complications were demonstrated and discussed. CONCLUSION: Full endoscopic uniportal lumbar discectomy is a novel and effective minimally invasive spinal surgical technique. However, the technique requires surgical skill training and experience.

Asunto(s)

RESUMEN

OBJECTIVE: Lumbo-peritoneal shunt was used as an alternative treatment in a large anterior sacral meningocele, a rare congenital malformation, is illustrated. CLINICAL PRESENTATION: A 48-year-old female patient presented with a two-month history of progressive paraparesis, leg pain and numbness of both legs. The investigation demonstrated spina bifida with a huge sac of meningocele, protruding anteriorly into the pelvic cavity. On two previous surgical operations for closure, the fistula through the posterior transsacral approach failed 20 years ago at another hospital, but her symptoms had subsided spontaneously without explanation. She came to Thammmasat Hospital with an episode of spinal cord compression for 2 months. MANAGEMENT: Because of the old surgical scar and high pressure of the meningocele, a lumbo-peritoneal shunt was selected to drain the cerebrospinal fluid from the meningocele to the peritoneal cavity. CONCLUSION: Lumbo-peritoneal shunting is an optional treatment for a large sacral meningocele, especially in a large fistula with unsuccessful surgical closure.

Asunto(s)

RESUMEN

The occurrence of severe hyponatremia is an unusual complication in patients with a mild head injury. Between December 2001 and January 2003, 1147 patients with a mild head injury were reviewed Only patients who presented with deterioration of consciousness or seizure due to hyponatremia, confirmed by serum investigation, were further evaluated, presenting features and clinical courses. The results revealed only 3 patients developed severe hyponatremia following a mild head injury. Surprisingly, all of them had a recent history of ecstasy (MDMA) use, as well as hyponatremia which didn't develop until the episode of a mild head injury. In the present report, the associated mechanisms of both conditions of severe hyponatremia are discussed and the literature is reviewed.

Asunto(s)