RESUMEN
Neuroendoscopy (NE) surgery emerged as a promising technique for the treatment of spontaneous intracerebral hemorrhage (ICH). A previous meta-analysis of randomized controlled trials (RCTs) analyzed the efficacy and safety of NE compared to craniotomy, but NE did not present a significant improvement in functional outcomes. However, a new study provided an opportunity to update the current knowledge. We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for RCTs reporting NE evacuation of spontaneous supratentorial ICH compared to craniotomy. The efficacy outcomes of interest were favorable functional outcome, functional disability, hematoma evacuation rate, and residual hematoma volume. The safety outcomes of interest were rebleeding, infection, and mortality. Seven RCTs were included containing 879 patients. The NE approach presented a significantly higher rate of favorable functional outcome compared with craniotomy (RR: 1.42; 95% CI 1.17, 1.73; p < 0.001). The evacuation rate was higher in patients who underwent the NE approach (MD: -8.36; 95% CI -12.66, -4.07; p < 0.001). NE did not show a benefit in improving the mortality rate (RR: 0.81, 95% CI 0.54, 1.22; p = 0.32). NE was associated with more favorable functional outcomes and lower rates of functional disabilities compared to craniotomy. Also, NE was superior regarding evacuation rate, while presenting a reduction in residual hematoma volume. NE might be associated with lower infection rates. Mortality was not improved by NE surgery. Larger, higher-quality randomized studies are needed to adequately evaluate the efficacy and safety of NE compared to craniotomy.
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Hemorragia Cerebral , Craneotomía , Neuroendoscopía , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Neuroendoscopía/métodos , Craneotomía/métodos , Craneotomía/efectos adversos , Hemorragia Cerebral/cirugía , Resultado del TratamientoRESUMEN
The physical processes of incision, traction and hemostasis used for craniotomy, stimulate nerve fibers and specific nociceptors, resulting in postoperative pain. During the first 24 h after craniotomy, 87% of patients have postoperatory pain. The rate of suffering pain after craniotomy falls 3% for every year of life. The objective of this study is to review the available therapeutic options to help physicians treating this pain, and discuss pain mechanisms, pathophysiology, plasticity, risk factors and psychological factors. This is a narrative review of the literature from 1970 to June 2019. Data were collected by doing a search in PubMed, EMBASE, Cochrane Reviews and a manual search of all relevant literature references. The literature includes some drugs treatment: Opioids, codeine, morphine, and tramadol, anti-inflammatory non-steroids such as cyclooxygenase-2 inhibitors, gabapentin. It discusses: side effects, pharmacodynamics and indications of each drug, anatomy and Inervation of Skull and its Linigs, pathogenesis of pain Post-craniotomy, scalp nerve block, surgical nerve injury, neuronal plasticity, surgical factors and chronic post-surgical pain.
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Dolor Agudo , Bloqueo Nervioso , Neurocirugia , Craneotomía/efectos adversos , Humanos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiologíaRESUMEN
ABSTRACT Objective: To determine the incidence of surgical site infection in patients undergoing craniotomy and to compare 12-month and 3-month post-discharge surveillance periods in terms of their impact on the incidence of surgical site infection in those patients. Methods: This was a retrospective cohort study involving 173 adult patients submitted to "clean" craniotomy, with or without implants, during the six-month period, at a university hospital in the city of São Paulo, Brazil. All the patients were evaluated in the pre-, trans- and postoperative periods and were followed for 12 months to analyze the development of surgical site infections. Results: Of the 173 patients undergoing craniotomy during the study period, 20 developed an surgical site infection during the first, and 12 months after discharge, the overall incidence of surgical site infection therefore being 11.56%, compared with a 1-month incidence of 8.67% and a 3-month incidence of 10.98%. Among the 106 patients who received implants, the 1-, 3-, and 12-month incidence of surgical site infection was 7.54% (n= 8), 8.49% (n= 9), and 9.43% (n= 10), respectively. Among the 67 patients who did not receive implants, the 1-, 3-, and 12-month incidence of surgical site infection was 10.44% (n= 7), 14.92% (n= 10), and 14.92% (n= 10), respectively. Conclusion: The incidence of surgical site infection after craniotomy is high. Reducing the duration of the post-discharge surveillance period from 12 months to 3 months did not cause significant losses in the numbers of surgical site infection identified or a substantial decrease in their incidence.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Infección de la Herida Quirúrgica/epidemiología , Craneotomía/efectos adversos , Monitoreo Epidemiológico , Factores de Tiempo , Brasil/epidemiología , Incidencia , Estudios Retrospectivos , Factores de Riesgo , Infecciones Relacionadas con Prótesis/epidemiología , Hospitales UniversitariosRESUMEN
OBJECTIVE: To determine the incidence of surgical site infection in patients undergoing craniotomy and to compare 12-month and 3-month post-discharge surveillance periods in terms of their impact on the incidence of surgical site infection in those patients. METHODS: This was a retrospective cohort study involving 173 adult patients submitted to "clean" craniotomy, with or without implants, during the six-month period, at a university hospital in the city of São Paulo, Brazil. All the patients were evaluated in the pre-, trans- and postoperative periods and were followed for 12 months to analyze the development of surgical site infections. RESULTS: Of the 173 patients undergoing craniotomy during the study period, 20 developed an surgical site infection during the first, and 12 months after discharge, the overall incidence of surgical site infection therefore being 11.56%, compared with a 1-month incidence of 8.67% and a 3-month incidence of 10.98%. Among the 106 patients who received implants, the 1-, 3-, and 12-month incidence of surgical site infection was 7.54% (n = 8), 8.49% (n = 9), and 9.43% (n = 10), respectively. Among the 67 patients who did not receive implants, the 1-, 3-, and 12-month incidence of surgical site infection was 10.44% (n = 7), 14.92% (n = 10), and 14.92% (n = 10), respectively. CONCLUSION: The incidence of surgical site infection after craniotomy is high. Reducing the duration of the post-discharge surveillance period from 12 months to 3 months did not cause significant losses in the numbers of surgical site infection identified or a substantial decrease in their incidence.
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Craneotomía/efectos adversos , Monitoreo Epidemiológico , Infección de la Herida Quirúrgica/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Femenino , Hospitales Universitarios , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Although rare, pseudoaneurysms (PA) can develop following Le Fort I osteotomy and lead to life-threatening hemorrhage. However, the typical presentation of a PA following a Le Fort I osteotomy is not well characterized. Evidence-based guidelines are not currently available for evaluation of PA following Le Fort I osteotomy. METHODS: A case report is presented of a 27-year-old man who underwent Le Fort I advancement and subsequently developed a bleeding PA. A comprehensive search of journal articles was performed using the MEDLINE/PubMed database between 1964 and April 2016. Keywords and phrases used were "(osteotomy OR craniofacial OR orthognathic) AND (pseudoaneurysm OR aneurysm OR epistaxis)." Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines were followed. RESULTS: The literature search yielded 13 reports of 18 patients. All 18 patients underwent Le Fort I osteotomy and subsequently developed a delayed postoperative bleeding PA. All studies were level IV or V evidence. Twenty-eight percent (Nâ=â5) of the cases documented "excessive" intraoperative bleeding or more than 500âmL of estimated blood loss. The average time for the first bleeding episode and time until final bleed was 17.3â±â14.3 days (range: 3-62 days) and 27.8â±â21.2 days following surgery (range: 6-77 days), respectively. Sixty-seven percent (Nâ=â12) had multiple episodes of bleeding. The duration between the bleeding events averaged 10.6â(± 7.9 days) with a range of 1 to 35 days. Bleeding PA's were treated with image-guided embolization (15/18 patients; 83.3%) or ligation or clamping (3/18 patients; 16.7%). CONCLUSION: In the setting of recurrent and/or delayed postoperative epistaxis following Le Fort I osteotomy, surgeons should maintain a high clinical suspicion for PA. Ruptured PA's are often preceded by multiple episodes of progressively worsening epistaxis. Based on the presented case report and pooled data from the literature, angiography is recommended to evaluate for PA in the setting of recurrent epistaxis following Le Fort I osteotomy, especially within the first 4 weeks following surgery.
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Aneurisma Falso , Craneotomía/efectos adversos , Arteria Maxilar , Adulto , Angiografía , Epistaxis/etiología , Humanos , Masculino , Arteria Maxilar/diagnóstico por imagen , Arteria Maxilar/lesiones , Hemorragia Posoperatoria/etiologíaAsunto(s)
Craneotomía/efectos adversos , Hipoxia/terapia , Complicaciones Intraoperatorias/terapia , Adulto , Humanos , Hipoxia/etiología , Hemorragias Intracraneales/etiología , Hemorragias Intracraneales/cirugía , Complicaciones Intraoperatorias/etiología , Leucemia Mielógena Crónica BCR-ABL Positiva/complicaciones , Leucocitosis/complicaciones , Leucocitosis/terapia , MasculinoRESUMEN
INTRODUCTION: Orbital compartment syndrome (OCS) is a rare condition characterized by increased intraorbital pressure and hypoperfusion of critical neural structures. It is usually associated with external ophthalmoplegia. We report a case of postoperative OCS following a frontotemporal craniotomy and review pertinent literature. CASE DESCRIPTION: A 3-year-old female patient presented with a 3-year history of refractory epilepsy and diagnosis of right frontobasal cortical dysplasia. She underwent an elective frontotemporal craniotomy to allow resection of dysplastic cortex. The intraoperative period was uneventful. Postoperatively, following removal of operating fields, we noticed proptosis and right periorbital swelling. A diagnosis of orbital compartment syndrome was made. At the pediatric intensive care unit, the patient underwent an emergency right lateral canthotomy with wide inferior and superior cantholysis. Nowadays she is in the fourth month of postoperative follow-up. There is still slight and almost indistinguishable exophthalmos, but her extrinsic eye movement ranges and reaction to light are normal. DISCUSSION: OCS is a rare ophthalmologic emergency characterized by an acute rise in orbital pressure and may result in complete irreversible blindness if not rapidly treated. The frontotemporal or "pterional" craniotomy exposure requires a myocutaneous flap to be retracted anteriorly and inferiorly near the orbit. There may be orbital compression due to this flap leading to potential harmful complications. Attention to factors such as direct ocular pressure from skin flaps, congestion from head positioning, and adequate intraoperative eye protection may reduce the risk or allow faster management.
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Síndromes Compartimentales/etiología , Craneotomía/efectos adversos , Descompresión Quirúrgica/efectos adversos , Preescolar , Síndromes Compartimentales/cirugía , Epilepsia/cirugía , Femenino , Humanos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugíaRESUMEN
Burr hole evacuation has been the most frequently-used procedure for the treatment of chronic subdural hematomas (CSDH). OBJECTIVE: To evaluate whether the use of a drain and/or the number of burr holes for treatment of CSDH modifies the rates of recurrence and complications. METHODS: A retrospective review of 142 patients operated on because of CSDH, between 2006 and 2015, analyzing recurrence and complications of the use of one or two burr holes with or without the use of a drain. RESULTS: Thirty-seven patients had bilateral CSDH (26%) and 105 (73.9%) patients had unilateral CSDH. Twenty-two (59.4%) patients were given a drain and 15 (40.6%) were not. A total number of recurrences occurred in 22 (15.5%) patients and the total number of complications was in six (4.2%) patients. Mean follow-up time was 7.67 months. CONCLUSIONS: The number of burr holes and the use of the drain did not alter the rates of recurrence and complications in the treatment of CSDH.
Asunto(s)
Craneotomía/métodos , Drenaje , Hematoma Subdural Crónico/cirugía , Trepanación/métodos , Anciano , Craneotomía/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Prevención Secundaria , Resultado del TratamientoRESUMEN
Purpose To compare the efficacy and safety of the percutaneous screw fixation (PSF) and the open pedicle screw fixation (OPSF) on thoracolumbar (TL) fracture. Methods Sixty-four adult patients with TL vertebral fractures who underwent open or percutaneous posterior short-segment transpedicular screw fixation between January of 2013 and September of 2015 were retrospectively reviewed. All patients underwent clinical, radiological and quality of life follow-up for at least 18 months. Results There was no significant difference in age, gender, time between injury and surgery, and preoperative percentage of anterior column height, preoperative sagittal regional Cobb angle, or kyphotic angle of fractured vertebra between these two groups (p > 0.05). There was significantly less intraoperative blood loss in the PSF (87.6 24.6 mL) than in the OPSF group (271.4 142.6 mL) (p < 0.05). The mean surgery time was 62 minutes (range 42130 minutes) for open and 58 minutes (range 35 to 128 minutes) for percutaneous screw fixation. The surgery time was shorter in the PSF group, but with no statistical significance (p > 0.05). The mean Oswestry disability index (ODI) scores after 18-months were 23.12 8.2 for the PSF and 24.12 9.2 for the OPSF group, without any statistical significance (p > 0.05). Conclusion Both open and percutaneous screw fixations are safe and effective. The percutaneous techniques significantly reduced the intraoperative blood loss compared with the open techniques.
Objetivo Comparar a eficácia e segurança das técnicas de fixação convencional e percutânea para fraturas toracolombares. Métodos Sessenta e quatro pacientes adultos com fraturas da transição toracolombar que foram submetidos a fixação pedicular curta por técnicas aberta convencional e percutânea entre janeiro de 2013 e setembro de 2015 foram retrospectivamente avaliados. Todos foram submetidos a avaliação clínica, radiológica e de qualidade de vida com no mínimo 18 meses do seguimento. Resultados Não houve diferença significativa na idade, sexo, tempo entre o trauma e o tratamento, porcentagem da redução da altura do corpo vertebral pré-operatório, angulo de Cob sagital na região da fratura, ou ângulo de de cifose da vértebra fraturada entre os dois grupos (p > 0,05). Houve uma menor perda sanguínea no grupo percutâneo (87,6 24,6 mL) em comparação com a técnica convencional (271,4 142,6 mL) (p < 0,05). O tempo médio da cirurgia foi 62 minutos (42 - 130 minutos) para a técnica convencional e 58 minutos (35 - 128 minutos) para a percutânea. Apesar de mais curto na técnica percutânea, não houve diferença estatisticamente significante no tempo cirúrgico entre os dois grupos (p > 0,05). Em relação ao índice de incapacidade de Oswestry após 18 meses do tratamento cirúrgico, também não houve diferença significante do ponto de vista estatístico entre os dois grupos, sendo 23,12 8,2 para a técnica percutânea e 24,12 9,2 para o grupo da técnica convencional (p > 0,05). Conclusão Ambas as técnicas mostraram-se eficazes e seguras para o tratamento de fraturas da transição toracolombar. A técnica percutânea apresentou uma taxa de perda sanguínea significativamente menor em comparação à técnica aberta convencional.
Asunto(s)
Humanos , Masculino , Femenino , Efusión Subdural , Efusión Subdural/epidemiología , Craneotomía/efectos adversos , Lesiones Traumáticas del Encéfalo , HidrocefaliaRESUMEN
ABSTRACT Burr hole evacuation has been the most frequently-used procedure for the treatment of chronic subdural hematomas (CSDH). Objective: To evaluate whether the use of a drain and/or the number of burr holes for treatment of CSDH modifies the rates of recurrence and complications. Methods: A retrospective review of 142 patients operated on because of CSDH, between 2006 and 2015, analyzing recurrence and complications of the use of one or two burr holes with or without the use of a drain. Results: Thirty-seven patients had bilateral CSDH (26%) and 105 (73.9%) patients had unilateral CSDH. Twenty-two (59.4%) patients were given a drain and 15 (40.6%) were not. A total number of recurrences occurred in 22 (15.5%) patients and the total number of complications was in six (4.2%) patients. Mean follow-up time was 7.67 months. Conclusions: The number of burr holes and the use of the drain did not alter the rates of recurrence and complications in the treatment of CSDH.
RESUMO A trepanação é o procedimento mais utilizado para o tratamento de hematomas subdurais crônicos (HSDC). Objetivo: Avaliar o uso de dreno subdural e / ou o número de trepanações para tratamento de HSDC modifica as taxas de recidiva e complicações. Métodos: Uma revisão retrospectiva de 142 pacientes operados por HSDC entre 2006 e 2015 analisando recidiva e complicações usando um ou dois orifícios com ou sem uso de dreno. Resultados: Trinta e sete casos apresentaram HSDC bilaterais (26%) e 105 (73,9%) unilaterais. Em vinte e dois (59,4%) casos houve uso de dreno e em 15 (40,6%) não houve. O número total de recidivas foi de 22 casos (15,5%) e o número total de complicações foi de 6 casos (4,2%). O tempo médio de seguimento foi de 7,67 meses. Conclusões: O número de trepanações e o uso do dreno não alteraram as taxas de recidiva e complicações no tratamento de HSDC.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Trepanación/métodos , Drenaje , Craneotomía/métodos , Hematoma Subdural Crónico/cirugía , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento , Craneotomía/efectos adversos , Prevención SecundariaRESUMEN
Intracranial infection is a common clinical complication after craniotomy. We aimed to explore the diagnostic and prognostic value of dynamic changing procalcitonin (PCT) in early intracranial infection after craniotomy. A prospective study was performed on 93 patients suspected of intracranial infection after craniotomy. Routine peripheral venous blood was collected on the day of admission, and C reactive protein (CRP) and PCT levels were measured. Cerebrospinal fluid (CSF) was collected for routine biochemical, PCT and culture assessment. Serum and CSF analysis continued on days 1, 2, 3, 5, 7, 9, and 11. The patients were divided into intracranial infection group and non-intracranial infection group; intracranial infection group was further divided into infection controlled group and infection uncontrolled group. Thirty-five patients were confirmed with intracranial infection after craniotomy according to the diagnostic criteria. The serum and cerebrospinal fluid PCT levels in the infected group were significantly higher than the non-infected group on day 1 (P<0.05, P<0.01). The area under curve of receiver operating characteristics was 0.803 for CSF PCT in diagnosing intracranial infection. The diagnostic sensitivity and specificity of CSF PCT was superior to other indicators. The serum and CSF PCT levels have potential value in the early diagnosis of intracranial infection after craniotomy. Since CSF PCT levels have higher sensitivity and specificity, dynamic changes in this parameter could be used for early detection of intracranial infection after craniotomy, combined with other biochemical indicators.
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Calcitonina/sangre , Calcitonina/líquido cefalorraquídeo , Infecciones Bacterianas del Sistema Nervioso Central/diagnóstico , Craneotomía/efectos adversos , APACHE , Adulto , Anciano , Biomarcadores/sangre , Biomarcadores/líquido cefalorraquídeo , Proteína C-Reactiva/análisis , Infecciones Bacterianas del Sistema Nervioso Central/sangre , Infecciones Bacterianas del Sistema Nervioso Central/líquido cefalorraquídeo , Infecciones Bacterianas del Sistema Nervioso Central/microbiología , Diagnóstico Precoz , Femenino , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/líquido cefalorraquídeo , Complicaciones Posoperatorias/microbiología , Pronóstico , Estudios Prospectivos , Valores de Referencia , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y Especificidad , Factores de TiempoRESUMEN
Abstract Background and objectives: We examined the additive effect of the Ramsay scale, Canadian Neurological Scale (CNS), Nursing Delirium Screening Scale (Nu-DESC), and Bispectral Index (BIS) to see whether along with the assessment of pupils and Glasgow Coma Scale (GCS) it improved early detection of postoperative neurological complications. Methods: We designed a prospective observational study of two elective neurosurgery groups of patients: craniotomies (CG) and non-craniotomies (NCG). We analyze the concordance and the odds ratio (OR) of altered neurological scales and BIS in the Post-Anesthesia Care Unit (PACU) for postoperative neurological complications. We compared the isolated assessment of pupils and GCS (pupils-GCS) with all the neurologic assessment scales and BIS (scales-BIS). Results: In the CG (n = 70), 16 patients (22.9%) had neurological complications in PACU. The scales-BIS registered more alterations than the pupils-GCS (31.4% vs. 20%; p < 0.001), were more sensitive (94% vs. 50%) and allowed a more precise estimate for neurological complications in PACU (p = 0.002; OR = 7.15, 95% CI = 2.1-24.7 vs. p = 0.002; OR = 9.5, 95% CI = 2.3-39.4). In the NCG (n = 46), there were no neurological complications in PACU. The scales-BIS showed alterations in 18 cases (39.1%) versus 1 (2.2%) with the pupils-GCS (p < 0.001). Altered CNS on PACU admission increased the risk of neurological complications in the ward (p = 0.048; OR = 7.28, 95% CI = 1.021-52.006). Conclusions: Applied together, the assessment of pupils, GCS, Ramsay scale, CNS, Nu-DESC and BIS improved early detection of postoperative neurological complications in PACU after elective craniotomies.
Resumo Justificativa e objetivos: Avaliamos o efeito aditivo da escala de Ramsay, Escala Neurológica Canadense (CNS), Escala da Enfermagem de Triagem de Delírio (Nu-DESC) e Índice Bispectral (BIS) para observar se, juntamente com a avaliação das pupilas e da Escala de Coma de Glasgow (GCS), melhorava a detecção precoce de complicações neurológicas no pós-operatório. Métodos: Projetamos um estudo observacional, prospectivo, de dois grupos de pacientes submetidos à neurocirurgia eletiva: craniotomia (Grupo C) e não craniotomia (Grupo NC). Analisamos a concordância e a razão de chance (OR) de alterações nas escalas neurológicas e no BIS na sala de recuperação pós-anestesia (SRPA) para complicações neurológicas no pós-operatório. Comparamos a avaliação isolada das pupilas e da GCS (pupilas-GCS) com todas as escalas de avaliação neurológica e o BIS (escalas-BIS). Resultados: No Grupo C (n = 70), 16 pacientes (22,9%) apresentaram complicações neurológicas na SRPA. As escalas-BIS registraram mais alterações do que as pupilas-GCS (31,4% vs. 20%; p < 0,001), foram mais sensíveis (94% vs. 50%) e permitiram uma estimativa mais precisa das complicações neurológicas na SRPA (p = 0,002; OR = 7,15, IC 95% = 2,1-24.7 vs. p = 0,002; OR = 9,5, IC 95% = 2,3-39,4). No grupo NC (n = 46) não houve complicações neurológicas na SRPA. As escalas-BIS mostraram alterações em 18 casos (39,1%) versus um caso (2,2%) com as pupilas-GCS (p < 0,001). Alteração na CNS na admissão à SRPA aumentou o risco de complicações neurológicas na enfermaria (p = 0,048; OR = 7,28, IC 95% = 1,021-52,006). Conclusões: Aplicados em conjunto, avaliação das pupilas, GCS, escala de Ramsay, CNS, Nu-DESC e BIS melhoraram a detecção precoce de complicações neurológicas no pós-operatório na SRPA após craniotomias eletivas.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Anciano , Complicaciones Posoperatorias/diagnóstico , Procedimientos Neuroquirúrgicos/efectos adversos , Craneotomía/efectos adversos , Técnicas de Diagnóstico Neurológico , Complicaciones Posoperatorias/epidemiología , Periodo Posoperatorio , Escala de Coma de Glasgow , Pupila/fisiología , Estudios Prospectivos , Delirio/diagnóstico , Diagnóstico Precoz , Monitores de Conciencia , Persona de Mediana EdadRESUMEN
BACKGROUND: Surgical trauma at the temporalis muscle is a potential cause of post-craniotomy headache and temporomandibular disorders (TMD). The aim of this study was to evaluate the prevalence of pain, masticatory dysfunction and trigeminal somatosensory abnormalities in patients who acquired aneurysms following pterional craniotomy. METHODS: Fifteen patients were evaluated before and after the surgical procedure by a trained dentist. The evaluation consisted of the (1) research diagnostic criteria for TMD, (2) a standardized orofacial pain questionnaire and (3) a systematic protocol for quantitative sensory testing (QST) for the trigeminal nerve. RESULTS: After pterional craniotomy, 80% of the subjects, 12 patients, developed orofacial pain triggered by mandibular function. The pain intensity was measured by using the visual analog scale (VAS), and the mean pain intensity was 3.7. The prevalence of masticatory dysfunction was 86.7%, and there was a significant reduction of the maximum mouth opening. The sensory evaluation showed tactile and thermal hypoesthesia in the area of pterional access in all patients. CONCLUSIONS: There was a high frequency of temporomandibular dysfunction, postoperative orofacial pain and trigeminal sensory abnormalities. These findings can help to understand several abnormalities that can contribute to postoperative headache or orofacial pain complaints after pterional surgeries.
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Aneurisma Roto/cirugía , Craneotomía/efectos adversos , Dolor Facial/etiología , Cefaleas Secundarias/etiología , Trastornos de la Articulación Temporomandibular/etiología , Enfermedades del Nervio Trigémino/etiología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Base del Cráneo/cirugíaRESUMEN
BACKGROUND: Awake craniotomy with brain mapping is the gold standard for eloquent tissue localization. Patients' tolerability and satisfaction have been shown to be high; however, it is a matter of debate whether these findings could be generalized, since patients across the globe have their own cultural backgrounds and may perceive and accept this procedure differently. METHODS: We conducted a prospective qualitative study about the perception and tolerability of awake craniotomy in a population of consecutive brain tumor patients in Brazil between January 2013 and April 2015. Seventeen patients were interviewed using a semi-structured model with open-ended questions. RESULTS: Patients' thoughts were grouped into five categories: (1) overall perception: no patient considered awake craniotomy a bad experience, and most understood the rationale behind it. They were positively surprised with the surgery; (2) memory: varied from nothing to the entire surgery; (3) negative sensations: in general, it was painless and comfortable. Remarks concerning discomfort on the operating table were made; (4) postoperative recovery: perception of the postoperative period was positive; (5) previous surgical experiences versus awake craniotomy: patients often preferred awake surgery over other surgery under general anesthesia, including craniotomies. CONCLUSIONS: Awake craniotomy for brain tumors was well tolerated and yielded high levels of satisfaction in a population of patients in Brazil. This technique should not be avoided under the pretext of compromising patients' well-being.
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Craneotomía/métodos , Satisfacción del Paciente , Vigilia , Adulto , Anciano , Neoplasias Encefálicas/cirugía , Brasil , Craneotomía/efectos adversos , Craneotomía/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Introduction Postoperative hemorrhage is a well-known complication after intracranial surgeries. It usually occurs at the site of the operation; however, there are many reports of cerebellar hemorrhage following supratentorial craniotomies. Despite that, there are only three cases of multiple postoperative supratentorial hemorrhages (distant from the site of the operation) following aneurysm clipping in the current literature. Case Report A 52-year-old previously healthy woman underwent a left pterional craniotomy for the clipping of an unruptured aneurysm. The surgery was performed without any intraoperative rupture or other occurrences. On the follow-up computed tomography (CT) scan performed 24h after surgery, bilateral posterior temporal lobe hematomas were identified, and they had no relation to the surgical site. The patient developed symptomatic vasospasm, with right-sided hemiparesis. This complication was treated conservatively, and the outcome was good. Conclusions Intracerebral hemorrhage far from the site of the craniotomy is an infrequent complication after neurosurgical procedures, especially in vascular neurosurgery. The present report warns of the occurrence of this entity even in asymptomatic patients.
Introdução Hemorragia pós-operatória é uma complicação bem conhecida após cirurgias intracranianas. Geralmente ocorre no sítio cirúrgico, porém há vários relatos de hemorragias cerebelares após craniotomias supratentoriais. Apesar disso, há somente três casos de hemorragias múltiplas supratentoriais (distantes do sítio cirúrgico) após clipagem de aneurisma intracraniano. Relato do Caso Paciente feminina, de 52 anos, previamente hígida, foi submetida a craniotomia pterional para clipagem de aneurisma não roto. A cirurgia ocorreu sem ruptura intraoperatória ou outra intercorrência. Na tomografia de crânio de controle, realizada 24h após o procedimento, 2 hematomas temporais posteriores foram identificados sem relação com o sítio cirúrgico. A paciente posteriormente desenvolveu vasoespasmo sintomático, com hemiparesia direita, mas essa complicação foi tratada conservadoramente, e teve boa evolução clínica, sem déficit residual. Conclusões Hemorragias intracranianas distantes do sítio cirúrgico são complicações infrequentes, especialmente em neurocirurgia vascular. O presente caso adverte para a ocorrência dessa complicação mesmo em pacientes assintomáticos.
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Humanos , Femenino , Persona de Mediana Edad , Craneotomía/efectos adversos , Hemorragias Intracraneales , Aneurisma Intracraneal/cirugíaRESUMEN
BACKGROUND AND OBJECTIVES: We examined the additive effect of the Ramsay scale, Canadian Neurological Scale (CNS), Nursing Delirium Screening Scale (Nu-DESC), and Bispectral Index (BIS) to see whether along with the assessment of pupils and Glasgow Coma Scale (GCS) it improved early detection of postoperative neurological complications. METHODS: We designed a prospective observational study of two elective neurosurgery groups of patients: craniotomies (CG) and non-craniotomies (NCG). We analyze the concordance and the odds ratio (OR) of altered neurological scales and BIS in the Post-Anesthesia Care Unit (PACU) for postoperative neurological complications. We compared the isolated assessment of pupils and GCS (pupils-GCS) with all the neurologic assessment scales and BIS (scales-BIS). RESULTS: In the CG (n=70), 16 patients (22.9%) had neurological complications in PACU. The scales-BIS registered more alterations than the pupils-GCS (31.4% vs. 20%; p<0.001), were more sensitive (94% vs. 50%) and allowed a more precise estimate for neurological complications in PACU (p=0.002; OR=7.15, 95% CI=2.1-24.7 vs. p=0.002; OR=9.5, 95% CI=2.3-39.4). In the NCG (n=46), there were no neurological complications in PACU. The scales-BIS showed alterations in 18 cases (39.1%) versus 1 (2.2%) with the pupils-GCS (p<0.001). Altered CNS on PACU admission increased the risk of neurological complications in the ward (p=0.048; OR=7.28, 95% CI=1.021-52.006). CONCLUSIONS: Applied together, the assessment of pupils, GCS, Ramsay scale, CNS, Nu-DESC and BIS improved early detection of postoperative neurological complications in PACU after elective craniotomies.
Asunto(s)
Craneotomía/efectos adversos , Técnicas de Diagnóstico Neurológico , Procedimientos Neuroquirúrgicos/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Adulto , Anciano , Monitores de Conciencia , Delirio/diagnóstico , Diagnóstico Precoz , Femenino , Escala de Coma de Glasgow , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Periodo Posoperatorio , Estudios Prospectivos , Pupila/fisiologíaRESUMEN
Intracranial infection is a common clinical complication after craniotomy. We aimed to explore the diagnostic and prognostic value of dynamic changing procalcitonin (PCT) in early intracranial infection after craniotomy. A prospective study was performed on 93 patients suspected of intracranial infection after craniotomy. Routine peripheral venous blood was collected on the day of admission, and C reactive protein (CRP) and PCT levels were measured. Cerebrospinal fluid (CSF) was collected for routine biochemical, PCT and culture assessment. Serum and CSF analysis continued on days 1, 2, 3, 5, 7, 9, and 11. The patients were divided into intracranial infection group and non-intracranial infection group; intracranial infection group was further divided into infection controlled group and infection uncontrolled group. Thirty-five patients were confirmed with intracranial infection after craniotomy according to the diagnostic criteria. The serum and cerebrospinal fluid PCT levels in the infected group were significantly higher than the non-infected group on day 1 (P<0.05, P<0.01). The area under curve of receiver operating characteristics was 0.803 for CSF PCT in diagnosing intracranial infection. The diagnostic sensitivity and specificity of CSF PCT was superior to other indicators. The serum and CSF PCT levels have potential value in the early diagnosis of intracranial infection after craniotomy. Since CSF PCT levels have higher sensitivity and specificity, dynamic changes in this parameter could be used for early detection of intracranial infection after craniotomy, combined with other biochemical indicators.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Calcitonina/sangre , Calcitonina/líquido cefalorraquídeo , Infecciones Bacterianas del Sistema Nervioso Central/diagnóstico , Craneotomía/efectos adversos , APACHE , Biomarcadores/sangre , Biomarcadores/líquido cefalorraquídeo , Proteína C-Reactiva/análisis , Infecciones Bacterianas del Sistema Nervioso Central/sangre , Infecciones Bacterianas del Sistema Nervioso Central/líquido cefalorraquídeo , Infecciones Bacterianas del Sistema Nervioso Central/microbiología , Diagnóstico Precoz , Recuento de Leucocitos , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/líquido cefalorraquídeo , Complicaciones Posoperatorias/microbiología , Pronóstico , Estudios Prospectivos , Valores de Referencia , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y Especificidad , Factores de TiempoRESUMEN
Resection of the anterior clinoid process results in the creation of the clinoid space, an important surgical step in the exposure and clipping of clinoidal and supraclinoidal internal carotid artery aneurysms. Cerebrospinal fluid rhinorrhea is an undesired and potentially serious complication. Conservative measures may be unsuccesful, and there is no consensus on the most appropriate surgical treatment. Two patients with persistent transclinoidal CSF rhinorrhea after aneurysm surgery were successfully treated with a combined endoscopic transnasal/transeptal binostril approach using a fat graft and ipsilateral mucosal nasal septal flap. Anatomical considerations and details of the surgical technique employed are discussed, and a management plan is proposed.
Asunto(s)
Aneurisma/cirugía , Enfermedades de las Arterias Carótidas/cirugía , Rinorrea de Líquido Cefalorraquídeo/etiología , Rinorrea de Líquido Cefalorraquídeo/cirugía , Craneotomía/efectos adversos , Aneurisma Intracraneal/cirugía , Cirugía Endoscópica Transanal/métodos , Adulto , Aneurisma/complicaciones , Enfermedades de las Arterias Carótidas/complicaciones , Femenino , Humanos , Aneurisma Intracraneal/complicaciones , Persona de Mediana Edad , Tabique Nasal/cirugía , Complicaciones Posoperatorias/cirugía , Reproducibilidad de los Resultados , Hueso Esfenoides/anatomía & histología , Hueso Esfenoides/cirugía , Colgajos Quirúrgicos , Resultado del TratamientoRESUMEN
ABSTRACT Resection of the anterior clinoid process results in the creation of the clinoid space, an important surgical step in the exposure and clipping of clinoidal and supraclinoidal internal carotid artery aneurysms. Cerebrospinal fluid rhinorrhea is an undesired and potentially serious complication. Conservative measures may be unsuccesful, and there is no consensus on the most appropriate surgical treatment. Two patients with persistent transclinoidal CSF rhinorrhea after aneurysm surgery were successfully treated with a combined endoscopic transnasal/transeptal binostril approach using a fat graft and ipsilateral mucosal nasal septal flap. Anatomical considerations and details of the surgical technique employed are discussed, and a management plan is proposed.
RESUMO A ressecção da clinóide anterior resulta na criação do espaço clinoideo, um passo cirúrgico importante na exposição e clipagem de aneurismas dos segmentos clinoideo e supraclinoideo da artéria carótida interna. Fístula liquórica é uma das complicaçoes mais indesejadas e é potencialmente grave. O manejo com medidas conservadoras pode ser bem sucedido, e não há consenso sobre o tratamento cirúrgico mais adequado. Dois pacientes com rinorréia persistente secundária a fistula liquórica transclinoidal após cirurgia de aneurisma foram tratados com sucesso por uma abordagem endoscópica combinada transnasal/transseptal binostril usando um enxerto de gordura e retalho de mucosa naso-septal ipsilateral. Considerações anatômicas e detalhes da técnica cirúrgica empregada são discutidos, e um plano de manejo destes tipo de fistula líquorica é proposto.