RESUMO
OBJECT: To identify pre-operative prognostic parameters for survival in patients with spinal epidural neoplastic metastasis when the primary tumour is unknown. METHODS: This study was a retrospective chart review of patients who underwent surgery for spinal epidural neoplastic metastases between February 1997 and January 2011. The inclusion criteria were as follows: known post-operative survival period, a Karnofsky Performance Score equal to or greater than 30 points and a post-operative neoplastic metastasis histological type. The Kaplan-Meier method was used to estimate post-operative survival, and the Log-Rank test was used for statistical inference. RESULTS: A total of 52 patients who underwent 52 surgical procedures were identified. The mean age at the time of spinal surgery was 53.92 years (std. deviation, 19.09). The median survival after surgery was 70 days (95% CI 49.97-90.02), and post-operative mortality occurred within 6 months in 38 (73.07%) patients. Lung cancer, prostate cancer, myeloma and lymphoma, the 4 most common primary tumour types, affected 32 (61.53%) patients. The three identified prognostic parameters were the following: pre-operative walking incapacity (American Spinal Injury Association, A and B), present in 86.53% of the patients (p-valueâ=â0.107); special care dependency (Karnofsky Performance Score, 10-40 points), present in 90.38% of the patients (p-valueâ=â0.322); and vertebral epidural neoplastic metastases that were in contact with the thecal sac (Weinstein-Boriani-Biagini, sector D), present in 94.23% of the patients (p-valueâ=â0.643). When the three secondary prognostic parameters were combined, the mean post-operative survival was 45 days; when at least one was present, the survival was 82 days (p-valueâ=â0.175). CONCLUSIONS: Walking incapacity, special care dependency and contact between the neoplastic metastases and the thecal sac can help determine the ultimate survival of this patient population and, potentially, which patients would benefit from surgery versus palliation alone. A 2- to 3-month post-operative survival period justified surgical treatment.
Assuntos
Neoplasias Epidurais/secundário , Neoplasias Epidurais/cirurgia , Neoplasias Primárias Desconhecidas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Neoplasias Epidurais/mortalidade , Feminino , Humanos , Avaliação de Estado de Karnofsky , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Desconhecidas/mortalidade , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Caminhada , Adulto JovemRESUMO
The upward odontoid displacement observed in basilar invagination (BI) is generally associated with a horizontal clivus and craniocervical kyphosis, conditions that exert ventral compression at the spinomedullary junction. Ventral brainstem decompression by reduction or elimination of the odontoid invagination is part of the desired treatment. The authors describe a case of BI in an adult, who was effectively treated with the easy and safe reduction of odontoid invagination via cervical traction. Normalization of kyphosis at the craniovertebral junction and the vertical position of both a previously horizontal clivus and the cerebellar tentorium demonstrated that these conditions were not part of the original malformation but instead were caused by a reducible craniovertebral instability.
Assuntos
Articulação Atlantoccipital , Instabilidade Articular/complicações , Instabilidade Articular/cirurgia , Platibasia/terapia , Fusão Vertebral , Tração , Adulto , Humanos , Instabilidade Articular/diagnóstico por imagem , Masculino , Platibasia/diagnóstico por imagem , Platibasia/etiologia , RadiografiaRESUMO
A hemorragia subaracnóidea (HSA) espontânea é causada, na maioria das vezes, por ruptura de aneurismas cerebrais. Através de análise retrospectiva, estudou-se o perfil clínico de 253 pacientes com HSA. A ruptura de aneurisma cerebral representou 83,7 por cento das causas; outras etiologias foram aterosclerose e ruptura de malformaçoes arteriovenosas. Foram excluídos os casos de HSA por tumor e distúrbios da coagulaçao. O estudo angiográfico demonstrou, em 201 pacientes, um total de 222 aneurismas. O local mais freqüente foi a artéria carótida interna no nível da comunicante posterior. Vasoespasmo complicou a evoluçao clínica de 36 por cento dos pacientes e houve incidência de 26 por cento de ressangramento. Cento e setenta e dois pacientes foram submetidos à clipagem de aneurisma. O grau Hunt-Hess na admissao teve correlaçao positiva com o estado clínico dos pacientes no pós-operatório tardio. Resultados cirúrgicos satisfatórios foram obtidos em 130 pacientes (75,5 por cento)