RESUMO
BACKGROUND: Shoulder stability, abduction and external rotation are vital for the performance of usual daily tasks. AIMS: To compare the functional outcomes in the shoulder following spinal accessory to suprascapular nerve transfer (SASNT). PATIENTS AND METHODS: Comparison of the outcome of adult patients with upper traumatic brachial plexus palsy undergoing SASNT with patients with complete palsy submitted to the same procedure. STATISTICAL ANALYSIS: Ranges of motion were compared via the Mann-Whitney U test. The percentages of patients with a favorable outcome were compared by the chi-square test. All tests were two-tailed and P values <0.05 were considered statistically significant. RESULTS: SASNT was performed in 76 patients: 23 cases (30.2%) of upper-plexus injuries and 53 cases (69.7%) of complete brachial plexus palsy. Good shoulder abduction was achieved in 15 patients (65.2%) with upper plexus palsy and a good external rotation in 5 (21.7%). In those patients with a good recovery, the average range of motion (ROM) was 53° for shoulder abduction and 71.2° for external rotation. Thirty-six patients (67.9%) with complete palsy had a good shoulder abduction recovery with 30.7° of average ROM, but only 3 patients (5.6%) recovered a good shoulder external rotation with 68.3° of average ROM. There was no statistical difference for the abduction outcome, but the external rotation outcome was superior in the upper plexus palsy group. CONCLUSION: SASNT is a consistent procedure to achieve functional recovery of shoulder abduction after a partial or complete plexus injury, but the outcomes of external rotation were quite disappointing in both the groups.
Assuntos
Nervo Acessório/cirurgia , Plexo Braquial/cirurgia , Traumatismos dos Nervos Periféricos/cirurgia , Ombro/inervação , Ombro/cirurgia , Adulto , Plexo Braquial/lesões , Humanos , Transferência de Nervo , Recuperação de Função Fisiológica , Ombro/fisiopatologia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Despite new techniques for the treatment of cerebral aneurysms, the percentage of aneurysm remnants after surgical intervention seems to be relatively constant. The objective of this study was to assess angiographic and epidemiological features associated with aneurysm remnants after microsurgical clipping. METHODS: This study was conducted from February 2009 to August 2012 on a series of 90 patients with 105 aneurysms referred to the Santa Casa of Belo Horizonte who were surgically treated and angiographically controlled. RESULTS: Surgical clipping was considered incomplete in 13.3% of the aneurysms. The mean age of cases with an aneurysm remnant was 57.5 years, whereas the mean age without aneurysm remnant was 49.7 years (P = 0.02). Aneurysm remnants were detected more frequently on the internal carotid artery, nevertheless, no statistically significant differences were verified when comparing the locations. Aneurysm size in the preoperative angiography verified that the mean size of aneurysms operated was 6.56 mm, such that in cases showing a postoperative remnant, the mean size was 9.7 mm and in cases with complete clipping it was 6.08 mm (P = 0.02). Postoperative angiography showed that, in cases with residual aneurysm, the number of clips used was higher - a mean of 1.8 for complete clipping and 3.1 for incomplete clipping (P < 0.001). CONCLUSIONS: Aneurysm size and patient age showed significant correlations with residual intracranial aneurysm. The mean number of clips used was higher in cases with incomplete occlusion.
RESUMO
INTRODUCTION: Adult traumatic brachial plexus lesions are devastating injuries. Their real incidence is difficult to ascertain, but are certainly growing due to the increasing number of high-speed motor-vehicle accidents, especially in big cities. OBJECTIVES: Analysis of the epidemiological characteristics of patients with traumatic brachial plexus lesions in São Paulo, Brazil, the sixth largest city in the world. METHODS: This was a retrospective analysis of the epidemiological characteristics of patients submitted to surgical treatment of traumatic brachial plexus lesions in the Peripheral Nerve Surgery Unit of the Department of Neurosurgery of the University of São Paulo Medical School. RESULTS: In the period from 2004 to 2012, 406 patients underwent surgery. There were 384 (94.6 %) men and 22 (5.4 %) women. In 45.9 % the compromised plexus was the right and in 54.1 %, the left. The average age was 28.38 years. Among the causes, the most frequent was motorcycle accidents (79 %). Most of the lesions were supraclavicular. In 46.1 % of cases the lesions were complete, in 30.1 % the lesions compromised C5/C6 roots, in 20.9 % the C5/C6/C7 roots were lesioned and in 2.9 % the lesion was in the lower roots, C8/T1. Among the associated lesions the most prevalent were head trauma, observed in 34.2 % of the cases; lesions of long bones in 38.8 %; clavicle fractures in 25.9 %; and thoracic trauma in 12.9 %. CONCLUSION: In a population of adult patients with brachial plexus lesions with surgical indication, most of them comprise young male adults involved in high-energy motorcycle accidents.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Plexo Braquial/lesões , Traumatismos dos Nervos Periféricos/epidemiologia , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Idoso , Plexo Braquial/cirurgia , Brasil/epidemiologia , Criança , Traumatismos Craniocerebrais/complicações , Feminino , Fraturas Ósseas/complicações , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Motocicletas , Neurocirurgia , Traumatismos dos Nervos Periféricos/complicações , Traumatismos dos Nervos Periféricos/cirurgia , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: The objective of the present study was to evaluate the efficacy of monitoring activated coagulation time (ACT) during carotid endarterectomy (CEA) in reducing surgical risks and complications. METHODS: A total of 175 consecutive patients who had CEA between July 2002 and January 2004 were studied. Activated coagulation time was monitored during the procedure in all patients. The results were compared with the data reported in the literature, and with those obtained in 2 previous series, totaling 1924 patients treated at the same service before the use of ACT. RESULTS: Only 4 of the 175 patients had cerebral ischemia, with 3 of them almost completely recovering during hospitalization. Significant morbidity was 0.6% and mortality was 0.6%. No statistically significant difference in the incidence of cerebral ischemia or death was observed between symptomatic and asymptomatic patients. In the 2 previous series used for comparison, operated by the same author, we found 0.7% and 0.8% of significant morbidity and 1.4% and 2.6% of mortality, respectively. Most series in the literature have shown a higher significant morbidity than the present one, mainly in symptomatic patients. The incidence of hematoma in the present series was 5.7%, only 3 (1.7%) of them being significant. No increase in the frequency of hematomas was observed in cases where heparin was not reversed or in those using a shunt. In the 2 other previous series, the incidence of hematomas was 1.5% and 3.6%. CONCLUSIONS: Activated coagulation time monitoring during CEA was effective in evaluating the level of heparinization of patients during surgery and the immediate postoperative period. The comparison of the present series with the literature and with the previous series of the same service, before the use of ACT, permits also to conclude that the control of the level of heparinization seems to reduce the risk of perioperative and immediate postoperative ischemia. In addition, ACT monitoring also seems to be effective in diminishing the risk of postoperative cervical hematoma.
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Endarterectomia das Carótidas/métodos , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/etiologia , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/prevenção & controle , Artérias Carótidas/patologia , Artérias Carótidas/fisiopatologia , Artérias Carótidas/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/mortalidade , Feminino , Hematoma/etiologia , Hematoma/fisiopatologia , Hematoma/prevenção & controle , Heparina/efeitos adversos , Heparina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Hemorragia Pós-Operatória/fisiopatologia , Fatores de Tempo , Tempo de Coagulação do Sangue Total/métodos , Tempo de Coagulação do Sangue Total/normasRESUMO
BACKGROUND: The aim of the present study was to evaluate the technical viability of the unilateral pterional approach to simultaneously treat symmetrical bilateral aneurysm (mirror image) of the middle cerebral arteries (SBAMCA) and to determine the morbidity and mortality rates of this approach. METHODS: Forty-six patients with SBAMCA underwent unilateral pterional craniotomy within a period of 9 years. Most patients were women (24, 80.0%) and mean age was 40.7 years. RESULTS: Obliteration of the contralateral aneurysm was not possible in 16 patients (34.8%) because of brain edema in 8 patients operated on during the acute phase, lateral projection of the aneurysm in 3, a very long contralateral M1 segment in 4, and the presence of atheromatous plaques at the MCA bifurcation and aneurysm neck in 1. The remaining 30 patients (65.2%) were submitted to the proposed treatment. Final evaluation showed that 26 patients (86.7%) were Glasgow Outcome Scale (GOS) V, 1 patient (3.3%) was GOS IV, 2 patients (6.6%) were GOS III, and 1 patient (3.3%) was GOS I. CONCLUSIONS: The unilateral pterional surgical approach to treat SBAMCA is a technically viable procedure associated with low morbidity and mortality. However, it requires a neurosurgeon experienced in cerebral aneurysm surgery and the appropriate technical conditions.
Assuntos
Craniotomia/métodos , Aneurisma Intracraniano/cirurgia , Artéria Cerebral Média/cirurgia , Crânio/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Artéria Carótida Interna/anatomia & histologia , Artéria Carótida Interna/cirurgia , Angiografia Cerebral , Córtex Cerebral/anatomia & histologia , Córtex Cerebral/cirurgia , Círculo Arterial do Cérebro/patologia , Círculo Arterial do Cérebro/cirurgia , Craniotomia/instrumentação , Estudos de Viabilidade , Feminino , Lateralidade Funcional/fisiologia , Escala de Resultado de Glasgow/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/patologia , Complicações Pós-Operatórias/epidemiologia , Crânio/anatomia & histologia , Osso Esfenoide/anatomia & histologia , Osso Esfenoide/cirurgia , Instrumentos Cirúrgicos/normas , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/instrumentaçãoRESUMO
A rare case of an epidermoid intramedullary spinal cord tumor, extending from the second to the fourth thoracic vertebra is reported, in a 15 years old girl, surgically treated successfully. The clinical feature, the ethiopatogeny and a literature review will be discussed.