RESUMO
Decompressive craniectomy is an urgent procedure that is increasingly used for treatment of intracranial hypertension. After recovery, reconstruction of the cranial defect is necessary. Cranioplasty is an elective procedure with a high potential for morbidity if care is not taken on different surgical factors such as the material used as the cranial flap. In Latin America, high costs in some materials used in cranioplasty make its use prohibitive for some patients and institutions, and looking for alternatives has become a priority in neurosurgical centers. An autologous bone flap is an excellent option possessing the characteristics of an ideal material for cranioplasty. Nevertheless, its use is associated with high morbidity and flap failure. We report our mono-institutional experience in a 10-year period of a hybrid technique for cranioplasty using an autologous bone flap with titanium plates. Sixty-five patients underwent the technique, with good cosmetic results in 89.2% and success in functional result in 90.8% of patients . No significant statistical differences were found on the timing of the surgery or the location of the cranial defect. We had a 1.5% rate of surgical site infection, less than that reported on previous series. We propose that the hybrid technique of cranioplasty is a safety and effective option for cranial defect reconstruction.
Assuntos
Craniectomia Descompressiva/métodos , Hipertensão Intracraniana/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Crânio/cirurgia , Adolescente , Adulto , Craniectomia Descompressiva/efeitos adversos , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Procedimentos de Cirurgia Plástica/efeitos adversos , Retalhos Cirúrgicos/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVES: The aim of the study is to present the therapeutic results of intradural tumor management over a 10 years period in a single institution. PATIENTS AND METHODS: The study consists in a prospective case series of patients treated at the neurosurgery service of the Social Security Institute of Mexico State and Provinces (ISSSEMYM), between January 2006 and December 2016. All patients were provided with information about the procedure and signed informed consent and institutional board approved files review for this study. RESULTS: Thirty-five patients with intradural tumor were treated between 2006-2016. Most frequent lesions were extramedullary (30 patients, 85.7%). Most frequent tumor was Schwannoma, with thoracic/thoraco-lumbar location, being the most frequent location. All patients underwent surgical treatment, with total gross resection accomplished in 19 patients (54.3%). Surgical complication rate was 11.4%. Spine instrumentation was necessary in 26 patients (74.3%) because of bone destruction by the tumor, or bone removal for approach. All patients with intramedullary lesions and 5 patients (16.7%) with extramedullary lesions received post-operative radiotherapy. During the follow-up, 8.5% of patients had recurrence/progression of residual disease. CONCLUSIONS: Microsurgery is the treatment of choice for intradural spinal tumors, and gross total resection with low morbidity must be the surgical goal. When this is not possible, partial resection and adjuvant therapy with radiosurgery are a valid option. Patients most be long followed-up because of recurrence risk or disease progression.