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OBJECTIVE: The development of microsurgical skills is crucial for neurosurgical education. The human placenta is a promising model for practicing vascular anastomosis due to its similarities with brain vessels. We propose a 2-stage model for training in extracranial-to-intracranial anastomosis using the placenta. METHODS: Initially, we propose practicing anastomosis in 2 adjacent placentas. Once successful, the procedure advances to a more challenging configuration that employs a 3-dimensionally printed skull with a window simulating a pterional craniotomy. It is positioned an intracranial placenta and an extracranial one, and the latter has a prominent vessel exposed toward the side of the craniotomy. Both placentas have one artery and vein cannulated in the umbilical cord, and we present an artificial placental circulation system for microvascular training that regulates pulsation and hydrodynamic pressure while keeping veins engorged with a pressurized bag. To verify anastomosis patency, we utilize sodium fluorescein and iodine contrast. RESULTS: The 2-stage model simulated several aspects of microvascular anastomosis. Our perfusion system allowed for intraoperative adjustments of hydrodynamic pressure and pulsation. Using iodine contrast and fluorescein enabled proper evaluation of anastomosis patency and hydrodynamic features. CONCLUSIONS: Training in the laboratory is essential for developing microsurgical skills. We have presented a model for microvascular anastomosis with artificial circulation and postoperative imaging evaluation, which is highly beneficial for enhancing the learning curve in microvascular procedures.
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Iodo , Neurocirurgia , Humanos , Feminino , Gravidez , Neurocirurgia/educação , Placenta/cirurgia , Placenta/irrigação sanguínea , Microcirurgia/métodos , Anastomose Cirúrgica/métodosRESUMO
Endoscopic third ventriculostomy (ETV) is a hydrocephalus treatment procedure that involves opening the Liliequist membrane (LM). However, LM anatomy has not been well-studied neuroendoscopically, because approach angles differ between descriptive and microsurgical anatomical explorations. Discrepancies in ETV efficacy, especially among children age 2 and younger, may be due to incomplete LM opening. The objective of this study was to characterize the LM anatomically from a neuroendoscopic perspective to better understand the impact of anatomical features during LM ostomy and the ETV success rate. Additionally, the ETV success score was tested to predict patient outcome after the intraoperatively difficult opening of LM. Fifty-four patients who underwent ETV were prospectively analyzed with a mean follow-up of 53.1 months (1-90 months). The ETV technical parameters of difficulty were validated by seven expert neurosurgeons. The pediatric population (44) of this study represents the majority of patients (81.4%). The overall ETV success rate was 68.5%. Anomalies on the IIIVT floor resulted in an increased rate of ETV failure. The IIIVT was anomalous, and LM was thick in 33.3% of cases. Fenestration of LM was difficult in 39% of cases, and the LM and TC were opened separately in 55.6% of cases. The endoscopic third ventriculostomy success score (ETVSS) accurately predicted the level of difficulty opening the LM (p = 0.012), and the group with easy opening presented greater durability in ETV success. Neurosurgeons should be aware of the difficulty level of the overture of LM during ETV and its impact on long-term ETV effectiveness.
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Hidrocefalia , Neuroendoscopia , Terceiro Ventrículo , Criança , Pré-Escolar , Humanos , Hidrocefalia/cirurgia , Lactente , Estudos Retrospectivos , Terceiro Ventrículo/cirurgia , Resultado do Tratamento , VentriculostomiaRESUMO
Human development rates in the Vale do Jequitinhonha, state of Minas Gerais, Brazil, called "Misery Valley," are among the lowest in the country, not to mention the often precarious psychosocial realities that daily contact with these families reveals. The history of neurosurgery at the Neurosurgical Reference Center at the Vale do Jequitinhonha e Mucuri dates from 2004, when the first neurosurgical procedures were performed in the recently organized Section of Neurosurgery. The historical surgical series shows the positive impact of the service. In 2007, the average was 3 neurosurgeries/month. In the last year, 2018, service growth boosted the record to 34.83 neurosurgeries/month. In addition to performing elective surgery, the neurosurgery team supports the emergency team by performing some neurosurgical procedures. The service number of patients operated since the development of the service is nearly 3,000. Neurosurgery at the Santa Casa de Caridade from Diamantina has been made comparable to the best national neurosurgery services.
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História do Século XXI , Brasil , Procedimentos Neurocirúrgicos/instrumentação , Unidades Hospitalares/história , Neurocirurgia/história , Neurocirurgia/estatística & dados numéricosRESUMO
BACKGROUND: Cerebrovascular bypass surgical procedures require highly developed dexterity and refined bimanual technical skills. To attain such a level of prowess, neurosurgeons and residents have traditionally relied on "flat" models (without depth of field), such as chicken wings, live rats, silicone vessels, and other materials that stray far from the reality of the operating room, albeit more accessible. We have explored the use of a hybrid ex vivo simulator that takes advantage of the availability of placenta vessels and retains the complexity of surgery performed on a human skull to create a more realistic method for the development of cerebrovascular bypass surgical skills. METHODS: Twelve ex vivo simulators were constructed using 3 human placentas and 1 synthetic human skull for each. Face, content, construct, and concurrent validity were assessed by 12 neurosurgeons (6 trained vascular surgeons and 6 general neurosurgeons) and compared with those of other bypass models. RESULTS: The fidelity grade was ranked as low (Linkert scale score, 1-2), medium (score, 3), and high (score, 4-5). The face and content validity of the model showed high fidelity to superficial temporal artery-middle cerebral artery bypass surgery. Construct validity showed that cerebrovascular neurosurgeons had better performance, and concurrent validity highlighted that all surgical steps were present. CONCLUSION: The simulator was found to have strong face and content, construct, and concurrent validity for microsurgical cerebrovascular training, allowing for simulation of all surgical steps of the bypass procedure. The hybrid simulator seems to be a promising method for shortening the bypass surgery learning curve. However, more studies are required to evaluate the predictive validity of the model.
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Revascularização Cerebral/educação , Artéria Cerebral Média/cirurgia , Modelos Anatômicos , Treinamento por Simulação , Artérias Temporais/cirurgia , Revascularização Cerebral/métodos , Competência Clínica , HumanosRESUMO
ABSTRACT Objective The objective of our study was to report 5 years of experience in the recognition and management of refractory meralgia paresthetica (MP) in patients who had undergone posterior approach lumbar surgery. Methods Patients who were submitted to procedures in the lumbar spine from January 2010 to January 2015 in three different hospital centers in Belo Horizonte/MG were selected for an evaluation of the postoperative development of MP. A prospective observational comparative case series study. Level of evidence III. Evaluation of the following parameters: type of support for the patient, surgical time, body mass index. Results 367 posterior approach lumbar spine surgeries for degenerative pathologies of the lumbar spine were performed. MP was observed in 81 patients (22%). In 65 of those patients (80%), there was complete resolution of the symptoms with conservative management (local measures and medications for neuropathic pain) in less than two months. Twelve patients improved with a corticosteroid depot injection in the inguinal ligament and four patients required a surgical procedure in the third month. Pneumatic support was the least involved in the development of MP, as well as surgical time <1h and body mass index <25. Conclusion Refractory MP may occur in patients submitted to posterior approach lumbar spine surgeries. Management includes local measures, medications for neuropathic pain, and corticosteroid injection in the inguinal ligament. Decompression surgery is reserved for rare refractory cases. Level of evidence III; Prospective observational study with comparative case series.
RESUMO Objetivo O objetivo do presente estudo consiste em relatar a experiência de cinco anos no reconhecimento e manejo da meralgia parestésica (MP) refratária em pacientes submetidos a cirurgias lombares por via posterior. Métodos Pacientes submetidos a procedimentos na coluna lombar, no período de janeiro de 2010 a janeiro de 2015, em três diferentes centros hospitalares de Belo Horizonte/MG, foram selecionados para avaliação do desenvolvimento da MP pós-operatória. Estudo prospectivo observacional com série de casos comparativos. Nível III de evidência. Avaliação dos seguintes parâmetros: tipo de suporte para o paciente, tempo de cirurgia, índice de massa corporal. Resultados Foram feitas 367 cirurgias por via posterior da coluna lombar para patologias degenerativas da coluna lombar. A MP foi observada em 81 pacientes (22%). Em 65 pacientes (80%), houve resolução completa dos sintomas com manejo conservador (medidas locais e medicamentos para dor neuropática) em menos de dois meses. Doze pacientes melhoraram através de infiltração com corticoide de depósito e anestésico no local no ligamento inguinal e, em quatro pacientes houve necessidade de procedimento cirúrgico no terceiro mês. O suporte pneumático foi o menos envolvido no desenvolvimento da MP, assim como o tempo cirúrgico <1h e índice de massa corporal <25. Conclusão A MP refratária pode ocorrer em pacientes submetidos a cirurgias na coluna lombar por via posterior. O manejo inclui medidas locais, medicamentos para dor neuropática e infiltração com corticoide no ligamento inguinal. A cirurgia descompressiva está reservada para os raros casos refratários. Nível de evidência III; Estudo prospectivo observacional com série de casos comparativos.
RESUMEN Objetivo El objetivo del presente estudio consiste en relatar la experiencia de 5 años en el reconocimiento y manejo de la meralgia parestésica (MP) refractaria en pacientes sometidos a cirugías lumbares por vía posterior. Métodos Pacientes sometidos a procedimientos en la columna lumbar, en el período de enero de 2010 a enero de 2015, en tres diferentes centros hospitalarios de Belo Horizonte/MG, fueron seleccionados para evaluación del desarrollo de la MP postoperatoria. Estudio prospectivo observacional con serie de casos comparativos. Nivel III de evidencia. Evaluación de los siguientes parámetros: tipo de soporte para el paciente, tiempo de cirugía, índice de masa corporal. Resultados Se realizaron 367 cirugías por vía posterior de la columna lumbar para patologías degenerativas de la columna lumbar. La MP fue observada en 81 pacientes (22%). En 65 pacientes (80%) hubo resolución completa de los síntomas con manejo conservador (medidas locales y medicamentos para el dolor neuropático) en menos de 2 meses. Doce pacientes mejoraron a través de infiltración de corticoide de depósito y anestésico en el local en el ligamento inguinal y, en cuatro pacientes, hubo necesidad de procedimiento quirúrgico en el tercer mes. El soporte neumático fue el menos involucrado en el desarrollo de la MP, así como el tiempo quirúrgico <1h e índice de masa corporal <25. Conclusión La MP refractaria puede ocurrir en pacientes sometidos a cirugías en la columna lumbar por vía posterior. El manejo incluye medidas locales, medicamentos para el dolor neuropático e infiltración con corticoide en el ligamento inguinal. La cirugía descompresiva está reservada para los raros casos refractarios. Nivel de evidencia III; Estudio prospectivo observacional con serie de casos comparativos.
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Humanos , Cirurgia Geral , Dor Lombar , Neuropatia Femoral , Região LombossacralRESUMO
BACKGROUND: Titanium and polyetheretherketone (PEEK) implants have been used in spinal surgery with low rejection rates. Compared to titanium, PEEK has many advantages, including a density more similar to that of bone, radiolucency, and a lack of artifacts in computed tomography (CT) and magnetic resonance imaging (MRI). In this study, we evaluated the effectiveness of PEEK cages as an alternative to titanium for bone fusion after fractures of the thoracolumbar spine. We also propose a classification to the impaction index. METHODS: We evaluated 77 patients with fractures of the thoracic or lumbar spine who were treated by anterior fixation with titanium cages (TeCorp®) in 46 (59.7%) patients or PEEK (Verte-stak®) in 31 (40.3%) patients from 2006 to 2012 (Neurological Hospital of Lyon). RESULTS: The titanium group achieved 100% fusion, and the PEEK group achieved 96.3% fusion. The titanium systems correlated with higher impact stress directed toward the lower and upper plateaus of the fused vertebrae; there were no nonunions for those treated with titanium group. Nevertheless, there was only one in the PEEK group. There was no significant difference in the pain scale outcomes for patients with ±10 degrees of the sagittal angle. Statistically, it is not possible to associate the variation of sagittal alignment or the impaction with symptoms of pain. The complication rate related to the implantation of cages was low. CONCLUSIONS: Titanium and PEEK are thus equally effective options for the reconstruction of the anterior column. PEEK is advantageous because its radiolucency facilitates the visualization of bone bridges.
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Objective Craniosynostosis is a group of growth disturbances of the skull, which can result in serious consequences for the children who suffer from it. Early diagnosis provides treatment at the correct time. Most of the time, the pediatrician uses the head circumference (HC) as a parameter for the diagnosis, but the HC does not appear to be changed in this disease, leading to incorrect interpretations. The anteroposterior distance (APD) and biauricular distance (BAD) appear to be more accurate. The aim of this study is to analyze the value of the HC and the ratio between the measurements of the APD and the BAD for this diagnosis. Methods We analyzed the data from 129 children who had already undergone an operation for craniosynostosis at an institution in Southeastern Brazil. These data were compared with the normal standards of the population and statistically analyzed to establish their alterations. Results The HC did not change significantly in cases of craniosynostosis, neither when it was considered as a single disease, nor when considering the different subtypes. The APD/BAD ratio changed significantly in the group. Conclusion The HC does not appear to be useful in the diagnosis of craniosynostosis as an individual parameter. The APD/BAD ratio appears to help in the diagnosis.
Objetivo Craniossinostoses são alterações do crescimento do crânio que podem resultar graves consequências para a criança. O diagnóstico precoce propicia o tratamento correto. O perímetro cefálico (PC) é habitualmente usado como parâmetro para o diagnóstico. Porém, como na maioria das vezes há alteração na forma e não no perímetro, sua utilização isolada pode levar a detecção tardia. As medidas do diâmetro ântero posterior (DAB) e bi auricular (DBA) parecem ser mais precisas. O objetivo do trabalho é analisar o valor do PC no diagnóstico, bem como o da razão entre as medidas DAP/ DBA. Métodos Foram analisadas dados de 139 crianças já operadas no Biocor Instituto, em Minas Gerais. Os dados foram comparados com os parâmetros normais já conhecidos da população. Resultados O PC não se alterou de maneira significativa nas craniossinostoses, seja como um grupo único ou nos subtipos. A razão das medidas DAP/ DBA alterou-se. Conclusão O PC isolado parece não ser útil para o diagnóstico das craniossinostoses. A razão das medidas DAP/ DBA parecendo ter utilidade.
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Humanos , Masculino , Feminino , Lactente , Craniossinostoses/diagnóstico , CefalometriaRESUMO
OBJECTIVE: The aim of this study was to evaluate the prevalence of hypopituitarism in the acute stage after aneurysmal subarachnoid hemorrhage (SAH) as well at the chronic stage, at least 1 year after bleeding, to assess its implications and correlation with clinical features of the studied population. PATIENTS AND METHODS: This was a prospective cohort study that evaluated patients admitted between December 2009 and May 2011 with a diagnosis of SAH secondary to cerebral aneurysm rupture. Clinical and endocrine assessment was performed during the acute stage after hospital admission and before treatment at a mean of 7.5 days (SD ± 3.8) following SAH, and also at the follow-up visit at a mean of 25.5 months (range: 12-55 months) after the bleeding. RESULTS: Out of the 119 patients initially assessed, 92 were enrolled for acute stage, 82 underwent hormonal levels analysis, and 68 (82.9%) were followed up in both acute and chronic phases. The mean age and median age were lower among patients with dysfunction in the acute phase compared to those without dysfunction (P < .05). The prevalence of dysfunction in the acute phase was higher among patients with hydrocephalus on admission computed tomography (57.9%) than among those without it (P < .05). At chronic phase, there was an association between dysfunction and Hunt & Hess scale score greater than 2 (P < .05). CONCLUSIONS: We believe that there is not enough literature evidence to incorporate routine endocrinological evaluation for patient victims of SAH, but we should always keep this differential diagnosis in mind when conducting long-term assessments of this population.
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Aneurisma Roto/epidemiologia , Hipopituitarismo/epidemiologia , Aneurisma Intracraniano/epidemiologia , Adeno-Hipófise/fisiopatologia , Hemorragia Subaracnóidea/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Angiografia Digital , Brasil/epidemiologia , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Feminino , Seguimentos , Humanos , Hipopituitarismo/diagnóstico , Hipopituitarismo/fisiopatologia , Incidência , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Testes de Função Hipofisária , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Fatores de Risco , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/terapia , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Cerebral amyloid angiopathy (CAA) is an important cause of spontaneous intracerebral hemorrhage in the elderly. A few case reports of CAA-related intracerebral hemorrhage after head injury, usually following a fall, have been published. More rarely, it may occur in the setting of a traffic accident, with only four cases having been reported. We describe a case of CAA-related intracerebral hemorrhage in an 88-year-old man injured in a road traffic accident. The patient died 14 h after the accident. Autopsy examination revealed a left frontoparietal hematoma and CAA of most of the small leptomeningeal and cortical arteries, as well as several capillaries, predominantly in the parietal and occipital lobes. Except for bruises in the frontal and zygomatic regions, elbow and forearm, to the left, there were no skull fractures or traumatic lesions in other parts of the body. We review the literature on CAA-related intracerebral hemorrhage associated with head injury. CAA-related intracerebral hemorrhage after head injury may occur due to a minor trauma, minor and severe falls, or in the setting of a traffic accident. However, even in this last condition, it seems to happen mostly in patients who had a mild to moderate head injury. These facts show that replacement of the contractile components of the arterial tunica media by amyloid renders the affected cerebral blood vessels more vulnerable to head injury associated with acceleration and deceleration, independently of the severity of the dynamic loading acting on the head.
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Angiopatia Amiloide Cerebral/etiologia , Angiopatia Amiloide Cerebral/patologia , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/patologia , Traumatismos Craniocerebrais/complicações , Acidentes de Trânsito , Idoso , Idoso de 80 Anos ou mais , Encéfalo/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Brain tumors are complex 3-dimensional lesions. Their resection involves training and the use of the multiple microsurgical techniques available for removal. Simulation models, with haptic and visual realism, may be useful for improving the bimanual technical skills of neurosurgical residents and neurosurgeons, potentially decreasing surgical errors and thus improving patient outcomes. OBJECTIVE: To describe and assess an ex vivo placental model for brain tumor microsurgery using a simulation tool in neurosurgical psychomotor teaching and assessment. METHODS: Sixteen human placentas were used in this research project. Intravascular blood remnants were removed by continuous saline solution irrigation of the 2 placental arteries and placental vein. Brain tumors were simulated using silicone injections in the placental stroma. Eight neurosurgeons and 8 neurosurgical residents carried out the resection of simulated tumors using the same surgical instruments and bimanual microsurgical techniques used to perform human brain tumor operations. Face and content validity was assessed using a subjective evaluation based on a 5-point Likert scale. Construct validity was assessed by analyzing the surgical performance of the neurosurgeon and resident groups. RESULTS: The placenta model simulated brain tumor surgical procedures with high fidelity. Results showed face and content validity. Construct validity was demonstrated by statistically different surgical performances among the evaluated groups. CONCLUSION: Human placentas are useful haptic models to simulate brain tumor microsurgical removal. Results using this model demonstrate face, content, and construct validity.
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BACKGROUND: Craniotomies involving the midline are regular practice in neurosurgery, during which injury to the superior sagittal sinus (SSS), an uncommon yet devastating event, may occur. The midline tends to be the most common landmark used to identify the position of the SSS. In this study we examined the reliability of the midline as a landmark for the SSS. METHODS: We performed bilateral craniectomies on eight cadaveric heads, preserving the coronal, sagittal, and lambdoid sutures. The width of the SSS and its displacement from midline were measured on the cadaveric specimens and on 105 normal magnetic resonance images (MRIs) of the head at the following locations: halfway between nasion and bregma (NB), bregma (B), halfway between bregma and lambda (BL), lambda (L), and inion (I). RESULTS: In all cadaveric specimens, the SSS was partially or totally displaced toward one side of midline, usually to the right. It tended to be closer to midline in the frontal region and more displaced posteriorly. The SSS usually drained into the right-side transverse sinus. The mean width of the SSS was 4.3, 5.9, 6.9, 7.9, and 7.8 mm, and the average displacement from midline was 4.3, 6.3, 5.5, 6.9, and 6.0 mm for NB, B, BL, L, and I, respectively. These measurements were then compared with those obtained from the MRIs. CONCLUSION: The SSS was consistently displaced on either side of midline. Thus, the midline is not reliable for identifying the SSS, and caution should be used within 6-10 mm on either side of midline.
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UNLABELLED: Classic anatomical studies describe two membranes - atlanto-occipital and atlanto-axial in the posterior aspect of the craniocervical region. During many surgical procedures in this area, however, we have not found such membranes. OBJECTIVE: To clarify the anatomical aspects and structures taking part of the posterior atlanto-occipital and atlanto-axial area. METHOD: Analysis of histological cuts of three human fetuses and anatomical studies of 8 adult human cadavers. RESULTS: In both atlanto-occipital and atlanto-axial areas, we have observed attachment between suboccipital deep muscles and the spinal cervical dura. However, anatomical description of such attachments could not be found in textbooks of anatomy. CONCLUSION: Our study shows the absence of the classical atlanto-occipital and atlanto-axial membranes; the occipito-C1 and C1-C2 posterior intervals are an open area, allowing aponeurotic attachment among cervical dura mater and posterior cervical muscles.
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Articulação Atlantoaxial/anatomia & histologia , Articulação Atlantoccipital/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Feto , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Classic anatomical studies describe two membranes – atlanto-occipital and atlanto-axial in the posterior aspect of the craniocervical region. During many surgical procedures in this area, however, we have not found such membranes. Objective To clarify the anatomical aspects and structures taking part of the posterior atlanto-occipital and atlanto-axial area. Method Analysis of histological cuts of three human fetuses and anatomical studies of 8 adult human cadavers. Results In both atlanto-occipital and atlanto-axial areas, we have observed attachment between suboccipital deep muscles and the spinal cervical dura. However, anatomical description of such attachments could not be found in textbooks of anatomy. Conclusion Our study shows the absence of the classical atlanto-occipital and atlanto-axial membranes; the occipito-C1 and C1-C2 posterior intervals are an open area, allowing aponeurotic attachment among cervical dura mater and posterior cervical muscles. .
Em livros clássicos de anatomia é referida a existência de duas membranas, atlanto-occipital e atlanto-axial, participando do fechamento da região cranio-cervical. Entretanto, em frequentes procedimentos cirúrgicos que envolvem esta região, jamais detectamos a presença de tais membranas. Objetivo Estudar os aspectos anatômicos e as estruturas que participam do fechamento posterior dos espaços atlanto-occipital e atlanto-axial. Método Estudo de cortes histológicos de três fetos humanos e estudos anatômicos em 8 cadáveres humanos adultos. Resultados Em ambos os espaços, atlanto-occipital e atlanto-axial, encontramos uma aderência entre as estruturas musculares profundas e a dura-mater, sem as membranas atlanto-occipital e atlanto-axial descritas nos livros clássicos de anatomia. Conclusão Não foram encontradas as membranas atlanto-occipital e atlanto-axial no material estudado; os espaços atlanto-occipital e atlanto-axial são abertos permitindo expansões aponeuróticas entre os músculos profundos e a dura-mater. .
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Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Articulação Atlantoaxial/anatomia & histologia , Articulação Atlantoccipital/anatomia & histologia , Cadáver , FetoRESUMO
OBJECTIVE: To compare the right and left sides of the same skulls as far as the described landmarks are concerned, and establish the craniometric differences between them. METHOD: We carried out measurements in 50 adult dry human skulls comparing both sides. RESULTS: The sigmoid sinus width at the sinodural angle level was larger on the right side in 78% of the cases and at the level of the digastric notch in 72%. The jugular foramen width was also larger on the right side in 84% of the cases. The sigmoid sinus distance at the level of the digastric notch was larger on the right side in 64% of the cases, and the sigmoid sinus distance at the level of the digastric notch to the jugular foramen was larger on the right side in 70% of the cases. CONCLUSION: Significant craniometric differences were found between both sides of the same skulls.
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Pontos de Referência Anatômicos/anatomia & histologia , Cefalometria/métodos , Cavidades Cranianas/anatomia & histologia , Base do Crânio/anatomia & histologia , Adulto , Cefalometria/instrumentação , Humanos , Lasers , Osso Occipital/anatomia & histologia , Valores de Referência , Transiluminação/métodosRESUMO
Objective To compare the right and left sides of the same skulls as far as the described landmarks are concerned, and establish the craniometric differences between them. Method We carried out measurements in 50 adult dry human skulls comparing both sides. Results The sigmoid sinus width at the sinodural angle level was larger on the right side in 78% of the cases and at the level of the digastric notch in 72%. The jugular foramen width was also larger on the right side in 84% of the cases. The sigmoid sinus distance at the level of the digastric notch was larger on the right side in 64% of the cases, and the sigmoid sinus distance at the level of the digastric notch to the jugular foramen was larger on the right side in 70% of the cases. Conclusion Significant craniometric differences were found between both sides of the same skulls. .
Objetivo Comparar os lados direito e esquerdo no mesmo crânio nos pontos referenciais descritos e definir as diferenças craniométricas entre ambos. Método Realizamos mensurações em 50 crânios secos de humanos adultos comparando os lados direito e esquerdo. Resultados Como resultado, obtivemos as medidas da largura do seio sigmóideo na altura do ângulo sinodural maiores no lado direito em 78% dos casos e na altura do ponto digástrico em 72%. A largura do forame jugular foi também maior no lado direito em 84% dos casos. A distância do seio sigmóideo na altura do ângulo sinodural até a altura do ponto digástrico foi maior do lado direito em 64% dos casos, e a distância do seio sigmóideo na altura do ponto digástrico até o forame jugular foi maior do lado direito em 70% dos casos. Conclusão Diferenças craniométricas significativas foram encontradas entre os dois lados do crânio. .
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Adulto , Humanos , Pontos de Referência Anatômicos/anatomia & histologia , Cefalometria/métodos , Cavidades Cranianas/anatomia & histologia , Base do Crânio/anatomia & histologia , Cefalometria/instrumentação , Lasers , Osso Occipital/anatomia & histologia , Valores de Referência , Transiluminação/métodosRESUMO
UNLABELLED: The laminoplasty technique was devised by Hirabayashi in 1978 for patients diagnosed with multilevel cervical spondylotic myelopathy. OBJECTIVE: To describe an easy modification of Hirabayashi's method and present the clinical and radiological results from a five-year follow-up study. METHOD AND RESULTS: Eighty patients had 5 levels of decompression (C3-C7), 3 patients had 6 levels of decompression (C2-T1) and 3 patients had 4 levels of decompression (C3-C6). Foraminotomies were performed in 23 cases (27%). Following Nurick`s scale, 76 patients (88%) improved, 9 (11%) had the same Nurick grade, and one patient worsened and was advised to undergo another surgical procedure. No deaths were observed. The mean surgery time was 122 min. Radiographic evaluation showed an increase in the mean sagittal diameter from 11.2 mm at pretreatment to 17.3 mm post surgery. There was no significant difference between pretreatment and post-surgery C2-C7 angles. CONCLUSIONS: This two-open-doors laminoplasty technique is safe, easy and effective and can be used as an alternative treatment for cases of multilevel cervical spondylotic myelopathy without instability.
Assuntos
Vértebras Cervicais/cirurgia , Laminectomia/métodos , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Descompressão Cirúrgica/métodos , Feminino , Seguimentos , Humanos , Masculino , Ilustração Médica , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Doenças da Medula Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
OBJECTIVE: This study was designed to use different segments of the cervical spine in cadavers to determine how much lateral mass should be resected for adequate foraminal decompression. METHODS: Six cadavers were used. The region of the cervical spine from C1 to the C7-T1 transition was dissected and exposed. The lateral mass of each vertebra was measured bilaterally before the foraminotomy in the following segments: C2-C3, C3-C4, C4-C5, C5-C6 and C6-C7. The procedure was performed with a high-speed drill and through surgical microscopy. Three foraminotomies were performed (F1, F2, F3) in each level. Lateral masses were measured after foraminotomy procedures and compared to the initial measurement, creating a percentage of lateral mass needed for decompression.. The value of the entire surface was defined as 100%. RESULTS: There was a statistical difference between the amounts of the resected lateral mass through each foraminotomy (F1, F2, F3) at the same level. However, there was no statistical significant difference among the different levels. The average percentage of resection of the lateral masses in F2 were 27.7% at C2-C3, 24.8% at C3-C4, 24.4% at C4-C5 and 23.8% and 31.2% at C5-C6 and C6-C7, respectively. In F3, the level that needed greater resection of the lateral masses was C6-C7 level, where the average resection ranged between 41.2% and 47.9%. CONCLUSION: In all segments studied, the removal of approximately 24 to 32% of the facet joint allowed adequate exposure of the foraminal segment, with visualization of the dural sac and the exit of the cervical root. .
OBJETIVO: Utilizar diferentes segmentos da coluna cervical em cadáveres para determinar quanto de massa lateral deve ser ressecada para adequada descompressão foraminal. MÉTODOS: Seis cadáveres foram usados e dissecados de modo a expor a região cervical posterior de C1 até a transição C7-T1. A massa lateral de cada vértebra foi medida bilateralmente antes da foraminotomia nos segmentos: C2-C3, C3-C4, C4-C5, C5-C6 e C6-C7. A foraminotomia foi realizada com "drill" de alta rotação e técnica microscópica. Três foraminotomias foram efetuadas: F1, F2, F3 em cada nível. As massas laterais foram medidas após procedimentos da foraminotomia e comparadas à medida inicial, criando uma porcentagem de massa lateral necessária para descompressão. O valor de cada face articular foi definido como 100%. RESULTADOS: Houve diferença estatística entre a quantidade de massa lateral ressecada entre cada foraminotomia (F1, F2, F3) no mesmo nível. Entretanto, não houve diferença estatística entre as foraminotomias em diferentes níveis. A porcentagem média de ressecção das massas laterais na foraminotomia F2 foi de 27,7% em C2-C3; 24,8% em C3-C4; 24,4% em C4-C5; 23,8% em C5-C6; 31,2% em C6-C7. Na foraminotomia F3, o nível que precisou de maior ressecção das massas laterais foi C6-C7, onde a foraminotomia variou entre 41,2% e 47,9%. CONCLUSÃO: Em todos os segmentos estudados, a remoção de aproximadamente 24 a 32% da articulação facetária permitiu exposição adequada do segmento foraminal com visualização do saco dural e da saída da raiz cervical. .
OBJETIVO: Utilizar diferentes segmentos de la columna cervical en cadáveres para determinar cuánto de masa lateral debe ser resecada para la adecuada descompresión foraminal. MÉTODOS: Seis cadáveres fueron usados y disecados de modo a exponer la región cervical posterior de C1 hasta la transición C7-T1. La masa lateral de cada vértebra fue medida bilateralmente, antes de la foraminotomía, en los segmentos: C2-C3, C3-C4, C4-C5, C5-C6 y C6-C7. La foraminotomía fue realizada con "drill" de alta rotación y técnica microscópica. Se efectuaron tres foraminotomías: F1, F2, F3 en cada nivel. Las masas laterales fueron medidas después de procedimientos de foraminotomía y se compararon con la medida inicial, creando un porcentaje de masa lateral necesaria para descompresión. El valor de cada faz articular fue definido como siendo 100%. RESULTADOS: Hubo diferencia estadística entre la cantidad de masa lateral resecada entre cada foraminotomía (F1, F2, F3) en el mismo nivel. No obstante, no hubo diferencia estadística entre las foraminotomías en niveles diferentes. El porcentaje promedio de resección de las masas laterales, en la foraminotomía F2, fue de 27,7% en C2-C3; 24,8% en C3-C4; 24,4% en C4-C5; 23,8% en C5-C6; 31,2% en C6-C7. En la foraminotomía F3, el nivel que precisó de más resección de las masas laterales fue C6-C7, en el cual la foraminotomía varió entre 41,2% y 47,9%. CONCLUSIÓN: En todos los segmentos estudiados, la remoción de aproximadamente 24 a 32% de la articulación facetaria permitió tener exposición adecuada del segmento foraminal con visualización del saco dural y de la salida de la raíz cervical. .
Assuntos
Foraminotomia , Coluna Vertebral , Cadáver , Descompressão CirúrgicaRESUMO
The laminoplasty technique was devised by Hirabayashi in 1978 for patients diagnosed with multilevel cervical spondylotic myelopathy. Objective: To describe an easy modification of Hirabayashi’s method and present the clinical and radiological results from a five-year follow-up study. Method and Results: Eighty patients had 5 levels of decompression (C3-C7), 3 patients had 6 levels of decompression (C2-T1) and 3 patients had 4 levels of decompression (C3-C6). Foraminotomies were performed in 23 cases (27%). Following Nurick`s scale, 76 patients (88%) improved, 9 (11%) had the same Nurick grade, and one patient worsened and was advised to undergo another surgical procedure. No deaths were observed. The mean surgery time was 122 min. Radiographic evaluation showed an increase in the mean sagittal diameter from 11.2 mm at pretreatment to 17.3 mm post surgery. There was no significant difference between pretreatment and post-surgery C2-C7 angles. Conclusions: This two-open-doors laminoplasty technique is safe, easy and effective and can be used as an alternative treatment for cases of multilevel cervical spondylotic myelopathy without instability. .
A laminoplastia é técnica clássica descrita por Hirabayashi em 1978 para descompressão do canal cervical sem utilizar prótese. A principal indicação é o tratamento da mielopatia espondilotica cervical sem instabilidade. Objetivo: Descrever modificação simples da técnica de laminoplastia clássica de Hirabayashi com resultados clínicos e radiográficos em 5 anos de acompanhamento. Resultados e Método: Foram acompanhados 86 pacientes. Em 80, foi feita descompressão por laminoplastia em 5 níveis (C3-C7); em 3, descompressão em 6 níveis (C2-T1); em 3, descompressao em 4 níveis (C3-C6). Em 23 casos (27%), foi realizada foraminotomia associada a descompressão medular. O acompanhamento dos pacientes foi feito utilizando a escala de Nurick. Em 76 pacientes (88%) houve melhora do grau de Nurick. Não houve mortalidade associada à técnica. O tempo médio do procedimento cirúrgico foi de 122 minutos. Em relação à avaliação radiográfica, houve aumento do diâmetro sagital médio do canal cervical de 11,2mm para 17,3mm. Não houve diferença estatística do ângulo C2-C7 nas avaliações antes e após o procedimento cirúrgico. Conclusão: A nova técnica de laminoplastia descrita no presente estudo foi segura, de fácil execução, efetiva, não utiliza protese e não há instabilidade do canal cervical. .