RESUMO
There are still some conditions that pediatric neurosurgeons may face in the context of coronavirus disease 2019 (COVID-19) which have not been fully addressed so far. Authors have postulated an ongoing inflammatory myocardial status in a significant proportion of patients who have recovered from COVID-19. We report our experience with a 10-month-old girl who had recovered form COVID-19 and had a case of fourthventricle mass in the midline of the posterior fossa. She was scheduled for microneurosurgical resection of the mass following the insertion of a ventriculoperitoneal shunt. There were no significant issues regarding the induction of anesthesia. A midline suboccipital approach was chosen, and the patient was fully prepared and draped. Suboccipital soft tissues and muscles were dissected layer by layer through the midline avascular line. A marked gush of blood off the midline was observed during the opening in Y of the dura mater. Then, we started to approach the occipital sinus. However, there was an unusual loss of 200 mL of blood lost from this area. Despite the proper packed cell transfusion, the patient developed bradycardia and a sudden rhythm of asystole. The cardiopulmonary cerebral resuscitation (CPCR) was initiated immediately. Despite the maximal effort, the heart rate did not change and remained asystole. We recommend that pediatric neurosurgeons postpone the procedures to be performed in patients who have recovered from COVID-19 for more than one month after a thorough preoperative cardiac evaluation has been performed.
Ainda existem algumas condições que os neurocirurgiões pediátricos podem enfrentar no contexto da doença por coronavírus 2019 (COVID-19) que não foram totalmente abordadas até agora. Os autores postularam um estado inflamatório miocárdico contínuo em uma proporção significativa de pacientes que se recuperaram da COVID-19. Relatamos nossa experiência com uma menina de 10 meses que se recuperou da COVID-19 e teve um caso de massa no quarto ventrículo na linha média da fossa posterior. Ela foi programada para ressecção microneurocirúrgica da massa após a inserção de uma derivação ventrículoperitoneal. Não houve problemas significativos em relação à indução da anestesia. Uma abordagem suboccipital na linha média foi escolhida e a paciente foi totalmente preparada e coberta. Tecidos moles e músculos suboccipitais foram dissecados camada por camada através da linha avascular da linha média. Durante a abertura em Y da dura-máter observou-se um jorro marcado de sangue na linha média. Em seguida, iniciamos a abordagem do seio occipital. No entanto, houve uma perda incomum de 200 ml de sangue perdido nesta área. Apesar da transfusão de hemácias adequada, a paciente evoluiu com bradicardia e ritmo súbito de assistolia. A ressuscitação cerebral cardiopulmonar (RCCP) foi iniciada.
RESUMO
Objective The aim of the present study was to evaluate the outcome of short segment instrumentation in patients affected by burst thoracolumbar fractures. Methods A total of 19 patients with unstable burst fractures of the thoracolumbar spine were eligible for short segment instrumentation. Their functional outcome (by using the Oswestry and Denis scales) and back pain (using the visual analog scale) were evaluated after 12 months. Results Themean age of the patients was 30.7 years old, andmost of them weremale (n » 15). The mean hospital stay was 4.6 days. The mean standard deviation (SD) of the pain score according to the visual analog scale was 1.63 1.25 after 12 months of surgery, and there were no patients classified with grades 4 or 5 on the Denis work scale. The average Oswestry disability index (ODI) was 17% during the follow-ups. Conclusions The outcome of the studied patients, including the clinical pain and the functional outcome of postsurgical patients, suggested that the short-segment instrumentation could be an appropriate method for patients with unstable thoracolumbar junction fractures. However, a long-term follow-up is recommended.