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[PMID]:29069046
[Au] Autor:Cai Q; Zhang H; Zhao D; Yang Z; Hu K; Wang L; Zhang W; Chen Z; Chen Q
[Ad] Endereço:aDepartment of Neurosurgery, Renmin Hospital of Wuhan University, Hubei Province bDepartments of Neurosurgery, PLA General Hospital, Beijing cDepartments of Neurosurgery, the Second Clinical Medical College, Yangtze University, Hubei Province dDepartment of Radiology, Renmin Hospital of Wuhan University, Hubei province eDepartment of Neurosurgery, Central Hospital of Xiangyang City, Hubei Province, China.
[Ti] Título:Analysis of three surgical treatments for spontaneous supratentorial intracerebral hemorrhage.
[So] Source:Medicine (Baltimore);96(43):e8435, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This retrospective study aimed to evaluate the effectiveness and safety of 3 surgical procedures for Spontaneous Supratentorial Intracerebral Hemorrhage (SICH).A total of 63 patients with SICH were randomized into 3 groups. Group A (n = 21) underwent craniotomy surgery, group B (n = 22) underwent burr hole, urokinase infusion and catheter drainage, and group C (n = 20) underwent neuroendoscopic surgery. The hematoma evacuation rate of the operation was analyzed by 3D Slice software and the average surgery time, visualization during operation, decompressive effect, mortality, Glasgow Coma Scale (GCS) improvement, complications include rebleeding, pneumonia, intracranial infection were also compared among 3 groups.All procedures were successfully completed and the hematoma evacuation rate was significant differences among 3 groups which were 79.8%, 43.1%, 89.3% respectively (P < .01), and group C was the highest group. Group B was smallest traumatic one and shared the shortest operation time, but for the lack of hemostasis, it also the highest rebleeding group (P = .03). Although there were different in complications, but there was no significant in pneumonia, intracranial infection, GCS improvement and mortality rate.All these 3 methods had its own advantages and shortcomings, and every approach had its indications for SICH. Although for neuroendoscopic technical's minimal invasive, direct vision, effectively hematoma evacuation rate, and the relatively optimistic result, it might be a more promising approach for SICH.
[Mh] Termos MeSH primário: Hemorragia Cerebral/cirurgia
Craniotomia/métodos
Drenagem/métodos
Hematoma/cirurgia
Neuroendoscopia/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Hemorragia Cerebral/mortalidade
Craniotomia/efeitos adversos
Drenagem/efeitos adversos
Feminino
Escala de Coma de Glasgow
Hematoma/mortalidade
Seres Humanos
Masculino
Meia-Idade
Neuroendoscopia/efeitos adversos
Duração da Cirurgia
Distribuição Aleatória
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171123
[Lr] Data última revisão:
171123
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171026
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008435


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[PMID]:28885096
[Au] Autor:Santos MM; Rubagumya DK; Dominic I; Brighton A; Colombe S; O'Donnell P; Zubkov MR; Härtl R
[Ad] Endereço:Department of Neurological Surgery, Weill Cornell Brain and Spine Center, and.
[Ti] Título:Infant hydrocephalus in sub-Saharan Africa: the reality on the Tanzanian side of the lake.
[So] Source:J Neurosurg Pediatr;20(5):423-431, 2017 Nov.
[Is] ISSN:1933-0715
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE Infant hydrocephalus is estimated to affect more than 100,000 new infants each year in sub-Saharan Africa (SSA). Bugando Medical Centre (BMC), a government-funded and patient cost-shared referral center, serves over 13 million people in the Lake and Western regions of Tanzania. The goals of this study were to characterize the infant population affected by hydrocephalus who presented to BMC and were treated with a ventriculoperitoneal shunt (VPS) to determine the rate of early complications associated with this surgical procedure and to assess its potential risk factors. METHODS Data were prospectively collected from all patients less than 1 year of age who, over a period of 7 months, were diagnosed with hydrocephalus and admitted to BMC for insertion of a primary VPS. Demographic data, maternal history, preoperative studies, surgical procedure, and surgical complications developing by the time of the first follow-up visit were analyzed. Risk factors associated with the surgical complications were determined. RESULTS During the 7-month study period, 125 infants eligible for the study were included in the analysis. Overall, 75% were younger than 6 months of age, and 56% were males. Only 7% of mothers had a gestational ultrasound, 98% did not receive preconception folic acid, and 25% delivered their child at home. In most patients with hydrocephalus the etiology was uncertain (56%), and other patients had postinfectious (22.4%) or myelomeningocele-associated (16%) hydrocephalus. Patients' mean head circumference on admission was 51.4 ± 6.3 cm. Their median age at shunt surgery was 137 days, and 22.4% of the patients were operated on without having undergone radiological assessment. The majority of shunts were placed in a right parietooccipital location. Thirteen patients had undergone a previous intraventricular endoscopic procedure. Overall, at least one surgical complication was found in 33.6% of patients up to the first follow-up assessment (median follow-up time of 70 days); shunt infection was the most common complication. The postoperative mortality rate was 9%. The risk factors associated with early surgical complications were tumor-related etiology, larger head circumference, and postoperative hospital stays of greater duration. CONCLUSIONS In a region of the continent where most infant hydrocephalus cases had an uncertain etiology, most patients presented to the hospital in a late stage, with no prenatal diagnosis and with large head circumferences. Standard preoperative investigations were not uniformly performed, and the surgical complications, led by VPS infection, were disturbingly high. Younger patient age, previous endoscopic procedure, surgeon involved, and cranial location of the VPS had no statistical relation to the surgical complications. This study shows that the positive results previously reported by SSA mission hospitals, subspecialized in pediatric neurosurgery, are still not generalizable to every hospital in East Africa. To improve maternal and neonatal care in the Lake region of Tanzania, the development of a fluxogram to determine hydrocephalus etiology, a strict perioperative protocol for VPS insertion, and an increase in the number of endoscopic procedures are recommended to BMC.
[Mh] Termos MeSH primário: Hidrocefalia/epidemiologia
Hidrocefalia/cirurgia
[Mh] Termos MeSH secundário: Suplementos Nutricionais
Feminino
Ácido Fólico/administração & dosagem
Seguimentos
Seres Humanos
Hidrocefalia/diagnóstico por imagem
Hidrocefalia/etiologia
Lactente
Recém-Nascido
Masculino
Neuroendoscopia
Complicações Pós-Operatórias/epidemiologia
Estudos Prospectivos
Tanzânia
Ultrassonografia Pré-Natal
Derivação Ventriculoperitoneal
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
935E97BOY8 (Folic Acid)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE
[do] DOI:10.3171/2017.5.PEDS1755


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[PMID]:28858100
[Au] Autor:Ye Z; Ai X; Hu X; Fang F; You C
[Ad] Endereço:Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
[Ti] Título:Comparison of neuroendoscopic surgery and craniotomy for supratentorial hypertensive intracerebral hemorrhage: A meta-analysis.
[So] Source:Medicine (Baltimore);96(35):e7876, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In recent years, neuroendoscopy has been used as a method for treating intracerebral hemorrhages (ICHs). However, the efficacy and safety of neuroendoscopic surgery is still controversial compared with that of craniotomy. Our aim was to compare the outcomes of neuroendoscopic surgery and craniotomy in patients with supratentorial hypertensive ICH using a meta-analysis. METHODS: We searched on PubMed, EMBASE, and Cochrane Central Register of Controlled Trials to identify relevant studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality of eligible studies was evaluated and the related data were extracted by 2 reviewers independently. This study assessed clinical outcomes, evacuation rates, complications, operation time, and hospital stay for patients who underwent neuroendoscopic surgery (NE group) or craniotomy (craniotomy group). RESULTS: Meta-analysis included 1327 subjects from verified studies of acceptable quality. There was no significant heterogeneity between the included studies based on clinical outcomes. Compared with craniotomy, neuroendoscopic surgery significantly improved clinical outcomes in both randomized controlled studies (RCTs) group (relative risk: 0.62; 95% confidence interval [CI], 0.47-0.81, P < .001) and non-RCTs group (relative risk: 0.84; 95% CI: 0.75-0.95, P = .005); decreased the rate of death (relative risk: 0.53; 95% CI, 0.37-0.76, P < .001) in non-RCTs group but not in RCTs group (relative risk: 0.58; 95% CI, 0.26-1.29, P = .18); increased evacuation rates in non-RCTs group (standard mean differences: 0.75; 95% CI, 0.24-1.26, P = .004) and had a tendency of higher evacuation rates in RCTs group (standard mean differences: 1.34; 95% CI, 0.01-2.68, P = .05); reduced the total risk of complications in non-RCTs group (relative risk: 0.45; 95% CI, 0.25-0.83, P = .01) and RCTs group (relative risk: 0.37; 95% CI, 0.28-0.49, P < .001); reduced the operation time in non-RCTs group (standard mean differences: 3.26; 95% CI: 1.20-5.33, P < .001) and RCTs group (standard mean differences: 4.37; 95% CI: 3.32-5.41, P < .001). CONCLUSIONS: Our results suggested that the NE group showed better clinical outcomes than the craniotomy group for patients with supratentorial hypertensive ICH. Moreover, the patients who underwent neuroendoscopy had a higher evacuation rate, lower risk of complications, and shorter operation time compared with those that underwent a craniotomy.
[Mh] Termos MeSH primário: Craniotomia/métodos
Hemorragia Intracraniana Hipertensiva/cirurgia
Neuroendoscopia/métodos
[Mh] Termos MeSH secundário: Idoso
Ensaios Clínicos como Assunto
Craniotomia/efeitos adversos
Craniotomia/mortalidade
Feminino
Seres Humanos
Masculino
Meia-Idade
Neuroendoscopia/efeitos adversos
Neuroendoscopia/mortalidade
Duração da Cirurgia
Complicações Pós-Operatórias/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170901
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007876


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[PMID]:28841109
[Au] Autor:Nguyen DC; Farber SJ; Skolnick GB; Naidoo SD; Smyth MD; Kane AA; Patel KB; Woo AS
[Ad] Endereço:Division of Plastic and Reconstructive Surgery, Department of Surgery, and.
[Ti] Título:One hundred consecutive endoscopic repairs of sagittal craniosynostosis: an evolution in care.
[So] Source:J Neurosurg Pediatr;20(5):410-418, 2017 Nov.
[Is] ISSN:1933-0715
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE Endoscope-assisted repair of sagittal craniosynostosis was adopted at St. Louis Children's Hospital in 2006. This study examines the first 100 cases and reviews the outcomes and evolution of patient care protocols at our institution. METHODS The authors performed a retrospective chart review of the first 100 consecutive endoscopic repairs of sagittal craniosynostosis between 2006 and 2014. The data associated with length of hospital stay, blood loss, transfusion rates, operative times, cephalic indices (CIs), complications, and cranial remolding orthosis were reviewed. Measurements were taken from available preoperative and 1-year postoperative 3D reconstructed CT scans. RESULTS The patients' mean age at surgery was 3.3 ± 1.1 months. Of the 100 patients, 30 were female and 70 were male. The following perioperative data were noted. The mean operative time (± SD) was 77.1 ± 22.2 minutes, the mean estimated blood loss was 34.0 ± 34.8 ml, and the mean length of stay was 1.1 ± 0.4 days; 9% of patients required transfusions; and the mean pre- and postoperative CI values were 69.1 ± 3.8 and 77.7 ± 4.2, respectively. Conversion to open technique was required in 1 case due to presence of a large emissary vein that was difficult to control endoscopically. The mean duration of helmet therapy was 8.0 ± 2.9 months. Parietal osteotomies were eventually excluded from the procedure. CONCLUSIONS The clinical outcomes and improvements in CI seen in our population are similar to those seen at other high-volume centers. Since the inception of endoscope-assisted repair at our institution, the patient care protocol has undergone several significant changes. We have been able to remove less cranium using our "narrow-vertex" suturectomy technique without affecting patient safety or outcome. Patient compliance with helmet therapy and collaborative care with the orthotists remain the most essential aspects of a successful outcome.
[Mh] Termos MeSH primário: Craniossinostoses/cirurgia
Neuroendoscopia
[Mh] Termos MeSH secundário: Perda Sanguínea Cirúrgica
Transfusão de Sangue
Craniossinostoses/patologia
Craniossinostoses/reabilitação
Feminino
Seguimentos
Seres Humanos
Lactente
Tempo de Internação
Masculino
Duração da Cirurgia
Aparelhos Ortopédicos
Estudos Retrospectivos
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170826
[St] Status:MEDLINE
[do] DOI:10.3171/2017.5.PEDS16674


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[PMID]:28753091
[Au] Autor:Bowes AL; King-Robson J; Dawes WJ; James G; Aquilina K
[Ad] Endereço:Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, London, United Kingdom.
[Ti] Título:Neuroendoscopic surgery in children: does age at intervention influence safety and efficacy? A single-center experience.
[So] Source:J Neurosurg Pediatr;20(4):324-328, 2017 Oct.
[Is] ISSN:1933-0715
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE The aim of this study was to review the safety of pediatric intraventricular endoscopy across separate age groups and to determine whether intraventricular endoscopy is associated with an increased risk of complications or reduced efficacy in infants younger than 1 year. METHODS In this retrospective cohort study, 286 pediatric patients younger than 17 years underwent intraventricular endoscopy at Great Ormond Street Hospital between December 2005 and December 2014. The primary diagnosis, procedure, and complications were recorded. RESULTS Neuroendoscopic surgery was performed in 286 pediatric patients (51 neonates 0-6 months [Group 1]; 37 infants 6-12 months [Group 2]; 75 patients 1-5 years [Group 3]; 54 patients 5-10 years [Group 4]; and 69 patients ≥ 10 years [Group 5]; male/female ratio 173:113). The most common procedures included endoscopic third ventriculostomy (ETV) in 159 patients and endoscopic fenestration of intracranial cysts in 64 patients. A total of 348 consecutive neuroendoscopic procedures were undertaken. Nine different complications were identified, of which postoperative seizures (1.7%), CSF leak (3.1%), CSF infection (2.4%), and intracranial hemorrhage (1.7%) were the most common. Specifically, no significant difference in complication rate (11.9%) or infection rate (2.4%) was observed among age groups (p = 0.40 and p = 0.91, respectively). In addition, there were no perioperative deaths; 30-day mortality was 1.1%. After neuroendoscopy for CSF diversion (n = 227), a significantly higher rate of shunt insertion was observed in the youngest group (Group 1, 63.0%) when compared with older groups (Group 2, 46.4%; Group 3, 26.3%; Group 4, 38.6%; and Group 5, 30.8%; p = 0.03). Similarly, for patients who underwent ETV as their initial neuroendoscopic procedure or in combination with additional surgical interventions (n = 171), a significantly higher rate of shunt insertion was also observed within young infants (Group 1, 67.9%; Group 2, 47.6%; Group 3, 19.6%; Group 4, 27.3%; and Group 5, 23.3%; p = 0.003). CONCLUSIONS Intraventricular endoscopy is a safe neurosurgical intervention in pediatric patients of all ages, although it might be associated with increased shunt rates after endoscopic surgery, specifically ETV, in younger infants.
[Mh] Termos MeSH primário: Fatores Etários
Encefalopatias/cirurgia
Neuroendoscopia/métodos
Complicações Pós-Operatórias/etiologia
Resultado do Tratamento
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Estudos de Coortes
Feminino
Seres Humanos
Lactente
Recém-Nascido
Masculino
Neuroendoscopia/efeitos adversos
Terceiro Ventrículo/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170729
[St] Status:MEDLINE
[do] DOI:10.3171/2017.4.PEDS16488


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[PMID]:28732421
[Au] Autor:Satyarthee GD
[Ad] Endereço:Department of Neurosurgery, Neuroscience Centre, AAIMS, New Delhi, India. Electronic address: duttaguru2002@yahoo.com.
[Ti] Título:Neuroendoscope: Evolving Spectrum of Utility in the Management of Hydrocephalus, Biopsy, and Resection of Ventricular Tumors and Cyst Fenestration.
[So] Source:World Neurosurg;104:1029-1030, 2017 08.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Hidrocefalia
Neuroendoscópios
[Mh] Termos MeSH secundário: Biópsia
Cistos/cirurgia
Seres Humanos
Imagem por Ressonância Magnética
Neuroendoscopia
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170723
[St] Status:MEDLINE


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[PMID]:28732418
[Au] Autor:Satyarthee GD
[Ad] Endereço:AIIMS Neurosurgery Neuroscience Centre, New Delhi, India. Electronic address: drguruduttaaiims@gmail.com.
[Ti] Título:Expanding Horizon of Neuroendoscopic Procedure from Endoscopic-Assisted Tumor Resection, Vascular Surgery, and Management of Hydrocephalus to Diagnostic and Therapeutic Management of Pyogenic Ventriculitis.
[So] Source:World Neurosurg;104:1024-1025, 2017 08.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Hidrocefalia
Neuroendoscopia
[Mh] Termos MeSH secundário: Seres Humanos
Neoplasias/cirurgia
Neuroendoscópios
Resultado do Tratamento
Ventriculostomia
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170723
[St] Status:MEDLINE


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[PMID]:28708018
[Au] Autor:Breimer GE; Dammers R; Woerdeman PA; Buis DR; Delye H; Brusse-Keizer M; Hoving EW; Dutch Pediatric Neurosurgery Study Group
[Ad] Endereço:Department of Neurosurgery, University Medical Center Groningen.
[Ti] Título:Endoscopic third ventriculostomy and repeat endoscopic third ventriculostomy in pediatric patients: the Dutch experience.
[So] Source:J Neurosurg Pediatr;20(4):314-323, 2017 Oct.
[Is] ISSN:1933-0715
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE After endoscopic third ventriculostomy (ETV), some patients develop recurrent symptoms of hydrocephalus. The optimal treatment for these patients is not clear: repeat ETV (re-ETV) or CSF shunting. The goals of the study were to assess the effectiveness of re-ETV relative to initial ETV in pediatric patients and validate the ETV success score (ETVSS) for re-ETV. METHODS Retrospective data of 624 ETV and 93 re-ETV procedures were collected from 6 neurosurgical centers in the Netherlands (1998-2015). Multivariable Cox proportional hazards modeling was used to provide an adjusted estimate of the hazard ratio for re-ETV failure relative to ETV failure. The correlation coefficient between ETVSS and the chance of re-ETV success was calculated using Kendall's tau coefficient. Model discrimination was quantified using the c-statistic. The effects of intraoperative findings and management on re-ETV success were also analyzed. RESULTS The hazard ratio for re-ETV failure relative to ETV failure was 1.23 (95% CI 0.90-1.69; p = 0.20). At 6 months, the success rates for both ETV and re-ETV were 68%. ETVSS was significantly related to the chances of re-ETV success (τ = 0.37; 95% bias corrected and accelerated CI 0.21-0.52; p < 0.001). The c-statistic was 0.74 (95% CI 0.64-0.85). The presence of prepontine arachnoid membranes and use of an external ventricular drain (EVD) were negatively associated with treatment success, with ORs of 4.0 (95% CI 1.5-10.5) and 9.7 (95% CI 3.4-27.8), respectively. CONCLUSIONS Re-ETV seems to be as safe and effective as initial ETV. ETVSS adequately predicts the chance of successful re-ETV. The presence of prepontine arachnoid membranes and the use of EVD negatively influence the chance of success.
[Mh] Termos MeSH primário: Hidrocefalia/cirurgia
Neuroendoscopia/métodos
Terceiro Ventrículo/cirurgia
Ventriculostomia/métodos
[Mh] Termos MeSH secundário: Adolescente
Distribuição por Idade
Criança
Pré-Escolar
Registros Eletrônicos de Saúde/estatística & dados numéricos
Feminino
Seguimentos
Seres Humanos
Hidrocefalia/epidemiologia
Hidrocefalia/mortalidade
Lactente
Recém-Nascido
Estimativa de Kaplan-Meier
Masculino
Países Baixos/epidemiologia
Modelos de Riscos Proporcionais
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170715
[St] Status:MEDLINE
[do] DOI:10.3171/2017.4.PEDS16669


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[PMID]:28705702
[Au] Autor:Peron S; Mandelli J; Galante N; Colombo S; Locatelli D
[Ad] Endereço:Department of Neurosurgery, ASST West Milan - Legnano Hospital, Legnano, Italy. Electronic address: ste.peron@libero.it.
[Ti] Título:Recurrent Pituicytoma with Pseudoaneurysm: Report of a Challenging Case.
[So] Source:World Neurosurg;105:1043.e1-1043.e5, 2017 Sep.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Pituicytoma is a rare tumor originating from glial cells of the adult neurohypophysis and infundibulum. Surgical removal is the treatment of choice for this neoplasm. In recent years the endoscopic endonasal approach has proven to be a viable and effective alternative to standard craniotomy. CASE DESCRIPTION: We report a case of a patient submitted to surgical treatment for a recurrence of pituicytoma, which was operated on transcranially at another hospital approximately 5 years previously. After transcranial surgery, the patient developed a symptomatic recurrence and an undisclosed intrasellar pseudoaneurysm that were treated with an endoscopic endonasal approach, but still required an intracranial approach to complete the resection. CONCLUSIONS: An intrasellar pseudoaneurysm can endanger the endoscopic removal of the pituicytoma, forcing the surgeon to reevaluate a microscopic transcranial approach or to consider a staged procedure.
[Mh] Termos MeSH primário: Adenoma/cirurgia
Falso Aneurisma/cirurgia
Recidiva Local de Neoplasia/cirurgia
Neuro-Hipófise/cirurgia
Neoplasias Hipofisárias/cirurgia
[Mh] Termos MeSH secundário: Adenoma/complicações
Adenoma/diagnóstico por imagem
Falso Aneurisma/complicações
Falso Aneurisma/diagnóstico por imagem
Seres Humanos
Masculino
Meia-Idade
Recidiva Local de Neoplasia/complicações
Recidiva Local de Neoplasia/diagnóstico por imagem
Neuroendoscopia/métodos
Neuro-Hipófise/diagnóstico por imagem
Neoplasias Hipofisárias/complicações
Neoplasias Hipofisárias/diagnóstico por imagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170715
[St] Status:MEDLINE


  10 / 1591 MEDLINE  
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[PMID]:28686122
[Au] Autor:Gianaris TJ; Nazar R; Middlebrook E; Gonda DD; Jea A; Fulkerson DH
[Ad] Endereço:Department of Neurological Surgery, Division of Pediatric Neurosurgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, Indiana.
[Ti] Título:Failure of ETV in patients with the highest ETV success scores.
[So] Source:J Neurosurg Pediatr;20(3):225-231, 2017 Sep.
[Is] ISSN:1933-0715
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE Endoscopic third ventriculostomy (ETV) is a surgical alternative to placing a CSF shunt in certain patients with hydrocephalus. The ETV Success Score (ETVSS) is a reliable, simple method to estimate the success of the procedure by 6 months of postoperative follow-up. The highest score is 90, estimating a 90% chance of the ETV effectively treating hydrocephalus without requiring a shunt. Treatment with ETV fails in certain patients, despite their being the theoretically best candidates for the procedure. In this study the authors attempted to identify factors that further predicted success in patients with the highest ETVSSs. METHODS A retrospective review was performed of all patients treated with ETV at 3 institutions. Demographic, radiological, and clinical data were recorded. All patients by definition were older than 1 year, had obstructive hydrocephalus, and did not have a prior shunt. Failure of ETV was defined as the need for a shunt by 1 year. The ETV was considered a success if the patient did not require another surgery (either shunt placement or a repeat endoscopic procedure) by 1 year. A statistical analysis was performed to identify factors associated with success or failure. RESULTS Fifty-nine patients met the entry criteria for the study. Eleven patients (18.6%) required further surgery by 1 year. All of these patients received a shunt. The presenting symptom of lethargy statistically correlated with success (p = 0.0126, odds ratio [OR] = 0.072). The preoperative radiological finding of transependymal flow (p = 0.0375, OR 0.158) correlated with success. A postoperative larger maximum width of the third ventricle correlated with failure (p = 0.0265). CONCLUSIONS The preoperative findings of lethargy and transependymal flow statistically correlated with success. This suggests that the best candidates for ETV are those with a relatively acute elevation of intracranial pressure. Cases without these findings may represent the failures in this highly selected group.
[Mh] Termos MeSH primário: Hidrocefalia/diagnóstico
Hidrocefalia/cirurgia
Neuroendoscopia
Terceiro Ventrículo/cirurgia
Ventriculostomia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Derivações do Líquido Cefalorraquidiano
Criança
Feminino
Seres Humanos
Masculino
Neuroendoscopia/métodos
Prognóstico
Reoperação
Estudos Retrospectivos
Terceiro Ventrículo/diagnóstico por imagem
Falha de Tratamento
Ventriculostomia/métodos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170708
[St] Status:MEDLINE
[do] DOI:10.3171/2016.7.PEDS1655



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