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[PMID]:27779560
[Au] Autor:Chern A; Hunter JB; Bennett ML
[Ad] Endereço:The Otology Group of Vanderbilt University, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
[Ti] Título:Cost Analysis of Cerebrospinal Fluid Leaks and Cerebrospinal Fluid Leak Prevention in Patients Undergoing Cerebellopontine Angle Surgery.
[So] Source:Otol Neurotol;38(1):147-151, 2017 01.
[Is] ISSN:1537-4505
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine if cranioplasty techniques following translabyrinthine approaches to the cerebellopontine angle are cost-effective. STUDY DESIGN: Retrospective case series. PATIENTS: One hundred eighty patients with available financial data who underwent translabyrinthine approaches at a single academic referral center between 2005 and 2015. INTERVENTION: Cranioplasty with a dural substitute, layered fat graft, and a resorbable mesh plate secured with screws Main Outcome Measures: billing data was obtained for each patient's hospital course for translabyrinthine approaches and postoperative cerebrospinal fluid (CSF) leaks. RESULTS: One hundred nineteen patients underwent translabyrinthine approaches with an abdominal fat graft closure, with a median cost of $25759.89 (range, $15885.65-$136433.07). Sixty-one patients underwent translabyrinthine approaches with a dural substitute, abdominal fat graft, and a resorbable mesh for closure, with a median cost of $29314.97 (range, $17674.28-$111404.55). The median cost of a CSF leak was $50401.25 (range, $0-$384761.71). The additional cost of a CSF leak when shared by all patients who underwent translabyrinthine approaches is $6048.15. The addition of a dural substitute and a resorbable mesh plate after translabyrinthine approaches reduced the CSF leak from 12 to 1.9%, an 84.2% reduction, and a median savings per patient of $2932.23. Applying our cohort's billing data to previously published cranioplasty techniques, costs, and leak rate improvements after translabyrinthine approaches, all techniques were found to be cost-effective. CONCLUSION: Resorbable mesh cranioplasty is cost-effective at reducing CSF leaks after translabyrinthine approaches. Per our billing data and achieving the same CSF leak rate, cranioplasty costs exceeding $5090.53 are not cost-effective.
[Mh] Termos MeSH primário: Ângulo Cerebelopontino/cirurgia
Vazamento de Líquido Cefalorraquidiano/economia
Craniotomia/economia
Craniotomia/métodos
Complicações Pós-Operatórias/economia
[Mh] Termos MeSH secundário: Idoso
Vazamento de Líquido Cefalorraquidiano/etiologia
Vazamento de Líquido Cefalorraquidiano/cirurgia
Custos e Análise de Custo
Craniotomia/efeitos adversos
Feminino
Seres Humanos
Masculino
Meia-Idade
Complicações Pós-Operatórias/epidemiologia
Complicações Pós-Operatórias/prevenção & controle
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


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[PMID]:29390458
[Au] Autor:Jang SH; Ha JW; Kim HY; Seo YS
[Ad] Endereço:Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University.
[Ti] Título:Recovery of injured Broca's portion of arcuate fasciculus in the dominant hemisphere in a patient with traumatic brain injury.
[So] Source:Medicine (Baltimore);96(51):e9183, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Recovery of injured AF in patients with traumatic brain injury (TBI) has not been reported. In this study, we report on a patient with TBI who recovered from an injury to Broca's portion of AF in the dominant hemisphere, diagnosed by diffusion tensor tractography (DTT). PATIENT CONCERNS: A 28-year-old right-handed male patient suffered head trauma resulting from sliding while riding a motorcycle. DIAGNOSES: He was diagnosed with a traumatic contusional hemorrhage in the left frontal lobe, subarachnoid hemorrhage, and subdural hemorrhage in the left fronto-temporal lobe. INTERVENTIONS: He underwent craniectomy on the left fronto-temporal area, and hematoma removal for the subdural hemorrhage in the neurosurgery department of a university hospital. Two weeks after the injury, he was transferred to the rehabilitation department of another university hospital. He showed severe aphasia and brain MRI showed leukomalactic lesion in the left frontal lobe. OUTCOMES: The result WAB for the patient showed severe aphasia, with an aphasia quotient of 45.3 percentile. However, his aphasia improved rapidly by 9 months with an aphasia quotient at the 100.0 percentile. 2-week DTT detected discontinuity in the subcortical white matter at the branch to Broca's area of left AF. By contrast, on 9-month DTT, the discontinued portion of left AF was elongated to the left Broca's area. LESSONS: Recovery of injured Broca's portion of AF in the dominant hemisphere along with excellent improvement of aphasia was demonstrated in a patient with TBI. This study has important implications in brain rehabilitation because the mechanism of recovery from aphasia following TBI has not been elucidated.
[Mh] Termos MeSH primário: Afasia de Broca/fisiopatologia
Núcleo Arqueado do Hipotálamo/fisiopatologia
Lesões Encefálicas Traumáticas/diagnóstico
Lesões Encefálicas Traumáticas/reabilitação
Vias Neurais/lesões
[Mh] Termos MeSH secundário: Adulto
Afasia de Broca/etiologia
Lesões Encefálicas Traumáticas/cirurgia
Área de Broca/lesões
Craniotomia/métodos
Imagem de Tensor de Difusão/métodos
Seguimentos
Lobo Frontal/lesões
Lobo Frontal/patologia
Lateralidade Funcional
Hematoma Subdural/diagnóstico
Hematoma Subdural/reabilitação
Hematoma Subdural/cirurgia
Seres Humanos
Escala de Gravidade do Ferimento
Imagem por Ressonância Magnética/métodos
Masculino
Recuperação de Função Fisiológica
Medição de Risco
Lobo Temporal/lesões
Lobo Temporal/patologia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009183


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[PMID]:28468158
[Au] Autor:Dang RR; Padwa BL; Resnick CM
[Ad] Endereço:*Department of Plastic and Oral Surgery, Boston Children's Hospital †Harvard School of Dental Medicine, Boston, MA.
[Ti] Título:Velopharyngeal Insufficiency After Le Fort I Osteotomy in a Patient With Undiagnosed Occult Submucous Cleft Palate.
[So] Source:J Craniofac Surg;28(3):752-754, 2017 May.
[Is] ISSN:1536-3732
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The authors present a 16-year-old patient with no known history of cleft palate who developed velopharyngeal insufficiency after a Le Fort I osteotomy performed for the correction of maxillary hypoplasia and a Class III malocclusion. Postoperative evaluation revealed the presence of velopharyngeal insufficiency and subtle findings of an occult submucous cleft palate. She had a pharyngeal flap 6 months later with successful correction of the velopharyngeal insufficiency. This case illustrates the need to screen for submucous cleft palate prior to orthognathic surgery.
[Mh] Termos MeSH primário: Fenda Labial/cirurgia
Fissura Palatina/cirurgia
Craniotomia/efeitos adversos
Erros de Diagnóstico
Má Oclusão de Angle Classe III/cirurgia
Osteotomia de Le Fort/efeitos adversos
Insuficiência Velofaríngea/etiologia
[Mh] Termos MeSH secundário: Adolescente
Fissura Palatina/diagnóstico
Feminino
Fluoroscopia
Seres Humanos
Complicações Pós-Operatórias
Insuficiência Velofaríngea/diagnóstico
Insuficiência Velofaríngea/cirurgia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1097/SCS.0000000000003427


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[PMID]:28468154
[Au] Autor:Farber SJ; Nguyen DC; Skolnick GB; Naidoo SD; Smyth MD; Patel KB
[Ad] Endereço:*Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine †Department of Neurosurgery, Washington University School of Medicine, St Louis, MO.
[Ti] Título:Anthropometric Outcome Measures in Patients With Metopic Craniosynostosis.
[So] Source:J Craniofac Surg;28(3):713-716, 2017 May.
[Is] ISSN:1536-3732
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Treatment of metopic craniosynostosis is performed by either fronto-orbital advancement (FOA) or endoscopic-assisted techniques. Interfrontal angle (IFA) is a validated measure of trigonocephaly, but requires a computed tomography scan. The most common direct measure to assess surgical outcome in patients with trigonocephaly is frontal width (ft-ft). The aim of this study is to determine if frontal width correlates with IFA and successful surgical correction 1 year after treatment. A review of current morphologic assessment techniques is also provided. METHODS: Three-dimensional computed tomography scans (preoperative and 1 year postoperative) of patients who underwent FOA (n = 13) or endoscopic (n = 13) treatment of metopic craniosynostosis were reviewed. Age-matched scans of unaffected patients served as controls. Frontal width was measured by a straight line between the bilateral frontotemporal points. Measurements were performed by 2 experienced observers and compared to IFA. RESULTS: Mean frontal width at preoperative scan for endoscopic and open patients was 55 ±â€Š0.6 and 64 ±â€Š0.7 mm, respectively (Z-score 1.6 and -3.7). Mean frontal width at postoperative scan for endoscopic and open patients was 80 ±â€Š0.4 and 81 ±â€Š0.7 mm (Z-score 0.0 for both groups). Frontal width for endoscopic correction significantly correlated with IFA (r = 0.536, P = 0.005), as well as for the open patients (r = 0.704, P < 0.001). CONCLUSION: Frontal width normalizes 1 year after operation, regardless of technique. Advantage of frontal width is that it can be measured in the clinic using a spreading vernier caliper. It correlates well with IFA and can be used as a metric for morphologic outcome.
[Mh] Termos MeSH primário: Antropometria/métodos
Craniossinostoses/diagnóstico
Imagem Tridimensional/métodos
Tomografia Computadorizada por Raios X/métodos
[Mh] Termos MeSH secundário: Craniossinostoses/cirurgia
Craniotomia/métodos
Endoscopia/métodos
Feminino
Seres Humanos
Lactente
Masculino
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180209
[Lr] Data última revisão:
180209
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1097/SCS.0000000000003495


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[PMID]:29236825
[Au] Autor:Heringer LC; Sousa UO; Oliveira MF; Nunes AS; Alves KA; Zancanaro ML; Botelho RV
[Ad] Endereço:Instituto de Assistência Médica ao Servidor Público Estadual, Programa de Pós Graduação, São Paulo SP, Brasil.
[Ti] Título:The number of burr holes and use of a drain do not interfere with surgical results of chronic subdural hematomas.
[So] Source:Arq Neuropsiquiatr;75(11):809-812, 2017 Nov.
[Is] ISSN:1678-4227
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:Burr hole evacuation has been the most frequently-used procedure for the treatment of chronic subdural hematomas (CSDH). OBJECTIVE: To evaluate whether the use of a drain and/or the number of burr holes for treatment of CSDH modifies the rates of recurrence and complications. METHODS: A retrospective review of 142 patients operated on because of CSDH, between 2006 and 2015, analyzing recurrence and complications of the use of one or two burr holes with or without the use of a drain. RESULTS: Thirty-seven patients had bilateral CSDH (26%) and 105 (73.9%) patients had unilateral CSDH. Twenty-two (59.4%) patients were given a drain and 15 (40.6%) were not. A total number of recurrences occurred in 22 (15.5%) patients and the total number of complications was in six (4.2%) patients. Mean follow-up time was 7.67 months. CONCLUSIONS: The number of burr holes and the use of the drain did not alter the rates of recurrence and complications in the treatment of CSDH.
[Mh] Termos MeSH primário: Craniotomia/métodos
Drenagem
Hematoma Subdural Crônico/cirurgia
Trepanação/métodos
[Mh] Termos MeSH secundário: Idoso
Craniotomia/efeitos adversos
Feminino
Seres Humanos
Masculino
Meia-Idade
Recidiva
Estudos Retrospectivos
Prevenção Secundária
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:28468142
[Au] Autor:Kölby D; Fischer S; Arab K; Maltese G; Olsson R; Paganini A; Tarnow P; Kölby L
[Ad] Endereço:Department of Plastic Surgery, Sahlgrenska University Hospital, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
[Ti] Título:Craniotomy of the Fused Sagittal Suture Over the Superior Sagittal Sinus Is a Safe Procedure.
[So] Source:J Craniofac Surg;28(3):650-653, 2017 May.
[Is] ISSN:1536-3732
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Spring-assisted cranioplasty to correct sagittal synostosis is based on midline craniotomy through the closed sagittal suture, over the superior sagittal sinus (SSS). The aim of the present study was to evaluate the perioperative safety of this technique. MATERIALS AND METHODS: This is a retrospective study of all patients operated with median craniotomy and springs from 1998 to the end of 2015. For comparison, all Pi-plasties performed during the same time interval were also evaluated. The safety measures were evaluated based on incidence of damage to SSS, incidence of dural tears, perioperative blood loss, operative time, and hospital stay. RESULTS: In the group that had undergone midline craniotomy combined with springs (n = 225), 4 perioperative damages to SSS and 1 dural tear were seen. The perioperative blood loss was 62.8 ±â€Š65.3 mL (mean ±â€Šstandard deviation). The operative time was 67.9 ±â€Š21.5 minutes and the hospital stay was 4.8 ±â€Š1.1 days. In the group that had undergone pi-plasty (n = 105), no damages to SSS but 3 dural tears were seen. The perioperative blood loss was 352.8 ±â€Š174.4 mL. The operative time was 126.0 ±â€Š31.7 minutes and the hospital stay was 7.1 ±â€Š1.4 days. CONCLUSION: Craniotomy SSS in sagittal synostosis is a safe procedure with low morbidity in terms of damage to the SSS. Midline craniotomy combined with springs has significantly lower preoperative blood loss, operative time, and hospital stay (P < 0.001 for all) compared to pi-plasty.
[Mh] Termos MeSH primário: Craniossinostoses/cirurgia
Craniotomia/métodos
Seio Sagital Superior/cirurgia
[Mh] Termos MeSH secundário: Suturas Cranianas/cirurgia
Dura-Máter/lesões
Feminino
Seres Humanos
Lactente
Tempo de Internação
Masculino
Duração da Cirurgia
Complicações Pós-Operatórias/etiologia
Estudos Retrospectivos
Seio Sagital Superior/lesões
Suturas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180126
[Lr] Data última revisão:
180126
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1097/SCS.0000000000003440


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[PMID]:29252954
[Au] Autor:Vollmer JP; Haen S; Wolburg H; Lehmann R; Steiner J; Reddersen S; Fend F; Fallier-Becker P
[Ad] Endereço:Institute of Anaesthesiology, Klinikum Stuttgart, Germany.
[Ti] Título:Propofol Related Infusion Syndrome: Ultrastructural Evidence for a Mitochondrial Disorder.
[So] Source:Crit Care Med;46(1):e91-e94, 2018 Jan.
[Is] ISSN:1530-0293
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The objective of this report of a fatal propofol-related infusion syndrome in a young adult was to present-to our knowledge for the first time-direct ultrastructural evidence for the central role of mitochondrial damage in the pathogenesis of this syndrome. DATA SOURCES: Histological and electron microscopical analysis of liver, skeletal, and heart muscle obtained by autopsy and blood obtained from patient. STUDY SELECTION: Case report. DATA EXTRACTION: In addition to conventional macroscopical and histological investigations, electron-microscopical analysis of myocardial- and skeletal muscle and liver tissue obtained at autopsy from a young man was performed in order to search for ultrastructural changes of mitochondria. Acylcarnitine concentrations of his blood were determined by ultra-high performance liquid chromatography mass spectrometry. DATA SYNTHESIS: A 19-year-old male was admitted with acute left-side hemiparesis. The patient was intubated, then propofol infusion started, and a craniotomy was performed to remove an intracerebral hematoma. In the postoperative period, the patient presented with elevated intracranial pressure and brain edema. After repeat surgery, the patient showed impaired systolic left ventricular function, increasing fever, anuria, hyperkalemia, and metabolic acidosis, and he finally expired. Electron microscopy revealed dark, electron dense amorphous structures associated with mitochondria in heart muscle and liver tissue obtained at autopsy. Peripheral blood analysis revealed increased levels of acetyl-, propionyl-, butyryl-, malonyl-, and valeryl-carnitine as an indicator for propofol-related infusion syndrome, as well as for propofol-mediated inhibition of free fatty acid uptake into mitochondria, affecting beta-oxidation. CONCLUSIONS: Electron dense bodies found in association with mitochondria in muscle and liver cells probably correspond to accumulation of free fatty acid provide direct morphological evidence for the mitochondrial damage in propofol-related infusion syndrome.
[Mh] Termos MeSH primário: Doenças Mitocondriais/induzido quimicamente
Doenças Mitocondriais/patologia
Síndrome da Infusão de Propofol/patologia
[Mh] Termos MeSH secundário: Carnitina/análogos & derivados
Carnitina/sangue
Craniotomia
Hematoma Subdural Intracraniano/cirurgia
Seres Humanos
Infusões Intravenosas
Masculino
Microscopia Eletrônica
Mitocôndrias Cardíacas/efeitos dos fármacos
Mitocôndrias Cardíacas/patologia
Mitocôndrias Hepáticas/efeitos dos fármacos
Mitocôndrias Hepáticas/patologia
Mitocôndrias Musculares/efeitos dos fármacos
Mitocôndrias Musculares/patologia
Complicações Pós-Operatórias/induzido quimicamente
Complicações Pós-Operatórias/patologia
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (acylcarnitine); S7UI8SM58A (Carnitine)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171227
[Lr] Data última revisão:
171227
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE
[do] DOI:10.1097/CCM.0000000000002802


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[PMID]:29176416
[Au] Autor:Wolfswinkel EM; Howell LK; Fahradyan A; Azadgoli B; McComb JG; Urata MM
[Ad] Endereço:Los Angeles, Calif. From the Division of Plastic and Reconstructive Surgery and the Department of Neurological Surgery, Keck School of Medicine, University of Southern California; and the Divisions of Plastic and Maxillofacial Surgery and Neurosurgery, Children's Hospital of Los Angeles.
[Ti] Título:Is Postoperative Intensive Care Unit Care Necessary following Cranial Vault Remodeling for Sagittal Synostosis?
[So] Source:Plast Reconstr Surg;140(6):1235-1239, 2017 Dec.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Of U.S. craniofacial and neurosurgeons, 94 percent routinely admit patients to the intensive care unit following cranial vault remodeling for correction of sagittal synostosis. This study aims to examine the outcomes and cost of direct ward admission following primary cranial vault remodeling for sagittal synostosis. METHODS: An institutional review board-approved retrospective review was undertaken of the records of all patients who underwent primary cranial vault remodeling for isolated sagittal craniosynostosis from 2009 to 2015 at a single pediatric hospital. Patient demographics, perioperative course, and outcomes were recorded. RESULTS: One hundred ten patients met inclusion criteria with absence of other major medical problems. Average age at operation was 6.7 months, with a mean follow-up of 19.8 months. Ninety-eight patients (89 percent) were admitted to a general ward for postoperative care, whereas the remaining 12 (11 percent) were admitted to the intensive care unit for preoperative or perioperative concerns. Among ward-admitted patients, there were four (3.6 percent) minor complications; however, there were no major adverse events, with none necessitating intensive care unit transfers from the ward and no mortalities. Average hospital stay was 3.7 days. The institution's financial difference in cost of intensive care unit stay versus ward bed was $5520 on average per bed per day. Omitting just one intensive care unit postoperative day stay for this patient cohort would reduce projected health care costs by a total of $540,960 for the study period. CONCLUSION: Despite the common practice of postoperative admission to the intensive care unit following cranial vault remodeling for sagittal craniosynostosis, the authors suggest that postoperative care be considered on an individual basis, with only a small percentage requiring a higher level of care. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
[Mh] Termos MeSH primário: Craniossinostoses/cirurgia
Craniotomia/métodos
Cuidados Críticos/utilização
Cuidados Pós-Operatórios/utilização
[Mh] Termos MeSH secundário: Perda Sanguínea Cirúrgica
Transfusão de Sangue/estatística & dados numéricos
Custos e Análise de Custo
Craniossinostoses/economia
Craniotomia/economia
Feminino
Seres Humanos
Lactente
Tempo de Internação/economia
Tempo de Internação/estatística & dados numéricos
Masculino
Duração da Cirurgia
Cuidados Pós-Operatórios/economia
Estudos Retrospectivos
Resultado do Tratamento
Procedimentos Desnecessários/economia
Procedimentos Desnecessários/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171204
[Lr] Data última revisão:
171204
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003848


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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]:28930819
[Au] Autor:Jang S; Kim J; Seo Y; Kwak S
[Ad] Endereço:aDepartment of Physical Medicine & Rehabilitation bDepartment of Neurosurgery, College of Medicine, Yeungnam University, Nam-gu, Daegu, Republic of Korea.
[Ti] Título:Recovery of an injured corticobulbar tract in a patient with stroke: A case report.
[So] Source:Medicine (Baltimore);96(38):e7636, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: The corticobulbar tract (CBT) is known to be involved in the motor function of the non-oculomotor cranial nuclei and controls the muscles of the face, head, and neck. Several studies have reported injury of the CBT in patients with brain injury, however, little is known about recovery of the injured CBT. PATIENT CONCERNS: A 59-year-old right-handed male underwent decompressive craniectomy for management of brain swelling and intracerebral hemorrhage following an infarction in the left middle cerebral artery territory. Initially, the patient had showed severe dysphagia and had to be fed using a Levin tube. Five weeks after the onset of stroke, the patient was transferred to the rehabilitation department and underwent comprehensive rehabilitative therapy. Cranioplasty was performed eight weeks after the onset. The patient was completely recovered from dysphagia and the Levine tube was removed nine weeks after the onset. INTERVENTIONS: Diffusion tensor imaging was performed twice; at five weeks and nine weeks from the onset. OUTCOME: On five-week diffusion tensor tractography (DTT), the right CBT was discontinued at the subcortical white matter and showed severe narrowing and the left CBT was not reconstructed. By contrast, on nine-week DTT, the right CBT was extended to the cerebral cortex and thickened while the left CBT remained not reconstructed in DTT. LESSONS: This case demonstrates the association of the recovery of injured CBT with the recovery of dysphagia using DTT.
[Mh] Termos MeSH primário: Craniotomia/métodos
Tratos Piramidais/fisiopatologia
Recuperação de Função Fisiológica
Reabilitação do Acidente Vascular Cerebral/métodos
Acidente Vascular Cerebral/fisiopatologia
[Mh] Termos MeSH secundário: Córtex Cerebral/cirurgia
Hemorragia Cerebral/etiologia
Hemorragia Cerebral/cirurgia
Transtornos de Deglutição/etiologia
Transtornos de Deglutição/fisiopatologia
Transtornos de Deglutição/reabilitação
Imagem de Tensor de Difusão
Seres Humanos
Masculino
Meia-Idade
Tratos Piramidais/lesões
Tratos Piramidais/cirurgia
Acidente Vascular Cerebral/complicações
Acidente Vascular Cerebral/cirurgia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171015
[Lr] Data última revisão:
171015
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170921
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007636



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