Acoustic Neuroma (vestibular Schwannoma): Surgical Results On 240 Patients Operated On Dorsal Decubitus Position.

To evaluate the result of the surgical treatment of vestibular schwannoma (VS) operated in dorsal decubitus (mastoid position). 240 patients with a VS underwent a retrosigmoid craniotomy for tumor resection in dorsal decubitus (mastoid position). The function of 7th and 8th cranial nerves was monitored during surgery and the opened internal auditory canal (IAC) was reconstructed using a vascularized dura flap, muscle and fibrin glue. Complete tumor removal was achieved in 99% of the cases, with a mortality of 1.6%. The facial nerve function was preserved in 85% of cases and hearing in 40% of the patients (with preoperative hearing) with tumors of up 1.5 cm in diameter. The incidence of cerebrospinal fluid leak was 5.8% and meningitis 2.9%. Venous air embolism was registered in 3% of cases; it was not associated to mortality. Surgical removal of VS in dorsal position has several advantages; the morbidity and mortality are very low.65605-

Neurinoma do acústico (schwannoma do vestibular): resultados do tratamento cirúrgico de 240 pacientes operados na posição de decúbito dorsal

OBJECTIVE: To evaluate the result of the surgical treatment of vestibular schwannoma (VS) operated in dorsal decubitus (mastoid position). METHOD: 240 patients with a VS underwent a retrosigmoid craniotomy for tumor resection in dorsal decubitus (mastoid position). The function of 7th and 8th cranial nerves was monitored during surgery and the opened internal auditory canal (IAC) was reconstructed using a vascularized dura flap, muscle and fibrin glue. RESULTS: Complete tumor removal was achieved in 99% of the cases, with a mortality of 1.6%. The facial nerve function was preserved in 85% of cases and hearing in 40% of the patients (with preoperative hearing) with tumors of up 1.5 cm in diameter. The incidence of cerebrospinal fluid leak was 5.8% and meningitis 2.9%. Venous air embolism was registered in 3% of cases; it was not associated to mortality. CONCLUSION: Surgical removal of VS in dorsal position has several advantages; the morbidity and mortality are very low.OBJETIVO: Avaliar o resultado do tratamento cirúrgico de pacientes portadores de schwannoma do vestibular (SV) operados em decúbito dorsal (posição de mastóide). MÉTODO: 240 pacientes foram submetidos a craniotomia retrosigmóide na posição de mastóide. A função do VII e VIII nervos cranianos foi monitorizada durante a cirurgia e a reconstrução da abertura do conduto auditivo interno foi realizada com retalho vascularizado de dura-mater, músculo e cola de fibrina. RESULTADOS: A exérese foi completa em 99% dos casos, com mortalidade de 1,6%. Houve preservação da função do nervo facial em 85% dos casos e da audição em 40% dos pacientes com audição prévia e tumores menores de 1,5 cm. A incidência de fístula liquórica foi 5,8% e meningite 2,9%. Embolia gasosa foi registrada em 3% dos casos, não associada à mortalidade. CONCLUSÃO: O tratamento cirúrgico dos SV utilizando-se a posição de mastóide tem várias vantagens, com baixa morbidade e mortalidade.60560

Vestibular schwannoma (Acoustic neuroma) : diganosis and treatment with variation of the surgical approach

Orientador: Antonio Guilherme Borges Neto, Ricardo RaminaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: O autor apresenta um estudo descritivo-retrospectivo, envolvendo 240 pacientes portadores de Schwannoma do Vestibular (SV) que foram operados em decúbito dorsal (posição de mastóide), monitorizados com doppler transtorácico, utilizando-se o acesso retrossigmóide transmeatal. A função do VII e VIII nervos cranianos foi monitorizada durante a cirurgia e a reconstrução da abertura do conduto auditivo interno (CAI) foi realizada com retalho vascularizado de duramáter, músculo e cola de fibrina. A exérese foi completa em 99% dos casos, com mortalidade de 1,6%. Houve preservação da função do nervo facial em 85% dos casos e da audição em 40% dos pacientes, com audição prévia e tumores menores de 1,5 cm. A incidência de fístula liquórica foi de 5,8% e meningite de 2,9%. Embolia gasosa foi registrada em 3% dos casos, não associada à mortalidade. O tratamento cirúrgico dos SV utilizando-se a posição de mastóide e o acesso retrossigmóide transmeatal tem várias vantagens, com baixa morbidade e mortalidade, permitindo elevadas taxas de remoção radical, com a cura do paciente. O estudo é comparado com outras séries cirúrgicas publicadas de grupos com grande experiência na cirurgia de SV, bem como em relação aos resultados de pacientes de outros grupos que foram submetidos a tratamento radioterápico.Abstract: To evaluate the result of the surgical treatment of Vestibular Schwannoma (VS) operated in dorsal decubitus (mastoid position). Material and methods: 240 patients with VS underwent a retrosigmoid craniotomy for tumor resection in dorsal decubitus (mastoid position). The function of 7 and 8 cranial nerves was monitored during surgery and the opened internal auditory canal (ICA) was reconstructed using a vascularized dura flap, muscle and fibrin glue. Results: Complete tumor removal was achieved in 99% of the cases, with a mortality of 1.6%. The facial nerve function was preserved in 85% of cases and hearing in 40% of the patients (with preoperative hearing) with tumors of up 1, 5 cm in diameter. The incidence of cerebrospinal fluid leak was 5.8% and meningitis 2.9%. Venous air embolism was registered in 3% of cases; it was not associated to mortality. Conclusion: Surgical removal of VS in dorsal position has several advantages; the morbidity and mortality are very low.DoutoradoNeurologiaDoutor em Ciências Médica

Analise dos fatores prognosticos na hemorragia subaracnoide aneurismatica

Orientador: Antonio G. Borges NetoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: o autor apresenta um estudo descritivo, retrospectivo, envolvendo 100 pacientes com hemorragia subaracnóide aneurismática que foram submetidos à microcirurgia vascular intracraniana, para verificar a relação entre dados demográficos, fatores de risco, condições clínicas e cirúrgicas e dados de investigação por imagem com o prognóstico. Para análise estatística foi aplicado o teste do qui-quadrado ou o teste exato de Fisher e o coeficiente de Kappa ponderado. O teste de Kruskal-Wallis foi aplicado para a comparação de variáveis contínuas. Tendência de proporção foi avaliada através do teste de Cochran-Armitage. O nível de significância adotado foi de 5%. Os pacientes estudados foram predominantemente da cor branca, sexo feminino, sem histórico prévio de hipertensão arterial e tabagismo. Na admissão, o grau II, na escala de Hunt-Hess, foi o mais freqüentemente observado (34%), enquanto o grau 3, na escala de Fisher, foi o mais prevalente. Os aneurismas mais comumente observados foram aqueles com diâmetro entre 12 e 24 mm, localizados na circulação anterior. Uma boa recuperação no pós-operatório foi observada em 60% dos pacientes. O grau clínico, na escala de Hunt-Hess, no momento da cirurgia e a presença de complicações durante o procedimento cirúrgico mostrou uma correlação positiva com o prognóstico (p = 0,00002e p = 0,001,respectivamente).Outras variáveis não foram correlacionadas com o prognóstico. Tendência de proporção foi observada entre a escala de Hunt-Hess e a escala de Fisher. Entre variáveis tais como dados epidemiológicos, história médica pregressa e dados clínicos e de imagem de pacientes com hemorragia subaracnóide aneurismática, a escala de Hunt-Hess, no momento da cirurgia, e a presença de adversidades cirúrgicas demonstraram correlação com o grau de incapacidadeAbstract: Clinical and surgical outcome of patients with subarachnoid hemorrhage due to ruptured aneurysm were assessed retrospectively and compared to pre-operative data and risk factors such as previous medical history, clinical presenting condition, CT findings and site of bleeding. The author evaluated the medical records of 100 pacients with aneurysmal subarachnoid hemorrhage. Gender, color, history of hypertension, smoking habit, site and size of aneurysm, admittance and surgical Hunt Hess scale, need for csf shunt, presence of complications during the surgical procedure, GOS scale, presence of vasospasm and of rebleeding were assessed and these data matched to outcome. For statistical analysis were applied the Chi-squared test or Fisher' s test using the pondered Kappa coefficient. The non-parametric Kruskal-Wallis test was applied for comparison of continue variables. Tendency of proportion was analysed through Cochran-Armitage testo Significance leveI adopted was 5%. Patients studied were mainly white, female , without previous history of hypertension and non-smokers. Upon hospital admittance, Grade 2 of HH scale was most frequently observed (34%), while grade 3 ofFisher scale was the most prevalent. Single aneurysms were most frequent at anterior circulation, with size between 12 and 24 mm. The most frequent GOS scale observed was 5 (60%). Hunt Hess upon the moment of surgery and presence of complications during surgical procedure showed positive correlation with clinical outcome ( p = 0,00002 and p = 0,001, respectively). Other variables were not significant1y correlated to prognosis. Tendency of proportion was observed between Hunt Hess scale and Fisher scale. Among variables such as epidemiological data, previous medical history and presenting conditions of patients with ruptured aneurysms , the Hunt Hess scale upon the moment of surgery and the presence of surgical adversities were statistically related to degree of disabilityMestradoMedicina InternaMestre em Ciências Médica

Acoustic neuroma (vestibular schwannoma): surgical results on 240 patients operated on dorsal decubitus position Neurinoma do acústico (schwannoma do vestibular): resultados do tratamento cirúrgico de 240 pacientes operados na posição de decúbito dorsal

OBJECTIVE: To evaluate the result of the surgical treatment of vestibular schwannoma (VS) operated in dorsal decubitus (mastoid position). METHOD: 240 patients with a VS underwent a retrosigmoid craniotomy for tumor resection in dorsal decubitus (mastoid position). The function of 7th and 8th cranial nerves was monitored during surgery and the opened internal auditory canal (IAC) was reconstructed using a vascularized dura flap, muscle and fibrin glue. RESULTS: Complete tumor removal was achieved in 99% of the cases, with a mortality of 1.6%. The facial nerve function was preserved in 85% of cases and hearing in 40% of the patients (with preoperative hearing) with tumors of up 1.5 cm in diameter. The incidence of cerebrospinal fluid leak was 5.8% and meningitis 2.9%. Venous air embolism was registered in 3% of cases; it was not associated to mortality. CONCLUSION: Surgical removal of VS in dorsal position has several advantages; the morbidity and mortality are very low.OBJETIVO: Avaliar o resultado do tratamento cirúrgico de pacientes portadores de schwannoma do vestibular (SV) operados em decúbito dorsal (posição de mastóide). MÉTODO: 240 pacientes foram submetidos a craniotomia retrosigmóide na posição de mastóide. A função do VII e VIII nervos cranianos foi monitorizada durante a cirurgia e a reconstrução da abertura do conduto auditivo interno foi realizada com retalho vascularizado de dura-mater, músculo e cola de fibrina. RESULTADOS: A exérese foi completa em 99% dos casos, com mortalidade de 1,6%. Houve preservação da função do nervo facial em 85% dos casos e da audição em 40% dos pacientes com audição prévia e tumores menores de 1,5 cm. A incidência de fístula liquórica foi 5,8% e meningite 2,9%. Embolia gasosa foi registrada em 3% dos casos, não associada à mortalidade. CONCLUSÃO: O tratamento cirúrgico dos SV utilizando-se a posição de mastóide tem várias vantagens, com baixa morbidade e mortalidade

Alcohol Consumption and Helmet Use in Patients with Traumatic Brain Injury due to Motorcycle Accident

Alcohol consumption is an important risk factor for traumatic brain injury (TBI), and it has a great impact on its incidence and severity. However, studies suggest potential beneficial effects of alcohol during hospitalization and in the prognosis of moderate or severe TBI, with conflicting results. The objective of the present study was to associate alcohol consumption and helmet use in TBI patients, as well as the prognostic variables and patterns of injuries secondary to TBI. We analyzed 109 medical records of patients who suffered TBI due to a motorcycle accident. We evaluated data on alcohol consumption, helmet use, TBI severity, and tomographic findings on admission. The subjects with moderate or severe TBI were evaluated regarding hospitalization, mortality and prognosis variables. Patients who wore a helmet at the time of trauma had lower rates of skull fracture and extradural hematoma (EDH), but an increased incidence of subarachnoid hemorrhage (SAH). Furthermore, patients with moderate or severe TBI who were those under alcohol intoxication had a greater need for Intensive Care Unit (ICU) admission and a tendency to have a lower in-hospital mortality rate and a higher score on the Glasgow Prognostic Score (GPS). Thus, although the consumption of alcohol has an impact on the incidence and severity of TBI at admission, it seems to be related to a lower in-hospital mortality rate and a better prognosis. In addition, helmet use is essential to prevent injuries from direct head-to-shield impact, but no similar reduction in the incidence of injuries caused by indirect forces was observed