Discectomia percutană în tratamentul herniei de disc lombare

Background. In our days are known multiple surgical treatment methods of a disc herniation but with some controversies in the individual selection of the operation type. Even with successes in degenerative pathology treatment, the term of „failed back syndrome” was established, that have imposed the development and implementation of minimally invasive techniques, such as percutaneous discectomy (PD). Objective of the study. The main goal of current study was the evaluation of the efficiency of PD in pain syndrome reduction (by VAS scale) at lumbar disc herniation (LDH) treatment. Materials and Methods. The study was based on the analysis of 100 cases with LDH that were operated in 2016-2020 through PD. The results of the treatment were appreciated according to the pain relief, reducing of neurological deficit, improving the psycho-emotional state, decreasing of analgesic intake, length of hospitalization and the return to daily activity (Denis scale). Results. PD has proven to be a convenient method of treatment through minor invasiveness, no need of general anesthesia, the absence of the alteration of the spine support function, reducing the risk of postoperative adhesions and patients’ rehabilitation period. Conclusion. Comparison of medical and surgical treatments’ results has demonstrated that PD clearly improves treatment outcomes compared to the conservative treatment and that the result could be compared with the microsurgical discectomy in an unencumbered LDH case (d £ 6 mm).Introducere. În prezent se cunosc multiple metode de tratament chirurgical a herniei discale dar cu controverse în selectarea individuală a tipului de operație. În pofida succeselor în tratamentul patologiei degenerative, s-a stabilit termenul de „failed back syndrome”, care a impus dezvoltarea și implementarea tehnicilor minimal invazive, una din care fiind discectomia percutană (DP). Scopul lucrării. Obiectivul studiului este de a evalua eficacitatea DP în reducerea sindromului algic (conform scalei VAS) la pacienții cu hernie de disc lombară (HDL). Material si metode. Studiul este bazat pe analiza a 100 de cazuri operați, anii 2016- 2020, pentru HDL prin DP. Rezultatele tratamentului au fost apreciate în baza diminuării durerii (scala VAS), diminuarea deficitului neurologic, îmbunătățirea stării psihoemoționale, diminuarea aportului de analgezice, durata spitalizării și revenirea la activitatea zilnică (scala Denis). Rezultate. DP s-a dovedit a fi o metodă avantajoasă de tratament prin: invazivitate minoră, lipsa necesității în anestezia generală, absența alterării a funcției de suport a coloanei vertebrale, reducerea riscului apariției aderențelor postoperatorii și perioadei de reabilitare a pacienților. Concluzii. Compararea rezultatelor tratamentului medicamentos și chirurgical a demonstrat că DP ameliorează vădit rezultatele tratamentului în comparație cu cel conservativ și ca eficacitate este comparabilă cu discectomia microchirurgicală în caz de HDL nesechestrate (d - până la 6 mm)

PERCUTANEOUS DISCECTOMY IN TREATMENT OF LUMBAR DISC HERNIATION

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. În prezent se cunosc multiple metode de tratament chirurgical a herniei discale dar cu controverse în selectarea individuală a tipului de operație. În pofida succeselor în tratamentul patologiei degenerative, s-a stabilit termenul de „failed back syndrome”, care a impus dezvoltarea și implementarea tehnicilor minimal invazive, una din care fiind discectomia percutană (DP). Scopul lucrării. Obiectivul studiului este de a evalua eficacitatea DP în reducerea sindromului algic (conform scalei VAS) la pacienții cu hernie de disc lombară (HDL). Material si metode. Studiul este bazat pe analiza a 100 de cazuri operați, anii 20162020, pentru HDL prin DP. Rezultatele tratamentului au fost apreciate în baza diminuării durerii (scala VAS), diminuarea deficitului neurologic, îmbunătățirea stării psihoemoționale, diminuarea aportului de analgezice, durata spitalizării și revenirea la activitatea zilnică (scala Denis). Rezultate. DP s-a dovedit a fi o metodă avantajoasă de tratament prin: invazivitate minoră, lipsa necesității în anestezia generală, absența alterării a funcției de suport a coloanei vertebrale, reducerea riscului apariției aderențelor postoperatorii și perioadei de reabilitare a pacienților. Concluzii. Compararea rezultatelor tratamentului medicamentos și chirurgical a demonstrat că DP ameliorează vădit rezultatele tratamentului în comparație cu cel conservativ și ca eficacitate este comparabilă cu discectomia microchirurgicală în caz de HDL nesechestrate (d - până la 6 mm).Background. In our days are known multiple surgical treatment methods of a disc herniation but with some controversies in the individual selection of the operation type. Even with successes in degenerative pathology treatment, the term of „failed back syndrome” was established, that have imposed the development and implementation of minimally invasive techniques, such as percutaneous discectomy (PD). Objective of the study. The main goal of current study was the evaluation of the efficiency of PD in pain syndrome reduction (by VAS scale) at lumbar disc herniation (LDH) treatment. Materials and Methods. The study was based on the analysis of 100 cases with LDH that were operated in 2016-2020 through PD. The results of the treatment were appreciated according to the pain relief, reducing of neurological deficit, improving the psycho-emotional state, decreasing of analgesic intake, length of hospitalization and the return to daily activity (Denis scale). Results. PD has proven to be a convenient method of treatment through minor invasiveness, no need of general anesthesia, the absence of the alteration of the spine support function, reducing the risk of postoperative adhesions and patients’ rehabilitation period. Conclusion. Comparison of medical and surgical treatments’ results has demonstrated that PD clearly improves treatment outcomes compared to the conservative treatment and that the result could be compared with the microsurgical discectomy in an unencumbered LDH case (d £ 6 mm)

Discectomia percutană ca tratament al herniei de disc lombare

Institutul de Neurologie și Neurochirurgie „Diomid Gherman”, Catedra de neurochirurgie, „Nicolae Testemiţanu”, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareBackground. In our days are known multiple surgical treatment methods of a disc herniation but with some controversies in the individual selection of the operation type. Even with successes in degenerative pathology treatment, the term of “Failed back syndrome” was established, that have imposed the development and implementation of minimally invasive techniques, such as percutaneous discectomy (PD). Objective of the study. The main goal of current study was the evaluation of the efficiency of PD in pain syndrome reduction (by VAS scale) at lumbar disc herniation (LDH) treatment. Material and Methods. The study was based on the analysis of 100 cases with LDH, that were operated in 2016-2020 through PD. The results of the treatment were appreciated according to the pain relief, reducing of neurological deficit, improving the psycho-emotional state, decreasing of analgesic intake, length of hospitalization and the return to daily activity (Denis scale). Results. PD has proven to be a convenient method of treatment through: minor invasiveness, no need of general anesthesia, the absence of the alteration of the spine support function, reducing the risk of postoperative adhesions and patients’ rehabilitation period. Conclusion. Comparison of medical and surgical treatments’ results has demonstrated that PD clearly improves treatment outcomes compared to the conservative treatment and that the result could be compared with the microsurgical discectomy in an unencumbered LDH case (d 6 mm). Introducere. În prezent se cunosc multiple metode de tratament chirurgical a herniei discale dar cu controverse în selectarea individuală a tipului de operație. În pofida succeselor în tratamentul patologiei degenerative, s-a stabilit termenul de ”failed back syndrome”, care a impus dezvoltarea și implementarea tehnicilor minimal invazive, una din care fiind discectomia percutană (DP). Scopul lucrării. Obiectivul studiului este de a evalua eficacitatea DP în reducerea sindromului algic (conform scalei VAS) la pacienții cu hernie de disc lombară (HDL). Material și Metode. Studiul este bazat pe analiza a 100 de cazuri operați, anii 2016-2020, pentru HDL prin DP. Rezultatele tratamentului au fost apreciate în baza diminuării durerii (scala VAS), diminuarea deficitului neurologic, îmbunătățirea stării psihoemoționale, diminuarea aportului de analgezice, durata spitalizării și revenirea la activitatea zilnică (scala Denis). Rezultate. DP s-a dovedit a fi o metodă avantajoasă de tratament prin: invazivitate minoră, lipsa necesității în anestezie generală, absența alterării a funcției de suport a coloanei vertebrale, reducerea riscului apariției aderențelor postoperatorii și a perioadei de reabilitare a pacienților. Concluzii. Compararea rezultatelor tratamentului medicamentos și chirurgical a demonstrat că DP ameliorează vădit rezultatele tratamentului, în comparație cu cel conservativ și ca eficacitate este comparabilă cu discectomia microchirurgicală în caz de HDL nesechestrate (d - până la 6 mm)

Embolizarea endovasculară a anevrismelor cerebrale: Studiu. Serie de cazuri

Background. Nontraumatic subarahnoid hemorrhage (SAH) of aneurysmal etiology is a neurosurgical emergency. Aneurysm rupture accounts for 80% of nontraumatic SAH and has a high rate of complications and death. Endovascular coiling embolization of the aneurysm is a basic method for aneurysm exclusion. Objective of the study. The objective of this study is to share the results of a series of cases that underwent aneurysm coiling for aneurysmal SAH. Material and Methods. The study represents a series of patients who underwent aneurysm coiling for the treatment of SAH. Before intervention the patients were assessed based on mFisher, Hunt-Hess and WFNS scales. Coiling embolization was performed under general anesthesia. Outcome criteria were assessed at 3 and 6 months. Results. All the patients were initially evaluated with an angiographic study (CT angio or angiography) for planning the intervention. The patients were operated under general anesthesia. Coiling and baloon-assisted coiling were procedures used in the majority of cases. One case were complicated by intraprocedural rupture of the aneurysm and later the patient passed away. All other cases were successfully and the patients were discharged in a mRS score below 3. Conclusion. Considering minimal invasiveness of endovascular coiling of an brain aneurysm for a patient than neurosurgical clipping, we conclude that implementation of this technique will improve the quality of patient care and improve clinical results. Introducere. Hemoragia subarahnoidiană (HSA) anevrismală este o urgență neurochirurgicală. Anevrismele erupte sunt responsabile de 80% din HAS nontraumatică. Embolizarea endovasculară este o metodă de bază pentru a exclude anevrismul din circulație. Scopul lucrării. Scopul lucrării este prezentarea rezultatelor unei serii de cazuri de embolizare endovasculară a anevrismelor cerebrale. Material și Metode. Studiul reprezintă o serie de cazuri de embolizare endovasculara a anevrismelor cerebrale. Preoperator, pacienții au fost evaluați conform scalelor uzuale: Hunt-Hess, WFNS, mFisher. Procedurile au fost efectuate în anestezie generală. Evaluarea pacienților a avut loc la 3 și 6 luni, postoperator. Rezultate. Preoperator, pacienții au fost evaluați printr-o metodă angiografică (CT angio sau angiografie clasică) în vederea planificării intervenției chirurgicale. Toate procedurile au avut loc în anestezie generală. Embolizarea și embolizarea balon-asistată au fost tehnicile folosite cel mai des. Un caz s-a complicat cu o erupție repetată intraoperatorie a anevrismului și ulterior, decesul pacientului. Restul cazurilor s-au finisat cu succes, pacienții fiind externați într-un scor Rankin mai mic ca 3. Concluzii. Având în vedere caracterul minimal invaziv al procedurii de embolizare, comparativ cu clipping-ul, implimentarea pe larg a acestei metode de tratament va ameliora outcome-ul și calitatea vieții pacienților cu anevrisme cerebrale

Causes of traumatic brain injuries in the Republic of Moldova

Background: Traumatic brain injury (TBI) is a major source of health loss and disability worldwide. Many survivors live with significant disabilities, resulting in major socioeconomic burden. Annually, in Europe are registered 57000 of deaths and 1.5 mln. of hospitalizations. The goal of our study was to examine the number and most frequent causes of TBI in the population of the Republic of Moldova and their distribution in reference groups. Material and methods: This study has included the 3-months’ retrospective and 6-months’ prospective data in 2 tertiary level hospitals in Moldova. Data were collected using specialized questionnaires, that were eventually analyzed. Results: During these 9 months 518 patients with TBI were registered, aged between 0 and 79, 294 of them were adults and 224 children. The trauma circumstances have been documented in accordance with national and international guidelines. The main causes were the following: the 1st place – falls from height (277 cases), the 2d place – road traffic injuries (149 cases), the 3d place – interpersonal violence (73 cases) and on the 4th place – self-harm injuries (73 cases). Conclusions: Our research provides a detailed picture of TBI-related situation in Moldova. To quantify the real burden of TBI, including the prevalence of TBI-related disability, more study is needed

Percutaneous discectomy in lumbar disc herniation treatment

Background: Multiple surgical treatment methods of a disc herniation are known our days but some controversies may occur in the individual selection of the operation type. In spite of the registered successes in degenerative pathology treatment, the term of “Failed back syndrome” was established. This in turn has imposed the development and implementation of minimally invasive techniques, such as percutaneous discectomy (PD). The main goal of current study was the evaluation of the efficiency of PD in pain syndrome reduction (by VAS scale) at lumbar disc herniation (LDH) treatment. Material and methods: The study was based on the analysis of 100 cases with LDH, that were operated in 2016 – 2020 through PD. The results of the treatment were appreciated according to the pain relief, neurological deficit reduction, the psycho-emotional state improvement, decrease of analgesic intake, length of hospitalization and the return to daily activity (Denis scale). Results: PD proved to be a convenient method of treatment. Out of 100 patients, 78 showed the disappearance of pain and the reduction of the neurological deficit after the procedure, 12 patients showed improvements over 3 months according to the Denis Scale. 10 patients underwent microsurgical treatment due to the absence of improvement in syndromes. Conclusions: The results of the study showed an effectiveness of 78% of the total, with the improvement of the VAS and Denis Scales criteria and a fast and early recovery of patients. At the same time, their hospital stay was reduced by only 24 hours

Intraoperative ultrasonography in brain tumor surgery: 5-year experience

Background: Ultrasonography is an accessible imaging modality that provides real-time guidance with minimal risk or additional time. There is a strong correlation between ultrasonography and postoperative computed tomography when evaluating the extent of tumor resection, suggesting ultrasonography can have significant clinical implications. The objective of this study was to provide more evidence on the usage of ultrasonography in the determination of gross-total resection of brain tumors. Material and methods: This study consisted of a retrospective review of patients treated at the Institute of Neurology and Neurosurgery between 2015 and 2020 for a brain tumor. All patients were treated with ultrasonography and then underwent postoperative tomography with or without contrast within first 3 days after surgery. Results: A total of 85 cases were included. Ultrasonography results showed a strong association with postoperative tomography. Ultrasonography was able to accurately identify residual tumor in 100% of subtotal resection cases where resection was stopped due to invasion of tumor into eloquent locations. Cases involving gliomas had a 75% intended total resection rate. Cases involving metastatic tumors had an 87% intended total resection rate. The sensitivity and specificity were reported for ultrasonography in all included tumor pathologies, glioma cases, and metastatic tumor cases, respectively. Conclusions: The use of ultrasonography may allow for a reliable imaging modality to achieve a more successful total resection of brain tumors. When attempting total resection, it was demonstrated an 81% total resection rate. Ultrasonography can be used in brain tumor surgery to improve surgical outcomes

Cauzele traumatismului cranio-cerebral în Republica Moldova

Background. Cranial injuries are the main cause of the mortality and neurological dysfunctions globally. It is a social and financial burden for the patients, their families and the Public System of Health. Because of that, annually, in Europe are registered 57000 of deaths and 1,5 mln. of hospitalizations. Objective of the study. The goal of the current study was to examine the number and the causes of cranio-cerebral trauma in the population of the Republic of Moldova and their distribution in reference groups. Material and Methods. This study has included the 3-months’ retrospective and 6-months’ prospective data in 2 tertiary level hospitals from Moldova. A questionnaire was applied to collect medical records’ data and they were analised with the help of Microsoft Excel app. Results. During these 9 months were registered 518 patients with traumatic cranio-cerebral injuries, with the age included between 0 and 79, 294 of them were adults and 224 children. The trauma circumstances have been documented in accordance with national and international guidelines. The main production mechanisms were: I place - falling from a height (277 cases), II place – traffic accidents (149 cases), III place - interpersonal violence (73 cases) and on the IV-th place – harming yourself (73 cases). Addressability and need for specialized treatment in proportion of 377 on men and 141 women, the majority need the advanced medical care. Conclusion. Beside all the cranio-cerebral injuries presented and treated in neurosurgery services in the Republic of Moldova, the majority were part of the adult male population and the majority being caused by the falling from a height and traffic accidents. Introducere. Leziunile craniene sunt o cauză principală de mortalitate și disfuncții neurologice la nivel mondial, o povară socială și financiară pentru pacienți, familiile lor și pentru sistemul public de sănătate, anual, în Europa, înregistrându-se 57 mii decese și 1,5 mln de internări în spitale. Scopul lucrării. Scopul studiului a fost de a evalua numărul și cauzele traumelor cranio-cerebrale în populația Republicii Moldova și repartizarea acestora în grupuri de referință. Material și Metode. Studiul a inclus 3 luni de colectare a datelor retrospective și 6 luni- prospective în 2 spitale de nivel terțiar din Republica Moldova. S-a aplicat un chestionar pentru colectarea datelor din registrele medicale, acestea fiind analizate cu Microsoft Excel. Rezultate. În decursul celor 9 luni, s-au înregistrat 518 pacienți cu leziuni traumatice cranio-cerebrale, cu vârsta cuprinsă între 0-79 ani, din ei 294 adulți și 224 copii. Circumstanțele traumei au fost documentate în conformitate cu protocoalele naționale și internaționale. Principalele mecanisme de producere au fost: I loc- căderea de la înălțime (277 cazuri), locul IIaccidentele rutiere (149 cazuri), locul III- violența interpersonală (73 cazuri) și pe locul IVautovătămarea (73 cazuri). Adresabilitatea și necesitatea de tratament specializat în proporție de 377 bărbați și 141 femei, majoritatea necesitând ajutor medical avansat. Concluzii. Cel mai mare număr de leziuni cranio-cerebrale prezentate și tratate în cadrul serviciilor de neurochirurgie din Republica Moldova, au fost la populația adultă de gen masculin, fiind cauzate de căderi de la înălțime și de accidente rutiere

Causes of cranio-cerebral trauma in the Republic of Moldova

Institute of Neurology and Neurosurgery ,,D.Gherman”, Chisinau, Republic of Moldova, Department of Surgery No. 1 „Nicolae Anestiadi”, Neurosurgery Department, State University of Medicine and Pharmacy "Nicolae Testemitanu" Chișinău, Republic of Moldova, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction: Cranial injuries are the main cause of the mortality and neurological dysfunctions globally. It is a social and financial burden for the patients, their families and the Public System of Health. Because of that, annually, in Europe are registered 57000 of deaths and 1,5 mln. of hospitalizations. Purpose: The goal of the current study was to examine the number and the causes of cranio-cerebral trauma in the population of the Republic of Moldova and their distribution in reference groups. Material and methods: This study has included the 3-months’ retrospective and 6- months’ prospective data in 2 tertiary level hospitals from Moldova. A questionnaire was applied to collect medical records’ data and they were analised with the help of Microsoft Excel app. Results: During these 9 months were registered 518 patients with traumatic craniocerebral injuries, with the age included between 0 and 79, 294 of them were adults and 224 children. The trauma circumstances have been documented in accordance with national and international guidelines. The main production mechanisms were: I place - falling from a height (277 cases), II place – traffic accidents (149 cases), III place - interpersonal violence (73 cases) and on the IVth place – harming yourself (73 cases). Addressability and need for specialized treatment in proportion of 377 on men and 141 women, the majority need the advanced medical care. Conclusions: Beside all the cranio-cerebral injuries presented and treated in neurosurgery services in the Republic of Moldova, the majority were part of the adult male population and the majority being caused by the falling from a height and traffic accidents

Evaluarea traumatismului cranio cerebral pediatric folosind scala Glasgow

Background. Traumatic brain injury (TBI) - a major public health problems and the leading cause of death/disability worldwide among children/adolescents. One of every 20 Emergency Department presentations at Pediatric Hospitals is caused by a TBI, more common than burns or poisonings. Objective of the study. We evaluated the state of consciousness among children with TBI at all levels of medical care, as not yet having adequately registered outcomes of pediatric TBI. Material and Methods. A prospective study was piloted among the children of Municipal Pediatric Hospital „V. Ignatenco”, Chisinau, in 6 months (01.03-31.08.2021). A questionnaire and Red Cap electronic data collection tool was applied for medical records’ data collecting and analyzed thought Epi Info 7. Results. The total number of pediatric TBI patients - 167. The majority – 109 boys, (65.3%) and 58 girls (34.7%). The average age – 9.0±5.04 years old. At the pre-hospital period, being conscious (GCS 15p) - 57 children (34,1%), moderate obnubilation (13-14p) - 103 (61,7%), profound obnubilation (11-12p) - 4 (2.4%), sopor state (8-10p) - 3 (1,8%). The state of the TBI children worsened during the transportation. Coming to ED: in the conscious state - 30 children (18%), moderate obnubilation - 102 (61.1%), profound obnubilation – 25 (15%), sopor state - 2 (1.2%), Coma I (6-7p) - 5 (3%) and Coma II - 2 (1,2%.). During the treatment, their state has changed: with GCS 15p - 155 children (92.8%), 13-14p - 3 (1.8%). Coma III exceeded state (3p) - 9 have died (5.4%). Conclusion. The results have shown some gapes in the provision of medical care of TBI that impose us to reevaluate and adopt some new politics of health and guidelines of TBI patients’ preventions and treatment.Introducere. Leziunile traumatice ale creierului (TCC) reprezintă o problemă majoră de sănătate publică și principala cauză de deces/dizabilități la nivel mondial în rândul copiilor/adolescenților. 1 din 20 de prezentări la Departamentul de Urgență al Spitalelor Pediatrice au fost cauzate de TCC, mai frecvent decât arsurile, otrăvirile. Scopul lucrării. Am evaluat starea de conștiință copiilor cu TCC la toate nivelurile de îngrijire medicală, neavând rezultatele TCC pediatrice inadecvat înregistrate în Republica Moldova. Material și metode. Un studiu prospectiv a fost pilotat în rândul copiilor cu TCC în SCM de Pediatrie „Valentin Ignatenco” din Chișinău pe o perioadă de 6 luni (01.03–31.08.2021). A fost aplicat un chestionar și un instrument electronic de colectare a datelor din fișele medicale Red Cap și analizat prin Epi Info 7. Rezultate. Numărul total de pacienți - 167. Băieți - 109, (65,3%) și 58 fetițe (34,7%). Vârsta medie de 9,0±5,04 ani. Prespitalicesc în conștiință (GCS 15p) - 57 copii (34,1%), în obnubilare moderată (13-14) - 103 copii (61,7%), în obnubilare profundă (11-12) - 4 copii (2,4%), sopor (8-10) - 3 copii (1,8%). Starea majorității s-a înrăutățit în timpul transportării. În DU, în starea conștientă - 30 copii (18%), obnubilare moderată – 102 (61,1%), obnubilare profundă – 25 (15%), sopor - 2 copii (1,2%), Coma I (6- 7p) - 5 copii (3%) iar în Coma II profundă - 2 copii (1,2%). În urma tratamentului: GCS 15p - 155 copii (92,8%), 13-14 - 3 copii (1,8%). În Coma III depășită (3p) - decedat 9 copii (5,4%). Concluzii. Rezultatele au evidențiat lacune în îngrijiri medicale pentru TCC, care ne impun să reevaluăm și să adoptăm noi politici și linii directoare pentru prevenirea și tratamentul pacienților cu TCC