Navegando por Palavras-chave "neurocirurgia"
Agora exibindo 1 - 6 de 6
Resultados por página
Opções de Ordenação
- ItemAcesso aberto (Open Access)Assessment of risk and incidence of falls in neurosurgical inpatients(Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo, 2008-08-01) Diccini, Solange [UNIFESP]; Pinho, Priscila Gomes de; Silva, Fabiana Oliveira da; Universidade Federal de São Paulo (UNIFESP); Hospital Sírio Libanês; Hospital PirajussaraNeurosurgical patients may present motor, sensitive and balance impairment and increased risk of falling. The aim of this study was to evaluate the fall-related risk factors and the incidence of falls in the pre and post-operative period of neurosurgical patients. A prospective cohort study with a research population of patients undergoing elective neurosurgical procedures. Ninety-seven patients took part in the study. Eight (8.2%) have presented falls with a total of 12 falls (12.4%). In two falls (16.7%), bed side rails were down, whereas in six falls (50%), beds had no rails at all. There was no difference among fall-related risk factors during pre and the post-operative periods. We have concluded that most falls could have been prevented through an improvement in the hospital internal structure and with the introduction of a falls prevention program.
- ItemSomente MetadadadosCaracterísticas de pacientes cirurgicamente tratados com tumores neuro-epiteliais de baixo grau do sistema nervoso central(Universidade Federal de São Paulo (UNIFESP), 2015-09-18) Slaviero, Felipe [UNIFESP]; Centeno, Ricardo Silva Centeno [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To define two different groups of neurosurgical patients with low-grade neuroepithelial brain tumors regarding the presence of medically refractory epilepsy (group A) or absence of medically refractory epilepsy (group B). To identify the characteristics and to define the differences between these groups in the clinical and surgical aspects. To measure the surgical impact in the control of medically refractory epilepsy. To describe the biological behavior of tumors in both groups. Methods: This paper retrospectively evaluate a cohort of patients who underwent resection or biopsy for low-grade gliomas and glioneuronal tumors in the Discipline of Neurosurgery at the Federal University of São Paulo between 2003 and 2013. The histologically proved tumors as grades I and II, according to the World Heath Organization (WHO) classification, were selected. The patients were stratified in two groups regarding the presence of medically refractory epilepsy (group A) or absence of medically refractory epilepsy (group B). The postoperative seizure control is evaluated in the group A with the Engel scale and the related factors are investigated. The biological tumor behavior is analyzed in both groups with measurement of the progression free survival, Kaplan-Meier curves for recurrence and, mortality rates. Results: A total of 76 patients with low grade tumors were selected and divided in group A (48 patients) and group B (28 patients) with a median follow-up of 4,2 years. Statistical analysis between groups A and B showed difference for the age at operation (23,5 vs 36,2 years), age at symptoms onset (15 vs 33,9 years) and duration of symptoms (8,4 vs 2,4 years),(p<0,001). In group A the temporomesial location was more common (63% vs 32%),(p=0,01) and in group B the extratemporal (24% vs 68%) and multilobar location (6% vs 54%),(p<0,001) were more prevalent. Regarding the histology, the group A was more affected by grade I tumors and glioneuronal histology (71% vs 0%), while group B had a higher prevalence of grade II gliomas (25% vs 86%)(p<0,001). There was a difference for the frequency of gross total resection (75% vs 7%),(p<0,001), mortality (0% vs 25%),(p<0,001) and recurrence (15% vs 39%),(p<0,003) between groups. In the group with refractory epilepsy, gross total resection and glioneuronal histology were predictive of longterm seizure control, (p=0,03). Conclusions: The patients with medically refractory epilepsy are younger, have longer period of symptoms and typically have !xvii temporomesial glioneuronal tumors, in which the gross total resection is usually possible. The patients without medically refractory epilepsy usually comprises grade II gliomas with more extratemporal and multilobar locations. The recurrences are earlier and the mortality rate is higher in this group. Gross total resection and glioneuronal histology are predictive of long-term seizure control in medically refractory epilepsy patients.
- ItemSomente MetadadadosComplicações nos períodos intra e pósoperatório de cirurgia de crânio eletiva e de urgência/emergência(Universidade Federal de São Paulo (UNIFESP), 2013-03-27) Pires, Ellen Maria de Campos [UNIFESP]; Diccini, Solange Diccini [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: To evaluate the incidence of neurological and systemic complications, adverse events and mortality among patients undergoing an elective cranial surgery and urgent/emergency surgery during the intra and post-operative periods. Methods: This was a prospective study in patients, who underwent elective cranial surgery and urgent/emergency surgery, aged equal to or above 18 years, of both genders and were followed daily from the surgical procedure until hospital discharge or death. Results: 127 patients were included in the elective group, with a mean age of 49,2 years with 45,7% being men and 75 patients were in the urgent/emergency group, with a mean age of 51,5 years and 64% being men. In the intraoperative period, the incidence of neurological complications was 12,7% in the elective group and 63.5% in the urgent/emergency group (p<0.0001) and systemic complications was 95,4% in the elective group and 82,7% in the urgent/emergency group (p=0,017). Patients in the urgent/emergency group presented more intracranial hypertension (ICH) (p=0,001) and arterial hypotension was more frequent in the elective group (p=0,001). In the immediate post-operative period (POI) the incidence of neurological complications was 45,5% in the elective group and 52,9% in the urgent/emergency group (p=0,402); systemic complications was 98,3% in the elective group and 98,5% in the urgent/emergency group (p=1,000) and adverse events was 19,7% in the elective group and 9,3% in the urgent/emergency group (p=0,071). The patients in the elective group had more vomiting (p=0,010), pain (p=0,003) and loss of arterial catheter (p=0,047) and patients in the urgent/emergency group showed more ICH (p=0,013), anisocoria (p=0,002), use of vasoactive drugs (DVA) (p=0,001), abnormal potassium (p=0,022) and hyperthermia (p=0,026). In the post-operatively mediate (POM) the incidence of neurological complications was 71,7% in the elective group and 79,7% in the urgent/emergency group (p=0,241), systemic complications was 99,2% in the elective group and 98,6% in the urgent/emergency group (p=1,000) and adverse events was 72,4% in the elective group and 81,3% in the urgent/emergency group (p=0,176). The patients in the elective group presented more pain (p<0.001) and patients in urgent/emergency group presented more ICH (p=0,001), vasospasm (p=0,043), pupils with no fotomotora reaction (p=0,006), re-operation (p=0,046), hypotension (p=0,001), use of vasoactive drugs (p<0,001), bradycardia (p=0,001), tachycardia (p=0,033), cardiopulmonary arrest (p=0,001), gastric reflux (p=0,001), acute renal failure (p=0,014), potassium electrolyte abnormalities (p=0,001), calcium (p=0,008) and sodium (p=0,001), hypoglycemia (p=0,001), hyperthermia (p=0,002), pulmonary infection (p<0,001), loss of arterial catheter (p=0,001), loss of gastric cateter (p=0,037), loss of enteral tube (p=0,001) and pressure ulcers (p=0,001). The mortality rate was 5,5% in the elective surgery group and 26,7% in the urgent/emergency surgery group (p<0,001). Conclusions: In the intra-operative period, the patients in the urgent/emergency surgery group presented more neurological complications such as ICH. In POI, patients in the elective surgery group presented more systemic complications and adverse events and neurological complications were more frequent in patients in the urgent/emergency surgery group. In POM, the patients of the urgent/emergency surgery group presented more neurological and systemic complications, adverse events than the patients in the elective surgery group. Mortality was higher among patients undergoing surgery of the cranium in the urgent/emergency surgery group.
- ItemAcesso aberto (Open Access)The far-lateral craniotomy: tips and tricks(Academia Brasileira de Neurologia - ABNEURO, 2014-09-01) Chaddad Neto, Feres Eduardo Aparecido [UNIFESP]; Doria-netto, Hugo Leonardo; Campos Filho, José Maria De; Reghin Neto, Mateus; Rothon Jr, Albert L; Oliveira, Evandro De; Universidade Federal de São Paulo (UNIFESP); Hospital Real e Benemérita Sociedade Portuguesa de Beneficência Instituto de Ciências Neurológicas Laboratório de Microcirurgia; Departamento de Neurocirurgia Vascular; Hospital Brigadeiro Departamento de Neurocirurgia Vascular; University of Florida Department of Neurosurgery; Universidade Estadual de Campinas (UNICAMP)This article intends to describe in a didactical and practical manner the suboccipital far-lateral craniotomy. This is then basically a descriptive text, divided according to the main stages involved in this procedure, and that describes with details how the authors currently perform this craniotomy.
- ItemAcesso aberto (Open Access)Manejo do paciente no período perioperatório em neurocirurgia pediátrica(Associação Médica Brasileira, 2012-06-01) Mekitarian Filho, Eduardo [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Cavalheiro, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); UPA Hospital Israelita Albert Einstein; Hospital Santa Catarina; Hospital Santa Catarina Unidade de Terapia Intensiva PediátricaOBJECTIVES: To describe the main pathophysiological differences in neurosurgical procedures between children and adults; the main complications and adverse events resulting from pediatric neurosurgery reported in studies; the singularities in anesthetic and intraoperative management in several neurosurgical diseases; the more specific and common complications and their management in the most frequent pediatric neurosurgical procedures, as well as causes and treatment for the main complications found in children undergoing neurosurgery. METHODS: A non-systematic review in literature databases PubMed, EMBASE, and SciELO was performed by using the keywords pediatrics, children, neurosurgery, risk factors, intraoperative complications, and postoperative period, as well as their matches in Portuguese and Spanish from January 2001 to January 2011, in addition to using important references from the selected material over any period of time. RESULTS: The three procedures most commonly performed in children are hydrocephalus, craniostenosis repair, and brain tumor resection. Complications as fever, bleeding, metabolic disturbances (hyponatremia and hyperglycemia), brain swelling, and transient focal deficits (limb weakness, speech and swallowing disorders) are frequent, but their course is often towards prompt improvement. Up to 50% of children may have an uneventful evolution over the postoperative period. Special attention must be given to the prevention of postoperative infections and seizures with the use of a drug therapy that suits each case. CONCLUSION: The complexity of neurosurgical procedures in children is increasing, and observation and recognition of complications in pediatric intensive care units are fundamental. Anticipating complications in order to achieve an early treatment and adverse event prophylaxis can contribute to reduced morbidity and mortality and increased patients' safety.
- ItemAcesso aberto (Open Access)Pretemporal craniotomy(Academia Brasileira de Neurologia - ABNEURO, 2014-02-01) Chaddad Neto, Feres Eduardo Aparecido [UNIFESP]; Dória-netto, Hugo Leonardo; Campos Filho, José Maria; Reghin Neto, Mateus; Oliveira, Evandro; Universidade Federal de São Paulo (UNIFESP); Instituto de Ciências Neurológicas; Hospital Beneficência Portuguesa de São Paulo; Universidade Estadual de Campinas (UNICAMP); Hospital Beneficência Portuguesa Instituto de Ciências NeurológicasThis paper aims to describe the performance of the pretemporal craniotomy performed didactically from 2002 to 2012 in eighty patients. It is therefore a fundamentally descriptive text, organized in the sequence of the main stages in which such a craniotomy is performed, and describing in detail the technique with which this group of evolutionarily authors came to accomplish the task.