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- ItemAcesso aberto (Open Access)Análise perioperatória de morbimortalidade em neurocirurgia pediátrica(Universidade Federal de São Paulo (UNIFESP), 2011-03-30) Mekitarian Filho, Eduardo [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction. The increasing complexity and improving care assistance and monitoring of children undergoing neurosurgical procedures has been remarkable in recent years. However, there are few publications about the main characteristics of perioperative morbidity and risk factors associated with worse outcomes from them. Objectives. To study, retrospectively, the main determinants of morbidity and mortality in children undergoing neurosurgical procedures hospitalized in the Hospital Santa Catarina’s Pediatric Intensive Care Unit and characterize them in to know the profile of the service studied. Methods. A retrospective cohort study was conducted using medical records review between 2005 to 2009 of all patients undergoing neurosurgical procedures, from 1 month to 16 years, and the main data regarding the diagnosis and surgical postoperative outcome and main complications and outcome of patients during hospitalization were reviewed. Results. We studied data from 198 patients during the study period. The most common diagnoses were craniosynostosis (31.3%), supratentorial tumors (19.7%), ventriculoperitoneal shunts (16.7%), spinal cord tumors (9.1%) and infratentorial tumors (8.6%) . Altogether, 57.6% of patients were male with a mean age of 50 months, mean ICU stay of 3.4 days and hospital stay of 7.2 days with an average time of mechanical ventilation of 6.6 hours. The most frequent complications were bleeding (48.5%), fever (30.3%), hypothermia (16.2%) and post-extubation laryngitis (15.2%). In the multivariate analysis, the risk factors associated with longer ICU lenght-of-stay were fever (p = 0.001), laryngitis (p = 0.001) and infection (p = 0.003); with greater hospital stay, fever (p = 0.001) and infection (p = 0.003) and with greater duration of mechanical ventilation, fever (p = 0.015), bleeding (p = 0.04), laryngitis (p = 0.007), coagulation disorders (p <0.001) and use of corticosteroids (p <0.001). There were two deaths in this population due to intracranial hypertension. Conclusions. It’s very important to study the major complications associated with poor prognosis in pediatric neurosurgery. Fever and bleeding were very frequent, impacting on almost all outcomes studied. Case series with the largest number of patients are needed to better establish the risk factors.
- ItemAcesso aberto (Open Access)Atualização sobre o tratamento neurocirúrgico do transtorno obsessivo-compulsivo(Associação Brasileira de Psiquiatria - ABP, 2004-03-01) Lopes, Antonio Carlos [UNIFESP]; Mathis, Maria Eugênia de; Canteras, Miguel Montes; Salvajoli, João Victor; Porto, Jose Alberto Del [UNIFESP]; Miguel, Euripedes Constantino; Universidade de São Paulo (USP); Instituto de Radiocirurgia Neurológica; Universidade Federal de São Paulo (UNIFESP)Responses to pharmacotherapy and psychotherapy in obsessive-compulsive disorder (OCD) range from 60 to 80% of cases. However, a subset of OCD patients do not respond to adequately conducted treatment trials, leading to severe psychosocial impairment. Stereotactic surgery can be indicated then as the last resource. Five surgical techniques are available, with the following rates of global post-operative improvement: anterior capsulotomy (38-100%); anterior cingulotomy (27-57%); subcaudate tractotomy (33-67%); limbic leucotomy (61-69%), and central lateral thalamotomy/anterior medial pallidotomy (62.5%). The first technique can be conducted as a standard neurosurgery, as radiosurgery or as deep brain stimulation. In the standard neurosurgery neural circuits are interrupted by radiofrequency. In radiosurgery, an actinic lesion is provoked without opening the brain. Deep brain stimulation consists on implanting electrodes which are activated by stimulators. Literature reports a relatively low prevalence of adverse events and complications. Neuropsychological and personality changes are rarely reported. However, there is a lack of randomized controlled trials to prove efficacy and adverse events/complication issues among these surgical procedures. Concluding, there is a recent development in the neurosurgeries for severe psychiatric disorders in the direction of making them more efficacious and safer. These surgeries, when correctly indicated, can profoundly alleviate the suffering of severe OCD patients.
- ItemSomente MetadadadosAvaliação do acesso petroso para os meningeomas petroclivais(Universidade Federal de São Paulo (UNIFESP), 1994) Silveira, Roberto Leal da [UNIFESP]; Ferraz, Fernando Patriani [UNIFESP]
- ItemSomente MetadadadosGamma ventral capsulotomy for treatment of resistant obsessive-compulsive disorder: A structural MRI pilot prospective study(Elsevier B.V., 2008-12-12) Cecconia, Janaina Philippi; Lopes, Antonio Carlos; Duran, Fabio Luis de Souza; Santos, Luciana Cristina; Hoexter, Marcelo Queiroz [UNIFESP]; Gentil, Andre Felix; Canteras, Miguel Montes; Castro, Claudio Campi de; Noren, George; Greenberg, Benjamin D.; Rauch, Scott L.; Busatto, Geraldo F.; Miguel, Euripedes Constantino; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Hosp Santa Paula; Brown Univ; Harvard Univ; Massachusetts Gen HospObjective: the purpose of this study was to investigate regional structural abnormalities in the brains of five patients with refractory obsessive-compulsive disorder (OCD) submitted to gamma ventral capsulotomy. Methods: We acquired morphometric magnetic resonance imaging (MRI) data before and after 1 year of radiosurgery using a 1.5-T MRI scanner. Images were spatially normalized and segmented using optimized voxel-based morphometry (VBM) methods. Voxelwise statistical comparisons between pre- and post-surgery MRI scans were performed using a general linear model. Findings in regions predicted a priori to show volumetric changes (orbitofrontal cortex, anterior cingulate gyrus, basal ganglia and thalamus) were reported as significant if surpassing a statistical threshold of p<0.001 (uncorrected for multiple comparisons). Results: We detected a significant regional postoperative increase in gray matter volume in the right inferior frontal gyri (Brodmann area 47, BA47) when comparing all patients pre and postoperatively. Conclusions: Our results support the current theory of frontal-striatal-thalamic-cortical (FSTC) circuitry involvement in OCD pathogenesis. Gamma ventral capsulotomy is associated with neurobiological changes in the inferior orbitofrontal cortex in refractory OCD patients. (C) 2008 Elsevier Ireland Ltd. All rights reserved.
- ItemAcesso aberto (Open Access)Implications of extubation failure and prolonged mechanical ventilation in the postoperative period following elective intracranial surgery(Associação Brasileira de Divulgação Científica, 2011-12-01) Vidotto, Milena Carlos [UNIFESP]; Sogame, Luciana Carrupt Machado [UNIFESP]; Gazzotti, Mariana Rodrigues [UNIFESP]; Prandini, Mirto Nelso [UNIFESP]; Jardim, José Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Santa Casa de Misericórdia de Vitória Escola Superior de Ciências Departamento de FisioterapiaPatients undergoing neurosurgery are predisposed to a variety of complications related to mechanical ventilation (MV). There is an increased incidence of extubation failure, pneumonia, and prolonged MV among such patients. The aim of the present study was to assess the influence of extubation failure and prolonged MV on the following variables: postoperative pulmonary complications (PPC), mortality, reoperation, tracheostomy, and duration of postoperative hospitalization following elective intra-cranial surgery. The study involved a prospective observational cohort of 317 patients submitted to elective intracranial surgery for tumors, aneurysms and arteriovenous malformation. Preoperative assessment was performed and patients were followed up for the determination of extubation failure and prolonged MV (>48 h) until discharge from the hospital or death. The occurrence of PPC, incidence of death, the need for reoperation and tracheostomy, and the length of hospitalization were assessed during the postoperative period. Twenty-six patients (8.2%) experienced extubation failure and 30 (9.5%) needed prolonged MV after surgery. Multivariate analysis showed that extubation failure was significant for the occurrence of death (OR = 8.05 [1.88; 34.36]), PPC (OR = 11.18 [2.27; 55.02]) and tracheostomy (OR = 7.8 [1.12; 55.07]). Prolonged MV was significant only for the occurrence of PPC (OR = 4.87 [1.3; 18.18]). Elective intracranial surgery patients who experienced extubation failure or required prolonged MV had a higher incidence of PPC, reoperation and tracheostomy and required a longer period of time in the ICU. Level of consciousness and extubation failure were associated with death and PPC. Patients who required prolonged MV had a higher incidence of extubation failure.
- ItemAcesso aberto (Open Access)Incidence, indication and complications of postoperative reintubation after elective intracranial surgery(Associação Paulista de Medicina - APM, 2013-01-01) Hayashi, Lucas Yutaka; Gazzotti, Mariana Rodrigues; Vidotto, Milena Carlos [UNIFESP]; Jardim, José Roberto [UNIFESP]; São Paulo Centro Universitario Sao Camilo Department of Physiotherapy; Centro Universitario Sao Camilo Department of Physiotherapy; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE There are no reports on reintubation incidence and its causes and consequences during the postoperative period following elective intracranial surgery. The objective here was to evaluate the incidence of reintubation and its causes and complications in this situation. DESIGN AND SETTING Prospective cohort study, using data obtained at a tertiary university hospital between 2003 and 2006. METHODS 169 patients who underwent elective intracranial surgery were studied. Preoperative assessment was performed and the patients were followed up until hospital discharge or death. The rate of reintubation with its causes and complications was ascertained. RESULTS The incidence of reintubation was 12.4%, and the principal cause was lowered level of consciousness (71.5%). There was greater incidence of reintubation among females (P = 0.028), and greater occurrence of altered level of consciousness at the time of extubation (P < 0.0001). Reintubated patients presented longer duration of mechanical ventilation (P < 0.0001), longer stays in the intensive care unit (ICU) and in the hospital (P < 0.0001), greater incidence of pulmonary complications (P < 0.0001), greater need for reoperation and tracheostomy, and higher mortality (P < 0.0001). CONCLUSION The incidence of reintubation in these patients was 12.4%. The main cause was lowering of the level of consciousness. Female gender and altered level of consciousness at the time of extubation correlated with higher incidence of reintubation. Reintubation was associated with pulmonary complications, longer durations of mechanical ventilation, hospitalization and stay in the ICU, greater incidence of tracheostomy and mortality.
- ItemAcesso aberto (Open Access)Perfil do cirurgião de coluna brasileiro(Sociedade Brasileira de Coluna, 2013-01-01) Alves, Pedro Luz [UNIFESP]; Ueta, Fernando Tadashi Salvioni [UNIFESP]; Ueta, Renato Hiroshi Salvioni [UNIFESP]; Del Curto, David [UNIFESP]; Martins, Délio Eulálio [UNIFESP]; Wajchenberg, Marcelo [UNIFESP]; Puertas, Eduardo Barros [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To conduct cross-sectional study identifying the profile of the Brazilian spinal surgeon. METHODS: Data were collected through a questionnaire with multiple alternatives during two major events for spine surgery at national level in 2011, the Congresso da Sociedade Brasileira de Coluna (Congress of the Brazilian Spine Society) and Simpósio Internacional de Coluna (International Spine Symposium, SINCOL). The data were submitted to statistical analysis comparing and stratifying the information obtained according to the profile. RESULTS: We obtained 182 questionnaires answered by orthopedists and neurosurgeons with peculiarities and similarities on their medical management. CONCLUSIONS: The data obtained in this study may be important for the development of health policies in the spine surgery in Brazil.
- ItemSomente MetadadadosPerioperative Factors Associated with Prolonged Intensive Care Unit and Hospital Length of Stay after Pediatric Neurosurgery(Karger, 2011-01-01) Mekitarian Filho, Eduardo [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Cavalheiro, Sergio [UNIFESP]; Horigoshi, Nelson Kazunobu; Freddi, Norberto Antonio; Universidade de São Paulo (USP); Hosp Israelita Albert Einstein; Santa Catarina Hosp; Universidade Federal de São Paulo (UNIFESP)Objectives: This study aims to describe the association between different postoperative complications and the length of hospital stay among children undergoing neurosurgical procedures. Methods: A retrospective cohort study was carried out between May 2004 and May 2009 in a tertiary community hospital. All postoperative complications following neurosurgical procedures and their association with the main outcomes [length of intensive care unit (ICU) and hospital stay] were investigated in a univariate and multivariate analysis. Results: the medical records of 198 patients treated during the study period were reviewed. the most frequently performed surgeries were ventriculoperitoneal shunting (16.7%), correction of craniosynostosis (30%) and brain tumor resections (28.3%). of the 198 patients eligible for this analysis, 79 (39.9%) suffered from at least one complication. the most frequent complications were fever (30.3%), hypothermia (16%), postextubation laryngitis (15.1%) and postoperative bleeding (7%). Factors independently associated with a longer pediatric ICU stay were fever (odds ratio 1.39, 95% confidence interval 1.1-3.2; p = 0.001), laryngitis (odds ratio 2.24, 95% confidence interval 1.8-5.2; p = 0.001), postoperative bleeding requiring reoperation (odds ratio 1.8, 95% confidence interval 1.4-3.9; p < 0.001) and infection (odds ratio 3.71, 95% confidence interval 1.8-12.4; p = 0.033). Fever (odds ratio 2.54, 95% confidence interval 2-7.4; p = 0.001) and infection (odds ratio 11.23, 95% confidence interval 4-22.4; p = 0.003) were related to the total length of the patient's hospital stay. Conclusions: in this study population, most elective neurosurgical procedures were not associated with significant complications, and morbidity and mortality were low. Some complications significantly influenced patients' outcomes and should be monitored for early diagnosis. This study may improve our understanding and identification of postoperative outcomes in pediatric neurosurgery. Copyright (C) 2012 S. Karger AG, Basel
- ItemAcesso aberto (Open Access)Postoperative study of vital capacity and ventilation measurements following elective craniotomy(Associação Paulista de Medicina - APM, 2008-01-01) Sogame, Luciana Carrupt Machado [UNIFESP]; Faresin, Sonia Maria [UNIFESP]; Vidotto, Milena Carlos [UNIFESP]; Jardim, José Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE: Changes in pulmonary function commonly occur after general surgery. The aims were to evaluate vital capacity, tidal volume and respiratory frequency among patients undergoing elective craniotomy and to determine possible correlations of these parameters with surgery duration and etiology for neurosurgery. DESIGN AND SETTING: Prospective, open study at a tertiary university hospital. METHODS: Twenty-six patients underwent elective craniotomy for aneurysm clipping (11) or tumor resection (15). Vital capacity (VC), tidal volume (TV), minute volume (VE) and respiratory rate were determined before the operation and on the first to fourth postoperative days. RESULTS: There were significant decreases of 25% in VC, 22% in TV and 12% in VE (p < 0.05) and no significant increase in respiratory frequency (5%) on the first postoperative day. VE returned to baseline on the second postoperative day and TV on the third postoperative day, while VC was 8% lower on the fourth postoperative day, compared with before the operation (p < 0.05). VC reduction was significantly greater in patients undergoing aneurysm clipping (43%) than in patients undergoing tumor resection (14%) when surgery duration was more than four hours (p < 0.05), with no significant change when surgery duration was less than four hours. CONCLUSION: Reductions in VC, TV and VE were observed during the postoperative period in patients undergoing aneurysm clipping or tumor resection. The reductions in VC and TV were greater in patients undergoing craniotomy due to aneurysm and with longer surgery duration.
- ItemSomente MetadadadosThe prediction of extubation success of postoperative neurosurgical patients using frequency-tidal volume ratios(Humana Press Inc, 2008-08-01) Vidotto, Milena Carlos [UNIFESP]; Sogame, Luciana Carrupt Machado; Calciolari, Christiane Costa [UNIFESP]; Nascimento, Oliver Augusto [UNIFESP]; Jardim, José Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); EMESCAMBackground the process of discontinuing neurological patients from mechanical ventilation is still controversial. the aim of this study was to report the outcome from extubating patients undergoing elective craniotomy and correlate the result with the measured f/V(t) ratio.Materials and Methods in a cohort prospective study, all consecutive patients who required mechanical ventilation for up to 6 h after elective craniotomy were eligible for inclusion in this study. Patients passing daily screening criteria automatically received a spontaneous breathing trial (SBT). Immediately previous to the extubation, the expired minute volume (VE), breathing frequency (f), and tidal volume (V(t)) were measured and the breathing frequency-to-tidal volume ratio (f/V(t)) was calculated; consciousness level based on Glasgow Coma Scale (GCS) was evaluated at the same time. the extubation was considered a failure when patients needed reintubation within 48 h.Results Ninety-two patients were extubated and failure occurred in 16%. Despite 15 patients failed extubation just one of them presented the f/V(t) score over 105. the best cutoff value for f/V(t) observed was 62, but with low specificity (0.53) and negative predictive values (0.29). Area under the ROC curve for the f/V(t) was 0.69 +/- 0.07 (P = 0.02). Patients who failed the extubation process presented higher incidence of pneumonia (80%), higher need for tracheostomy (33%) and mortality rate of 40%.Conclusion the f/V(t) ratio does not predict extubation failure in patients who have undergone elective craniotomy. Patients who fail extubation present higher incidence of pneumonia, tracheostomy and higher mortality rate.
- ItemSomente MetadadadosA survey of routine treatment of patients with intracranial hypertension (ICH) in specialized trauma centers in São Paulo, Brazil: A 11 million metropole!(Elsevier B.V., 2014-01-01) Alith, Marcela Batan [UNIFESP]; Vidotto, Milena Carlos [UNIFESP]; Jardim, José Roberto [UNIFESP]; Gazzotti, Mariana Rodrigues [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: A survey of intensive care units (ICU) in São Paulo that care for patients with TBI and ICH using the hyperventilation technique.Methods: A questionnaire was given to the physiotherapist coordinator at 57 hospitals in São Paulo, where 24-h neurosurgery service is provided.Results: Fifty-one (89.5%) hospitals replied. From this total, thirty-four (66.7% perform the hyperventilation technique, 30 (85%) had the objective to reach values below 35 mmHg, four (11%) levels between 35 mmHg and 40 mmHg and one (3%) values over 40 mmHg.Conclusions: We concluded that most hospitals in São Paulo perform hyperventilation in patients with severe brain trauma although there are not any specific Brazilian guidelines on this topic. Widespread controversy on the use of the hyperventilation technique in patients with severe brain trauma highlights the need for a specific Global policy on this topic. (C) 2013 Elsevier B.V. All rights reserved.
- ItemAcesso aberto (Open Access)Terapia Nutricional Enteral Em Pacientes Neurocirúrgicos(Universidade Federal de São Paulo (UNIFESP), 2017-03-29) Freitas, Marcia Maria Teixeira de [UNIFESP]; Diccini, Solange [UNIFESP]; http://lattes.cnpq.br/5204290282798385; http://lattes.cnpq.br/7972093373252555; Universidade Federal de São Paulo (UNIFESP)Enteral Nutrition (EN) early is essential for treatment of neurosurgical disease and has association with shortest time of hospitalization. Objective: monitor the EN and assess the nutritional status of patients elective and emergency neurosurgery. Methods: Cohort study, carried in intensive care unit (ICU) of a hospital tertiary level during the 2014 to 2016 period. We included patients over the age of 18 years, with neurological diagnosis, emergency or elective surgery with EN. The data were collected in first 24 hours of introduction EN with daily monitoring. The proposed follow-up time was 14 days, with the anthropometric measurements in the first, seventh and 14th day. For estimation of nutritional needs were considered the values of 25 to 30 calories/Kg/day and 1.2 to 2.0 g/kg/day protein. Polymeric formulas and/or oligomeric, with fractionation in 3/3 hours. Calories of sedatives of lipid emulsion were considered for calculation total calories. For cases where it has not been possible to achieve goal of protein with enteral formula prescribed, additional protein module. For monitoring EN was considered the adequacy of caloric and protein supply, fasting, inadvertent output of enteral probe and gastric residue. Results: 83 patients participated in study, being 80 patients evaluated in total, of which 78,7% in emergency surgery and 21,3% elective, being mostly male with an average age of 55 years in both groups. The emergency group presented more frequently diagnosed with stroke and acute brain injury, the group of elective surgery performed brain neoplasm. Caloric and protein adequacy showed slight superiority among the patients of emergency group. It can be observed that in both groups patients showed reduction of anthropometric measurements, particularly for urgent cases. There was a higher frequency of hospital outcomes and death among patients elective group, suggesting that emergency patients remained hospitalized for more than. Conclusion: Monitoring EN was adequate caloric offer early and protein until the fourth day there. Was change of body composition sharper in the urgency group, with reduction of anthropometric measurements, because some limiters for the effectiveness of EN.
- ItemAcesso aberto (Open Access)Traumatic spinal cord injury: current concepts and treatment update(Assoc Arquivos Neuro- Psiquiatria, 2017) Rouanet, Carolina [UNIFESP]; Reges, Danyelle [UNIFESP]; Rocha, Eva Carolina Andrade [UNIFESP]; Gagliardi, Vivian Dias Baptista [UNIFESP]; Silva, Gisele Sampaio [UNIFESP]Spinal cord injury (SCI) affects 1.3 million North Americans, with more than half occurring after trauma. In Brazil, few studies have evaluated the epidemiology of SCI with an estimated incidence of 16 to 26 per million per year. The final extent of the spinal cord damage results from primary and secondary mechanisms that start at the moment of the injury and go on for days, and even weeks, after the event. There is convincing evidence that hypotension contributes to secondary injury after acute SCI. Surgical decompression aims at relieving mechanical pressure on the microvascular circulation, therefore reducing hypoxia and ischemia. The role of methylprednisolone as a therapeutic option is still a matter of debate, however most guidelines do not recommend its regular use. Neuroprotective therapies aiming to reduce further injury have been studied and many others are underway. Neuroregenerative therapies are being extensively investigated, with cell based therapy being very promising.
- ItemSomente MetadadadosTumores orbitários: aspectos neurocirúrgicos(Universidade Federal de São Paulo (UNIFESP), 1988) Tella Júnior, Oswaldo Inácio de [UNIFESP]; Braga, Fernando Menezes [UNIFESP]