Peruvian Journal of Neurosurgery最新文献

{"title":"Neurological Severity Classification System (CSN-System) in adults with BTI, Hospital Cayetano Heredia, Lima - Peru, 2020. Preliminary study.","authors":"E. Castro, Rómulo Rodríguez","doi":"10.53668/2021.pjns33253","DOIUrl":"https://doi.org/10.53668/2021.pjns33253","url":null,"abstract":"Objectives: Traumatic Brain Injury (TBI) is the disruption of brain function and architecture. The Glasgow Coma Scale (GCS) is the most widely used TBI severity classification; however, it assesses the functional status of the brain resulting from highly heterogeneous lesions and has little accuracy. The Neurological Severity Classification System (NSC System), a clinical-tomographic instrument designed to overcome lesion heterogeneity, assesses brain function and structure in determining the severity of BTI. Methods: Observational, prospective, and cross-sectional study in adults with BTI from the emergency service of the Cayetano Heredia Hospital, April - August 2020. It included patients aged 18 years or older with acute BTI. The NSC system was compared with the GCS in the BTI classification. Results: Of 29 patients, 82.76% were male and 82.76% were between 18 and 64 years old. The severity of the TBI through the NSC System was very mild 6.70%, mild 17.24%, moderate 51.72%, severe 17.24%, and critical 6.70%. There was an association between the NSC System and the Rotterdam Computed Tomographic Score (RCTS) (p = 0.005), a moderate positive correlation of the NSC System with the RCTS (Rho 0.6773, p = 0.0001), an association between the NSC System and the indication for neurosurgical intervention (p = 0.002), as well as high sensitivity-specificity in the distinction of severity categories with the NSC System, and lower GCS performance. Conclusions: The NSC clinical-tomographic system improves the determination of the severity of BTI in comparison with GCS and provides an excellent relationship with the indication for neurosurgical intervention. Keywords: Brain Injuries, Traumatic, Brain, Glasgow Coma Scale, Functional Status (Source: MeSH NLM)","PeriodicalId":138765,"journal":{"name":"Peruvian Journal of Neurosurgery","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116090032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumocephalus and CSF leak secondary to skull base fracture by pyrotechnical object: case report","authors":"Marcos Vilca, Carlos Palacios, S. Rosas, Ermitaño Bautista","doi":"10.53668/2021.pjns33175","DOIUrl":"https://doi.org/10.53668/2021.pjns33175","url":null,"abstract":"Introduction: Pneumocephalus is mainly associated with traumatic injuries, being a rare complication but with high mortality rates; it behaves like a space-occupying lesion and increases intracranial pressure. The symptoms are not specific, but in the event of trauma it is necessary to suspect this entity to carry out a timely diagnosis and treatment, since being the product of the skull base fracture it can cause communication with the outside, and the appearance of cerebrospinal fluid (CSF) leak. Clinical Case: a 38-year-old male patient who suffers trauma from a pyrotechnic explosion near his right ear, when handling a pyrotechnic object (whistle) during the New Year, presenting severe pain, slight bleeding in the right ear, feeling faint and holocranial headache that increased in a standing position; likewise, he presents high-flow aqueous secretion (CSF) from the right ear. Brain and skull base tomography (CT) showed air in the intracranial cavity, fracture of the skull base, and the ossicles of the right middle ear. Conservative management was performed using rest and lumbar drainage, presenting a satisfactory evolution. Conclusion: Pneumocephalus is a frequent and expected complication of trauma with a skull base fracture. Its early and timely diagnosis using skull base CT is essential to define therapeutic measures. Accidents due to the misuse of pyrotechnics continue to be a relevant problem in our country. Knowing and disseminating its consequences can help raise awareness in the population. Keywords: Pneumocephalus, Skull Base, Intracranial Pressure, Cerebrospinal Fluid Leak. (Source: MeSH NLM)","PeriodicalId":138765,"journal":{"name":"Peruvian Journal of Neurosurgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115318343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the COVID-19 pandemic on patients with rupture of intracranial aneurysm at the Dos de Mayo National Hospital in Lima Peru","authors":"J. L. Acha, Julio Josymar Quispe","doi":"10.53668/2021.pjns33131","DOIUrl":"https://doi.org/10.53668/2021.pjns33131","url":null,"abstract":"Objective: To evaluate the impact on the outcome of patients with a ruptured aneurysm, who are admitted to the Dos de Mayo National Hospital in the context of the COVID-19 pandemic. Methods: 42 operated for ruptured aneurysms were included in the context of the COVID-19 pandemic between March 1 and December 31, 2020 (group A), and a control group of 44 patients operated on between March 1 and December 31, 2019 (group B). Upon admission, the poor neurological status defined by the WFNS> 3, the Fisher IV high-grade tomographic status with intracerebral hematoma or acute hydrocephalus, which required external ventricular drainage (EVD), and the presence of vasospasm were evaluated. The Modified Rankin Scale was evaluated at discharge. Statistical analysis was performed to compare both groups. Results: The rates of poor neurological presentation and complications during the presurgical evolution (intracerebral hemorrhage and acute hydrocephalus that required EVD) were higher in group A (p = 0.002 and p <0.05, respectively). The delay in the admission of the patient to the emergency room to receive treatment was 7.5 days in group A and 4.95 days for group B. All these factors contributed to a lower possibility of recovery in group A, which was correlated with higher Values on the Modified Rankin Scale at discharge for this group (p = 0.04). Conclusion: We did not find national reports on ruptured aneurysms treated in the context of the pandemic, this being one of the first studies that demonstrate the impact of the COVID-19 pandemic in patients with ruptured intracranial aneurysm. The population should be educated on how to act in case of specific symptoms such as sudden intense headache, neurological deficit, or acute chest pain, which should receive timely care, immediate referral, and priority of treatment in referral hospitals in order to reduce morbidity and mortality of complex neurological pathologies. Keywords: Intracranial Aneurysm, Aneurysm, Ruptured, Cerebral Hemorrhage, Pandemics, COVID-19. (Source: MeSH NLM)","PeriodicalId":138765,"journal":{"name":"Peruvian Journal of Neurosurgery","volume":"196 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114174347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double aneurysm clipping of true fetal posterior communicating artery by minipterional approach plus control with sodium fluorescein: a case report","authors":"Cristian Salazar, Allen Diaz, Ricardo Rojas, Miguel Gaitán, Armando Lúcar","doi":"10.53668/2021.pjns33169","DOIUrl":"https://doi.org/10.53668/2021.pjns33169","url":null,"abstract":"Introduction: True fetal or fetal type posterior communicating artery aneurysms (PComA) are a technical challenge for the neurosurgeon in both endovascular and microsurgical treatment. Microsurgical clipping using minimally invasive approaches is a safe and optimal alternative solution. Clinical case: a 53-year-old patient who presented subarachnoid hemorrhage, Hunt & Hess scale III, Fisher scale III, and Glasgow Coma Scale of 13. Cerebral angioCT showed two saccular aneurysms in the right true fetal PComA. The patient underwent a right interfacial minipterional craniotomy and clipping of the 2 aneurysms, using sodium fluorescein as a guide. Total occlusion of the aneurysms was achieved, maintaining the patency of the fetal PComA. Conclusion: The minipterional approach allows adequate access to the fetal PComA and the aneurysms originating from it. It is essential to review the patency of the adjacent vessels, being the use of intraoperative fluorescein is an essential complement to avoid complications such as cerebral infarction. Keywords: Intracranial Aneurysm, Craniotomy, Fluorescein, Subarachnoid Hemorrhage, Neurosurgeons (Source: MeSH NLM)","PeriodicalId":138765,"journal":{"name":"Peruvian Journal of Neurosurgery","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130239594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presigmoid transpetrous approach (partial petrosectomy) combined with subtemporal transtentorial approach for petroclival meningioma","authors":"F. Palacios, Manuel Lazón, E. Romero, R. Rodríguez","doi":"10.53668/2021.pjns33157","DOIUrl":"https://doi.org/10.53668/2021.pjns33157","url":null,"abstract":"Introduction: Petroclival meningiomas constitute 3 to 10% of meningiomas of the posterior fossa, they originate in the petroclival fissure, in the upper part of the clivus, petrosal apex, and medial to the trigeminal nerve. Resection of these tumors is a neurosurgical challenge. The combined partial petrosectomy approach associated with a sub-temporal approach is a technique described by various authors; however, its performance is considered highly complex. We report the case of a petroclival meningioma operated successfully in our hospital using a combined presigmoid and subtemporal transtentorial transpetrosal approach. Clinical case: 33-year-old female patient with a clinical picture of headache, nausea, and gait disturbance. Brain magnetic resonance imaging showed a large right petroclival tumor (4.2x3.9x3.8cm) that displaced the brainstem and secondary hydrocephalus. The hydrocephalus was treated with a ventricular peritoneal shunt. Then, the tumor was resected using a combined presigmoid and subtemporal transpetrosal approach, a technique that allowed adequate exposure of the tumor, achieving complete resection, without intraoperative complications. Postoperative evolution was favorable, with no sequelae. Conclusion: The combined presigmoid and transtentorial subtemporal transpetrous approach for petroclival meningiomas is an effective and feasible technique to perform in our environment. The support of technology such as Neuronavigation, the ultrasonic aspirator, intraoperative monitoring, and adequate experience in skull base surgery are fundamental factors for the success of this surgery. Keywords: Meningioma, Skull Base Neoplasms, Craniotomy, Neurosurgical Procedures. (Source: MeSH NLM)","PeriodicalId":138765,"journal":{"name":"Peruvian Journal of Neurosurgery","volume":"155 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134206353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Definitive treatment of cerebral aneurysms at the Cayetano Heredia National Hospital in Lima Peru: a case series results","authors":"Gonzalo Rojas, J. Garay, W. Alaba, C. Rodriguez, Rolando Lovaton, Rélix Huamán","doi":"10.53668/2021.pjns31113","DOIUrl":"https://doi.org/10.53668/2021.pjns31113","url":null,"abstract":"Objectives: Subarachnoid hemorrhage (SAH) due to rupture of a cerebral aneurysm continues to be a disease with high morbidity and mortality in our setting, despite advances in microsurgery and endovascular therapy. The objective of the present study was to determine the demography, vascular territory, and complications that occur in the perioperative management of patients with ruptured cerebral aneurysms treated at the Cayetano Heredia Hospital. Methods: An observational descriptive study of patients with cerebral aneurysm undergoing surgical and endovascular treatment was carried out in the Neurosurgery Service of the Cayetano Heredia Hospital from 2016 to 2018. The clinical records and operative reports were reviewed. Results: In a period of 30 months, definitive treatment was performed in 56 patients with a diagnosis of a ruptured cerebral aneurysm, of which 5 received endovascular treatment and 51 treatment by craniotomy and clipping. 62.5% were women, and 50% of the total were between the fifth and sixth decade of life. In more than 50% of cases, treatment was performed within 96 hours of SAH. Regarding the affected arterial territory, 15 patients (27%) had an aneurysm of the territory of the anterior communicating (AComA) and another 15 (27%) in the posterior communicating artery (PComA). Mortality was 17.8%, 70% being due to direct causes such as cerebral infarction and severe vasospasm. Conclusions: The treatment of the aneurysms was mainly by microsurgery, the aneurysms of the AComA, PComA, and middle cerebral (MCA) had a similar proportion and, in more than 50% the treatment was carried out in the first 4 days. More state support is required to increase endovascular therapy and obtain more promising results. Keywords: Intracranial Aneurysm, Microsurgery, Craniotomy, Endovascular Procedures (source: MeSH NLM)","PeriodicalId":138765,"journal":{"name":"Peruvian Journal of Neurosurgery","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122057772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopy-assisted microsurgery in the resection of epidermoid tumor of the pontocerebellar angle","authors":"Jerson Flores, Gonzalo Rojas, W. Alaba, Rómulo Rodríguez","doi":"10.53668/2020.pjns24142","DOIUrl":"https://doi.org/10.53668/2020.pjns24142","url":null,"abstract":"Introduction: Intracranial epidermoid tumors are rare, slow-growing, and histologically benign congenital neoplasms. The microsurgical approach with endoscopic assistance is described as a minimally invasive technique that facilitates the work of the neurosurgeon in the complete resection of an epidermoid tumor located in the cerebellopontine angle. Clinical Case: 62-year-old woman, with a 3-year disease characterized by pain on the right side of the face. Symptoms increase in the following 2 years, becoming disabling and only partially improving with pregabalin and oxcarbazepine. Brain MRI showed a hypointense lesion with a cystic appearance at the level of the prepontine cistern with expansion to the right cerebellopontine angle that compressed the right trigeminal nerve (V). Retromastoid craniotomy and a right cerebellopontine angle approach were performed. Under the microscopic vision, the trigeminal nerve was identified which was pulled by the tumor, the cranial nerve complex VII-VIII, and vessels such as the superior petrous vein and the anteroinferior cerebellar artery. With the support of the endoscope, the tumor was better visualized in inaccessible areas, the prepontine cistern was accessed and total resection of the tumor was achieved. The patient evolved favorably with remission of pain on the right side. Conclusion: The microsurgical technique assisted by endoscopy allows safe removal of the tumor, and it is immensely helpful in the resection of tumors from regions not visible under the microscope. Keywords: Brain Neoplasms, Trigeminal Nerve, Endoscopy, Cerebellopontine Angle. (source: MeSH NLM","PeriodicalId":138765,"journal":{"name":"Peruvian Journal of Neurosurgery","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121733765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transsphenoidal endoscopic surgical treatment of pituitary tumors at the Cayetano Heredia National Hospital in Lima Peru: outcomes of a series of cases.","authors":"J. Garay, Gonzalo Rojas, W. Alaba, Jerson Flores, Rómulo Rodríguez, Iván Salcedo","doi":"10.53668/2020.pjns24173","DOIUrl":"https://doi.org/10.53668/2020.pjns24173","url":null,"abstract":"Introduction: In recent years, transsphenoidal endoscopic surgery has become a surgical procedure of choice for the treatment of pituitary tumors. The objective of the present study was to describe the demographic, clinical characteristics, complications, and postoperative results of the patients who underwent transsphenoidal endoscopic resection. Methods: A descriptive case series study of patients with pituitary tumors operated through a transsphenoidal endoscopic approach was carried out from January 2016 to August 2018 in the Neurosurgery Department of the Cayetano Heredia National Hospital. Data were obtained by reviewing the medical records. Results: A total of 20 endoscopic surgeries were performed, of which 08 were for pituitary macroadenomas, 07 for giant pituitary adenomas, and 05 for other tumor lesions. Of the total number of operated patients, 11 were male (55%) and the most frequent age group was between the 3rd to 5th decade of life (70%). Regarding the postoperative results, a total and subtotal resection was performed in 60% of the patients and partial resection in 20%. Regarding postoperative complications, 45% of patients had transient diabetes insipidus. 1 patient died (5%) due to septic symptoms. Conclusions: Endoscopic transsphenoidal surgery provides several advantages over microscopic transsphenoidal surgery, such as providing greater anatomical detail, direct visualization of the tumor, and cerebrospinal fluid leak sites, which allows achieving better results in terms of disease control and the prevention of complications. However, studies with a larger number of patients are necessary. Keywords: Pituitary Neoplasms, Endoscopy, Neurosurgical Procedures, Diabetes Insipidus. (source: MeSH NLM)","PeriodicalId":138765,"journal":{"name":"Peruvian Journal of Neurosurgery","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127245714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracerebral hematoma caused by Moyamoya disease: a case report","authors":"J. Vargas, Giancarlo Saal, F. Palacios","doi":"10.53668/2020.pjns24165","DOIUrl":"https://doi.org/10.53668/2020.pjns24165","url":null,"abstract":"Introduction: Moyamoya disease is a chronic occlusive cerebrovascular disease of unknown etiology, characterized by bilateral stenotic and occlusive changes in the terminal portion of the internal carotid, as well as the presence of an abnormal vascular network at the base of the brain. The diagnosis is made with magnetic resonance (MRI) and digital subtraction angiography (DSA), SPECT is useful in the therapeutic decision. The surgical treatment of choice is revascularization. Clinical Case: A 50-year-old female patient from China, with the Glasgow Coma Scale (GCS) of 9, and a clinical picture of stroke. An admission brain tomography (CT) revealed a right temporal hematoma. Surgical evacuation of the intracerebral hematoma was performed. Cerebral angiography revealed distal stenosis of the internal carotid artery and its branches, being diagnosed with Moyamoya disease. The evolution was favorable, neither a motor deficit nor a decreased level of consciousness (GCS:15) was observed at the time of discharge. A subsequent revascularization surgery was indicated. Conclusion: Moyamoya disease is a rare cause of intracerebral hematoma but should be suspected in adults of Asian descent. MRI and angiography are the diagnostic methods of choice. Surgical treatment is revascularization, which improves the prognosis. Keywords: Moyamoya Disease, Cerebral Hemorrhage, Stroke, Cerebral Angiography (Source: MeSH NLM)","PeriodicalId":138765,"journal":{"name":"Peruvian Journal of Neurosurgery","volume":"262 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114374302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tension pneumocephalus after surgical evacuation of chronic subdural hematoma: case report and pathophysiological mechanism","authors":"F. Celi, Giancarlo Saal","doi":"10.53668/2020.pjns24151","DOIUrl":"https://doi.org/10.53668/2020.pjns24151","url":null,"abstract":"Introduction: Pneumocephalus is a frequent complication following neurosurgical procedures. The diagnosis is based on tomographic findings and the clinical evolution of the patient. Therefore, we detail the physiopathological mechanisms that trigger this complication. Clinical Case: We present the clinical case of an 85-year-old man who underwent a keyhole craniotomy and subdural drainage placement due to the diagnosis of a chronic subdural hematoma (CSDH) and subsequently developed sudden tension pneumocephalus which triggered the death of the patient due to intracranial hypertension. Conclusion: Tension pneumocephalus is a life-threatening complication that must be suspected early and must be treated as an emergency. Keywords: Hematoma, Subdural, Chronic, Pneumocephalus, Drainage, Craniotomy (Source: MeSH NLM)","PeriodicalId":138765,"journal":{"name":"Peruvian Journal of Neurosurgery","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114879427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}