Benedito Jamilson Araújo Pereira

Impact of body mass index in spinal surgery for degenerative lumbar spine disease

BACKGROUND Obesity is a factor for degenerative lumbar spine disease (DLSD), with increasing prevalence worldwide. Consequently, patients who are overweight or obese have benefited from surgical treatment for DLSD, despite their anatomical and clinical differences. OBJECTIVES To analyse the effect of body mass index (BMI) in spinal surgery for degenerative lumbar spine disease (DLSD). PATIENTS AND METHODS A retrospective analysis of 100 patients who underwent surgery for DLSD was performed. The study time was 13 months (January 2013-January 2014). The patients were first evaluated with regard to their BMI and were subsequently divided into four groups of patients: BMI <25, BMI between 25 and 30, BMI between 30 and 35, and BMI above 35. The same patients were assessed for their results regarding the extent of surgery in four groups: patients undergoing surgery for treatment of one segment, two segments, three segments, and four or more segments of DLS. The aspects evaluated were surgical time, bleeding, surgical complications, surgical site infection (SSI), and re-operation due to failure of the first procedure. RESULTS A total of 118 surgeries were performed on 100 patients (52 male/48 female), mean age 52.77 years old (52.77 ± 14.45), range between 26 and 85 years old, and a mean BMI of 29.43 kg/m(2) (29.43 ± 5.54). The surgical time averaged 258.1 min (258.1 ± 82.79); the bleeding was 660 millilitres (ml) (660 ± 509.1); complications that were related to the surgical procedure occurred in 38% of cases; SSI occurred in 5% of cases, and re-operations or SSI due to complications occurred in 12% of cases. After analysis of all variables, it was observed that the groups were homogeneous without statistical variation when divided by the BMI; however, it was also observed that the extent of surgery was the factor responsible for the increased rate of SSI (p=0.05) and increased potential of re-operation due to complications (p=0.003). CONCLUSION BMI is not a complicating factor for the outcome of patients undergoing surgery for DLSD in terms of SSI, surgical complications, and re-operation rates. Furthermore, the extent of surgery was associated with increased postoperative SSI and the need for a second surgery due to the failure of the first procedure.

Assessment of Cerebral Blood Flow with Micro-Doppler Vascular Reduces the Risk of Ischemic Stroke During the Clipping of Intracranial Aneurysms

OBJECTIVE To analyze the impact of the introduction of Micro-Doppler vascular (MDV) as a method of cerebral blood flow analysis during microsurgical clipping of intracranial aneurysms to check the partial occlusion of the aneurysm and the occurrence of stenosis by comparing these results with those provided by the postoperative digital subtraction angiography (DSA) scan as well as the occurrence of ischemic infarction on the postoperative computed tomography (CT) images. PATIENTS AND METHODS We reviewed retrospectively the last 50 patients operated on before the introduction of the MDV (group 1) compared with the first 50 patients operated on using this technique (group 2). RESULTS Nine (18%) of the 50 patients evaluated in the group 1 showed a new hypodensity in the postoperative CT images, whereas only 2 (4%) patients showed infarction in the group 2 (P = 0.02). In addition, in the group 1, 10 (20%) patients presented unexpected findings on DSA images (residual aneurysms, stenosis, and arterial occlusion), whereas in the group 2, those unexpected DSA findings were observed in only 3 (6%) patients (P = 0.023). CONCLUSION MDV is an excellent method for cerebral blood flow assessment during the microsurgical clipping of intracranial aneurysms, reducing the unexpected angiographic results (residual aneurysms, stenosis, and arterial occlusion), as well as reducing the incidence of ischemic infarction on postoperative CT images, evidence of the positive impact of this method in the microsurgical treatment of intracranial aneurysms.

Intracranial aneurysm arising from infundibular dilation

Infundibular dilations (IDs) are funnel-shaped enlargements in the origin of intracranial arteries. Usually, IDs occur at the junction between posterior communicating artery (PcomA) and internal carotid artery (ICA). Progression from an ID of the PcomA to aneurysms has been described, but is unclear whether an ID is a preaneurysmal state or a normal anatomical variant. The authors describe a 55-year-old female patient presenting multiple intracranial aneurysms with a small one arising from an ID at the level of posterior communicating segment of ICA. To the best of our knowledge, after a criterious search in the English literature, it is the first description of such unusual combination. The preoperative neurosurgical planning is discussed as well as the importance of intraoperative findings to the best management of this unusual situation.

Dissecting spinal aneurysms: conservative management as a therapeutic option

Objective Isolated dissecting spinal aneurysms are rare lesions that pose a therapeutic challenge. We report our experience in the management of four patients with dissecting spinal aneurysms. Methods After institutional review board approval was obtained, the neurointerventional databases of the two participating institutions were retrospectively reviewed. Aneurysms in the anterior spinal artery, posterior spinal artery, or in a radiculomedullary artery were included in the analysis. Flow-related aneurysms were excluded. Data on clinical presentation, hemorrhage location, aneurysm size, location, angiographic follow-up, re-hemorrhage, and clinical outcome were obtained and analyzed. Results Four patients with five spinal dissecting aneurysms met the inclusion criteria. There were two women and the mean age was 63 years (range 36–64). All patients presented with hemorrhage. Three radiculomedullary arteries in two different patients had one lesion each; the other two involved the anterior spinal artery and a posterior spinal artery in different patients. All four patients were managed conservatively. Follow-up angiography (5.5 months) demonstrated occlusion of all five aneurysms. There was no re-hemorrhage and all patients had a good outcome at the last follow-up (modified Rankin Scale score 0–2). Conclusions Conservative management of ruptured spontaneous dissecting spinal aneurysms is a reasonable therapeutic option capable of achieving favorable angiographic and clinical outcomes.

Natural history of intraventricular meningiomas: systematic review

Review the data published on the subject to create a more comprehensive natural history of intraventricular meningiomas (IVMs). A Medline search up to March 2018 using “intraventricular meningioma” returned 98 papers. As a first selection step, we adopted the following inclusion criteria: series and case reports about IVMs, as well as papers written in other languages, but abstracts written in English were evaluated. Six hundred eighty-one tumors were evaluated from 98 papers. The majority of the tumors were located in the lateral ventricles (602–88.4%), fourth ventricle (59–8.7%), and third ventricle (20–2.9%). These tumors accounted for a mortality rate of 4.0% (25 deaths) and a recurrence rate of 5.3% (26 recurrences). The majority of the tumors were grade I (89.8%) and consisted of the following subtypes: fibrous, 39.7% ( n  = 171); transitional, 22.0% ( n  = 95); meningothelial, 18.6% ( n  = 80); angiomatosus, 3.2% ( n  = 14); psammomatous, 2.6% ( n  = 11); and others, 13.9% ( n  = 60). Forty-five patients (7.4%) presented with grade II (GII) tumors, and 17 patients (2.8%) presented with grade III (GIII) tumors. These tumors follow the histopathological distribution of meningiomas in general, with the exception of the higher prevalence of the fibrous subtype, possibly due to its embryonic origin. Recurrence and mortality were lower than in other localizations likely due to a complete surgical resection rate than in the convexity and skull base, which suggests that GTR is the gold standard for the management of IVMs.

Paralisia do olhar conjugado horizontal e escoliose progressiva: características de imagem na ressonância magnética e tratamento cirúrgico

Paciente de 13 anos com indicacao cirurgica para tratamento de escoliose. O exame neurologico revelou perda completa de movimento do olhar horizontal com olhar vertical normal, sugerindo diagnostico de paralisia do olhar conjugado horizontal e escoliose progressiva. A imagem por ressonância magnetica revelou ponte hipoplasica e medula com proeminencia de fenda na linha media, resultando na configuracao caracteristica de “borboleta”.() A tractografia mostrou ausencia de trajetorias transversais principais nas pontes e no cerebro medio, com conexoes inter-hemisfericas normais no corpo [...]A 13-year-old patient was referred for surgical treatment of scoliosis. Her neurological examination revealed the complete loss of horizontal eye movements with normal vertical gaze, suggesting diagnosis of horizontal gaze palsy and progressive scoliosis. The magnetic resonance imaging revealed a hypoplastic pons and medulla with a prominent midline cleft, therefore resulting in characteristic “butterfly” configuration.() The tractography showed absence of major crossing pathways within the pons and midbrain, and normal interhemispheric connections in the corpus callosum (). Surgical treatment for [...]

Spinal surgery for degenerative lumbar spine disease: Predictors of outcome

OBJECTIVES Identify predictors of outcomes for results in Degenerative Lumbar Spine Disease (DLSD). PATIENTS AND METHODS A retrospective analysis of 164 patients who underwent surgery for DLSD was performed. The study duration was 24 months (January 2013-December 2014). The patients were first evaluated and were assessed for their results regarding the extent of surgery in four groups: patients undergoing surgery for treatment of one segment, two segments, three segments, and four or more segments of DLS. Posteriorly, the same group of patients was divided based on the presence or absence of Dural Tear (DT) during surgery. In addition, the relationship between elderlies and the incidence of surgical site infection (SSI) and reoperation was also analyzed. RESULTS A total of 193 surgeries were performed on 164 patients (74 males/90 females), with a mean age of 53.18 years old (53.18 ± 17.54). SSI occurred in 7.31% of cases and re-operations due to SSI or because of complications resulting from the first procedure occurred in 11,58% of cases. Results statistically significant were found regarding the incidence of SSI (P=0.05) and the rate of re-operation (p=0.003) in surgeries involving more than three segments. DT is directly related to the rate of re-operation (p=0.0172) and SSI (p=0.0002). Elderly patients were not a predictor of poor outcome, neither to incidence of SSI (p=0.2), nor chance of re-operation (p=0.36). CONCLUSION Surgeries involving more than three segments are directly related to SSI, incidence of accidental DT and chance of re-operation. The presence of DT during the procedure is presented as a predictor of postoperative SSI and an increase in re-operation rate. Furthermore, elderly patients are not related to a higher risk for SSI and re-operations.