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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Apesar da redu&#231;&#227;o da mortalidade nos doentes com abcessos cerebrais desde a introdu&#231;&#227;o axial computadorizada &#40;TAC&#41;&#44; persiste ainda controv&#233;rsia quanto ao melhor m&#233;todo para o tratamento desta patologia&#46; A prop&#243;sito dos 3 casos que apresentam&#44; os autores fazem tamb&#233;m urna revisao da literatura sobre a aplica&#227;o das t&#233;cnicas estereot&#225;xicas no tratamento dos abcessos cerebrais&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Os tres doentes com abcessos foram submetidos a cirurgia estereot&#225;xica&#44; guiada por TAC&#44; para remo&#231;&#227;o total ou drenagem de p&#250;s e para orienta&#231;&#227;o do tratamento antibi&#243;tico apropriado&#46; Todos os abcessos tinham localiza&#231;&#227;o supratentorial e nos tres casos o agente patog&#233;nico foi identificado&#46; Um excelente resultado cl&#237;nico foi atingido nos tres doentes&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A cirurgia estereot&#225;xica&#44; urna t&#233;cnica segura&#44; com grande efic&#225;cia e baixo risco&#44; permite a exclusao de neoplasia ou de hematoma em reabsor&#231;&#227;o&#44; evitando o diagn&#243;stico err&#243;neo e o tratamento emp&#237;rico de lesoes cerebrais em anel com tradu&#231;&#227;o tomogr&#225;fica semelhante&#46; Consegue ainda um diagn&#243;stico bacteriol&#243;gico em 97&#37; dos casos&#46; Verifica-se tamb&#233;m a resolu&#231;&#227;o definitiva da doen&#231;&#227;&#44; ap&#243;s um &#250;nico procedimento estereot&#225;xico em pelo menos 72&#37; dos doentes&#44; taxa que sobe para os 93&#37;&#44; se fOr realizada mais do que urna interven&#231;&#227;o&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">O uso da t&#233;cnica estereot&#225;xica tem sido descrito com enfase crescente no tratamento dos abcessos cerebrais&#44; dado que representa urna mais valia consider&#225;vel no objectivo de reduzir a morbilidade e a mortalidade desta doen&#231;&#227;&#44; sobretudo nos casos de abcessos m&#250;ltiplos&#44; historicamente compar&#225;vel ao produzido pela introdu&#231;&#227;o da tomografia axial computadorizada e da moderna antibioterapia&#46; Com a ilustra&#231;&#227;o de tres casos&#44; os autores real&#231;&#227;m e aconselham o recurso precoce a t&#233;cnica estereot&#225;xica para drenagem ou remo&#227;o em bloco de todos os abcessos cir&#250;rgicos&#44; desde que devidamente complementado com controlo tomogr&#225;fico apertado de 2 em 2 semanas e antibioterapia prolongada durante 8 semanas&#46;</p>"
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        "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Despite a reduction in the mortality of patients with cerebral abscess since the introduction of computerized tomography &#40;CT&#41; and modern antibiotherapy&#44; controversy persists as to the preferred method of treatment for this condition&#46; The authors report three cases and review the Iiterature concerning the impact of stereotactic techniques on the treatment of this disease&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Three patients with cerebral abscess were treated by CT guided stereotactic surgery&#44; for total removal or drainage of pus&#44; and appropriate antibiotic therapy&#46; All abscesses were supratentorial and in the three cases a pathogen was identified&#46; A good outcome was achieved in all patients&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Being a safe and reliable technique&#44; stereotactic surgery easily permits the exclusion of neoplasm or reabsorbing hematoma&#44; thus avoiding the erroneous treatment of ring-enhancing lesions on the CT scan&#46; Moreover&#44; it aHows the bacteriological diagnosis in 97&#37; of cases and the cure of the disease in 72&#37; of patients with a single procedure&#44; that rises to 93&#37; if more than one intervention is performed&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The use of stereotactic techniques represents a most valuable tool in the reduction of morbidity and mortality of this disease&#44; namely in multiple abscess&#44; only comparable to the introduction of CT scan and modern antibiotics&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Through the illustration of three cases&#44; the authors strongly advise the early use of stereotactic technique for drainage or &#8220;en bloc&#8221; removal of surgical abscess&#44; complemented with a close radiological follow-up&#44; with a 2 weeks interval CT scan&#44; and long-term antibiotherapy&#46;</p>"
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Vol. 10. Núm. 6.
Páginas 453-460 (enero 1998)
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Vol. 10. Núm. 6.
Páginas 453-460 (enero 1998)
Cirurgía estereotáxica no tratamento do abcesso cerebral
Stereotactic surgery for the treatment of cerebral abcess
Visitas
2702
O.L. Alves, O. Gomes, S. Paranhos
Serviço de Neurocirurgía, Hospital Geral de Santo António
Este artículo ha recibido
Información del artículo
Resumo

Apesar da redução da mortalidade nos doentes com abcessos cerebrais desde a introdução axial computadorizada (TAC), persiste ainda controvérsia quanto ao melhor método para o tratamento desta patologia. A propósito dos 3 casos que apresentam, os autores fazem também urna revisao da literatura sobre a aplicaão das técnicas estereotáxicas no tratamento dos abcessos cerebrais.

Os tres doentes com abcessos foram submetidos a cirurgia estereotáxica, guiada por TAC, para remoção total ou drenagem de pús e para orientação do tratamento antibiótico apropriado. Todos os abcessos tinham localização supratentorial e nos tres casos o agente patogénico foi identificado. Um excelente resultado clínico foi atingido nos tres doentes.

A cirurgia estereotáxica, urna técnica segura, com grande eficácia e baixo risco, permite a exclusao de neoplasia ou de hematoma em reabsorção, evitando o diagnóstico erróneo e o tratamento empírico de lesoes cerebrais em anel com tradução tomográfica semelhante. Consegue ainda um diagnóstico bacteriológico em 97% dos casos. Verifica-se também a resolução definitiva da doençã, após um único procedimento estereotáxico em pelo menos 72% dos doentes, taxa que sobe para os 93%, se fOr realizada mais do que urna intervenção.

O uso da técnica estereotáxica tem sido descrito com enfase crescente no tratamento dos abcessos cerebrais, dado que representa urna mais valia considerável no objectivo de reduzir a morbilidade e a mortalidade desta doençã, sobretudo nos casos de abcessos múltiplos, historicamente comparável ao produzido pela introdução da tomografia axial computadorizada e da moderna antibioterapia. Com a ilustração de tres casos, os autores realçãm e aconselham o recurso precoce a técnica estereotáxica para drenagem ou remoão em bloco de todos os abcessos cirúrgicos, desde que devidamente complementado com controlo tomográfico apertado de 2 em 2 semanas e antibioterapia prolongada durante 8 semanas.

Palavras chave:
Estereotaxia
Abcesso cerebral
Summary

Despite a reduction in the mortality of patients with cerebral abscess since the introduction of computerized tomography (CT) and modern antibiotherapy, controversy persists as to the preferred method of treatment for this condition. The authors report three cases and review the Iiterature concerning the impact of stereotactic techniques on the treatment of this disease.

Three patients with cerebral abscess were treated by CT guided stereotactic surgery, for total removal or drainage of pus, and appropriate antibiotic therapy. All abscesses were supratentorial and in the three cases a pathogen was identified. A good outcome was achieved in all patients.

Being a safe and reliable technique, stereotactic surgery easily permits the exclusion of neoplasm or reabsorbing hematoma, thus avoiding the erroneous treatment of ring-enhancing lesions on the CT scan. Moreover, it aHows the bacteriological diagnosis in 97% of cases and the cure of the disease in 72% of patients with a single procedure, that rises to 93% if more than one intervention is performed.

The use of stereotactic techniques represents a most valuable tool in the reduction of morbidity and mortality of this disease, namely in multiple abscess, only comparable to the introduction of CT scan and modern antibiotics.

Through the illustration of three cases, the authors strongly advise the early use of stereotactic technique for drainage or “en bloc” removal of surgical abscess, complemented with a close radiological follow-up, with a 2 weeks interval CT scan, and long-term antibiotherapy.

Key words:
Stereotactic surgery
Cerebral abscess

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