Variabilidad en las indicaciones quirúrgicas de las lesiones intradurales postraumáticas
Variability in the surgical indications for posttraumatic intradural lesions
F. Arikan
, J. Sahuquillo, J. Ibáñez, J. Vilalta, M.A. Poca, E. Rubio
Servicio de Neurocirugía, Hospital Universitario Valí d’ Hebron, Barcelona
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Rubio" "autores" => array:6 [ 0 => array:3 [ "nombre" => "F." "apellidos" => "Arikan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Sahuquillo" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Ibáñez" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Vilalta" ] 4 => array:2 [ "nombre" => "M.A." "apellidos" => "Poca" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Rubio" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Neurocirugía, Hospital Universitario Valí d’ Hebron, Barcelona" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia postal: Fuat Arikan Abelló. C/ Mora de Ebro 65–67 esc. A2°-4ª. 08023 Barcelona." ] ] ] 1 => array:3 [ "autoresLista" => "M. Riveiro, M.P. Mena, A. Gamacho" "autores" => array:3 [ 0 => array:3 [ "nombre" => "M." "apellidos" => "Riveiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "M.P." "apellidos" => "Mena" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Gamacho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Cuidados Intensivos de Traumatología, Hospital Universitario Valí d’ Hebron, Barcelona" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] 1 => array:3 [ "entidad" => "Unidad de Neurotraumatología, Hospital Universitario Valí d’ Hebron, Barcelona" "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff0015" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Variability in the surgical indications for posttraumatic intradural lesions" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2004-06-08" "fechaAceptado" => "2004-08-08" "PalabrasClave" => array:2 [ "es" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec158799" "palabras" => array:5 [ 0 => "Traumatismo craneoencefálico" 1 => "Lesiones intradurales postraumáticas" 2 => "Hematomas postrau-máticos" 3 => "Indicaciones quirúrgicas" 4 => "Variabilidad quirúrgica" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abreviaturas" "identificador" => "xpalclavsec158798" "palabras" => array:7 [ 0 => "EBIC" 1 => "GOSE" 2 => "HIC" 3 => "PIC" 4 => "PPC" 5 => "TCDB" 6 => "TCE" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec158800" "palabras" => array:5 [ 0 => "Head injuries" 1 => "Posttraumatic intradural lesions" 2 => "Posttraumatic hematomas" 3 => "Surgical indications" 4 => "Surgical variability" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El tratamiento de las lesiones focales intradurales continúa siendo motivo de controversia. Esto es especialmente importante en la decisión de evacuar contusiones cerebrales. Presentamos los resultados de un estudio prospectivo y observacional, cuyo objetivo ha sido analizar la variabilidad en las indicaciones quirúrgicas de lesiones focales intradurales postraumáticas en un servicio de neurocirugía perteneciente a un hospital universitario, dotado de una unidad especializada en neurotraumatología.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Entre el 1 de mayo y el 31 de diciembre de 2001, se incluyeron 32 pacientes con un traumatismo craneoencefálico (TCE) cerrado, con lesiones focales intradurales. Estos pacientes constituyen la aportación que nuestro centro realizó en el estudio multicéntrico y observacional sobre el manejo de lesiones intradurales dirigido por el European Brain Injury Consortium (EBIC).</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Las lesiones intradurales de volumen > 25 cc. se evacuaron de forma inmediata al diagnóstico. Nueve de los 13 pacientes con lesiones < 25 cc. fueron intervenidos de forma diferida debido a la aparición de un deterioro neurológico o al diagnóstico de una hipertensión intracraneal (HIC). Después de la evacuación, la TC de control mostró en todos los casos una clara mejoría en los signos radiológicos de efecto de masa o en el desplazamiento de la línea media.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A pesar que el reducido número de casos incluidos no nos permiten generalizar las conclusiones, en nuestro centro no se evidencia una variabilidad significativa en las indicaciones quirúrgicas de lesiones > 25 cc. Sin embargo, existen discrepancias en las indicaciones quirúrgicas de las lesiones con volumen < 25 cc. Los resultados definitivos del estudio del EBIC permitirán conocer mejor la variabilidad existente en el manejo de este tipo de pacientes.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The surgical treatment of focal intradural lesions is still a matter of considerable debate. This is especially important in the decisión to evacúate brain contusions. We present the results of a prospective observational study in which the main goal was to analyze intracenter variability in the indication for surgery in focal posttraumatic intradural lesions in a department of Neurosurgery of a University Hospital with a specialized neurotrauma unit.</p> <span class="elsevierStyleSectionTitle">Clinical material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Between May 1 and December 31, 2001, 32 patients with a closed trau-matic brain injury and an intradural posttraumatic focal lesión were included. The patients studied were a subgroup included in the European multicenter observational study of the management of intradural lesions conducted under the aegis of the European Brain Injury Consortium (EBIC).</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Intradural lesions > 25cc were immediately evacuated. Nine out of thirteen patients with lesions < 25cc also underwent surgery due to intracranial hyper-tension or neuroworsening. In all patients in whom lesions were surgically evacuated, the postoperative CT-scan showed neuroradiological improvement of the signs of mass effect or midline shift.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In our center, we found no evidence of significant variability in the indications for surgery in intradural lesions of more than 25 cc. However, significant differences were detected among neurosurgeons in the surgical indications for lesions below 25cc. The small sample analyzed precludes generalization of these conclusions. The deflnitive results of the EBIC study will provide the neurosurgical community with a better understanding of variability in the management of these lesions.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Arikan, F.; Sahuquillo, J.; Ibáñez, J.; Vilalta, J.; Poca, M.A.; Riveiro, M.; Mena, M.P.; Garnacho, A.; Rubio, E.: Variabilidad en las indicaciones quirúrgicas de las lesiones intradurales postraumáticas. Neurocirugía 2005; 16: 108–116.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Marzo | 2 | 2 | 4 |
| 2018 Marzo | 0 | 1 | 1 |
| 2018 Febrero | 13 | 3 | 16 |
| 2018 Enero | 20 | 10 | 30 |
| 2017 Diciembre | 17 | 8 | 25 |
| 2017 Noviembre | 29 | 8 | 37 |
| 2017 Octubre | 13 | 7 | 20 |
| 2017 Septiembre | 13 | 8 | 21 |
| 2017 Agosto | 11 | 7 | 18 |
| 2017 Julio | 13 | 12 | 25 |
| 2017 Junio | 19 | 11 | 30 |
| 2017 Mayo | 18 | 10 | 28 |
| 2017 Abril | 12 | 7 | 19 |
| 2017 Marzo | 12 | 5 | 17 |
| 2017 Febrero | 6 | 1 | 7 |
| 2017 Enero | 22 | 3 | 25 |
| 2016 Diciembre | 34 | 7 | 41 |
| 2016 Noviembre | 33 | 6 | 39 |
| 2016 Octubre | 56 | 5 | 61 |
| 2016 Septiembre | 46 | 6 | 52 |
| 2016 Agosto | 58 | 18 | 76 |
| 2016 Julio | 30 | 6 | 36 |
| 2015 Diciembre | 2 | 0 | 2 |
| 2015 Junio | 12 | 4 | 16 |
| 2015 Mayo | 14 | 11 | 25 |
| 2015 Abril | 20 | 11 | 31 |
| 2015 Marzo | 18 | 10 | 28 |
| 2015 Febrero | 12 | 8 | 20 |
| 2015 Enero | 14 | 7 | 21 |
| 2014 Diciembre | 14 | 9 | 23 |
| 2014 Noviembre | 12 | 6 | 18 |
| 2014 Octubre | 20 | 12 | 32 |
| 2014 Septiembre | 15 | 11 | 26 |
| 2014 Agosto | 11 | 13 | 24 |
| 2014 Julio | 13 | 9 | 22 |
| 2014 Junio | 18 | 17 | 35 |
| 2014 Mayo | 11 | 16 | 27 |
| 2014 Abril | 9 | 9 | 18 |
| 2014 Marzo | 10 | 12 | 22 |
| 2014 Febrero | 12 | 10 | 22 |
| 2014 Enero | 7 | 13 | 20 |
| 2013 Diciembre | 14 | 16 | 30 |
| 2013 Noviembre | 10 | 8 | 18 |
| 2013 Octubre | 16 | 17 | 33 |
| 2013 Septiembre | 20 | 13 | 33 |
| 2013 Agosto | 22 | 14 | 36 |
| 2013 Julio | 23 | 14 | 37 |
| 2013 Junio | 16 | 17 | 33 |
| 2013 Mayo | 13 | 8 | 21 |
| 2013 Abril | 12 | 8 | 20 |
| 2013 Marzo | 11 | 12 | 23 |
| 2013 Febrero | 6 | 10 | 16 |
| 2013 Enero | 16 | 9 | 25 |
| 2012 Diciembre | 9 | 10 | 19 |
| 2012 Noviembre | 0 | 4 | 4 |
| 2012 Octubre | 0 | 1 | 1 |
| 2012 Septiembre | 0 | 2 | 2 |
| 2012 Enero | 8 | 0 | 8 |
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