Craneotomía bifrontal y colgajo pediculado de pericráneo en el tratamiento de las fístulas traumáticas de LCR
Bifrontal craniotomy and pediculated pericranial flap in the management of traumatic fistula
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Acebes, J. Cabiol, L. López-Obarrio, A. Gabarrós, F. Isamat" "autores" => array:5 [ 0 => array:2 [ "nombre" => "J.J." "apellidos" => "Acebes" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Cabiol" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "López-Obarrio" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Gabarrós" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Isamat" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicios de Neurocirugía Ciutat Sanitaria i Universitaria de Bellvitge. Barcelona" ] ] ] 1 => array:3 [ "autoresLista" => "J.M. Serra" "autores" => array:1 [ 0 => array:3 [ "nombre" => "J.M." "apellidos" => "Serra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicios de Cirugía Plástica Ciutat Sanitaria i Universitaria de Bellvitge. Barcelona" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Bifrontal craniotomy and pediculated pericranial flap in the management of traumatic fistula" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec156822" "palabras" => array:7 [ 0 => "Traumatismo craneoencefálico" 1 => "Fractura craneal" 2 => "Meningitis postraumática" 3 => "Rinorrea" 4 => "Craneotomía bifrontal" 5 => "Injerto" 6 => "Anosmia" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec156823" "palabras" => array:6 [ 0 => "Head injury" 1 => "Skull base fracture" 2 => "Posttraumatic meningits" 3 => "Rhinorrhea" 4 => "Anosmia" 5 => "Bifrontal craniotomy" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Las fístulas traumáticas de LCR aparecen en un 511% de pacientes con fractura demostrada de base de cráneo. El riesgo potencial de las mismas es el desarrollo de meningitis postraumática. La prevención de la meningitis se basa en la reparación quirúrgica de la fístula cuando las medidas conservadoras no lo consiguen. Se han propuesto diversas técnicas de cierre, con una cifra de recidiva de fístula y/o meningitis de hasta el 25% según los autores. Analizamos nuestros resultados, en términos de cese de la rinorrea y desaparición de nuevos episodios de meningitis, en una serie consecutiva de 56 pacientes intervenidos en la CSUB entre 1987 y 1998 con la realización de un abordaje bifrontal intradural con exploración de la totalidad de la fosa anterior y recubrimiento de ésta con un colgajo pediculado de pericráneo. Todos los pacientes fueron estudiados mediante TAC craneal con cortes axiales y coronales prescindiendo de forma deliberada de otras técnicas de imagen para la localización de la fístula. Con un seguimiento de entre 1 y 11 años (media 5.6 años) no se ha detectado ningún caso de recidiva de fístula ni nuevos episodios de meningitis. La mortalidad operatoria fue nula y sólo dos pacientes presentaron anosmia tras la cirugía. La exploración quirúrgica bilateral de la fosa anterior y su tapizado completo con un colgajo pediculado permite un sellaje y separación definitivas entre la cavidad craneal y las cavidades nasosinusales. El uso de abordajes unilaterales y el uso de tejidos no vascularizados debe ser evitado en el manejo de esta patología.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Between 5–11% of patients harboring skull base fractures may present with cerebrospinal fluid (CSF) fistula. Their risk is the development of posttraumatic meningits. Surgical repair of the dural defect, when conservative measures fail, is mandatory in order to avoid new episodes of meningitis. Several surgical procedures have been proposed with an overall failure rate around 25%. Between 1987–1998 we treated 56 patients with posttraumatic CSF fistula and/or posttraumatic meningits with a bifrontal craniotomy, intradural exploration and carpeting of the anterior fossa with a pediculated pericranial flap. All patients underwent preoperative axial and coronal CT-scan and deliberately we did not use other imaging techniques to 10calize the fistula. After a follow-up of 1–11 years (mean 5.6 y) no recurrent episodes of meningitis or rhinorrhea have been detected. There was not operative mortality and 2 patients developped anosmia after the surgical procedure. A bilateral surgical exploration and complete covering of the anterior fossa floor with a pediculated pericranial flap allows a safe sealing as well as an effective isolation between anterior fossa and paranasal cavities. Unilateral approaches as well as nonvascularized materials should be avoided in the management of these patients.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Acebes, J.J.; Cabiol, J.; López-Obarrio, L.; Serra, J.M.; Gabarrós, A.; Isamat, F.: Craniotomía bifrontal y colgajo pediculado de pericráneo en el tratamiento de las fístulas traumáticas de LCR. Neurocirugía 1999; 10: 445–452.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:64 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurosurgical approaches to cerebrospinal fluid rhinorrhea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B. Aarabi" 1 => "L.G. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Marzo | 12 | 3 | 15 |
| 2019 Febrero | 1 | 2 | 3 |
| 2018 Marzo | 1 | 0 | 1 |
| 2018 Febrero | 25 | 4 | 29 |
| 2018 Enero | 27 | 18 | 45 |
| 2017 Diciembre | 23 | 23 | 46 |
| 2017 Noviembre | 28 | 36 | 64 |
| 2017 Octubre | 32 | 36 | 68 |
| 2017 Septiembre | 18 | 42 | 60 |
| 2017 Agosto | 25 | 33 | 58 |
| 2017 Julio | 27 | 41 | 68 |
| 2017 Junio | 39 | 33 | 72 |
| 2017 Mayo | 27 | 31 | 58 |
| 2017 Abril | 28 | 27 | 55 |
| 2017 Marzo | 29 | 58 | 87 |
| 2017 Febrero | 24 | 35 | 59 |
| 2017 Enero | 22 | 31 | 53 |
| 2016 Diciembre | 41 | 36 | 77 |
| 2016 Noviembre | 52 | 28 | 80 |
| 2016 Octubre | 49 | 67 | 116 |
| 2016 Septiembre | 66 | 55 | 121 |
| 2016 Agosto | 89 | 51 | 140 |
| 2016 Julio | 46 | 44 | 90 |
| 2015 Diciembre | 2 | 0 | 2 |
| 2015 Septiembre | 1 | 0 | 1 |
| 2015 Julio | 2 | 7 | 9 |
| 2015 Junio | 26 | 31 | 57 |
| 2015 Mayo | 22 | 48 | 70 |
| 2015 Abril | 16 | 39 | 55 |
| 2015 Marzo | 25 | 35 | 60 |
| 2015 Febrero | 19 | 41 | 60 |
| 2015 Enero | 22 | 33 | 55 |
| 2014 Diciembre | 21 | 42 | 63 |
| 2014 Noviembre | 14 | 41 | 55 |
| 2014 Octubre | 19 | 60 | 79 |
| 2014 Septiembre | 27 | 50 | 77 |
| 2014 Agosto | 19 | 59 | 78 |
| 2014 Julio | 17 | 62 | 79 |
| 2014 Junio | 34 | 58 | 92 |
| 2014 Mayo | 28 | 54 | 82 |
| 2014 Abril | 28 | 49 | 77 |
| 2014 Marzo | 24 | 38 | 62 |
| 2014 Febrero | 23 | 44 | 67 |
| 2014 Enero | 22 | 40 | 62 |
| 2013 Diciembre | 23 | 27 | 50 |
| 2013 Noviembre | 19 | 30 | 49 |
| 2013 Octubre | 21 | 56 | 77 |
| 2013 Septiembre | 25 | 64 | 89 |
| 2013 Agosto | 29 | 44 | 73 |
| 2013 Julio | 30 | 53 | 83 |
| 2013 Junio | 20 | 47 | 67 |
| 2013 Mayo | 21 | 46 | 67 |
| 2013 Abril | 15 | 38 | 53 |
| 2013 Marzo | 14 | 65 | 79 |
| 2013 Febrero | 9 | 24 | 33 |
| 2013 Enero | 16 | 26 | 42 |
| 2012 Diciembre | 13 | 27 | 40 |
| 2012 Noviembre | 0 | 34 | 34 |
| 2012 Octubre | 0 | 5 | 5 |
| 2012 Septiembre | 0 | 2 | 2 |
| 2012 Enero | 11 | 0 | 11 |
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