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array:23 [ "pii" => "S1130147306703153" "issn" => "11301473" "doi" => "10.1016/S1130-1473(06)70315-3" "estado" => "S300" "fechaPublicacion" => "2006-01-01" "aid" => "70315" "copyright" => "Sociedad Española de Neurocirugía" "copyrightAnyo" => "2006" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Neurocirugia. 2006;17:519-26" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3567 "formatos" => array:3 [ "EPUB" => 21 "HTML" => 2275 "PDF" => 1271 ] ] "itemSiguiente" => array:18 [ "pii" => "S1130147306703165" "issn" => "11301473" "doi" => "10.1016/S1130-1473(06)70316-5" "estado" => "S300" "fechaPublicacion" => "2006-01-01" "aid" => "70316" "copyright" => "Sociedad Española de Neurocirugía" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Neurocirugia. 2006;17:527-31" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2239 "formatos" => array:3 [ "EPUB" => 19 "HTML" => 1074 "PDF" => 1146 ] ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Time sparing and effective procedure for dural closure in the posterior fossa using a vicryl mesh (Ethisorb®)" "tienePdf" => "en" "tieneTextoCompleto" => 0 "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "527" "paginaFinal" => "531" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cierre de duramadre en cirugía de fosa posterior con una malla de vicryl (Ethisorb®): un procedimiento simple y efectivo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Reyes-Moreno, R. Verheggen" "autores" => array:2 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Reyes-Moreno" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Verheggen" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147306703165?idApp=UINPBA00004B" "url" => "/11301473/0000001700000006/v1_201305151259/S1130147306703165/v1_201305151259/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1130147306703141" "issn" => "11301473" "doi" => "10.1016/S1130-1473(06)70314-1" "estado" => "S300" "fechaPublicacion" => "2006-01-01" "aid" => "70314" "copyright" => "Sociedad Española de Neurocirugía" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Neurocirugia. 2006;17:495-518" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 31168 "formatos" => array:3 [ "EPUB" => 25 "HTML" => 12138 "PDF" => 19005 ] ] "es" => array:10 [ "idiomaDefecto" => true "titulo" => "Revisión del traumatismo craneoencefálico" "tienePdf" => "es" "tieneTextoCompleto" => 0 "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "495" "paginaFinal" => "518" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Overview of nead injury" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:2 [ 0 => array:2 [ "autoresLista" => "A. Bárcena-Orbe, J.M. Cañizal-García, C. Mestre-Moreiro, J.C. Calvo- Pérez, A.F. Molina-Foncea, J. Casado-Gómez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Bárcena-Orbe" ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "Cañizal-García" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Mestre-Moreiro" ] 3 => array:2 [ "nombre" => "J.C." "apellidos" => "Calvo- Pérez" ] 4 => array:2 [ "nombre" => "A.F." "apellidos" => "Molina-Foncea" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Casado-Gómez" ] ] ] 1 => array:2 [ "autoresLista" => "C.A. Rodríguez-Arias, B. Rivero-Martín" "autores" => array:2 [ 0 => array:2 [ "nombre" => "C.A." "apellidos" => "Rodríguez-Arias" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Rivero-Martín" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147306703141?idApp=UINPBA00004B" "url" => "/11301473/0000001700000006/v1_201305151259/S1130147306703141/v1_201305151259/es/main.assets" ] "es" => array:15 [ "idiomaDefecto" => true "titulo" => "Valor predictivo de la clasificación de Knosp en el grado de resección quirúrgica de los macroadenomas invasivos. Estudio prospectivo de una serie de 23 casos" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "519" "paginaFinal" => "526" ] ] "autores" => array:2 [ 0 => array:4 [ "autoresLista" => "J. Enseñat, T. Topcewski, J. Vilalta, J. Sahuquillo" "autores" => array:4 [ 0 => array:3 [ "nombre" => "J." "apellidos" => "Enseñat" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Topcewski" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Vilalta" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Sahuquillo" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicios de Neurocirugía, Hospital Universitario Vall d’Hebron. Universidad Autónoma de Barcelona. España" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia postal: Cr. Urgell 149- 151 Esc 2a. Ático 1. 08036 Barcelona." ] ] ] 1 => array:3 [ "autoresLista" => "G. Obiols, J. Mesa, A. Ortega" "autores" => array:3 [ 0 => array:3 [ "nombre" => "G." "apellidos" => "Obiols" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Mesa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Ortega" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicios de Endocrinología, Hospital Universitario Vall d’Hebron. Universidad Autónoma de Barcelona. España" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] 1 => array:3 [ "entidad" => "Servicios de Anatomía Patológica, Hospital Universitario Vall d’Hebron. Universidad Autónoma de Barcelona. España" "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff0015" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Predicitve value of the Knosp classification in the staging of invasive pituitary macroadenomas. A Prospective study of 23 cases" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-12-20" "fechaAceptado" => "2006-02-19" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec159436" "palabras" => array:4 [ 0 => "Macroadenomas invasivos" 1 => "Seno cavernoso" 2 => "Abordaje transesfenoidal" 3 => "Clasificación radiológica" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec159437" "palabras" => array:4 [ 0 => "Invasive macroadenomas" 1 => "Cavernous sinus" 2 => "Transsphenoidal approach" 3 => "Radiologic classification" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar y valorar el grado de resección y las complicaciones de la cirugía transesfenoidal en una serie de 23 casos de macroadenomas con invasión del seno cavernoso evaluados mediante la clasificación de Knosp.</p> <span class="elsevierStyleSectionTitle">Material, métodos y resultados</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de 22 pacientes (23 operaciones) intervenidos en nuestro centro entre Mayo del 2002 y Diciembre del 2004 de macroadenomas hipofisarios con diferentes grados de invasión del seno cavernoso según la clasificación de Knosp15. Entre las variables del estudio se incluyeron los grados de invasión y de resección postoperatoria con un seguimiento radiológico medio a largo plazo de 15 meses.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Nuestra serie consta de 15 varones y 7 mujeres, con una edad media de 48 años (27 – 75 años). Todos ellos presentaban macroadenomas con afectación de uno o ambos senos cavernosos. De acuerdo con la clasificación de Knosp 4 pacientes fueron grado 1, 2 grado 2, 1 grado 3 y 16 grado 4. En 20 casos se utilizó una vía transesfenoidal clásica y en tres casos se hizo un abordaje transesfenoidal endoscópico. Según la RMN postoperatoria los grados de resección fueron: completo o total en todos los pacientes con grados 1 y 2 y en sólo 2 pacientes con grado 4; subtotal (>80%) en 1 paciente con grado 3 y en 6 pacientes con grado 4 y parcial (<80%) en 7 pacientes con grado 4 de Knosp. Se compararon los grados de resección versus los grados de invasión mediante el Test exacto de Fisher y las diferencias no fueron estadísticamente significativas (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.12).</p> <span class="elsevierStyleSectionTitle">Discusión y conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Si bien únicamente la clasificación radiológica de Knosp por si sola no puede predecir el comportamiento biológico del tumor o si la pared medial del seno cavernoso está infiltrada o desplazada, en nuestra serie los tumores de grado 4 han sido los que han presentado un peor resultado de acuerdo al grado de resección. En los tumores que invaden el seno cavernoso, incluso en los casos donde la carótida está englobada es posible realizar resecciones completas con una morbimortalidad aceptable.</p>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To evaluate our experience regarding the treatment of pituitary macroadenomas with cavernous sinus invasion in a series of 23 cases of transphenoidal resection.</p> <span class="elsevierStyleSectionTitle">Materials, methods and results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Twenty two patients, fifteen males and seven females, with ages ranging from 27 to 75 (mean of 48), were operated under protocol by a single surgeon between May of 2002 and December of 2004. Preoperatively all lesions were diagnosed by MRI and staged according to the Knosp classification. All tumors had extension to one or both cavernous sinuses. Four patients were considered to be grade 1, two grade 2, one grade 3 and sixteen grade 4. Twenty three operations were performed on twenty-two patients. Twenty cases were the standard transsphenoidal approach, and three were endoscopic. Postoperatively, the excision was classified as Complete or Total, Subtotal or Partial. Mean follow up was 15 months. The variables considered for analysis include invasion and resection grades. All six patients with graded 1 and 2 lesions and two patients with grade 4 lesions underwent a complete resection. Subtotal (greater than 80%) excision was achieved in one patient with a grade 3 tumor and six patients with grade 4 tumors. The remaining seven patients with grade 4 adenomas had a Partial (less than 80%) excision. We compare de resection grade versus invasion grade with exact Fisher test. And there is not estadistical difference (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.12).</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The Knosp classification alone cannot predict the behavior of these tumors. In our experience, despite tumor extension to the cavernous sinus, pituitary macroadenomas can be safely resected with low morbidity and mortality.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Enseñat, J.; Ortega, A.; Topcewski, T.; Vilalta, J.; Obiols, G.; Mesa, J.; Sahuquillo, J.: Valor predictivo de la clasificación de Knosp en el grado de resección quirúrgica de los macroadenomas invasivos. Estudio prospectivo de una serie de 23 casos. Neurocirugía 2006; 17: 519–526.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cavernous sinus invasion by pituitary adenomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Ahmadi" 1 => "C.M. North" 2 => "H.D. Segall" 3 => "C.S. Zee" 4 => "M.H. Weiss" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/ajr.146.2.257" "Revista" => array:6 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "1986" "volumen" => "146" "paginaInicial" => "257" "paginaFinal" => "262" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3484572" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." 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