Thesis (M.S.)--University of Michigan, 1992.

Thesis (M.S.)--University of Michigan, 1992.

Técnicas cirúrgicas para realização de craniotomias são descritas na literatura há mais de cinqüenta anos. Contudo, a sua realização ainda é limitada, muitas vezes pela ausência de diagnóstico conclusivo. Com o advento de métodos não invasivos como a tomografia computadorizada, a especificidade quanto ao tipo e localização da lesão tornou-se possível. As principais abordagens cranianas são as técnicas de craniotomia transfrontal que promovem acesso ao cérebro. Os principais pontos de referência para a realização da técnica são os seios venosos da dura mater. Este estudo visou analisar o acesso cirúrgico em relação ao seio venoso sagital dorsal, bem como compará-lo nos diferentes tipos de crânio: braquicefálico e mesaticefálico. Foram utilizados 16 crânios provenientes de 8 cães da raça boxer, 5 cães sem raça definida, 1 rotweiller, 1 labrador e 1 pinscher. O trajeto do seio venoso sagital superior foi estudado pelo método de injeção de solução de látex com pigmento colorido e sulfato de bário. A relação do SVSD foi estudada através de análise das imagens obtidas pela tomografia computadorizada. Os crânios braquicefálicos apresentaram índice cefálico médio igual à 91,24 e índice crânio fácil igual à 2,89; enquanto nos crânio mesaticefálicos obtivemos os valores médios de 79,77 e 1,92 para os índices cefálico e crânio facial respectivamente. O trajeto do seio venoso sagital dorsal foi delimitado, tendo início na porção média do arco zigomático e término ao nível do osso occipital nos dois grupos de crânios. Em relação às mensurações do seio venoso relativas à calota craniana obtivemos os valores médios da área = 7,35+-2,51; D1 = 6,65+-2,27; D2 = 16,17+-4,08; D3 = 15,75-+5,09; D4 = 18,33+-5,25 e D5 = 18,04+-5,87 no grupo mesaticefálico e os valores médios da área = 10,18+-4,69; D1 = 11,84+-2,35; D2 = 19,57+-2,61; D3 = 17,88+-2,31; D4 = 25,32+-5,68 e D5 = 24,84=-4,40 no grupo braquicefálico. Os valores referentes á área, D4 e D5 apresentaram diferença estatística (P<0,05), que denota diferença no formato da calota craniana entre os dois grupos, assim consequentemente diferença na medida citada como margem de segurança para a realização da abordagem cirúrgica do cérebro. / The surgical approaches for craniotomy are describe since the fifties. However, this realization is limited, many times for the absence conclusive diagnosis. The non invasive methods like computed tomography, the lesion locatization and type are easily made. The most important surgical approach is transfrontal craniotomy which promoves brain access. The principal landmarks to the surgery are the dura mater venous sinus. The objetive of this study was to analise the surgical access relation to the dorsal sagittal sinus and to compare with the different skull type: mesaticephalic and braquicephalic. Sixteen skulls from 8 Boxer dogs, 5 Mongrel dogs, 1 Rottweiler, 1 Labrador and 1 Pinscher. The sinus path was studied by solution of bario and látex whith coloured pigment injection. The dorsal sagittal sinus relation was studied by CT image analysis. The braquicephalic skulls showed cephalic index = 91,24 and cranio facial index = 2,89, and the mesaticephalic skulls presents 79,77 and 1,92 for cephalic and crânio facial index. The dorsal sagittal sinus path was delimited, and the medium of the zigomatic arc is this begging and the occipital bone the final, in both skull types. The venous sinus mensurations interface to the skull are: area = 7,35+/-2,51; D1 = 6,65+-2,27; D2 = 16,17+-4,08; D3 = 15,75-+5,09; D4 = 18,33+-5,25 e D5 = 18,04+-5,87 in mesaticephalic dogs and the medium mensurations da area = 10,18+-4,69; D1 = 11,84+-2,35; D2 = 19,57+-2,61; D3 = 17,88+-2,31; D4 = 25,32+-5,68 e D5 = 24,84=-4,40 in braquicephalic group. The área, D4 and D5 mensurations presents statistic difference (P<0,05), which show the skull form difference betwen the two groups, and the edge for the surgical approach to the brain.

Few investigators have used robust analytic methods to assess risk factors and outcomes for surgical site infections (SSIs) after craniotomy and craniectomy (CRANI) procedures. We performed a retrospective study among patients undergoing CRANI procedures between 2006 and 2010 at the University of Iowa Hospitals and Clinics (UIHC) to assess the effect of an intervention (e.g., limiting Gliadel wafer use among patients with malignant brain tumors) on the trend of SSI rates, to identify independent risk factors for SSIs, and to evaluate one-year postoperative patient outcomes associated with these SSIs. We abstracted demographic data and clinical data from medical records or from the UIHC's Health information Management System. We identified 104 patients with SSIs and selected 312 controls. Of SSIs, 88% were deep incisional or organ space infections, 70% were identified after patients were discharged from their initial hospitalizations, 32% were caused by Staphylococcus aureus alone or in combination with other organisms, and 27% were caused by Gram-negative organisms alone or in combination with other organisms. Significant independent risk factors for SSIs were: previous chemotherapy (odds ratio [OR], 10.0; 95% confidence interval [CI] 1.1, 92.1), preoperative length of stay ≥ 1 day (OR, 2.1; 95% CI 1.3, 3.5), preoperative serum glucose ≥ 100 mg/dL (OR, 1.7; 95% CI, 1.0, 3.0), Gliadel® wafer use (OR, 8.6; 95% CI 3.2, 23.1), and postoperative cerebrospinal fluid leak (OR, 4.0; 95% CI, 1.6, 10.3). Gliadel® wafer use was the strongest risk factor; however, limiting Gliadel® wafer use did not decrease SSI rate significantly among patients with brain tumors. Perioperative ventricular drains or lumbar drains were not independently associated with an increased risk of SSIs, but drains may have clinical significance. An SSI risk index that included the significant preoperative patient-related risk factors had a better predictive power than the National Healthcare Safety Network (NHSN) risk index. After adjusting for preoperative length of stay, age, comorbidity score, severity of illness score, the reason for the procedure, and procedure month, patients with SSIs were hospitalized longer postoperatively than were controls during their readmissions (2.3 days; P < 0.0001). After controlling for the same covariates and treating SSI as a time-varying factor, patients with SSIs were more likely than controls to: die (hazard ratio [HR], 3.3; 95% CI, 1.8, 5.8), be readmitted (HR, 4.1; 95% CI, 2.9, 5.8), and have reoperations (HR, 56.6; 95% CI, 38.1, 84.0). In conclusion, surgeons could predict patients' risk of SSIs based on their preoperative risk factors and surgeons could modify some processes of care to lower the SSI risk. Preventing SSIs after CRANI procedures could improve patient outcomes and decrease healthcare utilization.

Técnicas cirúrgicas para realização de craniotomias são descritas na literatura há mais de cinqüenta anos. Contudo, a sua realização ainda é limitada, muitas vezes pela ausência de diagnóstico conclusivo. Com o advento de métodos não invasivos como a tomografia computadorizada, a especificidade quanto ao tipo e localização da lesão tornou-se possível. As principais abordagens cranianas são as técnicas de craniotomia transfrontal que promovem acesso ao cérebro. Os principais pontos de referência para a realização da técnica são os seios venosos da dura mater. Este estudo visou analisar o acesso cirúrgico em relação ao seio venoso sagital dorsal, bem como compará-lo nos diferentes tipos de crânio: braquicefálico e mesaticefálico. Foram utilizados 16 crânios provenientes de 8 cães da raça boxer, 5 cães sem raça definida, 1 rotweiller, 1 labrador e 1 pinscher. O trajeto do seio venoso sagital superior foi estudado pelo método de injeção de solução de látex com pigmento colorido e sulfato de bário. A relação do SVSD foi estudada através de análise das imagens obtidas pela tomografia computadorizada. Os crânios braquicefálicos apresentaram índice cefálico médio igual à 91,24 e índice crânio fácil igual à 2,89; enquanto nos crânio mesaticefálicos obtivemos os valores médios de 79,77 e 1,92 para os índices cefálico e crânio facial respectivamente. O trajeto do seio venoso sagital dorsal foi delimitado, tendo início na porção média do arco zigomático e término ao nível do osso occipital nos dois grupos de crânios. Em relação às mensurações do seio venoso relativas à calota craniana obtivemos os valores médios da área = 7,35+-2,51; D1 = 6,65+-2,27; D2 = 16,17+-4,08; D3 = 15,75-+5,09; D4 = 18,33+-5,25 e D5 = 18,04+-5,87 no grupo mesaticefálico e os valores médios da área = 10,18+-4,69; D1 = 11,84+-2,35; D2 = 19,57+-2,61; D3 = 17,88+-2,31; D4 = 25,32+-5,68 e D5 = 24,84=-4,40 no grupo braquicefálico. Os valores referentes á área, D4 e D5 apresentaram diferença estatística (P&lt;0,05), que denota diferença no formato da calota craniana entre os dois grupos, assim consequentemente diferença na medida citada como margem de segurança para a realização da abordagem cirúrgica do cérebro. / The surgical approaches for craniotomy are describe since the fifties. However, this realization is limited, many times for the absence conclusive diagnosis. The non invasive methods like computed tomography, the lesion locatization and type are easily made. The most important surgical approach is transfrontal craniotomy which promoves brain access. The principal landmarks to the surgery are the dura mater venous sinus. The objetive of this study was to analise the surgical access relation to the dorsal sagittal sinus and to compare with the different skull type: mesaticephalic and braquicephalic. Sixteen skulls from 8 Boxer dogs, 5 Mongrel dogs, 1 Rottweiler, 1 Labrador and 1 Pinscher. The sinus path was studied by solution of bario and látex whith coloured pigment injection. The dorsal sagittal sinus relation was studied by CT image analysis. The braquicephalic skulls showed cephalic index = 91,24 and cranio facial index = 2,89, and the mesaticephalic skulls presents 79,77 and 1,92 for cephalic and crânio facial index. The dorsal sagittal sinus path was delimited, and the medium of the zigomatic arc is this begging and the occipital bone the final, in both skull types. The venous sinus mensurations interface to the skull are: area = 7,35+/-2,51; D1 = 6,65+-2,27; D2 = 16,17+-4,08; D3 = 15,75-+5,09; D4 = 18,33+-5,25 e D5 = 18,04+-5,87 in mesaticephalic dogs and the medium mensurations da area = 10,18+-4,69; D1 = 11,84+-2,35; D2 = 19,57+-2,61; D3 = 17,88+-2,31; D4 = 25,32+-5,68 e D5 = 24,84=-4,40 in braquicephalic group. The área, D4 and D5 mensurations presents statistic difference (P&lt;0,05), which show the skull form difference betwen the two groups, and the edge for the surgical approach to the brain.

Le problème de planification de trajectoire des bras manipulateurs redondants est largement étudié dans la littérature. Sa résolution nécessite la prise en compte d'un certain nombre de contraintes, qui sont : • le calcul des différentes configurations par lesquelles le robot doit passer ; • l'obtention de courbes lisses (vitesses, accélérations, jerks).La prise en compte de ces deux contraintes dans la démarche de résolution peut se faire de deux manières différentes. La première consiste à supposer au préalable que les différentes courbes suivent des trajectoires lisses (utilisation de fonctions polynomiales ou trigonométriques). La résolution aura pour objectif de calculer les paramètres de chacune des courbes. La deuxième technique consiste à traiter les deux contraintes séparément. Ainsi, on calcule les différentes configurations, puis on procède à une interpolation. Outre ces deux contraintes, on doit aussi résoudre le problème de redondance du robot et la manière de l'exploiter. La première partie de cette thèse est ainsi consacrée à l'étude de cette problématique. La démarche de résolution proposée repose entièrement sur des algorithmes d'optimisation. Les deux contraintes citées précédemment étant traitées séparément, il devient aisé de prendre en compte davantage de critères dans le problème d'optimisation. Ainsi, de nouvelles formulations sont proposées. Ces dernières font appel aux techniques d'optimisation hiérarchique, afin de faciliter le traitement de la redondance, qui est exploitée pour l'évitement d'obstacles et les singularités du robot. Vu la complexité de ces formulations, nous avons préconisé une démarche de résolution approchée, qui fait appel aux métaheuristiques d'optimisation, en particulier les algorithmes génétiques. La validation de la démarche proposée est faite sur le modèle du robot Neuromate. La deuxième partie de cette thèse est consacrée à une application avec le robot Neuromate. Plus particulièrement, nous nous sommes intéressés à l'opération de craniotomie avec le robot Neuromate. L'objectif est de réaliser une petite ouverture au niveau du crâne humain afin que le chirurgien puisse glisser des instruments pour traiter des maladies affectant le cerveau. Réalisée par le chirurgien lui-même, sans assistance robotique, cette opération est très délicate, du fait du manque de précision et de l'allongement du temps d'intervention. Les risques d'aggravation sont particulièrement élevés si la zone d'intervention est proche des veines ou située dans des régions qui ont une fonction importante (région motrice ou région de langage, par exemple). La démarche classique de la craniotomie assistée fait appel à la co-manipulation, qui contraint le chirurgien à participer à l'action, et donc à fournir des efforts. Dans ce travail, une autre démarche est proposée, basée sur l'intégration au robot Neuromate d'un système d'usinage à grande vitesse. Des tests ont été réalisés sur des plaques en polyamide dont les caractéristiques mécaniques sont proches de celles du crâne / The problem of trajectory planning is largely studied in the literature. In order to solve this problem, we need to take into account two important constraints, which are : • the computation of the different configurations in which the robot must pass ; • the smoothness of the resulting curves (velocities, accelerations, jerks).Taking both constraints into consideration can be done in two different ways. The first one is to suppose that all the curves are smooth (using polynomial or trigonometric functions) and then, the aim of the resolution is to find the coefficient of each of them. The second way is to deal the constraints separately. Thus, we compute in first the different configurations in which the robot must pass. After that, we compute the whole curve by interpolation. Adding to the constraints mentioned before, we have to solve the problem of the redundancy of the robot. The first part of this thesis is then devoted to the study of this problem. The proposed solving technique is entirely based on optimization algorithms. The two constraints cited above are treated separately, which allows to take more criteria into account. Thus, new formulations are proposed. They are based on the hierarchical optimization problem, which facilitates handling of the redundancy which is used for the obstacle and the singularities avoidance. Because of the high complexity of the proposed formulations, we chose to use metaheuristics to resolve them, especially the genetic algorithms. We validated the proposed technique on the model of the Neuromate robot. The second part of this thesis is devoted to an application achieved with the Neuromate robot. The procedure of craniotomy is used to perform a very small hole in the human skull in order to allow the surgeon to introduce medical instruments, to take care of some illness that affects brain. Achieved by the surgeon himself, without any robotics aid, this operation is very delicate, because of its lack of precision and increase of processing time. The risks are particularly high if the area of intervention is near the veins. The classical solving technique is based on the co-manipulation principle, which means that the surgeon participates in the action and then, provides an effort. In this work, another solving technique is proposed. It is based on the integration of a machining system with the Neuromate robot. The tests are achieved on plates made of polyamide of which the mechanical characteristics are near to those of the human skull

Orientador: Yvens Barbosa Fernandes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T09:26:09Z (GMT). No. of bitstreams: 1 Zullo_JoaoFlavioDaniel_M.pdf: 4994617 bytes, checksum: 7f874ff0599b4cec270f92a8010dc856 (MD5) Previous issue date: 2014 / Resumo: As hemorragias intracerebrais supratentoriais espontâneas, correspondem a cerca de 10 a 20% de todos os acidentes vasculares cerebrais (AVC), acometendo mais de 4 milhões de pessoas por ano em todo o mundo(13). Apresenta as mais altas taxas de morbi-mortalidade dentre os diferentes tipos de AVC, sendo que a mortalidade desta patologia alcança índices ao redor de 30-40% dos doentes, além de grande número de pacientes com seqüelas graves, sendo que seu principal fator de risco é a hipertensão arterial sistêmica (HAS). Desde o trabalho de McKissock(1) at al em 1961, vem se tentando descobrir qual a melhor maneira para tratar pacientes que apresentam tais hemorragias. Com esse intuito, avaliamos 67 pacientes atendidos no HC/Unicamp e no Hospital Estadual de Sumaré/Unicamp (HES) entre os anos de 2007 e 2012, sendo 41 com hemorragias de núcleos da base e 26 com hematomas lobares. Estudamos a influência de vários fatores no prognóstico dos pacientes com hemorragias intracerebrais supratentoriais espontâneas, como idade, nível de consciência à admissão hospitalar (usando-se a escala de coma de Glasgow), profundidade do hematoma em relação à superfície cerebral, volume do hematoma, presença de hemorragia intraventricular, desvio de linha média, tempo entre ictus hemorrágico e cirurgia e tipo de tratamento (craniotomia ou conservador). O nível de consciência na chegada ao hospital é fator determinante com relação ao prognóstico funcional avaliado em 30 dias após o ictus, independente da modalidade de tratamento adotada, porém com diferentes nuances dependendo da localização da lesão (núcleos da base ou lobar). Algumas particularidades, como tamanho do hematoma, podem determinar o resultado prognóstico funcional, assim como o tratamento cirúrgico, hemoventrículo e desvio de linha média (DLM) tendem a influenciar o prognóstico / Abstract: Spontaneous supratentorial intracerebral hemorrhages correspond to 10 to 20% of all stroke cases, affecting more than 4.000.000 people/year worldwide(13). It shows the highest rates of morbidity and mortality among the different types of stroke. The mortality of this disease achieves around 30- 40% of all patients, besides a large number of pacientes with severe sequels. Its main risk factor is high blood pressure. Since McKissock(1) at al published his work in 1961, researchers are trying to figure out the best way to treat patients with this type of hemorrhage. Aiming this situation, we evaluated 67 patients treated at HC/Unicamp and State Hospital of Sumaré (HES)/Unicamp between 2007 and 2012, with 41 basal ganglia and 26 lobar hematomas. We studied the influence of several factors on the prognosis of patients with spontaneous supratentorial intracerebral hemorrhage, such as age, consciousness at hospital admision (using the Glasgow Coma Scale), hematoma depth, hematoma volume, intraventricular hemorrhage, midline shift, time between bleeding and surgery and treatment option (craniotomy or conservative). The consciousness on arrival at the hospital is a determinant factor relative to functional outcome in 30 days after bleeding, regardless of treatment modality adopted, but with different nuances depending on the lesion location (basal ganglia or lobar). Some special features, like the size of the hematoma, can determine the funcional outcome, as well as surgery, ventricular hemorrhage and midline shift have a trend to influence prognosis / Mestrado / Neurologia / Mestre em Ciências Médicas

Indiana University-Purdue University Indianapolis (IUPUI) / Post-craniotomy brain tumor patients often experience pain in the post-surgical period which can negatively affect recovery and surgical outcomes. Research with this population has focused on pharmacological treatments of post-craniotomy pain and measurement of pain intensity. Little is known about how these patients experience the quality of their pain and how this pain is managed. The purpose of this dissertation was to provide an in-depth description of the experience of post-craniotomy pain during the post-surgical period. The information gained about how post-craniotomy patients experience pain and pain management will contribute the development of effective, tailored interventions to enhance patient satisfaction and outcomes. This dissertation project was composed of two components. The first component was an integrative review of literature examining the evidence of pain and associated symptoms in adult (aged 21 and older), post-craniotomy brain tumor patients. The review examined studies from the past fourteen years that focused on the incidence and treatment of postcraniotomy pain. It revealed that the majority of post-craniotomy patients experience moderate to severe pain after surgery. This pain is associated with nausea, vomiting, changes in blood pressure, and increased length of hospital stay. The second component was a qualitative descriptive study of a sample of 28 adult (aged 21 and older) post-craniotomy patients hospitalized on an inpatient neurosurgical stepdown unit at a Midwestern urban teaching hospital. During semi-structured interviews, participants described their experiences of post-craniotomy pain and of their experiences of postcraniotomy pain management. Data generated from the qualitative descriptive study were analyzed and resulted in two qualitatively derived products. The first was a description of participants’ experiences of the quality of their post-craniotomy pain during the post-surgical period. The six types of pain quality described were pain as pressure, pain as tender or sore, pain as stabbing, pain as throbbing, pain as jarring, and pain as itching. The second was a description of how post-craniotomy patients experience the management of their pain during the post-surgical period. The four groups of types of pain management experiences described were pain-as-non-salient, routine pain management; pain-as-non-salient, complex pain management; pain-as-salient, routine pain management; and pain-as-salient, complex pain management.

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第24142号 / 人健博第105号 / 新制||人健||7(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 青山 朋樹, 教授 黒木 裕士, 教授 小林 恭 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

UA Open Access Publishing Fund / Titanium craniofacial hardware has become commonplace for reconstruction and bone flap fixation following craniotomy. Complications of titanium hardware include palpability, visibility, infection, exposure, pain, and hardware malfunction, which can necessitate hardware removal. We describe three patients who underwent craniofacial reconstruction following craniotomies for trauma with post-operative courses complicated by medically intractable facial pain. All three patients subsequently underwent removal of the symptomatic craniofacial titanium hardware and experienced rapid resolution of their painful parasthesias. Symptomatic plates were found in the region of the frontozygomatic suture or MacCarty keyhole, or in close proximity with the supraorbital nerve. Titanium plates, though relatively safe and low profile, can cause local nerve irritation or neuropathy. Surgeons should be cognizant of the potential complications of titanium craniofacial hardware and locations that are at higher risk for becoming symptomatic necessitating a second surgery for removal.