Tratamentos cirúrgicos de hematomas subdurais crônicos sintomáticos: revisão sistemática
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5498434 http://repositorio.unifesp.br/handle/11600/50175 |
Resumo: | Background: Chronic subdural hematomas (CSDHs) are common neurosurgical conditions among elderly patients. Objective: To perform a detailed critical appraisal of all randomized controlled trials (RCTs) of surgical treatments for chronic subdural hematomas and to quantify their intervention effects. Methods: We performed a broad search for all RCTs with no language or date restrictions, asked the authors for missing data, and applied the Cochrane methods. Results: A total of 24 RCTs involved 1900 patients and 15 comparisons. All outcomes of practical interest were analyzed. Postoperative drainage after burr-hole evacuation reduced the rate of recurrence (risk ratio 0.48, 95% confidence interval 0.34¿0.66, P < 0.00001) with no other clear benefits or complications. Conclusions: This comprehensive, best evidence¿based, quantitative, systematic review indicates that the use of a closed system drainage after burr-hole evacuation reduces the rate of recurrences but has no other significant differences. The findings also suggest that: (1) treatment with twist drills is equivalent to that with burr holes; (2) the postoperative bed header in the elevated position might reduce the length of hospital stay; (3) irrigation of the subdural space with thrombin solution in patients with high risk of recurrence might reduce this risk; and (4) treatment with twist drill followed by a closed system drainage during 48 hours, instead of 96 hours, might reduce general complication rates. Most of the trials suffered from unclear or high risks of bias and many involved small samples, precluding strong and definitive conclusions. |
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Ivamoto, Henrique Seiji [UNIFESP]Universidade Federal de São Paulo (UNIFESP)http://lattes.cnpq.br/6072512724890908http://lattes.cnpq.br/8461078281290598http://lattes.cnpq.br/1660567108692016Atallah, Alvaro Nagib [UNIFESP]Lemos Júnior, Hernani Pinto [UNIFESP]São Paulo2019-06-19T14:57:33Z2019-06-19T14:57:33Z2017-03-31https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5498434http://repositorio.unifesp.br/handle/11600/50175Background: Chronic subdural hematomas (CSDHs) are common neurosurgical conditions among elderly patients. Objective: To perform a detailed critical appraisal of all randomized controlled trials (RCTs) of surgical treatments for chronic subdural hematomas and to quantify their intervention effects. Methods: We performed a broad search for all RCTs with no language or date restrictions, asked the authors for missing data, and applied the Cochrane methods. Results: A total of 24 RCTs involved 1900 patients and 15 comparisons. All outcomes of practical interest were analyzed. Postoperative drainage after burr-hole evacuation reduced the rate of recurrence (risk ratio 0.48, 95% confidence interval 0.34¿0.66, P < 0.00001) with no other clear benefits or complications. Conclusions: This comprehensive, best evidence¿based, quantitative, systematic review indicates that the use of a closed system drainage after burr-hole evacuation reduces the rate of recurrences but has no other significant differences. The findings also suggest that: (1) treatment with twist drills is equivalent to that with burr holes; (2) the postoperative bed header in the elevated position might reduce the length of hospital stay; (3) irrigation of the subdural space with thrombin solution in patients with high risk of recurrence might reduce this risk; and (4) treatment with twist drill followed by a closed system drainage during 48 hours, instead of 96 hours, might reduce general complication rates. Most of the trials suffered from unclear or high risks of bias and many involved small samples, precluding strong and definitive conclusions.Dados abertos - Sucupira - Teses e dissertações (2017)68 f.porUniversidade Federal de São Paulo (UNIFESP)Hematoma subdural crônicoPratica clinica em evidênciasFitoterapiaExtratos VegetaisEfeitos colateraisProcedimentos cirúrgicos operatóriosRevisãoOperative surgical proceduresReviewHematoma, subdural, chronicEvidence-based practicePhytotherapyPlant extractsTratamentos cirúrgicos de hematomas subdurais crônicos sintomáticos: revisão sistemáticaSurgical treatments for symptomatic chronic subdural hematomas: systematic reviewinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESPEscola Paulista de Medicina (EPM)Saúde Baseada em EvidênciasClínica Médica e Medicina InternaMetodologia Para a Aplicação da Medicina Baseada em EvidênciasORIGINALTese Henrique Seiji Ivamoto PDF A.pdfTese Henrique Seiji Ivamoto PDF A.pdfTese de doutoradoapplication/pdf9357514${dspace.ui.url}/bitstream/11600/50175/1/Tese%20Henrique%20Seiji%20Ivamoto%20PDF%20A.pdf461779a3fe027ee2f0656741107172ccMD51open access11600/501752023-06-28 11:00:09.238open accessoai:repositorio.unifesp.br:11600/50175Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestopendoar:34652023-06-28T14:00:09Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.pt_BR.fl_str_mv |
Tratamentos cirúrgicos de hematomas subdurais crônicos sintomáticos: revisão sistemática |
dc.title.alternative.en.fl_str_mv |
Surgical treatments for symptomatic chronic subdural hematomas: systematic review |
title |
Tratamentos cirúrgicos de hematomas subdurais crônicos sintomáticos: revisão sistemática |
spellingShingle |
Tratamentos cirúrgicos de hematomas subdurais crônicos sintomáticos: revisão sistemática Ivamoto, Henrique Seiji [UNIFESP] Hematoma subdural crônico Pratica clinica em evidências Fitoterapia Extratos Vegetais Efeitos colaterais Procedimentos cirúrgicos operatórios Revisão Operative surgical procedures Review Hematoma, subdural, chronic Evidence-based practice Phytotherapy Plant extracts |
title_short |
Tratamentos cirúrgicos de hematomas subdurais crônicos sintomáticos: revisão sistemática |
title_full |
Tratamentos cirúrgicos de hematomas subdurais crônicos sintomáticos: revisão sistemática |
title_fullStr |
Tratamentos cirúrgicos de hematomas subdurais crônicos sintomáticos: revisão sistemática |
title_full_unstemmed |
Tratamentos cirúrgicos de hematomas subdurais crônicos sintomáticos: revisão sistemática |
title_sort |
Tratamentos cirúrgicos de hematomas subdurais crônicos sintomáticos: revisão sistemática |
author |
Ivamoto, Henrique Seiji [UNIFESP] |
author_facet |
Ivamoto, Henrique Seiji [UNIFESP] |
author_role |
author |
dc.contributor.institution.pt_BR.fl_str_mv |
Universidade Federal de São Paulo (UNIFESP) |
dc.contributor.authorLattes.none.fl_str_mv |
http://lattes.cnpq.br/6072512724890908 |
dc.contributor.advisorLattes.none.fl_str_mv |
http://lattes.cnpq.br/8461078281290598 |
dc.contributor.advisor-coLattes.none.fl_str_mv |
http://lattes.cnpq.br/1660567108692016 |
dc.contributor.author.fl_str_mv |
Ivamoto, Henrique Seiji [UNIFESP] |
dc.contributor.advisor1.fl_str_mv |
Atallah, Alvaro Nagib [UNIFESP] |
dc.contributor.advisor-co1.fl_str_mv |
Lemos Júnior, Hernani Pinto [UNIFESP] |
contributor_str_mv |
Atallah, Alvaro Nagib [UNIFESP] Lemos Júnior, Hernani Pinto [UNIFESP] |
dc.subject.por.fl_str_mv |
Hematoma subdural crônico Pratica clinica em evidências Fitoterapia Extratos Vegetais Efeitos colaterais Procedimentos cirúrgicos operatórios Revisão |
topic |
Hematoma subdural crônico Pratica clinica em evidências Fitoterapia Extratos Vegetais Efeitos colaterais Procedimentos cirúrgicos operatórios Revisão Operative surgical procedures Review Hematoma, subdural, chronic Evidence-based practice Phytotherapy Plant extracts |
dc.subject.eng.fl_str_mv |
Operative surgical procedures Review Hematoma, subdural, chronic Evidence-based practice Phytotherapy Plant extracts |
description |
Background: Chronic subdural hematomas (CSDHs) are common neurosurgical conditions among elderly patients. Objective: To perform a detailed critical appraisal of all randomized controlled trials (RCTs) of surgical treatments for chronic subdural hematomas and to quantify their intervention effects. Methods: We performed a broad search for all RCTs with no language or date restrictions, asked the authors for missing data, and applied the Cochrane methods. Results: A total of 24 RCTs involved 1900 patients and 15 comparisons. All outcomes of practical interest were analyzed. Postoperative drainage after burr-hole evacuation reduced the rate of recurrence (risk ratio 0.48, 95% confidence interval 0.34¿0.66, P < 0.00001) with no other clear benefits or complications. Conclusions: This comprehensive, best evidence¿based, quantitative, systematic review indicates that the use of a closed system drainage after burr-hole evacuation reduces the rate of recurrences but has no other significant differences. The findings also suggest that: (1) treatment with twist drills is equivalent to that with burr holes; (2) the postoperative bed header in the elevated position might reduce the length of hospital stay; (3) irrigation of the subdural space with thrombin solution in patients with high risk of recurrence might reduce this risk; and (4) treatment with twist drill followed by a closed system drainage during 48 hours, instead of 96 hours, might reduce general complication rates. Most of the trials suffered from unclear or high risks of bias and many involved small samples, precluding strong and definitive conclusions. |
publishDate |
2017 |
dc.date.issued.fl_str_mv |
2017-03-31 |
dc.date.accessioned.fl_str_mv |
2019-06-19T14:57:33Z |
dc.date.available.fl_str_mv |
2019-06-19T14:57:33Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
format |
doctoralThesis |
status_str |
publishedVersion |
dc.identifier.pt_BR.fl_str_mv |
https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5498434 |
dc.identifier.uri.fl_str_mv |
http://repositorio.unifesp.br/handle/11600/50175 |
url |
https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5498434 http://repositorio.unifesp.br/handle/11600/50175 |
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por |
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por |
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openAccess |
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68 f. |
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São Paulo |
dc.publisher.none.fl_str_mv |
Universidade Federal de São Paulo (UNIFESP) |
publisher.none.fl_str_mv |
Universidade Federal de São Paulo (UNIFESP) |
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