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  • Outpatient minimally invasive surgery for Incidental Aneurysms: Is it safe?. Preliminary report.

    Final Number:

    Mauricio Mandel MD; Eberval G. Figueiredo MD, PhD; Manoel Jacobsen Teixeira

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Minimally Invasive Neurosurgery is already a reality in many centers in the world . This is a broad and relative concept. We demonstraste preliminar results of the first clinical trial in Brazil questioning the safety of the of minimally invasive surgery to treat incidental cerebral aneurysms of the anterior circulation. The trial is also focused in the determination of ideal time of hospital stay.

    Methods: Patients undergoing neurosurgery were divided in two groups. In the study group patients were submitted to a minimally invasive approach (transpalpebral mini fronto-orbital craniotomy or modified minipterional craniotomy). All patients in this group were submitted to surgery starting at 8 o'clock in the morning. After 6 hours of the end of surgery, all patients underwent control CT scan and if the result was adequate, they were discharged from the ICU with no IV drugs. The hospital discharge occurred in the next day. The control group was patients that underwent classical pterional craniotomy with hospital discharge occurring in 5 days.

    Results: To date, 42 patients were enrolled in the clinical trial. 26 patients were allocated to the study group (15 patients underwent transpalpebral access and 11 minipterional modified), and 16 in the control group. With a mean follow up of 6 months, no patient presented severe severe neurological/ clinical complication although 2 patients in the control group and 1 in the study group have shown ischemic infarcts on initial CT scan, with motor deficits which reversed during the postoperative course. Regarding the safety of early discharge, only 1 patient could not be discharged on the next day. So far we did not observe significant statistical difference between groups surgical/ outcome results.

    Conclusions: Minimally invasive approaches appear to be safe when compared with classic ones. Through the study protocol we can infer that outpatient surgery for incidental aneurysms is not in a too distant future.

    Patient Care: Demonstrating that minimally invasive approaches are safe and can lower hospital stay.

    Learning Objectives: For countries like Brazil, the indirect demonstration of reduction in hospital costs through lower hospital stays is a breakthrough to provide better health for the entire population.


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