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Boccuni L, Roca-Ventura A, Buloz-Osorio E, Leno-Colorado D, Delgado-Gallén S, Cabello-Toscano M, Perellón-Alfonso R, Villalba-Martínez G, Martínez-Ricarte F, Martín-Fernández J, Buxeda-Rodriguez M, Conesa-Bertrán G, Illueca-Moreno M, Lladó-Carbó E, Perla Y Perla C, Garrido C, Pariente JC, Laredo C, Muñoz-Moreno E, Bargalló N, Trompetto C, Marinelli L, Bartrés-Faz D, Abellaneda-Pérez K, Pascual-Leone A, Tormos-Muñoz JM. Non-invasive prehabilitation to foster widespread fMRI cortical reorganization before brain tumor surgery: lessons from a case series. J Neurooncol 2024; 170:185-198. [PMID: 39044115 DOI: 10.1007/s11060-024-04774-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/08/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE The objective of this prospective, single-centre case series was to investigate feasibility, clinical outcomes, and neural correlates of non-invasive Neuromodulation-Induced Cortical Prehabilitation (NICP) before brain tumor surgery. Previous studies have shown that gross total resection is paramount to increase life expectancy but is counterbalanced by the need of preserving critical functional areas. NICP aims at expanding functional margins for extensive tumor resection without functional sequelae. Invasive NICP (intracranial neuromodulation) was effective but characterized by elevated costs and high rate of adverse events. Non-invasive NICP (transcranial neuromodulation) may represent a more feasible alternative. Nonetheless, up to this point, non-invasive NICP has been examined in only two case reports, yielding inconclusive findings. METHODS Treatment sessions consisted of non-invasive neuromodulation, to transiently deactivate critical areas adjacent to the lesion, coupled with intensive functional training, to activate alternative nodes within the same functional network. Patients were evaluated pre-NICP, post-NICP, and at follow-up post-surgery. RESULTS Ten patients performed the intervention. Feasibility criteria were met (retention, adherence, safety, and patient's satisfaction). Clinical outcomes showed overall stability and improvements in motor and executive function from pre- to post-NICP, and at follow-up. Relevant plasticity changes (increase in the distance between tumor and critical area) were observed when the neuromodulation target was guided by functional neuroimaging data. CONCLUSION This is the first case series demonstrating feasibility of non-invasive NICP. Neural correlates indicate that neuroimaging-guided target selection may represent a valid strategy to leverage neuroplastic changes before neurosurgery. Further investigations are needed to confirm such preliminary findings.
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Affiliation(s)
- Leonardo Boccuni
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
| | - Alba Roca-Ventura
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - Edgar Buloz-Osorio
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - David Leno-Colorado
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Selma Delgado-Gallén
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - María Cabello-Toscano
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ruben Perellón-Alfonso
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gloria Villalba-Martínez
- Department of Neurosurgery, Hospital del Mar, Barcelona, Spain
- Systems Neurologic and Neurotherapeutic Group at Research Institute Hospital del Mar, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Jesús Martín-Fernández
- Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier, France
- Department of Neurosurgery, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
- Universidad de La Laguna, Tenerife, Spain
| | | | | | | | | | | | - César Garrido
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Magnetic Resonance Image Core Facility (IDIBAPS), Barcelona, Spain
- Neuroradiology Section, Radiology Department, Diagnostic Image Centre, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - José Carlos Pariente
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Magnetic Resonance Image Core Facility (IDIBAPS), Barcelona, Spain
| | - Carlos Laredo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Magnetic Resonance Image Core Facility (IDIBAPS), Barcelona, Spain
| | - Emma Muñoz-Moreno
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Magnetic Resonance Image Core Facility (IDIBAPS), Barcelona, Spain
| | - Núria Bargalló
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Magnetic Resonance Image Core Facility (IDIBAPS), Barcelona, Spain
- Neuroradiology Section, Radiology Department, Diagnostic Image Centre, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - David Bartrés-Faz
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Kilian Abellaneda-Pérez
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain.
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Alvaro Pascual-Leone
- Wolk Center for Memory Health and Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Josep María Tormos-Muñoz
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.
- Centro de Investigación Traslacional San Alberto Magno, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.
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Sharma A, Song R, Sarmey N, Harasimchuk S, Bulacio J, Pucci F, Rammo R, Bingaman W, Serletis D. Validation and Safety Profile of a Novel, Noninvasive Fiducial Attachment for Stereotactic Robotic-Guided Stereoelectroencephalography: A Case Series. Oper Neurosurg (Hagerstown) 2024; 27:440-448. [PMID: 38651866 DOI: 10.1227/ons.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/06/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES We developed, tested, and validated a novel, noninvasive, Leksell G frame-based fiducial attachment, for use in stereotactic registration for stereoelectroencephalography (sEEG). Use of the device increased the number of fixed reference points available for registration, while obviating the need for additional scalp incisions. We report here on our experience and safety profile of using the device. METHODS We collected registration data using the fiducial device across 25 adult and pediatric patients with epilepsy consecutively undergoing robotic-guided sEEG for invasive epilepsy monitoring, treated between May 2022 and July 2023. ROSA One Brain was used for trajectory planning and electrode implantation. Postoperative clinical and radiographic data were computed and quantified, including mean registration error for all patients. Entry point, target point (TP), and angular errors were measured. Descriptive statistics and correlation coefficients for error were calculated. RESULTS Twenty-five patients underwent robotic-guided sEEG implantation (11 patients, bilateral; 10 patients, left unilateral; 4 patients, right). The mean number of electrodes per patient was 18 ± 3. The average mean registration error was 0.77 ± 0.11 mm. All patients were implanted with Ad-Tech depth electrodes. No clinically relevant complications were reported. Analysis of trajectory error was performed on 446 electrodes. The median entry point error was 1.03 mm (IQR 0.69-1.54). The median TP error was 2.26 mm (IQR 1.63-2.93). The mean angular error was 0.03 radians (IQR 0.02-0.05). There was no significant correlation between root mean square error and lead error. Root mean square error did not appreciably change over time, nor were there any significant changes in average angular, entry point, or TP error metrics. CONCLUSION A novel, noninvasive, Leksell G frame-based fiducial attachment was developed, tested, and validated, facilitating O-arm-based stereotactic registration for sEEG. This simple innovation maintained an excellent accuracy and safety profile for sEEG procedures in epilepsy patients, with the added advantages of providing additional reference points for stereotactic registration, without requiring additional scalp incisions.
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Affiliation(s)
- Akshay Sharma
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland , Ohio , USA
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland , Ohio , USA
| | - Ryan Song
- Lerner College of Medicine of Case Western Reserve University, Cleveland , Ohio , USA
| | - Nehaw Sarmey
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland , Ohio , USA
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland , Ohio , USA
| | - Stephen Harasimchuk
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland , Ohio , USA
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland , Ohio , USA
| | - Juan Bulacio
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland , Ohio , USA
| | - Francesco Pucci
- Department of Neurosurgery, University of Illinois, Chicago, Chicago , Illinois , USA
| | - Richard Rammo
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland , Ohio , USA
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland , Ohio , USA
| | - William Bingaman
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland , Ohio , USA
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland , Ohio , USA
- Lerner College of Medicine of Case Western Reserve University, Cleveland , Ohio , USA
| | - Demitre Serletis
- Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland , Ohio , USA
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland , Ohio , USA
- Lerner College of Medicine of Case Western Reserve University, Cleveland , Ohio , USA
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Gao F, Xie Q, Ran X, Zhao X, Yang M, Jiang K, Mao T, Yang J, Li K, Wu H. Use of indocyanine green-human serum albumin complexes in fluorescence image-guided laparoscopic anatomical liver resection: a case series study (with video). Surg Endosc 2024:10.1007/s00464-024-11295-8. [PMID: 39342539 DOI: 10.1007/s00464-024-11295-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 09/13/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND This study aimed to investigate the feasibility and efficacy of near-infrared fluorescence-guided laparoscopic anatomical hepatectomy (LAH) using a novel indocyanine green (ICG)-human serum albumin complex (HSA) in patients with hepatocellular carcinoma. METHODS Clinical data of hepatocellular carcinoma patients who underwent ICG-HSA fluorescence-guided LAH at our center from January 2024 to April 2024 were prospectively collected and analyzed. Ultraviolet absorption spectroscopy was used to test the absorption and stability of ICG-HSA complex solutions under different conditions. After determining the optimal ratio, the complex was administered intravenously during surgery to perform negative staining via Glissonean pedicle isolation. LAH was performed along the fluorescence-demarcated boundaries. RESULTS Thirty-one patients were included (24 men; mean age, 54.61 ± 13.54 years). The median maximum tumor diameter was 2.80 (interquartile range [IQR], 2.00-4.00) cm. S8 segmentectomy (22.6%) and right posterior segmentectomy (19.4%) were the most common resections performed. Successful fluorescence negative staining was achieved in all patients using ICG and HSA at a 1:6 molar ratio at room temperature. Mean operation time was 297.58 ± 85.53 min, Median intraoperative blood loss was 100.0 mL (IQR, 50.0-200.0). The median surgical margin distance was 0.90 cm (IQR, 0.40-1.50). The postoperative complication rate was 45.2% (35.5% Clavien-Dindo grade I and 9.7% grade II). The median length of hospital stay was 5.0 days (IQR, 4.0-5.0). CONCLUSION ICG-HSA-assisted LAH is safe and feasible. Compared with free ICG, the novel ICG-HSA complex exhibits better optical properties and in vivo stability, which can improve the accuracy of intraoperative liver segment localization and optimize the anatomical dissection plane. It has the potential to become an ideal fluorescent imaging agent for anatomical hepatectomy.
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Affiliation(s)
- Fengwei Gao
- Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, 37 Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Qingyun Xie
- Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, 37 Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Xiaoyun Ran
- Key Laboratory of Green Chemistry and Technology of Ministry of Education, College of Chemistry, Sichuan University, Chengdu, 61064, Sichuan, China
| | - Xin Zhao
- Department of Hepato-Pancreato-Biliary Surgery, People's Hospital of Leshan, Leshan, 614000, China
| | - Manyu Yang
- Department of Hepato-Pancreato-Biliary Surgery, People's Hospital of Leshan, Leshan, 614000, China
| | - Kangyi Jiang
- Department of Hepato-Pancreato-Biliary Surgery, People's Hospital of Leshan, Leshan, 614000, China
| | - Tianyang Mao
- Department of Hepato-Pancreato-Biliary Surgery, People's Hospital of Leshan, Leshan, 614000, China
| | - Jiayin Yang
- Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, 37 Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Kun Li
- Key Laboratory of Green Chemistry and Technology of Ministry of Education, College of Chemistry, Sichuan University, Chengdu, 61064, Sichuan, China
| | - Hong Wu
- Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, 37 Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China.
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Lin J, Cai Y, Wang H, Liang X, Xu W, Zhou Q, Xie S, Qi S, Wang C, Zhang X. The Relationship Between Jugular Foramen Schwannoma and Surrounding Membrane Structures and Its Surgical Application. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01351. [PMID: 39329511 DOI: 10.1227/ons.0000000000001357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 07/23/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Surgical resection of jugular foramen (JF) schwannomas with minimal neurological complications is challenging because of their difficult-to-access location and complex relationships with surrounding neurovascular structures, even for experienced neurosurgeons. In this article, we elucidate the membranous anatomy of JF schwannomas, with the aim of reducing iatrogenic injury to the lower cranial nerves (LCNs) during surgery. METHODS The clinical data of 31 consecutive patients with JF schwannomas were reviewed. The relationship between the tumor and the surrounding membranous structures was observed during dissection. Samples were analyzed using Masson's trichrome and immunofluorescence staining to study the membranous characteristics. Histological-radiographic correlations were also summarized. RESULTS In this series, we found that all 3 type B, 2 type C, and 8 type D tumors (according to the Kaye-Pellet grading system) were entirely extradural in location, whereas the 18 type A tumors could be subdural (9 cases) or extradural (9 cases), which frequently could not be predicted preoperatively based on whether the tumor had intraforaminal extension. The dural capsule, when present, could be used as an insulating layer to protect LCNs. With this subcapsular dissection technique, postoperative LCN dysfunction occurred in 10 patients (32.3%), which was usually temporary and mild. CONCLUSION The different relationships between the tumor and membranous structures of the JF is related to the distinct point of tumor origin and the complex anatomy of the meningeal dura within the JF. Subcapsular dissection technique is recommended for better preservation of LCNs when the dural capsule is identified.
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Affiliation(s)
- Jie Lin
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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Santiago PH, Tavares MG, Grillo R. Personalized Rehabilitation of Atrophic Customized Subperiosteal Implants. J Craniofac Surg 2024:00001665-990000000-01972. [PMID: 39325079 DOI: 10.1097/scs.0000000000010681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 08/25/2024] [Indexed: 09/27/2024] Open
Abstract
Severe maxillary atrophy and edentulism can pose a range of challenges in implant planning and oral rehabilitation. Modern dentistry has allowed for a review of the concepts and surgical protocols of subperiosteal implants, presenting them as a solution for the rehabilitation of atrophic maxillary and mandibular bone deficiencies. This study aims to address a series of 3 patients with severe maxillary atrophy, as evidenced by presurgical and postsurgical radiographic images, as well as computer-assisted planning and analysis of patient anatomy for rehabilitation with custom sintered subperiosteal implants. Promising results these clinical cases, highlighting the precise technique, biocompatibility, and durability of these materials. The absence of postoperative complications was evident, with high success rates in procedures and patient reports. Importantly, periodic follow-up is needed to assess the longevity and effectiveness of the technique used.
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Affiliation(s)
- Pedro H Santiago
- Department of Oral and Maxillofacial Surgery, Planalto Central Faculty, Brasília-DF
- Private Practice in Oral and Maxillofacial Surgery, Recife-PE, Brazil
| | - Marconi G Tavares
- Department of Oral and Maxillofacial Surgery, Planalto Central Faculty, Brasília-DF
| | - Ricardo Grillo
- Department of Oral and Maxillofacial Surgery, Planalto Central Faculty, Brasília-DF
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Lefevre E, Alciato L, Caudron Y, Jacquens A, Nguyen Y, Sterkers O, Kalamarides M. Vestibular schwannoma surgery in the ninth decade of life: a case series. Acta Neurochir (Wien) 2024; 166:379. [PMID: 39317814 DOI: 10.1007/s00701-024-06285-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 09/22/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND AND PURPOSE Large symptomatic Vestibular Schwannoma (VS) often requires surgical resection, regardless the patient's age. The aim of this study was to assess the surgical outcomes of patients in their ninth decade of life. METHODS This monocenter retrospective observational study included patients aged 80 years or older who underwent VS surgery between 2009 and 2020. We retrospectively analyzed their immediate post-surgical and long-term outcomes and complications. RESULTS Thirteen octogenarians who underwent VS surgery were included, with average age of 83.2 ± 1.97 years old (median 83.5, range 80-86 years). One patient had a Koos-Grade II tumor, and 12 patients had a grade IV. All patients had a preoperative ASA score ≤ 3 and underwent surgery in the supine position. Twelve patients underwent a pre-planned partial resection (PR) and one had a gross-total resection (GTR). Good facial function (House-Brackmann grade ≤ 2) was achieved in 10 patients (77%). We reported three Clavien-Dindo grade ≤ 3 treatment-related complications and no life-threatening complication. Two patients experienced tumor recurrence after PR. CONCLUSION In this series of patients who underwent VS surgery in their ninth decade of life, surgical outcomes were acceptable. Therefore, age alone should not serve as a contraindication for surgery. Preplanned PR is a reasonable attitude in elderly patients.
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Affiliation(s)
- Etienne Lefevre
- Department of Neurosurgery, APHP, Hôpital de La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'hôpital, 75013, Paris, France.
- Sorbonne Université, Paris, France.
| | - Lauranne Alciato
- Department of ENT, APHP, Hôpital de La Pitié-Salpêtrière, Paris, France
- Sorbonne Université, Paris, France
| | - Yohan Caudron
- Department of Neurosurgery, APHP, Hôpital de La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'hôpital, 75013, Paris, France
| | - Alice Jacquens
- Sorbonne Université, Paris, France
- Department of Anesthesia and Intensive Care, APHP, DMU DREAM, Pitié-Salpêtrière Hospital, Paris, France
| | - Yann Nguyen
- Department of ENT, APHP, Hôpital de La Pitié-Salpêtrière, Paris, France
- Sorbonne Université, Paris, France
| | - Olivier Sterkers
- Department of ENT, APHP, Hôpital de La Pitié-Salpêtrière, Paris, France
- Sorbonne Université, Paris, France
| | - Michel Kalamarides
- Department of Neurosurgery, APHP, Hôpital de La Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'hôpital, 75013, Paris, France
- Sorbonne Université, Paris, France
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7
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Izzo A, Bove F, D'Alessandris QG, Genovese D, Tufo T, D'Ercole M, Pennisi G, Figà F, Obersnel M, Perotti V, Fuggetta MF, Bentivoglio AR, Calabresi P, Olivi A, Piano C, Montano N. Risk factors and significance of post-operative edema in Parkinson Disease patients submitted to deep brain stimulation. A ten-year case series. Neurol Sci 2024:10.1007/s10072-024-07774-4. [PMID: 39294408 DOI: 10.1007/s10072-024-07774-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Accepted: 09/10/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND Peri-electrode edema after deep brain stimulation (DBS) surgery for Parkinson Disease (PD) has been reported in up to 100% of cases. The clinical significance of this finding is unclear, with most papers suggesting a benign course. The risk factors are also poorly defined. We aimed at defining the incidence rate, the clinical significance and the predictive factors of peri-electrode edema in patients undergoing DBS for PD. METHODS We reviewed data of 119 patients treated with frameless stereotactic DBS for PD between 2012 and 2022 at our Institution. A mixed-technique targeting was adopted. Awake surgery was used in 64.7% cases; in most cases, microelectrode recording (MER) was adopted. The target was the subthalamic nucleus (STN) in 91.2% cases. RESULTS Ninety patients were included. Postoperative edema related to lead placement was noticed in 40% patients after a median time of 2 days since surgery; in 88.9% of these cases, it was limited to subcortical white matter. Symptomatic edema was registered only in one case (1.1%), confirming previous reports on the benign clinical course. The only independent predictive factor for edema onset was asleep surgery (p = 0.0451). Notably, the use of directional electrodes was not associated with an increased risk of edema at multivariable analysis. Clinical parameters including age, and timing of CT scanning, did not affect edema onset. CONCLUSIONS We confirmed the very low rate of symptomatic edema in DBS for PD. When feasible, awake DBS using MER is the ideal technique to reduce the risk of radiologic postoperative edema.
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Affiliation(s)
- Alessandro Izzo
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Bove
- Department of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Quintino Giorgio D'Alessandris
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, Rome, 00168, Italy.
| | - Danilo Genovese
- Department of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Tommaso Tufo
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Manuela D'Ercole
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Pennisi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, Rome, 00168, Italy
| | - Federica Figà
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, Rome, 00168, Italy
| | - Marco Obersnel
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, Rome, 00168, Italy
| | - Valerio Perotti
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, Rome, 00168, Italy
- Department of Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Filomena Fuggetta
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anna Rita Bentivoglio
- Department of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, Rome, 00168, Italy
| | - Paolo Calabresi
- Department of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, Rome, 00168, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, Rome, 00168, Italy
| | - Carla Piano
- Department of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, Rome, 00168, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, Rome, 00168, Italy
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Steele CM, Burdick RJ, Dallal-York J, Shapira-Galitz Y, Abrams SW. EQUATOR Network Mapping Review for Dysphagia Research. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:2207-2219. [PMID: 39151057 DOI: 10.1044/2023_ajslp-23-00306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
PURPOSE The EQUATOR Network is an international initiative aimed at improving published health research through use of reporting guidelines. We conducted a review to determine the extent to which EQUATOR Network guidelines contain recommendations relevant for dysphagia research in human subjects. METHOD We downloaded all 542 EQUATOR Network guidelines on November 8, 2022. Each guideline was reviewed by two independent raters and judged for relevance to dysphagia and related fields (e.g., otolaryngology, gastroenterology). Dysphagia-relevant guidelines pertaining to quantitative human subjects research were further inspected to identify reporting guidance regarding (a) general research elements (e.g., data collection, statistical methods), (b) participant characteristics (e.g., demographics, accrual, randomization), (c) screening and clinical/noninstrumental assessments, (d) videofluoroscopic examinations, (e) flexible endoscopic examinations, (f) other instrumentation in swallowing research, (g) dysphagia treatment, (h) patient-/care provider-reported outcome measures, and (i) any other narrowly specified focus relevant for research on swallowing. Discrepancies were resolved by consensus. RESULTS Of 542 guidelines, 156 addressed quantitative research in human subjects relevant to dysphagia. Of these, 104 addressed general research elements and 108 addressed participant characteristics. Only 14 guidelines partially addressed the other topics of interest, and none addressed elements relevant to reporting videofluoroscopic or endoscopic assessments of swallowing. CONCLUSIONS We were unable to find guidelines with specific relevance to reporting key methods in dysphagia research. This lack of guidance illustrates a gap that hinders the critical appraisal of research quality in the field of dysphagia. Our review highlights the need to develop dysphagia-specific tools for critical appraisal and guidance regarding adequate research reporting. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25014017.
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Affiliation(s)
- Catriona M Steele
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Canada Research Chair in Swallowing and Food Oral Processing, Canada Research Chairs Secretariat, Ottawa, Ontario, Canada
| | - Ryan J Burdick
- Swallowing and Salivary Bioscience Lab, Department of Medicine, Division of Geriatrics and Gerontology, Department of Communication Sciences and Disorders, University of Wisconsin-Madison
| | - Justine Dallal-York
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Yael Shapira-Galitz
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
- Hadassah School of Medicine, Hebrew University of Jerusalem, Israel
| | - Sophia Werden Abrams
- Aging Swallow Research Laboratory, School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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Lenga P, Kühlwein D, Grutza M, Issa M, Hinz F, Sahm F, Selt F, Milde T, Günther P, Unterberg AW, Krieg SM, Damaty AE. Decoding pediatric spinal tumors: a single-center retrospective case series on etiology, presentation, therapeutic strategies, and outcomes. Neurosurg Rev 2024; 47:557. [PMID: 39240372 PMCID: PMC11379767 DOI: 10.1007/s10143-024-02770-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 08/20/2024] [Accepted: 08/27/2024] [Indexed: 09/07/2024]
Abstract
INTRODUCTION Spinal tumors (ST) often result in dire prognosis, carrying risks such as permanent paralysis, sensory loss, and sphincter dysfunction. Data on their incidence and etiology in pediatric populations are markedly scant. Our study investigates the etiology, clinical manifestation, treatment, and outcomes of pediatric ST. METHODS We conducted a retrospective review of our institutional pediatric oncology and neurosurgery database, examining 14 patients under 18 years admitted with ST due to oncological diseases since 2005. We analyzed the clinical presentations, evaluations, molecular diagnostics and treatments for these patients. RESULTS The study spanned 15 years and included 14 pediatric patients, each diagnosed with distinct spinal tumor entity. The mean patient age was approximately 19.6 ± 10.1 months. Severe axial pain along the vertebral column was observed in 13 patients, while acute neurological deterioration manifested in 7 patients. As a first-line intervention, 13 patients underwent decompressive surgery through laminectomy and tumor resection, and only one patient received chemotherapy solely. Before surgery, seven patients were unable to walk; post-surgery, six of them regained their ability to ambulate. The diagnosis encompassed a range of neoplasms: two instances of Ewing sarcoma, 3 instances of teratoma, one case presenting an atypical teratoid Rhabdoid tumor, two instances each of low-grade astrocytoma and neuroblastoma, and single instances of ependymoma, meningioma, rhabdomyosarcoma, and embryonal tumors with multilayered rosettes (ETMRs). Three patients succumbed two years after initiating therapy. CONCLUSION Despite their rarity, intraspinal tumors in pediatric patients pose substantial therapeutic challenges. The intertwined complexities of the disease entity and the patient's neurological status demand swift initiation of an individualized therapeutic strategy. This crucial step helps optimize outcomes for this patient cohort, who frequently grapple with debilitating health conditions. Inclusion of these patients within a registry is mandatory to optimize treatment outcomes due to their rarity in pediatric population.
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Affiliation(s)
- Pavlina Lenga
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
- Department of Neurosurgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Daniel Kühlwein
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Grutza
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Mohammed Issa
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Hinz
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Florian Selt
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Till Milde
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Pediatrics and Adolescent Medicine, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Patrick Günther
- Department of General, Visceral and Transplantation Surgery, Division of Pediatric Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas W Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ahmed El Damaty
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
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Dellaretti M, de Lima FBF, de Sena PHVP, Figueiredo HPG, Albuquerque JPS, Gomes FC, Dias Faria BC, de Almeida JC. Efficacy, safety, and impact of fluorescein in frameless stereotactic needle biopsies - a case series. Neurosurg Rev 2024; 47:523. [PMID: 39223420 DOI: 10.1007/s10143-024-02758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 06/27/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
Stereotactic needle biopsy stands as a crucial method for diagnosing intracranial lesions unsuitable for surgical intervention. Nonetheless, the potential for sampling errors lead to innovative approaches to enhance diagnostic precision. This study contrasts the outcomes of patients undergoing fluorescein-assisted frameless stereotactic needle biopsy with those receiving traditional biopsies to evaluate the impact on diagnostic accuracy and safety. This study included patients with contrast-enhancing intracranial lesions, comprising a prospective group undergoing fluorescein-assisted biopsies and a retrospective group undergoing conventional biopsies at the same institution. We've collected data on demographics, procedural specifics, diagnostic outcomes, and postoperative events. A comparative analysis involved 43 patients who received fluorescein-assisted biopsies against 77 patients who underwent conventional biopsies. The average age was 60.5 years. The fluorescein group exhibited a 93% success rate in diagnosis, markedly higher than the 70.1% in the non-fluorescein group (OR = 5.67; 95%IC: 1.59-20.24; p < 0.01). The rate of complications was statistically similar across both cohorts. Despite its established value, stereotactic needle biopsy is susceptible to inaccuracies and complications. The application of fluorescence-based adjuncts like 5-ALA and fluorescein has been investigated to improve diagnostic fidelity and reduce risks. These technologies potentially minimize the necessity for multiple biopsies, decrease surgical duration, and provide immediate verification of tumor presence. Fluorescein-assisted stereotactic biopsy emerges as an effective, secure alternative to conventional methods.
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Affiliation(s)
- Marcos Dellaretti
- Santa Casa de BH e Faculdade Santa Casa BH, Belo Horizonte, MG, Brasil.
| | | | | | | | | | | | | | - Júlio César de Almeida
- Santa Casa de BH e Faculdade Santa Casa BH, Belo Horizonte, MG, Brasil
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil
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11
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Matano F, Murai Y, Nounaka Y, Higuchi T, Mihara R, Isayama K, Morita A. Experience Using Gentian Violet-Free Dyes for Tissue Visualization. J Neurol Surg A Cent Eur Neurosurg 2024; 85:526-530. [PMID: 37703915 DOI: 10.1055/a-2175-3295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Gentian violet ink is used as a skin marker in various surgical procedures, including neurosurgery. The dye is also used to visualize the edges of blood vessels during bypass surgery. However, gentian violet ink carries the risks of carcinogenicity and venous injury, which causes microvascular thrombosis. In this study, we compare the gentian violet-free dye C.I. Basic Violet 4 (BV4) and gentian violet. The usefulness, in terms of color, and formation of microvascular thrombosis in anastomosis were compared. METHODS We used the gentian violet-free dye in 20 cases involving 3 vascular anastomoses. The bone cutting lines on the bone surface, superior temporal artery, and middle cerebral artery were drawn using BV4 and gentian violet ink. RESULTS The colors of BV4 and gentian violet ink were similar. No thrombus formation was observed at the vascular anastomosis when using BV4. CONCLUSION BV4 can be used similarly to gentian violet ink. No adverse effects such as thrombus formation in microvascular anastomosis were experienced when BV4 was used.
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Affiliation(s)
- Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Yohei Nounaka
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Tadashi Higuchi
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Riku Mihara
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Koshiro Isayama
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
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12
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Rossato A, Miguel MMV, Bonafé ACF, Mathias-Santamaria IF, Nunes MP, Santamaria MP. Treatment of single gingival recessions using biofunctionalized collagen matrix: A case series. Clin Adv Periodontics 2024; 14:180-184. [PMID: 38087882 DOI: 10.1002/cap.10276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/17/2023] [Accepted: 11/27/2023] [Indexed: 09/25/2024]
Abstract
BACKGROUND Connective tissue graft substitutes have been used widely to overcome autogenous graft limitations. Nevertheless, they do not provide comparable results in the treatment of periodontal and peri-implant soft tissue defects. Based on the principles of tissue-engineered materials, injectable platelet-rich fibrin (i-PRF) has been combined with collagen matrices (CMs) to enhance their clinical efficacy. To the best of our knowledge, this is the first case series demonstrating the use of i-PRF for the biofunctionalization of a volume-stable collagen matrix (VCMX) as an adjunct to coronally advanced flap (CAF) to treat single gingival recession (GR) defects. METHODS & RESULTS The study included 10 patients. Bleeding on probing, probing depth, GR height, clinical attachment level, esthetics, and dentin hypersensitivity were evaluated. After 6 months, a significant GR reduction (RecRed: 2.15 ± 0.7 mm; p = 0.005) and percentage of root coverage (% RC) of 81.13% were observed. Additionally, 40% of the sites showed complete root coverage. Gingival thickness increased 0.64 mm. Patient-centered evaluations demonstrated dentin hypersensitivity and esthetics improvements by the end of follow-up. CONCLUSION VCMX biofunctionalized with i-PRF associated with CAF technique showed promising clinical outcomes in the treatment of single RT1 GR defects.
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Affiliation(s)
- Amanda Rossato
- Division of Periodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos - São Paulo, San Francisco, Brazil
| | - Manuela Maria Viana Miguel
- Division of Periodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos - São Paulo, San Francisco, Brazil
| | - Ana Carolina Ferreira Bonafé
- Division of Periodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos - São Paulo, San Francisco, Brazil
| | | | | | - Mauro Pedrine Santamaria
- Division of Periodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos - São Paulo, San Francisco, Brazil
- College of Dentistry - Lexington, University of Kentucky, Lexington, Kentucky, USA
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Kondapavulur S, Scheer JK, Safaee MM, Clark AJ. Completely Minimally Invasive Implant Removal and Transforaminal Lumbar Interbody Fusion for Adjacent Segment Disease: Case Series and Operative Video. Oper Neurosurg (Hagerstown) 2024; 27:322-328. [PMID: 38451097 DOI: 10.1227/ons.0000000000001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/16/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Adjacent segment disease is a relatively common late complication after lumbar fusion. If symptomatic, certain patients require fusion of the degenerated adjacent segment. Currently, there are no posterior completely minimally invasive techniques described for fusion of the adjacent segment above or below a previous fusion. We describe here a novel minimally invasive technique for both implant removal (MIS-IR) and adjacent level transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar stenosis. METHODS Demographic, surgical, and radiographic outcome data were collected for patients with lumbar stenosis and previous lumbar fusion, who were treated with MIS-IR and MIS-TLIF through the same incision. Radiographic outcomes were assessed postoperatively and complications were assessed at the primary end point of 3 months. RESULTS A total of 14 patients (7 female and 7 male), with average age 64.6 years (SD 13.4), were included in this case series. Nine patients had single-level MIS-IR with single-level MIS-TLIF. Three patients had 2-level MIS-IR with single-level MIS-TLIF. Two patients had single-level MIS-IR with 2-level MIS-TLIF. Only 1 patient had a postoperative complication-hematoma requiring same-day evacuation. There were no other complications at the primary end point and no fusion failure at the hardware removal levels to date (average follow-up, 11 months). Average increases in posterior disk height and foraminal height after MIS-TLIF were 4.44, and 2.18 mm, respectively. CONCLUSION Minimally invasive spinal IR can be successfully completed along with adjacent level TLIF through the same incisions, via an all-posterior approach.
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Affiliation(s)
- Sravani Kondapavulur
- Department of Neurological Surgery, University of California, San Francisco, San Francisco , California , USA
| | - Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco, San Francisco , California , USA
| | - Michael M Safaee
- Department of Neurological Surgery, University of Southern California, Los Angeles , California , USA
| | - Aaron J Clark
- Department of Neurological Surgery, University of California, San Francisco, San Francisco , California , USA
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14
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Ivren M, Cherkezov A, Reuss D, Haux D, Herold-Mende C, Mohr A, Krieg SM, Unterberg A, Younsi A. Intracranial angioleiomyoma: a case series of seven patients and review of the literature. J Neurooncol 2024; 169:399-408. [PMID: 38842695 PMCID: PMC11341739 DOI: 10.1007/s11060-024-04734-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 06/01/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE Angioleiomyoma, predominantly arising from the extremities, is a benign soft tissue tumor. Reports on its intracranial location are rare. We assessed clinical, radiological, and pathological features of intracranial angioleiomyoma (iALM) treated at our neurosurgical institution. METHODS We consecutively enrolled all patients with neuropathologically confirmed iALM treated at a single neurosurgical institution between 2013 and 2021. Clinical and imaging data were collected, and histological tissue sections were analyzed. A review of the literature on iALM was conducted. RESULTS Seven patients with iALM (four female) with a median age of 45 years (range: 32-76 years) were identified. In three cases, the lesion was found incidentally. In magnetic resonance imaging (MRI), all tumors were hypo- to isointense on T1-weighted, hyperintense on T2-weighted sequences, and gadolinium-enhancing. A strong FLAIR signal was seen in six patients. Surgery consisted of gross total resection in all cases without perioperative complications. Neuropathological staining was positive for smooth muscle actin (SMA) in all lesions. Mature smooth muscle cells arranged around blood vessels were typically observed. The Ki-67 index was ≤ 3%. The patients were discharged after a median of 6 days (range: 4-9 days). During a median follow-up time of 14 months (range: 4-41 months), no tumor recurrence occurred. In the current literature, 42 additional cases of iALM were identified. CONCLUSION Intracranial angioleiomyoma is a benign soft tissue tumor treated by gross total resection. Tumor morphology and positive staining for SMA lead to the neuropathological diagnosis.
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Affiliation(s)
- Meltem Ivren
- Department of Neurosurgery, Heidelberg University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Asan Cherkezov
- Department of Neuopathology, Heidelberg University, Im Neuenheimer Feld 672, Heidelberg, Germany
| | - David Reuss
- Department of Neuopathology, Heidelberg University, Im Neuenheimer Feld 672, Heidelberg, Germany
| | - Daniel Haux
- Department of Neurosurgery, Heidelberg University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christel Herold-Mende
- Department of Neurosurgery, Heidelberg University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Alexander Mohr
- Department of Neuroradiology, Heidelberg University, Im Neuenheimer Feld 400, Heidelberg, Germany
- Department of Neuroradiology, Klinikum Darmstadt, Grafenstraße 9, Darmstadt, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Heidelberg University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Alexander Younsi
- Department of Neurosurgery, Heidelberg University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Schnurman Z, Fazl A, Feigin AS, Mogilner AY, Pourfar M. Rescue Lead Implantation After Deep Brain Stimulation for Parkinson's Disease: A Single-Center Experience and Case Series. Oper Neurosurg (Hagerstown) 2024; 27:295-302. [PMID: 39145662 DOI: 10.1227/ons.0000000000001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/29/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the well-established efficacy of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's Disease (PD), there remains a subset of patients with only a moderate improvement in symptoms even with appropriate lead placement and optimal programming. In patients with persistent tremor or dyskinesias, one consideration is the addition of a second "rescue lead" to provide dual stimulation to primary and secondary targets to address the refractory component. This study aimed to assess all "rescue lead" cases from our institution and characterize the patients and their outcomes. METHODS Records of all patients with PD treated at our institution between 2005 and 2023 were retrospectively reviewed. Clinical data of all patients treated with a second rescue lead to supplement a positive but inadequate initial DBS response were collected and reviewed. RESULTS Of 670 patients with PD treated at our institution during the study period, 7 were managed with a rescue lead. All 7 were initially treated with STN DBS with a partial improvement in underlying symptoms, had confirmed appropriate lead placement, and underwent thorough programming. Four patients underwent rescue with a globus pallidus interna lead for persistent dyskinesias, all with subsequent improvement in their dyskinesias. Three patients had persistent tremors that were treated with a rescue ventrointermediate thalamus stimulation with subsequent improvement in tremor scores. There were no operative complications, and all patients tolerated dual stimulation. CONCLUSION For a small subset of patients with PD with persistent dyskinesias or tremors after STN DBS despite optimized lead parameters and adequate lead placement, rescue lead placement offers an effective treatment option.
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Affiliation(s)
- Zane Schnurman
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Arash Fazl
- Department of Neurology, Booth Gardner Parkinson's Care Center, EvergreenHealth, Kirkland, Washington
| | - Andrew S Feigin
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Alon Y Mogilner
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Michael Pourfar
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
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Hagstrom R, Nossek E, Rutledge CW, Ponchione E, Suryadevara C, Kremer C, Alcon A, Sharashidze V, Shapiro M, Raz E, Nelson PK, Staffenberg DA, Riina HA. Transpalpebral/Blepharoplasty Incision and Supraorbital Craniotomy for the Treatment of Ethmoidal Dural Arteriovenous Fistulas: A Case Series. Oper Neurosurg (Hagerstown) 2024; 27:303-308. [PMID: 38376155 DOI: 10.1227/ons.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/03/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Inherent complex angioarchitecture associated with ethmoidal dural arteriovenous fistulas (dAVFs) can make endovascular treatment methods challenging. Many surgical approaches are accompanied by unfavorable cosmetic results such as facial scarring. Blepharoplasty incision of the eyelid offers a minimal, well-hidden scar compared with other incision sites while offering the surgeon optimal visualization of pathogenic structures. This case series aims to report an initial assessment of the safety and efficacy of supraorbital craniotomy by blepharoplasty transpalpebral (eyelid) incision for surgical disconnection of ethmoidal dAVFs. METHODS Retrospective chart review was conducted for all patients who underwent blepharoplasty incision and craniotomy for disconnection of ethmoidal dAVFs at our institution between October 2011 and February 2023. Patient charts and follow-up imaging were reviewed to report clinical and angiographic outcomes as well as periprocedural and follow-up complications. RESULTS Complete obliteration and disconnection of ethmoidal dAVF was achieved in all 6 (100%) patients as confirmed by intraoperative angiogram with no resulting morbidity or mortality. Periprocedural complications included one case of transient nasal cerebrospinal fluid leak that was self-limiting and resolved before discharge without intervention. CONCLUSION Surgical treatment for ethmoidal dAVFs, specifically by transpalpebral incision and supraorbital craniotomy, is a safe and effective treatment option and affords the surgeon greater access to the floor of the anterior fossa when necessary. In addition, blepharoplasty incision addressed patient concerns for facial scarring compared with other incision sites by creating a more well-hidden, minimal scar in the natural folds of the eyelid for patients with an eyelid crease.
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Affiliation(s)
- Rory Hagstrom
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Erez Nossek
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Caleb W Rutledge
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | | | - Carter Suryadevara
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Caroline Kremer
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
| | - Andre Alcon
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York , New York , USA
| | - Vera Sharashidze
- Department of Neurology, NYU Langone Health, New York , New York , USA
| | - Maksim Shapiro
- Department of Radiology, NYU Langone Health, New York , New York , USA
| | - Eytan Raz
- Department of Radiology, NYU Langone Health, New York , New York , USA
| | - Peter K Nelson
- Department of Radiology, NYU Langone Health, New York , New York , USA
| | - David A Staffenberg
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York , New York , USA
| | - Howard A Riina
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
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Alser K, Mallah SI, El-Oun YRA, Ghayada M, Sammour AAK, Gilbert M, Fitzgerald S, Shaikh Z, Alser O. Trauma care supported through a global telemedicine initiative during the 2023-24 military assault on the Gaza Strip, occupied Palestinian territory: a case series. Lancet 2024; 404:874-886. [PMID: 39216977 DOI: 10.1016/s0140-6736(24)01170-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/09/2024] [Accepted: 06/03/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Hospitals, patients, and health-care workers are legally protected by international humanitarian law and the Geneva Convention. However, since Oct 7, 2023, the health-care system in the Gaza Strip, occupied Palestinian territory, has been under unprecedented direct military attacks by Israel, with support for patients proving to be challenging for the remaining health-care workers. Peer-to-peer telemedicine holds promise for assisting surgeons in high-risk, low-resource environments, but might be of reduced utility in extremely austere settings. METHODS We present a patient case series of traumatic injuries shared in an international telemedicine group by the surgical team at Nasser Medical Complex, also known as Nasser Hospital, the largest remaining partially functioning hospital in Gaza. WhatsApp (Meta; Menlo Park, CA, USA), a widely available and user-friendly end-to-end encrypted smartphone application, was used to facilitate consultations for weapon-inflicted injuries. All the presented patient cases were shared after obtaining verbal consent from the patients and discussed through a multidisciplinary team approach. The group was developed into a community with more than 15 specialty and injury-oriented subgroups and over 1000 members who joined through non-targeted social media outreach followed by snowball recruitment. Prospective registration and formal ethics approval in Gaza was impossible because the Ministry of Health, including the local Helsinki Committee, had suspended all operations. In June, 2024, we obtained ethics approval from the local Helsinki committee in Gaza. FINDINGS We present 12 select patient case studies from a pool of hundreds of patients admitted to Nasser Hospital between Jan 28 and Feb 12, 2024. Four (33%) of the 12 patients were female and eight (67%) were male, with four patients (33%) being children (younger than 18 years). The age range was between 3 years and 70 years, with a median age of 25 years. Most patients presented with penetrating injuries (11 [92%] of 12), with six patients presenting with wounds secondary to fragment injury, and five patients presenting with wounds due to gunshots. One patient presented with a direct blast injury. The site of reported injuries included head and neck areas (four [33%] of 12), abdomen (four [33%] of 12), chest (three [25%] of 12), pelvis (two [17%] of 12), and limbs (one [8%] of 12). Most patients were lost to follow-up (11 [92%] of 12) and were affected by the invasion of the hospital by the Israeli Defense Forces, which subsequently rendered the hospital non-functional. One patient died following their injury. INTERPRETATION The health-care team at the now non-functioning Nasser Hospital in southern Gaza adapted their allocation and distribution of extremely low resources and relied on smartphones for specialised telemedicine outreach purposes. This enhanced the capability of the medical teams in management of mass casualties of military assaults that few are trained to work in. Nonetheless, the options available to a health-care system that is under-staffed, under-served, and under siege, are extremely constrained, regardless of such telemedicine initiatives. FUNDING None.
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Affiliation(s)
- Khaled Alser
- Department of Surgery, Nasser Hospital, Gaza Strip, occupied Palestinian territory
| | | | - Yehya Rami Abu El-Oun
- Faculty of Medicine, Islamic University of Gaza, Gaza Strip, occupied Palestinian territory
| | - Mohammed Ghayada
- Faculty of Medicine, Islamic University of Gaza, Gaza Strip, occupied Palestinian territory
| | - Abd Al-Karim Sammour
- Faculty of Medicine, Islamic University of Gaza, Gaza Strip, occupied Palestinian territory
| | - Mads Gilbert
- Clinic of Emergency Medicine, The Arctic University of Norway, Tromsø, Norway
| | | | | | - Osaid Alser
- Faculty of Medicine, Islamic University of Gaza, Gaza Strip, occupied Palestinian territory.
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18
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Serioli S, Leonel L, Celda MP, Lanzino G, Keser Z. Dissecting and fusiform aneurysms of the superior cerebellar artery: anatomy, clinical presentation, and treatment outcomes. Neurosurg Rev 2024; 47:516. [PMID: 39214870 DOI: 10.1007/s10143-024-02734-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 08/15/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
The management of superior cerebellar aneurysms is still controversial. Although several techniques are available, the deep localization of the lesion and the limited number of cases increase the complexity of decision-making for optimal treatment. Only a few cases of dissecting and fusiform aneurysms of the superior cerebellar artery (SCA) are described in the literature, many of which are without long follow-ups. The study aims to offer an exhaustive retrospective analysis of patients affected by SCA fusiform and dissecting aneurysms treated at our institution from 2008 to 2023, highlighting outcomes and complications. Moreover, a comprehensive narrative review was performed. A total of seven patients were treated at our institution. After a title and abstract screen, fifty-five papers met the criteria for inclusion in the review. In our case series, conservative treatment was proposed as the first therapeutic option in four cases (57.1%), while endovascular treatment (EVT) was in three cases (42.9%). A good recovery was observed in 66% of patients presenting with subarachnoid hemorrhage (SAH), while every patient without SAH achieved a good clinical outcome. A poor outcome was observed only in one patient with a dissecting aneurysm causing SAH, who also suffered a pontine infarction. In the literature review, conservative treatment was proposed as a first therapeutic option in eleven cases (16.6%), open microsurgical techniques in 19 patients (28.8%), and EVT in 31 patients (46.9%). Fatal outcome was documented in five patients (7.5%), all characterized by the rupture of the vascular lesion, while 6.1% of cases had non-fatal poor outcomes.
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Affiliation(s)
- Simona Serioli
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Luciano Leonel
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Maria Peris Celda
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Otolaryngology / Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Zafer Keser
- Division of Cerebrovascular Disorders and Stroke, Department of Neurology, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA.
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19
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Kimchi G, Lamsam L, Gu B, Mendel E, Harel R, Knoller N, Cohen ZR, Ungar L, Zibly Z. Minimally Invasive Anterolateral Cervical Cordotomy for Intractable Cancer Pain Using Microtubular Retractors: A Single Institution Case Series. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01303. [PMID: 39189765 DOI: 10.1227/ons.0000000000001326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 07/02/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES As advancements in cancer treatments have allowed patients with a high burden of disease to live longer, the number of patients who present with debilitating refractory pain has increased. Anterolateral cordotomy has long been used for the treatment of intractable unilateral cancer pain using either an imaging-guided percutaneous approach or an open surgical approach. In this report, we describe a novel minimally invasive modification to the open surgical approach. It combines the benefits of both approaches by providing direct visualization for lesioning without the collateral tissue damage of an open approach. METHODS This retrospective study evaluated medical records, operative reports, and imaging studies of patients who underwent a minimally invasive cordotomy at a single institute between 2018 and 2022. The surgical technique involved a microscope-assisted C2 hemilaminectomy using microtubular retractors followed by dural opening and anterolateral cordotomy under direct visualization and with intraoperative neurophysiological monitoring. RESULTS Eleven patients were included in the study. None were converted to an open approach, and no wound-related postoperative complications were observed. A clinically significant decrease in pain was observed after the procedure, and 10 of the 11 patients (91%) were ambulatory by the time of analysis. CONCLUSION Compared with image-guided percutaneous cordotomy, anterolateral cervical cordotomy with microtubular retractors potentially improves the safety of the procedure through direct visualization while being less invasive than a conventional open approach. Our preliminary experience with this technique demonstrates the feasibility of the approach, as it was both safe and effective.
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Affiliation(s)
- Gil Kimchi
- Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Layton Lamsam
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Brett Gu
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ehud Mendel
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ran Harel
- Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nachson Knoller
- Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvi R Cohen
- Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Ungar
- Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zion Zibly
- Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
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20
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Debortoli C, Falguiere A, Campana F, Catherine JH, Tardivo D, Lan R. Utilization of a Cortical Xenogeneic Membrane for Guided Bone Regeneration: A Retrospective Case Series. J Clin Med 2024; 13:4575. [PMID: 39124840 PMCID: PMC11312857 DOI: 10.3390/jcm13154575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/22/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Guided bone regeneration (GBR) is a reliable technique used in vertical and horizontal bone defects. The posterior mandibular region is an area limited by anatomic constraints. The use of resorbable membranes with a cortical component could compensate for the lack of rigidity of resorbable membranes without the complications of non-resorbable membranes. The aim of this study was to evaluate the mean bone gains of a xenogeneic cortical membrane in horizontal and vertical bone defects in comparison with other membranes in the literature. Methods: A porcine cortical membrane was used to perform 7 GBR in the posterior mandibular region of five patients. Preoperative (T0) and six months postoperative (T1) cone beam computed tomography were superimposed to measure the horizontal and vertical bone gain. Implants were positioned at all sites, six months after GBR. Complications and bone resorption around the implants were also documented. Results: The mean horizontal and vertical bone gains were 3.83 ± 1.41 mm and 4.17 ± 1.86 mm, respectively. The analysis of repeatability was 0.997. As many as 40% of patients experienced pain refractory to analgesics. No exposure or infectious phenomenon was observed. Conclusions: This xenogeneic cortical membrane seemed to provide interesting results in the regeneration of horizontal and vertical bone defects. Comparative and prospective studies are necessary to validate the effectiveness of this membrane.
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Affiliation(s)
- Cyril Debortoli
- Oral Surgery Department, Assistance Publique des Hôpitaux de Marseille, 264 Avenue St Pierre, 13005 Marseille, France; (A.F.); (F.C.); (J.-H.C.); (R.L.)
| | - Arthur Falguiere
- Oral Surgery Department, Assistance Publique des Hôpitaux de Marseille, 264 Avenue St Pierre, 13005 Marseille, France; (A.F.); (F.C.); (J.-H.C.); (R.L.)
| | - Fabrice Campana
- Oral Surgery Department, Assistance Publique des Hôpitaux de Marseille, 264 Avenue St Pierre, 13005 Marseille, France; (A.F.); (F.C.); (J.-H.C.); (R.L.)
| | - Jean-Hugues Catherine
- Oral Surgery Department, Assistance Publique des Hôpitaux de Marseille, 264 Avenue St Pierre, 13005 Marseille, France; (A.F.); (F.C.); (J.-H.C.); (R.L.)
- Laboratory ISM, Aix-Marseille University, CNRS, EFS, 13005 Marseille, France
| | - Delphine Tardivo
- Laboratory ADES, Aix-Marseille University, CNRS, EFS, 13005 Marseille, France;
| | - Romain Lan
- Oral Surgery Department, Assistance Publique des Hôpitaux de Marseille, 264 Avenue St Pierre, 13005 Marseille, France; (A.F.); (F.C.); (J.-H.C.); (R.L.)
- Laboratory ADES, Aix-Marseille University, CNRS, EFS, 13005 Marseille, France;
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Austerlitz J, Mann DS, Noel JE, Orloff LA. Thyroid Nodule Rupture Following Radiofrequency Ablation for Benign Thyroid Nodules. JAMA Otolaryngol Head Neck Surg 2024; 150:651-657. [PMID: 38869909 PMCID: PMC11177217 DOI: 10.1001/jamaoto.2024.1400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/15/2024] [Indexed: 06/14/2024]
Abstract
Importance Nodule rupture is a rare but serious complication of thyroid radiofrequency ablation (RFA). With growing adoption of thyroid RFA across the US, an understanding of thyroid nodule rupture (TNR) is crucial for recognition, management, and, ultimately, prevention. Objective To determine procedural and patient factors that may contribute to TNR and describe experiences in managing TNR while synthesizing existing literature. Design, Setting, and Participants This retrospective case series examined all RFA procedures for benign thyroid nodules performed by 2 attending physicians at a single academic referral center between December 2019 and January 2024. A total of 298 consecutive patients underwent RFA for benign thyroid nodules. Criteria for offering RFA included nodules with 2 benign fine-needle aspirations, no suspicious ultrasonography features, a greatest dimension of 2 cm or greater, compressive or cosmetic concerns, and accessibility to a straight needle. Exposures All RFAs were performed using ultrasonography guidance using the moving-shot technique and a 7-mm or 10-mm active tip. Main Outcomes and Measures The primary outcome was TNR, and measures were procedure, nodule, and patient characteristics that may have contributed to its pathogenesis. Secondary outcomes were nodule volume reduction, thyroid function, and management and sequelae of TNR. The hypothesis on the pathogenesis of TNR was formed before data collection. Results Six of 298 patients (2%; 4 women [67%]) with a mean age of 48.5 years (range, 34-65 years) experienced TNR for a mean of 36 days postprocedure (range, 19-54 days). The mean (SD) initial nodule volume among patients with TNR was 31.45 (16.52) mL, and 3 of 6 patients (50%) underwent prior lobectomy. All ruptures were anterior. All patients were treated conservatively, and none required surgery. Five patients recovered completely; the sixth and most recent patient was healing as of last follow-up. Conclusions and Relevance There are limited data on the etiology and optimal management of TNR. These 6 cases of anterior rupture suggest that a potential contributor to TNR is thermal and mechanical trauma exerted at the fulcrum point during the moving-shot technique. The use of a smaller active tip (eg, 7 mm) and cessation of energy delivery before this point may help avoid TNR. More robust reporting of this complication may clarify risk factors for and enhance prevention of TNR.
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Affiliation(s)
- Joaquin Austerlitz
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Daljit Singh Mann
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
- Department of Otolaryngology–Head and Neck Surgery, Sutter Medical Foundation, Davis, California
| | - Julia E. Noel
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
- Division of Otolaryngology–Head and Neck Surgery, Santa Clara Valley Medical Center, Santa Clara, California
| | - Lisa A. Orloff
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Yuri Ferreira M, Oliveira LB, Porto Júnior S, Semione G, Palavani LB, Batista S, Pari Mitre L, Borges PGLB, Abrantes Barros E, Andreão F, Porto Sousa M, Gomez D, Bertani R, Hakim F. Enhancing the quality of evidence, comparability, and reproducibility in ventriculoatrial shunt research for normal pressure hydrocephalus: A systematic review and VAS-NPH reporting guideline. J Clin Neurosci 2024; 126:328-337. [PMID: 39024937 DOI: 10.1016/j.jocn.2024.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/03/2024] [Accepted: 06/30/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Ventriculoatrial shunt (VAS) is an important treatment option for normal pressure hydrocephalus (NPH). However, clinical studies reporting the use of VAS for NPH lack sufficient standardization for meta-analytic comparisons that could provide robust evidence regarding its use. This study aims to assess the quality of reporting in these studies and develop a reporting guideline checklist to standardize terminology, concepts, and reporting while reinforcing the essential elements to ensure comparability and reproducibility. METHODS This is a systematic literature review that followed the PRISMA guidelines with the search in Medline, Embase, and Web of Science databases, with no timeframe restriction. The level of evidence of the studies was assessed using the GRADE system, and the rigor used in the publication of the results was assessed concerning adherence to the guidelines indicated by the EQUATOR Network Group. Furthermore, the studies were scrutinized focusing on eight domains: (1) Characteristics of the included studies and baseline characteristics of the patients; (2) Reporting methodology; (3) Pivotal concepts definition; (4) Adverse events assessment; (5) Data writing and reporting; (6) Detailed outcomes reporting; (7) Specific clinical outcomes assessment and reporting; and (8) Complications reporting. RESULTS A total of 14 studies with 734 patients and 753 shunts were included in this review, and the assessment exposes notable deficiencies in reporting, specifically in baseline patient details, methodology, and outcome assessments. Only two studies followed reporting guidelines, prompting concerns about comprehensive reporting of adverse events and intraoperative complications. Varied reporting completeness existed for shunt-related issues. The absence of standardized definitions for key concepts and insufficient intervention details were observed. A VAS-NPH reporting guideline, encompassing 36 items across eight domains, was developed to address these shortcomings. CONCLUSION This systematic review reveals significant deficiencies in methodological rigor and reporting quality. The proposed VAS-NPH Reporting Guideline covers all essential aspects and is a potential solution to rectify these shortcomings and increase transparency, comparability, and reproducibility. This initiative aims to advance the level of evidence and enhance knowledge regarding the use of VAS in NPH.
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Affiliation(s)
- Marcio Yuri Ferreira
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Leonardo B Oliveira
- Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | | | | | | | - Savio Batista
- Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Lucas Pari Mitre
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil
| | - Pedro G L B Borges
- Fundação Técnico-Educacional Souza Marques, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Filipi Andreão
- Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Diego Gomez
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Fernando Hakim
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia
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Dai Z, Wang X, Zhang Y, Qiu Y, Liu J. A highly malignant succinate dehydrogenase A‑deficient renal cell carcinoma with bone metastasis misdiagnosed as hereditary leiomyomatosis and renal cell carcinoma: A case report. Oncol Lett 2024; 28:351. [PMID: 38872860 PMCID: PMC11170261 DOI: 10.3892/ol.2024.14485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 05/07/2024] [Indexed: 06/15/2024] Open
Abstract
Succinate dehydrogenase (SDH)-deficient renal cell carcinoma (RCC) is an autosomal dominant syndrome caused by heterozygous pathogenic germline variants of the SDH gene. SDH mutations are associated with an increased risk of developing RCC, although studies describing SDH-deficient RCC are currently limited. The present study reported a case of SDH-deficient RCC with high malignancy and rare bone metastasis. The patient was diagnosed with a right renal mass through B-mode ultrasound imaging and showed a carcinoma embolus in the right renal vein and inferior vena cava through kidney contrast-enhanced computed tomography. A whole-body bone scan showed radionuclide accumulation in the upper end of the left humerus, which indicated possible pathological bone destruction. As a result, surgical resection was performed. The postoperative pathology indicated a high-grade RCC and although the specific classification remained uncertain, hereditary leiomyomatosis and RCC was suspected. Subsequently, a germline mutation of the succinate dehydrogenase complex flavoprotein subunit A gene was identified through high-throughput sequencing (c.1A>G, p. Met1?) and immunohistochemistry demonstrated the loss of succinate dehydrogenase complex flavoprotein subunit B expression. Postoperatively, the patient underwent radiotherapy and targeted therapy. After 6 months of follow-up treatment, there was no indication of recurrence or metastasis on thoracoabdominal CT and whole-body bone scintigraphy. Based on the present report, germline screening should potentially be encouraged in early-onset patients as family history or pathological results may not provide sufficient information for the early, differential diagnosis of SDH-deficient RCC.
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Affiliation(s)
- Zhicheng Dai
- Department of Clinical Medicine, Weifang Medical University, Weifang, Shandong 261053, P.R. China
| | - Xiaohui Wang
- Department of Nursing, Weifang Medical University, Weifang, Shandong 261053, P.R. China
| | - Yinghao Zhang
- Department of Clinical Medicine, Weifang Medical University, Weifang, Shandong 261053, P.R. China
| | - Ying Qiu
- Department of Pathology, Linyi People's Hospital, Linyi, Shandong 276000, P.R. China
| | - Jie Liu
- Department of Urology, Linyi People's Hospital, Linyi, Shandong 276000, P.R. China
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Fernicola A, Alvigi A, Angelone G, Scotti L, Salvucci A, Finelli R, Capuozzo V, Aprea G, Santangelo M, Scognamiglio G. Our Experience With 200 Cases of Inguinal Hernia Repair Using the Dynamic Self-Adjusting Prosthesis: A Case Series and Literature Review. Cureus 2024; 16:e68258. [PMID: 39350877 PMCID: PMC11441829 DOI: 10.7759/cureus.68258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2024] [Indexed: 10/04/2024] Open
Abstract
Introduction Inguinal hernioplasty (IH) is one of the most frequently performed surgical procedures globally. Today, a variety of surgical techniques and prosthesis types are available for this procedure. Methods At our center, we performed 200 inguinal hernioplasties using the dynamic self-adjusting prosthesis (protesi autoregolantesi dinamica, PAD) from May 1, 2022, to May 31, 2023. Our objective was to retrospectively analyze the outcomes and compare them with the current scientific literature on this surgical technique. Results Our results align with those reported by other authors using the same surgical technique. With the PAD technique, we assessed the type and frequency of adverse events up to 12 months following IH. All patients were male, with an average BMI of 26.6. Among the 200 hernias, 99 were right-sided, 101 were left-sided, 63 were direct, and 137 were indirect. The average length of hospitalization was one day. The most common postoperative complication was hematoma near the surgical site, but no prosthesis displacement was observed. In 71% of patients, analgesics were discontinued within 24 hours. The outcomes of our study are comparable to those reported by the inventor of this surgical technique. Conclusion The procedure has demonstrated safety and effectiveness and could serve as a viable alternative to traditional IH techniques.
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Affiliation(s)
- Agostino Fernicola
- Clinical Medicine and Surgery, Azienda Ospedaliera Universitaria Federico II, Naples, ITA
| | - Antonio Alvigi
- General and Minimally Invasive Surgery, Ospedale S. Maria della Pietà dei Religiosi Camilliani, Casoria, ITA
| | - Giovanni Angelone
- General and Minimally Invasive Surgery, Ospedale S. Maria della Pietà dei Religiosi Camilliani, Casoria, ITA
| | - Luigi Scotti
- General and Minimally Invasive Surgery, Ospedale S. Maria della Pietà dei Religiosi Camilliani, Casoria, ITA
| | - Alessandro Salvucci
- General and Minimally Invasive Surgery, Ospedale S. Maria della Pietà dei Religiosi Camilliani, Casoria, ITA
| | - Raffaele Finelli
- General and Minimally Invasive Surgery, Ospedale S. Maria della Pietà dei Religiosi Camilliani, Casoria, ITA
| | - Vincenza Capuozzo
- General and Minimally Invasive Surgery, Ospedale S. Maria della Pietà dei Religiosi Camilliani, Casoria, ITA
| | - Giovanni Aprea
- Clinical Medicine and Surgery, Azienda Ospedaliera Universitaria Federico II, Naples, ITA
| | - Michele Santangelo
- Advanced Biomedical Sciences, Azienda Ospedaliera Universitaria Federico II, Naples, ITA
| | - Giuseppe Scognamiglio
- General and Minimally Invasive Surgery, Ospedale S. Maria della Pietà dei Religiosi Camilliani, Casoria, ITA
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Le GAT, To K, Dang NT, Nguyen VT, Phan TN, Nguyen VT, Ton TTT, Vo TT. The anconeus-triceps lateral flap approach in terrible triad of the elbow: good outcome in a series of ten cases. Ann Med Surg (Lond) 2024; 86:4352-4357. [PMID: 39118682 PMCID: PMC11305737 DOI: 10.1097/ms9.0000000000002211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/14/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction Standard surgical management for the terrible triad of the elbow (TTE) has been established since 2004, yet postoperative complications are common and consensus on optimal management is absent. Different surgical algorithms for treating TTE and their efficacy have been reported worldwide, yet evidence from Vietnam remains limited. Methods Ten cases diagnosed with TTE admitted to the Hospital of Traumatology and Orthopedics, a tertiary orthopedic center in Ho Chi Minh City, were presented to demonstrate the effectiveness and rate of postoperative complications following our stepwise surgical procedures using the anconeus-triceps lateral flap approach. The intraoperative "drop sign", quantitative assessment of pain and level of upper arm disability (via VAS and QuickDASH score) was mentioned to assess the algorithm's benefit. All patients' information was retrieved from medical records from August 2022 to January 2024. Results All 10 cases required repair of the lateral ligament complex and underwent surgery within 2 days of hospitalization. Immediate postoperative imaging revealed no drop sign, and none of the patients experienced elbow dislocation nor the need for repeated surgery, and a full range of elbow motion was demonstrated at 3-6 months follow-up. Conclusion TTE is a challenging injury that almost always obligates surgical correction. The anconeus-triceps lateral flap approach, with its advantages of better visualization and preservation of certain essential stabilizing muscles of the elbow, was demonstrated to yield a high success rate and low postoperative complication rate.
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Affiliation(s)
- Gia Anh Thy Le
- Department of Upper Limbs, Hospital for Traumatology and Orthopaedics, Ho Chi Minh City
| | - Kha To
- School of Medicine, Vietnam National University Ho Chi Minh City
- Trauma and Orthopedics Department, Thong Nhat Hospital
- Division of Surgery and Interventional Science
- Institute of Sport, Exercise and Health, University College London, London, UK
| | - Nghia Thanh Dang
- School of Medicine, Vietnam National University Ho Chi Minh City
| | - Viet Tan Nguyen
- Department of Upper Limbs, Hospital for Traumatology and Orthopaedics, Ho Chi Minh City
| | - Tri Nguyen Phan
- Department of Upper Limbs, Hospital for Traumatology and Orthopaedics, Ho Chi Minh City
| | - Van Thai Nguyen
- Department of Upper Limbs, Hospital for Traumatology and Orthopaedics, Ho Chi Minh City
- Department of Orthopaedics and Trauma, Pham Ngoc Thach Medical University, Ho Chi Minh City, Vietnam
| | - Thi Thanh Thao Ton
- Department of Upper Limbs, Hospital for Traumatology and Orthopaedics, Ho Chi Minh City
| | - Thanh Toan Vo
- Trauma and Orthopedics Department, Thong Nhat Hospital
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Li W. Infiltration of nanocarbon into the trachea during thyroidectomy surgery: case series and literature review. Ann Med Surg (Lond) 2024; 86:4338-4343. [PMID: 39118756 PMCID: PMC11305766 DOI: 10.1097/ms9.0000000000001613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/01/2023] [Indexed: 08/10/2024] Open
Abstract
Introduction The presence of metastatic disease in the cervical lymph nodes can affect the recurrence and survival of patients with thyroid cancer. Parathyroid gland injury during surgery can result in hypoparathyroidism, particularly with total thyroidectomy. Injection of carbon nanoparticles into the thyroid will label draining lymph nodes and aid in the visualization of metastatic cervical lymph nodes during a radical operation, sparing accidental damage to the parathyroid glands. Although reported to be useful during surgery, the safety of nanocarbon particles has rarely been investigated, and adverse side effects need to be studied. Case presentation The author describes five patients with thyroid cancer who had carbon secretions in the trachea or mucosa after carbon nanoparticles were injected into the thyroid. A patient with carbon secretions in the trachea mucosa recovered but had progressive dyspnoea. Surgical treatment was performed, and a mass was found in the trachea mucosa. After excluding all other possibilities, the author concluded that the mass was caused by nanocarbon suspension. Discussion To the author's knowledge, there are no reports on nanocarbon suspension into the mucosa and no consensus has yet been reached on the precise injection site, depth, or dose for injecting carbon nanoparticles before thyroidectomy. Conclusion The author suggests that the most appropriate injection depth of nanocarbon suspensions should be no more than 3 mm of the thyroid gland thickness to avoid deep injection into the trachea.
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Affiliation(s)
- Wu Li
- Department of Thyroid Surgery, Hunan Cancer Hospital &The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
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Tanidir Y, Sekerci CA, Genc YE, Gokmen E, Arslan F, Yucel S, Tarcan T, Cam K. Endoscopic combined intrarenal surgery versus percutaneuos nephrolithotomy for complex pediatric stone disease: A comparative analysis of efficacy and safety. J Pediatr Urol 2024; 20:606.e1-606.e7. [PMID: 38871548 DOI: 10.1016/j.jpurol.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/23/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Decision-making for complex pediatric urinary system stone disease is still a challenge for pediatric urologists. The interest in supine percutaneous nephrolithotomy (PCNL) is increasing among centers to achieve high surgical success rates with less morbidity. Despite advanced retrograde intrarenal surgery armamentarium, percutaneous approaches remain the first-line surgical treatment modality for >2 cm and complex renal stones. There are no comparative studies yet in the literature for pediatric endoscopic combined intrarenal surgery (ECIRS) OBJECTIVE: In this study, we aimed to contribute to the literature by evaluating the safety and efficacy of ECIRS by comparing it with PCNL. STUDY DESIGN Patients under 18 years of age who underwent PCNL and ECIRS for urinary tract stone disease at our Pediatric Urology department between 2012 and 2024 were included. Preoperative (demographic characteristics, stone characteristics, biochemical parameters), perioperative (duration of surgery, number of accesses, lasing and fluoroscopy times, endoscopic and fluoroscopic stone-free rates) and postoperative (hospital stay, urinary tract infection, complication and radiological stone-free rates) parameters were retrospectively evaluated. RESULTS A total of 68 children [28 (41%) girls and 40 (59%) boys] aged 5 (0-17) years were included in the study. ECIRS was performed in 19 (28%), supine in 28 (41%) and prone PCNL in 21 (30%) patients. Age (p = 0.029), Guy's stone score (p < 0.001), S.T.O.N.E. (p < 0.001), and Seoul National University Renal Stone Complexity (S-ReSC) scores (p = 0.001) for preoperative parameters were found to be higher in ECIRS group over both PCNL methods (Summary Table). However, Clinical Research Office of the Endourological Society (CROES) score was seen lower for ECIRS group patients compared to other groups (p = 0.028). Surgery time (in favor of supine over prone PCNL), fluoroscopy time (in favor of ECIRS and Supine PCNL over Prone PCNL), preferred laser type (prone PCNL group was mostly performed with holmium laser, whereas other groups were balanced between Holmium and Thulium Fiber Laser) and exit strategy (the preferred exit strategy was DJ Stent in most of the ECIRS patients, whereas nephrostomy tube was used in some of the PCNL group) showed significant difference among the groups as perioperative parameters (p = 0.042, <0.001, <0.001, <0.001, respectively). Surgery time was lower for supine PCNL compared to prone PCNL. For postoperative parameters, stone-free rates, complication rates and urinary tract infections were similar between the 3 groups, while a difference was detected in terms of length of hospital stay in favor of ECIRS over both supine and prone PCNL (p = 0.006). DISCUSSION The current trial suggests that stone-free and complication rates of ECIRS and supine PCNL were similar in the pediatric complex stone patients. Although, the stones in the ECIRS group we found to be more complex. Also, ECIRS was superior to PCNL in terms of fluoroscopy exposure and hospital stay. CONCLUSION With the widespread use of new generation ureteral access sheaths and flexible ureterorenoscopes, ECIRS may have an important role in treatment of complex pediatric kidney stones.
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Affiliation(s)
- Yiloren Tanidir
- Department of Urology, School of Medicine, Marmara University, Fevzi Çakmak Mah., Muhsin Yazicioglu Cad., No:10 Ust Kaynarca, Pendik, Istanbul, Turkey.
| | - Cagri Akin Sekerci
- Department of Urology, Division of Pediatric Urology, School of Medicine, Marmara University, Fevzi Çakmak Mah., Muhsin Yazicioglu Cad., No:10 Ust Kaynarca, Pendik, Istanbul, Turkey.
| | - Yunus Emre Genc
- Department of Urology, School of Medicine, Marmara University, Fevzi Çakmak Mah., Muhsin Yazicioglu Cad., No:10 Ust Kaynarca, Pendik, Istanbul, Turkey.
| | - Ersin Gokmen
- Department of Urology, School of Medicine, Marmara University, Fevzi Çakmak Mah., Muhsin Yazicioglu Cad., No:10 Ust Kaynarca, Pendik, Istanbul, Turkey.
| | - Faruk Arslan
- Department of Urology, School of Medicine, Marmara University, Fevzi Çakmak Mah., Muhsin Yazicioglu Cad., No:10 Ust Kaynarca, Pendik, Istanbul, Turkey.
| | - Selcuk Yucel
- Department of Urology, Division of Pediatric Urology, School of Medicine, Marmara University, Fevzi Çakmak Mah., Muhsin Yazicioglu Cad., No:10 Ust Kaynarca, Pendik, Istanbul, Turkey.
| | - Tufan Tarcan
- Department of Urology, Division of Pediatric Urology, School of Medicine, Marmara University, Fevzi Çakmak Mah., Muhsin Yazicioglu Cad., No:10 Ust Kaynarca, Pendik, Istanbul, Turkey.
| | - Kamil Cam
- Department of Urology, School of Medicine, Marmara University, Fevzi Çakmak Mah., Muhsin Yazicioglu Cad., No:10 Ust Kaynarca, Pendik, Istanbul, Turkey.
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Dragonas P. Immediate implant placement in extraction sockets with buccal bone dehiscence: A case study. Clin Adv Periodontics 2024. [PMID: 39078337 DOI: 10.1002/cap.10307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Immediate implant placement (IIP) has been associated with a higher risk of esthetic complications and particularly buccal mucosal recession, which can be more pronounced in non-intact sockets or in the presence of thin phenotype in the esthetic zone. Nevertheless, multiple techniques have been published to address IIP in non-intact alveolar sockets with favorable outcomes. The purpose of this study is to present an approach on IIP in sites with buccal bone dehiscence. METHODS Three patients requiring extraction of one or multiple teeth in the presence of buccal bone dehiscence were treated with flapless extractions, IIP, guided bone regeneration (GBR), and connective tissue grafting (CTG) through a tunneling approach with a simultaneous use of custom healing abutments. RESULTS All sites exhibited 1-2 mm of buccal bone thickness at the level of the implant platform, as well as significant buccal soft tissue thickness with no recession and a favorable development of the emergence profile at 4 months to a year post implant placement. CONCLUSIONS IIP in sockets with buccal bone dehiscence can be managed by means of a flapless extraction, GBR and CTG through a tunneling approach exhibiting favorable hard and soft tissue responses. KEY POINTS When placing immediate implants in non-intact sockets, simultaneous connective tissue grafting is recommended, especially in the esthetic zone. Bone grafting in immediate implants in sockets with buccal bone dehiscence can be performed through a tunneling approach without the need for open flap approaches. Placement of CHAs over immediate implants may help promote maintenance of the buccolingual ridge contours and overall hard and soft tissue responses. PLAIN LANGUAGE SUMMARY Placing dental implants right after tooth extraction can lead to more visible aesthetic issues, especially gum recession. This is more common when the tooth socket is not intact or the gum tissue is thin. However, several techniques have shown good results even in these challenging situations. This study explores a method for implant placement right after tooth extraction in cases where there is bone missing on the socket. Three patients who needed teeth extracted and had bone loss on the outer side of their tooth sockets were treated. The treatment included: Extracting the teeth without cutting the gums, placing implants immediately, using GBR to help regrow bone, adding connective tissue grafts, and using custom healing cups to shape the gum tissue. After treatment, all the sites showed 1-2 mm of new bone on the outer side of the implants and thicker gum tissue without any recession. The gum and bone around the implants looked good 4 months to a year later. In conclusion, IIP in sockets with bone loss on the outer side can be effectively managed with this method, leading to good bone and gum tissue outcomes.
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Affiliation(s)
- Panagiotis Dragonas
- Department of Periodontics, Louisiana State University Health New Orleans-School of Dentistry, New Orleans, Louisiana, USA
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Suphakitchanusan W, Wongboonkuakul N, Trakulsujaritchok K, Decha-Umphai C, Chobpenthai T. Synovial hemangioma presenting with chronic painful infrapatellar mass: a case report. BMC Musculoskelet Disord 2024; 25:584. [PMID: 39054426 PMCID: PMC11270852 DOI: 10.1186/s12891-024-07708-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/19/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Synovial hemangiomas are rare benign vascular anomalies surrounded by a synovial lining and were first described by Bouchut in 1856. These neoplasms can develop in the intra-articular region, resulting in effusions and knee pain. However, their cause remains unknown. Prompt diagnosis and intervention are critical to prevent chondral damage. Histopathological examination is used to achieve the diagnosis, which is often delayed because of a lack of specific clinical signs. This report describes a unique case in which a painful infrapatellar mass was diagnosed as a synovial hemangioma. The absence of typical magnetic resonance imaging (MRI) findings highlights the importance of arthroscopic excision for diagnosis and symptom relief. CASE PRESENTATION A 20-year-old woman presented with persistent anterior left knee pain that became exacerbated when she climbed stairs. Despite previous pain management and physical therapy, she developed a painful lump beneath her patella that worsened over time. She had also undergone arthrocentesis, but this did not relieve her pain. Physical examination revealed a palpable, immobile 5-cm mass along the patellar tendon with limited knee flexion and extension and normal ligament stability. T1-weighted fat-saturated MRI of the left knee with gadolinium-based contrast revealed a lobulated intra-articular mass in Hoffa's fat pad that resembled a soft tissue chondroma. A biopsy of the mass was performed to provide histopathological evidence, confirming the benign nature of the mass. The subsequent excisional arthroscopy, combined with incision enlargement for mass removal, confirmed the histopathologic diagnosis of synovial hemangioma based on the presence of numerous dilated blood vessels and venous proliferation within sections of the synovium. Recovery was complete, and no residual tumor was detected on follow-up MRI after 1 year. CONCLUSION This case study emphasizes the importance of arthroscopic excision over open surgery for patients with synovial hemangioma. The minimally invasive nature of arthroscopy combined with the well-encapsulated nature and location of the mass facilitates complete resection.
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Affiliation(s)
- Wasaphon Suphakitchanusan
- Department of Orthopaedics, Chulabhorn Hospital, Chulabhorn Royal Academy, 906 Kampangpetch 6 Street, Lak Si, Bangkok, Thailand
| | - Napatr Wongboonkuakul
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, 906 Kampangpetch 6 Street, Lak Si, Bangkok, Thailand
| | - Kancharos Trakulsujaritchok
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, 906 Kampangpetch 6 Street, Lak Si, Bangkok, Thailand
| | - Chomkwan Decha-Umphai
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, 906 Kampangpetch 6 Street, Lak Si, Bangkok, Thailand
| | - Thanapon Chobpenthai
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, 906 Kampangpetch 6 Street, Lak Si, Bangkok, Thailand.
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Colepícolo LS, Mourão Martinez MA, Rodrigues AA, Baeta LS, Costa FO. The innovative double or triple dental abutment-implant: Case study with a 3-to-12-year follow-up. Clin Adv Periodontics 2024. [PMID: 39037121 DOI: 10.1002/cap.10300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND The aim of this case study is to present the rationality and scientific evidence of a new design for a double (DA) and triple (TA) dental abutment-implant with their specific new concept of biodynamic optimized peri-implant tissue (BOPiT). METHODS The innovative design of these abutments with a paraboloid geometry was based on BOPiT, simultaneously involving the principles of mechanobiology, biotensegrity, and mechanotransduction. Thus, 37 consecutive individuals/43 cases rehabilitated with single dental implant using the innovative DA (n = 28) and TA (n = 15) on 43 implants were included in this case study. The DA and TA support 2 or 3 dental crowns on a single implant, respectively. Clinic and radiographic examinations were presented at T1 (loading after 4 months) and T2 [final examination with an average follow-up time of 7.2 years (>3 to 12 years)]. RESULTS At T2, mean scores for plaque index, peri-implant bleeding on probing, and peri-implant probing depth were low, depicting healthy peri-implant conditions. All radiographic images showed insignificant annual marginal bone loss (0.022 ± 0.05 mm) when compared to T1, reflecting great bone stability. CONCLUSION DA and TA, based on the BOPiT concept, represent an advantageous, simple and non-invasive mechanism for the longevity and healthy regulation of the peri-implant tissues.
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Affiliation(s)
- Luciana Silva Colepícolo
- Federal University of Minas Gerais, Institute of Technology and Research (ITP), Belo Horizonte, Minas Gerais, Brazil
- Instituto Universitário Italiano de Rosario, Santa Fé, Argentina
| | - Maria Auxiliadora Mourão Martinez
- Federal University of Minas Gerais, Institute of Technology and Research (ITP), Belo Horizonte, Minas Gerais, Brazil
- Instituto Universitário Italiano de Rosario, Santa Fé, Argentina
| | | | | | - Fernando Oliveira Costa
- School of Dentistry, Department of Periodontology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Lucchi A, Romeo L, Ciarrocchi AP, Grassia M, Cacurri A, Agostinelli L, Vitali G, Ripoli MC, Petrarulo F, De Cristofaro C, Cipressi C, Urgo MFL. Laparoscopic retromuscular hernia repair (LaHRR): a case-series of 17 patients treated with a novel technique for laparoscopic ventral hernia and diastasis repair. Surg Endosc 2024:10.1007/s00464-024-11012-5. [PMID: 39014180 DOI: 10.1007/s00464-024-11012-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/30/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION Many minimally invasive techniques have been developed over the years to treat primary ventral hernias and rectus abdominis diastasis, all of which have their advantages and disadvantages in terms of complications, reproducibility, and cost. We present a case-series of a novel approach that was safe and reproducible in a cohort of 17 patients. PATIENTS AND METHODS All patients in the study underwent the novel procedure between October 2022 and July 2023. We collected data retrospectively, including patient general characteristics, surgical outcomes, and complications. Patient follow-up lasted 12 months to exclude recurrences. RESULTS Seventeen patients underwent the procedure for primary uncomplicated ventral hernias and rectus diastasis. The median length of hospital stay was 2 days (IQR 2-3). In 4 out of 17 cases minor complications occurred within 30 days, of which 3 were class I and 1 was a class II complication according to the Clavien-Dindo classification. There were no recurrences. CONCLUSION Although limited by a small cohort of patients and a non-comparative study design, our study presents encouraging results in regards to the safety of this technique. More studies with a larger study population are needed to evaluate the benefits and pitfalls of this new technique.[query names].
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Affiliation(s)
- Andrea Lucchi
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Luigi Romeo
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Angelo Paolo Ciarrocchi
- Division of Thoracic Surgery, Department of Diagnostic and Specialty Medicine, DIMES of the Alma Mater Studiorum, University of Bologna, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Michele Grassia
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Alban Cacurri
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Laura Agostinelli
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Giulia Vitali
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Maria Cristina Ripoli
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Francesca Petrarulo
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Carlotta De Cristofaro
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Chiara Cipressi
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Mariasole Federica Lucia Urgo
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy.
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Su X, Shang Z, Li X, Song Z, Ye M, Sun L, Hong T, Ma Y, Zhang H, Zhang P. Dural arteriovenous fistulas in the falx cerebri: case series and literature review. Neurosurg Rev 2024; 47:303. [PMID: 38954153 DOI: 10.1007/s10143-024-02544-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/19/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024]
Abstract
Dural arteriovenous fistulas (DAVFs) within the falx cerebri are infrequently documented and may be linked with the falcine sinus/venous plexus. The falcine sinus/venous plexus, often regarded as a normal venous structure, can exhibit pathological characteristics, differing from the persistent fetal falcine sinus. A retrospective analysis was conducted at a single center to identify all cases of DAVFs within the falx cerebri spanning from 2002 to 2022. Demographic data, fistula features, treatment modalities, clinical outcomes, and fistula closure were collected and analyzed. Additionally, relevant literature on DAVFs in this location was reviewed. Ten cases were identified at our center, supplemented by 13 cases reported in the literature. In our cohort, patients had an average age of 49.4 ± 8.1 years, with a male predominance of 90%. Trans-arterial embolization (TAE) alone achieved immediate complete occlusion in eight cases, while conservative treatment was pursued in two cases. No treatment-related complications or fistula recurrences were observed. In the literature, seven patients underwent direct surgery, three underwent TAE, and one underwent both direct surgery and radiosurgery for complete fistula closure. No instances of fistula recurrence or treatment complications were reported. Dural arteriovenous fistulas within the falx cerebri are rare, with limited literature available. They typically present as aggressive lesions. Treatment options include direct surgery or TAE. However, due to a lack of long-term DSA follow-up, the cure and recurrence rates are unknown for endovasdcular therapy. Further investigation is warranted to elucidate the involvement of the falcine sinus/venous plexus in falx cerebri DAVFs.
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Affiliation(s)
- Xin Su
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Zhiyuan Shang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Department of Neurosurgery, Beijing Fengtai You'anmen Hospital, Beijing, 100069, China
| | - Xiangyu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Zihao Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Ming Ye
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Liyong Sun
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Tao Hong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Yongjie Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
- , No. 45 Changchun Street, Xicheng District, Beijing, 10053, China.
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
| | - Peng Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
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Colling R, Indave I, Del Aguilla J, Cierco Jimenez R, Campbell F, Chechlinska M, Kowalewska M, Holdenrieder S, Trulson I, Worf K, Pollán M, Plans-Beriso E, Pérez-Gómez B, Craciun O, García-Ovejero E, Michalek IM, Maslova K, Rymkiewicz G, Didkowska J, Tan PH, Diyana Bte Md Nasir N, Myles N, Giesen C, Goldman-Lévy G, Lokuhetty D, Cree IA. Moving Forward on Tumor Pathology Research Reporting: A Guide for Pathologists From the World Health Organization Classification of Tumors Living Evidence Gap Map by Tumour Type Group. Mod Pathol 2024; 37:100515. [PMID: 38763419 DOI: 10.1016/j.modpat.2024.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/30/2024] [Accepted: 05/04/2024] [Indexed: 05/21/2024]
Abstract
Evidence-based medicine (EBM) can be an unfamiliar territory for those working in tumor pathology research, and there is a great deal of uncertainty about how to undertake an EBM approach to planning and reporting histopathology-based studies. In this article, reviewed and endorsed by the Word Health Organization International Agency for Research on Cancer's International Collaboration for Cancer Classification and Research, we aim to help pathologists and researchers understand the basics of planning an evidence-based tumor pathology research study, as well as our recommendations on how to report the findings from these. We introduce some basic EBM concepts, a framework for research questions, and thoughts on study design and emphasize the concept of reporting standards. There are many study-specific reporting guidelines available, and we provide an overview of these. However, existing reporting guidelines perhaps do not always fit tumor pathology research papers, and hence, here, we collate the key reporting data set together into one generic checklist that we think will simplify the task for pathologists. The article aims to complement our recent hierarchy of evidence for tumor pathology and glossary of evidence (study) types in tumor pathology. Together, these articles should help any researcher get to grips with the basics of EBM for planning and publishing research in tumor pathology, as well as encourage an improved standard of the reports available to us all in the literature.
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Affiliation(s)
- Richard Colling
- Nuffield Department of Surgical Sciences, University of Oxford, Level 4, John Radcliffe Hospital, Oxford, United Kingdom; Department of Cellular Pathology, Oxford University Hospitals NHS FT, Oxford, United Kingdom.
| | - Iciar Indave
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Javier Del Aguilla
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Ramon Cierco Jimenez
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Fiona Campbell
- Population Health Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Magdalena Chechlinska
- Department of Cancer Biology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Magdalena Kowalewska
- Department of Molecular and Translational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, German Heart Centre Munich, Munich, Germany
| | - Inga Trulson
- Institute of Laboratory Medicine, German Heart Centre Munich, Munich, Germany
| | - Karolina Worf
- Institute of Laboratory Medicine, German Heart Centre Munich, Munich, Germany
| | - Marina Pollán
- National Center for Epidemiology. Instituto de Salud Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Elena Plans-Beriso
- National Center for Epidemiology. Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Pérez-Gómez
- National Center for Epidemiology. Instituto de Salud Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Oana Craciun
- National Center for Epidemiology. Instituto de Salud Carlos III, Madrid, Spain
| | | | - Irmina Maria Michalek
- Department of Cancer Pathomorphology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Kateryna Maslova
- Department of Cancer Biology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Grzegorz Rymkiewicz
- Department of Cancer Pathomorphology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Joanna Didkowska
- Polish National Cancer Registry, Department of Epidemiology and Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | | | - Nickolas Myles
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Christine Giesen
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Gabrielle Goldman-Lévy
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Dilani Lokuhetty
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Ian A Cree
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
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Rodríguez-Suárez CA, Hernández-De Luis MN. Evaluation of the appropriateness of nursing case studies using the CARE checklist. ENFERMERIA CLINICA (ENGLISH EDITION) 2024; 34:330-342. [PMID: 39032784 DOI: 10.1016/j.enfcle.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 04/04/2024] [Indexed: 07/23/2024]
Abstract
Case report is a narrative description of the problem of one or several patients. The CARE checklist (CAse REport) is the consensus document for reporting clinical case reports and through adaptations to the different CARE disciplines is used to define standards for authors in scientific journals; however, the specificity of the nursing process makes it difficult to adjust nursing case reports to CARE. The aim was to analyze the publications of clinical cases with a nursing perspective in scientific journals, as well as the quality standards and evaluation systems used. Few journals reviewed agreed to publish nursing case reports or stated standards for authors to adjust to CARE. Preliminary results indicated average or poor adherence to CARE, with the most reported elements being: Keywords, patient information and introduction. Adherence was lower for the elements: Timeline, therapeutic intervention, follow-up and outcomes, and patient perspective. The characteristics of the nursing process implies a low adherence to CARE, so it is necessary to unify criteria to guide researchers, authors, reviewers and editors of scientific journals, as well as to improve the rigor and quality of the reports. Currently, there are no specific guidelines for reporting clinical case reports with a nursing perspective available. These normative gaps could be solved by developing a CARE extension adapted to the methodological characteristics of the nursing process.
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Affiliation(s)
- Claudio Alberto Rodríguez-Suárez
- Departamento de Enfermería, Universidad de Las Palmas de Gran Canaria, Canary Islands, Spain; Unidad de apoyo a la investigación del Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Servicio Canario de la Salud, Canary Islands, Spain.
| | - María Naira Hernández-De Luis
- Centro de Salud El Doctoral, Gerencia de Atención Primaria de Gran Canaria, Servicio Canario de la Salud, Canary Islands, Spain
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Nguyen M, Goel S, Tran L, Khan M, Jersmann H, Nguyen P, Krishnan S, Hodge JC, Foreman A. Management of complex adult airway pathology through a multidisciplinary approach: An 8-year case series. Clin Otolaryngol 2024; 49:518-523. [PMID: 38634330 DOI: 10.1111/coa.14163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 03/10/2024] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Marie Nguyen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Sahil Goel
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Liem Tran
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Maryam Khan
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Hubertus Jersmann
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - Phan Nguyen
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - Suren Krishnan
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - John-Charles Hodge
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Andrew Foreman
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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Pathak NJ, Singh AG, Surwase PJ, Agrawal SA, Ganpule AP, Sabnis RB, Desai MR. Primary Ewing sarcoma/primitive neuroectodermal tumors of the kidney: Case series of eight cases from a single center with follow-up details. Indian J Urol 2024; 40:185-190. [PMID: 39100602 PMCID: PMC11296582 DOI: 10.4103/iju.iju_175_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/02/2024] [Accepted: 06/04/2024] [Indexed: 08/06/2024] Open
Abstract
Introduction We aim to share the experience of a single center in the management of eight cases of renal primitive neuroectodermal tumor (PNET) which are uncommon, aggressive tumors. The objectives were to study the presentation of the disease, the treatment offered and its outcomes, and the comparison of the treatment with published literature. Methods The single-center renal PNET data of all patients were retrospectively reviewed from 2011 to 2022. Renal PNET was seen in eight patients. Minimum follow-up period of 1 year was required. Results Male-to-female ratio was 7:1. The mean age was 26.5 years. All were locally advanced tumors on presentation. One patient had an inferior vena cava thrombus, one patient had metastases on presentation, and two patients had tumor extending to paranephric space. The diagnosis was made by histopathology supported by immunohistochemistry showing CD99 positivity. All patients were treated with radical nephrectomy, followed by chemotherapy in all and radiotherapy in three patients. Two patients expired at 3½ and 6 years after surgery, the remaining six are alive at a median follow-up period of 34.5 months. Conclusion Renal PNET is an uncommon renal tumor which is aggressive and requires multimodal therapy for prolonged survival.
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Cain EL, Mussell EA, Crawford AE, Ithurburn MP, Layton BO, Fleisig GS, Rothermich MA, Emblom BA, Ryan MK, Dugas JR, Andrews JR. Long-term Outcomes of Multiligament Knee Injuries in American Football Players. Am J Sports Med 2024; 52:1918-1926. [PMID: 38822594 DOI: 10.1177/03635465241252440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
BACKGROUND Long-term outcomes for isolated anterior cruciate ligament (ACL) reconstructions in competitive American football athletes are well reported in the literature, but little data currently exist regarding multiligament knee injury (MLKI) reconstruction outcomes. PURPOSE To examine patient-reported and return-to-sport outcomes of competitive American football athletes who underwent primary, single-staged, multiligament knee reconstruction. STUDY DESIGN Case series; Level of evidence, 4. METHODS We identified patients from our institution's prospectively collected data repository between 2001 and 2020 who underwent single-staged surgical reconstruction of an MLKI sustained during competitive participation in American football. We assessed patient-reported outcomes at a minimum of 2 years after surgery using the International Knee Documentation Committee (IKDC) Subjective Knee Form and questions regarding surgical satisfaction and return to sport. Successful return to sport was defined as a return to preinjury level of competition. We summarized all outcome data and compared outcomes between 2-ligament and >2-ligament groups and between ACL-only MLKI injury and bicruciate MLKI injury groups using independent t test for IKDC scores and chi-square test for return to sport. Additionally, we evaluated predictors of postoperative IKDC scores using linear regression and predictors of return to sport using logistic regression. RESULTS Outcome data were successfully collected for 53 of 73 total eligible patients (73%; mean follow-up time, 7.7 ± 4.0 years; all male; mean age at surgery, 18.1 ± 2.7 years). The mean postoperative IKDC score was 84 ± 16. The most common level of preinjury competition was high school (n = 36; 68%), followed by college (n = 10; 19%). Seven patients did not return to sport competition at any level due to limitations from their knee surgery, and 82% of patients that attempted to return to preinjury level of sport were able to do so. A total of 50 patients (94%) were satisfied or very satisfied with their surgical outcome. The 2-ligament (n = 39) and >2-ligament (n = 14) groups did not significantly differ in IKDC scores (P = .96) or proportions with successful return to sport (P = .77). Similarly, the ACL-MLKI injury (n = 39) and bicruciate MLKI injury (n = 14) groups did not significantly differ in IKDC scores (P = .89) or proportions with successful return to sport (P = .77). Age and body mass index were not significantly associated with IKDC scores or successful return to sport at follow-up (all P > .05). CONCLUSION This study may represent the largest cohort of competitive American football athletes evaluated for longitudinal outcomes after multiligament knee reconstruction. Despite the severity of these injuries, we found good knee-related function and that the large majority of athletes who attempted to return to sport were successful. The majority of athletes (94%) were satisfied with their operative treatment.
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Affiliation(s)
- E Lyle Cain
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Eric A Mussell
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Anna E Crawford
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Matthew P Ithurburn
- The American Sports Medicine Institute, Birmingham, Alabama, USA
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Branum O Layton
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Glenn S Fleisig
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Marcus A Rothermich
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Benton A Emblom
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - Michael K Ryan
- The American Sports Medicine Institute, Birmingham, Alabama, USA
- Prevea Health Orthopaedics & Sports Medicine, Green Bay, Wisconsin, USA
| | - Jeffrey R Dugas
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
| | - James R Andrews
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
- The American Sports Medicine Institute, Birmingham, Alabama, USA
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Byrnes YM, Makar G, Madera JD, Ruffino AE, Frank K, Bowen TR, Devitt SM. Establishing a Collaborative Orthoplastic Approach for the Management of Primary Musculoskeletal Neoplasms: An 8-year Case Series. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5971. [PMID: 38988480 PMCID: PMC11236390 DOI: 10.1097/gox.0000000000005971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/10/2024] [Indexed: 07/12/2024]
Abstract
Orthoplastic surgery is a multidisciplinary approach that is well-studied for extremity trauma, but not for musculoskeletal oncologic reconstruction. Here, the authors describe the application of a collaborative orthoplastic approach for the management of primary musculoskeletal neoplasms and evaluate its impact. The collaboration protocol, implemented in July 2019, comprises specific checkpoints of interdisciplinary co-management, which span the pre-, intra-, and postoperative treatment period. This involves direct communication between attending surgeons and their respective clinical teams. Patients who underwent resection of a primary musculoskeletal neoplasm between March 2014 and April 2022 were retrospectively categorized into conventional or collaboration groups. Of the 136 total patients, there were 63.2% (n = 86) conventional and 36.8% (n = 50) collaboration; 31.6% (n = 43) had reconstruction and 68.4% (n = 93) did not. Compared with the conventional group, the collaboration group had significantly higher rates of diabetes (18% versus 7%, P = 0.048) and radiation treatment (68% versus 43%, P = 0.005). The collaboration group was significantly more likely to have plastic surgery involvement in their care than the conventional group (38% versus 14%, P = 0.001), and to undergo reconstruction (42% versus 26%, P = 0.047). The groups showed no difference in rates of hematoma, seroma, delayed healing, infection, 30- or 90-day reoperation, or partial or complete flap/graft failure. The collaborative approach described here is feasible and associated with increased plastic surgery involvement and reconstructive surgery. Complications were equivalent despite evidence suggesting increased case complexity in the collaboration group. These early results are promising and could inspire wider adoption of structured orthoplastic protocols for care of these patients.
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Affiliation(s)
- Yasmeen M Byrnes
- From the Department of Plastic and Reconstructive Surgery, Geisinger Medical Center, Danville, Pa
| | - Gabriel Makar
- Geisinger Musculoskeletal Institute, Geisinger Medical Center, Danville, Pa
| | | | | | - Katie Frank
- Biostatistics Core, Department of Population Health Sciences, Geisinger Medical Center, Danville, Pa
| | - Thomas R Bowen
- Geisinger Musculoskeletal Institute, Geisinger Medical Center, Danville, Pa
| | - Sean M Devitt
- From the Department of Plastic and Reconstructive Surgery, Geisinger Medical Center, Danville, Pa
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Findlay MC, Tenhoeve SA, Twitchell S, Sherrod BA, Mahan MA. Percutaneous Screw Distraction for Anatomic Restoration: Case Series. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01201. [PMID: 38888333 DOI: 10.1227/ons.0000000000001217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/26/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Percutaneous pedicle screw fixation with distraction reduces morbidity after traumatic thoracolumbar burst fractures; however, there are substantial limitations, particularly for correction of kyphosis. The use of fixed-angle screws may offer improved anatomic restoration, facilitating greater postdistraction vertebral height restoration and spinal canal fragment reduction. We examined the radiographic results of distraction across fixed-angle screws immediately after surgery and in long-term follow-up. METHODS Demographic and clinical characteristics were captured for patients with traumatic thoracolumbar fractures undergoing percutaneous pedicle screw fixation by a single surgeon. Radiographic measurements were collected at predistraction, postdistraction, and long-term follow-up time points. Paired t-tests, Student's t-tests, Mann-Whitney U tests, and χ2 tests were used to assess data where appropriate. RESULTS The case series included 22 patients (77.3% male; mean age 42.0 ± 18.4 years). Hounsfield density consistent with osteopenia was seen in 13.6% of patients at the time of injury. Sporting injuries and motor vehicle accidents were common (both 31.8%). Most injuries occurred at L1 (45.5%). Upon long-term follow-up, the mean injured-level predistraction cross-sectional area improved from 2.1 to 2.9 cm2 (P < .01). Compared with the superadjacent level, the injured-level cross-sectional canal area improved by 28.6% (P < .01). Vertebral body index also improved significantly (18.8° mean change, P < .01). The mean bisegmental Cobb angle improved by 6.2° (P = .01), and injured vertebral body compression decreased by 22.4% (P < .01). Significant improvement in correction was achieved with experience, with final technique yielding superior cross-sectional area (P = .04) and compression ratios (P = .03). CONCLUSION Distraction across fixed-angle percutaneous screw instrumentation systems stabilizes traumatic thoracolumbar burst fractures, corrects deformity, and decompresses the spinal canal. Further comparative research is necessary to demonstrate whether outcomes are different between percutaneous instrumentation vs open fusion for thoracolumbar trauma.
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Affiliation(s)
- Matthew C Findlay
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Sam A Tenhoeve
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Spencer Twitchell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Brandon A Sherrod
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Mark A Mahan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
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Mong ER, Kethireddy S, Staudt MD. Spinal Cord Stimulator Paddle Lead Revision and Replacement for Misplaced or Displaced Electrodes. World Neurosurg 2024; 186:e432-e439. [PMID: 38561030 DOI: 10.1016/j.wneu.2024.03.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Spinal cord stimulators (SCSs) are commonly implanted via a laminotomy or laminectomy. Revision surgery may be necessary in instances of hardware failure or loss of efficacy. It is uncommon for leads to have been initially misplaced in a suboptimal position and revision in these cases necessitates additional dissection for appropriate repositioning. Accordingly, there is concern with a more extensive revision for a potentially higher risk of associated complications. This study aims to describe a series of patients with failed paddle SCS electrodes due to misplacement who underwent revision and replacement. METHODS Patients who underwent SCS paddle replacement for misplaced paddles between 2021 and 2023 were identified. Medical charts were reviewed for demographic data, operative details, and incidence of complications. RESULTS Sixteen patients underwent thoracic SCS paddle revision and replacement. The mean age was 59.6 ± 12.6 years, with 11 females and 5 males. Misplaced paddles were too lateral (n = 12), too high (n = 2), or incompletely within the epidural space (n = 2). The mean duration from initial implantation to revision surgery was 44.8 ± 47.5 months. The mean operative duration was 126.1 ± 26.9 minutes and all patients required a "skip" laminectomy or laminotomy. No complications were encountered. The mean length of follow-up was 18.4 ± 7.3 months. Mean preoperative pain intensity was 7.9 ± 1.5 and at last follow-up was 3.6 ± 1.7 (P < 0.001). All but 1 patient continued to use their device in follow-up. CONCLUSIONS The revision and replacement of misplaced paddle SCS electrodes is a feasible and durable revision strategy, even in long-term implants with extensive scarring.
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Affiliation(s)
- Eric R Mong
- Department of Neurosurgery, Beaumont Neuroscience Center, Royal Oak, Michigan, USA
| | - Saini Kethireddy
- Department of Neurosurgery, Beaumont Neuroscience Center, Royal Oak, Michigan, USA
| | - Michael D Staudt
- Department of Neurosurgery, Beaumont Neuroscience Center, Royal Oak, Michigan, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
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Scavia S, Audino E, Salgarello S. Ridge Preservation Combined With Open Barrier Membrane Technique in Case of Postextractive Oroantral Communication: A Case Series Retrospective Study. J ORAL IMPLANTOL 2024; 50:141-152. [PMID: 38839071 DOI: 10.1563/aaid-joi-d-24-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
After dental extraction, a physiological phenomenon of reabsorption of the dentoalveolar process is triggered, especially if periradicular lesions are present, which can sometimes be associated with oroantral communication in the upper posterior maxilla. To investigate a minimally invasive approach, 19 patients undergoing tooth extraction in the posterosuperior maxilla were recruited. All cases presented an oroantral communication with a diameter of 2-5 mm after tooth extraction and the alveolar process and, in some cases, with a partial defect of 1 or more bony walls. In these cases, a single surgical procedure was used to preserve the alveolar ridge using an open barrier technique with an exposed dense polytetrafluoroethylene membrane. The bottom of the extraction socket was filled with a collagen fleece. The residual bone process was reconstructed using a biomaterial based on carbonate-apatite derived from porcine cancellous bone. After 6 months, all patients were recalled and subjected to radiographic control associated with an implant-prosthetic rehabilitation plan. Data relating to the sinus health status and the average height and thickness of the regenerated bone were collected. Radiographic evaluation verified the integrity of the maxillary sinus floor with new bone formation, detecting a vertical bone dimension between 3.1 mm and 7.4 mm (average 5.13 ± 1.15 mm) and a horizontal thickness between 4.2 mm and 9.6 mm (average 6.86 ± 1.55 mm). The goal of this study was to highlight the advantage of managing an oroantral communication and, simultaneously, obtain the preservation and regeneration of the alveolar bone crest. The open barrier technique appears to be effective for the minimally invasive management of oroantral communication up to 5 mm in diameter in postextraction sites, with a good regeneration of hard and soft tissue.
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Affiliation(s)
| | - Elisabetta Audino
- Department of Medical and Surgery Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, Brescia, Italy
| | - Stefano Salgarello
- Department of Medical and Surgery Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, Brescia, Italy
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Hailstone L, Tovmassian D, Nguyen CL, Wong P, Le Page PA, Martin D, Taylor C. Medium-Term Outcomes from a Series of 1000 One Anastomosis Gastric Bypass in Australia: A Case Series. Obes Surg 2024; 34:2111-2115. [PMID: 38609707 PMCID: PMC11127843 DOI: 10.1007/s11695-024-07213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE This study presents the short- (less than 6 months) and medium-term (6 months to 2 years) outcomes for weight loss and type 2 diabetes mellitus (T2DM) for all patients undergoing one anastomosis gastric bypass (OAGB) across multiple institutions between 2015 and 2021. MATERIALS AND METHODS A retrospective analysis of prospectively collected databases was performed including 1022 participants who underwent OAGB at multiple institutions by multiple surgeons between 2015 and 2021. Primary outcome was percentage total weight loss (TWL) and secondary outcomes were achieving resolution of T2DM; OAGB specific short- and medium-term complications including bile reflux, marginal ulceration and internal herniation. RESULTS One thousand and twenty-two patients underwent OAGB (81% primary surgery). A percentage of 34.1% (n = 349) had a preoperative diagnosis of type 2 diabetes mellitus (T2DM). Mean TWL was 33.6 ± 9% with a T2DM remission rate of 74% at 1-year post-op. Rates of bile reflux and marginal ulceration was 1.1% (n = 11) and 1.1% (n = 11). There were no cases of internal herniation during the follow-up period. CONCLUSION OAGB results has echoed previously published work as being efficacious and safe in a short-medium term. The prevalence of complications, especially bile reflux is overall low in our population and no current evidence exists to support an increased risk of metaplasia or malignancy related to bile within the stomach.
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Affiliation(s)
- Laura Hailstone
- Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - David Tovmassian
- Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia.
- University of Sydney, Sydney, NSW, Australia.
| | - Chu Luan Nguyen
- Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - Pearl Wong
- Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | | | - David Martin
- Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Craig Taylor
- Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
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van Uitert A, Chaman-Baz HA, van der Wal SEI, Zhu X, Wijntjes J, Timmers HJLM, Witjes JA, van Alfen N, Langenhuijsen JF. A prospective case series to evaluate subcostal nerve injury with high-resolution ultrasound in posterior retroperitoneoscopic adrenalectomy. Surg Endosc 2024; 38:3145-3155. [PMID: 38627259 PMCID: PMC11133209 DOI: 10.1007/s00464-024-10836-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/27/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Posterior retroperitoneoscopic adrenalectomy has several advantages over transabdominal laparoscopic adrenalectomy regarding operating time, blood loss, postoperative pain, and recovery. However, postoperatively several patients report chronic pain or hypoesthesia. We hypothesized that these symptoms may be the result of damage to the subcostal nerve, because it passes the surgical area. METHODS A prospective single-center case series was performed in adult patients without preoperative pain or numbness of the abdominal wall who underwent unilateral posterior retroperitoneoscopic adrenalectomy. Patients received pre- and postoperative questionnaires and a high-resolution ultrasound scan of the subcostal nerve and abdominal wall muscles was performed before and directly after surgery. Clinical evaluation at 6 weeks was performed with repeat questionnaires, physical examination, and high-resolution ultrasound. Long-term recovery was evaluated with questionnaires, and photographs from the patients were examined for abdominal wall asymmetry. RESULTS A total of 25 patients were included in the study. There were no surgical complications. Preoperative visualization of the subcostal nerve was possible in all patients. At 6 weeks, ultrasound showed nerve damage in 15 patients, with no significant association between nerve damage and postsurgical pain. However, there was a significant association between nerve damage and hypoesthesia (p = 0.01), sensory (p < 0.001), and motor (p < 0.001) dysfunction on physical examination. After a median follow-up of 18 months, 5 patients still experienced either numbness or muscle weakness, and one patient experienced chronic postsurgical pain. CONCLUSION In this exporatory case series the incidence of postoperative damage to the subcostal nerve, both clinically and radiologically, was 60% after posterior retroperitoneoscopic adrenalectomy. There was no association with pain, and the spontaneous recovery rate was high.
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Affiliation(s)
- Allon van Uitert
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Hossein A Chaman-Baz
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Selina E I van der Wal
- Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Xiaoye Zhu
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Juerd Wijntjes
- Department of Neurology, Clinical Neuromuscular Imaging Group, Donders Center for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Henri J L M Timmers
- Department of Internal Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Clinical Neuromuscular Imaging Group, Donders Center for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Johan F Langenhuijsen
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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Nguyen H, Luong TH, Nguyen AK, Nguyen TK. Laparoscopic antegrade spleen-preserving distal pancreatectomy with conservation of the splenic vessels: a prospective multi-centre case series (with video). Ann Med Surg (Lond) 2024; 86:3211-3215. [PMID: 38846863 PMCID: PMC11152876 DOI: 10.1097/ms9.0000000000002059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/02/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with conservation of the splenic artery and vein (Kimura' technique) is considered a technically challenging procedure that requires a high level of expertise in laparoscopic and pancreatic surgery. Methods A prospective descriptive study on 18 patients with laparoscopic "antegrade" spleen-preserving distal pancreatectomy with Kimura' technique from 2018 to 2023. The perioperative indications, clinical data, intraoperative index, pathological postoperative specimens, postoperative complications, and follow-up results were retrospectively evaluated. Results The mean age was 39.4±13.3. Only 2 male patients accounted for 11.1%. The average operating time is 171±23 min. The average blood loss is 65.7±43 ml. The average tumor size is 4.1 cm. The average hospitalization is 9.4 days. The rate of pancreatic fistula is 66.7%. There is no case of transferring open surgery or blood transfusion during surgery. The results of pathological after surgery there were eight cases of solid pseudopapillary tumors, four cases of mucinous cystadenoma, six cases of neuroendocrine tumors. Conclusion Kimura's technique for laparoscopic spleen-preserving distal pancreatectomy is safe and feasible, which can be applied to benign tumors in the body and tail of the pancreas. However, this is a difficult technique in laparoscopic surgery that requires surgeons to have a lot of experience and equipment need to be adequate.
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Affiliation(s)
- Hoang Nguyen
- Department of General Surgery, Hanoi Medical University Hospital
| | - Tuan Hiep Luong
- Center of Digestive Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - An Khang Nguyen
- Department of General Surgery, Hanoi Medical University Hospital
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Yoo H, Hong KY, Min S, Lee HS, Park DJ, Kim YS, Kong SH, Chang H. Distribution of Perigastric Station 4d Lymph Nodes in Vascularized Gastroepiploic Lymph Node Transfer: An Anatomic Study and Case Series. Ann Surg Oncol 2024; 31:3694-3704. [PMID: 38530528 DOI: 10.1245/s10434-024-15113-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/12/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Vascularized gastroepiploic lymph node transfer (VGLNT) is a well-accepted surgical treatment for restoring physiological function in chronic lymphedema. However, the inclusion of substantial lymph nodes (LNs) in the flap remains uncertain. This study aimed to identify the anatomical basis for reliable flap harvest for VGLNT. PATIENTS AND METHODS The anatomy of perigastric station 4d LNs was studied in healthy cadavers (n = 15) and patients with early gastric cancer (EGC) (n = 27). The omentum was divided into three segments: proximal, middle, and distal from the origin of the right gastroepiploic vessels. The flap dimension, number, location, size of LNs, and caliber of the vessels were reviewed. Eight patients underwent VGLNT for upper/lower limb lymphedema. RESULTS The mean numbers of LNs in the proximal, middle, and distal segment were 2.5, 1.4, 0.5 in the cadavers, and 4.9, 2.7, 0.7 in the gastrectomy specimens, respectively. The proximal third included a significantly greater number of LNs than the distal third in the cadaveric (p = 0.024) and ECG (p = 0.016) specimens. A total of 95% of the LNs were located within proximal two-thirds of the flap from the vessel origin both in the cadavers (21.0 × 5.0 cm) and in the gastrectomy specimens (20 × 3.5 cm). In VGLNT, the transferred flap was 25.5 ± 6.9 × 4.1 + 0.7 cm in dimension, containing a mean number of 6.5 ± 1.9 LNs. At postoperative 6 months, the volumetric difference was significantly reduced by 22.8 ± 9.2% (p < 0.001). CONCLUSIONS This study provides a distinct distribution pattern of station 4d LNs. Inclusion of the proximal two-thirds of the flap, which carries majority of the LNs, is recommended for VGLNT.
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Affiliation(s)
- Hyokyung Yoo
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki Yong Hong
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sally Min
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do-Joong Park
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yi-Suk Kim
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hak Chang
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Huang X, Li H, Gu S, Gao Y, Khoong Y, Liu Y, Luo S, Gu B, Li Q, Zan T. Intraoperative Indocyanine Green Angiography Facilitates Flap Fenestration and Facial Organ Fabrication in Total Facial Restoration. Plast Reconstr Surg 2024; 153:1416-1424. [PMID: 37382913 PMCID: PMC11104494 DOI: 10.1097/prs.0000000000010891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/31/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Because of a lack of effective measures to visualize flap vasculature and perfusion, flap fenestration and facial organ fabrication cannot be performed effectively, preventing the transition from two-dimensional coverage to restoration of the three-dimensional (3D) structure of facial organs. This study aimed to evaluate the efficacy of indocyanine green angiography (ICGA) in guiding flap fenestration and facial organ fabrication in total facial restoration. METHODS Ten patients with total facial scarring after burn injury were enrolled in the study. They were treated with preexpanded, prefabricated monoblock flaps for total face restoration. The openings of nostrils and oral and palpebral orifices, together with organ fabrication, were conducted under the guidance of intraoperative ICGA by hemodynamic evaluation of flap perfusion. Postoperative follow-up measures include vascular crisis, infection, flap necrosis, and aesthetic and functional recovery. RESULTS The opening of facial organ orifices was performed at the stage of flap transfer in nine patients. To avoid damaging the major nourishing vessels, the left palpebral orifice was opened 8 days after the flap transfer in one patient, as observed by ICGA. Based on ICGA evaluation, the decision to perform additional vascular anastomosis before flap fenestration was made in six patients. Hemodynamic analysis of flap perfusion after fenestration revealed no significant change. Follow-up showed satisfactory aesthetic recovery and well-restored 3D structures of facial organs. CONCLUSION This pilot study demonstrates how intraoperative ICGA can enhance the safety of flap fenestration, thereby transforming full facial restoration from the two-dimensional to the 3D realm by facilitating facial organ fabrication. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Xin Huang
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine
| | - Haizhou Li
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine
| | - Shuchen Gu
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine
| | - Yashan Gao
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine
| | - Yimin Khoong
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine
| | - Yunhan Liu
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine
| | - Shenying Luo
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine
| | - Bin Gu
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine
| | - Qingfeng Li
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine
| | - Tao Zan
- From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University, School of Medicine
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Troisi N, Bertagna G, Tomei F, Adami D, Cioni R, Perrone O, Juszczak M, Berchiolli R. Long-term Outcome Comparison of 2 Techniques for Embolization of Splenic Artery Aneurysms. J Endovasc Ther 2024:15266028241255531. [PMID: 38813950 DOI: 10.1177/15266028241255531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
PURPOSE The aim of the study is to analyze our single-center experience in endovascular treatment of splenic artery aneurysms (SAAs) with transcatheter coil embolization, comparing long-term outcomes of packing and sandwich techniques. MATERIALS AND METHODS Between January 2010 and December 2021, 28 patients with certain diagnosis of non-ruptured asymptomatic SAA were treated with 2 different embolization techniques (packing, n=10, and sandwich, n=18). Early outcomes assessed were technical success, overall mortality, mean hospital stay, post-embolization syndrome rate, and freedom from splenectomy rate. Estimated 5-year outcomes in terms of freedom from sac reperfusion, and freedom from reintervention were evaluated and compared between the 2 different embolization techniques. RESULTS The mean SAA diameter was 2.8±0.8 cm. Overall technical success rate was 100%. Intraoperative and 30-day mortality rates were 0 in both groups. One patient in the sandwich group required a postoperative splenectomy. The mean follow-up period was 58.3±44.5 months. Estimated overall 5-year survival was 86.7%. Five-year freedom from sac reperfusion was 100% in the sandwich group, and 85.7% in the packing group, with no difference between the 2 groups (p=0.131), whereas freedom from reintervention was 100% in the sandwich group, and 75% in the packing group with a statistically significant difference (p=0.049; log-rank=3.750). CONCLUSIONS Embolization of SAAs seemed to be safe and effective with 100% of technical success rate and good perioperative results. Both sandwich and packing techniques yielded promising results also in the long-term period. CLINICAL IMPACT Transcatheter coil embolization of splenic artery aneurysms seems to be a safe and effective procedure with a 100% technical success and satisfactory perioperative outcomes. Sandwich and packing techniques offer good results in the long-term period. Freedom from reintervention seems to be optimal and comparable between the 2 techniques.
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Affiliation(s)
- Nicola Troisi
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giulia Bertagna
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesca Tomei
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Daniele Adami
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberto Cioni
- Department of Interventional Radiology, Pisa University Hospital, Pisa, Italy
| | - Orsola Perrone
- Department of Interventional Radiology, Pisa University Hospital, Pisa, Italy
| | - Maciej Juszczak
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Raffaella Berchiolli
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Cook WH, Burton K, Jefferies SJ, Duke SL, Jena R, Burnet NG, Kirollos RW, Helmy AE, Santarius T. Intra-operative extracorporeal irradiation of tumour-invaded craniotomy bone flap in meningioma: a case series. Acta Neurochir (Wien) 2024; 166:229. [PMID: 38787452 PMCID: PMC11126431 DOI: 10.1007/s00701-024-06126-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Extracorporeal irradiation of tumorous calvaria (EITC) can be performed to restore function and form of the skull after resection of bone-invasive meningioma. We sought to examine the rate of tumour recurrence and other selected outcomes in patients undergoing meningioma resection and EITC. METHODS Retrospective single-centre study of adult patients undergoing meningioma resection and EITC between January 2015 and November 2022 at a tertiary neurosurgical centre. Patient demographics, surgery data, tumour data, use of adjuvant therapy, surgical complications, and tumour recurrences were collected. RESULTS Eighteen patients with 11 (61%) CNS WHO grade 1, 6 (33%) grade 2, and 1 (6%) grade 3 meningiomas were included. Median follow-up was 42 months (range 3-88). Five (28%) patients had a recurrence, but none were associated with the bone flap. Two (11%) wound infections requiring explant surgery occurred. Six (33%) patients required a further operation. Two operations were for recurrences, one was for infection, one was a washout and wound exploration but no evidence of infection was found, one patient requested the removal of a small titanium implant, and one patient required a ventriculoperitoneal shunt for a persistent CSF collection. There were no cases of bone flap resorption and cosmetic outcome was not routinely recorded. CONCLUSION EITC is feasible and fast to perform with good outcomes and cost-effectiveness compared to other reconstructive methods. We observed similar recurrence rates and lower infection rates requiring explant compared to the largest series of cranioplasty in meningioma. Cosmetic outcome is universally under-reported and should be reported in future studies.
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Affiliation(s)
- William H Cook
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | - Katherine Burton
- Department of Radiation Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sarah J Jefferies
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Simon L Duke
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rajesh Jena
- Department of Radiation Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Neil G Burnet
- Department of Oncology, University of Cambridge, Cambridge, UK
- Proton Beam Therapy Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Ramez W Kirollos
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- The National Neuroscience Institute, Tan Tock Seng, Singapore
| | - Adel E Helmy
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Thomas Santarius
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Yang M, Zhong N, Lou Y, Jiang D, Liu Y, Dai Z, Wan W, Jiao J, Yang X, Xiao J. A Novel and Reproducible Classification of Cervical Dumbbell Tumors to Inform Surgical Approach and Reconstruction Techniques. Spine (Phila Pa 1976) 2024; 49:715-725. [PMID: 38239008 DOI: 10.1097/brs.0000000000004927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/03/2024] [Indexed: 04/25/2024]
Abstract
STUDY DESIGN A retrospective case series. OBJECTIVE This study developed a novel classification system based on imaging and anatomy to select optimal surgical approaches and reconstruction strategies to achieve total resection of cervical dumbbell tumors and restore spinal stability. SUMMARY OF BACKGROUND DATA Total resection is necessary to decrease the recurrence rate of cervical dumbbell tumors. Previous cervical dumbbell tumor classifications are insufficient for determining surgical strategies; therefore, a practical classification is needed. MATERIALS AND METHODS This study included 295 consecutive patients with cervical dumbbell tumors who underwent total surgical resection. A novel classification of cervical dumbbell tumors was developed based on magnetic resonance imaging and computed tomography. Continuous variables were expressed as mean±SD and were compared using an unpaired two-tailed Student t test. The χ 2 test or the Fisher exact test was used for categorical variables. Kendall's W test assessed three independent raters' inter-rater and intrarater reliabilities on 140 cervical dumbbell tumors. RESULTS The inter-rater and intrarater consistency coefficient was 0.969 (χ 2 =404.3, P <0.001) and 0.984 (χ 2 =273.7, P <0.001). All patients with type I and II tumors underwent single-posterior surgeries to achieve total resection. Of the patients in this study, 86.1%, 25.9%, 75.9%, and 76.9% underwent posterior surgeries for types IIIa, IIIb, IVa, and V tumors, respectively. All patients with type IVb tumors underwent a combined anterior and posterior approach. Posterior internal fixation was used for all patients in posterior surgery. Anterior reconstruction was applied for patients with type IVb tumors (20/20, 100%) and some with type V tumors (3/13, 23.1%). The mean follow-up duration was 93.6±2.6 months. A recurrence was observed in 19 (6.4%) patients. CONCLUSION The authors describe a novel classification system that is of practical use for planning the complete resection of cervical dumbbell tumors.
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Affiliation(s)
- Minglei Yang
- Department of Orthopedic Oncology, Spine Tumor Center, The Second Affiliated Hospital of Naval Medical University, Shanghai, China
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Kinet S, van Weezelenburg MAS, Pijnenburg A, Stoot JHMB, van Bastelaar J. Feasibility and complications after transoral endoscopic thyroidectomy via vestibular approach (TOETVA) - a single-center first experience case series. Langenbecks Arch Surg 2024; 409:158. [PMID: 38748236 DOI: 10.1007/s00423-024-03347-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND This paper reports on the first experience after implementation of a transoral endoscopic thyroidectomy via vestibular approach (TOETVA) as an alternative to (partial) thyroidectomy or isthmusectomy in a single center. Feasibility, implementation and specific complications are addressed. METHODS All patients who underwent a TOETVA procedure in our center between November 2019 and March 2023 were included. The surgical technique was performed as described by Anuwong et al. All procedures were performed by two dedicated head- and neck surgeons. RESULTS A total of 20 patients were included. All patients underwent TOETVA surgery as planned and no conversions were needed. Observed complications were post-operative wound infections (POWI) (2/20; 10%), clinically significant seroma (1/20, 5%) and unilateral hemiparesis of the larynx (3/20; 15%). Permanent mental nerve damage was seen in 3/20 patients (15%), and 4 other patients (20%) experienced transient neuropraxia. CONCLUSIONS TOETVA is a feasible alternative to (partial) thyroidectomy or isthmusectomy in selected patients. Special care should be taken when placing the trocars in the oral vestibulum to prevent mental nerve damage. Experience and training are essential for implementing the TOETVA procedure. TRIAL REGISTRATION This study was registered to ClinicalTrials.gov. TRIAL REGISTRATION NUMBER NCT05396703.
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Affiliation(s)
- Sam Kinet
- Faculty of Medicine, KU Leuven, Herestraat 49, Leuven, 3000, Belgium.
| | | | - A Pijnenburg
- Department of Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands
| | - J H M B Stoot
- Department of Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands
| | - J van Bastelaar
- Department of Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands
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