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Agarwal N, Dutta Satyarthee G. Symptomatic Diffuse Vasospasm After Resection of Temporal Ganglioglioma: Review of the Literature with Case Illustration. World Neurosurg 2019; 132:230-235. [PMID: 31505290 DOI: 10.1016/j.wneu.2019.08.239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Symptomatic cerebral vasospasm may occur in the setting of aneurysmal subarachnoid hemorrhage, traumatic brain injury, or after anterior skull base surgery, but its occurrence is extremely rare in the background of glioma surgical resection. CASE DESCRIPTION We present a rare case of symptomatic diffuse vasospasm, which is the fourth reported case of symptomatic vasospasm after temporal lobectomy and the third in the setting of a glial tumor. This patient, a 10-year-old boy, developed bilateral, progressive cerebral infarcts because of diffuse vasospasm after anteromesial temporal lobectomy for a left temporal ganglioglioma leading to significant morbidity. CONCLUSIONS The risk factors, likely pathogenesis and the importance of early diagnosis and timely institution of treatment, in such cases are discussed in the background of relevant literature. The current case represents the first report of symptomatic diffuse vasospasm occuring after surgical resection of intracranial ganglioglioma in the Western literature.
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Affiliation(s)
- Nitish Agarwal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Guru Dutta Satyarthee
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
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Dickerson JC, Hidalgo JA, Smalley ZS, Shiflett JM. Diffuse vasospasm after transcortical temporal lobectomy for intractable epilepsy. Acta Neurochir (Wien) 2018; 160:1883-1887. [PMID: 29987392 DOI: 10.1007/s00701-018-3606-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/25/2018] [Indexed: 11/26/2022]
Abstract
Cerebral delayed ischemia due to arterial vasospasm is a rare complication following epilepsy surgery. Here we report the third known case and first of diffuse vasospasm. A 48-year-old woman underwent a transcortical anterior left temporal lobectomy. Eleven days later, she had new-onset expressive aphasia with narrowing of the anterior, middle, and posterior cerebral arteries, and increased velocities via transcranial Doppler. She was treated with fluids, nimodipine, and permissive hypertension. At 6 months, her speech was near baseline. Cerebral vasospasm may represent a rare cause of morbidity after anterior temporal lobectomy; a literature review on the subject is presented.
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Affiliation(s)
- James Charles Dickerson
- Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Joaquin Andres Hidalgo
- Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Zachary Stidham Smalley
- Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - James Mason Shiflett
- Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
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Singh K, Drouin K, Newmark LP, Filkins M, Silvers E, Bain PA, Zulman DM, Lee JH, Rozenblum R, Pabo E, Landman A, Klinger EV, Bates DW. Patient-Facing Mobile Apps to Treat High-Need, High-Cost Populations: A Scoping Review. JMIR Mhealth Uhealth 2016; 4:e136. [PMID: 27993761 PMCID: PMC5206484 DOI: 10.2196/mhealth.6445] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/01/2016] [Accepted: 11/23/2016] [Indexed: 01/01/2023] Open
Abstract
Background Self-management is essential to caring for high-need, high-cost (HNHC) populations. Advances in mobile phone technology coupled with increased availability and adoption of health-focused mobile apps have made self-management more achievable, but the extent and quality of the literature supporting their use is not well defined. Objective The purpose of this review was to assess the breadth, quality, bias, and types of outcomes measured in the literature supporting the use of apps targeting HNHC populations. Methods Data sources included articles in PubMed and MEDLINE (National Center for Biotechnology Information), EMBASE (Elsevier), the Cochrane Central Register of Controlled Trials (EBSCO), Web of Science (Thomson Reuters), and the NTIS (National Technical Information Service) Bibliographic Database (EBSCO) published since 2008. We selected studies involving use of patient-facing iOS or Android mobile health apps. Extraction was performed by 1 reviewer; 40 randomly selected articles were evaluated by 2 reviewers to assess agreement. Results Our final analysis included 175 studies. The populations most commonly targeted by apps included patients with obesity, physical handicaps, diabetes, older age, and dementia. Only 30.3% (53/175) of the apps studied in the reviewed literature were identifiable and available to the public through app stores. Many of the studies were cross-sectional analyses (42.9%, 75/175), small (median number of participants=31, interquartile range 11.0-207.2, maximum 11,690), or performed by an app’s developers (61.1%, 107/175). Of the 175 studies, only 36 (20.6%, 36/175) studies evaluated a clinical outcome. Conclusions Most apps described in the literature could not be located on the iOS or Android app stores, and existing research does not robustly evaluate the potential of mobile apps. Whereas apps may be useful in patients with chronic conditions, data do not support this yet. Although we had 2-3 reviewers to screen and assess abstract eligibility, only 1 reviewer abstracted the data. This is one limitation of our study. With respect to the 40 articles (22.9%, 40/175) that were assigned to 2 reviewers (of which 3 articles were excluded), inter-rater agreement was significant on the majority of items (17 of 30) but fair-to-moderate on others.
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Affiliation(s)
- Karandeep Singh
- Departments of Learning Health Sciences and Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Kaitlin Drouin
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Lisa P Newmark
- Information Systems, Partners HealthCare System, Wellesley, MA, United States
| | - Malina Filkins
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Elizabeth Silvers
- Information Systems, Partners HealthCare System, Wellesley, MA, United States
| | - Paul A Bain
- Harvard Medical School, Boston, MA, United States
| | - Donna M Zulman
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, United States.,Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, United States
| | - Jae-Ho Lee
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ronen Rozenblum
- Harvard Medical School, Boston, MA, United States.,Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Erika Pabo
- Harvard Medical School, Boston, MA, United States.,Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Adam Landman
- Harvard Medical School, Boston, MA, United States.,Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Elissa V Klinger
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - David W Bates
- Harvard Medical School, Boston, MA, United States.,Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States.,Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA, United States
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Zhu W, Liu S, Zhao J, Liu S, Jiang S, Li B, Yang H, Fan C, Cui W. Highly flexible and rapidly degradable papaverine-loaded electrospun fibrous membranes for preventing vasospasm and repairing vascular tissue. Acta Biomater 2014; 10:3018-28. [PMID: 24704697 DOI: 10.1016/j.actbio.2014.03.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 02/21/2014] [Accepted: 03/20/2014] [Indexed: 10/25/2022]
Abstract
Vasospasm is a common post-operative complication after vascular anastomosis. Currently, the main treatment is a local injection of antispasmodic drugs. However, this method has a high rate of relapse and is subject to a large degree of individual variation, and repeated injections cause additional pain for patients. In this study, we developed highly flexible and rapidly degradable papaverine-loaded electrospun fibrous membranes to be wrapped around vascular suturing to prevent vasospasm. Poly-l-lactic acid/polyethylene glycol (PLLA/PEG) electrospun fibers containing papaverine maintained a high degree of flexibility and could withstand any folding, and are therefore suitable for wrapping vascular suturing. A rapid release of papaverine, between 2 and 7 days, was achieved by adjusting the proportions of PEG and PLLA. PLLA electrospun fibers containing 40% PEG (PLLA-40%) could control drug release and polymer degradation most effectively during the first 2 weeks post-operation. Testing using an in vivo rabbit model showed that PLLA-40% fibrous membranes produced significant antispasmodic effect without observable inflammation or hyperplasia, and the fibrous membranes were ideally biodegradable, with no impact on regional blood flow, pressure, vessel diameter or surrounding tissue hyperplasia. Therefore, papaverine-loaded electrospun fibrous membranes show the potential to greatly reduce post-operative vasospasm and maintain regular vascular morphology during antispasmodic therapy.
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