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Iaccarino C, Chibbaro S, Sauvigny T, Timofeev I, Zaed I, Franchetti S, Mee H, Belli A, Buki A, De Bonis P, Demetriades AK, Depreitere B, Fountas K, Ganau M, Germanò A, Hutchinson P, Kolias A, Lindner D, Lippa L, Marklund N, McMahon C, Mielke D, Nasi D, Peul W, Poca MA, Pompucci A, Posti JP, Serban NL, Splavski B, Florian IS, Tasiou A, Zona G, Servadei F. Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel. Brain Spine 2024; 4:102761. [PMID: 38510640 PMCID: PMC10951750 DOI: 10.1016/j.bas.2024.102761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/21/2024] [Indexed: 03/22/2024]
Abstract
Introduction Planning cranioplasty (CPL) in patients with suspected or proven post-traumatic hydrocephalus (PTH) poses a significant management challenge due to a lack of clear guidance. Research question This project aims to create a European document to improve adherence and adapt to local protocols based on available resources and national health systems. Methods After a thorough non-systematic review, a steering committee (SC) formed a European expert panel (EP) for a two-round questionnaire using the Delphi method. The questionnaire employed a 9-point Likert scale to assess the appropriateness of statements inherent to two sections: "Diagnostic criteria for PTH" and "Surgical strategies for PTH and cranial reconstruction." Results The panel reached a consensus on 29 statements. In the "Diagnostic criteria for PTH" section, five statements were deemed "appropriate" (consensus 74.2-90.3 %), two were labeled "inappropriate," and seven were marked as "uncertain."In the "Surgical strategies for PTH and cranial reconstruction" section, four statements were considered "appropriate" (consensus 74.2-90.4 %), six were "inappropriate," and five were "uncertain." Discussion and conclusion Planning a cranioplasty alongside hydrocephalus remains a significant challenge in neurosurgery. Our consensus conference suggests that, in patients with cranial decompression and suspected hydrocephalus, the most suitable diagnostic approach involves a combination of evolving clinical conditions and neuroradiological imaging. The recommended management sequence prioritizes cranial reconstruction, with the option of a ventriculoperitoneal shunt when needed, preferably with a programmable valve. We strongly recommend to adopt local protocols based on expert consensus, such as this, to guide patient care.
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Affiliation(s)
- Corrado Iaccarino
- School of Neurosurgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurosurgery Unit, University Hospital of Modena, Modena, Italy
- Neurosurgery Unit, AUSL RE IRCCS, Reggio Emilia, Italy
| | - Salvatore Chibbaro
- Neurosurgery Department, University of Siena, AOUS Le Scotte, Siena, Italy
| | - Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ivan Timofeev
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ismail Zaed
- Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | | | - Harry Mee
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Box 167, Level 4, A block Addenbrookes Hospital, Cambridge, UK
- NIHR Global Health Research Group on NeuroTrauma, University of Cambridge, Cambridge, UK
| | - Antonio Belli
- The Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andras Buki
- Department of Neurosurgery, School of Medical Sciences, University of Orebro, Orebro, Sweden
| | - Pasquale De Bonis
- Department of Neurosurgery, University of Ferrara and Sant'Anna University Hospital, Ferrara, Italy
| | - Andreas K. Demetriades
- Department of Neurosurgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
| | - Bart Depreitere
- Department of Neurosurgery, University Hospital Leuven, Leuven, Belgium
| | - Kostantinos Fountas
- Department of Neurosurgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Antonino Germanò
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
| | - Peter Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
| | - Angelos Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB20QQ, UK
| | - Dirk Lindner
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Laura Lippa
- Department of Neurosurgery, ASST Grande Ospedale Metrnoplitano Niguarda, Milano, Italy
| | - Niklas Marklund
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Department of Neurosurgery, Skåne University Hospital, Lund, Sweden
| | - Catherine McMahon
- Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Dorothee Mielke
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Davide Nasi
- Neurosurgery Unit, Azienda Ospedaliero-Universitaria, Modena, Italy
| | - Wilco Peul
- University Neurosurgical Centre Holland, Leiden University Medical Centre,l, Leiden-The Hague, the Netherlands
| | - Maria Antonia Poca
- Centre de Recerca Matemàtica (CRM), Bellaterra, Spain
- Department of Neurosurgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Surgery, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Angelo Pompucci
- Neurosurgery Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Jussi P. Posti
- Department of Neurosurgery and Turku Brain Injury Centre, University of Turku, Turku, Finland
| | | | - Bruno Splavski
- Department of Anatomy, University of Applied Health Sciences, Zagreb, Croatia
- Department of Surgery, Service of Neurosurgery, Dubrovnik General Hospital, Dubrovnik, Croatia
| | | | - Anastasia Tasiou
- Department of Neurosurgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Gianluigi Zona
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Franco Servadei
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Sato S, Ichimura H, Kobayashi K, Kawabata S, Kawamura T, Suzuki H, Imai A, Matsuzaki K, Sakata A, Matsubara D, Sato Y. Pulmonary artery sarcoma and severe valvular diseases in late-septuagenarian women: was 2-stage surgery an appropriate strategy? A case report. Surg Case Rep 2024; 10:10. [PMID: 38190036 PMCID: PMC10774505 DOI: 10.1186/s40792-023-01805-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Pulmonary artery sarcomas (PASs) are rare, and complete tumor resection is often difficult at the time of detection. We encountered a case of PAS that was thought to be resectable; however, the patient had severe symptomatic valvular disease. We faced a difficult decision regarding the surgical strategy. CASE PRESENTATION A 76-year-old female presented with a history of polysurgery for multiple primary cancers. She was referred to our department with a calcified mass in the right pulmonary artery (PA) and severe symptomatic valvular disease. After a discussion with the cardiovascular surgeon, we decided to perform a two-stage surgery. She underwent valvuloplasty through a median sternotomy, resulting in an improvement in her exertional dyspnea. The tumor was removed three months later with a right upper lobectomy and PA patch reconstruction through a posterolateral thoracotomy. When the PA was opened, the edge of the tumor was entrapped by vascular clamp forceps because of insufficient dissection of the adhesions between the superior vena cava and the right main PA resulting from the first operation. The patient underwent proton therapy twice for chest wall metastases which recurred three months after surgery, and local recurrence in the PA was diagnosed five months after surgery. The patient was alive with stable disease 25 months after surgery. CONCLUSION Two-stage surgery for PAS and valvular disease resulted in incomplete resection of the PAS in the right PA. It is important not to underestimate surgical adhesions due to the initial surgery and to consider and implement measures to prevent adhesions of critical vessels during the second operation.
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Affiliation(s)
- Sakiko Sato
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Hideo Ichimura
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan.
- Department of Thoracic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Keisuke Kobayashi
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Shuntaro Kawabata
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Tomoyuki Kawamura
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Hisashi Suzuki
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Akito Imai
- Department of Cardiovascular Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Kanji Matsuzaki
- Department of Cardiovascular Surgery, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Akiko Sakata
- Department of Pathology, Hitachi General Hospital, Hitachi, Ibaraki, 317-0077, Japan
| | - Daisuke Matsubara
- Department of Diagnostic Pathology, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukio Sato
- Department of Thoracic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Zilong M, Jinan Z, Weixin L, Peng W, Wei Z. Comparison of the surgical outcomes of the posterior approach, video-assisted thoracic surgery, and combined approach for thoracic dumbbell tumors based on a new classification: a retrospective study. Neurosurg Rev 2024; 47:29. [PMID: 38167736 PMCID: PMC10761486 DOI: 10.1007/s10143-023-02267-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/22/2023] [Accepted: 12/24/2023] [Indexed: 01/05/2024]
Abstract
The appropriate surgical treatment strategy was based on the regions of tumor invasion. There is no classification to aid the surgeon in selection. A retrospective study of the clinical data of patients who underwent resection of thoracic dumbbell tumors at the Neurosurgery and Thoracic Surgery Department of Hospital between January 1, 2016, and December 31, 2021 was conducted. Patient data, images, and surgical outcome data were collected. The thoracic spine was divided into areas A, B, and C with respect to the line through the middle of the intervertebral foramen and the line of the costo-transverse joint lateral margin in the horizontal plane. Type I tumors were located in areas A or A and B, type II tumors were located in areas B or B and C, and type III tumors were located in areas A, B, and C. Fifty-five patients with thoracic dumbbell tumors were surgically treated (mean age, 43.1 years; 22 (40%) female). The patients with type I and III tumors underwent the posterior approach, type III tumors had more bleeding during the operation and longer operation times than type I. Among the patients with type II tumors who underwent video-assisted thoracic surgery and the posterior approach, the posterior group had more bleeding and a longer operation time than the others. The patients with type III tumors underwent the combined approach and the posterior approach; although there was no clear difference in the bleeding volume or operation time, the combined approach group had a lower incidence of complications. The new classification of different types of thoracic dumbbell tumors can simply and effectively guide the selection of surgery.
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Affiliation(s)
- Mao Zilong
- Department of Spine Surgery, Xi'an No 3. Hospital, the Affiliated Hospital of, Northwest University, Xi'an, 710018, Shannxi, China
| | - Zhang Jinan
- Department of Neurosurgery, Tangdu Hospital Affiliated Air Force Medical University, Xi'an, 710000, Shannxi, China
| | - Li Weixin
- Department of Neurosurgery, Tangdu Hospital Affiliated Air Force Medical University, Xi'an, 710000, Shannxi, China
| | - Wang Peng
- Department of Neurosurgery, Tangdu Hospital Affiliated Air Force Medical University, Xi'an, 710000, Shannxi, China
| | - Zuo Wei
- Department of Spine Surgery, Xi'an No 3. Hospital, the Affiliated Hospital of, Northwest University, Xi'an, 710018, Shannxi, China.
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Jiang JH, Wu RH, Ren MX, Lin K, Lin W, Hu XT, Chen F, Zhao ZQ, Ge LN, Lin Z. Surgical strategy and outcome in patients with bilateral proliferative diabetic retinopathy. Int Ophthalmol 2023; 43:4921-4931. [PMID: 37837486 DOI: 10.1007/s10792-023-02895-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/27/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES To investigate the current surgery strategies for bilateral proliferative diabetic retinopathy (PDR), as well as the surgical outcomes of patients with bilateral PDR who underwent pars plana vitrectomy (PPV). MATERIALS Patients undergoing bilateral vitrectomy for PDR from January 2019 to December 2020 at The Eye Hospital of Wenzhou Medical University were enrolled. Clinical data were collected from the electronic medical records. Factors associated with the time interval between the surgeries on two eyes and postoperative visual outcomes were analyzed. RESULTS In total, 152 patients with bilateral PDR who underwent bilateral PPV were included in this analysis. Mean age was 53.7 ± 11.4 years. Compared with second-surgery eyes, 60.5% of first-surgery eyes had worse preoperative best-corrected visual acuity (BCVA). The overall PPV time (median, quartile range) between first and second surgeries eye was 1.40 (0.70, 3.15) months. Multivariate analysis showed that the preoperative BCVA of the second-surgery eye had a significant effect on the inter-surgery time interval (P = 0.048). First-surgery eyes had greater vision improvement than second-surgery eyes (Difference of the logarithm of the minimum angle of resolution [LogMAR] BCVA: - 1.00 [- 1.48, - 0.12] versus 0.00 [- 1.30, 0.00], respectively, P < 0.001), especially when eyes with poorer BCVA underwent PPV first (- 1.15 [- 1.87, - 0.54] versus 0.00 [- 0.70, 0.00], respectively, P < 0.001). CONCLUSIONS Visual acuity is a significant factor that influences surgical strategies, including both surgery order and interval, for patients with bilateral PDR. The eyes operated upon first show more vision improvement due to prompt surgery.
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Affiliation(s)
- Jun Hong Jiang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Rong Han Wu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Ming Xue Ren
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Ke Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Wei Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Xu Ting Hu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Feng Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Zhen Quan Zhao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Li Na Ge
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China
| | - Zhong Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270 West College Road, Wenzhou, 325027, Zhejiang, China.
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Yin J, Wu Y, Zhang Z, Zhang Y, He J, Yang Z, Wang B, Wang X, Liu G, Bie Z, Liu P. Operative management of trigeminal schwannomas: based on a modified classification in a study of 93 cases. Acta Neurochir (Wien) 2023; 165:4157-4168. [PMID: 37999914 DOI: 10.1007/s00701-023-05857-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Advances in microscopic and endoscopic surgical techniques have outpaced traditional classification and transcranial surgical strategies, especially with reference to the treatment of trigeminal schwannomas (TSs). A modified TS classification is proposed and appropriate surgical strategies are discussed. METHODS The cases of 93 patients who underwent surgical treatment in Beijing Tiantan Hospital in the previous 6 years were analyzed retrospectively, and a literature review was conducted. RESULTS Classification is based on surgical direction. Tumors were classified as follows: type A, backward orientation, located in the orbit or orbit and middle cranial fossa (8 cases, 8.6%); type B, upward orientation, located in the pterygopalatine fossa, infratemporal fossa or pterygopalatine fossa, infratemporal fossa, and middle cranial fossa (23 cases, 24.7%); type C, forward and backward orientations, located in the middle cranial fossa, posterior cranial fossa or both (58 cases, 62.4%); and type D, located in multiple regions (4 cases, 4.3%). 91.40% of patients underwent gross total resection (GTR) with 29 cases receiving endoscopic resection of whom 93.10% (27/29) experienced GTR. CONCLUSION The 93 cases were satisfactorily divided into four types, according to tumor location and surgical orientation, enabling safe and effective removal by appropriate surgery.
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Affiliation(s)
- Jie Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yihao Wu
- Department of Neurosurgery, Xuzhou Central Hospital, Xuzhou, People's Republic of China
| | - Zhe Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yu Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Junhua He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhijun Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Bo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xinchao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Gemingtian Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhixu Bie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Pinan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
- Department of Neural Reconstruction, Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China.
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Condello V, Beaufilis P, Becker R, Ahmad SS, Bonomo M, Dejour D, Eriksson K, Filardo G, Feucht MJ, Grassi A, Wilson A, Menetrey J, Pujol N, Rathcke M, Seil R, Strauss MJ, Tischer T. Management of anterior cruciate ligament revision in adults: the 2022 ESSKA consensus: part II- surgical strategy. Knee Surg Sports Traumatol Arthrosc 2023; 31:4652-4661. [PMID: 37700168 PMCID: PMC10598082 DOI: 10.1007/s00167-023-07550-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/10/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE The aim of this ESSKA consensus is to give recommendations based on scientific evidence and expert opinion to improve the diagnosis, preoperative planning, indication and surgical strategy in Anterior Cruciate Ligament revision. METHODS Part 2, presented herein, followed exactly the same methodology as Part 1: the so-called ESSKA formal consensus derived from the Delphi method. Eighteen questions were ultimately asked. The quality of the answers received the following grades of recommendation: Grade A (high level scientific support), Grade B (scientific presumption), Grade C (low level scientific support) or Grade D (expert opinion). All answers were scored from 1 to 9 by the raters. Once a general consensus had been reached between the steering and rating groups, the question-answer sets were submitted to the peer-review group. A final combined meeting of all the members of the consensus was then held to ratify the document. RESULTS The review of the literature revealed a rather low scientific quality of studies examining the surgical strategy in cases of ACL reconstruction failure. Of the 18 questions, only 1 received a Grade A rating; 5, a Grade B rating; and 9, grades of C or D. The three remaining complex questions received further evaluations for each portion of the question and were looked at in more detail for the following grades: B and D; A, C and D; or A, B, C and D. The mean rating of all questions by the rating group was 8.0 + - 1.1. The questions and recommendations are listed in the article. CONCLUSION ACL revision surgery, especially the surgical strategy, is a widely debated subject with many different opinions and techniques. The literature reveals a poor level of standardization. Therefore, this international European consensus project is of great importance and clinical relevance for guiding the management of ACL revision in adults. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Vincenzo Condello
- Joint Preservation and Reconstructive Surgery and Sports Medicine Unit, Humanitas Castelli Clinic, Bergamo, Italy.
- Department of Orthopaedic Surgery, Clinica San Francesco - GHC Group, Verona, Italy.
| | | | - Roland Becker
- Centre of Orthopaedic and Traumatology, University of Brandenburg an der Havel, Brandenburg, Germany
| | - Sufian S Ahmad
- Department of Orthopaedic Surgery of the Medical School of Hannover MHH, Annastift Hospital, Hannover, Germany
| | - Marco Bonomo
- Dipartimento di Ortopedia e Traumatologia, IRCCS Ospedale Sacro Cuore don Calabria, Negrar, VR, Italy
| | - David Dejour
- Lyon Ortho Clinic, Clinique de la sauvegarde Ramsay Santé, 29 avenue des sources, Lyon, France
| | - Karl Eriksson
- Department of Orthopaedics, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Giuseppe Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Matthias J Feucht
- Department of Orthopaedic Surgery Paulinenhilfe, Diakonie Klinikum, Stuttgart, Germany
- Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Adrian Wilson
- Orthopaedic Specialist Group, Harley Street Specialist Hospital, Queen Anne St, London, UK
| | - Jacques Menetrey
- Center of Sports Medicine and Exercise, Hirslanden Clinique La Colline, Geneva, Switzerland
- Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland
| | - Nicolas Pujol
- Centre Hospitalier de Versailles, Department of Orthopaedic and Trauma Surgery, Le Chesnay, France
| | - Martin Rathcke
- Department of Orthopaedics and Sportstraumatology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier - Clinique d'Eich and Luxembourg Institute of Health, Luxembourg, Luxembourg
| | | | - Thomas Tischer
- Department of Orthopaedic and Trauma Surgery, Waldkrankenhaus Erlangen, Erlangen, Germany
- Department of Orthopaedic Surgery, University Medicine Rostock, Rostock, Germany
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Zhang W, Yin W, Cui X, Chai Z, Zheng G, Ding Y, Wang H, Zhai Y, Yu H. Operative strategies for ankylosing spondylitis-related thoracolumbar kyphosis: focus on the cervical stiffness, coronal imbalance and hip involvement. BMC Musculoskelet Disord 2023; 24:723. [PMID: 37697276 PMCID: PMC10494390 DOI: 10.1186/s12891-023-06810-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 08/18/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Cervical stiffness, coronal imbalance and limited hip movement all play crucial roles in designing the corrective surgery for ankylosing spondylitis-related thoracolumbar kyphosis (AS-TLK). However, a comprehensive classification and tailored strategies for directing clinical work are lacking. This study aims to investigate the types and surgical strategies for AS-TLK that consider cervical stiffness, coronal imbalance and hip involvement as the key factors. METHODS 25 consecutive AS-TLK patients were divided into three types according to their accompanying features: Type I: with a flexible cervical spine; Type IIA: with a stiff cervical spine; Type IIB: with coronal imbalance; Type IIC: with limited hip movement. Type III is the mixed type with at least two conditions of Type II. Individual strategies were given correspondingly. Spinal-pelvic-femoral parameters were measured, Scoliosis Research Society outcome instrument-22 (SRS-22) was used and complications were recorded and analysed. RESULTS All patients (Type I 10, Type II 8 and Type III 7) underwent surgery successfully. 13 cases with 16 complications were recorded and cured. The patients were followed up for 24-65 months with an average of 33.0 ± 9.6 months. Both the sagittal and coronal parameters were corrected and decreased significantly (all, p < 0.05). SRS-22 scores showed a satisfactory outcome. CONCLUSION Thoracolumbar kyphosis secondary to ankylosing spondylitis are complex and variable. Considering the factors of cervical stiffness, coronal imbalance and hip involvement assists in making decisions individually and achieving a desired surgical result.
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Affiliation(s)
- Wei Zhang
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Wen Yin
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Xilong Cui
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Zihao Chai
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Guohui Zheng
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Ya Ding
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Hongliang Wang
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Yunlei Zhai
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Haiyang Yu
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China.
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China.
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8
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Qian A, Li R, Zhou J, Yu J, Huo G, Wang X. Clinical features and surgical outcomes of Rathke cleft cysts with suprasellar components: a single-center experience of 157 cases. Acta Neurochir (Wien) 2023; 165:2267-2276. [PMID: 37160776 DOI: 10.1007/s00701-023-05617-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/29/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Both intrasuprasellar and suprasellar Rathke cleft cysts (RCCs) have suprasellar components, and we aimed to explore their clinical features and surgical outcomes. METHOD Patients with surgically treated intrasuprasellar or suprasellar RCCs were retrospectively analyzed. All patients with intrasuprasellar RCCs were treated with the standard endoscopic endonasal approach (EEA, group I); the patients with suprasellar RCCs received the extended EEA (group II) or supraorbital keyhole approach (SKA, group III) according to the relevant indications. A surgical strategy of maximal safe resection aiming to protect neuroendocrine function was adopted. In addition, patients (distinguished from the above 3 groups) who had aggressive resection of suprasellar RCC were also enrolled for comparison of different surgical strategies. RESULTS A total of 157 patients were eligible, including 121 patients with intrasuprasellar RCCs in group I, 19 patients with suprasellar RCCs in group II, and 17 patients with suprasellar RCCs in group III. Preoperatively, the patients with suprasellar RCC (groups II and III) more commonly presented with visual dysfunction, diabetes insipidus (DI), and hyperprolactinemia than the patients with intrasuprasellar RCCs (all p<0.05). A higher incidence of hypopituitarism and a larger diameter were observed for intrasuprasellar RCCs (both p<0.05). Postoperatively, group II had a higher rate of new-onset DI, hyponatremia, and recurrence than group I (all p<0.025) and similar outcomes to group III. For suprasellar RCCs, comparison of the maximal safe resection vs. aggressive resection (supplementary patients: 14 with extended EEA, 12 with SKA) showed similar improvement and recurrence, with higher rates of DI and hyponatremia with the latter strategy (all p<0.05). CONCLUSIONS Suprasellar RCC is associated with more complicated preoperative presentations, intricate postoperative complications, and frequent recurrence compared with intrasuprasellar RCC. Under rational indications, both extended EEA and SKA achieve satisfactory outcomes. The strategy of maximal safe resection is recommended for greatest functional preservation.
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Affiliation(s)
- Ao Qian
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ruichun Li
- Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jing Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiaojiao Yu
- Department of Neurosurgery ward II, BaZhong Central Hospital, Bazhong, China
| | - Gang Huo
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoshu Wang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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9
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Liu DN, Jia WW, Wang HY, Wu JH, Li CP, Hao CY. Cytoreductive surgery offers prognostic benefits in metastatic gastrointestinal stromal tumors with generalized progression following imatinib therapy: a single institute retrospective study. BMC Surg 2023; 23:189. [PMID: 37403109 DOI: 10.1186/s12893-023-02087-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Distant metastasis has been detected in approximately 50% of GIST patients at the first diagnosis. The surgical strategy for metastatic GIST with generalized progression (GP) after imatinib therapy remains unclear. METHODS We recruited 15 patients with imatinib-resistant metastatic GIST. They received cytoreductive surgery (CRS) for tumor rupture, intestinal obstruction and gastrointestinal bleeding. We collected clinical, pathological and prognostic data for analyses. RESULTS OS and PFS after R0/1 CRS were 56.88 ± 3.47 and 26.7 ± 4.12 months, respectively, when compared with 26 ± 5.35 and 5 ± 2.78 months after R2 CRS (P = 0.002 and P < 0.001, respectively). The OS of patients from the initiation of imatinib in the R0/1 group was 133.90 ± 15.40 months when compared with 59.80 ± 10.98 months in the R2 CRS group. There were two significant grade III complications after 15 operations (13.3%). No patient underwent reoperation. In addition, no perioperative death occurred. CONCLUSIONS R0/1 CRS is highly probable to provide prognostic benefits for patients with metastatic GIST who experience GP following imatinib treatment. An aggressive surgical strategy for achieving R0/1 CRS can be deemed safe. If applicable, R0/1 CRS should be carefully considered in imatinib-treated patients with GP metastatic GIST.
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Affiliation(s)
- Dao-Ning Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, People's Republic of China
| | - Wei-Wei Jia
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, People's Republic of China
| | - Hai-Yue Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Jian-Hui Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, People's Republic of China
| | - Cheng-Peng Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, People's Republic of China
| | - Chun-Yi Hao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, People's Republic of China.
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10
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Xu B, Zhao W, Chang J, Yin J, Wang N, Dong Z, Zhi X, Li T, Chen Z. Comparative study on left-sided versus right-sided hepatectomy for resectable peri-hilar cholangiocarcinoma: a systematic review and meta-analysis. World J Surg Oncol 2023; 21:153. [PMID: 37202795 DOI: 10.1186/s12957-023-03037-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/13/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Peri-hilar cholangiocarcinoma (pCCA) is a unique entity, and radical surgery provides the only chance for cure and long-term survival. But it is still under debate which surgical strategy (i.e., left-sided hepatectomy, LH or right-sided hepatectomy, RH) should be followed and benefitted. METHODS We performed a systematic review and meta-analysis to analyze the clinical outcomes and prognostic value of LH versus RH for resectable pCCA. This study followed the PRISMA and AMSTAR guidelines. RESULTS A total of 14 cohort studies include 1072 patients in the meta-analysis. The results showed no statistical difference between the two groups in terms of overall survival (OS) and disease-free survival (DFS). But compared to the LH group, the RH group exhibited more employment of preoperative portal vein embolization (PVE), higher rate of overall complications, post-hepatectomy liver failure (PHLF), and perioperative mortality, while LH was associated with higher frequency of arterial resection/reconstruction, longer operative time, and more postoperative bile leakage. There was no statistical difference between the two groups in terms of preoperative biliary drainage, R0 resection rate, portal vein resection, intraoperative bleeding, and intraoperative blood transfusion rate. CONCLUSIONS According to our meta-analyses, LH and RH have comparable oncological effects on curative resection for pCCA patients. Although LH is not inferior to RH in DFS and OS, it requires more arterial reconstruction which is technically demanding and should be performed by experienced surgeons in high-volume centers. Selectin of surgical strategy between LH and RH should be based on not only tumor location (Bismuth classification) but also vascular involvement and future liver remnant (FLR).
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Affiliation(s)
- Bowen Xu
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
- Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 West Wen Hua Road, Jinan, 250012, People's Republic of China
| | - Wei Zhao
- Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 West Wen Hua Road, Jinan, 250012, People's Republic of China
| | - Jianhua Chang
- Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 West Wen Hua Road, Jinan, 250012, People's Republic of China
| | - Jinghua Yin
- National Engineering Laboratory of Medical Implantable Devices, Key Laboratory for Medical Implantable Devices of Shandong Province, WEGO Holding Company Limited, Weihai, 264210, People's Republic of China
| | - Nan Wang
- Department of Hepatobiliary Surgery, General Surgery, The Second Hospital of Shandong University, Jinan, 250033, People's Republic of China
| | - Zhaoru Dong
- Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 West Wen Hua Road, Jinan, 250012, People's Republic of China
| | - Xuting Zhi
- Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 West Wen Hua Road, Jinan, 250012, People's Republic of China
| | - Tao Li
- Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 West Wen Hua Road, Jinan, 250012, People's Republic of China
- Department of Hepatobiliary Surgery, General Surgery, The Second Hospital of Shandong University, Jinan, 250033, People's Republic of China
| | - Zhiqiang Chen
- Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 West Wen Hua Road, Jinan, 250012, People's Republic of China.
- National Engineering Laboratory of Medical Implantable Devices, Key Laboratory for Medical Implantable Devices of Shandong Province, WEGO Holding Company Limited, Weihai, 264210, People's Republic of China.
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Liu Y, Fu X, Chen H, Yao Q. Surgical strategies for recurrent parastomal hernia after a primary repair with a Dynamesh(®) IPST mesh. Hernia 2023. [PMID: 36811791 DOI: 10.1007/s10029-023-02757-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/12/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To introduce our surgical strategies for recurrent parastomal hernia after a primary repair with a Dynamesh® IPST mesh. METHODS Ten patients who underwent recurrent parastomal hernia repair with previous Dynamesh® IPST mesh use were analyzed retrospectively. Distinct surgery strategies were applied. Accordingly, we investigated the recurrence rate and postoperative complications in these patients, who were followed for an average of 35.9 months after surgery. RESULTS There was no recorded death and no readmission during the 30-day postoperative period. And the lap-re-do Sugarbaker group had no recurrence, whereas the open suture group had one recurrence (16.7%). One patient in the Sugarbaker group developed ileus and recovered conservatively during the follow-up period. There were no other complications, including seroma, mesh infection and bulging, or prolonged postoperative pain. CONCLUSIONS We offer two predominant surgery strategies for recurrent parastomal hernia with a previous Dynamesh® IPST mesh usage, the open suture repair, and the Lap-re-do Sugarbaker repair. Even though the results of the Lap-re-do Sugarbaker repair are satisfactory, we recommend the open suture technique as it is safer in a setting of dense adhesions in recurrent parastomal hernias.
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Shetty AP, Murugan C, Karuppannan Sukumaran SVA, Yarlagadda A, Naik AS, Kanna RM, Rajasekaran S. Surgical Approach to Cervical Fractures in Ankylosing Spondylitis Patients: Rationale and Surgical Strategy. World Neurosurg 2023:S1878-8750(23)00185-7. [PMID: 36791881 DOI: 10.1016/j.wneu.2023.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Current literature lacks objective criteria to determine surgical management in patients with ankylosing spondylitis who sustain cervical fractures. The purpose of our study was to analyze the determinants for stratifying surgical approach, evaluate the outcome in patients, and postulate a management strategy. METHODS This was a retrospective study of patients with ankylosing spondylitis who underwent surgery for cervical spine injury with a minimum follow-up of 2 years. Neurological recovery, fracture pattern including translation and angulation, surgical duration, blood loss, and postoperative complications were recorded, and a comparative analysis of these factors with anterior, posterior, and combined surgical approaches was performed. RESULTS The study included 43 men with a mean age of 57 years; 49% underwent anterior-only stabilization, 16% underwent posterior-only stabilization, and 35% underwent combined anteroposterior stabilization. Mean operative time was significantly lower in anterior-only (81.4 minutes; P < 0.05) and posterior-only (124 minutes; P < 0.05) approaches compared with combined approach (266.6 minutes). Mean blood loss was significantly lower in anterior-only (87.5 mL, P < 0.05) approach compared with posterior-only (714.7 mL) and combined (912.7 mL) approaches. Mean translation was 1.8 mm, 1.7 mm, and 3.7 mm in anterior, posterior, and combined approaches (P < 0.05), respectively. CONCLUSIONS Our study provides insights into management of cervical spine fractures in ankylosing spondylitis patients. A fracture displacement ≤2 mm may be successfully managed by an anterior approach, while the posterior approach may be beneficial in similar fractures warranting instrumentation extending to the thoracic spine. All other fractures warrant a combined surgical approach.
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13
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Wu N, Ma X, Shen W, Hou Z, Han W, Dai P, Zhao H, Huang D, Han D, Yang S. Surgical management of endolymphatic sac tumor: classification, outcomes and strategy. A single institution's experience. Eur Arch Otorhinolaryngol 2023; 280:69-76. [PMID: 35739425 DOI: 10.1007/s00405-022-07447-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/11/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE To review the resections of endolymphatic sac tumor (ELST) and describe our experience in the surgical management of ELST. METHODS Retrospective investigation of consecutive patients who underwent resection of ELSTs at our hospital between 1999 and 2019. The symptoms, diagnosis, surgical findings, and outcomes were analyzed to develop a tumor staging system and corresponding surgical strategy. RESULTS Retrospective review revealed the surgical treatment of 22 ELSTs. Based on intraoperative findings of tumor extent and size, ELSTs were classified into two types. Type-I (n = 6) referred to the small tumors that were locally confined with limited invasion of semicircular canals and dura; type-II (n = 16) referred to the large tumors that presented extensive erosion of at least one anatomic structure apart from the semicircular canals and the dura around endolymphatic sac. In this case series, Type-I ELST is amenable to resection through a transmastoidal approach, and subtotal petrosectomy is appropriate for the resection of type-II ELST. Sensorineural hearing loss (SNHL) is the most commonly preoperative symptom in both two types of cases. Five type-II ELSTs experienced recurrence and underwent reoperation, whereas all type-I ELSTs did not. CONCLUSION ELST usually results in SNHL (95%) at the time of diagnosis. The surgical strategy and prognosis of ELST resections are different between type-I and type-II: type-I ELST is amenable to transmastoidal approach with the preservation of facial nerve, whereas type-II ELST increase the surgical difficulty and the risk of recurrence, and subtotal petrosectomy is the basic requirement for the resection of type-II ELST.
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Affiliation(s)
- Nan Wu
- Senior Department of Otolaryngology-Head & Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,State Key Lab of Hearing Science, Ministry of Education, Beijing, China.,Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Xiaoyan Ma
- Senior Department of Otolaryngology-Head & Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,State Key Lab of Hearing Science, Ministry of Education, Beijing, China.,Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China.,The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Weidong Shen
- Senior Department of Otolaryngology-Head & Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,State Key Lab of Hearing Science, Ministry of Education, Beijing, China.,Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Zhaohui Hou
- Senior Department of Otolaryngology-Head & Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,State Key Lab of Hearing Science, Ministry of Education, Beijing, China.,Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Weiju Han
- Senior Department of Otolaryngology-Head & Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,State Key Lab of Hearing Science, Ministry of Education, Beijing, China.,Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Pu Dai
- Senior Department of Otolaryngology-Head & Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,State Key Lab of Hearing Science, Ministry of Education, Beijing, China.,Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Hui Zhao
- Senior Department of Otolaryngology-Head & Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,State Key Lab of Hearing Science, Ministry of Education, Beijing, China.,Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Deliang Huang
- Senior Department of Otolaryngology-Head & Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,State Key Lab of Hearing Science, Ministry of Education, Beijing, China.,Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Dongyi Han
- Senior Department of Otolaryngology-Head & Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China. .,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China. .,State Key Lab of Hearing Science, Ministry of Education, Beijing, China. .,Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China. .,Department of Otolaryngology, Head and Neck Surgery, Institute of Otolaryngology, Chinese PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, China.
| | - Shiming Yang
- Senior Department of Otolaryngology-Head & Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China.,National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.,State Key Lab of Hearing Science, Ministry of Education, Beijing, China.,Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
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Tan Y, Li X, Zhang Q, Zhou X, Zhang J. Surgical strategy and outcomes for thoracolumbar disc herniation with Autologous Bone-Fusion or Cage-Fusion surgery: case series and literature review. Biotechnol Genet Eng Rev 2022:1-13. [PMID: 36544424 DOI: 10.1080/02648725.2022.2159634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
To analyze the clinical characteristics and surgical outcomes of TLDH with Autologous Bone-Fusion for T10-L1 TLDH or Cage-Fusion for T12-L3 TLDH. This is a retrospective multi-center clinical study, involving a total of 43 patients with TLDH who underwent surgery in our institutions from December 2013 to January 2021. In all, 15 of 43 patients (34.9%) with T10-11(2)/T11-12(5)/T12-L1 (8) TLDH underwent Autologous Bone-Fusion surgery and 28 of 43 patients (65.1%) with T12-L1(3)/L1-L2(12)/L2-L3(13) TLDH underwent Cage-Fusion surgery. Demographic data, clinical characteristics and perioperative outcomes were recorded. During the follow-up, pre- to post-operative ODI, VAS back and leg pain scores significantly decreased (P1.2 = 0.001) and the score changes had no significant difference between two groups (P3 = 0.81, 0.59, 0.68). The intraoperative blood loss and operation time showed no significant difference between two groups (P = 0.056, 0.072). The patients showed prominent improvement of hypokinesia and satisfactory rate in two groups (5/7, 71.4% VS 9/12, 75.0%, P = 0.633; 11, 73.3% VS 25, 89.3%, P = 0.281). Notably, no recurrence and severe complications were reported. The choice of surgery approach should be individualized by clinical characteristics and radiology. Selectively Autologous Bone-Fusion for T10-L1 TLDH or Cage-Fusion for T12-L3 TLDH provided adequate nerve decompression and immediate stability. The overall fusion surgical outcomes were satisfactory without major complications during follow-up.
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Affiliation(s)
- YiXuan Tan
- Department of Orthopedics, Shanghai Changzhen Hospital, Shanghai, China
| | - Xiaoming Li
- Department of Orthopaedics, 72nd Group Army Hospital, Huzhou University, Huzhou, Zhejiang, China
| | - Qian Zhang
- Qindao Special servicemen Recuperation Center of PLA Navy, Qingdao, China
| | - Xuhui Zhou
- Department of Orthopedics, Shanghai Changzhen Hospital, Shanghai, China
| | - Jiefeng Zhang
- Department of Orthopaedics, 72nd Group Army Hospital, Huzhou University, Huzhou, Zhejiang, China
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Bourget-Murray J, Horton I, Morris J, Bureau A, Garceau S, Abdelbary H, Grammatopoulos G. Periprosthetic joint infection following hip hemiarthroplasty : factors associated with infection and treatment outcome. Bone Jt Open 2022; 3:924-932. [PMID: 36454723 PMCID: PMC9783270 DOI: 10.1302/2633-1462.312.bjo-2022-0138.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
AIMS The aims of this study were to determine the incidence and factors for developing periprosthetic joint infection (PJI) following hemiarthroplasty (HA) for hip fracture, and to evaluate treatment outcome and identify factors associated with treatment outcome. METHODS A retrospective review was performed of consecutive patients treated for HA PJI at a tertiary referral centre with a mean 4.5 years' follow-up (1.6 weeks to 12.9 years). Surgeries performed included debridement, antibiotics, and implant retention (DAIR) and single-stage revision. The effect of different factors on developing infection and treatment outcome was determined. RESULTS A total of 1,984 HAs were performed during the study period, and 44 sustained a PJI (2.2%). Multiple logistic regression analysis revealed that a higher CCI score (odds ratio (OR) 1.56 (95% confidence interval (CI) 1.117 to 2.187); p = 0.003), peripheral vascular disease (OR 11.34 (95% CI 1.897 to 67.810); p = 0.008), cerebrovascular disease (OR 65.32 (95% CI 22.783 to 187.278); p < 0.001), diabetes (OR 4.82 (95% CI 1.903 to 12.218); p < 0.001), moderate-to-severe renal disease (OR 5.84 (95% CI 1.116 to 30.589); p = 0.037), cancer without metastasis (OR 6.42 (95% CI 1.643 to 25.006); p = 0.007), and metastatic solid tumour (OR 15.64 (95% CI 1.499 to 163.087); p = 0.022) were associated with increasing PJI risk. Upon final follow-up, 17 patients (38.6%) failed initial treatment and required further surgery for HA PJI. One-year mortality was 22.7%. Factors associated with treatment outcome included lower preoperative Hgb level (97.9 g/l (SD 11.4) vs 107.0 g/l (SD 16.1); p = 0.009), elevated CRP level (99.1 mg/l (SD 63.4) vs 56.6 mg/l (SD 47.1); p = 0.030), and type of surgery. There was lower chance of success with DAIR (42.3%) compared to revision HA (66.7%) or revision with conversion to total hip arthroplasty (100%). Early-onset PJI (≤ six weeks) was associated with a higher likelihood of treatment failure (OR 3.5 (95% CI 1.2 to 10.6); p = 0.007) along with patients treated by a non-arthroplasty surgeon (OR 2.5 (95% CI 1.2 to 5.3); p = 0.014). CONCLUSION HA PJI initially treated with DAIR is associated with poor chances of success and its value is limited. We strongly recommend consideration of a single-stage revision arthroplasty with cemented components.Cite this article: Bone Jt Open 2022;3(12):924-932.
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Affiliation(s)
| | - Isabel Horton
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Jared Morris
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Antoine Bureau
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Simon Garceau
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Hesham Abdelbary
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - George Grammatopoulos
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada,Correspondence should be sent to George Grammatopoulos. E-mail:
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Chen X, Zhang R, Zhang Q, Xu Z, Xu F, Li D, Li Y. Microtia Part I: Preoperation and In-operation Lessons from 1012 Ear Reconstruction Operations. Aesthetic Plast Surg 2022; 46:2781-2787. [PMID: 35195772 DOI: 10.1007/s00266-022-02818-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/30/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Organ reconstruction is one of the most challenging tasks in plastic and reconstructive surgery. This is particularly true of ear reconstruction, which requires enormous attention to detail. METHODS In the first of two articles, we set out details and precautions for each step of the preoperative and intraoperative stages of the ear reconstruction process for microtia patients. We cover preoperative screening and assessment of surgical conditions, the design of intraoperative incisions, flap separations, costal cartilage extraction, framework carving and cranial ear angle surgery. RESULTS Over the period Jan 2015-July 2021, our surgical team carried out 1012 microtia ear reconstructions, at the rate of 3-4 per week. This article presents the key learnings from this high volume of operations. Two typical cases involving different types of microtia are presented in order to illustrate the process of total ear reconstruction. CONCLUSIONS This article describes in detail the preoperative and intraoperative stages of the ear reconstruction process. We share our cumulative surgical experience gained over 20 years, especially the latest practical lessons gleaned over the last six and a half years. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Xia Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Ruhong Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Qun Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Zhicheng Xu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Feng Xu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Datao Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yiyuan Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
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Hijikata Y, Ueda S, Yasuhara T, Umebayashi D, Endo T, Takami T, Mizuno M, Hida K, Hoshimaru M. Description of the Diversity in Surgical Indication and Surgical Strategies for Primary Spinal Cord Tumors: A Nationwide Survey by the Neurospinal Society of Japan. Neurospine 2022; 19:1122-1129. [PMID: 36597646 PMCID: PMC9816577 DOI: 10.14245/ns.2244686.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/14/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To assess the current management of primary spinal cord tumors (PSCTs) and determine whether and to what extent there are differences in surgical strategies for PSCTs. METHODS The Neurospinal Society of Japan conducted a survey between April 1 and 30, 2021. Certified spine surgeons were requested for information on the frequency of surgeries in 2020 and the surgical strategies adopted for each PSCTs. The following tumor histologies were focused: schwannoma, meningioma, and cauda equina tumor as extramedullary tumors; and ependymoma, hemangioblastoma, astrocytoma, and cavernoma as intramedullary tumors. The participants were divided according to their response as follows: experts, who had experienced ≥ 100 surgeries for PSCTs, and nonexperts. RESULTS Among 308 participants (63%), 35 (11%) were experts. The total number of PSCTs in 2020 was 802 of which 564 tumors were extramedullary and 223 were intramedullary. Schwannoma accounted for 53% of the extramedullary tumors, and ependymoma accounted for 39% of the intramedullary tumors. Surgical strategies significantly differed among both the experts and nonexperts groups. Some discrepancies in the adopted surgical strategies were observed between groups. Some of the nonexperts, and none of the experts, ruled out surgery for schwannomas (Eden type 4), astrocytomas, or cavernomas. Five nonexperts (2.2%), and none of the experts, resected the entire dura for meningiomas. CONCLUSION A nationwide survey revealed that a sufficient consensus did not exist regarding surgical strategies for PSCTs. A disease-specific registry for PSCTs is necessary in academic societies.
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Affiliation(s)
- Yasukazu Hijikata
- Spine and Low Back Pain Center, Kitasuma Hospital, Kobe, Japan,Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan,Corresponding Author Yasukazu Hijikata Spine and Low Back Pain Center, Kitasuma Hospital, 1-1, 1 Cho-me, Higashishirakawadai, Sma-ku, Kobe 654-0102, Japan
| | - Shigeo Ueda
- Shin-Aikai Spine Center, Katano Hospital, Katano, Japan
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Daisuke Umebayashi
- Department of Neurosurgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiki Endo
- Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Toshihiro Takami
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masaki Mizuno
- Department of Minimum-Invasive Neurospinal Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kazutoshi Hida
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan
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Liu P, Liu Y, Shi Y, An Q, Zhu W, Liu Y, Li P, Tian Y. The Vascular Architecture of Cavernous Sinus Dural Arteriovenous Fistula and Its Impact on Endovascular Treatment Approach Selection and Outcome. World Neurosurg 2022; 166:e770-e780. [PMID: 35933096 DOI: 10.1016/j.wneu.2022.07.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND A cavernous sinus (CS) dural arteriovenous fistula (DAVF) is a form of abnormal arteriovenous communication that can be treated with endovascular embolization. Establishing an optimal access route should be based on vascular architecture. We reviewed 64 patients with CS-DAVF who underwent endovascular embolization and report the endovascular treatment approach selection and outcome. METHODS Clinical data were obtained from 64 patients with CS-DAVF who had been surgically treated at the authors' hospital between 2009 and 2022. Patients' medical records, imaging data, and follow-up outcomes were retrospectively analyzed. RESULTS All 64 patients (15 male, 49 female; mean age, 50 years) underwent CS-DAVF embolization. The most common symptoms were exophthalmos (39.1%), chemosis (35.9%), and headache (28.1%). On digital subtraction angiography images, 34.4% of the DAVFs were unilateral, and 82.8% were fed by both the external carotid artery and internal carotid artery. Of the patients' inferior petrosal sinuses (IPSs), 54.7% were nonopacified. The most common intravascular approaches included trans-IPS (37.5%) and trans-artery (28.1%) approaches. More than half of the CS-DAVFs were embolized by both coils and Onyx (62.5%). A total of 85.9% of the fistulas were completely embolized, and the follow-up rate was 76.6%. The modified Rankin Scale score was 0.9 ± 1.0. CONCLUSIONS The vascular architecture of CS-DAVF is closely related to endovascular treatment approach selection and outcome. Combined with the modified IPS recanalization technique, the trans-IPS approach is the safest and most effective approach. Dual microcatheter and balloon assistance techniques ensure the safety and completeness of embolization.
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Affiliation(s)
- Peixi Liu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Yingjun Liu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Yuan Shi
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Qingzhu An
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Wei Zhu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Yingtao Liu
- Department of Radiology, Huashan Hospital of Fudan University, Shanghai, China
| | - Peiliang Li
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Yanlong Tian
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.
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Sun C, Chen Z, Chen G, Li W, Qi Q, Guo Z, Zhong W. A new "de-tension"-guided surgical strategy for multilevel ossification of posterior longitudinal ligament in thoracic spine: a prospective observational study with at least 3-year follow-up. Spine J 2022; 22:1388-1398. [PMID: 35351669 DOI: 10.1016/j.spinee.2022.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/11/2022] [Accepted: 03/22/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND CONTEXT Multilevel ossification of the posterior longitudinal ligament in thoracic spine (mT-OPLL) is a rare but clinically significant spinal condition. Various surgical methods have been developed to address this disease. However, the outcomes are commonly unfavorable, and no standard surgical strategy has been established. To solve this problem, we introduced a new surgical strategy based on an innovative decompression concept, namely "de-tension." PURPOSE This study aimed to investigate the safety and efficacy of this new treatment, and to establish an improved surgical strategy. STUDY DESIGN A prospective observational study with at least 3 years of follow-up. PATIENT SAMPLE Fifty-one patients with consecutive mT-OPLL who were treated between August-2012 and June-2018 were enrolled in this study. OUTCOME MEASURES A modified Japanese Orthopedic Association (mJOA) scale assessing thoracic spine, recovery rate (RR), and surgical complications. METHODS All patients underwent 1-stage thoracic posterior laminectomy, selective OPLL resection, and spinal column shortening with/without reduction of kyphosis (dekyphosis). Initially, we recommended that when thoracic kyphosis of T1-T12 in sagittal reconstruction CT (TK) was less than 20°, no dekyphosis should be performed; when this angle was greater than 20°, dekyphosis could be conducted. Patients' demographic data, radiological findings, and intra/postoperative complications were recorded and analyzed. Neurological status was evaluated with mJOA score and RR. The correlation of preoperative TK or kyphosis angle in fusion area (FSK) with postoperative dekyphosis angle and spinal column shortening distance (SD) were respectively evaluated by Pearson correlation analysis. RESULTS Cerebrospinal fluid leakage (58.8%) and neurological deterioration (15.7%) were the most common complications. Average mJOA score was improved from preoperative 4.0±2.1 to 8.9±2.4 at the last follow-up, and the mean RR was 71.3±33.7%. There was no correlation between preoperative TK and SD (p=.56) or between preoperative FSK and SD (p=.21), but dekyphosis angle was significantly correlated with TK (r=0.504, p<.01) and FSK (r=0.5734, p<.01). TK of 24.6° and FSK of 23.0° were determined as the critical angles for dekyphosis, and a modified surgical strategy was formulated. CONCLUSIONS This new strategy provided a novel solution for mT-OPLL, and was proved to be safe and effective during long-term follow-up. Further rigorously designed large-scale prospective studies are needed to validate our findings.
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Affiliation(s)
- Chuiguo Sun
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, China
| | - Zhongqiang Chen
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, China.
| | - Guanghui Chen
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Qiang Qi
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, China
| | - Zhaoqing Guo
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, China
| | - Woquan Zhong
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, Haidian, Beijing, China
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Zhu W, Sun K, Li X, Kong C, Lu S. Symptomatic Sagittal Imbalance and Severe Degeneration of Paraspinal Muscle Predispose Suboptimal Outcomes After Lumbar Short Fusion Surgery for Degenerative Lumbar Spinal Stenosis. World Neurosurg 2022:S1878-8750(22)00674-X. [PMID: 35580778 DOI: 10.1016/j.wneu.2022.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to investigate the risk factors of suboptimal postoperative outcomes after short-segment surgery for degenerative lumbar spinal stenosis and severe sagittal imbalance and to recommend the appropriate candidates for the short fusion. METHODS A total of 101 elderly subjects who underwent short-segment surgery were included. Preoperative sagittal vertical axis decreased to ≤50 mm was determined as sagittal compensation; otherwise, it was determined as sagittal decompensation. At the latest follow-up, 64 patients with sagittal decompensation and 14 patients with proximal junctional kyphosis (PJK) were detected. Sagittal imbalance with the related symptoms was named as symptomatic sagittal imbalance. Preoperative clinical data and spinopelvic parameters were collected and compared between different groups. RESULTS Symptomatic sagittal imbalance and severe degeneration of paravertebral muscle were revealed to be the risk factors for sagittal decompensation and PJK. More sagittal decompensations (100%) and PJKs (60%) were observed in patients with both of these risk factors. On the contrary, postoperative outcomes were superior with less sagittal decompensation (46.9%) and PJK (0%) in those with neither of the 2 factors. CONCLUSIONS Symptomatic sagittal imbalance and severe degeneration of paraspinal muscle are the risk factors predisposing suboptimal surgical outcomes after lumbar short-segment decompression and fusion for degenerative lumbar spinal stenosis. We believe essential spinal function and substantial quality of paraspinal muscle are the keys to long-lasting good outcomes.
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Sugimoto A, Tachimori H, Hirata Y, Sakamoto K, Ota N, Shiraishi S, Tsuchida M, Motomura N. Contemporary surgical management of complete atrioventricular septal defect with tetralogy of Fallot in Japan. Gan To Kagaku Ryoho 2022. [PMID: 35332445 DOI: 10.1007/s11748-022-01809-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/12/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Complete atrioventricular septal defect with tetralogy of Fallot is a rare and complex heart disease. This study aimed to describe contemporary management approaches for this heart disease and the outcomes. METHODS Data were obtained from 46 domestic institutions in the Japan Cardiovascular Database (2011-2018). Patients with a fundamental diagnosis of complete atrioventricular septal defect with tetralogy of Fallot, without other complex heart diseases, were included. The primary outcome was operative mortality (30-day or in-hospital mortality). RESULTS A total of 119 patients underwent initial surgery for a complete atrioventricular septal defect with tetralogy of Fallot during this study period. Primary repair was performed in 40 (34%) patients (primary repair group), and palliative procedure was performed in 79 (66%) patients as part of a planned staged approach (staged group). Forty institutions (87%) experienced at least one case of staged repair. No institution experienced more than or equal to two cases/year on average during the study period. Overall, 11 operative mortalities occurred (9.2%). Operative mortality rates in the primary and staged groups were comparable (p = 0.5). Preoperative catecholamine use, repeat palliative surgeries, and emergency admission were significant risk factors for operative mortality in multivariate analysis (odds ratio, 95% confidence interval: 8.58, [0-0.11]; 12.65, [1.28-125.15]; 8.64, [1.87-39.32, respectively]). CONCLUSIONS Staged approach for complete atrioventricular septal defect with tetralogy of Fallot was the preferred option. The outcomes of this complex disease were favorable for patients in centers with low cases of complete atrioventricular septal defect with tetralogy of Fallot.
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Lai W, Yang J, Xu N, Chen JH, Yang C, Yao HH. Surgical strategies for Mirizzi syndrome: A ten-year single center experience. World J Gastrointest Surg 2022; 14:107-119. [PMID: 35317542 PMCID: PMC8908338 DOI: 10.4240/wjgs.v14.i2.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/13/2021] [Accepted: 01/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mirizzi syndrome (MS) remains a challenging biliary disease, and its low rate of preoperative diagnosis should be resolved. Moreover, technological advances have not resulted in decisive improvements in the surgical treatment of MS. Complex bile duct lesions due to MS make surgery difficult, especially when the laparoscopic approach is adopted. The safety and long-term effect of MS treatment need to be guaranteed in terms of preoperative diagnosis and surgical strategy.
AIM To analyze preoperative diagnostic methods and the safety, effectiveness, prognosis and related factors of surgical strategies for different types of MS.
METHODS The clinical data of MS patients who received surgical treatment from January 1, 2010 to December 31, 2020 were retrospectively reviewed. Patients with malignancies, choledochojejunal fistula, lack of data and lost to follow-up were excluded. According to preoperative imaging examination records and documented intraoperative findings, the clinical types of MS were determined using the Csendes classification. The safety, effectiveness and long-term prognosis of surgical treatment in different types of MS, and their interactions with the clinical characteristics of patients were summarized.
RESULTS Sixty-six patients with MS were included (34 males and 32 females). Magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) showed specific imaging features of MS in 58 cases (87.9%), which was superior to ultrasound scan (USS) in the diagnosis of MS and more sensitive to subtle biliary lesions than USS. The overall laparoscopic surgery completion rate was 53.03% (35/66), where the completion rates of MS type I, II and III were 69.05% (29/42), 42.86% (6/14) and zero (0/10), respectively. Thirty-one patients (46.97%) underwent laparotomy or conversion to laparotomy including 11 cases of iatrogenic bile duct injury which occurred in type I patients, and 25 of these patients underwent bile duct exploration, repair and T-tube drainage. In addition, 25 patients underwent intraoperative choledochoscopy and T-tube cholangiography. Overall, 21 cases (31.8%) were repaired by simple suturing, and 14 cases (21.2%) were repaired using the remaining gallbladder wall patch in the subtotal cholecystectomy. The ascendant of the Csendes classification types led to an increase in surgical complexity reflected by increased operation time, bleeding volume and cost. Gender, acute abdominal pain and measurable stone size had no effect on Csendes type of MS or final surgical approach. Age had no effect on the classification of MS, but it influenced the final surgical approach, hospital stay and cost. A total of 66 patients obtained a relatively high preoperative diagnostic rate and underwent surgery safely without serious complications, and no mortality was observed during the follow-up period of 36.5 ± 26.5 mo (range 13-76, median 22 mo).
CONCLUSION MRI/MRCP can improve the preoperative diagnosis of MS. The Csendes classification can reflect the difficulty of treatment. The surgical strategies including laparoscopic surgery for MS should be formulated based on full evaluation and selection.
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Affiliation(s)
- Wei Lai
- Department of Hepatobiliary-Pancreatic-Splenic Surgery, Chengdu First People’s Hospital (Chengdu Integrated TCM & Western Medicine Hospital), Chengdu 610044, Sichuan Province, China
| | - Jie Yang
- Department of Hepatobiliary-Pancreatic-Splenic Surgery, Chengdu First People’s Hospital (Chengdu Integrated TCM & Western Medicine Hospital), Chengdu 610044, Sichuan Province, China
| | - Nan Xu
- Department of Hepatobiliary-Pancreatic-Splenic Surgery, Chengdu First People’s Hospital (Chengdu Integrated TCM & Western Medicine Hospital), Chengdu 610044, Sichuan Province, China
| | - Jun-Hua Chen
- Department of Hepatobiliary-Pancreatic-Splenic Surgery, Chengdu First People’s Hospital (Chengdu Integrated TCM & Western Medicine Hospital), Chengdu 610044, Sichuan Province, China
| | - Chen Yang
- Department of Hepatobiliary-Pancreatic-Splenic Surgery, Chengdu First People’s Hospital (Chengdu Integrated TCM & Western Medicine Hospital), Chengdu 610044, Sichuan Province, China
| | - Hui-Hua Yao
- Department of Hepatobiliary-Pancreatic-Splenic Surgery, Chengdu First People’s Hospital (Chengdu Integrated TCM & Western Medicine Hospital), Chengdu 610044, Sichuan Province, China
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Jian Q, Song G, Liu Z, Duan W, Guan J, Jian F, Chen Z. Location Distribution of Fistulas and Surgical Strategies for Spinal Extradural Meningeal Cysts: A Retrospective Analysis of 30 Cases at a Single Center. Neurospine 2022; 19:188-201. [PMID: 34990537 PMCID: PMC8987550 DOI: 10.14245/ns.2142526.263] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/09/2021] [Indexed: 11/24/2022] Open
Abstract
Objective This study aimed to illustrate the features of fistula location distribution, surgical strategies, and outcomes in spinal epidural meningeal cysts (SEMCs).
Methods The authors searched and reviewed the medical records for cases of SEMCs. Imaging features, operative reports, and media were reviewed to accurately describe the surgical techniques employed. We recorded the level and laterality of the fistula according to the operative report and the media. Consistency analysis was performed on the dominant laterality of the cyst on preoperative axial magnetic resonance imaging and laterality of the fistula in the operative media or report. When cyst and fistula lateralities were the same, they were considered consistent. Finally, the Japanese Orthopedic Association (JOA) score was used to obtain patient-reported results at each follow-up.
Results Thirty patients with SEMCs were identified. Fistula repair was performed in all patients. Two patients experienced cyst recurrence after surgery and were repaired during the second surgery. Based on imaging findings, SEMCs mostly occurred in the thoracolumbar junction. Most of the fistulas (87.88%) were at the T12 or L1 levels. In patients with multiple adjacent SEMCs, the fistula may be at one end of the cyst rather than in the middle level of the cyst. A fistula laterality of 72.72% was consistent with cyst laterality. The JOA improvement rate was 61.84%±26.63%.
Conclusion Most fistulas were always located at the T12–L1 level as well as the middle level of the cyst, which is always consistent with cyst laterality. In patients with multiple adjacent SEMCs, the fistula may be at one end of the cyst. Cleft closure is key to healing SEMCs.
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Affiliation(s)
- Qiang Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Gang Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhenlei Liu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Guan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Wang S, Zhang J, Zhang Y, Du Y, Yang Y, Lin G. Outcomes of Posterior Lumbar Hemivertebra Resection and Short Fusion in Patients With Severe Sacral Tilt. Neurospine 2021; 18:562-569. [PMID: 34610687 PMCID: PMC8497244 DOI: 10.14245/ns.2142376.188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/12/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To introduce surgical strategies to restore coronal balance during limited fusion for early lumbar hemivertebra resection in patients with severe sacral tilt.
Methods Sacral tilt was defined as a sacral tilt angle ≥ 5, and severe sacral tilt was defined as a sacral tilt angle > 10. From July 2004 to December 2017, 73 consecutive patients treated with posterior hemivertebra resection and short fusion in our institution were evaluated. Severe sacral tilt was noted in 26 patients (14 boys and 12 girls), and all were enrolled in this study. Undercorrection of the primary lumbar curve as compensation for the sacral tilt and short fusion was performed in these patients. The medical charts and imaging data of the patients were retrospectively reviewed to evaluate the outcomes.
Results All patients were followed for at least 2 years. The mean age at the time of surgery was 3.7 (2–9) years old, with a total of 31 lumbar hemivertebra excised. On average, 2.8 (2–5) segments were fused for each patient. Sacral tilt minimally improved from 14.5° preoperatively to 13.6° postoperatively (p=0.15) and remained stable at the follow-up. The overall lumbar curve was 41.9° preoperatively, 11.7° immediately postoperatively, and 14.6° at the final follow-up. The segmental scoliosis curve was 39.1° preoperatively, 9.7° immediately postoperatively, and 11.2° at the final follow-up. Segmental kyphosis was corrected from 27.2° to 6.5° after the surgery and was 7.1° at the latest follow-up.
Conclusion Sacral tilt is seen in patients with congenital scoliosis in lumbar hemivertebra. Undercorrection of the lumbar curve and segmental scoliosis to compensate for sacral tilt and short fusion after hemivertebra resection may be helpful to restore coronal balance and preserve mobility in segments in patients with pronounced severe sacral tilt.
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Affiliation(s)
- Shengru Wang
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Jianguo Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Yanbin Zhang
- Department of Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - You Du
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Yang Yang
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Guanfeng Lin
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
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Biancosino C, Redwan B, Welker L, Nakashima M, Branscheid D, Koesek V, Diemel KD, Krüger M. Surgical Strategy and Clinical Outcome in Patients with Bronchial Carcinoids. Adv Exp Med Biol 2021; 1374:17-25. [PMID: 34550557 DOI: 10.1007/5584_2021_668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Carcinoids are malignant neuroendocrine neoplasms showing good long-term survival after oncologic therapy. The study evaluated the influence of operative strategies and individual decision-making on the outcome and long-term survival in 222 patients with bronchial carcinoids. The patients underwent preoperative pulmonary function tests and bronchoscopy to facilitate surgical decision-making. A hundred and twelve tumors were detected endoscopically, including 32 in the main and lobar bronchi. We performed 5 isolated bronchus resections, 4 segmentectomies, 15 wedge resections, 10 pneumonectomies, 19 sleeve resections, 26 bilobectomies, 138 lobectomies, and 2 chest wall resections. Three patients were technically inoperable. Systematic mediastinal lymphadenectomy was routinely performed although most patients' computer tomography scans showed N0. A hundred and sixty-two patients had typical (155 N0, 7 N+) and 60 patients had atypical carcinoids (39 N0, 21 N+). There was no intraoperative mortality. The hospital mortality was below 2%. Overall, 1-, 5-, and 10-year survival rates were 99%, 94%, and 89%, respectively, in typical carcinoids. Atypical carcinoids show similar 1- and 5-year survival rates, but the 10-year survival rate was below 70%, decreasing in higher N-stages. The N-stage was the most important survival factor. In conclusion, bronchial carcinoids should be surgically treated the way lung cancer is. Anatomic resection and systematic lymphadenectomy are the treatments of choice. The availability of bronchoplastic techniques and preoperative assessment is essential for individual decision-making, focusing predominantly on postoperative quality of life.
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Affiliation(s)
- Christian Biancosino
- Department of Thoracic Surgery, HELIOS University Hospital Wuppertal, Wuppertal, Germany.
| | - Bassam Redwan
- Department of Thoracic Surgery, Klinik am Park Lünen, Lünen, Germany
| | - Lutz Welker
- LungClinic Grosshansdorf, Center for Pneumology and Thoracic Surgery, Grosshansdorf, Germany
| | - Masaki Nakashima
- LungClinic Grosshansdorf, Center for Pneumology and Thoracic Surgery, Grosshansdorf, Germany
| | - Detlef Branscheid
- LungClinic Grosshansdorf, Center for Pneumology and Thoracic Surgery, Grosshansdorf, Germany
| | - Volkan Koesek
- Department of Thoracic Surgery, Klinik am Park Lünen, Lünen, Germany
| | | | - Marcus Krüger
- Department of Thoracic Surgery, Martha - Maria Hospital Halle - Dölau, Halle, Germany
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Zhou J, Ding J, Li D. Blepharochalasis: clinical and epidemiological characteristics, surgical strategy and prognosis-- a retrospective cohort study with 93 cases. BMC Ophthalmol 2021; 21:313. [PMID: 34454463 PMCID: PMC8399824 DOI: 10.1186/s12886-021-02049-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 07/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Blepharochalasis is a rare eyelid disorder but eventually leading to destructive eyelid deformation. Until now the clinical and epidemiological data are unavailable. This study aimed to report the manifestations, epidemiological characteristics and surgical strategy of a large series of blepharochalasis patients with long-term follow-up. The prognosis of different clinical deformities was also investigated. METHODS This was a retrospective cohort study, including consecutive patients diagnosed with blepharochalasis in a single center. Blepharoplasty and other surgical approaches were performed according to manifestations, after a 2-year quiescent period with no recurrent attacks and exacerbation of lesions. Prognosis after surgery was recorded. RESULTS A total of 93 patients, with a mean age of 30.77 ± 14.04 (range: 9.00-70.00) years were included. Of all those 93 patients, 72.04% were females (67, P = 0.02). The mean follow-up was 5.29 ± 2.07 (range: 3-10) years before surgery, and 2.07 (range:1.54-4.22)years follow-up after surgery. The mean age of onset of blepharochalasis symptoms was 10.09 ± 3.32 (range: 5-16) years, and 83.87% patients got symptoms in puberty. With an average of 5 times per year, the mean duration of each acute attack was 28.12 ± 1.01 (rang: 2-192) hours. The mean duration from the onset of acute attack to the quiescent stage lasted for 7.33 ± 2.05 (range: 4-10) years. Most of the cases (88, 94.62%) had more than one manifestation at the end of the last follow-up before surgery. Ptosis (48.39%) was the most common deformity. Followed by lacrimal gland prolapse (44.09%), canthal angle deformity (29.04%), lower eyelid retraction (17.20%). After surgery, the functional and cosmetically acceptable results were achieved in all patients except for overcorrection in 5 (11.90%) patients with ptosis. The lacrimal gland prolapse recurred in two (4.00%) patients at 29 and 36 months after surgery. CONCLUSIONS Blepharochalasis is rare but mostly occurred in adolescent females. The process from the onset to the stable stage usually lasted for about 7 years, which might be associated with the onset of puberty. Surgical management of clinical manifestations after at least 2-year follow-up period of quiescence would be appropriate in order to observe a great plastic effect, low overcorrection and recurrence rate.
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Affiliation(s)
- Jinqiong Zhou
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Laboratory, Capital Medical University, Beijing, China
| | - Jingwen Ding
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Laboratory, Capital Medical University, Beijing, China
| | - Dongmei Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Laboratory, Capital Medical University, Beijing, China.
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Nishio N, Hiramatsu M, Goto Y, Shindo Y, Yamamoto T, Jingushi N, Wakahara K, Sone M. Surgical strategy and optimal timing of tracheostomy in patients with COVID-19: Early experiences in Japan. Auris Nasus Larynx 2021; 48:518-524. [PMID: 33272716 PMCID: PMC7674116 DOI: 10.1016/j.anl.2020.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/23/2020] [Accepted: 11/12/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Tracheostomy is an important surgical procedure for coronavirus disease-2019 (COVID-19) patients who underwent prolonged tracheal intubation. Surgical indication of tracheostomy is greatly affected by the general condition of the patient, comorbidity, prognosis, hospital resources, and staff experience. Thus, the optimal timing of tracheostomy remains controversial. METHODS We reviewed our early experience with COVID-19 patients who underwent tracheostomy at one tertiary hospital in Japan from February to September 2020 and analyzed the timing of tracheostomy, operative results, and occupational infection in healthcare workers (HCWs). RESULTS Of 16 patients received tracheal intubation with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, five patients (31%) received surgical tracheostomy in our hospital. The average consultation time for surgical tracheostomy was 7.4 days (range, 6 - 9 days) from the COVID-19 team to the otolaryngologist. The duration from tracheal intubation to tracheostomy ranged from 14 to 27 days (average, 20 days). The average time of tracheostomy was 27 min (range, 17 - 39 min), and post-wound bleeding occurred in only one patient. No significant differences in hemoglobin (Hb) levels were found between the pre- and postoperative periods (mean: 10.2 vs. 10.2 g/dl, p = 0.93). Similarly, no difference was found in white blood cell (WBC) count (mean: 12,200 vs. 9,900 cells /µl, p = 0.25). After the tracheostomy, there was no occupational infection among the HCWs who assisted the tracheostomy patients during the perioperative period. CONCLUSION We proposed a modified weaning protocol and surgical indications of tracheostomy for COVID-19 patients and recommend that an optimal timing for tracheostomy in COVID-19 patients of 2 - 3 weeks after tracheal intubation, from our early experiences in Japan. An experienced multi-disciplinary tracheostomy team is essential to perform a safe tracheostomy in patients with COVID-19 and to minimize the risk of occupational infection in HCWs.
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Affiliation(s)
- Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Mariko Hiramatsu
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yukari Goto
- Department of Emergency and Critical Care Medicine, Nagoya University Hospital, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yuichiro Shindo
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Takanori Yamamoto
- Department of Emergency and Critical Care Medicine, Nagoya University Hospital, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Naruhiro Jingushi
- Department of Emergency and Critical Care Medicine, Nagoya University Hospital, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Keiko Wakahara
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Diana P, Lughezzani G, Uleri A, Casale P, Saita A, Hurle R, Lazzeri M, Mottrie A, De Naeyer G, De Groote R, Porter J, Buffi N. Multi-institutional Retrospective Validation and Comparison of the Simplified PADUA REnal Nephrometry System for the Prediction of Surgical Success of Robot-assisted Partial Nephrectomy. Eur Urol Focus 2020; 7:1100-1106. [PMID: 33272907 DOI: 10.1016/j.euf.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/03/2020] [Accepted: 11/18/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The use of a nephron-sparing surgery for the treatment of localized renal masses is being pushed to more challenging cases. However, this procedure is not devoid of risks, and the Radius, Exophytic/Endophytic, Nearness, Anterior/Posterior, Location (RENAL) and Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) classifications are commonly employed in the prediction of complications. Recently, the Simplified PADUA REnal (SPARE) scoring system has been proposed with the aim to provide a more simple system, to improve its reproducibility to predict postoperative risks. OBJECTIVE We aim to retrospectively validate and compare the proposed new SPARE system in a multi-institutional population. DESIGN, SETTING, AND PARTICIPANTS The Transatlantic Robotic Nephron-sparing Surgery (TRoNeS) study group collected data from 737 patients subjected to robot-assisted partial nephrectomy (RAPN) between 2010 and 2016 at three tertiary care referral centers. Of these patients, 536 presented complete demographic and clinical data. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Renal masses were classified according to the SPARE, RENAL, and PADUA nephrometry scores, and surgical success was defined according to the margin, ischemia, and complication scores. RESULTS AND LIMITATIONS Of 536 patients, 340 were male; the median age was 61 (53-69) yr and preoperative tumor size was 30 (22-43) mm. The margin, ischemia, and complication score was achieved in 399 of cases (74.4%). All three nephrometry scores were significant predictors of surgical outcomes both in univariate and in adjusted multivariate logistic regression model analysis. In accuracy analysis, the area under the curve (AUC) of the SPARE scoring system (0.73) was significantly higher than those of the PADUA (0.65) and RENAL (0.68) nephrometry scores in predicting surgical success. CONCLUSIONS The SPARE score appears to be a promising and reliable score for the prediction of surgical outcomes of RAPN, showing a higher accuracy relative to the traditional PADUA and RENAL nephrometry scores. Further, prospective studies are warranted before its introduction in clinical practice. PATIENT SUMMARY The Simplified PADUA REnal (SPARE) score is a reproducible and simple nephrometry score, offering better predictive capabilities of surgical success and complications.
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Affiliation(s)
- Pietro Diana
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
| | - Giovanni Lughezzani
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Alessandro Uleri
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Paolo Casale
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Alberto Saita
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Rodolfo Hurle
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Massimo Lazzeri
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Alex Mottrie
- ORSI, Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Geert De Naeyer
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Ruben De Groote
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - James Porter
- Department of Urology, Swedish Urology Group, Seattle, WA, USA
| | - Nicolomaria Buffi
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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Brenes Sánchez JM, Picado AL, Olivares Crespo ME, García Sáenz JÁ, De La Plata Merlo RM, De La Muela MH. Breast Cancer Management During COVID-19 Pandemic in Madrid: Surgical Strategy. Clin Breast Cancer 2021; 21:e128-35. [PMID: 33223393 DOI: 10.1016/j.clbc.2020.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND From the first case of SARS-CoV-2 infection in Wuhan (China), the infection spread all around the world causing a pandemic of coronavirus disease-2019 (COVID-19). Spain has been one of the most severely affected countries, and Madrid has reported a high number of cases and deaths. We discuss our strategies for optimal breast cancer management during COVID-19 pandemic. PATIENTS AND METHODS This was a retrospective observational study at Clínico San Carlos Hospital to analyze the management of patients with breast cancer during the pandemic outbreak and the surgical strategy after the pandemic outbreak. We created a practical and dynamic tool based on a "traffic light" system for prioritizing surgical time. Every patient was contacted by telephone with a preoperative COVID-19 protocol. After surgical procedures, patient satisfaction was assessed using the European Organisation for Research and Treatment of Cancer in-patient satisfaction with cancer care questionnaire (EORTC IN-PATSAT32). RESULTS Patients with breast cancer actively treated with surgical procedures were put on a waiting list and received systemic therapy. Telemedicine was used to evaluate any side effects and to avoid unnecessary hospital visits. Surgery was only considered after the pandemic outbreak, and then, only those procedures designed to minimize surgical complications and, therefore, reduce hospital stay. We also measured patients' satisfaction with medical and nursing scales that resulted in a "very good" evaluation tending to "excellent". CONCLUSION It is necessary to adapt management of oncology treatment and surgical strategy to optimize resources during the COVID-19 pandemic. Patients' perception of care quality and the degree of patients' satisfaction with health services has potential relevance in the absence of outcome data.
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Abstract
Intraoperative parathyroid hormone (IOPTH) determination is based on the short half-life of parathyroid hormone (PTH) and the rapid analytical technology. The IOPTH provides functional information regarding correction of the overproductive state in hyperparathyroidism (HPT) and is superior to macroscopic evaluation of the parathyroid gland (PG) as well as any (intraoperative frozen section) form of histology (so-called biochemical frozen section). In this article the relevance and evaluation of IOPTH is defined for the most important forms of HPT, for primary HPT, renal secondary and tertiary HPT, multiple endocrine neoplasia type 1 (MEN1) and parathyroid carcinoma and clinical scenarios based on the currently available data. It becomes apparent that the additional benefits of IOPTH depend on diverse prerequisites of the specific type of HPT, the diagnostics as well as individual patient factors and strategic considerations for resection. Overall, the costs for IOPTH are comparably low and seem to be justified with respect to the gain in quality. In the hands of specialized endocrine surgeons IOPTH is an essential tool for intraoperative decision-making and quality assurance.
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Affiliation(s)
- K Lorenz
- Klinik für Viszeral‑, Gefäß- und Endokrine Chirurgie, Universitätsklinikum Halle, Martin-Luther Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle an der Saale, Deutschland.
| | - R Schneider
- Klinik für Viszeral‑, Gefäß- und Endokrine Chirurgie, Universitätsklinikum Halle, Martin-Luther Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle an der Saale, Deutschland
| | - M Elwerr
- Klinik für Viszeral‑, Gefäß- und Endokrine Chirurgie, Universitätsklinikum Halle, Martin-Luther Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle an der Saale, Deutschland
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Wang XF, Meng Y, Liu H, Hong Y, Wang BY. Surgical strategy used in multilevel cervical disc replacement and cervical hybrid surgery: Four case reports. World J Clin Cases 2020; 8:3890-3902. [PMID: 32953869 PMCID: PMC7479569 DOI: 10.12998/wjcc.v8.i17.3890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/18/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Multilevel artificial cervical disc replacement and anterior hybrid surgery have been introduced as reliable treatments for multilevel cervical degenerative disc disease. Surgical techniques are important for resolving patients’ symptoms and maintaining the normal functioning of cervical implants. However, the use of inappropriate surgical strategies could lead to complications such as implant migration and neurological deficit. In this paper, we summarize our surgical strategies used in multilevel cervical disc replacement and hybrid surgery into five major notes.
CASE SUMMARY We share the key notes and our surgical procedures in the form of four typical case presentations. All patients were diagnosed with cervical degenerative disc disease with myelopathy or radiculopathy and needed multilevel cervical spine surgery. The first case demonstrated that index levels indicating the presence of highly serious spinal cord compression required a prioritized decompression. The second case demonstrated that the disc replacement should be performed before fusion in cervical hybrid surgery. The third and forth cases demonstrated that a top-down implantation sequence was needed in continuous two-level cervical disc replacement. The symptoms of all patients were significantly relieved after surgery.
CONCLUSION We hope that our surgical strategies can help improve the performance and outcomes of multilevel cervical spine surgery.
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Affiliation(s)
- Xiao-Fei Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yang Meng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ying Hong
- Department of Operation Room, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bei-Yu Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Deng Y, Dong S, Song B. Surgical Strategy for Intravenous Cardiac Leiomyomatosis. Heart Lung Circ 2020; 30:240-246. [PMID: 32830033 DOI: 10.1016/j.hlc.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/02/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
Intravenous-cardiac leiomyomatosis (IVCL) is a rare, histologically benign but biologically aggressive tumour. Accurate diagnosis and appropriate treatment choices are important for prognosis. The best surgical approach remains unclear owing to limited evidence. This study aimed to assess surgical strategies for treating IVCL and to propose individualised surgical strategies. We searched PubMed, Web of Science, and the Cochrane Library to identify case reports and case series published in English over the last 10 years. Two (2) reviewers independently screened the literature according to the inclusion and exclusion criteria, and subsequently extracted data. One hundred and ten (110) cases were included. According to our analysis, IV cardiac leiomyomatosis is most common in the fifth decade, and the mean age at detection is 45.71±7.67 years. Most patients had undergone previous hysterectomy/myomectomy, or had a co-existing uterine leiomyoma when admitted. The most common clinical presentations were dyspnoea, palpitation, pelvic mass, and leg oedema. More patients benefited more from one-stage surgery. Seventy-eight per cent (78%) of cases experienced a surgical approach of thoracic and abdominal incisions. Extractions of IVCL were varied. Eighty-seven (87) patients experienced cardiopulmonary bypass and deep hypothermic circulatory arrest was performed on 64.4% of them. Total hysterectomy and bilateral oophorectomy, together with pelvic leiomyoma excision, were done in 76.0% of patients. Overall, surgical strategies for IVCL are varied; the optimal strategy required consideration of multiple factors. Complete resection is recommended for both single- and two-stage operations. Once complete resection is achieved, recurrence is rare.
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Affiliation(s)
- Yundan Deng
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Gansu Province, China
| | - Shuai Dong
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Gansu Province, China
| | - Bing Song
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Gansu Province, China.
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Zhao Y, Wu J, Wei S, Xu F, Kong C, Zhi X, Huang M, Cai X. Surgical approach strategies for open reduction internal fixation of closed complex tibial Pilon fractures based on axial CT scans. J Orthop Surg Res 2020; 15:283. [PMID: 32718324 DOI: 10.1186/s13018-020-01770-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To explore the application and clinical efficacy of surgical approach strategies in open reduction internal fixation of closed complex tibial Pilon fractures based on axial CT scans. METHODS This retrospective cohort study included data of 25 patients with closed complex tibial Pilon fractures treated from October 2011 to March 2014, including 19 males and 6 females aged 18-54 years (average 39.5 years). According to classification criteria of the Association for Osteosynthesis/Orthopedic Trauma Association (AO/OTA), 4 patients were type 43C1, 10 type 43C2, and 11 type 43C3. Surgical approaches were selected based on fracture line distribution and bone displacement revealed by axial CT scans, and an open reduction method was adopted for internal fixation of the bone plates. Postoperatively, Burwell-Charnley radiographic criteria were used to determine fracture reduction quality. Functional evaluation was performed using the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. Complications, fracture union time, and the AOFAS scores at last follow-up were recorded. RESULTS The 25 included patients were followed for 22-60 months postoperatively (average follow-up 33.9 months). Of these, 19 patients achieved anatomical reduction of the articular surface, 5 achieved good reduction, and one achieved fair reduction. Two patients developed superficial infection on the anteromedial incision and delayed union but recovered well after local dressing change and oral administration of antibiotics. Another patient developed deep infection on the anterolateral incision, which was controlled by debridement, catheter irrigation, and intravenous antibiotic injection. All fractures healed well and average union time was 2.8 months (range, 2-3 months). No fracture malunion or internal fixation failures were found at last follow-up. All 25 patients had AOFAS scores ranging from 80 to 100 at last follow-up (average 88.4). Overall, 15 patients were excellent, 10 good, and 0 fair or poor, with excellent and good rates of 100%. CONCLUSIONS Surgical approach strategies for complex tibial Pilon fractures based on axial CT scans accurately reconstruct the articular surface and achieve solid internal fixation of assembled locking plates, while early postoperative functional exercises contribute to the functional recovery of affected limbs and reduce related complications.
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Xin Z, Orazmyradov B, Li J, Zhou Q, Peng L, Li H, Chen L, Weng Z, Shi L, Ma L, Qi S, Lu Y. A Novel Classification and Its Clinical Significance in Spinal Schwannoma Based on the Membranous Hierarchy. Neurosurgery 2020; 87:1206-1222. [PMID: 32691825 DOI: 10.1093/neuros/nyaa272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 04/15/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Spinal schwannoma is a common benign tumor. However, the high recurrence rate and incidence of surgical complications are unsolved problems. OBJECTIVE To propose a morphological classification of spinal schwannoma based on tumor-membrane relationships to increase the gross total resection (GTR) rate and to decrease the incidence of surgical complications. METHODS Histological techniques were used to study 7 adult cadavers. Following picrosirius staining, the membranes around the nerve root were observed under a microscope. Data from 101 patients with spinal schwannoma were also collected for clinical analysis. RESULTS The sleeve around the spinal nerve root consisted of dura and arachnoid tissues. The space between them gradually narrowed and fused at the proximal pole of the nerve root ganglion. Spinal schwannomas were divided into 4 types based on membranous structure: intrapial (type I), subarachnoidal (type II), intra- and extradural (type III), and extradural growth (type IV). Types II and III were further subdivided into 2 subtypes. GTR was achieved in all patients (100%), with no tumor recurrence during follow-up. Overall functional status significantly improved postoperatively. A total of 59 patients (92%) showed improvement or significant improvement postoperatively. There was no difference in surgical outcomes among the tumor classifications (P = .618). No intraoperative vertebral artery injuries or postoperative cerebrospinal fluid fistula occurred. CONCLUSION Spinal schwannoma classification based on a membranous hierarchy provides an intuitive platform for preoperative planning and intraoperative safety. This classification scheme may help surgeons better define surgical goals and anticipate or even avoid complications from resection.
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Affiliation(s)
- Zong Xin
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Berdimyrat Orazmyradov
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Junjie Li
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Nanfang Neurology Research Institution, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiang Zhou
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lin Peng
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Nanfang Neurology Research Institution, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hong Li
- Nanfang Neurology Research Institution, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lei Chen
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Nanfang Neurology Research Institution, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhijian Weng
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Nanfang Neurology Research Institution, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Linyong Shi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Nanfang Neurology Research Institution, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liyi Ma
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Nanfang Neurology Research Institution, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Nanfang Neurology Research Institution, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Nanfang Glioma Center, Guangzhou, China
| | - Yuntao Lu
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Nanfang Neurology Research Institution, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Nanfang Glioma Center, Guangzhou, China
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Chang Y, Li Q, Wu Q, Chi L, Bi X, Zeng Q, Huo H. Impact of surgical strategies on the survival of gallbladder cancer patients: analysis of 715 cases. World J Surg Oncol 2020; 18:142. [PMID: 32590998 PMCID: PMC7320575 DOI: 10.1186/s12957-020-01915-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/15/2020] [Indexed: 12/24/2022] Open
Abstract
Objective The aim of the study is to evaluate the impact of application of surgical strategies at different cancer stages on the survival of gallbladder cancer (GBC) patients. Methods The patients with GBC were divided into 3 groups according to their received surgical strategies: simple resection (full-thickness cholecystectomy for removal of primary tumor site), radical resection (gallbladder bed removal combined with partial hepatectomy), and palliative surgery (treatment at advanced stages). The overall survival (OS) of GBC patients who were received different surgical strategies was compared. Results Survival analysis showed that radical resection had a best OS at clinical stage II, and simple resection had a best OS at tumor clinical stage IV. Cox hazard proportional regression analysis showed that more advanced tumor stages, tumor location of gallbladder body or neck, and CA199 ≥ 27 U/mL were the major risk factors for the OS of GBC. Conclusions At tumor stage II, radical resection should be the most effective surgical therapy for GBC. However, the effect of radical resection at advanced stages could be restricted. The utilization of radical resection should be increased at tumor stage II for a better long-term survival outcome.
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Affiliation(s)
- Yigang Chang
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer & Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.,Department of Gastrointestinal and Pancreas Surgery, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
| | - Qiang Li
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer & Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
| | - Qian Wu
- Department of Traditional Chinese Medicine, Shanxi Tumor Hospital, Taiyuan, 030013, China
| | - Limin Chi
- Physical Examination Center, First Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Xiaogang Bi
- Department of Gastrointestinal and Pancreas Surgery, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
| | - Qingmin Zeng
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer & Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.,Department of Gastrointestinal Surgery, Peking University Shougang Hospital, Beijing, 100041, China
| | - Huaying Huo
- Department of Traditional Chinese Medicine, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
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Kemmochi R, Ohga Y, Kubo Y, Matsumoto M. Left circumflex artery aneurysm with fistula to the coronary sinus. Gen Thorac Cardiovasc Surg 2020; 68:1196-8. [PMID: 31728834 DOI: 10.1007/s11748-019-01247-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 11/06/2019] [Indexed: 12/29/2022]
Abstract
A giant coronary artery aneurysm with arteriovenous fistula is a unique pathology having few surgical reports. An 82-year-old woman presented with a symptomatic giant left circumflex artery aneurysm with a fistula to the coronary sinus. The left coronary artery was dilated, and an aneurysmal change was visible from the left main trunk to the fistula. Surgery was performed to close the fistula and seclude all parts of the aneurysmal coronary artery. All coronary branches emerging from the aneurysm required bypass grafting. Herein, we present the history of this unusual case and our successful surgical strategy.
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Yokoyama K, Sugie A, Yamada M, Tanaka H, Ito Y, Yamashita M, Kawanishi M. Formation of de Novo Symptomatic Premedullary Arachnoid Cyst in Adult. World Neurosurg 2019; 130:154-156. [PMID: 31301440 DOI: 10.1016/j.wneu.2019.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Intracranial de novo arachnoid cysts in adults are rare, suggesting the involvement of head trauma and inflammatory diseases. We report a symptomatic adult case of nontraumatic de novo arachnoid cyst on the ventral medulla oblongata. CASE DESCRIPTION A 56-year-old man came to our hospital complaining of dysphagia and writing difficult since 3 months ago. There was no history of head injury or inflammatory disease. A 25-mm cystic lesion was found on the ventral side of the medulla oblongata on brain magnetic resonance imaging, and the lower cranial nerve and medulla oblongata were highly compressed. The lesion did not exist on magnetic resonance imaging performed 9 years ago. Capsular resection was performed, and the histologic diagnosis was a typical arachnoid cyst. After the operation, all neurologic symptoms disappeared and no recurrence has been observed after 6 months. CONCLUSIONS The pathophysiology of nontraumatic de novo arachnoid cysts has many unknown features, and it appears necessary to accumulate further case reports.
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Affiliation(s)
- Kunio Yokoyama
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto.
| | - Akira Sugie
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto
| | - Makoto Yamada
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto
| | - Hidekazu Tanaka
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto
| | - Yutaka Ito
- Department of Neurosurgery, Takeda General Hospital, Fushimi, Kyoto
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Zawy Alsofy S, Stroop R, Fusek I, Welzel Saravia H, Sakellaropoulou I, Yavuz M, Ewelt C, Nakamura M, Fortmann T. Virtual Reality-Based Evaluation of Surgical Planning and Outcome of Monosegmental, Unilateral Cervical Foraminal Stenosis. World Neurosurg. 2019;129:e857-e865. [PMID: 31300351 DOI: 10.1016/j.wneu.2019.06.057] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 06/07/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Foraminal cervical nerve root compression can be caused by lateral disk herniation or osteophyte formation of the vertebrae. Improved diagnosis and evaluation can be achieved using different imaging techniques: radiographs, computed tomography (CT), and magnetic resonance imaging. We retrospectively evaluated the potential influence of a virtual reality (VR) visualization technique on surgery planning and evaluation of postoperative results in patients with monosegmental, unilateral osseous cervical neuroforaminal stenosis. METHODS Seventy-three patients were included. Ventral decompression of the neuroforamen was performed in 41 patients, dorsal decompression in 32 patients. Patients' files were evaluated. CT scans were visualized via VR software to measure the smallest cross-sectional area of the intervertebral neuroforamen in the lateral resection region. A questionnaire evaluated the influence of VR technique on surgical planning and strategy. RESULTS The VR-technique had a moderate influence on the choice of the approach (ventral or dorsal), a significant influence on the ventral approach strategy, and no influence on the positioning of the patient or the dorsal approach strategy. A significant difference was found in the size of the smallest cross-sectional area of the intervertebral neuroforamen in the lateral resection region between ventral and dorsal approaches, with no correlation to the clinical outcome. CONCLUSIONS Reconstruction of pre- and postoperative 2D-CT images of the cervical spine into 3D images, and the spatial and anatomical reconstructions in VR models, can be helpful in planning surgical approaches and treatment strategies for patients with cervical foraminal stenoses, and for evaluation of their postoperative results.
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Niebisch S, Staab H, Ullrich S, Hoffmann KT, Sabri O, Thieme R, Schierle K, Wittekind C, Gockel I. Retroperitoneal space-occupying lesion with displacement of the inferior vena cava. Int J Surg Case Rep 2019; 57:170-4. [PMID: 30981070 DOI: 10.1016/j.ijscr.2019.03.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/11/2019] [Accepted: 03/21/2019] [Indexed: 01/19/2023] Open
Abstract
Exact preoperative diagnosis and surgery of retroperitoneal schwannoma (RS) is sophisticated. Due to heterogeneity of the entity, preoperative negative biopsy does not exclude malignancy. A curative (R0) resection must be achieved in order to avoid local recurrence, always under consideration of multivisceral resections.
Introduction The differential diagnosis and therapy of retroperitoneal masses suspicious for soft tissue tumors remains difficult and needs individual decisions as to the best management of patients. We report an unusual case of retroperitoneal schwannoma (RS). Presentation of case We report on a 57-year-old female patient with a retroperitoneal space-occupying lesion with displacement, but no infiltration of surrounding vessels, especially the inferior vena cava. As presence of malignancy could not be completely excluded by imaging and biopsy, we performed an open resection of the tumor with plastic reconstruction of the right renal vein. Curative resection of the tumor could be achieved and benign RS verified. Discussion Preoperative work-up, including a broad spectrum of differential diagnoses, and consecutive appropriate surgical resection are challenging. Characteristic features of the pre-therapeutic diagnostics of retroperitoneal schwannomas are discussed and differential diagnostic considerations as well as surgical therapeutic options are outlined. Conclusion Deeper understanding of retroperitoneal schwannomas gained from preoperative radiologic diagnostics may serve to underline the need for targeted biopsy. This and its histopathological examination necessitate expert interventional radiologists and pathologists. Thus, even the pre-therapeutic diagnostic management should be performed in a specialized center. If doubts remain regarding the entity of the retroperitoneal lesion and findings are still controversial after thorough assessment, surgical oncologic resection represents the therapy of choice, if the surgical risk is adequate.
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Raheja A, Suri A, Sreenivasan SA, Singla R. Insurance and Flow-Alteration Superficial Temporal Artery to Middle Cerebral Artery (STA-MCA) Bypass in Management of Complex Anterior Intracranial Circulation Aneurysms in Postendovascular Era. World Neurosurg 2019; 126:e1387-98. [PMID: 30902771 DOI: 10.1016/j.wneu.2019.03.109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/10/2019] [Accepted: 03/11/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Optimal management of complex anterior circulation aneurysms is an enigmatic challenge because of frequent involvement of major vessel bifurcation, choroidal vessels, and lenticulostriate/thalamostriate perforators. Cerebral ischemia associated with prolonged clipping time is a major concern pertinent to their surgical management, especially in patients with poor cross-flow. To circumvent this hurdle, single/double-barrel low-flow superficial temporal artery (STA) to middle cerebral artery (M3/M4-MCA) can be performed, which can maintain distal cerebral perfusion while facilitating safe clip reconstruction of complex MCA and supraclinoidal internal carotid artery (ICA) aneurysms involving ICA bifurcation or supraclinoidal ICA aneurysms with poor cross-circulation-insurance bypass, as well as supplement/alter blood flow after MCA aneurysm trapping-flow-alteration bypass. METHODS A retrospective chart review of consecutive neurosurgical patients operated over 2 years at this center was performed. Patients with complex MCA and ICA aneurysms who were treated with STA-MCA bypass were included. The clinical profile, pre- and postoperative images, intraoperative imaging, and patient outcomes were recorded. Surgical reconstruction of aneurysm was the treatment of choice due to involvement of choroidal/thalamostriate perforators, MCA/ICA bifurcation, complex aneurysm morphology, or dissecting/thrombosed nature of aneurysm. STA-MCA low-flow bypass was performed using M3/M4 segment of MCA as the recipient in anticipation of prolonged temporary clipping time on M1-MCA, supraclinoidal ICA aneurysms with suspected ICA terminus involvement, or need for possible trapping of fusiform MCA aneurysm. The saccular/fusiform part of aneurysm was clip reconstructed and the partially thrombosed dissecting segment was opened for thrombectomy and trapped using proximal and distal clips after good patency of bypass was confirmed. The distal MCA flow was restored adequately and confirmed intraoperatively using indocyanine green angiography and micro-Doppler ultrasonography. RESULTS MCA (n = 4) and supraclinoid-ICA (n = 1) aneurysms were managed successfully using this strategy, which involved 6 STA-MCA bypass procedures (insurance and flow-alteration bypass, 3 each). Postoperative check angiograms demonstrated patent bypass in all 5 patients. Four patients had favorable outcome (modified Rankin Scale score 0/1); one had recovering hemiparesis and aphasia (modified Rankin Scale score 4). CONCLUSIONS This series highlights the surgical strategy and safety for successfully managing complex MCA and ICA aneurysms using low-flow STA-MCA revascularization procedures.
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Nagahama A, Goto T, Nagm A, Tanoue Y, Watanabe Y, Arima H, Nakajo K, Morisako H, Uda T, Ichinose T, Yamanaka K, Ohata K. Spheno-Orbital Meningioma: Surgical Outcomes and Management of Recurrence. World Neurosurg 2019; 126:e679-e687. [PMID: 30844527 DOI: 10.1016/j.wneu.2019.02.123] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Spheno-orbital meningioma (SOM) is a rare intracranial tumor that arises at the sphenoid wing, extends into the orbit, and is associated with hyperostosis of the sphenoid bone. These tumors often invade important neurovascular structures around the orbital apex, superior orbital fissure, and cavernous sinus. Aggressive tumor removal could achieve acceptable control; however, residual tumor can regrow. In this article, our surgical management and long-term outcomes are described. METHODS Retrospectively, 12 patients with SOM who were treated surgically over a 21-year period were included. The clinical features and long-term tumor control were evaluated. RESULTS Participants comprised 12 patients (5 men and 7 women). Mean follow-up was 74.4 months (range, 10-262 months). Ten patients (83%) were identified as World Health Organization grade 1 (WHO-I), and 2 patients (17%) were identified as WHO grade 2 (WHO-II). We encountered 4 recurrences, 2 of which needed additional surgeries. One patient with WHO-I (10%) experienced recurrence 10 years after the initial surgery and required a second surgery. Two patients with WHO-I (20%) showed slight regrowth of residual tumor around the superior orbital fissure; nevertheless, additive therapy was not recommended. Despite radical tumor resection, including eyeball and adjunctive radiotherapy for 1 patient with WHO-II, tumor recurrence in the posterior fossa was documented 19 years after the initial aggressive surgery. CONCLUSIONS SOM follows a relatively benign clinical course given the invasive radiologic findings. Abnormal bone resection is paramount to prevent early-stage recurrence. Although intradural residual tumor might regrow, additional surgery could achieve reasonable long-term tumor control with better outcome.
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Affiliation(s)
- Atsufumi Nagahama
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Takeo Goto
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Alhusain Nagm
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan; Department of Neurosurgery, Al-Azhar University Faculty of Medicine-Nasr City, Cairo, Egypt; Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuta Tanoue
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yusuke Watanabe
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hironori Arima
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kosuke Nakajo
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Morisako
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takehiro Uda
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tsutomu Ichinose
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuhiro Yamanaka
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kenji Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Guo H, Song G, Wang X, Bao Y. Surgical treatment of trigeminal neuralgia with no neurovascular compression: A retrospective study and literature review. J Clin Neurosci 2018; 58:42-48. [PMID: 30454694 DOI: 10.1016/j.jocn.2018.10.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/26/2018] [Accepted: 10/14/2018] [Indexed: 10/28/2022]
Abstract
The objective of the current study is to summarize the experiences of 360-degree circumferential arachnoid dissection for TN in patients without NVC. Clinical data from 19 TN patients without NVC who underwent 360-degree circumferential arachnoid dissection were retrospectively analyzed. All patients underwent preoperative examinations of three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) and three-dimensional nuclear magnetic resonance of constructive interference in steady state (3D-CISS) to identify the neurovascular structures around the trigeminal nerve. Surgical outcomes were evaluated based on the Barrow Neurological Institute (BNI) Pain Intensity Scale, and severity of pain was determined using the visual analogue scale (VAS) score. Preoperative imaging showed that no patients had NVC compression. The preoperative BNI pain score was IV among 9 patients and V among other 10 patients. The preoperative VAS score was 7.89 ± 0.658. After the operation, pain disappeared in all 19 patients, and transient facial numbness occurred in 3 patients. During follow-up, pain in 2 of 19 patients (10.5%) recurred at postoperative 20 and 23 months. This study demonstrated that 360-degree circumferential arachnoid dissection is an alternative treatment for trigeminal neuralgia in patients with no neurovascular compression, especially when a thickened arachnoid, angulation, or torsion of the trigeminal nerve root was found during the operation. However, further study is needed to compare the outcomes of different surgical strategies and prove the efficacy of 360-degree circumferential arachnoid dissection in cases without neurovascular compression (NVC).
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Affiliation(s)
- Hongchuan Guo
- Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China.
| | - Gang Song
- Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Xu Wang
- Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Yuhai Bao
- Department of Skull Base Surgery Center, Department of Neurosurgery, XuanWu Hospital, Capital Medical University, Beijing, China
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Fang L, Wang J, Dai WC, Liang B, Chen HM, Fu XW, Zheng BB, Lei J, Huang CW, Zou SB. Laparoscopic transcystic common bile duct exploration: surgical indications and procedure strategies. Surg Endosc 2018; 32:4742-4748. [PMID: 30298446 DOI: 10.1007/s00464-018-6195-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/20/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND LTCBDE combined with or without modified techniques is safe and efficacious for the management of gallstones and concomitant, even large, common bile duct (CBD) stones. METHODS To describe the surgical indications and procedure strategies of laparoscopic transcystic common bile duct exploration (LTCBDE), a retrospective analysis of 205 patients with concomitant gallstones and CBD stones treated using LTCBDE between June 2008 and June 2015 was performed. Clinical data on disease characteristics, methods for cystic duct incision and CBD stone extraction (with or without laser lithotripsy), and surgical outcomes were collected and reviewed. RESULTS CBD stones were successfully cleared in all patients. No patient was converted to choledochotomy or laparotomy. The cystic duct diameter ranged 3-8 mm, and 85 patients with cystic duct diameter ≥ 5 mm. The mean time for CBD stone extraction was 25.3 min, with the operative time ranged from 63 to 170 min. Lithotripsy was used in 74 (36.1%) patients among which 26 patients with cystic duct diameter ≥ 5 mm. Estimated blood loss during surgery was 10-120 ml per patient, and no intra-operative blood transfusions were needed. The mean postoperative hospital stay was 5.1 (range 3-7) days, and postoperative complications developed in seven patients. No bile duct injury, stricture, remnant, recurrent stones, or other adverse events were observed during the mean follow-up of 8 months. CONCLUSIONS Based on preoperative MRCP and intra-operative IOC findings about cystic duct diameter, the diameter of CBD, CBD stone size, we summarized and proposed the surgical indications and suitable techniques and strategies during LTCBDE.
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Affiliation(s)
- L Fang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China.
| | - J Wang
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - W C Dai
- Department of General Surgery, Yili Friendship Hospital, Yili, Xinjiang, China
| | - B Liang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - H M Chen
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - X W Fu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - B B Zheng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - J Lei
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
| | - C W Huang
- Department of Hepatobiliary Surgery, The People's Hospital of Jiangxi, Nanchang, Jiangxi, China
| | - S B Zou
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330000, Jiangxi, China
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Manekeller S, Kalff JC. [Treatment approach for gall bladder and extrahepatic bile duct cancer]. Chirurg 2018; 89:880-886. [PMID: 30094707 DOI: 10.1007/s00104-018-0704-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although the treatment and diagnostic regimens of gall bladder carcinoma and extrahepatic bile duct cancer have improved over the past years, the outcome and overall survival as prognostic values still remain poor. Early tumor stages of gall bladder carcinoma are the only exception. OBJECTIVE This article focuses on the latest surgical therapy approaches including neoadjuvant, adjuvant and palliative therapy regimens. RESULTS Neoadjuvant treatment concepts have so far been insufficiently evaluated and can therefore only be recommended within the framework of studies. In patients with primary resectable tumors there are so far no indications for improved results after neoadjuvant therapy. Radical R0 resection still remains the only curative treatment option; however, an advanced and inoperable stage is often already present at the time of diagnosis There are no uniform adjuvant treatment concepts and no standards evaluated by studies. Due to the currently available data, adjuvant radiochemotherapy and chemotherapy can also only be recommended within or as part of clinical trials. Palliative chemotherapy should only be used in advanced tumor stages and depending on the condition of the patient. CONCLUSION To sustainably improve treatment strategies for advanced gall bladder carcinoma and extrahepatic bile duct cancer, uniform adjuvant as well as neoadjuvant therapy regimens need to be developed after evaluation in prospective randomized trials. This is the only way to improve the still poor prognosis of these tumor entities.
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Affiliation(s)
- S Manekeller
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum der Rheinischen Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland.
| | - J C Kalff
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum der Rheinischen Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland
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Nitta T, Kataoka J, Ohta M, Fujii K, Takashima Y, Inoue Y, Ishibashi T. Surgical strategy for suspected early gallbladder carcinoma including incidental gallbladder carcinoma diagnosed during or after cholecystectomy. Ann Med Surg (Lond) 2018; 33:56-9. [PMID: 30197784 DOI: 10.1016/j.amsu.2018.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/07/2018] [Accepted: 07/25/2018] [Indexed: 02/06/2023] Open
Abstract
Purpose This paper presents an overview of the surgical strategy for patients with suspected gallbladder carcinoma (GBC), including incidental GBC cases, preoperatively or intraoperatively, as well as their outcomes. Methods Between April 2009 and December 2017, 529 patients underwent cholecystectomy for gallbladder disease at our hospital. Both intraoperative and postoperative histological examinations of the excised gallbladder facilitated the diagnosis of GBC. Surgery-related variables and surgical approaches were evaluated according to the extent of tumor invasion. Results Of 529 patients, eight were diagnosed with GBC during/after cholecystectomy, including four women and four men. Mean age was 75.4 (range, 59–89) years. Five patients had gallbladder stones and three had cholecystitis. Three patients with stages T1b and T2 underwent additional liver bed wedge resections with or without prophylactic common bile duct excision. Five of the eight patients are still alive and two of the remaining three died from other diseases; one patient with pT3 died of recurrent GBC (peritonitis carcinomatosa). Conclusion Because of the ability to obtain full-thickness frozen biopsies during laparoscopic cholecystectomy, we could diagnose GBC intraoperatively, allowing for rapid diagnosis and tumor resection. We recommend developing a surgical treatment strategy for suspected early GBC in advance of cholecystectomy. Gallbladder carcinoma can be diagnosed during or after cholecystectomy. Frozen biopsies from cholecystectomy allow for the intraoperative diagnosis of GBC. The intraoperative diagnosis of GBC facilitates surgical resection of tumors. Surgical strategies incorporating intraoperative diagnosis should be developed.
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Koriyama S, Nitta M, Kobayashi T, Muragaki Y, Suzuki A, Maruyama T, Komori T, Masui K, Saito T, Yasuda T, Hosono J, Okamoto S, Shioyama T, Yamatani H, Kawamata T. A surgical strategy for lower grade gliomas using intraoperative molecular diagnosis. Brain Tumor Pathol 2018; 35:159-67. [PMID: 29980868 DOI: 10.1007/s10014-018-0324-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/23/2018] [Indexed: 02/07/2023]
Abstract
Lower grade gliomas are both treated and diagnosed via surgical resection. Maximum tumor resection is currently the standard of care; however, this risks the loss of brain function. Glioma can be genetically subdivided into three different types, based on isocitrate dehydrogenase (IDH) mutation status and the presence of 1p/19q codeletion, which have radically different prognoses and responses to adjuvant therapies. Therefore, the means to identify the subtype and evaluate the surrounding tissues during surgery would be advantageous. In this study, we have developed a new surgical strategy for lower grade glioma based on the fourth edition of the World Health Organization Brain Tumor Classification, involving intraoperative molecular diagnosis. High-resolution melting analysis was used to evaluate IDH mutational status, while rapid immunohistochemistry of p53 and alpha-thalassemia/mental retardation syndrome X-linked (ATRX) was used to evaluate the 1p/19q codeletion status, allowing genetic classification during surgery. In addition, intraoperative flow cytometry was used to evaluate the surgical cavity for additional tumor lesions, allowing maximal resection while mitigating the risk of functional losses. This strategy allows the rapid intraoperative diagnosis and mapping of lower grade gliomas, and its clinical use could dramatically improve its prognosis.
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Liu H, Fang X, Yu Z, Lang Y, Xiong Y, Duan H. Surgical strategy for benign lesions in proximal femur: internal fixation or endoprosthetic replacement. Int Orthop 2018; 42:2691-2698. [PMID: 29666889 DOI: 10.1007/s00264-018-3922-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 03/26/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this study was to explore the indications for the two most frequently applied surgical procedures for benign lesions in the proximal femur. METHODS We retrospectively reviewed 142 patients with benign lesions in the proximal femur from January 2010 to January 2015. Internal fixation (IF) was adopted in 110 patients, while endoprosthetic replacement (EPR) was applied in 32 patients. Clinical data, including operation time, blood loss, hospitalization time, and hospitalization expenses, were compared between the groups. Limb mobilization was evaluated by the Musculoskeletal Tumor Society Score-93 (MSTS-93) and Harris Hip Score (HHS). Local recurrences and complications were statistically compared. RESULTS The average follow-up was 66 months (range 32-84 months). In the EPR group, operation time and hospitalization time were significantly shorter (p < 0.05 and p < 0.05, respectively), while blood loss and hospitalization expenses were significantly higher (p < 0.05 and p < 0.05, respectively). Functional outcomes of the MSTS-93 and HHS were higher at the three week follow-up in the EPR group (p < 0.001 and p < 0.001, respectively) but lower at 6 months (p = 0.031 and p = 0.042, respectively). No differences were observed in the two scores at three months (p = 0.261 and p = 0.134, respectively). Local recurrence and complication rates were similar in the two groups (p = 0.895 and p = 0.942, respectively). CONCLUSION The strategy for benign proximal femur lesions should depend on the site, size, initial diagnosis, and thinning degree of cortical bone. IF and EPR both result in satisfactory local control and functional and radiological results, while EPR is more suitable for aggressive and recurrent lesions and serves as an effective measure after IF failure.
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Affiliation(s)
- Hongyuan Liu
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiang Fang
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zeping Yu
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yun Lang
- Department of Orthopedics, People's Hospital of Deyang City, Deyang, 618000, Sichuan, People's Republic of China
| | - Yan Xiong
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, Sichuan, People's Republic of China.
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Abstract
BACKGROUND Perihilar cholangiocarcinoma (Klatskin tumor) is a rare tumor entity with an unfavorable prognosis despite optimal treatment. OBJECTIVES The aim of the study is to investigate beneficial histopathological features and recommendations for surgery in perihilar cholangiocarcinoma to improve patients' long term survival. MATERIAL AND METHODS 192 patients suffering from perihilar cholangiocarcinoma underwent attempted tumor resection between 1998 and 2008 at our clinic. 50 patients survived more than 2 years. The follow-up ended in December 2013. The resection type, the UICC stage and histopathological features were compared between three groups (2-3-year, 3-5-year and > 5-year survival groups). RESULTS The overall 5‑year survival rate of the study groups was 32 %, and even 16 % survived more than 10 years after surgery. Patients with lymph node positive tumors (p = 0.0126) and distant metastasis (p = 0.0376) had the poorest survival rate. Perineural invasion had no significant impact on the overall survival, but patients surviving more than 5 years had the lowest incidence of perineural invasion with 18.75 %. Caudate lobectomy was significantly (p = 0.011) associated with a survival of more than 5 years in our study. CONCLUSIONS Complete tumor resection with additional caudate lobe resection is associated with long-term survival. Perineural invasion seems to be a negative prognostic factor for long-term survival.
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Affiliation(s)
- B Juntermanns
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, Essen, Deutschland
| | - C D Fingas
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, Essen, Deutschland
| | - G C Sotiropoulos
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, Essen, Deutschland
| | - D Jaradat
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, Essen, Deutschland
| | - A Dechêne
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Deutschland
| | - H Reis
- Institut für Pathologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - S Kasper
- Innere Klinik (Tumorforschung), Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - A Paul
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, Essen, Deutschland
| | - G M Kaiser
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, Essen, Deutschland.
- Klinik für Allgemein- und Viszeralchirurgie, St. Bernhard-Hospital Kamp-Lintfort, Bürgermeister-Schmelzing-Str. 90, 47475, Kamp-Lintfort, Deutschland.
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Ogiwara T, Nagm A, Yamamoto Y, Hasegawa T, Nishikawa A, Hongo K. Clinical characteristics of pituitary adenomas with radiological calcification. Acta Neurochir (Wien) 2017; 159:2187-2192. [PMID: 28825138 DOI: 10.1007/s00701-017-3302-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/08/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Radiographic detection of calcification in pituitary adenoma is relatively rare, and the clinical characteristics of pituitary adenoma with calcification remain unclear. Herein, the clinical characteristics of pituitary adenoma with radiological calcification were investigated. METHODS A total of 160 patients who underwent surgical resection of pituitary adenomas between February 2004 and December 2016 were reviewed. Eighty-one patients had hormone-secreting pituitary adenomas, and 79 patients had nonfunctioning pituitary adenoma. Among these 160 patients, cases with radiological calcifications on preoperative neuroimaging were included in this study, and clinical characteristics with intraoperative findings were analyzed, retrospectively. RESULTS Pituitary adenoma with calcification on preoperative neuroimaging was observed in only nine cases (5.6%). The study population consisted of these nine patients with nonfunctioning pituitary adenoma (n = 5), mixed growth hormone and prolactin-secreting pituitary adenomas (n = 3), and a prolactinoma (n = 1). In 89% of cases (n = 8), calcified pituitary adenoma was soft enough for suction despite the presence of a granular gritty texture intraoperatively. Besides, in a single patient (11%), evidence of hard thick capsular calcification was seen surrounding a soft tumor component; however, it did not interfere with adequate removal of the soft part, and tumor resection was possible in all cases without any complications. CONCLUSIONS Pituitary adenoma presenting with calcification is relatively rare, but should be kept in mind to avoid making a wrong preoperative diagnosis. As not all pituitary adenomas with calcification are hard tumors, preoperative radiological calcification should not affect decision-making regarding surgical indications.
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Affiliation(s)
- Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Alhusain Nagm
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
- Department of Neurosurgery, Al-Azhar University Faculty of Medicine-Nasr city, Cairo, Egypt
| | - Yasunaga Yamamoto
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Takatoshi Hasegawa
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Akihiro Nishikawa
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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Ogiwara T, Nagm A, Hanaoka Y, Nishikawa A, Goto T, Horiuchi T, Hongo K. Management of hypertrophied dural lesions: Is surgery a better option? J Neurol Sci 2017; 381:245-249. [PMID: 28991691 DOI: 10.1016/j.jns.2017.08.3268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/04/2017] [Accepted: 08/31/2017] [Indexed: 11/27/2022]
Abstract
It is often difficult to definitively diagnose dural lesions with hypertrophy as they exhibit nonspecific imaging findings and clinical symptoms. Most cases require histopathological evaluation with surgical intervention (such as biopsy). However, complications related to surgical interventions remain as matter of concern. Herein, we analyzed and verified the significance of surgery in 39 patients with hypertrophic dural lesions who were histopathologically diagnosed with surgical interventions. Specimens of dural lesions were obtained successfully, and it was possible to make a definitive diagnosis for each case based on histopathological findings. All patients tolerate the procedures well, and there were no evidences of surgery-related complications during surgical approach to the dura mater. Preoperative and pathological diagnoses varied in eight cases. Our results indicate that histopathological evaluation is important for distinguishing diseases showing dural hypertrophy even if surgical invasiveness is concerned. Neurosurgeons should not hesitate to perform surgery for management of dural lesions with hypertrophy in order to achieve accurate diagnosis.
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Affiliation(s)
- Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Alhusain Nagm
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Al-Azhar University Faculty of Medicine, Nasr City, Cairo, Egypt
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akihiro Nishikawa
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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