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Jowdy PK, Soliman MAR, Quiceno E, Azmy S, Popoola DO, Aguirre AO, Khan A, Slosar PJ, Pollina J, Mullin JP. Clinical and Radiographic Outcomes of Anterior Lumbar Interbody Fusions Using a Titanium Cage with a Biomimetic Surface. J Neurol Surg A Cent Eur Neurosurg 2025; 86:238-246. [PMID: 38395054 DOI: 10.1055/a-2275-0528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
BACKGROUND We analyzed clinical and radiographic outcomes in patients undergoing anterior lumbar interbody fusions (ALIFs) using a new biomimetic titanium fusion cage (Titan nanoLOCK interbody, Medtronic, Minneapolis, Minnesota, United States). This specialized cage employs precise nanotechnology to stimulate inherent biochemical and cellular osteogenic reactions to the implant, aiming to amplify the rate of fusion. To our knowledge, this is the only study to assess early clinical and radiographic results in ALIFs. METHODS We conducted a retrospective review of data for patients who underwent single or multilevel ALIF using this implant between October 2016 and April 2021. Indications for treatment were spondylolisthesis, postlaminectomy syndrome, or spinal deformity. Clinical and radiographic outcome data for these patients were collected and assessed. RESULTS A total of 84 patients were included. The mean clinical follow-up was 36.6 ± 14 months. At 6 months, solid fusion was seen in 97.6% of patients. At 12 months, solid fusion was seen in 98.8% of patients. Significant improvements were seen in patient-reported outcome measures (PROMs; visual analog scale and Oswestry Disability Index) at 6 and 12 months compared with the preoperative scores (p < 0.001). One patient required reoperation for broken pedicle screws 2 days after the ALIF. None of the patients required readmission within 90 days of surgery. No patients experienced an infection. CONCLUSIONS ALIF using a new titanium interbody fusion implant with a biomimetic surface technology demonstrated high fusion rates (97.6%) as early as 6 months. There was significant improvement in PROMs at 6 and 12 months.
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Affiliation(s)
- Patrick K Jowdy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Mohamed A R Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Esteban Quiceno
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Shady Azmy
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
| | - Daniel O Popoola
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
| | - Alexander O Aguirre
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Paul J Slosar
- Peninsula Orthopedic Associates, Daly City, California, United States
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
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White SJ, Douvartzidis J, Lo J, Bhatia K. Evaluation of adherence to the Preferred Reporting of CasE Series in Surgery (PROCESS) 2020 guideline in case series describing endovascular management of vein of Galen malformation demonstrates suboptimal reporting practices. J Clin Neurosci 2025; 133:111061. [PMID: 39848121 DOI: 10.1016/j.jocn.2025.111061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Revised: 12/29/2024] [Accepted: 01/17/2025] [Indexed: 01/25/2025]
Abstract
BACKGROUND Interventional neuroradiology is a dynamic field with technological advancements constantly driving evolution in clinical practice. Case series provide interventional neuroradiologists the opportunity to describe the clinical implications of novel equipment and techniques almost in real-time, informing broader adoption and directing future research. Complete reporting in case series is vital in enabling readers to detect bias, determine the generalizability of results and replicate study methodology. The aim of this study was to assess the quality of reporting in case series describing endovascular management of vein of Galen malformations. METHODS A systematic search for case series describing endovascular management of vein of Galen malformations in paediatric patients was conducted using a previously published search strategy in Medline, Embase and Web of Science in February 2024. Screening and data extraction were performed by two independent reviewers with disagreements resolved by consensus discussion. Quality of reporting was assessed using adherence to the Preferred Reporting of CasE Series in Surgery (PROCESS) 2020 checklist. RESULTS We included 19 case series representing a broad range of approaches and endovascular techniques for management of vein of Galen malformations. Overall adherence to the PROCESS 2020 guideline was moderate with a mean of 7.0/13 (54%; range 5.2 - 9.7/13; SD 1.1) items reported. The most consistently reported items related to characteristics of the clinical cohort and details regarding the specific image-guided intervention(s) provided. Items relating to study design, source of funding, pre-intervention patient optimisation, clinical follow-up and potential complications and alternatives for novel techniques/devices were less frequently reported. CONCLUSIONS The quality of reporting in case series describing endovascular management of vein of Galen malformation is suboptimal. Measures to improve the quality of reporting in neurointerventional case series include mandating adherence to reporting guidelines in journal instructions for authors and requiring submission of completed copies of relevant reporting guidelines alongside manuscripts.
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Affiliation(s)
- Samuel J White
- South Australia Medical Imaging, Royal Adelaide Hospital, Adelaide, Australia; Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
| | - Joseph Douvartzidis
- South Australia Medical Imaging, Royal Adelaide Hospital, Adelaide, Australia
| | - Johnny Lo
- South Australia Medical Imaging, Royal Adelaide Hospital, Adelaide, Australia; Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Kartik Bhatia
- Department of Medical Imaging, Children's Hospital at Westmead, Westmead, Australia; Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Aji IP, Renaldo J, Andhika DP. Neglected giant bladder stone with bilateral ureteral stones: A case report of staged surgical treatment. Int J Surg Case Rep 2025; 128:110933. [PMID: 39921987 PMCID: PMC11848781 DOI: 10.1016/j.ijscr.2025.110933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Revised: 01/21/2025] [Accepted: 01/22/2025] [Indexed: 02/10/2025] Open
Abstract
INTRODUCTION AND IMPORTANCE A giant bladder stone is a rare urological condition in which a massive stone forms due to various contributing factors. We present a rare case of a giant bladder stone with concurrent ureteral stones, detailing its staged surgical management and relevant literature. CASE PRESENTATION A 44-year-old male presented with right flank, left flank, and suprapubic pain for one month prior to admission, accompanied by dysuria and a history of stones passage through the urinary tract. On examination, the patient presented with suprapubic pain, and laboratory results revealed severe anemia with elevated blood urea nitrogen (BUN) and serum creatinine levels. A vesicolithotomy was performed, followed by ureteroscopic lithotripsy (URS) one month later. A 15 × 10 cm bladder stone was found during the first surgery, and multiple ureteral stones were discovered during the second surgery. After surgery, the patient improved BUN (93.5 mg/dL to 27.6 mg/dL), serum creatinine (8.11 mg/dL to 1.85 mg/dL), and reduced flank and suprapubic pain. CLINICAL DISCUSSION The management of giant bladder stones involves open vesicolithotomy, which is considered the gold standard for complete removal, as AUA and EAU guidelines recommend. A subsequent URS for the removal of bilateral ureteral stones provides a favorable outcome for the patient. CONCLUSION A holistic approach for giant bladder stones is required, encompassing diagnosis and surgical planning to minimize misdiagnosis and complications. A staged surgical approach, including vesicolithotomy and ureteroscopic lithotripsy, may be beneficial.
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Affiliation(s)
- Iwan Purnomo Aji
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
| | - Johan Renaldo
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia.
| | - Dimas Panca Andhika
- Department of Urology, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
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Hameed I, Al-Habbal Y. Haemobilia in a patient on oral anticoagulation: A surgical case report. Int J Surg Case Rep 2025; 127:110853. [PMID: 39778494 PMCID: PMC11760801 DOI: 10.1016/j.ijscr.2025.110853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 01/01/2025] [Accepted: 01/04/2025] [Indexed: 01/11/2025] Open
Abstract
INTRODUCTION Haemobilia causing obstructive jaundice is a rare complication with most occurrences reported post instrumentation e.g. endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangioagraphy (PTC) and, trans-cystic duct exploration or due to hepatic tree pseudoaneurysms. Traumatic haemobilia typically presents with the classical triad of right upper quadrant pain, jaundice and upper gastrointestinal bleeding. On imaging, an obstructed biliary tree is commonly found dilated. CASE PRESENTATION We report a case of a large obstructing blood clot causing biliary sepsis for a patient on oral anticoagulation. The patient had no classical triad findings or demonstrable evidence of biliary obstruction on imaging. The patient was managed with clot retrieval via ERCP and sphincterotomy; anticoagulant was resumed seven days post procedure. DISCUSSION Haemobilia is a rare consequence in patients on anticoagulation therapy. The management principles are coagulopathy correction and obstruction relief. The pathophysiology in patients without bleeding disorders remains unknown. CONCLUSION Although rare, haemobilia can be a cause of obstructive jaundice for a patient on anticoagulation.
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Affiliation(s)
- Iman Hameed
- Department of Upper Gastrointestinal/Hepatobiliary Surgery, Western Hospital, Footscray, VIC 3011, Australia.
| | - Yahya Al-Habbal
- Department of Upper Gastrointestinal/Hepatobiliary Surgery, Western Hospital, Footscray, VIC 3011, Australia
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Rangu N, Pistone E, Tan J, Do T. Bibliometric Analysis of the Highest Cited Cosmetic Upper Facial Plastic Surgery Articles Over 50 Years. Aesthet Surg J Open Forum 2024; 7:ojae123. [PMID: 39867419 PMCID: PMC11758881 DOI: 10.1093/asjof/ojae123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2025] Open
Abstract
In this bibliometric analysis, the authors analyze the top 100 (T100) most cited articles on cosmetic upper facial plastic surgery. Throughout this study, the objective of the authors is to delineate the trends in cosmetic upper facial surgeries to identify prevailing techniques, emerging trends, and potential areas of future investigation. The articles were indexed from the Web of Science database and were extracted in a double-blinded manner by 2 independent graders. The search phrase used covered a wide range of cosmetic upper facial plastic surgeries, of which a short sample is included: ("cosmetic*" AND "bleph*") OR ("cosmetic*" AND "upper eyelid blepharoplasty") OR ("cosmetic*" AND "lower eyelid blepharoplasty"). In their statistical analysis of the number of citations received in each article in the T100, the authors reveal an average of 55.1 citations (a standard deviation of 38.7). Surgical methods were the most commonly cited unique study area, with 30% of the T100, followed by botulinum toxin and complication management with 29% and 15% of the T100, respectively. The unique study area with the highest average citations received was botulinum toxin, with an average of 64.7 citations. Invasive procedures made up 55% of the T100 articles. The authors found that the late 1990s and 2000s were a burgeoning period of growth in this field and highlight the evolution of many contemporary popular cosmetic procedures over time. Particularly, a growth in minimally invasive procedures was noted, with noted impacts in aesthetics training and research focus. Level of Evidence 4 Therapeutic
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Affiliation(s)
- Nitin Rangu
- Corresponding Author: Mr Nitin Rangu, 1138 NW 13 St, Oklahoma City, OK 73106, USA. E-mail:
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Dutta A. A consensus guideline on preferred items for reporting case series in homeopathy: The PITCH statement. J Ayurveda Integr Med 2024; 15:101023. [PMID: 39396436 DOI: 10.1016/j.jaim.2024.101023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/14/2024] [Accepted: 06/21/2024] [Indexed: 10/15/2024] Open
Abstract
BACKGROUND Case series is a valuable tool for sharing clinical experiences and generating research questions in the field of medicine. However, there is a lack of standardized reporting guideline for case series in homeopathy, which limits their utility and comparability. The aim of this study is to develop a reporting guideline for case series in homeopathy using a Delphi consensus process. METHOD A group of 21 experts, with experience in reviewing, publishing, or editing case reports or series in homeopathy, were participated in the study. A modified Delphi consensus process was conducted with three rounds of electronic surveys to gather feedback and opinions on the items to be included in the reporting guideline. The GRADE group's nine-point Likert scale was used to rate each item's importance and criticality. RESULT The Delphi process resulted in a consensus-based reporting guideline for case series in homeopathy, which includes recommendations for reporting case series in eleven sections, including 'Title,' 'Abstract,' 'Keywords,' 'Introduction,' 'Methods,' 'Results,' 'Discussion,' 'Conclusion,' 'Patient Perspectives,' 'References,' and 'Additional Information.' PITCH comprises a total of 59 items that achieved consensus agreement. Of these, 13 are optional items and 14 items are exclusively applicable for prospective type of case series. CONCLUSION The PITCH reporting guideline provides a structured and standardized approach for reporting case series in homeopathy. The authors, journal editors, reviewers, and educators are encouraged to adopt and implement the guideline to enhance the quality of case series in homeopathic publications.
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Affiliation(s)
- Abhijit Dutta
- International Cooperation Section, Ministry of Ayush (Government of India), New Delhi, India.
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Rodríguez-Suárez CA, Hernández-De Luis MN. Evaluation of the appropriateness of nursing case studies using the CARE checklist. ENFERMERIA CLINICA (ENGLISH EDITION) 2024; 34:330-342. [PMID: 39032784 DOI: 10.1016/j.enfcle.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 04/04/2024] [Indexed: 07/23/2024]
Abstract
Case report is a narrative description of the problem of one or several patients. The CARE checklist (CAse REport) is the consensus document for reporting clinical case reports and through adaptations to the different CARE disciplines is used to define standards for authors in scientific journals; however, the specificity of the nursing process makes it difficult to adjust nursing case reports to CARE. The aim was to analyze the publications of clinical cases with a nursing perspective in scientific journals, as well as the quality standards and evaluation systems used. Few journals reviewed agreed to publish nursing case reports or stated standards for authors to adjust to CARE. Preliminary results indicated average or poor adherence to CARE, with the most reported elements being: Keywords, patient information and introduction. Adherence was lower for the elements: Timeline, therapeutic intervention, follow-up and outcomes, and patient perspective. The characteristics of the nursing process implies a low adherence to CARE, so it is necessary to unify criteria to guide researchers, authors, reviewers and editors of scientific journals, as well as to improve the rigor and quality of the reports. Currently, there are no specific guidelines for reporting clinical case reports with a nursing perspective available. These normative gaps could be solved by developing a CARE extension adapted to the methodological characteristics of the nursing process.
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Affiliation(s)
- Claudio Alberto Rodríguez-Suárez
- Departamento de Enfermería, Universidad de Las Palmas de Gran Canaria, Canary Islands, Spain; Unidad de apoyo a la investigación del Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Servicio Canario de la Salud, Canary Islands, Spain.
| | - María Naira Hernández-De Luis
- Centro de Salud El Doctoral, Gerencia de Atención Primaria de Gran Canaria, Servicio Canario de la Salud, Canary Islands, Spain
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Dewilde F, Hindryckx M, Younes F, De Bruyckere T, Cosyn J. Lateral bone augmentation with a composite graft covered with a stretched and pinned collagen membrane: A retrospective case series using cone-beam computed tomography. Clin Implant Dent Relat Res 2024; 26:545-553. [PMID: 38391277 DOI: 10.1111/cid.13313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/27/2024] [Accepted: 02/03/2024] [Indexed: 02/24/2024]
Abstract
AIMS (1) To assess the effectiveness of the Sausage Technique™ when applied for lateral bone augmentation by multiple experienced clinicians; (2) To identify risk indicators for a poor outcome and to assess the need for adjunctive surgery. MATERIALS AND METHODS All patients who had been treated with the Sausage Technique™ for lateral bone augmentation by three experienced surgeons between January 2019 and December 2021 were included in a retrospective case series. The Sausage Technique™ technique includes the use of autogenous bone chips and deproteinized bovine bone mineral (1:1 ratio), covered with a stretched and pinned collagen membrane. The increase in alveolar width between the pre-operative situation and 9 months was assessed at different levels on superimposed cone-beam CT scans. RESULTS Twenty-five augmentations performed in 25 patients (17 males, 8 females, mean age 51 years) were available for evaluation. Mean alveolar width increased from 4.35 to 7.43 mm at 3 mm below the crest. The mean increase of 3.08 mm (95% CI 2.10-4.06; p < 0.001) was significant. The outcome of non-containing single implant sites was significantly worse than the outcome of other sites (MD 2.67 mm; p = 0.008). The need for regrafting was 4% and the need for soft tissue augmentation was 48%. Twenty percent of the patients needed soft tissue augmentation due to a lack of keratinized mucosa width, and 32% due to a lack of buccal convexity. The former was mainly needed at multiple implant sites, whereas the latter was mainly required at single implant sites. All implant survived and remained healthy until the final follow-up. CONCLUSION The Sausage Technique™ is an effective bone augmentation technique. Non-containing single implant sites were associated with a poor outcome and adjunctive soft tissue augmentation was needed in about half of the patients.
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Affiliation(s)
- Florence Dewilde
- Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
| | - Matthijs Hindryckx
- Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
| | - Faris Younes
- Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
| | - Thomas De Bruyckere
- Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
| | - Jan Cosyn
- Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
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Aquino JU, Felix GDAA, Feitosa RGF, Tumeh RA, Neto MS. Congenital and Acquired Symmastia: Experience from 100 Cases Treated. Plast Reconstr Surg 2024; 153:873e-883e. [PMID: 37921632 DOI: 10.1097/prs.0000000000010827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Symmastia, first defined by Spence et al. in 1984, is a medical condition characterized by the convergence of breast tissues in the midline, resulting in the absence of adhesion between the skin and subcutaneous tissue over the presternal area. It can be either congenital or acquired. Currently, there is no universally accepted treatment for symmastia. This study presents a surgical approach and preoperative and postoperative care for the correction of symmastia. METHODS Between January of 2014 and December of 2020, a surgical technique was performed on 100 patients, including 59 with congenital symmastia and 41 with acquired symmastia. The technique involved creating a thin skin flap and attaching it to the sternum to reconstruct the intermammary V-shaped region. RESULTS All patients in both groups underwent subglandular implant placement, with textured/polyurethane prostheses used in 97% of cases. Three cases did not use any implants. In the corrective surgery, patients received smaller, round implants, following the steps of the surgical approach devised by the author. The median satisfaction scores were high in both groups. CONCLUSIONS The surgical approach described in this study is a safe, one-time procedure with a low risk of complications and high patient satisfaction. The technique is reproducible and provides consistent outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Al-Madhi S, Acciuffi S, Meyer F, Dölling M, Beythien A, Andric M, Rahimli M, Croner RS, Perrakis A. The Pancreas as a Target of Metastasis from Renal Cell Carcinoma: Is Surgery Feasible and Safe? A Single-Center Experience in a High-Volume and Certified Pancreatic Surgery Center in Germany. J Clin Med 2024; 13:1921. [PMID: 38610686 PMCID: PMC11012243 DOI: 10.3390/jcm13071921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/07/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Secondary malignant tumors of the pancreas are rare, representing 2-5% of all pancreatic malignancies. Nevertheless, the pancreas is one of the target organs in cases of metastatic clear cell renal cell carcinoma (CCRCC). Additionally, recurrent metastasis may occur. Surgical resection remains the best and prognostically most favorable therapeutic option in cases of solitary pancreatic metastasis. Aim: To review retrospectively the clinical tumor registry of the University Hospital of Magdeburg, Germany, for this rare entity, performing a clinical systematic single-center observational study (design). Methods: A retrospective cohort analysis of consecutive patients who had undergone pancreatic resection for metastatic CCRC was performed in a single high-volume certified center for pancreatic surgery in Germany from 2010 to 2022. Results: All patients (n = 17) included in this study had a metachronous metastasis from a CCRCC. Surgery was performed at a median time interval of 12 (range, 9-16) years after primary resection for CCRCC. All 17 patients were asymptomatic at the time of diagnosis. Three of those patients (17.6%) presented with recurrent metastasis in a different part of the pancreas during follow-up. In a total of 17 patients, including those with recurrent disease, a surgical resection was performed; Pancreatoduodenectomy was performed in 6 patients (35%); left pancreatectomy with splenectomy was performed in 7 patients (41%). The rest of the patients underwent either a spleen-preserving pancreatic tail resection, local resection of the tumor lesion or a total pancreatectomy. The postoperative mortality rate was 6%. Concerning histopathological findings, seven patients (41%) had multifocal metastasis. An R0 resection could be achieved in all cases. The overall survival at one, three and five years was 85%, 85% and 72%, respectively, during a median follow-up of 43 months. Conclusions: CCRC pancreatic metastases can occur many years after the initial treatment of the primary tumor. Surgery for such a malignancy seems feasible and safe; it offers very good short- and long-term outcomes, as indicated. A repeated pancreatic resection can also be safely performed.
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Affiliation(s)
- Sara Al-Madhi
- Department of General, Abdominal, Vascular and Transplant Surgery, Otto-von-Guericke University with University Hospital, Leipziger Str. 44, 39120 Magdeburg, Germany; (S.A.); (F.M.); (A.B.); (M.A.); (M.R.); (R.S.C.); (A.P.)
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Aboubakr O, Domenech P, Heurtebise I, Gaillard R, Guy-Rubin A, Carron R, Duriez P, Gorwood P, Vinckier F, Pallud J, Zanello M. Vagus nerve stimulation allows to cease maintenance electroconvulsive therapy in treatment-resistant depression: a retrospective monocentric case series. Front Psychiatry 2024; 14:1305603. [PMID: 38352166 PMCID: PMC10861730 DOI: 10.3389/fpsyt.2023.1305603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/11/2023] [Indexed: 02/16/2024] Open
Abstract
Context The use of vagus nerve stimulation (VNS) to reduce or stop electroconvulsive therapy (ECT) in treatment-resistant depression seems promising. The aim of this study was to investigate the efficacy of VNS on the reduction of ECT sessions and mood stabilization. Methods We conducted a monocentric retrospective case series of patients who suffered from treatment-resistant depression, treated with ECT and referred to our center for VNS. We investigated the number and the frequency of ECT sessions before and after VNS implantation. Secondary criteria consisted in the Montgomery Åsberg Depression Rating Scale (MADRS) score, number of medical treatments, dosage of the main treatment and length of hospital stays before and after VNS. Additionally, we sent an anonymous survey to psychiatrists and other physicians in our institution to investigate their knowledge and perception of VNS therapy to treat treatment-resistant depression. Results Seven patients benefited from VNS: six (86%) were female (mean age of 51.7 +/- 16.0 years at surgery), and five (71%) suffered from bipolar depression (three type I and two type II). All patients were followed up at least 2 years post-implantation (range: 27-68 months). Prior to VNS, six patients were treated by maintenance ECT. After VNS, three (43%) patients did not require maintenance ECT anymore, and three (43%) patients required less frequent ECT session with a mean 14.7 +/- 9.8 weeks between sessions after VNS vs. 2.9 +/- 0.8 weeks before VNS. At last follow-up, 4 (57%) patients had stopped ECT. Five (71%) patients implanted with VNS were good responders (50% decrease relative to baseline MADRS). According to the survey, psychiatrists had a significantly better perception and knowledge of ECT, but a worse perception and knowledge of VNS compared to other physicians. Conclusion VNS is a good option for treatment-resistant depression requiring maintenance ECT dependence. Larger on-going studies will help broaden the implanted patients while strengthening psychiatrists' knowledge on this therapy.
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Affiliation(s)
- Oumaima Aboubakr
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
| | - Philippe Domenech
- Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, Paris, France
- Institut du Cerveau, Inserm U1127, CNRS UMR7225 Sorbonne Université, Paris, France
| | | | - Raphaël Gaillard
- Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, Paris, France
- Motivation, Brain, and Behavior (MBB) Lab, Paris Brain Institute (ICM) Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Romain Carron
- Department of Functional and Stereotactic Neurosurgery, Timone University Hospital, Marseille, France
- Aix Marseille Univ, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Epileptology Department, Marseille, France
| | - Philibert Duriez
- CMME Psychiatry Department, GHU PARIS Sainte-Anne, Paris, France
- Laboratoire de Physiopathologie des Maladies Psychiatriques, Institute of Psychiatry and Neuroscience of Paris INSERM, Paris, France
| | - Philip Gorwood
- CMME Psychiatry Department, GHU PARIS Sainte-Anne, Paris, France
- Laboratoire de Physiopathologie des Maladies Psychiatriques, Institute of Psychiatry and Neuroscience of Paris INSERM, Paris, France
| | - Fabien Vinckier
- Institut du Cerveau, Inserm U1127, CNRS UMR7225 Sorbonne Université, Paris, France
- Cardiology Department Centre Hospitalier de Bourges, Bourges, France
| | - Johan Pallud
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
| | - Marc Zanello
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
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González EO, Runge S, Mantziaris G, Ironside N, Sheehan JP. Stereotactic radiosurgery for brain arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia. Acta Neurochir (Wien) 2024; 166:21. [PMID: 38231447 PMCID: PMC10794397 DOI: 10.1007/s00701-024-05923-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/14/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE Brain arteriovenous malformations (AVMs) in patients with hereditary hemorrhagic telangiectasia (HHT) present different characteristics from sporadic AVMs, and they have lower initial bleeding rates. Conservative management is usually preferred for the treatment of these lesions. In this case study, we present the largest series of HHT patients treated with stereotactic radiosurgery to date. METHODS We identified eight patients with HHT and 14 AVMs. We retrospectively collected clinical, radiographic, and treatment characteristics of the patients and each AVM. RESULTS Most patients in our sample presented with small AVMs. The median volume of these AVMs was 0.22 cm3 (IQR 0.08-0.59). Three out of eight patients presented with initial intracerebral hemorrhage (ICH). The majority of lesions had low (12/14) Spetzler-Martin grades (I-II). Median maximum and margin doses used for treatment were 36.2 (IQR 35.25-44.4) and 20 (IQR 18-22.5) Gy, respectively. The overall obliteration rate after SRS was 11/14, and the median time to obliteration across all 11 obliterated AVMs was 35.83 months (IQR, 17-39.99). Neurological status was favorable with all patients having a mRS of 0 or 1 at the last follow-up. Symptomatic radiation-induced changes (RIC) after SRS were low (7.1%), and there were no permanent RIC. CONCLUSIONS Patients with HHT who present with multiple brain AVMs are generally well served by SRS. Obliteration can be achieved in the majority of HHT patients and with a low complication rate. In the current study, initial hemorrhage rates prior to SRS were noticeable which supports the decision to treat these AVMs. Future studies are needed to better address the role of SRS for HHT patients harboring ruptured and unruptured AVMs.
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Affiliation(s)
- Eduardo Orrego González
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, 22908, USA
| | - Sean Runge
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, 22908, USA
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, 22908, USA
| | - Natasha Ironside
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, 22908, USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, 22908, USA.
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He Z, Zhu CXL, Chan DTM, Cheung TCY, Ng HK, Mok VCT, Poon WS. Diagnostic Accuracy and Field for Improvement of Frameless Stereotactic Brain Biopsy: A Focus on Nondiagnostic Cases. J Neurol Surg A Cent Eur Neurosurg 2024; 85:48-61. [PMID: 36481998 DOI: 10.1055/a-1994-8033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The diagnostic accuracy of frameless stereotactic brain biopsy has been reported, but there is limited literature focusing on the reasons for nondiagnostic cases. In this study, we evaluate the diagnostic accuracy of frameless stereotactic brain biopsy, compare it with the current international standard, and review the field for improvement. METHODS This is a retrospective analysis of consecutive, prospectively collected frameless stereotactic brain biopsies from 2007 to 2020. We evaluated the diagnostic accuracy of the frameless stereotactic brain biopsies using defined criteria. The biopsy result was classified as conclusive, inconclusive, or negative, based on the pathologic, radiologic, and clinical diagnosis concordance. For inconclusive or negative results, we further evaluated the preoperative planning and postoperative imaging to review the errors. A literature review for the diagnostic accuracy of frameless stereotactic biopsy was performed for the validity of our results. RESULTS There were 106 patients with 109 biopsies performed from 2007 to 2020. The conclusive diagnosis was reached in 103 (94.5%) procedures. An inconclusive diagnosis was noted in four (3.7%) procedures and the biopsy was negative in two (1.9%) procedures. Symptomatic hemorrhage occurred in one patient (0.9%). There was no mortality in our series. Registration error (RE) and inaccurate targeting occurred in three trigonal lesions (2.8%), sampling of the nonrepresentative part of the lesion occurred in two cases (1.8%), and one biopsy (0.9%) for lymphoma was negative due to steroid treatment. The literature review suggested that our diagnostic accuracy was comparable with the published literature. CONCLUSION The frameless stereotactic biopsy is a safe procedure with high diagnostic accuracy only if meticulous preoperative planning and careful intraoperative registration is performed. The common pitfalls precluding a conclusive diagnosis are RE and biopsies at nonrepresentative sites.
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Affiliation(s)
- Zhexi He
- Department of Surgery, Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Department of Neurosurgery, Tuen Mun Hospital, Hong Kong, China
| | - Cannon Xian Lun Zhu
- Department of Surgery, Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Danny Tat Ming Chan
- Department of Surgery, Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Tom Chi Yan Cheung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ho-Keung Ng
- Department of Anatomical & Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Chung Tong Mok
- Department of Medicine and Therapeutics, Division of Neurology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai Sang Poon
- Department of Surgery, Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Staibano P, Khattak S, Amin F, Engels PT, Sommer DD. Tracheostomy in Critically Ill COVID-19 Patients on Extracorporeal Membrane Oxygenation: A Single-Center Experience. Ann Otol Rhinol Laryngol 2023; 132:1520-1527. [PMID: 37032528 PMCID: PMC10086820 DOI: 10.1177/00034894231166648] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
OBJECTIVES Novel coronavirus-19 (COVID-19) has led to over 6 million fatalities globally. An estimated 75% of COVID-19 patients who require critical care admission develop acute respiratory distress syndrome (ARDS) needing invasive mechanical ventilation (IMV) and/or extracorporeal membrane oxygenation (ECMO). Due to prolonged ventilation requirements, these patients often also require tracheostomy. We performed a review of clinical outcomes in COVID-19 patients on ECMO at a high-volume tertiary care center in Hamilton, Ontario, Canada. METHODOLOGY We performed a retrospective case series, including 24 adult patients diagnosed with COVID-19 who required IMV, veno-venous (ECMO), and tracheostomy. All patients were included from April to December 2021. We extracted demographic and clinical variables pertaining to the tracheostomy procedure and ECMO therapy. We performed descriptive statistical analyses. This study was approved by the Hamilton Integrated Research Ethics Board (14217-C). RESULTS We included 24 consecutive patients with COVID-19 who required tracheostomy while undergoing ECMO therapy. The mean age was 49.4 years [standard deviation (SD): 7.33], the majority of patients were male (75%), with mean body mass index of 32 (SD: 8.81). Overall mortality rate was 33.3%. Percutaneous tracheostomy was performed most frequently (83.3%) and, similar to open tracheostomy, was associated with a low rate of perioperative bleeding complications. Within surviving patients, the mean time to IMV weaning and decannulation was 60.2 (SD: 24.6) and 49.4 days (SD: 21.8), respectively. CONCLUSION Percutaneous tracheostomy appears to be safe in COVID-19 patients on ECMO and holding anticoagulation 24 hours prior to and after tracheostomy may limit bleeding events in these patients.
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Affiliation(s)
- Phillip Staibano
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
| | - Shahzaib Khattak
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
| | - Faizan Amin
- Department of Medicine, Division of Cardiology, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Paul T Engels
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Doron D Sommer
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
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15
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Mathew G, Sohrabi C, Franchi T, Nicola M, Kerwan A, Agha R. Preferred Reporting Of Case Series in Surgery (PROCESS) 2023 guidelines. Int J Surg 2023; 109:3760-3769. [PMID: 37988417 PMCID: PMC10720832 DOI: 10.1097/js9.0000000000000940] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION The Preferred Reporting Of CasE Series in Surgery (PROCESS) guidelines were developed in 2016 in order to improve the reporting quality of surgical case series. Since its inception, it has been updated twice, in 2018 and 2020, and has been cited over 1000 times. PROCESS guidelines have enjoyed great acceptance within the surgical research community. Our aim is to update the PROCESS guidelines in order to maintain its applicability in the field of surgical research. METHODS A PROCESS 2023 steering group was created. By working in collaboration, members of this group came up with proposals to update the PROCESS 2020 guidelines. These proposals were presented to an expert panel of researchers, who in turn scrutinised these proposals and decided whether they should become part of PROCESS 2023 guidelines or not, through a Delphi consensus exercise. RESULTS A total of 38 people participated in the development of PROCESS 2023 guidelines. The majority of items received a score between 7 and 9 from greater than 70% of the participants, indicating consensus with the proposed changes to those items. However, two items (3c and 6a) received a score between 7 and 9 from less than 70% of the participants, indicating a lack of consensus with the proposed changes to those items. Those items will remain unchanged. DISCUSSION The updated PROCESS 2023 guidelines are presented with an aim to continue improving the reporting quality of case series in surgery.
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Affiliation(s)
| | | | - Thomas Franchi
- Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | | | - Ahmed Kerwan
- Guy’s and St Thomas’ NHS Foundation Trust, London
| | - Riaz Agha
- Harley Clinic Group, 10 Harley Street
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16
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Price G, Schupper A, Kalagara R, Chennareddy S, He C, Zhang JY, Sudhir S, Rentzeperis F, Wanna G, Hadjipanayis C. Application of the Robotic-Assisted Digital Exoscope for Resection of Posterior Fossa Tumors in Adults: A Series of 45 Cases. Oper Neurosurg (Hagerstown) 2023; 25:397-407. [PMID: 37523626 DOI: 10.1227/ons.0000000000000838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/25/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Complete safe resection is the goal when pursuing surgical treatment for posterior fossa (PF) tumors. Efforts have led to the development of the exoscope that delineates tumors from non-neoplastic brain. This investigation aims to assess patient outcomes where PF tumor resection is performed with the exoscope by a retromastoid or suboccipital approach. METHODS A retrospective analysis was conducted for patients with PF tumors who underwent exoscope resection from 2017 to 2022. Patient demographics, clinical, operative, and outcome findings were collected. Extent of resection studies were also performed. Associations between perioperative data, discharge disposition, progression-free survival (PFS), and overall survival (OS) were evaluated. RESULTS A total of 45 patients (22 male patients) with a median age of 57 years were assessed. Eighteen (40%) and 27 patients (60%) were diagnosed with malignant and benign tumors, respectively. Tumor neurovascular involvement was found in 28 patients (62%). Twenty-four (53%) and 20 (44%) tumors formed in the cerebellum and cerebellopontine angle cistern, respectively. One tumor (2%) was found in the cervicomedullary junction. The mean extent of resection was 96.7% for benign and malignant tumors. The PFS and OS rate at 6 months (PFS6, OS6) was 89.7% and 95.5%, respectively. Neurological complications included sensory loss and motor deficit, with 11 patients reporting no postoperative symptoms. Of the neurological complications, 14 were temporary and 9 were permanent. CONCLUSION The exoscope is an effective intraoperative visualization tool for delineating PF tumors. In our series, we achieved low postoperative tumor volumes and a high gross total resection rate.
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Affiliation(s)
- Gabrielle Price
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Alexander Schupper
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Roshini Kalagara
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Susmita Chennareddy
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Celestine He
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jack Yin Zhang
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Sweta Sudhir
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Frederika Rentzeperis
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - George Wanna
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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17
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Surdiacourt L, Cosyn J. A prospective case series on the efficacy of a cross-linked collagen matrix to increase buccal soft tissue thickness at large edentulous gaps: One-year results. Clin Implant Dent Relat Res 2023; 25:853-860. [PMID: 37183884 DOI: 10.1111/cid.13216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/10/2023] [Accepted: 04/26/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The objective of this study is to assess profilometric changes following soft tissue augmentation with a cross-linked porcine-derived collagen matrix (CMX) at large edentulous gaps of at least two units. MATERIALS AND METHODS Systemically healthy, nonsmoking patients with a large edentulous gap of at least two units demonstrating a horizontal soft tissue defect, were enrolled in a prospective case series. Soft tissue augmentation was performed in a one-stage approach with a 6 mm thick CMX at the time of implant placement. The primary outcome was the change in buccal soft tissue profile (BSP) at a mesial, central, and distal area of interest (AOI) up to 1 year when compared to the preoperative situation based on superimposed digital surface models. Secondary outcomes included the horizontal dimension of the soft tissue defect, complications, and marginal bone loss (MBL). RESULTS Fifteen patients (eight females; mean age 58.73 years) were enrolled and 13 could be re-assessed at 1-year follow-up. The mean linear increase in BSP at 1 year was 0.66 mm (98.3% CI: 0.37-0.94), 0.80 mm (98.3% CI: 0.39-1.22), and 0.69 mm (98.3% CI: 0.32-1.06) at the mesial, central, and distal AOI, respectively. Substantial shrinkage of about 75% was observed in all areas between augmentation and 1-year follow-up. Even though 11 of 13 sites were fully augmented immediately postoperative, a soft tissue defect recurred in all sites at 1-year follow-up with a mean deficit of 2.30 mm. Altogether, 25% of the original soft tissue defect was eliminated by soft tissue augmentation. CMX was safe since no postoperative complications occurred and MBL was limited (0.70 mm). CONCLUSION CMX is efficacious for horizontal soft tissue augmentation at large edentulous gaps. However, considerable graft resorption may be expected, and the clinical relevance of the augmentation may be questionable since all patients demonstrated a recurring and considerable soft tissue defect 1 year after surgery.
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Affiliation(s)
- Lenz Surdiacourt
- Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
| | - Jan Cosyn
- Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium
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Rahman E, Philip-Dormston WG, Webb WR, Rao P, Carruthers JD, Carruthers A, Swift A, Goodman GJ, Mosahebi A, Nahai F. Developing Consensus-Based Guidelines for Case Reporting in Aesthetic Medicine: Enhancing Transparency and Standardization. Aesthet Surg J Open Forum 2023; 5:ojad076. [PMID: 37694226 PMCID: PMC10483583 DOI: 10.1093/asjof/ojad076] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
Clinical case reporting plays a vital role in sharing detailed patient narratives, providing insights into rare conditions, innovative treatments, and unexpected outcomes. However, existing reporting guidelines in aesthetic medicine fail to capture the specific nuances of procedures and outcomes in this field. The authors' objectives were to develop comprehensive guidelines for Case REporting in Aesthetic Medicine (CREAM). The study employed a 3-phase consensus process, including a literature review, expert interviews, and a consensus meeting. A diverse group of 10 expert participants (plastic surgeons, dermatologists, noncore specialists, evidence-based medicine expert, and research scientist) in Phase I and 30 experienced aesthetic practitioners in Phase II contributed to the research. Statistical analysis was conducted to assess agreement levels among participants and explore associations and variations within the data. The participants represented various specialties, genders, LGBTQ+ identities, and ethnic backgrounds. The research resulted in the development of the CREAM guidelines, consisting of a 16-item checklist. The guidelines covered essential aspects of case reporting, such as patient and practice information, procedure details, clinical assessment and outcomes, adverse events, and ethical considerations. Statistical analysis indicated a high level of consensus among participants, as well as significant associations between checklist items. CREAM guidelines represent a step toward enhancing transparency and standardization in case reporting in aesthetic medicine. Adhering to these guidelines will allow authors to contribute to a robust evidence base, prioritize patient safety, and drive advancements aesthetic medicine.
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Affiliation(s)
- Eqram Rahman
- Corresponding Author: Dr Eqram Rahman, Pond Street, Hampstead NW3 2QG, UK. E-mail: ; Instagram: @Beyond_border_Aesthetics
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19
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Peloza J, Malone H, Jacobian E, Kolsky DE, Harel R, Guyer RD, Millgram MA, Ashkenazi E. The use of a new high-speed shielded curved drill is associated with improved intraoperative and clinical outcomes after cervical corpectomy and fusion procedures: a retrospective case series. J Orthop Surg Res 2023; 18:364. [PMID: 37194059 DOI: 10.1186/s13018-023-03769-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/31/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Anterior cervical corpectomy and fusion (ACCF) is an effective technique to address multi-level degenerative cervical myelopathy. However, as the number of surgical levels increases, the outcomes worsen with respect to complication rates, range of motion and length of surgery. This study aimed to determine the clinical outcome of ACCF procedures performed using a new distally curved and shielded drilling device. METHODS A retrospective study was conducted on 43 ACCF procedures in which the device was used for osteophyte removal. Patient files were reviewed to assess the early clinical results and complications following ACCF. Clinical outcomes were evaluated using patient neck and arm pain scores and SF-36 questionnaires. Hospitalization characteristics were compared with historical controls. RESULTS All procedures were uneventful and without major complications or neurological deterioration. Single-level ACCF procedures required an average of 71 min and followed by an average hospitalization of 3.3 days. Osteophyte removal, verified by intraoperative imaging, was satisfactory. Average neck pain score was improved by 0.9 points (p = 0.24). Average arm pain score was improved by 1.8 points (p = 0.06). SF-36 scores were improved in all domains. CONCLUSIONS The new curved device enabled safe and efficient removal of osteophytes sparing adjacent vertebral removal in ACCF procedures, thus improving the clinical outcome.
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Affiliation(s)
- John Peloza
- Center for Spine Care, 17980 Dallas Pkwy Ste 300, Dallas, TX, 75287, USA
| | - Hani Malone
- Scripps Clinic Torrey Pines, 10666 N Torrey Pines Rd., La Jolla, CA, 92037, USA
| | - Erel Jacobian
- Israel Spine Center, Assuta Medical Centers, Habarzel 20, 6971028, Tel Aviv, Israel
| | - Daniel E Kolsky
- Israel Spine Center, Assuta Medical Centers, Habarzel 20, 6971028, Tel Aviv, Israel
| | - Ran Harel
- Spine Surgery Unit, Department of Neurosurgery, Sheba Medical Center, 52662, Ramat-Gan, Israel
| | - Richard D Guyer
- Texas Back Institute, 6020 W Parker Rd Suite 200, Plano, TX, 75093, USA
| | - Michael A Millgram
- Israel Spine Center, Assuta Medical Centers, Habarzel 20, 6971028, Tel Aviv, Israel.
| | - Ely Ashkenazi
- Israel Spine Center, Assuta Medical Centers, Habarzel 20, 6971028, Tel Aviv, Israel
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Shojaeian R, Hiradfar M, Bahrami Taqanaki P, Ameri L, Parvizi Mashhadi M. Evaluating the utility of cystoscopy, distal colostography, and sonography for locating the fistula in patients with anorectal malformation: a case series. Ann Med Surg (Lond) 2023; 85:1436-1441. [PMID: 37229021 PMCID: PMC10205290 DOI: 10.1097/ms9.0000000000000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/05/2023] [Indexed: 05/27/2023] Open
Abstract
UNLABELLED Anorectal malformations are congenital conditions ranging from a simple perianal fistula to a complex cloacal malformation. Since the precise determination of the location of the fistula is the central pillar in choosing the type of surgery, this study aims to evaluate and compare the efficacy of three techniques, transperineal ultrasound, distal colostography, and cystoscopy. MATERIALS AND METHODS This study was performed on patients with anorectal abnormalities who had undergone decompressive colostomy and were planned for anorectoplasty in the period from September 2017 to March 2019 in a pediatric surgical center. To answer our question, all three mentioned methods were conducted before the surgery and were compared with the intraoperative findings. RESULTS Sonography, distal colostography, and the second cystoscopy findings were similar to intraoperative conclusions concerning the presence of a fistula in patients, whereas blind cystoscopy had 30% accuracy and similarity. Regarding the type of fistula sonography, distal colostography, and second cystoscopy each had 50, 37.5, and 10 inconsistency with the intraoperative findings. In all cases where a fistula was detected in blind cystoscopy, the location of the fistula was correctly determined by this modality. Data analysis on the pouch to perineum distance measurements obtained from sonography and colostography were significantly different from that of surgery. CONCLUSION The results of this study emphasize the need to perform several diagnostic modalities to determine the location and type of fistula to improve diagnostic accuracy.
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Affiliation(s)
- Reza Shojaeian
- Department of Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran, Akbar Children’s Hospital
| | - Mehran Hiradfar
- Department of Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran, Akbar Children’s Hospital
| | - Pegah Bahrami Taqanaki
- Mashhad University of Medical Sciences, Mashhad, Iran, University of Medical Sciences, Azadi Square
| | - Leila Ameri
- Parsian Imaging Center, Mashhad, Iran, Parsian Imaging Center, Mashhad, Khorasan Razavi, Iran
| | - Mahdi Parvizi Mashhadi
- Department of Pediatric Surgery, Mashhad University of Medical Sciences, Mashhad, Iran, Akbar Children’s Hospital
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21
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Galal A. Study design methodology in neurosurgical research. EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-023-00186-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Abstract
Background
Medical research has evolved from individual expert-described opinions and techniques to scientifically designed methodology-based studies. There are different study designs, and selecting an appropriate study design is critical to appropriately answer the research question being investigated.
Main body
A research question may be addressed using different approaches that can be descriptive, analytical, or experimental. The choice of study design is influenced by features as that related to exposure (intervention) and disease (outcome); considerations related to time, resources, ethics and gaps in scientific knowledge that remain to be filled. The purpose of this review is to provide an overview of the basic study designs as it is the foundation of neurosurgical research to provide valid scientific evidence.
Conclusion
Quality in scientific research begins with a clear hypothesis and a well-formulated design. This entails a thorough understanding of the different study designs to choose the best suited to answer the investigated research question.
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22
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Tavelli L, Zucchelli G, Stefanini M, Rasperini G, Wang HL, Barootchi S. Vertical soft tissue augmentation to treat implant esthetic complications: A prospective clinical and volumetric case series. Clin Implant Dent Relat Res 2023; 25:204-214. [PMID: 36759964 DOI: 10.1111/cid.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/23/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Challenging implant esthetic complications are often characterized by implant malpositioning and interproximal attachment loss of the adjacent teeth. However, limited evidence is available on the treatment of these conditions. The aim of this study was to evaluate the clinical, volumetric, and patient-reported outcome following treatment of peri-implant soft tissue dehiscences (PSTDs) exhibiting interproximal attachment loss on adjacent teeth, performed through vertical soft tissue augmentation with implant submersion. METHODS Ten subjects with isolated PSTD in the anterior maxilla characterized by adjacent dentition exhibiting interproximal attachment loss were consecutively enrolled and treated with horizontal and vertical soft tissue augmentation, involving crown and abutment removal, two connective tissue grafts, and submerge healing. Clinical outcomes of interest included mean PSTD coverage, mean PSTD reduction, clinical attachment level (CAL) gain at the implant and adjacent sites and soft tissue phenotype modifications at 1 year. Optical scanning was used for assessing volumetric changes. Professional assessment of esthetic outcomes was performed using the Implant Dehiscence coverage Esthetic Score (IDES), while patient-reported esthetic assessment involved a 0-10 visual analogue scale. RESULTS The mean PSTD depth reduction and mean PSTD coverage at 1 year were 2.25 mm, and 85.14%, respectively. A mean keratinized tissue width (KTW) gain of 1.15 mm was observed, while the mean gain in mucosal thickness (MT) was 1.58 mm. A mean CAL gain of 1.45 mm was obtained at the interproximal aspect of the adjacent dentition at 1 year. Greater linear dimensional (LD) changes were observed at the midfacial aspect of the implant compared to the interproximal sites. The mean final IDES was 6.90 points, while patient-reported esthetic evaluation was 8.83 points. CONCLUSIONS The present study demonstrated that vertical soft tissue augmentation with a submerged healing is an effective treatment approach for the treatment of challenging PSTDs with adjacent dentition exhibiting interproximal attachment loss. This technique can be effective in resolution of esthetic complications in most cases, providing a substantial gain in interproximal attachment levels at the adjacent dentition.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA.,Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Boston, Massachusetts, USA.,Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Giovanni Zucchelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giulio Rasperini
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,IRCCS Foundation Polyclinic Ca' Granda, Milan, Italy
| | - Hom-Lay Wang
- Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Boston, Massachusetts, USA
| | - Shayan Barootchi
- Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Boston, Massachusetts, USA.,Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Hu S, Li J, Lu Y, Zhao S, Shao Y. Minimal lower eyelid epicanthoplasty combined with thermal contraction to treat epiblepharon in chinese children. BMC Ophthalmol 2023; 23:18. [PMID: 36627593 PMCID: PMC9832807 DOI: 10.1186/s12886-022-02763-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To evaluate the clinical efficacy of combined minimal lower eyelid epicanthoplasty and thermal contraction for epiblepharon repair in Chinese children. METHODS Between January 2017 and August 2020, a single surgeon corrected epiblepharon in Chinese children using minimal lower eyelid epicanthoplasty combined with thermal contraction. First, a minimal epicanthoplasty flap to balance the lower eyelid was made cross the lower eyelid epicanthus, which connected with a 20-mm-long incision 1.5 mm below the lower eyelid margin. After removing the hypertrophic orbicularis oculi muscle running between the lower epicanthal fold and the medial canthal tendon, thermal cauterization was applied to increase lower eyelid rotation by creating adhesions between the lower eyelid retractor and tarsus. The residual medial edge was sutured to the corner of the epicanthus to decrease the lower eyelid epicanthus. The postoperative follow-up ranged from 3 to 24 months. We retrospectively analyzed cases to determine whether this approach decreased the lower eyelid epicanthal fold to equalize the tension of the lower eyelid. The surgical outcomes including the direction of lower eyelid eyelashes, complications, and refractive errors were evaluated. RESULTS Data from each eye of 53 Chinese children (29 female, 24 males; mean age: 5.3 ± 2.3 years) who had undergone minimal lower eyelid epicanthoplasty combined with thermal contraction were included. During follow-up, recurrence was observed in just one of the 106 eyes (0.94%), and two eyes (1.89%) showed under-correction. No visible scars formed in the postoperative period. All patients' parents were satisfied with the cosmetic results and had no serious complaints. The mean astigmatism was significantly reduced by the surgery from 1.82 ± 0.45 diopters (D) preoperatively to 1.43 ± 0.36 D postoperatively (P < 0.05). CONCLUSION This surgery is easy to design, time-efficient, and is effective in the correction of epiblepharon. The procedure allows surgeons to achieve good appearance and natural eyelid contour without apparent complications.
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Affiliation(s)
- Shoulong Hu
- grid.24696.3f0000 0004 0369 153XNational Center for Children’s Health, MOE Key Laboratory of Major Diseases in Children, Department of Ophthalmology, Beijing Children’s Hospital, Capital Medical University, Beijing, 100045 China ,Department of Ophthalmology, Children’s Hospital of Zheng Zhou, Zheng Zhou, 450053 China
| | - Jingyi Li
- grid.460676.50000 0004 1757 5548Department of Endocrinology, Beijing United Family Hospital, Beijing, China
| | - Yuebing Lu
- Department of Ophthalmology, Children’s Hospital of Zheng Zhou, Zheng Zhou, 450053 China
| | - Shengnan Zhao
- Department of Ophthalmology, Children’s Hospital of Zheng Zhou, Zheng Zhou, 450053 China
| | - Yi Shao
- grid.412604.50000 0004 1758 4073Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute, Nanchang, Jiangxi Province 330006 China
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Peto I, Noureldine MHA, Zavadskiy G, Pressman E, Flores-Milan G, van Loveren H, Agazzi S. Postoperative magnetic resonance imaging signal changes in middle cerebral peduncle after vestibular schwannoma surgery. Br J Neurosurg 2022; 36:712-719. [PMID: 35913025 DOI: 10.1080/02688697.2022.2102147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Preoperative compression of middle cerebellar peduncle (MCP) is often observed in vestibular schwannomas. Its re-expansion is expected after tumour resection, however, frequently its thickness remains unchanged or undergoes further atrophy. Similarly, increased MCP FLAIR signal is often observed and thought to be associated with intraoperative MCP injury. This study investigates the dynamics of MCP FLAIR signal changes over time and their implications in long-term MCP atrophy. MATERIALS AND METHODS Retrospective analysis of patients operated between 2011 and 2019 was performed. Measurements of FLAIR signals and MCP thickness were performed preoperatively, postoperatively and at follow-up. RESULTS 28 patients (15 females, mean age 51.94 years) were included. The mean follow-up was 23.98 months. The mean tumour size was 2.99 cm. The MCP FLAIR signal was elevated preoperatively in 10 (35.7%) patients and further increased postoperatively in 22 (78.6%), followed by its decrease at follow up (7 patients, 25%). An immediate postoperative re-expansion of middle cerebellar peduncle was observed in 24 (85.7%) patients. No association between tumour size and preoperative FLAIR was established, however tumour size was negatively associated with the MCP thickness. A significant negative association between a postoperative FLAIR and follow-up thickness (p < 0.001) was noted, even if controlling for tumour size and both tumour size and preoperative MCP thickness. CONCLUSION In patients with vestibular schwannomas undergoing surgical resection, the middle cerebellar peduncle FLAIR signal seems to associated with long term thickness of MCP, regardless of its initial size, however does not seem to correlate with the clinical outcome.
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Affiliation(s)
- Ivo Peto
- Morsani College of Medicine, Department of Neurosurgery and Brain Repair, Tampa General Hospital, University of South Florida, Tampa, Florida, USA
| | - Mohammad Hassan A Noureldine
- University of South Florida Morsani College of Medicine, Department of General Surgery, Tampa General Hospital, Tampa, Florida, USA
| | - Gleb Zavadskiy
- Departmenf of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Elliot Pressman
- Morsani College of Medicine, Department of Neurosurgery and Brain Repair, Tampa General Hospital, University of South Florida, Tampa, Florida, USA
| | - Gabriel Flores-Milan
- Morsani College of Medicine, Department of Neurosurgery and Brain Repair, Tampa General Hospital, University of South Florida, Tampa, Florida, USA
| | - Harry van Loveren
- Morsani College of Medicine, Department of Neurosurgery and Brain Repair, Tampa General Hospital, University of South Florida, Tampa, Florida, USA
| | - Siviero Agazzi
- Morsani College of Medicine, Department of Neurosurgery and Brain Repair, Tampa General Hospital, University of South Florida, Tampa, Florida, USA
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Herta J, Rössler K, Dorfer C. Technical Assessment of Microvascular Decompression for Trigeminal Neuralgia Using a 3-Dimensional Exoscope: A Case Series. Oper Neurosurg (Hagerstown) 2022; 23:374-381. [PMID: 36227252 DOI: 10.1227/ons.0000000000000362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/24/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Detailed anatomic visualization of the root entry zone of the trigeminal nerve is crucial to successfully perform microvascular decompression surgery (MVD) in patients with trigeminal neuralgia. OBJECTIVE To determine advantages and disadvantages using a 3-dimensional (3D) exoscope for MVD surgery. METHODS A 4K 3D exoscope (ORBEYE) was used by a single surgical team for MVD in a retrospective case series of 8 patients with trigeminal neuralgia in a tertiary center. Clinical and surgical data were collected, and advantages/disadvantages of using the exoscope for MVD were recorded after each surgery. Descriptive statistics were used to summarize the data. RESULTS Adequate MVD of the trigeminal nerve root was possible in all patients by exclusively using the exoscope. It offered bright visualization of the cerebellopontine angle and the root entry zone of the trigeminal nerve that was comparable with a binocular operating microscope. The greatest advantages of the exoscope included good optical quality, the pronounced depth of field of the image for all observers, and its superior surgeon ergonomics. Disadvantages were revealed with overexposure at deep surgical sites and the lack of endoscope integration. In 6 patients, facial pain improved significantly after surgery (Barrow Neurological Institute pain intensity score I in 5 and III in 1 patient), whereas it did not in 2 patients (Barrow Neurological Institute score IV and V). No complications occurred. CONCLUSION Utilization of a 3D exoscope for MVD is a safe and feasible procedure. Surgeons benefit from better ergonomics, excellent image quality, and an improved experience for observers.
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Affiliation(s)
- Johannes Herta
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
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Banat M, Bara G, Salemdawod A, Rana S, Hamed M, Scorzin J, Vatter H. Vertebroplasty in geriatric patients with osteoporotic vertebral fractures: single-center cohort study at a level 1 center for spinal surgery. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00551-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Study design
Retrospective single-center cohort study.
Background
The spine is the most common anatomic site for osteoporotic fractures. Osteoporotic vertebral fractures play an increasingly important role in geriatric patients and percutaneous vertebroplasty (PVP) constitutes a common treatment option. The aim of this study was to evaluate the safety and efficacy of PVP in geriatric patients with cardiovascular comorbidities at our center.
Methods
In this retrospective single-center study, 49 patients aged ≥ 65 with a total of 88 vertebral fractures underwent vertebroplasty. MRI and CT scans of the spine were performed in all patients prior to surgery. All patients were evaluated 4 weeks after surgery as part of their clinical follow-up. VAS scores were recorded before and after the operation. Postoperative complications within 30 days of the initial surgery were analyzed.
Results
The mean age of patients was 77 years (± 6.4). Of the 49 patients, 39 (80%) were female, and 36 (76%) had cardiovascular comorbidities. The most frequent postoperative complications were cement leakage with no new neurological postoperative deficits (14.3%). The in-hospital mortality rate was 1 out of 49 patients (2%). VAS scores revealed an overall pain reduction of > 97%. None of the following affected patient safety: ASA, BMI, duration of surgery, or the level or localization of vertebroplasty.
Conclusions
Our data demonstrate that vertebroplasty was a feasible and effective treatment for pain reduction in geriatric patients with osteoporotic fractures despite cardiovascular comorbidities.
Level of evidence
3.
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27
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Complications Following Facial Injection of Growth Factor Solution. Aesthetic Plast Surg 2022; 47:612-621. [PMID: 36123508 DOI: 10.1007/s00266-022-03033-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/16/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Topical injection of growth factor (GF) for facial rejuvenation is unauthorized, but it is commonly performed in China, leading to emerging and challenging complications. The purpose of this study is to investigate the clinical, imaging, and histopathologic characteristics of complications caused by facial GF injection, as well as their treatments and outcomes. METHODS We performed a retrospective single-centered case series study on consecutive patients who were treated for complications following facial injection of GF. The primary outcome was the recurrence over follow-up period. The secondary outcomes were the subjective evaluations of the facial aesthetic, symptomatic, and psychological improvements using the Global Aesthetic Improvement Scale (GAIS) and a patient-reported outcome measurement (PROM). Kaplan-Meier analysis and log-rank test were performed to investigate the recurrence. RESULTS A total of 32 females with an average age of 42.6 ± 9.4 years were included. Most patients received GF injections in non-medical institutes such as beauty spas and presented with uncontrollable soft tissue hyperplasia, diffuse subcutaneous swelling, and skin redness. Ultrasonography showed heterogeneous hypoechoic or echogenic areas in a thickened and disorganized subcutaneous tissue hierarchy. MRI showed flaky isointensive or hypointensive signals on T1WI and hyperintensive signals on T2WI. 37.5% patient underwent triamcinolone acetonide injection, whereas 62.5% patients underwent surgical interventions. Lipoma-like hyperplastic tissue was found during surgery. HE staining confirmed intramuscular lipoma and fibrolipomatous tissue hyperplasia. Recurrence was found in 37.5% patients over a median follow-up of 6 months. KM curves and log-rank test demonstrated no significant difference in the recurrence between patients who underwent nonsurgical or surgical interventions (p = 0.77). GAIS and PROM scores indicated substantial aesthetic, symptomatic, and psychological improvements in 70%, 91.7%, and 75% patients, respectively. CONCLUSIONS Both surgical and nonsurgical interventions are feasible and effective treatment options for GF-induced complications. Although recurrence rate was relatively high, aesthetic, symptomatic, and psychological improvements were achieved in most patients. We developed a workflow that might help diagnose and treat complications following unknown dermal filler injections. 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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Tinano MM, Becker HMG, Franco LP, dos Anjos CPG, Ramos VM, Nader CMFF, Godinho J, de Párcia Gontijo H, Souki BQ. Morphofunctional changes following adenotonsillectomy of obstructive sleep apnea children: a case series analysis. Prog Orthod 2022; 23:29. [PMID: 35934732 PMCID: PMC9357578 DOI: 10.1186/s40510-022-00422-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
To perform a case series analysis of the changes in the pulmonary artery systolic pressure (PASP), nasal inspiratory flow (NIF), upper airway volume, obstructive apnea/hypopnea index (OAHI), and the maxillomandibular three-dimensional (3D) morphology after adenotonsillectomy (T&A) of obstructive sleep apnea children (OSA).
Materials and methods
Retrospective assessment of files from 1002 children screened between 2012 and 2020 in a hospital-based mouth-breather referral center. From this universe, 15 obstructive sleep apnea children (7 females; 8 males), ages 4.1 to 8.9 years old (mean age of 5.4 years ± 1.3), who presented indications of tonsillectomy and/or adenoidectomy were selected. The complete baseline examination (T0) was carried out before T&A and a second complete examination (T1) was made 18.7-month follow-up after T&A (ranging from 12 to 30 months). Eleven patients were submitted to T&A, and four patients had indications but did not receive authorization for surgery from the public health system. According to the protocol of the outpatient clinic for OSA patients, Doppler echocardiography, polysomnography, rhinomanometry, and computed tomography imaging was performed at (T0) and (T1).
Results
PASP decreased 16.6% after T&A. NIF increased more in T&A children (40.3%) than in non-T&A children (16.8%). The upper airway volume increased in T&A and non-T&A children, but greater volumetric gain (45.6%) was found in the nasopharynx of T&A patients. OAHI did not change in six T&A children (55%) and three non-T&A children (75%). The maxilla displaced downward and backward relative to the cranial base in six T&A children (55%) and two untreated children (50%). Nine of the T&A children (85%) and three untreated children (75%) presented extensive condylar growth and increased mandibular length. The qualitative 3D assessment showed similar morphological 3D changes in T&A and non-T&A patients.
Conclusion
Pulmonary artery systolic pressure decreased, nasal inspiratory flow increased, and nasopharynx volume increased following adenotonsillectomy, but obstructive apnea/hypopnea index and maxillomandibular morphology were similar in surgical and non-surgical patients.
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Shi BW, Xu L, Gong CX, Yang F, Han YD, Chen HZ, Li CG. Preoperative Neutrophil to Lymphocyte Ratio Predicts Complications After Esophageal Resection That can be Used as Inclusion Criteria for Enhanced Recovery After Surgery. Front Surg 2022; 9:897716. [PMID: 35910480 PMCID: PMC9326077 DOI: 10.3389/fsurg.2022.897716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/22/2022] [Indexed: 12/13/2022] Open
Abstract
Background The neutrophil to lymphocyte ratio (NLR) has been reported as an indicator for poor prognosis in many cancers including esophageal cancer. However, the relationship between the NLR and postoperative complications after esophageal cancer resection remains unclear. At present, enhanced recovery after surgery (ERAS) lacks inclusion criteria. The aim of this study is to determine whether the preoperative NLR (preNLR) can predict complications after esophageal cancer resection, which could represent the criteria for ERAS. Methods This was a retrospective study on 171 patients who underwent esophagectomy at Hospital between November 2020 and November 2021(68 patients from Changhai Hospital, 65 patients from Shanghai General Hospital and 38 patients from Affiliated Hospital of Qingdao University). Univariate and multivariate logistic regression analyses were performed to demonstrate that the preNLR could predict complications after esophagectomy. Results A preNLR cutoff value of 2.30 was identified as having the greatest ability to predict complications with a sensitivity of 76% and specificity of 65%. Moreover, the Chi-squared test results showed that the preNLR was significantly associated with complications (x2 = 13.641, p < 0.001), and multivariate logistic regression analysis showed that body mass index (BMI), p stage and preNLR were independent variables associated with the development of postoperative complications (p < 0.05). Conclusion The preNLR can predict complications after esophagectomy, and these predicted complications can represent the criteria for recruiting patients for ERAS.
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Affiliation(s)
- Bo-Wen Shi
- Department of Thoracic Surgery, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Li Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chun-Xia Gong
- Department of Thoracic Surgery, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Fu Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu-Dong Han
- Department of Thoracic Surgery, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - He-Zhong Chen
- Department of Thoracic Surgery, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Chun-Guang Li
- Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.,Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Surgical Complications in Immediate and Delayed Breast Reconstruction: A Systematic Review and Meta-Analysis. J Plast Reconstr Aesthet Surg 2022; 75:4085-4095. [DOI: 10.1016/j.bjps.2022.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 08/17/2022] [Indexed: 11/19/2022]
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Ali M, Hassan A, Shah S, Rashid A, Naguib A. The Effect of Tranexamic Acid on the Outcome of Total Ankle Replacement. Cureus 2022; 14:e26706. [PMID: 35959184 PMCID: PMC9360626 DOI: 10.7759/cureus.26706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Infection rates after total ankle replacement (TAR) are known to be greater than those after hip or knee arthroplasty. Swelling after TAR can make wound healing more difficult, which can lead to infection. Tranexamic acid (TXA) has been shown to minimize blood loss after surgery, improving healing outcomes. We aim to assess the effect of TXA on blood loss and wound complications in TAR. Methods: The research looked retrospectively at patients who had TAR procedures between September 2014 and December 2019. The procedures were done using the anterior approach at a single hospital by two, foot and ankle surgeons. Tranexamic acid was given intraoperatively before the tourniquet was inflated. The surgeons did not use surgical drains. Pre and postoperative hemoglobin levels, outcome scores as well as post-operative complications were all documented. Results: A total of 69 patients were included in the study with 33 of them receiving TXA. With a mean age of 67.2, we had 31 females and 38 males. Tranexamic acid was given in doses ranging from 1 gm to 2 gm. None of the patients required blood transfusions after surgery, and there was no statistically significant difference in pre and postoperative hemoglobin levels between the two groups. In the TXA group, there were fewer wound complications. The TXA group achieved better results compared to the non-TXA group (p=0.0130). Conclusion: Tranexamic acid is safe and effective in lowering postoperative bleeding and preserving hemostasis after deflating the tourniquet, reducing edema and postoperative wound problems such as breakdown and dehiscence.
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Observational Studies in Neurosurgery: Structure, Functioning, and Uses. World Neurosurg 2022; 161:265-274. [DOI: 10.1016/j.wneu.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/18/2022]
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Mantica G, Leonardi R, Diaz R, Malinaric R, Parodi S, Tappero S, Paraboschi I, Álvarez-Maestro M, Yuen-Chun Teoh J, Garriboli M, Ortega Polledo LE, Soriero D, Pertile D, De Marchi D, Pini G, Rigatti L, Ghosh SK, Onigbinde OA, Tafuri A, Carrion DM, Nikles S, Antoni A, Fransvea P, Esperto F, Herbella FAM, Oxley da Rocha A, Vanaclocha V, Sánchez-Guillén L, Wainman B, Quiroga-Garza A, Fregatti P, Murelli F, Van der Merwe A, Gomez Rivas J, Terrone C. Reporting ChAracteristics of cadaver training and sUrgical studies: The CACTUS guidelines. Int J Surg 2022; 101:106619. [PMID: 35429658 DOI: 10.1016/j.ijsu.2022.106619] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/17/2022] [Accepted: 04/08/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Recent systematic reviews highlighted increasing use of cadaveric models in the surgical training, but reports on the characteristics of the models and their impact on training are lacking, as well as standardized recommendations on how to ensure the quality of surgical studies. The aim of our survey was to provide an easy guideline that would improve the quality of the studies involving cadavers for surgical training and research. METHODS After accurate literature review regarding surgical training on cadaveric models, a draft of the CACTUS guidelines involving 10 different items was drawn. Afterwards, the items were improved by questionnaire uploaded and spread to the experts in the field via Google form. The guideline was then reviewed following participants feedback, ergo, items that scored between 7 and 9 on nine-score Likert scale by 70% of respondents, and between 1 and 3 by fewer than 15% of respondents, were included in the proposed guideline, while items that scored between 1 and 3 by 70% of respondents, and between 7 and 9 by 15% or more of respondents were not. The process proceeded with Delphi rounds until the agreement for all items was unanimous. RESULTS In total, 42 participants agreed to participate and 30 (71.4%) of them completed the Delphi survey. Unanimous agreement was almost always immediate concerning approval and ethical use of cadaver and providing brief outcome statement in terms of satisfaction in the use of the cadaver model through a short questionnaire. Other items were subjected to the minor adjustments. CONCLUSION 'CACTUS' is a consensus-based guideline in the area of surgical training, simulation and anatomical studies and we believe that it will provide a useful guide to those writing manuscripts involving human cadavers.
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Affiliation(s)
- Guglielmo Mantica
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | | | - Raquel Diaz
- Department of Senology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Universita' di Genova, (DINOGMI), Italy.
| | - Rafaela Malinaric
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Universita' di Genova, (DINOGMI), Italy.
| | - Stefano Parodi
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Universita' di Genova, (DINOGMI), Italy.
| | - Stefano Tappero
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Universita' di Genova, (DINOGMI), Italy.
| | - Irene Paraboschi
- Department of Paediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | | | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
| | | | | | - Domenico Soriero
- Department of Surgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | - Davide Pertile
- Department of Surgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | | | | | | | | | - Oluwanisola Akanji Onigbinde
- Department of Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences, Nile University of Nigeria, Abuja, Nigeria.
| | | | - Diego M Carrion
- Department of Urology, Torrejon University Hospital, Francisco de Vitoria University, Madrid, Spain.
| | - Sven Nikles
- Sestre Milosrdnice University Hospital, Zagreb, Croatia.
| | - Anna Antoni
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
| | - Pietro Fransvea
- Emergency Surgery and Trauma Unit, IRCCS Policlinico Gemelli University Hospital, Roma, Italy.
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy.
| | | | - Andrea Oxley da Rocha
- Department of Human Anatomy, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
| | - Vicente Vanaclocha
- Department of Surgery, Division of Neurosurgery, University of Valencia, Spain.
| | - Luis Sánchez-Guillén
- Colorectal & Gastrointestinal Department, Hospital General Universitario de Elche, Universidad Miguel Hernández, Elche, Alicante, Spain.
| | - Bruce Wainman
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada.
| | - Alejandro Quiroga-Garza
- Departamento de Anatomía Humana, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
| | - Piero Fregatti
- Department of Senology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Federica Murelli
- Department of Senology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - André Van der Merwe
- Department of Urology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa.
| | - Juan Gomez Rivas
- Department of Urology, Clínico San Carlos University Hospital, Madrid, Spain.
| | - Carlo Terrone
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Universita' di Genova, (DINOGMI), Italy.
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Khouri RK, Coleman SR, Yoshimura K, Rigotti G, Piccolo N, D’Amico R, Orgill DP. Commentary on: Safety and Effectiveness of Single Session Mega Volume Fat Grafting for Breast Augmentation: A Space Creating Concept and Clinical Experiences. Aesthet Surg J 2022; 42:NP589-NP591. [PMID: 35435212 DOI: 10.1093/asj/sjac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Sydney R Coleman
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kotaro Yoshimura
- Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan
| | | | | | | | - Dennis P Orgill
- Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Peterson B, Alajmi H, Ladak A, Samargandi OA. Breast Equalization Augmentation: The Use of Ultrasonic Assisted Liposuction for Correction of Primary Breast Asymmetry with Bilateral Augmentation. Aesthetic Plast Surg 2022; 46:667-674. [PMID: 34462800 DOI: 10.1007/s00266-021-02528-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The purpose of this study was to determine the effectiveness of using ultrasonic assisted liposuction (UAL) to achieve sufficient breast symmetry allowing for the use of same sized implants in patients presenting for elective breast augmentation surgery. METHODS A retrospective review was performed of patients presenting for augmentation mammoplasty with breast asymmetry who underwent ultrasonic assisted liposuction in combination with implant augmentation. Pre-operative differences in breast volumes were determined using water displacement, and these measurements were compared to final lipoaspirates required to achieve symmetry. To estimate the volume of lipoaspirate required, we suggested to aim for twice the volume difference obtained by water displacement. The success of the procedure was measured by the ability to use the same size implants bilaterally. RESULTS A total of 35 patients were included in this review. In 85% of patients, UAL was sufficient to permit the use of equally sized implants bilaterally. However, when different sized implants were required, the size difference between implants was not greater than 25 cc. The UAL was also effective in correcting minor ptosis and nipple position. The main observed disadvantage was prolonged bruising and swelling. CONCLUSION The use of UAL for correction of primary breast asymmetry with bilateral breast augmentation allows balancing of breast tissue volumes and the use of same size implants and eliminates the need for balancing mastopexy procedures. 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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Khan Hotak M, Fadia M, Gananadha S. The Clinical Significance of Hemorrhagic Cholecystitis. JSLS 2022; 26:JSLS.2022.00030. [PMID: 35815329 PMCID: PMC9255261 DOI: 10.4293/jsls.2022.00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Hemorrhagic cholecystitis (HC) is a rare complication of acute cholecystitis. HC is difficult to diagnose pre-operatively and previous case reports suggest a strong association with anticoagulation and an increased morbidity. The purpose of the study is to determine the clinical presentation and outcomes of patients with HC in a large cohort of patients. Method A retrospective review of HC patients diagnosed following review of the clinical and pathological database between January 1, 2000 - June 30, 2021 at two hospitals. A search of the histopathology database, patient medical records, laboratory results, and imaging was conducted. Results Thirty-five patients were diagnosed on the histopathology report from approximately 6458 patients who had cholecystectomies. Thirty-one had emergency presentation and four patients (11.4%) had elective surgery. Twenty-one patients (60%) were female and 15 patients (40%) were male. The median age was 51 years. All patients had laparoscopic cholecystectomy, four patients were converted to open and five patients required postoperative endoscopic retrograde cholangiopancreatography. Two patients (5.7%) were on anticoagulation therapy. Twenty-three (65.7%) had ultrasound, 12 patients (34.2%) had computed tomography, three patients (8.5%) had magnetic resonance cholangiopancreatography, and one patient with a pre-operative diagnosis of HC. Conclusion HC is a rare form of acute cholecystitis. Anticoagulation only accounts for a small fraction of these patients. Pre-operative diagnosis of HC is not often made. Patients were treated with cholecystectomies and made a full recovery with no complications. Our study seems to show HC is a histological diagnosis with no clinical consequences for the patients.
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Affiliation(s)
| | - Mitali Fadia
- Department of Anatomical Pathology, Canberra Hospital, Garran, Australia
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Duran M, Schelzig H, Petrov A, Knapsis A, Krausch M, Grabitz K, Garabet W. Reconstruction for symptomatic vertebral artery lesion using vertebral artery to carotid artery transposition: A retrospective study. Ann Vasc Surg 2022; 84:148-154. [DOI: 10.1016/j.avsg.2022.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/11/2022] [Accepted: 01/23/2022] [Indexed: 11/01/2022]
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Kusumo Rahardjo A. Case series: Treatment outcome of late presentation of acute appendicitis. Int J Surg Case Rep 2022; 92:106881. [PMID: 35231734 PMCID: PMC8885464 DOI: 10.1016/j.ijscr.2022.106881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/13/2022] [Accepted: 02/22/2022] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Late presentation of Acute Appendicitis (AA) is associated with a high risk of perforation-related complications and morbidity. Even though AA is a well-known disease, late presented AA is not uncommon. This study aims to report the treatment outcome of several cases of late presented AA, treated at a government public hospital at Mojokerto, a small town in East Java, Indonesia, where no previous report were known. CASE PRESENTATION Eleven patients experienced surgical removal of the appendix during one year period (January 2021 until December 2021). Those patients are treated by one surgeon at Dr. Wahidin Sudiro Husodo Kota Mojokerto Hospital. Furthermore, they were divided into 3 groups, (A: presented within 2 days after onset of abdominal pain; B: presented within 2-5 days after onset of abdominal pain; C: presented more than 5 days after onset of abdominal pain). The morbidities for all patients were studied, which they all followed up until the surgery wound healed completely. CLINICAL DISCUSSION The perforation of the appendix occurred in 7 patients consisting of 2 in Group A, 2 in Group B, and 3 in Group C. Furthermore, the two patients who experienced extension of surgical resection were all from Group C and this group has 10.67 days of highest Length of Stay (LOS). The two patients with perforated AA, 1 from group A and 1 from group C, developed surgical site infection. The main reason for the late presentation of AA was non-operative treatment due to equivocal clinical findings. CONCLUSION The late presentation of AA causes perforation-associated morbidities, including a possible extension of surgical resection, long hospitalization period, and surgical site infection. Some late presented AA does not develop into perforation since perforated and non-perforated AA may represents two different entities.
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Affiliation(s)
- Arif Kusumo Rahardjo
- Department of Surgery, Dr Wahidin Sudiro Husodo Kota Mojokerto Hospital, Mojokerto, East Java, Indonesia.
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Hamilton KM, Malcolm JG, Desai S, Reisner A, Chern JJ. The Utility of Intraoperative Magnetic Resonance Imaging in the Resection of Cerebellar Hemispheric Pilocytic Astrocytomas: A Cohort Study. Oper Neurosurg (Hagerstown) 2022; 22:187-191. [PMID: 35147577 DOI: 10.1227/ons.0000000000000112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The mainstay of treatment for cerebellar pilocytic astrocytomas in the pediatric population is surgery. The use of intraoperative magnetic resonance imaging (iMRI) as a surgical adjunct may lower the likelihood of reoperation. Studies have examined iMRI in heterogenous tumor populations, but few have looked at single pathologies. OBJECTIVE To compare iMRI vs non-iMRI for hemispheric cerebellar pilocystic astrocytomas, specifically looking at revision surgeries and residual disease in follow-up. METHODS Retrospective review of medical records for 60 sequential patients with cerebellar hemispheric pilocytic astrocytoma at a single institution was conducted. Thirty-two patients with cerebellar pilocytic astrocytoma underwent surgery without iMRI, whereas 28 patients underwent surgical resection with iMRI. All patients had at least 3-year follow-up. RESULTS There were no significant differences between the patient populations in age, tumor size, or need for cerebrospinal fluid diversion between groups. Operative time was shorter without iMRI (without iMRI 4.4 ± 1.3 hours, iMRI 6.1 ± 1.5, P = .0001). There was no significant difference in the patients who had repeat surgery within 30 days (9% without iMRI, 0% iMRI, P = .25), residual disease at 3 months (19% without iMRI, 14% iMRI, P = .78), or underwent a second resection beyond 30 days (9% without iMRI, 4% iMRI, P = .61). There were more total reoperations in the group without iMRI, although this did not reach significance (19% vs 4%, P = .11). CONCLUSION For hemispheric cerebellar pilocytic astrocytomas, iMRI tended to leave less residual and fewer reoperations; however, neither of these outcomes achieved statistical significance leaving utilization to be determined by the surgeon.
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Affiliation(s)
- Kimberly M Hamilton
- Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - James G Malcolm
- Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Sona Desai
- Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Andrew Reisner
- Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Joshua J Chern
- Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
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Transparent and Reproducible Research Practices in the Surgical Literature. J Surg Res 2022; 274:116-124. [PMID: 35150944 DOI: 10.1016/j.jss.2021.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 08/23/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Previous studies have established a baseline of minimal reproducibility in the social science and biomedical literature. Clinical research is especially deficient in factors of reproducibility. Surgical journals contain fewer clinical trials than non-surgical areas of medicine, suggesting that it should be easier to reproduce the outcomes of surgical literature. METHODS In this study, we evaluated a broad range of indicators related to transparency and reproducibility in a random sample of 387 articles published in Surgery journals between 2014 and 2018. RESULTS A small minority of our sample made available their materials (5.3%, 95% C.I. 2.4%-8.2%), protocols (1.2%, 0-2.5%), data (2.5%, 0.7%-4.2%), or analysis scripts (0.04%). Four studies were adequately pre-registered. No studies were explicit replications of previous literature. Most studies (58%), declined to provide a funding statement, while conflicts of interest were declared in a small fraction (9.3%). Most have not been cited by systematic reviews (83%) or meta-analyses (87%), and most were only accessible to paying subscribers (59%). CONCLUSIONS The transparency of the surgical literature could improve with adherence to baseline standards of reproducibility.
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Sousa DC, Jalil A, Patton N, Dhawahir-Scala F, Kim J, Charles S, Turner G, Ivanova T. Early Pars Plana Vitrectomy in Acute Endophthalmitis: The Manchester Series. Ophthalmic Surg Lasers Imaging Retina 2022; 53:96-102. [PMID: 35148220 DOI: 10.3928/23258160-20220121-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Current literature lacks good-quality evidence regarding the outcomes of early pars plana vitrectomy (PPV) for acute exogenous endophthalmitis. The aim for this study was to analyze and discuss the outcomes of PPV for endophthalmitis in a UK tertiary hospital. PATIENTS AND METHODS This study was a retrospective case series. The clinical records of consecutive patients who had PPV for acute exogenous endophthalmitis were reviewed. Demographic data, etiology, timing of onset, timing of PPV, intraand postoperative complications, baseline and final best-corrected visual acuity (BCVA), therapeutic regimens, and microbiology details were collected. Primary efficacy and safety outcome measures were BCVA improvement of two or more logMAR lines and intra- or postoperative complications, respectively. RESULTS Forty-one patients with a median age of 76 (interquartile range, 64 to 82) years were studied. The most common etiology was intravitreal injection (41%), followed by phacoemulsification (34%). Median interval to PPV was 1.0 (interquartile range, 1.0 to 3.0) days. In a multivariate model controlling for age, baseline BCVA, microbiology positivity, and etiology (post-intravitreal injection), PPV after 24 hours was seven times more likely to achieve significant BCVA improvement (odds ratio, 7.47; 95% confidence interval, 1.12 to 49.66; P = .038). PPV within 24 hours of presentation was associated with more intraoperative complications. CONCLUSIONS Favorable outcomes may be achieved with current antibiotic regimens and PPV for endophthalmitis. The series suggests that an early surgical intervention may be associated with poorer functional outcomes. Tap and inject at presentation, followed by a semi-urgent PPV as required, seems to be a sensible approach. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:96-102.].
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Dharmaratne P, Rahman N, Leung A, Ip M. Is there a role of faecal microbiota transplantation in reducing antibiotic resistance burden in gut? A systematic review and Meta-analysis. Ann Med 2021; 53:662-681. [PMID: 34170204 PMCID: PMC8238059 DOI: 10.1080/07853890.2021.1927170] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/03/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES The aim of current systematic review and meta-analysis is to provide insight into the therapeutic efficacy of fecal microbiota transplantation (FMT) for the decolonization of antimicrobial-resistant (AMR) bacteria from the gut. METHODS The protocol for this Systematic Review was prospectively registered with PROSPERO (CRD42020203634). Four databases (EMBASE, MEDLINE, SCOPUS, and WEB of SCIENCE) were consulted up until September 2020. A total of fourteen studies [in vivo (n = 2), case reports (n = 7), case series without control arm (n = 3), randomized clinical trials (RCT, n = 2)], were reviewed. Data were synthesized narratively for the case reports, along with a proportion meta-analysis for the case series studies (n = 102 subjects) without a control arm followed by another meta-analysis for case series studies with a defined control arm (n = 111 subjects) for their primary outcomes. RESULTS Overall, seven non-duplicate case reports (n = 9 participants) were narratively reviewed and found to have broad AMR remission events at the 1-month time point. Proportion meta-analysis of case series studies showed an overall 0.58 (95% CI: 0.42-0.74) AMR remission. Additionally, a significant difference in AMR remission was observed in FMT vs treatment naïve (RR = 0.44; 95% CI: 0.20-0.99) and moderate heterogeneity (I2=65%). A subgroup analysis of RCTs (n = 2) revealed FMT with further benefits of AMR remission with low statistical heterogeneity (RR = 0.37; 95% CI: 0.18-0.79; I2 =23%). CONCLUSION More rigorous RCTs with larger sample size and standardized protocols on FMTs for gut decolonization of AMR organisms are warranted.KEY MESSAGEExisting studies in this subject are limited and of low quality with moderate heterogeneity, and do not allow definitive conclusions to be drawn.More rigorous RCTs with larger sample size and standardized protocols on FMTs for gut decolonization of AMR organisms are warranted.
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Affiliation(s)
- Priyanga Dharmaratne
- Faculty of Medicine, Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, China
| | - Nannur Rahman
- Faculty of Medicine, Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, China
| | - Anthony Leung
- Faculty of Medicine, Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, China
| | - Margaret Ip
- Faculty of Medicine, Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
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Schupper AJ, Price G, Hadjipanayis CG. Robotic-Assisted Digital Exoscope for Resection of Cerebral Metastases: A Case Series. Oper Neurosurg (Hagerstown) 2021; 21:436-444. [PMID: 34561708 DOI: 10.1093/ons/opab356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 08/04/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Surgical resection is the primary treatment for cerebral metastases with safe complete resection as the goal. The robotically assisted digital surgical exoscope is a novel system with advanced visualization methods with recent applications in neurosurgery. OBJECTIVE To evaluate the outcomes for patients with cerebral metastases undergoing resection with the surgical exoscope. METHODS Data were retrospectively collected from patients with cerebral metastases where resection was achieved with using the surgical exoscope from 2016 to 2020. Demographics, clinical, imaging, and operative and outcome findings were collected. The relationship between perioperative data and discharge disposition as well as progression-free survival (PFS) and 12 mo overall survival (OS) was assessed. RESULTS A total of 31 patients (19 males) with a median patient age 63 yr (range 38-80) were included. Average pre- and postoperative volumes were 18.1 cc and 0.75 cc, respectively. Mean depth of the resected lesions was 0.6 cm (range 0-3.6 cm). Complete resection was achieved in 64.5% of patients. The mean extent of resection was 96.7%, with 71.0% achieving PFS at 6 mo. Overall PFS rate was 58.1% and the OS rate at 12 mo was 83.9%. Neurological complications included motor (35.5%) and sensory (12.9%) deficits, with 12 patients reporting no postoperative symptoms. CONCLUSION The surgical exoscope can delineate tumor tissues with high resolution, as shown by a gross total resection achieved for the majority of cases in our series. Postoperative complications and patient outcomes were similar to those reported with use of the operative microscope. Use of the exoscope can provide optimal visualization and delineation of cerebral metastases.
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Affiliation(s)
- Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Gabrielle Price
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Constantinos G Hadjipanayis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
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Abunimer AM, Abou-Al-Shaar H, White TG, Park J, Schulder M. The Utility of High-Definition 2-Dimensional Stereotactic Exoscope in Cranial and Spinal Procedures. World Neurosurg 2021; 158:e231-e236. [PMID: 34728394 DOI: 10.1016/j.wneu.2021.10.165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The use of an exoscope in neurosurgical procedures has been proposed to improve ergonomics and to overcome the limitations faced with the microscope and endoscope. However, there remains scarcity of data regarding its surgical utility and outcomes. OBJECTIVES The authors report their experience and evaluate the surgical outcomes using a high-definition 2-dimensional (HD-2D) stereotactic exoscope in the management of various cranial and spinal pathologies. METHODS We retrospectively identified patients who underwent neurosurgical procedures using the HD-2D stereotactic exoscope over a 2-year period. Demographic and surgical characteristics were analyzed. RESULTS Twenty-nine patients (70.7%) underwent cranial surgery, and 12 patients (29.3%) underwent spine surgery. In patients having brain tumor removal, gross total resection was achieved in 18 patients (62.1%); with an overall average pathology size of 4.2±1.6 cm. Adjuvant utilization of the microscope was required in 4 cranial cases (13.8%) to ensure optimal resection rate. Three complications and 2 mortalities were encountered in the cranial group during a mean follow-up of 4.6±3.3 months. In the spinal cohort, the HD-2D stereotactic exoscope was utilized for anterior decompression and fusion (n=5), posterior decompression and fusion (n=5), and microdiscectomy and foraminotomy (n=2). No complications were encountered in the spinal group during a mean follow-up of 3.8±2.7 months. CONCLUSION The HD-2D stereotactic exoscope offers a wider field of view, greater mean focal distance, enhanced ergonomics, and immersive stereotactic visual experience. The lack of stereopsis remains the principal limitation of its use, and further optimization of surgical outcomes might be achieved with newer 3D models.
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Affiliation(s)
- Abdullah M Abunimer
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Timothy G White
- Department of Neurosurgery, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
| | - Jung Park
- Department of Neurosurgery, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
| | - Michael Schulder
- Department of Neurosurgery, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA.
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Srinivasan VM, Koester SW, Wang MS, Rahmani R, Ma KL, Catapano JS, Labib MA, Lawton MT. Cavernous Malformations of the Optic Nerve and Optic Pathway: A Case Series and Systematic Review of the Literature. Oper Neurosurg (Hagerstown) 2021; 21:291-302. [PMID: 34460919 DOI: 10.1093/ons/opab284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/06/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although rare, cavernous malformations (CMs) of the optic nerve and anterior optic pathway (optic pathway cavernous malformations [OPCMs]) can occur, as described in several single case reports in the literature. OBJECTIVE To describe the technical aspects of microsurgical management of CMs of the optic pathway on the basis of an extensive single-center experience and review of the literature. METHODS A systematic literature review was performed to augment an earlier review, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In addition, an institutional database was searched for all patients undergoing surgical resection of OPCMs. Patient information, surgical technique, and clinical and radiographic outcomes were assessed. RESULTS Since the previous report, 14 CMs were resected at this institution or by the senior author at another institution. In addition, 34 cases were identified in the literature since the systematic review in 2015, including some earlier cases that were not discussed in the previous report. Most OPCMs were resected via pterional, orbital-pterional, and orbitozygomatic craniotomies. Visual outcomes were similar to those in earlier reports, with 70% of patients reporting stable to normal vision postoperatively. CONCLUSION OPCMs can occur throughout the anterior visual pathway and may cause significant symptoms. Surgery is feasible and should be considered for OPCMs presenting to a surface of the nerve. Favorable results can be obtained with resection, although optimal results are obtained with patients who present with milder symptoms without longstanding damage to the optic apparatus.
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Affiliation(s)
- Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Stefan W Koester
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michele S Wang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Redi Rahmani
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kevin L Ma
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mohamed A Labib
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Shakerian B, Mandegar MH. Huge Hydatid Cyst of the Right Ventricular Outflow Tract. Sultan Qaboos Univ Med J 2021; 21:485-487. [PMID: 34522418 PMCID: PMC8407898 DOI: 10.18295/squmj.4.2021.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/04/2020] [Accepted: 10/14/2020] [Indexed: 11/24/2022] Open
Abstract
Hydatid disease is a common health problem in sheep-farming countries such as Iran. The liver and lungs are the most common primary sites of hydatid cysts in humans. Cardiac involvement is an uncommon manifestation, and the right ventricle outflow tract (RVOT) is rarely involved. This is a case report of a 34-year-old man who presented to the Heart Clinic, Tehran, Iran, in 2019 with a history of dyspnoea and fatigue. Following an imaging study, the patient was diagnosed with an RVOT hydatid cyst. He underwent surgical resection of the cyst. The post-operative course was uneventful.
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Affiliation(s)
- Behnam Shakerian
- Tehran University of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.,Shahrekod University of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad H Mandegar
- Department of Cardiovascular Surgery, Tehran University of Medical Sciences, Tehran, Iran
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Rubino F, Eichberg DG, Cordeiro JG, Di L, Eliahu K, Shah AH, Luther EM, Lu VM, Komotar RJ, Ivan ME. Robotic guidance platform for laser interstitial thermal ablation and stereotactic needle biopsies: a single center experience. J Robot Surg 2021; 16:549-557. [PMID: 34258748 PMCID: PMC8276839 DOI: 10.1007/s11701-021-01278-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/04/2021] [Indexed: 11/28/2022]
Abstract
While laser ablation has become an increasingly important tool in the neurosurgical oncologist's armamentarium, deep seated lesions, and those located near critical structures require utmost accuracy during stereotactic laser catheter placement. Robotic devices have evolved significantly over the past two decades becoming an accurate and safe tool for stereotactic neurosurgery. Here, we present our single center experience with the MedTech ROSA ONE Brain robot for robotic guidance in laser interstitial thermal therapy (LITT) and stereotactic biopsies. We retrospectively analyzed the first 70 consecutive patients treated with ROSA device at a single academic medical center. Forty-three patients received needle biopsy immediately followed by LITT with the catheter placed with robotic guidance and 27 received stereotactic needle biopsy alone. All the procedures were performed frameless with skull bone fiducials for registration. We report data regarding intraoperative details, mortality and morbidity, diagnostic yield and lesion characteristics on MRI. Also, we describe the surgical workflow for both procedures. The mean age was 60.3 ± 15 years. The diagnostic yield was positive in 98.5% (n = 69). Sixty-three biopsies (90%) were supratentorial and seven (10%) were infratentorial. Gliomas represented 54.3% of the patients (n = 38). There were two postoperative deaths (2.8%). No permanent morbidity related to surgery were observed. We did not find intraoperative technical problems with the device. There was no need to reposition the needle after the initial placement. Stereotactic robotic guided placement of laser ablation catheters and biopsy needles is safe, accurate, and can be implemented into a neurosurgical workflow.
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Affiliation(s)
- Franco Rubino
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA.
| | - Daniel G Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA
| | - Joacir G Cordeiro
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA
| | - Long Di
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA
| | - Karen Eliahu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA
| | - Evan M Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA.,Sylvester Comprehensive Cancer Center, Miami, FL, 33146, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace (D4-6), Miami, FL, 33146, USA.,Sylvester Comprehensive Cancer Center, Miami, FL, 33146, USA
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Huckhagel T, Westphal M, Klinger R. The Impact of Surgery-Related Muscle Injury on Prevalence and Characteristics of Acute Postcraniotomy Headache - A Prospective Consecutive Case Series. J Neurol Surg A Cent Eur Neurosurg 2021; 83:242-251. [PMID: 34192783 DOI: 10.1055/s-0041-1725958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The latest third edition of the International Classification of Headache Disorders delineates diagnostic criteria for acute headache attributed to craniotomy (AHAC), but data on possible predisposing factors are sparse. This prospective observational study aims to evaluate the impact of surgery-related muscle incision on the prevalence, severity, and characteristics of AHAC. PATIENTS AND METHODS Sixty-four consecutive adults (mean age: 54.2 ± 15.2 years; 26 males and 38 females) undergoing cranial neurosurgery for various reasons without preoperative headache were included. After regaining consciousness, all patients reported their average daily headache on a numeric pain rating scale (NRS; range: 0-10), headache characteristics, as well as analgesic consumption from day 1 to 3 after surgery. Three distinct patient cohorts were built with respect to the surgical approach (craniotomy ± muscle incision; burr hole surgery) and group comparisons were performed. Additionally, patients with AHAC ≥ 3 NRS were reevaluated at 7.2 ± 2.3 months following treatment by means of standardized questionnaires to determine the prevalence of persistent headache attributed to craniotomy as well as headache-related disability and quality of life. RESULTS Thirty of 64 (46.9%) patients developed moderate to severe AHAC (NRS ≥ 3) after cranial neurosurgery. There were no significant group differences with regard to age, gender, or general health condition (American Society of Anesthesiologists Physical Status Classification). Craniotomy patients with muscle incision suffered from significantly higher early postoperative mean NRS scores compared with their counterparts without procedure-related muscle injury (3.4 ± 2.3 vs. 2.3 ± 1.9) as well as patients undergoing burr hole surgery (1.2 ± 1.4; p = 0.02). Moreover, the consumption of nonopioid analgesics was almost doubled following muscle-transecting surgery as compared with muscle-preserving procedures (p = 0.03). Young patient age (odds ratio/95% confidence interval for each additional year: 0.93/0.88-0.97) and surgery-related muscle injury (5.23/1.62-19.41) were identified as major risk factors for the development of AHAC ≥ 3 NRS. There was a nonsignificant trend toward higher pain chronification rate as well as headache-related disability after craniotomy with muscle injury. CONCLUSION Surgery-related muscle damage may be an important predisposing factor for AHAC. Therefore, if a transmuscular approach is unavoidable, the neurosurgeon should be aware of the need for adequately adjusted intra- and postoperative analgesia in these cases.
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Affiliation(s)
- Torge Huckhagel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Regine Klinger
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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49
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Ma X, Wang B, Chen Y, Ge S, Zou X, Zhang S, Xia H. Outcome of Thoracic Column Antedisplacement and Fusion in Treatment of Thoracic Myelopathy Caused by Ossification of Posterior Longitudinal Ligament: A Case Series Study. Oper Neurosurg (Hagerstown) 2021; 21:118-125. [PMID: 34097732 DOI: 10.1093/ons/opab193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/04/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Up to date, surgical outcome of multilevel thoracic ossification of posterior longitudinal ligament (T-OPLL) with high canal occupation ratio is less satisfactory. OBJECTIVE To explore the result of thoracic column antedisplacement and fusion (TCAF) in treatment of multilevel T-OPLL with high canal occupation ratio. METHODS A total of 5 patients who underwent TCAF procedure for T-OPLL were retrospectively reviewed. Parameters including extent of OPLL, thickness of the maximal OPLL (max-OPLL), maximal canal occupying ratio (max-COR) of OPLL, effective canal diameter (ECD) at the max-OPLL level, antedisplacement distance of thoracic columns, ASIA grades, Japanese Orthopedic Association (JOA) scores, and complications were collected and analyzed at preoperation and the last follow-up. RESULTS All patients (5 F, mean age 61.0 yr, mean follow-up 18.0 months) underwent TCAF successfully and no spinal cord injury or cerebrospinal fluid leakage occurred. The mean extent of OPLL was 2.8 vertebral bodies. The mean preoperative thickness of the max-OPLL was 5.9 mm. The average antedisplacement distance of thoracic columns was 5.6 mm. The mean ECD was improved from 6.5 mm to 10.9 mm, and the max-COR was improved from 50.7% to 7.1% at last follow-up. Two patients showed improvement in ASIA grades and JOA scores were significantly improved from 5.6 points to 10.4 points at final follow-up. The overall therapeutic results of 1 patient were classified into good and 4 into fair at last follow-up. CONCLUSION TCAF may be a safe and effective procedure in treatment of multilevel T-OPLL with high canal occupation ratio.
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Affiliation(s)
- Xiangyang Ma
- Department of Spine Surgery, Liuhua Qiao Hospital, Guangzhou, China
| | - Binbin Wang
- Department of Spine Surgery, Liuhua Qiao Hospital, Guangzhou, China
| | - Yuyue Chen
- Department of Spine Surgery, Liuhua Qiao Hospital, Guangzhou, China
| | - Su Ge
- Department of Spine Surgery, Liuhua Qiao Hospital, Guangzhou, China
| | - Xiaobao Zou
- Department of Spine Surgery, Liuhua Qiao Hospital, Guangzhou, China
| | - Shuang Zhang
- Department of Spine Surgery, Liuhua Qiao Hospital, Guangzhou, China
| | - Hong Xia
- Department of Spine Surgery, Liuhua Qiao Hospital, Guangzhou, China
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50
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North RY, Strong MJ, Yee TJ, Kashlan ON, Oppenlander ME, Park P. Navigation and Robotic-Assisted Single-Position Prone Lateral Lumbar Interbody Fusion: Technique, Feasibility, Safety, and Case Series. World Neurosurg 2021; 152:221-230.e1. [PMID: 34058358 DOI: 10.1016/j.wneu.2021.05.097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/23/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Single-position prone lateral interbody fusion is a recently introduced technical modification of the minimally invasive retroperitoneal transpsoas approach for lateral lumbar interbody fusion (LLIF). Several technical descriptions of single-position prone LLIF have been published with traditional fluoroscopy for guidance. However, there has been no investigation of either three-dimensional computed tomography-based navigation for prone LLIF or integration with robotic assistance platforms with the prone lateral technique. This study evaluated the feasibility and safety of spinal navigation and robotic assistance for single-position prone LLIF. METHODS Retrospective review of medical records and a prospectively acquired database for a single center was performed to examine immediate and 30-day clinical and radiographic outcomes for consecutive patients undergoing single-position prone LLIF with spinal navigation and/or robotic assistance. RESULTS Nine patients were treated, 4 women and 5 men. Mean age was 65.4 years (range, 46-75 years), and body mass index was 30.2 kg/m2 (range, 24-38 kg/m2). The most common surgical indication was adjacent segment disease (44.4%), followed by pseudarthrosis (22.2%), spondylolisthesis (11.1%), degenerative disc disease (11.1%), and recurrent stenosis (11.1%). Postoperative approach-related complications included pain-limited bilateral hip flexor weakness (4/5) and pain-limited left knee extension weakness (4/5) in 1 patient (11.1%) and right lateral thigh numbness and dysesthesia in 1 patient (11.1%). All cages were placed within quarters 2-3, signifying the middle portion of the disc space. There were no instances of misguidance by navigation. CONCLUSIONS Integration of spinal navigation and robotic assistance appears feasible, accurate, and safe as an alternative to fluoroscopic guidance for single-position LLIF.
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Affiliation(s)
- Robert Y North
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael J Strong
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy J Yee
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Osama N Kashlan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark E Oppenlander
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
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