scholarly journals Two-step staged resection of giant olfactory groove meningiomas

2021 ◽  
Author(s):  
Gerhard Marquardt ◽  
Johanna Quick-Weller ◽  
Stephanie Tritt ◽  
Peter Baumgarten ◽  
Christian Senft ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Brain Oedema ◽  
Second Step ◽  
Tumour Resection ◽  
Consecutive Series ◽  
Tumour Mass ◽  
Olfactory Groove ◽  
Frontal Brain ◽  
Lower Morbidity

Abstract Background The surgical treatment of giant olfactory groove meningiomas (OGMs) with marked perilesional brain oedema is still a surgical challenge. After tumour resection, increase of brain oedema may occur causing dramatic neurological deterioration and even death of the patient. The objective of this paper is to describe surgical features of a two-step staged resection of these tumours performed to counter increase of postoperative brain oedema. Methods This two-step staged resection procedure was carried out in a consecutive series of 19 patients harbouring giant OGMs. As first step, a bifrontal craniectomy was performed followed by a right-sided interhemispherical approach. About 80% of the tumour mass was resected leaving behind a shell-shaped tumour remnant. In the second step, carried out after the patients’ recovery from the first surgery and decline of oedema, the remaining part of the tumour was removed completely followed by duro- and cranioplasty. Results Ten patients recovered quickly from first surgery and the second operation was performed after a mean of 12.4 days. In eight patients, the second operation was carried out later between day 25 and 68 due to surgery-related complications, development of a trigeminal zoster, or to a persisting frontal brain oedema. Mean follow-up was 49.3 months and all but one patient had a good outcome regardless of surgery-related complications. Conclusions Our results suggest that a two-step staged resection of giant OGMs minimizes the increase of postoperative brain oedema as far as possible and translates into lower morbidity and mortality.

Pterional Approach for Surgical Treatment of Olfactory Groove Meningiomas

Neurosurgery ◽  
1989 ◽  
Vol 25 (6) ◽  
pp. 942-947 ◽  
Author(s):  
W. Hassler ◽  
J. Zentner
Keyword(s):  
Surgical Treatment ◽  
Superior Sagittal Sinus ◽  
Cerebrospinal Fluid Fistula ◽  
Pterional Approach ◽  
Olfactory Groove ◽  
Sagittal Sinus ◽  
Frontal Brain ◽  
Bridging Veins ◽  
Frontal Sinuses ◽  
Fluid Fistula

Abstract We present our experience with the surgical treatment of olfactory groove meningiomas using a pterional approach. This approach provides the advantages of previous techniques, such as preserving the frontal brain and superior sagittal sinus, early devascularization of the tumor, and late dissection of tumor borders. Moreover, it also compensates for the shortcomings of other techniques, e.g., compression of frontal bridging veins, late dissection of dorsal tumor aspects involving vessels and optic nerves as well as facultative infection and cerebrospinal fluid fistula-related complications caused by opening of frontal sinuses. To date, 11 patients were treated in this way. As we encountered no surgical complications in our series we are encouraged to present our procedure.

NEUROSURGICAL TREATMENT FOR ANEURYSM REMNANTS OR RECURRENCES AFTER COIL OCCLUSION

Neurosurgery ◽  
2008 ◽  
Vol 63 (4) ◽  
pp. 684-692 ◽  
Author(s):  
Jean-Paul Lejeune ◽  
Laurent Thines ◽  
Christian Taschner ◽  
Philippe Bourgeois ◽  
Hilde Henon ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Glasgow Outcome Scale ◽  
Postoperative Outcome ◽  
Consecutive Series ◽  
Anterior Circulation ◽  
Microsurgical Treatment ◽  
Coil Occlusion ◽  
Neurosurgical Treatment ◽  
Temporary Occlusion

ABSTRACT OBJECTIVE Neurosurgical management of residual aneurysms (RA) after coiling remains a challenging issue. We present a consecutive series of 21 patients who underwent microsurgical treatment of a previously coiled aneurysm. METHODS We retrospectively reviewed a consecutive series of 21 patients who underwent operations for an RA after coiling between 1997 and 2007. Postcoiling follow-up imaging included brain magnetic resonance angiography and digital subtraction angiography. The decision for surgical treatment was made when an RA was significant and unsuitable for re-embolization. Data related to the RA and to the surgical technique were analyzed. Postoperative outcome was evaluated with the Glasgow Outcome Scale. RESULTS Twenty aneurysms were initially ruptured. Twelve had undergone complete coil occlusion, whereas 6 had a residual neck, 2 had a residual lobule, and 1 had a residual sac. The aneurysms were in the anterior circulation in 18 cases and in the posterior circulation in 3 cases. Twenty RAs were excluded with the apposition of 1 clip beneath the coils, 2 required a temporary occlusion, 2 required extraction of the coils, and 1 presented with an operative rupture. All aneurysms, except 2 that had their residual neck wrapped, were completely occluded. The postoperative Glasgow Outcome Scale score was unchanged in 90% of patients, and 2 patients sustained a moderate disability. CONCLUSION Microsurgical treatment of RA after endovascular treatment is effective, provided that patients are selected appropriately. The surgical treatment of recanalized aneurysms after coiling is challenging but can result in a good outcome with low morbidity and no mortality.

Chorea in the clinical presentation of moyamoya disease: results of surgical revascularization and a proposed clinicopathological correlation

2013 ◽  
Vol 11 (3) ◽  
pp. 313-319 ◽  
Author(s):  
Edward S. Ahn ◽  
R. Michael Scott ◽  
Richard L. Robertson ◽  
Edward R. Smith
Keyword(s):  
Surgical Treatment ◽  
Basal Ganglia ◽  
Moyamoya Disease ◽  
Clinical Presentation ◽  
Disease Stage ◽  
Consecutive Series ◽  
Unilateral Disease ◽  
Collateral Vessels ◽  
Revascularization Surgery

Object Chorea is a movement disorder characterized by brief, irregular, involuntary contractions that appear to flow from 1 muscle to another. There are a limited number of reports in the literature that have linked moyamoya disease and chorea. The authors describe their experience in treating moyamoya disease in patients in whom chorea developed as part of the clinical presentation. Methods The authors conducted a retrospective review of a consecutive series of 316 children who underwent pial synangiosis revascularization for moyamoya disease at the Boston Children's Hospital. Results Of 316 surgically treated patients with moyamoya disease, 10 (3.2%; 6 boys and 4 girls) had chorea as a part of their presentation. The average age at surgical treatment was 9.9 years (range 3.8–17.9 years). All patients had evidence of hypertrophied lenticulostriate collateral vessels through the basal ganglia on preoperative angiography and/or MRI on affected sides. Two patients had cystic lesions in the basal ganglia. Nine patients underwent bilateral craniotomies for pial synangiosis, and 1 patient underwent a single craniotomy for unilateral disease. Follow-up was available in 9 patients (average 50.1 months). The mean duration of chorea was 1.36 years (range 2 days to 4 years), with resolution of symptoms in all patients. One patient developed chorea 3 years after surgical treatment, 4 patients had transient chorea that resolved prior to surgery, and 5 patients experienced resolution of the chorea after surgery (average 13 months). Conclusions The authors describe children with moyamoya disease and chorea as part of their clinical presentation. The data suggest that involvement of the basal ganglia by the hypertrophied collateral vessels contributes to the development of chorea, which can wax or wane depending on disease stage or involution of the vessels after revascularization surgery. In most patients, however, the chorea improves or disappears about 1 year after presentation.

scholarly journals Caesarean Scar Endometriosis May Require Abdominoplasty

2021 ◽  
Vol 14 ◽  
pp. 117954762110276
Author(s):  
Barczyński Bartłomiej ◽  
Sobstyl Małgorzata ◽  
Frąszczak Karolina ◽  
Sobstyl Anna
Keyword(s):  
Surgical Treatment ◽  
Abdominal Wall ◽  
Abdominal Wall Defect ◽  
Uterine Cavity ◽  
Tumour Resection ◽  
Wall Defect ◽  
Scar Endometriosis ◽  
Caesarean Scar ◽  
Hernia Prevention

Endometriosis is defined as an ectopic presence of endometrium-like tissue outside uterine cavity, which most commonly involves intraperitoneal organs. However, one of the less frequent forms of the disease is abdominal wall endometriosis usually developing in surgical scars following obstetric and gynaecological surgeries involving uterine cavity entering, that is, caesarean section, myomectomy or hysterectomy. In this case report we present a case of a patient with extensive caesarean scar endometriosis, who required complex surgical management. Successful surgical treatment involved not only radical tumour resection and application of mesh in postoperative hernia prevention but also adequate wound closure ensuring satisfactory cosmetic results, which was most challenging. The abdominal wall defect could not be sutured by traditional technique, thus polypropylene mesh was used and partial abdominoplasty was performed. The wound healed without complication and 24-month follow-up showed no evidence of local recurrence and satisfactory cosmetic result. In case of extensive endometrial abdominal wall tumours surgical treatment may involve application of advanced plastic surgery techniques, like abdominoplasty or skin/musculocutaneous flaps transposition.

scholarly journals Surgical Treatment of Spinal Dural Arteriovenous Fistulae: A Consecutive Series of 154 Patients

Neurosurgery ◽  
2010 ◽  
Vol 67 (5) ◽  
pp. 1350-1358 ◽  
Author(s):  
Andrea Saladino ◽  
John L D Atkinson ◽  
Alejandro A Rabinstein ◽  
David G Piepgras ◽  
W Richard Marsh ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Motor Function ◽  
Neurological Complications ◽  
Motor Dysfunction ◽  
Sensory Loss ◽  
Consecutive Series ◽  
Arteriovenous Fistulae ◽  
Female Ratio ◽  
Presenting Symptoms

Abstract BACKGROUND: Embolization of spinal dural arteriovenous fistulae (SDVAFs) has emerged as an alternative to surgery. However, surgical disconnection is a simple and effective procedure. OBJECTIVE: To review results and complications of surgical treatment of 154 consecutive SDAVFs. METHODS: The records of 154 consecutive patients with SDAVFs were retrospectively reviewed. RESULTS: There were 120 males and 34 females (male/female ratio 3.5:1, mean age 63.6 years). The SDAVFs were located at the thoracic level in 92 patients and at the lumbar and sacral spine levels in 45 and 15 patients, respectively. The most common presenting symptoms were motor dysfunction (65 patients), sensory loss (31 patients), and paresthesias without sensory loss (13 patients). The mean interval from symptom onset to definitive diagnosis was 24.7 months (median 12 months). Surgery resulted in complete exclusion of the fistula at first attempt in 146 patients (95%). There were no deaths or major neurological complications related to the surgery. Six percent of patients experienced subjective or objective worsening of preoperative symptoms and signs by the time of discharge that persisted at follow-up. Other surgical complications consisted of wound infection in 2 patients and deep venous thrombosis in 3. Eight patients were lost to follow-up; 141 patients (96.6%) experienced improvement (120 patients, 82.2%) or stability (21 patients, 14.4%) of motor function at last follow-up compared with their preoperative status. Other symptoms such as numbness, sphincter dysfunction, and dysesthesias/neuropathic pain improved in 51.5%, 45%, and 32.6%, respectively. CONCLUSION: Surgical obliteration of SDAVFs is safe and very effective. Prognosis of motor function is favorable after surgical treatment.

Cystic dilation of the ventriculus terminalis

2012 ◽  
Vol 17 (1) ◽  
pp. 86-92 ◽  
Author(s):  
Mario Ganau ◽  
Andrea Talacchi ◽  
Paolo C. Cecchi ◽  
Claudio Ghimenton ◽  
Massimo Gerosa ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Status ◽  
Relevant Literature ◽  
University Hospital ◽  
Neurological Deficits ◽  
Herniated Disc ◽  
Treatment Modalities ◽  
Consecutive Series ◽  
Type I

Object The ventriculus terminalis, an embryological remnant consisting of the ependymal-lined space of the conus medullaris, can occasionally become symptomatic after cystic dilation. In the existing literature, consisting of 32 cases, the preferred type of management (conservative vs surgical) is still debated. The object of this study was to report the surgical results in a consecutive series of 10 adult patients with cystic dilation of the ventriculus terminalis (CDVT), to match them with data retrieved from the relevant literature, and specifically to validate a new recent clinical classification. Methods The authors reported 13 new cases of CDVT treated in the Department of Neurosurgery at University Hospital in Verona, Italy. Treatment modalities and clinical and radiological outcomes, both early and at follow-up, were analyzed and compared with a preoperative classification of clinical presentation, as established by de Moura Batista and colleagues (2008). Results Surgical treatment seemed to guarantee the resolution of CDVT. Dorsolumbar laminotomy, myelotomy, and cystic drainage were performed in 10 patients. Patients with Type I symptoms (nonspecific complaints) often presented with comorbidities (herniated disc or facet hypertrophy) confusing their clinical status. The surgical treatment of patients with Type I symptoms promoted good results only if the diagnosis of CDVT was definitive and symptoms had rapidly evolved. In patients with Type II (focal neurological deficits) and III (sphincter disturbances) symptoms, surgical treatment sustained improvement even at the late follow-up. Conclusions While confirming the usefulness of de Moura Batista and colleagues' classification in its impact on prognosis, the authors propose a revision of the classification with subgroups Type Ia (nonspecific symptoms without clear relation to CDVT), which is best treated conservatively, and Type Ib (rapid onset and invalidating unspecific complaints without comorbidities), which may benefit from surgical evacuation.

scholarly journals A Pilot Clinical Study on the Prognostic Relevance of Plasmatic Exosomes Levels in Oral Squamous Cell Carcinoma Patients

Cancers ◽  
2019 ◽  
Vol 11 (3) ◽  
pp. 429 ◽  
Author(s):  
Samuel Rodríguez Zorrilla ◽  
Mario Pérez-Sayans ◽  
Stefano Fais ◽  
Mariantonia Logozzi ◽  
Mercedes Gallas Torreira ◽  
...  
Keyword(s):  
Overall Survival ◽  
Surgical Treatment ◽  
Cancer Patients ◽  
Distant Metastases ◽  
Tumour Mass ◽  
Double Blind ◽  
Mean Values ◽  
Local Bone ◽  
Before And After

Background: To evaluate the relationship between the plasmatic CD63 and CAV1 positive exosome levels, in patients with OSCC before and after surgical treatment and to correlate it with their overall survival. Methods: A double-blind pilot study over 10 patients OSCC and T4 stage without distant metastases or local bone invasion has been performed. The average follow-up period was 37.64 months (34.3–40.84). We obtained 2 plasma tubes of 1 mL each before surgery and 7 days after surgery. Before performing the immunocapture-based analysis, EVs (Extracellular Vesicles) were isolated from the plasma and characterized with western blot analysis. Results: Mean values of CD63 positive plasmatic exosomes (EXO-CD63) after surgery decreased from 750.88 ± 286.67 to 541.71 ± 244.93 (p = 0.091). On the other hand, CAV-1 positive plasmatic exosomes (EXO-CAV-1) increased after surgery from 507 ± 483.39 to 1120.25 ± 1151.17 (p = 0.237). Patients with EXO-CD63 levels lower than the mean global value before the surgery had a survival of 36.04 months compared with the group with EXO-CD63 higher than the average who only survived 12.49 ± 1.67 months from the diagnosis, p = 0.225. When EXO-CAV-1 levels before surgery was lower than the average (813.94 ± 801.21) overall survival was 24.69 ± 22.23 months in contrast when it was higher that was only 11.64 months, p = 0.157. Patients with lower EXO-CD63 levels after surgery lived an average of 23.84 ± 23.9 months, while those with higher plasmatic levels of EXO-CD63 live 13.35 months, p = 0.808. When EXO-CAV-1 levels after surgery were lower, the average overall survival was 20.344 ± 15.40 months, in contrast when the EXO-CAV-1 levels were higher showing rather an estimate survival expectation of 1.64 months. Conclusions: Surgical treatment induced a dramatic reduction of the plasmatic levels of exosomes expressing CD63 as early as 1 week after resection. This first result suggests that the tumour mass is responsible of the high levels of circulating exosomes detected in cancer patients. At the same time point exosome expressing CAV-1 increased, possibly due to the inflammatory reaction immediately after surgery. Lastly, statistical analysis showed that lower levels of plasmatic exosomes both before and after surgery correlated with a better life expectancy of OSCC patients. Hopefully, this approach will prove useful in the clinical follow-up of cancer patients.

Epicardial cryoablation as surgical treatment for atrial fibrillation: One year follow up in 84 patients

2008 ◽  
Vol 56 (S 1) ◽  
Author(s):  
R Uhl ◽  
I Marcolino ◽  
E Zimmer ◽  
F Beyersdorf ◽  
E Eschenbruch
Keyword(s):  
Atrial Fibrillation ◽  
Surgical Treatment ◽  
One Year

Treatment of Pilonidal Sinus by Limberg Flap-Only Hope of Cure (Study of 50 Cases)

2020 ◽  
Vol 22 (2) ◽  
pp. 89-94
Author(s):  
Nasir Uddin Mahmud ◽  
ABM Khurshid Alam ◽  
Mohammad Altaf Hossain Chawdhury ◽  
Mohammad Abul Khair
Keyword(s):  
Pilonidal Sinus ◽  
Skin Barrier ◽  
Limberg Flap ◽  
College Hospital ◽  
Medical College ◽  
Flap Technique ◽  
Unpleasant Smell ◽  
Lower Morbidity ◽  
Computer Operator

Background : Pilonidal sinus was first described by Dr. A.W. Anderson in 1847 and is often seen in the intergluteal region. It is a disease of mainly younger male and rarely affects after 40. Main causes for the formation of this sinus are hirsutism, sweating in the area, repeated maceration due to trauma, leading to breakage of the skin barrier, attracting hair inside which initiates a foreign body reaction leading to infection with abscess or sinus formation. Most common embarrassing situation is discharging sinus. The diagnosis is mainly on clinical ground. Though there are a lot of modalities of treatment but recurrence is still a challenge. We have adopted Limberg flap technique since 2012 with a least recurrent chance. Objectives : To prove that this procedure will be end up with lower morbidity & least chance of recurrence Methods : This prospective study was done jointly by the Department of Surgery of Central Medical College and Comilla Medical College Hospital. In this series 50 patients were selected from July 2012 to June 2017. Results : Out of 50 patients operated by Limberg flap technique 42(84%) were males and 8(16%) were females. Mean age was 27.3 years (range 18–37years). Of them,12(24%) were driver, 6(12%) police, 6(12%) teacher, 6(12%) student, 5(10%) worker, 4(8%) millitary army, 4(8%) housewife, 4 (8%)service holder, 2(4%) computer operator, 1(2%) doctor and 1(2%) were barber. In our study most common mode of presentation were chronic discharging sinuses 15(30%), beside this 12(24%) had multiple sinuses, 10(20%) had multiple pits,7(14%) had acute abscess and 6(12%) had unpleasant smell. Associated hirsutism were present in 30(60%) and absent in 20(40%) patients. One (2%) male patient had wound gap & discharge and six(12%) patients had flap edema. We have found no recurrence in follow up period. Conclusion : Pilonidal sinus is a notoriously recurrent disease, so treatment by this flap technique is the only hope of cure with lower morbidity. Journal of Surgical Sciences (2018) Vol. 22 (2) : 89-94

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