scholarly journals Microsurgical management of midbrain cavernous malformations: does lesion depth influence the outcome?

2021 ◽  
Vol 163 (10) ◽  
pp. 2739-2754
Author(s):  
Caiquan Huang ◽  
Helmut Bertalanffy ◽  
Souvik Kar ◽  
Yoshihito Tsuji
Keyword(s):  
Clinical Outcome ◽  
Vascular Lesion ◽  
Vascular Lesions ◽  
Cavernous Malformations ◽  
Large Patient ◽  
Before And After ◽  
Unfavorable Clinical Outcome ◽  
Large Patient Population ◽  
Microsurgical Resection

Abstract Background The purpose of this study was to clarify whether the intrinsic depth of midbrain cavernous malformations (MCMs) influenced the surgical outcome. Methods The authors conducted a retrospective study of 76 consecutive patients who underwent microsurgical resection of a MCM. The vascular lesions were categorized into 4 distinct groups based on how these lesions had altered the brainstem surface. Additionally, it was verified whether the actual aspect of the brainstem surface could be predicted only by evaluating the pertinent preoperative MRI slices. Clinical outcome was assessed by determining the modified Rankin Scale Score (mRS) before and after surgery. Results Twenty-three MCMs (30.3%) were located deeply within the midbrain. The overlying midbrain surface appeared to be normal (group nl). In 33 patients (43.4%), the midbrain surface showed only a yellowish discoloration (group yw). In another 14 individuals (18.4%), the midbrain surface was distorted by the underlying MCM and bulging out while the vascular lesion still remained covered by a thin parenchymal layer (group bg). In the smallest group comprising 6 patients (7.9%), the exophytic MCM had disrupted the midbrain surface and was clearly visible at microsurgical exposure (group ex). The mean mRS decreased in the group nl from 1.43 preoperatively to 0.61 at follow-up. Conclusion This study demonstrates in a large patient population that a deep intrinsic MCM location is not necessarily associated with an unfavorable clinical outcome after microsurgical lesionectomy. Predicting the aspect of the midbrain surface by evaluating preoperative MR images alone was not sufficiently reliable.

Abstract P249: Effects of Lifestyle Changes on Metabolism and Early Vascular Lesion in Healthy People

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Xu Fengcheng ◽  
Yu Chaoping ◽  
Liu Tianhu
Keyword(s):  
Healthy Lifestyle ◽  
Low Density Lipoprotein ◽  
Fasting Blood Glucose ◽  
Ankle Brachial Index ◽  
Density Lipoprotein ◽  
Vascular Lesion ◽  
Lifestyle Changes ◽  
Healthy People ◽  
Vascular Lesions ◽  
Before And After

Objective: Through propaganda and education on lifestyle change, we study the effects on metabolism and vascular lesions in healthy people. Methods: the healthy subjects that conform to the requirements, through propaganda and education on vascular health, through moderate exercise, proper control of starchy foods, low salt, low fat diet, reduce smoking and other lifestyle changes, compare changes in weight, renal function, fasting blood glucose, blood lipids and ankle brachial index (ABI), cardio ankle vascular index(CAVI) before and after lifestyle changes. Results: After lifestyle changed, the subjects’ body mass index [(23.13±3.18)kg/m 2 vs (22.67±3.36)kg/m 2 ], ABI[1.11±0.08 vs 1.09±0.09], CAVI[(7.14±1.13 ) vs (7. 01±1.18) ], serum creatinine[(84.31±22.41)umol/L vs (79.92±23.64)umol/L], blood uric acid[(337.79±102.17 )umol/L vs (328.12±88.33)umol/L], low density lipoprotein cholesterol[(2.49±0.65) mmol/L vs (2.37±0.69) mmol/L],all have good changes. Conclusion: Healthy lifestyle is good for metabolism and early vascular lesions, can improve metabolic disorder and slow the occurrence of arteriosclerosis.

Response of Vascular Lesions of the Head and Neck to Argon Laser Radiation

1983 ◽  
Vol 91 (2) ◽  
pp. 203-208 ◽  
Author(s):  
Joseph R. DiBartolomeo
Keyword(s):  
Laser Radiation ◽  
Surgical Technique ◽  
Head And Neck ◽  
Excellent Result ◽  
Argon Laser ◽  
Vascular Lesion ◽  
Vascular Lesions ◽  
Hypertrophic Scars ◽  
Argon Ion

Argon laser radiation is used to treat congenital and acquired vascular lesions of the head and neck. Thirteen patients requiring a total of 36 treatments were followed up for a minimum of 1 year to assess the response of the vascular lesion to argon ion radiation. Of the 13 patients, 10 had an excellent result, with the lesion no longer being identifiable. Three of the patients had residual but minimal color remaining in the lesion. There were no complications or hypertrophic scars after 1 year of follow-up. The laser parameters used and the surgical technique followed are outlined.

Treatment of smell loss with systemic methylprednisolone

2012 ◽  
Vol 50 (3) ◽  
pp. 284-289
Author(s):  
V.A. Schriever ◽  
C. Merkonidis ◽  
N. Gupta ◽  
C. Hummel ◽  
T. Hummel
Keyword(s):  
Patient Population ◽  
Current Approach ◽  
Olfactory Dysfunction ◽  
Systemic Corticosteroids ◽  
Large Patient ◽  
Before And After ◽  
Large Patient Population ◽  
Randomized Control ◽  
Smell Loss ◽  
Tdi Score

Background and aim: Olfactory dysfunction is a common complaint in a large number of people. As the aetiologies of olfactory dysfunction vary greatly so do the treatment approaches. The aim of this retrospective study was to evaluate treatment with systemic corticosteroids, particularly focusing on its effectiveness on the different olfactory dysfunction aetiologies. Although a prospective randomized control trail is preferred for such an investigation, using the current approach, we were able to test a very large patient population. Material and methods: A total of 425 patients with olfactory dysfunction were treated with systemic corticosteroids for 14 days. Olfactory performance was measured using the `Sniffin` Sticks` battery before and after the treatment. Results: The treatment with systemic corticosteroids significantly increased the performance on the TDI score and on each of the three subtests; threshold, discrimination and identification. In 26.6% of the patients improvement of more than six points of the TDI score was observed. The treatment proved to be more effective in patients with sinunasal olfactory dysfunction, where this percentage increased to 36.7, compared to other aetiologies. In addition, the increase in olfactory function was negatively correlated with the TDI score before the treatment. Conclusion: This study confirms the effectiveness of systemic corticosteroids on olfactory dysfunction in a large patient population. Specifically, the results show that treatment is: (a) more effective in patients with sinunasal than in patients with idiopathic olfactory dysfunction, (b) most effective in patients with sinunasal disease with nasal polyps, and (c), at best, effective in half of the patients. The current study may provide help in counselling patients.

Long-term Results after Stereotactic Radiosurgery for Patients with Cavernous Malformations

Neurosurgery ◽  
2002 ◽  
Vol 50 (6) ◽  
pp. 1190-1198 ◽  
Author(s):  
Toshinori Hasegawa ◽  
James McInerney ◽  
Douglas Kondziolka ◽  
John Y.K. Lee ◽  
John C. Flickinger ◽  
...  
Keyword(s):  
High Risk ◽  
Stereotactic Radiosurgery ◽  
Gamma Knife Radiosurgery ◽  
Long Term Results ◽  
Major Hemorrhage ◽  
Cavernous Malformations ◽  
Before And After ◽  
Risk Of Hemorrhage

Abstract OBJECTIVE Stereotactic radiosurgery has been used for patients with high-risk cavernous malformations of the brain. We performed radiosurgery for patients with symptomatic, imaging-confirmed hemorrhages for which resection was believed to be associated with high risk. This study examines the long-term hemorrhage rate after radiosurgery. METHODS We reviewed data obtained before and after gamma knife radiosurgery on 82 patients treated between 1987 and 2000. Most patients had multiple hemorrhages from brainstem or diencephalic cavernous malformations. Follow-up data were examined to identify hemorrhages, and an overall hemorrhage rate was calculated. RESULTS Observation before treatment averaged 4.33 years (range, 0.17–18 yr) for a total of 354 patient-years. During this period, 202 hemorrhages were observed, for an annual hemorrhage rate of 33.9%, excluding the first hemorrhage. Temporal clustering of hemorrhages was not significant. After radiosurgery, patient follow-up averaged 5 years (range, 0.42–12.08 yr), for a total of 401 patient-years. During this period, 19 hemorrhages were identified, 17 in the first 2 years posttreatment and 2 after 2 years. The annual hemorrhage rate was 12.3% per year for the first 2 years after radiosurgery, followed by 0.76% per year from Years 2 to 12. Eleven patients had new neurological symptoms without hemorrhage after radiosurgery (13.4%). The symptoms were minor in six of these patients and temporary in five. CONCLUSION Radiosurgery confers a reduction in the risk of hemorrhage for high-risk cavernous malformations. Risk reduction, although in evidence during initial follow-up, is most pronounced after 2 years. Given the difficulty of identifying high-risk patients, treatment after one major hemorrhage should be considered in selected younger patients. Such a strategy warrants further investigation.

scholarly journals Short- and long-term clinical outcome after Q wave and non-Q wave myocardial infarction in a large patient population.

Circulation ◽  
1989 ◽  
Vol 79 (3) ◽  
pp. 528-536 ◽  
Author(s):  
P Nicod ◽  
E Gilpin ◽  
H Dittrich ◽  
R Polikar ◽  
A Hjalmarson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcome ◽  
Patient Population ◽  
Large Patient ◽  
Large Patient Population ◽  
Short And Long Term ◽  
Q Wave

Incidence and clinical implications of stent fractures of the Xpert self-expanding nitinol stent in infrainguinal arteries

VASA ◽  
2009 ◽  
Vol 38 (1) ◽  
pp. 47-52 ◽  
Author(s):  
Keo ◽  
Kickuth ◽  
Diehm ◽  
Baumgartner ◽  
Dai-Do
Keyword(s):  
Clinical Outcome ◽  
Clinical Improvement ◽  
Clinical Implications ◽  
Stent Fracture ◽  
Fracture Rate ◽  
Stent Patency ◽  
Nitinol Stent ◽  
Infrainguinal Arteries ◽  
Unfavorable Clinical Outcome

Background: Different stents in infrainguinal arteries have recently been associated with stent fractures and unfavorable clinical outcome, although data is limited regarding fractures of the Xpert selfexpanding nitinol stent. Thus, purpose of the present investigation was to evaluate its incidence and clinical implications in lower limb arteries. Patients and methods: Fifty-three consecutive patients (53 limbs) with peripheral arterial disease underwent secondary Xpert stent implantation due to suboptimal primary balloon angioplasty (PTA). Median age was 76 years. Stent fractures were evaluated by plain X-ray at median follow-up of 16 months. Stent patency was assessed by duplex ultrasound and sustained clinical improvement was defined as improvement of the ABI of ≥ 0.10 together with improvement of at least one Rutherford class above the baseline finding throughout follow-up. Results: Median length of femoropopliteal and infrapopliteal lesion was 3.0 and 2.3 cm, respectively. Sixtyfive stents were implanted in 43 limbs with femoropopliteal and 10 stents in 10 limbs with infrapopliteal lesion, respectively. Stent fractures occurred in 3 of 43 limbs (7.0%) of patients with femoropopliteal lesion with stent-based fracture rate of 4.6%. All fractured stents showed multiple struts fractures and occurred in the distal and middle superficial femoral artery. No stent fracture was observed in infrapopliteal lesions. The fractured stents were not associated with any clinical deterioration. Sustained clinical improvement was 71.0% and 54.6% for femoropopliteal and infrapopliteal lesions, respectively. Stent patency assessed by duplex was 65.2 and 63.9% for femoropopliteal and infrapopliteal lesions, respectively. Conclusions: Fractures of the Xpert stent were seldom and not associated with unfavorable clinical outcome at midterm follow-up.

scholarly journals Long term follow-up of a large patient population with stage 2 and 3 esophageal cancer

2020 ◽  
pp. 110-115
Author(s):  
Christensen Diana M ◽  
Paulsson Anna K ◽  
Thind Balkarn S ◽  
Miller Trevor T ◽  
Zeng Jing ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Patient Population ◽  
Large Patient ◽  
Large Patient Population ◽  
Long Term Follow Up

scholarly journals Outcomes of stereotaxic radiosurgery for subtentorial cavernous malformations

2019 ◽  
Vol 20 (4) ◽  
pp. 40-51 ◽  
Author(s):  
L. Ya. Kravets ◽  
S. N. Gryaznov ◽  
S. Ya. Kalinina ◽  
Yu. D. Avdonina ◽  
P. I. Ivanov
Keyword(s):  
Clinical Outcomes ◽  
Treatment Success ◽  
Gamma Knife Radiosurgery ◽  
Study Objective ◽  
Cavernous Malformations ◽  
Before And After ◽  
Frontline Treatment ◽  
Long Term Follow Up ◽  
Magnetic Resonance Imaging Mri

The study objective is to estimate treatment success of gamma knife radiosurgery (GKRS) in the patients with subtentorial cavernous malformation (CM) based on follow-up data and magnetic resonance imaging (MRI).Materials and methods. The long-term follow-up of GKRS in 87 patients with CM in brain stem and cerebellum was obtained. The clinical outcomes were observed using phone-based SF-36 health status survey in 55 patients. MRI data was collected before and after GKRS within 1, 2, 3 and more years. The natural history of CM without GKRS were observed in 20 patients.Results. The 1st year MRI observation after GKRS have demonstrated CM reduction in 66,6 % patients. At subsequent MRI-control the tendency of increase in number of CM, reacted on irradiation, and continuation of started processes of its sclerotization is revealed. The fast reduction of CM sizes was associated with lower risk of recurrent hemorrhages, that were observed in 3 patients with slow reduction. The CM reduction was also associated with good clinical outcomes, that was observed in 64,5 % patients.Conclusion. The presence of CM reduction (72,4 %) and good clinical outcome in suggests GKRS as a frontline treatment modality in patient with subtentorial CM. In the cases of slow rate of treatment response and unexpired risk of repeated hemorrhage no mortality and significant disability were mentioned.

Patterns and Clinical Impact of Angiographically Visible Distal Emboli During Thrombectomy With Solitaire for Acute Ischemic Stroke

Neurosurgery ◽  
2015 ◽  
Vol 78 (2) ◽  
pp. 242-250 ◽  
Author(s):  
Marcus D. Mazur ◽  
Craig Kilburg ◽  
Min S. Park ◽  
Philipp Taussky
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Vascular Territory ◽  
Before And After ◽  
Unfavorable Clinical Outcome ◽  
Flow Restoration ◽  
Poor Outcomes

ABSTRACT BACKGROUND: Revascularization rates with stent retrievers after acute ischemic stroke are 69% to 86%, but favorable clinical outcomes occur in just 43% to 58% of cases. New distal emboli may negatively impact clinical outcomes. OBJECTIVE: To determine the prevalence and angiographic pattern of distal emboli associated with mechanical thrombectomy using the Solitaire Flow Restoration device and evaluate their correlation with clinical outcome. METHODS: We retrospectively reviewed the cerebral angiography of all patients with acute ischemic stroke who underwent mechanical thrombectomy with the use of the Solitaire FR device from 2012 to 2013. Angiographic microcatheter runs prior to Solitaire deployment and after thrombectomy were compared to identify new distal filling defects. Clinical outcome was assessed at discharge and after 90 days. RESULTS: Successful revascularization using the Solitaire device occurred in 36 of 39 patients (92%). Three distinct patterns were identified: new distal emboli in the same vascular territory (n = 3), new distal emboli in a new vascular territory (n = 3), and distal emboli that resolved after proximal revascularization (n = 7). Thirteen patients had distal emboli before and after Solitaire runs, and 13 showed no evidence of distal emboli. Favorable outcome (modified Rankin scores 0-2) was seen in 54% of all patients and 83% of patients with new distal emboli; thus, there was no correlation between new emboli and unfavorable clinical outcome (P = .67). CONCLUSION: We report an incidence rate of at least 15% of new emboli associated with use of the Solitaire device during thrombectomy in our series. Filling defects after Solitaire use were not associated with poor outcomes at discharge or 90-day follow-up.

scholarly journals Surgical treatment and outcome of cerebral cavernomas – a 10 years’ experience

2014 ◽  
Vol 21 (4) ◽  
pp. 395-405
Author(s):  
A. Giovani ◽  
Aurelia Sandu ◽  
Angela Neacsu ◽  
R.M. Gorgan
Keyword(s):  
Vascular Malformations ◽  
Clinical Status ◽  
Low Flow ◽  
Vascular Lesions ◽  
Term Outcome ◽  
Cavernous Malformations ◽  
Long Term Outcome ◽  
Long Term Follow Up

Abstract Cavernous malformations (cavernomas) are congenital low flow angiographic occult vascular lesions with a high tencency to bleeding. The prevalence of cerebral cavernous vascular malformations is estimated to be 0.4% to 0.9%.2,7 CMs in deep locations, including the brainstem, thalamus, and basal ganglia, account for 9% to 35% of all malformations in the brain. We performed a retrospective 10 years study on 130 operated cerebral cavernomas and discussed the clinical status at presentation, the choice and timing of the surgical approach and the short and longterm follow up. The 130 operated cases were divided into a supratentorial 102 (78.46%) group and an infratantorial group 28 (21.53%). The average age at presentation was 43,62 years old (17-76) and there was no sex predominance, male/female = 1,44 (77/53). Only in 14 cases (10.76%) we could find multiple cavernomas which had relatives with multiple cavrnomas, but the familial inheritance was not studied, and only the symptomatic lesion was resected. We divided the outcome results reporting for agroup with superficial respectively profound lesions. The long term follow up for the patients in the profound lesions group showed that 31/37 (83,78%) of patients had a mRS between 0 and 2, and the rest had a poor long term outcome. After surgery there was no clinical deterioration in the superficial lesions group and 22 patients from those who presented in mRS 2 showed neurological improvement on long term follow up, meaning that 82,79% of patients had a 0 or 1 mRS. Microsurgery is the treatment of choice in symptomatic brain cavernomas, total resection being the only curative treatment, capable to prevent further bleeding and to offer an efficient control of seizures.

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