scholarly journals Management strategies for pediatric patients with tectal gliomas: a systematic review

2021 ◽  
Author(s):  
Megan M. J. Bauman ◽  
Archis R. Bhandarkar ◽  
Clark R. Zheng ◽  
Cecile Riviere-cazaux ◽  
Cynthia J. Beeler ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pediatric Population ◽  
Obstructive Hydrocephalus ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Treatment Modalities ◽  
Management Options ◽  
Csf Diversion ◽  
Aggressive Tumors ◽  
Level I

AbstractPediatric tectal gliomas generally have a benign clinical course with the majority of these observed radiologically. However, patients often need treatment for obstructive hydrocephalus and occasionally require cytotoxic therapy. Given the lack of level I data, there is a need to further characterize management strategies for these rare tumors. We have therefore performed the first systematic review comparing various management strategies. The literature was systematically searched from January 1, 2000, to July 30, 2020, to identify studies reporting treatment strategies for pediatric tectal gliomas. The systematic review included 355 patients from 14 studies. Abnormal ocular findings—including gaze palsies, papilledema, diplopia, and visual field changes—were a common presentation with between 13.6 and 88.9% of patients experiencing such findings. CSF diversion was the most performed procedure, occurring in 317 patients (89.3%). In individual studies, use of CSF diversion ranged from 73.1 to 100.0%. For management options, 232 patients were radiologically monitored (65.4%), 69 received resection (19.4%), 30 received radiotherapy (8.4%), and 19 received chemotherapy (5.4%). When examining frequencies within individual studies, chemotherapy ranged from 2.5 to 29.6% and radiotherapy ranged from 2.5 to 28.6%. Resection was the most variable treatment option between individual studies, ranging from 2.3 to 100.0%. Most tectal gliomas in the pediatric population can be observed through radiographic surveillance and CSF diversion. Other forms of management (i.e., chemotherapy and radiotherapy) are warranted for more aggressive tumors demonstrating radiological progression. Surgical resection should be reserved for large tumors and/or those that are refractory to other treatment modalities.

scholarly journals Cerebellar hemangioblastoma during pregnancy: Management options and review of literature

2020 ◽  
Vol 11 ◽  
pp. 123
Author(s):  
Nitish Nayak ◽  
Anil Kumar
Keyword(s):  
Obstructive Hydrocephalus ◽  
Mass Effect ◽  
Lateral Position ◽  
Management Options ◽  
Cerebellar Hemangioblastoma ◽  
Suboccipital Craniotomy ◽  
History Of ◽  
Nerve Paresis ◽  
Csf Diversion

Background: Symptomatic cerebellar hemangioblastomas are extremely rare in pregnant women and the ideal management is not well established. In the present article, we aimed to report a case of large cerebellar hemangioblastoma complicated by pregnancy and managed successfully by surgical resection. In addition, we also discuss management options and review of the current literature pertaining to this pathology. Case Description: A 22-year-old female presented with a history of headache and vomiting for 4 weeks. She was carrying 28 weeks of pregnancy. She had left cerebellar signs, gait ataxia, and bilateral six nerve paresis. Fundus examination revealed bilateral papilledema. She was diagnosed to have large cerebellar hemangioblastoma with mass effect and obstructive hydrocephalus. She underwent suboccipital craniotomy and excision of lesion in lateral position. She recovered well postoperatively and delivered a healthy baby in the full term. Imaging at10- month follow-up demonstrates no residual lesion or another hemangioblastoma. Conclusion: Early diagnosis and direct surgery for excision of hemangioblastoma is a good option during pregnancy while avoiding CSF diversion procedures. The symptomatic hemangioblastoma during pregnancy can be safely operated during early pregnancy.

Facial Schwannoma Management Outcomes: A Systematic Review of the Literature

2020 ◽  
Vol 163 (2) ◽  
pp. 293-301
Author(s):  
Matthew Bartindale ◽  
Jeffrey Heiferman ◽  
Cara Joyce ◽  
Douglas Anderson ◽  
John Leonetti
Keyword(s):  
Systematic Review ◽  
Facial Nerve ◽  
Stereotactic Radiosurgery ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Tumor Location ◽  
Subtotal Resection ◽  
Review Of The Literature ◽  
Total Resection ◽  
Clinical Scenarios

Objective To evaluate facial nerve outcomes of various management strategies for facial schwannomas by assimilating individualized patient data from the literature to address controversies in management. Data Sources PubMed–National Center for Biotechnology Information and Scopus databases. Review Methods A systematic review of the literature was performed for studies regarding facial schwannomas. Studies were included if they presented patient-level data, type of intervention, pre- and postintervention House-Brackmann (HB) grades, and tumor location by facial nerve segment. Results Individualized data from 487 patients were collected from 31 studies. Eighty (16.4%) facial schwannomas were managed with observation, 25 (5.1%) with surgical decompression, 20 (4.1%) with stereotactic radiosurgery, 225 (46.2%) with total resection, and 137 (28.1%) with subtotal resection/stripping surgery. Stripping surgery/subtotal resection with good preoperative facial nerve function maintained HB grade 1 or 2 in 96% of cases. With a total resection of intradural tumors, preoperative HB grade did not significantly affect facial nerve outcome (n = 45, P = .46). However, a lower preoperative HB grade was associated with a better facial nerve outcome with intratemporal tumors (n = 56, P = .009). When stereotactic radiosurgery was performed, 40% of patients had improved, 35% were stable, and 25% had worsened facial function. Facial nerve decompression rarely affected short-term facial nerve status. Conclusion The data from this study help delineate which treatment strategies are best in which clinical scenarios. The findings can be used to develop a more definitive management algorithm for this complicated pathology.

scholarly journals Management Options for Advanced Low or Intermediate Grade Gastroenteropancreatic Neuroendocrine Tumors: Review of Recent Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-14 ◽  
Author(s):  
Vladimir Neychev ◽  
Electron Kebebew
Keyword(s):  
Neuroendocrine Tumors ◽  
Tryptophan Hydroxylase ◽  
Management Strategies ◽  
Somatostatin Analogs ◽  
Treatment Strategies ◽  
Peptide Receptor Radionuclide Therapy ◽  
Phase Iii ◽  
Management Options ◽  
Intermediate Grade ◽  
Gastroenteropancreatic Neuroendocrine Tumors

Our understanding of the biology, genetics, and natural history of neuroendocrine tumors (NETs) of the gastrointestinal tract and pancreas has improved considerably in the last several decades and the spectrum of available therapeutic options is rapidly expanding. The management of patients with metastatic low or intermediate grade NETs has been revolutionized by the development of new treatment strategies such as molecular targeting therapies with everolimus and sunitinib, somatostatin analogs, tryptophan hydroxylase inhibitors, and peptide receptor radionuclide therapy that can be used alone or as a multimodal approach with or without surgery. To further define and clarify the utility, appropriateness, and the sequence of the growing list of available therapies for this patient population will require more high level evidence; however, data from well-designed randomized phase III clinical trials is rapidly accumulating that will further stimulate development of new management strategies. It is therefore important to thoroughly review emerging evidence and report major findings in frequent updates, which will expand our knowledge and contribute to a better understanding, characterization, and management of advanced NETs.

scholarly journals Perioperative Pain and Addiction Interdisciplinary Network (PAIN): protocol of a practice advisory for the perioperative management of buprenorphine using a modified Delphi process

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e027374 ◽  
Author(s):  
Akash Goel ◽  
Saam Azargive ◽  
Joel S Weissman ◽  
Harsha Shanthanna ◽  
Karim S Ladha ◽  
...  
Keyword(s):  
Systematic Review ◽  
Perioperative Management ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Clinical Excellence ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Perioperative Pain ◽  
Modified Delphi ◽  
Opioid Administration

IntroductionThe ongoing opioid epidemic has necessitated increasing prescriptions of buprenorphine, which is an evidence-based treatment for opioid use disorder, and also shown to reduce harms associated with unsafe opioid administration. A systematic review of perioperative management strategies for patients taking buprenorphine concluded that there was little guidance for managing buprenorphine perioperatively. The aim of this project is to develop consensus guidelines on the optimal perioperative management strategies for this group of patients. In this paper, we present the design for a modified Delphi technique that will be used to gain consensus among patients and multidisciplinary experts in addiction, pain, community and perioperative medicine.Methods and analysisA national panel of experts identified by perioperative, pain and/or addiction systematic review authorship established an international profile in perioperative, pain and/or addiction research, community clinical excellence and by peer referral. A steering group will develop the first round with a list of indications to be rated by the panel of national experts, patients and allied healthcare professionals. In round 1, the expert panel will rate the appropriateness of each individual item and provide additional suggestions for revisions, additions or deletions. The definition of consensus will be seta priori. Consensus will be gauged for both appropriateness and inappropriateness of treatment strategies. Where an agreement is not reached and items are suggested for addition/deletion/modification, round 2 will take place over teleconference in order to obtain consensus.Ethics and disseminationInstitutional research ethics board provided a waiver for this modified Delphi protocol. We plan on developing a national guideline for the management of patients taking buprenorphine in the perioperative period that will be generalisable across three sets of preoperative diagnoses including opioid use disorder and/or co-occurring pain disorders. The findings will be published in peer-reviewed publications and conference presentations.

scholarly journals PDE-5i Management of Erectile Dysfunction After Rectal Surgery: A Systematic Review Focusing on Treatment Efficacy

2020 ◽  
Vol 14 (5) ◽  
pp. 155798832096906
Author(s):  
Margherita Notarnicola ◽  
Valerio Celentano ◽  
Paschalis Gavriilidis ◽  
Bilal Abdi ◽  
Nassiba Beghdadi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Erectile Dysfunction ◽  
Management Strategies ◽  
Rectal Surgery ◽  
Treatment Strategies ◽  
Case Series ◽  
Case Control Studies ◽  
Phosphodiesterase Type 5 Inhibitor ◽  
Rectal Cancers ◽  
Phosphodiesterase Type

Erectile dysfunction (ED) is one of the main functional complications of surgical resections of the rectum due to rectal cancers or inflammatory bowel disease (IBD). The present systematic review aimed at revising ED management strategies applied after rectal resections and their efficacy in terms of improvement of the International Index of Erectile Function (IIEF) score. A literature search was conducted on Medline, EMBASE, Scopus, and Cochrane databases by two independent reviewers following the PRISMA guidelines. Randomized and nonrandomized controlled trials (RCTs, NRCTs), case-control studies, and case series evaluating medical or surgical therapies for ED diagnosed after rectal surgery for both benign and malignant pathologies were eligible for inclusion. Out of 1028 articles initially identified, only five met the inclusion criteria: two RCTs comparing oral phosphodiesterase type-5 inhibitor (PDE-5i) versus placebo; one NRCT comparing PDE-5i versus PDE-5i + vacuum erection devices (VEDs) versus control; and two before-after studies on PDE-5i. A total of 253 (82.7%) rectal cancer patients and 53 (17.3%) IBD patients were included. Based on two RCTs, PDE-5i significantly improved IIEF compared to placebo at 3 months (SMD = 1.07; 95% CI [0.65, 1.48]; p < .00001; I2 = 39%). Improved IIEF was also reported with PDE-5i + VED at 12 months. There is a paucity of articles in the literature that specifically assess efficacy of ED treatments after rectal surgery. Many alternative treatment strategies to PDE-5is remain to be investigated. Future studies should implement standardized preoperative, postoperative, and follow-up sexual function assessment in patients undergoing rectal resections.

scholarly journals Return to Sport After Metacarpal and Phalangeal Fractures: A Systematic Review and Evidence Appraisal

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098001
Author(s):  
Luke Geoghegan ◽  
Alexander Scarborough ◽  
Jeremy N. Rodrigues ◽  
Mike J. Hayton ◽  
Maxim D. Horwitz
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Return To Sport ◽  
Poor Quality ◽  
Accurate Estimation ◽  
Level Of Evidence ◽  
Metacarpal Fractures ◽  
Phalangeal Fractures

Background: Fractures of the metacarpals and phalanges account for more than half of all upper extremity fractures sustained by competitive athletes. Purpose: To determine which management strategy is best for expediting return to preinjury levels of competition in adult athletes with metacarpal and/or phalangeal fractures. Study Design: Systematic review; Level of evidence, 4. Methods: A methodology compliant with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used. A custom search strategy was designed and applied to MEDLINE and In-Process, Embase, EMCARE, and CINAHL. Results: Overall, 3135 records were identified, of which 8 met full inclusion criteria. All patients returned to preinjury levels of competition, at a mean of 30.6 days for phalangeal fractures and 21.9 days for metacarpal fractures. Meta-analysis demonstrated delayed return-to-sport time for operatively managed metacarpal fractures as compared with nonoperatively managed ones (28.5 vs 22.0 days). All studies were of fair or poor quality, and none were randomized. Conclusion: Optimal management strategies for athletes with metacarpal and phalangeal fractures remain equivocal. Injury, treatment, and sport-specific factors may confound results and preclude accurate estimation of optimal treatment strategies at present.

scholarly journals Central slip extensor tendon injuries: a systematic review of treatments

2019 ◽  
Vol 44 (8) ◽  
pp. 825-832
Author(s):  
Luke Geoghegan ◽  
Justin Conrad Rosen Wormald ◽  
Raina Zarb Adami ◽  
Jeremy N. Rodrigues
Keyword(s):  
Systematic Review ◽  
Treatment Strategies ◽  
Extensor Tendon ◽  
Operative Management ◽  
Evidence Base ◽  
Tendon Injuries ◽  
Treatment Modalities ◽  
Full Text Review ◽  
Central Slip ◽  
Extensor Tendon Injuries

This systematic review describes and compares outcomes of operative and non-operative management of central slip extensor tendon injuries. A PRISMA-compliant methodology identified 3785 studies. Of these, 29 underwent full text review. No randomized controlled trials were identified. Nine studies evaluated treatment modalities specific to cohorts with acute central slip injuries in adults. A range of operative and non-operative elements of management was identified although no studies directly compared the two. Where aspects of rehabilitation were studied, this was always after surgery. The evidence base regarding treatment of central slip injury is limited and the roles of different treatment strategies for open as well as closed injuries are not well-supported by evidence.

Comparative effectiveness review of treatment options for pituitary microadenomas in acromegaly

2012 ◽  
Vol 117 (3) ◽  
pp. 522-538 ◽  
Author(s):  
Nicholas F. Marko ◽  
Emily LaSota ◽  
Amir H. Hamrahian ◽  
Robert J. Weil
Keyword(s):  
Quality Of Life ◽  
Decision Tree ◽  
Comparative Effectiveness ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Treatment Modalities ◽  
Individual Treatment ◽  
Life Questionnaire ◽  
Biochemical Control

Object Acromegaly, a syndrome of excess growth hormone (GH) secretion typically caused by a GH-secreting pituitary adenoma, reduces life expectancy by approximately 10 years when left untreated. Treatment of acromegaly involves combinations of one or more discrete therapeutic modalities to achieve biochemical control. Unfortunately, data capable of informing decisions among alternate management strategies are presently lacking. Methods The authors performed a comparative effectiveness research (CER) review integrating efficacy, cost, and quality of life (QOL) analysis for treatment strategies comprising various combinations of surgery, radiotherapy, stereotactic radiosurgery, and pharmacotherapy in patients with acromegaly caused by a pituitary microadenoma. A management decision tree was used to identify 5 treatment strategies, each with up to 4 potential treatment steps. Efficacy was assessed using recent literature reports of biochemical control rates for each modality. Cost estimations were derived from wholesale drug prices and from the Healthcare Cost and Utility Project. Quality of life data were obtained from studies utilizing the Acromegaly Quality of Life Questionnaire. Results Individual treatment modalities were analyzed and ranked in each of 3 domains: highest rate of success, lowest cost, and highest QOL, and these scores were combined to facilitate comparison of overall effectiveness of each of the management strategies. These aggregate effectiveness scores were used to compare the 5 strategies from the decision tree, and a novel strategy was also proposed. Conclusions The choice of management strategy must be individualized for each patient with acromegaly. This CER analysis provides a comprehensive framework to inform clinical decisions among alternate management strategies in patients with GH-secreting pituitary microadenomas.

scholarly journals Extensive Ossification of the Achilles Tendon with and without Acute Fracture: A Scoping Review

2021 ◽  
Vol 10 (16) ◽  
pp. 3480
Author(s):  
Daniel Sullivan ◽  
Allison Pabich ◽  
Ryan Enslow ◽  
Avery Roe ◽  
Donald Borchert ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Treatment Regimen ◽  
Scoping Review ◽  
Standard Treatment ◽  
Treatment Strategies ◽  
Treatment Modalities ◽  
Molecular Signaling ◽  
Management Options ◽  
Acute Fracture ◽  
Standard Treatment Regimen

Extensive Ossification of the Achilles Tendon (EOAT) is an uncommon condition characterized by the presence of heterotopic ossification within the substance of the Achilles Tendon and is distinct from other tendinopathies associated with tendon mineralization. The purpose of this scoping review of the literature on EOAT is to describe the pathogenesis, patient population, presentation, management, and outcomes of this rare condition. Fifty-four articles were included in the scoping review after screening and selection. According to the literature, EOAT often presents with pain and swelling around the Achilles Tendon and is frequently associated with acute trauma. EOAT is more common in men, and although the exact mechanisms of the pathology are not fully understood, EOAT may demonstrate specific molecular signaling patterns. The lack of knowledge regarding the molecular mechanism may be a significant hindrance to the management of the condition. Even though a standard treatment regimen for EOAT does not exist, conservative management for six months in patients without complications is recommended. Those who have an acute fracture of the ossification should be managed more aggressively and will often require surgical repair with autograft, although there is no standardized procedure at this time. Clinicians should be aware of the typical presentation, risk factors, and management options of patients with EOAT. Additionally, they should be cautious when selecting treatment strategies and conduct a thorough evaluation of long-term outcomes with various treatment modalities, which this review provides. Most important, this review highlights the need for further research to determine the best course of clinical treatment of EOAT injuries, in order to establish a standard treatment regimen.

Management of granular myringitis: A systematic review

2007 ◽  
Vol 122 (1) ◽  
pp. 3-10 ◽  
Author(s):  
L J Neilson ◽  
S S M Hussain
Keyword(s):  
Systematic Review ◽  
Antibiotic Therapy ◽  
Current Literature ◽  
Management Strategies ◽  
Surgical Excision ◽  
Treatment Modalities ◽  
Inclusion Criteria ◽  
Inflammatory Infiltration ◽  
Ovid Medline ◽  
Canal Atresia

AbstractIntroduction:Granular myringitis is a chronic disorder characterised by lateral squamous de-epithelialisation and granulation of the tympanic membrane. Untreated, granular myringitis can lead to post-inflammatory medial external auditory canal fibrosis, acquired canal atresia and inflammatory infiltration of the deep canal.Aim:This study aimed to establish optimal management strategies which could be applied to clinical practice, through systematic review of the current literature.Methods:Current literature was obtained by searching evidence-based medical databases, the Cochrane database, the Database of Abstracts of Reviews of Effects, the Cochrane controlled trials register, Ovid Medline, the variousBritish Medical Journalimprint journals, individual journal websites and citation indexes, and by hand-searching current journals. Detailed inclusion criteria were set. Data were retrieved from the selected studies and checked for accuracy and consistency. The primary outcome measured was the effect of the proposed intervention on recurrence of granular myringitis, compared with empirical antibiotic therapy.Results:Fifty-eight publications were identified, dating from 1964 to 2005; 46 of these were potentially relevant. After assessment using the preset inclusion criteria, only two studies remained. El-Seifi and Fouad (2000) found that surgical excision of granulation tissue resulted in an 80 per cent reduction in recurrence of granular myringitis when compared with conventional antibiotic therapy. However, Junget al.(2002) demonstrated a 96 per cent reduction in granular myringitis recurrence when managed with dilute vinegar solution.Conclusions:There was a reduced recurrence of granular myringitis in both studies' intervention groups, although neither study was randomised or blinded, making it difficult to assess the clinical relevance of the results. However, the following conclusions can be inferred. (1) Conventional topical antibiotic and steroid drops appear to be less efficacious and more likely to lead to recurrence of symptoms, compared with other proposed treatment modalities. (2) Treatment with dilute vinegar solution presents a logical, unharmful alternative to conventional antibiotic drops. Further research of high value is needed.

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