Cutaneous innervation of the distal forearm and hand — Minimizing complication rate by defining danger zones for surgical approaches

2018 ◽  
Vol 220 ◽  
pp. 38-50 ◽  
Author(s):  
Lena Hirtler ◽  
Florian A. Huber ◽  
Vincent Wlodek
Keyword(s):  
Complication Rate ◽  
Surgical Approaches ◽  
Distal Forearm ◽  
Cutaneous Innervation

scholarly journals The efficacy of cystoperitoneal shunting for the surgical management of intracranial arachnoid cysts in the elderly: A systematic review of the literature

2021 ◽  
Vol 12 ◽  
pp. 624
Author(s):  
Joseph Merola ◽  
Susruta Manivannan ◽  
Setthasorn Ooi ◽  
Wen Li Chia ◽  
Milan Makwana ◽  
...  
Keyword(s):  
Systematic Review ◽  
Complication Rate ◽  
The Elderly ◽  
Chronic Subdural Haematoma ◽  
Arachnoid Cysts ◽  
Surgical Approaches ◽  
Review Of The Literature ◽  
Cystoperitoneal Shunting ◽  
Elderly Cohort ◽  
Neurosurgical Intervention

Background: Intracranial arachnoid cysts (AC) are benign, cerebrospinal fluid filled spaces within the arachnoid layer of the meninges. Neurosurgical intervention in children and young adults has been extensively studied, but the optimal strategy in the elderly remains unclear. Therefore, we performed a single center retrospective study combined with a systematic review of the literature to compare cystoperitoneal (CP) shunting with other surgical approaches in the elderly cohort. Methods: Retrospective neurosurgical database search between January 2005 and December 2018, and systematic review of the literature using PRISMA guidelines were performed. Inclusion criteria: Age 60 years or older, radiological diagnosis of intracranial AC, neurosurgical intervention, and neuroradiological (NOG score)/clinical outcome (COG score). Data from both sources were pooled and statistically analyzed. Results: Our literature search yielded 12 studies (34 patients), which were pooled with our institutional data (13 patients). CP shunts (7 patients; 15%), cyst fenestration (28 patients; 60%) and cyst marsupialisation/resection (10 patients; 21%) were the commonest approaches. Average duration of follow-up was 23.6, 26.9, and 9.5 months for each approach, respectively. There was no statistically significant association between choice of surgical intervention and NOG score (P = 0.417), COG score (P = 0.601), or complication rate (P = 0.955). However, CP shunting had the lowest complication rate, with only one patient developing chronic subdural haematoma. Conclusion: CP shunting is a safe and effective surgical treatment strategy for ACs in the elderly. It has similar clinical and radiological outcomes but superior risk profile when compared with other approaches. We advocate CP shunting as first line neurosurgical intervention for the management of intracranial ACs in the elderly.

scholarly journals Surgical management of spinal meningiomas: focus on unilateral posterior approach and anterior localization

2019 ◽  
Vol 30 (3) ◽  
pp. 308-313 ◽  
Author(s):  
Julia Onken ◽  
Kathrin Obermüller ◽  
Franziska Staub-Bartelt ◽  
Bernhard Meyer ◽  
Peter Vajkoczy ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Complication Rate ◽  
Posterior Approach ◽  
Surgical Complication ◽  
Extent Of Resection ◽  
Surgical Approaches ◽  
Special Focus ◽  
Complication Rates ◽  
Duration Of Surgery ◽  
Spinal Meningiomas

OBJECTIVESpinal meningiomas (sMNGs) are relatively rare in comparison to intracranial MNGs. sMNGs localized anterior to the denticulate ligament (aMNGs) represent a surgically challenging subgroup. A high perioperative complication rate due to the need for complex surgical approaches has been described. In the present study, the authors report on their surgical experience that involves two institutions in which 207 patients underwent surgery for sMNGs. Special focus was placed on patients with aMNGs that were treated via a unilateral posterior approach (ULPA).METHODSBetween 2005 and 2017, 207 patients underwent resection of sMNGs at one of two institutions. The following characteristics were assessed: tumor size and localization, surgical approach, duration of surgery, grade of resection, peri- and postoperative complication rates, and neurological outcome. Data were compared between the subgroups of patients according to the lesion’s relationship to the denticulate ligament and to surgical approach.RESULTSThe authors identified 48 patients with aMNGs, 86 patients with lateral MNGs, and 76 patients with posterior MNGs (pMNGs). Overall, 66.6% of aMNGs and 64% of pMNGs were reached via a ULPA. aMNGs that were approached via a ULPA showed reduced duration of surgery (131 vs 224 minutes, p < 0.0001) and had surgical complication rates and neurological outcomes comparable to those of lesions that were approached via a bilateral approach. No significant differences in complication rate, outcomes, and extent of resection were seen between aMNGs and pMNGs.CONCLUSIONSThe duration of surgery, extent of resection, and outcomes are comparable between aMNGs and pMNGs when removed via a ULPA. Thus, ULPA represents a safe route to achieve a gross-total resection, even in cases of aMNG.

scholarly journals P076 DIFFERENT SURGICAL APPROACH IN DIASTASIS RECTI REPAIR: IMPORTANCE OF AN OVERALL VIEW OF THE DISEASE

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Federico Fiori ◽  
Francesco Ferrara ◽  
Daniele Gentile ◽  
Caterina Baldi ◽  
Laura Benuzzi ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Approach ◽  
Complication Rate ◽  
Surgical Complications ◽  
Umbilical Hernia ◽  
Surgical Approaches ◽  
Anterior Repair ◽  
Linea Alba ◽  
Diastasis Recti ◽  
Critical Issues

Abstract Aim Diastasis Recti (DR) is characterized by a defect of the linea alba sometimes associated with midline hernias, and frequent lipocutaneous excess. We present our experience in the treatment of diastasis recti with Inter Recti Distance (IRD) &gt; 50mm -with or without umbilical hernia- by 3 different approaches. Material and Methods From January 2018 to February 2020, 104 patients were referred to our unit for clinical and radiological diagnosis of DR with IRD &gt; 50 mm. Three different surgical approaches were used, based on presence of lipocoutaneous excess: laparoabdominoplasty, laparominiabdominoplasty and minimally-invasive/endoscopic with Totally Sublay Anterior Repair (TESAR) approach. Results We performed 28 TESAR (29.8%), 44 laparoabdominoplasties (42.3%) and 32 laparominiabdominoplasties (30.8%). Overall complication rate was 26% (27 patients). In 3 (2.9%) cases major surgical complications (Clavien-Dindo 3-4) occurred, all for open operations. Minor complications (Clavien-Dindo 1-2) included: 13 cutaneous ischemia, 10 small muscular hematomas and 1 subcutaneous seroma. The overall median post-operative stay was 3 days (range 2 – 14 days), and 3, 4 and 3 days for TESAR, laparoabdominoplasty and laparominiabdominoplasty groups, respectively. No recurrence registered to date. Conclusions Our experience shows the importance of an overall view of the functional and cosmetic impairment created by the DR. The surgeon must obtain an optimal functional outcome also aiming for the best cosmetic result. Therefore different approaches have to be considered, tailored to the clinical, instrumental and psychological aspects of the disease. The complication rate, while in line with the literature, emphasize how in this type of operation the critical issues of functional as well as morphological surgery coexist.

Obliteration of the Middle Ear and Mastoid Cleft in Subtotal Petrosectomy: Indications, Technique, and Results

1986 ◽  
Vol 95 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Newton J. Coker ◽  
Herman A. Jenkins ◽  
Ugo Fisch
Keyword(s):  
Temporal Bone ◽  
Middle Ear ◽  
External Auditory Canal ◽  
Complication Rate ◽  
Surgical Approaches ◽  
Mastoid Cavity ◽  
Subtotal Petrosectomy ◽  
Vascular Structures ◽  
Base Of The Skull ◽  
Conductive Hearing

Lateral surgical approaches to the base of the skull through the temporal bone often result in a large cavity with exposed dura and vascular structures and no possibility of reconstruction of the middle ear conductive hearing mechanism. Subtotal petrosectomy with tympanomastoid obliteration provides a relatively safe and secure closure of the surgical defect in the temporal bone and eliminates the problems associated with an open mastoid cavity. Eradication of all accessible air cell tracts and mucosa in the petrous pyramid, obliteration of the eustachian tubal orifice, closure of the external auditory canal, and fat obliteration of the middle ear and mastoid clefts are essential in the procedure. Over the last 10 years this technique has been utilized in 372 base of skull procedures with a complication rate of less than 5%. Infection occurred only in those cases with draining cavities or contaminated wounds.

P103 Chiari malformation type I: a review of literature to compare bony posterior fossa decompression with and without duraplasty

2019 ◽  
Vol 90 (3) ◽  
pp. e49.3-e48
Author(s):  
KP Tam ◽  
M Foroughi
Keyword(s):  
Clinical Improvement ◽  
Posterior Fossa ◽  
Complication Rate ◽  
Surgical Approaches ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Chiari Type I Malformation ◽  
Advantages And Disadvantages ◽  
Lower Complication

ObjectivesTwo main surgical approaches for symptomatic Chiari type I malformation (CM-I) patients are posterior fossa decompression (PFD) involving craniectomy alone, and posterior fossa decompression with duraplasty (PFDD). The aim of this review was to outline the indications, advantages and disadvantages of each surgical approach, with guidance regarding surgical decisions.MethodsWe reviewed pertinent articles. Data on the clinical improvement, radiological improvement, complications and reoperations were compared.ResultsSeventeen articles containing data on 3713 paediatric and adult participants met the inclusion criteria. PFDD was associated with more favourable clinical improvement in CM-I patients with syringomyelia (RR 1.59, 95% Cl, 1.09 to 2.31; p<0.05), but had a higher complication rate (RR 3.34, 95% Cl, 1.66 to 6.73; p<0.05) when compared with PFD. Regarding radiological improvement and reoperation rates, no significant differences were observed between the two surgical approaches.ConclusionsBoth PFD and PFDD are effective and safe surgical strategies for symptomatic CM-I associated with posterior fossa volume mismatch, in the absence of hydrocephalus and craniocervical region instability. Bony PFD has a lower complication rate and seems to be good option when carried out in those without major tonsillar impaction and in the absence of a syrinx. However, these patients should be adequately counseled regarding the requirement for possible further intra-dural decompression.

Surgical Approaches to the Brain Stem

1993 ◽  
Vol 4 (3) ◽  
pp. 457-468 ◽  
Author(s):  
Dennis Y. Wen ◽  
Roberto C. Heros
Keyword(s):  
Brain Stem ◽  
Surgical Approaches ◽  
The Brain

Outcome of carotid endarterectomy under local anaesthesia with respect to the patients’ risk profile

VASA ◽  
2009 ◽  
Vol 38 (3) ◽  
pp. 225-233 ◽  
Author(s):  
Aleksic ◽  
Luebke ◽  
Brunkwall
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Carotid Endarterectomy ◽  
Complication Rate ◽  
Local Anaesthesia ◽  
High Risk Group ◽  
High Risk Patients ◽  
Hostile Neck ◽  
Risk Patients ◽  
Angioplasty And Stenting

Background: In the present study the perioperative complication rate is compared between high- and low-risk patients when carotid endarterectomy (CEA) is routinely performed under local anaesthesia (LA). Patients and methods: From January 2000 through June 2008 1220 consecutive patients underwent CEA under LA. High-risk patients fulfilled at least one of the following characteristics: ASA 4 classification, “hostile neck”, recurrent ICA stenosis, contralateral ICA occlusion, age ≥ 80 years. The combined complication rate comprised any new neurological deficit (TIA or stroke), myocardial infarction or death within 30 days after CEA, which was compared between patient groups. Results: Overall 309 patients (25%) were attributed to the high-risk group, which differed significantly regarding sex distribution (more males: 70% vs. 63%, p = 0,011), neurological presentation (more asymptomatic: 72% vs. 62%, p = 0,001) and shunt necessity (33% vs. 14%, p < 0,001). In 32 patients 17 TIAs and 15 strokes were observed. In 3 patients a myocardial infarction occurred. Death occurred in one patient following a stroke and in another patient following myocardial infarction, leading to a combined complication rate of 2,9% (35/1220). In the multivariate analysis only previous neurological symptomatology (OR 2,85, 95% CI 1,38-5,91) and intraoperative shunting (OR 5,57, 95% CI 2,69-11,55) were identified as independent risk factors for an increased combined complication rate. Conclusions: With the routine use of LA, CEA was not associated with worse outcome in high-risk patients. Considering the data reported in the literature, it does not appear justified to refer high-risk patients principally to carotid angioplasty and stenting (CAS) when LA can be chosen to perform CEA.

Current Strategies in the Management of Spinal Metastatic Disease

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 55-62 ◽  
Author(s):  
Bartanusz ◽  
Porchet
Keyword(s):  
Spinal Cord ◽  
Surgical Techniques ◽  
Cord Compression ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Spinal Stabilization ◽  
Management Algorithm ◽  
Specific Manner ◽  
Extensive Surgery ◽  
Selection Of

The treatment of metastatic spinal cord compression is complex. The three treatment modalities that are currently applied (in a histologically non-specific manner) are surgery, radiotherapy and the administration of steroids. The development of new spinal instrumentations and surgical approaches considerably changed the extent of therapeutic options in this field. These new surgical techniques have made it possible to resect these tumours totally, with subsequent vertebral reconstruction and spinal stabilization. In this respect, it is important to clearly identify those patients who can benefit from such an extensive surgery. We present our management algorithm to help select patients for surgery and at the same time identifying those for whom primary non-surgical therapy would be indicated. The retrospective review of surgically treated patients in our department in the last four years reveals a meagre application of conventional guidelines for the selection of the appropriate operative approach in the surgical management of these patients. The reasons for this discrepancy are discussed.

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