scholarly journals Haemorrhagic brainstem cavernous malformation: early and long term functional outcomes after microsurgical resection

2021 ◽  
Vol 1 ◽  
pp. 100358
Author(s):  
C.A. Donofrio ◽  
F. Badaloni ◽  
J.M. Aliaga Arias ◽  
C. Valtulina ◽  
S. Bianchini ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Cavernous Malformation ◽  
Microsurgical Resection ◽  
Brainstem Cavernous Malformation

Long-Term Outcome of Gamma Knife Radiosurgery for Symptomatic Brainstem Cavernous Malformation

2018 ◽  
Vol 116 ◽  
pp. e1054-e1059 ◽  
Author(s):  
Kawngwoo Park ◽  
Jin Wook Kim ◽  
Hyun-Tai Chung ◽  
Sun Ha Paek ◽  
Dong Gyu Kim
Keyword(s):  
Gamma Knife ◽  
Cavernous Malformation ◽  
Gamma Knife Radiosurgery ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Brainstem Cavernous Malformation

Abstract WMP117: Conservative versus Surgical Treatment for Brainstem Cavernous Malformation.

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Hernan M Patino ◽  
Monica Chavarria-Medina ◽  
Mayra Becerril ◽  
Gabriel M Longo ◽  
Edgar Nathal ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Median Time ◽  
Cavernous Malformation ◽  
Recurrent Hemorrhage ◽  
Conservative Group ◽  
Clinical Series ◽  
Brainstem Cavernous Malformation ◽  
Surgical Group

Brainstem cavernous malformation (BCM) account for 8-22% of all intracranial cavernomas. Currently, they can be treated microsurgically or conservative but it is still difficult to choose the best treatment for each patient. The main objective of our series was to evaluate the long-term functional outcome and recurrence in patients with BCM treated with conservative or surgical treatments. Hypothesis: We assessed the hypothesis that surgical and conservative treatments are associated with different functional outcome and re-hemorrhage rate in long-term follow-up. Methods: In this non-randomized, clinical series, we compared the clinical and radiological findings of patients with their first hemorrhage secondary to confirmed BCM, treated in a tertiary neurological center, during a twenty five- year period. Treatment of each patient was selected by the attending physician and consisted of either conservative or surgical evacuation of BCM. The primary end-points were recurrent hemorrhage and functional outcome. Favorable prognosis was defined as modified Rankin scale (mRs) of 0 to 2. Results: From January of 1990 to July of 2015; 99 patients with BCM hemorrhage were treated (59 [59,6%] female; mean age 37± 13 years). 37 patients (37,4%) were surgically treated and 62 (62,6%) received conservative treatment. During the follow-up; 20 patients in the medical group (median time of recurrence: 34,5 months; IQR: 13,75-93) and 4 patients in the surgical group (median time of recurrence: 22 months; IQR: 9-46,5) had a recurrence (OR: 0,255; 95% IC: 0,079-0,817), with a cumulative incidence of 5,1 per 100 years-person and 3,96 per 100 years-person respectively. Because of rebleeding, 11 patients of the conservative group were taken to surgery and 3 of the surgical group were to required re-intervention. At the end of follow-up (median: 51 months; IQR: 19-104) 51 patients remained in the conservative group and 28 (54,9%) had a favorable mRs. 48 patients remained in the surgical group and 27 (56,2%) had a favorable mRs (OR:0,94 95% IC: 0,42-2,09). Conclusion: Despite a significant high recurrent hemorrhage rate was observed in conservative treated patients, we did not found difference in clinical outcome between both groups of patients with BCM.

Microsurgical resection of medullary cavernoma via the olivary zone by the retrosigmoid supracondylar approach

2019 ◽  
Vol 1 (2) ◽  
pp. V7
Author(s):  
Ken Matsushima ◽  
Michihiro Kohno ◽  
Helmut Bertalanffy
Keyword(s):  
Cavernous Malformation ◽  
Cleavage Plane ◽  
Foramen Magnum ◽  
Senior Author ◽  
Neurological Deficits ◽  
Lateral Part ◽  
Sitting Position ◽  
Brainstem Cavernoma ◽  
Microsurgical Resection

Microsurgical resection of the medullary cavernoma is rare, comprising less than 15% of more than 250 surgeries of brainstem cavernoma performed by the senior author (H.B.).1 This video demonstrates a case of a cavernous malformation inside the lateral part of the medulla, which was surgically treated via the olivary zone by the retrosigmoid supracondylar approach in a half-sitting position. Osseous drilling of the lateral foramen magnum provided wide exposure of the cerebellomedullary cistern around the olive.2,3 The lesion was completely dissected at the appropriate cleavage plane from the normal parenchyma. The patient developed no new neurological deficits and had no recurrence during 3 years of follow-up after the operation.The video can be found here: https://youtu.be/7i7SccS5HmU.

Medulla oblongata cavernoma removal through a lazy far lateral approach: operative video and technical nuances

2019 ◽  
Vol 1 (2) ◽  
pp. V21
Author(s):  
Carlos Candanedo ◽  
Samuel Moscovici ◽  
Sergey Spektor
Keyword(s):  
Medulla Oblongata ◽  
Cavernous Malformation ◽  
Complete Removal ◽  
Lateral Approach ◽  
Neurological Deficits ◽  
Total Resection ◽  
Postoperative Mri ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
Brainstem Cavernous Malformation

Removal of brainstem cavernous malformation remains a surgical challenge. We present a case of a 63-year-old female who was diagnosed with a large cavernoma located in the medulla oblongata. The patient suffered three episodes of brainstem bleeding resulting in significant neurological deficits (hemiparesis, dysphagia, and dysarthria). It was decided to remove the cavernoma through a left-sided modified far lateral approach.3The operative video demonstrates the surgical steps and nuances of a complete removal of this complex medulla oblongata cavernous malformation. Total resection was achieved without complications. Postoperative MRI revealed no signs of residual cavernoma with clinical improvement.The video can be found here: https://youtu.be/BTtMvvLMOFM.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

scholarly journals Long‐term individual and population functional outcomes in older adults with atrial fibrillation

2021 ◽  
Author(s):  
Anna L. Parks ◽  
Sun Y. Jeon ◽  
W. John Boscardin ◽  
Michael A. Steinman ◽  
Alexander K. Smith ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Older Adults ◽  
Functional Outcomes

Scaphoid Nonunion Is a Disabling Problem in a Military Population

Hand ◽  
2021 ◽  
pp. 155894472110031
Author(s):  
Nicholas H. Lake ◽  
Rafae Khan ◽  
Kyle W. Mombell ◽  
Mary Fergus ◽  
Dominic Gomez-Leonardelli
Keyword(s):  
Functional Outcome ◽  
Military Service ◽  
Functional Outcomes ◽  
High Rate ◽  
Scaphoid Nonunion ◽  
Military Population ◽  
Outcome Scores ◽  
The Mean ◽  
Return To Duty

Background Scaphoid nonunion can occur in up to 55% of displaced scaphoid fractures. Long-term functional outcomes of this injury are lacking. In addition, no study has published rate of return to active military service after this injury. Our goal was to educate providers and patients on expected functional outcomes and return to duty after treatment of scaphoid nonunion. Methods We conducted a retrospective review of patients who underwent scaphoid nonunion repair at our institution from 2008 to 2017. The primary outcome measures were union rates, return to duty rates, and functional outcome scores obtained by telephone call. A total of 144 patients were included and 40 responded to our call for long-term follow-up. Results A total of 72% of patients achieved union after surgery, 18% required revision surgery, and 74% of patients were able to return to full duty after surgery. However, this number progressively decreased at 1, 2, and 5 years after surgery. At an average of 5.9 years after surgery, the mean Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) score was 23.9. The mean qDASH for patients who achieved union (21.9) was significantly lower than those with persistent nonunion (29.2) ( P = .0115). Conclusion Scaphoid nonunion is a difficult problem in the military. We found a high rate of persistent nonunion often requiring revision to partial or full wrist arthrodesis. In addition, our long-term functional outcome scores demonstrate significant disability after this injury, even when union is achieved. This information can help us better counsel our patients and set expectations after treatment of this injury.

scholarly journals Recovery of Visuospatial Neglect Subtypes and Relationship to Functional Outcome Six Months After Stroke

2021 ◽  
pp. 154596832110329
Author(s):  
Margaret J. Moore ◽  
Kathleen Vancleef ◽  
M. Jane Riddoch ◽  
Celine R. Gillebert ◽  
Nele Demeyere
Keyword(s):  
Functional Outcomes ◽  
Stroke Severity ◽  
Visuospatial Neglect ◽  
Recovery Pattern ◽  
Stroke Impact Scale ◽  
Impact Scale ◽  
Significant Difference ◽  
Initial Severity

Background/Objective. This study aims to investigate how complex visuospatial neglect behavioural phenotypes predict long-term outcomes, both in terms of neglect recovery and broader functional outcomes after 6 months post-stroke. Methods. This study presents a secondary cohort study of acute and 6-month follow-up data from 400 stroke survivors who completed the Oxford Cognitive Screen’s Cancellation Task. At follow-up, patients also completed the Stroke Impact Scale questionnaire. These data were analysed to identify whether any specific combination of neglect symptoms is more likely to result in long-lasting neglect or higher levels of functional impairment, therefore warranting more targeted rehabilitation. Results. Overall, 98/142 (69%) neglect cases recovered by follow-up, and there was no significant difference in the persistence of egocentric/allocentric (X2 [1] = .66 and P = .418) or left/right neglect (X2 [2] = .781 and P = .677). Egocentric neglect was found to follow a proportional recovery pattern with all patients demonstrating a similar level of improvement over time. Conversely, allocentric neglect followed a non-proportional recovery pattern with chronic neglect patients exhibiting a slower rate of improvement than those who recovered. A multiple regression analysis revealed that the initial severity of acute allocentric, but not egocentric, neglect impairment acted as a significant predictor of poor long-term functional outcomes (F [9,300] = 4.742, P < .001 and adjusted R2 = .098). Conclusions. Our findings call for systematic neuropsychological assessment of both egocentric and allocentric neglect following stroke, as the occurrence and severity of these conditions may help predict recovery outcomes over and above stroke severity alone.

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