Preserved arachnoid membrane acts as a predictor of postoperative visual improvement in clinoidal meningioma

Abstract Introduction The extended endoscopic approach (EEA) provides direct access for resection of tuberculum sellae (TSM) and olfactory groove meningiomas (OGM) but is associated with cerebrospinal fluid (CSF) leak in up to 25% of patients. To evaluate the impact of improved skull base reconstructive techniques, we assessed published CSF leak percentages in EEA over the last two decades. Method Random-effects meta-analyses were performed for studies published between 2004-2020. Outcomes assessed were CSF leak, gross total resection, visual improvement, intraoperative arterial injury and 30-day mortality. For the main analyses, publications were pragmatically grouped based on publication year in three categories: 2004-2010, 2011-2015, and 2016-2020. Results We included 29 studies describing 540 TSM and 115 OGM patients. CSF leak incidence dropped over time from 22% (95% CI: 6-43%) in studies published between 2004 and 2010, to 16% (95% CI: 11-23%) between 2011 and 2015, and 4% (95% CI: 1-9%) between 2016 and 2020. Outcomes of gross total resection, visual improvement, intraoperative arterial injury, and 30-day mortality remained stable over time Conclusions We report a noticeable decrease in CSF leak over time, which might be attributed to the development of reconstructive techniques (e.g., hadad bassagasteguy flap, and gasket seal), refined multilayer repair protocols, and selected lumbar drain usage.

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The results of therapeutic keratoplasties performed in severely thinned or perforated corneas

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v15i3.245 ◽

2017 ◽

Vol 15 (3) ◽

Author(s):

Bora Yuksel ◽

Menekse Binzet ◽

Umut Duygu Uzunel ◽

Tuncay Kusbeci

Keyword(s):

Medical Records ◽

Stevens Johnson Syndrome ◽

Bullous Keratopathy ◽

Visual Improvement ◽

Acne Rosacea ◽

Johnson Syndrome ◽

Interstitial Keratitis ◽

Patch Graft ◽

Corneal Melting

Purpose: To report the visual and anatomic outcomes of therapeutic keratoplasties performed in severely thinned or perforated corneas.Material and methods: Medical records of 37eyes of 37 patients operated between 2000 to 2014 were reviewed retrospectively. Indications, preoperative findings, surgical procedures, donor size, post-operative graft clarity, visual improvement, globe integrity and follow-up periods were analyzed. Mean age was 57,7 (20-85 ). Nineteen patients were male and 18 female. Mean follow-up was 28.7 (14-132) months.Results: Surgical indication was infectious in 17 (45.9%) and noninfectious in 20 eyes (54.1%). Infectious causes were bacterial ulcer 8 (21.7%), herpes simplex 7 (18.9%) and fungus in 2 (5.4%) eyes. Noninfectious causes were traumatic 6 (16.2%), Stevens-Johnson syndrome 2 (5.4%), desmatocele 2 (5.4%) other causes ( keratectasia, bullous keratopathy, acne rosacea, interstitial keratitis, lagophthalmos, and rheumatoid arthtritis). The underlying cause of cornel melting was unknown in 4 eyes (10.8%). Combined PK was performed in18 of 37 eyes (48.7%), PK alone in 14 (37.8%) and patch graft in 5 (13.5%). Graft survival rate was 30/37 (81.1%) through follow-up. Anatomical integrity was achieved in 23 (92.0%) of 25 perforated corneas. Visual improvement was obtained in 28 eyes (75.6%). Visual acuity was ≥ 0.05 in 6 eyes (16.2%) preoperatively, it increased to 22 eyes (59.4%) post-operatively.Conclusion: Therapeutic keratoplasty including PK and patch grafting is an effective surgical procedure in patients with severe corneal melting or perforation due to varying aetiologies. It restores the globe integrity also provides visual improvement.

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Association between individual retinal layer thickness and visual acuity in patients with epiretinal membrane: a pilot study

PeerJ ◽

10.7717/peerj.9481 ◽

2020 ◽

Vol 8 ◽

pp. e9481

Author(s):

Jing Zou ◽

Wei Tan ◽

Wenlong Huang ◽

Kangcheng Liu ◽

Fangling Li ◽

...

Keyword(s):

Visual Acuity ◽

Layer Thickness ◽

Epiretinal Membrane ◽

Linear Regression Analysis ◽

Plexiform Layer ◽

Surgical Patients ◽

Retinal Layer ◽

Inner Plexiform Layer ◽

Post Surgery ◽

Visual Improvement

Purpose We investigated the correlation between visual acuity (VA) and individual retinal layer thickness in the foveal, parafoveal, and perifoveal regions of patients with an idiopathic epiretinal membrane (ERM). Methods One hundred and five subjects presenting with unilateral idiopathic ERM were included in this study. We segmented each patient’s optical coherence tomography (OCT) image into seven layers and calculated the mean layer thickness in the foveal, parafoveal, and perifoveal regions using the Iowa Reference Algorithm. In 105 patients with ERM, we detected correlations between their macular regions’ individual retinal layer thickness and their best corrected VA. Thirty-one of the 105 patients with ERM underwent vitrectomy and completed six months of follow-up. We then compared the 31 surgical patients’ preoperative and postoperative individual retinal layer thickness in each macular region. Additionally, the association between preoperative individual retinal layer thickness in each macular region and VA six months post-surgery in patients with ≥ two Snellen lines of visual improvement was determined. Results Multiple linear regression analysis showed that the inner nuclear layer (INL) thickness in the foveal, parafoveal, and perifoveal region were all associated with VA in the 105 patients (R2 = 0.344, P < 0.001; R2 = 0.427, P < 0.001; and R2 = 0.340, P < 0.001, respectively). Thirty-one surgical patients 6 months post-surgery showed significantly decreased thicknesses (P ≤ 0.012) of the foveal INL, inner plexiform layer (IPL), and outer nuclear layer (ONL); the parafoveal retina nerve fiber layer (RNFL), IPL, INL, and ONL; and the perifoveal RNFL, IPL, INL, ganglion cell layer (GCL), outer plexiform layer (OPL), and photoreceptor layer (PRL). We found a weak correlation between postoperative VA and preoperative foveal and perifoveal RNFL thickness (r = 0.404 and r = 0.359, respectively), and a moderate correlation between postoperative VA and preoperative foveal and parafoveal INL thickness (r = 0.529 and r = 0.583, respectively) in the 31 surgical patients (P ≤ 0.047). The preoperative INL thickness in the foveal, parafoveal, and perifoveal regions showed a moderate to strong correlation (r = 0.507, 0.644, and 0.548, respectively), with postoperative VA in patients with ≥ 2 lines of visual improvement (P ≤ 0.038). Conclusion We detected a correlation between retinal damage and VA in the parafoveal, perifoveal, and foveal regions. Our results suggest that INL thickness in all macular regions may be a prognostic factor for postoperative VA in ERM patients.

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Electrical properties and structure of the frog arachnoid membrane

Journal of Neurobiology ◽

10.1002/neu.480070309 ◽

1976 ◽

Vol 7 (3) ◽

pp. 259-270 ◽

Cited By ~ 13

Author(s):

J�se Perez-Gomez ◽

Niels Bindslev ◽

Paula M. Orkand ◽

Ernest M. Wright

Keyword(s):

Electrical Properties ◽

Arachnoid Membrane

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Arachnoid Membrane

Encyclopedia of Pain ◽

10.1007/978-3-540-29805-2_273 ◽

2006 ◽

pp. 110-110

Keyword(s):

Arachnoid Membrane

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Arachnoid cysts

Oxford Textbook of Neurological Surgery ◽

10.1093/med/9780198746706.003.0096 ◽

2019 ◽

pp. 1101-1106

Author(s):

Ruichong Ma ◽

Stana Bojanic

Keyword(s):

Cerebral Spinal Fluid ◽

Spinal Column ◽

Middle Cranial Fossa ◽

Paediatric Population ◽

Arachnoid Cysts ◽

Arachnoid Membrane ◽

Head Growth ◽

Asymptomatic Patients ◽

Cranial Fossa ◽

Endoscopic Fenestration

First described in 1831, arachnoid cysts are cerebral spinal fluid-filled spaces lined with arachnoid membrane. They account for 1% of all intracranial space occupying lesions and can also be found rarely in the spinal column. Most intracranial arachnoid cysts are found in the middle cranial fossa with a male predilection and a slight preponderance for the left side. With the availability of modern imaging, many more arachnoid cysts are being picked up incidentally in asymptomatic patients. However, symptomatic arachnoid cysts are predominantly found in the paediatric population with patients typically presenting with headaches, rapid head growth, developmental delay, and seizures. Treatment of patients with asymptomatic arachnoid cysts has typically been conservative management with surgery only considered in patients with symptoms. Surgical management remains controversial and includes open techniques, endoscopic fenestration of cyst, or shunting procedures.

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