Can an Imaging Marker of Consistency Predict Intraoperative Experience and Clinical Outcomes for Vestibular Schwannomas? A Retrospective Review

2019 ◽  
Author(s):  
Robert J. Macielak ◽  
Michael S. Harris ◽  
Jameson K. Mattingly ◽  
Varun S. Shah ◽  
Luciano M. Prevedello ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Outcome Measures ◽  
Tumor Volume ◽  
Perioperative Complications ◽  
Retrospective Chart Review ◽  
Vestibular Schwannomas ◽  
Surgical Time ◽  
Tertiary Referral Center ◽  
Microsurgical Resection ◽  
Tumor Consistency

Abstract Objective The main purpose of this article is to determine if vestibular schwannoma consistency as determined by tissue intensity on T2-weighted magnetic resonance imagings (MRIs) is predictive of intraoperative experience and postoperative clinical outcomes. Study Design Retrospective chart review. Setting Tertiary referral center. Patients Seventy-seven patients diagnosed with vestibular schwannomas who were treated with microsurgical resection. Intervention Diagnostic. Main Outcome Measures Intraoperative measures include totality of resection, surgical time and cranial nerve VII stimulation and postoperative measures include House–Brackmann grade and perioperative complications. Results Tumor consistency determined via tissue intensity on MRI was only found to correlate with surgical time, with a softer tumor being associated with a longer surgical time (p < 0.0001). However, this was primarily driven by tumor volume with larger tumors being associated with longer surgical time based on multivariate analysis. None of the other intraoperative or postoperative measures considered were found to correlate with tumor consistency. Conclusions Tumor consistency determined by MRI is not predictive of intraoperative experience or postoperative outcomes in vestibular schwannomas. Tumor volume is the strongest driver of these outcome measures as opposed to tumor consistency.

Outcomes of Salvage Resection and Radiosurgery Following Failed Primary Treatment of Vestibular Schwannomas

2021 ◽  
pp. 019459982110397
Author(s):  
Emily Kay-Rivest ◽  
John G. Golfinos ◽  
Sean O. McMenomey ◽  
David R. Friedmann ◽  
Daniel Jethanamest ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Retrospective Chart Review ◽  
Primary Treatment ◽  
Vestibular Schwannomas ◽  
Sensory Loss ◽  
Safe Alternative ◽  
Gradual Improvement ◽  
Tertiary Referral Center ◽  
Salvage Resection ◽  
Facial Function

Objective To evaluate outcomes following salvage microsurgery (MS) and salvage stereotactic radiosurgery (SRS) after failure of primary treatment for vestibular schwannomas (VS). Study Design Retrospective chart review. Setting Tertiary referral center. Methods Patients with more than 1 intervention for their VS were divided into 4 groups: MS followed by SRS (n = 61), MS followed by MS (n = 9), SRS followed by MS (n = 7), and SRS followed by SRS (n = 7), and outcomes were evaluated. Results A total of 77 patients were included (84 procedures). In group 1 (MS then SRS), 3% developed a decline in facial function, 3% developed trigeminal sensory loss, and 13% patients had gradual improvement of facial nerve function following SRS. Group 2 (MS then MS) had the highest rates of facial nerve deterioration, although all but 1 patient achieved a House-Brackmann score of II or III. Gross-total resection (GTR) was achieved in 56% of patients. When a different approach was used for salvage resection, GTR occurred more commonly, and facial nerve outcomes were similar. In group 3 (SRS then MS), GTR occurred in 43% of cases, and 2 of 7 patients developed worsened facial function. In group 4 (SRS then SRS), no patient developed facial weakness after reirradiation, and 1 developed a trigeminal nerve deficit. Conclusions For MS recurrences/residuals, SRS is the mainstay of treatment and does not preclude facial function recovery. If salvage microsurgery is required, an alternate approach should be considered. For SRS failures, when MS is required, less-than GTR may be preferable, and reirradiation is a potential safe alternative.

Conservative Treatment of Vestibular Schwannomas: A Follow-Up Study on Clinical Outcomes

2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
M. Sadadcharam ◽  
R. Wormald ◽  
M. Javadpour ◽  
D. Rawluk ◽  
R. McConn-Walsh
Keyword(s):  
Conservative Treatment ◽  
Clinical Outcomes ◽  
Vestibular Schwannomas ◽  
Follow Up Study

The Learning Curve in Arthroscopic ACL Reconstruction. The impact on the Surgical Time and Postoperative Clinical Results

2018 ◽  
Vol 69 (10) ◽  
pp. 2874-2876
Author(s):  
Teodor Negru ◽  
Stefan Mogos ◽  
Ioan Cristian Stoica
Keyword(s):  
Anterior Cruciate Ligament ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Positive Impact ◽  
Cruciate Ligament ◽  
Clinical Results ◽  
Single Bundle ◽  
Surgical Time ◽  
Anterior Cruciate ◽  
The Impact

Rupture of the anterior cruciate ligament (ACL) is a common injury. The objective of the current study was to evaluate if the learning curve has an impact on surgical time and postoperative clinical outcomes after anatomic single-bundle anterior cruciate ligament reconstruction (ACLR) using an outside-in tunnel drilling hamstrings technique. The learning curve has a positive impact on surgical time but has no influence on postoperative clinical outcomes at short time follow-up.

scholarly journals 1758. Impact of Accelerate Pheno™ Rapid Blood Culture Detection System on Laboratory and Clinical Outcomes in Bacteremic Patients

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S61-S61 ◽  
Author(s):  
Ryan Dare ◽  
Kelsey McCain ◽  
Katherine Lusardi ◽  
Kay Daniels ◽  
Jacob Painter ◽  
...  
Keyword(s):  
Blood Culture ◽  
Clinical Outcomes ◽  
Bacterial Infections ◽  
Detection System ◽  
Positive Culture ◽  
Retrospective Chart Review ◽  
Improve Patient Care ◽  
Standard Of Care ◽  
Historical Cohort ◽  
Stewardship Program

Abstract Background Molecular-based automated systems for the rapid diagnosis of bacterial infections have potential to improve patient care. The Accelerate Pheno™ blood culture detection system (ACCEL) is an FDA approved platform that allows for identification (ID) and antimicrobial susceptibility testing (AST) 8 hours following growth in routine culture. Methods This is a single-center retrospective chart review of bacteremic adult inpatients before and after implementation of ACCEL. Laboratory and clinical data were collected February–March 2018 (intervention) and compared with a January–April 2017 historical cohort (standard of care). Standard of care ID and AST were performed using VITEK® MS (MALDI-TOF MS) and VITEK®2, respectively. An active antimicrobial stewardship program was in place during both study periods. Patients with polymicrobial cultures, off-panel isolates, previous positive culture, or who were discharged prior to final AST report were excluded. Primary outcome was length of stay (LOS). Secondary outcomes were inpatient antibiotic duration of therapy (DOT) and time to optimal therapy (TTOT). Nonparametric unadjusted analyses were performed due to non-normal distributions. Statistics were performed using SAS 9.4. Results Of the 143 positive cultures performed on ACCEL during intervention, 118 (83%) were identified as on-panel organisms. Seventy-five (64%) of these 118 cultures and 79 (70%) of 113 reviewed standard of care cultures met inclusion criteria. Patient comorbidities (P = NS), MEWS severity score (P = 0.10), source of bacteremia (P = NS), and pathogen detected (P = 0.30) were similar between cohorts. Time from collection to ID (28.2 ± 12.7 hours vs. 53.8 ± 20.9 hours; P &lt; 0.001) and AST (31.9 ± 11 hours vs. 71.8 ± 20 hours; P &lt; 0.001) were shorter in the intervention arm. Conclusion Compared with standard of care, ACCEL shortens laboratory turn-around-time and improves clinical outcomes. The use of this system has resulted in decreased mean antibiotic DOT, TTOT, and LOS. Further studies are needed to verify these findings. Disclosures All authors: No reported disclosures.

scholarly journals Biologically effective dose correlates with linear tumor volume changes after upfront single-fraction stereotactic radiosurgery for vestibular schwannomas

2021 ◽  
Author(s):  
Constantin Tuleasca ◽  
Mohamed Faouzi ◽  
Philippe Maeder ◽  
Raphael Maire ◽  
Jonathan Knisely ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Effective Dose ◽  
Stereotactic Radiosurgery ◽  
Tumor Volume ◽  
Vestibular Schwannomas ◽  
Benign Tumors ◽  
Biologically Effective Dose ◽  
Volume Changes ◽  
Single Fraction

AbstractVestibular schwannomas (VSs) are benign, slow-growing tumors. Management options include observation, surgery, and radiation. In this retrospective trial, we aimed at evaluating whether biologically effective dose (BED) plays a role in tumor volume changes after single-fraction first intention stereotactic radiosurgery (SRS) for VS. We compiled a single-institution experience (n = 159, Lausanne University Hospital, Switzerland). The indication for SRS was decided after multidisciplinary discussion. Only cases with minimum 3 years follow-up were included. The Koos grading, a reliable method for tumor classification was used. Radiosurgery was performed using Gamma Knife (GK) and a uniform marginal prescription dose of 12 Gy. Mean BED was 66.3 Gy (standard deviation 3.8, range 54.1–73.9). The mean follow-up period was 5.1 years (standard deviation 1.7, range 3–9.2). The primary outcome was changes in 3D volumes after SRS as function of BED and of integral dose received by the VS. Random-effect linear regression model showed that tumor volume significantly and linearly decreased over time with higher BED (p < 0.0001). Changes in tumor volume were also significantly associated with age, sex, number of isocenters, gradient index, and Koos grade. However, the effect of BED on tumor volume change was moderated by time after SRS and Koos grade. Lower integral doses received by the VSs were inversely correlated with BED in relationship with tumor volume changes (p < 0.0001). Six (3.4%) patients needed further intervention. For patients having uniformly received the same marginal dose prescription, higher BED linearly and significantly correlated with tumor volume changes after SRS for VSs. BED could represent a potential new treatment paradigm for patients with benign tumors, such as VSs, for attaining a desired radiobiological effect. This could further increase the efficacy and decrease the toxicity of SRS not only in benign tumors but also in other SRS indications.

Three-Dimensional Printing in Cleft Care: A Systematic Review

2021 ◽  
pp. 105566562110131
Author(s):  
Farrukh R. Virani ◽  
Evan C. Chua ◽  
Mary Roz Timbang ◽  
Tsung-yen Hsieh ◽  
Craig W. Senders
Keyword(s):  
Systematic Review ◽  
3D Printing ◽  
Clinical Outcomes ◽  
Outcome Measures ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Secondary Outcome ◽  
Exclusion Criteria ◽  
3 Dimensional ◽  
Dimensional Printing

Objective: To determine the current applications of 3-dimensional (3D) printing in the care of patients with cleft lip and palate. We also reviewed 3D printing limitations, financial analysis, and future implications. Design: Retrospective systematic review. Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used by 3 independent reviewers. Articles were identified from Cochrane library, Ovid Medline, and Embase. Search terms included 3D printing, 3 dimensional printing, additive manufacturing, rapid prototyping, cleft lip, and cleft palate. Exclusion criteria included articles not in English, animal studies, reviews without original data, oral presentations, abstracts, opinion pieces, and articles without relevance to 3D printing or cleft lip and palate. Main Outcome Measures: Primary outcome measure was the purpose of 3D printing in the care of patients with cleft lip and palate. Secondary outcome measures were cost analysis and clinical outcomes. Results: Eight-four articles were identified, and 39 met inclusion/exclusion criteria. Eleven studies used 3D printing models for nasoalveolar molding. Patient-specific implants were developed via 3D printing in 6 articles. Surgical planning was conducted via 3D printing in 8 studies. Eight articles utilized 3D printing for anatomic models/educational purposes. 3-Dimensional printed models were used for surgical simulation/training in 6 articles. Bioprinting was utilized in 4 studies. Secondary outcome of cost was addressed in 8 articles. Conclusion: 3-Dimensional printing for the care of patients with cleft lip and palate has several applications. Potential advantages of utilizing this technology are demonstrated; however, literature is largely descriptive in nature with few clinical outcome measures. Future direction should be aimed at standardized reporting to include clinical outcomes, cost, material, printing method, and results.

scholarly journals Clinical Outcome of Mid-Length Proximal Femoral Nail for Patients With Trochanteric Hip Fractures: Preliminary Investigation in a Japanese Cohort of Patients More Than 70 Years Old

2020 ◽  
Vol 11 ◽  
pp. 215145932093644
Author(s):  
Tomohiro Matsumura ◽  
Tsuneari Takahashi ◽  
Mitsuharu Nakashima ◽  
Yoshiya Nibe ◽  
Katsushi Takeshita
Keyword(s):  
Blood Loss ◽  
Internal Fixation ◽  
Clinical Outcomes ◽  
Hip Fractures ◽  
Preliminary Investigation ◽  
Japanese Patients ◽  
Proximal Femoral Nail ◽  
Surgical Time ◽  
Japanese Cohort ◽  
Femoral Nail

Introduction: The TFN-ADVANCED Proximal Femoral Nailing System (TFNA) 235 mm (DePuySynthes) and Proximal Femoral Nail Antirotation (PFNA)-II 240 mm (DePuySynthes) were developed to obtain better stability for patients with trochanteric hip fractures without increasing surgical time and amount of blood loss. However, there are currently no studies concerning clinical and radiological outcomes of patients treated using these proximal femoral nails (PFNs) that have been performed in the Japanese population. The aim of this study was to retrospectively evaluate the clinical outcomes associated with 235 to 240 mm PFNs for Japanese patients >70 years old with trochanteric hip fractures who could walk independently before the injury. Materials and Methods: This study involved a retrospective analysis of data on trochanteric hip fracture patients who had undergone internal fixation from March 2016 to June 2018. The inclusion criteria were patients >70 years old with trochanteric hip fractures who could walk independently before the injury and were followed up for ≥3 months after surgery. Initially, 124 patients were identified, but 33 of these were excluded because other implants were used for internal fixation. Of the remaining 91 patients in whom PFNs were used at the time of internal fixation who were included for the perioperative evaluation, 66 patients followed up for ≥3 months were included in the clinical evaluations. Results: The average surgical time was 56.8 ± 19.6 minutes (range, 23-123 minutes). The average blood loss was 89 ± 41 mL (range, 0-245 mL). The union rate was 98%. Discussion: There were no cases of nail jamming, and all nails were successfully inserted below the end of the distal isthmus without additional reaming to dilate the canal. Conclusions: Proximal femoral nails were a useful implant in Japanese elderly patients with trochanteric hip fractures and gave comparable clinical outcomes despite the femoral length being short and occurrence of intensive bowing.

scholarly journals Patient-Reported Outcome Measures and Clinical Outcomes in Children with Foregut Anomalies

Children ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 587
Author(s):  
Isabel I. Sreeram ◽  
Chantal A. ten Kate ◽  
Joost van Rosmalen ◽  
Johannes M. Schnater ◽  
Saskia J. Gischler ◽  
...  
Keyword(s):  
Linear Regression ◽  
Clinical Outcomes ◽  
Outcome Measures ◽  
Clinical Decision Making ◽  
Linear Regression Analysis ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Added Value ◽  
Patient Reported

Increasing numbers of children and adults with chronic disease status highlight the need for a value-based healthcare system. Patient-reported outcome measures (PROMs) are essential to value-based healthcare, yet it remains unclear how they relate to clinical outcomes such as health and daily functioning. We aimed to assess the added value of self-reported PROMs for health status (HS) and quality of life (QoL) in the long-term follow-up of children with foregut anomalies. We evaluated data of PROMs for HS and/or QoL among eight-year-olds born with congenital diaphragmatic hernia (CDH), esophageal atresia (EA), or congenital lung malformations (CLM), collected within the infrastructure of a multidisciplinary, longitudinal follow-up program. Clinical outcomes were categorized into different outcome domains, and their relationships with self-reported HS and QoL were assessed through multivariable linear regression analyses. A total of 220 children completed HS and/or QoL self-reports. In children with CDH and EA, lower cognition was significantly associated with lower self-reported HS. Due to the low number of cases, multivariable linear regression analysis was not possible in children with CLM. HS, QoL, and clinical outcomes represent different aspects of a child’s wellbeing and should be measured simultaneously to facilitate a more holistic approach to clinical decision making.

scholarly journals Suprapectoral vs. Intra Articular Biceps Tenodesis: A Comparison of Clinical Outcomes

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0010
Author(s):  
Brian M. Godshaw ◽  
Nicholas Kolodychuk ◽  
Benjamin Bryan Browning ◽  
Gerard Williams ◽  
Rachel Burdette ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Outcome Measures ◽  
Glenohumeral Joint ◽  
Short Form ◽  
Biceps Tendon ◽  
Biceps Tenodesis ◽  
Measured Time ◽  
Long Head ◽  
Distally Based

Objectives: The long head of the biceps tendon is a frequent pain generator within the shoulder. It is subjected to trauma and wear within the glenohumeral joint and within the intertubercular groove. Tenodesis of this tendon is a common treatment option for patients experiencing biceps tendon related pain. There are several different techniques to perform this procedure. Proximal intra-articular tenodesis can be performed but leaves the tendon within the intertubercular groove. Alternatively, suprapectoral tenodesis can be performed removing the tendon from the bicipital groove and sheath while avoiding conversion to an open procedure. Further, suprapectoral tenodesis limits complications associated with an open distally based incision. Several studies have compared these techniques to tenotomy or open-subpectoral tenodesis. This is the first study to directly compare patient outcomes between intra-articular and suprapectoral bicep tenodeses. Methods: Retrospective review of patients undergoing intra-articular or suprapectoral arthroscopic biceps tenodesis from 2010 - 2015. Clinical outcomes were measured at set intervals post-operatively (3 months, 6 months, and 12 months) and compared to pre-operative scores. Outcome measures included short form-12, both physical (PSF) and mental (MSF) component scores, and the American Shoulder and Elbow Surgeons score (ASES). Results: A total of 96 patients were available for this study, 43 had intra-articular tenodesis and 56 had suprapectoral tenodesis. There was no difference in functional outcomes between intra and extra articular biceps tenodesis at 1-year post-operative. The intra-articular group had a quicker improvement in scores with the greatest increase at 3 months post-operatively, specifically in PSF group (p=0.016): however, this difference leveled off at 1-year follow up (p=0.238). The intra-articular group had greater absolute scores at all measured time points, but not significantly. Both groups showed improvement in all outcome measures and there was found to be no difference in changes for ASES, PSF, or MSF (p=0.262, p=0.489, and p=0.907 respectively). Conclusion: This study demonstrates that both intra-articular and surpapectoral techniques are acceptable options for biceps tenodesis. Despite leaving the biceps tendon within the glenohumeral joint and intertubercular groove, the intra-articular technique offers similar improvement in outcome measures to the suprapectoral technique.

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