scholarly journals Sigmoid Sinus Patency following Vestibular Schwannoma Resection via Retrosigmoid versus Translabyrinthine Approach

2020 ◽  
Author(s):  
Andrea Ziegler ◽  
Nadeem El-Kouri ◽  
Zaneta Dymon ◽  
David Serrano ◽  
Mariah Bashir ◽  
...  
Keyword(s):  
Acoustic Neuroma ◽  
Treatment Options ◽  
Middle Cranial Fossa ◽  
Sigmoid Sinus ◽  
Surgical Approaches ◽  
Stereotactic Radiation ◽  
Acoustic Neuromas ◽  
Significant Difference ◽  
Sinus Stenosis ◽  
Dural Venous Sinus

Abstract Introduction The treatment options for acoustic neuromas are observation with serial imaging, stereotactic radiation, or surgical resection. The most common surgical approaches are the translabyrinthine (TL), the retrosigmoid (RS), and the middle cranial fossa. During the TL approach the sigmoid sinus is decompressed with bipolar cautery to allow greater medial exposure. It is unknown if this causes any long-term narrowing or thrombus of the sigmoid sinus. Methods We performed a retrospective review of patients who underwent acoustic neuroma resection to determine if patients undergoing a TL approach for acoustic neuroma resection develop radiographic evidence of sigmoid sinus stenosis or thrombosis compared with patients undergoing a RS approach. Results A total of 128 patients were included in this study, 56 patients underwent a TL approach and 72 patients underwent a RS approach. We compared the preoperative and postoperative diameter of the ipsilateral and contralateral sigmoid sinus at proximal, midpoint, and distal locations on magnetic resonance imaging examinations. There was no significant difference between the preoperative and postoperative diameter of the ipsilateral or contralateral sigmoid sinus based on surgical approach. Conclusion Decompression of the sigmoid sinus during the TL approach does not have a significant postoperative effect on the dural venous sinus patency.

scholarly journals Middle Cranial Fossa Encephalocele and Cerebrospinal Fluid Leakage: Etiology, Approach, Outcomes

2019 ◽  
Vol 81 (03) ◽  
pp. 268-274
Author(s):  
Beth McNulty ◽  
Christopher A. Schutt ◽  
Dennis Bojrab ◽  
Seilesh Babu
Keyword(s):  
Cerebrospinal Fluid ◽  
Middle Cranial Fossa ◽  
Csf Leak ◽  
Surgical Approaches ◽  
Cerebrospinal Fluid Leakage ◽  
Combined Approach ◽  
Common Location ◽  
Significant Difference ◽  
Cranial Fossa ◽  
Transmastoid Approach

Objective To compare outcome data for surgical approaches in the management of a middle cranial fossa encephalocele or cerebrospinal fluid (CSF) leak and, secondarily, to evaluate the role of obesity and the etiology of the defect. Design Retrospective Setting Quaternary referral center Participants The study included 73 patients who underwent surgical repair of middle cranial fossa tegmen defects, two of which underwent bilateral repair. Outcome Measures Demographic characteristics, clinical presentation, etiology, imaging, audiometry, surgical findings, method and material for repair, and postoperative course. Results Fifty cases were spontaneous in origin, 2 were iatrogenic, and 23 were because of chronic otitis media. Of the 50, 18 underwent middle fossa craniotomy, 29 underwent a transmastoid approach, and 28 underwent a combined approach for repair. A postoperative CSF leak was seen in five patients: one who had undergone a transmastoid approach and four after a combined approach. There was no significant difference between the three approaches and risk of postoperative CSF fistulae. Two of the CSF fistulae resolved after a lumbar drain, and the remaining three patients required revision surgery. Conclusions Middle cranial fossa tegmen defects are most commonly seen in obese females and are spontaneous in origin. The most common location was the tegmen mastoideum, and these defects were most commonly repaired through the transmastoid approach, with no greater risk of recurrence.

scholarly journals Middle cranial fossa approach for acoustic neuroma

2021 ◽  
Vol 5 (2) ◽  
pp. V12
Author(s):  
Paul W. Gidley ◽  
Joel Z. Passer ◽  
Joshua C. Page ◽  
Franco DeMonte
Keyword(s):  
Acoustic Neuroma ◽  
Hearing Preservation ◽  
Middle Cranial Fossa ◽  
Middle Fossa ◽  
Surgical Indications ◽  
Total Resection ◽  
Technical Aspects ◽  
Middle Fossa Approach ◽  
Acoustic Neuromas ◽  
Cranial Fossa

The middle fossa approach for the resection of small acoustic neuromas is a viable, but underutilized treatment modality with the goal of hearing preservation. The authors aim to demonstrate this approach and its nuances through this video presentation. A 38-year-old man presented with an incidentally discovered small, intracanalicular acoustic neuroma that was initially observed, but growth was noted. The patient had good hearing, and therefore a hearing preservation approach was offered. A gross-total resection was achieved, and the patient maintained good hearing postoperatively. This video demonstrates relevant anatomy, surgical indications, technical aspects of resection, including reconstruction, and postoperative outcomes. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID21124

scholarly journals Contralateral approach to transverse-sigmoid sinus stenting

2020 ◽  
Vol 26 (5) ◽  
pp. 658-663
Author(s):  
Weston Gordon ◽  
Michael Abraham
Keyword(s):  
Case Series ◽  
Transverse Sinus ◽  
Sigmoid Sinus ◽  
Dural Sinus ◽  
Presenting Symptoms ◽  
Antegrade Approach ◽  
Alternative Approach ◽  
Mean Pressure ◽  
Sinus Stenosis ◽  
Dural Venous Sinus

Introduction Endovascular dural venous sinus stenting (DVSS) has emerged as a safe and effective therapy for idiopathic intracranial hypertension (IIH) in patients with transverse-sinus stenosis associated with an elevated mean pressure gradient (MPG). The typical antegrade approach, jugular to sigmoid to transverse, is not always technically feasible due to the degree of stenosis and other anatomic factors. To this point, there has been no reported cases of contralateral DVSS. We describe four cases of DVSS from a contralateral transverse-sigmoid sinus approach. Methods We describe 4 patients presenting with symptoms of IIH between 2019 and 2020 who we treated with contralateral transverse-sigmoid sinus stenting. Cases were reviewed for clinical data including initial presenting symptoms, devices used, other attempted IIH treatments, and follow up symptoms. Results Four female patients were identified and treated under general endotracheal anesthesia. Stenoses measured 72%, 78%, 67%, and 70% with MPGs across the transverse-sigmoid sinus of 19, 16, 9 and 13 mmHg, respectively. Post-stenting MPGs were 1, 0, 1 and 1 mmHg, respectively. Three patients had complete resolution of symptoms and 1 had partial resolution. No complications occurred. Conclusions This case series demonstrates successful transverse-sigmoid sinus stenting from the contralateral dural sinus and provides an alternative approach to DVSS in patients with IIH.

The robotic era of radical prostatectomy: A retrospective analysis of patient characteristics in contemporary robotic and open prostatectomy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16061-e16061
Author(s):  
A. Murphy ◽  
L. Barlow ◽  
M. Mann ◽  
K. Badani ◽  
M. Benson ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Patient Selection ◽  
Statistical Significance ◽  
Treatment Options ◽  
Specific Antigen ◽  
Patient Characteristics ◽  
Tumor Stage ◽  
Surgical Approaches ◽  
Significant Difference ◽  
Selection Factors

e16061 Background: As new treatment options become available without being tested in randomized controlled trials, trends in the patient populations receiving these novel therapies often emerge prior to the determination of ideal patient selection factors. In the case of robotic-assisted laparoscopic radical prostatectomy (RALRP), biases in patient selection for this relatively new procedure may influence the evaluation of postoperative outcomes in comparison to open retropubic radical prostatectomy (RRP). This study describes the disease-specific characteristics of patients currently undergoing RALRP and RRP in a contemporary fashion at a single institution. Methods: A total of 1,088 patients who had surgery since the inception of RALRP at our institution (2003–2007) were identified for analysis. The cohort was divided into two groups based on surgical technique (RALRP versus open RRP). Characteristics of the patient pool analyzed included age at surgery, Kattan Nomogram (KN) score, preoperative prostate-specific antigen (PSA), Gleason sum (GS) at biopsy, and pathological tumor stage. Unpaired t-tests with Welch correction and Mann-Whitney tests were used to determine the differences in patient characteristics between the two surgical approaches. Results: The median age was 61. The mean preoperative PSA was 6.2, and GS 2–6, 7, and 8–10 of 48.2%, 40.4%, and 11.4%, respectively. 519 and 569 patients underwent RALRP and RRP, respectively. There was a significant difference between GS (p<0.0001) and tumor stage (p=0.002) between patients undergoing the two approaches. There were trends in favor of younger age, decreased preoperative PSA, and better KN scores in the RALRP group, but these observations lacked statistical significance (age: p=0.06, PSA: p= 0.07, KN: p=0.15). Conclusions: Although there is insufficient evidence to declare an overall difference in patient characteristics between these two surgical approaches in our patient population, trends toward lower-risk patients in the RALRP group suggest a series of patient selection forces for this procedure. These observations have the potential to influence the results obtained in retrospective analyses comparing outcomes between RALRP and open RRP. No significant financial relationships to disclose.

Long-term survival of the nasal NK/T cell lymphoma

2008 ◽  
Vol 149 (17) ◽  
pp. 801-805
Author(s):  
Péter Rajnics ◽  
László Krenács ◽  
András Kenéz ◽  
Zoltán Járay ◽  
Enikő Bagdi ◽  
...  
Keyword(s):  
T Cell ◽  
Treatment Guidelines ◽  
Cell Lymphoma ◽  
Treatment Options ◽  
Diagnostic Procedures ◽  
T Cell Lymphoma ◽  
Term Survival ◽  
Barr Virus ◽  
Significant Difference ◽  
Nk T Cell

The nasal NK/T cell lymphoma is a rare, extranodal non-Hodgkin lymphoma in western civilizations, which has poor prognosis. The Epstein–Barr virus can be detected in tumor cells in nearly all cases. There are no definite treatment guidelines in our days. There is no significant difference in survival between radiotherapy and chemotherapy according to Asian studies. In this case study we show our diagnostic procedures, our treatment options and we present the summary of this illness based on the data found in the literature.

Efficiency of diffusion-weighted MRI for differentiating radiologically similar simple and type I hydatid cysts of the liver

2021 ◽  
pp. 028418512098813
Author(s):  
Ilyas Dundar ◽  
Mesut Ozgokce ◽  
Fatma Durmaz ◽  
Sercan Ozkacmaz ◽  
Saim Turkoglu ◽  
...  
Keyword(s):  
Treatment Options ◽  
Type I ◽  
Hydatid Cysts ◽  
Liver Cysts ◽  
Diffusion Weighted ◽  
Significant Difference ◽  
Mean Diameter ◽  
Apparent Diffusion ◽  
Adc Values ◽  
Hepatic Lesions

Background Determining the nature of purely cystic hepatic lesions is essential because different kinds have different follow-ups, treatment options, and complications. Purpose To explore the potential of apparent diffusion coefficient (ADC) values of diffusion-weighted imaging (DWI) for the differentiation of type I hydatid cysts (HC) and simple liver cysts (SLC), which have similar radiological appearances. Material and Methods This single-center prospective study was conducted during 2016–2019. Round, homogenous, anechoic liver cysts >1 cm were classified according to at least two years of imaging follow-up, radiological features, serology, as well as puncture aspiration injection reaspiration procedure and pathology results. ADC values of 95 cysts (50 type I HCs and 45 SLCs) were calculated on DWI. The differences in ADC values were analyzed by independent t-test. Results Of 51 patients, 28 were female, 23 were male (mean age 32.07 ± 22.95 years; age range 5–82 years). Mean diameter of 45 SLCs was 2.59 ± 1.23 cm (range 1.2–7.6 cm) and ADCmean value was 3.03 ± 0.47 (range 2.64–5.85) while mean diameter of 50 type I HCs was 7.49 ± 2.95 cm (range 2.8–14 cm) and ADCmean value was 2.99 ± 0.29 (range 2.36–3.83). There was no statistically significant difference in ADC values between type I HCs and SLCs Conclusion Some studies report that ADC values of type I HCs are statistically significantly lower than those of SLCs. Others suggest no significant difference. In our study with a higher number of cases, using ADC parameters similar to those in previous studies, we did not find any statistically significant difference.

scholarly journals The Investigation and Management of Adenomyosis in Women Who Wish to Improve or Preserve Fertility

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Jin-Jiao Li ◽  
Jacqueline P. W. Chung ◽  
Sha Wang ◽  
Tin-Chiu Li ◽  
Hua Duan
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Treatment Options ◽  
Management Strategies ◽  
Definitive Treatment ◽  
Surgical Approaches ◽  
Child Bearing ◽  
Fertility Sparing

The management of adenomyosis remains a great challenge to practicing gynaecologists. Until recently, hysterectomy has been the only definitive treatment in women who have completed child bearing. A number of nonsurgical and minimally invasive, fertility-sparing surgical treatment options have recently been developed. This review focuses on three aspects of management, namely, (1) newly introduced nonsurgical treatments; (2) management strategies of reproductive failures associated with adenomyosis; and (3) surgical approaches to the management of cystic adenomyoma.

Acoustic Neuromas and the Acoustic Impedance of the Ear

1973 ◽  
Vol 38 (3) ◽  
pp. 345-353 ◽  
Author(s):  
J. H. Macrae
Keyword(s):  
Tympanic Membrane ◽  
Acoustic Neuroma ◽  
Acoustic Impedance ◽  
Theoretical Calculations ◽  
Low Frequencies ◽  
Cochlear Duct ◽  
Acoustic Neuromas ◽  
Affected Side ◽  
Contralateral Ear ◽  
Conductive System

The acoustic impedance at the tympanic membrane was measured at frequencies in the range 100–1000 Hz and found to be abnormal on the affected side in four patients with acoustic neuroma. In all four the resistance was abnormally high at low frequencies on the affected side, and in three the reactance of the affected ear was raised relative to that of the contralateral ear, particularly at low frequencies. The abnormality is attributed to an increase in the input acoustic impedance of the cochlea produced by the increase in protein content of the cochlear fluids and dilatation of the cochlear duct known to occur in acoustic neuroma. This explanation is supported by theoretical calculations carried out on an electric analogue of the conductive system, and it is suggested that similar abnormalities in the acoustic impedance at the tympanic membrane might occur in other pathologies which produce abnormal mechanical conditions in the cochlea.

Advances in Surgical Approaches to Dural Fistulas

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S32-S41 ◽  
Author(s):  
Patrick P. Youssef ◽  
Albert Jess Schuette ◽  
C. Michael Cawley ◽  
Daniel L. Barrow
Keyword(s):  
Treatment Options ◽  
Venous Drainage ◽  
Venous Hypertension ◽  
Surgical Approaches ◽  
Dural Sinus ◽  
Intraoperative Angiography ◽  
Indocyanine Green Videoangiography ◽  
Arteriovenous Fistulas ◽  
The Past ◽  
Dural Arteriovenous Fistulas

Abstract Dural arteriovenous fistulas are abnormal connections of dural arteries to dural veins or venous sinuses originating from within the dural leaflets. They are usually located near or within the wall of a dural venous sinus that is frequently obstructed or stenosed. The dural fistula sac is contained within the dural leaflets, and drainage can be via a dural sinus or retrograde through cortical veins (leptomeningeal drainage). Dural arteriovenous fistulas can occur at any dural sinus but are found most frequently at the cavernous or transverse sinus. Leptomeningeal venous drainage can lead to venous hypertension and intracranial hemorrhage. The various treatment options include transarterial and transvenous embolization, stereotactic radiosurgery, and open surgery. Although many of the advances in dural arteriovenous fistula treatment have occurred in the endovascular arena, open microsurgical advances in the past decade have primarily been in the tools available to the surgeon. Improvements in microsurgical and skull base approaches have allowed surgeons to approach and obliterate fistulas with little or no retraction of the brain. Image-guided systems have also allowed better localization and more efficient approaches. A better understanding of the need to simply obliterate the venous drainage at the site of the fistula has eliminated the riskier resections of the past. Finally, the use of intraoperative angiography or indocyanine green videoangiography confirms the complete disconnection of fistula while the patient is still on the operating room table, preventing reoperation for residual fistulas.

Translabyrinthine Approach for Acoustic Neuroma

Neurosurgery ◽  
2004 ◽  
Vol 54 (2) ◽  
pp. 391-396 ◽  
Author(s):  
John Diaz Day ◽  
Douglas A. Chen ◽  
Moises Arriaga
Keyword(s):  
Surgical Treatment ◽  
Acoustic Neuroma ◽  
Cerebellopontine Angle ◽  
Hearing Preservation ◽  
Retrosigmoid Approach ◽  
The Past ◽  
Translabyrinthine Approach ◽  
Acoustic Neuromas

Abstract THE TRANSLABYRINTHINE APPROACH has been popularized during the past 30 years for the surgical treatment of acoustic neuromas. It serves as an alternative to the retrosigmoid approach in patients when hearing preservation is not a primary consideration. Patients with a tumor of any size may be treated by the translabyrinthine approach. The corridor of access to the cerebellopontine angle is shifted anteriorly in contrast to the retrosigmoid approach, resulting in minimized retraction of the cerebellum. Successful use of the approach relies on a number of technical nuances that are outlined in this article.

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