scholarly journals Endovascular Super-Selective Intra-Arterial Chemotherapy for Retinoblastoma: Systematic Review and Institutional Experience

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Simon Menaker ◽  
Samir Sur ◽  
Anil Mahavadi ◽  
Stephanie H Chen ◽  
Eric C Peterson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Modality ◽  
Tumor Staging ◽  
Neurological Complication ◽  
Tumor Grade ◽  
Complication Rates ◽  
Transient Phenomena ◽  
Pertinent Data ◽  
Institutional Experience ◽  
Salvage Rate

Abstract INTRODUCTION Selective intra-arterial delivery of chemotherapy (IAC) via microcatheter infusion into the ophthalmic artery has become an increasingly popular treatment modality to accomplish globe salvage in children with retinoblastoma. While previously limited to highly specialized centers, interest in and popularity of this treatment are growing. Here, we provide a comprehensive review of available data in addition to our own experience. METHODS Systematic literature review was conducted using PRISMA guidelines and 22 studies were identified that met inclusion criteria. In our own series, consecutive patients undergoing IAC for retinoblastoma were identified between January 2009 and December 2016. Pertinent data, including tumor grade, enucleation vs globe salvage, and both ocular and systemic adverse events were recorded. RESULTS In all1593 total eyes were treated as reported in 22 studies published between 2011 and 2019. Among those in which tumor staging data was available, 396 (27.6%) were less advanced (Reese–Ellsworth A-C, or International Classification I-III) and 997 (69.4%) were more advanced (D-E, IV-V). A total of 21 studies included data on systemic and/or ocular complications, which with few exceptions were transient and resulted in no permanent morbidity. A single permanent neurological complication occurred. Analysis of our institutional experience demonstrated a globe salvage rate of 73% (identical to pooled data from the literature). In 442 procedures, our ocular and systemic complication rates were 10.6% and 13.8%, respectively; virtually all were transient phenomena including orbital edema, myelosuppression, and and brief intraprocedural bronchospasm/bradycardia during drug delivery. CONCLUSION Although reported predominantly in retrospective series, a systematic review of outcomes in selective IAC for retinoblastoma demonstrates efficacy (73% globe salvage rate) with minimal morbidity, even in advanced disease. Our own results reflect a similar experience and taken together, provide strong evidence that this treatment modality is safe and effective. The data support adoption of this technique as first-line therapy for globe salvage in selected cases of retinoblastoma.

Morbidity of Transcallosal and Transcortical Approaches to Lesions in and Around the Lateral and Third Ventricles: A Single-Institution Experience

Neurosurgery ◽  
2010 ◽  
Vol 67 (6) ◽  
pp. 1483-1496 ◽  
Author(s):  
Brian D Milligan ◽  
Fredric B Meyer
Keyword(s):  
Neurological Complication ◽  
Major Complication ◽  
Tumor Grade ◽  
Karnofsky Performance Score ◽  
Complication Rates ◽  
Performance Score ◽  
Transcallosal Approach ◽  
Excellent Outcome ◽  
Increased Risk ◽  
Postoperative Seizure

Abstract BACKGROUND: Resection of an intraventricular mass can result in life-altering complications. Many advocate transcallosal rather than transcortical approaches to these lesions, citing differential postoperative seizure risk. OBJECTIVE: To test the hypothesis that the complication rates and patient outcomes are no different between these ventricular approaches. METHODS: The medical records of 127 patients (93 adults and 34 children) operated on for intraventricular lesions between 1996 and 2007 were retrospectively analyzed. Risk factors for specific postoperative complications and outcome were assessed by multivariate analysis. RESULTS: The transcallosal (59%) or transcortical (41%) approach was used. Gross or nearly total resection was achieved in 87% of cases. The permanent neurological complication rate determined by a staff neurologist was 23.6%. Seizure attributable to surgery occurred after 8% of transcortical and 25% of transcallosal operations (P = .01). After controlling for a variety of factors, the transcallosal approach carried a 4.4-fold increased risk of seizure (95% confidence interval, 1.3-18.9). The operative approach was not a risk factor for any other postoperative complication. One year after surgery, 72% of patients had excellent functional outcome (Karnofsky Performance Score ≥ 70 and Glasgow Outcome Score = 5). High tumor grade and impaired preoperative Karnofsky Performance Score predicted poor outcome. More than 90% of patients operated on for symptomatic colloid cysts (n = 34) had an excellent outcome. CONCLUSION: Although the 2 traditional approaches to the ventricular system had similar major complication rates, the transcallosal approach was associated with significantly increased seizure risk. Accordingly, the chosen operative corridor should optimize tumor access and the protection of vulnerable neurovascular structures.

scholarly journals The Utility of Virtual Reality Simulation in Cataract Surgery Training: A Systematic Review

2020 ◽  
Vol 12 (02) ◽  
pp. e221-e233
Author(s):  
James P. Winebrake ◽  
Jeffrey F. McMahon ◽  
Grace Sun
Keyword(s):  
Systematic Review ◽  
Virtual Reality ◽  
Cataract Surgery ◽  
Laboratory Simulation ◽  
Complication Rates ◽  
Virtual Reality Simulation ◽  
Surgery Training ◽  
Pertinent Data ◽  
Simulation Based ◽  
The Impact

Abstract Introduction Cataract surgery is a fundamental intraocular procedure with a steep learning curve. Virtual reality simulation offers opportunity to streamline this aspect of ophthalmic education by exposing trainees to operative techniques in a controlled setting. Materials and Methods A systematic review of the PubMed database was conducted through December 2019 for English language studies reporting on use of virtual reality simulation in cataract surgery training to assess usefulness. Studies meeting inclusion criteria were examined for pertinent data: study design, number of subjects and live cases, simulator model, training regimen, surgical skills assessed, and overall outcomes. Results Of the 41 analyzed studies, 15 investigated the impact of virtual reality simulation-based training on performance in live surgery or wet laboratories; 20 used simulation as a device for direct assessment of operative proficiency; 6 explored simulation-based training's effect on performance in simulated surgery. Thirty-seven studies employed an iteration of the Eyesi simulator, though methodologies varied widely with a few randomized trials available. The literature endorsed validity of simulator-based assessment and benefits of structured training on live complication rates, operative times, and self- and faculty-perceived competency, particularly in novice surgeons. Discussion The literature surrounding simulation in cataract surgery training is characterized by significant heterogeneity in design. However, most works describe advantages that may outweigh the costs of implementation into training curricula. Collaborative efforts at establishing a structured, proficiency-based cataract surgery curriculum built around virtual reality and wet laboratory simulation have the potential to improve outcomes and enhance future surgical training.

scholarly journals Complications of Outpatient and Inpatient Renal Biopsy: A Systematic Review and Meta-Analysis

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 651
Author(s):  
Shih-Yi Lin ◽  
Cherry Yin-Yi Chang ◽  
Cheng-Chieh Lin ◽  
Wu-Huei Hsu ◽  
I.-Wen Liu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Biopsy ◽  
Meta Analysis ◽  
Random Effect ◽  
Bleeding Risk ◽  
Complication Rates ◽  
Bleeding Events ◽  
Cochrane Database ◽  
Renal Biopsies ◽  
Inpatient Settings

Background: The evidence indicates that the optimal observation period following renal biopsy ranges between 6 and 8 h. This systematic review and meta-analysis explored whether differences exist in the complication rates of renal biopsies performed in outpatient and inpatient settings. Methods: We searched the MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from 1985 to February 2020. Two reviewers independently selected studies evaluating the bleeding risk from renal biopsies performed in outpatient and inpatient settings and reviewed their full texts. The primary and secondary outcomes were risks of bleeding and major events (including mortality) following the procedure, respectively. Subgroup analysis was conducted according to the original study design (i.e., prospective or retrospective). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random effect meta-analysis. Heterogeneity was assessed using the I2 test. Results: Data from all 10 eligible studies, which included a total of 1801 patients and 203 bleeding events, were included for analysis. Renal biopsies in outpatient settings were not associated with a higher bleeding risk than those in inpatient settings (OR = 0.81; 95% CI, 0.59–1.11; I2 = 0%). The risk of major events was also comparable across both groups (OR = 0.45; 95% CI, 0.16–1.29; I2 = 4%). Conclusions: Similar rates of bleeding and major events following renal biopsy in outpatient and inpatient settings were observed.

Free Flap Reconstruction of the Anterior Skull Base: A Systematic Review

2021 ◽  
Author(s):  
Rajan P. Dang ◽  
Abhinav R. Ettyreddy ◽  
Zain Rizvi ◽  
Michelle Doering ◽  
Angela L. Mazul ◽  
...  
Keyword(s):  
Systematic Review ◽  
Skull Base ◽  
Free Flap ◽  
High Reliability ◽  
Anterior Skull Base ◽  
Microvascular Reconstruction ◽  
Complication Rates ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Comprehensive Search

Abstract Objectives Given the limitations in the available literature, the precise indications, techniques, and outcomes of anterior skull base free flap reconstruction remain uncertain. The objective of this study was to perform a systematic review of published literature and evaluate indications, methods, and complications for anterior skull base free flap reconstruction. Methods A systematic review of the literature was performed using a set of search criteria to identify patients who underwent free flap reconstruction of the anterior skull base. Articles were reviewed for inclusion based on relevance, with the primary outcome being surgical complications. Results After a comprehensive search, 406 articles were obtained and 16 articles were ultimately found to be relevant to this review—79 patients undergoing free flap reconstruction were identified. Overall complication rates were 17.7% (95% confidence interval [CI]: 16.6–33.1%) for major complications and 19.0% (95% CI: 17.8–35.5%) for minor complications. Conclusion Microvascular reconstruction of the anterior skull base is feasible with high reliability reported in the literature.

Systematic Review Comparing Open versus Endoscopic Surgery in Clival Chordomas and a 10-Year Single-Center Experience

2021 ◽  
Author(s):  
Ravindran Visagan ◽  
Asfand Baig Mirza ◽  
Mohamed Okasha ◽  
Timothy Martyn Boardman ◽  
Eleni Maratos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Management ◽  
Open Surgery ◽  
Literature Search ◽  
Optimal Management ◽  
Total Resection ◽  
Single Center Experience ◽  
Institutional Experience ◽  
Open Versus ◽  
Slow Growing

Abstract Objectives Chordomas are rare, slow-growing, and osteo-destructive tumors of the primitive notochord. There is still contention in the literature as to the optimal management of chordoma. We conducted a systematic review of the surgical management of chordoma along with our 10-year institutional experience. Design A systematic search of the literature was performed in October 2020 by using MEDLINE and EMBASE for articles relating to the surgical management of clival chordomas. We also searched for all adult patients surgically treated for primary clival chordomas at our institute between 2009 and 2019. Participants Only articles describing chordomas arising from the clivus were included in the analysis. For our institution experience, only adult primary clival chordoma cases were included. Main Outcome Measures Patients were divided into endoscopic or open surgery. Rate of gross total resection (GTR), recurrence, and complications were measured. Results Our literature search yielded 24 articles to include in the study. Mean GTR rate among endoscopic cases was 51.9% versus 41.7% for open surgery. Among the eight cases in our institutional experience, we found similar GTR rates between endoscopic and open surgery. Conclusion Although there is clear evidence in the literature that endoscopic approaches provide better rates of GTR with fewer overall complications compared to open surgery. However, there are still situations where endoscopy is not viable, and thus, open surgery should still be considered if required.

Flow redirection endoluminal device (FRED) for treatment of intracranial aneurysms: A systematic review

2021 ◽  
pp. 159101992110279
Author(s):  
Muhammad Waqas ◽  
Rimal H Dossani ◽  
Modhi Alkhaldi ◽  
Jocelyn Neveu ◽  
Justin M Cappuzzo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Complication Rates ◽  
Mesh Terms ◽  
Aneurysm Occlusion ◽  
Occlusion Rate ◽  
Layered Flow ◽  
Comparative Safety

Introduction The Flow Redirection Endoluminal Device (FRED; MicroVention) is a dual-layered flow diverter used for the treatment of intracranial aneurysms. The objective of this systematic review was to compile device-related safety and effectiveness data. Methods The literature from January 1, 2013 to April 30, 2021 was searched for studies describing use of the FRED for intracranial aneurysm treatment irrespective of aneurysm location and morphology. The review included anterior and posterior circulation ruptured and unruptured saccular, fusiform or dissection, and blister aneurysms. MeSH terms related to “flow re-direction endoluminal device” and “FRED for aneurysms” were used. Data related to indication, complications, and rates of aneurysm occlusion were retrieved and analyzed. Results Twenty-two studies with 1729 intracranial aneurysms were included in this review. Overall reported morbidity was 3.9% (range 0–20%). Overall procedure-related mortality was 1.4% (range 0–6%). Complication rates fell into 5 categories: technical (3.6%), ischemic (3.8%), thrombotic or stenotic (6%), hemorrhagic (1.5%), and non-neurological (0.8%). The aneurysm occlusion rate between 0 and 3 months (reported in 11 studies) was 47.8%. The occlusion rate between 4 and 6 months (reported in 14 studies) was 73.8%. Occlusion rates continued to increase to 75.1% at 7–12 months (reported in 10 studies) and 86.6% for follow-up beyond 1 year (reported in 10 studies). Conclusion This review indicated that the FRED is a safe and effective for the treatment of intracranial aneurysms. Future studies should directly compare the FRED with other flow diverters for a better understanding of comparative safety and effectiveness among the different devices.

EVAR in Patients With Abdominal Aortic Aneurysm and Horseshoe Kidney: A Systematic Review

2021 ◽  
pp. 152660282110594
Author(s):  
Mauricio Gonzalez-Urquijo ◽  
Diana Paola Padilla-Armendariz ◽  
David Eugenio Hinojosa-Gonzalez ◽  
Gerardo Lozano-Balderas ◽  
Eduardo Flores-Villalba ◽  
...  
Keyword(s):  
Systematic Review ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Operative Time ◽  
Endovascular Aneurysm Repair ◽  
Horseshoe Kidney ◽  
Complication Rates ◽  
Abdominal Aortic ◽  
Endovascular Approach ◽  
Aneurysm Repair

Purpose: A systematic review of all patients that have been reported in the literature with abdominal aortic aneurysm (AAA) concomitant with horseshoe kidney (HSK) treated electively by endovascular aneurysm repair (EVAR) is presented. A new grouping system for describing HSK vasculature is implemented. Materials and Methods: We searched for published manuscripts using the Medical Subject Headings terms “abdominal aortic aneurysm,” “AAA,” “EVAR,” “endovascular aneurysm repair,” and “horseshoe kidney” in PubMed, Google Scholar, Scopus, and National Center for Biotechnology Information databases. Inclusion criteria include all published material of patients with AAA with HSK treated electively by an endovascular approach. We excluded patients who were treated by a hybrid or open repair or patients with ruptured AAA. Statistical analysis was carried out using SPSS Statistics version 25 (IBM Corp, Armonk, New York) software. Results: A total of 50 patients from 30 studies were included for analysis. Males made up 88% (n=44) of the population. The median age for this cohort was 70 years (range: 47–86 years). Median aneurysmal diameter was 6.0 cm (range: 4.0–10.3 cm). The median operative time for endovascular repair was 84 minutes (range: 40–332 minutes). The most common graft used was Zenith, used in 40% (n=20) of the cases, followed by Endurant in 14% (n=7). The overall complication rate was 14% (n=7). The median follow-up was 19 months (range: 1–108 months). While comorbidities did not appear to impact outcomes significantly, median operative times for smokers were higher than those in nonsmokers, 84 versus 118 minutes, respectively (p=0.048). Univariate linear regression modeling of aneurysmal size with age, operative time, and length of stay revealed a significant coefficient association between aneurysmal size and operative times. After adjusting for comorbidities and aneurysmal size, prior history of chronic kidney disease significantly increased odds for renal infarction. Conclusion: This review presents the most complete data set possible of patients with concomitant HSK and AAA treated by an endovascular approach. Furthermore, the A + B + C classification for grouping the HSK vasculature is implemented. This systematic review suggests EVAR to be an excellent option with low complication rates for the treatment of AAA in patients with HSK.

scholarly journals ENDOSCOPIC TREATMENT OF POST-LIVER TRANSPLANTATION ANASTOMOTIC BILIARY STRICTURE: systematic review andmeta-analysis

2014 ◽  
Vol 51 (3) ◽  
pp. 240-249 ◽  
Author(s):  
Lucas Souto NACIF ◽  
Wanderley Marques BERNARDO ◽  
Luca BERNARDO ◽  
Wellington ANDRAUS ◽  
Lucas TORRES ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Transplantation ◽  
Endoscopic Treatment ◽  
Clinical Success ◽  
Controlled Trial ◽  
Balloon Dilation ◽  
Plastic Stents ◽  
Metal Stents ◽  
Complication Rates ◽  
Biliary Strictures

Context Biliary strictures after liver transplantation are recognized as its Achilles’ heel. The strictures are classified in anastomotic and ischemic or non-anastomotic biliary strictures, and they figure among the most common complications after liver transplantation. There are some treatment options including balloon dilation, the placement of multiple plastic stents and the placement of self-expandable metal stents and all of them seem to have good results. Objectives The aim of this study was to systematically review the literature concerning the results of the endoscopic treatment of anastomotic biliary strictures after liver transplantation. Methods A systematic review of the literature was performed on the management of anastomotic biliary strictures post- orthotopic liver transplantation. The Medline-PubMed, EMBASE, Scielo-LILACS, and Cochrane Databases were electronically searched from January 1966 to April 2013. Results No well-designed randomized controlled trial was found. Most studies were retrospective or prospective comparisons in design. One study (86 patients) compared the endoscopic and the percutaneous accesses. The sustained clinical success rates were similar but the treatment duration was longer in the percutaneous group access. Two studies (56 patients) compared balloon dilation with balloon dilation and multiple plastic stents. There were no differences concerning sustained clinical success and complication rates. Conclusions Balloon dilation is as effective as balloon dilation plus multiple plastic stenting for the resolution of the anastomotic biliary strictures. Well-designed randomized trials are still needed to compare balloon dilation versus multiple plastic stenting versus metallic stenting.

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