P95 Surgical approach and morbidity of paediatric fourth ventricular tumours: analysis of a large institutional series

ObjectivesTo characterise the surgical management of paediatric 4th ventricular tumours and their attendant neurological complications.DesignRetrospective cohort study.SubjectsChildren referred to our institution with tumours of the 4th ventricle between 2008–2017 inclusive.MethodsClinical notes and imaging review. Two-tailed Fisher’s test used to determine differences between proportions.Results95 patients were seen (53 males, mean 5.81y). The commonest presenting symptom was vomiting (63.3%). The commonest tumour type was medulloblastoma (54 cases)>pilocytic astrocytoma (20)>anaplastic ependymoma (12)>ATRT(4)>Teratoma (2), with 3 miscellaneous lesions. 55 pts presented with hydrocephalus. 27.4% of patients had an EVD (30.8% of these prior to tumour surgery), and 23.3% a VP shunt sited. The surgical approach was either via telovelar (50%) or transvermian (50%) routes; 29.5% were done in the sitting position. In the first 5y of the series, 7/31 cases used the telovelar approach, whilst in the latter 5y, this proportion was 30/51 (p=0.0015). New post-operative deficit was evident in 68% of cases (42.4% gait abnormality, 23.9% cranial neuropathy, 16.3% diplopia). There was no significant difference in the rates of cerebellar mutism syndrome between telovelar or transvermian approaches (p=0.62). There was 1 mortality within 30d of operation.ConclusionsResection of paediatric 4th ventricular tumours is increasingly performed by the telovelar route, and carries significant morbidity, although surgical mortality remains low.

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Fourth ventricle tumors in children: complications and influence of surgical approach

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.6.peds2089 ◽

2021 ◽

Vol 27 (1) ◽

pp. 52-61 ◽

Cited By ~ 1

Author(s):

Sebastian M. Toescu ◽

Gargi Samarth ◽

Hugo Layard Horsfall ◽

Richard Issitt ◽

Ben Margetts ◽

...

Keyword(s):

Posterior Fossa ◽

Surgical Management ◽

Surgical Approach ◽

Fourth Ventricle ◽

External Ventricular Drain ◽

Preoperative Imaging ◽

Posterior Fossa Tumors ◽

Presenting Symptoms ◽

Significant Difference ◽

Telovelar Approach

OBJECTIVESThe goal of this study was to characterize the complications and morbidity related to the surgical management of pediatric fourth ventricle tumors.METHODSAll patients referred to the authors’ institution with posterior fossa tumors from 2002 to 2018 inclusive were screened to include only true fourth ventricle tumors. Preoperative imaging and clinical notes were reviewed to extract data on presenting symptoms; surgical episodes, techniques, and adjuncts; tumor histology; and postoperative complications.RESULTSThree hundred fifty-four children with posterior fossa tumors were treated during the study period; of these, 185 tumors were in the fourth ventricle, and 167 fourth ventricle tumors with full data sets were included in this analysis. One hundred patients were male (mean age ± SD, 5.98 ± 4.12 years). The most common presenting symptom was vomiting (63.5%). The most common tumor types, in order, were medulloblastoma (94 cases) > pilocytic astrocytoma (30 cases) > ependymoma (30 cases) > choroid plexus neoplasms (5 cases) > atypical teratoid/rhabdoid tumor (4 cases), with 4 miscellaneous lesions. Of the 67.1% of patients who presented with hydrocephalus, 45.5% had an external ventricular drain inserted (66.7% of these prior to tumor surgery, 56.9% frontal); these patients were more likely to undergo ventriculoperitoneal shunt (VPS) placement at a later date (p = 0.00673). Twenty-two had an endoscopic third ventriculostomy, of whom 8 later underwent VPS placement. Overall, 19.7% of patients had a VPS sited during treatment.Across the whole series, the transvermian approach was more frequent than the telovelar approach (64.1% vs 33.0%); however, the telovelar approach was significantly more common in the latter half of the series (p < 0.001). Gross-total resection was achieved in 70.7%. The most common postoperative deficit was cerebellar mutism syndrome (CMS; 28.7%), followed by new weakness (24.0%), cranial neuropathy (18.0%), and new gait abnormality/ataxia (12.6%). Use of intraoperative ultrasonography significantly reduced the incidence of CMS (p = 0.0365). There was no significant difference in the rate of CMS between telovelar or transvermian approaches (p = 0.745), and multivariate logistic regression modeling did not reveal any statistically significant relationships between CMS and surgical approach.CONCLUSIONSSurgical management of pediatric fourth ventricle tumors continues to evolve, and resection is increasingly performed through the telovelar route. CMS is enduringly the major postoperative complication in this patient population.

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POS1280 SPINAL LOCATION OF TUBERCULOSIS: WHAT HAS CHANGED OVER THE LAST YEARS?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3365 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 923.3-923

Author(s):

S. Boussaid ◽

M. Mrabet ◽

S. Jemmali ◽

H. Sahli ◽

H. Ajlani ◽

...

Keyword(s):

Neurological Complications ◽

Developing Nations ◽

Lumbar Pain ◽

X Rays ◽

Resonance Imaging ◽

Vertebral Collapse ◽

The Past ◽

Significant Difference ◽

Tuberculous Spondylodiscitis ◽

Different Parts

Background:Tuberculosis (TB) is no longer a disease limited to developing nations and is still a major cause of significant morbidity and mortality worldwide. It can affect the different parts of the spine.Objectives:The aim of this study was to determine the preferred spinal location of TB.Methods:We conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from observations of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with tuberculous spondylodiscitis (TS).Results:Fifty-two patients were included (37F/15M). Their mean age was 55.21 years ± 17.79 [19-91]. TS was more frequently unifocal (75%) than multifocal (25%). Lumbar spine involvement was the most common (57.7%) and more frequent in women (63.3%) but with no statistically significant difference (p = 0.2). Other localizations were described such as: dorso-lumbar (21.2%), dorsal (15.4%), lumbosacral (3.8%) and cervical (1.9%). Lumbar pain was present in 34 patients (65.4%) and 29 patients (55.8%) suffered from segmental lumbar stiffness. Imaging was contributive by showing the vertebral location using standard X-rays, computed tomography and magnetic resonance imaging. Disc pinch, erosion of vertebral plateaus and vertebral collapse were the major signs (82.7%, 65.4% and 67.3%, respectively).Conclusion:TS is a rare but serious clinical condition which may lead to severe deformity and early or late neurological complications. Spinal involvement is often unifocal and mostly diagnosed with lumbar pain or stiffness. Multifocal forms, touching several parts of the spine, however remain rare. Our findings remain consistent with those of the literature.Disclosure of Interests:None declared

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Surgical Complications Requiring Intervention in Open versus Minimally Invasive Radical Prostatectomy

Urologia Internationalis ◽

10.1159/000515618 ◽

2021 ◽

pp. 1-5

Author(s):

Lorine Haeuser ◽

Stephen W. Reese ◽

Marco Paciotti ◽

Joachim Noldus ◽

Ethan Y. Brovman ◽

...

Keyword(s):

Radical Prostatectomy ◽

Minimally Invasive ◽

Surgical Approach ◽

Large Bowel ◽

Bowel Injury ◽

Improvement Program ◽

Significant Difference ◽

American College Of Surgeons ◽

Vascular Structures ◽

Open Versus

Introduction: Injuries to surrounding structures during radical prostatectomy (RP) are rare but serious complications. However, it remains unknown if injuries to intestines, rectum, or vascular structures occur at different rates depending on the surgical approach. Methods: We compared the frequency of these outcomes in open RP (ORP) and minimally invasive RP (MIS-RP) using the national American College of Surgeons National Surgical Quality Improvement Program database (2012–2017). Along with important metrics of clinical and surgical outcomes, patients were identified as undergoing surgical repair of small or large bowel, vascular structures, or hernias based on Current Procedural Terminology codes. Results: In our propensity matched analysis, a total of 13,044 patients were captured. Bowel injury occurred more frequently in ORP than in MIS-RP (0.89 vs. 0.26%, p < 0.01). By intestinal segment, rectal and large bowel injuries were more common in ORP than MIS-RP (0.41 vs. 0.11% and 0.31 vs. 0.05%, both p < 0.01). However, there was no statistically significant difference between the groups for small bowel injury (0.17 vs. 0.11%, p = 0.39). Vascular injury was more common in MIS-RP (0.18 vs. 0.08%, p = 0.08). Hernias requiring repair were only identified in the MIS-RP group (0.12%). Conclusion: When considering surgical approach, rectal and large bowel injuries were more common in ORP, while vascular injuries and hernia repair were more common in MIS-RP. Our findings can be used in counseling patients and identifying risk factors and strategies to reduce these complications.

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Proximal Gastrectomy versus Total Gastrectomy for Siewert Type II Adenocarcinoma of the Esophagogastric Junction: A Comprehensive Analysis of Data from the SEER Registry

Disease Markers ◽

10.1155/2019/9637972 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 2

Author(s):

Kaixuan Zhu ◽

Yingying Xu ◽

Jiaxin Fu ◽

Farah Abdidahir Mohamud ◽

Zongkui Duan ◽

...

Keyword(s):

Total Gastrectomy ◽

Surgical Approach ◽

Esophagogastric Junction ◽

Proximal Gastrectomy ◽

Locally Advanced ◽

Cox Proportional Hazards Model ◽

Type Ii ◽

Siewert Type ◽

Siewert Type Ii ◽

Significant Difference

Background. To determine the ideal surgical approach (total gastrectomy (TG) vs. proximal gastrectomy (PG)) for Siewert type II adenocarcinoma of the esophagogastric junction (AEG), we searched and analyzed the Surveillance, Epidemiology, and End Results (SEER) data. Methods. Patients with Siewert type II AEG treated by TG or PG were identified from the 2004–2014 SEER dataset. We obtained the patients’ overall survival (OS) and cancer-specific survival (CSS) and stratified the patients by surgical approach. We performed a propensity score 1 : 1 matching (PSM) analysis and a univariate and multivariate Cox proportional hazards model. Results. A total of 2,217 patients with 6th AJCC stage IA–IIIB Siewert type II AEG was examined: 1,584 patients (71.4%) underwent PG, and 633 patients (28.6%) underwent TG. The follow-up time was 1–131 months. OS favored total gastrectomy before the PSM analysis (χ2=3.952, p=0.047), but after this analysis, there was no significant difference between TG and PG (χ2=2.227, p=0.136). The univariate and multivariate analyses identified age as an independent factor, and an X-tail analysis revealed 70 years as a cut-off point. The patients aged≥70 years obtained a significant long-term OS benefit from PG compared to TG (χ2=8.245, p=0.004), and those aged<70 years showed no difference between TG and PG (χ2=0.167, p=0.682). Conclusions. PG showed an equivalent survival benefit to TG in both the early and locally advanced stages of Siewert type II AEG. For elderly patients, PG is strongly recommended because of its clearer OS benefit compared to TG.

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SURGICAL APPROACH FOR KNEE JOINT ARTHROPLASTY IN CHILDREN WITH CANCER: THE INTRODUCTION OF A LATERAL APPROACH FOR SEGMENTAL RESECTION OF THE PROXIMAL TIBIA

PEDIATRIA Journal named after G N SPERANSKY ◽

10.24110/0031-403x-2021-100-3-227-233 ◽

2021 ◽

Vol 100 (3) ◽

pp. 227-233

Author(s):

N.A. Bolshakov ◽

◽

A.Yu. Artemov ◽

A.S. Slinin ◽

E.O. Bezdolnova ◽

...

Keyword(s):

Knee Joint ◽

Surgical Approach ◽

Ewing’S Sarcoma ◽

Rating Scale ◽

Ewing's Sarcoma ◽

Functional Results ◽

Lateral Approach ◽

Joint Arthroplasty ◽

Lateral Side ◽

Significant Difference

The aim of the study was to analyze our own experience of using the lateral approach in knee joint arthroplasty in children with oncopathology. Materials and methods of research: the results of a retrospective nonrandomized uncontrolled single-center study are analyzed, within the framework of which 97 endoprosthetics of the knee joint were performed in children and adolescents with oncological pathology over 7 years (2012–2018). Lateral approach was used in 28 patients. The functional results were assessed using the MSTS rating scale 6 and 12 months after the surgery. Postoperative complications were analyzed according to the Henderson classification (modified by the ISOLS committee). Results: when comparing the functional outcome depending on the surgical approach, no statistically significant difference was found either after 6 months (p=0,124) or after 12 months (p=0,755). There is no more frequent development of complications detected (p=0,551). The access used also did not affect overall survival in osteosarcoma (p=0,577), in Ewing's sarcoma (p=0,493), as well as on event-free survival in osteosarcoma (p=0,829) and in Ewing's sarcoma (p=0,886). Conclusion: the use of the lateral surgical approach for knee arthroplasty in children with oncopathology does not affect the treatment results, however, it provides the surgeon with greater variability of actions during preoperative planning. This is especially true for patients whose biopsy tract is located on the lateral side.

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Localised gastrointestinal diffuse large B cell lymphomas; Does surgical approach still exist?

Forum of Clinical Oncology ◽

10.1515/fco-2015-0003 ◽

2015 ◽

Vol 6 (1) ◽

pp. 10-17

Author(s):

Abeer Ibrahim ◽

Ali Zedan ◽

Alia M. A. Attia

Keyword(s):

B Cell ◽

Surgical Approach ◽

Gastric Lymphoma ◽

B Cell Lymphoma ◽

Anatomical Site ◽

Intestinal Lymphoma ◽

Significant Difference ◽

Group 2 ◽

Large B Cell ◽

Group 1

Abstract Background: Diffuse large B-cell lymphoma (DLBCL) is the commonest pathological type of gastrointestinal lymphoma and its management was changed from surgery to combined chemoimmunotherapy in the last decade; however, this strategy is questionable, especially if rituximab is not available. Methods: Seventy-nine files were reviewed retrospectively. We divided the patients into two groups; group 1 included 37 patients who underwent surgery followed by chemotherapy and group 2 included 42 patients who received chemotherapy. The indication of surgery was mainly due to obstruction/perforation. We compared the outcomes of PFS and OS between the two groups and according to primary anatomical site. Results: We found that the outcomes for the surgery group before chemotherapy was superior to chemotherapy alone in terms of DFS, p = 0.012 and OS p = 0.037. But in the anatomical subgroups analysis, it did not show any significant difference in primary gastric lymphoma (PGL) regarding DFS and OS, p = 0.706, p = 0.858, respectively; On the contrary, we found significant improvement in PFS and OS, p = 0.032, p = 0.025, respectively, in primary intestinal lymphoma (PIL) favouring the use of the surgical approach. Conclusion Surgery is still an important strategy in the case of DLBCL in PIL intestinal lymphoma; however, in the case of PGL, the use of chemotherapy even without rituximab achieves similar results. Our conclusions are limited by the small numbers of the study

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Continuous Blood Purification on Influenza-associated Neurological Disease in Children: A Retrospective Cohort Study

10.21203/rs.3.rs-145075/v1 ◽

2021 ◽

Author(s):

Jingwen Ni ◽

Kenan Fang ◽

Zhe Zhao ◽

Zhiyuan Wang ◽

Qian Huang ◽

...

Keyword(s):

Cohort Study ◽

Intensive Care ◽

Retrospective Cohort Study ◽

Neurological Disease ◽

Retrospective Cohort ◽

Neurological Complications ◽

Inflammatory Factors ◽

Continuous Variables ◽

Exact Test ◽

Significant Difference

Abstract Background: Due to lack of proven therapies，we evaluated the effect of CBP on Influenza-Associated Neurological Disease in children.Methods: A single-center, retrospective, cohort study was conducted in Luoyang, Henan province China from January 2018 to January 2020. The children with Influenza-associated neurological disease (<18 years old) were enrolled into this study. The children with CBP indications and the parents’ consent received CBP, and the others were treated with maximal intensive care due to failure of parents consent. The outcomes were compared between CBP group and non-CBP group.Categorical variables were presented as percentage and compared by Chi-square test or Fisher’s exact test. Continuous variables were expressed as median (interquartile ranges) and compared with non-parametric independent sample test. Statistical analyses were finished by SPSS (version 26.0) and p < 0.05 (2 tailed) was considered statistically significant.Results: 30 influenza children with Influenza-associated neurological disease were enrolled in this study. 18 received CBP and other 12 were treated with maximal intensive care. There were no differences between CBP and non-CBP children in age, sex, body weight, type of influenza virus, neurological complications, Glasgow score, PIM-2 score and PCIS at admission (p > 0.05). The inflammatory factors (CRP, PCT and IL-6) of 30 cases were tested at admission and after 3 days of admission. In CBP group, the level of IL-6 decreased significantly at 3-day of admission (p = 0.003), the level of CRP and PCT also decreased, but there was no significant difference (p > 0.05). In the non-CBP group, there were no significant difference on level of CRP, PCT and IL-6 between at admission and 3-day of admission (p > 0.05). The 28-day mortality in the CBP group was significantly lower compared to non-CBP group (11.11% vs 50%, p = 0.034).Conclusions: CBP could Reduce inflammatory factors and may reduce 28-day mortality and improve neurologic function of influenza children.Trial registration: http://www.chictr.org.cn/index.aspx (ChiCTR2000031754).

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Heterotopic ossification after total hip arthroplasty: radiological comparison between a direct anterior approach without an orthopaedic table and a posterior approach

Hip International ◽

10.1177/1120700020970793 ◽

2020 ◽

pp. 112070002097079

Author(s):

Naïm Zran ◽

Etienne Joseph ◽

Gabriel Callamand ◽

Xavier Ohl ◽

Renaud Siboni

Keyword(s):

Soft Tissue ◽

Heterotopic Ossification ◽

Surgical Approach ◽

Anterior Approach ◽

Posterior Approach ◽

Direct Anterior Approach ◽

Soft Tissue Release ◽

Surgical Trauma ◽

Total Hip ◽

Significant Difference

Introduction: Heterotopic ossification (HO) occurs in almost ⅓ of total hip arthroplasties (THAs). A direct anterior approach (DAA) with an orthopaedic table is less likely to cause HO than a posterior approach. Without an orthopaedic table, the exposure of the femur requires additional soft tissue release. Soft tissue trauma leads to the production of HO inductors. Our study evaluated the incidence of HO 6 months after THA and compared the results between DAAs without an orthopaedic table and posterior approaches. Methods: Retrospectively, 164 consecutive, primary THAs were included: 76 through a posterior approach and 88 through a DAA. The main objective was to measure the presence of HO on pelvis radiography 6 months after surgery. Results: The incidence of HO was significantly higher in the DAA group than in the posterior approach group (47.7% vs. 27.6%, respectively; p < 0.01). The overall incidence of HO was 38.4%. No significant difference was found between the 2 approaches regarding the severity of HO. No significant risk factor for HO was identified other than the surgical approach. Discussion: In our study, the incidence of HO after THA in patients undergoing DAA without an orthopaedic table was higher than in patients undergoing a posterior approach after 6 months of follow-up. This result is closely related to the surgical trauma. It suggests that the minimally invasive feature of a surgical approach cannot be dissociated from the overall conditions in which it is performed.

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Comparison of Volar and Dorsal Approach for PIP Arthroplasty

Hand ◽

10.1177/1558944719861718 ◽

2019 ◽

pp. 155894471986171

Author(s):

Geneva V. Tranchida ◽

Scott T. Allen ◽

Susan M. Moen ◽

Lauren O. Erickson ◽

Christina M. Ward

Keyword(s):

Surgical Approach ◽

Revision Surgery ◽

Statistical Difference ◽

Demographic Data ◽

Complication Rates ◽

Hand Therapy ◽

Dorsal Approach ◽

Volar Approach ◽

Significant Difference

Background: No consensus exists about whether a volar approach (VA) or dorsal approach (DA) for proximal interphalangeal (PIP) arthroplasty yields better results. Previously reported range of motion (ROM) and complications vary from study to study. This retrospective review compared the ROM and complication rates of VA and DA approaches to PIP arthroplasty. Methods: The study included 66 adults (88 digits) who underwent PIP arthroplasty from 2000 to 2015, with minimum 30-day follow-up. Demographic data, surgical approach, pre- and post-operative ROM, duration of immobilization, timing and duration of hand therapy (occupational therapy [OT]), and major and minor complications were recorded. We compared mean change in ROM, postoperative ROM, and complication rates, and examined the association of duration of immobilization and time to OT initiation with postoperative ROM. Results: While there was no difference in postoperative ROM between volar and dorsal groups (56° and 54°, respectively, P > .05), there was a greater gain in ROM in the DA group (25° vs 2.7°, P = .017). There was no statistically significant difference in overall incidence of complications (VA: 37.8%, DA: 30.3%; P > .05) or revision surgery (VA: 15.6%, DA: 17.1%; P > .05). There were no differences in duration of immobilization, time to OT initiation, or number of OT sessions between the two groups, and none of these correlated with postoperative ROM. Conclusions: We identified no statistical difference in mean postoperative ROM, incidence of complications or revision surgery between volar and dorsal approaches for PIP arthroplasty.

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The Coefficient of Variation of Step Time Can Overestimate Gait Abnormality: Test-Retest Reliability of Gait-Related Parameters Obtained with a Tri-Axial Accelerometer in Healthy Subjects

Sensors ◽

10.3390/s20030577 ◽

2020 ◽

Vol 20 (3) ◽

pp. 577 ◽

Cited By ~ 2

Author(s):

Shunrou Fujiwara ◽

Shinpei Sato ◽

Atsushi Sugawara ◽

Yasumasa Nishikawa ◽

Takahiro Koji ◽

...

Keyword(s):

Coefficient Of Variation ◽

Intraclass Correlation ◽

Step Length ◽

Gait Parameter ◽

Data Set ◽

Gait Abnormality ◽

Significant Difference ◽

Assessment Time ◽

The Difference ◽

Gait Abnormalities

The aim of this study was to investigate whether variation in gait-related parameters among healthy participants could help detect gait abnormalities. In total, 36 participants (21 men, 15 women; mean age, 35.7 ± 9.9 years) performed a 10-m walk six times while wearing a tri-axial accelerometer fixed at the L3 level. A second walk was performed ≥1 month after the first (mean interval, 49.6 ± 7.6 days). From each 10-m data set, the following nine gait-related parameters were automatically calculated: assessment time, number of steps, stride time, cadence, ground force reaction, step time, coefficient of variation (CV) of step time, velocity, and step length. Six repeated measurement values were averaged for each gait parameter. In addition, for each gait parameter, the difference between the first and second assessments was statistically examined, and the intraclass correlation coefficient (ICC) was calculated with the level of significance set at p < 0.05. Only the CV of step time showed a significant difference between the first and second assessments (p = 0.0188). The CV of step time also showed the lowest ICC, at <0.50 (0.425), among all parameters. Test–retest results of gait assessment using a tri-axial accelerometer showed sufficient reproducibility in terms of the clinical evaluation of all parameters except the CV of step time.

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