TM3-5 Venous sinus stenting for IIH: what are the long-term outcomes?

ObjectivesIdiopathic intracranial hypertension (IIH) is associated with dural venous sinus stenosis (DVSS). This is increasingly treated with endovascular insertion of stents. Clinical and manometric improvements after stent placement have been described. However, there is little data reporting further need for CSF diversion, complication rates and sustained improvements in ICP.DesignSingle centre case series.SubjectsTwenty-four IIH patients underwent stent insertion on discovery of DVSS with medical management ongoing.MethodsClinical notes, radiographic reports and 24 hour ICP monitoring data before and after stent placement was collected.ResultsAfter 1089.2±107.1 days, 6 patients remained symptomatic and went onto require CSF diversion, 75.0% did not require CSF diversion. One patient developed stent thrombosis requiring VKA anticoagulation for 3 months, this patient also developed new stenosis proximal to the stent at 2 years. A second patient developed in-stent stenosis requiring balloon angioplasty at 2 years and subsequent repeat stenting at 3 years. Eleven patients had 24 hour ICP monitoring at baseline and a mean of 231.9±129.5 days after DVSS stent placement. The mean reduction in ICP was 7.92±1.80 mmHg (p<0.01) and PA was 2.84±0.84 mmHg (p<0.01).ConclusionsDVSS stenting is a viable endovascular therapy for IIH with modest long-term patency and ICP reduction. However, a quarter of stented patients required subsequent CSF diversion to manage their symptoms.

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P109 Experience of tunnelled vs. bolt EVDs on the intensive care unit

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.164 ◽

2019 ◽

Vol 90 (3) ◽

pp. e50.4-e51

Author(s):

H Asif ◽

CL Craven ◽

U Reddy ◽

LD Watkins ◽

AK Toma

Keyword(s):

Intensive Care Unit ◽

External Ventricular Drain ◽

Complication Rates ◽

Single Centre ◽

Acute Hydrocephalus ◽

Clinical Notes ◽

Before And After ◽

Csf Diversion ◽

Neurosurgical Operation ◽

Mean Time

ObjectivesThe placement of an external ventricular drain (EVD) is a common neurosurgical operation that carries great benefit in acute hydrocephalus but is not without risk. In our centre, bolt EVDs (B-EVD) are being placed in favour of tunnelled EVDs (T-EVD). The former has allowed for urgent CSF diversion in ITU. We compared EVD survival and complication rates between the two types of EVDs.DesignSingle centre prospective case-cohort.SubjectsTwenty-five patients with B-EVDs and thirty-four patients with T-EVDs.MethodsClinical notes and radiographic reports were collected before and after the placement of EVDs for patients in ITU between January 2017 and June 2018.ResultsFourteen of the 25 B-EVDs were placed on ITU, of which 2 were under stealth guidance. All 34 T-EVDs were placed in theatre. Mean time to CSF access after decision for diversion was 134 min in the B-EVD group and 227 min in the T-EVD group (p<0.05). Mean survival was 35 days for B-EVDs and 29 days for T-EVDs (p<0.05). Eight T-EVDs went onto be replaced as B-EVDs due to retraction or infection. Complications including infection, detachment or retraction were higher in the T-EVD group at 32% compared to 20% in the B-EVD group.ConclusionsBolt EVDs have a lower frequency of complications and higher survival compared to tunnelled EVDs. Since B-EVDs require fewer resources they can be placed faster and on ITU.

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Idiopathic intracranial hypertension: 120-day clinical, radiological, and manometric outcomes after stent insertion into the dural venous sinus

Journal of Neurosurgery ◽

10.3171/2017.4.jns162871 ◽

2018 ◽

Vol 129 (3) ◽

pp. 723-731 ◽

Cited By ~ 10

Author(s):

Hasan Asif ◽

Claudia L. Craven ◽

Almas H. Siddiqui ◽

Syed N. Shah ◽

Samir A. Matloob ◽

...

Keyword(s):

Clinical Outcome ◽

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Case Series ◽

Outcome Data ◽

Venous Sinus ◽

Stent Insertion ◽

Complication Rates ◽

Considerable Uncertainty ◽

Dural Venous Sinus

OBJECTIVEIdiopathic intracranial hypertension (IIH) is commonly associated with venous sinus stenosis. In recent years, transvenous dural venous sinus stent (DVSS) insertion has emerged as a potential therapy for resistant cases. However, there remains considerable uncertainty over the safety and efficacy of this procedure, in particular the incidence of intraprocedural and delayed complications and in the longevity of sinus patency, pressure gradient obliteration, and therapeutic clinical outcome. The aim of this study was to determine clinical, radiological, and manometric outcomes at 3–4 months after DVSS in this treated IIH cohort.METHODSClinical, radiographic, and manometric data before and 3–4 months after DVSS were reviewed in this single-center case series. All venographic and manometric procedures were performed under local anesthesia with the patient supine.RESULTSForty-one patients underwent DVSS venography/manometry within 120 days. Sinus pressure reduction of between 11 and 15 mm Hg was achieved 3–4 months after DVSS compared with pre-stent baseline, regardless of whether the procedure was primary or secondary (after shunt surgery). Radiographic obliteration of anatomical stenosis correlating with reduction in pressure gradients was observed. The complication rate after DVSS was 4.9% and stent survival was 87.8% at 120 days. At least 20% of patients developed restenosis following DVSS and only 63.3% demonstrated an improvement or resolution of papilledema.CONCLUSIONSReduced venous sinus pressures were observed at 120 days after the procedure. DVSS showed lower complication rates than shunts, but the clinical outcome data were less convincing. To definitively compare the outcomes between DVSS and shunts in IIH, a randomized prospective study is needed.

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Pseudotumor cerebri syndrome: venous sinus obstruction and its treatment with stent placement

Journal of Neurosurgery ◽

10.3171/jns.2003.98.5.1045 ◽

2003 ◽

Vol 98 (5) ◽

pp. 1045-1055 ◽

Cited By ~ 146

Author(s):

Brian K. Owler ◽

Geoffrey Parker ◽

G. Michael Halmagyi ◽

Victoria G. Dunne ◽

Verity Grinnell ◽

...

Keyword(s):

Stent Placement ◽

Pseudotumor Cerebri ◽

Venous Sinus ◽

Stent Insertion ◽

Benign Intracranial Hypertension ◽

Content Type ◽

Venous Sinuses ◽

Pseudotumor Cerebri Syndrome ◽

New Treatment ◽

Fine Print

Object. Pseudotumor cerebri, or benign intracranial hypertension, is a condition of raised intracranial pressure in the absence of a mass lesion or cerebral edema. It is characterized by headache and visual deterioration that may culminate in blindness. Pseudotumor cerebri is caused by venous sinus obstruction in an unknown percentage of cases. The purpose of this study was to investigate the role of cerebral venous sinus disease in pseudotumor cerebri and the potential of endoluminal venous sinus stent placement as a new treatment. Methods. Nine consecutive patients in whom diagnoses of pseudotumor cerebri had been made underwent examination with direct retrograde cerebral venography (DRCV) and manometry to characterize the morphological features and venous pressures in their cerebral venous sinuses. The cerebrospinal fluid (CSF) pressure was measured simultaneously in two patients. If patients had an amenable lesion they were treated using an endoluminal venous sinus stent. Five patients demonstrated morphological obstruction of the venous transverse sinuses (TSs). All lesions were associated with a distinct pressure gradient and raised proximal venous sinus pressures. Four patients underwent stent insertion in the venous sinuses and reported that their headaches improved immediately after the procedure and remained so at 6 months. Vision was improved in three patients, whereas it remained poor in one despite normalized CSF pressures. Conclusions. Patients with pseudotumor cerebri should be evaluated with DRCV and manometry because venous TS obstruction is probably more common than is currently appreciated. In patients with a lesion of the venous sinuses, treatment with an endoluminal venous sinus stent is a viable alternative for amenable lesions.

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Clinical characteristics and long-term outcome of lung lobe torsions in cats: a review of 10 cases (2000–2021)

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x211054816 ◽

2021 ◽

pp. 1098612X2110548

Author(s):

Catherine Tindale ◽

Filippo Cinti ◽

Matteo Cantatore ◽

Alistair Freeman ◽

Leonardo Cavaliere ◽

...

Keyword(s):

Intraoperative Complications ◽

Clinical Signs ◽

Case Series ◽

The Other ◽

Complication Rates ◽

Term Outcome ◽

Long Term Outcome ◽

Lung Lobe ◽

Lung Lobes

Case series summary Lung lobe torsion is rare in cats. The aim of this multi-institution retrospective study was to describe clinical and diagnostic findings, treatments and outcomes of lung lobe torsion (LLT) in 10 cats. Dyspnoea and tachypnoea were the most common clinical signs. Pleural effusion was present in nine cats at presentation. Fluid analysis confirmed chylothorax in three cats. Nine cats underwent CT and five cats had thoracic radiographs taken. A diagnosis was made preoperatively in six cats, while in the other four cats it was made at exploratory thoracotomy. Affected lung lobes were the right cranial (n = 4/11), left cranial (n = 4/11) and right middle (n = 3/11). One cat had a concurrent torsion of two lung lobes. Lung lobectomy was successfully performed in all cases. Based on clinical, diagnostic and lung histopathology findings, three cats had idiopathic and seven cats secondary LLT. Intraoperative complications included hypotension and hypothermia in four and five cats, respectively. Postoperative complications occurred in six cats and lead to euthanasia or death in four cats, whereas complications resolved in the other two cats. Three cats were euthanased within 5 weeks of discharge. For the three cats surviving long term, including one euthanased at 252 days postoperatively, owner-described outcomes and quality of life were considered good to excellent. Relevance and novel information Secondary LLT associated with underlying thoracic pathology was associated with high complication rates and poor outcomes. Long-term outcomes of cats undergoing surgery for LLT and surviving the perioperative period were deemed good to excellent.

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A unique type of fully covered metal stent for the management of post liver transplant biliary anastomotic strictures

BMC Gastroenterology ◽

10.1186/s12876-020-01479-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Ben Warner ◽

Phillip Harrison ◽

Muhammad Farman ◽

John Devlin ◽

David Reffitt ◽

...

Keyword(s):

Liver Transplant ◽

Liver Function Tests ◽

Stent Insertion ◽

Complication Rates ◽

Metal Stent ◽

Unique Type ◽

Anastomotic Strictures ◽

Stricture Recurrence

Abstract Background We report our experience of treating anastomotic strictures using a novel type of fully covered metal stent (FCSEMS). This stent, known as the Kaffes Stent, is short-length with an antimigration waist and is easily removable due to long retrieval wires deployed within the duodenum. Methods Sixty-two patients underwent ERCP and Kaffes stent insertion for post-transplant anastomotic strictures following confirmation of a stricture on MRCP. These patients were retrospectively analysed for immediate and long-term stricture resolution, improvement in symptoms and liver function tests (LFTs), stricture recurrence and complication rates. Results Of the 56 patients who had their stent removed at the time of analysis, 54 (96%) had immediate stricture resolution and 42 continued to have long-term resolution (mean follow-up period was 548 days). Of the 16 patients with symptoms of biliary obstruction, 13 had resolution of their symptoms. Overall, there was a significant improvement in LFTs after stent removal compared to before stent insertion. Complication rates were 15% with only one patient requiring biliary reconstruction. Conclusions The Kaffes stent is effective and safe at resolving post liver transplant biliary anastomotic strictures.

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Day surgery for achalasia cardia: Time for consensus?

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0063 ◽

2016 ◽

Vol 98 (2) ◽

pp. 150-154 ◽

Cited By ~ 3

Author(s):

DN Naumann ◽

S Zaman ◽

M Daskalakis ◽

R Nijjar ◽

M Richardson ◽

...

Keyword(s):

Endoscopic Treatment ◽

Case Series ◽

Length Of Hospital Stay ◽

Day Surgery ◽

Complication Rates ◽

Day Case ◽

Achalasia Cardia ◽

Before And After ◽

Consensus Decision ◽

Symptom Recurrence

Introduction Laparoscopic Heller’s myotomy (LHM) is the most effective therapy for achalasia of the oesophagus. Most case series of LHM report a length of hospital stay (LOS) >1 day. We present 14 years of experience of LHM to examine the safety and feasibility of LHM as a day case procedure. Methods We retrospectively examined patients undergoing elective LHM for achalasia at our institution between 2000 and 2014. Demographics, episode statistics, prior investigations and interventions were collated. Outcomes, including LOS, complications and re-interventions, were compared for the periods before and after a consensus decision at our institution in 2008 to perform LHM as a day case procedure. Results Sixty patients with a mean age of 41±13 years were included, of whom 58% were male. The median LOS for all patients was 1 day (interquartile range [IQR] 0–2.25). Overall, LHM was performed as a day case in 27 (45%) cases, at 2/26 (7.7%) in the first period versus 25/34 (73.5%) in the second (p<0.01). There were no significant differences in age, gender or previous interventions between day surgery and non-day surgery groups. One patient required subsequent unplanned surgery, while six (10%) needed endoscopic treatment of recurrent symptoms within 12 months. Conclusions LHM can be performed safely as a day case procedure. Complication rates are low, with only a small proportion of patients requiring endoscopic treatment for symptom recurrence within 1 year.

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Long-term follow-up of neodymium:YAG laser anterior capsulotomy for the treatment of anterior capsular phimosis

Journal of International Medical Research ◽

10.1177/0300060518777652 ◽

2018 ◽

Vol 46 (9) ◽

pp. 3692-3697 ◽

Cited By ~ 2

Author(s):

Hehua Ye ◽

Jiming Zhang ◽

Yiyong Qian

Keyword(s):

Nd:Yag Laser ◽

Case Series ◽

Anterior Capsule ◽

Long Term Study ◽

Before And After ◽

Long Term Follow Up ◽

The Mean ◽

Anterior Capsulotomy

Objective To investigate the long-term safety and efficacy of Nd:YAG laser anterior capsulotomy for the treatment of anterior capsular phimosis. Methods We retrospectively analyzed a consecutive case series of Nd:YAG laser anterior capsulotomy in patients with anterior capsular phimosis, who were treated between November 2012 and April 2014. Data collected included risk factors, interval between surgery and capsulotomy, best-corrected visual acuity (BCVA), and diameter of anterior capsule opening before and after Nd:YAG laser anterior capsulotomy. Results Eleven eyes of 11 patients were included in the study. The mean follow-up time was 30.1 ± 4.5 months (range: 26–42 months). At the last follow-up, the mean diameter of the anterior capsule opening was 5.1 ± 0.2 mm, which was significantly greater than the diameter before laser capsulotomy (2.2 ± 0.8 mm). BCVA remained stable or improved in nine eyes (81.8%) following capsulotomy. No patients experienced recurrence of phimosis. Conclusions In a long-term study of >2 years, we found that Nd:YAG laser anterior capsulotomy is safe and effective for the treatment of anterior capsule phimosis.

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Complications following intracranial pressure monitoring in children: a 6-year single-center experience

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.9.peds17360 ◽

2018 ◽

Vol 21 (3) ◽

pp. 278-283 ◽

Cited By ~ 8

Author(s):

Ruichong Ma ◽

David Rowland ◽

Andrew Judge ◽

Amedeo Calisto ◽

Jayaratnam Jayamohan ◽

...

Keyword(s):

Intracranial Pressure ◽

Case Series ◽

Complication Rates ◽

Safe Procedure ◽

Icp Monitoring ◽

Retrospective Case ◽

Wide Range ◽

Neurosurgical Patients ◽

Significant Difference ◽

Csf Leakage

OBJECTIVEIntracranial pressure (ICP) monitoring is an important tool in the neurosurgeon’s armamentarium and is used for a wide range of indications. There are many different ICP monitors available, of which fiber-optic intraparenchymal devices are very popular. Here, the authors document their experience performing ICP monitoring from 2005 to 2015 and specifically complication rates following insertion of the Microsensor ICP monitor.METHODSA retrospective case series review of all patients who underwent ICP monitoring over a 10-year period from 2005 to 2015 was performed.RESULTSThere were 385 separate operations with an overall complication rate of 8.3% (32 of 385 cases). Hardware failure occurred in 4.2% of cases, the CSF leakage rate was 3.6%, the postoperative hemorrhage rate was 0.5%, and there was 1 case of infection (0.3% of cases). Only patients with hardware problems required further surgery as a result of their complications, and no patient had any permanent morbidity or mortality from the procedure. Younger patients (p = 0.001) and patients with pathologically high ICP (13% of patients with high ICP vs 6.5% of patients with normal ICP; p = 0.04) were significantly more likely to have complications. There was no significant difference in the complication rates between general neurosurgical patients and craniofacial patients (7.6% vs 8.8%, respectively; p = 0.67).CONCLUSIONSIntraparenchymal ICP monitoring is a safe procedure associated with low complications and morbidity in the pediatric craniofacial and neurosurgical population and should be offered to appropriate patients to assess ICP with the reassurance of the safety record reported in this study.

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