Surgical Approaches to First Branchial Cleft Anomaly Excision: A Case Series

Objectives. First branchial cleft anomalies (BCAs) constitute a rare entity with variable clinical presentations and anatomic findings. Given the high rate of recurrence with incomplete excision, identification of the entire tract during surgical treatment is of paramount importance. The objectives of this paper were to present five anatomic variations of first BCAs and describe the presentation, evaluation, and surgical approach to each one.Methods. A retrospective case review and literature review were performed. We describe patient characteristics, presentation, evaluation, and surgical approach of five patients with first BCAs.Results. Age at definitive surgical treatment ranged from 8 months to 7 years. Various clinical presentations were encountered, some of which were atypical for first BCAs. All had preoperative imaging demonstrating the tract. Four surgical approaches required a superficial parotidectomy with identification of the facial nerve, one of which revealed an aberrant facial nerve. In one case the tract was found to travel into the angle of the mandible, terminating as a mandibular cyst. This requireden blocexcision that included the lateral cortex of the mandible.Conclusions. First BCAs have variable presentations. Complete surgical excision can be challenging. Therefore, careful preoperative planning and the recognition of atypical variants during surgery are essential.

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Primary Hepatic Angiosarcoma: A Rare Liver Malignancy – Varying Manifestations but Grave Prognosis

Case Reports in Gastroenterology ◽

10.1159/000506928 ◽

2020 ◽

Vol 14 (1) ◽

pp. 137-149 ◽

Cited By ~ 1

Author(s):

Natthapat Rujeerapaiboon ◽

Panu Wetwittayakhlang

Keyword(s):

Liver Tumors ◽

Case Series ◽

High Rate ◽

Therapeutic Approaches ◽

Tumor Rupture ◽

Liver Malignancies ◽

Liver Malignancy ◽

Hepatic Angiosarcoma ◽

Clinical Presentations ◽

Primary Hepatic Angiosarcoma

Primary hepatic angiosarcoma (PHA) is a rare mesenchymal liver tumor, accounting for 0.1–2% of primary liver malignancies. The clinical presentations of PHA are variable, from asymptomatic to liver failure or complicated with tumor rupture. The diagnosis of PHA is difficult due to the lack of specific clinical manifestation and investigation results, which can be confused with other liver tumors resulting in late diagnosis. However, there is currently a paucity of effective therapeutic approaches. We advocate early diagnosis with radiological imaging and histopathology because most of them are diagnosed in late-stage and carry a grave prognosis. Surgical resection remains the mainstay of treatment, which can significantly prolong survival. Chemotherapy, including transarterial chemoembolization, is an option for palliative treatment. Unfortunately, molecular treatment has limited efficacy and liver transplantation is also not recommended due to high rate of recurrence. We present a case series of four patients with biopsy-proven PHA which had distinct presentations and clinical courses.

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Facial nerve outcomes after surgery for large vestibular schwannomas: do surgical approach and extent of resection matter?

Neurosurgical FOCUS ◽

10.3171/2012.7.focus12199 ◽

2012 ◽

Vol 33 (3) ◽

pp. E16 ◽

Cited By ~ 42

Author(s):

Richard K. Gurgel ◽

Salim Dogru ◽

Richard L. Amdur ◽

Ashkan Monfared

Keyword(s):

Facial Nerve ◽

Surgical Approach ◽

Tumor Resection ◽

Extent Of Resection ◽

Vestibular Schwannomas ◽

Surgical Approaches ◽

Subtotal Resection ◽

Total Resection ◽

Translabyrinthine Approach ◽

Better Than

Object The object of this study was to evaluate facial nerve outcomes in the surgical treatment of large vestibular schwannomas (VSs; ≥ 2.5 cm maximal or extrameatal cerebellopontine angle diameter) based on both the operative approach and extent of tumor resection. Methods A PubMed search was conducted of English language studies on the treatment of large VSs published from 1985 to 2011. Studies were then evaluated and included if they contained data regarding the size of the tumor, surgical approach, extent of resection, and postoperative facial nerve function. Results Of the 536 studies initially screened, 59 full-text articles were assessed for eligibility, and 30 studies were included for analysis. A total of 1688 tumor resections were reported. Surgical approach was reported in 1390 patients and was significantly associated with facial nerve outcome (ϕ= 0.29, p < 0.0001). Good facial nerve outcomes (House-Brackmann Grade I or II) were produced in 62.5% of the 555 translabyrinthine approaches, 65.2% of the 601 retrosigmoid approaches, and 27.4% of the 234 extended translabyrinthine approaches. Facial nerve outcomes from translabyrinthine and retrosigmoid approaches were not significantly different from each other, but both showed significantly more good facial nerve outcomes, compared with the extended translabyrinthine approach (OR for translabyrinthine vs extended translabyrinthine = 4.43, 95% CI 3.17–6.19, p < 0.0001; OR for retrosigmoid vs extended translabyrinthine = 4.98, 95% CI 3.57–6.95, p < 0.0001). There were 471 patients for whom extent of resection was reported. There was a strong and significant association between degree of resection and outcome (ϕ= 0.38, p < 0.0001). Of the 80 patients receiving subtotal resections, 92.5% had good facial nerve outcomes, compared with 74.6% (n = 55) and 47.3% (n = 336) of those who received near-total resections and gross-total resections, respectively. In the 2-way comparison of good versus suboptimal/poor outcomes (House-Brackmann Grade III–VI), subtotal resection was significantly better than near-total resection (OR = 4.21, 95% CI 1.50–11.79; p = 0.004), and near-total resection was significantly better than gross-total resection (OR = 3.26, 95% CI 1.71–6.20; p = 0.0002) in producing better facial nerve outcomes. Conclusions In a pooled patient population from studies evaluating the treatment of large VSs, subtotal and near-total resections were shown to produce better facial nerve outcomes when compared with gross-total resections. The translabyrinthine and retrosigmoid surgical approaches are likely to result in similar rates of good facial nerve outcomes. Both of these approaches show better facial nerve outcomes when compared with the extended translabyrinthine approach, which is typically reserved for especially large tumors. The reported literature on treatment of large VSs is extremely heterogeneous and minimal consistency in reporting outcomes was observed.

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Novel Surgical Treatment Strategies for Unstable Lumbar Osteodiscitis: A 3-Patient Case Series

Operative Neurosurgery ◽

10.1093/ons/opx162 ◽

2017 ◽

Vol 14 (6) ◽

pp. 639-646 ◽

Cited By ~ 2

Author(s):

Michael A Bohl ◽

Randall J Hlubek ◽

Jay D Turner ◽

Edward M Reece ◽

U Kumar Kakarla ◽

...

Keyword(s):

Surgical Treatment ◽

Iliac Crest ◽

Surgical Techniques ◽

Case Series ◽

Recurrent Infection ◽

Surgical Approaches ◽

Spinal Instability ◽

Iliac Crest Graft ◽

Imaging Results ◽

Novel Methods

Abstract BACKGROUND Lumbar osteomyelitis frequently affects patients with medical comorbidities and poor preoperative health. Surgery is indicated when medical management fails or patients present with spinal instability or neural compromise. Successful arthrodesis can be difficult and sometimes requires alternative surgical techniques. OBJECTIVE To report 3 novel methods, each illustrated by a case, for achieving arthrodesis for lumbar osteomyelitis. METHODS A retrospective review was performed of 3 cases of surgical treatment of lumbar osteomyelitis. Novel aspects of the surgical techniques are reported, as are perioperative clinical details and imaging results. RESULTS In the first patient, a vascularized iliac crest graft on a quadratus lumborum pedicle was rotated into the posterolateral fusion bed of the affected level. In the second, an anterior approach with debridement of affected lumbar levels was followed by rotation of a vascularized iliac crest graft on an iliacus muscle pedicle into the anterior lumbar defect. In the third, a structural, nonvascularized iliac crest graft was harvested via a lateral approach to provide better surgical access, and an autologous tricortical bone graft was obtained for placement in the debridement defect. Follow-up imaging suggested successful early incorporation of all the grafts in the fusion beds. CONCLUSION Patients with multiple risk factors for pseudarthrosis and recurrent infection often require alternative surgical strategies to augment fusion. These 3 novel methods for lumbar debridement, fixation, and fusion using vascularized or nonvascularized autograft accommodate posterior, anterior, and lateral surgical approaches. Further experience with these techniques is required to compare outcomes with those of traditional techniques.

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Schwannomas along Different Segments of Facial Nerve: Case Series with Review of Literature

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1061 ◽

2011 ◽

Vol 2 (2) ◽

pp. 103-108 ◽

Cited By ~ 2

Author(s):

Deepa Nair ◽

Prathamesh S Pai ◽

Shawn T Joseph ◽

Aliasgar V Moiyadi

Keyword(s):

Facial Nerve ◽

English Literature ◽

Case Series ◽

Review Of Literature ◽

Delay In Diagnosis ◽

Clinical Presentations ◽

Early Imaging ◽

Facial Nerve Schwannoma ◽

High Degree ◽

Work Up

ABSTRACT Facial nerve schwannomas are rare conditions which can mimic many other conditions. A series of patients with facial nerve schwannomas were treated in our department, all of whom had a delay in diagnosis resulting in a significant morbidity. This prompted us to present this rare case series of schwannomas along different segments of facial nerve and also review the literature on such tumors—the different presentations, work-up issues in management and rehabilitation. A wide text and PubMed English literature-based search was done on the existing literature on facial nerve schwannomas and the summary presented. Facial nerve schwannomas can have multiple clinical presentations with or without a facial paresis. Only a high degree of clinical suspicion and early imaging can lead to this diagnosis. An early diagnosis of facial nerve schwannoma is important as the morbidity associated with the condition as well as the surgery increases with the delay in diagnosis.

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The Surgical Treatment of Posttraumatic Skull Base Defects with Cerebrospinal Fluid Leak

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1606555 ◽

2017 ◽

Vol 79 (02) ◽

pp. 205-216 ◽

Cited By ~ 1

Author(s):

Ashish Thapa ◽

Bing-Xi Lei ◽

Mei-Guang Zheng ◽

Zhong-Jun Li ◽

Zheng-Hao Liu ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Surgical Treatment ◽

Skull Base ◽

Surgical Approach ◽

Common Factors ◽

Csf Leak ◽

Surgical Approaches ◽

Skull Base Defect ◽

The Common ◽

Skull Base Defects

Objectives The objective was to explore further the surgical treatment of posttraumatic skull base defects with cerebrospinal fluid (CSF) leak and to identify the most common factors affecting the surgical treatment of posttraumatic skull base defect with CSF leak retrospectively. Materials and Methods This study included 144 patients with head trauma having skull base defect with CSF leak who had been surgically treated at Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from 1998 to June 2016. There were 113 (78.5%) males and 31 (21.5%) females, with age ranging from 1 to 78 years and mean age of 26.58 ± 14.95 years. We explored the surgical approaches for the treatment of the skull base defect and the graft materials used and also measured the association among surgical approaches; location, size, and type of skull base defects; presence or absence of associated intracranial pathologies; postoperative complications; outcome; age; Glasgow outcome score (GOS) at discharge; and days of hospital stay. Results The location, size, and types of skull base defect and the presence of associated intracranial pathologies were the common factors identified not only for choosing the appropriate surgical approach but also for choosing the materials for defect repair, timing of the surgery, and the method used for the defect as well as leak repair. The statistically significant correlation with p < 0.001 was found in this study. Conclusion From this study, we could conclude that size, location, and types of the defect and the presence of associated intracranial injuries were the common factors that affected the surgical treatment of posttraumatic skull base defect with CSF leak. Hence, the importance of careful evaluation of these factors is essential for proper selection of the surgical approach and for avoiding unnecessary hassles.

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Atypical tumors of the facial nerve: case series and review of the literature

Neurosurgical FOCUS ◽

10.3171/2013.1.focus12380 ◽

2013 ◽

Vol 34 (3) ◽

pp. E2 ◽

Cited By ~ 9

Author(s):

Lindsey Ross ◽

Doniel Drazin ◽

Paula Eboli ◽

Gregory P. Lekovic

Keyword(s):

Facial Nerve ◽

Relevant Literature ◽

Case Series ◽

Retrospective Chart Review ◽

Neurofibromatosis Type ◽

Operative Management ◽

Preoperative Imaging ◽

Diagnostic Features ◽

Facial Nerve Schwannoma

Object The authors present a series of 4 patients with rare facial nerve tumors. The relevant literature is reviewed and is discussed regarding diagnostic features, the role of operative management, and surgical approach. Methods A retrospective chart review was conducted for patients with tumors of the facial nerve that were treated between 2008 and 2011. Patients undergoing observation with serial MRI and those who were treated with up-front radiosurgery and for whom tissue diagnosis was not available were excluded. In addition, patients with suspected vestibular schwannoma, facial nerve schwannoma, neurofibromatosis Type 2, and metastatic disease were also excluded. The charts of 4 patients (2 men and 2 women) with “atypical” tumors were reviewed and analyzed. Results A total of 12 patients with tumors of the facial nerve were identified during the study period. Patient characteristics, preoperative imaging, operative approach, tumor histology, and outcomes are described. Conclusions Atypical facial nerve tumors must be distinguished from the more common facial nerve schwannoma. How the authors of this study treat rare facial nerve tumors is based on their experience with the more common facial nerve schwannomas, characterized by a slow progression of symptoms and growth. Less is known about the rare lesions, and thus a conservative approach may be warranted. Open questions include the role of radiosurgery, facial nerve decompression, and indications for resection of tumor and cable grafting for these rare lesions.

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Outcomes of Arthroscopic Surgical Treatment of Osteochondral Lesions of the Elbow in Pediatric and Adolescent Athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120963054 ◽

2020 ◽

Vol 8 (11) ◽

pp. 232596712096305

Author(s):

Sachin Allahabadi ◽

Jessica K. Bryant ◽

Ashish Mittal ◽

Nirav K. Pandya

Keyword(s):

Surgical Treatment ◽

Demographic Data ◽

Case Series ◽

Return To Sport ◽

High Rate ◽

Osteochondral Lesions ◽

Adolescent Athletes ◽

Activity Restriction ◽

Persistent Symptoms ◽

Sporting Activity

Background: Osteochondral injuries of the elbow are limiting and affect the ability of pediatric and adolescent athletes to participate in sports. Purpose: To report short- and midterm outcomes on athletes undergoing microfracture or fragment fixation of osteochondral elbow lesions and evaluate the effects thereof on sporting activity. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective study analyzing patients who underwent surgical treatment via microfracture or fragment fixation for osteochondral elbow lesions. Patients were treated at a single institution by a single surgeon between 2012 and 2019. Diagnosis was confirmed with magnetic resonance imaging, and patients were indicated for surgery after having persistent symptoms despite trialing rest, immobilization, and/or activity restriction for at least 3 months. Demographic data including sports of choice were collected preoperatively. Imaging and intraoperative findings were documented, and any complications were noted. Range of motion (ROM) was compared pre- to postoperatively. Return-to-sport evaluation included the ability to play the preoperative sport of choice. Results: In total, 23 patients (25 elbows) were included with a mean follow-up of 23.5 months (range, 6-60.3 months) and a mean age of 13.8 years. Of 25 lesions, 20 (80%) were on the athlete’s dominant side. There was significant improvement from pre- to postoperative ROM, including extension (mean ± SD, 6.4° ± 5.3° to 0.04° ± 0.2°; P < .00001), flexion (129.2° ± 10.6° to 138.6° ± 4.4°; P = .00013), and arc of ROM (122.6° ± 13.2° to 138.6° ± 4.4°; P < .00001). Mean lesion size was 81.9 ± 59.3 mm2 (range, 15-225 mm2). All elbows demonstrated radiographic healing postoperatively. Mean time to release to sport was 4.48 ± 1.38 months (range, 2.5-8 months). Six (26.1%) patients changed or stopped their preoperative sporting activity, including 2 of 4 gymnasts and 4 of 11 baseball players. Conclusion: Arthroscopic technique with lesion debridement and microfracture or fixation appears safe and results in radiographic healing; however, with these techniques, there remains a high rate of inability to return to sport in patients involved in higher-demand upper extremity activity, such as baseball and gymnastics. Further treatment strategies, including cartilage restoration procedures, may be warranted in this population.

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Selection of surgical approaches for meningiomas affecting the temporal bone

Otolaryngology ◽

10.1177/019459988910700605.1 ◽

1992 ◽

Vol 107 (6_part_1) ◽

pp. 738-744 ◽

Cited By ~ 17

Author(s):

Moises Arriaga ◽

Clough Shelton ◽

Paul Nassif ◽

Derald E. Brackmann

Keyword(s):

Facial Nerve ◽

Temporal Bone ◽

Surgical Approach ◽

Infratemporal Fossa ◽

Surgical Approaches ◽

Recurrence Rates ◽

Surgical Morbidity ◽

Long Term Outcome ◽

Selection Of

The varied locations of meningiomas within the temporal bone require a wide array of neurotologic approaches to accomplish complete resection with minimal morbidity. We reviewed 56 consecutive patients with temporal bone meningiomas. The six surgical approaches are described with regard to site of lesion, morbidity of procedure, and long-term patient outcome. Recommendations are made for selection of surgical approach. Hearing preservation was attempted in 25%. Middle fossa tumor removal was performed in nine patients (16%), retrosigmoid (suboccipital) in five patients (9%), translabyrinthine In 24 patients (43%), transcochlear in 15 patients (27%), infratemporal fossa In two patients (4%), and retrolabyrinthine In one patient (2%). Overall, meningioma surgery has higher morbidity, poorer facial nerve outcome, and higher recurrence rates than acoustic neuroma surgery. Thirteen percent of patients were unable to resume full preoperative activities after their surgery. Facial nerve transection occurred In 9% of the cases, and 83% of cases with more than 1 year followup had satisfactory or Intermediate facial function (grades I to IV). Meningiomas of the temporal bone are insidious and aggressive lesions. Particular care is required to select the surgical approach appropriate for location, level of hearing, and the anatomic structures Involved. Patients must be realistically counseled about the surgical morbidity and long-term outcome associated with each approach.

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Arthroscopic Brostrom technique

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2020.v14.1147 ◽

2020 ◽

Vol 14 (2) ◽

pp. 138-143

Author(s):

Thiago Penido Moreira Ferreira ◽

Mateus Martins Marcatti ◽

Fabrício Melo Bertolini ◽

Otaviano de Oliveira Junior ◽

Gustavo Araújo Nunes

Keyword(s):

Surgical Treatment ◽

Case Series ◽

High Rate ◽

Tilt Test ◽

Lateral Ligament ◽

Level Of Evidence ◽

Chronic Instability ◽

Anterior Drawer ◽

Ankle Stability

Objective: To present the clinical and functional results of surgical treatment of patients with chronic instability of the ankle using the arthroscopic Brostrom technique. Methods: This is a case series of patients who underwent surgical treatment for chronic instability of the lateral ligament of the ankle using the arthroscopic Brostrom technique. Clinical assessments of ankle stability were performed preoperatively and at the last follow-up using the American Orthopedic Foot and Ankle Score (AOFAS), a visual analog scale (VAS) for pain, and the anterior drawer and talar inversion tilt tests. Surgical complications and patient satisfaction ratings were also analyzed. Results: A total of 16 patients were analyzed, with a mean follow-up of 14 months. There was a statistically significant (p<0.001) improvement in mean AOFAS, which increased from 67.2 to 90.8 points and the mean VAS for pain score reduced from 6.5 to 1.5 points. All ankles were stable and had normal results for the anterior drawer test and the talar inversion tilt test. Three patients (19%) reported that resumption of sporting activities provoked subjective pain in the ankle, which improved progressively during follow-up. Two patients (12.5%) exhibited neurapraxia of the superficial peroneal nerve. A majority of the patients (81%) rated treatment as good or excellent. Conclusion: Treatment of chronic instability of the ankle ligament using the arthroscopic Brostrom technique restored ankle stability and achieved good clinical results. There was a high rate of early complications, but the majority were transitory and underwent complete remission during follow-up. Level of Evidence IV; Therapeutic Studies; Case Series.

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Combination Surgical Procedure for Fourth Branchial Anomalies: Operative Technique and Outcomes

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420971674 ◽

2020 ◽

pp. 000348942097167

Author(s):

Matthew Maksimoski ◽

Sarah E. Maurrasse ◽

Matthew Purkey ◽

John Maddalozzo

Keyword(s):

Surgical Procedure ◽

Residual Disease ◽

Surgical Excision ◽

University Hospital ◽

High Rate ◽

Surgical Approaches ◽

Suppurative Thyroiditis ◽

Complete Surgical Excision ◽

Surgical Methods ◽

Branchial Anomalies

Objective: Branchial apparatus anomalies of the fourth cleft are the rarest subtype of anomaly and occasionally present with suppurative thyroiditis or thyroid abscess due to their relationship with the thyroid gland. Surgical approaches vary and some surgeons favor cauterization of associated pyriform sinus tracts alone versus complete surgical excision. Currently, the literature is scarce and there is limited data on surgical outcomes and procedural steps. Here we describe a combination surgical technique for fourth branchial anomalies including: (1) surgical excision of the cyst and any external pit, (2) hemithyroidectomy, and (3) direct laryngoscopy with cauterization of pyriform apex tract, if present. Methods: A retrospective review was performed on all patients who underwent surgical excision of fourth branchial apparatus lesions (including fistulae, cysts, and sinus tracts) at an urban pediatric university hospital from 2000 to 2019. Data regarding demographics, medical history, surgical methods, complications, and surgical cure rates were collected. Results: A total of 16 patients (9 female, 7 male) underwent a combination surgical procedure for fourth branchial apparatus lesions. Success rate after primary surgery was 94%. One patient had residual disease requiring re-operation. Two patients had post-operative complications: 1 transient vocal fold paresis and 1 seroma, both managed conservatively. A consensus surgical algorithm was created based on operative steps present in the majority of cases. Conclusion: A combination approach to fourth branchial apparatus lesions—including endoscopic cauterization, external excision, and hemithyroidectomy—is safe and provides a high rate of primary cure. Although less invasive options exist, remnants of the branchial lesion, especially in the thyroid, may remain and cause recurrent issues. Therefore, we advocate for complete surgical excision of this rare developmental anomaly, especially when obvious thyroid involvement exists.

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