Preoperative Acetazolamide Challenge in Pediatric Chiari I Malformation

2021 ◽  
pp. 1-6
Author(s):  
Vincent Rossi ◽  
Scott Wait ◽  
Sarah Jernigan ◽  
Mark Van Poppel ◽  
Deborah Pfortmiller ◽  
...  
Keyword(s):  
Pain Score ◽  
Cranial Nerve ◽  
Challenge Test ◽  
Case Series ◽  
Chiari I Malformation ◽  
Inclusion Criteria ◽  
Diagnostic Dilemma ◽  
Chiari 1 Malformation ◽  
Cranial Nerve Dysfunction ◽  
Acetazolamide Challenge

<b><i>Purpose:</i></b> In patients who present with headaches and Chiari 1 malformation without cranial nerve or brainstem dysfunction or syrinx formation, the decision to decompress can be difficult to make. We present a case series examining the use of acetazolamide as a diagnostic aid to determine candidacy for decompression. <b><i>Methods:</i></b> A single pediatric neurosurgeon’s (M.M.H.) experience from 2003 to 2018 was retrospectively reviewed. All cases evaluated in the clinic for CPT code of Chiari 1 malformation were analyzed. Inclusion criteria were patients with diagnosis of Chiari 1 malformation and headache-predominant symptoms who underwent an acetazolamide challenge test. Exclusion criteria included age over 18, syrinx, or significant clinical evidence of brainstem compression or cranial nerve dysfunction. Data were recorded with respect to response to acetazolamide. Surgical outcomes were assessed using the Chicago Chiari Outcome Scale (CCOS) pain category and the improve/same/worse (IWS) scale. Overall satisfaction from surgery was also recorded. <b><i>Results:</i></b> Forty-five patients met inclusion criteria and underwent acetazolamide challenge. Thirty-three (73.3%) patients showed improvement of their symptoms with acetazolamide challenge (responders). Of the 33 responders, 25 (75.8%) underwent Chiari decompression. The remaining 8 (24.2%) responders experienced persistent improvement of their symptoms after the acetazolamide trial and did not require intervention. Twelve (26.7%) patients did not improve with acetazolamide (nonresponders) of which 11 (91.7% of nonreponders) never required intervention. One nonresponder eventually underwent Chiari decompression due to progressively worsening and debilitating headaches. All twenty-five (100%) responders improved after surgery and 24 (96%) were satisfied with the outcome of surgery. The average responder CCOS pain score was 3.52 out of 4. The nonresponder who did not improve with acetazolamide had persistent severe headaches after decompression. The CCOS pain score for this nonresponder was 2 out of 4. <b><i>Conclusion:</i></b> Pediatric headache-predominant Chiari 1 malformation presents a difficult diagnostic dilemma. The authors describe a trial of acetazolamide as a preoperative diagnostic tool to aid the decision to decompress. Further studies will need to be performed to determine the effectiveness of preoperative acetazolamide in identifying which patients may benefit from surgical decompression.

scholarly journals Head and Neck Paragangliomas in the Czech Republic: Management at the Otorhinolaryngology Department

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 28
Author(s):  
Anasuya Guha ◽  
Martin Chovanec
Keyword(s):  
Head And Neck ◽  
Cranial Nerve ◽  
Case Series ◽  
Clinical Aspects ◽  
Benign Tumors ◽  
Tumor Control ◽  
Cranial Nerve Dysfunction ◽  
Critical Issues ◽  
Head And Neck Paragangliomas ◽  
Jugular Paragangliomas

Head and neck paragangliomas (HNPGLs) are rare neuroendocrine tumors, comprising only 3% of all head and neck tumors. Early diagnosis forms an integral part of the management of these tumors. The two main aims of any treatment approach are long-term tumor control and minimal cranial nerve morbidity. The scope of this article is to present our case series of HNPGLs to stress most important clinical aspects of their presentation as well as critical issues of their complex management. Thirty patients with suspected HNPGLs were referred to our otorhinolaryngology clinic for surgical consultation between 2016–2020. We assessed the demographical pattern, clinicoradiological correlation, as well as type and outcome of treatment. A total of 42 non-secretory tumors were diagnosed—16.7% were incidental findings and 97% patients had benign tumors. Six patients had multiple tumors. Jugular paragangliomas were the most commonly treated tumors. Tumor control was achieved in nearly 96% of operated patients with minimal cranial nerve morbidity. Surgery is curative in most cases and should be considered as frontline treatment modality in experienced hands for younger patients, hereditary and secretory tumors. Cranial nerve dysfunction associated with tumor encasement is a negative prognostic factor for both surgery and radiotherapy. Multifocal tumors and metastasis are difficult to treat, even with early detection using genetic analysis. Detecting malignancy in HNPGLs is challenging due to the lack of histomorphological criteria; therefore, limited lymph node dissection should be considered, even in the absence of clinical and radiological signs of metastasis in carotid body, vagal, and jugular paragangliomas.

scholarly journals Failed Latarjet procedure: a systematic review of surgery revision options

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Matteo Buda ◽  
Riccardo D’Ambrosi ◽  
Enrico Bellato ◽  
Davide Blonna ◽  
Alessandro Cappellari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Case Series ◽  
Review Of The Literature ◽  
Inclusion Criteria ◽  
Latarjet Procedure ◽  
Shoulder Stabilization ◽  
Recurrent Instability ◽  
Level Of Evidence ◽  
Radiographic Outcomes

Abstract Background Revision surgery after the Latarjet procedure is a rare and challenging surgical problem, and various bony or capsular procedures have been proposed. This systematic review examines clinical and radiographic outcomes of different procedures for treating persistent pain or recurrent instability after a Latarjet procedure. Methods A systematic review of the literature was performed using the Medline, Cochrane, EMBASE, Google Scholar and Ovid databases with the combined keywords “failed”, “failure”, “revision”, “Latarjet”, “shoulder stabilization” and “shoulder instability” to identify articles published in English that deal with failed Latarjet procedures. Results A total of 11 studies (five retrospective and six case series investigations), all published between 2008 and 2020, fulfilled our inclusion criteria. For the study, 253 patients (254 shoulders, 79.8% male) with a mean age of 29.6 years (range: 16–54 years) were reviewed at an average follow-up of 51.5 months (range: 24–208 months). Conclusions Eden–Hybinette and arthroscopic capsuloplasty are the most popular and safe procedures to treat recurrent instability after a failed Latarjet procedure, and yield reasonable clinical outcomes. A bone graft procedure and capsuloplasty were proposed but there was no clear consensus on their efficacy and indication. Level of evidence Level IV Trial registration PROSPERO 2020 CRD42020185090—www.crd.york.ac.uk/prospero/

scholarly journals Reappearance of Cranial Nerve Dysfunction Symptoms Caused by New Artery Compression More than 20 Years after Initially Successful Microvascular Decompression: Report of Two Cases

2016 ◽  
Vol 56 (2) ◽  
pp. 77-80 ◽  
Author(s):  
Hiroto INOUE ◽  
Akinori KONDO ◽  
Hiroshi SHIMANO ◽  
Soichiro YASUDA ◽  
Kenichi MURAO
Keyword(s):  
Microvascular Decompression ◽  
Cranial Nerve ◽  
Cranial Nerve Dysfunction ◽  
Nerve Dysfunction

scholarly journals Sinus Floor Augmentation—Associated Surgical Ciliated Cysts: Case Series and a Systematic Review of the Literature

2021 ◽  
Vol 11 (4) ◽  
pp. 1903
Author(s):  
Adrian Kahn ◽  
Shlomo Matalon ◽  
Rahaf Bassam Salem ◽  
Lazar Kats ◽  
Liat Chaushu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Microscopic Examination ◽  
Literature Search ◽  
Case Series ◽  
Systematic Literature Search ◽  
Review Of The Literature ◽  
Inclusion Criteria ◽  
Sinus Floor Augmentation ◽  
Sinus Floor

This study aimed to characterize the demographic and clinical features of underreported surgical ciliated cysts developing after sinus floor augmentation, based on a series of cases from our files and a systematic review of the literature. A series of five cases (four patients) of microscopically confirmed surgical ciliated cysts following sinus floor augmentation procedures from our files are described. A systematic literature search (1991–2020) with strict clinical-, radiological- and microscopic-based exclusion and inclusion criteria was performed to detect additional similar cases. The systematic review revealed only five cases that fulfilled the inclusion criteria. Altogether, surgical ciliated cysts associated with sinus floor augmentation have been rarely reported in the literature, and have not been characterized either demographically or clinically. Graft materials were diverse, implants were placed simultaneously, or up to two years post-augmentation. The associated surgical ciliated cysts developed between 0.5 and 10 years post-augmentation. Although limited in its extent, this study is the first series to characterize possible underreported sequelae of surgical ciliated cysts associated with sinus floor augmentation. It emphasizes the need for long post-operative follow-up and confirmation of lesion by microscopic examination.

Persistent triplegia and cranial nerve dysfunction after lysis of epidural adhesions

2021 ◽  
Vol 8 (4) ◽  
Author(s):  
Marco LA GRUA ◽  
Irene GRAZZINI ◽  
Gian L. CUNEO ◽  
Gianfranco SINDACO ◽  
Matteo ZANELLA ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Dysfunction ◽  
Nerve Dysfunction

Reconstructive Techniques of Primary Distal Penile Hypospadias: A Meta-Analysis Study of Last 10 Years

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Omar Goda Hassan Mohammad ◽  
Khaled Ahmed Mahmoud Reyad ◽  
Ahmed Ali Hassan ◽  
Osama Fouad Mohamed Abdelgawad
Keyword(s):  
Meta Analysis ◽  
Surgical Techniques ◽  
Case Series ◽  
Hypospadias Repair ◽  
Inclusion Criteria ◽  
Meatal Stenosis ◽  
Postoperative Fistula ◽  
Distal Hypospadias ◽  
Reported Data ◽  
Reconstructive Techniques

Abstract Background Hypospadias is one of the most common congenital anomalies affecting males worldwide, with distal variants representing up to 70% of all cases. Several surgical techniques are adopted for distal hypospadias repair. However, there is still much controversy about the ideal technique. Objectives The aim of this study is to compare between the most popular reconstructive techniques for distal penile hypospadias repair. Highlighting their effectiveness, in term of success rate as well as the risk of postoperative complications. Methods For this systematic review, PubMed/Medline and ScinceDirect online databases were searched using the keywords ‘distal hypospadias, complications and outcome’. Inclusion criteria were primary repairs; distal hypospadias; pediatric case series and standard techniques. Abstracts of articles identified were reviewed, and then relevant articles were retrieved in full. Papers were only included if data on at least one of the main outcome measures was obtainable, which are postoperative fistula, meatal stenosis and glanular dehiscence. Data were pooled using CMA software, effect sizes were reported as event rates with 95% confidence intervals (CI) been calculated for each outcome. Results A total of 25 studies, which included 4572 patients, met the inclusion criteria. The tubularised incised plate (TIP) was the most commonly adopted procedure followed by the peri-meatal flap (Mathieu). Few studies reported data for other techniques like onlay flap, Thiersch-Duplay, meatal advancement and MAGPI procedures, in addition to urethral mobilization technique. The overall incidence of main complications was 10.5% with comparable results among different techniques. The results are in favor of urethral mobilization and TIP procedures over Mathieu regarding the incidence of both meatal stenosis and post-operative fistula. Overall, the quality of the included studies was determined to be satisfactory. Conclusion Compared with Mathieu technique, urethral mobilization and the TIP procedure for distal penile hypospadias (DPH) reconstruction were associated with a lower risk of overall complications specifically postoperative fistula and meatal stenosis.

Overview of the Relevant Literature on the Possible Role of Acupuncture in Treating Male Sexual Dysfunction

2014 ◽  
Vol 32 (5) ◽  
pp. 406-410 ◽  
Author(s):  
Ming-Yen Tsai ◽  
Chun-Ting Liu ◽  
Cheng-Chieh Chang ◽  
Shih-Yu Chen ◽  
Sheng-Teng Huang
Keyword(s):  
Sexual Dysfunction ◽  
Premature Ejaculation ◽  
Relevant Literature ◽  
Case Series ◽  
Sham Acupuncture ◽  
Risk Of Bias ◽  
Inclusion Criteria ◽  
Male Sexual Dysfunction ◽  
Randomised Controlled

Objective To systematically review scientific reports on the effectiveness of acupuncture to treat male sexual dysfunction. Methods The Medline database was searched for published clinical trials of acupuncture for erectile dysfunction (ED) and premature ejaculation (PE) with English abstracts. Risk of bias was assessed for randomised controlled trials (RCTs). Results Seven studies on two conditions of male sexual dysfunction met the inclusion criteria. Three out of four RCTs were patient-blinded, but all had a high risk of bias. Three suggested that acupuncture has a therapeutic effect as compared with sham acupuncture. Comparisons with paroxetine were inconsistent. Other uncontrolled studies and case series suggested satisfactory improvements of ED and PE after acupuncture. Conclusions Acupuncture appears to have promise for treating male sexual dysfunction, but in view of the small number of studies and their variable quality, doubts remain about its effectiveness. Further studies are justified.

Cranial Nerve Dysfunction in Conscious Galactosemic Rats as Measured by the Auditory-Evoked Brainstem Response

1990 ◽  
Vol 193 (4) ◽  
pp. 264-268
Author(s):  
R. R. Notvest ◽  
J. J. Inserra ◽  
T. A. Emrey ◽  
J. Sredy
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Dysfunction ◽  
Brainstem Response ◽  
Nerve Dysfunction

scholarly journals Tubularized proximally-incised plate in distal/midshaft hypospadias repair

2017 ◽  
Vol 39 (2) ◽  
Author(s):  
Antonio Marte ◽  
Lucia Pintozzi
Keyword(s):  
Perioperative Complications ◽  
Foley Catheter ◽  
Case Series ◽  
Functional Results ◽  
Inclusion Criteria ◽  
Urethral Plate ◽  
Age At Surgery ◽  
Long Term Follow Up

The aim of this study was to verify the validity, feasibility, and the functional results, by uroflowmetry, of Tubularized proximallyincised plate technique in selected case of distal/midshaft hypospadias. Out of 120 patients scheduled to undergo TIP (or Snodgrass) procedure, 23 were selected between January 2013 and January 2016 (19.1%). This case series comprised 16 patients with distal and 7 with midshaft hypospadias. Mean age at surgery was 2.9 years. The inclusion criteria were a deep and wide glandular groove and a proximal narrow urethral plate. The procedure was carried out as described by Snodgrass but the incision of the urethral plate, including the mucosal and submucosal tissue, was made only proximally, between the original meatus and the glandular groove in no case extending to the entire length of the plate. Postoperatively a foley catheter was left in place from 4 to 7 days. Uroflowmetry was performed when the patients age ranged from 2.5 to 5.7 years (mean age 3.11 years and mean follow-up 1.8 years, body surface 2). No patient presented fistulas nor perioperative complications. At uroflowmetry, eighteen patients presented values above the 25<sup>th</sup> percentile and 5 showed a borderline flow. All patients in this group remained stable without urinary symptoms. In selected cases, the tubularized proximally-incised plate yields satisfactory cosmetic and functional results for the treatment of midshaft proximal hypospadias. A long-term follow-up study is needed for further evaluation. Patient selection is crucial for the success of this technique.

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