Superior oblique split tendon elongation for Brown’s syndrome: Long-term outcomes

2021 ◽  
pp. 112067212199105
Author(s):  
Biana Dubinsky-Pertzov ◽  
Eran Pras ◽  
Yair Morad
Keyword(s):  
Intraoperative Complications ◽  
Long Term Outcomes ◽  
Superior Oblique Palsy ◽  
Primary Position ◽  
Age At Surgery ◽  
Tendon Elongation ◽  
Acceptable Outcome ◽  
Superior Oblique

Purpose:To report the outcomes of superior oblique split tendon elongation in Brown’s syndrome.Methods:Charts of 17 consecutive Brown’s syndrome patients who underwent superior oblique split tendon elongation were reviewed and clinical data regarding preoperative, intraoperative, and postoperative data were collected.Results:About 17 eyes of 17 children with congenital Brown’s syndrome underwent superior oblique split tendon elongation between January 2012 and March 2020 by a single surgeon. Mean age at surgery was 5.47 ± 2.82 (range 1.50–13.2). Eight (47.1%) were female. Preoperative deficit of elevation in adduction was −4 in all children. At the end of surgery, all eyes were freely elevated on adduction, on forced duction test. Mean follow-up time of 26.24 ± 11.22 (range 11–53) months. In 15 of 17 children (88.2%), motility improved, orthotropia in primary position was achieved, and head posture eliminated ( p < 0.001). Superior oblique palsy occurred in two children, who after reoperation, achieved an acceptable outcome. No intraoperative complications were recorded.Conclusion:The superior oblique split tendon elongation procedure is a useful surgical technique with stable and satisfying outcomes for the treatment of severe congenital Brown’s syndrome.

A single inferior rectus muscle surgery for treatment of congenital superior oblique palsy with small deviation in primary position

2021 ◽  
pp. 112067212110143
Author(s):  
Lijuan Huang ◽  
Yuyu Wu ◽  
Ningdong Li
Keyword(s):  
Rectus Muscle ◽  
Head Position ◽  
Superior Oblique Palsy ◽  
Inferior Rectus ◽  
Primary Position ◽  
Class V ◽  
Abnormal Head ◽  
Inferior Rectus Muscle ◽  
Superior Oblique

Purpose: To evaluate outcomes of one muscle surgery for treatment of congenital superior oblique palsy (SOP) with Knapp Class V. Methods: Medical records were retrospectively reviewed for the patients with the congenital SOP type V who underwent surgical treatment through one muscle surgery between July 2015 and September 2020. The surgical procedure was resection-recession on the contralateral inferior rectus muscle of the hypertrophic or paretic eye. Vertical alignment at nine cardinal gaze positions, and resolution of the abnormal head posture were evaluated pre- and postoperatively. The follow-up was scheduled regularly at postoperative day 1, 1 week, 1 month, and followed by 2-month intervals until 18 months. Results: Twelve patients were included in this study, with a mean age of 6.4 years (range from 3 to 10 years). The mean follow-up period was 10.5 months after surgery (range from 6 to 18 months). The average vertical deviation at primary position was 6.33△ ± 2.93△ preoperatively and 0.75△ ± 1.14△ postoperatively ( p < 0.05). The average vertical deviation at downgaze was 23.33△ ± 4.75△ preoperatively and 1.92△ ± 1.62△ postoperatively ( p < 0.05). All patients had an abnormal head position preoperatively. Postoperative results indicated that the patients’ abnormal head position had been improved significantly. Conclusions: The surgical procedure of resection-recession on a single inferior rectus muscle is a successful intervention for the correction of superior oblique palsy (SOP) with Knapp Class V.

scholarly journals The radiological outcomes of one-stage posterior-only hemivertebra resection and short segmental fusion for lumbosacral hemivertebra: a minimum of 5 years of follow-up

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Yu Wang ◽  
Zhen Liu ◽  
Changzhi Du ◽  
Benlong Shi ◽  
Xu Sun ◽  
...  
Keyword(s):  
Congenital Scoliosis ◽  
Long Term Outcomes ◽  
Short Term ◽  
One Stage ◽  
Hemivertebra Resection ◽  
Age At Surgery ◽  
The Mean ◽  
Upper Instrumented Vertebra

Abstract Background Previous studies have reported favorable short-term outcomes after posterior-only hemivertebra resection and short fusion in patients with LSHV. However, there is a paucity of data evaluating the long-term outcomes following this procedure. The aim of the study is to evaluate the radiological outcomes following posterior-only hemivertebra resection and short fusion for the treatment of congenital scoliosis (CS) secondary to lumbosacral hemivertebra (LSHV) with a minimum of a 5-year follow-up. Methods A total of 23 patients treated with one-stage posterior-only LSHV resection and short fusion with a minimum of a 5-year follow-up were reviewed. Radiographic parameters including the Cobb angles of the lumbosacral curve and compensatory curve, the upper instrumented vertebra (UIV) tilt, and trunk shift were measured. The complications were recorded accordingly. Results The mean duration of follow-up was 88.6 ± 28.5 months, and the average age at surgery was 7.8 ± 3.5 years. Fusion levels averaged 3.0 ± 0.7 segments. The lumbosacral curve was corrected from 30.7 ± 10.4° to 6.7 ± 7.1° after surgery (P < 0.001), 7.3 ± 6.1° 2 years after surgery, and 8.1 ± 7.0° at the last follow-up. The compensatory curve was spontaneously corrected from 23.7 ± 9.4° before surgery to 8.3 ± 5.2° after surgery (P < 0.001). However, the angle slightly increased to 9.0 ± 4.8° 2 years after surgery and to 9.6 ± 6.4° at the last follow-up. Trunk shift was improved from 27.3 ± 8.6 mm before surgery to 11.7 ± 9.4 mm after surgery, and it decreased to 10.8 ± 8.2 mm 2 years after surgery and 10.4 ± 8.8 mm at the last follow-up. One patient experienced transient neurologic deficits after surgery. One patient was observed to have screw loosening at 1-year follow-up and received revision surgery. Conclusion One-stage posterior-only hemivertebra resection with short fusion is an effective procedure for LSHV, and the correction can be well maintained during longitudinal follow-up. Great attention should be paid to the restoration of lumbosacral horizontalization.

scholarly journals Laparoscopically assisted uterovaginal canalization and vaginoplasty for patients with congenital cervical and vaginal atresia: a step-by-step guide and long-term outcomes

2020 ◽  
Author(s):  
Jia Kang ◽  
Na Chen ◽  
Ye Zhang ◽  
Congcong Ma ◽  
Yidi Ma ◽  
...  
Keyword(s):  
Intraoperative Complications ◽  
Long Term Outcomes ◽  
Vaginal Atresia ◽  
Vaginal Length ◽  
Gynecological Examination ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
Febrile Morbidity

Abstract Objective: To study the long-term outcomes of laparoscopically assisted uterovaginal canalization and vaginoplasty in patients with congenital cervical and vaginal atresia and to introduce the surgery step-by-step.Methods: A prospective observational study was conducted including 10 patients diagnosed with congenital cervical and vaginal atresia underwent laparoscopically assisted cervicovaginal canalization between January 2016 and Jun 2020 in a tertiary teaching hospital. Clinical characteristics and perioperative data were recorded. Patients were followed up in outpatient clinic at 3, 6 and 12 months postoperatively, and once a year thereafter. Menstruation cycles and degree of dysmenorrhea were recorded. Gynecological examination was performed to measure vaginal length and to examine whether there was restenosis.Results: All procedures went smoothly, with no case requiring conversion to laparotomy or no intraoperative complications occurred. Postoperative febrile morbidity occurred in one patient (1/10, 10%). The median (quartile) follow-up time was 26.0 (21.3, 48.3) months. All patients resumed menstruation, including nine patients (9/10, 90%) with regular monthly menstruation. Eight patients (8/10, 80%) experienced mild-to-moderate dysmenorrhea; the remaining 2 patients (2/10, 20%) had no dysmenorrhea. Cervical restenosis occurred in one patient (1/10,10%) 12 months postoperatively, and cervical dilation was performed. So far, eight months after the second surgery, no restenosis has been found. The mean postoperative vaginal length was 7.9 ± 1.3 cm by the time of last follow up. Only one patient prepared for pregnancy for two years, but she had not conceived yet.Conclusion: Laparoscopically assisted uterovaginal canalization and vaginoplasty is an easy, safe and promising management option for correcting congenital cervical and vaginal atresia.

Recurrent Ventral Curvature with Long-Term Follow-up after Transverse Preputial Island Urethroplasty

2019 ◽  
Vol 30 (05) ◽  
pp. 429-433
Author(s):  
Chaoxu Wang ◽  
Hongcheng Song ◽  
Weiping Zhang
Keyword(s):  
Island Flap ◽  
Surgical Reconstruction ◽  
Long Term Outcomes ◽  
Urethral Plate ◽  
Urethral Strictures ◽  
Primary Surgery ◽  
Age At Surgery ◽  
Long Term Follow Up

Abstract Objective This study was aimed to assess the long-term outcomes of recurrent ventral curvature (VC) repaired in early childhood after transverse preputial island flap urethroplasty. Materials and Methods A total of 378 patients underwent transverse preputial island flap urethroplasty between January 2000 and January 2005 at our hospital. Of these patients, 43 were invited for assessment of VC after puberty. The age at surgery, types of hypospadias, degrees of recurrent VC, and surgical procedures were analyzed. Results The study included 43 patients with a mean age of 15.9 years (range, 12.3–17.9). The average age at the time of primary surgery was 1.9 years (range, 1.2–3.6). Of 43 patients, recurrent VC was identified in 14 (32.5%). In total, 8 out of 16 patients (50.0%) were successfully treated by urethral plate transection with skin release during the primary surgery, and 6 out of 27 patients (28.6%) underwent additional dorsal plication (DP; p = 0.093). Severe recurrent VC was observed in four, moderate curvature was observed in four, and mild curvature was observed in six cases. Recurrent VC was present more often in patients with complications (34.6 vs. 24.1%, p = 0.331), especially in severe urethral strictures that required open surgical reconstruction (p = 0.039). Conclusion Although the patients in our study represent only a small portion of the overall hypospadias population, it is notable that 32.5% of these patients showed recurrent VC, including 28.6% of patients with transection plus DP. We suggest long-term follow-up of hypospadias at least during adolescence or even into adulthood.

Comparison of Perioperative Outcomes and Parental Satisfaction Outcomes of Strip Craniectomy with Postoperative Helmet versus Spring-Mediated Remodeling in Sagittal Craniosynostosis

2021 ◽  
pp. 1-8
Author(s):  
Luke G.F. Smith ◽  
Varun Shah ◽  
Helen Duenas ◽  
Amanda Onwuka ◽  
Anne E. Graver ◽  
...  
Keyword(s):  
Parental Satisfaction ◽  
Outcome Data ◽  
Perioperative Outcomes ◽  
Long Term Outcomes ◽  
Sagittal Craniosynostosis ◽  
Estimated Blood Loss ◽  
Age At Surgery ◽  
Strip Craniectomy

<b><i>Introduction:</i></b> We sought to compare outcomes and parental satisfaction between 2 approaches for sagittal craniosynostosis: strip craniectomy with spring-mediated skull remodeling (SMSR) and strip craniectomy with postoperative helmet (SCH). <b><i>Methods:</i></b> Perioperative and outcome data for SMSR or SCH patients between September 2010 and July 2019 were retrospectively reviewed. A telephone survey was administered to parents of children who underwent both procedures. <b><i>Results:</i></b> A total of 62 children were treated for sagittal craniosynostosis by either SMSR (<i>n</i> = 45) or SCH (<i>n</i> = 17). The SCH group had a lower estimated blood loss (27 vs. 47.06 mL, <i>p</i> = 0.021) and age at surgery (13.0 vs. 19.8 weeks) than the SMSR group. Three patients underwent early springs removal due to trauma or dislodgement, all of whom converted to helmeting. Of the 62 children initially identified, 59 were determined to have an adequate follow-up time to assess long-term outcomes. The mean follow-up time was 30.1 months (<i>n</i> = 16) in the SCH group and 32.0 months in the SMSR group (<i>n</i> = 43, <i>p</i> = 0.39). Two patients in the SCH group and one in the SMSR group converted to open cranial vault reconstruction. Thirty parents agreed to respond to the satisfaction survey (8 SCH, 22 SMSR) based on a Likert scale of responses (0 being most dissatisfied possible, 4 most satisfied possible). Average satisfaction was 3.86/4.0 in the SCH group and 3.45/4.0 in the SMSR group. No parents in the SCH group would change to SMSR, while 3 of the 22 SMSR survey responders would have changed to SCH. <b><i>Conclusions:</i></b> Perioperative outcomes and average parental satisfaction were similar in both groups. Importance of helmet wear compliance and risk of spring dislodgement should be discussed with parents.

Periprocedural risk and long-term outcome of intracranial angioplasty based on a single-centre experience

VASA ◽  
2013 ◽  
Vol 42 (4) ◽  
pp. 264-274
Author(s):  
Dagmar Krajíčková ◽  
Antonín Krajina ◽  
Miroslav Lojík ◽  
Martina Mulačová ◽  
Martin Vališ
Keyword(s):  
Death Rate ◽  
Long Term Outcomes ◽  
Single Centre ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis ◽  
Angioplasty And Stenting ◽  
Aggressive Medical Management ◽  
Stroke Death

Background: Intracranial atherosclerotic stenosis is a major cause of stroke and yet there are currently no proven effective treatments for it. The SAMMPRIS trial, comparing aggressive medical management alone with aggressive medical management combined with intracranial angioplasty and stenting, was prematurely halted when an unexpectedly high rate of periprocedural events was found in the endovascular arm. The goal of our study is to report the immediate and long-term outcomes of patients with ≥ 70 % symptomatic intracranial atherosclerotic stenosis treated with balloon angioplasty and stent placement in a single centre. Patients and methods: This is a retrospective review of 37 consecutive patients with 42 procedures of ballon angioplasty and stenting for intracranial atherosclerotic stenosis (≥ 70 % stenosis) treated between 1999 and 2012. Technical success (residual stenosis ≤ 50 %), periprocedural success (no vascular complications within 72 hours), and long-term outcomes are reported. Results: Technical and periprocedural success was achieved in 90.5 % of patients. The within 72 hours periprocedural stroke/death rate was 7.1 % (4.8 % intracranial haemorrhage), and the 30-day stroke/death rate was 9.5 %. Thirty patients (81 %) had clinical follow-up at ≥ 6 months. During follow-up, 5 patients developed 6 ischemic events; 5 of them (17 %) were ipsilateral. The restenosis rate was 27 %, and the retreatment rate was 12 %. Conclusions: Our outcomes of the balloon angioplasty/stent placement for intracranial atherosclerotic stenosis are better than those in the SAMMPRIS study and compare favourably with those in large registries and observational studies.

Risk scoring by CHADS2 and CHA2DS2-VASc as predictors for long-term outcomes after surgical ablation for atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Lauritzen ◽  
H.J Vodstrup ◽  
T.D Christensen ◽  
M Onat ◽  
R Christensen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Isolation Procedure ◽  
Survival Times ◽  
Long Term Outcomes ◽  
Surgical Ablation ◽  
Follow Up Study ◽  
Risk Scoring

Abstract Background Following catheter ablation for atrial fibrillation (AF), CHADS2 and CHA2DS2-VASc have utility in predicting long-term outcomes. However, it is currently unknown if the same holds for patients undergoing surgical ablation. Purpose To determine whether CHADS2 and CHA2DS2-VASc predict long-term outcomes after surgical ablation in concomitance with other cardiac surgery. Methods In this prospective, follow-up study, we included patients who underwent biatrial ablation - or pulmonary vein isolation procedure concomitantly with other cardiac surgery between 2004 and 2018. CHADS2 and CHA2DS2-VASc scores were assessed prior to surgery and categorized in groups as 0–1, 2–4 or ≥5. Outcomes were death, AF, and AF-related death. Follow-up was ended in April 2019. Results A total of 587 patients with a mean age of 68.7±0.4 years were included. Both CHADS2 and CHA2DS2-VASc scores were predictors of survival p=0.005 and p&lt;0.001, respectively (Figure). For CHADS2, mean survival times were 5.9±3.7 years for scores 0–1, 5.0±3.0 years for scores 2–4 and 4.3±2.6 years for scores ≥5. For CHA2DS2-VASc mean survival times were 7.3±4.0 years for scores 0–1, 5.6±2.9 years for scores 2–4 and 4.8±2.1 years for scores ≥5. The incidence of death was 20.1% for CHADS2 0–1, 24.8% for CHADS2 2–4, and 35.3% for CHADS2 ≥5, p=0.186. The incidence of AF was 50.2% for CHADS2 0–1, 47.9% for CHADS2 2–4, and 76.5% for CHADS2 ≥5, p=0.073. The incidence of AF related death was 13.0% for CHADS2 0–1, 16.8% for CHADS2 2–4, and 35.3% for CHADS2 ≥5, p=0.031. The incidence of death was 16.8% for CHA2DS2-VASc 0–1, 26.2% for CHA2DS2-VASc 2–4, and 45.0% for CHA2DS2-VASc ≥5, p=0.001. The incidence of AF was 49.6% for CHA2DS2-VASc 0–1, 52.5% for CHA2DS2-VASc 2–4, and 72.5% for CHA2DS2-VASc ≥5, p=0.035. The incidence of AF related death was 12.2% for CHA2DS2-VASc 0–1, 16.0% for CHA2DS2-VASc 2–4, and 42.5% for CHA2DS2-VASc ≥5, p&lt;0.001. Conclusion Both CHADS2 and CHA2DS2-VASc scores predict long-term outcomes after surgical ablation for AF. However, CHA2DS2-VASc was superior in predicting death, AF, and AF-related death. Survival curves Funding Acknowledgement Type of funding source: None

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