scholarly journals Treatment of carotid cavernous sinus fistulas with flow diverters. A case report and systematic review

2021 ◽  
pp. 159101992110147
Author(s):  
Theodosios Stamatopoulos ◽  
Evangelos Anagnostou ◽  
Sotirios Plakas ◽  
Konstantinos Papachristou ◽  
Panagiotis Lagos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cavernous Sinus ◽  
Treatment Options ◽  
Embolic Agents ◽  
Endovascular Methods ◽  
Prospective Trials ◽  
Occlusion Rate ◽  
Embolic Materials ◽  
Carotid Cavernous Fistulas

Introduction Carotid cavernous fistulas (CCFs) are rare, usually follow head trauma or aneurysmal rupture. Recent treatment options include endovascular techniques such as flow diversion devices (FDDs). Objective To present our case treated with FDD application with transarterial cavernous-sinus coiling and present a systematic review on the use and effectiveness of FDDs in CCF treatment. Materials and methods We present our case of CCF treatment with FDD. A search was also conducted in PubMed, EMBASE and Cochrane until November 2020. Reference lists were also cross-checked. Results Including our case, thirty-eight patients were identified with a CCF that was treated with FDDs in sixteen studies. Twenty-two patients were females, nine were males and the rest unidentified. The mean age was 52,6 years (range 17–86, SD± 19.28). Thirty-six patients suffered from direct and two from indirect CCFs. Single FDD was used in four cases, single FDD with embolic materials in eleven cases, multiple overlapping FDDs were used in six cases and multiple overlapping FDDs with embolic materials were used in seventeen cases. Thirty-five patients (92,1%) had clinical improvement, immediate angiographic occlusion was seen in 44,7% of the cases, while long-term occlusion rate was 100% but with variable follow-up periods. One patient (2,6%) presented with a neurological deficit related to FDD deployment. Conclusion Targeted treatment of CCFs with single or overlapping FDDs with or without adjunct embolic agents offers a high success rate, both clinically and long-term angiographically compared to other endovascular methods alone. However, further research with multi-center prospective trials is warranted.

scholarly journals Do patients benefit from physiotherapy for shoulder dysfunction following neck dissection? A systematic review

2020 ◽  
Vol 134 (2) ◽  
pp. 104-108
Author(s):  
A S Harris
Keyword(s):  
Systematic Review ◽  
Neck Dissection ◽  
Current Evidence ◽  
Shoulder Dysfunction ◽  
Cost Efficacy ◽  
Prospective Trials ◽  
Randomised Controlled ◽  
Upper Limb Dysfunction ◽  
Term Benefit

AbstractObjectiveAccessory nerve palsy affects a proportion of patients following neck dissection, and results in shoulder dysfunction and regional pain. This project aimed to establish the evidence supporting post-operative physiotherapy for the shoulder following neck dissection.MethodA systematic review was conducted of prospective trials investigating the efficacy of rehabilitation for shoulder or upper limb dysfunction and pain following any type of neck dissection.ResultsA total of 820 papers were identified; through a staged review process, 7 trials were found that fulfilled the inclusion criteria. These included three randomised, controlled trials and four non-randomised studies. Five out of the seven trials demonstrated a statistically significant benefit of physiotherapy.ConclusionCurrent evidence shows a benefit from physiotherapy in patients with shoulder dysfunction following neck dissection. Some evidence suggests progressive resistance is superior to other types of physiotherapy. Long-term benefit and cost efficacy have not been studied.

Medial Sphenoid Ridge Meningiomas: Classification, Microsurgical Anatomy, Operative Nuances, and Long-Term Surgical Outcome in 35 Consecutive Patients

2008 ◽  
Vol 62 (suppl_1) ◽  
pp. ONS38-ONS50 ◽  
Author(s):  
Stephen M. Russell ◽  
Vallo Benjamin
Keyword(s):  
Cavernous Sinus ◽  
Treatment Options ◽  
Morbidity Rate ◽  
Microsurgical Anatomy ◽  
Simpson Grade ◽  
Long Term Follow Up ◽  
Grade Ii ◽  
Sphenoid Ridge

Abstract Objective: On the basis of contemporary multiplanar imaging, microsurgical observations, and long-term follow-up in 60 consecutive patients with sphenoid ridge meningiomas, we propose a modification to Cushing's classification of these tumors. This article will concentrate on patients from this series with global medial sphenoid ridge tumors. Methods: Data were collected prospectively for 35 patients with global meningiomas arising from the medial portion of the sphenoid ridge that were surgically treated between 1982 and 2002. Results: All patients were followed for the entire length of this study (mean, 12.8 yr). The tumor size ranged from 2 to 8 cm (mean, 4.5 cm). Of the 24 patients with purely intradural tumors, four (17%) had Simpson Grade I and 19 had Simpson Grade II resections; 23 (96%) had gross total resections. Of the 11 patients with tumors extending extradurally (i.e., cavernous sinus), one (9%) patient had a Simpson Grade II resection, whereas nine (82%) had Simpson Grade III resections, with the latter being all visible tumor removed except that in the cavernous sinus. One (9%) of these 11 patients had a gross total resection, and 9 (82%) had radical resections, with the latter defined as total removal of all intradural tumor. The overall morbidity rate was 18%. There was no surgical mortality or symptomatic cerebral infarction. Conclusion: An accurate classification of global medial sphenoid meningiomas is mandatory to gain insight into their clinical behavior and for understanding the long-term efficacy and safety of available treatment options. Primary medial sphenoid ridge tumors consistently involve the unilateral arteries of the anterior cerebral circulation, and therefore, the resection of tumor from around these arteries is the most important operative nuance for their safe excision.

Onyx embolization of a carotid cavernous fistula via direct transorbital puncture

2011 ◽  
Vol 114 (1) ◽  
pp. 129-132 ◽  
Author(s):  
Mohamed Samy Elhammady ◽  
Eric C. Peterson ◽  
Mohammad Ali Aziz-Sultan
Keyword(s):  
Cavernous Sinus ◽  
Sinus Thrombosis ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Ethylene Vinyl Alcohol ◽  
Embolic Agents ◽  
Superior Petrosal Sinus ◽  
Carotid Cavernous Fistulas ◽  
Transvenous Approach ◽  
Pterygoid Plexus

The treatment of indirect carotid cavernous fistulas (CCFs) is challenging and primarily accomplished by endovascular means utilizing a variety of embolic agents. Transvenous access to the cavernous sinus is the preferred method of embolizaiton of indirect CCFs as they are frequently associated with numerous small-caliber meningeal branches. Although the inferior petrosal sinus is the simplest, shortest, and most commonly used venous route to the cavernous sinus, the superior ophthalmic vein, superior petrosal sinus, basilar plexus, and pterygoid plexus present other endovenous options. Occasionally, however, use of these venous routes may not be possible due to vessel tortuosity or sinus thrombosis and occlusion. The authors report a case of an indirect CCF that could not be treated endovascularly due to inability to access the cavernous sinus via a transfemoral transvenous approach. Angiography revealed a small, deeply located superior ophthalmic vein that was thought to be suboptimal for a direct cutdown. The cavernous sinus was cannulated directly via a transorbital approach using fluoroscopic guidance with a 3D skull reconstruction overlay. The fistula was subsequently obliterated using ethylene vinyl alcohol copolymer (Onyx). The technique and advantages of both 3D osseous reconstruction as well as Onyx embolization are discussed.

scholarly journals Long-Term Non-progression in Metastatic Breast Cancer Beyond 5 Years: Case Series and Review

2021 ◽  
Author(s):  
Alexander Sytov ◽  
Christiana Brenin ◽  
Trish Millard ◽  
Shayna Showalter ◽  
Patrick Dillon
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Treatment Options ◽  
Case Series ◽  
Metastatic Breast ◽  
Small Subset ◽  
Term Survival ◽  
Disease Characteristics ◽  
Prospective Trials

Abstract Purpose of review Metastatic breast cancer (MBC) was traditionally viewed as homogeneously progressive and incurable among all comers, but there is new evidence that MBC harbors a range of tumor molecular/immune subtypes and degrees of aggressiveness. Thus, MBC is not rapidly fatal in all affected patients. Recent findings A small subset of patients will attain long-term disease control, or undetectable disease, and will enjoy a prolonged survival with little disability from their disease or treatment. Though the term is controversial, some patients with long-term non-detectable disease may effectively be considered “cured”. To best advise treatment options in these patients, it is imperative to identify patients most likely to benefit from aggressive treatment. Summary In this review, we delineate the clinical, pathologic, and disease characteristics associated with long-term non-progression in MBC. We include a single institution case series of long-term non-progressive MBC patients and their characteristics as an example of the frequency of this sub-population of MBC. Future prospective trials are warranted to examine the utility of clinical characteristics as predictors of long-term survival in MBC.

scholarly journals Transarterial Onyx Embolization of Intracranial Dural Fistulas: A Prospective Cohort, Systematic Review, and Meta-Analysis

Neurosurgery ◽  
2017 ◽  
Vol 82 (6) ◽  
pp. 854-863 ◽  
Author(s):  
Udi Sadeh-Gonike ◽  
Nicolas Magand ◽  
Xavier Armoiry ◽  
Roberto Riva ◽  
Paul Emile Labeyrie ◽  
...  
Keyword(s):  
Systematic Review ◽  
Endovascular Treatment ◽  
Recurrence Rate ◽  
Meta Analysis ◽  
Transarterial Embolization ◽  
Morbidity And Mortality ◽  
Complication Rates ◽  
Clinical Registry ◽  
Occlusion Rate

Abstract BACKGROUND Onyx is important embolic material in the endovascular treatment of intracranial dural arteriovenous fistula (DAVF). However, its impact on DAVF occlusion rates, morbidity, mortality, and complication rates is not fully examined. OBJECTIVE To improve understanding of safety and effectiveness profiles associated with transarterial endovascular treatment using Onyx for intracranial DAVF METHODS We analyzed data from our prospective clinical registry and conducted a systematic review of all previous transarterial embolization studies using Onyx published between January 2005 and December 2015 in MEDLINE and EMBASE. RESULTS In the prospective study, 41 transarterial procedures were performed in 33 consecutive patients harboring 36 DAVFs. Complete initial exclusion was obtained in 32 of 36 (88.9%) fistulas; 31 fistulas were followed up showing 4 (12.9%) recurrences. Procedure-related morbidity and mortality were 3% and 0%, respectively. The literature review identified 19 studies involving a total of 425 patients with 463 DAVFs. Meta-analysis, including our registry data, showed an initial complete occlusion rate of 82% (95% confidence interval [CI]: 74%, 88%; I2, 70.6%), and recurrence rate at midterm of 2% (95% CI: 0%, 5%; I2, 21.5%). Pooled postoperative neurological deficit, procedure-related morbidity, and mortality rates were 4% (95% CI: 2%, 6%; I2, 0%), 3% (95% CI: 1%, 5%; I2, 0%), and 0%, respectively. CONCLUSION This meta-analysis suggests that transarterial embolization with Onyx is a safe treatment modality for DAVFs. Although Onyx showed a low recurrence rate at midterm, the long-term risk is poorly addressed in our study and should warrant a longer follow-up.

scholarly journals Comparative effectiveness of treatment options for plantar heel pain: a systematic review with network meta-analysis

2018 ◽  
Vol 53 (3) ◽  
pp. 182-194 ◽  
Author(s):  
Opeyemi O Babatunde ◽  
Amardeep Legha ◽  
Chris Littlewood ◽  
Linda S Chesterton ◽  
Martin J Thomas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Comparative Effectiveness ◽  
Meta Analysis ◽  
Treatment Options ◽  
Heel Pain ◽  
Medium Term ◽  
Sham Control ◽  
Short Term ◽  
Plantar Heel Pain

ObjectiveTo evaluate the comparative effectiveness of current treatment options for plantar heel pain (PHP).DesignSystematic review and network meta-analysis (NMA).Data sourcesMedline, EMBASE, CINAHL, AMED, PEDro, Cochrane Database, Web of Science and WHO Clinical Trials Platform were searched from their inception until January 2018.Study selectionRandomised controlled trials (RCTs) of adults with PHP investigating common treatments (ie, corticosteroid injection, non-steroidal anti-inflammatory drugs, therapeutic exercise, orthoses and/or extracorporeal shockwave therapy (ESWT)) compared with each other or a no treatment, placebo/sham control.Data extraction and analysisData were extracted and checked for accuracy and completeness by pairs of reviewers. Primary outcomes were pain and function. Comparative treatment effects were analysed by random effects NMA in the short term, medium term and long term. Relative ranking of treatments was assessed by surface under the cumulative ranking probabilities (0–100 scale).ResultsThirty-one RCTs (total n=2450 patients) were included. There was no evidence of inconsistency detected between direct and indirect treatment comparisons in the networks, but sparse data led to frequently wide CIs. Available evidence does not suggest that any of the commonly used treatments for the management of PHP are better than any other, although corticosteroid injections, alone or in combination with exercise, and ESWT were ranked most likely to be effective for the management of short-term, medium-term and long-term pain or function; placebo/sham/control appeared least likely to be effective; and exercise appeared to only be beneficial for long-term pain or function.ConclusionsCurrent evidence is equivocal regarding which treatment is the most effective for the management of PHP. Given limited understanding of long-term effects, there is need for large, methodologically robust multicentre RCTs investigating and directly comparing commonly used treatments for the management of PHP.PROSPERO registration numberCRD42016046963.

scholarly journals Therapy of clinical stage IIA and IIB seminoma: a systematic review

2021 ◽  
Author(s):  
Julia Heinzelbecker ◽  
Stefanie Schmidt ◽  
Julia Lackner ◽  
Jonas Busch ◽  
Carsten Bokemeyer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Comparative Studies ◽  
Randomized Clinical Trials ◽  
Clinical Stage ◽  
Treatment Options ◽  
Survival Rates ◽  
Treatment Modalities ◽  
Retroperitoneal Lymph Node Dissection ◽  
Cancer Specific Survival

Abstract Purpose The optimal treatment for clinical stage (CS) IIA/IIB seminomas is still controversial. We evaluated current treatment options. Methods A systematic review was performed. Only randomized clinical trials and comparative studies published from January 2010 until February 2021 were included. Search items included: seminoma, CS IIA, CS IIB and therapy. Outcome parameters were relapse rate (RR), relapse-free (RFS), overall and cancer-specific survival (OS, CSS). Additionally, acute and long-term side effects including secondary malignancies (SMs) were analyzed. Results Seven comparative studies (one prospective and six retrospective) were identified with a total of 5049 patients (CS IIA: 2840, CS IIB: 2209). The applied treatment modalities were radiotherapy (RT) (n = 3049; CS IIA: 1888, CSIIB: 1006, unknown: 155) and chemotherapy (CT) or no RT (n = 2000; CS IIA: 797, CS IIB: 1074, unknown: 129). In CS IIA, RRs ranged from 0% to 4.8% for RT and 0% for CT. Concerning CS IIB RRs of 9.5%–21.1% for RT and of 0%–14.2% for CT have been reported. 5-year OS ranged from 90 to 100%. Only two studies reported on treatment-related toxicities. Conclusions RT and CT are the most commonly applied treatments in CS IIA/B seminoma. In CS IIA seminomas, RRs after RT and CT are similar. However, in CS IIB, CT seems to be more effective. Survival rates of CS IIA/B seminomas are excellent. Consequently, long-term toxicities and SMs are important survivorship issues. Alternative treatment approaches, e.g., retroperitoneal lymph node dissection (RPLND) or dose-reduced sequential CT/RT are currently under prospective investigation.

Transvenous embolization of dural carotid cavernous fistulas: the role of liquid embolic agents in association with coils on patient outcomes

2017 ◽  
Vol 10 (5) ◽  
pp. 461-462 ◽  
Author(s):  
Luís Henrique de Castro-Afonso ◽  
Felipe Padovani Trivelato ◽  
Marco Túlio Rezende ◽  
Alexandre Cordeiro Ulhôa ◽  
Guilherme Seizem Nakiri ◽  
...  
Keyword(s):  
Nerve Palsy ◽  
Complication Rates ◽  
Transvenous Embolization ◽  
Embolic Material ◽  
Ocular Symptoms ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Embolic Materials ◽  
Carotid Cavernous Fistulas

IntroductionTransvenous embolization is the standard treatment for dural carotid cavernous fistulas (DCCF). Although various embolic materials have been used, the best embolic material for the treatment of DCCF is still unknown.ObjectiveTo assess the safety and efficacy of different embolic materials used for the endovascular treatment of DCCF.MethodsA retrospective data analysis of a consecutive series of 62 patients presenting DCCF was performed. Clinical and radiological data from patients were assessed, and the embolic material used—coils or liquids—were compared between two groups of patients.ResultsComplete angiographic occlusion of DCCF after treatment was achieved in 83.9% of the patients (52/62). We found a higher rate of complete occlusion of DCCF when liquids were associated with coils than with coils alone (96.5% vs 71.8%, p=0.01), and no differences in complication rates or clinical outcomes were seen between the two groups. At the 6-month follow-up, we found a higher rate of improvement in ocular symptoms compared with cranial nerve palsy improvement (94.7% vs 77.7%, p=0.02). Two patients (3.2%) had treatment-related complications without clinical symptoms.ConclusionIn this study, in comparison with the use of coils alone, the association of transvenous embolization with liquid embolic agents for DCCF treatment resulted in higher rates of complete occlusion without increasing complication rates. The clinical outcome at the 6-month follow-up showed significant improvement in ocular symptoms over cranial nerve palsy regression, which was independent of the embolic agent chosen for treatment.

scholarly journals Advances in the endovascular treatment of direct carotid-cavernous fistulas

2016 ◽  
Vol 62 (1) ◽  
pp. 78-84 ◽  
Author(s):  
Guilherme Brasileiro de Aguiar ◽  
Maurício Jory ◽  
João Miguel de Almeida Silva ◽  
Mario Luiz Marques Conti ◽  
José Carlos Esteves Veiga
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Treatment Options ◽  
High Flow ◽  
Endovascular Techniques ◽  
Carotid Cavernous Fistulas ◽  
Carotid Flow ◽  
The Ideal

SUMMARY Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus. They are considered direct when there is a direct connection between the internal carotid artery and the cavernous sinus. These cases are generally traumatic. Direct CCFs are high-flow lesions, possibly related to intracranial bleeding, visual loss, corneal exposure or even fatal epistaxis. Treatment of such lesions is, thus, always recommended. The ideal treatment for direct CCF is to exclude the fistula from circulation, preserving the carotid flow. This can be attained using diverse endovascular techniques. The objective of the present article is to review the current techniques for treatment of direct CCFs, with special attention to the currently available endovascular treatment options.

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