scholarly journals Arthroscopically Assisted Treatment of Complex Ankle Fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0038
Author(s):  
Hans Polzer ◽  
Sebastian Baumbach ◽  
Mareen Braunstein
Keyword(s):  
Ankle Fractures ◽  
Secondary Outcome ◽  
Chondral Lesions ◽  
Standardized Protocol ◽  
Trimalleolar Fractures ◽  
Arthroscopic Findings ◽  
Arthroscopically Assisted ◽  
The Mean ◽  
Lost To Follow Up

Category: Arthroscopy Introduction/Purpose: Especially after complex ankle fractures, patients suffer from residual pain, swelling and stiffness. Evidence suggests that this poor outcome might be related to occult intraarticular injuries. Recent studies documented chondral lesions in up to 89%. Therefore, many authors emphasize the value of ankle arthroscopy in acute fracture treatment (AORIF). Only few studies reported on the findings of AORIF, even less documented the subjective and objective outcome thereafter. Aim of this study was to evaluate the intraarticular lesions and the results following AORIF for complex ankle fractures after 1-year of follow-up. Methods: Patients presenting with closed, complex ankle fractures were included. AORIF was performed following a standardized protocol. Primary outcome was the AOFAS Score. Secondary outcome parameters were the Olerud and Molander Score, Tegner activity scale, arthroscopic findings, functional assessment and complications. Statistical analysis was performed using SSPS 22.0 (IBM). Results: Between 05/13-12/14, 32 patients were enrolled (56% female, 45±16 years). Three patients were lost to follow-up. 16% suffered from uni-, 22% from bi- and 62% from trimalleolar fractures. Chondral lesions were observed in 91% (ICRS 2.9±0.9). In 34% micro fracturing was performed. Full thickness lesions were observed exclusively in in bi- and trimalleolar fractures. Three patients suffered from minor complications. After 1 year, the mean AOFAS was 93±6 and the mean OMAS was 88±8. Linear regression revealed no significant variables affecting the outcome. Conclusion: Intra-articular injuries are common in complex ankle fractures requiring chondral therapy in 34%. AORIF leads to good-excellent results in all but one patient, including those with bi- and trimalleolar fractures without increasing the risk for complications.

scholarly journals Acute retrograde tibiotalocalcaneal nailing in osteoporotic periarticular ankle fractures

2020 ◽  
Vol 14 (2) ◽  
pp. 117-122
Author(s):  
Mario Herrera-Perez ◽  
Pablo Martín-Vélez ◽  
Diego Rendón-Díaz ◽  
José Luis Pais-Brito
Keyword(s):  
Case Series ◽  
Deep Infection ◽  
Ankle Fractures ◽  
Assistive Device ◽  
Short Term ◽  
Level Of Evidence ◽  
The Mean ◽  
Fracture Level ◽  
Lost To Follow Up

Objective: This study aimed to report the short-term results of retrograde tibiotalocalcaneal (TTC) nailing in a selected series of patients with fragility ankle fractures. Methods: This study included 17 patients who underwent primary retrograde TTC nailing from January 2016 to April 2019. The Olerud-Molander ankle score (OMAS) was recorded preoperatively and at the final follow-up. Results: Mean patient age was 81.5 years (range, 67-91 years), and mean follow-up duration was 20.9 months (range, 8-50 months). No patient was lost to follow-up. Eleven patients had diabetes. Thirteen patients were able to walk with an assistive device, and 4 with help from another person. Two patients died at 8 and 9 months after treatment. Radiographic healing was observed in 100% of the fractures. No deep infection or scarring problems were recorded. Two patients were wheelchair bound after treatment, whereas 15 recovered their previous autonomy. The mean OMAS score changed from 64.1 (range, 55-75) preoperatively to 55.3 (range, 45-65) postoperatively. Conclusion: Our results suggest that primary retrograde TTC nailing is a valid option in selected patients with fragility ankle fractures, multiple comorbidities, poor soft tissue condition, and difficulty in walking before the fracture. Level of Evidence IV; Therapeutic Studies, Case Series.

Abstract TP303: Improved Metrics and Outcomes Post Implementation of an ELVO Taskforce

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Destiny Hooper ◽  
Meryim Poursheykhi ◽  
David McCane ◽  
Jason Lee ◽  
Ken C Ling ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Stroke Care ◽  
Functional Independence ◽  
Anterior Circulation ◽  
Protocol Implementation ◽  
Standardized Protocol ◽  
Scale Scores ◽  
The Mean ◽  
Lost To Follow Up

Objective: To assess whether the implementation of a standardized protocol for the rapid diagnosis, transfer, and management of emergent large vessel occlusions (ELVO) improves treatment times and reduces disability in patients that undergo mechanical thrombectomy. Methods: Retrospective review was conducted on all patients who underwent thrombectomy within 6 hours of last known well (LKW) from May 22, 2016 to May 1, 2019. Patients with proximal anterior circulation occlusion confirmed on CTA and admission NIHSS of ≥6 were included. Comparisons were made to assess differences in workflow metrics and outcomes pre- and post-ELVO taskforce implementation. 90-day modified Rankin Scale scores (mRS) and patient information was collected from the Houston Methodist Hospital Outcomes Based Prospective Endpoints in Stroke (HOPES) registry. Results: A total of 287 patients met inclusion criteria. 116 were excluded for low NIHSS, out-of-window presentation, undocumented metrics, or lost to follow up. 102 patients presented prior to protocol implementation, with 48 (71.81y [SD±13.51]; 50% M) arriving directly to our CSC and 54 (68.56y [SD±16.85]; 46% M) arriving via inter-facility transfer from a PSC. 69 patients presented post-implementation, 32 (69.78y [SD±16.33]; 53% M) directly and 37 (70.57y [SD±13.96]; 62% M) were transferred. In those presenting directly to the CSC, a statistically significant reduction in the mean door to CT time was observed post-implementation, 12.25 to 5.03 minutes (7.22, 95% CI [1.50, 12.93] p=0.007). In those who were transferred, we found a significant reduction in the mean door-in to door-out time, 138.06 to 128.00 minutes (10.06, 95% CI [7.90, 28.02] p=0.028). A trend towards improved functional outcomes was observed in both cohorts post-protocol implementation. Admission NIHSS, use of lytics, and LKW were found not to be confounders. Conclusion: Based on our review of patients who underwent mechanical thrombectomy, implementation of a standardized protocol for the management of ELVO patients both improved treatment times and showed a trend toward greater functional independence at 90 days. This protocol can be easily replicated to help improve stroke care and potentially reduce disability for patients presenting with ELVO.

Early Clinical Outcomes of the Active Seal Technology of the AFX Endovascular Aortic Aneurysm System With the VELA Cuff for Patients With a Conical Proximal Neck

2022 ◽  
pp. 152660282110709
Author(s):  
Naoki Fujimura ◽  
Hideaki Obara ◽  
Takaaki Nagano ◽  
Yukihisa Ogawa ◽  
Taira Kobayashi ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Proximal Neck ◽  
Landing Zone ◽  
The Core ◽  
The Mean ◽  
Instructions For Use ◽  
Lost To Follow Up

Purpose: To evaluate the efficacy of the Active Seal technology employed in the AFX endovascular aortic aneurysm system (AFX), during endovascular aneurysm repair (EVAR) in patients with abdominal aortic aneurysms (AAAs) having a conical proximal neck. Materials and Methods: A retrospective analysis of the EVAR for AAA with a conical proximal neck using the AFX was performed at 17 Japanese hospitals between January 2016 and August 2020. The conical proximal neck was defined as a cone-shaped proximal neck, with more than 10% diameter increase within a 15 mm length at the proximal landing zone. All anatomical analyses were performed in the core laboratory, and cases with parallel walls within the proximal neck adequate for the landing zone were excluded from the study. Results: This study included 53 patients, but only 39 patients (mean age, 76.6 ± 6.7 years; 87.0% males; mean aneurysm diameter, 52.0 ± 8.0 mm) were analyzed after being characterized as having a pure conical neck by the core laboratory. The mean proximal neck diameters at the lower renal artery and proximal edge of the aneurysm were 20.0 ± 2.9 mm and 27.5 ± 4.9 mm, respectively. The mean proximal neck length was 21.5 ± 6.0 mm. Instructions for use violations other than the conical neck were observed in 15 patients (38.5%). The VELA cuff was used in all cases; however, additional proximal cuff was required in 9 more cases (23.1%). The Active Seal technology was able to significantly extend the proximal sealing zone from 21.5 ± 6.0 to 26.0 ± 12.2 mm ( p = .047). Thirty-six patients completed the 12-month follow-up (one patient was lost to follow-up, and 2 patients died from causes unrelated to the aneurysm), and there were no type-1a and 3 endoleaks with only one reintervention (2.6%) related to type 1b endoleak in the 12-month period. Furthermore, there was no significant enlargement of the proximal neck diameter at 12 months (at 1 month: 20.6 ± 3.4 mm and at 12 months: 21.3 ± 3.8 mm; p = .420). Conclusion: The Active Seal technology of the AFX significantly extended the proximal seal zone and no type-1a endoleak and proximal neck dilation was observed in patients with conical proximal neck at 12 months.

Transanal Hemorrhoidal Dearterialization Versus Stapled Hemorrhoidopexy: Long-Term Follow-up of a Prospective Randomized Study

2018 ◽  
Vol 25 (3) ◽  
pp. 236-241 ◽  
Author(s):  
Gabriella Giarratano ◽  
Edoardo Toscana ◽  
Claudio Toscana ◽  
Giuseppe Petrella ◽  
Mostafa Shalaby ◽  
...  
Keyword(s):  
Return To Work ◽  
Recurrence Rate ◽  
Randomized Study ◽  
Stapled Hemorrhoidopexy ◽  
Secondary Outcome ◽  
Sh Group ◽  
The Mean ◽  
Complications Rate ◽  
Grade Iii

Aim. This study aims to compare the early and late outcomes of transanal hemorrhoidal dearterialization (THD) versus stapled hemorrhoidopexy (SH) for the treatment of hemorrhoidal disease. Methods. From January 2013 to December 2014, 100 patients—50 patients on each arm—were randomly allocated to THD or SH groups. The inclusion criteria were grade III and IV hemorrhoids diagnosed by clinical examination and proctoscopy. The primary outcome was to compare the recurrence rate with a minimum follow-up of 2 years, and the secondary outcome was to compare complications rate, time to return to work postsurgery, procedure length, and patient’s satisfaction between the 2 techniques. Results. The mean follow-up period was 33.7 ± 7.6. The recurrence rate was 4% in the SH group and 16% in the THD group ( P = .04). There was no difference in the intraoperative and postoperative complications rate; the pain score was significantly higher in the THD group. The mean operative time was significantly shorter in the SH group compared with the THD group. Patients in the THD group returned to work or routine activities significantly later compared with patients in the SH group. The overall satisfaction rate was also higher in the SH group. Conclusion. Both procedures are simple and easy to perform for the treatment of grade III and IV hemorrhoids. SH showed better results in terms of lower rate of recurrence, lower postoperative pain, quicker return to work, and higher patient satisfaction.

scholarly journals Spatz3 Adjustable Balloon: Weight Loss and Response Rates in Brazil

2018 ◽  
Vol 1 (1) ◽  
pp. 38-41
Author(s):  
Leonard Salles De Almeida
Keyword(s):  
Intragastric Balloon ◽  
Response Rate ◽  
Successful Outcome ◽  
Implantation Time ◽  
Duration Of Effect ◽  
The Mean ◽  
Total Body ◽  
Lost To Follow Up ◽  
Adjustable Balloon

Background: The degree of efficacy and duration of effect of Intragastric Balloons (IGBs) can be variable and unpredictable. The Spatz Adjustable Intragastric Balloon (AIGB) was developed to address these issues by extending implantation to 1 year, decreasing balloon volume for intolerance and increasing volume for decreased balloon effect.Aims: To determine the efficacy and response rate of the Spatz3 AIGB.Methods: Results of 379 consecutive patients (pts) implanted with the Spatz3 AIGB were retrospectively reviewed (3 lost to follow up). Mean BMI 35.5; mean weight (wt) 97.5 kg; mean excess wt 29.1 kg; mean balloon volume 600ml. Balloon volume adjustments were offered: Down adjustments for intolerance and up adjustments for decreased balloon effect.Results: The mean implantation time of 376 pts was 10.6 months yielding mean wt loss 14.9 kg; mean 15.1% Total Body Wt Loss (%TBL) and 58% Excess Wt Loss(%EWL). Response rate (> 25%EWL) was achieved in 79% (297/376) of pts. Down adjustments in 95 pts (mean 2.4 months; mean -152.4 ml) allowed 76/95 (80%) to continue IGB therapy for at least 6 months (mean 9.1 months). Up adjustments in 205/376 (54.5%) pts (mean 5.8 months; mean + 179.2 ml) yielded additional mean wt loss of 6.5 kg. There was 1 gastric ulcer (0.27%). One balloon deflated at 7.4 months and 4 others deflated after 1 year (13-23 months).Conclusions: In this retrospective review of 376 Spatz3 AIGB patients, up adjustments yielded a mean 6.5kg extra wt loss for those with wt loss plateau, and down adjustments alleviated early intolerance. These two adjustment functions may be instrumental in yielding a successful outcome (> 25% EWL) in 79% of pts.

scholarly journals Back to the medical classes-Part I- Strategy for return to the presential practices during COVID-19 pandemics in a Brazilian Medical School

2021 ◽  
Author(s):  
Maria Auxiliadora Nogueira Saad ◽  
Vinicius Cesar Jardim Pereira ◽  
Arnaldo Costa Bueno ◽  
Alan Araujo Vieira ◽  
Maria de Fatima Pombo March ◽  
...  
Keyword(s):  
Medical Students ◽  
Small Groups ◽  
Private Health Insurance ◽  
Protective Equipment ◽  
Face To Face ◽  
Standardized Protocol ◽  
Symptomatic Case ◽  
Remote Training ◽  
The Mean

Introduction: In Brazil, practices of medical students have been interrupted due to COVID-19 to meet emergency demands. Aim: To describe a strategy for a controlled return to the presential practices for medical students. Methods: We developed a standardized protocol to be applied before and during the return of the practical classes in medical students of Universidade Federal Fluminense, in the follow months after COVID-19 pandemic beginning. The protocol was comprised in three parts: Remote training on COVID-19 prevention; Face-to-face training focused in COVID-19 prevention, handwashing and personal protective equipment use; Investigation of students COVID-19 status before starting practical activities and weekly monitoring for COVID-19 during seven weeks. The training was done by medical teachers in small groups for medical students of the last lective semester. Results: The classes were interrupted on March 12, 2020 and returned in August 10, 2020. Seventy-one students were trained and followed. The mean age was 26.6 years (26.7 +/- 0.835) and 54% were female. Forty-nine (69%) students over 71 had a private health insurance, 60 (84.5%) shared a house/apartment with one or more person and 12(16.9%) reported a previous comorbidity. Eighteen (25.4%) over 71 reported previous symptoms of COVID-19, being positive in two students. During the follow-up, fourteen (19.7%) over 71 students were placed in quarantine due to signals/symptoms compatible with COVID-19 or contact with symptomatic case. Only two cases (2.8%) were confirmed and occurred in Brazilian epidemiological week 37. Conclusion: The protocol was successful in minimizing COVID-19 acquisition during practical classes of medical students.

P–328 Dienogest significantly decreases the size of the cyst and alters Anti-Müllerian Hormone concentration in patients with endometrioma

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
E Karataş ◽  
B E Temiz ◽  
S Mumusoglu ◽  
H Yarali ◽  
G Bozdag
Keyword(s):  
Primary Outcome ◽  
Statistical Significance ◽  
Mean Difference ◽  
Secondary Outcome ◽  
Control Group ◽  
Significant Drop ◽  
Mean Size ◽  
The Mean ◽  
Respective Figure

Abstract Study question Does utilization of dienogest make any impact on the size of cyst and Anti-Müllerian Hormone (AMH) concentration in patients with endometrioma throughout 12-months? Summary answer Although dienogest makes a gradual reduction in the size of endometrioma cyst throughout 12-months, a significant drop in AMH serum concentration was also noticed. What is known already According to recent studies, pre-operative serum AMH levels might be illusively increased with parallel to the size of endometrioma which will be a misleading factor while deciding to operate the patient via cystectomy. Although dienogest is one of the medical options that might be commenced in patients with endometrioma cyst, there is limited data about its effect on the size of the endometrioma and hence serum AMH concentration throughout 12 months of follow up. Study design, size, duration The current observational cohort study was conducted among patients with endometrioma those treated with dienogest from January 2017 to January 2020. The primary outcome was alteration in diameter of endometrioma cyst at 6th and 12th months of treatment. Secondary outcome was alteration in serum AMH concentration in the same period. Of 104 patients treated with dienogest, 44 patients were excluded due to being treated with any type of surgical intervention during follow up period. Participants/materials, setting, methods A total of 60 patients were recruited for the final analysis. Of them, primary symptom was dysmenorrhea, chronic pelvic pain and menstrual irregularity in 16 (26.7%), 25 (41.7%) and 8 (13.3%) patients, respectively. Eighteen patients (30%) were asymptomatic. As 21 patients had bi-lateral endometrioma, size of the leading cyst was considered to be analyzed for the primary outcome measure. Paired-t test was used for comparison of numerical values and p ≤ 0.05 was taken as statistical significance. Main results and the role of chance The mean age was 31.5±8.0 years. In the time point when dienogest was started, the mean size of the endometrioma was 46.3±17.4 mm. The mean serum AMH concentration was 3.6±2.4 ng/ml. After 6 months of treatment, the mean size of the endometrioma decreased to 38.6±14.0 mm which corresponds to a mean difference of 7.8 mm (95% CI: 3.0 to 12.6; p: 0.003). The respective figure for AMH was 3.3±2.7 ng/ml which corresponds to a mean difference of 0.3 ng/ml (95% CI: –0.2 to 0.8; p: 0.23) at 6 months. After 12 months of treatment, the mean size of the endometrioma was 37.5±15.7 mm which corresponds to a mean difference of 8.9 mm (95% CI: 2.9 to 14.9; p: 0.005) at the end of 12 months. The respective figure for AMH was 2.7±1.9 ng/ml which corresponds to a mean difference of 0.9 ng/ml (95% CI: 0.1 to 1.7; p: 0.045) at the end of 12 months. The mean diameter of endometrioma and AMH concentration did not differ throughout the time period between 6th and 12th months of the treatment. Limitations, reasons for caution Although herein we present the largest data that depicts the alteration of endometrioma cyst and AMH concentration with the application of dienogest, the lack of control group is a limitation that avoids to perform any comparison. Wider implications of the findings: A shrinkage after commencement of treatment suggest that dienogest might present improvement in patients with endometrioma with respect to radiological findings, but further studies are required whether a decline in AMH concentration after 12 months refers to a genuine decrease in ovarian reserve or resolution of misleading high pre-treatment levels. Trial registration number not available

An ulnar parametacarpal perforator flap for volar digital soft tissue reconstruction

2020 ◽  
Vol 45 (8) ◽  
pp. 842-848
Author(s):  
Satoshi Usami ◽  
Kohei Inami ◽  
Yuichi Hirase ◽  
Hiroki Mori
Keyword(s):  
Donor Site ◽  
Perforator Flap ◽  
Soft Tissue Reconstruction ◽  
Level Of Evidence ◽  
Tissue Reconstruction ◽  
The Mean ◽  
Lost To Follow Up ◽  
Pulp Repair ◽  
Sensory Reinnervation

We present outcomes of using a perforator-based ulnar parametacarpal flap in 25 patients for digital pulp defects. These included 17 free transfers to the thumb, index, middle and ring fingers and eight reverse pedicled transfers to the little fingers. This flap includes a dorsal sensory branch of the ulnar nerve, which was sutured to the digital nerve in all transfers. Each flap had one to three reliable perforators (mean 0.44 mm diameter) to the ulnar parametacarpal region and contained at least one perforator within 2 cm proximal to the palmar digital crease. All the 25 flaps survived completely. Twenty-two patients were followed for 15 months (range 12 to 24), and three were lost to follow-up. The mean static and moving two-point discrimination of the flap was 7 mm and 5 mm, respectively. At the donor site, sensory reinnervation was acceptable. We conclude that ulnar parametacarpal perforator flaps offer sensate, thick and glabrous skin for finger pulp repair, all in a single operative field. Level of evidence: IV

scholarly journals The Development of Heterotopic Ossification Following Ankle Fracture Syndesmotic Screw Fixation

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0044
Author(s):  
Benjamin R. Williams ◽  
Paul M. Lafferty
Keyword(s):  
Risk Factors ◽  
Heterotopic Ossification ◽  
Ankle Fracture ◽  
Screw Fixation ◽  
Low Energy ◽  
Ankle Fractures ◽  
Factors Associated ◽  
Syndesmotic Screw ◽  
The Mean

Category: Ankle, Trauma Introduction/Purpose: Syndesmotic fixation with screws is commonly used for ankle fractures with syndesmotic disruption. Few studies have reported the development of heterotopic ossification (HO) within the syndesmosis following ankle injuries, which may lead to abnormal joint kinematics and even joint synostosis. However, there is little data on the prevalence and on the risk factors associated with the development of HO. The purpose of this study is to determine the (1) prevalence and (2) risk factors associated with the development of HO within the distal tibiofibular syndesmosis following ankle fractures requiring syndesmotic fixation. We hypothesized that screws within the syndesmosis articulation and broken screws would be associated with a higher incidence of HO than extraarticular and intact screws, respectively. Methods: A retrospective review was conducted for patients who sustained an ankle fracture with syndesmotic disruption. Inclusion criteria: age between 18 and 65 years old, a closed ankle fracture treated operatively with syndesmotic screw fixation. Exclusion criteria: additional lower extremity injury, history of prior ankle fracture, lack of radiographic follow-up and fixation other than 1 or 2 syndesmosis screws. Medical records were reviewed for: age, sex, high or low energy injury mechanism, smoking status, diabetes, BMI, perioperative complications, and further procedures. Fractures were classified by Lauge-Hansen and Weber systems. Immediate postoperative radiographs were reviewed for the number of syndesmotic screws, whether screws were intraarticular or extraarticular and the number of cortices each screw crossed. Final postoperative radiographs were reviewed for retention or screw removal and the presence of HO. The presence of HO was defined as new or increased bone formation within the syndesmosis compared to immediate postoperative radiographs. Results: Included were 264 patients, mean radiographic follow-up of 10.5+/-10.2 months. The mean age was 39.2+/-12.6 years (38.7% female) with a mean BMI of 32.1+/-7.8. Current smokers made up 39.4% of patients and 10.6% were diabetic. The mean time to fracture fixation was 12.6+/-3.2 days and 198 patients (75%) had a low energy injury. There was no significant difference in HO formation for demographics, injury mechanism or time to fixation. Overall, HO developed in 160 patients (60.6%). There was no difference, additionally for fracture pattern, number screws or fixation construct (Table 1). HO developed in 92% of broken, 75% of loose and 44% of intact screws (P<0.001). Screws were removed in 107 patients (40.5%) with no difference in HO formation compared to patients with intact screws. Conclusion: Heterotopic ossification is commonplace following screw fixation for syndesmotic injuries with a prevalence of 60.6%. Broken screws and loosened screws are a significant risk factor for the development of HO. However, no other risk factors in this study were found to be associated with the development of HO, including intraarticular syndesmotic screw placement. Patients should be counseled on the prevalence although further research is needed to determine the effect on ankle motion and progression of post-traumatic osteoarthritis.

Gamma Knife surgery for trigeminal schwannoma

2007 ◽  
Vol 106 (5) ◽  
pp. 839-845 ◽  
Author(s):  
Jason Sheehan ◽  
Chun Po Yen ◽  
Yasser Arkha ◽  
David Schlesinger ◽  
Ladislau Steiner
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Long Term Results ◽  
University Of Virginia ◽  
Trigeminal Schwannoma ◽  
The Mean ◽  
The University ◽  
Lost To Follow Up

Object Trigeminal schwannomas are rare intracranial tumors. In the past, resection and radiation therapy were the mainstays of their treatment. More recently, neurosurgeons have begun to use radiosurgery in the treatment of trigeminal schwannomas because of its successful use in the treatment of vestibular schwannomas. In this article the authors evaluate the radiological and clinical outcomes in a series of patients in whom Gamma Knife surgery (GKS) was used to treat trigeminal schwannomas. Methods Twenty-six patients with trigeminal schwannomas underwent GKS at the University of Virginia Lars Lek-sell Gamma Knife Center between 1989 and 2005. Five of these patients had neurofibromatosis and one patient was lost to follow up. The median tumor volume was 3.96 cm3, and the mean follow-up period was 48.5 months. The median prescription radiation dose was 15 Gy, and the median prescription isodose configuration was 50%. There was clinical improvement in 18 patients (72%), a stable lesion in four patients (16%), and worsening of the disease in three patients (12%). On imaging, the schwannomas shrank in 12 patients (48%), remained stable in 10 patients (40%), and increased in size in three patients (12%). These results were comparable for primary and adjuvant GKSs. No tumor growth following GKS was observed in the patients with neurofibromatosis. Conclusions Gamma Knife surgery affords a favorable risk-to-benefit profile for patients harboring trigeminal schwannomas. Larger studies with open-ended follow-up review will be necessary to determine the long-term results and complications of GKS in the treatment of trigeminal schwannomas.

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