Leptomeningeal Cyst Development after Endoscopic Craniosynostosis Repair: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 55 (1) ◽  
pp. 235-238 ◽  
Author(s):  
Henry E. Aryan ◽  
Hal S. Meltzer ◽  
Gregory G. Gerras ◽  
Rahul Jandial ◽  
Michael L. Levy
Keyword(s):  
Minimally Invasive ◽  
Pediatric Neurosurgery ◽  
Osteotomy Site ◽  
Dural Defect ◽  
Leptomeningeal Cyst ◽  
Dural Tears ◽  
Safe Performance ◽  
Initial Results ◽  
Cyst Development

Abstract OBJECTIVE AND IMPORTANCE: Endoscopically assisted (minimally invasive) craniosynostosis repair has been suggested as an alternative to traditional open craniosynostosis repair. Advocates of this approach assert advantages, including decreased blood loss, operative time, and hospital stay, while providing esthetic results and safety comparable with traditional open craniosynostosis repair. The difficulties inherent in endoscopic visualization may result in complications, however, that could temper enthusiasm for this procedure. The authors report a child in whom a leptomeningeal cyst developed after performance of endoscopic craniosynostosis repair, presumably from an iatrogenic dural laceration. CLINICAL PRESENTATION: A 5-month-old girl with sagittal synostosis underwent endoscopically assisted craniosynostosis repair. By report, the procedure was uneventful and the initial results were acceptable. The authors performed a chart review of their own experience with both endoscopically assisted craniosynostosis repair and traditional open repair. INTERVENTION: Five months after surgery, a pulsating forehead mass developed. Neuroimaging confirmed the diagnosis of a leptomeningeal cyst. The child was referred to our pediatric neurosurgery practice for operative repair. At the time of surgery, a dural defect lying directly under a previous osteotomy site was identified. After uneventful repair and follow-up of more than 1 year, the child is well and is without the development of a clinical seizure disorder or recurrence of her leptomeningeal cyst. CONCLUSION: Unrecognized dural injury combined with an overlying osteotomy in an infant can result in the development of a leptomeningeal cyst. Care must be taken at the time of endoscopic extradural surgery to recognize any inadvertent dural tears and to perform a direct repair at the time of the initial occurrence. Facility with and use of an appropriate endoscope is essential to the safe performance of minimally invasive craniosynostosis surgery.

Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) of the Fifth Metatarsal for Bunionette Correction

2018 ◽  
Vol 39 (4) ◽  
pp. 450-457 ◽  
Author(s):  
Kar Hao Teoh ◽  
Kartik Hariharan
Keyword(s):  
Minimally Invasive ◽  
Callus Formation ◽  
Case Series ◽  
Clinical Results ◽  
Osteotomy Site ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Average Improvement ◽  
The Mean

Background: Different osteotomies have been proposed for the treatment of bunionette deformity. Minimally invasive surgery is now increasingly popular for a variety of forefoot conditions. The aim of this study was to evaluate the outcome following fifth minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) for bunionette deformity. Methods: Nineteen patients (21 feet) who had symptomatic bunionette deformity and failed conservative treatment between 2014 and 2016 were included in this retrospective study. Clinical data were recorded, and pre- and postoperative Manchester-Oxford Foot Questionnaire (MOXFQ) scores and visual analog scale (VAS) pain score were collected. The mean follow-up was 28 months (range, 12-47). Results: The mean MOXFQ summary index score decreased from 71 (range, 59-81) preoperatively to 10 (range, 0-30) postoperatively. All 3 MOXFQ domains also improved. The average improvement in VAS score was 7. Forefoot swelling and some painful symptoms took an average of 3 months to settle. There were no wound or nerve complications. One patient required a dorsal cheilectomy for a symptomatic prominent dorsolateral callus formation. Conclusion: The minimally invasive fifth DMMO for bunionette deformity was a safe and effective technique. It had relatively few complications and led to good clinical results. We believe it is important to warn patients that the forefoot swelling will take months to settle compared to an osteotomy with fixation, and there is a 10% chance of a prominent callus over the osteotomy site. Level of Evidence: Level IV, retrospective case series.

scholarly journals Sliding distal metatarsal minimally invasive osteotomy (S-DMMO) for correction of bunionette deformity

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0050
Author(s):  
Jorge Del Vecchio ◽  
Mauricio Ghioldi ◽  
Lucas Chemes ◽  
Miki Dalmau-Pastor
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Weight Bearing ◽  
Osteotomy Site ◽  
Surgical Trauma ◽  
Aofas Score ◽  
Reliable Technique ◽  
The Mean

Category: Midfoot/Forefoot Introduction/Purpose: Bunionette refers to painful lateral prominence at the fifth metatarsal head. For refractory cases, surgical intervention is indicated. Several operative treatments have been used to treat this deformity. Open surgery has been associated with wound healing problems, symptomatic hardware and infection. Recently, there has been a growing interest in the u utilization of minimally invasive surgery (MIS) essentially because of its inherent advantages, including less surgical trauma and preservation of blood supply. This has a direct impact in the patient leading to lower morbidity rates and faster recovery with immediate weight bearing. The purpose of the study was to describe both clinical and radiographic medium-term results of a sliding distal metatarsal minimally invasive osteotomy (S-DMMO) for correction of bunionette deformity. Methods: This is a retrospective review of patients who underwent S-DMMO to treat symptomatic bunionette deformity. We studied 46 feet from 36 patients, who were treated between Feb 2012 and March 2016. The surgeries were performed by two surgeons trained in minimally invasive surgery or percutaneous. The average follow-up was 49,74 years (33-70). The average age was 48 years (25-76). Radiographic measurements and clinical assessment were obtained preoperatively, six weeks postoperatively, and at final follow-up. Radiographic assessment includes evaluation of the fifth metatarsophalangeal angle, 4-5 intermetatarsal angles and medial osteotomy displacement (mm). Clinical evaluation included the lesser toe American Orthopaedic Foot and Ankle Society (AOFAS) score. The subjective satisfaction rate was measured using the Coughlin Score. Results: The mean 4-5 intermetatarsal angles was reduced from 10,88° to 7,1° and the fifth metatarsophalangeal angle was reduced from 14,7° to 6,47° postoperatively. Functional and clinical outcome, as assessed by a postoperative lesser toe AOFAS score showed good and excellent results (80-100 points) in all feet. The mean AOFAS score improved from 62,81pre-operatively to 92,42 points at final follow-up. Consolidation of the osteotomy site was achieved in all cases with a periosteal callus. According to the Coughlin classification system patient’s subjective assessments were: excellent (32 feet), good (12 feet) and fair (2 feet). No mayor complications were seen. One patient required reoperation (resection of symptomatic residual fifth metatarsal). Other complications found were: 1 superficial infection and 1 wound dehiscence. Conclusion: Our results showed that S-DMMO to be a safe and reliable technique for surgeons trained in MIS surgery. The mentioned is a novel, extrarticular and epiphasary technique that doesn´t need to be stabilized with osteosynthesis and provides a definite advantage over other techniques described. It is necessary to emphasize the importance of prevention of complications by a careful preoperative planning, a correct surgical procedure (specific instruments are required) and a strict postoperative control.

Intracorporeal electrokinetic lithotripsy: an advancement in minimally invasive management of parotid duct calculus

2008 ◽  
Vol 122 (4) ◽  
pp. 428-431 ◽  
Author(s):  
P C Modayil ◽  
V Jacob ◽  
G Manjaly ◽  
G Watson
Keyword(s):  
Shock Wave ◽  
Minimally Invasive ◽  
Uneventful Recovery ◽  
Salivary Duct ◽  
Anatomical Structures ◽  
Electrohydraulic Lithotripsy ◽  
Parotid Duct ◽  
Initial Results ◽  
Invasive Management

AbstractBackground:Symptomatic salivary stones in the middle or proximal parotid duct have previously been treated by gland excision, which is associated with a 3–7 per cent risk to the facial nerve. Minimally invasive approaches to the management of salivary duct calculi have been devised over the past decade. Fluoroscopically guided basket retrieval, lithotripsy and intra-oral stone removal under general anaesthesia have found favour with most surgeons. Endoscopically controlled intracorporeal shock wave lithotripsy using the pneumoblastic lithotripter has been replaced by electrohydraulic lithotripsy (used in sialolith treatment).Method:The electrokinetic lithotripter is normally used for the treatment of lower ureteric stones, and has the benefit of minimal concomitant tissue damage. We have extended its use to the treatment of parotid duct calculi. We present initial results for its use in the treatment of a proximal parotid duct stone.Result:Application of the shock wave to the stone under direct vision avoided injury to the duct or to any local structure. The patient made an uneventful recovery and was asymptomatic after 18 months' follow up.Conclusion:Continuous, endoscopically monitored electrokinetic lithotripsy with good irrigation gives a well illuminated field and absolute delivery of energy to the target. It avoids the side effects caused by impact of the shock wave on the parotid duct and adjacent anatomical structures, thereby making it a safer procedure.

Minimally Invasive Transaortic Repair of the Mitral Valve

2011 ◽  
Vol 14 (4) ◽  
pp. 232 ◽  
Author(s):  
Orlando Santana ◽  
Joseph Lamelas
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Operative Mortality ◽  
The Mean ◽  
Transaortic Approach

<p><b>Objective:</b> We retrospectively evaluated the results of an edge-to-edge repair (Alfieri stitch) of the mitral valve performed via a transaortic approach in patients who were undergoing minimally invasive aortic valve replacement.</p><p><b>Methods:</b> From January 2010 to September 2010, 6 patients underwent minimally invasive edge-to-edge repair of the mitral valve via a transaortic approach with concomitant aortic valve replacement. The patients were considered to be candidates for this procedure if they were deemed by the surgeon to be high-risk for a double valve procedure and if on preoperative transesophageal echocardiogram the mitral regurgitation jet originated from the middle portion (A2/P2 segments) of the mitral valve.</p><p><b>Results:</b> There was no operative mortality. Mean cardiopulmonary bypass time was 137 minutes, and mean cross-clamp time was 111 minutes. There was a significant improvement in the mean mitral regurgitation grade, with a mean of 3.8 preoperatively and 0.8 postoperatively. The ejection fraction remained stable, with mean preoperative and postoperative ejection fractions of 43.3% and 47.5%, respectively. Follow-up transthoracic echocardiograms obtained at a mean of 33 days postoperatively (range, 8-108 days) showed no significant worsening of mitral regurgitation.</p><p><b>Conclusion:</b> Transaortic repair of the mitral valve is feasible in patients undergoing minimally invasive aortic valve replacement.</p>

Socioeconomic patient benefits of a pediatric neurosurgery telemedicine clinic

2020 ◽  
Vol 25 (2) ◽  
pp. 204-208 ◽  
Author(s):  
Kelsey Hayward ◽  
Sabrina H. Han ◽  
Alexander Simko ◽  
Hector E. James ◽  
Philipp R. Aldana
Keyword(s):  
Travel Time ◽  
Cost Savings ◽  
Transportation Cost ◽  
Pediatric Neurosurgery ◽  
University Of Florida ◽  
Remote Location ◽  
Socioeconomic Data ◽  
The University ◽  
Time Away

OBJECTIVEThe objective of this study was to examine the socioeconomic benefits to the patients and families attending a regional pediatric neurosurgery telemedicine clinic (PNTMC).METHODSA PNTMC was organized by the Division of Pediatric Neurosurgery of the University of Florida College of Medicine–Jacksonville based at Wolfson Children’s Hospital and by the Children’s Medical Services (CMS) to service the Southeast Georgia Health District. Monthly clinics are held with the CMS nursing personnel at the remote location. A retrospective review of the clinic population was performed, socioeconomic data were extracted, and cost savings were calculated.RESULTSClinic visits from August 2011 through January 2017 were reviewed. Fifty-five patients were seen in a total of 268 initial and follow-up PNTMC appointments. The average round-trip distance for a family from home to the University of Florida Pediatric Neurosurgery (Jacksonville) clinic location versus the PNTMC remote location was 190 versus 56 miles, respectively. The families saved an average of 2.5 hours of travel time and 134 miles of travel distance per visit. The average transportation cost savings for all visits per family and for all families was $180 and $9711, respectively. The average lost work cost savings for all visits per family and for all families was $43 and $2337, respectively. The combined transportation and work cost savings for all visits totaled $223 per family and $12,048 for all families. Average savings of $0.68/mile and $48.50/visit in utilizing the PNTMC were calculated.CONCLUSIONSManaging pediatric neurosurgery patients and their families via telemedicine is feasible and saves families substantial travel time, travel cost, and time away from work.

scholarly journals Minimally-invasive mitral valve repair of symmetric and asymmetric Barlow´s disease

2021 ◽  
Author(s):  
Gloria Faerber ◽  
Sophie Tkebuchava ◽  
Mahmoud Diab ◽  
Christian Schulze ◽  
Michael Bauer ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Wide Spectrum ◽  
Mitral Valve Surgery ◽  
Valve Repair ◽  
Prolapse Repair ◽  
Repair Rate ◽  
Barlow’S Disease ◽  
Increased Risk

Abstract Objectives Barlow´s disease represents a wide spectrum of mitral valve pathologies associated with regurgitation (MR), excess leaflet tissue, and prolapse. Repair strategies range from complex repairs with annuloplasty plus neochords through resection to annuloplasty-only. The latter requires symmetric prolapse patterns and central regurgitant jets. We aimed to assess repair success and durability, survival, and intraoperative outcomes with symmetric and asymmetric Barlow’s disease. Methods Between 09/10 and 03/20, 103 patients (of 1939 with mitral valve surgery) presented with Barlow´s disease. All received surgery through mini-thoracotomy with annuloplasty plus neochords (n = 71) or annuloplasty-only (n = 31). One valve was replaced for endocarditis (repair rate: 99%). Results Annuloplasty-only patients were older (64 ± 16 vs. 55 ± 11 years, p = 0.008) and presented with higher risk (EuroSCORE II: 4.2 ± 4.9 vs. 1.6 ± 1.7, p = 0.007). Annuloplasty-only patients had shorter cross-clamp times (53 ± 18 min vs. 76 ± 23 min, p < 0.001) and received more tricuspid annuloplasty (15.5% vs. 48.4%, p < 0.001). Operating times were similar (170 ± 41 min vs. 164 ± 35, p = 0.455). In three patients, annuloplasty-only caused intraoperative systolic anterior motion (SAM), which was fully resolved by neochords to the posterior leaflet. There were no conversions to sternotomy or deaths at 30-days. Three patients required reoperation for recurrent MR (at 25 days, 2.8 and 7.8 years). At the latest follow-up, there was no MR in 81.4%, mild in 14.7%, and moderate in 2.9%. Three patients died due to non-cardiac reasons. Surviving patients report the absence of relevant symptoms. Conclusions Minimally-invasive Barlow’s repair is safe with good durability. Annuloplasty-only may be a simple solution for complex but symmetric pathologies. However, it may carry an increased risk of intraoperative SAM.

Autologous Calvarial Bone Remodeling Technique for Small to Medium-Sized Cranial Defects in Young Children: The “Switch-Cranioplasty” Technique

2021 ◽  
pp. 1-6
Author(s):  
Sonal Jain ◽  
Shelly Wang ◽  
Carolina Sandoval-Garcia ◽  
George M. Ibrahim ◽  
Walker L. Robinson ◽  
...  
Keyword(s):  
Bone Growth ◽  
Autologous Bone Graft ◽  
Dural Defect ◽  
Skull Defect ◽  
Calvarial Bone ◽  
Leptomeningeal Cyst ◽  
Case Presentation ◽  
Skull Defects ◽  
Calvarial Defects ◽  
Autologous Bone

<b><i>Introduction:</i></b> Reconstruction of cranial defects in children less than 2 years of age, particularly when there is an associated dural defect, is challenging due to the need to accommodate active skull growth, limited options for autologous bone graft and thin calvarial bones. We use a simple remodeling technique that exploits the normal dura’s inherent potential for new bone growth while covering the dural defect with adjacent skull. <b><i>Case Presentation:</i></b> We describe an alternating, two-piece craniotomy or “switch-cranioplasty technique” to repair an occipital meningocele. The two pieces of craniotomy bone flap created around the existing skull and dural defect are switched in the horizontal plane in order to cover the site of the defect and the abnormal dura of the meningocele closure. The area of the original skull defect is transposed laterally over the normal dura. The healing of the lateral skull defects is facilitated with autologous bone chips and dust and covered by periosteal flaps that stimulate spontaneous re-ossification. <b><i>Discussion:</i></b> The advantages of this technique are the use of autologous bone adjacent to the skull defect, incorporation of the autologous bone into the growing skull, an acceptable cosmetic and functional outcome in a simple manner. The indications can be extended to include small to medium-sized calvarial defects secondary to leptomeningeal cyst and trauma.

scholarly journals Minimally invasive debridement and drainage using intraoperative CT-Guide in multilevel spondylodiscitis: a long‐term follow‐up study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jianbiao Xu ◽  
Leiming Zhang ◽  
Rongqiang Bu ◽  
Yankang Liu ◽  
Kai-Uwe Lewandrowski ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Clinical Manifestations ◽  
Operation Time ◽  
Intervertebral Discs ◽  
Intraoperative Ct ◽  
Long Term Follow Up ◽  
Invasive Method ◽  
Vertebral Bodies ◽  
Adjacent Segments

Abstract Background Spondylodiscitis is an unusual infectious disease, which usually originates as a pathogenic infection of intervertebral discs and then spreads to neighboring vertebral bodies. The objective of this study is to evaluate percutaneous debridement and drainage using intraoperative CT-Guide in multilevel spondylodiscitis. Methods From January 2002 to May 2017, 23 patients with multilevel spondylodiscitis were treated with minimally invasive debridement and drainage procedures in our department. The clinical manifestations, evolution, and minimally invasive debridement and drainage treatment of this refractory vertebral infection were investigated. Results Of the enrolled patients, the operation time ranged from 30 minutes to 124 minutes every level with an average of 48 minutes. Intraoperative hemorrhage was minimal. The postoperative follow-up period ranged from 12 months to 6.5 years with an average of 3.7 years. There was no reactivation of infection in the treated vertebral segment during follow-up, but two patients with fungal spinal infection continued to progress by affecting adjacent segments prior to final resolution. According to the classification system of Macnab, one patient had a good outcome at the final follow-up, and the rest were excellent. Conclusions Minimally invasive percutaneous debridement and irrigation using intraoperative CT-Guide is an effective minimally invasive method for the treatment of multilevel spondylodiscitis.

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