Endovascular Retrograde Suction Decompression as an Adjunct to Surgical Treatment of Ophthalmic Aneurysms: Analysis of Risks and Clinical Outcomes

2009 ◽  
Vol 64 (suppl_1) ◽  
pp. ONS107-ONS112 ◽  
Author(s):  
Daniel H. Fulkerson ◽  
Terry G. Horner ◽  
Troy D. Payner ◽  
Thomas J. Leipzig ◽  
John A. Scott ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Statistical Difference ◽  
Internal Carotid ◽  
Balloon Occlusion ◽  
The Other ◽  
Published Data ◽  
Intraoperative Angiography ◽  
Technical Aspects ◽  
Endovascular Balloon Occlusion

Abstract Objective: Endovascular retrograde suction decompression with balloon occlusion of the internal carotid artery is a useful adjunct in the surgical treatment of ophthalmic aneurysms. This technique helps establish proximal control, facilitates intraoperative angiography and may aid dissection by evacuating blood and softening the aneurysm. Although the technical aspects of this procedure have been described, the published data on its safety are scant. This study analyzed 2 groups of patients who underwent craniotomies for treatment of ophthalmic aneurysms, comparing a group who received suction decompression with a group who did not. Methods: A retrospective analysis of prospectively collected data on 118 craniotomies for ophthalmic aneurysms performed from 1990 to 2005 is presented. A group of 63 patients treated with endovascular suction decompression during surgery is compared with 55 patients who did not undergo this technique. Results: In our overall analysis of ophthalmic aneurysms, the clinical outcome was statistically related to aneurysm size (P = 0.046). The endovascular suction decompression group in this study had overall larger aneurysms (P < 0.0001) compared with the other group. There was no statistical difference between the 2 groups in rates of complications, stroke, new visual deficit, or death. The clinical outcomes were statistically similar at discharge and at 1 year. Conclusion: Endovascular balloon occlusion and suction decompression did not increase the complication rate in a large cohort of craniotomy patients with ophthalmic aneurysms. This technique may be used to augment surgical capabilities without significantly increasing the operative risk.

scholarly journals Long-Term Clinical Outcomes of Osteochondritis Dissecans Lesions of the Elbow Treated with Arthroscopy

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0020
Author(s):  
Michael Ryan ◽  
Benton Emblom ◽  
E. Lyle Cain ◽  
Jeffrey Dugas ◽  
Marcus Rothermich
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Failure Rate ◽  
Osteochondritis Dissecans ◽  
Surgical Techniques ◽  
The Other ◽  
Return To Play ◽  
Exclusion Criteria

Objectives: While numerous studies exist evaluating the short-term clinical outcomes for patients who underwent arthroscopy for osteochondritis dissecans (OCD) of the capitellum, literature on long-term clinical outcomes for a relatively high number of this subset of patients from a single institution is limited. We performed a retrospective analysis on all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. Our hypothesis was that clinical outcomes for patients treated arthroscopically for OCD of the capitellum would be favorable, with improved subjective pain scores and acceptable return to play for these patients. Methods: Inclusion criteria for this study included the diagnosis and surgical treatment of OCD of the capitellum treated arthroscopically with greater than 2-year follow-up. Exclusion criteria included any surgical treatment on the ipsilateral elbow prior to the first elbow arthroscopy for OCD at our institution, a missing operative report, and/or any portions of the arthroscopic procedure that were done open. Follow-up was achieved over the phone by a single author using three questionnaires: American Shoulder and Elbow Surgeons – Elbow (ASES-E), Andrews/Carson KJOC, and our institution-specific return-to-play questionnaire. Results: After the inclusion and exclusion criteria were applied to our surgical database, our institution identified 101 patients eligible for this study. Of these patients, 3 were then excluded for incomplete operative reports, leaving 98 patients. Of those 98 patients, 81 were successfully contacted over the phone for an 82.7% follow-up rate. The average age for this group at arthroscopy was 15.2 years old and average post-operative time at follow-up was 8.2 years. Of the 81 patients, 74 had abrasion chondroplasty of the capitellar OCD lesion (91.4%) while the other 7 had minor debridement (8.6%). Of the 74 abrasion chondroplasties, 29 of those had microfracture, (39.2% of that subgroup and 35.8% of the entire inclusion group). Of the microfracture group, 4 also had an intraarticular, iliac crest, mesenchymal stem-cell injection into the elbow (13.7% of capitellar microfractures, 5.4% of abrasion chondroplasties, and 4.9% of the inclusion group overall). Additional arthroscopic procedures included osteophyte debridement, minor synovectomies, capsular releases, manipulation under anesthesia, and plica excisions. Nine patients had subsequent revision arthroscopy (11.1% failure rate, 5 of which were at our institution and 4 of which were elsewhere). There were also 3 patients within the inclusion group that had ulnar collateral ligament reconstruction/repair (3.7%, 1 of which was done at our institution and the other 2 elsewhere). Lastly, 3 patients had shoulder operations on the ipsilateral extremity (3.7%, 1 operation done at our institution and the other 2 elsewhere). To control for confounding variables, scores for the questionnaires were assessed only for patients with no other surgeries on the operative arm following arthroscopy (66 patients). This group had an adjusted average follow-up of 7.9 years. For the ASES-E questionnaire, the difference between the average of the ASES-E function scores for the right and the left was 0.87 out of a maximum of 36. ASES-E pain was an average of 2.37 out of a max pain scale of 50 and surgical satisfaction was an average of 9.5 out of 10. The average Andrews/Carson score out of a 100 was 91.5 and the average KJOC score was 90.5 out of 100. Additionally, out of the 64 patients evaluated who played sports at the time of their arthroscopy, 3 ceased athletic participation due to limitations of the elbow. Conclusions: In conclusion, this study demonstrated an excellent return-to-play rate and comparable subjective long-term questionnaire scores with a 11.1% failure rate following arthroscopy for OCD of the capitellum. Further statistical analysis is needed for additional comparisons, including return-to-play between different sports, outcome comparisons between different surgical techniques performed during the arthroscopies, and to what degree the size of the lesion, number of loose bodies removed or other associated comorbidities can influence long-term clinical outcomes.

Aneurysms of the Intracavernous Carotid Artery: Natural History and Indications for Treatment

Neurosurgery ◽  
1990 ◽  
Vol 26 (6) ◽  
pp. 933-938 ◽  
Author(s):  
Mark E. Linskey ◽  
Laligam N. Sekhar ◽  
William L. Hirsch ◽  
Howard Yonas ◽  
Joseph A. Horton
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Natural History ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Balloon Occlusion ◽  
The Other ◽  
Cavernous Sinus Syndrome ◽  
Intracavernous Carotid Artery

Abstract Of 37 patients with 44 intracavernous carotid artery aneurysms (ICCAAns) diagnosed between 1976 and 1988. patients with 20 aneurysms were followed without treatment for 5 months to 13 years (median, 2.4 years). Ten of the 20 ICCAAns were asymptomatic at diagnosis, and 10 were symptomatic. Three of the asymptomatic ICCAAns were symptomatic at follow-up. One of these required clipping because of a progressing cavernous sinus syndrome; the other 2 were minimally symptomatic and have not required treatment. Of the 10 initially symptomatic ICCAAns, 2 had not changed, 4 became more symptomatic, and 4 had symptomatically improved by follow-up. One patient with an ICCAAn that had not changed clinically was lost to follow-up 6 months after diagnosis. Of the 4 ICCAAns that became more symptomatic, 2 continue to be monitored, and 2 required intervention; one with detachable balloon occlusion of the aneurysm with preservation of the internal carotid artery lumen, and the other with gradual cervical internal carotid artery occlusion. The clinical course of this selected group of patients with ICCAAns suggests that the natural history of ICCAAns can be quite variable. Although clinical progression does occur, symptomatic ICCAAns also can improve spontaneously. Therapeutic intervention for asymptomatic ICCAAns should be reserved for patients with aneurysms arising at the anterior genu of the carotid siphon and/or extending into the subarachnoid space, where subarachnoid hemorrhage is most likely. Intervention for symptomatic ICCAAns should be reserved for patients with subarachnoid hemorrhage, epistaxis, severe facial or orbital pain, evidence of radiographic enlargement, progressive ophthalmoplegia, or progressive visual loss.

scholarly journals Introduction: Surgery of the Central Skull Base

2008 ◽  
Vol 25 (6) ◽  
pp. E1 ◽  
Author(s):  
Vinko V. Dolenc
Keyword(s):  
Surgical Treatment ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Internal Carotid ◽  
Petrous Bone ◽  
The Other ◽  
Vascular Lesions ◽  
Anatomical Studies ◽  
Carotid Cavernous Fistulas

With his anatomical studies of the parasellar space, the so-called cavernous sinus (CS), Taptas opened Pandora's box more than 60 years ago. Parkinson continued the anatomical studies, and operated on vascular lesions in the CS with the help of extracorporeal circulation. The need for endovascular treatment of intracavernous internal carotid artery (ICA) aneurysms, as well as carotid–cavernous fistulas (CCFs), was obvious. Serbinenko started with the endovascular treatment of CCFs and ICA aneurysms using a balloon. At nearly the same time, Hakuba undertook surgical treatment of tumorous lesions in the region. Glascock studied the ICA in relation to the petrous bone, and with his studies of the ICA and this artery's relationship to the other structures, it became clear that further understanding of the pathological entities in the parasellar space hinged on additional microanatomical studies.

scholarly journals Obesity And Telomere Status In The Prognosis Of Colorectal Cancer Patients Submitted To Curative Intention Surgical Treatment

2020 ◽  
Author(s):  
Sergio García-Martínez ◽  
Daniel González-Gamo ◽  
Tamara Fernández-Marcelo ◽  
Sofía de la Serna ◽  
Inmaculada Serrano ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Surgical Treatment ◽  
Telomere Length ◽  
Clinical Outcomes ◽  
Published Data ◽  
Prognostic Impact ◽  
Telomere Attrition ◽  
Clinical Evolution ◽  
Obesity Status ◽  
The Impact

Abstract Background The risk of colorectal cancer (CRC) development has been related to telomere dysfunction and obesity. However, prognosis of patients affected by CRC has not clearly established considering both telomere attrition and obesity status. Previous published data highlights the importance of studying how obesity influences telomere function and its potential role as a predictor of prognosis in CRC. The aim of this study was to evaluate the impact of obesity and telomere status in the prognosis of patients affected by CRC and submitted to curative surgical treatment. Methods We performed a prospective study including 162 CRC patients submitted to curative surgical treatment. Samples were obtained from tumor and non-tumor tissues. Subjects were classified according to their Body Mass Index (BMI). Telomere status was established through telomere length and telomerase evaluation. Statistical analyses were performed using the SPSS software package version 22. Differences in two or more groups of study were calculated by parametric or non-parametric tests, depending on normality and homoscedasticity conditions of the variables. Prognosis was analyzed using the Kaplan-Meier method. The potential prognostic impact of the variables considered in this work jointly, was evaluated by Cox multivariate regression analyses. Results Patients with shorter telomeres, both in the tumor (median telomere length < 6.5 kb) and their non-tumor paired tissues (median telomere length < 7.1 kb), had the best clinical evolution, independently of the Dukes' stage of cancers (P = 0.025, for tumor samples; P = 0.003, for non-tumor samples). Telomere shortening was inversely associated with BMI in CRC patients. Also, subjects with a BMI > 31.85kg/m 2 showed the worse clinical outcomes. Of interest, the impact of BMI showed gender dependence, since only the group of men showed significant differences in CRC prognosis in relation to obesity status (P = 0.037). Conclusions Telomere length constitutes a useful biomarker to predict prognosis in CRC. Independently of BMI values, the better clinical evolution was associated with shorter telomeres. Obesity seems to have an impact on the clinical outcomes of CRC; however, the impact of BMI seems to be related to other factors such as gender.

New Techniques in Hemorrhage Control

2017 ◽  
Author(s):  
Megan Brenner ◽  
Joseph DuBose
Keyword(s):  
Treatment Algorithm ◽  
Balloon Occlusion ◽  
Published Data ◽  
Solid Organ ◽  
Stent Grafting ◽  
Pelvic Hemorrhage ◽  
Key Words Angiography ◽  
Vessel Injury ◽  
Definitive Therapy ◽  
Endovascular Balloon Occlusion

The use of interventional procedures in trauma has increased steadily over the past 10 years. With advancements in both imaging and device technology, endovascular techniques have become part of the treatment algorithm for both large and small vessel injury. Endovascular therapy in trauma involves a minimally invasive, catheter-based approach, which can be used as a temporizing measure in patients in extremis or as definitive therapy in a wide variety of diagnoses. Sheaths, catheters, and guide wires are universal instruments, regardless of procedure. Devices passed over guide wires form the basis of diagnosis and treatment. Using this technology provides many advantages to traditional open surgical therapy, namely the avoidance of large and potentially morbid incisions. Angioembolization, stent grafting, and resuscitative endovascular balloon occlusion of the aorta (REBOA) are being used with increasing frequency in trauma centers, with established algorithms, multiinstitutional trials, and more published data available, particularly for solid-organ and pelvic hemorrhage. Key words: angiography, embolization, hemorrhage, resuscitative endovascular balloon occlusion of the aorta, stent graft

Temporary Balloon Occlusion of a Proximal Vessel as an Aid to Clipping Aneurysms of the Basilar and Paraclinoid Internal Carotid Arteries: Technical note

Neurosurgery ◽  
1990 ◽  
Vol 27 (1) ◽  
pp. 116-119 ◽  
Author(s):  
William A. Shucart ◽  
Eddie S. Kwan ◽  
Carl B. Heilman
Keyword(s):  
Basilar Artery ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Balloon Occlusion ◽  
Technical Note ◽  
Vascular Control ◽  
Intraoperative Angiography ◽  
Paraclinoid Aneurysms ◽  
Temporary Balloon Occlusion ◽  
Internal Carotid Arteries

Abstract One aneurysm of the basilar artery and three large, paraclinoid aneurysms of the internal carotid artery (ICA) were treated with the aid of intraoperative temporary balloon occlusion of the vessel. Optimal clip placement was confirmed using intraoperative angiography. This technique provided excellent proximal vascular control and for the large aneurysms of the paraclinoid ICA obviated the need for surgical exposure of the ICA in the neck. We think this is a useful adjunct in the surgical management of aneurysms of both the basilar artery and proximal ICA.

scholarly journals Macroanatomy of the cranial cervical ganglion in Angora goats

2010 ◽  
Vol 55 (No. 8) ◽  
pp. 389-393
Author(s):  
HH Ari ◽  
Z. Soyguder ◽  
S. Cinaroglu
Keyword(s):  
Internal Carotid ◽  
The Other ◽  
External Carotid ◽  
Published Data ◽  
Medial Branch ◽  
Cervical Ganglion ◽  
Pterygoid Canal ◽  
Cranial Cervical Ganglion ◽  
Angora Goats ◽  
Cervical Ganglia

The cranial cervical ganglia (CCG) in the heads of six adult (three male and three female) Angora goats were dissected in detail. The ganglion was located on the ventral aspect of the tympanic bulla, cranio-ventral to the atlas, medio-ventral to the jugular process and lateral to the longus capitis muscle. The branches of the ganglion were the internal and external carotid nerves, the jugular and laryngopharyngeal nerves and the connecting branches to the vagus and glossopharyngeal nerve. The internal carotid nerve arose as three branches (cranial, caudal and medial) from the cranial region of the ganglion. The cranial branch, the profound petrosal nerve, entered the pterygoid canal. The caudal branch terminated at the trigeminal ganglion. The medial branch terminated at the cavernous sinus. The other cranial branch ramifying from the cranial region of the ganglion was the jugular nerve. The internal carotid and laryngopharyngeal nerves arose from the caudal region of the ganglion. In conclusion, compared with published data on other species, we found differences in the number and courses of the branches ramifying from the CCG of Angora goats and in the branches connected to the vagus, glossopharyngeal and hypoglossal nerves.

Giant aneurysm of the petrous internal carotid artery: diagnosis and treatment

1998 ◽  
Vol 112 (2) ◽  
pp. 196-198 ◽  
Author(s):  
S. C. Coley ◽  
A. Clifton ◽  
J. Britton
Keyword(s):  
Hearing Loss ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Imaging Techniques ◽  
Giant Aneurysm ◽  
Balloon Occlusion ◽  
Fusiform Aneurysm ◽  
Non Invasive ◽  
Endovascular Balloon Occlusion

AbstractWe report the case of a giant fusiform aneurysm of the petrous internal carotid artery in a 15-year-old patient who had presented with headache, hearing loss and Horner's syndrome. Definitive radiological diagnosis was made by non-invasive imaging techniques, including magnetic resonance angiography (MRA). The aneurysm was obliterated by endovascular balloon occlusion following successful tolerance of test occlusion of the internal carotid artery.

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