Endoscopic Treatment of Arachnoid Cysts

Neurosurgery ◽  
2010 ◽  
Vol 67 (3) ◽  
pp. 824-836 ◽  
Author(s):  
Joachim M.K. Oertel ◽  
Wolfgang Wagner ◽  
Yvonne Mondorf ◽  
Joerg Baldauf ◽  
Henry W.S. Schroeder ◽  
...  
Keyword(s):  
Arachnoid Cyst ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Endoscopic Technique ◽  
Arachnoid Cysts ◽  
Success Rates ◽  
Endoscopic Procedures ◽  
Endoscopic Techniques ◽  
Presenting Symptoms ◽  
Long Term Follow Up

Abstract BACKGROUND Surgical treatment of arachnoid cysts remains under debate. Although many authors favor endoscopic techniques, others attribute a higher recurrence rate to the endoscope. OBJECTIVE The authors report their experience with endoscopic procedures for arachnoid cyst. METHODS All pure endoscopic procedures for arachnoid cysts performed by the authors were analyzed. Particular reference was given to surgical complications and patient outcome in relation to cyst location and endoscopic technique. RESULTS Sixty-six endoscopic procedures were performed in 61 patients (mean age, 28 years; range, 23 days to 74 years; 35 males, 26 females). The main presenting symptoms were cephalgia (61%), hemisymptoms (18%), and macrocephalus (18%). Cyst location was temporobasal (34%), suprasellar (21%), at the cisterna quadrigemina (18%), paraxial supratentorial (16%), and various (10%). Thirty cystocisternostomies, 14 ventriculocystostomies, 12 cystoventriculostomies, and 10 ventriculocystocisternostomies were performed. The overall clinical success rate was 90%. The endoscopic technique was abandoned in 4 cases (7%). Postoperative complications were found in 16%; there was only one permanent deficit (2%). Five recurrences (8%) occurred up to 7 years after the first procedure. Of the various locations, the temporobasal cysts were the most difficult to treat with lowest clinical success (81%), highest recurrence (19%), and highest complication rate (24%). Of the various endoscopic techniques, ventriculocystostomy and ventriculocystocisternostomy reached the highest success rates with 100%. CONCLUSIONS Endoscopic techniques provide very good results in arachnoid cyst treatment. The most frequent cyst location is the most difficult to treat. A long-term follow-up is recommended since recurrences can occur many years after the procedure.

Endoscopic Ultrasound-Guided Drainage and Treatment of Symptomatic Pancreatic Fluid Collection following Acute or Acute-on-Chronic Pancreatitis – A Single Center Case Series

2018 ◽  
Vol 143 (06) ◽  
pp. 577-585
Author(s):  
Dominik Kaczmarek ◽  
Jacob Nattermann ◽  
Christian Strassburg ◽  
Tobias Weismüller
Keyword(s):  
Success Rate ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Fluid Collection ◽  
Clinical Success Rate ◽  
Long Term Results ◽  
Pancreatic Fluid Collection ◽  
Endoscopic Procedures ◽  
Pancreatic Fluid

Abstracts Introduction Pancreatic fluid collection (PFC) is a common complication of acute pancreatitis. Endoscopic ultrasound (EUS)-guided drainage, which is often followed by direct endoscopic necrosectomy (DEN), has become the primary approach to treat PFC, including pancreatic pseudocysts (PP) and walled-off necrosis (WON). We aimed to determine retrospectively the short- and long-term results of patients treated in our endoscopy unit and to identify parameters that are associated with treatment efficacy and outcome. Methods The data of 41 consecutive patients with post-pancreatitic PFC, who underwent endoscopic transmural intervention between 2014 and 2016, were analyzed retrospectively. After an initial EUS-guided puncture, one or more plastic stents were placed and DEN was performed if necrotic tissue remained. Results The mean diameter of the PFC was 74.0 ± 4.8 mm. Of the PFCs, 29.3% were classified as PP and 70.7% as WON. Altogether, 196 transmural endoscopic procedures were performed, including 73 endoscopic necrosectomies in a subgroup of 21 patients (20 WON, 1 PP). Initial technical success was achieved in 97.6% of patients and the short-term clinical success rate was 90.2%. The long-term clinical success rate was 82.9%, since four patients died from septic shock and/or multiple organ failure and three patients developed recurrent PFC some months after the initial discharge from endoscopic treatment. Procedural complications were registered in 9 patients during 10 of 196 endoscopic procedures (5.1%): bleeding (6), cardiorespiratory insufficiency (2), perforation with pneumoperitoneum (1), aspiration with respiratory insufficiency (1), and non-perforating superficial damage of the gastric wall (1). Neither the size of the PFC nor the initial value of C-reactive protein (CRP) or other biochemical markers were correlated with efficacy or outcome of treatment. Only the cumulative number of days with CRP > 50 mg/L significantly correlated with the number of follow-up endoscopic sessions and DEN. Fungal colonization of PFC correlated significantly (p < 0.05) with the risk of mortality (44% vs. 0%), need for intensive care treatment (66.7% vs. 25%), and sepsis (55.6% vs. 12.5%). Conclusions We confirm that EUS-guided drainage followed by DEN in patients with solid necrotic material is an effective and relatively safe therapeutic approach. Prolonged elevation of CRP and fungal colonisation of the PFC are associated with a worse course of the disease.

scholarly journals Feasibility of transrectal and transperineal fiducial marker placement for prostate cancer before proton therapy

2020 ◽  
Author(s):  
Kengo Ohta ◽  
Hiroyuki Ogino ◽  
Hiromitsu Iwata ◽  
Shingo Hashimoto ◽  
Yukiko Hattori ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Proton Therapy ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Fiducial Marker ◽  
Success Rates ◽  
Migration Rates ◽  
Pain Scores ◽  
Number Of Patients ◽  
Lower Pain

Abstract Background To compare the feasibility of transrectal and transperineal fiducial marker placement for prostate cancer before proton therapy. Materials and Methods From 2013 to 2015, the first 40 prostate cancer patients that were scheduled for proton therapy underwent transrectal fiducial marker placement, and the next 40 patients underwent transperineal fiducial marker placement (the first series). Technical and clinical success and pain scores were evaluated. In the second series (n = 280), the transrectal or transperineal approach was selected depending on the presence/absence of comorbidities, such as blood coagulation abnormalities. Seven patients refused to undergo the procedure. Thus, the total number of patients across both series was 353 (262 and 91 underwent the transrectal and transperineal approach, respectively). Technical and clinical success, complications, marker migration and the distance between the two markers were evaluated. Results In the first series, the technical and clinical success rates were 100% in both groups. The transrectal group exhibited lower pain scores than the transperineal group. The overall technical success rates of the transrectal and transperineal groups were 100% (262/262) and 99% (90/91), respectively (P &gt; 0.05). The overall clinical success rate was 100% in both groups, and there were no major complications in either group. The migration rates of the two groups did not differ significantly. The mean distance between the two markers was 25.6 ± 7.1 mm (mean ± standard deviation) in the transrectal group and 31.9 ± 5.2 mm in the transperineal group (P &lt; 0.05). Conclusion Both the transrectal and transperineal fiducial marker placement methods are feasible and safe.

scholarly journals Long-term follow-up of abandoned transvenous defibrillator leads: a nationwide cohort study

EP Europace ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. 1097-1102
Author(s):  
Anders Fyhn Elgaard ◽  
Jens Brock Johansen ◽  
Jens Cosedis Nielsen ◽  
Christian Gerdes ◽  
Sam Riahi ◽  
...  
Keyword(s):  
Clinical Success ◽  
Extraction Procedure ◽  
Clinical Success Rate ◽  
High Volume ◽  
Lead Extraction ◽  
Related Data ◽  
Major Complications ◽  
Long Term Follow Up

Abstract Aims  Commonly, a dysfunctional defibrillator lead is abandoned and a new lead is implanted. Long-term follow-up data on abandoned leads are sparse. We aimed to investigate the incidence and reasons for extraction of abandoned defibrillator leads in a nationwide cohort and to describe extraction procedure-related complications. Methods and results  All abandoned transvenous defibrillator leads were identified in the Danish Pacemaker and ICD Register from 1991 to 2019. The event-free survival of abandoned defibrillator leads was studied, and medical records of patients with interventions on abandoned defibrillator leads were audited for procedure-related data. We identified 740 abandoned defibrillator leads. Meantime from implantation to abandonment was 7.2 ± 3.8 years with mean patient age at abandonment of 66.5 ± 13.7 years. During a mean follow-up after abandonment of 4.4 ± 3.1 years, 65 (8.8%) abandoned defibrillator leads were extracted. Most frequent reason for extraction was infection (pocket and systemic) in 41 (63%) patients. Procedural outcome after lead extraction was clinical success in 63 (97%) patients. Minor complications occurred in 3 (5%) patients, and major complications in 1 (2%) patient. No patient died from complication to the procedure during 30-day follow-up after extraction. Conclusion  More than 90% of abandoned defibrillator leads do not need to be extracted during long-term follow-up. The most common indication for extraction is infection. Abandoned defibrillator leads can be extracted with high clinical success rate and low risk of major complications at high-volume centres.

scholarly journals Salvage therapy using self-expandable metal stents for recalcitrant anastomotic strictures after living-donor liver transplantation

2017 ◽  
Vol 10 (3) ◽  
pp. 297-309 ◽  
Author(s):  
Sung Ill Jang ◽  
Se Yong Sung ◽  
Hyunsung Park ◽  
Kwang-Hun Lee ◽  
Seung-Moon Joo ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Clinical Success ◽  
Anastomotic Stricture ◽  
Clinical Success Rate ◽  
Metal Stents ◽  
Success Rates ◽  
Donor Liver Transplantation ◽  
Percutaneous Procedure ◽  
Anastomotic Strictures ◽  
The Mean

Background: Recently, there has been an increase in clinical success rates using nonsurgical methods to resolve anastomotic biliary strictures (ABSs) that develop after liver transplantation (LT). However, some strictures are particularly refractory and cannot be completely resolved by an endoscopic or percutaneous procedure. Consequently, the aim of this study was to examine the feasibility and efficacy of using a newly designed fully covered self-expandable metal stent (FCSEMS) to resolve refractory ABS. Methods: A total of 35 patients with an ABS that developed after LT, but could not be resolved by an endoscopic or percutaneous procedure, were included in this study. FCSEMSs were positioned endoscopically and removed after 2–3 months. After stent removal, the patients were followed to assess complications, including re-stenosis. Results: The mean period from LT to stricture was 13.7 months, and the mean duration of the stricture was 31.8 months. The type and mean number of procedures previously attempted were endoscopic retrograde cholangiopancreatography (ERCP) (9.1 ± 5.1) in 19 patients and percutaneous transhepatic biliary drainage (9.2 ± 4.8) in 16 patients. All patients had successful FCSEMS insertions and removals; the mean stent indwelling time was 3.2 months. The mean follow-up period was 18.7 months (range: 6.4–37.8 months). Stricture recurrence was observed in 6 of 29 patients (recurrence rate: 20.7%). The anastomotic stricture resolved with the FCSEMS insertion in 29 of 35 patients (clinical success rate: 82.9%). Conclusions: The newly designed FCSEMS is a potentially feasible and effective treatment for anastomotic strictures that develop after LT but are not amenable to treatment by conventional procedures.

Endoscopic Treatment of Intracranial Arachnoid Cysts: A Retrospective Analysis of a 25-Year Experience

2020 ◽  
Vol 20 (1) ◽  
pp. 32-44 ◽  
Author(s):  
Joachim Oertel ◽  
Stefan Linsler ◽  
Wolfgang Wagner ◽  
Michael Gaab ◽  
Henry Schroeder ◽  
...  
Keyword(s):  
Endoscopic Treatment ◽  
Arachnoid Cysts ◽  
Invasive Technique ◽  
Complication Rates ◽  
Patients Âgés ◽  
Endoscopic Techniques ◽  
Long Term Follow Up ◽  
Shunt Dependency

Abstract BACKGROUND Since the development of neuroendoscopy, pure endoscopic fenestration for intracranial arachnoid cysts (ACs) became more and more popular and is actually preferred by many neurosurgeons. OBJECTIVE To explore their techniques and experiences with endoscopic treatment of intracranial ACs over a 25-yr period. METHODS A total of 95 endoscopic procedures in 87 patients with 88 intracranial ACs performed at the authors’ departments between February 1993 and October 2018 were retrospectively analyzed. Particular respect was given to surgical technique, complications, patients’ outcome, and radiological benefit in relation to cyst location. RESULTS Patients’ ages ranged from 23 d to 81 yr (mean: 29.9 yr). Cysts were located temporobasal (n = 31; 35.2%), paraxial supratentorial (n = 14; 15.9%), suprasellar/prepontine (n = 14; 15.9%), quadrigeminal (n = 12; 13.6%), infratentorial (n = 11; 12.5%), and supratentorial intraventricular (n = 6; 6.8%). Four different endoscopic techniques were applied: cystocisternostomies (n = 48; 50.5%), ventriculocystostomies (n = 23; 24.2%), cystoventriculostomies (n = 14; 14.7%), and ventriculocystocisternostomies (n = 10; 10.5%). Pure endoscopic technique was feasible in 89 of the 95 surgeries (93.7%). Clinical improvement was documented after 82 surgeries (86.3%) and radiological benefit after 62 surgeries (65.3%). Recurrences developed in 8 cases (8.4%). Overall complication rate was 21.1% (n = 20), postoperative new shunt dependency was observed in 4.2% of the cases (n = 4). CONCLUSION Pure endoscopic AC fenestration is a safe, effective, and less invasive technique providing high success and low permanent complication rates. The most frequent temporobasal cysts are the most difficult to treat endoscopically. A long-term follow-up is recommended because recurrences may occur many years after first treatment.

Seventeen-Year Follow-up After Meniscal Repair With Concomitant Anterior Cruciate Ligament Reconstruction in a Pediatric and Adolescent Population

2018 ◽  
Vol 46 (14) ◽  
pp. 3361-3367 ◽  
Author(s):  
Adam J. Tagliero ◽  
Vishal S. Desai ◽  
Nicholas I. Kennedy ◽  
Christopher L. Camp ◽  
Michael J. Stuart ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Clinical Success ◽  
Cruciate Ligament ◽  
Meniscal Repair ◽  
Clinical Success Rate ◽  
Adolescent Population ◽  
Long Term Follow Up ◽  
Anterior Cruciate

Background: Studies have shown good and excellent clinical and radiographic results after meniscal repair. Limited published information exists on the long-term outcomes, however, especially in a pediatric and adolescent population. Purpose: To determine long-term results of meniscal repair and concomitant anterior cruciate ligament (ACL) reconstruction in a pediatric and adolescent population. Specifically, the aims were to determine the clinical success rate of meniscal repair with concomitant ACL reconstruction, compare results with midterm outcomes, and analyze risk factors for failure. Study Design: Case series; Level of evidence, 4. Methods: Cases of meniscal repair with concomitant ACL reconstruction between 1990 and 2005 were reviewed among patients aged ≤18 years. Patient demographics, injury history, and surgical details were recorded, and risk factors for failure were analyzed. Physical examination findings and clinical outcomes at latest available follow-up were collected. Subjective knee outcomes were compared with midterm results. Descriptive statistics and univariate analysis were used to evaluate the available data. Results: Forty-seven patients (30 females, 17 males) with a mean age of 16 years (SD, 1.37) and a mean follow-up of 16.6 years (SD, 3.57) were included in this study. Overall, 13 patients (28%) failed meniscal repair and required repeat surgery at the time of final follow-up. Of the 13 failures, 9 underwent a subsequent meniscectomy; 2, meniscectomy and revision ACL reconstruction; 1, meniscal repair and revision ACL reconstruction; and 1, meniscal repair and subsequent meniscectomy. Mean International Knee Documentation Committee scores improved from 47.9 preoperatively to 87.7 postoperatively ( P < .01), and the mean score at long-term follow-up (87.7) did not significantly differ from that at the midterm follow-up (88.5) at a mean 7.4 years ( P = .97). Mean Tegner Activity Scale scores improved from 1.9 preoperatively to 6.3 postoperatively ( P < .01) and decreased from 8.3 at preinjury to 6.3 at final long-term follow-up ( P < .01). Conclusion: In conclusion, the long-term overall clinical success rate (failure-free survival) was 72% for repair of pediatric and adolescent meniscal tears in the setting of concomitant ACL reconstruction. Patients reported excellent knee subjective outcome scores that remained favorable when compared with midterm follow-up.

scholarly journals Long-term Follow-up of a Multiloculated Arachnoid Cyst of the Middle Cranial Fossa

2007 ◽  
Vol 86 (6) ◽  
pp. 338-341 ◽  
Author(s):  
Marc A. Cohen ◽  
Noam A. Cohen ◽  
Gul Moonis ◽  
David W. Kennedy
Keyword(s):  
Arachnoid Cyst ◽  
Radiographic Progression ◽  
Middle Cranial Fossa ◽  
Arachnoid Cysts ◽  
Close Observation ◽  
Long Term Follow Up ◽  
Intracranial Lesions ◽  
Cranial Fossa

Arachnoid cysts are benign intracranial lesions that are typically diagnosed incidentally. We describe the case of a 56-year-old man who presented with a multiloculated arachnoid cyst of the middle cranial fossa that extended into the sphenoid sinus. The lesion was identified on computed tomography of the head, which had been obtained for an unrelated investigation. However, establishing a definitive diagnosis proved to be difficult. Because the cyst had caused extensive skull base erosion, the patient was managed conservatively with close observation. We report the radiographic progression of this lesion during more than a decade of follow-up, and we review the literature pertaining to the presentation, pathophysiology, and treatment of arachnoid cysts.

Formocresol versus Calcium Hydroxide Direct Pulp Capping of Human Primary Molars: Two Year Follow-Up

2010 ◽  
Vol 34 (4) ◽  
pp. 317-321 ◽  
Author(s):  
Naser Asl Aminabadi ◽  
Ramin Mostofi Zadeh Farahani ◽  
Sina Ghertasi Oskouei
Keyword(s):  
Calcium Hydroxide ◽  
Root Resorption ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Radiographic Evaluation ◽  
Primary Molars ◽  
Spontaneous Pain ◽  
Success Rates ◽  
Direct Pulp Capping ◽  
Pulp Capping

Objectives: Clinical and radiographic evaluation of the premedicated direct pulp capping using formocresol(PDC) versus conventional direct pulp capping using calcium hydroxide (CDC) in human carious primary molars. Study design: A total of 120 vital primary molars with pinpoint exposure during caries removal in 84 patients aged 4-5 years were selected. In the PDC group (n = 60), 20% Buckley's formocresol solution, and in the CDC group (n = 60), calcium hydroxide powder were applied to the exposure sites followed by placement of zinc oxide-eugenol base. Teeth were restored with preformed stainless steel crowns. Clinical and radiographic evaluations of the treatment outcomes were performed at regular intervals of 6 and 12 months, respectively, for two years post-operatively. Results: The prevalence of spontaneous pain,sensitivity on percussion, and fistula were significantly higher in the CDC group compared to the PDC group (P &lt; 0.05). The number of teeth exhibiting periapical/furcal radiolucency or external/internal root resorption was also higher in the CDC group (P &lt; 0.05). The clinical success rate of the PDC was 90% compared to the 61.7% of the CDC (P &lt; 0.05). The radiographic success rates of the PDC and CDC groups were 85% and 53.3%, respectively (P &lt; 0.05). Conclusion: It seems formocresol premedicated direct pulp capping could safely be used as a substitute for conventional direct pulp capping.

scholarly journals Endoscopic Management of Arachnoid Cysts

2018 ◽  
Vol 22 (4) ◽  
pp. 164-168
Author(s):  
Flávio Ramalho Romero ◽  
Eduardo De Freitas Bertolini ◽  
Adalberto Sestari ◽  
Sérgio Soares Guerrero ◽  
Ramon Barbalho Guerreiro ◽  
...  
Keyword(s):  
Arachnoid Cyst ◽  
Arachnoid Cysts ◽  
Endoscopic Management ◽  
Safe Procedure ◽  
Success Rates ◽  
Surgical Indications ◽  
Operative Morbidity ◽  
Proper Patient Selection ◽  
Posterior Fossa Cyst ◽  
Suprasellar Arachnoid Cyst

Object: Arachnoid cysts are developmental space-occupying lesions filled with CSF-like content and surrounded by a membrane resembling arachnoid mater, with controversial etiology and natural history. Endoscopy has been successfully used for decades to treat a variety of pathologies within thecentral nervous system. Methods: Thirteen patients who underwent endoscopic fenestration for treatment of arachnoid cyst were selected for this study. The surgical indications and techniques were reviewed, and surgical success rates and patient outcomes were assessed. Results: Five patients had middle fossa cysts; 2 a posterior fossa cyst; 3 a quadrigeminal cistern arachnoid cyst and 3 a suprasellar arachnoid cyst. Endoscopic management consisted in a cystoventriculostomy in 8 patients and cystocisternotomy in 5 patients. There was neither mortality nor operative morbidity. Discussion: Arachnoid cysts are a relatively benign pathological entity that can be managed by performing endoscopically guided cyst wall fenestrations into the ventricular system or cerebrospinal fluid containing cisterns. Conclusion: Proper patient selection, preoperative planning of endoscope trajectory, use of frameless navigation, and advances in endoscope lens technology and light intensitycombine to make this a safe procedure with excellent outcomes. 

scholarly journals Evaluation of the clinical efficiency of rotary and manual files for root canal instrumentation in primary teeth pulpectomies: A comparative randomized clinical trial

2021 ◽  
pp. 21-34
Author(s):  
KL Girish Babu ◽  
◽  
Guraj Hebbar Kavyashree ◽  
Keyword(s):  
Root Canal ◽  
Clinical Success ◽  
File Systems ◽  
Clinical Success Rate ◽  
Mean Difference ◽  
Primary Molars ◽  
Success Rates ◽  
Primary Molar ◽  
The Mean

Aim: To evaluate and compare the instrumentation time, obturation time, quality of obturation, and clinical and radiological success of pulpectomized teethfollowing root canal preparation of primary molars with rotary and manual file system. Methods: A total of 150 primary molars requiring pulpectomy were selected from children aged four to seven years. These teeth were divided into three groups of 50 teeth each. In Groups 1, 2, and 3, cleaning and shaping were carried out with Kedo-S pediatric rotaryfiles, HERO Shaper rotary files, and manual NiTi K-files, respectively. Obturation was carried out with zinc oxide eugenol cement and an engine-driven Lentulo spiral. The instrumentation and obturation times were recorded. A radiographic assessment of thequality of the root filling was carried out immediately after obturation. Finally, the pulpectomized teeth were clinically and radiographically evaluated over a two-year period. Results: The mean instrumentation times for Groups 1, 2, and 3 were 14.56 ± 2.89 min, 17.93 ± 3.51 min, and 29.00 ± 2.08 min, respectively. The mean obturation times for Groups 1, 2, and 3 were 8.11 ± 1.7 min, 7.93 ± 1.3 min, and 9.64 ± 17.61 min, respectively. The mean difference in the quality of obturation was not statistically significant in primary molars instrumented with Kedo-S pediatricand HERO Shaper rotary file systems (p = 0.16). However, this mean difference was significant when compared between primary molar instrumented with rotary file systems and manual NiTi files (p = <0.001). At two years, the clinical success rate was 100% and the radiological success rates were 95.3%, 97.9%, and 89.5% in Groups 1, 2, and 3, respectively. Conclusions: The rotary file systems took significantly less instrumentation and obturation time than the manual NiTi files. There were no significant differences in obturation quality or success rates after two years.

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