1367 A Rare Feat: Successful ERCP Treatment of Mirrizi's Syndrome After Failed Surgery

Abstract BACKGROUND: Trigeminal neuralgia (TN) that recurs after surgery can be difficult to manage. OBJECTIVE: To define management outcomes in patients who underwent gamma knife stereotactic radiosurgery (GKSR) after failing 1 or more previous surgical procedures. METHODS: We retrospectively reviewed outcomes after GKSR in 193 patients with TN after failed surgery. The median patient age was 70 years (range, 26-93 years). Seventy-five patients had a single operation (microvascular decompression, n = 40; glycerol rhizotomy, n = 24; radiofrequency rhizotomy, n = 11). One hundred eighteen patients underwent multiple operations before GKSR. Patients were evaluated up to 14 years after GKSR. RESULTS: After GKSR, 85% of patients achieved pain relief or improvement (Barrow Neurological Institute grade I-IIIb). Pain recurrence was observed in 73 of 168 patients 6 to 144 months after GKSR (median, 6 years). Factors associated with better long-term pain relief included no relief from the surgical procedure preceding GKSR, pain in a single branch, typical TN, and a single previous failed surgical procedure. Eighteen patients (9.3%) developed new or increased trigeminal sensory dysfunction, and 1 developed deafferentation pain. Patients who developed sensory loss after GKSR had better long-term pain control (Barrow Neurological Institute grade I-IIIb: 86% at 5 years). CONCLUSION: GKSR proved to be safe and moderately effective in the management of TN that recurs after surgery. Development of sensory loss may predict better long-term pain control. The best candidates for GKSR were patients with recurrence after a single failed previous operation and those with typical TN in a single trigeminal nerve distribution.

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Perampanel treatment in highly drug-resistant epilepsies including nonsurgical candidates and failed surgery

Epilepsy & Behavior ◽

10.1016/j.yebeh.2021.108073 ◽

2021 ◽

Vol 121 ◽

pp. 108073

Author(s):

Chusak Limotai ◽

Suda Jirasakuldej

Keyword(s):

Drug Resistant ◽

Failed Surgery

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Utility of diffusion tensor imaging studies linked to neuronavigation and other modalities in repeat hemispherotomy for intractable epilepsy

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.7.peds15101 ◽

2016 ◽

Vol 17 (4) ◽

pp. 483-490 ◽

Cited By ~ 10

Author(s):

Erin N. Kiehna ◽

Elysa Widjaja ◽

Stephanie Holowka ◽

O. Carter Snead ◽

James Drake ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Diffusion Tensor ◽

Intractable Epilepsy ◽

Seizure Freedom ◽

Rasmussen’S Encephalitis ◽

Initial Procedure ◽

Surgical Options ◽

Failed Surgery ◽

Association Fibers

OBJECT Hemispherectomy for unilateral, medically refractory epilepsy is associated with excellent long-term seizure control. However, for patients with recurrent seizures following disconnection, workup and investigation can be challenging, and surgical options may be limited. Few studies have examined the role of repeat hemispherotomy in these patients. The authors hypothesized that residual fiber connections between the hemispheres could be the underlying cause of recurrent epilepsy in these patients. Diffusion tensor imaging (DTI) was used to test this hypothesis, and to target residual connections at reoperation using neuronavigation. METHODS The authors identified 8 patients with recurrent seizures following hemispherectomy who underwent surgery between 1995 and 2012. Prolonged video electroencephalography recordings documented persistent seizures arising from the affected hemisphere. In all patients, DTI demonstrated residual white matter association fibers connecting the hemispheres. A repeat craniotomy and neuronavigation-guided targeted disconnection of these residual fibers was performed. Engel class was used to determine outcome after surgery at a minimum of 2 years of follow-up. RESULTS Two patients underwent initial hemidecortication and 6 had periinsular hemispherotomy as their first procedures at a median age of 9.7 months. Initial pathologies included hemimegalencephaly (n = 4), multilobar cortical dysplasia (n = 3), and Rasmussen's encephalitis (n = 1). The mean duration of seizure freedom for the group after the initial procedure was 32.5 months (range 6–77 months). In all patients, DTI showed limited but definite residual connections between the 2 hemispheres, primarily across the rostrum/genu of the corpus callosum. The median age at reoperation was 6.8 years (range 1.3–14 years). The average time taken for reoperation was 3 hours (range 1.8–4.3 hours), with a mean blood loss of 150 ml (range 50–250 ml). One patient required a blood transfusion. Five patients are seizure free, and the remaining 3 patients are Engel Class II, with a minimum follow-up of 24 months for the group. CONCLUSIONS Repeat hemispherotomy is an option for consideration in patients with recurrent intractable epilepsy following failed surgery for catastrophic epilepsy. In conjunction with other modalities to establish seizure onset zones, advanced MRI and DTI sequences may be of value in identifying patients with residual connectivity between the affected and unaffected hemispheres. Targeted disconnection of these residual areas of connectivity using neuronavigation may result in improved seizure outcomes, with minimal and acceptable morbidity.

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Predictors of Failure for Vascularized and Nonvascularized Bone Grafting of Scaphoid Nonunions: A Systematic Review

Journal of Hand and Microsurgery ◽

10.1055/s-0041-1735349 ◽

2021 ◽

Author(s):

Schneider K. Rancy ◽

Scott W. Wolfe ◽

J. Terrence Jose Jerome

Keyword(s):

Bone Graft ◽

Bone Grafting ◽

Failure Time ◽

Smoking Status ◽

Meta Analysis ◽

Fixation Time ◽

Proximal Fragment ◽

Arcsine Transformation ◽

Failed Surgery ◽

Time From Injury

Abstract Objective This article compares predictors of failure for vascularized (VBG) and nonvascularized bone grafting (NVBG) of scaphoid nonunions. Methods We conducted a systematic literature review of outcomes after VBG and NVBG of scaphoid nonunion. Fifty-one VBG studies (N = 1,419 patients) and 81 NVBG studies (N = 3,019 patients) met the inclusion criteria. Data were collected on surgical technique, type of fixation, time from injury to surgery, fracture location, abnormal carpal posture (humpback deformity and/or dorsal intercalated segmental instability [DISI]), radiographic parameters of carpal alignment, prior failed surgery, smoking status, and avascular necrosis (AVN) as defined by punctate bleeding, magnetic resonance imaging (MRI) with contrast, MRI without contrast, X-ray, and histology. Meta-analysis of proportions was conducted with Freeman–Tukey double arcsine transformation. Multilevel mixed-effects analyses were performed with univariable and multivariable Poisson regression to identify confounders and evaluate predictors of failure. Results The pooled failure incidence effect size was comparable between VBG and NVBG (0.09 [95% confidence interval [CI] 0.05–0.13] and 0.08 [95% CI 0.06–0.11], respectively). Humpback deformity and/or DISI (incidence-rate radios [IRRs] 1.57, CI: 1.04–2.36) and lateral intrascaphoid angle (IRR 1.21, CI: 1.08–1.37) were significantly associated with an increased VBG failure incidence. Time from injury to surgery (IRR 1.09, CI: 1.06–1.12) and height-to-length (H/L) ratio (IRR 53.98, CI: 1.16–2,504.24) were significantly associated with an increased NVBG failure incidence, though H/L ratio demonstrated a wide CI. Decreased proximal fragment contrast uptake on MRI was a statistically significant predictor of increased failure incidence for both VBG (IRR 2.03 CI: 1.13–3.66) and NVBG (IRR 1.39, CI: 1.16–1.66). Punctate bleeding or radiographic AVN, scapholunate angle, radiolunate angle, and prior failed surgery were not associated with failure incidence for either bone graft type (p > 0.05). Conclusion Humpback deformity and/or DISI and increasing lateral intrascaphoid angle may be predictors of VBG failure. Time from injury to surgery may be a predictor of NVBG failure. AVN as defined by decreased contrast uptake on MRI may be a marker of increased failure risk for both bone graft types.

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Spontaneous closure of a chronic full thickness macular hole after failed surgery

American Journal of Ophthalmology Case Reports ◽

10.1016/j.ajoc.2018.12.006 ◽

2019 ◽

Vol 13 ◽

pp. 59-61 ◽

Cited By ~ 2

Author(s):

Jennifer Lee ◽

Vincent Q. Nguyen ◽

Mallika K. Doss ◽

Andrew W. Eller

Keyword(s):

Macular Hole ◽

Spontaneous Closure ◽

Full Thickness ◽

Full Thickness Macular Hole ◽

Failed Surgery

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Endovascular Treatment of an Acute Superior Mesenteric Artery Occlusion following Failed Surgical Embolectomy

Journal of Endovascular Therapy ◽

10.1177/152660280301000236 ◽

2003 ◽

Vol 10 (2) ◽

pp. 386-391 ◽

Cited By ~ 2

Author(s):

Saim Yilmaz ◽

Alihan Gürkan ◽

Okan Erdoğan ◽

Timur Sindel ◽

Kağan Çeken ◽

...

Keyword(s):

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Artery Occlusion ◽

Distal Embolization ◽

Primary Stenting ◽

History Of ◽

Surgical Embolectomy ◽

Failed Surgery ◽

Symptom Recurrence

Purpose: To present the successful primary stenting of a superior mesenteric artery (SMA) occlusion following failed surgical embolectomy. Case Report: A 65-year-old woman with a history of atrial fibrillation underwent surgical embolectomy of an acute embolic occlusion of the superior mesenteric artery (SMA). The following day, symptom recurrence suggested reocclusion, which was confirmed with emergent arteriography. Two balloon-expandable stents were deployed primarily, which ameliorated the patient's symptoms. Follow-up angiography at 3 months showed continued SMA patency, with no evidence of distal embolization or restenosis. The patient remains asymptomatic at 9 months after the stent procedure. Conclusions: Although more experience is required, primary stenting may be a valuable alternative in the treatment of acute SMA occlusions, in particular, for reocclusions after failed surgery.

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Techniques for the Management of Failed Surgery for Fractures of the Neck of Femur

The Open Orthopaedics Journal ◽

10.2174/1874325001711011223 ◽

2017 ◽

Vol 11 (1) ◽

pp. 1223-1229

Author(s):

Philip M Stott ◽

Sunny Parikh

Keyword(s):

Hip Fracture ◽

High Volume ◽

The Elderly ◽

Normal Function ◽

Optimal Management ◽

Tips And Tricks ◽

Neck Of Femur ◽

Management Of Complications ◽

Failed Surgery ◽

Surgical Treatments

Background: The majority of modern surgical treatments for managing hip fracture in the elderly are successful and result in a very low rate of revision surgery. Subsequent operations are however occasionally necessary. Optimal management of complications such as infection, dislocation or failed fixation is critical in ensuring that this frail patient group is able to survive their treatment and return to near normal function. Methods: This paper is a discussion of techniques, tips and tricks from a high volume hip fracture unit Conclusion: This article is a technique-based guide to approaching the surgical management of failed hip fracture treatment and includes sections on revising both failed fixation and failed arthroplasty.

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