Tanycytic Ependymoma of the Filum Terminale Region; a Case Report

Abstract Tanycytic ependymoma is a very rare spindle-cell variant of ependymoma derived from tanycytes, which are part of the primitive nervous system. This paper is presenting 48-year old woman who presented with low back and right-sided leg pain of moderate intensity. MRI showed spinal intradural tumor at the level of the L1 vertebral body. Right-sided L1 hemilaminectomy and en bloc tumor resection were performed. Neuroradiological and intraoperative diagnosis of schwannoma was revised to tanycytic ependymoma after careful immunohistochemical analysis. Six months post-operativly, MRI did not show tumor recurrence. Tanycytic ependymoma at the region of filum terminale is extremely uncommon and only three cases have been described in the literature. The low incidence of this tumor and atypical histological image, which is distinct from the typical features of commonly encountered ependymomas, can present a challenge in terms of making an accurate diagnosis. Awareness of this transitional form of ependymoma among neurosurgeons and pathologists may avoid incorrect surgical approaches and postoperative treatment course.

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548 COMPARISON OF ESOPHAGECTOMY OUTCOMES BETWEEN A NATIONAL CENTER, A NATIONAL AUDIT COLLABORATIVE, AND AN INTERNATIONAL DATABASE USING ECCG STANDARDIZED DEFINITIONS

Diseases of the Esophagus ◽

10.1093/dote/doab052.548 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Cited By ~ 1

Author(s):

John V Reynolds ◽

Jessie A Elliott ◽

Noel Donlon ◽

Claire Donohoe ◽

Narayanasamy Ravi ◽

...

Keyword(s):

Anastomotic Leak ◽

Leak Rate ◽

Collaborative Group ◽

Surgical Approaches ◽

Consecutive Series ◽

Recurrent Nerve ◽

En Bloc ◽

Curative Intent ◽

Chyle Leak ◽

Anastomotic Leak Rate

Abstract The ECCG developed a standardized platform for reporting operative complications, with consensus definitions, and DUCA adopted these definitions and have reported a comparison against these benchmarks. The aim of this study was to report five year complications data using the standardized definitions of the Esophageal Complications Consensus Group (ECCG), and to compare with published ECCG benchmark studies from the collaborative group and from the Dutch Upper Gastrointestinal Cancer Audit (DUCA). Methods All patients undergoing multimodal therapy or surgery with curative intent from 2014 to 2018 inclusive were studied. All data were recorded prospectively and maintained internally as well as entered onto a secure online database (Esodata.org) from 2015. Statistical analysis was performed using SPSS® (version 18.0). Results 219 patients (mean age 67; 77% male) underwent open resection, 66.6% via transthoracic en bloc resection. 30-day and 90-day mortality were 0.0 and 0.9%, respectively. The anastomotic leak rate was 5.4%, and chyle leak 5.4%. Pneumonia was recorded in 18.2%, respiratory failure 10.9%, and ARDS in 2.7%. Atrial dysrhythmia occurred in 22.8%, recurrent nerve injury 3.1%, and delirium in 5.0%. Compared with both ECCG and DUCA, where MIE constituted 47% and 86% of surgical approaches, respectively, overall complications were similar in this open series, as was complications severity, however anastomotic leak rate were several-fold less, and mortality rates were lower. Conclusion In this unselected consecutive series and comparative audit with benchmark averages from the ECCG and DUCA publication, a low mortality and anastomotic leak rate were the key differential findings. Although not risk-stratified or directly matched, the severity of complications from this ‘open’ series is consistent with series containing large numbers of total or hybrid MIE, highlighting a need to adhere to these strictly defined definitions in further prospective research and randomized studies.

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Total ulna replacement with a 3D-printed custom-made prosthesis after en bloc tumor resection: A case report

Pediatric Blood & Cancer ◽

10.1002/pbc.27522 ◽

2018 ◽

Vol 66 (2) ◽

pp. e27522 ◽

Cited By ~ 1

Author(s):

Xiang Fang ◽

Wenli Zhang ◽

Zeping Yu ◽

Hongyuan Liu ◽

Yan Xiong ◽

...

Keyword(s):

Case Report ◽

Tumor Resection ◽

En Bloc ◽

Custom Made ◽

3D Printed

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Left Pan-Hippocampal Low Grade Glioma—2-Stage Transsylvian Transventricular and Paramedian Supracerebellar Transtentorial Approaches: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy214 ◽

2018 ◽

Vol 16 (3) ◽

pp. E82-E82

Author(s):

Juan C Fernandez-Miranda

Keyword(s):

Tumor Resection ◽

Spatial Relationship ◽

Low Grade Glioma ◽

Parahippocampal Gyrus ◽

Surgical Approaches ◽

Low Grade ◽

Fiber Tractography ◽

High Definition ◽

Posterior Portion ◽

Fiber Tracts

Abstract The surgical goal for low-grade gliomas (LGGs) is to maximize resection while minimizing morbidity. Pan-hippocampal LGGs extend from the hippocampal head to the hippocampal tail, and involve the parahippocampal gyrus and uncus. Given their anteroposterior extension, they cannot be completely removed with 1 single approach, requiring a 2-stage front-to-back operation. In this video, we present the case of a 52-yr-old man with new onset of generalized seizures and a dominant-side, nonenhancing, pan-hippocampal infiltrative lesion compatible with a low-grade glioma. Preoperative high-definition fiber tractography (HDFT) showed the spatial relationship of the tumor with surrounding fiber tracts, such as the arcuate, inferior fronto-occipital, and middle longitudinal fascicles, and optic radiations. Surgical resection was planned in 2 separate stages. The first stage consisted of a transsylvian transinferior insular sulcus approach to the extra- and intraventricular aspects of the uncohippocampal region. The entire anterior and middle portions of the tumor were successfully removed with minimal morbidity, including transient naming difficulties and permanent superior quadrantanopia. Postoperative HDFT showed preservation of all fiber tracts, except for a portion of Meyer's loop and the inferior-most aspect of the inferior fronto-occipital fascicle. The second stage was completed 8 wk later and consisted of a paramedian supracerebellar-transtentorial approach on sitting position. The posterior portion of the tumor was entirely removed to achieve a complete macroscopic tumor resection. The final diagnosis was IDH1-positive LGG. Pan-hippocampal tumors remain a surgical challenge but accurate knowledge of surgical neuroanatomy and surgical approaches facilitates their safe and effective treatment. The patient signed an informed consent including the use of photographic and video material for educational or academic purposes.

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Mohs Micrographic Surgery Peripheral Margin Control Prior to En Bloc Tumor Resection: A Report of Three Cases

SKIN The Journal of Cutaneous Medicine ◽

10.25251/skin.2.1.7 ◽

2018 ◽

Vol 2 (1) ◽

pp. 49-53

Author(s):

Daniel Bernstein ◽

Sara Giddings ◽

Hooman Khorasani

Keyword(s):

Plastic Surgery ◽

Tumor Resection ◽

Mohs Micrographic Surgery ◽

Micrographic Surgery ◽

En Bloc ◽

Facial Plastic Surgery ◽

Facial Plastic ◽

Tumor Extirpation ◽

The Right ◽

Margin Control

Background: Mohs micrographic surgery (MMS) is an important part of non-melanoma skin cancer (NMSC) management but may even be useful for tumors that cannot be cleared in an office setting. There are sparse reports of MMS for peripheral margin control in the dermatology literature but various techniques have been reported.Case 1: 58-year-old male with morpheaform basal cell carcinoma of the left midface treated with MMS peripheral margin control followed by facial plastic surgery central tumor extirpation and defect repair.Case 2: 56-year-old female with recurrent morpheaform BCC of the scalp treated with MMS peripheral margin control followed by facial plastic surgery central tumor extirpation and defect repair.Case 3: 73-year-old male with multiply recurrent SCC of the right lower extremity treated with MMS peripheral margin control followed by above the knee amputation.Conclusions: MMS peripheral margin control followed by central tumor extirpation and defect reconstruction at a later date in the operating room is an option for deeply invasive, large and aggressive NMSC. Benefits include decreased time under general anesthesia and superior rates of tumor clearance. In the interim, the peripheral defect between the central tumor and healthy outer tissue can be sutured closed to decrease patient morbidity.

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Usefulness of tumor traction with a snare and endoclips in gastric submucosal tumor resection: a propensity-score-matching analysis

Gastroenterology Report ◽

10.1093/gastro/goaa050 ◽

2020 ◽

Author(s):

Qiang Zhang ◽

Jian-Qun Cai ◽

Zhen Wang

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Operative Time ◽

Perioperative Complications ◽

Tumor Resection ◽

En Bloc Resection ◽

Bloc Resection ◽

Resection Rate ◽

En Bloc ◽

Gastric Submucosal Tumors

Abstract Background Endoscopic resection, including endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFR), was used to resect small gastric submucosal tumors (SMTs). Our team explored a method of tumor traction using a snare combined with endoclips to assist in the resection of SMTs. This study aims to explore the safety and effectiveness of the method. Methods This research performed a propensity-score-matching (PSM) analysis to compare ESD/EFR assisted by a snare combined with endoclips (ESD/EFR with snare traction) with conventional ESD/EFR for the resection of gastric SMTs. Comparisons were made between the two groups, including operative time, en bloc resection rate, perioperative complications, and operation-related costs. Results A total of 253 patients with gastric SMTs resected between January 2012 and March 2019 were included in this study. PSM yielded 51 matched pairs. No significant differences were identified between the two groups in perioperative complications or the costs of disposable endoscopic surgical accessories. However, the ESD/EFR-with-snare-traction group had a shorter median operative time (39 vs 60 min, P = 0.005) and lower rate of en bloc resection (88.2% vs 100%, P = 0.027). Conclusions ESD/EFR with snare traction demonstrated a higher efficiency and en bloc resection rate for gastric SMTs, with no increases in perioperative complications and the costs of endoscopic surgical accessories. Therefore, the method seems an appropriate choice for the resection of gastric SMTs.

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Surgical Management Patterns of Sinonasal Malignancy: A Population-Based Study

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1675233 ◽

2018 ◽

Vol 80 (04) ◽

pp. 371-379 ◽

Cited By ~ 5

Author(s):

Qasim Husain ◽

Rohan R. Joshi ◽

Jennifer R. Cracchiolo ◽

Benjamin R. Roman ◽

Ian Ganly ◽

...

Keyword(s):

Surgical Management ◽

Survival Rates ◽

Tumor Resection ◽

Population Based ◽

Oncologic Outcomes ◽

Surgical Approaches ◽

Open Approach ◽

National Cancer Database ◽

Sinonasal Malignancy ◽

Sinonasal Malignancies

Objectives Determining surgical trends and outcomes for sinonasal tumors is challenging given their low incidence and heterogeneous pathology. This study utilized the National Cancer Database (NCDB) to identify trends and outcomes associated with surgical management of sinonasal tumors. Design Retrospective database analysis. Setting National Cancer Database. Participants Patients with sinonasal malignancies identified from the NCDB between 2010 and 2015. Main Outcome Measures The primary outcome was the choice of surgical therapy used for sinonasal tumor resection: endoscopic versus open approach. Each was cohort analyzed with respect to various demographic and clinicopathologic factors. A treatment effect model was used to identify potential differences between surgical approaches. Survival was evaluated using Kaplan–Meier analysis. Results A total of 10,193 patients with sinonasal malignancies were identified in the NCDB database; of these, 2,292 had a documented subsite, histology, and definitive surgical treatment with documented surgical approach and were included in the analysis. About 71.9% of patients had an open approach and 28.1% a purely endoscopic procedures. Tumor histology, treatment facility type, margin status, and length of stay were all variables that were associated with significant differences between the open and endoscopic cohort. Five-year survival rates for the open and endoscopic cohorts were not significantly different (59.6 and 60.8%, respectively). Conclusions Assessment of the NCDB revealed that 28% patients with sinonasal malignancy were selected for endoscopic surgery. These patients had comparable oncologic outcomes to open resection.

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Carotid body tumor resection utilizing a covered stent graft to enable resection of the tumor en bloc with the internal carotid artery

Journal of Vascular Surgery Cases and Innovative Techniques ◽

10.1016/j.jvscit.2019.07.012 ◽

2019 ◽

Vol 5 (4) ◽

pp. 481-484

Author(s):

Mohammad Alqaim ◽

Ajit S. Puri ◽

Alec E. Vaezi ◽

Andres Schanzer

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Stent Graft ◽

Carotid Body ◽

Internal Carotid ◽

Tumor Resection ◽

Covered Stent ◽

Carotid Body Tumor ◽

En Bloc ◽

Covered Stent Graft

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En bloc giant cell tumor resection following direct hemiarthroplasty shoulder reconstruction–functional outcome: A case report

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2019.07.052 ◽

2019 ◽

Vol 61 ◽

pp. 202-206 ◽

Cited By ~ 1

Author(s):

Muhammad Andry Usman ◽

Andi Dhedie Prasatia Sam ◽

Marcell Wijaya ◽

Roichan Muhammad Firdaus ◽

Khrisna Yudha

Keyword(s):

Case Report ◽

Functional Outcome ◽

Giant Cell Tumor ◽

Giant Cell ◽

Tumor Resection ◽

Cell Tumor ◽

En Bloc ◽

Shoulder Reconstruction

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Early Postoperative Results after Removal of Cranially Migrated Lumbar Disc Prolapse: Retrospective Comparison of Three Different Surgical Strategies

Advances in Orthopedics ◽

10.1155/2014/702163 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

C. Schulz ◽

U. Kunz ◽

U. M. Mauer ◽

R. Mathieu

Keyword(s):

Lumbar Disc ◽

Leg Pain ◽

Surgical Approaches ◽

Postoperative Results ◽

Retrospective Comparison ◽

Interlaminar Approach ◽

Disc Material ◽

Disc Herniations ◽

Group A ◽

Group B

Background. To compare the early postoperative results of three surgical approaches to lumbar disc herniations that migrated cranially. Minimally invasive techniques such as the translaminar and endoscopic transforaminal approaches are utilized in patients with lumbar disc herniations to gain access to cranially located disc material and to avoid the potentially destabilizing resection of ligament and bone tissue, which is associated with an extended interlaminar approach.Methods. This retrospective study compares the postoperative pain and functional capacity levels of 69 patients who underwent an interlaminar (Group A,n=27), a translaminar (Group B,n=22), or an endoscopic transforaminal procedure (Group C,n=20).Results. Median VAS scores for leg pain decreased significantly from before to after surgery in all groups. Surgical revisions were required in thirteen cases (five in Group A, one in Group B, and seven in Group C;P=0.031). After six weeks, there were significant differences in back pain and functional outcome scores and in the results for the MacNab criteria but not in leg pain scores.Conclusions. The interlaminar and translaminar techniques were the safest and fastest ways of gaining access to cranially migrated disc material and the most effective approaches over a period of six weeks.

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Sacral and Presacral Tumors: Problems in Diagnosis and Management

Neurosurgery ◽

10.1227/00006123-198912000-00006 ◽

1989 ◽

Vol 25 (6) ◽

pp. 884-891 ◽

Cited By ~ 61

Author(s):

John A. Feldenzer ◽

James L. McGauley ◽

John E. McGillicuddy

Keyword(s):

Imaging Techniques ◽

Bone Cyst ◽

Leg Pain ◽

Surgical Approaches ◽

Duration Of Symptoms ◽

Delay In Diagnosis ◽

Initial Symptoms ◽

Rectal Mass ◽

Surgical Options ◽

Sacral Tumors

Abstract We reviewed 9 cases of sacral tumors with presacral extension. These included 2 chordomas. 1 metastatic renal cell carcinoma, 2 schwannomas (1 malignant, 1 benign), 1 neurofibroma, 1 neurofibrosarcoma, 1 aneurysmal bone cyst, and an exceedingly rare meningioma. The sex of the patients was not significant. The age of the patients at diagnosis ranged from 13 to 68 years (mean, 47 years). Initial symptoms of low back and radiating leg pain were present in all but 1 patient. The duration of symptoms prior to diagnosis ranged from 1 month to 9 years (mean, 2.6 years). A delay in diagnosis of 2 years or more occurred in 6 of the 9 patients. Progressive perineal numbness and/or sphincter dysfunction were seen in 6 patients, and a palpable rectal mass was noted in 6 of 9 patients. The efficacy of various diagnostic tests is presented, as are the surgical options—needle biopsy and anterior and posterior approaches. Despite improved radiographic imaging techniques, these unusual tumors are often diagnosed at an advanced stage, and may masquerade as discogenic radiculopathy. Late diagnosis contributes to the difficulty of surgical extirpation. Anterior and posterior surgical approaches involving general, orthopedic, and urological surgeons may be required.

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