scholarly journals Collateral Predictors of Neovascularization After Indirect Revascularization in Adult Patients with Moyamoya Disease: A Single-Center Retrospective Study

2021 ◽  
Author(s):  
Kefang Dai ◽  
Zhiyong Shi ◽  
Xingju Liu ◽  
Rong Wang ◽  
Yan Zhang ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Multivariate Analyses ◽  
Adult Patients ◽  
Long Term Outcomes ◽  
Single Institution ◽  
Indirect Revascularization ◽  
Level 2 ◽  
Selection Of ◽  
Collateral Formation

Abstract Objective. The underlying factors of neovascularization after indirect bypass in the adult patients with moyamoya disease (MMD) remained unknow. The aim of this study was to explore potential predictors based on collateral characteristics for neovascularization after indirect bypass in adult MMD patients. Methods. The adult MMD patients treated by indirect bypass in a single-institution from August 2012 and January 2018 were retrospectively selected into our research. The collaterals based on cerebral angiography were classified into the following subtypes: intracerebral anastomosis, duro-cortical anastomosis, and leptomeningeal anastomosis. Neovascularization evaluation was based on Matsushima classification, with “good” collateral formation in level 2 and 3, and poor formation in level 0 and 1. Univariate and multivariate analyses were performed to identify neovascularization predictors after indirect bypass. Results. A total of 86 patients (97 hemispheres) (mean ± SD age 35.06 ± 15.09 years, range 18–61 years) were retrospectively included. Preoperative collateral circulation included intracerebral anastomosis in 49 (50.5%) cases, duro-cortical anastomosis in 19 (19.6%) cases, and leptomeningeal anastomosis in 29 (29.9%) cases, respectively. Postoperative good neovascularization was observed in 56 (57.7%) hemispheres. Multivariate analysis showed that intracerebral anastomosis (P<0.001, OR [95% CI] 2.984 [2.031-5.437]) was associated with favorable neovascularization, whereas older age (P<0.001, OR [95% CI] 0.827 [0.793-0.916]) and hemorrhagic onset (P<0.001, OR [95% CI] 0.138 [0.054–0.353]) were significantly associated with poor neovascularization. Hemispheres in the good neovascularization had lower modified Rankin scale score, and better long-term improvement than those in the poor neovascularization. Conclusions. Hemorrhagic onset and old age predict poor neovascularization after indirect bypass, while duro-cortical anastomosis and intracerebral anastomosis predict good neovascularization. Good neovascularization was associated with better long-term outcomes. The current study provides a basis for the selection of surgical procedure for MMD candidates.

Long-term outcomes in adult patients with ischemic-type moyamoya disease involving posterior circulation

2014 ◽  
Vol 156 (9) ◽  
pp. 1745-1751 ◽  
Author(s):  
Tomohito Hishikawa ◽  
Koji Tokunaga ◽  
Kenji Sugiu ◽  
Isao Date
Keyword(s):  
Moyamoya Disease ◽  
Posterior Circulation ◽  
Adult Patients ◽  
Long Term Outcomes

Long-term Outcomes After Encephaloduroarteriosynangiosis in Adult Patients with Moyamoya Disease Presenting with Ischemia

2018 ◽  
Vol 115 ◽  
pp. e482-e489 ◽  
Author(s):  
Xiang-Yang Bao ◽  
Yong Zhang ◽  
Qian-Nan Wang ◽  
Qian Zhang ◽  
Hui- Wang ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Adult Patients ◽  
Long Term Outcomes

Petroclival meningiomas: long-term outcomes of multimodal treatments and management strategies based on 30 years of experience at a single institution

2020 ◽  
Vol 132 (6) ◽  
pp. 1675-1682 ◽  
Author(s):  
Jin Wook Kim ◽  
Hee-Won Jung ◽  
Yong Hwy Kim ◽  
Chul-Kee Park ◽  
Hyun-Tai Chung ◽  
...  
Keyword(s):  
Adjuvant Treatment ◽  
Management Strategies ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Years Of Experience ◽  
Local Tumor ◽  
Long Term Outcomes ◽  
Single Institution ◽  
Petroclival Meningiomas

OBJECTIVEA thorough investigation of the long-term outcomes and chronological changes of multimodal treatments for petroclival meningiomas is required to establish optimal management strategies. The authors retrospectively reviewed the long-term clinical outcomes of patients with petroclival meningioma according to various treatments, including various surgical approaches, and they suggest treatment strategies based on 30 years of experience at a single institution.METHODSNinety-two patients with petroclival meningiomas were treated surgically at the authors’ institution from 1986 to 2015. Patient demographics, overall survival, local tumor control rates, and functional outcomes according to multimodal treatments, as well as chronological change in management strategies, were evaluated. The mean clinical and radiological follow-up periods were 121 months (range 1–368 months) and 105 months (range 1–348 months), respectively.RESULTSA posterior transpetrosal approach was most frequently selected and was followed in 44 patients (48%); a simple retrosigmoid approach, undertaken in 30 patients, was the second most common. The initial extent of resection and following adjuvant treatment modality were classified into 3 subgroups: gross-total resection (GTR) only in 13 patients; non-GTR treatment followed by adjuvant radiosurgery or radiation therapy (non-GTR+RS/RT) in 56 patients; and non-GTR without adjuvant treatment (non-GTR only) in 23 patients. The overall progression-free survival rate was 85.8% at 5 years and 81.2% at 10 years. Progression or recurrence rates according to each subgroup were 7.7%, 12.5%, and 30.4%, respectively.CONCLUSIONSThe authors’ preferred multimodal treatment strategy, that of planned incomplete resection and subsequent adjuvant radiosurgery, is a feasible option for the management of patients with large petroclival meningiomas, considering both local tumor control and postoperative quality of life.

Pneumonectomy for Treatment of Destroyed Lung: A Retrospective Study of 137 Patients

2016 ◽  
Vol 65 (07) ◽  
pp. 528-534 ◽  
Author(s):  
Yuping Li ◽  
Gening Jiang ◽  
Chang Chen ◽  
Xuefei Hu
Keyword(s):  
Risk Factor ◽  
Postoperative Complications ◽  
Operative Technique ◽  
Independent Risk Factor ◽  
Multivariate Analyses ◽  
Bronchopleural Fistula ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Destroyed Lung

Objectives Whether pneumonectomy is needed for the treatment of destroyed lungs is still controversial and unresolved in the clinic. Pneumonectomy is destructive and is associated with a significant incidence of postoperative complications. The purpose of this study is to analyze the operative techniques, postoperative morbidity, mortality, and long-term outcomes of patients with destroyed lungs who underwent pneumonectomy. Patients and Methods We retrospectively analyzed 137 patients with destroyed lungs who underwent pneumonectomy. The data were queried for the details of operative technique, development of perioperative complications, mortality, and long-term survival. Univariate and multivariate analyses were performed to investigate the risk factors of pneumonectomy among the patients. Results A total of 77 male and 60 female patients were reviewed. The youngest patient was 18 years, and the oldest was 75 years, with a mean age of 40.1 years. Postoperative complications were observed in 25 patients (18.2%). The rate of bronchopleural fistula (BPF) was 5.1% (7/137). Two perioperative deaths (1.5%) were noted. Univariate and multivariate analyses indicated the blood loss (hazard ratio [HR], 5.32; 95% confidence interval [CI], 1.27–18.50; p = 0.021) was the independent risk factor of postoperative complications, and the type of the disease (HR, 4.50; 95% CI, 1.19–9.69; p = 0.034) was the independent risk factor of the BPF, for the patients with destroyed lung after pneumonectomy. Conclusion Pneumonectomy for destroyed lung is a high risk for postoperative complications. Our findings suggested that pneumonectomy in destroyed lung was satisfactory with strict surgical indications, adequate preoperative preparation, and careful operative technique, and the long-term outcomes can be especially satisfactory. Pneumonectomy for destroyed lung is still a treatment option.

scholarly journals Replicating infant astrocyte behavior in the adult after brain injury improves outcomes

2020 ◽  
Author(s):  
Leon Teo ◽  
Anthony G. Boghdadi ◽  
Jihane Homman-Ludiye ◽  
Iñaki Carril-Mundiñano ◽  
William C. Kwan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Brain Injury ◽  
Brain Injuries ◽  
Adult Patients ◽  
Long Term Outcomes ◽  
Neuroprotective Effects ◽  
Age Dependent ◽  
Underlying Mechanisms ◽  
Glial Scarring

AbstractInfants and adults respond differently to brain injuries. Specifically, improved neuronal sparing along with reduced astrogliosis and glial scarring often observed earlier in life, likely contributes to improved long-term outcomes. Understanding the underlying mechanisms could enable the recapitulation of neuroprotective effects, observed in infants, to benefit adult patients after brain injuries. We reveal that in primates, Eph/ ephrin signaling contributes to age-dependent reactive astrocyte behavior. Ephrin-A5 expression on astrocytes was more protracted in adults, whereas ephrin-A1 was associated only with infant astrocytes. Furthermore, ephrin-A5 exacerbated major hallmarks of astrocyte reactivity via EphA2 and EphA4 receptors, which was subsequently alleviated by ephrin-A1. Rather than suppressing reactivity, ephrin-A1 signaling shifted astrocytes towards GAP43+ neuroprotection, accounting for improved neuronal sparing in infants. Reintroducing ephrin-A1 after middle-aged ischemic stroke significantly attenuated glial scarring, improved neuronal sparing and preserved circuitry. Therefore, beneficial infant mechanisms can be recapitulated in adults to improve outcomes after CNS injuries.

Long-term outcomes of surgery for choledochal cysts: a single-institution study focusing on follow-up and late complications

Surgery Today ◽  
2018 ◽  
Vol 48 (9) ◽  
pp. 835-840 ◽  
Author(s):  
Motoi Mukai ◽  
Tatsuru Kaji ◽  
Ryuta Masuya ◽  
Koji Yamada ◽  
Koshiro Sugita ◽  
...  
Keyword(s):  
Late Complications ◽  
Choledochal Cysts ◽  
Long Term Outcomes ◽  
Single Institution
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