scholarly journals Strategies for ear elevation and the treatment of relevant complications in autologous cartilage microtia reconstruction

2021 ◽  
Author(s):  
Zhicheng Xu ◽  
Yiyuan Li ◽  
Datao Li ◽  
Ruhong Zhang ◽  
Qun Zhang ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Negative Influence ◽  
Surgical Approaches ◽  
Complication Management ◽  
Second Stage ◽  
Autogenous Cartilage

Abstract Despite various surgical techniques for ear elevation in autogenous cartilage microtia reconstruction, it is still challenging for plastic surgeons to obtain a satisfactory depth of the cephaloauricular sulcus and stable projection of the reconstructed ear. Here, the authors demonstrate individualized options for surgical approaches and relevant details for complication management. Between January 2014 and June 2020, a series of 895 patients who underwent the second stage of microtia reconstruction were reviewed. Complications occurred in 103 patients aged between 8 and 34 years. Recommended surgical selections, as well as appropriate strategies for complication prophylaxis and treatment, were shown to minimize the negative influence on the contour of the cephaloauricular sulcus according to individual conditions. We found that 78% of the patients were satisfied with the auricle contour with harmonious integrity. Individualized strategies for ear elevation and complication treatment contribute to symmetry and satisfactory projection of the reconstructed auricle.

Current Strategies in the Management of Spinal Metastatic Disease

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 55-62 ◽  
Author(s):  
Bartanusz ◽  
Porchet
Keyword(s):  
Spinal Cord ◽  
Surgical Techniques ◽  
Cord Compression ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Spinal Stabilization ◽  
Management Algorithm ◽  
Specific Manner ◽  
Extensive Surgery ◽  
Selection Of

The treatment of metastatic spinal cord compression is complex. The three treatment modalities that are currently applied (in a histologically non-specific manner) are surgery, radiotherapy and the administration of steroids. The development of new spinal instrumentations and surgical approaches considerably changed the extent of therapeutic options in this field. These new surgical techniques have made it possible to resect these tumours totally, with subsequent vertebral reconstruction and spinal stabilization. In this respect, it is important to clearly identify those patients who can benefit from such an extensive surgery. We present our management algorithm to help select patients for surgery and at the same time identifying those for whom primary non-surgical therapy would be indicated. The retrospective review of surgically treated patients in our department in the last four years reveals a meagre application of conventional guidelines for the selection of the appropriate operative approach in the surgical management of these patients. The reasons for this discrepancy are discussed.

scholarly journals The concept of “Four Walls, Two Poles” in the lesions of the thalamus and ganglion regions: case report and literature review

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Haiyang Yang ◽  
Gang Bai ◽  
Yongli Zhang ◽  
Guolong Chen ◽  
Lei Duan ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Literature Review ◽  
Surgical Resection ◽  
Three Dimensional ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Surgical Results ◽  
Case Presentation ◽  
Operation Process ◽  
Thalamic Glioma

Abstract Background There are few articles about the surgical techniques of thalamic glioma and the lesions in the basal ganglia area. According to three existing cases and the literature review (Twelve articles were summarized which mainly described the surgical techniques), we discuss the surgical characteristics of lesions of the thalamus and basal ganglia area and summarize the relevant surgical skills. Case presentation Of the three cases, two were thalamic gliomas and one was brain abscess in basal ganglia. According to the three-dimensional concept of the “Four Walls, Two Poles”, lesions of the thalamus and basal ganglia were surgically removed, and the operative effect was analysed by relevant surgical techniques. Surgical resection of the lesions of the thalamus and basal ganglia area according to the three-dimensional concept of the “Four Walls, Two Poles” has achieved good surgical results. Relevant surgical techniques, such as the use of retractors, the use of aspirators, the choice of surgical approaches, and the haemostasis strategy, also played an important role in the operation process. Conclusions In the presented three cases the three-dimensional concept of the “Four Walls, Two Poles” allowed for safe surgical resection of lesions of the thalamus and basal ganglia.

scholarly journals Primary Malignant Orbital Tumors

2021 ◽  
Vol 82 (01) ◽  
pp. 081-090
Author(s):  
Jacquelyn Laplant ◽  
Kimberly Cockerham
Keyword(s):  
Multimodal Therapy ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Imaging Features ◽  
Orbital Surgery ◽  
Diagnosis And Management ◽  
Microsurgical Techniques ◽  
Invasive Techniques ◽  
Traditional Approaches ◽  
Orbital Imaging

Abstract Objective Primary orbital malignancy is rare. Awareness of the characteristic clinical and imaging features is imperative for timely identification and management. Surgery remains an important diagnostic and treatment modality for primary orbital malignancy, but determining the optimal surgical approach can be challenging. The purpose of this article is to explore recent advances in the diagnosis, management, and surgical approaches for primary orbital malignancies. Design In this review, the clinical presentation, imaging features, and medical and surgical management of primary orbital malignancies with representative cases will be discussed. Setting Outpatient and inpatient hospital settings. Participants Patients with diagnosed primary orbital malignancies. Main Outcome Measures Descriptive outcomes. Results Advancements in orbital imaging, microsurgical techniques, and multimodal therapy have improved the diagnosis and management of primary orbital malignancies. Special considerations for biopsy or resection are made based on the tumor's location, characteristics, nearby orbital structures, and goals of surgery. Minimally invasive techniques are supplanting traditional approaches to orbital surgery with less morbidity. Conclusions Advances in imaging technologies and surgical techniques have facilitated the diagnosis and management of primary orbital malignancies. Evolution toward less invasive orbital surgery with focus on preservation and restoration of function is underway.

scholarly journals Glans Resurfacing in Carcinoma in situ of the Penis: A Case Report

2020 ◽  
pp. 1-5
Author(s):  
Raquel Catarino ◽  
André Cardoso ◽  
Carlos Ferreira ◽  
Diogo Pereira ◽  
Tiago Correia ◽  
...  
Keyword(s):  
Case Report ◽  
Carcinoma In Situ ◽  
Penile Cancer ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Disease Recurrence ◽  
Premalignant Lesions ◽  
Surgical Approaches ◽  
Aesthetic Result

Aims: Penile cancer is an uncommon malignancy in Western countries. There are known premalignant lesions that can progress to invasive penile cancer, namely carcinoma in situ (CIS) of the glans. Treatment options for this disease include topical chemotherapy and laser ablation, but the published literature demonstrates limited efficacy for these approaches. Surgical techniques with penile-preserving approaches are performed with the goal of removing the entire tumor and preserving as much of penis as possible. There are no large, randomized studies comparing treatment options for these lesions, and reports concerning the surgical approaches are scarce. Presentation of Case: In this study, we present a case report of a patient with CIS of the glans penis surgically treated with glans resurfacing. Discussion and Conclusions: There were no complications during follow-up, and after 20 months, the patient has no evidence of disease recurrence, has preserved urinary and erectile functions and is currently satisfied with the cosmetic appearance. CIS treatment with glans resurfacing allows the maintenance penile length and function with a good aesthetic result without compromising oncologic control. This approach also allows an accurate staging of the disease and assessment of the treatment efficacy.

EFFECTS OF USING COMBINED TRANSPETROSAL SURGICAL APPROACHES TO TREAT PETROCLIVAL MENINGIOMAS

Neurosurgery ◽  
2007 ◽  
Vol 60 (6) ◽  
pp. 982-992 ◽  
Author(s):  
Tiit Mathiesen ◽  
Åsa Gerlich ◽  
Lars Kihlström ◽  
Mikael Svensson ◽  
Dan Bagger-Sjöbäck
Keyword(s):  
Facial Nerve ◽  
Psychosocial Support ◽  
Cranial Nerves ◽  
Negative Influence ◽  
Surgical Approaches ◽  
Tumor Control ◽  
Recurrence Rates ◽  
Trigeminal Neuropathy ◽  
Mean Values ◽  
Petroclival Meningiomas

Abstract OBJECTIVE Surgical treatment may be required for large petroclival meningiomas; however, surgery for these lesions is a major undertaking, and modern surgical approaches are still associated with considerable morbidity and recurrence rates. We analyzed our series of transpetrosally operated petroclival meningiomas to obtain detailed information regarding the surgery outcomes with respect to facial nerve effects, hearing changes, general neurological and psychosocial differences, and recurrence rates to identify opportunities for improvement. METHODS Between 1994 and 2004, we used transpetrosal approaches to operate on 29 patients for petroclival meningiomas larger than 30 mm. All patients were analyzed in detail regarding neurological outcomes and hearing abilities after surgery. Swedish-speaking patients were contacted for a psychosocial follow-up evaluation using the short-item 36 (SF-36) form. Results After surgery, the Glasgow Outcome Score improved in 14 patients, was unchanged in 11 patients, and worsened in four patients. Facial nerve function was found to be of House-Brackmann Grade 3 or worse in six patients (including three individuals with transcochlear surgery and facial nerve rerouting). Of the 23 patients who underwent hearing-preservation surgery, serviceable hearing was preserved in 17 individuals. Nineteen Swedish patients were contacted for psychosocial evaluation. Three patients could not participate for health reasons; of the remaining 16 patients, 12 reported physical health scores that were below mean values for the general population. For patients who did not experience very serious neurological compromise, we found that unexpected painful trigeminal neuropathy and unilateral swallowing difficulties conveyed a negative influence on health. Three years after surgery, the patients reported more normalized health scores. CONCLUSION Generally, outcomes compared well with current reports. Outcomes can be improved, however by improving patients' psychosocial support; striving to decompress, preserve, and minimize dissection of ill-defined planes of cranial nerves; and using Simpson Grade 4 gamma knife approaches when radicality is precluded. Currently, the performance of transpetrosal surgery for petroclival meningiomas is a major undertaking that significantly affects a patient's health for several years; however, the approaches that we used allowed a high degree of tumor control with relatively little neurological morbidity.

Colorectal Liver Metastasis

2019 ◽  
Author(s):  
Brian E Kadera ◽  
Michael D’Angelica
Keyword(s):  
Colorectal Cancer ◽  
Surgical Techniques ◽  
Disease Free Survival ◽  
Hepatic Arterial Infusion ◽  
The United States ◽  
Surgical Approaches ◽  
Portal Vein Ligation ◽  
Arterial Infusion ◽  
Liver Remnant ◽  
Infusion Chemotherapy

Metastatic colorectal cancer isolated to the liver is a common clinical presentation in the United States, occurring in an estimated 50,000 patients per year. Unlike most stage IV malignancies, surgery is an effective mainstay of therapy. In the past several decades, novel surgical approaches, improved systemic chemotherapy, and locoregional therapies such as ablation and hepatic arterial infusion chemotherapy have broadened the indications for resection. At the same time, advances in perioperative care and adoption of parenchymal-sparing surgical techniques have lowered the perioperative mortality of liver resection to approximately 1%. Surgical cure is possible and using 10-year disease-free survival as a definition, this can be achieved in approximately 20 to 30% of well-selected patients. The majority of patients recur; thus, active surveillance is appropriate to identify patients for potential salvage therapy, including in some cases repeat resections and/or ablation, which is associated with prolonged survival and potential cure. More research is needed in biomarker drivers of prognosis, as there are few reliable clinicopathologic indicators to identify those in whom surgery will not benefit. This review contains 7 figures, 7 tables, and 90 references. Key Words: colorectal cancer, FOLFOX, FOLFIRI, hepatic arterial infusion, hepatic resection, liver remnant, microwave ablation, portal vein ligation, ALPPS

Thromboprophylaxis in atrial fibrillation: device therapy and surgical techniques

ESC CardioMed ◽  
2018 ◽  
pp. 2198-2204
Author(s):  
Thorsten Lewalter ◽  
Clemens Jilek ◽  
Klaus Tiemann
Keyword(s):  
Antiplatelet Therapy ◽  
Oral Anticoagulation ◽  
Left Atrial ◽  
Surgical Techniques ◽  
Bleeding Risk ◽  
Surgical Approaches ◽  
Antiplatelet Medication ◽  
High Bleeding Risk ◽  
Bleeding History

The concept of left atrial appendage (LAA) occlusion is to mainly prevent stroke by excluding the most relevant source of embolism from the blood circulation. The LAA can be occluded by a number of interventional or surgical approaches. Following a successful LAA occlusion implant procedure or surgical LAA exclusion, oral anticoagulation is typically terminated, followed by antiplatelet therapy, which is routinely used in the post-implant phase for 3–6 months. The need for chronic antiplatelet therapy is still unclear. Most patients are maintained on a single antiplatelet medication, but patients with a particularly high bleeding risk receive no chronic drug therapy. Currently, the main indication for LAA occluder implantation or LAA exclusion is stroke prevention in patients at high stroke risk, with contraindications for long-term oral anticoagulation due to a bleeding history or an otherwise elevated risk for major bleeding.

Minimally Invasive Resection of Benign Gastric Tumors in Challenging Locations: Prepyloric Region or Gastroesophageal Junction

2013 ◽  
Vol 79 (10) ◽  
pp. 968-972 ◽  
Author(s):  
Christopher Armstrong ◽  
Alana Gebhart ◽  
Brian R. Smith ◽  
Ninh T. Nguyen
Keyword(s):  
Minimally Invasive ◽  
Perioperative Complications ◽  
Wedge Resection ◽  
Gastroesophageal Junction ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Anatomic Resection ◽  
Submucosal Tumors ◽  
Gastric Tumors ◽  
Minimally Invasive Surgical

Benign gastric tumors in a prepyloric location or within 3 cm adjacent of the gastroesophageal junction (GEJ) are often challenging to resect using minimally invasive surgical techniques. The aim of this study was to examine the outcomes of patients who underwent minimally invasive enucleation or resection of benign gastric tumors at these difficult locations. The charts of patients undergoing minimally invasive resection of benign-appearing submucosal gastric tumors between June 2001 and December 2012 were reviewed. Data on tumor size and location, type of minimally invasive surgical resection, perioperative complications, 90-day mortality, pathology, and recurrence were collected. A total of 70 consecutive patients underwent laparoscopic resection of benign-appearing submucosal gastric tumors; there were 24 patients with lesions close to the GEJ and nine patients with lesions close to the prepyloric region. All lesions were successfully resected laparoscopically. For prepyloric tumors, surgical approaches included enucleation (n = 1), wedge resection (n = 2), and distal gastrectomy with reconstruction (n = 6). For tumors close to the GEJ, surgical approaches included enucleation (n = 16), wedge resection (n = 3), and esophagogastrectomy (n = 5). Complications in this series of 33 patients included late strictures requiring endoscopic dilation in three patients who underwent esophagogastrectomy. The 90-day mortality rate was zero. There were no recurrences over a mean follow-up of 15 months (range, 1 to 86 months). Minimally invasive enucleation or formal anatomic resection of submucosal tumors located adjacent to the GEJ or at the prepyloric region is safe and carries a low risk for tumor recurrence. Submucosal gastric lesions adjacent to the GEJ are amenable to laparoscopic enucleation or wedge resection unless they extend proximally into the esophagus. Prepyloric lesions often require formal anatomic resection with reconstruction.

Energy Sources for the Surgical Treatment of Atrial Fibrillation

2019 ◽  
Vol 14 (6) ◽  
pp. 503-508
Author(s):  
Robert M. MacGregor ◽  
Spencer J. Melby ◽  
Richard B. Schuessler ◽  
Ralph J. Damiano
Keyword(s):  
Atrial Fibrillation ◽  
Surgical Treatment ◽  
Tissue Injury ◽  
Surgical Techniques ◽  
Maze Procedure ◽  
Energy Sources ◽  
Surgical Approaches ◽  
Surgical Ablation ◽  
The Past ◽  
Minimally Invasive Surgical

The surgical treatment of atrial fibrillation has evolved over the past 2 decades due to the advent of ablation technology, and the introduction of less invasive surgical approaches. Current devices produce ablation lines that aim to replace the incisions of traditional surgical ablation strategies, such as the Cox-Maze procedure. This has helped to simplify and shorten surgical ablation procedures and has allowed for the development of minimally invasive surgical techniques. This review discusses surgical ablation energy sources and devices, providing background on device characteristics, mechanism of tissue injury, and success in creating transmural lesions.

scholarly journals Management of anterior inferior cerebellar artery aneurysms: an illustrative case and review of literature

2009 ◽  
Vol 26 (5) ◽  
pp. E6 ◽  
Author(s):  
Nicholas C. Bambakidis ◽  
Sunil Manjila ◽  
Shervin Dashti ◽  
Robert Tarr ◽  
Cliff A. Megerian
Keyword(s):  
Surgical Techniques ◽  
Surgical Approaches ◽  
Anterior Inferior Cerebellar Artery ◽  
Parent Artery ◽  
Illustrative Case ◽  
Detailed Knowledge ◽  
Clinical Effects ◽  
Advantages And Disadvantages ◽  
Parent Artery Occlusion ◽  
Cerebellar Artery

Aneurysms of the anterior inferior cerebellar artery (AICA) are relatively rare among intracranial aneurysms. They can occur in 1 of 3 regions of the AICA: 1) craniocaudal (high or low riding), 2) mediolateral-premeatal (proximal), and 3) meatal-postmeatal (distal). The management strategies for treatment differ according to the location and configuration of the aneurysm. The existing body of neurosurgical literature contains articles published on aneurysms arising from the AICA near the basilar artery (BA), intracanalicular/meatal aneurysms, and distal AICA. Several therapeutic options exist, encompassing microsurgical and endovascular techniques. The authors describe a case of treatment involving a large BA-AICA aneurysm approached via exposure of the presigmoid dura using a retromastoid suboccipital craniectomy and partial petrosectomy. Treatment of these lesions requires detailed knowledge of the anatomy, and an anatomical overview of the AICA with its arterial loops and significant branches is presented, including a discussion of the internal auditory (labyrinthine) artery, recurrent perforating arteries, subarcuate artery, and cerebellosubarcuate artery. The authors discuss the various surgical approaches (retromastoid, far lateral, subtemporal, and transclival) with appropriate illustrations, citing the advantages and disadvantages in accessing these AICA lesions in relation to these approaches. The complications of these different surgical techniques and possible clinical effects of parent artery occlusion during AICA surgery are highlighted.

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