scholarly journals Predictors of hydrocephalus after lateral ventricular tumor resection

2021 ◽  
Author(s):  
Chengda Zhang ◽  
Lingli Ge ◽  
Tingbao Zhang ◽  
Zhengwei Li ◽  
Jincao Chen
Keyword(s):  
Risk Factors ◽  
Ventriculoperitoneal Shunt ◽  
Malignant Tumors ◽  
Obstructive Hydrocephalus ◽  
Tumor Resection ◽  
External Ventricular Drainage ◽  
Postoperative Hemorrhage ◽  
Ventricular Tumors ◽  
Independent Risk Factors ◽  
Postoperative Hydrocephalus

Abstract The aim of this study was to identify the predictors of postoperative hydrocephalus in patients with lateral ventricular tumors (LVTs) and to guide the management of perioperative hydrocephalus. We performed a retrospective analysis of patients who received LVT resection at the Department of Neurosurgery, Zhongnan Hospital of Wuhan University between January 2011 and March 2021. Patients were divided between a prophylactic external ventricular drainage (EVD) group and a non-prophylactic EVD group. We analyzed the non-prophylactic EVD group to identify predictors of acute postoperative hydrocephalus. We analyzed all enrolled patients to determine predictors of postoperative ventriculoperitoneal shunt placement. A total of 97 patients were included in this study. EVD was performed in 23 patients with postoperative acute obstructive hydrocephalus, nine patients with communicative hydrocephalus, and two patients with isolated hydrocephalus. Logistic regression analysis showed that tumor anterior invasion of the ventricle (P = 0.020) and postoperative hemorrhage (P = 0.004) were independent risk factors for postoperative acute obstructive hydrocephalus, while a malignant tumor (P = 0.004) was an independent risk factor for a postoperative ventriculoperitoneal shunt. In conclusion, anterior invasion of the lateral ventricle and postoperative hemorrhage are independent risk factors for acute obstructive hydrocephalus after LVT resection. Patients with malignant tumors have a greater risk of shunt dependence after LVT resection.

scholarly journals Risk factors for hydrocephalus following fourth ventricle tumor surgery: A retrospective analysis of 121 patients

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241853
Author(s):  
Tengyun Chen ◽  
Yanming Ren ◽  
Chenghong Wang ◽  
Bowen Huang ◽  
Zhigang Lan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Retrospective Analysis ◽  
Fourth Ventricle ◽  
Univariate Analysis ◽  
Tumor Resection ◽  
Tumor Location ◽  
Subtotal Resection ◽  
Independent Risk Factors ◽  
Postoperative Hydrocephalus

Background and aim Most patients who present with a fourth ventricle tumor have concurrent hydrocephalus, and some demonstrate persistent hydrocephalus after tumor resection. There is still no consensus on the management of hydrocephalus in patients with fourth ventricle tumor after surgery. The purpose of this study was to identify the factors that predispose to postoperative hydrocephalus and the need for a postoperative cerebrospinal fluid (CSF) diversion procedure. Materials and methods We performed a retrospective analysis of patients who underwent surgery of the fourth ventricle tumor between January 2013 and December 2018 at the Department of Neurosurgery in West China Hospital of Sichuan University. The characteristics of patients and the tumor location, tumor size, tumor histology, and preventive external ventricular drainage (EVD) that were potentially correlated with CSF circulation were evaluated in univariate and multivariate analysis. Results A total of 121 patients were enrolled in our study; 16 (12.9%) patients underwent postoperative CSF drainage. Univariate analysis revealed that superior extension (p = 0.004), preoperative hydrocephalus (p<0.001), and subtotal resection (p<0.001) were significantly associated with postoperative hydrocephalus. Multivariate analysis revealed that superior extension (p = 0.013; OR = 44.761; 95% CI 2.235–896.310) and subtotal resection (p = 0.005; OR = 0.087; 95% CI 0.016–0.473) were independent risk factors for postoperative hydrocephalus after resection of fourth ventricle tumor. Conclusion Superior tumor extension (into the aqueduct) and failed total resection of tumor were identified as independent risk factors for postoperative hydrocephalus in patients with fourth ventricle tumor.

Complications After Pancreaticoduodenectomy for Pancreatic Cancer: A Retrospective Study

2011 ◽  
Vol 96 (3) ◽  
pp. 220-227 ◽  
Author(s):  
Shiyan Ren ◽  
Peng Liu ◽  
Ningxin Zhou ◽  
Jiahong Dong ◽  
Rong Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Duct ◽  
Univariate Analysis ◽  
Postoperative Hemorrhage ◽  
Morbidity Rate ◽  
Surgical Time ◽  
Pancreatic Cancers ◽  
Duct Diameter ◽  
Independent Risk Factors ◽  
Abdominal Hemorrhage

Abstract Postoperative complications, such as pancreatic fistulae, after pancreaticoduodenectomy for pancreatic cancers are associated with surgical outcomes of patients with pancreatic cancers. A total of 160 patients with pancreatic cancers undergoing pancreaticoduodenectomy were retrospectively analyzed. Patients were grouped into a fistulae group (n  =  34) and a nonfistulae group (n  =  126). The fistulae group had a significantly higher morbidity rate than the nonfistulae group (P &lt; 0.0001), but hospital mortality was not different in both groups (P  =  0.481). There was a higher incidence of intra-abdominal hemorrhage in patients with pancreatic fistulae than in those without fistulae. Two patients in fistulae group underwent reoperation. Patients with pancreatic fistulae had significantly longer hospital stay than those without fistulae. Pancreatic duct diameter, smoking, years of tobaccos consumption, preoperative jaundice, and surgical hours were associated with risk of fistulae on univariate analysis. In a multivariate analysis, diameter of pancreatic duct, surgical hours, and preoperative jaundice were independent risk factors of pancreatic fistulae. Incidence of pancreatic fistulae after pancreaticoduodenectomy is significantly influenced by the size of pancreatic duct diameter, surgical time, and preoperative jaundice. Early postoperative hemorrhage could be cautiously prevented. The survival is not significantly impacted by pancreatic fistulae.

Risk factors for surgical site infection in spinal surgery

2003 ◽  
Vol 98 (2) ◽  
pp. 149-155 ◽  
Author(s):  
Margaret A. Olsen ◽  
Jennie Mayfield ◽  
Carl Lauryssen ◽  
Louis B. Polish ◽  
Marilyn Jones ◽  
...  
Keyword(s):  
Risk Factors ◽  
Morbid Obesity ◽  
Spinal Fusion ◽  
Spinal Surgery ◽  
Posterior Approach ◽  
Tumor Resection ◽  
Content Type ◽  
Independent Risk Factors ◽  
Postoperative Incontinence ◽  
Fine Print

Object. The objective of this study was to identify specific independent risk factors for surgical site infections (SSIs) occurring after laminectomy or spinal fusion. Methods. The authors performed a retrospective case-control study of data obtained in patients between 1996 and 1999 who had undergone laminectomy and/or spinal fusion. Forty-one patients with SSI or meningitis were identified, and data were compared with those acquired in 178 uninfected control patients. Risk factors for SSI were determined using univariate analyses and multivariate logistic regression. The spinal surgery—related SSI rate (incisional and organ space) during the 4-year study period was 2.8%. Independent risk factors for SSI identified by multivariate analysis were postoperative incontinence (odds ratio [OR] 8.2, 95% confidence interval [CI] 2.9–22.8), posterior approach (OR 8.2, 95% CI 2–33.5), procedure for tumor resection (OR 6.2, 95% CI 1.7–22.3), and morbid obesity (OR 5.2, 95% CI 1.9–14.2). In patients with SSI the postoperative hospital length of stay was significantly longer than that in uninfected patients (median 6 and 3 days, respectively; p < 0.001) and were readmitted to the hospital for a median additional 6 days for treatment of their infection. Repeated surgery due to the infection was required in the majority (73%) of infected patients. Conclusions. Postoperative incontinence, posterior approach, surgery for tumor resection, and morbid obesity were independent risk factors predictive of SSI following spinal surgery. Interventions to reduce the risk for these potentially devastating infections need to be developed.

scholarly journals Risk Factors for Postoperative Hydrocephalus Following Subependymal Giant Cell Astrocytoma Resection: A Study of Under 18-Year-Old Patients in China

2021 ◽  
Author(s):  
Fangjie Shen ◽  
Jia Wang ◽  
Loren Skudder Hill ◽  
Gang Cui ◽  
Xu Kang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Giant Cell ◽  
Tumor Resection ◽  
Maximum Diameter ◽  
Subependymal Giant Cell Astrocytoma ◽  
Resection Rate ◽  
Old Patients ◽  
The Mean ◽  
Postoperative Hydrocephalus ◽  
Giant Cell Astrocytoma

Abstract Background: Hydrocephalus may occur after subependymal giant cell astrocytoma (SEGA) resection. In existing literatures, SEGA almost always occurred in patients with tuberous sclerosis complex (TSC), however, many SEGA also occurred alone in our Chinese pediatric patients. Objective: To discuss the risk factors of postoperative hydrocephalus following SEGA resection and the relationship between SEGA and TSC in Chinese children.Materials and methods: A total of 35 children (≤18-year-old) who underwent SEGA resection were selected. From 3 months postoperatively until December 2020 all patients received telephone or clinical follow-up. Related risk factors were first screened by univariate analysis and then analyzed by multivariate logistic regression.Results: The ratio of males to females was 3:2 and the mean age was 11.6 years. Twenty cases were associated with TSC and 15 were not. The mean maximum diameter of the SEGA for patients with and without associated TSC was 49.7mm and 30.5mm, respectively (Z=-3.293, P=0.001). Twenty-eight patients had preoperative hydrocephalus. Sixteen patients developed postoperative hydrocephalus, and amongst these, 2 did not have hydrocephalus before surgery. Multivariate analysis showed that association with TSC [odds ratio (OR), 18.81, P=0.048] and tumor resection rate (OR, 0.042, P=0.025) were independent risk factors for postoperative hydrocephalus. Conclusion:SEGA could be associated with TSC or appear alone. The maximum diameter of SEGA associated with TSC is larger than that without TSC. Hydrocephalus is a common onset symptom and might recur following SEGA resection. Association with TSC and tumor resection rate are risk factors for postoperative hydrocephalus.

scholarly journals Hyponatremia with intracranial malignant tumor resection in children

2012 ◽  
Vol 9 (5) ◽  
pp. 524-529 ◽  
Author(s):  
Cydni Williams ◽  
Tamara D. Simon ◽  
Jay Riva-Cambrin ◽  
Susan L. Bratton
Keyword(s):  
Malignant Tumors ◽  
Average Length ◽  
Obstructive Hydrocephalus ◽  
Tumor Resection ◽  
Brain Structures ◽  
Neurosurgical Procedures ◽  
Emergency Department Admission ◽  
Factors Associated ◽  
Intracranial Neoplasm ◽  
Deep Brain

Object Intracranial neoplasms are the second most common childhood cancer, and lead to significant morbidity and mortality. Hyponatremia is a complication associated with neurosurgical procedures, but children undergoing intracranial tumor resection have not been selectively studied. In this study, the authors aimed to determine the incidence and risk factors associated with hyponatremia among children undergoing intracranial neoplasm resection. Methods A retrospective cohort was compiled using the 2006 Kids' Inpatient Database to identify children younger than 21 years of age who underwent intracranial neoplasm resection. Hyponatremia was ascertained by diagnosis codes. Bivariate analyses were conducted using chi-square and Mann-Whitney U-tests. Logistic regression models were developed to evaluate factors associated with hyponatremia in bivariate analyses. Results Hyponatremia occurred in 205 (8.7%) of 2343 annual weighted cases, and was independently associated with tumor location in the deep brain structures and ventricles compared with the cortical area (adjusted odds ratio [aOR] 2.4; 95% CI 1.1–5.3). Hyponatremia was also associated with obstructive hydrocephalus (aOR 2.7; 95% CI 1.7–4.3) and emergency department admission (aOR 1.7; 95% CI 1.1–2.4). Hyponatremia was significantly associated with mechanical ventilation, ventriculostomy placement, ventriculoperitoneal shunt placement, and sepsis. Hyponatremia was also associated with a significantly longer average length of stay (24.6 vs 10.2 days), higher average charges ($191,000 vs $92,000), and a higher percentage of discharges to intermediate-care facilities. Conclusions Hyponatremia commonly occurs with resection of intracranial malignant tumors, especially for lesions located in the deep brain and in patients with obstructive hydrocephalus. Hyponatremia was associated with higher morbidity. Further research is needed to develop targeted monitoring and intervention strategies to decrease perioperative hyponatremia and to determine if this could decrease the number of complications in this specialized population.

scholarly journals CTLA-4 Synergizes With PD1/PD-L1 in the Inhibitory Tumor Microenvironment of Intrahepatic Cholangiocarcinoma

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiao-Jun Guo ◽  
Jia-Cheng Lu ◽  
Hai-Ying Zeng ◽  
Rong Zhou ◽  
Qi-Man Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Recurrence Rate ◽  
Intrahepatic Cholangiocarcinoma ◽  
Proportional Hazards ◽  
Cytotoxic T Lymphocyte ◽  
Checkpoint Inhibitors ◽  
Combined Therapy ◽  
Tumor Resection ◽  
Cox Proportional Hazards ◽  
Independent Risk Factors

Intrahepatic cholangiocarcinoma (ICC) is highly invasive and carries high mortality due to limited therapeutic strategies. In other solid tumors, immune checkpoint inhibitors (ICIs) target cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) and programmed death 1 (PD1), and the PD1 ligand PD-L1 has revolutionized treatment and improved outcomes. However, the relationship and clinical significance of CTLA-4 and PD-L1 expression in ICC remains to be addressed. Deciphering CTLA-4 and PD-L1 interactions in ICC enable targeted therapy for this disease. In this study, immunohistochemistry (IHC) was used to detect and quantify CTLA-4, forkhead box protein P3 (FOXP3), and PD-L1 in samples from 290 patients with ICC. The prognostic capabilities of CTLA-4, FOXP3, and PD-L1 expression in ICC were investigated with the Kaplan–Meier method. Independent risk factors related to ICC survival and recurrence were assessed by the Cox proportional hazards models. Here, we identified that CTLA-4+ lymphocyte density was elevated in ICC tumors compared with peritumoral hepatic tissues (P &lt;.001), and patients with a high density of CTLA-4+ tumor-infiltrating lymphocytes (TILsCTLA-4 High) showed a reduced overall survival (OS) rate and increased cumulative recurrence rate compared with patients with TILsCTLA-4 Low (P &lt;.001 and P = .024, respectively). Similarly, patients with high FOXP3+ TILs (TILsFOXP3 High) had poorer prognoses than patients with low FOXP3+ TILs (P = .021, P = .034, respectively), and the density of CTLA-4+ TILs was positively correlated with FOXP3+ TILs (Pearson r = .31, P &lt;.001). Furthermore, patients with high PD-L1 expression in tumors (TumorPD-L1 High) and/or TILsCTLA-4 High presented worse OS and a higher recurrence rate than patients with TILsCTLA-4 LowTumorPD-L1 Low. Moreover, multiple tumors, lymph node metastasis, and high TumorPD-L1/TILsCTLA-4 were independent risk factors of cumulative recurrence and OS for patients after ICC tumor resection. Furthermore, among ICC patients, those with hepatolithiasis had a higher expression of CTLA-4 and worse OS compared with patients with HBV infection or undefined risk factors (P = .018). In conclusion, CTLA-4 is increased in TILs in ICC and has an expression profile distinct from PD1/PD-L1. TumorPD-L1/TILsCTLA-4 is a predictive factor of OS and ICC recurrence, suggesting that combined therapy targeting PD1/PD-L1 and CTLA-4 may be useful in treating patients with ICC.

Risk factors for and outcomes of intraprocedural rupture during endovascular treatment of unruptured intracranial aneurysms

2017 ◽  
Vol 10 (4) ◽  
pp. 362-366 ◽  
Author(s):  
Shuhei Kawabata ◽  
Hirotoshi Imamura ◽  
Hidemitsu Adachi ◽  
Shoichi Tani ◽  
So Tokunaga ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracranial Aneurysms ◽  
External Ventricular Drainage ◽  
Anterior Communicating Artery ◽  
Thromboembolic Complications ◽  
Acute Hydrocephalus ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Independent Risk Factors ◽  
Poor Outcomes

Background and purposeThe risk factors for intraprocedural rupture (IPR) of unruptured intracranial aneurysms (UIAs) and the outcomes of IPR itself are unclear. This study was performed to identify the independent risk factors for and outcomes of IPR.Materials and methodsWe retrospectively evaluated the medical records and radiologic data of 1375 patients (1406 UIAs) who underwent coil embolization from January 2001 to October 2016.ResultsIPR occurred in 20 aneurysms of 20 patients (1.4%). Univariate analyses showed that the rate of IPR was significantly higher in the treatment of aneurysms with a small dome size, aneurysms in the anterior communicating artery (AcomA) (6.6%), and patients with a medical history of dyslipidemia. Multivariate analyses showed that a small dome size and aneurysms in the AcomA were independently associated with IPR (p=0.0096 and p=0.0001, respectively). IPR induced by a microcatheter was associated with a higher risk of severe subarachnoid hemorrhage than other causes of IPR (57% vs 0%, respectively). Thromboembolic complications occurred in seven (35%) patients with IPR. Six (30%) patients required external ventricular drainage placement after developing symptoms of acute hydrocephalus. The overall morbidity and mortality rates from IPR were 0.22% and 0.15%, respectively.ConclusionsAneurysms in the AcomA and with a small dome size are likely to be risk factors for IPR. IPR induced by microcatheters can result in poor outcomes. The rate of IPR-associated thromboembolic complications is high, and IPR itself is associated with acute hydrocephalus. If managed appropriately, however, most patients with IPR can survive without neurological deterioration.

scholarly journals Endoscopic management of hydrocephalus secondary to tumors of the posterior third ventricle

1999 ◽  
Vol 7 (4) ◽  
pp. E3 ◽  
Author(s):  
Charles Teo ◽  
Ronald Young
Keyword(s):  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Tumor Resection ◽  
Endoscopic Management ◽  
Third Ventriculostomy ◽  
Invasive Approach ◽  
Cerebrospinal Fluid Diversion ◽  
Number Of Patients ◽  
Less Invasive Approach ◽  
Ventricular Tumors

Management of the obstructive hydrocephalus that accompanies tumors located in the third ventricle has traditionally involved either urgent tumor resection, with resultant ventricular decompression, or cerebrospinal fluid diversion that requires either ventriculostomy or shunt placement prior to tumor removal. Although this approach has worked well for the better part of a century, it has both short- and long-term sequelae that can possibly be avoided. Beacause a number of lesions in this area are benign or are amenable to radiotherapy, a less invasive approach to their treatment is desirable. The advances in both instrumentation and techniques of endoscopic surgery have established alternatives to the traditional treatment of third ventricular tumors and resultant hydrocephalus. The authors review the treatment of 19 patients with posterior third ventricular tumors who presented to Arkansas Children's Hospital over a 5-year period (September 1993–July 1999). In 11 patients signs and/or symptoms of hydrocephalus were demonstrated and were treated with endoscopic third ventriculostomy, additionally, a biopsy procedure, resection, or fenestration of the tumor was performed in a number of patients. Endoscopy was believed to have been of benefit in all patients, despite the eventual failure of the ventriculostomy in one patient. There were no complications in this series. The algorithm thus developed by the authors provides both a diagnostic and therapeutic pathway that may ultimately reduce the morbidity associated with the treatment of patients with posterior third ventricular lesions.

scholarly journals AB0627 PROGNOSIS AND MORTALITY OF DERMATOMYOSITIS AND POLYMYOSITIS PATIENTS WITH MALIGNANCY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1609.1-1609
Author(s):  
X. Yang ◽  
Y. Hao ◽  
Z. Zhang
Keyword(s):  
Risk Factors ◽  
Malignant Tumor ◽  
Age Of Onset ◽  
Malignant Tumors ◽  
Survival Rates ◽  
Disease Onset ◽  
National Bureau ◽  
Peking University ◽  
Independent Risk Factors ◽  
Male Patients

Background:Previous studies indicate that cancers in DM/PM patients are associated with increased mortality. Hence, identifying predictors of malignancy in PM and DM is crucial. However, few large series studies have reported prognostic and predictive factors of malignancy in patients with PM and DM. Moreover, in recent years, several published studies also allow us to better understand the clinical characteristics of malignancy in PM and in DM.Objectives:To analyze the mortality and identify the major independent risk factors for death in patients with dermatomyositis/polymyositis (DM/PM) complicated with malignant tumor.Methods:The clinical data of all patients with DM/PM in Peking University First Hospital from January 2007 to Jan 2019 were retrospectively reviewed. All patients were followed up to confirm whether they had malignant tumors. According to the statistics of the National Bureau of Statistics of China, the standard mortality (SMR) and life lost years (YLL) of patients with DM/PM were combined with malignant tumors. The Kaplan-Meier method was used to analyze the 10-year survival of DM/PM patients with malignant tumors. Cox multivariate regression was used to predict independent risk factors for DM/PM patients with malignant tumors.Results:A total of 334 patients with dermatomyositis and 69 patients with polymyositis were enrolled in the study. The mean age of onset was 50.5 ± 14.8 years and 48.9 ± 16.1 years, with a median follow-up of 40.6 (11.6-77.6) months. Among them, 320 patients were successfully followed up, including 69 patients with death, 46 DM/PM with malignant tumors (38 with dermatomyositis and 8 with polymyositis). The average age of onset of DM/PM patients with malignant tumors was 55.4 ± 15.1 years and 59.5 ± 4.7 years, respectively, of which 17 died. The age-sex adjusted SMR of DM/PM patients without malignant tumors was 9.0 (95% CI 6.8-11.2). The age-sex adjusted SMR of DM/PM with malignant tumors was 12.3 (95% CI 9.0-14.7). The life loss of male patients with dermatomyositis complicated with malignant tumors was 30.1 years, and that of females was 38.6 years; the life loss of male patients with polymyositis was 27.6 years, and that of females was 22.1 years. A 10-year survival analysis showed that DM/PM patients with malignant tumor had significantly worse prognosis than patients without malignancy (p=0.001 Log-rank). The 1-, 5-, and 10-year survival rates of DM/PM patients who did not have malignant tumors were 87.9%, 81.9%, and 78.4%, respectively. DM/PM Patients with malignant tumors 1, 5, and 10 years The survival rates were 73.3%, 56.0%, and 45.7%, respectively. The independent risk factors for death in DM/PM patients with malignant tumors were advanced age (HR=1.11 95% CI 1.02-1.20, p=0.014) and infection (HR=17.07 95% CI 1.66-175.75, p= 0.017).Conclusion:Malignant tumor is a common in patients with DM/PM, and the mortality of DM/PM patients with malignant tumors is high. The independent predictors of mortality for PM/DM patients with malignant tumors were age at disease onset and infection.Acknowledgments:We thank our patients with PM/DM participating in this study.Disclosure of Interests:None declared

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