scholarly journals Neurosurgical management of Currarino syndrome: A case series and review of literature

2019 ◽  
Vol 10 ◽  
pp. 70
Author(s):  
Alexander M. Tucker ◽  
Peter Morgenstern ◽  
Daniel Diaz ◽  
Shaina Sedighim ◽  
Donald Shaul ◽  
...  
Keyword(s):  
Case Series ◽  
Laparoscopic Approach ◽  
Pediatric Neurosurgery ◽  
Anorectal Malformations ◽  
Surgical Approaches ◽  
Dural Defect ◽  
Presacral Mass ◽  
Intraoperative Complication ◽  
Currarino Syndrome ◽  
Posterior Procedure

Background: The Currarino syndrome (CS), defined by the triad of anorectal malformations, sacral bone deformities, and presacral masses, is rare. There are few surgical series that discuss conservative management versus the surgical approaches to these lesions. Here, we describe utilizing a combined anterior and posterior approach for resecting these lesions in four patients. Methods: Four patients with CS were treated with two-stage approaches performed by a multidisciplinary team, including pediatric neurosurgery and general surgery. The first anterior laparoscopic approach mobilized the presacral mass from its ventral attachments. The second posterior procedure detethered the spinal cord, repaired the dural defect, and facilitated removal of the presacral mass. Results: Gross total resection of all four presacral masses was accomplished without intraoperative complication; all patients clinically improved. Conclusion: The CS is characterized by a large presacral mass. Here, one must rule out malignancy and also consider diagnosis/resection due to the risks for malignant transformation. The operative approach we described in four patients utilized standard anterior mobilization of the mass, followed by posterior detethering, dural repair, and ultimate resection.

Complete familial currarino triad in association with hirschsprung's disease: magnetic resonance imaging features and the spectrum of anorectal malformations

2006 ◽  
Vol 47 (4) ◽  
pp. 422-426 ◽  
Author(s):  
O. Kilickesmez ◽  
I. Hakki Gol ◽  
M. Uzun ◽  
C. Oruk
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Anorectal Malformations ◽  
Imaging Features ◽  
Resonance Imaging ◽  
Presacral Mass ◽  
Currarino Syndrome ◽  
Hereditary Condition

Currarino syndrome, a rare hereditary condition, is defined as a partial sacral agenesis associated with a presacral mass and anorectal malformation. The authors present two siblings with complete Currarino triad and their mother with incomplete triad. The complete Currarino triad in the older sibling was associated with Hirschsprung's disease as the second reported case in the literature. Anorectal malformations, whether suspected of Currarino syndrome or not, should be examined with lumbosacral magnetic resonance imaging.

scholarly journals Transischiorectal fossa approach for resection of pudendal nerve schwannoma: case report

2016 ◽  
Vol 25 (5) ◽  
pp. 636-639 ◽  
Author(s):  
Stephanie Chen ◽  
Brandon Gaynor ◽  
Allan D. Levi
Keyword(s):  
Pelvic Pain ◽  
Pudendal Nerve ◽  
English Language ◽  
Case Reports ◽  
Laparoscopic Approach ◽  
Direct Access ◽  
Surgical Approaches ◽  
Complete Relief ◽  
Pelvic Muscles ◽  
Intraoperative Electrophysiological Monitoring

Pudendal nerve schwannomas are very rare, with only two cases reported in the English-language literature. The surgical approaches described in these two case reports are the transgluteal approach and the laparoscopic approach. The authors present the case of a patient with progressive pelvic pain radiating ipsilaterally into her groin, vagina, and rectum, who was subsequently found to have a pudendal schwannoma. The authors used a transischiorectal fossa approach and intraoperative electrophysiological monitoring and successfully excised the tumor. This approach has the advantage of direct access to Alcock's canal with minimal disruption of the pelvic muscles and ligaments. The patient experienced complete relief of her pelvic pain after the procedure.

Pipeline Embolization Device for treatment of high cervical and skull base carotid artery dissections: clinical case series

2015 ◽  
Vol 8 (7) ◽  
pp. 722-728 ◽  
Author(s):  
Grzegorz Brzezicki ◽  
Dennis J Rivet ◽  
John Reavey-Cantwell
Keyword(s):  
Skull Base ◽  
Treatment Option ◽  
Case Series ◽  
Endovascular Intervention ◽  
Long Term Results ◽  
Complete Revascularization ◽  
Intraoperative Complication ◽  
Pipeline Embolization Device ◽  
High Cervical

BackgroundMost cervical dissections are treated with anticoagulation or antiplatelet agents with very good results; however, some patients may benefit from endovascular intervention. High cervical and skull base dissections are often more challenging to treat because of the distal location and tortuous anatomy. The Pipeline Embolization Device (PED) may be a reasonable treatment option for this indication.ObjectivesTo report a case series of patients treated with the PED for high cervical and skull base dissections, focusing on their presentation, indications for treatment, dissection revascularization success, and pseudoaneurysm obliteration evaluated by imaging, and to review available pertinent literature.MethodsWe retrospectively reviewed all cases of high cervical and skull base dissections treated with a PED at our institution. Patient clinical characteristics, presentation, procedural and follow-up imaging, and clinical course were analyzed to evaluate for procedure complications, dissection revascularization success, pseudoaneurysm obliteration, and clinical outcome.ResultsThis is a retrospective case series including 11 patients with 13 carotid dissections treated in our center. There were nine traumatic and four spontaneous dissections. The most common presentation was cerebrovascular accident/transient ischemic attack (CVA/TIA; 5 patients) and headache/face pain (4 patients). Eleven dissections were associated with pseudoaneurysms. Three patients failed medical management with anticoagulation, although flow-limiting stenosis was the main indication for endovascular intervention. Up to three PEDs per vessel were deployed. Angioplasty was used in 10 cases. Complete revascularization (<10% residual stenosis) was achieved in 91% of vessels and 50% of pseudoaneurysms were completely or near completely obliterated immediately after PED(s) deployment. Proximal iatrogenic dissection was the only intraoperative complication. Follow-up imaging was available for nine treated vessels and demonstrated patent PEDs without significant in-stent stenosis up to 9 months after intervention. 75% of pseudoaneurysms were completely obliterated at follow-up. One PED partially collapsed but had no neurological consequences. There were no new CVA/TIAs.ConclusionsOur initial experience with treatment of high cervical and skull base dissections with the PED appears to show that this technique may be a safe and viable treatment option. However, long-term results are needed to fully evaluate the efficacy of such treatment.

A Case Series of the Use of Piezosurgery Instrument for Minimally Invasive Metopic Suturectomy

2021 ◽  
Author(s):  
Ben G McGahan ◽  
Joravar Dhaliwal ◽  
Gregory D Pearson ◽  
Ibrahim Khansa ◽  
Annie I Drapeau
Keyword(s):  
Case Series ◽  
Retrospective Chart Review ◽  
Minimal Invasive ◽  
Surgical Approaches ◽  
Average Weight ◽  
Entire Cohort ◽  
Metopic Suture ◽  
The Many ◽  
Single Suture ◽  
Metopic Craniosynostosis

Abstract BACKGROUND Minimal invasive suturectomy is one of the many surgical approaches to treat isolated single suture craniosynostosis. This approach can be technically challenging in metopic craniosynostosis given the narrow corridor and steep angle of the forehead. New instruments such as the Piezosurgery device (Mectron) have the potential to improve the ability to safely perform minimal invasive surgery in metopic craniosynostosis. OBJECTIVE To demonstrate the safety and efficacy of Piezosurgery technology in minimal invasive suturectomy for nonsyndromic metopic suture craniosynostosis and to describe our technique. METHODS A retrospective chart review was performed of all the single metopic suturectomies performed at our single institution from March 2018 to November 2019. Pre-, intra-, and postoperative data were collected to assess the safety of Piezosurgery. RESULTS The cohort consisted of 12 patients with an average of 95.25 d old and an average weight of 6.2 kg. A total of 91.7% were male, and 91.7% were Caucasian. There were no intraoperative or postoperative Piezosurgery device-related complications in the entire cohort. CONCLUSION The use of the Piezosurgery instrument was safe in this cohort of minimal invasive metopic suturectomy. This device has greatly increased the ease of this procedure in our hands.

scholarly journals LATE IMPACT OF THE LAPAROSCOPIC TREATMENT OF DEEP INFILTRATING ENDOMETRIOSIS WITH SEGMENTAL COLORECTAL RESECTION

2018 ◽  
Vol 31 (4) ◽  
Author(s):  
Antonio Matos ROCHA ◽  
Maurício Mendes de ALBUQUERQUE ◽  
Eduardo Miguel SCHMIDT ◽  
Cristiano Denoni FREITAS ◽  
João Paulo FARIAS ◽  
...  
Keyword(s):  
Colorectal Resection ◽  
Positive Impact ◽  
Therapeutic Option ◽  
Case Series ◽  
Laparoscopic Approach ◽  
Deep Infiltrating Endometriosis ◽  
Preoperative Period ◽  
Laparoscopic Treatment ◽  
Bowel Symptoms ◽  
Infiltrating Endometriosis

ABSTRACT Background: Deep infiltrating colorectal endometriosis may severely affect the quality of life and fertility of patients. Although segmental resection is a therapeutic option that provides positive outcomes in the management of symptoms, its functional effects are still unproven. Aim: Assess the late impact of the laparoscopic approach in treating deep infiltrating endometriosis with segmental colorectal resection. Methods: Prospective case series of 46 patients submitted to laparoscopic treatment of deep infiltrating endometriosis with segmental colorectal resection between 2013 and 2016. Fertility, gynecological and bowel symptoms were assessed at the preoperative period and at three and 12 months (or more) after the procedure. Results: Preoperative interview assessed the prevalence of infertility (45.6%), gynecological (87%) and intestinal (80.4%) symptoms. At the third month after the procedure a significant reduction in the prevalence of gynecological symptoms (p<0,001), tenesmus (p=0,001) and dysquesia (p=0,002) was observed. After a period of 12 months or more following the procedure a significant reduction in the prevalence persisted for dysmenorrhea (p=0,001), deep dyspareunia (p=0,041), chronic pelvic pain (p=0,011) and dysquesia (p=0,001), as compared to the preoperative period. Total pregnancy rate was 57.1% and spontaneous pregnancy 47.6%. Conclusion: The treatment of deep infiltrating endometriosis using segmental colorectal resection has provided early and late relief of gynecological and bowel symptoms. The outcomes also indicate a positive impact on the fertility of infertile patients.

Surgical reconstruction of pilonidal sinus disease with concomitant extracellular matrix graft placement: a case series

2021 ◽  
Vol 30 (Sup7) ◽  
pp. S28-S34
Author(s):  
Abigail E Chaffin ◽  
Shane G Dowling ◽  
Mychajlo S Kosyk ◽  
Brandon A Bosque
Keyword(s):  
Extracellular Matrix ◽  
Postoperative Complications ◽  
Pilonidal Sinus ◽  
Case Series ◽  
Surgical Reconstruction ◽  
Pilonidal Sinus Disease ◽  
Surgical Approaches ◽  
Flap Reconstruction ◽  
Recurrence Rates ◽  
Sinus Disease

Background: Pilonidal sinus disease (PSD) is a chronic inflammatory disease affecting the soft tissue of the sacrococcygeal region and remains a challenging disease for clinicians to treat. The optimal treatment for PSD remains controversial and recent reports describe several different surgical approaches offering different benefits. Approximately 40% of initial incision and drainage cases require subsequent surgery. Due to high recurrence rates and postoperative complications, a more complex revision surgery involving a flap reconstruction may be required. We hypothesised that the combination of an extracellular matrix (ECM) graft with tissue flap reconstruction may decrease the postoperative complications and recurrence rates for PSD. Method: We report a retrospective case series using a surgical flap reconstruction with concomitant implantation of an ovine forestomach ECM graft under a fasciocutaneous flap with an off-midline closure for recurrent PSD, where previously surgical intervention had failed due to wound dehiscence and/or recurrent disease. Results: The case series included six patients. After three weeks, all patients except one were fully healed, and the sixth was fully healed by week 4; all wounds remained fully healed at 12 weeks. All patients achieved good cosmesis and were able to return to normal function without any residual symptoms. Conclusion: This pilot case series explored augmenting a flap reconstruction for complex PSD with advanced ECM graft materials, demonstrating that it may improve outcomes and minimise typical complications seen in flap closure, such as inflammation, infection, haematoma/seroma and hypoperfusion. Although the study had a limited number of participants, long-term outcomes were promising and suggest that further studies are warranted.

Pharmacological treatment of hepatocellular carcinoma with cavoatrial tumor thrombus – case series and literature review

2019 ◽  
Vol 57 (04) ◽  
pp. 501-507 ◽  
Author(s):  
Tianzuo Zhan ◽  
Janina Sollors ◽  
Niels Steinebrunner ◽  
Hans Schlitt ◽  
Christian Stroszczynski ◽  
...  
Keyword(s):  
Tumor Thrombus ◽  
Systemic Treatment ◽  
Treatment Options ◽  
Survival Rates ◽  
Vena Cava ◽  
Case Series ◽  
Surgical Approaches ◽  
Surgical Interventions ◽  
Advanced Hcc ◽  
Multimodal Therapy Concept

AbstractHepatocellular carcinomas (HCC) that extend into the vena cava and the right atrium have a poor prognosis. Surgical approaches including partial hepatectomy and thrombectomy are the most frequently reported treatment options. However, most patients with advanced HCC are not eligible for complex surgical interventions due to reduced liver function, comorbidities, and metastases. At the same time, systemic treatment options of HCC have expanded in recent years. Here, we report 3 cases of patients with advanced HCC who developed a cavoatrial tumor thrombus (CATT) after initial surgical or interventional therapy. The patients were consequently treated with sorafenib or nivolumab. In all cases, the tumor responded to systemic treatment with disease stabilization or partial regression. Overall survival after diagnosis of CATT was 3 and 17 months for sorafenib and 7 + months for nivolumab. Compared to survival rates of alternative treatment options, systemic therapies demonstrated comparable outcomes. In summary, pharmacotherapy is an efficient and well worth option to treat patients with HCC and CATT and should be an integral part of a multimodal therapy concept.

scholarly journals Intraoperative Complications of Cataract Surgery Using Intracameral Illumination in the Elderly over 75 Years

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Yu Jeong Kim ◽  
Su Jin Park ◽  
Jong Yeon Lee ◽  
Dae Yeong Lee ◽  
Dong Heun Nam
Keyword(s):  
Cataract Surgery ◽  
Intraoperative Complications ◽  
Case Series ◽  
The Elderly ◽  
Posterior Capsule ◽  
Anterior Capsule ◽  
Intraoperative Complication ◽  
Surgery Group ◽  
Posterior Capsule Rupture ◽  
Capsule Rupture

Purpose. To evaluate intraoperative complications and utilization of adjunctive devices between microscope and intracameral illuminations during cataract surgery in the elderly over 75 years. Design. A retrospective, consecutive, interventional case series Participants. Two hundred eighty-six eyes of 184 patients older than 75 years who underwent cataract surgery using microscope and intracameral illuminations. Methods. A chart review was performed on an advanced cataract surgery group of 141 consecutive cases in which the intracameral illumination was used and on a standard cataract surgery group of 145 consecutive cases in which the intracameral illumination was not used. Main Outcome Measures. Intraoperative complications (posterior capsule rupture, radial tear of the anterior capsule, dropped nucleus, or sulcus-implanted/sclera-fixated IOL) and utilization of adjunctive devices (pupil expansion device or anterior capsule staining). Results. The frequency of use of the pupil expansion device was lower in the advanced cataract surgery group than that in the standard cataract surgery group (0.7% vs 6.9%; p=0.007). Furthermore, the rates of a posterior capsule rupture and at least one intraoperative complication were lower in the advanced cataract surgery group than those in the standard cataract surgery group (0.7% vs 4.8%; p=0.067) (0.7% vs 7.6%; p=0.004). Conclusions. In the current cohort of patients over 75 years, the rate of intraoperative complications was lower when using the intracameral illumination than that when using the conventional method. Cataract surgery using intracameral illumination would be good option for elderly people.

scholarly journals Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes

2014 ◽  
Vol 8 (9-10) ◽  
pp. 695 ◽  
Author(s):  
Vincent Trudeau ◽  
Giorgio Gandaglia ◽  
Jonas Shiffmann ◽  
Ioana Popa ◽  
Shahrokh F Shariat ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Perioperative Complications ◽  
Large Population ◽  
Laparoscopic Approach ◽  
Population Based ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Lower Probability ◽  
Weighted Estimate ◽  
Prolonged Length

Introduction: We compared short-term outcomes and costs between robotic-assisted nephroureterectomy (RANU) and laparoscopic radical nephroureterectomy (LNU) in a large population-based cohort of patients with upper-tract urothelial carcinoma (UTUC).Methods: Overall, 1914 patients with UTUC treated with RANU or LNU between 2008 and 2010 within the Nationwide Inpatient Sample were abstracted. Propensity-score matching was performed to account for inherent differences between patients undergoing RANU and LNU. Multivariable logistic regression models were fitted to compare postoperative complications, blood transfusions, prolonged length of stay, and costs between the 2 procedures.Results: Overall, a weighted estimate of 1199 (62.6%) and 715 (37.4%) patients received LNU and RANU, respectively. In multivariable analyses no significant differences were observed in postoperative transfusion and length of stay between the 2 surgical approaches (all p > 0.1). However, patients undergoing RANU were less likely to experience any complications compared to their counterparts undergoing LNU (p = 0.04). The utilization of RANU was associated with substantially higher costs compared to the laparoscopic approach. Our study is limited by its retrospective nature and the lack of adjustment for tumour stage and grade.Conclusions: Our results support the safety and feasibility of RANU for the treatment of UTUC. Indeed, the use of the robotic approach was associated with lower probability of experiencing perioperative complications compared to LNU. On the other hand, the utilization of RANU is associated with higher costs compared to LNU.

scholarly journals Transorbital Endoscopic Surgery for Sphenoid Wing Meningioma: Long-Term Outcomes and Surgical Technique

2020 ◽  
Vol 81 (04) ◽  
pp. 357-368
Author(s):  
N. Goncalves ◽  
D.E. Lubbe
Keyword(s):  
Minimally Invasive ◽  
Endoscopic Surgery ◽  
Case Series ◽  
Surgical Approaches ◽  
Benign Tumors ◽  
Long Term Outcomes ◽  
Invasive Approach ◽  
Visual Outcomes ◽  
Presenting Symptoms

AbstractSphenoid wing meningiomas are benign tumors that can result in proptosis, visual impairment, and pain. Traditional open surgical approaches are associated with significant morbidity. Transorbital endoscopic surgery has been developed as a minimally invasive approach to gain access to these tumors and address the main presenting symptoms. Case series reporting transorbital endoscopic resection of sphenoid wing meningiomas using combined endonasal, pre-caruncular, and extended superior eyelid approaches have demonstrated stable and/or improved short- and medium-term visual outcomes. Earlier medial optic nerve decompression appears to result in more favorable long-term visual outcomes. Transorbital endoscopic surgery therefore represents an emerging minimally invasive alternative to deal with these challenging lesions.

Sign in / Sign up

Export Citation Format

Share Document