Predictors for complete surgical resection of posterior fossa neurenteric cysts: A case report and meta-analysis

Background: Incomplete resection of neurenteric cysts (NCs) has been associated with increased recurrence rates in patients compared to complete resection (CR) and information on intracranial NCs appearance on diagnostic imaging is scarce. We sought to identify factors associated with CR and provide the largest up-to-date review of NCs appearances on various diagnostic images. Methods: Data from Medline, EMBASE, and Web of Science were extracted. Univariate and multivariate logistic regression models were used to analyze factors associated with CR. Results: A total of 120 publications reporting 162 original cases on posterior fossa NCs met the inclusion criteria for analysis. Eighty-nine (55.6%) of the patients were female, the mean (SD) age of the patients’ during operation was 34.3 (16.9) years, and CR was achieved in 98 (60%) of patients. Univariate analysis identified male sex as a statistically significant predictor for complete reaction (OR 2.13, 95% Cl 1.10–4.11, P = 0.02). The retrosigmoid approach (OR 1.89, 95% Cl 0.98–3.63, P = 0.06), far lateral approach (OR 0.46, 95% Cl 0.21–1.02, P = 0.06), and pediatric patient (OR 2.45, 95% Cl 0.94–6.56, P = 0.07) may be possible predictors for CR, however, they were not statistically significant. NCs are mainly hypodense on CT (32 [61.5%]), varied greatly in intensity on T1WI, hyperintense on T2WI magnetic resonance imaging (98 [67.1%]), and hyperintense on fluid-attenuated inversion recovery (17 [63.0%]). Conclusion: We recommend utilizing various diagnostic imaging tests to help reduce misdiagnoses when identifying intracranial NCs. For patient safety, CR should be achieved when possible, to reduce risk of additional operations due to recurrence.

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Microsurgical Resection of Craniocervical Dermoid Cyst by Far Lateral Approach: Case Report and Literature Review

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1676530 ◽

2018 ◽

Vol 37 (04) ◽

pp. 339-342

Author(s):

Lucas Meguins ◽

Antonio Spotti ◽

Dionei Morais ◽

Carlos Rocha ◽

Ricardo Caramanti ◽

...

Keyword(s):

Case Report ◽

Dermoid Cyst ◽

Posterior Fossa ◽

Symptom Control ◽

Lateral Approach ◽

Neurological Deficits ◽

Uneventful Recovery ◽

Far Lateral Approach ◽

Far Lateral ◽

Posterior Fossa Dermoid

Introduction Intracranial dermoid tumors represent a rare clinical entity that accounts for 0.04 to 0.6% of all intracranial tumors. Their location in the posterior fossa is uncommon. Objectives To report the case of a young woman with a posterior fossa dermoid cyst treated by right far lateral approach. Case Report A 17-year-old woman presenting with swallowing difficulties for 6 weeks was referred for a neurological investigation. A magnetic resonance imaging (MRI) scan showed a hyperintense T1-weighted large expansive lesion occupying the posterior fossa and compressing the anterior face of the brain stem and cerebellum. The patient underwent surgical treatment by right far lateral approach with decompression of vascular and neural structures. The patient presented an uneventful recovery, and was discharged home on the fourth postoperative day without any additional neurological deficits. The anatomopathological analysis confirmed the diagnosis of dermoid cyst. Conclusion The far lateral approach is a safe and feasible route to appropriately treat large posterior fossa dermoid cysts. Decompression of vascular and neural structures is essential to achieve good symptom control.

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The role of alternative anastomosis sites in occipital artery–posterior inferior cerebellar artery bypass in the absence of the caudal loop using the far-lateral approach

Journal of Neurosurgery ◽

10.3171/2015.11.jns151385 ◽

2017 ◽

Vol 126 (2) ◽

pp. 634-644 ◽

Cited By ~ 3

Author(s):

Hitoshi Fukuda ◽

Alexander I. Evins ◽

Koichi Iwasaki ◽

Itaro Hattori ◽

Kenichi Murao ◽

...

Keyword(s):

Posterior Fossa ◽

Posterior Inferior Cerebellar Artery ◽

Technical Difficulty ◽

Foramen Magnum ◽

Lateral Approach ◽

Difficulty Level ◽

Occipital Artery ◽

Cerebellar Artery ◽

Far Lateral Approach ◽

Far Lateral

OBJECTIVE Occipital artery–posterior inferior cerebellar artery (OA-PICA) bypass is a technically challenging procedure for posterior fossa revascularization. The caudal loop of the PICA is considered the optimal site for OA-PICA anastomosis, however its absence can increase the technical difficulty associated with this procedure. The use of the far-lateral approach for accessing alternative anastomosis sites in OA-PICA bypass in patients with absent or unavailable caudal loops of PICA is evaluated. METHODS A morphometric analysis of OA-PICA bypass with anastomosis on each segment of the PICA was performed on 5 cadaveric specimens through the conventional midline foramen magnum and far-lateral approaches. The difficulty level associated with anastomoses at each segment was qualitatively assessed in each approach for exposure and maneuverability by multiple surgeons. A series of 8 patients who underwent OA-PICA bypass for hemodynamic ischemia or ruptured dissecting posterior fossa aneurysms are additionally reviewed and described, and the clinical significance of the caudal loop of PICA is discussed. RESULTS Anastomosis on the caudal loop could be performed more superficially than on any other segment (p < 0.001). A far-lateral approach up to the medial border of the posterior condylar canal provided a 13.5 ± 2.2–mm wider corridor than the conventional midline foramen magnum approach, facilitating access to alternative anastomosis sites. The far-lateral approach was successfully used for OA-PICA bypass in 3 clinical cases whose caudal loops were absent, whereas the midline foramen magnum approach provided sufficient exposure for caudal loop bypass in the remaining 5 cases. CONCLUSIONS The absence of the caudal loop of the PICA is a major contributing factor to the technical difficulty of OA-PICA bypass. The far-lateral approach is a useful surgical option for OA-PICA bypass when the caudal loop of the PICA is unavailable.

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A modified far-lateral approach for large or giant meningiomas of the posterior fossa

Journal of Neurosurgery ◽

10.3171/2009.6.jns09120 ◽

2010 ◽

Vol 112 (5) ◽

pp. 907-912 ◽

Cited By ~ 9

Author(s):

Nader Sanai ◽

Michael W. McDermott

Keyword(s):

Posterior Fossa ◽

Signs And Symptoms ◽

Lateral Approach ◽

Neurological Deficits ◽

Cranial Neuropathy ◽

Consecutive Series ◽

Simpson Grade ◽

Far Lateral Approach ◽

Far Lateral ◽

The Mean

Object Resecting large meningiomas along the posterior fossa convexity or cerebellopontine angle (CPA) through a suboccipital approach can be challenging. Limitations include a restricted angle of view, high venous pressures, and suboptimal brain relaxation. While a far-lateral craniotomy is a viable alternative, the risks associated with condylar resection are undesirable. Methods The authors retrospectively evaluated a modified far-lateral approach in a consecutive series of 12 patients with large or giant posterior fossa convexity and CPA meningiomas. This approach incorporates transverse-sigmoid sinus exposure and C-1 laminectomy, but there is no condylar resection. Results Between January 2006 and February 2008, 12 patients (mean age 52 years) presented with large or giant meningiomas of the posterior fossa convexity or CPA. The mean tumor volume was 72.6 cm3 (range 8–131 cm3). Signs and symptoms at presentation included headache (in 8 patients), cranial neuropathy (in 4), and progressive hemiparesis (in 4). There were no operative complications, and the majority of patients (9) had Simpson Grade I or II resections. There were no new permanent neurological deficits following resection, although 2 patients (17%) had transient deficits. The mean modified Rankin score decreased from 2.2 preoperatively to 0.6 postoperatively. Conclusions A modified far-lateral approach to the posterior fossa and CPA allows for safe, and often total, resection of large meningiomas with minimal morbidity. While avoiding the risks of condylar resection, this microsurgical strategy allows for greater field of view, minimal venous bleeding, and immediate access to the spinal subarachnoid space.

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Risk Factors Associated with 30-Day Readmission in Patients with Diabetic Foot Infections

Journal of the American Podiatric Medical Association ◽

10.7547/19-023 ◽

2020 ◽

Vol 110 (6) ◽

Author(s):

Marshall Miller ◽

Bryan Knepper ◽

Heather Young

Keyword(s):

Treatment Failure ◽

Diabetic Foot ◽

Univariate Analysis ◽

International Classification Of Diseases ◽

Diabetic Patients ◽

C Reactive Protein ◽

Logistic Regression Models ◽

Factors Associated ◽

Reactive Protein ◽

Diabetic Foot Infections

Background Diabetic foot infections (DFIs) are the most common cause of hospitalization for patients with diabetes. Studies have shown diabetic patients have high readmission rates. It is important to identify variables that contribute to readmission. This study aimed to investigate clinical variables associated with 30-day hospital readmission in patients with DFI. Methods We conducted a retrospective study of adults admitted to the hospital for DFI between July 1, 2012, and July 1, 2015. We identified patients by International Classification of Diseases, Ninth Revision codes and randomly selected 35% of medical records for review. Patients were excluded if they did not have a DFI by review, were pregnant, or were incarcerated. The primary outcome was 30-day readmission. Data collected included baseline demographics, medical comorbidities, substance abuse, homelessness, tobacco use, and laboratory and surgical pathology data. Univariate and multivariate logistic regression models were used to identify independent predictors. Results Of 140 included patients, 106 (76%) were male. Median age was 55 years and length of stay (LOS) was 7 days. In univariate analysis, 31 patients (22%) were readmitted in the 30 days after the index hospitalization. Factors associated with readmission included treatment failure, elevated C-reactive protein level, and hospital LOS (P < .05). In multivariate analyses, LOS and treatment failure were independent predictors of readmission. Conclusions The 30-day readmission rate for patients with DFI is high. Treatment failure, C-reactive protein, and LOS are independently associated with readmission. More work is needed to determine reasons for readmission so that appropriate measures can be taken before discharge.

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