Safety and efficacy of vascular tumor embolization using Onyx: is angiographic devascularization sufficient?

2010 ◽  
Vol 112 (5) ◽  
pp. 1039-1045 ◽  
Author(s):  
Mohamed Samy Elhammady ◽  
Stacey Quintero Wolfe ◽  
Ramsey Ashour ◽  
Hamad Farhat ◽  
Roham Moftakhar ◽  
...  
Keyword(s):  
Blood Loss ◽  
Vascular Tumor ◽  
Spinal Tumors ◽  
Vascular Tumors ◽  
Embolic Material ◽  
Safety And Efficacy ◽  
Tumor Embolization ◽  
The Mean ◽  
Tumor Bleeding ◽  
Head Neck

Object The authors assessed the safety and efficacy of embolization of head, neck, and spinal tumors with Onyx and determined the correlation between tumor embolization and intraoperative blood loss. Methods The authors prospectively collected all head, neck, and spinal tumors embolized with Onyx at their institution over a 28-month period. Information on tumor type, location, extent of tumor devascularization, endovascular and surgical complications, and intraoperative estimated blood loss (EBL) was evaluated. Results Forty-three patients with various head, neck, and spinal lesions underwent vascular tumor embolization with Onyx. Indications for embolization included uncontrolled tumor bleeding in 8 cases, elective preoperative devascularization in 34, and tumor-induced consumptive thrombocytopenia in 1 case. Embolization was performed via direct tumoral puncture in 14 cases and through the traditional transarterial route in the remaining lesions. Embolization was successful in ending uncontrolled tumor bleeding in all 8 cases and in reversing the consumptive coagulopathy in 1 case. Intraparenchymal penetration of embolic material was possible in all percutaneously embolized tumors and in 4 of the 20 tumors embolized preoperatively via the transarterial route. The mean percentage of devascularization in tumors with intraparenchymal penetration of Onyx was 90.3% compared with 83.7% in tumors without intraparenchymal penetration. The mean EBL with intraparenchymal penetration of Onyx was significantly lower than when there was no intraparenchymal penetration (459 vs 2698 ml; p = 0.0067). There were no neurological complications related to the embolization procedures. Conclusions Embolization of vascular tumors with Onyx can be performed safely but may not reach optimal effectiveness in reducing intraoperative EBL if the embolic material does not penetrate the tumor vasculature. In the authors' experience, the best method of intraparenchymal penetration is achieved with direct tumor puncture. Transarterial embolization may not result in tumor penetration, particularly when injected from a long distance through small caliber or slow flow vessels.

Transpedicular N-butyl cyanoacrylate–mediated percutaneous embolization of symptomatic vertebral hemangiomas

2013 ◽  
Vol 18 (5) ◽  
pp. 450-455 ◽  
Author(s):  
Kevin C. Yao ◽  
Adel M. Malek
Keyword(s):  
Blood Loss ◽  
Direct Injection ◽  
Transarterial Embolization ◽  
High Volume ◽  
Vascular Tumors ◽  
Intraoperative Blood Loss ◽  
Percutaneous Embolization ◽  
Direct Puncture ◽  
Tumor Embolization ◽  
Large Channel

Object The resection of spinal hemangiomas is often challenging because of characteristic high-volume and potentially prohibitive intraoperative blood loss. Although transarterial embolization can mitigate this risk, it can be suboptimal when tumor arterial supply is diffuse or poorly defined. The authors present their experience in the use of preoperative percutaneous direct injection of spinal hemangiomas with N-butyl cyanoacrylate (NBCA) as an effective preoperative adjunct that may reduce operative blood loss and facilitate resection of these vascular tumors. Methods Four patients with symptomatic spinal hemangiomas were treated using percutaneous transpedicular direct NBCA-Lipiodol injection; 2 patients had undergone prior spinal angiography, with suboptimal transarterial embolization in 1. Each patient underwent percutaneous bilateral transpedicular NBCA-assisted tumor embolization prior to resection. Retrospective analysis of operative times, blood loss, and clinical data is presented. Results There were no complications associated with the percutaneous NBCA embolization technique. The procedure was effective at facilitating tumor removal and minimizing intraoperative blood loss, especially at the vertebral body resection stage. Improved tumor filling was achieved as the filling characteristics of dilute NBCA-Lipiodol mixture within large-channel, high-flow hemangiomas were appreciated with experience. Conclusions Transpedicular NBCA direct-puncture embolization of spinal hemangiomas is an effective preoperative adjunct that facilitates resection of these highly vascular tumors. It is particularly useful when transarterial embolization is unsafe or suboptimal due to constraints imposed by the local angioarchitecture.

scholarly journals Advantages of Tonsillectomy done under Local Anesthesia compared to General Anesthesia in Adults

2013 ◽  
Vol 4 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Sudhir Naik ◽  
Sarika S Naik ◽  
S Ravishankara ◽  
Mohan K Appaji ◽  
MK Goutham ◽  
...  
Keyword(s):  
Blood Loss ◽  
General Anesthesia ◽  
Local Anesthesia ◽  
Case Series ◽  
Limited Resources ◽  
Pain Scores ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
The Mean ◽  
Head Neck

ABSTRACT Background/Objectives Tonsillectomy using local anesthesia (local tonsillectomy) is a safe and effective alternative to general anesthesia in the healthy cooperative teenage or adult patients. Blood loss, morbidity, complications and patient satisfaction were better in some studies with tonsillectomies done under general anesthesia. Design Comparative case series analysis study of two groups of patients who underwent tonsillectomies under local and general anesthesia during the study period of 57 months from March 2007 to December 2011. Materials and methods Overall 1,349 cases of tonsillectomies done for chronic tonsillitis were included under the study. Three hundred and sixty-seven cases operated under general anesthesia and 982 cases operated under local anesthesia were compared. The parameters compared were duration of surgery, blood loss and the mean pain visual analog score. Results Significant difference in duration of surgery, blood loss during surgery and visual analog scale (VAS) pain scores were seen in the two groups with local anesthesia scoring over general anesthesia. Conclusion Tonsillectomy under local anesthesia is a good alternate for the procedure under general anesthesia with limited resources and in cooperative adults. How to cite this article Naik SM, Naik SS, Ravishankara S, Appaji MK, Goutham MK, Devi NP, Mushannavar AS. Advantages of Tonsillectomy done under Local Anesthesia compared to General Anesthesia in Adults. Int J Head Neck Surg 2013;4(1):13-18.

Safety and Efficacy of Preoperative Embolization of Intracranial Hemangioblastomas

2015 ◽  
Vol 12 (2) ◽  
pp. 135-140 ◽  
Author(s):  
Chibawanye I Ene ◽  
David Xu ◽  
Ryan P Morton ◽  
Samuel Emerson ◽  
Michael R Levitt ◽  
...  
Keyword(s):  
Blood Loss ◽  
Surgical Resection ◽  
Gross Total Resection ◽  
Embolic Agent ◽  
Vascular Tumors ◽  
Preoperative Embolization ◽  
Intraoperative Blood Loss ◽  
Total Resection ◽  
Safety And Efficacy ◽  
Embolic Agents

Abstract BACKGROUND Intracranial hemangioblastomas are highly vascular tumors that account for 1% to 2% of all central nervous system tumors. Preoperative embolization has been proposed to limit the often significant intraoperative blood loss associated with resection and potentially make the tumor more soft/necrotic and thus more amenable to gross total resection. The safety and efficacy of preoperative embolization of intracranial hemangioblastomas, however, are not well characterized. OBJECTIVE To evaluate the safety and efficacy of preoperative endovascular embolization of intracranial hemangioblastomas using a variety of embolic agents. METHODS A retrospective review of all surgically resected intracranial hemangioblastomas treated with preoperative embolization between 1999 and 2014 at 2 high-volume centers was performed. Clinical and radiographic criteria, including von Hippel-Lindau status, magnetic resonance imaging tumor characteristics, embolization-related complications, degree of angiographic devascularization, intraoperative blood loss, ability to obtain gross total resection, transfusion requirements, and operative time, were analyzed. RESULTS A total of 54 patients underwent surgery, with 24 undergoing preoperative embolization followed by surgical resection, and 30 patients undergoing surgical resection alone. Embolization-related neurological complications were seen in 6 patients (25%), including 3 hemorrhages when polyvinyl alcohol particles (P = .04) were used and 3 infarctions when liquid embolic agents were used (P = .27). Permanent neurological deficits were seen in 15%. CONCLUSION Preoperative embolization of intracranial hemangioblastomas should be performed with caution, given the potential for neurological morbidity. Further studies are needed to help guide patient and embolic agent selection.

The efficacy and risks of preoperative embolization of spinal tumors

2015 ◽  
Vol 8 (8) ◽  
pp. 859-864 ◽  
Author(s):  
Al-Wala Awad ◽  
Kaith K Almefty ◽  
Andrew F Ducruet ◽  
Jay D Turner ◽  
Nicholas Theodore ◽  
...  
Keyword(s):  
Blood Loss ◽  
Surgical Outcomes ◽  
Operative Time ◽  
Spinal Tumor ◽  
Spinal Tumors ◽  
Preoperative Embolization ◽  
Safe Procedure ◽  
Intraoperative Blood Loss ◽  
Tumor Embolization ◽  
Clinical Records

BackgroundThe goal of preoperative embolization of spinal tumors is to improve surgical outcomes by diminishing the vascular supply to the tumor to reduce intraoperative blood loss and operative time.ObjectiveTo report our institutional experience with spinal tumor embolization and review the present literature.MethodsClinical records from January 1, 2001 to December 31, 2012 were reviewed and analyzed. Angiograms were used to calculate the percentage reduction in tumor vascularity, and relevant clinical and operative data were collected and analyzed.ResultsThirty-seven patients underwent preoperative spinal tumor embolization (24 metastatic and 13 primary lesions) and were included in the study. One complication resulted in transient lower extremity weakness and was attributed to post-embolization swelling, which fully resolved after surgical resection. The transient neurological complication rate was 1/37 (3%) and the permanent rate was 0/37 (0%). The average surgical estimated blood loss (EBL) was 1946 mL (100–7000 mL) and the average operative time was 330 min (range 164–841 min). After embolization, tumor blush was reduced by 83% on average. Average pre- and postoperative modified Rankin Scale scores were 2.10 and 1.36, respectively (p=0.03). Cases in which tumor blush was decreased by ≥90% (classes 1 or 2) after embolization had significantly less operative blood loss than those cases in which <90% (classes 3 or 4) was achieved (mean EBL 1391 vs 2296 mL, respectively, p=0.05).ConclusionsSpinal tumor embolization is a safe procedure, is associated with few complications, and may improve surgical outcomes by limiting intraoperative blood loss and reducing operative time.

scholarly journals Comparison of minimally invasive transspinous and open approaches for thoracolumbar intradural-extramedullary spinal tumors

2015 ◽  
Vol 39 (2) ◽  
pp. E12 ◽  
Author(s):  
Kunal P. Raygor ◽  
Khoi D. Than ◽  
Dean Chou ◽  
Praveen V. Mummaneni
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Tumor Resection ◽  
Spinal Tumors ◽  
Categorical Variables ◽  
Extramedullary Tumor ◽  
Significant Difference ◽  
Asia Score ◽  
Intradural Extramedullary ◽  
The Mean

OBJECT Spinal tumor resection has historically been performed via open approaches, although minimally invasive approaches have recently been found to be effective in small cohort series. The authors compare surgical characteristics and clinical outcomes of surgery in patients undergoing mini-open and open approaches for intradural-extramedullary tumor resection. METHODS The authors retrospectively reviewed 65 consecutive intradural-extramedullary tumor resections performed at their institution from 2007 to 2014. Patients with cervical tumors or pathology demonstrating neurofibroma were excluded (n = 14). The nonparametric Mann-Whitney U-test and Pearson chi-square test were used to compare continuous and categorical variables, respectively. Statistical analyses were performed using SPSS, with significance set at p < 0.05. RESULTS Fifty-one thoracolumbar intradural-extramedullary tumor resections were included; 25 were performed via the minimally invasive transspinous approach. There were no statistically significant differences in age, sex, body mass index, preoperative American Spinal Injury Association (ASIA) score, preoperative symptom duration, American Society of Anesthesiologists (ASA) physical status class, tumor size, or tumor location. There was no statistically significant difference between groups with respect to the duration of the operation or extent of resection, but the mean estimated blood loss was significantly lower in the minimally invasive surgery (MIS) cohort (142 vs 320 ml, p < 0.05). In each group, the 2 most common tumor pathologies were schwannoma and meningioma. There were no statistically significant differences in length of hospitalization, ASIA score improvement, complication rate, or recurrence rate. The mean duration of follow-up was 2 years for the MIS group and 1.6 years for the open surgery group. CONCLUSIONS This is one of the largest comparisons of minimally invasive and open approaches to the resection of thoracolumbar intradural-extramedullary tumors. With well-matched cohorts, the minimally invasive transspinous approach appears to be as safe and effective as the open technique, with the advantage of significantly reduced intraoperative blood loss.

scholarly journals Preoperative catheter spinal angiography and embolization of cervical spinal tumors: Outcomes from a single center

2016 ◽  
Vol 22 (4) ◽  
pp. 457-465 ◽  
Author(s):  
Athos Patsalides ◽  
Lewis Z Leng ◽  
David Kimball ◽  
Joshua Marcus ◽  
Jared Knopman ◽  
...  
Keyword(s):  
Blood Loss ◽  
Vertebral Artery ◽  
Spinal Tumors ◽  
Spinal Angiography ◽  
Tumor Embolization ◽  
Superselective Catheterization ◽  
Vertebrobasilar Ischemia ◽  
Estimated Blood Loss ◽  
Cervical Artery ◽  
Hypervascular Tumors

Objective The existing literature regarding preoperative cervical spinal tumor embolization is sparse, with few discussions on the indications, risks, and best techniques. We present our experience with the preoperative endovascular management of hypervascular cervical spinal tumors. Methods We performed a retrospective review of all patients who underwent preoperative spinal angiography (regardless of whether tumor embolization was performed) at our institution (from 2002 to 2012) for primary and metastatic cervical spinal tumors. Tumor vascularity was graded from 0 (tumor blush equal to the normal adjacent vertebral body) to 3 (intense tumor blush with arteriovenous shunting). Tumors were considered “hypervascular” if they had a tumor vascular grade from 1 to 3. Embolic materials included particles, liquid embolics, and detachable coils. The main embolization technique was superselective catheterization of an arterial tumor feeder followed by injection of embolic material. This technique could be used alone or supplemented with occlusion of dangerous anastomoses of the vertebral artery as needed to prevent inadvertent embolization of the vertebrobasilar system. In cases when superselective catheterization of the tumoral feeder was not feasible, embolization was performed from a proximal catheter position after occlusion of branches supplying areas other than the tumor (“flow diversion”). Results A total of 47 patients with 49 cervical spinal tumors were included in this study. Of the 49 total tumors, 41 demonstrated increased vascularity (vascularity score > 0). The most common tumor pathology in our series was renal cell carcinoma (RCC) ( N = 16; 32.7% of all tumors) followed by thyroid carcinoma ( N = 7; 14.3% of all tumors). Tumor embolization was undertaken in 25 hypervascular tumors resulting in complete, near-complete, and partial embolization in 36.0% ( N = 9), 44.0% ( N = 11), and 20.0% ( N = 5) of embolized tumors, respectively. We embolized 42 tumor feeders in 25 tumors. The most commonly embolized tumor feeders were branches of the vertebral artery (19.0%; N = 8), the deep cervical artery (19.0%; N = 8), and the ascending cervical artery (19.0%; N = 8). Sixteen hypervascular tumors were not embolized because of minimal hypervascularity (8/16), unacceptably high risk of spinal cord or vertebrobasilar ischemia (4/16), failed superselective catheterization of tumor feeder (3/16), and cancellation of surgery (1/16). Vertebral artery occlusion was performed in 20% of embolizations. There were no new post-procedure neurological deficits or any serious adverse events. Estimated blood loss data from this cohort show a significant decrease in operative blood loss for embolized tumors of moderate and significant hypervascularity. Conclusions Preoperative embolization of cervical spinal tumors can be performed safely and effectively in centers with significant experience and a standardized approach.

scholarly journals Safety and Efficacy of Pressure-assisted Tissue-welding Tonsillectomy: A Preliminary Evaluation

2008 ◽  
Vol 87 (2) ◽  
pp. 100-112 ◽  
Author(s):  
Randall G. Michel ◽  
Bernard I. Weinstock ◽  
Kang Tsau
Keyword(s):  
Blood Loss ◽  
Postoperative Bleeding ◽  
Normal Diet ◽  
Intraoperative Blood Loss ◽  
Total Recovery ◽  
Safety And Efficacy ◽  
Tissue Welding ◽  
Welding Technology ◽  
The Mean ◽  
Clinic Visits

We conducted a retrospective study of the safety and efficacy of a new pressure-assisted tissue-welding technology (ENTceps; Starion Instruments Corp.; Sunnyvale, Calif.) for total tonsillectomy, either alone or with adenoidectomy. The use of this instrument was compared in two groups of patients categorized by age. The younger group was made up of 50 patients aged 2 to 12 years who had undergone total tonsillectomy and adenoidectomy (T&A), and the older group was made up of 50 patients aged 13 to 47 years who had undergone either T&A or isolated total tonsillectomy. The primary safety endpoint was the presence or absence of intra- or postoperative complications—particularly the amount of intraoperative blood loss and the incidence of delayed postoperative bleeding. In each group, the mean amount of intraoperative blood loss was no more than 30 ml, and only 2 of the 100 patients experienced postoperative hemorrhage. Among the efficacy parameters were the amount of operating and recovery time and the postoperative appearance of the tonsillar fossae. The mean operating time was 13.0 minutes in the younger group and 19.5 minutes in the older group, and the mean total recovery times were 120.0 and 130.4 minutes, respectively; all tonsillar fossae were well epithelialized by 2 weeks after surgery. Finally, surgical morbidity was determined on the basis of the amount of perioperative pain medication administered, the number of unscheduled patient telephone contacts and clinic visits, and the amount of time needed to return to a normal diet and activities. Nine patients in the younger group and 6 in the older group required no pain medications during recovery; overall, pain was not a significant issue for most patients. Sixteen patients made a total of 20 telephone calls and 8 clinic visits prior to their scheduled postoperative appointment; almost all of these encounters dealt with postoperative pain. Only 1 patient, who had previously undiagnosed von Willebrand disease, had not returned to a normal diet and activities by the end of 1 week. Based on our preliminary findings—and a comparison of our results with those of other studies published in the literature relative to the amount of intraoperative bleeding, the incidence of postoperative bleeding, and operating times—we conclude that pressure-assisted tissue-welding technology is safe and compares favorably with other tonsillectomy techniques. This method of electrocautery is straightforward and relatively easy to learn.

Preoperative Embolization of Venous Malformations Using n-Butyl Cyanoacrylate

2018 ◽  
Vol 52 (4) ◽  
pp. 269-274 ◽  
Author(s):  
Wibke Uller ◽  
Sherif El-sobky ◽  
Ahmad I. Alomari ◽  
Steven J. Fishman ◽  
Samantha A. Spencer ◽  
...  
Keyword(s):  
Blood Loss ◽  
Preoperative Embolization ◽  
Inpatient Stay ◽  
Venous Malformations ◽  
Iodized Oil ◽  
Safety And Efficacy ◽  
Median Volume ◽  
The Mean ◽  
Initial Results ◽  
Median Blood Loss

Purpose: The purpose of this study was to evaluate the safety and efficacy of preoperative percutaneous n-butyl cyanoacrylate (nBCA) embolization of venous malformations in children. Material and Methods: Clinical data were retrospectively reviewed in children who underwent embolization using nBCA followed by resection of venous malformations. Results: A total of 17 embolizations were performed in 14 patients (9 females, mean age: 5.5 years; median age: 3 years; range 0.1-16 years). The venous malformations involved the lower extremity and the knee joint (n = 7), the trunk (n = 4), head and neck (n = 2), and hand (n = 1). n-Butyl cyanoacrylate was diluted with iodized oil at a ratio of 1:3 to 1:5. The mean and median volume of nBCA per procedure were 2.1 and 2 mL, respectively (range: 0.5-8 mL). There were no complications associated with the procedures. The mean and median time between final embolization and resection were 3.6 and 2 days, respectively. All children underwent successful resection of the symptomatic lesions. The estimated mean and median blood loss were 75 and 50 mL, respectively (range: 5-350 mL). The postprocedure course was uneventful, the days to discharge ranged between 1 and 6 days (mean 3 days). Conclusion: Initial results suggest that preoperative percutaneous n-butyl cyanoacrylate embolization of venous malformations is safe and effective in children, with the potential for minimizing blood loss and inpatient stay.

The Effect of Desmopressin on Reducing Blood Loss in Cardiac Surgery – A Meta-Analysis of Double-Blind, Placebo-Controlled Trials

1995 ◽  
Vol 74 (04) ◽  
pp. 1064-1070 ◽  
Author(s):  
Marco Cattaneo ◽  
Alan S Harris ◽  
Ulf Strömberg ◽  
Pier Mannuccio Mannucci
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Meta Analysis ◽  
Postoperative Blood Loss ◽  
Controlled Trials ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Transfusion Requirements ◽  
The Mean ◽  
Excessive Blood Loss

SummaryThe effect of desmopressin (DDAVP) on reducing postoperative blood loss after cardiac surgery has been studied in several randomized clinical trials, with conflicting outcomes. Since most trials had insufficient statistical power to detect true differences in blood loss, we performed a meta-analysis of data from relevant studies. Seventeen randomized, double-blind, placebo-controlled trials were analyzed, which included 1171 patients undergoing cardiac surgery for various indications; 579 of them were treated with desmopressin and 592 with placebo. Efficacy parameters were blood loss volumes and transfusion requirements. Desmopressin significantly reduced postoperative blood loss by 9%, but had no statistically significant effect on transfusion requirements. A subanalysis revealed that desmopressin had no protective effects in trials in which the mean blood loss in placebo-treated patients fell in the lower and middle thirds of distribution of blood losses (687-1108 ml/24 h). In contrast, in trials in which the mean blood loss in placebo-treated patients fell in the upper third of distribution (>1109 ml/24 h), desmopressin significantly decreased postoperative blood loss by 34%. Insufficient data were available to perform a sub-analysis on transfusion requirements. Therefore, desmopressin significantly reduces blood loss only in cardiac operations which induce excessive blood loss. Further studies are called to validate the results of this meta-analysis and to identify predictors of excessive blood loss after cardiac surgery.

Customized anterior craniocervical reconstruction via a modified high-cervical retropharyngeal approach following resection of a spinal tumor involving C1–2/C1–3

2020 ◽  
Vol 32 (3) ◽  
pp. 432-440
Author(s):  
Shaohui He ◽  
Chen Ye ◽  
Nanzhe Zhong ◽  
Minglei Yang ◽  
Xinghai Yang ◽  
...  
Keyword(s):  
Cervical Spinal Cord ◽  
Perioperative Complications ◽  
Japanese Orthopaedic Association ◽  
Spinal Tumor ◽  
Spinal Tumors ◽  
Limited Information ◽  
Improvement Rate ◽  
The Mean ◽  
High Cervical ◽  
Occipital Condyles

OBJECTIVEThe surgical treatment of an upper cervical spinal tumor (UCST) at C1–2/C1–3 is challenging due to anterior exposure and reconstruction. Limited information has been published concerning the effective approach and reconstruction for an anterior procedure after C1–2/C1–3 UCST resection. The authors attempted to introduce a novel, customized, anterior craniocervical reconstruction between the occipital condyles and inferior vertebrae through a modified high-cervical retropharyngeal approach (mHCRA) in addressing C1–2/C1–3 spinal tumors.METHODSSeven consecutive patients underwent 2-stage UCST resection with circumferential reconstruction. Posterior decompression and occiput-cervical instrumentation was conducted at the stage 1 operation, and anterior craniocervical reconstruction using a 3D-printed implant was performed between the occipital condyles and inferior vertebrae via an mHCRA. The clinical characteristics, perioperative complications, and radiological outcomes were reviewed, and the rationale for anterior craniocervical reconstruction was also clarified.RESULTSThe mean age of the 7 patients in the study was 47.6 ± 19.0 years (range 12–72 years) when referred to the authors’ center. Six patients (85.7%) had recurrent tumor status, and the interval from primary to recurrence status was 53.0 ± 33.7 months (range 24–105 months). Four patients (57.1%) were diagnosed with a spinal tumor involving C1–3, and 3 patients (42.9%) with a C1–2 tumor. For the anterior procedure, the mean surgical duration and average blood loss were 4.1 ± 0.9 hours (range 3.0–6.0 hours) and 558.3 ± 400.5 ml (range 100–1300 ml), respectively. No severe perioperative complications occurred, except 1 patient with transient dysphagia. The mean pre- and postoperative visual analog scale scores were 8.0 ± 0.8 (range 7–9) and 2.4 ± 0.5 (range 2.0–3.0; p < 0.001), respectively, and the mean improvement rate of cervical spinal cord function was 54.7% ± 13.8% (range 42.9%–83.3%) based on the modified Japanese Orthopaedic Association scale score (p < 0.001). Circumferential instrumentation was in good position and no evidence of disease was found at the mean follow-up of 14.8 months (range 7.3–24.2 months).CONCLUSIONSThe mHCRA provides optimal access to the surgical field at the C0–3 level. Customized anterior craniocervical fixation between the occipital condyles and inferior vertebrae can be feasible and effective in managing anterior reconstruction after UCST resection.

Sign in / Sign up

Export Citation Format

Share Document