The role of preoperative embolization for intracranial meningiomas

Object As endovascular techniques have become more advanced, preoperative embolization has become an increasingly used intervention in the management of meningiomas. To date, however, no consensus has been reached on the use of this technique. To clarify the role of preoperative embolization in the management of meningiomas, the authors conducted a systematic review of case reports, case series, and prospective studies to increase the current understanding of the management options for these common lesions and complications associated with preoperative embolization. Methods A PubMed search was performed to include all relevant studies in which the management of intracranial meningiomas with preoperative embolization was reported. Immediate complications of embolization were reported as major (sustained) or minor (transient) deficits, death, or no neurological deficits. Results A total of 36 studies comprising 459 patients were included in the review. Among patients receiving preoperative embolization for meningiomas, 4.6% (n = 21) sustained complications as a direct result of embolization. Of the 21 patients with embolization-induced complications, the incidence of major complications was 4.8% (n = 1) and the mortality rate was 9.5% (n = 2). Conclusions Preoperative embolization is associated with an added risk for morbidity and mortality. Preoperative embolization may be associated with significant complications, but careful selection of ideal cases for embolization may help reduce any added morbidity with this procedure. Although not analyzed in the authors' study, embolization may still reduce rates of surgical morbidity and mortality and therefore may still have a potential benefit for selected patients. Future prospective studies involving the use of preoperative embolization in certain cases of meningiomas may further elucidate its potential benefit and risks.

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Prenatal Diagnosis of Neuroblastoma

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1371 ◽

2014 ◽

Vol 8 (3) ◽

pp. 321-327

Author(s):

Mona Zvanca ◽

Cristian Andrei

Keyword(s):

Prenatal Diagnosis ◽

Case Reports ◽

Case Series ◽

Expectant Management ◽

Individual Case ◽

Management Options ◽

Tertiary Center ◽

Low Incidence ◽

Tumor In Childhood

ABSTRACT Fetal malignancies are rare complications during pregnancies, but when they appear, they are very challenging for the perinatology team. Because of their low incidence, the information is limited, with data provided from individual case reports or small case series. Although neuroblastoma is the most frequent extracranial solid tumor in childhood, prenatal diagnosis by ultrasound is very rare and almost always discovered during routine third trimester ultrasound. Expectant management is usually indicated prenatally, with serial ultrasound examination. Delivery should be planned in a tertiary center together with pediatric oncologists and surgeons to allow appropriate postnatal management. We present two cases of neuroblastoma diagnosed at 36 and 33 weeks of gestation with multiple aspects of this tumor identified by ultrasound. Both cases needed surgery and had a favorable outcome. The key role of ultrasound in diagnosis and follow-up of neuroblastoma in pregnancy is discussed, together with the management options recommended in literature. How to cite this article Andrei C, Vladareanu R, Zvanca M, Vladareanu S. Prenatal Diagnosis of Neuroblastoma. Donald School J Ultrasound Obstet Gynecol 2014;8(3):321-327.

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Controversies in the role of preoperative embolization in meningioma management

Neurosurgical FOCUS ◽

10.3171/2013.9.focus13351 ◽

2013 ◽

Vol 35 (6) ◽

pp. E17 ◽

Cited By ~ 42

Author(s):

Amit Singla ◽

Eric M. Deshaies ◽

Vlad Melnyk ◽

Gentian Toshkezi ◽

Amar Swarnkar ◽

...

Keyword(s):

Blood Loss ◽

Case Series ◽

Endovascular Embolization ◽

Controlled Study ◽

Preoperative Embolization ◽

Time To Surgery ◽

Randomized Controlled ◽

Cranial Nerve Palsies ◽

Duration Of Surgery

The role of preoperative embolization in meningioma management remains controversial, even though 4 decades have passed since it was first described. It has been shown to offer benefits such as decreased blood loss and “softening of the tumor” during subsequent resection. However, the actual benefits remain unclear, and the potential harm of an additional procedure along with the cost of embolization have limited its use to a small proportion of the meningiomas treated. In this article the authors retrospectively reviewed their experience with preoperative embolization of meningiomas over the previous 6 years (March 2007–March 2013). In addition, they performed a MEDLINE search using a combination of the terms “meningioma,” “preoperative,” and “embolization” to analyze the indications, embolizing agents, timing, and complications reported during preoperative embolization of meningiomas. In this retrospective review, 18 cases (female/male ratio 12:6) were identified in which endovascular embolization was used prior to resection of an intracranial meningioma. Craniotomy for tumor resection was performed within 4 days after endovascular embolization in all cases, with an average time to surgery of 1.9 days. The average duration of surgery was 4 hours and 18 minutes, and the average blood loss was 574 ml, with a range of 300–1000 ml. Complications following endovascular therapy were identified in 3 (16.7%) of 18 cases, including one each of transient hemiparesis, permanent hemiparesis, and tumor swelling. The literature review returned 15 articles consisting of a study population greater than 25 patients. No randomized controlled study was found. The use of small polyvinyl alcohol particles (45–150 μm) is more effective in preoperative devascularization than larger particles (150–250 μm), but is criticized due to the higher risk of complications such as cranial nerve palsies and postprocedural hemorrhage. Time to surgery after embolization is inconsistently reported across the articles, and conclusions on the appropriate timing of surgery could not be drawn. The overall complication rate reported after treatment with preoperative meningioma embolization ranges from as high as 21% in some of the older literature to approximately 6% in recent literature describing treatment with newer embolization techniques. The evidence in the literature supporting the use of preoperative meningioma embolization is mainly from case series, and represents Level III evidence. Due to the lack of randomized controlled clinical trials, it is difficult to draw any significant conclusions on the overall usefulness of preoperative embolization during the management of meningiomas to consider it a standard practice.

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Patient Safety in Surgical Residency: Root Cause Analysis and the Surgical Morbidity and Mortality Conference—Case Series from Clinical Practice

The Permanente Journal ◽

10.7812/tpp/11-097 ◽

2012 ◽

Vol 16 (1) ◽

Cited By ~ 12

Author(s):

Samir Johna

Keyword(s):

Patient Safety ◽

Clinical Practice ◽

Case Series ◽

Morbidity And Mortality ◽

Surgical Morbidity ◽

Cause Analysis ◽

Surgical Residency ◽

Root Cause ◽

Morbidity And Mortality Conference ◽

Mortality Conference

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Morbidly Adherent Placenta: Management options

Pakistan Postgraduate Medical Journal ◽

10.51642/ppmj.v31i01.375 ◽

2021 ◽

Vol 31 (01) ◽

pp. 3-7

Author(s):

Abida Sajid ◽

Aqsam Sajid Aqsam Sajid ◽

Arham Sajid Arham Sajid ◽

Maham Abid Maham Abid

Keyword(s):

Maternal Morbidity ◽

Tertiary Care ◽

Case Series ◽

Morbidity And Mortality ◽

Care Hospital ◽

Management Options ◽

Morbidly Adherent Placenta ◽

Adherent Placenta ◽

Vaginal Deliveries ◽

Maternal Morbidity And Mortality

Background Placenta previa with placenta accreta spectrum is one of the most feared complications responsible for increased maternal morbidity and mortality. This study aims to reduce maternal morbidity and mortality by detecting risk factors, performing relevant investigations, and deciding appropriate management options. Methods: The study design is a descriptive case series, carried out on 72 patients of MAP of a tertiary care hospital, in a 6-years duration from January 2014 to December 2019. Patients of OPD and the emergency department were diagnosed for MAP by using grayscale ultrasounds, color Doppler USG's (in most cases), and MRI's (in only a few cases). Different management options were studied and maternal morbidities were observed. In the majority of cases, patients had operative deliveries with planned/ emergency hysterectomies, except for some having conservative surgery. Results: In the period of 6 years, the total number of deliveries was 35940. Out of these, 22140 were spontaneous vaginal deliveries and 13800 were C-sections. The incidence of MAP was 1 per 499 normal deliveries and 1 per 192 in C-sections. The criteria for MAP was fulfilled by 72 patients. MAP diagnosed in the antenatal period was 43% while 57% were diagnosed in an emergency. The majority of patients had a history of C-sections and many underwent emergency obstetric hysterectomies. Blood transfusions were given to all patients in our study. Only 4(5.5%) patients died in our study. Conclusion: Antenatal diagnosis of morbidly adherent placenta, followed by a well-planned surgical management, avoidance of placental separation and early caesarean hysterectomy ultimately result in a better maternal outcome. Keywords: Morbidly Adherent Placenta, Maternal Morbidity, Massive Obstetric Hemorrhage, Obstetric Hysterectomy.

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Laparoscopic antireflux surgery - our initial experience

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v18i3.15269 ◽

2016 ◽

Vol 18 (3) ◽

pp. 14

Author(s):

S Pradhan ◽

Bikal Ghimire ◽

P Kansakar ◽

YP Singh ◽

P Vaidya ◽

...

Keyword(s):

Hospital Stay ◽

Antireflux Surgery ◽

Case Series ◽

Laparoscopic Antireflux Surgery ◽

Morbidity And Mortality ◽

Surgical Morbidity ◽

Achalasia Cardia ◽

Duration Of Surgery ◽

Dor’S Fundoplication

Introduction: Laparoscopic antireflux surgery (LARS) currently represents the gold standard in the surgical management of gastrointestinal reflux disease (GERD) with minimal morbidity and mortality. Routine fundoplication following laparoscopic Heller’s cardiomyotomy is also being recommended to reduce the incidence of pathological gastro-oesophageal reflux after surgery. The aim of the current study was to evaluate patients receiving LARS and to assess their surgical outcomesMethods: Prospective data of all patients admitted in our department with these diseases and undergoing LARS, from May 2014 to November 2015 were reviewed. Patients with Achalasia cardia underwent Laparoscopic Heller’s cardiomyotomy with Dor’s fundoplication and those with GERD with hiatus hernia underwent Laparoscopic Toupet’s fundoplication. Age, sex, duration of surgery, surgical morbidity and hospital stay were recorded. Results: Eleven patients underwent LARS. Females were 5(45.5%) and males were 6 (54.5%). Mean age of patients was 36.18 ± 15.79 years (range 18-68 years). 6 patients (54.5%) underwent Laparoscopic Heller’s cardiomyotomy with Dor’s fundoplication for Achalasia cardia while 5 patients (45.5%) underwent Laparoscopic fundoplication. The median operating room time was 133.64 ± 15.66 minutes (range, 110–160). There were no conversions. The median hospital stay was 3.45±0.522 days (range, 3-4 days). No postoperative complications or preoperative deaths occurred. No patient had a perforation revealed on the postoperative contrast swallow when performed. Gastro esophageal reflux symptoms were significantly improved and severity of dysphagia was also reduced after surgery. The average follow-up period is 5.45 ± 2.67 months (range, 3- 12).Conclusion: LARS is well established technique and becoming more popular over conventional open surgery in view of its equal safety and efficacy with added advantage of less morbidity and mortality. However larger case series and long term follow up would be warranted.

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Confronting the Problems of Professional Sports: A Public Policy Response to Franchise Relocation and Stadium Subsidization

Vanderbilt Undergraduate Research Journal ◽

10.15695/vurj.v1i0.2723 ◽

2005 ◽

Vol 1 ◽

Cited By ~ 1

Author(s):

Taylor F Brinkman

Keyword(s):

Local Community ◽

Professional Sports ◽

The United States ◽

Direct Result ◽

Sports Organizations ◽

Sports Leagues ◽

Sports Finance ◽

Sports Venues ◽

Benefits And Costs

During the past decade, forty-six professional sports venues were constructed in the United States, while only 16 expansion teams were created by the major sports leagues. Nearly two thirds of these newly built stadiums and arenas were funded with public tax revenues, despite substantial evidence showing no positive economic impact of new sports stadium construction on local communities. In reviewing the economic literature, this article investigates the role of professional sports organizations in the construction and public subsidization of new sports venues. Franchise relocation and public stadium subsidization is a direct result of the monopoly power of professional sports leagues, whose franchise owners extract large subsidies from their host communities by threatening to relocate to viable alternative locations. After explaining how the most common methods of stadium subsidization project a disproportionate allocation of the benefits and costs of hosting a professional team to local community interests, this article outlines several considerations for local policymakers who seek to reinvigorate public discussion of equity concerns in professional sports finance.

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