Foramen magnum meningiomas: surgical results and risks predicting poor outcomes based on a modified classification

2017 ◽  
Vol 126 (3) ◽  
pp. 661-676 ◽  
Author(s):  
Da Li ◽  
Zhen Wu ◽  
Cong Ren ◽  
Shu-Yu Hao ◽  
Liang Wang ◽  
...  
Keyword(s):  
Cranial Nerves ◽  
Multivariate Logistic Regression Analysis ◽  
Type A ◽  
Foramen Magnum ◽  
Neurological Function ◽  
Preoperative Imaging ◽  
Long Term Outcome ◽  
Lower Cranial Nerve ◽  
Dural Attachment

OBJECTIVE This study aimed to evaluate neurological function and progression/recurrence (P/R) outcome of foramen magnum meningioma (FMM) based on a modified classification. METHODS This study included 185 consecutive patients harboring FMMs (mean age 49.4 years; 124 females). The authors classified the FMMs into 4 types according to the previous classification of Bruneau and George as follows: Type A (n = 49, 26.5%), the dural attachment of the lesion grows below the vertebral artery (VA); Type B (n = 39, 21.1%), the dural attachment of the lesion grows above the VA; Type C1 (n = 84, 45.4%), the VA courses across the lesion with or without VA encasement or large lesions grow both above and below the bilateral VA; and Type C2 (n = 13, 7.0%), Type C1 plus partial/total encasement of the VA and extradural growth. RESULTS The median preoperative Karnofsky Performance Scale (KPS) score was 80. Gross-total resection (GTR) was achieved in 154 patients (83.2%). Lower cranial nerve morbidity was lowest in Type A lesions (16.3%). Type C2 lesions were inherently larger (p = 0.001), had a greater percentage of ventrolateral location (p = 0.009) and VA encasement (p < 0.001), lower GTR rate (p < 0.001), longer surgical duration (p = 0.015), higher morbidity (38.5%), higher P/R rate (30.8%, p = 0.009), and poorer recent KPS score compared with other types. After a mean follow-up duration of 110.3 months, the most recent follow-up data were obtained in 163 patients (88.1%). P/R was observed in 13 patients (7.2%). The median follow-up KPS score was 90. Compared with preoperative status, recent neurological status was improved in 91 (49.2%), stabilized in 76 (41.1%), and worsened in 18 (9.7%) patients. The multivariate Cox proportional hazard regression model demonstrated Type C2 (HR 3.94, 95% CI 1.04–15.0, p = 0.044), nontotal resection (HR 6.30, 95% CI 1.91–20.8, p = 0.003), and pathological mitosis (HR 7.11, 95% CI 1.96–25.8, p = 0.003) as independent adverse predictors for tumor P/R. Multivariate logistic regression analysis identified nontotal resection (OR 4.06, 95% CI 1.16–14.2, p = 0.029) and pathological mitosis (OR 6.29, 95% CI 1.47–27.0, p = 0.013) as independent risks for poor outcome (KPS score < 80). CONCLUSIONS The modified classification helped to predict surgical outcome and P/R in addition to the position of the lower cranial nerves. Preoperative imaging studies and neurological function should be reviewed carefully to establish an individualized management strategy to improve long-term outcome.

REMNANTS OF OCCIPITAL VERTEBRAE

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. 945-954 ◽  
Author(s):  
Arnold H. Menezes ◽  
Kathleen A. Fenoy
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Prospective Study ◽  
Cranial Nerves ◽  
Foramen Magnum ◽  
Occipital Condyle ◽  
Resonance Imaging ◽  
Lower Cranial Nerve ◽  
3 Dimensional

Abstract OBJECTIVE Developmental remnants around the foramen magnum, or proatlas segmentation abnormalities, have been recorded in postmortem studies but very rarely in a clinical setting. Because of their rarity, the pathological anatomy has been misunderstood, and treatment has been fraught with failures. The objectives of this prospective study were to understand the correlative anatomy, pathology, and embryology and to recognize the clinical presentation and gain insights on the treatment and management. METHODS Our craniovertebral junction (CVJ) database started in 1977 and comprises 5200 cases. This prospective study has retrieval capabilities. Neurodiagnostic studies changed with the evolution of imaging. Seventy-two patients were recognized as having symptomatic proatlas segmentation abnormalities. RESULTS Ventral bony masses from the clivus or medial occipital condyle occurred in 66% (44/72), lateral or anterolateral compressive masses in 37% (27 of 72 patients), and dorsal bony compression in 17% (12 of 72 patients). Hindbrain herniation was associated in 33%. The age at presentation was 3 to 23 years. Motor symptoms occurred in 72% (52 of 72 patients); palsies in Cranial Nerves IX, X, and XII in 33% (24 of 72 patients); and vertebrobasilar symptoms in 25% (18 of 72 patients). Trauma precipitated symptoms in 55% (40 of 72 patients). The best definition of the abnormality was demonstrated by 3-dimensional computed tomography combined with magnetic resonance imaging. Treatment was aimed at decompression of the pathology and stabilization. CONCLUSION Remnants of the occipital vertebrae around the foramen magnum were recognized in 72 of 5200 CVJ cases (7.2%). Magnetic resonance imaging with 3-dimensional computed tomography of the CVJ provides the best definition and understanding of the lesions. Brainstem myelopathy and lower cranial nerve deficits are common clinical presentations in the first and second decades of life. Treatment is aimed at decompression of the pathology and CVJ stabilization.

FORAMEN MAGNUM MENINGIOMAS

Neurosurgery ◽  
2006 ◽  
Vol 59 (6) ◽  
pp. 1177-1187 ◽  
Author(s):  
Hischam Bassiouni ◽  
Vasilios Ntoukas ◽  
Siamak Asgari ◽  
Erol I. Sandalcioglu ◽  
Dietmar Stolke ◽  
...  
Keyword(s):  
Foramen Magnum ◽  
Consecutive Series ◽  
Surgical Morbidity ◽  
Simpson Grade ◽  
Dural Attachment ◽  
Preoperative Magnetic Resonance ◽  
Magnetic Resonance Imaging Mri ◽  
Tumor Remnant

Abstract OBJECTIVE We analyzed a consecutive series of patients operated for a foramen magnum (FM) meningioma located on the ventral aspect of the medulla oblongata via a posterolateral suboccipital retrocondylar approach with regard to long-term surgical outcome. METHODS Clinical data in a consecutive series of 25 patients experiencing a meningioma attached to dura of the anterior or anterolateral FM rim were retrospectively reviewed. RESULTS The most common symptoms of the 19 women and six men (mean age, 59.2 yr) was cervico-occipital pain (72%) and gait disturbance (32%). Clinical examination revealed gait ataxia in 48% of the patients. As depicted from preoperative magnetic resonance imaging (MRI), dural attachment of the meningioma at the FM rim was anterior in 36% and anterolateral in 64% of cases. Tumor removal was accomplished via a posterolateral suboccipital retrocondylar approach in all patients. A Simpson Grade 2 resection was achieved in 96% of the patients. Permanent surgical morbidity and mortality rates were 8 and 4%, respectively. No tumor recurrence was observed after a mean follow-up period of 6.1 years (range, 1–14 yr) with clinical and MRI examination, and 80% of the patients have regained full daily activity. CONCLUSION Anterior and anterolateral FM meningiomas that displace the medulla/spinal cord can be safely and completely resected via a posterolateral suboccipital retrocondylar approach. A tumor remnant should be left on critical neurovascular structures in cases with poor arachnoid dissection planes.

scholarly journals Endoscopic-Assisted Resection of Anterior Foramen Magnum Meningiomas through a Midline Suboccipital Subtonsillar Approach

2021 ◽  
Author(s):  
Florian Roser ◽  
Luigi Rigante
Keyword(s):  
Anterior Part ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Foramen Magnum ◽  
Anterior Portion ◽  
Suboccipital Craniotomy ◽  
Dural Attachment ◽  
Surgical Corridor ◽  
Lower Cranial Nerves ◽  
Brain Retraction

Abstract Objective This study was aimed to demonstrate the resection of anterior foramen magnum meningiomas through an endoscopic-assisted posterior midline suboccipital subtonsillar approach. Design This study was designed with illustration of the surgical steps and safety of this approach. Setting Evidence of cerebrospinal fluid (CSF) cleft between the tumor and brainstem on MRI was studied (Fig. 1A and B). Preoperative tracheotomy was considered in cases of preoperative dysphagia to prevent any further neurological deterioration due to the bilateral access through the lower cranial nerves corridors. Semisitting position with extensive electrophysiological neuromonitoring and transesophageal echocardiogram was adopted. A standard midline incision with bilateral suboccipital craniotomy and C1-laminotomy was performed (Fig. 2A). After partial resection and elevation of the tonsils, tumor was debulked unilaterally around the lower cranial nerves and the vertebral artery, devascularized from the clival dura and then dissected from the brainstem (Fig. 2B, C). Endoscopic-assisted removal of its anterior portion followed. The same procedure was repeated from the opposite site for the contralateral portion, before approaching the purely anterior part with endoscope assistance (Fig. 2D). Participants Four consecutive patients were included in the study. Main Outcome Measures Grade of tumor resection and outcome (mRS) were primary measurement of this study. Results Clinical outcome and grade of resection are comparable to other series of patient treated with other foramen magnum approaches (Fig. 1C and D). Conclusion Anterior foramen magnum meningiomas can be safely removed through this relatively faster midline suboccipital approach with bilateral exposure of lower cranial nerves (CNs) and vertebral arteries and lower approach-related morbidity (no condyle drilling). The surgical corridor is created by the tumor during debulking reducing need for brain retraction and the removal of the anterior dural attachment coagulated under the microscope is verified and completed endoscopically with pituitary curettes (Simpson's grade II) (Fig. 1C and D).The link to the video can be found at: https://youtu.be/9eACAJVwQBs.

scholarly journals Microneurosurgical Management of Posterior Inferior Cerebellar Artery Aneurysms: Results of a Consecutive Series

2021 ◽  
pp. 33-38
Author(s):  
Mattia Del Maestro ◽  
Sabino Luzzi ◽  
Renato Galzio
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Lateral Approach ◽  
Senior Author ◽  
Preoperative Imaging ◽  
Imaging Evaluation ◽  
Complex Anatomy ◽  
Cerebellar Artery ◽  
Pica Aneurysms

AbstractAneurysms of the posterior inferior cerebellar artery (PICA) are uncommon. The complex anatomy of PICA and its intimate relationships with medulla, lower cranial nerves, and jugular tubercle makes the surgical treatment of these aneurysms fascinating. The reported is study aimed at a critical review of the overall results of a personal series of PICA aneurysms, treated by the senior author, R. Galzio. Demographics, charts, videos, outcome, and follow-up of a cohort of PICA aneurysms managed in the last 10 years were retrospectively analyzed, focusing only upon those treated with microneurosurgery. Twenty-five patients, harboring a single aneurysm, were operated on. Fifteen aneurysms were ruptured. Nineteen were proximal, all of these being been treated through a far-lateral approach. Trans-condylar or trans-tubercular variants were rarely necessary and however reserved to peculiar cases. Twenty-three aneurysms underwent direct treatment consisting of clip ligation. At 6-month follow-up, 60% of patients had a modified Rankin Score (mRS) of 0–2. Given the high anatomical variability of both PICA and patients’ bony anatomy, a case-by-case meticulous preoperative imaging evaluation is mandatory for the choice of the most suitable and tailored surgical corridor which, in turn, is pivotal to achieve the best outcome.

scholarly journals Individualized Cerebral Artery Protection Strategies for the Surgical Treatment of Parasellar Meningiomas on the Basis of Preoperative Imaging

2021 ◽  
Vol 11 ◽  
Author(s):  
Yang Li ◽  
XingShu Zhang ◽  
Jun Su ◽  
Chaoying Qin ◽  
Xiangyu Wang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cerebral Artery ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Preoperative Imaging ◽  
Surgical Approaches ◽  
Karnofsky Performance Scale ◽  
Protection Strategies

ObjectiveParasellar meningiomas (PMs) represent a cohort of skull base tumors that are localized in the parasellar region. PMs tend to compress, encase, or even invade the cerebral arteries and their perforating branches. The surgical resection of PMs without damaging neurovascular structures is challenging. This study aimed to analyze functional outcomes in a series of patients who underwent surgery with individualized cerebral artery protection strategies based on preoperative imaging.MethodsA retrospective review was performed on a single surgeon’s experience of the microsurgical removal of PMs in 163 patients between January 2012 and March 2020. Individualized approaches with a bidirectional dissection strategy were used. Cerebral artery invasion classification, neurological outcomes, MRC Scale for muscle strength, and Karnofsky performance scale were used to assess tumor vascular invasion, functional outcome, and patient quality-of-life outcomes, respectively.ResultsTotal resection (Simpson grade I or II) was achieved in 114 patients (69.9%) in our study. A total of 44.7% of patients had improved vision at consecutive follow-ups, 51.1% were stable, and 3.8% deteriorated. Improvements in cranial nerves III, IV, and VI were observed in 41.1%, 36.2%, and 44.8% of patients, respectively. The mean follow-up time was (38.8 ± 27.9) months, and the KPS at the last follow-up was 89.6 ± 8.5. Recurrence was observed in eight patients (13.8%) with cavernous sinus meningiomas, and the recurrence rates in anterior clinoid meningiomas and medial sphenoid wing meningiomas were 3.8% and 2.8%, respectively.ConclusionsPreoperative imaging is important in the selection of surgical approaches. Maximum tumor resection and cerebral artery protection can be achieved concurrently by utilizing the bidirectional dissection technique. Individualized cerebral artery protection strategies provide great utility in improving a patient’s quality of life.

scholarly journals Outcome of Delayed Surgery in Treatment of Acute Traumatic Central Cord Syndrome without Fracture or Instability: A Retrospective Study

2020 ◽  
Author(s):  
Binbin Wang ◽  
Yuemian Huang ◽  
Haozhi Yang ◽  
Xiaobao Zou ◽  
Ling Ni ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Motor Vehicle ◽  
Spinal Injury ◽  
Neurological Function ◽  
Cervical Disc ◽  
Long Term Outcome ◽  
Delayed Surgery ◽  
Neurological Improvement ◽  
Central Cord Syndrome

Abstract Background: The optimal surgical timing for acute traumatic central cord syndrome (ATCCS) without fracture or instability has not been established. The purpose of this study is to explore the outcome of delayed surgery in treatment of ATCCS and to investigate potential factors associated with postoperative neurological improvement. Methods: Patients who underwent delayed surgery for ATCCS with at least 2 year follow up time were retrospectively reviewed. Parameters including age, gender, traumatic mechanism, interval to operation, surgical procedures, and complications were collected. Magnetic resonance imaging was performed to determine levels of spinal cord signal change and concomitant pathology. American Spinal Injury Association (ASIA) classification and Japanese Orthopedic Association (JOA) scores were evaluated and compared at admission and the 2 year follow-up visit for neurologic function assessment. Correlations of neurological improvement and age, traumatic mechanism, interval to operation, surgical procedures, concomitant pathology, and preoperative neurological function were investigated by Spearman ’ s correlation test. Results: A total of 39 patients (M:F=28:11, mean age 52.2±10.4 yrs) were enrolled into this study. 21 cases were caused by falls followed by 16 by motor-vehicle accidents and 2 by sports. 19 patients presented with preexisting cervical disc herniation (CDH)，12 with spinal canal stenosis (SCS), 5 with OPLL, and 3 with a combined pathology of CDH and CS. 14 samples received ACDF procedure, 8 obtained ACCF, and 17 underwent posterior unilateral open-door laminoplasty. The mean interval from trauma to surgery was 20.8±3.7 days. All cases except three (ASIA B) showed improvement of ASIA grades with a mean improvement of 1.1±0.5 grades at 2-year follow-up. JOA scores significantly improved from 6.3±3.1 points at admission to 11.4±3.9 points at 2-year follow up. No difference of neurological improvement was found between different procedures groups. No correlation was showed between neurological improvement and age, concomitant pathology, traumatic mechanism, interval to operation, surgical procedures, or preoperative neurological function. Conclusions: Delayed surgery was a feasible and effective therapy for ATCCS without fracture or instability although long-term outcome and more details still need to be investigated.

Abstract TP61: Elevated CRP Between Day 1 And 7 and not Admission CRP Is An Independent Predictor For Outcome at 3 Months In Thrombolized Acute Stroke Patients

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Andrea Rocco ◽  
Fam Geraldine ◽  
Peter Ringleb ◽  
Simon Nagel
Keyword(s):  
Ischemic Stroke ◽  
Infarct Size ◽  
Ct Scan ◽  
Brain Infarction ◽  
Multivariate Logistic Regression Analysis ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Term Outcome ◽  
Long Term Outcome

Background: The value of CRP in stroke patients undergoing thrombolysis, in the acute and subacute phase of ischemic stroke as a prognostic tool for outcome is unclear, since conflicting reports exist. Aim of our study was to explore the role of admission CRP and follow-up CRP between day 1 and 7, for outcome and mortality in stroke patients treated with rtPa. Methods: From March 1998 to 2011 all patients admitted to our hospital and undergoing thrombolysis for acute ischemic stroke were included into an open, prospective database. Stroke severity was assessed using the NIHSS. In all patients CRP levels was measured upon admission in the emergency room, after 24 hours from the acute event and in the following days. CT scan before treatment and routine brain CT scan 24-36 h after thrombolysis were performed. Symptomatic haemorrhage (sICH) was defined according to ECASS II criteria. Functional outcome was assed by mRS at three months and divided into independent (mRS0-2) and dependent (mRS 3-5). Results: In total, 1292 patients were registered in our database. About 70% of patients had an increase of CRP values in the first 7 days after admission. Infection occurred in 22% of patients and about 25% had a large brain infarction (>1/3 of vessel territory). sICH occurred in 6.7% of patients. Follow-up CRP levels between day 1 and 7 were significantly associated with cardio embolic stroke (p=0.033), infarct size (p<0.001), infection (p<0.001), symptomatic haemorrhage (p<0.001), independent (p<0.001), dependent outcome (p<0.001) and mortality (p<0.001). CRP values between day 1 and 7 (OR 2.824 CI95%; 1.534 - 5.201, p=0.001), infarct size (OR 2.254; CI95% 1.480 - 3.432, p<0.001), infection (OR1.752; CI95% 1.100 - 2.789, p=0.018) and NIHSS (OR 1.043; CI95% 1.016 - 1.069, p=0.001) were independent predictors for dependent outcome. Admission CRP values were not independently associated with outcome and mortality after multivariate logistic regression analysis. Conclusion: Together with know predictors like infarct size, NIHSS and infections, maximally elevated CRP levels within day 1 and 7 were strongly and independently associated with long-term outcome in thrombolyzed stroke patients after correction for baseline variables.

Long-Term Outcome Following Stereotactic Radiosurgery for Glomus Jugulare Tumors: A Single Institution Experience of 20 Years

Neurosurgery ◽  
2017 ◽  
Vol 83 (5) ◽  
pp. 1007-1014 ◽  
Author(s):  
Mayur Sharma ◽  
Antonio Meola ◽  
Sushma Bellamkonda ◽  
Xuefei Jia ◽  
Joshua Montgomery ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Stereotactic Radiosurgery ◽  
Tumor Volume ◽  
Benign Tumors ◽  
Tumor Diameter ◽  
Long Term Outcome ◽  
Lower Cranial Nerve ◽  
Glomus Jugulare

Abstract BACKGROUND Glomus jugulare tumors (GJTs) are rare benign tumors, which pose significant treatment challenges due to proximity to critical structures. OBJECTIVE To evaluate the long-term clinical and radiological outcome in patients undergoing stereotactic radiosurgery (SRS) for GJTs through retrospective study. METHODS Forty-two patients with 43 GJTs were treated using Gamma Knife radiosurgery (GKRS; Elekta AB, Stockholm, Sweden) at our institute from 1997 to 2016. Clinical, imaging, and radiosurgery data were collected from an institutional review board approved database. RESULTS Most patients were females (n = 35, 83.3%) and median age was 61 yr (range 23-88 yr). Median tumor volume and diameter were 5 cc and 3 cm, respectively, with a median follow-up of 62.3 mo (3.4-218.6 mo). Overall, 20 patients (47.6%) improved clinically and 14 (33.3%) remained unchanged at last follow-up. New onset or worsening of hearing loss was noted in 6 patients (17.2%) after SRS. The median prescription dose to the tumor margin was 15 Gy (12-18 Gy). Median reduction in tumor volume and maximum tumor diameter at last follow-up was 33.3% and 11.54%, respectively. The 5-yr and 10-yr tumor control rates were 87% ± 6% and 69% ± 13%, respectively. There was no correlation between maximum or mean dose to the internal acoustic canal and post-GK hearing loss (P &gt; .05). CONCLUSION SRS is safe and effective in patients with GJTs and results in durable, long-term control. SRS has lower morbidity than that associated with surgical resection, particularly lower cranial nerve dysfunction, and can be a first-line management option in these patients.

scholarly journals Foramen Magnum Meningioma: A Rare Case Report

2014 ◽  
Vol 13 (3) ◽  
pp. 69-73
Author(s):  
Haradhan Deb Nath ◽  
Kanak Kanti Barua ◽  
Shahnewaj Bari ◽  
Hafizul Amin
Keyword(s):  
Case Report ◽  
Vertebral Artery ◽  
Rare Case ◽  
Cranial Nerves ◽  
Foramen Magnum ◽  
Rare Case Report ◽  
Proper Training ◽  
Lower Cranial Nerves ◽  
Medical University

Background: Foramen magnum meningiomas are challenging tumors, requiring special considerations because of the vicinity of the medulla oblongata, the lower cranial nerves, and the vertebral artery. After detailing the relevant anatomy of the foramen magnum area, we will explain our classification system based on the compartment of development, the dural insertion, and the relation to the vertebral artery. Method: A 35 years age lady with foramen magnum meningioma was operated at the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University 6 months back. A case report was taken before surgery and 6 month follow up was done after operation. Conclusion: As foramen magnum meningioma is very difficult to approach, with the help of microscope with proper training. We can remove completely without any deficit.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i3.21031 

The effect of TEVAR for blunt traumatic thoracic aortic injury on maximal aortic diameter: Mid- and long-term outcome

Vascular ◽  
2019 ◽  
Vol 27 (4) ◽  
pp. 411-416
Author(s):  
Hozan Mufty ◽  
Geert Maleux ◽  
Sabrina Houthoofd ◽  
Sandra A Cornelissen ◽  
Kim Daenens ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Aortic Injury ◽  
Aortic Diameter ◽  
Preoperative Imaging ◽  
Long Term Outcome ◽  
Thoracic Aortic Injury ◽  
Long Term Follow Up

Objective Thoracic endovascular aortic repair (TEVAR) has become the standard of care for blunt thoracic aortic injury (BTAI). Long-term effects of TEVAR on the aortic diameter are not well studied. This study evaluates the effect of TEVAR for BTAI on the aortic diameter in mid- and long-term follow-up. Methods All patients treated with TEVAR for BTAI between August 2000 and May 2016 were included. Maximum aortic diameter was measured at four predetermined thoracic aortic levels in the preoperative and first postoperative CT angiography (CTa) and in the last control CTa or MR angiography: 1 cm proximal (D1) and 1 cm distal to the left subclavian artery (D2), 3 cm distal to the left subclavian artery (D3) and 3 cm proximal to the celiac trunk (D4). Results A total of 27 patients (20 men, mean age 40 years (±17.55) were included. Mean follow-up time was 90 months (±48.36)). No re-interventions were needed. Mean growth of aortic diameter at level D1, D2, D3 and D4 was 0.22 mm ± 3.66, 1.79 mm ± 3.82, 0.73 mm ± 4.18 and –1.06 mm ± 2.82, respectively, when comparing last follow-up to the preoperative imaging without any statistical significant differences. When comparing the preoperative diameter with the first postoperative CT, only a statistical significant growth of 2.81 mm ± 2.69 was seen at level of D2 ( p < 0.05) Conclusion During mid- to long-term follow-up, a temporary significant increase of the maximum aortic diameter was seen at level D2 in the direct postoperative phase This increase was not associated with clinical events and suggests long-term efficacy of TEVAR after BTAI.

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