scholarly journals Management of severe intraoperative hemorrhage during intraventricular neuroendoscopic procedures: the dry field technique

2019 ◽  
Vol 131 (3) ◽  
pp. 931-935 ◽  
Author(s):  
Joachim Oertel ◽  
Stefan Linsler ◽  
Akos Csokonay ◽  
Henry W. S. Schroeder ◽  
Sebastian Senger
Keyword(s):  
Endoscopic Surgery ◽  
Intraventricular Hemorrhage ◽  
Tumor Resection ◽  
The Other ◽  
Tumor Removal ◽  
Reliable Technique ◽  
Bleeding Source ◽  
Field Technique ◽  
Life Threatening ◽  
Life Threatening Complication

OBJECTIVEThe unexpected intraoperative intraventricular hemorrhage is a rare but feared and life-threatening complication in neuroendoscopic procedures because of loss of endoscopic vision. The authors present their experience with the so-called “dry field technique” (DFT) for the management of intraventricular hemorrhages during purely endoscopic procedures. This technique requires the aspiration of the entire intraventricular CSF to achieve clear visualization of the bleeding source.METHODSMore than 500 neuroendoscopic intraventricular procedures were retrospectively analyzed over the last 24 years for documented severe hemorrhages, which were treated by the application of the DFT.RESULTSThe technique was required in 6 cases, including tumor resection/biopsy, cyst resection, and intraventricular lavage. Additionally, the technique was applied as part of the planned strategy in 3 cases of endoscopic tumor removal. The hemorrhage was stopped in all cases and no associated postoperative deficits occurred.CONCLUSIONSAlthough severe hemorrhages are rare, the neurosurgeon needs to be aware of them and has to establish strategies for their management. Most hemorrhages can be stopped by constant irrigation and coagulation. In the other rare cases, the DFT is a safe, reliable technique and can be easily incorporated into endoscopic surgery.

scholarly journals Two Case Reports of Biliary Tract Injuries during Laparoscopic Cholecystectomy

2011 ◽  
Vol 2011 ◽  
pp. 1-4
Author(s):  
O. Romano ◽  
C. Romano ◽  
D. Cerbone ◽  
P. Sperlongano ◽  
L. Caserta ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Real Time ◽  
Biliary Tract ◽  
Case Reports ◽  
The Other ◽  
Primary Intervention ◽  
Life Threatening ◽  
Life Threatening Complication

Background and Study Aims. Biliary tract injuries (BTI) represent the most serious and potentially life-threatening complication of cholecystectomy occurring also during laparoscopic approaches. Patients and Methods. We describe and discuss two different cases of BTI occurring during laparoscopic cholecystectomy (LC). Results. Two patients developed BTI during LC and one evidenced the complication during the LC itself and was treated during the same LC in real time. The other patient evidenced BTI only after the primary intervention and was successfully reoperated in laparotomy after 10 days from the LC. Conclusions. The factors that predispose to the occurrence of BTI during cholecystectomy and the cautions to be used to prevent BTI are discussed.

Intraoperative Language Localizationin Multilingual Patients With Gliomas

Neurosurgery ◽  
2006 ◽  
Vol 59 (1) ◽  
pp. 115-125 ◽  
Author(s):  
Lorenzo Bello ◽  
Francesco Acerbi ◽  
Carlo Giussani ◽  
Pietro Baratta ◽  
Paolo Taccone ◽  
...  
Keyword(s):  
Oral Language ◽  
Language Production ◽  
Tumor Resection ◽  
Awake Craniotomy ◽  
The Other ◽  
Tumor Removal ◽  
Language Mapping ◽  
Current Threshold ◽  
Subcortical Stimulation ◽  
Intraoperative Localization

Abstract OBJECTIVE Intraoperative localization of speech is problematic in patients that are fluent with different languages. Previous studies have generated various results depending on the series of patients studied, the type of language and the sensitivity of the tasks applied. It is not clear if languages are mediated by multiple and separate cortical areas, or shared by common areas. Globally considered, previous studies recommended performing a multiple intra-operative mapping for all the languages the patient is fluent for. Aim of this work was to study the feasibility of performing an intra-operative multiple language mapping in a group of multilingual patients with a glioma undergoing awake craniotomy for tumor removal, to describe the intraoperative cortical and subcortical findings in the area of craniotomy, with the final goal to maximally preserve their functional language. METHODS Seven late highly proficient multilingual patients with a left frontal glioma were submitted pre-operatively to a battery of tests to evaluate oral language production, comprehension, and repetition. Each language was tested serially starting from the first acquired language. Items which were correctly named during these tests were used to build personalized blocks to be used intraoperatively. Language mapping was undertaken during awake craniotomies, by the use of a Ojemann cortical stimulator during counting and oral naming tasks. Subcortical stimulation by using the same current threshold was applied during tumor resection, in a back and forth fashion, and the same tests. RESULTS Cortical sites essential for oral naming were found in 87.5% of patients, those for the first acquired language in 1 to 4 sites, those for the other languages in 1 to 3 sites. Sites for each language were distinct and separate. Number and location of sites were not predictable, being randomly and widely distributed in the cortex around or less frequently over the tumor area. Subcortical stimulations found tracts for the first acquired language in 4 patients, and for the other languages in 3 patients. Three of these patients decreased their fluency immediately after surgery, affecting the first acquired language, which fully recovered in two patients and partially in one. The procedure was agile and well tolerated by the patients. CONCLUSION These findings show that multiple cortical and subcortical language mapping during awake craniotomy for tumor removal is a feasible procedure. They support the concept that intraoperative mapping should be performed for all the languages the patient is fluent for to preserve functional integrity.

Presentation of Gall Stone Ileus as Gut Obstruction

JMS SKIMS ◽  
2019 ◽  
Vol 21 (2) ◽  
pp. 117-119
Author(s):  
Munir Ahmad Wani ◽  
Mubarak Ahmad Shan ◽  
Syed Muzamil Andrabi ◽  
Ajaz Ahmad Malik
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Ct Scan ◽  
Bowel Obstruction ◽  
Emergency Surgery ◽  
Gallstone Ileus ◽  
Gall Stone ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
Gall Stone Ileus

Gallstone ileus is an uncommon and often life-threatening complication of cholelithiasis. In this case report, we discuss a difficult diagnostic case of gallstone ileus presenting as small gut obstruction with ischemia. A 56-year-old female presented with abdominal pain and vomiting. A CT scan was performed and showed an evolving bowel obstruction with features of gut ischemia with pneumobilia although no frank hyper density suggestive of a gallstone was noted. The patient underwent emergency surgery and a 60 mm obstructing calculus was removed from the patient's jejunum, with a formal tube cholecystostomy. JMS 2018: 21 (2):117-119

A technique for endoscopic pituitary tumor removal

1996 ◽  
Vol 1 (1) ◽  
pp. E3 ◽  
Author(s):  
Michael D. Cusimano ◽  
Ronald S. Fenton
Keyword(s):  
Case Report ◽  
Minimally Invasive ◽  
Pituitary Tumor ◽  
Tumor Resection ◽  
Region Of Interest ◽  
Operating Microscope ◽  
Tumor Removal ◽  
Endoscopic Techniques ◽  
Effective Manner ◽  
Highly Effective

A number of milestones have marked the development of transsphenoidal pituitary tumor resection this century. The introduction of headlamp illumination, followed by the use of the operating microscope and fluoroscopy have allowed neurosurgeons to perform this surgery in a safe and highly effective manner. With the aid of a case report, we describe the incorporation of endoscopic techniques in pituitary tumor resection. The technique described is minimally invasive, avoiding septal dissection and allowing unsurpassed, unobstructed, and panoramic visualization of the region of interest to the surgeon and operative team.

scholarly journals 187 Improving Awareness of Managing Post-Operative Haemorrhage in Patients Undergoing Thyroid and Parathyroid Surgery: The SCOOP Protocol

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Bhattacharya ◽  
J Jegadeeson ◽  
J Ramsingh ◽  
P Truran
Keyword(s):  
Nursing Staff ◽  
Simulation Training ◽  
Clinical Signs ◽  
Skin Wound ◽  
Junior Doctors ◽  
Parathyroid Surgery ◽  
Surgical Department ◽  
Life Threatening ◽  
Clinical Questions ◽  
Life Threatening Complication

Abstract Introduction Post-operative haemorrhage is a rare but potentially life-threatening complication of thyroid surgery and occurs in 1 in 100 patients. Our aim was to assess current levels of awareness of post-operative haemorrhage in the surgical department and to improve confidence in managing this. Method Questionnaires with a combination of clinical questions were distributed amongst nurses, foundation doctors, senior house officers and registrars in the surgical department. Results There was a clear gap in awareness in all grades. The British Association of Endocrine and Thyroid surgeons (BAETS) have guidance on the management of these patients and in particular the acronym SCOOP (Steristrips removed, Cut subcuticular sutures, Open skin wound, Open strap muscles, Pack wound). 18/24 of participants had not heard of the SCOOP protocol. Most nurses (6/12) all junior doctors (8/8) showed lack of confidence in managing patients with suspected bleeding. Conclusions An informative poster was created for relevant clinical areas as per the BAETS recommendation. These posters outlined the steps in the SCOOP acronymas well as the main clinical signs of haemorrhage. BAETS recommend that all first responders, including nursing staff, junior doctors and the crash team should be aware of the SCOOP protocol. Simulation training sessions are in progress for these members of staff.

scholarly journals Rivaroxaban-Induced Nontraumatic Spinal Subdural Hematoma: An Uncommon Yet Life-Threatening Complication

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Mazen Zaarour ◽  
Samer Hassan ◽  
Nishitha Thumallapally ◽  
Qun Dai
Keyword(s):  
Subdural Hematoma ◽  
Lower Risk ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
Bleeding Events ◽  
Spinal Hematoma ◽  
The Third ◽  
Spinal Subdural Hematoma ◽  
Life Threatening ◽  
Life Threatening Complication

In the last decade, the desire for safer oral anticoagulants (OACs) led to the emergence of newer drugs. Available clinical trials demonstrated a lower risk of OACs-associated life-threatening bleeding events, including intracranial hemorrhage, compared to warfarin. Nontraumatic spinal hematoma is an uncommon yet life-threatening neurosurgical emergency that can be associated with the use of these agents. Rivaroxaban, one of the newly approved OACs, is a direct factor Xa inhibitor. To the best of our knowledge, to date, only two published cases report the incidence of rivaroxaban-induced nontraumatic spinal subdural hematoma (SSDH). Our case is the third one described and the first one to involve the cervicothoracic spine.

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