Endoscopic endonasal approach for suprasellar meningiomas: introduction of a new scoring system to predict extent of resection and assist in case selection with long-term outcome data

OBJECTIVEThe endoscopic endonasal approach (EEA) has gained increasing popularity for the resection of suprasellar meningiomas (SSMs). Appropriate case selection is critical in optimizing patient outcome. Long-term outcome data are lacking. The authors systematically identified preoperative factors associated with extent of resection (EOR) and determined the relationship between EOR and long-term recurrence after EEA for SSMs.METHODSIn this retrospective cohort study, the authors identified preoperative clinical and imaging characteristics associated with EOR and built on the recently published University of California, San Francisco resectability score to propose a score more specific to the EEA. They then examined the relationship between gross-total resection (GTR; 100%), near-total resection (NTR; 95%–99%), and subtotal resection (STR; < 95%) and recurrence or progression with Kaplan-Meier survival analysis.RESULTSA total of 51 patients were identified. Radiographic GTR was achieved in 40 of 47 (85%) patients in whom it was the surgical goal. Significant independent risk factors for incomplete resection were prior surgery (OR 25.94, 95% CI < 2.00 to 336.49, p = 0.013); tumor lateral to the optic nerve (OR 13.41, 95% CI 1.82–98.99, p = 0.011); and complete internal carotid artery (ICA) encasement (OR 15.12, 95% CI 1.17–194.08, p = 0.037). Tumor size and optic canal invasion were not significant risk factors after adjustment for other variables. A resectability score based on the multivariable model successfully predicted the likelihood of GTR; a score of 0 had a positive predictive value of 97% for GTR, whereas a score of 2 had a negative predictive value of 87.5% for incomplete resection. After a mean follow-up of 40.6 ± 32.4 months (mean ± SD), recurrence was 2.7% after GTR (1 patient with atypical histology), 44.4% after NTR, and 80% after STR (p < 0.0001). Vision was stable or improved in 93.5% and improved in 67.4% of patients with a preoperative deficit. There were 5 (9.8%) postoperative CSF leaks, of which 4 were managed with lumbar drains and 1 required a reoperation.CONCLUSIONSThe EEA is a safe and effective approach to SSMs, with favorable visual outcomes in well-selected cases. The combination of postoperative MRI-based EOR with direct endoscopic inspection can be used in lieu of Simpson grade to predict recurrence. GTR dramatically reduces recurrence and can be achieved regardless of tumor size, proximity or encasement of the anterior cerebral artery, or medial optic canal invasion. Risk factors for incomplete resection include prior surgery, tumor lateral to the optic nerve, and complete ICA encasement.

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Non-Surgical and Non-Radioiodine Techniques for Ablation of Benign Thyroid Nodules: Consensus Statement and Recommendation

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-1075-2025 ◽

2020 ◽

Vol 128 (10) ◽

pp. 687-692 ◽

Cited By ~ 3

Author(s):

Joachim Feldkamp ◽

F. Grünwald ◽

Markus Luster ◽

Kerstin Lorenz ◽

Christian Vorländer ◽

...

Keyword(s):

Thyroid Nodules ◽

Consensus Statement ◽

German Society ◽

Outcome Data ◽

High Frequency Ultrasound ◽

Term Outcome ◽

Long Term Outcome ◽

Ultrasound Ablation ◽

General And Visceral Surgery

AbstractThyroid nodules and cysts are frequently diagnosed in Germany with a prevalence of about 20% in young adults reaching up to 70% in older adults. Surgery is the standard treatment of symptomatic nodules, nodules with suspicion of malignancy and thyroid cancer. Radioiodine treatment is applied for autonomously functioning nodules. During the last years new non-surgical and non-radioiodine techniques have been introduced to treat thyroid nodules. These techniques include ethanol/polidocanol treatment, radiofrequency, microwave, and laser ablation, and high frequency ultrasound ablation. A significant reduction in nodule size could be documented for these techniques in several studies, but long-term outcome data are missing. Until now, there is no general consensus regarding the appropriate indications for these methods. For this reason, the Thyroid Section (German Society for Endocrinology), the Thyroid Working Committee (German Society for Nuclear Medicine), and the German Association of Endocrine Surgeons (CAEK) for the German Society of General and Visceral Surgery (DGAV) reviewed the respective literature, discussed the pro and cons and developed a consensus statement and recommendation to help physicians and patients in their decision making.

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Long-term outcome of children undergoing surgery for suspected perilymph fistula

The Journal of Laryngology & Otology ◽

10.1017/s0022215108003046 ◽

2008 ◽

Vol 123 (3) ◽

pp. 298-302 ◽

Cited By ~ 2

Author(s):

R J Sim ◽

A H Jardine ◽

E J Beckenham

Keyword(s):

Hearing Loss ◽

Case Series ◽

Outcome Data ◽

Rank Test ◽

Short Term ◽

Term Outcome ◽

Long Term Outcome ◽

Signed Rank ◽

Signed Rank Test

AbstractA number of authors have suggested that surgery for suspected perilymph fistula is effective in preventing deterioration of hearing and in improving hearing in some cases in the short term. We present long-term hearing outcome data from 35 children who underwent exploration for presumed perilymph fistula at The Children's Hospital, Sydney, Australia, between 1985 and 1992.Methods:The pre-operative audiological data (mean of 500, 1000, 2000 and 4000 Hz results) were compared with the most recently available data (range two to 15 years) and the six-month post-operative data.Results:The short-term results showed no significant change in hearing at six months, with a subsequent, statistically significant progression of hearing loss in both operated and non-operated ears (Wilcoxon signed rank test: operated ear, p < 0.017; non-operated ear, p < 0.009).Conclusion:In this case series, exploratory surgery for correction of suspected perilymph fistula did not prevent progression of long-term hearing loss.

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P146 Disease progression in del (5q) MDS patients treated with lenalidomide: analysis of risk factors and long-term outcome in 44 patients

Leukemia Research ◽

10.1016/s0145-2126(07)70216-3 ◽

2007 ◽

Vol 31 ◽

pp. S120-S121

Author(s):

A.A.N. Giagounidis ◽

S. Haase ◽

V. Lohrbacher ◽

M. Heinsch ◽

B. Schuran ◽

...

Keyword(s):

Risk Factors ◽

Disease Progression ◽

Term Outcome ◽

Long Term Outcome

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Menstrual, Sexual, and Obstetrical Outcomes after Vaginal Replacement for Vaginal Atresia Associated with Anorectal Malformation

European Journal of Pediatric Surgery ◽

10.1055/s-0036-1593610 ◽

2016 ◽

Vol 27 (06) ◽

pp. 495-502 ◽

Cited By ~ 6

Author(s):

Clare Skerritt ◽

Alejandra Vilanova Sánchez ◽

Victoria Lane ◽

Richard Wood ◽

Geri Hewitt ◽

...

Keyword(s):

Anorectal Malformation ◽

Outcome Data ◽

Current Evidence ◽

Vaginal Agenesis ◽

Vaginal Reconstruction ◽

Term Outcome ◽

Long Term Outcome ◽

Vaginal Atresia ◽

Rectovestibular Fistula

Background The authors of this article became aware of significant differences in the management of two females with a rectovestibular fistula and associated vaginal agenesis. In one patient, a sigmoid colovaginoplasty was performed at the time of the posterior sagittal anorectoplasty (PSARP), and the other underwent repair of the rectovestibular fistula with a primary PSARP, but the surgeons elected to delay the timing of vaginal reconstruction. We decided to review the literature, to establish if recommendations could be made to optimize the management of these children based on current evidence. Methods A literature review was conducted to determine the management and long-term outcomes in patients with an anorectal malformation and associated vaginal atresia. Specific gynecological outcomes assessed were menstrual egress and adequacy of the vaginal replacement for penile–vaginal intercourse. Results Eighty-eight cases were included in the review. Age at diagnosis had a bimodal distribution: 0 to 5 years, 56%; >10 years, 37%. Vaginal atresia was recognized before the operation in 45 patients. Types of vaginal atresia encountered were: (a) distal vaginal atresia (n = 17), (b) vaginal agenesis with absent Mullerian development (n = 47), (c) vaginal agenesis with variable Mullerian development (n = 17), and (d) cervico-vaginal agenesis (n = 7). Types of vaginal replacement used were sigmoid colovaginoplasty (n = 26), distal rectal fistula as neovagina (n = 30), terminal ileum (n = 5), vaginal pull-through (n = 9), and others/unknown (n = 8). Two patients followed a perineal dilatation program and nine patients await reconstruction. Median follow-up was 18 months (6 weeks to 31 years). Long-term menstrual outcomes were reported in 18 (21%) patients. Sexual function was reported in 10 (11%) patients. Three pregnancies were reported but none resulted in live births. Conclusion Vaginal atresia is often missed in association with ARMs. Management should be in collaboration with pediatric gynecologists. Due to a lack of long-term outcome data, no definite conclusion can be drawn for the best technique, tissue, or timing of vaginal replacement. The opportunity to perform vaginal replacement in conjunction with the rectal repair may be worth considering because of a shallower pelvis, nonscarred tissue planes, and the excellent surgical exposure.

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Long-term outcome of seizure-free patients and risk factors of relapse following antiepileptic drug withdrawal

Epilepsy & Behavior ◽

10.1016/j.yebeh.2018.09.028 ◽

2018 ◽

Vol 88 ◽

pp. 295-300 ◽

Cited By ~ 1

Author(s):

Shuchun Ou ◽

Lu Xia ◽

Rong Li ◽

Li Wang ◽

Li Xia ◽

...

Keyword(s):

Risk Factors ◽

Antiepileptic Drug ◽

Drug Withdrawal ◽

Term Outcome ◽

Long Term Outcome ◽

Antiepileptic Drug Withdrawal

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Predictors for the Immediate and Long-Term Outcome of Avascular Surgical Procedure

Scandinavian Journal of Surgery ◽

10.1177/145749690909800307 ◽

2009 ◽

Vol 98 (3) ◽

pp. 164-168 ◽

Cited By ~ 4

Author(s):

J. Virkkunen ◽

M. Venermo ◽

J. Saarinen ◽

J. Salenius

Keyword(s):

Risk Factors ◽

Risk Factor ◽

High Risk ◽

Predictive Value ◽

Surgical Procedure ◽

Operative Mortality ◽

Survival Rates ◽

Term Outcome ◽

Long Term Outcome

Background and Aims: The ability to predict post-operative mortality reliably will be of assistance in making decisions concerning the treatment of an individual patient. The aim of this study was to test the GAS score as a predictor of post-operative mortality in vascular surgical patients. Material and Methods: A total of 157 consecutive patients who underwent an elective vascular surgical procedure were included in the study. The Cox proportional hazards model was used in analyzing the importance of various preoperative risk factors for the postoperative outcome. ASA and GAS were tested in predicting the short and long-term outcome. On the basis of the GAS cut-off value 77, patients were selected into low-risk (GAS low: GAS < 77) and high-risk (GAS high: GAS > = 77) groups, and the examined risk factors were analyzed to determine which of them had predictive value for the prognosis. Results: None of the patients in the GAS low group died, and mortality in the GAS high group was 4.8% (p = 0.03) at 30 days' follow-up. The 12-month survival rates were 98.6% and 78.6% (p = 0.0001), respectively, with the respective 5-year survival rates of 76.7% and 44.0% (p = 0.0001). The only independent risk factor for 30-day mortality was the renal risk factor (OR 20.2). The combination of all three GAS variables(chronic renal failure, cardiac disease and cerebrovascular disease), excluding age, was associated with a 100% two-year mortality. Conclusions: Mortality is low for patients with GAS<77. For the high-risk patients (GAS> = 77), due to its low predictive value for death, GAS yields limited value in clinical practice. In cases of patients with all three risk factors (renal, cardiac and cerebrovascular), vascular surgery should be considered very carefully.

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