Endoscope-assisted microsurgical repair in trigeminal meningocele: case report

2021 ◽  
pp. 1-6
Author(s):  
Takaya Yasuda ◽  
Yoshitaka Kurosaki ◽  
Ryota Ishibashi ◽  
Kensuke Takada ◽  
Masaki Chin
Keyword(s):  
Check Valve ◽  
Effective Strategy ◽  
Recurrent Meningitis ◽  
Recurrence Rates ◽  
Prepontine Cistern ◽  
Anterior Transpetrosal Approach ◽  
Direct View ◽  
Cystic Cavity ◽  
History Of ◽  
Tailored Approach

Trigeminal meningocele is a rare disease that results in rhinorrhea. Treatments with endoscopic approaches and open craniotomies have high recurrence rates, and controversy regarding the most effective surgical strategy for trigeminal meningocele is ongoing. The authors report a case of a 13-year-old female patient with a diagnosis of trigeminal meningocele determined after she presented with a history of intermittent headaches, suspected rhinorrhea, and recurrent meningitis. In addition to the conventional method of covering the efflux point of CSF and filling the inside of the meningocele with fascial tissues, the authors selectively closed the influx point of CSF from the prepontine cistern to the meningocele using an anterior transpetrosal approach. On the basis of the preoperative images, the authors hypothesized that the influx point of CSF could not be observed under the microscopic direct view and instead used a flexible endoscope. A check valve–like structure with one-way communication of CSF from the prepontine cistern into the cystic cavity was identified and was closed. At the time of this report, 36 months postoperatively, the patient had no indications of recurrence. Although cases of trigeminal meningoceles are infrequently encountered and require a tailored approach, the results in this case thus far indicate that the use of an endoscope and open craniotomy is an effective strategy for surgical treatment.

scholarly journals Spontaneous Cerebrospinal Fluid Leakage and Middle Ear Encephalocele in Seven Patients

2000 ◽  
Vol 79 (5) ◽  
pp. 372-378 ◽  
Author(s):  
Rakesh B. Patel ◽  
Jed A. Kwartler ◽  
Richard M. Hodosh ◽  
Soly Baredes
Keyword(s):  
Cerebrospinal Fluid ◽  
Hearing Loss ◽  
Middle Ear ◽  
Diagnostic Methods ◽  
Cerebrospinal Fluid Leakage ◽  
Recurrent Meningitis ◽  
Lumbar Drain ◽  
Csf Leakage ◽  
History Of ◽  
Conductive Hearing

Isolated cases of spontaneous cerebrospinal fluid (CSF) leakage with and without middle ear encephalocele have been reported. These leaks are usually accompanied by episodes of recurrent meningitis, hearing loss, or chronic headache. In this article, we report seven new cases of spontaneous CSF leakage. Six of these patients had conductive hearing loss and serous otitis media, and three had recurrent meningitis. Prior to a definitive diagnosis, six patients had received myringotomy tubes, which produced profuse clear otorrhea. Three patients had positive beta-2 transferrin assays. Computed tomography and magnetic resonance imaging confirmed a defect in the temporal bone tegmen. A combined transmastoid and middle fossa surgical approach with a three-layer closure was used to repair the tegmen defect. All patients had a lumbar drain placed prior to surgery. In addition to describing the seven new cases, we review the history of CSF leakage and discuss diagnostic methods, surgical findings, and our recommendations for management.

scholarly journals Risk for intravesical recurrence of bladder cancer stratified by the results on two consecutive UroVysion fluorescence in situ hybridization tests: a prospective follow-up study in Japan

2020 ◽  
Vol 25 (6) ◽  
pp. 1163-1169
Author(s):  
Atsushi Ikeda ◽  
Takahiro Kojima ◽  
Koji Kawai ◽  
Shiro Hinotsu ◽  
Naoto Keino ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Positive Result ◽  
Recurrence Rates ◽  
Follow Up Study ◽  
Negative Results ◽  
Negative Findings ◽  
History Of ◽  
Muscle Invasive ◽  
Positive Results

Abstract Background A previous comparative study in Japan has demonstrated that the two consecutive UroVysion tests are useful tools to detect the presence of bladder cancer during follow-up after transurethral resection, but they also presented their high rates of false-positive results. Here, we aimed to evaluate the relationship between the UroVysion tests and subsequent intravesical recurrence. Methods In the previous study, patients without bladder cancer during the first analysis showed the same examination set repeated 3 months later as the second analysis. In this follow-up study, 326 patients showed negative findings confirmed on cystoscopy during the second UroVysion test. Recurrence-free survival was assessed using a median follow-up of 27 months. Results In the two consecutive UroVysion tests, 214 patients (65.6%) showed negative UroVysion results in both tests, whereas 91 presented a positive result on either tests and 21 patients presented positive results in both tests. During the follow-up, 40 patients (12.3%) had an intravesical recurrence with non-muscle-invasive bladder cancer. The recurrence rates in patients with negative results in both tests, those with one positive result in either tests, and those with positive results in both tests were 8.4%, 16.5%, and 33.3%, respectively. The multivariate analysis indicated that the history of bladder cancer and the consecutive UroVysion test pattern were independent risk factors for recurrence. Conclusions Our data confirmed the effectiveness of two consecutive UroVysion tests in predicting intravesical recurrence after TURBT. Further prospective studies would help determine an appropriate interval for cystoscopy follow-up.

scholarly journals The Middle Fossa Approach for the Removal of a Trochlear Schwannoma

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Andrew B. Boucher ◽  
L. Madison Michael
Keyword(s):  
Nerve Palsy ◽  
Brain Magnetic Resonance Imaging ◽  
Complete Removal ◽  
Pathological Examination ◽  
Trochlear Nerve ◽  
Middle Fossa Approach ◽  
Anterior Transpetrosal Approach ◽  
History Of ◽  
The Right ◽  
Fourth Nerve Palsy

Objectives. Schwannomas originating from the trochlear nerve are extremely rare; only 30 cases have been reported in the literature. Many operative approaches have been utilized for lesion resection, but the advantages of the anterior transpetrosal approach are numerous and include excellent exposure, minimal extradural retraction of the temporal lobe, and minimal cerebrospinal fluid leaks. We report the second case of a trochlear schwannoma resected via the anterior transpetrosal approach.Setting. A 64-year-old male presented with 3-month history of diplopia and headaches. On physical examination, he was found to have a right fourth nerve palsy. Brain magnetic resonance imaging revealed a mass within the right ambient cistern compressing the adjacent midbrain. A right-sided anterior transpetrosal approach was used—which confirmed that the trochlear nerve entered the mass—to achieve gross total resection. Pathological examination confirmed diagnosis of schwannoma. The patient was discharged on postoperative day 3. He experienced a persistent fourth nerve palsy postoperatively with an otherwise normal neurological examination. Follow-up imaging confirmed complete removal of the tumor.Conclusion. The anterior transpetrosal approach is an excellent approach for removal of trochlear schwannomas involving the cisternal course of the trochlear nerve. It affords complete visualization of this anatomical region while introducing minimal morbidity.

Low back pain – literature review

Ból ◽  
2020 ◽  
Vol 20 (3) ◽  
pp. 51-59
Author(s):  
Marcin Kopka
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Intervertebral Discs ◽  
Prior History ◽  
Low Back ◽  
Red Flags ◽  
Recurrence Rates ◽  
Reduction Of Pain ◽  
History Of ◽  
Optimal Visualization

Low back pain (LBP) is the third most common disorder presenting in the neurology outpatient clinic. It is usually defined as acute (less than 4 weeks), subacute (4–8 weeks) and chronic (more than 12 weeks). It is estimated that lifetime prevalence of up to 84 %. LBP is the most common cause of disability. LBP is divided into musculoskeletal and neurologic low back pain. In 90% of patients under the age of 65 the cause of pain is nerve root compression caused by disk herniation. Although serious spinal pathology is rare (less than 1%), the identification of red flags remains key in the evaluation of patients with LBP. A prior history of cancer, even in the absence of other red flags, has the highest predictive value for detection of malignancy. In conjunction with the history, a careful neurologic examination can help establish the presence and localize the lesion. According to guidelines imaging studies should not be obtained in patients with LBP of less than 6 weeks duration in the absence of red flags. Magnetic resonance imaging is the study of choice in patients with LBP. It allows for optimal visualization of the spinal cord, nerve roots and intervertebral discs. The results of MRI should be interpreted with caution because incidental degenerative spine changes unrelated to the pain are commonly seen in MRI. The main goals of treatment the patients presenting with acute LBP are reduction of pain and preservation of sensory and motor function. In the absence of red flags, for most cases conservative management will be appropriate. Prognosis are favorable, although recurrence rates range from 23% to 80%.

scholarly journals Radiation-induced meningioma

2008 ◽  
Vol 24 (5) ◽  
pp. E7 ◽  
Author(s):  
Felix Umansky ◽  
Yigal Shoshan ◽  
Guy Rosenthal ◽  
Shifra Fraifeld ◽  
Sergey Spektor
Keyword(s):  
Neural Tissue ◽  
Primary Brain Tumor ◽  
X Rays ◽  
Recurrence Rates ◽  
Central Nervous System Neoplasms ◽  
History Of ◽  
Radiation Induced ◽  
High Doses ◽  
Nervous System Neoplasms

✓ The long-term or delayed side effects of irradiation on neural tissue are now known to include the induction of new central nervous system neoplasms. However, during the first half of the 20th century, human neural tissue was generally considered relatively resistant to the carcinogenic and other ill effects of ionizing radiation. As a result, exposure to relatively high doses of x-rays from diagnostic examinations and therapeutic treatment was common. In the present article the authors review the literature relating to radiation-induced meningiomas (RIMs). Emphasis is placed on meningiomas resulting from childhood treatment for primary brain tumor or tinea capitis, exposure to dental x-rays, and exposure to atomic explosions in Hiroshima and Nagasaki. The incidence and natural history of RIMs following exposure to high- and low-dose radiation is presented, including latency, multiplicity, histopathological features, and recurrence rates. The authors review the typical presentation of patients with RIMs and discuss unique aspects of the surgical management of these tumors compared with sporadic meningioma, based on their clinical experience in treating these lesions.

scholarly journals Russia’s Digital Economy Program: An Effective Strategy for Digital Transformation?

2020 ◽  
pp. 53-75
Author(s):  
Anna Lowry
Keyword(s):  
Decision Making ◽  
Russian Federation ◽  
Digital Economy ◽  
Digital Transformation ◽  
Effective Strategy ◽  
Subsequent Transformation ◽  
Design And Implementation ◽  
History Of ◽  
The Russian Federation ◽  
Constructive Criticism

AbstractThis chapter focuses on the state program “Digital Economy of the Russian Federation” (2017) and its subsequent transformation into the national project (2018) to be implemented from 2018 to 2024. It examines the effectiveness of the government’s strategy in this area and provides an analysis of the program’s content in terms of its main objectives and mechanisms of implementation, drawing on the constructive criticism of the program in the literature. It also reviews the history of the development of the program, main actors involved in its design and implementation, and the nature of the decision-making process.

Watchful Waiting for Ventral Hernias: A Longitudinal Study

2014 ◽  
Vol 80 (3) ◽  
pp. 245-252 ◽  
Author(s):  
Charles F. Bellows ◽  
Celia Robinson ◽  
Robert J. Fitzgibbons ◽  
Larry S. Webber ◽  
David H. Berger
Keyword(s):  
Natural History ◽  
Repeated Measures ◽  
Watchful Waiting ◽  
Recurrence Rates ◽  
Safe Option ◽  
Sf 36 ◽  
History Of ◽  
The Mean ◽  
Ventral Hernias

Ventral hernias are a common clinical problem. Immediate repair is recommended for most ventral hernias despite significant recurrence rates. This practice may be related to a lack of understanding of the natural history of ventral hernias. The purpose of this study was to determine the natural history of ventral hernias and to determine if watchful waiting is an acceptable and safe option. Forty-one patients with ventral hernias were enrolled in a longitudinal cohort study of watchful waiting. Primary outcomes were functional impairment resulting from hernia disease as measured by the Activities Assessment Scale (AAS) and changes from baseline to two years in the physical and mental component score of the SF-36 Health Survey. Secondary outcomes included complications such as incarceration. Mixed-effects model for repeated measures and Student's t tests were used to evaluate scale performance. The mean age of enrollees was 64 years, and the mean hernia size was 239 cm2. Eleven patients were lost to follow-up, and seven patients died of other causes. All remaining patients were followed for two years. There was one incarceration during the follow-up period. There was no deterioration in the AAS score (baseline vs 24 months = 28 vs 25, P = 0.60). There was deterioration of the physical functioning dimension of the SF-36 (baseline vs 24 months = 40 vs 32, P < 0.01), but the mental functioning dimension was improved (45 vs 51; P = 0.01). Watchful waiting was a safe option for patients in this study with ventral hernias.

Health disparity in Central Valley of California: Higher incidence of breast cancer in Asian population.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19029-e19029
Author(s):  
Soujanya Sodavarapu ◽  
Kate Hatter ◽  
Megha Goyal ◽  
Prakash Ramdass ◽  
Majed Sayedi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Socioeconomic Status ◽  
African American ◽  
Ductal Carcinoma ◽  
Central Valley ◽  
Asian Population ◽  
Foreign Born ◽  
Recurrence Rates ◽  
History Of ◽  
The Impact

e19029 Background: California has the most immigrants of any state in the U.S., with approximately a quarter of the residents being foreign-born. The impact of migration on breast cancer incidences over time has not yet been characterized in the Northern Central Valley. This provides a unique opportunity to study the influence of migration, socioeconomic gradient, and racial identity on the incidence of breast cancer in San Joaquin County. Methods: This study was a retrospective, single-institution study that compared the socio-demographic variables and clinical characteristics of the patients who had a history of breast cancer in a teaching central valley hospital. We reviewed all charts with a breast cancer diagnosis from 2014-2019. We compared age, demographics, socioeconomic status comorbidities, pathology, treatment, and outcomes. Appropriate statistics have been used to analyze the data. Results: A retrospective chart review of all patients with a diagnosis of breast cancer from 2014-2019 at a central valley teaching hospital. 33.5% were white, 17.2% African American, 26.6% Hispanic, and 22.6% were Asian. Migrated Asian women are having three times increased incidence in central California compared to their peers in Asian. Additionally, those of lower socioeconomic status were more often affected (61.9% vs. 30.4% of middle-class status) in our population. Demographics and comorbidities were studied. Smoking was seen in 23.2% of patients, alcohol in 16.3%, hypertension in 43.6%, Diabetes in 18.9%, lung disease in 11.7%, and Kidney disease in 6.9%. 23.8% of the patients had a family history of cancer. Screening was only done in 41% of patients, and the distribution of race was as follows: white 10.6%, African American 7.7%, Hispanic 8.9%, Asian 8.9%. It was found that infiltrating ductal carcinoma was seen in 54.8% of patients, of which 16.1% were white, 10% African American, 15.5% Hispanic, and 13.2% were Asian. Triple-negative breast cancer was seen in 14.9% in our patient population. We further reviewed treatment methods, including chemotherapy, radiation, and surgery, as well as recurrence rates. Conclusions: We suggest that screening has to be more concentrated in all communities. The fact that the Asian population in the Central Valley shows higher rates of breast cancer could be due to epigenetic, western lifestyle, and environmental factors. Higher awareness and willingness as a subgroup may be contributing as well or there may be an actual increase; this requires further investigation, and we will present further subgroup analysis at presentation.

scholarly journals A Comparative Study of Chronic Subdural Hematoma in Patients With and Without Head Trauma: A Retrospective Cross Sectional Study

2020 ◽  
Vol 11 ◽  
Author(s):  
Yunwei Ou ◽  
Xiaofan Yu ◽  
Xiaojuan Liu ◽  
Qian Jing ◽  
Baiyun Liu ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Head Trauma ◽  
Clinical Characteristics ◽  
Linear Regression Analysis ◽  
Chronic Subdural Hematoma ◽  
Recurrence Rates ◽  
Similar Treatment ◽  
Number Of Patients ◽  
History Of ◽  
Trauma Group

Background: The clinical features of chronic subdural hematomas (CSDHs) in patients with and without a history of head trauma have remained unclear. Here, we investigated differences in clinical characteristics in CSDH patients with and without head trauma.Methods: We retrospectively collected clinical characteristics of CSDH patients who had undergone exhaustive drainage strategies via burr-hole craniostomies from August 2011 to May 2019. We divided patients into a trauma group (i.e., head trauma) and a no-trauma group. Chi-square tests or t-tests were used to analyze differences in clinical characteristics between the two groups. Multiple linear regression analysis was performed to analyze the relationships between the clinical characteristics and either reduction of the hematoma cavity or length of the hospital stay in CSDH patients with trauma.Results: We collected data from 1,307 CSDH patients, among whom 805 patients had a history of head trauma whereas 502 patients did not. The mean age of patients with head trauma was 64.0 ± 16.1 years, while that of patients without head trauma was significantly younger at 61.5 ± 17.9 years (p = 0.010). Furthermore, more patients in the no-trauma group had a history of hypertension compared to those in the trauma group (40.2 vs. 32.9%, p = 0.007). Dizziness occurred in 29.2% of patients with trauma and in 23.1% of patients without trauma (p = 0.016). A greater number of patients with trauma showed a reduction of hematoma cavity after surgery compared to that of patients without trauma (p = 0.002). The length of hospital stay in patients with trauma was 7.9 ± 4.5 days, which was longer than that of patients without trauma (7.3 ± 3.7 days, p = 0.016). In contrast, there were no significant different differences between the two groups in terms of the densities of hematomas on computed-tomography scans, complications, mortality rates, recurrence rates, or outcomes.Conclusion: Our findings indicate that there were some noteworthy differences in the clinical and pathogenic characteristics of CSDH patients with and without head trauma. However, our findings also indicate that if an optimal treatment method is employed, such as our exhaustive drainage strategy, similar treatment outcomes can be achieved between these groups.

scholarly journals Dermoid Cyst of the Prepontine Cistern and Meckel's Cave: Illustrative Case and Systematic Review

2017 ◽  
Vol 79 (02) ◽  
pp. 139-150 ◽  
Author(s):  
Lawrance Chung ◽  
Carlito Lagman ◽  
Courtney Duong ◽  
Daniel Nagasawa ◽  
Alexander Tucker ◽  
...  
Keyword(s):  
Systematic Review ◽  
Dermoid Cyst ◽  
Surgical Excision ◽  
Extent Of Resection ◽  
Symptom Improvement ◽  
Illustrative Case ◽  
Recurrence Rates ◽  
Prepontine Cistern ◽  
Presenting Symptoms ◽  
Visual Disturbances

Objective Dermoid cysts are benign, congenital malformations that account for ∼0.5% of intracranial neoplasms. The authors describe a 42-year-old female with a prepontine dermoid cyst who underwent apparent gross total resection (GTR) but experienced cyst recurrence. To date, very few cases of prepontine dermoid cysts have been reported. The prevalent region where these cysts are located can be difficult to determine. In addition, the authors systematically review the literature to characterize the clinical presentation, anatomical distribution, and surgical outcomes of intracranial dermoid cysts. Design Systematic review. Setting/Participants PubMed, Web of Science, and Scopus databases. Main Outcome Measures Extent of resection, symptom improvement, and recurrence rates. Results A total of 69 patients with intracranial dermoid cysts were identified. Three (4.3%) intracranial dermoid cysts were located in the prepontine cistern. The average age of patients was 33.3 years. The most common presenting symptoms were headache (52.2%) and visual disturbances (33.3%). Intracranial dermoid cysts were distributed similarly throughout the anterior, middle, and posterior cranial fossae (29.0%, 36.2%, and 29.0%, respectively). GTR was achieved in 42.0% of cases. Thirty-four (49.3%) patients experienced symptom resolution. Recurrence rate was 5.8% at a mean follow-up of 2.1 years. Conclusions Intracranial dermoid cysts most often present as headaches and visual disturbances. Intracranial dermoid cysts were found in the anterior, middle, and posterior cranial fossae at similar frequencies but with clear predilections for the Sylvian fissure, sellar region, and cerebellar vermis. Outcomes following surgical excision of intracranial dermoid cysts are generally favorable despite moderate rates of GTR.

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