Surgical management of quadrigeminal cistern arachnoid cysts: case series and literature review

2022 ◽  
pp. 1-8
Keyword(s):  
Literature Review ◽  
Initial Treatment ◽  
Case Series ◽  
Arachnoid Cysts ◽  
Third Ventriculostomy ◽  
Inclusion Criteria ◽  
Radiographic Findings ◽  
Quadrigeminal Cistern ◽  
Endoscopic Fenestration

OBJECTIVE Quadrigeminal cistern arachnoid cysts (QACs) are congenital lesions that can cause pineal region compression and obstructive hydrocephalus when sufficiently large. Management of these cysts is controversial and rates of reintervention are high. Given the limited data on the management of QACs, the authors retrospectively reviewed 20 years of cases managed at their institution and performed a literature review on this topic. METHODS The authors performed a retrospective analysis of patients treated for QAC at their institution between 2001 and 2021. They also performed a literature review of studies published between 1980 and 2021 that reported at least 5 patients treated for QACs. Patient characteristics, radiographic findings, management course, and postoperative follow-up data were collected and analyzed. RESULTS A total of 12 patients treated for a QAC at the authors’ institution met the inclusion criteria for analysis. Median age was 9 months, mean cyst size was 5.1 cm, and 83% of patients had hydrocephalus. Initial treatment was endoscopic fenestration in 92% of these patients, 27% of whom had an endoscopic third ventriculostomy (ETV) performed concurrently. Reintervention was required in 42% of patients. Cases that required reintervention had a statistically significant lower median age at the initial intervention (5 months) than the cases that did not require reintervention (24.33 months; p = 0.018). There were no major complications. At a mean follow-up of 5.42 years, 83% of patients had improvement or resolution of their symptoms. A literature review revealed 7 studies that met the inclusion criteria, totaling 108 patients with a mean age of 8.8 years. Eighty-seven percent of patients had hydrocephalus at presentation. Ninety-two percent of patients were initially treated with endoscopic fenestration, 44% of whom underwent concurrent ETV. Complications occurred in 17.6% of cases, and reintervention was required in 30.6% of cases. The most frequent reason for reintervention was untreated or unresolved hydrocephalus after the initial procedure. CONCLUSIONS Endoscopic fenestration is the most common treatment for QACs. While generally safe and effective, there is a high rate of reintervention after initial treatment of QACs, which may be associated with a younger age at the first intervention. Additionally, identifying patients who require initial treatment of hydrocephalus is critically important, as the literature suggests that untreated hydrocephalus is a common cause of reintervention.

Plafond Malreduction and Talar Dome Impaction Accelerates Arthrosis After Supination-Adduction Ankle Fracture

2021 ◽  
pp. 107110072110060
Author(s):  
Michael F. Githens ◽  
Malcolm R. DeBaun ◽  
Kimberly A Jacobsen ◽  
Hunter Ross ◽  
Reza Firoozabadi ◽  
...  
Keyword(s):  
Case Series ◽  
High Energy ◽  
Ankle Fractures ◽  
Posttraumatic Arthritis ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Radiographic Findings ◽  
Posttraumatic Arthrosis ◽  
Patient Reported

Background: Supination-adduction (SAD) type II ankle fractures can have medial tibial plafond and talar body impaction. Factors associated with the development of posttraumatic arthritis can be intrinsic to the injury pattern or mitigated by the surgeon. We hypothesize that plafond malreducton and talar body impaction is associated with early posttraumatic arthrosis. Methods: A retrospective cohort of skeletally mature patients with SAD ankle fractures at 2 level 1 academic trauma centers who underwent operative fixation were identified. Patients with a minimum of 1-year follow-up were included. The presence of articular impaction identified on CT scan was recorded and the quality of reduction on final intraoperative radiographs was assessed. The primary outcome was radiographic ankle arthrosis (Kellgren-Lawrence 3 or 4), and postoperative complications were documented. Results: A total of 175 SAD ankle fractures were identified during a 10-year period; 79 patients with 1-year follow-up met inclusion criteria. The majority of injuries resulted from a high-energy mechanism. Articular impaction was present in 73% of injuries, and 23% of all patients had radiographic arthrosis (Kellgren-Lawrence 3 or 4) at final follow-up. Articular malreduction, defined by either a gap or step >2 mm, was significantly associated with development of arthrosis. Early treatment failure, infection, and nonunion was rare in this series. Conclusion: Malreduction of articular impaction in SAD ankle fractures is associated with early posttraumatic arthrosis. Recognition and anatomic restoration with stable fixation of articular impaction appears to mitigate risk of posttraumatic arthrosis. Investigations correlating postoperative and long-term radiographic findings to patient-reported outcomes after operative treatment of SAD ankle fractures are warranted. Level of Evidence: Level IV, retrospective case series.

scholarly journals Failed Latarjet procedure: a systematic review of surgery revision options

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Matteo Buda ◽  
Riccardo D’Ambrosi ◽  
Enrico Bellato ◽  
Davide Blonna ◽  
Alessandro Cappellari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Case Series ◽  
Review Of The Literature ◽  
Inclusion Criteria ◽  
Latarjet Procedure ◽  
Shoulder Stabilization ◽  
Recurrent Instability ◽  
Level Of Evidence ◽  
Radiographic Outcomes

Abstract Background Revision surgery after the Latarjet procedure is a rare and challenging surgical problem, and various bony or capsular procedures have been proposed. This systematic review examines clinical and radiographic outcomes of different procedures for treating persistent pain or recurrent instability after a Latarjet procedure. Methods A systematic review of the literature was performed using the Medline, Cochrane, EMBASE, Google Scholar and Ovid databases with the combined keywords “failed”, “failure”, “revision”, “Latarjet”, “shoulder stabilization” and “shoulder instability” to identify articles published in English that deal with failed Latarjet procedures. Results A total of 11 studies (five retrospective and six case series investigations), all published between 2008 and 2020, fulfilled our inclusion criteria. For the study, 253 patients (254 shoulders, 79.8% male) with a mean age of 29.6 years (range: 16–54 years) were reviewed at an average follow-up of 51.5 months (range: 24–208 months). Conclusions Eden–Hybinette and arthroscopic capsuloplasty are the most popular and safe procedures to treat recurrent instability after a failed Latarjet procedure, and yield reasonable clinical outcomes. A bone graft procedure and capsuloplasty were proposed but there was no clear consensus on their efficacy and indication. Level of evidence Level IV Trial registration PROSPERO 2020 CRD42020185090—www.crd.york.ac.uk/prospero/

scholarly journals Sinus Floor Augmentation—Associated Surgical Ciliated Cysts: Case Series and a Systematic Review of the Literature

2021 ◽  
Vol 11 (4) ◽  
pp. 1903
Author(s):  
Adrian Kahn ◽  
Shlomo Matalon ◽  
Rahaf Bassam Salem ◽  
Lazar Kats ◽  
Liat Chaushu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Microscopic Examination ◽  
Literature Search ◽  
Case Series ◽  
Systematic Literature Search ◽  
Review Of The Literature ◽  
Inclusion Criteria ◽  
Sinus Floor Augmentation ◽  
Sinus Floor

This study aimed to characterize the demographic and clinical features of underreported surgical ciliated cysts developing after sinus floor augmentation, based on a series of cases from our files and a systematic review of the literature. A series of five cases (four patients) of microscopically confirmed surgical ciliated cysts following sinus floor augmentation procedures from our files are described. A systematic literature search (1991–2020) with strict clinical-, radiological- and microscopic-based exclusion and inclusion criteria was performed to detect additional similar cases. The systematic review revealed only five cases that fulfilled the inclusion criteria. Altogether, surgical ciliated cysts associated with sinus floor augmentation have been rarely reported in the literature, and have not been characterized either demographically or clinically. Graft materials were diverse, implants were placed simultaneously, or up to two years post-augmentation. The associated surgical ciliated cysts developed between 0.5 and 10 years post-augmentation. Although limited in its extent, this study is the first series to characterize possible underreported sequelae of surgical ciliated cysts associated with sinus floor augmentation. It emphasizes the need for long post-operative follow-up and confirmation of lesion by microscopic examination.

scholarly journals Tubularized proximally-incised plate in distal/midshaft hypospadias repair

2017 ◽  
Vol 39 (2) ◽  
Author(s):  
Antonio Marte ◽  
Lucia Pintozzi
Keyword(s):  
Perioperative Complications ◽  
Foley Catheter ◽  
Case Series ◽  
Functional Results ◽  
Inclusion Criteria ◽  
Urethral Plate ◽  
Age At Surgery ◽  
Long Term Follow Up

The aim of this study was to verify the validity, feasibility, and the functional results, by uroflowmetry, of Tubularized proximallyincised plate technique in selected case of distal/midshaft hypospadias. Out of 120 patients scheduled to undergo TIP (or Snodgrass) procedure, 23 were selected between January 2013 and January 2016 (19.1%). This case series comprised 16 patients with distal and 7 with midshaft hypospadias. Mean age at surgery was 2.9 years. The inclusion criteria were a deep and wide glandular groove and a proximal narrow urethral plate. The procedure was carried out as described by Snodgrass but the incision of the urethral plate, including the mucosal and submucosal tissue, was made only proximally, between the original meatus and the glandular groove in no case extending to the entire length of the plate. Postoperatively a foley catheter was left in place from 4 to 7 days. Uroflowmetry was performed when the patients age ranged from 2.5 to 5.7 years (mean age 3.11 years and mean follow-up 1.8 years, body surface 2). No patient presented fistulas nor perioperative complications. At uroflowmetry, eighteen patients presented values above the 25<sup>th</sup> percentile and 5 showed a borderline flow. All patients in this group remained stable without urinary symptoms. In selected cases, the tubularized proximally-incised plate yields satisfactory cosmetic and functional results for the treatment of midshaft proximal hypospadias. A long-term follow-up study is needed for further evaluation. Patient selection is crucial for the success of this technique.

scholarly journals Effect of Cataract Surgery on Intraocular Pressure in Glaucoma Patients

2020 ◽  
Vol 37 (1) ◽  
Author(s):  
Shua Azam ◽  
Abdul Hameed Talpur ◽  
Mahak Shaheen ◽  
Sadia Bukhari
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Angle Closure ◽  
Inclusion Criteria ◽  
Primary Angle Closure Glaucoma ◽  
Closed Angle ◽  
Operative Assessment

Purpose:  To determine the change in intraocular pressure after cataract surgery in patients diagnosed with glaucoma. Study Design:  Interventional case series. Place and Duration of Study:  Glaucoma Clinic. Al-Ibrahim Eye Hospital (AIEH) Karachi, Pakistan from May to October, 2019. Methods:  Thirty-eight patients diagnosed with glaucoma and cataract and registered in glaucoma clinic were recruited for this study. Inclusion Criteria was age > 41 years and patients diagnosed with primary open/closed angle glaucoma and cataract. Patients with secondary glaucoma, history of trabeculectomy and any other ocular diseases were excluded from the study. Pre-operative assessment was done for phacoemulsification. In post-operative examination, first and second follow-up IOP was measured. Data analysis was done on statistical package for social science (SPSS) version 20.0. Statistical changes were present in the form of bar chart, frequency and graphs. The mean standard deviation for pre-operative, post-operative 1st and 2nd follow-up IOP was calculated. Results:  A total of 38 participants and 48 eyes satisfied the inclusion criteria. Out of 48 eyes, 39 (81.3%) eyes were diagnosed with Primary open angle glaucoma and 9 (18.8%) eyes with Primary Angle Closure Glaucoma. The pre-operative mean IOP was 16.56 ± 6.67 mm Hg and post-operative mean IOP at first follow-up was 13.39 ± 4.04 mm Hg. At second follow-up at one-month mean IOP was 12.14 ± 2.28 mm Hg. Conclusion:  Phacoemulsification produces a useful decrease in IOP in glaucoma patients. Key Word:  Glaucoma, Cataract, Phacoemulsification, Intraocular Pressure.

scholarly journals Characterizing Flow and Structure of Diabetic Retinal Neovascularization after Intravitreal Anti-VEGF Using Optical Coherence Tomography Angiography: A Pilot Study

2021 ◽  
Vol 2021 ◽  
pp. 1-16
Author(s):  
Christof Haensli ◽  
Katrin Fasler ◽  
Daniel Barthelmes ◽  
Sandrine A. Zweifel
Keyword(s):  
Optical Coherence Tomography ◽  
Initial Treatment ◽  
Measurement Method ◽  
Optical Coherence Tomography Angiography ◽  
Case Series ◽  
Retinal Neovascularization ◽  
Flow Density ◽  
Optical Coherence ◽  
En Face

Background/Aims. This study evaluates changes of flow and structure of diabetic retinal neovascularization (NV) treated with intravitreal antivascular endothelial growth factor (VEGF) agents using optical coherence tomography angiography (OCTA). With OCTA, retinal blood vessels are visualized at high resolution to separately look at flow and structure information without the need for dye injection. We introduce a new measurement method including and combining information of flow and structure. Methods. Retrospective observational case series. Patients with proliferative diabetic retinopathy (PDR) were treated with intravitreal antiVEGF injections. Retinal NV were repeatedly imaged using swept-source OCTA (Zeiss PlexElite 9000) at baseline, after initial treatment block with 3-4 monthly injections, and during a follow-up period of up to 51 weeks. Change of size and flow density of the structural and angio area of NV was assessed. Results. Nine NV in eight eyes of five patients were analyzed with a median follow-up time of 45 weeks. After the initial treatment block, en face structural area regressed, 18.7% ± 39.0% (95% CI 44.2–6.8%, p = 0.26 ), and en face angio area regressed, 51.9% ± 29.5% (95% CI 32.6 to 71.2%, p = 0.007 ). Flow density within the en face structural area decreased by 33% ± 19.2% (95% CI 20.5–45.5%, p = 0.0077 ). Flow density within the en face angio area decreased by mean 17.9% ± 25.2% (95% CI 1.4–34.4%, p = 0.066 ). In two fellow eyes, NV recurrence could be observed before the onset of vitreous bleeding in one. Conclusion. Our study introduces a new quantitative measurement for NV in PDR, combining structure and flow measurement. The structure area remained after treatment, while its flow density and angio area regressed. We propose this measurement method as a more physiological and possibly more comparable metrics.

scholarly journals The use of videoconferencing in nursing for people in their homes

2018 ◽  
Author(s):  
Bente Nordtug ◽  
Hildfrid V. Brataas ◽  
Lisbeth Ø. Rygg
Keyword(s):  
Literature Review ◽  
Chronic Illnesses ◽  
Bibliographic Databases ◽  
Network Access ◽  
Inclusion Criteria ◽  
Nursing Service ◽  
Suitable Alternative ◽  
Support Person ◽  
Conventional Content Analysis

The aim of this literature review is to bring to the forefront knowledge about the suitability of videoconferencing in nursing for patients and their families living at home. A systematic literature review that included studies of videoconferencing in nursing care. Inclusion criteria were original studies relevant to concept of study. Computerized bibliographic databases (PubMed, CINAHL and PsycINFO) were searched from January 2008 to October 2016. In total, 325 articles were identified. Eight articles (1539 participants) met the inclusion criteria, and were finally included. The eight articles covered videoconferencing used in follow-up care for patients living in their homes after surgery, postpartum, chronic illnesses, families with premature infants, and children with cancer. A conventional content analysis was conducted. The results show that the success of videoconferencing depends on satisfying network access. Nurses as well as patients thought videoconferencing was similar to meeting in person. Videoconferencing seems to support person-centred nursing, promote selfmanagement and motivate patients and families to engage in their health. The use of videoconferencing requires further organization of the nursing practice. The study indicates that videoconferencing can be a suitable alternative to traditional nursing follow-up when network access and technology function properly and the nursing service is well organized. Videoconferencing seems to underpin person-centred nursing. Knowledge gaps identified, more research needed as bases for assessment of videoconferencing suitability in nursing for individual persons in different treatment situations.

scholarly journals Long-term outcomes of acromegaly treated with fractionated stereotactic radiation: case series and literature review

2017 ◽  
Vol 4 (4) ◽  
pp. 255-262
Author(s):  
Ryan Rhome ◽  
Isabelle M Germano ◽  
Ren-Dih Sheu ◽  
Sheryl Green
Keyword(s):  
Systematic Review ◽  
Literature Review ◽  
Case Series ◽  
Tumor Control ◽  
Pituitary Neoplasms ◽  
Review Of The Literature ◽  
Biochemical Control ◽  
Low Incidence

Abstract Background Growth hormone (GH)-secreting pituitary adenomas represent an uncommon subset of pituitary neoplasms. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) have been used as primary or adjuvant treatment. The purpose of this study is to report the long-term tumor control and toxicity from our institution and to perform a systematic literature review of acromegaly patients treated with FSRT. Methods We retrospectively reviewed all patients treated with FSRT (median dose 50.4 Gray [Gy], range 50.4–54 Gy) between 2005 and 2012 who had: 1) GH-secreting adenoma with persistently elevated insulin growth factor-1 (IGF-1) despite medical therapy and 2) clinical follow up >3 years after FSRT. Patients were treated with modern FSRT planning techniques. Biochemical control was defined as IGF-1 normalization. Systematic review of the literature was performed for FSRT in acromegaly. Results With a median follow-up of 80 months, radiographic control was achieved in all 11 patients and overall survival was 100%. Long-term biochemical control was achieved in 10 patients (90.9%) with either FSRT alone (36.4%) or FSRT with continued medical management (45.5%). No patient experienced new hypopituitarism, cranial nerve dysfunctions, or visual deficits. Our systematic review found published rates of biochemical control and hypopituitarism vary, with uniformly good radiographic control and low incidence of visual changes. Conclusions Adjuvant FSRT offered effective long-term biochemical control and radiographic control, and there was a lower rate of complications in this current series. Review of the literature shows variations in published rates of biochemical control after FSRT for acromegaly, but low incidence of serious toxicities.

Short-Term Results of a Ruptured Deltoid Ligament Repair During an Acute Ankle Fracture Fixation

2017 ◽  
Vol 39 (1) ◽  
pp. 35-45 ◽  
Author(s):  
Seung Hun Woo ◽  
Su-Young Bae ◽  
Hyung-Jin Chung
Keyword(s):  
Clinical Outcomes ◽  
Fracture Fixation ◽  
Ankle Fracture ◽  
Linear Regression Analysis ◽  
Case Series ◽  
Deltoid Ligament ◽  
Radiographic Findings ◽  
Group 2 ◽  
Repair Group

Background: There is no consensus on the optimal treatment or preferred method of operation for the management of acute deltoid ligament injuries during an ankle fracture fixation. This study aimed to analyze the outcomes of repairing the deltoid ligament during the fixation of an ankle fracture compared to conservative management. Methods: We retrospectively evaluated 78 consecutive cases of a ruptured deltoid ligament with an associated ankle fracture between 2001 and 2016. All of the ankle fractures were treated with a plate and screw fixation. Patients in the conservative treatment for ruptured deltoid ligament underwent management from 2001 to 2008 (37 fractures, group 1), while the operative treatment for ruptured deltoid ligament was included from 2009 to 2016 (41 fractures, group 2). The outcome measures included radiographic findings, the American Orthopaedic Foot & Ankle Society ankle-hindfoot scores, visual analog scale scores, and the Foot Function Index. All patients were followed for an average of 17 months. Results: Radiologic findings in both groups were comparable, but the final follow-up of the medial clear space (MCS) was significantly smaller in the group 2 ( P < .01). Clinical outcomes were similar between the two groups ( P > .05). Comparing those who underwent syndesmotic fixation between both groups, group 2 showed a significantly smaller final follow-up MCS, and all clinical outcomes were better in group 2 ( P < .05). Linear regression analysis showed that the final follow-up MCS had a significant influence on clinical outcomes ( P < .05). Conclusion: Although the clinical outcomes were not significantly different between the 2 groups, we obtained a more favorable final follow-up MCS in the deltoid repair group. Particularly when accompanied by a syndesmotic injury, the final follow-up MCS and the clinical outcomes were better in the deltoid repair group. In the case of high-grade unstable fractures of the ankle with syndesmotic instability, a direct repair of the deltoid ligament was adequate for restoring medial stability. Level of Evidence: Level III, retrospective comparative case series.

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