Surgical treatment and outcome of posterior fossa arachnoid cysts in infants

2021 ◽  
pp. 1-9
Author(s):  
Jehuda Soleman ◽  
Danil A. Kozyrev ◽  
Shlomi Constantini ◽  
Jonathan Roth
Keyword(s):  
Surgical Treatment ◽  
Posterior Fossa ◽  
Revision Surgery ◽  
Arachnoid Cysts ◽  
Study Patient ◽  
Younger Age ◽  
Additional Surgery ◽  
Age At Surgery ◽  
Permanent Morbidity

OBJECTIVE The aim of this cohort study was to describe and analyze the surgical treatment and outcome of posterior fossa arachnoid cysts (PFACs) in infants. METHODS Patients presenting with a PFAC at infancy or prenatally, between the years 2000 and 2019, and who were surgically treated before the age of 2 years, were included in this study. Patient data were retrospectively collected including baseline characteristics and surgical variables. Factors related to revision surgery were analyzed through uni- and multivariate analysis. RESULTS Thirty-five patients, of whom 54.3% were male, were included. The cyst was diagnosed prenatally in 23 patients (65.7%). Surgery was typically recommended after a mean cyst follow-up of 3.4 ± 3.9 months, with a mean age at surgery of 6.1 ± 5.1 months. In 54.3% of patients (n = 19), surgery was performed before the age of 6 months. The PFAC was treated purely neuroendoscopically in 57.1% of patients (n = 20), while 28.6% of patients underwent open cyst procedures (n = 10), 5.7% (n = 2) were treated with a shunt, and 8.6% (n = 3) underwent a combined procedure. Additional surgery was required in 31.4% of patients (n = 11; mean 2.36 ± 2.11 surgeries per patient). At the last follow-up (61.40 ± 55.33 months), no mortality or permanent morbidity was seen; radiological improvement was apparent in 83.9% of the patients. Those patients treated before the age of 6 months (p = 0.09) and who presented before surgery with a stable cyst size that was maintained throughout preoperative monitoring (p = 0.08) showed a trend toward higher revision rates after surgical treatment. CONCLUSIONS PFACs in infancy may require surgical treatment before the age of 6 months. Navigated endoscopy was a valid surgical option. Overall mortality or permanent morbidity was rare. Additional surgery was required in up to 30% of the patients; younger age and a preoperatively stable cyst might be risk factors for revision surgery.

scholarly journals SURGICAL TREATMENT OF OSGOOD-SCHLATTER DISEASE IN ADOLESCENT ATHLETES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0006
Author(s):  
Frederick Mun ◽  
William L. Hennrikus
Keyword(s):  
Surgical Treatment ◽  
Age At Onset ◽  
Tibial Tubercle ◽  
Adolescent Athletes ◽  
Patella Tendon ◽  
Radiographic Findings ◽  
Post Operative Pain ◽  
Additional Surgery ◽  
Age At Surgery

Background: Osgood-Schlatter disease is an apophysitis of the tibial tubercle causing pain and difficulty kneeling. A majority of cases resolve spontaneously at skeletal maturity when the tibial tubercle apophysis fuses. Treatment is symptomatic when the physis is open. Adolescent athletes with closed physes and continued symptoms can benefit from surgery. Purpose: The purpose of this study is to report the outcomes of ossicle excision and tubercleplasty for unresolved Osgood-Schlatter disease that has failed conservative treatment. Methods: A retrospective review was performed on 6 athletes who underwent ossicle excision and tibial tubercleplasty for unresolved Osgood-Schlatter disease. Data collected include age at onset of symptoms, age at surgery, gender, laterality, radiographic findings, sports played, time to return to sport, length of follow up, and complications. Surgery involved an open ossicle excision, tubercleplasty, and repair of the patella tendon to bone using a suture anchor. A longitudinal incision was made over the antero-lateral aspect of the patella tendon. The patella tendon was reflected medially to gain access to the ossicle and bump. A direct anterior incision was avoided to minimize post-operative pain with kneeling. Post-operatively, patients were allowed to fully weight bear in an extension knee brace for 4 weeks, and then allowed to gradually resume activity. Results: 4 males and 2 females were studied. The right knee was involved in 3 cases and the left knee in 3. The average age at onset of symptoms was 15.8 (range 12-18). The average age at surgery was 17.3 (range 17-18). Radiographic findings included a large bump in 3 cases, an ossicle in 2 cases, and free fragments at the tendon insertion in 3 cases. Sports played included basketball, football, running, and dancing. All patients returned to sports at an average of 23.9 weeks post-surgery (range 5-56). The average length of follow up was 14.2 weeks (range 5-27). No patients reported post-operative pain with kneeling, limp, need for a cane, locking sensations, giving way sensations, pain, swelling, difficulty climbing stairs or difficulty squatting. No patients needed additional surgery. Conclusion: Surgical treatment of unresolved Osgood-Schlatter disease was successful in 100% of adolescent athletes in this series. For symptomatic patients after closure of the growth plate, we recommend removal of the ossicle and adjacent bursae, smoothing down the bump with a burr, and repairing the reflected patella tendon to bone using suture anchors. The outcomes were excellent in all patients with no complications.

Patients with “benign” Chiari I malformations require surgical decompression at a low rate

2019 ◽  
Vol 23 (4) ◽  
pp. 498-506 ◽  
Author(s):  
Tofey J. Leon ◽  
Elizabeth N. Kuhn ◽  
Anastasia A. Arynchyna ◽  
Burkely P. Smith ◽  
R. Shane Tubbs ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Posterior Fossa ◽  
Multivariate Logistic Regression Analysis ◽  
Large Cohort ◽  
Initial Evaluation ◽  
Published Data ◽  
Posterior Fossa Decompression ◽  
Signal Abnormality ◽  
Chiari I

OBJECTIVEThere are sparse published data on the natural history of “benign” Chiari I malformation (CM-I)—i.e., Chiari with minimal or no symptoms at presentation and no imaging evidence of syrinx, hydrocephalus, or spinal cord signal abnormality. The purpose of this study was to review a large cohort of children with benign CM-I and to determine whether these children become symptomatic and require surgical treatment.METHODSPatients were identified from institutional outpatient records using International Classification of Diseases, 9th Revision, diagnosis codes for CM-I from 1996 to 2016. After review of the medical records, patients were excluded if they 1) did not have a diagnosis of CM-I, 2) were not evaluated by a neurosurgeon, 3) had previously undergone posterior fossa decompression, or 4) had imaging evidence of syringomyelia at their first appointment. To include only patients with benign Chiari (without syrinx or classic Chiari symptoms that could prompt immediate intervention), any patient who underwent decompression within 9 months of initial evaluation was excluded. After a detailed chart review, patients were excluded if they had classical Chiari malformation symptoms at presentation. The authors then determined what changes in the clinical picture prompted surgical treatment. Patients were excluded from the multivariate logistic regression analysis if they had missing data such as race and insurance; however, these patients were included in the overall survival analysis.RESULTSA total of 427 patients were included for analysis with a median follow-up duration of 25.5 months (range 0.17–179.1 months) after initial evaluation. Fifteen patients had surgery at a median time of 21.0 months (range 11.3–139.3 months) after initial evaluation. The most common indications for surgery were tussive headache in 5 (33.3%), syringomyelia in 5 (33.3%), and nontussive headache in 5 (33.3%). Using the Kaplan-Meier method, rate of freedom from posterior fossa decompression was 95.8%, 94.1%, and 93.1% at 3, 5, and 10 years, respectively.CONCLUSIONSAmong a large cohort of patients with benign CM-I, progression of imaging abnormalities or symptoms that warrant surgical treatment is infrequent. Therefore, these patients should be managed conservatively. However, clinical follow-up of such individuals is justified, as there is a low, but nonzero, rate of new symptom or syringomyelia development. Future analyses will determine whether imaging or clinical features present at initial evaluation are associated with progression and future need for treatment.

Radiological and clinical associations with scoliosis outcomes after posterior fossa decompression in patients with Chiari malformation and syrinx from the Park-Reeves Syringomyelia Research Consortium

2020 ◽  
Vol 26 (1) ◽  
pp. 53-59 ◽  
Author(s):  
Jennifer M. Strahle ◽  
Rukayat Taiwo ◽  
Christine Averill ◽  
James Torner ◽  
Jordan I. Gewirtz ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Chiari Malformation ◽  
Craniocervical Junction ◽  
Curve Progression ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Younger Age ◽  
Curve Magnitude ◽  
The Mean

OBJECTIVEIn patients with Chiari malformation type I (CM-I) and a syrinx who also have scoliosis, clinical and radiological predictors of curve regression after posterior fossa decompression are not well known. Prior reports indicate that age younger than 10 years and a curve magnitude < 35° are favorable predictors of curve regression following surgery. The aim of this study was to determine baseline radiological factors, including craniocervical junction alignment, that might predict curve stability or improvement after posterior fossa decompression.METHODSA large multicenter retrospective and prospective registry of pediatric patients with CM-I (tonsils ≥ 5 mm below the foramen magnum) and a syrinx (≥ 3 mm in width) was reviewed for clinical and radiological characteristics of CM-I, syrinx, and scoliosis (coronal curve ≥ 10°) in patients who underwent posterior fossa decompression and who also had follow-up imaging.RESULTSOf 825 patients with CM-I and a syrinx, 251 (30.4%) were noted to have scoliosis present at the time of diagnosis. Forty-one (16.3%) of these patients underwent posterior fossa decompression and had follow-up imaging to assess for scoliosis. Twenty-three patients (56%) were female, the mean age at time of CM-I decompression was 10.0 years, and the mean follow-up duration was 1.3 years. Nine patients (22%) had stable curves, 16 (39%) showed improvement (> 5°), and 16 (39%) displayed curve progression (> 5°) during the follow-up period. Younger age at the time of decompression was associated with improvement in curve magnitude; for those with curves of ≤ 35°, 17% of patients younger than 10 years of age had curve progression compared with 64% of those 10 years of age or older (p = 0.008). There was no difference by age for those with curves > 35°. Tonsil position, baseline syrinx dimensions, and change in syrinx size were not associated with the change in curve magnitude. There was no difference in progression after surgery in patients who were also treated with a brace compared to those who were not treated with a brace for scoliosis.CONCLUSIONSIn this cohort of patients with CM-I, a syrinx, and scoliosis, younger age at the time of decompression was associated with improvement in curve magnitude following surgery, especially in patients younger than 10 years of age with curves of ≤ 35°. Baseline tonsil position, syrinx dimensions, frontooccipital horn ratio, and craniocervical junction morphology were not associated with changes in curve magnitude after surgery.

Extended Follow-Up After Atrial Repair for Transposition of the Great Arteries: A Younger Age at Surgery Improves Late Survival

1985 ◽  
Vol 2 (4) ◽  
pp. 246-251
Author(s):  
Michele Genoni ◽  
Paul Vogt ◽  
Ludwig Segesser ◽  
Burkhardt Seifert ◽  
Urs Arbenz ◽  
...  
Keyword(s):  
Younger Age ◽  
Age At Surgery ◽  
Late Survival

Cyst-ventricle stent as primary or salvage treatment for posterior fossa arachnoid cysts

2011 ◽  
Vol 7 (5) ◽  
pp. 549-556 ◽  
Author(s):  
Daniel H. Fulkerson ◽  
Todd D. Vogel ◽  
Abdul A. Baker ◽  
Neal B. Patel ◽  
Laurie L. Ackerman ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Arachnoid Cyst ◽  
Arachnoid Cysts ◽  
Morbidity Rate ◽  
Initial Symptom ◽  
Salvage Procedure ◽  
The Third ◽  
First Line Therapy ◽  
Posterior Fossa Cyst

Object The optimal treatment of symptomatic posterior fossa arachnoid cysts is controversial. Current options include open or endoscopic resection, fenestration, or cyst-peritoneal shunt placement. There are potential drawbacks with all options. Previous authors have described stenting a cyst into the ventricular system for supratentorial lesions. The current authors have used a similar strategy for posterior fossa cysts. Methods The authors performed a retrospective review of 79 consecutive patients (1993–2010) with surgically treated intracranial arachnoid cysts. Results The authors identified 3 patients who underwent placement of a stent from a posterior fossa arachnoid cyst to a supratentorial ventricle. In 2 patients the stent construct consisted of a catheter placed into a posterior fossa arachnoid cyst and connecting to a lateral ventricle catheter. Both patients underwent stent placement as a salvage procedure after failure of open surgical fenestration. In the third patient a single-catheter cyst-ventricle stent was stereotactically placed. All 3 patients improved clinically. Two patients remained asymptomatic, with radiographic stability in a follow-up period of 1 and 5 years, respectively. The third patient experienced initial symptom resolution with a demonstrable reduction of intracystic pressure. However, he developed recurrent headaches after 2 years. Conclusions Posterior fossa cyst–ventricle stenting offers the benefits of ease of surgical technique and a low morbidity rate. It may also potentially reduce the incidence of shunt-related headaches by equalizing the pressure between the posterior fossa and the supratentorial compartments. While fenestration is considered the first-line therapy for most symptomatic arachnoid cysts, the authors consider cyst-ventricle stenting to be a valuable additional strategy in treating these rare and often difficult lesions.

scholarly journals NCMP-25. CLINICAL FEATURES, NEUROLOGIC RECOVERY, AND RISK PREDICTION OF POST-OPERATIVE POSTERIOR FOSSA SYNDROME: A PROSPECTIVE STUDY

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii128-ii128
Author(s):  
Raja B Khan ◽  
Zoltan Patay ◽  
Paul Kilmo ◽  
Jie Huang ◽  
Arzu Onar-Thomas ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Multivariable Analysis ◽  
Posterior Fossa Syndrome ◽  
Neurologic Recovery ◽  
Younger Age ◽  
Severe Ataxia ◽  
One Year ◽  
A Prospective Study ◽  
Surgery Center

Abstract INTRODUCTION Posterior fossa syndrome (PFS) is a known consequence of medulloblastoma resection. Our aim was to clinically define PFS, its evolution over time, and ascertain risk factors for its development and poor recovery. METHODS Children with medulloblastoma treated at St Jude Children’s Research Hospital from 6/2013-7/2019 received standardized neurological examinations, before and periodically after radiation therapy. Most (98.3%) were enrolled on the ongoing multi-institutional protocol (SJMB12; NCT 01878617). RESULTS Sixty (34%) of 178 evaluated children had PFS. Forty (23%) had complete mutism (PFS1) and 20 (11%) had diminished speech (PFS2). All children with PFS had severe ataxia and 42.5% of PFS1 had movement disorders. By multivariable analysis, younger age (p=0.0005) and surgery in a low-volume surgery center (p=0.0146) increased PFS risk, while SHH tumors had reduced risk (p=0.0025). Speech and gait returned in PFS1/PFS2 children at a median of 2.3/0.7 and 2.1/1.5 months respectively, however, 12 (44.4%) of 27 PFS1 children with 12 months of follow-up were non-ambulatory at one-year. Movement disorder (p= 0.037) and high ataxia score (p&lt; 0.0001) were associated with delayed speech recovery. Older age (p= 0.0147) and high ataxia score (p&lt; 0.0001) were association with delayed gait return. Symptoms improved in all children but no child with PFS had normal neurologic examination at a median of 23 months after surgery. CONCLUSION Categorizing PFS in to types 1 and 2 has prognostic relevance. Almost half of the children with PFS1 remained non-ambulatory at 12-month follow-up. Surgical experience was a major modifiable contributor to the development of PFS.

scholarly journals Revision Surgery for Metal Component Failure in Total Ankle Arthroplasty

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0007
Author(s):  
James Lachman ◽  
Jania A. Ramos ◽  
Samuel Adams ◽  
Mark Easley ◽  
James DeOrio
Keyword(s):  
Revision Surgery ◽  
Short Form ◽  
Total Ankle Arthroplasty ◽  
Study Patient ◽  
Foot And Ankle ◽  
Metal Component ◽  
Component Failure ◽  
Ankle Arthroplasty ◽  
Patient Reported

Category: Ankle Arthritis Introduction/Purpose: Metal component failure in total ankle arthroplasty(TAA) is difficult to treat. Traditionally, to an arthrodesis has been advocated. Revision TAA surgery has become more and more common with availability of revision implants and refinement of bone conserving primary implants. It this study, patient reported results and clinical outcomes are analyzed for patients undergoing revision total ankle arthroplasty. Methods: We retrospectively reviewed prospectively collected data on 45 patients (cases) with a mean age of 63.7 +/-10.2 years who developed loosening or collapse of either major metal component in the primary total ankle arthroplasty. Cases of isolated polyethylene exchange, infection, or extra-articular realignment procedures were excluded. Prospectively collected patient reported outcomes measures including the American Orthopaedic Foot and Ankle Society(AOFAS) hindfoot score, Visual Analog Scale (VAS), Short Form 36 (SF-36), Short Musculoskeletal Function Assessment (SMFA), and the Foot and Ankle Outcomes Score (FAOS) questionnaires were collected. Clinical data was collected through thorough review of the electronic medical record to identify clinical failure defined as explant and second revision or conversion to arthrodesis or amputation. Results: The causes of failure of primary TAA in this study were aseptic loosening of both components (40%), talar component subsidence/loosening (37.7%), tibial loosening (8.8%), coronal talar subluxation (8.8%) and talar malrotation (2.2%). Twenty-four patients (53.3%) underwent revision of all components, nineteen (42.2%) just the talar and polyethylene components, and two (4.4%) the tibial and polyethylene components. The average time to revision was 5.56 years +/- 5.71 with a follow-up of 3.02 years +/- 1.25 after revision. Ten (22.2%) revision arthroplasties required further surgery; five required conversion to arthrodesis and five required second revision TAA. VAS scores, SF36 scores, SMFA scores, AOFAS Hindfoot scores, and FAOS all improved after revision surgery but took 2 years to reach scores comparable to 1 year after primary TAA. Conclusion: Clinical and patient reported results of revision ankle arthroplasty after metal component failure were comparable to those after primary ankle arthroplasty. In our series, 22.2% of revision TAAs required a second revision TAA or arthrodesis surgery. Various prosthesis performed similarly when used in revision scenarios. Patients recovered faster from primary ankle arthroplasty when compared to revision ankle arthroplasty but all scores were comparable by the two-year follow-up visit after revision arthroplasty surgery.

Surgical management of intracranial arachnoid cysts in pediatric patients: radiological and clinical outcome

2021 ◽  
pp. 1-11
Author(s):  
Matthias Schulz ◽  
Yasin Oezkan ◽  
Andreas Schaumann ◽  
Miriam Sieg ◽  
Anna Tietze ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Symptoms ◽  
Pediatric Population ◽  
Mass Effect ◽  
Reoperation Rate ◽  
Arachnoid Cysts ◽  
Cyst Volume ◽  
Intracranial Cysts ◽  
Intracranial Lesions

OBJECTIVE Congenital intracranial cysts account for a significant portion of intracranial lesions in the pediatric population. The efficiency of surgical treatment in a pediatric cohort with intracranial arachnoid cysts (ACs) at different locations regarding clinical symptoms and mass effect was evaluated. METHODS A retrospective study of all children who underwent surgical treatment of an intracranial AC during an 11-year period (2007–2018) was performed. Demographics, clinical symptoms, and radiological cyst size pre- and postoperatively, as well as the reoperation rate and possible treatment complications, were analyzed. RESULTS A total of 116 intracranial cysts at 8 different anatomical locations were surgically treated in 113 children (median age 5 years and 10 months) predominantly by endoscopic technique (84%). The complication rate was 3%, and the reoperation rate was 16%. Preoperative cyst enlargement was significantly more common in infants (p < 0.0001), as was the need for reoperation (p = 0.023). After a median radiological follow-up of 26 months, > 50% reduction of cyst volume was seen in 53 cysts (46%), and 47 cysts (40%) showed a 10%–50% reduction. Acute clinical symptoms improved: nausea and vomiting, accelerated head growth, and headaches improved at 100%, 92% and 89%, respectively. However, chronic symptoms responded less favorably after a median clinical follow-up of 26 months. CONCLUSIONS The strategy of predominantly endoscopic treatment with navigation planning is efficient to alleviate clinical symptoms and to significantly reduce the mass effect of pediatric intracranial cysts at different anatomical locations. The subgroup of infants requires close pre- and postoperative monitoring.

Extended Follow-Up After Atrial Repair for Transposition of the Great Arteries: A Younger Age at Surgery Improves Late Survival

1999 ◽  
Vol 14 (4) ◽  
pp. 246-251 ◽  
Author(s):  
Michele Genoni ◽  
Paul Vogt ◽  
Ludwig Segesser ◽  
Burkhardt Seifert ◽  
Urs Arbenz ◽  
...  
Keyword(s):  
Younger Age ◽  
Age At Surgery ◽  
Late Survival

scholarly journals Cohort profile: The Australian Parkinson's Genetics Study (APGS)

2021 ◽  
Author(s):  
Svetlana Bivol ◽  
George D. Mellick ◽  
Jacob Gratten ◽  
Richard Parker ◽  
Aiobhe Mulcahy ◽  
...  
Keyword(s):  
Neurodegenerative Disorder ◽  
Study Patient ◽  
Individual Risk ◽  
Younger Age ◽  
Patient Reported ◽  
Genetic And Environmental Factors ◽  
Reported Data ◽  
Future Work

Purpose: Parkinson's disease (PD) is a neurodegenerative disorder associated with progressive disability. While the precise aetiology is unknown, there is evidence of significant genetic and environmental influences on individual risk. The Australian Parkinson's Genetics Study (APGS) seeks to study patient-reported data from a large cohort of individuals with PD in Australia to understand the sociodemographic, genetic, and environmental basis of PD susceptibility, symptoms and progression. Participants: In the pilot phase reported here, 1,819 participants were recruited through assisted mailouts facilitated by Services Australia (formerly known as the Australian Government Department of Human Services), based on having three or more prescriptions for anti-PD medications in their Pharmaceutical Benefits Scheme (PBS) records. The average age at the time of the questionnaire was 64 +/- 6 years. We collected patient-reported PD information and socio-demographic variables via an online (93% of the cohort) or paper-based (7%) questionnaire. 1,532 participants (84.2%) had a current PD diagnosis and consented to provide a DNA sample via a saliva sampling kit sent by traditional post. Of these, 1435 (94%) returned the saliva samples for genotyping. Findings to date: 65% of participants were male, and 92% identified as being of European descent. A previous traumatic brain injury was reported by 16% of participants and was associated with a younger age of symptom onset. At the time of the questionnaire, constipation (36% of participants), depression (34%), anxiety (17%), melanoma (16%) and diabetes (10%) were the most commonly reported comorbid conditions. Future plans: We are actively seeking funding to expand the project's scope and reach, including recruiting unaffected controls, and a follow-up questionnaire focused on non-motor symptoms and cognitive function assessment. Future work will explore the role of genetic and environmental factors in the aetiology of PD susceptibility, onset, symptoms and progression, including as part of international PD research consortia.

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