Prognostic factors for long-term outcomes of microvascular decompression in the treatment of glossopharyngeal neuralgia: a retrospective analysis of 97 patients

2021 ◽  
pp. 1-8
Keyword(s):  
Microvascular Decompression ◽  
Cox Regression ◽  
Lower Degree ◽  
Neurovascular Conflict ◽  
Entry Zone ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Root Entry Zone ◽  
Venous Compression

OBJECTIVE The authors aimed to investigate predictors of postoperative outcomes of microvascular decompression (MVD) for the treatment of glossopharyngeal neuralgia (GPN). METHODS A cohort of 97 patients with medically refractory GPN who underwent MVD at the authors’ institution between January 2010 and July 2019 was retrospectively reviewed. Univariate and multivariate regression models were used to identify predictors of long-term outcome in patients after MVD. RESULTS Eighty-nine patients (91.8%) reported immediate and complete relief of pain after the procedure. Of the remaining 8 patients (8.2%), 6 achieved partial pain relief and pain gradually diminished within 2 weeks after surgery, and 2 did not experience postoperative pain relief. In univariate Cox regression analysis, venous compression of the glossopharyngeal nerve root entry zone (HR 3.591, 95% CI 1.660–7.767, p = 0.001) and lower degree of neurovascular conflict (HR 2.449, 95% CI 1.177–5.096, p = 0.017) were significantly associated with worse pain-free survival. In multivariate Cox regression analysis, venous compression (HR 8.192, 95% CI 2.960–22.669, p < 0.001) and lower degree of neurovascular conflict (HR 5.450, 95% CI 2.069–14.356, p = 0.001) remained independently associated with worse pain-free survival. CONCLUSIONS Venous compression of the glossopharyngeal nerve root entry zone and lower degree of neurovascular conflict were significantly correlated with shorter pain-free survival in patients who underwent MVD for GPN. Microvascular decompression is a safe, feasible, and durable approach with a low complication rate for the treatment of GPN.

A novel scoring system as a preoperative predictor for pain-free survival after microsurgery for trigeminal neuralgia

2020 ◽  
Vol 132 (1) ◽  
pp. 217-224 ◽  
Author(s):  
Fran A. Hardaway ◽  
Hanna C. Gustafsson ◽  
Katherine Holste ◽  
Kim J. Burchiel ◽  
Ahmed M. Raslan
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Scoring System ◽  
Neurovascular Conflict ◽  
Radiographic Findings ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Mri Studies ◽  
Internal Neurolysis

OBJECTIVEPain relief following microvascular decompression (MVD) for trigeminal neuralgia (TN) may be related to pain type, degree of neurovascular conflict, arterial compression, and location of compression. The objective of this study was to construct a predictive pain-free scoring system based on clinical and radiographic factors that can be used to preoperatively prognosticate long-term outcomes for TN patients following surgical intervention (MVD or internal neurolysis [IN]). It was hypothesized that contributing factors would include pain type, presence of an artery or vein, neurovascular conflict severity, and compression location (root entry zone).METHODSAt the authors’ institution 275 patients with type 1 or type 2 TN (TN1 or TN2) underwent MVD or IN following preoperative high-resolution brain MRI studies. Outcome data were obtained retrospectively by chart review and/or phone follow-up. Characteristics of neurovascular conflict were obtained from preoperative MRI studies. Factors that resulted in a probability value of < 0.05 on univariate logistic regression analyses were entered into a multivariate Cox regression analysis in a backward stepwise fashion. For the multivariate analysis, significance at the 0.15 level was used. A prognostic system was then devised with 4 possible scores (0, 1, 2, or 3) and pain-free survival analyses conducted.RESULTSUnivariate predictors of pain-free survival were pain type (p = 0.013), presence of any vessel (p = 0.042), and neurovascular compression severity (p = 0.038). Scores of 0, 1, 2, and 3 were found to be significantly different in regard to pain-free survival (log rank, p = 0.005). At 5 and 10 years there were 36%, 43%, 61%, and 69%, and 36%, 43%, 56%, and 67% pain-free survival rates in groups 0, 1, 2, and 3, respectively. While TN2 patients had worse outcomes regardless of score, a subgroup analysis of TN1 patients with higher neurovascular conflict (score of 3) had significantly better outcomes than TN1 patients without severe neurovascular conflict (score of 1) (log rank, p = 0.005). Regardless of pain type, those patients with severe neurovascular conflict were more likely to have arterial compression (99%) compared to those with low neurovascular conflict (p < 0.001).CONCLUSIONSPain-free survival was predicted by a scoring system based on preoperative clinical and radiographic findings. Higher scores predicted significantly better pain relief than lower scores. TN1 patients with severe neurovascular conflict had the best long-term pain-free outcome.

127 A Novel Scoring System for Preoperative Prediction for Pain-Free Survival After Microsurgery for Trigeminal Neuralgia: TN-MVD Score

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 228-229 ◽  
Author(s):  
Frances Hardaway ◽  
Hanna Gustafsson ◽  
Katherine Holste ◽  
Kim J Burchiel ◽  
Ahmed M T Raslan
Keyword(s):  
Trigeminal Neuralgia ◽  
Scoring System ◽  
Cox Regression ◽  
Outcome Data ◽  
Neurovascular Compression ◽  
Neurovascular Conflict ◽  
Radiographic Findings ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Internal Neurolysis

Abstract INTRODUCTION Pain relief following microsurgery for trigeminal neuralgia (TN) may be related to multiple factors including pain type, degree of neurovascular conflict, arterial compression, and location of compression. The objective of this study was to construct a predictive scoring system based on clinical and radiographic factors that can preoperatively prognosticate long-term outcomes in TN following surgery. METHODS 275 patients with Type 1 or Type 2 TN underwent microvascular decompression (MVD) or internal neurolysis (IN) following a preoperative high-resolution MRI. Outcome data was obtained retrospectively by chart review and/or phone follow-up. Characteristics of neurovascular conflict were obtained from preoperative MRI. Factors that resulted in a probability value of <0.05 on univariate logistic regression analyses were entered into a multivariate cox regression analysis in a backward stepwise fashion. For the multivariate analysis, significance at the 0.15 level was used. A prognostic system was then devised with three possible scores (0/1, 2, or 3) and survival analyses were conducted. RESULTS >Univariate predictors of pain-free survival were pain type (P = 0.013), presence of any vessel (P = 0.042), and neurovascular compression severity (0.038). Scores of 0/1, 2, and 3 were found to be significantly different in regard to pain-free survival (log rank, P = 0.008). At 5 and 10 years there were 42, 57, and 72% and 42,52, and 58%, pain free survival in groups 0/1, 2, and 3, respectively. TN1 patients with severe neurovascular conflict (score of 3) had the best outcome, which was significantly better that TN1 patients without neurovascular conflict (score of 1) (log rank, P = 0.005). Severe neurovascular conflict is more likely to have arterial compression (99%) (P< 0.001). CONCLUSION Pain-free survival of TN patients after microsurgery can be predicted in a step-wise statistically significant fashion, by a simple scoring system based on preoperative clinical and radiographic findings.

Long-term outcomes and determinants of restenosis after renal artery angioplasty in hypertensive patients with renovascular disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Roslawiecka ◽  
A Kablak-Ziembicka ◽  
R Badacz ◽  
P Pieniazek ◽  
D Rzeznik ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Artery ◽  
Cox Regression ◽  
Survival Curves ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Stent Diameter

Abstract Introduction Restenosis (RS) following percutaneous angioplasty (PTA) of renal artery stenosis (RAS) might have an unfavorable impact on renal function and blood pressure (BP) outcomes. Aim To evaluate prevalence and predictors of RS in patients treated with PTA for RAS, and relationship between BP and renal function (RF) changes with RS. Material and methods We analyzed freedom from RS in 210 patients (64.6±12.8; range:20–85y.o.), who underwent 248 successful stent-assisted PTAs in RAS. The change in levels of serum creatinine (SCC), eGFR, systolic/diastolic BPs (SBP/DBP) were analyzed prior to PTA, at 6-, 12-months and final follow-up visits, and whenever RS was diagnosed. Results RS was identified in 30 (14.3%) patients and 36 (14.5%) lesions. The Kaplan-Meier RS-free survival curves in fibromuscular dysplasia, atherosclerosis and vasculitis were: 100% and 100%; 95.6 and 83.9%, while 71.4 and 39.7% at 1 and 7-years, respectively. Patients with RS, as compared to RS-free patients, presented with lesser response in changes of: SBP (1.4±17.6 vs −15.8±25.8mmHg; p=0.01), DBP (2.64±10.1 vs. −6.5±14.1mmHg; p=0.002), SCC (22.4±55.2 vs −3.6±43.9μmol/L; p=0.002) and eGFR (−1.85±18 vs. −5.34±19.5mmHg; p=0.045). In multivariate Cox regression analysis, independent predictors of RS occurred: lack of BP decrease (HR: 4.19, 95% CI: 1.67–10.3; p=0.002), lack of eGFR increase of less than ≤0.17 ml/min/1.73m2 (HR: 2.93, 95% CI: 1.08–7.91; p=0.033), stent diameter ≤5mm (HR: 2.76, 95% CI: 1.09–6.97; p=0.031) and vasculitis (HR: 5.61, 95% CI: 1.83–17.2; p=0.003). RS was treated in 24 patients with RS recurrence in 20%. Conclusions RS rate differs depending on RAS etiology. Lack of SBP/DBP and eGFR improvement, vasculitis, and stent diameter are associated with RS risk. Repeated PTA is effective, but recurrent RS occurs in 20% of cases. Kaplan-Meier RS-free survival curves Funding Acknowledgement Type of funding source: None

scholarly journals Comparative Analysis of Trigeminal Neuralgia Caused by Sole Arterial and Venous Compression: Clinical Features and Surgical Outcomes From 222 Cases

2021 ◽  
Vol 12 ◽  
Author(s):  
Junwen Wang ◽  
Hongquan Niu ◽  
Kai Zhao ◽  
Kai Shu ◽  
Ting Lei
Keyword(s):  
Trigeminal Neuralgia ◽  
Clinical Features ◽  
Surgical Outcomes ◽  
Long Term Outcomes ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Venous Compression ◽  
Short And Long Term ◽  
Cranial Fossa

Background: Compared with trigeminal neuralgia (TN) caused by arterial neurovascular conflict (NVC), the clinical characteristics and managements for TN with venous NVC are not well-established. This study aims to comparatively summarize the clinical features and surgical outcomes of microvascular decompression (MVD) for patients with TN caused by sole arterial and venous compression, with a particular focus on the morphological features of posterior cranial fossa (PCF).Methods: A total of 222 patients with TN caused by sole arterial NVC (188/84.7%) and venous NVC (34/15.3%) underwent MVD in our department from January 2014 to December 2018. The patient data were analyzed retrospectively. Particularly, we focused on the potential impact of PCF on surgical outcomes.Results: Compared with arterial NVC, V3 branch of the trigeminal nerve was more frequently involved in venous NVC (p = 0.009). The most common compression site was root entry zone for arterial NVC (68.6%) and midcisternal segment for venous NVC (76.5%) (p &lt; 0.001). No serious post-operative complication was observed in the two groups. Both short- and long-term outcomes were relatively worse in venous NVC cases compared with arterial NVC cases (p = 0.001 and p = 0.030, respectively); and a dominantly higher rate of delayed cure was demonstrated in venous NVC cases (p &lt; 0.001). TN patients with venous NVC revealed a more flat-shaped PCF than those with arterial NVC. Moreover, flat-shaped PCF morphometry was negatively correlated with surgical outcomes of TN patients with arterial NVC, but not with those of venous NVC cases.Conclusions: MVD is an effective and safe treatment for patients with TN caused by either arterial or venous NVC. Patients with a more flat-shaped PCF might be vulnerable to venous compression. Our study demonstrated that PCF morphometry only affected the surgical outcomes of patients with TN caused by arterial NVC, but not the outcomes of those with venous NVC.

scholarly journals Comparison of open liver resection and RFA for the treatment of solitary 3–5-cmhepatocellular carcinoma: a retrospective study

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lei Jianyong ◽  
◽  
Yan Lunan ◽  
Li Dajiang ◽  
Wang Wentao
Keyword(s):  
Liver Resection ◽  
Cox Regression ◽  
Survival Rates ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Clinical Results ◽  
Small Hepatocellular Carcinoma ◽  
Free Survival ◽  
Cox Regression Analysis

Abstract Background The goal of this study was to compare the postoperative results of liver resection and radiofrequency ablation (RFA) for the treatment of small hepatocellular carcinoma (HCC) (3–5 cm). Patients and methods We retrospectively collected 122 cases of small solitary HCC treated at our center from Jan 2011 to Dec 2015, with diameters in the range of 3–5 cm. According to the treatment program received at our center, the patients were divided into liver resection (72 patients) and RFA (50 patients) groups. Result In comparison with the RFA group, the resection group had a longer operative time, greater intraoperative blood loss (P < 0.01), more hepatic inflow occlusion, and a longer postoperative hospital stay (P < 0.01). The 1-, 3-, and 5-year expected overall survival rates and tumor-free survival rates were comparable between the two groups. Cox regression analysis showed that neither resection nor RFA was a significant risk factor for overall or tumor-free survival in HCC. Conclusions For solitary HCC of 3–5 cm in diameter, RFA can achieve better in-hospital clinical results and similar long-term outcomes than resection and can be considered for wide application, especially for central-location cases.

scholarly journals Impact of Chronobiological Variation in Takotsubo Syndrome: Prognosis and Outcome

2021 ◽  
Vol 8 ◽  
Author(s):  
Ibrahim El-Battrawy ◽  
Assem Aweimer ◽  
Siegfried Lang ◽  
Uzair Ansari ◽  
Thorsten Gietzen ◽  
...  
Keyword(s):  
Cox Regression ◽  
Fourth Quarter ◽  
Qtc Interval ◽  
Takotsubo Syndrome ◽  
Event Free Survival ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Short And Long Term

Background: A considerable amount of evidence has shown that acute cardiovascular diseases exhibit specific temporal patterns in their onset.Aim: This study was performed to determine if takotsubo syndrome (TTS) shows chronobiological variations with short and long-term impacts on adverse events.Design: Our institutional database constituted a collective of 114 consecutive TTS patients between 2003 and 2015.Methods: Patients were divided into groups defined by the onset of TTS as per time of the day, day of the week, month and quarter of year.Results: TTS events were most common afternoon and least common in the night, indicating a wave-like pattern (p = 0.001) of manifestation. The occurrence of TTS events was similar among days of the week and weeks of the month. TTS patients diagnosed in the month of November and subsequently in the fourth quarter showed a significantly longer QTc interval. These patients also revealed a significantly lower event-free-survival over a 1-year follow-up. In a multivariate Cox regression analysis, TTS events occurring in the fourth quarter of year (HR 6.8, 95%CI: 1.3–35.9; p = 0.02) proved to be an independent predictor of lower event-free-survival.Conclusions: TTS seems to exhibit temporal preference in its onset, but nevertheless this possibly coincidental result needs to be analyzed in a large multicenter registry.

Long-Term Clinical Outcome in Elderly Patients Undergoing Mitral Valve Repair

2020 ◽  
Author(s):  
Julia Götte ◽  
Armin Zittermann ◽  
Kavous Hakim-Meibodi ◽  
Masatoshi Hata ◽  
Rene Schramm ◽  
...  
Keyword(s):  
Mitral Valve ◽  
General Population ◽  
Elderly Patients ◽  
Cox Regression ◽  
Functional Class ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Cox Regression Analysis

Abstract Background Long-term data on patients over 75 years undergoing mitral valve (MV) repair are scarce. At our high-volume institution, we, therefore, aimed to evaluate mortality, stroke risk, and reoperation rates in these patients. Methods We investigated clinical outcomes in 372 patients undergoing MV repair with (n = 115) or without (n = 257) tricuspid valve repair. The primary endpoint was the probability of survival up to a maximum follow-up of 9 years. Secondary clinical endpoints were stroke and reoperation of the MV during follow-up. Univariate and multivariable Cox regression analysis was performed to assess independent predictors of mortality. Mortality was also compared with the age- and sex-adjusted general population. Results During a median follow-up period of 37 months (range: 0.1–108 months), 90 patients died. The following parameters were independently associated with mortality: double valve repair (hazard ratio, confidence interval [HR, 95% CI]: 2.15, 1.37–3.36), advanced age (HR: 1.07, CI: 1.01–1.14 per year), diabetes (HR: 1.97, CI: 1.13–3.43), preoperative New York Heart Association (NYHA) functional class (HR: 1.41, CI: 1.01–1.97 per class), and operative creatininemax levels (HR: 1.32, CI: 1.13–1.55 per mg/dL). The risk of stroke in the isolated MV and double valve repair groups at postoperative year 5 was 5.0 and 4.1%, respectively (p = 0.65). The corresponding values for the risk of reoperation were 4.0 and 7.0%, respectively (p = 0.36). Nine-year survival was comparable with the general population (53.2 vs. 53.1%). Conclusion Various independent risk factors for mortality in elderly MV repair patients could be identified, but overall survival rates were similar to those of the general population. Consequently, our data indicates that repairing the MV in elderly patients represents a suitable and safe surgical approach.

scholarly journals The Role of Hydraulic Silicate Cements on Long-Term Properties and Biocompatibility of Partial Pulpotomy in Permanent Teeth

Materials ◽  
2021 ◽  
Vol 14 (2) ◽  
pp. 305
Author(s):  
Chung-Min Kang ◽  
Saemi Seong ◽  
Je Seon Song ◽  
Yooseok Shin
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Antimicrobial Properties ◽  
Permanent Teeth ◽  
Success Rates ◽  
Pulp Tissue ◽  
Cox Regression Analysis ◽  
Clinical Variables

The use of hydraulic silicate cements (HSCs) for vital pulp therapy has been found to release calcium and hydroxyl ions promoting pulp tissue healing and mineralized tissue formation. The present study investigated whether HSCs such as mineral trioxide aggregate (MTA) affect their biological and antimicrobial properties when used as long-term pulp protection materials. The effect of variables on treatment outcomes of three HSCs (ProRoot MTA, OrthoMTA, and RetroMTA) was evaluated clinically and radiographically over a 48–78 month follow-up period. Survival analysis was performed using Kaplan–Meier survival curves. Fisher’s exact test and Cox regression analysis were used to determine hazard ratios of clinical variables. The overall success rate of MTA partial pulpotomy was 89.3%; Cumulative success rates of the three HSCs were not statistically different when analyzed by Cox proportional hazard regression analysis. None of the investigated clinical variables affected success rates significantly. These HSCs showed favorable biocompatibility and antimicrobial properties in partial pulpotomy of permanent teeth in long-term follow-up, with no statistical differences between clinical factors.

Impact of Hybrid Operating Rooms on Long-Term Clinical Outcomes Following Fenestrated and Branched Endovascular Aortic Repair

2021 ◽  
pp. 152660282199672
Author(s):  
Giovanni Tinelli ◽  
Marie Bonnet ◽  
Adrien Hertault ◽  
Simona Sica ◽  
Gian Luca Di Tanna ◽  
...  
Keyword(s):  
Operating Room ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Statistical Significance ◽  
Aortic Aneurysms ◽  
Study Patient ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
The Impact

Purpose: Evaluate the impact of hybrid operating room (HOR) guidance on the long-term clinical outcomes following fenestrated and branched endovascular repair (F-BEVAR) for complex aortic aneurysms. Materials and Methods: Prospectively collected registry data were retrospectively analyzed to compare the procedural, short- and long-term outcomes of consecutive F-BEVAR performed from January 2010 to December 2014 under standard mobile C-arm versus hybrid room guidance in a high-volume aortic center. Results: A total of 262 consecutive patients, including 133 patients treated with a mobile C-arm equipped operating room and 129 with a HOR guidance, were enrolled in this study. Patient radiation exposure and contrast media volume were significantly reduced in the HOR group. Short-term clinical outcomes were improved despite higher case complexity in the HOR group, with no statistical significance. At a median follow-up of 63.3 months (Q1 33.4, Q3 75.9) in the C-arm group, and 44.9 months (Q1 25.1, Q3 53.5, p=0.53) in the HOR group, there was no statistically significant difference in terms of target vessel occlusion and limb occlusion. When the endograft involved 3 or more fenestrations and/or branches (complex F-BEVAR), graft instability (36% vs 25%, p=0.035), reintervention on target vessels (20% vs 11%, p=0.019) and total reintervention rates (24% vs 15%, p=0.032) were significantly reduced in the HOR group. The multivariable Cox regression analysis did not show statistically significant differences for long-term death and aortic-related death between the 2 groups. Conclusion: Our study suggests that better long-term clinical outcomes could be observed when performing complex F-BEVAR in the latest generation HOR.

scholarly journals First line treatment selection modifies disease course and long-term clinical outcomes in Mycobacterium avium complex pulmonary disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kiyoharu Fukushima ◽  
Seigo Kitada ◽  
Sho Komukai ◽  
Tomoki Kuge ◽  
Takanori Matsuki ◽  
...  
Keyword(s):  
Pulmonary Disease ◽  
Mycobacterium Avium ◽  
Propensity Scores ◽  
Cox Regression ◽  
Line Treatment ◽  
First Line ◽  
Standard Regimen ◽  
Cox Regression Analysis ◽  
First Line Treatment

AbstractThe combination of rifamycin (RFP), ethambutol (EB), and macrolides is currently the standard regimen for treatment of Mycobacterium avium complex pulmonary disease (MAC-PD). However, poor adherence to the standardized regimens recommended by current guidelines have been reported. We undertook a single-centred retrospective cohort study to evaluate the long-term outcomes in 295 patients with MAC-PD following first line treatment with standard (RFP, EB, clarithromycin [CAM]) or alternative (EB and CAM with or without fluoroquinolones (FQs) or RFP, CAM, and FQs) regimens. In this cohort, 80.7% were treated with standard regimens and 19.3% were treated with alternative regimens. After heterogeneity was statistically corrected using propensity scores, outcomes were superior in patients treated with standard regimens. Furthermore, alternative regimens were significantly and independently associated with sputum non-conversion, treatment failure and emergence of CAM resistance. Multivariate cox regression analysis revealed that older age, male, old tuberculosis, diabetes mellitus, higher C-reactive protein, and cavity were positively associated with mortality, while higher body mass index and M. avium infection were negatively associated with mortality. These data suggest that, although different combination regimens are not associated with mortality, first line administration of a standard RFP + EB + macrolide regimen offers the best chance of preventing disease progression in MAC-PD patients.

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