scholarly journals Anti-reflux surgery for gastroesophageal reflux in neurological impaired and non-impaired children: Long term outcomes after a median follow-up of more than 10 years

2020 ◽  
pp. 138-146
Keyword(s):  
Gastroesophageal Reflux ◽  
Medication Administration ◽  
P Value ◽  
Safe Procedure ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Laparoscopic Nissen ◽  
Clinical Records

Introduction: The durability of a fundoplication (FP) in the treatment of gastroesophageal reflux disease (GERD) in children must be confirmed in the long-term. This study aimed to present the long-term outcome after a minimum of five years. Methods: Perioperative data were retrospectively reviewed from clinical records, and the follow-up data were collected through a standardized questionnaire. In total, 21 neurologically impaired (NI) and nine neurologically non-impaired (NNI) children were included in this study. The statistical analysis was performed using SPSS software (version 25) through Fisher’s exact test, t-test, and Kaplan-Meier analysis. A p-value of less than 0.05 was considered statistically significant. Results: The median follow-up period was 10.8 years (5-19.7), and the refundoplication rates ranged from 11% to 19%. Revisions were usually necessary within the first two postoperative years. Most delayed refundoplications were necessary for the NI children with a laparoscopic Nissen FP. In the long-term, symptoms and medication administration program were favorable in most cases. Most parents were highly satisfied with the postoperative outcome and would approve that FP is conducted on their child again under the same circumstances. Conclusions: The FP is a safe procedure with consistent benefits in the first 10 postoperative years in NI and NNI children with documented GERD. The NI children treated with a laparoscopic Nissen FP necessitate longer postoperative surveillance since more delayed redofundoplications were required in this group.

scholarly journals Cavernous Malformation of Brainstem, Thalamus, and Basal Ganglia

Neurosurgery ◽  
2012 ◽  
Vol 72 (4) ◽  
pp. 573-589 ◽  
Author(s):  
Paritosh Pandey ◽  
Erick M. Westbroek ◽  
Peter A. Gooderham ◽  
Gary K. Steinberg
Keyword(s):  
Basal Ganglia ◽  
Neurological Deficits ◽  
Term Outcome ◽  
Cavernous Malformations ◽  
Long Term Outcome ◽  
Brain Malformations ◽  
Hemorrhage Risk ◽  
Clinical Records

Abstract BACKGROUND: Cavernous malformations (CMs) in deep locations account for 9% to 35% of brain malformations and are surgically challenging. OBJECTIVE: To study the clinical features and outcomes following surgery for deep CMs and the complication of hypertrophic olivary degeneration (HOD). METHODS: Clinical records, radiological findings, operative details, and complications of 176 patients with deep CMs were reviewed retrospectively. RESULTS: Of 176 patients with 179 CMs, 136 CMs were in the brainstem, 27 in the basal ganglia, and 16 in the thalamus. Cranial nerve deficits (51.1%), hemiparesis (40.9%), numbness (34.7%), and cerebellar symptoms (38.6%) presented most commonly. Hemorrhage presented in 172 patients (70 single, 102 multiple). The annual retrospective hemorrhage rate was 5.1% (assuming CMs are congenital with uniform hemorrhage risk throughout life); the rebleed rate was 31.5%/patient per year. Surgical approach depended on the proximity of the CM to the pial or ependymal surface. Postoperatively, 121 patients (68.8%) had no new neurological deficits. Follow-up occurred in 170 patients. Delayed postoperative HOD developed in 9/134 (6.7%) patients with brainstem CMs. HOD occurred predominantly following surgery for pontine CMs (9/10 patients). Three patients with HOD had palatal myoclonus, nystagmus, and oscillopsia, whereas 1 patient each had limb tremor and hemiballismus. At follow-up, 105 patients (61.8%) improved, 44 (25.9%) were unchanged, and 19 (11.2%) worsened neurologically. Good preoperative modified Rankin Score (98.2% vs 54.5%, P = .001) and single hemorrhage (89% vs 77.3%, P < .05) were predictive of good long-term outcome. CONCLUSION: Symptomatic deep CMs can be resected with acceptable morbidity and outcomes. Good preoperative modified Rankin Score and single hemorrhage are predictors of good long-term outcome.

Complex basilar artery aneurysms treated using surgical basilar occlusion: a modern case series

2011 ◽  
Vol 115 (2) ◽  
pp. 319-327 ◽  
Author(s):  
Christopher P. Kellner ◽  
Raqeeb M. Haque ◽  
Philip M. Meyers ◽  
Sean D. Lavine ◽  
E. Sander Connolly ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Case Series ◽  
Endovascular Techniques ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Complex Aneurysms ◽  
Long Term Follow Up ◽  
Clinical Records

Object Complex aneurysms of the basilar artery (BA) apex can be successfully treated using surgical occlusion of the proximal BA. Since the introduction of the Guglielmi detachable coil in 1991, the focus on treating BA aneurysms has been on using endovascular techniques. Outcomes with endovascular techniques have been less than optimal for large and complex aneurysms. The authors therefore report on their current 22-year experience with surgical BA occlusion for complex BA aneurysms and long-term outcome. Methods Fifteen patients underwent surgical BA occlusion at Columbia University Medical Center for complex basilar apex aneurysms between 1987 and 2009. The clinical records of each patient were reviewed for details of presentation, hospital course, operative intervention, and outcome. Results Postoperatively, all patient encounters were recorded at discharge, at the 1-month and 1-year follow-up evaluations, and at long-term outcome. Twelve (80%) of 15 patients experienced no new postoperative neurological deficits. Three patients presenting with severe neurological impairment (modified Rankin Scale [mRS] score > 3) made excellent recoveries (mRS Scores 1–2) at long-term follow-up. One patient died, 1 suffered a stroke during the postoperative angiogram which resulted in hemiparesis, and 1 suffered internuclear ophthalmoplegia which resolved by the 1-month follow-up. Long-term follow-up occurred at an average of 3 ± 4.5 years, ranging from 2 months (for a recently treated patient) to 18 years. The average mRS score at long-term follow-up was 1 ± 1.5. No patient experienced postoperative hemorrhage, rebleeding, or delayed neurological deterioration. Conclusions Surgical occlusion of the BA is an effective treatment option offering a high rate of angiographic cure in a single procedure for patients with complex BA aneurysms. The ability to surgically perform point occlusion of the BA without impairment of brainstem perforators, while maintaining collateral blood flow to the posterior circulation branch vessels, may provide an advantage compared with endovascular treatments.

scholarly journals Long-term outcome following lateral foraminotomy as treatment for canine degenerative lumbosacral stenosis

2018 ◽  
Vol 183 (11) ◽  
pp. 352-352 ◽  
Author(s):  
Sergio Andrade Gomes ◽  
Mark Lowrie ◽  
Mike Targett
Keyword(s):  
Clinical Signs ◽  
Effective Procedure ◽  
Foraminal Stenosis ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Dorsal Laminectomy ◽  
Clinical Records

Lateral foraminotomy has been described as an effective surgical treatment for foraminal stenosis in the treatment of degenerative lumbosacral stenosis (DLSS) in dogs. Clinical records were reviewed from 45 dogs which had undergone lateral foraminotomy at the lumbosacral junction either alone or in combination with decompressive midline dorsal laminectomy. Short-term outcome at six weeks was assessed by the surgeon to be good (11.1 per cent) or excellent (88.9 per cent) in all 45 cases. Long-term outcome beyond six months for lumbosacral syndrome was assessed by the owner as excellent in all 34 cases for which follow-up was available despite recurrence in five cases. Recurrence of clinical signs was not related to re-establishment of foraminal compression at the surgical site when assessed on repeat MRI and was managed by either contralateral foraminotomy in one case or conservative management with excellent response. This study confirms lateral foraminotomy as an effective procedure in the management of DLSS-affected dogs suffering from foraminal stenosis and demonstrates that initial good short-term results are maintained long term despite some treatable recurrences. Lateral foraminotomy is an effective procedure when used appropriately in DLSS with foraminal stenosis either alone or in combination with midline dorsal laminectomy.

Multilevel oblique corpectomy without fusion in managing cervical myelopathy: long-term outcome and stability evaluation in 268 patients

2009 ◽  
Vol 10 (5) ◽  
pp. 458-465 ◽  
Author(s):  
Salvatore Chibbaro ◽  
Giuseppe Mirone ◽  
Orphée Makiese ◽  
Bernard George
Keyword(s):  
Spinal Canal ◽  
Japanese Orthopaedic Association ◽  
Spinal Stability ◽  
Safe Procedure ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Oblique Corpectomy ◽  
A Prospective Study

Object The multilevel oblique corpectomy (MOC) allows widening of the spinal canal and foramen trough via an anterolateral access to the cervical spine with control of the vertebral artery and does not require vertebral stabilization or fusion. In the present study, the authors' goal was to demonstrate the long-term efficacy and safety of MOC in the treatment of selected cases of spondylotic myelopathy. Methods The authors conducted a prospective study in a series of 268 patients who underwent MOC for cervical spondylotic myelopathy over a 14-year period. Preoperative and postoperative neurological functioning were evaluated with the modified Japanese Orthopaedic Association scale. Spinal stability was assessed in all patients on serial plain and dynamic cervical radiographs at the last follow-up. The degree of canal expansion after MOC was also measured using the spinal canal/vertebral body ratio, and directly by measuring the diameter of osseous canal on pre- and postoperative CT scans and high-resolution MR images. Results At a mean follow-up of 96 months, clinical improvement was recorded in 86.6% of patients with a global recovery rate of 87.6%, clinical stability in 8%, and worsening in 5%. Long-term spinal stability was demonstrated in 98% of patients. Conclusions Multilevel oblique corpectomy was demonstrated to be a safe procedure that provided good results in terms of improved functional status and long-term spinal stability.

Long-term outcome of surgically and medically treated patients with gastroesophageal reflux disease: A matched-pair follow-up study

2005 ◽  
Vol 40 (3) ◽  
pp. 264-274 ◽  
Author(s):  
Petter Olberg ◽  
Rune Johannessen ◽  
Gjermund Johnsen ◽  
Helge E. Myrvold ◽  
Tormod Bjerkeset ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Matched Pair ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Follow Up Study
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