Routinely Performed Serial Follow-Up Imaging in Asymptomatic Patients With Multiple Cerebral Cavernous Malformations Has No Influence on Surgical Decision Making

OBJECTIVEThe aim of this study was to assess the usefulness of radiological parameters for surgical decision-making in patients with degenerative lumbar scoliosis (DLS) by comparing the clinical and radiological results after decompression or decompression and fusion surgery.METHODSThe authors prospectively planned surgical treatment for 298 patients with degenerative lumbar disease between September 2005 and March 2013. The surgical method used at their institution to address intervertebral instability is precisely defined based on radiological parameters. Among 64 patients with a Cobb angle ranging from 10° to 25°, 57 patients who underwent follow-up for more than 2 years postoperatively were evaluated. These patients were divided into 2 groups: those in the decompression group underwent decompression alone (n = 25), and those in the fusion group underwent decompression and short segmental fusion (n = 32). Surgical outcomes were reviewed, including preoperative and postoperative Cobb angles, lumbar lordosis based on radiological parameters, and Japanese Orthopaedic Association (JOA) scores.RESULTSThe JOA scores of the decompression group and fusion group improved from 5.9 ± 1.6 to 10.0 ± 2.8 and from 7.2 ± 2.0 to 11.3 ± 2.8, respectively, which was not significantly different between the groups. At the final follow-up, the postoperative Cobb angle in the decompression group changed from 14° ± 2.9° to 14.3° ± 6.4° and remained stable, while the Cobb angle in the fusion group decreased from 14.8° ± 4.0° to 10.0° ± 8.5° after surgery.CONCLUSIONSThe patients in both groups demonstrated improved JOA scores and preserved Cobb angles after surgery. The improvement in JOA scores and preservation of Cobb angles in both groups show that the evaluation of spinal instability using radiological parameters is appropriate for surgical decision-making.

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Role of sciatic nerve stiffness in surgical decision making and follow up in patients with deep gluteal syndrome

10.1101/390120 ◽

2018 ◽

Cited By ~ 1

Author(s):

Sava Stajic ◽

Aleksandar Vojvodic ◽

Luis Perez Carro ◽

Jelena Mihailovic ◽

Milos Gasic ◽

...

Keyword(s):

Decision Making ◽

Sciatic Nerve ◽

Knee Flexion ◽

Acoustic Radiation Force Impulse ◽

Stiffness Ratio ◽

Surgical Decision ◽

Strain Elastography ◽

Deep Gluteal Syndrome ◽

Surgical Decision Making

AbstractThe study shows the relevance of sciatic nerve stiffness assessed by strain elastography using ARFI (Acoustic Radiation Force Impulse) for surgical decision making and the follow up of patients with deep gluteal syndrome (DGS). The research focuses on nerve stiffness associated with knee movements in order to determine the degree of nerve entrapment. Neurological examination, MRI of pelvis and electromyography (EMG) were performed as well. The sciatic nerve was scanned by ARFI (strain) elastography during knee movements in patients with DGS (143). In 54 patients surgical treatment was indicated, while 24 of them underwent surgery. The results were based on tissue response to ARFI by color elastogram and stiffness ratio. Diameters of the sciatic nerve in patients with DGS during knee flexion were statistically significantly lower than during extension movement (p<0.01). In patients with DGS (in ones without indication and the ones scheduled for surgery) sciatic nerve stiffness ratio was significantly increased (p<0.01) during knee flexion. Patients scheduled for surgery confirmed increased sciatic nerve stiffness during knee movements, compared with those without indications for surgery (p<0.05). Sciatic nerve recovery after surgery by diameter and stiffness ratio was marked (r=0.881). The correlation between MRI and EMG findings and ARFI nerve stiffness values in patients scheduled for surgery was high (r=0.963). The overall specificity of method was 93.5%, sensitivity was 88.9% with accuracy of 90.6%. ARFI elastography (by strain) is a diagnostic procedure based on nerve stiffness assessment and a useful tool in decision making for surgery and the follow up.

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Isolated Congenital Right Atrial Aneurysm: Monitoring Parameters for Asymptomatic Patients

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135116682466 ◽

2016 ◽

Vol 11 (4) ◽

pp. NP7-NP10

Author(s):

Pooja Desai ◽

Vitor C. Guerra ◽

Christian Lilje

Keyword(s):

Decision Making ◽

Medical Management ◽

Right Atrial ◽

Prophylactic Surgery ◽

Indications For Surgery ◽

Surgical Decision ◽

Asymptomatic Patients ◽

Right Atrial Aneurysm ◽

Surgical Decision Making ◽

Right Atria

Isolated congenital right atrial aneurysm is rare. Indications for surgery in asymptomatic patients with moderate-size right atria remain controversial. Evidence in support of medical management and timing of prophylactic surgery is reviewed. We propose the use of three echocardiographic indices to help identify inappropriate atrial growth and facilitate surgical decision-making.

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Prospective follow-up of 33 asymptomatic patients with familial cerebral cavernous malformations

Neurology ◽

10.1212/wnl.57.10.1825 ◽

2001 ◽

Vol 57 (10) ◽

pp. 1825-1828 ◽

Cited By ~ 89

Author(s):

P. Labauge ◽

L. Brunereau ◽

S. Laberge ◽

J.-P. Houtteville

Keyword(s):

Cerebral Cavernous Malformations ◽

Cavernous Malformations ◽

Asymptomatic Patients ◽

Familial Cerebral Cavernous Malformations

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Management of idiopathic pediatric syringohydromyelia

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.3.peds14433 ◽

2015 ◽

Vol 16 (4) ◽

pp. 452-457 ◽

Cited By ~ 8

Author(s):

Analiz Rodriguez ◽

Elizabeth N. Kuhn ◽

Aravind Somasundaram ◽

Daniel E. Couture

Keyword(s):

Decision Making ◽

Clinical Course ◽

Inclusion Criteria ◽

Single Institution ◽

Surgical Decision ◽

Spinal Imaging ◽

Spinal Mri ◽

Surgical Decision Making ◽

Median Maximum

OBJECT Syringohydromyelia is frequently identified on spinal imaging. The literature provides little guidance to decision making regarding the need for follow-up or treatment. The purpose of this study was to review the authors' experience in managing pediatric syringohydromyelia of unknown cause. METHODS A single-institution retrospective review of all cases involving pediatric patients who underwent spinal MRI from 2002 to 2012 was conducted. Patients with idiopathic syringohydromyelia (IS) were identified and categorized into 2 subgroups: uncomplicated idiopathic syrinx and IS associated with scoliosis. Clinical and radiological course were analyzed. RESULTS Ninety-eight patients (50 female, 48 male) met the inclusion criteria. Median age at diagnosis of syrinx was 11.9 years. Median maximum syrinx size was 2 mm (range 0.5–17 mm) and spanned 5 vertebral levels (range 1–20 vertebral levels). Thirty-seven patients had scoliosis. The most common presenting complaint was back pain (26%). Clinical follow-up was available for 78 patients (80%), with a median follow-up of 20.5 months (range 1–143 months). A neurological deficit existed at presentation in 36% of the patients; this was either stable or improved at last follow-up in 64% of cases. Radiological follow-up was available for 38 patients (39%), with a median duration of 13 months (range 2–83 months). There was no change in syrinx size in 76% of patients, while 16% had a decrease and 8% had an increase in syrinx size. Thirty-six patients had both clinical and radiological follow-up. There was concordance between clinical and radiological course in 14 patients (39%), with 11 patients (31%) showing no change and 3 patients (8%) showing clinical and radiological improvement. No patients had concurrent deterioration in clinical and radiological course. One patient with scoliosis and muscular dystrophy underwent direct surgical treatment of the syrinx and subsequently had a deteriorated clinical course and decreased syrinx size. CONCLUSIONS There remains a paucity of data regarding the management of pediatric IS. IS in association with scoliosis can complicate neurosurgical decision making. There was no concordance between radiological syrinx size increase and clinical deterioration in this cohort, indicating that surgical decision making should reflect clinical course as opposed to radiological course.

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Association of Biopsy Procedures During Follow-up for Breast Cancer With Surgical Decision Making in Patients

JAMA Surgery ◽

10.1001/jamasurg.2017.5573 ◽

2018 ◽

Vol 153 (6) ◽

pp. 569

Author(s):

Cheng-Har Yip

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Surgical Decision ◽

Surgical Decision Making

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Schizencephaly and intractable epilepsy: an FDG-PET study

Journal of the International Child Neurology Association ◽

10.17724/jicna.2016.117 ◽

2017 ◽

Author(s):

Tuhina Govil-Dalela ◽

Ajay Kumar ◽

Praneetha Konka ◽

Harry T Chugani

Keyword(s):

Decision Making ◽

Fdg Pet ◽

Intractable Epilepsy ◽

Infantile Spasms ◽

Contralateral Hemisphere ◽

Complex Partial Seizures ◽

Surgical Decision ◽

Unilateral Disease ◽

Surgical Decision Making

Background: To assess the role of 2-deoxy-2(18F)-fluoro-D-glucose positron emission tomography (FDG-PET) scans in the comprehensive evaluation and surgical decision-making in patients with schizencephaly. Methods: We evaluated 11 patients (8M) with schizencephaly (mean follow-up: 4.5 years), including detailed clinical, MRI, FDG-PET, EEG, surgical and neuropathology data. Results: Eight patients had unilateral and three had bilateral clefts on MRI. Mean age at seizure onset was 20 months, with seizure being frequent in 10 and rare in one. Multiple seizure types were noted, with complex partial seizures being the most common (n=8) followed by infantile spasms (n=6). FDG-PET showed larger area of involvement than MRI in all the patients which corresponded better with the electrophysiological changes. Five patients (with unilateral disease on MRI) underwent epilepsy surgery (4 hemispherectomy and 1 multilobar resection). Two patients with focal defect on MRI underwent hemispherectomy due to larger area of abnormality revealed by FDG-PET. One patient was excluded from the surgery due to bilateral abnormalities on FDG PET. Six patients (4 with surgery) were seizure-free at last follow-up (average seizure-free duration: 70 months). One patient who underwent hemispherectomy due to apparently unilateral disease on both video-EEG and MRI but having bilateral abnormality on PET continued to have seizures. ACTH treatment had only a brief (1 month to 1 year) or no response in the six infantile spasms patients. Conclusions: FDG-PET typically shows a much larger area of involvement than MRI thus supplementing MRI in defining the full extent of malformation and assessing the functional integrity of the contralateral hemisphere. FDG-PET may prove to be a useful tool to aid in surgical decision-making and predicting surgical outcome, as patients with contralateral abnormality on FDG-PET may have poor surgical outcomes. When the malformation is unilateral with an intact contralateral hemisphere, surgery (usually hemispherectomy) may be curative of the epilepsy.

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International survey on the management of lumbosacral cutaneous stigmata in infants with suspected occult spinal dysraphism

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.5.peds2126 ◽

2021 ◽

pp. 1-8

Author(s):

Konstantina Svokos ◽

Lígia Batista-Silverman ◽

Sarah J. Graber ◽

Brent R. O’Neill ◽

Michael H. Handler

Keyword(s):

Decision Making ◽

Practice Patterns ◽

Spinal Dysraphism ◽

Conus Medullaris ◽

Ultrasound Screening ◽

Filum Terminale ◽

Occult Spinal Dysraphism ◽

Surgical Decision ◽

Asymptomatic Patients ◽

Surgical Decision Making

OBJECTIVE Occult spinal dysraphism (OSD) is a common pediatric neurosurgical diagnosis rife with controversy surrounding both the screening of asymptomatic infants and the threshold to offer a prophylactic detethering operation. The authors sought to clarify international practice patterns with a survey of pediatric neurosurgeons. METHODS A survey asked pediatric neurosurgeons whether they would perform imaging in patients with a variety of cutaneous stigmata associated with OSD and whether they would offer prophylactic detethering surgery for asymptomatic patients with a variety of imaging findings on the OSD spectrum. RESULTS Completed surveys were received from 141 pediatric neurosurgeons. Broad consensus was demonstrated on the need for obtaining images in sample patients with more severe stigmata ranging from large lipoma with a skin appendage to focal dysplastic skin in the lumbar midline. Ninety percent of respondents would perform MRI for these patients. In contrast, for patients with a low-sacral dimple, flat hemangioma, and symmetric (Y-shaped) splaying of the intergluteal cleft, opinion on the need for imaging varied considerably (between 57% and 89% recommended imaging). Respondents differed on the type of imaging that they would perform, with 31% to 38% recommending ultrasound screening. The responses reflected less consensus on when to offer surgery to patients with simple spinal tethering (low-lying conus medullaris and fatty filum terminale). Both a lower level of the conus and increased thickness of the filum terminale affected decision-making. CONCLUSIONS The results of this survey showed significant consensus on the recommendation for screening imaging in patients with more dramatic cutaneous stigmata, although these stigmata are the rarest. A significant variance in opinions was reflected in the recommendation for imaging of the most common cutaneous stigmata. Consensus was also lacking on which lesions deserve prophylactic detethering surgery. Significant equipoise exists for future study of screening imaging and of surgical decision-making in patients with asymptomatic OSD and associated cutaneous stigmata.

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