Surgical Strategies and Clinical Outcome of Large to Giant Sphenoid Wing Meningiomas: A Case Series Study

Large to giant sphenoid wing meningiomas (SWMs) remain surgically challenging due to frequent vascular encasement and a tendency for tumoral invasion of the cavernous sinus and optic canal. We aimed to study the quality of resection, postoperative clinical evolution, and recurrence rate of large SWMs. This retrospective study enrolled 21 patients who underwent surgery between January 2014 and December 2019 for SWMs > 5 cm in diameter (average 6.3 cm). Tumor association with cerebral edema, extension into the cavernous sinus or optic canal, degree of encasement of the major intracranial arteries, and tumor resection grade were recorded. Cognitive decline was the most common symptom (65% of patients), followed by visual decline (52%). Infiltration of the cavernous sinus and optical canal were identified in five and six patients, respectively. Varying degrees of arterial encasement were seen. Gross total resection was achieved in 67% of patients. Long-term follow-up revealed improvement in 17 patients (81%), deterioration in two patients (9.5%), and one death (4.7%) directly related to the surgical procedure. Seven patients displayed postoperative tumor progression and two required reintervention 3 years post initial surgery. Tumor size, vascular encasement, and skull base invasion mean that, despite technological advancements, surgical results are dependent on surgical strategy and skill. Appropriate microsurgical techniques can adequately solve arterial encasement but tumor progression remains an issue.

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Extradural anterior clinoidectomy in surgical management of clinoidal meningiomas

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-021-00336-x ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

K. El-Bahy ◽

Ashraf M. Ibrahim ◽

Ibrahim Abdelmohsen ◽

Hatem A. Sabry

Keyword(s):

Cavernous Sinus ◽

Tumor Resection ◽

Visual Outcome ◽

Extent Of Resection ◽

Optic Canal ◽

Falciform Ligament ◽

Cavernous Sinus Invasion ◽

Anterior Clinoidectomy ◽

Microsurgical Techniques

Abstract Background Despite the recent advances in skull base surgery, microsurgical techniques, and neuroimaging, yet surgical resection of clinoidal meningiomas is still a major challenge. In this study, we present our institution experience in the surgical treatment of anterior clinoidal meningiomas highlighting the role of extradural anterior clinoidectomy in improving the visual outcome and the extent of tumor resection. This is a prospective observational study conducted on 33 consecutive patients with clinoidal meningiomas. The surgical approach utilized consisted of extradural anterior clinoidectomy, optic canal deroofing with falciform ligament opening in all patients. The primary outcome assessment was visual improvement and secondary outcomes were extent of tumor resection, recurrence, and postoperative complications. Results The study included 5 males and 28 females with mean age 49.48 ± 11.41 years. Preoperative visual deficit was present in 30 (90.9%) patients. Optic canal involvement was present in 24 (72.7%) patients, ICA encasement was in 16 (48.5%), and cavernous sinus invasion in 8 (24.2%). Vision improved in 21 patients (70%), while 6 patients (20%) had stationary course and 1 patient (3%) suffered postoperative new visual deterioration. Gross total resection was achieved in 24 patients (72.7%). The main factors precluding total removal were cavernous sinus involvement and ICA encasement. Mortality rate was 6.1%; mean follow-up period was 27 ± 13 months. Conclusions In this series, the use of extradural anterior clinoidectomy provided a favorable visual outcome and improved the extent of resection in clinoidal meningioma patients.

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Urinary and sexual functions after surgical treatment of penile fracture concomitant with complete urethral disruption

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2014.1.15 ◽

2014 ◽

Vol 86 (1) ◽

pp. 15 ◽

Cited By ~ 5

Author(s):

Ali Abdel Raheem ◽

Hassan El-Tatawy ◽

Ahmed Eissa ◽

Abdel Hamid Elbahnasy ◽

Mohamed Elbendary

Keyword(s):

Case Series ◽

Surgical Reconstruction ◽

Urethral Injury ◽

Penile Curvature ◽

Retrospective Case ◽

Penile Fracture ◽

Case Series Study ◽

Long Term Follow Up

Objectives: Penile fracture with concomitant complete urethral disruption is an uncommon urologic disorder. Data about the treatment and outcome measurements of this condition are scarce in the literature. The aim of the present study is to evaluate the long term urinary and sexual functions of patients with penile fracture associated with complete urethral injury after immediate surgical reconstruction. Patients and methods: Twelve patients met our inclusion criteria and were included in this retrospective case series study; however, one was lost during follow-up. Patient's medical records were reviewed and all patients were interviewed for clinical evaluation. Urinary function was assessed by history, uroflometry and retrograde urethrography, while, sexual function was assessed by questionnaire (Sexual Health Inventory for Men) and penile Doppler for patients with erectile dysfunction. Results: Patients’ mean age was 32.3 ± 7.5 years (range 21-43) and the mean follow-up period was 72.6 ± 45.4 months (range 14-187). Vigorous sexual intercourse was the main cause in 91% of our patients. No serious long term complications was found. Only 1 patient (9%) suffered from anterior urethral stricture, 1 patient (9%) complained of weak erection, 3 patients (27%) had a palpable fibrosis and 2 patients (18%) reported a slight penile curvature during erection. Ninety one percent of all our patients maintained their normal urinary and sexual functions. Conclusion: On the long term follow-up, most of the patients maintained their normal erectile and voiding functions with no harmful long-term complications. We advocate immediate surgical intervention and reconstruction of both corpora cavernous and urethra as a first line treatment for those patients.

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Efficacy and long-term follow-up of IL-1R inhibitor anakinra in adults with Still's disease: a case-series study

Arthritis Research & Therapy ◽

10.1186/ar3366 ◽

2011 ◽

Vol 13 (3) ◽

pp. R91 ◽

Cited By ~ 70

Author(s):

Katerina Laskari ◽

Athanasios G Tzioufas ◽

Haralampos M Moutsopoulos

Keyword(s):

Case Series ◽

Still’S Disease ◽

Still's Disease ◽

Case Series Study ◽

Long Term Follow Up ◽

Series Study

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NEAR FATAL AMITRAZ: A NOT SO UNCOMMON POISONING

10.36106/gjra/5601517 ◽

2021 ◽

pp. 42-43

Author(s):

Rohan J Desai ◽

Prasad Ugargol

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Clinical Features ◽

Case Series ◽

Agricultural Product ◽

Common Symptom ◽

Retrospective Case ◽

Case Series Study ◽

Cns Depression ◽

Series Study

Background: Amitraz is a pharmaceutical, veterinary, and agricultural product which is used worldwide to control ectoparasites in animals. Its widespread use has led to increased cases of poisoning in rural parts of India. Aim: To study the clinical features, complications, laboratory abnormalities and outcome of the patients with acute amitraz intoxication. Methodology: The study is a retrospective case series study conducted in HSK hospital between the period of Feb 2019 and May 2020. Results: A total of 11 patients were analysed and results revealed CNS depression and vomiting in 8 of those patients with 1 patient with respiratory failure requiring mechanical ventilation. Conclusion: Amitraz poisoning appears to be severe with CNS depression being the most common symptom. But most patients stabilise and recover quickly. Patients should be monitored for respiratory failure as it is a dreadful complication. Treatment is symptomatic as no antidote is available.

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Letter to the editor comments on JPRAS publication “Autologous abdominal wall reconstruction using anterolateral thigh and iliotibial tract flap after extensive tumor resection: A case series study of 50 consecutive cases”

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2020.05.101 ◽

2020 ◽

Author(s):

Jan Jeroen Vranckx

Keyword(s):

Abdominal Wall ◽

Tumor Resection ◽

Abdominal Wall Reconstruction ◽

Case Series ◽

Iliotibial Tract ◽

Letter To The Editor ◽

Case Series Study ◽

Anterolateral Thigh ◽

Series Study

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Endoscopic Endonasal Transmaxillary Transsphenoidal Approach for Excision of a Superior Orbital Fissure-Cavernous Sinus Meningioma: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy093 ◽

2018 ◽

Vol 15 (5) ◽

pp. E61-E62

Author(s):

Ehab El Refaee ◽

Steffen Fleck ◽

Marc Matthes ◽

Henry W S Schroeder

Keyword(s):

Mr Imaging ◽

Cavernous Sinus ◽

Tumor Resection ◽

Middle Turbinate ◽

Lateral Wall ◽

Optic Canal ◽

Superior Orbital Fissure ◽

Endoscopic Endonasal ◽

Cavernous Sinus Meningioma ◽

Left Middle

Abstract We present a 43-old-male who suffered from a slowly progressive loss of vision in the left eye. Magnetic resonance (MR) imaging revealed a well-circumscribed contrast-enhancing lesion in the region of the anterior cavernous sinus and superior orbital fissure that extended into the optic canal. A schwannoma or meningioma was suspected. A transcranial surgery performed at another institution was not successful in removing the tumor and further deterioration of vision occurred. After resection of the left middle turbinate, the sphenoid and maxillary sinus were opened. The bulging of the tumor was seen at the lateral wall of the sphenoid sinus. After bony decompression of the optic canal, the dura was opened. A meningioma was exposed that arose in between the dural layers of the cavernous sinus. A nice dissection plane was found and the tumor was circumferentially dissected and finally totally removed. There were no complications such as double vision or visual field deficit. MR imaging confirmed a total tumor resection. The visual acuity normalized within a few days. MR imaging obtained 3 yr after surgery shows no recurrence.

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Intraoperative ultrasonography for presumed brain metastases: a case series study

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2012001000008 ◽

2012 ◽

Vol 70 (10) ◽

pp. 793-798 ◽

Cited By ~ 6

Author(s):

Helder Picarelli ◽

Marcelo de Lima Oliveira ◽

Edson Bor-Seng-Shu ◽

Eduardo Santamaria Carvalhal Ribas ◽

Alexandre Maria Santos ◽

...

Keyword(s):

Brain Metastases ◽

Functional Outcomes ◽

Systemic Disease ◽

Survival Rates ◽

Tumor Resection ◽

Intraoperative Ultrasound ◽

Case Series ◽

Case Series Study ◽

Actual Contribution ◽

Series Study

Brain metastases (BM) are one of the most common intracranial tumors and surgical treatment can improve both the functional outcomes and patient survival, particularly when systemic disease is controlled. Image-guided BM resection using intraoperative exams, such as intraoperative ultrasound (IOUS), can lead to better surgical results. METHODS: To evaluate the use of IOUS for BM resection, 20 consecutives patients were operated using IOUS to locate tumors, identify their anatomical relationships and surgical cavity after resection. Technical difficulties, complications, recurrence and survival rates were noted. RESULTS: IOUS proved effective for locating, determining borders and defining the anatomical relationships of BM, as well as to identify incomplete tumor resection. No complications related to IOUS were seen. CONCLUSION: IOUS is a practical supporting method for the resection of BM, but further studies comparing this method with other intraoperative exams are needed to evaluate its actual contribution and reliability.

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Evaluation of Musculoskeletal Hydatid Cyst Cases in Terms of Clinical Manifestations, Method of Dealing, Treatment, and Recurrence

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.4274 ◽

2020 ◽

Vol 8 (E) ◽

pp. 99-104

Author(s):

Setareh Soltany ◽

Hamid Reza Hemmati ◽

Jafar Alavy Toussy ◽

Hamid Nazifi ◽

Abbas Alibakhshi ◽

...

Keyword(s):

Differential Diagnosis ◽

Hydatid Cyst ◽

Diagnostic Method ◽

Clinical Manifestations ◽

Case Series ◽

Treatment Method ◽

Common Symptom ◽

Case Series Study ◽

Paravertebral Muscles ◽

Endemic Areas

Hydatid disease is one of the most common parasitic diseases caused by Echinococcus granulosus worm. In this disease, involvement of all organs is likely. However, primary hydatid cysts of muscle tissue are so rare that occasionally in differential diagnosis, cystic masses are not placed in endemic areas. Timely and accurate diagnosis is crucial to prevent unnecessary biopsy. In this case-series study conducted in hospitals of Semnan and Tehran, Iran, from 2009 to 2014, 15 patients with musculoskeletal problems due to hydatid cyst were evaluated. In each case, information about the patient’s clinical manifestations, including initial complaint, cyst location, treatment method, location of involvement organ, duration, dose of drug used and diagnostic method was evaluated. According to results of the present study, the prevalence of musculoskeletal system involvement was 7.21%. The most common site of involvement was spine and paravertebral muscles (7 cases) and the most common symptom was compressive symptoms on the spinal canal. Magnetic resonance imaging was the most commonly used diagnostic method and only in 1 case a wrong pre-operative diagnosis was made. Eleven patients reported a history of recurrence at the site of previous surgery (3 cases of hip involvement and 6 cases of spine involvement). There were 5 cases of recurrence following recent treatment, 2 of which were hip involvement and 2 cases of spine involvement. Furthermore, most patients (12 cases) underwent cyst resection surgery. The results of this study showed that although hydatid cystic skeletal muscle is rare, due to the possibility of repeated recurrence, especially in cases of spine and bone involvement, endemic areas should be considered in the differential diagnosis of each cystic mass of muscle and bone.

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Intracranial solitary fibrous tumor/hemangiopericytoma – A case series

Surgical Neurology International ◽

10.25259/sni_490_2020 ◽

2020 ◽

Vol 11 ◽

pp. 414

Author(s):

Chi-Man Yip ◽

Shu-Shong Hsu ◽

Wei-Chuan Liao ◽

Szu-Hao Liu ◽

Yung-Shang Lin ◽

...

Keyword(s):

Solitary Fibrous Tumor ◽

Adjuvant Radiotherapy ◽

Tumor Resection ◽

Case Series ◽

Extent Of Resection ◽

Treatment Modalities ◽

Total Resection ◽

Initial Surgery ◽

Fibrous Tumor

Background: Intracranial solitary fibrous tumor/hemangiopericytoma (HPC) is a rare and aggressive tumor. We conducted this retrospective study to investigate the outcome of patients after treatment, the efficacy of postoperative adjuvant radiotherapy, and the factors not conducive to total resection. Methods: We conducted a retrospective review of the medical records of patients harboring fresh intracranial solitary fibrous tumor/HPC treated from January 2009 to December 2019 in our hospital. We reviewed their clinical presentations, radiologic appearances, tumor size and location, extent of resection, estimate intraoperative blood loss, treatment modalities and results, and duration of follow-up. Results: There were seven consecutive patients (three males and four females). The ages of the patients at the time of diagnosis ranged from 35 to 77 years (mean: 52.86 years). Five patients (71.43%) got tumor bigger than 5 cm in dimension and only 1 patient (14.29%) underwent gross total tumor resection in the first operation without complication. Five patients (71.43%) underwent postoperative adjuvant radiotherapy. Follow-up period ranged from 4.24 to 123.55 months and the median follow-up period was 91.36 months. Three patients had favorable outcome with Glasgow Outcome Scale (GOS) equal to 4; four patients had unfavorable outcome with GOS equal to 2 or 3. No mortality was happened. Conclusion: Gross total tumor resection in the initial surgery is very important to achieve a better outcome. Massive intraoperative bleeding and venous sinus or major vessels adjoining are factors not conducive to total resection. Radiotherapy can be administered as adjuvant therapy for cases showing an aggressive phenotype or not treated with gross total resection.

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