scholarly journals Endoscopic and Endoscopically-Assisted Resection of Intraventricular Lesions Using a Neuroendoscopic Ultrasonic Aspirator

2021 ◽  
Vol 10 (17) ◽  
pp. 3889
Author(s):  
Florian Ebel ◽  
Ladina Greuter ◽  
Maria Licci ◽  
Raphael Guzman ◽  
Jehuda Soleman
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Pediatric Patients ◽  
Case Series ◽  
Retrospective Case ◽  
Total Resection ◽  
Size Consistency ◽  
Ultrasonic Aspirator ◽  
Type Size ◽  
Permanent Morbidity

The development of minimally invasive neuroendoscopy has advanced in recent years. The introduction of the neuroendoscopic ultrasonic aspirator (NUA) broadened the treatment spectrum of neuroendoscopy. We aim to describe our experience with the use of NUA for the resection of intraventricular lesions. Here, we present consecutive retrospective case series of adult and pediatric patients undergoing resection of an intraventricular lesion with a NUA (Endoscopic Neurosurgical Pen, Söring GmbH, Quickborn, Germany) between January 2019 and April 2020. Eight patients between the age of 0.5 and 73 years underwent surgery using NUA and were included in this study. In four patients, an endoscopic assisted (EA) resection of the lesion was undertaken, while in four patients, the lesion was removed using purely endoscopic (PE) resection. In all cases, gross/near total resection was achieved. The average blood loss was 142.5 ± 90.4 mL (range 50–300 mL). Transient morbidity was seen in four patients (50%), while permanent morbidity or mortality did not occur. The NUA seems to be a safe and valuable tool for the minimally invasive resection of intraventricular lesions in selected cases. The type, size, consistency, and vascularization of the lesion limit at times the purely endoscopic use of the NUA.

scholarly journals Macrophage Activation Syndrome in Adults: A Retrospective Case Series

2021 ◽  
Vol 9 ◽  
pp. 232470962110264
Author(s):  
Taylor Warmoth ◽  
Malvika Ramesh ◽  
Kenneth Iwuji ◽  
John S. Pixley
Keyword(s):  
Macrophage Activation Syndrome ◽  
Macrophage Activation ◽  
Pediatric Patients ◽  
Inflammatory Diseases ◽  
Systemic Juvenile Idiopathic Arthritis ◽  
Case Series ◽  
Adult Patients ◽  
Retrospective Case ◽  
Life Threatening ◽  
Activation Syndrome

Macrophage activation syndrome (MAS) is a form of hemophagocytic lymphohistocytosis that occurs in patients with a variety of inflammatory rheumatologic conditions. Traditionally, it is noted in pediatric patients with systemic juvenile idiopathic arthritis and systemic lupus erythematous. It is a rapidly progressive and life-threatening syndrome of excess immune activation with an estimated mortality rate of 40% in children. It has become clear recently that MAS occurs in adult patients with underlying rheumatic inflammatory diseases. In this article, we describe 6 adult patients with likely underlying MAS. This case series will outline factors related to diagnosis, pathophysiology, and review present therapeutic strategies.

scholarly journals Impact of Tonsillectomy on Obesity in Pediatric Patients With Sleep-Disordered Breathing

OTO Open ◽  
2021 ◽  
Vol 5 (4) ◽  
pp. 2473974X2110591
Author(s):  
Rohith S. Voora ◽  
Daniela Carvalho ◽  
Wen Jiang
Keyword(s):  
Sleep Disordered Breathing ◽  
Weight Status ◽  
Pediatric Patients ◽  
Case Series ◽  
Surgical Indication ◽  
Strongly Correlated ◽  
Retrospective Case ◽  
Academic Center ◽  
Disordered Breathing

Objective Both tonsillar hypertrophy and obesity contribute to pediatric sleep-disordered breathing (SDB). Tonsillectomy addresses anatomical obstruction causing SDB; however, it may adversely affect the obesity profile postoperatively. Herein, we investigate posttonsillectomy body mass index (BMI) changes in pediatric patients. Study Design Retrospective case series. Setting Tertiary, pediatric urban academic center. Methods All patients undergoing tonsillectomy from January 1, 2016, to December 31, 2016, were included. Patients’ age, sex, surgical indication, and preoperative BMI were recorded. Postoperative BMI data were collected between March 1, 2016, and December 31, 2017. Statistical analysis was performed using a generalized regression model, using BMI percentile-for-age weight status. Results A total of 1153 patients were included (50% female), with age ranging from 2.0 to 19.5 years (mean [SD], 7.6 [4.0]). The majority (87.8%) had tonsillectomy for SDB. Of the cohort, 560 (48.6%) had available follow-up BMI data. The BMI percentile on the day of the surgery had a median of 65.8, and the BMI percentile on follow-up had a median of 76.4. The median time to follow-up was 197 days with a range of 50 to 605 days. Higher postoperative BMI percentile strongly correlated to higher preoperative BMI percentile ( P < .001), as well as younger age ( P < .001), male sex ( P = .0005), and SDB as a surgical indication ( P = .003). Conclusion We observed a significant increase in BMI percentile following tonsillectomy, which accounted for a significantly higher proportion of the cohort being classified as overweight or obese postoperatively. These findings necessitate greater preoperative counseling, closer follow-up, and adjunctive measures for obesity management in pediatric patients undergoing tonsillectomy.

Use of the SpineJack direct reduction for treating type A2, A3 and A4 fractures of the thoracolumbar spine: a retrospective case series

2021 ◽  
pp. neurintsurg-2021-017682
Author(s):  
Giorgio Lofrese ◽  
Luca Ricciardi ◽  
Pasquale De Bonis ◽  
Francesco Cultrera ◽  
Michele Cappuccio ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Direct Reduction ◽  
Thoracolumbar Spine ◽  
Case Series ◽  
Osteoporotic Fractures ◽  
Neurological Impairment ◽  
Radiological Outcome ◽  
Retrospective Case ◽  
Younger Patients ◽  
Kyphosis Correction

BackgroundCompression injuries of the thoracolumbar spine without neurological impairment are usually treated with minimally invasive procedures. Intravertebral expandable implants represent an alternative strategy in fractures with low fragments’ displacement.MethodsPatients with A2, A3 and A4 fractures of the T10–L2 spinal segment without neurological impairment, fracture gap >2 mm, vertebra plana, pedicle rupture, pedicle diameter <6 mm, spinal canal encroachment ≥50%, and vertebral body spread >30% were treated with the SpineJack device. Patients with pathological/osteoporotic fractures were excluded. Demographic and fracture-related data were assessed together with vertebral kyphosis correction, vertebral height restoration/loss of correction and final kyphosis. The modified Rankin Scale (mRS), Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), Smiley–Webster Pain Scale (SWPS) and EuroQol-5D (EQ-5D) were evaluated at 1 (-post), 6 and 12 months (-fup) after surgery. Statistical analysis was performed and p values ≤0.05 were considered significant.ResultsFifty-seven patients were included in the study. Patients aged >60 years reported worse kyphosis correction (<4°) with more postoperative complications, while vertebral plasticity in younger patients, fragmentation-related greater remodeling in A3/A4 fractures, and treatments within 7 days of trauma determined superior wedging corrections, with better EQ-5D-post and mRS-fup. Cement leakages did not affect functional outcome, while female gender and American Society of Anesthesiologists (ASA) score of 3–4 were associated with worse ODI-fup and VAS-fup. Although fracture characteristics and radiological outcome did not negatively influence the clinical outcome, A2 fracture was a risk factor for complications, thus indirectly compromising both the functional and radiological outcome.ConclusionWith spread of <30%, the SpineJack is an alternative to minimally invasive fixations for treating A3/A4 thoracolumbar fractures, being able to preserve healthy motion segments in younger patients and provide an ultra-conservative procedure for elderly and fragile patients.

scholarly journals Posterior Minimally Invasive Transpedicular Approach for Giant Calcified Thoracic Disc Herniation

2020 ◽  
pp. 219256822093327 ◽  
Author(s):  
Daniel Shedid ◽  
Zhi Wang ◽  
Ahmad Najjar ◽  
Sung-Joo Yuh ◽  
Ghassan Boubez ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Disc Herniation ◽  
Case Series ◽  
Thoracic Disc Herniation ◽  
Retrospective Case ◽  
Tubular Retractor ◽  
Posterior Surgery ◽  
Transpedicular Approach ◽  
Dural Tears ◽  
Thoracic Disc

Study Design: Retrospective case series. Objective: Posterior surgery for thoracic disc herniation was associated with increased morbidity and mortality and new minimally invasive approaches have been recommended for soft disc herniation but not for calcified central disc. The objective of this study is to describe a posterolateral microscopic transpedicular approach for central thoracic disc herniation. Methods: This is a single center retrospective review of all the cases of giant thoracic calcified disc herniation as defined by Hott et al. Presence of myelopathy, percentage of canal compromise, T2 hypersignal, ASIA score, and ambulatory status were recorded. This posterolateral technique using a tubular retractor was thoroughly described. Results: Eight patients were operated upon with a mean follow-up of 16 months. Mean canal compromise was 61%. Mean operative time was 228 minutes and mean operative bleeding was 250 mL. There were no cases of dural tear or neurologic degradation. Conclusion: This is the first report of posterior minimally invasive transpedicular approach for giant calcified disc herniation. There were neither cases of neurological deterioration nor increased rate of dural tears. This technique is thus safe and could be recommended for treatment of this rare disease.

scholarly journals Effect of Mini-invasive Floating Metatarsal Osteotomy on Plantar Pressure in Patients With Diabetic Plantar Metatarsal Head Ulcers

2020 ◽  
pp. 107110072097609
Author(s):  
Eran Tamir ◽  
Michael Tamar ◽  
Moshe Ayalon ◽  
Shlomit Koren ◽  
Noam Shohat ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Plantar Pressure ◽  
Case Series ◽  
Metatarsal Head ◽  
Metatarsal Osteotomy ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Retrospective Case Series ◽  
Pressure Time ◽  
Peak Plantar Pressure

Background: Distal metatarsal osteotomy has been used to alleviate plantar pressure caused by anatomic deformities. This study’s purpose was to examine the effect of minimally invasive floating metatarsal osteotomy on plantar pressure in patients with diabetic metatarsal head ulcers. Methods: We performed a retrospective case series of prospectively collected data on 32 patients with diabetes complicated by plantar metatarsal head ulcers without ischemia. Peak plantar pressure and pressure time integrals were examined using the Tekscan MatScan prior to surgery and 6 months following minimally invasive floating metatarsal osteotomy. Patients were followed for complications for at least 1 year. Results: Peak plantar pressure at the level of the osteotomized metatarsal head decreased from 338.1 to 225.4 kPa ( P < .0001). The pressure time integral decreased from 82.4 to 65.0 kPa·s ( P < .0001). All ulcers healed within a mean of 3.7 ± 4.2 weeks. There was 1 recurrence (under a hypertrophic callus of the osteotomy) during a median follow-up of 18.3 months (range, 12.2-27). Following surgery, adjacent sites showed increased plantar pressure and 4 patients developed transfer lesions (under an adjacent metatarsal head); all were managed successfully. There was 1 serious adverse event related to surgery (operative site infection) that resolved with antibiotics. Conclusion: This study showed that the minimally invasive floating metatarsal osteotomy successfully reduced local plantar pressure and that the method was safe and effective, both in treatment and prevention of recurrence. Level of Evidence: Level III, retrospective case series of prospectively collected data.

scholarly journals Instrumentation Removal following Minimally Invasive Posterior Percutaneous Pedicle Screw-Rod Stabilization (PercStab) of Thoracolumbar Fractures Is Not Always Required

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Neil Manson ◽  
Dana El-Mughayyar ◽  
Erin Bigney ◽  
Eden Richardson ◽  
Edward Abraham
Keyword(s):  
Patient Satisfaction ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Rating Scales ◽  
Case Series ◽  
Leg Pain ◽  
Mild Pain ◽  
Open Stabilization ◽  
Percutaneous Pedicle Screw

Study Design. Clinical case series. Background. Percutaneous stabilization for spinal trauma confers less blood loss, reduces postoperative pain, and is less invasive than open stabilization and fusion. The current standard of care includes instrumentation removal. Objective. 1. Reporting patient outcomes following minimally invasive posterior percutaneous pedicle screw-rod stabilization (PercStab). 2. Evaluating the results of instrumentation retention. Methods. A prospective observational study of 32 consecutive patients receiving PercStab without direct decompression or fusion. Baseline data demographics were collected. Operative outcomes of interest were operative room (OR) time, blood loss, and length of hospital stay. Follow-up variables of interest included patient satisfaction, Numeric Rating Scales for Back and Leg (NRS-B/L) pain, Oswestry Disability Index (ODI), and return to work. Clinical outcome data (ODI and NRS-B/L) were collected at 3, 12, 24 months and continued at a 24-month interval up to a maximum of 8 years postoperatively. Results. 81.25% of patients (n = 26) retained their instrumentation and reported minimal disability, mild pain, and satisfaction with their surgery and returned to work (mean = 6 months). Six patients required instrumentation removal due to prominence of the instrumentation or screw loosening, causing discomfort/pain. Instrumentation removal patients reported moderate back and leg pain until removal occurred; after removal, they reported minimal disability and mild pain. Neither instrumentation removal nor retention resulted in complications or further surgical intervention. Conclusions. PercStab without instrumentation removal provided high patient satisfaction, mild pain, and minimal disability and relieved the patient from the burden of finances and resources allocation of a second surgery.

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