scholarly journals Surgery for Coagulopathy-Related Intracerebral Hemorrhage: Craniotomy vs. Minimally Invasive Neurosurgery

Life ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 564
Author(s):  
Yen-Bo Liu ◽  
Lu-Ting Kuo ◽  
Chih-Hao Chen ◽  
Woon-Man Kung ◽  
Hsin-Hsi Tsai ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Functional Outcomes ◽  
Large Scale ◽  
Promising Result ◽  
Multivariable Logistic Regression Analysis ◽  
Published Data ◽  
Complication Rates ◽  
Minimally Invasive Neurosurgery ◽  
Reduction Of Mortality

Coagulopathy-related intracerebral hemorrhage (ICH) is life-threatening. Recent studies have shown promising results with minimally invasive neurosurgery (MIN) in the reduction of mortality and improvement of functional outcomes, but no published data have recorded the safety and efficacy of MIN for coagulopathy-related ICH. Seventy-five coagulopathy-related ICH patients were retrospectively reviewed to compare the surgical outcomes between craniotomy (n = 52) and MIN (n = 23). Postoperative rebleeding rates, morbidity rates, and mortality at 1 month were analyzed. Postoperative Glasgow Outcome Scale Extended (GOSE) and modified Rankin Scale (mRS) scores at 1 year were assessed for functional outcomes. Morbidity, mortality, and rebleeding rates were all lower in the MIN group than the craniotomy group (8.70% vs. 30.77%, 8.70% vs. 19.23%, and 4.35% vs. 23.08%, respectively). The 1-year GOSE score was significantly higher in the MIN group than the craniotomy group (3.96 ± 1.55 vs. 3.10 ± 1.59, p = 0.027). Multivariable logistic regression analysis also revealed that MIN contributed to improved GOSE (estimate: 0.99650, p = 0.0148) and mRS scores (estimate: −0.72849, p = 0.0427) at 1 year. MIN, with low complication rates and improved long-term functional outcome, is feasible and favorable for coagulopathy-related ICH. This promising result should be validated in a large-scale prospective study.

scholarly journals Complication rates for preexisting baclofen pumps and ventricular shunts following scoliosis correction: a preliminary study

2018 ◽  
Vol 22 (1) ◽  
pp. 108-112
Author(s):  
Jonathan Dallas ◽  
Katherine D. Sborov ◽  
Bradley S. Guidry ◽  
Silky Chotai ◽  
Christopher M. Bonfield
Keyword(s):  
Spinal Fusion ◽  
Large Scale ◽  
Posterior Spinal Fusion ◽  
Spastic Cerebral Palsy ◽  
Published Data ◽  
Complication Rates ◽  
Implant Complications ◽  
Scoliosis Correction ◽  
Cranial Implant ◽  
The Mean

OBJECTIVEMany patients undergoing spinal fusion for neuromuscular scoliosis have preexisting neurosurgical implants, including ventricular shunts (VSs) for hydrocephalus and baclofen pumps (BPs) for spastic cerebral palsy. Recent studies have discussed a possible increase in implant complication rates following spinal fusion, but published data are inconclusive. The authors therefore, sought to investigate: 1) the rate of implant complications following fusion, 2) possible causes of these complications, and 3) factors that place patients at higher risk for implant-related complications.METHODSCases involving pediatric patients with a preexisting VS or BP who underwent spinal fusion for scoliosis correction between 2005 and 2016 at a single tertiary children’s hospital were retrospectively analyzed. Patient demographics, implant characteristics, spinal fusion details, neurosurgical follow-up, and implant complications in the 180 days following fusion were recorded and analyzed.RESULTSOverall, 75 patients who underwent scoliosis correction had preexisting implants: 39 had BPs, 31 VSs, and 5 both. The patients’ mean age at fusion was 13.49 ± 2.78 years (range 3.62–18.81 years), and the mean time from the most recent previous implant surgery to fusion was 5.70 ± 4.65 years (range 0.10–17.3 years). The mean preoperative and postoperative Cobb angles were 62.4° ± 18.9° degrees (range 20.9°–109.0°) and 23.5° ± 13.3° degrees (range 2.00°–67.3°), respectively. No VS complications were identified. Two patients with BPs were found to have complications (unintentional cutting of their BP catheter during posterior spinal fusion) within 180 days postfusion. There were no recorded neurosurgical implant infections, failures, fractures, or dislodgements. Although 10 patients required at least 1 surgical procedure for irrigation and debridement of the spine wound following fusion, there were no abdominal or cranial implant wound infections requiring revision, and no implants required removal.CONCLUSIONSThe results of this study suggest that spinal fusion for scoliosis correction does not increase the rates of complications involving previously placed neurosurgical implants. A large-scale, prospective, multicenter study is needed to fully explore and confirm this finding.

scholarly journals Evaluation of minimally invasive fixation with ESIN in the management of displaced mid-shaft clavicle fractures: a case series with minimum of 2 years follow-up

2016 ◽  
Vol 3 (1) ◽  
pp. 86 ◽  
Author(s):  
Sourabh Chachan ◽  
Biswajit Sahu
Keyword(s):  
Minimally Invasive ◽  
Operative Treatment ◽  
Functional Outcomes ◽  
Case Series ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
P Value ◽  
Complication Rates ◽  
Intramedullary Pinning ◽  
Clavicle Fractures

<p class="abstract"><strong>Background:</strong> Over the last few years, operative treatment has become the standard for treatment of clavicle fractures. Both plating and intra-medullary pinning techniques are available for treating clavicle fractures. The aim of the study was to evaluate the role of minimally invasive technique using elastic stable intramedullary nailing (ESIN) in surgical treatment of displaced mid-shaft clavicle fractures<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> It is a prospective case series study conducted at the Department of Orthopaedics of a tertiary care centre. 44 cases of acute displaced mid-shaft clavicle fractures with a mean age of 32.7 years were treated by intramedullary pinning with titanium elastic stable nails and were followed-up for a mean period of 30.6 months(range= 24-40 months). Functional outcomes were evaluated by using Constant Shoulder score. The results obtained were analysed using student’s t-test.<strong></strong></p><p class="abstract"><strong>Results:</strong> Union was achieved in all except one case which showed delayed union. 7 cases were complicated by telescoping (incidence= 15.9%) and 6 out of these 7 cases also had medial nail protrusion (incidence= 13.6%) simultaneously. 9 cases had shortening of less than 1cm and 2 had shortening of more than 1cm.  No other complication was reported from any of the case. Mean constant shoulder scores improved from 15 to 85.6 (p value &lt;0.001) after 12 months from surgery. However, no further improvement was seen after 12 months of surgery, with no statistical difference (p value= 0.789) between the mean scores at 12 (85.6) and 24 (85.7) months<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> ESIN offers the advantages of treating displaced mid-shaft clavicle fractures with minimal incision and decreased surgery time with minimal intra-operative blood loss. The results were excellent in terms of functional outcomes. The complication rates were low and return to normal activity was quiet fast. ESIN is a minimally invasive technique with good cosmetic and functional results. This method should be seen as an alternative to plate fixation and non-operative treatment<span lang="EN-IN">.</span></p>

Perihemorrhagic edema

Neurology ◽  
2019 ◽  
Vol 93 (12) ◽  
pp. e1159-e1170 ◽  
Author(s):  
Maximilian I. Sprügel ◽  
Joji B. Kuramatsu ◽  
Bastian Volbers ◽  
Stefan T. Gerner ◽  
Jochen A. Sembill ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Time Course ◽  
Multivariable Logistic Regression Analysis ◽  
Lesion Volume ◽  
Hematoma Volume ◽  
Edema Volume ◽  
Major Parameter ◽  
Perihemorrhagic Edema

ObjectiveTo determine the influence of intracerebral hemorrhage (ICH) location and volume and hematoma surface on perihemorrhagic edema evolution.MethodsPatients with ICH of the prospective Universitätsklinikum Erlangen Cohort of Patients With Spontaneous Intracerebral Hemorrhage (UKER-ICH) cohort study (NCT03183167) between 2010 and 2013 were analyzed. Hematoma and edema volume during hospital stay were volumetrically assessed, and time course of edema evolution and peak edema correlated to hematoma volume, location, and surface to verify the strength of the parameters on edema evolution.ResultsOverall, 300 patients with supratentorial ICH were analyzed. Peak edema showed a high correlation with hematoma surface (R2 = 0.864, p < 0.001) rather than with hematoma volumes, regardless of hematoma location. Smaller hematomas with a higher ratio of hematoma surface to volume showed exponentially higher relative edema (R2 = 0.755, p < 0.001). Multivariable logistic regression analysis revealed a cutoff ICH volume of 30 mL, beyond which an increase of total mass lesion volume (combined volume of hematoma and edema) was not associated with worse functional outcome. Specifically, peak edema was associated with worse functional outcome in ICH <30 mL (odds ratio [OR] 2.63, 95% confidence interval [CI] 1.68–4.12, p < 0.001), contrary to ICH ≥30 mL (OR 1.20, 95% CI 0.88–1.63, p = 0.247). There were no significant differences between patients with lobar and those with deep ICH after adjustment for hematoma volumes.ConclusionsPeak perihemorrhagic edema, although influencing mortality, is not associated with worse functional outcomes in ICH volumes >30 mL. Although hematoma volume correlates with peak edema extent, hematoma surface is the major parameter for edema evolution. The effect of edema on functional outcome is therefore more pronounced in smaller and irregularly shaped hematomas, and these patients may particularly benefit from edema-modifying therapies.

scholarly journals Minimally Invasive Intracerebral Hemorrhage Evacuation Techniques: A Review

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 576
Author(s):  
Theodore C. Hannah ◽  
Rebecca Kellner ◽  
Christopher P. Kellner
Keyword(s):  
Clinical Trials ◽  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Functional Outcomes ◽  
Surgical Intervention ◽  
Neuronal Damage ◽  
High Morbidity ◽  
Edema Formation ◽  
Stereotactic Aspiration ◽  
Rapid Removal

Intracerebral hemorrhage (ICH) continues to have high morbidity and mortality. Improving ICH outcomes likely requires rapid removal of blood from the parenchyma and restraining edema formation while also limiting further neuronal damage due to the surgical intervention. Minimally invasive surgery (MIS) approaches promise to provide these benefits and have become alluring options for management of ICH. This review describes six MIS techniques for ICH evacuation including craniopuncture, stereotactic aspiration with thrombolysis, endoport-mediated evacuation, endoscope-assisted evacuation, adjunctive aspiration devices, and the surgiscope. The efficacy of each modality is discussed based on current literature. The largest clinical trials have yet to demonstrate definitive effects of MIS intervention on mortality and functional outcomes for ICH. Thus, there is a significant need for further innovation for ICH treatment. Multiple ongoing trials promise to better clarify the potential of the newer, non-thrombolytic MIS techniques.

scholarly journals Early results of patellofemoral inlay resurfacing arthroplasty using the HemiCap Wave prosthesis

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901769270 ◽  
Author(s):  
Akash Patel ◽  
Zakir Haider ◽  
Amarjit Anand ◽  
Dominic Spicer
Keyword(s):  
Disease Progression ◽  
Functional Outcomes ◽  
Short Form ◽  
Oxford Knee Score ◽  
Published Data ◽  
Complication Rates ◽  
Patellofemoral Osteoarthritis ◽  
Resurfacing Arthroplasty ◽  
Early Results ◽  
Sf 36

Background: Common surgical treatment options for isolated patellofemoral osteoarthritis include arthroscopic procedures, total knee replacement and patellofemoral replacement. The HemiCap Wave patellofemoral resurfacing prosthesis is a novel inlay design introduced in 2009 with scarce published data on its functional outcomes. We aim to prospectively evaluate early functional outcomes and complications, for patients undergoing a novel inlay resurfacing arthroplasty for isolated patellofemoral arthrosis in an independent centre. Methods: From 2010 to 2013, 16 consecutive patients underwent patellofemoral resurfacing procedures using HemiCap Wave (Arthrosurface Inc., Franklin, Massachusetts, USA) for anterior knee pain with confirmed radiologically and/or arthroscopically isolated severe patellofemoral arthrosis. Standardized surgical technique, as recommended by the implant manufacturer, was followed. Outcome measures included range of movement, functional knee scores (Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Short Form-36 (SF-36)), radiographic disease progression, revision rates and complications. Results: Eight men and eight women underwent patellofemoral HemiCap Wave resurfacing, with an average age of 63 years (range: 46–83). Average follow-up was 24.1 months (6–34). Overall, post-operative scores were excellent. There was a statistically significant improvement in the post-operative OKS, KOOS and SF-36 scores ( p < 0.01). One patient had radiological disease progression. One patient underwent revision for deep infection. Two other minor complications were observed and treated conservatively. Conclusions: The HemiCap Wave patellofemoral resurfacing prosthesis has excellent early results in terms of functional outcomes, radiological outcomes and low complication rates. At the very least, early results show that the HemiCap Wave is comparable to more established onlay prostheses. The HemiCap Wave thus provides a safe and effective surgical option in the treatment of isolated patellofemoral osteoarthritis in selected patients.

Minimally invasive approaches for the evacuation of intracerebral hemorrhage: a systematic review

2018 ◽  
Vol 62 (6) ◽  
Author(s):  
Claudio Cavallo ◽  
Xiaochun Zhao ◽  
Hussam Abou-Al-Shaar ◽  
Miriam Weiss ◽  
Sirin Gandhi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Intracerebral Hemorrhage

Complication Rate after Radical Cystectomy Depends on the Surgical Technique and Patient’s Clinical Status

2021 ◽  
pp. 1-8
Author(s):  
Przemysław Adamczyk ◽  
Paweł Pobłocki ◽  
Mateusz Kadlubowski ◽  
Adam Ostrowski ◽  
Witold Mikołajczak ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Complication Rate ◽  
Tnm Stage ◽  
Complication Rates ◽  
Open Approach ◽  
Invasive Approach ◽  
Asa Score

<b><i>Purpose:</i></b> This study aimed to explore the complication rates of radical cystectomy in patients with muscle-invasive bladder cancer and identify potential risk factors. <b><i>Methods:</i></b> A total of 553 patients were included: 131 were operated on via an open approach (ORC), 242 patients via a laparoscopic method (LRC), and 180 by a robot-assisted procedure (RARC). Patient age, gender, American Society of Anesthesiologists (ASA) score, urinary diversion type, preoperative albumin level, body mass index (BMI), pathological (TNM) stage, and surgical times were collected. The severity of complications was classified according to the Clavien-Dindo scale (Grades 1–5). <b><i>Results:</i></b> The surgical technique was significantly related to the number of complications (<i>p</i> &#x3c; 0.00005). Grade 1 complications were observed most frequently following LRC (52.5%) and RARC (51.1%), whereas mostly Grade 2 complications were detected after ORC (78.6%). Those with less severe complications had significantly higher albumin levels than those with more severe complications (<i>p</i> &#x3c; 0.05). Patients with an elevated BMI had fewer complications if a minimally invasive approach was used rather than ORC. The patient’s general condition (ASA score) did not impact the number of complications, and urinary diversion type did not affect the severity of the complications. Mean surgical time differed according to the urinary diversion type in patients with a similar TNM stage (<i>p</i> &#x3c; 0.005); however, no difference was found in those with more locally advanced disease. Longer operation time and lower protein concentration were associated with higher probability of complication rate, that is, Clavien-Dindo score 3–5. <b><i>Conclusions:</i></b> The risk of complications after RC is not related to the type of urinary diversion, and can be reduced by using a minimally invasive surgical technique, especially in patients with high BMI.

scholarly journals Biological Impact of a Large-Scale Genomic Inversion That Grossly Disrupts the Relative Positions of the Origin and Terminus Loci of theStreptococcus pyogenesChromosome

2019 ◽  
Vol 201 (17) ◽  
Author(s):  
Dragutin J. Savic ◽  
Scott V. Nguyen ◽  
Kimberly McCullor ◽  
W. Michael McShan
Keyword(s):  
Dna Sequences ◽  
Parental Strain ◽  
Large Scale ◽  
Galleria Mellonella ◽  
Acute Infection ◽  
Relative Length ◽  
Published Data ◽  
Rich Medium ◽  
Content Type

ABSTRACTA large-scale genomic inversion encompassing 0.79 Mb of the 1.816-Mb-longStreptococcus pyogenesserotype M49 strain NZ131 chromosome spontaneously occurs in a minor subpopulation of cells, and in this report genetic selection was used to obtain a stable lineage with this chromosomal rearrangement. This inversion, which drastically displaces theorisite relative to the terminus, changes the relative length of the replication arms so that one replichore is approximately 0.41 Mb while the other is about 1.40 Mb in length. Genomic reversion to the original chromosome constellation is not observed in PCR-monitored analyses after 180 generations of growth in rich medium. Compared to the parental strain, the inversion surprisingly demonstrates a nearly identical growth pattern in the first phase of the exponential phase, but differences do occur when resources in the medium become limited. When cultured separately in rich medium during prolonged stationary phase or in an experimental acute infection animal model (Galleria mellonella), the parental strain and the invertant have equivalent survival rates. However, when they are coincubated together, bothin vitroandin vivo, the survival of the invertant declines relative to the level for the parental strain. The accompanying aspect of the study suggests that inversions taking place nearoriCalways happen to secure the linkage oforiCto DNA sequences responsible for chromosome partition. The biological relevance of large-scale inversions is also discussed.IMPORTANCEBased on our previous work, we created to our knowledge the largest asymmetric inversion, covering 43.5% of theS. pyogenesgenome. In spite of a drastic replacement of origin of replication and the unbalanced size of replichores (1.4 Mb versus 0.41 Mb), the invertant, when not challenged with its progenitor, showed impressive vitality for growthin vitroand in pathogenesis assays. The mutant supports the existing idea that slightly deleterious mutations can provide the setting for secondary adaptive changes. Furthermore, comparative analysis of the mutant with previously published data strongly indicates that even large genomic rearrangements survive provided that the integrity of theoriCand the chromosome partition cluster is preserved.

OUTCOME PREDICTORS AND SPECTRUM OF TREATMENT ELIGIBILITY WITH PROSPECTIVE PROTOCOLIZED MANAGEMENT OF INTRACEREBRAL HEMORRHAGE

Neurosurgery ◽  
2009 ◽  
Vol 64 (3) ◽  
pp. 436-446 ◽  
Author(s):  
Jennifer Jaffe ◽  
Lora AlKhawam ◽  
Hongyan Du ◽  
Kristen Tobin ◽  
Judith O'Leary ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcomes ◽  
Best Practice ◽  
Initial Assessment ◽  
Consecutive Series ◽  
Best Practice Guidelines ◽  
Management Protocol ◽  
Scale Scores ◽  
Contemporary Management ◽  
Risk Predictors

Abstract OBJECTIVE Risk predictors, spectrum of treatment eligibility, and range of expected outcomes have not been validated in consecutive series including all cases of intracerebral hemorrhage (ICH) subjected to a prospective management protocol based on current guidelines. METHODS Eighty-six cases of ICH were prospectively identified in conjunction with screening for a clinical trial during an 18-month period. All patients were subjected to protocolized management based on published “best practice” guidelines for ICH. Medical records were reviewed by trained researchers, and outcomes were assessed at various time points including latest follow-up (range, 0–24 months; mean, 3.97 months). Initial assessment parameters, treatment eligibility, and outcomes were based on standardized criteria. RESULTS In accordance with past literature, mortality and functional outcomes were significantly worse in older patients, those with a larger ICH volume, and worse Glasgow Coma Scale scores, in univariate and multivariate models. The presence and severity of associated intraventricular hemorrhage also correlated with mortality and outcome. Significantly lower mortality (P = 0.024) and better functional outcomes (P = 0.018) were achieved at 30 days in patients with an ICH volume of less than 30 cm3 in this series than in previously published community-based historical controls without protocolized care. A tight correspondence between treatment eligibility and treatment administered was found. CONCLUSION Previous estimates of poorer outcome in patients with ICH might not apply to contemporary management protocols, especially in patients with a smaller ICH volume. Outcome ranges in various risk categories and modeling of treatment eligibility will help project more realistic prognostication and assist with the design of future trials.

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