scholarly journals Chronic subdural hematomas: challenges and solutions. Part 2. New concept for treatment of chronic subdural hematomas and the results

2021 ◽  
Vol 2 (3) ◽  
pp. 51-57
Author(s):  
Leonid B. Likhterman ◽  
◽  
Aleksandr D. Kravchuk ◽  
Vladimir A. Okhlopkov ◽  
◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Chronic Subdural Hematoma ◽  
Fold Increase ◽  
Fatality Rate ◽  
Good Recovery ◽  
Fibrin Degradation Product ◽  
Subdural Hematomas ◽  
Operative Complications

The observed dramatic 6–60-fold increase in fibrin degradation product levels in the cSDH cavity compared to peripheral blood was the rationale that underpinned the development of new concept for treatment of chronic subdural hematoma. The minimally invasive surgery results are reported, demonstrating decrease in fatality rate from 12–18% to 1.2% compared to craniotomy, as well as disappearance of severe post-operative complications, such as cerebral collapse. According to 1–10-year follow-up data, 91.7% of patients have shown good recovery.

Video Tutorials Increase Precision in Minimally Invasive Surgery Training – a Prospective Randomised Trial and Follow-up Study

2018 ◽  
Vol 144 (02) ◽  
pp. 153-162
Author(s):  
Michael Thomaschewski ◽  
Hamed Esnaashari ◽  
Anna Höfer ◽  
Lotta Renner ◽  
Claudia Benecke ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Randomised Trial ◽  
Prospective Randomised Trial ◽  
Simulation Based ◽  
Video Tutorials ◽  
Group A ◽  
Group B

Abstract Background Simulation-based practice has become increasingly important in minimally invasive surgery (MIS) training. Nevertheless, personnel resources for demonstration and mentoring simulation-based practice are limited. Video tutorials could be a useful tool to overcome this dilemma. However, the effect of video tutorials on MIS training and improvement of MIS skills is unclear. Methods A prospective randomised trial (n = 24 MIS novices) was conducted. A video-trainer with three different tasks (#1 – 3) was used for standardised goal-directed MIS training. The subjects were randomised to two groups with standard instructional videos (group A, n = 12) versus comprehensive video tutorials for each training task watched at specific times of repetition (group B, n = 12). Performance was analysed using the MISTELS score. At the beginning and following the curriculum, an MIS cholecystectomy (CHE) was performed on a porcine organ model and analysed using the GOALS score. After 18 weeks, participants performed 10 repetitions of tasks #1 – 3 for follow-up analysis. Results More participants completed tasks #1 and #2 in group B (83.3 and 75%) than in group A (66.7 and 50%, ns). For task #2, there was a significant improvement in precision in group B (p < 0.001). For the entire cohort, the GOALS-Scores were 12.9 before and 18.9 after the curriculum (p < 0.001), with no significant difference between groups. Upon follow-up, 84.2% (task#1), 26.3% (task#2) and 100% (task#3) of MIS novices were able to reach the defined goals (A vs. B ns). There was a trend for a better MISTELS score in group B upon follow-up. Conclusions Standardised comprehensive video tutorials watched frequently throughout practice can significantly improve precision in MIC training. This aspect should be incorporated in MIS training.

scholarly journals Initial CT blend sign is not associated with poor outcome in patients following stereotactic minimally invasive surgery

2021 ◽  
Author(s):  
Xu Yang ◽  
Yan Zhu ◽  
Linshan Zhang ◽  
Likun Wang ◽  
Yuanhong Mao ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Cardiac Complications ◽  
Control Group ◽  
Haematoma Expansion ◽  
Poor Outcomes ◽  
The Impact ◽  
The Relationship

Abstract Background: The initial computed tomography (CT) blend sign has been used as an imaging marker to predict haematoma expansion and poor outcomes in patients with a small volume intracerebral haemorrhage (ICH). However, the relationship between the blend sign and outcomes remains elusive. The present study aimed to retrospectively measure the impact of initial CT blend signs on short-term outcomes in patients with hypertensive ICH who underwent stereotactic minimally invasive surgery (sMIS). Methods: We enrolled 242 patients with spontaneous ICH. Based on the initial CT features, the patients were assigned to a blend sign group (91 patients) or a nonblend sign (control) group (151 patients). The NIHSS, GCS and mRS were used to measure the effects of sMIS. The rates of severe pulmonary infection and cardiac complications were also compared between the two groups. Results: No significant differences in NIHSS and GCS scores were observed between the two groups. The proportion of patients with good outcomes during follow-up was not different between the two groups. The rate of rehaemorrhaging increased in the blend sign group. No significant differences in severe pulmonary infections and cardiac complications were noted between the two groups. Conclusions: The initial CT blend sign was not associated with poor outcomes in patients with hypertensive ICH who underwent sMIS. ICH patients with CT blend signs should undergo sMIS if they are suitable candidates for surgery.

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Outcome of adrenal sparing surgery in heritable pheochromocytoma

2016 ◽  
Vol 174 (1) ◽  
pp. R9-R18 ◽  
Author(s):  
F Castinetti ◽  
D Taieb ◽  
J F Henry ◽  
M Walz ◽  
C Guerin ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Cortical Tissue ◽  
Adrenal Surgery ◽  
Endocrine Disease ◽  
Von Hippel Lindau ◽  
Glucocorticoid Replacement Therapy ◽  
Hereditary Pheochromocytoma ◽  
Insight Into

The management of hereditary pheochromocytoma has drastically evolved in the last 20 years. Bilateral pheochromocytoma does not increase mortality in MEN2 or von Hippel-Lindau (VHL) mutation carriers who are followed regularly, but these mutations induce major morbidities if total bilateral adrenalectomy is performed. Cortical sparing adrenal surgery may be proposed to avoid definitive adrenal insufficiency. The surgical goal is to leave sufficient cortical tissue to avoid glucocorticoid replacement therapy. This approach was achieved by the progressive experience of minimally invasive surgery via the transperitoneal or retroperitoneal route. Cortical sparing adrenal surgery exhibits <5% significant recurrence after 10 years of follow-up and normal glucocorticoid function in more than 50% of the cases. Therefore, cortical sparing adrenal surgery should be systematically considered in the management of all patients with MEN2 or VHL hereditary pheochromocytoma. Hereditary pheochromocytoma is a rare disease, and a randomized trial comparing cortical sparing vs classical adrenalectomy is probably not possible. This lack of data most likely explains why cortical sparing surgery has not been adopted in most expert centers that perform at least 20 procedures per year for the treatment of this disease. This review examined recent data to provide insight into the technique, its indications, and the results and subsequent follow-up in the management of patients with hereditary pheochromocytoma with a special emphasis on MEN2.

Minimally invasive surgery for simple bone cysts using hydroxyapatite cannulated pin: A long-term follow-up.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. e21501-e21501
Author(s):  
Takashi Higuchi ◽  
Norio Yamamoto ◽  
Hideji Nishida ◽  
Hiroaki Kimura ◽  
Akihiko Takeuchi ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Bone Cysts ◽  
Long Term Follow Up

Minimally invasive surgery for thoracolumbar spinal deformity: initial clinical experience with clinical and radiographic outcomes

2010 ◽  
Vol 28 (3) ◽  
pp. E9 ◽  
Author(s):  
Michael Y. Wang ◽  
Praveen V. Mummaneni
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Interbody Fusion ◽  
Complication Rates ◽  
Surgical Morbidity ◽  
Minimally Invasive Surgical ◽  
Csf Leakage ◽  
The Mean

Object Adult degenerative scoliosis can be a cause of intractable pain, decreased mobility, and reduced quality of life. Surgical correction of this problem frequently leads to substantial clinical improvement, but advanced age, medical comorbidities, osteoporosis, and the rigidity of the spine result in high surgical complication rates. Minimally invasive surgery is being applied to this patient population in an effort to reduce the high complication rates associated with adult deformity surgery. Methods A retrospective study of 23 patients was undertaken to assess the clinical and radiographic results with minimally invasive surgery for adult thoracolumbar deformity surgery. All patients underwent a lateral interbody fusion followed by posterior percutaneous screw fixation and possible minimally invasive surgical transforaminal lumbar interbody fusion if fusion near the lumbosacral junction was necessary. A mean of 3.7 intersegmental levels were treated (range 2–7 levels). The mean follow-up was 13.4 months. Results The mean preoperative Cobb angle was 31.4°, and it was corrected to 11.5° at follow-up. The mean blood loss was 477 ml, and the operative time was 401 minutes. The mean visual analog scale score improvement for axial pain was 3.96. Clear evidence of fusion was seen on radiographs at 84 of 86 treated levels, with no interbody pseudarthroses. Complications included 2 returns to the operating room, one for CSF leakage and the other for hardware pullout. There were no wound infections, pneumonia, deep venous thrombosis, or new neurological deficits. However, of all patients, 30.4% experienced new thigh numbness, dysesthesias, pain, or weakness, and in one patient these new symptoms were persistent. Conclusions The minimally invasive surgical treatment of adult deformities is a promising method for reducing surgical morbidity. Numerous challenges exist, as the surgical technique does not yet allow for all correction maneuvers used in open surgery. However, as the techniques are advanced, the applicability of minimally invasive surgery for this population will likely be expanded and will afford the opportunity for reduced complications.

scholarly journals CT Blend Signs are not Associated with Poor Outcome in Patients with ICH Following a Stereotactic Minimally Invasive Surgery

2020 ◽  
Author(s):  
Xu Yang ◽  
Linshan Zhang ◽  
Likun Wang ◽  
Yuanhong Mao ◽  
Yinghui Li ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Cardiac Complications ◽  
Control Group ◽  
Term Outcome ◽  
Poor Outcome ◽  
Group Control Group ◽  
The Impact

Abstract Backgrounds: The initial CT blend sign has been used as an imaging maker to predict haematoma expansion and poor outcome in patients with small volume intracerebral haemorrhage (ICH). However, the relationship between the blend sign and the outcome of patients remains elusive. The present study aimed to retrospectively observe the impact of initial CT blend signs on the short-term outcome of patients with hypertensive ICH underwent a stereotatic minimally invasive surgery (sMIS). Methods: Two hundreds and forty-two patients with spontaneous ICH were enrolled. Based on the initial CT features, the patients were assigned to a blend sign group (including 91 patients) or a non-blend sign group (control group, including 151 patients). The NIHSS, GCS and the mRS were used to observe the efficacy of the sMIS. The rates of severe pulmonary infection, cardiac complications were also compared between the two groups. Results: No significant differences in NIHSS and GCS in one week or two weeks after surgery were observed between the two groups. The proportion of patients with good outcome during follow-up did not show any difference between the two groups. However, both the two groups displayed good functional outcome over admission. The rate of rehaemorrhage increased in the blend sign group. No significant differences in severe pulmonary infections and cardiac complications were noted between the two groups. Conclusions：The initial CT blend sign are not associated with poor outcome of patients with hypertensive ICH underwent sMIS. ICH patients with CT blend sign should be also treated by performing sMIS if they are candidates for surgery.

scholarly journals Minimally Invasive Surgery for Pediatric Adrenal Masses—Report on Four Cases

2019 ◽  
Vol 07 (01) ◽  
pp. e75-e78 ◽  
Author(s):  
Ahmed ElHaddad ◽  
Christoph Castellani ◽  
Erich Sorantin ◽  
Martin Benesch ◽  
Eva Kampelmühler ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Malignant Tumors ◽  
Adrenocortical Tumor ◽  
Patient Case ◽  
Simple Cyst ◽  
Potentially Malignant ◽  
Adrenal Masses

AbstractThe dignity of adrenal masses in children varies from benign lesions like adenoma and ganglioneuroma to malignant tumors like adrenocortical carcinoma and neuroblastoma. Any surgical approach, especially minimally invasive surgery (MIS), requires careful risk stratification based on oncological and technical criteria. Herein, we present four patients who underwent MIS for adrenal masses. Laboratory testing differentiated between simple cysts and adenoma, but could not identify a child with adrenocortical tumor preoperatively. Analysis of image-defined risk factors excluded vascular encasement in all cases. All patients underwent laparoscopic adrenalectomy without complications. Histopathology revealed simple cyst, ganglioneuroblastoma, adenoma, and potentially malignant adrenocortical tumor in one patient/case each. All specimen showed clear margins and no recurrence was noted at a mean follow-up of 18 months.

TVT and TOT: a comparison between these two techniques based on our clinical experience

2008 ◽  
Vol 75 (4) ◽  
pp. 232-236
Author(s):  
A. Tamai ◽  
A. Donazzan ◽  
V. Gallo ◽  
S. Durante
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Voiding Dysfunction ◽  
De Novo ◽  
Single Side ◽  
De Novo Urgency ◽  
Group A ◽  
Group B

Aim of the Study A retrospective evaluation and a comparison of results from two minimally invasive surgery techniques that we adopted for the treatment of SUI. Materials and Methods. In this study we evaluated 113 selected patients who underwent SUI minimally invasive surgery from 1–1-2000 to 31–12–2007. 87 patients underwent epidural anesthesia. 26 local anesthesia. In Group A (TVT) 61 patients were enrolled, mean age 57.6 (±22). 43 patients (70%) were on menopause. In Group B (TOT out-in) 52 patients were enrolled (for 34 of them we used the Obtape® sling while for 18 the Obtryx® one), their mean age was 58.5 (±20.5) and 39 patients (75%) were on menopause. Patients from both groups did not undergo any past previous urogynecological surgery and suffered from stress urinary incontinence with cervico-urethral hypermobility butno other associated pathology. The pre-operative work-up included an evaluation of patients based on ICS guidelines. Results. Group A (TVT) - mean follow-up 66.3 months, dry patients 53/61 (86.8%). Bladder perforations resolved by catheterization 3/61 (5%). Transient voiding dysfunction 14/61 (22.8%). “De novo” urgency 8/61 (13%). One patient on self-catheterization due to persistent urinary retention underwent a single-side section of the sling with spontaneous micturition and complete continence recovery. Group B (TOT out-in) - mean follow-up 35.5 months, dry patients 43/52 (82%). 4 patients (7.6%) complained oftransient voiding dysfunction, 5 patients (9.5%) for “de novo” urgency, 1 patient underwent a sling removal due to vaginal erosion 4 months after surgery (Obtape®).

Percutaneous Instrumentation Without Arthrodesis for Thoracolumbar Flexion-Distraction Injuries: A Review of the Literature

Neurosurgery ◽  
2016 ◽  
Vol 80 (2) ◽  
pp. 171-179 ◽  
Author(s):  
Jason K. Chu ◽  
Rima S. Rindler ◽  
Gustavo Pradilla ◽  
Gerald E. Rodts ◽  
Faiz U. Ahmad
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Conservative Management ◽  
Thoracolumbar Spine ◽  
Review Of The Literature ◽  
Level Of Evidence ◽  
Percutaneous Instrumentation ◽  
Neurologically Intact

Abstract BACKGROUND: Flexion-distraction injuries (FDI) represent 5% to 15% of traumatic thoracolumbar fractures. Treatment depends on the extent of ligamentous involvement: osseous/Magerl type B2 injuries can be managed conservatively, while ligamentous/Magerl type B1 injuries undergo stabilization with arthrodesis. Minimally invasive surgery without arthrodesis can achieve similar outcomes to open procedures. This has been studied for burst fractures; however, its role in FDI is unclear. OBJECTIVE: To conduct a systematic review of the literature that examined minimally invasive surgery instrumentation without arthrodesis for traumatic FDI of the thoracolumbar spine. METHODS: Four electronic databases were searched, and articles were screened using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines for patients with traumatic FDI of the thoracolumbar spine treated with percutaneous techniques without arthrodesis and had postoperative follow-up. RESULTS: Seven studies with 44 patients met inclusion criteria. There were 19 patients with osseous FDI and 25 with ligamentous FDI. When reported, patients (n = 39) were neurologically intact preoperatively and at follow-up. Osseous FDI patients underwent instrumentation at 2 levels, while ligamentous injuries at approximately 4 levels. Complication rate was 2.3%. All patients had at least 6 mo of follow-up and demonstrated healing on follow-up imaging. CONCLUSION: Percutaneous instrumentation without arthrodesis represents a low-risk intermediate between conservative management and open instrumented fusion. This “internal bracing” can be used in osseous and ligamentous FDIs. Neurologically intact patients who do not require decompression and those that may not tolerate or fail conservative management may be candidates. The current level of evidence cannot provide official recommendations and future studies are required to investigate long-term safety and efficacy.

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