scholarly journals Role of Craniectomy Versus Craniotomy via the Retrosigmoid Approach in Decreasing the Incidence of Postoperative Headache

2021 ◽  
Author(s):  
Can Sezer ◽  
Murat Gokten ◽  
Aykut Sezer ◽  
Inan Gezgin ◽  
Mehmet Onay ◽  
...  
Keyword(s):  
Cerebrospinal Fluid Leak ◽  
Retrosigmoid Approach ◽  
Sex Type ◽  
Postoperative Headache ◽  
Group 5 ◽  
Group 2 ◽  
Postoperative Meningitis ◽  
Fluid Leak

Background: Postoperative headache is a major complaint after RS surgery. PH affected the patient’s quality of life. The role of craniotomy in the prevention of such headaches. We aimed to evaluate the role of craniectomy versus craniotomy via the retrosigmoid approach in reducing the incidence of postoperative headaches. Materials and methods: Patients who underwent surgery between January 2012 and December 2018 were retrospectively assessed and were classified into the craniectomy and craniotomy groups. Clinical data, such as those on age, sex, type of surgery, surgical repair technique, development of infection, postoperative cerebrospinal fluid leak, postoperative meningitis, size of the bone flap, and wound infection, were collected. The severity of headache in all patients was clinically assessed using the Catalano grading system. Results: Overall, 95 patients underwent microsurgery via the retrosigmoid approach. Of these, 48 were men and 47 were women. In total, 34 patients underwent craniectomy, and 61 patients underwent craniotomy. On discharge, postoperative headache was observed in 47% (16/34) and 21% (13/61) of patients who underwent craniectomy and craniotomy, respectively ( P =.01). The incidence of headache decreased at follow-up. At 12 months after surgery, 15% of patients in the craniectomy group (5/34) and 2% of patients in the craniotomy group (2/61) experienced headache ( P =.01). Of the 61 patients in the craniotomy group, 2 (2%) had less severe headache at 12 months of follow-up. Conclusion: The severity of headache after surgery and upon discharge significantly decreased in patients who underwent craniotomy than in those who underwent craniectomy.

Results of transsphenoidal microsurgery for growth hormone-secreting pituitary adenoma in a series of 214 patients

1988 ◽  
Vol 68 (6) ◽  
pp. 854-867 ◽  
Author(s):  
Donald A. Ross ◽  
Charles B. Wilson
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Cerebrospinal Fluid Leak ◽  
Postoperative Radiation Therapy ◽  
Content Type ◽  
Long Term Follow Up ◽  
Surgical Cure ◽  
Postoperative Meningitis ◽  
Fluid Leak

✓ Of 214 patients with acromegaly who underwent transsphenoidal microsurgical resection of a pituitary adenoma, 54% had growth hormone (GH) levels below 5 ng/ml and 74% had levels less than 10 ng/ml immediately after surgery. Among the 174 patients who could be contacted for long-term follow-up review (average duration 76 months), most recent GH determinations were available for 165. Of these 165 patients, 131 (79.4%) have a GH level less than 5 ng/ml and 153 (92.7%) have a level below 10 ng/ml; these represent 75.3% and 87.9%, respectively, of the total 174 patients reviewed. Fifty-two patients received postoperative radiation therapy. Nine patients underwent reoperation. There were five cases of tumor recurrence following an apparent surgical cure (4.3%), nine new instances of anterior pituitary hypofunction (5%), and five failures of multimodality therapy (2.3%). There were no perioperative deaths, five cases of cerebrospinal fluid leak requiring surgical repair (2.2%), and four cases of postoperative meningitis (1.8%). Permanent diabetes insipidus did not occur. Two of 52 patients who were irradiated postoperatively had severe complications; 23 (54.8%) of 42 patients who were available for follow-up evaluation had developed panhypopituitarism; and eight (19%) of 42 had normal pituitary function an average of 44 months postirradiation.

The role of ICP monitoring in patients with persistent cerebrospinal fluid leak following spinal surgery: a case series

2016 ◽  
Vol 158 (9) ◽  
pp. 1813-1819 ◽  
Author(s):  
Claudia Craven ◽  
Ahmed K. Toma ◽  
Akbar A. Khan ◽  
Laurence D. Watkins
Keyword(s):  
Cerebrospinal Fluid ◽  
Spinal Surgery ◽  
Case Series ◽  
Cerebrospinal Fluid Leak ◽  
Icp Monitoring ◽  
Fluid Leak

scholarly journals Endoscopic Endonasal Transpterygoid Approach to Sphenoid Sinus Lateral Recess Defects

2019 ◽  
Vol 81 (05) ◽  
pp. 553-561
Author(s):  
Gülpembe Bozkurt ◽  
Mario Turri-Zanoni ◽  
Elisa Coden ◽  
Federico Russo ◽  
Hassan Ahmed Elhassan ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Dry Eye ◽  
Sphenoid Sinus ◽  
Cerebrospinal Fluid Leak ◽  
Significant Morbidity ◽  
Endoscopic Endonasal ◽  
Lateral Recess ◽  
Fluid Leak ◽  
Extensive Surgery

Background Lesions affecting sphenoid sinus lateral recess (SSLR) are difficult to visualize and manipulate through the transnasal routes, especially when the sinus is highly pneumatized. External approaches to this area involve extensive surgery and are associated with significant morbidity. The aims of this study are to present our experience with the endoscopic transpterygoid approach as a method for approaching lesions of the SSLR and to evaluate the outcomes of this procedure.Methods Clinical charts of patients who had lesions in the SSLR and who were treated at our institution from September 1998 to June 2018 were retrospectively reviewed. All these patients were managed by the endoscopic endonasal transpterygoid approach.Results Thirty-nine patients were identified. No cerebrospinal fluid leak recurrences were observed during follow-up (range: 1–19.7 years; median: 2.3 years). Hypoesthesia (temporary, 1; persistent, 4) in the region innervated by the maxillary branch of the trigeminal nerve was detected in five (12.8%) patients, while symptoms due to the Vidian nerve damage (dry eye, 3; dry nasal mucosa, 1) were present in four (10%) patients.Conclusions Although the endoscopic endonasal transpterygoid approach is an excellent corridor for dealing with lesions of the SSLR, limited rate of neurologic and lacrimal complications was observed. Potential morbidity of the intervention should be discussed during preoperative counselling.

Craniopharyngiomas

2018 ◽  
Author(s):  
Daniel M. S. Raper ◽  
John A. Jane
Keyword(s):  
Multidisciplinary Approach ◽  
Preoperative Assessment ◽  
Cerebrospinal Fluid Leak ◽  
Bimodal Distribution ◽  
Visual Evaluation ◽  
Diagnostic Modality ◽  
Cholesterol Crystals ◽  
Fluid Leak ◽  
Radical Surgical Resection

Craniopharyngiomas (CPs) are rare tumors arising from the developmental Rathke’s pouch and present in a bimodal distribution peaking at 5 to 14 and 50 to 74 years. Symptoms at onset include visual loss, headache, and hypopituitarism. Most tumors contain solid and cystic components, and fluid within the cyst usually contains cholesterol crystals. Histopathology is classified into adamantinomatous (most common in children) and papillary (almost exclusively in adults) subtypes. Magnetic resonance imaging is the definitive diagnostic modality for sellar and suprasellar lesions. In addition to imaging, formal visual evaluation and detailed endocrinologic workup are a critical aspect of preoperative assessment. The role of radical surgical resection, versus decompression combined with radiotherapy, remains controversial. The most common complications of surgical and radiotherapeutic treatments include pituitary stalk and hormonal deficiencies, along with cerebrospinal fluid leak. As 5-year overall survival for patients with CP is in the range of 55% to 85%, CP remains a challenging condition to treat and requires a multidisciplinary approach.

Combination therapy with interferon alfa-2a and interleukin-2 for the treatment of metastatic cancer.

1995 ◽  
Vol 13 (5) ◽  
pp. 1110-1122 ◽  
Author(s):  
F M Marincola ◽  
D E White ◽  
A P Wise ◽  
S A Rosenberg
Keyword(s):  
Response Rate ◽  
Metastatic Cancer ◽  
Objective Response ◽  
Interleukin 2 ◽  
Interferon Alfa ◽  
Group 4 ◽  
Ifn Alpha ◽  
Group 5 ◽  
Group 2

PURPOSE Here we report the long-term follow-up evaluation of a phase I/II study of toxicity and response of combination interferon alfa-2a (IFN alpha) and interleukin-2 (IL-2) in patients with metastatic cancer. PATIENTS AND METHODS From November 1987 through October 1990, 189 patients were treated with 379 courses. IFN alpha (3 x 10(6) U/m2) was administered three times per day as an intravenous (IV) bolus with IV IL-2 2.6 x 10(6) IU/m2 (six patients, group 1), 7.8 x 10(6) IU/m2 (32 patients, group 2), or 11.7 x 10(6) IU/m2 (26 patients, group 3). Subsequently, IFN alpha dose was escalated to 6 x 10(6) U/m2 plus IL-2 11.7 x 10(6) IU/m2 (22 patients, group 4). Two further dosage schedules of IL-2 were tested at 7.8 x 10(6) IU/m2 (29 patients, group 5) and 15.6 x 10(6) IU/m2 (74 patients, group 6); however, because of IFN alpha-related toxicity, these two groups received IFN alpha once per day (6 x 10(6) U/m2). A treatment course consisted of two cycles (maximum, 15 doses per cycle) separated by a 10-day interval. RESULTS All patients were assessable for response: 82 patients had melanoma, 75 renal cell carcinoma (RCC), and 16 colorectal cancer. There were two treatment-related deaths. The objective response rate was 23% (43 patients). Response rates were 17%, 19%, 19%, 32%, 41%, and 16%, respectively, for groups 1 through 6. Ten responses are still ongoing (nine in RCC patients) at 57 to 74 months, and 21 patients are alive, for an overall 5-year survival rate of 11%. The median potential follow-up period was 65 months. Although a significantly higher response rate was noted for group 4 (highest dose of IFN alpha three times per day), no benefit for survival and increased toxicity were noted in this group. CONCLUSION Based on these findings, we conclude that further studies of this combination treatment are not warranted.

Follow-up Management of Patients After Transsphenoidal Approach for Resection of Pituitary Adenomas

2019 ◽  
Vol 34 (2) ◽  
pp. 150-155
Author(s):  
Allison K. Ikeda ◽  
Lauren J. Luk ◽  
Zara M. Patel ◽  
Nelson M. Oyesiku ◽  
C. Arturo Solares ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Care Center ◽  
Tertiary Care ◽  
Cerebrospinal Fluid Leak ◽  
Patient Records ◽  
Tertiary Care Center ◽  
Postoperative Course ◽  
Transsphenoidal Adenomectomy ◽  
Fluid Leak

Background Endoscopic transsphenoidal adenomectomy (eTSA) is widely utilized for resection of pituitary adenoma. eTSA patients undergo healing for weeks to months and are potentially at risk for complications. Multidisciplinary follow-up monitoring is necessary. We hypothesized that patients with deviations from the routine postoperative course, broadly termed complications of interest (COI) in this study, following eTSA would increase the duration of follow-up in the rhinology clinic. Methods Retrospective review was performed on patients undergoing eTSA for pituitary adenoma from August 2007 to May 2016 at a single tertiary care center. COIs were reviewed for their influence on follow-up time. Results A total of 985 patient records were reviewed (mean age 51.0 ± 15.7 years, 55.2% female), of which, 21.1% of patients had a deviation from the expected postoperative course (7.0% rhinologic, 10.8% surgical, 0.6% perioperative medical, and 2.7% endocrinologic COIs). The most common COI was cerebrospinal fluid leak 5.6% (n = 55) followed by sinusitis 5.0% (n = 49). Moreover, 935 patients (94.9%) attended rhinology follow-up (172 patients with COI). For patients seen postoperatively by the rhinology service, COIs significantly increased the number of rhinologic follow-up visits (median 2 [interquartile range, IQR: 2–3] vs 3 visits [IQR: 2–4], P < .001), duration of rhinologic follow-up (median 54.0 days [IQR: 43.0–104.0] vs 88.0 days [IQR: 54.5–242.0], P < .001), and duration of overall multidisciplinary follow-up (median 354.0 days [IQR: 104.0–789.0] vs 537.0 days [IQR: 171.5–1313.5], P < .001), compared to those without COIs. Conclusions Patients who develop postoperative complications after eTSA have significantly extended follow-up with the multidisciplinary team.

Role of Anticoagulation in Patients with Inferior Vena Cava Filter but with No Risk Factor or History of DVT/PE

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4317-4317
Author(s):  
Mustapha A. Khalife ◽  
Vrushali S. Dabak ◽  
Marwa Hammoud ◽  
Karim Arnaout
Keyword(s):  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Vein Thrombosis ◽  
History Of ◽  
Group 2 ◽  
Deep Vein ◽  
Group 1

Abstract Abstract 4317 Introduction: Inferior Vena Cava (IVC) filters have been available for almost 40 years but their clinical utility and safety have not been completely evaluated in patients with no previous history of deep vein thrombosis (DVT) or pulmonary embolism (PE). The role of anticoagulation in patients with IVC filter with no history of DVT/PE is questionable. In this study, we try to determine if there is a role or benefit from anticoagulation in patients with an IVC filter placed but without any other risk factor for deep vein thrombosis (DVT) or pulmonary embolism (PE). Methods: we retrospectively reviewed the charts of 562 patients who had an IVC filter placed between 2003 and 2005. 442 patients were excluded because they had a history of DVT/PE, or because of a hypercoagulable state (genetic predisposition, prolonged hospitalization/immobilization, surgery, or malignancy). Of the 120 remaining patients included in this study, 6 had their IVC filter removed. And therefore we only analyzed the charts of 114 patients who had a permanent IVC filter placed for prophylactic reasons. Group 1 consisted of 17 patients who received different forms of anticoagulation (subcutaneous heparin, low molecular weight heparin or coumadin). Group 2 consisted of the remaining 97 patients who did not receive any form of anticoagulation. Results: 2 out of 17 patients in group 1 had a DVT and 14 out of 97 patients in group 2 had a DVT. The incidence of DVT was 11.8% in group 1 versus 14.4% in group 2 (p-value 0.770). The median onset of DVT/PE after IVC filter placement was 31 days. The median time of follow up was 77.33 months. Conclusion: Patients who had a permanent prophylactic IVC filter placed but with no history or risk factors for DVT/PE appear to be at an elevated risk for new DVT/PEs. In these patients, the role of anticoagulation is questionable. With a median 6 year follow up, anticoagulation seemed to non significantly lower the risk of DVT/PE. Larger randomized prospective trials are needed to examine the efficacy and duration of anticoagulation in patients with a prophylactic IVC filter placed. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Early Posterior Vault Distraction Osteogenesis for the Treatment of Syndromic Craniosynostosis

2016 ◽  
Vol 9 (3) ◽  
pp. 219-223 ◽  
Author(s):  
Dana Johns ◽  
Erin Anstadt ◽  
Daniel Donato ◽  
John Kestle ◽  
Jay Riva-Cambrin ◽  
...  
Keyword(s):  
Salt Lake ◽  
Salt Lake City ◽  
Cerebrospinal Fluid Leak ◽  
Cranial Vault ◽  
Intracranial Volume ◽  
Syndromic Craniosynostosis ◽  
Time Period ◽  
Lake City ◽  
Fluid Leak

Posterior cranial vault distraction (PCVD) has become an important modality in the management of complex craniosynostosis to increase intracranial volume and improve the cranial vault appearance. This technique can safely be performed as early as 3 months of age for the initial management of patients with complex craniosynostosis. A retrospective review was performed of all the patients with syndromic, multiple-suture synostosis treated with PCVD at Primary Children's Hospital in Salt Lake City, Utah, between 2012 and 2014. During this time period, a total of nine children with an average corrected age of 21.4 weeks were treated. Demographics, intraoperative data, and postoperative distraction data were collected. Occipital frontal head circumferences (OFCs) were recorded pre- and postdistraction, and at 3- and 6-month follow-up examinations. All patients had a substantial increase in head circumference with subjective improvement of the posterior calvarium shape. The average increase in OFC from preoperative to postdistraction was 4.9 cm. Only two significant postoperative complications were encountered, one hardware infection and one cerebrospinal fluid leak. PCVD is an effective procedure in the management of complex craniosynostosis and can be safely initiated very early in life.

Arthrography in thumb polydactyly with bifurcation at the interphalangeal or metacarpophalangeal joints provides practical information at surgery

2012 ◽  
Vol 38 (3) ◽  
pp. 267-271 ◽  
Author(s):  
K. Iba ◽  
T. Wada ◽  
K. Kanaya ◽  
G. Oki ◽  
T. Yamashita
Keyword(s):  
Average Duration ◽  
Proximal Phalanx ◽  
Type Iv ◽  
Group 4 ◽  
Age At Surgery ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Group 1

We carried out arthrography in 19 thumbs of 18 patients in whom duplication was observed at the interphalangeal (Wassel type II) or metacarpophalangeal (Wassel type IV) joints on radiographs. The average age at surgery was 12.3 months and average duration of post-surgical follow-up was 21.3 months. Based on the arthrographic findings, the types of cartilaginous connections were subdivided into five groups. In group 1, there was a cartilaginous connection at the base of duplicated phalanges. In group 2, there was a cartilaginous connection of the radial digit between the distal and proximal phalanges, or between the proximal phalanx and metacarpal. In group 3, the phalanges separated at a common joint without any cartilaginous connection. In group 4, the radial digit demonstrated fibrous attachment to the capsule without any joint formation. In group 5, each joint was completely separated without any cartilaginous connection. These arthrographic findings could not be detected on radiographs. Different surgical procedures were carried out according to the form of cartilaginous connection.

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