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Talaat M, Premat K, Lenck S, Shotar E, Boch AL, Bessar A, Taema M, Hassan F, Elserafy TS, Degos V, Sourour N, Clarençon F. Exclusion treatment of ruptured and unruptured low-grade brain arteriovenous malformations: a systematic review. Neuroradiology 2021; 64:5-14. [PMID: 34562139 DOI: 10.1007/s00234-021-02714-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/06/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the obliteration rate, functional outcome, hemorrhagic complication, and mortality rates of exclusion treatment of low-grade brain arteriovenous malformations (BAVMs) (Spetzler and Martin grades (SMGs) 1 and 2), either ruptured or unruptured. METHODS Electronic databases-Ovid MEDLINE and PubMed-were searched for studies in which there was evidence of exclusion treatment of low-grade BAVMs treated either by endovascular, surgical, radiosurgical, or multimodality treatment. The primary outcome of interest was angiographic obliteration post-treatment and at follow-up. The secondary outcomes of interest were functional outcome (mRS), mortality rate, and hemorrhagic complication. Descriptive statistics were used to calculate rates and means. RESULTS Eleven studies involving 1809 patients with low-grade BAVMs were included. Among these, 1790 patients treated by either endovascular, surgical, radiosurgical, or multimodality treatment were included in this analysis. Seventy-two percent of BAVMs were Spetzler-Martin grade II. The overall (i.e., including all exclusion treatment modalities) complete obliteration rate ranged from 36.5 to 100%. The overall symptomatic hemorrhagic complication rate ranged from 0 to 7.3%; procedure-related mortality ranged from 0 to 4.7%. CONCLUSION Our systematic review of the literature reveals a high overall obliteration rate for low-grade BAVMs, either ruptured or unruptured, with low mortality rate and an acceptable post-treatment hemorrhagic complication rate. These results suggest that exclusion treatment of low-grade BAVMs may be safe and effective, regardless of the treatment modality chosen.
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Affiliation(s)
- Maichael Talaat
- Department of Interventional Neuroradiology, GRC BioFast, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, 75013, Paris, France.,Department of Radiodiagnosis, Faculty of Medicine, Zagazig University E44519, Zagazig, Egypt
| | - Kévin Premat
- Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, 47-83 Boulevard de l'Hôpital 75013, Paris, France
| | - Stéphanie Lenck
- Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, 47-83 Boulevard de l'Hôpital 75013, Paris, France
| | - Eimad Shotar
- Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, 47-83 Boulevard de l'Hôpital 75013, Paris, France
| | - Anne-Laure Boch
- Department of Neurosurgery, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, 75013, Paris, France
| | - Awad Bessar
- Department of Radiodiagnosis, Faculty of Medicine, Zagazig University E44519, Zagazig, Egypt
| | - Mohammed Taema
- Department of Radiodiagnosis, Faculty of Medicine, Zagazig University E44519, Zagazig, Egypt
| | - Farouk Hassan
- Department of Radiodiagnosis, Faculty of Medicine, Cairo University, Cairo, C12613, Egypt
| | - Tamer S Elserafy
- Department of Neurology, Faculty of Medicine, Zagazig University, Zagazig, E44519, Egypt
| | - Vincent Degos
- Department of Anesthesiology and Critical Care, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, 75013, Paris, France
| | - Nader Sourour
- Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, 47-83 Boulevard de l'Hôpital 75013, Paris, France
| | - Frédéric Clarençon
- Department of Interventional Neuroradiology, GRC BioFast, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, 75013, Paris, France. .,Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, 47-83 Boulevard de l'Hôpital 75013, Paris, France.
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Nasr WF, ElSheikh E, El-Anwar MW, Sweed AH, Bessar A, Ezzeldin N. Two- versus Three-Point Internal Fixation of Displaced Zygomaticomaxillary Complex Fractures. Craniomaxillofac Trauma Reconstr 2017; 11:256-264. [PMID: 30574268 DOI: 10.1055/s-0037-1604199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/14/2017] [Indexed: 10/19/2022] Open
Abstract
Despite the high frequency of the zygomaticomaxillary complex (ZMC) fractures, there is no consensus among facial reconstructive surgeons regarding the best surgical management; thus, surgical choice for ZMC fractures is still challenging. This study included 40 patients with displaced ZMC fracture. Twenty patients were treated with open reduction and internal fixation (OR/IF) using two-point fixation technique (at infraorbital margin and zygomaticofrontal buttress region) and the remaining 20 patients were treated with OR/IF using three-point fixation technique (at frontozygomatic suture, infraorbital margin, and zygomatico maxillary buttress). The results of both types of ZMC fractures repair were then statistically compared. No statistical differences between the two types regarding malar eminence asymmetry; projection (forward displacement) and width (medial displacement) in axial CT; inferior displacement; superior displacement and width (medial displacement) in coronal CT; angle of displacement (outward displacement) in 3D CT; masseter and temporalis muscles power electromyography; actual duration of surgery; and patient satisfaction. On the other hand, the total cost of the used plates and screws was significantly higher with three-point repair than two-point repair ( p = 0.003). Moreover, postoperative CT lateral zygoma displacement was statistically significantly better in three-point fixation. Two-point fixation modality for displaced ZMC fractures is as effective as three-point method in fixation and prevents postreduction rotation or clinical displacement with significantly lower cost.
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Affiliation(s)
- Wail Fayez Nasr
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, El Sharkya, Egypt
| | - Ezzeddin ElSheikh
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, El Sharkya, Egypt
| | - Mohammad Waheed El-Anwar
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, El Sharkya, Egypt
| | - Ahmed Hassan Sweed
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Human Medicine, Zagazig University, Zagazig, El Sharkya, Egypt
| | - Awad Bessar
- Department of Radio Diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, El Sharkya, Egypt
| | - Nillie Ezzeldin
- Department of Rheumatology and Rehabilitation, Faculty of Human Medicine, Zagazig University, Zagazig, El Sharkya, Egypt
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