[The benefits of a hybrid operation room in neurosurgery.]

INTRODUCTION

The hybrid operation room - with a robotic arm equipped angiographic device - started its operation in November 2019 at the Department of Neurosurgery, Szeged, Hungary.

OBJECTIVE

We report the benefits of the hybrid operation room in the neurosurgery practice based on our results and experiences of the last 1.5 years.

METHOD

576 operations took place between 15. 11. 2019 and 01. 03. 2021, which include 332 neurointerventions amd 244 skull-brain and spine surgeries. By using Siemens ARTIS pheno®, we performed purely catheter only interventions or surgical only interventions, but combined treatments were also performed in several cases (catheter and surgical intervention). Thanks to ARTIS pheno® versatility, it is used as a modern imaging system in preoperative examination or as navigation system in spine surgery and control imaging for intra- and postoperative examinations.

DISCUSSION

We created three categories based on the results of the last months according to the need of using the hybrid operation room for the given operation: (1) strongly recommended, (2) recommended, (3) advantageous. Strongly recommended: if the two teams (surgical and interventional team) have to work together during the operation. Recommended: if the two teams are not participating together in the operation, but the other team is on standby and may join the operation if necessary. Advantageous: this category means the possibility of performing control imaging before the wound closure.

CONCLUSION

Based on our experience, the hybrid operation room provides significant help in neurosurgery. It has become part of our daily care, and we think it is indispensable in the work of a neurosurgery center. Orv Hetil. 2023; 164(43): 1701-1711.

Tonsillectomia versus tonsillotomia

Összefoglaló. Bevezetés és célkitűzés: A szerzők a posztoperatív fájdalom és a sebgyógyulás tekintetében prospektív vizsgálattal hasonlították össze gyermekeken (67 fő, 1-12 év) a hagyományos hidegeszközzel történő extracapsularis tonsillectomiát (23 fő) a microdebriderrel (23 fő) és a coblatorral (21 fő) végzett intracapsularis tonsillotomiával. Módszer: A vizsgálatok a betegek által kitöltött kérdőívek, valamint prospektív klinikai adatgyűjtés alapján történtek. Eredmények: Az intracapsularis tonsillotomia gyógyulási idejét 50%-kal rövidebbnek találtuk, és az első 13 napban szignifikánsan kevesebb fájdalommal és fájdalomcsillapító igénnyel járt, mint az extracapsularis tonsillectomia eseteiben. A tonsillotomiás csoporton belül egyedül a posztoperatív első napi fájdalom tekintetében észleltünk szignifikáns különbséget a két különböző módszer között a coblator javára (p<0,05). A vizsgálatokat retrospektív áttekintéssel is kiegészítettük, 4 évi gyermek- (1-15 éves) tonsillaműtéten átesett beteganyagunk (1487 fő) eredményeinek feldolgozásával. Tonsillectomia (1253 fő) után 7,7%-os utóvérzési arányt észleltünk, műtéti vérzéscsillapításra 1,3%-ban volt szükség. Tonsillotomia esetén (234 fő) 0,43%-os utóvérzési arányt regisztráltunk. Ebben a csoportban vérzés miatt nem, de 2 esetben ismételt obstrukciót okozó hypertrophia, 1 esetben góctünetek miatt reoperációt végeztünk (1,28%). Következtetés: Eredményeiket a szerzők a nemzetközi ajánlások tükrében elemezték. Az intracapsularis tonsillotomia kisebb fájdalommal, kisebb vérzéssel és kisebb megterheléssel jár. A közösségbe való aktív visszatérés akár egy hét után lehetséges a tonsillectomiára jellemző 3 héttel szemben, mindez jelentős szocioökonómiai előnyökkel járhat. Orv Hetil. 2020; 161(45): 1920-1926.

SUMMARY

INTRODUCTION AND OBJECTIVE

Examining operated children in this prostective study inditerscompared (67 pts, 1-12 yrs) the extracapsular tonsillectomy with conventional cold-knife (23 pts) to extracapsular tonsillotomy with microdebrider (23 pts) and coblator (21 pts) for postoperative pain and wound-healing disorders.

METHOD

The study was based on patient-completed questionnaires as well as prospective clinical data collection.

RESULTS

The recovery time of intracapsular tonsillotomy was found less than 50%, with less pain than in the cases of extracapsular tonsillectomy. Postoperative pain was significantly less in the tonsillototomy group than the tonsillectomy group. Within the tonsillotomy group, a significant difference was observed between the two different methods in favor of the coblator for only the postoperative first-day pain. The studies were supplemented with a retrospective review by processing the 4 yrs results of their pediatric (1-15-yrs) patients who underwent tonsillectomy (1487 pts). After tonsillectomy (1253 pts), a postoperative bleeding rate of 7.7% was observed, and surgical hemostasis was required in 1.3%. In the case of tonsillotomy (234 pts), a postoperative bleeding rate of 0.43% was recorded. In this group, reoperation was not performed due to bleeding, whereas it was neccesary in 2 cases due to hypertrophy causing repeated obstruction, in 1 case due by virtue of focal symptomes (1.28%).

CONCLUSION

Our results were analyzed on the basis of international recommendations. Intracapsular tonsillotomy is associated with less pain, less bleeding, and less strain. Active return to the community is possible after up to a week compared to the 3 weeks typical of tonsillectomy, all of which can have significant socioeconomic benefits. Orv Hetil. 2020; 161(45): 1920-1926.

The treatment of pseudoaneurysms with flow diverters after malignant otitis externa

Background We report a case of bilateral malignant otitis externa complicated with bilateral petrous internal carotid artery pseudoaneurysms and their successful treatment with a flow diverter. Case report A 68-year-old woman with serious complications of type II diabetes mellitus had malignant otitis externa on the right side. She was treated with combined antibiotic therapy and underwent mastoidectomy for mastoiditis. She presented at our hospital with acute hemorrhage from the right external auditory canal. The emergency computed tomography (CT) angiography revealed a multiobulated pseudoaneurysm at the petrous segment of the right internal carotid artery. The pseudoaneurysm was treated with a 5 × 40-mm Surpass flow diverter. Three months later, she developed a malignant external otitis on the left side. As the infection progressed, a left-sided mastoiditis, a brain abscess, and a pseudoaneurysm at the petrous segment of the left internal carotid artery developed. The pseudoaneurysm caused bleeding from the left ear, and was treated with a 5 × 50-mm Surpass flow diverter. No recurrent bleeding was observed. Four months later, a follow-up angiography showed complete occlusion of the pseudoaneurysm on the left side, but a residual aneurysm could be detected on the right side. One year after the first intervention, the follow-up CT and magnetic resonance angiography revealed the complete occlusion of the aneurysms bilaterally. Conclusion The use of a flow diverter appears to be an efficient and safe method to occlude carotid pseudoaneurysms even in an inflammatory milieu.

Multidisciplinary management of cervical neuroblastoma in infants

OBJECTIVES

Neuroblastoma is the most common malignancy in infancy, it is a histologically and genetically heterogeneous tumor, the therapy and outcome of which is influenced by age, histological variant and genetic background as well.

METHODS

We present two consecutive infant patients with neuroblastoma of the neck discussing the etiology, the diagnosis and the surgical and oncological treatment of the tumor, which was observed in a relatively rare manifestation in the head-neck region.

RESULTS

Our first patient (age: 5.5 months) was MYCN (v-myc myelocytomatosis viral related oncogene, neuroblastoma derived) negative, INSS (International Neuroblastoma Staging System) Stage 3 and INRGSS (International Neuroblastoma Risk Group Staging System) Stage 3 because of the contralateral lymph node involvement while the complete gross resection of the primary tumor mass was feasible. The patient is tumor free after three years of follow-up. Our second patient (age: 5 months) was MYCN negative, INSS Stage 2 and INRGSS Stage 1, as both the primary tumor and the ipsilateral lymph nodes were totally removed via a modified radical neck dissection. The patient is tumor free after three years of follow-up.

CONCLUSION

For MYCN negative patients, especially in early age, the prognosis of neuroblastoma is good, surgical resection and chemotherapy together is an adequate treatment protocol (as in our two patients). While MYCN-amplified patients require a combined and aggressive treatment with surgery, chemotherapy, radiotherapy, and immunotherapy to be able to obtain a favorable survival rate according to the literature.