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Lee KS, Lee C, Dhillon PS, Kirollos R, Nga VDW, Yeo TT, Henkes H, Arthur AS, Yeo LLL, Bhogal P. Antiplatelet therapy in aneurysmal subarachnoid hemorrhage: an updated meta-analysis. Neurosurg Rev 2023; 46:221. [PMID: 37665377 PMCID: PMC10477151 DOI: 10.1007/s10143-023-02120-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/12/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023]
Abstract
Antiplatelet therapy (AT) may serve to reduce the effects of aneurysmal subarachnoid hemorrhage (aSAH)-induced pro-coagulant state in the cerebral circulation. Several studies, however, have delivered conflicting conclusions on the efficacy of AT post aSAH. Systematic searches of Medline, Embase, and Cochrane Central were undertaken on 27th March 2023. The primary outcome was delayed cerebral ischaemia (DCI). Secondary outcomes were symptomatic and angiographic vasospasm, good functional outcome (modified Rankin Scale [mRS] with scores 0-2), hemorrhagic events, and in-hospital mortality. Twenty-two studies reporting 4378 patients with aSAH were included in the meta-analysis. AT was associated with lower rates of DCI (RR=0.62, 95% CI: 0.43; 0.89), symptomatic vasospasm (RR=0.63, 95% CI: 0.46; 0.86), and moderate/severe angiographic vasospasm (RR=0.74, 95% CI: 0.65; 0.84), with no effect on hemorrhagic complications (RR=1.36, 95% CI: 0.77; 2.41). When analyzing only post-ictal use of AT, AT additionally favored rates of good functional outcomes (RR=1.18, 95% CI: 1.10; 1.26) and in-hospital mortality (RR=0.56, 95% CI: 0.39; 0.80). In the subgroup treated with cilostazol, AT was associated with lower rates of DCI (RR=0.40, 95% CI: 0.32), symptomatic vasospasm (RR=0.47, 95% CI: 0.33; 0.65), moderate/severe angiographic vasospasm (RR=0.75, 95% CI: 0.57; 0.98) and good functional outcome (RR=1.24, 95% CI: 1.08; 1.43). In the surgically treated aSAH subgroup, AT favored rates of symptomatic vasospasm (RR=0.55, 95% CI: 0.30; 0.98), moderate/severe angiographic vasospasm (RR=0.70, 95% CI: 0.54; 0.90) and good functional outcome (RR=1.23, 95% CI: 1.09; 1.41). In the endovascularly treated aSAH subgroup, AT was associated with lower rates of in-hospital mortality (RR=0.60, 95% CI: 0.41; 0.88). In aSAH patients, post-ictal AT is associated with benefits in terms of rates of DCI, vasospasm, good functional outcomes, and in-hospital mortality without an increased risk of hemorrhagic events.
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Affiliation(s)
- Keng Siang Lee
- Department of Neurosurgery, King's College Hospital, London, UK.
- Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.
| | - Cheyenne Lee
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
| | - Permesh S Dhillon
- Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ramez Kirollos
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Vincent D W Nga
- Division of Neurosurgery, Department of Surgery, National University Health System, Singapore, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, Department of Surgery, National University Health System, Singapore, Singapore
| | - Hans Henkes
- Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
- Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Adam S Arthur
- Department of Neurosurgery, Semmes-Murphey Clinic, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Leonard L L Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore and Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, London, UK
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2
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Toh EMS, Thenpandiyan AA, Foo ASC, Zhang JJY, Lim MJR, Goh CP, Dinesh N, Vedicherla SV, Yang M, Teo K, Yeo TT, Nga VDW. Clinical Outcomes of 3D-Printed Bioresorbable Scaffolds for Bone Tissue Engineering-A Pilot Study on 126 Patients for Burrhole Covers in Subdural Hematoma. Biomedicines 2022; 10:0. [PMID: 36359222 PMCID: PMC9687313 DOI: 10.3390/biomedicines10112702] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 09/13/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 10/29/2023] Open
Abstract
Burrhole craniostomy is commonly performed for subdural hematoma (SDH) evacuation, but residual scalp depressions are often cosmetically suboptimal for patients. OsteoplugTM, a bioresorbable polycaprolactone burrhole cover, was introduced by the National University Hospital, Singapore, in 2006 to cover these defects, allowing osseous integration and vascular ingrowth. However, the cosmetic and safety outcomes of OsteoplugTM-C-the latest (2017) iteration, with a chamfered hole for subdural drains-remain unexplored. Data were collected from a single institution from April 2017 to March 2021. Patient-reported aesthetic outcomes (Aesthetic Numeric Analog (ANA)) and quality of life (EQ-5D-3L including Visual Analog Scale (VAS)) were assessed via telephone interviews. Clinical outcomes included SDH recurrence, postoperative infections, and drain complications. OsteoplugTM-C patients had significantly higher satisfaction and quality of life compared to those without a burrhole cover (ANA: 9 [7, 9] vs. 7 [5, 8], p = 0.019; VAS: 85 [75, 90] vs. 70 [50, 80], p = 0.021), and the absence of a burrhole cover was associated with poorer aesthetic outcomes after multivariable adjustment (adjusted OR: 4.55, 95% CI: 1.09-22.68, p = 0.047). No significant differences in other clinical outcomes were observed between OsteoplugTM-C, OsteoplugTM, or no burrhole cover. Our pilot study supports OsteoplugTM-C and its material polycaprolactone as suitable adjuncts to burrhole craniostomy, improving cosmetic outcomes while achieving comparable safety outcomes.
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Affiliation(s)
- Emma M. S. Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.M.S.T.); (A.A.T.)
| | - Ashiley A. Thenpandiyan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.M.S.T.); (A.A.T.)
| | - Aaron S. C. Foo
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - John J. Y. Zhang
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Mervyn J. R. Lim
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Chun Peng Goh
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Nivedh Dinesh
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Srujana V. Vedicherla
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Ming Yang
- Division of Neurosurgery, Department of Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore;
| | - Kejia Teo
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Tseng Tsai Yeo
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
| | - Vincent D. W. Nga
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore; (A.S.C.F.); (J.J.Y.Z.); (M.J.R.L.); (C.P.G.); (N.D.); (S.V.V.); (K.T.); (T.T.Y.)
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3
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Lian BX, Ng NBH, Wang F, Nga VDW, Tan AP, Lin J. Diagnosis of hydrocephalus by cranial transillumination. Arch Dis Child Fetal Neonatal Ed 2022; 107:550. [PMID: 34261768 DOI: 10.1136/archdischild-2021-322430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/30/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Berenice Xueli Lian
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| | - Nicholas Beng Hui Ng
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| | - Furene Wang
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| | - Vincent D W Nga
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
| | - Ai Peng Tan
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Jeremy Lin
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
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4
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Liu SJ, Aw NMY, Lim MJR, Tew Seow W, Low DCY, Kimpo MS, Ee Kar Tan E, Tsai Yeo T, Low SYY, Nga VDW. Paediatric brain tumours in Singapore: A 15-year epidemiological and outcome study. J Clin Neurosci 2022; 101:154-161. [PMID: 35597064 DOI: 10.1016/j.jocn.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/29/2021] [Revised: 04/06/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022]
Abstract
Paediatric brain tumours (PBTs) are the most common solid tumours in children. Previous publications reflect variations in incidence rates and frequency of histological types in different global populations. However, there are limited studies on the epidemiology of PBTs in Singapore. This study aims to summarise the epidemiology of paediatric brain tumours managed in Singapore. This is an ethics-approved retrospective study of all patients below 19 years old diagnosed with PBTs managed by Singapore's 2 tertiary paediatric neurosurgical centres, KK Women's and Children's Hospital (KKH) and the National University Hospital (NUH) over a 15-year period from 01 January 2002 to 31 December 2017. Data collected was analysed for age, gender, tumour characteristics, presenting complaints, location, treatment modalities, 1-year and 5-year overall survival (OS). A total of 396 patients were included. The mean age of diagnosis was 7.05 years (0.25-18; ± 4.83) and male-to-female ratio was 1.41:1. Top histological groups were astrocytic (30.6%), embryonal (26.0%), germ cell (11.1%), ependymoma (30, 7.58%) and craniopharyngioma (27, 6.82%). Outcomes included recurrence rate (31.2%), 1-year OS (89.5%) and 5-year OS (72.2%). Poorer 5-year OS were noted in embryonal tumours (47.0%; p < 0.001) and ependymoma (50.0%; p = 0.0074) patients. Of note, the following cohorts also had poorer OS at 5 years: supratentorial tumours (76.2%; p = 0.0426), radiotherapy (67.4%; p = 0.0467) and surgery (74.9%, HR; p < 0.001). Overall, our data reflects patient demographics, presenting complaints, treatment modalities and survival outcomes, that are comparable to other international paediatric neurosurgical centres.
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Affiliation(s)
- Sherry J Liu
- Division of Neurosurgery, Department of Surgery, National University Health System, Singapore
| | - Natalie M Y Aw
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore
| | - Mervyn J R Lim
- Division of Neurosurgery, Department of Surgery, National University Health System, Singapore
| | - Wan Tew Seow
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - David C Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Miriam S Kimpo
- Division of Paediatric Oncology, Department of Paediatrics, National University Health System, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - Enrica Ee Kar Tan
- Paediatric Haematology/Oncology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, Department of Surgery, National University Health System, Singapore
| | - Sharon Y Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, 11 Jalan Tan Tock Seng, 308433, Singapore.
| | - Vincent D W Nga
- Division of Neurosurgery, Department of Surgery, National University Health System, Singapore
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5
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Tan CH, Karlsson B, Wang S, Zhang JJY, Ang Y, Vellayappan B, Teo K, Nga VDW, Lwin S, Yeo TT. RADI-06. Gamma knife surgery for brain stem metastases. Neurooncol Adv 2021. [PMCID: PMC8351180 DOI: 10.1093/noajnl/vdab071.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Gamma Knife Surgery (GKS) is widely used for treatment of brainstem metastases (BSMs) with or without whole bran radiation therapy (WBRT). We hypothesized that BSMs treated with GKS using lower doses and omitting WBRT result in acceptable tumor control rates and low complication rates. Methods A retrospective single center study was performed to investigate the outcome following GKS of BSMs. All 33 patients with follow-up information treated with GKS for 39 metastases located in the cerebral peduncle, midbrain, pons or medulla oblongata were included in the study. The median treatment dose, defined as the lowest dose to 95% of the tumor volume, was 18 Gy. The tumor control rate as well as the survival time were related to a number of patients, tumor and treatment parameters. Results The local tumor control rate was 100% at one year and 89% at five years, and the overall median survival was 17 months. A good performance status and a treatable extracranial disease were favorably related to survival time. Two complications were observed, one lethal hemorrhage at the day of the treatment and one transient complication three months following GKS, resulting in a 6% complication rate at five years. Four of the 10 patient with symptomatic BSM improved clinically after GKS, while six remained unchanged. Conclusions High local control and a low complication rates can be achieved using GKS for BSMs using lower doses as compared to brain metastases in other locations.
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Affiliation(s)
- Choo Heng Tan
- National University Hospital, Singapore
- National Neuroscience Institute, Singapore
| | | | | | | | | | | | - Kejia Teo
- National University Hospital, Singapore
| | | | - Sein Lwin
- National University Hospital, Singapore
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6
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Zhang JJY, Aw NMY, Tan CH, Lee KS, Chen VHE, Wang S, Dinesh N, Foo ASC, Yang M, Goh CP, Bolem N, Quah BL, Sun IS, Ng ZX, Teo K, Pang BC, Yang EW, Lwin S, Low SW, Yeo TT, Santarius T, Nga VDW. Impact of time to resumption of antithrombotic therapy on outcomes after surgical evacuation of chronic subdural hematoma: A multicenter cohort study. J Clin Neurosci 2021; 89:389-396. [PMID: 34088580 DOI: 10.1016/j.jocn.2021.05.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/15/2021] [Accepted: 05/20/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The decision to resume antithrombotic therapy after surgical evacuation of chronic subdural hematoma (CSDH) requires judicious weighing of the risk of bleeding against that of thromboembolism. This study aimed to investigate the impact of time to resumption of antithrombotic therapy on outcomes of patients after CSDH drainage. METHODS Data were obtained retrospectively from three tertiary hospitals in Singapore from 2010 to 2017. Outcome measures analyzed were CSDH recurrence and any thromboembolic events. Logistic and Cox regression tests were used to identify associations between time to resumption and outcomes. RESULTS A total of 621 patients underwent 761 CSDH surgeries. Preoperative antithrombotic therapy was used in 139 patients. 110 (79.1%) were on antiplatelets and 35 (25.2%) were on anticoagulants, with six patients (4.3%) being on both antiplatelet and anticoagulant therapy. Antithrombotic therapy was resumed in 84 patients (60.4%) after the surgery. Median time to resumption was 71 days (IQR 29 - 201). Recurrence requiring reoperation occurred in 15 patients (10.8%), of which 12 had recurrence before and three after resumption. Median time to recurrence was 35 days (IQR 27 - 47, range 4 - 82 days). Recurrence rates were similar between patients that were restarted on antithrombotic therapy before and after 14, 21, 28, 42, 56, 70 and 84 days, respectively. Thromboembolic events occurred in 12 patients (8.6%), of which five had the event prior to restarting antithrombosis. CONCLUSIONS Time to antithrombotic resumption did not significantly affect CSDH recurrence. Early resumption of antithrombotic therapy can be safe for patients with a high thromboembolic risk.
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Affiliation(s)
- John J Y Zhang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Natalie M Y Aw
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Choo Heng Tan
- Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Keng Siang Lee
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Vanessa H E Chen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shilin Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nivedh Dinesh
- Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Aaron Song Chuan Foo
- Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Ming Yang
- Division of Neurosurgery, Department of Surgery, Khoo Teck Puat Hospital, Singapore
| | - Chun Peng Goh
- Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Nagarjun Bolem
- Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Boon Leong Quah
- Division of Neurosurgery, Department of Surgery, Khoo Teck Puat Hospital, Singapore
| | - Ira Siyang Sun
- Division of Neurosurgery, Department of Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Zhi Xu Ng
- Division of Neurosurgery, Department of Surgery, Khoo Teck Puat Hospital, Singapore
| | - Kejia Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Boon Chuan Pang
- Division of Neurosurgery, Department of Surgery, Khoo Teck Puat Hospital, Singapore
| | - Eugene Weiren Yang
- Division of Neurosurgery, Department of Surgery, Khoo Teck Puat Hospital, Singapore
| | - Sein Lwin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Shiong Wen Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurosurgery, Department of Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Tseng Tsai Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Thomas Santarius
- Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Vincent D W Nga
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
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Zhang JJY, Ong JAH, Tan YX, Yeo JYP, Lee KS, Goh CP, Bolem N, Tan CL, Yuan SY, Teo K, Lwin S, Yeo TT, Kirollos RW, Nga VDW. Predictors of 30-day postoperative systemic complications in geriatric patients undergoing elective brain tumor surgery. J Clin Neurosci 2021; 85:72-77. [PMID: 33581794 DOI: 10.1016/j.jocn.2020.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/30/2020] [Accepted: 12/17/2020] [Indexed: 11/15/2022]
Abstract
Little evidence exists to guide the preoperative selection of elderly brain tumor patients who are fit for surgery. We aimed to evaluate the safety of brain tumor resection in geriatric patients and identify predictors of postoperative 30-day systemic complications. We conducted a retrospective cohort study of 212 consecutive patients at or above the age of 60 years who underwent elective brain tumor resection between 2007 and 2017. The primary outcome measures analyzed were perioperative systemic complications within 30 days after the operation. A total of 212 geriatric brain tumor patients were included. Fifty-two (24.5%) had a 30-day systemic complication. Among them, 29 (13.7%) had systemic infections, 13 (6.1%) had perioperative seizures, 10 (4.7%) had syndrome of inappropriate antidiuretic hormone secretion (SIADH), five (2.4%) had deep venous thrombosis (DVT), four (1.9%) had perioperative stroke, three (1.4%) had acute myocardial infarction (AMI) and three (1.4%) had central nervous system (CNS) infections. One patient (0.5%) died. Perioperative stroke was predicted by previous stroke (p = 0.040), chronic liver disease (p < 0.001) and vestibular schwannoma (p = 0.002 with reference to meningiomas). Perioperative AMI was predicted by co-existing ischemic heart disease (p = 0.031). Systemic infection was predicted by female gender (p = 0.007) and preoperative Karnofsky Performance Scale (KPS) score < 70 (p = 0.019). DVT was predicted by GBM (p = 0.014). In conclusion, brain tumor surgery can be safe in carefully-selected geriatric patients. The risk factors identified in this study would be helpful to select suitable candidates for surgery.
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Affiliation(s)
- John J Y Zhang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Jamie A H Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yu Xiang Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joshua Y P Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Keng Siang Lee
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Chun Peng Goh
- Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Nagarjun Bolem
- Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Chin Lik Tan
- Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Si Yang Yuan
- Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Kejia Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Sein Lwin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Tseng Tsai Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
| | - Ramez W Kirollos
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Vincent D W Nga
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore
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8
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Cho N, Nga VDW, Ahmed R, Ku JC, Munarriz PM, Muthusami P, Rutka JT, Dirks P. Surgical management of pediatric rolandic arteriovenous malformations: a single-center case series. J Neurosurg Pediatr 2020; 27:62-68. [PMID: 33126222 DOI: 10.3171/2020.6.peds18547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 06/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Pediatric rolandic arteriovenous malformations (AVMs) present a treatment challenge given the lifetime risk of hemorrhage, rehemorrhage, and associated long-term morbidity. Microsurgical resection has been recommended as the optimal treatment for AVMs in general, but there is no dedicated literature on the outcomes of resection of pediatric rolandic AVMs. Here, the study objective was to review the outcomes of microsurgical resection of pediatric rolandic AVMs in the modern era, together with the utilization of surgical adjuncts including navigation, intraoperative angiography, and neurophysiological monitoring. METHODS The authors performed a retrospective review of patients 18 years of age and younger with cerebral AVMs microsurgically treated between January 2000 and May 2016 at The Hospital for Sick Children. Only those patients with an AVM whose nidus was located within the rolandic region were analyzed. A descriptive analysis was performed to identify patient demographics, preoperative AVM characteristics, and postoperative obliteration rates and neurological complications. RESULTS A total of 279 AVMs were evaluated in the study period. Twenty-three of these AVMs were rolandic, and the median age in the 11 microsurgically treated cases was 11 years (range 1-17 years). AVM hemorrhage was the most common presentation, occurring in 8 patients (73%). Lesions were either Spetzler-Martin grade II (n = 8, 73%) or grade III (n = 3, 27%). The postoperative obliteration rate of AVMs was 100%. The mean imaging follow-up duration was 33 months (range 5-164 months). There was no documented recurrence of an AVM during follow-up. One patient developed a transient postoperative hemiparesis, while another patient developed right fingertip hyperesthesia. CONCLUSIONS Microsurgical resection of rolandic pediatric AVMs yields excellent AVM obliteration with minimal neurological morbidity in selected patients. The incorporation of surgical adjuncts, including neurophysiological monitoring and neuronavigation, allows accurate demarcation of functional cortex and enables effective resection.
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Affiliation(s)
- Newton Cho
- 1The Hospital for Sick Children, Toronto.,Departments of2Neurosurgery and
| | - Vincent D W Nga
- 3Department of Neurosurgery, National Hospital of Singapore, Singapore; and
| | - Raheel Ahmed
- 4Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin
| | - Jerry C Ku
- 1The Hospital for Sick Children, Toronto.,Departments of2Neurosurgery and
| | - Pablo M Munarriz
- 1The Hospital for Sick Children, Toronto.,Departments of2Neurosurgery and
| | - Prakash Muthusami
- 1The Hospital for Sick Children, Toronto.,5Neuroradiology, University of Toronto, Toronto, Ontario, Canada
| | - James T Rutka
- 1The Hospital for Sick Children, Toronto.,Departments of2Neurosurgery and
| | - Peter Dirks
- 1The Hospital for Sick Children, Toronto.,Departments of2Neurosurgery and
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9
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Lim JX, Leong AZ, Tan CH, Teo K, Nga VDW, Lwin S, Chou N, Yeo TT. Coronavirus Disease 2019 (COVID-19) Response Measures-A Singapore Neurosurgical Academic Medical Center Experience in Emerging from the Worldwide Pandemic. World Neurosurg 2020; 142:526-527. [PMID: 32987585 PMCID: PMC7510554 DOI: 10.1016/j.wneu.2020.07.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jia Xu Lim
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Adriel Z Leong
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore
| | - Choo Heng Tan
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore
| | - Kejia Teo
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore
| | - Vincent D W Nga
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore
| | - Sein Lwin
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore
| | - Ning Chou
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore
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10
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Leong AZ, Lim JX, Tan CH, Teo K, Nga VDW, Lwin S, Chou N, Yeo TT. COVID-19 response measures - a Singapore Neurosurgical Academic Medical Centre experience segregated team model to maintain tertiary level neurosurgical care during the COVID-19 outbreak. Br J Neurosurg 2020; 35:719-724. [PMID: 32530308 DOI: 10.1080/02688697.2020.1758629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim: This article aims to inform and share the experience of a Singaporean tertiary level neurosurgical unit in an academic medical centre during the COVID-19 outbreak. Method: This is a descriptive study of our segregation team model which is designed with the aim of optimizing manpower and ensuring the safety and welfare of the neurosurgical unit, while maintaining and prioritizing excellent patient care. Result: We describe our method of team segregation, rostering, and outline some principles that we adhere to in its design. We also summarise the restructuring of our inpatient and outpatient service, including the operating theatre and protocols for specific procedures, intensive care and general wards, as well as clinic services and multidisciplinary meetings. Conclusion: We end with a commentary on residency training and anticipated challenges. Given the likely protracted course of the pandemic, it is key to account for sustainability of such measures and the conservation of resource via the reduction of pateint volume, upkeep of staff emotional and physical health and harnessing technologies such as telemedicine.
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Affiliation(s)
- Adriel Z Leong
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Jia Xu Lim
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Choo Heng Tan
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Kejia Teo
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Vincent D W Nga
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Sein Lwin
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Ning Chou
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
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11
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Kraneburg UM, Nga VDW, Ting EYS, Hui FKH, Lwin S, Teo C, Chou N, Yeo TT. Intracranial pial arteriovenous fistula in infancy: a case report and literature review. Childs Nerv Syst 2014; 30:365-9. [PMID: 23817995 DOI: 10.1007/s00381-013-2217-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 06/19/2013] [Indexed: 11/27/2022]
Abstract
Intracranial pial arteriovenous fistulas (AVF) are rare vascular malformation especially in the first 2 years of life. The pathology in this age group is associated with greater morbidity and mortality. We report a rare case of 36-day-old male infant with a pial AVF associated with an arterial aneurysm, who presented with intraventricular hemorrhage and hydrocephalus. In addition, an online review of the literatures on pediatric pial AVF was performed using PubMed on published case reports and articles from 1980 to April 2013.
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Affiliation(s)
- U M Kraneburg
- University of Witten/Herdecke School of Medicine, Witten, Germany
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