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Lun Y, Jiang H, Zhang J. Novel chimney balloon technique to safeguard cerebral blood flow during total endovascular aortic arch repair. J Vasc Surg Cases Innov Tech 2024; 10:101489. [PMID: 38666006 PMCID: PMC11043866 DOI: 10.1016/j.jvscit.2024.101489] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/12/2024] [Indexed: 04/28/2024] Open
Abstract
During endovascular total aortic arch repair by in situ fenestration, extra procedures are needed to sustain cerebral blood flow when targeting all three supra-aortic branches. Recently, our group successfully interposed a chimney balloon between the greater curvature of the aortic arch and an aortic stent to safeguard cerebral blood flow during total endovascular aortic arch repair.
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Affiliation(s)
- Yu Lun
- Department of Vascular Surgery, The First Hospital, China Medical University, Shenyang, China
| | - Han Jiang
- Department of Vascular Surgery, The First Hospital, China Medical University, Shenyang, China
| | - Jian Zhang
- Department of Vascular Surgery, The First Hospital, China Medical University, Shenyang, China
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Endo H, Nakamura H. Fenestration of the posterior cerebral artery P1-P2 junction: A case report. Radiol Case Rep 2024; 19:2192-2195. [PMID: 38515766 PMCID: PMC10955084 DOI: 10.1016/j.radcr.2024.02.088] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/05/2024] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
Fenestration is a rare anatomical variation in the posterior cerebral artery. To the best of our knowledge, there are few reports of fenestrations at the posterior cerebral artery P1-P2 junction. Herein, we report a case of fenestration of the posterior cerebral artery P1-P2 junction diagnosed by 3-T magnetic resonance imaging and magnetic resonance angiography. A 75-year-old woman visited our hospital because of headaches. Magnetic resonance imaging incidentally showed fenestration around the P1-P2 segment of the right posterior cerebral artery. Magnetic resonance angiography revealed a small fenestration at the right posterior cerebral artery P1-P2 junction. The vessel diameter of both limbs forming the fenestration was nearly equal. Careful imaging assessment is important to identify fenestration of the posterior cerebral artery P1-P2 junction. Both magnetic resonance angiography and magnetic resonance imaging were useful for diagnosis in this case.
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Affiliation(s)
- Hideki Endo
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan
| | - Hirohiko Nakamura
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan
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Baghbani-Oskouei A, Savadi S, Mesnard T, Sulzer T, Mirza AK, Baig S, Timaran CH, Oderich GS. Transcatheter electrosurgical septotomy technique for chronic postdissection aortic aneurysms. J Vasc Surg Cases Innov Tech 2024; 10:101402. [PMID: 38304296 PMCID: PMC10830870 DOI: 10.1016/j.jvscit.2023.101402] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Aortic dissection often results in chronic aneurysmal degeneration due to progressive false lumen expansion. Thoracic endovascular aortic repair and other techniques of vessel incorporation such as fenestrated-branched or parallel grafts have been increasingly used to treat chronic postdissection aneurysms. True lumen compression or a vessel origin from the false lumen can present considerable technical challenges. In these cases, the limited true lumen space can result in inadequate stent graft expansion or restrict the ability to reposition the device or manipulate catheters. Reentrance techniques can be used selectively to assist with target vessel catheterization. Transcatheter electrosurgical septotomy is a novel technique that has evolved from the cardiology experience with transseptal or transcatheter aortic valve procedures. This technique has been applied in select patients with chronic dissection to create a proximal or distal landing zone, disrupt the septum in patients with an excessively compressed true lumen, or connect the true and false lumen in patients with vessels that have separate origins. In the present report, we summarize the indications and technical pitfalls of transcatheter electrosurgical septotomy in patients treated by endovascular repair for chronic postdissection aortic aneurysms.
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Affiliation(s)
- Aidin Baghbani-Oskouei
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Safa Savadi
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Thomas Mesnard
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Titia Sulzer
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Aleem K. Mirza
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Shadman Baig
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Carlos H. Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Gustavo S. Oderich
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
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Thiele K, Unmann A, Geyer S, Siebenlist S, Scheibel M, Seemann R, Lerchbaumer M, Schoch C, Mader K. Evaluation of the efficiency of an ultrasound-supported infiltration technique in patients with tennis elbow applying the ITEC medical device: a multicenter study. JSES Int 2024; 8:361-370. [PMID: 38464435 PMCID: PMC10920118 DOI: 10.1016/j.jseint.2023.11.006] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background The treatment of lateral epicondylitis remains unsatisfactory in certain cases. The aim of this study is to investigate the efficiency of an ultrasound-guided infiltration combined with fenestration of the extensor tendon postulating a 50% reduction in pain on exertion within 6 months. Methods In a prospective, nonrandomized, multicenter study design, 68 patients with chronic lateral epicondylitis and symptoms lasted for at least 6 weeks were included. Each hospital has been assigned for Traumeel (A), autologous whole blood (B), or dextrose (C) in advance. Preinterventional, 6 weeks, 12 weeks, 6 and 12 months after infiltration, patient-related outcome parameter, and dorsal wrist extension strength were documented. Preinterventional (obligate) and after 6 months (optional) radiological evaluation (magnetic resonance imaging) was performed. Results The Visual Analog Scale showed a significant reduction after 6 months in all groups (A. 4.8-2.5, B. 6.2-2.3, C. 5.8-2.4). Similar results could be observed with Subjective elbow value, Disabilities of Arm, Shoulder, and Hand Score, Mayo Elbow Performance Score, and Patient Rated Tennis Elbow Evaluation. The loss of strength could be completely compensated after about 6 months. Magnetic resonance imaging did not fully reflect clinical convalescence. Re-infiltrations were sometimes necessary for final reduction of symptoms (A = 11, B = 8, C = 4). Switching to surgical intervention was most frequently observed in group C (A = 2, B = 1, C = 5). In 14.5% of the cases, no improvement of the symptoms could be achieved with this method. Conclusion The primary hypothesis of a significant long-term pain reduction of at least 50% could be achieved regardless of the medication chosen.
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Affiliation(s)
- Kathi Thiele
- Center for Musculoskeletal Surgery, Charité–University of Berlin, Berlin, Germany
| | - Annemarie Unmann
- Center for Musculoskeletal Surgery, Charité–University of Berlin, Berlin, Germany
- Trauma Department, LKH Feldbach, Feldbach, Austria
| | - Stephanie Geyer
- Department of Shoulder and Elbow Surgery, St. Vinzenz Klinik Pfronten, Pfronten, Germany
- Sektion Sportorthopädie, Klinikum rechts der Isar, München, Germany
| | | | - Markus Scheibel
- Center for Musculoskeletal Surgery, Charité–University of Berlin, Berlin, Germany
- Department of Shoulder and Elbow Surgery, Schulthess Klinik, Zürich, Switzerland
| | - Ricarda Seemann
- Center for Musculoskeletal Surgery, Charité–University of Berlin, Berlin, Germany
- Zentrum für Orthopädie&Unfallchirurgie Tettnang, Tettnang, Germany
| | | | - Christian Schoch
- Sektion Sportorthopädie, Klinikum rechts der Isar, München, Germany
| | - Konrad Mader
- Zentrum für Orthopädie&Unfallchirurgie Tettnang, Tettnang, Germany
- Division Hand, Forearm and Elbow Surgery, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Zhou Z, Zhao F, Yu J. The effect of the occipital sinus on the torcular Herophili and neighboring structures. Heliyon 2024; 10:e25547. [PMID: 38375300 PMCID: PMC10875375 DOI: 10.1016/j.heliyon.2024.e25547] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/23/2023] [Accepted: 01/29/2024] [Indexed: 02/21/2024] Open
Abstract
Objective The occipital sinus (OS) has many variations. It is unknown whether OS can change the angioarchitecture of torcular Herophili. Therefore, we performed magnetic resonance venography (MRV) in a cohort of Han Chinese individuals to determine whether OS can change the angioarchitecture of torcular Herophili. Methods Participants were divided into a normal OS group and a hyperplastic OS group. Parameters of the OS and torcular Herophili and its neighboring structures were recorded. Statistical analysis was used to determine the effects of OS on torcular Herophili and neighboring structures. Results One hundred forty-five healthy participants were enrolled. One hundred patients were in the normal OS group, and 45 were in the hyperplastic OS group. In the normal OS group, the diameters at the transverse sinus (TS) origin were 5.8 ± 2.3 mm on the left side and 7.5 ± 2.2 mm on the right side. In the hyperplastic OS group, the diameters at the TS origin were 6.0 ± 2.1 mm on the left side and 7.0 ± 2.7 mm on the right side. Fenestration was observed in 33% of the torculars in the normal OS group and 6.7% of the torculars in the hyperplastic group. An unpaired t-test revealed a significant difference between bilateral TSs in the normal OS group (P < 0.05) but no difference in the hyperplastic OS group. The chi-square test revealed a significant difference in torcular Herophili fenestration between the normal and hyperplastic OS groups (P < 0.05). Conclusions Hyperplastic OS makes bilateral TSs equal in diameter and weakens the predominance of the right TS. A hyperplastic OS reduces the occurrence of torcular Herophili fenestration.
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Affiliation(s)
- Zibo Zhou
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, China
| | - Fasheng Zhao
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, China
| | - Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, China
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Crowley JD, Oliver RA, Wang T, Pelletier MH, Walsh WR. Lateral fenestration of lumbar intervertebral discs in rabbits: development and characterisation of an in vivo preclinical model with multi-modal endpoint analysis. Eur Spine J 2024:10.1007/s00586-024-08153-5. [PMID: 38372793 DOI: 10.1007/s00586-024-08153-5] [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] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/19/2023] [Accepted: 01/21/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE To evaluate the biological and biomechanical effects of fenestration/microdiscectomy in an in vivo rabbit model, and in doing so, create a preclinical animal model of IVDD. METHODS Lateral lumbar IVD fenestration was performed in vivo as single- (L3/4; n = 12) and multi-level (L2/3, L3/4, L4/5; n = 12) fenestration in skeletally mature 6-month-old New Zealand White rabbits. Radiographic, micro-CT, micro-MRI, non-destructive robotic range of motion, and histological evaluations were performed 6- and 12-weeks postoperatively. Independent t tests, one-way and two-way ANOVA and Kruskal-Wallis tests were used for parametric and nonparametric data, respectively. Statistical significance was set at P < 0.05. RESULTS All rabbits recovered uneventfully from surgery and ambulated normally. Radiographs and micro-CT demonstrated marked reactive proliferative osseous changes and endplate sclerosis at fenestrated IVDs. Range of motion at the fenestrated disc space was significantly reduced compared to intact controls at 6- and 12-weeks postoperatively (P < 0.05). Mean disc height index percentage for fenestrated IVDs was significantly lower than adjacent, non-operated IVDs for both single and multi-level groups, at 6 and 12 weeks (P < 0.001). Pfirrmann MRI IVDD and histological grading scores were significantly higher for fenestrated IVDs compared to non-operated adjacent and age-matched control IVDs for single and multi-level groups at 6 and 12 weeks (P < 0.001). CONCLUSIONS Fenestration, akin to microdiscectomy, demonstrated significant biological, and biomechanical effects in this in vivo rabbit model and warrants consideration by veterinary and human spine surgeons. This described model may be suitable for preclinical in vivo evaluation of therapeutic strategies for IVDD in veterinary and human patients.
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Affiliation(s)
- James D Crowley
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales (UNSW) Sydney, Prince of Wales Hospital, Sydney, NSW, Australia.
| | - Rema A Oliver
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales (UNSW) Sydney, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Tian Wang
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales (UNSW) Sydney, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Matthew H Pelletier
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales (UNSW) Sydney, Prince of Wales Hospital, Sydney, NSW, Australia
| | - William R Walsh
- Surgical and Orthopaedic Research Laboratories (SORL), Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales (UNSW) Sydney, Prince of Wales Hospital, Sydney, NSW, Australia
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Luo ZR, Li SL, Chen LW, Huang RD. Utilizing physician modified fenestration on the castor branched stent technique for reconstruction of an isolated left vertebral artery on the aortic arch. Sci Rep 2024; 14:4051. [PMID: 38374192 PMCID: PMC10876643 DOI: 10.1038/s41598-024-54781-8] [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: 11/21/2023] [Accepted: 02/16/2024] [Indexed: 02/21/2024] Open
Abstract
The study aimed to provide physician modified fenestration (PMF) on a single-branched stent for the aortic arch (Castor) to protect the isolated left vertebral artery (ILVA) during thoracic endovascular aortic repair (TEVAR). Patients who underwent TEVAR involving ILVA reconstruction through PMF performing on the Castor branched stent were included in a retrospective, multi-centre study from June 2018 to December 2022. In these patients, all proximal landing zones of "Castor" were positioned in Ishimaru zone 2a. A total of twenty-five patients met the inclusion criteria and the achievement rate showed 25/25 (100%) success in them. The twenty-five patients had a median follow-up length of 28.5 ± 14.6 months. One patient (4.0%) suffered from postoperative ischemic stroke before discharge. One patient (4.0%) died from a hemodialysis-related brain hemorrhage before discharge on the 29th day after the procedure. One patient died of advanced liver cancer in the 33th month after discharge. Aortic rupture, stroke or spinal cord injury did not occur throughout the follow-up period after discharge. Two patients (8.0%) experienced endoleak at the fenestration, however, resulting in only one's necessity for reintervention. Notably, the procedure effectively maintained ILVAs patency for all patients during follow up. According to our preliminary findings, performing a TEVAR under local anaesthesia using PMF on a Castor branched stent for ILVA preservation appeared practical, secure, and effective.
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Affiliation(s)
- Zeng-Rong Luo
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, Fujian Province, China
| | - Sai-Lan Li
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, Fujian Province, China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, Fujian Province, China
| | - Rong-Da Huang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, Fujian Province, China.
- Department of Cardiovascular Surgery and Cardiac Disease Center, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
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Lin L, Zhang H. Treatment of pediatric invasive mucor lung abscess with local fenestration and drainage surgery: A case report. Asian J Surg 2024:S1015-9584(24)00346-4. [PMID: 38378415 DOI: 10.1016/j.asjsur.2024.02.087] [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] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Affiliation(s)
- Liangkang Lin
- Department of Pediatrics, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
| | - Haiyang Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
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Bonasia S, Di Caterino F, Robert T. Embryology of the vertebral artery and variants of the adult. Neurochirurgie 2024; 70:101517. [PMID: 38277860 DOI: 10.1016/j.neuchi.2023.101517] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 01/28/2024]
Abstract
The vertebral arteries represent in the adult the main blood supply of the posterior cranial fossa, even if they appear relatively late during the embryological life. We reviewed all the most important steps of the vertebral artery's embryological development and the most common variants that can occur in the adult. The aim of this review is to summarize the main events of the development of this artery and to give an embryological explication for the most common variants of this artery.
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Affiliation(s)
- Sara Bonasia
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.
| | - Fortunato Di Caterino
- Department of Interventional Neuroradiology, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Thomas Robert
- University of Southern Switzerland, Lugano, Switzerland
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Kuramochi M, Shinonaga M, Kuraoka S. Closure of open window thoracostomy due to MRSA pyothorax by EWS bronchial occlusion and modified extraperiosteal air plombage: a case report. Surg Case Rep 2024; 10:19. [PMID: 38228980 DOI: 10.1186/s40792-024-01815-y] [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: 11/18/2023] [Accepted: 01/07/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Refractory pyothorax caused by methicillin-resistant Staphylococcus aureus (MRSA) is a challenging clinical condition; complications such as bronchopleural fistulae can further hinder its treatment. To avoid a fatal state caused by aspirating pneumonia, open window thoracotomy is not only sometimes performed, but subsequent closure of the window can also be difficult. In this report, we describe the case of a patient with MRSA pyothorax with bronchopleural fistula in whom a successful closure of window thoracostomy was achieved by utilizing Endobronchial Watanabe Spigot (EWS; Novatech, La Ciotat, France) bronchial occlusion and a modified extraperiosteal air plombage technique. CASE PRESENTATION A 66-year-old man underwent an open window thoracotomy for pyothorax with bronchopleural fistula with MRSA infection at the age of 59. After 7 years, he was referred to our department for the closure of the window. Initially, we occluded the right B6a + b by EWS under bronchoscopy. Subsequently, we dissected the intercostal muscles between the 3rd, 4th, 5th, and 6th ribs to collapse the pyothorax cavity and ensure the coverage of the fistula of lung including the hypertrophied parietal pleura and soft tissues of the chest wall. We filled the extrapleosteal space with a pedicled anterior serratus muscle flap to compress the parietal pleura. Postoperatively, lung expansion was satisfactory, and there has been no recurrence for 6 years since the window closure surgery. CONCLUSIONS We were able to achieve closure and healing in a patient who underwent open window thoracostomy for MRSA bronchopleural fistula by applying EWS and modified extraperiosteal air plombage technique.
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Affiliation(s)
- Masami Kuramochi
- Department of Thoracic Surgery, Mito Saiseikai General Hospital, 3-3-10 Futabadai Mito, Ibaraki, 311-4198, Japan.
| | - Mayumi Shinonaga
- Department of Thoracic Surgery, Mito Saiseikai General Hospital, 3-3-10 Futabadai Mito, Ibaraki, 311-4198, Japan
| | - Setsuo Kuraoka
- Department of Thoracic Surgery, Mito Saiseikai General Hospital, 3-3-10 Futabadai Mito, Ibaraki, 311-4198, Japan
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Zhang JY, Qiu M. Techniques and Preferences for Nonvalved Aqueous Shunts: A Survey of American Glaucoma Society Members. Ophthalmol Glaucoma 2024; 7:82-92. [PMID: 37454974 DOI: 10.1016/j.ogla.2023.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/16/2023] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To assess practice patterns and opinions of glaucoma specialists regarding indications, surgical technique, and postoperative management for nonvalved aqueous shunts. DESIGN Anonymous online survey study. PARTICIPANTS American Glaucoma Society (AGS) members. METHODS An anonymous online survey was distributed to glaucoma specialists via the AGS forum from June to August 2022. MAIN OUTCOME MEASURES Survey questions and responses were assessed in 4 sections: (1) general demographics and practice patterns; (2) nonvalved tubes vs. trabeculectomy; (3) nonvalved tubes vs. valved tubes; and (4) nonvalved tube techniques. RESULTS There were 132 respondents; nonvalved tubes were reported to be performed more often than trabeculectomy by 61% of respondents within 5 years of completing training and 23% of respondents with more than 15 years since completing training. The most frequently preferred types of nonvalved tubes were Baerveldt-350 (41%), Baerveldt-250 (27%), and ClearPath-250 (18%). In patients with lower target intraocular pressure (IOP), 92% of respondents preferred trabeculectomy over nonvalved tube; 33% cited a cutoff of < 12 mmHg, and 31% cited a cutoff of < 15 mmHg. In patients with higher preoperative IOP, 50% of respondents preferred valved over nonvalved tubes; 29% cited a cutoff of > 40 mmHg, and 38% cited a cutoff of > 30 mmHg. The most frequently used ligature was 7-0 Vicryl (69%). The most frequently used strategies for early IOP lowering were fenestrations without wicks (70%) and with wicks (22%), with one 10-0 Nylon being the most used wick technique (22%). Overall, 37% of respondents use a ripcord; among ripcord users, 55% use it for hypotony prevention (3-0 Prolene most common for this purpose at 35%), and 40% use it for optional early IOP lowering (4-0 Nylon most common for this purpose at 21%). If IOP is too high at postoperative week 4, 38% of respondents do not open the tube early. CONCLUSIONS We demonstrate significant heterogeneity regarding specific indications, surgical technique, and postoperative management for nonvalved tubes. Future work is needed to identify and develop standardized guidelines alongside best practices. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Jason Y Zhang
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois; Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois
| | - Mary Qiu
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois.
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Omotoso BR, Harrichandparsad R, Lazarus L. Prevalence of anatomical variations at the suboccipital (V3) segment of the vertebral artery: a systematic review. Neuroradiology 2023; 65:1677-1684. [PMID: 37878031 PMCID: PMC10654174 DOI: 10.1007/s00234-023-03223-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/12/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND AND OBJECTIVE A recent meta-analysis on the incidence of iatrogenic injury to the VA has revealed that patients with variant anatomy are more prone to iatrogenic injury. Therefore, this review is designed to investigate the incidence of variations in the suboccipital component of the vertebral artery in different population groups according to the available literature. METHODS This systematic review was conducted according to PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The review is based on a comprehensive and extensive search of PubMed, Google Scholar, and ResearchGate. The following search terms were used: "vertebral artery" AND "suboccipital segment" AND "anomalies/anatomical variations of the V3 segment." Reference lists of all extracted articles were also extensively searched for references to any further relevant publications. RESULTS A total of 17 papers met the inclusion criteria. The 17 studies corresponded to a total of 10,820 patients. A persistent first intersegmental artery was registered in 1.8% (197 out of 10,820) of the patients. Extradural PICA origin was observed in 1.6% (175 out of 10,820) of the patients. Fenestration was detected in 0.7% (72 out of 10,820) of the patients. CONCLUSION The authors summarize the incidence of vascular variation at the suboccipital segment of the VA in different population groups across the Asian, European, American, and African continents. Awareness of the extent of possible anatomical variation will help interpret radiographs, which will enhance the identification of vascular pathologies and reduce the risk of iatrogenic injury.
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Affiliation(s)
- Bukola R Omotoso
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa.
| | - Rohen Harrichandparsad
- Department of Neurosurgery, School of Clinical Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Lelika Lazarus
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa
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Sonoda Y, Uchino A, Kohyama S, Baba Y. Fenestration of the superior cerebellar artery diagnosed by magnetic resonance angiography. Radiol Case Rep 2023; 18:4419-4421. [PMID: 37929048 PMCID: PMC10624766 DOI: 10.1016/j.radcr.2023.09.023] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 11/07/2023] Open
Abstract
We herein report a case of fenestration of the superior cerebellar artery (SCA), which was incidentally diagnosed by magnetic resonance (MR) angiography. A 65-year-old woman was referred to our hospital for unruptured cerebral aneurysms. MR angiography revealed 2 unruptured aneurysms. It also showed fenestration of the left SCA near its origin from the basilar artery, as well as several other vascular variations: a left common carotid artery arising from the brachiocephalic trunk, and a right vertebral artery terminating to the right posterior inferior cerebellar artery. Yearly observation was chosen as a treatment strategy due to the small size of the cerebral aneurysms. According to previous reports, SCA fenestration is an extremely rare variation. This is the second case of SCA fenestration diagnosed by MR angiography in the relevant English-language literature.
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Affiliation(s)
- Yuki Sonoda
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298 Japan
| | - Akira Uchino
- Department of Radiology, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa Sayama, Saitama 350-1305, Japan
| | - Shinya Kohyama
- Department of Endovascular Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298 Japan
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298 Japan
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McComiskey D, Glikstein R. Incidental Fenestration of the Transverse Sinus. Can J Neurol Sci 2023; 50:950-951. [PMID: 36398523 DOI: 10.1017/cjn.2022.322] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- David McComiskey
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada
| | - Rafael Glikstein
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada
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Küçük A, Mohamed SS, Abdi AM, Ali AY. Intestinal obstruction due to giant liver cyst: A case report. World J Clin Cases 2023; 11:6246-6251. [PMID: 37731578 PMCID: PMC10507561 DOI: 10.12998/wjcc.v11.i26.6246] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/17/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Congenital hepatic cysts are relatively rare but are now diagnosed earlier and more frequently with a routine prenatal ultrasound. Solitary liver cysts are divided into simple and solitary intrahepatic biliary cysts, depending on the biliary connection. While some solitary liver cysts are symptomatic in childhood, even in newborns, they are often found incidentally in adults. CASE SUMMARY A 3-mo-old female infant was admitted to Mogadishu Somali Training and Research Hospital with recurrent vomiting, respiratory problems, and abdominal bloating complaints. On examination, the abdomen was greatly distended and extremely tight. She had repeated vomiting for 3 d, no stool output, and decreased urine. The abdominal ultrasonography detected a solitary cystic lesion measuring 10 cm × 10 cm × 14 cm, extending from the liver or right kidney to the pelvis. In the magnetic resonance imaging examination of the patient, a solitary cystic structure of 10 cm × 10 cm × 14 cm in the right abdomen was observed, extending to the pelvis and possibly originating from the liver. The patient was operated via fenestration after her fluid and electrolytes improved. Oral nutrition was initiated on the 2nd postoperative day, and the drain was removed on the 5th postoperative day. The patient visited the outpatient clinic control 1 mo later with no clinical complaints. CONCLUSION Congenital liver cysts are usually followed without complications. They rarely reach gigantic dimensions and may cause respiratory distress, intestinal obstruction and recurrent vomiting. Surgery can provide quite successful outcomes in the treatment of giant sized simple liver cysts.
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Affiliation(s)
- Adem Küçük
- Düzce University Faculty of Medicine, Pediatric Surgery Clinic, Düzce 81110, Merkez, Turkey
| | - Shukri Said Mohamed
- Department of Pediatric Surgery, Somali Mogadishu Training and Research Hospital, Mogadishu 0000000, Somalia
| | - Abdishakur Mohamed Abdi
- Department of Pediatric Surgery, Somali Mogadishu Training and Research Hospital, Mogadishu 0000000, Somalia
| | - Abdullahi Yusuf Ali
- Department of Pediatric Surgery, Somali Mogadishu Training and Research Hospital, Mogadishu 0000000, Somalia
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Kimura S, Komiyama M, Taniguchi H, Wanibuchi M. Ruptured small cerebral aneurysm occurring at the fenestration of the A1 portion of the anterior cerebral artery, combined with accessory middle cerebral artery branching from the crus: A case report. Surg Neurol Int 2023; 14:311. [PMID: 37810291 PMCID: PMC10559372 DOI: 10.25259/sni_507_2023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/18/2023] [Indexed: 10/10/2023] Open
Abstract
Background Cerebral aneurysms arising from fenestration of the A1 portion of the anterior cerebral artery (ACA) (A1 fenestration) with the accessory middle cerebral artery (MCA) is rare. Herein, we report a ruptured cerebral aneurysm arising from A1 fenestration combined with the accessory MCA that was successfully treated with coil embolization. Case Description A 51-year-old woman suddenly experienced a severe occipital headache and was admitted to our hospital. Detailed examination revealed subarachnoid hemorrhage due to a cerebral aneurysm arising from A1 fenestration combined with the accessory MCA. Hence, coil embolization was performed, and a favorable outcome was obtained. Conclusion Coil embolization of the cerebral aneurysm arising from the A1 fenestration of the ACA combined with the accessory MCA is considered to be useful.
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Affiliation(s)
- Seigo Kimura
- Department of Neurosurgery, Kouzenkai Yagi Neurosurgical Hospital, Osaka, Japan
| | - Masaki Komiyama
- Department of Neuro-Intervention, Osaka City General Hospital, Osaka, Japan
| | - Hirokatsu Taniguchi
- Department of Neurosurgery, Kouzenkai Yagi Neurosurgical Hospital, Osaka, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Japan
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Mathios D, Joshua S, Bobeff EJ, Mistry AA, Schwartz AC, Dobri GA, Tabaee A, Kacker A, Anand VK, Schwartz TH. Durable headache relief following endoscopic endonasal resection of sub-centimeter Rathke cleft cysts in medically refractory patients. Acta Neurochir (Wien) 2023; 165:2277-2282. [PMID: 37046123 DOI: 10.1007/s00701-023-05575-w] [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: 03/05/2023] [Accepted: 03/23/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND The most common presenting symptom in patients with both small and large Rathke cleft cysts (RCC) is headache (H/A). It is well established that patients with large RCC can have significant symptomatic improvement after cyst drainage. However, patients with small RCC (≤ 1 cm) are rarely operated on, even if they present with debilitating H/A. It is not well understood whether resection of these smaller RCCs can lead to durable H/A resolution. METHODS A retrospective search of our institutional database for sub-centimeter RCCs presenting with intractable H/A and treated with an endoscopic endonasal approach was carried out. A detailed H/A questionnaire as well as patient chart review was conducted to assess the long-term outcome of these patients after surgical intervention. RESULTS Ten consecutive patients with 11 endonasal surgeries met inclusion criteria. Eight responded to the questionnaire. The median cyst diameter was 6 mm (IQR 3-9). Median preoperative H/A duration was 12 months (range 2 months-15 years). H/As occurred on average for 20 days per month and all required analgesics for symptomatic control for more than 15 of these 20 days. Half of the patients also had to miss work because of H/A. Average preoperative H/A intensity was 8.7 (scale 0-10) compared with postoperative scores of 2.9 at one month, 1.6 at 3 months, and 0.9 at 1 year. There were no permanent endocrinological or other surgical complications. After a median follow-up of 2 years, one patient had radiographic and symptomatic recurrence which resolved after re-operation. CONCLUSIONS Endoscopic fenestration of sub-centimeter RCCs provides a safe and durable treatment for patients with intractable H/A.
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Affiliation(s)
- Dimitrios Mathios
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Shejoy Joshua
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
- Department of Neurosurgery, Aster Medcity, Kochi, Kerala, India
| | - Ernest J Bobeff
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
- Department of Neurosurgery, Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Adina A Mistry
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Alexandra C Schwartz
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Georgiana A Dobri
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
- Department of Endocrinology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Abtin Tabaee
- Department of Otolaryngology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Ashutosh Kacker
- Department of Otolaryngology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Vijay K Anand
- Department of Otolaryngology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Theodore H Schwartz
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA.
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El Damaty A, Issa M, Paggetti F, Seitz A, Unterberg A. Intracranial arachnoid cysts: What is the appropriate surgical technique? A retrospective comparative study with 61 pediatric patients. World Neurosurg X 2023; 19:100195. [PMID: 37151993 PMCID: PMC10160597 DOI: 10.1016/j.wnsx.2023.100195] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 05/09/2023] Open
Abstract
Objective Symptomatic intracranial arachnoid cysts (ACs) should be treated either through microsurgical (MS) or endoscopic surgical (ES) fenestration. Implantation of cysto-peritoneal shunt (CPS) system is another treatment option with decreasing indication. In our study, we compared the complication and revision rates between the three operative techniques in pediatric patients. Methods We included patients below 18 years with symptomatic intracranial ACs operated between 2004 and 2021. Initial symptoms, location, complication rate, clinical and radiological improvement, postoperative events and revision rate were compared retrospectively. Results Sixty-one patients; 33 (54.1%) MS operated (mean age 7.6 years), 18 (29.5%) ES operated (mean age 6.2 years) and 10 (16.4%) with CPS (mean age 3.0 years) were collected. The most common initial symptom was headache in 45.9%. 20 (32.8%) postoperative events were documented. The highest revision rate (60%) was seen in the CPS group compared to 33.3% in MS group and 16.7% in ES group. 31 patients harbored perisylvian ACs, 89% remained event-free after ES, 71% after MS and 20% after CPS. Clinical improvement immediately after surgery was observed in 58 patients (96.9% in MS, 88.9% in ES and 100% in CPS). A radiological volume reduction could be proven postoperative in 51 patients (78.8% MS, 88.9% ES and 90% CPS). Conclusion Endoscopic fenestration of AC is a safe and efficient technique which is being widely used nowadays with the highest event free survival compared to microsurgical fenestration especially in perisylvian arachnoid cysts. CPS shows on long terms the highest revision rate but carries the least surgical risks.
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Affiliation(s)
- Ahmed El Damaty
- Dept. of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
- Corresponding author. Head of Pediatric Neurosurgery Division Heidelberg University Hospital Im Neuenheimer Feld, 400 69120, Heidelberg, Germany.
| | - Mohammed Issa
- Dept. of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Filippo Paggetti
- Dept. of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Angelika Seitz
- Dept. of Pediatric Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Unterberg
- Dept. of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
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Tian Y, Chen Y, Chen L, Meng X, Fu M, Shi X, Lin Y. How to locate the fistula orifice of spinal extradural arachnoid cyst: Surgical experience and clinical outcome. BMC Surg 2023; 23:184. [PMID: 37386402 DOI: 10.1186/s12893-023-02013-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/20/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND In clinical practice, spinal extradural arachnoid cysts (SEAC) are relatively rare. The key to the treatment of SEAC is recognize and close the dural defects (fistula orifice), but there is currently no convenient method to locate and identify the fistula. We propose a method for predicting the location of lumbar/thoracolumbar SEAC fistula based on surgical experience, subsequently closing the fistula through posterior unilateral interlaminar fenestration. Evaluating its surgical efficacy and investigated its effect on patient prognosis. METHODS A stepped approach based on clinical experience is proposed. A retrospective analysis was performed on 6 patients diagnosed with thoracolumbar SEAC disease and treated with posterior unilateral interlaminar fenestration through the position by pre-estimated fistula orifice in our hospital's Department of Neurosurgery between January 2017 and January 2022. RESULTS All patients who received this treatment experienced significantly lower postoperative VAS pain scores and ODI index compared to their corresponding preoperative values (P < 0.01). During the ongoing follow-up after surgery, no unstable vertebral column, adverse effects, or complications were reported. CONCLUSIONS The use of posterior unilateral interlaminar fenestration for the treatment of large SEAC in the adult lumbar/thoracolumbar segment can reduce spinal cord manipulation and enhance spine stability. The disease can be treated by sealing the fistula orifice through a small fenestra, the position of which is assessed before surgery. This surgical method reduces trauma and improves the prognosis of patients with large SEAC.
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Affiliation(s)
- Yu Tian
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian, China
| | - Yong Chen
- Department of Neurosurgery, Clinical Medical Academy Centre, Shenzhen University General Hospital, Shenzhen University, Shenzhen University, 1098 Xueyuan Avenue, Nanshan District, Shenzhen, 518000, Guangdong, China
| | - Long Chen
- Department of Neurosurgery, Clinical Medical Academy Centre, Shenzhen University General Hospital, Shenzhen University, Shenzhen University, 1098 Xueyuan Avenue, Nanshan District, Shenzhen, 518000, Guangdong, China
| | - Xianghong Meng
- Department of Neurosurgery, Clinical Medical Academy Centre, Shenzhen University General Hospital, Shenzhen University, Shenzhen University, 1098 Xueyuan Avenue, Nanshan District, Shenzhen, 518000, Guangdong, China
| | - Mengmeng Fu
- Department of Neurosurgery, Clinical Medical Academy Centre, Shenzhen University General Hospital, Shenzhen University, Shenzhen University, 1098 Xueyuan Avenue, Nanshan District, Shenzhen, 518000, Guangdong, China
| | - Xin Shi
- Department of Neurosurgery, Clinical Medical Academy Centre, Shenzhen University General Hospital, Shenzhen University, Shenzhen University, 1098 Xueyuan Avenue, Nanshan District, Shenzhen, 518000, Guangdong, China.
| | - Yuanxiang Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian, China.
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20
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Zhou Z, Yu J. Endovascular treatment of a supraclinoid internal carotid artery fenestration aneurysm: A case report and literature review. Heliyon 2023; 9:e17605. [PMID: 37408880 PMCID: PMC10318508 DOI: 10.1016/j.heliyon.2023.e17605] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023] Open
Abstract
Supraclinoid internal carotid artery (ICA) fenestration aneurysm is rare. Except for open surgery, endovascular treatment (EVT) is considered an alternative for such an aneurysm. However, experience with this procedure is lacking. Therefore, we reported such a case. A 61-year-old woman suffered subarachnoid hemorrhage. Digital subtracted angiography (DSA) showed bilateral middle cerebral artery (MCA) aneurysms and a saccular aneurysm associated with fenestration of the supraclinoid ICA. Two MCA aneurysms were treated with single coiling, and the supraclinoid ICA fenestration aneurysm was coiled under stent assistance. The postoperative recovery was uneventful. At this time, a literature review was performed on the role of EVT in supraclinoid ICA fenestration aneurysms. A total of 13 supraclinoid ICA fenestration aneurysms treated by EVT in 11 cases, including our case, were obtained. After EVT, good outcomes were obtained in all cases. To our knowledge, this is the first study to review the role of EVT for supraclinoid ICA fenestration aneurysms. Our case report and literature review indicated that EVT for such aneurysms may be feasible and act as a therapeutic alternative.
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Affiliation(s)
| | - Jinlu Yu
- Corresponding author. Department of Neurosurgery, The First Hospital of Jilin University, 1 Xinmin Avenue, Changchun, Jilin, 130021, China.
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21
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Afzali K, Fujimoto DK, Mohammadi SO, Lin KY. Race and Gender Shift among Academic Glaucoma Specialists in the Last 5 Decades. J Curr Glaucoma Pract 2023; 17:98-103. [PMID: 37485463 PMCID: PMC10357023 DOI: 10.5005/jp-journals-10078-1407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/03/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose To evaluate the demographic composition of academic glaucoma specialists currently practicing in the United States. Design Retrospective and observational study. Subjects Academic glaucoma specialists identified from ophthalmology residency programs listed on the Doximity database. Methods The American Board of Ophthalmology (ABO) membership directory, Doximity database, publicly available data, and direct communications were used to identify academic glaucoma specialists and their demographics. Information collected included-name, gender, race/ethnicity, geographic location, board certification date, academic affiliation, and academic rank. Ophthalmic age was defined as the number of years since ophthalmology board certification. Underrepresented minority (URM) groups were defined as Hispanics, Black or African Americans, Latinos, American Indians, or Alaskan Natives as defined by San Francisco match. In addition, the temporal, geographic, and academic rank distributions among females and URMs were explored. Main outcome measures Women and URMs representations among academic glaucoma specialists across academic ranks, geographic regions, as well as ophthalmic age. Results There were 457 active academic glaucoma specialists identified from 110 institutions in 38 states. Among them, 185 (40.5%) were women and 42 (9.2%) were URM. The proportion of women glaucoma specialists in academia had increased significantly with a rate of 1.049 in odds ratio (OR) per year (p < 0.001). However, there were no significant changes in the proportion of URMs over time. The earliest year of certification was 1,964 for males and 1,974 for females. When controlled for ophthalmic age, there were no significant differences in the distribution of women or URMs between the different academic ranks (p = 0.572 and p = 0.762, respectively). Among assistant professors, women had a significantly higher ophthalmic age compared to men (p < 0.001), but there was no significant difference in ophthalmic age in both the associate and full professor groups. There were no significant differences in the geographic distribution of gender (p = 0.516) and URM across United States regions (p = 0.238). Conclusion The proportion of women among academic glaucoma specialists has significantly increased over the past 5 decades; however, the proportion of URMs has been stagnant in the same period. Enhancing URM representation among academic glaucoma specialists deserves to be a future priority. How to cite this article Afzali K, Fujimoto DK, Mohammadi SO, et al. Race and Gender Shift among Academic Glaucoma Specialists in the Last 5 Decades. J Curr Glaucoma Pract 2023;17(2):98-103.
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Affiliation(s)
- Kasra Afzali
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine, California, United States
| | - Dylann K Fujimoto
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine, California, United States
| | - Seyed Omid Mohammadi
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine, California, United States
| | - Ken Y Lin
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine, California, United States
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Canonge J, Heim F, Chakfé N, Coscas R, Cochennec F, Jayet J. Mechanical Performance Assessment of Physician Modified Aortic Stent Graft. Eur J Vasc Endovasc Surg 2023; 65:435-443. [PMID: 36343747 DOI: 10.1016/j.ejvs.2022.11.004] [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: 01/23/2022] [Revised: 07/03/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to compare various fenestration configurations of physician modified aortic stent grafts in order to identify which design parameters have a significant influence on the mechanical behaviour of the fenestration. METHODS the fenestration configurations were considered according to different manufacturing parameters: cutting technique, fenestration reinforcement, suture material, reinforcement loop design, and number of suture points. The performance of the graft/bridging stent assembly was assessed at various levels: (1) branch pull out force; (2) fenestration enlargement and rupture strength; (3) balloon angioplasty resistance; and (4) behaviour under cyclic fatigue. RESULTS Sixty manual fenestrations were created. The tests performed on the fenestrations had several main findings. First, reinforcement increased the radial force on the branch, which increased the pull out force; this may limit migration of the bridging stent in vivo. The phenomenon was amplified with a snare reinforced fenestration, which seemed to be the most efficient. Moreover, increasing the number of suture passes also appeared to increase the branch extraction force securing the assembly. The enlargement tests showed that non-reinforced fenestrations had the weakest radial strength. This was confirmed with the balloon angioplasty test, which showed that these latter specimens undergo the most significant textile degradation. After fatigue tests, all fenestrations were larger, showing that elastic recoil was incomplete in all samples. The largest recoil was observed in the non-reinforced ophthalmological cautery (OC) fenestrations (40%). Regarding the behaviour of the samples up to rupture, all samples behaved in a similar way; however, the double loop fenestration strength level was the highest. CONCLUSION This study demonstrated that the snare double loop reinforcement has an advantage regarding durability of the graft branch assembly. Moreover, non-reinforced fenestrations show signs of weakness and lack of stability, which questions the in situ or laser fenestration procedures.
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Affiliation(s)
- Jennifer Canonge
- Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire (GEPROVAS), Strasbourg, France; Department of Vascular Surgery, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Frédéric Heim
- Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire (GEPROVAS), Strasbourg, France; Laboratoire de Physique et Mécanique Textiles (LPMT), ENSISA, Mulhouse, France
| | - Nabil Chakfé
- Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire (GEPROVAS), Strasbourg, France; Department of Vascular Surgery and Kidney Transplantation, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Raphael Coscas
- UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, Villejuif, France; Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, and Faculté de Médecine Paris-Ile de France-Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France
| | - Frédéric Cochennec
- Department of Vascular Surgery, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Jérémie Jayet
- Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire (GEPROVAS), Strasbourg, France; Laboratoire de Physique et Mécanique Textiles (LPMT), ENSISA, Mulhouse, France; UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, Villejuif, France; Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, and Faculté de Médecine Paris-Ile de France-Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France.
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23
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Franchi T, Patterson A. Rare Intraoperative Finding of the Spinal Accessory Nerve Piercing a Fenestration in the Internal Jugular Vein: A Case Report and Review of the Modern Literature. J Maxillofac Oral Surg 2023; 22:262-264. [PMID: 36703653 PMCID: PMC9871109 DOI: 10.1007/s12663-021-01613-1] [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: 05/13/2021] [Accepted: 06/29/2021] [Indexed: 01/29/2023] Open
Abstract
Variations in the anatomy of venous structures in the neck are not uncommon, but fenestrations are extremely unusual. Here, we report a rare case of the spinal accessory nerve piercing a fenestration in the internal jugular vein, found during elective neck dissection of a patient undergoing hemiglossectomy. Further, we present a literature review of recent previously published cases of this intraoperative finding. This paper is intended to provide readers with an appreciation for this particularly rare variation and to highlight its existence to surgeons who perform neck dissection. This knowledge is important in order to minimise the possibility of intraoperative damage.
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Affiliation(s)
- Thomas Franchi
- The Medical School, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
| | - Alan Patterson
- Department of Oral and Maxillofacial Surgery, The Rotherham NHS Foundation Trust, Moorgate Road, Rotherham, S60 2UD UK
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Fu Y, Hu XN, Cui SJ, Shi J. [Decompensation effectiveness and alveolar bone remodeling analysis of mandibular anterior teeth after preoperative orthodontic treatment in high-angle patients with skeletal class Ⅱ malocclusion]. Beijing Da Xue Xue Bao Yi Xue Ban 2023; 55:62-9. [PMID: 36718690 DOI: 10.19723/j.issn.1671-167X.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate the decompensation effectiveness and alveolar bone remodeling of mandibular anterior teeth after preoperative orthodontic treatment in high-angle patients with skeletal class Ⅱ malocclusion using lateral cephalogram and cone-beam computed tomography (CBCT). METHODS Thirty high-angle patients with skeletal class Ⅱ malocclusion who had received preoperative orthodontic treatment and orthognathic surgery in Peking University School and Hospital of Stomatology between Ja-nuary 2017 and August 2022 and had taken lateral cephalogram and CBCT before and after preoperative orthodontic treatment were selected. Items were measured with lateral cephalogram including: The lower central incisor (L1)-Frankfort plane angle (L1-FH), the L1-mandibular plane angle (L1-MP), the L1-nasion-supramental angle (L1-NB) and the vertical distance from the incisal edge of lower central incisor to NB line (L1-NB distance), etc. The incidence of dehiscence/fenestration and the length of dehiscence at labial side (d-La) and lingual side (d-Li) were measured using CBCT. Pearson correlation analysis was used to evaluate the correlation between the changes of d-Li of L1 and age, duration of preoperative orthodontic treatment and the cephalometric measurements before preoperative orthodontic treatment to screen out risk factors affecting the periodontal risk of preoperative orthodontic treatment in high-angle patients with skeletal class Ⅱ malocclusions. RESULTS After preoperative orthodontic treatment, L1-FH, L1-MP, L1-NB and L1-NB distances changed by 11.56°±5.62°, -11.13°±5.53°, -11.57°±5.43° and (-4.99±1.89) mm, respectively, and the differences were all statistically significant (P < 0.05). Among the 180 measured mandibular anterior teeth, 45 cases with labial dehiscence/fenestration before preoperative orthodontic treatment (T0) had no longer labial dehiscence/fenestration after preope-rative orthodontic treatment (T1); 142 cases without lingual dehiscence/fenestration at T0 had lingual dehiscence/fenestration at T1. After preoperative orthodontic treatment, the d-La of lower lateral incisors (L2), lower canines (L3) and lower anterior teeth (L1+L2+L3) decreased by (0.95±2.22) mm, (1.20±3.23) mm and (0.68±2.50) mm, respectively, and the differences were statistically significant (P < 0.05); the d-Li of L1, L2, L3 and L1+L2+L3 increased by (4.43±1.94) mm, (4.53±2.35) mm, (3.19±2.80) mm and (4.05±2.46) mm, respectively, and the differences were statistically significant (P < 0.05). The increase of d-Li of L1 was positively correlated with L1-FH (r=0.373, P=0.042). CONCLUSION This study showed that high-angle patients with skeletal class Ⅱ ma-locclusion could achieve ideal decompensation effect of mandibular anterior teeth after preoperative orthodontic treatment with bilateral mandibular first premolars extracted, but the lingual periodontal risk of mandibular anterior teeth was increased. This risk could be correlated to L1-FH before preoperative orthodontic treatment, which should be paid more attention in the design of orthodontic-orthognathic surgical treatment.
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Beltagy MAE, Enayet AER. Surgical indications in pediatric arachnoid cysts. Childs Nerv Syst 2023; 39:87-92. [PMID: 36284010 DOI: 10.1007/s00381-022-05709-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/13/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Arachnoid cysts are developmental lesions consisting of CSF collections within the subarachnoid space. There are many theories and hypotheses about their pathogenesis and histopathology and this may also explain the diversities seen in clinical behaviors of these cysts, their natural history and consequently their management where there is a great controversy about selecting patients for surgical intervention. The most common location in pediatrics is the Sylvian or middle cranial fossa and this made it gain more concern and greater debate about its management where its diagnosis is often accidently or associated with nonspecific symptoms. AIM Our aim in this article was to review the main surgical indications for pediatric arachnoid cysts in the literature. CONCLUSION We concluded that the decision for surgical intervention for pediatric arachnoid cysts is not a simple one and highly debatable and should be taken cautiously especially with sylvian arachnoid cysts that may reach a large size without symptoms. However, there is a consensus that the occurrence of symptoms definitely correlated to the presence of these cysts or their rupture with consequent subdural hematoma or hygroma are indications for surgical intervention. Large cysts in locations compressing CSF pathways causing hydrocephalus are also candidates for surgical fenestration. The surgical gain from prophylactic surgery is questionable particularly when asymptomatic.
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Affiliation(s)
- Mohamed A El Beltagy
- Children's Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt. .,Neurosurgery Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
| | - Abd El Rhman Enayet
- Children's Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt.,Neurosurgery Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
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El-Ghandour NMF. Role of Endoscopy in Treatment of Complex Hydrocephalus in Children. Adv Tech Stand Neurosurg 2023; 46:221-243. [PMID: 37318578 DOI: 10.1007/978-3-031-28202-7_12] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Complex hydrocephalus or loculated hydrocephalus is a challenging problem in the field of pediatric neurosurgery. Early diagnosis and treatment are paramount in order to ensure success of treatment. Therefore, alertness is required among pediatricians who are dealing with premature children and children having meningitis and/or intraventricular hemorrhage. Disproportionate hydrocephalic changes in CT scan of the brain are suspicious, whereas gadolinium-enhanced multiplanar MR imaging (axial, sagittal, and coronal) is the best diagnostic modality. The definitive treatment is surgical, yet the approach remains a matter of debate. Cyst fenestration, communicating the isolated compartments together and with the ventricular system, is the main strategy of treatment. Cyst fenestration can be performed through either microsurgery or endoscopy, in order to improve the hydrocephalus, decrease number of shunts, and reduce shunt revision rates. However, the endoscopic procedure has an advantage over microsurgery of being simple and minimally invasive. It is evident that uniloculated hydrocephalus carries better prognosis than multiloculated hydrocephalus; this can be attributed to the initial pathological disease contributing to the ventricular compartmentalization. Because of the bad prognosis in multiloculated hydrocephalus, and because there are few numbers of patients available in any given center, a multicentric prospective study with long-term follow-up evaluating the results of outcome and quality of life is warranted.
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Nomier AS, Gaweesh YSED, Taalab MR, El Sadat SA. Efficacy of low-dose cone beam computed tomography and metal artifact reduction tool for assessment of peri-implant bone defects: an in vitro study. BMC Oral Health 2022; 22:615. [PMID: 36528573 PMCID: PMC9759909 DOI: 10.1186/s12903-022-02663-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Early accurate radiographic assessment of peri-implant bone condition is highly important to avoid excessive loss of supporting bone and implant failure. Cone beam computed tomography (CBCT) is the radiographic technique of choice if peri-implant dehiscence and fenestration defects are suspected. The higher radiation dose and the presence of beam hardening artifacts are the main drawbacks of CBCT imaging techniques. This study aims to evaluate the influence of low-dose cone beam computed tomography (LD-CBCT) and metal artifact reduction (MAR) tool on the assessment of peri-implant dehiscence and fenestration. METHODOLOGY Thirty titanium implants were inserted into bovine rib blocks. Twenty had standardized bone defects (10 with dehiscence and 10 with fenestration), while the remaining 10 were used as control group with no defects. Radiographic examinations held with high-definition CBCT (HD-CBCT) and LD-CBCT with and without application of MAR tool. Images were assessed by four examiners for the presence or absence of peri-implant defects. The area under the area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, and accuracy were calculated for all radiographic protocols. RESULTS In the absence of MAR tool, there was no difference in AUC and diagnostic values between LD-CBCT and HD-CBCT for detection of both defects. When the MAR tool was applied, the AUC values, sensitivity, and accuracy were higher in HD-CBCT than in LD-CBCT for the detection of both defects, especially for the dehiscence, while specificity remained the same. CONCLUSION LD-CBCT can be used in the evaluation of peri-implant dehiscence and fenestration without any decrease in diagnostic accuracy. The application of MAR tool decrease the diagnostic ability of both defects, especially for the detection of dehiscence defects.
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Affiliation(s)
- Alaa Shafiek Nomier
- grid.7155.60000 0001 2260 6941Department of Oral Medicine, Periodontology, Oral Diagnosis and Oral Radiology, Faculty of Dentistry, Alexandria University, Champolion St. Azarita, Alexandria, 21521 Egypt
| | - Yousria Salah El-Din Gaweesh
- grid.7155.60000 0001 2260 6941Department of Oral Medicine, Periodontology, Oral Diagnosis and Oral Radiology, Faculty of Dentistry, Alexandria University, Champolion St. Azarita, Alexandria, 21521 Egypt
| | - Maha R. Taalab
- grid.7155.60000 0001 2260 6941Department of Oral Medicine, Periodontology, Oral Diagnosis and Oral Radiology, Faculty of Dentistry, Alexandria University, Champolion St. Azarita, Alexandria, 21521 Egypt
| | - Shaimaa Abu El Sadat
- grid.7269.a0000 0004 0621 1570Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ain-Shams University, Cairo, Egypt
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Shin SH, Cho WH, Cha SH, Ko JK. Wire perforation of the missed tiny aneurysm originating from the fenestrated A1 segment during the endovascular approach. J Cerebrovasc Endovasc Neurosurg 2022; 24:393-397. [PMID: 35818686 PMCID: PMC9829558 DOI: 10.7461/jcen.2022.e2021.12.001] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 01/21/2023] Open
Abstract
Vascular anomaly and aneurysmal formation of an anterior communicating artery (ACOM) complex has often been reported. Because of such a complicated relationship between the vascular structure and aneurysms, ACOM aneurysm is one of the most difficult aneurysms to treat among other common anterior circulation aneurysms. We herein report a case of wire perforation of a missed tiny aneurysm arising from the fenestrated A1 segment during the endovascular approach to ACOM aneurysm. Although the fenestration of A1 segment is a rare vascular anomaly, it is likely to accompany saccular type aneurysms in the vicinity of the vascular anomaly. Endovascular treatment for ACOM aneurysm requires more detailed evaluations of the accompanying vascular anomaly and hemodynamics around ACOM to avoid complications.
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Affiliation(s)
- Seung Ho Shin
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Won Ho Cho
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Seung Heon Cha
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jun Kyeung Ko
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Ahmed AK, Gudapati K, Eggenberger ER, McGeary R, Gupta V, Vibhute P. Oculomotor nerve root split: incidental finding on MRI-case report and literature review. Surg Radiol Anat 2022; 44:1379-1383. [PMID: 36178524 DOI: 10.1007/s00276-022-03024-4] [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] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The oculomotor nerve (OMN) innervates the pupil, ciliary body, upper eyelid, and extraocular muscles through two divisions: a superior division that innervates the levator palpebrae superioris (LPS) and superior rectus (SR), and an inferior division that supplies the medial rectus (MR), inferior rectus (IR), inferior oblique (IO), and parasympathetic fibers to the pupil and ciliary body. We present a case of complete splitting of the cisternal segment of bilateral OMNs that was discovered incidentally on magnetic resonance imaging (MRI) in a patient who had no ocular complaints. CASE REPORT A 69-year-old patient was found to have bilateral splitting of the cisternal segments of OMNs during an MRI for trigeminal neuralgia workup. Both nerves sprang from the midbrain as distinct roots. They were symmetric on the right and minimally asymmetric on the left. On both sides, the medial root was slightly inferiorly situated. The patient had no visual problems and continued to function normally. A review of the literature for similar cases identified no such variants; however, it did identify eight examples of OMN fenestrations produced by aneurysms (AN), six of which had no OMN palsy symptoms. CONCLUSION An anatomic variant of split bilateral OMN cisternal segments is described. The superior and inferior divisions may have different brainstem origins. Although this variant is an anatomic curiosity, it may have clinical significance and explain the various presentation of compressive OMN palsies.
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Affiliation(s)
- Ahmed K Ahmed
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Kaavya Gudapati
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | | | - Ryan McGeary
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Vivek Gupta
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Prasanna Vibhute
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Kurt Demirsoy K, Türker G, Amuk M, Kurt G. How much should incisors be decompensated? periodontal bone defects during presurgical orthodontic treatment in class III double-jaw orthognathic surgery patients. J Stomatol Oral Maxillofac Surg 2022; 123:e133-e139. [PMID: 35263684 DOI: 10.1016/j.jormas.2022.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 05/16/2023]
Abstract
INTRODUCTION The aims of this study were to evaluate periodontal bone defects around the lower and upper incisors and to identify changes in the buccolingual inclination of the incisors during orthodontic decompensation in skeletal Class III orthognathic surgery patients. MATERIALS AND METHODS The sample consisted of 26 adults with skeletal Class III deformity who had undergone presurgical orthodontic treatment and orthognathic surgery. Lateral cephalograms obtained before orthodontic treatment and before surgery were used to determine the inclination and position changes of the incisors. Cephalometric measurements were taken using Dolphin Imaging 11.95. Three-dimensional images were generated from cone-beam computed tomography (CBCT) scans prior to surgery and used to detect periodontal bone defects, including fenestration (F) and dehiscence (D). RESULTS Intraclass correlation coefficients (ICC) were determined and the measurements showed high reproducibility. The cephalometric data showed normal distribution and there were no differences between genders in terms of cephalometric changes, dehiscence, fenestration, or coexistent (D-F/DF) formation. The patients presented maxillary incisor retroclination and mandibular incisor proclination, which was consistent with the tooth decompensation. CBCT assessment was performed for a total of 208 teeth; while 81 upper and 94 lower incisors had D-F/DF formation, 23 upper and 10 lower incisors were healthy. Statistically significant correlations were not found between the inclination degree of the incisors and D-F/DF formation. CONCLUSIONS Decompensation of incisors during presurgical orthodontic treatment increases the risk of periodontal defects. There is no linear relationship between the increase in the inclination degrees of incisors and D-F/DF formation.
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Affiliation(s)
- Kevser Kurt Demirsoy
- Department of Orthodontics, Faculty of Dentistry Nevşehir Hacı Bektaş Veli University, Nevşehir, Türkiye.
| | - Gökhan Türker
- Department of Orthodontics, Faculty of Dentistry, Mersin University, Mersin, Türkiye
| | - Mehmet Amuk
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, Kayseri, Türkiye
| | - Gökmen Kurt
- Department of Orthodontics, Faculty of Dentistry, Bezmialem Foundation University, İstanbul, Türkiye
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Gündoğdu E, Serçek M, Aşılıoğlu BK, Gündoğdu M. The first reported case of left renal vein fenestration. Surg Radiol Anat 2022; 44:1181-1184. [PMID: 35941238 DOI: 10.1007/s00276-022-03000-y] [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] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Vascular fenestrations are mostly seen in the arterial system and cerebral vessels, but they can be seen rarely in the venous system. In this article, we aimed to present the first case of left renal vein fenestration, which has not been previously reported in the English literature to the best our knowledge. METHODS Computed tomography angiography (CTA) examination was performed on a 40-year-old male patient who presented with rectal bleeding, and iron deficiency anemia, detected hemorrhoids in colonoscopy, and was planned for superior rectal artery embolization. RESULTS In CTA examination, a fenestration in the middle part of the left renal vein was detected. The fenestrated segment length was measured approximately 3 cm. The diameter of anterior and posterior channels were 7.66 and 6.01 mm, respectively. The 2.85 mm diameter inferior segmental artery of the left renal artery was passing between the anterior and posterior channels of the fenestrated segment, and there was a slight indentation of this artery to the posterior canal. CONCLUSION Although venous fenestrations are rare, they can also be seen in the renal venous system, and can be detected with CTA. It is important for radiologists to be aware of this situation, to increase its detectability and to prevent iatrogenic injury in possible surgical procedures. And also as in our case, left renal vein fenestration may be one of the causes of microscopic hematuria.
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Affiliation(s)
- Elif Gündoğdu
- Department of Radiology, Faculty of Medicine, Eskişehir Osmangazi University, Meşelik Yerleşkesi, 26480, Eskişehir, Turkey.
| | - Mürsel Serçek
- Department of Radiology, Faculty of Medicine, Eskişehir Osmangazi University, Meşelik Yerleşkesi, 26480, Eskişehir, Turkey
| | - Buğra Kaan Aşılıoğlu
- Department of Radiology, Faculty of Medicine, Eskişehir Osmangazi University, Meşelik Yerleşkesi, 26480, Eskişehir, Turkey
| | - Muhammed Gündoğdu
- Department of Radiology, Faculty of Medicine, Eskişehir Osmangazi University, Meşelik Yerleşkesi, 26480, Eskişehir, Turkey
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Orduna Martínez J, López Pisón J, Curto Simón B, García-Iñiguez JP, Samper Villagrasa P, Lafuente Hidalgo M. Intracranial arachnoid cysts and epilepsy in children: Should this be treated surgically? Our 29-year experience and review of the literature. Neurocirugia (Astur : Engl Ed) 2022; 33:157-164. [PMID: 35725217 DOI: 10.1016/j.neucie.2021.03.001] [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] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/14/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND OBJECTIVE Arachnoid cysts (ACs) are relatively frequent lesions related to different neurological symptoms, being mostly incidentally diagnosed. This study aims to clarify whether AC surgery in epileptic patients is useful in their treatment. MATERIAL AND METHODS The patients registered in the database of the Neuropediatrics Section from May 1990 to August 2019 are analyzed retrospectively. Patients in whom the diagnosis of ACs and epilepsy coincide are studied. The location, size and number of ACs, neurological development, age at diagnosis, follow-up time, the performance of surgery on the cyst, evolution, anatomical relationship between brain electrical activity and location of AC, and type of epilepsy are analyzed. RESULTS After analyzing the database, we found 1881 patients diagnosed with epilepsy, of which 25 had at least one intracranial AC. In 9 of the patients, cerebral or genetic pathologies were the cause of epilepsy. Of the other 16, only 2 patients showed that the type of epilepsy and the epileptogenic focus coincided with the location of the AC; one of them was surgically treated without success, and the other one remained asymptomatic without receiving medical or surgical treatment. CONCLUSIONS Although it is necessary to design a prospective study to establish causality, the results of our research and the available literature suggest that there is no causal relationship between the presence of ACs and epilepsy. The study and treatment of these patients should be carried out in a multidisciplinary epilepsy surgery unit, without initially assuming that the AC is the cause of epilepsy.
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Affiliation(s)
| | - Javier López Pisón
- Department of Pediatrics, Universitary Hospital Miguel Servet, Zaragoza, Spain
| | - Beatriz Curto Simón
- Department of Pediatrics, Universitary Hospital Miguel Servet, Zaragoza, Spain
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Madapoosi A, Uram Z, Tsiang J, Pecoraro N, Patel C, Germanwala AV. Rathke's cleft cyst marsupialization and repair with a free mucosal graft - Video case report and literature review. Am J Otolaryngol 2022; 43:103519. [PMID: 35690516 DOI: 10.1016/j.amjoto.2022.103519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/20/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022]
Abstract
Rathke's cleft cysts (RCCs) are sellar or suprasellar cystic lesions arising from the remnants of the embryological Rathke's pouch. When symptomatic, RCCs are usually treated surgically via marsupialization. Free mucosal graft (FMG) repair has shown promise in decreasing recurrence versus marsupialization alone. The authors present a case report with operative video of a patient with visual and endocrinological symptoms with a RCC treated with FMG following marsupialization. A search of the PubMed database from July 1997 through April 2022 was conducted using the terms 'Rathke's cleft cyst', 'Rathke's cleft cyst management', 'Rathke's cleft cyst repair', 'mucosal graft', 'mucosal coupling', 'transsphenoidal', and 'endoscopic endonasal'. Clinical and pathological aspects of the case presented were compared with information obtained from literature review. A 25-year-old female presented with a six-year history of amenorrhea, one-year history of anemia, headaches, and progressive visual loss. Imaging revealed an RCC. The patient underwent surgical treatment via an endoscopic endonasal approach. Marsupialization was achieved with placement of an FMG to help prevent restenosis. Post-operative examination revealed that the patient's OD vision returned to normal, although her OS vision was only slightly improved. Our review of the English literature resulted in 35 full-length articles that were published between 1997 and 2022. The literature suggests that FMG prevents scar formation by allowing for adequate epithelialization, thus decreasing the recurrence rate and being well tolerated by patients. Our findings support the utility of the FMG as a superior surgical treatment option for RCC management.
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Affiliation(s)
- Adrusht Madapoosi
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL, United States of America
| | - Zachary Uram
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States of America
| | - John Tsiang
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL, United States of America
| | - Nathan Pecoraro
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL, United States of America
| | - Chirag Patel
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States of America; Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, IL, United States of America
| | - Anand V Germanwala
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States of America; Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL, United States of America; Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, IL, United States of America.
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Jünger ST, Knerlich-Lukoschus F, Röhrig A, Al Hourani J, Kunze S, Eberle J, Oelkers P, Messing-Jünger M. Clinical variety and prognosis of intracranial arachnoid cysts in children. Neurosurg Rev 2022. [PMID: 35657443 DOI: 10.1007/s10143-022-01809-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/26/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
Arachnoid cysts (AC) occur in different intracranial locations. Management and prognosis depend on the clinical presentation and treatment guidelines do not exist. With this study, we want to demonstrate the clinical variety of arachnoid cysts in children and place a focus on outcome factors in operated cases. This retrospective study of a consecutive single unit series of children, who underwent AC surgery between January 2010 and September 2019, provides demographic, clinical, imaging data, and information about surgical treatment and outcome. Overall, 63 patients (71.4 male) underwent surgery. Mean age was 50 months (0-191). Mean follow-up was 40 months (0-121). Eighty-one percent of patients presented with symptoms/signs of raised ICP. Focal neurological deficits were present in 15.9%, headache in 11.1% of children. Galassi cysts represented the predominant type (30.2%), followed by suprasellar (14.3%), quadrigeminal (12.7%), retrocerebellar, CPA and midline (each 11.1%), and hemispheric cysts (7.9%). Endoscopic and microsurgical fenestrations were performed in 27% and 58.7%, stent or shunt insertion in 6.3%/57.9% of the cases. In 33.3% of the cases one and in 12.7%, a second reintervention became necessary. Reoperation rate was significantly higher in children < 1 year (p = 0.003). Cyst volume decreased in 85.7%. Seventy percent of the patients were symptom free, 5% suffered from headache, and 22% from developmental disorders. All focal neurological symptoms resolved. Complication rate and outcome are depending on age and cyst location. Recurrence and revision rates are significantly higher in young infants (p = 0.003). Midline cysts with CCA are associated with developmental disorders.
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Akutsu JI, Iwahashi T, Nariai Y. Fenestration is a logical and effective treatment for a large primordial cyst with cholesterol granuloma: a case report. J Int Med Res 2022; 50:3000605221104185. [PMID: 35681254 PMCID: PMC9189541 DOI: 10.1177/03000605221104185] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A cholesterol granuloma (CG) is characterized by the presence of cholesterol crystals that cause a chronic granulomatous reaction in an enclosed space. It occurs most commonly in the head and neck region, particularly in the middle ear. Although CGs in the maxilla have also been reported, odontogenic cysts in conjunction with CGs in the maxilla are very rare. We herein present a case of a 72-year-old man who developed a large primordial cyst with a maxillary CG that extended into the maxillary sinus, nasal cavity, and infraorbital region, causing left-sided facial swelling and discomfort. We successfully controlled the symptoms and reduced the size of the lesion using the treatment approach for a common odontogenic cyst: fenestration followed by complete excision. This case suggests that fenestration is an effective technique to treat odontogenic cysts with CGs. Although the mechanisms underlying the pathogenesis and growth of CGs are still unknown, our report highlights a potential therapeutic approach for these lesions.
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Affiliation(s)
- Jun-Ichi Akutsu
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Teruaki Iwahashi
- Department of Surgical Pathology, Shimane University Hospital, Shimane 693-8501, Japan
| | - Yoshiki Nariai
- Department of Oral and Maxillofacial Surgery, Matsue City Hospital, Shimane 690-8509, Japan.,Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Shimane 693-8501, Japan
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van Leeuwen BJ, Dijkstra PU, Dieters JA, Verbeek HPJ, Kuijpers-Jagtman AM, Ren Y. Effect of voxel size in cone-beam computed tomography on surface area measurements of dehiscences and fenestrations in the lower anterior buccal region. Clin Oral Investig 2022; 26:5663-5672. [PMID: 35513582 PMCID: PMC9474376 DOI: 10.1007/s00784-022-04521-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 04/23/2022] [Indexed: 11/26/2022]
Abstract
Objectives This study aims to assess whether different voxel sizes in cone-beam computed tomography (CBCT) affected surface area measurements of dehiscences and fenestrations in the mandibular anterior buccal region. Materials and methods Nineteen dry human mandibles were scanned with a surface scanner (SS). Wax was attached to the mandibles as a soft tissue equivalent. Three-dimensional digital models were generated with a CBCT unit, with voxel sizes of 0.200 mm (VS200), 0.400 mm (VS400), and 0.600 mm (VS600). The buccal surface areas of the six anterior teeth were measured (in mm2) to evaluate areas of dehiscences and fenestrations. Differences between the CBCT and SS measurements were determined in a linear mixed model analysis. Results The mean surface area per tooth was 88.3 ± 24.0 mm2, with the SS, and 94.6 ± 26.5 (VS200), 95.1 ± 27.3 (VS400), and 96.0 ± 26.5 (VS600), with CBCT scans. Larger surface areas resulted in larger differences between CBCT and SS measurements (− 0.1 β, SE = 0.02, p < 0.001). Deviations from SS measurements were larger with VS600, compared to VS200 (1.3 β, SE = 0.05, P = 0.009). Fenestrations were undetectable with CBCT. Conclusions CBCT imaging magnified the surface area of dehiscences in the anterior buccal region of the mandible by 7 to 9%. The larger the voxel size, the larger the deviation from SS measurements. Fenestrations were not detectable with CBCT. Clinical relevance CBCT is an acceptable tool for measuring dehiscences but not fenestrations. However, CBCT overestimates the size of dehiscences, and the degree of overestimation depends on the actual dehiscence size and CBCT voxel size employed.
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Affiliation(s)
- B J van Leeuwen
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, Groningen, GZ, Netherlands
| | - P U Dijkstra
- Department of Rehabilitation and Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, Groningen, GZ, Netherlands
| | - J A Dieters
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, Groningen, GZ, Netherlands
| | - H P J Verbeek
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, Groningen, GZ, Netherlands
| | - A M Kuijpers-Jagtman
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, Groningen, GZ, Netherlands.
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine/Medical Faculty, University of Bern, Freiburgstrasse 7, 3010, Bern, CH, Switzerland.
- Faculty of Dentistry, Universitas Indonesia, Campus Salemba, Jalan Salemba Raya No. 4, Jakarta, 10430, Indonesia.
| | - Y Ren
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713, Groningen, GZ, Netherlands
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Yeh JK, Lu YY, Hsieh IC, Hsieh MJ, Ho MY. Large False Lumen Prevailed After Coronary Dissection and Intramural Haematoma Fenestration With Cutting Balloon. Heart Lung Circ 2022; 31:e82-3. [PMID: 35065894 DOI: 10.1016/j.hlc.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/20/2021] [Accepted: 12/09/2021] [Indexed: 11/21/2022]
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Han T, Wu Y, Jin C, Wei X, Zhao Z. Reverse "cheese wire" fenestration for abdominal aortic dissection repair: a case report and literature review. BMC Surg 2022; 22:145. [PMID: 35449045 PMCID: PMC9022330 DOI: 10.1186/s12893-022-01581-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background Aortic dissection is one of the most common emergency condition leading to internal organs or lower limb ischemia and aortic rupture. Herein, we described a reverse “cheese wire” endovascular fenestration repair (CWFER) in a patient with complicated abdominal aortic dissection which had never been reported. Case presentation A 62-year-old male presented abdominal tear-like pain and acute ischemia of the right lower extremity during the endovascular treatment of celiac trunk aneurysms. Computed tomography angiography (CTA) and digital subtraction angiography (DSA) showed abdominal aortic type B dissection with acute ischemia of the right lower extremity preoperatively. After a detailed preoperative examination, the patient then was performed a reverse CWFER. So far, the patient has been followed-up for 6 months, postoperative CTA demonstrated good stent-graft expansion and perfusion of bilateral common iliac arteries; also, no endoleak was detected. Conclusions The right iliac artery in this patient supplied by false lumen, which lead to acute ischemia of the right lower extremity, needed to be treated as an emergency and dealt with promptly. CWFER is a very high-risk treatment that requires the rich experience of vascular surgeon and accurate assessment of aortic dissection. After interventional treatment, the patient recovered uneventfully after 6 months’ follow-up. Supplementary information The online version contains supplementary material available at 10.1186/s12893-022-01581-4.
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Affiliation(s)
- Tonglei Han
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Yani Wu
- Department of Breast and Thyroid Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Chong Jin
- Department of General Surgery, Taizhou Central Hospital, Taizhou University Hospital, No. 999 Donghai Avenue, Taizhou, 318000, Zhejiang, China.
| | - Xiaolong Wei
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China.
| | - Zhiqing Zhao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China
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Sun L, Mu C, Chen L, Zhao B, Pan J, Liu Y. Dehiscence and fenestration of Class I individuals with normality patterns in the anterior region: a CBCT study. Clin Oral Investig 2022; 26:4137-4145. [PMID: 35254527 PMCID: PMC9072473 DOI: 10.1007/s00784-022-04384-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/17/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the prevalence of alveolar bone dehiscence and fenestration of Class I individuals with normality patterns in the anterior region using cone-beam computed tomography (CBCT). MATERIALS AND METHODS A total of 4715 retrospective cases from January 2018 to December 2020 in the Orthodontic Department of xxx Hospital were screened. Sixty-one cases were Class I individuals with normality patterns in the anterior region. Their incidence of dehiscence and fenestration in the anterior teeth region was studied and statistically analyzed. RESULTS Dehiscence was found in 27.46% of the evaluated anterior teeth and fenestration was found in 26.91% of anterior teeth. Severe dehiscences and fenestrations mainly occurred in mandibular canines and maxillary canines, respectively. Alveolar bone defects were present in 100% of patients, while one patient had alveolar bone defects in 91.67% of the anterior teeth. CONCLUSIONS Dehiscence was found in 27.46% of the anterior teeth of Class I individuals with normality patterns, while fenestration was found in 26.91% of them. Alveolar bone defects were present in 100% of patients. CLINICAL RELEVANCE Alveolar bone dehiscence and fenestration were normal and common in our sample, indicating that they are more likely to be physiological rather than pathological defects. Orthodontists should be aware of the presence and severity of these defects before treatment in order to avoid both possible complications and overtreatment.
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Affiliation(s)
- Liangyan Sun
- Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, No.356 East Beijing Road, Shanghai, China
| | - Chuangchuang Mu
- Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, No.356 East Beijing Road, Shanghai, China
| | - Li Chen
- Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, No.356 East Beijing Road, Shanghai, China
| | - Bingjiao Zhao
- Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, No.356 East Beijing Road, Shanghai, China
| | - Jie Pan
- Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, No.356 East Beijing Road, Shanghai, China
| | - Yuehua Liu
- Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology, Fudan University, No.356 East Beijing Road, Shanghai, China.
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Augustin AM, Wolfschmidt F, Elsässer T, Sauer A, Dierks A, Bley TA, Kickuth R. Color-coded summation images for the evaluation of blood flow in endovascular aortic dissection fenestration. BMC Med Imaging 2022; 22:19. [PMID: 35120493 PMCID: PMC8817583 DOI: 10.1186/s12880-022-00744-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background To analyze the benefit of color-coded summation images in the assessment of target lumen perfusion in patients with aortic dissection and malperfusion syndrome before and after fluoroscopy-guided aortic fenestration.
Methods Between December 2011 and April 2020 25 patients with Stanford type A (n = 13) or type B dissection (n = 12) and malperfusion syndromes were treated with fluoroscopy-guided fenestration of the dissection flap using a re-entry catheter. The procedure was technically successful in 100% of the cases and included additional iliofemoral stent implantation in four patients. Intraprocedural systolic blood pressure measurements for gradient evaluation were performed in 19 cases. Post-processed color-coded DSA images were obtained from all DSA series before and following fenestration. Differences in time to peak (dTTP) values in the compromised aortic lumen and transluminal systolic blood pressure gradients were analyzed retrospectively. Correlation analysis between dTTP and changes in blood pressure gradients was performed.
Results Mean TTP prior to dissection flap fenestration was 6.85 ± 1.35 s. After fenestration, mean TTP decreased significantly to 4.96 ± 0.94 s (p < 0.001). Available systolic blood pressure gradients between the true and the false lumen were reduced by a median of 4.0 mmHg following fenestration (p = 0.031), with significant reductions in Stanford type B dissections (p = 0.013) and minor reductions in type A dissections (p = 0.530). A moderate correlation with no statistical significance was found between dTTP and the difference in systolic blood pressure (r = 0.226; p = 0.351). Conclusions Hemodynamic parameters obtained from color-coded DSA confirmed a significant reduction of TTP values in the aortic target lumen in terms of an improved perfusion in the compromised aortic region. Color-coded DSA might thus be a suitable complementary tool in the assessment of complex vascular patterns prevailing in aortic dissections, especially when blood pressure measurements are not conclusive or feasible.
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Affiliation(s)
- Anne Marie Augustin
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany.
| | | | | | - Alexander Sauer
- BAG Radiologie Und Nuklearmedizin Aschaffenburg, Aschaffenburg, Germany
| | - Alexander Dierks
- Nuclear Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Ralph Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
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Nonaka S, Tsutsumi S, Inaba T, Ishii H. Bilateral vertebral artery fenestrations in the craniocervical junction region: the clinical role of 3D computed tomography angiography. Surg Radiol Anat 2022. [PMID: 35061095 DOI: 10.1007/s00276-022-02886-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/08/2022] [Indexed: 10/19/2022]
Abstract
Fenestration of the vertebral artery (FVA) is a rare occurrence that comprises only 2% of fenestrations formed in the intracranial arteries. Herein, we report a unique case of bilateral FVA in the craniocervical junction (CCJ) region using conventional magnetic resonance angiography (MRA) and three-dimensional computed tomography angiography (3D-CTA). Compared to MRA, 3D-CTA was more sensitive in delineating the FVAs located in the region. Furthermore, it effectively depicted the relationships between the VAs and surrounding bony structures. The clinical implications of FVAs can be better understood in relation to the surrounding bony structures. 3D-CTA is mandatory when performing endovascular and open surgical interventions in and around the VA segments in the CCJ region.
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Stankov Z, Petrov I, Vasilev S, Yanevska L. Fenestration of the intima to facilitate successful endovascular repair of a dissecting abdominal aneurysm. Rev Cardiovasc Med 2021; 22:1547-1551. [PMID: 34957794 DOI: 10.31083/j.rcm2204159] [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: 08/15/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 11/06/2022] Open
Abstract
Aortic aneurysm is an enlargement of the aorta with a loss of the arterial wall parallelism. There are several possible causes concerning etiology, one of which is the postsurgical presence of a patent distal false lumen. An aortic aneurysm is mainly seen after a surgery for type A aortic dissection and it represents an important late complication. Even more, in some cases the abdominal aortic aneurysm could be complicated by a patent distal false lumen, which makes it challenging for further treatment. We present a case of a 44-year-old male patient with Marfan syndrome and the history of a surgical repair of type A aortic dissection. He was diagnosed with a large abdominal aortic aneurysm and patent distal false lumen. In this report, we describe our technique and the outcome for endovascular fenestration of the persistent intimal flap and the stent-graft implantation for abdominal aortic aneurysm isolation after the surgery for aortic dissection type A. Our technique presents a novelty approach to patients with abdominal aortic aneurysm, complicated with a patent distal false lumen.
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Affiliation(s)
- Zoran Stankov
- Department of Cardiology and Angiology, Acibadem City Clinic, Cardiovascular Center, 1000 Sofia, Bulgaria
| | - Ivo Petrov
- Department of Cardiology and Angiology, Acibadem City Clinic, Cardiovascular Center, 1000 Sofia, Bulgaria
| | - Strahil Vasilev
- Department of Cardiology and Angiology, Acibadem City Clinic, Cardiovascular Center, 1000 Sofia, Bulgaria
| | - Lyubinka Yanevska
- Department of Cardiology and Angiology, Acibadem City Clinic, Cardiovascular Center, 1000 Sofia, Bulgaria
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Zafirovikj E, Krsteska B. Laparoscopic fenestration and omentopexy as treatment for large splenic pseudocyst: Case report. Int J Surg Case Rep 2021; 88:106475. [PMID: 34666251 PMCID: PMC8524750 DOI: 10.1016/j.ijscr.2021.106475] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Pseudocysts of the spleen are rare entities with cystic lesions of the spleen being uncommon in general. It is estimated that splenic cysts occur in about 0, 07% of the population1. In general, splenic cystic lesions are discovered incidentally or by mass effect. In the literature, only a limited number of splenic cysts are reported. We report a case of splenic pseudocyst with mass effect where we used laparoscopic fenestration of the pseudocyst with omentopexy as a treatment of choice. CASE PRESENTATION The patient is a 62-year-old male with no previous history of trauma. He visited his GP for abdominal pain with flaring towards the left shoulder accompanied by early satiety, occasional obstipation, and breathing difficulties. He was referred to our hospital after enhanced computed tomography showed a 15 × 13 cm splenic cyst with displaced stomach and pancreatic tail medially and left kidney downward. Management options were discussed with the patient and he opted for a laparoscopic approach. In this case, we performed laparoscopic fenestration of the pseudocyst with omentopexy. CLINICAL DISCUSSION Until recently splenectomy was the surgical treatment of choice for all large or symptomatic cystic lesions of the spleen2, however with growing knowledge about the protective role of the spleen an approach with spleen protection is advocated. CONCLUSION There are many advantages to the laparoscopic approach of splenic cystic lesions and it may be the treatment of choice for this uncommon surgical problem.
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Affiliation(s)
- Elena Zafirovikj
- Department of Abdominal Surgery, University Hospital St. Naum Ohridski-Skopje, Macedonia.
| | - Blagica Krsteska
- Institute of Pathology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Macedonia
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Prendes CF, Lindström D, Mani K, Tegler G, Wanhainen A. A systematic review of experimental and clinical studies reporting on in situ laser fenestration of aortic endografts. J Vasc Surg 2021; 75:740-752.e1. [PMID: 34634422 DOI: 10.1016/j.jvs.2021.09.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 11/16/2020] [Accepted: 09/12/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To summarize available in-situ laser fenestration (ISLF) literature, including experimental studies with their subsequent recommendations regarding optimal fenestration technique and fabric; as well as the short and mid-term results of clinical studies. METHODS A systematic review of English articles was performed in MEDLINE, the Cochrane Database and EMBASE, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines by two researchers. The search period was without starting date until the 31st August 2020, and search terms included were in situ, laser, fenestration, and endograft. Quality assessment of the studies was performed using the Newcastle-Ottawa scale by two other independent researchers. RESULTS A total of 19 clinical studies were included, with a total of 428 patients (390 supra-aortic trunk ISLF, 38 visceral vessel ISLF). The technical success was 96.9% and 95.6% supra-aortic and visceral vessel ISLF, respectively. Most studies have less than 12-month follow-up, and the longest available follow-up (in one study) was 5-years for left-subclavian fenestration and 17-months for visceral vessel ISLF. Overall, the quality of the evaluated clinical studies was low. Six experimental studies were included, with the highest level of evidence suggesting fenestration of multifilament polyethylene terephthalate grafts, followed by dilation with either a 6- or 8-mm non-compliant balloon. CONCLUSION Experimental studies favour the use of multifilament polyethylene terephthalate , followed by dilation with non-compliant balloons as the most durable "in-vitro" technique for ISLF. Short-term outcomes for arch and visceral vessel revascularization are promising, with low rates of in-hospital mortality, stroke, and end-organ ischemia. Nonetheless, the long-term durability of ISLF is yet to be determined and they should be limited to selected symptomatic or urgent cases.
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Affiliation(s)
| | - David Lindström
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Kevin Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Gustaf Tegler
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Anders Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
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Galarza M, Chaban G, Gazzeri R, de la Rosa P, Montoya CG, Laut MM, Sosa F. Functional recovery following resection of large Tarlov cyst malformation: a multicentre longitudinal cohort study. Acta Neurochir (Wien) 2021; 163:2769-76. [PMID: 33761006 DOI: 10.1007/s00701-021-04817-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The authors report their experience with 44 consecutive patients who underwent cyst fenestration and wall repair or cerebrospinal fluid communication closure for the management of sacral Tarlov cysts. METHODS The procedure was performed on 32 women and 12 men with a mean age of 42 years. Clinical complaints in all patients included lumbar-sacral aching, sphincter dysfunction perineal pain, and sexual intercourse pain. The patients' symptoms had developed within a mean time period of 45 months. Five patients had a previous cyst puncture. In all patients, the cyst was exposed through a sacral laminectomy. In 30 patients, the cyst was partially resected its wall repaired, and in the remaining patients, the cyst was fenestrated, and the cerebrospinal fluid communication was located and tamponaded. Thirty-seven patients had intraoperative EMG monitoring. While the perineal pain, urinary, or sexual dysfunction improved in all patients, eleven patients reported lasting pain control following surgery. The cyst was reduced in all resected cases and seven of 14 patients with CSF tamponade. The mean length of the follow-up period was 57 months. CONCLUSIONS Either cyst repair or CSF tamponade can be sufficient for alleviating symptoms in patients with Tarlov cyst. Advice should be given to patients regarding expectations for pain improvement after surgery.
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Maxwell CR, Joshi N, Feller CN, McAree M, Hedayat HS. Reversal of cognitive, behavioral, and language impairments after the left frontal arachnoid cyst fenestration in a pediatric patient. Surg Neurol Int 2021; 12:371. [PMID: 34513138 PMCID: PMC8422412 DOI: 10.25259/sni_135_2021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/31/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Arachnoid cysts (ACs) are cerebrospinal fluid-containing cysts located between the surface of the brain or spinal cord and arachnoid layer of the leptomeninges. ACs have been known to cause cognitive, language, and behavioral deficits and currently there is no standard treatment paradigm. Surgical indications include papilledema, increasing growth with mass effect causing neurological deficit, or rapid head growth, however, cognitive symptoms related to mass effect may not always be considered. Case Description: We present a 3-year-old male with an AC of the left anterior fossa causing frontal lobe compression with resultant behavioral, language, and cognitive deficits. Conclusion: Surgical intervention for AC decompression may be indicated when there are cognitive, behavioral, or language delays related to the mass effect and location of the AC. Neuropsychiatric testing or more advanced imaging studies may further support surgical treatment. After craniotomy for fenestration of the left frontal AC, there was drastic improvement in cognitive, language, and behavioral symptoms in our pediatric patient.
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Affiliation(s)
- Christina R Maxwell
- Department of Neurosurgery, Global Neurosciences Institute, Philadelphia, Pennsylvania
| | - Neal Joshi
- Department of Cell Biology and Neuroscience, Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | - Christina N Feller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Michael McAree
- Department of Cell Biology and Neuroscience, Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | - Hirad S Hedayat
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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Ahuja A, Parekh C, Salomon A, Lawande M, Daftary A. Role of ultrasound-guided decompression in management of mucoid degeneration of the anterior cruciate ligament. Skeletal Radiol 2021; 50:1837-1843. [PMID: 33683407 DOI: 10.1007/s00256-021-03750-7] [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: 06/23/2020] [Revised: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the effectiveness of ultrasound-guided decompression in managing symptomatic mucoid degeneration of the anterior cruciate ligament (ACL). MATERIALS AND METHODS Retrospective analysis of 55 patients who underwent ultrasound-guided ACL mucoid degeneration decompression between July 2013 and August 2019. Subjective satisfaction scores were gathered immediately post-procedure for all 55 patients; follow-up satisfaction scores (scale of 0-10, 10 being excellent) were gathered telephonically for 46 patients (83.6%) up to 63 months post-procedure. Follow-up duration of each patient was classified as short (1-6 months), intermediate (7-12 months), or long (more than 12 months) post-procedure. Forty-five patients (81.8%) MRI were retrospectively analyzed and classified into cystic (n = 13, 28.9%), mucoid (n = 11, 24.4%), or mucoid-cystic (21, 46.7%) types. Multivariate logistic regression was used to identify associations between follow-up satisfaction score, follow-up duration, patient age, and type of ACL degeneration. RESULTS All patients had immediate marked post-procedure improvement, with excellent (>7/10) satisfaction scores. Forty-six of 55 patients were telephonically followed up: 21 (45.6%) short-term interval, 18 (39.1%) intermediate term, and 7 (15.2%) long-term. Thirty (65.22%) patients had excellent and eight (17.4%) patients had average satisfaction scores at follow-up. Eight (17.4%) patients had poor post-procedure satisfaction scores within six months. There were no significant associations between immediate or follow-up satisfaction score and duration of follow-up, age of patient, or type of ACL degeneration. CONCLUSION Ultrasound-guided aspiration, fenestration, and injection are an effective, safe, minimally invasive and radiation-free technique for management of mucoid degeneration of ACL with excellent immediate- and long-term results.
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Affiliation(s)
- Ankita Ahuja
- Innovision Imaging, 210 Doctor House, 14 Pedder Road, Mumbai, Maharashtra, 400026, India.
| | - Chaitali Parekh
- Innovision Imaging, 210 Doctor House, 14 Pedder Road, Mumbai, Maharashtra, 400026, India
| | - Angela Salomon
- Queen's University School of Medicine, 15 Arch Street, Kingston, Ontario, K7L 3N6, Canada
| | - Malini Lawande
- Innovision Imaging, 210 Doctor House, 14 Pedder Road, Mumbai, Maharashtra, 400026, India.,Sir H N Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Aditya Daftary
- Innovision Imaging, 210 Doctor House, 14 Pedder Road, Mumbai, Maharashtra, 400026, India.,Sir H N Reliance Foundation Hospital and Research Centre, Mumbai, India
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Kiya S, Nakamoto K, Fujii T, Sakka E, Tsutsumi Y, Yoshida K. Should spring water cysts of the mediastinum require excisional resection? A case report. Int J Surg Case Rep 2021; 85:106293. [PMID: 34393096 PMCID: PMC8361041 DOI: 10.1016/j.ijscr.2021.106293] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Mediastinal cysts account for 20-32% of all mediastinal lesions. Complete surgical excision is the standard therapy for mediastinal cysts. Translucent cysts containing crystal-clear fluid are called "spring water cysts." We experienced a case of mediastinal spring water cyst fenestrated under video-assisted thoracoscopy with a miniaturized endoscope (mini-VATS) as an alternative to excisional resection. CASE PRESENTATION A 49-year-old woman presented with back pain. Chest CT revealed a posterior mediastinal mass measuring 4.2 × 1.8 × 3.2 cm closed to the tenth thoracic vertebra. Chest MRI demonstrated hypo-intensity on T1-weighted images and hyper-intensity on T2-weighted images. It was estimated that the posterior mediastinal mass did not contain a tumor component. The tumor was growing and symptomatic; therefore, we performed surgical cyst fenestration without excision of the cyst under mini-VATS. The patient experienced complete relief of symptoms. Fluid accumulation in the cyst was not observed on CT images 12 months postoperatively. CLINICAL DISCUSSION Kozu et al. reported that all 108 primary mediastinal cysts were resected completely and were recurrence-free after a mean follow-up of 41 ± 26 months. In the case of a functional hydrocele such as spring water cyst, we believe that even if fluid is produced, the thoracic pleura is capable of absorbing the fluid, and the cyst wall might not recur even if the wall is left in place. Fluid drainage through fenestration may prevent recurrent fluid collection. CONCLUSION Fenestration of non-neoplastic mediastinal cysts under mini-VATS might be a less invasive radical procedure compared to complete resection.
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Affiliation(s)
- Soichiro Kiya
- Division of General Thoracic Surgery, Shunan Memorial Hospital, 1-10-1 Ikunoyaminami, Kudamatsu-shi, Yamaguchi 744-0033, Japan,Corresponding author at: Division of General Thoracic Surgery, Shunan Memorial Hospital, Japan.
| | - Kembu Nakamoto
- Division of General Thoracic Surgery, Shunan Memorial Hospital, 1-10-1 Ikunoyaminami, Kudamatsu-shi, Yamaguchi 744-0033, Japan
| | - Toshiyuki Fujii
- Division of General Thoracic Surgery, Shunan Memorial Hospital, 1-10-1 Ikunoyaminami, Kudamatsu-shi, Yamaguchi 744-0033, Japan
| | - Eriko Sakka
- Division of Anesthesiology, Shunan Memorial Hospital, 1-10-1 Ikunoyaminami, Kudamatsu-shi, Yamaguchi 744-0033, Japan
| | - Yousuke Tsutsumi
- Division of Anesthesiology, Shunan Memorial Hospital, 1-10-1 Ikunoyaminami, Kudamatsu-shi, Yamaguchi 744-0033, Japan
| | - Kazuya Yoshida
- Division of General Thoracic Surgery, Shunan Memorial Hospital, 1-10-1 Ikunoyaminami, Kudamatsu-shi, Yamaguchi 744-0033, Japan
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Ozawa H, Hoashi T, Ohuchi H, Kurosaki K, Ichikawa H. Long-Term Outcomes After Fenestration Closure in High-Risk Fontan Candidates. Pediatr Cardiol 2021; 42:1356-1364. [PMID: 33881601 DOI: 10.1007/s00246-021-02619-9] [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: 12/09/2020] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
The study aimed to assess the long-term outcomes after fenestration closure in patients at risk for Fontan failure. Of 119 patients who underwent Fontan operation between 1995 and 2004, fenestration was not created in 89 patients (NF group) and created in 30 patients with hypoplastic left heart syndrome, heterotaxy syndrome, high pulmonary arterial pressure, high systemic ventricular end-diastolic pressure, low ventricular ejection fraction, or atrioventricular valve regurgitation. All fenestrations were closed spontaneously or by catheter/surgical interventions, excepting two patients, and therefore, they were excluded. In fenestration group, patients with pre-Fontan mean pulmonary arterial pressure ≥ 15 mmHg or systemic atrioventricular valve regurgitation ≥ moderate were classified as high-risk Fontan candidates (F-HR group, n = 16), and the remaining patients were as standard-risk (F-SR group, n = 12). Protein-losing enteropathy-free survival rates did not differ among the three groups (p = 0.72). Serial follow-up catheter examinations after Fontan operation were completed in 69 patients in NF group and 11 patients in both F-SR and F-HR groups. Cardiac index and pulmonary vascular resistance significantly and similarly decreased over time in all groups, though the F-HR group showed lowest arterial oxygen saturation, lowest cardiac index, and highest pulmonary vascular resistance. The F-HR group also showed much veno-venous collaterals (p = 0.049), low peak oxygen consumption (p = 0.019), and low anaerobic threshold (p = 0.023) as compared to those in the F-SR group. In F-HR group, cyanosis remained after fenestration closure due to transformation from fenestration to veno-venous collaterals, which resulted in elevation of pulmonary vascular resistance, low cardiac index, and deterioration of exercise tolerance.
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Affiliation(s)
- Hideto Ozawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Takaya Hoashi
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
| | - Hideo Ohuchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenichi Kurosaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
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Well A, Stewart E, Mery CM. Long-term outcomes after Fontan palliation-the many shades of blue. Eur J Cardiothorac Surg 2021; 61:62-63. [PMID: 34279026 DOI: 10.1093/ejcts/ezab331] [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] [Indexed: 11/15/2022] Open
Affiliation(s)
- Andrew Well
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, TX, USA.,Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Eileen Stewart
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, TX, USA.,Department of Pediatrics, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, TX, USA.,Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin, TX, USA
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