1
|
Hurwitz TA, Avecillas-Chasin JM, Bogod NM, Honey CR. Ventral targeted anterior capsulotomy for treatment-resistant depression and obsessive-compulsive disorder: A treatment method with cases. J Affect Disord 2024; 350:887-894. [PMID: 38272366 DOI: 10.1016/j.jad.2024.01.176] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Ablative surgery using bilateral anterior capsulotomy (BAC) is an option for treatment resistant depression (TRD) and obsessive-compulsive disorder (TROCD). The location and extent of the lesion within anterior limb of the internal capsule (ALIC) remains uncertain. Accumulating evidence has suggested that the lesion should be located ventrally while limiting the dorsal extent. Our center is now targeting specific fiber tracts within the lower half of the ALIC. METHOD Presurgical diffusion tensor Magnetic Resonance Imaging (MRI) was used to identify individual fibre tracts within the ventral aspect of the ALIC in the last two patients who underwent BAC at our center. One patient had TRD and the other had both TROCD and TRD. Radiofrequency-induced thermal lesions were created in the identified targets with lesion volumes between 20 and 229 mm3 (average 95 mm3). FINDINGS Both patients were responders with neither experiencing significant side effects including compromised executive functions. LIMITATIONS The generalizability of our findings is limited because the outcome is based on two subjects. CONCLUSION This work suggests that BAC can be individually tailored and more limited to the ventral aspect of the ALIC and is effective and safe for TRD and TROCD. Accumulating data also suggests that to be clinically effective the length of the capsulotomy should be about 10mm. BAC's use may increase with the growing utilization and mastery of magnetic resonance guided focused ultrasound.
Collapse
Affiliation(s)
- Trevor A Hurwitz
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | | | - Nicholas M Bogod
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada.
| | - Christopher R Honey
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
2
|
Abstract
Should one recommend stereotactic ablation for Parkinson disease, tremor, dystonia, and obsessive compulsive disorder, in this era of DBS? The answer depends on several variables such as the symptoms to treat, the patient's preferences and expectations, the surgeons' competence and preference, the availability of financial means (by government health care, by private insurance), the geographical issues, and not least the current and dominating fashion at that particular time. Both ablation and stimulation can be either used alone or even combined (provided expertise in both of them) to treat various symptoms of movement and mind disorders.
Collapse
Affiliation(s)
- Marwan Hariz
- Department of Clinical Neuroscience, University Hospital, Umeå 90185, Sweden.
| |
Collapse
|
3
|
Zittel S, Moratin J, Horn D, Metzger K, Ristow O, Engel M, Mrosek J, Freier K, Hoffmann J, Freudlsperger C. Clinical outcome and prognostic factors in recurrent oral squamous cell carcinoma after primary surgical treatment: a retrospective study. Clin Oral Investig 2021. [PMID: 34581884 DOI: 10.1007/s00784-021-04186-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/17/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Survival for patients with recurrent oral squamous cell carcinoma is usually poor, and the most effective treatment has not yet been clearly defined. The present study evaluates the outcome in radiotherapy-naïve patients after recurrence of oral squamous cell carcinoma with respect to different treatment modalities including surgery, radiation, chemoradiation, and palliative treatment. PATIENTS AND METHODS In this retrospective study, we included all patients with primary oral squamous cell carcinoma who received exclusively surgical therapy between 2010 and 2020 and who suffered from locoregional recurrence in their follow-up. Patients with previous adjuvant therapy were excluded from this protocol. Clinical and pathological parameters were collected and statistically evaluated. Survival analysis was performed according to Kaplan-Meier. The primary endpoints were overall and progression-free survival in dependance of treatment strategy for recurrent tumors. RESULTS Out of a total of 538 patients with surgically treated primary oral squamous cell carcinoma, 76 patients met the inclusion criteria. The mean follow-up was 38 ± 32 months. Patients who received surgically based therapy had a significantly better outcome in terms of disease-free survival (DFS) and overall survival (OS) (DFS p < 0.001; OS p < 0.001). The presence of regional metastases and a short disease-free interval (DFI) between primary and recurrent cancer were significant predictors for adverse outcomes (DFI p < 0.001). CONCLUSION We recommend primary surgical therapy for radiotherapy-naïve patients with recurrent oral squamous cell carcinoma, supplemented by risk-adapted adjuvant therapy. CLINICAL RELEVANCE Surgical therapy continues to play a central role in the treatment of radiotherapy-naïve patients with recurrent oral squamous cell carcinoma.
Collapse
|
4
|
Zeller AN, Neuhaus MT, Weissbach LVM, Rana M, Dhawan A, Eckstein FM, Gellrich NC, Zimmerer RM. Patient-Specific Mandibular Reconstruction Plates Increase Accuracy and Long-Term Stability in Immediate Alloplastic Reconstruction of Segmental Mandibular Defects. J Maxillofac Oral Surg 2020; 19:609-615. [PMID: 33071511 PMCID: PMC7524954 DOI: 10.1007/s12663-019-01323-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 11/07/2019] [Accepted: 12/18/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of the current study was to evaluate potential differences in the accuracy of mandibular reconstruction and long-term stability, with respect to different reconstructive procedures. METHODS In total, 42 patients who had undergone primary segmental mandibular resection with immediate alloplastic reconstruction, with either manually pre-bent or patient-specific mandibular reconstruction plates (PSMRP), were included in this study. Mandibular dimensions, in terms of six clinically relevant distances (capitulum [most lateral points], capitulum [most medial points], incisura [most caudal points], mandibular foramina, coronoid process [most cranial points], dorsal tip of the mandible closest to the gonion point) determined from tomographic images, were compared prior to, and after surgery. RESULTS Dimensional alterations were significantly more often found when conventionally bent titanium reconstruction plates were used. These occurred in the area of the coronoid process (p = 0.014). Plate fractures were significantly (p = 0.022) more often found within the manually pre-bent group than within the PSMRP group (17%/0%). CONCLUSION The results suggest that the use of PSMRP may prevent rotation of the proximal mandibular segment, thus avoiding functional impairment. In addition, the use of PSMRP may potentially enhance the long-term stability of alloplastic reconstructions.
Collapse
Affiliation(s)
- A. N. Zeller
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - M. T. Neuhaus
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - L. V. M. Weissbach
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - M. Rana
- Department of Oral and Maxillofacial Surgery, University Hospital Duesseldorf, Düsseldorf, Germany
| | - A. Dhawan
- Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, India
| | - F. M. Eckstein
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - N. C. Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| | - R. M. Zimmerer
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
5
|
Weschenfelder W, Gast-Froehlich S, Spiegel C, Vogt M, Hofmann GO. Factors influencing quality of life, function, reintegration and participation after musculoskeletal tumour operations. BMC Cancer 2020; 20:351. [PMID: 32334563 PMCID: PMC7183621 DOI: 10.1186/s12885-020-06837-x] [Citation(s) in RCA: 4] [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: 12/06/2019] [Accepted: 04/06/2020] [Indexed: 01/09/2023] Open
Abstract
Background The number of people living with soft-tissue and bone sarcomas is increasing due to improved individual therapy and changes in demographics. At present, there are no recommendations for psychological co-treatment, occupational and social reintegration following the treatment of soft tissue and bone sarcomas. Methods Seventy-four patients, 42 males and 32 females, aged between 18 and 80 years (54.58 ± 16.99 yr.) with soft-tissue (62) and bone sarcomas (12) were included to answer five standardized and one personal questionnaire regarding quality of life, function, reintegration and participation after surgical treatment. Results A number of tumour-specific and patient-specific factors were identified that affected the therapeutic outcome. Patients with sarcoma of the lower extremity described poorer mobility. Patients who underwent amputation reported a higher anxious preoccupation. Patients with a higher range of education were less fatalistic and avoiding. The size of tumours or additive radiation therapy did not affect the post-therapeutic quality of life, coping and function. There was a good correlation between anxiety and depression with occupational reintegration, function, quality of life and coping. Conclusion Patients with sarcomas of the lower limb have a higher demand for postoperative rehabilitation and need more help in the postoperative occupational reintegration. Furthermore patients that underwent limb-preserving operations reported better postoperative function and quality of life. Risk assessment using patient-specific factors and an intensive psychological co-treatment may have a large role in the co-treatment of patients from the beginning of their cancer therapy.
Collapse
Affiliation(s)
- Wolfram Weschenfelder
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Sabine Gast-Froehlich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Christian Spiegel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Matthias Vogt
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Gunther O Hofmann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| |
Collapse
|
6
|
Franzini A, Franzini A, Levi V, Cordella R, Messina G. An unusual surgical indication for cerebral tuberculosis: status dystonicus. Case report. Acta Neurochir (Wien) 2018; 160:1355-8. [PMID: 29766338 DOI: 10.1007/s00701-018-3561-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/03/2018] [Indexed: 01/20/2023]
Abstract
Actual indications for surgery in tuberculosis are limited to obtaining a diagnosis, acquiring tissue for culture studies, treating hydrocephalus, aspiring a brain abscess, and reducing intracranial pressure in patients with multiple tuberculomas. Tuberculosis-related movement disorders are usually treated pharmacologically. We report on a child affected by post-tubercular generalized dystonia, who progressed to status dystonicus (SD) and underwent stereotactic bilateral pallidotomy. After surgery, SD resolved, and drugs were rapidly tapered. The successful reversal of SD and the motor improvement observed in our patient demonstrate the safety, feasibility, and clinical efficacy of pallidotomy in post-tuberculous-meningoencephalitis dystonia and SD.
Collapse
|
7
|
Abstract
INTRODUCTION Treatment of dystonia should be individualized and tailored to the specific needs of patients. Surgical treatment is an important option in medically refractory cases. Several issues regarding type of the surgical intervention, targets, and predict factors of benefit are still under debate. Areas covered: To date, several clinical trials have proven the benefit and safety of deep brain stimulation (DBS) for inherited and idiopathic isolated dystonia, whereas there is still insufficient evidence in combined and acquired dystonia. The globus pallidus internus (GPi) is the target with the best evidence, but data on the subthalamic nucleus seems also to be promising. Evidence suggests that younger patients with shorter disease duration experience greater benefit following DBS. Pallidotomy and thalamotomy are currently used in subset of carefully selected patients. The development of MRI-guided focused ultrasound might bring new options to ablation approach in dystonia. Expert commentary: GPi-DBS is effective and safe in isolated dystonia and should not be delayed when symptoms compromise quality of life and functionality. Identifying the best candidates to surgery on acquired and combined dystonias is still necessary. New insights about pathophysiology of dystonia and new technological advances will undoubtedly help to tailor surgery and optimize clinical effects.
Collapse
Affiliation(s)
- Rubens Gisbert Cury
- a Service de Neurologie, Centre Hospitalier Universitaire de Grenoble , Université Grenoble Alpes , Grenoble , France.,b Department of Neurology, School of Medicine , University of São Paulo , São Paulo , Brazil
| | - Suneil Kumar Kalia
- c Division of Neurosurgery and Krembil Research Institute, Department of Surgery , University of Toronto , Toronto , Canada
| | - Binit Bipin Shah
- d Parkinson's Disease and Movement Disorders Center, Department of Neurology , University of Virginia , Charlottesville , VA , USA
| | - Joohi Jimenez-Shahed
- e Parkinson's Disease Center and Movement Disorders Clinic , Baylor College of Medicine , Houston , TX , USA
| | | | - Elena Moro
- a Service de Neurologie, Centre Hospitalier Universitaire de Grenoble , Université Grenoble Alpes , Grenoble , France
| |
Collapse
|
8
|
Rubod C, Jean Dit Gautier E, Yazbeck C. [Surgical management of endometrioma: Different alternatives in term of pain, fertility and recurrence. CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018; 46:278-89. [PMID: 29510964 DOI: 10.1016/j.gofs.2018.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Indexed: 11/22/2022]
Abstract
Surgical management of ovarian endometrioma is most often part of a global approach of endometriosis pathology. Isolated endometrioma are rare. Laparoscopic cystectomy is the gold standard for surgical management of endometrioma. Nevertheless, this technique impacts the ovarian function. The hemostasis of the ovarian cyst bed should be performed to conserve the ovarian stroma. Ultrasonography-guided cyst aspiration, laparoscopic drainage and simple bipolar coagulation are not recommended as first line of treatment. Based on the actual literature, we cannot state the place of laser-vaporization and plasma-energy ablation in surgical management. Ethanol sclerotherapy could be an alternative to treat recurrent endometrioma. Uncompleted surgical removal of endometriosis lesions increases the recurrence rate. Endometriosis management should take into account the research and treatment of all the pelvic lesion, especially before surgical management of endometrioma. In this context, the evaluation of ovarian reserve could be useful before surgery.
Collapse
|