1
|
Naicker D, Leola K, Mkhaliphi MM, Mpanza MN, Ouma J, Nakwa FL, Velaphi S, Profyris C. Single surgeon case series of myelomeningocele repairs in a developing world setting: Challenges and lessons. World Neurosurg X 2023; 19:100213. [PMID: 37260695 PMCID: PMC10227453 DOI: 10.1016/j.wnsx.2023.100213] [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: 07/15/2022] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 06/02/2023] Open
Abstract
Purpose Neural Tube Defects are the second most common group of birth malformations following congenital heart anomalies, with myelomeningoceles being the most severe manifestation (MMC). They require expedited surgical repair, preferably within 72 h of birth. In low- and middle-income countries (LMIC) where resources are limited, timing to MMC repair is not optimal and leads to undesirable outcomes. The purpose of this study was to determine whether a proactive approach in a setting from a LMIC could achieve repair within 72 h. Methods A concerted effort to expedite repair of all neonates referred with a MMC was undertaken from 01 January 2014 to 1 August 2015. A consensus was reached between neonatologists and neurosurgeons that neonates born or admitted with a MMC are referred immediately to surgeons and that repair will be performed within 72 h of birth. Hospital records of neonates who had MMC repaired during this period were reviewed for infant characteristics and hospital outcomes. Results 24 patients with a MMC were operated upon by the senior author (CP) during the study period. Only 13 of these patients were born at the treating institution and 11 were referred from outside hospitals. Most MMCs were in the lumbosacral region and mean MMC surface area was 19.4 cm2. Mean time to repair for the entire series was 13.6 days. Patients born at the treating institution has a mean time to repair of 10.5 days and patients referred from outside had a mean time to repair of 17.3 days. Series wide, only 21% of neonates were operated upon in less than 72 h. Conclusion Despite a pro-active commitment to repairing MMCs within 72 h for the duration of this series, satisfactory time to repair was not achieved. Late referral, referral from outside hospitals and operating theatre availability were the predominant factors leading to delay in MMC repair. Nevertheless, time to repair in our series was significantly shorter than that reported in MMC repair series based in similar environments. This suggests that even if the gold-standard of a 72-h window cannot be achieved, neonates benefit from much quicker repair when a concerted effort to minimise repair time is employed. This study also highlights the urgent need to address health care constraints in LMIC to improve outcomes for this vulnerable group.
Collapse
Affiliation(s)
- Denver Naicker
- Department of Neurosurgery, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Keletso Leola
- Department of Neurosurgery, Helen Joseph Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mlamuli Mzamo Mkhaliphi
- Department of Neurosurgery, Helen Joseph Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Morena Nthuse Mpanza
- Department of Neurosurgery, Helen Joseph Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - John Ouma
- Department of Neurosurgery, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Firdose Lambey Nakwa
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithembiso Velaphi
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christos Profyris
- Department of Neurosurgery, Helen Joseph Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
2
|
Saroul N, Rumeau C, Verillaud B, Patron V, Righini C, De Bonnecaze G, Daveau C, Mortuaire G, Mom T, Gilain L, Pereira B, Montrieul L. Failure of anterior skull base reconstruction for sinonasal carcinoma: consequence on the postoperative follow up. A multicentre evaluation of management. Acta Otolaryngol 2021; 141:630-634. [PMID: 33947299 DOI: 10.1080/00016489.2021.1914858] [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] [Indexed: 10/21/2022]
Abstract
BACKGROUND Numerous techniques for closure of the anterior skull base in cancer patients have a high success rate but management of failure is poorly documented. OBJECTIVES To standardize the post-operative follow-up after reconstruction surgery of the anterior skull base after removal for sinonasal carcinoma. MATERIALS AND METHODS Retrospective review of failure of anterior skull base reconstruction between 2005 and 2018 in a multicenter setting. RESULTS Twenty four patients were included. Reconstruction failure was detected by a cerebrospinal (CSF) leak in 79.2%, by an infectious complication without CSF leak (i.e. meningitis) in 12.5%, and in 8.3% by extensive pneumocephalus. Failure was observed during the first week after surgery in 75% of patients, in the second week in 21%, and in 4% after day 15. The delay in discovery of the failure was associated with multilayer reconstruction (p=.03). Failure was treated surgically in 54% of the patients and medically in 46%, with a similar success rate (85 vs. 100%). CONCLUSION AND SIGNIFICANCE After carcinologic resection of the anterior skull base, monitoring should be systematic during the first postoperative week. Surgical management of failure is not always necessary.
Collapse
Affiliation(s)
- Nicolas Saroul
- Otolaryngology Head and Neck Surgery Department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Cécile Rumeau
- Otolaryngology Head and Neck Surgery Department, CHU de Nancy, Vandoeuvre les Nancy, France
| | - Benjamin Verillaud
- Otolaryngology Head and Neck Surgery Department, Hôpital Lariboisière, AP-HP, Paris, France
| | - Vincent Patron
- Otolaryngology Head and Neck Surgery Department, CHU de Caen, Caen, France
| | - Christian Righini
- Otolaryngology Head and Neck Surgery Department, CHU de Grenoble, Grenoble, France
| | | | - Clémentine Daveau
- Otolaryngology Head and Neck Surgery Department Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Geoffrey Mortuaire
- Otolaryngology Head and Neck Surgery Department, CHU de Lille, Lille, France
| | - Thierry Mom
- Otolaryngology Head and Neck Surgery Department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Laurent Gilain
- Otolaryngology Head and Neck Surgery Department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Department (DRCI), CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Laura Montrieul
- Otolaryngology Head and Neck Surgery Department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| |
Collapse
|
3
|
Kim JH, Ge M, Su P, Suh JD, Ference EH. CSF Leaks due to Electric Scooter Injury. Laryngoscope 2020; 131:E1035-E1037. [PMID: 32965695 DOI: 10.1002/lary.29104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/20/2020] [Revised: 06/12/2020] [Accepted: 08/14/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND There has been a rapid increase in electric motorized scooter (e-scooter) usage after the introduction of dockless, shareable devices. METHODS Case series from three tertiary hospitals in Los Angeles between May-September 2019. RESULTS Five patients had skull base fractures and CSF leaks or pneumocephalus after e-scooter accident, none wore helmets. Two patients were treated with observation alone, two patients were treated with lumbar drain or external ventriculostomy placement, and one patient died of their injuries prior to definitive management. CONCLUSION Without appropriate safety policies in place, the number of such injuries may increase as the use of e-scooters increase. Laryngoscope, 131:E1035-E1037, 2021.
Collapse
Affiliation(s)
- Jee-Hong Kim
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - Marshall Ge
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - Peiyi Su
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - Jeffrey D Suh
- Department of Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine of the University of California, Los Angeles, Los Angeles, U.S.A
| | - Elisabeth H Ference
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, U.S.A
| |
Collapse
|
4
|
Ganesh PB, Basavarajaiah BM, Rudrappa BA, Kasaragod SK. Cerebrospinal fluid rhinorrhoea: does fibrin glue change the surgical outcome? J Laryngol Otol 2020; 134:582-5. [PMID: 32672143 DOI: 10.1017/S0022215120000845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Cerebrospinal fluid rhinorrhoea takes place when there is a breakdown of the barriers separating the nasal cavity from the subarachnoid space. The aim of this study was to assess the surgical outcomes of endoscopic transnasal cerebrospinal fluid leak repair with and without fibrin glue. METHOD There were 43 patients with cerebrospinal fluid rhinorrhoea who underwent surgery for cerebrospinal fluid leak repair between 2014 and 2018. Patients were divided into group A, where fibrin glue was used, and group B, where fibrin glue was not used. RESULTS It was found that 74.4 per cent of cases were due to spontaneous cerebrospinal fluid leak. The most common site of a leak was the cribriform plate (65 per cent). There was a success rate of 96.1 per cent (25 of 26) in group A and 83 per cent (15 of 17) in group B. There was no statistically significant difference between the results of the two groups (chi-square test: p = 0.31). CONCLUSION There was no statistically significant difference in the results of cerebrospinal fluid leak repair with and without fibrin glue.
Collapse
|
5
|
Abstract
This article reviews the role of imaging in the diagnosis, management, and treatment of spontaneous intracranial hypotension (SIH). SIH is a debilitating and often misdiagnosed condition caused by either a spinal cerebrospinal fluid (CSF) leak or a CSF to venous fistula. This pathologic condition is identified and localized via spinal imaging, including computed tomographic (CT) myelography, dynamic myelography, dynamic (ultrafast) CT myelography, MR imaging, or MR myelography with intrathecal gadolinium. Treatment of SIH involves conservative measures, surgery, or imaging-guided epidural blood patching.
Collapse
Affiliation(s)
- Timothy J Amrhein
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA.
| | - Peter G Kranz
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA
| |
Collapse
|
6
|
Abstract
OBJECTIVE AND IMPORTANCE To report a rare case of cerebrospinal fluid gusher and subsequent seizure immediately after cochlear implant electrode insertion. CLINICAL PRESENTATION After the cochlear implant electrode was inserted, brisk flow of 10 mL of cerebrospinal fluid was seen. The electrode was promptly inserted and the leak was additionally sealed with fascia. Seconds later, the patient had a tonic-clonic seizure lasting 30 seconds. Two additional episodes occurred during the case. Her postoperative course was uneventful with no subsequent seizures. The device has been successfully activated. Intervention & Technique: Postoperative imaging showed correct intracochlear placement of the electrode as well as an incidental enlarged vestibular aqueduct. Neurology consultation including electroencephalogram was unremarkable. CONCLUSION To our knowledge, this is the first report of a seizure temporally associated with cochlear implant electrode insertion. The significance and possible casual relationship between these two events is discussed.
Collapse
Affiliation(s)
- Alexander B Musser
- a Departments of Surgery, Division of Oral and Maxillofacial Surgery , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Justin S Golub
- b Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center , CIncinnati , OH , USA.,d Neurosensory Disorders Center, University of Cincinnati Neuroscience Institute , Cincinnati , OH , USA.,e Department of Otolaryngology-Head and Neck Surgery , Columbia University College of Physicians and Surgeons , New York , NY , USA
| | - Ravi N Samy
- b Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center , CIncinnati , OH , USA.,d Neurosensory Disorders Center, University of Cincinnati Neuroscience Institute , Cincinnati , OH , USA
| | - James C Phero
- c Department of Anesthesiology , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| |
Collapse
|