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Surgical Outcome (surgical + outcome)
Kinds of Surgical Outcome Selected AbstractsSURGICAL OUTCOME OF SUPERFICIAL AND DEEP CASTLEMAN DISEASEANZ JOURNAL OF SURGERY, Issue 5 2007Chih-Hao Chen Background: Castleman disease is a rare lymphoproliferative disease of low malignant potential occurring in two forms, unicentric and multicentric. Surgery, chemotherapy, immunotherapy and radiation therapy have all been used to manage the disease. In this study, we evaluate whether the site of the lesions, that is, superficial or deep, influences the surgical outcome. Methods: We retrospectively reviewed the records of 20 patients operated on for Castleman disease from 1994 to 2003, of whom 11 patients had superficial disease and 9 had deep lesions. The end-points of this study were survival and recurrence. Results: Of the 20 patients, 19 had unicentric (cervical in 8, mediastinal in 5, retroperitoneal in 2, axillary in 2, hepatic in 1, and mesenteric in 1) and 1 had multicentric Castleman disease. Among 19 patients who had complete resection (18 with unicentric and 1 with multicentric disease), there has been no evidence of recurrence. Conclusion: Whether Castleman disease is superficial or deep has no effect on surgical outcome as long as resection is complete. [source] Parietal Lobe Epilepsy: The Semiology, Yield of Diagnostic Workup, and Surgical OutcomeEPILEPSIA, Issue 6 2004Dong Wook Kim Summary: Purpose: To characterize the clinical features, the prognostic value, and diagnostic sensitivities of various presurgical evaluations and the surgical outcomes in parietal lobe epilepsy (PLE), we describe 40 patients who were diagnosed as having PLE, including 27 surgically treated patients. Methods: The diagnosis was established by means of a standard presurgical evaluation, including magnetic resonance imaging (MRI), fluorodeoxyglucose,positron emission tomography (FDG-PET), ictal single-photon emission tomography (SPECT), and scalp video-electroencephalography (EEG) monitoring, with additional intracranial EEG monitoring in selected cases. Results: Among the 40 patients, 27 experienced at least one type of aura. The most common auras were somatosensory (13 patients), followed by affective, vertiginous, and visual auras. The patients had diverse manifestations. Eighteen patients showed simple motor seizure, followed by automotor seizure, and dialeptic seizure. Two patients manifested generalized tonic,clonic seizures only, and 19 patients experienced more than one type of seizure. The surgical outcome was favorable in 22 of 26 patients including 14 who were seizure free. Patients with localized MRI abnormality had a higher probability to be seizure free, with marginal significance (p = 0.062), whereas other diagnostic modalities failed to predict the surgical outcome. In the seizure-free group, localization sensitivity was 64.3% by MRI, 50% by PET, 45.5% by ictal SPECT, and 35.7% by ictal EEG. The concordance rate of the various diagnostic modalities was higher in the seizure-free group than in the non,seizure-free group, although it did not reach statistical significance. Conclusions: Seizures, in the case of PLE, can manifest themselves in a wider variety of ways than was previously thought. Surgical outcome was favorable in most of the patients. MRI abnormality and concordance of different diagnostic modalities were associated with high seizure-free rate. [source] Influence of Age on the Surgical Outcome After Endoscopic Sinus Surgery for Chronic Rhinosinusitis With Nasal PolyposisTHE LARYNGOSCOPE, Issue 6 2007Jae Yong Lee MD Abstract Objectives: To determine whether patient age is associated with the surgical outcome after endoscopic sinus surgery (ESS) with polypectomy. Study Design: A prospective, controlled case series. Materials and Methods: This study consisted of 60 patients who were diagnosed as having chronic rhinosinusitis (CRS) with nasal polyposis (NP) that was refractory to medical treatment. Three groups were classified according to patient age: pediatric (5,18 yr), adult (19,65 yr), and geriatric (over 65 yr). We collected 20 patients in each age group after applying the exclusion criteria. The extent of the polyps and the Lund-Mackay score were calculated for each patient, and they underwent ESS with polypectomy. We compared the objective endoscopic findings and subjective improvements in symptoms among the groups 6 months after the procedure. Results: There were no statistical differences in polyp extent or Lund-Mackay score between the three age groups. The objective surgical outcome based on the endoscopic findings was worst in the pediatric group (45%), whereas the geriatric group showed the best results (90%). The differences in objective outcome among the three groups were significant, and patient age was a predictive variable for surgical result based on multiple logistic regression analysis. No major complications occurred, and the overall improvement in subjective symptoms was statistically significant in all three age groups at 6 months postoperatively. The subjective surgical outcome did not differ statistically between the groups, with the exception of olfactory disturbance. Conclusions: The results of the present study suggest that patient age influences the objective postoperative outcome in the endoscopic treatment of CRS with NP, and that ESS is an effective and reliable method for improving the subjective symptoms in patients of all age groups despite the statistically different objective surgical outcomes between the groups. [source] Impact of Perioperative Systemic Steroids on Surgical Outcomes in Patients With Chronic Rhinosinusitis With Polyposis: Evaluation With the Novel Perioperative Sinus Endoscopy (POSE) Scoring System,THE LARYNGOSCOPE, Issue S115 2007Erin D. Wright MDCM Abstract Objectives/Hypothesis: The objective of this randomized, double-blind, placebo-controlled study was to assess the effect of perioperative systemic steroids on subjective and objective surgical outcomes for patients undergoing endoscopic sinus surgery (ESS) for chronic rhinosinusitis with polyposis (CRSwP). The secondary objective was to begin validation of the newly developed Perioperative Sinus Endoscopy (POSE) scoring system. Methods: Patients who had failed maximal medical therapy and were scheduled to undergo ESS were eligible for the study. Participants were randomized to receive either 30 mg of prednisone or placebo for 5 days preoperatively and 9 days postoperatively. Operative and baseline clinical data were collected using the Lund-McKay staging system including its Sinus Symptom Questionnaire as well as additional data regarding mucosal health, the technical difficulty of surgery, and endoscopic data using the Lund-Kennedy Endoscopic Score (LKES) and POSE scale. Data were also collected at 2 weeks, 1 month, 3 months, and 6 months postoperatively. A sample size of 24 was calculated to detect a clinically relevant difference between groups of 40%. Routine statistical comparisons were performed as were repeated measures analysis of variance with Bonferroni adjustment because of the multiple comparisons performed. To address the secondary objective, data were also collected at all postoperative time points using the POSE instrument, which was designed with the intention of enhancing face validity and responsiveness to change. Comparisons were performed between the POSE and LKES, including assessment of sensitivity to change, correlation between the two scales, and correlation with symptom scores. Results: Twenty-six patients participated in the study. Operative data demonstrated a significantly higher percentage of severely inflamed sinonasal mucosa in patients not pretreated with systemic steroids, which was associated with technically more difficult surgery in the estimation of the operating surgeon. In terms of postoperative symptoms, there was no difference between treatment groups, with both placebo and prednisone significantly improved over baseline up to 4 weeks postoperatively. Endoscopic assessment of patients postoperatively demonstrated a treatment effect (P < .05), with clinically healthier cavities seen in patients treated with prednisone up to 6 months postoperatively as compared with baseline (P < .001), although the strongest effect was seen at the 2-week time point. In comparing the two endoscopic scales, the POSE and LKES correlated highly (R > 0.70; P < .001) both in terms of absolute score and change in score. There is some evidence that the POSE score may be more sensitive to change than the LKES, and the POSE scores did correlate more strongly with symptom scores than the LKES, although both endoscopic scores correlated only weakly with symptom scores. Conclusions: The data presented in this study support the practice of administering preoperative systemic steroids to patients undergoing ESS for CRSwP. Furthermore, in the practice of surgeons who provide intensive postoperative care post-ESS, including debridement and medical therapy based on the endoscopic findings, there is evidence to support administering systemic steroids in the postoperative period. The POSE scoring system compares favorably with the LKES and may confer advantages in terms of face/content validity and responsiveness to change and is worthy of further validation. [source] Surgical Outcomes Following the Endoscopic Modified Lothrop Procedure,THE LARYNGOSCOPE, Issue 5 2007Mobeen A. Shirazi MD Abstract Objective: We performed a systematic review of 97 patients in whom an entirely endoscopic modified Lothrop procedure (EMLP) was performed. We studied the safety, efficacy, need for revision surgery, and rate of complication following an EMLP. Study Design: The study design was a retrospective chart analysis. Methods: We performed a retrospective chart review and patient survey of 97 patients who underwent an EMLP at our institution from January 1999 to March 2006. Main outcomes measured were the need for revision surgery including an osteoplastic flap (OPF), improvement in patients' symptoms, and rate of cerebrospinal fluid (CSF) leak. Results: The most common indication for the procedure was chronic frontal sinusitis and/or formation of mucocele. The frontal recess and floor of the frontal sinus were the most common areas of persistent disease. CSF leak rate was 1% (1/97) and was managed successfully at the time of surgery without any long-term sequelae. Twenty-two (23%) patients required revision surgery. Three (3%) patients required revision with an OPF. Some degree of symptomatic clinical improvement was reported by 98% (95/97) of patients. Conclusion: EMLP is a safe and effective surgical alternative to OPF for patients with recalcitrant frontal sinus disease. Major complications are rare. A large percentage of patients may require revision surgery. [source] Surgical Outcomes of Drillout Procedures for Complex Frontal Sinus Pathology,THE LARYNGOSCOPE, Issue 5 2007Pete S. Batra MD Abstract Objectives: The purpose of this report is two-fold: 1) to determine the incidence and 2) to determine the efficacy of drillout procedures in the management of frontal sinus disease in a tertiary rhinology practice. Study Design: Retrospective data analysis. Methods: Chart review was performed for all patients undergoing frontal sinus surgery from May 1999 to April 2004. The incidence of drillout surgery was determined. Demographic data, symptomatology, type of drillout procedure, and primary pathology were determined. Postoperative outcome was assessed based on subjective symptomatology and objective endoscopic patency. Results: A total of 186 patients underwent 207 frontal sinus procedures during this time period; 25 patients (13.4%) required a total of 30 (14.5%) drillout procedures. The patient population had previously undergone an average of 3.2 procedures; four cases were primary and 26 were revision procedures. The breakdown of the procedures was as follows: Draf III, 17; Draf IIB, 7; and transseptal frontal sinusotomy, 6. The major indications included mucoceles (11 cases), chronic frontal sinusitis (6 cases), and tumors (5 cases). Postoperatively, presenting symptomatology resolved in 32%, improved in 56%, and remained unchanged in 12% of the patients. Endoscopic patency of the neo-ostium was noted in 23 cases (92%). Average follow-up was 16.3 months. Conclusions: In this series, drillout procedures were successfully used in 25 patients as an important adjunct to the standard endoscopic techniques for management of complex frontal sinus disease. Because the procedure was used only 30 times during a 5-year period, it was reserved for specific circumstances in carefully selected patients. [source] Significance of Nasal Polyps in Chronic Rhinosinusitis: Symptoms and Surgical OutcomesTHE LARYNGOSCOPE, Issue 7 2005Article first published online: 3 JAN 200 No abstract is available for this article. [source] Sleep Disordered Breathing: Surgical Outcomes in Prepubertal ChildrenTHE LARYNGOSCOPE, Issue 1 2004BiolD, Christian Guilleminault MD Abstract Objective To evaluate the treatment outcomes of sleep disordered breathing (SDB) in prepubertal children 3 months following surgical intervention. Study Design Retrospective investigation of 400 consecutively seen children with SDB who were referred to otolaryngologists for treatment. Method After masking the identities and conditions of the children, the following were tabulated: clinical symptoms, results of clinical evaluation and polysomnography at entry, the treatment chosen by the otolaryngologists, and clinical and polysomnographic results 3 months after surgery. Results Treatment ranged from nasal steroids to various surgical procedures. Adenotonsillectomy was performed in only 251 of 400 cases (68%). Four cases included adenotonsillectomy in conjunction with pharyngoplasty (closure of the tonsillar wound by suturing the anterior and posterior pillar to tighten the airway). Persistent SDB was seen in 58 of 400 children (14.5%), and an additional 8 had persistent snoring. Best results were with adenotonsillectomy. Conclusion SDB involves obstruction of the upper airway, which may be partially due to craniofacial structure involvement. The goal of surgical treatment should be aimed at enlarging the airway, and not be solely focused on treating inflammation or infection of the lymphoid tissues. This goal may not be met in some patients, thus potentially contributing to residual problems seen after surgery. The possibility of further treatment, including collaboration with orthodontists to improve the craniofacial risk factors, should be considered in children with residual problems. [source] Parietal Lobe Epilepsy: The Semiology, Yield of Diagnostic Workup, and Surgical OutcomeEPILEPSIA, Issue 6 2004Dong Wook Kim Summary: Purpose: To characterize the clinical features, the prognostic value, and diagnostic sensitivities of various presurgical evaluations and the surgical outcomes in parietal lobe epilepsy (PLE), we describe 40 patients who were diagnosed as having PLE, including 27 surgically treated patients. Methods: The diagnosis was established by means of a standard presurgical evaluation, including magnetic resonance imaging (MRI), fluorodeoxyglucose,positron emission tomography (FDG-PET), ictal single-photon emission tomography (SPECT), and scalp video-electroencephalography (EEG) monitoring, with additional intracranial EEG monitoring in selected cases. Results: Among the 40 patients, 27 experienced at least one type of aura. The most common auras were somatosensory (13 patients), followed by affective, vertiginous, and visual auras. The patients had diverse manifestations. Eighteen patients showed simple motor seizure, followed by automotor seizure, and dialeptic seizure. Two patients manifested generalized tonic,clonic seizures only, and 19 patients experienced more than one type of seizure. The surgical outcome was favorable in 22 of 26 patients including 14 who were seizure free. Patients with localized MRI abnormality had a higher probability to be seizure free, with marginal significance (p = 0.062), whereas other diagnostic modalities failed to predict the surgical outcome. In the seizure-free group, localization sensitivity was 64.3% by MRI, 50% by PET, 45.5% by ictal SPECT, and 35.7% by ictal EEG. The concordance rate of the various diagnostic modalities was higher in the seizure-free group than in the non,seizure-free group, although it did not reach statistical significance. Conclusions: Seizures, in the case of PLE, can manifest themselves in a wider variety of ways than was previously thought. Surgical outcome was favorable in most of the patients. MRI abnormality and concordance of different diagnostic modalities were associated with high seizure-free rate. [source] Repair of vaginal vault prolapse and pelvic floor relaxation using polypropylene mesh,NEUROUROLOGY AND URODYNAMICS, Issue 7 2005Matthew P. Rutman Abstract Aims The sacrouterine ligament/cardinal (SULC) complex and prerectal fascia attach at the perineal body, forming a single support unit preventing levator descent. Many patients with vault prolapse have levator descent and widening of the hiatus. Existing transvaginal procedures do not address pelvic floor descent. We describe a technique utilizing polypropylene mesh to repair pelvic floor relaxation and prevent levator descent, along with restoration of the SULC complex in vaginal vault repair. Materials and Methods We prospectively evaluated 50 patients who had a transvaginal mesh vault/posterior wall reconstruction. A T-shaped soft prolene mesh is prepared fixing the two arms of the mesh and recreating the SULC complex in support of the cuff. The vertical segment of the mesh is transferred over the prerectal fascia and secured to the pelvic floor musculature. The rectocele is repaired incorporating the mesh distally preventing pelvic floor descent. Surgical outcome was determined by patient self-assessment including quality of life (QoL) measure as well as pelvic examination using POP-Q staging. Results Mean age was 67 years. Mean follow-up was 6 months (range 3,12). There were no intraoperative complications. There have been two apical (4%) recurrences. Mean QoL score postoperatively on a 0,6 scale was 0.74 (0,=,delighted, 1,=,pleased). Pelvic floor descent has been repaired on all patients. Postoperative POP-Q reveals restoration of normal anatomy. Conclusions We report a new technique that recreates the SULC complex in support of the vaginal vault with the aid of prolene mesh. It is the first transvaginal procedure described to reconstruct the pelvic floor in attempt to prevent pelvic floor descent. Neurourol. Urdynam. © 2005 Wiley-Liss, Inc. [source] Long-Term Follow-Up Results of Selective Laryngeal Adductor Denervation-Reinnervation Surgery for Adductor Spasmodic DysphoniaTHE LARYNGOSCOPE, Issue 4 2006Dinesh K. Chhetri MD Abstract Selective laryngeal adductor denervation-reinnervation surgery for the treatment of adductor spasmodic dysphonia was reported in 1999 in 21 patients with encouraging results. Here, we report long-term results of this procedure. Surgical outcome was evaluated using patient surveys and perceptual voice assessment. Measured outcomes included Voice Handicap Index (VHI)-10 scores, patient questionnaire, and perceptual evaluation for voice breaks and breathiness. Patient survey was obtained from 83 patients, and perceptual voice evaluation was performed in voice samples from 46 patients. Average follow-up interval was 49 months. Mean VHI-10 scores improved from a mean of 35.6 to 12.7. Eighty-three percent showed significantly improved VHI-10 scores, representing improved physical, social, and emotional well-being. There was a high degree of patient satisfaction, with 91% agreeing that their voice is more fluent after the surgery. Perceptual evaluation of postoperative voice samples revealed voice breaks in 26% (15% mild, 4% moderate, 7% severe) and breathiness in 30% (11% mild, 13% moderate, 6% severe). A majority of patients had stable, long-lasting resolution of spasmodic voice breaks. [source] Modified De Vita pinning technique for the management of canine hip luxation: preliminary findingsAUSTRALIAN VETERINARY JOURNAL, Issue 8 2000IH DOUGLAS Objective To describe for the first time a modification of the De Vita pinning technique to manage hip luxation in the dog and to assess its use in a preliminary study. Design A prospective, clinical study using five client-owned dogs with naturally occurring injuries. Procedure A modified De Vita pinning technique was employed, using a nonthreaded Steinmann pin to reduce the risk of trauma to the sciatic nerve during pin insertion. The pin was anchored by implanted Kirschner-Ehmer clamps in an attempt to lower the risk of postoperative pin migration. Results Surgical outcome was very favourable with respect to pain on manipulation, restriction of range of movement and lameness in all dogs as assessed by veterinary examination. In four of five dogs, owners also reported normal movement at rest, walk and trot. The fifth dog was lost to follow-up. Conclusion This preliminary study found that a modified De Vita pinning technique was useful in dogs with uni and bilateral hip luxation and hip luxation in the presence of other limb injuries. The modified technique may provide a sound surgical alternative to existing procedures. The described modification allows the use of a nonthreaded pin and also substantially reduces the risk of postoperative pin migration. [source] Surgical outcome and long-term follow up after laparoscopic rectosigmoid resectionBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2008A Patwardhan No abstract is available for this article. [source] Author response to: Surgical outcome and long-term follow-up after laparoscopic rectosigmoid resection in cases of deep infiltrating endometriosisBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2008R Seracchioli No abstract is available for this article. [source] Surgical outcomes of partial nephrectomy for renal cell carcinoma: A joint study by the Japanese Society of Renal CancerINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2007Yutaka Senga Objective: A joint study was undertaken by the Japanese Society of Renal Cancer to investigate the present status of partial nephrectomy in Japan and to speculate about what may be the indications for partial nephrectomy in patients with renal cell carcinoma. Methods: Data were tabulated for 469 patients from participating medical institutions and various clinical factors were investigated with regard to disease progression (local recurrence and distant metastasis). Results: Disease progression was observed in 21 patients (4.5%). No significant relation to disease progression was observed for sex, laterality, tumor histology, grade and tumor size. Although patients with solitary tumors displayed excellent prognosis irrespective of tumor diameter, patients with multiple tumors displayed a high likelihood of disease progression. Patients older than 77 years old and patients with imperative indication were found to have a poorer prognosis. Conclusion: In patients with solitary tumors, partial nephrectomy can be actively performed, even if the patient displays elective indications and the tumor is >4 cm in diameter. In patients displaying multiple tumors with imperative indications, the decision whether to perform partial nephrectomy should be made by the patients and their physicians after considering the impact on curability and the quality of life. [source] Outcomes Studies of Epiglottic and Base of Tongue Prolapse in Children,THE LARYNGOSCOPE, Issue 3 2008FACS, Robert F. Yellon MD Abstract Objectives: The purpose of this study was to compare previously reported flexible fiberoptic laryngoscopy (FFL) findings of a grading system for children with epiglottic and base of tongue (EBT) prolapse with findings at follow-up FFL. Surgical outcomes and tracheotomy decannulation are also reported. Study Design: Retrospective medical record review. Methods: Fourteen children with EBT prolapse had transnasal FFL in the supine position on at least two occasions. Findings were graded for initial versus most recent FFL. The previously published EBT prolapse grading system was reapplied. Mean age was 8.7 years at the last evaluation. Mean interval between initial and most recent FFL was 1.9 years. Results: At follow-up FFL, six (43%) children had the same grade of EBT prolapse, five (36%) had a milder grade, and three (21%) had a more severe grade. Five (36%) children were decannulated, and nine (64%) children remain tracheotomy dependant. Of nine children who had surgery, four (44%) were decannulated. Eight (89%) of nine children who were not decannulated have a history of developmental delay (P < .03). Twelve (86%) children had gastroesophageal reflux disease, and six (43%) had abnormal swallowing function. Conclusions: The grading system was successfully reapplied to compare initial with follow-up findings in a cohort of children with EBT prolapse. Gastroesophageal reflux disease and swallowing dysfunction are common in this population. Judicious surgery may have some efficacy for EBT prolapse in selected patients. Many children with EBT prolapse still require tracheotomy, especially those with developmental delay. [source] 4235: Vitreoretinal considerations in OOKPACTA OPHTHALMOLOGICA, Issue 2010E HUGHES Purpose To present the difficulties of managing vitreoretinal complications in patients with OOKP and open a discussion about future strategies to prevent and deal with these problems. Methods Retrospective review of cases. Results Vitreo-retinal complications occurred in 14 of 54 patients receiving OOKP surgery. These included vitreous hemorrhage (4 patients), rhegmatogenous retinal detachment (3 patients), endophthalmitis with retinal detachment (5 patients), endophthalmitis without retinal detachment (1 patient) and intraoperative choroidal hemorrhage (1 patient). Most cases of endophthalmitis presented late and may result from lamina resorption, leak and hypotony. The prognosis of retinal detachment in an eye with OOKP was poor with successful repair in 1 of 3 cases not related to endophthalmitis and 0 of 5 cases with endophthalmitis. Overall, pars plana vitrectomy was performed on 10 occasions (8 patients), of which 2 were endoscopic and 2 utilised a temporary keratoprosthesis. Conclusion There is a relatively high rate of posterior segment problems in OOKP patients and their management is challenging both in assessment (limited view and ultrasound amenability) and surgical approach. Surgical outcomes were poor for these complications. Other concepts in management, including endoscopic vitrectomy at stage I surgery should be considered, which will be discussed. [source] Lateral Wedge Resection: A Simple Technique for Repairing Involutional Lower Eyelid EntropionDERMATOLOGIC SURGERY, Issue 9 2010IGAL LEIBOVITCH MD BACKGROUND Lower lid involutional entropion is a common eyelid pathology affecting the elderly population. Most of the reported surgical techniques are mainly based on a lateral tarsal strip anchored to the orbital rim. OBJECTIVES To report the surgical outcome using a simple single-stitch lateral wedge technique to repair involutional lower entropion. METHODS This single-surgeon, retrospective, noncomparative cases series included all patients with involutional lower eyelid entropion who were operated on using the lateral wedge technique. RESULTS Fifty-eight eyelids of 52 patients (46 unilateral, 6 bilateral; 27 men, 25 women; age, mean 67±10; range 50,85) underwent surgical repair. Immediate resolution of entropion and associated ocular symptoms was achieved in 55 eyelids (94.9%). One case had postoperative ectropion that completely resolved spontaneously after 4 weeks, and one had wound dehiscence that healed completely without any intervention. Another patient had residual entropion that resolved after an additional surgical repair. No other cases of recurrence were noted during a mean follow-up period of 16 months (range 6,24 months). CONCLUSION This minimally invasive single-stitch lateral wedge technique is a simple and effective procedure for repairing involutional lower eyelid entropion and is associated with low recurrence and complication rates. Igal Leibovitch, MD, has indicated no significant interest with commercial supporters. [source] Trigeminal Trophic Syndrome,Report of Four Cases and Review of the LiteratureDERMATOLOGIC SURGERY, Issue 5 2004Parrish Sadeghi MD Background. Trigeminal trophic syndrome is a unilateral, frequently crescent-shaped neurotrophic ulceration of the face occurring after injury to the trigeminal nerve. The appearance of the ulcers resembles other disease entities such as granulomatous disease, neoplasm, vasculitis, infection, and factitial dermatitis. Objectives. The objectives of this study are to increase awareness of this disorder and to emphasize the importance of eliciting a thorough neurologic history when evaluating facial ulcerations. Methods. Four cases are reported and, using MEDLINE, the English and non-English literature from 1982 to 2002 is reviewed. Results. Including this report, there have been 60 cases of trigeminal trophic syndrome reported from 1982 to 2002. The age at presentation ranged from 14 months to 93 years. Time of onset from injury to the trigeminal ganglion or its branches and the development of the ulcers ranged from 2 weeks to 30 years. One-third of the patients had undergone trigeminal nerve ablation for the treatment of trigeminal neuralgia and another third had a history of stroke. Other causes included craniotomy, head trauma, herpes infection. Conclusion. The majority of cases of trigeminal trophic syndrome are associated with a history of stroke or trigeminal nerve ablation. Successful surgical outcome can be achieved if the underlying neurologic pathology is addressed before the reconstructive procedure. [source] Surgical treatment of esophageal leiomyoma located near or at the esophagogastric junction via a thoracoscopic approachDISEASES OF THE ESOPHAGUS, Issue 2 2009Z. G. Li SUMMARY Esophageal leiomyoma can be enucleated safely and effectively by minimally invasive surgery. The laparoscopic approach has been a conventional option for this kind of tumor located near or at the esophagogastric (EG) junction. The aims of this study were to evaluate the surgical outcome of thoracoscopic resection of leiomyoma at the EG junction, and discuss factors affecting the incidence of postoperative gastroesophageal reflux. Fourteen patients who underwent thoracoscopic resection of esophageal leiomyoma located near or at the EG junction (<4 cm above the esophageal hiatus) from January 2002 to August 2007 were reviewed retrospectively. Tumor characteristics, surgical methods, and postoperative outcomes were evaluated. A left approach of video-assisted thoracoscopy was used in 13 patients; a right approach was used for the other patient, whose multiple tumors were located in the EG junction and mid-esophagus. Postoperative recovery was uneventful in all patients, with no mucosa leakage or other significant complications. Mean tumor size was 3.2 cm (1.2,6.0 cm). Of the 14 patients, two had serpiginous leiomyoma, two had multiple tumors, and the others had solitary tumors. Mean postoperative stay in hospital was 7 days (4,11 days). Postoperative dysphagia was not reported, although gastroesophageal reflux was noted in one patient. Thoracoscopic resection of esophageal leiomyomas near or at the EG junction is feasible, with a low prevalence of postoperative gastroesophageal reflux. [source] Intraoperative Transesophageal Echocardiography in Valve Replacement SurgeryECHOCARDIOGRAPHY, Issue 8 2002Raphael Rosenhek M.D. Transesophageal echocardiography (TEE) is applied widely during heart valve replacement surgery. Intraoperative TEE (IOTEE) is used to formulate the surgical plan, assess cardiac function, and evaluate surgical outcome. This review describes the methodology of IOTEE, focusing on its role in valve replacement surgery. Specific aspects, such as its role in surgical decision making, selection of the prosthetic model and size, detection and quantification of paravalvular leaks, outflow tract obstruction, and acute prosthetic valve obstruction, are discussed. Furthermore, a description of the value of IOTEE in newer procedures, such as port access surgery, is presented. [source] Reliability of patterns of hippocampal sclerosis as predictors of postsurgical outcomeEPILEPSIA, Issue 9 2010Maria Thom Summary Purpose:, Around one-third of patients undergoing temporal lobe surgery for the treatment of intractable temporal lobe epilepsy with hippocampal sclerosis (HS) fail to become seizure-free. Identifying reliable predictors of poor surgical outcome would be helpful in management. Atypical patterns of HS may be associated with poorer outcomes. Our aim was to identify atypical HS cases from a large surgical series and to correlate pathology with clinical and outcome data. Methods:, Quantitative neuropathologic evaluation on 165 hippocampal surgical specimens and 21 control hippocampi was carried out on NeuN-stained sections. Neuronal densities (NDs) were measured in CA4, CA3, CA2, and CA1 subfields. The severity of granule cell dispersion (GCD) was assessed. Results:, Comparison with control ND values identified the following patterns based on the severity and distribution of neuronal loss: classical HS (CHS; n = 60) and total HS (THS; n = 39). Atypical patterns were present in 30% of cases, including end-folium sclerosis (EFS; n = 5), CA1 predominant pattern (CA1p; n = 9), and indeterminate HS (IHS, n = 35). No HS was noted in 17 cases. Poorest outcomes were noted for no-HS, and CA1p groups with 33,44% International League Against Epilepsy (ILAE) class I at up to 2 years follow-up compared to 69% for CHS (p < 0.05). GCD associated with HS type (p < 0.01), but not with outcome. Conclusions:, These findings support the identification and delineation of atypical patterns of HS using quantitative methods. Atypical patterns may represent distinct clinicopathologic subtypes and may have predictive value following epilepsy surgery. [source] Epilepsy with dual pathology: Surgical treatment of cortical dysplasia accompanied by hippocampal sclerosisEPILEPSIA, Issue 8 2010Dong W. Kim Summary Purpose:, The presence of two or more epileptogenic pathologies in patients with epilepsy is often observed, and the coexistence of focal cortical dysplasia (FCD) with hippocampal sclerosis (HS) is one of the most frequent clinical presentations. Although surgical resection has been an important treatment for patients with refractory epilepsy associated with FCD, there are few studies on the surgical treatment of FCD accompanied by HS, and treatment by resection of both neocortical dysplastic tissue and hippocampus is still controversial. Methods:, We retrospectively recruited epilepsy patients who had undergone surgical treatment for refractory epilepsy with the pathologic diagnosis of FCD and the radiologic evidence of HS. We evaluated the prognostic roles of clinical factors, various diagnostic modalities, surgical procedures, and the severity of pathology. Results:, A total of 40 patients were included, and only 35.0% of patients became seizure free. Complete resection of the epileptogenic area (p = 0.02), and the presence of dysmorphic neurons or balloon cells on histopathology (p = 0.01) were associated with favorable surgical outcomes. Patients who underwent hippocampal resection were more likely to have a favorable surgical outcome (p = 0.02). Conclusions:, We show that patients with complete resection of epileptogenic area, the presence of dysmorphic neurons or balloon cells on histopathology, or resection of hippocampus have a higher chance of a favorable surgical outcome. We believe that this observation is useful in planning of surgical procedures and predicting the prognoses of individual patients with FCD patients accompanied by HS. [source] Dense array EEG: Methodology and new hypothesis on epilepsy syndromesEPILEPSIA, Issue 2008Mark D. Holmes Summary Dense array EEG is a method of recording electroencephalography (EEG) with many more electrodes (up to 256) than is utilized with standard techniques that typically employ 19,21 scalp electrodes. The rationale for this approach is to enhance the spatial resolution of scalp EEG. In our research, dense array EEG is used in conjunction with a realistic model of head tissue conductivity and methods of electrographic source analysis to determine cerebral cortical localization of epileptiform discharges. In studies of patients with absence seizures, only localized cortical regions are involved during the attack. Typically, absences are accompanied by "wave,spike" complexes that show, both at the beginning and throughout the ictus, repetitive cycles of stereotyped, localized involvement of mainly mesial and orbital frontal cortex. Dense array EEG can also be used for long-term EEG video monitoring (LTM). We have used dense array EEG LTM to capture seizures in over 40 patients with medically refractory localization-related epilepsy, including both temporal and extra temporal cases, where standard LTM failed to reveal reliable ictal localization. One research goal is to test the validity of dense array LTM findings by comparison with invasive LTM and surgical outcome. Collection of a prospective series of surgical candidates who undergo both procedures is currently underway. Analysis of subjects with either generalized or localization-related seizures suggest that all seizures, including those traditionally classified as "generalized," propagate through discrete cortical networks. Furthermore, based on initial review of propagation patterns, we hypothesize that all epileptic seizures may be fundamentally corticothalamic or corticolimbic in nature. Dense array EEG may prove useful in noninvasive ictal localization, when standard methods fail. Future research will determine if the method will reduce the need for invasive EEG recordings, or assist in the appropriate placement of novel treatment devices. [source] Seizure Outcome after Resection of Supratentorial Cavernous Malformations: A Study of 168 PatientsEPILEPSIA, Issue 3 2007Christian R. Baumann Summary:,Purpose: The optimal management of cerebral cavernous malformations (CCMs) with epileptic seizures is still a matter of debate. The aim of our study was to examine seizure outcome in the largest published series of surgically treated patients with epilepsy due to a supratentorial CCM, and to define predictors for good surgical outcome. Methods: We retrospectively studied 168 consecutive patients with a single supratentorial CCM and symptomatic epilepsy in a multicenter study. Pre- and postoperative clinical examinations, age at epilepsy onset, age at operation, type of symptoms due to the CCM (seizures, headache, hemorrhage, focal deficits), type and frequency of epileptic seizures, and the localization and size of the CCM were assessed. Seizure outcome was determined in the first, second, and third postoperative years. Results: The CCM was completely resected in all patients. More than two thirds of the patients were classified as seizure free in the first 3 postoperative years. Predictors for good seizure outcome were age older than 30 years at the time of surgery, mesiotemporal CCM localization, CCM size <1.5 cm, and the absence of secondarily generalized seizures. No mortality occurred in our series, but only mild postoperative neurologic deficits in 12 (7%) patients. Conclusions: Considering the natural history of CCMs, the favorable neurologic and seizure outcome, surgical resection of CCMs should be considered in all patients with supratentorial CCMs and concomitant epilepsy, irrespective of the presence or absence of predictors for a favorable seizure outcome. [source] Prognostic Factors for the Surgery for Mesial Temporal Lobe Epilepsy: Longitudinal AnalysisEPILEPSIA, Issue 8 2005Sang-Wuk Jeong Summary:,Purpose: Determining long-term prognostic factors of surgery for mesial temporal lobe epilepsy (MTLE) is important for identifying ideal candidates and predicting the prognosis for individual patients. We tried to identify the prognostic factors of anterior temporal lobectomy (ATL) for MTLE with longitudinal multivariate analysis. Methods: Two hundred twenty-seven patients with MTLE were included in this study. The primary outcome variable was patient status 1,5 years after surgery: seizure free, or not. Clinical characteristics and recent diagnostic modalities were considered as prognostic factors. Univariate and standard multiple logistic-regression analysis for outcome at 1 and 5 years after surgery and the generalized estimation equation (GEE) model for longitudinal multiple logistic regression of the 5-year follow-up period were used. Results: The seizure-free rate at 1 year was 81.1% and decreased to 75.2% at 5 years after surgery. By the univariate or standard multiple logistic-regression analysis, age at surgery or hippocampal sclerosis on magnetic resonance imaging (MRI) ipsilateral to surgery was significant for the postsurgical outcome. However, the longitudinal analysis by the GEE model revealed that younger age at surgery [odds ratio (OR), 0.59; 95% confidence interval (CI), 0.43,0.81], absence of secondarily generalized tonic,clonic seizure (2°GTCS; OR, 0.45; 95% CI, 0.26,0.79), and hippocampal sclerosis on MRI (OR, 2.44; 95% CI, 1.11,5.26) were significant predictors of a good surgical outcome. Conclusions: Age at surgery, presence of 2°GTCS, and hippocampal sclerosis on MRI are independent prognostic factors for ATL in MTLE. These findings suggest that MTLE is a progressive disorder, and surgical outcome is better when early ATL is performed. [source] High-resolution MRI Enhances Identification of Lesions Amenable to Surgical Therapy in Children with Intractable EpilepsyEPILEPSIA, Issue 8 2004Monisha Goyal Summary:,Purpose: Many children with refractory epilepsy can achieve better seizure control with surgical therapy. An abnormality on magnetic resonance imaging (MRI), along with corroborating localization by other modalities, markedly increases chances of successful surgical outcome. We studied the impact of high-resolution MRI on the surgical outcome of intractable epilepsy. Methods: High-resolution MRI using four-coil phased surface array was obtained as part of the comprehensive presurgical protocol for children with focal onset intractable seizures evaluated by our epilepsy center during the first half of 2002. Results: Thirteen consecutive children, ages 5 to 18 years, entered this prospective study. For four patients with a lesion on a recent MRI examination with a standard head coil, management did not change with high-resolution MRI. Standard MRI in the other nine patients did not identify a lesion. However, high-resolution MRI with the phased-array surface coil found previously undiagnosed focal abnormalities in five of nine patients. These abnormalities included hippocampal dysplasia, hippocampal atrophy, and dual pathology with frontal cortical dysplasia. In four of nine patients, no identifiable lesion was identified on the high-resolution MRI. All patients underwent invasive monitoring. In three of five patients, newly diagnosed lesions correlated with EEG abnormalities, and resection was performed. Conclusions: In our center, high-resolution MRI identified lesions not detected by standard MRI in more than half the children (56%). Technical advances such as four-coil phased surface array MRI can help identify and better delineate lesions, improving the diagnosis of patients who are candidates for surgical treatment of refractory epilepsy. [source] Parietal Lobe Epilepsy: The Semiology, Yield of Diagnostic Workup, and Surgical OutcomeEPILEPSIA, Issue 6 2004Dong Wook Kim Summary: Purpose: To characterize the clinical features, the prognostic value, and diagnostic sensitivities of various presurgical evaluations and the surgical outcomes in parietal lobe epilepsy (PLE), we describe 40 patients who were diagnosed as having PLE, including 27 surgically treated patients. Methods: The diagnosis was established by means of a standard presurgical evaluation, including magnetic resonance imaging (MRI), fluorodeoxyglucose,positron emission tomography (FDG-PET), ictal single-photon emission tomography (SPECT), and scalp video-electroencephalography (EEG) monitoring, with additional intracranial EEG monitoring in selected cases. Results: Among the 40 patients, 27 experienced at least one type of aura. The most common auras were somatosensory (13 patients), followed by affective, vertiginous, and visual auras. The patients had diverse manifestations. Eighteen patients showed simple motor seizure, followed by automotor seizure, and dialeptic seizure. Two patients manifested generalized tonic,clonic seizures only, and 19 patients experienced more than one type of seizure. The surgical outcome was favorable in 22 of 26 patients including 14 who were seizure free. Patients with localized MRI abnormality had a higher probability to be seizure free, with marginal significance (p = 0.062), whereas other diagnostic modalities failed to predict the surgical outcome. In the seizure-free group, localization sensitivity was 64.3% by MRI, 50% by PET, 45.5% by ictal SPECT, and 35.7% by ictal EEG. The concordance rate of the various diagnostic modalities was higher in the seizure-free group than in the non,seizure-free group, although it did not reach statistical significance. Conclusions: Seizures, in the case of PLE, can manifest themselves in a wider variety of ways than was previously thought. Surgical outcome was favorable in most of the patients. MRI abnormality and concordance of different diagnostic modalities were associated with high seizure-free rate. [source] Lateralising Value of Neuropsychological Protocols for Presurgical Assessment of Temporal Lobe EpilepsyEPILEPSIA, Issue 3 2003Nozomi Akanuma Summary: ,Purpose: To estimate the value of neuropsychological measurements in determining the side of seizure onset for presurgical assessment in patients with temporal lobe epilepsy. The lateralising value of neuropsychological protocols was evaluated for all patients and in subpopulations depending on surgical outcome with regard to seizure control, speech dominance, neuropathology, and need for intracranial EEG recordings. Methods: A battery of neuropsychological procedures was carried out preoperatively in 125 patients who underwent left (n = 66) or right (n = 59) temporal lobectomies. Binary logistic regression analysis was performed to find sets of variables that allowed the best prediction of the side of seizure onset (assumed to be the operated-on side). Results: Combinations of noninvasive neuropsychological tests and Wada subscores showed the highest lateralising values: 80.8% for all patients, 79.4% in seizure-free patients, 86.0% in patients not rendered seizure free, 85.7% in left speech patients, 77.8% in non,left speech patients, 89.3% in patients with mesial temporal sclerosis (MTS), 78.1% in non-MTS patients, 80.3% in patients who underwent intracranial EEG recordings, and 77.3% in those who did not. Conclusions: The lateralising value (80-90%) of neuropsychological protocols appears similar to that of other tests widely accepted for lateralisation (ictal and interictal scalp EEG and neuroimaging). Attention should be paid to neuropsychological results, particularly from the Wada test, during presurgical assessment of temporal lobe epilepsy, as they can provide strong support for findings from other lateralising tests, particularly in patients with presumed MTS or in left-speech patients. [source] FDG-PET Images Quantified by Probabilistic Atlas of Brain and Surgical Prognosis of Temporal Lobe EpilepsyEPILEPSIA, Issue 9 2002Sang Kun Lee Summary: ,Purpose: This study evaluated the relation between hypometabolism, diagnosed by fluorodeoxyglucose positron emission tomography (FDG-PET), and the surgical outcome of a large and homogeneous series of cases of mesial temporal lobe epilepsy (mTLE), by using a probabilistic atlas of the human brain (statistical probabilistic anatomical maps: SPAM). Methods: Ninety-five surgically proven intractable mTLE patients and 22 age-matched controls were spatially normalized to the average brain PET template of international consortium of brain mapping (ICBM). The diagnosis of mTLE was confirmed by the presence of hippocampal sclerosis on magnetic resonance imaging (MRI) and video-EEG monitoring. Counts from normalized PET images were multiplied by the probability from 98 volumes of interest (VOIs) of SPAM. Asymmetric indexes (AIs) reflecting the severity of hypometabolism were calculated by counts of selected 12 VOIs from SPAM images in both temporal lobes. Extent of hypometabolism was determined by the number of voxels showing decreased metabolism in each VOI segmented by SPAM. Results: Of the 95 patients studied, 76 (80%) were seizure free, and 19 (20%) had postoperative seizures for the ,2-year follow-up period. No significant association between the severity of hypometabolism in each VOI of the temporal lobe and surgical outcome was identified (p > 0.05). The number of voxels showing decreased hypometabolism was not significantly different between the good- and poor-outcome groups (p > 0.05). Conclusions: Our results demonstrated that focal severity and extent of hypometabolism quantified by a probabilistic atlas of brain were not related to the surgical outcome in mTLE patients who had hippocampal sclerosis on MRI. We should develop a more localized and specified anatomic map for mTLE for further results. [source] | |||||||||||||||||||||||||||||||