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1.
Endoscopy ; 56(1): 14-21, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37769690

RESUMO

BACKGROUND: Cold snare defect protrusions (CSDPs) that occur after cold snare polypectomy (CSP) are considered indicators of incomplete polyp resection (IPR). We have sometimes experienced difficulty resecting polyps with snaring alone; in such cases, a forcible pull on the snare by the endoscopist is necessary. We call this procedure "forced CSP (FCSP)." However, no previous studies have evaluated this procedure. METHODS: This was a prospective observational study. From November 2020 to June 2021, the frequency, safety, and validity of FCSP were evaluated at our hospital. We distinguished CSP with snaring alone performed by the assistant as conventional CSP, and CSP requiring a forcible pull on the snare by the endoscopist as FCSP. RESULTS: Of 1315 polyps removed, 105 underwent FCSP (8%). The perforation rate was 0% in both groups. The rate of CSDP after the procedure was 96.2% (101/105) with FCSP and 6.4% (77/1210) with conventional CSP (P<0.001). The rate of IPR was 12.5% (13/104) with FCSP and 6.2% (75/1208) with conventional CSP (P=0.02). Multivariable analysis identified polyps located in the cecum (risk ratio [RR], 1.13; 95%CI 1.050-1.179; P=0.003) and polyps ≥6mm in diameter (RR, 2.37; 95%CI 2.146-2.542; P<0.001) as independent risk factors for FCSP. CONCLUSIONS: FCSP was performed on 105 polyps (8%) in this study. FCSP may be associated with the occurrence of CSDP and IPR. Further studies are necessary to confirm our results.


Assuntos
Pólipos do Colo , Humanos , Pólipos do Colo/cirurgia , Colonoscopia/efeitos adversos , Colonoscopia/métodos , Microcirurgia , Estudos Prospectivos , Fatores de Risco
2.
Endoscopy ; 56(2): 102-107, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37816393

RESUMO

BACKGROUND: Cold forceps and snares are each effective for removing polyps of 1-3 mm, while snares are more effective for polyps of 4-10 mm in size. If, in the same patient, polyps of 1-3 mm are removed with forceps and those of 4-10 mm with snares, two devices are used. If cold snares are used to resect all lesions of 1-10 mm (one-device colonoscopy), there is a potential for lower costs and less plastic waste. METHODS: A single high detecting colonoscopist prospectively measured the feasibility of cold snaring all colorectal lesions of ≤10 mm in size, along with the associated costs and plastic waste reduction. RESULTS: 677 consecutive lower gastrointestinal endoscopies (not for inflammatory bowel disease) were assessed. Of 1430 lesions of 1-3 mm and 1685 lesions of 4-10 mm in size, 1428 (99.9%, 95%CI 99.5%-100%) and 1674 (99.3%, 95%CI 98.8%-99.7%), respectively, were successfully resected using cold snaring. Among 379 screening and surveillance patients, universal cold snaring of lesions ≤10 mm saved 35 and 47 cold forceps per 100 screening and surveillance patients, respectively. CONCLUSION: Cold snare resection of all lesions ≤10 mm (one-device colonoscopy) was feasible, and reduced costs and plastic waste.


Assuntos
Pólipos do Colo , Neoplasias Colorretais , Humanos , Pólipos do Colo/cirurgia , Colonoscopia/métodos , Redução de Custos , Estudos de Viabilidade , Microcirurgia , Neoplasias Colorretais/cirurgia
3.
J Neurooncol ; 169(2): 299-308, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38951458

RESUMO

PURPOSE: It has been shown that in large vestibular schwannomas (VS), radiosurgery (SRS) is inferior with respect to tumor control compared to microsurgical resection (SURGERY). However, SURGERY poses a significantly higher risk of facial-function deterioration (FFD). The aim of this study was to illustrate the effectiveness in terms of number-needed-to-treat/operate (NNO), number-needed-to-harm (NNH), and likelihood-of-harm/help (LHH) by comparing both treatment modalities in large VS. METHODS: This was a retrospective, dual-center cohort study. Tumor size was classified by Hannover Classification. Absolute risk reduction and risk increase were used to derive additional estimates of treatment effectiveness, namely NNO and NNH. LHH was then calculated by a quotient of NNH/NNO to illustrate the risk-benefit-ratio of SURGERY. RESULTS: Four hundred and forty-nine patients treated met the inclusion criteria. The incidence of tumor recurrence was significantly higher in SRS (14%), compared to SURGERY (3%) resulting in ARR of 11% and NNO of 10. At the same time, SURGERY was related to a significant risk of FFD resulting in an NNH of 12. Overall, the LHH calculated at 1.20 was favored SURGERY, especially in patients under the age of 40 years (LHH = 2.40), cystic VS (LHH = 4.33), and Hannover T3a (LHH = 1.83) and T3b (LHH = 1.80). CONCLUSIONS: Due to a poorer response of large VS to SRS, SURGERY is superior with respect to tumor control. One tumor recurrence can be prevented, when 10 patients are treated by SURGERY instead of SRS. Thus, LHH portrays the benefit of SURGERY in large VS even when taking raised FFD into account.


Assuntos
Microcirurgia , Neuroma Acústico , Radiocirurgia , Humanos , Radiocirurgia/métodos , Radiocirurgia/efeitos adversos , Neuroma Acústico/cirurgia , Neuroma Acústico/radioterapia , Neuroma Acústico/patologia , Microcirurgia/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , Adulto , Resultado do Tratamento , Adulto Jovem , Recidiva Local de Neoplasia/patologia , Seguimentos , Idoso de 80 Anos ou mais
4.
J Neurooncol ; 169(2): 379-390, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38829577

RESUMO

BACKGROUND: Advancements in metastatic breast cancer (BC) treatment have enhanced overall survival (OS), leading to increased rates of brain metastases (BM). This study analyzes the association between microsurgical tumor reduction and OS in patients with BCBM, considering tumor molecular subtypes and perioperative treatment approaches. METHODS: Retrospective analysis of surgically treated patients with BCBM from two tertiary brain tumor Swiss centers. The association of extent of resection (EOR), gross-total resection (GTR) achievement, and postoperative residual tumor volume (RV) with OS and intracranial progression-free survival (IC-PFS) was evaluated using Cox proportional hazard model. RESULTS: 101 patients were included in the final analysis, most patients (38%) exhibited HER2-/HR + BC molecular subtype, followed by HER2 + /HR + (25%), HER2-/HR- (21%), and HER2 + /HR- subtypes (13%). The majority received postoperative systemic treatment (75%) and radiotherapy (84%). Median OS and intracranial PFS were 22 and 8 months, respectively. The mean pre-surgery intracranial tumor volume was 26 cm3, reduced to 3 cm3 post-surgery. EOR, GTR achievement and RV were not significantly associated with OS or IC-PFS, but higher EOR and lower RV correlated with extended OS in patients without extracranial metastases. HER2-positive tumor status was associated with longer OS, extracranial metastases at BM diagnosis and symptomatic lesions with shorter OS and IC-PFS. CONCLUSIONS: Our study found that BC molecular subtypes, extracranial disease status, and BM-related symptoms were associated with OS in surgically treated patients with BCBM. Additionally, while extensive resection to minimize residual tumor volume did not significantly affect OS across the entire cohort, it appeared beneficial for patients without extracranial metastases.


Assuntos
Neoplasias Encefálicas , Neoplasias da Mama , Microcirurgia , Carga Tumoral , Humanos , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/metabolismo , Feminino , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Neoplasias da Mama/metabolismo , Neoplasias da Mama/mortalidade , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , Adulto , Receptor ErbB-2/metabolismo , Taxa de Sobrevida , Seguimentos , Prognóstico , Análise de Sobrevida
5.
Eur J Clin Microbiol Infect Dis ; 43(10): 1969-1976, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39093526

RESUMO

PURPOSE: Infectious spondylitis is caused by hematogenous seeding or adjacent soft tissue infection. No study has provided evidence that incubating biopsy specimens in blood culture bottles could enhance detection rates, nor has any study compared this method with conventional culture techniques. We aimed to assess the diagnostic yield of open microsurgical biopsies for infectious spondylitis and the efficacy of various culture media in the presence and absence of pre-biopsy antibiotic therapy. METHODS: This retrospective study, which was conducted at a university-affiliated teaching hospital in Korea, enrolled 165 adult patients with suspected infectious spondylitis between February 2014 and September 2020. The diagnostic yield of open biopsy was compared among three culture media, namely, blood culture bottles, swab culture using transport media, and tissue culture using plain tubes, while considering preoperative antibiotic exposure. RESULTS: Causative bacteria were identified in 84.2% of all cases. Blood culture bottles had the highest positivity rate (83.5%), followed by swab cultures (64.4%) and tissue cultures (44.9%). The differences in positivity rates were significant (P < 0.001). Preoperative antibiotic therapy reduced detection rates across all media, particularly in tissue cultures. CONCLUSIONS: We established the high diagnostic yield of open microsurgical biopsy using blood culture bottles, suggesting that pre-biopsy antibiotic therapy significantly affects bacterial detection, thereby underscoring the importance of culture medium selection in the diagnosis of infectious spondylitis.


Assuntos
Hemocultura , Salas Cirúrgicas , Espondilite , Humanos , Estudos Retrospectivos , Feminino , Masculino , Pessoa de Meia-Idade , Biópsia , Espondilite/diagnóstico , Espondilite/microbiologia , Hemocultura/métodos , Idoso , Adulto , Microcirurgia/métodos , Bactérias/isolamento & purificação , Bactérias/classificação , Meios de Cultura , República da Coreia , Antibacterianos/uso terapêutico , Antibacterianos/farmacologia , Idoso de 80 Anos ou mais
6.
BMC Neurol ; 24(1): 170, 2024 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-38783204

RESUMO

PURPOSE: QT interval prolongation is one of the most common electrocardiographic (ECG) abnormalities in patients with aneurysmal subarachnoid hemorrhage (aSAH). Whether corrected QT interval (QTc) prolongation is associated with perioperative cardiac events and dismal neurological outcome in mid to long-term follow-up in patients after aSAH is insufficiently studied and remains controversial. METHODS: We retrospectively studied the adult (≥ 18 years) patients admitted to our institution between Jan 2018 and Dec 2020 for aSAH who underwent intracranial aneurysm clipping or embolization. The patients were divided into 2 groups (normal and QTc prolongation groups) according to their QTc. To minimize the confounding bias, a propensity score matching (PSM) analysis was performed to compare the neurologic outcomes between patients with normal QTc and QTc prolongation. RESULTS: After screening, 908 patients were finally included. The patients were divided into 2 groups: normal QTc groups (n = 714) and long QTc group (n = 194). Female sex, hypokalemia, posterior circulation aneurysm, and higher Hunt-Hess grade were associated with QTc prolongation. In multiple regression analysis, older age, higher hemoglobin level, posterior circulation aneurysm, and higher Hunt-Hess grade were identified to be associated with worse outcome during 1-year follow-up. Before PSM, patients with QTc prolongation had higher rate of perioperative cardiac arrest or ventricular arrhythmias. After PSM, there was no statistical difference between normal and QTc prolongation groups in perioperative cardiac events. However, patients in the QTc prolongation group still had worse neurologic outcome during 1-year follow-up. CONCLUSIONS: QTc prolongation is associated with worse outcome in patients following SAH, which is independent of perioperative cardiac events.


Assuntos
Embolização Terapêutica , Aneurisma Intracraniano , Síndrome do QT Longo , Hemorragia Subaracnóidea , Humanos , Masculino , Feminino , Estudos Retrospectivos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/cirurgia , Pessoa de Meia-Idade , Aneurisma Intracraniano/cirurgia , Aneurisma Intracraniano/complicações , Síndrome do QT Longo/etiologia , Embolização Terapêutica/métodos , Embolização Terapêutica/efeitos adversos , Adulto , Idoso , Microcirurgia/métodos , Microcirurgia/efeitos adversos , Resultado do Tratamento , Eletrocardiografia/métodos
7.
Curr Opin Ophthalmol ; 35(6): 526-532, 2024 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-39145488

RESUMO

PURPOSE OF REVIEW: Technologies in healthcare incorporating artificial intelligence tools are experiencing rapid growth in static-image-based applications such as diagnostic imaging. Given the proliferation of artificial intelligence (AI)-technologies created for video-based imaging, ophthalmic microsurgery is likely to experience significant benefits from the application of emerging technologies to multiple facets of the care of the surgical patient. RECENT FINDINGS: Proof-of-concept research and early phase clinical trials are in progress for AI-based surgical technologies that aim to provide preoperative planning and decision support, intraoperative image enhancement, surgical guidance, surgical decision-making support, tactical assistive technologies, enhanced surgical training and assessment of trainee progress, and semi-autonomous tool control or autonomous elements of surgical procedures. SUMMARY: The proliferation of AI-based technologies in static imaging in clinical ophthalmology, continued refinement of AI tools designed for video-based applications, and development of AI-based digital tools in allied surgical fields suggest that ophthalmic surgery is poised for the integration of AI into our microsurgical paradigm.


Assuntos
Inteligência Artificial , Procedimentos Cirúrgicos Oftalmológicos , Humanos , Procedimentos Cirúrgicos Oftalmológicos/métodos , Cirurgia Assistida por Computador/métodos , Microcirurgia/métodos , Oftalmopatias/cirurgia , Oftalmologia/métodos
8.
Curr Opin Ophthalmol ; 35(4): 278-283, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38700941

RESUMO

PURPOSE OF REVIEW: Laser keratorefractive surgery achieves excellent visual outcomes for refractive error correction. With femtosecond laser, small incision lenticule extraction (SMILE) is an increasingly viable alternative to laser-assisted in situ keratomileusis (LASIK). Comparative studies demonstrate similar efficacy and predictability between SMILE and LASIK, making it difficult for clinicians to choose which to use. This review thus compares femtosecond-LASIK (FS-LASK) and SMILE in various scenarios, to assist clinicians in deciding which refractive surgery procedure to recommend. RECENT FINDINGS: SMILE may be superior for highly myopic eyes due to a smaller decrease in functional optical zone. SMILE further induces less spherical aberration and less overall higher order aberrations in mesopic conditions. SMIILE also has less postoperative dry eye, making it suitable those with preexisting dry eye. For low to moderate myopic astigmatism correction, FS-LASIK has less undercorrection compared to SMILE. Lastly, SMILE has not yet received Food and Drug Administration or Conformité Européenne approval for hyperopic correction, rendering FS-LASIK the choice of procedure for hyperopic correction. SUMMARY: Both FS-LASIK and SMILE demonstrate good efficacy and predictability. Understanding specific clinical scenarios where one may be superior to the other will aid clinicians in choosing the most suitable procedure for personalized care.


Assuntos
Substância Própria , Ceratomileuse Assistida por Excimer Laser In Situ , Lasers de Excimer , Miopia , Acuidade Visual , Humanos , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Substância Própria/cirurgia , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Miopia/fisiopatologia , Refração Ocular/fisiologia , Astigmatismo/cirurgia , Astigmatismo/fisiopatologia , Cirurgia da Córnea a Laser/métodos , Microcirurgia/métodos
9.
Neurol Sci ; 45(5): 2311-2319, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38151626

RESUMO

INTRODUCTION: Meningiomas are usually slow-growing tumours, constituting about one third of all primary intracranial tumours. They occur more frequently in women. Clinical manifestation of meningiomas depends on their location, tumour size and growth rate. In most cases, surgical treatment is the procedure of choice. The success of this treatment is, however, associated with the radicality of the resection. Radiotherapy represents an additional or alternative treatment modality. Gamma knife surgery is another notable treatment method, especially in small and/or slow-growing tumours in eloquent areas or in elderly patients. MATERIAL AND METHODS: Authors describe their experience with the diagnosis, treatment and outcome of the patients with meningioma (n = 857). Furthermore, they also assess the postoperative morbidity/mortality and recurrence rate. RESULTS AND CONCLUSIONS: In view of the benign histology of meningiomas, the success of the treatment largely depends (besides the tumour grading) on the radicality of the resection. The emphasis is also put on appropriate follow-up of the patients. In certain patients, the watch and wait strategy should be also considered as a suitable treatment method.


Assuntos
Neoplasias Meníngeas , Meningioma , Humanos , Feminino , Idoso , Meningioma/cirurgia , Meningioma/patologia , Neoplasias Meníngeas/cirurgia , Recidiva Local de Neoplasia/cirurgia , Microcirurgia , Resultado do Tratamento , Estudos Retrospectivos , Procedimentos Neurocirúrgicos/métodos
10.
BMC Ophthalmol ; 24(1): 45, 2024 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-38287289

RESUMO

BACKGROUND: To evaluate the possible topographic and surgical risk factors for high postoperative residual astigmatism in patients who undergo small-incision lenticule extraction (SMILE) surgery and have different myopia degrees. METHODS: A retrospective cohort study was conducted, and patients who underwent SMILE surgery were enrolled. A total of 80 and 150 eyes from 40 to 75 individuals, respectively, were selected as the low myopia and high myopia groups. The demographic data, visual acuity, refraction, topographic parameters and surgical settings were recorded. Multiple linear regression with interaction tests were performed to survey the risk factors for high postoperative residual astigmatism in each group. RESULTS: Five (6.25%) and 9 (6.00%) eyes presented with high postoperative residual astigmatism in the low myopia and high myopia groups, respectively, but these differences were not significant (P = 0.569). A steep corneal curvature was correlated with a greater risk of high postoperative residual astigmatism in the low myopia group (P = 0.015), while a higher degree of cycloplegic cylinder power, steeper corneal curvature, greater topographic cylinder power, smaller optic zone and longer incision length were associated with a high rate of postoperative residual astigmatism in the high myopia group (all P < 0.05). In addition, the interaction effects of cycloplegic and topographic cylinder power and longer incision length on the incidence of high postoperative residual astigmatism development were more evident in the high myopia group than in the low myopia group (all P < 0.05). CONCLUSIONS: A steep corneal curvature correlates with a high risk of high postoperative residual astigmatism after SMILE surgery, and a higher degree of cycloplegic and topographic cylinder and longer incision are associated with high postoperative residual astigmatism in individuals with high myopia.


Assuntos
Astigmatismo , Cirurgia da Córnea a Laser , Miopia , Humanos , Astigmatismo/etiologia , Astigmatismo/cirurgia , Estudos Retrospectivos , Midriáticos , Topografia da Córnea , Microcirurgia , Refração Ocular , Miopia/cirurgia , Córnea/cirurgia , Substância Própria/cirurgia , Lasers de Excimer/uso terapêutico
11.
Adv Tech Stand Neurosurg ; 53: 27-49, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39287801

RESUMO

BACKGROUND: Neurosurgery is a medical branch characterized by small and deep surgical field with the need of manipulation and dissection of anatomical structures. High light and magnification are required in order to avoid injuries to important anatomical structures and to avoid permanent neurological deficits. Introduction of operative microscope made a change of paradigm in neurosurgery allowing to better see what could not be seen with common light. Nowadays, introduction of several technologies have increased the safety and efficacy of neurosurgery. Among new technologies, the 3D exoscope is emerging pretending to shift the paradigm of microneurosurgery. In this work, we aim to show our first experience with the use of the exoscope showing advantages and disadvantages. MATERIALS AND METHODS: We reviewed our surgical database from the introduction of the exoscope in our department (in November 2020 temporarily; then from November 2021 definitively) searching for all the microsurgery interventions performed in the period. RESULTS: From the introduction of the exoscope in our department, we operated 244 cases with the OM and 228 with the exoscope. We operated 175 lesions located in the supratentorial compartment, 29 in the infratentorial, and 24 in the spinal column. Regarding the OM, the ratios were as follows: 122 females and 122 males; 235 adults and 9 children; 66 supratentorial lesions, 14 infratentorial lesions, and 164 spine surgeries. Our team showed a progressive switch from the microscope to the exoscope. Only one member of our team preferred to continue to use the standard operative microscope. CONCLUSIONS: Our experience showed no complications related to the use of the exoscope that proved to be safe and effective both for surgery and teaching.


Assuntos
Microcirurgia , Procedimentos Neurocirúrgicos , Humanos , Microcirurgia/métodos , Microcirurgia/instrumentação , Feminino , Masculino , Adulto , Criança , Procedimentos Neurocirúrgicos/métodos , Pessoa de Meia-Idade , Adolescente , Idoso , Adulto Jovem , Pré-Escolar
12.
Artigo em Inglês | MEDLINE | ID: mdl-39017782

RESUMO

This chapter is intended to provide a brief overview of the optics of surgical microscopes and rigid endoscopes, with the aim of providing the reader with the principles dictating the nature of surgical visualization when either of the visual control systems is used. It is not by any means geared toward elaborating on the detailed optical physics of these systems, which is beyond the scope and objective of this chapter.


Assuntos
Microscopia , Humanos , Microscopia/instrumentação , Microscopia/métodos , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos , Microcirurgia/instrumentação , Microcirurgia/métodos , Endoscópios , Neuroendoscópios
13.
Childs Nerv Syst ; 40(8): 2431-2442, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38662221

RESUMO

INTRODUCTION: Brain arteriovenous malformations (bAVMs) present complex challenges in neurosurgery, requiring precise pre-surgical planning. In this context, 3D printing technology has emerged as a promising tool to aid in understanding bAVM morphology and enhance surgical outcomes, particularly in pediatric patients. This study aims to assess the feasibility and effectiveness of using 3D AVM models in pediatric bAVM surgery. METHODOLOGY: The study was conducted at Great Ormond Street Hospital, and cases were selected sequentially between October 2021 and February 2023. Eight pediatric bAVM cases with 3D models were compared to eight cases treated before the introduction of 3D printing models. The 3D modelling fidelity and clinical outcomes were assessed and compared between the two cohorts. RESULTS: The study demonstrated excellent fidelity between 3D models and actual operative anatomy, with a median difference of only 0.31 mm. There was no statistically significant difference in angiographic cure rates or complications between the 3D model group and the non-3D model group. Surgical time showed a non-significant increase in cases involving 3D models. Furthermore, the 3D model cohort included higher-grade bAVMs, indicating increased surgical confidence. CONCLUSION: This study demonstrates the feasibility and efficacy of utilizing 3D AVM models in pediatric bAVM surgery. The high fidelity between the models and actual operative anatomy suggests that 3D modelling can enhance pre-surgical planning and intraoperative guidance without significantly increasing surgical times or complications. Further research with larger cohorts is warranted to confirm and refine the application of 3D modelling in clinical practice.


Assuntos
Malformações Arteriovenosas , Cuidados Intraoperatórios , Microcirurgia , Segurança do Paciente , Cuidados Pré-Operatórios , Impressão Tridimensional , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Malformações Arteriovenosas/classificação , Malformações Arteriovenosas/patologia , Malformações Arteriovenosas/cirurgia , Estudos de Coortes , Estudos de Viabilidade , Microcirurgia/métodos , Cuidados Pré-Operatórios/métodos , Reprodutibilidade dos Testes , Resultado do Tratamento , Cuidados Intraoperatórios/métodos
14.
Childs Nerv Syst ; 40(2): 371-379, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37695369

RESUMO

PURPOSE: Since its introduction in the 1950s, the microsurgical paradigm has revolutionized neurosurgery. New technologies have been introduced over the years trying to overcome limits of the classical operating microscope. The recently developed 3D exoscopes represent a potential new paradigm for micro-neurosurgery. We analyzed our own experience with a 4 K-3D exoscope in a series of pediatric brain tumors to verify its advantages and limitations in comparison to the operating microscope and in light of the literature. METHODS: Twenty-five pediatric patients with brain tumors underwent surgery at our Institute; the population has been analyzed and described. A score to evaluate the exoscopes and compare it to the operating microscope was considered and postoperatively applied to each single case. RESULTS: The exoscope appears to be at least comparable to the operating microscope (OM) in all analyzed aspects. In the case of deep-seated or fourth ventricle tumors, the exoscope seems to be superior to the microscope. A surgeon-dependent learning curve is necessary for neurosurgeons to be confident with the exoscope. CONCLUSION: Exoscopes appear to be as safe and effective as operating microscopes in pediatric neuro-oncological surgery. They have some advantages that make them superior to microscopes, particularly regarding surgeon ergonomics and fatigue, visual field qualities, and higher choice of intraoperative viewing angles.


Assuntos
Neoplasias Encefálicas , Neurocirurgia , Humanos , Criança , Microcirurgia , Procedimentos Neurocirúrgicos , Neoplasias Encefálicas/cirurgia , Imageamento Tridimensional
15.
Childs Nerv Syst ; 40(3): 635-645, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37889276

RESUMO

PURPOSE: To describe the characteristics, management, and outcomes of pediatric patients with sporadic vestibular schwannoma (sVS). METHODS: This was a case series at a tertiary care center. Patients were identified through a research repository and chart review. Interventions were microsurgery, stereotactic radiosurgery (SRS), and observation. Outcome measures were tumor control, facial nerve function, and hearing. RESULTS: Eight patients over 2006-2022 fulfilled inclusion criteria (unilateral VS without genetic or clinical evidence of neurofibromatosis type 2 (NF2); age ≤ 21) with a mean age of 17 years (14-20). Average greatest tumor length in the internal auditory canal was 9.7 mm (4.0-16.1). Average greatest tumor dimension (4/8 tumors) in the cerebellopontine angle was 19.1 mm (11.3-26.8). Primary treatment was microsurgery in five (62.5%) patients, observation in two (25%), and SRS in one (12.5%). Four (80%) surgical patients had gross total resections, and one (20%) had regrowth post-near total resection and underwent SRS. One observed patient and the primary SRS patient have remained radiographically stable for 3.5 and 7 years, respectively. The other observed patient required surgery for tumor growth after 12 months of observation. Two surgical patients had poor facial nerve outcomes. All post-procedural patients developed anacusis. Mean follow-up was 3 years (0.5-7). CONCLUSIONS: We describe one of the largest reported cohorts of pediatric sVS in the USA. Diligent exclusion of NF2 is critical. Given the high likelihood of eventually requiring intervention and known adverse effects of SRS, microsurgery remains the preferred treatment. However, observation can be considered in select situations.


Assuntos
Neurofibromatose 2 , Neuroma Acústico , Radiocirurgia , Humanos , Criança , Adolescente , Neuroma Acústico/cirurgia , Neuroma Acústico/patologia , Neurofibromatose 2/cirurgia , Nervo Facial/cirurgia , Audição , Microcirurgia/métodos , Radiocirurgia/métodos , Resultado do Tratamento , Estudos Retrospectivos , Seguimentos
16.
Childs Nerv Syst ; 40(3): 613-624, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37999790

RESUMO

Posterior fossa tumors are the most common pediatric brain tumors, and present unique challenges in terms of their location and surgical management. The posterior fossa comprehends complex anatomy and represents the smallest and deepest of the three cranial base fossae. An in-depth understanding of posterior fossa anatomy is crucial when it comes to the surgical resection of pediatric brain tumors. Mastering the knowledge of posterior fossa anatomy helps the neurosurgeon in achieving a maximal and safe volumetric resection, that impacts in both overall and progression free survival. With the advancements in microsurgery, the telovelar approach has emerged as the workhorse technique for the resection of posterior fossa tumors in pediatric patients. This approach involves meticulously dissecting of the natural clefts present in the cerebellomedullary fissure, making a comprehensive understanding of the underlying anatomy key for its success.


Assuntos
Neoplasias Encefálicas , Neoplasias do Ventrículo Cerebral , Neoplasias Infratentoriais , Humanos , Criança , Procedimentos Neurocirúrgicos/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Microcirurgia/métodos , Neoplasias do Ventrículo Cerebral/cirurgia , Neoplasias Infratentoriais/diagnóstico por imagem , Neoplasias Infratentoriais/cirurgia
17.
Neurosurg Rev ; 47(1): 200, 2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38722409

RESUMO

Appropriate needle manipulation to avoid abrupt deformation of fragile vessels is a critical determinant of the success of microvascular anastomosis. However, no study has yet evaluated the area changes in surgical objects using surgical videos. The present study therefore aimed to develop a deep learning-based semantic segmentation algorithm to assess the area change of vessels during microvascular anastomosis for objective surgical skill assessment with regard to the "respect for tissue." The semantic segmentation algorithm was trained based on a ResNet-50 network using microvascular end-to-side anastomosis training videos with artificial blood vessels. Using the created model, video parameters during a single stitch completion task, including the coefficient of variation of vessel area (CV-VA), relative change in vessel area per unit time (ΔVA), and the number of tissue deformation errors (TDE), as defined by a ΔVA threshold, were compared between expert and novice surgeons. A high validation accuracy (99.1%) and Intersection over Union (0.93) were obtained for the auto-segmentation model. During the single-stitch task, the expert surgeons displayed lower values of CV-VA (p < 0.05) and ΔVA (p < 0.05). Additionally, experts committed significantly fewer TDEs than novices (p < 0.05), and completed the task in a shorter time (p < 0.01). Receiver operating curve analyses indicated relatively strong discriminative capabilities for each video parameter and task completion time, while the combined use of the task completion time and video parameters demonstrated complete discriminative power between experts and novices. In conclusion, the assessment of changes in the vessel area during microvascular anastomosis using a deep learning-based semantic segmentation algorithm is presented as a novel concept for evaluating microsurgical performance. This will be useful in future computer-aided devices to enhance surgical education and patient safety.


Assuntos
Algoritmos , Anastomose Cirúrgica , Aprendizado Profundo , Humanos , Anastomose Cirúrgica/métodos , Projetos Piloto , Microcirurgia/métodos , Microcirurgia/educação , Agulhas , Competência Clínica , Semântica , Procedimentos Cirúrgicos Vasculares/métodos , Procedimentos Cirúrgicos Vasculares/educação
18.
Neurosurg Rev ; 47(1): 507, 2024 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-39207563

RESUMO

Superior petrosal sinus (SPS) dural arteriovenous fistulas (DAVFs) are a commonly encountered type of tentorial DAVF that occasionally requires microsurgical intervention. This study aims to analyze the tributaries of the superior petrosal vein (SPV) observed intraoperatively, their association with clinical symptoms, and venous drainage patterns. This retrospective study reviewed 34 consecutive patients with SPS DAVFs who underwent microsurgical treatment at a single institution between 2014 and 2022. The cohort had a mean age of 52.8 ± 11.8 years, with 85.3% (29/34) being male. Predominant symptoms included venous hypertensive myelopathy (VHM) (55.9%) and intraparenchymal or subarachnoid hemorrhage (23.5%). Standard retrosigmoid approach was used to ligate 94.1% (32/34) of the lesions, resulting in immediate complete fistula occlusion for all patients. Supratentorial venous drainage patterns were associated with a higher incidence of intracranial hemorrhage and venous varix (P = 0.047). Infratentorial drainage patterns were more frequently linked with VHM-related symptoms (P<0.001). Patients presenting VHM-related symptoms showed a higher prevalence of drainage through the vein of the cerebellopontine fissure (VCPF) (P = 0.01), while those with intracranial hemorrhage symptoms exhibited a higher prevalence of pontotrigeminal vein (PTV) drainage (P = 0.033) in their DAVFs. Endovascular management of SPS DAVFs carries inherent risks. Surgical treatment via standard retrosigmoid craniotomy offers favorable clinical outcomes with high rates of cure. In cases featuring infratentorial venous drainage, the predominant arterialized tributary of the SPV was the VCPF, commonly associated with VHM-related symptoms. Conversely, in cases with supratentorial venous drainage, the predominant arterialized SPV tributary was the PTV, often associated with intracranial hemorrhage symptoms.


Assuntos
Malformações Vasculares do Sistema Nervoso Central , Cavidades Cranianas , Microcirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Adulto , Microcirurgia/métodos , Idoso , Estudos Retrospectivos , Cavidades Cranianas/cirurgia , Procedimentos Neurocirúrgicos/métodos , Resultado do Tratamento
19.
Neurosurg Rev ; 47(1): 536, 2024 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-39230764

RESUMO

OBJECTIVE: To determine the collated rate of postoperative dysgeusia after microsurgical intervention in acoustic neuroma patients. METHODS: The systematic review with meta-analysis was undertaken following PRISMA guidelines. A thorough search of PubMed/Medline, the Cochrane Database of Systematic Reviews, and Epistemonikos was undertaken for studies published up until May 16, 2024 reporting postoperative taste disturbance rates after microsurgical intervention for acoustic neuroma. The methodological quality of the included studies was assessed via the Methodological Index for Non-Randomized research (MINORS) tool. Using MedCalc (v. 20.215) software, the random-effects model was developed for proportional meta-analysis. RESULTS: Eight studies, encompassing 2,402 patients (mean age = 49.06 years; 48.54% female population), were included in the analysis. The overall pooled rate of postoperative dysgeusia following microsurgical management of acoustic neuroma was 23.7% (95% CI: 9.266-42.359, p < 0.0001). When stratified by surgical approach, the rate of postoperative dysgeusia for the retrosigmoid approach was 18.8% (95% CI: 2.821-44.461, p < 0.0001). Postoperative dysgeusia data stratified for other major microsurgical approaches (subtemporal and translabirynthine approaches) was not reported by any of the included studies. CONCLUSION: Our systematic review and meta-analysis calculated a collated rate of almost 25% and recognized postoperative dysgeusia as a common complication following microsurgical management of acoustic neuromas. These results highlight the significance of preoperative counselling and the development of strategies that minimize the likelihood of harm to the chorda tympani nerve during microsurgical intervention for acoustic neuroma.


Assuntos
Disgeusia , Microcirurgia , Neuroma Acústico , Complicações Pós-Operatórias , Neuroma Acústico/cirurgia , Humanos , Disgeusia/etiologia , Microcirurgia/métodos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/efeitos adversos , Feminino
20.
Neurosurg Rev ; 47(1): 812, 2024 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-39441455

RESUMO

BACKGROUND: The management for craniocervical junction dural arteriovenous fistulas (CCJ-DAVFs) remains controversial and clinically challenging. We systemically summarized the clinical and angiographic outcomes of microsurgery, embolization, and conservative management. METHODS: Relevant articles were retrieved from PubMed, Scopus, Web of Science, and Cochrane, following PRISMA guidelines. A systematic review and meta-analysis were conducted on the clinical characteristics, management approaches, and clinical and angiographic outcomes. RESULTS: We included 13 articles (166 patients). The weighted mean age was 58.9 years (95%CI: 53.2-64.5), 58.8 years (95%CI: 48.4-69.2), and 63.8 years (95%CI: 60.1-67.5), in microsurgery, embolization, and conservative groups respectively, with an overall male sex predominance (microsurgery [n = 51/77, 66.2%], embolization [n = 44/56, 78.6%], and conservative management [n = 6/8, 75.0%]). Patients were managed with microsurgery (n = 80/172, 46.5%), embolization (n = 79/172, 45.9%), and conservative treatment (n = 13/172, 7.6%). Foramen magnum was the most common location (microsurgery [n = 34/77, 44.2%], embolization [n = 31/56, 55.4%], and conservative treatment [n = 3/8, 37.5%]). Vertebral artery was the primary feeder (microsurgery [n = 58/84, 69.1%], embolization [n = 41/86, 47.6%], and conservative treatment [n = 4/7, 57.1%]). Complete fistula obliteration rates were 74.1% (95%CI:52.3-88.2%) in the microsurgery group and 54.9% (95%CI:30.7-77.0%) in the embolization group. Complications rates were 16.2% (95%CI:6.7-34.5%) in the embolization group, 11.6% (95%CI:3.8-30.4%) in the microsurgery group, and 7.7% (95%CI:1.1-39.1%) in the conservative group. Different rates of good clinical outcomes were observed [microsurgery: 66.4% (95%CI:48.1-80.8%), embolization: 51.9% (95%CI:30.8-72.4%), and conservative: 11.6% (95%CI:4.4-27.4%)]. CONCLUSIONS: In patients with CCJ-DAVFs, each management approach has its own merits based on the fistula and patient characteristics.


Assuntos
Malformações Vasculares do Sistema Nervoso Central , Embolização Terapêutica , Microcirurgia , Humanos , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Malformações Vasculares do Sistema Nervoso Central/terapia , Embolização Terapêutica/métodos , Microcirurgia/métodos , Pessoa de Meia-Idade , Masculino , Feminino , Resultado do Tratamento
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