Thyroid cancer surgery during the coronavirus disease 2019 pandemic: perioperative management and oncological and anatomical considerations.

The coronavirus disease 2019 (COVID-19) pandemic has changed many aspects of our everyday lives and medical practice, including oncology treatment; thyroid cancer surgery is not an exception. The reported number of fine-needle aspirations performed during the first semester of 2020 was significantly reduced. Poorly differentiated, medullary and anaplastic thyroid tumors are considered important indications for immediate surgical intervention. By contrast, most well-differentiated carcinomas present slow growth, and thus surgery can be deferred for a short period of time during which patients are under active surveillance. Thyroid surgeries have decreased during the COVID-19 pandemic. Furthermore, prior to any intervention, negative COVID-19 status - with the use of a nasopharyngeal swab and reverse transcription PCR assay as the gold standard and chest CT scan as a complementary modality in some cases - must be confirmed to achieve a COVID-free pathway. Thorough preoperative assessment regarding both oncological and anatomical aspects should be performed to identify optimal timing for safe management.

Hemorrhagic complications after removal of an external ventricular drain: A case report and literature review.

Background: External ventricular drainage (EVD) is one of the most common neurosurgical procedures. Complications are rather rare and mostly include hemorrhage and infection. Hematomas may form during placement or even after the removal of an EVD. Regarding the latter, the literature is scarce, with only nine clinically significant cases reported. Case Description: We present the case of a young woman who suffered an extensive hemorrhage after removal of an EVD, in the setting of a posterior fossa stroke. We discuss the management and possible consequences of such an event and we emphasize the need for alertness to avoid such complications. Conclusion: Removal of an EVD is a safe procedure, with rare cases of hemorrhagic complications being reported. A case of a large hematoma that formed after the removal of an EVD is presented. Stricter follow-up protocols should be implemented to better estimate the risk of hemorrhage.

Percutaneous laser ablation of cervical metastatic lymph nodes in papillary thyroid carcinoma: clinical efficacy and anatomical considerations.

Background: Papillary thyroid carcinoma is the most common type of thyroid cancer; despite its generally indolent course, patients often develop local post-operative recurrences. Re-operation, however, holds a high complication rate, while at the same time, not all patients benefit from radioiodine ablation. This systematic review investigates the application of laser ablation therapy (LAT) for cervical lymph node metastases as an additional treatment modality.Methods: This systematic review was conducted in accordance with the PRISMA Statement. Medline electronic database and Cochrane Library were searched for eligible articles.Results: Five studies were included in the systematic review. All studies included patients with metastatic lymph nodes from papillary thyroid carcinoma, that were unsuitable for further radioiodine or surgical treatment. Patients were treated with two different LAT devices. Regardless of the utilized assessment modalities, all researchers reported significant outcomes on local disease control. No permanent complications were observed.Conclusions: LAT is relatively safe and effective for the treatment of cervical metastatic lymph nodes in patients with papillary thyroid carcinoma.

Single-session high-intensity focused ultrasound (HIFU) ablation for benign thyroid nodules: a systematic review.

BACKGROUND: Thyroid nodules are common; the majority of them are benign and asymptomatic. Thyroidectomy might be an option; however, the frequency of post-operative complications mandates the development of alternative approaches, such as high-intensity focused ultrasound ablation (HIFU). HIFU induces thermal destruction without penetrating the skin. The present systematic review aims to synthesize all available data, evaluating studies with single-session HIFU therapy and investigating its efficacy. MATERIALS AND METHODS: This systematic review was conducted in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and MetaAnalyses). Eligible articles were identified by a search of Medline bibliographic database (PubMed) and Cochrane Library. Out of 39 results, 11 articles were considered to meet the inclusion criteria. RESULTS: All eligible studies included patients with solid or predominantly solid benign thyroid nodules. All patients were treated with the same HIFU device. The success rate of the method was defined in the majority, with the volume reduction rate (VRR) over 50% from baseline. The mean or median VRR ranged from 48.7 to 70.41%, depending on the last follow-up date. No major complications were observed. CONCLUSION: Single-session HIFU is safe and effective for the treatment of benign thyroid nodules.