RESUMO
Treatment options for aneurysmal bone cysts include intralesional curettage, segmental excision, en bloc resection and endovascular embolization. The most commonly used treatment is intralesional curettage and selective arterial embolization is normally an adjunctive therapy, not a definitive treatment. We report a case of a C1 lateral mass aneurysmal bone cyst treated with a single session of endovascular embolization. Long-term follow up demonstrated complete resolution of the cyst. A study of aneurysmal bone cyst embolization was conducted and the key points for obtaining maximal devascularization of the cyst along with embolic material and technique are discussed.
Assuntos
Cistos Ósseos Aneurismáticos/cirurgia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Doenças da Coluna Vertebral/cirurgia , Adulto , Cistos Ósseos Aneurismáticos/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Doenças da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Iatrogenic vertebral artery injury is an uncommon but well recognized complication during cervical spine surgery. Intraoperative surgical repair is extremely challenging, and options for endovascular repair are limited because of the lack of proper equipment in the operating room setting. CASE DESCRIPTION: A 53-year-old woman who presented with myelopathy underwent anterior cervical diskectomy and fusion of C3-7. A significant laceration injury of the left vertebral artery was encountered during surgery, which was salvaged by intraoperative endovascular repair with a covered stent under portable fluoroscopy guidance. The salvage and repair led to the rest of the surgery being finished as planned preoperatively without any consequences. CONCLUSIONS: Vertebral artery injury is an uncommon but severe complication of cervical spine surgery. For uncontrolled bleeding, intraoperative endovascular repair with portable fluoroscopy is warranted and possible. A covered stent can seal the laceration and stop the bleeding completely which enables completion of the surgery.
Assuntos
Perda Sanguínea Cirúrgica , Complicações Intraoperatórias/cirurgia , Stents Metálicos Autoexpansíveis , Artéria Vertebral/lesões , Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Feminino , Hemostasia Cirúrgica/métodos , Humanos , Doença Iatrogênica , Degeneração do Disco Intervertebral/cirurgia , Complicações Intraoperatórias/etiologia , Lacerações/etiologia , Lacerações/cirurgia , Pessoa de Meia-Idade , Terapia de Salvação/métodos , Doenças da Medula Espinal/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Obesity has been associated with poor oncologic outcomes following pancreatoduodenectomy for pancreatic cancer. However, there is a paucity of evidence on the impact of obesity on postoperative complications, oncologic outcome and survival in patients with hepatocellular carcinoma (HCC) undergoing orthotopic liver transplantation (OLT). METHODS: From a database of over 1000 patients who underwent OLT during 1996-2008, 159 patients with a diagnosis of HCC were identified. Demographic data, body mass index (BMI), perioperative parameters, recurrence and survival were obtained. Complications were grouped according to Clavien-Dindo grading (Grades I-V). RESULTS: There were increased incidences of life-threatening complications in overweight (58%) and obese (70%) patients compared with the non-obese patient group (41%) (P < 0.05). Furthermore, the incidence of recurrence of HCC was doubled in the presence of overweight (15%) and obesity (15%) compared with non-obesity (7%) (P < 0.05). Time to recurrence also decreased significantly. Differences in mean ± standard deviation survival in the overweight (45 ± 3 months) and obese (41 ± 4 months) groups compared with the non-obese group (58 ± 6 months) did not reach statistical significance. CONCLUSIONS: These findings indicate that BMI is an important surrogate marker for obesity and portends an increased risk for complications and a poorer oncologic outcome following OLT for HCC.