Abstract
BACKGROUND
Despite some evidence for the adoption of endoscopic transnasal trans-sphenoidal surgery (ETSS) for pituitary adenomas, the advantages of this technique over the traditional ...approach have not been robustly confirmed.
OBJECTIVE
To compare ETSS with the microscopic sublabial trans-septal trans-sphenoidal surgery (MTSS) for pituitary adenomas.
METHODS
We retrospectively reviewed 2 cohorts of ETSS and MTSS performed at our institution from 1995 to 2017. Patient characteristics, surgical data, and outcomes were recorded prospectively. We performed a univariate and multivariable analysis to determine the best surgical approach. To improve the quality of the results, we matched the distribution of patient characteristics between groups by propensity score (PS) method.
RESULTS
A total of 187 procedures (90 MTSS, 97 ETSS) were reviewed. We found better results in the ETSS group in terms of gross total resection (P = .002) and hormone-excess secretion control (P = .014). There was also a lower incidence of cerebrospinal fluid leakage (P = .039), transitory diabetes insipidus (P = .028), and postoperative hypopituitarism (P = .045), as well as a shorter hospital length of stay (P < .001). After PS matching, we confirmed by multivariable logistic regression analysis an increased odds ratio of gross total resection for the ETSS (3.910; 95% CI 1.720-8.889; P = .001).
CONCLUSION
By PS method, our results suggest that the ETSS provides advantages over the traditional MTSS approach for tumor resection. Better control of secreting tumors and a lower rate of most complications also support the selection of the ETSS approach for the treatment of pituitary adenomas.
Graphical Abstract
Graphical Abstract
•A modified 3-round Delphi survey resulted in a clinician-led guideline in Hirayama disease (HD).•This is the first time to establish a clinician-led guideline for clinical practice in HD.•Given lack ...of high-grade studies, this experts’ guideline may provide a helpful direction for HD.
To establish a clinician-led guideline for the diagnosis and treatment of Hirayama disease (HD) using a modified Delphi technique.
Based on a combination of a systematic review and opinion of ten experts, a protocol for the consensus of the diagnosis, treatment and follow-up assessment of HD was established. A modified 3-round Delphi survey was then performed by more than 40 panelists from various countries of the world. Both levels of evidence and levels of agreement were derived in all statements of finial guideline.
A total of 47 experts from 6 countries were enrolled in the expert panel in this study. Highly consistent results were achieved during the three Delphi rounds. An expert-led guideline finally constructed includes 24 statements related to diagnosis, treatment and follow-up assessment of HD.
The modified Delphi technique used in this study resulted in an expert-led guideline concerning several clinical aspects of HD.
This clinician-led guideline may provide a helpful direction for clinical practice with regard to the diagnosis and treatment of HD.
Abstract Rupture is the most serious consequence of cerebral aneurysms, and its likelihood depends on non-modifiable and modifiable risk factors. Recent efforts have focused on analyzing the effects ...of hemodynamic forces on the initiation, growth and rupture of cerebral aneurysms. Studies of role of hemodynamics on the physiopathology of intracranial aneurysms fall between mechanical engineering and molecular biology. This review is intended to summarize the basic principles of the effect of hemodynamic forces on the cerebral vascular wall. Nowadays, the size of the aneurysm dome is the most common parameter used in clinical practice to estimate the risk of rupture. However, relying only on aneurysm size means excessively simplifying a more complicated reality. Aneurysms emerge in areas of the vascular wall exposed to high wall shear stress. The direction that blood flows once an aneurysm forms depends on aspects such as neck diameter, its angle with respect to the parent artery, the parent vessel caliber, the caliber or the angle of efferent vessels, and aneurysm shape. The progression and rupture of aneurysms have been associated with zones of the aneurysm wall exposed to both high and low wall shear stresses. Advances in this challenging and growing field are intended to predict more precisely the risk of rupture of aneurysms and to better understand the mechanisms of origin and growth of aneurysms.
Abstract Background and Purpose: Several studies have looked for an association between radiological findings and neurological outcome after cervical trauma. In the current literature, there is a ...paucity of evidence proving the prognostic role of soft tissue damage or bony integrity. Our objective is to determine radiological findings related to neurological prognosis in patients after incomplete acute traumatic cervical spinal cord injury, regardless of initial neurological exam. Material and Methods We retrospectively reviewed patients with acute traumatic cervical Spinal Cord Injury who had an MRI performed within the first 96 hours. Clinical and epidemiological data were recorded from the medical records along with several radiological findings from the initial CT scan and MRI. Data was analyzed using non-parametric test. Significant prognostic factors were analyzed through a stepwise multivariable logistic regression, adjusted by neurological status at baseline. The receiver-operating characteristic curve (ROC curve) was used to test the discriminative capacity of the model. Results 86 cases (68 males and 18 females) were included for the analysis. Mean age was 49 years old. Ligamentum flavum injury, intramedullary edema larger than 36 mm and facet dislocation demonstrated to be associated with a lack of neurological improvement at follow up. Multivariable analysis showed that edema larger than 36 mm and facet dislocation were strong predictors of clinical outcome, regardless of the initial neurological examination. Conclusion Early MRI has an intrinsic prognostic value. Ligamentous injury and larger edema are strong predicting factors of a bad neurological outcome at long term follow-up.
Hirayama disease, or juvenile amyotrophy of distal upper extremity, is a benign, self-limiting cervical myelopathy consisting of selective unilateral weakness of the hand and forearm. The weakness ...slowly progresses until spontaneous arrest occurs within 5 years of onset. The condition predominantly affects Asian males and is thought to be secondary to spinal cord compression during neck flexion, because of a forward displacement of the posterior dural sac. The authors present what is to their knowledge the first reported case of a Caucasian male with a severe form of Hirayama disease, suffering from weakness of the leg as well as the forearm. An abnormal range of cervical flexion was observed at the C5-6 level. The patient was successfully treated by anterior cervical discectomy and fusion.
Sciatica. Management for family physicians Aguilar-Shea, Antonio; Gallardo-Mayo, Cristina; Sanz-González, Rosa ...
Journal of family medicine and primary care,
08/2022, Letnik:
11, Številka:
8
Journal Article
Recenzirano
Odprti dostop
Sciatica or lower back pain with sciatic radiation is a frequent medical problem in primary care. The aim of this article is to better inform medical practitioners on diagnosis and management of ...lower back pain with sciatic radiation. Updated information on sciatica management is important for family physicians. Here, we review the available literature on sciatica. Relevant articles were identified via a literature search in PubMed by focusing on the following key points: diagnostic and definition criteria, red flags, and therapy. In addition, the authors' clinical experience has been utilised to propose a schema to assist in the assessment and treatment of sciatica in a primary care setting. Sciatica diagnosis is based on a careful history and clinical examination. Imaging is usually not necessary at first; testing with X-ray and MRI are key to diagnosing lumbar instability and herniated discs. Management includes physical conditioning, proper pain management, and surgery as a last resort. Pain treatment includes analgesics, anticonvulsants and muscle relaxants. A more aggressive approach would include epidural infiltrations and radiofrequency.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract
Background
Partially thrombosed giant aneurysms at the basilar apex (BA) artery are challenging lesions with a poor prognosis if left untreated. Here we describe a rare case of extensive ...brain edema after growth of a surgically treated and thrombosed giant basilar apex aneurysm.
Case presentation
We performed a proximal surgical basilar artery occlusion on a 64-year-old female with a partially thrombosed giant BA aneurysm. MRI showed no ischemic lesions but showed marked edema adjacent to the aneurysm. She had a good recovery, but 3 months after surgical occlusion, her gait deteriorated together with urinary incontinence and worsening right hemiparesis. MRI showed that the aneurysm had grown and developed intramural hemorrhage, which caused extensive brain edema and obstructive hydrocephalus. She was treated by a ventriculoperitoneal shunt placement. Follow-up MRI showed progressive brain edema resolution, complete thrombosis of the lumen and shrinkage of the aneurysm. At 5 years follow-up the patient had an excellent functional outcome.
Conclusions
Delayed growth of a surgically treated and thrombosed giant aneurysm from wall dissection demonstrates that discontinuity with the initial parent artery does not always prevent progressive enlargement. The development of transmural vascular connections between the intraluminal thrombus and adventitial neovascularization by the vasa vasorum on the apex of the BA seems to be a key event in delayed aneurysm growth. Extensive brain edema might translate an inflammatory edematous reaction to an abrupt enlargement of the aneurysm.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PDF
