Intraoperative monitoring of cerebral blood flow (CBF) has become an invaluable adjunct to vascular and oncological neurosurgery, reducing the risk of postoperative morbidity and mortality. Several ...technologies have been developed during the last two decades, including laser-based techniques, videomicroscopy, intraoperative MRI, indocyanine green angiography, and thermography. Although these technologies have been thoroughly studied and clinically applied outside the operative room, current practice lacks an optimal technology that perfectly fits the workflow within the neurosurgical operative room. The different available technologies have specific strengths but suffer several drawbacks, mainly including limited spatial and/or temporal resolution. An optimal CBF monitoring technology should meet particular criteria for intraoperative use: excellent spatial and temporal resolution, integration in the operative workflow, real-time quantitative monitoring, ease of use, and non-contact technique. We here review the main contemporary technologies for intraoperative CBF monitoring and their current and potential future applications in neurosurgery.
Abstract Objective The natural history of pineal cysts still remains unclear. Incidental pineal cysts have become more common which raises the question of their management. Symptomatic pineal cysts ...may require a surgical solution but therapeutic indications have not yet been clearly established. Method From 1986 to 2012, 26 patients with pineal cysts were identified. Their medical records were retrospectively assessed focusing on the initial symptoms, imaging characteristics of the cyst, management strategy, operative technique and their complications, as well as the latest follow-up. A systematic review of the literature is also presented. Results Twenty-six patients with pineal cysts were identified. The mean age was 23.5 years ranging from 7 to 49 years. Symptoms included intracranial hypertension with obstructive hydrocephalus in 18 cases and oculomotor anomalies in 12 cases. Two adult cases presented with non-specific headaches and did not require surgery. Twenty patients were operated via a suboccipital transtentorial approach with total removal of the cyst in 70% of the cases, while the remaining 4 cases were treated with an intraventricular endoscopic marsupialization associating a third ventriculostomy. Four patients required a preoperative ventriculo-peritoneal shunt due to life-threatening obstructive hydrocephalus. Overall, peri-operative mortality was nil. In the two non-operated patients, the cyst remained stable and no recurrences were observed in all operated patients with a mean follow-up of 144 months. Conclusion In the majority of incidental pineal cysts, a clinical and imaging follow-up is sufficient but occasionally not required especially in adults as very rare cases of increase in size have been reported.
Nutritional rickets remains a significant public health issue for children worldwide. Although it has almost disappeared in industrialized countries following routine vitamin D supplementation, ...recent evidence suggests an increasing incidence, especially in young children. In addition to the classical clinical consequences on bone and the growth plate, rickets may also be associated with life-threatening neurological and cardiac complications in the most severe forms. Consequently, early screening and treatment are required. Here, we report the case of a 2-year-old child who presented with severe nutritional rickets associated with seizure and cardiomyopathy. Family screening revealed rickets in all the siblings. This case report emphasizes the importance of being aware of this disease, notably in population with sociocultural risk factors.
Le rachitisme carentiel reste un problème de santé publique majeur dans de nombreuses parties du monde. Alors qu’il avait quasiment disparu dans les pays industrialisés suite à la supplémentation ...systématique en vitamine D chez l’enfant, plusieurs études récentes (notamment danoises et anglaises) suggèrent une augmentation de son incidence, notamment chez le nourrisson. À côté des manifestations osseuses classiques, le rachitisme peut se manifester par des complications neurologiques et cardiaques qui peuvent mettre en jeu le pronostic vital dans les formes les plus sévères ; un dépistage et une prise en charge précoces sont donc importants. Nous rapportons le cas d’un nourrisson de 2 ans qui présentait un rachitisme carentiel sévère associé à des convulsions et à une cardiomyopathie ayant permis de dépister un rachitisme chez les autres enfants de la fratrie. Ces observations soulignent l’importance d’une vigilance maintenue sur cette pathologie, notamment dans les populations particulièrement exposées du fait de facteurs socioculturels.
Nutritional rickets remains a significant public health issue for children worldwide. Although it has almost disappeared in industrialized countries following routine vitamin D supplementation, recent evidence suggests an increasing incidence, especially in young children. In addition to the classical clinical consequences on bone and the growth plate, rickets may also be associated with life-threatening neurological and cardiac complications in the most severe forms. Consequently, early screening and treatment are required. Here, we report the case of a 2-year-old child who presented with severe nutritional rickets associated with seizure and cardiomyopathy. Family screening revealed rickets in all the siblings. This case report emphasizes the importance of being aware of this disease, notably in population with sociocultural risk factors.
The efficacy of overnight wear of four types of reverse-geometry lenses was compared. The length of time needed to achieve correction and any adverse events that occurred during the course of the ...study were recorded.
In this prospective, randomized study, 60 subjects (18 to 35 years old) with refractive error between -1.00 to -4.00 D (cyl </= -1.50) wore reverse-geometry lenses overnight only. All subjects were assigned a Rinehart Reeves lens in one eye, and subsets of 20 subjects were randomly assigned a Mountford BE, DreimLens, or Contex D Series 4 lens for the contralateral eye. Visits included baseline, dispensing, 1 day, 1 week, and 1 month. Biomicroscopy, unaided visual acuity, subjective refraction, best-corrected visual acuity at high and low contrast and high and low illumination, corneal topography, and subjective rating data were collected.
Forty-six subjects completed the study. At 1 month, there were no significant differences between lens types in their effect on unaided visual acuity, subjective sphere, subjective cylinder, best-corrected visual acuity at high and low contrast at high illumination and low contrast at low illumination, apical corneal radius, corneal eccentricity, and subjective ratings. Between 1 week and 1 month, there was a significant improvement in subjective ratings of quality of day and night vision (p < 0.05) but no significant change in the objective measures. No significant ocular adverse events were observed during the trial.
The lens types tested were all similarly effective in the reduction of myopic refractive error. Subjective ratings continued to improve after objective measures stabilized at 1 week. Overnight lens wear proceeded for 1 month without significant adverse reactions.
Efficacy of Sapien XT valve has been reported for percutaneous pulmonary valve implantation (PPVI). Implantation is complex given the rigidity and the of the Novaflex® delivery system. Sapien 3 valve ...is the latest evolution of Edwards valves with a more flexible Commander® delivery system. We report our results of off-label use of Sapien 3 for PPVI.
Between September 2016 and April 2017, 16 procedures were performed with the Sapien 3 and compared to 26 procedures performed with the Sapien XT between January 2015 and July 2016.
Sapien 3 were implanted in 16 patients 26 years old (23–38). Conduit were native patched valves (n=6), bioprosthesis (n=4), tube (n=4), homograft (n=1) and Melody valve (n=1). All patients had pulmonary prestenting (Andrastent XXL, n=12; eV3 LDmax, n=4). Valve implantation was performed during a second procedure in 5 cases. Valve diameters were 23 (n=3), 26 (n=4) and 29mm (n=9). Valves were successfully implanted in all cases. After procedure, one patient had minor pulmonary valve regurgitation. Peak-to-peak gradient across the valves was ≤15mmHg in 14 cases. Two patients had minor valve mismatch. Nor valve dysfunction nor infective endocarditis was reported during follow-up. Procedure duration, fluoroscopy time, dose-length product and kerma were lower with Sapien 3 compared to Sapien XT procedures (0.002, 0.01, 0.006, and 0.007 respectively).
Sapien 3 valve implantation in pulmonary position with the Commander delivery system is efficient and faster. However, the lack of valve covering onto the delivery system remains an issue.
Multiple surgical revisions are often necessary in individuals with congenital heart defects affecting the right ventricular outflow tract (RVOT) or pulmonary valve. To prolong the need for ...additional open-heart interventions, percutaneous pulmonary valve implantation (PPVI) may be performed as a less invasive alternative.
No multi-patient studies currently report the feasibility and safety of this procedure using the new generation SAPIEN 3 (S3) transcatheter heart valve.
Pulmonic S3 is a multicentre observational registry of patients undergoing PPVI with the S3 valve across Europe, and Canada started in March 2016.
Until end of January 2018, data for 81 patients with a mean age of 26.5 years was obtained. The most common underlying diagnosis was tetralogy of Fallot (ToF) (58.0%), with only 16.3% of patients having native RVOT anatomy. Ninety percent received pre-stenting. Procedural success was 100%. Prosthesis dislodgement (without need for open surgery) occurred in one patient, with another experiencing conduit perforation. Both were successfully resolved and no other procedural complications, endocarditis, stent fracture or mortality were reported up to two years. The peak systolic gradient over the RVOT fell from 45.6mmHg pre-procedurally to 16.2mmHg post-procedurally, the proportion of patients with moderate/severe pulmonary regurgitation from 89.2% to 0.0% and those with an NYHA class ≥ II from 86.8% to 15.9%.
PPVI with the S3 valve appears feasible and safe in a wide range of patients with congenital heart defects, with good short-term haemodynamic and functional outcomes. Longer-term outcomes remain to be described.
NCT02777892.
Percutaneous pulmonary valve implantation (PPVI) remains technically challenging.
We describe the early results of PPVI with the SAPIEN 3 (S3) valve facilitated by a large delivery sheath.
We ...designed a prospective, single cohort study.
Between December 2017 and April 2018, 16 patients (median age 24 y/o; median weight 70kg) underwent PPVI with the SAPIEN 3 using a 65cm, 26Fr GORE® DrySeal delivery sheath. Through the sheath, the landing zone was stented, then the valve implanted during the same procedure. PPVI was performed on native or patched outflow tract in 75.0% of patients. Pre-stenting was performed in 13 cases (81.3%). While advancing the sheath through the stent, stent migration occurred in one case. The stent was moved back and PPVI performed. Size 23, 26 and 29 valves were successfully implanted in 2, 3 and 11 cases, respectively. Median post valve gradient was 2mmHg. Minor paravalvular leak was reported in 2 cases. Median fluoroscopy time was 18min. Vessel access minimal hematomas and vessel access delayed healing were reported in 4 cases (25.0%) and in one case (6.3%) without any secondary procedure or blood transfusion.
A large delivery sheath allows a fast and safe PPVI with the S3 valve.
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