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International Journal of Surgery... Dec 2023This study aimed to compare the risk and benefit profile of microsurgery (MS) and stereotactic radiosurgery (SRS) as the first-line treatment for unruptured and ruptured...
Long-term outcomes of microsurgery and stereotactic radiosurgery as the first-line treatment for arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data.
BACKGROUND
This study aimed to compare the risk and benefit profile of microsurgery (MS) and stereotactic radiosurgery (SRS) as the first-line treatment for unruptured and ruptured arteriovenous malformations (AVMs).
MATERIALS AND METHODS
The authors included AVMs underwent MS or SRS as the first-line treatment from a nationwide prospective multicenter registry in mainland China. The authors used propensity score-matched methods to balance baseline characteristics between the MS and SRS groups. The primary outcomes were long-term hemorrhagic stroke or death, and the secondary outcomes were long-term obliteration and neurological outcomes. Subgroup analyses and sensitivity analyses with different study designs were performed to confirm the stability of our findings.
RESULTS
Of the 4286 consecutive AVMs in the registry from August 2011 to December 2021; 1604 patients were eligible. After matching, 244 unruptured and 442 ruptured AVMs remained for the final analysis. The mean follow-up duration was 7.0 years in the unruptured group and 6.1 years in the ruptured group. In the comparison of primary outcomes, SRS was associated with a higher risk of hemorrhagic stroke or death both in the unruptured and ruptured AVMs (unruptured: hazard ratio 4.06, 95% CI: 1.15-14.41; ruptured: hazard ratio 4.19, 95% CI: 1.58-11.15). In terms of the secondary outcomes, SRS was also observed to have a significant disadvantage in long-term obliteration [unruptured: odds ratio (OR) 0.01, 95% CI: 0.00-0.04; ruptured: OR 0.09, 95% CI: 0.05-0.15]. However, it should be noted that SRS may have advantages in preventing neurofunctional decline (unruptured: OR 0.56, 95% CI: 0.27-1.14; ruptured: OR 0.41, 95% CI: 0.23-0.76). The results of subgroup analyses and sensitivity analyses were consistent in trend but with slightly varied powers.
CONCLUSIONS
This clinical practice-based real-world study comprehensively compared MS and SRS for AVMs with long-term outcomes. MS is more effective in preventing future hemorrhage or death and achieving obliteration, while the risk of neurofunctional decline should not be ignored.
Topics: Humans; Treatment Outcome; Retrospective Studies; Intracranial Arteriovenous Malformations; Microsurgery; Radiosurgery; Hemorrhagic Stroke; Propensity Score; Routinely Collected Health Data; Follow-Up Studies
PubMed: 37720924
DOI: 10.1097/JS9.0000000000000751 -
Hand Clinics May 2024Microsurgery is undoubtedly the pinnacle of hand surgery. Significant advancement in recent years has stretched the indications for toe-to-hand transfer in both acquired... (Review)
Review
Microsurgery is undoubtedly the pinnacle of hand surgery. Significant advancement in recent years has stretched the indications for toe-to-hand transfer in both acquired and congenital hand defects to restore function, esthetics, and motion, with minimal morbidity to the donor site. There is no one fixed microsurgical transfer technique but a surgeon's versatility and innovation in using what one could spare because each case is unique. Esthetic refinements and reducing donor site morbidities have taken a front seat in recent years. We present a few cases to put forward the senior author's preferred techniques with this objective in mind.
Topics: Humans; Child; Thumb; Toes; Amputation, Traumatic; Hand; Microsurgery
PubMed: 38553095
DOI: 10.1016/j.hcl.2023.10.004 -
Expert Review of Gastroenterology &... 2023Endoscopic resection of colonic precancerous lesions has been demonstrated to significantly decrease colorectal cancer (CRC) incidence and mortality. Among resection... (Review)
Review
INTRODUCTION
Endoscopic resection of colonic precancerous lesions has been demonstrated to significantly decrease colorectal cancer (CRC) incidence and mortality. Among resection techniques, cold snare polypectomy (CSP) has been shown as a highly feasible, effective and safe option and is widely used in clinical practice, being regarded as the first-line technique for removal of small and diminutive colorectal polyps. On the other hand, conventional hot snare polypectomy (HSP) and endoscopic mucosal resection (EMR), namely the gold standard treatments for larger polyps, may be occasionally associated to complications due to electrocautery injury.
AREAS COVERED
To overcome these shortcomings of electrocautery-based resection techniques, in the last few years CSP has been increasingly assessed as a treatment option for additional indications, with a focus on nonpedunculated colorectal polyps ≥10 mm.
EXPERT OPINION
This review aims to present current and widened indications of CSP discussing the latest findings from the most remarkable studies, with an insight into technical issues, novelties and potential advances in the near future.
Topics: Humans; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Microsurgery; Endoscopic Mucosal Resection
PubMed: 37318101
DOI: 10.1080/17474124.2023.2223976 -
Clinical Anatomy (New York, N.Y.) Jul 2024The glossopharyngeal nerve is a complicated and mixed nerve including sensory, motor, parasympathetic, and visceral fibers. It mediates taste, salivation, and... (Review)
Review
The glossopharyngeal nerve is a complicated and mixed nerve including sensory, motor, parasympathetic, and visceral fibers. It mediates taste, salivation, and swallowing. The low cranial nerves, including IXth, Xth, and XIth, are closely related, sharing some nuclei in the brainstem. The glossopharyngeal nerve arises from the spinal trigeminal nucleus and tract, solitary tract and nucleus, nucleus ambiguous, and inferior salivatory nucleus in the brainstem. There are communicating branches forming a neural anastomotic network between low cranial nerves. Comprehensive knowledge of the anatomy of the glossopharyngeal nerve is crucial for performing surgical procedures without significant complications. This review describes the microsurgical anatomy of the glossopharyngeal nerve and illustrates some pictures involving the glossopharyngeal nerve and its connective and neurovascular structures.
Topics: Glossopharyngeal Nerve; Humans; Microsurgery
PubMed: 38380502
DOI: 10.1002/ca.24143 -
Laryngo- Rhino- Otologie Jul 2023
Topics: Humans; Mohs Surgery
PubMed: 37399821
DOI: 10.1055/a-2062-7134 -
Laryngo- Rhino- Otologie Jul 2023
Topics: Humans; Outpatients; Microsurgery; Ultrasonography
PubMed: 37399818
DOI: 10.1055/a-2040-9388 -
World Neurosurgery Oct 2023Complex cerebral arteriovenous malformations (AVMs) require a combined therapy of endovascular embolization and microsurgical resection to eliminate the lesion and...
OBJECTIVE
Complex cerebral arteriovenous malformations (AVMs) require a combined therapy of endovascular embolization and microsurgical resection to eliminate the lesion and maximize neurological protection, while a deliberate time interval might contribute to optimal clinical outcomes. The present study aimed to explore the feasibility of this paradigm.
METHODS
All patients who underwent deliberately planned presurgery embolization and microsurgery resection between 2015 and 2023 were reviewed, with baseline data, postoperative complications, and follow-up outcomes recorded. The modified Rankin scale (mRS) was used to evaluate clinical outcomes, with mRS 0-2 defined as good.
RESULTS
A total of 30 patients were included in the study (15 were ruptured AVMs). The median Spetzler-Martin grade of baseline AVMs was 3 (interquartile range: 2-3). The median interval between the last embolization and microsurgery was 5 days (interquartile range: 2.25-7). The complete removal rate was 100%, and the overall permanent complication rate was 16.67%. At the last follow-up, 26 patients achieved mRS 0-2, while 28 had improved or unaltered mRS. The last follow-up mRS significantly improved from baseline and discharge (P = 0.0006 and P = 0.006). The last follow-up mRS decreased by 0.65 for each additional day of time interval before the 4.4-day inflection point (β = -0.65, P = 0.02) in the AVM ruptured cohort.
CONCLUSIONS
The deliberately staged combined procedure of embolization and microsurgery might be a safe and efficacious strategy for Spetzler-Martin grade 2-5 AVMs, 4-5 days might be an appropriate staged time interval for ruptured AVMs, although further studies are needed to substantiate these findings.
Topics: Humans; Microsurgery; Treatment Outcome; Retrospective Studies; Embolization, Therapeutic; Intracranial Arteriovenous Malformations; Radiosurgery; Rupture
PubMed: 37467953
DOI: 10.1016/j.wneu.2023.07.040 -
Surgical Innovation Oct 2023Surgical robots have innovated the microsurgical field by providing advantages that improve surgical performance. These robots have been adopted by certain specialties... (Review)
Review
BACKGROUND
Surgical robots have innovated the microsurgical field by providing advantages that improve surgical performance. These robots have been adopted by certain specialties more than others. This study discusses the potential advantages of robotics in plastic and reconstructive surgery.
METHOD
This study is a literature review of articles investigating "robotic microsurgery in plastic and reconstructive surgery" using the PubMed database and the Cochrane Library.
RESULT
A total of nineteen relevant articles were found and 5 articles performed a direct comparison between the robotic and manual approaches. Longer operating times were reported in the robotic groups featuring higher learning curves. Reported advantages to robotic use included higher accuracy, precision and flexibility, elimination of tremor and improvement of ergonomic factors.
CONCLUSION
While the results provide an outlook into the outcome of robotic platforms in this field, current research is limited and further studies are required to provide a fundamental analysis.
Topics: Robotics; Microsurgery; Surgery, Plastic; Plastic Surgery Procedures; Robotic Surgical Procedures
PubMed: 37490999
DOI: 10.1177/15533506231191211 -
Journal of the Chinese Medical... Jan 2024Lymphedema is a progressive disease with no known cure. Characterized by the accumulation of lymphatic fluid and subsequent swelling in the affected limbs, it often... (Review)
Review
Lymphedema is a progressive disease with no known cure. Characterized by the accumulation of lymphatic fluid and subsequent swelling in the affected limbs, it often poses significant challenges to those living with it. Although various conservative treatments have been used to manage lymphedema, such as compression therapy and physical rehabilitation, surgical interventions have emerged as promising avenues for more substantial relief. Lymphovenous shunts have been described since the 1960s and have garnered much attention in the recent two decades due to technological advances in optics, imaging, and surgical instruments. This review article explores the use of different lymphovenous shunts such as lymphatic implantation, lymph node-to-vein anastomoses (LNVAs), dermal-adipose lymphatic flap venous wrapping (DALF-VW), and supermicrosurgical lymphovenous anastomoses (LVAs) as treatment modalities for lymphedema. We will discuss the underlying principles, indications, techniques, and potential benefits. By examining the current state of knowledge and ongoing research in the field, we aim to provide insights into the role of lymphovenous shunts in the comprehensive management of lymphedema and shed light on the prospects for this treatment option.
Topics: Humans; Lymphedema; Lymphatic Vessels; Lymph Nodes; Veins; Microsurgery
PubMed: 37962114
DOI: 10.1097/JCMA.0000000000001016 -
British Dental Journal May 2024
Topics: Humans; Microsurgery; Root Canal Therapy; Endodontics
PubMed: 38789766
DOI: 10.1038/s41415-024-7469-6