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World Neurosurgery Nov 2022To investigate combined external ventricular drainage and endoscope-assisted microsurgery using the middle frontal gyrus approach in patients with severe ventricular... (Randomized Controlled Trial)
Randomized Controlled Trial
Combined External Ventricular Drainage and Endoscope-Assisted Microsurgery Using the Middle Frontal Gyrus Approach in Severe Ventricular Hemorrhage with Casting of the Fourth Ventricle.
OBJECTIVE
To investigate combined external ventricular drainage and endoscope-assisted microsurgery using the middle frontal gyrus approach in patients with severe ventricular hemorrhage with casting of the fourth ventricle and patients' recovery after this treatment.
METHODS
Patients with severe ventricular hemorrhage with casting of the fourth ventricle (n = 41) were randomly assigned to intervention and control groups. Modified Graeb score was used to assess 3-day hematoma clearance rate before and after surgery, drainage tube extubation time for the 2 groups was compared, and time when blood clot in the fourth ventricle was not blocked with cerebrospinal fluid was compared. Glasgow Coma Scale was used to assess consciousness after surgery; Glasgow Coma Scale scores recorded 1 and 7 days after surgery were also compared. Modified Rankin Scale was used to evaluate patients' recovery 1 and 6 months after surgery. Hydrocephalus and intracranial infections in patients after surgery were recorded for 90 days.
RESULTS
The 3-day hematoma clearance rate was dramatically higher in the intervention group. Modified Graeb score showed that more hemorrhage was delimited in 3 days in the intervention group. The intervention group exhibited significantly reduced length of block of the fourth ventricle and drainage tube extubation time. High Glasgow Coma Scale and modified Rankin Scale scores and significantly low incidence of complications (e.g., hydrocephalus and intracranial infection) were observed in patients in the intervention group.
CONCLUSIONS
Combined external ventricular drainage and endoscope-assisted microsurgery using the middle frontal gyrus approach can effectively improve severe ventricular hemorrhage with casting of the fourth ventricle and enhance patients' neurological function and recovery.
Topics: Humans; Microsurgery; Treatment Outcome; Cerebral Hemorrhage; Drainage; Hydrocephalus; Endoscopes; Hematoma; Glasgow Coma Scale
PubMed: 35995357
DOI: 10.1016/j.wneu.2022.08.056 -
Clinical Interventions in Aging 2021Demographic changes are leading to population aging, and free flap reconstructions for various indications are expected to become increasingly common among older...
PURPOSE
Demographic changes are leading to population aging, and free flap reconstructions for various indications are expected to become increasingly common among older patients. Therefore, this study evaluated free flap reconstruction of the extremities in older patients and compared the outcomes to those from younger patients who underwent similar procedures during the same period.
PATIENTS AND METHODS
This single-center retrospective study used a case-control design to compare older and younger patients who underwent free flap reconstruction of soft tissue defects in the extremities. One-to-one matching was performed for older patients (≥65 years) and younger patients (≤64 years) according to indication, flap recipient site, and flap type. The parameters of interest were clinico-demographic characteristics, flap type, defect location, indication for free flap reconstruction, number of venous anastomoses, and postoperative complications (flap loss, infection, and wound healing disorders).
RESULTS
The study included 48 older patients and 133 younger patients, with a mean follow-up of 12 months after discharge. The free flap reconstruction was performed at a mean interval of 19.8±22.8 days (range: 0-88 days). The 1:1 matching created 38 pairs of patients, which revealed no significant differences in the rates of flap necrosis and flap failure.
CONCLUSION
This study failed to detect a significant age-related difference in the flap necrosis rate after free flap reconstruction of extremity defects. Therefore, with careful perioperative management and patient selection, microsurgical free flap reconstruction is a feasible option for older patients.
Topics: Aged; Case-Control Studies; Extremities; Female; Free Tissue Flaps; Humans; Male; Microsurgery; Middle Aged; Postoperative Complications; Plastic Surgery Procedures; Retrospective Studies; Soft Tissue Injuries; Treatment Outcome
PubMed: 33776427
DOI: 10.2147/CIA.S300558 -
Brazilian Journal of Otorhinolaryngology 2022In many regions, laryngeal carcinoma is a common upper respiratory tract cancer, most commonly involving the glottic region. The treatment of early glottic cancer...
INTRODUCTION
In many regions, laryngeal carcinoma is a common upper respiratory tract cancer, most commonly involving the glottic region. The treatment of early glottic cancer includes radiotherapy, open surgery and laryngeal laser microsurgery. However, the preferred treatment for early glottic cancer is still controversial.
OBJECTIVES
To study the factors affecting the 5-year survival rate of TNM early glottis cancer and to demonstrate the oncological safety of different treatments.
METHODS
144 patients with early glottic cancer were analyzed retrospectively. All patients were clinically node negative. 53 patients underwent open surgery, transoral CO laser microsurgery in 46 cases and radiotherapy in 45 cases. The patients were followed up for 26 - 84 months, with an average follow-up period of 62.9 months.
RESULTS
The 5-year overall survival was 82.6%. The 5 year survival rates of open surgery, laser microsurgery and radiotherapy were 83.0%, 82.6% and 82.2%, respectively. There was no significant difference in 5-year survival rate among the three treatments (p = 0.987). In multivariate analysis, age, T-stage, pathological grading, and anterior commissure involvement were important prognostic factors for early glottic cancer.
CONCLUSION
There was no significant difference in 5 year survival rate among patients treated by either radiotherapy, laser microsurgery or open surgery for early glottic cancer. We urge more attention to the age, T-stage, pathological grade, and anterior commissure involvement of the patients.
Topics: Carcinoma, Squamous Cell; Glottis; Humans; Laryngeal Neoplasms; Laser Therapy; Microsurgery; Neoplasm Staging; Prognosis; Retrospective Studies; Tongue Neoplasms; Treatment Outcome
PubMed: 32830100
DOI: 10.1016/j.bjorl.2020.06.013 -
Acta Cirurgica Brasileira 2023To evaluate the gain of microsurgical skills and competencies by urology residents, using low-fidelity experimental models.
PURPOSE
To evaluate the gain of microsurgical skills and competencies by urology residents, using low-fidelity experimental models.
METHODS
The study involved the use of training boards, together with a low-fidelity microsurgery simulator, developed using a 3D printer. The model consists in two silicone tubes, coated with a resin, measuring 10 cm in length and with internal and external diameters of 0.5 and 1.5 mm. The support for the ducts is composed by a small box, developed with polylactic acid. The evaluation of the gain of skills and competencies in microsurgery occurred throughout a training course consisting of five training sessions. The first sessions (S1-S4) took place at weekly intervals and the last session (S5) was performed three months after S4. During sessions, were analyzed: the speed of performing microsurgical sutures in the pre and post-training and the performance of each resident through the Objective Structure Assessment of Technical Skill (OSATS) and Student Satisfaction Self-Confidence tools in Learning (SSSCL).
RESULTS
There was a decrease in the time needed to perform the anastomosis (p=0.0019), as well as a progressive increase in the score in the OSATS over during sessions S1 to S4. At S5, there was a slightly decrease in performance (p<0.0001), however, remaining within the expected plateau for the gain of skills and competences. The SSSCL satisfaction scale showed an overall approval rating of 96.9%, with a Cronback alpha coefficient of 83%.
CONCLUSIONS
The low-fidelity simulation was able to guarantee urology residents a solid gain in skills and competencies in microsurgery.
Topics: Humans; Internship and Residency; Microsurgery; Urology; Clinical Competence; Anastomosis, Surgical; Simulation Training
PubMed: 38055400
DOI: 10.1590/acb386523 -
Neurology India 2021Intraventricular tumors pose a surgical challenge because of the difficulty in reaching their deep location through safe corridors and their adherence or proximity to... (Review)
Review
BACKGROUND
Intraventricular tumors pose a surgical challenge because of the difficulty in reaching their deep location through safe corridors and their adherence or proximity to vital neurovascular structures. Although microneurosurgery is the mainstay of surgical management, neuroendoscopy aided by adjuncts, namely, navigation and ultrasonic aspirators, has made a great contribution to improving surgical results.
OBJECTIVE
This article reviews the experience of a neurosurgical unit with endoscopic procedures for intraventricular tumors. The current indications, benefits, and complications of neuroendoscopy are described.
MATERIALS AND METHODS
This is a retrospective, observational study of lateral and third ventricular tumors tackled either purely with an endoscope or with its assistance over 19 years in a single unit at Bombay Hospital Institute of Medical Sciences, Mumbai.
RESULTS
Of a total of 247 operated patients with intraventricular tumors, 85 cases operated using an endoscope were included. The majority of the patients had a tumor in the third ventricle (n = 62), whereas 23 patients had tumor in the lateral ventricle. The most common pathologies were colloid cyst and arachnoid cyst (n = 18). An endoscope was used for microsurgical assisted excision of tumors in 31 cases, biopsy in 24, cyst fenestration in 23, and pure endoscopic excision in seven cases.
CONCLUSION
Microsurgery remains the gold standard for the removal of giant, vascular intraventricular tumors. However, endoscopic fenestration or excision of cysts and biopsy have become better alternatives in many cases. Endoscope-assisted microsurgery affords safety and helps in achieving a more complete excision.
Topics: Cerebral Ventricle Neoplasms; Colloid Cysts; Humans; Microsurgery; Neuroendoscopy; Observational Studies as Topic; Third Ventricle
PubMed: 34979645
DOI: 10.4103/0028-3886.333458 -
Current Oncology (Toronto, Ont.) Oct 2021We determined the feasibility of the combined exoscopic-endoscopic technique (CEE) as an alternative to the microscope in craniofacial resection (CFR). This...
We determined the feasibility of the combined exoscopic-endoscopic technique (CEE) as an alternative to the microscope in craniofacial resection (CFR). This retrospective study was conducted at a single institution and included eight consecutive patients with head and neck tumors who underwent CFR between September 2019 and July 2021. During the transcranial approach, microsurgery was performed using an exoscope in the same manner as in traditional microscopic surgery, and an endoscope was used at the blind spot of the exoscope. The exoscope provided images of sufficient quality to perform microsurgery, while the sphenoid sinus lumen was the blind spot of the exoscope during anterior ( = 3) and anterolateral CFR ( = 2), and the medial aspect of the temporal bone was the blind spot of the exoscope during temporal bone resection ( = 2). These blind spots were visualized by the endoscope to facilitate accurate transection of the skull base. The advantages of the exoscope and endoscope include compact size, ergonomics, surgical field accessibility, and equal visual experience for neurosurgeons and head and neck surgeons, which enabled simultaneous transcranial and transfacial surgical procedures. All the surgeries were successful without any relevant complications. CEE is effective in transcranial skull base surgery, especially CFR involving simultaneous surgical procedures.
Topics: Endoscopy; Humans; Microsurgery; Neurosurgical Procedures; Retrospective Studies; Skull Base
PubMed: 34677254
DOI: 10.3390/curroncol28050336 -
Journal of Orthopaedic Research :... Jul 2023For more than six decades, the use of the operating microscope for extremity surgery has led to remarkable advances in the management of orthopedic trauma, tumors,...
For more than six decades, the use of the operating microscope for extremity surgery has led to remarkable advances in the management of orthopedic trauma, tumors, infections, and congenital differences. The microsurgical reconstructive ladder ascends from basic microsurgical procedures such as a digital artery or nerve repair to more complex procedures such as autologous tissue transplantation. Functional muscle transfers, toe-to-hand transfers, and recently vascularized composite allotransplantation are the highest rungs on this ladder that help restore extremity function. The development of the orthoplastic approach over the last three decades simultaneously integrates the principles and practices of both orthopedic surgery and plastic surgery for optimal care and salvage of extremities. Clinical, anatomic, and basic science research in reconstructive microsurgery has resulted in significant improvements in extremity salvage, reconstruction, and restoration.
Topics: Surgical Flaps; Replantation; Plastic Surgery Procedures; Microsurgery; Extremities
PubMed: 36413095
DOI: 10.1002/jor.25488 -
Indian Journal of Ophthalmology Oct 2022Phacoemulsification in soft cataracts can be challenging due to the lack of rigid cleavage planes and the inability to crack. We describe a new phacoemulsification...
Phacoemulsification in soft cataracts can be challenging due to the lack of rigid cleavage planes and the inability to crack. We describe a new phacoemulsification technique for dealing with soft cataracts using high vacuum and zero energy. Following capsulorhexis and hydrodissection, we introduced the phacoemulsification probe, keeping the torsional and longitudinal power at zero. A central groove was created in sculpting mode. We held the nucleus with adequate vacuum in chop mode and divided the nucleus. Then, we rotated and chopped the nucleus similarly into small pieces without using any power. For emulsification, we increased the vacuum to 600 mmHg and then shredded and stuffed the pieces into the phaco probe by the chopper. A newer generation phaco machine with active fluidic system and monitored pressurized infusion helps the surgeon control the intraocular pressure (IOP) and hold the nucleus with vacuum alone, allowing chopping and emulsifying of the pieces without any energy.
Topics: Capsulorhexis; Cataract; Cataract Extraction; Humans; Microsurgery; Phacoemulsification
PubMed: 36190070
DOI: 10.4103/ijo.IJO_1149_22 -
Journal of Dentistry Mar 2022This study aimed to establish and validate machine learning models for prognosis prediction in endodontic microsurgery, avoiding treatment failure and supporting...
OBJECTIVES
This study aimed to establish and validate machine learning models for prognosis prediction in endodontic microsurgery, avoiding treatment failure and supporting clinical decision-making.
METHODS
A total of 234 teeth from 178 patients were included in this study. We developed gradient boosting machine (GBM) and random forest (RF) models. For each model, 80% of the data were randomly selected for the training set and the remaining 20% were used as the test set. A stratified 5-fold cross-validation approach was used in model training and testing. Correlation analysis and importance ranking were conducted for feature selection. The predictive accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), F1 score, and the area under the curve (AUC) of receiver operating characteristic (ROC) curves were calculated to evaluate the predictive performance.
RESULTS
There were eight important predictors, including tooth type, lesion size, type of bone defect, root filling density, root filling length, apical extension of post, age, and sex. For the GBM model, the predictive accuracy was 0.80, with a sensitivity of 0.92, specificity of 0.71, PPV of 0.71, NPV of 0.92, F1 of 0.80, and AUC of 0.88. For the RF model, the accuracy was 0.80, with a sensitivity of 0.85, specificity of 0.76, PPV of 0.73, NPV of 0.87, F1 of 0.79, and AUC of 0.83.
CONCLUSIONS
The trained models were developed by eight common variables, showing the potential ability to predict the prognosis of endodontic microsurgery. The GBM model outperformed the RF model slightly on our dataset.
CLINICAL SIGNIFICANCE
Clinicians can use machine learning models for preoperative analysis in endodontic microsurgery. The models are expected to improve the efficiency of clinical decision-making and assist in clinician-patient communication.
Topics: Clinical Decision-Making; Humans; Machine Learning; Microsurgery; Predictive Value of Tests; Prognosis
PubMed: 35021070
DOI: 10.1016/j.jdent.2022.103947 -
Neurology India 2019Aneurysms arising from the proximal segment (A1) of the anterior cerebral artery (ACA) are relatively rare. Because of their small size, abnormal location in relation to...
BACKGROUND
Aneurysms arising from the proximal segment (A1) of the anterior cerebral artery (ACA) are relatively rare. Because of their small size, abnormal location in relation to the parent artery and the risk of damage to the surrounding perforators, their surgical management is a big challenge. We present our experience with 7 patients of A1 segment aneurysms.
SETTINGS AND DESIGN
Tertiary care referral center.
MATERIALS AND METHODS
Seven patients who were diagnosed with A1 aneurysms between 2009 and 2017 were included. Preoperative evaluation included Non-Contrast Computed Tomography (NCCT) head and angiography (Digital Subtraction Angiography with/without CT-Angiography). The clinicoradiological condition of the patients was graded as per World Federation of Neurological Surgeons (WFNS), Fisher and Hunt and Hess (H and H) Grading systems. A retrospective review of clinical features, radiological descriptions, surgical treatment, and outcomes was done.
RESULTS
All patients underwent microneurosurgical clipping. All aneurysms were saccular, ranging in size from 4 to 14 mm and neck size varied from 2 to10 mm. Most aneurysms 5 (71.4%) had a posterior direction. Anatomical variations were noticed in 3 (42.8%) patients. Posteroinferiorly directed aneurysms were difficult to clip. As per Glasgow Outcome scale (GOS), 6 (85.7%) patients had a good outcome, whereas 1 (14.2%) had poor outcome. As per the modified Rankin Scale (mRS) too, 6 (85.7%) had a favorable outcome. There were no deaths.
CONCLUSION
A1 aneurysms are frequently associated with vascular anomalies and generally rupture when small. A1 aneurysms with a superior and anterior direction are relatively easy to clip whereas those directed postero-inferiorly are difficult. Close association with critical perforators also compounds the situation. Due to the rarity of A1 aneurysms, large series are few in literature.
Topics: Adult; Aged; Aneurysm, Ruptured; Anterior Cerebral Artery; Female; Humans; Intracranial Aneurysm; Male; Microsurgery; Middle Aged; Neurosurgical Procedures; Surgical Instruments; Treatment Outcome
PubMed: 31744954
DOI: 10.4103/0028-3886.271266