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The Neuroradiology Journal Jun 2023Spinal filum terminale pial arteriovenous fistulas (FT PAVFs) are uncommon. Most FT PAVFs are located in the lumbar region; far fewer are located in the sacral region....
Spinal filum terminale pial arteriovenous fistulas (FT PAVFs) are uncommon. Most FT PAVFs are located in the lumbar region; far fewer are located in the sacral region. Due to the rarity of sacral FT PAVFs, the precise surgical dissection and removal of these lesions are challenging. Here, we report an FT PAVF in the sacral region. The patient was a 45-year-old male who suffered from progressive weakness and numbness of the bilateral lower limbs; his symptoms gradually worsened. Digital subtraction angiography (DSA) showed an AVF at the sacral canal at the S3-4 level. Microsurgical treatment with intraoperative DSA was performed, and the FT PAVF was resected. After the operation, the patient gradually recovered. Follow-up magnetic resonance imaging revealed a recession in the dilation of the spinal cord venous plexuses. A literature review was also performed, and a total of 14 FT PAVFs of the sacral region were identified. The patients identified in the literature review had an average age of 58.9 ± 12.9 years, and 92.9% of the patients were male. Spinal cord edema was present in 85.7% of the FT PAVF patients. Regarding treatment, 64.3% of the FT PAVF patients underwent microsurgical resection, 28.6% patients underwent endovascular treatment, and 7.1% patients underwent a hybrid operation; good outcomes were achieved with all three methods. Therefore, FT PAVF of the sacral region is a unique lesion whose angioarchitecture needs to be identified carefully; prompt treatment is necessary, and microsurgery can yield good outcomes.
Topics: Aged; Female; Humans; Male; Middle Aged; Arteriovenous Fistula; Cauda Equina; Magnetic Resonance Imaging; Sacrococcygeal Region; Spinal Cord Diseases
PubMed: 36086815
DOI: 10.1177/19714009221126017 -
Obstetrics and Gynecology Feb 2009To compare postoperative complication and reoperation rates for surgical procedures correcting apical vaginal prolapse. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare postoperative complication and reoperation rates for surgical procedures correcting apical vaginal prolapse.
DATA SOURCES
Eligible studies were selected through an electronic literature search covering January 1985 to January 2008 using PubMed, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews and Effects.
METHODS OF STUDY SELECTION
Only clinical trials and observational studies addressing apical prolapse repair and recurrence or complication rates were included. The search was restricted to original articles published in English with 50 or more participants and a follow-up period of 3 months or longer. Oral platform and poster presentations from the American Urogynecological Society, the Society for Gynecologic Surgeons, the International Urogynecological Association, and the International Continence Society from January 2005 to December 2007 were hand searched to determine whether they were eligible for inclusion.
TABULATION, INTEGRATION, AND RESULTS
Procedures were separated into three groups: traditional vaginal surgery, sacral colpopexy, and vaginal mesh kits. Complications were classified using the Dindo grading system. Weighted averages were calculated for each Dindo grade, complication, and reoperation. Dindo grade IIIa (433/3,425 women) and IIIb (245/3,425) rates were highest in the mesh kit group owing to higher rates of mesh erosion (198/3,425) and fistulae (8/3,425). Reoperation rates for prolapse recurrence were highest in the traditional vaginal surgery group (308/7,827). The total reoperation rate was greatest in the mesh kit group (291/3, 425, 8.5%).
CONCLUSION
The rate of complications requiring reoperation and the total reoperation rate was highest for vaginal mesh kits despite a lower reoperation rate for prolapse recurrence and shorter overall follow-up.
Topics: Female; Gynecologic Surgical Procedures; Humans; Incidence; Postoperative Complications; Reoperation; Suburethral Slings; Urologic Surgical Procedures; Uterine Prolapse
PubMed: 19155908
DOI: 10.1097/AOG.0b013e318195888d -
Journal of Neurointerventional Surgery Jan 2019Thoracolumbar and sacral spinal epidural arteriovenous fistulas (SEDAVFs) are an increasingly recognized form of spinal vascular malformation. The purpose of this study... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND PURPOSE
Thoracolumbar and sacral spinal epidural arteriovenous fistulas (SEDAVFs) are an increasingly recognized form of spinal vascular malformation. The purpose of this study was to perform a systematic review of the demographics, clinical presentation and treatment results of thoracolumbar SEDAVFs.
MATERIALS AND METHODS
Pubmed, Scopus and Web of Science databases were searched from January 2000 to January 2018 for articles on treatment of SEDAVFs. Pooled data of individual patients were analyzed for demographic and clinical features of SEDAVFs as well as treatment outcomes.
RESULTS
There were 125 patients from 11 studies included. Mean age was 63.5 years. There was a male sex predilection (69.6%). Sensory symptoms including pain or numbness were the most frequently presenting symptoms. Fistula location was the lumbosacral spine in 79.2% and the thoracic spine in 20.8%. Involvement of intradural venous drainage was more common than extradural venous drainage only (89.6% vs 10.4%). Of the 123 treated patients, endovascular therapy was performed in 67.5% of patients, microsurgery in 23.6%, and combined treatment in 8.9%. The overall complete obliteration rate was 83.5% and did not differ between groups. Clinical symptoms improved in 70.7% of patients, were stable in 25%, and worsened in 1.7% with no difference between treatment modalities.
CONCLUSIONS
Thoracic and lumbosacral SEDAVFs often present with symptoms secondary to congestive myelopathy or compressive symptoms. Both endovascular and microsurgical treatments were associated with high obliteration rates and good clinical outcomes.
Topics: Aged; Arteriovenous Fistula; Embolization, Therapeutic; Epidural Space; Female; Humans; Lumbosacral Region; Male; Microsurgery; Middle Aged; Sacrum; Spinal Diseases; Thoracic Arteries; Treatment Outcome
PubMed: 30166334
DOI: 10.1136/neurintsurg-2018-014203 -
Pediatric Surgery International Nov 2020This study reviewed the literature on the postoperative complications following laparoscopic-assisted anorectoplasty (LAARP).
AIM
This study reviewed the literature on the postoperative complications following laparoscopic-assisted anorectoplasty (LAARP).
METHODS
A Medline and Embase search was performed for the terms "anorectal malformation" (ARM) "laparoscopic" and "complication". Articles without English full text, review articles, systematic reviews, case reports, case series < 5 cases and duplicate articles were excluded. Two reviewers independently performed the eligibility assessment and data extraction. Data were collected for type of malformation, surgical technique, postoperative complications and functional outcomes RESULTS: The search retrieved 108 articles, of which 38 met the inclusion criteria and offered 1058 patients for analysis. Rectoprostatic and rectobladder neck fistula were the most common types of ARM in males, whereas it was the common cloaca in females. Analysis of complications demonstrated rectal prolapse (n = 149; 14.08%) being the most prominent, followed by urethral diverticulum (n = 32; 3.02%), anal stenosis (n = 37; 3.49%), recurrent fistula (n = 7; 0.66%) and rectal stricture (n = 4; 0.37%). Krickenbeck classification was used for functional assessment in 638 patients, with fecal soiling grade 2 or > 2 in 79. Data on functional outcome specific to the type of malformation was available for 246 patients: fecal soiling grade 2 or > 2 in 15/94 (15.95%) with rectoprostatic fistula, 26/73 (35.61%) with rectobladder neck fistula, 6/47 (12.76%) with common cloaca, and 1/22 (4.54%) with no fistula.
CONCLUSION
Rectal prolapse, posterior urethral diverticulum and anal stenosis are the most common complications after LAARP. Inconsistent and non-uniform functional assessment and non-availability of information about the sacrum and spine make it difficult to analyze the functional outcome following LAARP.
Topics: Anorectal Malformations; Humans; Laparoscopy; Postoperative Complications; Rectum
PubMed: 32980932
DOI: 10.1007/s00383-020-04748-3 -
Colorectal Disease : the Official... Mar 2019Three-dimensional (3D) printing has been recognized as a revolutionary technological innovation that has benefitted numerous disciplines, including medicine. The present...
AIM
Three-dimensional (3D) printing has been recognized as a revolutionary technological innovation that has benefitted numerous disciplines, including medicine. The present systematic review aimed to demonstrate the current applications of 3D printing in colorectal surgery along with the limitations and potential future applications of this innovation.
METHOD
A PRISMA-compliant systematic literature search of studies that applied 3D printing in colorectal surgery in the period from January 1990 to July 2018 was conducted. Electronic databases including PubMed/Medline, Scopus and the Cochrane Library were searched. All full-text original articles were eligible for inclusion.
RESULTS
Nine studies including 58 patients with a median age of 60.7 years were reviewed. The studies assessed 3D printing in patients with planned stoma construction, colon cancer with liver metastasis, right colon cancer, rectal cancer, intractable constipation and anal fistula. The applications of 3D printing were classified into three categories: patient education, preoperative planning and evaluation of response of colorectal liver metastasis to chemotherapy. 3D printed models aided in planning resection of colorectal liver metastasis, facilitating D3 lymphadenectomy in complete mesocolic excision, improving the understanding of pelvic anatomy in laparoscopic rectal cancer treatment, guiding electrode implantation in sacral neuromodulation for intractable constipation, and elucidating the morphology of anal fistula tract and anal sphincter muscles.
CONCLUSION
Colorectal surgery may benefit from 3D printing in enhancing patient education before stoma construction, preoperative planning and evaluation of the response of liver metastasis to chemotherapy using 3D ultrasonography.
Topics: Colorectal Neoplasms; Colorectal Surgery; Digestive System Surgical Procedures; Female; Humans; Liver Neoplasms; Male; Middle Aged; Models, Anatomic; Printing, Three-Dimensional
PubMed: 30457180
DOI: 10.1111/codi.14480