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Archives de Pediatrie : Organe Officiel... Sep 2013Anorectal malformations (ARM) are the result of an abnormal development of the terminal part of the digestive tract interesting anus and/or rectum that occur early...
Anorectal malformations (ARM) are the result of an abnormal development of the terminal part of the digestive tract interesting anus and/or rectum that occur early between the sixth and tenth week of embryonic development. They carry a malformation spectrum of severity depending on the level of disruption of the anorectal canal and of the associated caudal malformations (sacrum and spine). ARM are associated in over half the cases with other malformations that can be integrated in some cases in known syndromes. If surgical treatment to restore anatomy as normal as possible is indispensable, post-operative care is essential for these patients whose defecation mechanisms are altered, to reach if not continence, at least a socially acceptable cleanliness.
Topics: Anal Canal; Anorectal Malformations; Anus, Imperforate; Digestive System Surgical Procedures; France; Humans; Infant, Newborn; Postoperative Care; Prevalence; Prognosis; Quality of Life; Rectal Fistula; Rectum; Severity of Illness Index; Treatment Outcome
PubMed: 23992833
DOI: 10.1016/S0929-693X(13)71405-2 -
Urology Feb 2022Urosymphyseal fistula (UF) with osteomyelitis most commonly occurs as a result of prostate cancer and benign prostate hyperplasia therapy. UF presentation typically...
INTRODUCTION AND OBJECTIVE
Urosymphyseal fistula (UF) with osteomyelitis most commonly occurs as a result of prostate cancer and benign prostate hyperplasia therapy. UF presentation typically includes debilitating pelvic pain exacerbated with ambulation. Traditional management required open surgical genitourinary (GU) reconstruction with pubectomy leading to significant morbidity. However, progressive utilization of robotic approaches and advances in holmium laser technology has led to a less invasive alternative. Herein, we present our series of robotic-assisted holmium laser debridement of pubic osteomyelitis in the setting of UF.
METHODS
After physical exam, all patients presenting with concerns for GU fistula and osteomyelitis are evaluated with BMP, CBC, serum albumin, urine culture, and cystoscopy. Patients often present with previously obtained CT abdomen/pelvis. However, all patients presenting with concerns of pubic osteomyelitis should undergo a MRI of the pelvis to characterize the pubis. Specific indications for holmium laser debridement of the pubic bone include: 1) history of sacral insufficiency fractures which eliminate management with partial pubectomy due to risk of pelvic ring instability and 2) mild osteomyelitis which can be managed with debridement. The patient is placed in dorsal lithotomy position. After the robot is docked, the space of retzius is developed and the fistula is resected down to the pubic bone. The symphysis is debrided using the Cobra grasper followed by holmium laser debridement at 2J and 50Hz settings. Appropriate GU reconstruction versus urinary diversion is then performed per clinical judgement. Antibiotic beads are then placed in the symphyseal defect. If available, an interposition flap may be advanced between the urethra/bladder and symphysis.
RESULTS
In our series of four patients, all patients underwent successful robotic pubic symphyseal debridement and were discharged without experiencing a major complication. At follow up (7-16 months) there have been no fistula recurrence or recurrent episodes of osteomyelitis.
CONCLUSION
Robotic assisted pubic symphyseal debridement with a holmium laser is feasible, safe, and efficacious in this small series with short follow up. This approach represents a minimally invasive alternative to open pubectomy while minimizing incisions and overall morbidity. Additional long-term data is necessary before wide spread adoption of this approach.
Topics: Debridement; Fistula; Humans; Lasers, Solid-State; Male; Osteomyelitis; Pubic Bone; Pubic Symphysis; Robotic Surgical Procedures; Robotics
PubMed: 34740712
DOI: 10.1016/j.urology.2021.10.019 -
Spine Apr 2002A case of spinal dural arteriovenous fistula arising from a branch of the internal iliac artery is reported.
STUDY DESIGN
A case of spinal dural arteriovenous fistula arising from a branch of the internal iliac artery is reported.
OBJECTIVE
To report a rare case of spinal dural arteriovenous fistula supplied by a lateral sacral artery and treated with endovascular therapy.
SUMMARY OF BACKGROUND DATA
Spinal dural arteriovenous fistulas usually occur in the thoracic and lumbosacral regions and arise from the intercostal and lumbar arteries. Rarely, they may occur in the sacral region, as in the reported case.
METHODS
A 60-year-old man presented with progressive lower extremity paresis and decreased sensation below the waist of 6 months duration, which had progressed to paraparesis. Diagnostic imaging included magnetic resonance imaging and spinal angiography.
RESULTS
A sacral spinal dural arteriovenous fistula was diagnosed with spinal angiography, which showed the spinal dural arteriovenous fistula arising from the right lateral sacral artery branches at S2, and magnetic resonance imaging, which showed enlarged pial vessels along the surface of the spinal cord and central cord hyperintensity, with peripheral hypointensity on T2-weighted images. The patient was definitively treated with endovascular therapy using polyvinyl alcohol particles and Tornado coils. His symptoms almost completely resolved within 6 months of therapy.
CONCLUSIONS
Although surgical ligation is the treatment of choice, endovascular therapy may be an effective treatment for patients with sacral region spinal dural arteriovenous fistula in cases of high surgical risk. Spinal angiography remains the definitive diagnostic examination for pinpointing the site of the dural arteriovenous fistula.
Topics: Angiography; Arteries; Central Nervous System Vascular Malformations; Embolization, Therapeutic; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Paraparesis; Sacrococcygeal Region; Sacrum; Spinal Diseases; Treatment Outcome
PubMed: 11935116
DOI: 10.1097/00007632-200204150-00023 -
World Neurosurgery Oct 2019Filum terminale arteriovenous fistulae (FTAVFs) are rare entities. For those with the fistulous point located in the lower sacral region (below S2), neither surgical nor...
BACKGROUND
Filum terminale arteriovenous fistulae (FTAVFs) are rare entities. For those with the fistulous point located in the lower sacral region (below S2), neither surgical nor endovascular strategies are the optimal treatment.
CASE DESCRIPTION
We describe 2 FTAVF cases with the fistulous point below S2: one had the anterior spinal artery (ASA) as a single feeder with a long distance to the fistula and the other developed an inaccessible feeder after the initial non-ASA feeder embolization. In a hybrid operating room, through an L4 laminectomy, we surgically exposed and cannulated the cephalad draining vein, other than the feeding arteries, to retrograde occlude the proximal draining vein along with the fistulous point and feeders using Onyx. All shunt points were obliterated with the help of intraoperative digital subtraction angiography.
CONCLUSIONS
Retrograde embolization of the draining vein to obliterate FTAVFs in the lower sacral region is feasible and complete. This technique may provide a new treatment option for FTAVFs.
Topics: Angiography, Digital Subtraction; Arteriovenous Fistula; Catheterization; Cauda Equina; Central Nervous System Vascular Malformations; Embolization, Therapeutic; Humans; Laminectomy; Male; Middle Aged; Sacrococcygeal Region; Vertebral Artery
PubMed: 31299309
DOI: 10.1016/j.wneu.2019.06.236 -
Journal of Neurosurgery. Spine May 2008A rectothecal fistula secondary to anterior sacral meningocele is an extremely rare disease. To the authors' knowledge, only 2 cases have been reported in the...
A rectothecal fistula secondary to anterior sacral meningocele is an extremely rare disease. To the authors' knowledge, only 2 cases have been reported in the English-language literature. It can cause symptoms by compressing adjacent structures, causing urinary difficulties and constipation. The authors report an unusual case of a patient in whom this condition was diagnosed as an incidental finding. The patient had a sacral myelomeningocele with secondary meningitis to a rectothecal fistula. The authors will briefly review the diagnosis, the various treatments, and the surgical approach to treat this infrequent entity.
Topics: Constipation; Fistula; Humans; Male; Meningitis, Bacterial; Meningocele; Middle Aged; Rectal Fistula; Sacrum; Spinal Canal; Spinal Diseases; Urination Disorders
PubMed: 18447698
DOI: 10.3171/SPI/2008/8/5/487 -
Journal of Neurointerventional Surgery Apr 2018Sacral dural arteriovenous fistulas (DAVFs) are rare vascular abnormalities of the spine characterised by slowly progressive symptoms that can mimic different myelopathy... (Review)
Review
BACKGROUND
Sacral dural arteriovenous fistulas (DAVFs) are rare vascular abnormalities of the spine characterised by slowly progressive symptoms that can mimic different myelopathy disorders.
OBJECT
To report our single Institution experience with sacral DAVFs.
METHODS
We retrospectively reviewed the clinical records of patients admitted from 1 January 2006 to 31 December 2016 with a diagnosis of sacral DAVFs, treated by endovascular embolisation or surgical clipping. Clinical presentation, imaging characteristics, treatment results and follow-up were analysed.
RESULTS
We identify 13 patients with sacral DAVFs supplied by lateral sacral arteries. Clinical presentation was characterised by different degrees of motor weakness and sphincter disturbances. In all patients, spinal MRI showed spinal cord hyperintensities with enhancement and prominent perimedullary vessels. Selective internal iliac angiography was mandatory to identify the exact location of the fistula. A complete embolisation was achieved in eight patients performing a single endovascular embolisation and in three patients performing a single surgical disconnection: two patients required combined procedures. Follow-up imaging showed a complete resolution of the spinal cord hyperintensities in 81% of patients and a reduction of the intramedullary enhancement in 91%. Gait improvement was observed in 73% of patients, while remaining stable in 27%. Sphincter disturbances improved in 36% of patients and remained stable in 64%.
CONCLUSION
Awareness of sacral location of DAVFs is critical because standard spinal angiography will not identify sacral supplies, unless internal iliac arteries are properly examined. In our experience, the endovascular treatment show results comparable to surgery when the fistula point is correctly disconnected.
Topics: Adult; Aged; Angiography; Central Nervous System Vascular Malformations; Embolization, Therapeutic; Endovascular Procedures; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sacrum; Treatment Outcome
PubMed: 29025963
DOI: 10.1136/neurintsurg-2017-013307 -
Neurosurgery Jun 1985A patient who sustained an isolated transverse sacral fracture is presented. A large ventral sacral pseudomeningocele with cerebrospinal fluid (CSF) fistula developed....
A patient who sustained an isolated transverse sacral fracture is presented. A large ventral sacral pseudomeningocele with cerebrospinal fluid (CSF) fistula developed. Eighteen previous cases of traumatic pseudomeningocele have been documented. A review of those cases leads these authors to conclude that: transverse sacral fractures are rare and have not been reported in association with a pseudomeningocele formation; at the 4th sacral vertebra, this is the lowest reported pseudomeningocele; and CSF fistula with sacral fracture is distinctly uncommon, reported in only one previous case. The presenting symptoms, diagnostic evaluation, treatment, and prognosis are discussed.
Topics: Adult; Fistula; Fractures, Bone; Humans; Male; Meningocele; Myelography; Sacrum; Spinal Diseases; Tomography, X-Ray Computed
PubMed: 4010910
DOI: 10.1227/00006123-198506000-00022 -
Interventional Neurology Mar 2017The authors report 2 cases of sacral dural arteriovenous fistula (AVF) presenting with gradual neurologic decline characterized by progressive lower extremity weakness...
The authors report 2 cases of sacral dural arteriovenous fistula (AVF) presenting with gradual neurologic decline characterized by progressive lower extremity weakness and bowel and bladder incontinence. Spinal angiography demonstrated a sacral dural AVF with perimedullary vein engorgement and drainage extending to the level of the cervical spine in both cases. The fistulas were completely obliterated with n-BCA (-butyl cyanoacrylate) embolic agent in one case, and with ethylene vinyl alcohol (Onyx) in the second, resulting in improvement of the symptoms in both patients. The unique features of this case report include the rare location of the fistula's origin, the necessity for complete spinal angiography, and the use of intraoperative monitoring in one case to guide embolization treatment.
PubMed: 28611837
DOI: 10.1159/000454929 -
Child's Nervous System : ChNS :... Apr 2024In this case report, we aimed to describe the clinical presentation, surgical approach, and follow-up of a patient with rare anterior meningocele associated with...
In this case report, we aimed to describe the clinical presentation, surgical approach, and follow-up of a patient with rare anterior meningocele associated with rectothecal fistula. An 17-year-old female patient was admitted to the emergency department with meningitis. On further examinations, an anterior sacral meningocele accompanied by rectothecal fistula was detected. Appropriate antibiotic treatment was arranged and surgical plan was made with the pediatric surgery clinic. The patient underwent meningocele repair via posterior approach and colostomy operation. The patient did not experience any neurological issues after the surgery. The colostomy was reversed 3 months later, and third-month follow-up MRI showed complete regression of the meningocele sac with no neurological complications. Anterior meningocele accompanied by a rectothecal fistula is a rare and complicated case. Only seven cases of coexisting ASM and RTF have been reported in literature. Although both anterior and posterior approaches have been used for the treatment of ASM, the choice of treatment is essentially based on the patient's clinical and imaging findings.
Topics: Female; Child; Humans; Adolescent; Meningocele; Fistula; Spinal Diseases; Sacrum; Magnetic Resonance Imaging
PubMed: 38224364
DOI: 10.1007/s00381-024-06286-y -
Journal of Neurosurgery Nov 1989A patient presenting with progressive paraparesis was found to have a dural sacral arteriovenous (AV) fistula. His condition deteriorated abruptly after thoracolumbar...
A patient presenting with progressive paraparesis was found to have a dural sacral arteriovenous (AV) fistula. His condition deteriorated abruptly after thoracolumbar angiography. Embolization of the fistula improved the patient's status so that he was able to walk with crutches. One year later his neurological condition worsened. He was treated via an enlarged laminectomy because of uncertainty concerning a lipoma noted on the initial computerized tomography scan. The lesion consisted of an intradural filum terminale lipoma associated with an AV fistula, both of which were excised. The patient's condition was unchanged 6 months later. The different types of spinal lipomas and spinal AV malformations are reviewed, and mechanisms are proposed to explain the clinical deterioration in this patient. Venous hypertension seems to be the most likely possibility. The lipoma may have produced local hypervascularization of the dura mater with a subsequently acquired AV fistula.
Topics: Arteriovenous Fistula; Dura Mater; Humans; Lipoma; Male; Middle Aged; Spinal Cord; Spinal Cord Neoplasms
PubMed: 2809732
DOI: 10.3171/jns.1989.71.5.0768