A Minimally Invasive Endoscopic Technique for Fascia Lata Graft Acquisition and Fascial Reapproximation

2020 ◽  
Author(s):  
Jesse Skoch ◽  
Mauricio J Avila ◽  
Vernard S Fennell ◽  
Nikolay L Martirosyan ◽  
Ali A Baaj ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Case Series ◽  
Fascia Lata ◽  
Blunt Dissection ◽  
Endoscopic Neurosurgery ◽  
Novel Technique ◽  
Small Incision ◽  
Fascia Lata Graft ◽  
Endoscopic Retrieval

Abstract BACKGROUND Fascia lata remains a popular and robust graft to repair osteodural defects in endoscopic neurosurgery. Classically, this graft is obtained via a large incision in the thigh that is prone to pain and muscle herniation after surgery. OBJECTIVE To present a novel technique for harvesting fat and fascia lata graft and reapproximating the edges via an endoscopic approach through the thigh using an “outside-in” technique to prevent muscle herniation. METHODS Initially our technique was performed in cadavers and includes the following: small 2 cm incision in the lateral thigh to accommodate the endoscope, use of blunt dissection and endoscopic tools to obtain the graft, and reapproximation of the fascia via an outside-in technique using conventional sutures with endoscopic visualization to retrieve the sutures beneath the skin and tie them. We then applied the technique to a patient undergoing transsphenoidal tumor resection. RESULTS This technique was trialed in 3 cadaver specimens (6 limbs) and was used successfully in a patient with excellent cosmetic results seen in follow-up. CONCLUSION Endoscopic retrieval of fascia lata is feasible via a very small incision. Reapproximation of the cut fascial edges to minimize muscle herniation can quickly and easily be performed with an outside-in technique detailed here. Additional case series may help to solidify the endoscopic retrieval as a preferred technique for fascia lata graft.

Primary Calvarial Ewing Sarcoma: A Case Series

2021 ◽  
Author(s):  
Sandeep Mohindra ◽  
Manjul Tripathi ◽  
Aman Batish ◽  
Ankur Kapoor ◽  
Ninad Ramesh Patil ◽  
...  
Keyword(s):  
Ewing Sarcoma ◽  
Tumor Resection ◽  
Case Series ◽  
Radical Excision ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Intradural Tumor ◽  
Age Range

Abstract Background Calvarial Ewing tumor is a relatively rare differential among bony neoplasms. We present our experience of managing primary calvarial Ewing sarcoma (EWS), highlighting their clinical and radiological findings. Method In a retrospective analysis, we evaluated our 12-year database for pathologically proven EWS. A literature search was conducted for the comparative presentation and update on the management and outcome. Result From January 2008 to December 2020, we managed eight patients (male:female = 5:3; age range 6 months to 19 years, mean 11.5 years) harboring primary calvarial EWS. All cases underwent wide local excision; two patients required intradural tumor resection, while one required rotation flap for scalp reconstruction. Mean hospital stay was 8 days. All patients received adjuvant chemo- and radiotherapy. Three patients remained asymptomatic at 5 years of follow-up, while two patients died. Conclusion Primary calvarial EWS is a rare entity. It usually affects patients in the first two decades of life. These tumors can be purely intracranial, causing raised intracranial pressure symptoms, which may exhibit rapidly enlarging subgaleal tumors with only cosmetic deformities or symptoms of both. Radical excision followed by adjuvant therapy may offer a favorable long-term outcome.

Reconstruction with Custom Unicondylar Hemiarthroplasty following Tumor Resection: A Case Series and Review of the Literature

2019 ◽  
Vol 33 (08) ◽  
pp. 818-824
Author(s):  
Joseph A. Ippolito ◽  
Megan L. Campbell ◽  
Brianna L. Siracuse ◽  
Joseph Benevenia
Keyword(s):  
Distal Femur ◽  
Weight Bearing ◽  
Tumor Resection ◽  
Case Series ◽  
Full Weight Bearing ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Optimal Function ◽  
Tumor Involvement

AbstractFor patients with tumors of the distal femur, options for limb salvage include tumor resection followed by reconstruction. While reconstruction commonly involves a distal femoral replacement, careful selection of patients with tumor involvement limited to a single condyle may be candidates for reconstruction with distal femur hemiarthroplasty. In these procedures, resection spares considerably more native anatomy. Three consecutive patients who underwent resection and reconstruction at the distal femur with custom unicondylar hemiarthroplasty are presented in this case series at a mean follow-up of 45 months (range, 26–78). In two cases, prostheses were utilized as a secondary procedure after failure of initial reconstruction. In one case, the custom prosthesis was utilized as the primary method of reconstruction. Mean Musculoskeletal Tumor Society disease-specific scores were 26.7 (range, 25–28). All patients achieved a return to full weight bearing, activities of daily living, and functional range of motion. In appropriately selected patients with tumors of the distal femur, reconstruction with custom unicondylar hemiarthroplasty provides benefits including optimal function postoperatively via preservation of tumor-free bone and ligamentous structures. Additionally, maintenance of greater bone stock may confer benefits to patients with pathology at a high likelihood for recurrence and need for subsequent procedures.

A 10-min novel technique for involutional entropion: Mini-incisional continuous ligation everting sutures

2021 ◽  
pp. 112067212110500
Author(s):  
Yong M Choi ◽  
Namju Kim
Keyword(s):  
Recurrence Rate ◽  
Surgical Outcome ◽  
Case Series ◽  
Interquartile Range ◽  
Retrospective Case ◽  
Novel Technique ◽  
Time To Recurrence ◽  
Involutional Entropion ◽  
Surgical Modality

Purpose To introduce a novel technique of mini-incisional continuous ligation everting sutures for correction of involutional entropion and report the surgical outcome. Methods A retrospective case series. Eighty-five eyelids of 77 patients who underwent correction of involutional lower lid entropion using mini-incisional continuous ligation everting sutures were included in this study. The medical records of patients with at least 24 months of follow-up after surgery were reviewed. We collected information on demographic and clinical characteristics, including sex, age at surgery, duration of follow-up, horizontal lid laxity, surgical outcomes, and complications. Main outcome measures were success of surgery, recurrence rate, time to recurrence, and risk factors for recurrence. Results The median (interquartile range) age at the time of surgery was 72.0 (65.5–78.0) years and the median (interquartile range) follow-up duration was 24.0 (24.0–42.5) months. Thirty-seven eyelids (43.5%) showed horizontal eyelid laxity on a lid distraction test The surgical outcome was successful in the majority of patients (94.1%) with a recurrence rate of 5.9% in the 2 years after surgery. Only female sex was significantly correlated with recurrence of entropion (odds ratio 9.466, 95% confidence interval 1.022 to 87.670, P  =  0.048). Conclusion This novel technique is a promising surgical modality for correction of lower lid involutional entropion because of its ease of application, simplicity, compatibility with anticoagulants, and low recurrence rate.

Frey's Syndrome - A Technical Remedyr

1975 ◽  
Vol 84 (6) ◽  
pp. 734-739 ◽  
Author(s):  
Roy B. Sessions ◽  
David T. Roark ◽  
Bobby R. Alford
Keyword(s):  
Fascia Lata ◽  
The Other ◽  
Long Term Results ◽  
Frey’S Syndrome ◽  
Frey's Syndrome ◽  
Long Term Follow Up ◽  
Fascia Lata Graft ◽  
Sufficient Magnitude

The symptoms of Frey's syndrome are occasionally of sufficient magnitude to warrant curative treatment. In four patients, a fascia lata graft was placed under the involved skin in an attempt to offer permanent relief from the cutaneous discomfort suffered during eating. Two of these patients have excellent long-term results. The other two patients were lost to long-term follow-up but were asymptomatic several months following grafting.

Transmucosal diverticular myotomy for the treatment of oesophageal diverticula associated with spastic motility disorders

Gut ◽  
2020 ◽  
Vol 69 (9) ◽  
pp. 1552-1554 ◽  
Author(s):  
Mayenaaz Sidhu ◽  
David J Tate ◽  
Michael J Bourke
Keyword(s):  
Case Series ◽  
Clinical Results ◽  
Motility Disorder ◽  
Adverse Outcomes ◽  
The Novel ◽  
Significant Morbidity ◽  
Motility Disorders ◽  
Endoscopic Techniques ◽  
Novel Technique

Thoracic oesophageal diverticula are often associated with spastic motility disorders. Despite correction of the underlying motility disorder, in a subgroup of patients, symptoms persist, primarily regurgitation. Surgical diverticulectomy is then proposed; however, as the approach is thoracoscopic or via thoracotomy, it is associated with significant morbidity and cost. Descriptions of endoscopic techniques for the treatment of symptomatic midoesophageal diverticula are few. We propose the novel technique of diverticular myotomy (DM) to treat this disorder. In this case series, we describe two patients who successfully underwent DM with no adverse outcomes and excellent clinical results at 24-month follow-up.

A Case Series of Surgically Treated Spinal Dumbbell Tumors of Critical Parent Nerve Roots: To Cut or Not to Cut?

2020 ◽  
Author(s):  
Vicki Marie Butenschoen ◽  
Nikolaus Kögl ◽  
Bernhard Meyer ◽  
Claudius Thomé ◽  
Maria Wostrack
Keyword(s):  
Motor Function ◽  
Nerve Root ◽  
Tumor Resection ◽  
Case Series ◽  
Neurological Deficits ◽  
Motor Deficits ◽  
Nerve Roots ◽  
Dumbbell Tumor ◽  
Lumbar Level

Abstract BACKGROUND Dumbbell tumors present challenging cases, with either an incomplete tumor resection or a need to sacrifice nerve roots. Published literature suggests encouraging neurological outcomes after nerve root amputation. OBJECTIVE To determine the incidence of postoperative neurological deficits after amputating the parent nerve root. METHODS A retrospective consecutive analysis of all patients treated for dumbbell nerve sheet tumors with a reported amputation of the functional relevant parent nerve roots C5-Th1 and L3-S1. RESULTS Among 21 evaluated patients, minor postoperative neurological motor function deterioration occurred in 4 patients (19%). Most patients recovered to the preoperative level at the follow-up examination, and only one patient retained a new Medical Research Council (MRC) scale of 4/5 for deltoid weakness. The majority of tumors were resected at the lumbar level (nerve root L3: 28.6%, L5: 19%). Gross total resection was achieved in 90.5% of patients. Neuropathic pain was reported in one third of the patients during the long-term follow-up. CONCLUSION Amputating critical parent nerve roots during the dumbbell tumor resections seems to result in a low incidence of postoperative motor deficits and may offer an acceptable sacrifice in otherwise only incompletely resectable dumbbell tumors. The cross-innervation of neighboring nerve roots and its, probably, per-se-reduced functionality may be a possible mechanism for maintaining motor function.

scholarly journals Novel technique using tensor fascia lata graft to reconstruct a floor of mouth postablative defect from invasive ectopic papillary carcinoma of the thyroglossal duct tract

2019 ◽  
Vol 101 (7) ◽  
pp. e160-e163
Author(s):  
D Izadi ◽  
S Al-Zahid ◽  
J Smith ◽  
CG Wallace
Keyword(s):  
Rare Case ◽  
Fascia Lata ◽  
Papillary Thyroid ◽  
Tensor Fascia Lata ◽  
Thyroglossal Duct ◽  
Floor Of Mouth ◽  
Novel Technique ◽  
Fascia Lata Graft ◽  
Tongue Position ◽  
Normal Speech

We describe a rare case of ectopic papillary thyroid cancer in the thyroglossal duct tract invading the floor-of-mouth musculature. The postablative defect was reconstructed with a bone-anchored tensor fascia lata graft to resuspend the floor of mouth to the mandible as a neogeniohyoid sling, enabling maintenance of a functional tongue position for normal speech and swallowing. This reconstruction should be considered when suprahyoid musculature is resected without breaching the oral lining.

scholarly journals A 540° posterior-anterior-posterior approach for 360° fused rigid severe cervical kyphosis: patient series

2022 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Posterior Approach ◽  
Tumor Resection ◽  
Case Series ◽  
Combined Approach ◽  
Cervical Kyphosis ◽  
Anterior Plate ◽  
Bone Fusion ◽  
Posterior Anterior ◽  
Anterior Posterior

BACKGROUND Treatment of severe rigid 360° fused cervical kyphosis (CK) is challenging and often requires a combined approach for ankylosis release, establishment of sagittal balance, and fixation with fusion. OBSERVATIONS Four patients with iatrogenic 360° fused severe rigid CK (Cobb angle ≥40°) were enrolled for this retrospective analysis. All patients in the case series were female, with an average age of 27 years. All patients previously underwent posterior laminectomy/laminoplasty and cervical tumor resection when they were children (13–17 years). They underwent correction surgery with a 540° posterior-anterior-posterior approach. Preoperative and final follow-up radiography and computed tomography (CT) were used to evaluate kyphosis correction, internal fixation implants, and bone fusion. The preoperative and final follow-up average C2–7 Cobb angles were −32.4° ± 12.0° and 5.3° ± 7.1°, respectively. Preoperative and final follow-up CK angles averaged −47.2° ± 7.4° and −0.9° ± 16.1°, respectively. The mean correction angle was 46.3° ± 9.6°. At final follow-up, CT showed stable fixation and solid bone fusion. LESSONS The rare iatrogenic severe kyphosis with 360° ankylosis requires a combined approach. The 540° posterior-anterior-posterior approach can completely release the bony fusion, and the CK can be corrected using an anterior plate. This technique can achieve good results and is an effective strategy.

scholarly journals Intracranial solitary fibrous tumor/hemangiopericytoma – A case series

2020 ◽  
Vol 11 ◽  
pp. 414
Author(s):  
Chi-Man Yip ◽  
Shu-Shong Hsu ◽  
Wei-Chuan Liao ◽  
Szu-Hao Liu ◽  
Yung-Shang Lin ◽  
...  
Keyword(s):  
Solitary Fibrous Tumor ◽  
Adjuvant Radiotherapy ◽  
Tumor Resection ◽  
Case Series ◽  
Extent Of Resection ◽  
Treatment Modalities ◽  
Total Resection ◽  
Initial Surgery ◽  
Fibrous Tumor

Background: Intracranial solitary fibrous tumor/hemangiopericytoma (HPC) is a rare and aggressive tumor. We conducted this retrospective study to investigate the outcome of patients after treatment, the efficacy of postoperative adjuvant radiotherapy, and the factors not conducive to total resection. Methods: We conducted a retrospective review of the medical records of patients harboring fresh intracranial solitary fibrous tumor/HPC treated from January 2009 to December 2019 in our hospital. We reviewed their clinical presentations, radiologic appearances, tumor size and location, extent of resection, estimate intraoperative blood loss, treatment modalities and results, and duration of follow-up. Results: There were seven consecutive patients (three males and four females). The ages of the patients at the time of diagnosis ranged from 35 to 77 years (mean: 52.86 years). Five patients (71.43%) got tumor bigger than 5 cm in dimension and only 1 patient (14.29%) underwent gross total tumor resection in the first operation without complication. Five patients (71.43%) underwent postoperative adjuvant radiotherapy. Follow-up period ranged from 4.24 to 123.55 months and the median follow-up period was 91.36 months. Three patients had favorable outcome with Glasgow Outcome Scale (GOS) equal to 4; four patients had unfavorable outcome with GOS equal to 2 or 3. No mortality was happened. Conclusion: Gross total tumor resection in the initial surgery is very important to achieve a better outcome. Massive intraoperative bleeding and venous sinus or major vessels adjoining are factors not conducive to total resection. Radiotherapy can be administered as adjuvant therapy for cases showing an aggressive phenotype or not treated with gross total resection.

scholarly journals Preservation of olfactory function following endoscopic resection of select malignancies of the nasal vault

2012 ◽  
Vol 2 (1) ◽  
pp. 5 ◽  
Author(s):  
Yew Kwang Ong ◽  
C. Arturo Solares ◽  
Ricardo L. Carrau ◽  
Daniel M. Prevedello ◽  
Amin B. Kassam
Keyword(s):  
Skull Base ◽  
Endoscopic Resection ◽  
Tumor Resection ◽  
Case Series ◽  
Anterior Skull Base ◽  
Olfactory Function ◽  
Lateral Nasal Wall ◽  
Retrospective Case ◽  
Case Series Study

Preservation of olfactory function during anterior skull base surgery has been previously described. However, its feasibility during oncological resection remains undefined. The aim of this study was to clarify the feasibility of preserving olfactory function in select patients undergoing oncological anterior skull base resection via endonasal endoscopic approach. This is a retrospective case series study. Postoperatively, all patients underwent a standardized smell identification test (Sensonics Inc., Haddon, NJ, USA). From January 2002 to December 2009, we attempted to preserve olfactory function in 9 patients who required an endoscopic resection involving the anterior skull base for treatment of various malignancies presenting unilateral extension. These included: esthesioneuroblastoma (n=6), squamous cell carcinoma (n=1), adenocarcinoma (n=1) and hemangiopericytoma (n=1). In 7 patients, resection included a unilateral endoscopic craniectomy with preservation of the contralateral middle and superior turbinates. Two patients underwent resection of the entire lateral nasal wall and the olfactory epithelium as the superior limit of tumor resection. Six patients received adjuvant radiotherapy. Postoperatively, olfaction was documented in 7 patients (3 normosmic, 4 microsmic). All patients are free of recurrence at the original site at a mean follow-up period of 55.7 months (range 21-101 months). One patient with an esthesioneuroblastoma developed a cervical lymph node recurrence four years after surgery. In selected cases, it is feasible to preserve olfactory function without apparent compromise of oncological outcomes. The success rate depends largely on the extent of the resection, which, in turn, is dictated, by the extent of the tumor.

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