scholarly journals Neurointerventional “Near Morbidity”: A Candid Appraisal of an Early Case Series

2018 ◽  
Vol 7 (6) ◽  
pp. 419-430 ◽  
Author(s):  
Bradley A. Gross ◽  
Ashutosh P. Jadhav ◽  
Tudor G. Jovin ◽  
Brian T. Jankowitz
Keyword(s):  
Case Series ◽  
Neurological Complications ◽  
Medical Complications ◽  
Complication Rates ◽  
Safety And Efficacy ◽  
Technical Complications ◽  
Neurological Morbidity ◽  
Technical Issues ◽  
Early Case ◽  
Permanent Morbidity

Background: Modern case series often focus on emphasizing low complication rates, “safety,” and “efficacy.” Although patients may not suffer significant or obviously apparent neurological complications, many lessons are buried in the “no complications” cohort. Methods: The junior author’s prospectively maintained caselog was reviewed over a 1-year period for both symptomatic and “minor”/technical complications of neurointerventional cases, the latter referring to an intraprocedural inability to treat a lesion, suboptimal result, or potentially morbid angiographic occurrence/finding that did not result in permanent neurological morbidity – neurointerventional “near morbidity” (NNM). Results: Of 602 treatments performed over the reviewed period, 163 were interventional neuroendovascular procedures. The most common neuroendovascular procedure performed was stroke thrombectomy (67 cases). Major neurological complications, defined as symptomatic stroke or hemorrhage, occurred in 7 cases (4%). NNM, consisting of instructive, technical issues arose in an additional 9 cases that did not result in neurological morbidity (6%). Overall, in 20/163 cases (12%), there were either major neurological complications, NNM, groin complications, or major medical complications. Conclusions: “Minor”/technical complications – NNM – can be as instructive and illustrative as major complications despite not resulting in permanent morbidity. In reviewing case series, particularly early in one’s career, these cases should be highlighted.

scholarly journals SURG-21. STEREOTACTIC BIOPSY FOR DEEP SEATED BRAIN LESIONS USING THE LEKSELL STEREOTACTIC FRAME SYSTEM

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi244-vi244
Author(s):  
Takamitsu Fujimaki ◽  
Sachiko Hirata ◽  
Naruhiko Terano ◽  
Kenji Wakiya ◽  
Jun-ichi Adachi ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Stereotactic Biopsy ◽  
Case Series ◽  
Neurological Complications ◽  
Cerebral White Matter ◽  
Complication Rates ◽  
Glial Tumor ◽  
Plastic Tube ◽  
Stereotactic Frame ◽  
Lower Complication

Abstract PURPOSE To evaluate the results of stereotactic biopsies. PATIENTS AND METHODS Fifty-two patients with intraaxial lesions suspected of brain tumor. The locations of lesions includes, 19 deep cerebral white matter, 9 basal ganglia, 10 thalamus, 4 midbrain and 6 pons. Patients age ranged from 9 to 86 years (median 65 years), 33 were men and 19 were women. Under local anesthesia the Leksell stereotactic frame was fixed and the MRI were taken. Neuroimages such as enhanced CT scan or PET study were also used as references. After MRI patients were transferred to OR and under general anesthesia, several samples were taken with 2.1mm diameter needle by aspiration. Most of the cases the biopsy was done through frontal lobe, but in some cases through temporal lobe or through cerebellum. The samples were taken deeper and nearer regions of the designed targets with same trajectory, also. If there were cysts, aspiration of the cyst was performed as much as possible. The trajectory should avoid sulci, cortical veins or ventricular system. After biopsy inside the needle were irrigated repeatedly with 0.1 - 0.2 ml saline using thin plastic tube until the fluid does not contain bloody fluids to ensure hemostasis. RESULTS In all patients appropriate samples for pathological diagnosis were obtained. The diagnoses were 28 gliomas (pilocytic 1, grade II 8, grade III 11, grade VI (GBM) 6, high grade 1, glial tumor 1), 17 lymphomas, 3 germinoma and 2 were non-tumorous pathology. There were no symptomatic bleeding nor neurological complications. CONCLUSION With detailed planning, stereotactic biopsy was safely performed even from basal ganglia or brainstem. Trajectories other than from frontal can be also considered for some lesions. Repeated irrigation with saline might effective to prevent symptomatic bleeding and this case series shows lower complication rates compared to the published literatures.

scholarly journals Use of N-Butyl Cyanoacrylate Embolization in the Treatment of Venous İnsufficiency Case Series

2021 ◽  
Author(s):  
Zafer Cengiz Er ◽  
Alper İbrahim Tosya
Keyword(s):  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Color Doppler ◽  
Case Series ◽  
Operation Time ◽  
Average Diameter ◽  
Neurological Complications ◽  
Venous Stasis ◽  
Complication Rates ◽  
Vena Saphena Magna

Objective: Objective of this study is to analyze the results of patients who underwent embolization treatment with n-butyl cyanoacrylate in vena saphena magna due to chronic venous insufficiency (CVi). Methods: 241 patients who underwent saphena ablation due to venous stasis between January 2017 and 2020 at Bozok University Medical Faculty Hospital were included in the study. Cyanoacrylate embolization (CAE) was performed on 249 extremities in 241 patients with vena saphena magna (VSM) diameter above 5.5 mm and saphena-femoral junction reflux duration longer than 0.5 s as measured by Color Doppler Ultrasonography (CDU). Patients were followed up with clinical examination at post-op Day 7 post-op and CDU scans at Months 1 and 6. Results: Mean age was 42.7±12.35 years, and the average diameter of the saphenous vein was 8.21±2.5. The operation time was 15.27 minutes on average and the patients were discharged on the same day. Thrombophlebitis developed in 12 (4.81%) of our cases; cellulitis in 4 patients (1.60%); and erythema on the skin over the trace of the saphenous vein in 20 patients (8.03%) and improved with medical treatment. Partial recanalization was identified in 8 VSMs (3.21%) in CDU controls at Month 6. No patients developed deep vein thrombosis or neurological complications. Conclusion: Shorter operation and discharge durations, high VSM obliteration, low complication rates are the outstanding properties of CAE. The fact that the technique is limited with patients with tortuous veins as is the case with all procedures requiring a catheter has not been able to completely exclude conventional surgery.

scholarly journals Neurological symptoms, manifestations, and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19)

2021 ◽  
Author(s):  
Biyan Nathanael Harapan ◽  
Hyeon Joo Yoo
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Case Reports ◽  
Case Series ◽  
Altered Mental Status ◽  
Neurological Complications ◽  
Neurological Symptoms ◽  
Neurological Manifestations ◽  
Fisher Syndrome ◽  
Novel Coronavirus ◽  
The Impact

AbstractSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, is responsible for the outbreak of coronavirus disease 19 (COVID-19) and was first identified in Wuhan, China in December 2019. It is evident that the COVID-19 pandemic has become a challenging world issue. Although most COVID-19 patients primarily develop respiratory symptoms, an increasing number of neurological symptoms and manifestations associated with COVID-19 have been observed. In this narrative review, we elaborate on proposed neurotropic mechanisms and various neurological symptoms, manifestations, and complications of COVID-19 reported in the present literature. For this purpose, a review of all current published literature (studies, case reports, case series, reviews, editorials, and other articles) was conducted and neurological sequelae of COVID-19 were summarized. Essential and common neurological symptoms including gustatory and olfactory dysfunctions, myalgia, headache, altered mental status, confusion, delirium, and dizziness are presented separately in sections. Moreover, neurological manifestations and complications that are of great concern such as stroke, cerebral (sinus) venous thrombosis, seizures, meningoencephalitis, Guillain–Barré syndrome, Miller Fisher syndrome, acute myelitis, and posterior reversible encephalopathy syndrome (PRES) are also addressed systematically. Future studies that examine the impact of neurological symptoms and manifestations on the course of the disease are needed to further clarify and assess the link between neurological complications and the clinical outcome of patients with COVID-19. To limit long-term consequences, it is crucial that healthcare professionals can early detect possible neurological symptoms and are well versed in the increasingly common neurological manifestations and complications of COVID-19.

scholarly journals Complications and Revisions After Spine Surgery in Patients With Skeletal Dysplasia: Have We Improved?

2021 ◽  
pp. 219256822199478
Author(s):  
Karim Shafi ◽  
Francis Lovecchio ◽  
Maria Sava ◽  
Michael Steinhaus ◽  
Andre Samuel ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Skeletal Dysplasia ◽  
Spinal Surgery ◽  
Cardiovascular Health ◽  
Surgical Complication ◽  
Case Series ◽  
Neurologic Complication ◽  
Complication Rates ◽  
Retrospective Case ◽  
Average Patient

Study Design: Retrospective case series. Objective: To report contemporary rates of complications and subsequent surgery after spinal surgery in patients with skeletal dysplasia. Methods: A case series of 25 consecutive patients who underwent spinal surgery between 2007 and 2017 were identified from a single institution’s skeletal dysplasia registry. Patient demographics, medical history, surgical indication, complications, and subsequent surgeries (revisions, extension to adjacent levels, or for pathology at a non-contiguous level) were collected. Charlson comorbidity indices were calculated as a composite measure of overall health. Results: Achondroplasia was the most common skeletal dysplasia (76%) followed by spondyloepiphyseal dysplasia (20%); 1 patient had diastrophic dysplasia (4%). Average patient age was 53.2 ± 14.7 years and most patients were in excellent cardiovascular health (88% Charlson Comorbidity Index 0-4). Mean follow up after the index procedure was 57.4 ± 39.2 months (range). Indications for surgery were mostly for neurologic symptoms. The most commonly performed surgery was a multilevel thoracolumbar decompression without fusion (57%). Complications included durotomy (36%), neurologic complication (12%), and infection requiring irrigation and debridement (8%). Nine patients (36%) underwent a subsequent surgery. Three patients (12%) underwent a procedure at a non-contiguous anatomic zone, 3 (12%) underwent a revision of the previous surgery, and another 3 (12%) required extension of their previous decompression or fusion. Conclusions: Surgical complication rates remain high after spine surgery in patients with skeletal dysplasia, likely attributable to inherent characteristics of the disease. Patients should be counseled on their risk for complication and subsequent surgery.

scholarly journals Open Appendicectomy under Spinal Anesthesia—A Valuable Alternative during COVID-19

2021 ◽  
Vol 07 (02) ◽  
pp. e69-e72
Author(s):  
Dinh Van Chi Mai ◽  
Alex Sagar ◽  
Oliver Claydon ◽  
Ji Young Park ◽  
Niteen Tapuria ◽  
...  
Keyword(s):  
United Kingdom ◽  
Patient Satisfaction ◽  
Spinal Anesthesia ◽  
Stated Preference ◽  
Case Series ◽  
District General Hospital ◽  
Complication Rates ◽  
Open Appendicectomy ◽  
Surgical Department ◽  
The United Kingdom

Abstract Introduction Concerns relating to coronavirus disease 2019 (COVID-19) and general anesthesia (GA) prompted our department to consider that open appendicectomy under spinal anesthesia (SA) avoids aerosolization from intubation and laparoscopy. While common in developing nations, it is unusual in the United Kingdom. We present the first United Kingdom case series and discuss its potential role during and after this pandemic. Methods We prospectively studied patients with appendicitis at a British district general hospital who were unsuitable for conservative management and consequently underwent open appendicectomy under SA. We also reviewed patient satisfaction after 30 days. This ran for 5 weeks from March 25th, 2020 until the surgical department reverted to the laparoscopic appendicectomy as the standard of care. Main outcomes were 30-day complication rates and patient satisfaction. Results None of the included seven patients were COVID positive. The majority (four-sevenths) had complicated appendicitis. There were no major adverse (Clavien-Dindo grade III to V) postoperative events. Two patients suffered minor postoperative complications. Two experienced intraoperative pain. Mean operative time was 44 minutes. Median length of stay and return to activity was 1 and 14 days, respectively. Although four stated preference in hindsight for GA, the majority (five-sevenths) were satisfied with the operative experience under SA. Discussion Although contraindications, risk of pain, and specific complications may be limiting, our series demonstrates open appendicectomy under SA to be safe and feasible in the United Kingdom. The technique could be a valuable contingency for COVID-suspected cases and patients with high-risk respiratory disease.

scholarly journals Safety and efficacy of cold‐water immersion in the treatment of older patients with heat stroke: a case series

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Chikao Ito ◽  
Isao Takahashi ◽  
Miyuki Kasuya ◽  
Kyoji Oe ◽  
Masahito Uchino ◽  
...  
Keyword(s):  
Older Patients ◽  
Cold Water ◽  
Water Immersion ◽  
Heat Stroke ◽  
Case Series ◽  
Cold Water Immersion ◽  
Safety And Efficacy

scholarly journals Endonasal endoscopic pituitary surgery in the elderly

2018 ◽  
Vol 128 (2) ◽  
pp. 429-436 ◽  
Author(s):  
Peter J. Wilson ◽  
Sacit B. Omay ◽  
Ashutosh Kacker ◽  
Vijay K. Anand ◽  
Theodore H. Schwartz
Keyword(s):  
Elderly Patients ◽  
Complication Rate ◽  
Pituitary Adenomas ◽  
Statistical Tests ◽  
The Elderly ◽  
Medical Complications ◽  
Tumor Diameter ◽  
Complication Rates ◽  
Pseudoaneurysm Formation ◽  
Significant Difference

OBJECTIVEPituitary adenomas are benign, slow-growing tumors that cause symptoms either through mass effect or hormone overproduction. The decision to operate on a healthy young person is relatively straightforward. In the elderly population, however, the risks of complications may increase, rendering the decision more complex. Few studies have documented the risks of surgery using the endonasal endoscopic approach in a large number of elderly patients. The purpose of this study was to audit a single center's data regarding outcomes of purely endoscopic endonasal transsphenoidal resection of pituitary adenomas in elderly patients and to compare them to the current literature.METHODSA retrospective review of a prospectively acquired database of all endonasal endoscopic surgeries done by the senior authors was queried for patients aged 60–69 years and for those aged 70 years or older. Demographic and radiographic preoperative data were reviewed. Outcomes with respect to extent of resection and complications were examined and compared with appropriate statistical tests.RESULTSA total of 135 patents were identified (81 aged 60–69 years and 54 aged 70 years or older [70+]). The average tumor diameter was slightly larger for the patients in the 70+ age group (mean [SD] 25.7 ± 9.2 mm) than for patients aged 60–69 years (23.1 ± 9.8 mm, p = 0.056). There was no significant difference in intraoperative blood loss (p > 0.99), length of stay (p = 0.22), or duration of follow-up (p = 0.21) between the 2 groups. There was a 7.4% complication rate in patients aged 60–69 years (3 nasal and 3 medical complications) and an 18.5% complication rate in patients older than 70 years (4 cranial, 3 nasal, 1 visual, and 2 medical complications; p = 0.05 overall and 0.013 for cranial complications). Cranial complications in the 70+ age category included 2 postoperative hematomas, 1 pseudoaneurysm formation, and 1 case of symptomatic subdural hygromas.CONCLUSIONSEndonasal endoscopic surgery in elderly patients is safe, but there is a graded increase in complication rates with increasing age. The decision to operate on an asymptomatic or mildly symptomatic patient in these age groups should take this increasing complication rate into account. The use of a lumbar drain or lumbar punctures should be weighed against the risk of subdural hematoma in patients with preexisting atrophy.

Technical Complications and Failures of Zirconia-Based Prostheses Supported by Implants Followed Up to 7 Years: A Case Series

2014 ◽  
Vol 27 (6) ◽  
pp. 544-552 ◽  
Author(s):  
Lumni Kolgeci ◽  
Erno Mericske ◽  
Andreas Worni ◽  
Petra Walker ◽  
Joannis Katsoulis ◽  
...  
Keyword(s):  
Case Series ◽  
Technical Complications

scholarly journals P14.123 Neurological complications related to checkpoints inhibitors

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii97-iii98
Author(s):  
I Esparragosa ◽  
R Valenti-Azcarate ◽  
D Moreno-Ajona ◽  
J Gallego Perez de Larraya
Keyword(s):  
Cerebrospinal Fluid ◽  
Checkpoint Inhibitors ◽  
Early Recognition ◽  
Oral Prednisone ◽  
Fatal Outcome ◽  
Case Series ◽  
Neurological Complications ◽  
Ovarian Adenocarcinoma ◽  
Inflammatory Myositis ◽  
Oncological Treatment

Abstract BACKGROUND Currently, immunotherapy is part of the therapeutic arsenal for oncological treatment. Indeed, the need for new medications has led to the development of immune checkpoint inhibitors. Despite favourable oncological outcomes, these treatments have been associated with immune-related adverse events. Although infrequent, neurological toxicities have been reported. Early recognition is crucial for improvement of functional outcome and requires a multidisciplinary approach. OBJECTIVE To describe a case series of patients with neurological complications related to checkpoint inhibitors. PATIENTS AND METHODS We identified six oncological patients who presented immunomediated neurological complications, derived from the use of checkpoints inhibitors. Five cases were men. Ages ranged from 58 to 73 years. Nivolumab, alone or combined, was the most commonly associated drug (4/6). Underlying diseases included lung carcinoma (2/6), melanoma (2/6), renal carcinoma (1/6) and ovarian adenocarcinoma (1/6). An acute demyelinating sensory-motor polyneuropathy and an acute axonal sensory polyneuropathy were documented in two and one case, respectively. In these, the cerebrospinal fluid analysis revealed albuminocytologic dissociation. All three cases improved after treatment with intravenous immunoglobulins (0.4 g/Kg a day for five days). The latter and another case were diagnosed of aseptic meningitis after cerebrospinal fluid lymphocytic pleocytosis was found. High fever was also associated with lower extremities areflexia, weakness and ataxia. Methylprednisolone (1g/day for five days) was administered. One case of necrotizing inflammatory myositis with high levels of creatine kinasa, confirmed by muscular biopsy, involving cervical weakness and ptosis, was effectively treated with Methylprednisolone (1g/day for five days) follow by oral prednisone tapering. An anti-Yo related pancerebellar syndrome was the only case with a fatal outcome despite treatment. CONCLUSION The increasingly frequent use of immunotherapy in the treatment of cancer may lead to an increase in neurological complications. These include a broad spectrum of syndromes with peripheral nervous system predominantly susceptible. Early identification of these and appropriate management of drug-related toxicity are required. Immune-modulating therapies are particularly beneficial.

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