Feasibility and safety of percutaneous computed tomography guided radiofrequency ablation of lymph nodes in oligometastatic patients: a single center’s experience

2021 ◽  
Vol 94 (1121) ◽  
pp. 20200445
Author(s):  
Dimitrios Filippiadis ◽  
George Charalampopoulos ◽  
Athanasios Tsochatzis ◽  
Lazaros Reppas ◽  
Argyro Mazioti ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Lymph Nodes ◽  
Clinical Success ◽  
Complete Response ◽  
Tumor Control ◽  
Complication Rates ◽  
Ct Guided ◽  
Female Ratio ◽  
Contrast Enhanced Ct ◽  
The Mean

Objectives: To retrospectively evaluate feasibility and safety of CT-guided percutaneous radiofrequency ablation (RFA) of metastatic lymph nodes (LN) in terms of achieving local tumor control. Methods: Institutional database research identified 16 patients with 24 metastatic LNs who underwent percutaneous CT-guided radiofrequency ablation. Mean patient age was 66.6 ± 15.70 years (range 40–87) and male/female ratio was 8/8. Contrast-enhanced CT or MRI was used for post-ablation follow-up. Patient and tumor characteristics and RFA technique were evaluated. Technical and clinical success on per tumor and per patient basis as well as complication rates were recorded. Results: Mean size of the treated nodes was 1.78 ± 0.83 cm. The mean number of tumors per patient was 1.5 ± 0.63. The mean procedure time was 56.29 ± 24.27 min including local anesthesia, electrode(s) placement, ablation and post-procedural CT evaluation. Median length of hospital stay was 1.13 ± 0.34 days. On a per lesion basis, the overall complete response post-ablation according to the mRECIST criteria applied was 75% (18/24) of evaluable tumors. Repeat treatment of an index tumor was performed on two patients (three lesions) with complete response achieved in 87.5% (21/24) of evaluable tumors following a second RFA. On a per patient basis, disease progression was noted in 10/16 patients at a mean of 13.9 ± 6.03 months post the ablation procedure. Conclusion: CT-guided percutaneous RFA for oligometastatic LNs is a safe and feasible therapy. Advances in knowledge: With this percutaneous therapeutic option, metastatic LNs can be eradicated with a very low complication rate.

Effectiveness of Ultrasound-Guided Radiofrequency Ablation in the Treatment of 36 Renal Cell Carcinoma Tumours Compared with Published Results of Using Computed Tomography Guidance

2012 ◽  
Vol 63 (3_suppl) ◽  
pp. S23-S32 ◽  
Author(s):  
Kellie Davis ◽  
Ania Kielar ◽  
Katayoun Jafari
Keyword(s):  
Computed Tomography ◽  
Radiofrequency Ablation ◽  
Residual Disease ◽  
Tumour Size ◽  
Complication Rates ◽  
Ct Guided ◽  
Renal Lesions ◽  
Contrast Enhanced Ct ◽  
The Mean

This study aimed to analyse the outcomes of ultrasound (US) guided radiofrequency ablation (RFA) in patients with renal lesions and to compare our outcomes with published results of ablations carried out when using computed tomography (CT) guidance. This retrospective study evaluated RFA of 36 renal tumours in 32 patients (M = 21, F = 11). The mean patient age was 70 years (range, 39–89 years). Ablations were performed by using either multi-tined applicators or cooled and/or cluster applicators under US guidance. Applicator size varied from 2–5 cm, depending on the size of the index tumour. Conscious sedation was administered by an anesthetist. Follow-up imaging by using contrast-enhanced CT was performed 1, 3, 6, and 12 months after RFA, and yearly thereafter. The mean tumour follow-up time was 12 months (range, 1–35 months). The mean tumour size was 2.7 cm (range, 1–5 cm). Primary effectiveness was achieved in 31 cases (86.1%), with patients in 5 cases (11.1%) demonstrating residual disease. Three patients had repeated sessions, which were technically successful. The remaining 2 patients were not re-treated because of patient comorbidities. As a result, secondary effectiveness was achieved in 34 patients (94.4%). In 1 patient, a new lesion developed in the same kidney but remote from the 2 prior areas of treatment. Hydrodissection was performed in 3 patients (8.3%), manipulation or electrode repositioning in 11 patients (30.6%), and ureteric cooling in 1 patient (2.8%). Minor and major complications occurred in 3 (8.3%) and 3 (8.3%) patients, respectively. Correlation coefficients were calculated for distance from skin to tumour and risk of complication as well as compared with primary and secondary effectiveness. This study demonstrates that US-guided RFA is an effective treatment for renal lesions, with rates of effectiveness and complication rates comparable with published CT-guided RFA results.

Gamma Knife surgery for invasive pituitary macroadenoma

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 26-30 ◽  
Author(s):  
Mooseong Kim ◽  
Sunghwa Paeng ◽  
Seyoung Pyo ◽  
Yeonggyun Jeong ◽  
Sunil Lee ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Pituitary Macroadenoma ◽  
Female Ratio ◽  
Fractionated Radiotherapy ◽  
The Mean

ObjectPituitary adenomas have been treated using a variety of modalities including resection, medication, fractionated radiotherapy, and stereotactic radiosurgery. The policy has been that all adenomas should first be treated with resection to reduce the volume of the tumor. The authors' study was conducted to determine the efficacy of using Gamma Knife surgery (GKS) for pituitary adenomas invading the cavernous sinus.MethodsOf 397 patients with pituitary tumors who underwent GKS between October 1994 and October 2005, 68 patients had pituitary macroadenomas invading the cavernous sinus. Sixty-seven cases were available for follow up. The mean age of the patients in these cases was 42.8 years (range 14–73 years). The male/female ratio was 0.8:1. The mean adenoma volume was 9.3 cm3. A total of 24 patients had undergone craniotomies and resection, and 11 patients had undergone transsphenoidal surgery prior to GKS. The mean follow-up period was 32.8 months. Tumor control was defined as a decrease or no change in tumor volume after GKS. Endocrinological improvement was defined as a decline in hormone levels to below 50% of the pre-GKS level.Tumor control was achieved in 95.5% of the cases. Endocrinological improvement was achieved in 68% of 25 patients. One patient suffered hypopituitarism after GKS.Conclusions Gamma Knife surgery is a safe and effective treatment for invasive pituitary macroadenoma with few complications.

scholarly journals Comparison of radiosurgery and conventional surgery for the treatment of glomus jugulare tumors

2004 ◽  
Vol 17 (2) ◽  
pp. 22-30 ◽  
Author(s):  
Oren N. Gottfried ◽  
James K. Liu ◽  
William T. Couldwell
Keyword(s):  
Tumor Size ◽  
Treatment Options ◽  
Cerebrospinal Fluid Leak ◽  
Residual Tumor ◽  
Morbidity Rate ◽  
Tumor Control ◽  
Complication Rates ◽  
Glomus Jugulare ◽  
Initial Surgery ◽  
The Mean

Object The optimal management of glomus jugulare tumors remains controversial. Available treatments were once associated with poor outcomes and significant complication rates. Advances in skull base surgery and the delivery of radiation therapy by stereotactic radiosurgery have improved the results obtained using these treatment options. The authors summarize and compare the contemporary outcomes and complications for these therapies. Methods Papers published between 1994 and 2004 that detailed the use of radiosurgery or surgery to treat glomus jugulare tumors were reviewed. Eight radiosurgery series including 142 patients and seven surgical studies including 374 patients were evaluated for neurological outcome, change in tumor size (radiosurgery) or percent of total resection (surgery), recurrences, tumor control, need for further treatment, and complications. The mean age at treatment for patients who underwent surgery and radiosurgery was 47.3 and 56.7 years, respectively. The mean follow-up duration was 49.2 and 39.4 months, respectively. The surgical control rate was 92.1%, with 88.2% of tumors totally resected in the initial surgery. A cerebrospinal fluid leak occurred in 8.3% of patients who underwent surgery and recurrences were found in 3.1%; the mortality rate was 1.3%. Among patients who underwent radiosurgery, tumors diminished in 36.5%, whereas 61.3% had no change in tumor size, and subjective or objective improvements occurred in 39%. Despite the presence of residual tumor in 100% of radiosurgically treated patients, recurrences were found in only 2.1%, the morbidity rate was 8.5%, and there were no deaths. Conclusions Death and recurrences after these treatments are infrequent, and therefore both treatments are considered to be safe and efficacious. Although surgery is associated with higher morbidity rates, it immediately and totally eliminates the tumor. The radiosurgery results are very promising, although the incidence of late recurrence (after 10–20 years) is unknown.

scholarly journals Radiofrequency Ablation for Cervical Metastatic Lymph Nodes in Children and Adolescents With Papillary Thyroid Carcinoma: A Preliminary Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Lin Yan ◽  
Ying Zhang ◽  
Bo Jiang ◽  
Yukun Luo
Keyword(s):  
Radiofrequency Ablation ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Children And Adolescents ◽  
Papillary Thyroid ◽  
Metastatic Lymph Nodes ◽  
Metastatic Lymph ◽  
The Mean

ObjectiveTo evaluate the safety and efficacy of radiofrequency ablation (RFA) for metastatic lymph nodes (LNs) in children and adolescents with papillary Thyroid Carcinoma (PTC).Materials and MethodsFrom December 2014 to March 2018, 10 metastatic LNs(mean volume 0.30 ± 0.38 ml, range 0.06-1.23ml) in 5 children and adolescents (3 females, 2 males; mean age 15.60 ± 2.97 years, range 12-19 years) with PTC treated by RFA were evaluated in this study. The mean number of surgical procedures performed before RFA was 1.2 (range 1-2) and the mean number of treated metastatic LNs per patient was 2 (rang 1-3). RFA was performed with an 18–gauge bipolar RF applicator under local anesthesia. Follow-up consisted of US and serum thyroglobulin (Tg) level at 1, 3, 6, 12 months and every 12 months thereafter.ResultsAll the patients were well tolerant to RFA procedure and no procedure-related complications occurred. During a mean follow-up time of 52.00 ± 21.44 months, the initial volume of LNs was 0.30 ± 0.38 ml, which significantly decreased to 0.01 ± 0.03 ml (P = 0.005) with a mean VRR of 99.28 ± 2.27%. A total of 9 metastatic LNs (90.00%) completely disappeared. After RFA, 2 patients developed newly metastases. One patient had additional RFA. The other one with multiple LN metastases underwent total thyroidectomy with central neck dissection.ConclusionAs a less invasive and effective technique, RFA may provide another alternative to the existing therapeutic modalities for cervical metastatic LNs in children and adolescents with PTC.

scholarly journals Outcomes of laparoscopic subtotal gastrectomy for gastric adenocarcinoma in Nghe An Friendship General Hospital

2019 ◽  
Vol 9 (3) ◽  
Author(s):  
Văn Chiến Đinh ◽  
Keyword(s):  
Lymph Nodes ◽  
General Hospital ◽  
Gastric Adenocarcinoma ◽  
Survival Rates ◽  
Subtotal Gastrectomy ◽  
Female Ratio ◽  
The Mean ◽  
Laparoscopic Subtotal Gastrectomy ◽  
One Year ◽  
Lymph Nodes Dissection

Tóm tắt Đặt vấn đề: Đánh giá tính an toàn và hiệu quả của phẫu thuật nội soi cắt đoạn dạ dày nạo vét hạch trong điều trị ung thư biểu mô dạ dày. Phương pháp nghiên cứu: Nghiên cứu hồi cứu mô tả, tất cả người bệnh ung thư biểu mô dạ dày được phẫu thuật nội soi cắt đoạn dạ dày từ 2012 đến 2019. Kết quả: 278 người bệnh ung thư dạ dày được phẫu thuật nội soi cắt đoạn dạ dày, tuổi trung bình 60,2 (33 -78), tỷ lệ nam/nữ 3,3. Ung thư ở giai đoạn IA, IB, IIA, IIB, IIIA và IIIB lần lượt là 2,2%, 9,7%, 22,3%, 30,9%, 27,3% và 7,5%. Số hạch vét được trung bình 12,2 hạch, số hạch di căn trung bình 3,1 hạch. Tỷ lệ tai biến, biến chứng chung là 2,5%. Không có tử vong trong và sau mổ. Thời gian mổ trung bình là 185 phút, nằm viện sau mổ 8,1 ngày. Thời gian sống sau mổ 1 năm, 2 năm, 3 năm và 5 năm là 95,7%, 80,2%, 71,1% và 53,4%. Kết luận: Phẫu thuật nội soi cắt đoạn dạ dày nạo vét hạch là khả thi, an toàn và hiệu quả trong điều trị ung thư biểu mô dạ dày, thời gian hồi phục và nằm viện ngắn. Abstract Introduction: To assess the initial outcomes including the effectiveness, safety of laparoscopic subtotal gastrectomy with lymph nodes dissection for gastric adenocarcinoma. Material and Methods: Prospective study conducted from 2012 to 2019 in Nghe An Friendship General Hospital. All the patients underwent the laparoscopic subtotal gastrectomy with lymph nodes dissection for gastric adenocarcinoma enrolled. Results: 278 patients underwent laparoscopic subtotal gastrectomy with lymph nodes dissection, mean age was 60.2 (33 - 78). Male and female ratio was 3.3. Stages of the tumor were 2.2% IA, 9.7% IB, 22.3% IIA, 30.9% IIB, 27.3% IIIA and 7.5% IIIB. The mean of lymph nodes removed were 12.2 and mean lymph nodes metastasis were 3.1. The overall complication and incident rates were 2.5%. No per-operative and post-operative mortality was observed. The mean operative time was 185 min. The mean postoperative length stays were 8.1 days. Overall survival rates for one year, two years, three year and five years were 95.7%, 80.2%, 71,1% and 53.4% respectively. Conclusion: Laparoscopic subtotal gastrectomy with lymph node resection for gastric adenocarcinoma is safe and effective, shorten recovery time and hospitalization. Keyword: Laparoscopic subtotal gastrectomy.

scholarly journals The Role of a Navigational Radiofrequency Ablation Device and Concurrent Vertebral Augmentation for Treatment of Difficult-to-Reach Spinal Metastases

2021 ◽  
Vol 28 (5) ◽  
pp. 4004-4015
Author(s):  
Claudio Pusceddu ◽  
Davide De Francesco ◽  
Luca Melis ◽  
Nicola Ballicu ◽  
Alessandro Fancellu
Keyword(s):  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Spinal Metastases ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Vertebral Augmentation ◽  
Local Tumor ◽  
Metastatic Lesions ◽  
The Mean

Aims: The purpose of this study was to assess the effectiveness of a navigational radiofrequency ablation device with concurrent vertebral augmentation in the treatment of posterior vertebral body metastatic lesions, which are technically difficult to access. Primary outcomes of the study were evaluation of pain palliation and radiologic assessment of local tumor control. Materials and Methods: Thirty-five patients with 41 vertebral spinal metastases involving the posterior vertebral body underwent computed tomography-guided percutaneous targeted radiofrequency ablation, with a navigational radiofrequency ablation device, associated with vertebral augmentation. Twenty-one patients (60%) had 1 or 2 metastatic lesions (Group A) and fourteen (40%) patients had multiple (>2) vertebral lesions (Group B). Changes in pain severity were evaluated by visual analog scale (VAS). Metastatic lesions were evaluated in terms of radiological local control. Results: The procedure was technically successful in all the treated vertebrae. Among the symptomatic patients, the mean VAS score dropped from 5.7 (95% CI 4.9–6.5) before tRFA and to 0.9 (95% CI 0.4–1.3) after tRFA (p < 0.001). The mean decrease in VAS score between baseline and one week follow up was 4.8 (95% CI 4.2–5.4). VAS decrease over time between one week and one year following radiofrequency ablation was similar, suggesting that pain relief was immediate and durable. Neither patients with 1–2 vertebral metastases, nor those with multiple lesions, showed radiological signs of local progression or recurrence of the tumor in the index vertebrae during a median follow up of 19 months (4–46 months) and 10 months (4–37 months), respectively. Conclusion: Treatment of spinal metastases with a navigational radiofrequency ablation device and vertebral augmentation can be used to obtain local tumor control with immediate and durable pain relief, providing effective treatment in the multimodality management of difficult-to-reach spinal metastases.

scholarly journals Single-use ureteroscopes in ectopic pelvic kidney stones

2021 ◽  
Vol 14 (4) ◽  
pp. 557-564
Author(s):  
Bogdan Geavlete ◽  
◽  
◽  
Razvan Popescu ◽  
Dragos Georgescu ◽  
...  
Keyword(s):  
High Energy ◽  
Holmium Laser ◽  
Complication Rates ◽  
Pelvic Kidney ◽  
Female Ratio ◽  
Hospitalization Period ◽  
Surgical Data ◽  
Single Use ◽  
The Mean ◽  
Long Pulse

We analyzed the results of single-use flexible ureteroscopy (su-fURS) with the holmium laser in treating renal stones associated with ectopic pelvic kidney (EPK). The study retrospectively analyzed data of 11 patients diagnosed with EPK and stone disease who underwent su-fURS between May 2017 and November 2019. The analyzed surgical data included the mean operation time, stone-free and complication rates, as well as hospitalization period. Disposable digital flexible ureteroscopes were exclusively used. The mean age was 55, with a 1.2:1 male to female ratio. The mean stone burden was 30±9 mm (ranging from 17 to 49 mm). The mean calculi digitized surface area (DSA) was 299±56 mm2 (ranging from 170 to 597 mm2). A ureteral access sheath was used in all 11 patients, and holmium laser lithotripsy was performed (dusting mode parameters: low energy – 0.5J, high frequency – 50 Hz, long pulse; pop-corn mode: high energy >1 J, medium frequency– 10–50 Hz, long pulse; fragmenting mode: high energy >1 J, low frequency <10 Hz, short pulse). The average operative time was 78±19 minutes (ranging from 68 to 144 minutes). The stone-free status (residual fragments <3 mm) after one session was 60.1%, 84.1% after the second session, and 94.4% after the third session. The hospitalization period was 29 hours (ranging from 17 to 39 hours). The overall complications rate (according to the Clavien-Dindo system) was 19.7%. Therefore, su-fURS represents an effective therapeutic approach characterized by a remarkably high stone-free rate and few complications in EPK-associated calculi.

scholarly journals Image-guided microwave ablation of hepatocellular carcinoma (≤5.0 cm): is MR guidance more effective than CT guidance?

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhaonan Li ◽  
Chaoyan Wang ◽  
Guangyan Si ◽  
Xueliang Zhou ◽  
Yahua Li ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Microwave Ablation ◽  
Ct Guidance ◽  
Rank Test ◽  
Tumor Diameter ◽  
Complication Rates ◽  
Ct Guided ◽  
Log Rank Test ◽  
Mr Guidance ◽  
The Mean

Abstract Background Given their widespread availability and relatively low cost, percutaneous thermal ablation is commonly performed under the guidance of computed tomography (CT) or ultrasound (US). However, such imaging modalities may be restricted due to insufficient image contrast and limited tumor visibility, which results in imperfect intraoperative treatment or an increased risk of damage to critical anatomical structures. Currently, magnetic resonance (MR) guidance has been proven to be a possible solution to overcome the above shortcomings, as it provides more reliable visualization of the target tumor and allows for multiplanar capabilities, making it the modality of choice. Unfortunately, MR-guided ablation is limited to specialized centers, and the cost is relatively high. Is ablation therapy under MR guidance better than that under CT guidance? This study retrospectively compared the efficacy of CT-guided and MR-guided microwave ablation (MWA) for the treatment of hepatocellular carcinoma (HCC ≤ 5.0 cm). Methods In this retrospective study, 47 patients and 54 patients received MWA under the guidance of CT and MR, respectively. The inclusion criteria were a single HCC ≤ 5.0 cm or a maximum of three. The local tumor progression (LTP), overall survival (OS), prognostic factors for local progression, and safety of this technique were assessed. Results All procedures were technically successful. The complication rates of the two groups were remarkably different with respect to incidences of liver abscess and pleural effusion (P < 0.05). The mean LTP was 44.264 months in the CT-guided group versus 47.745 months in the MR-guided group of HCC (P = 0.629, log-rank test). The mean OS was 56.772 months in the patients who underwent the CT-guided procedure versus 58.123 months in those who underwent the MR-guided procedure (P = 0.630, log-rank test). Multivariate Cox regression analysis further illustrated that tumor diameter (< 3 cm) and the number of lesions (single) were important factors affecting LTP and OS. Conclusions Both CT-guided and MR-guided MWA are comparable therapies for the treatment of HCC (< 5 cm), and there was no difference in survival between the two groups. However, MR-guided MWA could reduce the incidence of complications.

scholarly journals Radiofrequency ablation under 3D intraoperative Iso-C C- arm navigation for the treatment of osteoid osteomas

10.29007/mkfn ◽  
2018 ◽  
Author(s):  
Yu Feng ◽  
Niu Xiao-Hui ◽  
Zhang Qing ◽  
Zhao Hai-Tao ◽  
Xu Li-Hui ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Three Dimensional ◽  
Pathological Examination ◽  
X Rays ◽  
Ct Guided ◽  
Biopsy Specimens ◽  
Effective Option ◽  
Vas Scores ◽  
The Mean

Objective: To evaluate the efficacy of intraoperative three-dimensional (3D) Iso-C C-arm- navigated percutaneous radiofrequency ablation (RFA) of osteoid osteomas.Methods: 35 patients (20 males and 15 females) with osteoid osteomas underwent treatment with intraoperative 3D Iso-C C-arm navigation-guided RFA. The tumour was first biopsied for pathological examination, the core needle was removed and the RFA needle was inserted into the nidus. Post-operative X-rays and CT scans were performed to evaluate the degree of ablation and to assess for recurrence at 3-month follow-up. Patients also completed a visual analogue scale (VAS) both pre-operatively and 3 days post-operatively to subjectively assess pain.Results: Pathological diagnosis confirmed osteoid osteoma in 19 cases. The other 16 cases were not pathologicallydiagnosed owing to inadequate biopsy specimens. In all cases, localized pain was immediately relieved following RFA. Patients reported significantly decreased pain, with mean pre- operative VAS scores of 3.4 reducing to 0.80 at 3 days post-operatively and further to 0.06 at 3-month follow-up (p ,0.05). The mean follow-up time was 15.5 months (range: 3–38 months).Conclusion: 3D Iso-C C-arm navigation-guided RFA is a safe and effective option for the treatment of osteoid osteomas and may be considered in place of intra-operative CT-guided and open resection.Advances in knowledge: C-arm image-guided percutaneous RFA mitigates the need for pre- operative CT as well as intraoperative scintigraphy, provides real-time imaging of the anatomy, facilitates accurate resection of the tumour and enables immediate confirmation of excision.

scholarly journals Retrospective Evaluation of Chronic Idiopathic Thrombocytopenia in Libyan Children

2021 ◽  
pp. 13-21
Author(s):  
Haloom Abdel Salam Elhashmi ◽  
Ainour Ibrahim Abdulhamid
Keyword(s):  
Platelet Count ◽  
Laboratory Data ◽  
Complete Response ◽  
Response To Therapy ◽  
Treatment Modalities ◽  
Female Ratio ◽  
Idiopathic Thrombocytopenia ◽  
Chronic Itp ◽  
History Of ◽  
The Mean

Immune thrombocytopenic purpura (ITP) is the most common cause of acquired thrombocytopenia in children. Approximately 10-20% of children with Immune thrombocytopenia (ITP) suffer from a chronic clinical disease that requires follow up and medical intervention according to the severity of bleeding manifestation. Aims: To evaluate the demographic, clinical, and laboratory features, treatment modalities, and response to therapy in Libyan children with chronic idiopathic thrombocytopenia. Methods: A retrospective study was conducted at the hematology clinic of the pediatric department, Benghazi medical center, and Benghazi Children Hospital. The duration of the study was from January 1998 to December 2018. comprised of demographics, clinical, laboratory data, therapy and therapy response in Libyan chronic ITP. Results: In our study, the mean age of chronic ITP patients was 4.9 years, slightly higher in male patients 43 (52.4%) With a male/female ratio 1.1:1. The most frequent symptoms were mild   which were limited to bruises and petechiae on the skin. (57.3%). The preceding history of viral infection was uncommon in patients with chronic ITP (22%) while the past history of MMR vaccination is quite rare and constituted only (2%). The mean platelet count before treatment (i.e. at presentation) was (22.7x109/L) while mean platelet count after treatment (213.6 x109/L. Treatment consisted of combined Steroid + IVIG in 27 (77.1% response), steroids in 23 (73.9% response), intravenous immunoglobulin (IVIG) in 11 (90.9% response), and no therapy in 21 (95.2% response).Complete response was achieved in 82.9% % showed a complete response either spontaneous or following the treatment. No patient was presented with intracranial hemorrhage. Conclusions: Chronic ITP in Libyan children had a benign nature, none of our patients developed severe symptoms as life-threatening bleeding like CNS bleeding or died, IVIG give more optimistic response as compare to steroid. And the majority of children with chronic ITP in this study achieved remission.

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