Fresh Cadaver Simulation Model with Continuous Extracorporeal Circulation as a Training Platform for Intracranial High-Flow Bypass: Technical Note and Rheologic Feasibility Evaluation

xlomafota13 shared this article with you from Inoreader Fresh Cadaver Simulation Model with Continuous Extracorporeal Circulation as a Training Platform for Intracranial High-Flow Bypass: Technical Note and Rheologic Feasibility Evaluation Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1729179 Introduction As endovascular techniques evolve toward replacing open surgery, several clinical scenarios still require surgical revascularization. Characterizing this era are decreasing surgical volumes and lack of realistic training models. In an effort to develop lifelike simulation models, we developed a platform for surgical training on high-flow bypass in a fresh cadaver model. Our technique incorporated an extracorporeal circulating system that resembled clinical conditions and confirmed anastomosis efficacy by clinical parameters. Methods On three fresh cadaveric heads, the subtemporal approach exposed the petrous internal carotid artery (ICA) (C2) as the donor vessel for an interposition radial artery graft. Using a continuous extracorporeal circulation system, the bypass model was tested in three fresh heads and verified using clinical technologies. Results Successful C2 ICA to M2 anastomosis was completed in all three fresh heads, confirmed with qualitative and quantitative Doppler, and indocyanine green angiography. Antegrade distribution through graft and revascularized territory was documented on postoperative computed tomography (CT) scan with radiopaque silicone injected through the ipsilateral carotid. Conclusion This study confirmed the feasibility of a totally intracranial high-flow bypass in a fresh cadaver model that achieved hemodynamic features aligned with those of normal middle cerebral artery flow in the clinical setting. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Role of Extradural Clinoidectomy and Optic Unroofing in Resection of an Anterior Clinoidal Meningioma with Encasement of the Internal Carotid Artery and Its Branches

xlomafota13 shared this article with you from Inoreader Role of Extradural Clinoidectomy and Optic Unroofing in Resection of an Anterior Clinoidal Meningioma with Encasement of the Internal Carotid Artery and Its Branches Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1729996 Anterior clinoidal meningiomas (ACMs) remain a major neurosurgical challenge. The skull base techniques, including extradural clinoidectomy and optic unroofing performed at the early stage of surgery, provide advantages for improving the extent of resection, and thereby enhancing overall outcome, and particularly visual function. Additionally, when the anterior clinoidal meningiomas encase neurovascular structures, particularly the supraclinoid internal carotid artery and its branches, this further increases morbidity and decreases the extent of resection. Although it might be possible to remove the tumor from the artery wall despite complete encasement or narrowing, the decision of whether the tumor can be safely separated from the arterial wall ultimately must be made intraoperatively.The patient is a 75-year-old woman with right-sided progressive vision loss. In the neurological examination, she only had light perception in the right eye without any visual acuity or peripheral loss in the left eye. MRI showed a homogeneously enhancing right-sided anterior clinoidal mass with encasing and narrowing of the supraclinoid internal carotid artery (ICA). Computed tomography (CT) angiography showed a mild narrowing of the right supraclinoid ICA with associated a 360-degree encasement. The decision was made to proceed using a pterional approach with extradural anterior clinoidectomy and optic unroofing. The surgery and postoperative course were uneventful. MRI confirmed gross total resection (Figs. 1 and 2). The histopathology was a meningothelial meningioma, World Health Organization (WHO) grade I. The patient continues to do well without any recurre nce and has shown improved vision at 15-month follow-up.This video demonstrates important steps of the microsurgical skull base techniques for resection of these challenging tumors.The link to the video can be found at https://youtu.be/vt3o1c2o8Z0 [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Peripheral and Central Smell Regions in Migraine Patients using Maraş Powder (Smokeless Tobacco): A Magnetic Resonance Imaging Evaluation

xlomafota13 shared this article with you from Inoreader Peripheral and Central Smell Regions in Migraine Patients using Maraş Powder (Smokeless Tobacco): A Magnetic Resonance Imaging Evaluation Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1729907 Objective In the present study, we investigated the efficacy of Maraş powder (smokeless tobacco) use on smell regions in migraine patients. Methods The cranial magnetic resonance imaging images of 58 adult patients were included in this retrospective study. Thirty-eight of them were migraine patients (18 of them using Maraş powder and 20 of them not using Maraş powder) and 20 of them were healthy controls. Bilateral peripheral (olfactory bulb [OB] volume and olfactory sulcus depth) and central smell regions (insular gyrus area and corpus amygdala area) as well as nasal septal deviation were evaluated. Results In migraine patients (using or not using Maraş powder), OB volumes, and in Maraş powder using migraine patients, corpus amygdala areas were lower than those in the control group (p < 0.05). In Maraş powder-using migraine patients, left insular gyrus areas of the females were significantly lower than the males (p < 0.05). Conclusion We concluded that the peripheral smell region of the OB volume decreased in migraine patients (using or not using Maraş powder). However, the central smell region of corpus amygdala area decreased in Maraş powder using migraine patients. Maraş powder usage may increase vascular shrinkage, and the decrease in OB volume and corpus amygdala area becomes prominent. It can be said that Maraş powder usage may cause a size decrease in the peripheral and central smell regions in migraine patients. Therefore, migraine patients and non-migrainous people should be noticed for the harmful effects of Maraş powder on the vascular system and smell system in the aspects of OB volume and corpus amygdala area decrease. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals : Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sinonasal Symptom Outcomes following Endoscopic Anterior Cranial Base Surgery in the Pediatric Population

xlomafota13 shared this article with you from Inoreader Sinonasal Symptom Outcomes following Endoscopic Anterior Cranial Base Surgery in the Pediatric Population Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1729976 Objective This study aimed to evaluate the impact of endoscopic anterior cranial base (ACB) surgery on sinonasal symptoms in the pediatric population utilizing the Sino-Nasal Outcome Test (SNOT)-22 questionnaire. Design This is a retrospective review. Setting The study was conducted at a tertiary academic medical center. Participants Thirty-four consecutive patients, age 6 to 17 years, M:F 14:20, who underwent endoscopic ACB surgery from July 2008 to August 2019. Ten patients had baseline and a minimum of two subsequent postoperative SNOT-22 questionnaires available for analysis. Main Outcome Measures Baseline and postoperative SNOT-22 scores were compared. The mean change from baseline sinonasal symptom scores in the pediatric and historical adult cohorts was compared. Results The mean baseline SNOT-22 score for our 10 patient cohort was 0.46 out of 5 for each of the first 10 sinonasal-specific questions. This worsened to 1.69 at 1 month and returned to near baseline, 0.7, at 3 months postoperatively. The mean quality-of-life score improved to 0.91 at 1 month and 0.6 at 3 months postoperatively. The mean change from baseline for the following items: need to blow nose, runny nose, postnasal discharge, thick nasal discharge, wake up at night, reduced concentration, and frustrated/restless/irritable were similar to those in our historical adult cohort at 3 months postoperatively. Conclusion Endoscopic ACB surgery in the pediatric population results in increased sinonasal symptom morbidity in the early postoperative period; however, symptoms return to near baseline by ∼3 months, and quality-of-life scores progressively improve in the postoperative period. These trends were similar to those seen in our historic adult cohort. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Health Literacy and Web-Based Audiovisual Multimedia in Pituitary and Endoscopic Skull Base Surgery

xlomafota13 shared this article with you from Inoreader Health Literacy and Web-Based Audiovisual Multimedia in Pituitary and Endoscopic Skull Base Surgery Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1729979 Introduction The internet presents a rich milieu of multimedia options relating to pituitary and endoscopic skull base surgery (ESBS). Misinformation can create discordance between patient and provider expectations. The purpose of this study is to analyze the understandability and actionability of available ESBS and pituitary surgery audiovisual information on YouTube and Google. Methods The top 50 videos generated by searching "pituitary surgery/transsphenoidal surgery" and "endoscopic skull base surgery" in both YouTube and Google were sorted by relevance. Two independent reviewers evaluated each for understandability and actionability based on the Patient Education Materials Assessment Tool for audiovisual material (PEMAT-A/V). Source, authorship, audience, and education/advertisement variables were collected. Chi-square test followed by univariate and multivariate regression analyses assessed the association between these variables and quality. Results A total of 85 videos (52 YouTube and 33 Google) met inclusion criteria for analysis. There was no significant difference in the presence of the aforementioned variables between YouTube and Google (p < 0.05). Also, 72% of videos targeted patients and 28% targeted surgeons. Academic institutions uploaded 58% of videos. Surgeon-targeted videos were more educational (p = 0.01) and patient-targeted videos involved more advertisement (p = 0.01). Understandability and actionability scores were below the 70% threshold for both YouTube (65 ± 15, 38 ± 33, p = 0.65) and Google (66 ± 12, 38 ± 26, p = 0.94). Patient-targeted videos (p = 0.002) were more understandable, while surgeon- (p < 0.001) and education-focused videos (p < 0.001) were more actionable. Conclusion Understandability and actionability of YouTube and Google audiovisual patient information on ESBS and pituitary surgery is poor. Consideration should be given to the formation of a standardized patient information resource. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Ergonomics in Endoscopic Transsphenoidal Surgery: A Survey of the North American Skull Base Society

xlomafota13 shared this article with you from Inoreader Ergonomics in Endoscopic Transsphenoidal Surgery: A Survey of the North American Skull Base Society Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1729906 Objective Different surgical set-ups for endoscopic transsphenoidal surgery (ETS) have been described, but studies on their ergonomics are limited. The aim of this article is to describe present trends in the ergonomics of ETS. Design and Participants A 33-question, web-based survey was sent to North American Skull Base Society members in 2018 and 116 responded to it (16% of all members). Most respondents were from North America (76%), in academic practice (87%), and neurosurgeons (65%); they had more than 5 years of experience in ETS (73%), had received specific training (66%), and performed at least 5 procedures/mo (55%). Results Mean reported time for standard and complex procedures were 3.7 and 6.3 hours, respectively. The patient's body is usually positioned in a straight, supine position (84%); the head is in a neutral position (46%) or rotated to the side (38%). Most surgeons perform a binostril technique, work with a partner (95%), and operate standing (94%), holding suction (89%) and dissector (83%); sometimes the endoscope is held by the primary surgeon (22–24%). The second surgeon usually holds the endoscope (72%) and irrigation (42%). During tumor removal most surgeons stand on the same side (65–66%). Many respondents report strain at the dorsolumbar (50%) or cervical (26%) level. Almost one-third of surgeons incorporate a pause during surgery to stretch, and approximately half exercise to be fit for surgery; 16% had sought medical attention for ergonomic-related symptoms. Conclusion Most respondents value ergonomics in ETS. The variability in surgical set-ups and the relatively high report of complaints underline the need for further studies to optimize ergonomics in ETS. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Successful upgrade to cardiac resynchronization therapy for cardiac implantation-associated left subclavian vein occlusion: A case report

paythelady.612 shared this article with you from Inoreader Successful upgrade to cardiac resynchronization therapy for cardiac implantation-associated left subclavian vein occlusion: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 6;9(13):3157-3162. doi: 10.12998/wjcc.v9.i13.3157. ABSTRACT BACKGROUND: Subclavian vein stenosis or occlusion may be caused by a transvenous pacemaker, which makes the reimplantation of a new pacemaker lead difficult. Transvenous pacemaker lead implantation-related subclavian vein occlusion may present difficulty with regard to cardiac resynchronization therapy (CRT) upgrade. CASE SUMMARY: We report the case of a 46-year-old man who was admitted with total subclavian vein occlusion caused by a permanent pacemaker that had been implanted 2 years previously. We successfully treated this patient with an upgrade to a CRT pacemaker by utilizing transferable interventional coronary and radiological techniques. The patient recovered uneventfully during the follow-up period. CONCLUSION: CRT upgrade is still a viable technique for the treatment of subclavian vein obstruction caused by previous pacemaker implantation. PMID:33969103 | PMC:PMC8080731 | DOI:10.12998/wjcc.v9.i13.3157 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.