scholarly journals Primary vs Secondary Osteochondral Autograft Transplantation in Patients with Large Sized OLT

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Kwang Hwan Park ◽  
Yeokgu Hwang ◽  
Yoo Jung Park ◽  
Dong-Woo Shim ◽  
Jin Woo Lee
Keyword(s):  
Clinical Outcomes ◽  
Bivariate Analysis ◽  
Clinical Failure ◽  
Aofas Score ◽  
Marrow Stimulation ◽  
Kaplan Meier ◽  
Operation Rate ◽  
Significant Difference ◽  
The Mean

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Osteochondral autograft transplantation (OAT) for large sized osteochondral lesions of the talus (OLT) has presented promising clinical results in recent studies. However, there was no study which has compared clinical outcomes between primary OAT and secondary OAT in the large sized OLT. The purpose of this study is to compare clinical outcomes between patients receiving primary transplantation and patients receiving secondary transplantation after failure of previous marrow stimulation for large sized OLT and investigate prognostic factor affecting clinical failures. Methods: Between 2005 and 2014, 18 patients with large sized OLT (=150 mm2) underwent primary OAT as a primary surgery (primary group) and 28 patients with large sized OLT underwent secondary OAT after a failure of arthroscopic marrow stimulation (secondary group). After arthroscopic inspection and debridement for concomitant soft tissue pathologies, conventional OAT procedures were performed. Clinical outcomes were assessed using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS) and re-operation rate. Factors associated with clinical failure were evaluated using bivariate analysis and logistic regression analysis. Survival outcomes were compared using Kaplan-Meier analysis. Results: The mean follow-up time was 6.0 years (range 2.0-10.8) and the mean size of the lesion was 194.9 mm2 (range 151.7- 296.3). There was no significant difference in patients` demographics, and preoperative findings between primary and secondary groups. Postoperative VAS, AOFAS score, FAOS, and re-operation rate had no significant difference between primary and secondary groups at the last follow-up. According to bivariate analysis, significant factor associated with clinical failure was not prior marrow stimulation but more than 225 mm2 of lesion size in preoperative MRI. Logistic regression analysis revealed that preoperative AOFAS score was significant predictor of clinical failure after the OAT in this study. The survival probabilities were not significantly different between primary and secondary groups in Kaplan-Meier plots (P = .947). Conclusion: Outcomes of secondary OAT were comparable to those of primary OAT in the large sized OLT. Therefore, we suggested that symptomatic patients with large sized OLT could be initially treated by either arthroscopic marrow stimulation or OAT and if failed with marrow stimulation, secondary OAT could be considered.

scholarly journals Arthroscopic Bone Marrow Stimulation in the Treatment of Osteochondral Lesions of the Talus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0009
Author(s):  
Kwang Hwan Park ◽  
JaeHan Park ◽  
Jai Bum Kwon ◽  
Seung Hwan Han ◽  
Jin Woo Lee
Keyword(s):  
Bone Marrow ◽  
Clinical Outcomes ◽  
Osteochondral Lesion ◽  
Osteochondral Lesions ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
Operation Rate ◽  
The Mean

Category: Arthroscopy Introduction/Purpose: Arthroscopic bone marrow stimulation for osteochondral lesions of the talus (OLT) has presented promising clinical outcomes in recent studies. However, there were few studies which had investigated long-term clinical outcomes. The purpose of this study is to evaluate the long-term outcomes of arthroscopic bone marrow stimulation for osteochondral lesion of the talus and to identify prognostic factors that affect the outcome. Methods: Between January 2001 and December 2007, 159 patients (172 ankles) with OLT underwent arthroscopic bone marrow stimulation as a primary surgery. Clinical outcomes were assessed using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS) and re-operation rate. Factors associated with re-operation were evaluated using bivariate analysis. Kaplan-Meier plot showed survival outcomes of OLT in long-term follow-up. Results: The mean follow-up time was 12.7 years (range 10.1-16.8) and the mean size of the lesion was 105.4 mm2 (range 19.8- 322.8). The mean VAS improved from 7.21 ± 1.71 to 1.76 ± 1.60. The mean preoperative AOFAS score was 57.98 ±14.43 and the mean postoperative AOFAS was 82.91 ± 11.58. FAOS at the time of final follow-up was comparable with those of previous literatures which showed outcomes of surgical treatments of OLT in short- and mid-term follow-up. Re-operation rate was 6.40% (11 patients with 12 revision surgery) including seven cases of re-arthroscopic bone marrow stimulation, and five cases of OAT. According to bivariate analysis, significant factor associated with re-operation was large sized OLT in preoperative MRI measurement. Conclusion: Arthroscopic bone marrow stimulation for osteochondral lesion of the talus has made satisfactory clinical outcomes through long-term follow-up over 10 years.

Primary Versus Secondary Osteochondral Autograft Transplantation for the Treatment of Large Osteochondral Lesions of the Talus

2018 ◽  
Vol 46 (6) ◽  
pp. 1389-1396 ◽  
Author(s):  
Kwang Hwan Park ◽  
Yeokgu Hwang ◽  
Seung Hwan Han ◽  
Yoo Jung Park ◽  
Dong Woo Shim ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Revisional Surgery ◽  
Lesion Size ◽  
Osteochondral Lesions ◽  
Clinical Failure ◽  
Factors Associated ◽  
Marrow Stimulation ◽  
Kaplan Meier ◽  
Surgery Rates

Background: Recent studies have reported promising clinical results after osteochondral autograft transplantation (OAT) for the treatment of large osteochondral lesions of the talus (OLT). However, no study has yet compared clinical outcomes between primary and secondary OAT for large OLT. Purpose: To compare clinical outcomes among patients with large OLT who receive primary OAT versus those who receive secondary OAT after failure of marrow stimulation and to identify factors associated with clinical failure. Study Design: Cohort study; Level of evidence, 3. Methods: From 2005 to 2014, 46 patients with large OLT (≥150 mm2) underwent OAT: 18 underwent OAT as initial surgical management (primary OAT group), and 28 patients underwent secondary OAT after failure of previous arthroscopic marrow stimulation (secondary OAT group). In both groups, OAT procedures included arthroscopic inspection and debridement of concomitant soft tissue injuries. Clinical outcomes were assessed using pain visual analog scale (VAS), the Roles and Maudsley score, Foot and Ankle Outcome Scores (FAOS), and revisional surgery rates. Factors associated with clinical failures were evaluated using bivariate and logistic regression analyses. Survival outcomes were compared using Kaplan-Meier analysis. Results: Mean follow-up time was 6 years (range, 2-10.8 years). Mean lesion size was 194.9 mm2 (range, 151.7-296.3 mm2). There were no significant differences between groups in patient demographics and preoperative findings. Postoperative pain VAS, Roles and Maudsley score, FAOS, and revisional surgery rates were not significantly different at last follow-up. Prior marrow stimulation was not significantly associated with clinical failure on bivariate analysis. Lesion size greater than 225 mm2 on preoperative magnetic resonance imaging was significantly associated with clinical failure. Survival probabilities from Kaplan-Meier plots were not significantly different between the primary and secondary OAT groups ( P = .947). Conclusion: Clinical outcomes of patients with large OLT treated with secondary OAT after failed marrow stimulation were found to be comparable with those who were treated with primary OAT. These results may be helpful to orthopaedic surgeons deciding appropriate surgical options for patients with large OLT.

scholarly journals Satisfactory long-term clinical outcomes after bone marrow stimulation of osteochondral lesions of the talus

2021 ◽  
Author(s):  
Quinten G. H. Rikken ◽  
Jari Dahmen ◽  
Sjoerd A. S. Stufkens ◽  
Gino M. M. J. Kerkhoffs
Keyword(s):  
Bone Marrow ◽  
Clinical Outcomes ◽  
Degenerative Changes ◽  
Osteochondral Lesions ◽  
Ankle Osteoarthritis ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
The Mean

Abstract Purpose The purpose of the present study was to evaluate the clinical and radiological outcomes of arthroscopic bone marrow stimulation (BMS) for the treatment of osteochondral lesions of the talus (OLTs) at long-term follow-up. Methods A literature search was conducted from the earliest record until March 2021 to identify studies published using the PubMed, EMBASE (Ovid), and Cochrane Library databases. Clinical studies reporting on arthroscopic BMS for OLTs at a minimum of 8-year follow-up were included. The review was performed according to the PRISMA guidelines. Two authors independently conducted the article selection and conducted the quality assessment using the Methodological index for Non-randomized Studies (MINORS). The primary outcome was defined as clinical outcomes consisting of pain scores and patient-reported outcome measures. Secondary outcomes concerned the return to sport rate, reoperation rate, complication rate, and the rate of progression of degenerative changes within the tibiotalar joint as a measure of ankle osteoarthritis. Associated 95% confidence intervals (95% CI) were calculated based on the primary and secondary outcome measures. Results Six studies with a total of 323 ankles (310 patients) were included at a mean pooled follow-up of 13.0 (9.5–13.9) years. The mean MINORS score of the included studies was 7.7 out of 16 points (range 6–9), indicating a low to moderate quality. The mean postoperative pooled American Orthopaedic Foot and Ankle Society (AOFAS) score was 83.8 (95% CI 83.6–84.1). 78% (95% CI 69.5–86.8) participated in sports (at any level) at final follow-up. Return to preinjury level of sports was not reported. Reoperations were performed in 6.9% (95% CI 4.1–9.7) of ankles and complications related to the BMS procedure were observed in 2% (95% CI 0.4–3.0) of ankles. Progression of degenerative changes was observed in 28% (95% CI 22.3–33.2) of ankles. Conclusion Long-term clinical outcomes following arthroscopic BMS can be considered satisfactory even though one in three patients show progression of degenerative changes from a radiological perspective. These findings indicate that OLTs treated with BMS may be at risk of progressing towards end-stage ankle osteoarthritis over time in light of the incremental cartilage damage cascade. The findings of this study can aid clinicians and patients with the shared decision-making process when considering the long-term outcomes of BMS. Level of evidence Level IV.

scholarly journals Clinical outcomes of arthroscopic repair of acetabular labral tears

2018 ◽  
Vol 4 (1) ◽  
pp. e000328 ◽  
Author(s):  
Carlos César Vassalo ◽  
Antônio Augusto Guimarães Barros ◽  
Lincoln Paiva Costa ◽  
Euler de Carvalho Guedes ◽  
Marco Antônio Percope de Andrade
Keyword(s):  
Clinical Outcomes ◽  
Arthroscopic Repair ◽  
Final Evaluation ◽  
Labral Repair ◽  
Harris Hip Score ◽  
Senior Surgeon ◽  
Labral Tears ◽  
Significant Difference ◽  
The Mean

PurposeTo evaluate the primary clinical outcomes of arthroscopic labral repair.MethodsAll patients who underwent arthroscopic repair of the acetabular labrum performed by a senior surgeon between October 2010 and December 2013 were invited to participate in this prospective study. Patients included were those who had a preoperative diagnosis of labral tears, a lateral centre edge greater than 25° and a labral tear believed to be suturable during the intraoperative evaluation. Patients with Tönnis grade 2 or grade 3 hip osteoarthritis and those who had undergone a previous hip surgery were excluded. All patients were evaluated using the modified Harris Hip Score (mHHS) during the final appointment before surgery, 4 months after surgery and at the final evaluation. Interviews were conducted by the senior surgeon.ResultsEighty-four patients (90 hips) underwent arthroscopic repair. The mean age was 44.2 years and the mean follow-up period was 43.0 months (minimum of 25 months and maximum of 59 months). The mean mHHS was 80.4 preoperatively, 95.0 at 4 months postoperatively and 96.6 at final evaluation. A statistically significant difference existed among these scores (p<0.001).ConclusionArthroscopic labral repair was associated with a clinically significant improvement in mHHS after short-term (4 months) and medium-term (43 months) follow-up.Level of evidenceLevel IV, therapeutic case series.

scholarly journals 32-mm ceramic-on-ceramic total hip arthroplasty versus 28-mm ceramic bearings: 5- to 15-year follow-up study

2018 ◽  
Vol 29 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Yoshitoshi Higuchi ◽  
Taisuke Seki ◽  
Yukiharu Hasegawa ◽  
Yasuhiko Takegami ◽  
Daigo Morita ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Total Hip ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Average Patient ◽  
The Mean ◽  
Ceramic On Ceramic

Introduction: This study aimed to compare the clinical and radiographic results of 28-mm ceramic-on-ceramic (CoC) total hip arthroplasty (THA) to those of 32-mm CoC during a 5- to 15-year follow-up period. Methods: 107 joints (95 women and 6 men) underwent 28-mm CoC, and 60 (49 women and 7 men) underwent 32-mm CoC. The average patient age at the time of surgery was 56.1 and 55.7 years in the 28-mm and 32-mm CoC groups, respectively. Clinical and radiologic measurements of all patients were analysed. Results: The mean preoperative Harris hip score (HHS) was similar in the 2 groups (28-mm, 58.9; and 32-mm, 58.5). However, at final follow-up, the mean HHS of the 32-mm CoC (91.8) was significantly better than that of the 28-mm CoC (88.2) ( p = 0.003), as were the ranges of motion (ROM) for flexion (98.3 ± 13.5° vs. 87.3 ± 19.3°, p < 0.001) and abduction (27.8 ± 14.9° vs. 22.1 ± 19.3°, p = 0.007). The mean wear rate was 0.0044 mm/year for the 28-mm CoC and 0.0044 mm/year for the 32-mm CoC. No ceramic fractures were found in the 2 groups. One joint in the 28-mm CoC (0.9%) required revision owing to progressive osteolysis. Kaplan-Meier survival at 10 years, with implant loosening or revision THA as the endpoint, was 98.3% for 28-mm CoC and 100% for 32-mm CoC ( p = 0.465). Conclusion: There was no significant difference in ceramic-related complications between the 2 groups. Our study demonstrated that the 32-mm and 28-mm CoC are safe and are associated with good clinical outcomes.

Lower Signal Intensity of the Anterior Talofibular Ligament is Associated with a Higher Rate of Return to Sport After ATFL Repair for Chronic Lateral Ankle Instability

2019 ◽  
Vol 47 (10) ◽  
pp. 2380-2385 ◽  
Author(s):  
Hong Li ◽  
Yinghui Hua ◽  
Sijia Feng ◽  
Hongyun Li ◽  
Shiyi Chen
Keyword(s):  
Signal Intensity ◽  
Functional Outcomes ◽  
Ankle Instability ◽  
Return To Sport ◽  
Rate Of Return ◽  
Anterior Talofibular Ligament ◽  
Aofas Score ◽  
Significant Difference ◽  
The Mean

Background: The treatment strategy for anterior talofibular ligament (ATFL) injury is usually determined by the ATFL remnant condition during surgery. Preoperative magnetic resonance imaging (MRI)–based signal intensity of the ATFL remnant, represented by the signal/noise ratio (SNR) value, can reveal the ATFL remnant condition. Thus far, there is a lack of evidence regarding the relationship between the ATFL remnant condition and functional outcomes. Purpose/Hypothesis: The purpose was to quantitatively evaluate whether the MRI-based ATFL ligament SNR value is related to functional outcomes after ATFL repair for ankles with chronic lateral ankle instability. The hypothesis was that a lower preoperative SNR is related to a better clinical outcome, particularly a higher rate of return to sport. Study Design: Cohort study; Level of evidence, 3. Methods: First, a preliminary study was performed to measure the ATFL SNR in preoperative MRI, the results of which suggested that a preoperative SNR >10.4 was indicative of a poor ATFL condition. Then, a cohort study was retrospectively performed with consecutive patients who underwent open repair of ATFL injuries between January 2009 and August 2014. Accordingly, the patients were divided into 2 groups: high SNR (HSNR; ≥10.4) and low SNR (LSNR; <10.4). Functional outcomes based on the American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), and Tegner Activity Scale were then compared between the HSNR group and the LSNR group. Results: Ultimately, 70 patients were available for the final follow-up: 37 in the HSNR group and 33 in the LSNR group. No significant difference was detected between the HSNR group and the LSNR group in terms of the AOFAS score, KAFS, or Tegner Activity Scale ( P > .05 for all) preoperatively. At the final follow-up, the mean ± SD AOFAS score in the LSNR group (92 ± 6) was higher than that in the HSNR group (87 ± 12), although no significant difference was detected postoperatively ( P = .16). The mean KAFS in the LSNR group (94 ± 7) was significantly higher than that in the HSNR group (88 ± 11) postoperatively ( P = .03). At follow-up, the mean Tegner score in the LSNR group (6; range, 3-7) was significantly higher than that in the HSNR group (5; range, 1-8) postoperatively ( P = .03). Patients in the LSNR group had a significantly higher percentage of sports participation than those in the HSNR group (91% vs 65%, P = .02) postoperatively. Conclusion: A lower signal intensity in the ATFL ligament based on preoperative MRI is associated with a better clinical outcome, particularly a higher rate of return to sport.

scholarly journals Oncologic outcomes comparison of partial ureterectomy and radical nephroureterectomy for urothelial carcinoma

BMC Urology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Shengxian Li ◽  
Yuchen Pan ◽  
Jinghai Hu
Keyword(s):  
Cox Regression ◽  
Oncologic Outcomes ◽  
Radical Nephroureterectomy ◽  
Cancer Specific Survival ◽  
Urothelial Carcinomas ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Function Preservation ◽  
The Mean

Abstract Background The appropriate application of various treatment for upper tract urothelial carcinomas (UTUCs) is the key to prolong the survival of UTUC patients. Herein, we used data in our database to assess the oncological outcomes between partial ureterectomy (PU) and radical nephroureterectomy (RNU). Methods From 2007 to 2014, 255 patients with UTUC undergoing PU or RNU in our hospital database were investigated. Perioperative, postoperative data, and pathologic outcomes were obtained from our database. Cancer-specific survival (CSS) was assessed through the Kaplan-Meier method with Cox regression models to test the effect of these two surgery types. Results The mean length of follow-up was 35.8 months (interquartile range 10–47 months). Patients with high pT stage (pT2–4) suffered shorter survival span (HR: 9.370, 95% CI: 2.956–29.697, P < 0.001). There were no significant differences in CSS between PU and RNU (P = 0.964). In the sub-analysis, CSS for RNU and PU showed no significant difference for pTa–1 or pT2–4 tumor patients (P = 0.516, P = 0.475, respectively). Conclusions PU is not inferior to RNU in oncologic outcomes. Furthermore, PU is generally recognized with less invasive and better renal function preservation compared with RNU. Thus, PU would be rational for specific patients with UTUCs.

scholarly journals Osteochondral allograft transplantation for large Hill-Sachs lesions: a retrospective case series with a minimum 2-year follow-up

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Hongwu Zhuo ◽  
Yangkai Xu ◽  
Fugui Zhu ◽  
Ling Pan ◽  
Jian Li
Keyword(s):  
Clinical Outcomes ◽  
Case Series ◽  
Osteochondral Allograft ◽  
Satisfaction Rate ◽  
Allograft Transplantation ◽  
Constant Murley Score ◽  
Significant Difference ◽  
The Mean ◽  
Graft Resorption

Abstract Purpose To investigate the clinical outcomes after osteochondral allograft transplantation for large Hill-Sachs lesions. Methods Patients who underwent osteochondral allograft transplantation for large Hill-Sachs lesions were identified. Clinical assessment consisted of active range of motion (ROM), American Shoulder and Elbow Surgeons score (ASES), Constant-Murley score, Rowe score, and patient satisfaction rate. Radiographic assessment was performed with CT scan. Results Nineteen patients met the inclusion criteria. The mean age was 21.7 years. The mean preoperative size of the Hill-Sachs lesion was 35.70 ± 3.02%. The mean follow-up was 27.8 months. All grafts achieved union at an average of 3.47 months after surgery. At the final follow-up, graft resorption was observed in 43.1% of patients. The average size of residual humeral head articular arc loss was 12.31 ± 2.79%. Significant improvements (P < .001) were observed for the active ROM, ASES score, Constant-Murley score, and Rowe score. The overall satisfaction rate was 94.7%. No significant difference was found between the resorption group and the nonresorption group in postoperative clinical outcomes. Conclusion Osteochondral allograft transplantation is a useful treatment option for patients with large Hill-Sachs lesions. Although the incidence of graft resorption may be relatively high, the clinical outcomes at a minimum 2-year follow-up are favorable. Level of evidence Level IV, case series

scholarly journals Pre-therapy extrahepatic 68Ga-DOTATATE avid tumor burden is associated with shortterm clinical outcomes of 177Lu-DOTATATE in advanced metastatic gastroenteropancreatic neuroendocrine tumors

2021 ◽  
Author(s):  
Hong Song ◽  
Pamela L. Kunz ◽  
Benjamin L. Franc ◽  
Farshad Moradi ◽  
Judy Nguyen ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Prognostic Marker ◽  
Neuroendocrine Tumors ◽  
Tumor Volume ◽  
Somatostatin Receptor ◽  
Rank Test ◽  
Gastroenteropancreatic Neuroendocrine Tumors ◽  
Kaplan Meier ◽  
Significant Difference

Abstract Lutetium-177 ( 177 Lu)-DOTATATE is an effective systemic therapy for metastatic somatostatin receptor positive neuroendocrine tumors (NETs). Here we report our experience with the use of pre-therapy 68 Ga-DOTATATE PET as prognostic marker for short-term clinical outcomes of 177 Lu-DOTATATE therapy in patients with advanced NETs. Materials and methods: We retrospectively reviewed patients who received at least one dose of 177 Lu-DOTATATE between Dec. 2016 and July 2019 at our institution. 50 patients (63.6 ± 10.0 years) with advanced gastroenteropancreatic neuroendocrine tumors (GEP-NETs) who had pre-therapy 68 Ga-DOTATATE PET were included in the analysis. 68 Ga-DOTATATE avid tumor volumes were determined automatically using an SUV thresholding approach. Total and extrahepatic 68 Ga-DOTATATE avid tumor volumes were measured and dichotomized into large and small tumor volume groups. Association with progression free survival (PFS) and overall survival (OS) were determined at median follow up of 32 months by Kaplan-Meier survival analysis with Log-Rank test. Results: During follow up, 38 patients (76%) had disease progression and 15 patients (30%) died. Kaplan-Meier analysis of PFS in GEP-NETs patients showed that smaller extrahepatic 68 Ga-DOTATATE avid tumor volume (<140 mL) is associated with significantly longer PFS (Median PFS 29.0 ± 6.7 months vs 9.0 ± 1.7 months, P = 0.0001). This trend in PFS is less prominent when total 68 Ga-DOTATATE avid tumor volume is analyzed. Similarly, Kaplan-Meier analysis of OS found that GEP-NETs patients with smaller extrahepatic 68 Ga-DOTATATE avid tumor volume (<150 mL) is associated with significantly longer OS (Median OS not reached vs 44.0 ± 12.3 months, P = 0.002). This association with OS is not statistically significant when total 68 Ga-DOTATATE avid tumor volume is analyzed. When 68 Ga-DOTATATE avid hepatic tumor volume is grouped into low (<500 mL), medium (500-1000mL) and large (> 1000 mL) tumor volumes, no statistically significant difference in PFS is observed, P = 0.19. The accuracy of extrahepatic 68 Ga-DOTATATE avid tumor volume as prognostic marker for PFS and OS at 32 months are moderate at 58% and 72%. Conclusions: Smaller extrahepatic 68 Ga-DOTATATE avid tumor volumes are associated with longer PFS and OS following 177 Lu-DOTATATE treatment in patients with advanced GEP-NETs. The accuracy of extrahepatic 68 Ga-DOTATATE avid tumor volume as prognostic marker for PFS and OS at 32 months are moderate, which may limit its clinical application.

scholarly journals The Incidence of Postoperative Seizures Following Treatment of Postinfectious Hydrocephalus in Ugandan Infants: A Post Hoc Comparison of Endoscopic Treatment vs Shunt Placement in a Randomized Controlled Trial

Neurosurgery ◽  
2019 ◽  
Vol 85 (4) ◽  
pp. E714-E721 ◽  
Author(s):  
Maria Punchak ◽  
Edith Mbabazi Kabachelor ◽  
Michael Ogwal ◽  
Esther Nalule ◽  
Joyce Nalwoga ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Bivariate Analysis ◽  
Third Ventriculostomy ◽  
Published Data ◽  
Intention To Treat ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Postoperative Seizure ◽  
Post Hoc

Abstract BACKGROUND There are currently no published data directly comparing postoperative seizure incidence following endoscopic third ventriculostomy (ETV), with/without choroid plexus cauterization (CPC), to that for ventriculoperitoneal shunt (VPS) placement. OBJECTIVE To compare postoperative epilepsy incidence for ETV/CPC and VPS in Ugandan infants treated for postinfectious hydrocephalus (PIH). METHODS We performed an exploratory post hoc analysis of a randomized trial comparing VPS and ETV/CPC in 100 infants (&lt;6 mo old) presenting with PIH. Minimum follow-up was 2 yr. Variables associated with and the incidence of postoperative epilepsy were compared (intention-to-treat) using a bivariate analysis. Time to first seizure was compared using the Kaplan–Meier method, and the relative risk for the 2 treatments was determined using Mantel-Haenszel hazard ratios. RESULTS Seizure incidence was not related to age (P = .075), weight (P = .768), sex (P = .151), head circumference (P = .281), time from illness to hydrocephalus onset (P = .973), or hydrocephalus onset to treatment (P = .074). Irritability (P = .027) and vision deficit (P = .04) were preoperative symptoms associated with postoperative seizures. Ten (10%) patients died, and 20 (20%) developed seizures over the follow-up period. Overall seizure incidence was 9.4 per 100 person-years (9.4 and 9.5 for ETV/CPC and VPS, respectively; P = .483), with no significant difference in seizure risk between groups (hazard ratio, 1.02; 95% CI: 0.42, 2.45; P = .966). Mean time to seizure onset was 8.5 mo for ETV/CPC and 11.2 mo for VPS (P = .464). As-treated, per-protocol, and attributable-intervention analyses yielded similar results. CONCLUSION Postoperative seizure incidence following treatment of PIH was 20% within 2 yr, regardless of treatment modality.

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