Stenting of the Lateral Sinus in Idiopathic Intracranial Hypertension According to the Type of Stenosis

Neurosurgery ◽  
2017 ◽  
Vol 80 (3) ◽  
pp. 393-400 ◽  
Author(s):  
Stéphanie Lenck ◽  
Fabrice Vallée ◽  
Marc-Antoine Labeyrie ◽  
Valérie Touitou ◽  
Jean-Pierre Saint-Maurice ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Lateral Sinus ◽  
Long Term Effects ◽  
Average Body Mass Index ◽  
The Past ◽  
Sinus Stenosis ◽  
Average Body Mass ◽  
Average Body

Abstract BACKGROUND: Over the past decade, stenting of lateral sinus stenosis has been used to treat idiopathic intracranial hypertension. Two types of stenoses have been identified: extrinsic and intrinsic. OBJECTIVE: The aim of this study was to report the results of our use of this procedure to treat patients with extrinsic or intrinsic stenoses in idiopathic intracranial hypertension. METHODS: We retrospectively studied clinical, radiological, and manometric data from patients with idiopathic intracranial hypertension who were treated at our institution between January 2009 and January 2015 by stenting of the lateral sinus. RESULTS: Data were studied from 19 women and 2 men. Average body mass index was 29 kg/m2, and the median age at stenting was 33 years. Patients with extrinsic stenoses were younger than those with intrinsic stenoses. Transstenotic gradients measured with patients under general anesthesia were lower than those measured with patients under local anesthesia. In all cases, stenting was effective for papilledema and pulsatile tinnitus. Seventeen patients reporting headaches found that they disappeared completely after stenting. Two complications without long-term effects were reported. CONCLUSION: Irrespective of the type of stenosis, stenting of lateral sinus stenoses is an effective treatment for intracranial hypertension symptoms. At our institution, this treatment has replaced draining of cerebrospinal fluid when treatment with acetazolamide has proved to be ineffective.

Quality of life, need for retreatment, and the re-equilibration phenomenon after venous sinus stenting for idiopathic intracranial hypertension

2020 ◽  
Vol 13 (1) ◽  
pp. 79-85 ◽  
Author(s):  
Rebecca M Garner ◽  
Jennifer Bernhardt Aldridge ◽  
Stacey Q Wolfe ◽  
Kyle M Fargen
Keyword(s):  
Quality Of Life ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Surgical Intervention ◽  
Venous Sinus ◽  
Sinus Stenosis ◽  
Cerebrospinal Fluid Shunting

BackgroundLong term failure rates after venous sinus stenting (VSS) for idiopathic intracranial hypertension (IIH) are poorly understood.MethodsRetrospective analysis was performed on a prospectively-maintained single center database to identify patients with medically refractory IIH who underwent VSS. Patients with persistent or severe recurrent symptoms after VSS undergo lumbar puncture (LP), therefore LP serves as a marker for treatment failure.Results81 patients underwent VSS with a mean follow-up of 10 months; 44 (54.3%) patients underwent LP after VSS due to persistent or recurrent symptoms at a mean of 12 months (median 7, range 2–43). There was a mean decrease in opening pressure (OP) on LP from pre- to post-VSS of 9.1 cm H2O (median 9.5). Overall, a total of 21 (25.9%) patients underwent further surgical intervention following VSS, including five who underwent repeat VSS (6.2% of total) and 18 who underwent cerebrospinal fluid shunting (22.2% of total). There was a non-significant (p=0.18) but overall increase in quality of life scores from pre-stenting (61.2) to last follow-up (71.2), and a significant decrease in Headache Impact Test-6 (HIT-6) scores (p=0.03) with mean pre-stenting and last follow-up scores of 62.7 and 55.8, respectively.ConclusionsVSS is an effective treatment for venous sinus stenosis in IIH; however, this study found higher rates of symptomatic recurrence and need for further surgical intervention (26%) than previously reported in the literature. Recurrence of symptoms occurred at a median of 7 months, even though OP remained lower at follow-up LP, suggestive of a re-equilibration phenomenon.

Organizational Reforms as Routines

2017 ◽  
Author(s):  
Nils Brunsson
Keyword(s):  
Long Term Effects ◽  
The Past ◽  
Limited Experience

This chapter argues that organizational reforms are driven by problems to be addressed, by solutions to be applied, and by forgetfulness. The greater the supply of any of these factors, the more likely it is that reforms will occur. Without problems, reforms are difficult to justify; without solutions they cannot be formulated; and without forgetfulness there is a risk that people will be discouraged by the fact that similar reforms have been tried and have failed in the past. In contemporary large organizations, problems tend to be easily found. Those interested in selling solutions often try to supply problems as well — problems that can be solved by their solutions. Forgetfulness can be promoted by the use of consultants with limited experience of the implementation and long-term effects of reforms. Reforms are also self-referential; they tend to cause new reforms. Thus, reforms can be considered as routines: they are likely to be repeated over and over again.

The PAP Flap Breast Reconstruction: A Practical Option for Slim Patients

2021 ◽  
Author(s):  
Taehee Jo ◽  
Dong Nyeok Jeon ◽  
Hyun Ho Han
Keyword(s):  
Donor Site ◽  
Wound Dehiscence ◽  
Diep Flap ◽  
Separate Analysis ◽  
Flap Reconstruction ◽  
Average Body Mass Index ◽  
Deep Inferior Epigastric Perforator ◽  
Average Body Mass ◽  
Artery Perforator ◽  
Average Body

Abstract Background The posterior thigh-based profunda artery perforator (PAP) flap has been an emerging option as a secondary choice in breast reconstructions. However, whether a PAP flap could consistently serve as the secondary option in slim patients has not been investigated. Methods Records of immediate unilateral breast reconstructions performed from May 2017 to June 2019 were reviewed. PAP flap breast reconstructions were compared with standard deep inferior epigastric perforator (DIEP) flap breast reconstructions, and were grouped into single or stacked PAP flaps for further analysis. Results Overall, 43 PAP flaps were performed to reconstruct 32 breasts. Eleven patients underwent stacked PAP flap reconstruction, while 17 patients underwent 21 single PAP flap reconstruction. The average body mass index (BMI) of the patients was 22.2 ± 0.5 kg/m2. The results were as follows: no total loss, one case of venous congestion (2.3%), two donor site wound dehiscence cases (4.7%), and one case of fat necrosis from partial flap loss (2.3%). When compared with 192 DIEP flap reconstructions, the final DIEP flap supplied 98.1 ± 1.7% of mastectomy weight, while the final PAP flap supplied 114.1 ± 6.2% of mastectomy weight (p < 0.005), demonstrating that PAP flaps can successfully supply final reconstruction volume. In a separate analysis, single PAP flaps successfully supplied 104.2% (84.2-144.4%) of mastectomy weights, while stacked PAP flaps supplied 103.7% (98.8-115.2%) of mastectomy weights. Conclusion In our series of PAP flap reconstructions performed in low-to-normal BMI patients, we found that PAP flaps, as single or stacked flaps, provide sufficient volume to reconstruct mastectomy defects.

scholarly journals Intracranial Venous Sinus Stenting in Idiopathic Intracranial Hypertension: A Case Report and Review of the Literature

2021 ◽  
Vol 11 (3) ◽  
pp. 382
Author(s):  
Dinesh Ramanathan ◽  
Zachary D. Travis ◽  
Emmanuel Omosor ◽  
Taylor Wilson ◽  
Nikhil Sahasrabudhe ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Vision Loss ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Subdural Hygroma ◽  
Presenting Symptoms ◽  
Minimal Improvement ◽  
Sinus Stenosis ◽  
Work Up

We describe a case of severe headaches, double vision, and progressive vision loss secondary to a ruptured intracranial cyst (IAC) in a 31-year-old woman with no relevant past medical history. The case is peculiar because drainage of the subdural hygroma led to a minimal improvement in vision with persistent elevated intracranial pressure (ICP). Further exploration revealed transverse sinus stenosis necessitating stenting. Evaluation post-stenting showed marked reduction of ICP and improvement in symptoms. This report underscores the importance of comprehensive work-up and suspicion of multiple underlying etiologies that may be crucial to complete resolution of presenting symptoms in some cases. We provide an overview of the clinical indications and evidence for venous sinus stenting in treating idiopathic intracranial hypertension (IIH).

scholarly journals Idiopathic intracranial hypertension presenting as iron deficiency anemia: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Peng Yong Sim ◽  
Priyal Taribagil ◽  
Ione O. C. Woollacott ◽  
Safina Rashid ◽  
Desmond P. Kidd
Keyword(s):  
Case Report ◽  
Iron Deficiency ◽  
Intracranial Hypertension ◽  
Iron Deficiency Anemia ◽  
Idiopathic Intracranial Hypertension ◽  
Deficiency Anemia ◽  
Visual Deficits ◽  
Fluid Analysis ◽  
Optic Disc Swelling

Abstract Background The presentation of idiopathic intracranial hypertension (IIH) in association with iron deficiency anemia (IDA) is rare. Case presentation This case report depicts the unusual case of a 31-year-old woman of mixed Jamaican and English heritage with IIH who presented initially as IDA in the context of menorrhagia. Subsequent ophthalmic review, lumbar puncture, cerebrospinal fluid analysis and neuroimaging studies revealed severe bilateral optic disc swelling and raised intracranial pressure in keeping with IIH. Prompt treatment of IDA with blood transfusion and orally administered iron supplements, in addition to medical treatment for IIH, contributed to significant improvement of symptoms and prevented long-term visual deficits. Conclusion The possibility of IDA, albeit rare, should always be considered and investigated appropriately in all patients with IIH, as the treatment of the anemia alone may be sight-saving.

Abstract 1122‐000232: The Importance of Performing Venous Pressure Measurements Following Venous Sinus Stenting for Idiopathic Intracranial Hypertension

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Yazan Radaideh
Keyword(s):  
Pressure Gradient ◽  
Intracranial Hypertension ◽  
Stent Placement ◽  
Idiopathic Intracranial Hypertension ◽  
Venous Pressure ◽  
Sigmoid Sinus ◽  
Venous Sinus ◽  
Pressure Measurements ◽  
Sinus Stenosis ◽  
The Right

Introduction : Although venous sinus stenting is an established treatment for medically refractory idiopathic intracranial hypertension, a subset of patients shows little or no improvement of symptoms after stenting. While this could be related to a number of factors, failure to sufficiently address the pressure gradient is one that can be recognized during the treatment procedure. We describe two patients who had a persistent venous pressure gradient after stent placement. Once identified, a second stent was placed with subsequent resolution of the pressure gradient. Methods : This retrospective chart review identified patients at a single institution who underwent venous sinus stenting and required immediate placement of a second venous sinus stent for a persistent pressure gradient. Results : Two patients with refractory idiopathic intracranial hypertension underwent cerebral angiography with venous manometry. In the first patient, unilateral venous sinus stenosis was present with a maximum pressure of 50 mmHg, which only decreased to 30 mmHg after placement of a right transverse‐sigmoid sinus stent. Subsequent manometry revealed a persistent gradient between the superior sagittal sinus and the right transverse sinus, which resolved after placement of a second stent in this location. In the second patient, bilateral stenosis was observed at the transverse‐sigmoid sinus junction; the maximum venous pressure was 40 mmHg, and a gradient of 30 mmHg was measured at the right transverse‐sigmoid junction, where a venous sinus stent was placed. Venous sinus pressure measurements performed immediately after the stent placement demonstrated a persistent pressure gradient of 20 mmHg in the contralateral transverse‐sigmoid sinus junction, which resolved after contralateral stent placement. Both patients showed sustained improvement in their symptoms at 1 year follow up. Conclusions : In some patients with idiopathic intracranial hypertension and venous sinus stenosis, a single stent may not sufficiently reduce the pressure gradient. A second stent may be required; however, this is only detectable with post‐stent pressure measurements. Performing manometry after stent placement should be routinely performed in order to detect persistent venous pressure gradient.

scholarly journals Peer Victimization in Middle Childhood: Characteristics, Causes, and Consequences of School Bullying

1999 ◽  
Vol 9 (1) ◽  
Author(s):  
Zopito Marini
Keyword(s):  
Peer Victimization ◽  
Middle Childhood ◽  
Empirical Data ◽  
School Bullying ◽  
Long Term Effects ◽  
School Life ◽  
The Past

This paper focuses on a particular type of peer victimization commonly identified as school bullying. In the past. myths and inaccurate assumptions coupled with the lack of empirical data on the long term effects and stability of peer victimization have presented serious obstacles toward a greater understanding of bullying. Recent research, however, suggests that the number of students affected is much higher than previously believed, the range of behaviours involved more severe, and the consequences long-lasting; in many cases, the maladjustment for both victims and bullies can extend well into adulthood. Clearly, peer victimization is a complex and multidimensional aspect of school life that needs to be understood in greater depth and taken much more seriously because of the associated consequences. This paper will provide an overview of four central aspects of bullying, namely, the myths, characteristics, callses, and consequences.

scholarly journals Comparison of Juvenile Feed Protocols on Growth and Spawning in Zebrafish

2021 ◽  
Author(s):  
Stephen C Frederickson ◽  
Mark D Steinmiller ◽  
Tiffany Rae Blaylock ◽  
Mike E Wisnieski II ◽  
James D Malley ◽  
...  
Keyword(s):  
Reproductive Performance ◽  
Critical Role ◽  
Fertilization Rate ◽  
Long Term Effects ◽  
The Past ◽  
Adult Feeding ◽  
Freeze Dried ◽  
Feeding Protocol ◽  
Spawning Success

Over the past 2 decades, zebrafish, Danio rerio, have become a mainstream laboratory animal model, yet zebrafish husbandrypractices remain far from standardized. Feeding protocols play a critical role in the health, wellbeing, and productivity ofzebrafish laboratories, yet they vary significantly between facilities. In this study, we compared our current feeding protocol for juvenile zebrafish (30 dpf to 75 dpf), a 3:1mixture of fish flake and freeze-dried krill fed twice per day with live artemia twice per day (FKA), to a diet of Gemma Micro 300 fed once per day with live artemia once per day (GMA). Our results showed that juvenile EK wild-type zebrafish fed GMA were longer and heavier than juveniles fed FKA. As compared with FKA-fed juveniles, fish fed GMA as juveniles showed better reproductive performance as measured by spawning success, fertilization rate, and clutch size. As adults, fish from both feeding protocols were acclimated to our standard adult feeding protocol, and the long-term effects of juvenile diet were assessed. At 2 y of age, the groups showed no difference in mortality or fecundity. Reproductive performance is a crucial aspect of zebrafish research, as much of the research focuses on the developing embryo. Here we show that switching juvenile zebrafish from a mixture of flake and krill to Gemma Micro 300 improves reproductive performance, even with fewer feedings of live artemia, thus simplifying husbandry practices.

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