Long-term visual outcome after microsurgical removal of occipital lobe cavernomas

2012 ◽  
Vol 117 (2) ◽  
pp. 295-301 ◽  
Author(s):  
Juri Kivelev ◽  
Elina Koskela ◽  
Kirsi Setälä ◽  
Mika Niemelä ◽  
Juha Hernesniemi
Keyword(s):  
Visual Field ◽  
Visual Fields ◽  
Visual Field Loss ◽  
Occipital Lobe ◽  
Visual Outcome ◽  
Surgical Removal ◽  
Long Term Outcome ◽  
Visual Field Deficit

Object Cavernomas in the occipital lobe are relatively rare. Because of the proximity to the visual cortex and incoming subcortical tracts, microsurgical removal of occipital cavernomas may be associated with a risk of visual field defects. The goal of the study was to analyze long-term outcome after operative treatment of occipital cavernomas with special emphasis on visual outcome. Methods Of the 390 consecutive patients with cavernomas who were treated at Helsinki University Central Hospital between 1980 and 2011, 19 (5%) had occipital cavernomas. Sixteen patients (4%) were surgically treated and are included in this study. The median age was 39 years (range 3–59 years). Seven patients (56%) suffered from hemorrhage preoperatively, 5 (31%) presented with visual field deficits, 11 (69%) suffered from seizures, and 4 (25%) had multiple cavernomas. Surgery was indicated for progressive neurological deterioration. The median follow-up after surgery was 5.25 years (range 0.5–14 years). Results All patients underwent thorough neuroophthalmological assessment to determine visual outcome after surgery. Visual fields were classified as normal, mild homonymous visual field loss (not disturbing the patient, driving allowed), moderate homonymous visual field loss (disturbing the patient, driving prohibited), and severe visual field loss (total homonymous hemianopia or total homonymous quadrantanopia). At the last follow-up, 4 patients (25%) had normal visual fields, 6 (38%) had a mild visual field deficit, 1 (6%) complained of moderate visual field impairment, and 5 (31%) had severe homonymous visual field loss. Cavernomas seated deeper than 2 cm from the pial surface carried a 4.4-fold risk of postoperative visual field deficit relative to superficial ones (p = 0.034). Six (55%) of the 11 patients presenting with seizures were seizure-free postoperatively. Eleven (69%) of 16 patients had no disability during the long-term follow-up. Conclusions Surgical removal of occipital cavernomas may carry a significant risk of postoperative visual field deficit, and the risk is even higher for deeper lesions. Seizure outcome after removal of these cavernomas appeared to be worse than that after removal in other supratentorial locations. This should be taken into account during preoperative planning.

Optical Coherent Tomography Predicts Long-Term Visual Outcome of Pituitary Adenoma Surgery: New Perspectives From a 5-Year Follow-up Study

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 106-112 ◽  
Author(s):  
Young Soo Chung ◽  
Minkyun Na ◽  
Jihwan Yoo ◽  
Woohyun Kim ◽  
In-Ho Jung ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Visual Field ◽  
Assessment Tool ◽  
Visual Fields ◽  
Visual Field Defects ◽  
Mean Deviation ◽  
Rnfl Thickness ◽  
Long Term Follow Up

Abstract BACKGROUND Compressive optic neuropathy is the most common indication for transsphenoidal surgery for pituitary adenomas. Optical coherence tomography (OCT) is a useful visual assessment tool for predicting postoperative visual field recovery. OBJECTIVE To analyze visual parameters and their association based on long-term follow-up. METHODS Only pituitary adenoma patients with abnormal visual field defects were selected. A total of 188 eyes from 113 patients assessed by visual field index (VFI) and 262 eyes from 155 patients assessed by mean deviation (MD) were enrolled in this study. Postoperative VFI, MD, and retinal nerve fiber layer (RNFL) thickness were evaluated and followed up. After classifying the patients into normal (>5%) and thin (<5%) RNFL groups, we investigated whether preoperative RNFL could predict visual field outcomes. We also observed how RNFL changes after surgery on a long-term basis. RESULTS Both preoperative VFI and MD had a linear proportional relationship with preoperative RNFL thickness. Sustained improvement of the visual field was observed after surgery in both groups, and the degree of improvement over time in each group was similar. RNFL thickness continued to decrease until 36 mo after surgery (80.2 ± 13.3 μm to 66.6 ± 11.9 μm) while visual field continued to improve (VFI, 61.8 ± 24.5 to 84.3 ± 15.4; MD, −12.9 ± 7.3 dB to −6.3 ± 5.9 dB). CONCLUSION Patients with thin preoperative RNFL may experience visual recovery similar to those with normal preoperative RNFL; however, the probability of normalized visual fields was not comparable. RNFL thickness showed a strong correlation with preoperative visual field defect. Long-term follow-up observation revealed a discrepancy between anatomic and functional recovery.

Postsurgical Outcome in Cats with Exocrine Pancreatic Carcinoma: Nine Cases (2007–2016)

2018 ◽  
Vol 54 (5) ◽  
pp. 291-295 ◽  
Author(s):  
Ryan Nicoletti ◽  
Ruthanne Chun ◽  
Kaitlin M. Curran ◽  
Louis-Philippe de Lorimier ◽  
Michelle A. Morges ◽  
...  
Keyword(s):  
Pancreatic Carcinoma ◽  
Surgical Removal ◽  
Survival Times ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Localized Disease ◽  
Pancreatic Exocrine ◽  
Aggressive Tumor

ABSTRACT Feline exocrine pancreatic carcinoma has been reported to be an aggressive tumor with a high metastatic rate and poor prognosis. Studies reporting long-term outcome of cats after surgical removal of solitary pancreatic carcinomas are rare, due to the uncommon diagnosis and paucity of cats who undergo treatment. In this study, nine cases of feline exocrine pancreatic carcinoma from seven academic and private practice veterinary hospitals were reviewed to examine the outcome in cats undergoing surgical removal of the mass. The median postsurgical survival time for the nine cats was 316.5 days (range, 25–964 days), with three cats alive at a median follow-up time of 309 days. This study demonstrates that surgical removal of pancreatic exocrine tumors in cats with localized disease can result in survival times of over 300 days.

Perinatal Outcome in Fetuses with Dislodged Thoraco-Amniotic Shunts

2021 ◽  
pp. 1-10
Author(s):  
Nimrah Abbasi ◽  
Rory Windrim ◽  
Johannes Keunen ◽  
P.G.R. Seaward ◽  
Tim Van Mieghem ◽  
...  
Keyword(s):  
Ventilatory Support ◽  
Surgical Removal ◽  
Pleural Effusions ◽  
Amniotic Cavity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Significant Difference

<b><i>Objective:</i></b> Fetal thoraco-amniotic shunts (TASs) can dislodge in utero, migrating internally into the fetal thorax or externally into the amniotic cavity. Our objective was to evaluate the perinatal and long-term outcome of fetuses with TAS dislodgement and conduct a review of the literature. <b><i>Methods:</i></b> This is a retrospective review of all TAS inserted for primary pleural effusions and macrocystic congenital pulmonary airway malformations (CPAMs) in a tertiary fetal medicine center (1991–2020). Antenatal history, procedural factors, and perinatal and long-term outcomes were reviewed in all fetuses with dislodged shunts and compared to fetuses with shunts that did not dislodge. <b><i>Results:</i></b> Of 211 TAS inserted at a mean gestational age of 27.8 weeks ± 5.47 (17.4–38.1 weeks), 187 (89%) were inserted for pleural effusions and 24 (11%) for macrocystic CPAMs. Shunts dislodged in 18 fetuses (8.5%), 17 (94%) of which were for pleural effusions. Shunts migrated into the chest wall/amniotic cavity or into the thorax among 7/18 (39%) and 11/18 (61%) fetuses, respectively. Eleven (61%) fetuses were initially hydropic, which resolved in 8 (72%) cases. Effusions were bilateral in 9 (50%), amnioreduction was required in 6 (33%), and fetal rotation in 8 cases (44%). Four (22%) fetuses underwent repeat shunting, 12 (67%) neonates required ventilatory support, and 2 (11%) neonates required chest tubes. There was no significant difference in technical factors or outcomes between infants with shunts that dislodged and those that did not. Among 11 intrathoracic shunts, 2 (18%) were removed postnatally and the remainder are in situ without any shunt-related or respiratory complications over a follow-up period of 9 months to 22 years. <b><i>Conclusion:</i></b> TAS dislodged antenatally in 8.5% of fetuses, with 2/3 of shunts migrating into the thorax, and nearly 25% requiring re-shunting. Retained intrathoracic shunts were well tolerated and may not necessarily require surgical removal after birth.

scholarly journals Long-term outcome of primary intraocular lens implantation in bilateral congenital cataract in infants with a median age of 35 days at surgery: a case series

2021 ◽  
Vol 6 (1) ◽  
pp. e000836
Author(s):  
Mari Kathrine Sand ◽  
Symira Cholidis ◽  
Kjartan Rimstad ◽  
Elise Dees Krekling ◽  
Olav Kristianslund ◽  
...  
Keyword(s):  
Intraocular Lens ◽  
Congenital Cataract ◽  
Intraoperative Complications ◽  
Case Series ◽  
Visual Outcome ◽  
Secondary Glaucoma ◽  
Long Term Outcome ◽  
Iol Implantation

ObjectiveTo evaluate the long-term visual outcome and safety after bilateral cataract surgery with primary intraocular lens (IOL) implantation in infants with visually significant cataract at birth operated before 12 weeks of age.Methods and analysisMedical records of infants with congenital cataract who had bilateral surgery with primary IOL implantation before 12 weeks of age at Oslo University Hospital between 2007 and 2016 were retrospectively reviewed. Fifteen infants (30 eyes) were enrolled for a prospective study examination in 2017. Corrected distance visual acuity (CDVA) and intraocular pressure (IOP) were assessed. Visual axis opacification (VAO) was defined as opacification on the anterior or posterior surface of the IOL, capsular phimosis or fibrinous membrane. Secondary glaucoma was evaluated according to international guidelines.ResultsMedian age at the time of primary surgery was 35 days (range, 15 to 70 days). There were no serious intraoperative complications, and all eyes had the IOL implanted in the capsular bag. After a median follow-up of 6.1 years (range, 1.5 to 10.2 years), the CDVA was 0.5 logMAR (range, 1.2 to 0.04). All eyes had surgery for VAO and the median number of surgical procedures was 2.0 (range, 1 to 5). The cumulative incidence of secondary glaucoma was 10% after 5 years of follow-up.ConclusionPrimary IOL implantation before 12 weeks of age gave a satisfactory visual outcome, and the incidence of secondary glaucoma was similar to that reported after primary IOL implantation in older infants. However, the risk of VAO was high.

Rate of visual field loss and long-term visual outcome in primary open-angle glaucoma

2001 ◽  
Vol 132 (1) ◽  
pp. 47-56 ◽  
Author(s):  
Young H Kwon ◽  
Chang-sik Kim ◽  
M.Bridget Zimmerman ◽  
Wallace L.M Alward ◽  
Sohan S Hayreh
Keyword(s):  
Visual Field ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Visual Field Loss ◽  
Visual Outcome ◽  
Open Angle

A Proposed Grading System of Brain and Spinal Cavernomas

Neurosurgery ◽  
2011 ◽  
Vol 69 (4) ◽  
pp. 807-814 ◽  
Author(s):  
Juri Kivelev ◽  
Aki Laakso ◽  
Mika Niemelä ◽  
Juha Hernesniemi
Keyword(s):  
Risk Factors ◽  
Glasgow Outcome Scale ◽  
Outcome Measure ◽  
Postoperative Outcome ◽  
Unfavorable Outcome ◽  
Surgical Removal ◽  
Grading System ◽  
Long Term Outcome

Abstract BACKGROUND: Most cavernomas in the central nervous system are characterized by a benign natural course. Progressive symptoms warrant surgical removal. In the literature, the factors affecting long-term postoperative outcome are not statistically well confirmed. OBJECTIVE: To perform a multifactorial analysis of risk factors on a large patient series and to use the results to propose a simple grading scale to predict outcome. METHODS: We studied 303 consecutive patients with cavernomas treated surgically at our department from 1980 to 2009. Follow-up assessment was performed on average 5.7 years postoperatively (range, 0.2-36 years). The main outcome measure was the patients' condition at the last follow-up on Glasgow Outcome Scale. For statistical analysis, the outcome measure was dichotomized to favorable (Glasgow Outcome Scale 5) and unfavorable (Glasgow Outcome Scale 1–4). Binary logistic regression analysis was used to estimate the effect of age, sex, seizures, preexisting neurological deficits, hemorrhage, and size and location of cavernoma on long-term outcome. RESULTS: Infratentorial, basal ganglia, or spinal location and preexisting neurological deficit were the only independent risk factors for unfavorable outcome, with relative risks of 2.7 (P = .008) and 3.2 (P = .002), respectively. We formulated a grading system based on a score of 1 to 3. When applied to our series, the proposed grading system strongly correlated with outcome (P &lt; .001, Pearson χ2 test). The risk for long-term unfavorable outcome was 13%, 22%, and 55% for grades 1 through 3, respectively. CONCLUSION: The proposed grading system showed a convincing correlation with postoperative outcome in surgically treated cavernoma patients.

Klinische Langzeitergebnisse der perkutanen transluminalen Angioplastie bei Patienten mit peripherer arterieller Verschlusskrankheit

VASA ◽  
2002 ◽  
Vol 31 (1) ◽  
pp. 36-42 ◽  
Author(s):  
. Bucek ◽  
Hudak ◽  
Schnürer ◽  
Ahmadi ◽  
Wolfram ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Stage ◽  
Ankle Brachial Index ◽  
Clinical Situation ◽  
Clinical Results ◽  
Transluminal Angioplasty ◽  
Term Outcome ◽  
Long Term Outcome

Background: We investigated the long-term clinical results of percutaneous transluminal angioplasty (PTA) in patients with peripheral arterial occlusive disease (PAOD) and the influence of different parameters on the primary success rate, the rate of complications and the long-term outcome. Patients and methods: We reviewed clinical and hemodynamic follow-up data of 166 consecutive patients treated with PTA in 1987 in our department. Results: PTA improved the clinical situation in 79.4% of patients with iliac lesions and in 88.3% of patients with femoro-popliteal lesions. The clinical stage and ankle brachial index (ABI) post-interventional could be improved significantly (each P < 0,001), the same results were observed at the end of follow-up (each P < 0,001). Major complications occurred in 11 patients (6.6%). The rate of primary clinical long-term success for suprainguinal lesions was 55% and 38% after 5 and 10 years (femoro-popliteal 44% and 33%), respectively, the corresponding data for secondary clinical long-term success were 63% and 56% (60% and 55%). Older age (P = 0,017) and lower ABI pre-interventional (P = 0,019) significantly deteriorated primary clinical long-term success for suprainguinal lesions, while no factor could be identified influencing the outcome of femoro-popliteal lesions significantly. Conclusion: Besides an acceptable success rate with a low rate of severe complications, our results demonstrate favourable long-term clinical results of PTA in patients with PAOD.

Psychopathology 8½ Years Post Parasuicide

Crisis ◽  
1999 ◽  
Vol 20 (3) ◽  
pp. 115-120 ◽  
Author(s):  
Stephen Curran ◽  
Michael Fitzgerald ◽  
Vincent T Greene
Keyword(s):  
Rating Scales ◽  
Psychiatric Morbidity ◽  
Parental Bonding ◽  
Social Maladjustment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Face To Face ◽  
Long Term Follow Up

There are few long-term follow-up studies of parasuicides incorporating face-to-face interviews. To date no study has evaluated the prevalence of psychiatric morbidity at long-term follow-up of parasuicides using diagnostic rating scales, nor has any study examined parental bonding issues in this population. We attempted a prospective follow-up of 85 parasuicide cases an average of 8½ years later. Psychiatric morbidity, social functioning, and recollections of the parenting style of their parents were assessed using the Clinical Interview Schedule, the Social Maladjustment Scale, and the Parental Bonding Instrument, respectively. Thirty-nine persons in total were interviewed, 19 of whom were well and 20 of whom had psychiatric morbidity. Five had died during the follow-up period, 3 by suicide. Migration, refusals, and untraceability were common. Parasuicide was associated with parental overprotection during childhood. Long-term outcome is poor, especially among those who engaged in repeated parasuicides.

Role of Closed Mitral Commissurotomy for Mitral Stenosis: Mid- and Long-term Surgical Outcome of 36 Patients

2005 ◽  
Vol 8 (1) ◽  
pp. 55 ◽  
Author(s):  
Azman Ates ◽  
Yahya �nl� ◽  
Ibrahim Yekeler ◽  
Bilgehan Erkut ◽  
Yavuz Balci ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Stenosis ◽  
Operating Time ◽  
Term Survival ◽  
Long Term Outcome ◽  
Mitral Commissurotomy ◽  
Closed Mitral Commissurotomy

Purpose: To evaluate long-term survival and valve-related complications as well as prognostic factors for mid- and long-term outcome after closed mitral commissurotomy, covering a follow-up period of 14 years. Material and Methods: Between 1989 and 2003, 36 patients (28 women and 8 men, mean age 28.8 6.1 years) underwent closed mitral commissurotomy at our institution. The majority of patients were in New York Heart Association (NYHA) functional class IIB, III, or IV. Indication for closed mitral commissurotomy was mitral stenosis. Closed mitral commissurotomy was undertaken with a Tubbs dilator in all cases. Median operating time was 2.5 hours 30 minutes. Results: After closed mitral commissurotomy, the mitral valve areas of these patients were increased substantially, from 0.9 to 2.11 cm2. No further operation after initial closed mitral commissurotomy was required in 86% of the patients (n = 31), and NYHA functional classification was improved in 94% (n = 34). Postoperative complications and operative mortality were not seen. Follow-up revealed restenosis in 8.5% (n = 3) of the patients, minimal mitral regurgitation in 22.2% (n = 8), and grade 3 mitral regurgitation in 5.5% (n = 2) patients. No early mortality occurred in closed mitral commissurotomy patients. Reoperation was essential for 5 patients following closed mitral commissurotomy; 2 procedures were open mitral commissurotomies and 3 were mitral valve replacements. No mortality occurred in these patients. Conclusions: The mitral valve area was significantly increased and the mean mitral valve gradient was reduced in patients after closed mitral commissurotomy. Closed mitral commissurotomy is a safe alternative to open mitral commissurotomy and balloon mitral commissurotomy in selected patients.

Muenke syndrome: long-term outcome of a syndrome-specific treatment protocol

2019 ◽  
Vol 24 (4) ◽  
pp. 415-422 ◽  
Author(s):  
Bianca K. den Ottelander ◽  
Robbin de Goederen ◽  
Marie-Lise C. van Veelen ◽  
Stephanie D. C. van de Beeten ◽  
Maarten H. Lequin ◽  
...  
Keyword(s):  
Treatment Protocol ◽  
First Year ◽  
Ventricular Size ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Skull Growth ◽  
Muenke Syndrome ◽  
First Year Of Life

OBJECTIVEThe authors evaluated the long-term outcome of their treatment protocol for Muenke syndrome, which includes a single craniofacial procedure.METHODSThis was a prospective observational cohort study of Muenke syndrome patients who underwent surgery for craniosynostosis within the first year of life. Symptoms and determinants of intracranial hypertension were evaluated by longitudinal monitoring of the presence of papilledema (fundoscopy), obstructive sleep apnea (OSA; with polysomnography), cerebellar tonsillar herniation (MRI studies), ventricular size (MRI and CT studies), and skull growth (occipital frontal head circumference [OFC]). Other evaluated factors included hearing, speech, and ophthalmological outcomes.RESULTSThe study included 38 patients; 36 patients underwent fronto-supraorbital advancement. The median age at last follow-up was 13.2 years (range 1.3–24.4 years). Three patients had papilledema, which was related to ophthalmological disorders in 2 patients. Three patients had mild OSA. Three patients had a Chiari I malformation, and tonsillar descent < 5 mm was present in 6 patients. Tonsillar position was unrelated to papilledema, ventricular size, or restricted skull growth. Ten patients had ventriculomegaly, and the OFC growth curve deflected in 3 patients. Twenty-two patients had hearing loss. Refraction anomalies were diagnosed in 14/15 patients measured at ≥ 8 years of age.CONCLUSIONSPatients with Muenke syndrome treated with a single fronto-supraorbital advancement in their first year of life rarely develop signs of intracranial hypertension, in accordance with the very low prevalence of its causative factors (OSA, hydrocephalus, and restricted skull growth). This illustrates that there is no need for a routine second craniofacial procedure. Patient follow-up should focus on visual assessment and speech and hearing outcomes.

Sign in / Sign up

Export Citation Format

Share Document