RESUMEN
Treatment options for aneurysmal bone cysts include intralesional curettage, segmental excision, en bloc resection and endovascular embolization. The most commonly used treatment is intralesional curettage and selective arterial embolization is normally an adjunctive therapy, not a definitive treatment. We report a case of a C1 lateral mass aneurysmal bone cyst treated with a single session of endovascular embolization. Long-term follow up demonstrated complete resolution of the cyst. A study of aneurysmal bone cyst embolization was conducted and the key points for obtaining maximal devascularization of the cyst along with embolic material and technique are discussed.
Asunto(s)
Quistes Óseos Aneurismáticos/cirugía , Embolización Terapéutica/métodos , Procedimientos Endovasculares/métodos , Enfermedades de la Columna Vertebral/cirugía , Adulto , Quistes Óseos Aneurismáticos/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: Iatrogenic vertebral artery injury is an uncommon but well recognized complication during cervical spine surgery. Intraoperative surgical repair is extremely challenging, and options for endovascular repair are limited because of the lack of proper equipment in the operating room setting. CASE DESCRIPTION: A 53-year-old woman who presented with myelopathy underwent anterior cervical diskectomy and fusion of C3-7. A significant laceration injury of the left vertebral artery was encountered during surgery, which was salvaged by intraoperative endovascular repair with a covered stent under portable fluoroscopy guidance. The salvage and repair led to the rest of the surgery being finished as planned preoperatively without any consequences. CONCLUSIONS: Vertebral artery injury is an uncommon but severe complication of cervical spine surgery. For uncontrolled bleeding, intraoperative endovascular repair with portable fluoroscopy is warranted and possible. A covered stent can seal the laceration and stop the bleeding completely which enables completion of the surgery.
Asunto(s)
Pérdida de Sangre Quirúrgica , Complicaciones Intraoperatorias/cirugía , Stents Metálicos Autoexpandibles , Arteria Vertebral/lesiones , Vértebras Cervicales/cirugía , Discectomía/efectos adversos , Femenino , Hemostasis Quirúrgica/métodos , Humanos , Enfermedad Iatrogénica , Degeneración del Disco Intervertebral/cirugía , Complicaciones Intraoperatorias/etiología , Laceraciones/etiología , Laceraciones/cirugía , Persona de Mediana Edad , Terapia Recuperativa/métodos , Enfermedades de la Médula Espinal/cirugía , Resultado del TratamientoRESUMEN
Five trials that investigated the efficacy of modern endovascular therapies for stroke--MR CLEAN, ESCAPE, SWIFT PRIME, EXTEND IA and REVASCAT--have been published within the past year, changing the landscape of acute stroke management. The trials used a variety of imaging modalities and combinations of treatment approaches, including the mandatory use of intravenous thrombolysis before the initiation of endovascular therapy. All five trials provided strong evidence to support the use of thrombectomy that is initiated within 6 h of stroke onset, prompting worldwide changes in the guidelines for management of acute stroke by endovascular treatment. The benefits of endovascular therapy were observed irrespective of a patient's age, their NIH Stroke Scale score, or whether they received intravenous thrombolysis. In this article, we review the main findings of these recent trials, focusing on key aspects of their designs, and discuss their impact on the future management of patients with acute stroke that results from large-vessel occlusion. We discuss the values of noncontrast CT ASPECTS, perfusion imaging and angiography for selecting patients to receive endovascular interventions. We also consider the role of thrombectomy beyond 6 h after stroke onset, and in patients with posterior circulation strokes.
Asunto(s)
Procedimientos Endovasculares , Accidente Cerebrovascular/cirugía , Isquemia Encefálica/patología , Isquemia Encefálica/cirugía , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/métodos , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Accidente Cerebrovascular/patología , Tiempo de TratamientoRESUMEN
BACKGROUND: Obesity has been associated with poor oncologic outcomes following pancreatoduodenectomy for pancreatic cancer. However, there is a paucity of evidence on the impact of obesity on postoperative complications, oncologic outcome and survival in patients with hepatocellular carcinoma (HCC) undergoing orthotopic liver transplantation (OLT). METHODS: From a database of over 1000 patients who underwent OLT during 1996-2008, 159 patients with a diagnosis of HCC were identified. Demographic data, body mass index (BMI), perioperative parameters, recurrence and survival were obtained. Complications were grouped according to Clavien-Dindo grading (Grades I-V). RESULTS: There were increased incidences of life-threatening complications in overweight (58%) and obese (70%) patients compared with the non-obese patient group (41%) (P < 0.05). Furthermore, the incidence of recurrence of HCC was doubled in the presence of overweight (15%) and obesity (15%) compared with non-obesity (7%) (P < 0.05). Time to recurrence also decreased significantly. Differences in mean ± standard deviation survival in the overweight (45 ± 3 months) and obese (41 ± 4 months) groups compared with the non-obese group (58 ± 6 months) did not reach statistical significance. CONCLUSIONS: These findings indicate that BMI is an important surrogate marker for obesity and portends an increased risk for complications and a poorer oncologic outcome following OLT for HCC.