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Standalone Endovascular Embolization versus Stereotactic Radiosurgery in the Treatment of Arteriovenous Malformations in Eloquent Brain.
No full textBackground Arteriovenous malformations (AVMs) in eloquent brain regions pose significant challenges due to the increased risk of neurologic deficits associated with treatment. Although stereotactic radiosurgery (SRS) and endovascular embolization are used as standalone approaches, their comparative outcomes in eloquent brain AVMs remain unclear. Purpose To directly compare the outcomes of standalone endovascular embolization versus SRS for patients with AVMs in the eloquent brain. Materials and Methods This retrospective multicenter study analyzed patients with AVMs located in eloquent brain regions treated with standalone SRS or embolization from January 2010 to December 2023 as part of the Multicenter International Study for Treatment of Brain AVMs, or MISTA, consortium. Angiographic outcomes were assessed using digital subtraction arterial angiography, MR angiography, or CT angiography. Propensity score weighting (PSW) was used to account for baseline differences. Results A total of 119 patients were included (median age, 35 years [IQR, 21-54 years]; 64 female), with 96 patients treated with SRS and 23 with embolization. SRS achieved 71% (61 of 86 patients) complete obliteration at last follow-up compared with 56% (10 of 18 patients) in the embolization group (odds ratio [OR], 1.95
Does Pelvic Angioembolization Increase Pelvic Ischemic Complication? A Multicenter American Association for the Surgery of Trauma Study.
No full textBACKGROUND: Controversy exists if pelvic angioembolization (PAE) causes ischemic complications of the pelvis and if selective vs non-selective embolization influences the risk of these complications.
METHODS: We conducted a multicenter prospective observational study of adult blunt trauma patients with pelvic fractures who underwent angiography over 55 months. Patients who underwent angiography were divided into four groups: no embolization (No-Embo), selective embolization (Sel), unilateral nonselective embolization (Non-Sel) and bilateral Non-Sel embolization (B-Non-Sel). The primary outcome was ischemic complications; defined as gluteal skin/muscle necrosis, pelvic abscess, pelvic wound infection, pelvic wound breakdown, and osteomyelitis of the pelvis or femoral head.
RESULTS: Of the 460 patients undergoing angiography, pelvic ischemic complications occurred in 45 patients (9.8%). Of these 45 patients, 4 patients were in the No-Embo group (5.1%), 24 patients (10.0%) in the Sel group, 11 patients (15.1%) in the Non-Sel group, and 6 patients (8.8%) in the B-Non-Sel. There was no significant difference when comparing the groups on univariate analysis (p=0.23), multivariable analysis (Sel OR=2.16, p=0.3; Non-Sel OR=4.17, p=0.07; B-Non-Sel OR=1.00, p=0.99) nor when comparing each complication individually.
CONCLUSION: The current study is the largest to date of blunt pelvic fracture patients undergoing angiography. Upon comparing those not embolized with those selectively and non-selectively embolized, we found no association between PAE and pelvic ischemic complications. The decision of when and where to embolize should be individualized to the injury encountered and the stability of the patient
Hidradenitis Suppurativa Is Associated with an Increased Risk of Adverse Cardiac Events and All-Cause Mortality.
No full textAre Mildly Disabled Patients Appropriate for Spine Bundles? An Application of the Operative Value Index.
No full textBACKGROUND: Many studies have evaluated the effect of preoperative disability status on functional outcomes following spine surgery. However, no research has compared the value (outcomes per dollar spent) of surgery for patients with different levels of diagnosis-specific disability.
METHODS: We retrospectively reviewed 429 patients who underwent neurosurgical anterior cervical discectomy and fusion. Time-driven activity-based costing was used to calculate total intraoperative costs. Neck Disability Index (NDI) scores were recorded at baseline and 3 months postsurgery. Patients were categorized into groups based on their preoperative NDI score. Our primary outcome was a novel Operative Value Index (OVI), defined as the percent change in NDI per $1000 spent intraoperatively. Generalized linear mixed model regression was used to determine if severe-to-complete ( high ) baseline neck disability was significantly associated with OVI and total cost.
RESULTS: Compared to patients with high preoperative neck disability, the OVI was significantly lower for patients with no neck disability (β-coefficient: -14.0; P \u3c 0.001) and mild neck disability (β-coefficient: -4.06; P \u3c 0.001). There were no significant associations between the NDI groups and total intraoperative cost.
CONCLUSIONS: Surgery provided the most value for patients with high baseline neck disability, with more favorable outcomes per dollar spent compared to those with low baseline neck disability. Patients with low baseline neck disability may therefore be suboptimal candidates for bundled payments, emphasizing the importance of careful patient selection to optimize resource use and outcomes in value-based care models
The Impact of Postprocedural Anticoagulant Use in Patients Undergoing Woven EndoBridge: A Multicenter Propensity Score-Matched Study.
No full textThe Woven EndoBridge (WEB) device has become a prominent treatment for wide-neck bifurcation intracranial aneurysms since its FDA approval in 2018. However, the impact of anticoagulant therapy on its efficacy and patient outcomes remains underexplored. This study aims to evaluate the effects of postoperative anticoagulant use on aneurysm occlusion, retreatment rates, and functional outcomes following WEB device implantation. This retrospective multicenter study included 457 patients treated with the WEB device across 10 academic institutions in the United States between January 2012 and June 2024. Patients were categorized based on postoperative anticoagulant use: 91 patients (19.9%) received anticoagulants, while 366 patients (80.1%) did not. Propensity score matching (PSM) was employed to control for potential confounders, resulting in 316 matched patients (229 non-anticoagulant and 87 anticoagulant). After PSM, the anticoagulant group had lower rates of excellent functional outcomes (mRS 0-1: 73% vs. 85%, p = 0.026) and higher mortality rates (6.7% vs. 3.7%, p = 0.33), though the latter difference was not statistically significant. No significant differences in the last follow-up adequate occlusion were observed between the two groups (p = 0.7). However, patients in the anticoagulant group had lower major device compaction (\u3e 50%) (4.9% vs. 12%, p = 0.12) and retreatment rates (4.6% vs. 12%, p = 0.045). Postoperative anticoagulant use is associated with poor functional outcomes and higher tendency for higher mortality rate. No significant differences in the last follow-up adequate occlusion rate were observed between the anticoagulant group and non-anticoagulant group. However, patients in the anticoagulant group had lower major compaction and retreatment rates. These findings suggest that the WEB mechanism of occlusion is more complex than what have been hypothesized and highlight the need for individualized management strategies to optimize outcomes in patients requiring anticoagulation post-WEB. Further studies are needed
Erratum to Cardiac screening findings and referral patterns in male African-American basketball players: Analysis of the HeartBytes Registry [The American Journal of Cardiology 243 (2025) 73-80].
No full textNine Years, 293 Cases: Advancing Wide Cleft Palate Repair: Insights, Techniques, and Outcomes From Cleft Lip and Palate Association of Pakistan\u27s Institutional Experience.
No full textBACKGROUND: Wide cleft palate repair poses a considerable challenge due to the potential for closure under tension, and an elevated risk of postoperative oronasal fistula and velopharyngeal insufficiency (VPI). Preoperative cleft width and Cleft Palate Index (CPI) are recognized as key predictors of outcome. This study presents Cleft Lip And Palate Association of Pakistan\u27s (CLAPP) institutional experience with wide cleft palate repair, analyzing the influence of anatomical severity, surgical technique, and other variables on fistula formation and speech outcomes.
METHODS: A retrospective review was conducted of patients undergoing repair at CLAPP Hospital between January 2015 and December 2023. Data collected included demographics, cleft width, palatal shelf width, CPI, surgical technique, fistula location and rate, speech outcomes, and need for secondary speech-correcting surgery. Cleft width and CPI were stratified into predefined categories. Univariate and multivariate logistic regression were performed to identify predictors of postoperative fistula formation.
RESULTS: A total of 293 patients (mean age 8 years, range 9 months-48 years) were included. Nearly one-third (35.5%) had cleft widths greater than the combined right and left palatal shelf widths. CPI distribution revealed progressive fistula rates from 12.1% in the narrowest group to 28.2% in the widest. The overall postoperative fistula rate was 21.2%, most frequently at the soft palate (27.4%) and hard-soft junction (12.9%). In univariate analysis, left palate width ≥ 1.1 cm and von Langenbeck repair were associated with significantly lower fistula rates, although only the latter remained significant in multivariate analysis (adjusted odds ratio = 0.34; 95% confidence interval = 0.16-0.72; P = 0.004). Bardach repair was preferentially performed in more severe, wider clefts, accounting for its higher unadjusted fistula rate. Preoperative and postoperative speech assessments (N = 173) showed a mean composite score improvement of 13.4%, with 8.9% requiring secondary speech-correcting surgery.
CONCLUSIONS: Wide cleft palate repair outcomes are strongly influenced by cleft morphology, with CPI emerging as a key prognostic tool. While von Langenbeck repair demonstrated lower adjusted fistula rates, technique selection remains contingent on preoperative assessment, with Bardach repair favored in severe cases. Long-term monitoring for VPI is crucial, with early repair and tailored technique selection critical for optimizing functional outcomes in this challenging subset
Interhemispheric-Transcortical Approach for Resection of an Atypical Teratoid/Rhabdoid Tumor (AT/RT) of the Left Lateral and Third Ventricle.
No full textINTRODUCTION: Atypical teratoid/rhabdoid tumors (AT/RT) are malignant central nervous system (CNS) tumors that represent 3% of all pediatric CNS tumors. Majority of cases have SMARCB1 gene mutations and historically carried a poor prognosis.
CASE PRESENTATION: A 9-year-old boy was diagnosed with a third ventricle AT/RT and initially underwent endoscopic surgical biopsy. Subsequent tumor resection was completed using an interhemispheric-transcortical approach.
LESSONS: Surgical approaches to ventricular system must be tailored to the tumor characteristics on a case-by-case basis. We present a case using a transcortical approach for understanding of the microsurgical anatomy for safe resection of a third ventricle AT/RT
