| 1. |
- Bartek jr, Jiri, et al.
(författare)
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Standardized reporting of adverse events after microvascular decompression of cranial nerves; a population-based single-institution consecutive series.
- 2016
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Ingår i: Acta Neurochirurgica. - : Springer Science and Business Media LLC. - 0001-6268 .- 0942-0940. ; 158:9, s. 1775-1781
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate frequencies of adverse events occurring within 30 days after microvascular decompression (MVD) surgery using a standardized report form of adverse events. Methods We conducted a retrospective review of 98 adult patients (≥16 years) treated with MVD between 1 January 1994 and 1 June 2013. Adverse events occurring within 30 days were classified according to the Landriel Ibanez classification for neurosurgical complications: grade I represents any non-life threatening complication treated without invasive procedures; grade II is complications requiring invasive management; grade III is life-threatening adverse events requiring treatment in an intensive care unit (ICU); grade IV is death as a result of complications. We sought to compare our results with reports from the literature. RESULTS: Patients' median age was 61 years (range 26-83), and 64 (65 %) were females. Indications for MVD were trigeminal neuralgia (n=77, 79 %), glossopharyngeal neuralgia (n=4, 4 %), hemifacial spasm (n=16, 16 %) and combined trigeminal neuralgia and hemifacial spasm (n=1, 1 %). The overall 30-day complication rate was 20 %, with 14 % grade I complications, 5 % grade II complications and 1 % grade III complications. The comparison with the literature was hampered by the diverse and unsystematic way of reporting complications. CONCLUSION: We provide a standardized report of postoperative complications in a consecutive patient series undergoing MVD. Due to the heterogeneous and non-standardized reporting of complications in the literature, it is difficult to know if our 20 % complication rate is low or high. Standardized reporting is a necessity for meaningful and more valid comparisons across studies. The safety of MVD, a fairly standardized neurosurgical procedure, is well suited for comparisons across centers provided that complications are reported in a standardized manner
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| 2. |
- Bø, Hans Kristian, et al.
(författare)
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Intraoperative 3D ultrasound-guided resection of diffuse low-grade gliomas: radiological and clinical results.
- 2020
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Ingår i: Journal of neurosurgery. - 1933-0693. ; 132:2, s. 518-529
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVEExtent of resection (EOR) and residual tumor volume are linked to prognosis in low-grade glioma (LGG) and there are various methods for facilitating safe maximal resection in such patients. In this prospective study the authors assess radiological and clinical results in consecutive patients with LGG treated with 3D ultrasound (US)-guided resection under general anesthesia.METHODSConsecutive LGGs undergoing primary surgery guided with 3D US between 2008 and 2015 were included. All LGGs were classified according to the WHO 2016 classification system. Pre- and postoperative volumetric assessments were performed, and volumetric results were linked to overall and malignant-free survival. Pre- and postoperative health-related quality of life (HRQoL) was evaluated.RESULTSForty-seven consecutive patients were included. Twenty LGGs (43%) were isocitrate dehydrogenase (IDH)-mutated, 7 (14%) were IDH wild-type, 19 (40%) had both IDH mutation and 1p/19q codeletion, and 1 had IDH mutation and inconclusive 1p/19q status. Median resection grade was 93.4%, with gross-total resection achieved in 14 patients (30%). An additional 24 patients (51%) had small tumor remnants < 10 ml. A more conspicuous tumor border (p = 0.02) and lower University of California San Francisco prognostic score (p = 0.01) were associated with less remnant tumor tissue, and overall survival was significantly better with remnants < 10 ml (p = 0.03). HRQoL was maintained or improved in 86% of patients at 1 month. In both cases with severe permanent deficits, relevant ischemia was present on diffusion-weighted postoperative MRI.CONCLUSIONSThree-dimensional US-guided LGG resections under general anesthesia are safe and HRQoL is preserved in most patients. Effectiveness in terms of EOR appears to be consistent with published studies using other advanced neurosurgical tools. Avoiding intraoperative vascular injury is a key factor for achieving good functional outcome.
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| 3. |
- Munkvold, Bodil Karoline Ravn, et al.
(författare)
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Tumor Volume Assessment in Low-Grade Gliomas: A Comparison of Preoperative Magnetic Resonance Imaging to Coregistered Intraoperative 3-Dimensional Ultrasound Recordings.
- 2018
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Ingår i: Neurosurgery. - : Ovid Technologies (Wolters Kluwer Health). - 1524-4040 .- 0148-396X. ; 83:2, s. 288-296
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Tidskriftsartikel (refereegranskat)abstract
- Image guidance based on magnetic resonance imaging (MRI) and/or ultrasound (US) is widely used to aid decision making in glioma surgery, but tumor delineation based on these 2 modalities does not always correspond.To analyze volumes of diffuse low-grade gliomas (LGGs) based on preoperative 3-D FLAIR MRIs compared to intraoperative 3-D US image recordings to quantitatively assess potential discrepancies between the 2 imaging modalities.Twenty-three patients with supratentorial WHO grade II gliomas undergoing primary surgery guided by neuronavigation based on preoperative FLAIR MRI and navigated 3-D US were included. Manual volume segmentation was performed twice in 3-D Slicer version 4.0.0 to assess intrarater variabilities and compare modalities with regard to tumor volume. Factors possibly related to correspondence between MRI and US were also explored.In 20 out of 23 patients (87%), the LGG tumor volume segmented from intraoperative US data was smaller than the tumor volume segmented from the preoperative 3-D FLAIR MRI. The median difference between MRI and US volumes was 7.4 mL (range: -4.9-58.7 mL, P < .001) with US LGG volumes corresponding to a median of 74% (range: 42%-183%) of the MRI LGG volumes. However, there was considerable intraobserver variability for US volumes. The correspondence between MRI and US data was higher for astrocytomas (92%).The tumor volumes of LGGs segmented from intraoperative US images were most often smaller than the tumor volumes segmented from preoperative MRIs. There was a much better match between the 2 modalities in astrocytomas.
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| 4. |
- Ravn Munkvold, Bodil Karoline, et al.
(författare)
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The diagnostic properties of intraoperative ultrasound in glioma surgery and factors associated with gross total tumor resection.
- 2018
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Ingår i: World neurosurgery. - : Elsevier BV. - 1878-8769 .- 1878-8750. ; 115
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Tidskriftsartikel (refereegranskat)abstract
- In glioma operations, we sought to analyze sensitivity, specificity and predictive values of intraoperative 3D ultrasound (US) for detecting residual tumor compared to early postoperative MR imaging. Factors possibly associated with radiological complete resection were also explored.144 operations for diffuse supratentorial gliomas were included prospectively in an unselected, population-based single institution series. Operating surgeons filled out a questionnaire immediately after surgery, stating if residual tumor was seen with US at the end of resection and rated US image quality (good, medium, poor). Extent of surgical resection was estimated from pre- and postoperative MRI images.Overall specificity was 85% for "no tumor remnant" seen in US images at the end of resection as compared to postoperative MRI findings. Sensitivity was 46%, but tumor remnants seen on MRI were usually small (median 1.05 ml) in operations with false negative US findings. Specificity was highest in low-grade glioma operations (94%), and lowest in patients who had previously undergone radiotherapy (50%). Smaller tumor volume and superficial location were factors significantly associated with gross total resection in a multivariable logistic regression analysis, while good ultrasound image quality did not reach statistical significance (p = 0.061).The specificity of intraoperative US is rather good, but sensitivity for detecting the last milliliter is low compared to postoperative MRI. Tumor volume and tumor depth are the predictors of achieving gross total resection, while ultrasound image quality was not.
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