Avoidance Of Complications Research Articles

Unplanned early hospital readmissions in a vascular surgery population

Patients who undergo vascular surgery are burdened by high early readmission rates. We examined the frequency and cause of early readmissions after elective and emergent admission to the vascular surgery service at our institution to identify modifiable targets for quality improvement. Over a 5-year period, all patients admitted and readmitted to the vascular surgery service were identified. Medical records were then individually reviewed to identify baseline characteristics from the index admission and the most responsible diagnosis for readmission within 28 days of discharge. Of a total of 3324 patients, 421 (12.7%) were readmitted to our institution within 28 days of discharge. Forty-seven were found to have more than 1 readmission following their index admission. The readmission rate ranged from 11.8% to 14.1% over the 5-year study period, resulting in an average readmission rate of 12.7%. There were similar rates for men (12.9%) and women (12.3%). Of the readmitted cases, 236 (63.1%) were unplanned readmissions. The most common diagnoses for unplanned readmissions were worsening of peripheral arterial disease status including complications related to peripheral bypass graft (30.9%), surgical site infections (15.3%) and nonsurgical infections (14.8%). To reduce readmission rates effectively, institutions must identify highrisk patients. In our study cohort, the most frequent pathology resulting in readmission was peripheral arterial disease. The most frequent preventable reason for readmission was surgical site infection. Interventions focused on early assessment of clinical status and wounds in addition to avoidance of infectious complications could help reduce readmission rates. Preventive resources can be efficiently targeted by focusing on subgroups at risk for readmission.

Nível de conhecimento sobre diabetes e perfil epidemiológico dos pacientes diabéticos atendidos no Hospital Electro Bonini de Ribeirão Preto/SP

Avaliamos o perfil epidemiológico e o conhecimento dos pacientes com diagnóstico de diabetes mellitus (DM) atendidos em ambulatórios na cidade de Ribeirão Preto – SP. Trata-se de um estudo de pesquisa básica, de campo, quantitativa, transversal, observacional e descritiva, realizada por entrevista estruturada. O instrumento da pesquisa foi constituído de um questionário, com perguntas objetivas. A amostra total foi composta de 191 participantes. Quanto ao grau de escolaridade, apenas 13,1% apresentaram curso superior, 63,9% cursaram apenas o ensino fundamental e 23% o ensino médio. Em relação ao tempo de doença, 22 tiveram o diagnóstico há menos de um ano, 62 entre 2-5 anos, 43 entre 6-10 anos e 64 há mais de 10 anos. Identificamos quanto às consultas pela oftalmologia, que 54% faz avaliação anual, 22% semestral, 12% procuram o oftalmologista somente quando têm queixa visual e 12% relataram ter feito apenas consulta. Sobre as complicações que o DM pode ocasionar, 3,1% relataram impotência sexual, 8,3% infarto agudo do miocárdio, 16,3% falência renal, 15,2% amputação de membros e 57,1% cegueira. Em relação a perguntas sobre o autocuidado, um elevado percentual de pessoas não o realiza de forma adequada. Em conclusão, a maioria dos pacientes, apesar do acompanhamento multidisciplinar, apresentou pouco conhecimento sobre o DM e suas complicações. Para que haja aderência adequada ao tratamento e se possam evitar as complicações relativas ao diabetes, é fundamental a disseminação da informação a respeito da doença e cuidado adequado

Early and Late Results After David vs Bentall Procedure: A Propensity Matched Analysis

The aim of this study was to compare the short- and long-term outcomes of patients who underwent aortic valve-sparing reimplantation (David) vs aortic root replacement (Bentall) operations in a propensity-matched analysis. The study compared the data of propensity-matched patients who underwent David (n= 261) or Bentall (n= 262) procedures from 2000 to 2015. The mean age at surgery in the entire cohort was 53 ± 13 years, and 19.7% (n= 103) of the study patients were female. Connective tissue disease was present in 9.4% (n= 49) of patients, whereas 37.1% (n= 194) presented with a bicuspid aortic valve. The overall 30-day mortality was 1.1% (n= 6) and was not significantly different in patients with the David compared with the Bentall operation (0.4% [n= 1] vs 1.9% [n= 5]; P= .1). The 5- and 10-year survival rates were 93.7 ± 1.8% vs 93.8 ± 1.6% and 84.4 ± 4.7% vs 89.5 ± 3.2% for David vs Bentall, respectively (log-rank P= .98). Cox regression analysis identified age, smoking and previous cardiac surgery as independent predictors of long-term mortality. Freedom from reoperation did not significantly differ between patient groups (89.5 ± 3.4% vs 87.8 ± 4.1% 10 years postoperatively; log-rank P= .71). Bentall-treated patients had a higher rate of serious bleeding during follow-up (P= .025). Both the David and Bentall operations are associated with excellent early and long-term results in patients with aortic root aneurysmal disease. The David operation is associated with less bleeding than the Bentall operation, without an increased risk of reoperation. Because of avoidance of bleeding and other long-term complications associated with prosthetic heart valves, the David operation is preferable to the Bentall operation in patients with appropriate pathoanatomy.

Iatrogenic Right Hepatic Duct, Right Posterior Hepatic Duct, Right Hepatic Artery and Duodenum Injury during Routine Laparoscopic Cholecystectomy Due to Symptomatic Gallstones: Rare but Serious Complication - Case Report and Literature Review

Laparoscopic cholecystectomy is a very frequent surgical procedure with a low complication rate. The reasons for such complications range from anatomical anomalies, obesity, poor exposure of anatomic structures, bleeding or lack of surgical experience. If complications arise, prompt recognition and correct management are essential. Early and correct treatment allows avoidance of serious complications, such as secondary biliary cirrhosis, hepatic failure, and ultimately death. In this paper is presented a case of a 40-years-old male patient, who sustained iatrogenic major bile duct, right hepatic artery and duodenum injury during routine laparoscopic cholecystectomy due to symptomatic gallstones.

Assessing the cost-effectiveness of a once-weekly GLP-1 analogue versus an SGLT-2 inhibitor in the Spanish setting: Once-weekly semaglutide versus empagliflozin

Aims: Controlling costs while maximizing healthcare gains is the predominant challenge for healthcare providers, and therefore cost-effectiveness analysis is playing an ever-increasing role in healthcare decision making. The aim of the present analysis was to assess the long-term cost-effectiveness of subcutaneous once-weekly semaglutide (0.5 mg and 1 mg) versus empagliflozin (10 mg and 25 mg) in the Spanish setting for the treatment of patients with type 2 diabetes (T2D) with inadequate glycemic control on oral anti-hyperglycemic medications.Material and methods: The IQVIA CORE Diabetes Model was used to project outcomes over patient lifetimes with once-weekly semaglutide versus empagliflozin, with treatment effects based on a network meta-analysis. The analysis captured treatment costs, costs of diabetes-related complications, and the impact of complications on quality of life, based on published sources. Outcomes were discounted at 3.0% per annum.Results: Once-weekly semaglutide 0.5 mg and 1 mg were associated with improvements in discounted quality-adjusted life expectancy of 0.12 and 0.15 quality-adjusted life years (QALYs), respectively, versus empagliflozin 10 mg and improvements of 0.11 and 0.14 QALYs, respectively, versus empagliflozin 25 mg. Treatment costs were higher with once-weekly semaglutide compared with empagliflozin, but this was partially offset by cost savings due to avoidance of diabetes-related complications. Once-weekly semaglutide 0.5 mg and 1 mg were associated with incremental cost-effectiveness ratios of EUR 2,285 and EUR 161 per QALY gained, respectively, versus empagliflozin 10 mg, and EUR 3,090 and EUR 625 per QALY gained, respectively, versus empagliflozin 25 mg.Conclusions: Based on a willingness-to-pay threshold of EUR 30,000 per QALY gained, once-weekly semaglutide 0.5 mg and 1 mg were projected to be cost-effective versus empagliflozin 10 mg and 25 mg for the treatment of patients with T2D with inadequate glycemic control on oral anti-hyperglycemic medications in the Spanish setting, irrespective of patients’ BMI at baseline.

Best Approach to Prevent Diabetic Nephropathy

The last two decades have witnessed a storm in our understanding of the pathogenesis of diabetic nephropathy. In parallel, the newly evolved hypoglycemic agents have shown different mechanisms of action that would effectively tackle the different pathogenic mechanisms involved in the development and progression of diabetic nephropathy. Several large prospective placebo controlled clinical trials have supported the significant impact of these different agents to withhold the progression of diabetic nephropathy. Almost all these trials involved type 2 diabetes mellitus (T2DM). However, most of these agents can additionally be used in type1 diabetes mellitus (T1DM) patients aiming at avoidance of long-term complications of this disease. The most recent of these trial, the DECLARE - TIMI 58 renal outcome trial, have additionally declared the preventive value of dapagliflozin in T2DM. In this review, we are going to discuss the most recent and relevant pathogenic mechanisms highlight the therapeutic and value of the early use of the different agents to prevent the development of diabetic nephropathy.

PDB23 SWITCHING TO INSULIN DEGLUDEC IS A COST-SAVING THERAPY FOR PATIENTS WITH TYPE 1 AND TYPE 2 DIABETES IN THE SWEDISH SETTING BASED ON REAL WORLD DATA

The Europe-based, prospective, observational ReFLeCT study recently showed that switching to the ultralong-acting basal insulin analogue degludec (IDeg) was associated with improved glycemic control and reductions in hypoglycemic events versus previous basal insulin therapies in patients with type 1 (T1D) or type 2 diabetes (T2D). The present analysis aimed to assess the impact of these findings on long-term cost-effectiveness outcomes in the Swedish setting. Cost-effectiveness was evaluated separately in patients with T1D and T2D over a 50-year time horizon using the IQVIA CORE Diabetes Model (version 9.0). Patients were assumed to receive IDeg or continue previous insulin therapy (with or without bolus insulin) for 5 years, before all patients intensified to insulin degludec plus bolus insulin for the remainder of their lifetimes. Baseline cohort characteristics were sourced from ReFLeCT where possible. Treatment effects on initiation of IDeg were based on data from ReFLeCT. Costs were estimated from a Swedish societal perspective and expressed in 2018 Swedish krona (SEK). IDeg was associated with improvements in quality-adjusted life expectancy of 0.14 and 0.07 quality-adjusted life years versus continuation of previous insulin therapy in patients with T1D and T2D, respectively, resulting from improved glycemic control and fewer hypoglycemic events. Combined direct and indirect costs were estimated to be SEK 137,020 and SEK 2,009 lower for insulin degludec versus previous insulin therapy in patients with T1D and T2D, respectively, with higher treatment costs offset by cost savings from avoidance of diabetes-related complications. IDeg was therefore considered dominant versus continuation of previous insulin therapies for the treatment of both T1D and T2D. Based on real-world evidence, IDeg represents an effective and cost-saving treatment option versus other basal insulin therapies for patients with T1D and T2D in Sweden.

Transapical aortic perfusion using a deep hypothermic procedure during descending thoracic or thoracoabdominal aortic surgery.

In descending thoracic aortic aneurysm (DTAA) or thoracoabdominal aortic aneurysm (TAAA) surgery, though proximal anastomosis using deep hypothermic circulatory arrest (DHCA) is often selected, there are issues surrounding brain and heart protection. In this study, the usefulness of concomitant upper body perfusion via transapical aortic cannulation during deep hypothermic surgery was examined. Between October 2014 and May 2019, 5 patients (Crawford extent II chronic dissection, N.=3; extent IV aneurysms, N.=1; DTAA, N.=1) underwent DTAA/TAAA repair under deep hypothermia using transapical aortic perfusion. A proximal anastomosis and artery of Adamkiewicz (AKA) reconstruction were performed under continuous perfusion of the upper and lower body at 20 °C. The time from aortic cross-clamping to proximal anastomosis was 69±33 minutes, and it took 86±47 minutes to AKA reperfusion. There was no spinal cord ischemic injury or brain or heart complications. One patient required tracheostomy, and the average postoperative intubation time for the other patients was 57±52 hours. All patients were discharged, and the average postoperative hospital stay was 25.6±8.1 days. Concomitant upper body perfusion by the transapical aortic approach contributes to avoidance of brain and heart complications and maintaining spinal cord circulation under deep hypothermic DTAA/TAAA surgery.

Introducing Fluorescence Guided Surgery into Neuro-Oncology Practice and Getting It Right First Time

Abstract Introduction Fluorescence Guided Surgery (FGS) using 5-ALA is recommended for patients undergoing resection of suspected high grade glioma and this type of surgery is increasingly being used in more units throughout the UK. We report on our experience of introducing 5-ALA guided surgery for suspected HGG in a regional neurosciences unit. Methods Consecutive series of the first 24 patients in our unit to receive 5-ALA guided surgery for suspected HGG from June 2017 to October 2018. Data was prospectively collected. Results 5-ALA fluorescence guided surgery was used for a range of histologically confirmed WHO grade III-IV gliomas. All but 1 tumour (GBM) fluoresced with 5-ALA, with strong fluorescence in recurrent GBM and anaplastic foci of grade 3 tumours. EOR varied according to the eloquence of the lesion with 70% of cases achieving gross total resection. 40% of cases used awake mapping or intraoperative neurophysiology. 5 patients (20.8%) had temporary neurological deficits which resolved in all cases. Individual surgeon learning curves resulted in 2 styles of practice- complete FGS with fluorescence used throughout the case, and intermittent use of fluorescence as an adjunct often at the end of debulking under white light. Conclusions Adopting 5-ALA use comes with specific challenges in terms of service organisation, learning curves and complication avoidance. Our experience is that it is useful both to improve EOR and as an adjunct to identify tumour tissue in eloquent region tumours with monitoring of function. This is possible through a day admission pathway in line with GIRFT.

Recognising and understanding cryopyrin-associated periodic syndrome in adults.

Cryopyrin-associated periodic syndrome (CAPS) is a group of rare hereditary autoinflammatory diseases characterised by recurrent flares of mild to severe systemic inflammation and fever. CAPS is the umbrella term for a spectrum of individual conditions, namely familial cold autoinflammatory syndrome (FCAS), Muckle-Wells syndrome (MWS) and neonatal-onset multisystem inflammatory disease (NOMID), also known as chronic infantile neurologic, cutaneous and articular (CINCA) syndrome. The flare symptoms include fever, fatigue, rashes, headaches, arthralgia and myalgia that can last for a few hours or for several days. These symptoms are debilitating, contributing to poor quality of life for patients if left untreated. Serious life-changing complications such as hearing loss, blindness and AA amyloidosis resulting in kidney failure can occur. Until recently, treatment of the disease was symptomatic using non-steroidal anti-inflammatory and immunosuppressant drugs with limited success. In contrast, biological treatments targeting interleukin 1 (IL-1) have proved remarkably effective, often associated with complete and sustained disease remission, vastly improved quality of life and avoidance of serious long-term complications.

Lässt sich eine dauerhafte Katheterversorgung bei geriatrischen Patienten mit Harnverhalt oder chronischer Harnretention durch eine 180-W-XPS-Greenlight-Lasertherapie der Prostata vermeiden?

This study aims to analyse the impact of a simultaneous 180-Watt XPS™ GreenLight laser treatment of the prostate in addition to an initially planned sole placement of a suprapubic catheter in geriatric patients initially hospitalised only for the purpose of the latter procedure. A retrospective analysis was carried out on 48 patients undergoing both procedures simultaneously over an 18-month period (1/2015 - 6/2016). On admission, the examined patients (mean age 72.46 years) had a mean ISAR score of 2.5 (0 - 6) points indicating a need for geriatric care. These patients had a mean number of 7.676 (2 - 27) diagnoses and took a mean of 6.77 drugs (0 - 14) according to the discharge report. The mean residual urine volume was measured to be 600 (300 - 2,800) ml preoperatively with a mean prostate size of 38 ccm (35 - 75 ccm). In 63.2 % of these patients, the removal of the suprapubic catheter was possible after a mean period of 52.39 (3 - 365) days in an outpatient setting. Factors predicting successful catheter removal were "geriatric issues" such as the ISAR score on admission (p = 0.001), number of diagnoses stated in the discharge letter (p = 0.023), number of diagnoses recorded in the DRG database (p = 0.002), number of drugs stated in the discharge letter (p = 0.015), "assistance needed" (p = 0.001) and "living in a nursing home" (p = 0.008). Any additional concomitant medication exceeding the mean value of 6.77 drugs in the discharge report lowered the chance of catheter removal by 50 %. In 63.2 % of patients, lifelong bladder drainage was avoided by simultaneous 180-Watt XPS GreenLight laser treatment administered additionally to the placement of a suprapubic catheter. This has a positive impact on quality of life, avoidance of catheter complications and long-term costs. Factors predicting a successful catheter removal were geriatric aspects such as ISAR score, multimorbidity and multimedication. These factors indicate a need to introduce geriatric aspects and methods in urology.

A randomized controlled study comparing the outcome of laparoscopic totally extra peritoneal repair versus Desarda repair in the management of inguinal hernia

Background: Desarda repair is a technique of a tissue based tension free mesh free inguinal hernia repair, shown to be comparable to the standard Lichtenstein repair. Till date, no study has been done comparing Desarda repair with laparoscopic total extra peritoneal repair (TEP), hence this study was planned.Methods: The prospective randomized controlled study was done over a period of 18 months, and included a total of 50 patients, randomly allocated into 2 groups: TEP (group 1) and Desarda repair (group 2), 25 in each group, and followed up for a period of 1 year.Results: Chronic inguinodynia, including groin stiffness showed a statistically significant difference between the 2 groups (p=0.02). Foreign body sensation (16% in TEP group and none in Desarda group) and recurrence rate (12% in TEP group and none in Desarda group) did not show a significant difference. The operating time in the Desarda group (66.8±20.35 minutes) was significantly less than TEP group (78.6±11.86 minutes), with p<0.01. There was no significant difference in terms of post-operative pain scores (VAS scores) at five time points, post-operative analgesic requirement, hospital stay and return to normal daily routine activity or work and post-operative complications. Desarda repair was also found to be much more economical.Conclusions: The present study establishes the potential benefits of Desarda repair over TEP in terms of shorter duration of surgery, lesser incidence of chronic inguinodynia and lesser cost of the procedure, along with the avoidance of mesh related complications.

Unwrapped hydroxyapatite orbital implants: our experience in 347 cases.

To report the results of a large case series of enucleations with primary insertion of an unwrapped hydroxyapatite (HA) orbital implant. We retrospectively reviewed consecutive enucleations with primary orbital (HA) implant insertion performed at the Scottish Ocular Oncology Service, Glasgow between 1990 and 2014. The unwrapped hydroxyapatite orbital implant was placed in the posterior portion of the socket and recti muscles sutured end-to-end over the implant. Out of 347 consecutive enucleations, the indication for enucleation was tumour-related pathology in 59.7% and painful blind eye in 40.3%. Majority (70%) received an implant of 22-mm diameter. At an average follow-up of 3.5 years, complications included post-enucleation socket syndrome (11.5%), chronic discharge (9.2%), chronic pain (4.3%), recurrent conjunctival infection (2.3%),conjunctival cysts (2%), contracted socket (1.4%), implant exposure (1.2%), haematoma (0.6%) and ill-fitting prosthesis (0.6%). Implant exposure (1.2%, n = 4) occurred at a mean of 4.5 months post surgery and was managed by temporalis fascia graft (n = 1), tarsoconjunctival flap (n = 1), implant removal (n = 1) and observation (n = 1). Overall, 9.8% of patients needed further surgery including lower lid tightening (4.3%), ptosis repair (2.3%), conjunctival cyst excision (1.2%), fornix reconstruction (1.2%), graft/flap for exposure (0.6%) and implant removal (0.3%). A low rate of implant exposure indicates that absence of wrapping material around hydroxyapatite orbital implants does not compromise surgical outcomes and has the added benefit of reduced surgical time and avoidance of complications from wrapping materials. Posterior implant placement and end-to-end recti suturing contribute to the success of the procedure.

Review of Avoidance of Complications in Cerebral Aneurysm Surgery: The Fujita Experience.

Avoidance of complications during cerebral aneurysm surgery marks the future outcome in the patient. Various modalities such as adequate opening of the Sylvian fissure, motor-evoked potential, endoscope-assisted microsurgery, indocyanine green dye, and dual image video angiography are available to reduce these complications during surgery, either by prevention of injury to the small perforators or the parent artery. We present our experience at the Fujita Health University Banbuntane Hospital, Japan, of the cerebral aneurysm surgery along with the use of these modalities in our patients from September 2014 to December 2016 along with a brief review of the various techniques for avoidance of complications.

Complication avoidance and management in ambulatory spine surgery.

The positive safety profile and potential cost savings associated with ambulatory spine surgery have resulted in an increasing number of spine procedures being performed on an outpatient basis. As indications become more inclusive and the variety and volume of ambulatory procedures grow, the incidence of complications may rise. Limiting adverse events in the outpatient setting starts with patient selection. Surgeons should be aware of the potential complications and associated risk factors for common ambulatory spine procedures and employ strategies to limit and appropriately manage them. Protocols which include patient education, multimodal anesthesia and analgesia, standardized post-operative monitoring, and safe discharge planning are also essential for maximizing safety in the ambulatory setting.

Book Review: Cerebrovascular and Endovascular Neurosurgery: Complication Avoidance and Management

Book Review: Cerebrovascular and Endovascular Neurosurgery: Complication Avoidance and Management

Astigmatism Correction Using SMILE.

Small incision lenticule extraction (SMILE) was introduced in the recent decade for the treatment of myopia and myopic astigmatism. This flap-free technique has a high efficacy and safety profile and also carries potential advantages over laser in situ keratomileusis such as a better corneal biomechanical stability, reduction in dry eyes rate, and the avoidance of flap complications. However, there have been concerns regarding the precision of astigmatism correction that undercorrection has been reported to be apparent. Various factors that affect astigmatism correction have been identified in the literature. The purpose of this review is to discuss the factors that affect astigmatism correction in SMILE and several techniques to improve the refractive outcomes.

Delayed diagnosis of anorectal malformations in neonates.

Anorectal malformations (ARM) are common congenital abnormalities of the terminal hindgut. Ideally, ARM should be diagnosed at, or shortly following, birth by careful physical examination of the perineum. Delayed diagnosis has been implicated as a risk factor for complications, including intestinal perforation. This study aimed to determine the rate of delayed diagnosis and associated intestinal perforation in ARM. A retrospective review was performed for all ARM patients managed at The Royal Children's Hospital over a 16-year period (2000-2015). Data collected included ARM type, timing of diagnosis and complications. Delayed diagnosis was defined as being at more than 24 h of age. A total of 243 ARM patients (male 146/243, 60%) were included. The most frequent ARM types were perineal fistula (83/243, 34%) and rectovestibular fistula (40/243, 16%). Diagnosis was delayed beyond 24 h of age in 92 of 243 (38%) patients. The ARM type most commonly delayed in diagnosis was perineal fistula (37/83, 45%). Two patients in whom diagnosis was delayed suffered an intestinal perforation. Delayed diagnosis in ARM patients remains a common, and potentially fatal, occurrence. Improved assessment of newborns is required to ensure timely diagnosis of ARM, and avoidance of complications associated with delayed diagnosis.

Morphometric Comparison of the Pterional Trans-sylvian and the Pretemporal Transclinoidal Approaches to Posterior Communicating Artery Aneurysms: Anatomical Study

Abstract INTRODUCTION Due to the advent of endovascular techniques, modern series of surgically treated posterior communicating (Pcom) aneurysms have shown a tendency towards higher complexity and more technical difficulties. The pretemporal approach was described as a valuable extension to the pterional approach in treating basilar apex aneurysms. Its use for clipping of ruptured Pcom aneurysms was associated with decreased ischemic complications. However, its anatomical advantages for Pcom aneurysm surgery have not been previously analyzed. METHODS Six cadaveric heads (12 sides) underwent a sequential dissection, starting with a pterional craniotomy, and then extended to a pretemporal transclinoidal approach. In each step, the following variables were measured, taking the origin of Pcom as a focal point: (1) exposed length of the internal carotid artery (ICA) proximal to the Pcom artery, (2) exposed angular circumference of ICA at the origin of Pcom, (3) deep working area between the optic nerve and tentorium/oculomotor nerve, (4) superficial working area, (5) depth of the exposure and the (6) fronto-temporal (superior posterolateral), and (7) orbito-sphenoidal (inferior anterolateral) angles of exposure. Clinical case examples are used to illustrate the advantages of the pretemporal approach. RESULTS Compared to the pterional craniotomy, the pretemporal transclinoidal approach increased the exposed length of the proximal ICA from 3.3 to 11.7 mm (P = .0001), and its circumference from 5.1 to 7.8 mm (P = .0003), allowing a 210-degree view of the ICA (vs 137.9). The deep and superficial working areas also significantly widened from 53.7 to 92.4 mm2 (P = .0048) and 252.8 to 418.2 mm2 (P = .0001), respectively; while the depth of the exposure was equivalent. The frontotemporal and the sphenosylvian angles increased on average by 17 (P = .0006) and 10 (P = .0037) degrees, respectively. The clinical case examples demonstrate the visual, technical and strategic advantages of the pretemporal approach as a consequence of its anatomical exposure. CONCLUSION The pretemporal approach can be useful for complex Pcom aneurysms by providing easier proximal control, wider working space, aneurysm visualization, and more versatile clipping angles. The enhanced exposure potentially results in a higher rate of complete aneurysm obliteration and complication avoidance.

Intradural Transpetrosectomy for Petrous Apex Meningiomas.

ObjectiveThis study aimed to assess the surgical results of the intradural transpetrosectomy for petrous apex meningiomas (PAMs). In addition, we describe the methods and techniques used to expose and manage superior petrous vein and greater superficial petrosal nerve. MethodsThe authors conducted a retrospective study of 16 patients with PAMs operated by the senior author via the intradural transpetrosectomy between February 2012 to May 2017. We reviewed patient data regarding the general characteristics, surgical technique and surgery-related outcomes and adopted a combined follow-up strategy of clinic and telephone contacts to evaluate postoperative complications. ResultsSimpson grade I and II resection was performed in 10 out of 16 cases (62.5%), and grade III resection were reported in the remaining six cases (37.5%) with no resultant mortality. The mean Karnofsky Performance Status score was 85.6 preoperatively and improved to 91.9 postoperatively, with a mean follow-up period of 34.4 months (range, 6–66 months). Tumor recurrence was found in two patients and they underwent the second surgical operation. ConclusionPAMs could be completely resected by the intradural transpetrosectomy with an improved survival rate and postoperative life quality. Superior petrous vein and greater superficial petrosal nerve should be managed properly in avoidance of postoperative complications. Finally, most meningioma inside cavernous sinus or adhered to brainstem could be totally removed without postoperative complications.