Surgery For Malformations Research Articles

Analysis of postoperative complications in patients undergoing anorectal malformation surgery: are there any predisposing factors?

To describe our experience with anorectal malformation (ARM) patients, while analyzing complications and risk factors. A retrospective study of ARM patients aged 0-18 years old undergoing surgery from 2006 to 2023 was carried out. Demographic variables, associated malformations, age and repair surgery operating times, presence and type of colostomy, previous intestinal preparation, and presence and type of surgical complications -intestinal occlusion, anal prolapse, stenosis, bleeding, dehiscence, extrusion, anoplasty misposition, urethral perforation, and stomal complications- were collected. 89 patients were studied. 44 patients were boys and 45 were girls. Median age was 7 years (3-18). Baseline treatment was posterior sagittal anorectoplasty (PSARP) in 61 (69%) patients, and colostomy in 24 (27%) patients (4/24 loop, 1/24 Hartmann, 19/24 divided ends). Median age at PSARP was 5.4 months (5 days-7 years), with a mean operating time of 112 min (38-259). The incidence of complications was 38% (34/89). The most frequent complication was anal prolapse (19%) (1/3 reintervention as a result of pain/bleeding), followed by dehiscence (17%). Statistically significant differences were noted between intestinal preparation (p=0.001, -1.49 95% CI: -2.69 to -1.24), presence of colostomy (p=0.05, -2,54 95% CI: -6.5 to -0.987), and age at surgical repair (p=0.047, 1.198 95% CI: 1.1 to 3.15) with the incidence of complications. The age-complications correlation score was 0.21 (p=0.046). No differences in terms of operating time (p=0.073) and type of colostomy (p=0.81) were observed. 38% of the patients had complications. Intestinal preparation, presence of colostomy, and age at repair can have an impact on the incidence of complications. The first two could stand as protective factors (RR=-1,49 and -2.54, respectively). Age would increase the risk by 1.2-fold.

Surgery of brainstem cavernous malformations: surgical nuances and outcomes of a monocentric series of 34 patients.

Brainstem cavernous malformations (BCM) constitute one of the most controversial and challenging neurological pathologies: both natural course and surgical manipulation can lead to severe neurological symptoms by direct compression or following hemorrhage of this highly eloquent brain region. The vascular section of the prospectively collected neurosurgical database of our center (2011-2023) was retrospectively reviewed, seeking all patients operated on for a sporadic BCM. Clinical, radiological and surgical data, operative records and videos were analyzed by independent reviewers with the assistance of a dedicated neuropsychologist, blinded to the hospital course. Thirty-four patients aged between 19 and 70 years were identified and considered for analyses, with different brainstem localizations. The clinical onset was hemorrhagic in almost all cases: the average mRS on admission was 2.47 (21 patients ≤ 2). Surgical treatment was performed on average 15.1 weeks after the last bleeding. At hospital discharge, the mean mRS was 3.26 (6 patients ≤ 2). After a mean follow-up of 56.59 weeks, 29 patients (85.3%) presented an improved or stable mRS compared to hospitalization and 5 had a slight worsening (14.7%). Brainstem cavernoma is a rare entity with aggressive features due to the involved eloquence despite of the benign histology itself. Microsurgical resection should be tailored for each patient to the peculiar characteristics of the harbored lesion. Advanced planning techniques reduced morbidity; patients should be centralized in wide caseload hospitals with high specialization in neurovascular pathologies and should receive an appropriate counseling about natural history and risks of interventional treatment.

T-shaped myofascial incision for Chiari I malformation surgery without dural closure in children: Technical note

BackgroundLike in all posterior fossa surgeries the avoidance of cerebrospinal fluid leaks (CSF) leaks is of paramount importance for foramen magnum decompression in Chiari I malformation in children. The present technical note decribes the experience with the creation of a T-shaped myofascial cuff to reduce the risk of postoperative CSF leaks. MethodsThe medical records of 98 children were evaluated. They underwent foramen magnum decompression without dural closure using a T-shaped myofascial cuff whose incision lines run completely within the fascia and the muscles not extending beyond their attachment line to the bone. ResultsThere were 2 CSF leaks and no infections in 98 operated patients. The follow-up was between 4 and 48 months. ConclusionsThe placement of a T-shaped myofascial cuff allows for watertight closure of the muscles and the fascia which is likely to reduce the rate of CSF leaks in pediatric Chiari I patients operated on without closure of the dura.

Structural Challenges to the Reimbursement of Corrective Surgery of Complex Malformations Through the German G-DRG System

Zusammenfassung Hintergrund Komplexe Fehlbildungen erfordern eine ressourcenintensive Versorgung. Vergütungsmuster der korrektiven Fehlbildungschirurgie wurden vor dem Hintergrund der Versorgungslandschaft bisher nicht analysiert. Methoden Krankenhausabrechnungsdaten zu Korrekturoperationen von zehn ausgewählten komplexen Fehlbildungen von 2020–2022 wurden analysiert. Nach dem jährlichen Durchschnitt der Fallzahlen wurden Standorte in Hochvolumenkrankenhäuser (HVK; mindestens 10 Fälle), Mittelvolumenkrankenhäuser (MVK; mindestens 5 aber weniger als 10 Fälle), Niedrigvolumenkrankenhäuser (NVK; mindestens 1 aber weniger als 5 Fälle) und in extreme Niedrigvolumenkrankenhäuser (eNVK; mehr als 0 aber weniger als 1 Fall) kategorisiert. Ergebnisse Von 2020–2022 wurden jährlich durchschnittlich 1429 Korrekturoperationen für die zehn komplexen Fehlbildungen in Deutschland an 158 Standorten erbracht. Der Case Mix Index (CMI) für diese Leistungen betrug 7,057. Die Leistungserbringung war dezentral. Es gab vier HVK für anorektale Malformation, drei HVK für Spina bifida, zwei HVK für kongenitale Zwerchfellhernie und jeweils eines für Blasenekstrophie, Epispadie, Gallengangsatresie und Morbus Hirschsprung. Es gab kein HVK für Gastrochisis, Omphalozele oder Ösophagusatresie. 127 Standorte (80%) erreichten für keine der Leistungen eine Mindestfallzahl von 5 Korrekturoperationen pro Jahr. Fazit Der CMI der korrektiven Fehlbildungschirurgie ist weit höher als der CMI der allgemeinen „Kinder- und Jugendchirurgie“. Die Versorgungslandschaft ist dezentral. Gelegenheitsversorgung stellt für Krankenhausstandorte ein finanzielles Risiko dar.

Autologous micrografting improves regeneration of tissue-engineered urinary conduits in vivo

Urogenital reconstructive malformation surgery is sometimes hampered by lack of tissue for the repair. We have previously shown that autologous micrografting allows for single-staged scaffold cellularization after surgical implantation. Here, a collagen-based scaffold reinforced with biodegradable mesh and a stent was implanted as a bladder conduit in ten full-grown female minipigs. We aimed to assess short-term regenerative outcomes, safety, and feasibility of implanting tubular urinary micrografted scaffolds versus acellular controls. Five scaffolds were embedded with autologous urothelial micrografts harvested perioperatively. After six weeks, all animals were assessed by cystoscopy, CT-urography, and microanatomical assessment of the urinary conduits. The procedure proved technically feasible within the confines of a regular surgical theater, with duration-times comparable to corresponding conventional procedures. No animals experienced postoperative complications, and all implanted conduits were patent at follow-up. Improved tissue regeneration was observed in the micrografted conduits compared with the acellular controls, including increased luminal epithelialization, increased cell proliferation, decreased cell apoptosis, and increased conduit vascularization. We concluded that single-staged on-site construction and implantation of tissue engineered urinary conduits proved feasible and safe, with improved regenerative potentials in micrografted conduits. This study presents a new approach to urinary conduits, and merits further investigations for advancement towards clinical translation.

Intraoperative neuromonitoring in Chiari I malformation surgery: a systematic review and meta-analysis.

Chiari Malformation Type I (CMI) is a prevalent neurosurgical condition characterized by the descent of cerebellar tonsils below the foramen magnum. Surgery, aimed at reducing symptomatology and syrinx size, presents risks, making intraoperative neuromonitoring (IONM) a potentially vital tool. Despite its widespread use in cervical spine surgery, the utility of IONM in CMI surgery remains controversial, with concerns over increased operative time, cost, restricted anesthetic techniques and tongue lacerations. This systematic review and meta-analysis followed the Cochrane Group standards and PRISMA framework. It encompassed an extensive search through PubMed, Embase, and Web of Science up to December 2023, focusing on clinical and surgical outcomes of IONM in CMI surgery. Primary outcomes included the use of various IONM techniques, complication rates, clinical improvement, reoperation, and mortality. The review, registered at PROSPERO (CRD42024498996), included both prospective and retrospective studies, with rigorous selection and data extraction processes. Statistical analysis was conducted using R software. The review included 16 studies, comprising 1358 patients. It revealed that IONM techniques predominantly involved somatosensory evoked potentials (SSEPs), followed by motor evoked potentials (MEPs) and Brainstem auditory evoked potentials (BAEPs). The estimated risk of complications with IONM was 6% (95% CI: 2-11%; I2 = 89%), lower than previously reported rates without IONM. Notably, the clinical improvement rate post-surgery was high at 99% (95% CI: 98-100%; I2 = 56%). The analysis also showed lower reoperation rates in surgeries with IONM compared to those without. Interestingly, no mortality was observed in the included studies. This systematic review and meta-analysis indicate that intraoperative neuromonitoring in Chiari I malformation surgery is associated with favorable clinical outcomes, including lower complication and reoperation rates, and high rates of clinical improvement.

EEG Findings in a Patient with Holmes Tremor after AVM Surgery: A Case Report and Literature Review.

Background: Holmes tremor (HT) is a rare motor disorder characterized by high-amplitude and low-frequency resting, intentional, and postural tremors. HT typically arises from disruptions in neural pathways, including the dopaminergic system. Its causes include cerebrovascular incidents, neoplasms, demyelination, and infections. Diagnosis involves thorough clinical, neurophysiological, and neuroimaging assessments. Our report details the clinical profile, neuroimaging and EEG results and levodopa treatment response of an HT patient after cerebral arteriovenous malformation (AVM) surgery. Case Report: A female patient who underwent AVM surgery developed head tremor and dystonia. Neuroimaging revealed left thalamus involvement. Video electroencephalography (EEG) revealed high-amplitude, low-frequency tremors. The patient responded well to levodopa treatment. Conclusions: Involuntary rhythmic or non-rhythmic movements are a primary clinical feature of HT. A differential diagnosis of epilepsy and HT can be achieved through neurophysiological monitoring, avoiding the overuse of antiepileptic drugs. Symptoms can be alleviated with levodopa intervention.

Yuri Yu. Sokolov is 60 years old!

On May 27, 2024, Yuri Yu. Sokolov, Doctor of Medical Sciences, Professor, Member of the Editorial Board of journal “Russian Journal of Pediatric Surgery” celebrates his 60-year jubilee. The leading area of his scientific interest is minimally invasive surgery of malformations in the thoracic and abdominal cavities in children. Prof. Sokolov has conducted on-site master classes on pediatric endosurgery more than 50 times in various Russian cities and neighboring foreign countries. He was the first in Russia to perform laparoscopic (in 2005) and robot-assisted (in 2021) extirpation of a cyst in the common bile duct in a child.

Comparison of intraoperative sodium fluorescein and indocyanine green videoangiography during intracranial aneurysm and arteriovenous malformation surgery

ObjectiveIndocyanine green (ICG) and sodium fluorescein (Na-Fl) are two fluorophores, which are used for videoangiography purposes. This prospective study reports our experience by using surgical microscopes equipped with two special filters. We compared the imaging efficacy of Na-FL and ICG videoangiography techniques during aneurysm and arteriovenous malformations (AVM) surgeries.Patient and methods:Fourtynine consecutive patients were operated between September 2015 and December 2022. Patients with ruptured/unruptured aneurysms or with AVMs presented with/without hemorrhage were included to the current study. ResultsThere were a total of 48 aneurysms and 11 AVMs in 49 patients in the current study. Na-Fl enables the surgeon to manipulate vessels and aneurysms real-time. ICG provides the ability to watch the videoangiography repeatedly and understand the angioarchitecture. The use of FLOW-800 module allows the surgeon to make concrete judgements about the flow dynamics of AVMs and therefore ICG videoangiography found useful in AVM surgery. Na-Fl has been found more useful for the evalution of the low caliber perforating arteries and anatomical features of the aneursym dome in aneurysm surgery. ConclusionThe results of our series demonstrated the safety and efficacy of Na-Fl use in the surgery of aneurysms and AVMs. Both the ICG and Na-Fl videoangiographies are easy to perform and complimentary to each other. Combined use of these two mediums may provide better surgical results, considering the separate advantages and disadvantages of these both techniques.

Gender-Related Differences in Dry Eye Symptoms Following Involutional Ectropion and Entropion Surgery.

This prospective case-control study investigated gender-related differences in dry eye symptoms following surgery for involutional ectropion and entropion. A total of 109 patients, aged between 65 and 89, were categorized by eyelid condition and gender. Postoperative assessments included the Tear Film Break-Up Time (TBUT) test, Schirmer I test results, corneal and conjunctival staining, eyelid margin characteristics, and scores from the Ocular Surface Disease Index (OSDI) questionnaire. The analysis revealed notable gender-related differences in dry eye manifestations. Initially, men exhibited lower TBUT scores but higher Schirmer test readings compared to women; however, these disparities diminished over time. No significant gender differences were detected in corneal and conjunctival staining, indicating similar levels of ocular surface damage across genders. Males showed significantly higher values in several eyelid margin characteristics (LMI, LMT) at various postoperative time points. According to the OSDI questionnaire, women experienced more severe symptoms of dry eye both pre- and post-operatively, suggesting a greater subjective symptom burden. When comparing surgical outcomes for ectropion and entropion, both conditions showed improvement in eyelid positioning and dry eye symptoms post-surgery. Despite these improvements, women with either condition reported more severe dry eye symptoms compared to men throughout the postoperative period. This study highlights the gender-specific variations in dry eye symptoms following eyelid malformation surgery and emphasizes the importance of adopting gender-sensitive approaches in postoperative care to improve outcomes and ocular health.

Laparoscopic-assisted distal colon excision and proximal colon pull-through anorectoplasty for anorectal malformation.

During the second stage surgery for anorectal malformations (ARM), patients whose distal intestine of the colostomy is particularly short underwent laparoscopic-assisted distal colon excision and proximal colon pull-through anorectoplasty (PCPARP). This study aimed to discuss the outcomes of PCPARP after colostomy in patients with ARM. This is a single-center propensity score-matched (PSM) study which was retrospectively initiated patients with intermediate- or high-type ARM who underwent laparoscopic surgery from June 2007 to December 2018. These patients were divided into PCPARP group and conventional laparoscopic-assisted anorectoplasty (LAARP) group according to specific surgical methods. The general data, surgical data, postoperative complications, and functional results were evaluated. In total, 216 patients were included in this study: 190 (88.0%) undergoing LAARP approach and 26 (12.0%) undergoing PCPARP approach. After PSM, two well-balanced groups of 26 patients were analyzed and showed the postoperative complications (P = 0.126) and bowel function (P = 0.809) were similiar between the two groups. The curative effect of PCPARP after colostomy is similar to that of classic LAARP surgery, which can be used for ARM patients with a very short and abnormal distal intestine of the stoma.

One-Point Technique in Brainstem Cavernous Malformation Surgery: Evaluation of Approaches and Outcomes From a Different Perspective.

Brainstem cavernous malformations (BCMs) are a distinct clinical entity that carry a high risk of patient morbidity because of location and risk of hemorrhage. Surgical management of these lesions requires intimate knowledge of surgical anatomy and skull base approaches. This article is intended to highlight a modern approach for the treatment of BCMs, with an emphasis on the use of the one-point technique to guide resection. We describe a case series of BCMs treated through a variety of skull base approaches, describing our decision-making strategy. We review the concept of the one-point technique focusing on the safest access to the malformation through 2 representative cases and also perform a retrospective review of 32 consecutive patients who underwent BCM resection to present outcomes and the comparison of two-point vs one-point techniques. Consecutive series of 32 patients in whom the one-point technique was used is presented. In 8 patients (25%), the traditional two-point technique would suggest a different trajectory than the one-point technique. Postoperative MRI confirmed complete resection in 30 patients (95%), and 29 patients (91%) had modified Rankin Scale (0-2) at follow-up. All patients in whom the one-point technique guided a different trajectory had gross total removal of the cavernous malformation, with one patient having long-term new neurological impairment from the surgery. There were no mortalities. Despite surgical advances in recent decades and more widespread understanding of surgical anatomy and safe entry zones, surgical resection of BCMs remains a formidable challenge. While not necessarily the shortest access, the one-point technique offers a safe approach considering all the different modalities in our armamentarium and can be used as part of a strategy to determine the optimal approach to resect BCMs.

Risk factors for delayed extubation after pediatric perineal anaplasty in patients less than 1 year of age: a retrospective study

BackgroundAnorectal malformation is a common congenital problem occurring in 1 in 5,000 births and has a spectrum of anatomical presentations, requiring individualized surgical treatments for normal growth. Delayed extubation or reintubation may result in a longer intensive care unit (ICU) stay and hospital stay, increased mortality, prolonged duration of mechanical ventilation, increased tracheostomy rate, and higher hospital costs. Extensive studies have focused on the role of risk factors in early extubation during major infant surgery such as Cardiac surgery, neurosurgery, and liver surgery. However, no study has mentioned the influencing factors of delayed extubation in neonates and infants undergoing angioplasty surgery.Materials and MethodsWe performed a retrospective study of neonates and infants who underwent anorectal malformation surgery between June 2018 and June 2022. The principal goal of this study was to observe the incidence of delayed extubation in pediatric anorectal malformation surgery. The secondary goals were to identify the factors associated with delayed extubation in these infants.ResultsWe collected data describing 123 patients who had anorectal malformations from 2019 to 2022. It shows that 74(60.2%) in the normal intubation group and 49(39.8%) in the longer extubation. In the final model, anesthesia methods were independently associated with delayed extubation (P < 0.05).ConclusionWe found that the anesthesia method was independently associated with early extubation in neonates and infants who accepted pediatric anorectal malformation surgery.

Thoracoscopic surgery for rare congenital pulmonary airway malformations in adults: a decade of retrospective study.

Congenital pulmonary airway malformation (CPAM) is a rare benign deformity of the lungs in adults. Our study aimed to evaluate the clinical features and compare the effect of thoracoscopic lobectomy and wedge resection for adult CPAMs. This was a retrospective study including eighteen adults with CPAMs recruited between 2013 and 2023. Radiological scans and pulmonary function test (PFT) were performed before operation. All the patients were treated with thoracoscopic approach, which were categorized into groups of lobectomy and wedge resection. The baseline, preoperative, and operative data were evaluated and analyzed. Four males and fourteen females were diagnosed with CPAMs at a median age of 57.5 years. Cough was the main symptom, reported by 55.6% of the patients. CPAMs were always initially misdiagnosed as other conditions due to heterogeneous computed tomography (CT) characteristics. The mean of PFT results showed normal (>80% predicted) in forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1 to FVC ratio (FEV1/FVC), but less than 70% predicted in forced expiratory flow (FEF) at 25-75%, 50% and 75% of FVC. All patients underwent video-assisted thoracic surgery (VATS) with a total of nine wedge resections and nine lobectomies. Age at surgery varied statistically between the two groups. Whereas, duration of surgery, blood loss, postoperative drainage, days of drainage, days of hospitalization and postoperative complications showed no statistical difference between the two groups. There were 27.8% of the lesions showing CPAMs mixed with other diseases during histological evaluations. CPAM in adults showed a complex presentation in terms of clinical symptoms, imaging performance and pathological findings. Half of the patients were detected with small airway dysfunction preoperatively. Thoracoscopic lobectomy and wedge resection for the treatment can achieve satisfactory short-term outcomes.

160 Gamme Knife Radio Surgery for Cerebral Arteriovenous Malformation (AVM) in Children: A Systematic Review and Meta-analysis of Clinical Outcomes

INTRODUCTION: As radiosurgical devices are becoming more commonly used and applied to treat cerebral arteriovenous malformations (cAVMs), there is a growing concern about whether the outcomes of radiosurgery might differ between children, adolescents, and adults due to the distinct characteristics of cAVMs in these age groups. METHODS: Search: A search for RCT, not RCT, prospective and retrospective cohort studies in PUBMED; SCOPUS; Central Cochrane Registry ofControlled Trials (The Cochrane Library); MEDLINE; EMBASE (Ovid); CINAHL. The search strategy include subject headings (MeSH) and text words connected with Booleans term. Population: Children (younger than 18 years old) with Cerebral Arterio-venous Malformation (AVMs). Intervention: Gamma Knife radiosurgery (GKS). Outcomes: Primary Outcome: Mortality to end of Follow-up and Surgery successfull determined by the percentage of obliterated AVMs. Secondary Outcome: New Neurological deterioration and Post-Radiosurgery intracranial hemorrhage. RESULTS: 21 studies with 2142 children who had Gamma knife surgery for cerebral arteriovenous malformations were found for this systematic review. For children with cerebral AVMs treat with GKS, the death rate was 0.725% (95% CI 0.411%-1.126%; I2 = 0%) while the success rate of gamma knife radiosurgery was 71.74% (95% CI 65.716%-77.211%; I2 = 88.13). The rate of complications, such as the rate of new neurological deficits, was 2.57% (1.43% to 3.89%; I2 = 66.78%), and the postoperative intracranial bleeding rate was 2.463% (1.348% to 3.9%; I2 = 70.14%). CONCLUSIONS: Gamma Knife radiosurgery is a safe and effective treatment option for cerebral arteriovenous malformations, with high surgical success rates, low mortality, and low complication rates. However, further high-quality case-control studies are needed to evaluate its long-term efficacy and safety.

Can exoscope improve brain AVMs surgery?

The advantages of the surgical view provided by the exoscope have been described before, although reports of its application to brain arteriovenous malformation (AVM) surgery are lacking. The ampler field of view and magnification up to ×24 allow for enhanced visualization during microsurgical procedures. Furthermore, the live visualization provided by indocyanine green video angiography (ICG-VA) helps emphasize the hemodynamics of AVMs, even allowing the detection of possible residual vein arterialization as an indirect expression of nidal remnants. With this illustrative video showing the resection of a hemorrhagic right frontoinsular Spetzler-Martin grade III AVM, the authors describe the technical implications of exoscope brain AVM surgery using the Olympus ORBEYE 4K-3D, with a final focus on ICG-VA as an asset. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23114.

Complication Avoidance in Chiari Malformation Surgery.

Posterior fossa decompression for symptomatic Chiari malformation is an effective and frequently performed procedure, but it does carry risks of significant complications including cerebrospinal fluid leak and craniocervical instability. Patients sometimes do not improve or worsen after decompression, which may discourage neurosurgeons from performing Chiari decompression surgery. In this chapter, management strategies and surgical approaches are discussed that minimize the risks of complications and maximize favorable outcomes in Chiari malformation surgery.

Natural History and Histopathology of Expanding Cysts and Hematomas After Stereotactic Radiosurgery for Arteriovenous Malformations of the Brain: A Case Series

We reviewed the clinical course and histopathologic findings for cases involving the formation of expanding cysts and/or hematomas after gamma knife surgery (GKS) for arteriovenous malformations (AVMs). We report a single-center retrospective review of 18 patients who presented with cyst and/or hematoma expansion after GKS for AVMs between 1993 and 2023. Expanding cysts and hematomas were defined as well-demarcated cavities filled with fluid or well-marginated heterogenous hematomas presenting with expansion proximal to or in the location of the original AVM, respectively. Patient demographics, AVM characteristics, history of interventions and surgeries, and imaging and histopathologic features of expanding cysts and hematomas were collected for analysis. Among 1072 AVM patients treated using GKS, 18 presented with expanding cysts or hematomas during a total follow-up period of 16,757 patient-years (0.11 case/100 persons/patient-year). The time to cyst or hematoma identification was 4-13 years after initial GKS, with a mean duration of 8.6 years. Among the patients examined, 7 (38.9%) presented mainly with hematoma, 10 (55.6%) presented mainly with cysts, and 1 presented with approximately equal components of both. Among the 18 patients, 13 (72.2%) underwent craniotomy to treat cyst or hematoma expansion. All the specimens had similar histopathologic characteristics, including organizing hematoma with fresh and old hemorrhage, fibrinoid necrosis of the vessels, gliosis of normal brain tissue, infiltration of hemosiderin-laden histiocytes, and extravascular protein leakage. Our findings suggest that the formation of these 2 complications can be attributed to a common mechanism involving radiation-induced vascular damage in brain tissue adjacent to the AVM and subsequent chronic inflammation and capillary dilatation.

Risk factors for sequelae after surgery for lymphatic malformations in children

ObjectiveThe first-line treatment of lymphatic malformations (LMs) is pharmacological or interventional; however, surgery is still necessary in selected cases. Our aim was to identify factors associated with the occurrence of permanent postoperative complications. MethodsThis was a case series study of children operated on for LMs between 2001 and 2021 and followed-up in our institution. Patients who presented sequelae derived from surgical treatment (cases) and those who did not (controls) were compared. ResultsWe included 112 children who underwent surgery for LMs in different centers. Forty-nine cases and 63 controls were included (58% male), with a mean age of 34 months. Patients younger than 1 year presented more complications than older children, 59% (n = 29/49) vs 41% (n = 24/49), respectively (P = .02). LMs were in the cervicofacial region in seven patients in the control group compared with 30 of the cases (P ≤ .001), with microcystic malformations the most associated with sequelae (n = 11/15; P = .019). Concerning permanent complications, 88% were neurological (n = 43/49), mainly peripheral facial palsy (n = 17). There was greater postoperative residual disease in controls compared with cases (65% vs 14%, respectively; P ≤ .0001). However, following a second procedure in the control group, there was no significant difference in long-term cure rates (P = .38). ConclusionsThe risk of sequelae following surgery for LM increases significantly in patients younger than 12 months in cervicofacial and microcystic malformations. Because non-radical resections are associated with fewer complications and an optimal long-term cure rate, we consider that aggressive surgical approaches should be avoided if the absence of sequelae is not guaranteed.

Prospective, Longitudinal Study of Clinical Outcome and Morphometric Posterior Fossa Changes after Craniocervical Decompression for Symptomatic Chiari I Malformation.

The time course of changes in posterior fossa morphology, quality of life, and neurologic function of patients with Chiari I malformation after craniocervical decompression requires further elaboration. To better understand the pace of these changes, we longitudinally studied patients with Chiari I malformation, with or without syringomyelia, before and after the operation for up to 5 years. Thirty-eight symptomatic adult patients (35 women, 3 men) diagnosed with Chiari I malformation only (n = 15) or Chiari I malformation and syringomyelia (n = 23) and without previous Chiari I malformation surgery were enrolled in a clinical study. Patients underwent outpatient study visits and MR imaging at 7 time points (ie, initial [before the operation], 3 months, 1 year, 2 years, 3 years, 4 years, and 5 years) during 5 years. The surgical procedure for all patients was suboccipital craniectomy, C1 laminectomy, and autologous duraplasty. Morphometric measurements demonstrated an enlargement of the CSF areas posterior to the cerebellar tonsils after the operation, which remained largely stable through the following years. There was a decrease in pain and improved quality of life after the operation, which remained steady during the following years. Reduction in pain and improved quality of life correlated with CSF area morphometrics. Most changes in MR imaging morphometrics and quality of life measures occurred within the first year after the operation. A 1-year follow-up period after Chiari I malformation surgery is usually sufficient for evaluating surgical efficacy and postoperative MR imaging changes.