Open Surgical Resection Research Articles

Stent-Graft Placement Procedures for Descending Thoracic Aortic Aneurysms

Descending thoracic aortic aneurysms most often are caused by arteriosclerosis and appear most frequently in elderly males. These patients often are asymptomatic, but they may experience symptoms related to compression of adjacent thoracic structures, or they may present for treatment when their-aneurysms rupture. Open surgical resections and repairs of descending thoracic aortic aneurysms are associated with bleeding, paraplegia, strokes, renal insufficiency, and the need for prolonged ventilatory support in the postoperative period. At Stanford (Calif) University Hospital, surgeons are placing endovascular stent-grafts in patients with descending thoracic aortic aneurysms who meet specific anatomic selection criteria. This new treatment modality provides patients with a less invasive, less hazardous, and potentially less expensive alternative to open surgical resection and repair procedures. Preoperative teaching and skilled perioperative nursing care are essential for positive patient outcomes with stent-graft treatment of descending thoracic aortic aneurysms.

Pineal Region Choroid Plexus Papilloma Treated With Stereotactic Radiosurgery: A Case Study

The treatment of a patient with a third-ventricular choroid plexus papilloma is described. This relatively unusual lesion was treated with stereotactic radiosurgery. Follow-up at 17 months demonstrates substantial reduction in tumor volume and an excellent clinical outcome. The treatment of this patient suggests that radiosurgery may be an effective alternative to open surgical resection.

Pineal Region Choroid Plexus Papilloma Treated With Stereotactic Radiosurgery: A Case Study

The treatment of a patient with a third-ventricular choroid plexus papilloma is described. This relatively unusual lesion was treated with stereotactic radiosurgery. Follow-up at 17 months demonstrates substantial reduction in tumor volume and an excellent clinical outcome. The treatment of this patient suggests that radiosurgery may be an effective alternative to open surgical resection.

Laparoscopic Marsupialization of Symptomatic Polycystic Kidney Disease

Purpose Although laparoscopic unroofing of simple renal cysts has proved to be an effective form of therapy, its use for treatment of multiple renal cysts or symptomatic autosomal dominant polycystic kidney disease only recently has been investigated. Materials and Methods The results of laparoscopic marsupialization of symptomatic renal cysts in 13 patients was determined 12 to 28 months postoperatively by assessing subjective pain relief, and comparing preoperative and postoperative computerized tomography (CT). Eight patients had autosomal dominant polycystic kidney disease. Multiple dominant (more than 3 cm.) cysts were marsupialized in 11 patients and 1 dominant cyst was treated in 2. Results Of 13 patients with symptomatic renal cysts and 8 with autosomal dominant polycystic kidney disease 8 (62 percent) and 4, respectively were pain-free 12 to 28 months postoperatively. Two patients had persistent pain, while 3 had recurrent pain 7 to 16 months postoperatively. All 5 patients had persistent or recurrent dominant cysts on followup CT. Followup CT demonstrated resolution or a significant decrease of the largest and all or all but 1 of the other dominant cysts in 6 of 7 pain-free patients. Intraoperative ultrasound detected unidentified cysts during an open and laparoscopic procedure. No deleterious effects on serum creatinine were observed. Conclusions Laparoscopic marsupialization is a safe, relatively successful technique for providing persistent pain relief in patients with autosomal dominant polycystic kidney disease. Although the 2-year pain-free rate approaches the 62 percent rate reported for open surgical cyst resection, continued efforts to improve current laparoscopic techniques are clearly indicated. Persistence or recurrence of dominant cysts on CT correlated with persistent or recurrent symptoms. Intraoperative ultrasound is effective in identifying dominant cysts.

Open surgical excision of subglottic hemangioma in children

Subglottic hemangioma is an unusual entity which may involute spontaneously without aggressive surgical intervention; although tracheotomy is sometimes necessary. The actual time course for involution is not clear by reviewing the literature [1,14]. Numerous treatment modalities are described for the treatment of this condition, including tracheotomy, CO 2 laser ablation and intralesional steroid injection with or without endotracheal intubation. Surgical resection of subglottic hemangioma is an option which is described in the literature and may be utilized in certain selected cases. We present seven cases of subglottic hemangioma treated at three institutions which were resected via a crico-tracheotomy approach. Postoperative follow-up for these patients range from 6 months to 4.5 years. Although conservative measures are still advocated as the treatment of choice for subglottic hemangioma, open surgical resection may be indicated in selected cases resulting in a satisfactory outcome.

Stereotactic Approach to Skull-Base Lesions

With improved knowledge of the anatomy and increased collaboration between the neurosurgeon and the otolaryngologist, successful surgical resection of skull-based tumors is being achieved with reduced mortality and morbidity. In spite of this, there remains a group of patients in whom an alternate surgical approach of stereotaxis may be indicated. This group of patients includes those in whom only biopsy is required, or those in whom brachytherapy using high-intensity (125)I is planned because the patients' general condition is not good enough to undergo open surgical resection of the tumor or the tumor is unresectable or the patient refuses open surgery. This article presents a preliminary report on stereotactic approach to skull base lesions with special emphasis on the technique.

The role of preoperative colonoscopy in colorectal cancer.

Routine preoperative colonoscopy has been recommended for those patients with the diagnosis of colorectal cancer to identify synchronous polyps and/or cancers which might otherwise be undetected on barium enema or at the time of operation. It has been suggested that this approach may alter surgical therapy or follow-up. The charts of 98 patients who underwent preoperative colonoscopy solely for the purpose of detecting additional polyps or cancers prior to open surgical resection for colorectal cancer were retrospectively reviewed. All patients had biopsy or barium-enema evidence of colorectal cancer. Patients with familial polyposis or chronic ulcerative colitis were excluded. Synchronous cancers were detected in 7.1 percent of patients, and synchronous neoplastic polyps in 29 percent. Forty-three percent of synchronous cancers and 73 percent of synchronous neoplastic polyps would not have been included in the standard surgical resection for the index cancer if the additional information provided by colonoscopy had not been available. Surgical treatment and/or follow-up were altered in 33 percent of patients as a consequence of the colonoscopic evaluation. Colonoscopy prior to surgery for colorectal carcinoma is highly desirable and may potentially improve long-term survival.

Granular Cell Myoblastoma of the Bronchus: Report of 2 Cases and Review of the Literature

Granular cell myoblastoma of the bronchus is rare. Two patients are described, bringing the total reported to 44. Review of the literature shows that cough, chest pain, hemoptysis, and wheezing are frequent presenting symptoms and that distal atelectasis and recurrent or persistent pneumonitis are common roentgenographic findings. Though the histogenesis of this tumor remains controversial, most pathologists now believe that the cells have a neurogenic origin. Adequate open surgical resection is the treatment of choice.

Results of treatment os squamous-cell carcinoma arising in mandibular gingiva.

In other communications, 1,2 we have briefly reviewed the progress of treatment of squamous-cell carcinoma of the anterior portion of the tongue and the floor of the mouth. The treatment of carcinoma of the mandibular gingiva, like that of the two types just mentioned, has passed through many different phases. Prior to this century, the occasional open surgical resection of such lesions was truly a major undertaking. As methods of electrosurgery and irradiation improved, the majority of such lesions were treated by these techniques, and the immediate mortality rate was reduced considerably. However, it became apparent that patients who had malignant invasion of the mandible were cured only occasionally by irradiation. Also, irradiation was found to be unsatisfactory as a treatment of metastatic tumors in the cervical lymph nodes. Thus, the primary lesion usually was treated by irradiation or electrocoagulation, and the cervical metastatic lesions were treated by surgical removal,