Predictors Of Surgical Success Research Articles

Midterm Outcomes of the Endoscopic Endonasal Approach for Treating Tuberculum Sellae Meningiomas: The Impact of Malleable Forceps and Predictors of Surgical Success

Abstract Objective To evaluate the midterm surgical outcomes and factors associated with the extent of resection (EOR), postoperative visual improvement, and risk factors for postoperative cerebrospinal fluid (CSF) leaks in cases of the endoscopic endonasal approach (EEA) for tuberculum sellae meningiomas (TSMs), including cases utilizing the malleable forceps. Design Retrospective clinical study. Setting Single-center tertiary referral hospital. Participants Twenty-two patients who underwent the EEA for TSMs between November 2013 and April 2024. Main Outcome Measures Patient characteristics, intraoperative findings, and postoperative outcomes were evaluated. Predictors of the EOR, postoperative visual improvement, and postoperative CSF leaks were investigated. Results The median age was 58 years, with 77.2% being women. The median follow-up was 70.5 months, and the mean tumor size was 23.5 mm. Gross total resection (GTR) was achieved in 18 patients (81.8%), with no recurrence. Adhesion to the optic nerve was significantly associated with the EOR (p = 0.001). The malleable forceps were used in 14 out of 22 cases, and the GTR rate increased to 92.8% (13 out of 14 cases) with this instrument._Postoperative visual improvement was achieved in 16 of 19 patients (84.2%) and was significantly associated with tumor size (p = 0.02) and the duration of preoperative visual disturbances (p = 0.002). Two patients (9.0%) experienced postoperative CSF leaks, significantly associated with sex (p = 0.04) and Simpson grade (p = 0.032). Conclusion The EEA yielded favorable outcomes and significant postoperative visual improvement for TSMs, supporting early intervention for symptomatic TSMs and radical treatment for GTR. The malleable forceps can enhance the management of complex procedures.

Success rates and predictors of outcomes of type I tympanoplasty performed by residents in a teaching tertiary hospital

Several technical variations of tympanoplasty have been reported, usually involving the type of graft and/or instruments used. Few studies have focused on the outcome of type-1 tympanoplasty specifically in teaching scenarios. We aimed to describe the results of type-1 tympanoplasty performed by residents, and to investigate potential predictive factors of surgical success. To do so, we did a retrospective analysis of medical records of patients who underwent type-1 tympanoplasty in a tertiary university hospital. We evaluated the tympanic membrane closure and audiometric outcomes during the first year of follow-up, and compared the results according to some clinical and surgical factors. 130 operated ears were included in the study. The closure rate reached 84.12% after one month and 72.72% after twelve months of surgery. The mean air-bone gap was 22.98 dB preoperatively, and reached 10.55 dB after surgery. Perforation closure rates were 85% and 57.14% for those operated by endoscopic and microscopic-assisted approaches, respectively (p = 0.004). The use of cartilage grafts and time without otorrhea of more than three months prior to surgery were also predictors of surgical success (p = 0.002 and 0.041, respectively). Gender, age, perforation size, contralateral disease, operated side, reoperation, and degree of hearing loss did not significantly interfere with outcomes. Tympanoplasty showed good overall results when performed by residents, although inferior to those reported by experienced surgeons. The use of the endoscope, cartilage grafting, and longer preoperative time without otorrhea were predictors of surgical success in this scenario. Level of evidenceIIB.

Role of Bladder Functional Testing Prior to Surgeries for Benign Prostatic Obstruction.

Thereis no consensus on preoperative functional testing prior to surgeries forbenign prostatic obstruction causing lower urinary tract symptoms (LUTS). Surgical management offers definite benefits, but the results are not always satisfactory. The urodynamic study (UDS) is the gold standard for assessing bladder outlet obstruction (BOO) which is the best predictor of surgical success. Yet, it is not recommended by our urologic societies as standard testing prior to surgery. In this narrative review of the literature, we report recent findings and controversies regarding the benefits and downside of UDS, and the use of other less-invasive approaches to achieve this goal. The lack of strong evidence for or against performing UDS was surprising. Prospective UDS data may not predict surgical outcomes if there is no consensus on criteria that directs surgical intervention. However, confirming the presence of BOO and characterizing the bladder function to identify detrusor over- and underactivity may help counselling and setting patient's post-operative expectations. Urocuff, a non-invasive testing offers promising results to address this problem with a less-invasive assessment of BOO. We emphasize better pre-operative characterization of patients to confirm BOO and better define subgroups to improve surgical decision-making.

Early post-operative angle as a predictor of surgical success in adult patients with intermittent exotropia

ABSTRACT Purpose: Intermittent exotropia is a condition where divergent strabismus is present at certain times or fixation distances and is surgically treated with bilateral lateral rectus recession or unilateral lateral rectus recession with medial rectus resection. The main purpose of our study is to assess the relationship between the initial post-operative deviation and surgical outcomes in adult exotropes undergoing recess-resect surgery. Methods: A retrospective chart review was performed on adult patients who underwent unilateral recess-resect surgery for intermittent exotropia between March 2010 and February 2022 at a single institution with at least 3 months of follow-up. Based on their motor alignment at 2 weeks following surgery, they were categorized as having exodeviation, esodeviation within 10 PD and esodeviation exceeding 10 PD. Surgical success was defined as motor alignment within 10 PD of exotropia and 5 PD of esotropia at distance and near at final follow-up. Results: 93 patients were included, 55% female and average age was 37 years. At postoperative week 2, 26 patients demonstrated residual exodeviation (Group A), 53 patients demonstrated an esodeviation of within 10 PD (Group B) and 14 patients demonstrated an esodeviation greater than 10 PD (Group C). There were no significant differences in pre-operative and demographic factors between the group. At the final follow-up, surgical success was observed in 57 patients: 12 in Group A, 41 in Group B and 4 in Group C (P < .01). Conclusion: Overcorrection of within 10 PD at 2 weeks following surgery showed a more favorable surgical outcome compared to exodeviation or esodeviation exceeding 10 PD.

Clinical Outcomes of Arthroscopic Revision Rotator Cuff Repair.

Multiple studies have shown excellent clinical results in primary rotator cuff repairs; however, not much evidence is available in the literature on the outcomes of arthroscopic revision rotator cuff repairs. The purpose of this study was to report a cohort of patients who underwent revision arthroscopic rotator cuff repair and identify factors that may influence its outcomes. We examined a cohort of 62 patients which underwent revision arthroscopic rotator cuff repair in a single UK institution with a minimum of 24months follow-up. Active shoulder movements including forward flexion, abduction and external rotation were evaluated, as well as Oxford Shoulder Score (OSS). Further subgroup analysis was performed looking of the effects of age, size of tear, obesity and diabetes mellitus had on clinical outcomes. 59 patients were available for final review. 39 male and 23 were female. The mean age was 64years. Overall, significant improvements were seen in terms of OSS (p < 0.05), active forward flexion (p < 0.05), active abduction (p < 0.05) and active external rotation (p < 0.05). Our study showed that a significant proportion of patients undergoing arthroscopic revision rotator cuff repair achieve good outcomes. Repairing small- and medium-size tears was successful, diabetics had no post-operative improvements, obese patients achieved significant improvement in range of movement and age was not a predictor of surgical success. Overall, arthroscopic revision surgery is a successful option; however, appropriate patient selection and counselling is paramount.

Predictors of success in hypoglossal nerve stimulator implantation for obstructive sleep apnea.

ObjectiveCurrent guidelines for hypoglossal nerve stimulator (HGNS) implantation eligibility include drug-induced sleep endoscopy (DISE) findings and other patient characteristics but lead to highly variable rates of surgical success across institutions. Our objective was to determine whether additional factors seen on preoperative evaluation could be used as predictors of surgical success.Study designRetrospective chart review.SettingSingle-institution academic tertiary care medical center.Subjectsand Methods:This study included patients with obstructive sleep apnea (OSA) who underwent HGNS implantation between 2015 and 2018. Surgical success was defined as a postoperative apnea-hypopnea index (AHI) of less than 20 events per hour and an AHI reduction of at least 50%. Preoperative polysomnogram (PSG) results, DISE findings, and physical parameters were compared between surgical successes and failures.ResultsA total of 68 patients were included in the analysis. The overall surgical success rate was 79.4% (54/68). Elevated preoperative AHI was associated with an increased likelihood of treatment failure, with an AHI of (36.9 ± 16.8) events/hour in the success group compared to (49.4 ± 19.6) events/hour in the failure group (P = 0.05). Patients observed to have partial lateral oropharyngeal collapse on DISE was more frequently associated with the treatment failure group than in the success group (P = 0.04).ConclusionPatients who underwent HGNS implantation overall had a very high treatment response rate at our institution. Factors that may predispose patients to surgical failure included the presence of lateral oropharyngeal collapse and a significantly elevated preoperative AHI. These should be considered when determining surgical candidacy for HGNS implantation.

XEN45 Gel Stent implantation in eyes with primary open angle glaucoma: A study from a single hospital in Taiwan.

To evaluate the effectiveness and safety of the XEN45 Gel Stent in East Asian patients with primary open angle glaucoma (POAG). We retrospectively reviewed 37 medically uncontrolled POAG patients who received XEN45 Gel Stent. The primary outcomes were reduction in intraocular pressure (IOP) and in the number of glaucoma medications 12 months after surgery. The secondary outcomes were requirement for intervention and further glaucoma surgery. The adverse intraoperative and postoperative events were investigated. At the 12-month postoperative follow-up, the mean IOP was significantly reduced from the preoperative value of 21.7 ± 7.7 mmHg to 15.0 ± 2.0 mmHg (p = 0.001). The mean number of glaucoma medications decreased from 3.4 ± 0.9 to 1.3 ± 1.5 (p < 0.001). Seventeen patients (45.9%) required postoperative interventions. Four patients (10.8%) received additional glaucoma surgery. Postoperative IOP at month 1 was significantly associated with outcomes at the 12-month follow-up and the need for subsequent intervention and additional glaucoma surgery. The XEN45 Gel Stent effectively reduced the IOP values and number of glaucoma medications in East Asian patients with POAG. No major complications were observed, but almost half of the eyes in the study required intervention for wound healing modification. Postoperative IOP at month 1 was a predictor of surgical success at 12 months after surgery.

Phacoemulsification vs phacoemulsification with micro-bypass stent implantation in primary angle closure and primary angle closure glaucoma: A randomized single-masked clinical study.

Primary angle closure glaucoma (PACG) is a major cause of irreversible visual impairment in Asia, but there is no published data on the effect of iStent on these patients. To compare the efficacy and safety of combined phacoemulsification and iStent implantation with standard phacoemulsification in an Asian population. A prospective, single-masked, randomized study in a public tertiary eye clinic. Patients with concomitant visually significant cataracts and primary angle closure (PAC) or PACG. Patients were randomized and underwent either phacoemulsification alone (phaco) or with concurrent iStent injection (phaco-iStent). Demographic and clinical data were collected. Complete and qualified success rates at 12 months were compared between both treatment arms. Thirty-two patients were recruited between September 2015 and February 2016. All patients completed 12 months of follow-up. There was no statistically significant difference in preoperative IOP (phaco, 17.5 ± 3.1 mmHg; phaco-iStent, 18.6 ± 4.7 mmHg, P = .65) and 12-months postoperative IOP (phaco, 15.0 ± 2.5 mmHg; phaco-iStent, 14.7 ± 3.1 mmHg, P = .86) between both groups. Complete success rates were 43.8% (95% CI, 19.8-65.6) for the Phaco group and 87.5% (95% CI, 58.6-96.7) for the Phaco-iStent group (P = .01). Thinner preoperative optical coherence tomography (retinal nerve fibre layer) thickness (hazard ratio [HR] = 7.34 [95% CI, 1.53-35.30]) and phacoemulsification alone (HR = 0.93 [95% CI, 0.87-0.02]) were independent factors associated with failure to achieve complete success. Combined phacoemulsification with iStent implantation is associated with a higher likelihood of complete success compared with phacoemulsification alone in eyes with primary angle closure disease at 12 months postoperatively. Further studies are required to establish the longer term efficacy of iStent implantation and to identify other predictors for surgical success.

Resident Perspectives

Resident Perspectives

3451 Pain, Quality of Life, and Emotional Measures as Predictors for Outcomes following Surgery for Nerve Injuries

OBJECTIVES/SPECIFIC AIMS: Examine data from PNID patients to evaluation the strength of associations between pre-operative and post-operative levels of pain, quality of life, and emotional reactions to pain to determine if one or more can serve as better predictors of surgical success than pain. METHODS/STUDY POPULATION: In our preliminary study, we gathered data from a pre-existing database of 464 PNID patients that contains self-reported visual analog scale scores (VAS) of pain intensity, QoL, and depression. We measured these variables at three time points: pre-operatively, post-operatively, and at the final visit. We used the Wilcoxon signed rank test to determine if each of these three variables differed significantly between the pre-operative visit and the post-operative visit period and from the pre-operative visit to the final visit. RESULTS/ANTICIPATED RESULTS: Median time from the pre-operative visit to surgery was 9 weeks; median time from surgery to the post-operative visit was 4 weeks; and median time from the post-operative visit to the final visit was 23.5 weeks. There was a clinically meaningful difference in pain scores between the pre-operative and post-operative visits (median difference 1.15; 95% CI 0.75-1.55). In the period between the post-operative visit and the final visit there was also a decrease in pain (0.90; 95% CI 0.55-1.30). The magnitude of change in median difference of 1.85 (95% CI 1.50-2.20) between the pre-operative visit and the final visit was larger than the change in median difference of 0.90 (95% CI 0.55-1.30) between the post-operative visit and the final visit. The pre-operative visit median QoL score was higher than the median score at the post-operative visit (1.65; 95% CI 1.25-2.10). The smallest median difference in QoL of occurred between the post-operative and the final visit (1.10; 95% CI 0.60-1.45). As seen with the pain scores, the magnitude of change in median difference of 2.50 (95% CI 2.20-2.85) for QoL was greatest between the pre-operative and the final visit. Depression scores showed the least amount of change amongst all the variables, between the pre-operative and the post-operative visit (1.00; 95% CI (0.70-1.40), and similarly between the post-operative visit and the final visit (0.15; 95% CI (0-.40). The median differences between the pre-operative and final visit were greatest in QoL (2.50; 95% CI 2.20-2.85), followed by pain scores (1.85; 95% CI 1.50-2.20), and finally, depression (1.05; 95% CI 0.70-1.40). DISCUSSION/SIGNIFICANCE OF IMPACT: Our results show that all three variables measured improve with surgery and continue to improve over the post-operative course to the final visit. This suggest that the relationships between pain, QoL, and depression should be further investigated. We are hopeful that elucidating how these variables interact in the PNID patient population, will encourage peripheral nerve surgeons to use these parameters in conjunction with pain intensity to measure outcomes. A follow-up study expanding on these results and including measures of anger and frustration in a larger sample is underway.

Snoring sound energy as a potential biomarker for disease severity and surgical response in childhood obstructive sleep apnoea: A pilot study.

To investigate the relationship between baseline snoring sound energy (SSE) and disease severity, changes in SSE after adenotonsillectomy, and the predictors of surgical success in children with obstructive sleep apnoea (OSA). Prospective cohort study. Tertiary referral medical centre. Thirty-two children with OSA whose apnoea-hypopnoea index ≥5 or apnoea-hypopnoea index ≥1.5 with OSA comorbidities were recruited. Patients with complicated OSA were excluded. All participants underwent snoring sound analysis, polysomnography, and adenotonsillectomy. Snoring sound energy and apnoea-hypopnoea index were assessed at baseline and 6months after adenotonsillectomy. Surgical success was defined as a postoperative apnoea-hypopnoea index <1.5. The median age, body mass index, and apnoea-hypopnoea index was 9years, 19.0kg/m2 , and 13.2events/h, respectively. Multivariate logistic regression showed that a baseline tonsil size of IV (odds ratio 15.7 [95% CI: 1.5-166.3]) and SSE of 801-1000Hz>21.9dB (odds ratio 32.3 [95% CI: 2.6-396.6]) were significantly related to severe OSA. Following adenotonsillectomy, apnoea-hypopnoea index decreased significantly (P<0.001). SSE of 41-200Hz, 201-400Hz and 801-1000Hz also decreased significantly (P=0.04, 0.01 and 0.006, respectively). Baseline SSE of 801-1000Hz<8.5dB significantly predicted surgical success (odds ratio 11.0 [95% CI: 1.4-85.2]). Our findings suggest the potential utility of SSE of 801-1000Hz to screen for severe OSA, predict surgical success and assess therapeutic outcomes. Specific baseline SSE may represent a potential biomarker for childhood OSA.

Effects of microsurgical varicocelectomy on semen analysis and sperm function tests in patients with different grades of varicocele: Role of sperm functional tests in evaluation of treatments outcome.

It seems that varicocele play a role in male infertility, as such, their prevalence increases from 15% in the normal population to 80% in secondary infertility subjects. Varicoceles may have negative effects on semen quality. Our goal was to assess the effects of microsurgical varicocelectomy on semen analysis and sperm functional tests in men with different grades of varicoceles. Thirty infertile men with different grades of varicoceles (grades 1 to 3) were enrolled in our study. Semen quality was assessed by semen analysis according to the WHO guideline (WHO, 1999) and four different sperm functional tests (aniline blue, toluidine blue, chromomycin A3 and TUNEL test) were carried out before and 3months after microsurgical varicocelectomy (M-varicocelectomy). When considered all three grades together, we showed that M-varicocelectomy had statistically significant effects on all four types of sperm functional tests (p value<0.05). It also had positive effects on conventional semen parameters, although the effects were not statistically significant for some parameters (for example sperm count). When analysed separately (based on varicocele grades) the surgery, although caused improvements in semen quality, but may have more statistically significant effects on patients with varicocele of higher grade. In addition, in varicocele of lower grade (for example grade 2), sperm function test may be a better predictor of surgical success than the conventional semen analysis. Thus, we show that not only M-varicocelectomy has significant positive effect on semen quality but also if sperm functional tests become more affordable in the future, because they yield more precise results, their use in daily practice may increase significantly in patients with varicoceles.

Bony reconstruction of hip in cerebral palsy children Gross Motor Function Classification System levels III to V: a systematic review.

Hip dislocation is a common source of disability in cerebral palsy children. It has been remedied by various reconstructive procedures. This review aims at providing the best evidence for bony reconstructive procedures in cerebral palsy hip migration. The literature extraction process yielded 36 articles for inclusion in this review. There is fair evidence to indicate that the comparative effectiveness of femoral versus combined pelvifemoral reconstruction favours pelvifemoral reconstruction. All except one were retrospective articles with a significant degree of selection and performance bias and confounding variables that limited the validity and generalizability of the conclusions. The findings of this systematic review provide fair evidence for the use of adequate soft tissue and combined pelvifemoral reconstruction in the management of hip migration in none and minimally ambulatory cerebral palsy children in the short and long term. This has been shown in studies with a summed sizable patient population. There is limited evidence available that would support the use of soft-tissue and isolated femoral reconstruction. In the context of these retrospective and biased studies, it is extremely difficult to identify, with great precision, predictors of surgical success. Future studies should consider prospective designs that allow for bias control, strict patient selection criteria and incorporation of validated quality-of-life scales.

Current paediatric orthopaedic practice in hereditary multiple osteochondromas of the forearm: a systematic review.

Introduction: This systematic review aims to answer three research questions concerning the management of hereditary multiple osteochondromas of forearm in children: What is the best available evidence for the currently employed surgical procedures? What patient characteristics are associated with better prognosis? What disease characteristics are associated with better prognosis?Methods: We searched the literature using three major databases with no publication date restrictions. To enhance search sensitivity and maintain precision we used keywords/subject terms correlating with patient population, problem and interventions. We used strict inclusion/exclusion criteria to improve validity evidence.Results: The search process yielded 34 eligible studies with a total of 282 patients (315 forearms). We comprehensively analysed study and patient demographics and interventions and outcomes. Eleven studies (32%) had a long-term follow-up and 31 studies (91%) were retrospective. Of the total number of forearms, ulnar lengthening +/− associated procedures was used in 210 forearms (66.7%), isolated osteochondroma excision in 65 forearms (20.6%) and isolated distal radius hemiepiphysiodesis in 15 forearms (4.7%) among others.Discussion: Ulnar lengthening can restore radiologic anatomy, improve appearance and to a lesser extent objective clinical parameters like joint range of motion on the short/intermediate term. Isolated osteochondroma excision can relief pain and satisfy cosmetic concerns occasionally. There is poor evidence to suggest that surgery improves quality of life or function. Predictors of surgical success in regard to patient and disease characteristics remain elusive. Natural history and prospective randomized control studies where the control group receives no treatment should be rethought. They have the potential for bias control and identification of the ideal surgical candidate. The complex interplay between the confounding variables has undermined the capability of most studies to provide well-grounded evidence to support and generalize their conclusions. Valid quality of life scales should supplement objective outcome measures.

Secrets for successful laparoscopic antireflux surgery: preoperative workup

Gastroesophageal reflux disease (GERD) is a highly-prevalent multifactorial disease, with primary symptoms including heartburn and regurgitation. Despite the widespread pharmacologic treatment of GERD, antireflux surgery is cur-rently the most effective and definitive treatment for the disease. An accurate indication for surgery and the appropriate preoperative workup are the best predictors of surgical success in those patients. Several factors affect the decision of performing anti-reflux surgery, including the patient’s response to anti-acid medication and therapy duration, presence of side-effects, and progression of disease. Other diagnoses, such as esophageal cancer, must also be ruled out. A proper preoperative workup includes esophageal symptom evaluation and esophageal testing. Ambulatory pH testing is the gold standard for GERD diagnosis, and it is crucial for the assessment of the relationship between symptom presen-tation and reflux episodes. High-resolution manometry evaluates esophageal body motility and lower esophageal sphincter function, playing an important role in the definition of the surgical technique to be adopted. Upper GI endoscopy is the exam of choice for the diagnosis of disease progression and presence of other complications. Esophagram provides a detailed anatomy of the esophagus and stomach. In summary, a meticulous preoperative workup done by experts is crucial for improving patient outcomes.

Predictors of surgical success in patients with intermittent exotropia

In patients with moderate- to large-angle exotropic deviations, surgical correction remains the definitive treatment. The purpose of this study was to identify preoperative factors that correlate with surgical success and to produce a binomial model that predicts success based on preoperative factors. We performed a retrospective review of patients with intermittent exotropia who underwent uniocular recession-resection surgery. Success was defined as ocular deviation ≤10Δ exotropia and ≤5Δ esotropia at distance at last follow-up (at least 3months' postoperatively). Preoperative factors such as age at surgery, sex, visual acuity, spherical equivalent, prism fusion range, stereopsis, and ocular deviation were analyzed for correlation with success using binomial logistic regression. A total of 82 patients were identified (average age, 33years; range, 3.7-81.6years). Average prismatic deviation was 35Δ at near and 34Δ at distance. Average stereopsis was 167″. The average success rate was 58.5%. Univariate binomial regression revealed that patients with smaller angle of deviation at near (OR=0.96, P=0.013) or distance (OR=0.96, P=0.005), larger myopic refractive errors in terms of mean spherical equivalent (OR=0.71, P=0.022) and spherical equivalent in the more myopic eye (OR=0.75, P=0.029) contributed to success. A multivariate regression model was able to predict success with an accuracy of 72% (sensitivity, 81%; specificity, 58%; negative predictive value, 67%; positive predictive value, 74%). A smaller preoperative angle of deviation and larger myopic refractive error correlated with success in uniocular intermittent exotropia surgery in our cohort. Larger deviations and more hyperopia correlated with lower success rates.

Intranasal Pathology in the Migraine Surgery Population: Incidence, Patterns, and Predictors of Surgical Success.

The purpose of this study was to identify patterns of nasal pathology in patients with rhinogenic migraine headaches (site III). A retrospective review was performed on patients with rhinogenic migraine headaches. Demographics, pre- and post-migraine surgery symptoms, and pathology seen on preoperative computed tomographic scans were reviewed. Twenty percent of 98 patients had preoperative sinus disease. The following abnormalities were seen on computed tomographic scan: septal deviation, 75 (77 percent); septal spur, 33 (34 percent); middle concha bullosa, 48 (49 percent); sinus pathology, 20 (20 percent); and intranasal contact points, 62 (62 percent). A higher incidence of clinical sinusitis (20 percent migraine versus 5 to 15 percent in the general population) was also seen. Septoplasty was performed in 89 percent of patients, and conservative turbinectomy was performed in 60 percent of patients. Patients who failed surgery (<50 percent reduction in migraine headache index) had a significantly higher incidence of contact points (80 percent versus 56 percent; p = 0.034) than successful migraine patients. The surgery success group also had a higher incidence of preoperative middle concha bullosa compared with the failure group (71 percent versus 48 percent; p = 0.035). This is the first cohort study to identify the incidence and pattern of nasal pathology in migraine III patients. It is likely that the failure to achieve more successful outcomes in this patient population was the consequence of conservative nasal management and residual contact points because of concern for the development of nasal dryness. More frequent middle turbinate surgery may result in better clinical outcomes in this group of patients.

P.124 Meta-analysis comparing predictors of good postoperative seizure control in children with dysembryoplastic neuroepithelial tumors and gangliogliomas

Background: Dysembryoplastic neuroepithelial tumors (DNETs) and gangliogliomas are the most common cause of tumor-related seizures in children and adolescents. Little is known about predictors of surgical success, in terms of seizure freedom. All relevant papers since 1995 were identified. Methods: Over 4000 abstracts were screened on MedLine to identify data comparing tumor type (DNET vs. ganglioglioma) and predictors of post-operative seizure freedom. Results: Seventeen papers were identified encompassing 97 DNET and 95 ganglioglioma patients. Fifteen patients were found with other neuroglial tumors (NGT) or NGT not-otherwise-specified. DNET patients were found to have less frequent seizures, more likely to have second lobe involvement, and to achieve gross total resection. Seizure freedom was achieved in roughly 80% of patients, with no distinction by tumor type, with no surgery-related or peri-operative deaths. For DNETs, seizure freedom was associated with shorter seizure duration, simple lesionectomy, gross total resection, and shorter duration of follow-up. In ganglioglioma patients, seizure freedom was associated with younger age at surgery, secondary generalization (unexpectedly), absence of dysplasia, and gross total resection. Gross total resection was the strongest predictor. Conclusions: Epilepsy surgery for DNET and ganglioglioma had similar outcomes with gross total resection being the strongest predictor.

ENDOSCOPY-ASSISTED VITRECTOMY AND MEMBRANE DISSECTION OF ANTERIOR PROLIFERATIVE VITREORETINOPATHY FOR CHRONIC HYPOTONY AFTER PREVIOUS RETINAL DETACHMENT REPAIR.

To review 6-month outcomes for patients with hypotony secondary to anterior proliferative vitreoretinopathy after previous retinal detachment repair who were treated with endoscopic vitrectomy and anterior membrane dissection. Retrospective review. All individuals underwent endoscopic vitrectomy with removal of anterior proliferative vitreoretinopathy involving the ciliary body. Outcome measurements included intraocular pressure (IOP), visual acuity, and development of phthisis bulbi. Fifteen eyes of 15 patients had an average of 4.5 previous intraocular surgeries (range 1-8). Forty Percent of eyes had silicone oil at the time of endoscopic surgery. Six months postoperatively, 4 eyes had IOP >11 mmHg while 11 had IOP <6 mmHg. The nonresponder group was older in age, had more previous intraocular surgeries, and a lower preoperative IOP. There were no differences in visual acuity or the development of prephthisis at any point. No eyes underwent enucleation or evisceration. Endoscopy-assisted vitrectomy with removal of anterior proliferative vitreoretinopathy from the ciliary body is an effective treatment for chronic hypotony after previous retinal detachment repair in a minority of cases. The IOP improved in patients who tended to be younger and who had fewer previous intraocular surgeries. Further study is indicated to evaluate long-term outcomes and predictors of surgical success.

Outcomes of Mandibular Distraction Osteogenesis in the Treatment of Severe Micrognathia

Patients with severe micrognathia are predisposed to airway obstruction. Mandibular distraction osteogenesis (MDO) is an alternative to tracheotomy that lengthens the mandible in order to improve the retrolingual airway. This study presents outcomes from one of the largest cohorts reported. To assess the rate and predictors of surgical success and complications among (1) patients who underwent MDO prior to other airway procedures (MDO first), and (2) patients who required an initial tracheotomy and were subsequently treated with MDO (tracheotomy first). Retrospective cohort study at a tertiary care pediatric medical center of patients diagnosed as having micrognathia resulting in symptomatic airway obstruction (Pierre Robin sequence) and who underwent MDO from September 1995 to December 2009. Electronic medical records were reviewed. Multivariable regression analysis was used to assess for predictors of outcome. Rates of surgical success (defined as either tracheotomy avoidance or decannulation) and complications. Potential predictors included demographics, syndrome presence, follow-up time, and surgical history. A total of 123 patients (61 in MDO-first subgroup, 62 in tracheotomy-first subgroup) underwent MDO during the study period. Median age at time of distraction was 21 months (range, 7 days-24 years). Surgical success and complication rates were 83.6% and 14.8% in the MDO-first subgroup and 67.7% and 38.7% in the tracheotomy-first subgroup. Tracheotomy-first patients were more likely to have a syndromic diagnosis (66.0% vs 43.0%; P = .009) and were older at the time of MDO (median age, 30 months vs 5.1 months; P < .001). Poorer odds of success were associated with the need for 2 or more other airway procedures (odds ratio [OR], 0.14 [95% CI, 0.02-0.82]) in the MDO-first subgroup and craniofacial microsomia or Goldenhar syndrome (OR, 0.07 [95% CI, 0.009-0.52]) in the tracheotomy-first subgroup. Mandibular distraction osteogenesis has a high rate of success in avoiding tracheotomy. Patients who required a tracheotomy before MDO had a lower success rate in achieving decannulation and a higher rate of complications. However, these patients also had a higher rate of syndromic diagnoses and associated comorbidities. Patients with Goldenhar syndrome have a decreased likelihood of surgical success.