Subsequent Reimplantation Research Articles

Risk factors for severe hypocalcemia after total thyroidectomy

Background: Hypocalcemia is the most common complication after a total thyroidectomy. It may occur as biochemical hypocalcemia, or with mild or severe symptoms.Objectives: The aim of this study was to analyze the risk factors associated with the development of severe hypocalcemia after total thyroidectomy.Material and methods: Patients undergoing primary total thyroidectomy were included. The risk factors for the development of severe hypocalcemia (signs and symptoms requiring hospitalization and treatment with intravenous calcium or persistence of signs and symptoms after 48 hours of initial oral treatment) were analyzed. The evaluation included analysis of the demographic, clinical, surgical and histopathological variables.Results: Of 1665 thyroid resections performed between 2007 and 2018, 918 corresponded to primary total thyroidectomies; 203 (22%) of these patients developed hypocalcemia. Mild hypocalcemia occu- rred in 183 (20%) cases and sever hypocalcemia in 20 (2%) patients, The univariate analysis showed that a procedure performed by head and neck surgeons, thyroid gland weight > 30 g, resection of the parathyroid glands and thyroid cancer were associated with the development of severe hypocalcemia.On multivariate analysis, the last three variables were risk factors significantly associated with this complication.Conclusions: In our series, noticed or inadvertent resection of the parathyroid glands with subsequent reimplantation, high weight of the thyroid gland and malignancy were identified as risk factors for the development of severe hypocalcemia after total thyroidectomy. Therefore, we should pay special attention to the development of such complication in the postoperative period.

Extraction of infected cardiac implantable electronic devices and the need for subsequent re-implantation

BackgroundLittle is known about rates of re-implantation and outcomes of patients not implanted with a device after transvenous lead extraction (TLE) in cardiac device related infections (CDRI). MethodsAll patients with CDRI were included in a prospective registry. After TLE, the indication for re-implantation was evaluated according to the patients' history and most recent cardiac examinations. All patients were followed for complications and mortality. In addition, in patients discharged without device the frequency of device implantations was analyzed. ResultsAmong 302 patients, only 123 (40.7%) met the indication for implantation of the same cardiac implantable electronic device (CIED), 68 (22.5%) received a different device and 111 (36.8%) patients were discharged without CIED. Reimplanted patients were younger (70 ± 11 vs. 73 ± 13 years; p = 0.004), more often male (83 vs. 69%, p = 0.006), had less systemic infection (38 vs. 60%; p < 0.001) and a higher prevalence of complete heart block (28 vs. 7%, p < 0.001). Reasons against re-implantation were: loss of indication (45%), never met indication (27%), patients' preference (17%), persistent infection (8%) and advanced age (3%). During 26 ± 18 months of follow-up, mortality in both groups was similar after adjusting for cofactors (HR 0.79; 95% CI 0.49–1.29; p = 0.352). ConclusionMore than one third of patients undergoing TLE for CDRI in our study are not implanted with a new device. Careful evaluation of the initial CIED indication allows for detection of over treated patients and may avoid unnecessary device–related complications.

Autofluorescence imaging of parathyroid glands: An assessment of potential indications

BackgroundThe aim of this study was to determine both the accuracy of near infrared fluorescence imaging to detect parathyroid glands and the potential indications of near infrared fluorescence imaging in thyroid and parathyroid surgery by correlating the autofluorescence signature with the pathologic specimen. MethodsThis was an institutional review board-approved, prospective study of patients undergoing thyroidectomy and parathyroidectomy with near infrared fluorescence imaging. Each specimen sent to pathology was inspected with near infrared fluorescence imaging and predicted to be either parathyroid or non-parathyroid tissue by its autofluorescence signature and then correlated with the pathologic findings. ResultsAutofluorescence was demonstrated to be present in 98% of the parathyroid glands, with 23% identified correctly with infrared based on the autofluorescence signature before visual identification by the surgeon. There were 550 specimens that were imaged with autofluorescence and then sent to pathology. For these samples, sensitivity, specificity, and positive and negative predictive values to predict parathyroid tissue were 98.5%, 97.2%, 95.1%, and 99.1%. In 5% of the total thyroidectomy specimens, incidentally resected parathyroid glands were identified with autofluorescence, leading to their subsequent reimplantation. In patients with parathyroid disease and negative preoperative localization, 21% of abnormal glands were recognized with autofluorescence before visual identification by the surgeon. ConclusionAlthough the ability of infrared autofluorescence to confirm the presence of parathyroid tissue within surgical specimens was high, its power to find parathyroid glands in situ before visual recognition by surgeons was low. These advantages and limitations should be kept in mind when incorporating this technology into an endocrine surgical practice. Once a parathyroid seems to have been identified by the surgeon or tissue that looks like a parathyroid gland is identified, the autofluorescence signature is a very accurate assurance of parathyroid tissue.

Shaeer's Anti-Scarring Technique: A Preventive Measure Against Corporal Fibrosis Upon Explantation of Infected Penile Implants.

IntroductionIn cases of explantation and delayed reimplantation of an infected penile prosthesis, the scarring that afflicts the corporal bodies renders reimplantation difficult and risky, with potential loss in penile size.AimMitomycin C is an antitumor, antibiotic agent with a potent antifibrotic action that can be used to limit corporal scarring following explantation with the aim of achieving easy and safe subsequent reimplantation, in addition to preserving penile size.MethodsThis was a prospective study involving 5 patients with infected penile prostheses who were referred to our tertiary implantation center. The infected prostheses were explanted, followed by corporal washout with antiseptics and antibiotics. Patients were rescrubbed and redraped. Mitomycin C, 10 mg in 250 cc saline, was instilled into the corpora cavernosa (125 cc each), avoiding extracavernous spilling and contact with corporotomy and skin edges. Corporotomy and skin edges were freshened and closed. Reimplantation was performed 10 to 12 weeks later.Main Outcome MeasureWe evaluated the ease of blunt dilatation upon reimplantation and success in implanting cylinders the same size as the ones explanted.ResultsWe were able to dilate the corporal bodies with ease in all cases using blunt Hegar dilators. All cases received the same size implant as the one explanted, in terms of length and girth, with the exception of a case where the length was only 1 cm shorter.ConclusionsIrrigation of the cavernous spaces with mitomycin C upon explantation of an infected penile prosthesis appears to ameliorate corporal scarring and keep the cavernous spaces open. On a larger scale, this approach could render the most feared complication of penile prosthesis implantation surgery much more manageable.Shaeer O, Abdel Rahman IFS, Shaeer K. Shaeer’s Anti-Scarring Technique: A Preventive Measure Against Corporal Fibrosis Upon Explantation of Infected Penile Implants. Sex Med 2019; 7:357–360.

Lead extraction for reduction of chronic pain related to cardiovascular implantable electronic device.

Chronic pain at the cardiovascular implantable electronic device (CIED) generator or lead insertion site that is not otherwise manageable carries a IIA indication for extraction. However, limited data exist evaluating causes of pain and outcomes of extraction in eliminating pain. A multi-centre retrospective observational study was conducted to evaluate outcomes of patients undergoing device extraction for treatment of chronic device pain. Twenty-seven out of 2188 lead extraction candidates (1.3%) met the chronic pain IIA indication for extraction [50 ± 16 years; 14 (51%) women]. Onset, severity, triggers, and pain management were measured before and after extraction. Device type, procedure done (with/without reimplantation), and positive tissue cultures were noted. Pain was reported as constant (n = 14; 50%), intermittent (n = 13; 46%), and movement-triggered (n = 14; 50%). Average severity of pain was seven out of 10 (10 being the worst). Post-extraction, 18 (66%) received freedom from pain, including all patients with poorly formed pockets (n = 2) and subclinical infections (n = 2). Of the 18, 11 underwent reimplantation (61%) without recurrent pain. Nine still had pain (44 ± 17 years; seven women) after extraction. Eight of the nine underwent reimplantation, three on the contralateral chest wall and five ipsilaterally. Pain severity decreased (n = 5), increased (n = 1), or was unchanged (n = 3). Chronic pain at the CIED generator site can present as chronic or movement-triggered pain, and can be due to subclinical infection or a poorly formed device pocket. Extraction relieved constant and intermittent pain in two-thirds of patients. Extraction appears less successful in eliminating pain in women who undergo subsequent reimplantation.

Retrievable hydrogels for ovarian follicle transplantation and oocyte collection.

Cancer survivorship rates have drastically increased due to improved efficacy of oncologic treatments. Consequently, clinical concerns have shifted from solely focusing on survival to quality of life, with fertility preservation as an important consideration. Among fertility preservation strategies for female patients, ovarian tissue cryopreservation and subsequent reimplantation has been the only clinical option available to cancer survivors with cryopreserved tissue. However, follicle atresia after transplantation and risk of reintroducing malignant cells have prevented this procedure from becoming widely adopted in clinics. Herein, we investigated the encapsulation of ovarian follicles in alginate hydrogels that isolate the graft from the host, yet allows for maturation after transplantation at a heterotopic (i.e., subcutaneous) site, a process we termed in vivo follicle maturation. Survival of multiple follicle populations was confirmed via histology, with the notable development of the antral follicles. Collected oocytes (63%) exhibited polar body extrusion and were fertilized by intracytoplasmic sperm injection and standard in vitro fertilization procedures. Successfully fertilized oocytes developed to the pronucleus (14%), two-cell (36%), and four-cell (7%) stages. Furthermore, ovarian follicles cotransplanted with metastatic breast cancer cells within the hydrogels allowed for retrieval of the follicles, and no mice developed tumors after removal of the implant, confirming that the hydrogel prevented seeding of disease within the host. Collectively, these findings demonstrate a viable option for safe use of potentially cancer-laden ovarian donor tissue for in vivo follicle maturation within a retrievable hydrogel and subsequent oocyte collection. Ultimately, this technology may provide novel options to preserve fertility for young female patients withcancer.

Characterization of Outcomes of 2-Stage Exchange Arthroplasty in the Treatment of Prosthetic Joint Infections

BackgroundTwo-stage revision is the preferred treatment for prosthetic hip and knee infections in the United States. Recent studies have questioned the true success rate of this treatment. The purpose of this study is to investigate outcomes of prosthetic hip and knee infections undergoing resection arthroplasty and spacer insertion at a single institution. MethodsWe identified 103 patients who underwent prosthesis resection and spacer placement for infection over a 10-year period. Twenty-three cases were excluded based on preset exclusion criteria leaving 80 cases (56 knees, 24 hips). A retrospective review was performed to examine the outcomes of these patients. ResultsFollowing spacer placement but before reimplantation, 9 (11.25%) of the 80 joints underwent repeat debridement and spacer exchange for persistent infection. Twenty-four (30.00%) patients had a serious complication during their treatment course. Fourteen (17.50%) patients never underwent reimplantation. Of these, 10 continued with spacer retention, 2 had resection arthroplasty, and 1 each had an amputation and an arthrodesis. Of the 66 patients with successful reimplantation, 48 (72.70%) remained infection free at most recent follow-up. ConclusionsTwo-stage revision does not result in the high rates of cure reported previously, when taking into account the substantial number of patients who never undergo the subsequent reimplantation surgery. Of those who underwent reimplantation in our study, many required additional spacer exchange or had complications. Surgeons and patients should consider these outcomes when discussing the treatment of prosthetic hip and knee infections.

Criopreserved ovarian tissue transplantation and bone restoration metabolism in castrated rats.

to evaluate estradiol levels and autotransplantation heated ovarian tissue effects, after vitrification, on rats bone metabolism previously oophorectomized bilaterally. experimental study with 27 rats aged 11 to 12 weeks and weighing 200g to 300g, submitted to bilateral oophorectomy and ovarian tissue cryopreservation for subsequent reimplantation. Animals were divided into two groups, A and B, with 8 and 19 rats, respectively. Autotransplantation occurred in two periods according to castration time: after one week, in group A, and after one month in group B. Serum estradiol measurements and ovary and tibia histological analysis were performed before and after oophorectomy period (early or late) and one month after reimplantation. in groups A and B, tibia median cortical thickness was 0.463±0.14mm (mean±SD) at the baseline, 0.360±0.14mm after oophorectomy and 0.445±0.17mm one month after reimplantation p<0.005). Trabecular means were 0.050±0.08mm (mean±SD) at baseline, 0.022±0.08mm after oophorectomy and 0.049±0.032mm one month after replantation (p<0.005). There was no statistical difference in estradiol variation between the two study groups (p=0.819). cryopreserved ovarian tissue transplantation restored bone parameters, and these results suggest that ovarian reimplantation in women may have the same beneficial effects on bone metabolism.

Traumas caused by orthodontic treatment: A retrospective review

Even though orthodontic treatment is indispensable for nearly 16-20% of the whole world population with functional efficiency, structural balance and aesthetic harmony as its main advantages and rationale, the treatment particularly with a range of removable, fixed, functional and extraoralorthopaedic appliances can cause various deleterious hard tissue and soft tissue injuries in particular, intraorally. These intraoral and extra oral hard and soft tissue injuries can be iatrogenic, self-induced, caused by bad patient compliance or just by accidents intervened by the patient while wearing the appliance. These traumas/injuries are not uncommon since an orthodontic treatment are mainly done with stainless steel [metal] and the treatment usually continues for a long period of time ranging from 6- 36 months in themajority of the cases. The high pervasiveness of individuals with dental trauma preceding to orthodontic treatment justify the safety measures that should be followed before and during treatment while bearing in mind all the possible effects of orthodontic movement on traumatized teeth. Among the major traumatic dental injuries, avulsion with subsequent tooth reimplantation entails a higher than average risk of complications, such as pulp necrosis, root resorption,and ankyloses. Therefore, it gives orthodontists numerous reasons for apprehension during orthodontic treatment.

Transient Multiple Removal and Subsequent Reimplantation of Abdominal and Retroperitoneal Organs with Multisystemic Neoplastic Lesions

The aim of the study was to develop simple, minimally invasive method of transient multiple removal and subsequent reimplantation of abdominal and retroperitoneal organs with multisystemic neoplastic lesions, allowing subsequent reimplantation of the organ block after extracorporeal surgery. Material and Methods. Ten human cadavers of subjects who died of causes unrelated to pathology of the abdominal organs were used in this study. The anatomical experiment involved transient multiple removal of the abdominal and retroperitoneal organs with multisystemic neoplastic lesions and their subsequent reimplantation. Surgery was performed using the method developed at the Department of Operative Surgery and Topographic Anatomy of I.M. Sechenov First Moscow State Medical University (Patent RU 2601100). Results. The proposed method showed several advantages: consistency of cold perfusion in deep hypothermia of the patient,hypothermic circulatory arrest of the abdominal organs (up to 4–6 h); feasibility of insertion and subsequent removal of arterial and venous shunts, reimplantation of the abdominal organs; restoration of arterial and venous blood flow in the patient (cadaver) and preserved integrity of the transected anatomical structures. Conclusion. The proposed method of transient multiple removal and subsequent reimplantation of the abdominal and retroperitoneal organs with multisystemic neoplastic lesions provides sustained viability of the organs and can be recommended as a suitable model for further application in clinical practice.

EVALUATION OF VITRECTOMY AND REIMPLANTATION FOLLOWING LATE DISLOCATION OF THE INTRAOCULAR LENS-CAPSULAR BAG COMPLEX: A 3-Year Follow-up Study.

To study the predisposition factors for dislocation of the intraocular lens (IOL)-capsular bag complex and analyze the results of subsequent reimplantation surgery. The exclusion criteria were complicated cataract surgery and minor dislocations that appeared in the first year after cataract surgery. Thirty-six months of monitoring of the reimplantation surgery was required. The primary measurements of results were factors concerning dislocation, the interval between cataract surgery and dislocation, and postoperative complications. Thirty-six patients with dislocation of the capsular bag and lens were identified. Pseudoexfoliation was mentioned in 17 cases (47.2%) and was the main predisposition factor. The average interval between cataract surgery and dislocation was 11.5 years. The dislocated IOL was replaced by a posterior chamber implant in 38% of cases and an anterior chamber implant in 62%. The average best-corrected visual acuity improved significantly after the reposition surgery (P < 0.01). The average monitoring period after secondary reimplantation was 5.95 years (min. 3.03-max. 8.46). Three patients developed bullous keratopathy, all of them with an anterior chamber IOL implantation. According to our knowledge, this article is the one with the longest monitoring time to date. Pseudoexfoliation was the main risk factor for the dislocation of the IOL. Surgery significantly improved best-corrected visual acuity, and the reimplantation of the IOL in the posterior chamber was associated with less serious complications.

Cost of Deep Brain Stimulation Infection Resulting in Explantation

Background: Deep brain stimulation (DBS) hardware infection is a serious complication, often resulting in multiple hardware salvage attempts, hospitalizations, and long-term antibiotic therapy. Objectives: We aimed to quantify the costs of DBS hardware-related infections in patients undergoing eventual device explantation. Methods: Of 362 patients who underwent 530 electrode placements (1 January 2010 to 30 December 2014), 16 (4.4%) had at least 2 hardware salvage procedures. Most (n = 15 [93.8%]) required complete explantation due to recurrent infection. Financial data (itemized hospital and physician costs) were available for 13 patients and these were analyzed along with the demographic data. Results: Each patient underwent 1-5 salvage procedures (mean 2.5 ± 1.4; median 2). The mean total cost for a patient undergoing the median number of revisions (n = 2), device explantation, and subsequent reimplantation after infection clearance was USD 75,505; just over half this cost (54.2% [USD 40,960]) was attributable to reimplantation, and nearly one-third (28.9% [USD 21,816]) was attributable to hardware salvage procedures. Operating-room costs were the highest cost category for hardware revision and explantation. Medical and surgical supplies accounted for the highest reimplantation cost. Conclusions: DBS infection incurs significant health care costs associated with hardware salvage attempts, explantation, and reimplantation. The highest cost categories are operating-room services and medical and surgical supplies.

Microflora of Retained Intracochlear Electrodes from Infected Cochlear Implants.

Objectives Cochlear implant infections may be refractory to medical management and require device removal with subsequent reimplantation. During device removal, the intracochlear electrode array is commonly left in place to prevent obliteration of the cochlear lumen. If the electrode is colonized with pathogens, this risks contaminating the replacement implant. In this study, we compare the microorganisms detected on infected cochlear implants against those on the retained electrode using culture and microbial gene-sequencing techniques. Study Design Prospective single-cohort study. Setting Tertiary medical center. Subjects and Methods Six patients with refractory cochlear implant infections had the receiver-stimulator and extracochlear electrode removed to facilitate treatment of the infection. The intracochlear electrode was removed at (delayed) reimplantation. Implant specimens were analyzed by microbial culture and 16S DNA gene sequencing. Results Staphylococcus aureus was the organism most commonly identified. None of the 6 patients' intracochlear electrodes yielded microbes by culture. Two intracochlear electrodes revealed bacterial species, and 1 revealed fungal species by gene sequencing. There was no correlation between the microbes on the infected extracochlear implants and the retained intracochlear electrodes. All subjects underwent reimplantation after resolution of their infections. One of 6 subjects developed a second infection after reimplantation, with S aureus in the primary and secondary infections. Conclusions The intracochlear electrodes of infected cochlear implants carry a low microbial burden. Preserving intracochlear electrodes upon removal of infected cochlear implants appears to carry a low risk of contaminating a replacement cochlear implant.

Mandibular Condyle Reimplantation and Free Bone Grafting: Considerations to Increase Its Efficacy.

Mandibulectomy and disarticulation, resection of the lesion, and subsequent reimplantation of the condyle is a method to manage benign mandibular intraosseous lesions, involving the ramus but not extending to the mandibular condyle. This article presents some considerations to increase the efficacy of this method. Archived files of the patients that this method had been used for mandibular reconstruction were reevaluated. Patients were recalled and favorable and unfavorable results in reconstruction of the mandible with this technique were evaluated. Intact large segment of the condyle is necessary for success of this procedure. Inferior alveolar nerve anastomosis, coronoidectomy, concomitant free bone grafting with adequate width, and attention to the intraoral soft tissue incision design will decrease unfavorable outcomes.

Synovial Cytokines and the MSIS Criteria Are Not Useful for Determining Infection Resolution After Periprosthetic Joint Infection Explantation.

Diagnosing periprosthetic joint infection (PJI) requires a combination of clinical and laboratory parameters, which may be expensive and difficult to interpret. Synovial fluid cytokines have been shown to accurately differentiate septic from aseptic failed total knee (TKA) and hip (THA) arthroplasties. However, after first-stage explantation, there is still no reliable test to rule out PJI before a second-stage reimplantation procedure. (1) Which synovial fluid cytokines have the highest diagnostic accuracy for PJI? (2) Which cytokine shows the greatest decrease associated with the resolution of infection in the same patient between explantation and subsequent reimplantation of an infected arthroplasty? (3) What is the accuracy of synovial fluid cytokines and the Musculoskeletal Infection Society (MSIS) criteria to rule out PJI after first-stage explantation? (4) What are the most studied synovial fluid cytokines for diagnosing PJI as reported in the literature and what are their cumulative diagnostic accuracy? Between May 2013 and March 2014, 104 patients with painful THA and TKA evaluated for possible PJI were included in our study. Of these, 90 (87%) had cytokine levels measured from synovial fluid samples collected as part of this prospective study (n = 33 hips, n = 57 knees). A second group of 35 patients (n = 36 samples) who presented during the same time period with an antibiotic spacer also had synovial cytokines measured before second-stage reimplantation. For the first group of 90 patients, the MSIS definition classified each joint at the time of surgery as infected (n = 31) or not infected (n = 59) and was used as the standard to test the accuracy in diagnosing PJI. Of the 35 patients with synovial marker data before second-stage surgery, 15 patients had cytokine measurements both at explantation and reimplantation and were used to quantify the change between stages. The reimplantation group had a minimum 1-year followup (with four [11%] patients lost to followup) and was classified into successful or failed treatment based on Delphi-based consensus data and was used to test the accuracy in detecting infection resolution at reimplantation. Interleukin (IL)-1β and interferon-γ demonstrated the highest diagnostic utility (area under the curve 0.92, 0.91, respectively); IL-1β and IL-6 had the highest sensitivities (0.90 [95% confidence interval {CI}, 0.74-0.98] and 0.81 [0.63-0.93]). As a measure of infection resolution, IL-1β had the greatest decrease (12.4-fold; level at explantation: 232.4 [range, 23.1-1545.7]; level at reimplantation: 18.8 (range 1.2-298.9); mean difference: 325.5 [95% CI, 65.0-596.0]; p = 0.0001), and IL-6 had a nearly similar decrease (11.2-fold; level at explantation: 228.1 [range, 10,158.4-182,725.0]; level at reimplantation: 2518.2 [range, 10.4-41,319.3]; mean difference: 33,176.0 [95% CI, 7543.6-58,808.3]; p < 0.0001). Cytokines and MSIS criteria had low sensitivity to rule out infection in a joint treated for PJI. IL-6 and IL-1β demonstrated high sensitivities to diagnose PJI and showed the greatest decrease between first and second stages, which may potentially be used to monitor treatment response to PJI. However, cytokines and MSIS criteria had low sensitivity to rule out infection before reimplantation. Level III, diagnostic study.

Experimental substantiation of platelet enriched plasma application for stimulation of cartilage autografts regeneration

The objective of this work was to study the influence of platelet enriched plasma on regeneration of cartilage tissue after its mechanical destruction using morphological methods. In the process of study, withdrawal and fragmentation of cartilage tissue sections of both ear conches of rabbits was performed with subsequent reimplantation of the crushed cartilage tissue to the same place in the left ear and crushed cartilage tissue mixed with platelet­enriched plasma obtained from the blood of the same laboratory animal - to the right auricle. After that a cut was made and the peculiarities of regeneration of the cartilage on the 10th, 20th days and after 1, 2 and 3 months after surgery were studied. After that the platelet enriched plasma was injected in the defect site on the right ear conch once a week. The study revealed that in the experimental group in terms of platelet enriched plasma application, regeneration of cartilage tissue occurred more adequately in comparison with the control group, and was accompanied by the acceleration of healing processes, which was expressed in activation of fibroblastic and chondroblastic of programed differentiation.

Combination of Neuroendoscopic and Stereotactic Procedures for Total Resection of Colloid Cysts with Favorable Neurological and Cognitive Outcomes

Despite a wide range of surgical procedures, an unresolved debate remains regarding which attempt is optimal for the treatment of colloid cysts in the third ventricle. In this article, we present a new combination of stereotactic and endoscopic techniques. This prospective study includes 27 consecutive patients with symptomatic primary and recurrent colloid cysts. All cysts were removed via a neuroendoscope through a rostral transfrontal, transforaminal approach. The endoscope was supported by an additional cannula fixed in the stereotactic frame. Both tools were inserted into one lateral ventricle through two separate burr holes using stereotactic guidance. The median operating time was 135 minutes. All cysts were removed completely, and no mortality or permanent complications related to surgery occurred. The mean time of observation was 43.5 months (range, 3-78 months), and no clinical or radiologic recurrences were observed. One patient with a history of an infected ventriculoperitoneal shunt did not improve after cyst removal, but improved after subsequent reimplantation of the shunt. In all other cases, symptoms resolved (67%) or decreased (30%). Cognitive functions improved or remained unchanged in all 10 elective cases examined neuropsychologically before and after surgery. The techniques we describe for removal of colloid cysts are safe and effective, even for recurrent cases, and they provide 100% total resection, favorable cognitive outcomes, low risk of recurrence, and low risk of morbidity. The disadvantages of this method are a longer time for surgery and the need for more complex instrumentation compared with conventional endoscopic resection.

Negative effect of deep cochlear implant electrode insertion on speech perception.

This case study details the evaluation, explantation, and subsequent reimplantation of a cochlear implant (CI) recipient with an unusually deep electrode array insertion. Although the positive value of sufficiently deep insertion and the effect of insertion variability have been researched, there are few data available that illustrate the detrimental effects on speech recognition when deep insertion corrupts optimal use of the CI. This unique case report challenges the assumption that deeper insertion will result in improved speech understanding and demonstrates the importance of fully evaluating recipients' complaints and recognizing the impact of frequency-to-place mismatch.

What You See Is What You Get: Lead Location Within Deep Brain Structures Is Accurately Depicted by Stereotactic Magnetic Resonance Imaging.

Magnetic resonance imaging (MRI)-verified deep brain stimulation relies on the correct interpretation of stereotactic imaging documenting lead location in relation to visible anatomic target. However, it has been suggested that local signal distortion from the lead itself renders its depiction on MRI unreliable. To compare lead location on stereotactic MRI with subsequent location of its brain track after removal. Patients underwent deep brain stimulation with the use of MRI-guided and MRI-verified Leksell frame approach. Infection or suboptimal efficacy required lead removal and subsequent reimplantation by using the same technique. Postimplantation stereotactic MR images were analyzed. Lateral (x) and anteroposterior (y) distances from midcommissural point to center of the lead hypointensity were recorded at the anterior commissure-posterior commissure plane (pallidal electrode) or z = -4 (subthalamic electrode). Stereotactic MRI before the second procedure, x and y distances from the center of the visible lead track hypointensity to midcommissural point were independently recorded. Vectorial distance from center of the lead hypointensity to the center of its track was calculated. Sixteen electrode tracks were studied in 10 patients. Mean differences between lead artifact location and lead track location were: x coordinate 0.4 mm ± 0.2; y coordinate 0.6 mm ± 0.3. Mean vectorial distance was 0.7 mm ± 0.2. Stereotactic distance between lead location and subsequent brain track location on MRI was small. The mean discrepancy was approximately half the deep brain stimulation lead width. This suggests that lead hypointensity seen on postimplantation MRI is indeed an accurate representation of its real location within deep brain structures.

PTU-165 Outcomes of re-implantation of sacral neurostimulation for faecal incon-tinence are similar to those of first time implants

Introduction There is a paucity of data related to the outcome of sacral neurostimulation (SNS) device re-implantation for faecal incontinence (FI). This study aimed to determine the outcomes of re-implantation of SNS for FI. Method An IRB approved retrospective review of prospectively collected data of patients with FI receiving SNS was performed. Demographic variables, co-morbidities, operative details, reportable events, and functional outcomes were analysed. Continuous variables were assessed for Gaussian distribution. Non-parametric variables were compared with the Mann-Whitney test, and normally distributed variables were compared with an independent samples t-test. In assessing the role of each intervention in decreasing FI score (FIS) comparatively, an analysis of covariance was performed (ANCOVA). Results 115 patients (mean age 58.5 ± 15 years, 98 females) had implantation of SNS device from 2010–2014. 13% (15/115) underwent lead re-implantation. Implanted and re-implanted groups had similar demographics, co-morbidities, complication, and explantation rates. Operative time was significantly higher in the re-implanted group (first implanted 56.7 ± 17 min; re-implanted 70.1 ± 33 min; p = 0.01). Most common reason for re-implantation was lead-related in 33% (5/15). Loss of efficacy was identified in 20% (3/15) as was lack of efficacy 20% (3/15). Infection was observed in 20% (3/15) of patients, all of whom failed antibiotic therapy and were explanted. A significant decrease in FIS was seen in patients with a first time implantation (median FIS 16 to 7; p Conclusion Reimplantation of SNS is feasible and has similar outcomes as first time implantation. Failure and explantation of SNS should not preclude subsequent reimplantation. Disclosure of interest None Declared.