Surgical Case Series Research Articles

Outcomes of sutureless secondary intraocular lens fixation with haptic flanging in a cohort of surgically complex eyes.

To describe clinical outcomes of secondary intraocular lens (IOL) implantation using sutureless trans-scleral techniques in surgically complex eyes. Retrospective surgical case series of 45 eyes that underwent secondary IOL implantation using a sutureless haptic flange technique. Demographic data of age, sex, primary diagnosis, best-corrected visual acuity (BCVA), refractive error, intraocular pressure, full ophthalmic exam findings, surgical approach, and any intraoperative complications were noted. The most common indication for secondary IOL implantation was aphakia, most commonly after ocular trauma. The primary outcome measures were pre-operative and post-operative BCVA, which revealed recovery of pre-operative vision levels by post-operative week 1 and improved vision by post-operative month 1 (p = 0.03). Secondary outcome measures of target refraction pre-operatively and post-operatively revealed significant reduction in post-operative spherical equivalent to achieve BCVA (p < 0.001). Targeting of the secondary IOLs using Barrett Universal II, Holladay 1, Holladay 2, and SRK/T all exhibited a hyperopic shift post-operatively in post-traumatic aphakic eyes and a myopic shift in the post complicated cataract extraction eyes. No intraoperative adverse events were noted. The most common post-operative complication was transient IOP elevation, with most patients completing 6 months of follow-up. There is rapid visual rehabilitation and reduction of spherical equivalent correction to attain BCVA in eyes with a history of ocular trauma that undergo secondary IOL implantation using a trans-scleral flange technique. Moreover, this study highlights that a specific IOL power formula can be more predictive of the desired refractive outcome depending on the indication for secondary IOL implantation.

Dual mini-fragment plate fixation for Neer type-II and -V distal clavicle fractures.

Contemporary methods for open reduction and internal fixation of displaced distal clavicle fractures have excellent rates of union and high rates of reoperation for symptomatic implant removal. The authors describe their preferred surgical technique and case series of patients with Neer Type-II and -V distal clavicle fractures treated with lower profile dual mini-fragment plates using interdigitating screws placed into the distal segment to enhance fixation.

Percutaneous Plate Osteosynthesis of Ulnar Shaft Fractures: A Surgical Technique and Case Series.

Treatment of ulnar diaphyseal fractures can range broadly from nonoperative with immobilization to surgical intervention with a variety of implants or approaches. At a Level 1 trauma center, a series of ulnar shaft fractures have been treated using a percutaneous plating technique that is base beneath the extensor carpi ulnaris. This technique description illustrates relevant anatomy, important patient and injury characteristics, implant considerations, and potential outcomes and complications. The described treatment option provides an effective way of spanning comminuted fracture patterns without disrupting the surrounding biology while providing stable fixation. An associated patient series is included which enumerates associated injuries and describes limited follow-up. In the multiply injured trauma patient, such a fixation method also had potential benefits for their overall care and rehabilitation.

Reloadable Stapler Use during Peripartum Hysterectomy for Placenta Accreta Spectrum: A Novel Surgical Technique and Case Series.

This study aimed to describe a novel surgical technique for the management of antenatally suspected placenta accreta spectrum (PAS). This is a retrospective, case series of patients with suspected PAS undergoing peripartum hysterectomy with a reloadable articulating stapler at a tertiary care center. Eighteen patients with antenatally suspected PAS were identified and underwent peripartum hysterectomy with the aid of a reloadable stapler. Mean gestational age at delivery was 344/7 ± 11/7 weeks. Mean total operative time (skin-to-skin) was 117.3 ± 39.3 minutes, and 79.8 ± 19.8 minutes for the hysterectomy. Mean blood loss for the entire case was 1,809 ± 868 mL. Mean blood loss for the hysterectomy was 431 ± 421 mL. Mean units of intraoperative red blood cells transfused was 3 ± 1 units. Mean units of postoperative red blood cells transfused was 1 ± 0.5 units. Five cases were complicated by urological injury (two intentional cystotomies). Four patients were admitted to the intensive care unit (ICU) for a mean of ≤24 hours. Mean postoperative LOS was 4.11 ± 1.45 days. Three patients had final pathology that did not demonstrate PAS while four were consistent with accreta, six increta, and five percreta. Use of a reloadable articulating stapler device as part of the surgical management of antenatally suspected PAS results in a shorter operative time (117 ± 39 minutes vs. 140-254 minutes previously reported), lower average blood loss (1,809 ± 868 mL vs. 2,500-5,000 mL previously reported) and shorter LOS (4.11 ± 1.45 days vs. 9.8 ± 13.5 days previously reported) compared with traditional cesarean hysterectomy. The reloadable stapling device offers an advantage of more rapidly achieving hemostasis in the surgical management of PAS. · PAS is associated with severe maternal morbidity.. · Decreased operative time and blood loss have many clinical benefits.. · Reloadable stapler use for PAS decreases operative time.. · Reloadable stapler use for PAS decreases operative blood loss..

The lateral supramalleolar flap as solution for lower leg, ankle and foot defects: a surgical case series

Introduction. One of the most challenging regions of the body to cover is the lower part of the leg, the ankle, and the foot, especially with the exposure of bones or tendons. Many options for covering soft tissue defects in this area have been proposed. This article describes the lateral supramalleolar flap, which is used for the reconstruction of defects of the lower leg, ankle, heel, and foot. This flap is a surgical technique to salvage the lower extremity due to its large skin paddle and a wide rotation arc. In this case series, patients with lower leg and ankle defects requiring flaps had the lateral supramalleolar flaps performed. This article discusses the overview, technique, and outcomes.Methods. These flaps were performed under spinal anesthesia and tourniquet control. The upper limit of the flap was about 8 cm from the popliteal crease, and the lower border was 5 cm from the axis of the ankle joint. The lateral extent of the flap was up to the fibula, contrary to mid-calf. The flap was harvested in the sub-facial plane, and the donor site was grafted.Results. The Flap was generally easy to raise and secure in place at the donor site. Partial necrosis of the flap was reported in one case. The overall donor site morbidity was minimal.Conclusion. The lateral supramalleolar flap is a reliable and useful flap for coverage of the lower third of the leg, ankle, and dorsal foot defects. It is a viable option available to the reconstructive surgeon, especially with the exposure of bones or tendons.Â

Osteomyelitis-Discitis at the Thoracolumbar Junction and the Development of Postinfectious Spinal Deformity: A Surgical Case Series

Progressive spinal deformity and neural compromise are the main indications for surgical management of vertebral osteomyelitis-discitis. However, when such pathology presents at the thoracolumbar (TL) junction, it remains unclear what the appropriate intervention is. The therapeutic dilemmas of decompression with or without instrumented fusion, the need for circumferential decompression and reconstruction, as well as the prognostic factors for progression of kyphosis, all remained ill-defined in the literature. The objective of this study is to evaluate risk factors for instrumentation at TL junction in spinal osteomyelitis-discitis. A review of patients at a single center with osteomyelitis-discitis at the TL junction between 2014 and 2018 was performed. Patients were 18 years or older with infectious pathologies at T10 to L2. Sixteen patients were included. Indication for instrumentation included progression of kyphosis following prior laminectomy/medical management. Of the 16 patients, 4 patients received laminectomy at initial treatment versus 12 patients receiving medical management alone. All 4 patients receiving laminectomy experienced progressive kyphosis requiring revision with instrumented fusion versus only 4 of 12 of the medically managed. Laminectomy, epidural compression, and vertebral body collapse were significant risk factors for kyphosis progression requiring instrumentation. The average time to surgical intervention for the indication of progressive kyphosis was 2.6 months after prior laminectomy and 6 months after initiation of medical management. Given the proclivity for kyphotic deformity at the TL junction, patients may benefit from long segment instrumentation in addition to decompression at the initial surgery. Laminectomy alone may hasten kyphosis progression.

Blount's disease - an up-to-date insight with contemporary treatment guidelines deduced from critical analysis of a large 146 surgical case series.

To elucidate an up-to-date insight and derive clear treatment guidelines for Blount's disease deduced from critical analysis of 146 surgical case series. Cases were presented and analyzed separately under its two basic clinical groups and the author further derived four subcategories under each of these two groups; the first basic group was the early onset clinical variant; infantile tibia vara (ITV) included 56 cases. The second group was the late onset clinical variant; late onset tibia vara (LOTV) included 90 cases. Different operative procedures used for treatment of these cases were proximal tibial osteotomy (PTO), temporary eight-plate proximal lateral tibial hemiepiphyseodesis (PLTH), or medial plateau elevation either on a monomodal or multimodal line of treatment. After a mean follow-up period of ~5 (2-12) years, the results were critically analyzed using case series descriptive analysis. In ITV variant, both PTO and temporary eight-plate PLTH monomodal line of treatment gave satisfactory results for de-novo (stages I, II, and III) subcategory while multimodal line of treatment was needed for achieving satisfactory results for neglected (stages IV, V, and VI) and relapsed subcategories. For LOTV variant, PTO monomodal line of treatment gave satisfactory results when applied for treatment of its de-novo subcategory. The derived treatment guidelines for Blount's disease can be of value for recruiting the most suitable treatment modality for each case entity of the disease, leading to satisfactory outcome with prevention of recurrence.

Surgical Technique and Case Series of Total Hip Arthroplasty with the Hueter Anterior Approach for Crowe Type-IV Dysplasia.

Total hip arthroplasty (THA) is being increasingly performed via the Hueter anterior approach (HAA), which has proven benefits with nondysplastic hips; however, little has been published on its outcomes with dysplastic hips, where it can provide better acetabular exposure. We describe our technique for THA via the HAA in hips with Crowe type-IV developmental dysplasia and report the mid-term outcomes of cases that were performed over 5 consecutive years. We retrospectively evaluated a continuous series of 8 hips (6 patients) with Crowe type-IV dysplasia; the patient ages ranged from 44 ± 20 years (range, 17 to 65 years) at the index THA. All of the patients received uncemented implants via the HAA on a traction table to restore the hip center of rotation to the true acetabulum. Femoral head autografts (FHAs) were used to increase acetabular coverage in 6 hips, and subtrochanteric shortening osteotomies (SSOs) were performed in 5 hips. Patients were assessed clinically and radiographically at a minimum follow-up of 2 years. There were no revisions, deaths, dislocations, or infections. Two hips (25%) had intraoperative complications, and 1 hip (13%) had a postoperative complication that required reoperation without implant removal. All of the hips were assessed clinically and radiographically at 4 ± 1 years (range, 2 to 6 years). The modified Harris hip score (mHHS) improved from 33 ± 7 to 90 ± 7, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) improved from 53 ± 14 to 89 ± 6; the postoperative leg-length discrepancy was 3.2 mm (range, -10 to 20 mm). None of the hips had osteolysis or radiolucent lines of >2 mm. THA via the HAA on a traction table for hips with Crowe type-IV dysplasia yielded satisfactory mid-term outcomes. Both FHA and SSO can be adequately performed via the HAA to help restore the hip center of rotation to the true acetabulum. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Chest Wall Resection for Sarcoma: A Surgical Technique and Case Series

Chest wall resection for sarcoma can present a surgical challenge. The unique concerns of the chest wall, including a confluence of anatomic and physiologic systems, may require a multispecialty surgical team to address the necessities of achieving a wide sarcoma resection. We present our experience with chest wall resection and reconstruction for sarcoma, including the surgical technique and a case series.

SUN-187 A Case of Adrenal Mass with Elevated ACTH and Cortisol in a Woman with No Cushingoid Features

BackgroundAdrenal incidentalomas can present with subclinical Cushing’s Syndrome (SCS), which is defined as elevated cortisol levels without overt clinical signs or symptoms. Inaccuracies in ACTH levels due to issues with the assay and non-classic presentation of Cushing’s Syndrome (CS) can delay appropriate diagnosis and timely intervention.Clinical CaseA 50-year-old female with a history of an incidentally discovered 3.4 x 1.8 cm adrenal mass was referred for evaluation of hypercortisolism (midnight salivary cortisol 0.17 μg/dL, normal < 0.09 μg/dL) with lack of suppression of both ACTH (19 pg/mL, normal 6-50 pg/mL) and cortisol (13.1 μg/dL, normal 6.0-18.4 μg/dL) on overnight 1-mg dexamethasone suppression test (DST). Pheochromocytoma work up was negative.Her medical history was remarkable for premature ovarian failure at age 40 and osteoporosis at age 48 (Lumbar spine T-score -3.6, Femoral neck T-score -3.7, Hip T-score -2.7).She denied alcohol abuse and depression screening was negative. She reported high levels of stress and insomnia. She denied muscle weakness, acne, or change to body habitus. Fasting blood glucose was intermittently as high as 212 mg/dl but HbA1c was 5.5%. She did not have a history of hypertension or glucocorticoid use. Her BMI was 20 kg/m2 and she did not appear Cushingoid. A pitutiary MRI showed no evidence of pituitary lesions or enlargement.Discussion and Follow upA non-suppressed ACTH made an adrenal source of cortisol unlikely. The working diagnosis was pseudo-CS secondary to stress, loss of diurnal rhythm due to insomnia, or overlooked depression.She was taking supplements, including biotin, and was asked to discontinue these for two weeks. Repeat 1-mg DST revealed an elevated cortisol of 9.8 μg/dL with a once again non-suppressed ACTH of 20 pg/mL. Her dexamethasone level was 109 ng/dL (normal after 1 mg dexamethasone 180-950 ng/dL), which may suggest slightly faster metabolism. All ACTH levels were run on Immulite assays, which has recently been suggested to be unreliable (1). When repeated using the Roche Assay, ACTH was low at 1.6 pg/mL. Given suppressed ACTH in conjunction with hypercortisolemia and osteoporosis, an adrenal source of CS was confirmed. Diagnosis was further solidified by a DHEA-S level of 11.4 μg/dL (normal 35.4 - 256 ug/dL). She underwent adrenalectomy and pathology revealed adrenal cortical adenomas.ConclusionThe correct diagnosis of adrenal CS in this patient was delayed due to erroneously higher ACTH result by the Immulite assay. Similar cases have been reported in the literature with the use of Immulite assays for measurement of ACTH leading to invasive diagnostic procedures and even unnecessary pituitary surgery (1).1.Greene LW, Geer EB, Page-Wilson G, Findling JW, Raff H. Assay-Specific Spurious ACTH Results Lead to Misdiagnosis, Unnecessary Testing, and Surgical Misadventure-A Case Series. J Endocr Soc. 2019;3(4):763-72.

Hemorrhagic Presentation of Rathke Cleft Cysts: A Surgical Case Series.

Rathke cleft cysts (RCCs) are benign sellar and suprasellar lesions commonly presenting as asymptomatic incidental findings. Rarely, RCCs hemorrhage and mimic pituitary apoplexy on presentation. To review a series of hemorrhagic RCCs for physicians encountering this rare presentation. A database review of>1700 transsphenoidal pituitary operations was performed at the USC Pituitary Center to identify patients with pathologically confirmed RCCs presenting with acute symptoms and evidence of hemorrhage at the time of surgery. Surgical treatment involved transsphenoidal RCC fenestration and drainage. Clinical, endocrine, and imaging outcomes were reviewed. A total of 119 RCCs were identified, and 6 (5.0%) presented with hemorrhage mimicking pituitary apoplexy. Presenting symptoms included acute onset headaches (5/6), vision loss (2/6), and oculomotor nerve palsy (n=1). Endocrine disturbances at presentation included pre-existing amenorrhea in all female patients (3/3), hypothyroidism (n=2), panhypopituitarism (n=2), and one with profound hyponatremia (Na 116 meq/L). All patients underwent endonasal transsphenoidal fenestration and drainage with no major complications. Over mean follow-up of 38.4 mo, 2/2 patients with vision loss reported improvement, and 2/5 patients with headaches reported improvement. Although all women resumed menses, patients with preoperative hypopituitarism did not experience pituitary axis improvement. Follow-up magnetic resonance imaging showed no instances of RCC recurrence with a mean imaging follow-up of 38.6 mo. RCCs occasionally present with hemorrhage and clinical symptoms that may be confused with apoplexy. Outcomes following hemorrhagic RCC treatment are excellent when treated at tertiary pituitary centers. Although hyperprolactinemia often improves following surgery, other pituitary axis deficits typically do not.

Reconstruction of Paprosky type IIIB acetabular bone defects using a cup-on-cup technique: A surgical technique and case series.

Paprosky type IIIB acetabular bone defects are very difficult to reconstruct. For severe defects, we developed our own cup-on-cup technique. We defined the tantalum metal (TM) revision shell with the peripheral titanium ring removed as a TM-cup augment and the cementless hemispherical acetabulum component combined with a TM-cup augment as the cup-on-cup technique. To report the short-term results of patients with type IIIB acetabular bone defects reconstructed using the cup-on-cup technique. We retrospectively reviewed six patients (six hips) with a mean age of 59 years who underwent acetabular reconstruction using our cup-on-cup technique between January 2015 and January 2017. All acetabular bone defects were classified as type IIIB without pelvic discontinuity using the system of Paprosky. All patients were followed both clinically and radiographically for a mean duration of 42 mo. The mean Harris hip score improved from 32.4 pre-operatively to 80.7 at the last follow-up. The mean vertical position of the hip rotation centre changed from 60.9 mm pre-operatively to 31.7 mm post-operatively, and the mean horizontal position changed from 33.6 mm pre-operatively to 38.9 mm post-operatively. Greater trochanteric migration after extended trochanteric osteotomy occurred in one of six hips at 3 mo. There was no evidence of component migration at the last follow-up. The short-term results suggest that our cup-on-cup technique could be considered an effective management option for Paprosky type IIIB acetabular bone defects without pelvic discontinuity.

Anterior Cervical Debridement and Fusion for Cervical Pyogenic Spondylodiscitis: Use of Anterior Cervical Plating or Not?

Retrospective multicenter case series. We sought to evaluate the safety and efficacy of anterior cervical plating in anterior cervical debridement and fusion (ACDF) for patients with cervical pyogenic spondylodiscitis (CPS). Due to concerns about bacterial seeding on the foreign material after instrumentations in pyogenic infections, the safety and efficacy of anterior cervical plating for CPS are still undetermined and controversial. Little information is available about the safety and efficacy of anterior cervical plating to manage CPS. Twenty-three patients who underwent ACDF with (n = 12) or without (n = 11) plating for CPS were included. The mean age was 62.6 years. Medical records were reviewed and radiological parameters including segmental height, segmental angle, C2-C7 angle, and fusion status were analyzed. The mean follow-up period after surgery was 21.3 months. After ACDF with plating, segmental height, segmental angle, and C2-C7 angle were significantly improved compared with preoperative conditions and remained well-maintained at the last follow-up. After ACDF without plating, three radiological parameters were also initially improved compared with preoperative condition, but significantly deteriorated to preoperative levels at the time of the last follow-up. The fusion rate was higher in the ACDF with plating group compared with the ACDF without plating group (90.9% vs. 63.6%; P < 0.01). One patient who received ACDF with plating and four patients who received ACDF without plating underwent revision surgery due to nonunion or bone graft dislodgement. No recurrence of pyogenic spondylodiscitis occurred in either group. ACDF with plating showed better surgical outcomes compared with ACDF without plating for CPS. We recommend the use of anterior cervical plating, which can provide biomechanical stability, for better healing of CPS. To our knowledge, this is the largest surgical case series of CPS. 4.

Modular stem in total hip arthroplasty for patients with trochanter valgus deformity: surgical technique and case series

BackgroundTrochanter valgus deformity (TVD) is a rare condition of total hip arthroplasty (THA). Femoral osteotomy could be required in correcting the deformity to implant femoral stem in severe TVD. In this study, we described one unpublished technique of reverse sleeve of S-ROM to get through the complex situation. This study aimed to summarize and evaluate its technical challenges, safety and effectiveness.MethodsFrom January 2006 to December 2014, we enrolled patients whose sleeves were implanted towards the great trochanter in THA with TVD. Their demographics, perioperative and postoperative information were recorded. To explore its indication, we measured and analyzed the ratio of greater trochanter/lesser trochanter (G/L ratio) and trochanter valgus angle (TVA).ResultsTwelve patients (1 male and 11 female, average age 42.30 ± 10.23) had mean follow-up of 6 years. Among them, only two patients had intraoperative femoral fracture. The survivorship of femoral prosthesis was 100%. The Harris hip score (HHS) increased from preoperative 34.31 ± 14.43 to postoperative 84.12 ± 11.33. All patients’ G/L ratio were larger than 1.50.ConclusionsThe reverse sleeve of S-ROM was a reliable method for the patients with severe TVD, which brought satisfying clinical outcomes in mid-term follow-up.

Minimally invasive video-assisted thyroidectomy and transoral video-assisted thyroidectomy: A comparison of two systematic reviews.

Background:We compared two systematic reviews, one focusing on transoral video-assisted thyroidectomy (TOVAT) and the other on minimally invasive video-assisted thyroidectomy (MIVAT), to highlight the pros and cons that can determine the choice of one or the other procedure.Materials and Methods:PubMed, Scopus and ISI Web of Science databases were searched for relevant articles published from 2000 to June 2018. Both searches were performed using the same keywords. All articles describing human surgical case series of any size were included, while the following were excluded: articles published in languages other than English, case reports, reviews, early cadaver and animal studies and old reports of cases now included in more recent works. Application of the above selection criteria yielded 151 articles on TOVAT and 246 on MIVAT. Of these, 34 articles were selected for inclusion in the present study: 17 for the TOVAT group and 17 for the MIVAT group. The comparison was made considering the most common variables used in evaluating thyroid surgery procedures. The statistical methods used were Cohen's delta, Student's t-test and the non-parametric Mann–Whitney U-test.Results:The variable 'operative time' was found to show a very large effect size, and 'hospital stay' also differed significantly between the MIVAT and TOVAT groups.Conclusions:TOVAT and MIVAT should not be considered in competition with each other, but seen simply as alternative choices. Both appear to be safe methods, comparable in terms of post-operative complications, although the main reason for using TOVAT seems to be purely aesthetic.

Artrhoscopic Resection of Volar Wrist Ganglion: Surgical Technique and Case Series.

Objectives To describe the technique and results of the arthroscopic surgical treatment of volar ganglion cyst of the wrist. Materials and Methods The present study comprised 21 patients submitted to the arthroscopic treatment of volar ganglion cysts of the wrist from January 2015 to May 2017, with a full evaluation for at least 6 months. The technique was indicated for patients presenting pain and functional impairment for more than four months, with no improvement with the conservative treatment, or for those with cosmetic complaints and cyst present for more than three months. Results The mean age of the patients was 43.6 years; 16 (76%) patients were female, and 5 (24%) were male. The mean follow-up time from surgery to the final assessment was of 10.9 months. A total of 2 (9.6%) patients complained of mild pain after the procedure, and another patient presented slight motion restrictions. The 18 (90.4%) remaining patients reported cosmetic improvement, complete functional recovery, and pain improvement. There were no recurrences or infections. No patient required further surgery. Conclusions The arthroscopic resection of volar ganglion cysts is a useful and safe technique. It is a minimally-invasive procedure, with low morbidity and very few complications, representing a good alternative to the open technique.

27-GAUGE SUTURELESS INTRASCLERAL FIXATION OF INTRAOCULAR LENSES WITH HAPTIC FLANGING

To determine whether haptic flanging during 27-gauge sutureless intrascleral fixation of intraocular lenses (IOLs) increases IOL stability and to report the short-term clinical outcomes of sutureless intrascleral surgery using 27-gauge trocar cannulas with haptic flanging. Retrospective surgical case series using live and cadaveric human eyes. In the cadaveric experiment using five eyes, flanged haptics required more force to dislocate the IOL compared with unflanged haptics (14 ± 4 vs. 3 ± 1 g, P = 0.03). The clinical series included 52 eyes from 52 patients. The average age at the time of surgery was 73 ± 14 years, with a mean follow-up of 27 ± 19 weeks. The most common indication for surgery was IOL dislocation/subluxation (n = 43, 83%). Mean visual acuity improved from 20/140 preoperatively to 20/50 at postoperative Month 1 (P < 0.001). The most common postoperative issue was intraocular pressure elevation (n = 12, 23%). Two patients (4%) needed a reoperation for IOL dislocation. Haptic flanging during 27-gauge sutureless intrascleral surgery creates a more stable scleral-fixated IOL compared with the traditional unflanged technique based on a cadaveric human eye study. In addition, this variation of sutureless intrascleral surgery seems safe and effective for patients who require secondary IOLs.

Pediatric Intracavernous Sinus Lesions: A Single Institutional Surgical Case Series and Review of the Literature.

Pediatric intracavernous sinus tumors are exceedingly rare and thus poorly characterized. Their neurosurgical management is challenging and diagnostic, and management guidelines are limited. To report our institutional experience with the surgical resection of pediatric intracavernous sinus tumors. We also compare and contrast our results with the 14 cases of pediatric intracavernous sinus lesions in the current literature. A retrospective descriptive analysis of consecutive pediatric patients (ages 0-18 yr) presenting to our institution with a diagnosis of an intracavernous sinus lesion was performed. From January 2012 to January 2017, 5 cases were identified. Eleven patients with secondary invasion of the cavernous sinus (2 meningiomas, 7 pituitary adenomas) or dermoid tumors involving the cavernous sinus (2) were not included in our review. Surgical resection via a frontotemporal orbitozygomatic approach was performed in all cases by a single senior neurosurgeon (M.L.). There were no perioperative or postoperative complications attributable to the surgery or approach. Four of 5 patients remained neurologically stable throughout the perioperative and postoperative period. The fifth patient had a complete resolution of their cranial neuropathies postoperatively. A pathological diagnosis that guided long-term management was obtained in all cases. Neurosurgical management of pediatric cavernous sinus lesions can be safely performed and critically guide future therapies. Surgeon familiarity with cavernous sinus and skull-base anatomy is critical to the successful management of these patients. The benefits of surgery should be balanced against the potential complications and need for a tissue diagnosis in children. The senior author had a significant experience with cavernous sinus approaches in adults prior to initiating use of the approach in the pediatric population.

Updated chandelier illumination-assisted scleral buckling using 3D visualization system.

PurposeTo assess the updated chandelier illumination-assisted scleral buckle procedures using a 3D visualization system.Subjects and methodsWe report a single-center, retrospective, consecutive surgical case series of 18 eyes of 16 patients that underwent scleral buckle procedures combining the use of chandelier endoillumination, a noncontact wide-angle viewing system, an anti-drying contact lens, and a recently developed 3D visualization system. The mean age of the patients was 30.2 years, and the mean follow-up time was 11.3 months.ResultsRetinal reattachment was achieved after the first surgery in all cases. There were no cases that required conversion of the 3D visualization to a conventional microscopic view. This updated chandelier-assisted scleral buckle procedure was successfully performed without any intraoperative or postoperative complications, except for the occurrence of postoperative diplopia in one case in which a supplementary radial buckle was used for a deep tear.ConclusionThe updated chandelier illumination-assisted scleral buckling surgery using a 3D visualization system appears to be a valuable and promising method for managing rhegmatogenous retinal detachment due to atrophic holes in lattice degeneration or ciliary tears in younger cases.

Three-dimensional ocular endoscope system for vitrectomy.

PurposeTo introduce a new three-dimensional (3D) endoscope system for vitrectomy.Subjects and methodsWe report a single-center, retrospective, consecutive surgical case series of 391 eyes that underwent 25G hybrid vitrectomy. To create 3D endoscopic images, a 3D converter HD-3D-A was connected to a monocular endoscopic system.ResultsThe 3D endoscope system was successfully used to perform hybrid vitrectomy. No intra- or postoperative complications related to this system were encountered in any of the cases.ConclusionThis 3D endoscope system appears to be a valuable and promising tool for use in vitrectomy.