Total Obliteration Research Articles

Two-Fraction Proton Beam Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations

Stereotactic radiosurgery (SRS) is a well-established treatment option that can obliterate cerebral arteriovenous malformations (AVMs). However, larger AVMs are more challenging to manage, with lower rates of obliteration and higher risk of complications. In this study, we report the obliteration rate and associated adverse effects of planned two-fraction proton SRS (PSRS) used to treat patients with larger AVMs that were deemed inoperable.A retrospective analysis including 75 patients with cerebral AVMs who received two-fraction PSRS at our institution between 1991 and 2019 was conducted. The median AVM nidus volume was 21.5 cc (range 1.4-58.1 cc). AVMs were located in critical/deep locations (basal ganglia, thalamus, or brainstem) in 21.3%. The median total dose for PSRS was 16 Gy(RBE) delivered in two fractions at a median of 7 days apart (range 1-82 days). Factors associated with obliteration and hemorrhage were assessed via univariable and multivariable analyses.Median follow up was 90 months (range 0.9-223.4 months). Total (8 patients, 11%) or partial (28 patients, 37%) obliteration was achieved among 48% of AVMs at a median time of 85.4 months (range 12.2-222.7 months). Five-year cumulative incidence of total obliteration was 29%. Five-year cumulative incidence of hemorrhage post-PSRS was 33%. Lesions with higher AVM scores were more likely to hemorrhage (P = 0.042). The most common adverse effect was Grade 1 headache acutely (11%) and long-term (9%). One patient developed a Grade 2 generalized seizure disorder.Planned two-fraction PSRS may be an effective and safe treatment option for achieving obliteration in patients with larger cerebral AVMs that are inoperable. Post-treatment hemorrhage remains a potential adverse event.D.W. Kim: None. G. Lee: None. P.H. Chapman: None. M.R. Bussiere: Consultant; American College of Radiology. J. Daartz: None. J.S. Loeffler: None. H.A. Shih: Employee; Dartmouth Hitchcock. Research Grant; AbbVie, NIH. Honoraria; UpToDate. Consultant; Cleveland Clinic. Speaker's Bureau; prIME Oncology. advisory; The Radiosurgery Society. director of clinical operations; Massachusetts General Hospital. clinical operational leader; Massachusetts General Hospital.

Initial experience with the Scepter Mini catheter for the embolization of vascular malformations in the pediatric population.

Achieving distal access and flow control are of significant importance for the treatment of intracerebral arteriovenous shunting lesions. The Scepter Mini catheter is a low-profile, dual-lumen balloon catheter, designed to provide navigability in small-caliber, tortuous intracranial vessels. To describe the initial experience of the Scepter Mini catheter in the treatment of pediatric arteriovenous malformations and fistulas. A single-institution, retrospective chart review identified all consecutive uses of the Scepter Mini catheter for endovascular embolization of vascular malformations in the pediatric population. Three different arterial pedicles were embolized with the Scepter Mini catheter in two different patients. One patient was diagnosed with a vein of Galen malformation that had undergone multiple treatments and the other with a torcular dural arteriovenous fistula. All cases encompassed quite challenging tortuosity of small-caliber feeders which prevented the use of another microcatheter. The Scepter Mini catheter navigated into feeding arteries of diameters 0.65, 1.9, and 1.25 mm, and its balloon was inflated to achieve excellent blood flow control. Total obliteration (100%) of the shunting lesion was achieved in both cases. No reflux, pedicle rupture or other untoward effects were observed. Both patients had an uneventful recovery. The Scepter Mini catheter afforded fast and safe distal access, flow control, and treatment of arteriovenous malformations in this initial pediatric cohort. The catheter's low profile and easy navigability should support its use in tortuous and small arterial feeders, especially in the pediatric population.

Successful closure of open window thoracostomy using omental flap without total dead-space obliteration: A case of empyema with pleural plaques

Successful closure of open window thoracostomy using omental flap without total dead-space obliteration: A case of empyema with pleural plaques

The reasons of unsatisfactory results of extracorporeal shock wave lithotripsy in patients with ureterolithiasis

The article dedicate to the problem of failure of extracorporeal shockwave lithotripsy in patients with ureterolithiasis and reveal the changes which appear in the ureter in the location of the stone.The aim. Analysis of the results of treatment in patients, suffering ureteric stones, using the ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy.
 Materials and methods. In 137 patients with ureteric stones, whom ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy was conducted, the symptoms of the disease, the diagnostic methods value, efficacy of surgical treatment and reasons of the failure of previous method of treatment were analyzed.
 Results. In 135 patients endoscopic removal of stones has been succeeded, in 2 patients because of total obliteration of the ureter, uretero-ureteral anastomosis has been performed. If the symptoms, with are characteristic of ureterolithiasis, persists up to one week stones don’t cause significant macroscopic changes to the ureter wall. If the stone persists in the ureter longer than a week we identified local appearing of oedema. Long–term (more than two months) ureteric stone persistence increase the risk of intramucosal “ingrowth” of the calculi greatly.
 Conclusion. The URS and ESWL are high effective and minimal invasive methods of surgical intervention for patients with ureterolithiasis, guaranteeing high level of postoperative “stone free rate”. Prolongation of the stone insertion time in the ureter causes the ureteric wall changes, complicating performance of minimal invasive interventions (ureterolithotripsy and extracorporeal shock–wave lithotripsy) and reduce its efficacy.

Ruptured Brainstem Arteriovenous Malformation Successfully Treated with Endovascular Surgery Used PHIL

Brainstem arteriovenous malformations (AVMs) are rare and complex, presenting mainly with hemorrhage, which can be catastrophic. The objective of its treatment is the angiographic obliteration of the lesion without worsening or with improvement of the neurological symptoms. Embolization is an efficient treatment for these AVMs but there are very few reported cases, although total obliteration is difficult, but it can also serve to reduce the nest and close the most dangerous factors of the AVM. Brainstem AVM is a rare pathology with high associated morbidity and mortality, with a high rate of rebleeding without treatment, which in selected cases embolization can be curative with a good neurological prognosis.

Peripheral Arterial Disease of the Lower Limbs: Epidemiological and Ultrasound Profile of Patients with Stenosis at the Conakry University Hospital

Introduction: Peripheral arterial disease of the lower limbs (PAD) is a partial or total obliteration of one or more arteries intended for the lower limbs by atheroma. Its prevalence increases with age, but also with other major cardiovascular risk factors such as diabetes, smoking, high blood pressure and dyslipidemia. Its diagnosis is essentially based on arterial Doppler ultrasound, which studies the topography and extension of the lesions, thus constituting the essential tool for therapeutic decision-making. The objective was to describe the epidemiological and ultrasound profile of patients with atheromatous arterial stenosis of the lower limbs. Methodology: This was a cross-sectional descriptive study running from 1 January 2019 to 31 March 2020, we took a duration of 15 months. This study was carried out at the Conakry University Hospital (Donka and Ignace Deen Hospitals). Results: In our series, the average age was 64.7 ± 13 years, with a sex ratio of 1.04. The average age was 64.7 ± 13 years, with a sex ratio of 1.04. The average age of the women in our series was 64.7 ± 13 years. Risk factors were dominated by advanced age (78.67%), diabetes (58%), hypertension (57%) and physical inactivity (47.66%). Among the 300 patients, 145 were carriers of atheromatous arterial stenosis, or a frequency of 48.33%. The leg arteries were the most affected, followed by the common femoral arteries. Concerning the degree of stenosis, patients with stenosis greater than 70% were the most represented. Conclusion: Peripheral arterial disease of the lower limbs (AOMI) is a pathology not to be neglected in Guinea. Patients have several risk factors : stenosis is an important part of the ultrasound lesions of this disease.

CLINICAL CASE OF DENTINE DYSPLASIA TYPE I

Developmental dental hard tissues disorders are rarely diagnosed both in children and adults, and their treatment is a problem for dentist. Despite the fact that molecular genetics studies allow to discriminate some dentine disorders, pathogenesis of radicular dentin dysplasia is still obscure. Type I dentin dysplasia is characterized by normal or slightly coloured crowns with no roots or only rudimentary roots, reduced pulp space in permanent teeth and incomplete or total obliteration of the pulp chambers, and periapical radiolucent areas or cysts which might result in premature loss of tooth. Fortunately, teeth demonstrate higher resistance to caries than normal teeth do.
 Dentin dysplasia type II is characterized by yellow, brown, grey, translucent primary teeth with complete pulpal obliteration. Permanent teeth are normal or might be slightly coloured. Roots are normal in size, but pulp chamber has pulp stones. A third type of dentine dysplasia or focal odontoblastic dysplasia has radiographic aspects of the other two types of disease.
 Also dentine dysplasia type I has subtypes Ia, Ib, Ic and Id. Dentine dysplasia Ia is characterized by complete obliteration of the pulp, disorder of root development, and many periapical radiolucent areas. A single small horizontally oriented and half-moon shaped pulp is presented in case of dentine dysplasia Ib, roots have a few millimetres length and frequent periapical radiolucencies. Dentine dysplasia Ic is characterized by the presence of two horizontal or vertical semicircle-shaped pulpal remnants which surround dentine in pulp chamber. Also teeth have shortened roots and variable periapical radiolucencies. Dentine dysplasia Id is characterized by the distinct pulp chambers with pulp stones in the coronal third of the root canal; periapical radiolucencies are possible as well. Aim of this study was to analyse clinical case of dentine dysplasia in 8,5-year-old boy.
 A 8,5-year old boy patient with parents came to a dental office due to caries cavity in tooth 62. Shape of tooth crowns was not changed and teeth with no signs of mobility; white lines and spots on teeth are were detected. Based on age, the decision of orthopantomogram was made to evaluate status of primary and permanent teeth. The image showed almost obliterated pulp chamber in both erupted and developing teeth and considerably shortened, blunted and malformed roots without a visible lumen of root canals in primary teeth. Periapical lesions were found about roots of primary molars and follicles of teeth 12 and 14 without caries lesions.
 Patient's medical history revealed no disturbance in general health. Clinical examination of the patient's mother did not show dental hard tissues disorders, but radiograph examination revealed such disorder in the orthopantomogram. Thus, history, clinical and radiographic findings revealed this case as dentine dysplasia type I subtype 1c inherited from mother.
 Oral rehabilitation of patients with dentine dysplasia type I require effective prevention and a complex approach. Thus, meticulous oral hygiene measures and dietary instructions, regular check-ups twice a year were established for this patient; orthodontic consultation was recommended. Varnish «Ftoplen-LC» was applied on the permanent teeth 3 times. To prevent early exfoliation, plan of preventive measures was developed included application of fluoride varnish twice a year and fissure sealing in the premolars in 9-10 years and in the second premolars in 12-13 years.
 Treatment of dentine dysplasia I type that depends on patient age and severity of disease may include also filling of carious teeth, orthodontic, surgical and orthodontic treatment. In this regard, dentist has to know developmental dental hard tissues disorders and select measures to prolong the retention of affected teeth maintaining them as long as possible.

Transcanal Endoscopic Ear Surgery for Epitympanic Cholesteatoma With Obliteration Using Bioglass.

Transcanal Endoscopic Ear Surgery for Epitympanic Cholesteatoma With Obliteration Using Bioglass.

Substantiation of organ-preserving surgical treatment of children with nonparasitic spleen cysts

BACKGROUND: The urgency of surgical treatment of children with nonparasitic spleen cysts is determined by the lack of consensus in the professional community, lack of regulatory documents governing the treatment of these patients, frequency of postoperative complications, and unfavorable outcomes.
 AIM: This study aimed to improve the efficiency and safety of organ-preserving minimally invasive interventions in children with nonparasitic spleen cysts based on the development of a multifactorial preoperative planning system and substantiation of an algorithm for choosing the optimal surgical strategies.
 MATERIALS AND METHODS: Results of surgical treatment of 60 children aged 218 yrs with nonparasitic spleen cysts are presented. The spleen cyst volume varied from 3 ml to 1000 ml (Me 50 ml). Preoperative examination included clinical examination, laboratory diagnostics, ultrasonography, computed tomography or magnetic resonance imaging, and angiography of the spleen vessels. The range of surgical technologies included percutaneous puncture (n = 2) and percutaneous puncture drainage (n = 28), followed by sclerosing of the cyst with 96% ethyl alcohol, combined interventions, supplemented by superselective embolization of the spleen arteries feeding the pathological formation (n = 15), laparoscopic fenestrations of cysts with physical de-epithelialization of the inner lining (n = 14), and laparoscopic resection of the spleen pole (n = 1).
 RESULTS: The analysis of postoperative complications was carried out depending on the chosen technology of surgical treatment. The follow-up period of 44 patients varied from 6 mon to 3 yrs, which made it possible to reveal the regularities of the reduction of residual cyst cavities and the course of the regeneration processes with an objective assessment of the volumetric characteristics of the spleen. Obliteration of the residual cyst cavities was observed in 79.1% of the patients during the first month after surgery. Subsequent total obliteration of the residual cyst cavities was observed within 1 yr after surgery in 91.7% of children and residual pathological formations persisted in five patients, which accounted for 8.3% of clinical observations. The volume of residual cysts ranged from 1.2% to 10.0% of the initial value, which was regarded as a satisfactory treatment result.
 CONCLUSION: Results of a retrospective multivariate analysis made it possible to develop an algorithm for substantiating surgical techniques, providing a radical cure for 95.5% of children with nonparasitic spleen cysts.

The Role of Biological Effective Dose in Predicting Obliteration After Stereotactic Radiosurgery of Cerebral Arteriovenous Malformations

ObjectiveTo determine whether biological effective dose (BED) was predictive of obliteration after stereotactic radiosurgery (SRS) for cerebral arteriovenous malformations (AVMs). Patients and MethodsWe studied patients undergoing single-session AVM SRS between January 1, 1990, and December 31, 2014, with at least 2 years of imaging follow-up. Excluded were patients with syndromic AVM, previous SRS or embolization, and patients treated with volume-staged SRS. Biological effective dose was calculated using a mono-exponential model described by Jones and Hopewell. The primary outcome was likelihood of total obliteration defined by digital subtraction angiography or magnetic resonance imaging (MRI). Variables were analyzed as continuous and dichotomous variables based on the maximum value of (sensitivity–[1–specificity]). ResultsThis study included 352 patients (360 AVM, median follow-up, 5.9 years). The median margin dose prescribed was 18.75 Gy (interquartile range [IQR]: 18 to 20 Gy). Two hundred fifty-nine patients (71.9%) had obliteration shown by angiography (n=176) or MRI (n=83) at a median of 36 months after SRS (IQR: 26 to 44 months). Higher BED was associated with increased likelihood of obliteration in univariate Cox regression analyses, when treated as either a dichotomous (≥133 Gy; hazard ratio [HR],1.52; 95% confidence interval [CI], 1.19 to 1.95; P<.001) or continuous variable (HR, 1.00, 95% CI, 1.0002 to 1.005; P=.04). In multivariable analyses including dichotomized BED and location, BED remained associated with obliteration (P=.001). ConclusionBiological effective dose ≥133 Gy was predictive of AVM obliteration after single-session SRS within the prescribed margin dose range 15 to 25 Gy. Further study is warranted to determine whether BED optimization should be considered as well as treatment dose for AVM SRS planning.

Clinical and radiological response of aggressive dural arteriovenous fistula after combined glue embolization and hypofractionated helical TomoTherapy

AbstractPurpose:We reported the clinical and radiological outcome of an aggressive dural arteriovenous fistula (DAVF) after combined glue embolization and hypofractionated helical TomoTherapy (Hypo-HT).Materials and methods:Eleven patients whose radiological examinations are consistent with aggressive DAVF were treated with combined glue embolization and Hypo-HT 30–36 Gy in 5–6 fractions. The dosimetric analysis, clinical response and radiological imaging obliteration rate by magnetic resonance angiography or computed tomography angiography were investigated.Results:There were eight males and three females with a male and female ratio of 2·67. The mean age was 51·2 years old (range 37–69). Anatomical imaging sites of disease included transverse-sigmoid sinuses (n = 7), superior sagittal sinus (n = 3) and tentorium cerebelli (n = 1). The mean pitch and MF of treatment plans were 0·273 ± 0·032 and 1·70 ± 0·31, respectively. The average size of PTV were 15·39 ± 7·74 cc whereas the Reff,PTV was 1·50 ± 0·25 cm. The average Dmax and Dmin were 37·52 ± 3·34 and 31·77 ± 2·64 Gy, respectively. HI, CI and CI50 were 0·16 ± 0·06, 1·80 ± 0·56 and 7·85 ± 4·16, respectively. The Reff,Rx and Reff,50%Rx were 1·80 ± 0·24 and 2·90 ± 0·45 cm, respectively. The Reff between 50%Rx and 100%Rx was 1·10 ± 0·28 cm on average. With a mean follow up of 28·5 months (range 9–48), the complete recovery of symptoms was found in 72·7 % (eight patients) within 2–12 months after completion Hypo-HT. Partial recovery was reported in 18·2% (two patients). No clinical response was found in 9·1% (one patient). The total radiographic obliteration rate was 27·3% (three patients), subtotal obliteration was 27·3% (three patients) and partial obliteration was 45·4% (five patients).Conclusions:Satisfactory clinical response of aggressive DAVF was found in all treated patients by combining glue embolization and Hypo-HT. All dosimetric parameters were acceptable. We still need an extended follow up time to assess further radiographic obliteration rate and late side effects of the treatment.

Оперативное лечение больного туберкулезом почек, осложненным туберкулезом мочеточника

Late diagnosis of renal tuberculosis leads to complications that cannot be eliminated by treatment. A clinical observation of renal tuberculosis, complicated by total ureteral obliteration, in a comorbid patient is presented. He underwent planned bowel substitution of the right ureter. In the postoperative period, pyelonephritis developed, which was resolved by drug therapy. In this case, there is the correct tactics of outpatient urologists. When hydronephrosis was diagnosed, a nephrostomy tube was put, which allowed to preserve the kidney, Then the patient was immediately referred to a phthisiatrician to exclude urogenital tuberculosis. In the local TB dispensary, the patient did not have the opportunity to receive necessary treatment, and he was transferred to the TB Research Institute of Ministry of Health of Russia, where a reconstructive laparoscopic procedure was performed.

P0619 / #1524: ACUTE NECROTIZING ENCEPHALOPATHY (ANE) RELATED TO INFLUENZA AND MYCOPLASMA PNEUMONIAE IN A CHILD

Aims & Objectives: Background: ANE is a rare neurologic complication of influenza which lead to profound disability or death.The co-infection role of M. pneumoniae on this condition has not been previously reported. Aims: Clinical case presentation. Methods: Methodology: Chart review and literature search. Results: A previously healthy 5-year-old female, 3 hours before admission presents with fever, restlessness, and an involuntary bowel movement. She became confused and developed right hemiparesis and dysarthria. Soon after arrival to the ER, she developed right-sided clonic seizures, coma, bilateral areactive mydriasis with no corneal reflex, and hypotension. An admission brain-CT (Fig. 1)scan reported no intracranial abnormalities, but a MRI (Fig. 2), performed 2 hours after stabilization, reported diffuse hyperintensity with cytotoxic edema in cerebellar hemispheres, posterior brainstem, thalamus, basal ganglia, gray and white supra and infratentorial substance, findings consistent with ANE. Despite decompressive craniotomy and maximum therapeutic efforts, intracranial hypertension was severe and refractory to treatment. A PCR respiratory panel was positive for Influenza A/H1-2009, A/H1-pan, A/pan1, A/pan2 and M. pneumoniae. Blood and urine cultures were negative. A CT scan after 12 hours reported total obliteration of the CSF spaces, occipital transcranial herniation, and absence of intracranial circulation. The patient died after 36 hours. A post-mortem CSF analysis, including a PCR panel and culture, were negative.Conclusions: ANE is a consequence of an inappropriate immune response to virus and bacteria associated with poor outcomes or severe complications. More research is needed to stablish an association with a genetic predisposition.

A Hybrid Strategy for Patients With Complex Cerebral Aneurysm: STA-MCA Bypass in Combination With Endovascular Embolization.

Objective: This work aims to present our experience of patients with complex cerebral aneurysm treated with a hybrid approach: superficial temporal artery–middle cerebral artery (STA–MCA) bypass in combination with endovascular exclusion of the aneurysm.Method: Patients with aneurysms deemed unclippable and uncoilable were included. All patients were treated with a hybrid approach. After STA–MCA bypass, the parent artery was temporarily occluded. If the intraoperative motor evoked potential (MEP) and somatosensory evoked potential (SEP) waveforms remain normal and last for 30 min, the aneurysm and te parent artery will be embolized permanently with detachable balloons or coils.Results: A total of 20 patients with 22 aneurysms were included in this study. There were 13 women and 7 men, with an average age of 42.5 years. Intraoperative angiography showed the good patency of all the STA grafts, and neither SEP nor MEP abnormalities were detected. After the parent artery and the aneurysm were occluded, the intraoperative angiography showed an immediately successful exclusion of the aneurysm in 20 aneurysms and immediate contrast stasis in two. All patients recovered uneventfully without ischemic or hemorrhagic complication. Angiography at 6-month follow-up showed the total obliteration in 20 aneurysms. Two aneurysms showed residuals and were recoiled. All STA grafts showed a good patency, and the mean graft flow was 124.2 ml/min.Conclusion: STA–MCA bypass in combination with endovascular exclusion is an appropriate option for patients with complex cerebral aneurysms that are not amenable to direct surgical clipping or endovascular embolization.

Vertebral artery dissection and associated ruptured intracranial pseudoaneurysm successfully treated with coil assisted flow diversion: A case report and review of the literature.

Dissecting intracranial pseudoaneurysms (IPs) are associated with a high incidence of rupture and poor neurologic outcomes. Lesions in the posterior circulation are particularly malignant and pose even greater management challenges. Traditional management consists of microsurgical vessel sacrifice with or without bypass. Flow diversion (FD) in the setting of subarachnoid hemorrhage (SAH) represents a reconstructive treatment option and can be paired with coil embolization to promote more rapid thrombosis of the lesion. We report a case of a ruptured dissecting vertebral artery (VA) IP successfully acutely treated with coil-assisted FD. A 53-year-old male presented with a right V4 dissection spanning the origin of the posterior inferior cerebellar artery and associated ruptured V4 IP. The patient was treated with coil-assisted FD. Oral dual-antiplatelet therapy (DAPT) was initiated during the procedure, and intravenous tirofiban was used as a bridging agent. Immediate obliteration of the IP was achieved, with near-complete resolution of the dissection within 48 h. The patient made a complete recovery, and angiography at 6 weeks confirmed total IP obliteration, reconstruction of the VA, and a patent stent. The use of FD and DAPT in the setting of acute SAH remains controversial. We believe that coil-assisted FD in carefully selected patients offers significant advantages over traditional microsurgical and endovascular options. The risks posed by DAPT and potential for delayed thrombosis with FD can be effectively mitigated with planning and the development of protocols. We discuss the current literature in the context of our case and review the challenges associated with treating these often devastating lesions.

Exploring the Politics of Widowhood in Vrindavan: An Analysis of Life Narratives of Vrindavan Widows

The experience of Hindu widowhood in the Indian context constitutes social exclusion and marginalization of the woman who has lost her husband. The practice, which is the product of intersection of Indian patriarchy with the Hindu caste system, aims at total obliteration of the widow and rendering her invisible. The widow who is already in a precarious position due to adverse socio-economic and cultural ramifications of being a woman in the Indian society is pushed further to the margins. Her only recourse to means of dignified survival is to conform to the norms of Hindu widowhood that entail curtailment of freedoms associated with dress code, diet, social relationships and sexual conduct. The present paper intends to shed light on the workings of widowhood phenomenon in Vrindavan, Uttar Pradesh, a revered place due to its prominence in Hinduism. A life of religiosity in Vrindavan offers itself as a viable option for widows’ subsistence. Vrindavan, in turn, benefits from the presence of widows. The dynamics of the interrelationship between the spiritual economy of Vrindavan and life of widows is explored to shed light on the negotiations that widows undertake on a day-to-day basis to further their existence. Life narratives of widows are analyzed to shed light on the bargains that they undertake to become and survive as a Vrindavan widow.

One-Stage Treatment in a Hybrid Operation Room to Cure Brain Arteriovenous Malformation: A Single-Center Experience

To report the principles and techniques of using a hybrid operation room in the treatment of brain arteriovenous malformation (BAVM). From October 1, 2016 to December 31, 2018, we treated 54 consecutive patients with nonemergent BAVM in a hybrid operation room. The clinical data, radiologic images, and outcomes were collected to establish a prospective database for evaluation. Thirty-two male and 22 female patients were enrolled with a mean age of 32.6 ± 13.1 years (range, 10-61 years). Bleeding (n= 32, 59.3%) was the main clinical presentation, followed by headache (n= 27, 50.0%), seizures (n= 14, 25.9%), neurofunctional deficits (n= 16, 29.6%), and no symptoms (n= 2, 3.7%). Thirty-one patients (57.4%) accepted resection without intraoperative embolization, 18 (33.3%) were treated with combined embolization and resection, and 5 (9.3%) were cured with intraoperative embolization and resection was cancelled. All patients achieved total BAVM obliteration confirmed with intraoperative angiography. There were no significant differences in outcomes between low-grade (Spetzler-Martin grades I, II, and modified grade III-) and high-grade (Spetzler-Martin grades ≥IV and modified grade III+) groups, except that the high-grade group had more blood loss (667.9 ± 647.5 vs. 284.3 ± 148.6 mL; P= 0.046) and longer postoperative hospitalization (17.1 ± 9.1 vs. 10.8 ± 5.4 days; P= 0.026). At discharge, 52 patients (96.3%) had favorable outcomes (Glasgow Outcome Scale score ≥4). Forty-three patients (79.6%) received 1 year follow-up after treatment; 97.7% (n= 42) of these had ongoing favorable outcomes. However, 4 patients with low-grade BAVM had recurrence. The hybrid operation room can ensure safe, comprehensive treatment of BAVM, offering the opportunity for a favorable curative treatment in 1 stage.

Stent-Assisted Coiling of Unruptured Intracranial Aneurysms with Wide Neck.

Objective:Morbidity and mortality in patients experiencing the rupture of intracranial aneurysm ruptures are high. We conducted a systematic review and meta-analysis to investigate the role of stent-assisted coiling (SAC) for unruptured intracranial aneurysms (UIAs) with wide neck.Materials and Methods:The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled proportions with 95% confidence intervals (CIs) of ten outcomes of interest were calculated.Results:We finally reviewed 13 studies, including 976 patients. The technical success of the method was 98.43% (95% CI: 95.62–99.95). Early outcomes included total periprocedural obliteration with a rate of 50.20% (95% CI: 36.09–64.30) and periprocedural rupture with zero rate. During the follow-up period, ranging from 6 months to 2 years, the total postprocedural obliteration rate was 63.83% (95% CI: 45.80–80.18) and the overall late rupture rate was 0.41% (95% CI: 0.00–2.38). The pooled in-stent stenosis rate was calculated at 1.24% (95% CI: 0.02–3.63). We also estimated a pooled rate of 0.02% (95% CI: 0.00–0.51) and 4.33% (95% CI: 2.03–7.23) for total mortality and overall neurological complications, respectively. A pooled rate of 3.94% (95% CI: 1.48–7.33) was found for stroke. Finally, the recanalization rate was recorded at 7.07% (95% CI: 4.35–10.26).Conclusions:SAC of UIAs with wide neck seems to be a safe and acceptable alternative to surgical clipping. Although early results concerning total periprocedural obliteration may be modest, follow-up outcomes may be indicative of adequate occlusion of treated UIAs.

Management of Calcific metamorphosis by conventional Root Canal Treatment. A case report

The calcified root canals cause many problems during endodontic treatment due to difficulty in canal orifice location, negotiation, preparation as well as consideration of operating time. Most serious problem may arise during any phase of root canal treatment procedure even taking a lot of precaution. Partial or total obliteration of pulpal chamber or root canal space is the most common consequences of a tooth which is exposed to traumatic injury. The most common presentation of such a tooth is complete or partial loss of the pulp space radiographically and discoloration particularly yellow discoloration of the clinical crown. Around 7–27% of teeth having the feature of partial canal calcification shows features of pulp necrosis accompanied by radiographic signs of chronic periapical periodontitis. Very low numbers of teeth( 2-3%) may present with total obliteration of pulp chamber and the root canal system . Teeth with such features is challenging to provide a successful root canal treatment; . In this case report a 21 years old female patient attended with complaints of discoloration , mild spontaneous pain , and several episodes of gingival swelling with history of trauma four years back in her both maxillary central incisors. The case was evaluated clinico radiographically and the diagnosis was a case of calcification both maxillary central incisors. Root canal treatment to manage the calcified canals following conventional technique was planned . After treatment patient was free from subjective and objective signs and symptoms and she was advised for periodic follow-up&#x0D; Update Dent. Coll. j: 2020; 10 (2): 21-25

Stereotactic Radiosurgery for Spetzler-Martin Grade I and II Arteriovenous Malformations: International Society of Stereotactic Radiosurgery (ISRS) Practice Guideline.

BACKGROUNDNo guidelines have been published regarding stereotactic radiosurgery (SRS) in the management of Spetzler-Martin grade I and II arteriovenous malformations (AVMs).OBJECTIVETo establish SRS practice guidelines for grade I-II AVMs on the basis of a systematic literature review.METHODSPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant search of Medline, Embase, and Scopus, 1986-2018, for publications reporting post-SRS outcomes in ≥10 grade I-II AVMs with a follow-up of ≥24 mo. Primary endpoints were obliteration and hemorrhage; secondary outcomes included Spetzler-Martin parameters, dosimetric variables, and “excellent” outcomes (defined as total obliteration without new post-SRS deficit).RESULTSOf 447 abstracts screened, 8 were included (n = 1, level 2 evidence; n = 7, level 4 evidence), representing 1102 AVMs, of which 836 (76%) were grade II. Obliteration was achieved in 884 (80%) at a median of 37 mo; 66 hemorrhages (6%) occurred during a median follow-up of 68 mo. Total obliteration without hemorrhage was achieved in 78%. Of 836 grade II AVMs, Spetzler-Martin parameters were reported in 680: 377 were eloquent brain and 178 had deep venous drainage, totaling 555/680 (82%) high-risk SRS-treated grade II AVMs.CONCLUSIONThe literature regarding SRS for grade I-II AVM is low quality, limiting interpretation. Cautiously, we observed that SRS appears to be a safe, effective treatment for grade I-II AVM and may be considered a front-line treatment, particularly for lesions in deep or eloquent locations. Preceding publications may be influenced by selection bias, with favorable AVMs undergoing resection, whereas those at increased risk of complications and nonobliteration are disproportionately referred for SRS.