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At least 379 records · Page 21Linked to original sources
PubMed2005

Stereotactic radiosurgery, microsurgery, and expectant management of acoustic neuroma: basis for informed consent.

There is diversity in the techniques and instrumentation used to perform stereotactic radiosurgery. The field continues to evolve rapidly, and improvements are being made in accuracy, effective radiation dose, and parameters necessary to maximize patient outcome. Stereotactic radio-surgery, like any other treatment modality, has advantages and disadvantages that must be discussed with a patient who has an acoustic neuroma or other skull base tumor. An informed decision to pursue observation,microsurgery, stereotactic radiosurgery, or a combination of these methods must be made, and it remains the responsibility of the surgeon to provide a balanced view of the relative advantages and disadvantages of each method.

Dose Fractionation, Radiation↗
PubMed1978

A new headrest for ophthalmic microsurgery.

We designed and successfully used a new headrest for ophthalmic microsurgery. The symmetrical instrument has a U-shaped frame and is designed to be clamped to an operating table as a projecting extension. The headrest has been satisfactory for patients having either general or local anesthesia, and particularly useful for vitreous surgery with the Zeiss Mark VI microscope; this headrest gives excellent control over the visual field and eliminates all extraneous movement.

Humans↗
PubMed2001

[Vascular microsurgery and progress of free flap surgery].

In 1960 Jacobson and Suarez realized and described the first vascular microanastomosis. They introduced microsurgical operating technique, improved instrumentation and operating microscope. Many improvements were tried: vascular intubation, laser, biological glue, microvascular anastomotic system, non transfixing microstaples. After expert's report, these techniques have shown many drawbacks and have not supplanted the manual anastomosis. The failure rate was 6.6% in a review of 9,503 cases from the literature. The rate of vascular thrombosis decreased when subcutaneous heparin was administered in the post-operative period. Microvascular surgery has become an important method for reconstructing complex surgical defects by using free vascularized transplants. The majority of free flaps were applied to the reconstruction of defects resulting from tumor ablation or trauma. The recipient sites were mainly distributed to the head and neck and to the limbs. Reconstruction of an irradiated recipient site is a significant predictor of failure. The vascular microsurgery using thread and needle requires a strict training with an important invested time.

Anastomosis, Surgical↗
PubMed2006

[Transanal endoscopic microsurgery (TEM). Current situation and future expectations].

Transanal endoscopic microsurgery (TEM) uses specific equipment that allows resection of large rectal adenomas and incipient malignancies in the rectal ampulla. TEM aims to provide an alternative to conventional abdominal surgery (low anterior resection or abdominoperineal amputations), which carries not inconsiderable morbidity and mortality. Application of the technique of endoanal excision is limited by the height and extension of the lesions. In this review, the authors present their own experience with this technique and that described in the literature. The protocol for selecting candidates for TEM, their preoperative preparation, equipment, characteristics of the surgical technique, postoperative complications, and follow-up are described. The collaboration of a multidisciplinary team is essential when developing this technique. TEM-associated morbidity is low and mortality is practically nil. TEM is the technique of choice in large rectal adenomas and malignant rectal tumors in stages pT1 localized in the rectal ampulla. The frequency of recurrence is similar to that in abdominal surgery. The technique does not cause complications of urinary or sexual dysfunction and fecal incontinence is minimal. In more advances stages of rectal cancer, the results of better patient selection and future studies on the possible application of neoadjuvant therapy associated with TEM are required.

Adenoma↗
PubMed1986

Prognostic factors of fimbrial microsurgery.

From January 1978 to December 1983, 600 infertile women underwent microsurgery for tubal infertility. Only 257 women with the same extent of distal lesions on both sides or with unilateral occlusion (after contralateral salpingectomy) were considered. Patients were classified in four subgroups on the basis of the extent of occlusion. After fimbrioplasty for occlusion of degree I and salpingostomy for occlusion of degree II, the term pregnancy rate was more than 50%. After salpingostomy for occlusion of degrees III and IV, the term pregnancy rate was, respectively, 25% and 22%. The ectopic pregnancy rate was the highest (12%) after salpingostomy for occlusion of degree IV. After microsurgical salpingolysis, the term pregnancy rate reached 64%, whereas the ectopic pregnancy rate was as low as 2%. Ampullary dilatation, as determined by hysterosalpingography and laparoscopy, influences the postoperative pregnancy rate. Fimbrial microbiopsies were taken, and the ciliated cell percentage was obtained. Results suggest that the ciliation index is a valuable method of prognosis of tubal surgery. In conclusion, the pregnancy rate after distal surgery is related to the tubal morphologic findings: ampullary dilatation, fimbrial ciliated cell percentage, and tubal wall thickness.

Fallopian Tubes↗
PubMed1990

Autologous fibrin sealant in reconstructive rabbit oviduct microsurgery.

A simple method for preparing concentrated fibrinogen for use in a tissue adhesive system is described. Approximately 75% to 80% of the plasma fibrinogen can be separated and concentrated within 45 to 60 minutes from a small blood sample collected from the patient before the operation. Autologous fibrinogen prepared by this method was evaluated in reconstructive microsurgery of the rabbit oviduct.

Animals↗
PubMed1998

Congenital aural sinuses: clinical study and application of microsurgery.

METHODS: The authors studied 45 cases of congenital aural sinuses. RESULTS: Aural sinuses were observed on both sides in 17 cases (37.8%) and in girls (24 cases, 53.3%). Family history was positive in 12 cases (26.6%), and history of local infection was present in 40 cases (88.9%). The opening of aural sinuses was located most frequently in the marginal helicine region (36 cases, 80%). CONCLUSIONS: Microsurgery was extremely effective for accurate determination of the margins of intricately ramified aural sinuses, their detachment from surrounding tissues, and their total resection. Complete resolution without postoperative complications was achieved in 43 cases (95.6%).

Adolescent↗
PubMed1999

Management of nonfunctioning pituitary adenomas with suprasellar extensions by transsphenoidal microsurgery.

BACKGROUND: We evaluated the feasibility and therapeutic effectiveness of transsphenoidal microsurgical removal of nonfunctioning pituitary adenomas with suprasellar extensions. The diagnostic modes, surgical technique, and outcome were reviewed in 208 patients with pituitary adenomas extending beyond the sella turcica who were treated by transsphenoidal microsurgery. All patients except three presented with significantly diminished visual acuity and visual field defects. METHODS: Diagnosis was confirmed by skull X-ray plain films, CT, or MRI scanning. Operations were performed via a transsphenoidal approach under microscope. A subarachnoid catheter was preoperatively inserted in the lumbar cistern, through which saline was slowly injected during operation to increase the intracranial pressure so as to move the suprasellar tumor into the operative field to aid the removal. RESULTS: In this series, gross total removal of an adenoma in 146 cases (70.2%) and subtotal removal in 50 cases (24.0%) was achieved; partial removal was carried out in the remaining 12 cases (5.8%) of fibrous or dumbbell-shaped adenomas. There were no deaths in this group. Follow-up review (median 3.8 years) in 187 patients revealed that 97.8% of those with preoperative diminished visual acuity had postoperative improvement; 2.2% had no change, and none deteriorated significantly. Among 181 patients with preoperative visual field defects, postoperative improvement was good in 169 (93.4%), and poor in 12 (6.6%). The major complications were diabetes insipidus and cerebrospinal fluid rhinorrhea, which occurred in 13.5% and 4.8% of patients, respectively. The tumors recurred in 12 patients (6.4%) who were considered to have a macroscopically complete removal at surgery. Continuing growth of residual tumors was found in 31 (16.6%) based on visual acuity decrease, visual field defects, and CT or MRI examination. Of the recurrent and residual tumors, 4, 9, 17, and 13 cases belonged to Grades A, B, C, and D, respectively. CONCLUSIONS: Comparison with transfrontal surgery suggests that these results are as good as those of transfrontal procedures and that the incidence of serious side effects is considerably lower. We consider that the microsurgical removal of pituitary tumors by the transsphenoidal approach is safe and effective even in very large or giant adenomas, since it allows rapid and adequate decompression of the optic nerves and chiasm.

Adenoma↗
PubMed1987

Autoantibodies to pituitary corticotropin-producing cells: possible marker for unfavourable outcome after pituitary microsurgery for Cushing's disease.

Circulating autoantibodies to human fetal pituitary cells were detected in 13 out of 51 patients who underwent transsphenoidal microsurgery for Cushing's disease. The absence of Fc receptors on human fetal pituitary corticotropin-producing cells allowed the detection of antibodies to these cells. In all the 13 patients, the antibodies were present before surgery, and 10 of them showed clinical and/or biochemical signs of incomplete cure of Cushing's disease after surgery. Only 3 out of 27 patients with a favourable outcome were antibody-positive. In all the antibody-positive patients, the antibodies were directed to corticotropin-producing cells and in 8 patients also to luteinising hormone or human growth hormone producing cells. A non-antigen-specific adherence of antibodies to Fc-receptors on corticotropin-cells was excluded by unchanged binding after preincubation of sections with purified rabbit Fc or Fc aggregates. The presence of pituitary corticotropin-cell antibodies in patients with Cushing's disease is associated with an unsuccessful outcome after transsphenoidal selective adenectomy.

Adenoma↗
PubMed1997

Laser microsurgery for superficial T1-T2 basal cell carcinoma of the eyelid margins.

BACKGROUND: Basal cell carcinoma (BCC), the most common malignancy of the eyelid margins, poses therapeutic problems. Surgery, radiation therapy, and cryotherapy are the currently accepted methods for the treatment of this affliction. To verify the technical and clinical effectiveness of the surgical laser method, a specific approach was developed by performing laser-combined procedures under microscopic control. METHODS: A series of 26 patients underwent carbon dioxide (CO2) laser microsurgical excision of 27 primary superficial BCCs of the eyelid margins. Eighteen tumors were T1 and 9 were T2. The lesions were located at the lid margins in 18 and at the canthus in 9 cases. The eyelash line was involved in all cases, whereas intermarginal space was involved in 17 cases, without extension to the conjunctival border. Six lesions were in the lacrimal region. Median linear extent of the lesion was 5 mm (range, 4-10 mm). Treatment was performed with the patient under local anesthesia in a Day Hospital regimen. The authors used the microscope-mounted CO2 laser as a scalpel to excise the tumor mass, thus obtaining the specimen for histologic evaluation. The authors treated the deep and lateral resection margins with laser vaporization and left the wound bed to heal by secondary intention. RESULTS: No significant complications were observed. As full-thickness eyelid resections were avoided, the authors noted conservation of lid function and cosmetic aspect in all patients. With a median follow-up of 73 months (range, 18-118), only one patient had tumor recurrence after 22 months. This tumor, located at the outer canthus, had a second microsurgical laser excision, and the patient is disease free 51 months after the last treatment. CONCLUSIONS: Laser microsurgery appears to be a safe and effective treatment method for primary superficial T1 and T2 BCC of the eyelid margins without conjunctival extension.

Adult↗
PubMed1998

Comparison of external radiotherapy, laser microsurgery and partial laryngectomy for the treatment of T1N0M0 glottic carcinomas: a retrospective evaluation.

PURPOSE: The aim of this study was to retrospectively compare the efficacy and functional results of three treatment options for T1N0M0 glottic carcinomas applied in a single institution. MATERIALS AND METHODS: One hundred six charts of patients with biopsy-proven T1N0M0 glottic carcinomas treated between 1979 and 1995 were reviewed. There were 81 T1a and 25 T1b tumors. Forty-one patients were treated by radiotherapy (RT) (median dose of 64 Gy), 34 patients were treated by partial laryngectomy (PL) and 31 patients were treated by laser microsurgery (L) of which 10 received postoperative RT for positive margins. In 18 patients, a perceptual voice rating on a visual scale was performed by the patients themselves, three non-speech specialists and two speech therapists. RESULTS: With a median follow-up time of 63.5 months, the 5- and 10-year loco-regional control probabilities reached 91 and 87%, respectively, without any difference between the treatment groups. After salvage laryngectomy, the 5- and 10-year loco-regional control probabilities reached 97% without any difference between the treatment groups. For the whole population, overall survival reached 78 and 62.4% at 5 and 10 years, respectively. The actuarial incidence of second primary reached 19% at 10 years. Regarding the quality of voice, overall there was a trend towards a worse satisfaction index, more hoarseness and more breathiness after PL than after L or RT. CONCLUSIONS: Our data suggested that assuming proper selection of patients, RT and L yielded similar outcomes and functional results. Local recurrence can be adequately salvaged by surgery. On the other hand, PL appeared to yield similar loco-regional control probability but with a worse quality of voice.

Actuarial Analysis↗
PubMed1999

Cost-minimization analysis of treatment options for T1N0 glottic squamous cell carcinoma: comparison between external radiotherapy, laser microsurgery and partial laryngectomy.

BACKGROUND AND PURPOSE: A cost minimization analysis of radiotherapy (RT), laser microsurgery (L) or partial laryngectomy (PL), which are equally effective options for T1N0 glottic SCC was carried out from the perspective of the National Health Care System. METHODS: For each modality, the various events associated with the diagnostic procedure, the primary treatment, the complications, and the salvage treatment were individualized. The charges of each of these events weighted for the frequency of occurrence were then determined using the 'fee for service' policy established by the National Health Insurance of Belgium. RESULTS: A total cost of 5172, 5847 and 11563 EURO were calculated for RT, L and PL, respectively. For L, cost included post-operative RT applied in case of positive margins (30%). For PL, the cost of the primary treatment accounted for 68% of the total cost whereas it only accounted for 50 and 43% for L and RT, respectively. For RT, L or PL, complications accounted for less than 10% of the total cost. The cost of salvage treatment reached 19, 14 and 8% of the total cost for RT, L and PL, respectively. A sensitivity analysis indicated that reduction of the duration of hospitalization decreases the costs without affecting the ranking between the three options. Also, the cost of L could be reduced even slightly below the cost of RT by decreasing the need for post-operative RT. CONCLUSIONS: RT and L have almost the same expected average cost for the treatment of T1N0 glottic SCC, whereas PL is twice as expensive.

Belgium↗
PubMed1999

Effect of pituitary microsurgery on acromegaly complicated nephrotic syndrome with focal segmental glomerulosclerosis: report of a rare clinical case.

A case of nephrotic syndrome complicated by acromegaly is presented. The first renal biopsy specimen showed minor glomerular abnormalities with glomerular hypertrophy, corresponding with minimal change nephrotic syndrome. Corticosteroid therapy led to a partial remission, followed by frequent relapses after reduction of the drug. A diagnosis of atypical focal segmental glomerulosclerosis (FSGS) was made based on the second renal biopsy results 6 months after the first. We combined steroid therapy with the administration of an anticoagulant, cytotoxic agents, angiotensin-converting enzyme inhibitor, and low-density lipoprotein adsorption. Except for the angiotensin-converting enzyme inhibitor, these medications were not effective in terms of allowing a reduction in the high dosage of steroid, which in turn threatened progressive osteoporosis and lumbar vertebrae fracture. Administering the steroid at a moderate dosage, treatment was focused on the complicating acromegaly from pituitary microadenoma. Subcutaneous injections of octreotide acetate, a somatostatin analogue, reduced proteinuria and increased urine volume. Subsequent transsphenoidal microsurgery of the adenoma resulted in the normalization of the elevated creatinine clearance and the further reduction in steroid dosage while maintaining a remission state. This is the first reported clinical case with acromegaly followed by FSGS, and it is suggested that hypersecretion of growth hormone participates in the development and progression of glomerular disease.

Acromegaly↗
PubMed2001

[Microsurgery and esthetic considerations. Two cases of heel reconstruction].

With two case reports of heel reconstruction on female patients the authors report the advantages and drawbacks of the two main types of reconstruction: free or regional flaps. Regional flaps are technically easy and reliable but their aesthetic after-effects on the donor site may be disabling, specially on the leg of a female patient. Microsurgery is technically more difficult and presents more complications specially on the lower limb. However, in certain conditions, and with the appropriate choice of donor site, free flaps authorize good quality reconstructions with minimal aesthetic after-effects.

Accidents, Occupational↗
PubMed1991

Transnasal microsurgery of Cushing's disease 1990. Overview including personal experiences with 256 patients.

The current concepts of differential diagnosis and therapy of Cushing's disease are reviewed. Our own results in a recent series of 103 patients are compared with patients treated by transsphenoidal microsurgery until 1986. In 97% as compared to 91% of prior series a discrete adenoma was found and selective adenomectomy led to remission in about 90%. The endocrine tests alone proved to be highly reliable to discriminate pituitary-dependent Cushing's disease from other forms of Cushing's syndrome. All our 3 patients without pituitary adenoma had some atypical endocrine tests. From these findings and results of other published series invasive investigations as inferior petrosal venous sampling may be reserved for equivocal cases. Magnetic resonance imaging now reveals two thirds of the micro-adenomas and provides the surgeon with excellent anatomical pictures. Rapid intraoperative measurement of peripituitary venous ACTH gradients may help to identify occult adenomas. In spite of different modes of therapy as pharmacological suppression of the adrenals and more sophisticated forms of radiotherapy, transsphenoidal microadenomectomy in experienced hands remains the most effective and the only immediately definite treatment of Cushing's disease.

Adrenocorticotropic Hormone↗
PubMed1987

[Effects of isoflurane on bleeding in microsurgery of the middle ear].

40 patients undergoing middle ear microsurgery were anaesthetized with a narconeuroleptanalgesia (droperidol, phenoperidine, thiopentone) associated with a randomly selected halogenated volatile anaesthetic, either halothane or isoflurane at a concentration of 1 MAC. Clinical and haemodynamic tolerance was perfect. Respiratory and haemodynamic parameters were not significantly different in either series at the different moments that were common to all the operations. There was less bleeding in the isoflurane group, and it was stable (p less than 0.01). Isoflurane would seem to have the double advantage of maintaining anaesthesia and producing a bloodless surgical field, so avoiding the use of added hypotensive agents.

Adult↗
PubMed1996

Vocal fold microsurgery in singers.

Some singers with benign vocal fold mucosal lesions remain unacceptably impaired vocally in spite of compliance with a regimen of medical treatment and voice therapy lasting several months-or even years. I present here my experience with 62 singers who, because of this predicament, chose to undergo vocal fold microsurgery. This series is the second largest reported to date in English literature. Procedures are presented which were used for patient selection, education, and vocal retraining, as well as for surgery itself and postoperative care. Results reported here include (a) comparison of my auditory-perceptual ratings of singing voice impairment before and after surgery, (b) preoperative versus postoperative videostroboscopic findings, (c) postoperative rate of return to public singing, and (d) postoperative patient questionaires which sought to uncover patient/singer perceptions of the results of vocal fold surgery. Excellent results were achieved overall with a very low incidence of untoward results, and no complications were encountered.

Cysts↗