ABSTRACT
A spinal extradural arachnoid cyst (SEAC) results from a rare small defect of the dura matter that leads to cerebrospinal fluid accumulation and communication defects between the cyst and the subarachnoid space. There is consensus for the treatment of the dural defect, but not for the treatment of the cyst. Some advocate a total resection of the cysts and repair of the communication site to prevent the recurrence of a SEAC, while others recommended more conservative therapy. Here we report the outcomes of selective laminectomy and closure of the dural defect for a 72-year-old and a 33-year-old woman. Magnetic resonance imaging of these patients showed an extradural cyst from T12 to L4 and an arachnoid cyst at the posterior epidural space of T12 to L2. For both patients, we surgically fenestrated the cyst and repaired the dural defect using a partial hemi-laminectomy. The patient’s symptoms dramatically subsided, and follow-up radiological images show a complete disappearance of the cyst in both patients. Our results suggest that fenestration of the cyst can be a safe and effective approach in treating SEACs compared to a classical complete resection of the cyst wall with multilevel laminectomy.
Subject(s)
Adult , Aged , Female , Humans , Arachnoid , Cerebrospinal Fluid , Consensus , Epidural Space , Fenestration, Labyrinth , Follow-Up Studies , Laminectomy , Magnetic Resonance Imaging , Recurrence , Subarachnoid SpaceABSTRACT
<p><b>OBJECTIVE</b>To compare the effects of small fenestra stapedotomy with semiconductor diode laser and microdrill in patients with otosclerosis.</p><p><b>METHODS</b>Twenty-six patients (29 ears) undergoing stapedotomy with semiconductor diode laser and 19 patients (21 ears) with microdrill were compared for the hearing results and complication rates.</p><p><b>RESULTS</b>No statistically significant differences were found in postoperative speech frequency and high frequency pure tone average in closing the air-bone gap between the two groups. The ears treated by stapedotomy with semiconductor diode laser showed significantly better preoperative minus the postoperative air-bone gap and milder dizziness.</p><p><b>CONCLUSION</b>In spite of the good hearing outcomes in both groups, small fenestra stapedotomy with semiconductor diodelaser can achieve better results and reduce the incidence of complications.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Fenestration, Labyrinth , Methods , Hearing Tests , Lasers, Semiconductor , Otosclerosis , General Surgery , Stapes Surgery , MethodsABSTRACT
<p><b>OBJECTIVE</b>To compare the effect of small fenestra stapedotomy and total stapedectomy in patients with otosclerosis.</p><p><b>METHODS</b>Twenty-seven patients (30 ears) undergoing small fenestra stapedotomy and 36 patients (43 ears) receiving total stapedectomy were compared for hearing results and complication rates.</p><p><b>RESULTS</b>No statistically significant differences were seen in postoperative speech pure tone average in closing air-bone gap between the two groups. The ears treated by small fenestra stapedotomy showed statistically better air-bone gap closure at high frequencies with lower rates of sensorineural hearing loss at high frequencies and milder dizziness.</p><p><b>CONCLUSION</b>In spite of the successful hearing outcomes in both groups, small fenestra stapedotomy can achieve better results at high frequencies and reduce the incidence of complications.</p>
Subject(s)
Female , Humans , Male , Fenestration, Labyrinth , Methods , Hearing Loss, Conductive , General Surgery , Otosclerosis , General Surgery , Postoperative Complications , Stapes Surgery , Treatment OutcomeABSTRACT
Se realizó un análisis retrospectivo de los pacientes sometidos a cirugía de Fontan con túnel lateral intra-atrial fenestrado, de enero de 1990 a mayo de 1996, indicada por alguno de los siguientes factores de riesgo: presión pulmonar media >20 mmHg; RVP >2 UW; fracción de expulsión <60 por ciento; presión diastólica final del ventrículo sistémico >8 mmHg; índices de tamaño de ramas pulmonares de Nakata <200mm²/m2 y/o McGoon <2. Los diagnósticos fueron: ausencia de conexión AV izquierda con disconrdancia ventrículo arterial y estenosis pulmonar. La media de edad de 6.7 años con límites de 2.5 y 11 años. La mortalidad fue del 23 por ciento y no se encontraron diferencias significativas entre el grupo de pacientes sobrevivientes y el de fallecidos. Estos últimos tenían entre 2 y 4 factores de riesgo. Como complicaciones postoperatorias destacan: un paciente con enteropatía perdedora de proteínas y otro con accidente vascular cerebral. El tiempo de drenaje pleural varió de 4 a 45 días con una media de 16 días. Se considera a la cirugía de Fontan con túnel lateral intra-atrial fenestrado como una variante útil para pacientes con cardiopatía congénita con un ventrículo hipoplásico y uno o más factores de riesgo para tolerar la reparación univentricular
Subject(s)
Humans , Male , Female , Child, Preschool , Adolescent , Heart Defects, Congenital/surgery , Heart Defects, Congenital/mortality , Comorbidity , Fenestration, Labyrinth , Fontan Procedure , Risk FactorsABSTRACT
El granuloma posestapedectomía es una complicación de la estapedectomía de causa desconocida y consiste en una reacción inflamatoria de reparación excesiva; si no se diagnóstica y trata a tiempo, lleva a un daño irreversible del oído. Su incidencia en los reportes internacionales es de 0.6 a 3 por ciento. En este estudio se revisaron los expedientes de 450 estapedectomías realizadas en los últimos cinco años en el Hospital de Especialidades del Centro Médico Nacional Siglo XXI, encontrando cinco casos de granuloma posestapedectomía que corresponden a una incidencia de 1.11 por ciento. Se revisa el cuadro clínico, diagnóstico, tratamiento y pronóstico, además de analizar su probable etiología.
Subject(s)
Otosclerosis/therapy , Fenestration, Labyrinth , Granuloma/etiology , Stapes Surgery/adverse effects , Ear Diseases/etiology , Ear, Middle/surgery , Auditory Perception/physiologyABSTRACT
Nos últimos anos todos os nossos pacientes portadores de hipoacusia provocada por otosclerose foram operados pela técnica de estapedotomia ou da microfenestra. Esta tem sido, aliás, a tendência moderna adotada pela maioria dos otologistas. A cirurgia é simples nos seus princípios e requer atençäo para com todos seus pormenores. A habilidade do especialista e a experiência adquirida com numerosas operaçöes o possibilitam enfrenter e contornar dificuldades que podem ocorrer em qualquer etapa de operaçäo. Atualmente, com o advento da estapedotomia ou técnica da microfenestra, os resultados cirúrgicos säo mais constantes do que os obtidos com a retirada total do estribo,a estapedectomia, que vigorou durante muitos anos como técnica de rotina. Ainda näo é possível avaliar-se com segurança as condiçöes de desenvolvimento do foco de otsclerose antes da cirurgia, nem o comportamento da doença depois da intervençäo, ambos fatores importantes no sucesso e na manutençäo do resultado imediato