ABSTRACT
Background: Synovial cysts are benign fluid-filled sacs commonly found in the degenerative lumbar spine. Few studies have reported the detailed epidemiology and standardized therapy for this disease. Conservative treatment is recommended if synovial cysts are asymptomatic or show mild clinical symptoms. If percutaneous facet joint steroid injections are ineffective or neurologic symptoms are aggravated, the open decompression with additional fusion is the reasonable surgical strategy to remove the pain generator. Furthermore, the synovial cysts that occur at the cervicothoracic spine are infrequently, especially accompanied by hemorrhagic radiographic evidence. Therefore, we describe the efficacy and safety of the full-endoscopy surgical procedure assisted by intraoperative O-arm navigation guidance to manage C7/T1 spinal synovial cysts. Case description: We describe a 71-year-old male patient diagnosed with cervicothoracic hemorrhagic synovial cysts. The pathologic site is located at the posterior side of the C7 vertebral body to the medial side of the C7-T1 left facet joint. Herein is described a step-by-step protocol for the full-endoscopic procedure via the posterior approach to remove the lesions under intraoperative O-arm navigation guidance. Outcome: The patient was successfully treated via full-endoscopic removal of the synovial cysts guided by intraoperative O-arm navigation. Intraoperative bleeding of 30 mL occurred, and the operative time was 150 minutes. The patient's sensory strength improved, and no opioid medicine was required with no complications postoperatively. One-year follow-up magnetic resonance imaging (MRI) and computed tomography (CT) scans showed no synovial cyst recurrence. Conclusions: Full-endoscopy assisted with intraoperative O-arm navigation guidance improves precision and safety in treating patients with synovial cysts of the cervicothoracic spine. The O-arm navigation system improves the efficiency and safety of intraoperative positioning at the cervicothoracic lesion and reduces radiation exposure to the surgeons. Meanwhile, this technique preserves the range of cervicothoracic motion and facilitates the patient return to normal life.
ABSTRACT
INTRODUCTION: The impact of obesity on survival outcomes in patients with glioblastoma (GBM) has not been well reported and the results for patients are currently unclear. We investigated the effect of obesity on survival outcomes in patients with newly diagnosed GBM. METHODS: Using electronic medical records, all GBM patients that visited the Seoul St. Mary's Hospital between 2008 and 2018 were reviewed. A total of 177 patients met our eligibility criteria. The cut-off point for BMI was 23.0 kg/m2 based on previous studies which focused on Asian populations. RESULTS: A total of 177 patients met our eligibility criteria. The overall median BMI of patients was 24.5 kg/m2 (range 15.82-39.26). About 62 patients who had a BMI less than the cut-off value were assigned to the "lower BMI" group, while 115 patients who had a BMI greater than the cut-off value were assigned to the "higher BMI" group. In Kaplan-Meier survival analysis, the median OS of the higher BMI group was longer than that of the lower BMI group (21.3 months vs 15.3 months, P = .002). In multivariate Cox regression analysis for OS, lower BMI was associated with inferior OS (HR 1.48 CI 1.06-2.08, P = .002). CONCLUSION: Our findings suggest that elevated BMI may be associated with better survival in patients with newly diagnosed GBM. Additional larger prospective studies could help validate our findings to confirm the effect of body composition and survival outcomes in GBM patients.
