Ancient schwannoma is an uncommon variant of schwannoma. While many reports have presented defining histologic and clinical features of ancient schwannoma, there are only a very few cases in the literature, to our knowledge, of ancient schwannoma presenting at the cauda equina. The current report of ancient schwannoma presenting at the cauda equina adds to the literature and discusses the identification of specific histologic characteristics, the role of conservative medical management, surgical resection, and prognostication in this select subset of patients.
implementing a quality improvement protocol in January 2022 in which pulse rate and frame rate were reduced from 15 p/s to 7.5 p/s and 7.5 f/s to 4.0 f/s respectively. We studied consecutive, unilateral middle meningeal artery embolizations treated with particles. Total radiation dose, radiation per angiographic run, total radiation exposure, and exposure per run were calculated. Multivariable log-linear regression was performed to account for patient body mass index (BMI), number of angiographic runs, and number of vessels catheterized. Statistical analysis was performed using STATA MP Version 17.0 (Stata Corp LP, College Station, Texas). Significance was defined as p < 0.05. Results A total of 16 consecutive, unilateral middle meningeal artery embolizations were retrospectively analyzed, 8 prior to the protocol change and 8 after (table 1). Univariable analysis revealed that radiation dose (660.9 vs. 407.5 mGy, p=0.002), radiation dose per angiographic run (40.3 vs. 25.7, p<0.001), total radiation exposure (8825.8 vs. 5510.4 mGym 2 , p=0.002), and exposure per run (537.9 vs. 353.5, p=0.002) were all significantly decreased after the protocol was implemented. Average patient BMI, fluoroscopy time, number of vessels catheterized, and number of angiographic runs did not differ between groups, demonstrating consistency in practice despite the change in protocol.On multivariable log-linear regression adjusting for BMI, number of runs, vessels catheterized, and fluoroscopy time, the radiation reduction protocol was associated with a 33.8% decrease in the total radiation dose (95% Confidence Interval [CI] 8.0-59.6%, p=0.015) and a 34.8% decrease in radiation dose per run (11.7-57.8%, p=0.007). The protocol was associated with a 32.8% decrease in the total radiation exposure (6.5-59.1%), p=0.019) and a 33.8% decrease in exposure per run (10.0-57.6, p=0.010). Conclusion Radiation reduction protocols can be readily applied to neuroendovascular interventions without increasing overall fluoroscopy time and reduce radiation dose and exposure by 32.8% and 33.8% respectively. We strongly encourage all interventionalists to be cognizant of pulse rate and frame rate when performing routine interventions to avoid unnecessary radiation towards patients, providers, and health care staff.
Autosomal dominant polycystic kidney disease (ADPKD) is a connective tissue disease with vascular abnormalities involving multiple organs. The prevalence of ADPKD associated with a spontaneous subdural hematoma (SDH) is very low, with less than 10 cases reported in the literature to date. Symptomatic chronic SDH is classically treated with a twist drill, burr holes, or craniotomy. Recently, middle meningeal artery (MMA) embolization has emerged as an ancillary modality. We present the first case in the literature of a bilateral SDH in a young ADPKD patient successfully managed with MMA embolization. Moreover, we discuss the role of different treatment modalities on this subset of patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.