Surgeries, Volume 1, Issue 2 (December 2020) – 4 articles

We present a case of a 75-year-old patient who underwent reconstruction of the lower eyelid and lateral canthus following removal of 80% of the lower eyelid due to basal cell carcinoma. A Hughes transconjunctival eyelid-sharing flap was used to form the posterior lamella, and a free skin graft from the ipsilateral upper lid was used to recreate the anterior lamella. The lateral canthal ligament was reconstructed using a free fascia lata graft. A periosteal flap was not used due to local scarring that was the result of previous multiple lateral canthal surgeries. Skin preservation in the lateral canthal area and additional horizontal support for the lower eyelid were achieved by using a local advancement flap. This two-stage surgery produced excellent functional and cosmetic effects. Fascia lata free graft can be an alternative to the periosteal flap for reconstruction of the lateral canthal ligament when use of the lateral orbital periosteum is not feasible. Full article

Patient-reported outcome measures (PROMs) have become an important aspect of quality control in modern healthcare. In this prospective observational study on 199 patients undergoing thoracolumbar stabilization surgery, we quantified preoperative expectations and PROMs at six and twelve months after surgery, and we investigated what constitutes patient satisfaction with the outcome. We used the visual analogue scale (VAS) for pain and the Oswestry Disability Index (ODI). Preoperative expectations were high (expected ODI: 9 ± 13%; leg pain: 1.0 ± 1.4; back pain: 1.3 ± 1.5). Pain and disability improved substantially, but expectations were mostly unrealistic (ODI expectation fulfilled after six months: 28% of patients; back pain: 48%). However, satisfaction was high (70% at six months after surgery). Satisfied patients had significantly better pain and disability outcomes and higher rates of expectation fulfillment than non-satisfied patients. Patients undergoing revision stabilization had worse outcomes than all other diagnosis groups. Prior stabilization surgery was identified as an independent risk factor for dissatisfaction. There were no preoperative pain or disability levels that predicted dissatisfaction. The data presented in this study can provide benchmarks for diagnosis-specific PROM targets in thoracolumbar stabilization surgery. Future studies should investigate whether satisfaction can be influenced, e.g., by discussing realistic outcome targets with patients ahead of surgery. Full article

Spinal dural arterio-venous fistulas (SDAVF) are rare vascular pathologies. Degree of symptom improvement after surgery remains unclear. We evaluated surgically treated SDAVF patients for functional outcome and symptom improvement. Retrospective inclusion of consecutive patients treated surgically in our department between 2007–2019. We measured functional outcome using the McCormick Scale and modified Japanese Orthopaedic Association (mJOA) score. We included 27 patients with a median follow-up of 8.8 months (IQR 27.8). Mean age was 61.8 years (SD 8.4), 40.7% were female. Most frequent location was the thoracic spine in 15 (55.6%) followed by lumbar in 8 (29.6%), cervical in 3 (11.1%) and sacral spine in one patient (3.7%). Most common presenting symptom was progressive myelopathy (24/27 patients, 88.9%). In all patients the SDAVF was completely resected; however, four patients (14.8%) required a second surgery. Six patients (22.2%) deteriorated immediately after surgery with five recovering to baseline upon discharge. On discharge, presenting symptoms had improved in 17 patients (63%); 8/25 patients (32%) had a McCormick score of 1. Twenty (74.1%) continued to improve on follow-up. In total 23/27 patients (85.2%) improved. In the univariable analysis mJOA score on admission was associated with mJOA score on follow-up (coefficient 0.6, 95%CI 0.4–0.81, p < 0.001), whereas age was inversely associated (coefficient −0.1, 95%CI −0.19–0.01, p = 0.08). Untreated SDAVF leads to progressive myelopathy which may result in considerable disability. Surgical disconnection and resection provides a safe treatment option with low perioperative morbidity and excellent chances for symptom improvement or progression prevention. Full article

Warthin’s tumor (WT) is the second most common benign tumor of the parotid gland. Located almost exclusively in the parotid gland and presenting a slow growth rate, WT usually does not exceed 4 cm and rarely benefits from early surgical treatment. The aim of this paper is to present a case of giant parotid Warthin’s tumor. The occurrence of large and deforming WT is rare, previous research showed a single similar reported case. The patient’s computed tomography scans showed a solid and cystic 15 × 13 cm² mass of the parotid gland, without visible signs of invading the adjacent structures. Superficial parotidectomy with tumor excision was performed, with preservation of glandular and facial nerve functions. The paper also presents a brief literature review addressing the main controversies regarding etiopathology, epidemiology, diagnostic methods and treatment options for this parotid gland tumor. Full article