当前位置: X-MOL 学术J. Neurosurg. Pediatr. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Surgical revascularization for pediatric moyamoya: the role of surgical mentorship in sustaining and developing a neurovascular service
Journal of Neurosurgery: Pediatrics ( IF 2.713 ) Pub Date : 2022-05-06 , DOI: 10.3171/2022.3.peds21590
Adikarige Haritha Dulanka Silva 1, 2 , Sanjay Bhate 2, 3 , Vijeya Ganesan 2, 3 , Dominic Thompson 1, 2 , Greg James 1, 2
Affiliation  

OBJECTIVE

Obtaining operative experience for the treatment of rare conditions in children represents a challenge for pediatric neurosurgeons. Starting in November 2017, a surgeon was mentored in surgical revascularization (SR) for pediatric moyamoya with a view to service development and sustainability. The aim of this audit was to evaluate early outcomes of SR for pediatric moyamoya during and following a surgical mentorship.

METHODS

A retrospective cohort study with chart/database review of consecutive moyamoya surgeries performed by a new attending surgeon (between November 2017 and March 2020) was compared to a previously published cohort from the authors’ institution in terms of clinical and angiographic outcomes, complications, operating time, and length of stay. A standardized technique of encephaloduroarteriomyosynangiosis with the superficial temporal artery was used.

RESULTS

Twenty-two children underwent 36 indirect SRs during the study period. Patient demographics were similar between cohorts. The first group of 6 patients had 11 SRs performed jointly by the new attending surgeon mentored by an established senior surgeon (group A), followed by 10 patients with 16 SRs performed independently by the new attending surgeon (group B). The last 6 patients had 9 SRs with the new attending surgeon mentoring a senior fellow (group C) in performing SR.

Good angiographic collateralization (Matsushima grades A and B) was observed in 80% of patients, with similar proportions across all 3 groups. A total of 18/19 symptomatic patients (95%) derived symptomatic benefit. There was no perioperative death and, compared to the historical cohort, a similar proportion had a recurrent arterial ischemic event (i.e., acute ischemic stroke) necessitating a second SR (1/22 vs 3/73). Operative times were longest in group C, with no difference in length of hospital stay among the 3 groups.

CONCLUSIONS

Early outcomes demonstrate the feasibility of mentorship for safely incorporating new neurosurgeons in sustaining and developing a tertiary-level surgical service.



中文翻译:

小儿烟雾病的外科血运重建:外科指导在维持和发展神经血管服务中的作用

客观的

获得治疗儿童罕见病症的手术经验对儿科神经外科医生来说是一个挑战。从 2017 年 11 月开始,一名外科医生接受了针对小儿烟雾病的外科血运重建 (SR) 方面的指导,以期实现服务发展和可持续性。本次审计的目的是评估 SR 在手术指导期间和之后对小儿烟雾病的早期结果。

方法

一项回顾性队列研究对一名新主治外科医生(2017 年 11 月至 2020 年 3 月期间)进行的连续烟雾病手术进行了图表/数据库审查,并在临床和血管造影结果、并发症、手术方面与作者所在机构先前发表的队列进行了比较时间和停留时间。使用了颞浅动脉的脑硬膜动脉肌肉血管病的标准化技术。

结果

22 名儿童在研究期间接受了 36 次间接 SR。队列之间的患者人口统计数据相似。第一组 6 名患者由新的主治外科医生在资深外科医生的指导下共同完成 11 次 SR(A 组),随后是 10 名患者,由新的主治外科医生独立完成 16 次 SR(B 组)。最后 6 名患者有 9 次 SR,新的主治外科医生指导高级研究员(C 组)执行 SR。

在 80% 的患者中观察到良好的血管造影抵押(松岛 A 级和 B 级),所有 3 组的比例相似。共有 18/19 名有症状的患者 (95%) 获得了症状益处。没有围手术期死亡,并且与历史队列相比,有相似比例的复发性动脉缺血事件(即急性缺血性卒中)需要第二次 SR(1/22 对 3/73)。C组手术时间最长,三组住院时间无差异。

结论

早期结果证明了指导新神经外科医生安全地维持和发展三级外科服务的可行性。

更新日期:2022-05-06
down
wechat
bug