Cleveland Clinic Florida

Idiopathic intracranial hypertension (IIH) features elevated intracranial pressure (ICP) without a secondary cause. Trigeminal neuralgia (TN), usually attributed to neurovascular conflict (NVC), has been reported only rarely in association with IIH. We reviewed the literature and present three institutional cases to better characterize this association while explicitly acknowledging the limits of case-based causal inference. We systematically searched PubMed, Ovid Medline, Ovid Embase, Scopus, and Web of Science from inception through August 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The core search combined terms for idiopathic intracranial hypertension or pseudotumor cerebri with trigeminal neuralgia, trigeminal neuropathy, and facial pain. Because causal attribution from case reports is limited, we applied a qualitative framework based on temporality, objective evidence of raised ICP, exclusion of more convincing alternative causes, especially definite NVC, and response to ICP-lowering therapy. Methodological quality was appraised using the Joanna Briggs Institute case report checklist. Quantitative summaries were restricted to published TN phenotypes; trigeminal neuropathy without pain and persistent idiopathic facial pain were summarized separately. Out of 1302 records, 12 case reports met the criteria. Nine described TN, two involved trigeminal neuropathy without pain, and one involved a persistent idiopathic facial pain phenotype. Across the nine TN cases, all patients were female (mean age 38.7 ± 12.5 years). Reported opening pressure ranged from 220 to 480 mmH2O (mean 393.0 ± 89.2 mmH2O), although diagnostic certainty varied, and not all cases fulfilled the full Friedman criteria for definite IIH. Maxillary (V2) and mandibular (V3) involvement predominated, and multidivisional pain was common. Imaging features of raised ICP and improvement after ICP-lowering therapy were recurrent themes, but standardized high-resolution trigeminal magnetic resonance imaging (MRI) sequences were inconsistently reported, limiting exclusion of coexisting classical TN. We additionally describe three institutional cases: two with documented elevated opening pressure (290 and 320 mmH2O) and one probable ICP-related case with suggestive imaging but unavailable opening pressure. In the institutional cohort, dedicated Constructive Interference in Steady State (CISS) or Fast Imaging Employing Steady-state Acquisition (FIESTA) assessment was not uniformly available; in one case, venous contact was of uncertain significance, and in another, microvascular decompression was performed without operative confirmation of arterial compression or pain relief. TN associated with IIH is a rarely reported association. Given the limited case-based evidence, the available data should be regarded as hypothesis-generating rather than definitively causal. When objective intracranial hypertension is present, careful evaluation of both ICP-related markers and alternative TN mechanisms, including NVC, is essential. ICP-lowering therapy has been reported to improve pain in some cases and may address a potential contributing mechanism.

Indocyanine green fluorescence angiography is being increasingly used in colorectal surgery to reduce anastomotic leak risk, but few studies have analyzed its cost efficacy. In this study, cost modeling was used to compare costs in the United States using versus not using indocyanine green fluorescence angiography. Exhaustive searches of PubMed/MEDLINE, EMBASE, and Scopus were used to identify all meta-analyses and randomized controlled trials assessing the effectiveness of indocyanine green fluorescence angiography in reducing anastomotic leaks. Additionally, we conducted our own meta-analysis restricted to randomized controlled trials with ≥100 patients in both indocyanine green fluorescence angiography and control groups. Three years (2021-2023) of Medicare Provider Analysis and Review billing data were then employed to identify direct health care costs. Minimum, intermediate, and maximum cost analysis models were created using indocyanine green fluorescence angiography-associated anastomotic leak reduction rates identified by synthesizing the results of meta-analyses and randomized controlled trials, procedural and complication-related costs identified via Medicare Provider Analysis and Review, and $225 as the per-unit cost of indocyanine green administration. Synthesis of the results of our own and 19 published meta-analyses revealed a 51.9% reduction in anastomotic leak rate with indocyanine green fluorescence angiography, whereas 5 meta-analyses restricted to randomized controlled trials, including our own, revealed level 1 evidence of at least a 36.5% reduction. Minimum and maximum cost analysis models were generated using conservative anastomotic leak reduction rates of 35% and 50%, from which mean per-patient cost reductions ranged from $962 to $1,138, and overall health care system savings ranged from $71 million to $84 million. For anastomotic assessments in colorectal surgery, indocyanine green fluorescence angiography reduces direct per-patient health care costs in the United States by $962 to $1,138. Additional savings may be derived from reduced rehospitalization and reoperation rates.

Abstract Purpose of Review To evaluate whether current evidence supports the use of robotic-assisted techniques over laparoscopic approaches in bariatric surgery. Background Robotic platforms have gained popularity in minimally invasive surgery, including bariatric procedures, due to their ergonomic and technical advantages. However, concerns persist regarding the cost-effectiveness and clinical benefits relative to laparoscopy. Brief Summary This review critically analyzes the existing literature comparing robotic and laparoscopic bariatric surgery, focusing on cost, operative outcomes, complication rates, and applicability in complex cases. The findings demonstrate that while robotic surgery is safe and feasible, it incurs significantly higher costs without providing superior weight loss, complication reduction, or metabolic outcomes. Even in high-risk subgroups such as revisional or super-obese patients, the clinical advantages remain marginal and inconsistent. Current data, primarily from retrospective studies, do not justify the routine adoption of robotics in bariatric surgery.

Carotid body tumors (CBTs) are rare paragangliomas arising at the carotid bifurcation, with Shamblin III lesions posing substantial operative risk due to circumferential arterial encasement. When arterial resection and reconstruction are required, reliable confirmation of carotid perfusion is essential. This is the case of a 24-year-old male patient with a right-sided Shamblin III CBT managed with preoperative embolization, segmental internal fluorescence-guided carotid artery resection, and end-to-end reconstruction. Intraoperative indocyanine green fluorescence angiography (ICG-FA) demonstrated immediate, homogeneous perfusion across the reconstructed segment, with no delay or focal hypofluorescence. The postoperative course was uneventful, with no neurologic or vascular complications. This case illustrates the potential role of intraoperative ICG-FA as a real-time adjunct to confirm carotid patency and perfusion following complex vascular tumor resection.

Radiation-induced colorectal strictures represent a challenging late complication of pelvic malignancy treatment, often accompanied by extensive fibrosis and multi-organ involvement. We report the case of a 55-year-old female with a history of cervical cancer treated with pelvic radiation, complicated by radiation proctitis, diverticular disease, pelvic adhesions, and bilateral ureteral obstruction, who underwent a single-stage multidisciplinary surgical reconstruction. The procedure included colostomy takedown, rectosigmoid resection with coloanal anastomosis, pelvic abscess debridement, diverting loop ileostomy creation, total abdominal hysterectomy, ileoureteral conduit formation, and ventral hernia repair with myocutaneous flap closure. The postoperative course was complicated by a high-output ileostomy resulting in electrolyte derangements, acute kidney injury, and malnutrition, requiring coordinated medical management with antidiarrheal therapy, electrolyte repletion, and nutritional support. This case underscores the complexity of late radiation sequelae and highlights the importance of multidisciplinary collaboration in achieving successful surgical and medical outcomes.

Introduction: Estrogen, alone or with progesterone, increases thromboembolic risk, especially with migraine with aura, smoking, or cardiovascular disease. Evidence on stroke risk from exogenous hormones across age groups is limited, particularly regarding migraine as a modifier. We conducted an exploratory analysis of stroke odds with sex steroid prescriptions among young women using Colorado claims data. Hypothesis: Exogenous sex steroids may affect stroke risk differently by age in young women, possibly due to age-related hormone fluctuations Methodology: We performed a secondary analysis of retrospective case–control data from Colorado’s All Payer Claims Database (2012–2019). Hormone exposure was defined as a sex steroid prescription within 1 year before index stroke in women aged 18–55. Stroke cases were matched to controls by age, sex, prestroke period, and insurance. Conditional logistic regression evaluated stroke odds for estrogen alone, progesterone alone, and combined exposure (concurrent or separate) in the year before stroke. Cohorts were stratified into 3 age groups, analyzed independent of migraine history and by migraine status. Models adjusted for socioeconomic status, language, cardiovascular and non-cardiovascular risk factors, menopause,&pregnancy/postpartum status Results: Our model included 1,369 cases and 4,083 matched controls, stratified by age. More controls had no risk factors than cases (Table 1). Women 18–34 and 35–44 on combined estrogen–progesterone had increased stroke odds (OR 1.91, 95%CI 1.23–2.95, p=0.004; OR 2.32, 95%CI 1.37–3.92, p=0.002), but not 45–55. Women 35–44 on estrogen alone also had increased odds (OR 2.61, 95%CI 1.28–5.33, p=0.009). Progesterone-only prescriptions were not associated with stroke. Migraine was associated with increased stroke odds: OR 2.96 (95%CI 2.02–4.33) for 18–34, OR 2.04 (95%CI 1.48–2.81) for 35–44, and OR 1.61 (95%CI 1.32–1.97) for 45–55 (all p<0.001) but when evaluted by hormone exposure did not increased odds across groups. Women without migraine, combined estrogen–progesterone increased stroke odds in all ages: OR 2.68 (95%CI 1.56–4.61) for 18–34, OR 3.23 (95%CI 1.65–6.32) for 35–44, and OR 1.62 (95%CI 1.01–2.60) for 45–55. Estrogen-only increased odds in 35–44 (OR 5.24, 95%CI 2.22–12.39) Conclusion: Combined estrogen–progesterone use were associated with higher stroke odds overall&in women without migraine. No association was seen between sex steroid and stroke in women with migraine