32,51,54 Simple reconstruction involves in situ elevation and plating of the sinus wall fracture with preservation of the nasofrontal ducts and sinus mucosa. Repair options for frontal sinus fractures include reconstruction, obliteration, and cranialization. Stiver, in Schmidek and Sweet Operative Neurosurgical Techniques (Sixth Edition), 2012 Methods Because most patients have hepatic cirrhosis secondary to hepatitis B or C and BRTO does not have a direct effect on liver cirrhosis, these improvements in hepatic function and portosystemic encephalopathy would be transient, and long-term efficacy would depend on the extent of residual hepatic function. 6,26–28 These effects on hepatic function and portosystemic encephalopathy are due to an increase in hepatofugal portal flow as a result of obliteration of a large shunt. 18,25 Several authors have reported improvement in hepatic function, including serum albumin levels, indocyanine green test, and symptoms of portosystemic encephalopathy after BRTO. 8 In two studies of BRTO for bleeding gastric varices, rebleeding after BRTO occurred in 0% and 9%. investigated prognostic factors in 78 patients after BRTO and demonstrated that the presence of hepatocellular carcinoma (relative risk 24.342) and the Child-Pugh classification (relative risk 5.780) were statistically associated with decreased survival after BRTO. Therefore, CT performed 1 to 2 weeks after BRTO can predict the long-term efficacy of BRTO. By contrast, in all 58 cases in which complete thrombosis of gastric varices was observed on CT 1 to 2 weeks after BRTO, no recurrences developed. In all 5 recurrences, partial thrombosis of the gastric varices was noted on follow-up CT 1 or 2 weeks after BRTO. From our data, including 69 cases monitored over a period of 6 months, recurrence or regrowth of gastric varices was observed in 5 cases (7.2%) on follow-up endoscopy.
Some studies with long-term follow-up have shown recurrent gastric varices in 0% to 10% of cases. Reported technical success rates for BRTO procedures have ranged from 90% to 100%, and regression or disappearance of gastric varices on endoscopy was achieved in 80% to 100% of patients after BRTO. Hiro Kiyosue, Hiromu Mori, in Image-Guided Interventions (Third Edition), 2020 Outcomes
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