The Outcome of Endoscopic Optic Nerve Decompression for Bilateral Traumatic Optic Neuropathy.

OBJECTIVE: To investigate the outcomes of endoscopic optic nerve decompression (EOND) for bilateral traumatic optic neuropathy (TON). METHODS: A retrospective analysis was conducted in 5 patients with bilateral TON, between January 2003 and December 2013. All the patients underwent preoperative ophthalmological evaluation, flash visual-evoked potentials, computed tomography scan, and systemic corticosteroid therapy. All the patients required an EOND surgery, due to poor response to medical therapy, and the remainder one was only treated with corticosteroid due to operative contraindication. RESULTS: Of the 5 patients (10 eyes) undergoing EOND, visual acuity improved in 30% of eyes (n = 3) with a mean follow-up of 3 months. The remainder 7 eyes still had no light perception. All of the 5 patients undergoing EOND had no operative complications. CONCLUSION: Treatment for bilateral TON should not be limited on the length of time to injury and visual-evoked potentials results. If surgical conditions permit and with no contraindications, patients should receive active surgical treatment as soon as possible.

[Diagonistic and prognostic analysis of olfactory neuroblastoma].

Objective:To explore the therapeutic effect and prognostic risk factors of olfactory neuroblastoma. Methods:Retrospective analysis of clinical data of 31 patients with olfactory neuroblastoma. The Kaplan-Meier method was used for survival analysis to calculate the overall survival rate and progress-free survival rate. Results:All 31 patients underwent surgical treatment and 7 patients died, of which 4 patients died of simple intracranial invasion and 3 patients died of concurrent distant metastasis （lung and spinal cord）. The average death time was 40.7 （20-57） months. Statistical analysis showed that craniocerebral invasion （P=0.035）, age ≥60 years （P=0.042）, and Ki-67≥20%（P=0.018） were closely related to the poor prognosis. It is speculated that the increase of T staging and modified Kadish staging are also predictors of poor prognosis. The 1-year and 5-year overall survival rates were 100.0% and 72.5%, and the 1-year and 5-year progress-free survival rates were 87.8% and 33.6% after first surgery. Conclusion:Surgery combined with radiotherapy and chemotherapy are the main treatments for olfactory neuroblastoma, but postoperative recurrence and metastasis are common. About 22.6% of the patients died during the follow-up. Advanced age, intracranial invasion and Ki-67≥20% are closely related to poor prognosis. The tumor was completely removed by the initial surgery and restricted in nasal cavity and sinuses are the key factors for a good prognosis.

[Clinical characteristics and surgical treatment analysis of paranasal ossifying fibroma].

Objective:To analyze the clinical features and discuss the treatment of ossifying fibroma in the nasal cavity and sinuses. Method:The patients were performed surgical treatment after admission. 6 cases were treated by endoscopic transnasal approach with image guidance system to resect the mass, 8 cases were operated by simple endoscopic approach, tumor resection was performed via endoscopic surgery with external approach in 2 cases, and endoscopic surgery combined with modified Caldwell-Luc procedure in 1 case. 1 patient was operated through labiolingual groove approach. Result:The intraoperative blood loss of ossified fibroma patients was large, with an average blood loss of 550ml. All the patients were followed up for 6 months to 8 years, 15 patients with complete resection had no recurrence after surgery, and 3 patients with partial resection survived with tumor. Conclusion:Ossifying fibroma in the nasal cavity and sinuses can be completely resected by nasal endoscopic surgery with less trauma and good effect. Transnasal endoscopic surgery assisted by image navigation system can protect important structures in lesions involving orbital cardboard and anterior skull base. Nasal endoscopic surgery combined with small eyebrow incision approach is feasible for ossifying fibroma invading frontal sinus. Ossifying fibroma, which requires adequate preoperative evaluation and blood preparation is prone to bleeding, and lesions with rich blood supply need preoperative interventional therapy.

Aberrant expression of miR-663 and transforming growth factor-ß1 in nasal polyposis in children.

The aim of the present study was to investigate the expression of microRNA (miR)-663 and its regulatory effects on the pathogenesis of nasal polyposis in children. Nasal polyp tissue, as well as serum and peripheral blood eosinophils were collected from 35 children diagnosed with nasal polypectomy between August 2013 and August 2015. As a control, the inferior nasal concha, serum and peripheral blood eosinophils were collected from 46 patients with nasal septal deviation complicated by inferior turbinate hypertrophy or patients with simple inferior turbinate hypertrophy who had undergone surgical removal of the inferior nasal concha. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was used to measure the expression of miR-663 and transforming growth factor-ß1 (TGF-ß1) in the nasal polyp tissue, serum and peripheral blood eosinophils of patients with nasal polyposis and controls. Western blotting was used to measure the expression of TGF-ß1 protein in nasal tissue and eosinophils and an enzyme-linked immunosorbent assay was used to measure serum level of TGF-ß1 protein. A dual luciferase reporter assay was used to determine whether TGF-ß1 was a target gene of miR-663. Compared with the control group, levels of TGF-ß1 mRNA and protein were significantly increased in all three types of specimens from pediatric patients with nasal polyposis (P<0.05). miR-663 expression was significantly decreased in nasal polyp tissue and peripheral blood eosinophils (P<0.05). The dual luciferase reporter assay confirmed that TGF-ß1 was a target gene of miR-663. The current study suggests that the upregulation of TGF-ß1 may be associated with the downregulation of miR-663 in nasal polyposis in children. miR-663 may have regulatory effects on the pathogenesis of nasal polyposis by regulating TGF-ß1 and may be developed as a genetic marker of nasal polyposis in children.

[The standardized perioperative treatment of chronic rhinosinusitis with nasal polyps and asthma].

OBJECTIVE: To discuss the perioperative treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma. METHOD: Retrospective analysis of perioperative clinical data of 43 cases with CRSwNP and asthma. The admitted and under endoscopic surgery. Patients with preventing perioperative asthma attacks and corresponding standardized treatment were Observed. RESULT: Thirty-five cases were stable during perioperative period and without asthma. Seven patients diagnosed as mild and moderate asthma attacks because of low pulse oximetry (SpO2 92%-95%) and scattered wheeze heard in the lungs. So these patients were sent to ICU for the treatment. They went back to ward after their conditions turned to stable and no asthma during perioperative. One patient diagnosed as severe asthma attack, because irritability and suffocation happened, SpO2 decreased from 99% to 84%-81%, diffuse wheeze could be heard in the whole lung . So we give him tracheal intubation and sent him to ICU for advanced treatment after breathing smooth. Five days later the patient retuned to the ward in stable condition and with no asthma attack again. CONCLUSION: Before operation the patients should be give some corresponding standardized comprehensive treatment according to the nasal symptoms and the degree of asthma attack, such as the application of topical steroid and antiallergic medicine. And some special treatment should be given to reduce airway hyperresponsiveness mucosa during anesthesia. These methods can reduce the risk of the asthma attacks and improve perioperative safety, prevent serious complications.

[Endoscopic endonasal approach resection for anterior skull base, pterygopalatine fossa and infratemporal fossa tumors: retrospective analysis of 73 patients].

OBJECTIVE: To summarize the clinical experience with endoscopic transnasal resection of nasal skull- base neoplasms, which involved anterior skull base, pterygopalatine fossa, nfratemporal fossa. METHOD: Clinical data from 73 patients performed on endoscopic transnasal resection of nasal skull-base neoplasms were analyzed retrospectively. RESULT: Total tumor removal was obtained in 54 cases, subtotal removal in 19 cases. In 16 cases of benign tumor, the postoperative survival rate was 100%; Malignancy in 57 cases, of which 16 patients were died, and half-year survival rate was 71.9%. CONCLUSION: Endoscopic endonasal approach be able to fully reveal and re- moval of lesions involving the anterior skull base, pterygopalatine fossa and infratemporal fossa. The approach is feasible and safe.

[Endoscopic optic nerve decompression in traumatic visual loss].

OBJECTIVE: To review our experience of treatment of optic nerve decompression in traumatic visual loss by using endoscopic technique. METHOD: Fourteen cases patients with traumatic visual loss were undergone endoscopic optic nerve decompression. All patients were followed up for 3-18 months. RESULT: Eight cases had improved visual acuity, and 6 cases did not. No complication had happened. CONCLUSION: Endoscopic optic nerve decompression is an appropriate technique for patients with traumatic visual loss. Even though high-dose steroid treatment has failed, optic nerve decompression may improve visual acuity.