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Objective Electromagnetic navigation was used to observe and measure important anatomical structures through endoscopic endoscopic approach (EEA) to the ventral skull base to provide data for clinical surgery. Methods Using electromagnetic navigation to measure the anatomical structure of the central and paracentral ventral skull base on 10 fresh cadavers, the internal carotid artery (ICA) was the most important. Results Electromagnetic navigation helped to determine the course of important neurovascular. The ICA of the ventral skull base was divided into 5 segments+ 7 major branches, and the length and course of each were measured and recorded. Conclusion The identification and protection of ICA is the key to EEA treatment of ventral skull base lesions, and electromagnetic navigation assistance can improve the efficiency and safety of EEA surgery.
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<p><b>OBJECTIVE</b>To evaluate the long-term results of combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy for mixed cystic and solid craniopharyngiomas.</p><p><b>METHODS</b>Sixty-seven consecutive patients with mixed cystic and solid craniopharyngioma treated by Gamma Knife radiosurgery combined with stereotactic brachytherapy from October 1996 to December 2005 were selected for retrospective analysis. The inclusion criterion was the patients who survived for at least 5 years after combined treatment. There were 39 male and 28 female patients and the mean age was 31.5 years (ranged from 3 to 70 years). The clinical evaluations including neurological, neuro-ophthalmological, and neuro-endocrinological examinations, assessment of comprehensive quality of life and neuroimaging examinations were performed periodically. The actuarial survival rates and the mean survival time were calculated by using Kaplan-Meier product limit method. The rates were compared using the χ(2) test.</p><p><b>RESULTS</b>Follow-up period varied from 60 to 168 months, with an average of 114 months. The tumor response rate gained from combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy for predominantly solid and cystic craniopharyngiomas were 10/12 and 90.9% respectively, and 89.6% in all. Mean survival after combination treatment was (110 ± 9) months. The mean survival of patients with predominantly solid and cystic craniopharyngioma were (97 ± 12) months and (120 ± 14) months and the actuarial 10-year survival rates were 7/12 and 69.1%. There was no statistics difference in tumor response rate and 10-year survival rate between 2 groups of patients with predominantly solid and cystic craniopharyngioma. The actuarial 5-, 6-, 7-, 8-, 9- and 10-year survival rates were 90.5%, 85.7%, 83.3%, 76.4%, 69.4% and 60.0% respectively. The decreased visual acuity had improved in 68.3% at 6 months postoperatively and in 70.0% in long term results. Comprehensive quality of life in long term follow-up of 67 patients was excellent in 28 cases(41.8%), good in 19 cases(28.4%), fair in 17 cases(25.4%) and poor in 3 cases(4.5%), respectively. The side effects that occurred 6 to 12 months after treatment were worsening of visual acuity (4 patients), dysfunction of hypothalam (4 patients) and third nerve palsy was found in 1 patents 5 years after treatment. The rate of complications was 13.4%.</p><p><b>CONCLUSION</b>Combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy is highly effective and safety in the treatment of mixed cystic and solid craniopharyngiomas.</p>
Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Combined Modality Therapy , Craniopharyngioma , General Surgery , Follow-Up Studies , Imaging, Three-Dimensional , Pituitary Neoplasms , General Surgery , Radiosurgery , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
Objective To investigate the clinical characteristics and treatment choice of patients with multiloculated pyogenic brain abscess (MLPBA).Methods The clinical data of 89 patients with pyogenic brain abscess (including 20 with MLPBA and 69 with uniloculated pyogenic brain abscess [ULPBA]) treated during the recent 21 years (1991-2011) were collected and analyzed retrospectively.Results MLPBA patients counted for 22.5％ of our patients with pyogenic brain abscess.The male-female ratio,age distribution,history duration,location of abscess,kinds of isolated microorganisms,predisposing factors and clinical manifestations of patients with MCPAB were similar to those of patients with ULPBA.The ratio of positive isolated microorganism and ratio breaking into ventricles in patients with MLPBA were significantly higher than those in patients with ULPBA (P＜0.05); and the average volume of abscess was 8.8 mL in patients with MLPBA and 13.3 mL in patients with ULPBA.A higher rate of abscess recurrence after stereotactic surgery in patients with MLPBA (26.7％) was found as compared with that in patients with ULPBA (3.2％).The mortality in patients with MLPBA was 0％ and that in patients with ULPBA was 4.3％.Conclusion MLPBA is not rare; the volume of abscess in patients with MLPBA is significantly smaller than that in patients with ULPBA,but the abscess in patients with MLPBA is significantly easier broken into the ventricles than that of ULPBA.Stereotactic operation is the first treatment choice; the prognosis for patients with MLPBA can be as good as that for patients with ULPBA,although the possibility of recurrent abscess formation after surgery is higher.
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Objective To investigate the value of endoscopic biopsy and third ventriculostomy in the diagnosis and treatment of pineal germ cell tumors. Methods Endoscopic biopsy and third ventricuiostomy were performed in 20 patients with pineal tumors to relieve obstructive hydrocephalus and determine the nature of the neoplasms. Results CT and magnetic resonance imaging confirmed successful third ventriculostomy and biopsy in the 20 cases with total relief of obstructive hydrocephalus. The diagnoses of germ cell tumors were established in all this cases. Conclusions Endoscopic biopsy and third ventriculostomy are effective and safe neuroendoscopic procedures in minimally invasive management of pineal region germ cell tumors.