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Objective:To study the cause of frontal sinusitis and the prevention methods after opened frontal sinus in the trans-frontal approach surgery.Methods:Retrospectively analyze 18 cases of frontal sinusitis secondary to the trans-frontal approach surgery in Sanbo Brain Hospital, Capital Medical University from January 2016 to December 2020. The main symptoms include headache, stuffy nose, skin redness and skin abscess in frontal. The mean history was 3.2 years, all the patients were performed surgical treatment, including 5 patients undergone trans-nasal trans-sphenoid sinus operation, 14 patients undergone debridement surgery following the original surgical approach. The cause of frontal sinusitis were analyzed statistically.Results:All the patients were totally cured post operation, the standard included no frontal sinus inflammation symptoms, no imaging characters of frontal sinusitis.Conclusions:Proper management of opened frontal sinus in trans-frontal approach is very important for preventing the frontal sinusitis. Completely remove the frontal sinus mucosa, avoid using bone wax, chemical glue stuffing, which can effectively prevent the frontal sinusitis.
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Objective:To analyze the surgical (anatomical) approach of craniopharyngioma based on the concept of anterior central space of brain base.Methods:The clinical data of MRI images of 10 cases of craniopharyngioma who treated in Sanbo Brain Hospital, Capital Medical University from January 2021 to December 2021 were analyzed retrospectively. The brain cisterns involved in the growth of craniopharyngioma were analyzed from the perspective of anterior central space of brain base. Meanwhile, the surgical approach and the basis of selection were discussed.Results:Among all the surgical approaches that can reach the anterior central space of the brain base, the fronto-basal interhemispheric approach was the best.Conclusions:The concept of anterior central space of the brain base is a new observation and interpretation of the anatomy of the brain base from a new perspective, and then create a new concept of brain base surgery. As a new method to analyze the surgical anatomy of this area, its inclusion has important clinical significance.
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Objective:To investigate the surgical method and curative effect of resection of craniopharyngioma through sub-frontal longitudinal fissure duramater-keyhole approach.Methods:The clinical data, imaging data of 179 patients with craniopharyngioma treated by sub-frontal longitudinal fissure duramater-keyhole approach from January 2017 to January 2021 in Sanbo Brain Hospital Capital Medical University were studied retrospectively.Results:Through this approach, total resection in 175 cases (97.77%), near total resection in 2 cases (1.12%), partial resection in 2 cases (1.12%); drilling of the tuberculum sellae in 31 cases (17.32%); the pituitary stalk was reserved in166 cases (92.74%), preserved in 13cases (7.26%); papillary craniopharyngioma in 27 cases (15.08%), ameloblastic craniopharyngioma in 152cases (84.92%); postoperative visual acuity improved in 65 cases (36.31%), not improved in 53 cases (29.61%), decreased in 6 cases (3.35%); electrolyte disorder in 101 cases (56.42%), polydipsia and polyuria in 65cases (36.31%), cerebrospinal fluid rhinorrhea in 3 cases (1.68%), hydrocephalus in 6 cases (3.35%). Postoperative hematoma in 2 (1.12%) cases and cerebral infarction in 6 cases (3.35%), intracranial infection in 8 cases (4.47%), postoperative disturbance of consciousness in 4 cases (2.23%) and death in 3cases (1.68%).Conclusions:Sub-frontallongitudinal fissure duramater-keyhole approach is an effective combination of minimally invasive and delicate surgery principle. It is a safe and effective method for the treatment of craniopharyngioma.
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Objective:To investigate the clinical and neuroimaging features of atypical teratoid/rhabdoid tumors (AT/RT) of the central nervous system and the survival prognosis in different locations.Methods:The clinical data of 27 patients with AT/RT confirmed by biopsy or postoperative pathology in Sanbo Brain Hospital of Capital Medical University from October 2012 to September 2020 were collected, including 17 males and 10 females, aged (7.6±10.0) years, ranging from 0.2 to 39.0 years old.The clinical features and the results of the first preoperative imaging examination were retrospectively analyzed.The patients were divided into supratentorial, infratentorial and trans supratentorial and infratentorial groups according to the location.The survival time of the three groups was compared by Kaplan-Meier survival curve.Results:All patients presented with headache, including 12 cases with vomiting.There were 12 cases of supratentorial, 10 cases of infratentorial and 5 cases of supratentorial and infratentorial.There were 20 cases of cystic degeneration, 7 cases of calcification, 6 cases of hemorrhage and 13 cases of peritumoral edema.The median survival time of patients with infratentorial AT/RT was longer than that of patients with supratentorial and transtentorial AT/RT (χ 2=7.353, P=0.025). Conclusion:Central nervous system AT/RT is easy to occur in young children, and the survival time of AT/RT patients is longer.
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Objective:To explore the surgical method and clinical effect of craniopharyngioma resection through the cockscomb approach.Methods:A retrospective case-control study was conducted from December 2010 to May 2018.The clinical data, imaging data and follow-up data of 101 patients with craniopharyngioma confirmed by pathology by pathology after resection of the frontal floor longitudinal fissure through the crow′s comb approach were performed in Department of Neurosurgery, Sanbo Brain Hospital Capital Medical University.The total tumor resection rate, mortality and complications were analyzed by statistical methods.Results:Through this approach, the total resection rate of tumor was 90.1%(91/101), and the mortality was 1.9%(2/101). The most common postoperative complications were disturbance of sodium metabolism (54.5%(55/101)).Conclusion:Sub-frontal longitudinal fissure crista galli approach can safely and thoroughly remove the tumor and avoid the injury of the hypothalamus and its surrounding tissues as far as possible.
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Objective To evaluate the feasibility and safety of supratotal resection of frontal or temporal lobe glioblastoma by the postoperative cognitive function and overall survival. Methods The clinical data of patients with frontal or temporal lobe glioblastoma and treated from January 2010 to January 2015 were analyzed retrospectively.The patients underwent supratotal resection of glioblastoma after March 2012(trial group, 33 cases). Before March 2012, the patients underwent total resection of glioblastoma(control group,28 cases).The Montreal cognitive assessment(MoCA)scores before operation and the 7th day after operation were used to evaluate the security, while overall survival was used to evaluate the feasibility. Variance analysis of repeated measurement quantitative data was used for the statistical analysis of the results. Multivariate Cox model was used as a method to estimate the independent association of a variable set with overall survival. Survival time observation was plotted by the Kaplan-Meier analysis,starting from the data of surgery.Results The MoCA scores in control group at the 7th day after operation were significantly lower than those before operation:(25.39 ± 3.04)scores vs.(26.67 ± 2.19)scores, t = 4.446,P < 0.05. The MoCA scores in trial group at the 7th day after operation were significantly lower than those before operation:(21.93 ± 4.46)scores vs.(25.39 ± 3.04) scores,t = 3.485,P < 0.05. The survival analysis of Kaplan-Meier method showed that age, surgical method and preoperative KPS scores were statistically significant (P < 0.05). Cox regression analysis showed that the choice of surgical method and preoperative KPS was 0.286 and 0.965,respectively.The risk of death in control group was 0.286 times of that in trial group.The survival time of trial group was better than that of control group.Conclusions The cognitive function of patients with frontal or temporal glioblastoma may have a certain degree of decline after tumor resection or supratotal resection.Supratotal resection could represent a promising strategy that can impact on outcome in glioblastoma patients. Supratotal resection could be a factor influencing survival.
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Objective To explore how to improve the sensitivity and specificity of CT cisternography (CTC) examination.Methods The clinical data of 20 cases of CTC in detecting cerebrospinal fluid rhinorrhea were analyzed,and the influence of continuous dripping of fluid and the filling time of subarachnoid space upon the image quality were observed.Results Nineteen cases of active cerebrospinal fluid rhinorrhea were found with CTC,and the fistula sites were determined by CTC.Eighteen cases received operation which confirmed the fistula sites.One case was found with no active fistula site.According to the image of ethmoid sinus leaks results,7 cases had better image quality in 9 cases whose subarachnoid space filling time was longer than or equal to 10 min.One case had better image quality in 6 cases whose subarachnoid space filling time was shorter than 10 min.There was significant difference (P =0.0406).Conclusion To raise the positive rate of CTC,the position of active fistula should be maintained and keep the time between the injection and scan longer than or equal to 10 min,which help to get better image quality.