Technical Case Report of a Cranioplasty With ex vivo Frozen Ostoblastic Bone Graft From Large Skull Metastasis.

Objective: Liquid nitrogen cryotherapy has shown efficacy in the treatment of bone tumors of the extremities with good oncologic and functional outcomes. However, its application in metastatic skull tumors has been rarely reported and whether the adjuvant radiotherapy affects the future bone healing is not yet explored. We report an immediate cranioplasty with the resected osteoblastic bone, which underwent ex vivo cryotherapy, and discuss the surgical techniques and postoperative images. Methods: A 58-year-old man with esophageal adenocarcinoma, undergoing chemoradiotherapy, presented with a rapidly enlarging scalp mass for 5 months. Imaging revealed an enhancing mass, centered in the frontal skull bone with extracranial and intracranial invasion, suggestive of osteoblastic metastasis. After preoperative transarterial embolization, the tumor was excised en bloc. Immediate cranioplasty was performed with the osteoblastic bone graft after ex vivo cryotherapy. It was soaked in liquid nitrogen for 20 min, thawed at room temperature for 15 min, and soaked in povidone-iodine solution for 10 min. Then, the bone graft was fixed to its original place. Pathologic examination revealed metastasis originating from the esophagus. He underwent adjuvant radiotherapy for local tumor control. Results: He had an uneventful clinical course without any neurologic deficit. Brain imaging during the six-month follow-up showed no tumor recurrence and partial bony union. Conclusions: Cranioplasty using an autologous bone graft with ex vivo cryotherapy was helpful in the reconstruction of osteoblastic metastatic skull tumor treatment. It was a simple and cost-effective procedure that achieved satisfactory cosmetic results without negatively impacting bone healing, even after adjuvant radiotherapy.

Efficacy of topical cross-linked hyaluronic acid hydrogel in preventing post laminectomy/laminotomy fibrosis in a rat model.

Post-laminectomy/laminotomy epidural fibrosis (EF) has been implicated as an important cause of failed back syndrome (FBS). The various clinical approaches used to control EF yield mixed outcomes. Cross-linked hyaluronic acid hydrogel (cHA) was synthesized to increase mechanical stability and residence time. We evaluated the therapeutic attenuation of proliferative EF in laminectomy/laminotomy groups treated and not treated with cHA. A bilateral T11-L1 total laminectomy or unilateral T12 laminotomy was done on four groups (n = 10 each) of Sprague-Dawley rats and then histologically examined 2 months post-surgery: (I) laminectomy group treated with and (II) not treated with cHA, (III) laminotomy group treated with and (IV) not treated with cHA. The grade of EF, the diameters within the spinal canal, dura mater thickness, and the area of the epidural space, subarachnoid space, and conus medullaris space were assessed. The cHA-treated subgroups (I, III) had a significantly lower grade of EF, thinner dura mater, and larger epidural and subarachnoid spaces than did the control subgroups (II, IV) (p < 0.05). The cHA formed a solid interpositional membrane barrier that prevented invasive fibrosis, and also helped reduce pathological changes to the adjacent structures. In conclusion, topically applied cHA is effective for reducing EF.

Direct radiofrequency application improves pain and gait in collagenase-induced acute achilles tendon injury.

Radiofrequency (RF) is often used as a supplementary and alternative method to alleviate pain for chronic tendinopathy. Whether or how it would work for acute tendon injury is not addressed in the literatures. Through detailed pain and gait monitoring, we hypothesized that collagenase-induce acute tendinopathy model may be able to answer these questions. Gait parameters, including time, distance, and range of motion, were recorded and analyzed using a walking track equipped with a video-based system. Expression of substance P (SP), calcitonin gene related peptide (CGRP), and galanin were used as pain markers. Beta-III tubulin and Masson trichrome staining were used as to evaluate nerve sprouting, matrix tension, and degeneration in the tendon. Of fourteen analyzed parameters, RF significantly improved stance phase, step length, preswing, and intermediary toe-spread of gait. Improved gait related to the expression of substance P, CGRP, and reduced nerve fiber sprouting and matrix tension, but not galanin. The study indicates that direct RF application may be a valuable approach to improve gait and pain in acute tendon injury. Altered gait parameters may be used as references to evaluate therapeutic outcomes of RF or other treatment plan for tendinopathy.