The influence of direct anterior approach and postero-lateral approach on wound complications after total hip arthroplasty: A meta-analysis.

To date, we have reviewed the synthesis literature critically through four databases: PubMed, Embase, Cochrane Library and Web of Science. Eight relevant studies were examined after compliance with the criteria for inclusion and exclusion, as well as documentation quality evaluation. This report covered all randomised, controlled studies of total hip arthroplasty (THA) comparing the direct anterior approach (DAA) with the postero-lateral approach (PLA). The main result was surgical site infection rate. The secondary results were duration of the operation, length of the incision and VAS score after surgery. The results of the meta-analyses of wound infections in the present trial did not show any statistically significant difference in DAA versus PLA (between DAA and PLA) (OR = 1.42, 95%CI: 0.5 to 4.04, p = 0.51). Compared with PLA, DAA had shorter surgical incision (WMD = -3.2, 95%CI: -4.00 to -2.41; p < 0.001) and longer operative times(WMD = 14. 67, 95%CI: 9.24 to 20.09; p < 0.001). Postoperative VAS scores were markedly lower in DAA compared with PLA within 6 weeks of surgery (p < 0.05), with low heterogeneities(I2 = 0). We found that DAA did not differ significantly from PLA in terms of the risk of wound infection for THA and that the surgical incisions was shorter and less postoperative pain after surgery, even though DAA surgery takes longer.

The Treatment Strategy for Skull Base Reconstruction for Anterior Cranial Fossa Intra- and Extracranial Tumors.

ABSTRACT: Anterior cranial fossa intra- and extracranial tumors arise from the anterior cranial fossa and invade the orbit and nose. Anterior cranial fossa tumor resection and skull base reconstruction are challenging for neurosurgeons due to the complex anatomy, leakage of cerebrospinal fluid, and critical neurovasculature involvement. The authors report a case series of cranio-orbital communicating tumors and cranionasal-orbital communicating tumors. All patients underwent a modified Derome approach or transfrontal basal approach, and all tumor resections were satisfactory. Skull base reconstruction for small defects (<1.5 cm) can be performed with autogenous fascia, muscle, and fat. Large defects (≥1.5 cm) require autogenous fascia, muscle, and fat combined with osseous reconstruction (autogenous bone, titanium mesh, and polyetheretherketone). The techniques and treatments were successful, and only 1 patient experienced mild cerebrospinal fluid leak but no intracranial infection, pneumocrania or intracranial hemorrhage. Additionally, long-term follow-up demonstrated that the outcomes remain favorable. According to a literature review, this technique might be an alternative strategy for treating anterior cranial fossa intra- and extracranial tumors, and better skull base reconstruction can prevent many postoperative complications.

Treatment Strategies for Different Types of Intraneural Offending Vessels in Microvascular Decompression Surgery for Trigeminal Neuralgia: An Analytic Report of 58 Cases.

BACKGROUND: Microvascular decompression (MVD) surgery is the treatment of choice for trigeminal neuralgia (TGN). However, decompression becomes difficult when the offending vessel penetrates the trigeminal nerve root. OBJECTIVE: To estimate the rates and patterns of different types of intraneural offending vessels in patients with TGN for MVD and to discuss respective management strategies. METHODS: All patients with TGN undergoing MVD in our center from January 1, 2015, to December 31, 2019, were analyzed retrospectively. The intraneural offending vessels included veins and arteries. The postoperative pain relief rate, complications, and recurrences were evaluated. RESULTS: Of the 302 TGN cases, the intraneural offending vessels were identified in 58 of the cases (19.2%). The 9 cases (15.5%) of intraneural offending arteries were decompressed using shredded Teflon wrapping interposition. Of the 49 cases (84.5%) of intraneural offending veins (INOVs), 29 were not considered true offending vessels, and the treatment only addressed the offending artery in these patients. Of the remaining 20 INOVs, 15 were electrocoagulated and divided, and 5 were decompressed with shredded Teflon. Complete pain relief was achieved in all 58 patients. However, the pain recurred in 5 patients (8.6%), and transient hemifacial numbness occurred in 4 patients (6.9%). CONCLUSION: Intraneural offending vessels requiring treatment are uncommon and are seen in less than 1 in 10 patients undergoing MVD for TGN. For intraneural offending artery, decompression by shredded Teflon wrapping interposition is recommended. Management of the INOV depends on the individual situations, and the management includes sacrifice, wrapping decompression, or leaving them untreated.