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Objective:To investigate the application of in situ interposition bypass surgery in the treatment of complex intracranial aneurysms.Methods:A retrospective analysis was conducted on the clinical data of 18 patients with complex intracranial aneurysms treated by the in situ interposition bypass at the Department of Neurosurgery of Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University from July 2015 to September 2022. Fourteen aneurysms were found being located in the middle cerebral artery(MCA), 2 in anterior cerebral artery(ACA), 1 in posterior inferior cerebellar artery(PICA) and 1 in posterior cerebral artery(PCA). Fourteen bypass surgery were with radial artery(RA) vessel grafts, 3 with superficial temporal artery(STA) vessel grafts and 1 with occipital artery(OA) vessel graft. All patients underwent a surgical procedure of in situ interposition bypass with end-to-end anastomosis after resection of the aneurysms. I-type grafts were applied in 13 bypasses, V-type grafts in 3 bypasses, and Y-type grafts in 2 bypasses. All patients had undergone postoperative Digital subtraction angiography(DSA) or CTA reviews. Glasgow Outcome Scale(GOS) was used to assess postoperative outcome. Scheduled postoperative follow-ups were conducted on all patients.Results:Two patients suffered hemiplegia after surgery. One patient had transient aphasia and it recovered in 3 months. No new neurological dysfunction was observed in the rest of patients. Postoperative DSAs showed good patency of the anastomoses and grafted vessels, except one anastomosis that had a severe stenosis, and no aneurysm was shown. The follow-ups lasted for 3 to 89 months and no recurrence of aneurysm was observed. Sixteen patients achieved GOS score 5 and 2 with GOS score 3.Conclusion:In situ interposition bypass surgery is a safe and effective procedure for the treatment of complex intracranial aneurysms.
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Objective To investigate the surgical outcomes and strategies selection of endoscopic endonasal approach and craniotomy in the treatment of cranial base chordomas.Methods Thirty-one patients diagnosed pathologically with cranial base chordoma in Tianjin huanhu hospital from Jan.2010 to Sep.2020 were analyzed retrospectively.The patients were divided into the endoscopic endonasal group and the craniotomy microscope group according to the different surgical approaches.The surgical results and follow-up between the two groups were compared.Results In the endoscopic endonasal group,there were 7 cases of gross total resection,9 cases of subtotal resection and 2 cases of partial resection.The main complications included death in 2 cases,cerebrospinal fluid leakage in 8 cases,cranial nerve injury in 2 cases and hypopituitarism in 1 case.In the craniotomy microscope group,there were 2 cases of gross total resection,10 cases of subtotal resection,and 1 case of partial resection.The main complications included cerebrospinal fluid leakage in 1 case,cranial nerve injury in 3 cases,epilepsy in 1 case and epidural hematoma in 1 case.There was no statistical significance in the resection rate between the two groups(P＞0.05).The rate of cerebrospinal fluid leakage in the endoscopic group was significantly higher than that in the craniotomy microscope group,and the comparison was statistically significant(P＜0.05).There was no statistically significant between the two groups for tumor recurrence or progression.Conclusions The endoscopic endonasal approaches for resection of cranial base chordomas have improved the gross total resection rate,but craniotomy is still an important surgical method for tumor resection.It is necessary to select an appropriate surgical approach according to the lesion location and pattern of tumor growth.
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Objective@#: Cranial base chordomas are rare, but their treatment is challenging. Tumor recurrence is still common despite improvements in microsurgical techniques and postoperative radiotherapy. We retrospectively analyzed the course of treatment, overall survival, and recurrence/progression of chordomas over the past 10 years. @*Methods@#: We retrospectively reviewed 50 patients who underwent surgery at Tianjin Huanhu Hospital between 2010 and 2020 and were pathologically diagnosed with chordomas. Tumor resection was performed within the maximum safe range in all patients; the extent of resection was evaluated by imaging; and the incidence of complications, recurrence or progression, and overall survival were assessed. @*Results@#: Fifty patients were divided into the low-risk group (LRG) and high-risk group (HRG) based on the cranial chordoma grading system (CCGS). The Karnofsky Performance Scale scores and gross total resection rate of the LRG were significantly higher than those of the HRG (p<0.05). The incidence of complications and mortality in the LRG were lower than those of HRG. The analysis of cumulative survival and cumulative recurrence free survival/progression free survival (RFS/PFS) showed no statistical differences in the extent of resection for survival, recurrence, or progression. Univariate and multivariate analyses showed that Ki-67 was significantly associated with tumor recurrence and was an independent hazard factor (p=0.02). @*Conclusion@#: The CCGS can help neurosurgeons anticipate surgical outcomes. Pathological results are important in evaluating the possibility of tumor recurrence, and postoperative radiotherapy improves overall survival and RFS/PFS.
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Objective@#: The clinical management paradigm of skull base chordomas is still challenging. Surgical resection plays an important role of affecting the prognosis. Endonasal endoscopic approach (EEA) has gradually become the preferred surgical approach in most cases, but traditional transcranial surgery cannot be completely replaced. This study presents a comparison of the results of the two surgical strategies and a summary of the treatment algorithms for skull base chordomas. @*Methods@#: We retrospectively analyzed the surgical outcomes and follow-up data of 48 patients with skull base chordomas diagnosed pathologically who received transnasal midline approaches (TMA) and transcranial lateral approaches (TLA) from 2010 to 2020. @*Results@#: Among the 48 patients, 36 cases were adopted TMA and 12 cases were performed with TLA. In terms of gross total resection (GTR) rate, 27.8% in TMA and 16.7% in TLA and with EEA alone it was increased to 38.9%, while 29.7% in primary surgery. In TMA, the cerebrospinal fluid (CSF) leak remains the most common complication (13 cases, 36.1%), other main complications included death, cranial nerve palsy, hypopituitarism, all the comparisons were no statistical significance. The Karnofsky Performance Scale scores in TMA were all better than those in TLA at different time, and the overall survival (OS) and recurrence free survival/progression free survival was just the reverse. @*Conclusion@#: The EEA for skull base chordomas resection has improved the GTR rate, but transcranial approach is still an alternative approach. It is necessary to select an appropriate surgical approach based on the location and the pattern of tumor growth in order to obtain the best surgical outcomes.
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Objective@#To explore the application value of three dimensional (3D) printing technique in the surgical treatment of nasal skull base tumor.@*Methods@#Seven patients with complicated skull base tumors admitted in Department of Otorhinolaryngology Head and Neck Surgery and Department of Neurosurgery of Tianjin HuanHu Hospital from Mar. 2017 to Feb. 2018 were selected. According to three sets of DICOM data of patients obtained from enhanced spiral CT scanning, navigation MRI scanning and CT angiography (CTA) magnetic navigation, data information of skull, blood vessel and tumor were extracted and reconstructed with different segmentation methods. The assembly and integration were achieved in the same coordinate system to form 3D visual composite virtual models. Combined with 3D printing technology, 3D visual composite virtual models were substantialized, and were applied for preoperative surgical strategy making and intraoperative reference.@*Results@#Virtual models of the nasal skull base of 7 patients were reconstructed successfully and 3D 1∶1 entity models were produced. The models demonstrated the relationship among the skull, tumors, and adjacent blood vessels.Seven cases were successfully performed.@*Conclusion@#3D virtual model of composite nasal skull base and its dissection model based on 3D printing technology can guide the medical staff to develop and perfect the operation scheme.
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Objective To study the microscopic anatomy of the petroclival region through simulated subtemporal transtentorial and transpetrosal presigmoid approaches, and discuss their respective scope for clinical application and provide reference to petroclival region surgical approaches. Methods Ten wet adult head specimens (20 sides) were studied by subtemporal transtentorial and transpetrosal presigmoid approach under microscope, respectively; the features of vessels and nerves of the petroclival area, microanatomic relations of vessels and nerves with their surrounding structures were researched; the exposure scope of these two operative approaches to petroclival region was described. Results The trochlear nerve entered the edge of tentorium in post-lateral posterior clinoid process with a mean distance of (15.72±3.81) mm, and it sneaked (6.82±1.81) mm in the tentorium into the external wall of the cavernous sinus. When the tentorium was cut off, it could expose the posterior clinoid process and posterior communicating artery at upper bound, and petrous ridge at lower bound. The distance from petrous sigmoid sinus junction to the posterior semicircular canal was about (10.48 ±0.42) mm, Trautman's triangle could be exposed about (243.5±26.1) mm2. The rear of the cavernous sinus, Meckel's cavity and saddle back at upper bound, the contralateral slopes at the inside, and the bridge of groove and ventral medulla oblongata at lower bound could be reached via transpetrosal presigmoid approach. Conclusions Subtemporal transtentorial approach mainly applys to the upper, middle parts of slopes and petrous apex lesions;the temporal lobe needs to be lifted in the operation, which may damage Labbe vein. Transpetrosal presigmoid approach can be applied to superior, middle and inferior slope and petrous apex lesions, it has advantage of light pulling brain tissues and wide exposure than subtemporal transtentorial approach; however, intraoperative trauma and long operation time may cause hearing impairment and cerebrospinal fluid leakage.
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Objective To explore the methods to reduce the occlusion of perforating arteries after intracranial stenting of the vertebral artery. Methods Clinical data of 32 cases of Gateway-Wingspan stent implantation for intracranial branch of vertebral artery were retrospectively analyzed. The postoperative stricture and perfusion improvement situation were evaluated, the reason of perforating artery occlusion was analyzed. Results Thirty-two patients were implanted with 33 pieces of Wingspan stent and 1 piece of Apollo bracket. The operation success rate were 100%, and the stenosis rate reduced from (76.6±6.1)%to (27.9±5.2)%. After three months, the transcranial doppler sonography (TCD) and CT angiography were checked, showing no in-stent restenosis in all patients. Two patients occurred the perforating artery occlusion within 24 hours after operation. The possible reason was the change of stability of atherosclerotic plaque at the stenosis and the plaque displacement caused by the mechanical action of the balloon or stent, which may lead to medulla oblongata artery block. After drug and rehabilitation treatment, the symptoms in patients were improved significantly. Conclusion The perforating artery occlusion after stent implantation in intracranial branch of vertebral artery can be prevented by strict evaluation and preoperative preparation, the right selection of intraoperative balloon and stent, which still needs larger sample data to prove.
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Objectives To investigate the methods of protecting external branch of the superior laryngeal nerve (EBSLN)in carotid endarterectomy and to observe the effect of using these methods in clinical surgery. Methods EBSLN (20 sides)of 10 heads of corpse were studied by using microanatomy from January 2013 to December 2013. The occurrence probability of EBSLN on the lower edge of posterior belly of digastric muscle,medial edge of external carotid artery and upper edge of superior thyroid artery in anatomy triangle was analyzed. The distances from the midpoint of the EBSLN to carotid bifurcation, mandibular angle and mastoid tip were measured. Sixty-five patients with carotid endarterectomy in Tianjin Huanhu Hospital from December 2013 to November 2014 were treated with the protective methods of the relevant EBSLN by using anatomy triangle as a mark. Whether the patients had injury symptoms of EBSLN were followed up after procedure. Results (1)The occurrence probability of 20-side EBSLN in anatomy triangle was 95%(19 sides). The midpoint of EBSLN in the anatomy triangle at the posterior mandibular angle was median 0. 34 (-1. 62 to 2. 43)cm,at the inferior mandibular angle was 1. 28 (-1. 33 to 3. 42) cm,at anterior mastoid tip was 2. 84 (0. 51 to 5. 14)cm,at inferior was 4. 51 (2. 82 to 6. 39)cm,and at anterior superior of the carotid bifurcation was 1. 64 (0. 57 to 3. 78)cm. (2)65 patients who underwent carotid endarterectomy used the protective methods of intraoperative EBSLN. There was no manifestation of EBSLN injury at 3 weeks to 9 months after procedure. Conclusion In carotid endarterectomy,taking an anatomic triangle as a symbol,it is no more than 2 cm of the anterior superior of carotid bifurcation during the separation process. As for the patients with higher or lower position of carotid bifurcation,in the range of crossing rear mandibular angle 0. 50 cm or below the mastoid tip 4. 50 cm for arterial separation should be avoided,and this can effectively protect EBSLN.
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Objective:To study the treatment effect of zoledronic acid and letrozole on life quality of postmenopausal women with breast cancer operation. Methods:Totally 26 patients were in the control group,and given letrozole,and 23 patients were in the treat-ment group with zoledronic and letrozole. The patients in the two groups were assessed bone mineral density ( BMD) of hip and lumbar vertebrate before the treatment and the 6th and 12th month after the treatment. BALP, CTX, VAS, FACT-B and adverse reactions were also assessed at the 6th and 12th month after the treatment. Results:Improvement of BMD and FACT-B in the treatment group was sig-nificantly better than that in the control group. BALP, CTX and VAS in the treatment group were all decreased more significantly than those in the control group (P0. 05). Conclusion:By preventing bone loss and increasing BMD, the combination of zoledronic acid and letrozole can effectively im-prove the life quality of postmenopausal women with breast cancer operation.
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Objective To investigate the relationship between the sensitivity of gastric cancer cells to arsenic trioxide（As2O3）and the level of reactive oxygen species（ROS）production.Methods The viability of gastric cancer cell lines MGC803,BGC823 and SGC7901 treated with As2O3 was determined by MTT assay.ROS levels of the gastric cancer cells before and after the treatment of As2O3 were detected by flow cytometry.Results Cell growth was significantly inhibited by As2O3 in time-and dose-dependent manner in three gastric cancer cell lines.The IC50（72 h）of As2O3 for MGC803,BGC823 and SGC7901 was about 2.8,3.1 and 10.2 μmol/L,respectively.IC50（72 h）of MGC803 and BGC823 was lower than that of SGC7901（P 0.01）,gastric cancer cell line SGC7901 was less sensitive than the others.The inherent ROS level of MGC803,BGC823 and SGC7901 was 20.3±2.0,64.2±3.3 and 57.7±2.0.After treatment with As2O3 5 μmol/L for 24 h,the peak level of ROS in MGC803 and BGC823 cells increased to 100.8±3.8 and 103.5±2.3,compared with inherent ROS level,the difference had statistical significance（P 0.001,P 0.01）,but the inherent ROS level in SGC7901 cells was 56.5±2.4（P 0.05）.Conclusion The sensitivity of gastric cancer cells to arsenic trioxide is associated with the increase of reactive oxygen species level.