Real-world experience with the new pulsed solid-state Thulium: YAG laser (Thulio) for endoscopic enucleation of the prostate.

PURPOSE: The solid-state Thulium laser (Tm: YAG) is a novel alternative to the widely used Holmium laser for endoscopic enucleation of the prostate (EEP) due to its relatively high peak power. The aim of this study was to examine the efficacy and safety of a new pulsed Tm: YAG laser in its first application in humans. METHODS: Data were retrospectively collected for the first 103 patients who underwent EEP with a new pulsed solid-state Tm: YAG laser (Thulio®, Dornier MedTech Systems GmbH, Weßling, Germany). Peri- and postoperative data were assessed. Procedure-specific complications were graded using Clavien-Dindo Classifications (CDC). Patients were interviewed 15 months after the surgery to evaluate functional and long-term outcomes. Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS®). RESULTS: The mean preoperative prostate volume was 105.6 ± 55.0 ml. Median enucleation speed was 4.1 g per minute (range 1.1-9.7). Short-term postoperative complications occurred in 21 patients (20.4%), but no high-grade complications (CDC ≥ IV) were observed. Five patients suffered gross haematuria and required reintervention (CDC IIIb; 4.9%). After 15 months, 76 patients (73.8%) participated in the follow-up interview, where seven patients (9.2%) reported complications, including two reinterventions for urethral strictures (CDC IIIb; 2.6%). Most patients reported an improvement in continence (54.0%) and urine stream (93.4%), but no difference in erectile function (81.6%). No persistent dysuria was reported. Patient satisfaction with the surgery results was very high (96.1%). CONCLUSION: Endoscopic enucleation of the prostate with the new pulsed solid-state Tm: YAG laser is a safe and effective option for surgical BPH treatment. TRIAL REGISTRATION: German Clinical Trials Register number: DRKS00031676. Registration date: 10 May 2023, retrospectively registered.

Comparison of Total Endoscopic Ear Surgery and Microscopic Postauricular Canal-Wall-Down Approach on Primary Acquired Cholesteatoma.

This study aimed to compare total endoscopic ear surgery (TEES) and microscopic postauricular canal-wall-down tympanomastoidectomy (CWD) in cholesteatoma surgery in our clinic. This study included 59 patients, of whom 30 and 29 were operated on with CWD in 2016-2018 and TEES in 2019-2021, respectively and compared regarding intraoperative findings, hearing outcomes, long-term outcomes, and recidivism rates between groups. This study excluded patients in stage IV according to the European Academy of Otology and Neurotology/Japan Otological Society Staging System on Middle Ear Cholesteatoma, aged < 18, with congenital cholesteatoma, who underwent revision surgery. Two patients in the TEES group had recidivism (6.9%), with recurrent disease observed in both patients and residual disease in none, whereas 3 patients in the CWD group had recidivism (10%), including recurrent disease in 2 and residual disease in 1 patient. Tympanic membrane perforation occurred in 2 (6.9%) and 1 (3.3%) patients in the TEES and CWD groups, respectively. The 2 groups revealed no significant difference in terms of recidivism and perforation rates (P=1.000, P = .612). The CWD group had a longer mean operation time (225.54 ± 47.86 minutes) than the TEES group (160.55 ± 24.98 minutes) (P < .001). The 2 groups demonstrated no significant difference regarding pre- and postoperative air-bone gap (ABG) and ABG gain (P = .105, P=.329, P=.82, respectively). Total endoscopic ear surgery provides similar results in terms of hearing, recidivism, and long-term outcomes with the microscopic CWD approach. However, the CWD approach is still important, especially in patients in advanced stages.

[Clinical observation of 7 cases of functional pituitary neuroendocrine tumor treated by endoscopic transnasal selective resection of the cavernous sinus medial wall].

The clinical data of 7 patients (3 males and 4 females) with functional pituitary neuroendocrine tumor treated by endoscopic transnasal resection of the cavernous sinus medial wall from May to October 2023 in the Department of Neurosurgery of the First Affiliated Hospital of University of Science and Technology of China were retrospectively analyzed. They ranged in age from 29 to 60, with an average age of 45. The clinical diagnosis was acromegaly in 5 cases and Cushing's disease in 2 cases. There were 1 cases of microadenoma and 6 cases of macroadenoma. Knosp grade: Grade 1 adenoma in 3 cases, grade 2 adenoma in 3 cases and grade 3A adenoma in 1 case. Intraoperative resection of cavernous sinus medial wall was performed on the side of tumor. Five cases were determined to be invaded by tumor, and 2 cases were uncertain. No internal carotid artery injury occurred in all patients. The average intraoperative blood loss was 156 ml, and no patient was transfused. Postoperative endocrine remission was found in 6 cases, and tumor cells were found in 6 cases by pathological examination of the medial wall of cavernous sinus. No serious complications occurred in all patients. For Knosp grade 1-3 functional pituitary neuroendocrine tumor surgery, if there is no clear false envelope or normal pituitary between the tumor and the cavernous sinus medial wall during the operation, the cavernous sinus medial wall should be actively removed to improve the postoperative endocrine remission rate.

[Heterogeneous acellular dermal matrix for wound repair after endoscopic Type-â ¤a cordectomy].

Objective:To observe the clinical effect of placing heterogeneous acellular dermal matrix membrane for laryngeal cavity wound healing after CO2 laser Type-Ⅴa cordectomy for glottic carcinoma. Methods:Thirty-five patients with bilateral vocal cord laryngeal cancer who underwent endoscopic CO2 laser surgery at the Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital of Central South University from March 2018 to December 2019 were selected and divided into 2 groups, including 18 patients in the study group and 17 patients in the control group. The control group was simply placed silicone tube stent, while in the study group, heterogeneous acellular dermal matrix membrane was coated with silicone tube stent. The postoperative laryngeal wound repair and clinical manifestations were observed and compared between the two groups. Results:Compared postoperative laryngeal wound after 6 months: no patients in the study group had granulation tissue, whereas 4 patients in the control group had granulation tissue; 3 patients in the study group developed moderate to severe tissue adhesion, while 9 patients in the control group; 10 patients in the control group developed 2nd to 4th degree laryngeal obstruction, compared with only 4 patients in the study group. Conclusion:The primary placement of ADM can reduce laryngeal granulation tissue and tissue adhesion after CO2 laser Type-Ⅴa cordectomy for laryngeal cancer, and may reduce the occurrence of postoperative laryngeal obstruction.

[Analysis of curative effect of orbital apex syndrome caused by sinus disease].

Objective:To compare the efficacy of endoscopic sinus surgery and conservative treatment for orbital apex syndrome caused by sinus lesions. Methods:The clinical data of 56 patients with orbital apex syndrome caused by sinus lesions who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2018 to August 2023 were retrospectively analyzed and divided into a surgical group of 21 cases and a conservative group of 35 cases. The clinical features and prognosis of the two groups were compared. Results:Among the sinus lesions in the surgical group, 61.9% were fungal sinusitis, 28.6% were bacterial sinusitis, and 9.5% were sphenoid sinus tumors. In the conservative group, non-fungal sinusitis accounted for 65.7% and fungal sinusitis accounted for 34.3%. In addition to sinus lesions, patients had underlying diseases. In the surgical group, 71.4% had hypertension and 80.9% had diabetes; in the conservative group, 28.6% had hypertension and 42.9% had diabetes. After a follow-up of 1 month to 5 years, the symptom improvement rate in the surgical group was 85.7%, with 1 case of recurrence. No recurrence was found after reoperation, while the symptom improvement rate in the conservative group was 22.9%, and 6 cases recurred after symptom improvement, and were transferred to rhinology department. No recurrence was seen after surgery. Conclusion:Most of the sinus lesions in this study were fungal sinusitis. In addition, patients with underlying diseases such as diabetes, hypertension, nephrotic syndrome, etc. have reduced nasal immunity, which significantly increases the risk of disease. Since early nasal symptoms are not obvious, multidisciplinary cooperation in diagnosis and treatment is very necessary. Once imaging examination suggests orbital apex syndrome caused by sinus lesions, endoscopic sinus opening should be performed as soon as possible.

[Endoscopic assisted parathyroid surgery via a subclavian approach].

Objective:To explore the safety and efficacy of airless endoscopic surgery in the treatment of parathyroid diseases. Methods:By retrospective comparison, clinical treatment of 26 patients with primary hyperparathyroidism admitted to the Department of Otolaryngology and Head and Neck Surgery of the Hospital, Sun Yat-sen University from January 2018 to January 2023 were collected. They were divided into traditional group（13 cases） and endoscopic group（13 cases） according to the surgical method. The traditional group underwent traditional open parathyroid surgery, and the endoscopic group underwent airless endoscopic surgery through the subclavian approach. The efficacy, postoperative incision pain, incidence of adverse events, and aesthetic effects of the two groups were evaluated. Results:A total of 26 patients were included, including 13 patients in the traditional group and 13 patients in the endoscopic group. There was no significant difference in the incidence of hypocalcemia and transient hypoparathyroidism on the first day after surgery between the two groups（P>0.05）. No patients with incision pain（>3 points） or swallowing pain were found in both groups after the operation, and they were afraid or unwilling to cough and expel phlegm. There were no significant differences in the amount of blood loss, duration of operation, incidence of temporary recurrent laryngeal nerve palsy and transient hypocalcemia, and postoperative pain score between the two groups. The endoscopic group's scar evaluation score and aesthetic effect satisfaction score at 6 months after surgery were higher than those of the traditional group（P<0.01）. Conclusion:Airless Endoscopic parathyroid surgery via the subclavian approach has good effectiveness and safety, which did not significantly increase the risk of surgery. It can safely remove the lesion and leave no surgical scar on the anterior neck, which has the advantage of a good cosmetic effect. It is a safe and feasible endoscopic parathyroid surgery and can be used as a new choice for patients undergoing parathyroid surgery.

[Sinonasal hemangiomas: principles of diagnosis and treatment. Literature review]. / Sinonazal'nye gemangiomy: printsipy diagnostiki i lecheniya (obzor literatury).

Hemangiomas of the nasal cavity are extremely rare in the practice of an otorhinolaryngologist and can be presented in various histopathological variants. Scientific data on hemangiomas of the sinonasal region are analyzed and systematized. The article describes the principles of diagnosis and choice of the method of surgical treatment of hemangiomas. An analysis of the literature data shows that with hemangiomas of the nasal cavity, a comprehensive examination of the patient is required, including collection of complaints and anamnesis, endoscopy of the nasal cavity and computed tomography of the paranasal sinuses, and with significant hemangiomas spreading to neighboring anatomical areas, magnetic resonance imaging with intravenous contrast.

Percutaneous Endoscope-assisted Visualized Implantation of Puncture Cylindrical Electrodes for Spinal Cord Stimulation: A Cadaveric Feasibility Study.

BACKGROUND: Spinal cord stimulation is an established technique wherein diverse electrode types are strategically implanted within the spinal epidural space for neuromodulation. Traditional percutaneous puncture cylindrical electrodes (PEs) are predominantly implanted by interventionalists utilizing a percutaneous technique under the monitor of radiation, which is a nonvisualized procedure. OBJECTIVE: Our study aimed to assess the feasibility of percutaneous endoscope-assisted visualized implantation approach for PEs, delineating its specific merits and demerits compared to the traditional method. STUDY DESIGN: Laboratory study with Institutional Review Board Number B2023-056SETTING: Clinical Anatomy Research Center, Fudan University. METHODS: Eight freshly procured adult cadavers (4 women and 4 men) were operated on in this study. They were divided into either Group A or Group B, each encompassing 4 cadavers. Group A was subjected to endoscope-assisted PEs implantation, whereas Group B followed the conventional PEs implantation route.In both groups the operative time of introducer needles placement (OTNP), total operative time (TOT), fluoroscopy time of introducer needles placement (FTNP), and total fluoroscopy time (TFT) were documented and analyzed. Furthermore, the precise positioning of the PEs and any ensuing complications were systematically examined. RESULTS: Both Group A and Group B successfully executed all predetermined surgical steps. A total of 16 PEs were implanted (dual electrodes in each cadaver): 8 using the percutaneous endoscope-assisted visualized approach (Group A) and 8 via the traditional methodology (Group B). Group A's mean ± SD durations for OTNP, TOT, FTNP, and TFT were 10.25 ± 1.03 minutes, 31.63 ± 5.87 minutes, 4.58 ± 1.35 seconds, and 43.73 ± 14.46 seconds, respectively. In contrast, Group B exhibited mean ± SD times of 11.55 ± 2.81 minutes, 44.75 ± 7.85 minutes, 23.53 ± 4.16 seconds, and 66.30 ± 6.35 seconds for the same metrics. No discernible statistical difference in OTNP and TOT emerged between the groups. However, Group A demonstrated reduced durations for both FTNP and TFT compared to Group B. The optimal position of the PEs was verified via fluoroscopy, with no recorded instances of dura rupture. These outcomes suggest that this endoscope-assisted technique neither increases surgical time nor compromises efficacy. Instead, it leads to a marked reduction in fluoroscopic duration relative to the traditional methodology. LIMITATIONS: Anatomical study on a human cadaver, the quantity of cadavers, and the procedure's steep learning curve. CONCLUSION: With the assistance of percutaneous spinal endoscopy, introducer needles can be punctured through the ligamentum flavum at the anticipated interlaminar window locus under direct visualization, improving the convenience of the puncture and reducing fluoroscopic exposure. It is a viable alternative for surgeons from diverse training backgrounds to implant PEs, particularly benefiting those well-versed in endoscopic spine surgery techniques.

Follow-up analysis and research of very low-risk and low-risk gastrointestinal stromal tumors after endoscopic resection.

Currently, due to limited long-term evidence, there remains some controversy surrounding the recommended postoperative monitoring strategy for primary low-risk gastrointestinal stromal tumors (GISTs). This study recruited a total of 532 patients diagnosed with very low-risk and low-risk GISTs who underwent endoscopic resection from 2015 to 2021, including 460 very low-risk patients and 72 low-risk patients. Descriptive statistical analysis was used to evaluate the clinical and pathological characteristics of GIST patients, and Kaplan-Meier methods were employed for survival analysis. The results showed that the 5-year recurrence-free survival rates for very low-risk and low-risk patients were 98.5% and 95.9%, respectively. The 5-year disease-specific survival rates for both groups were 100%. Additionally, the 5-year overall survival rates were 99.7% for very low-risk patients and 100% for low-risk patients (P = 0.69). Therefore, it is suggested that routine follow-up monitoring, including endoscopic surveillance and imaging, may not be necessary for very low-risk and low-risk GISTs after endoscopic resection.

Endoscopic techniques for early diagnosis of cloacal pathologies and sex determination in blue spotted tree monitor (Varanus macraei) and Cuming's water monitor (Varanus cumingi).

This article attempts to present, for the first time, the usefulness and feasibility of using endoscopic techniques in the cloacal region of Varanus cumingi and Varanus macraei. This method can serve both diagnostic and therapeutic purposes, as well as offering an early approach to sex determination through the observation of the urodeum which in males ends in a blind end while in females it consists of two ostia which represent the outlets of the oviducts. In this context, commonly employed sex determination techniques, such as post-cloacal spur detection, have shown unreliability. The study involved the examination of ten specimens, approximately one year old, from a private breeding farm, following a complete clinical evaluation to confirm their general state of health. All subjects underwent sedation, which allowed the evaluation of anatomical structures, the health status of the cloaca and the determination of sex. This study and its findings may provide a critical basis for addressing population declines of these species, particularly for V. macraei, which has already been classified as 'endangered' by the IUCN.

Does concordance between preoperatively measured prostate volume and enucleated weight predict outcomes in endoscopic enucleation of the prostate? Results from the REAP database.

BACKGROUND: We aimed to determine if preoperative prostate volume-enucleated weight concordance predicts short-term anatomical endoscopic enucleation of the prostate (AEEP) outcomes using the REAP international database. METHODS: 649 patients with data on both preoperative ultrasound-derived prostate volume and enucleated specimen weight were analyzed. Linear regression was used to investigate the effect of volume-weight concordance on postoperative outcomes. Model residuals were used to divide the cohort into 3 centiles: (1) less-than-expected enucleated specimen weight; (2) appropriate concordance between prostate volume and specimen weight; (3) more-than-expected specimen weight. Outcomes were also analyzed with only enucleated weight as a predictor (comparing ≤ 80 g and > 80 g). RESULTS: There was a trend towards more-than-expected enucleated specimen weight with increased age (p = 0.006). There was an increasing trend of operation time (p = 0.012) and enucleation time (p = 0.015) as specimen weight increased, and a decreasing trend of postoperative acute urinary retention (p = 0.005). Laser type, enucleation method, and early apical release were similar. In correlation analysis, greater-than-expected prostate weight was associated with greater Qmax improvement at 3 months. Prostate weight alone did not appear to be a significant predictor of outcomes. CONCLUSIONS: If enucleated specimen weight is more than expected according to preoperative ultrasound volume measurement, greater Qmax improvement and less postoperative acute urinary retention is expected. Although precision may be limited by ultrasound approximation and inexact specimen weight measurements, these shortcomings are similar in real-world clinical practice. Overall, preoperative prostate volume and actual enucleated specimen weight should be interpreted in the context of each other to predict clinical outcomes.

Retinex theory-based nonlinear luminance enhancement and denoising for low-light endoscopic images.

BACKGROUND: The quality of low-light endoscopic images involves applications in medical disciplines such as physiology and anatomy for the identification and judgement of tissue structures. Due to the use of point light sources and the constraints of narrow physiological structures, medical endoscopic images display uneven brightness, low contrast, and a lack of texture information, presenting diagnostic challenges for physicians. METHODS: In this paper, a nonlinear brightness enhancement and denoising network based on Retinex theory is designed to improve the brightness and details of low-light endoscopic images. The nonlinear luminance enhancement module uses higher-order curvilinear functions to improve overall brightness; the dual-attention denoising module captures detailed features of anatomical structures; and the color loss function mitigates color distortion. RESULTS: Experimental results on the Endo4IE dataset demonstrate that the proposed method outperforms existing state-of-the-art methods in terms of Peak Signal-to-Noise Ratio (PSNR), Structural Similarity (SSIM), and Learned Perceptual Image Patch Similarity (LPIPS). The PSNR is 27.2202, SSIM is 0.8342, and the LPIPS is 0.1492. It provides a method to enhance image quality in clinical diagnosis and treatment. CONCLUSIONS: It offers an efficient method to enhance images captured by endoscopes and offers valuable insights into intricate human physiological structures, which can effectively assist clinical diagnosis and treatment.

Endoscopic minimally invasive treatment of congenital muscular torticollis in children.

BACKGROUND: This study aimed to investigate the clinical efficacy of minimally invasive endoscopic treatment of children with congenital muscular torticollis (CMT). METHODS: In total, 72 children (41 male, 31 female) with CMT who underwent endoscopic surgery at the Department of Orthopedics, Xi'an Children's Hospital, between January 2021 and January 2023 were included. Their mean age was 54 ± 36.1 (range, 12-141) months. Of these, 29 (40.3%) cases involved the left side while 43 (59.7%) involved the right side. Preoperative preparation involved precise body surface markings of the sternocleidomastoid muscle(SCM), clavicle, and important nerve and blood vessels, followed by the establishment of surgical channels through passive separation techniques. An arthroscope and a low-temperature plasma knife were utilized for accurate localization and surgical release of the clavicular and sternal heads of the SCM. The duration of surgery, blood loss, postoperative hospital stay, neck range of motion measurements, and any intraoperative or postoperative complications were analyzed using the rank sum test. Cervical and thoracic braces were applied for three months postoperatively, with follow-up assessments conducted using Cheng's scoring system. RESULTS: All patients successfully underwent endoscopic surgery, without the need for conversion to open surgery. No intra- or postoperative complications were observed. The average surgical duration was 56.4 ± 15.7 min, with minimal intraoperative bleeding (1-5 mL) and no need for blood transfusion. The mean postoperative hospital stay was 2.7 ± 0.8 days. Over a mean follow-up period of 22.2 ± 5.5 (range, 14-32) months, significant improvements were observed in neck rotation (from 20.2° [17.7° to 25°] to only 3.6° [2° to 6.7°]) and lateral flexion (from 19° [17° to 22.6°] to only 3° [2° to 7.8°]) restrictions (p < 0.05). According to Cheng's scoring system, 70 (97.2%) patients achieved excellent or good clinical outcomes, while 2 (2.8%) had average outcomes. The torticollis deformity was corrected during the follow-up period, and all surgical incisions healed without noticeable scarring. CONCLUSION: Endoscopic release is a safe, effective, and minimally invasive treatment option for CMT in children.

Necessary Factors for Efficient Frontal Sinus Irrigation After Endoscopic Sinus Surgery: A Systematic Review.

OBJECTIVE: The frontal sinus remains a challenging site for irrigation due to its position relative to the nostril and ethmoid sinus. This study aims to summarize the necessary factors for efficient irrigation of the frontal sinus after endoscopic sinus surgery (ESS) among patients with chronic rhinosinusitis (CRS). METHODS: Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic literature review was conducted on PubMed, Scopus, and Cochrane databases to identify studies assessing the effect of frontal sinus irrigation in patients with CRS, cadaver models, or 3D-printed models of the sinonasal cavity after ESS. RESULTS: Of the initial 206 abstracts reviewed, 18 full-text articles were included. The degree of the frontal sinus ostium opening after ESS was found to be associated with the efficacy of frontal sinus irrigation. More extensive frontal sinus surgeries tended to increase frontal sinus penetration. A Draf IIA procedure was identified as the minimum standard to achieve sufficient irrigation in the frontal sinus. Due to decreased backpressure in the nasal passage, increasing septectomy in Draf III did not significantly improve irrigation delivery. Squeeze bottles achieved significantly higher irrigation flow in the frontal sinus than syringes and pulsating devices. Large-volume irrigation devices provided better irrigation for the frontal sinus by entering or flushing the entire frontal sinus. The head position influenced the frontal sinus irrigation by altering the ostia position relative to fluid flow and vertical height of the frontal sinus during irrigation. While the vertex down head position was likely to enhance frontal sinus irrigation, the comfort of the head position and patient compliance should be considered. CONCLUSION: Elements for optimization of frontal sinus irrigation are a minimum of a Draf IlA procedure for frontal sinus dissection, use of large-volume irrigation, and vertex down head positioning. Developing comfortable head positions with high frontal sinus irrigation efficiency would increase patient compliance and improve outcomes. LEVEL OF EVIDENCE: NA.

[Efficacy of endoscopic surgical management for recurrent nasopharyngeal carcinoma].

Compared with re-radiotherapy or open surgery, endoscopic surgery for recurrent nasopharyngeal carcinoma has a better effect, which not only improves the overall survival rate, but also reduces serious complications, improves the quality of life and saves medical costs. With the advancement of modern surgical equipment and instruments, the deepening of anatomical research in the field of skull base, the improvement of surgical techniques and the development of multidisciplinary teamwork, the safety of endoscopic surgery and the rate of complete tumor resection will also increase. The indications for surgery are further expanded, and more patients with recurrent nasopharyngeal carcinoma benefit from endoscopic minimally invasive surgery. This article reviews the efficacy of endoscopic surgery for recurrent nasopharyngeal carcinoma, and then provides insights for the selection of clinical treatment strategies for recurrent nasopharyngeal carcinoma.

Anterior percutaneous full-endoscopic transcorporeal decompression for cervical disc herniation: a finite element analysis and long-term follow-up study.

OBJECTIVE: The purpose of this study was to investigate the long-term consequences on the cervical spine after Anterior transcorporeal percutaneous endoscopy cervical discectomy (ATc-PECD) from the biomechanical standpoint. METHODS: A three-dimensional model of the normal cervical spine C2-T1 was established using finite element method. Subsequently, a disc degeneration model and degeneration with surgery model were constructed on the basis of the normal model. The same loading conditions were applied to simulate flexion, extension, lateral bending and axial rotation of the cervical spine. We calculated the cervical range of motion (ROM), intradiscal pressure, and intravertebral body pressure under different motions for observing changes in cervical spine biomechanics after surgery. At the same time, we combined the results of a long-term follow-up of the ATc-PECD, and used imaging methods to measure vertebral and disc height and cervical mobility, the Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) score were used to assess pain relief and neurological functional recovery. RESULTS: The long-term follow-up results revealed that preoperative JOA score, neck VAS score, hand VAS score, IDH, VBH, and ROM for patients were 9.49 ± 2.16, 6.34 ± 1.68, 5.14 ± 1.48, 5.95 ± 0.22 mm, 15.41 ± 1.68 mm, and 52.46 ± 9.36° respectively. It changed to 15.71 ± 1.13 (P < 0.05), 1.02 ± 0.82 (P < 0.05), 0.77 ± 0.76 (P < 0.05), 4.73 ± 0.26 mm (P < 0.05), 13.67 ± 1.48 mm (P < 0.05), and 59.26 ± 6.72° (P < 0.05), respectively, at 6 years postoperatively. Finite element analysis showed that after establishing the cervical spondylosis model, the overall motion range for flexion, extension, lateral bending, and rotation decreased by 3.298°, 0.753°, 3.852°, and 1.131° respectively. Conversely, after establishing the bone tunnel model, the motion range for these actions increased by 0.843°, 0.65°, 0.278°, and 0.488° respectively, consistent with the follow-up results. Moreover, analysis of segmental motion changes revealed that the increased cervical spine mobility was primarily contributed by the surgical model segments. Additionally, the finite element model demonstrated that bone tunneling could lead to increased stress within the vertebral bodies and intervertebral discs of the surgical segments. CONCLUSIONS: Long-term follow-up studies have shown that ATc-PECD has good clinical efficacy and that ATc-PECD can be used as a complementary method for CDH treatment. The FEM demonstrated that ATc-PECD can lead to increased internal stresses in the vertebral body and intervertebral discs of the operated segments, which is directly related to cervical spine degeneration after ATc-PECD.

Application of the semidiving technique in fully endoscopic microvascular decompression.

Microvascular decompression (MVD) is the preferred treatment for hemifacial spasm (HFS) and trigeminal neuralgia (TN), and fully endoscopic microvascular decompression (E-MVD) has been widely discussed in recent years. Considering the endoscopic diving technique used in endoscopic transsphenoidal pituitary adenoma resection, we developed the endoscopic semidiving technique. This technique involves preserving some cerebrospinal fluid (CSF) and positioning the endoscope at an appropriate distance from it; the potential advantages include reducing cerebellar retraction, accurately identifying the responsible vessels and minimizing mechanical damage. This study aimed to preliminarily evaluate the safety and feasibility of the semidiving technique in E-MVD. A total of 359 patients with HFS and TN scheduled to undergo E-MVD were included in the study. Patients with each disease were divided into a nonsemidiving technique group and a semidiving technique group. Surgical data, postoperative outcomes, complications, and recurrence rates were compared between the groups. In patients with HFS, the effective rate was 95.6% (nonsemidiving)and 92.9% (semidiving) respectively, with no statistically significant difference. The semidiving technique group had a lower incidence of postoperative permanent hearing loss compared with the nonsemidiving technique group (0% vs. 5.9%). In TN patients, no significant differences in effectiveness or postoperative complications were observed. The application of the semidiving technique in E-MVD for HFS not only ensures surgical quality and postoperative efficacy but also reduces the incidence of postoperative hearing loss, shortens the surgical duration and reduces the number of postoperative hospitalization days, aligning with the concept of enhanced recovery after surgery (ERAS).

Survival Analysis and Prognostic Factors After Endonasal Resection of Advanced Olfactory Neuroblastomas: A Single Institution Experience.

OBJECTIVES: To explore the prognostic factors in patients with advanced olfactory neuroblastoma (ONB) underwent endoscopic surgery. MATERIALS AND METHODS: Retrospective medical records were reviewed of patients with pathologically proven ONB who underwent endoscopic surgical resection. Clinicopathological characteristics including patient demographics, treatment, complications, follow-up, and outcomes were analyzed. Kaplan-Meier overall survival (OS) and disease-free survival (DFS) curves were plotted. Univariate and multivariate Cox regression models were used to determine prognostic factors. RESULTS: Eighty-five patients with Kadish stage C ONB were examined. According to the various staging systems used, most patients harbored modified Kadish stage C (78.8%). Twenty-six patients (30.6%) underwent bony skull base resection, 11 (12.9%) underwent dura resection, and 24 (28.2%) underwent additional intracranial resection that included the olfactory bulb and duct. Median follow-up was 39 months. Five-year OS and DFS rates were 83.7% and 74.9%, respectively. Five-year OS was 100% in patients treated with bony skull base resection and 77.5% in those who were not (P = .052). Dura resection did not improve OS. Multivariate Cox regression analysis identified perioperative complications (P = .009), gross total resection (P = .004), orbital invasion (P = .014), postoperative radiotherapy (P = .030), and bony skull base resection (P = .019) as independent prognostic predictors. CONCLUSION: For patients with advanced ONB, endoscopic surgery in conjunction with radiotherapy and chemotherapy is effective and safe. Dura resection should be performed with caution in selected patients to balance survival and complications. Postoperative radiotherapy is important to improve OS and DFS.

Efficacy of Otoendoscopy for Residual Cholesteatoma Detection During Microscopic Chronic Ear Surgery.

The aim of this article is to determine the efficacy of otoendoscopy during microscopic cholesteatoma surgery on residual cholesteatoma rates postoperatively. The medical records of patients (aged 4-90) with primary acquired cholesteatoma who underwent microscopic cholesteatoma surgery (exclusively transcanal approach or canal wall-up tympano-mastoidectomy) with subsequent otoendoscopic examination (80 ears) for intraoperative cholesteatoma residues were retrospectively reviewed. All cases with mixed microscopic/endoscopic, fully endoscopic, or fully microscopic dissection were excluded, as well as cases where a canal wall-down technique was used. After microscopic cholesteatoma removal, the otoendoscope was used to inspect the middle ear recesses for intraoperative cholesteatoma residues. The intra- and postoperative cholesteatoma residue rate were evaluated. On endoscopic examination, intraoperative cholesteatoma residues were encountered in 24 patients (30%). A total of 30 foci were detected. Most of them were found in the superior retrotympanum (15 foci). In 9 cases an antral remnant guided the surgeon to convert to a canal wall up tympanomastoidectomy. During the postoperative follow-up period, residual cholesteatoma was detected on postoperative magnetic resonance imaging in 6 patients (7.5%). Adding an otoendoscopic examination to microscopic cholesteatoma surgery reduced the postoperative cholesteatoma residues rate (odds ratio=0.16). A negative otoendoscopic examination led to a cholesteatoma residue-free follow-up period in 95% of cases(NPV=0.95). Otoendoscopy is effective in identifying intraoperative cholesteatoma residues after microscopic cholesteatoma surgery. It reduces the postoperative cholesteatoma residue rate, and a negative otoendoscopic examination increases the likelihood of a cholesteatoma residue-free follow-up.