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1.
J Fungi (Basel) ; 7(7)2021 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-34356952

RESUMO

BACKGROUND: Invasive fungal rhinosinusitis (IFS) is a rare but often fatal disease. There are limited studies regarding IFS with orbital complications (IFSwOC). The present study aimed to identify the clinical signs associated with IFSwOC and prognosticators of the disease. METHODS: A retrospective case series was conducted of patients histopathologically confirmed IFS or fungal rhinosinusitis with clinically apparent neuro-orbital complications who underwent surgery between 2008 and 2018. Demographic data, presenting symptoms and signs, culture data, laboratory results, and patient outcomes were obtained from medical records. RESULTS: A total of 38 patients were identified, including 9 patients with IFSwOC, and 29 patients with IFS without orbital complications (IFSsOC). The clinical signs associated with developing orbital complications include headache, fever, sphenoid sinus, or posterior ethmoid sinus involvement, CRP level ≥ 1.025 mg/dL, or ESR level ≥ 46.5 mm/h. In IFSwOC group, male, posterior ethmoid sinus involvement, WBC count ≥ 9000 µL, CRP level ≥ 6.91 mg/dL, or ESR level ≥ 69 mm/h were correlated with a significantly poorer prognosis. CONCLUSION: IFS patients with sphenoid or posterior ethmoid sinus involvement, headache or fever as presenting symptoms, elevated CRP, and ESR level were at risk of developing orbital complications. Timely surgical debridement followed by systemic antifungal treatment may improve treatment outcomes.

2.
Theranostics ; 11(16): 7879-7895, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34335970

RESUMO

Rationale: Previous studies have shown that human embryonic stem cell-derived cardiomyocytes improved myocardial recovery when administered to infarcted pig and non-human primate hearts. However, the engraftment of intramyocardially delivered cells is poor and the effectiveness of clinically relevant doses of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) in large animal models of myocardial injury remains unknown. Here, we determined whether thymosin ß4 (Tb4) could improve the engraftment and reparative potency of transplanted hiPSC-CMs in a porcine model of myocardial infarction (MI). Methods: Tb4 was delivered from injected gelatin microspheres, which extended the duration of Tb4 administration for up to two weeks in vitro. After MI induction, pigs were randomly distributed into 4 treatment groups: the MI Group was injected with basal medium; the Tb4 Group received gelatin microspheres carrying Tb4; the CM Group was treated with 1.2 × 108 hiPSC-CMs; and the Tb4+CM Group received both the Tb4 microspheres and hiPSC-CMs. Myocardial recovery was assessed by cardiac magnetic resonance imaging (MRI), arrhythmogenesis was monitored with implanted loop recorders, and tumorigenesis was evaluated via whole-body MRI. Results: In vitro, 600 ng/mL of Tb4 protected cultured hiPSC-CMs from hypoxic damage by upregulating AKT activity and BcL-XL and promoted hiPSC-CM and hiPSC-EC proliferation. In infarcted pig hearts, hiPSC-CM transplantation alone had a minimal effect on myocardial recovery, but co-treatment with Tb4 significantly enhanced hiPSC-CM engraftment, induced vasculogenesis and the proliferation of cardiomyocytes and endothelial cells, improved left ventricular systolic function, and reduced infarct size. hiPSC-CM implantation did not increase incidence of ventricular arrhythmia and did not induce tumorigenesis in the immunosuppressed pigs. Conclusions: Co-treatment with Tb4-microspheres and hiPSC-CMs was safe and enhanced the reparative potency of hiPSC-CMs for myocardial repair in a large-animal model of MI.


Assuntos
Infarto do Miocárdio/terapia , Miócitos Cardíacos/metabolismo , Timosina/farmacologia , Animais , Diferenciação Celular , Proliferação de Células , Células Cultivadas , China , Modelos Animais de Doenças , Células Endoteliais/patologia , Humanos , Células-Tronco Pluripotentes Induzidas/metabolismo , Infarto do Miocárdio/metabolismo , Miocárdio/patologia , Regeneração , Transplante de Células-Tronco/métodos , Suínos , Timosina/metabolismo , Timosina/fisiologia
3.
Oper Neurosurg (Hagerstown) ; 20(6): E434-E435, 2021 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-33575736

RESUMO

This 59-yr-old man presented with headache, dizziness, diplopia, and right-side hearing impairment for years. The objective degree of hearing impairment was not available. Magnetic resonance imaging (MRI) showed a right petrous apex lesion centered behind the right petrous internal carotid artery and extending lateral to the medial aspect of the right internal auditory canal. A combined endoscopic endonasal and left contralateral transmaxillary (CTM) approach was performed, and gross-total resection was achieved. Peeling the cyst wall from the dura resulted in minor weeping. It was covered with a left-sided, vascularized nasoseptal flap. His dizziness and diplopia improved immediately after the surgery. Histopathology revealed an epidermoid cyst. In this surgical video, we demonstrate the key steps of the CTM approach for access to the petrous apex posterior to the petrous internal carotid artery (ICA). The patient gave informed consent for surgery and video recording.


Assuntos
Colesteatoma , Cirurgia Endoscópica por Orifício Natural , Colesteatoma/diagnóstico por imagem , Colesteatoma/cirurgia , Humanos , Masculino , Nariz , Osso Petroso/diagnóstico por imagem , Osso Petroso/cirurgia , Base do Crânio
4.
J Neurosurg ; : 1-9, 2020 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-32168478

RESUMO

OBJECTIVE: For symptomatic nonsecreting pituitary adenomas (PAs), resection remains a critical option for treatment. In this study, the authors used a large-population national database to compare endoscopic surgery (ES) to nonendoscopic surgery (NES) for the surgical management of PA. METHODS: The National Cancer Database was queried for all patients diagnosed with histologically confirmed PA who underwent resection between 2010 and 2016 in which the surgical approach was specified. Due to database limitations, microsurgery and craniotomy were both categorized as NES. RESULTS: Of 30,488 identified patients, 16,373 (53.7%) underwent ES and 14,115 (46.3%) underwent NES. There was a significant increase in the use of ES over time (OR 1.16, p < 0.01). Furthermore, there was a significant temporal increase in ES approach for tumors ≥ 2 cm (OR 1.17, p < 0.01). Compared to NES, patients who underwent ES were younger (p = 0.01), were treated at academic centers (p < 0.01), lived a greater distance from their treatment site (p < 0.01), had smaller tumors (p < 0.01), had greater medical comorbidity burden (p = 0.04), had private insurance (p < 0.01), and had a higher household income (p < 0.01). After propensity score matching to control for age, tumor size, Charlson/Deyo score, and type of treatment center, patients who underwent ES had a shorter length of hospital stay (LOS) (3.9 ± 4.9 days vs 4.3 ± 5.4 days, p < 0.01), although rates of gross-total resection (GTR; p = 0.34), adjuvant radiotherapy (p = 0.41), and 90-day mortality (p = 0.45) were similar. On multivariate logistic regression, African American race (OR 0.85, p < 0.01) and tumor size ≥ 2 cm (OR 0.89, p = 0.01) were negative predictors of receiving ES, whereas diagnosis in more recent years (OR 1.16, p < 0.01), greater Charlson/Deyo score (OR 1.10, p = 0.01), receiving treatment at an academic institution (OR 1.67, p < 0.01) or at a treatment site ≥ 20 miles away (OR 1.17, p < 0.01), having private insurance (OR 1.09, p = 0.01), and having a higher household income (OR 1.11, p = 0.01) were predictive of receiving ES. Compared to the ES cohort, patients who started with ES and converted to NES (n = 293) had a higher ratio of nonwhite race (p < 0.01), uninsured insurance status (p < 0.01), longer LOS (p < 0.01), and higher rates of GTR (p = 0.04). CONCLUSIONS: There is an increasing trend toward ES for PA resection including its use for larger tumors. Although ES may result in shorter LOS compared to NES, rates of GTR, need for adjuvant therapy, and short-term mortality may be similar. Factors such as tumor size, insurance status, facility type, income, race, and existing comorbidities may predict receiving ES.

5.
J Neurooncol ; 146(3): 407-416, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32020471

RESUMO

PURPOSE: Surgical treatments for skull base meningiomas are challenging. We found that most of these lesions (75%), despite locating at the anterior, middle or posterior fossa, could be dealt with a combo skill-the pretemporal trans-cavernous trans-Meckel's trans-tentorial trans-petrosal approach (PCMTP), which adopted the same curvilinear skin incision as for the classic pterional approach. Our aim of this study is to validate the application of this technique in treating skull base meningiomas. METHODS: Patients underwent surgical intervention at our institute during 2010-2018 were retrospectively reviewed. We statistically analyzed the clinical, radiological, and pathological outcomes. RESULTS: In total, 109 patients operated with at least part of the PCMTP combo technique were included. The median follow-up time was 26.6 months. Tumor locations were categorized into: Zone I-sphenoid ridge, olfactory groove, and juxtasellar meningiomas which could be dealt with pterional approach. Zone II-clinoidal and cavernous sinus meningiomas which could be dealt with pretemporal trans-cavernous approach. Zone III-Meckel's and Incisura meningiomas which could be dealt with trans-Meckel's trans tentorial approach. Zone IV-petroclival menigiomas which could be dealt with trans-petrosal approach. When an extensive tumor occupied the anterior, middle, and posterior fossa, the whole combination of the PCMTP technique was applied. The mortality rate is 3.7% (4 patients). Three patients (2.8%) suffered from postoperative deterioration and required occasional assistance. The location of tumor was associated with different Simpson grade removal (p = 0.0015) and resection rate (p < 0.001). CONCLUSION: The PCMTP is effective in treating skull base meningiomas.


Assuntos
Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias da Base do Crânio/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Estudos Retrospectivos
6.
ESC Heart Fail ; 7(1): 92-102, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31851785

RESUMO

AIMS: A significant proportion of heart failure (HF) patients have HF preserved ejection fraction (HFpEF). The lack of effective treatments for HFpEF remains a critical unmet need. A key obstacle to therapeutic innovation in HFpEF is the paucity of pre-clinical models. Although several large animal models have been reported, few demonstrate progression to decompensated HF. We have established a model of HFpEF by enhancing a porcine model of progressive left ventricular (LV) pressure overload and characterized HF in this model including advanced cardiometabolic imaging using cardiac magnetic resonance imaging and hyperpolarized carbon-13 magnetic resonance spectroscopy. METHODS AND RESULTS: Pigs underwent progressive LV pressure overload by means of an inflatable aortic cuff. Pigs developed LV hypertrophy (50% increase in wall thickness, P < 0.001, and two-fold increase in mass compared to sham control, P < 0.001) with no evidence of LV dilatation but a significant increase in left atrial volume (P = 0.013). Cardiac magnetic resonance imaging demonstrated T1 modified Look-Locker inversion recovery values increased in 16/17 segments compared to sham pigs (P < 0.05-P < 0.001) indicating global ventricular fibrosis. Mean LV end-diastolic (P = 0.047) and pulmonary capillary wedge pressures (P = 0.008) were elevated compared with sham control. One-third of the pigs demonstrated clinical signs of frank decompensated HF, and mean plasma BNP concentrations were raised compared with sham control (P = 0.008). Cardiometabolic imaging with hyperpolarized carbon-13 magnetic resonance spectroscopy agreed with known metabolic changes in the failing heart with a switch from fatty acid towards glucose substrate utilization. CONCLUSIONS: Progressive aortic constriction in growing pigs induces significant LV hypertrophy with cardiac fibrosis associated with left atrial dilation, raised filling pressures, and an ability to transition to overt HF with raised BNP without reduction in LVEF. This model replicates many aspects of clinical HFpEF with a predominant background of hypertension and can be used to advance understanding of underlying pathology and for necessary pre-clinical testing of novel candidate therapies.


Assuntos
Insuficiência Cardíaca , Imageamento por Ressonância Magnética , Animais , Modelos Animais de Doenças , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Volume Sistólico , Suínos
7.
Sci Rep ; 9(1): 19743, 2019 12 24.
Artigo em Inglês | MEDLINE | ID: mdl-31874979

RESUMO

This is a retrospective study examining the efficacy and safety of Gamma Knife radiosurgery (GKS) in treating patients with cerebral cavernous malformations (CCMs). Between 1993 and 2018, 261 patients with 331 symptomatic CCMs were treated by GKS. The median age was 39.9 years and females were predominant (54%). The median volume of CCMs was 3.1 mL. The median margin dose was 11.9 Gy treat to a median isodose level of 59%. Median clinical and imaging follow-up times were 69 and 61 months, respectively. After the initial hemorrhage that led to CCM diagnosis, 136 hemorrhages occurred in the period prior to GKS (annual incidence = 23.6%). After GKS, 15 symptomatic hemorrhages occurred within the first 2 years of follow-up (annual incidence = 3.22%), and 37 symptomatic hemorrhages occurred after the first 2 years of follow-up (annual incidence = 3.16%). Symptomatic radiation-induced complication was encountered in 8 patients (3.1%). Mortality related to GKS occurred in 1 patient (0.4%). In conclusion, GKS decreased the risk of hemorrhage in CCM patients presenting with symptomatic hemorrhage. GKS is a viable alternative treatment option for patients with surgically-inaccessible CCMs or significant medical comorbidities.


Assuntos
Hemangioma Cavernoso do Sistema Nervoso Central , Hemorragias Intracranianas , Radiocirurgia/efeitos adversos , Adolescente , Adulto , Idoso , Criança , Feminino , Seguimentos , Hemangioma Cavernoso do Sistema Nervoso Central/epidemiologia , Hemangioma Cavernoso do Sistema Nervoso Central/radioterapia , Humanos , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
J Neurosurg ; : 1-6, 2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31628289

RESUMO

OBJECTIVE: Injury to the internal carotid artery (ICA) is the most critical complication of endoscopic endonasal skull base surgery. Packing with a crushed muscle graft at the injury site has been an effective management technique to control bleeding without ICA sacrifice. Obtaining the muscle graft has typically required access to another surgical site, however. To address this concern, the authors investigated the application of an endonasally harvested longus capitis muscle patch for the management of ICA injury. METHODS: One colored silicone-injected anatomical specimen was dissected to replicate the surgical access to the nasopharynx and the stepwise dissection of the longus capitis muscle in the nasopharynx. Two representative cases were selected to illustrate the application of the longus capitis muscle patch and the relevance of clinical considerations. RESULTS: A suitable muscle graft from the longus capitis muscle could be easily and quickly harvested during endoscopic endonasal skull base surgery. In the illustrative cases, the longus capitis muscle patch was successfully used for secondary prevention of pseudoaneurysm formation following primary bleeding control on the site of ICA injury. CONCLUSIONS: Nasopharyngeal harvest of a longus capitis muscle graft is a safe and practical method to manage ICA injury during endoscopic endonasal surgery.

9.
In Vivo ; 33(6): 1893-1899, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31662517

RESUMO

BACKGROUND/AIM: Olfactory dysfunction can be caused by stroke but the pathogenesis is still unclear. Previous studies have proved that olfactory dysfunction could be caused by microglia activation in the olfactory bulb and that middle cerebral artery occlusion (MCAO) may induce ipsilateral olfactory bulb microglia activation. This study aimed to explore the possible pathogenesis of ischemic stroke-induced olfactory dysfunction. MATERIALS AND METHODS: We used a rat model of MCAO to simulate ischemic stroke. Olfactory function tests were performed using buried food test. The mRNA expression of olfactory marker protein (OMP), microglia/macrophage activation, and proinflammatory mediators were measured using reverse transcription-quantitative polymerase chain reaction. RESULTS: Following MCAO, rats had poorer olfactory performance. In the olfactory bulb of the rats, the mRNA expression of OMP decreased and the mRNA expression of microglia/macrophage activation and proinflammatory mediators increased. CONCLUSION: Ischemic stroke causes microglia/macrophage activation and promotes neuroinflammation in the olfactory bulb, causing olfactory dysfunction.


Assuntos
Citocinas/metabolismo , Inflamação/metabolismo , Macrófagos/metabolismo , Microglia/metabolismo , Bulbo Olfatório/metabolismo , Acidente Vascular Cerebral/metabolismo , Animais , Modelos Animais de Doenças , Feminino , Infarto da Artéria Cerebral Média/metabolismo , Masculino , Proteína de Marcador Olfatório/metabolismo , RNA Mensageiro/metabolismo , Ratos , Ratos Endogâmicos WKY
10.
J Neurosurg ; : 1-12, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30544351

RESUMO

OBJECTIVEThe foramen lacerum is a relevant skull base structure that has been neglected for many years. From the endoscopic endonasal perspective, the foramen lacerum is a key structure due to its location at the crossroad between the sagittal and coronal planes. The objective of this study was to provide a detailed investigation of the surgical anatomy of the foramen lacerum and its adjacent structures based on anatomical dissections and imaging studies, propose several relevant key surgical landmarks, and demonstrate the surgical technique for its full exposure with several illustrative cases.METHODSTen colored silicone-injected anatomical specimens were dissected using a transpterygoid approach to the foramen lacerum region in a stepwise manner. Five similar specimens were used for a comparative transcranial approach. The osseous anatomy was examined in 32 high-resolution multislice CT studies and 1 disarticulated skull. Representative cases were selected to illustrate the application of the findings.RESULTSThe pterygosphenoidal fissure is the synchondrosis between the lacerum process of the pterygoid bone and the floor of the sphenoid bone. It constantly converges with the posterior end of the vidian canal at a 45° angle, and its posterolateral end points directly to the lacerum foramen. The pterygoid tubercle separates the vidian canal from the pterygosphenoidal fissure, and forms the anterior wall of the lower part of the foramen lacerum. The lingual process, which forms the lateral wall of the foramen lacerum, was identified in 53 of 64 sides and featured an average height of 5 mm. The mandibular strut separates the foramen lacerum from the foramen ovale and had an average width of 5 mm.CONCLUSIONSThis study provides relevant surgical landmarks and a systematic approach to the foramen lacerum by defining anterior, medial, lateral, and inferior walls that may facilitate its safe exposure for effective removal of lesions while minimizing the risk of injury to the internal carotid artery.

11.
Oper Neurosurg (Hagerstown) ; 13(4): 522-528, 2017 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-28838109

RESUMO

BACKGROUND: The maxillary nerve (V2) can be approached via the open middle fossa approach. OBJECTIVE: To delineate the anatomy of V2 and its specific segments with respect to the endonasal landmarks. We present the endoscopic endonasal interdural middle fossa approach to V2 and its potential application for the treatment of perineural spread in sinonasal/skull base tumors. METHODS: Five human head silicon-injected specimens underwent bilateral endoscopic endonasal transpterygoid approaches. V2 prominence and the maxillary strut were identified in the lateral recess along with paraclival carotid protruberance. The regions superior and inferior to V2 corresponding to the anteromedial and anterolateral triangles of the middle fossa were exposed. RESULTS: V2 can be classified into 3 segments: interdural (from the Gasserian ganglion to the proximal part of the maxillary strut), intracanalicular (corresponding to the anteroposterior length of the maxillary strut), and pterygopalatine (distal to the maxillary strut and the site of its divisions). Endonasally, the average length of the interdural and the intracanalicular segments were approximately 9 and 4.4 mm, respectively. V2, following its division distal to the maxillary strut, was successfully dissected off the middle fossa dura and transected just distal to the Gasserian ganglion. CONCLUSION: Endonasally, the interdural segment can be safely mobilized between the periosteal and meningeal dural layers while ensuring the integrity of the middle fossa dura. This allows transection of infiltrated V2 to facilitate tumor resection without entering the intradural/arachnoidal space. Posteriorly, this is limited by the Gasserian ganglion and superomedially by the dural envelope surrounding the cavernous sinus and the paraclival carotid artery.


Assuntos
Seio Cavernoso/anatomia & histologia , Endoscopia/métodos , Nervo Maxilar/anatomia & histologia , Nervo Maxilar/cirurgia , Procedimentos Neurocirúrgicos/métodos , Nariz/cirurgia , Carcinoma Adenoide Cístico/diagnóstico por imagem , Carcinoma Adenoide Cístico/cirurgia , Seio Cavernoso/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/cirurgia
12.
Faraday Discuss ; 196: 55-69, 2017 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-27904898

RESUMO

This manuscript describes the preparation of water soluble aggregation-induced emission enhancement (AIEE)-based fluorescent organic nanoparticles (FONs). The fluorescence diversity of the FONs was investigated in the presence of silver nanowires. We observed that the emission of the FONs can be enhanced by mixing with the nanowires, which is believed to originate from resonance between the emission of the FONs and the surface plasmon resonances of the metal surface. That is, the AIEE phenomenon was promoted according to the metal-enhanced fluorescence (MEF) mechanism that can be used to build up a novel double emission enhancement (DEE) platform and to extend the range of AIEE applications. The systemic fluorescence enhancement, lifetime and photostability were measured and the AIEE-MEF evaluation and the interaction between the FONs and nanowires were discussed based on the obtained spectral data and SEM and fluorescent microscopy images.

13.
J Neurooncol ; 130(2): 319-330, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27766473

RESUMO

The endoscopic endonasal approach (EEA) has significantly evolved since its initial uses in pituitary and sinonasal surgery. The literature is filled with reports and case series demonstrating efficacy and advantages for the entire ventral skull base. With competence in 'minimally invasive' parasellar approaches, larger and more complex approaches were developed to utilize the endonasal corridor to create maximally invasive endoscopic skull base procedures. The challenges of these more complex endoscopic procedures include a long learning curve and navigating in a narrow corridor; reconstruction of defects presented new challenges and early experience revealed a significantly higher risk of cerebrospinal fluid leak. Despite these challenges, there are many benefits to the EEA including avoidance of brain and neurovascular retraction, improved visualization, a direct corridor onto many tumors and the two-surgeon approach. Most importantly, the EEA provides a midline corridor to directly access tumors, which displace critical neurovascular structures laterally, giving it an inherent advantage of minimizing any manipulation of these structures and thus decreasing their potential injury.


Assuntos
Cirurgia Endoscópica por Orifício Natural/métodos , Neuronavegação/métodos , Procedimentos Neurocirúrgicos/métodos , Base do Crânio/cirurgia , Humanos , Neoplasias da Base do Crânio/cirurgia
14.
Oper Neurosurg (Hagerstown) ; 12(2): 153-162, 2016 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-29506094

RESUMO

BACKGROUND: The endoscopic endonasal approach provides a direct route to ventral foramen magnum (FM) lesions like meningiomas, which are difficult to access. Endonasal access at the FM is limited laterally by the occipital condyles and inferiorly by the C1 anterior arch and the odontoid process, which may need partial resection. OBJECTIVE: We investigated the surgical anatomy and technical nuances for endonasally increasing the surgical corridor at the FM region both laterally and inferiorly. Unique to our report, we quantified the amount of required medial condyle resection to obtain exposure of the lateral aspects of the FM. METHODS: Five fresh human head silicone-injected specimens underwent endonasal inferior transclival, transcondylar approaches. The lateral limit of medial condyle resection was defined using a vertical line extending inferiorly from foramen lacerum and its intersection with the occipital condyle. The condylectomy was limited posteriorly by the cortical bone surrounding the hypoglossal canal. The volume of the resected condyle (cubic centimeters) for 10 sides was measured using the pre- and postdissection computed tomography-volumetric analysis. RESULTS: The mean percentage condylar volume resected during a unilateral medial condylectomy was 18% (9.7%-28.3%). The surgical corridor was extended inferiorly in all specimens without violating the transverse ligament by drilling the superior aspects of C1 anterior arch and the exposed odontoid tip. These operative nuances were successfully applied in the operating room. CONCLUSION: Anatomical landmarks can reliably guide an endonasal anteromedial condyle resection. Minimal condyle resection is required to widen lateral access at the FM, which minimizes the risk of craniocervical instability.

15.
World Neurosurg ; 87: 557-64, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26485417

RESUMO

BACKGROUND: Atypical and anaplastic meningiomas have much higher recurrence rates after surgical resection compared with benign meningiomas, but the role of adjuvant radiosurgery remains unclear. This study was undertaken to evaluate the outcomes of gamma knife radiosurgery for patients with atypical and anaplastic meningiomas. METHODS: In this retrospective analysis of a prospectively maintained database, 46 patients with histologically proven atypical or anaplastic meningiomas by current World Health Organization (WHO) criteria underwent postoperative Gamma Knife radiosurgery between 1993 and 2013. The median follow-up period was 32.6 months. The median tumor volume and margin dose were 11.7 mL (range, 2-53 mL) and 13.1 Gy (range, 12.0-16.5 Gy), respectively. RESULTS: Local control at 3 and 5 years was 50.6% and 32.1%, respectively. Gender (P = 0.013) and marginal dose less than or equal to 13 Gy (P = 0.049) were associated with the local control. The 3- and 5-year overall survival for patients with WHO grade II was 97.1% and 88.3%, respectively, compared with 66.7% and 66.7% for patients with WHO grade III meningiomas. Radiation therapy before Gamma Knife radiosurgery (GKRS; P = 0.018) and tumor grade (P = 0.019) were the factors associated with a worse overall survival rate. Fourteen patients (30.4%) developed adverse radiation effects after GKRS treatment, and all were Radiation Therapy Oncology Group grade I. CONCLUSIONS: Postoperative GKRS treatment for patients with atypical and anaplastic meningioma is challenging. More aggressive treatment, including of safely maximizing the extent of surgical resection and using a higher margin dose (>13Gy), should be applied to achieve better local control.


Assuntos
Meningioma/cirurgia , Radiocirurgia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Meningioma/patologia , Pessoa de Meia-Idade , Doses de Radiação , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Caracteres Sexuais , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
16.
Otolaryngol Clin North Am ; 49(1): 9-20, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26614826

RESUMO

The anatomy of the skull base is complex with multiple neurovascular structures in a small space. Understanding all of the intricate relationships begins with understanding the anatomy of the sphenoid bone. The cavernous sinus contains the carotid artery and some of its branches; cranial nerves III, IV, VI, and V1; and transmits venous blood from multiple sources. The anterior skull base extends to the frontal sinus and is important to understand for sinus surgery and sinonasal malignancies. The clivus protects the brainstem and posterior cranial fossa. A thorough appreciation of the anatomy of these various areas allows for endoscopic endonasal approaches to the skull base.


Assuntos
Seio Cavernoso/anatomia & histologia , Fossa Craniana Posterior/anatomia & histologia , Hipófise/anatomia & histologia , Osso Esfenoide/anatomia & histologia , Seio Esfenoidal/anatomia & histologia , Endoscopia/métodos , Humanos
17.
Neurosurgery ; 11 Suppl 3: 431-45; discussion 445-6, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26177488

RESUMO

BACKGROUND: Increasing use of endoscopic endonasal surgery for suprasellar lesions with extension into the optic canal (OC) has necessitated a better endonasal description of the OC. OBJECTIVE: To identify the osseous OC transcranially and then investigate its anatomic relationship to the key endonasal intrasphenoidal landmarks. We also aimed to determine and describe the technical nuances for safely opening the falciform ligament and intracanalicular dura (surrounding the optic nerve [ON]) endonasally. METHODS: Ten fresh human head silicon-injected specimens underwent an endoscopic transtuberculum/transplanum approach followed by 2-piece orbitozygomatic craniotomy to allow identification of 20 OCs. After completing up to 270° of endonasal bony decompression of the OC, a dural incision started at the sella and continued superiorly across the superior intercavernous sinus. Subsequently the dural opening was extended anterolaterally across the dura of the prechiasmatic sulcus, limbus sphenoidale, and planum. RESULTS: Endonasally, the length of the osseous OC was approximately 6 mm and equivalent to the length of the lateral opticocarotid recess, as measured anteroposteriorly. The ophthalmic artery arose from the supraclinoidal carotid artery at approximately 2.5 mm from the medial osseous OC entrance. Transcranial correlation of the endonasal dural incision confirmed medial detachment of the falciform ligament and exposure of the preforaminal ON. CONCLUSION: The lateral opticocarotid recess allows distinction of the preforaminal ON, roofed by the falciform ligament from the intracanalicular segment in the osseous OC. This facilitates the preoperative surgical strategy regarding the extent of OC decompression and dural opening. Extensive endonasal decompression of the OC and division of the falciform ligament is feasible.


Assuntos
Endoscopia/métodos , Cavidade Nasal/cirurgia , Procedimentos Neurocirúrgicos/métodos , Trato Óptico/anatomia & histologia , Trato Óptico/cirurgia , Adulto , Cadáver , Descompressão Cirúrgica , Dura-Máter/anatomia & histologia , Dura-Máter/cirurgia , Feminino , Hemianopsia/patologia , Hemianopsia/cirurgia , Humanos , Ligamentos/anatomia & histologia , Ligamentos/cirurgia , Meningioma/patologia , Meningioma/cirurgia , Pessoa de Meia-Idade , Nervo Óptico/anatomia & histologia , Nervo Óptico/cirurgia , Órbita/anatomia & histologia , Órbita/cirurgia , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Zigoma/anatomia & histologia , Zigoma/cirurgia
18.
J Chin Med Assoc ; 78(2): 101-7, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25467795

RESUMO

BACKGROUND: Surgical evacuation of spontaneous supratentorial intracerebral hemorrhage (ICH) is controversial because the traditional surgical approach sometimes causes further brain injury. The introduction of the neuroendoscope has brought with it the new idea of minimal invasiveness, which may improve the surgical results of ICH. METHODS: Twenty-one patients with spontaneous supratentorial ICH underwent endoscopic hematoma evacuation between December 2010 and January 2012. Safe entry points could be Kocher's, Keen's, or Frazier's point, depending on the locations of the hemorrhages. The surgical steps were as follows: (1) cortical incision and dilation of the channel; (2) introduction of the transparent sheath; (3) gushing out of the hematoma under high intracranial pressure; (4) changing the angle of the transparent sheath, endoscope, and suction tip to remove residual hematoma; and (5) paving a layer of hemostatic agents after hematoma removal. RESULTS: The median operative time was 120 minutes (range: 90-190 minutes), and the median blood loss was 160 mL (range: 50-300 mL). The median duration of intensive care unit stay was 6 days (range: 2-18 days). The median hematoma evacuation ratio was 90% (range: 60-99%). Two patients had rebleeding events, and the mortality rate was 9.5% (n = 2/21). The median Glasgow Coma Scale score improved from 8 to 11 within 1 week after surgery, and the median Glasgow Outcome Scale score was 3 after 6 months and 12 months follow-up. CONCLUSION: With the introduction of the minimally invasive techniques and the evolution of the neuroendoscope and hemostatic agents, the median operative time and blood loss have been significantly decreased. Although the hematoma evacuation rates were similar between the endoscope (90%) and craniotomy (85%) groups, the median intensive care unit stay was decreased from 11 days to 6 days due to reduced surgical invasiveness. This represents an important advancement in treating spontaneous supratentorial ICH, and provides a measured preview of the promising results that can be expected in the future.


Assuntos
Hemorragia Cerebral/cirurgia , Endoscopia/métodos , Hematoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Medula Espinal , Resultado do Tratamento
19.
Auris Nasus Larynx ; 42(2): 113-8, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25199746

RESUMO

OBJECTIVE: Mastoidectomy can be risky due to the chance of iatrogenic facial nerve dysfunction. Avoiding injuries to the mastoid segment of the facial nerve is mandatory when drilling the bone. With advancements in intraoperative near-infrared indocyanine green (ICG) video angiography, we describe the application of a novel fluorescent guidance technique during mastoidectomies to identify the facial canal with safety. METHODS: Mastoidectomies were performed as the key step in the presigmoid, petrosal or translabyrinthine approaches in 16 patients with different pathologies located at the cerebellopontine angle or petroclival region. After the facial canal was drilled to paper thin, ICG was injected via the central venous catheter. Compared with the dark bony portion, the vessels inside the vasa nervorum were highlighted as a result. The fluorescence guides the operator through the course of the facial nerve and facilitates opening of the internal auditory canal and the dissection of tumors. RESULTS: All 16 facial nerves were recognized during mastoidectomies under fluorescence guidance for varied periods of enhancing time (range, 23-50s). In all, one to four attempts after repeated drilling works to enhance the facial nerve were required before these nerves could be clearly seen. The tumor resection procedure yielded the following results: grossly total removal in seven patients, near total removal in five, and subtotal removal in three. Complete obliteration of a giant vertebral artery aneurysm in one patient was seen in the follow-up angiogram. The post-mastoidectomy facial nerve function, examined by triggered EMG, was preserved in all 16 patients, and no patients had postoperative facial palsy worse than House-Brackmann grade IV after 6 months of follow-up. CONCLUSION: With this novel technique, the course of the facial nerve can be confirmed during mastoidectomy, which reduces the possibility of iatrogenic facial nerve dysfunction. This fluorescence technique is especially helpful in establishing confidence and shortening the learning curve for beginners at mastoidectomies.


Assuntos
Ângulo Cerebelopontino/cirurgia , Traumatismos do Nervo Facial/prevenção & controle , Paralisia Facial/prevenção & controle , Doença Iatrogênica/prevenção & controle , Processo Mastoide/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adolescente , Adulto , Aneurisma/cirurgia , Estudos de Coortes , Corantes , Craniofaringioma/cirurgia , Eletromiografia , Nervo Facial , Feminino , Humanos , Verde de Indocianina , Masculino , Meningioma/cirurgia , Pessoa de Meia-Idade , Neuroma Acústico/cirurgia , Imagem Óptica , Projetos Piloto , Artéria Vertebral/cirurgia
20.
IEEE J Biomed Health Inform ; 18(6): 1822-30, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25375679

RESUMO

Despite patients with Alzheimer's disease (AD) were reported of revealing gait disorders and balance problems, there is still lack of objective quantitative measurement of gait patterns and balance capability of AD patients. Based on an inertial-sensor-based wearable device, this paper develops gait and balance analyzing algorithms to obtain quantitative measurements and explores the essential indicators from the measurements for AD diagnosis. The gait analyzing algorithm is composed of stride detection followed by gait cycle decomposition so that gait parameters are developed from the decomposed gait details. On the other hand, the balance is measured by the sway speed in anterior-posterior (AP) and medial-lateral (ML) directions of the projection path of body's center of mass (COM). These devised gait and balance parameters were explored on twenty-one AD patients and fifty healthy controls (HCs). Special evaluation procedure including single-task and dual-task walking experiments for observing the cognitive function and attention is also devised for the comparison of AD and HC groups. Experimental results show that the wearable instrument with the designed gait and balance analyzing system is a promising tool for automatically analyzing gait information and balance ability, serving as assistant indicators for early diagnosis of AD.


Assuntos
Acelerometria/instrumentação , Doença de Alzheimer/fisiopatologia , Marcha/fisiologia , Monitorização Ambulatorial/instrumentação , Processamento de Sinais Assistido por Computador/instrumentação , Idoso , Algoritmos , Vestuário , Feminino , Pé/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial/métodos , Tronco/fisiologia
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