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1.
J Clin Neurosci ; 61: 189-195, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30782318

RESUMO

BACKGROUND: Preservation of cranial nerve function in patients with benign tumors such as meningiomas and vestibular schwannomas remains difficult following microsurgery. METHODS: In this study, awake surgery was performed in 22 consecutive patients with meningiomas or vestibular schwannomas that compressed cranial nerves (I-XII). Improved, unchanged, or deteriorated cranial nerve function after surgery was evaluated. RESULTS: The function of 44 cranial nerves in 22 consecutive patients who underwent awake surgery for meningiomas or vestibular schwannomas improved, was unchanged, or deteriorated in eight, 35, and one nerves, respectively. Regarding the function of the olfactory (Ist) nerve, which is difficult to preserve, hyposmia improved after surgery in two patients with olfactory groove meningiomas. Regarding the auditory (VIIIth) nerve, which is also difficult to preserve, the function was improved, unchanged, or deteriorated after surgery in two, 11, and one patients, respectively, with cerebello-pontine angle meningiomas or vestibular schwannomas. In all patients with serviceable auditory function before surgery, function was preserved after surgery. In the same patients, the function of the facial (VIIth) nerve was also preserved after surgery in all patients. CONCLUSIONS: These results suggest that awake surgery for benign brain tumors such as meningiomas and vestibular schwannomas is associated with low patient morbidity regarding cranial nerve function.


Assuntos
Neoplasias Encefálicas/cirurgia , Meningioma/cirurgia , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Vigília , Adulto , Idoso , Idoso de 80 Anos ou mais , Traumatismos dos Nervos Cranianos/prevenção & controle , Nervos Cranianos , Descompressão Cirúrgica , Feminino , Humanos , Masculino , Neoplasias Meníngeas/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos
2.
Brain Behav ; 8(6): e00981, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-30106250

RESUMO

INTRODUCTION: Cranial nerve (CN) VII localization is a critical step during acoustic neuroma surgery because the nerve is generally hidden due to the tumor mass. The patient can suffer from Bell's palsy if the nerve is accidentally damaged during tumor removal. Surgeons localize CN VII by exploring the target area with a stimulus probe. Compound muscle action potentials (CMAPs) are elicited when the probe locates the nerve. However, false positives and false negatives are possible due to unpredictable tissue impedance in the operative area. Moreover, a single CMAP amplitude is not correlated with probe-to-nerve distance. OBJECTIVES: This paper presents a new modality for nerve localization. The probe-to-nerve distance is predicted by the proposed nerve location prediction model. METHODS: Input features are extracted from CMAP responses, tissue impedance, and stimulus current. The tissue impedance is calculated from the estimated resistance and capacitance of the tissue equivalent circuit. In this study, experiments were conducted in animals. A frog's sciatic nerve and gastrocnemius were used to represent CN VII and facial muscle in humans, respectively. Gelatin (2.8%) was used as a mock material to mimic an acoustic neuroma. The %NaCl applied to the mock material was used to emulate uncontrollable impedance of tissue in the operative area. RESULTS: The 10-fold cross-validation results revealed an average prediction accuracy of 86.71% and an average predicted error of 0.76 mm compared with the measurement data. CONCLUSION: The proposed nerve location prediction model could predict the probe-to-nerve distance across various impedances of the mock material.


Assuntos
Estimulação Elétrica/métodos , Neuroma Acústico/cirurgia , Pontos de Referência Anatômicos , Animais , Anuros , Paralisia de Bell/fisiopatologia , Paralisia de Bell/prevenção & controle , Traumatismos dos Nervos Cranianos/fisiopatologia , Traumatismos dos Nervos Cranianos/prevenção & controle , Impedância Elétrica , Nervo Facial/fisiologia , Paralisia Facial/prevenção & controle , Modelos Animais , Músculo Esquelético/fisiologia , Neuroma Acústico/fisiopatologia , Nervo Isquiático/fisiologia
3.
Folia Med (Plovdiv) ; 60(1): 154-157, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29668454

RESUMO

AIM: To compare the level of intra-operative identification of external branch of the superior laryngeal nerve (EBSLN) through classical conventional clinical methods of prevention against those applying intraoperative neuromonitoring (IONM). MATERIALS AND METHODS: The study included 102 patients with interventions on the thyroid gland performed in the surgical clinics of St George University Hospital and the Department of Special Surgery of Plovdiv Medical University. All operative procedures were performed by the standard technique of capsular dissection and IONM. RESULTS: Of all 102 thyroid procedures 87 (85.3%) patients underwent total thyroidectomy and 15 (14.7%) had unilateral thyroid lobectomy. One hundred fifty-five (82.01%) out of 189 expected EBSLN were identified and investigated intraoperatively when trying to identify visually EBSLN by the so called classical (conventional) methods of prevention. With the use of IONM, 181 (96.76%) EBSLN were correctly identified. Compared to the preliminary results of visual identification - 155/189 (82.01%) EBSLN, the degree of identification of EBSLN through IONM reached 96.76% which is a statistically significant difference (P <0.05) Conclusion: The use of IONM during thyroid resection significantly improves the degree of identification of EBSLN compared to conventional means of prevention. Routine use of IONM in surgical interventions on the thyroid gland will be beneficial for more secure identification and prevention of EBSLN.


Assuntos
Traumatismos dos Nervos Cranianos/prevenção & controle , Monitorização Neurofisiológica Intraoperatória/métodos , Nervos Laríngeos/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Tireoidectomia/efeitos adversos , Adulto , Idoso , Dissecação/métodos , Feminino , Humanos , Músculos Laríngeos/inervação , Músculos Laríngeos/cirurgia , Nervos Laríngeos/anatomia & histologia , Masculino , Pessoa de Meia-Idade , Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto Jovem
4.
Clin Implant Dent Relat Res ; 20(4): 531-534, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29624863

RESUMO

BACKGROUND: Anterior loop of the mental nerve is a very important anatomic landmark in implant placement and anterior mandibular osteotomies. PURPOSE: Two-dimensional imaging techniques are not competent enough to locate and measure the mental nerve loop in majority of the cases. Any injury to this loop results in pain/paresthesia/numbness in the region supplied by the mental nerve. The aim of this study is to analyze the prevalence and measure the length of the loop using cone beam computerized tomography (CBCT) and calculate the average length and prevalence so that a safe margin can be given while placing the implants or the osteotomy cuts in the premolar region. MATERIALS AND METHODS: A cross-sectional study was done using CBCT images of 85 patients taken for impaction surgery. The length of the loop was measured in mm using standardized lines drawn along specific anatomic landmarks. RESULTS: In our study 11.76% of patients had anterior loop in their mental nerve. Mean length of the mental nerve loop was calculated and found to be 2.79 mm. CONCLUSION: A margin of 4 mm anterior to the mental foramen should be safe to avoid any damage to the mental nerve loop bundle in majority of the cases where the loop is present.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Mandíbula/anatomia & histologia , Mandíbula/diagnóstico por imagem , Mandíbula/inervação , Nervo Mandibular/anatomia & histologia , Nervo Mandibular/diagnóstico por imagem , Adulto , Pontos de Referência Anatômicos , Traumatismos dos Nervos Cranianos/prevenção & controle , Estudos Transversais , Implantação Dentária Endo-Óssea/efeitos adversos , Feminino , Humanos , Imagem Tridimensional/métodos , Masculino , Mandíbula/cirurgia , Osteotomia/efeitos adversos , Osteotomia/métodos , Prevalência , Dente/inervação , Adulto Jovem
5.
J Oral Maxillofac Surg ; 76(7): 1539-1545, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29406261

RESUMO

PURPOSE: According to the literature, ultrasonic surgery reduces the incidence of neurosensory disturbance (NSD) of the inferior alveolar nerve (IFAN) after bilateral sagittal split osteotomy (BSSO). The purpose of this study was to evaluate the effects of ultrasonic surgery and the anatomic position of the IFAN canal on NSD after BSSO. PATIENTS AND METHODS: This retrospective cohort study included skeletal mandibular prognathism cases operated on with an ultrasonic bone scalpel or a reciprocating saw. The primary predictor variable was osteotomy technique (ultrasonic or conventional surgery). The primary outcome variable was NSD. Other variables included age, gender, operator, degree of setback, surgical duration, blood loss, and IFAN position. Comparisons of 2 variables were performed by use of the Student t test or Fisher exact test. A regression model was used to examine the relationship between the presence or absence of NSD and other variables. The level of significance was set at P < .05 for all statistical tests. RESULTS: The ultrasonic group was composed of 35 patients, whereas the conventional group was composed of 32. Three months after surgery, NSD was observed on 16 of 70 sides (22.9%) in the ultrasonic group and 28 of 64 sides (43.8%) in the conventional group; this difference was significant. Furthermore, recovery from NSD at 3 months after BSSO was significantly more common in the ultrasonic group than in the conventional group. In the ultrasonic group, even when the distance from the buccal aspect of the IFAN canal to the outer buccal cortical margin was shorter, NSD of the IFAN was less frequent. CONCLUSIONS: Ultrasonic surgery may be an effective technique to reduce the incidence of NSD after BSSO, and it contributed to recovery from NSD. The use of an ultrasonic device for BSSO is recommended when the distance from the buccal aspect of the IFAN canal to the outer buccal cortical margin is shorter on computed tomography.


Assuntos
Traumatismos dos Nervos Cranianos/prevenção & controle , Osteotomia Sagital do Ramo Mandibular/métodos , Complicações Pós-Operatórias/prevenção & controle , Prognatismo/cirurgia , Transtornos das Sensações/prevenção & controle , Procedimentos Cirúrgicos Ultrassônicos/métodos , Traumatismos dos Nervos Cranianos/etiologia , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Transtornos das Sensações/etiologia , Adulto Jovem
6.
J Prosthet Dent ; 119(4): 568-573, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28838820

RESUMO

STATEMENT OF PROBLEM: The genial tubercle is a clinically palpable landmark in the mandible and can be identified in cone beam computed tomography (CBCT). Its location can be used to measure the safe zone in the interforaminal region of the mandible. These measurements may be helpful for implant treatment planning in patients with complete edentulism. PURPOSE: The purpose of this clinical study was to evaluate the safe distance in the interforaminal region of the mandible measured from the genial tubercle level for implant osteotomy in a Chinese-Malaysian population. MATERIAL AND METHODS: A total of 201 Digital Imaging and Communications in Medicine (DICOM) files were selected for the study from the CBCTs of dentate or edentulous Chinese-Malaysian adult patients with ongoing or completed treatments. Measurements were made with implant planning software. The anatomy of the whole mandible was assessed in the coronal cross-sectional, horizontal view and in panoramic view. Measurements were obtained in millimeters on one side by locating and marking a genial tubercle and then marking the mesial margin of the mental foramen and the anterior loop of the inferior alveolar nerve. The corresponding points of these landmarks were identified on the crest of the mandibular ridge to measure the linear distances. All the measurement steps were repeated on the other side. The linear distance of 2 mm was deducted from the total distance between the genial tubercle and the anterior loop separately for left and right side measurements to identify the safe zone. The mixed 2-way analysis of variance (ANOVA) test was used to analyze side and sex-related variations. RESULTS: The mean safe zone measured at the crestal level from the genial tubercle site on the left side of the mandible was 21.12 mm and 21.67 mm on the right side. A statistically significant (P<.05) difference was found between the left and right sides of the safe zone measurements in both men and women. No statistically significant differences were found in the safe zone between men and women on either the left or right side (P=.655). The minimum distance from the genial tubercle to the right side safe zone in women was 12.82 mm and 14.99 mm in men; however, on the left side, the minimum distance was observed to be 14.81 mm in women and 15.54 mm in men. CONCLUSIONS: The safe zone related to the genial tubercle was 21.12 mm on the left side and 21.67 mm on the right side, with no significant sex-related variations. Within the same individuals, a significant difference was found in the safe zone between the left and right side.


Assuntos
Pontos de Referência Anatômicos , Tomografia Computadorizada de Feixe Cônico , Implantação Dentária Endo-Óssea , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Traumatismos dos Nervos Cranianos/prevenção & controle , Feminino , Humanos , Arcada Edêntula/cirurgia , Malásia , Masculino , Mandíbula/anatomia & histologia , Nervo Mandibular , Pessoa de Meia-Idade , Osteotomia , Adulto Jovem
7.
Int. j. morphol ; 35(2): 564-570, June 2017. ilus
Artigo em Inglês | LILACS | ID: biblio-893022

RESUMO

Some dental treatments that are performed in the mandibular teeth involve manipulation of anatomical structures near the dental periapex, so it is likely to cause nerve damage due to the proximity of the inferior alveolar nerve with the apices of the mandibular teeth, mainly in the molar area. The aim of this study was to determine through Computed Tomography (CT) scan the existing distance between the mandibular canal and the anatomical structures adjacent to its path which will help to reduce the risk of injury to the inferior alveolar nerve during the different dental treatments developed in this zone. A cross-sectional study was performed where the study population consisted of 50 patients of both sexes, between 20 and 30 years with a full dentition mandible. Patients underwent a CT study of the mandible with coronal planes at 1.5 mm, the right side and the left side of each jaw were considered for the analysis and millimetric measuring was held of the distances of the mandibular canal (MC) from different anatomical structures. Subsequently, a statistical analysis was performed to obtain the mean and standard deviation of the distances between the mandibular canal and some adjacent anatomical structures. The distance from the alveolar nerve canal to the apex of the lower third molar in average was 1.49 mm on the right side and 1.69 mm on the left side, the distance between the mandibular canal and lingual cortical at the lower first molar level on average was 3.54 mm on the right side and 4.02 mm on the left side and the distance between the lingual cortical at the second molar level was on average 2.86 mm on the right side and 3.6 mm on the left side.


Algunos tratamientos dentales que se realizan en los dientes mandibulares implican la manipulación de estructuras anatómicas cercanas al periapice dental, por lo que existe la probabilidad de causar lesiones nerviosas debido a la cercanía del canal mandibular con los ápices de los dientes mandibulares, principalmente los molares. El objetivo de este estudio fue determinar a través de tomografía computarizada la distancia existente entre el canal mandibular a las estructuras anatómicas adyacentes a su trayecto lo que ayudará a disminuir el riesgo de lesiones del nervio alveolar inferior durante los diferentes tratamientos dentales desarrollados en esta zona. Se realizó un estudio transversal en donde la población de estudio estuvo compuesta por 50 pacientes de ambos sexos, entre 20 a 30 años con dentición completa en mandíbula. A los pacientes se les realizó un estudio de Tomografía Computarizada (TC) en mandíbula con cortes coronales a 1.5mm, se consideraron para el análisis el lado derecho y el lado izquierdo de cada mandíbula, y se realizó la medición milimétrica de las distancias que existen desde el CNAI a diferentes estructuras anatómicas. Posteriormente, se realizó un análisis estadístico para obtener Medias y Desviación Estándar de las distancias que existen entre el canal mandibular y algunas estructuras anatómicas adyacentes. La distancia del canal mandibular al ápice del tercer molar inferior en promedio fue de 1,49 mm del lado derecho y de 1,69 mm del lado izquierdo,la distancia entre el canal mandibular y la cortical lingual a nivel del primer molar inferior en promedio fue de 3,54 mm del lado derecho y de 4,02 mm del lado izquierdo y la distancia entre la cortical lingual a nivel del segundo molar fue en promedio de 2,86 mm del lado derecho y de 3,6 mm del lado izquierdo.


Assuntos
Humanos , Masculino , Feminino , Adulto , Traumatismos dos Nervos Cranianos/prevenção & controle , Nervo Mandibular/diagnóstico por imagem , Dente Molar/diagnóstico por imagem , Estudos Transversais , Nervo Mandibular/anatomia & histologia , Dente Molar/anatomia & histologia , Tomografia Computadorizada por Raios X , Traumatismos do Nervo Trigêmeo/prevenção & controle
8.
Clin Anat ; 30(6): 817-820, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28556243

RESUMO

The internal nasal branch of the infraorbital nerve (ION) runs down the nose and around the ala to be distributed to the nasal septum and vestibule. The aim of this study was to measure the internal nasal branch around the ala of the nose and discuss its possible relevance in clinical/surgical practice. Twelve sides from seven specimens derived from fresh frozen and embalmed Caucasian cadaveric heads were dissected. The specimens included three males and four females. The ages of the cadavers at death ranged from 65 to 84 years. The diameter of the internal nasal branch, horizontal distance from the lateral contour of the ala (Point A) to the branch (distance H) and vertical distance from the bottom part of the ala (Point B) to the branch (distance V) were recorded. Distance H ranged from -1.6 to 1.5 mm on right sides and -1.0 to 1.5 mm on left sides. The diameter of the nerves at Point A ranged from 1.3 to 1.8 mm on right sides and 1.3 to 1.6 mm on left sides. Distance V ranged from -1.5 to 1.0 mm on right sides and -2.3 to 1.1 mm on left sides. The diameter of the nerves at Point B ranged from 0.7 to 1.3 mm on right sides and 0.8 to 1.2 mm on left sides. The results of this study are the first to detail the topography of the internal nasal branch of the ION. Clin. Anat. 30:817-820, 2017. © 2017Wiley Periodicals, Inc.


Assuntos
Nervo Maxilar/anatomia & histologia , Nariz/inervação , Idoso , Idoso de 80 Anos ou mais , Cadáver , Traumatismos dos Nervos Cranianos/prevenção & controle , Feminino , Humanos , Masculino , Nervo Maxilar/lesões , Nariz/cirurgia
10.
Cancer Radiother ; 20(6-7): 475-83, 2016 Oct.
Artigo em Francês | MEDLINE | ID: mdl-27614519

RESUMO

Modern techniques such as intensity modulated radiation therapy (IMRT) have been proven to significantly decrease the dose delivered to the cochleovestibular apparatus, limiting consecutive toxicity especially for sensorineural hearing loss. However, recent data still report a 42% rate of radio-induced hypoacusia underscoring the need to protect the cochleovestibular apparatus. Due to the small size of the cochlea, a precise dose-volume analysis could not be performed, and recommendations only refer to the mean dose. Confusing factors such as age, concomitant chemotherapy, primary site and tumor stage should be taken into account at the time of treatment planning. (Non-coplanar) VMAT and tomotherapy have been proven better at sparing the cochlea in comparison with 3D CRT. Brainstem radio-induced injuries were poorly studied because of their infrequency and the difficulty of distinguishing between necrosis and tumor progression in the case of a primary tumor located at the base of skull. The following toxicities have been described: brainstem focal radionecrosis, cognitive disorders without dementia, cranial nerve injuries and sensori motor disability. Maximal dose to the brainstem should be kept to < 54Gy for conventional fractionation. This dose could be exceeded (no more than 10mL should receive more than 59Gy), provided this hot spot is located in the peripheral area of the organ.


Assuntos
Tronco Encefálico/efeitos da radiação , Cóclea/efeitos da radiação , Neoplasias de Cabeça e Pescoço/radioterapia , Órgãos em Risco , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/prevenção & controle , Traumatismos dos Nervos Cranianos/etiologia , Traumatismos dos Nervos Cranianos/prevenção & controle , Relação Dose-Resposta à Radiação , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Neurossensorial/prevenção & controle , Humanos , Transtornos Motores/etiologia , Transtornos Motores/prevenção & controle , Necrose/etiologia , Necrose/prevenção & controle
11.
J Neurooncol ; 130(2): 367-375, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27650193

RESUMO

Vestibular schwannoma (VS) surgery requires appropriate patient selection, meticulous microsurgical technique and optimal post-operative care. Focused radiation is an effective alternative for the treatment of smaller VSs. For VS surgery to remain a reasonable option, surgery must be performed with a limited number of complications. Complication rates for VS surgery have increased over the last decade. This is likely due to (1) decreased surgical volume and as a result decreased microsurgical experience, (2) larger tumors undergoing surgery while smaller tumors are reserved for radiation, and (3) surgery for previously radiated tumors resulting in more difficult anatomic dissection. Appropriate management of complications is paramount. Herein, we discuss complications related to VS microsurgery and methods of avoidance. Specifically, we discuss the most frequently encountered complications, intraoperative monitoring and finally, methods of addressing these complications. With meticulous microsurgical technique, careful intraoperative monitoring and vigilant perioperative care one will ensure optimal patient outcomes.


Assuntos
Complicações Intraoperatórias , Microcirurgia/efeitos adversos , Neuroma Acústico/complicações , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/prevenção & controle , Transtornos Cerebrovasculares/etiologia , Transtornos Cerebrovasculares/prevenção & controle , Traumatismos dos Nervos Cranianos/etiologia , Traumatismos dos Nervos Cranianos/prevenção & controle , Cefaleia/etiologia , Cefaleia/prevenção & controle , Humanos , Hidrocefalia/etiologia , Hidrocefalia/prevenção & controle , Meningite/etiologia , Meningite/prevenção & controle , Monitorização Intraoperatória , Trombose dos Seios Intracranianos/etiologia , Trombose dos Seios Intracranianos/prevenção & controle
12.
World Neurosurg ; 94: 26-31, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27373414

RESUMO

BACKGROUND: Microvascular decompression (MVD) represents the most effective and safe surgical option for the treatment of trigeminal neuralgia since it was first popularized by Jannetta 50 years ago. Despite several advances, complications such as cerebellar and vascular injury, hearing loss, muscular atrophy, cerebrospinal fluid (CSF) leak, postoperative cutaneous pain, and sensory disturbances still occur and may negatively affect the outcome. We propose some technical nuances of the surgical procedure that were used in our recent series. METHODS: We used a novel hockey stick-shaped retromastoid skin incision, preserving the major nerves of the occipital and temporal areas. Microsurgical steps were performed without the use of retractors. CSF leakage was prevented with a watertight dural closure and multilayer osteodural reconstruction. RESULTS: The refined surgical steps were perfected in the last consecutive 15 cases of our series. In these cases we did not record any cutaneous pain, sensory disturbances, or CSF leakage. The average diameter of the craniectomy was 18 mm. No patient reported major complications related to the intradural microsurgical maneuvers. In all cases the neurovascular conflict was found and solved with a good outcome in terms of pain disappearance. CONCLUSIONS: Our minimally invasive approach was demonstrated to guarantee an optimal exposure of the cerebellopontine angle and minimize the rate of complications related to skin incision and muscular dissection, microsurgical steps, and closure.


Assuntos
Vazamento de Líquido Cefalorraquidiano/prevenção & controle , Traumatismos dos Nervos Cranianos/prevenção & controle , Perda Auditiva/prevenção & controle , Microcirurgia/métodos , Cirurgia de Descompressão Microvascular/métodos , Dor Pós-Operatória/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Transtornos das Sensações/prevenção & controle , Neuralgia do Trigêmeo/cirurgia , Humanos , Posicionamento do Paciente , Técnicas de Fechamento de Ferimentos
13.
Head Neck ; 38 Suppl 1: E1562-7, 2016 04.
Artigo em Inglês | MEDLINE | ID: mdl-26929189

RESUMO

BACKGROUND: Reconstruction of the internal carotid artery (ICA) is an operative challenge for lesions involving the lateral skull base because of excessive blood loss, intraoperative cranial nerve injury, and difficulties in cerebral protection. METHODS: Between January 2010 and October 2014, 9 patients with vascular lesions at the lateral skull base were treated with a "pre-reconstruction" technique, which means reconstruction of the ICA in advance of excising the lesions. RESULTS: All operations were technically successful with no mortality or strokes. The mean blood loss was 921 ± 210 mL. The mean total clamping time was 18 ± 5 minutes. Among the 5 patients without invasion of specific cranial nerves, no long-term sequelae occurred during the follow-up period ranging from 11 to 54 months. CONCLUSION: With less blood loss, slighter cranial nerve injuries, and shorter clamping time, the "pre-reconstruction" technique was safe and effective for the treatment of vascular lesions at the lateral skull base. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1562-E1567, 2016.


Assuntos
Artéria Carótida Interna/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Base do Crânio/cirurgia , Adolescente , Adulto , Perda Sanguínea Cirúrgica , Artéria Carótida Interna/patologia , Traumatismos dos Nervos Cranianos/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço , Base do Crânio/patologia , Adulto Jovem
14.
Surg Radiol Anat ; 38(1): 55-63, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26163825

RESUMO

PURPOSE: The purpose of this study was to produce an overview of the present visualization techniques of the inferior alveolar nerve (IAN) in order to reduce the rates of nerve damage after third molar (M3) removal and bilateral sagittal split osteotomy (BSSO). METHODS: An electronic literature search was performed of the English-language scientific literature published prior to December 31, 2014 using the LIMO KU Leuven search platform. Information on the specifications of the different imaging techniques, their clinical application, advantages, disadvantages, and duration was extracted from 11 reports. RESULTS: Five methods for IAN visualization were obtained from the search results, which are cone-beam computed tomography (CBCT) and automatic extraction of the IAN canal using computed tomography (CT), magnetic resonance imaging (MRI), panoramic radiography, endoscopy, and ultrasonographic visualization. CONCLUSION: The results of this study suggest that high-resolution MRI is the most commonly used method for direct visualization of the IAN. Six out of the eleven manuscripts use this technique. Recently, there have been some (experimental) modifications to the conventional MRI in the form of diffusion tensor tractography (DTT), phase-contrast magnetic resonance angiography (PC-MRA), and dental MRI. Future studies will focus on an intraoperative application of MRI to visualize the IAN during surgery.


Assuntos
Nervo Mandibular/diagnóstico por imagem , Traumatismos dos Nervos Cranianos/etiologia , Traumatismos dos Nervos Cranianos/prevenção & controle , Humanos , Dente Serotino/cirurgia , Osteotomia Sagital do Ramo Mandibular/efeitos adversos
15.
J Neurosurg ; 124(3): 657-64, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26274985

RESUMO

OBJECTIVE: A pilot study of prophylactic nimodipine and hydroxyethyl starch treatment showed a beneficial effect on facial and cochlear nerve preservation following vestibular schwannoma (VS) surgery. A prospective Phase III trial was undertaken to confirm these results. METHODS: An open-label, 2-arm, randomized parallel group and multicenter Phase III trial with blinded expert review was performed and included 112 patients who underwent VS surgery between January 2010 and February 2013 at 7 departments of neurosurgery to investigate the efficacy and safety of the prophylaxis. The surgery was performed after the patients were randomly assigned to one of 2 groups using online randomization. The treatment group (n = 56) received parenteral nimodipine (1-2 mg/hr) and hydroxyethyl starch (hematocrit 30%-35%) from the day before surgery until the 7th postoperative day. The control group (n = 56) was not treated prophylactically. RESULTS: Intent-to-treat analysis showed no statistically significant effects of the treatment on either preservation of facial nerve function (35 [67.3%] of 52 [treatment group] compared with 34 [72.3%] of 47 [control group]) (p = 0.745) or hearing preservation (11 [23.4%] of 47 [treatment group] compared with 15 [31.2%] of 48 [control group]) (p = 0.530) 12 months after surgery. Since tumor sizes were significantly larger in the treatment group than in the control group, logistic regression analysis was required. The risk for deterioration of facial nerve function was adjusted nearly the same in both groups (OR 1.07 [95% CI 0.34-3.43], p = 0.91). In contrast, the risk for postoperative hearing loss was adjusted 2 times lower in the treatment group compared with the control group (OR 0.49 [95% CI 0.18-1.30], p = 0.15). Apart from dose-dependent hypotension (p < 0.001), no clinically relevant adverse reactions were observed. CONCLUSIONS: There were no statistically significant effects of the treatment. Despite the width of the confidence intervals, the odds ratios may suggest but do not prove a clinically relevant effect of the safe study medication on the preservation of cochlear nerve function after VS surgery. Further study is needed before prophylactic nimodipine can be recommended in VS surgery.


Assuntos
Traumatismos dos Nervos Cranianos/prevenção & controle , Neuroma Acústico/cirurgia , Nimodipina/uso terapêutico , Complicações Pós-Operatórias , Vasodilatadores/uso terapêutico , Adulto , Nervo Coclear/fisiopatologia , Traumatismos dos Nervos Cranianos/etiologia , Nervo Facial/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Otol Neurotol ; 37(1): 89-98, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26649610

RESUMO

HYPOTHESIS: A multielectrode probe in combination with an optimized stimulation protocol could provide sufficient sensitivity and specificity to act as an effective safety mechanism for preservation of the facial nerve in case of an unsafe drill distance during image-guided cochlear implantation. BACKGROUND: A minimally invasive cochlear implantation is enabled by image-guided and robotic-assisted drilling of an access tunnel to the middle ear cavity. The approach requires the drill to pass at distances below 1  mm from the facial nerve and thus safety mechanisms for protecting this critical structure are required. Neuromonitoring is currently used to determine facial nerve proximity in mastoidectomy but lacks sensitivity and specificity necessaries to effectively distinguish the close distance ranges experienced in the minimally invasive approach, possibly because of current shunting of uninsulated stimulating drilling tools in the drill tunnel and because of nonoptimized stimulation parameters. To this end, we propose an advanced neuromonitoring approach using varying levels of stimulation parameters together with an integrated bipolar and monopolar stimulating probe. MATERIALS AND METHODS: An in vivo study (sheep model) was conducted in which measurements at specifically planned and navigated lateral distances from the facial nerve were performed to determine if specific sets of stimulation parameters in combination with the proposed neuromonitoring system could reliably detect an imminent collision with the facial nerve. For the accurate positioning of the neuromonitoring probe, a dedicated robotic system for image-guided cochlear implantation was used and drilling accuracy was corrected on postoperative microcomputed tomographic images. RESULTS: From 29 trajectories analyzed in five different subjects, a correlation between stimulus threshold and drill-to-facial nerve distance was found in trajectories colliding with the facial nerve (distance <0.1  mm). The shortest pulse duration that provided the highest linear correlation between stimulation intensity and drill-to-facial nerve distance was 250  µs. Only at low stimulus intensity values (≤0.3  mA) and with the bipolar configurations of the probe did the neuromonitoring system enable sufficient lateral specificity (>95%) at distances to the facial nerve below 0.5  mm. However, reduction in stimulus threshold to 0.3  mA or lower resulted in a decrease of facial nerve distance detection range below 0.1  mm (>95% sensitivity). Subsequent histopathology follow-up of three representative cases where the neuromonitoring system could reliably detect a collision with the facial nerve (distance <0.1  mm) revealed either mild or inexistent damage to the nerve fascicles. CONCLUSION: Our findings suggest that although no general correlation between facial nerve distance and stimulation threshold existed, possibly because of variances in patient-specific anatomy, correlations at very close distances to the facial nerve and high levels of specificity would enable a binary response warning system to be developed using the proposed probe at low stimulation currents.


Assuntos
Implante Coclear/efeitos adversos , Traumatismos dos Nervos Cranianos/patologia , Traumatismos dos Nervos Cranianos/prevenção & controle , Nervo Facial/patologia , Monitorização Neurofisiológica/métodos , Procedimentos Cirúrgicos Otológicos/métodos , Complicações Pós-Operatórias/prevenção & controle , Robótica , Cirurgia Assistida por Computador/métodos , Animais , Estimulação Elétrica , Eletromiografia , Nervo Facial/anatomia & histologia , Processo Mastoide/patologia , Processo Mastoide/cirurgia , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Ovinos , Cirurgia Assistida por Computador/efeitos adversos , Instrumentos Cirúrgicos
17.
Oral Maxillofac Surg Clin North Am ; 27(3): 373-82, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26093820

RESUMO

Coronectomy is considered in patients older than 25, where there is an intimate relationship between the roots of a retained lower third molar (occasionally second or first molars) and the inferior alveolar nerve, in noncontraindicated circumstances. It may be used on younger patients with a medium to high risk of inferior alveolar nerve damage. The decision to use this technique is made with the aid of cone-beam computed tomography scans. Short- to medium-term success rate is excellent, but long-term studies are not yet available. The technique is gaining wider acceptance, although there are differences in the indications and actual technique used within and between countries.


Assuntos
Traumatismos dos Nervos Cranianos/prevenção & controle , Dente Serotino/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Coroa do Dente/cirurgia , Raiz Dentária/inervação , Adulto , Tomografia Computadorizada de Feixe Cônico , Traumatismos dos Nervos Cranianos/etiologia , Humanos , Complicações Intraoperatórias/prevenção & controle , Dente Serotino/diagnóstico por imagem , Dente Serotino/inervação , Complicações Pós-Operatórias/prevenção & controle , Radiografia Panorâmica , Coroa do Dente/diagnóstico por imagem , Extração Dentária/métodos , Raiz Dentária/diagnóstico por imagem
18.
Acta Otolaryngol ; 135(9): 937-41, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25925072

RESUMO

CONCLUSIONS: We found that the great auricular nerve (GAN) passes at the median (m) point between the tips of the mandibular angle and mastoid process. We also established the GAN definitive line using this point for rapid identification of the trunk of the GAN and systematic parotidectomy combined with procedures for identification of the GAN, elevation of the skin flap, and exposure of the parotid capsule, which showed a high rate of preservation of the nerve and the lobular branch. OBJECTIVE: The aim of this study was to improve parotidectomy and the rate of preservation of the GAN. METHODS: This study comprised 74 consecutive patients who were scheduled to have parotidectomy for benign tumors at our department between November 2011 and April 2014. We examined whether our GAN definitive line including the m point was useful to identify the trunk of the GAN and whether anterograde dissection of the nerve could be performed simultaneously with skin flap elevation and exposure of the parotid capsule and contributed to preservation of the trunk to the lobular branch. RESULTS: The trunk was identified under the GAN definitive line drawn preoperatively in 97.3% of cases (72/74). Combined surgery was successfully performed with a 95.9% (71/74) preservation rate of the GAN including the lobular branch.


Assuntos
Adenoma/cirurgia , Traumatismos dos Nervos Cranianos/prevenção & controle , Dissecação/métodos , Neoplasias Complexas Mistas/cirurgia , Neoplasias Parotídeas/cirurgia , Adenoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Orelha Externa/inervação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/inervação , Neoplasias Complexas Mistas/patologia , Neoplasias Parotídeas/patologia , Resultado do Tratamento , Adulto Jovem
19.
Head Face Med ; 11: 9, 2015 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-25890111

RESUMO

The aim of this systematic review was to evaluate the clinical effectiveness of the surgical technique of coronectomy for third molars extraction in close proximity with the inferior alveolar nerve.A literature survey carried out through PubMed, SCOPUS and the Cochrane Library from inceptions to the last access in January 31, 2014, was performed to intercept randomised clinical trials, controlled clinical trials, prospective cohort studies or retrospective studies (with or without control group) that examined the clinical outcomes after coronectomy. The following variable were evaluated: inferior alveolar nerve injury, lingual nerve injury, postoperative adverse effects, pulp disease, root migration and rate of reoperation. Ten articles qualified for the final analysis. The successful coronectomies varied from a minimum of 61.7% to a maximum of 100%. Coronectomy was associated with a low incidence of complications in terms of inferior alveolar nerve injury (0%-9.5%), lingual nerve injury (0%-2%), postoperative pain (1.1%-41.9%) and swelling (4.6%), dry socket infection (2%-12%), infection rate (1%-9.5%) and pulp disease (0.9%). Migration of the retained roots seems to be a frequent occurrence (2%-85.3%).Coronectomy appears to be a safe procedure at least in the short term, with a reduced incidence of postoperative complications. Therefore, a coronectomy can be indicated for teeth that are very close to the inferior alveolar nerve. If a second operation is needed for the remnant roots, they can be removed with a low risk of paresthesia, because the roots are generally receded from the mandubular nerve.


Assuntos
Traumatismos dos Nervos Cranianos/prevenção & controle , Dente Serotino/cirurgia , Extração Dentária/métodos , Dente Impactado/cirurgia , Tomografia Computadorizada de Feixe Cônico/métodos , Traumatismos dos Nervos Cranianos/etiologia , Feminino , Seguimentos , Humanos , Masculino , Mandíbula/cirurgia , Nervo Mandibular , Dente Serotino/diagnóstico por imagem , Dente Serotino/fisiopatologia , Dor Pós-Operatória/fisiopatologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Extração Dentária/efeitos adversos , Dente Impactado/diagnóstico por imagem , Resultado do Tratamento
20.
Int J Oral Maxillofac Surg ; 44(2): 252-8, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25304755

RESUMO

A randomized, prospective, controlled trial was conducted to determine the efficacy of single and repeated betamethasone doses on facial oedema, pain, and neurosensory disturbances after bilateral sagittal split osteotomy. Thirty-seven patients (mean age 23.62 years, range 17-62 years) with either mandibular prognathism or retrognathism were enrolled consecutively into the study and divided into three groups: control (n=12), repeated dose 4+8+4mg betamethasone (n=14), single dose 16mg betamethasone (n=11). The intake of diclofenac and paracetamol was assessed individually. Measurements of facial oedema, pain, and sensitivity in the lower lip/chin were obtained 1 day, 7 days, 2 months, and 6 months postoperatively. Furthermore, we investigated the possible influences of gender, age, total operating time, amount of bleeding, postoperative hospitalization, and advancement versus setback of the mandible. A significant difference (P=0.017) was observed in percentage change between the two test groups and the control group regarding facial oedema (1 day postoperatively). Less bleeding was associated with improved pain recovery over time (P=0.043). Patients who required higher postoperative dosages of analgesics due to pain had significantly delayed recovery of the inferior alveolar nerve at 6 months postoperatively (P<0.001). Betamethasone did not reduce neurosensory disturbances over time.


Assuntos
Betametasona/uso terapêutico , Traumatismos dos Nervos Cranianos/prevenção & controle , Edema/prevenção & controle , Dor Facial/prevenção & controle , Glucocorticoides/uso terapêutico , Doenças Mandibulares/cirurgia , Osteotomia Sagital do Ramo Mandibular , Adolescente , Adulto , Betametasona/administração & dosagem , Cefalometria , Traumatismos dos Nervos Cranianos/etiologia , Método Duplo-Cego , Edema/etiologia , Dor Facial/etiologia , Feminino , Glucocorticoides/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos
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