Transclival approaches for intradural pathologies: historical overview and present scenario.

Recently, endoscopic transsphenoidal transclival approaches have been developed and their role is widely accepted for extradural pathologies. Their application to intradural pathologies is still debated, but is undoubtedly increasing. In the past five decades, different authors have reported various extracranial, anterior transclival approaches for intradural pathologies. The aim of this review is to provide a historical overview of transclival approaches applied to intradural pathologies. PubMed was searched in October 2018 using the terms transcliv*, cliv* intradural, transsphenoidal transcliv*, transoral transcliv*, transcervical transcliv*, transsphenoidal brainstem, and transoral brainstem. Exclusion criteria included not reporting reconstruction technique, anatomical studies, reviews without new data, and transcranial approaches. Ninety-one studies were included in the systematic review. Since 1966, transcervical, transoral, transsphenoidal microsurgical, and, recently, endoscopic routes have been used as a corridor for transclival approaches to treat intradural pathologies. Each approach presents a curve that follows Scott's parabola, with evident phases of enthusiasm that quickly faded, possibly due to high post-operative CSF leak rates and other complications. It is evident that the introduction of the endoscope has led to a significant increase in reports of transclival approaches for intradural pathologies. Various reconstruction techniques and materials have been used, although rates of CSF leak remain relatively high. Transclival approaches for intradural pathologies have a long history. We are now in a new era of interest, but achieving effective dural and skull base reconstruction must still be definitively addressed, possibly with the use of newly available technologies.

Design and manufacturing of biomimetic scaffolds for bone repair inspired by bone trabeculae.

Porous scaffold (PorS) implants, particularly those that mimic the structural features of natural cancellous bone (NCanB), are increasingly essential for the treatment of large-area bone defects. However, the mechanical properties of NCanB-based bionic bone scaffold (BioS) and its performance as a bone repair material have not been fully explored. This study investigates the effect of bionic structure parameters on the mechanical properties and bone reconstruction performance of BioS. Using laser powder bed fusion (L-PBF) technology, different BioS with various structural parameters were created and evaluated using Micro-CT, compression testing, Finite Element (FE) Simulation, and computational fluid dynamics (CFD), and compared to commonly used clinical PorS. Assess the capacity of the BioS scaffold to support and enhance bone reconstruction following implantation through the evaluation of its mechanical properties, permeability, and fluid shear stress (FSS). BioS-85-90 and BioS-80-50 showed suitable mechanical properties, performed well in FE simulation of implantation, demonstrated outstanding abilities for osteoinductive ingrowth and bone tissue differentiation, and proved to be reliable materials for the reconstruction of bone defects. Therefore, BioS shows significant potential for clinical application as a bone reconstruction material, providing a solid foundation for the integration of tissue engineering and bionic design.

[Comparative analysis of the hearing of three type reconstruction material in type â ¡ tympanoplasty of 286 cases].

Objective:To compare the effect on hearing of different reconstruction material in type Ⅱ tympanoplasty. Methods:Retrospectively analysis of 286 patients who accepted type Ⅱ tympanoplasty. The air-bone gap of 0.5, 1, 2, 4 kHz was analyzed before and after operation. We compared the hearing change and the complications between each group. Results:In incus group, the manubrium mallei and the head of stapes were connected with shaped incus, PORP group were implanted with PORP during operation, and cartilage group used auricular cartilage to cover the head of stapes. There was no significant difference in 4 kHz air-bone gap（ABG） between the cartilage group and PORP group either before or after the operation （P>0.05）. Air-bone gap of 0.5, 1, 2, 4 kHz of the incus group, and the 0.5, 1, 2 kHz of the cartilage and PORP group were significantly reducedafter the operation（P<0.05）. One patient got severe sensorineural hearing loss in incus group after the operation. The high frequency of bone conduction decreased in 1 patient（2, 4 kHz）.In the incus group, 3 patients had temporary facial paralysis after operation. Incus and cartilage group each have 1 patient with dizziness after the operation. Incus, cartilage and PORP group had 5, 3 and 11 patients with perforation again respectively. There was extrusion occurred in 1 patient of PORP group. Conclusion:Self incus, cartilage and PORP can be used in typeⅡ tympanoplasty, the effect of hearing reconstruction is similar. The first two are more economical, PORP implantation has the lowest technical difficulty and the most widely application, but there is a certain risk of extrusion .