Using of titanium mesh for the reconstruction of skull base defect / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The purpose of this study is to evaluate the possibility and surgical principle of titanium mesh used for the reconstruction of skull base bone defect.</p><p><b>METHODS</b>The clinical data of 11 patients with defect of skull base bone repaired with titanium mesh were retrospectively analysed.</p><p><b>RESULTS</b>Among 11 patients, there were 6 patients with skull base tumor, 3 patients with fibrosis hyperplasia, 2 patients with encephalomeningocele. The surgical approach included craniofacial approach in 7 patients, transfrontal and extended transfrontal approach in 3 patients, trans-midface approach in 1 patient. The anterior and lateral skull base was repaired in 2 patients, anterior and middle skull base and sellar repaired in 6 patients, anterior skull base and orbital floor repaired in 3 patients. In early postoperative period, there were 3 patients with intracranial pneumatosis, but without symptom, and 1 patient with transient cerebrospinal leakage. Following-up for average 14.4 months, there was no titanium mesh displacement and intracranial infection in all patients.</p><p><b>CONCLUSIONS</b>The titanium mesh used for the repair of skull base bone defect was both possible and safe.</p>

Image-guided endoscopic transsphenoidal removal of pituitary adenoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To assess the role of neuronavigation in assisting endoscopic transsphenoidal surgery for pituitary adenomas.</p><p><b>METHODS</b>Ten endoscopic endonasal transsphenoidal reoperations for pituitary adenomas were selected. Clinical records were reviewed retrospectively. Five of 10 patients had gigantic adenoma, 3 microadenoma, 2 large adenoma.</p><p><b>RESULTS</b>The mean setup time was 5 minutes, and the operative time was 50 minutes in image-guided procedures. In all cases, the system worked well without malfunction. Continuous information regarding instrument location and trajectory was provided to the surgeon. Measurements of intraoperative accuracy in the axial, coronal, and.sagittal planes indicated a mean verified system error of 1.5 mm. for pituitary adenomas. After operation, the symptoms relieved in all patients.</p><p><b>CONCLUSIONS</b>Neuronavigation can be applied during endonasal transsphenoidal endoscopic surgery and requires a minimal amount of time. It makes reoperation easier, faster, and safer.</p>

Endoscopic endonasal surgery for tumors of petroclival region and infratemporal fossa / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Nasal endoscope has been used increasingly during skull base surgery. However, most of endoscopic surgery limited to the repair of cerebrospinal rhinorrhea, decompression of traumatic optic nerve, hypophysectomy, etc. This study was undertaken to determine whether endoscopic endonasal approach was safe and effective for the resection of tumors located in petroclival region and infratemporal fossa.</p><p><b>METHODS</b>Seventeen patients with tumors of petroclival region and infratemporal fossa treated by endoscopic endonasal surgery between January 2002 and February 2005 were studied prospectively. The operative technique was described in detail. There were 5 chordoma, 1 esthesioneuroblastoma, 1 chondrosarcoma, 1 lymphoma, 1 craniopharyngioma, 1 hemangioblastoma, 4 meningioma, 1 schwannoma, and 2 metastatic carcinoma. 3 patients were selected for neuronavigation-aided endoscopic endonasal surgery.</p><p><b>RESULTS</b>Total tumor removal was obtained in 15 cases, subtotal removal in 2 case. With follow-up of 5 to 43 months, 1 case with chordoma was recurrent 5 months later postoperatively and underwent reoperation subsequently. The other cases with benign tumors were no recurrence. All of 5 cases with malignant tumors followed up for longer than 2 years were no recurrence and death. The complications included subarachnoid hemorrhage in 1 patient, transient cerebrospinal leakage in 2 cases.</p><p><b>CONCLUSIONS</b>The endoscopic endonasal surgery provides satisfied treatment for selected tumors of petroclival region and infratemporal fossa. This approach promises a simple and rapid access to petroclival region and infratemporal fossa. It is a safe, minimally invasive and efficient procedure. Using neuronavigation system, it is helpful to determining anatomical landmark and removing the tumor completely and securely.</p>