Clinical Hemostasis Effect of Hemocoagulase for Injection in Scalp Incision in Craniocerebral Surgery / 中国药师

Objective: To investigate the hemostasis effect of hemocoagulase for injection in scalp incision in craniocerebral surgery, and evaluate its effect on coagulation function and drug safety. Methods: Before undergoing craniotomy, 60 patients were randomly divid-ed into the study group and the control group. The study group was injected with hemocoagulase for injection at 1u im at the night before surgery, 1u im 1h before incision and 1u im 15min before incision. The control group was injected with 0. 9% saline at the same time with the same volume. The hemorrhagic volume, hemorrhagic volume per square decimeter, hemostatic time, blood coagulation and ad-verse events were tested and compared between the groups. Results: In the study group, the mean hemorrhagic volume was (37. 18 ± 2. 96)g, the mean hemorrhagic volume per square decimeter was (0. 23 ± 0. 16)g·cm-2and the mean hemostatic time was (125. 53 ± 36. 42)s. In the control group, the corresponding value was (60. 69 ± 2. 30) g, (0. 42 ± 0. 25) g·cm-2and (182. 72 ± 52. 29) s, re-spectively. The hemorrhagic volume, hemorrhagic volume per square decimeter and hemostatic time significantly decreased in the study group when compared with those in the control group (P<0. 05). No significant difference in blood coagulation and safety (P>0. 05). No adverse event was reported. Conclusion: Hemocoagulase for injection shows promising hemostasis effect with high safety, which can ensure craniocerebral surgery going well with shortened operation time.

Pterional approach microsurgical removal of giant tuberculum sellae meningiomas / 中国微创外科杂志

Objective To summarize the experience of pterional craniotomy microsurgical resection of giant tuberculum sellae meningiomas. Methods A total of 18 patients with giant tuberculum sellae meningiomas were treated microsurgically in this hospital from February 2000 to November 2004. The patients were operated on by use of pterional craniotomy on the side of worse vision. The basal part of the tumor was firstly dissected to control the blood supply of the lesion. Through the cerebral cisterns at the sellar region and the interfaces between the tumor and the adjacent structures, the tumor was removed to the greatest possible extent with minimal invasion to the neighbouring structures. Results[WTBZ] A total resection was conducted in 16 patients (88.9%), and a subtotal resection, in 2 patients (11.1%). No surgery related death was observed. Follow-up examinations in 14 patients for 3 months ~ 4 years (mean, 2.5 years) found no recurrence of meningiomas. Conclusions[WTBZ] The pterional approach provides excellent exposure of the middle fossa and the parasellar area. Pterional approach microsurgical technique can improve the rate of total resection of giant tuberculum sellae meningiomas.

Microsurgical resection of large acoustic neurinoma through suboccipital retrosigmoid approach / 中国微创外科杂志

Objective To evaluate the safety and efficacy of microsurgical resection of large acoustic neurinoma via the suboccipital retrosigmoid approach.Methods Forty-nine patients with large acoustic neurinoma(≥4 cm) underwent microsurgical resection through suboccipital retrosigmoid approach.The craniotomy was performed by way of an unilateral S-shaped suboccipital incision.With microsurgical techniques the outmost layer of the arachnoid membrane was preserved in order to avoid damaging to the surrounding vital structures.The tumor was resected intracapsularly from the superior pole and the internal auditory meatus was finally opened.The last pieces of tumor were removed by sharp dissection from the facial nerve bidirectionally,and were resected cautiously in a piecemeal fashion.Results Of the 49 patients,45 patients(92%) received a total resection of the tumors,and 4 patients(8%) subtotal resection.No patients died.The facial nerve was preserved anatomically in 42 patients(86%) and functionally in 36 patients(73%).The acoustic nerve was preserved anatomically in 7 patients(14%) and functionally in 3 patients(6%).One patient experienced a postoperative haematoma,and a re-operation was required.No recurrence was seen in 37 patients during a follow-up for 6 months ～ 5 years(mean,2.8 years).These patients had recovered for normal work and daily activities.Conclusions Microsurgical operation through suboccipital retrosigmoid approach is a favorable treatment for large acoustic neurinomas.The procedure can improve the rate of total resection,decrease the morbidity and mortality,and effectively protect the function of the acoustic and facial nerves.