Application of intraoperative ultrasound combined with neuronavigation for resection of intracranial cavernous malformations in minimally invasive neurosurgery / 中华外科杂志

<p><b>OBJECTIVES</b>To analyze the reliability and clinical value of intraoperative ultrasound combined with neuronavigation for resection of intracranial cavernous malformations.</p><p><b>METHODS</b>From January 2007 to December 2009, 40 cases of intracranial cavernous malformations were operated under the application of intraoperative ultrasound combined with neuronavigation. There were 18 male and 22 female, aged 18 to 58 years, with a mean age of 34.5 years. Neuronavigation was used for all patients before operation to display the three-dimensional model of nervous system and lesions, so to design the operative approach and determine the scope of the incision. Lesions were allocated by real-time neuronavigation in order to continuously verify the accuracy of operative approach during the operation, supplemented by real-time monitoring of intraoperative ultrasound to guide the process of surgery and determine the extent of resection of lesions.</p><p><b>RESULTS</b>The registration error of neuronavigation was 1.3 - 3.2 mm, with an average of 2.0 mm. All the patients' three-dimensional model of nervous system and lesions were satisfactorily displayed, and the area of lesions were all accurately located. Structural brain-shifts occurred in 4 cases in the remove process of the lesion, with shift degree 5.0 - 10.0 mm, and were corrected by intraoperative ultrasound. All lesions were well displayed by intraoperative ultrasound. Gross total resection was achieved in all patients, with no patient infected or dead. Neurological deterioration was seen in 2 patients, the morbidity was 5.0%.</p><p><b>CONCLUSIONS</b>The combination of neuronavigation and intraoperative ultrasound for resection of intracranial cavernous malformations can provide valuable intraoperative informations of the location and resection level of the lesion, thereby maximize the accuracy of lesion localization and the extent of resection, with less complications and enhanced efficacy of the surgery.</p>

Protection and Treatment of the Pituitary Stalk and Hypothalamus in the Microsurgery of Craniopharyngiomas in Adult / 中国康复理论与实践

@#ObjectiveTo investigate the pattern of the relationship of craniopharyngiomas with pituitary stalks and hypothalamus. Furthermore, based on different patterns affirmed during the operations, surgical strategies were designed for radical excision. MethodsA series of 66 patients with primary suprasellar craniopharyngiomas were treated with microsurgical techniques and the relationships of the craniopharyngiomas with pituitary stalk and hypothalamus were analyzed prospectively. Appropriate surgical approaches were selected preoperatively according to the lesion's sizes and expanding directions. The relationships of the lesions to the pituitary stalks and hypothalamus were identified in detail and dissected carefully with protection of perforating vessels. ResultsThe patterns that pituitary stalks were involved by craniopharyngiomas were identified in 36 cases and divided into four types: no relation (5 cases), adhesion (10 cases), partial invasion (8 cases) and total invasion (13 cases). The anterior floor of the third ventricle was involved in 42 cases, in which it disappeared totally in 10 cases. Total resection was achieved in 58 case, subtotal resection in 8 cases. Diabetes insipidus (DI) was identified in 44 cases postoperatively. No surgical mortality, no recurrence was found during follow-up of mean 35 months. ConclusionThe appropriate selection of surgical approaches preoperatively, careful identification and according treatment of the relationships of the tumors with pituitary stalks and hypothalamus are the keys to protect the pituitary stalk; hypothalamus in craniopharyngiomas resection in adults.

Treatment of alternated water-electrolyte balance and endocrine status after removal of craniopharyngioma in adults / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Water-electrolyte disturbance and endocrine alterations are common complications of adult patients with craniopharygioma in the postoperative period and may affect their recovery and prognosis. Some of these complications even lead to death. Appropriate remedy based upon the status of water-electrolyte balance and the endocrine system is essential to good therapeutic results of adult patients with craniopharyngioma.</p><p><b>METHODS</b>The alterations in water-electrolyte balance (117 patients) and endocrine status (42) of adult patients with craniopharyngioma after surgery were analyzed retrospectively.</p><p><b>RESULTS</b>Most patients with craniopharyngioma experienced postoperative water-electrolyte disturbances and hypotonic dehydration. Moreover, the incidences of hypothyroidism and hypoadrenocorticism were relatively high.</p><p><b>CONCLUSION</b>It is critical to deal with dehydration and endocrine disorders for a sound outcome of craniopharyngioma surgery.</p>

Clinical and pathological characteristics of septum pellucidum tumor and choice of surgical approaches for its resection / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Tumor involving the septum pellucidum is uncommon. Surgery as the main therapeutic procedure for this lesion is a challenge to neurosurgeons. We analyzed the clinical characteristics and pathological features of septum pellucidum tumor in 41 patients and compared the curative effects of frontal transcortical, trans-sulcal and interhemispheric transcallosal approaches.</p><p><b>METHODS</b>Clinical characteristics and the pathological features of septum pellucidum tumor were investigated retrospectively in 41 patients. The differences in postoperative residual rates, extents of tumors and resection of normal brain tissues after use of the three approaches in these patients were analyzed statistically.</p><p><b>RESULTS</b>Septum pellucidum tumor is more likely to attack young or middle-aged persons. The tumor mainly presents itself as a central neurocytoma or cerebral low-grade glioma in pathology and manifests as intracranial hypertension clinically. No difference was found in the extent of tumor resection but significant difference in the extent of normal brain tissue resection and in postoperative disability rate among the three approaches. The transcortical approach brought about the most serious injury to brain tissue and the highest disability rate, Whereas the frontal transcallosal approach the lightest injury and the lowest disability rate. The injury to brain tissue and the disability rate brought about by the front trans-sulcus approach were between the above two approaches.</p><p><b>CONCLUSIONS</b>Operation is still regarded the major treatment for septum pellucidum tumor. Transcallosal and trans-sulcus approaches are fit with the concept of minimally invasive surgery, and transcallosal approach is the first choice for septum pellucidum tumor.</p>

Photodynamic diagnosis and fluorescence-guided resection of malignant gliomas: a report of 15 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To study the usefulness of the intraoperative photodynamic diagnosis (PDD) and fluorescence-guided resection of malignant gliomas.</p><p><b>METHODS</b>Fifteen consecutive patients with malignant gliomas received doses of hematoporphyrin derivative (HPD, 2 mg/kg body weight) 48 hours before induction of anesthesia. After the tumors recognized by bare eyes they were removed routinely. The fluorescence around 690 nm excited by laser beam (wavelength 632.5 nm) was detected by laser electronic spectrum analyzer and then fluorescing tissue was removed whenever it was considered safel. Tissue samples derived from the walls of tumor cavities after resection and PDD were sent for histological examination. Compared with the result of the histological examination, the sensitivity and specificity of PDD were calculated and recorded. Early postoperative MRI or CT were done to determine the extend of the resection of the tumors. Surgical mortality and morbidity were also recorded.</p><p><b>RESULTS</b>Intraoperatively, in all of 15 cases tumor areas with HPD fluorescence could be recognized by laser electronic spectrum analyzer. On the basis of 106 tissue samples derived from 15 tumors, a sensitivity of 90.6%, a specificity of 96.8% and an accuracy of 94.3% of PDD were achieved. In 2 cases the resection of residual tumor were performed after finding left tumors by PDD. Complete resection of contrast-enhancing tumor was accomplished in 9 patients (60%). Residual intraoperative tissue fluorescence left unresected for safety reasons predicted residual enhancement on MR images in 5 of the 6 remaining patients. No perioperative deaths and one case of morbidity were encountered.</p><p><b>CONCLUSIONS</b>Intraoperative photodynamic diagnosis following resection of malignant gliomas can detect residual tumor tissue with high accuracy. Photodynamic diagnosis and fluorescence-guided resection of malignant gliomas have a positive role in improving the radicality of malignant glioma resection.</p>

Prevention of hypothalamus injury in surgical management of craniopharyngioma / 中国康复理论与实践

@#Objective To study the better way of avoidance of hypothalamus injury in surgical management of craniopharyngioma.Methods 40 cases with craniopharyngioma accepted surgery treatment were analyzed respectively.Results The pterional approach was performed in 30 cases, interfornical approach in 8 cases,subfrontal approach in 2 cases.Total removal of tumor was achieved in 35 cases,subtotal removal in 5 cases.One died from extradural hematoma after operation. No one died from hypothalamus injury.Conclusion Some way was key to avoid hypothalamus injury and to achieve a better surgical result, such as proper approach, separating strictly along tumor, identification of pituitary stalk and hypothalamus structure,preservation of perforating arteries to hypothalamus.

The supraorbital keyhole approach with eyebrow incisions for treating lesions in the anterior fossa and sellar region / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Keyhole surgery has developed since the 1990s as a less invasive therapeutic strategy for intracranial lesions, initially for the treatment of intracranial aneurysms. The purpose of this study was to describe and evaluate the results of surgical treatment of lesions in the anterior fossa and sellar region via a supraorbital keyhole approach using eyebrow incisions.</p><p><b>METHODS</b>Between April 1994 and July 2003, 54 patients with lesions in the anterior fossa and sellar region were operated on via the supraorbital keyhole approach. The surgical results were studied retrospectively and compared with that of patients with lesions at the same locations but treated via a conventional subfrontal approach.</p><p><b>RESULTS</b>No significant difference in curative effect was found between the conventional subfrontal approach and the supraorbital keyhole approach. However, the supraorbital approach required a much smaller skin incision, causing less surgical trauma, while achieving excellent surgical exposure and good recovery.</p><p><b>CONCLUSION</b>The supraorbital keyhole approach using an eyebrow incision is safe, effective, and both suitable and convenient for treating lesions in the anterior fossa and sellar region, with almost no adverse consequences on the facial features of patients.</p>