Transnasal endoscopic anatomy and approaches to the cavernous sinus / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The goal of the current study is to describe the transnasal endoscopic anatomy of the cavernous sinus and to provide the surgical approaches to this area.</p><p><b>METHODS</b>Six silicon-injected adult cadaveric heads (12 sides) were dissected through endoscopic endonasal approach. The cavernous sinus and adjacent structures were exposed; detailed anatomies were demonstrated. High-quality pictures were produced.</p><p><b>RESULTS</b>The cavernous sinus had four walls, namely medial, lateral, posterior and superior walls. Five venous spaces within the sinus were identified by their relation to the carotid artery; those were the medial, lateral, posterosuperior, posteroinferior and anterolateral compartments. Three branches arising from the cavernous segment of internal carotid artery from proximal to distal were meningohypophyseal trunk, inferolateral trunk and McConnell capsular artery. Cavernous sinuses communicated each other by intercavernous sinuses, as well as basilar sinus in middle line, and connected with superior and inferior petrosal sinuses. The third and fourth nerves coursed in superior part of the lateral wall of the cavernous sinus; Meckel's cave located in the posteroinferior part of the lateral wall of the cavernous sinus; V1 sloped to the superior orbital fissure along the lateral wall; the sixth nerve entered the posteroinferior compartment then passed through the internal carotid artery and reached to superior orbital fissure. The approaches to the cavernous sinus included trans-sphenoid-sellar-medial cavernous sinus (medial to the internal carotid artery) and trans-ethmoid-pterygoid-sphenoid-lateral cavernous sinus (lateral to the internal carotid artery). Trans-sphenoid-sellar-medial cavernous sinus approach was able to expose medial compartment and posterosuperior compartment and part of posteroinferior compartment. Trans-ethmoid-pterygoid-sphenoid-lateral cavernous sinus approach was able to expose anteroinferior compartment, lateral cavernous sinus and cranial nerves in lateral wall.</p><p><b>CONCLUSION</b>An understanding of the complex relationships of the cavernous segment of internal carotid artery and cranial nerves in cavernous sinus is paramount for surgically dealing with the disease involved cavernous sinus and adjacent region.</p>

Endoscopic transsphenoidal approach to pituitary adenomas invading the cavernous sinus / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Surgery of pituitary adenomas invading cavernous sinus has always been thought as a challenge due to the complex anatomical structures and high risk of complications. The purpose of this study was to evaluate endoscopic transsphenoidal approach to pituitary adenomas invading cavernous sinus.</p><p><b>METHODS</b>The clinical data of 22 patients who admitted to Xuanwu Hospital with pituitary adenomas invading cavernous sinus were analyzed retrospectively. All patients underwent endoscopic transsphenoidal surgery. To expose the surgical field sufficiently, the opening of sellar floor was exceeded the bone overlying the invaded cavernous sinus, and synthetic dura was used to repair and strengthen the sella floor for preventing the leak of cerebrospinal fluid.</p><p><b>RESULTS</b>Among 22 patients, total resection was achieved in 14, subtotal resection in 5, and partial resection in 3; no patient underwent insufficient resection. Visual symptoms improved in 7 of 9 patients. In one patient diplopia disappeared. Headache was relieved to various extents in all patients. No serious complications were found. Patient's hospital stay ranged from 7 to 20 days.</p><p><b>CONCLUSION</b>These data suggest that the endoscopic transsphenoid approach is a safe, minimally invasive, and efficient surgical technique, which might be an important therapeutic strategy for the pituitary adenoms invading cavernous sinus.</p>

Construction, expression and refolding of recombinant luteinizing hormone releasing hormone-angiogenin toxin / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To express, purify and refold recombinant luteinizing hormone releasing hormone-angiogenin (LHRH-Ang) toxin using E. coli. expression system.</p><p><b>METHODS</b>Recombinant LHRH-Ang expression vector was constructed by replacing of EGF fragment in plasmid pET28a/EGF-Ang with LHRH-PII fragment amplified from plasmid pET28/MSH-PE40. DNA sequencing would be used to verify the correction of fused LHRH-PII-Ang gene. Then, E. coli strain BL21 (DE3) was transformed by pET28a/LHRH-Ang vector. Expression of recombinant LHRH-Ang toxin was induced by Isopropyl-β-D-Thiogalactoside (IPTG). Refolding effects of gradient dialysis was evaluated by SDS-PAGE.</p><p><b>RESULTS</b>Prokaryotic expression vector pET28a/LHRH-Ang, containing LHRH-PII-Ang fusion gene, was constructed by PCR amplification, restriction enzyme digestion and ligation method. Sequence correction of fusion gene was confirmed by DNA sequencing. After IPGT induction, recombinant LHRH-Ang protein was expressed in BL21 (DE3) as inclusion body, it took 18.43% of total protein. Inclusion body was resolved in 8 mol/L urea and purified by DEAE-Sepharose FF column, the purity was 85%. Recombinant LHRH-Ang toxin was refolded and concentrated by gradient dialysis and PEG 20000, respectively.</p><p><b>CONCLUSIONS</b>Recombinant LHRH-Ang protein was expressed in E. coli and refolded successfully.</p>

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>

Expression of E-cadherin catenin complex and invasiveness of pituitary adenoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the relationship between the E-cadherin catenin complex and invasiveness of pituitary adenoma.</p><p><b>METHODS</b>The expression of E-cadherin catenin complex was determined by immunohistochemistry in 78 cases of human pituitary adenomas including invasive adenoma 44 cases, noninvasive adenoma 34 cases and the relativity of their expressions with hormone-producing, pituitary apoplexy and necrosis or cystoid change, tumor diameter were analyzed.</p><p><b>RESULTS</b>The invasive group had a significantly lower expression of E-cad and alpha-cat than that of noninvasive group (chi-squared = 13.969, P < 0.01). There was no statistical significance for beta-cat expression between the invasive group and noninvasive group (chi-squared = 0.430, P > 0.05). Moreover, the expressions of beta-cad and alpha-cat were significantly lower in macro-adenoma group than that in micro-adenoma group (chi-squared = 5.038, P < 0.05). The expression of E-cad was significantly lower in endocrine inactive group than that in endocrine active group (chi-squared = 4.614, P < 0.05). The expression of beta-cat was significantly lower in the group with apoplexy and necrosis than that in the group without apoplexy and necrosis (chi-squared = 6.701, P < 0.05).</p><p><b>CONCLUSIONS</b>The reduction of E-cad catenin complex is related to invasiveness and clinical pathological characteristics.</p>