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Objective:To investigate the efficacy of new-type stereotaxic apparatus-assisted transfrontal puncture and drainage in the treatment of hypertensive intracerebral hemorrhage in the basal ganglia.Methods:A retrospective analysis was performed on the clinical data of 60 patients with hypertensive intracerebral hemorrhage in the basal ganglia who received disposable new-type stereotaxic apparatus-assisted transfrontal insertion with soft tunnels for hematoma aspiration drainage in our hospital from August 2017 to September 2019. The treatment efficacy was analyzed.Results:All patients were successfully punctured at one time; the puncture surface was 5-6.5 cm on the basement plane, where the hematoma surface was the largest; the puncture angle was 10-14°, and the puncture depth was 9-11.5 cm. Fifteen patients were operated within 6 h of hemorrhage, and the intraoperative hematoma clearance rate was about 25%; 40 patients were operated 6-24 h after hemorrhage, and the hematoma clearance rate was about 20%; 5 patients were operated one-3 d after hemorrhage, and the hematoma clearance rate was as high as 30%. The first postoperative re-check CT showed that 51 patients had ideal position of the drainage tube, 2 were too deep, one was too shallow, 2 were below the position, 2 were above the position, one was inside the position, and one was outside the position. The Glasgow Coma Scale (GOS) scores of the patients on 3 rd d of operation (9.88±3.998) were significantly higher than those of the patients before operation (6.24±3.159, P<0.05). One month after the operation, GOS showed that 20 patients (33.3%) had good recovery, 28 (46.7%) had mild disability, 7 (11.7%) had severe disability, 3 (5.0%) had plant survival, and 2 (3.3%) died. Conclusion:The disposable new-type stereotaxic apparatus-assisted transfrontal puncture drainage is easy to be conducted and practicable with a reasonable design, accurate positioning, minimal surgical traumas and satisfactory curative effect.
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Objective To summarize the microsurgical techniques for removal of large neoplasms located in the suprasellar,back of sellar region and anterior part of third ventricle through bilateral frontobasal interhemispheric approach.Methods Fifty-six patients with large neoplasms located in the suprasellar,back of sellar region and anterior part of third ventricle,admitted to our hospital from January 2002 to January 2013 and performed removal via bilateral frontobasal interhemispheric approach; their clinical data and treatment efficacy were analyzed retrospectively.The microsurgical techniques were summarized,and the factors affecting the prognosis were analyzed.Results Total removal of the tumors was achieved in 49 patients (88％) and subtotal removal in 7 (12％).The pituitary stalk was reserved in 47 patients (84％),severed in 4 (7％),and unidentified in 5 (9％).The bilateral olfactory nerves were successfully preserved in 50 patients (89％) and unilateral severed in 6 (11％).Visual impairment was found in 41 patients before surgery,39 of them achieved postoperative visual improvement and 2 patients had no change during the follow-up at 6 months.In our series,there were no procedure-related mortalities and bacterial meningitis.Unilateral anosmia was detected on examination in 2 patients.Minimal frontal lobe contusion developed in 2 patients but resolved within 3 weeks.Cerebrospinal fluid leakage occurred in 1 patient,which was cured for 2 week.Transient diabetus insipidus developed in 25 patients but resolved within 1 month; permanent postoperative diabetes insipidus was present in 5 patients during the follow-up at 6 months.During the follow-up of 12 months,56 patients (100％) gained Glasgow outcome scale (GOS) scores of 5,only 4 (7％) patients with tumors resected partially had tumor relapse and received surgery again.Conclusions The bilateral frontobasal interhemispheric approach is appropriate for removing tumors located in the suprasellar,back of sellar region and anterior part of third ventricle.With sufficient exposure of lesion,the important anatomic structures such as the pituitary stalk,hypothalamic structure,perforating vessels,anterior communicating complex,the visual pathway,and the olfactory nerves could be preserved effectively.The surgery via this approach can increase total removal rate of the tumors,decrease the complications and achieve a good outcome.
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To evaluate the application of blood salvage techmque in spine orthopaedic operation. 26 cases of spine orthopaedic operations were divided into two groups. Group A received homologous blood transfusion. Group B received intraoperative blood salvage by cell saver in spine orthopaedic operations. No complications of transfusion and dysfunciton were found in all pateints. The results showed that blood salvage technique can decrease effectively the need of homologous blood transfusion in spine orthopaedic operation and can be used safely in clinical practice.
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Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Blood Transfusion, Autologous , Methods , Orthopedic Procedures , Scoliosis , General SurgeryABSTRACT
Objective To provide anatomical basis for endoscopic endonasal transsphenoidal surgery for excision of sellar tumors. Methods The relationship between ostia of sphenoidal sinus and sellar areas of 25 heads of adult cadavers, and the structure of pituitary fossa and the relationship of the anterior-posterior clinoid processes of 21 heads of adult cadavers were observed and measured. At the same time, structure of 9 fresh heads of adult cadavers were observed with the operating endoscope. Results The distance between the ostia of the sphenoidal sinus to the tuberculum sellae, internal carotid artery, optic nerve and dorsum sellae were 14.6?3.0mm, 13.7?2.2mm, 11.6?1.8mm, and 22.6?3.2mm, respectively. The sagittal diameter of the pituitary fossa was 10.2?1.5mm. The transverse diameter of the pituitary fossa was 1.4?2.4mm. The distance between two anterior clinoid processes was 25.0?3.0mm. The distance between two posterior clinoid processes was 15.8?3.3mm. The distance between anterior clinoid process and ipsilateral posterior clinoid process was 7.8?1.7mm. The distance between anterior clinoid process to contralateral posterior clinoid process was 21.8?2.4mm. Conclusion These results would provide the surgeons a stereoscopic image about sellar areas, so that the operative field could be accurately defined in endoscopic endonasal transsphenoidal surgery for the excision of sellar tumors.