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Objective To summarize the experience of the simple neuroendoscopic endonasal transsphenoidal surgery for the large pituitary adenoma and discuss it's application value.Methods Seventy-eight cases of the large pituitary adenoma treated by simple neuroendoscopic endonasal transsphenoidal surgery from July,2011 to May,2014 were analyzed retrospectively.Tumors were resected using 0 and 30 degree endoscope after opening the same side of the anterior wall of the sphenoidal sinus and sellar bone using the abrasive drilling during operation.Results The tumor removal was total in 62 (79.49％),subtotal in 12 (15.38％),major in 3(3.85％) and part in 1 (1.28％).Seventy-one cases were followed up for 2 months to 2 years after operation and no recurrence was founded,the symptoms of headache disappeared in 49 cases;The vision of patients was improved in 47 cases,menstruation resumed in 12 cases;The acromegaly of patients reduced in 21 cases.Hormone level review of PRL returned to normal in 32 cases,GH returned to normal in 21 cases,ACTH returned to normal in 2 cases.Conclusion The endoscopic transsphenoidal surgery for large pituitary tumors is the safely,minimally invasive surgical techniques.With the development of endoscopic equipment constantly updated and the operational flexibility and comfort is improved ceaselessly,endoscopic transsphenoidal surgery for the sellar tumor will be carried out more widely.
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Objective To investigate the therapeutic effect of the hemilaminectomy approach in intraspinal tumor with the help of intraoperative ultrasound,high-speed drill and ultrasound knife.Methods Clinical data of 35 cases with the intraspinal tumor were analyzed retrospectively.All the patients were treated by hemilaminectomy approach,the position of the lesions were fixed by preoperative X-ray and intraoperative ultrasound,root of the spinous process were removed in order to achieve adequate visual field by high-speed drill and ultrasound knife.Electrophysiologic monitoring were used if the lesions were in the spinal cord.Results Total surgical resection was achieved in 32 cases,gross total resection was in 3 cases.Twenty-eight of the 35 cases were followed up.The symptom alteration of the first period ( 1 - 3 months postoperative):improved in 25 cases,no changed in 2 cases,aggravated in 1 case.The symptom alteration of the second period (6-24 months postoperative):no changed in all cases,no stability change of the vertebral column had been found.Conclusions Followed with the development of the electrophysiologic monitoring,high-speed drill,intraoperative ultrasound,the indication of the hemilaminectomy and have no influence of the spinal stability.However,to spinal meningioma which have a wide base,the hemilaminectomy approach may not adapt.
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Objective To investigate the micro-anatomical approach to resect both intracranial and extracranial jugular foramen tumors in one-stage. Methods With the aid of surgical microscope, fifteen cadaver heads were used to study the microsurgical anatomy of high cervical part and jugular foramen, measure relative data. Results Detailed dissection was performed on high cervical part between the 1st cervical vertebra and the 4th cervical vertebra, resect foramen processus transversi of the 1st cervical vertebra, free vertebral artery 2nd and 1st cervical vertebra segment and horizontal segment. The jugular tubercle, jugular tunisia and part of the occipital condylus was drilled away as much as possible, total exposure of lateral semicircular canal was completed after the removal of the mastoid revealed labyrinthinem. Then the sigmoid sinus and jugular bulb were skeletonized. The vertical of segment of facial nerve was fully skeletonized to study the necessity of the facial nerve translocation. Full exposure to the sigmoid sinus, open jugular foramen. JF areas expanded, and the measured parameters revealed. The distance was (29.65 ± 3.24)mm from mastoidalec to oncentrated focus of condyle (10.18 ± 0.81)mm from hinder margin of condyle to endostoma of hypoglossal canal. The left distance was (6.8 ± 0.35)mm from jugular foramen to perpendicular part of facial nerve, right was (4.6 ± 0.33)mm. Conclusions Total exposure of JF can be achieved through the approach we described, and will enable the facial nerve, cochlea, and the structure of the vertebral artery to be performed. Both intracranial and extracranial tumors can be removed in a one-stage procedure related to anatomical parameters. Improve the cure, reduce complication and lower mortality.
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Objective To approach operative technique for chronic sub, dural hematoma (CSDH).Method The clinical information including general state of health, operative technique and prognosis of the 250 cases with CSDH were retrospectively analyzed. Results Within the 250 cases, 202 were old people with age over 50 and 176 had definite trauma history. In 25 cases treated by burr hole and drainage, 5 cases who had hematoma recurrence and 10 cases who had pneumocephalus, among whom, 6 had tensional pneumoeephalus, were all cured by second operation while the rest got cured. In 207 cases treated by burr hole, douche and drainage, no pneumocephalus or intracranial infection occurred. Twenty of them relapsed and were cured by second operation. Cerebral contusion eccurred in 1 case for pipe was inserted into the brain tissue by mistake, but it got better after active therapy. The other 18 cases were all cured through eraniotomy,hematomas removal as well as envelope excision. Conclusions CSDH is common in the old with age over 50 and it has relationship with head injury,mostly. The single hole trepanation, douche and drainage is simple, safe ,with minimal trauma and high cure rate. To master the operative technique including douching thoroughly, drainage through a pipe and brain protection is very important to the success of the operation.
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Objective To explore further the abilities of cerebellar lesions in skills of time estimation, and to test the hypothesis that cerebellum is involved in the special network of time perception. Methods Time reproduction was required for 3 time intervals of 600-milliseconds, 3 and 5 seconds with visual discrimination for control. Participants reproduce those time intervals after 1-second or 5-seconds of delay. Twenty-six patients with cerebellar lesions were compared to 26 healthy controls, matched for age, handedness, education. Results 600-milliseconds was overestimated by both cerebellar lesions and healthy controls, however, both 3-seconds and 5-seconds were underestimated. Patients with cerebellar lesions were significantly impaired on 600-milliseconds reproduction task ( delaying 1 s or 5 s, 1.37 ± 0.24, 1.26 ± 0.29 respectively, Z=-5.347, -4.230, both P<0.01). No group differences were found for the 3-seconds and 5-seconds time reproduction (delaying 1 s or 5 s, Z=-1.200,-0.092,-1.519, -0.723, all P>0.05). Conclusion The findings suggest that patients with cerebellar lesions perform poorly during measurement of the shorter interval, but show no impairment of longer intervals perception, supporting the hypotheses that cerebellum is specifically involved in the perception of sub-second intervals.
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Objective To determine attention networks impairmnet in patients with localized brain injury and to examine the characteristics of the impairment.Methods The attention network test was used to compare patients(n=59)with controls(n=53)on the efficiency of 3 anatomically defined attention networks:alerting,orienting,and executive control.Results Firstly,patients with frontal lobe injury showed a significant deficit in the executive network(frontal lobe injury,controls:(143.7±46.6),(91.6±46.4)ms,Z=-4.714,P＜0.01)and also a significant deficit in the orienting network(frontal lobe injury,controls:(71.2±35.2),(55.1±21.8)ms,Z=-2.125,P＜0.05).There was no deficit in the alerting network(Z=-0.901,P＞0.05).Secondly,the orienting network effect was significantly lower in patients with parietal lobe injury((34.9±25.2)ms)than in normal controls((55.1±21.8)ms.Z=-2.418.P＜0.05).However,there were no significant difierences between the other two networks and between the patients and the controls(Z=-1.873,-0.186.P＞0.05).Thirdly,patients with temporal lobe injury showed no deficit in the three networks(Z=-0.037,-1.224,-0.718,all P＞0.05)as well as in overall RT and accuracy(Z=-1.385,-0.699,all P＞0.05).Conclusions These results suggest that there are selective impairments of the orienting and executive networks in patients with the frontal lobe and the parietal lobe injury,while the alerting network is spared.Furthermore,the frontallobe plays a key role in the executive control.meanwhile,the orienting network is closely related with the parietal lobe.
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Objective To explore the efficacy and postoperative survival times of stereotactic radiosurgery by X-knife in the treatment of brain metastatic tumors.Methods Between March 1996 and March 2008,520 patients with brain metastatic tumors were treated in our hospital by stereotactic radiosurgery using X-knife.Among the cases,336 had single metastatic lesions,and 184 presented with multifocal tumors(2 lesions in 51 patients,3-5 lesions in 63,and 6-10 lesions in 70).The tumors sized 5 to 35 mm in diameter with a mean of 16.4 mm.Stereotactic radiosurgery was carried out in the cases with a mean central dose of 22 Gy(20 to 25 Gy),and mean marginal dose of 12 Gy(10 to 14 Gy).Over 80% of the lesions were encircled with the dosage.Results The 520 patients were followed up for 8 to 36 months(mean,20 months).CT and MRI performed in the 6th months postoperation showed complete response in 218 patients(41.9%),partial response in 182(35.0%),no response in 78(15.0%),and progressed disease in 42(8.1%).The overall control rate of the tumors were 91.9%(478/520).In this series,the 6-months survival rate was 85.0%(442/520),12-month survival rate was 68.1%(354/520),and the 1-year and 3-year survival rates were 40% and 5.5% respectively.The medium survival time was 12.6 months.Conclusions Stereotactic radiosurgery is an effective method for brain metastatic tumors.It can improve the life quality and survival time of the patients.
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Objective To explore the operating approaches through cavity for large tumors in sellar area. Methods The one side orbit-below frontal approach was used for 13 cases with large tumor on axial line from inside suprasellar and the orbit pterional approach was selected for 11 cases with larger tumor in suprasellar area or outside the area. Results Total removal was achieved in 9 cases, subtotal in 9 cases and partial in 6 cases. 1 patient died after operation. The rest recovered well recoveered without serious complication. Conclusions The two approaches have the merits of simple technique, exposing well, gentle brain pulling and few complication, which are suitable for operation on the large tumor in sellar area.
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Objectiye To discover the related factors that affect nerveus function rehibilation after noninjuries spinal cord of. Method A total of 19 patients with intramedullary spinal function, characters of tumors, opertive methods snd early rehibilations of nervous functions postoperstion were studied. Result Benign tumors had clear demarcations , and rate of total resection was high, prognosis was better. But malignant tumors could infiltratively grow. It was difficult to recognize its demarcation, so function spinal tissue can be injured by operation, and trealment effect was affected. If a patient had already complete palsy preoperation, his spineal cord functions was difficult to improve postoperation. Conclusiou There were important factors that affected early rehibilation of spinal cord functions, inclunding pathologic character, degree of resection, operation methods and preoperative spinal cord conditions etc. But early rehabilating therapy can quicken the step of rehibilation and degree of rehabilation of spinal function after operation.
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Objective To assess the technique and the safety of radical resection for large pituitary adenoma. Methods Unilateral transorbital subfrontal approach operations were employed for treating 14 cases of large or giant pituitary adenomas. Tumors, at least the suprasellar extension of them, were removed as thoroughly as possible in surgery. Then the X-knife was administered for intrasellar residual lesions 1.5～3.5 months after the surgery. Results Total removal of tumors was achieved in 4 patients, while intrasellar residual tumors were found in the remaining 10 patients. No severe complications occurred. Out of the 10 patients with residual tumors, 8 underwent postoperative X-knife therapy, without visual defects or pituitary function failure. Follow-up observations in these 8 patients for 5～26 months (mean,14.8 months) revealed no recurrence. Conclusions Transorbital subfrontal approach surgery which is characterized by simplicity of its performance facilitates the radical resection of tumors and the avoidance of complications. Postoperative X-knife therapy may further control the recurrence of tumors.