Radiofrequency thermocoagulation rhizotomy for recurrent trigeminal neuralgia after microvascular decompression / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Microvascular decompression (MVD) is a well accepted surgical treatment strategy for trigeminal neuralgia (TN) with satisfying long-term outcome. However, considerable recurrent patients need more effective management. The purpose of this study was to evaluate the effectiveness of radiofrequency thermocoagulation rhizotomy (RTR) on patients with recurrent TN after MVD.</p><p><b>METHODS</b>Totally 62 cases of recurrent TN after MVD undergoing RTR from January 2000 to January 2010 were retrospectively evaluated. Based on surgical procedures undertaken, these 62 cases were classified into two subgroups: group A consisted of 23 cases that underwent traditional RTR by free-hand; group B consisted of 39 cases that underwent RTR under the guidance of virtual reality imaging technique or neuronavigation system. The patients in group A were followed up for 14 to 70 months (mean, 40 ± 4), and those in group B were followed up for 13 to 65 months (mean, 46 ± 7). Kaplan-Meier analyses of the pain-free survival curves were used for the censored survival data, and the log-rank test was used to compare survival curves of the two groups.</p><p><b>RESULTS</b>All patients in both groups A and B attained immediate pain relief after RTR. Both groups attained good pain relief rate within the first two years of follow-up: 92.3%, 84.6% and 82.6%, 69.6% respectively (P > 0.05). After 2 years, the virtual reality or neuronavigation assisted RTR group (group B) demonstrated higher pain relief rates of 82.5%, 76.2% and 68.8% at 3, 4 and 5 years after operation respectively, while those in group A was 57.2%, 49.6%, and 36.4% (P < 0.05). Low levels of minor complications were recorded, while neither mortalities nor significant morbidity was documented.</p><p><b>CONCLUSIONS</b>RTR was effective in alleviating the pain of TN cases suffering from unsuccessful MVD management. With the help of virtual reality imaging technique or neuronavigation system, the patients could attain better long-term pain relief.</p>

Study on surgical approaches and electrode implantation of oculomotor nerve and inferior obliquus in beagle dogs

To study the surgical anatomy and approaches of intracranial oculomotor nerve [OMN] and inferior obliquus [IO], and the methods of their electrode implantation in dogs. The research was performed on 30 adult beagle dogs at Shanghai Jiaotong University Medical College, Shanghai, China from November 2007 to August 2008. All animals were subjected to a right transfrontotemperal approach to intracranial OMN, a transconjunctival route to IO, and the neuro-stimulating and recording electrode implantation under general anaesthesia. The OMN was stimulated and the electromyography of IO recorded and analyzed with the Powerlab System. The security and reliability of the implanted electrodes were investigated. The surgical anatomy and approaches of both the OMN from its exit from midbrain to the entrance into cavernous sinus and the IO were described. Moreover, the implantation methods of OMN stimulating electrode and the electromyographic recording electrode of IO were displayed. The implanted electrodes were safe and reliable. Some electrophysiologic data of IO were obtained in the healthy dogs. Also, some perioperative precautions for intracranial and ophthalmic surgical procedures in dog were exhibited. The mortality rate of the dogs was 0%, and no operative complications were observed. With the data provided, these surgical approaches and the methods of electrode implantation offer a choice to construct an animal model for studying various aspects of OMN regeneration

Clinicopathologic characteristics and microsurgical treatment of glioma of limbic and paralimbic system / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the features of the clinical manifestations, imaging, pathology and microsurgery on the patients with gliomas of limbic and paralimbic system.</p><p><b>METHODS</b>The clinical data of 28 patients with gliomas of limbic and paralimbic system were analyzed respectively.</p><p><b>RESULTS</b>Seizure was the most common symptom, presented in 24 cases. CT scans showed hypodensity in 19 cases and isodensity in 9 cases. MRI scans were achieved in 23 cases, showing hypointense signal on T(1)WI and hyperintense signal on T(2)WI. Total resection was achieved in 19 cases, subtotal in 6 cases and partial in 3 cases. All patients had excellent postoperative recovery, except 5 patients who developed temporary frontal aphasia and 6 patients who developed contralateral hemiplegia. The patients had a postoperative follow-up ranging from 6 months to 5 years, and 23 cases still survived.</p><p><b>CONCLUSION</b>High-resolution CT and MRI may reveal the size, location, confines and sharp demarcation of the tumors. Gliomas can be microsurgically removed with considerable results.</p>

Multiple meningiomas: report of 32 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the genesis and classification and diagnosis as well as the treatment of multiple meningiomas.</p><p><b>METHODS</b>Retrospective study of the materials of 32 cases of multiple meningiomas, simultaneously review of the related articles.</p><p><b>RESULTS</b>All patients were divided into 5 groups, primary 18 cases, postoperative 7 cases, accompanied by neurofibromatosis (NF) 4 cases, meningiomatosis 1 case, accompanied with other intracranial tumor 2 cases, one with pituitary adenoma and the other with glioma. All the patients accepted operation, cured 25 cases, improved 7 cases.</p><p><b>CONCLUSIONS</b>The cytogenesis of different type of multiple meningiomas probably varied. Estrogen may play an important role in the genesis of multiple meningiomas. One stage resection of all the tumors was feasible to most cases and advocated. Most cases had strong tolerance to several times of operation, staging operation was permitted. The prognosis and principle of treatment of different group varied.</p>

Traumatic subdural hydroma developing into chronic subdural hematoma / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To probe the incidence, pathogenesis and clinical characteristics of traumatic subdural hydroma (TSH) developing into chronic subdural hematoma (CSDH).</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 32 patients with TSH developing into CSDH and reviewed related literature.</p><p><b>RESULTS</b>16.7% of TSH developed into CSDH in this study. The time of evolution was from 22 to 100 days after head injury. All the patients were cured with hematoma drainage.</p><p><b>CONCLUSIONS</b>TSH is one of the origins of CSDH. The clinical characteristics of TSH developing into CSDH follow that the ages of the patients are polarized, that the evolution often happens in the patients with small chronic hydromas and being treated conservatively, that the patients are usually injured deceleratedly and that the accompanying cerebral damage is often very mild.</p>

Diagnosis and treatment of cystic acoustic neuroma / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical features and treatment of cystic acoustic neuroma.</p><p><b>METHODS</b>Twenty-two patients with cystic acoustic neuromas were diagnosed by CT and MRI preoperatively, and the tumors were resected by retrosigmoid approach, and verified by pathological studies.</p><p><b>RESULTS</b>Of the 22 patients, 18 had tumors totally resected (postoperative house Brackman facial nerve grading: grade II in 4 patients, III in 7, IV in 3, V in 2, VI in 2) and 4 had tumors subtotally resected.</p><p><b>CONCLUSION</b>Because of its specific clinical features and poor operative results, cystic acoustic neuroma should be regarded as a specific subtype.</p>

Type and its clinical characteristics of traumatic subdural hydroma / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the types and clinical characteristics of traumatic subdural hydroma (TSH).</p><p><b>METHOD</b>One hundred and ninety-two cases of TSH were classified into four types: The types of resolution, steadiness, development and evolution on the basis of their clinical characteristics and dynamic observation of CT scanning.</p><p><b>RESULTS</b>The patients in the resolution type often occurred in the prime of life. They had normal intracranial pressure and good prognoses using the conservative therapy. The majority of the elderly patients was in the steadiness type. Their main clinical manifestations included headache, dizziness, nausea, vomit, abnormal mentality and so on. Generally, there was no positive nervous systemic sign related to TSH. The prognoses of patients with the steadiness type treated by conservative therapy were satisfactory. The development type was common in the babies and children. This was mainly manifested as progressive increased intracranial pressure, mild hemiplegia, aphasia and abnormal mentality. The patients with development type often needed surgical treatment and might die once in a while due to accompanying cerebral parenchymal damage or postoperative complications. The evolution type was characterized by the polarized age, chronic increased intracranial pressure, often happening between 22 and 100 days after TSH and in the cases of small hydromas treated conservatively and mild accompanying cerebral damage, which always have a good prognosis by the treatment of surgery.</p><p><b>CONCLUSIONS</b>The mechanism, clinical characteristics, treatment methods and prognoses varied with different types of TSH.</p>