Salvage management and subsequent treatment after internal carotid artery injury during transnasal endoscopic surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the cause, urgent management, further treatment, outcome and prevention of internal carotid artery (ICA) injury during transnasal endoscopic surgery.</p><p><b>METHODS</b>Five ICA injury happened during transnasal endoscopic surgery of sphenoidal sinus and (or) sellar region, involving 1 case of traumatic optic neuropathy, 1 case of sphenoidal cyst, 1 case of fungal sphenoid sinusitis, 1 case of sellar adenoid cystic carcinoma and 1 case of pituitary tumor. These five cases were from three different hospitals in 1990 - 2009, and the clinical data were collected and retrospectively reviewed.</p><p><b>RESULTS</b>Injury of ICA was related with improper anatomic localization and operative procedures. The locations of injury were in cavernous segment in 3 cases, lacerum segment in 1 case, and clinic segment in 1 case, respectively. The types of injury included 3 cases of bleeding of laceration, 1 case of carotid cavernous fistula and 1 case of pseudoaneurysm. Salvage sphenoid sinus packing with vaseline strip and subsequent intravascular stent graft implantation (2 cases) and endovascular embolization (2 cases) effectively controlled bleeding. Four cases were successfully treated without craniocerebral or ocular complications, only 1 case died of massive blood loss. Among 4 survival cases, 1 patient abandoned further therapy, the other 3 patients were cured of primary disease by reoperation or subsequent treatment.</p><p><b>CONCLUSION</b>Preoperatively, reading carefully the imaging data, intraoperatively, identifying anatomical positions accurately, performing proper operation, and stopping bleeding decidedly, postoperatively, seeking interdisciplinary cooperation to repair vascular damages, all these procedures can effectively reduce the surgical risk of ICA injury.</p>

Diagnosis and treatment of cervical Castleman disease presenting as a neck mass / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical and pathological features, diagnosis and treatment of Castleman disease (CD).</p><p><b>METHODS</b>Clinical features and related information on diagnosis and treatment of eight cases of CD were retrospectively analyzed. The size of involved lymph nodes ranged from (2 cm x 2 cm x 3 cm) - (4 cm x 3 cm x 2 cm). The lymph nodes were found in level I (1 case), level II (3 cases), level III (3 cases) and level IV (1 case). CT examination in eight patients showed the lesions manifested as ellipse soft masses. Dynamic contrast CT scan in four patients showed ring-enhanced area around the masses. Blood routine examination in eight patients were generally normal, with six patients had mild anemia.</p><p><b>RESULTS</b>Based on the clinical classification, all lesions in this group were localized CD. Histopathology indicated that all lesions were of hyaline-vascular type. After surgery, there was no recurrence during the follow-up period.</p><p><b>CONCLUSIONS</b>Patients with localized CD mainly have lymphadenectasis in a single location. The CT scan can give some evidence. Surgery should be given first priority.</p>

Complications of transsphenoidal surgery for sellar region: intracranial vessel injury / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intracranial vessel injury is a severe complication of transsphenoidal surgery (TSS) for lesions of sellar region. The purpose of this study was to improve recognition of the complication.</p><p><b>METHODS</b>The clinical data of 400 cases of TSS for sellar region from 1964 to 2004 were reviewed retrospectively. Ten patients with complications of intracranial vessel injury were included in this study, 7 underwent transsphenoidal microsurgery and 3 underwent endoscopic TSS. Subarachnoid hemorrhage (SAH) occurred in 8 cases, hemorrhage of cavernous sinus in one, and post-operative cerebral hemorrhagic infarction caused by thrombosis of injured right internal carotid artery in one. The clinical data of all the patients were analyzed.</p><p><b>RESULTS</b>The SAH resulted from hemorrhage of residues of tumor in 2 patients and from damaged sellar and arachnoidea in 6 patients. The cause of hemorrhage of anterior intercavernous sinus was malformation of anterior intercavernous sinus. The reason of thrombus of internal carotid artery was manipulation of operation. Three patients died and six patients were cured. One patient lived with hemiplegia.</p><p><b>CONCLUSIONS</b>The cause of intracranial vessels injury of TSS is complicated. Detailed anatomic knowledge of seller and skilled operation is helpful to reduce the complication.</p>

Surgical treatment of tumors in anterior and middle skull base by modified maxillary bone disassembly procedures / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the therapeutic effect of the modified maxillary bone disassembly procedures on patients with tumors in the anterior and middle skull base.</p><p><b>METHODS</b>Retrospective analysis was made of patients treated with the modified maxillary bone disassembly procedures. Ten tumors in the anterior and middle skull base were resected according to the pathology, size and site of the skull base tumors including 9 benign tumors and 1 malignant tumor.</p><p><b>RESULTS</b>All tumors were resected completely. All patients were followed up from 12 months to 5 years postoperatively. The complications were less and the life quality was increased. The patients with benign tumors showed no recurrence . Two patients with cerebrospinal rhinorrhea cured spontaneously after 7 days. One patient with melanoma died of brain metastase.</p><p><b>CONCLUSIONS</b>It is necessary to estimate the tumors thoroughly before surgery. According to the location of the tumor, the modified maxillary bone disassembly is the nearest and harmless approach, through which the tumors can be completely excised with minimal invasiveness. The life quality is thus increased.</p>

Surgical treatment of transclavicular and transsternal tumor / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate surgical treatment approach of transclavicular and transsternal tumor.</p><p><b>METHODS</b>Twelve cases of neck-root and mediastinum thoracis tumor subjected to cervicothoracic-combined surgical treatment were retrospectively analyzed and summarized.</p><p><b>RESULTS</b>Seven cases of benign tumor survived 1-8 years after surgery. The other 5 patients were malignant tumor. Among 4 cases of metastatic squamous cell carcinoma without definite origin at neck-root site who underwent operation and routine radiotherapy, one case died of orthotopic relapse and armpit metastasis at the 16th months postoperatively; one case was lost of follow-up after surgery; another two cases showed no relapse after follow-up of 50 months and 27 months, respectively. In addition, one case of thyroid papillary carcinoma located at neck-root and mediastinum remained alive for 40 months after operation combined with radiotherapy and chemotherapy.</p><p><b>CONCLUSIONS</b>The evaluation of twelve cases of transclavicular and transsternal tumor with adoption of cervicothoracic-combined surgical approach improves and develops traditional knowledge of surgical therapy of neck-root tumors.</p>

Effects of hypericin associated with light irradiation on human laryngeal squamous cell carcinoma strain Hep-2 / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study effects of hypericin associated with light irradiation on human laryngeal squamous cell carcinoma strain Hep-2.</p><p><b>METHODS</b>Using techniques of tumor cells culture in vitro, Hep-2 cells were exposed to different concentration hypericin as 0.5, 1.0, 2.0, 3.0, 5.0 microg/ml, then 10 minutes 7.5 J/cm2 light irradiation was given after an hour. Other groups Hep-2 culture cells were also exposed to different concentration hypericin as 5.0, 10.0, 20.0, 25.0 microg/ml, without light irradiation. In all groups, contrast groups were set up. And 48 hours later, growth characteristics of Hep-2 cells were studied by morphological observation, fluorescence microscope, MTT assay and flow cytometry.</p><p><b>RESULTS</b>In normal contrast group, Hep-2 cells grew intensively and contacted with each other. However, cells which were treated with hypericin, combination with light irradiation were declined greatly. In higher dose hypericin group, necrosis could be found. MTT assay showed that hypericin associated with light irradiation inhibited growth of laryngeal cell with dose dependence manner. Flow cytometry showed that hypericin with light irradiation could block cell growth at G0/G1 phase, inducing apoptosis of laryngeal cell. Under fluorescence microscope, some sings of cell apoptosis including coagulation of chromatin, fragmentation of nuclei and apoptotic body could be found.</p><p><b>CONCLUSION</b>Human laryngeal squamous cell carcinoma strain Hep-2 can be inhibited and induced into apoptosis by treated with hypericin combination with light irradiation.</p>

Experimental study of cranial-cervical lymph return in rabbit / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the cranial-cervical lymph return and pathway in rabbit in order to provide the experimental and theoretical basis for the study of intracranial metastasis of cervical tumor and extracranial metastasis of intracranial tumor.</p><p><b>METHOD</b>The distribution and clearance of tracers were observed after microinjection of lymph developer labeled by 99mTc into cerebral cortex and deep cervical lymph nodes of rabbit.</p><p><b>RESULTS</b>In the cerebral cortex microinjection with 99=Tc-labeled lymph developer group, the radioactivity were detected in Willis artery, deep cervical lymph nodes and venous blood. The radioactivity curve was the same in Willis artery and deep cervical lymph nodes. The peak in the artery blood was higher than that in venous blood. In the lymph nodes microinjection with 99mTc-labeled lymph developer cervical group, the radioactivity were detected in skull base dura mater, brain, cerebrospinal fluid and venous blood. The peak in skull base dura mater showed earlier than that in cerebrospinal fluid and brain. The peak in venous blood was the last, but the radioactivity in it was the highest.</p><p><b>CONCLUSION</b>The cranial-cervical lymph return in rabbit is existent. Their pathway perhaps is Willis artery, skull base dura mater and cerebrospinal fluid circulation.</p>