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Objective: To investigate the effectiveness of percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation in the treatment of paracentral cervical disc herniation. Methods: Between December 2015 and October 2018, 29 cases of paracentral cervical disc herniation were treated with percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation. There were 16 males and 13 females, with an average age of 49.7 years (range, 39-78 years). The disease duration was 3.5-15.0 months (mean, 6.2 months). The herniated disc located at C 3, 4 in 2 cases, C 4, 5 in 5 cases, C 5, 6 in 9 cases, C 6, 7 in 12 cases, and C 7, T 1 in 1 case. The main symptoms were radiculopathy symptom. The operation time, intraoperative blood loss, hospital stay, and complications were observed and recorded. Visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, cervical range of motion (ROM), Macnab standard, and cervical segment stability were used to evaluate the efficacy and safety of the operation. Results: All patients were followed up 11-43 months, with an average of 19.4 months. The operation time was 67-89 minutes (mean, 73.3 minutes); the intraoperative blood loss was 18-30 mL (mean, 22.9 mL); the hospital stay was 5-10 days (mean, 7.3 days). All the incisions healed by first intention. There was 1 case of hypodynia and hyperalgesia in the affected limb after operation,1 case of decreased limb muscle strength. The VAS scores and JOA scores at each time point after operation were superior to those before operation ( P0.05). At last follow-up, the effectiveness was rated according to the Macnab standard as excellent in 11 cases, good in 15 cases, fair in 2 cases, and bad in 1 case, with an excellent and good rate of 89.7%. The CT and MRI showed the decompression of spinal canal and nerve canal. There was no significant difference in cervical ROM between pre- and post-operation ( t=1.427, P=0.165), and no surgical segment instability occurred by X-ray films of flexion and extension of cervical vertebrae. Conclusion: For the paracentral cervical disc herniation with simultaneous compression of nerve roots and spinal cord, percutaneous endoscopic posterior cervical Key-Hole fenestration decompression and nucleus pulposus extirpation has the advantages of small trauma, quick recovery, and satisfactory effectiveness, and can be used as a safe and effective minimally invasive procedure.
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Objective To compare the efficacy, complications, safety and prognosis of the minimally invasive puncture approach and key hole in the treatment of hypertensive cerebral hematoma.Methods A totol of 68 patients with hypertensive cerebral hematoma confirmed by CT from April 2012 to October 2013 in Nongken Sanya Hospital were randomly divided into key hole evacuation group(n=32) and minimally invasive puncture group (n =36).Comparisons were made between the two surgical methods in the operative time, postoperative complications, the fatality and the postoperative re-haemorrhagia rate, neurological function deficit score also been observed and evaluated in the 1 st,2nd and 4th weeks after surgery.Results The NFDS scores of the two groups both decreased in the 1st week after surgery,but compare with preoperative the difference was not statistically significant (P ＞ 0.05).In the 2nd weeks and 4th weeks after surgery, NFDS scores further decreased in both group,and there was statistically significant compare with preoperative(the key hole evacuation group : (26.2±4.5) vs.(17.8 ± 3.6) vs.(44.1 ± 5.4) scores;the minimally invasive puncture group: (22.1 ± ±3.7) vs.(15.4±2.8) vs.(43.9±6.2)scores;P＜0.05) ,but during the same period there was no significant difference between the two groups with NFDS scores(P＞0.05).The rebleeding rate of the minimally invasive puncture group was significantly lower than the key hole evacuation group (4.08％ vs.16.33％, x2=6.56, P＜0.05).There was no significant difference in mortality rate and long term total effect between two groups (P＞0.05).Conclusion Although both key hole and minimally invasive puncture are effective measures for treatment of hypertensive cerebral hemorrhage, but minimally invasive puncture with less trauma, definite curative effect and higher security advantages in clinical.
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Este trabajo presenta la experiencia de 64 pacientes tratados con abordaje supraorbitario lateral (key hole): 33 pacientes con hidrocefalia en los que se realizó fenestración de la lamina terminalis, 11 pacientes con extirpación de tumores de base de cráneo, 20 pacientes con aneurisma cerebral de circulación anterior. Se describen algunas modificaciones en la técnica quirúrgica, complicaciones y seguimiento.
This works presents the experience of 64 patients treated with supraorbital approach (key hole): 33 with hydrocephalus in which was performed the fenestration of the lamina terminalis, 11 with cranial basal tumors, 20 with anterior circulation aneurysm. Some modification of the technique, complications and medical following are described.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Child , Young Adult , Middle Aged , Intracranial Aneurysm/surgery , Craniotomy/methods , Hydrocephalus/surgery , Skull Neoplasms/surgery , Minimally Invasive Surgical Procedures/methods , Microsurgery , Postoperative ComplicationsABSTRACT
Objective To evaluate the therapeutic effects of Lumber continued drainage of cerebrospinal fluid after Key-hole approach operation and craniotomic hematoma elimination on the prognosis of hypertensive in-tracerebral hemorrhage patients. Methods Lumber continued drainage of cerebrospinal fluid after Key-hole ap-proach operation was conducted on 38 hypertensive intracerebral hemorrhage patients. At the 1st month and 6th month after operation, Glasgow coma scale (GCS), Glasgow outcome scale (GOS), Barthel index, language barrier degree evaluation and sports function barrier degree evaluation were measured. The therapeutic effects were observed and compared with 34 patients who were operated by craniotomic hematoma elimination. Results GCS was 6.8± 2.1,6.6±2.3 before operation and 10.5±2.5,8.7±2.2 one week after operation in experimental group and con-trol group respectively; GOS was 3.4±0.3,2.8±0.2 one month after operation and 4.1±0.6,3.2±0.4 six month after operation in experimental group and control group respectively; Bartherl index, language barrier degree and sports function barrier degree were 63.15±11.64,51.76±12.81 and 1.7±0.3,2.3±0.2,2.0±0.3, and 2.6± 0.4 (P<0.05 or P<0.01). Conclusion Lumber continued drainage of cerebrospinal fluid after Key-hole approach operation offers greater help in improving the patients' quality of existence, by which the neurological function recov-ers faster and the patients recover well.
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Objective To study the endoscopic anatomy of operative fissures in the sellar region related to pterional key-hole approach and to provide the anatomic basis for endoscope-assisted microneuro-surgery in the region. Methods Fifteen cadaver heads were dissected via pterional key-hole approach and the five operative fissures(Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ) were studied with both microscope and endoscope, by which the outcomes observed were recorded and compared. Results The basic information obtained by the pterio-nalkeyhole approach was comparable to that of the classic ptefional approach. According to the anatomic guideposts under neuroendoscope, the microstructures of the five fissures and Willis' circle would be well demonstrated. It is better to display the various anatomic structures in sellar region by neuroendoscope rather than microscope, particularly some important microstructures. Angled endoscope can be used to inspec thidden but important structure behind the arteries and nerves. Conclusion According to the anatomic guideposts, an endoscopy can be used to enhance the visible field of an operative microscope related to pterional key-hole approach. The endoscope-assisted microsurgery can reduce complications and injury of the important structures and increase the curative effect on the lesions in the sellar region.
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Objective To research the microinvasive therapy for intraspinal tumors resection and study the ways for spinal function protection. Methods Twenty-four cases were detected by MR. The intraspinal tumors located variously and the size of them ranging from 0.9 cm to 3.0 cm. All the tumors underwent resection via Key-hole on mono-lamina and the clinical data were analyzed. Results After tumor pathological examination,the cases of neurofibroma,neurinoma,and spinal meningioma were 9,12 and 3 cases. respectively. All the patient recovered and they walked within one week after operation. No recurrenced on MR examination after 3 months and no spinal tube destruction on CT examination after 6 months. Conclusion The microinvasive therapy via Key-hole on mono-lamina is benefic to the totally resection of intraspinal tumors and also benific to the spinal function protection.
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We compared postoperative visual outcome and corneal refractive power depending on preoperative corneal topographic pattern and the predictibility of corneal topographic measurement compared with keratometric measurement after PRK. The subjects were 91 eyes divided into two goups composed of 44 eyes, symmetric bow tie type(SB) and 47 eyes, asymmetric bow tie type (aSB). The visual acuity, central power, and topographic pattern were measured before operation, postoperative 1 week, 1, 2 and 6 month in two groups, but no statistical difference(p>0.05). The averages of uncorrected visual acuity at 6 month were improved to 0.80(SB) and 0.85(aSB) from 0.09(SB) and 0.11(aSB) before operation. Topographic central refractive powers of +42.98D (SB), +43.32D(aSB) before operation were changed to +37.68D(SB), 37.56D(aSB) at 6month. The pattern of the region affected by the excimer laser was classified by key hole type 38%(SB) , 34%(aSB) , uniform roud type 41%(SB), 43%(aSB), semicircular type 21%(SB), 23%(aSB). The proportion of the difference less than one diopter between PRK setting and the change of the corneal refractive power at 6month was 36% and 76% in keratometric and topographic measurement. Above results show that the asymmetricity of bow tie type did not influence the visual outcome. The topographic measurement was better than keratometric measurement in evaluating the corneal refractory change after PRK.