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Objective:To observe the effect of neuroendoscope-assisted drainage with lumbar cistern and large bone flap decompression in the treatment of craniocerebral injury complicated with temporal uncinate herniation.Methods:A total of 80 patients with craniocerebral trauma and temporal uncinate herniation hospitalized in Lanling County People′s Hospital from January 2017 to October 2020 were retrospectively included and divided into the observation group and the control group according to the surgical methods, with 40 patients in each group. Surgical procedures were performed by the same group of experienced neurosurgeons. The observation group was treated with neuroendoscope-assisted drainage with lumbar cistern and large bone flap decompression, while the control group was treated with large bone flap decompression only. Cephalic CT was reexamined before and 48 h after the surgery to compare the appearance rates of cisterna ambiens and suprasellar cistern. Intracranial pressure (ICP) was monitored at 3, 5 and 7 d after the surgery, and the scores of Glasgow coma scale(GCS) was recorded. Drainage time, postoperative cerebral edema and cerebral infarction complications were recorded and compared between the two groups. Six months after the surgery, the prognosis was assessed by the Glasgow prognostic scale (GPS).Results:The occurrence rates of cisterna ambiens and suprasellarcistern in the observation group were higher than those in the control group: 67.50%(27/40) vs. 45.00%(18/40), 65.00%(26/40) vs. 42.50%(17/40), χ2 = 4.11, 4.07, P<0.05. The ICP value in the observation group at 3, 5 and 7 d after the surgery were significantly lower than those in the control group, and the scores of GCS in the observation group were significantly higher than those in the control group, there were statistical differences( P<0.05). There was no statistically significant difference in drainage time between the two groups ( P>0.05). The incidence of postoperative cerebral edema in the observation group was lower than that in the control group:7.50%(3/40) vs. 25.00%(10/40), χ2 = 4.50, P<0.05. The incidence of postoperative cerebral infarction in the observation group was lower than that in the control group, and the volume of cerebral infarction was smaller than that in the control group: 5.00%(2/40) vs. 22.50%(9/40), (6.68 ± 1.75) cm 3 vs. (8.20 ± 2.15) cm 3, there were statistical differences ( P<0.05). The incidence of postoperative complications in the observation group was lower than that in the control group: 7.50%(7/40) vs. 40.00%(16/40), χ2 = 4.94, P<0.05. Six months after the surgery, the rate of good prognosis in the observation group was higher than that in the control group: 62.50%(25/40) vs. 35.00%(14/40), χ2 = 6.05, P<0.05. Conclusions:Neuroendoscope-assisted drainage with lumbar cistern and large bone flap decompression in the treatment of craniocerebral trauma and temporal uncinate herniation has good efficacy and safety.
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Objective To investigate the clinical effect of surgical treatment of pituitary adenoma via neuroendoscopic-assisted transsphenoidal approach in elderly patients.Methods This was a prospective case-control study.Eighty-five patients with senile pituitary adenoma admitted to our hospital from May 2015 to February 2018 were consecutively enrolled in our study.Patients with pituitary adenoma were divided into the control group(n=42)undergoing conventional microsurgery and the observation group(n=43)receiving microsurgery via neuroendoscopic-assisted transsphenoidal approach.The effect of surgery,perioperative indexes (intraoperative blood loss,operation time,hospitalization time) and the serum level changes of prolactin (PRL),growth hormone (GH) and adrenocorticotropic hormone(ACTH)before and after surgery were recorded and compared between two groups.The incidences of complications in both groups and the dimensions of life quality(physical,cognitive,emotional,social activities)before and after surgery were calculated and assessed.Results The total effective rate was higher in the observation group(88.4 ％,38/43)than in the control group (69.0 ％,29/42) (P ＜ 0.05).The intraoperative blood loss,operation time and hospital days were less in the observation group than in the control group(P＜0.05).No significant differences were found in serum levels of PRL,GH and ACTH between the two groups before and at 3 days after surgery (P＞0.05).However,serum levels of PRL,GH and ACTH were deceased in both groups at 3 days after operation compared with before operation.The incidence of complications was lower in the observation group than in the control group(4.7％ or 2/43 vs.21.4％ or 9/42,P＜0.05).The quality of life scores of the cognitive,role,physical,emotional and social dimensions were higher in the observation group than in the control group (P ＜ 0.01).Conclusions Neuroendoscopic-assisted transsphenoidal approach for surgical treatment of senile pituitary adenomas has less intraoperative blood loss,shorter operation time and lower complication rate,improves the endocrine hormone levels and the quality of life,and shortens the hospital stays.
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Objective@#To investigate the clinical effect of surgical treatment of pituitary adenoma via neuroendoscopic-assisted transsphenoidal approach in elderly patients.@*Methods@#This was a prospective case-control study.Eighty-five patients with senile pituitary adenoma admitted to our hospital from May 2015 to February 2018 were consecutively enrolled in our study.Patients with pituitary adenoma were divided into the control group(n=42)undergoing conventional microsurgery and the observation group(n=43)receiving microsurgery via neuroendoscopic-assisted transsphenoidal approach.The effect of surgery, perioperative indexes(intraoperative blood loss, operation time, hospitalization time)and the serum level changes of prolactin(PRL), growth hormone(GH)and adrenocorticotropic hormone(ACTH)before and after surgery were recorded and compared between two groups.The incidences of complications in both groups and the dimensions of life quality(physical, cognitive, emotional, social activities)before and after surgery were calculated and assessed.@*Results@#The total effective rate was higher in the observation group(88.4%, 38/43)than in the control group(69.0%, 29/42)(P<0.05). The intraoperative blood loss, operation time and hospital days were less in the observation group than in the control group(P<0.05). No significant differences were found in serum levels of PRL, GH and ACTH between the two groups before and at 3 days after surgery(P>0.05). However, serum levels of PRL, GH and ACTH were deceased in both groups at 3 days after operation compared with before operation.The incidence of complications was lower in the observation group than in the control group(4.7% or 2/43 vs.21.4% or 9/42, P<0.05). The quality of life scores of the cognitive, role, physical, emotional and social dimensions were higher in the observation group than in the control group(P<0.01).@*Conclusions@#Neuroendoscopic-assisted transsphenoidal approach for surgical treatment of senile pituitary adenomas has less intraoperative blood loss, shorter operation time and lower complication rate, improves the endocrine hormone levels and the quality of life, and shortens the hospital stays.
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Objective To evaluate the risk of intracranial infection in patients treated with neuroendoscopy optic nerve tube decompression, and compare the risk of intracranial infection between surgery treatment and methylprednisolone treatment. Methods The clinical data of 105 patients with traumatic optic neuropathy from January 2013 to December 2017 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. Among them, 74 patients were treated with transsphenoidal approach neuroendoscopy optic nerve tube decompression (operation group), and cured with antibiotics during perioperative period; 31 patients were treated with intravenous methylprednisolone sodium succinate (hormone group), and combined with mouse nerve growth factor etc. Meanwhile, broad-spectrum antibiotics were used to prevent the potential infection during the first 3 d of hospitalization. The incidence of intracranial infection was compared between 2 groups. Results The incidence of intracranial infection in operation group was 4.05%(3/74), that in hormone group was 3.23%(1/31), and there was no statistical difference between 2 groups (χ2=0.127, P＞0.05). Conclusions Compared with conservative treatment, the neuroendoscopy optic nerve tube decompression has less or equivalent chance to increase the risk of intracranial infection in patients with traumatic optic neuropathy. Accordingly, it could be viewed as the first-line treatment.
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Objective To explore the therapeutic effect of pedicled nasal septum mucosal flap on high-flow cerebrospinal fluid leakage in transsphenoidal approach. Methods The clinical data of 31 patients with high-flow cerebrospinal fluid leakage during neuroendoscope transsphenoidal approach from January 2012 to April 2018 were analyzed retrospectively. Among them, skull base of 18 patients was reconstructed with pedicled nasal septum mucosal flap technique (observation group), and skull base of 13 patients was reconstructed with the'sandwich'method (control group). The postoperative cerebrospinal fluid leakage and complications were compared between 2 groups. Results Postoperative cerebrospinal fluid leakage occurred in 6 cases in control group, and 1 case in observation group, and there was statistical difference between 2 groups (P<0.05). Postoperative olfactory loss occurred in 2 cases in control group, and 3 cases in observation group, and there was no statistical difference between 2 groups (P>0.05). Conclusions Multilayer skull base reconstruction with pedicled nasal septum mucosal flap can significantly reduce the incidence of cerebrospinal fluid leakage after transsphenoidal tumor resection, and is a safe and reliable method to treat the high flow cerebrospinal fluid leakage in operation.
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Objective To explore the clinical efficacy and application value of CT virtual endoscopy (CTVE) in endoscopic resection of pituitary via transsphenoidal approach. Methods From January 2015 to December 2017, 21 patients with pituitary adenomas undergoing endoscopic transsphenoidal approach surgery were selected. All the patients were performed CT scan with GE64 spiral CT before operation, then reconstructed by CTVE. The preoperative CTVE simulated images and the observed images in the operation were compared, and the consistency of the 2 images was analyzed. Results CTVE simulated images and the observed images in the operation showed good consistency in the ratings of sphenoid sinus opening, optic canal protuberance, internal carotid artery protuberance and optic canal internal carotid recess (O-C recess) ( Kappa ＝ 0.774, 0.912, 0.959 and 0.958); and general consistency in the ratings of septum of sphenoid sinus, sellar floor and ramp recess ( Kappa＝0.479, 0.691 and 0.721). Conclusions CTVE technology can accurately simulate the reconstruction of the important anatomical structure of the saddle area before operation, which helps to design the operation plan and improve the curative effect and safety of the operation; this technique also helps to learn and master the endoscope technology.
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Objective To explore the technique and clinical efficacy of single-nostril transsphenoidal neuroendoscopic resection of pituitary adenomas. Methods A total of 47 patients with pituitary adenoma, among them 21 were male and 26 female, aged 15-70 years old with a mean of 42.7 years, were treated with neuroendoscopic single-nostril transsphenoidal surgical resection in the Air Force General Hospital of PLA from August 2007 to August 2013. Clinical data were analyzed retrospectively, including the operative results, complications, and follow up results. Results Post-operative MRI revealed that the tumor was totally removed in 38 (80.9%) patients, and subtotally in 9 (19.1%, the tumors were large and had invaded the cavernous sinus). Post-operative improvement of clinical symptoms was achieved in 40 (85.1%) patients, among them, headache disappeared in 35 patients, vision and visual field improved in 30 patients. Among the 47 patients, an increase in prolactin hormone (PRH type) was seen in 29, an increase in growth hormone (GH type) in 6, and non-functioning pituitary carcinoma in 12 patients. In 80% (28/36) of the patients hormone secretion was improved after the operation, including 23 of PRH type and 5 of GH type. Post-operative complications were diabetes insipidus in 10 patients, cerebrospinal fluid leakage in 8 and meningitis in one. All the patients were followed up for 6 months up to 6 years, and no death occurred. Conclusion Single-nostril transsphenoidal endoscopic surgery consists of many advantages, such as minimal trauma, clear visual field, higher total resection rate, and rapid recovery after operation, therefore it is a safe and effective approach for the resection of pituitary adenomas.
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Objective To study the giant invasive pituitary tumor neuroendoscopic operation indications,operation excision,risk aversion,and the operation skills.Methods The clinical data of 7 patients with giant invasive pituitary tumor among of endoscopic transsphenoidal surgery 61 cases of neurological patients with pituitary tumors were analyzed retrospectively.Results There were 1 case of total resection,6 cases of subtotal resection invading cavernous sinus cases,diaphragma sellar was seen in 5 cases of resection of the tumor,and 2 cases showed no diaphragma sellar.The average operation time was 100 minutes.No intraoperative transfusion.Postoperative hemorrhage in 2 cases,and 1 death case in this group after 36 hours,and 1 case undergoing endoscopic hematoma resection and cured.Conclusions With the development of endoscopic techniques,indications for operation with the new changes,for the giant invasive pituitary tumor operation therapy,endoscopic technique provides a disposable operation resection,the method is safe and avoid catastrophic consequences.
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Objective By combined application of endoscopic and microscopic vivisection-pronged approach,forms a three-dimensional morphological observation through focusing on an observation of structure of various signs, imaging features, morphology and measuring in vivo data, which are concerned with expansion of transsphenoidal approach. This will provide expansion of transsphenoidal approach with an intuitive morphological imagines,detailed anatomical parameters,accurate imaging data,viviperception and data measurement. Methods 80 patients were recruited for investigation, preoperative measurement of the size of the patient' s nose,height of nasal columella,the plane angle among bridge of nose,inner canthal of eyes and nose columella,and the length of bridge of nose.in the operation,measure the distance from nasal columella to aperture of sphenoidal sinus; observe the shape of aperture of sphenoidal sinus; measure the longest and the shortest distance between aperture of sphenoidal sinus; observe the shape of septum of sphenoidal sinus,three uplift and the relationship among them,as well as the color and texture of the tumor.Measure sphenoid sinus wall,screening room,sellar floor,extent of slope resection,operating space,as well as observation & study of selection and repairing of skull base reconstruction materials. Results The shape according to the discretion of the column is divided into butterfly saddle nose, normal nose, eagle nose and acromegaly hypertrophy nose.The nostrils shape is kidney form,ball form,snow humanoid formand triangle form.The butterfly saddle biggest digging distance:between the cavernous sinus is( 18.9±2.51 ) mm,from saddle nodules to slope is(19.2 ±2.67) mm.After tumor resection,the transsphenoidal observation space is forward to former group of ethmoid sinus,back to the slope. Conclusion The measurement data might be benefit for selecting of speculum, evalution of placing depth on speculum and operation position and sellar floor opening range. It would also make it possible for a safer, minimally invasive and effective surgery by avoid damage to the internal carotid artery,cavernous sinus or cranial nerve.
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Objective To investigate the clinical effects of communicating tumors on anterior skull base with neuroendoscope-assisted surgery. Methods Nineteen eases of crani-nosel and crani-orbital nosel communicating tumors underwent the combined craniofacial approach. The defect of anterior skull base was repaired with the compound flap with pedicel frontal galea muscle and temporalis myofascial flap.Results All 19 patients were successfully treated without CSF leak and cranial infection. The tumor total re-section rate was 78.9%, subtotal resection rate was 15.8% ,partial resection rate was 5.3%. Four patients of benign tumor were survival,15 patients of malignant tumor 2- year survival was 11, 3-year survival was 8,above 5- year survival was 6. Conclusion The neuroendoscope-assisted combined craniofacial approach can provide a relatively safe and effective resection for communicating tumors on anterior skull base,and has better clinicall value.
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Objective To study the techniques of the treatment for epidermoid with endoscope-as- sisted microneurosurgery.Methods The suboccipital,infratemporal transtentorial approach and endoscope- assisted microneurosurgery were used.Results Total resection was achieved in 10 cases,and subtotal resec- tion was made only in 2, and had no complications of all.Conclusion Endoscope-assisted microneuro- surgery can increase the total-resection rate for tumors,and reduce complications.
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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.