Tratamiento multimodal en los schwanomas vestibulares grandes / Multimodal Treatment for Large Vestibular Schwannomas

Introducción: Los schwanomas vestibulares son lesiones clasificadas como grado I por la Organización Mundial de la Salud. Las opciones conductuales incluyen la observación, la radiocirugía o la resección microquirúrgica endoscópica. Objetivo: Describir el rol del tratamiento multimodal en los schwanomas vestibulares. Métodos: Se realizó una búsqueda sistemática de literatura médica para la identificación e inclusión de artículos en las siguientes bases de datos: PubMed/Medline, SciELO y Google Scholar, además de los servidores de preprints BioRvix y MedRvix. Se usaron los siguientes descriptores: vestibular schwanoma OR acoustic neuroma AND nerve centered approach OR combined approach AND partial resection OR subtotal resection OR near total resection. Se excluyeron editoriales, cartas al editor, libros, revisiones, metaanálisis y aquellos artículos con método deficiente de más de 20 años de publicación o sin mención al tema de interés. Fueron incluidos 16 artículos. Desarrollo: Los artículos incluyeron un total de 699 pacientes, de los cuales solo 228 (32,6 porciento) recibieron radioterapia en el período posoperatorio. El período de seguimiento promedió 49,6 meses. La preservación de la función facial se logró en el 88,3 porciento de los casos y el control tumoral en el 80,7 porciento. El estado de la preservación auditiva solo fue informado en el 50 porciento de los estudios. El uso de la radioterapia adyuvante mostró gran variabilidad. Conclusiones: El tratamiento multimodal para los schwanomas vestibulares grandes -compuesto por la resección subtotal, vaciamiento intratumoral, seguido de radiocirugía- se ha convertido en una opción plausible. Se necesita la publicación de mayor cantidad de reportes para ofrecer recomendaciones y estratificar la conducta(AU)

Introduction: Vestibular schwannomas are lesions classified as grade I by the World Health Organization. Behavioral options include observation, radiosurgery or endoscopic microsurgical resection. Objective: To describe the role of multimodal treatment for vestibular schwannomas. Methods: A systematic search of medical literature, for the identification and inclusion of articles, was carried out in the databases PubMed/Medline, SciELO and Google Scholar, as well as in the preprint servers BioRvix and MedRvix. The following descriptors were used: vestibular schwannoma OR acoustic neuroma AND nerve centered approach OR combined approach AND partial resection OR subtotal resection OR near total resection. Editorials, letters to the editor, books, reviews and metaanalyses were excluded, as well as articles with deficient method of more than 20 years of publication or not mentioning the topic of interest. Sixteen articles were included. Development: The articles included a total of 699 patients, of which only 228 (32.6 ) received radiotherapy in the postoperative period. The average follow-up period was 49.6 months. Preservation of facial function was achieved in 88.3 percent of cases; and tumor control, in 80.7 percent. Hearing preservation status was reported in only 50 percent of the studies. The usage of adjuvant radiotherapy showed great variability. Conclusions: Multimodal treatment for large vestibular schwannomas -composed of subtotal resection and intratumoral draining, followed by radiosurgery- has become a plausible option. The publication of a greater amount of reports is necessary to provide recommendations and stratify the behavior(AU)

Outcomes of surgical treatment of 29 patients with stages Ⅱ-Ⅲ bisphosphonate-related osteonecrosis of the jaw / 口腔疾病防治

Objective@# To examine the outcome of surgical treatment in patients with stages Ⅱ-Ⅲ bisphosphonate-related osteonecrosis of the jaw. @*Methods@#Twenty-nine patients with bisphosphonate-related osteonecrosis of the jaw were examined. The patients were followed up for more than 6 months, and the treatment outcome was reviewed. @*Results@# After curettage of local lesions, 19 out of the 21 patients were cured, and 2 were relieved of symptoms. Six patients underwent subtotal resection of the maxilla, and the symptoms disappeared completely after the surgery. Two patients underwent partial resection of the mandible and recovered.@*Conclusion@#Surgical debridement is an effective measure for the treatment of patients with bisphosphonate-related osteonecrosis of the jaw in stages Ⅱ-Ⅲ. In most cases, curettage of local lesions via the intraoral approach can completely remove sequestrum and inflammatory granulomatous tissue. Subtotal maxillary resection or partial mandible resection is performed when the bone death reaches the level of the maxillary sinus floor or continues to the mandible. By timely surgical intervention, the bone lesion is removed to maintain the sterile, active bone microenvironment locally.

A study on the clinical outcomes using different laparoscopic methods to treat hepatic cystic hydatidosis / 中华肝胆外科杂志

Objective@#To study the clinical outcomes using laparoscopic complete dissection of cysts, subtotal cystectomy and partial hepatectomy in the treatment of hepatic cystic echinococcosis.@*Methods@#A retrospective study was conducted on 40 patients with hepatic cystic echinococcosis treated by laparoscopic surgery from January 2014 to June 2018 at the First Affiliated Hospital of Xinjiang Medical University. According to the different surgical methods, these patients were divided into three groups: group A (n=14): the laparoscopic complete capsulectomy group, group B (n=14): the laparoscopic subtotal capsulectomy group, group C (n=12): the laparoscopic partial hepatectomy group. The operation time, intraoperative blood loss, time to pass first flatus, duration of drainage tube placement, days of hospitalization after operation, hospitalization expenses, complications of the residual cavity and local recurrence were compared among the 3 groups.@*Results@#In this study, all the 40 patients with hepatic cystic hydatidosis were cured, and no death occurred during the perioperative period. The intraoperative blood loss, postoperative duration of drainage tube placement, and hospitalization cost of the three groups were significantly the highest in group C (all P<0.05). The operative time and the time to pass first flatus in group C were both significantly greater than group B (P<0.05). The length of postoperative hospitalization in group A was significantly less than in group C (P<0.05). Postoperative recurrence and complications in group B were significantly worse than those in group A and group C (all P<0.05).@*Conclusion@#Laparoscopic complete dissection of the external capsule turned out to be the best laparoscopic treatment of hepatic cystic echinococcosis, followed by laparoscopic partial hepatectomy. Open surgery should be considered in patients with lesions which are evaluated preoperatively to have difficulty in carrying out laparoscopic complete dissection of capsule or partial hepatectomy.

A study on the clinical outcomes using different laparoscopic methods to treat hepatic cystic hydatidosis / 中华肝胆外科杂志

Objective To study the clinical outcomes using laparoscopic complete dissection of cysts,subtotal cystectomy and partial hepatectomy in the treatment of hepatic cystic echinococcosis.Methods A retrospective study was conducted on 40 patients with hepatic cystic echinococcosis treated by laparoscopic surgery from January 2014 to June 2018 at the First Affiliated Hospital of Xinjiang Medical University.According to the different surgical methods,these patients were divided into three groups:group A (n =14):the laparoscopic complete capsulectomy group,group B (n =14):the laparoscopic subtotal capsulectomy group,group C (n =12):the laparoscopic partial hepatectomy group.The operation time,intraoperative blood loss,time to pass first flatus,duration of drainage tube placement,days of hospitalization after operation,hospitalization expenses,complications of the residual cavity and local recurrence were compared among the 3 groups.Results In this study,all the 40 patients with hepatic cystic hydatidosis were cured,and no death occurred during the perioperative period.The intraoperative blood loss,postoperative duration of drainage tube placement,and hospitalization cost of the three groups were significantly the highest in group C (all P ＜ 0.05).The operative time and the time to pass first flatus in group C were both significantly greater than group B (P ＜ 0.05).The length of postoperative hospitalization in group A was significantly less than in group C (P ＜ 0.05).Postoperative recurrence and complications in group B were significantly worse than those in group A and group C (all P ＜ 0.05).Conclusion Laparoscopic complete dissection of the external capsule turned out to be the best laparoscopic treatment of hepatic cystic echinococcosis,followed by laparoscopic partial hepatectomy.Open surgery should be considered in patients with lesions which are evaluated preoperatively to have difficulty in carrying out laparoscopic complete dissection of capsule or partial hepatectomy.

Cochlear implantation combined with subtotal resection of temporal bone in treatment of nasopharyngeal carcinoma after radiotherapy of temporal bone necrosis / 肿瘤研究与临床

Objective To investigate the effects of cochlear implantation combined with subtotal resection of temporal bone in treatment of nasopharyngeal carcinoma after radiotherapy of temporal bone necrosis. Methods A prospective study method was used, and 76 cases of nasopharyngeal carcinoma after radiotherapy of temporal bone necrosis from February 2013 to October 2015 in our hospital for diagnosis and treatment were selected. According to the open control paired principle,the patients were equally divided into observation group and control group, each of 38 cases. Both groups received subtotal temporal bone resection in the treatment, and the observation group received cochlear implant therapy. The surgical effect and hearing improvement of two groups were observed. Results All patients successfully completed surgery. In the observation group, the patients showed normal reactions to intraoperative electrode detection and postoperative electrode impedance, without electrode slippage. There were no statistical differences between the two groups in postoperative pneumothorax and other complication (P>0.05). The sound intensity level of hearing test in postoperative 1 month in the observation group and control group were (21.23±5.22) dB and (28.42±4.19) dB, which was significantly lower than that in the preoperative 1d [(38.24 ±4.98) dB and (38.12 ±5.00) dB], with significantly statistical difference (P<0.05). The postoperative 1 month of hearing and speech score in the observation group were (87.24 ±2.98) points and (82.10 ±3.91) points respectively, which were significantly higher than those in the control group [(73.02 ±5.30) points and (71.84 ±3.11) points] (P<0.05). The two groups of postoperative 1 months of hearing and speech scores were also significantly higher than those in the preoperative 1 d [observation group: (34.29±3.49) points and (32.10±5.30) points; control group: (33.20±4.14) points and (31.98±4.92) points] (P<0.05). Conclusion Cochlear implantation combined with subtotal resection of temporal bone in treatment of nasopharyngeal carcinoma after radiotherapy of temporal bone necrosis shows high safety and success rate, which can promote the improvement of hearing and speech ability, and be widely used in clinic.

Effects of total laparoscopic thyroid subtotal resection on intraoperative incision length and postoperative serum Tg and VEGF levels in patients with early differentiated thyroid carcinoma / 实用医学杂志

Objective To investigate the effect of total laparoscopic thyroid subtotal resection in early differentiation thyroid carcinoma. Methods Seventy-two patients with early differentiated thyroid cancer from November 2013 to September 2016 weredivided into groups according to the random number table methods,with 36 cases in each group.Control group was treated with open thyroidectomy,and study group total laparoscopic thyroid subtotal resection.Patients′condition at the first day after operation,the level changes of serum VEGF and Tg levels at the first day at admission and after operation and aesthetic effect of operation were compared between 2 groups. Results There were shorter incision length,lower pain score and less intraoperative blood loss in study group when compared with those in control group,and the operation time was shorter than that in control group(P<0.05).The number of lymph node dissection in study group was not significantly different from that in control group(P>0.05). The levels of serum VEGF and Tg in 2 groups were lower than those before the operation,and the levels of all indexes in study group were lower than those in control group(P < 0.05). The total satisfaction of aesthetic effect (97.22%)in study group was higher than that of control group(75.00%)(P < 0.05). Conclusions Total endoscopic thyroid subtotal resection is effective for the treatment of early differentiation of thyroid cancer with small incisionand less postoperative pain. It can effectively reduce serum Tg and VEGF levels and improve the surgical aesthetic satisfaction.

Clinical effect of Miccoli surgical thyroid bilateral subtotal resection for Graves disease / 中国基层医药

Objective To investigate clinical effect of Miccoli surgical thyroid bilateral subtotal resection for Graves disease,to provide a reference for clinical treatment.Methods 80 patients with Graves disease were selected, they were divided into the observation group and the control group according to the surgical approach.44 patients in control group were taken small incision under direct vision routine bilateral subtotal thyroid treatment,36 patients in the observation group took Miccoli surgical.Surgical success rate,surgical index were compared between two groups. Results The patients of the two groups were operated smoothly,the success rate was 100.00% in the observation group,the incision length,blood loss,operative time were (3.04 ±0.64)cm,(32.25 ±3.29)mL,(81.19 ±6.68)min respectively,which were significantly less than those of the control group,the differences were statistically significant (t =5.214,P =0.004;t =14.514,P =0.000;t =6.514,P =0.001).The VAS score,length of stay,incidence rate of complication in the observation group were (1.93 ±0.43),(3.82 ±0.79)d,5.26%,which were significantly better than those in the control group,the differences were statistically significant (t =5.697,P =0.003;t =4.654,P =0.009;χ2 =11.214,P =0.000).The hospitalization cost of the observation group was (9 043.65 ±565.76)Yuan, which was significantly higher than the control group,the difference was statistically significant (P <0.05).The cut rating of the observation group was (8.35 ±2.15)points,which was significantly higher than the control group,the difference was statistically significant (t =8.364,P =0.001 ).The hyperthyroidism relapse during follow -up,the incidence of thyroid dysfunction between the two groups had no significant difference (χ2 =0.568,P =0.311;χ2 =0.604,P =0.294).Conclusion Miccoli improved surgical incision and under direct vision thyroid bilateral subtotal resection both have similar clinical effects for Graves disease,Miccoli surgery has smaller trauma,more satisfaction incision,but under direct vision small incisions has lower treatment costs.

Radiation or Chemotherapy rather than Observation may be a Better Modality after Subtotal Resection for Pilocytic Astrocytoma in Children / 임상소아혈액종양

BACKGROUND: Pilocytic astrocytoma (PA) is a low-grade glioma that occurs primarily in children and young adults. The optimal postoperative treatment modality after subtotal resection (STR) of PAs remains to be elucidated. The aim of this study was to compare the efficacies of different post-STR treatment modalities and to examine the risk factors for the progression of PAs. METHODS: We reviewed the medical records of 91 pediatric PA patients in a single institute during a 30-year period. Kaplan-Meier analysis was used to assess overall survival (OS) and progression-free survival (PFS), and Cox proportional hazard models were used to calculate hazard ratios. RESULTS: The median age of 91 patients was 8.9 years (range, 0.3-17.9). GTR was perfomed, whenever possible. Patients who underwent STR afterwards received either radiotherapy, chemotherapy, or were observed without further treatment, according to clinician preference. In total group, 10-year OS was 97.4% and 10-year PFS was 57.2%. In GTR group (N=33), 10-year OS and PFS was 100%. In STR group (N=49), 10-year OS was 97.7%, while 10-year PFS was 38.6%. STR group underwent following postoperative (PO) modalities; observation (PO-Obs, N=32), radiotherapy (PO-RT, N=10), chemotherapy (PO-CTx, N=7). The 10-year PFS rate was higher in patients who received postoperative treatment (either PO-RT or PO-CTx) than in patients who received PO-Obs (62.5% vs 27.0%, P=0.039). In multivariate analysis for STR group, PO-CTx (Hazard ratio (HR)=0.20, P=0.035) and PO-RTx (HR=0.13, P=0.008) were superior to observation, respectively. CONCLUSION: Radiation and chemotherapy are better post-STR treatment modalities than observation for pediatric PA patients.

Radiation or Chemotherapy rather than Observation may be a Better Modality after Subtotal Resection for Pilocytic Astrocytoma in Children / 임상소아혈액종양

BACKGROUND: Pilocytic astrocytoma (PA) is a low-grade glioma that occurs primarily in children and young adults. The optimal postoperative treatment modality after subtotal resection (STR) of PAs remains to be elucidated. The aim of this study was to compare the efficacies of different post-STR treatment modalities and to examine the risk factors for the progression of PAs.METHODS: We reviewed the medical records of 91 pediatric PA patients in a single institute during a 30-year period. Kaplan-Meier analysis was used to assess overall survival (OS) and progression-free survival (PFS), and Cox proportional hazard models were used to calculate hazard ratios.RESULTS: The median age of 91 patients was 8.9 years (range, 0.3-17.9). GTR was perfomed, whenever possible. Patients who underwent STR afterwards received either radiotherapy, chemotherapy, or were observed without further treatment, according to clinician preference. In total group, 10-year OS was 97.4% and 10-year PFS was 57.2%. In GTR group (N=33), 10-year OS and PFS was 100%. In STR group (N=49), 10-year OS was 97.7%, while 10-year PFS was 38.6%. STR group underwent following postoperative (PO) modalities; observation (PO-Obs, N=32), radiotherapy (PO-RT, N=10), chemotherapy (PO-CTx, N=7). The 10-year PFS rate was higher in patients who received postoperative treatment (either PO-RT or PO-CTx) than in patients who received PO-Obs (62.5% vs 27.0%, P=0.039). In multivariate analysis for STR group, PO-CTx (Hazard ratio (HR)=0.20, P=0.035) and PO-RTx (HR=0.13, P=0.008) were superior to observation, respectively.CONCLUSION: Radiation and chemotherapy are better post-STR treatment modalities than observation for pediatric PA patients.

Xanthomas of the Bilateral Achilles Tendon in a Normolipidemic Patient / 대한족부족관절학회지

Xanthoma is a relatively rare soft tissue lesion on the Achilles tendon and is usually associated with hyperlipidemia (lipid metabolism abnormality), mental retardation, cataract and atherosclerotic disease. We report on a case of normolipidemic bilateral Achilles tendon xanthoma without any notable cause. We herein describe the case where we achieved a satisfactory result by subtotal resection.

Classification and surgical management of pancreatic duct stones / 中华消化外科杂志

Objective To explore the classification and surgical management of pancreatic duct stones.Methods The clinical data of 54 patients with pancreatic duct stones who were admitted to the People's Hospital of Hunan Province from June 1994 to November 2009 were retrospectively analyzed. Stones were found in the head of the pancreas (type Ⅰ ) in 31 patients, in the body and tail of the pancreas (type Ⅱ ) in 7 patients, and in all the pancreas (type Ⅲ ) in 16 patients. According to the types of the pancreatic duct stones, ten patients (6 with type Ⅰ , two with type Ⅱ and two with type Ⅲ pancreatic duct stones) received opening of the main pancreatic duct + pancreaticojejunostomy or pancreaticogastrostomy ( group A). Twenty-four patients ( 16 with type Ⅰ and eight with type Ⅲ pancreatic duct stones) received pancreaticoduodenectomy (group B). Fifteen patients (nine with type Ⅰ and six with type Ⅱ pancreatic duct stones) received subtotal resection of pancreatic head preserving duodenum (group C). Five patients with type Ⅱ pancreatic duct stones received resection of the body and tail of the pancreas and the spleen (group D). All data were analyzed using the t test. Results The mean operation time, blood loss, length of postoperative stay and hospital charges of group A were (2.2 ± 1.2)hours,( 127 ±24)ml,( 11.4 ±4.3) days and (3.24 ± 1.15 ) × 104 yuan, respectively. Five out of nine patients who were followed up had stone recurrence. The mean operation time, blood loss, length of postoperative stay and hospital charges of group B were (7.6 ± 1.1 ) hours, (409 ± 37 ) ml, ( 18.9 ± 2.5 ) days and (7.93 ± 1.35 ) × 104 yuan, respectively.No stone recurrence was detected in the 21 patients who were followed up. The mean operation time, blood loss,length of postoperative stay and hospital charges of group C were (4. 1 ± 0.7 ) hours, ( 156 ± 63 ) ml, ( 10.3 ±2.1 )days and (4. 12 ± 1.22) × 104 yuan, respectively. No stone recurrence was detected in the 15 patients who were followed up. The mean operation time, blood loss, length of postoperative stay and hospital charges of group D were (3.3 ± 1.4) hours, ( 185 ± 36 ) ml, ( 9.3 ± 2.0) days and ( 3.22 ± 1.05 ) × 104 yuan, respectively. No complication was detected after the operation, and no stone recurrence was detected in the three patients who were followed up. There were significant differences in the mean operation time, blood loss, length of postoperative stay and hospital charges between patients with type Ⅰ and Ⅲ pancreatic duct stones who received pancreaticoduodenectomy and subtotal resection of pancreatic head preserving duodenum (t = 12. 143, 14. 099, 11. 550, 9. 103,P < 0.05 ). Conclusions Classification of the pancreatic duct stones is important for choosing the proper surgical procedure. Subtotal resection of pancreatic head preserving duodenum is ideal for the treatment of patients with type Ⅰ or Ⅱ pancreatic duct stones.

Quality of Life in Patients with Vestibular Schwannoma after Treatment: Short Form-36 Based Study

OBJECTIVE: To evaluate the quality of life(QOL) of patients with vestibular schwannoma(VS) and to compare QOL among subtotal resection(STR) group, radical resection(RR) group, and gamma knife surgery only (GKS) group, we report a retrospective analysis of consecutive 104 patients with VS who were treated between 1997 and 2000. METHODS: The STR group included 31 patients, RR group did 26, and GKS only did 47. Various approaches such as retrosigmoid transmeatal approach(45), translabyrinthine approach(4), transotic approach(2), middle fossa approach(3), and combined approach(3) were used. A questionnaire concerning postoperative symptoms and the Short Form 36(SF-36) QOL instrument were mailed to 104 patients with VS. Follow-up imaging studies, Karnofsky performance scale(KPS) scores, and SF-36 scores at the last follow-up were assessed. The mean duration of follow-up was 33.4 months. RESULTS: The survey response rate was 51%(53 patients). The postoperative QOL in VS patients, as quantified by the eight SF-36 health scales was less than the appropriate matched healthy standard. Furthermore there were differences between the doctor's assessment(KPS) and the patient's assessment(SF-36). Facial nerve outcome had little influence on QOL in VS patients. CONCLUSION: Patients with VS have a significant impairment of their QOL. In the selection of treatment options for VS, the QOL of patient should be considered seriously.

Ganglioneuroma of the Cerebellum: Case Report

A case of ganglioneuroma of the cerebellum is reported in 31-year-old woman. The clinical features were dull headache, dizziness, nausea and gait disturabance. Computerized tomography revealed a nonenhancing mass lesion surrounded by focal area of calcification. Subtotal resection and vetriculoperitoneal shunt were effective in this case.

Chaniopharyngioma in Children and Adults

The authors studied 16 cases of craniopharyngioma who admitted to the Department of Neurosurgery of Dong San Medical center, Keimyung university, during the past 5 years from 1981 to 1985. Of these 16 cases, 9 belonged to a juvenile group with ages under 20 based on full pubertal development, and 7 cases belonged to an adult group. It was observed the difference between the age groups of the clinical, neuroradiogical and histopathopathological findings. Raised ICP symptoms were showed in juvenile group and decreased vision and visual field defect in adult group, respectivelly, as the chief complaint. All cases of the juvenile group were classified as juvenile type and three cases out of seven in the adult group were adult types in their histopathological pattern. Four juvenile types of adult group showed poor outcome. We concluded that subtotal resection with radiotherapy gave a better prognosis in both group and that hormone therapy before and operation decreased mortality and morbidity and improved the quality of survival significantly.