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BACKGROUND: In China, although microscope-assisted anterior cervical decompression has been performed by many spine surgeons in recent years, the application of microscope still needs to be further promoted in China. Therefore, it is necessary to systematically evaluate and analyze the clinical efficacy of cervical spondylopathy by comparing patients under microscope-assisted anterior cervical approach to traditional anterior cervical approach. As a result, it can provide the evidence for clinical decision in these cervical spondylopathy patients. OBJECTIVE: To systematically evaluate the effect between microscope-assisted anterior cervical approach and traditional anterior cervical approach in cervical spondylopathy patients. METHODS: Databases such as Medline, Embase, PubMed, Web of science, CBM, Wangfang databases, VIP, and CNKI were searched from inception to July 2019 to find literature related to microscope-assisted anterior cervical approach and traditional anterior cervical approach in treatment of cervical spondylopathy. Two investigators evaluated the researches independently and compared the operative time, intraoperative blood loss, the preoperative and postoperative Japanese Orthopedic Association score, neurological success rate, the preoperative and the postoperative visual analogue scale score, and the complication rates between two groups. The quality of the included literature was evaluated by the modified Jadad scale, the modified Newcastle Ottawa score and the methodological index for non-randomized-studies. The correlative clinical outcome in inclusive research was analyzed systematically by using Stata 12.0 Software. RESULTS AND CONCLUSION: (1) Twelve studies were accorded with the inclusion criteria, containing 892 cases (438 cases in the microscope-assisted group, while 454 cases in the traditional group). (2) There were no significant differences in the preoperative Japanese Orthopedic Association score (WMD=-0.100, 95%C/(-0.459, 0.259), P=0.585), operative time (WMD=6.852, 95%C/(-0.446, 14.149), P=0.066), the preoperative and postoperative visual analogue scale score (WMD=0.293, 95%C/(-0.023, 0.608), P=0.069; WMD=-0.T\8, 95%C/(-1.495, 0.059), P=0.070) between two groups. (3) Postoperative Japanese Orthopedic Association score (WMD= 1.310, 95%C/(0.621, P < 0.001), the rate of neurological success (WMD-4.639, 95%C/(0.294, 8.984), P=0.036) in the microscope-assisted group were higher than those in the traditional group. The intraoperative blood loss (l/MMD=-18.068, 95%C/(-24.504, -11.632), P< 0.001) and the rate of complication (RR=1.068, 95%C/(1.012,1.126), P=0.002) in the microscope-assisted group were significantly lower than those in the traditional group. (4) Performing anterior cervical approach under microscope has a better clinical effect than using traditional anterior cervical approach in the treatment of cervical spondylopathy, but more high-quality clinical studies are needed to verify it.
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Objective: To study the efficacy and safety of microscope assisted nasal transsphenoidal pituitary tumor resection. Methods: pituitary tumor patients in our hospital from March 2011 to May 2013 were enrolled and divided into observation group given microscope assisted nasal transsphenoidal pituitary tumor resection and control group given oral-nasal septum-sphenoid sinus pituitary tumor resection according to different operation mode. Then stress level, curative effect related index and complications were observed and compared with existing research. Results: (1) Adrenaline, noradrenaline, rennin, angiotensin Ⅱlevel and operation time, intraoperative bleeding volume, postoperative hospitalization time of observation group were lower than control group, cases of hormone levels return to normal and improve were more than control group, complication cases were less than control group. (2)compared with the existing research on nerve endoscopic surgery, operation time, intraoperative bleeding volume, postoperative hospitalization time and cases of hormone levels return to normal, improve and complications of observation group had no statistical difference. Conclusion:microscope assisted nasal transsphenoidal pituitary tumor resection is helpful to reduce surgery trauma, relieve stress condition and can achieve equal operation effect and complications.
ABSTRACT
IntroductionA cerebral aneurysm has been surgically treated since the early twentieth century. Since then, numerous new surgical methods and technologies have been developed in neurosurgical practice to improve outcome of the neurosurgical treatments. In fall of 1980, the very first aneurysm surgery was successfully performed in Mongolia. Until 2011, the bitemporal and pterional approaches had been used as the main treatment option for anterior circulation aneurysms in Mongolian neurosurgicalpractice. The keyhole approach, cultivated by German neurosurgeon A.Perneczky, was introduced to Mongolian neurosurgical practice in 2011 as another threatment option for the anterior circulation aneurysmGoalThis study aimed to design new key hole surgical techniques with four small burr holes, based on the method of German neurosurgeon A. Perneczky for treatment of anterior circulation aneurysms and decrease the rate of surgically related complications.Materials and MethodsBetween January 2011 and March 2012, in the neurosurgical department of Third State Central Hospital 259 patients were treated with anterior circulation aneurysms. 103 of them treated with key hole approaches (as the study groupe), while 55 were treated with pterional approaches. We choose 103 patients reports (as the control groupe), who were treated with traditional approaches and studied the results retrospectively, which were compared with the results of the new techniquesof surgical treatment. We compared the outcomes of the new keyhole surgical approach with the outcomes of traditional approaches based on the severity of after surgery complications, focal neurological deficits, postoperative mental changes and functional impairments, and duration of hospital stay (recovery period). The skin incision begins laterally from the supraorbital incisura and is made within the eyebrow. Posterior to the temporal line at the level just above the zygomatic arch we drilled two small (0.5 cm) burr holes, and two more burr holes above the orbital rim. Quadrangle shaped bone flap is cut with the angle 45o, and removed, after which drill of the inner edge of the bone above the orbital rim. Inner edge of the other side is not drilled off. After intradural procedure, we fixed bone flap using the inner edge, which was not drilled off.ResultsFrom Jan, 2011 to Dec, 2012, 235 patients received surgical treatment (78 women and 79 men, median age, 46.3±2.3 yo). The lesions included 9 anterior cerebral artery aneurysms, 6 in posterior communicating artery, 35 in middle cerebral artery, 34 in anterior communicating artery, 1 in ophthalmic artery, and 18 in internal carotid artery aneurysms. The ratio of men and women with aneurysmal SAH was 1:1, which demonstrated different results comparing with the countries such as Japan, Austria and Canada. Two patients died after operation due to cerebral vasospasm, who were admitted to our hospital with the WFNS grade III-IV after SAH. The postoperative hemiparesis accounts 4.8% (5 cases). After short-term observations (3 months) 4 of these patients showed a good recovery of paralyzed extremities. One patient missed out of follow up. Surgically related complications like mental change, temporal muscle atrophy were about 4%-8%. (The difference between two methods is P<0,009). The average duration of hospital stay was 8.2 ±2. ConclusionsSubtemporal, subfrontal, and paranasal key hole with pterional approaches have several advantages over the traditional craniotomies, including minor tissue damage, less brain retraction, a superior cosmetic results, and shorter duration of surgery and hospital stay. The operative field becomes wider in the deep area, providing sufficient space for microscope-assisted surgeries without need of highly specialized instruments.