Application of far lateral craniocervical approach in the microsurgical treatment of the jugular foramen tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the administration of far lateral craniocervical approach in the jugular foramen (JF) tumors.</p><p><b>METHODS</b>A retrospective analysis was performed in 14 cases of JF tumors (9 neurilemmomas, 3 meningiomas, 1 glomus jugulare tumor, and 1 adenoid cystic carcinoma) surgically treated between January 2009 and January 2012, with focus on the surgical approach. Six patients (6/14) showed hydrocephalus. The tumor type was composed of 5 intracranial and intraforamen tumors with patent or occluded jugular bulb, 1 intracranial tumor with extension into the upper cervical canal, 4 extracranial and intra foramen tumors, 4 intra- and extracranial dumbbell-shaped communicating tumors involving the parapharyngeal space above C2 or extending caudally below C3. Far lateral postcondylar approach (FLPC) was carried out in 2 cases, far lateral tansjugular process approach (FLTJP) in 3 cases, combined FLPC + C1-2 semi-laminectomy approach in 1 case, combined FLTJP + trans-C1 transverse process approach in 7 cases, and combined FLTJP + neck approach with dissection of carotid sheath to the skull base in 1 case. Endovascular embolotherapy prior to surgical resection was performed in 1 glomus jugulare tumor.</p><p><b>RESULTS</b>Total tumor removal was achieved in 12 patients and subtotal removal in 2 patients, with no cerebrospinal fluid leakage or operative mortality. New cranial nerve paresis occurred after surgery in 1 case of facial nerve and 1 case of lower cranial nerve. Transient worsening of preoperative lower cranial nerve deficits was noted in 3 patients. Long-term follow-up study ranging from 5 to 32 months (average 13.7 months) showed 7 patients with lower cranial nerve deficits (6 preexisting and 1 new), with exception of one preoperative lower cranial nerve dysfunction due to the infiltration of an adenoid cystic carcinoma, experienced favorable improvement with recovery of adequate swallowing function, but voice disturbance remained in 4 cases. One patient with new facial nerve deficit presented with partial improvement and the hydrocephalus in 6 patients all spontaneously regressed. There was no tumor recurrence in patients receiving total removal and no tumor progression in patients undergoing subtotal removal.</p><p><b>CONCLUSIONS</b>FLTJP is a basic approach for JF tumors. The combined cranial and cervical approach should be considered in those tumors extending into the upper cervical canal and parapharyngeal space. The associated hydrocephalus seldom requires additional surgical management.</p>

Pathological features of cerebral gliomas after stereotactic radiosurgery and radiotherapy: a comparative study / 中华神经医学杂志

Objective To study the histopathological changes and ultrastructure features of human gliomas after receiving stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT), and observe the changes of tumor-associated factor Ki-67 level, endothelial growth factor (VEGF) level and microvessel density (MVD).Methods A comparative, retrospective study of pathological and immunohistochemical changes of 25 gliorna specimens without radiotherapy (controls) and 25 patients with glioma received with SRS and SRT (treatment group), admitted to our hospital from November 1995to July 2008, were carried out. Eight specimens from both groups, fixed with glutaraldehyde, were chosen for electron microscope observation; the ultrastructure changes in the tumor center, tumor margin and peripheral edema brain tissues in each specimen were observed. Immunohistochemical staining was employed to detect the expressions of Ki-67 and VEGF, and the MVD. And these data were statistically analyzed. Results The square and extent of tumor necrosis and liquation were positively significantly correlated with the tumor grade (r=0.649, P=0.001). Electron microscope indicated that the organdles,capillaries and blood-brain barrier in the tumor center, tumor margin and peritumoral edema cortex of the treatment group occurred different degrees of brain tissue degeneration and necrosis; while these were without damage in the controls. Immunohistochemistry showed that the protein expression of VEGF, the Ki-67 positive cells, and the MVD in the control group and treatment group were positively correlated with the glioma grade (P＜0.05). Of the glioma with the same grade, the Ki-67 protein expression and MVD in the treatment group were significantly lower than those in the control group (P＜0.05).Conclusion SRS and SRT may lead tumor cells to different degrees of degeneration, necrosis, and apoptosis, as well as the three-tier structure damage of capillaries in the blood-brain barrier, which provides a laboratory and theoretical foundation to take individualized comprehensive treatment of different gliomas.

Analysis of the factors affecting the prognosis of surgical patients with intracranial aneurysm / 中华神经医学杂志

Objective To analyze the factors affecting the clinical outcomes of surgical patients with intracranial aneurysm(IA).Methods The clinical data of 215 patients undergoing surgeries for IA between May,2002 and May,2007 were retrospectively analyzed.In all these cases,the diagnoses were established according to the results of CT,CT angiography(CTA)and digital subtraction angiography(DSA).With the therapeutic effect as the dependent variable,logistic regression analysis was performed to examine 10 factors that potentially affected the outcome of the patients.Results In all the patients,190(87.7%)were cured,22(10.9%)had mild to moderate disabilities,and 4(1.4%)died.Statistical analysis showed that age,aneurysm location,temporary occlusion of the parent artery,intraoperative aneurysm rupture,and the preoperative scores of Hunt-Hess scale and Fisher scale were correlated to the prognosis of the patients.Such factors as gender,operative time,and times of preoperative subarachnoid hemorrhage and aneurysm size were not found to obviously affect the patients' prognosis.Conclusions The prognosis of surgical patients with 1A is affected by multiple factors,and intraoperative aneurysm rupture is directly associated with the surgical outcome.