Practice of joint base training of traumatic brain injury in standardized training of neurosurgery specialists / 中华医学教育探索杂志

The diagnosis and treatment of traumatic brain injury (TBI) are basic skills that should be mastered by neurosurgery specialists during the standardized training. In view of the lack of TBI patients in our center, TBI training was entrusted to a joint base with more TBI patients. Based on clinical training and practice experience of the authors in recent years, including joint base introduction, basic requirement, theory and skill training, research training, humanity accomplishment improvement, inter-base communication and evaluation standard, we discuss the appropriate joint base training mode of TBI in standardized training of neurosurgery specialists, so as to provide reference for cultivating qualified and comprehensively developed neurosurgery specialists.

Experimental Study of Hemilaminectomy, Total Laminectomy and Recapping laminoplasty of Cervical Spine in Sheep / 医用生物力学

Objective To study the effect of hemilaminectomy, total laminectomyand recapping laminoplasty on stability of the cervical spine. Methods Fourteen fresh adult sheep cervical spine specimens were divided into two groups, with 7 cases in each group. Each specimen was applied with a pure moment load of 3.0 N·m under flexion/extension, left/right lateral bending, and left/right axial rotation. The range of motion (ROM) and neutral zone (NZ) of specimens were measured. In the first group, the ROMs and NZs of the specimens were measured and compared under the intact state, C5 hemilaminectomy state and C4-6 hemilaminectomy state respectively. In the second group, the ROMs and NZs of specimens under the intact state, C4-6 total laminectomy state and C4-6 recapping laminoplasty state were measured and compared. Results There were no significant differences in ROMs and NZs between C5 hemilaminectomy state and C4-6 hemilaminectomy state compared with the intact state (P<0.05). Compared with the intact state, ROMs of the specimens were significantly increased during flexion and extension under C4-6 laminectomy state and C4-6 recapping laminoplasty state (P<0.05). In addition, compared with the C4-6 laminectomy state, ROMs of the specimen were significantly decreased only during extension unde C4-6 recapping laminoplasty state (P<0.05), while no significant differences were found in ROMs between total laminectomy and laminoplasty under other loads. Conclusions With hemilaminectomy, ROMs and NZs of the cervical spine did not increase significantly, and stability of the cervical spine was not affected. With C4-6 total laminectomy, ROMs and NZs during flexion and extension increased significantly, and stability of the cervical spine was affected. Recapping laminoplasty did not significantly improve stability of the cervical spine with total laminectomy.

Surgical Treatment of Ten Adults with Spinal Extradural Meningeal Cysts in the Thoracolumbar Spine

Objective@#: To retrospectively analyze the clinical characteristics and surgical experience of 10 adults with spinal extradural meningeal cysts (SEMCs) in the thoracolumbar spine which may further provide evidence for surgical decision-making. @*Methods@#: Ten adults with SEMCs in the thoracolumbar spine were surgically treated and enrolled in this study. Clinical manifestations, imaging data, intraoperative findings and postoperative outcome were recorded. @*Results@#: Clinical manifestations of SEMCs included motor and sensory dysfunction of the lower limbs and urination and defecation disturbance. The cysts presented as intraspinal occupying lesions dorsal to the spine, ranging from the T8 to L3 level. Defects of eight cases were found on preoperative magnetic resonance imaging (MRI). Selective hemilaminectomy or laminectomy were used to reveal the defect within the cyst, which was further sutured with microscopic technique. The final outcome was excellent or good in seven cases and fair in three cases. No recurrence was observed during follow-up. @*Conclusion@#: SEMCs are rare intraspinal cystic lesions. Radiography and MRI are clinically practical methods to assess defects within SEMCs. Selective hemilaminectomy or laminectomy may reduce surgical trauma. Detection and microscopic suturing of the defects are the key steps to adequately decompress the nervous tissue and prevent postoperative recurrence.

Reduction of the atlantoaxial dislocation associated with basilar invagination through single-stage posterior approach: using Xuanwu occipital-cervical reduction surgical suite / 中华外科杂志

Objective@#To examine the effect of posterior reduction in atlantoaxial dislocation (AAD) associated with basilar invagination(BI) using Xuanwu occipital-cervical fusion system in single stage.@*Methods@#Thirty-seven AAD accompanied with BI cases treated at Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy and the Second Hospital of Hebei Medical University were retrospective analyzed. There were 15 males and 22 females with age of (42.3±12.3) years (range: 18-69 years). All the cases had congenital osseous abnormalities, such as assimilation of atlas and abnormal cervical fusion. Anterior tissue was released through posterior route followed by cage implantation into facet joint and occipital-cervical fixation with cantilever technique. The clinical results were evaluated using Japanese Orthopedic Association scale(JOA) and the main radiological measurements including anterior atlantodental interval (ADI), the distance of odontoid tip above Chamberlain line, clivus-canal angle(CCA) and the length of syrinx were collected. The preoperative and postoperative JOA score and radiological measurements were compared by paired t-test.@*Results@#The mean JOA score of the patients increased from 10.5 to 14.4 at the one-year follow-up(t=14.3, P=0.00). Complete reduction of AAD and BI was achieved in 34 patients.The mean clivus-canal angle improved from (118.0±6.5) degrees preoperative to (143.7±5.0) degrees postoperative(t=6.2, P=0.00). Shrinkage of the syrinx was observed 1 week after surgery in 24 patients, and 6 months in 31 patients.Twenty-eight patients achieved bone fusion 6 months after surgery. All the patients achieved bone fusion 12 months after surgery. One-side vertebral artery occlusion was diagnosed in 1 case postoperatively for transient dizziness, and relieved in 2 weeks.Two patients developed moderate neck pain after surgery, and relieved in 1 month. No implant failure, spacer subsidence or infection was observed.@*Conclusions@#The treatment of AAD associated with BI using Xuanwu occipital-cervical fusion system from posterior approach in single stage is effective and safe. Cage implantation intraarticularly and fixation with cantilever technique achieve complete reduction in most cases.

Preliminary clinical report of bilateral decompression under microscope via unilateral approach for the treatment of lumbar stenosis / 中华显微外科杂志

@#Objective To report the surgical technique and preliminary clinical results of bilateral decompression under microscope via unilateral approach for the treatment of lumbar stenosis. Methods Sixteen eases of lumbar stenosis were treated in our institute. For the surgical treatment, only one side paraspinous muscle was dissected. The upper and lower margins of the adjacent laminae were drilled, and the underlying ligament flavum was exposed. By changing the direction of the microscopy, the base of the spinous process and the internal side of the contralateral laminae were also drilled off till the lateral recess. Finally, decompression of the spinal canal was achieved by removing the ligament llavum. Results Follow-up ranged from 6 to 47 months. Intermittent claudication was totally relieved in 14 out of 16 cases, and markedly relieved in 2 cases. Back pain was relieved totally in 6 cases, marked improved in 8 cases, not change in 2 cases. Pain was significantly relieved in all 5 cases with sciatica, among them, diseetomy had to be performed in 3 cases. During follow-up, there was no symptom recurrence, and dynamic X ray did not show lumbar in-stability. Conclusion Bilateral decompression under microscope via unilateral approach for the treatment of lumbar stenosis is minimally invasive surgery, the effect of the operation is good. The technique has little in-fluence on spinal stability.