Risk factors and the prognosis of sexual dysfunction in male patients with pituitary adenomas: a multivariate analysis / 亚洲男科学杂志(英文版)

The impact of sexual dysfunction (SD) is distressing to many male patients with pituitary adenomas which affect both physical and psychological health. The research explored to identify risk factors affecting sexual function and the prognosis of male patients with pituitary adenomas. Two hundred and fifty-four male patients, who aged between 18 and 60 (mean ± s.d.: 44.16 ± 10.14) years and diagnosed with pituitary adenomas, were retrospectively analyzed. One hundred and fifty-nine patients (62.6%) complained of SD prior to surgery. The mean International Index of Erectile Function (IIEF-5) in patients with giant adenomas was 16.13 ± 2.51, much smaller than those with microadenomas or macroadenomas (P < 0.05). All the patients showed significant improvement in terms of erectile dysfunction (ED) following surgery (P < 0.05). In addition, complete resection achieved a higher degree of SD relief than partial resection. The incidence of SD in functioning pituitary adenomas (FPAs) was much higher than that in nonfunctioning pituitary adenomas (NFPAs) (P < 0.05). In addition, compared with NFPAs, males with prolactinomas (82.8%) had the higher prevalence of SD and significantly improvement following surgical intervention (P < 0.05). An inverse relationship was identified between decreasing testosterone levels and increasing incidence of SD before surgery (P < 0.05). There was no significant difference between 6 months and 12 months after surgery in serum testosterone level (P > 0.05). Our results indicated that surgical therapy could be optimized for improvements in SD and that testosterone levels can be used as a sensitive indicator to predict the recovery rate of sexual function in patients with pituitary adenomas following surgery and the serum testosterone level will stay stable in 6 months after surgery.

Intraoperative facial motor evoked potentials monitoring with transcranial electrical stimulation for preservation of facial nerve function in patients with large acoustic neuroma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although various monitoring techniques have been used routinely in the treatment of the lesions in the skull base, iatrogenic facial paresis or paralysis remains a significant clinical problem. The aim of this study was to investigate the effect of intraoperative facial motor evoked potentials monitoring with transcranial electrical stimulation on preservation of facial nerve function.</p><p><b>METHOD</b>From January to November 2005, 19 patients with large acoustic neuroma were treated using intraoperative facial motor evoked potentials monitoring with transcranial electrical stimulation (TCEMEP) for preservation of facial nerve function. The relationship between the decrease of MEP amplitude after tumor removal and the postoperative function of the facial nerve was analyzed.</p><p><b>RESULTS</b>MEP amplitude decreased more than 75% in 11 patients, of which 6 presented significant facial paralysis (H-B grade 3), and 5 had mild facial paralysis (H-B grade 2). In the other 8 patients, whose MEP amplitude decreased less than 75%, 1 experienced significant facial paralysis, 5 had mild facial paralysis, and 2 were normal.</p><p><b>CONCLUSIONS</b>Intraoperative TCEMEP can be used to predict postoperative function of the facial nerve. The decreased MEP amplitude above 75 % is an alarm point for possible severe facial paralysis.</p>

A long term follow-up study of the skull base chordomas / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the prognostic features of the skull base chordomas treated with neurosurgical operations.</p><p><b>METHODS</b>One hundred and six patients of skull base chordomas were enrolled by means of telephone, letter and out-patient recheck who presented between May 1993 and June 2005. They were scored by Karnofsky Performance Scale (KPS) during admission respectively, before period of discharge and follow-up. SPSS Life-table method was used to calculate the recurrent rates and survival rates.</p><p><b>RESULTS</b>Seventy-nine patients were followed for 10-158 months. The average period was 63.9 months. Survival rates of 1, 3, 5 and 10 year were 87.2%, 79.4%, 67.6% and 59.5%, meanwhile recurrent rates of 1, 3, 5 and 10 years were 19.1%, 34.7%, 52.9% and 88.3% respectively. The mean KPS on admission, before discharge and follow-up were 71.0, 72.5 and 67.1 respectively, which demonstrated the significant differences between the before discharge item and the follow-up.</p><p><b>CONCLUSIONS</b>The prognosis of the skull base chordomas was poor. The recurrent rate was ascending year by year, meanwhile the survival rate was descending and 8 years later the tendency became gently. Neurosurgical treatments can improve majority long-term qualities, so they should be viewed as the first treatment choice.</p>

Postauricular tran-supracondylar approach removed jugular foramen and hypoglossal canal tumors / 中华外科杂志

<p><b>OBJECTIVE</b>Discuss the surgical treatment of jugular foramen and hypoglossal canal tumor, and choice of the best surgical approach.</p><p><b>METHODS</b>32 patients with jugular foramen and hypoglossal canal tumor were operated through the postauricular tran-supracondylar approach, 13 neurinoma, 7 glomus jugular tumors, 4 meningioma, 3 chordoma. 23 were total removed, with a subtotal of 9.</p><p><b>RESULTS</b>21 patients were followed up, mean 2.5 years. 18 patients work normally, 7 of them were hoarseness, 2 of other 3 patients lived by themselves, 1 of existed obstruct of limbs.</p><p><b>CONCLUSIONS</b>Postauricular tran-supracondylar approach exposes satisfactory for the dumbbell-shape tumors of intra-or extra cranial. It has high rate of total removal and low rate of complications. It is the best approach of treatment in jugular foramen and hypoglossal canal tumors. The outcome is good.</p>

Diagnosis and treatment of cavernous sinus neurinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To study the diagnosis and microneurosurgical treatment of cavernous sinus neurinoma.</p><p><b>METHODS</b>Twenty-two patients with cavernous sinus neurinoma which had been diagnosed by MRI were operated on by microsurgery. Fourteen patients received excision of tumor through frontotemporal approach with zygomatic osteotomy and, 8 patients via subtemporal and suboccipital transtentorial approaches.</p><p><b>RESULTS</b>Total resection was achieved in 21 patients (95.5%), and subtotal resection in 1. There was no operative death. The all operative samples were confirmed neurinoma pathologically. The symptoms postoperation such as headache and exophthalmos were reduced. Three months after operation, the function of the 6th nerve was improved in 12 of 19 patients with paresis of the 6th nerve. One patient with hemiplegia recovered well. The function of the 3th nerve recovered in 4 of 6 patients with recurrent paresis of the 3th nerve. Those patients with hydrocephalus were improved after operation. The patients were follow up 8 - 60 months (mean 20 months). No tumor recurrence was observed.</p><p><b>CONCLUSION</b>Cavernous sinus neurinoma can be removed successfully via subtemporal and suboccipital transtentorial approaches.</p>