Regenerative procedure using rotary titanium brush for surface decontamination of peri-implantitis: 3 cases with a 2-year follow-up

Peri-implantitis, in which inflammation caused by plaque and biofilm on the implant surface spreads to the hard tissue, can be treated by decontamination of the implant surface and reconstruction of the lost hard tissue through surgical methods. We have described the management of 3 peri-implantitis cases by decontamination of the implant surface using a round titanium brush and regenerative therapy. All cases showed clinical improvements, and no further radiographic bone loss was observed during a 2-year follow-up. This treatment method can be effective for clinical improvement and bone regeneration. However, a longer follow-up period is necessary to support these outcomes.

Management of the Extracranial and Intracranial Traumatic Arterial Lesions

OBJECTIVE: This study is designed to elucidate the requirements for angiographic evaluation and the selection of appropriate therapeutic approaches in patients who had strongly suggestive traumatic carotid arterial lesions. METHODS: Ten cases of traumatic internal carotid arterial lesions were analysed in this study. Injury mechanisms, neurological status, computed tomography scans, pre-and postoperative angiograms, and methods and results of the treatment were included. RESULTS: Of 10 cases, carotid-cavernous fistula(CCF) alone in three, CCF with intracranial pseudoaneurysms in three, pseudoaneurysm with dissection in one, extracranial internal carotid artery thrombosis in one, extracranial pseudoaneurysm in one, and the remaining one had all of the CCF, intracranial pseudoaneurysm and dissection. Seven of these 10 cases had sphenoid sinus wall fractures and six had subarachnoid hemorrhage. Six cases were treated with endovascular techniques, and four with direct parent artery occlusion and bypass surgery. No postoperative morbidity or additional permanent neurological deficits occurred except one patient who suffered from reperfusion hemorrhage after bypass surgery. CONCLUSION: Head trauma patients with facial bone fractures and thick subarachnoid hemorrhage should be evaluated for the development of traumatic injuries to the carotid artery as soon as possible. Endovascular treatment to these lesions have come to play an increasing role. Patients with traumatic internal carotid artery lesions who do not tolerate test occlusion require extracranial to intracranial bypass surgery before occlusion.

Clinical Outcome of the Mixed Glioma: Preliminary Analysis

The authors analyzed preliminary outcome of 10 patients with mixed glioma(3 patients with low-grade oligoastrocytoma and 7 patients with anaplastic oligoastrocytoma) who underwent surgical resection and were treated or are in treatment with or without adjuvant therapy at our institute since May 1993. In the low-grade oligoastrocytoma group, gross total tumor resection was done in all three cases and postoperative radiation therapy was performed in 2 cases. In the anaplastic oligoastrocytoma group, all seven cases were divided as to the amount of tumor removal(gross total resection; 4 cases, subtotal resection; 1 case, partial resection; 2 cases) and clinical course and prognosis were analyzed as to performing postoperative radiation therapy with or without chemotherapy. In the low-grade oligoastrocytoma group, one patient who didn't undergo postoperative radiation therapy suffered from tumor recurrence that showed histopathologically malignant transformation. In the anaplastic oligoastrocytoma group, 2 patients who underwent subtotal tumor resection and partial tumor resection with postoperative radiation therapy showed tumor progression and histopathologically more malignant transformation. The authors propose that gross total tumor resection with postoperative radiation therapy in low-grade oligoastrocytoma and adding chemotherapy(especially with procarbazine, lomustine, vincristine; PCV regimen) in anaplastic oligoastrocytoma appear to be associated with more prolongation of patient's survival.

Surgical Approaches to Basilar Tip Aneurysms

In an attempt to decide the surgical approach to basilar tip aneurysms, 27 cases of ruptured aneurysms were retrospectively analysed for size of aneurysm, direction of fundus and height of bifurcation. The fundus pointed superiorly in 18 cases, posteriorly in six, and anteriorly in three. The aneurysm neck was positioned as follows : very high(more than 20mm above midsellar) in one case, high(between 10mm and 20mm above midsellar) in 13, mid(from midsellar to 10mm above it) in nine, low(from midsellar to sellar floor) in two, and very low(below the sellar floor) in two. In 11 cases, surgery followed the conventional pterional approach ; in eight, the orbitozygomatic ; in three, the pterional-anterior temporal ; in two, the subtemporal ; in two, the anterior transpetrosal ; and in one, the temporopolar. In complex aneurysms or basilar bifurcation was at an unusual height, surgery involved a skull-base or modified technique based on a conventional pterional and subtemporal approach. On the basic of our surgical data and related findings, our suggestious are as follows : surgery involving basilar tip aneurysms with an extremely high-positioned neck should follow the transsylvian route above the carotid bifurcation, or use a transventricular or intravascular approach ; in cases with a high positioned-neck, the orbitozygomatic temporopolar or transzygomatic subtemporal approach should be used ; in cases with a normal-positioned neck, the combined pterional-anterior temporal approach, which has a much wider operative field and wider angle of vision than the classic pterional and subtemporal approach ; in cases with a low-positioned neck, the subtemporaltranstentorial) pterional, with resection of the posterior clinoid process ; and in cases with a very low-positioned neck, the transpetrosal approach.