Surgical effect of skull defect in children / 中华神经医学杂志

Objective:To explore the clinical features, surgical treatments and treatment effects of children with skull defect.Methods:Sixty children with skull defect, admitted to our hospital from January 2010 to December 2020, were chosen in our study. These children were divided into encephalocele group ( n=28) and non-encephalocele group ( n=32) according to the imaging results (whether brain tissues were 1.5 cm higher than the bone window plane or not). The time and area of skull defect were compared between the two groups. Titanium mesh or polyether ether ketone material were used to repair the skull defect; 24 children without nerve fiber bundle distribution from encephalocele group underwent resection of the encephalocele tissues additionally. All children were followed up for 3-10 years in the outpatient department, and the prognoses of children from the two groups were evaluated by Glasgow Outcome Scale (GOS) one year after surgery. Results:As compared with the non-encephalocele group, children in the encephalocele group had significantly younger age accepted skull removal, significantly longer skull defect course, significantly higher incidence of epilepsy, significantly more common secondary changes in the brain tissues around the defect, but statistically smaller skull defect area ( P<0.05). There was no bleeding, severe edema, wound infection or cerebrospinal fluid leakage after surgery in both groups, and primary healing was achieved. In the encephalocele group, 16 children were complicated with epilepsy; 10 got complete seizure control, and 6 got seizure improvement. In the non-encephalocele group, 8 children were complicated with epilepsy; 6 got complete seizure control, and 2 got seizure improvement. Postoperative follow-up showed that GOS scores in the non-encephalocele group were significantly higher than those in encephalocele group ( P<0.05). Conclusion:As ompared with skull defect children without encephalocele, skull defect children with encephalocele have earlier defect age, longer course of disease, higher incidences of ventricular perforation malformation and epilepsy, and a relatively poorer prognosis.

The clinical analysis of 29 patients in spontaneous intraspinal canal hematoma / 中华急诊医学杂志

Objective To explore the management of spontaneous intraspinal hematoma.Methods From January 2011 to July 2018,29 cases with spontaneous intraspinal hematoma were admitted to our department.Date on etiology,clinical presentation,radiological features,treatment strategy and prognosis were analyzed retrospectively.The prognosis was assessed by American Spinal Injury Association impairment scale (ASIA) before and after the treatment.Results Total of 29 cases,only 10 cases (34.5％) revealed specific etiology,including 7 cases of spinal vascular malformation,2 of tumor apoplexy,1 of cavernous hemangioma.After 2 weeks of conservative treatment,3 patients with grade D and 3 patients with grade E were assessed for spinal function.The average interval from onset to surgery was(9.4±7.5) days,the ASIA after two weeks of the operation was as follows:5 patients were assessed at grade A,5 patients at grade C,8 patients at grade D and 4 patients at grade E.28 patients were followed up for (48.7±23.1) months on average,6 patients without surgery were E,22 cases with surgery were as follows:4 cases A,18 cases D/E.Conclusions The etiology of spontaneous intraspinal hematoma is hard to define even after complete preoperative examination and exploratory operation.The preoperative neurologic functions are important predicting factors for the prognosis of spontaneous intraspinal hematoma.For patients who had neurologic function deficit,surgical treatment should be performed urgently to remove the hematoma and release the decompression of spinal cord.The majority of these patients can achieve a positive prognosis after surgery.

Application of intraoperative ultrasound and neuromonitoring in microsurgical treatment of intramedullary tumor in the superior cervical spinal cord / 中华显微外科杂志

Objective To analyze the effect of clinical application of ultrasound in microsurgical treatment of intramedullary tumors in the superior cervical spinal cord.Methods Retrospective study the clinical data of 15 patients with intramedullary tumors in the superior cervical spinal cord,which were underwent a laminectomy for microsurgical tumor resection during January,2014 and January,2018.Intraoperative ultrasound and neuromonitoring was accompanied by the whole surgical procedure for each case.The follow-up data was collected by outpatient department visits and telephone interviews.Results All the described patients were performed with microscopic tumor resection by using intraoperative neurophysiological monitoring and ultrasound.The pathological diagnosis was ependymocytoma (n=8) and astrocytoma (n=7).Gross total resections comprised 86.7％ of cases (n=13),and subtotal resections 13.3％ (n=2).The neurological outcome was as follows:Mc-Cormick scale grade Ⅰ,10 patients;grade Ⅱ,3 patients;grade Ⅲ,1 patient;and grade Ⅳ 1 patient;Follow-up was applied for (19.2±7.6) months in 13 cases and 12.0 months in 2 cases.Compared to the preoperative period,66.6％ of patients recovered postoperatively,20.0％ improved,6.7％ remained without deficit and deterioration persisted in 6.7％.Conclusion The microscopic resection of tumors is the effective way to cure this disease.By using intraoperative neurophysiological monitoring and ultrasound,the complete tumor resection and the minimal spinal cord injury were certainly achieved.

Diagnosis and treatment of clear cell hidradenocarcinoma of the scalp / 华中科技大学学报（医学）（英德文版）

Clear cell hidradenocarcinoma (CCH) is an exceedingly rare and highly malignant tumor of the eccrine sweat glands. Its treatment is extremely difficult due to the characteristically aggressive clinical course including repeated local recurrence and uncontrollable distal metastasis coming along with a very poor prognosis. Most published case studies recommend a wide surgical excision followed by adjuvant conservative therapy, which is generally considered to be the standard treatment. Two cases of nodular CCH of the scalp either presenting as a singular primary lesion or at an already metastatic stage were analyzed retrospectively. Wide local excision of the tumor couldn't prevent the primary carcinoma from recurring and metastasizing. Both cases received various therapies but the results were unsatisfactory. Although most authors have recommended that early wide surgical excision of the tumor is a feasible therapeutic measurement, our results raise doubts on the efficacy of this treatment strategy. As alternative approaches (i.e. chemotherapy, radiotherapy) are similarly controversial, further studies and a wide exchange of clinical experiences are crucial.

Diagnosis and treatment of clear cell hidradenocarcinoma of the scalp / 华中科技大学学报（医学）（英德文版）

Clear cell hidradenocarcinoma (CCH) is an exceedingly rare and highly malignant tumor of the eccrine sweat glands. Its treatment is extremely difficult due to the characteristically aggressive clinical course including repeated local recurrence and uncontrollable distal metastasis coming along with a very poor prognosis. Most published case studies recommend a wide surgical excision followed by adjuvant conservative therapy, which is generally considered to be the standard treatment. Two cases of nodular CCH of the scalp either presenting as a singular primary lesion or at an already metastatic stage were analyzed retrospectively. Wide local excision of the tumor couldn't prevent the primary carcinoma from recurring and metastasizing. Both cases received various therapies but the results were unsatisfactory. Although most authors have recommended that early wide surgical excision of the tumor is a feasible therapeutic measurement, our results raise doubts on the efficacy of this treatment strategy. As alternative approaches (i.e. chemotherapy, radiotherapy) are similarly controversial, further studies and a wide exchange of clinical experiences are crucial.