ABSTRACT
Objetivo: Presentar el relato de un caso clínico de cirugía virtual guiada para rehabilitación implantosoportada de maxilar edéntulo con carga inmediata. Relato del caso: Paciente, edéntulo total en ambos maxilares, expresó su deseo de cambiar la prótesis total superior removible por una prótesis total fija sobre implantes. Durante la evaluación clínica, se observaron condiciones biológicas favorables al tratamiento como, adecuada faja de tejido queratinizado y leve reabsorción ósea. Como tratamiento se le sugiere al paciente, una planificación inversa, asistida por cirugía virtual guiada, utilizando un prototipo de guía quirúrgica para la colocación de seis implantes dentales en el maxilar y la instalación de una prótesis protocolo de carga inmediata. Conclusiones: Los resultados nos permiten concluir que la cirugía virtual guiada por computadora para rehabilitación protésica implantosoportada de maxilar edéntulo, con carga inmediata, proporciona precisión en los procedimientos quirúrgicos, es fundamental para la confección de prótesis inmediatas, representa una alternativa mínimamente invasiva y el resultado complace a los pacientes.
Objective: present the report of a clinical case of a virtual guided surgery for implant-supported rehabilitation of the edentulous maxilla with immediate loading. Case report: Patient, bi-maxillary edentulous expressed the desire to replace the removable upper total prothesis for a total fixed prothesis on implants. During the clinical evaluation, favorable biological conditions for treatment were observed, such as adequate keratinized tissue band and mild bone resorption. As part of the treatment, the patient was recommended a reverse planning approach, assisted by virtual guided surgery. This involved a prototype surgical guide for the fixation of six dental implants in the maxilla and the installation of an immediate loading protocol prosthesis. Conclusions: The results lead us to conclude that computer-guided virtual surgery for implant-supported prosthetic rehabilitation of the edentulous maxilla with immediate loading, provides a high precision in surgical procedures. It is essential to fabrication of immediate prostheses, represents a minimally invasive alternative, and results in patient satisfaction.
ABSTRACT
Background and Purpose: Surgical decompression of the posterior fossa is often performed in cases with a space-occupying cerebellar infarction to prevent coma and death. In this study, we analyzed our institutional experience with this condition. We specifically attempted to address timing issues and investigated the role of cerebellar necrosectomy using imaging data and conducting volumetric analyses. Methods: We retrospectively studied pertinent clinical and imaging data, including computerized volumetric analyses (preoperative/postoperative infarction volume, necrosectomy volume, and posterior fossa volume), from all 49 patients who underwent posterior fossa decompression surgery for cerebellar infarction in our department from January 2012 to January 2021. Results: Thirty-five (71%) patients had a Glasgow Coma Scale (GCS) of 14-15 at admission vs. only 14 (29%) before vs. 41 (84%) following surgery. Seven (14%) patients had preventive surgery (initial GCS 14-15, preoperative GCS change ≤ 1). Only 18 (37%) patients had an mRS score of 0-3 at discharge. Estimated overall survival was 70.5% at 1 year. Interestingly, 18/20 (90%) surviving cases had a modified Rankin Scale (mRS) outcome of 0-3 (mRS 0-2: 12/20 [60%]) 1 year after surgery. Surgical timing, including preventive surgery and mass effect of the infarct, in the posterior fossa assessed semi-quantitatively (Kirollos grade) and with volumetric parameters that were not predictive of the patients' (functional) outcomes. Conclusion: Posterior fossa decompression for cerebellar infarction is a life-saving procedure, but rapid recovery of the GCS after surgery does not necessarily translate into good functional outcome. Many patients died during follow-up, but long-term mRS outcomes of 4-5 are rare. Surgery should probably aim primarily at pressure relief, and our clinical as well as volumetric data suggest that the impact of removing an infarcted tissue may be limited. It is presumably relatively safe to initially withhold surgery in cases with a GCS of 14-15.
ABSTRACT
BACKGROUND: Intermediate nerve neuralgia (INN) is a rare and often overlooked form of primary otalgia. The pathophysiological mechanism is unknown, although one of the possible contributing factors is a neurovascular conflict at the root entry zone of the intermediate nerve. The pain can be severely debilitating, and the palette of treatment options is small. OBJECTIVE: To assess the outcome of microvascular decompression (MVD) of the VII/VIII cranial nerve complex for treating INN. METHODS: We retrospectively reviewed the records of a group of 8 consecutive patients with INN who underwent MVD of the VII/VIII cranial nerve complex in the period 1994 to 2015. RESULTS: In total, 7 of the 8 patients experienced almost immediate and complete relief of pain, which remained at long-term follow-up (mean 35 mo ± 24 mo, range 8-84 mo). Postoperatively, 1 patient had a cerebrospinal fluid (CSF) leak, 3 patients experienced permanent ipsilateral hearing loss, and 3 patients had temporary complaints associated with excessive drainage of CSF. CONCLUSION: This study suggests MVD as a valid treatment for medically refractory INN. MVD carries surgical risk, but given the severity of complaints of these patients, we believe the treatment benefits outweigh the associated complications.
Subject(s)
Facial Nerve/surgery , Microvascular Decompression Surgery/methods , Neuralgia/surgery , Vestibulocochlear Nerve/surgery , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
Glioblastoma (GBM) is the most aggressive primary brain tumor in adults. The mechanisms that confer GBM cells their invasive behavior are poorly understood. The electroneutral Na+-K+-2Cl- co-transporter 1 (NKCC1) is an important cell volume regulator that participates in cell migration. We have shown that inhibition of NKCC1 in GBM cells leads to decreased cell migration, in vitro and in vivo. We now report on the role of NKCC1 on cytoskeletal dynamics. We show that GBM cells display a significant decrease in F-actin content upon NKCC1 knockdown (NKCC1-KD). To determine the potential actin-regulatory mechanisms affected by NKCC1 inhibition, we studied NKCC1 protein interactions. We found that NKCC1 interacts with the actin-regulating protein Cofilin-1 and can regulate its membrane localization. Finally, we analyzed whether NKCC1 could regulate the activity of the small Rho-GTPases RhoA and Rac1. We observed that the active forms of RhoA and Rac1 were decreased in NKCC1-KD cells. In summary, we report that NKCC1 regulates GBM cell migration by modulating the cytoskeleton through multiple targets including F-actin regulation through Cofilin-1 and RhoGTPase activity. Due to its essential role in cell migration NKCC1 may serve as a specific therapeutic target to decrease cell invasion in patients with primary brain cancer.
