RESUMO
Objective To investigate the application of 3.0 MR for Gamma knife radios surgery(GKS) for treatment trigeminal neuralgia(TN) and the effect of 3.0 MR on therapy.Methods Sixty-two patients with TN underwent GKS,between May 2005 to June 2011 at Wanjie Hospital were included as our subjects.3.0MR 3-D FIESTA sequence scan were performed before treatment,during treatment 3.0MR orientation guided to select the trigeminal neuralgia (TN) brain cistern segment target spot.The 4 mm collimator was used and the maximum dose was to 70-90 Gy.Results The followed up periods was 6-36 months,total effective rate was 92 ％,the total alleviate cases was 51 part for 8 cases,none for 3,ipsilateral facial numbness,tinnitus,masticatory muscle weakness was found.Conclusion 3.0MR can clearly display trigeminal neuralgia and duty blood vessel,nicety orientation TN root,and then enhance GKS treatment TN rate,as well as avoid complication.
RESUMO
Objective To observe the effect of remifentanil combined with propofol to induce and sustain controlled hypotension in children during endoscopic sinus surgery(ESS). Methods Forty ASA Ⅰ children undergoing adenoidectomy in ESS were divided into control group and controlled hypotension group by random digits table with 20 cases in each group. No controlled hypotension in control group. Anesthesia was induced with propofol,remifentanil and atracurium, and maintained with continuous infusion of propofol 2 min until the target mean arterial pressure (MAP)(55 - 60 mm Hg, 1 mm Hg = 0.133 kPa) was reached,and MAP was maintained at this level during operation in controlled hypotension group. During 15 min before surgical procedure pharynx nasalis blood flow was measured and recorded with laser Dopper flowmetry continuously. The quality of the surgical field in term of blood loss and dryness was established at 15 min after operation starting. Results Controlled hypotension was induced within (2.5 ± 0.3 ) min, the infusion rate ofMAP and heart rate at 15 min after controlled hypotension and 15 min after operation starting were significantly lower than those at controlled hypotension instantly in controlled hypotension group and control group (P ＜ 0.05 ). The pharynx nasalis blood flow decreased at 15 min after controlled hypotension from baseline [(68.3 ± 8.3 )% vs. (99.8 ± 7.9 )%] (P ＜ 0.05 ). The operation time and the quality of the surgical field in term of blood loss and dryness in controlled hypotension group were better than those in control group [(21 ± 4) min vs. (32 ± 6) min and ( 1.8 ± 0.1 ) scores vs. (3.5 ± 0.5) scores] (P ＜ 0.05 ). The awakeextubate time was within 10 min in two groups, and there were no anesthesia related complications.Conclusion Remifentanil combined with propefol can induce and sustain controlled hypotension,reduce pharynx nasal is blood flow and provide good surgical conditions in children for ESS.
