Search

Objective To explore the operative method and therapeutic efficacy of surgical resection of large invasive pituitary adenomas with individualized approach under neuronavigator guidance.Methods Seventeen patients(10 males and 7 females,aged from 22 to 78 years with a mean of 39.2±9.2 years) suffering from large invasive pituitary adenoma of higher than Hardy IV grade hospitalized from 2004 to 2009 were involved in the present study.All procedures were performed with the assistance of neuronavigator via individualized pterion approach,subfrontal extradural approach,trans-sphenoidal approach,or combined approach.The dispersedly invasive pituitary adenomas were resected under the guidance of neuronavigator by fully utilizing the natural anatomical cleavages.All the patients received follow-up CT scanning 3 days after operation,MRI scanning 1 to 3 months after operation,and clinical follow-up ranged from 6 to 72 months.The resection extent and outcome were assessed by imaging examination and clinical results.Results Total tumor removal was achieved in 15 cases,subtotal removal in 1 case,and extensive partial removal in 1 case.The visual impairment and headache were ameliorated in most cases,but in 1 patient they were worsened.Transient diabetes insipidus occurred in 8 cases,electrolyte disturbances were observed in 2 cases,leakage of cerebrospinal fluid appeared in 2 cases,hyposmia in 2 cases,visual impairment aggravated in 1 case,oculomotor nerve and abducens nerve paralysis on the operative side in 1 case,epidural hematoma in occipital and parietal regions in 1 case.No patient died during the follow-up period.Conclusions Individualized surgical approach designed according to the growth direction of tumor under neuronavigator guidance is helpful for the operators to identify the vessels and nerves in the operative field distinctly during the operation,thus the total removal rate is improved,safely of the operation to remove large invasive pituitary adenomas is secured,and disability rate due to surgery is decreased.

Objective To explore the microsurgical technique of medial sphenoid ridge meningioma resectional therapy.Methods The clinical data were retrospectively analyzed of 29 patients(13 males and 16 females;aged 18-68 years with average of 42 years;duration of disease was 5 months to 8 years,averaged 28 months) with medial sphenoidal ridge meningioma and admitted from Jan.2005 to Jan.2010.The anatomical relationship of the tumor to surrounding structures was assessed intraoperatively,the tumor was then completely resected through cutting off the tumor supplying vessels,shrinking the tumor volume and separating the tumors from adjacent vessels and nerves.All the patients were followed up for 4 months to 4 years.Results Of the 29 cases,20 got total tumor removal,7 got subtotal and 2 got partial tumor removal.Of the 20 patients with obviously preoperative visual impairment,12 were obviously relieved,6 showed no improvement and 2 got symptoms aggravation.Hemiplegia occurred in 2 cases and oculomoter nerve palsy in 6 cases.There was no death after surgery.A 6 months to 4 years follow-up showed that no recurrence was found in 27 patients with tumor resection level of Simpson I and II,2 patients with tumor resection level of Simpson III received postoperative radiotherapy or gamma knife surgery,and 1 recurred and received reoperation.Conclusions Fine intraoperative assessment of the anatomical relationship of the tumor to surrounding structures,separating and excising tumor according to the assessed result is the key of medial sphenoid ridge meningioma resection,and the tumor resection is favorable to visual rehabilitation and tumor control.

Objective To evaluate the therapeutic effect of small craniotomic posterior fossa decompression combined with occipital-cervical bone graft fusion and internal fixation on Chiari malformation complicated with basilar impression.Methods The clinical data of 16 cases(7 males and 9 females,aged 17 to 65 years,mean 36.4) of Chiari malformation complicated with basilar impression from 2006 to 2010 were retrospectively analyzed.The diagnoses for all the patients were confirmed by radiology.Small craniotomic posterior fossa decompression was performed in all patients,cerebellar tonsils were resected,and then one-stage occipital-cervical bone graft fusion using autogenous iliac bone and internal wiring fixation were performed.Neck support was used for 3 months after surgery.Results Symptoms were significantly improved in all cases after surgical operation.No patient died or infected.Cerebrospinal fluid leakage was found at draining site in one case.Transient pain of scapular and chest was found in one case and disappeared spontaneously.A 6-months follow-up showed that 6 patients were cured,9 improved and 1 unchanged according to Symon and Lavender standard.Postoperative MRI showed the reconstructed cisterna magna was clear in all patients,no cerebellar ptosis was found,and the occipital-cervical graft bone was fused.Conclusion In patients with Chiari malformation complicated with basilar impression,small craniotomic posterior fossa decompression combined with one-stage occipital-cervical bone graft fusion and internal wiring fixation has a clear and definite effect,it can increase the volume of posterior fossa and alleviate the ventral brain stem compression simultaneously,and reconstruct the stability of cranio-cervical junction.

Objective To explore the surgical technique for excision of mid-superior petroclival region tumor through subtemporal transtentorial approach.Methods Forty-three patients with tumor at superior-middle petroclival region hospitalized from Jun.20003 to Apr.2010 were involved in present study,and their clinical data were retrospectively analyzed.Of the 43 patients,19 were male and 24 were female,age ranged from 23 to 64 years(with mean of 42 years),disease duration ranged from 2 months to 3 years(with average of 14 months).All the patients underwent tumor resection via subtemporal transtentorial approach.The relationship between tumors and adjacent superior-middle petroclival structures was evaluated,and then the adhesion between tumor and tentorium cerebelli or petroclival meninges was separated,the tumor was resected piecemeal from closest area to distant part.The arachnoidal planes between tumor and brain stem,hypothalamus,or cavernous was dissected to enlarge the gap between the tumor and brain tissue,at the same time avoiding irritation to the above important structures.The therapeutic effects and postoperative complications were recorded.Results Total resection was achieved in 31 cases(72.1%),subtotal resection in 7 cases(16.2%),and partial resection in 5 cases(11.6%).One patient died(3.3%).Twenty-three patients developed new postoperative neurological deficits.The patients were followed up for 3 to 48 months,and the neurological functions were found to recover in varying degrees.Conclusion Subtemporal transtentorial approach for excision of tumors at superior-middle petroclival region has advantages of shorter approach and easy to expose.The key of the operative procedure is to reduce the tumor volume and enlarge the operative space.

Objective To explore the therapeutic efficacy of a new type sapphire contact laser using wavelength-shifting technique on microsurgery of brain stem tumors.Methods The clinical data were retrospectively analyzed of 23 patients(13 males and 10 females,aged 6 to 69 years with an average of 38 years,and the duration of disease was 14 to 36 months with average of 22 months) with brain stem tumor admitted from Mar.2006 to May 2010.The major symptoms of the patients were cranial nerve impairment,cerebellum function impairment or paralysis.All patients received microsurgical resection of brain stem tumor using sapphire contact laser through median suboccipital incision and posterior brain stem approach,and the tumors were resected with precision operation and vaporization and ablation.Results Of the 23 patients,4 were with glioma,15 with cavernous angioma,2 with angioreticuloma and 2 with metastatic tumor.Total resection was achieved in 15 cases,while subtotal resection(more than 80%) in 6 cases.Intraoperative hemorrhage was less and no intraoperative blood transfusion was required.A 6-months follow-up showed symptoms recovered in 15 patients,improved in 4,unchanged in 2,and worsen in 1.One patient died of recurrence of tumor.No postoperative intracranial infection was occurred,and 2 patients were undergone tracheotomy after operation.The average hospital stay was 15d.Conclusion The contact laser can precisely dissect and vaporize the tumors,increase the resection rate,reduce intraoperative hemorrhage and accessory injuries,and has a clear and definite effect.