Skull Base Osteomyelitis: A Rare Cause of Multiple Cranial Nerve Palsies—A Case Report from Ghana

Introduction: Skull Base Osteomyelitis (SBO) is an infectious inflammation of the skull bones that is often caused by malignant otitis externa (MOE) and affects the temporal bone. This condition commonly affects immunocompromised individuals and the elderly, particularly those with a history of diabetes mellitus. Diagnosis is challenging because of non-specific symptoms that lead to late detection and complications. This report discusses a case of SBO with multiple bilateral cranial nerve abnormalities and highlights the diagnostic and management challenges in high-risk individuals with subtle clinical signs. Case presentation: This report describes a 63-year-old patient with hypertension and diabetes who underwent surgical debridement of the left ear due to malignant otitis externa 4 months prior to presentation. The patient presented with significant dysarthria, dysphagia, ptosis of the left eye with double vision, and hearing impairment in the left ear. Examination revealed bilateral CN VI palsy, right CN VII palsy, left CN VIII palsy, and a right CN XII deficit. Initial tests were unremarkable, but a high Fungitell assay and a second review of the CT scan and MRI revealed a pathological process in the base of the skull involving bony structures and cranial nerves bilaterally, which helped diagnose SBO. The patient was subsequently discharged with oral voriconazole and continued his usual medications. The patient requested further management abroad, because he did not notice resolution of his symptoms. Surgical treatment was employed abroad to relieve his symptoms, as he recovered slowly. Conclusion: This case report underscores the importance of a multidisciplinary approach to address SBO. Collaboration between specialists in infectious diseases, otolaryngology, radiology, and neurology plays a pivotal role in achieving an accurate diagnosis and developing a tailored treatment plan. Although SBO may be infrequent, this case report highlights the need to maintain heightened clinical suspicion in high-risk individuals.

Bone Defect of the Cranial Vault: Difficulty of the Diagnostic about a Case, and Revew of Literature

The bone defects of the cranial vault encompassed rare malformations including acalvaria, hypocalvaria, acrania, hypocrania, anencephaly and exencephaly. They are also described in some pathological entities such as aplasia cutis congenita of the scalp. We report an unusual case of cephalic malformation which combine defects of the skin, the dura mater, and the bones of the vault, with a malformation of the central nervous system. This unique case emphasizes a problem of nosological definition between the terms mentioned above. acalvaria, the acrania, the hypocalvaria and the aplasia cutis congenita. Thus, herein, we proceed to a literature review of bone defects of the skull and their differential diagnosis.

Tirobot Cranial立体定向手术机器人辅助脑深部电极植入定位精度的研究

目的目前,国外研发的Neuromate、Rosa等立体定向手术机器人已通过美国FDA、欧洲CE标准认证,从而使得立体定向电极植入术逐渐在神经外科展开使用。北京天坛医院充分利用立体定向手术技术的优势,与北京天智航公司合作开展应用,研究Tirobot Cranial机器人辅助颅内电极植入定位的精准性,并分析影响电极植入定位精确度的相关因素。方法北京天坛医院神经外科与北京天智航公司合作,以家猪头颅为实验对象,进行Tirobot Cranial机器人辅助脑深部电极植入实验。术后复查CBCT验证入颅点及靶点的偏差,计算平均值及标准差,以评价机器人定位精准性;并进行误差影响因素分析。结果共进行7次实验,计划植入电极35根,术中实际植入电极35根,成功率达100%。电极平均植入长度(43.17±6.64)mm,植入电极平均入颅点误差为(0.63±0.23)mm,平均靶点定位误差为(0.96±0.41)mm。误差影响因素分析显示,入颅点偏离与靶点偏离的误差呈正相关(r=0.399,P<0.05)。结论通过修正电极植入工具参数的偏差,以及预先使用螺纹针钻孔,防止打滑等措施;Tirobot Cranial系统辅助颅内电极植入整体最佳的定位精度达到0.5 mm,具有良好的精准性及稳定性;电极植入的准确性可基本满足临床定位的需求。

Management of Intracranial Complications of Sinusitis

Intracranial complications of sinusitis are rare. However, they have an important morbidity and mortality rate, and can be a source of disabling neurological sequelae in the absence of a rapid diagnosis and adequate treatment. We carry a retrospective study of 23 patients having sinusitis with intracranial complications, treated between 1996 and 2011. All patients underwent complete ENT and neurological examination, biological investigations and sinonasal and cerebral CT. An intraveinous large-spectrum antibiotherapy was administered to all patients. Twenty patients underwent surgery. It included evacuation of the intracranial collection, sinus drainage, with or without cranialization of the frontal sinus. Evolution was assessed on clinical biological and radiological criteria. Mean age was 25 years and sex-ratio was 3.6. Neurological signs were the most frequent symptoms. Rhinological signs were essentially purulent rhinorrhea (14 cases) and nasal obstruction (12 cases). Nasal endoscopy showed pus in the middle meatus in 10 cases. On CT, intracranial complications included subdural empyema (11 cases), extradural empyema (7 cases) and brain abscess (5 cases). Associated cerebral thrombophlebitis was noted in 4 cases. Three patients with extradural empyema had had an exclusive medical treatment. All other patients (20 cases) were operated. Clinical and radiological evolution was favorable after initial treatment in 14 cases (60.8%). Six patients required secondary surgery. Two patients have died despite intensive care. The intracranial complications of sinusitis are serious and source of important morbidity and mortality. Management should rapid and adequate, combining effective antibiotic therapy and eventually neurosurgical treatment.

STUDY OF NEONATAL INTRACRANIAL HAEMORRHAGE AND HYPOXIC ISCHEMIC ENCEPHALOPATHY

A series of 100 cases of newborn babies of Apgar scores ≤7 or gestationage ≤32 weeks were studied by head ultrasonography (US) and CT scans. Forty-twopoint four percent of the cerebral lesions observed was subependymal-intraventricularhaemorrhage (SEH-IVH), 24.1% of which was in preterm infants and 18. 3% infull-terms, 7. 6% had subdural haemorrhage (SDH), 6. 3% had intraparenchymalhaemorrhage (IPH), 2.5% had subarachnoid haemorrhage (SAH) and 1.9% hadintracerebellar haemorrhage (ICEH). Sixteen point five percent were diagnosed ashypoxic-ischemic encephalopathy (HIE). The diagnostic accuracy of cerebralultrasonography was 82.8% by comparing with necropsy findings in 14 infants. Agreementbetween US and CT scan was 63.3%. The study shows that it was not easy to distinguishHIE from intracranial haemorrhage (ICH) clinically, the US and CT scans may be neces-sary. We revealed that the clinical severity of HIE did not follow the degree of CTchanges, and US was more sensitive in SEH-IVH, however, SDH was more sensitive inCT scans. Neurodevelopmental follow-ups were performed at 1.5-24 months (mean 7.5months) in 76 survival infants. Twenty-three of these infants (30. 3%) hadventriculomegaly. The mental and psychomotor performances on the Bayley scales were ab-normal in 33.3% (12/36) infants. Eight infants were noted to have major handicapsincluding impaired vision, diplegia, epilepsy or/and severe developmental delay.

Management of an intracranial hypotension patient with diplopia as the primary symptom:A case report

BACKGROUND Intracranial hypotension(IH)is a disorder involving cerebrospinal fluid(CSF)hypovolemia due to spontaneous or traumatic spinal CSF leakage and is easily being misdiagnosed or missed,especially in these patients without the prototypical manifestation of an orthostatic headache.At present,the management of IH with both cranial nerve VI palsy and bilateral subdural hematomas(SDHs)is still unclear.CASE SUMMARY A 67-year-old male Chinese patient complained of diplopia on the left side for one and a half mo.Computed tomography revealed bilateral SDHs and a midline shift.However,neurotrophic drugs were not effective,and 3 d after admission,he developed a non-orthostatic headache and neck stiffness.Enhanced magnetic resonance imaging revealed dural enhancement as an additional feature,and IH was suspected.Magnetic resonance myelography was then adopted and showed CSF leakage at multiple sites in the spine,confirming the diagnosis of having IH.The patient fully recovered following multiple targeted epidural blood patch(EBP)procedures.CONCLUSION IH is a rare disease,and to the best of our knowledge,IH with diplopia as its initial and primary symptom has never been reported.In this study,we also elucidated that it could be safe and effective to treat IH patients with associated cranial nerve VI palsy and bilateral SDHs using repeated EBP therapy.

Clinical Analysis of Lumbar Pool Drainage Combined with Antibiotics in the Treatment of Intracranial Infection

Objective: To explore the clinical effect of lumbar pool drainage combined with antibiotics in the treatment of patients with intracranial infections, and to provide a reference basis for clinical treatment. Methods: To collect and select patients admitted to the First People’s Hospital of Jingzhou City for craniotomy from January 2016 to June 2022, the infected were 20 cases, and continuous drainage of the lumbar pool was used under the premise of systemic application of sensitive antibiotics. Results: Twenty cases in this group were discharged cured. Conclusion: Lumbar pool placement drainage combined with systemic application of antibiotics for intracranial infection is a safe and effective treatment method.

Minimally Invasive Pericranial Flap for Reconstruction after Endonasal Endoscopic Surgery of 30 Consecutive Patients

Objectives/Hypothesis: The introduction of intranasal pedicled flaps has reduced the incidence of postoperative cerebrospinal fluid (CSF) leaks to less than 5%. Nevertheless, in malignant tumors those flaps are not always available because of nasal septum invasion. Minimally invasive pericranial flaps (PCF) are associated with minimal adverse effects and good cosmetic appearance. In spite of that, there are only a few reports of this reconstructive technic limited to short surgical series and radio-anatomical analysis. Clinical results of a surgical cohort are presented. Study Design: Cohort prospective study. Methods: Clinical data, including age, gender, stage, histopathological findings, rate of complications and appearance of PCF at fifth day and two months postoperative were recorded. Postoperative morbidities were recorded as wound abnormalities, nasosinusal, orbital and central nervous system complications. Chi-squared test was used to correlate qualitative variables and Student-t-test to correlated qualitative and quantitative variables. Items were considered statistically significant with a p value of less than 0.05 (confidence Interval of 95%). Results: Thirty patients (18 males and 12 females) were registered. Mean age was 51.5 years ± 23.0 and range between 20 and 71 years. Most common histologic subtypes were adenocarcinoma, epidermoid carcinoma and squamous cell carcinoma. Complete resection of the tumor was achieved in all patients including surgical margins. Length of the PCF varies between 9.9 cm and 13.9 cm with a mean of 11.8 cm. There was an association between length of the flaps and the covering structure with the nose apex relation. None patient experienced postoperative cerebrospinal fluid (CSF) leak, frontal sinusitis or other complications. Conclusions: Minimally invasive PCF constitute a good and inexpensive reconstructive option in patients with malignant anterior cranial base tumors in whose nasoseptal flap was not a feasible option.

Undiagnosed Anterior Cranial Fossa Dural Arteriovenous Fistula with Intracranial Hematoma: Case Report and Review of the Literature about Its Natural History

Dural arteriovenous fistulas (dAVFs) of an anterior cranial fossa are rare. Because of the high risk of intracranial hemorrhage and relatively easy access for direct surgery, aggressive treatment has been recommended. The natural history of anterior cranial fossa dAVFs (ACF dAVFs) is unclear in spite of many reports for the natural history of general dAVFs. To treat ACF dAVFs, direct surgery has traditionally been performed and endovascular surgery has recently been introduced. A 74-year-old man was transferred with severe consciousness disturbance and presented with devastating intracerebral hemorrhage on the CT scan. Digital subtraction angiography revealed the ACF dAVFs with a large venous pouch. The patient received direct surgery, nevertheless he became vegetative state. Later on, a smaller venous pouch was recognized on the CT scan when he had suffered from the thalamic hemorrhage sixteen months before. There are twelve cases including our case which was treated for a certain period and documented in detail. Eleven of twelve cases were asymptomatic. Three of the six cases with a venous pouch had some events possibly related to the disease, though none of the six cases without a venous pouch had any events during observation. In conclusion, an ACF dAVF with a venous pouch should be treated by direct surgery or endovascular surgery even if it is incidentally found. By contrast, careful observation might be a possible therapeutic option for an ACF dAVF without a venous pouch if there is mild reflux flow.

Current landscape in motoneuron regeneration and reconstruction for motor cranial nerve injuries

The intricate anatomy and physiology of cranial nerves have inspired clinicians and scientists to study their roles in the nervous system. Damage to motor cranial nerves may result from a variety of organic or iatrogenic insults and causes devastating functional impairment and disfigurement. Surgical innovations directed towards restoring function to injured motor cranial nerves and their associated organs have evolved to include nerve repair, grafting, substitution, and muscle transposition. In parallel with this progress, research on tissue-engineered constructs, development of bioelectrical interfaces, and modulation of the regenerative milieu through cellular, immunomodulatory, or neurotrophic mechanisms has proliferated to enhance the available repertoire of clinically applicable reconstructive options. Despite these advances, patients continue to suffer from functional limitations relating to inadequate cranial nerve regeneration, aberrant reinnervation, or incomplete recovery of neuromuscular function. These shortfalls have profound quality of life ramifications and provide an impetus to further elucidate mechanisms underlying cranial nerve denervation and to improve repair. In this review, we summarize the literature on reconstruction and regeneration of motor cranial nerves following various injury patterns. We focus on seven cranial nerves with predominantly efferent functions and highlight shared patterns of injuries and clinical manifestations. We also present an overview of the existing reconstructive approaches, from facial reanimation, laryngeal reinnervation, to variations of interposition nerve grafts for reconstruction. We discuss ongoing endeavors to promote nerve regeneration and to suppress aberrant reinnervation and the development of synkinesis. Insights from these studies will shed light on recent progress and new horizons in understanding the biomechanics of peripheral nerve neurobiology, with emphasis on promising strategies for optimizing neural regeneration and identifying future directions in the field of motor cranial neuron research.

Cranial variation in allactagine jerboas(Allactaginae,Dipodidae, Rodentia): a geometric morphometric study

Allactaginae is a subfamily of dipodids consisting of four-and five-toed jerboas(Allactaga, Allactodipus,Orientallactaga, Pygeretmus, Scarturus) found in open habitats of Asia and North Africa. Recent molecular phylogenies have upended our understanding of this group's systematics across taxonomic scales. Here, I used cranial geometric morphometrics to examine variation across 219 specimens of 14 allactagine species(Allactaga major, A. severtzovi, Orientallactaga balikunica, O.bullata, O. sibirica, Pygeretmus platyurus, P. pumilio,P. shitkovi, Scarturus aralychensis, S. euphraticus,S. hotsoni, S. indicus, S. tetradactylus, S. williamsi)in light of their revised taxonomy. Results showed no significant sexual size or shape dimorphism. Species significantly differed in cranial size and shape both overall and as species pairs. Species identity had a strong effect on both cranial size and shape. Only a small part of cranial shape variation was allometric,with no evidence of unique species allometries, and most specimens fit closely to the common allometric regression vector. Allactaga was the largest,followed by Orientallactaga, Scarturus, and finally Pygeretmus. Principal component 1(PC1) separated O. bullata+O. balikunica+S. hotsoni(with inflated bullae along with reduced zygomatic arches and rostra) from A. major+A. severtzovi+O. sibirica(with converse patterns), while PC2 differentiated Orientallactaga(with enlarged cranial bases and rostra along with reduced zygomatic arches and foramina magna) from Scarturus+Pygeretmus(with the opposite patterns). Clustering based on the unweighted pair group method with arithmetic mean(UPGMA) contained the four genera, but S. hotsoni clustered with O. bullata+O. balikunica and O.sibirica clustered with A. major+A. severtzovi, likely due to convergence and allometry, respectively.

Effective administration of cranial drilling therapy in the treatment of fourth degree temporal,facial and upper limb burns at high altitude:A case report

BACKGROUND Fourth degree burns damage the full thickness of the skin and affect underlying tissues.Skin grafting after debridement is often used to cover the wounds of salvageable severe burns.A granulation wound can be formed by drilling the skull to the barrier layer to solve the problem of skull exposure.Low oxygen levels present at high altitudes aggravate ischemia and hypoxia which can negatively impact wound healing.The impaired healing in such cases can be ameliorated by hyperbaric oxygen therapy.CASE SUMMARY We describe a patient who presented with fourth degree burns to the left temporal and facial regions upon admission in December 2018.The periosteum of the skull and the deep fascia of the face were exposed.After the first stage of debridement and skin grafting,the temporal skin did not survive well.Granulation was induced by cranial drilling,and then a local flap was transferred to cover the wound.The left temporal and facial wounds were completely covered and the patient recovered well.CONCLUSION Skin grafting and flap transfer after early debridement to cover the wound and control infection were of great significance.In the later stages of the patient's treatment,survival of the skin graft and skin flap was observed.The second stage repair was performed to achieve successful skin grafting by cranial granulation.Granulation was formed by drilling the skull,and then the wound was closed,which is suitable for cases with skull exposure and wounds with poor blood supply.We consider that hyperbaric oxygen treatment and improving tissue oxygen supply were beneficial in this patient.

Active fraction combination from Liuwei Dihuang decoction improves adult hippocampal neurogenesis and neurogenic microenvironment in cranially irradiated mice

OBJECTIVE Cranial radiotherapy is clinically used in the treatment of brain tumors;however,the consequent cognitive and emotional dysfunctions seriously impair the life quality of patients.LW-AFC,an active fraction combination extracted from classical traditional Chinese medicine prescription Liuwei Dihuang decoction,can improve cognitive and emotional dysfunctions in many animal models;however,the protective effect of LW-AFC on cranial irradiation-induced cognitive and emotional dysfunctions has not been reported.Recent studies indicate that impairment of adult hippocampal neurogenesis(AHN)and alterations of the neurogenic microenvironment in the hippocampus constitute critical factors in cognitive and emotional dysfunctions following cranial irradiation.Here,our research further investigated the potential protective effects and mechanisms of LW-AFC on cranial irradiation-induced cognitive and emotional dysfunctions in mice.METHODS LW-AFC(1.6 g·kg^(-1))was intragastrically administered to mice for 14 d before cranial irradiation(7 Gyγ-ray).AHN was examined by quantifying the number of proliferative neural stem cells and immature neurons in the dorsal and ventral hippocampus.The contextual fear conditioning test,open field test,and tail suspension test were used to assess cognitive and emotional functions in mice.To detect the change of the neurogenic microenvironment,colorimetry and multiplex bead analysis were performed to measure the level of oxidative stress,neurotrophic and growth factors,and inflammation in the hippocampus.RESULTS LW-AFC exerted beneficial effects on the contextual fear memory,anxiety behavior,and depression behavior in irradiated mice.Moreover,LW-AFC increased the number of proliferative neural stem cells and immature neurons in the dorsal hippocampus,displaying a regional specificity of neurogenic response.For the neurogenic microenvironment,LW-AFC significantly increased the contents of superoxide dismutase,glutathione peroxidase,glutathione,and catalase and decreased the content of malondialdehyde in the hippocampus of irradiated mice,accompanied by the increase in brain-derived neurotrophic factor,insulin-like growth factor-1,and interleukin-4 content.Together,LW-AFC improved cognitive and emotional dysfunctions,promoted AHN preferentially in the dorsal hippocampus,and ameliorated disturbance in the neurogenic microenvironment in irradiated mice.CONCLUSION LW-AFC ameliorates cranial irradiation-induced cognitive and emotional dysfunctions,and the underlying mechanisms are mediated by promoting AHN in the dorsal hippocampus and improving the neurogenic microenvironment.LW-AFC might be a promising therapeutic agent to treat cognitive and emotional dysfunctions in patients receiving cranial radiotherapy.

Clinical Application of Quantitative Nursing for Lower Cranial Nerves Injury after Cerebellopontine Angle Tumors

Objective: To retrospectively analyze the clinical utility of quantitative nursing measures of 10 cases of lower cranial nerves injury after cerebellopontine angle tumors surgery to provide the experience for improving the recovery rate and living quality of these patients. Methods: The clinical data of 10 cases of lower cranial nerves injury after cerebellopontine angle tumors surgery was analyzed. For problems such as dysphagia and dyspnea of these patients, the nursing care focused on strict monitoring, timely oxygen inhalation nursing, posture nursing, ventilator nursing, swallowing function training, etc. Results: After received quantitative care, 10 patients with lower cranial nerves injury after cerebellopontine angle tumors surgery were recovered well, and their symptoms such as dysphagia and dyspnea were gradually improved and safely discharged. Conclusion: Lower cranial nerves injury is one of the serious complications after removal of cerebellopontine angle tumors, which impacts the life and health of patients. Caregivers should accurately understand and analyze the symptoms, and quantitative and targeted nursing measures for posterior cranial nerves injury are helpful in the postoperative rehabilitation of patients and improve their living quality.

Concurrent chemotherapy and reduced - dose cranial spinal irradiation followed by conformal posterior fossa tumor bed boost for average - risk medulloblastoma: efficacy and patterns of failure

PURPOSE:To review the efficacy and patterns of failure in average-risk medulloblastoma patients treated withconcurrent chemotherapy and reduced-dose cranial spinal irradiation and a conformal tumor bed boost.METH-ODS AND MATERIALS:Thirty-three patients with average risk(defined as<==1.5 cm(2)of residual tumorafter resection,age>3 years,and no involvement of the cerebrospinal fluid or spine)medulloblastoma werediagnosed at our institution between January 1994 and December 2001.They were enrolled in an institutional

Cranial Nerve Decompression Gasket

A series of cranial nerve decompression gaskets were prepared with fibers of different fineness and high crimp which were obtained in knit-de-knit texturing process by using different specification general polyethylene terepthalate( PET) multifilament bought from market. The physical properties of the gasket were evaluated comprehensively and biocompatibility was analyzed with MTT assay.

Transcranial Doppler screening in sickle cell disease: The implications of using peak systolic criteria

AIM: To compare time average maximum mean velocity(TAMV) and peak systolic velocity(PSV) criteria of Trans Cranial Doppler(TCD) in their ability to predict abnormalities on magnetic resonance imaging(MRI)/magnetic resonance angiogram(MRA) in patients with sickle cell disease. METHODS: A retrospective evaluation was performed of the outcomes in all patients with a Transcranial Doppler examination at our institution since the implementation of the hospital picture archiving and communication system(PACS) system in January 2003 through December 2012. All ultrasound imaging exams were performed by the same technologist with a 3 MHz transducer. Inclusion criteria was based upon the Transcranial Doppler procedure code in our PACS which had an indication of sickle cell disease in the history. The patient's age and gender along with the vessel with the highest time averaged mean velocity as well as the highest peak systolic velocity was recorded for analysis. A subset of the study cohort also had subsequent MR imaging and Angiograms performed within 6 mo of the TCD examination. MRI results were categorized as having a disease related abnormality(vessel narrowing, collateral formation/moya-moya, or abnormal fluid attenuation inversion recovery signal in parenchyma indicative of prior stroke) or normal. The MRI results formed the comparison standards for TCD exams in evaluating intracranial injury. Sensitivity and specificity for the two TCD criteria(TAMV and PSV) were calculated to determine which could be a better predictor for intracranial vasculopathy /clinically occult strokes.RESULTS: The study cohort for our institution was 110patients with a total of 291 TCD examinations. These patients had a mean age of 7.6 years with a range from 2-18 years of age. Sixty-two of the 110 patients(56%) had two or more TCD exams. Thirty-seven patients(34%) had at least one MRI following a TCD examination. Of the 291 TCD examinations, 46(16%) were conditional or abnormal by TAMV criteria. One hundred and sixteen(40%) were conditional or abnormal by PSV criteria. All studies that were abnormal by TAMV were also abnormal by PSV criteria. Seventy of the 116(60%) studies which were conditional or abnormal by peak systolic criteria would not have been identified by time averaged mean maximum velocity criteria. The most frequent location of highest velocity measurement was noted to be in the middle cerebral artery regardless of whether it was measured by PSV or TAMV. From the 37 patients having one or more MRIs, 43 MRI exams were performed within 6 mo of a TCD examination. Twenty two(51%) MRIs had a disease related abnormality reported. When evaluating conditional or abnormal exams by PSV criteria against follow-up MRI/MRA, the sensitivity was 73% [16/(16 + 6)] and specificity was 81% [17/(4 + 17)]. When evaluating conditional or abnormal exams by TAMV criteria by follow-up MRI/MRA as the gold standard, the sensitivity was 41% [9/(9 + 13)] and the specificity was 100% [21/(21 + 0)]. In using conditional or abnormal criteria from PSV and TAMV to predict abnormalities on followup MRI/MR Angiogram, PSV was more sensitive(73% vs 41%) while TAMV was more specific(100% vs 81%). CONCLUSION: Based on the data obtained at our institution and using the assumption that the best screening test is the one with the highest sensitivity, the peak systolic velocity could be the measurement of choice for TCD screening.

ACUPUNCUTRE THERAPY FOR 12 CASES OF CRANIAL TRAUMA

Cranial trauma and its sequelae are se-rious neurosurgical disorders.Since April of1987,the authors adopted acupuncturetherapy For 12 cases of cranial trauma,in-cluding 10 cases with serious sequelae.Theresults have been good,as reported in thefollowing.

Differentiation in cranial variables among six species of Hylopetes(Sciurinae:Pteromyini)

There is some discrepancy in the classification of different species of Hylopetes,particularly regarding systematic status of H.electilis and H.phayrei and their relationship to other species.In the present study,for the first time we have brought together six of the nine Hylopetes species and performed statistical analysis of 14 measurable cranial variables,analyzing in total 89 specimens,including H.electilis,H.alboniger,H.phayrei,H.lepidus,H.spadiceus,and H.nigripes.Both univariate and multivariate analysis results indicate that H.electilis can not only be obviously distinguished from H.phayrei,but also clearly differs from the other four Hylopetes species.These results sustain the contention that H.electilis is neither a synonym nor subspecies of H.phayrei,but should be considered a distinct and valid species.Subsequently,a straightforward discussion on the biogeography of Hylopetes in southeastern Asia gives further insight into the differentiation and variety of species belonging to this genus.

STUDY ON THE STANDARDIZED APPLICATION OF ACUPUNCTURE ANESTHESIA TO CRANIOCEREBRAL OPERATIONS ON TEMPORO-PARIETO-OCCIPITAL REGION AND POSTERIOR CRANIAL FOSSA

The effect of acupuncture anesthesia(AA) performed with unified protocol andmethod was evaluated by the National Unified Scaling Criteria. Among the 536 cases studied,there are 488 cases Grade I, the rate of Grade I (success rate) being 91.05%. Of the 357 casesof temporo-parieto-occipital operations, the success rate is 91.88%, with the success rates of bodyneedling and ear needling groups being 88.16% and 98.45% respectively. Of the 179 cases of po-sterior cranial fossa operations, the success rate is 89.38%, with the success rates of body needlingand ear needling groups being 85.58% and 95.59% respectively. Randomized controlled trials wereconducted among the simple 0.1% lidocaine group, AA plus 0.1% lidocaine group and AA plusnormal saline group, the results of which prove that acupuncture analgesia plays predominant rolein AA and adjuvants can remarkably enhance the AA effect. The neuroanatomical basis of thesuperiority of ear needling to body needling is discussed here, so is the mechanism of the poten-tiating effect of the adjuvants on AA. Besides the advantages of AA in neurosurgery and problemsremaining unsolved have been summarized.