Objective To investigate the exposed areas in brainstem in brainstem ventral region via the suboccipital far lateral transcondylar approach. Methods Ten (20 sides) adult cadaveric specimens which perfused with colored...Objective To investigate the exposed areas in brainstem in brainstem ventral region via the suboccipital far lateral transcondylar approach. Methods Ten (20 sides) adult cadaveric specimens which perfused with colored silicone were studied. Stepwise dissections via the suboccipital far-lateral展开更多
BACKGROUND: In recent years some reports have been published propagating microsurgical resection of ventral foramen magnum meningiomas (VFMMs). Operative approaches to these lesions have been studied by various author...BACKGROUND: In recent years some reports have been published propagating microsurgical resection of ventral foramen magnum meningiomas (VFMMs). Operative approaches to these lesions have been studied by various authors, but remain controversial. OBJECTIVE: To discuss the operative technique and outcome in patients with VFMMs who had been treated via a far lateral suboccipital approach. DESIGN: Retrospectively clinic case investigation. SETTING: Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. PARTICIPANTS: Between January 1997 and June 2003, 10 patients were treated surgically with VFMMs in Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. In the series of 10 patients, ages ranged from 37 to 72 years, mean (53±10) years, were consisted of 6 males and 4 females. All the subjects were informed of the treatment plan and agreed to join the experiment. Early symptoms included headache and upper cervical pain. The time between the first occurrence of symptoms and the diagnosis ranged from 6 months to 17 months, mean (10.3±3.4) months. Main presenting symptoms were unilateral upper extremity sensory and motor deficits in 6 cases, swallowing difficulties in 2 and spastic quadriparesis in 2. VFMMs were demonstrated as round by the computed tomographic (CT) scan and magnetic resonance imaging (MRI) in all patients. The maximum diameter of tumors ranged from 2 to 4 cm, mean (2.55±0.57) cm, including 2 cm in one case, 2.0-3.0 cm in six and 3.0-4.0 cm in three. METHODS: ①All tumors were removed via the far lateral suboccipital approach. Resection of the posterior 5 mm of the condyle was necessary in one patient whose tumors' diameter were 2 cm. The patient was situated in the lateral decubitus position. The head was fixed in a Mayfield headrest. A C-shaped incision made behind the ear 2 cm medial to the mastoid process, turning vertically down to the level C4, to expose the extradural segment of the vertebral artery (VA). After the dura was opened longitudinally behind VA entry point, the tumor was revealed to identify the complete cranial nerves and the intracranial VA under magnification of the surgical microscope. Every attempt should be made to keep the arachnoid and the dentate ligament was sectioned. Then the tumor was debulked significantly, and dissected away from the cranial nerves and the blood vessels with microsurgical techniques. If it was risk to dissect tumor from the vertebral artery, its branches, or any cranial nerve, the progression was discontinued and portion of the tumor was left behind. After resection of the tumor, the site of its attachment was coagulated and the involved layer of dura was resected. ②The degree of tumor resection was classified based on Al-Mefty's grade into three categories: gross-total resection: excision of the dural attachment and drilling of adjacent bone; near-total resection: a few millimeters of insulated and cauterized tumor were left on the vertebral artery or other vital; subtotal resection: more than 50% of the tumor mass were removed. ③All patients underwent clinical examination for lower cranial nerves or long tract deficits on the first day postoperatively. CT or MRI and neurological examinations were performed at 3 months of follow-up. MAIN OUTCOME MEASURES: Operative effect. RESULTS: All ten patients with VFMMs were treated via a far lateral suboccipital approach. Gross total resection was achieved in 6 patients, near-total resection was carried out in 2 and subtotal resection in 2 patients. One patients died in the postoperative period due to acute respiratory distress syndrome, five patients kept normal neurological status, whereas other four patients suffered from lower cranial nerve deficits and aspiration pneumonia was observed in two of them. The data of following up for 3 months showed that 2 patients still had lower cranial nerve deficit and others recovered from their illness. No tumor relapse or increment was found in CT or MRI scans. CONCLUSION: Most of VFMMs could be totally removed via a far lateral suboccipital approach with or without resection of the occipital condyle according to the tumor size, allowing most of these patients to achieve a good outcome in a 3 months follow-up.展开更多
Background:The three-dimensional(3D)visualization model has ability to quantify the surgical anatomy of farlateral approach.This study was designed to disclose the relationship between surgical space and exposed tissu...Background:The three-dimensional(3D)visualization model has ability to quantify the surgical anatomy of farlateral approach.This study was designed to disclose the relationship between surgical space and exposed tissues in the far-lateral approach by the volumetric analysis of 3D model.Methods:The 3D skull base models were constructed using MRI and CT data of 15 patients(30 sides)with trigeminal neuralgia.Surgical corridors of the far-lateral approach were simulated by triangular pyramids to represent two surgical spaces exposing bony and neurovascular tissues.Volumetric comparison of surgical anatomy was performed using pair t test.Results:The morphometric results were almost the same in the two surgical spaces except the vagus nerve(CN X)exposed only in one corridor,whereas the volumetric comparison represented the statistical significant differences of surgical space and bony and neurovascular tissues involved in the two corridors(P<0.001).The differences of bony and neurovascular tissues failed to equal the difference of surgical space.Conclusions:For far-lateral approach,the increase of exposure for the bony and neurovascular tissues is not necessarily matched with the increase of surgical space.The volumetric comparative analysis is helpful to provide more detailed anatomical information in the surgical design.展开更多
目的观察骶1节段多裂肌劈开入路微创经锥间孔腰椎锥间融合术(MIS-TILF)治疗腰椎滑脱症的临床疗效。方法选择2017年2月-2018年2月期间在我院接受治疗的腰椎滑脱症患者98例,按照随机数字表法分为对照组和观察组,每组各49例。给予对照组患...目的观察骶1节段多裂肌劈开入路微创经锥间孔腰椎锥间融合术(MIS-TILF)治疗腰椎滑脱症的临床疗效。方法选择2017年2月-2018年2月期间在我院接受治疗的腰椎滑脱症患者98例,按照随机数字表法分为对照组和观察组,每组各49例。给予对照组患者常规正中骶棘肌剥离入路MIS-TILF治疗,给予观察组患者骶1节段多裂肌劈开入路MIS-TILF治疗。比较两组患者治疗前后腰椎功能、术后疼痛情况以及术中出血量、手术时间、术后引流量等手术相关指标。结果两组患者术前的ODI、JOA评分差异无统计学意义(P>0.05);术后,观察组患者ODI评分低于对照组,JOA评分高于对照组,差异具有统计学意义(P<0.05);术前,两组患者的疼痛VAS评分差异无统计学意义(P> 0.05);观察组患者术后3 d、14 d VAS评分均低于对照组,差异有统计学意义(P<0.05);观察组患者术中出血量、手术时间及术后引流量低于对照组,住院时间短于对照组,差异有统计学意义(P<0.05)。结论与传统正中骶棘肌剥离入路MIS-TILF治疗比较,骶1节段多裂肌劈开入路MIS-TILF在腰椎滑脱症的治疗中可有效促进患者腰椎功能恢复,同时具有术后疼痛小、术中出血少、术后恢复快等优势。展开更多
文摘Objective To investigate the exposed areas in brainstem in brainstem ventral region via the suboccipital far lateral transcondylar approach. Methods Ten (20 sides) adult cadaveric specimens which perfused with colored silicone were studied. Stepwise dissections via the suboccipital far-lateral
文摘BACKGROUND: In recent years some reports have been published propagating microsurgical resection of ventral foramen magnum meningiomas (VFMMs). Operative approaches to these lesions have been studied by various authors, but remain controversial. OBJECTIVE: To discuss the operative technique and outcome in patients with VFMMs who had been treated via a far lateral suboccipital approach. DESIGN: Retrospectively clinic case investigation. SETTING: Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. PARTICIPANTS: Between January 1997 and June 2003, 10 patients were treated surgically with VFMMs in Department of Neurosurgery, the Ninth People's Hospital, Medical School of Shanghai Jiao Tong University. In the series of 10 patients, ages ranged from 37 to 72 years, mean (53±10) years, were consisted of 6 males and 4 females. All the subjects were informed of the treatment plan and agreed to join the experiment. Early symptoms included headache and upper cervical pain. The time between the first occurrence of symptoms and the diagnosis ranged from 6 months to 17 months, mean (10.3±3.4) months. Main presenting symptoms were unilateral upper extremity sensory and motor deficits in 6 cases, swallowing difficulties in 2 and spastic quadriparesis in 2. VFMMs were demonstrated as round by the computed tomographic (CT) scan and magnetic resonance imaging (MRI) in all patients. The maximum diameter of tumors ranged from 2 to 4 cm, mean (2.55±0.57) cm, including 2 cm in one case, 2.0-3.0 cm in six and 3.0-4.0 cm in three. METHODS: ①All tumors were removed via the far lateral suboccipital approach. Resection of the posterior 5 mm of the condyle was necessary in one patient whose tumors' diameter were 2 cm. The patient was situated in the lateral decubitus position. The head was fixed in a Mayfield headrest. A C-shaped incision made behind the ear 2 cm medial to the mastoid process, turning vertically down to the level C4, to expose the extradural segment of the vertebral artery (VA). After the dura was opened longitudinally behind VA entry point, the tumor was revealed to identify the complete cranial nerves and the intracranial VA under magnification of the surgical microscope. Every attempt should be made to keep the arachnoid and the dentate ligament was sectioned. Then the tumor was debulked significantly, and dissected away from the cranial nerves and the blood vessels with microsurgical techniques. If it was risk to dissect tumor from the vertebral artery, its branches, or any cranial nerve, the progression was discontinued and portion of the tumor was left behind. After resection of the tumor, the site of its attachment was coagulated and the involved layer of dura was resected. ②The degree of tumor resection was classified based on Al-Mefty's grade into three categories: gross-total resection: excision of the dural attachment and drilling of adjacent bone; near-total resection: a few millimeters of insulated and cauterized tumor were left on the vertebral artery or other vital; subtotal resection: more than 50% of the tumor mass were removed. ③All patients underwent clinical examination for lower cranial nerves or long tract deficits on the first day postoperatively. CT or MRI and neurological examinations were performed at 3 months of follow-up. MAIN OUTCOME MEASURES: Operative effect. RESULTS: All ten patients with VFMMs were treated via a far lateral suboccipital approach. Gross total resection was achieved in 6 patients, near-total resection was carried out in 2 and subtotal resection in 2 patients. One patients died in the postoperative period due to acute respiratory distress syndrome, five patients kept normal neurological status, whereas other four patients suffered from lower cranial nerve deficits and aspiration pneumonia was observed in two of them. The data of following up for 3 months showed that 2 patients still had lower cranial nerve deficit and others recovered from their illness. No tumor relapse or increment was found in CT or MRI scans. CONCLUSION: Most of VFMMs could be totally removed via a far lateral suboccipital approach with or without resection of the occipital condyle according to the tumor size, allowing most of these patients to achieve a good outcome in a 3 months follow-up.
基金Capital health development research special fund(2014-4-5073)Educational science and technology projects for young and middle-aged teachers of Fujian Provincial Department of Education(JAY190824)
文摘Background:The three-dimensional(3D)visualization model has ability to quantify the surgical anatomy of farlateral approach.This study was designed to disclose the relationship between surgical space and exposed tissues in the far-lateral approach by the volumetric analysis of 3D model.Methods:The 3D skull base models were constructed using MRI and CT data of 15 patients(30 sides)with trigeminal neuralgia.Surgical corridors of the far-lateral approach were simulated by triangular pyramids to represent two surgical spaces exposing bony and neurovascular tissues.Volumetric comparison of surgical anatomy was performed using pair t test.Results:The morphometric results were almost the same in the two surgical spaces except the vagus nerve(CN X)exposed only in one corridor,whereas the volumetric comparison represented the statistical significant differences of surgical space and bony and neurovascular tissues involved in the two corridors(P<0.001).The differences of bony and neurovascular tissues failed to equal the difference of surgical space.Conclusions:For far-lateral approach,the increase of exposure for the bony and neurovascular tissues is not necessarily matched with the increase of surgical space.The volumetric comparative analysis is helpful to provide more detailed anatomical information in the surgical design.
文摘目的观察骶1节段多裂肌劈开入路微创经锥间孔腰椎锥间融合术(MIS-TILF)治疗腰椎滑脱症的临床疗效。方法选择2017年2月-2018年2月期间在我院接受治疗的腰椎滑脱症患者98例,按照随机数字表法分为对照组和观察组,每组各49例。给予对照组患者常规正中骶棘肌剥离入路MIS-TILF治疗,给予观察组患者骶1节段多裂肌劈开入路MIS-TILF治疗。比较两组患者治疗前后腰椎功能、术后疼痛情况以及术中出血量、手术时间、术后引流量等手术相关指标。结果两组患者术前的ODI、JOA评分差异无统计学意义(P>0.05);术后,观察组患者ODI评分低于对照组,JOA评分高于对照组,差异具有统计学意义(P<0.05);术前,两组患者的疼痛VAS评分差异无统计学意义(P> 0.05);观察组患者术后3 d、14 d VAS评分均低于对照组,差异有统计学意义(P<0.05);观察组患者术中出血量、手术时间及术后引流量低于对照组,住院时间短于对照组,差异有统计学意义(P<0.05)。结论与传统正中骶棘肌剥离入路MIS-TILF治疗比较,骶1节段多裂肌劈开入路MIS-TILF在腰椎滑脱症的治疗中可有效促进患者腰椎功能恢复,同时具有术后疼痛小、术中出血少、术后恢复快等优势。
