两端弧形开窗术式切除皮下包块性肿物的疗效观察

 目的: 评价弧形开窗术切除皮下包块性肿物的临床疗效。方法：选择皮下包块性肿物患者10例,采用肿物两端弧形开窗术式切开表皮后完整剥离肿物,评价疗效。结果：术后10例患者均切口愈合良好,瘢痕位置隐蔽,未见拉宽,毛发区域毛囊存在,毛发生长。患者满意度较高。结论：皮下包块性肿物两端弧形开窗术式疗效较好,简单易操作,愈后切口瘢痕不明显,是皮肤外科一种优选的肿物切除术式。     

OSMS在左侧乳腺癌根治术后放疗中的临床应用

目的 研究基于光学表面监测系统（optical monitoring system,OSMS）引导左侧乳腺癌根治术后深吸气屏气（deep inspiration breath-hold,DIBH），自由呼吸FB1(free breathing,FB)以及自由呼吸FB2（不经过OSMS引导，直接通过激光灯摆好身体标记线）3种状态下放疗的摆位误差，为主管医生勾画靶区提供个体化CTV-PTV外扩依据。方法 选取36例左侧乳腺癌根治术后患者，分为3组，分别进行DIBH、FB1和FB2 3种状态下拍摄CBCT，与CT图像进行分析配准并记录腹背、头脚、左右方向上的线性位移绝对误差数据，并计算外扩边界。结果 DIBH组的腹背、头脚、左右方向平移误差为（0.06±0.22） cm、（0.05±0.23） cm、（0.01±0.24） cm;FB1组为（0.07±0.21） cm、（0.02±0.23） cm、（0.02±0.21） cm;FB2组为（0.07±0.24） cm、（0.07±0.34） cm、（0.25±0.09） cm。DIBH组与FB1组在腹背、RTN、ROLL方向统计结果有统计学意...     

Understanding root fenestration: A systematic scoping review of prevalence and clinical factors

The aim of this systematic scoping review is to explore the literature on root fenestration prevalence and its possible etiologic, aggravating and predisposing clinical factors. A systematic search was conducted in 5 electronic databases, by two independent reviewers, without any language and date restrictions. Forty-six full-text records were included in the study, out of which 27 were used for prevalence analysis and 42 for clinical factor analysis. The results suggest that the literature is heterogenous, with major differences in the study protocols and results' presentation, providing limited information regarding root fenestration prevalence and possible racial distribution patterns. Further documentation is also required regarding clinical parameters that may affect root fenestration's presence and severity. Despite their few limitations, retrospective cone beam computed tomography studies with high-resolution protocols, as well as open flap studies for direct observation of possible root fenestration sites, seem the most reliable methods to better comprehend its presence and possible distribution patterns.     

MR血管成像血流动力学预测椎-基底动脉交界处裂隙型开窗患者发生后循环脑梗死

目的 评估基于MR血管成像(MRA)血流动力学预测椎-基底动脉交界处裂隙型开窗患者发生后循环脑梗死的价值。方法 随机收集40例经头部MRA诊断的椎-基底动脉交界处裂隙型开窗患者，将其中20例伴后循环脑梗死归为脑梗死组，20例无脑梗死者纳入对照组。基于MRA建立椎-基底动脉模型，以开窗汇合处为A位，开窗左侧血管支为B位，开窗右侧血管支为C位，开窗起点处为D位，分别测量血流动力学参数，包括血流速度(V)、梯度振荡数(GON)、振荡剪应指数(OSI)、壁面压力(WP)、壁面切应力(WSS)及动脉瘤形成指数(AFI)。采用单因素及二元logistic逐步回归分析筛选椎-基底动脉交界处裂隙型开窗患者发生后循环脑梗死的血流动力学参数相关独立危险因素，并以之建立回归模型；绘制受试者工作特征(ROC)曲线，计算曲线下面积(AUC),评估单一独立危险因素及回归模型预测椎-基底动脉交界处裂隙型开窗患者发生后循环脑梗死的效能。结果 脑梗死组V(A)、V(B)及WSS(D)均高于对照组(P均<0.05),且三者均为椎-基底动脉交界处裂隙型开窗患者发生后循环脑梗死的独立危险因素。以V(A)、V(B)及WS...     

Endo-LOVE技术中应用可视环锯治疗退行性腰椎管狭窄症的疗效分析

探讨在全内镜下椎板开窗术（Endo-LOVE）中采用可视环锯行椎管扩大成形治疗退行性腰椎管狭窄症的临床疗效。方法 选取2019年9月—2020年9月我院采用Endo-LOVE手术方式治疗的69例退行性腰椎管狭窄症患者，术中均应用可视环锯进行椎管扩大成形。统计平均手术时间、术中透视次数、术中出血量、住院日及术后并发症的发生率。分别在术前、术后1 d、术后3个月和末次随访时间点，使用疼痛视觉模拟评分（VAS）、功能障碍Oswestry指数（ODI）对患者进行评估，并使用改良MacNab评价患者的临床疗效。总结Endo-LOVE术式中应用可视环锯的技术优势。结果 69例患者手术均顺利完成，手术时间(66.9±12.4) min，术中出血量(10.7±6.1) mL，术中透视次数(3.1±1.2)次，平均住院日(6.4±1.0) d，术后出现脑脊液漏1例，未出现神经损伤、感染等其他并发症。随访时间3～8个月,术后1 d、3个月、末次随访时的ODI指数及腰痛和腿痛VAS评分均较术前明显改善，差异有统计学意义（P＜0.05）。末次随访时，采用改良MacNab标准评价临床疗效：优62例，良4例，可3例，优良率为95.65%。结论 可视环锯在Endo-LOVE技术治疗退行性腰椎管狭窄症中的应用有助于缩短手术时间，减压范围广，可视化操作，安全性高，临床疗效满意，可在脊柱内镜手术中推广     

Optic nerve sheath fenestration for treating papilloedema in the era of cerebral venous sinus stenting

Background

Pseudotumour cerebri (PTC) is the syndrome of intracranial hypertension without intracranial mass or hydrocephalus and is the commonest cause of papilloedema seen in many eye clinics. In the last 10 years, we have increasingly used TSS in patients whose papilloedema was not well controlled with medical treatment and have done fewer ONSFs. Here, we review our experience at Royal Prince Alfred Hospital Sydney with ONSF in 35 patients over the period 2002–2021.

Methods

Retrospective case series of 35 patients, 30 of whom had primary PTC [i.e., idiopathic intracranial hypertension (IIH)] and 5 with secondary PTC.

Results

Eighteen patients had bilateral ONSF and 17 patients unilateral ONSF, in each case of the worse eye. Thirteen patients then underwent transverse sinus stenting (TSS), in each case following ONSF. The primary outcome measures were visual acuity (VA) and mean deviation (MD) on visual field (VF) testing. MD improved by 5 dB or more in 34 of 70 total eyes (48.6%); VA improved by 0.2 logMAR (two lines on Snellen chart) or more in 21 eyes (30%), and by both in 15 eyes (21.4%). Final MD was −10 dB or better in 38 eyes (54.3%); final VA was 0.3 (6/12) or better in 54 eyes (77.1%), and both in 39 eyes (55.7%).

Conclusions

The results confirm that ONSF can relieve papilloedoema in both eyes and improve both VF and VA, even in cases of fulminant PTC with severe acute visual impairment.