144例显微根尖外科手术疗效观察及分析

目的通过对显微根尖手术后患者临床随访评估,探讨显微根尖手术的成功率以及相关预后影响因素,为无法行根管治疗的复杂根尖周病的治疗提供参考。方法对2012—2014年底在我院行显微根尖手术的144例患者进行1年随访,收集患者主观症状、临床检查以及拍摄根尖X线片相关资料,综合评估显微根尖手术疗效,并统计分析性别、年龄及牙位预后影响因素。结果对144例患者共190颗患牙相关资料进行分析,1年有效率达92.63%(176颗),无效率为7.37%(14颗)。统计学分析结果显示患者的性别、年龄及牙位分布对显微根尖外科手术的预后无明显影响。结论显微根尖外科手术可以有效治疗复杂根尖周病变的有效方法,值得临床推广。     

Purine Metabolism During Microsurgical Transfer of Human Skeletal Muscle

The effect of ischaemia followed by reperfusion on energy metabolism was studied in human skeletal muscle after microsurgical free transfer. Muscle biopsy specimen from 11 patients treated by free muscle transfer for facial palsy, injury to an extremity, or scalp defect were studied. The biopsy specimens were taken during ischaemia and after one hour of reperfusion, respectively. They were analysed for ATP to uric acid and creatine phosphate by high pressure liquid chromatography. Ischaemia lasting one or two hours affected the energy metabolism of the muscle cell as evidenced by a 50% reduction in creatine phosphate; a 20% reduction in ATP and in the energy charge; a 100% increase in inosine monophosphate, and a 700% increase in hypoxanthine and xanthine. Reperfusion for one hour improved these figures somewhat, and induced the production of uric acid. Skeletal muscle can therefore tolerate ischaemia for up to two hours in the clinical situation without permanent damage to the tissues.     

Compartment syndrome and rhabdomyolysis as a positioning complication following retrosigmoid craniotomy

The goal of surgical positioning is to provide optimal surgical access and visualization while maintaining the patient's safety, with the least physiological compromise. Here, we report a 30-year-old man with an unremarkable past medical history who developed superior vena cava syndrome after a 15-hour retrosigmoid craniotomy for removal of a right cerebellopontine (CP) angle tumor. Compartment syndrome from the head to neck and rhabdomyolysis were recognized, with extensive swelling of his head and neck, markedly swollen soft tissues and necrosis of multiple muscles revealed by computed tomography, and very high concentrations of creatine kinase (CK) and aspartate transaminase. Immediate intensive care and rehabilitation therapy were provided and aimed at maintaining adequate perfusion/oxygenation and decreasing tissue pressure. He was successfully weaned from ventilation on postoperative day (POD) 25, transferred to a general ward on POD 29, and discharged with mild muscular and neurological sequelae on POD 51. Careful adjustment of surgical positioning is crucial for patient safety, especially when positioned at an extreme position in association with prolonged surgery.     

TREATMENT OF NON-HEALING ULCERS OF THE LOWER EXTREMITY WITH FREE MUSCLE FLAPS: Case reports

The surgical management of ulcers in the lower extremity is traditionally conservative, and includes debridement and split thickness skin grafting. In the most intractable cases, however, this management is often not enough. In this report of three patients with non-healing ulcers of the lower extremity successfully treated with free muscle flaps, we advocate a more active surgical approach to the treatment of such conditions. This is also appropriate in patients for whom a microsurgical approach might not be considered because of advanced age, peripheral arterio-occlusive disease, or the presence of other risk factors.     

The role of prophylactic antiepileptic drugs for seizure prophylaxis in meningioma surgery: A systematic review

Meningiomas are the commonest type of primary brain tumours. Whilst most patients are seizure-free prior to surgery, antiepileptic drugs are frequently administered to reduce the risk of developing post-operative seizures. However, evidence to support their efficacy in providing this outcome is sparse. To this end, we performed a systematic review to assess the impact of prophylactic antiepileptic drugs on post-operative epilepsy rates in seizure-naïve patients undergoing craniotomy for resection of meningiomas. The literature search was performed using PubMed for studies published between January 1990 and November 2016. The total number of patients in each study was extracted and divided into cohorts according to administration of prophylactic antiepileptic drugs. Clinical characteristics, study type and post-operative epilepsy rates were recorded. A total of 11 studies involving 1143 patients met the selection criteria. There was no statistically significant difference in the number of patients who developed post-operative epilepsy in the cohort that received prophylactic antiepileptic drugs (20 of 766; 2.6%) and the cohort that did not (10 of 377; 2.7%) (Chi-square test; P = 0.96). A detailed meta-analysis could not be performed due to the insufficiency in data reported. Based on the results of this systematic review, the routine use of antiepileptic drugs for seizure prophylaxis in seizure-naïve patients undergoing meningioma resection could not be substantiated. However, limitations of a systematic review should be considered on interpretation. High quality prospective randomised controlled trials are required to definitively answer this important clinical question.     

Endoscope-Assisted Microsurgical Removal of an Epidermoid Tumor within the Cavernous Sinus

Epidermoid tumor of the cavernous sinus is rare. The aim of this case report is to discuss the role of neuroendoscopes in the removal of such lesions. A 21-year-old man presented with 6-year history of progressive headache, diplopia, and visual disturbance. Work-up revealed an epidermoid tumor located in the right cavernous sinus. An extradural transcavernous approach was utilized via a traditional frontotemporal craniotomy with endoscopic assistance. The postoperative course was uneventful with immediate improvement of the patient''s headache. Postoperative magnetic resonance imaging demonstrated complete removal of the tumor. There were no signs of recurrence during a 2-year follow-up period. The endoscope is a useful tool for removing epidermoid tumors from the cavernous sinus and enhances visualization of areas that would otherwise be difficult to visualize with microscopes alone. Endoscopes also help minimize the retraction of neurovascular structures.