碳纤维复合材料人工颅骨板急性期生物相容性的研究

目的 评价碳纤维复合材料人工颅骨板在急性期的生物相容性。方法 制作碳纤维复合材料、含重组人骨形态发生蛋白-2（rhBMP-2）的碳纤维复合材料、钛网、MEM培养基、含有0.64%苯酚的MEM培养基的浸出液，用于测试。采用L929小鼠成纤维细胞进行细胞毒性试验，采用健康ICR小鼠进行急性毒性试验，采用新西兰大白兔耳静脉血进行急性溶血试验，采用白化豚鼠进行皮肤致敏试验。结果 碳纤维复合材料、含rhBMP-2的碳纤维复合材料、钛网浸提液对L929细胞的相对增殖率均在75%以上，细胞毒性1级，无明显细胞毒性；小鼠腹腔注射相应材料的浸提液后，均活动良好，均无不良反应，均无明显急性毒性；碳纤维复合材料、含rhBMP-2的碳纤维复合材料、钛网浸提液溶血率均小于5%，均不引起溶血反应；碳纤维复合材料、含rhBMP-2的碳纤维复合材料、钛网浸提液不引起致敏性。结论 碳纤维复合人工颅骨板急性期生物相容性良好。     

颅脑外伤性癫痫发病的危险因素分析

目的探讨颅脑外伤性癫痫(PTE)发病的危险因素。方法选取我院神经外科2016年1月至2019年10月收治的120例颅脑外伤患者,既往均有癫痫史,分为PTE组和非PTE组各60例。分析两组的临床因素,采用Logistic回归分析PTE发病的危险因素。结果单因素分析结果显示,PTE发病与年龄、严重程度(GCS)、受伤部位、凹陷性颅骨骨折相关(P <0.05),与性别、蛛网膜下腔出血无相关性(P>0.05)。多因素Logistic回归分析结果显示,年龄(OR=0.652, 95%CI:1.246~2.419),严重程度(GCS)(OR=2.041, 95%CI:1.394~4.842)、受伤部位(OR=1.642, 95%CI:2.105~4.378)、凹陷性颅骨骨折(OR=6.548, 95%CI:1.541~3.547)为PTE发病的影响因素。结论年龄、严重程度(GCS)、受伤部位、凹陷性颅骨骨折为PTE发病的影响因素,临床中应针对PTE发病因素进行预防和及时治疗,以提高临床疗效和预后。     

Outcomes,Prognostic Factors and Salvage Treatment for Recurrent Chordoma After Pencil Beam Scanning Proton Therapy at the Paul Scherrer Institute

AimsThe outcome of chordoma patients with local or distant failure after proton therapy is not well established. We assessed the disease-specific (DSS) and overall survival of patients recurring after proton therapy and evaluated the prognostic factors affecting DSS.Materials and methodsA retrospective analysis was carried out of 71 recurring skull base (n = 36) and extracranial (n = 35) chordoma patients who received adjuvant proton therapy at initial presentation (n = 42; 59%) or after post-surgical recurrence (n = 29; 41%). The median proton therapy dose delivered was 74 GyRBE (range 62–76). The mean age was 55 ± 14.2 years and the male/female ratio was about one.ResultsThe median time to first failure after proton therapy was 30.8 months (range 3–152). Most patients (n = 59; 83%) presented with locoregional failure only. There were only 12 (17%) distant failures, either with (n = 5) or without (n = 7) synchronous local failure. Eight patients (11%) received no salvage therapy for their treatment failure after proton therapy. Salvage treatments after proton therapy failure included surgery, systemic therapy and additional radiotherapy in 45 (63%), 20 (28%) and eight (11%) patients, respectively. Fifty-three patients (75%) died, most often from disease progression (47 of 53 patients; 89%). The median DSS and overall survival after failure was 3.9 (95% confidence interval 3.1–5.1) and 3.4 (95% confidence interval 2.5–4.4) years, respectively. On multivariate analysis, extracranial location and late failure (≥31 months after proton therapy) were independent favourable prognostic factors for DSS.ConclusionThe survival of chordoma patients after a treatment failure following proton therapy is poor, particularly for patients who relapse early or recur in the skull base. Although salvage treatment is administered to most patients with uncontrolled disease, they will ultimately die as a result of disease progression in most cases.     

Significance of the simultaneous combined transcranial and endoscopic endonasal approach for prevention of postoperative CSF leak after surgery for lateral skull base meningioma

Lateral skull base meningiomas, particularly sphenoorbital meningiomas, sometimes extend extremely widely into adjacent structures including the paranasal sinuses. For endonasal skull base reconstruction using a vascularized nasoseptal flap for prevention of postoperative cerebrospinal fluid (CSF) leak, the simultaneous combined transcranial and endoscopic endonasal approach was applied for resection of these extensive tumors. We performed a retrospective review of four patients treated with the simultaneous combined transcranial and endoscopic endonasal approach for resection of lateral skull base meningiomas. Preoperative characteristics, tumor extent, extent of resection, complications, and postoperative outcomes were analyzed. The tumor extended into the paranasal sinus, infratemporal fossa, and pterygopalatine fossa in all patients. Extracranial extension into the cavernous sinus or superior orbital fissure was detected in two and three patients, respectively. In one patient without extension into the cavernous sinus and superior orbital fissure, gross total resection was achieved, whereas in the other three patients, subtotal resection was performed, and small residual masses of the tumor remained in the cavernous sinus or superior orbital fissure to minimize the risk of postoperative ocular nerve damage. No patients experienced postoperative CSF leak. The simultaneous combined transcranial and endoscopic endonasal approach is useful for a subgroup of patients with lateral skull base meningiomas for prevention of postoperative CSF leak. Particularly in recurrent cases in which vascularized flaps from the transcranial side are likely unavailable due to prior tumor resection, this combined approach is worth considering depending on tumor extension into the paranasal sinus.     

The Vidian Canal: Radiological Features in Japanese Population and Clinical Implications

The vidian canal (VC), a bony tunnel in which the vidian artery and nerve pass, has been widely known as an important landmark to identify the anterior genu of the petrous carotid artery (AGPCA) especially during lateral extended endoscopic endonasal approachs (LEEEAs). The objectives of this study in the Japanese population are to describe the radiological anatomic features and relationships between VC and its surrounding structures, and discuss the clinical implications. We studied 231 high-resolution computed tomography (CT) scans with a slice thickness of 0.5 mm. All the patients had known sellar or parasellar pathologies but without any involvement of VC. The following VC-related parameters were examined: its length, relationship to AGPCA, course from the pterygopalatine fossa to the carotid canal, its position relative to the medial pterygoid plate and pneumatization pattern of the sphenoid sinus. Mean length of VC is 14.6 mm. There is more tendency of straight-running VC compared to other populations. VC locates infero-lateral to AGPCA in all the cases. The protrusion of VC and the paraclival carotid artery to the sphenoid sinus, as well as well-pneumatization of the sinus is also observed more frequently in almost a half of the population. Surgeons who perform LEEEAs in Japanese patients must know these anatomical features. The characteristics particular to Japanese populations may facilitate better identification of VC and exposure to AGPCA intraoperatively.