Spinal Cord Stimulation for Neuropathic Pain in England From 2010 to 2020: A Hospital Episode Statistics Analysis

ObjectivesSpinal cord stimulation (SCS) is a recognized intervention for the management of chronic neuropathic pain. The United Kingdom National Institute of Health and Care Excellence has recommended SCS as a management option for chronic neuropathic pain since 2008. The aim of this study is to undertake an assessment of SCS uptake across the National Health Service in England up to 2020.Materials and MethodsHospital Episode Statistics were obtained for patients with neuropathic pain potentially eligible for SCS and patients receiving an SCS–related procedure. Data were retrieved nationally and per region from the years 2010–2011 to 2019–2020.ResultsThere were 50,288 adults in England attending secondary care with neuropathic pain in 2010–2011, increasing to 66,376 in 2019–2020. The number of patients with neuropathic pain with an SCS procedure increased on a year-to-year basis until 2018–2019. However, less than 1% of people with neuropathic pain received an SCS device with no evidence of an increase over time when considering the background increase in neuropathic pain prevalence.ConclusionOnly a small proportion of patients in England with neuropathic pain potentially eligible for SCS receives this intervention. The recommendation for routine use of SCS for management of neuropathic pain has not resulted in an uptake of SCS over the last decade.     

啮蚀艾肯菌致鼻咽颅底感染1例报道

目的 总结1例啮蚀艾肯菌引起鼻咽颅底感染的诊疗经验,提高对该菌感染病的认识。方法 回顾性分析1例啮蚀艾肯菌致鼻咽颅底感染患者的病例资料,并结合文献进行讨论。结果 本例患者完善内镜检查、影像学检查以及实验室检查,鼻咽颅底组织2次病理报告均为慢性肉芽肿性炎,经实验室确诊为啮蚀艾肯菌感染,予清创引流、口服抗生素2个月后,患者痊愈,术后随访3个月未复发。结论 鼻咽颅底感染临床少见,临床症状、影像学检查与鼻咽癌相似。啮蚀艾肯菌为罕见致病菌,发病率低。诊治上,需结合病理学、病原学检查明确诊断,及早清创引流、选取合适的抗感染药物。     

内镜经鼻浴缸塞技术在儿童脑脊液鼻漏修补术中的应用

目的探讨内镜经鼻浴缸塞技术在儿童脑脊液鼻漏修补术中的安全性和有效性。方法回顾性分析2016年9月—2019年9月北京儿童医院耳鼻咽喉头颈外科收治的16例脑脊液鼻漏患儿的临床资料。其中男10例,女6例,年龄5~123月龄,中位年龄57.5月龄。患儿常规进行鼻窦薄层CT及MRI检查,并进行了全身麻醉下经鼻内镜浴缸塞技术脑脊液鼻漏修补术。术后定期随访,对手术效果及并发症进行评估。对所有患儿的人口学特点、症状、体征、颅底漏口位置及面积、治疗及预后情况等进行归纳总结。结果16例患儿中,外伤性脑脊液鼻漏7例,先天性脑脊液鼻漏9例。单纯性脑脊液鼻漏2例,合并基底型脑膜脑膨出14例。颅底漏口分别为左侧筛板6例,右侧筛板4例,左侧筛顶2例,右侧筛顶1例,左侧额窦后壁2例,右侧蝶窦顶壁1例。漏口最大直径1~4 mm 4例,5~10 mm 7例,11~20 mm 5例。其中15例手术获得一次性成功,仅1例额窦后壁外伤性脑脊液漏内镜手术修补失败,改由神经外科行开颅修补术。术后随访24~60个月,中位随访时间32.5个月,均未复发或出现并发症。结论内镜经鼻浴缸塞技术法儿童脑脊液鼻漏修补术是一种安全、有效的手术方式,具有操作简便、创伤小、并发症少等优点。     

Utilidad de los colgajos e injertos endonasales en cirugía endoscópica nasosinusal y de base de cráneo. Documento de consenso

IntroductionSkull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery. Many grafts and flaps from the endonasal fossa have been demonstrated to be useful in the control of complications such a cerebrospinal fluid leaks. Review and analysis of these resources are necessary in skull base recontruction to improve outcomes.ObjectivesThe target is to create a consensus document on the use of different endonasal flaps and grafts in the skull base surgery.Material and methodsLiterature review of the most relevant free grafts and vascularized flaps from the endonasal fossa. Analysis using the Delphi method on the use of the different endonasal resources for endoscopic repair of skull base defects.ResultsWe obtained two results: 1) A selection of the most representative flaps and grafts from the endonasal fossa, describing origin, surface and indications, based on a literature review. 2) A consensus document, using Delphi methodology, with general considerations (2), recommendations (10) and limitations (6) of the different endonasal flaps and grafts.ConclusionsWe present the first consensus document in the field of extended endonasal endoscopic surgery using the Delphi method as a working tool. We highlight the usefulness of the nasoseptal flap together with other endonasal flaps and grafts for skull base reconstruction.     

恒牙先天缺失患者蝶鞍和颅底的头影测量研究

目的 探究不同程度恒牙先天缺失患者蝶鞍与颅底的大小及形态差异。 方法 选取2020—2021年就诊于四川大学华西口腔医院正畸科的322例患者为研究对象,依据先天缺牙数目将患者分为3组：对照组（无恒牙先天缺失,112例）;试验Ⅰ组（先天缺失1~2颗恒牙,104例）;试验Ⅱ组（先天缺失3颗及以上恒牙,106例）。使用Uceph头影测量软件对每位患者头颅侧位片的蝶鞍的长度、深度和直径以及颅底相关线性和角度参数进行测量。对每位患者的蝶鞍形态进行判定。采用SPSS 21.0软件对数据进行统计学分析。 结果 3组的蝶鞍长度、深度、直径以及颅底相关的线性和角度参数差异均无统计学意义（P>0.05）。3组的鞍桥发生率的差异有统计学意义（P=0.013）,试验组高于对照组（P<0.05）,试验Ⅰ组和试验Ⅱ组差异无统计学意义（P>0.05）。 结论 虽然蝶鞍的线性大小及颅底特征在正常人和先天缺牙患者中未见明显差异,但在先天缺牙患者中鞍桥发生率更高,提示该人群的蝶鞍解剖学形态可能异常。