简介：无

简介：AbstractObjective:There has been a significant shift from open craniofacial resection of the anterior skull base to endoscopic approaches that accomplish the same outcomes in tumor ablation. However, when open resection is required, free flap reconstruction is often necessary to provide sufficient well-vascularized tissue for optimal wound healing as well as providing adequate tissue bulk for cosmesis. This articleaims to providea focused review of free flaps most commonly used in anterior skull base reconstruction.Methods:This is a state-of-the-art review based on expert opinion and previously published reviews and journal articles, queried using PubMed and Google Scholar.Results & conclusion:Anterior skull base reconstruction via free tissue transfer is imperative in limiting complications and promoting healing, particularly with large defects, post-radiation, and in at-risk patients. The type of free flap utilized for a particular anterior skull base reconstruction should be tailored to the patient and nature of the disease. This review offers insight into the numerous reconstructive options for the free flap surgeon.

简介：AbstractObjective:To describe and assess the repair technique and perioperative management for cerebrospinal fluid (CSF) leak resulting from extensive anterior skull base fracture via extradural anterior skull base approach.Methods:This was a retrospective review conducted at the Department of Neurosurgery of the Shanghai Tenth People's Hospital from January 2015 to April 2020. Patients with traumatic CSF rhinorrhea resulting from extensive anterior skull base fracture treated surgically via extended extradural anterior skull base approach were included in this study. The data of medical and radiological records, surgical approaches, repair techniques, peritoperative management, surgical outcome and postoperative follow-up were analyzed. Surgical repair techniques were tailored to the condition of associated injuries of the scalp, bony and dura injuries and associated intracranial lesions. Patients were followed up for the outcome of CSF leak and surgical complications. Data were presented as frequency and percent.Results:Thirty-five patients were included in this series. The patients’ mean age was 33 years (range 11-71 years). Eight patients were treated surgically within 2 weeks; while the other 27 patients, with prolonged or recurrent CSF rhinorrhea, received the repair surgery at 17 days to 10 years after the initial trauma. The mean overall length of follow-up was 23 months (range 3-65 months). All the patients suffered from frontobasal multiple fractures. The basic repair tenet was to achieve watertight seal of the dura. The frontal pericranial flap alone was used in 20 patients, combined with temporalis muscle and/or its facia in 10 patients. Free fascia lata graft was used instead in the rest 5 patients. No CSF leak was found in all the patients at discharge. There was no surgical mortality in this series. Bilateral anosmia was the most common complication. At follow-up, no recurrent CSF leak or meningitis occurred. No patients developed mucoceles, epidural abscess or osteomyelitis. One patient ultimately required ventriculoperitoneal shunt because of progressive hydrocephalus.Conclusion:Traumatic CSF rhinorrhea associated with extensive anterior skull base fractures often requires aggressive treatment via extended intracranial extradural approach. Vascularized tissue flaps are ideal grafts for cranial base reconstruction, either alone or in combination with temporalis muscle and its fascia—fascia lata sometimes can be opted as free autologous graft. The approach is usually reserved for patients with traumatic CSF rhinorrhea in complex frontobasal injuries.

简介：AbstractObjective:Endoscopic repair of large anterior skull base (ASB) defects has excellent results when using multilayered repairs with a nasoseptal flap. However, in extensive intranasal tumors, a nasoseptal flap may not always be available. One alternative option is a flexible single-layer ASB repair. Initial studies indicate low cerebrospinal fluid leak rates with a single-layer repair. However, the level of frontal lobe support, particularly the propensity for a significant inferior displacement of the frontal lobe, is not known. The goal of this study is to determine the frontal lobe position after single-layer acellular dermal allograft repair in large ASB defects.Study Design:Retrospective cohort study.Setting:Tertiary care medical center.Subjects and Methods:This cohort study compares the frontal lobe position in adults who underwent endoscopic endonasal ASB tumor resection and single-layer cadaveric dermal matrix repair (ASB cohort) with control subjects without intracranial abnormalities (control cohort). The ASB cohort includes subjects with an ASB defect of ≥5 cm anterior/posterior and ≥1.5 cm wide and who had imaging at least 2 months after surgery. The frontal lobe position is measured on sagittal CT/MRI using a reference line from the base of the sella to the nasion. A value of zero indicates that the inferior-most aspect of the frontal lobe is at the level of the nasion-sellar line. A positive value indicates that the frontal lobe is inferior to the nasion-sellar line. The ASB cohort frontal lobe position is compared with the control cohort using the Mann-Whitney U test. A priori we set an absolute difference of 5 mm as a clinically significant difference.Results:The ASB cohort includes 47 subjects who are 57% male with an average age of 60 years (range: 31-89 years). The most common ASB pathology is esthesioneuroblastoma (n = 21) and 81% of the ASB cohort had postoperative radiation. The control cohort includes 20 subjects who are 60% male, with a mean age of 45 years (range: 19-74 years). The majority of controls underwent imaging for head trauma (n = 13). The ASB mean frontal lobe position is -0.2 mm superior to the nasion-sellar line (range: -9.2 to 10.4 mm), while the control's mean frontal lobe position is 1.1 mm inferior to the nasion-sellar line. This difference is not statistically significant (P= 0.13) and does not reach our a priori definition of clinical significance. The frontal lobe position of ASB subjects who had radiation is closer to the nasion-sellar line as compared with those who did not undergo radiation.Conclusions:Single-layer acellular dermal graft repair maintains frontal lobe support and position in large ASB defects.

简介：<正>Theskullbasegenerallyreferstotheanterior,middleandposteriorcranialfossaandstructuresontheoutsidesideoftheseskullareas.Thecranialroofandskullbaseareseparatedbyalineconnectingtheexternaloccipitalprotuberance,parietalnotchandsupraorbitalridge[1].Theskullbasesupportsthebrainabove,isconnectedto

简介：AbstractPediatric skull base lesions are complex and challenging disorders. Safe and comprehensive management of this diverse group of disorders requires the expertise of an experienced multidisciplinary skull base team. Adult endoscopic skull base surgery has evolved due to technologic and surgical advancements, multidisciplinary team approaches, and continued innovation. Similar principles continue to advance the care delivered to the pediatric population. The approach and management of these lesions varies considerably based on tumor anatomy, pathology, and surgical goals. An understanding of the nuances of skull base reconstruction unique to the pediatric population is critical for successful outcomes.

简介：AbstractBackground:Chordomas are locally invasive neoplasms, arising from notochordal remnants and can appear anywhere along the axial skeleton. Local recurrences are common, and distant metastases may occur years after the initial presentation.Methods:Literature review of current treatment strategies for chordomas of the skull base.Results:Surgery is the mainstay of treatment and complete resection has paramount importance for prognosis. When complete resection is not achieved recurrent disease is common. The anatomical complexity of the skull base makes resection complex. Endonasal endoscopic approaches to the clivus has become increasingly favored in recent years although addressing reconstruction of the skull base to prevent CSF leak may be challenging. Evidence suggests that radiotherapy should not be considered as a primary single modality when trying to achieve cure of the disease. Nonetheless, immediate post-operative radiotherapy improves survival. Many strategies have been suggested to preserve sensitive vital structures in the skull base during treatment but as for survival there is no evidence of advantage when comparing adjuvant therapy with photon radiotherapy, gamma knife surgery, proton beam therapy, and carbon ion radiation therapy. There is no evidence to support cytotoxic chemotherapy in the treatment of chordomas but targeted therapies have started to show promise. Several optional molecular targets exist. Brachyury is overexpressed in 95% of chordomas but not in other mesenchymal neoplasms. However, its precise role in chordoma pathogenesis is currently unclear, and its cellular location in the nucleus makes it difficult to target. The inhibition of brachyury in chordoma cell lines induces growth arrest and apoptosis. This does not have clinical application to date. There are retrospective results with different molecular targeted therapies for advanced chordomas with some effectiveness.Conclusion:Despite improvements made in the past 10 years in our knowledge of chordoma biology, available therapies still offer a limited benefit. There is an unmet need for new therapeutic options for patients with advanced disease. Therefore, patients with advanced disease should be encouraged to participate in clinical trials when and where available.

简介：ObjectivesConventionalapproachesforremovaloflateralskullbasetumors,includingtransmandibular,infratemporalfossa,preauriculartranszygmaticsubtemporalapproaches,aremajorinvasiveproceduresthatoftensacrificehearingandcauseabnormalocclusionandcosmeticdefects.Reportsofthetranscervicalapproachforresectionofskullbasetumorsarerare,althoughitwasdescribedforresectionofclivalchordomasinasearlyas1966.Thepurposeofthisstudyistoreviewourexperiencesinmanagementoflateralskullbasetumorsusingthetranscervicalapproach.StudyDesignRetrospectivechartreview.MethodsSixlateralskullbasetumorcasestreatedwithtranscervicalapproachprocedureswerereviewed,includingthemedicalrecords.ResultsTherewere4malesand2females.Agerangedfrom12through52years.Histopathologicaldiagnosesincludedmalignantschwannoma(n=1),malignantcarotidbodytumor(n=1),heamangioma(n=1),schwannoma(n=2)andpleomorphicadenoma(n=1).Transcervicaltechniqueswereusedinallcaseswiththeuseofmicroscopeinthelateralskullbasearea.Completetumorremovalwasachievedinallcases.Postoperativeradiotherapywasimplementedin1caseofmalignantschwannomaand1caseofmalignantcarotidbodytumor.Jugularforamensyndromeoccurredasasurgicalcomplicationin1caseofmalignantSchwannomaofthevagusnerve.Therewasnotumorrecurrenceduringthe10-42monthfollow-upperiod.ConclusionComparedwithconventionalapproaches,thetranscervicalapproachprovidesaeasy,safe,minimalinvasiveandeffectiveprocedureforremovalofselectedlateralskullbasetumors.

简介：AbstractObjective:Proficiency in endoscopic endonasal skull base surgery requires both substantial baseline training and progressive lifelong learning. Endoscopic simulation models continue to evolve in an effort to optimize trainee education and preoperative preparation and improve surgical outcomes. The current scoping review systematically reviews all available literature and synthesizes the current paradigms of simulation models for endoscopic skull base surgery training and skill enhancement.Methods:In accordance with Preferred Reporting Items for Systemic Review and Meta-Analyses guidelines, we systematically searched PubMed, Embase, CINAHL, and Cochrane databases. Studies were categorized according to the type of simulation models investigated.Results:We identified 238 unique references, with 55 studies ultimately meeting inclusion criteria. Of these, 19 studies described cadaveric dissection models, 17 discussed three-dimensional (3D) printed models, 14 examined virtual surgical planning and augmented reality-based models, and five 5 articles described task trainers.Conclusions:There are a wide variety of simulation models for endoscopic skull base surgery, including high-fidelity cadaveric, virtual reality, and 3D-printed models. These models are an asset for trainee development and preoperative surgical preparation.

简介：BACKGROUND:Wedevelopedanimage-guidedrobotsystemtoprovidemechanicalassistanceforskullbasedrilling,whichisperformedtogainaccessforsomeneurosurgicalinterventions,suchastumourresection.Themotivationforintroduc-ingthisrobotwastoimprovesafetybypreventingthesurgeonfromaccidentallydamagingcriticalneurovascularstructuresdur-

简介：无

简介：AbstractObjectives:Patients with obstructive sleep apnea (OSA) are at increased risk of perioperative and postoperative morbidity. The use of continuous positive airway pressure (CPAP) in the perioperative period may be of potential benefit. However, among patients who have undergone endonasal skull base surgery, many surgeons avoid prompt re-initiation of CPAP therapy due to the theoretical increased risk of epistaxis, excessive dryness, pneumocephalus, repair migration, intracranial introduction of bacteria, and cerebrospinal fluid (CSF) leak. The objective of this article is to review the most up-to-date literature regarding when it is safe to resume CPAP usage in the patient undergoing endonasal skull base surgery.Data Sources and Methods:This review combines the most recent literature as queried through PubMed regarding the safety of CPAP resumption following endonasal skull base surgery.Results:Recent surveys of skull base surgeons demonstrate little consensus regarding the post-operative management of OSA. Recent cadaveric studies suggest that approximately 85% of delivered CPAP pressures are transmitted to the sphenoid sinus. Further, at frequently prescribed CPAP pressure settings, common sellar reconstruction techniques maintain their integrity while preventing very little transmission of pressure into the sella. In small retrospective case series, patients with OSA who received CPAP immediately following transsphenoidal pituitary surgery had similar rates of surgical complications as OSA patients who did not receive CPAP in the immediate post-operative period. Concerns of reinitiating CPAP too early, such as the development of pneumocephalus, rarely develop.Conclusions:There remains a paucity of objective data regarding when it is safe to resume CPAP following endonasal skull base surgery. Recent cadaveric studies and small retrospective case series suggest that it may be safe to resume CPAP earlier than is often practiced following endonasal skull base surgery.

简介：AbstractWe reported a case of a 32 years old male presenting with a perforating gunshot injury in craniocerebral region 3 h after the assault. The bullet entered above the right zygomatic arch, travelling through the coronal plane, and exited from the left zygomatic arch. The patient was fully conscious at presentation and developed facial nerve palsy during his hospital stay. Non-contrast CT scan of the head revealed fractures of the right orbit, bilateral maxilla, bilateral pterygoid plates, ethmoid air cells, vomer and left zygoma, and without any cerebral damage. He was treated conservatively and the facial palsy was resolved. The patient survived without any complications. Such case has not been described in the available literature till date.

简介：AbstractBackground:Endonasal endoscopic skull base surgery has undergone rapid technological developments and is now widely performed, but its strengths and weaknesses deserve further investigation and deliberation. This study was performed to investigate the surgical indications, complications, and technical advantages and disadvantages of endonasal endoscopic skull base surgery.Methods:The clinical data of 1886 endoscopic endonasal skull base surgeries performed in our ward at Beijing Tiantan Hospital from June 2006 to June 2016 were retrospectively analyzed.Results:One thousand ninety-three (73.4%, 1490) pituitary adenomas, 54 (24.9%, 217) chordomas, 28 (80.0%, 35) craniopharyngiomas, and 15 (83.3%, 18) meningiomas underwent total resection. Two patients died postoperatively, both having pituitary adenomas. Other postoperative complications included olfactory disorders (n = 226, 11.9%), postoperative cerebrospinal fluid leakage (n = 78, 4.1%), hypopituitarism (n = 74, 3.9%), diabetes insipidus (n = 64, 3.4%), intracranial infection (n = 36, 1.9%), epistaxis (n = 24, 1.3%), vascular injury (n = 8, 0.4%), optic nerve injury (n = 8, 0.4%), and oculomotor movement impairment (n = 4, 0.2%). In total, 1517 (80.4%) patients were followed up for 6 to 126 months (average, 42.5 months) postoperatively. A total of 196 (13.2%) pituitary adenomas and 13 (37.1%) craniopharyngiomas recurred but no meningiomas recurred. Chordomas recurred in 97 (44.7%) patients, in whom 5-year survival rate was 65%.Conclusion:Endoscopic surgery is an innovative surgical technique and the first choice for most midline extradural lesions such as chordomas, and an excellent choice for pituitary adenomas. It probably will be a good technique for many kinds of craniopharyngiomas and a common technique for most of skull base meningiomas, so the surgical indications of these cases should be chosen carefully to make good use of its respective advantages.

简介：Althoughthyroidcarcinomaisarelativelycommonformofmalignancy,metastaticspreadtotheskullisrare.Here,wereportacaseofpapillarythyroidcarcinomawithfrontalandparietalmetastasis.A61-year-oldChinesewomanpresentedwithaoneyearhistoryofagrowingmassonthecenterofthefrontalandparietalbone,initiallythoughttobemeningioma.Biopsyoftheskullbasemassafterintracalvariumexcision,indicatedatumorofthyroidorigin.Onemonthlaterthepatientunderwentatotalthyroidectomy.Pathologicalexaminationconfirmedadiagnosisofpapillarythyroidcarcinomawithfrontalandparietalbonemetastasis.Basedonthisexperience,thekeytosuccessfulmanagementoftheskullmetastasisofthyroidcarcinomaispromptdiagnosisandappropriatetreatment.Skullmetastasisshouldbeconsideredattheoutsetoftheclinicalcourseofpapillarythyroidcancer.Tofacilitatethis,patientsshouldbemeticulouslyinvestigatedbyamultidisciplinaryteamtoimprovequalityoflife.

简介：在古老的中国，魏王心血来潮决定修建一座极高的塔，并将其命名为——通天塔。

简介：TheSINOPECJinanBranchCompanybyadoptingtheprocessflowschemeinvolvingsolventrefining-hydrotreating-solventdewaxing-clayrefiningandrelevanttechnologydevelopedbyRIPPhasconstructedtheHVIIIlubebaseoilsproductionunit,whichcameonstreaminOctober-November2012.Thisunithasmanufacturedsuccessivelyfromthedistillatesof#3and#4drawlines

简介：Purpose:Thepurposeofthisstudywastocompare4techniquesforarrivalatabaseaftersprintingmaximallytoreachit:slidinghead-first,slidingfeet-first,runningthroughthebasewithoutslowing,andstoppingonthebase.Asecondarypurposeofthestudywastodetermineanyadvantagetheremaybetodivingintofirstbasetoarrivesoonerthanrunningthroughthebase.Methods:Twohigh-definitionvideocameraswereusedtocapture3-dimensionalkinematicsofslidingtechniquesof9intercollegiatebaseballplayers.Anothervideocamerawasusedtotimerunsfromfirstbasetosecondin4counterbalancedconditions:runningthroughthebase,slidinghead-first,slidingfeet-first,andrunningtoastop.Mathematicalmodelingwasusedtosimulatedivingtofirstbasesuchthattheslidewouldbeginwhenthehandtouchesthebase.Results:Baseduponoverallresults,thequickestwaytothebaseisbyrunningthroughit,followedbyhead-first,feet-first,andrunningtoastop.Conclusion:Therewasanon-significanttrendtowardanadvantagefordivingintofirstbaseoverrunningthroughit,butmoreresearchisneeded,andeveniftheadvantageisreal,therisksofexecutingthistechniqueprobablyoutweightheminisculegain.

简介：Haemangiopericytoma(HPC)isararevasculartumorwithborderlinemalignancy,considerablehistologicalvariability,andunpredictableclinicalandbiologicalbehavior.HPCcanpresentadiagnosticchallengebecauseofitsindeterminateclinical,radiological,andpathologicalfeatures.HPCgenerallypresentsinadulthoodandisequallyfrequentinbothsexes.HPCcanariseinanysiteinthebodyasaslowlygrowingandpainlessmass.TheprecisecelltypeoriginofHPCisuncertain.OnethirdofHPCsoccurintheheadandneckareas.Exceptionalcasesofhemangioblastomaarisingoutsidetheheadandneckareashavebeenreported,butlittleisknownabouttheirclinicopathologicandimmunohistochemicalfeatures.Thisstudyreportsonacaseofalargesacro-anteriorHPCina65-year-oldmale.

简介：针灸是在中国的普通处理方法之一，并且它的临床的有效性现在在许多国家被接受了或它全球被扩展了并且作为一种医药形式适用。在中国，临床的实践证明了针灸的指示在神经系统，内分泌系统，免疫系统，循环系统，消化系统，呼吸系统，泌尿系统，生殖系统，血系统，感觉系统和马达包括超过300混乱系统，并且指示逐渐地与针灸的临床的应用程序的开发被创造。自从1949，中国把大重要性纳入了中国药原因的发展，投资了大量钱资助中国药，并且完成了多产的结果，到，作为结果在世界上维持针灸的主角。前面的研究证明了那针灸在临床的实践是有效的，并且它由象nerve-endocrine-im-munenerwork那样的许多过程在双向规定工作，它无疑显示出针灸效果的客观性。上面的研究成就越过世界引起了广泛的注意。