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Clinical application of reserved gastric tube in neuroendoscopic endonasal surgery for pituitary tumor

World Journal of Clinical Oncology 2024年第3期15卷 411-418页

作者： Xi Chen Long-Yao Zhang Zhi-Feng Wang Yi Zhang Yu-Hua Yin Xue-Jian Wang Department of Nursing Affiliated Hospital 2 of Nantong UniversityNantong 226000Jiangsu ProvinceChina Department of Neurosurgery Affiliated Hospital 2 of Nantong UniversityNantong 226000Jiangsu ProvinceChina Department of Neurosurgery Renji HospitalShanghai Jiao Tong UniversityShanghai 226000China

BACKGROUND The neuroendoscopic approach has the advantages of a clear operative field,convenient tumor removal,and less damage,and is the development direction of modern neurosurgery.At present,transnasal surgery for sphenoidal pituitary tumor is widely used.But it has been found in clinical practice that some patients with this type of surgery may experience post-operative nausea and vomiting and other discomforts.AIM To explore the effect of reserved gastric tube application in the neuroendoscopic endonasal resection of pituitary tumors.METHODS A total of 60 patients who underwent pituitary adenoma resection via the endoscopic endonasal approach were selected and randomly divided into the experimental and control groups,with 30 in each group.Experimental group:After anesthesia,a gastric tube was placed through the mouth under direct vision using a visual laryngoscope,and the fluid accumulated in the oropharynx was suctioned intermittently with low negative pressure throughout the whole process after nasal disinfection,during the operation,and when the patient recovered from anesthesia.Control group:Given the routine intraoperative care,no gastric tube was left.The number of cases of nausea/vomiting/aspiration within 24 h post-operation was counted and compared between the two groups;the scores of pharyngalgia after waking up,6 h post-operation,and 24 h postoperation.The frequency of postoperative cerebrospinal fluid leakage and intracranial infection were compared.The hospitalization days of the two groups were statistically compared.RESULTS The times of postoperative nausea and vomiting in the experimental group were lower than that in the control group,and the difference in the incidence of nausea was statistically significant(P<0.05).After the patient woke up,the scores of sore throat 6 h after the operation and 24 h after operation were lower than those in the control group,and the difference was statistically significant(P<0.05).The number of cases of postoperative cerebrospinal fluid leakage and intracran

关键词： neuroendoscopy Endonasal approach Pituitary tumor Reserved gastric tube Nausea Vomiting Aspiration Complications

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Efficacy evaluation of neuroendoscopy vs burr hole drainage in the treatment of chronic subdural hematoma:An observational study

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World Journal of Clinical Cases 2022年第35期10卷 12920-12927页

作者： Xue-Jian Wang Yu-Hua Yin Zhi-Feng Wang Yi Zhang Cheng Sun Zhi-Ming Cui Department of Neurosurgery Affiliated Hospital 2 to Nantong UniversityNantong 226001Jiangsu ProvinceChina Department of Neurosurgery Renji HospitalShanghai Jiao Tong UniversityShanghai 200000China Jiangsu Provincial Key Laboratory of Nerve Regeneration Nantong UniversityNantong 226001Jiangsu ProvinceChina Department of Orthopedic Affiliated Hospital 2 to Nantong UniversityNantong 226001Jiangsu ProvinceChina

BACKGROUND Chronic subdural hematoma(CSDH)is a common disease in neurosurgery.The traditional treatment methods include burr hole drainage,bone flap craniectomy and other surgical methods,and there are certain complications such as recurrence,pneumocephalus,infection and so on.With the promotion of neuroendoscopic technology,its treatment effect and advantages need to be further evaluated.AIM To study the clinical effect of endoscopic small-bone approach in CSDH.METHODS A total of 122 patients with CSDH admitted to our hospital from August 2018 to August 2021 were randomly divided into two groups using the digital table method:the neuroendoscopy group(n=61 cases)and the burr hole drainage group(n=61 cases).The clinical treatment effect of the two groups of patients with CSDH was compared.RESULTS At the early postoperative stage(1 d and 3 d),the proportion of 1/2 re-expansion of brain tissue in the hematoma cavity and the proportion of complete reexpansion was higher in the neuroendoscopy group than in the burr hole drainage group,and the difference between the two groups was statistically significant(Pneuroendoscopy group was lower than that in the burr hole drainage group,and the difference between the two groups was statistically significant(Pneuroendoscopy group.CONCLUSION The neuroendoscopic approach for the treatment of CSDH can clear the hematoma under direct vision and separate the mucosal lace-up.The surgical effect is apparent with few complications and definite curative effect,which is worthy of clinical promotion and application.

关键词： neuroendoscopy Small bone window approach Chronic subdural hematoma Curative effect Burr hole drainage

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neuroendoscopy Combined with Lateral Ventricle Drainage and Urokinase Infusion in the Treatment of 20 Patients with Hypertensive Intraventricular Hemorrhage

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Journal of Cerebrovascular Disease 2020年第2期3卷 10-14页

作者： Guo-Dong Qian Xiao-Xu Shen Jian Xu Wei-Hua Xu Dong Zhao Yang Wang Qi Liu Department of Neurosurgery The First Affiliated Hospital of Medical CollegeShihezi UniversityShihezi 832008China

Objective:To explore the clinical efficacy of neuroendoscopy combined with lateral ventricle drainage and urokinase infusion for the treatment of hypertensive intraventricular hemorrhage.Methods:A retrospective analysis of 20 patients diagnosed with intraventricular hemorrhage between March 2017 and August 2018 at the First Affiliated Hospital of Medical College,Shihezi University(Shiohezi,China)was performed.While actively treating primary lesions,20 patients with intraventricular hemorrhage were selected and treated using minimally invasive neuroendoscopic removal of intraventricular hematoma combined with lateral ventricular drainage and urokinase perfusion according to each patient’s condition.Results:One day after surgery,head computed tomography examination revealed that>50% of the hematoma in the lateral ventricle was removed in 14 cases,and 20%-50% of the hematoma in the other 6 cases.After follow-up,13 patients exhibited satisfactory recovery,5 died(3 due to lung infection,1 due to intracranial infection,and 1 due to multiple organ failure),and 2 were in a vegetative state.Conclusion:neuroendoscopy should be used as much as possible in treating intraventricular hemorrhage given its advantages of minimal injury,complete removal of hematoma,high safety,and wide clinical applicability.

关键词： neuroendoscopy Intraventricular hemorrhage Lateral ventricle drainage Urokinase perfusion

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neuroendoscopy in Epilepsy Surgery

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World Journal of Neuroscience 2016年第2期6卷 114-118页

作者： Oscar Humberto Jimenez-Vazquez Norma Nagore Department of Neurosurgery State General Hospital Morelia México Nagore Norma Facultad de QFB UMSNH Morelia México

Epilepsy surgery has constantly evolved in various fields of knowledge. Surgical criteria have shifted from standard procedures to individualized forms of treatment, depending on physiological tests and specific imagenology findings in an individual patient. New instruments and applications based upon older instruments have been described in the treatment of epilepsy surgery, including the use of endoscopes. Frequent indications of neuroendoscopy in epilepsy surgery have been mostly to assist in open procedures, particularly when fluid-filled spaces are present within the surgical field, such as cystic parasites, tumors, arachnoid, or other types of cysts. Other indications certainly include cases of temporal lobe epilepsy, where ventricular exploration precedes intraventricular electrode placing as a tool to localize epileptogenic zones. Although described several years ago, there has been a recent trend in performing endoscopy-assisted section of the corpus-callosum in patients with generalized seizures. As neurosurgical instruments and techniques continue their progress, endoscopy will be included more frequently as part of the armamentarium in epilepsy surgery.

关键词： neuroendoscopy Epilepsy Surgery Intracranial Cysts

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Endoscopic surgery versus craniotomy in the treatment of spontaneous intracerebral hematoma:a systematic review and meta-analysis

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Chinese Neurosurgical Journal 2023年第1期9卷 39-50页

作者： Xiaolin Du Xiaoning Lin Cheng Wang Kun Zhou Yigong Wei Xinhua Tian Department of Neurosurgery The Jinyang Hospital Affiliated to Guizhou Medical UniversityGuiyang 550084China Department of Neurosurgery Zhong Shan hospital Xiamen UniversityXiamen 361012China

Background:Spontaneous intracerebral hemorrhage(SICH)has high morbidity and mortality,with no clear standard of treatment available.Compared with the craniotomy approach,neuroendoscopy is a relatively minimally invasive treatment method,and may be an efficient alternative.Therefore,this meta-analysis aimed to assess the clinical efficacy of neuroendoscopy and craniotomy in SICH patients.Methods:The electronic databases Web of Science,PubMed,EmBase,MEDLINE,and the Cochrane Library were systematically searched.According to the PRISMA template,we finally selected and analyzed 14 eligible studies that evaluated neuroendoscopy versus craniotomy.Primary outcomes included operation time,intraoperative blood loss volume,evacuation rate,residual hematoma,complications,hospital stay duration,clinical outcomes,and other parameters.Results:A total of 4 randomized controlled trials(RCTs)and 10 retrospective studies(non-RCTs)involving 1652 patients were included in the final analysis.In the neuroendoscopy(NE)group,operation time(p<0.00001),intraoperative blood loss volume(p<0.0001),hematoma evacuation rate(p=0.0002),complications(p<0.00001),hospitalization days(p=0.004),and mortality(p<0.0001)were significantly different from those of the craniotomy(C)group,with a higher rate of good recovery compared with the craniotomy group(P<0.00001).Conclusions:These findings suggest that patients with SICH and physicians may benefit more from neuroendoscopic surgery than craniotomy.

关键词： Intracerebral hematoma neuroendoscopy Craniotomy

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“In situ bone flap” combined with vascular pedicled mucous flap to reconstruction of skull base defect

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World Journal of Clinical Cases 2023年第29期11卷 7053-7060页

作者： Ming Qian Xi Chen Long-Yao Zhang Zhi-Feng Wang Yi Zhang Xue-Jian Wang Department of Neurosurgery Affiliated Hospital 2 of Nantong UniversityNantong 226000Jiangsu ProvinceChina Department of Nursing Affiliated Hospital 2 of Nantong UniversityNantong 226001Jiangsu ProvinceChina Department of Neurosurgery Nantong Clinical Medical CollegeKangda CollegeNanjing Medical UniversityNantong 226000Jiangsu ProvinceChina

BACKGROUND At present,neuroendoscopy technology has made rapid development,and great progress has been made in the operation of lesions in the saddle area of the skull base.However,the complications of cerebrospinal fluid and intracranial infection after the operation are still important and life-threatening complications,which may lead to poor prognosis.AIM To investigate the method of in situ bone flap combined with nasal septum mucosal flap for reconstruction of enlarged skull base defect by endonasal sphenoidal approach and to discuss its application effect.METHODS Clinical data of 24 patients undergoing transnasal sphenoidal endoscopic approach in the Department of Neurosurgery,Affiliated 2 Hospital of Nantong University from January 2019 to December 2022 were retrospectively analyzed.All patients underwent multi-layer reconstruction of skull base using in situ bone flap combined with nasal septum mucosa flap.The incidence of intraoperative and postoperative cerebrospinal fluid leakage and intracranial infection were analyzed,and the application effect and technical key points of in situ bone flap combined with nasal septum mucosa flap for skull base bone reconstruction were analyzed.RESULTS There were 5 cases of high flow cerebrospinal fluid(CSF)leakage and 7 cases of low flow CSF leakage.Postoperative cerebrospinal fluid leakage occurred in 2 patients(8.3%)and intracranial infection in 2 patients(8.3%),which were cured after strict bed rest,continuous drainage of lumbar cistern combined with antibiotic treatment,and no secondary surgical repair was required.The patients were followed up for 8 to 36 months after the operation,and no delayed cerebrospinal fluid leakage or intracranial infection occurred during the follow-up.Computed tomography reconstruction of skull base showed satisfactory reconstruction after surgery.CONCLUSION The use of in situ bone flap combined with vascular pedicled mucous flap to reconstruction of skull base defect after endonasal sphenoidal approach under neuroendoscopy has a lower

关键词： In situ bone flap Nasal septum mucosa flap Multilayer reconstruction Skull base reconstruction neuroendoscopy Endonasal sphenoidal approach

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Unilateral Bone Window Cerebral Falx Incision of Bilateral Frontal Lobes Cerebral Contusion and Laceration under neuroendoscopy and Literature Review

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Open Journal of Modern Neurosurgery 2021年第3期11卷 164-170页

作者： Gang Yang Shaojun Yang Chao Gu Chenbing Wang Lulu Weng Department of Neurosurgery Zhuji Affiliated Hospital of Shaoxing University Shaoxing China

Background: Bilateral frontal lobes cerebral contusion and laceration is one unique brain injury in neurosurgery department. It is characteristic of recessive attacking and develops quickly. The unilateral cerebral falx incision is a new minimally invasive surgery that can solve bilateral frontal lobes cerebral contusion and laceration in one surgery. However, it has some limitations in removal of contralateral frontal hematoma and hemostasis due to the limited field of view under the microscope. The unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy can acquire a good illumination and field of view. This is beneficial to complete removal of contralateral hematoma, effective hemostasis and retaining brain tissue functions to the maximum extent. Case Presentation: The patient, a 55-year-old man, was hospitalized for “consciousness disorder by 12 h because of car accident”. Physical Examination: Coma, GCS score of E1V2M5, bilateral pupil diameter of 2 mm, presence of light response, contusion of scalp at the left top, peripheral dysphoria and bilateral Bartter syndrome negative. The patient has a history of non-traumatic cerebral stroke 3 years ago. Head CT: Longitudinal fracture of frontal parietal occipital bone, bilateral frontal lobes contusion and laceration, subarachnoid hemorrhage. Diagnosis: Bilateral frontal lobes contusion and laceration, longitudinal fracture of frontal parieta

关键词： neuroendoscopy Cerebral Falx Incision Bilateral Frontal Lobes Cerebral Contusion and Laceration

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Application of neuroendoscopic surgical techniques in the assessment and treatment of cerebral ventricular infection

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Neural Regeneration Research 2019年第12期14卷 2095-2103页

作者： Feng Guan Wei-Cheng Peng Hui Huang Zu-Yuan Ren Zhen-Yu Wang Ji-Di Fu Ying-Bin Li Feng-Qi Cui Bin Dai Guang-Tong Zhu Zhi-Yong Xiao Bei-Bei Mao Zhi-Qiang Hu Department of Neurosurgery Beijing Shijitan Hospital Capital Medical University Beijing China Department of Neurosurgery Peking Union Medical College Hospital Beijing China Department of Neurosurgery Peking University Third Hospital Peking University Beijing China Department of Neurosurgery Beijing Tongren Hospital Capital Medical University Beijing China Department of Neurosurgery the Second Affiliated Hospital of Nanjing Medical University Nanjing Jiangsu Province China Department of Neurosurgery Beijing Liangxiang Hospital Beijing China

Cerebral ventricular infection (CVI) is one of the most dangerous complications in neurosurgery because of its high mortality and disability rates. Few studies have examined the application of neuroendoscopic surgical techniques (NESTs) to assess and treat CVI. This multicenter, retrospective study was conducted using clinical data of 32 patients with CVI who were assessed and treated by NESTs in China. The patients included 20 men and 12 women with a mean age of 42.97 years. NESTs were used to obliterate intraventricular debris and pus, fenestrate or incise the intraventricular compartment and reconstruct cerebrospinal fluid circulation, and remove artificial material. Intraventricular irrigation with antibiotic saline was applied after neuroendoscopic surgery (NES). Secondary hydrocephalus was treated by endoscopic third ventriculostomy or a ventriculoperitoneal shunt. Neuroendoscopic findings of CVI were used to classify patients into Grade Ⅰ(n = 3), Grade Ⅱ(n = 13), Grade Ⅲ(n = 10), and Grade Ⅳ(n = 6) CVI. The three patients with grade ⅠCVI underwent one NES, the 23 patients with grade Ⅱ/Ⅲ CVI underwent two NESs, and patients with grade Ⅳ CVI underwent two (n = 3) or three (n = 3) NESs. The imaging features and grades of neuroendoscopy results were positively related to the number of neurosurgical endoscopic procedures. Two patients died of multiple organ failure and the other 30 patients fully recovered. Among the 26 patients with secondary hydrocephalus, 18 received ventriculoperitoneal shunt and 8 underwent endoscopic third ventriculostomy. There were no recurrences of CVI during the 6- to 76-month follow-up after NES. Application of NESTs is an innovative method to assess and treat CVI, and its neuroendoscopic classification provides an objective, comprehensive assessment of CVI. The study trial was approved by the Institutional Review Board of Beijing Shijitan Hospital, Capital Medical University, China.

关键词： nerve regeneration neuroendoscopy surgery cerebral ventricular infection assessment treatment hydrocephalus irrigation neural regeneration

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Application of osteoinductive calcium phosphate ceramics in children’s endoscopic neurosurgery:report of five cases

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Regenerative Biomaterials 2018年第4期5卷 221-227页

作者： Jia Wei Hufei Qian Yu Liu Jiangang Liu Rui Zhao Xiao Yang Xiangdong Zhu Ruoping Chen Xingdong Zhang Department of Neurosurgery Shanghai Children’s HospitalShanghai Jiao Tong UniversityShanghai 200060China National Engineering Research Center for Biomaterials Sichuan UniversityChengdu 610064China

This work aimed at investigating the possibility and effectiveness of osteoinductive calcium phosphate(CaP)ceramics to close the drilled skull holes and prevent the postoperative cerebrospinal fluid(CSF)leaking in children’s endoscopic neurosurgery.Five children patients(four boys and one girl,3-to 8-years old)underwent the surgery,in which the endoscopic third ventriculostomy(ETV)was operated in four cases of hydrocephalus,and biopsy and ETV were both performed in one case of pineal tumor.The drilled skull holes were filled with the commercial osteoinductive CaP ceramics.The patients were followed up by CT scan at 1,7 days,3 and 6 months postoperatively.All the five cases were successful,and the holes were closed well after filled with the ceramics.The follow-up survey showed that no CSF leaking or rejection reaction was found.The CT scan indicated that the drilled holes began healing at 7 days postoperatively,and a relatively complete healing happened at 6 months postoperatively.The excellent ability of the CaP ceramics to induce bone regeneration was also confirmed by repairing the skull defects in a monkey model.The results of μ-CT and histological analysis showed that a bony structure with irregular array occurred at the defect area,and the newly formed bone volume density reached 65.7%.In conclusion,the osteoinductive CaP ceramics could be an ideal material to treat the drilled skull holes in children’s endoscopic neurosurgery and prevent CSF leaking afterwards.However,further investigation with more cases and longer follow-up was required to evaluate the clinical effect.

关键词： neuroendoscopy skull holes CSF leaking osteoinductive CaP ceramics bone healing

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Evolution of transmaxillary approach to tumors in pterygopalatine fossa and infratemporal fossa:anatomic simulation and clinical practice

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Chinese Medical Journal 2019年第7期132卷 798-804页

作者： Zhan Xue Jian Liu Zhi-Yong Bi Zhi-Qiang Yi Sheng-De Bao Pi-Nan Liu Zhi-Jun Yang Department of Neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijing 100070China Department of Neurosurgery Peking University First HospitalBeijing 100034China

Background:The endoscopic transnasal approach has been proven to have advantages on the removal of the tumors in pterygopalatine fossa(PPF)and infratemporal fossa(ITF).Herein,this study aimed to describe a modified approach for resection of the tumors in these areas,both in cadaveric specimen and clinical patients.Methods:The 20 adult cadaveric specimens and five patients with tumors in PPF and ITF were enrolled in this study.For the cadaveric specimens,ten were simulated anterior transmaxillary approach and ten were performed modified endoscopic transnasal transmaxillary approach.The exposure areas were compared between two groups and main anatomic structure were measured.Surgery was operated in the five patients with tumors of PPF and ITF to verify the experience from the anatomy.Perioperative management,intraoperative findings and postoperative complications were recorded and analyzed.Results:The modified endoscopic transnasal transmaxillary approach provided as enough surgical exposure and high operability to the PPF and ITF as the anterior transmaxillary approach did.The diameter of maxillary artery in the PPF was 3.77±0.78 mm(range:2.06-4.82mm),the diameter of middle meningeal artery in the ITF was 2.79±0.61 mm(range:1.54-3.78 mm).Four patients who suffered schwannoma got total removal and one of adenocystic carcinoma got subtotal removal.The main complications were facial numbness and pericoronitis of the wisdom tooth.No permanent complication was found.Conclusions:With the widespread use of neuroendoscopy,the modified endoscopic transnasal transmaxillary approach is feasible and effective for the resection of tumors located in PPF and ITF,which has significant advantages on less trauma and complications to the patients.

关键词： neuroendoscopy Pterygopalatine fossa Infratemporal fossa Maxillary sinus Surgical approach

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