Objective To summarize the experience of laparoscopic ventriculo-peritoneal shunt for treating patients with hydrocephalus. Methods Twenty-two cases with hydrocephalus were treated with laparoscopic ventriculo-peritoneal shunt.The drainage-tube was put into the right liver-diaphragm interspace in 9 patients and inserted into the pelvic kidney in the others. Postoperative complications, ameliorating conditions of intracranial hypertension and recovery conditions of these patients were observed. Results All the operations were succeeded and the patients got amelioration of intracranial hypertension.No complication correlating with laparoscopic surgery occured. Conclusion Laparoscopic ventriculo-peritoneal shunt have the advantages of less invasive,better intra-abdominal view and more rapid recovery than conventional laparotomy. It’s a safe and feasible method which is worth of wide using.
【摘要】 目的 分析手术治疗垂体瘤患者长期临床恢复以及生活质量改善情况。 方法 回顾性分析2007年12月-2008年9月手术治疗的103例垂体瘤患者术前以及术后长期随访资料，使用SF-36量表对术前、术后患者生活质量进行评估，分析手术治疗前后患者症状、激素水平恢复情况以及生活质量改善情况，并进一步分析肿瘤大小、侵袭程度对术后生活质量的影响。 结果 术后头痛症状消失52例，视力改善76例，其他症状具有不同程度改善；术后SF-36生活质量评估结果显示，患者除精神健康外的7个维度（生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能）均有明显改善（P＜0.05），不同肿瘤大小及侵袭程度的患者术后生活质量评分均无统计学意义（P＞0.05），垂体功能完全恢复者生活质量评分高于垂体功能低下者（P＜0.05）。 结论 显微手术治疗垂体瘤患者可明显改善患者的一般症状、提高患者的生活质量，单纯肿瘤的大小和侵袭程度对术后生活质量的影响程度较小，术后垂体功能的恢复程度明显影响患者的生活质量，垂体瘤术后患者的激素长期替代治疗尚需进一步加强。【Abstract】 Objective To analyze the long-term clinical recovery and quality of life (QoL) in patients with pituitary adenoma treated by microneurosurgery. Methods The clinical data of 103 patients undergoing microneurosurgery from December 2007 to September 2008 were retrospectively analyzed, health-related questionnairs (SF-36) were used to assess the QoL. The post-surgery recovery of symptoms, endocrine function, and QoL were compared with those of pre-surgery, then the correlation between tumor size, invasive behavior, and QoL were analyzed. Results Headache disappeared in 52 patients. Visual symptoms improved in 76 patients. Other symptoms were also improved. Seven concepts (physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotioning) were improved after surgery (Plt;0.05). The eight health concepts of SF-36 showed no significant difference between patients with different tumor size and invasive behavior (Pgt;0.05). Differences were considered statistically significant between normal and abnormal pituitary function groups after surgery(Plt;0.05) in all concepts. Conclusion Microneurosurgical treatment can improve the general symptoms and the QoL. The tumor size and invasion have little influence on the QoL after surgery, but the improvement of hormone deficiency has influence on the QoL significantly. More attention should be given to the long-term hormone replacement therapy after the pituitary adenoma surgery.
ObjectiveTo investigate the effect of microsurgical therapy and the key techniques in resection of large bilateral olfactory groove meningiomas via unilateral subfrontal approach.MethodsThe clinical data and follow-up results of 181 patients with large bilateral olfactory groove meningiomas who underwent microsurgical removal between June 2007 and May 2014 were retrospectively analyzed. The initial symptom was headache or (and) dizzy in 95 cases, hyposmia or anosmia in 53, impairment of visual function or (and) visual field deficits in 26, cognitive deficits in 3, epilepsy in 2, and accidentally discovered in 2. Unilateral subfrontal approach was applied in all patients (neuroendoscopy was applied in some cases in the later period); incision of falxcerebri, and when necessary, ligation of superior sagittal sinus to resect contralateral tumor were performed. Simultaneous or staged period resection of tumors invading skull base such as ethmoid sinus and superior meatus and reconstruction of the skull base were performed.ResultsThere was no perioperative mortality. Simpson grade Ⅰ resection was obtained in 33 cases, grade Ⅱ resection was in 141, grade Ⅲ resection was in 4, and grade Ⅳ resection was in 3. Among the 229 eyes with preoperative visual impairment, postoperative visual improvement was found in 215 eyes, unimproved was in 12, and aggravation was in 2. The 59 sides which lost their function of olfactory nerve before surgery obtained no recoveries after surgery, while olfactory nerve with residual function preoperative still kept sensing after surgery in 149 lateral sides (149/303). The patients were followed up for (76.9±43.8) months, and postoperative recurrence or residual tumor growth were found in 21 cases.ConclusionsBecause of the contralateral ocular and (or) nasal compensation, early discovery is very difficult for patients with olfactory groove meningioma. The unilateral subfrontal approach can provide sufficient exposure for resection of large bilateral olfactory groove meningiomas and improve the visual acuity and visual field deficits. But it is poor at the preservation of olfactory function. The approach, better with the aid of neuroendoscopy, can improve the total cutting rate, with the advantages of minimally invasion and fewer complications. It is a worthy priority for these tumors.
To investigate the microsurgical management of cranionasal tumors and the method of the reconstruction of the skull base. Methods From June 2005 to October 2007, 20 patients with cranionasal tumor were treated. There were 10 males and 10 females, aged between 13 and 77 years (median 49 years). The disease course was 2 months to 13 years.The cranionasal tumors, proved by MRI and CT scans, located in the anterior skull base, paranasal sinus, nasal and/or orbit cavity. And their cl inical presentations were l isted as follows: dysosphresia in 14 patients, headache in 11 patients, nasal obstruction in 9 patients, epistaxis in 8 patients, visual disorder in 4 patients, exophthalmos in 4 patients and conscious disturbance in 2 patients. All 20 patients underwent transbasal surgery combined with transnasal surgery, and tumors were resected by one-stage operation. The skull base was reconstructed by surgical technique “Pull Down Sandwich” with pedicle periosteum flap. Results Tumors were resected by one-stage operation, and the anterior skull bases were reconstructed. Pathological examination showed 8 cases of mal ignant tumors and 12 cases of benign tumors. The total surgical excision was complete in 16 patients, and 4 patients with subtotal excision. There was no operative death. Eighteen patients were followed up 3 months to 2 years and 6 months. Transient cerebrospinal fluid rhinorrhea was found in 2 cases which were cured by lumbar drainage. And recurrence of tumor was observed in 5 patients 3 months to 2 years after operation. Conclusion Microsurgical operation via subfrontal approach assisted bytransnasal endoscopy is an effective method in management of cranionasal tumors, with the advantages of econstruction of the skull base with pedicle periosteum flap or “Pull Down Sandwich” and low compl ication rate.