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find Keyword "Skull" 15 results
  • REPAIR OF LARGE ARTICULAR CARTILAGE DEFECT OF HIP WITH ALLOGRAFT OF SKULL PERIOSTEUM

    It is very difficult to repair large articular cartilage defect of the hip. From May 1990 to April 1994, 47 hips in 42 patients of large articuler cartilage defects were repaired by allograft of skull periosteum. Among them, 14 cases, whose femoral heads were grade. IV necrosis, were given deep iliac circumflex artery pedicled iliac bone graft simultaneously. The skull periosteum had been treated by low tempreturel (-40 degrees C) before and kept in Nitrogen (-196 degrees C) till use. During the operation, the skull periosteum was sutured tightly to the femoral head and sticked to the accetabulum by medical ZT glue. Thirty eight hips in 34 patients were followed up for 2-6 years with an average of 3.4 years. According to the hip postoperative criteria of Wu Zhi-kang, 25 cases were excellent, 5 cases very good, 3 cases good and 1 case fair. The mean score increased from 6.4 before operation to 15.8 after operation. The results showed, in compare with autograft of periosteum for biological resurface of large articular defect, this method is free of donor-site morbidity. Skull periosteum allograft was effective for the treatment of large articular cartilage defects in hip.

    Release date:2016-09-01 11:07 Export PDF Favorites Scan
  • REPAIR OF IMMEDICABLE ULCER IN SKULL CAP WITH EXPANDED BIPEDICAL AXIAL FLAP IN SENILE PATIENTS

    Objective To investigate the method to repair immedicable ulcer in skull cap in senile patient and the clinical effect of expanded bipedical axialflap in skull cap. Methods From September 2002 to June 2006, 5 patients with immedicable and chronic ulcer in skull cap were treated. All patients were males, aging 55-76 years. Among them, the causes of disease were trauma in 1 case, infection in 1 case, squamous cell carcinoma in 2 cases, and basal cell carcinoma in 1case. The disease course was 625 months. All patients had been treated by 1-4 operations. The area of ulcer ranged from 5 cm×3 cm to 10 cm×9 cm. At first stage,soft tissue expander was implanted under the frontal branch of superficial temporal artery and the musculus frontalis according to preoperative design. Then periodic saline injection was carried out after operation. At second stage, the soft tissue expander was taken out. The immedicable ulcer in skull cap was removed,then expanded bipedical axial flap in forehead was designed and transferred to the wound according to the size of the wound. And the donor site was covered with odd expanded flap or splitthickness skin graft. The defect size was 6.0 cm×3.5 cm to 12.0 cm×10.5 cm. The size of the flap was from 26 cm×10 cm to 34 cm×17cm. Results All the expanded bipedical axial flap survived after operation. The wound had a primary healing. The donor sites healed well. No complications occurred at donor site. All patients were followed up from 3 to 24 months (mean 10 months).No ulcer recurrence and no incompetence in papebral fissurewas found. The patients were satisfied with the operation results. Conclusion The satisfactory clinical results are obtained in repairing immedical ulcer in skull cap in old patients by using expanded bipedical axial flap in skull cap. This operation design can be used as a new method to repair immedical ulcer in skull cap in senile patients.

    Release date:2016-09-01 09:23 Export PDF Favorites Scan
  • CLINICAL OBSERVATION OF ONE STAGE CRANIOPLASTY FOR SKULL DEFECT WITH SELF-CRANIAL BONE POWDER

    Objective To investigate the clinical application of self-cranial bone powder in one stage cranioplasty.Methods From October 1999 to December 2002,self-cranial bone powder and medical adhesive were used to repair the skull defect, for one stage cranioplasty, caused by operations on cranium in 128 casesof severe dangerous craniocerebral injury, acute intracranial hematome, sick skull and intracranial tumor.The bone growth was observed by CT or X-ray examination 3-24 months after replantation of cranioplasty.Results The decompression and cranioplasty were performed simultaneously, the time prolonged 5-10 minutes than that of routine, the appearance of repaired cranial bone was normal, without concavity and convexity. After 12 months of operation, the replanted bone merged with the normal bone completely, with normal appearance. The operation successful rate was 96.1%(123/125) without any complication. Only fivecases were not better in growing because of less bone powder, but withoutcerebral pulse and defective syndrome. All the cases did not need secondary cranioplasty.Conclusion The effect of cranioplasty with self-cranial bone powder effect is good in taking shape. This new method can avoid the traditional secondary cranioplasty for skull defect and complications. 

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  • MODIFIED TRANSCRANIAL APPROACH TO RESECT TUMOR AROUND THE ANTERIOR SKULL BASE AND DOUBLE TISSUE FLAP TO RECONSTRUCT THE ANTERIOR SKULL BASE

    Objective To explore better approach of resecting tumoraround the anterior skull base and reconstructing the anterior skull base.Methods In November 2004, a 49-years-old male patient with intracranial recrudescent adenoid cystic carcinoma in the anterior cranial fossa was treated using modified transcranial approach. Neurosurgeon and rhinolaryngologist cooperated to excise the tumour completely, and to reconstruct anterior skull base using the pedicle periosteum temproal musculofascial flap(15 cm×10 cm) andthe pedicle flap of aponeurosis of occipitofron talis muscle and muscular fasciae(10 cm×6 cm).Results After operation, the wound healed by first intention. Complication, such as infection and cerebrospinal rhinorrhea, did not occur. The patient was discharged 10 days after operation, and was followed up for 8 months, no local recurrence were investigated and no scar formed over the face.Conclusion The modified transcranial approachis a relatively novel exposure that enables the skilled cranial base surgeon tosafely resect many malignant lesions previously and to reconstruct the defect of anterior skull base together. 

    Release date:2016-09-01 09:26 Export PDF Favorites Scan
  • REPAIR OF CARTILAGE DEFECT IN JOINT WITH TRANSPLANTATION OF CRYOPRESERVED HOMOLOGOUS EMBRYONIC PERIOSFEUM OF RABBITS

    In order to repair cartilage defect in joint with transplantation of cryopreserved homologous embryonic periosteum, 30 rabbits were used and divided into two groups. A 4 mm x 7 mm whole thickness cartilage defect was made in the patellar groove of femur of each rabbit. The homologous embryonic rabbit skull periosteum (ERSP), preserved in two-step freezing schedule, was transplanted onto the cartilage defect of joints of one group and autogenous periosteal graft was done in the joint defect of the other group. The knees were not immobilized, following operation and 16 weeks later, the newly formed tissue in the defects were assessed by gross observation, histochemical examination and biochemical analysis. The results showed that new hyaline-like cartilage was formed in the cryopreserved ERSP grafted knee, and had no significant difference from that of the knee receiving autogenous periosteal graft, but had significant difference from that of the fresh ERSP grafted knee and the non-grafted knee. Furthermore, the new hyaline-like cartilage had the biochemical characteristics of a fibrous cartilage. The conclusion was that this method might be feasible to repair articular cartilage defects.

    Release date:2016-09-01 11:07 Export PDF Favorites Scan
  • PRELIMINARY APPLICATION OF ABSORBABLE FIXATION SYSTEM ON CRANIAL BONE FLAP REPOSITION AND FIXATION AFTER CRANIOTOMY

    Objective To investigate the effectiveness and adverse effect of the absorbable fixation system on cranial bone flap reposition and fixation after craniotomy. Methods Between July 2010 and December 2011, 67 cases underwent cranial bone flap reposition and fixation with absorbable fixation system after craniotomy and resection of intracranial lesions. There were 38 males and 29 females with a median age of 32 years (range, 5 months to 73 years). The disease duration ranged from 3 months to 6 years (median, 25 months). Forty-one lesions were located at supratentorial and 26 at subtentorial, including at the frontotemporal site in 13 cases, at the frontoparietal site in 12 cases, at the temporal oprietal site in 8 cases, at the temporooccipital site in 5 cases, at the occipitoparietal site in 4 cases, and at the posterior cranial fossa in 25 cases. The diagnosis results were glioma in 15 cases, cerebral vascular diseases (aneurysm, arteriovenous malformation, and cavemous angioma) in 8 cases, meningioma in 7 cases, arachnoid cyst in 7 cases, acoustic neurinoma in 5 cases, cholesteatoma in 3 cases, primary trigeminal neuralgia in 5 cases, cerebral abscess in 3 cases, hypophysoma in 2 cases, craniopharyngioma in 2 cases, metastatic tumor in 2 cases, radiation encephalopathy in 2 cases, medulloblastoma in 1 case, ependymocytoma in 1 case, germinoma in 1 case, atypical teratoma/rhabdoid tumor in 1 case, facial spasm in 1 case, and subdural hematoma in 1 case. Intracranial lesion size ranged from 3 cm × 2 cm to 7 cm × 5 cm. The changes of local incision and general condition were observed. Results Subcutaneous effusion occurred in 2 supratentorial lesions and 3 subtentorial lesions, which was cured at 2 weeks after puncture and aspiration. All incisions healed primarily and no redness or swelling occurred. CT scans showed good reposition of the cranial bone flap and smooth inner and outer surfaces of the skull at 2 weeks after operation. All 67 patients were followed up 3-20 months (mean, 10.3 months). During follow-up, the skull had satisfactory appearance without discomfort, local depression, or effusion. Moreover, regular CT and MRI scans showed no subside, or displacement of the cranial bone flap or artifacts. Conclusion Absorbable fixation system for reposition and fixation of the cranial bone flap not only is simple, safe, and reliable, but also can eliminate the postoperative CT or MRI artifact caused by metals fixation system.

    Release date:2016-08-31 04:21 Export PDF Favorites Scan
  • CRANIAL BONE RECONSTRUCTION AFTER ONE-STAGE RESECTION OF SCALP SQUAMOUS CARCINOMA INVADING THE SKULL

    Objective To investigate the operative procedure and the effectiveness of cranial bone reconstruction after one-stage resection of scalp squamous carcinoma invading the skull. Methods Between January 2005 and December 2008,14 patients with scalp squamous carcinoma invading the skull were treated. There were 6 males and 8 females with a median age of 53 years (range, 29-76 years). The disease duration ranged from 3 to 8 years (mean, 6 years). The tumor locations were right temporal area in 2 cases, left temporal area in 2 cases, right frontal area in 3 cases, left frontal area in 1 case, right occi pital area in 1 case, left occi pital area in 2 cases, frontal area in 2 cases, and the top of the head in 1 case. Scalp lesions showed exogenous growth, and lesion diameter ranged from 5 to 12 cm (mean, 8 cm). TNM classification showed T4N0M0 tumor in all cases. MRI showed that tumors invaded the skull, 12 cases had smooth intradural side and 2 cases had brain involvement without lymph node metastasis or detected distant metastasis. Under general anesthesia, all the lesions of the scalp, skull, dura, and brain tissue were removed completely. The size defect of the scalp, skull, and dura ranged from 8 cm × 7 cm to 15 cm × 14 cm, from 5 cm × 4 cm to 12 cm × 12 cm, and from 4 cm × 4 cm to 9 cm × 8 cm, respectively, which were repaired with artificial patch, titanium metal, mesh, and local flaps, respectively. The donor site was repaired by spl it-thickness skin graft. Results The skin flaps and grafts survived and incision healed by first intention without cerebrospinal fluid leakage, intracranial and subdural hemorrhage, andother compl ications. All patients were followed up 2 to 5 years (mean, 4 years), and no recurrence was found. The compatibil ity of titanium mesh and local tissue was good. The patients had good hair growth without exposure of titanium mesh, seizures, partial paralysis, and other neurological damage performance. Conclusion After one-stage resection of scalp squamous carcinoma invading the skull, it is effective to reconstruct the skull with titanium mesh and to repair dural defects with artificial dura.

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • SKULL BASE RECONSTRUCTION AND PEROPERATIVE TREATMENT FOR CRANIO-ORBITAL TUMORS/

    Objective To investigate the peroperative treatment of cranio-orbital tumors and the method of the reconstruction of the skull base. Methods Between April 2008 and April 2011, 35 patients with cranio-orbital tumor were treated. There were 21 males and 14 females, aged 17-73 years (mean, 46.3 years). The first symptoms were orbital pain in 13 cases, hypopsia in 12 cases, exophthalmos or abnormal eye position in 5 cases, headache and dizziness in 2 cases, di plopia in 2cases, and pulsating eyeball in 1 case. Some of the patients needed resecting the zygomatic arch, supercil iary arch, and orbit roof. The autogenous bone, titanium net, frontal bone periosteum, biogel, and artificial meninges were used to reconstruct the skull base. Results Tumors were resected by one-stage operation, and the anterior skull bases were reconstructed. Postoperative MRI indicated that total removal of tumors was achieved in 30 cases, subtotal in 3 cases, and partial in 2 cases at 3 days. There was no operative death. Cerebrospinal rhinorrhea and infection occurred at 1 week in 1 and 2 cases respectively, and were cured after lumbar drainage and antibiotics. The patients were followed up 6 to 36 months (mean, 18 months). In patients having hypopsia, the visual function was improved in 9 cases at 1 month; in patients having orbital pain, pain rel ief was achieved at 2 weeks after operation; in patients having exophthalmos or abnormal eye position and pulsating eyeball, sympotoms disappeared after operation. In 27 patients with benign tumor, 24 were cured, without recurrence during follow-up; in 8 patients with mal ignant tumor, 6 had recurrence within 18 months and underwent second operation or radiotherapy, 2 relapsed cases died of cerebral hernia and respiratory circulating failure at 24 months after operation. No complication of enophthalmos, pulsating exophthalmos, or collapse of zygomatic region occurred. Conclusion Using the autogenous bone, titanium net, frontal bone periosteum, biogel, and artificial meninges to reconstruct the skull base has rel iable foundation, simple operation, and easy anatomical reconstruction, so it is an effective method after the removal of cranio-orbital tumors; better effectiveness would beobtained when combining with the peroperative nursing.

    Release date:2016-08-31 04:23 Export PDF Favorites Scan
  • EXPERIMENTAL STUDY ON POROUS HYDROXYAPATITE CERAMICS IN REPAIR OF SKULL BONE DEFECT OF RABBIT

    In order to investigate the possibility of porous hydroxyapatite ceramics (HAC) in the repair of skull bone defect, twenty-four rabbits were used. The bone defect model was created by operation to obtain a defect in parietal bone in a size of 1 cm x 1 cm. Filled the defect with HAC and methyl-methacrylate-syrene copolymer (MMAS) to fill the defect as control. At 1st, 2nd and 3rd months after operation, behavior of the rabbits was observed and then these animals were sacrificed and specimens were examined under microscope. Results showed as follows: after operation, behavior of all animals were normal. By histological examination, it was found that in HAC group, there were granulation tissue, fibrous tissue and newly formed vessels grew into the pores and the osteoblasts formed osseous trabeculae. There was no inflammatory cell infiltration. In the MMAS grafted asea, there was formation of fibrous membrane. It suggested that HAC might be a good material for bone substitute in repair of skull bone defect.

    Release date:2016-09-01 11:08 Export PDF Favorites Scan
  • BRIDGED DURAL SUSPENSION FOR CRANIOPLASTY BY USING THREE- DIMENSIONAL MOULDING TITANIUM MESH

    Objective To investigate the value of bridged dural suspension for cranioplasty by using three- dimensional moulding titanium mesh. Methods A retrospective analysis was made on the clinical data of 156 patients with skull defects, who underwent cranioplasty using three-dimensional moulding titanium mesh between April 2012 and October 2015. Bridged dural suspension was performed in 73 patients (bridging group) and routine cross mesh dural suspension in 83 patients (routine group). There was no significant difference in gender, age, and causes, duration, and area of skull defects between 2 groups (P > 0.05), and they were comparable. The operation time, hospitalization time, and postoperative complication were recorded for analysis. Results The operation time was (86.7±13.5) minutes in bridging group and was (84.3±16.3) minutes in routine group, showing no significant difference (t=1.061, P=0.290); but hospitalization time of bridging group [(16.8±2.7) days] was significantly shorter than that of routine group [(18.7±5.7) days] (t=-2.661, P=0.009). Postoperative complications occurred in 16 patients of routine group (19.3%), including epidural hydrops in 13 cases, epidural hematoma in 2 cases, and epidural infection in 1 case, while epidural hydrops occurred in 4 cases of bridging group (5.5%). There was significant difference in complication rate between 2 groups (χ2=6.616, P=0.010). All patients were followed up 5-46 months (mean, 25.2 months). The satisfactory cosmetic results of the skull were obtained, and CT images showed good coverage of defect. Conclusion Bridged dural suspension for cranioplasty is more simple and effective than routine cross mesh suspension, and it is beneficial to reduction of postoperative complications.

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