Objective:Radiation osteonecrosis of the skull base after radiotherapy for nasopharyngeal carcinoma is one of the most serious complications,affecting patient survival and quality of life.To date,surgical resection is...Objective:Radiation osteonecrosis of the skull base after radiotherapy for nasopharyngeal carcinoma is one of the most serious complications,affecting patient survival and quality of life.To date,surgical resection is the main treatment for radiation osteonecrosis.The repair after the operation is very important.Inappropriate repair or lack of repair can easily cause local infection that can even spread to the brain,aggravating osteonecrosis.This study aimed to verify the feasibility and safety of the ante-rolateral thigh free fascia flap in repairing large skull base defects.Methods:From June 2021 to July 2022,a total of 12 patients with a history of radiotherapy for naso-pharyngeal carcinoma received surgical treatment at the Department of Otolaryngology Head&Neck Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.All patients were diagnosed with radiation osteonecrosis of the skull base with large skull base defects.During the endoscopic operation,a free anterolateral thigh fascia flap was used to repair the skull base and complete vascular anastomosis reconstruction.The preoperative and postoperative pain scores were retrospectively analyzed,and the dynamic changes in endoscopic surgery sites were observed.Results:The 12 patients had a median age of 58 y,with 8(66.7%)males and 4(33.3%)females.The median headache score for the patients was 5(4-7)before surgery.The patient's headache was significantly relieved postoperatively,with 11 patients having a score of 0 and one patient having a score of 1.The stench was completely resolved after the operation.There were no serious complications during the perioperative period or 12 months after the operation.Conclusion:The application of anterolateral thigh free fascia flap in skull base reconstruction is a safe and reliable reconstruction technique suitable for endoscopic surgical repair of large-scale skull base necrosis.展开更多
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 f...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 incidence of cerebrospinal fluid leakage and lower complications,which has certain advantages and is worthy of clinical promotion.展开更多
Introduction: Skull Base Osteomyelitis (SBO) is an infectious inflammation of the skull bones that is often caused by malignant otitis externa (MOE) and affects the temporal bone. This condition commonly affects immun...Introduction: Skull Base Osteomyelitis (SBO) is an infectious inflammation of the skull bones that is often caused by malignant otitis externa (MOE) and affects the temporal bone. This condition commonly affects immunocompromised individuals and the elderly, particularly those with a history of diabetes mellitus. Diagnosis is challenging because of non-specific symptoms that lead to late detection and complications. This report discusses a case of SBO with multiple bilateral cranial nerve abnormalities and highlights the diagnostic and management challenges in high-risk individuals with subtle clinical signs. Case presentation: This report describes a 63-year-old patient with hypertension and diabetes who underwent surgical debridement of the left ear due to malignant otitis externa 4 months prior to presentation. The patient presented with significant dysarthria, dysphagia, ptosis of the left eye with double vision, and hearing impairment in the left ear. Examination revealed bilateral CN VI palsy, right CN VII palsy, left CN VIII palsy, and a right CN XII deficit. Initial tests were unremarkable, but a high Fungitell assay and a second review of the CT scan and MRI revealed a pathological process in the base of the skull involving bony structures and cranial nerves bilaterally, which helped diagnose SBO. The patient was subsequently discharged with oral voriconazole and continued his usual medications. The patient requested further management abroad, because he did not notice resolution of his symptoms. Surgical treatment was employed abroad to relieve his symptoms, as he recovered slowly. Conclusion: This case report underscores the importance of a multidisciplinary approach to address SBO. Collaboration between specialists in infectious diseases, otolaryngology, radiology, and neurology plays a pivotal role in achieving an accurate diagnosis and developing a tailored treatment plan. Although SBO may be infrequent, this case report highlights the need to maintain heightened clinical suspicion in high-risk individuals.展开更多
The bone regenerative scaffold with the tailored degradation rate matching with the growth rate of the new bone is essential for adolescent bone repair.To satisfy these requirement,we proposed bone tissue scaffolds wi...The bone regenerative scaffold with the tailored degradation rate matching with the growth rate of the new bone is essential for adolescent bone repair.To satisfy these requirement,we proposed bone tissue scaffolds with controlled degradation rate using osteoinductive materials(Ca-P bioceramics),which is expected to present a controllable biodegradation rate for patients who need bone regeneration.Physicochemical properties,porosity,compressive strength and degradation properties of the scaffolds were studied.3D printed Ca-P scaffold(3DS),gas foaming Ca-P scaffold(FS)and autogenous bone(AB)were used in vivo for personalized beagle skull defect repair.Histological results indicated that the 3DS was highly vascularized and well combined with surrounding tissues.FS showed obvious newly formed bone tissues.AB showed the best repair effect,but it was found that AB scaffolds were partially absorbed and degraded.This study indicated that the 3D printed Ca-P bioceramics with tailored biodegradation rate is a promising candidate for personalized skull bone tissue reconstruction.展开更多
We reported the development of a Ф100 cm growth apparatus for skull melting growth of yttria-stabilized cubic zirconia(YSZ) crystals and more than 1000 kg crystals have been grown in the furnace each time.The growth ...We reported the development of a Ф100 cm growth apparatus for skull melting growth of yttria-stabilized cubic zirconia(YSZ) crystals and more than 1000 kg crystals have been grown in the furnace each time.The growth conditions were optimized and the structure of the as-grown crystals was characterized by X-ray diffraction.The transmittance of 15 mol.% yttria-stabilized cubic zirconia crystal was nearly 80% in the range of 400-1600 nm.The refractive indices were measured and fitted the Sellmeier equation which was obtained by least-squares method.The results showed that the apparatus was very suitable for industrial growth of YSZ crystals.展开更多
A 56-year-old male visited our hospital for evaluation of an occipital mass.Contrast computed tomography showed hypervascular enhancement with osteolytic change in the skull and a huge enhanced mass in the liver.Magne...A 56-year-old male visited our hospital for evaluation of an occipital mass.Contrast computed tomography showed hypervascular enhancement with osteolytic change in the skull and a huge enhanced mass in the liver.Magnetic resonance imaging showed bone metastasis in the thoracic vertebrae.Assays for hepatitis B surface antigen and hepatitis B core antibody were positive and his liver condition was Child-Pugh grade A.Our diagnosis was hepatocellular carcinoma(HCC) with skull and vertebrae metastases on chronic hepatitis B.He was treated with radiation therapy for bone metastases and transcatheter arterial chemoembolization for HCC.But he developed acute respiratory failure because of aspiration pneumonia,congestion and oedema with haemorrhage of the lungs and died.Dissection showed HCC with multiple bone metastases.The liver tumor was categorized as well-differentiated HCC,Edmondson classification Ⅰ,trabecular type and pseudoglandular type.In the liver mild infiltration of lymphocytes was seen in Glisson's capsules which were signif icantly enlarged with well preserved limiting plates.Piecemeal necrosis was not obvious.No fibrosis was noted.An 8 cm × 7 cm × 3 cm metastatic lesion had formed in the left occipitotemporal part of the cranial bone.The lesion was osteolytic and showed invasion into the dura mater.Neither the subdural cavity nor the brain showed involvement from the metastatic tumor.However,skull metastasis from HCC is very rare and it affects the patient's prognosis and the quality of life.Therefore,it is very important to make an early diagnosis and carry out proper management of skull metastasis from HCC.展开更多
Three-point head fixation was constructed to provide mechanical stability for single unit recording(SUR)on vestibular sensory system in living chinchilla previously.However,it is no more qualified to this work when th...Three-point head fixation was constructed to provide mechanical stability for single unit recording(SUR)on vestibular sensory system in living chinchilla previously.However,it is no more qualified to this work when the stimulation intensity becomes large because of frequent unit losing and neuron damage,which strongly implies that the mechanical stability has been broken during the stimulation.Here,we constructed a novel hea0 fixation(skull cap assistant head fixation)provided by skull cap on the basis of three-point head fixation in order to improve the mechanical stability for SUR under the stimulation with large magnitude.The large area bone connection is the feature and advantage of this improved method,which directly fixes the tested local nervous tissue and microelectrode in an intact stable system through skull cap except two ear bars and a tube face mask.Our data exhibited that skull cap assistant head fixation could significantly improve the success rate of neural response activity recording in the population of semicircular canal neurons under the stimulation with large intensity(amplitudd 00 deg/s).Based on the analysis of neural response activity and noise base-line during stimulation,our data further indicated that this method could significantly improve the mechanical stability for SUR during high-speed motion stimulation on vestibular system in living chinchilla.Skull cap assistant head fixation extends the application of SUR on vestibular neuron in linear response range and provides a solid foundation for electrophysiological research on vestibular sensory system in fhrther studies.展开更多
Objective: To apply trifocal distraction osteogenesis in canine model of skull segmental defects and to provide reference for clinical treatment. Methods: Six labrador dogs were selected in this study and divided into...Objective: To apply trifocal distraction osteogenesis in canine model of skull segmental defects and to provide reference for clinical treatment. Methods: Six labrador dogs were selected in this study and divided into observation group and control group randomly. Each group contained 3 dogs. Skull segmental defects models were established by surgery, and dogs in bservation group received trifocal distraction osteogenesis treatment. Bone density was observed and compared between two groups during treatment. Results: There were no significant difference in bone density between two groups on th 1st day ( P>0.05). The bone density of observation group on the 30th day, and 60th day were higher than that of control group ( P<0.01). Conclusions: Trifocal distraction osteogenesis has significant clinical effect, and it would be widely used in clinical treatment.展开更多
Endolymphatic sac tumors(ELSTs) are rare, papillary adenomatous tumors that arise from the endothelium of the endolymphatic sac. We demonstrate a difficult case of endolymphatic sac tumor and how it is managed via tra...Endolymphatic sac tumors(ELSTs) are rare, papillary adenomatous tumors that arise from the endothelium of the endolymphatic sac. We demonstrate a difficult case of endolymphatic sac tumor and how it is managed via transcanal endoscopic assisted technique, with discussion of feasibility of transcanal approach to lateral skull base tumor.展开更多
The skull base generally refers to the anterior, middle and posterior cranial fossa and structures on the outside side of these skull areas. The cranial roof and skull base are separated by a line connecting the exter...The skull base generally refers to the anterior, middle and posterior cranial fossa and structures on the outside side of these skull areas. The cranial roof and skull base are separated by a line connecting the external occipital protuberance, parietal notch and supraorbital ridge[1].The skull base supports the brain above, is connected展开更多
In this paper, the authors have observed the relation between the focuses shown by CT and patient’s condition as well as the curative effect of electroacupuncture on 70 cases of acute cerebral infarction. The result ...In this paper, the authors have observed the relation between the focuses shown by CT and patient’s condition as well as the curative effect of electroacupuncture on 70 cases of acute cerebral infarction. The result shows that electroacupuncture for acute cerebral infarction has remarkable cura tive effect (the remarkable effective rate was 82.9 %, and the total effective rate was 97.1 % ). Com bining with the CT analysis, the authors found that the condition of acute cerebral infarction patients and curative effect have close relation with the size and depth of fouses’ position (P<0.01 ).展开更多
The change of the skull shape and size has been predicated through computer simulation technique and compared with the experimental results. The microstructure of the skull and the elemental line distribution in the s...The change of the skull shape and size has been predicated through computer simulation technique and compared with the experimental results. The microstructure of the skull and the elemental line distribution in the skull have been analyzed with optical microscope and EPMA etc. The results show that the skull height and thickness become small with increasing melting power; the skull consists of two zones, that is, fine equiaxial crystal zone and coarse columnar crystal zone; there exists some segregation in the bottom of the skull.展开更多
BACKGROUND Basal cell adenoma (BCA) is a rare benign tumour that has unique histological characteristics and primarily arises in the parotid glands. According to published reports, nearby tissue destruction by BCA see...BACKGROUND Basal cell adenoma (BCA) is a rare benign tumour that has unique histological characteristics and primarily arises in the parotid glands. According to published reports, nearby tissue destruction by BCA seems impossible. CASE SUMMARY We presented a case of a 54-year-old woman with a mass in the deep lobe of the right parotid gland involving the ipsilateral skull base and mastoid. The patient exhibited gradual right facial swelling but no other obvious symptoms. Combined resection of the total right parotid gland and partial skull base excision were performed. The biopsy conducted before the surgery and sections cut from intraoperatively obtained tissues were not definitive for identifying the character of the neoplasm. A final diagnosis of tubular BCA without malignant elements was established based on postoperative pathology results and immunohistochemical analysis. The tumour did not recur during the 12-mo follow-up period. CONCLUSION A diagnosis of BCA can only be established based on a histopathological examination after an excisional biopsy, and tubular BCA should carefully be considered as a destructive type.展开更多
Objectives Conventional approaches for removal of lateral skull base tumors, including transmandibular, infratemporal fossa, preauricular transzygmatic subtemporal approaches, are major invasive procedures that often ...Objectives Conventional approaches for removal of lateral skull base tumors, including transmandibular, infratemporal fossa, preauricular transzygmatic subtemporal approaches, are major invasive procedures that often sacrifice hearing and cause abnormal occlusion and cosmetic defects. Reports of the transcervical approach for resection of skull base tumors are rare, although it was described for resection of clival chordomas in as early as 1966. The purpose of this study is to review our experiences in management of lateral skull base tumors using the transcervical approach. Study Design Retrospective chart review. Methods Six lateral skull base tumor cases treated with transcervical approach procedures were reviewed, including the medical records. Results There were 4 males and 2 females. Age ranged from 12 through 52 years. Histopathological diagnoses included malignant schwannoma(n = 1), malignant carotid body tumor(n = 1), heamangioma(n=1), schwannoma (n=2) and pleomorphic adenoma (n = 1). Transcervical techniques were used in all cases with the use of microscope in the lateral skull base area. Complete tumor removal was achieved in all cases. Postoperative radiotherapy was implemented in 1 case of malignant schwannoma and 1 case of malignant carotid body tumor. Jugular foramen syndrome occurred as a surgical complication in 1 case of malignant Schwannoma of the vagus nerve. There was no tumor recurrence during the 10 - 42 month follow-up period. Conclusion Compared with conventional approaches, the transcervical approach provides a easy, safe, minimal invasive and effective procedure for removal of selected lateral skull base tumors.展开更多
Necropsies and extensive histological evaluation for clinical and sub-clinical disease of approximately three hundred Portuguese Water dogs are available as part of an ongoing study to assess their state of health at ...Necropsies and extensive histological evaluation for clinical and sub-clinical disease of approximately three hundred Portuguese Water dogs are available as part of an ongoing study to assess their state of health at the end of life. Throughout life these dogs enjoyed a variety of lifestyles and environments. Here we carry out retrospective quantitative assessments of life-time dietary input and physical activity for each dog. To do this, collagens from skull vault bone and from dentine have been analyzed for ratios of stable isotopes to determine differences in diet that individual dogs experienced during late or early life respectively. Robustness of skull bone (weight/unit of skull size) was used as a relative indicator of the amount of physical activity experienced during a dog’s lifetime. These environmental parameters were correlated with the frequency and severity of specific disease processes determined at necropsy. Both measures were shown to exert significant low-level展开更多
Introduction:Majority of petrous bone and lateral skull base pathologies are benign in nature.The complex anatomy usually warrants an extensive approach with associated morbidity.Case summary:Two cases of petrous bone...Introduction:Majority of petrous bone and lateral skull base pathologies are benign in nature.The complex anatomy usually warrants an extensive approach with associated morbidity.Case summary:Two cases of petrous bone cholesteatoma(1 congenital cholesteatoma with facial palsy and 1 acquired cholesteatoma)and a case of glomus tympanicum were treated with exclusive endoscopic transcanal approach.The cases of petrous cholesteatoma were addressed with trans-promontorial and infra-cochlear approaches.The mean operative time was approximately 140 min.No CSF otorrhoea was noticed in the post-operative period.The average period of hospital stay was 3.7 days.Conclusion:In the subset of cases with limited benign disease an endoscopic trans-canal approach is a better alternative to an external approach.It decreases operative time,blood loss,chance of meningitis,morbidity and hospital stay.The lack of depth perception is a major hurdle which can be come over by experience in endoscopic middle ear surgery.This approach can create direct access to cochlea/petrous apex/internal auditory canal(IAC)/Supra-geniculate ganglion region.展开更多
BACKGROUND Rhabdomyosarcoma(RMS)is a rare malignant tumor of mesenchymal origin that mainly affects children.Spindle cell/sclerosing RMS(SSRMS)is even rarer.It is a new subtype that was added to the World Health Organ...BACKGROUND Rhabdomyosarcoma(RMS)is a rare malignant tumor of mesenchymal origin that mainly affects children.Spindle cell/sclerosing RMS(SSRMS)is even rarer.It is a new subtype that was added to the World Health Organization disease classification in 2013.To the best of our knowledge,this is the first reported case of adult SSRMS disease classification originating in the temporal muscle.CASE SUMMARY SSRMS originating in the temporal muscle of a male adult enlarged rapidly,destroyed the skull,and invaded the meninges.The tumor was completely removed,and the postoperative pathological diagnosis was SSRMS.Postoperative recovery was good and chemotherapy and radiotherapy were given after the operation.Followed up for 3 mo,no tumor recurred.CONCLUSION RMS is one of the differential diagnoses for head soft tissue tumors with shortterm enlargement and skull infiltration.Preoperative computed tomography or magnetic resonance imaging is necessary for early detection of tumor invasion of the skull and brain tissue.展开更多
The size,shape,and physical characteristics of the human skull are distinct when considering individual humans.In physical anthropology,the accurate management of skull collections is crucial for storing and maintaini...The size,shape,and physical characteristics of the human skull are distinct when considering individual humans.In physical anthropology,the accurate management of skull collections is crucial for storing and maintaining collections in a cost-effective manner.For example,labeling skulls inaccurately or attaching printed labels to skulls can affect the authenticity of collections.Given the multiple issues associated with the manual identification of skulls,we propose an automatic human skull classification approach that uses a support vector machine and different feature extraction methods such as gray-level co-occurrence matrix features,Gabor features,fractal features,discrete wavelet transforms,and combinations of features.Each underlying facial bone exhibits unique characteristics essential to the face’s physical structure that could be exploited for identification.Therefore,we developed an automatic recognition method to classify human skulls for consistent identification compared with traditional classification approaches.Using our proposed approach,we were able to achieve an accuracy of 92.3–99.5%in the classification of human skulls with mandibles and an accuracy of 91.4–99.9%in the classification of human skills without mandibles.Our study represents a step forward in the construction of an effective automatic human skull identification system with a classification process that achieves satisfactory performance for a limited dataset of skull images.展开更多
Geographic variation of morphology is an important topic of evolutionary biology,and research on geographic variation can provide insights on the formation,evolution,and adaptation of species and subspecies.The verteb...Geographic variation of morphology is an important topic of evolutionary biology,and research on geographic variation can provide insights on the formation,evolution,and adaptation of species and subspecies.The vertebrate skull is a developmentally and functionally complex morphological structure with multiple functions,that is susceptible to vary according to selection pressure.In this study,geographic variations in skull morphology of Batrachuperus karlschmidti from four different geographic populations(Shade,Gexi,Shangluokema,and Xinduqiao)were examined via geometric morphometrics.No significant differences were found among these populations with regard to skull size;however,significant variation was found in skull shape.The most notable shape changes are the relative sizes and positions of the frontal,maxilla,pterygoid,and vomer.Skull shape changes were not related to allometry.However,due to limitation of sample populations and size,the results of this study need to be further verified by more sample populations and individuals in the future.The results of this study contribute to our knowledge about these aspects of morphological variability in this species as well as in hynobiid salamanders.展开更多
BACKGROUND Malignant pheochromocytoma with cerebral and skull metastasis is a very rare disease.Combining our case with 16 previously reported cases identified from a PubMed search,an analysis of 17 cases of malignant...BACKGROUND Malignant pheochromocytoma with cerebral and skull metastasis is a very rare disease.Combining our case with 16 previously reported cases identified from a PubMed search,an analysis of 17 cases of malignant cerebral pheochromocytoma was conducted.This literature review aimed to provide information on clinical manifestations,radiographic and histopathological features,and treatment strategies of this condition.CASE SUMMARY A 60-year-old man was admitted with a progressive headache and enlarging scalp mass lasting for 3 mo.Radiographic images revealed a left temporal biconvexshaped epidural mass and multiple lytic lesions.The patient underwent a left temporal craniotomy for resection of the temporal tumor.Histopathological analysis led to identification of the mass as malignant pheochromocytoma.The patient’s symptoms were alleviated at the postoperative 3-mo clinical follow-up.However,metastatic pheochromocytoma lesions were found on the right 6th rib and the 6th to 9th thoracic vertebrae on a 1-year clinical follow-up computed tomography scan.CONCLUSION Magnetic resonance spectroscopy and histopathological examination are necessary to make an accurate differential diagnosis between malignant cerebral pheochromocytoma and meningioma.Surgery is regarded as the first choice of treatment.展开更多
基金This study was approved by Ethics Committee of Sir Run Run Shaw Hospital,Zhejiang University School of Medicine(20200210[18]).
文摘Objective:Radiation osteonecrosis of the skull base after radiotherapy for nasopharyngeal carcinoma is one of the most serious complications,affecting patient survival and quality of life.To date,surgical resection is the main treatment for radiation osteonecrosis.The repair after the operation is very important.Inappropriate repair or lack of repair can easily cause local infection that can even spread to the brain,aggravating osteonecrosis.This study aimed to verify the feasibility and safety of the ante-rolateral thigh free fascia flap in repairing large skull base defects.Methods:From June 2021 to July 2022,a total of 12 patients with a history of radiotherapy for naso-pharyngeal carcinoma received surgical treatment at the Department of Otolaryngology Head&Neck Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.All patients were diagnosed with radiation osteonecrosis of the skull base with large skull base defects.During the endoscopic operation,a free anterolateral thigh fascia flap was used to repair the skull base and complete vascular anastomosis reconstruction.The preoperative and postoperative pain scores were retrospectively analyzed,and the dynamic changes in endoscopic surgery sites were observed.Results:The 12 patients had a median age of 58 y,with 8(66.7%)males and 4(33.3%)females.The median headache score for the patients was 5(4-7)before surgery.The patient's headache was significantly relieved postoperatively,with 11 patients having a score of 0 and one patient having a score of 1.The stench was completely resolved after the operation.There were no serious complications during the perioperative period or 12 months after the operation.Conclusion:The application of anterolateral thigh free fascia flap in skull base reconstruction is a safe and reliable reconstruction technique suitable for endoscopic surgical repair of large-scale skull base necrosis.
基金Supported by Traditional Chinese medicine science and technology project in Jiangsu province,No.YB2015113the Science and Technology Program of Nantong Health Committee,No.MA2019003,No.MA2021017+5 种基金Thirteenth Five-Year Plan of Nantong Science Education and Health Engineering Medical Key Talent Training Project,No.Key003Fourteenth Five-Year Plan of Nantong Science Education and Health Engineering Medical Key Talent Training ProjectFourth Batch of Municipal Science and Technology Programs in 2015,No.MS12015016Nantong Basic Science and Social Livelihood Science and Technology Program in 2022,No.JCZ2022040Kangda College of Nanjing Medical University 2021 Educational Research Project,No.KD2021JYYJYB025Kangda College of Nanjing Medical University 2022 Educational Research Project,No.KD2022KYJJZD019,No.KD2022KYJJZD022。
文摘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 incidence of cerebrospinal fluid leakage and lower complications,which has certain advantages and is worthy of clinical promotion.
文摘Introduction: Skull Base Osteomyelitis (SBO) is an infectious inflammation of the skull bones that is often caused by malignant otitis externa (MOE) and affects the temporal bone. This condition commonly affects immunocompromised individuals and the elderly, particularly those with a history of diabetes mellitus. Diagnosis is challenging because of non-specific symptoms that lead to late detection and complications. This report discusses a case of SBO with multiple bilateral cranial nerve abnormalities and highlights the diagnostic and management challenges in high-risk individuals with subtle clinical signs. Case presentation: This report describes a 63-year-old patient with hypertension and diabetes who underwent surgical debridement of the left ear due to malignant otitis externa 4 months prior to presentation. The patient presented with significant dysarthria, dysphagia, ptosis of the left eye with double vision, and hearing impairment in the left ear. Examination revealed bilateral CN VI palsy, right CN VII palsy, left CN VIII palsy, and a right CN XII deficit. Initial tests were unremarkable, but a high Fungitell assay and a second review of the CT scan and MRI revealed a pathological process in the base of the skull involving bony structures and cranial nerves bilaterally, which helped diagnose SBO. The patient was subsequently discharged with oral voriconazole and continued his usual medications. The patient requested further management abroad, because he did not notice resolution of his symptoms. Surgical treatment was employed abroad to relieve his symptoms, as he recovered slowly. Conclusion: This case report underscores the importance of a multidisciplinary approach to address SBO. Collaboration between specialists in infectious diseases, otolaryngology, radiology, and neurology plays a pivotal role in achieving an accurate diagnosis and developing a tailored treatment plan. Although SBO may be infrequent, this case report highlights the need to maintain heightened clinical suspicion in high-risk individuals.
基金This work was supported by the National Key Research and Development Program of China(No.18YFB1105600,2018YFC1106800)National Natural Science Foundation of China(51875518)+1 种基金Sichuan Province Science&Technology Department Projects(2016CZYD0004,2017SZ0001,2018GZ0142,2019YFH0079)Research Foundation for Young Teachers of Sichuan University(2018SCUH0017)and The“111”Project(No.B16033).
文摘The bone regenerative scaffold with the tailored degradation rate matching with the growth rate of the new bone is essential for adolescent bone repair.To satisfy these requirement,we proposed bone tissue scaffolds with controlled degradation rate using osteoinductive materials(Ca-P bioceramics),which is expected to present a controllable biodegradation rate for patients who need bone regeneration.Physicochemical properties,porosity,compressive strength and degradation properties of the scaffolds were studied.3D printed Ca-P scaffold(3DS),gas foaming Ca-P scaffold(FS)and autogenous bone(AB)were used in vivo for personalized beagle skull defect repair.Histological results indicated that the 3DS was highly vascularized and well combined with surrounding tissues.FS showed obvious newly formed bone tissues.AB showed the best repair effect,but it was found that AB scaffolds were partially absorbed and degraded.This study indicated that the 3D printed Ca-P bioceramics with tailored biodegradation rate is a promising candidate for personalized skull bone tissue reconstruction.
基金supported by the National Natural Science Foundation of China (50672111)Shanghai Science and Technology Committee (08520513100)
文摘We reported the development of a Ф100 cm growth apparatus for skull melting growth of yttria-stabilized cubic zirconia(YSZ) crystals and more than 1000 kg crystals have been grown in the furnace each time.The growth conditions were optimized and the structure of the as-grown crystals was characterized by X-ray diffraction.The transmittance of 15 mol.% yttria-stabilized cubic zirconia crystal was nearly 80% in the range of 400-1600 nm.The refractive indices were measured and fitted the Sellmeier equation which was obtained by least-squares method.The results showed that the apparatus was very suitable for industrial growth of YSZ crystals.
文摘A 56-year-old male visited our hospital for evaluation of an occipital mass.Contrast computed tomography showed hypervascular enhancement with osteolytic change in the skull and a huge enhanced mass in the liver.Magnetic resonance imaging showed bone metastasis in the thoracic vertebrae.Assays for hepatitis B surface antigen and hepatitis B core antibody were positive and his liver condition was Child-Pugh grade A.Our diagnosis was hepatocellular carcinoma(HCC) with skull and vertebrae metastases on chronic hepatitis B.He was treated with radiation therapy for bone metastases and transcatheter arterial chemoembolization for HCC.But he developed acute respiratory failure because of aspiration pneumonia,congestion and oedema with haemorrhage of the lungs and died.Dissection showed HCC with multiple bone metastases.The liver tumor was categorized as well-differentiated HCC,Edmondson classification Ⅰ,trabecular type and pseudoglandular type.In the liver mild infiltration of lymphocytes was seen in Glisson's capsules which were signif icantly enlarged with well preserved limiting plates.Piecemeal necrosis was not obvious.No fibrosis was noted.An 8 cm × 7 cm × 3 cm metastatic lesion had formed in the left occipitotemporal part of the cranial bone.The lesion was osteolytic and showed invasion into the dura mater.Neither the subdural cavity nor the brain showed involvement from the metastatic tumor.However,skull metastasis from HCC is very rare and it affects the patient's prognosis and the quality of life.Therefore,it is very important to make an early diagnosis and carry out proper management of skull metastasis from HCC.
文摘Three-point head fixation was constructed to provide mechanical stability for single unit recording(SUR)on vestibular sensory system in living chinchilla previously.However,it is no more qualified to this work when the stimulation intensity becomes large because of frequent unit losing and neuron damage,which strongly implies that the mechanical stability has been broken during the stimulation.Here,we constructed a novel hea0 fixation(skull cap assistant head fixation)provided by skull cap on the basis of three-point head fixation in order to improve the mechanical stability for SUR under the stimulation with large magnitude.The large area bone connection is the feature and advantage of this improved method,which directly fixes the tested local nervous tissue and microelectrode in an intact stable system through skull cap except two ear bars and a tube face mask.Our data exhibited that skull cap assistant head fixation could significantly improve the success rate of neural response activity recording in the population of semicircular canal neurons under the stimulation with large intensity(amplitudd 00 deg/s).Based on the analysis of neural response activity and noise base-line during stimulation,our data further indicated that this method could significantly improve the mechanical stability for SUR during high-speed motion stimulation on vestibular system in living chinchilla.Skull cap assistant head fixation extends the application of SUR on vestibular neuron in linear response range and provides a solid foundation for electrophysiological research on vestibular sensory system in fhrther studies.
基金supported by Shanghai Municipal Science and Technology Commission, International Cooperation Projects (No. 10410702100)
文摘Objective: To apply trifocal distraction osteogenesis in canine model of skull segmental defects and to provide reference for clinical treatment. Methods: Six labrador dogs were selected in this study and divided into observation group and control group randomly. Each group contained 3 dogs. Skull segmental defects models were established by surgery, and dogs in bservation group received trifocal distraction osteogenesis treatment. Bone density was observed and compared between two groups during treatment. Results: There were no significant difference in bone density between two groups on th 1st day ( P>0.05). The bone density of observation group on the 30th day, and 60th day were higher than that of control group ( P<0.01). Conclusions: Trifocal distraction osteogenesis has significant clinical effect, and it would be widely used in clinical treatment.
文摘Endolymphatic sac tumors(ELSTs) are rare, papillary adenomatous tumors that arise from the endothelium of the endolymphatic sac. We demonstrate a difficult case of endolymphatic sac tumor and how it is managed via transcanal endoscopic assisted technique, with discussion of feasibility of transcanal approach to lateral skull base tumor.
文摘The skull base generally refers to the anterior, middle and posterior cranial fossa and structures on the outside side of these skull areas. The cranial roof and skull base are separated by a line connecting the external occipital protuberance, parietal notch and supraorbital ridge[1].The skull base supports the brain above, is connected
文摘In this paper, the authors have observed the relation between the focuses shown by CT and patient’s condition as well as the curative effect of electroacupuncture on 70 cases of acute cerebral infarction. The result shows that electroacupuncture for acute cerebral infarction has remarkable cura tive effect (the remarkable effective rate was 82.9 %, and the total effective rate was 97.1 % ). Com bining with the CT analysis, the authors found that the condition of acute cerebral infarction patients and curative effect have close relation with the size and depth of fouses’ position (P<0.01 ).
文摘The change of the skull shape and size has been predicated through computer simulation technique and compared with the experimental results. The microstructure of the skull and the elemental line distribution in the skull have been analyzed with optical microscope and EPMA etc. The results show that the skull height and thickness become small with increasing melting power; the skull consists of two zones, that is, fine equiaxial crystal zone and coarse columnar crystal zone; there exists some segregation in the bottom of the skull.
文摘BACKGROUND Basal cell adenoma (BCA) is a rare benign tumour that has unique histological characteristics and primarily arises in the parotid glands. According to published reports, nearby tissue destruction by BCA seems impossible. CASE SUMMARY We presented a case of a 54-year-old woman with a mass in the deep lobe of the right parotid gland involving the ipsilateral skull base and mastoid. The patient exhibited gradual right facial swelling but no other obvious symptoms. Combined resection of the total right parotid gland and partial skull base excision were performed. The biopsy conducted before the surgery and sections cut from intraoperatively obtained tissues were not definitive for identifying the character of the neoplasm. A final diagnosis of tubular BCA without malignant elements was established based on postoperative pathology results and immunohistochemical analysis. The tumour did not recur during the 12-mo follow-up period. CONCLUSION A diagnosis of BCA can only be established based on a histopathological examination after an excisional biopsy, and tubular BCA should carefully be considered as a destructive type.
文摘Objectives Conventional approaches for removal of lateral skull base tumors, including transmandibular, infratemporal fossa, preauricular transzygmatic subtemporal approaches, are major invasive procedures that often sacrifice hearing and cause abnormal occlusion and cosmetic defects. Reports of the transcervical approach for resection of skull base tumors are rare, although it was described for resection of clival chordomas in as early as 1966. The purpose of this study is to review our experiences in management of lateral skull base tumors using the transcervical approach. Study Design Retrospective chart review. Methods Six lateral skull base tumor cases treated with transcervical approach procedures were reviewed, including the medical records. Results There were 4 males and 2 females. Age ranged from 12 through 52 years. Histopathological diagnoses included malignant schwannoma(n = 1), malignant carotid body tumor(n = 1), heamangioma(n=1), schwannoma (n=2) and pleomorphic adenoma (n = 1). Transcervical techniques were used in all cases with the use of microscope in the lateral skull base area. Complete tumor removal was achieved in all cases. Postoperative radiotherapy was implemented in 1 case of malignant schwannoma and 1 case of malignant carotid body tumor. Jugular foramen syndrome occurred as a surgical complication in 1 case of malignant Schwannoma of the vagus nerve. There was no tumor recurrence during the 10 - 42 month follow-up period. Conclusion Compared with conventional approaches, the transcervical approach provides a easy, safe, minimal invasive and effective procedure for removal of selected lateral skull base tumors.
文摘Necropsies and extensive histological evaluation for clinical and sub-clinical disease of approximately three hundred Portuguese Water dogs are available as part of an ongoing study to assess their state of health at the end of life. Throughout life these dogs enjoyed a variety of lifestyles and environments. Here we carry out retrospective quantitative assessments of life-time dietary input and physical activity for each dog. To do this, collagens from skull vault bone and from dentine have been analyzed for ratios of stable isotopes to determine differences in diet that individual dogs experienced during late or early life respectively. Robustness of skull bone (weight/unit of skull size) was used as a relative indicator of the amount of physical activity experienced during a dog’s lifetime. These environmental parameters were correlated with the frequency and severity of specific disease processes determined at necropsy. Both measures were shown to exert significant low-level
文摘Introduction:Majority of petrous bone and lateral skull base pathologies are benign in nature.The complex anatomy usually warrants an extensive approach with associated morbidity.Case summary:Two cases of petrous bone cholesteatoma(1 congenital cholesteatoma with facial palsy and 1 acquired cholesteatoma)and a case of glomus tympanicum were treated with exclusive endoscopic transcanal approach.The cases of petrous cholesteatoma were addressed with trans-promontorial and infra-cochlear approaches.The mean operative time was approximately 140 min.No CSF otorrhoea was noticed in the post-operative period.The average period of hospital stay was 3.7 days.Conclusion:In the subset of cases with limited benign disease an endoscopic trans-canal approach is a better alternative to an external approach.It decreases operative time,blood loss,chance of meningitis,morbidity and hospital stay.The lack of depth perception is a major hurdle which can be come over by experience in endoscopic middle ear surgery.This approach can create direct access to cochlea/petrous apex/internal auditory canal(IAC)/Supra-geniculate ganglion region.
文摘BACKGROUND Rhabdomyosarcoma(RMS)is a rare malignant tumor of mesenchymal origin that mainly affects children.Spindle cell/sclerosing RMS(SSRMS)is even rarer.It is a new subtype that was added to the World Health Organization disease classification in 2013.To the best of our knowledge,this is the first reported case of adult SSRMS disease classification originating in the temporal muscle.CASE SUMMARY SSRMS originating in the temporal muscle of a male adult enlarged rapidly,destroyed the skull,and invaded the meninges.The tumor was completely removed,and the postoperative pathological diagnosis was SSRMS.Postoperative recovery was good and chemotherapy and radiotherapy were given after the operation.Followed up for 3 mo,no tumor recurred.CONCLUSION RMS is one of the differential diagnoses for head soft tissue tumors with shortterm enlargement and skull infiltration.Preoperative computed tomography or magnetic resonance imaging is necessary for early detection of tumor invasion of the skull and brain tissue.
基金The work of I.Yuadi and A.T.Asyhari has been supported in part by Universitas Airlangga through International Collaboration Funding(Mobility Staff Exchange).
文摘The size,shape,and physical characteristics of the human skull are distinct when considering individual humans.In physical anthropology,the accurate management of skull collections is crucial for storing and maintaining collections in a cost-effective manner.For example,labeling skulls inaccurately or attaching printed labels to skulls can affect the authenticity of collections.Given the multiple issues associated with the manual identification of skulls,we propose an automatic human skull classification approach that uses a support vector machine and different feature extraction methods such as gray-level co-occurrence matrix features,Gabor features,fractal features,discrete wavelet transforms,and combinations of features.Each underlying facial bone exhibits unique characteristics essential to the face’s physical structure that could be exploited for identification.Therefore,we developed an automatic recognition method to classify human skulls for consistent identification compared with traditional classification approaches.Using our proposed approach,we were able to achieve an accuracy of 92.3–99.5%in the classification of human skulls with mandibles and an accuracy of 91.4–99.9%in the classification of human skills without mandibles.Our study represents a step forward in the construction of an effective automatic human skull identification system with a classification process that achieves satisfactory performance for a limited dataset of skull images.
基金supported by the National Natural Science Foundation of China(31471971)。
文摘Geographic variation of morphology is an important topic of evolutionary biology,and research on geographic variation can provide insights on the formation,evolution,and adaptation of species and subspecies.The vertebrate skull is a developmentally and functionally complex morphological structure with multiple functions,that is susceptible to vary according to selection pressure.In this study,geographic variations in skull morphology of Batrachuperus karlschmidti from four different geographic populations(Shade,Gexi,Shangluokema,and Xinduqiao)were examined via geometric morphometrics.No significant differences were found among these populations with regard to skull size;however,significant variation was found in skull shape.The most notable shape changes are the relative sizes and positions of the frontal,maxilla,pterygoid,and vomer.Skull shape changes were not related to allometry.However,due to limitation of sample populations and size,the results of this study need to be further verified by more sample populations and individuals in the future.The results of this study contribute to our knowledge about these aspects of morphological variability in this species as well as in hynobiid salamanders.
文摘BACKGROUND Malignant pheochromocytoma with cerebral and skull metastasis is a very rare disease.Combining our case with 16 previously reported cases identified from a PubMed search,an analysis of 17 cases of malignant cerebral pheochromocytoma was conducted.This literature review aimed to provide information on clinical manifestations,radiographic and histopathological features,and treatment strategies of this condition.CASE SUMMARY A 60-year-old man was admitted with a progressive headache and enlarging scalp mass lasting for 3 mo.Radiographic images revealed a left temporal biconvexshaped epidural mass and multiple lytic lesions.The patient underwent a left temporal craniotomy for resection of the temporal tumor.Histopathological analysis led to identification of the mass as malignant pheochromocytoma.The patient’s symptoms were alleviated at the postoperative 3-mo clinical follow-up.However,metastatic pheochromocytoma lesions were found on the right 6th rib and the 6th to 9th thoracic vertebrae on a 1-year clinical follow-up computed tomography scan.CONCLUSION Magnetic resonance spectroscopy and histopathological examination are necessary to make an accurate differential diagnosis between malignant cerebral pheochromocytoma and meningioma.Surgery is regarded as the first choice of treatment.
