Postoperative Improvement Rate Research Articles

Single-stage cross-facial nerve grafting has a result equivalent to that of two-stage cross-facial nerve grafting.

Cross-face nerve grafting (CFNG) is an important treatment for patients with facial palsy. Currently, two-stage CFNG is frequently performed. CFNG is performed first, followed by coaptation when innervation reaches the grafted nerve ending. The present study compared single-stage CFNG with conventional two-stage CFNG. We retrospectively reviewed data of 17 patients who underwent CFNG with zygomatic and buccal branch with hypoglossal crossover. Patients with single-stage (group 1) and two-stage (group 2) CFNG were comparatively analyzed 2 years postoperatively. There were nine and eight patients in groups 1 and 2, respectively. The patient's perioperative status was measured with imaging and animation using the Yanagihara grade, altitude, and angle differences of the oral commissure and eye closure. Patients in group 1 could recognize their first postoperative spontaneous movement earlier than those in group 2 (268.3 ± 25.1 days vs. 327.5 ± 51.3 days, respectively, p = 0.015). The Yanagihara grade significantly improved for patients in both groups postoperatively (group 1: 12.8 ± 5.5 to 25.3 ± 6.1, p < 0.01; group 2: 12.4 ± 5.6 to 24.3 ± 5.0, p = 0.012). Height and angle difference of the oral commissure showed a significant improvement during resting and smiling in both groups. Eye closure also showed significant improvement in both groups (group 1: 4.1 ± 0.6 to 2.6 ± 0.5, p < 0.01; group 2: 4.0 ± 0.5 to 2.8 ± 0.7, p < 0.01). There was no significant difference in the postoperative improvement rate between the groups. Single-stage CFNG shows results equivalent to those of two-stage CFNG. Single-stage CFNG is associated with a shorter treatment period and fewer operations.

Analysis of Contact Position for Subthalamic Nucleus Deep Brain Stimulation-Induced Hyperhidrosis.

Objectives To analyze the hyperhidrosis neural network structure induced by subthalamic nucleus (STN) - deep brain stimulation (DBS). Materials and Methods Patients with Parkinson's disease treated with STN-DBS in Changhai Hospital between July 1, 2015, and December 1, 2016, were analyzed retrospectively. Using records of side effects of the intraoperative macrostimulation test, patients with skin sweats were selected as the sweating group. Based on the number of cases in the sweating group, the same number of patients was randomly selected from other STN-DBS patients without sweating to form the control group. The study standardized electrode position with Lead-DBS software to Montreal Neurological Institute (MNI) standard stereotactic space to compare the differences in three-dimensional coordinates of activated contacts between groups. Results Of 355 patients, 11 patients had sweats during intraoperative macrostimulation tests. There was no significant difference in the preoperative baseline information and the postoperative UPDRS-III improvement rate (Med-off, IPG-on) between groups. Contacts inducing sweat were more medial (X-axis) (11.02 ± 0.69 mm vs 11.98 ± 0.84 mm, P=0.00057) and more upward (Z-axis) (−7.15 ± 1.06 mm VS −7.98 ± 1.21 mm, P=0.032) than those of the control group. The straight-line distance between the center of the sweat contact and the nearest voxel of the red nucleus was closer than that of the control group (2.72 ± 0.65 mm VS 3.76 ± 0.85 mm, P=0.00012). Conclusions STN-DBS-induced sweat indicated that the contact was at superior medial of STN.

The outcomes comparison between autologous incus and titanium PORP in Austin A and C type ossicle defect cases

Objective: A series of otitis media patients with Austin A and C type ossicles defects received ossicular chain reconstruction surgery using either autologous incus or titanium partial ossicular replacement prosthesis (PORP).The hearing outcomes and exclusion rate of prosthesis were compared between these two groups. Method: One hundred and seventy-six patients with chronic otitis media underwent ossiculoplasty in our hospital during 2016-2017. These patients were divided into 2 groups: group A consisted of those receiving autologous incus replacement (n=85), and group B consisted of those receiving titanium PORP (n=91). All the patients received CWD mastoidectomy and ossiculoplasty in one stage and were followedup in postoperative 3, 6 and 12 months. Result: The postoperative hearing improvement rates in group A and B were 85.88% and 92.31%, respectively, and there was no statistical difference. No statistical difference of the postoperative hearing improvement rates was observed between Austin A and C type in 2 groups. Three cases (3.29%) had ossicle exclusion in B group, and 0 case in A group, which was not statistical different (P>0.05). Conclusion: Patients receiving ossicular chain reconstruction surgery using autologous incus show similar hearing outcomes as those using titanium PORP. The risk of prosthesis exclusion is lower for autologous incus than titanium PORP. The residual handle of malleus has no obvious influence on the postoperative hearing improvement.

A new 3D printed titanium metal trabecular bone reconstruction system for early osteonecrosis of the femoral head.

Presently, biomechanical support therapy for the femoral head has become an important approach in the treatment of early osteonecrosis of the femoral head (ONFH). Previous studies have reported that the titanium metal trabecular bone reconstruction systems (TMTBRS) achieved satisfactory clinical results for the treatment of early femoral head necrosis. Electron beam melting technology (EBMT) is an important branch of 3D printing technology, which enables the construction of an interface that is required for support of bone in-growth. However, the effect of TMTBRS created using EBMT for clinical applications for early ONFH is still unknown. At present, there are no reports on this topic worldwide. The purpose of this study was to assess the safety of a new 3D printed TMTBRS implant and to evaluate its clinical efficacy in early ONFH.Thirty patients who underwent surgery for ONFH were selected. The stages of ONFH were classified according to the Association Research Circulation Osseus (ARCO) classification. They were followed-up and radiological examination was performed at 6, 12, and 24 months post-surgery to assess TMTBRS stability and bone growth in the bone trabecular holder portion surface. To evaluate hip function, postoperative Harris and Visual Analogue Scale (VAS) scores were used.The postoperative Harris score increased significantly and VAS score decreased significantly at the 12-month follow-up compared to the 24-month follow-up, wherein the Harris score declined slightly and the VAS score was slightly elevated with the aggravation of ONFH. With the passage of time, postoperative improvement rates were 100% for IIA, 70% for IIB, and 0% for IIC. Hip-preserving rates were 100% for IIA, 100% for IIB, and 50% for IIC.The effect of TMTBRS treatment for early ONFH in ARCO IIA and ARCO IIB is satisfactory. However, it is not recommended for a relatively large area of necrosis such as in ARCO IIC.

Comparison of flow diversion with clipping and coiling for the treatment of paraclinoid aneurysms in 115 patients.

Paraclinoid aneurysms represent approximately 5% of intracranial aneurysms (Drake et al. [1968]). Visual impairment, which occurs in 16%-40% of patients, is among the most common presentations of these aneurysms (Day [1990], Lai and Morgan [2013], Sahlein et al. [2015], and Silva et al. [2017]). Flow-diverting stents, such as the Pipeline Embolization Device (PED), are increasingly used to treat these aneurysms, in part because of their theoretical reduction of mass effect (Fiorella et al. [2009]). Limited data on paraclinoid aneurysms treated with a PED exist, and few studies have compared outcomes of patients after PED placement with those of patients after clipping or coiling. The authors performed a retrospective analysis of 115 patients with an aneurysm of the cavernous to ophthalmic segments of the internal carotid artery treated with clipping, coiling, or PED deployment between January 2011 and March 2017. Postoperative complications were defined as new neurological deficit, aneurysm rupture, recanalization, or other any operative complication that required reintervention. A total of 125 paraclinoid aneurysms in 115 patients were treated, including 70 with PED placement, 23 with coiling, and 32 with clipping. Eighteen (14%) aneurysms were ruptured. The mean aneurysm size was 8.2 mm, and the mean follow-up duration was 18.4 months. Most aneurysms were discovered incidentally, but visual impairment, which occurred in 21 (18%) patients, was the most common presenting symptom. Among these patients, 15 (71%) experienced improvement in their visual symptoms after treatment, including 14 (93%) of these 15 patients who were treated with PED deployment. Complete angiographic occlusion was achieved in 89% of the patients. Complications were seen in 17 (15%) patients, including 10 (16%) after PED placement, 2 (9%) after coiling, and 5 (17%) after clipping. Patients with incomplete aneurysm occlusion had a higher rate of procedural complications than those with complete occlusion (p = 0.02). The rate of postoperative visual improvement was significantly higher among patients treated with PED deployment than in those treated with coiling (p = 0.01). The significant predictors of procedural complications were incomplete occlusion (p = 0.03), hypertension, (p = 0.04), and diabetes (p = 0.03). In a large series in which patient outcomes after treatment of paraclinoid aneurysms were compared, the authors found a high rate of aneurysm occlusion and a comparable rate of procedural complications among patients treated with PED placement compared with the rates among those who underwent clipping or coiling. For patients who presented with visual symptoms, those treated with PED placement had the highest rate of visual improvement. The results of this study suggest that the PED is an effective and safe modality for treating paraclinoid aneurysms, especially for patients who present with visual symptoms.

Nonfunctioning pituitary adenomas in elderly patients

BackgroundRecently, several reports have revealed new aspects regarding transsphenoidal surgery (TSS) for pituitary lesions in elderly patients. ObjectiveThe aim of present study is to provide an updated review of the recent literature, which we hope will contribute to the management of nonfunctioning pituitary adenoma (NFPA) in elderly patients. MethodsWe searched PubMed and Web of Science for reports on TSS for NFPAs in elderly patients and reviewed the literature. ResultsNFPAs, which cause the symptoms of tumor mass effect, are the most common form of pituitary adenoma in elderly individuals. The rates of tumor resection and postoperative visual improvement in elderly patients are similar to those in younger patients; however, elderly patients have greater difficulty in recovering from preoperative hypopituitarism. TSS is associated with low rates of morbidity and mortality in elderly patients. However, there is a possibility that the risks of morbidity and mortality increase with advancing age. TSS is not considered for elderly patients who show hypopituitarism alone, but who either have or are predicted to experience a tumor mass effect. Prospective MRI follow-up without surgery can be also proposed for elderly patients with a high American Society of Anesthesiologists (ASA) grade or those in whom there is no evidence of tumor growth towards the optic pathway. ConclusionsTSS is considered a safe procedure for the treatment of NFPA and is even tolerated by elderly patients; however, the surgical indications, which are based on the patient’s clinical condition and the results of radiological examinations, should be strict.

Postoperative Changes in Metabolic Parameters of Patients with Surgically Controlled Acromegaly: Assessment of New Stringent Cure Criteria.

The criteria for surgical cure of acromegaly have become more stringent during the past decades and a change from Cortina to new consensus criteria has recently been proposed. However, the superiority of the new consensus over Cortina criteria with respect to postoperative metabolic parameters remains to be ascertained. We retrospectively assessed metabolic parameters, the body habitus, and other health-related parameters of 48 patients with surgically controlled acromegaly who met the Cortina criteria [normalized insulin-like growth factor-1 (IGF-1) level and nadir growth hormone (GH) level <1.0 ng/ml during postoperative oral glucose tolerance test]. The 48 patients were divided into two groups. Group A (n = 33) met the new consensus criteria (normalized IGF-1 and nadir GH level <0.4 ng/ml). Group B (n = 15) met Cortina criteria, but their nadir GH ranged from 0.4 to 1.0 ng/ml. In both groups, the level of triglyceride and homeostasis model assessment-insulin resistance (HOMA-IR) was significantly decreased 1 year after the operation (P < 0.05). High-density lipoprotein cholesterol showed a significant increase only in group B (P = 0.02). However, the two groups did not differ with respect to the postoperative improvement rate of these parameters and the other health-related parameters including body mass index, blood pressure, anterior pituitary function, and self-estimated quality of life scale. In conclusion, our findings show that with respect to changes in metabolic parameters and the body habitus assessed 1 year after surgery, the stricter consensus criteria seemed not to be superior to Cortina criteria.

Different states of otitis media were retrospectively analyzed of myringoplasty

Objective:Through analysis of the tympanic membrane perforation rate and hearing improvement rate with chronic suppurative otitis media (CSOM) by myringoplasty,to observe the effect of different preoperative conditions such as middle ear lesion,eustachian tube (ET) function and infection status on the postoperative curative effect.Method:Retrospective analysis of EENT Hospital of Fudan University from January 2012 to November 2016 during the 203 cases (203 ears) with clinical data of myringoplasty: according to intraoperative exploration of the presence of purulent secretions in the tympanic cavity,divided into infection active group and infection quiescence group; according to the preoperative results of the function of ET with acoustic impedance test divided into dysfunction or good group; according to the preoperative temporal bone HRCT suggested that the middle ear (mastoid cells,tympanic antrum and tympanic cavity) with or without soft tissue density,divided into the group with no focal lesion and the group with focal lesion. Review endoscopy and pure tone audiometry after 3 to 6 months. Using SPSS 19.0 statistical software to compare the differences among them of tympanic membrane perforation rate and hearing improvement rate.Result:Single factor analysis: ①The infection quiescence group of tympanic membrane perforation rate was 11.93%(13/109),higher than the infection active group ［8.51%(8/94)］; the infection quiescence group of hearing improvement rate was 75.23%(82/109),below the infection active group ［79.79%(75/94)］,no statistically significant differences of them (P>0.05).②The group with dysfunction of ET of tympanic membrane perforation rate was 14.06%(9/64),significantly higher than the group［4.04%(4/99)］with good function ET,with statistical difference of them (P<0.05); the group with dysfunction of ET of hearing improvement rate was 76.56% (49/64),lower than the group［81.82%(81/99)］with good function of ET,no significant difference of them (P>0.05).③The group with no obvious lesion of tympanic membrane perforation rate was 9.09% (10/110),lower than the group ［11.83%(11/93)］with focal lesion; the group with no obvious lesion of hearing improvement rate was 78.18% (86/110),higher than the group with focal lesion ［76.34%(71/93)］,no significant difference of them (P>0.05).Multivariate analysis: ①There was a significant correlation of postop-erative tympanic membrane perforation rate with preoperative ET functi-on (P<0.05).There was no significant correlation of the postoperative tympanic membrane perforation rate with the infection status and the temporal bone HRCT images in the middle ear lesions (P>0.05).②There was no significant correlation of the postoperative hearing improvement rate with the infection status,the ET function and the temporal bone HRCT images in the middle ear lesions (P>0.05).Conclusion:Dysfunction of ET and localized lesions of the ear were more common in infection active;the accumulation of purulent exudate on the surface of the tympanic mucosa and localized lesions of the middle ear did not affect the healing rate of the tympanic membrane and the hearing improvement rate; ET function is one of the most important factors that affect the healing rate of tympanic membrane after operation,the patients with ET dysfunction are more likely to affect tympanic membrane perforation,but does not affect the hearing improvement rate.

Differences in myringoplasty between endoscopic and microscope

Objective:The intraoperative and postoperative clinical indexes of myringoplasty performed by endoscope or by microscope were collected retrospectively, the differences between the two different surgical methods were analysized. Method:Retrospective analysis of the clinical data of 70 cases (70 ears) udergoing myringoplasty in the department of Otolaryngology-Head and Neck Surgery, at the Second People's Hospital of Kashi from June 2014 to August 2015. According to the surgical approach cases were divided into two groups, 30 cases in group A by endoscopic myringoplasty and 40 cases in group B by microscope myringoplasty. The operation time, blood loss, postoperative dry ear time, wound healing scar hyperplasia, tympanic membrane perforation rate and hearing improvement rate were compared between the two groups, and SPSS 19.0 statistical software was used to analyze the differences between the two groups. Result:The operation time: Group A had an average of (35.23±6.38)min, less than group B (42.60±7.97)min, with statistical difference (P<0.05). The intraoperative blood loss: the average of group A was (7.33±2.11)ml, less than group B (17.93±3.84)ml, with statistical difference (P<0.05). The postoperative dry ear time more than 1 month: group A was 40%, lower than Group B (75%), with statistical difference (P<0.05). The postoperative incision healing scar hyperplasia: group A was 0%, lower than group B (5%), no significant difference (P>0.05). The tympanic membrane perforation rate: group A was 3.33%, lower than group B (7.5%), no significant difference (P>0.05). The postoperative hearing improvement rate: group A was 76.67%, lower than group B (80.00%), no significant difference (P>0.05). Conclusion:Compared with the traditional microscope surgery, endoscopic myringoplasty is a minimally invasive surgical technique which can get the same curative effect, but with a shorter operation time, less intraoperative blood loss, dry ear in shorter time , recovery more quickly, beautiful incision and other advantages. So it is worthy of clinical application.

Cervical expensive open-door laminoplasty combined with vitamin B12 treatment for patients of cervical spondylotic myelopathy with subacute combined degeneration of the spinal cord

Objective To investigate the clinical outcome of cervical expensive open-door laminoplasty combined with vitamin B12 treatment for patients of cervical spondylotic myelopathy with subacute combined degeneration of the spinal cord. Methods Data of 10 patients with cervical spondylotic myelopathy with subacute combined degeneration of the spinal cord in February 2013 to August 2013 were retrospectively analyzed. There were 7 males and 3 females with an average age of 46 years (range, 32-73 years). Eight patients’ history was in six months, and others’ was beyond six months. All patients had undergone cervical expansive open-door laminoplasty with mini-plate fixation combined with intramuscular injection or pre os vitamin B12. Patient imaging data were used to assess the stability of the cervical spine, and spinal cord compression in the fixed position before and after their surgery. Japanese Orthopaedic Association (JOA) score was used to evaluate function, and the rate of neurological improvement was calculated. The American Spinal Injury Association was used to evaluate the neurological function inpatients be-fore and after surgery. The preoperative and postoperative numerical changes of SEP and vitamin B12 were compared using corre-lation analysis. Each dimension of preoperative and postoperative scores change was compared by Life quality evaluation F-36 scale. Results All patients were followed up for an average period of 15 months (range, 6-26 months). There were no complica-tions related to the internal fixation, such as fixation loosened or broken. Cerebrospinal fluid surrounding the spinal cord within the C3-7 range of the signal on MRI T2WI of the continuous had been recovered. JOA score increased from preoperative 9.6±2.04 to postoperative 14.7±2.04, and postoperative neurological improvement rate was 20%-80%. The excellent and good rate was 90% (9/10) including 4 excellent and 5 good. Vitamin B12 level before operation: 78.30±42.82 pg/ml, postoperative: 176.50±85.77 pg/ml. Electromyography and SEP had been all recovered. There was correlation between preoperative and postoperative vitamin B12 lev-els with spinal cord function score. According to ASIA score, there were 4 cases in C level, 6 in D level preoperatively, while 2 in C level, 5 in D level, 3 in E level postoperatively. Conclusion Cervical spondylotic myelopathy with subacute combined degen- eration of the spinal cord could be treated by surgery. Vitamin B12 by per os or intramuscular injection with removal of the cervi-cal spinal cord compression which creates a space for recovery of spinal cord could improve the surgical curative effect. Key words: Cervical vertebrae; Vitamin B12 deficiency; Subacute combined degeneration

Application of intra-operative yellow fluorescence to intramedullary spinal cord ependymoma resection

Objectives To study the application of intraoperative yellow fluorescence to intramedullary spinal cord ependymoma resection. Methods The clinical data of 83 in-patients with spinal cord tumors were retrospectively analyzed, who were admitted to Department of Neurosurgery, Beijing Tsinghua Changgung Hospital from December 2014 to December 2015. Among them, the diagnosis of intramedullary spinal cord ependymoma was histologically confirmed in 56 cases (39 men and 17 women), whose mean age was 43.5±4.2 years old (range: 31～65 years). All cases in this study received preoperative MRI scan to demonstrate the location, size and segment of tumors.Fluorescein sodium(3～4 mg/kg) was administered intravenously 30 minutes prior to anesthesia. Tumor resection was performed under alternation between conventional white light and yellow fluorescent light source. At 3 months post operation, MRI scans were conducted for observation of residual tumors, and spinal cord function was evaluated according to the McCormick scale. The mean follow-up period was 3 months. Results The rate of gross total resection (GTR)was 100.0% in this series of 56 cases. Among them, 47 cases were significantly stained under fluorescein sodium model (correlated with preoperative MRI enhancement) and received fluorescence-guided tumor resection.The other 9 cases with little staining (including 2 cases with little preoperative MRI enhancement and 4 cases demonstrating uneven MRI enhancement due to tumor apoplexy) underwent resection with conventional white light. Compared with 7-day and 1-month follow-ups, the 3-month postoperative improvement rates of sensory and motor functions were 83.0%(44/53)and 82.4%(42/51), respectively(P 0.05). Based on the McCormick grading system, 3.6%(2), 55.4%(31), 25.0%(14)and 16.1%(9)of the 56 patients were preoperatively categorized as gradeⅠ, Ⅱ, Ⅲ and Ⅳ, respectively. At 3 months post operation, 7.2%(32), 21.4%(12), 14.3%(8) and 7.1%(4) of the patients were categorized as gradeⅠ, Ⅱ, Ⅲ and Ⅳ, respectively, which demonstrated significant difference compared with preoperative conditions (P<0.01). The patients preoperatively categorized as grade Ⅰ and Ⅱ reported good surgical outcomes, while grade Ⅲ and Ⅳ patients did not. MRI results demonstratedno residual tumors or recurrence 3 months post operation. Conclusion Fluorescein sodium could be used for intramedullary ependymoma resection and contribute to complete excision of tumors. Key words: Spinal cord neoplasms; Ependymoma; Fluoresceins; Neurosurgical procedures

Endovascular therapy for complex ostial vertebral artery stenosis

Objective To investigate the characteristics of endovascular intervention to treat complex ostial vertebral artery stenosis. Methods The 56 patients of complex ostial vertebral artery stenosis were summarized with endovascular treatment by vascular surgery at Xuanwu Hospital of Capital Medical University from 2013 Jun to 2015 Jun. The lesion features of the cases, the success rate of endovascular treatment, relief of postoperative symptoms, and the patency rate were analyzed. Results The complex of vertebral artery lesion was divided into three types: Type Ⅰwas the almost occlude lesion of vertebral artery, Type Ⅱ was the stenting of ostial vertebral artery need upper limb artery approach, and Type Ⅲ was the ostial vertebral artery lesion combined with the subclavian artery stenosis or occlusion. The success rate of endovascular treatment was 92.9%. Postoperative symptom improvement rate was 56.5%. The patency rate was 88.5% after 1 year. Conclusions Predilation could improve the stent success rate to the almost occlude lesion of vertebral artery. Upper limb artery approach could improve the stent success rate of vertebral artery. The vertebral artery should be protected during the procedure of the subclavian artery stenting. Key words: Vertebrobasilar insufficiency/SU; Angioplasty; Vascular surgical procedures; Stents

Subthalamic nucleus stimulation improves Parkinson's disease-associated camptocormia in parallel to its preoperative levodopa responsiveness

ObjectiveThe aim of this work was to identify factors predictive of postoperative improvement of camptocormia in patients with Parkinson's disease (PD) treated by subthalamic nucleus (STN) stimulation.BackgroundCamptocormia, one of the...

Posterolateral fusion with interbody for lumbar spondylolisthesis is associated with less repeat surgery than posterolateral fusion alone

ObjectivePosterior or transforaminal lumbar interbody fusions (PLIF/TLIF) may improve the outcomes in patients with lumbar spondylolisthesis. This study aims to compare outcomes after posterolateral fusion (PLF) only versus PLF with interbody fusion (PLF+PLIF/TLIF) in patients with spondylolisthesis. MethodsWe retrospectively reviewed103 patients who underwent first-time instrumented lumbar fusions for degenerative or isthmic spondylolisthesis. Anterior techniques and multilevel interbody fusions were excluded. All patients were followed for at least 2 years postoperatively. Clinical outcomes including back pain, radiculopathy, weakness, sensory deficits, and loss of bowel/bladder function were ascertained from clinic notes. Radiographic measures were calculated with Tillard percentage of spondylolisthesis. Reoperation for progression of degenerative disease, a primary endpoint, was indicated for all patients with (1) persistent or new-onset neurological symptoms; and (2) radiographic imaging that correlated with clinical presentation. ResultsOf the 103 patients, 56.31% were managed with PLF and 43.69% with PLF+PLIF/TLIF. On radiographic studies, spondylolisthesis improved by a mean of 13.06% after PLF+PLIF/TLIF versus 5.67% after PLF (p<0.001). In comparison to PLF+PLIF/TLIF, patients undergoing PLF experienced higher rates of postoperative improvement in back pain, sensory deficits, motor weakness, radiculopathy, and bowel/bladder difficulty; however, these differences did not reach statistical significance. The PLF cohort had a significantly higher incidence of reoperation (p=0.011) and pseudoarthrosis/instrumentation failure (p=0.043). In the logistical analyses, non-interbody fusion was the strongest predictor of reoperation for progression of degenerative disease. ConclusionCompared to PLF only, PLF+PLIF/TLIF were statistically significantly associated with a greater correction of spondylolisthesis. Patients with interbody fusions were less likely to undergo reoperation for degenerative disease progression compared to non-interbody fusions. However, greater listhesis correction and decreased reoperation in the PLF+PLIF/TLIF cohort should be weighed with favorable clinical outcomes in the PLF cohort.

Prospective, Self-controlled, Comparative Study of Transposterior Arch Lateral Mass Screw Fixation and Lateral Mass Screw Fixation of the Atlas in the Treatment of Atlantoaxial Instability

A prospective self-controlled study. The aim of the present study was to compare the application and clinical outcomes of transposterior arch lateral mass screw and lateral mass screw fixation of the atlas in the treatment of atlantoaxial instability. Atlas posterior screw fixation techniques comprise transposterior arch lateral mass screw fixation and lateral mass screw fixation. Previous studies have focused mainly on the feasibility of the anatomy and the biomechanics of the methods. From June 2006 to February 2011, 66 patients with atlantoaxial instability were randomly assigned for treatment with transposterior arch lateral mass screw or lateral mass screw fixation of the atlas, combined with axis pedicle screw fixation. Patients were followed up regularly. The operation time, blood loss, intraoperative complications, Japan Department of Orthopedics Association Score, visual analog scale score, and bone fusion rates were recorded. The operation was successful in all 66 cases, with all patients showing improvement in clinical symptoms. There were significant differences in operation time and blood loss between the 2 groups (P<0.001). The mean follow-up time was 49 months. At the final follow-up, the Japan Department of Orthopedics Association score was significantly better than the preoperative score (mean, 13.5; P<0.05). The mean postoperative improvement rate was 88.2% and the mean visual analog scale score was 1.9; both results were significant as compared with preoperative results (P<0.05). Bone fusion was achieved within 6 months after operation. No screw loosening, shifting, breakage, or atlantoaxial instability was observed. Six patients with atlas lateral mass screw placement had burst bleeding of C1-C2 venous plexus during surgery. Five patients had immediate pain and numbness at the occipitocervical region. Atlas transposterior arch lateral mass screw fixation is less invasive, simple, has fewer complications, and offers good fixation results for atlantoaxial instability as compared with lateral mass screw fixation.

SPECT cerebral perfusion imaging and its quantitative analysis for the assessment of stent implantation for cerebral artery stenosis

Objective To evaluate the role of SPECT cerebral perfusion imaging in assessing the stent implantation for cerebral artery stenosis. Methods A total of 35 patients (31 males, 4 females, average age (63.9±10.8) years) with cerebral artery stenosis confirmed by DSA for cerebral artery stent implantation were retrospectively analyzed. 99Tcm-ECD cerebral perfusion imaging was performed for all patients before and after stent implantation. The images were realigned and normalized by SPM 2.0 and then analyzed by Brain Search software for quantitative analysis. The brain was automatically separated to 210 functional areas according to Talarich map. The normalized averaged counts (NAC) of each area were calculated and compared with the data of 28 health controls(8 males, 20 females, average age (35.8±9.4) years). Less than 1.96s was defined as low perfusion lesions. The NAC values before and after stent implantation were compared for classifying improved from non-improved group. The mean number of lesions and Essen stroke risk score (ESRS) were analyzed between the two groups. The mean number of lesions and postoperative improvement rate of the internal carotid artery (ICA) occlusion and stenosis were compared. Paired rank sum test, two-sample t test, two-sample rank sum test and χ2 test were used for statistical analysis. Results In 35 patients with low perfusion areas, 20 were significantly improved after stent implantation. The mean number of lesions in the improved group(34.05±14.41) was significantly higher than that in the non-improved group (22.93±17.24; t=2.067, P 0.05). The mean number of the ICA occlusion lesions (34.36±14.31) was higher than that of the ICA stenosis lesions(31.35±16.37), but the difference was not statistically significant(t=0.498, P>0.05). The improvement rate of the ICA occlusion was higher than that of the ICA stenosis (7/11 vs 10/17), but the difference was not statistically significant(P>0.05). Conclusion SPECT cerebral perfusion imaging and its quantitative analysis can evaluate the low perfusion lesions before stent implantation and predict the perfusion improvement after stent implantation. Key words: Carotid stenosis; Stents; Tomography, emission-computed, single-photon; ECD

Retrospective study on the hearing improvement and postoperative perforation rates in 121 myringoplasty cases

Retrospectively analyzed the influences of preoperative acoustic immittance pressure balance tests and intraoperative wet ear findings in myringoplasty surgery results. One hundred and twenty-one chronic suppurative otitis media patients underwent myringoplasty surgeries were included and divided into functional group and non-functional group according to preoperative acoustic immittance pressure balance tests. Meanwhile, cases were divided into dry ear group and wet ear group according to intraoperative findings. Postoperative hearing improvement and perforation rate were compared between the two groups. Functional group had 72 cases, including 58 dry ears and 14 wet ears. Non-functional group had 46 cases, including 19 dry ears and 27 wet ears. Postoperative hearing improvement rate in functional group was 85.5% (59/69), and 72.1% (31/43) in non-functional group (χ(2) = 2.230, P = 0.093). Perforation rate in functional group was 16.7% (12/72), significant higher when compared with 2.2% (1/46) in non-functional group (χ(2) = 4.626, P = 0.015). Postoperative hearing improvement rate in dry ear group was 85.3% (64/75), and 71.8% (28/39) in wet ear group (χ(2) = 2.213, P = 0.085) . Perforation rate in dry ear group was 12.8% (10/78), and 7.0% (3/43) in wet ear group (χ(2) = 0.472, P = 0.377). Non-functional result of preoperative acoustic immittance pressure balance test had significant relationship with the intraoperative wet ear findings. It may result in lower postoperative hearing level, and lower perforation rate. Large sample studies should be carried out in future.

A study on determinants of utilization in health and welfare services among the elderly who were recognized non-grade for long-term care insurance

Purpose: To compare the outcomes of indocyanine green (ICG) and triamcinolone (TA) assisted internal limiting membrane (ILM) peeling during idiopathic macular hole surgery. Methods: Fifty-four eyes of 54 patients with idiopathic macular hole underwent pars plana vitrectomy including peeling of the posterior cortical hyaloid and peeling of the internal limiting membrane. For enhanced visualization of ILM, ICG was used in 25 eyes and TA in the remaining 29 eyes. Postoperative visual acuity was measured and OCT was performed. Results: Anatomical closure was achieved in 25 eyes (100%) in ICG group and 28 eyes (97%) in TA group, Best corrected visual acuity improvement by ?2 lines was in 15 eyes (60%) in ICG group and 18 eyes (62%) in TA group. Postoperative visual improvement rates by ?20/50 were 10 eyes (40%) in ICG group and 9 eyes (31%) in TA group. Conclusions: Peeling of the internal limiting membrane using triamcinolone and indocyanine green was safe and effective for anatomic and functional success in idiopathic macular hole surgery. Further studies of the toxicity of TA, ICG and the result of internal limiting membrane peeling is needed.

Comparison in Clinical Outcome of Two Surgical Treatments in Degenerative Scoliosis

To evaluate the clinical outcome of two different surgical treatments in treating degenerative scoliosis. Forty patients with degenerative scoliosis hospitalized in our department from June 2010 to June 2012 were selected. They were randomly divided into two groups. The first group was performed on the points with nerve or spinal compression for decompression, bone grafting, and short-segmental fixation in situ; The second group was treated with sufficient decompression, long-segmental fixation, and short-segmental fusion to operate orthopedic on scoliosis in three dimensions. All patients completed the follow-up period for more than 1 year, with the average of 18 months. Bone grafting fusion was achieved in all of the patients. The second group showed significantly better result in remission rate of postoperative pain and ODI improvement rate than the first group. Long-segmental internal fixation orthopedic is a better surgical option for patients with degenerative scoliosis to achieve sufficient decompression and three-dimensional orthopedic; therefore, it is a better solution for biomechanical reconstruction of spine.

Individualized neurosurgical treatments of spastic cerebral palsy

To explore the outcomes of individualized neurosurgical treatments of spastic cerebral palsy. A total of 452 spastic cerebral palsy patients undergoing microneurosurgery during March 2006 and December 2011 were retrospectively analyzed. Performed on the basis of clinical manifestations, comprehensive procedures included selective cutting of neck or lumbosacral dorsal root ganglia (SPR, n = 182) for multiple muscle spasm, selective peripheral neurotomy (SPN, n = 270) for focal muscle spasm, line tendon lengthening or cutting and orthopedic surgery (n = 116) for tendon contracture plus limb deformities and carotid artery adventitia endarterectomy (n = 46) for salivation plus athetoid. The average follow-up period was 18 (10-24) months. The limb spasm relief rate of SPR was 95.6% and that of SPN 98.3%. And the postoperative symptom improvement rate of common carotid arterial adventitia stripping was 91.3%. There were 8 cases (4.4%) of recurrent spasticity after SPR and 28 (10.4%) after SPN. Offering individualized microsurgical treatments on the basis of clinical manifestations is essential for patients with spastic cerebral palsy.