Comparison of three-way effect stoic sedation for surgical removal of olphinmenacoma

Ref: Liu JK,et al.
 Neurosurg Focus2018 Apr;44 (4): E8doi: 10.3171/2018.1.FOCUS17722.:olfactory groove meningiomas, OGMs) originated from the olfactory grouse, sieve and forehead sieves at the base of the skull, accounting for 8%-13% of all intracranial meningiomasTumors are closely related to the olfactory nerve and often attack sieves and adjacent bone and blood vesselsOGMs' surgical entry is controversialJames KLiu of The New Jersey School of Medicine in Rutgers, N.J., and others review edify the efficacy and impact of a variety of OGMs surgery, published in the April 2018 issue of The Journal of Neurosurg Focusthe authors collected data from the database on 28 OGMs patients who had been surgically treated by a neurosurgeon (J.K.L.) between July 2007 and November 2016Of these, 15 cases of the endoscope bottom into the road (Figure1, 2), 5 cases of endoscopic under the nose into the road (Figure 3, 4) and 8 cases of joint into the road, that is, the endoscope by the nasal binding through the forehead bottom into the road (Figure 5, 6)Figure 1A-CPreoperative MRI shows OGM; D-FMRI imaging after the endothel to excision OGMFigure 2For patients with Figure 1, the bottom of the expanded forehead is extendedAReclining, double crown incision; BRetaining the bone valve with the vasculature, turned forward for the reconstruction of the cranial base; C, Ddouble-sided forehead flap sits comprising the front bone plate of the sinuses, the front edge of the bone window to the nasal seam and the top level; Ebone bone The window front edge exposure is low, prevents blocking the line of sight of the sieve plate, does not have to remove the eyebrow bow, Ftwo-sided forehead of the double-front of the parallel epidural parallel bone window edge and the back edge crown-shaped cut, the sachet sinuses are stitched, and then separated from the brain, turning to the nose, the side of the eyeFigure 3A-BPreoperative MRI shows OGM;Figure 4For patients with Figure 3, OGM was removed by nasal passage under a 30-degree endoscopyAIn the front cranial base (ASB) abdominal side of the keyhole small bone window to remove the skull bottom bone, the scale surface from the sinuses (FS) to the butterfly bone platform, the coronal surface from the left sieve bone plate to the right sieve bone plate forming a bone window, electrocoagulant ASB epidural to close the tumor blood vessels; After the tumor is removed, the cavity left by the front alves (FL), Eplaced in the cranial base epidural defect with an artificial epidural, Frotating and covering the cranial base defect of the nasal mucosal valve (NSF) with the vascular ti; and make a loose butterfly incision (arrow) on the mucous valve to increase the front and back stretch, forward to the back surface of the forehead sinus and to cover the whole surface of the skull; Figure 5 A-C Preoperative MRI shows OGM; MrI imaging of OGM after nasal intake and joint trans-menstrual bottom removal of OGM under the D-F endoscopy Figure 6 For patients with Figure 5, a joint path removal OGM A The tumor (T) is located at the front of the cranial base and grows on both sides along the upper wall of the cructois There is a clear bone hyperplasia (H) on the inner surface of the forehead bone The intracranial and extracranial part of the tumor was removed by the forehead, the thickening bone was removed, B After the tumor was removed from the forehead, the epidural membrane was missing with artificial meninges patch repair, and the nasal interlocutory (NS) and lower part of the nose were visible through the top of the double-eye (OR) Nasal armor (IT); C Endoscopic under the nose examination, no residual tumor in the nasal cavity, the cranial base defect can be seen artificial meninges patch; D endoscopy with a double-sided nasal mucosal valve (NSF) to repair the cranial base defect studies found that the average volume of OGM in the joint entry group was 101.148 to 71.24cm3 greater than the longitude-bottomed into the road group 92.02 to 97.64cm3 The incidence of tumor growth on both sides of the upper wall was 100%, significantly greater than 73.3% (p 0.001) in the upper wall of the tumor The cerebral edema of the week of the subcutanic tumor was more common (73.3%, p 0.001), the blood vessel splem was also more common (66.7%, p 0.001), and the tumor limbic cortex stenosis (33.3%, p.019) The tumors in the combined incoming group were all recurrent tumors that attacked the nasal cavity The average volume of tumors in the single endoscope through the nasal passage group was the smallest, 33.3 to 18.98cm3, all of which had a cortical band on the edge of the tumor, and no widespread exposure to the lateral epidural total removal of the tumor under the forehead accounted for 80% of patients, the total removal of the tumor under the endoscope through the nasal intake group reached 100%, and the total excision of the tumor in the joint into the road group accounted for 62.5% In 20% of patients with the end of the forehead and 37.5% of patients with joint access to the tumor near lyclastucy (-95%), there are residues in the tumor and important neurovascular adhesion There was no cerebrospinal fluid leakage after the operation of the forehead bottom and joint into the road group, and 1 case (20%) of cerebrospinal fluid leakage occurred in the nasal intake group under the endoscope, and the overall cerebrospinal fluid leakage incidence was 3.6% The olfactory retention rate of the population-bottomed group was 66.7% The difference between "hospital stay" and "30-day readmission rate" between the three groups was not statistically significant Postoperative follow-up 1-76 months, an average of 14.5 months; improved Rankin scale score: average of 0.79 for patients with bottom of the forehead, 2.0 for nasal entry group under the endoscope, and 2.4 for joint access group (p-0.0604) the final authors believe that for the diameter of 40mm OGM tumor or smell-good, 40mm diameter of small OGM tumor, the effect of the end-of-the-forehead surgery, the lowest incidence of complications Endoscopic nasal access seems to apply only to patients with smaller tumors and a lost sense of smell Endoscopic endoscopic lying through the nasal conjugance of the endothelial binding forehead into the road can play an important advantage in the treatment of recurrent OGM tumors in the sinus cavity It is important that the author suggests that a personalized surgical path should be selected according to the patient's specific situation.