Surgical techniques and efficacy of sudden-grinding of the post-bed by the nose endoscopic epidural

In recent years, surgery to remove a tumour from the bottom of the skull has been extensive under the endoscopic endonasal approach, EEA, while EEA has been able to provide a wider surgical field of visionHiroki Ohata, of Osaka City University School of Medicine in Japan, and others report on the surgical techniques of grinding out the back of the bed in the nose," published in the May 2019 issue of J Neurosurgresearch methodsthrough the nose endoscopic epidural after-bed sudden grinding (1)through the nose endoscopic epidural after the bed sudden grinding (2)the study was included in a total of 44 cases of saddle side or saddle tumor patients, all eEA epidural after-the-bed sudden abrasionAmong them, 18 cases were for men and 26 for women, and the age was 3-80 years old, with an average age of 43.8 to 20.5 yearsThe tumors removed included 19 cases of craniopharypharyum tube tumor after the funnel, 7 cases of spinal stoma, 6 cases of meningioma, 6 cases of large pituitary adenoma sofories extending after slope, 4 cases of cartilage sarcoma, 1 case of single fibrous tumor and 1 case of neurosisSixteen patients (37%) had a history of surgery at other hospitalsPostoperative follow-up time was 6-30 months, with an average of 16.5 to 8.2 monthsAll patients underwent 6-12 months of neuroimaging and follow-upThe researchers conducted retrospective analyses of clinical symptoms, radiographic examination, endocrine testing and neuropsychological function testing, as well as surgical complicationspatients full of hemp, take the reclining position, the upper body raised 30 degrees, the head frame fixed, rotate to the right 15 degrees, the head tilted to the leftWith the aid of the neural navigation system, four-hand technical operation is takenUnder a 30-degree endoscopy, the bone around the bottom of the saddle is removed, the inner part of the saddle knot and the optic nerve tube is identified, gently polished with a 4 mm drill (Figure 1A, B), exposing the front wall and the lower wall of the sponge sinuses on both sides (Figure 1C); Very carefully remove the ICA bone that covers the slope, and then removes the entire bone from the sponge sinus to the rupturehole with a peeler (Figure 1D-F)At the same time, grind off the slope and expose the epidural behind the slope (Figure 1G)After completing the above preparation process, "look up" under the 30-degree endoscope and begin to wear out the rear bed burst and saddle backThe use of 30-degree endoscopy is conducive to the saddle into the road, "looking up" from the bottom up to see the space after the removal of the PCPthen gently pull the ICA off the ramp outwards, exposing the outer edge of the upper slope and the outer attachment point of the PCPThen pull up the lower wall of the butterfly saddle and sponge sinus epidural, revealing the back of the saddle and the near end of the PCP on both sides (Figure 1H)The inside of the PCP is attached to the saddle back and the outside is attached to the outer edge of the upper slopeThe ICA next to the pull ramp can widen the surgical passage to the outer edge of the upper slope, while moving the pituitary body above the epidural also provides a safer epidural operating space for safely grinding off the saddle back and PCPGrind the upper slope and saddle back and separate them at the center line to break the pcP from the inside attachment to the saddle backThen, carefully remove the near end of the PCP and separate it from the outer edge of the upper slope (Figure 1I)At this point, the PCP has been detached from the inner and outer attachment points (Figure 1J)Carefully separate the remaining PCP tips from the surrounding epidurals and bed bursts, as well as from the conclining ligaments, and finally remove the PCP (Figures 1K and L)This is done to remove the bone from the epidural, eliminating the need to cut the sponge sinuses and sacrifice the lower pituitary arteryIf the PCP is large and cannot be exposed outside the epidural (Figure 1H-L), the middle line of the saddle bottom epidural (Figure 1M) can be cut with a hook knife after the completion of the preparatory step (Figure 1A-G), lift up the saddle bottom epidural and pituitary body, and further expose PCP (Figure 1N)The upper pituitary body and the pull-out slope side of the ICA, can safely remove the large PCP without opening the sponge sinus (Figure 1O-Q)The surgeon may also further remove the slope or move the pituitary body within the epidural, depending on the growth of the patient's tumor or lesionsgrinding out the saddle back and the PCP on both sides, opening the hard manmen of the saddle knot, the bottom of the saddle, the back of the saddle and the slope vertically and pulling outwards to form a passage to the foot pool and the bridge front poolThe motor eye nerve, the rear traffic artery and its perforated artery can be safely separated directly with surgical instruments (Figure 1R-T)Figure 1 The surgical procedure of wearing out the back bed suddenly by the nasal butterfly sinuses under the endoscope the outer-diaphragm rear bed bursts to obtain deep and wide lesions and full exposure to lesions, thus contributing to a greater degree of removal of tumors in the foot pool and the bridge front pool (Figures 2A, B) the post-surgery thin CT bone scan and MRI imaging examination of 44 patients, and image fusion to evaluate the effect of double-sided rear bed burst On ct and MRI fusion images, the anatomical distance of the nostrils to the pcP base base is measured on 3 levels, and the expected surgical space (Figure 2 C) :(1) is assessed at the distance between the rear bed burst distance (PC distance): the distance between the two-sided PCP (2) Surgical distance (OF): the distance between the midpoint of the nostrils to the two-sided PCP connection and the cut line of the brain stem surface (3) Expected field distance (POF): the distance between the midpoint of the nostrils and the midpoint of the artery in the two-sided neck and the cut line of the brain stem Figure 2 Models for surgical schematics and radiology assessments the results of the study the results found that 24 normal-sized PCP patients, without cutting the midline of the saddle bottom of the diaphragm and successfully grinding off the rear bed In another 20 large PCP patients, after cutting the midline line in the back of the saddle, the bed was suddenly removed after the line On the 44 cases of CT-MRI fusion images after surgery, the results of measuring 3 anatomical distances showed that the surgical field in the horizontal direction was more than 2 times more than doubled after the double-sided rear bed was extruded (Table 1) Table 1 3 anatomical distances were measured in 44 patients using CT-MRI fusion images conclusion the author, after summarizing 44 cases of endoscopic excision of the post-bed extrusion of the tumor in the back of the cranial tract, pointed out that there was sufficient surgical space for the treatment of the inter-foot pool and the bridge front pool tumor after grinding off the post-bed protrusion, and that safe operation could be carried out to avoid the bleeding of sponge sinus veins and the occurrence of neuroendocrine complications.