Humans ; Minimally Invasive Surgical Procedures ; instrumentation ; methods ; Neurosurgical Procedures ; instrumentation ; methods

Background To investigate the feasibility of a novel anterior subtemporal transepidural-anterior transpetrous keyhole approach assisted by neuronavigation in attempt to apply the keyhole conception to imitate a new keyhole approach and to observe microanatomical structures, which can be regard as the base of this approach for clinical use. Methods The new keyhole approach was imitated by using ten adult cadaveric heads fixed in 10% formalin and perfused intracranial vessels with colored silicone. Under operative microscope, the anatomic structures were observed and important structures were measured after the maximal anterior petrous bone removal and the cavernous sinus exposure. Results The approach could provide a full visualization for the lateral structures and the internal contents of the cavernous sinus. The upper and middle clivus, the cerebellopintine angle, basilar artery and anterior inferior cerebellar artery were exposed after the maximal anterior petrous bone removal. Conclusions It is feasible to perform the anterior subtemporal transepidural-anterior transpetrous keyhole approach on operation of lesions involved in the cavernous sinus or/and the upper and middle clival regions.

Objective To explore the feasibility and operation methods of interforniceal diaterma keyhole approach for operative therapy of apex basilar artery aneurysm. Methods Interforniceal diaterma keyhole approach was designed to interpeduncular cistern with diaterma incision from tuber cinereum to posterior perforated substance and between bilateral mammillary bodies. The simulation operations of interforniceal diaterma keyhole approach were performed in 16 cadaveric heads by assisting with Stryker neuronavigation. Anatomic structures were observed by surgical microscope and measured by Stryker neuronavigation in the keyhole approach operations. Results The operations of interforniceal diaterma keyhole approach could be accomplished successfully in 16 cadaveric heads. The distances from bregma to superior margin of interventricular foramen, superior margin of adhaesio interthalamica, mammillary body, superior margin of aqueduct of midbrain and bifurcation of basilar artery were (68.4±4.6)mm, (66.3±6.0)mm,(86.3±5.3)mm, (82.0±7.6)mm and (91.8±5.0)mm respectively. The length of surgical window of diaterma was (9.5±2.6)mm from tuber cinereum to posterior perforated substance between bilateral mamillary bodies. The apex of basilar artery, P1 and P2 of posterior cerebral artery, superior cerebellar artery, posterior communicating artery and perforating branches from them could be exposed distinctly in interpeduncular cistern. The scope of operative exposure region was front to clivus and dorsum sellae by dissected the Liliequist panniculus, lateral to oculomotor nerve and posterior to interpeduncular fossa. The bifurcation of basilar artery apex was deviation to left in 68.8%. The bilateral posterior cerebral arteries were oblique to the anterolateral in 68.8%. There were 1-4 perforating branches from the apex of basilar artery in the included angle of bilateral posterior cerebral arteries. Conclusion Interforniceal diaterma keyhole approach is feasible for technique. It is worth of implementing and perfecting in surgical therapy of the apex basilar artery aneurysm.

Diabetes Mellitus ; drug therapy ; Diabetic Angiopathies ; drug therapy ; Diagnosis, Differential ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Hypoglycemic Agents ; therapeutic use ; Medicine, Chinese Traditional ; Phytotherapy

Autophagy can be activated after cerebral ischemia and involved in the occurrence and development of ischemic brain injury. Therefore, the study of autophagy related signal transduction pathways may provide a new therapeutic target for ischemic brain injury. This article reviews the signal transduction pathways of autophagy after cerebral ischemia.

Objective To explore the posibility of removing the jugular tubercle precisely and design a new far-lateral supraeondylar keyhole approach based on keyhole idea.Methods Eight cadaveric heads fixed by 10% formalin and perfused intracranial vessels with colored silicone were used in this study.Before the operation,navigation data of these cadaveric heads were established and circumscriptions of jugular tuber- cle were outlined in the navigation system in order to aid drilling it in operation.A 7cm longitudinal“S”shaped skin incision as we reported was performed.After inverting suboccipital muscles and exposing the far lateral of the occipital bone,occipital condyle,jugular tubercle,hemilamina of C_1,vertebral artery and pos- terolateral portion of foramen magnum,a 3cm retro-condylar bone window was made.Under the microscope, anatomic structures were observed and important structures were measured after jugular tubercle removal assis- ted by neuro-navigation.Results The 7cm longitudinal“S”shaped skin incision with its superior border 2cm behind the middle point of mastoid and inferior margin at the level of C_2 can fully meet the needs of the far-lateral supracondylar keyhole approach;jugular tubercle can be drilled satisfactorily with the help of neuro- navigation;inferior segment of basilar artery[long(15.65?1.34)mm]and anterior inferior cerebellar artery [long(20.36?4.18)mm] can be exposed.Conchlsion Owing to the area of middle clivus is increasingly exposed after removal of jugular tubercle,it is feasible to perform the far-lateral supracondylar keyhole ap- proach on the operations of vertebral-basilar artery aneurysm,anterior inferior cerebellar artery aneurysm and tumor located inferior and middle clivi or jugular foramen.

s.

Objective This study is to explore the infratentoriat-supracerebellar keyhole approach for microsurgical treatment of pineal region tumors and to evaluate its curative efficacy and safety.Methods According to hi-fi quality MRI images,individual operation schemes were designed.Microsurgical infratentori- al-supracerebellar keyhole approach was used to resect lesions in 7 consecutive patients with prone postition.A 2.0 cm?2.5 cm surgical bone window was performed with its superior margin reaching to the inferior margin of the transverse sinus and confluence sinus.Results Among the 7 pineal region tumors,there were 2 ger- minomas,2 pineocytomas,1 pineoblastoma,1 glioma and 1 chlesteatoma.All cases were re-examined with MRI after operation and it was found that 6 lesions were totally removed and 1 was subtotally removed.The outcome of the treatment was satisfying.There was no infection,bleeding or death after surgery.The follow-up result in the near future was good.Conclusion The infratentorial-supracerebellar keyhole approach for the excision of pineal region tumors was proved to be a satisfactory means with a total removal rate,an excellent curative effect and small surgical trauma.

Objective To design a new presigmoid translabyrinthine keyhole approach assisted by Stryker neuro-navigation system according to the keyhole idea,and observe microscopic anatomy structures, which could be.regarded as the bases of this approach in clinical application.Methods Navigation data were established on 8 cadaveric heads fixed by formalin and perfused intracranial vessels with colored silicone. A 7-cm postauricular C-shaped skin incision as we reported was performed.After elevating the skin flap and musculofascial flap,a 3.5 cm?3.0 cm bone window was made.On skeletonizing the sigmoid sinus,bony lab- yrinth and the canal for facial nerve,the presigmoid retrolabyrinthine,partial labyrinthectomy with petrous api- cectomy,translabyrinthine keyhole approaches were simulated in turn.The length of important structures ex- posed and the angle of vision were measured step by step, and the anatomic structures were observed.Re- suits The approach-correlated bone could precisely be drilled with the aid of neuro-navigation,which could avoid the bewilder in drilling process.The angles of visual field,the length of clivus andⅦcranial nerve were significantly increased after partial labyrinthectomy with petrous apicectomy or all labyrinth removal,but there were no significant difference between partial and all labyrinth removal.The retrolabyrinthine keyhole approach spares hearing and facial function but provided for limited window of petroclival region exposure.The partial labyrinthectomy with petrous apicectomy keyhole approach provided wider exposure to petroclival region,cere- bellopontine angle,prepontine region and posterior cavernous sinus;an area between theⅢ-XI cranial nerves was easily visible with an excellent chance of hearing and facial nerve preservation.The translabyrin- thine keyhole approach,producing more morbidity,provided for greater versatility in treating lesions,added little exposure of petroclival region.Conclusion The presigmoid translabyrinthine keyhole approach,which could provide excellent exposure of the petroclival region,was feasible to be performed in our study.The ap- proach-correlated bone could be precisely removed assisted by neuro-navigation system.The exposure was oh- viously increased hy partial labyrinthectomy with petrous apicectomy or all labyrinthine removal,the former provided an excellent chancre of hearing and facial nerve preservation.