ObjectiveTo investigate the role of intraoperative ultrasound (IOUS) in the surgical treatment of cerebral gliomas.MethodsThirty patients with primary supratentorial gliomas underwent microsurgery guided by intraoperative real-time ultrasound, IOUS was utilized for localization and delineation of the tumor as well as determination of the extent of resection.ResultsAll of 30 lesions were accurately defined by IOUS due to the distinct echogenicity compared with the normal brain. Solid low grade gliomas tended to be well circumscribed with regular sulcus, while central necrosis was most commonly present with malignant gliomas. Complete tumor extirpation was achieved by IOUS guidance in this group. Two patients exhibited mild neurological deficit following the surgery.ConclusionIOUS may provide valuable real-time information and facilitate effectual surgery with accuracy for the cerebral gliomas.

OBJECTIVETo study the clinical characteristics, diagnosis and surgical treatment of malignant intracranial teratomas.

METHODSThirty-four patients with intracranial teratoma proved by histopathology were treated by operation. The growth pattern of this tumor, assessed by its clinical manifestations and neuroimaging together with surgical treatment and results were analyzed retrospectively.

RESULTSOnly 6 lesions had been correctly suspected as teratoma before surgery. Total removal was achieved in 14 patients with a operative mortality of 32.4%. The survival of 23 patients with lesions showing aggressive growth was significantly different from those without (P < 0.05). Nineteen of these patients did not survive beyond the sixth month after surgery.

CONCLUSIONAccurate preoperative diagnosis is difficult in malignant intracranial teratoma, especially for patients with the tumor in the sella region. The invasive biological behavior of the tumor is proved to be the main cause of surgery being dwarfed. Protection of the hypothalamus and brainstem, relief of hydrocephalus are the crucial points in surgical treatment. Comprehensive histopathologic examination combined with serum and CSF tumor marker detection is necessary for correct diagnosis and treatment.

Adolescent ; Adult ; Biomarkers, Tumor ; blood ; cerebrospinal fluid ; Brain Neoplasms ; diagnosis ; mortality ; pathology ; surgery ; Child ; Female ; Humans ; Male ; Neoplasm Invasiveness ; Prognosis ; Teratoma ; diagnosis ; mortality ; pathology ; surgery

Objective To explore the incidence of tibial plateau fracture with ligament injuries and the early diagnosis and management of the condition. Methods Fifty seven cases of tibial plateau fractures which had been treated operatively from Jan. 2001 to Jun.2003 and had satisfactory reduction of the articular surface were reviewed. The stability of their knee joints was analyzed. Results The follow up lasted 6 to 30 months with an average of 15 months. The incidence of knee unstability was low. The four potential reasons for the postoperative knee stability were found to be: 1) the low prevalence of ligament injury with displaced fractures of tibial plateau; 2) incomplete ligament disruption or mild ligament injury; 3) anatomic reduction and rigid internal fixation; 4) fine and detailed plan for immobilization and functional exercise. Conclusion The prevalence of complete ligament disruption is low, and nonoperative management can result in satisfactory outcomes for tibial plateau fracture with incomplete ligament injury.

Objective To analyze the causes of postoperative step off of the tibial plateau fracture and to suggest strategies to cope with them. Methods 57 cases of tibial plateau fracture who had been treated operatively in our department from January 2001 to June 2003 with satisfactory reduction of the articular surface were reviewed. Their radiograms were analyzed. Results The follow ups lasted 6 to 30 months (average 15 months). Postoperative step off rate was 28.1%in all the cases according to radiological step off criteria. (A depression of the articular surface more than 3 millimeters or malalignment of the extremity more than 5 degrees is considered as step off.). Six causes of loss of reduction were: 1) more than sixty years of age, 2) severe osteoporosis, 3) preoperative displacement and fracture fragmentation, 4) poor anti shearing strength of screw and plate, 5) loose bonegraft, and 6) premature weight bearing. Conclusions The key points to enhance the outcome include precise judgment of the type of fracture, sufficient amount of bonegraft, rigid internal fixation after anatomic reduction and an appropriate plan for performing early, loadless, functional exercise. The traumatic osteoarthritis may be avoided or deferred if the above mentioned six causes can be taken into full consideration or preventive measures can be taken.