Objective:To evaluate the feasibility and outcomes of transnasal endoscopic clipping of the paraclival internal carotid artery (ICA) in skull base surgery.Methods:The paraclival ICA was anatomically dissected in cadaveric head specimens. The clinical data of 15 patients with skull base lesions involving the ICA who admitted to the Department of Otorhinolaryngology Head and Neck Surgery at Tianjin Huanhu Hospital from January 2021 to December 2023 were retrospectively analyzed. Among them, 4 patients underwent transnasal endoscopic clipping of the paraclival ICA and concurrent lesion resection. The surgical methods were summarized, and the key points and indications of this technique were analyzed.Results:Intraoperative clipping of the ICA was successful and hemostatic in all 4 patients. Postoperatively, 3 patients had no complications, while 1 patient developed delayed ischemic cerebral infarction. Two patients were cured, 1 patient was maintained on immunotherapy, and 1 patient died. During follow-up, the clip was in situ in 1 patient, had detached in another, and was obscured by temporal muscle coverage in the remaining 2 patients.Conclusions:Transnasal endoscopic clipping of the paraclival ICA represents a potential option for managing the ICA in skull base surgery. However, it carries significant risks and limitations, mandating careful patient selection based on specific circumstances.

Objective:To evaluate the feasibility and outcomes of transnasal endoscopic clipping of the paraclival internal carotid artery (ICA) in skull base surgery.Methods:The paraclival ICA was anatomically dissected in cadaveric head specimens. The clinical data of 15 patients with skull base lesions involving the ICA who admitted to the Department of Otorhinolaryngology Head and Neck Surgery at Tianjin Huanhu Hospital from January 2021 to December 2023 were retrospectively analyzed. Among them, 4 patients underwent transnasal endoscopic clipping of the paraclival ICA and concurrent lesion resection. The surgical methods were summarized, and the key points and indications of this technique were analyzed.Results:Intraoperative clipping of the ICA was successful and hemostatic in all 4 patients. Postoperatively, 3 patients had no complications, while 1 patient developed delayed ischemic cerebral infarction. Two patients were cured, 1 patient was maintained on immunotherapy, and 1 patient died. During follow-up, the clip was in situ in 1 patient, had detached in another, and was obscured by temporal muscle coverage in the remaining 2 patients.Conclusions:Transnasal endoscopic clipping of the paraclival ICA represents a potential option for managing the ICA in skull base surgery. However, it carries significant risks and limitations, mandating careful patient selection based on specific circumstances.

Objective To investigate the association of single nucleotide polymorphisms in the rs2268458 locus of thyroid-stimulating hormone receptor (TSHR) gene with Graves disease (GD) and Hashimoto's thyroiditis (HT).Methods Part of the cases diagnosed through the epidemiological investigation project about thyroid diseases of Cangzhou City in 2016 was selected as the case group.The case group was subdivided into GD group and HT group according to the diagnosis.At the same time,healthy people with similar gender and age to the case group were selected as the control group.All subjects were from the Han nationality and were not related to each other.The genotypes and alleles of the TSHR gene rs2268458 (C/T) of all subjects were detected by restriction endonuclease (RFLP).And based on genotyping analysis of patient risk (odds ratio,OR) and 95％ confidence interval (95％CI).Results There were 87 cases in GD group [aged (43.17 ± 12.56) years old],including 64 females and 23 males.There were 31 cases in HT group [aged (44.41 ± 16.51) years old],including 26 females and 5 males.In the control group,there were 147 cases [age (40.26 ± 9.31) years old],including 80 females and 67 males.HardyWeinberg equilibrium test was performed on each group.The results showed that P ＞ 0.05,suggesting that the study samples were representative of the population.The results of genetic analysis showed that in females,the C allele frequency of GD patients was significantly higher than that of the control group [x2 =4.632,36.7％ (47/128) vs 25.0％ (40/160),P ＜ 0.05,OR =1.741,95％CI =1.048-2.891].The frequency distribution of each genotype (CC,CT,TT) at TSHR rs2268458 (T/C) was statistically different (x2 =6.104,P ＜ 0.05),and the frequency of TC ± CC combined genotype was significantly higher in GD patients than in controls (x2 =6.092,P ＜ 0.05,OR =2.333,95％ CI =1.184-4.598),however,there was no statistical difference between the HT group and the control group in genotype (CC,CT,TT) frequency distribution and alleles (P ＞ 0.05).In males,there was no statistically significant difference in genotype (CC,CT,TT) frequency distribution and allele between groups (P ＞ 0.05).Conclusion Among women in Cangzhou,the single nucleotide polymorphism of rs2268458 in TSHR gene is associated with the susceptibility to GD,but not to HT,and C genotype increases the risk of GD by dominant inheritance.

OBJECTIVETo study the changes of partial pressure of oxygen in brain tissue (P(bt)O(2)) and brain temperature (BT) in patient s in acute phase of severe head injury, and to study the effect of mild hypothermia on P(bt)O(2) and BT.

METHODSThe P(bt)O(2) and the BT of 18 patients with severe head injury were monitored, and the patients were treated with mild hypothermia within 20 hours after injury. The rectal temperature (RT) of the patients was kept on 31.5-34.9 degrees C for 1-7 days (57.7 hours+/-28.4 hours averagely), simultaneously, the indexes of P(bt)O(2) and BT were monitored for 1-5 days (with an average of 54.8 hours+/-27.0 hours). According to Glasgow Outcome Scale (GOS), the prognosis of the patients was evaluated at 6 months after injury.

RESULTSWithin 24 hours after severe head injury, the P(bt)O(2) was significantly lower (9.6 mm Hg+/-6.8 mm Hg, 1 mm Hg=0.133 kPa) than the normal value (16-40 mm Hg). After treatment of mild hypothermia, the mean P(bt)O(2) increased to 28.7 mm Hg+/-8.8 mm Hg during the first 24 hours, and the P(bt)O(2) was still maintained within the range of normal value at 3 days after injury. The BT was higher than the RT in the patients in acute phase of severe head injury, and the difference between the BT and the RT significantly increased after treatment of mild hypothermia. Hyperventilation (the partial pressure of carbon dioxide in artery (P(a)CO(2)) approximately 25 mm Hg) decreased the high intracranial pressure (ICP) and significantly decreased the P(bt)O(2).

CONCLUSIONSThis study demonstrates that P(pt)O(2) and BT monitoring is a safe, reliable and sensitive diagnostic method to follow cerebral oxygenation. It might become an important tool in our treatment regime for patients in the acute phase of severe head injury requiring hypothermia and hyperventilation.

Adult ; Aged ; Blood Gas Monitoring, Transcutaneous ; Body Temperature ; Brain ; metabolism ; Craniocerebral Trauma ; metabolism ; therapy ; Female ; Glasgow Coma Scale ; Humans ; Hypothermia, Induced ; Male ; Middle Aged ; Oxygen ; metabolism ; Treatment Outcome