Endoscopic transnasal optic nerve decompression surgery plays a crucial role in minimal invasive treatment of complex traumatic optic neuropathy.However,a major challenge faced during the procedure is the inability to...Endoscopic transnasal optic nerve decompression surgery plays a crucial role in minimal invasive treatment of complex traumatic optic neuropathy.However,a major challenge faced during the procedure is the inability to visualize the optic nerve intraoperatively.To address this issue,an endoscopic image-based augmented reality surgical navigation system is developed in this study.The system aims to virtually fuse the optic nerve onto the endoscopic images,assisting surgeons in determining the optic nerve’s position and reducing surgical risks.First,a calibration algorithm based on a checkerboard grid of immobile points is proposed,building upon existing calibration methods.Additionally,to tackle accuracy issues associated with augmented reality technology,an optical navigation and visual fusion compensation algorithm is proposed to improve the intraoperative tracking accuracy.To evaluate the system’s performance,model experiments were meticulously designed and conducted.The results confirm the accuracy and stability of the proposed system,with an average tracking error of(0.99±0.46)mm.This outcome demonstrates the effectiveness of the proposed algorithm in improving the augmented reality surgical navigation system’s accuracy.Furthermore,the system successfully displays hidden optic nerves and other deep tissues,thus showcasing the promising potential for future applications in orbital and maxillofacial surgery.展开更多
We performed a 2-year follow-up survey of 523 patients with peripheral nerve injuries caused by the earthquake in Wenchuan, Sichuan Province, China. Nerve injuries were classiifed into three types： type I injuries we...We performed a 2-year follow-up survey of 523 patients with peripheral nerve injuries caused by the earthquake in Wenchuan, Sichuan Province, China. Nerve injuries were classiifed into three types： type I injuries were nerve transection injuries, type II injuries were nerve compression injuries, and type III injuries displayed no direct neurological dysfunction due to trauma. In this study, 31 patients had type I injuries involving 41 nerves, 419 had type II injuries involving 823 nerves, and 73 had type III injuries involving 150 nerves. Twenty-two patients had open tran-section nerve injury. The restoration of peripheral nerve function after different treatments was evaluated. Surgical decompression favorably affected nerve recovery. Physiotherapy was effective for type I and type II nerve injuries, but not substantially for type III nerve injury. Pharmaco-therapy had little effect on type II or type III nerve injuries. Targeted decompression surgery and physiotherapy contributed to the effective treatment of nerve transection and compression injuries. The Louisiana State University Health Sciences Center score for nerve injury severity de-clined with increasing duration of being trapped. In the ifrst year after treatment, the Louisiana State University Health Sciences Center score for grades 3 to 5 nerve injury increased by 28.2% to 81.8%. If scores were still poor （0 or 1） after a 1-year period of treatment, further treatment was not effective.展开更多
Decompression is the major therapeutic strategy for acute spinal cord injury,but there is some debate about the time window for decompression following spinal cord injury.An important goal and challenge in the treatme...Decompression is the major therapeutic strategy for acute spinal cord injury,but there is some debate about the time window for decompression following spinal cord injury.An important goal and challenge in the treatment of spinal cord injury is inhibiting or reversing secondary injury.Governor Vessel electroacupuncture can improve symptoms of spinal cord injury by inhibiting cell apoptosis and improving the microenvironment of the injured spinal cord.In this study,Governor Vessel electroacupuncture combined with decompression at different time points was used to treat acute spinal cord injury.The rat models were established by inserting a balloon catheter into the atlanto-occipital space.The upper cervical spinal cord was compressed for 12 or 48 hours prior to decompression.Electroacupuncture was conducted at the acupoints Dazhui（GV14） and Baihui（GV 20）（2 Hz,15 minutes） once a day for 14 consecutive days.Compared with decompression alone,hind limb motor function recovery was superior after decompression for 12 and 48 hours combined with electroacupuncture.However,the recovery of motor function was not significantly different at 14 days after treatment in rats receiving decompression for 12 hours.Platelet-activating factor levels and caspase-9 protein expression were significantly reduced in rats receiving electroacupuncture compared with decompression alone.These findings indicate that compared with decompression alone,Governor Vessel electroacupuncture combined with delayed decompression（48 hours） is more effective in the treatment of upper cervical spinal cord injury.Governor Vessel electroacupuncture combined with early decompression（12 hours） can accelerate the recovery of nerve movement in rats with upper cervical spinal cord injury.Nevertheless,further studies are necessary to confirm whether it is possible to obtain additional benefit compared with early decompression alone.展开更多
Objective To investigate the clinical outcomes of facial never decompression via a combined subtemporal-su- pralabyrinthine approach to geniculate ganglion for management of facial paralysis in temporal bone fracture....Objective To investigate the clinical outcomes of facial never decompression via a combined subtemporal-su- pralabyrinthine approach to geniculate ganglion for management of facial paralysis in temporal bone fracture. Methods Eighteen patients with unilateral facial paresis due to temporal bone fracture were treated between March 2003 and March 2011. Facial function was House-Braekmann（HB） grade m in 6 patients, HB grade V in 9 patients and HB grade VI in 3 patients. The preoperative mean air conduction threshold was 52 dB HL for the 15 cases with longitudinal temporal bone fracture and showed severe sensorineural heating loss in the 3 cases with transverse temporal bone fracture. Fracture lines were detected in 15 cases on temporal bone axial CT scans and ossicular disruption was determined in 11 cases by virtual CT endoscopy. The geniculate ganglion or the tympanic mastoid segment of the facial nerve showed an irregular morphology on curved planar reformation images of the facial nerve canal. After an intact canal wall mastoi- do-epitympanectomy, the ossicular chain recess was opened by drilling through the was disrupted, the incus was removed to damage was evaluated. If the ossicular chain was intact, the supralabyrinthine cells between the tegmen tympani and ossicular chain. If the ossicular chain access the supralabyrinthine recess. The geniculate ganglion and the distal labyrinthine segment of the facial nerve were exposed. After completing facial nerve decompression, the dislocated incus was replaced, or a fractured incus was reshaped to bridge the space between the malleus and the stapes. Results Pronounced ganglion geniculatum swelling was found in 15 cases of longitudinal temporal bone fracture, with greater petrosus nerves damage in 3 cases and bleeding in 5 cases. Disrupted ossicular chains were seen in 11 cases, including dislocated incus resulting in crushing of the horizontal portion of the facial nerve in 3 cases and fracture of the incus long process in 1 case. In 3 cases of transverse fractures, dehiscence on the promontory, semicircular canal or oval window was found. All cases had primary healing with no complication. At follow-ups ranging from 0.5 to 3 years （average 1.2 years）, facial nerve function recovered to HB grade I in 11 cases, 11 in 5 cases and m in 2 cases. Overall hearing recovery was 33 dB. Conclusion The clinical outcomes concerning facial nerve function and hearing recovery are satisfactory via a combined subtemporal-supralabyrinthine approach to the geniculate ganglion for facial nerve decompression in temporal bone fracture patients with facial paralysis.展开更多
The most common nerve compression in the upper extremity is that of carpal tunnel syndrome.Although generally recognized and treated,as much as a 20%failure rate is reported.Recent publications are indicating that one...The most common nerve compression in the upper extremity is that of carpal tunnel syndrome.Although generally recognized and treated,as much as a 20%failure rate is reported.Recent publications are indicating that one of the sources of persistent median nerve symptoms may be missed proximal median nerve entrapments,of which the lacertus fibrosus represents a principal cause of compression,and rarely other sites such as the flexor superficialis arch or pronator teres.Compression by the lacertus fibrosus is called lacertus syndrome,and as this is a clinically diagnosed entity,only rarely confirmed using electrodiagnostic or imaging studies,it is frequently overlooked.Clinicians regularly treating patients with carpal tunnel syndrome or patients with signs of median nerve neuropathy should be aware of the lacertus fibrosus as a possible compression site.In this review,we will define lacertus syndrome,describe its clinical manifestations and diagnosis,and demonstrate surgical techniques used to treat it.展开更多
Ulnar nerve neuropathy at the elbow represents the second most frequent compression neuropathy of the upper extremity.Of the five different anatomical areas responsible for ulnar nerve compression at the elbow region,...Ulnar nerve neuropathy at the elbow represents the second most frequent compression neuropathy of the upper extremity.Of the five different anatomical areas responsible for ulnar nerve compression at the elbow region,the epitrochlear-olecranon channel and Osborne’s arcade are the most common.An additional cause of nerve damage is a dynamic process in which the ulnar nerve dislocates anteriorly at the epitrochlear-olecranon level during elbow flexion,partially or completely,causing nerve friction and constriction leading to chronic neuropathic pain.Failure after primary surgery is generally secondary to procedural errors or technical omissions,frequently represented by incomplete nerve decompression,failure to recognize nerve instability after nerve decompression,loosening of the nerve anchor after superficial nerve transposition with consequent spontaneous nerve relocation in the epitrochlear-olecranon channel,perineural fibrosis and neurodesis,which creates new nerve compression.In association with the clinical evaluation,electromyography studies,magnetic resonance imaging and ultrasound are useful tools that may aid in the decision-making process when considering revision surgery.Superficial anterior transposition is the most commonly employed technique but also has a high failure rate,as opposed to anterior deep transposition that is the method of choice for many surgeons despite being more technically demanding.The results of revision surgery following recalcitrant ulnar nerve compression at the elbow are inferior to those obtained after primary surgery.Nonetheless,the clinical advantages remain relevant provided that the revision surgery is performed by an expert surgeon.To avoid misinterpretation,the patient is completely informed of the quality of results.展开更多
Objective:: To study the main prognostic factors and significance of facial nerve decompression for facial paralysis in temporal bone fracture. Methods: The main relative prognostic factors of 64 patients with facial ...Objective:: To study the main prognostic factors and significance of facial nerve decompression for facial paralysis in temporal bone fracture. Methods: The main relative prognostic factors of 64 patients with facial paralysis were analyzed. An experimental model of facial paralysis was made. The expansion rates of facial nerve in the facial canal opening group and the facial canal non-opening group were measured and observed under electron microscope. Results: The main factors affecting the prognosis were facial nerve decompression and selection of surgery time. The expansion rate of facial nerve in the facial canal opening group was significantly higher than that of the facial canal non-opening group (t= 7.53 , P< 0.01 ). The injury degree of the nerve fiber in the facial canal non-opening group was severe. Conclusions: Early facial nerve decompression is beneficial to restoration of the facial nerve function.展开更多
基金the National Natural Science Foundation of China(Nos.82330063 and M-0019)the Interdisciplinary Program of Shanghai Jiao Tong University(Nos.YG2022QN056,YG2023ZD19,and YG2023ZD15)+2 种基金the Cross Disciplinary Research Fund of Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine(No.JYJC202115)the Translation Clinical R&D Project of Medical Robot of Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine(No.IMR-NPH202002)the Shanghai Key Clinical Specialty,Shanghai Eye Disease Research Center(No.2022ZZ01003)。
文摘Endoscopic transnasal optic nerve decompression surgery plays a crucial role in minimal invasive treatment of complex traumatic optic neuropathy.However,a major challenge faced during the procedure is the inability to visualize the optic nerve intraoperatively.To address this issue,an endoscopic image-based augmented reality surgical navigation system is developed in this study.The system aims to virtually fuse the optic nerve onto the endoscopic images,assisting surgeons in determining the optic nerve’s position and reducing surgical risks.First,a calibration algorithm based on a checkerboard grid of immobile points is proposed,building upon existing calibration methods.Additionally,to tackle accuracy issues associated with augmented reality technology,an optical navigation and visual fusion compensation algorithm is proposed to improve the intraoperative tracking accuracy.To evaluate the system’s performance,model experiments were meticulously designed and conducted.The results confirm the accuracy and stability of the proposed system,with an average tracking error of(0.99±0.46)mm.This outcome demonstrates the effectiveness of the proposed algorithm in improving the augmented reality surgical navigation system’s accuracy.Furthermore,the system successfully displays hidden optic nerves and other deep tissues,thus showcasing the promising potential for future applications in orbital and maxillofacial surgery.
文摘We performed a 2-year follow-up survey of 523 patients with peripheral nerve injuries caused by the earthquake in Wenchuan, Sichuan Province, China. Nerve injuries were classiifed into three types： type I injuries were nerve transection injuries, type II injuries were nerve compression injuries, and type III injuries displayed no direct neurological dysfunction due to trauma. In this study, 31 patients had type I injuries involving 41 nerves, 419 had type II injuries involving 823 nerves, and 73 had type III injuries involving 150 nerves. Twenty-two patients had open tran-section nerve injury. The restoration of peripheral nerve function after different treatments was evaluated. Surgical decompression favorably affected nerve recovery. Physiotherapy was effective for type I and type II nerve injuries, but not substantially for type III nerve injury. Pharmaco-therapy had little effect on type II or type III nerve injuries. Targeted decompression surgery and physiotherapy contributed to the effective treatment of nerve transection and compression injuries. The Louisiana State University Health Sciences Center score for nerve injury severity de-clined with increasing duration of being trapped. In the ifrst year after treatment, the Louisiana State University Health Sciences Center score for grades 3 to 5 nerve injury increased by 28.2% to 81.8%. If scores were still poor （0 or 1） after a 1-year period of treatment, further treatment was not effective.
基金supported by the Capital Characteristic Clinical Application Research Projects of Beijing Municipal Science and Technology Plan of China,No.Z16110000516009
文摘Decompression is the major therapeutic strategy for acute spinal cord injury,but there is some debate about the time window for decompression following spinal cord injury.An important goal and challenge in the treatment of spinal cord injury is inhibiting or reversing secondary injury.Governor Vessel electroacupuncture can improve symptoms of spinal cord injury by inhibiting cell apoptosis and improving the microenvironment of the injured spinal cord.In this study,Governor Vessel electroacupuncture combined with decompression at different time points was used to treat acute spinal cord injury.The rat models were established by inserting a balloon catheter into the atlanto-occipital space.The upper cervical spinal cord was compressed for 12 or 48 hours prior to decompression.Electroacupuncture was conducted at the acupoints Dazhui（GV14） and Baihui（GV 20）（2 Hz,15 minutes） once a day for 14 consecutive days.Compared with decompression alone,hind limb motor function recovery was superior after decompression for 12 and 48 hours combined with electroacupuncture.However,the recovery of motor function was not significantly different at 14 days after treatment in rats receiving decompression for 12 hours.Platelet-activating factor levels and caspase-9 protein expression were significantly reduced in rats receiving electroacupuncture compared with decompression alone.These findings indicate that compared with decompression alone,Governor Vessel electroacupuncture combined with delayed decompression（48 hours） is more effective in the treatment of upper cervical spinal cord injury.Governor Vessel electroacupuncture combined with early decompression（12 hours） can accelerate the recovery of nerve movement in rats with upper cervical spinal cord injury.Nevertheless,further studies are necessary to confirm whether it is possible to obtain additional benefit compared with early decompression alone.
文摘Objective To investigate the clinical outcomes of facial never decompression via a combined subtemporal-su- pralabyrinthine approach to geniculate ganglion for management of facial paralysis in temporal bone fracture. Methods Eighteen patients with unilateral facial paresis due to temporal bone fracture were treated between March 2003 and March 2011. Facial function was House-Braekmann（HB） grade m in 6 patients, HB grade V in 9 patients and HB grade VI in 3 patients. The preoperative mean air conduction threshold was 52 dB HL for the 15 cases with longitudinal temporal bone fracture and showed severe sensorineural heating loss in the 3 cases with transverse temporal bone fracture. Fracture lines were detected in 15 cases on temporal bone axial CT scans and ossicular disruption was determined in 11 cases by virtual CT endoscopy. The geniculate ganglion or the tympanic mastoid segment of the facial nerve showed an irregular morphology on curved planar reformation images of the facial nerve canal. After an intact canal wall mastoi- do-epitympanectomy, the ossicular chain recess was opened by drilling through the was disrupted, the incus was removed to damage was evaluated. If the ossicular chain was intact, the supralabyrinthine cells between the tegmen tympani and ossicular chain. If the ossicular chain access the supralabyrinthine recess. The geniculate ganglion and the distal labyrinthine segment of the facial nerve were exposed. After completing facial nerve decompression, the dislocated incus was replaced, or a fractured incus was reshaped to bridge the space between the malleus and the stapes. Results Pronounced ganglion geniculatum swelling was found in 15 cases of longitudinal temporal bone fracture, with greater petrosus nerves damage in 3 cases and bleeding in 5 cases. Disrupted ossicular chains were seen in 11 cases, including dislocated incus resulting in crushing of the horizontal portion of the facial nerve in 3 cases and fracture of the incus long process in 1 case. In 3 cases of transverse fractures, dehiscence on the promontory, semicircular canal or oval window was found. All cases had primary healing with no complication. At follow-ups ranging from 0.5 to 3 years （average 1.2 years）, facial nerve function recovered to HB grade I in 11 cases, 11 in 5 cases and m in 2 cases. Overall hearing recovery was 33 dB. Conclusion The clinical outcomes concerning facial nerve function and hearing recovery are satisfactory via a combined subtemporal-supralabyrinthine approach to the geniculate ganglion for facial nerve decompression in temporal bone fracture patients with facial paralysis.
文摘The most common nerve compression in the upper extremity is that of carpal tunnel syndrome.Although generally recognized and treated,as much as a 20%failure rate is reported.Recent publications are indicating that one of the sources of persistent median nerve symptoms may be missed proximal median nerve entrapments,of which the lacertus fibrosus represents a principal cause of compression,and rarely other sites such as the flexor superficialis arch or pronator teres.Compression by the lacertus fibrosus is called lacertus syndrome,and as this is a clinically diagnosed entity,only rarely confirmed using electrodiagnostic or imaging studies,it is frequently overlooked.Clinicians regularly treating patients with carpal tunnel syndrome or patients with signs of median nerve neuropathy should be aware of the lacertus fibrosus as a possible compression site.In this review,we will define lacertus syndrome,describe its clinical manifestations and diagnosis,and demonstrate surgical techniques used to treat it.
文摘Ulnar nerve neuropathy at the elbow represents the second most frequent compression neuropathy of the upper extremity.Of the five different anatomical areas responsible for ulnar nerve compression at the elbow region,the epitrochlear-olecranon channel and Osborne’s arcade are the most common.An additional cause of nerve damage is a dynamic process in which the ulnar nerve dislocates anteriorly at the epitrochlear-olecranon level during elbow flexion,partially or completely,causing nerve friction and constriction leading to chronic neuropathic pain.Failure after primary surgery is generally secondary to procedural errors or technical omissions,frequently represented by incomplete nerve decompression,failure to recognize nerve instability after nerve decompression,loosening of the nerve anchor after superficial nerve transposition with consequent spontaneous nerve relocation in the epitrochlear-olecranon channel,perineural fibrosis and neurodesis,which creates new nerve compression.In association with the clinical evaluation,electromyography studies,magnetic resonance imaging and ultrasound are useful tools that may aid in the decision-making process when considering revision surgery.Superficial anterior transposition is the most commonly employed technique but also has a high failure rate,as opposed to anterior deep transposition that is the method of choice for many surgeons despite being more technically demanding.The results of revision surgery following recalcitrant ulnar nerve compression at the elbow are inferior to those obtained after primary surgery.Nonetheless,the clinical advantages remain relevant provided that the revision surgery is performed by an expert surgeon.To avoid misinterpretation,the patient is completely informed of the quality of results.
文摘Objective:: To study the main prognostic factors and significance of facial nerve decompression for facial paralysis in temporal bone fracture. Methods: The main relative prognostic factors of 64 patients with facial paralysis were analyzed. An experimental model of facial paralysis was made. The expansion rates of facial nerve in the facial canal opening group and the facial canal non-opening group were measured and observed under electron microscope. Results: The main factors affecting the prognosis were facial nerve decompression and selection of surgery time. The expansion rate of facial nerve in the facial canal opening group was significantly higher than that of the facial canal non-opening group (t= 7.53 , P< 0.01 ). The injury degree of the nerve fiber in the facial canal non-opening group was severe. Conclusions: Early facial nerve decompression is beneficial to restoration of the facial nerve function.
