Background and Objective Electromagnetic navigation technology has demonstrated significant potential in enhancing the accuracy and safety of neurosurgical procedures.However,traditional electromagnetic navigation sys...Background and Objective Electromagnetic navigation technology has demonstrated significant potential in enhancing the accuracy and safety of neurosurgical procedures.However,traditional electromagnetic navigation systems face challenges such as high equipment costs,complex operation,bulky size,and insufficient anti-interference performance.To address these limitations,our study developed and validated a novel portable electromagnetic neuronavigation system designed to improve the precision,accessibility,and clinical applicability of electromagnetic navigation technology in cranial surgery.Methods The software and hardware architecture of a portable neural magnetic navigation system was designed.The key technologies of the system were analysed,including electromagnetic positioning algorithms,miniaturized sensor design,optimization of electromagnetic positioning and navigation algorithms,anti-interference signal processing methods,and fast three-dimensional reconstruction algorithms.A prototype was developed,and its accuracy was tested.Finally,a preliminary clinical application evaluation was conducted.Results This study successfully developed a comprehensive portable electromagnetic neuronavigation system capable of achieving preoperative planning,intraoperative real-time positioning and navigation,and postoperative evaluation of navigation outcomes.Through rigorous collaborative testing of the system’s software and hardware,the accuracy of electromagnetic neuronavigation has been validated to meet clinical requirements.Conclusions This study developed a portable neuroelectromagnetic navigation system and validated its effectiveness and safety through rigorous model testing and preliminary clinical applications.The system is characterized by its compact size,high precision,excellent portability,and user-friendly operation,making it highly valuable for promoting navigation technology and advancing the precision and minimally invasive nature of neurosurgical procedures.展开更多
The cranial base synchondroses,comprised of opposite-facing bidirectional chondrocyte layers,drive anteroposterior cranial base growth.In humans,RUNX2 haploinsufficiency causes cleidocranial dysplasia associated with ...The cranial base synchondroses,comprised of opposite-facing bidirectional chondrocyte layers,drive anteroposterior cranial base growth.In humans,RUNX2 haploinsufficiency causes cleidocranial dysplasia associated with deficient midfacial growth.However,how RUNX2 regulates chondrocytes in the cranial base synchondroses remains unknown.To address this,we inactivated Runx2 in postnatal synchondrosis chondrocytes using a tamoxifen-inducible Fgfr3-creER(Fgfr3-Runx2cKO)mouse model.Fgfr3-Runx2cKO mice displayed skeletal dwarfism and reduced anteroposterior cranial base growth associated with premature synchondrosis ossification due to impaired chondrocyte proliferation,accelerated hypertrophy,apoptosis,and osteoclast-mediated cartilage resorption.Lineage tracing reveals that Runx2-deficient Fgfr3+cells failed to differentiate into osteoblasts.Notably,Runx2-deficient chondrocytes showed an elevated level of FGFR3 and its downstream signaling components,pERK1/2 and SOX9,suggesting that RUNX2 downregulates FGFR3 in the synchondrosis.This study unveils a new role of Runx2 in cranial base chondrocytes,identifying a possible RUNX2-FGFR3-MAPK-SOX9 signaling axis that may control cranial base growth.展开更多
This narrative review examines the use of imaging biomarkers for diagnosing and monitoring hydrocephalus from birth through childhood.Early detection and longitudinal follow-up are essential for guiding timely interve...This narrative review examines the use of imaging biomarkers for diagnosing and monitoring hydrocephalus from birth through childhood.Early detection and longitudinal follow-up are essential for guiding timely interventions and asse-ssing treatment outcomes.Cranial ultrasound and magnetic resonance imaging(MRI)are the primary imaging modalities,providing critical insights into ventri-cular size,cerebrospinal fluid dynamics,and neurodevelopmental implications.Key parameters,including Evans’index,Levene’s index,and the Cella Media index,as well as volumetric and diffusion-based MRI techniques,have been explored for their diagnostic and prognostic value.Advances in automated image analysis and artificial intelligence have further improved measurement precision and reproducibility.Despite these developments,challenges remain in standar-dizing imaging protocols and establishing normative reference values across different pediatric populations.This review highlights the strengths and limita-tions of current imaging approaches,emphasizing the need for consistent metho-dologies to enhance diagnostic accuracy and optimize patient management in hydrocephalus.展开更多
Objective:To analyze the value of bedside cranial ultrasonography in the early diagnosis of neonatal brain tissue injury in intrauterine distress.Methods:128 neonates with suspected intrauterine distress admitted to t...Objective:To analyze the value of bedside cranial ultrasonography in the early diagnosis of neonatal brain tissue injury in intrauterine distress.Methods:128 neonates with suspected intrauterine distress admitted to the Yichang Central People’s Hospital from January 2023 to December 2024 were selected as study subjects based on the inclusion and exclusion criteria,and all subjects underwent bedside craniocerebral ultrasonography and MRI,and the results of MRI were used as the gold standard to divide the infants into the brain-injury group(n=31)and the no-brain-injury The children were divided into brain injury group(n=31)and no brain injury group(n=97),and the value of bedside cranial ultrasonography for early diagnosis of brain tissue injury in neonates with intrauterine distress was analyzed.Results:(1)Among the 128 cases of intrauterine distress neonates,31 cases were examined for abnormal signs,including 22 cases(70.97%)examined by bedside craniocerebral ultrasonography and 28 cases(90.32%)examined by MRI.(2)Bedside cranial ultrasound detected hypoxic-ischemic encephalopathy in 6 cases,accounting for 4.69%,ventricular widening in 2 cases,accounting for 1.56%,intracranial hemorrhage in 8 cases,accounting for 6.25%,periventricular softening of white matter in 5 cases,accounting for 3.91%,and cerebral edema in 1 case,accounting for 0.78%,while MRI detected hypoxic-ischemic encephalopathy in 9 cases,accounting for 7.03%.3 cases of ventricular widening,accounting for 2.34%,4 cases of intracranial hemorrhage,accounting for 3.13%,9 cases of periventricular-intraventricular white matter softening,accounting for 7.03%,and 3 cases of cerebral edema,accounting for 2.34%were examined.Among them,the detection rate of periventricular-intraventricular hemorrhage by bedside cranial ultrasound was significantly higher than that of MRI(P<0.05).Conclusion:The diagnostic value of bedside cranial ultrasound in periventricular-intraventricular hemorrhage is high,but the diagnostic value is not as good as that of MRI in other brain tissue injuries,and clinically appropriate examination protocols can be selected according to the specific types of craniocerebral injuries.展开更多
Understanding frictional anisotropy,which refers to the variation in frictional resistance based on the shear direction,is crucial for optimizing the friction angle between a bio-inspired structure and the surrounding...Understanding frictional anisotropy,which refers to the variation in frictional resistance based on the shear direction,is crucial for optimizing the friction angle between a bio-inspired structure and the surrounding soil.Previous studies focused on estimating the interface frictional anisotropy mobilized by snakeskin-inspired textured surfaces and sand under monotonic shear loading conditions.However,there is a need to estimate interface frictional anisotropy under repetitive shear loads.In this study,a series of repetitive direct shear(DS)tests are performed with snakeskin-inspired textured surfaces under a constant vertical stress and two shear directions(cranial first half→caudal second half or caudal first half→cranial second half).The results show that(1)mobilized shear stress increases with the number of shearing cycles,(2)cranial shearing(shearing against the scales)consistently produces a higher shear resistance and less contractive behavior than caudal shearing(shearing along the scales),and(3)a higher scale height or smaller scale length of the surface yields a higher interface friction angle across all shearing cycles.Further analysis reveals that the gap between the cranial and caudal shear zones of the interface friction angle as a function of L/H(i.e.the ratio of scale length L to scale height H)continues to decrease as the number of shearing cycles approaches asymptotic values.The directional frictional resistance(DFR)decreases as the number of shearing cycles increases.Furthermore,the discussion covers the impact of initial relative density,vertical stress,and the number of shearing cycles on interface frictional anisotropy.展开更多
BACKGROUND Laparoscopic hepatectomy is a proven safe and technically feasible approach for liver tumor resection,but laparoscopic anatomical SVIII resection(LASVIIIR)remains rarely reported due to poor accessibility,d...BACKGROUND Laparoscopic hepatectomy is a proven safe and technically feasible approach for liver tumor resection,but laparoscopic anatomical SVIII resection(LASVIIIR)remains rarely reported due to poor accessibility,difficult exposure,and the deep-lying Glissonean pedicle.This study examined the safety,feasibility,and perio-perative outcomes of LASVIIIR via a middle hepatic fissure approach at our in-stitution.AIM To investigate the safety,feasibility,and perioperative outcomes of LASVIIIR via a middle hepatic fissure approach at our institution.METHODS From November 2017 to December 2022,all patients with a liver tumor who underwent LASVIIIR were enrolled.The perioperative outcomes and postope-rative complications were evaluated.RESULTS Thirty-four patients underwent LASVIIIR via a middle hepatic fissure approach from the side or cranio side and were included.The mean operation time was 164±54 minutes,and the intra-operative blood loss was 100 mL(range:20-1000 mL).The mean operative times were,respectively,152±50 minutes and 222±29 minutes(P=0.001)for the caudal side and cranial side approaches.In addition,the median blood loss volumes were 100 mL(range:20-300 mL)and 250 mL(range:20-1000 mL),respectively,for the caudal and cranial sides(P=0.064).Three patients treated using the cranial side approach experienced bile leakage,while 1 patient treated using the caudal side approach had subphrenic collection and underwent percutaneous drainage to successfully recover.There were no differences regarding postoperative hospital stays for the caudal and cranial side approaches[9(7-26)days vs 8(8-19)days](P=0.226).CONCLUSION LASVIIIR resection remains a challenging operation,but the middle hepatic fissure approach is a reasonable and easy-to-implement technique.展开更多
Objective To observe the value of isotropic volumetric MRI for displaying perineural spread(PNS)of cranial nerve(CN)in nasopharyngeal carcinoma.Methods Eighty-seven patients with pathologically proven nasopharyngeal c...Objective To observe the value of isotropic volumetric MRI for displaying perineural spread(PNS)of cranial nerve(CN)in nasopharyngeal carcinoma.Methods Eighty-seven patients with pathologically proven nasopharyngeal carcinoma were prospectively enrolled.MR scanning,including three-dimensional liver acquisition with volume acceleration-flexible(3D LAVA_Flex)image,T2WI with fat suppression(T2WI-FS),T1WI,contrast enhancement(CE)T1WI-FS of nasopharynx and neck region were performed.The displaying rates of CN PNS were evaluated and compared between 3D LAVA_Flex and T2WI-FS,T1WI,CE-T1WI-FS at patient level,CN group level and neural level,respectively.Results The displaying rate of CN PNS in all 87 nasopharyngeal carcinoma patients by 3D LAVA_Flex sequence was 49.43%(43/87),higher than that of conventional MRI(30/87,34.48%,P=0.001).Among 59 patients with advanced nasopharyngeal carcinoma diagnosed with conventional sequences,the displaying rate of CN PNS was 71.19%(42/59)by 3D LAVA-Flex sequence,higher than that of conventional MRI(30/59,50.85%,P=0.001).At both patient level and posterior CN level,significant differences of the displaying rate of CN PNS were found between 3D LAVA-Flex sequence and T2WI-FS,T1WI,CE-T1WI-FS,while at CN level,the displaying rates of mandibular nerve PNS,CNⅨ—ⅪPNS in jugular foramen(P<0.05)and CNⅨ—ⅫPNS in carotid space of 3D LAVA_Flex sequence were all significantly higher than that of T2WI-FS,T1WI and CE-T1WI-FS(all P<0.05),of PNS of CNⅢ—Ⅴin cavernous sinus were higher than that of T2WI-FS(P<0.05),while of PNS of hypoglossal nerve were significantly higher than that of T2WI-FS and T1WI(both P<0.05).Conclusion 3D LAVA_Flex sequence could be used to effectively display CN PNS of nasopharyngeal carcinoma.展开更多
3D printed polyether-ether-ketone(PEEK)implant has become a popular clinical alternative to implants made of titanium alloy for cranial bone substitutes due to its bone-match properties,however its biological inert hi...3D printed polyether-ether-ketone(PEEK)implant has become a popular clinical alternative to implants made of titanium alloy for cranial bone substitutes due to its bone-match properties,however its biological inert hin-dered the progress of clinical applications of such material.To enhance the tissue integration capability of PEEK implants and promote their long-term stability,cranial implants of gradient porous structures were designed and manufactured via fused filament fabrication(FFF)3D printing technology in both PEEK and PEEK/HA com-posites materials,then functionally evaluation of the implants on the tissue in-growth and the osteointegration mechanisms was conducted via animal tests.The 3D printed PEEK scaffold was found to have 2-5 folds of the compressive strength to those of the natural cranial bone.The in vivo studies verified that the porous PEEK/HA scaffold could effectively induce the bone ingrowth to form a stable biointegration boundary surrounding the host bone tissue after 4 weeks of implantation.Moreover,the PEEK/HA scaffold showed no significant advantages in improving the soft tissue in-growth,only making its distribution more evenly.It is also interestingly to find out that the vertically connective pores throughout the implant did not enhance the tissue binding force even though it did promote the nutrient transportation.In conclusion,the use of PEEK/HA composite material and a well-designed porous structure was proved to be an effective approach to improve the biointegration between the implant and host tissues.展开更多
BACKGROUND With very high mortality and disability rates,cerebrovascular diseases and intracranial tumors severely threaten the health and fighting strength of flying personnel,requiring great concern and intensive sc...BACKGROUND With very high mortality and disability rates,cerebrovascular diseases and intracranial tumors severely threaten the health and fighting strength of flying personnel,requiring great concern and intensive screening in clinic,early warning in an early and accurate manner and early intervention of diseases possibly resulting in inflight incapacitation are key emphases of aeromedical support in clinic.AIM To probe into the spectra of intracranial diseases,flight factors and medical imaging characteristics of military pilots(cadets)in the physical examination for transfer to pilot modified high performance aircraft,thus rendering theoretical references for clinical aeromedical support of pilots.METHODS A total of 554 military pilots(cadets)undergoing physical examination for transfer to pilot modified high performance aircraft from December 2020 to April 2024 in a military medical center were enrolled in this study.Then,a retrospective study was carried out on intracranial disease spectra and head magnetic resonance imaging(MRI)data of 36 pilots(cadets)who were unqualified for transfer to pilot modified high performance aircraft.Besides,a descriptive statistical analysis was conducted on the clinical data,age,fighter type and head MRI data of such pilots(cadets).RESULTS Abnormal head images were found in 36 out of 554 pilots(cadets)participating in the physical examination for transfer to pilot modified high performance aircraft,including arachnoid cyst in 17(3.1%)military pilots(cadets),suspected very small aneurysm in 11(2.0%),cavernous hemangioma in 4(0.7%),vascular malformation in 2(0.4%),and pituitary tumor in 3(0.5%,one of which developed cavernous hemangioma simultaneously).Among the 17 pilots(cadets)with arachnoid cyst,4 were identified as unqualified for transfer to pilot modified high performance aircraft because the marginal brain tissues were compressed by the cyst>6 cm in length and diameter.The 11 pilots(cadets)with suspected very small aneurysms identified by 3.0T MRI consisted of 6 diagnosed with conus arteriosus by digital subtraction angiography and qualified for transfer to pilot modified high performance aircraft,and 5 identified as very small intracranial aneurysms with diameter<3 mm and unqualified for transfer to pilot modified high performance aircraft.No symptoms and signs were observed in the 4 military pilots(cadets)with cavernous hemangioma,and the results of MRI revealed bleeding.The 1 of the 4 had the lesion located in pons and developed Rathke cyst in pituitary gland at the same time,and unqualified for transfer to pilot modified high performance aircraft.The 2 of the 4 were unqualified for flying,and 2 transferred to air combat service division.The 2 pilots(cadets)with vascular malformation were identified as unqualified for transfer to pilot modified high performance aircraft.Among the 3 pilots(cadets)with pituitary tumor,one pilot cadet was identified as unqualified for flying since the tumor compressed the optic chiasma,one had cavernous hemangioma in pons in the meantime and transferred to air combat service division,and one was diagnosed with nonfunctional microadenoma and qualified for transfer to pilot modified high performance aircraft.CONCLUSION High-resolution head MRI examination is of great significance for screening and detecting cerebrovascular diseases and intracranial tumors in military flying personnel,and attention should be paid to its clinical application to physical examination for transfer to pilot modified high performance aircraft.展开更多
Cholesteatoma is a fairly otologic common problem. However, cholesteatoma invading the internal auditory canal (IAC) is rare and typically results in profound hearing loss and facial paralysis. This is a case of a 46-...Cholesteatoma is a fairly otologic common problem. However, cholesteatoma invading the internal auditory canal (IAC) is rare and typically results in profound hearing loss and facial paralysis. This is a case of a 46-year-old female with a history of prior right complex cholesteatoma that had undergone multiple procedures. She had multiple complications including right cerebral spinal fluid (CSF) leak, meningitis, recurrent mastoid bowl infections and right facial paralysis which resulted in multiple facial plastics procedures and overclosure of the right ear. Over the last three years, she has noticed an increase in right sided otalgia, facial pressure, facial numbness and headaches. An MRI temporal bone with diffusion weighted imaging (DWI) showed a DW positive soft tissue mass filling the mastoid bowl as well as extending into the IAC and cerebellar pontine angle (CPA) cistern with contact of the middle cerebellar peduncle and trigeminal nerve. A translabyrinthine approach to the IAC found the mastoid bowl to be filled with cholesteatoma and an osseous defect from the mastoid bowl along the labyrinthine facial nerve tracking cholesteatoma into the IAC/CPA. This case highlights the complex and aggressive nature a cholesteatoma can take and the need for diligent surveillance in any ear that had prior cholesteatoma. The utilizations of MRI temporal bone with diffusion weighted imaging allow for surveillance in an over closed ear canal that is vital to the care of cholesteatoma patients who have a similar history.展开更多
This is a case of a 60-year-old male with a history of prior left middle fossa meningioma that was partially resected with an operative report noting diffuse attachment to the middle fossa floor. Gamma knife was recom...This is a case of a 60-year-old male with a history of prior left middle fossa meningioma that was partially resected with an operative report noting diffuse attachment to the middle fossa floor. Gamma knife was recommended but he never completed this management. He then presented about eight years later with a mass from his left external auditory canal. It was reported that two years prior another surgeon operated on the left ear for a cholesteatoma. CT temporal bone showed complete opacification of left EAC, mastoid bowl, and remaining mastoid air cells. In addition, there were irregular bony/hyperostotic changes seen within the left sphenoid and temporal bone. There was dural thickening within the middle fossa adjacent to the previously described hyperostotic bony changes. A mastoidectomy and excision of mass revealed extensive adhesive tissue throughout the middle ear, and mastoid up to the tegmen. Pathology of the portions that were resected confirmed Grade 1 meningioma. Stereotactic gamma knife radiation was completed to the area to prevent further growth. This case highlights extracranial meningioma that did not have definitive management for prior middle fossa floor meningioma. It also highlights the need to think of less common pathology in the middle ear and external auditory canal.展开更多
The present study revisited the controversial taxonomic status ofPetaurista yunanensis, P. philippensis, P. hainana, and P. petaurista by using a considerably extended set of morphometrical characters （26 cranial var...The present study revisited the controversial taxonomic status ofPetaurista yunanensis, P. philippensis, P. hainana, and P. petaurista by using a considerably extended set of morphometrical characters （26 cranial variables from 60 adult specimen skulls）. The results revealed no sexual dimorphism in any of the four species but confirmed significant craniometric differences among the four species in both the principal components analysis （PCA） and discriminant function analysis （DFA）, with the greatest distinction observed between P. petaurista and other Petaurista species. Both univariate and multivariate analysis indicated that the morphological differences between P. yunanensis and P. philippensis were less than that between P. philippensis and P. hainana. The morphometric results were concordant in geographic patterns with mtDNA data from previous studies and indicated that P. petaurista, P. hainana, P. philippensis, and P. yunanensis could be recognized as valid species.展开更多
Objective To investigate the clinical efficacy of acupuncture combined with medicine for AIzheimer＇s disease. Methods Fifty-five patients of Alzheimer＇s disease were randomly divided into two groups in accordance wi...Objective To investigate the clinical efficacy of acupuncture combined with medicine for AIzheimer＇s disease. Methods Fifty-five patients of Alzheimer＇s disease were randomly divided into two groups in accordance with random number table： the drug group （n=28） was treated with oral donepezil hydrochloride tablets, once a day for 5-10 mg with 10 days as a course of treatment; the combined acupuncture and drug group （n=27） was treated with cranial suture acupuncture combined with donepezil hydrochloride tablets in the above-mentioned way. The cranial suture acupuncture was given once a day for 30 min with 10 days as a course of treatment. Both groups were given treatment for two courses. Mini-mental state examination （MMSE）, Alzheimer＇s disease assessment scale （ADAS-Cog）, activities of daily living scale （Barthel） and electroencephalogram （EEG） were checked before and after treatment, to evaluate the efficacy of each group via integral changes of Barthel. Results MMSE score increased, Barthel index score increased, and ADAS-Cog score decreased in the two groups after treatment （P〈0.05, P〈0.01）, and the efficacy of the combined acupuncture and drug group was more significant （P〈0.01）. The α wave frequency and amplitude and θ wave frequency of EEG increased after treatment in both groups （P〈0.05）, θ wave amplitude decreased （P〈0.01）, and the efficacy of the combined acupuncture and drug group was superior to that of the drug group in terms of EEG improvement （P〈0.05）. The total effective rate of the combined acupuncture and drug group （88.9%, 24/27） was superior to that of drug group （67.9%, 18/28, P〈0.05）. Conclusion The effect of cranial suture acupuncture combined with donepezil hydrochloride tablets for Alzheimer＇s disease is more significant than only medicine therapy.展开更多
Objective: To study the imaging features of extra-axial tumors and tumor-likelesions involving both middle and posterior cranial fossae and to make a classification. Methods:Sixty cases of pathologically confirmed ext...Objective: To study the imaging features of extra-axial tumors and tumor-likelesions involving both middle and posterior cranial fossae and to make a classification. Methods:Sixty cases of pathologically confirmed extra-axil tumors and tumor-like lesions involving bothmiddle and posterior cranial fossae were analyzed. They were divided into central and lateral types,the latter of which were subdivided into three types: middle cranial fossae type, posterior cranialfossae type and the over-riding type. The constitution and imaging features of each type wereanalyzed. Results: There were 12 cases of central type, including chordoma (n=5), pituitary adenoma(n=3), nasopharyngeal carcinoma (n=2), craniopharyn-gioma (n=1) and meningioma (n=l). 48 cases oflateral type including trigeminal nerve tumors (n=14), meningioma (n=12), epidermoid cyst (n=11),dural cavernous hemangioma (n=4), dermoid cyst (n=2), metastasis (n=2), hemangiopericytoma (n=1),paraganglioma of glonius jugular (n=1) and nasopharyngeal carcinoma (n=1). Each type of the lesionshad its own shape features, some of which were characteristic for some specific tumors. Most of thetumors and tumor-like lesions could be qualitatively diagnosed according to their imagingcharacteristics and the extent of the lesions could be defined definitely. Conclusion: It is helpfulto categorize extra-axial tumors and tumor-like lesions involving both middle and posterior cranialfossae according to their location for qualitative diagnosis and description of the extent of theselesions. It is of great clinical value in providing more precise and thorough imaging informationfor planning therapeutic methods and route of operation.展开更多
Intracranial complications of sinusitis are rare. However, they have an important morbidity and mortality rate, and can be a source of disabling neurological sequelae in the absence of a rapid diagnosis and adequate t...Intracranial complications of sinusitis are rare. However, they have an important morbidity and mortality rate, and can be a source of disabling neurological sequelae in the absence of a rapid diagnosis and adequate treatment. We carry a retrospective study of 23 patients having sinusitis with intracranial complications, treated between 1996 and 2011. All patients underwent complete ENT and neurological examination, biological investigations and sinonasal and cerebral CT. An intraveinous large-spectrum antibiotherapy was administered to all patients. Twenty patients underwent surgery. It included evacuation of the intracranial collection, sinus drainage, with or without cranialization of the frontal sinus. Evolution was assessed on clinical biological and radiological criteria. Mean age was 25 years and sex-ratio was 3.6. Neurological signs were the most frequent symptoms. Rhinological signs were essentially purulent rhinorrhea (14 cases) and nasal obstruction (12 cases). Nasal endoscopy showed pus in the middle meatus in 10 cases. On CT, intracranial complications included subdural empyema (11 cases), extradural empyema (7 cases) and brain abscess (5 cases). Associated cerebral thrombophlebitis was noted in 4 cases. Three patients with extradural empyema had had an exclusive medical treatment. All other patients (20 cases) were operated. Clinical and radiological evolution was favorable after initial treatment in 14 cases (60.8%). Six patients required secondary surgery. Two patients have died despite intensive care. The intracranial complications of sinusitis are serious and source of important morbidity and mortality. Management should rapid and adequate, combining effective antibiotic therapy and eventually neurosurgical treatment.展开更多
基金funded by National Natural Science Foundation of China(No.82272134)Innovative Research Group Project of the National Natural Science Foundation of China(No.82272134,Xiao-lei Chen).
文摘Background and Objective Electromagnetic navigation technology has demonstrated significant potential in enhancing the accuracy and safety of neurosurgical procedures.However,traditional electromagnetic navigation systems face challenges such as high equipment costs,complex operation,bulky size,and insufficient anti-interference performance.To address these limitations,our study developed and validated a novel portable electromagnetic neuronavigation system designed to improve the precision,accessibility,and clinical applicability of electromagnetic navigation technology in cranial surgery.Methods The software and hardware architecture of a portable neural magnetic navigation system was designed.The key technologies of the system were analysed,including electromagnetic positioning algorithms,miniaturized sensor design,optimization of electromagnetic positioning and navigation algorithms,anti-interference signal processing methods,and fast three-dimensional reconstruction algorithms.A prototype was developed,and its accuracy was tested.Finally,a preliminary clinical application evaluation was conducted.Results This study successfully developed a comprehensive portable electromagnetic neuronavigation system capable of achieving preoperative planning,intraoperative real-time positioning and navigation,and postoperative evaluation of navigation outcomes.Through rigorous collaborative testing of the system’s software and hardware,the accuracy of electromagnetic neuronavigation has been validated to meet clinical requirements.Conclusions This study developed a portable neuroelectromagnetic navigation system and validated its effectiveness and safety through rigorous model testing and preliminary clinical applications.The system is characterized by its compact size,high precision,excellent portability,and user-friendly operation,making it highly valuable for promoting navigation technology and advancing the precision and minimally invasive nature of neurosurgical procedures.
基金National Institutes of Health grant F30DE030675(S.A.H.)National Institutes of Health grant T32DE007057(S.A.H.)+7 种基金University of Michigan Rackham Graduate School Pre-Candidate Research Grant(S.A.H.)University of Michigan Rackham Graduate School Candidate Research Grant(S.A.H.)National Institutes of Health grant R35DE034348(N.O.)National Institutes of Health grant R01DE026666(N.O.)National Institutes of Health grant R01DE030630(N.O.)National Institutes of Health grant R01DE029465(R.T.F.)Department of Defense grant W81XWH2010571(R.T.F.)National Institutes of Health grant P30 AR069620(The Michigan Integrative Musculoskeletal.Health Core Center).
文摘The cranial base synchondroses,comprised of opposite-facing bidirectional chondrocyte layers,drive anteroposterior cranial base growth.In humans,RUNX2 haploinsufficiency causes cleidocranial dysplasia associated with deficient midfacial growth.However,how RUNX2 regulates chondrocytes in the cranial base synchondroses remains unknown.To address this,we inactivated Runx2 in postnatal synchondrosis chondrocytes using a tamoxifen-inducible Fgfr3-creER(Fgfr3-Runx2cKO)mouse model.Fgfr3-Runx2cKO mice displayed skeletal dwarfism and reduced anteroposterior cranial base growth associated with premature synchondrosis ossification due to impaired chondrocyte proliferation,accelerated hypertrophy,apoptosis,and osteoclast-mediated cartilage resorption.Lineage tracing reveals that Runx2-deficient Fgfr3+cells failed to differentiate into osteoblasts.Notably,Runx2-deficient chondrocytes showed an elevated level of FGFR3 and its downstream signaling components,pERK1/2 and SOX9,suggesting that RUNX2 downregulates FGFR3 in the synchondrosis.This study unveils a new role of Runx2 in cranial base chondrocytes,identifying a possible RUNX2-FGFR3-MAPK-SOX9 signaling axis that may control cranial base growth.
文摘This narrative review examines the use of imaging biomarkers for diagnosing and monitoring hydrocephalus from birth through childhood.Early detection and longitudinal follow-up are essential for guiding timely interventions and asse-ssing treatment outcomes.Cranial ultrasound and magnetic resonance imaging(MRI)are the primary imaging modalities,providing critical insights into ventri-cular size,cerebrospinal fluid dynamics,and neurodevelopmental implications.Key parameters,including Evans’index,Levene’s index,and the Cella Media index,as well as volumetric and diffusion-based MRI techniques,have been explored for their diagnostic and prognostic value.Advances in automated image analysis and artificial intelligence have further improved measurement precision and reproducibility.Despite these developments,challenges remain in standar-dizing imaging protocols and establishing normative reference values across different pediatric populations.This review highlights the strengths and limita-tions of current imaging approaches,emphasizing the need for consistent metho-dologies to enhance diagnostic accuracy and optimize patient management in hydrocephalus.
文摘Objective:To analyze the value of bedside cranial ultrasonography in the early diagnosis of neonatal brain tissue injury in intrauterine distress.Methods:128 neonates with suspected intrauterine distress admitted to the Yichang Central People’s Hospital from January 2023 to December 2024 were selected as study subjects based on the inclusion and exclusion criteria,and all subjects underwent bedside craniocerebral ultrasonography and MRI,and the results of MRI were used as the gold standard to divide the infants into the brain-injury group(n=31)and the no-brain-injury The children were divided into brain injury group(n=31)and no brain injury group(n=97),and the value of bedside cranial ultrasonography for early diagnosis of brain tissue injury in neonates with intrauterine distress was analyzed.Results:(1)Among the 128 cases of intrauterine distress neonates,31 cases were examined for abnormal signs,including 22 cases(70.97%)examined by bedside craniocerebral ultrasonography and 28 cases(90.32%)examined by MRI.(2)Bedside cranial ultrasound detected hypoxic-ischemic encephalopathy in 6 cases,accounting for 4.69%,ventricular widening in 2 cases,accounting for 1.56%,intracranial hemorrhage in 8 cases,accounting for 6.25%,periventricular softening of white matter in 5 cases,accounting for 3.91%,and cerebral edema in 1 case,accounting for 0.78%,while MRI detected hypoxic-ischemic encephalopathy in 9 cases,accounting for 7.03%.3 cases of ventricular widening,accounting for 2.34%,4 cases of intracranial hemorrhage,accounting for 3.13%,9 cases of periventricular-intraventricular white matter softening,accounting for 7.03%,and 3 cases of cerebral edema,accounting for 2.34%were examined.Among them,the detection rate of periventricular-intraventricular hemorrhage by bedside cranial ultrasound was significantly higher than that of MRI(P<0.05).Conclusion:The diagnostic value of bedside cranial ultrasound in periventricular-intraventricular hemorrhage is high,but the diagnostic value is not as good as that of MRI in other brain tissue injuries,and clinically appropriate examination protocols can be selected according to the specific types of craniocerebral injuries.
基金the funding supported from the National Research Foundation of Korea(NRF)grant funded by the Korea Government MSIT(No.2021R1C1C1006003).
文摘Understanding frictional anisotropy,which refers to the variation in frictional resistance based on the shear direction,is crucial for optimizing the friction angle between a bio-inspired structure and the surrounding soil.Previous studies focused on estimating the interface frictional anisotropy mobilized by snakeskin-inspired textured surfaces and sand under monotonic shear loading conditions.However,there is a need to estimate interface frictional anisotropy under repetitive shear loads.In this study,a series of repetitive direct shear(DS)tests are performed with snakeskin-inspired textured surfaces under a constant vertical stress and two shear directions(cranial first half→caudal second half or caudal first half→cranial second half).The results show that(1)mobilized shear stress increases with the number of shearing cycles,(2)cranial shearing(shearing against the scales)consistently produces a higher shear resistance and less contractive behavior than caudal shearing(shearing along the scales),and(3)a higher scale height or smaller scale length of the surface yields a higher interface friction angle across all shearing cycles.Further analysis reveals that the gap between the cranial and caudal shear zones of the interface friction angle as a function of L/H(i.e.the ratio of scale length L to scale height H)continues to decrease as the number of shearing cycles approaches asymptotic values.The directional frictional resistance(DFR)decreases as the number of shearing cycles increases.Furthermore,the discussion covers the impact of initial relative density,vertical stress,and the number of shearing cycles on interface frictional anisotropy.
基金Supported by Guangdong Provincial Science and Technology Plan Project,No.2022A0505050065Guangdong Natural Science Foundation,No.2022A1515011632.
文摘BACKGROUND Laparoscopic hepatectomy is a proven safe and technically feasible approach for liver tumor resection,but laparoscopic anatomical SVIII resection(LASVIIIR)remains rarely reported due to poor accessibility,difficult exposure,and the deep-lying Glissonean pedicle.This study examined the safety,feasibility,and perio-perative outcomes of LASVIIIR via a middle hepatic fissure approach at our in-stitution.AIM To investigate the safety,feasibility,and perioperative outcomes of LASVIIIR via a middle hepatic fissure approach at our institution.METHODS From November 2017 to December 2022,all patients with a liver tumor who underwent LASVIIIR were enrolled.The perioperative outcomes and postope-rative complications were evaluated.RESULTS Thirty-four patients underwent LASVIIIR via a middle hepatic fissure approach from the side or cranio side and were included.The mean operation time was 164±54 minutes,and the intra-operative blood loss was 100 mL(range:20-1000 mL).The mean operative times were,respectively,152±50 minutes and 222±29 minutes(P=0.001)for the caudal side and cranial side approaches.In addition,the median blood loss volumes were 100 mL(range:20-300 mL)and 250 mL(range:20-1000 mL),respectively,for the caudal and cranial sides(P=0.064).Three patients treated using the cranial side approach experienced bile leakage,while 1 patient treated using the caudal side approach had subphrenic collection and underwent percutaneous drainage to successfully recover.There were no differences regarding postoperative hospital stays for the caudal and cranial side approaches[9(7-26)days vs 8(8-19)days](P=0.226).CONCLUSION LASVIIIR resection remains a challenging operation,but the middle hepatic fissure approach is a reasonable and easy-to-implement technique.
文摘Objective To observe the value of isotropic volumetric MRI for displaying perineural spread(PNS)of cranial nerve(CN)in nasopharyngeal carcinoma.Methods Eighty-seven patients with pathologically proven nasopharyngeal carcinoma were prospectively enrolled.MR scanning,including three-dimensional liver acquisition with volume acceleration-flexible(3D LAVA_Flex)image,T2WI with fat suppression(T2WI-FS),T1WI,contrast enhancement(CE)T1WI-FS of nasopharynx and neck region were performed.The displaying rates of CN PNS were evaluated and compared between 3D LAVA_Flex and T2WI-FS,T1WI,CE-T1WI-FS at patient level,CN group level and neural level,respectively.Results The displaying rate of CN PNS in all 87 nasopharyngeal carcinoma patients by 3D LAVA_Flex sequence was 49.43%(43/87),higher than that of conventional MRI(30/87,34.48%,P=0.001).Among 59 patients with advanced nasopharyngeal carcinoma diagnosed with conventional sequences,the displaying rate of CN PNS was 71.19%(42/59)by 3D LAVA-Flex sequence,higher than that of conventional MRI(30/59,50.85%,P=0.001).At both patient level and posterior CN level,significant differences of the displaying rate of CN PNS were found between 3D LAVA-Flex sequence and T2WI-FS,T1WI,CE-T1WI-FS,while at CN level,the displaying rates of mandibular nerve PNS,CNⅨ—ⅪPNS in jugular foramen(P<0.05)and CNⅨ—ⅫPNS in carotid space of 3D LAVA_Flex sequence were all significantly higher than that of T2WI-FS,T1WI and CE-T1WI-FS(all P<0.05),of PNS of CNⅢ—Ⅴin cavernous sinus were higher than that of T2WI-FS(P<0.05),while of PNS of hypoglossal nerve were significantly higher than that of T2WI-FS and T1WI(both P<0.05).Conclusion 3D LAVA_Flex sequence could be used to effectively display CN PNS of nasopharyngeal carcinoma.
基金supported by National Natural Science Foundation of China(Grant.Nos.51835010,12202347)Natural Science Basic Research Program of Shaanxi Province of China(Grant.No.2022JQ-378)+1 种基金Fundamental Research Funds for the Central Universities and the Program for Innovation Team of Shaanxi Province of China(Grant.No.2023-CX-TD-17)Natural Science Foundation of Guangdong Province of China(Grant.No.2022A1515012552).
文摘3D printed polyether-ether-ketone(PEEK)implant has become a popular clinical alternative to implants made of titanium alloy for cranial bone substitutes due to its bone-match properties,however its biological inert hin-dered the progress of clinical applications of such material.To enhance the tissue integration capability of PEEK implants and promote their long-term stability,cranial implants of gradient porous structures were designed and manufactured via fused filament fabrication(FFF)3D printing technology in both PEEK and PEEK/HA com-posites materials,then functionally evaluation of the implants on the tissue in-growth and the osteointegration mechanisms was conducted via animal tests.The 3D printed PEEK scaffold was found to have 2-5 folds of the compressive strength to those of the natural cranial bone.The in vivo studies verified that the porous PEEK/HA scaffold could effectively induce the bone ingrowth to form a stable biointegration boundary surrounding the host bone tissue after 4 weeks of implantation.Moreover,the PEEK/HA scaffold showed no significant advantages in improving the soft tissue in-growth,only making its distribution more evenly.It is also interestingly to find out that the vertically connective pores throughout the implant did not enhance the tissue binding force even though it did promote the nutrient transportation.In conclusion,the use of PEEK/HA composite material and a well-designed porous structure was proved to be an effective approach to improve the biointegration between the implant and host tissues.
基金Supported by The Key Projects of Medical Service Scientific Research of the Navy Medical Center,China,No.20M2302.
文摘BACKGROUND With very high mortality and disability rates,cerebrovascular diseases and intracranial tumors severely threaten the health and fighting strength of flying personnel,requiring great concern and intensive screening in clinic,early warning in an early and accurate manner and early intervention of diseases possibly resulting in inflight incapacitation are key emphases of aeromedical support in clinic.AIM To probe into the spectra of intracranial diseases,flight factors and medical imaging characteristics of military pilots(cadets)in the physical examination for transfer to pilot modified high performance aircraft,thus rendering theoretical references for clinical aeromedical support of pilots.METHODS A total of 554 military pilots(cadets)undergoing physical examination for transfer to pilot modified high performance aircraft from December 2020 to April 2024 in a military medical center were enrolled in this study.Then,a retrospective study was carried out on intracranial disease spectra and head magnetic resonance imaging(MRI)data of 36 pilots(cadets)who were unqualified for transfer to pilot modified high performance aircraft.Besides,a descriptive statistical analysis was conducted on the clinical data,age,fighter type and head MRI data of such pilots(cadets).RESULTS Abnormal head images were found in 36 out of 554 pilots(cadets)participating in the physical examination for transfer to pilot modified high performance aircraft,including arachnoid cyst in 17(3.1%)military pilots(cadets),suspected very small aneurysm in 11(2.0%),cavernous hemangioma in 4(0.7%),vascular malformation in 2(0.4%),and pituitary tumor in 3(0.5%,one of which developed cavernous hemangioma simultaneously).Among the 17 pilots(cadets)with arachnoid cyst,4 were identified as unqualified for transfer to pilot modified high performance aircraft because the marginal brain tissues were compressed by the cyst>6 cm in length and diameter.The 11 pilots(cadets)with suspected very small aneurysms identified by 3.0T MRI consisted of 6 diagnosed with conus arteriosus by digital subtraction angiography and qualified for transfer to pilot modified high performance aircraft,and 5 identified as very small intracranial aneurysms with diameter<3 mm and unqualified for transfer to pilot modified high performance aircraft.No symptoms and signs were observed in the 4 military pilots(cadets)with cavernous hemangioma,and the results of MRI revealed bleeding.The 1 of the 4 had the lesion located in pons and developed Rathke cyst in pituitary gland at the same time,and unqualified for transfer to pilot modified high performance aircraft.The 2 of the 4 were unqualified for flying,and 2 transferred to air combat service division.The 2 pilots(cadets)with vascular malformation were identified as unqualified for transfer to pilot modified high performance aircraft.Among the 3 pilots(cadets)with pituitary tumor,one pilot cadet was identified as unqualified for flying since the tumor compressed the optic chiasma,one had cavernous hemangioma in pons in the meantime and transferred to air combat service division,and one was diagnosed with nonfunctional microadenoma and qualified for transfer to pilot modified high performance aircraft.CONCLUSION High-resolution head MRI examination is of great significance for screening and detecting cerebrovascular diseases and intracranial tumors in military flying personnel,and attention should be paid to its clinical application to physical examination for transfer to pilot modified high performance aircraft.
文摘Cholesteatoma is a fairly otologic common problem. However, cholesteatoma invading the internal auditory canal (IAC) is rare and typically results in profound hearing loss and facial paralysis. This is a case of a 46-year-old female with a history of prior right complex cholesteatoma that had undergone multiple procedures. She had multiple complications including right cerebral spinal fluid (CSF) leak, meningitis, recurrent mastoid bowl infections and right facial paralysis which resulted in multiple facial plastics procedures and overclosure of the right ear. Over the last three years, she has noticed an increase in right sided otalgia, facial pressure, facial numbness and headaches. An MRI temporal bone with diffusion weighted imaging (DWI) showed a DW positive soft tissue mass filling the mastoid bowl as well as extending into the IAC and cerebellar pontine angle (CPA) cistern with contact of the middle cerebellar peduncle and trigeminal nerve. A translabyrinthine approach to the IAC found the mastoid bowl to be filled with cholesteatoma and an osseous defect from the mastoid bowl along the labyrinthine facial nerve tracking cholesteatoma into the IAC/CPA. This case highlights the complex and aggressive nature a cholesteatoma can take and the need for diligent surveillance in any ear that had prior cholesteatoma. The utilizations of MRI temporal bone with diffusion weighted imaging allow for surveillance in an over closed ear canal that is vital to the care of cholesteatoma patients who have a similar history.
文摘This is a case of a 60-year-old male with a history of prior left middle fossa meningioma that was partially resected with an operative report noting diffuse attachment to the middle fossa floor. Gamma knife was recommended but he never completed this management. He then presented about eight years later with a mass from his left external auditory canal. It was reported that two years prior another surgeon operated on the left ear for a cholesteatoma. CT temporal bone showed complete opacification of left EAC, mastoid bowl, and remaining mastoid air cells. In addition, there were irregular bony/hyperostotic changes seen within the left sphenoid and temporal bone. There was dural thickening within the middle fossa adjacent to the previously described hyperostotic bony changes. A mastoidectomy and excision of mass revealed extensive adhesive tissue throughout the middle ear, and mastoid up to the tegmen. Pathology of the portions that were resected confirmed Grade 1 meningioma. Stereotactic gamma knife radiation was completed to the area to prevent further growth. This case highlights extracranial meningioma that did not have definitive management for prior middle fossa floor meningioma. It also highlights the need to think of less common pathology in the middle ear and external auditory canal.
基金National Natural Science Fund of China (30970332)National Basic Research Program of China (973 Program) (2007CB411600)+1 种基金Natural Science Found of Yunnan Province (2007C099M)Special Subjects Funds of National Natural Science Fund of China (J0930004)
文摘The present study revisited the controversial taxonomic status ofPetaurista yunanensis, P. philippensis, P. hainana, and P. petaurista by using a considerably extended set of morphometrical characters （26 cranial variables from 60 adult specimen skulls）. The results revealed no sexual dimorphism in any of the four species but confirmed significant craniometric differences among the four species in both the principal components analysis （PCA） and discriminant function analysis （DFA）, with the greatest distinction observed between P. petaurista and other Petaurista species. Both univariate and multivariate analysis indicated that the morphological differences between P. yunanensis and P. philippensis were less than that between P. philippensis and P. hainana. The morphometric results were concordant in geographic patterns with mtDNA data from previous studies and indicated that P. petaurista, P. hainana, P. philippensis, and P. yunanensis could be recognized as valid species.
文摘Objective To investigate the clinical efficacy of acupuncture combined with medicine for AIzheimer＇s disease. Methods Fifty-five patients of Alzheimer＇s disease were randomly divided into two groups in accordance with random number table： the drug group （n=28） was treated with oral donepezil hydrochloride tablets, once a day for 5-10 mg with 10 days as a course of treatment; the combined acupuncture and drug group （n=27） was treated with cranial suture acupuncture combined with donepezil hydrochloride tablets in the above-mentioned way. The cranial suture acupuncture was given once a day for 30 min with 10 days as a course of treatment. Both groups were given treatment for two courses. Mini-mental state examination （MMSE）, Alzheimer＇s disease assessment scale （ADAS-Cog）, activities of daily living scale （Barthel） and electroencephalogram （EEG） were checked before and after treatment, to evaluate the efficacy of each group via integral changes of Barthel. Results MMSE score increased, Barthel index score increased, and ADAS-Cog score decreased in the two groups after treatment （P〈0.05, P〈0.01）, and the efficacy of the combined acupuncture and drug group was more significant （P〈0.01）. The α wave frequency and amplitude and θ wave frequency of EEG increased after treatment in both groups （P〈0.05）, θ wave amplitude decreased （P〈0.01）, and the efficacy of the combined acupuncture and drug group was superior to that of the drug group in terms of EEG improvement （P〈0.05）. The total effective rate of the combined acupuncture and drug group （88.9%, 24/27） was superior to that of drug group （67.9%, 18/28, P〈0.05）. Conclusion The effect of cranial suture acupuncture combined with donepezil hydrochloride tablets for Alzheimer＇s disease is more significant than only medicine therapy.
文摘Objective: To study the imaging features of extra-axial tumors and tumor-likelesions involving both middle and posterior cranial fossae and to make a classification. Methods:Sixty cases of pathologically confirmed extra-axil tumors and tumor-like lesions involving bothmiddle and posterior cranial fossae were analyzed. They were divided into central and lateral types,the latter of which were subdivided into three types: middle cranial fossae type, posterior cranialfossae type and the over-riding type. The constitution and imaging features of each type wereanalyzed. Results: There were 12 cases of central type, including chordoma (n=5), pituitary adenoma(n=3), nasopharyngeal carcinoma (n=2), craniopharyn-gioma (n=1) and meningioma (n=l). 48 cases oflateral type including trigeminal nerve tumors (n=14), meningioma (n=12), epidermoid cyst (n=11),dural cavernous hemangioma (n=4), dermoid cyst (n=2), metastasis (n=2), hemangiopericytoma (n=1),paraganglioma of glonius jugular (n=1) and nasopharyngeal carcinoma (n=1). Each type of the lesionshad its own shape features, some of which were characteristic for some specific tumors. Most of thetumors and tumor-like lesions could be qualitatively diagnosed according to their imagingcharacteristics and the extent of the lesions could be defined definitely. Conclusion: It is helpfulto categorize extra-axial tumors and tumor-like lesions involving both middle and posterior cranialfossae according to their location for qualitative diagnosis and description of the extent of theselesions. It is of great clinical value in providing more precise and thorough imaging informationfor planning therapeutic methods and route of operation.
文摘Intracranial complications of sinusitis are rare. However, they have an important morbidity and mortality rate, and can be a source of disabling neurological sequelae in the absence of a rapid diagnosis and adequate treatment. We carry a retrospective study of 23 patients having sinusitis with intracranial complications, treated between 1996 and 2011. All patients underwent complete ENT and neurological examination, biological investigations and sinonasal and cerebral CT. An intraveinous large-spectrum antibiotherapy was administered to all patients. Twenty patients underwent surgery. It included evacuation of the intracranial collection, sinus drainage, with or without cranialization of the frontal sinus. Evolution was assessed on clinical biological and radiological criteria. Mean age was 25 years and sex-ratio was 3.6. Neurological signs were the most frequent symptoms. Rhinological signs were essentially purulent rhinorrhea (14 cases) and nasal obstruction (12 cases). Nasal endoscopy showed pus in the middle meatus in 10 cases. On CT, intracranial complications included subdural empyema (11 cases), extradural empyema (7 cases) and brain abscess (5 cases). Associated cerebral thrombophlebitis was noted in 4 cases. Three patients with extradural empyema had had an exclusive medical treatment. All other patients (20 cases) were operated. Clinical and radiological evolution was favorable after initial treatment in 14 cases (60.8%). Six patients required secondary surgery. Two patients have died despite intensive care. The intracranial complications of sinusitis are serious and source of important morbidity and mortality. Management should rapid and adequate, combining effective antibiotic therapy and eventually neurosurgical treatment.
