Home About us Contact
|
Home About us Contact | ||
|
|
||
Nerve Resection (nerve + resection)
Selected AbstractsCombined endovascular and surgical treatment of head and neck paragangliomas,A team approach,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2002Mark S. Persky MD Abstract Background Paragangliomas are highly vascular tumors of neural crest origin that involve the walls of blood vessels or specific nerves within the head and neck. They may be multicentric, and they are rarely malignant. Surgery is the preferred treatment, and these tumors frequently extend to the skull base. There has been controversy concerning the role of preoperative angiography and embolization of these tumors and the benefits that these procedures offer in the evaluation and management of paragangliomas. Methods Forty-seven patients with 53 paragangliomas were treated from the period of 1990,2000. Initial evaluation usually included CT and/or MRI. All patients underwent bilateral carotid angiography, embolization of the tumor nidus, and cerebral angiography to define the patency of the circle of Willis. Carotid occlusion studies were performed with the patient under neuroleptic anesthesia when indicated. The tumors were excised within 48 hours of embolization. Results Carotid body tumors represented the most common paraganglioma, accounting for 28 tumors (53%). All patients underwent angiography and embolization with six patients (13%), demonstrating complications (three of these patients had embolized tumor involving the affected nerves). Cerebral angiography was performed in 28 patients, and 5 of these patients underwent and tolerated carotid occlusion studies. The range of mean blood loss according to tumor type was 450 to 517 mL. Postoperative cranial nerve dysfunction depended on the tumor type resected. Carotid body tumor surgery frequently required sympathetic chain resection (21%), with jugular and vagal paraganglioma removal frequently resulting in lower cranial nerve resection. These patients required various modes of postoperative rehabilitation, especially vocal cord medialization and swallowing therapy. Conclusions The combined endovascular and surgical treatment of paragangliomas is acceptably safe and effective for treating these highly vascular neoplasms. Adequate resection may often require sacrifice of one or more cranial nerves, and appropriate rehabilitation is important in the treatment regimen. © 2002 Wiley Periodicals, Inc. [source] Time-dependent expression of myostatin RNA transcript and protein in gastrocnemius muscle of mice after sciatic nerve resectionMICROSURGERY, Issue 5 2007Chenxin Shao M.D. Myostatin, a member of the transforming growth factor-, (TGF-,) superfamily, has been identified as a negative regulator of skeletal muscle mass. To provide more data on the role of myostatin in denervation-induced muscle atrophy, we examined the time-dependent changes in myostatin mRNA and protein as well as Smad2 and phospho-Smad2 protein levels in the denervated gastrocnemius muscle of mice after sciatic neurectomy, using quantitative real-time RT-PCR and Western blotting, respectively. We conducted morphometric analyses to measure the wet weight ratio of the denervated muscle (the operated side/contralateral nonoperated side) and the cross-sectional area of muscle fibers, and observed the morphology of denervated muscle. The experimental results showed that in the early stage of denervation, the levels of myostatin mRNA and protein in the denervated gastrocnemius muscle increased instantly, reaching a peak at day 3 and day 7 after sciatic neurectomy, respectively, when compared with the normal values. In addition, the phospho-Smad2 protein was observed to have a similar expression profile to that of the myostatin mRNA. The present study perhaps opens a new window into myostatin modulation in muscle atrophy due to denervation. © 2007 Wiley-Liss, Inc. Microsurgery, 2007. [source] Outcomes following temporal bone resection,,THE LARYNGOSCOPE, Issue 8 2010Nichole R. Dean DO Abstract Objectives/Hypothesis: To evaluate survival outcomes in patients undergoing temporal bone resection. Study Design: Retrospective review. Methods: From 2002 to 2009 a total of 65 patients underwent temporal bone resection for epithelial (n = 47) and salivary (n = 18) skull base malignancies. Tumor characteristics, defect reconstruction, and postoperative course were assessed. Outcomes measured included disease-free survival and cancer recurrence. Results: The majority of patients presented with recurrent (65%), advanced stage (94%), cutaneous (72%), and squamous cell carcinoma (57%). Thirty-nine patients had perineural invasion (60%) and required facial nerve resection; 16 (25%) had intracranial extension. Local (n = 6), regional (n = 2), or free flap (n = 46) reconstruction was required in 80% of patients. Free flap donor sites included the anterolateral thigh (31%), radial forearm free flap (19%), rectus (35%), and latissimus (4%). The average hospital stay was 4.9 days (range, 1,28 days). The overall complication rate was 15% and included stroke (n = 4), cerebrospinal fluid leak (n = 2), hematoma formation (n = 1), infection (n = 1), flap loss (n = 1), and postoperative myocardial infarction (n = 1). A total of 22 patients (34%) developed cancer recurrence during the follow-up period (median, 10 months), 17 (77%) of whom presented with recurrent disease at the time of temporal bone resection. Two-year disease-free survival was 68%, and 5-year disease-free survival was 50%. Conclusions: Aggressive surgical resection and reconstruction is recommended for primary and recurrent skull base malignancies with acceptable morbidity and improved disease-free survival. Laryngoscope, 2010 [source] Outcomes of static and dynamic facial nerve repair in head and neck cancerTHE LARYNGOSCOPE, Issue 3 2010Tim A. Iseli MBBS Abstract Objectives/Hypothesis: Determine outcomes associated with nerve grafting versus static repair following facial nerve resection. Study Design: Retrospective chart review. Methods: Charts from 105 patients who underwent facial nerve reconstruction between January 1999 and January 2009 were reviewed. The majority had parotid malignancy (78.1%), most commonly squamous cell carcinoma (50.5%). Patients underwent static (n = 72) or dynamic (n = 33) reconstruction with nerve grafting. Facial nerve function was measured using the House-Brackmann (H-B) scale. Results: Patients receiving static reconstruction were on average 10.3 years older (P = .002). Mean overall survival for tumor cases was 61.9 months; parotid squamous cell carcinoma was associated with worse prognosis (P = .10). Median follow-up was 16.1 months (range, 4,96.1 months). Most (97%) patients receiving a nerve graft had some return of function at a median of 6.2 months postoperatively (range, 4,9 months) and the majority (63.6%) had good function (H-B score ,4). Patients having static reconstruction (29.2%) were more likely to have symptomatic facial palsy than those having a nerve graft (15.2%, P = .12). Conclusions: Where possible, nerve grafting is the preferred method of facial nerve reconstruction. Although elderly patients with parotid malignancy have traditionally been considered poor candidates for nerve grafting, we demonstrate good results within 9 months of facial nerve repair even with radiotherapy, the use of long grafts (>6 cm), and prolonged preoperative dysfunction. Laryngoscope, 2010 [source] 38 Antegrade ejaculation can be preserved after lumbar sympathetic nerve sparing during post chemotherapy retroperitoneal lymph node dissection for testicular cancerBJU INTERNATIONAL, Issue 2006M.I. PATEL Resection of residual masses in the retroperitoneum (RPLND), following chemotherapy for testicular cancer was traditionally performed by full bilateral dissection. To minimise the loss of antegrade ejaculation (AGE), a new technique of modified template dissection (contralateral lymphnodes were not dissected in order to preserve the lumbar sympathetic nerves and maintain AGE) was later developed. More recently, lumbar sympathetic nerves have been individually dissected and preserved (sparing) in an attempt to maintain AGE. In this study we report on 18 consecutive men with postchemotherapy testicular cancer who under went RPLND. In each man the limit of dissection and number of sympathetic nerves "spared" or left undissected along with the lymphnodes (modified template) were recorded prospectively. Postoperatively all men were questioned about their ejaculation status. Of the 18 men, 10 men had left sided primary testicular tumours. 10 men had para-aortic lymphnode masses, eight had interaortocaval masses and one also had a paracaval mass. Masses ranged from 155 mm to 10 mm. Fourteen men had bilateral resections and four men had unilateral resections because of extremely small masses. With regards to nerve preservation, two men had complete sympathetic nerve resection and neither has AGE. All other men had between one and five nerves spared, and all these men have preserved antegrade ejaculation. Median follow up is 12 months, and no man has yet suffered an in-field recurrence. In conclusion, preservation of even one lumbar sympathetic nerve can maintain AGE, and does not appear to compromise tumour eradication. [source] | ||||||||||