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At least 217 records · Page 12Linked to original sources

PubMed1978

Transsphenoidal microsurgery for pituitary tumors associated with hyperprolactinemia.

The results of transsphenoidal microsurgery in treating 37 patients (30 women and seven men) with pituitary tumors associated with hyperprolactinemia are presented. Immediate (10-day) postoperative fasting prolactin levels were normal (less than 25 ng/ml) in 19 of 26 patients whose preoperative prolactin level was less than 200 ng/ml, and in only three of 11 patients in whom preoperative prolactin was greater than 200 ng/ml. Twelve of 13 patients with normal preoperative pituitary-target organ function maintained normal axes postoperatively. Thirteen other patients had preoperative deficiencies in one or more pituitary-target organ axes. Postoperatively, in these latter 13 patients, a pituitary-target organ axis that was deficient preoperatively returned to normal in six cases; there was no change in five, and there was impairment in another axis in four instances. Although gross total tumor removal was believed to be complete in 35 of 37 patients, serial postoperative prolactin determinations in four of these 35 patients indicate tumor regrowth. The authors conclude that transsphenoidal microsurgery is currently the operative procedure of choice for the majority of pituitary tumors associated with hyperprolactinemia.

Adenoma, Acidophil↗

PubMed1982

Transsphenoidal microsurgery for prolactin-secreting pituitary adenomas.

The authors present the results of transsphenoidal microsurgery in 100 women with the amenorrhea-galactorrhea syndrome caused by pituitary adenomas associated with hyperprolactinemia (prolactinomas). As the surgical results were closely related to the preoperative levels of serum prolactin, the patients were divided into two groups: patients with preoperative prolactin less than 200 ng/ml (Group 1), and those with preoperative prolactin greater than 200 ng/ml (Group 2). The results in Group 1 (72 patients) were significantly better. In this group, 56 (78%) patients regained normal menstrual cycles, and 55 (76%) had return of elevated prolactin to normal following surgery. In Group 2 (28 patients), however, only 11 (39%) resumed normal menstrual periods postoperatively, and 13 (*46%) had return of elevated prolactin levels to normal. There was good correlation between tumor size and the preoperative level of prolactin. Of the 72 women in Group 1, 58 (81%) had tumors less than 1 cm (microadenomas), whereas of the 28 women in Group 2, only four (14%) had tumors of that size. All patients with visual field deficits preoperatively improved or had a normal visual examination postoperatively; none was made worse by surgery. Four patients (three in Group 2) have required additional surgery and/or irradiation. In the last six patients of the series, contrast-enhanced coronal computerized tomography slices made with the updated General Electric scanner detected five microadenomas. Considering that a relatively high percentage of sellar polytomograms are negative in patients with proven microadenomas (that is, only 40 of 72 patients in Group 1 has abnormal polytomography), it is likely that sellar polytomography will significantly decrease in importance in the diagnostic work-up of these patients. The authors provide a rationale for transsphenoidal microsurgery in these patients as opposed to other forms of management, such as bromocriptine therapy and irradiation.

Adenoma↗

PubMed1999

[Ambulatory laryngeal microsurgery].

OBJECTIVE: The aim of the present study was to determine if laryngeal microsurgery (LMS) under general anesthesia is a safe and convenient procedure when carried out on an outpatient basis in selected patients. MATERIAL AND METHODS: Seventy-eight adult patients (60 men and 18 women) were scheduled for outpatient LMS under general anesthesia between February 1995 and December 1996. RESULTS: Their age range was 19 to 77 years (mean 48 years). Forty-four (56.4%) were ASA I, 32 (41%) ASA II, and 2 (2.6%) ASA III. Laryngeal biopsy was performed in 40 cases (51.3%), polypectomy in 30 cases (38.5%), excision of Reinke's edema in 5 cases (6.4%), and cyst excision in 3 cases (3.8%). The mean stay in the Day Hospital was 7 hours (range 2.5-10 h). Seven patients (9%) had immediate postoperative complications. Three patients were admitted overnight. No patient had to be readmitted to the hospital after discharge. CONCLUSIONS: Outpatient laryngeal microsurgery is an appropriate and safe alternative to inpatient surgery in carefully selected patients, who are kept under strict observation in the immediate postoperative period.

Adolescent↗

PubMed1999

[Apneic anesthesia for microsurgery of the larynx under propofol anesthesia].

Apneic anesthesia with intermittent ventilation (AAIV) under inhalational anesthesia has been reported to improve visualization of the larynx with lack of vocal cord motion in laryngeal microsurgery. In this study, we evaluated AAIV using total intravenous anesthesia with propofol and fentanyl instead of inhalational anesthesia in 11 patients undergoing microsurgery of the larynx, and examined the effects of AAIV on respiration and circulation. Anesthesia was maintained with infusion of propofol 4-10 mg.kg-1.h-1 and intermittent administration of fentanyl and vecuronium intravenously. The lungs were ventilated with 100% oxygen, and the endotracheal tube was removed during the apneic period. AAIV provided the otorhinolaryngologist sufficient room in which to operate and an immobile field without complications in any of the patients. The number of periods of apnea (mean +/- SD) was 3.3 +/- 1.3, and the duration of apnea was 292 +/- 23 seconds. Neither blood pressure nor heart rate changed during the apneic periods. Arterial oxygen saturation measured using pulse oxymetry (Spo2) changed in none of the patients except an obese patient whose Spo2 declined to 90%. End-tidal carbon dioxide level increased for 14.9 mmHg immediately after apneic periods. Propofol vielded stable and adequate levels of anesthesia during apneic periods. We conclude that AAIV using constant monitoring of Spo2 is a useful and safe technique, and that propofol is a suitable anesthetic agent for AAIV.

Anesthesia, Intravenous↗

PubMed2000

Transanal endoscopic microsurgery for excision of rectal lesions: technique and initial results.

The aim of this study was to review experience with transanal endoscopic microsurgery (TEM) and to assess its applicability to an existing practice of colorectal surgeons. Patients undergoing TEM excision of rectal lesions from March 1997 through May 1999 were selected for this study. Medical records were reviewed retrospectively to obtain pertinent data, including indications for TEM, tumor size, distance from anal verge, duration of operation, completeness of tumor resection, postoperative complications, duration of stay and follow-up, and recurrence. Thirty-one patients underwent TEM during the 2-year period. Indications for TEM included benign disease in eight patients and cancer in 23 patients. Mean distance of the tumor from the anal verge was 8.3 cm. Mean size of the lesion was 2.8 cm, and mean specimen size was 4.5 cm. Larger specimen sizes allowed for tumors to be removed with negative margins (97%) in all cases but one. Mean duration of operation was 140 minutes (including set-up time), and mean duration of hospital stay was 1.2 days. Major postoperative complications occurred in one patient. Mean duration of follow-up was 15 months, and recurrence developed in two patients during this period. Transanal endoscopic microsurgery excision of rectal lesions with negative margins was possible in 97% of cases with minimal morbidity and a short-duration hospital stay. Follow-up was too brief to evaluate recurrence, but the thoroughness of resection of tumor in a high proportion of cases is promising.

Aged↗

PubMed2000

[From surgical gloves to the rat. The various stages of microsurgery learning].

The paper describes the different stages of microsurgical training which should be followed in an experimental laboratory; it also stresses the main characteristics to which microsurgical trainees must pay attention without neglecting any steps, even the most banal ones, because microsurgery is a sequence of exercises and not a single one (microsuture). The rigorous and increasingly difficult step-by-step progress of the different phases allows the trainee to face the different passages with greater ability and mastery without losing that enthusiasm which is the motivating force. Obstacles and failures can be evaluated with a more critical and reflective eye. Microsurgical training foresees the gradual passage from synthetic materials, such as surgical gloves, to non-living biological structures, such as chicken legs, finishing with experimental animals such as the rat. These biological models are almost identical to human structures making the experimental stage very similar to direct clinical application. Microsurgery, nowadays, is an integral part of all surgical disciplines. A correct approach to surgery using a microscope, according to this teaching scheme, is surely of great help not only for young surgeons but for the veterans of surgery too.

Animals↗

PubMed2001

[Transanal endoscopic microsurgery: a forgotten minimally invasive technique].

OBJECTIVES: The aim of this study was to evaluate transanal endoscopic microsurgery in patients with benign and malignant rectal tumours with special reference to feasibility, morbidity, and recurrence rate. METHODS: Forty-three patients underwent transanal endoscopic microsurgical excision of rectal tumours between 1996 and 2000. The histological diagnosis was benign adenoma in 30 and invasive carcinoma in 13. The mean height of the tumour above the anal verge was 11.2 +/- 3 cm and the mean diameter of the lesion was 3.4 +/- 1.5 cm. RESULTS: The mean operative time was 85 +/- 26 min and in one case (2%), it was necessary to convert to an anterior resection. The morbidity rate was 18%. Mean hospital stay was 3.9 +/- 2.4 days. Complete excision of the tumour with histological confirmation was achieved in 42 cases (98%). With a mean follow-up of 26 months, benign tumour recurrence was observed in one patient (3%). Of the 13 patients with carcinoma, two had immediate further radical resection. For the remaining 11 patients, with a mean follow-up of 19 months, the recurrence rate was 75% for T2 tumours and nil for T1 tumours. CONCLUSIONS: Transanal endoscopic microsurgery is safe and feasible technique which should have a useful place in the management of sessile adenomas of the mid and upper rectum. Its role in the management of rectal cancer is limited, although it may be appropriate for carefully selected cases.

Adenoma↗

PubMed2001

[Microsurgery of brainstem cavernous malformation].

OBJECTIVE: To evaluate the effectiveness and benefits of surgical treatment of cavernous malformations (CMs) in brainstem. METHODS: From 1992 to 1999, 7 cases of brainstem cavernous malformations (six females and one male, aged 44 on average) with 6 lesions in pons, one in mesencephalon, and one in medulla oblongata, were operated on with microsurgery. In the recent three years neuronavigation system has been applied. RESULTS: All of the eight lesions were removed without death toll. The functional disorders of nervous system were improved after operation in four cases. The neurological deficits worsened in two cases, however, their neurological functions improved gradually to the preoperative level in four months or three years. The neurological function in the case with lesion in mesencephalon worsened after operation. Pathology revealed a grade one oligodendroglioma in addition to the CM lesion. Neuronavigation helped facilitate the accurate location of the lesions and minimize the surgical injury. CONCLUSION: Microsurgery is effective in treating brainstem cavernous malformations with appropriate indications and minimal invasive technique.

Adult↗

PubMed2002

[Image-guided microsurgery in resection of intracranial cavernous hemangioma].

OBJECTIVE: To study the methods and effectiveness of image-guided microsurgery in resection of intracranial cavernous hemangioma. METHODS: Between July 1997 and January 2001, 44 patients with intracranial cavernous hemangioma, 27 males and 17 females with a mean age of 35 years, among which 5 cases had multiple lesions, underwent image-guided microsurgery. The locations of lesions included frontal lobe (n = 14), temporal lobe (n = 12), parietal lobe (n = 6), cerebellum (n = 6), thalamus (n = 5), pons (n = 5), and orbital lobe (n = 1). A small silicon catheter, used as a guider, was implanted to the deep-seated lesion (except the brain stem lesions) before excision of the lesion in order to prevent brain shift. RESULTS: Total removal of the lesions was achieved in all patients without operational death. Follow-up revealed marked improvement of symptoms in 26 case and no change of symptom(s) in 13 cases. 5 cases suffered from additional neurological deficits, mainly exacerbation of hemiparalysis and aphasia, the condition of two of which, however, gradually improved within the period of follow-up. No residue of lesion and relapse were found during follow up. CONCLUSION: With the assistance of the image-guided surgical system, functional area can be effectively avoided, and surgical injury can be decreased. It is well suited for accurate localization and safe resection of small, deep-seated cavernous malformations.

Adolescent↗

PubMed2002

[Modification and application of anterior skull base microsurgery with navigation system].

OBJECTIVE: To investigate the accuracy and safety of the modified techniques in anterior skull base microsurgery with navigation system. METHODS: Operation was performed upon 42 patients with benign and malignant tumor of anterior skull base involving both cerebral cranium and visceral cranium with the help of modified navigation system. A new arrangement was designed for stable maintenance of the headset with dynamic reference frame to avoid disturbance during emission of encoded infrared signal. Six reference points were used, distributed in the parietal, frontal, zygomatic, maxillary, and mastoid regions. The STN navigation system and SMN surgical microscope navigator were used to provide virtual pointer, virtual approach route and virtual contour as an orientation for stereotaxic guidance during surgery. RESULTS: The modified technique could keep the accuracy of surgical guidance within 1 approximately 1.5 mm in comparison with the accuracy of 4 mm or more by the original design, thus guaranteeing the safety of surgery. CONCLUSION: The modified techniques raise the accuracy and safety of anterior skull base microsurgery. However, the cost remains high.

Adolescent↗

PubMed2002

The role of periodontal plastic microsurgery in oral facial esthetics.

Periodontal plastic microsurgery incorporates the use of a surgical dissecting microscope in an attempt to increase visibility, minimize trauma, and enhance surgical results. This paper will attempt to demonstrate how periodontal plastic surgery utilizing periodontal microsurgery could contribute in the role of soft tissue modification to enhance the smile and ideally allow for improved oral facial esthetics.

Alveolar Bone Loss↗

PubMed2002

[Study on voice quality after different layers injured in vocal fold with CO2 laser microsurgery].

OBJECTIVE: To investigate the nature of pathological voice after injured in different layers of vocal fold with CO2 laser microsurgery. METHOD: 50 cases of precancerous lesion (keratosis and leukoplakia) were treated with laser mucosa ablation. Glottal carcinoma (Tis-T2) were treated with laser microsurgery in mucosal stripping(30 cases) or with laser cordectomy(60 cases). Vocal function was examined by acoustic analysis (F0, Jitter, Shimmer, NNE, HNR), aerodynamic analysis (MPT, S/Z) and videostroboscopic examination. RESULT: For lesion mucosa ablation, hoarseness improved quickly after operation and acoustic analysis became normal. There were 18.2% decreased mucosa wave, 16.7% mild-moderate supraglottal hyperfunction. For mucosa stripping (cover layers excised), 63.3% decreased and 10.0% absented with mucosa wave, 46.7% mild-moderate supraglottal hyperfunction, glottal closure was incomplete. Acoustic analysis showed that Jitter, Shimmer, F0 different from normal(P < 0.05), HNR significantly different from normal(P < 0.01). For cordectomy: Acoustic analysis showed significantly worse than normal(P < 0.01), 61.7% mild-moderate supraglottal hyperfunction. The ipsilateral mucosa wave was absent, but 30.0% showed mucosa wave of vocal process and 13.3% with ventricular fold wave. There was little difference with or without vocalis muscle excision in acoustic analysis. To compared with mucosa stripping, the NNE, HNR, Jitter, Shimmer of cordectomy group was worse and amplitude was higher in cordectomy(P < 0.01). CONCLUSION: Although the acoustic characteristic and vibration mode of mucosa ablation and mucosa stripping was distinct to each other, within the cover layer injured, vocal function will be good. Once the body layer is injured, vocal quality will decrease significantly.

Adult↗

PubMed2002

Paravertebral retropleuric microsurgery approach to the treatment of thoracic disc herniation. Personal experience and consideration of unsatisfactory results.

AIM: The authors report their experience on the paravertebral retropleuric microsurgery approach to the treatment of thoracic disc herniation. The paper describes both the approach and its result and it further expands on the reason behind the few cases of unsatisfactory results. METHODS: Twenty-three patients were operated upon for thoracic disc herniation between 1994 and 2000. The paravertebral retropleuric microsurgery approach was used in each. RESULTS: The results were very satisfactory in 20 cases, with all symptoms completely disappearing. In only 3 cases we had unsatisfactory results. CONCLUSION: We think that the postero-lateral retropleuric approach is a correct method for the treatment of thoracic disc herniation because it did not cause any significant bone intervention.

Adolescent↗

PubMedDate not supplied

[Endoscopic microsurgery in cervical disc hernias].

The paper provides outcomes of treatment in 37 patients with cervical diskal hernias, operated on by endoscopic portal microsurgery. Surgery involved the use of video endoscopic techniques, microsurgery under fluoroscopic control. The duration of an operation was 22 +/- 2.7 min. Hospital stay was not more than 24 hours. Fair early and late outcomes were noted in 94.1% of the patients.

Cervical Vertebrae↗

PubMed2003

[Microsurgery for intracranial aneurysm, clinical analysis of 1,041 cases].

OBJECTIVE: To study the effect of microsurgery on incranial aneurysm and factors influential in prognosis. METHODS: A retrospective analysis was made on the clinical data of 1,041 patients, 505 males and 536 females, aged 44.2 +/- 12.6, with incranial aneurysm treated by microsurgery 1988 approximately 2001, including clipping of aneurysm (982 cases, 94.3%), isolating of the aneurysm (32 cases, 3.1%), and coating of the aneurysm (27 cases, 2.6%). RESULTS: 93 patients (8.9%) had multiple aneurysms. 357 aneurysms (31.2%) were in the posterior communicating artery, 261 (22.8%) in the anterior communicating artery, 210 (18.4%) in the internal carotid artery, 158 (13.8%) in the middle cerebral artery, 63 (5.5%) in the anterior cerebral artery, 59 (5.2%) in the vertebral-basilar artery, and 35 (3.1%) in the posterior cerebral artery. The overall operative mortality was 1.8%. Angiography performed post-operationally showed that the aneurysm was occluded in 978 patients (99.6%). The prognosis was related to the age of patient (P = 0.001), Hunt and Hess grading before operation (P = 0.001), diameter of aneurysm (P = 0.000), and whether the aneurysm ruptures during operation (P = 0.006), and was not related to the gender of patient (P = 0.059). CONCLUSION: Clipping of the aneurysm is considered the best treatment. Microinvasive neurosurgery has improved significantly the effect of treatment of intracranial aneurysm. Factors influencing prognosis after operation include the age of patient, Hunt and Hess grading before operation, diameter of aneurysm, and whether the aneurysm ruptures during operation.

Adolescent↗

PubMedDate not supplied

[Application of high frequency jet ventilation during microsurgery of the larynx under suspending laryngoscopy].

OBJECTIVES: This study describes the results obtained with high frequency jet ventilation (HFJV) in 19 patients who underwent laryngeal microsurgery under suspending laryngoscopy. MATERIAL AND METHODS: After premedication and anesthetic induction with propofol (Diprivan R, ICI-Farma), we performed an endotracheal intubation (28F tube) under succinyl-choline facilitation. Conventional ventilation was started at a rate of 14-16 cpm with a minute volume of 8-10 l, and a FiO2 of 0.4 (air-oxygen). The endotracheal tube was replaced by an insufflation catheter of 2 mm internal diameter and HFJV was initiated at a rate of 100 cpm, inspiratory time equal to the 33% of the total cycle, generator pressure of 2.5-3.6 kg/cm2, and similar FiO2. We used an Ergojet CVT (Temel SA) respirator that allowed continuous monitoring of the injector released volume during each cycle (Vjet) as well as the air way pressure. Anesthesia was maintained with continuous propofol perfusion. RESULTS: During HFJV there were no significant hemodynamic alterations and surgeons considered that the condition of the surgical field was excellent. Air way pressure was maintained at low levels in all cases, although brief hypertensive episodes occurred during laryngeal manipulation. Oxygenation was satisfactory in all except one patient with chronic obstructive pulmonary disease. Conventional ventilation and HFJV did not induce significant differences in alveolar ventilation nor in PaCO2. However, during HFJV oxygenation and ventilatory levels suffered a high degree of interindividual variability. This phenomenon could be due to the existence of variable degrees of gas reflux during insufflation. CONCLUSIONS: We conclude that HFJV is a very useful technique for anesthesia in laryngeal microsurgery. However, an appropriate monitoring of ventilatory dynamics and a detailed knowledge of the influences of patient's characteristics on HFJV are required.

Adult↗

PubMed2004

The potential of robotic technology applied to meet requirements for tools to support microsurgery and cellular surgery.

Microsurgery and processes involving cell manipulation or cell surgery are clinical practices where the operator works at or beyond the threshold of human dexterity. Current tools available are conventional in their design, and this limits consistency and the level of reliability and achievement. Surgical robotic devices have been explored to improve precision in minimal access surgical procedures to augment control of tool points in tissues, and have enabled feedback of sensory data from which the operator is able to deduce information on the tool at the working site. In this paper, relevant technologies are described that can be harnessed to improve perception of tool point interaction with tissues at the working site and to improve tool control at the small scale required in clinical practice for microsurgery and for cell surgery.

Humans↗

PubMed2002

A preliminary report of 40 cases of strabismus microsurgery.

OBJECTIVE: To improve the quality of strabismus surgery and to find out the role of microsurgery in the field of strabismus. METHODS: We performed separation and preservation of anterior ciliary vessels (ACV), adjustable sutures, routine rectus recession, and oblique muscle surgeries under microscope in 13 cases of comitant strabismus, 19 cases of A-V syndrome and 8 cases of paralytic strabismus. RESULTS: Surgeries were performed in a very clear field under microscope. We successfully did vascular microdissection and ACV preservation. Also with the use of microscope, various kinds of strabismus microsurgery videos were recorded. CONCLUSIONS: Microscopic technique can be used to enhance the quality and accuracy of strabismus surgery and to reduce surgical damage, postoperative inflammatory reaction and scar formation. All kinds of strabismus surgery , especially, oblique muscles and complex paralytic operations can be performed under microscope.

Adolescent↗