Objective This study aimed to investigate the prognostic value of the lateral spread response (LSR) for predicting surgical outcomes following microvascular decompression (MVD) in patients with hemifacial spasm. Methods Seventy-three patients with hemifacial spasm underwent MVD with intraoperative LSR monitoring. Surgical outcomes were evaluated 1 week and 1 year after MVD and correlations between LSR characteristics and surgical outcomes were analyzed. Results The LSR disappeared completely in 61 patients during surgery (Group A; prior to insertion of Teflon felt pledgets in 11, after insertion of pledgets in 50), disappeared partially in nine patients (Group B), and remained unchanged in three patients (Group C). Fifty-five patients showed short-term and 61 patients showed long-term clinical cures during the follow-up period. The short-term and long-term cure rates were significantly higher in Group A than in Group C. There was no correlation between the time of complete LSR disappearance and surgical outcomes. Conclusions Disappearance of the LSR during MVD is correlated with the surgical outcomes. Intraoperative LSR monitoring is a reliable approach for predicting the prognosis of hemifacial spasm following MVD, but the time at which LSR disappears is not a prognostic indicator.

Facial nerve paralysis is a common complication following cerebellopontine angle (CPA) surgery. This study investigated the prognostic value of facial nerve motor-evoked potentials (FNMEPs) elicited by transcranial electrical stimulation for facial nerve outcome after CPA tumorectomy.A total of 95 patients were enrolled in this study between January 2014 and January 2016. All these patients underwent CPA tumorectomy (unilateral, n = 95; bilateral, n = 1). Intraoperative FNMEP elicited by transcranial electrical stimulation was recorded. The short- and long-term postoperative facial nerve functions were evaluated according to the House–Brackmann (HB) scale. The correlation between perioperative changes in the FNMEP stimulus threshold (delta FNMEP = postoperative stimulus threshold level–preoperative stimulus threshold level) and postoperative facial nerve functions were analyzed.On the first day postoperatively, the facial nerve function was HB grade I in 67, grade II in 17, grade III in 7, and grade IV in 5 facial nerves. One year postoperatively, the facial nerve function was grade I in 80, grade II in 11, grade III in 3, and grade IV in 2 facial nerves. The delta FNMEP was significantly correlated with the short- and long-term facial nerve function; receiver operating characteristic (ROC) curves yielded a cut-off delta FNMEP value of 30 V (sensitivity, 91.3%; specificity, 98.6%) and 75 V (sensitivity, 100%; specificity, 98.8%) for predicting short- and long-term facial nerve function damage, respectively.FNMEP elicited by transcranial electrical stimulation is an effective and safe approach for predicting facial nerve function in CPA tumorectomy. A high delta FNMEP is a potential indicator for the prediction of postoperative facial nerve damage.

Background: To investigate the survival outcomes of abdominal radical hysterectomy (ARH), laparoscopic radical hysterectomy (LRH), and vaginal-assisted laparoscopic radical hysterectomy (VALRH) in the treatment of cervical cancer patients.Methods: This was a retrospective study. We collected the clinical data of 654 patients with cervical cancer (406 ARH, 172 LRH, and 76 VALRH), then compared the effects of different surgical methods on recurrence and survival.Results: Total overall survival (OS) were no significant differences in three groups (P>0.05). Total diseasefree survival (DFS) was significantly higher in ARH group than in LRH group [hazard ratio (HR) =2.8, 95% confidence interval (CI): 1.199-3.607, P=0.004]; however, there were no significant differences between the VALRH (94.7%) and ARH (93.3%) groups. Subgroup stratification analysis showed that the overall recurrence rate in LRH group was significantly higher than that of the ARH groups for patients with a tumor size from ≥2 to <4 cm, negative postoperative lymph nodes, and no postoperative adjuvant therapy (all P<0.05). However, in the subgroup with tumor sizes of ≥2, <4, and ≥4 cm, no matter whether the lymph nodes were positive or not, and those with no postoperative supplementary adjuvant therapy, LRH was associated with a significantly higher local pelvic recurrence rate than ARH (all P<0.05). No significant differences between VALRH and ARH in any of the subgroup analyses (all P>0.05). A Cox analysis indicated that LRH increased the risk of overall and local pelvic recurrence after surgery compared with ARH (HR =2.338, 95% CI: 1.186-4.661, P=0.014; HR =10.313, 95% CI: 2.839-37.460, P<0.001); however, no significant difference between VALRH and ARH (all P>0.05). Sensitivity analysis of surgeons did not change the conclusions.Conclusions: Our analyses showed that the local pelvic recurrence rates and overall recurrence rates of LRH were significantly higher than ARH. VALRH could avoid tumor intraperitoneal exposure and achieve the same tumor prognosis as open surgery. By improving the standardization of minimally invasive surgery for early cervical cancer and paying close attention to the tumor-free concept, minimally invasive radical hysterectomy may achieve the same tumor outcome as open surgery.

Background: Idiopathic spontaneous intramedullary hemorrhage is a rare clinical disease. No cases of intraoperative ultrasound-assisted treatment of the disease have been reported in the literature. To present a case of idiopathic spontaneous intramedullary hemorrhage treated with intraoperative ultrasound and review the diagnosis and treatment of the disease.Case presentation: An 11-year-old child was admitted to our department because of a sudden severe pain on the left side of her back. Magnetic resonance images of the thoracic vertebrae showed abnormal signals in T2-T3 and spontaneous intramedullary hemorrhage was suspected. Intraoperative ultrasound-assisted evacuation of the intramedullary hematoma was performed and no abnormal blood vessels or malformations were found during intraoperative exploration.Conclusion: We report a rare case of idiopathic spontaneous intramedullary hemorrhage with intraoperative ultrasound-assisted hematoma clearance and a good prognosis.

Objective: To identify which the combination of diffusion tensor imaging (DTI) and neurophysiological monitoring (NM) is reliable in the quantitative and predictive evaluation of spinal cord function. Methods: Data acquisition was collected in 12 patients who underwent spinal cord tumor surgery in our hospital. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) data of the regions of interest (ROIs) on DTI images were obtained. Preoperative NM and intraoperative neurophysiological monitoring (IONM) were performed. Patients were followed up 2 weeks later. European myelopathy score (EMS score) was recorded pre- and post-operatively. Correlation analysis was conducted to evaluate spinal cord function.Results: The average value of ADC in the two ROIs before operation was higher than that in the area without spinal cord compression (P=0.026), while the average value of FA was the opposite (p=0.018). Preoperative FA value significantly decreased in the fiber-interrupted group and the moderate-to-severe-damage group (P<0.05). The preoperative FA value had more significant positive correlation with the postoperative EMS score (R=0.853, P=0), while the preoperative SEP amplitude had more significant positive correlation with the improvement rate (R=0.826, P=0.001). Conclusion: For spinal cord tumor patients, the combination of preoperative DTI and NM could quantify the postoperative spinal cord function and predict the prognosis more comprehensively. Preoperative FA value is more valuable to reflect the postoperative subjective symptom, while preoperative SEP amplitude is more meaningful to predict the improvement degree of disease.