Application of Keyhole Microneurosurgery in China

Chen, Ligang; Chen, Shuda; Huang, Guang-Fu; Huang, Ying; Kang, Dezhi; Lan, Qing; Li, Gang; Li, Xingang; Zhi-xiong, Liu; Qi, Songtao; Tian, Xin; Wang, Guoliang; Wang, Shuo; Wang, Xiangyu; Wang, Yongfei; You, Chao; Yanbing, Yu; Yue, Shuyuan; Zhang, Dong; Zhang, Jianmin; Zhang, Jianning; Zhang, Junting; Zhang, Shizhong; Xian, Zhang; Zhang, Yazhou; Zhao, Jizong; Zhao, Weiguo; Zhao, Yuanli; Zhou, Ding-biao; Zhou, Lei

doi:10.4103/0366-6999.211884

Cited by 6 publications

(4 citation statements)

References 31 publications

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“…In agreement with our findings, Sanada described 3 CT enhancement patterns based on an analysis of 11 cases of cHCC-CC: Type I (n=4), demonstrating hyperenhancement in the early phase followed by washout in the delayed phase; Type II (n=2), demonstrating continuous marginal enhancement, and peripheral enhancement in both the early and delayed phases; and Type III (n=4), demonstrating 2 distinctive enhancement patterns in the same tumor, one showing enhancement with washout in the delayed phase and the second showing delayed enhancement [14]. Chen analyzed 25 cases of cHCC-CC with multi-phase enhancement scanning, and identified 3 enhancement patterns: (1) overall heterogeneous enhancement of the tumor in the arterial phase, and continuous heterogeneous enhancement in the delayed phase (n=12); (2) overall uneven enhancement in the arterial phase, slow diffusion of the contrast agent and a low density or low signal in the delayed phase, with strip-like enhancements in some lesions (n=8); and (3) annular enhancement of the tumor with uneven thickness at the edges in the arterial phase, and annular or irregular enhancement on the delayed phase (n=5) [15]. One hepatobiliary stage tumor showed weak rim enhancement and patchy enhancement at the center, presenting as a “bull’s eye”.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Imaging and Clinically Relevant Features of Combined Hepatocellular Carcinoma and Cholangiocarcinoma with Hepatocellular Carcinoma

Huang

2019

Med Sci Monit

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BackgroundThe aim of this study was to compare the clinical, imaging, pathological, and prognostic characteristics of combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) and hepatocellular carcinoma (HCC).Material/MethodsMedical records of 21 patients with cHCC-CC and 21 patients with HCC were retrospectively reviewed. Patients underwent a computed tomography (CT) examination within 1 month before surgery and did not receive preoperative interventional therapy. Clinical, imaging, pathological, and prognostic characteristics of cHCC-CC and HCC were compared.ResultsOn multi-phase contrast-enhanced CT, cHCC-CC could be differentiated from HCC based on the presence of a pseudocapsule (p<0.0001; χ2=14.538) and extensive necrosis (p=0.009; χ2=8.400). The changes in the arterial phase and venous phase (V>A) and arterial phase and delayed phase (D>A) of CT enhanced scanning in HCC and cHCC-CC were statistically significant (both p<0.0001, χ2=28.560 and 25.846). Immunohistochemistry showed more HCC were positive for VEGF (P=0.012, χ2=7.785). A Kaplan-Meier survival analysis showed no statistically significant difference in progression-free survival (PFS) after treatment between patients with cHCC-CC and those with HCC (p=0.526).ConclusionsMulti-phase contrast-enhanced CT may be useful for preoperative diagnosis of cHCC-CC in tumors with a diffuse boundary, no pseudocapsule, extensive necrosis (>50%), and a dilated bile duct, and when the CT value in the delayed phase is higher than in the arterial phase. VEGF expression is more likely to be positive in HCC than cHCC-CC. There was no significant difference between cHCC-CC and HCC in prognosis, but cHCC-CC was more likely to recur after treatment than HCC.

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Section: Discussionmentioning

confidence: 99%

Comparison of Imaging and Clinically Relevant Features of Combined Hepatocellular Carcinoma and Cholangiocarcinoma with Hepatocellular Carcinoma

Huang

2019

Med Sci Monit

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“…It has been reported that the keyhole method is not limited, but rather a tailored adjustment method that minimizes brain exposure and retraction. Its advantages include minimal brain exposure, good cosmetic results, preservation of surrounding structures and short program time (Chen, Chen, & Huang, 2017). It also has some shortcomings: fewer opportunities to change plans, weaker microscopic illumination, and difficulty in controlling the proximal end of the paternal artery (Zhu, Mao, & Zhou, 2008).…”

Section: Discussionmentioning

confidence: 99%

Application of three dimensional (3D) curved multi‐planar reconstruction images in 3D printing mold assisted eyebrow arch keyhole microsurgery

Wang

Chen

et al. 2020

Brain and Behavior

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“…Supraorbital, subtemporal, medial suboccipital, paramedian suboccipital, retromastoid, temporal, occipital, parietal, pterional, longitudinal fissure, and combined temporo-parietal approaches were used. For each approach, a 4-cm straight incision was made for all patients for the keyhole approach [7]. The incision was hidden in the eyebrow or hairline when indicated.…”

Section: Operative Techniquementioning

confidence: 99%

Minimally invasive keyhole techniques for resection of giant intracranial tumors

2022

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Background While keyhole neurosurgery is increasingly utilized in the operating room, there are few reports regarding the use of keyhole techniques to resect giant intracranial tumors. The feasibility and technique of that were discussed in this paper. Methods We retrospectively reviewed 95 consecutive patients who were admitted to our service between February 2012 and September 2017 with a maximum intracranial tumor diameter >5 cm. Keyhole approaches were used to resect these tumors in each case, including supraorbital, subtemporal, suboccipital, retromastoid, frontal, temporal, occipital, parietal, pterional, a combined temporo-parietal keyhole approach, and an approach via the longitudinal fissure. Results We achieved gross total resection in 68/95 cases (71.6%) and subtotal resection in 27/95 cases (28.4%). No surgical death or severe disabilities such as coma and limb dyskinesia occurred following surgery. At the time of discharge, 8 patients had complications related to impaired cranial nerve function. In addition, 2 patients developed hydrocephalus requiring ventriculo-peritoneal shunt placement, and 4 patients developed a postoperative CSF leak requiring surgical intervention. Conclusion With meticulous design and reasonable selection, resection of giant intracranial tumors utilizing minimally invasive keyhole approaches can be done safely with satisfactory surgical outcomes.

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Application of Keyhole Microneurosurgery in China

Cited by 6 publications

References 31 publications

Comparison of Imaging and Clinically Relevant Features of Combined Hepatocellular Carcinoma and Cholangiocarcinoma with Hepatocellular Carcinoma

Comparison of Imaging and Clinically Relevant Features of Combined Hepatocellular Carcinoma and Cholangiocarcinoma with Hepatocellular Carcinoma

Application of three dimensional (3D) curved multi‐planar reconstruction images in 3D printing mold assisted eyebrow arch keyhole microsurgery

Minimally invasive keyhole techniques for resection of giant intracranial tumors

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