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Wu CT, Yang YH, Chang YZ. Creating high-resolution 3D cranial implant geometry using deep learning techniques. Front Bioeng Biotechnol 2023; 11:1297933. [PMID: 38149174 PMCID: PMC10750412 DOI: 10.3389/fbioe.2023.1297933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/22/2023] [Indexed: 12/28/2023] Open
Abstract
Creating a personalized implant for cranioplasty can be costly and aesthetically challenging, particularly for comminuted fractures that affect a wide area. Despite significant advances in deep learning techniques for 2D image completion, generating a 3D shape inpainting remains challenging due to the higher dimensionality and computational demands for 3D skull models. Here, we present a practical deep-learning approach to generate implant geometry from defective 3D skull models created from CT scans. Our proposed 3D reconstruction system comprises two neural networks that produce high-quality implant models suitable for clinical use while reducing training time. The first network repairs low-resolution defective models, while the second network enhances the volumetric resolution of the repaired model. We have tested our method in simulations and real-life surgical practices, producing implants that fit naturally and precisely match defect boundaries, particularly for skull defects above the Frankfort horizontal plane.
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Affiliation(s)
- Chieh-Tsai Wu
- Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | | | - Yau-Zen Chang
- Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan
- Department of Mechanical Engineering, Ming Chi University of Technology, New Taipei City, Taiwan
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Siu WHS, Wang CJ, Wu CT, Wu CY, Ou LS. C1-C2 subluxation in enthesitis-related arthritis: two case reports and literature review of ten cases. Pediatr Rheumatol Online J 2023; 21:77. [PMID: 37537687 PMCID: PMC10401742 DOI: 10.1186/s12969-023-00862-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND C1-C2 subluxation is a rare complication of enthesitis-related arthritis (ERA). If left untreated, it may lead to functional impairment or cervical spinal cord compression. This study aims to highlight key points regarding the management of C1-C2 subluxation in ERA. CASE PRESENTATION We present two cases of C1-C2 subluxation: an 8-year-old boy with ERA and 16-year-old boy with ERA with bilateral sacroiliitis. Ten cases of ERA in the literature were reviewed. The diagnosis of C1-C2 subluxation is mostly based on radiographs and cervical spine computed tomography. All patients were treated with non-steroidal anti-inflammatory drugs. Six ERA patients were treated surgically for cervical fusion. Most ERA patients with sacroiliitis had cervical collar protection. Neurologic abnormalities after treatment were not reported. Despite the use of cervical collar, cervical fusion and persisting ankylosis were found in two ERA patients with sacroiliitis without surgical treatment. CONCLUSIONS Cervical spine protection and ruling out spinal cord compression should be prioritized, in addition to controlling the underlying inflammation in ERA. Cervical halter traction may be applied after severe cervical inflammation is excluded. To reduce the risk of complications, early recognition and appropriate treatments of C1-C2 subluxation in ERA are essential.
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Affiliation(s)
- Wing Hin Stanford Siu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Medical Education, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chao-Jan Wang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chieh-Tsai Wu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chao-Yi Wu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kweishan, Taoyuan City, Taiwan
| | - Liang-Shiou Ou
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kweishan, Taoyuan City, Taiwan.
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Wang YC, Cheng MY, Hung PC, Kuo CY, Hsieh HY, Lin KL, Tu PH, Wu CT, Hsu PW, Wei KC, Chuang CC. Robot-Assisted Radiofrequency Ablation Combined with Thermodynamic Simulation for Epilepsy Reoperations. J Clin Med 2022; 11:jcm11164804. [PMID: 36013044 PMCID: PMC9409811 DOI: 10.3390/jcm11164804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022] Open
Abstract
Repeat craniotomies to treat recurrent seizures may be difficult, and minimally invasive radiofrequency ablation is an alternative therapy. On the basis of this procedure, we aimed to develop a more reliable methodology which is helpful for institutions where real-time image monitoring or electrophysiologic guidance during ablation are not available. We used simulation combined with a robot-assisted radiofrequency ablation (S-RARFA) protocol to plan and execute brain epileptic tissue lesioning. Trajectories of electrodes were planned on the robot system, and time-dependent thermodynamics was simulated with radiofrequency parameters. Thermal gradient and margin were displayed on a computer to calculate ablation volume with a mathematic equation. Actual volume was measured on images after the ablation. This small series included one pediatric and two adult patients. The remnant hippocampus, corpus callosum, and irritative zone around arteriovenous malformation nidus were all treated with S-RARFA. The mean error percentage of the volume ablated between preoperative simulation and postoperative measurement was 2.4 ± 0.7%. No complications or newly developed neurologic deficits presented postoperatively, and the patients had little postoperative pain and short hospital stays. In this pilot study, we preliminarily verified the feasibility and safety of this novel protocol. As an alternative to traditional surgeries or real-time monitoring, S-RARFA served as successful seizure reoperation with high accuracy, minimal collateral damage, and good seizure control.
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Affiliation(s)
- Yu-Chi Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Mei-Yun Cheng
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Neurology, Change Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
| | - Po-Cheng Hung
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Pediatric Neurology, Chang Gung Children’s Hospital, Taoyuan 333, Taiwan
| | - Cheng-Yen Kuo
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Pediatrics, Chang Gung Children’s Hospital, Taoyuan 333, Taiwan
| | - Hsiang-Yao Hsieh
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Neurology, Change Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
| | - Kuang-Lin Lin
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Pediatric Neurology, Chang Gung Children’s Hospital, Taoyuan 333, Taiwan
| | - Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Peng-Wei Hsu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Kuo-Chen Wei
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Neurosurgery, New Taipei Municipal Tu Cheng Hospital, Chang Gung Medical Foundation, Taipei 236, Taiwan
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: ; Tel.: +886-3-328-1200 (ext. 2412)
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Tsao CK, Liao KH, Hsiao HY, Liu YH, Wu CT, Cheng MH, Zhong WB. Tracheal reconstruction with pedicled tandem grafts engineered by a radial stretch bioreactor. J Biomater Appl 2022; 37:118-131. [PMID: 35412872 DOI: 10.1177/08853282221082357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The engineering of tracheal substitutes is pivotal in improving tracheal reconstruction. In this study, we aimed to investigate the effects of biomechanical stimulation on tissue engineering tracheal cartilage by mimicking the trachea motion through a novel radial stretching bioreactor, which enables to dynamically change the diameter of the hollow cylindrical implants. Applying our bioreactor, we demonstrated that chondrocytes seeded on the surface of Poly (ε-caprolactone) scaffold respond to mechanical stimulation by improvement of infiltration into implants and upregulation of cartilage-specific genes. Further, the mechanical stimulation enhanced the accumulation of cartilage neo-tissues and cartilage-specific extracellular macromolecules in the muscle flap-remodeled implants and reconstructed trachea. Nevertheless, the invasion of fibrous tissues in the reconstructed trachea was suppressed upon mechanical loading.
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Affiliation(s)
- Chung-Kan Tsao
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, 38014Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Kuan-Hao Liao
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, 38014Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Hui-Yi Hsiao
- Center for Tissue Engineering, 38014Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Yun-Hen Liu
- Division of Thoracic Surgery, 38014Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Chieh-Tsai Wu
- Division of Pediatric Neurosurgery, Chang Gung Children's Hospital, 38014Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Ming-Huei Cheng
- Center of Lymphedema Microsurgery, Department of Plastic and Reconstructive Surgery, 38014Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Wen-Bin Zhong
- Center for Tissue Engineering, 38014Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan.,Center for Biomedical Engineering, College of Engineering, 38014Chang Gung University, Taoyuan, Taiwan
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Abstract
We present a 3D deep learning framework that can generate a complete cranial model using a defective one. The Boolean subtraction between these two models generates the geometry of the implant required for surgical reconstruction. There is little or no need for post-processing to eliminate noise in the implant model generated by the proposed approach. The framework can be used to meet the repair needs of cranial imperfections caused by trauma, congenital defects, plastic surgery, or tumor resection. Traditional implant design methods for skull reconstruction rely on the mirror operation. However, these approaches have great limitations when the defect crosses the plane of symmetry or the patient's skull is asymmetrical. The proposed deep learning framework is based on an enhanced three-dimensional autoencoder. Each training sample for the framework is a pair consisting of a cranial model converted from CT images and a corresponding model with simulated defects on it. Our approach can learn the spatial distribution of the upper part of normal cranial bones and use flawed cranial data to predict its complete geometry. Empirical research on simulated defects and actual clinical applications shows that our framework can meet most of the requirements of cranioplasty.
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Affiliation(s)
- Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan
| | - Yao-Hung Yang
- Department of Mechanical Engineering, Chang Gung University, Taoyuan, 33302, Taiwan
| | - Yau-Zen Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan. .,Department of Mechanical Engineering, Chang Gung University, Taoyuan, 33302, Taiwan.
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Huang CJ, Yen CI, Chang CS, Wu CT, Chen HC, Hsiao YC. Transferring three-dimensional mirror image into two-dimensional template for nasal reconstruction. J Plast Reconstr Aesthet Surg 2021; 75:893-939. [PMID: 34866007 DOI: 10.1016/j.bjps.2021.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/06/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Chih-Jung Huang
- Department of Plastic and Reconstruction Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-I Yen
- Department of Plastic and Reconstruction Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Shin Chang
- Department of Plastic and Reconstruction Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan Taiwan, Chief of Augmented Reality Research and Development Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hung-Chang Chen
- Department of Plastic and Reconstruction Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Chang Hsiao
- Department of Plastic and Reconstruction Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Yeap MC, Chen CC, Chen CT, Liu ZH, Wu CT, Hsieh PC, Lai HY, Wang YC, Chang TW, Lee CC, Liu YT, Huang YC, Wei KC, Tu PH. Predictive Value of Swab Cultures for Cryopreserved Flaps During Delayed Cranioplasties. World Neurosurg 2021; 157:e173-e178. [PMID: 34610447 DOI: 10.1016/j.wneu.2021.09.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the predictive value of swab cultures of cryopreserved skull flaps during cranioplasties for surgical site infections (SSIs). METHODS A retrospective review was conducted of consecutive patients who underwent delayed cranioplasties with cryopreserved autografts between 2009 and 2017. The results of cultures obtained from swabs and infected surgical sites were assessed. The accuracy, sensitivity, and specificity of swab cultures for SSIs were evaluated. RESULTS The study included 422 patients categorized into two groups, swab and nonswab, depending on whether swab cultures were implemented during cranioplasties. The overall infection rate was 7.58%. No difference was seen in infection rates between groups. There were 18 false-positive and no true-positive swab culture results. All bacteria between swab cultures and SSI cultures were discordant. Meanwhile, there were 19 false-negative swab cultures. The results showed high specificity but low sensitivity for swab cultures to predict SSI occurrence and the pathogens. CONCLUSIONS Owing to low accuracy and sensitivity, swab cultures of cryopreserved autografts should not be routinely performed during delayed cranioplasties.
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Affiliation(s)
- Mun-Chun Yeap
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Ching-Chang Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Chun-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Zhuo-Hao Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Po-Chuan Hsieh
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Hong-Yi Lai
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Chi Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Ting-Wei Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Cheng-Chi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Tse Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yin-Cheng Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Kuo-Chen Wei
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
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Yeh YC, Lin YJ, Yeh CH, Hsieh PS, Wu CT. Anterior sacral meningocele repair assisted by intraoperative intrathecal fluorescence and 3D printing model: illustrative case. Journal of Neurosurgery: Case Lessons 2021; 1:CASE20159. [PMID: 35855020 PMCID: PMC9245847 DOI: 10.3171/case20159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Marfan syndrome is rarely accompanied by anterior sacral meningocele (ASM) resulting from erosion of the sacrum by dural ectasia. ASM may induce symptoms due to severe mass effects. ASM may also mimic ovarian cysts, and the risk of cerebrospinal fluid (CSF) leakage is high if spontaneous rupture of the cyst occurs. In this study, the authors presented a rare case of ASM with iatrogenic CSF leakage in a 34-year-old woman with suspected Marfan syndrome. OBSERVATIONS The patient initially presented with a giant ASM that was first misdiagnosed as an ovarian cyst. Previously, it had been partially resected, which was followed by iatrogenic CSF leakage. Symptoms of intracranial hypotension, including postural headache and dizziness, developed within 1 month. Brain magnetic resonance imaging (MRI) showed pituitary enlargement, bilateral subdural effusion, and tonsillar herniation. Preoperative computed tomography myelography provided three-dimensional (3D) examination of the deformed sacrum and CSF leakage site. Transabdominal approaches led to primary repair, and repair of the meningocele was achieved by intraoperative fluorescein fluorescence and 3D printed model–guided polymethyl methacrylate bone cement reconstruction. No CSF leakage or recurrent ASM was found at the 1.5-year follow-up visit. LESSONS Intraoperative intrathecal fluorescence and 3D-printed models are useful for ASM repair. Preoperative MRI is helpful for differentiating ASM from other causes of a huge pelvic mass, including ovarian cyst.
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Affiliation(s)
- Yu-Chaing Yeh
- Department of Neurosurgery, Chang-Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Ya-Jui Lin
- Department of Neurosurgery, Chang-Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan
- The Graduate Institute of Biomedical Sciences and
| | - Chih-Hua Yeh
- Department of Neuroradiology and
- Department of Neuroradiology and
| | - Pao-Shiu Hsieh
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Guishan Township, Taoyuan City, Taiwan
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang-Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan
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Wu CT, Lu TC, Chan CS, Lin TC. Corrigendum to 'Patient-Specific Three-Dimensional Printing Guide for Single-Stage Skull Bone Tumor Surgery: Novel Software Workflow with Manufacturing of Prefabricated Jigs for Bone Resection and Reconstruction' [World Neurosurgery 147 (2021) e416-e427]. World Neurosurg 2021; 150:264. [PMID: 33888432 DOI: 10.1016/j.wneu.2021.03.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Chieh-Tsai Wu
- Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Ting-Chen Lu
- Department of Plastic and Reconstructive Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Sheng Chan
- Medical Augmented Reality Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzu-Chin Lin
- Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Chang HY, Chiu CF, Jung SM, Wong AMC, Wu CT, Lo FS. Neurological and endocrinological manifestations of 49 children with intracranial pure germinoma at initial diagnosis in Taiwan. Pediatr Neonatol 2021; 62:106-112. [PMID: 33218934 DOI: 10.1016/j.pedneo.2020.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Intracranial pure germinoma is a rare extragonadal neoplasm. Affected patients may have motor impairment, visual disturbance, neurological signs, and endocrine disorder, depending on the size and location of the tumor. This study investigated and analyzed patients' demographic data and neuroimaging, clinical, laboratory, and endocrinological findings. METHODS We performed a retrospective chart review of 49 children diagnosed with pure germinoma in Taiwan from 1990 to 2018. The initial clinical presentation, tumor markers (beta-hCG, alpha fetoprotein, and carcinoembryonic antigen), pituitary function, and brain images were reviewed and analyzed. RESULTS This study included 49 patients (37 boys and 12 girls). Their ages ranged from 7.5 to 17.9 years, and the mean age at diagnosis was 13.6 years. Initial symptoms included visual disturbance (n = 23, 47.9%), motor impairment (n = 20, 40.8%), polyuria (n = 20, 40.8%), headache (n = 17, 34.7%), dizziness or vertigo (n = 14, 28.6%), nausea/vomiting (n = 13, 26.5%), and short stature (n = 8, 18.2%). Laboratory data indicated growth hormone deficiency or low IGF-1 levels (n = 18, 85.7%), adrenal insufficiency (n = 21, 77.8%), central diabetes insipidus (n = 27, 55.1%), central hypothyroidism (n = 15, 48.4%), and hypogonadotropic hypogonadism (n = 4, 44.4%). CONCLUSION Intracranial pure germinomas may initially manifest as neurological symptoms or endocrinological findings at diagnosis. As endocrinologic presentation is related to delayed diagnosis, clinicians should be aware of patients with such complaints. Laboratory data should be surveyed carefully, and neuroimaging must be considered if the result is abnormal.
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Affiliation(s)
- Hsin-Yuan Chang
- Division of Pediatric Endocrinology and Genetics, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
| | - Chiao-Fan Chiu
- Division of Pediatric Endocrinology and Genetics, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
| | - Shih-Ming Jung
- Department of Pathology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Alex Mun-Ching Wong
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung/Linkou, and Chang Gung University, Taiwan
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Fu-Sung Lo
- Division of Pediatric Endocrinology and Genetics, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
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Wu CT, Lu TC, Chan CS, Lin TC. Patient-Specific Three-Dimensional Printing Guide for Single-Stage Skull Bone Tumor Surgery: Novel Software Workflow with Manufacturing of Prefabricated Jigs for Bone Resection and Reconstruction. World Neurosurg 2020; 147:e416-e427. [PMID: 33359737 DOI: 10.1016/j.wneu.2020.12.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe a novel system workflow to design and manufacture patient-specific three-dimensional (3D) printing jigs for single-stage skull bone tumor excision and reconstruction and to present surgical outcomes of 14 patients. METHODS A specific computer-aided design/computer-aided manufacturing software and hardware system was set up, including a virtual surgical planning subsystem and a 3D printing-associated manufacturing subsystem. Computed tomography data of the patient's skull were used for 3D rendering of the skull and tumor. The output of patient-specific designing included a 3D printing guide for tumor resection and a 3D printing model of the bone defect after tumor excision. A polymethyl methacrylate implant was fabricated preoperatively and used for repair. RESULTS The specific 3D printing guide was used to design intraoperative jigs and implants for 14 patients (age range, 1-72 years) with skull bone tumors. In all cases, the cutting jig allowed precise excision of tumor and bone, and implants were exact fits for the defects created. All operative results were successful, without intraoperative or postoperative complications. Postoperative computed tomography scans were obtained for analysis. Postoperative 3D measurement of the skull symmetry index (cranial vault asymmetry index) showed significant improvement of head contour after surgery. CONCLUSIONS The computer-aided design/computer-aided manufacturing system described allows definitive preoperative planning and fabrication for treatment of skull bone tumors. Apparent benefits of the method include more accurate determination of surgical margins and better oncological outcomes.
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Affiliation(s)
- Chieh-Tsai Wu
- Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Ting-Chen Lu
- Department of Plastic and Reconstructive Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Sheng Chan
- Medical Augmented Reality Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzu-Chin Lin
- Department of Neurosurgery, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Hung PC, Chou IJ, Wu CT, Wong HF. Anterior chest pain as an unusual initial presentation in pediatric spinal arteriovenous malformations. Pediatr Neonatol 2020; 61:551-553. [PMID: 32586749 DOI: 10.1016/j.pedneo.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/25/2020] [Accepted: 05/19/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | | | - Ho-Fai Wong
- Division of Radiology, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
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Hu CY, Wu CT, Chen CC, Fu CH. Bicoronal Incision and Frontal-Basal Approach for Removal of Sinonasal Fibrous Dysplasia Complicated by Orbital Subperiosteal Abscess. World Neurosurg 2020; 143:389-391. [PMID: 32745647 DOI: 10.1016/j.wneu.2020.07.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/24/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Fibrous dysplasia (FD) is a benign, slowly progressive disease resulting from the replacement of normal bone by fibro-osseous tissue. The incidence of craniofacial involvement of FD is as high as 23%. Sinonasal involvement of FD may lead to obstruction of the natural sinus ostium, resulting in acute sinusitis. We present a rare case of sinonasal FD complicated by subperiosteal abscess that was removed by bicoronal incision and frontal-basal approach in the second surgery. CASE DESCRIPTION A 16-year-old male patient presented with painful swelling on his left eye that had persisted for 2 days. Transnasal endoscopic drainage of the left orbital subperiosteal abscess was performed and progressive improvement of the swelling of the left eye was noted. After the acute phase, transcranial removal of the sinonasal bony lesion and mesh reconstruction of the left orbital wall were performed. There has been no progression of FD to date, with 24 months of follow-up. CONCLUSIONS After the acute phase, radical excision with reconstruction or debulking surgery after skeletal maturation may prevent recurrence. Although malignant transformation is rare, long-term follow-up is necessary for FD.
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Affiliation(s)
- Chih-Yu Hu
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Medical Augmented Reality Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Chien-Cheng Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia-Hsiang Fu
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Yeap MC, Chen CC, Liu ZH, Hsieh PC, Lee CC, Liu YT, Yi-Chou Wang A, Huang YC, Wei KC, Wu CT, Tu PH. Postcranioplasty seizures following decompressive craniectomy and seizure prophylaxis: a retrospective analysis at a single institution. J Neurosurg 2019; 131:936-940. [PMID: 30239312 DOI: 10.3171/2018.4.jns172519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 04/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cranioplasty is a relatively simple and less invasive intervention, but it is associated with a high incidence of postoperative seizures. The incidence of, and the risk factors for, such seizures and the effect of prophylactic antiepileptic drugs (AEDs) have not been well studied. The authors' aim was to evaluate the risk factors that predispose patients to postcranioplasty seizures and to examine the role of seizure prophylaxis in cranioplasty. METHODS The records of patients who had undergone cranioplasty at the authors' medical center between 2009 and 2014 with at last 2 years of follow-up were retrospectively reviewed. Demographic and clinical characteristics, the occurrence of postoperative seizures, and postoperative complications were analyzed. RESULTS Among the 583 patients eligible for inclusion in the study, 247 had preexisting seizures or used AEDs before the cranioplasty and 336 had no seizures prior to cranioplasty. Of these 336 patients, 89 (26.5%) had new-onset seizures following cranioplasty. Prophylactic AEDs were administered to 56 patients for 1 week after cranioplasty. No early seizures occurred in these patients, and this finding was statistically significant (p = 0.012). Liver cirrhosis, intraoperative blood loss, and shunt-dependent hydrocephalus were risk factors for postcranioplasty seizures in the multivariable analysis. CONCLUSIONS Cranioplasty is associated with a high incidence of postoperative seizures. The prophylactic use of AEDs can reduce the occurrence of early seizures.
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Hung PC, Chang YC, Hsieh MY, Wu CT. Primary intracranial meningeal melanoma mimicking chronic meningitis: A case report. Pediatr Neonatol 2019; 60:589-591. [PMID: 30497968 DOI: 10.1016/j.pedneo.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 09/15/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Po-Cheng Hung
- Division of Pediatric Neurology, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
| | - Yu-Ching Chang
- Division of Pediatric Neurology, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Meng-Ying Hsieh
- Division of Pediatric Neurology, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chieh-Tsai Wu
- Division of Pediatric Neurosurgery, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
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16
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Elia J, Hassidim A, Billig A, Chapchay K, Wu CT, Hung SY, Cheong DCF, Tsao CK. Objective and quantifiable measuring mechanism for assessing flap pliability: Our experience with 92 patients. Head Neck 2019; 41:3348-3355. [PMID: 31283090 DOI: 10.1002/hed.25851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 04/19/2019] [Accepted: 06/14/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Pliability describes a flaps' ability to bend under spatial limitations, yet a quantifiable measurement for this flexibility does not exist. METHODS Between January 2015 and January 2017, we applied a novel measuring mechanism to two free flaps for head and neck reconstruction. We allocated a flap pliability score (FPS) to these flaps and observed correlations to common variables. RESULTS Forty profunda artery perforator (PAP) and 52 anterolateral thigh (ALT) flaps were allotted a score depending on how pliable they performed on our test. Proximal PAP and distal ALT were more pliable than their respective opposite ends. Other interesting conclusions regarding these flaps were also made. CONCLUSIONS With our technique, pliability of the proximal and distal ends of PAP and ALT flaps was ascertained. Herein, we describe an innovative measuring mechanism via which we can allocate a FPS to any flap and thus obtain information regarding how suitable they are for a given recipient site.
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Affiliation(s)
- Jhonatan Elia
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
| | - Ayal Hassidim
- Department of Plastic and Reconstructive Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Allan Billig
- Department of Plastic and Reconstructive Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Katya Chapchay
- Department of Plastic and Reconstructive Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Yu Hung
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
| | - David Chon-Fok Cheong
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
| | - Chung-Kan Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Deng WC, Yan JL, Chuang CC, Wei KC, Chang CN, Wu CT, Chen HC, Wang CC, Tseng CK, Hsu PW. Adjuvant Radiation Therapy Compared with Observation Alone for Postoperative Residual Nonfunctional Pituitary Adenomas. World Neurosurg 2019; 128:e1024-e1033. [PMID: 31103758 DOI: 10.1016/j.wneu.2019.05.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The management of residual nonfunctional pituitary tumors after surgical resection remains controversial. In this study, we compared the prognosis of postoperative radiation therapy and observation only in patients with residual nonfunctional pituitary adenoma and reviewed the long-term complications after radiation therapy. METHODS We retrospectively analyzed 90 patients who underwent surgery for nonfunctional pituitary adenomas from January 2008 to April 2012. Residual tumors were classified by size, location, and pathologic staining. Tumor progression was defined as volume progression ≥15% with or without clinical symptoms. Postoperative radiation therapy was performed <1 year after the last surgery. We compared the progression and 3-year and 5-year progression-free survival between the observation group and postoperative radiation therapy group. Postradiation complications including hypopituitarism, diabetes insipidus, deterioration in visual field or acuity, cranial nerve palsy, and hydrocephalus were also analyzed. RESULTS More of the patients who received postoperative radiation therapy had a tumor progression-free survival of ≥3 years than did those who did not receive postoperative radiation therapy. Postoperative radiation therapy was significantly beneficial for the patients with a tumor size ≥3 cm or with tumors in the cavernous sinus. The most frequent complication after radiation therapy was hypopituitarism and a few cases had third cranial nerve palsy; however, there were no significant relationships with radiation therapy. CONCLUSIONS In this study, immediate radiation therapy after tumor resection was an effective and relatively safe treatment for residual or progressive nonfunctional pituitary adenomas. Moreover, the long-term complications of radiation therapy were mild.
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Affiliation(s)
- Wen-Chun Deng
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Jun-Lin Yan
- Department of Neurosurgery, Keelung Chang Gung Memorial Hospital at Keelung, Chang Gung University, Keelung, Taiwan, Republic of China
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Kuo-Chen Wei
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Chen-Nen Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Hsien-Chih Chen
- Department of Neurosurgery, Keelung Chang Gung Memorial Hospital at Keelung, Chang Gung University, Keelung, Taiwan, Republic of China
| | - Chun-Chieh Wang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Chen-Kan Tseng
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Peng-Wei Hsu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan City, Taiwan, Republic of China.
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Lin TC, Chang TW, Wu YM, Chen CC, Chen CT, Erich Wu TW, Wu CT, Hsieh PC. De Novo Formation of Pial Arteriovenous Fistulas: Systematic Review of Acquired Lesions and Their Clinical Differences Compared with Primary Lesions. World Neurosurg 2019; 128:e276-e282. [PMID: 31026655 DOI: 10.1016/j.wneu.2019.04.135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Acquired pial arteriovenous fistula (pAVF) is an extremely rare intracranial vascular malformation, with few case reports in the English literature. This study presents a thorough review and analysis of all acquired pAVF cases from the literature in addition to an illustrated case. METHODS We report a case with de novo development of intracranial pAVF after craniotomy. A medical literature database search between 1975 and 2018, including the Medline, Ovid, and PubMed databases, was performed to identify all reports with possible acquired lesions. Differences between these acquired lesions and previously reported primary lesions were evaluated. RESULTS A total of 8 patients with de novo formation of acquired pAVF were included in this series. Most of these pAVFs were fed and drained via a similar arteriovenous pattern, from distal/cortical branches of the middle cerebral artery (6/8, 75%) to the superficial middle cerebral vein (6/8, 75%). Compared with a previously reported primary pAVF series, acquired pAVF tended to be asymptomatic (P < 0.0001) and found essentially in adults (P = 0.0061). Fewer venous varices (P = 0.0049) and associated intracranial mass effect (P = 0.0189) were found in the cases of acquired pAVF. All 4 reported acquired pAVFs that were treated microsurgically resulted in complete angiographic obliteration (4/4, 100%). The overall outcome was good or stable even with observation only (7/8, 87.5%). CONCLUSIONS Acquired pAVF is highly correlated with sentinel neurosurgical procedures or venous occlusion events. These lesions should be regarded as a different disease entity from primary pAVF because of the relatively low-flow shunting and benign clinical course.
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Affiliation(s)
- Tzu-Chin Lin
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Linkou, Taiwan
| | - Ting-Wei Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Linkou, Taiwan
| | - Yi-Ming Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Linkou, Taiwan
| | - Ching-Chang Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Linkou, Taiwan
| | - Chun-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Linkou, Taiwan
| | - Tai-Wei Erich Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Linkou, Taiwan
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Linkou, Taiwan
| | - Po-Chuan Hsieh
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Linkou, Taiwan.
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19
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Chen CC, Yeap MC, Liu ZH, Hsieh PC, Chen CT, Liu YT, Lee CY, Lai HY, Wu CT, Tu PH. A Novel Protocol to Reduce Early Seizures After Cranioplasty: A Single-Center Experience. World Neurosurg 2019; 125:e282-e288. [PMID: 30685374 DOI: 10.1016/j.wneu.2019.01.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cranioplasty is a relatively simple and straightforward intervention; however, it is associated with a high incidence of postoperative seizures. Postcranioplasty seizures, especially early seizures, are common and associated with poor outcomes and longer hospital stays. Protocols for preventing and managing early seizures have not been well established. METHODS The medical records of 595 patients who underwent cranioplasty were retrospectively reviewed. Of these patients, 259 had preexisting seizures and 336 had no seizures before cranioplasty. Prophylactic antiepileptic drugs (AEDs) were administered to patients who had no seizures before cranioplasty for 1 week, whereas an advanced AED regimen was administered to patients with preexisting seizures. Subsequently, clinical characteristics, occurrence of recurrent seizures, early seizures, and postoperative complications were analyzed. RESULTS Our previous study showed positive results for prophylaxis in new-onset early seizures. In the patients with preexisting seizures, 46.7% of the patients (121/259) experienced recurrent seizures after cranioplasty and 17.4% of the patients (45/259) experienced early recurrent seizures within 1 week of their operation. In the group who received the advanced AEDs, early recurrent seizures were significantly reduced to 8.7% compared with the regular group (20.5%; P = 0.027). Younger age and preoperative hydrocephalus engendered a higher risk of recurrent seizures. The number of previous craniotomies was observed to have a trend of increasing early recurrent seizures. CONCLUSIONS Cranioplasty is associated with a high incidence of postoperative seizures. Our management protocol for postcranioplasty seizures includes seizure prophylaxis and advanced use of AEDs, which can reduce the occurrence of early seizures.
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Affiliation(s)
- Ching-Chang Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College &University, Taoyuan City, Taiwan
| | - Mun-Chun Yeap
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College &University, Taoyuan City, Taiwan
| | - Zhuo-Hao Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College &University, Taoyuan City, Taiwan
| | - Po-Chuan Hsieh
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College &University, Taoyuan City, Taiwan
| | - Chun-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College &University, Taoyuan City, Taiwan
| | - Yu-Tse Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College &University, Taoyuan City, Taiwan
| | - Ching-Yi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College &University, Taoyuan City, Taiwan
| | - Hong-Yi Lai
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College &University, Taoyuan City, Taiwan
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College &University, Taoyuan City, Taiwan
| | - Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College &University, Taoyuan City, Taiwan.
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20
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Hsu PW, Ong TC, Lin PY, Wu CT, Siow TY, Chuang CC, Chang CN, Chen HC, Liu ZH, Lu YJ, Tsai HC. Linear accelerator-based radiosurgery in treating indirect carotid cavernous fistulas. Formos J Surg 2019. [DOI: 10.4103/fjs.fjs_43_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Wu ML, Chien JC, Wu CT, Lee JD. An Augmented Reality System Using Improved-Iterative Closest Point Algorithm for On-Patient Medical Image Visualization. Sensors (Basel) 2018; 18:E2505. [PMID: 30071645 PMCID: PMC6111829 DOI: 10.3390/s18082505] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 12/02/2022]
Abstract
In many surgery assistance systems, cumbersome equipment or complicated algorithms are often introduced to build the whole system. To build a system without cumbersome equipment or complicated algorithms, and to provide physicians the ability to observe the location of the lesion in the course of surgery, an augmented reality approach using an improved alignment method to image-guided surgery (IGS) is proposed. The system uses RGB-Depth sensor in conjunction with the Point Cloud Library (PCL) to build and establish the patient's head surface information, and, through the use of the improved alignment algorithm proposed in this study, the preoperative medical imaging information obtained can be placed in the same world-coordinates system as the patient's head surface information. The traditional alignment method, Iterative Closest Point (ICP), has the disadvantage that an ill-chosen starting position will result only in a locally optimal solution. The proposed improved para-alignment algorithm, named improved-ICP (I-ICP), uses a stochastic perturbation technique to escape from locally optimal solutions and reach the globally optimal solution. After the alignment, the results will be merged and displayed using Microsoft's HoloLens Head-Mounted Display (HMD), and allows the surgeon to view the patient's head at the same time as the patient's medical images. In this study, experiments were performed using spatial reference points with known positions. The experimental results show that the proposed improved alignment algorithm has errors bounded within 3 mm, which is highly accurate.
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Affiliation(s)
- Ming-Long Wu
- Department of Electrical Engineering, Chang Gung University, Taoyuan 333, Taiwan.
| | - Jong-Chih Chien
- Degree Program of Digital Space and Product Design, Kainan University, Taoyuan 333, Taiwan.
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital, LinKou, Taoyuan 333, Taiwan.
| | - Jiann-Der Lee
- Department of Electrical Engineering, Chang Gung University, Taoyuan 333, Taiwan.
- Department of Neurosurgery, Chang Gung Memorial Hospital, LinKou, Taoyuan 333, Taiwan.
- Department of Electrical Engineering, Ming Chi University of Technology, New Taipei City 24301, Taiwan.
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22
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Wu CN, Tseng CC, Fanchiang YT, Cheng CK, Lin KY, Yeh SL, Yang SR, Wu CT, Liu T, Wu M, Hong M, Kwo J. High-quality thulium iron garnet films with tunable perpendicular magnetic anisotropy by off-axis sputtering - correlation between magnetic properties and film strain. Sci Rep 2018; 8:11087. [PMID: 30038363 PMCID: PMC6056423 DOI: 10.1038/s41598-018-29493-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 07/05/2018] [Indexed: 11/13/2022] Open
Abstract
Thulium iron garnet (TmIG) films with perpendicular magnetic anisotropy (PMA) were grown on gadolinium gallium garnet (GGG) (111) substrates by off-axis sputtering. High-resolution synchrotron radiation X-ray diffraction studies and spherical aberration-corrected scanning transmission electron microscope (Cs-corrected STEM) images showed the excellent crystallinity of the films and their sharp interface with GGG. Damping constant of TmIG thin film was determined to be 0.0133 by frequency-dependent ferromagnetic resonance (FMR) measurements. The saturation magnetization (Ms) and the coercive field (Hc) were obtained systematically as a function of the longitudinal distance (L) between the sputtering target and the substrate. A 170% enhancement of PMA field (H⊥) was achieved by tuning the film composition to increase the tensile strain. Moreover, current-induced magnetization switching on a Pt/TmIG structure was demonstrated with an ultra-low critical current density (jc) of 2.5 × 106 A/cm2, an order of magnitude smaller than the previously reported value. We were able to tune Ms, Hc and H⊥ to obtain an ultra-low jc of switching the magnetization, showing the great potential of sputtered TmIG films for spintronics.
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Grants
- 105-2112-M-007-014-MY3 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2112-M-002-010 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2622-8-002-001 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 105-2112-M-007-014-MY3 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2112-M-002-010 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2622-8-002-001 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 105-2112-M-007-014-MY3 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2112-M-002-010 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2622-8-002-001 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 105-2112-M-007-014-MY3 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2112-M-002-010 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2622-8-002-001 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 105-2112-M-007-014-MY3 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2112-M-002-010 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2622-8-002-001 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 105-2112-M-007-014-MY3 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2112-M-002-010 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2622-8-002-001 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 105-2112-M-007-014-MY3 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2112-M-002-010 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2622-8-002-001 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 105-2112-M-007-014-MY3 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2112-M-002-010 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2622-8-002-001 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 105-2112-M-007-014-MY3 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2112-M-002-010 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2622-8-002-001 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 105-2112-M-007-014-MY3 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2112-M-002-010 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2622-8-002-001 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 105-2112-M-007-014-MY3 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2112-M-002-010 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2622-8-002-001 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 105-2112-M-007-014-MY3 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2112-M-002-010 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
- 106-2622-8-002-001 Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan)
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Affiliation(s)
- C N Wu
- Department of Physics, National Tsing Hua University, Hsinchu, 30013, Taiwan
| | - C C Tseng
- Department of Physics, National Tsing Hua University, Hsinchu, 30013, Taiwan
| | - Y T Fanchiang
- Graduate Institute of Applied Physics and Department of Physics, National Taiwan University, Taipei, 10617, Taiwan
| | - C K Cheng
- Graduate Institute of Applied Physics and Department of Physics, National Taiwan University, Taipei, 10617, Taiwan
| | - K Y Lin
- Graduate Institute of Applied Physics and Department of Physics, National Taiwan University, Taipei, 10617, Taiwan
| | - S L Yeh
- Department of Physics, National Tsing Hua University, Hsinchu, 30013, Taiwan
| | - S R Yang
- Department of Physics, National Tsing Hua University, Hsinchu, 30013, Taiwan
| | - C T Wu
- National Nano Device Laboratories, Hsinchu, 30013, Taiwan
| | - T Liu
- Department of Physics, Colorado State University, Fort Collins, CO, 80523, USA
| | - M Wu
- Department of Physics, Colorado State University, Fort Collins, CO, 80523, USA
| | - M Hong
- Graduate Institute of Applied Physics and Department of Physics, National Taiwan University, Taipei, 10617, Taiwan.
| | - J Kwo
- Department of Physics, National Tsing Hua University, Hsinchu, 30013, Taiwan.
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Wang YC, Chuang CC, Tu PH, Wei KC, Wu CT, Lee CC, Liu ZH, Chen PY. Seizures in surgically resected atypical and malignant meningiomas: Long-term outcome analysis. Epilepsy Res 2018; 140:82-89. [DOI: 10.1016/j.eplepsyres.2017.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/10/2017] [Accepted: 12/14/2017] [Indexed: 12/22/2022]
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Hsieh PC, Wu YM, Wang AYC, Chen CC, Chang CH, Chin SC, Wu TWE, Wu CT, Lee ST. The venous delay phenomenon in computed tomography angiography: a novel imaging outcome predictor for poor cerebral perfusion after severe aneurysmal subarachnoid hemorrhage. J Neurosurg 2017; 129:876-882. [PMID: 29171807 DOI: 10.3171/2017.5.jns17794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Diverse treatment results are observed in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH). Significant initial perfusion compromise is thought to predict a worse treatment outcome, but this has scant support in the literature. In this cohort study, the authors correlate the treatment outcomes with a novel poor-outcome imaging predictor representing impaired cerebral perfusion on initial CT angiography (CTA). METHODS The authors reviewed the treatment results of 148 patients with poor-grade aSAH treated at a single tertiary referral center between 2007 and 2016. Patients with the "venous delay" phenomenon on initial CTA were identified. The outcome assessments used the modified Rankin Scale (mRS) at the 3rd month after aSAH. Factors that may have had an impact on outcome were retrospectively analyzed. RESULTS Compared with previously identified outcome predictors, the venous delay phenomenon on initial CTA was found to have the strongest correlation with posttreatment outcomes on both univariable (p < 0.0001) and multivariable analysis (OR 4.480, 95% CI 1.565-12.826; p = 0.0052). Older age and a higher Hunt and Hess grade at presentation were other factors that were associated with poor outcome, defined as an mRS score of 3 to 6. CONCLUSIONS The venous delay phenomenon on initial CTA can serve as an imaging predictor for worse functional outcome and may aid in decision making when treating patients with poor-grade aSAH.
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Affiliation(s)
| | | | | | | | - Chien-Hung Chang
- 3Neurology, Chang Gung Memorial Hospital, Linkou, Chang Gung University and Medical College, Kweishan, Taoyuan, Taiwan
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Wu CT, Zhao JH, Wei D, Shi YX, Zhu GF. [Lung function influenced the prognosis of cardiac surgery in patients with chronic obstructive pulmonary disease]. Zhonghua Jie He He Hu Xi Za Zhi 2017; 40:86-89. [PMID: 28209037 DOI: 10.3760/cma.j.issn.1001-0939.2017.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the value of lung function for the prognosis of cardiac surgery in patients with chronic obstructive pulmonary disease(COPD). Methods: A retrospective analysis was conducted on the hospitalized patients with coronary heart disease or valvular heart disease in Beijing Anzhen hospital during Janury 2013 to December 2015. The relationship between lung function and extubation time, time of staying in ICU, second time tracheal incubation, tracheotomy and mortality rate were analyzed. Results: There were 355 patients without surgery in a total 1 729 of patients, of which 65 (18.31%)suffered from severe pulmonary dysfunction. There were 242 patients with obstructive ventilation dysfunction, 75 with mild, 127 with moderate, and 40 with severe and very severe obstructive ventilation dysfunction. There were significant differences in the rates of planned extubation and late extubation between patients with normal lung function (81.6% and 10.7%) and those with abnormal lung function(74.4% and 12.8%). In patients with different GOLD classification (Ⅰ, Ⅱ, and Ⅲ-Ⅳ), there were significant differences in the rates of early extubation 14.7%, 14.2% and 5%, planned extubation (80%, 74% and 65%) and late extubation (5.3%, 11.8% and 30%). By comparison with patients without COPD, the extubation time of COPD patients increased by 20.3%, the time of staying in ICU prolonged by 14.2%, and the mortality rate increased to 180%(P<0.05). However, there was no significant difference in the rate of second time tracheal incubation or tracheotomy. Conclusion: There was a close relationship between GOLD classification and prognosis of cardiac surgery patients with COPD. Cardiac surgery needs to be cautious because of increase in incidence of postoperative adverse events in patients with severe pulmonary dysfunction.
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Affiliation(s)
- C T Wu
- Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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Lin CC, Lin HC, Lee WY, Lee ST, Wu CT. Neurosurgical robotic arm drilling navigation system. Int J Med Robot 2016; 13. [PMID: 27910205 DOI: 10.1002/rcs.1790] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/22/2016] [Accepted: 10/23/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim of this work was to develop a neurosurgical robotic arm drilling navigation system that provides assistance throughout the complete bone drilling process. METHODS The system comprised neurosurgical robotic arm navigation combining robotic and surgical navigation, 3D medical imaging based surgical planning that could identify lesion location and plan the surgical path on 3D images, and automatic bone drilling control that would stop drilling when the bone was to be drilled-through. Three kinds of experiment were designed. RESULTS The average positioning error deduced from 3D images of the robotic arm was 0.502 ± 0.069 mm. The correlation between automatically and manually planned paths was 0.975. The average distance error between automatically planned paths and risky zones was 0.279 ± 0.401 mm. The drilling auto-stopping algorithm had 0.00% unstopped cases (26.32% in control group 1) and 70.53% non-drilled-through cases (8.42% and 4.21% in control groups 1 and 2). CONCLUSIONS The system may be useful for neurosurgical robotic arm drilling navigation.
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Affiliation(s)
- Chung-Chih Lin
- Department of Computer Science and Information Engineering, College of Engineering, Chang Gung University, Taiwan.,Department of Neurosurgery, Chang Gung Memorial Hospital, Taiwan
| | - Hsin-Cheng Lin
- Department of Computer Science and Information Engineering, College of Engineering, Chang Gung University, Taiwan
| | - Wen-Yo Lee
- Department of Computer Information and Network Engineering, Lunghwa University of Science and Technology, Taiwan
| | - Shih-Tseng Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taiwan.,Medical Augmented Reality Research Center, Chang Gung Memorial Hospital, Taiwan
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taiwan.,Medical Augmented Reality Research Center, Chang Gung Memorial Hospital, Taiwan
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Chen KT, Lee ST, Wu CT. The Clinical Value of Intraoperative Mobile Computed Tomography in Managing High-Risk Surgical Patients with Traumatic Brain Injury-A Single Tertiary Trauma Center Experience. World Neurosurg 2016; 98:727-733.e3. [PMID: 27890762 DOI: 10.1016/j.wneu.2016.11.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/15/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE A subset of surgically treated patients with traumatic brain injury (TBI) cannot be stabilized by initial surgery. Mobile computed tomography (CT) provides real-time information for diagnosis in these TBI surgically high-risk (TBI-SHR) patients. The objective of this study was to analyze a 5-year series of TBI-SHR patients to evaluate the impact of intraoperative mobile CT (imCT) on prognosis. METHODS Of 1017 surgically treated patients with TBI retrospectively reviewed over a 5-year period (2009-2013), 59 patients required second operations within 72 hours of their initial surgery because of progressive or delayed hematomas (TBI-SHR group). Their clinical, radiographic, and intraoperative findings were compared among 19 patients who received imCT versus 40 patients who received fixed-unit CT. RESULTS Our TBI-SHR group accounted for 5.8% of all surgically treated patients with TBI. The use of imCT led to a change in surgical plan in 56% of patients with TBI intraoperatively. Younger patients (≤55 years; P < 0.05) with multifocal hemorrhage on preoperative CT (P = 0.033) and with an intraoperative unexpected event such as intraoperative intracranial pressure >20 mm Hg or acute brain swelling after adequate decompression (P = 0.003 and 0.004, respectively) significantly benefited from imCT in the TBI-SHR group. imCT also provided a quicker diagnosis (P < 0.001), led to a trend toward shorter intensive care unit stays (P = 0.077), and was associated with better neurologic outcomes at discharge days (P = 0.044). CONCLUSIONS The use of imCT is associated with better neurologic outcomes at discharge days compared with the use of fixed-unit CT in TBI-SHR patients.
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Affiliation(s)
- Ko-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shih-Tseng Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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Abstract
BACKGROUND Pediatric primary spinal tumors (PST) are fairly uncommon, with little available data regarding incidence and outcomes. MATERIALS AND METHODS We conducted a retrospective review of the 22 consecutive patients less than 18 years old diagnosed with PST between March 1997 and May 2011 and treated at Chang Gung Children Hospital. All patients had undergone magnetic resonance imaging (MRI) for pre-operative evaluation and operations for PST. The extent of tumor removal was assessed by surgical report by the neurosurgeon or by post-operative MRI if available. RESULTS Ten of them had intramedullary tumors and 12 had intradural extramedullary tumors. All patients were treated with surgery to the primary site. A total of 15 patients underwent gross total tumor resection and seven patients received post-operative radiotherapy. Five patients received adjuvant chemotherapy for their primary tumor. Fourteen patients (64%) survived from study entry without tumor progression. CONCLUSIONS PST encompassed a diverse group of pathologic entities that differ markedly based on the location and age of the children. Total resection of pediatric PST in children could be performed with acceptable risk and satisfactory long-term results.
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Affiliation(s)
- Po-Cheng Hung
- Department of Pediatrics, Division of Neurology, Chang Gung Children's Hospital, Taoyuan, Taiwan
| | - Chieh-Tsai Wu
- Department of Surgery, Division of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tang-Her Jaing
- Department of Pediatrics, Divisions of Hematology and Oncology, Chang Gung Children's Hospital, Taoyuan, Taiwan
| | - Jiunn-Ming Sheen
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Liang Chou
- Department of Pediatrics, Division of Neurology, Chang Gung Children's Hospital, Taoyuan, Taiwan
| | - Kuang-Lin Lin
- Department of Pediatrics, Division of Neurology, Chang Gung Children's Hospital, Taoyuan, Taiwan
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Chen CT, Lai HY, Jung SM, Lee CY, Wu CT, Lee ST. Neurenteric Cyst or Neuroendodermal Cyst? Immunohistochemical Study and Pathogenesis. World Neurosurg 2016; 96:85-90. [PMID: 27586176 DOI: 10.1016/j.wneu.2016.08.089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/18/2016] [Accepted: 08/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Neurenteric cysts are rare central nervous system lesions derived from an endodermal origin. There is no consensus concerning pathogenesis because of the paucity of occurrences. We report an immunohistochemical study of 10 cases with neurenteric cysts and postulate its pathogenesis. METHODS Ten patients underwent surgical treatment for neurenteric cysts from 1995 to 2015. We retrospectively reviewed clinical, radiologic, operative, and pathologic findings for these patients. Immunohistochemical stains were completed in all cases to distinguish cell type and origin. RESULTS Three cell types were identified: pseudostratified-ciliated, goblet-columnar, and simple cuboidal cells. All cases were positive for cytokeratin 7, and negative for cytokeratin 20, caudal-type homeobox 2, mucin 2, thyroid transcription factor 1, human chorionic gonadotropin, placental alkaline phosphatase, and cluster of differentiation 31. Four of them had positive staining for mucin 5AC, with expression only in goblet-columnar cells. According to the immunohistochemical results, the cells resembled the respiratory tract (pseudostratified-ciliated), stomach (goblet-columnar), and respiratory bronchioles (simple cuboidal). Seventy-five percent of cases with recurrence had a goblet-columnar component, emphasizing the importance of total resection of the cyst and complete pathologic examination. CONCLUSIONS We postulate that the cystic tumor was derived from multipotent endodermal cells that migrated and traveled along the neuroectoderm, with incomplete differentiation into various cell types as a result of an unsuitable microenvironment. Because the neurenteric canal was only the channel of migration rather than a component of the cysts, the term neuroendodermal cysts is more precise in presenting the embryopathogenesis.
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Affiliation(s)
- Chun-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taiwan, Republic of China
| | - Hung-Yi Lai
- Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taiwan, Republic of China
| | - Shih-Ming Jung
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taiwan, Republic of China
| | - Ching-Yi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taiwan, Republic of China.
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taiwan, Republic of China
| | - Shih-Tseng Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, Taiwan, Republic of China
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Chen CT, Lee CY, Lee ST, Chang CN, Wei KC, Wu CT. Neurenteric cysts: risk factors and management of recurrence. Acta Neurochir (Wien) 2016; 158:1325-31. [PMID: 27169426 DOI: 10.1007/s00701-016-2828-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/28/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Neurenteric cysts are rare central nervous system lesions with excellent outcome after total excision. The authors report their experience in the management of these lesions, especially if recurrence occurs. Risk factors of recurrence were analyzed, which have never been reported according to the literature review. METHODS Twelve patients underwent surgical treatment for neurenteric cysts from April 1998 to July 2015. We retrospectively reviewed the clinical, radiological, operative, and pathological findings for these patients. Correlations between clinical characteristics and recurrence were analyzed. RESULTS This series included six intracranial and six intraspinal cases. Total resection was achieved in 4 of the 12 cases and partial resection in 8. Six of the patients that underwent partial resection suffered from recurrence, and an additional operation was needed in five. Three of the recurrent intracranial lesions had refractory symptoms and were finally controlled through cyst-peritoneal or ventricle-peritoneal shunts. Risk factors of recurrence were revealed as age ≦30 years old (p = 0.02), subtotal resection in the first operation (p = 0.01), and size of supratentorial NECs >30 ml (p = 0.04). Two-thirds of recurrences occurred in the first 2 years after treatment. CONCLUSIONS NECs express high recurrence rates when total excision cannot be achieved. The preoperative diagnosis error plays a major role leading to an incorrect surgical strategy and recurrence. MRI with FLAIR and DWI is recommended to improve the preoperative diagnosis. Although timely reoperation is indicated for symptomatic recurrence, adhesion may cause reoperation to become more challenging. C-P or V-P shunts are suggested as the second-line treatment, resulting in excellent prognosis. Patients with mucin-secreting cells noted histologically are susceptible to recurrence.
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Affiliation(s)
- Chun-Ting Chen
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, 5 Fu-Shing Street, 333, Kweishan, Taoyuan, Taiwan, Republic of China
| | - Ching-Yi Lee
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, 5 Fu-Shing Street, 333, Kweishan, Taoyuan, Taiwan, Republic of China
| | - Shih-Tseng Lee
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, 5 Fu-Shing Street, 333, Kweishan, Taoyuan, Taiwan, Republic of China
| | - Chen-Nen Chang
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, 5 Fu-Shing Street, 333, Kweishan, Taoyuan, Taiwan, Republic of China
| | - Kuo-Chen Wei
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, 5 Fu-Shing Street, 333, Kweishan, Taoyuan, Taiwan, Republic of China
| | - Chieh-Tsai Wu
- Departments of Neurosurgery, Chang Gung Memorial Hospital and Chang Gung University at Linko, 5 Fu-Shing Street, 333, Kweishan, Taoyuan, Taiwan, Republic of China.
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Liu TN, Wu CT, He F, Yuan W, Li SX, Li HW, Yu HY, Wu M. Relationship between the G75A polymorphism in the apolipoprotein A1 (ApoA1) gene and the lipid regulatory effects of pravastatin in patients with hyperlipidemia. Genet Mol Res 2016; 15:gmr8216. [PMID: 27323196 DOI: 10.4238/gmr.15028216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In this study, we investigated the relationship between the G75A polymorphism in the apolipoprotein A1 (ApoA1) gene and the lipid regulatory effect of pravastatin in patients with hyperlipidemia. A total of 179 patients were divided into two groups: the pravastatin (N = 97) and policosanol (N = 82) treatment groups. The total cholesterol (TC), triglyceride, low-density lipoprotein (LDL-c), high-density lipoprotein, ApoA, and ApoB concentrations in the serum were measured using an automatic biochemical analyzer before and after treatment for 12 weeks. The genotypes of the ApoA1 G75A SNP were detected by polymerase chain reaction-restriction fragment length polymorphism, and were subsequently statistically analyzed. Pravastatin treatment induced a significant decrease in the TC, LDL-c, and ApoB levels in patients expressing the ApoA1 AA+GA genotype (P < 0.05), and not in those expressing the GG genotype (P > 0.05). However, policosanol treatment induced a non-significant decrease in the serum TC levels (P > 0.05) and a significant decrease in the ApoB levels (P < 0.05), and did not induce a decrease in the LDL-c (P > 0.05) levels in patients with the AA+GA genotype. Policosanol also induced a significant decrease in the TC and LDL-c levels in patients with the GG genotype (P < 0.05). The various genotypes of the ApoA1 G75A SNP influence the efficacy of lipid regulation by pravastatin and policosanol in patients with hyperlipidemia.
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Affiliation(s)
- T N Liu
- Cardiovascular Division, Affiliated Hospital of the North China University of Technology, Tangshan, Hebei, China
| | - C T Wu
- Cardiovascular Division, Affiliated Hospital of the North China University of Technology, Tangshan, Hebei, China
| | - F He
- Cardiovascular Division, Affiliated Hospital of the North China University of Technology, Tangshan, Hebei, China
| | - W Yuan
- Cardiovascular Division, Affiliated Hospital of the North China University of Technology, Tangshan, Hebei, China
| | - S X Li
- Cardiovascular Division, Affiliated Hospital of the North China University of Technology, Tangshan, Hebei, China
| | - H W Li
- Cardiovascular Division, Affiliated Hospital of the North China University of Technology, Tangshan, Hebei, China
| | - H Y Yu
- Cardiovascular Division, Affiliated Hospital of the North China University of Technology, Tangshan, Hebei, China
| | - M Wu
- The People's Hospital of Tangshan, Tangshan, China
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Ito R, Wu CT, Lin MCY, Cheng MH. Successful treatment of early-stage lower extremity lymphedema with side-to-end lymphovenous anastomosis with indocyanine green lymphography assisted. Microsurgery 2015; 36:310-5. [DOI: 10.1002/micr.30010] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/30/2015] [Accepted: 11/10/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Ran Ito
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of Plastic and Reconstructive Surgery; Kyoto University; Kyoto Japan
| | - Chieh-Tsai Wu
- Department of Neurosurgery; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Miffy Chia-Yu Lin
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Ming-Huei Cheng
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine; Chang Gung University; Taoyuan Taiwan
- Center for Tissue Engineering; Chang Gung Memorial Hospital; Taoyuan Taiwan
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Li CZ, Zhang P, Li RW, Wu CT, Zhang XP, Zhu HC. Axillary lymph node dissection versus sentinel lymph node biopsy alone for early breast cancer with sentinel node metastasis: A meta-analysis. Eur J Surg Oncol 2015; 41:958-66. [PMID: 26054706 DOI: 10.1016/j.ejso.2015.05.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/21/2015] [Accepted: 05/06/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In early breast cancer patients with sentinel node metastasis, the effect of axillary lymph node dissection (ALND) is controversial. The purpose of this study is to compare the safety and efficacy of sentinel lymph node biopsy (SLNB) alone versus ALND in patients with early breast cancer and sentinel node metastasis. METHODS We searched PubMed, Embase, Web of Science, and Cochrane Library databases from 1965 to February 2014. All data were analyzed using Review Manager Software 5.2. RESULTS 12 studies, which included 130,575 patients from five randomized controlled trials and seven observational studies, met our inclusion criteria. 26,870 early breast cancer patients underwent SLNB alone and 103,705 underwent ALND. Patients underwent ALND had more paresthesia (risk ratio [RR] 0.26, 95% confidence interval [CI] 0.20-0.33; p < 0.01) and lymphedema (RR 0.28, 95% CI 0.20-0.41; p < 0.01) than those had SLNB alone. There were no significant differences in overall survival (hazard ratio [HR] 0.95, 95% CI 0.85-1.06; p = 0.35), disease-free survival (HR 1.00, 95% CI 0.98-1.02, p = 0.96), and locoregional recurrence (RR 0.92, 95% CI 0.59-1.44; p = 0.73). CONCLUSION Current evidence indicates that axillary dissection may be omitted in early breast cancer patients with sentinel lymph metastasis.
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Affiliation(s)
- C Z Li
- Oncological Surgery, Affiliate Hospital of Hebei United University, Tangshan 063000, Hebei, China
| | - P Zhang
- Nursing and Rehabilitation College, Hebei United University, Tangshan 063000, Hebei, China
| | - R W Li
- Oncological Surgery, Affiliate Hospital of Hebei United University, Tangshan 063000, Hebei, China
| | - C T Wu
- Oncological Surgery, Affiliate Hospital of Hebei United University, Tangshan 063000, Hebei, China
| | - X P Zhang
- Oncological Surgery, Affiliate Hospital of Hebei United University, Tangshan 063000, Hebei, China
| | - H C Zhu
- Oncological Surgery, Affiliate Hospital of Hebei United University, Tangshan 063000, Hebei, China.
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Chen KT, Wu TWE, Chuang CC, Hsu YH, Hsu PW, Huang YC, Lin TK, Chang CN, Lee ST, Wu CT, Tseng CK, Wang CC, Pai PC, Wei KC, Chen PY. Corpus callosum involvement and postoperative outcomes of patients with gliomas. J Neurooncol 2015; 124:207-14. [PMID: 26033546 DOI: 10.1007/s11060-015-1823-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/24/2015] [Indexed: 11/26/2022]
Abstract
Corpus callosum involvement is associated with poorer survival in high grade glioma (HGG), but the prognostic value in low grade glioma (LGG) is unclear. To determine the prognostic impact of corpus callosum involvement on progression free survival (PFS) and overall survival (OS) in HGG and LGG, the records of 233 glioma patients treated from 2008 to 2011 were retrospectively reviewed. Preoperative magnetic resonance (MR) images were used to identify corpus callosum involvement. Age, sex, preoperative Karnofsky performance scale, postoperative Eastern Cooperative Oncology Group (ECOG) score and extent of resection (EOR) were evaluated with respect to PFS and OS. The incidence of corpus callosum involvement was similar among HGG (14 %) and LGG (14.5 %). Univariate analysis revealed that PFS and OS were significantly shorter in both WHO grade II and grade IV glioma with corpus callosum involvement (both, p < 0.05). Multivariate analysis showed that grade II glioma with corpus callosum involvement have shorter PFS (p = 0.03), while EOR, instead of corpus callosum involvement (p = 0.16), was an independent factor associated with PFS in grade IV glioma (p < 0.05). Corpus callosum involvement was no longer significantly associated with OS after adjusting age, gender, EOR, preoperative and postoperative performance status (p = 0.16, 0.17 and 0.56 in grade II, III and IV gliomas, respectively). Corpus callosum involvement happened in both LGG and HGG, and is associated with lower EOR and higher postoperative ECOG score both in LGG and HGG. Corpus callosum involvement tends to be an independent prognostic factor for PFS in LGG, but not for OS in LGG or in HGG.
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Affiliation(s)
- Ko-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu Xing St., Gueishan Township, Taoyuan County, 333, Taiwan, ROC
| | - Tai-Wei Erich Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu Xing St., Gueishan Township, Taoyuan County, 333, Taiwan, ROC
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu Xing St., Gueishan Township, Taoyuan County, 333, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yung-Hsin Hsu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu Xing St., Gueishan Township, Taoyuan County, 333, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Peng-Wei Hsu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu Xing St., Gueishan Township, Taoyuan County, 333, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yin-Cheng Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu Xing St., Gueishan Township, Taoyuan County, 333, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Tzu-Kang Lin
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu Xing St., Gueishan Township, Taoyuan County, 333, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chen-Nen Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu Xing St., Gueishan Township, Taoyuan County, 333, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shih-Tseng Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu Xing St., Gueishan Township, Taoyuan County, 333, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu Xing St., Gueishan Township, Taoyuan County, 333, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chen-Kan Tseng
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang-Gung University, Taoyuan, Taiwan, ROC
| | - Chun-Chieh Wang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang-Gung University, Taoyuan, Taiwan, ROC
| | - Ping-Ching Pai
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang-Gung University, Taoyuan, Taiwan, ROC
| | - Kuo-Chen Wei
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu Xing St., Gueishan Township, Taoyuan County, 333, Taiwan, ROC
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Pin-Yuan Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No. 5, Fu Xing St., Gueishan Township, Taoyuan County, 333, Taiwan, ROC.
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.
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Gazyakan E, Lee CY, Wu CT, Tsao CK, Craft R, Henry SL, Cheng MH, Lee ST. Indications and Outcomes of Prophylactic and Therapeutic Extracranial-to-intracranial Arterial Bypass for Cerebral Revascularization. Plast Reconstr Surg Glob Open 2015; 3:e372. [PMID: 25973350 PMCID: PMC4422203 DOI: 10.1097/gox.0000000000000339] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 02/09/2015] [Indexed: 11/25/2022]
Abstract
Background: Extracranial-to-intracranial (EC-IC) arterial bypass is a technically demanding procedure used to treat complex cerebral artery diseases. The indications, proper surgical techniques, and outcomes of this procedure have been under debate over the recent decades. Methods: Between January 2004 and December 2012, 28 patients, including patients with cerebral artery occlusion, intracranial aneurysm, cranial base tumor, and Moyamoya disease, underwent EC-IC bypass. Patients’ records were retrospectively reviewed for demography, indications, complications, high-flow versus low-flow bypass, patency rate of bypass, and neurological outcome. The patients were sorted into prophylactic (n = 16) and therapeutic (n = 12) groups based on the preoperative presentation of their neurological symptoms. Follow-up evaluation was performed at a mean of 32.7 ± 24.3 months. Results: The overall patency rate of bypass was 100%, the postoperative stroke rate was zero, and the surgical complication rate was 14.3%. There was no significant difference in the bypass patency rate between the 2 groups or between the high-flow and low-flow bypass patients. Patients who underwent prophylactic bypass had minimal surgical and total complications (P = 0.03 and P < 0.01, respectively) and a better neurological outcome. Surgical complications were more common in patients who underwent therapeutic bypass (25%). Conclusions: The collaboration of neurosurgeons and plastic surgeons in performing EC-IC bypass can result in excellent outcomes with a high bypass patency rate and few complications, particularly for prophylactic EC-IC bypass.
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Affiliation(s)
- Emre Gazyakan
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Neurosurgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, Banner MD Anderson Cancer Center, Gilbert, Ariz.; and Institute of Reconstructive Plastic Surgery, Seton Institute of Reconstructive Plastic Surgery, Austin, Tex
| | - Ching-Yi Lee
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Neurosurgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, Banner MD Anderson Cancer Center, Gilbert, Ariz.; and Institute of Reconstructive Plastic Surgery, Seton Institute of Reconstructive Plastic Surgery, Austin, Tex
| | - Chieh-Tsai Wu
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Neurosurgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, Banner MD Anderson Cancer Center, Gilbert, Ariz.; and Institute of Reconstructive Plastic Surgery, Seton Institute of Reconstructive Plastic Surgery, Austin, Tex
| | - Chung-Kan Tsao
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Neurosurgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, Banner MD Anderson Cancer Center, Gilbert, Ariz.; and Institute of Reconstructive Plastic Surgery, Seton Institute of Reconstructive Plastic Surgery, Austin, Tex
| | - Randall Craft
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Neurosurgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, Banner MD Anderson Cancer Center, Gilbert, Ariz.; and Institute of Reconstructive Plastic Surgery, Seton Institute of Reconstructive Plastic Surgery, Austin, Tex
| | - Steven L Henry
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Neurosurgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, Banner MD Anderson Cancer Center, Gilbert, Ariz.; and Institute of Reconstructive Plastic Surgery, Seton Institute of Reconstructive Plastic Surgery, Austin, Tex
| | - Ming-Huei Cheng
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Neurosurgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, Banner MD Anderson Cancer Center, Gilbert, Ariz.; and Institute of Reconstructive Plastic Surgery, Seton Institute of Reconstructive Plastic Surgery, Austin, Tex
| | - Shih-Tseng Lee
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Neurosurgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Plastic and Reconstructive Surgery, Banner MD Anderson Cancer Center, Gilbert, Ariz.; and Institute of Reconstructive Plastic Surgery, Seton Institute of Reconstructive Plastic Surgery, Austin, Tex
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Jaing TH, Chuang CC, Jung SM, Wu CT, Tseng CK, Chen CS. Malignant triton tumor of the cervical spine: report of one case and review of the literature. Pediatr Neonatol 2015; 56:58-61. [PMID: 23597523 DOI: 10.1016/j.pedneo.2013.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 01/19/2012] [Accepted: 01/22/2013] [Indexed: 10/27/2022] Open
Abstract
Malignant triton tumor (MTT) is a highly aggressive malignant neoplasm, classified as a variant of malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation. MTT is rarely reported in children, and its true prevalence may be underestimated. We herein report such a case in an 8-year-old boy who presented with a mass over the trapezius muscle. He was previously diagnosed with neurofibromatosis in the same area. Four years later, a follow-up magnetic resonance imaging revealed an intradural tumor recurrence at the level of C1-C7. An immunohistochemical test result was positive for S-100 protein and desmin, which confirmed the diagnosis. The patient outcome was fatal despite multimodal therapy. The possibility of this rare but devastating tumor must always be considered when patients present with new compressive spinal symptoms.
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Affiliation(s)
- Tang-Her Jaing
- Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Chwei-Chin Chuang
- Department of Plastic and Reconstructive Surgery, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ming Jung
- Department of Pathology, Chang Gung University, Taoyuan, Taiwan
| | - Chieh-Tsai Wu
- Division of Neurosurgery, Department of Surgery, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Kan Tseng
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Wang YC, Huang YC, Chen HC, Wei KC, Chang CN, Lee ST, Wu CT, Tseng CK, Wang CC, Chen YL, Hsu PW. Linear accelerator stereotactic radiosurgery in the management of intracranial arteriovenous malformations: long-term outcome. Cerebrovasc Dis 2014; 37:342-9. [PMID: 24941898 DOI: 10.1159/000360756] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/18/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Arteriovenous malformation (AVM) is one of the cerebrovascular diseases that bear a high risk of hemorrhage. The treatment modalities include microsurgical resection, endovascular embolization, stereotactic radiosurgery, or combinations that vary widely. Several large series have been reported, while data from Asian populations were few. The aim of this study was to examine the efficacy of linear accelerator stereotactic radiosurgery (LINAC SRS) for the treatment of intracranial AVMs, to evaluate the hemorrhage rate and to analyze associated factors. METHODS One hundred and sixteen patients with AVM were treated with LINAC SRS in a single institute between September 1994 and May 2005 and were retrospectively evaluated. The demographics of patients, clinical characteristics of AVM, the treatment modalities, and the parameters of the LINAC SRS were analyzed. Delayed toxicity and hemorrhage rate after treatment were also evaluated. The AVM obliteration and bleed rates were calculated using the Kaplan-Meier method and Cox regression analyses. RESULTS The efficacy rate with total obliteration after treatment was 81.9% (95 of 116 patients). The median interval to achieve total obliteration was 49 months. Microsurgical resection combined with SRS for residual AVMs achieved better obliteration rates compared to SRS alone (statistically significant, p = 0.001), while no significant difference was found between the embolization group and the group with no prior treatment (p = 0.895). The Spetzler-Martin grade of AVM is a relative factor of obliteration, higher grades resulting in a worse outcome (p = 0.009). Obliteration was significantly influenced by AVM volume in univariate analysis (p = 0.034), and volume <5 cm(3) contributed to improved obliteration (p = 0.01). There was no statistically significant difference in the hemorrhagic rate and the complication rate between ruptured and unruptured AVMs, while the unruptured group had a higher obliteration rate (p = 0.024). The annual hemorrhage rate after LINAC SRS treatment was 1.9%. The bleeding rate was 3.3% in the first year after radiosurgery, 2.1% in the second year, 1.9% between the second and fifth year, and 1.5% between the fifth and tenth year. Patients with hemorrhagic events before radiosurgery appeared to have a higher rebleeding risk during the latency period. Twenty-three patients (19.8%) had late adverse effects with regard to posttreatment radiological follow-up, but only 1 (0.8%) had newly developed neurological deficits. CONCLUSION LINAC SRS achieved a high obliteration rate and reduced the risk of hemorrhage effectively in ruptured and unruptured intracranial AVMs. Prior microsurgical resection provided better outcome, while embolization showed no benefit. Adverse effects after treatment are acceptable and require long-term follow-up.
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Affiliation(s)
- Yu-Chi Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, ROC
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Zheng YC, Jung SM, Lee ST, Chang CN, Wei KC, Hsu YH, Wu CT, Liao CC, Lin CL, Lu YJ, Huang YC. Adult supratentorial extra-pineal primitive neuro-ectodermal tumors. J Clin Neurosci 2014; 21:803-9. [DOI: 10.1016/j.jocn.2013.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 07/15/2013] [Accepted: 07/15/2013] [Indexed: 01/24/2023]
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Tsai ML, Wu CT, Lin TF, Lin WC, Huang YC, Yang CH. Chemical Composition and Biological Properties of Essential Oils of Two Mint Species. TROP J PHARM RES 2013. [DOI: 10.4314/tjpr.v12i4.20] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
OBJECT Liver cirrhosis was identified as an independent predictor of poor outcomes in patients suffering trauma and in those undergoing major surgeries. The aim of this study was to report the authors' experiences treating patients with cirrhosis who undergo brain surgeries. METHODS Between 2004 and 2009, 121 consecutive patients with cirrhosis underwent 144 brain procedures. Patients were categorized as Child-Turcotte-Pugh (referred to as "Child") Class A, B, or C. The patient profiles, including the severity of cirrhosis, reason for surgery, complications, and prognosis factors, were analyzed. RESULTS In this retrospective study, the overall surgical complication rate for patients with cirrhosis was 52.1% and the mortality rate was 24.3%. For patients with acute traumatic brain injury (TBI), the complication, rebleeding, and mortality rates reached 84.4%, 68.8%, and 37.5%, respectively. Surgery for TBI was a significant risk factor for postoperative complications (p = 0.0002) and postoperative hemorrhage (p < 0.0001). Otherwise, according to the Child classification, the complication rate increased in a stepwise fashion from 38.7% to 60% to 84.2%, the rebleeding rate from 29.3% to 48.0% to 63.2%, and the mortality rate from 5.3% to 38% to 63.2% for Child A, B, and C, respectively. The Child classification was associated with higher risk of complications-Child B vs A OR 2.84 (95% CI 1.28-6.29), Child C vs A OR 5.39 (95% CI 1.32-22.02). It was also associated with risk of death-Child C vs A OR 30.43 (95% CI 7.71-120.02), Child B vs A OR 10.88 (95% CI 3.42-34.63). CONCLUSIONS Liver cirrhosis is a poor comorbidity factor for brain surgery. The authors' results suggest that the Child classification used independently is a poor prognostic factor; in addition, grave outcomes were observed in patients with TBI.
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Affiliation(s)
- Ching-Chang Chen
- Department of Neurosurgery, Chang Gung University and Chang Gung Memorial Hospital-Linkou, Kwei-Shan, Taiwan
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Tu PH, Liu ZH, Chuang CC, Yang TC, Wu CT, Lee ST. Postoperative midline shift as secondary screening for the long-term outcomes of surgical decompression of malignant middle cerebral artery infarcts. J Clin Neurosci 2012; 19:661-4. [DOI: 10.1016/j.jocn.2011.07.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 07/01/2011] [Accepted: 07/06/2011] [Indexed: 11/15/2022]
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Lee CY, Wu CT, Lin KL, Hsu HH. Occult cerebrospinal fluid fistula between ventricle and extra-ventricular position of the ventriculoperitoneal shunt tip. Acta Neurol Taiwan 2011; 20:197-201. [PMID: 22009124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE Ventriculoperitoneal (VP) shunt or ventriculoatrial shunt is a common operation for treatment of hydrocephalus. Usually, shunt series (plain radiographs of the skull, neck, chest and abdomen) and brain computed tomography (CT) are used to monitor the status of hydrocephalus and VP shunt. However, does the result of a brain CT really reflect the status of the hydrocephalus and shunt function? In patients with VP shunt, brain CT image only may lead to misdiagnosis of the status of the hydrocephalus and result in inadequate treatment plan. CASE REPORT The authors reported a 6-year-old patient with occult cerebrospinal fluid (CSF) fistula between ventricle and extra-ventricular position of the VP shunt tip on CT scan and resulted in inappropriate shunt removal. CONCLUSION The patient was diagnosed to have shunt-dependent hydrocephalus with inadequate shunt removal. In this kind of patient, further studies may reduce unnecessary morbidity or mortality.
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Affiliation(s)
- Ching-Yi Lee
- Department of Neurosurgery, Chang Gung University Colleage of Medicine, Taoyuan, Taiwan
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Yao BQ, Chen F, Zhang CH, Wang Q, Wu CT, Duan XM. Room temperature single-frequency output from a diode-pumped Tm,Ho:YAP laser. Opt Lett 2011; 36:1554-1556. [PMID: 21540925 DOI: 10.1364/ol.36.001554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Single-frequency operation in the range of 2102.45-2102.54 nm and 2130.72-2130.82 nm is demonstrated from a Tm,Ho:YAP laser at room temperature. To our knowledge, this is the first time a room temperature single-frequency Tm,Ho:YAP laser of up to 72.6 mW at 2102.5 nm with Fabry-Perot etalons has been obtained. Regulating the elevation angle of the two etalons, 42.0 mW at 2130.8 nm was obtained. The single-longitudinal-mode laser can be used as a seed laser for coherent wind measurements and differential absorption lidar systems.
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Affiliation(s)
- B Q Yao
- National Key Laboratory of Tunable Laser Technology, Harbin Institute of Technology, Harbin 150001, China.
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Chao HY, You SH, Lu JY, Cheng JH, Chang YH, Liang CT, Wu CT. The growth and characterization of ZnO/ZnTe core-shell nanowires and the electrical properties of ZnO/ZnTe core-shell nanowire field effect transistor. J Nanosci Nanotechnol 2011; 11:2042-2046. [PMID: 21449346 DOI: 10.1166/jnn.2011.3128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Vertically aligned ZnO/ZnTe core-shell nanowires were grown on a-plane sapphire substrate by using chemical vapor deposition with gold as catalyst for the growth of ZnO core and then followed by growing ZnTe shell using metal-organic chemical vapor deposition (MOCVD). Transmission electron microscope (TEM) and Raman scattering indicate that the core-shell nanostructures have good crystalline quality. Three-dimensional fluorescence images obtained by using laser scanning confocal microscope demonstrate that the nanowires have good optical properties. The core-shell nanowire was then fabricated into single nanowire field effect transistor by standard e-beam photolithography. Electrical measurements reveals that the p-type ZnO/ZnTe FET device has a turn on voltage of -1.65 V and the hole mobility is 13.3 cm2/V s.
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Affiliation(s)
- H Y Chao
- Department of Physics, National Taiwan University, Taipei 106, Taiwan
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Liao YL, Lu CF, Sun YN, Wu CT, Lee JD, Lee ST, Wu YT. Three-dimensional reconstruction of cranial defect using active contour model and image registration. Med Biol Eng Comput 2010; 49:203-11. [DOI: 10.1007/s11517-010-0720-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 11/20/2010] [Indexed: 10/18/2022]
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Chen JF, Lee ST, Wu CT. A Hollow Cylindrical PMMA Strut for Cervical Spine Reconstruction After Cervical Multilevel Corpectomy. ACTA ACUST UNITED AC 2010; 23:321-7. [PMID: 20084029 DOI: 10.1097/bsd.0b013e3181b15bc8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
OBJECT The management of subdural empyema (SDE) has been debated in the literature for decades. Craniotomy and bur hole drainage have been shown to achieve a favorable outcome. However, there is a lack of comparative data for these modes of management of SDE subsequent to meningitis in infants. METHODS The authors conducted a retrospective review of 33 infants identified with SDE due to meningitis at the Department of Neurosurgery, Chang Gung Memorial Hospital between 2000 and 2006. Preoperative clinical presentation, duration of symptoms, radiological investigations, CSF data, and postoperative outcome were analyzed and compared between these 2 surgical groups. RESULTS At diagnosis, there were no differences between the groups in age, weight, degree of consciousness, CSF analysis, or duration of fever. The outcome data showed no difference in the number of days until afebrile, number of days of postsurgical antibiotic treatment, neurological outcome, recurrence rate, or complication rate. There was only 1 death in the series. CONCLUSIONS Subdural empyema due to meningitis in infants is unique with respect to the pathophysiology, presentation, and treatment of SDE. Early detection and removal of SDE provide a favorable outcome in both surgical intervention groups. Bur hole drainage is less invasive, and it is possible to expect a clinical outcome as good as with craniotomy in postmeningitic SDE.
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Affiliation(s)
- Zhuo-Hao Liu
- Department of Neurosurgery, Chang Gung Memorial College of Medicine, Hospital and Chang Gung University, Linkou, Taiwan
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Chang NW, Wu CT, Wang SY, Pei RJ, Lin CF. Alpinia pricei Hayata rhizome extracts have suppressive and preventive potencies against hypercholesterolemia. Food Chem Toxicol 2010; 48:2350-6. [PMID: 20561946 DOI: 10.1016/j.fct.2010.05.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 04/13/2010] [Accepted: 05/25/2010] [Indexed: 10/19/2022]
Abstract
The aim of this study was to investigate the effects of 70% ethanol extracts of Alpinia pricei (APE) on lipid profiles and lipid peroxidation. Syrian hamsters were fed a chow-based hypercholesterolemic diet (HCD) for 2 weeks to induce hypercholesterolemia (>250 mg/dl). To evaluate the potency of APE in suppressing hypercholesterolemia, hamsters were then fed HCD plus a high dose (500 mg/kg body weight) or a low dose (250 mg/kg body weight) of APE, or only HCD for another 4 weeks. We found that hypercholesterolemic hamsters fed a high dose of APE had lower serum total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C) levels, lower thiobarbituric acid reactive substances (TBARS) and alanine aminotransferase (ALT) activities, lower atherogenic indices (LDL-C/HDL-C and TC/HDL-C ratios), and lower hepatic protein expression of peroxisome proliferators activated receptor gamma (PPARgamma) than hamsters fed a HCD diet. In addition, we also determined the preventive effects of APE on hamsters fed a HCD for 6 weeks. The hypocholesterolemic effects were also found in hamsters co-fed a high dose of APE and HCD for 6weeks. These results suggest that APE has both suppressive and preventive potencies against hypercholesterolemia and has the potency to protect against lipid peroxidation.
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Affiliation(s)
- N W Chang
- Departments of Biochemistry, College of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung 404, Taichung, Taiwan, ROC.
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Abstract
INTRODUCTION Pott's puffy tumor is characterized by subperiosteal abscess associated with osteomyelitis of frontal bone. Reports are limited for this rare entity in the antibiotics era but increase during past decade. METHODS We had clinical analysis of a series with six consecutive pediatric patients of Pott's puffy tumor during 20 years in a tertiary medical center via retrospective chart review. One case was described in detail. RESULTS Male-to-female ratio was 5:1. The mean age at the time of diagnosis was 13 years-3 months. The risk factors were acute sinusitis in two (33%), chronic sinusitis in two (33%), recent head trauma in two (33%), and acupuncture therapy on skull in one (17%). The commonest presenting symptoms were fever, headache, forehead tenderness, vomiting, and fatigue/malaise (100%). Pott's puffy tumor was diagnosed on average the seventh day after fever, and half had intracranial involvement at diagnosis. All had intracranial infections, and most of them had subdural empyema. The most often involved sinus was frontal sinus (100%). The frontal lobe was the most common site of intracranial infection (100%), two thirds of which are polymicrobial from two or more sites. The initial operation was performed on average on the 5.8th days after diagnosis. Half of the patients underwent reoperation. The mortality rate was 17% (one of six). CONCLUSION The symptoms of Pott's puffy tumor are inconspicuous even though early intracranial involvement often occurred. The importance of early diagnosis and aggravated and prompt treatment with prolonged antibiotic therapy is emphasized for better outcome.
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Affiliation(s)
- Bih-Yu Tsai
- Division of Pediatric Neurology, Chang Gung University College of Medicine, Taoyuan, Taiwan
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