hello thida-ga
Here are the results of the research,
(China, Shanghai)
Below is acoustic neuroma research, and treatment, with an indication
of the success level from a clinical study of 18 patients.
Excerpt from abstract
"Objective: To investigate the surgical methods and outcomes of the
enlarged translabyrinthine approach in the removal of large acoustic
neuromas...
There were no deaths or other complications such as intracranial
infection and persistent cerebrospinal fluid leakage. There were no
obvious cerebral sequelae. The facial nerve was preserved both
anatomically and functionally in 14 cases, with Grade I or II in 8
cases, Grade III or IV in 6 cases. Nerve interruption occurred in 4
patients who all had severe facial palsy or nerve interruption before
operation. Six teen patients resumed work within 1-3 months.
Conclusion: Total removal of large acoustic neuroma could be
accomplished via the translabyrinthine approach, with good
preservation of facial nerve function and minimum incidence of
morbidity...
1.1 Clinical data
This study included 18 patients (8 men and 10 women) surgically
treated for large acoustic neuromas via the enlarged translabyrinthine
approach at our department between March 1999 and March 2000, whose
age ranged from 20 to 74 years, with a mean of 53.1 years. The tumor
related history ranged from 6 months to 20 years . Seventeen patients
had sporadic acoustic neuromas, and one had bilateral acoustic
neuroma. Two patients who had undergone gamma unit treatment 2 and 4
years before presented continuous tumor growth. Three patients had
recurrence after sub occipital removal of the tumors. The primary
symptoms included progressive hearing loss in 14 cases, sudden hearing
loss in 2, facial palsy in one and facial anaesthesia in one. The main
preoperative symptoms included high intracranial pressure in 12 cases,
profound hearing loss in 14, severe hearing loss in 4, facial
anaesthesia in 14, facial neuralgia in one, facial palsy in 4 (grade 4
in one case, grade 5 in 2 and grade 6 in one), and ataxia in 11. Two
patients who presented chronic suppurative otitis media were operated
on via a two stage procedure. Subtotal temporal bone resection was
performed to eradicate all active infections. Tumor removal was
successfully done after two weeks...
The aim of enlarged translabyrinthine approach is to achieve a wide
operative field by sufficient temporal bone dissection...
RESULTS
Total removal was achieved in all cases. There was no death during the
follow-up period. Two patients had a postoperative CSF leakage in whom
lumbar drainage o r surgical revision was required. There was no
postoperative meningitis. The average operative time was 5.5 h with a
mean blood loss of 300 ml. The facial nerve was anatomically preserved
in 14 cases with a postoperative facial function grade I in 5 cases,
grade II in 3, grade III in 2 and grade IV in 4. The facial nerves
were interrupted in two patients in whom facial palsy occurred
preoperatively. They underwent immediate repair by hypoglossal-facial
anastomosis. One patient had preoperative facial nerve interruption
due to the previous suboccipital removal procedure. Except the one
with preoperative facial nerve interruption, the excellent rate of
facial function (grade I and II) was 44% and the acception rate (grade
I to IV) was 77%. There was no residual tumor as revealed by follow-up
imaging studies...
Sixteen [of 18] patients were discharged between 10 and 14 days
postoperatively and returned to work within 3 months."
"Removal of large acoustic neuromas by enlarged translabyrinthine
approach"
by WU HaoLü, Chun-LeiMA, Chao-WuZHANG, Su-QinZHOU, Shui-MiaoLI,
Zhao-Ji, [Received] 2000-05-22 Department of Otolaryngology, Changhai
Hospital, China 37c.com
http://www.37c.com.cn/literature/analecta/data/dejydxxb/200012/006.html
Address:
Changhai Hospital,
174 Changhai Lu,
Yangpu,
Shanghai,
China
(86-21) 6549-0018
(China, Hong Kong)
The following excerpt highlights the use of Gamma Knife Surgery at the
Canossa Hospital, China:
"Gamma Knife Surgery is a non-invasive method used for the treatment
of arteriovenous malformations (AVMs), benign and malignant tumors of
the brain. It does not involve traditional surgical incisions and thus
devoid of post-operative complications with virtually no risk of
mortality...
In a single session, 201 separate converging beams of ionizing
radiation is directed to the targeted lesion with an accuracy of
better than 0.3mm. This 'crossfiring' results in destruction of the
lesion with sparing of the adjacent normal brain tissues...
The benign tumours commonly treated include acoustic neuromas,
skullbase meningiomas and pituitary tumours...
Since the effect of Gamma Knife surgery is gradual, it may take
several weeks to months before the effect of treatment becomes
apparent...
The fact that the irradiation from the Gamma Knife can be very
precisely targeted to the treatment lesion means that only a very
small amount of radiation is received by the normal brain tissue and
adjacent structures. However, a small risk of adverse radiation
effects (2 to 4%). This is usually in the form of swelling of the
tumour and surrounding brain. Most of the effects are transient and
can be treated effectively with medications...
The main advantage of the Gamma Knife treatment is that it is
non-invasive. No lengthy recuperation is required and the patient may
resume his normal occupation and life style within a few days."
Gamma Knife Centre (HK) by Joel Y.C. CHEUNG, PhD
http://www.gammaknife.com.hk
An illustration of an acoustic neurinoma lesion volume decrease due to
treatment
http://www.gammaknife.com.hk/acoust.htm
Address:
Gamma Knife Centre,
Canossa Hospital,
No.1 Old Peak Road,
Hong Kong, SAR,
China.
Tel: (852)2522-2332
Fax: (852)2522-2663
Y.C. Cheung PhD is a specialist in Gamma Knife Surgery treatment and
was a contributor to the “Sequential Volume Mapping (SVM) Confirms
Negative Growth in Gamma Knife Treated Acoustic Neuromas” presentation
at the 10th International Meeting of the Leksell Gamma Knife Society,
The Resort at Squaw Creek in Squaw Valley, Squaw Valley, California,
USA, 14-17 April 2000 [Congress Presentations item 21] and other Gamma
Knife events and publications.
"International Conferences & Publications" Gamma Knife.com.hk
http://www.gammaknife.com.hk/publish.htm
Excerpt which highlights the effectiveness of Gamma Knife Surgery:
"For acoustic neuromas (synonymous with vestibular schwannoma), the
role of Gamma Knife radiosurgery has been well documented by large
scale clinical studies with scientific methodology and long term
follow up as published in prestigious peer reviewed journals.
It is now clear that Gamma Knife radiosurgery using high resolution
neuro-imaging and sophisticated planning software has raised the bar
of excellence. Recent studies, including one from Hong Kong, confirm
Gamma Knife induces tumour shrinkage or negative growth rather than by
growth control alone. The most recent analysis as published in the
January 2001 issue of Journal of Neurosurgery, entitled “current
results of radiosurgery for acoustic neuromas” summarises the current
status: tumour control, 97%; facial neuropathy, 1%; trigeminal
neuropathy, 2.6%; hearing preservation, 91%, with zero mortality and
procedural related morbidity. We strongly believe microsurgery and
Gamma Knife radiosurgery are complimentary to each other. For small
tumours, advocates of open surgery must show their results are at
least as good as those of Gamma Knife radiosurgery. Best results of
open surgery come from centres of excellence where hundreds of
patients are treated per year. In this context, direct comparison of
published local experience is much more relevant."
"Letters to the Editor" by C P Yu MBBS, FRCS(Ed), FHKAM, FHKCS -
Neurosurgeon in Charge, Gamma Knife Centre, Canossa Hospital, and S C
L Leung, MBBS, FRCS(Ed), FHKAM, FHKCS - Consultant Neurosurgeon Queen
Elizabeth Hospital
http://www.hkcfp.org.hk/article/2001/sep/20010902.pdf
Excerpt from the Chinese University of Hong Kong page:
"Neuro-otology
There is extensive collaboration between the Division of ENT and
Neurosurgery in the assessment, work-up and operation for patient with
acoustic neuroma. The division of ENT and the associated audiology
services provides the screening of patients with hearing loss and
assessment of patients with acoustic neuroma. When appropriate,
excision of acoustic neuroma through the trans-labyrinthine approach
is performed by both the ENT surgeon and the neurosurgeon. The ENT
surgeons with special interest in neuro-otology include Prof. C.
Andrew VAN HASSELT (Professor of Otorhinnolaryngoloy, Department of
Surgery, CUHK) and Dr. Michael CF TONG (Consultant ENT surgeon, UCH).
We had also pioneered in the providence of auditory brain sten inplant
in Asia."
Neurosurgery main page
http://www.surgery.cuhk.edu.hk/neuro/main.htm
Address:
Department of Surgery
The Chinese University of Hong Kong
surgery@cuhk.edu.hk
map:
http://www.cuhk.edu.hk/content/cumap.shtml
(China, Beijing)
Excerpt showing Dr. Zhang Liwei's research in avoiding intra-operative
nerve injury during acoustic neuroma surgery:
"Dr. Zhang Liwei, associate professor of neurosurgery, Beijing Tiantan
Hospital, recently discovered in his research that the protection of
intermediate nerve has the same importance as that of the facial nerve
during a neurological operation. This project with the financial
assistance from the Chinese Postdoctorate Science Fund provided much
more scientific evidence for the prognostic functional classification
of acoustic neuroma, and was of important significance for surgical
planning to avoid intra-operative nerve injury...
Dr. Zhang carried out simulated surgery in 16 specimens of cadaver
skull using three different surgical approaches to acoustic neuromas
and observed the structural relationships of 32 intermediate nerves
with the adjacent tissue at different locations...
Among the three surgical approaches for acoustic neuroma, the sigmoid
sinus translabyrinthine approach is able to expose the total course of
intermediate nerve and its relationship with the adjacent structures.
The infra-temporal transpetrous route is able to expose the pars
intermedia of the cerebellopontine angle and the facial nerve, while
the infra-occipital retro-sigmoid sinus approach generally will not be
able to expose the pars intermedia of the cerebellopontine angle.
Preferably, the first two approaches are selected for the protection
of the intermediate nerve."
"Protection of intermediate nerve is as important as protecting facial
nerve in neurosurgeries" China Medial Tribune 2000
http://www.cmt.com.cn/article/020411/a020411e03.htm
Address:
Neurology Dept.
Beijing Tiantan Hospital,
Tiantan Xili,
100050.
Beijing,
China
Tel: 86-10-65112164
Fax: 86-10-65112164
http://www.imicams.ac.cn/en/cams/tiantanhos.htm
News article excerpt which highlights that this Beijing facility is
the most advanced in China:
"Beijing's first neuropathy diagnosis center equipped with computers
and digital technology was recently set up in Tiantan Hospital.
Beijing Daily said the center combines neurosurgery, neuroradiation,
neuromedicine, and neuropaediatrics. Altogether 37 well-known
neurologists, including Wang Zhongcheng and Zhao Yadu, from 12
hospitals in the city will work in the center.
Experts will use digital technology and computers to analyze and store
related information and medical reports of the patients during the
diagnosing period. They will also supply patients outside Beijing with
distance medical consultation.
Based on the medical records, examination results, and pictures sent
by the patients in other provinces and regions via the Internet, the
experts will be able to offer consultation and work out feasible
treatment plans."
"Beijing Sets up First Neuropathy Diagnosis Center" Mar 14, 2001
People's Daily
http://216.239.39.100/search?q=cache:XUabNb6GMvMC:english.peopledaily.com.cn/english/200103/14/eng20010314_65002.html+%22Tiantan+Hospital%22+Beijing&hl=en&ie=UTF-8
Other :
Abstract To investigate the clinical characteristics and management
strategies of bilateral acoustic neuromas
"Neurofibromatosis type 2" by XIE Dinghua, XIAO Zian, YUAN Xianrui
July 27, 1999 Department of Otorhinolaryngology & Hearing Research
Laboratory, Second Affiliated Hospital, Hunan Medical University
China, 37c.com
http://www.37c.com.cn/literature/analecta/data/zhebyhzz/200003/013.html
Zhongping Chen, M.D., Ph.D. Professor and Chairman
Department of Neurosurgery/Neuro-Oncology
Cancer Center, SunYat-sen University
President of Guangzhou Neuro-Oncology Society
651 DongFeng Road East
Guangzhou,
510060,
China
Telephone & Fax: 020-87752547 (in China)
Fax: (708)570-5940 (in North America)
E-mail: chenzp@gzsums.edu.cn
MAJOR FIELD:
Clinical practice (Neurosurgery/Neuro-oncology)
[including cerebello-pontine angle tumor surgery, specifically for
hearing preservation during acoustic neuroma surgery]
Department of Brain Oncology tumorh.gzsums.edu.cn
http://tumorh.gzsums.edu.cn/En/Departments/Brain_Oncology/czp.htm
Routine studies in acoustic neuroma by the China Medical College
Taiwan
(click right arrow to continue the slide show)
http://www.cmc.edu.tw/new/cmid/radiolog/book1/6/sld057.htm
Also some medical research at the Taiwan Medical Unit
http://medres.tmu.edu.tw/Ear/Pony/vd_1_rf_b.htm
(you need to have the simplified Chinese language component in your
browser otherwise the text will not show properly... Netscape 6 seems
to work OK)
The resources in mainland China appear to be relatively scarce. Maybe
due to the lack of specialist training / investment in the acoustic
neuroma area, cost of internet infrastructure / web publishing
capability, or a simple failure of search engines to pick up
simplified Chinese text acoustic neuroma websites... or a combination
of all. The 3 main medical locations appear, perhaps unsurprisingly,
to be in the 3 largest cities, Shanghai, Beijing and Hong Kong. I was
unable to source any Chinese specialist who dealt solely with acoustic
neuromas, as neurosurgeons who treat acoustic neuromas tend to give it
a focus, and continue with other neurosurgery activities.
Search Strategy:
"acoustic neuromas" china
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&newwindow=1&q=%22acoustic+neuromas%22+china
"acoustic neuroma" china
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&newwindow=1&q=%22acoustic+neuroma%22+china
"acoustic neuroma" .cn china OR PRC OR p.r.c.
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&newwindow=1&q=%22acoustic+neuroma%22+.cn+china+OR+PRC+OR+p.r.c.
Acoustic Neuroma
http://hk.websearch.yahoo.com/bin/query_hk?p=Acoustic+Neuroma&u=B&hc=0&hs=0
"acoustic neuroma" hong kong
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&newwindow=1&q=%22acoustic+neuroma%22+hong+kong
I hope that helps, if you need any clarification of the answer just
ask.
Kind regards
lot-ga |
