本研究报告得到了当地机构审查委员会 (能源公司-2016-00887) 的批准。
1. 标本的准备
<ol><li>将真空床垫放在解剖台上, 用无菌毯覆盖。将解剖标本放置在床垫上的外科位置, 头部微微旋转至对侧。</li>
	<li>收回耳屏与对侧的一个灵活的钩。</li>
	<li>把标本盖在外面的耳朵上, 就像在手术室里一样。 注: 请参阅材料表以了解所需设备的完整列表。</li>
</ol>2. 入门
<ol><li>采用舒适的站立或坐姿, 调整内窥镜屏幕。这是一个重要的问题, 以防止颈部肌肉硬化, 因此更快的疲惫。</li>
	<li>在您的相机菜单中执行白平衡, 并在内窥镜提示上应用一滴雾溶液。</li>
	<li>在你的优势手和内窥镜的另一只手拿着手术器械。</li>
	<li>引入0°, 3 毫米直径, 15 厘米长度内窥镜进入选管会。作为第一项任务, 清洁选管会彻底从最终目前的耳蜡使用吸管。用水冲洗选管会。在选管会内用一把小剪刀剪下头发, 防止内窥镜在每段期间变得肮脏。</li>
	<li>一旦选管会清洁, 检查鼓膜 (TM)。确定: -锤骨短流程, 柄和鳞 -鼓膜环 -松弛 (Shrappnel 膜)</li>
</ol>3. Tympano-道口皮瓣的标高 (TMF)
注: 在内窥镜耳手术中, TMF 的表现略小, 呈三角形。原因是选管会内的空间有限。
<ol><li>用镰刀或圆刀切割锤骨的皮肤, 稍微在短的过程前。</li>
	<li>将切口延伸至选管会后上部, 并将切口延长至 TM 的前、下缘, 以配置三角形状皮瓣。</li>
	<li>用45°角度圆刀, 露出骨骼并将皮肤抬高直到到达环形环。严格遵守骨骼是很重要的。</li>
	<li>用圆刀抬高环隙以进入鼓室腔 (TC)。TC 的粘膜比皮肤略微透明, 在鼓索的水平上用钩切开。</li>
	<li>利用 Thomassin 解剖, 调动环下和前。</li>
	<li>鉴定锤骨 (PLML) 的后侧韧带。这韧带代表了 Prussak 空间的下极限。用哈特曼钳抓住韧带, 在鳞的方向轻轻前, 直到揭开锤骨的短过程。</li>
	<li>轻轻地解剖前 Prussak 的空间, 直到到达前高级插入环。现在确定: 环 -鼓索 -后踝韧带 -侧踝 ligamental 褶皱 -前踝 ligamental 折叠 -Prussak 空间</li>
</ol>4. TMF 从锤骨的手柄上脱离
<ol><li>从锤骨的短过程, 继续解剖和切割的 periostium 踝手柄对鳞与针解剖。重要的是要分离 TM 在正确的平面, 以防止意外穿孔。</li>
	<li>从柄完全分离 TM。干燥的 cottonoid 也许是有用的, 因为它促进正确的层数和它的解剖的识别。</li>
	<li>一旦到达鳞, 用微剪刀切割 TM 的剩余纤维层。</li>
	<li>现在, 将整个皮瓣放在选管会的前壁上, 让他们可以自由进入 TC。确定: -鼓膜纤维层 -前高级环 -锤骨短流程, 柄和鳞 -鼓索前锤骨</li>
</ol>5. 中耳探查
注意: 这部分解剖有助于识别和排练中耳解剖。TC 的每个细分应分别使用0°和45°内镜进行探讨。最终出现的褶皱或坚持应小心去除。
<ol><li>Epitympanum确定: -锤骨: 颈部、短过程、柄和鳞 -骨: 身体, 长过程, 透镜状过程, 砧关节 -上膈肌: 前外侧踝韧带, 侧 incudomalleolar ligamental 襞 -前后脊柱 -鼓索 -鼓膜和通气模式的窦 -Cochleariform 工艺 -张索肌, 肌腱和骨管 -张量褶皱</li>
	<li>Mesotympanum确定: -镫: 小头, 前后小腿, 踏板 -镫肌肌腱 -金字塔隆起 -岬骨 -雅各布森的神经与下鼓室动脉</li>
	<li>Retrotympanum: 如果坚持存在, 他们应该彻底删除。将外科医生的位置改变为对侧, 便于角度光学 (45 °) retrotympanum。确定: -面部休息 -后窦 -Ponticulus 窦索 -Subiculum -茎隆起 -Subtympanic 窦 -Fustis 骨 -地区 concamerata -tegmen、前后柱的圆形窗龛 -圆窗膜 -Subcochlear 小 -Finiculus</li>
	<li>下 -下细胞 -估计 JVB 的本地化 (如果不可见)</li>
	<li>Protympanum确定: -Protiniculus -颈内动脉 -咽鼓管 (ET)</li>
	<li>Disarticulate 砧接头, 取出骨。用刮去掉盾牌。确定: -面神经鼓室段 -侧半规管 -窦 -齿轮或横向波峰 -Tegmen 索</li>
	<li>切开索肌的肌腱, 取出锤骨。确定: -前 Epitympanum -膝曲神经节</li>
</ol>

<ol>
	<li>Presutti, L., Marchioni, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Endoscopic Ear Surgery. , (2015).</li><li>Weiss, M. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgery+for+recurrent+and+residual+cholesteatoma.">Surgery for recurrent and residual cholesteatoma.</a> Laryngoscope. 102, 145-151 (1992).</li><li>Pickett, B. P., Cail, W. S., Lambert, P. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sinus+tympani:+anatomic+considerations,+computed+tomography,+and+a+discussion+of+the+retrofacial+approach+for+removal+of+disease.">Sinus tympani: anatomic considerations, computed tomography, and a discussion of the retrofacial approach for removal of disease.</a> Am J Otol. 16, 541-550 (1995).</li><li>James, A. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscope+or+microscope-guided+pediatric+tympanoplasty?+Comparison+of+grafting+technique+and+outcome.">Endoscope or microscope-guided pediatric tympanoplasty? Comparison of grafting technique and outcome.</a> Laryngoscope. , (2017).</li><li>Tarabichi, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+management+of+limited+attic+cholesteatoma.">Endoscopic management of limited attic cholesteatoma.</a> Laryngoscope. 114 (7), 1157-1162 (2004).</li><li>Bonali, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+variants+of+the+retro-+and+hypotympanum:+an+endoscopic+anatomical+study.">The variants of the retro- and hypotympanum: an endoscopic anatomical study.</a> Eur Arch Otorhinolaryngol. , (2017).</li><li>Bennett, M. L., Zhang, D., Labadie, R. F., Noble, J. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+Middle+Ear+Visualization+With+Endoscopy+and+Microscopy.">Comparison of Middle Ear Visualization With Endoscopy and Microscopy.</a> Otol Neurotol. 37 (4), 362-366 (2016).</li><li>Anschuetz, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+Ovine+Model+for+Exclusive+Endoscopic+Ear+Surgery.">An Ovine Model for Exclusive Endoscopic Ear Surgery.</a> JAMA Otolaryngol Head Neck Surg. 143 (3), 247-252 (2017).</li><li>Wang, M. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+costs+and+quality+of+operative+training+for+residents+in+tympanoplasty+type+I.">The costs and quality of operative training for residents in tympanoplasty type I.</a> Acta Otolaryngol. 129, 512-514 (2009).</li><li>Dedmon, M. M., Kozin, E. D., Lee, D. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+a+Temporal+Bone+Model+for+Transcanal+Endoscopic+Ear+Surgery.">Development of a Temporal Bone Model for Transcanal Endoscopic Ear Surgery.</a> Otolaryngol Head Neck Surg. 153 (4), 613-615 (2015).</li><li>Barber, S. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=3D-printed+pediatric+endoscopic+ear+surgery+simulator+for+surgical+training.">3D-printed pediatric endoscopic ear surgery simulator for surgical training.</a> Int J Pediatr Otorhinolaryngol. 90, 113-118 (2016).</li></ol>

作者声明没有利益冲突。LA 由 Bangerter-Rhyner 基金会, 伯尔尼, 瑞士和由卡尔 Storz GmbH, 图特林根, 德国。资助者在研究设计、数据收集和分析、决定出版或准备原稿方面没有作用。

所建议的解剖手册是有用的进行完整解剖的中耳。对中耳解剖的全面了解是任何中耳手术干预的基本前提。尸体解剖允许在选管会中训练照相机和手术器械的处理。对于一个新手在 EES, 眼睛和仪器之间的协调以及正确处理内窥镜 (没有弯曲, 在重要的解剖结构之间的听骨在一个有限的空间和 two-dimensional 图像) 是至关重要的这一新兴的外科技术开始的步骤。
与实际手术情况相比, 该模型的主要局限性是出血量不足。这适用于任何尸体解剖模型。最近, Dedmond et al。描述了一个颞骨模型, 其中出血是模拟在海拔的 TMF。这种模式实际上可能是一个很好的选择, 先进的外科医生已经习惯了 EES。根据我们的经验, 对 EES 的初步熟悉应尽可能简单, 因为处理这些文书已经是一项具有挑战性的任务。尸体解剖被认为是外科教育的黄金标准。然而, 它是受高费用和道德章程的。相比之下, 合成或动物模型可以克服这些问题8,11。然而, 在合成模型中, 组织的触觉感觉很困难, 3D 印刷的分辨率还不能提供解剖标本所能得到的所有细节。相比之下, 动物模型提供了优良的组织性能, 但有不同的解剖。我们可以考虑尸体模型作为解剖学教学的唯一合适的模型, 而合成和动物模型为外科训练提供便宜的选择。
与中耳解剖的显微技术相比, 内窥镜允许通过自然口、选煤厂观察和准备微妙的中耳结构。因此, 没有骨头必须被删除的目的和中耳可以研究它的自然状态。此外, 内窥镜允许非常密切的观察任何解剖结构, 从而也放大, 而不会失去照明。当然, 内镜检查方法不教授突, 这可能是在内窥镜解剖后同一个标本上进行的。鼻内窥镜技术是国际传播, 因此需要适当的外科训练将增加。

中耳位于颞骨的中心, 具有高度复杂的解剖学。最毗邻的结构是面神经 (FN), 耳蜗 (CO), ossiculary 链 (OC), 颈静脉球 (JVB) 和颈内动脉 (ICA)。中耳裂在解剖学上分为五部分: epitympanum 位于优, 并由窦连接到乳突空气细胞系统 (mac);retrotympanum 后是一系统的骨桥和或多或少浅的鼻窦;下在于下;前是与咽鼓管连接的 protympanum;在中心, 位于 mesotympanum1。
通过外耳道 (选管会) 的生理通路是狭窄的。因此, 标准的手术方法对中耳需要一个耳切口和钻井的 mac。这类干预是使用操作显微镜进行的。它的介绍是一个里程碑在耳手术, 因为它允许治疗显微中耳结构。然而, 显微镜有一个牵强的平直的看法, 并且一些区域, 特别是窦索, 是难接近的。尤其在胆脂瘤手术中, 有残留疾病的风险2,3。此外, 选管会、互委会及中耳的健康组织, 必须简单地移除, 以供取用。这不仅延长了手术时间, 而且还为更多的外科发病率和延长愈合时间4。
最近的进展导致引入内窥镜作为一个强有力的工具, 耳外科。内窥镜是第一次用于协助传统的手术外科医生, 以可视化的隐蔽区域的中耳。技术和手术的改进使内窥镜的介绍成为主要操作工具5。内窥镜的主要优点是全景和宽角度的中耳的看法。例如, 在不成形6的情况下, 可以使用独占内窥 transcanal 方法访问其他隐藏的复古和下。最近的一项研究显示, 与显微技术7相比, 所有中耳腔室的可见性均优于内窥镜。使用倾斜的内窥镜 (30 °和45°) 进一步提高了能见度, 并允许对中耳最隐蔽的区域进行解剖。
然而, 内窥镜耳手术 (EES) 是一种 one-handed 外科技术, 因为第二手一般持有内窥镜。这个问题和在选管会内狭窄的空间需要训练, 以提高外科医生的技能, 安全地应用在病人的技术。一般来说, 手术训练的金标准被认为是尸体解剖。在没有尸体标本或当地伦理问题的情况下, 一种用于内窥镜耳外科训练的动物模型最近被描述为8。外科训练被认为是一个重要因素在教育的受训人员在一个新的技术9。
尽管外科训练的重要性, 对如何进行尸体解剖的重要考虑的简要描述仍然缺乏文献。本文的目的是描述完全内镜下尸体中耳解剖的方法。此外, 我们的目的是为内窥镜中耳解剖提供一个全面的指南。

<table>
	<tbody>
		<tr>
			<td>Endoscopes: 3mm diameter, 15cm length, 0&#176; and 45&#176;</td>
			<td>Karl Storz</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Otologic dissectors, round knifes, hooks, curette, microscissors (Bellucci) and microforceps (Hartmann)</td>
			<td>Karl Storz</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Straight and curved suction tubes</td>
			<td>Karl Storz</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Flexible hook</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Scissors</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Video Equipment 
			- HD-scree 
			- 3-CCD camera 
			- Xenon light source</td>
			<td>Karl Storz</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Cadaveric Head</td>
			<td>-</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Vacuum matress</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Aspirator</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Consumables 
			- Water to rinse 
			- Antifog solution 
			- Cotton pads 
			- Cottonoid pledges 
			- Gown 
			- Gloves 
			- Mask</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

discovering middle ear anatomy by transcanal endoscopic ear surgery: a dissection manual

中耳位于颞骨的中心, 具有高度复杂的解剖学。最近引进的专门内窥镜 transcanal 方法的中耳是一种微创技术, 不遗余力的骨和粘膜的乳突骨, 因为中耳是通过外部听觉渠道访问。这种新兴的方法有几个优势优于传统的 (微观) 的方法, 以中耳, 如全景 wide-angle 的观点解剖, 可能接近和放大微小的结构, 并有可能环顾四周角落使用角度内窥镜。
这里提出的尸体解剖方法包括对技术要求的概述和一个 step-by 步协议的精确描述, 以发现中耳的解剖。每一个步骤和解剖结构被仔细描述, 以提供一个全面的指导, 内窥镜耳解剖。在我们看来, 这是特别重要的任何新手在内窥镜耳外科, 因为它提供了全面的解剖知识, 并可能提高手术技能。

我们使用所描述的指令解剖了总共五个头部标本和12颞骨标本 (n=22 侧)。对 TC 的不同区域进行了摄影和进一步分析。使用0°和45°内窥镜对所有区域进行了探索。我们对所有解剖区域进行了全面的探索, 并确定了所有的解剖标志。
解剖结构根据解剖的进展被说明。图 1说明了 Prussak 空间和踝韧带, 而图 2显示了完整的 TMF 提升后的解剖。wide-angle 视图允许可视化的中间-和下以及部分的 epi, 复古, 和 protympanum。在图 3中, 高级 retrotympanum 显示在45°内窥镜中, 而外科医生则站在表的另一侧。图 4详细说明了带有开裂 ICA 的 protympanum。在去除 OC 和 transcanal atticotomy 后, epitympanum 被检查到侧半规管和腔, 如图 5所示。
没有标本需要成形进行完整的探查鼓膜腔。在所有使用0°和45°范围的标本中都可以识别解剖结构。然而, retrotympanum, 特别是面部凹槽和窦索的完整的探索, 是不可能的在27% 的案件 (n=6), 因为这些骨的海湾是太深, 无法完全探索。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/56390/56390fig1.jpg"> 图 1。左耳朵, 0 °内窥镜: Prussak 的空间和周围的 ligamental 褶皱的锤骨的看法。tm: 鼓膜, a: 环, u: 鳞, sp: 锤骨的短的过程, 踝, 调频: 侧踝折叠, plm: 锤骨的后韧带, ct: 鼓索, *: Prussak 空间<a href="//cloudflare.jove.com/files/ftp_upload/56390/56390fig1large.jpg" target="_blank">请单击此处查看更大版本的此图.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/56390/56390fig2.jpg"> 图 2。左耳, 0 °内窥镜: tympano 道口瓣抬高后鼓室的视野。中、下以及部分的 epi-, 复古和 protympanum 是可视化的。公关: 海角, 约: 雅各布森: 下, fi: finiculus, 海温: 窦 subtympanicus, 硒: 茎隆起, pe: 金字塔隆起, st: 镫腱, isj: 砧关节, fn: 面神经, u: 鳞, m: 柄, sp: 短过程, n: 颈部锤骨, ttm: 张量索肌, 专题信托: 张量索褶皱, ica。颈内动脉<a href="//cloudflare.jove.com/files/ftp_upload/56390/56390fig2large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/56390/56390fig3.jpg"> 图 3。右耳、45°内窥镜、外科医生对侧位置: 使用角度内镜说明 retrotympanum 的优越性。fn: 面部神经, s: 镫, st: 镫肌腱, ps: 后窦, fp: 踏板, po: ponticulus, pe: 金字塔隆起, 坐: 窦索, 分, subiculum, se: 茎隆起, sst: 窦 subtympanicus, ap: 前柱, 三: tegmen, 聚丙烯: 后支柱, rw: 圆窗, 傅: fustis, tu: subcochlear 隧道<a href="//cloudflare.jove.com/files/ftp_upload/56390/56390fig3large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/56390/56390fig4.jpg"> 图 4。左耳, 45 °内窥镜: protympanum 的详细视图。注意颈动脉的开裂。et: 咽鼓管, ica: 颈内动脉, 临: protiniculus, co: 耳蜗, ttm: 张量索肌<a href="//cloudflare.jove.com/files/ftp_upload/56390/56390fig4large.jpg" target="_blank">请单击此处查看此图的较大版本.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/56390/56390fig5.jpg"> 图 5。左耳朵, 0 °内窥镜: 在去除骨和踝部和刮除盾牌之后, tegmen 索和窦的广泛的概要这里被说明。注意侧半规管和张量索肌在一条线上与面神经交叉。三: tegmen, 齿轮: 齿状或横脊, gg: 膝曲神经节, cp: cochleariform 过程, ttm: 张量索肌, 侧半规管, fn: 面神经鼓室段, s: 镫, co: 耳蜗, ica: 颈内动脉<a href="//cloudflare.jove.com/files/ftp_upload/56390/56390fig5large.jpg" style="font-size: 14px;" target="_blank">请单击此处可查看此图的较大版本.</a>

Watch this Scientific Journal Video about Discovering Middle Ear Anatomy by Transcanal Endoscopic Ear Surgery: A Dissection Manual at JoVE.com

Discovering Middle Ear Anatomy by Transcanal Endoscopic Ear Surgery: A Dissection Manual

本文的目的是描述完全内镜下尸体中耳解剖的方法。此外, 我们的目的是为内窥镜中耳解剖提供一个全面的指南。

Transcanal 内窥镜下耳部手术发现中耳解剖: 解剖手册

The middle ear is located in the center of the temporal bone and bears a highly complex anatomy. The recently introduced exclusively endoscopic transcanal ...

discovering-middle-ear-anatomy-transcanal-endoscopic-ear-surgery

Research

JoVE Journal

Medicine

63.9K 次观看.  University of Bern. 本文的目的是描述完全内镜下尸体中耳解剖的方法。此外, 我们的目的是为内窥镜中耳解剖提供一个全面的指南。

视频: Discovering Middle Ear Anatomy by Transcanal Endoscopic Ear Surgery: A Dissection Manual

Development of an Audio-based Virtual Gaming Environment to Assist with Navigation Skills in the Blind

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio based cues and set within the context of a video game metaphor, users gather relevant spatial information regarding a building's layout. This allows the user to develop an accurate spatial cognitive map of a large-scale three-dimensional space that can be manipulated for the purposes of a real indoor navigation task. After game play, participants are then assessed on their ability to navigate within the target physical building represented in the game. Preliminary results suggest that early blind users were able to acquire relevant information regarding the spatial layout of a previously unfamiliar building as indexed by their performance on a series of navigation tasks. These tasks included path finding through the virtual and physical building, as well as a series of drop off tasks. We find that the immersive and highly interactive nature of the AbES software appears to greatly engage the blind user to actively explore the virtual environment. Applications of this approach may extend to larger populations of visually impaired individuals.

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind.

基于音频的虚拟游戏环境的发展，以帮助盲人的导航技巧

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio ...

科研

医学

Retinal Detachment Model in Rodents by Subretinal Injection of Sodium Hyaluronate

Subretinal injection of sodium hyaluronate is a widely accepted method of inducing retinal detachment (RD). However, the height and duration of RD or the occurrence of subretinal hemorrhage can affect photoreceptor cell death in the detached retina. Hence, it is advantageous to create reproducible RDs without subretinal hemorrhage for evaluating photoreceptor cell death. We modified a previously reported method to create bullous and persistent RDs in a reproducible location with rare occurrence of subretinal hemorrhage. The critical step of this modified method is the creation of a self-sealing scleral incision, which can prevent leakage of sodium hyaluronate after injection into the subretinal space. To make the self-sealing scleral incision, a scleral tunnel is created, followed by scleral penetration into the choroid with a 30 G needle. Although choroidal hemorrhage may occur during this step, astriction with a surgical spear reduces the rate of choroidal hemorrhage. This method allows a more reproducible and reliable model of photoreceptor death in diseases that involve RD such as rhegmatogenous RD, retinopathy of prematurity, diabetic retinopathy, central serous chorioretinopathy, and age-related macular degeneration (AMD).

Creating experimental retinal detachments with a reproducible and sustained height of detachment, and without subretinal hemorrhage, is important for studying the pathophysiology of photoreceptor cell loss in retinal disease and evaluating potential therapeutic interventions. Here, we report such a method in detail.

视网膜脱离模型鼠害由透明质酸钠的视网膜下注射

Subretinal injection of sodium hyaluronate is a widely accepted method of inducing retinal detachment (RD). However, the height and duration of RD or the ...

Heterotopic Mucosal Engrafting Procedure for Direct Drug Delivery to the Brain in Mice

Delivery of therapeutics into the brain is impeded by the presence of the blood-brain barrier (BBB) which restricts the passage of polar and high molecular weight compounds from the bloodstream and into brain tissue. Some direct delivery success in humans has been achieved via implantation of transcranial catheters; however this method is highly invasive and associated with numerous complications. A less invasive alternative would be to dose the brain through a surgically implanted, semipermeable membrane such as the nasal mucosa that is used to repair skull base defects following endoscopic transnasal tumor removal surgery in humans. Drug transfer though this membrane would effectively bypass the BBB and diffuse directly into the brain and cerebrospinal fluid. Inspired by this approach, a surgical approach in mice was developed that uses a donor septal mucosal membrane engrafted over an extracranial surgical BBB defect. This model has been shown to effectively allow the passage of high molecular weight compounds into the brain. Since numerous drug candidates are incapable of crossing the BBB, this model is valuable for performing preclinical testing of novel therapies for neurological and psychiatric diseases.

A mouse model of human endoscopic skull base reconstruction has been developed that creates a semipermeable interface between the brain and nose using nasal mucosal grafts. This method allows researchers to study delivery to the central nervous system of high molecular weight therapeutics which are otherwise excluded by the blood-brain barrier when administered systemically.

异位黏膜移植程序直接给药到小鼠的大脑

Delivery of therapeutics into the brain is impeded by the presence of the blood-brain barrier (BBB) which restricts the passage of polar and high ...

Inducing Ischemia-reperfusion Injury in the Mouse Ear Skin for Intravital Multiphoton Imaging of Immune Responses

Ischemia-reperfusion injury (IRI) occurs when there is transient hypoxia due to the obstruction of blood flow (ischemia) followed by a subsequent re-oxygenation of the tissues (reperfusion). In the skin, ischemia-reperfusion (IR) is the main contributing factor to the pathophysiology of pressure ulcers. While the cascade of events leading up to the inflammatory response has been well studied, the spatial and temporal responses of the different subsets of immune cells to an IR injury are not well understood. Existing models of IR using the clamping technique on the skin flank are highly invasive and unsuitable for studying immune responses to injury, while similar non-invasive magnet clamping studies in the skin flank are less-than-ideal for intravital imaging studies. In this protocol, we describe a robust model of non-invasive IR developed on mouse ear skin, where we aim to visualize in real-time the cellular response of immune cells after reperfusion via multiphoton intravital imaging (MP-IVM).

This protocol describes the induction of an ischemia-reperfusion (IR) model on mouse ear skin using magnet clamping. Using a custom-built intravital imaging model, we study in vivo inflammatory responses post-reperfusion. The rationale behind the development of this technique is to extend the understanding of how leukocytes respond to skin IR injury.

在鼠耳皮肤的免疫反应的活体多光子成像诱导缺血再灌注损伤

Ischemia-reperfusion injury (IRI) occurs when there is transient hypoxia due to the obstruction of blood flow (ischemia) followed by a subsequent ...

A Surgical Procedure for the Administration of Drugs to the Inner Ear in a Non-Human Primate Common Marmoset (Callithrix jacchus)

Hearing research has long been facilitated by rodent models, although in some diseases, human symptoms cannot be recapitulated. The common marmoset (Callithrix jacchus) is a small, easy-to-handle New World monkey which has a similar anatomy of the temporal bone, including the middle ear ossicular chains and inner ear to humans, than in comparison with that of rodents. Here, we report a reproducible, safe, and rational surgical approach to the cochlear round window niche for the drug delivery to the inner ear of the common marmoset. We adopted posterior tympanotomy, a procedure used clinically in human surgery, to avoid manipulation of the tympanic membrane that may cause conductive hearing loss. This surgical procedure did not lead to any significant hearing loss. This approach was possible due to the large bulla structure of the common marmoset, although the lateral semicircular canal and vertical portion of the facial nerve should be carefully considered. This surgical method allows us to perform the safe and accurate administration of drugs without hearing loss, which is of great importance in obtaining pre-clinical proof of concept for translational research.

A Surgical Procedure for the Administration of Drugs to the Inner Ear in a Non-Human Primate Common Marmoset Callithrix jacchus

We report a surgical method to administrate drugs to the inner ear of a non-human primate, the common marmoset (Callithrix jacchus), via the round window membrane.

一种非人类灵长类常见狨中内耳药物的外科手术方法 (Callithrix jacchus)

Hearing research has long been facilitated by rodent models, although in some diseases, human symptoms cannot be recapitulated. The common marmoset ...

Posterior Semicircular Canal Approach for Inner Ear Gene Delivery in Neonatal Mouse

Inner ear gene therapy offers great promise as a potential treatment for hearing loss and dizziness. One of the critical determinants of the success of inner ear gene therapy is to find a delivery method which results in consistent transduction efficiency of targeted cell types while minimizing hearing loss. In this study, we describe the posterior semicircular canal approach as a viable method for inner ear gene delivery in neonatal mice. We show that gene delivery through the posterior semicircular canal is able to perfuse the entire inner ear. The easy anatomic identification of the posterior semicircular canal, as well as minimal manipulation of the temporal bone required, make this surgical approach an attractive option for inner ear gene delivery.

In this study, we describe the posterior semicircular canal approach as a reliable method for inner ear gene delivery in neonatal mice. We show that gene delivery through the posterior semicircular canal is able to perfuse the entire inner ear.

后半圆管法在新生小鼠内耳基因传递中的研究

Inner ear gene therapy offers great promise as a potential treatment for hearing loss and dizziness. One of the critical determinants of the success of ...

Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation

Endoscopic septoplasty is a surgical procedure in otolaryngology that is commonly performed to treat nasal airway obstruction caused by nasal septal deviation. It has a long history with multiple variations. In this article, a modified endoscopic septoplasty procedure using the limited two-line resection (2LoRs) technique at the posterior and inferior junction of the cartilaginous and bony septum is presented based on embryologic and anatomic knowledge of the nasal septum and the biomechanics of cartilaginous behavior. With this procedure, the quadrangular cartilage can be preserved as much as possible, which is helpful in retaining the supporting framework and rigidness of the septum. 2LoRs has been proven effective and sound for the correction of nasal septal deviation with rare complications. This modified procedure can be applied to correct the deviated nasal septum in the absence of any external nasal deformity to improve nasal patency or to improve access to the middle meatus or to the axillary region of the middle turbinate. It may also be used to expand the indications of septoplasty to children and adolescents because of its minimally invasive approach.

Endoscopic septoplasty is a time-honored surgical procedure with multiple variations. This paper focuses on a step-by-step surgical approach to perform a modified septoplasty procedure known as limited two-line resection. This surgical technique can be applied to correct a deviated nasal septum in the absence of an external nasal deformity.

内镜下鼻中隔成形术有限双线切除: 间隔偏差微创手术

Endoscopic septoplasty is a surgical procedure in otolaryngology that is commonly performed to treat nasal airway obstruction caused by nasal septal ...

Learning Modern Laryngeal Surgery in a Dissection Laboratory

Surgery for laryngeal malignancies requires millimetric accuracy from the different endoscopic and open techniques available. Practice of this surgery is almost completely reserved to a few referral centers that deal with a large proportion of this pathology. Practice on human specimens is not always possible for ethical, economic, or availability reasons. The aim of this study is to provide a reproducible method for the organization of a laryngeal laboratory on ex vivo animal models where it is possible to approach, learn, and refine laryngeal techniques. Porcine and ovine larynges are ideal, affordable, models to simulate laryngeal surgery given their similarity to the human larynx in their anatomical layout and tissue composition. Herein, the surgical steps of transoral laser surgery, open partial horizontal laryngectomy, and total laryngectomy are reported. The merging of endoscopic and exoscopic views guarantees an inside-out perspective, which is vital for the comprehension of the complex laryngeal anatomy. The method was successfully adopted during three sessions of a dissection course &#34;Lary-Gym&#34;. Further perspectives on robotic surgical training are described.

The purpose of this paper is to illustrate how to organize a reproducible laboratory for laryngeal surgery on affordable and closely similar animal laryngeal models in order to improve anatomical and surgical knowledge and skills.

在解剖实验室学习现代喉外科

Surgery for laryngeal malignancies requires millimetric accuracy from the different endoscopic and open techniques available. Practice of this surgery is ...

Using an Automated Hirschberg Test App to Evaluate Ocular Alignment

A smartphone app has been developed to perform the automated photographic Hirschberg test for objective measurement of ocular misalignment. By computing the difference in corneal reflection generated by the phone camera flash relative to the iris center based on high resolution images, the app can measure misalignment with a much higher precision than the naked eye performing the Hirschberg test. It has been validated in a previous clinical evaluation study by comparing to the clinical gold standard-prism and alternate cover test. The goal of this article is to describe the testing techniques regarding how to use the app to measure ocular alignment for different fixation distances, without or with cover to break fusion, as well as angle kappa, so that users can use the app to perform equivalent tests typically done in clinic using prisms.

We present a protocol of using a smartphone app to perform Hirschberg test for measuring manifest and intermittent ocular misalignment (strabismus) under near and far fixation conditions.

使用自动赫希伯格测试应用程序评估眼部对齐

A smartphone app has been developed to perform the automated photographic Hirschberg test for objective measurement of ocular misalignment. By computing ...

The Microscopic Transcanal Approach in Stapes Surgery Revisited

The microscopic transcanal (aka transmeatal) surgical approach was first described in the 60s, offering a minimally invasive means of reaching the external auditory canal, the middle ear, and epitympanon. Such an approach avoids a retroauricular or endaural skin incision; however, working through a narrow space needs angled microsurgical instruments and specific training in otologic surgery. The transcanal approach restricts the working space; however, it offers a binocular microscopic vision into the middle ear without extended skin incisions and thus, reducing post-operative pain and bleeding. In addition, this minimally invasive approach avoids scar tissue complications, hypoesthesia of the auricle, and potential protrusion of the pinna. Despite its numerous advantages, this method is still not routinely performed by otologic surgeons. Since this minimally invasive technique is more challenging, there is a need for extensive training in order for it to be widely adopted by otologic surgeons. This article provides step-by-step surgical instructions for stapes surgery and reports possible indications, pitfalls, and limitations using this microscopic transcanal technique.

This article describes the microscopic transcanal technique for stapes surgery, providing step-by-step surgical instructions for familiarizing surgeons with this approach.