Surgeons at Shanghai Jiao Tong College have developed a method that creates a “fence” of sutures round large nerve tumors earlier than elimination, dramatically bettering security for sufferers with plexiform neurofibromas that may develop bigger than footballs.
The FENCY ligation methodology, mixed with preoperative blood vessel blocking, has proven promising ends in 11 sufferers with big tumors measuring as much as 55.6 centimeters.
These uncommon tumors, related to neurofibromatosis Kind 1, have an effect on roughly 1 in 3,000 folks and may trigger extreme disfigurement and useful issues. Conventional surgical approaches usually fail as a result of large bleeding throughout operation, leaving sufferers with restricted therapy choices.
The Fence Technique
“It has been difficult resecting big PNF, notably when the tumors are extremely vascular and positioned in crucial anatomical areas the place bleeding and irreversible nerve injury are more likely to happen,” explains Dr. Zhichao Wang, the research’s lead researcher. The FENCY method addresses this by methodically inserting sutures across the tumor in a fence-like sample earlier than chopping.
The surgical course of entails marking the tumor space with blue dye, then inserting heavy silk sutures about 2-3 centimeters aside in a steady perimeter across the marked zone. Every suture penetrates deep sufficient to compress blood vessels feeding the tumor, creating seen pallor inside the enclosed space earlier than any chopping begins.
This systematic method proved efficient even in difficult areas just like the face and neck, the place proximity to crucial buildings usually makes surgical procedure extraordinarily dangerous.
Dramatic Leads to Complicated Circumstances
The analysis staff tracked outcomes for 11 sufferers with big tumors, discovering outstanding success charges:
- Median tumor measurement handled was 30.4 cm, with the biggest reaching 55.6 cm
- Most sufferers confirmed vital useful enchancment post-surgery
- Affected person satisfaction scores averaged 10 out of 10
- Just one affected person developed post-surgical an infection
- Median hospital keep was 17 days
Revolutionary Case: 14-Kilogram Tumor Elimination
The method’s most hanging success concerned a 23-year-old lady whose again and buttock tumor weighed 14 kilograms—roughly 31 kilos. Regardless of requiring vital blood transfusion in the course of the prolonged operation, she achieved outstanding mobility enchancment and returned 21 months later for elimination of remaining tumor tissue.
“Regardless of the complexity of the surgical procedures, most sufferers reported vital useful enchancment and excessive ranges of satisfaction,” Wang famous. “It’s gratifying to see how these sufferers, a few of whom had been coping with these tumors for years, regained mobility and improved their high quality of life after surgical procedure.”
Enhanced Security By means of Embolization
For essentially the most vascular tumors, surgeons added preoperative embolization—a process that blocks blood vessels feeding the tumor utilizing tiny coils inserted by means of catheters. Three sufferers acquired this extra therapy, which helped cut back bleeding throughout subsequent surgical procedure.
The research revealed fascinating patterns in blood loss. With out embolization, the median bleeding throughout surgical procedure was 208 milliliters, whereas sufferers who acquired each embolization and FENCY ligation skilled larger median bleeding of 756 milliliters—seemingly reflecting the choice of extra complicated instances for the mixed method.
Addressing a Important Medical Hole
The analysis addresses a major medical problem, as present therapy choices for these tumors stay extraordinarily restricted. Whereas MEK inhibitor medication exist for inoperable instances, they arrive with substantial prices, strict medicine schedules, and vital unwanted side effects that many sufferers discover troublesome to tolerate.
The method reveals specific promise for tumors in anatomically complicated areas the place conventional approaches like tourniquets can’t be used. The research discovered that 63.6% of big tumors occurred on the face, the place surgical precision proves particularly crucial.
Trying forward, researchers envision combining FENCY ligation with rising applied sciences like AI-assisted surgical planning and image-guided methods to additional improve precision and security. The staff emphasizes that bigger affected person research will probably be wanted to totally set up the tactic’s effectiveness and refine affected person choice standards.
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