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Autori principali:	Yu Huang, Qiang Liu, Ye Gu, Kai Xue, Quan Liu, Shixing Zheng, Huankang Zhang, Wanpeng Li, Xiaole Song, Han Li, Jingjing Wang, Weidong Zhao, Yuzhen Wang, Bo Peng, Liang Zeng, Huimin Xu, Lei Wang, Xicai Sun, Hongmeng Yu
Natura:	Artículo Open Access
Pubblicazione:	Wiley 2025
Soggetti:	Head & Neck
Accesso online:	https://onlinelibrary.wiley.com/doi/10.1002/hed.28107
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EC–IC Bypass for Skull Base Necrosis and ICA Rupture Hemorrhage After Radiotherapy for Nasopharyngeal Carcinoma Yu Huang Qiang Liu Ye Gu Kai Xue Quan Liu Shixing Zheng Huankang Zhang Wanpeng Li Xiaole Song Han Li Jingjing Wang Weidong Zhao Yuzhen Wang Bo Peng Liang Zeng Huimin Xu Lei Wang Xicai Sun Hongmeng Yu Head & Neck ABSTRACTBackgroundSkull base necrosis can cause life‐threatening massive bleeding in patients following radiotherapy and chemotherapy for nasopharyngeal carcinoma. Patients with bilateral internal carotid artery rupture and hemorrhage are especially susceptible, which is a major challenge for clinicians.MethodsA team at the Eye and ENT Hospital affiliated with Fudan University recently successfully treated a patient with skull base necrosis after radiotherapy and chemotherapy for nasopharyngeal carcinoma. The patient experienced bilateral internal carotid artery rupture with massive nasopharyngeal hemorrhage and was treated with extracranial–intracranial bypass surgery, resection of the nasal skull base necrotic lesions, and bilateral internal carotid artery occlusion.ResultsOne week after the last surgery, the patient recovered well, and normal activity was restored.ConclusionsSimultaneous EC–IC bypass and TMF repair increase intracranial blood flow compensation without the need for an additional incision, saving the patient's life and improving their quality of life. These results highlight a promising surgical practice for rescuing patients suffering from skull base necrosis and ICA rupture hemorrhage. 10.1002/hed.28107 http://onlinelibrary.wiley.com/termsAndConditions#vor

if (filemtime($filename) + $maxlifetime < time()) { unlink($filename); $count++; } } return $count; } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ protected function saveSession($sessId, $data): bool { $sessFile = $this->path . '/sess_' . $sessId; if ($handle = fopen($sessFile, 'w')) { $return = false; // Lock the file for exclusive access to avoid issues with multiple // processes writing session simultaneously: if (flock($handle, LOCK_EX)) { $return = fwrite($handle, $data); // Make sure that there's no trailing data by truncating the file to // the correct length: ftruncate($handle, strlen($data)); fflush($handle); flock($handle, LOCK_UN); } fclose($handle); if ($return !== false) { return true; } } // If we got this far, something went wrong with the file output... // It is tempting to throw an exception here, but this code is called // outside of the context of exception handling, so all we can do is // echo a message.

// Anecdotal testing Today and Yesterday seems to indicate destroy() // is called by the garbage collector and everything is good. // Something to keep in mind though. return 0; } /** * Write function that is called when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ public function write($sessId, $data): bool { if ($this->writesDisabled) { return true; } return $this->saveSession($sessId, $data); } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ abstract protected function saveSession($sessId, $data): bool; }

* * @return void */ public function writeClose() { // The assumption is that we're using PHP's ext/session. // session_write_close() will actually overwrite $_SESSION with an // empty array on completion -- which leads to a mismatch between what // is in the storage object and $_SESSION. To get around this, we // temporarily reset $_SESSION to an array, and then re-link it to // the storage object. // // Additionally, while you _can_ write to $_SESSION following a // session_write_close() operation, no changes made to it will be // flushed to the session handler. As such, we now mark the storage // object isImmutable. $storage = $this->getStorage(); if (! $storage->isImmutable()) { $_SESSION = $storage->toArray(true); session_write_close(); $storage->fromArray($_SESSION); $storage->markImmutable(); } } /** * Attempt to set the session name * * If the session has already been started, or if the name provided fails * validation, an exception will be raised. * * @param string $name * @return SessionManager * @throws Exception\InvalidArgumentException */ public function setName($name) { if ($this->sessionExists()) { throw new Exception\InvalidArgumentException( 'Cannot set session name after a session has already started'

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