伴有颅内血肿的前循环破裂出血动脉瘤超早期显微手术治疗

目的 探讨伴有颅内血肿的前循环破裂出血动脉瘤超早期显微手术治疗.方法 27例前循环动脉瘤破裂伴颅内血肿形成患者24 h内行显微手术治疗,探讨其影像学特点、手术方法.结果 27例术中诊断与术前一致,责任动脉瘤为前交通动脉瘤6例,后交通动脉瘤8例,大脑中动脉瘤13例.多发动脉瘤3例,2例位于同侧前循环,1次手术夹闭,1例另1枚动脉瘤位于对侧大脑中动脉分叉处,择期手术处理.出血动脉瘤均为中小型动脉瘤.术后GOS分级Ⅴ级14例,Ⅳ级9例,Ⅲ级2例,Ⅰ级2例.结论 前循环动脉瘤破裂伴颅内血肿形成超早期显微手术清除血肿,夹闭动脉瘤,效果满意.

Abstract：

Objective To explore ultra - early microsurgical management in patients with ruptured aneurysms of anterior circlulation combined with intracerebral hematoma. Method The imaging characteristics and operation methods of 27 cases of ruptured aneurysms of anterior circlulation combined with intracerebral hematoma underwent surgery within 24 hours were collected. Results The surgical outcomes indicated that the intraoperative diagnoses were consistent with preoperative diagnoses in all cases. The rupture aneurysms include 6 cases of anterior communicating artery aneurysms,8 posterior communicating artery aneurysms,and 13 middle cerebral artery aneurysms. There were 3 patients harbored two aneurysms,2 in homolateral anterior circulation clipped at the same time, 1 in contralateral middle artery clipped in another operation. The aneurysms were all middle or small size. The postoperative Glasgow Outcome Scales (GOS) were grade Ⅴ in 14 patients,grade Ⅳ in 9, grade Ⅲ in 2, grade Ⅰ in 2. Conclusions For patients with ruptured aneurysms of anterior circlulation combined with intracerebral hematoma, favorable outcome chould be achieved through ultra - early microsurgical management     

Study of CT and etiology In 11B cases of eoute headache without hemlplegla

objectal To study the relation between CT and etiology of acute headache without hemiplegia. Methods 118 cases of acute headache without hemiplegia were studied with CT scan. The patients with normal CT were diagnosed with lumbar punc -tura or diagnostic standard for establishing disease. Results The first three etiologies were cerebrovescular disease (65 cases, 55%), migraine (25 cases, 21%), meningitis and encephalitis (19 cases, 155. 9%). 53% of patients with subarachnoid hemorrhage(SAH) was diagnosed in CT unnormal group, and 12.4% of patients with Sall was showed by lumbar puncture in CT normal group(P＜0. 001). CT was normal in 18% of patients with a definite SAH(7/39). The positive rates of intracranial infection in CT normal group(by lumbar puncture) was reearkably higher than in CT unnormal group (18/58 versus 2/60, p＜0.005), Conolusion CT is more sensitive to intracranial hemorrhage, tumor and infarction. SAH of a negative Ctscan is not rare. CT is far inferior to lumbar puncture in meningitis or encephalitis.     

Alterations in amyloid beta-protein and apolipoprotein E in cerebrospinal fluid after subarachnoid hemorrhage

BACKGROUND: The findings about the alterations in cerebrospinal fluid beta-amyloid protein (Aβ) and apolipoprotein E (ApoE) after subarachnoid hemorrhage indicate that they have significant correlation with prognosis of patients. OBJECTIVE: To observe the alterations in cerebrospinal fluid Aβ and ApoE after subarachnoid hemorrhage (SAH). DESIGN: Contrast observation. SETTING: Department of Neurosurgery, the First Hospital of Lanzhou University. PARTICIPANTS: A total of 25 SAH patients including 16 males and 9 females aged from 13 to 72 years were selected form Department of Neurosurgery, the First Affiliated Hospital of Lanzhou University from October 2003 to February 2004. The Hunt-Hess grade ranged from Ⅰ to Ⅳ, and patients admitted hospital in 24 hours after invasion, affirmed by the brain CT scan and lumbar vertebra puncture, no other severe complications and important organs' functional defect and severe infection, no hematological system disease. METHODS: All admitted patients were collected CSF by lumbar vertebra puncture in 24 hours. The cerebrospinal fluid (CSF) of control group came from the admitted 15 patients of our hospital that have no nervous system disease. Aβ content was detected by enzyme linked immunosorbent assay (ELISA), the kit was provided by the Central Laboratory of the First Hospital of Lanzhou University; ApoE concentration was detected by monoclone enzyme linked immunosorbent assay (ELISA), the kit was provided by the Immunotechnique Research Institute of the Fourth Military Medical University. S100B concentration was detected by enzyme linked immunosorbent assay double antibody sandwich method, the kit was provided by the Physiological Research Room of the Fourth Military Medical University. The data were indicated on Mean±SD and were analyzed by SPSS 10.0 statistical package. All data were handled through test of significance variance analysis, and groups were compared through independent sampler t test. The concentration was handled through Pearson correlation analysis between Aβ and ApoE. The relationship between Aβ, ApoE concentration with pathogenetic condition and prognosis of the patients was handled through Spearman ranking correlation analysis. MAIN OUTCOME MEASURES: ① The concentration of ApoE, Aβ and S100B after SAH in contrast to the control group in CSF by different Hunt-Hess and Glasgow Outcome Scale (GOS) grades; ② The level of correlation between ApoE and Aβ; ③ Correlation between ApoE and Aβin pathogenetic condition and prognosis of the patients. RESULTS: All 25 SAH patients and 15 controls were involved in the final analysis. ① The concentration of ApoE, Aβand S100B in CSF: The concentration of ApoE decreased after SAH in contrast to the control group [(0.46±0.007), (0.85±0.11) μg/L, P < 0.01], the concentration of ApoE decreased after SAH in contrast to the control group [(5.36±1.19), (8.41±1.60) μg/L, P < 0.01], and the concentration of S100B increased after SAH in contrast to the control group [(18.60±7.31), (6.56±1.02) pg/L, P < 0.01]. ② The concentration of ApoE, Aβ and S100B in CSF after SAH on different Hunt-Hess and GOS grades: The concentration of Aβin Hunt-Hess Ⅰ–Ⅲ grade was higher than Hunt-Hess Ⅳ, Ⅴ grade [(6.63±1.25), (3.35±1.02) μg/L, P < 0.01], and the concentration of ApoE in Hunt-Hess Ⅰ–Ⅲ grade was higher than Hunt-Hess IV, V grade [(0.56±0.07), (0.38±0.04) μg/L, P < 0.05], the concentration of S100B in Hunt-Hess Ⅰ–Ⅲ grade was lower than Hunt-Hess Ⅳ–Ⅴ grade [(16.32±5.58), (22.85±8.10) pg/L, P < 0.01]; the concentration of Aβ in GOSⅠ–Ⅲ grade was lower than GOS Ⅳ, Ⅴ grade [(3.76±1.04), (5.89±1.20) μg/L, P < 0.01], and the concentration of ApoE in GOS Ⅰ–Ⅲ grade was lower than GOS Ⅳ, Ⅴ grade [(0.32±0.02), (0.58±0.07) μg/L, P < 0.01], and the concentration of S100B in GOS Ⅰ–Ⅲ grade was higher than GOS Ⅳ, Ⅴ grade [(25.36±9.70), (14.33±6.69) pg/L, P < 0.01]. ③ The results of Pearson correlation analysis and Spearman ranking correlation analysis: There was significantly positive correlation between CSF Aβconcentration and clinical outcome (r =0.65, P < 0.01), and the decrease in CSF Aβconcentration correlated significant with that of ApoE (r =0.85, P < 0.01). CONCLUSION: There is a significant decrease in both Aβ and ApoE in the CSF after SAH, and there is significant correlation between CSF Aβand ApoE concentration with clinical outcome, the interactions between these proteins may have important effects on SAH, ApoE and Aβas surrogate markers for the outcome of patients with SAH.     

血肿腔钻孔联合侧脑室置管引流治疗老年性高血压脑出血的临床研究(附168例报道)

目的 探讨血肿腔钻孔联合侧脑室置管引流治疗老年性高血压脑出血的临床效果.方法对解放军第四七四医院神经外科自2002年3月至2009年2月收治的168例老年性高血压脑出血患者应用血肿腔钻孔联合侧脑室置管引流加尿激酶溶解血肿的方法进行治疗,术后随访6～12个月,根据GOS评分评价患者治疗效果,并分别对患者术前意识分级、出血量大小与预后程度关系进行统计学分析.结果 本组患者预后良好91例,轻残41例,重残及植物生存13例,死亡23例,术后并发症较少.术前意识分级Ⅰ～Ⅱ级组和Ⅲ～Ⅳ级组、出血量30～70 mL组和70 mL以上组患者预后差异有统计学意义(P＜0.05),平均秩次比较显示Ⅰ～Ⅱ级组患者疗效明显优于Ⅲ～Ⅳ级组,30～70mL组患者疗效明显优于70mL以上组.结论 血肿腔钻孔联合侧脑室置管引流加尿激酶溶解血肿是治疗老年性高血压脑出血的有效方法.

Abstract：

Objective To explore the clinical treatment efficacy of punch drainage combined with ventricle puncture in patients with senile hypertensive hemorrhage. Methods One hundred and sixty-eight patients with senile hypertensive hemorrhage, admitted to our hospital from March 2002 to February 2009, were treated by punch drainage combined with ventricle puncture and hematoma dissolution with urokinase. Meanwhile, follow-up for 6-12 months was performed to every patient; the postoperative treatment effects and complications were evaluated by Glasgow Outcome Scale; the relations between the prognosis and both the amount of intracerebral hemorrhage and grades of consciousness situation were statistically analyzed. Results Good prognosis was noted in 91 patients,mild disability in 41, severe disability and vegetative state in 13, and death in 23; few postoperative complications were noted. The prognoses were significantly different in patients with different amounts of intracerebral hemorrhage; so are those in patients with different grades of consciousness situation (P＜0.05); the prognosis of patients under grade Ⅰ-Ⅱ consciousness situation was better than that of patients under grade Ⅲ-Ⅳ consciousness situation and the prognosis of patients with hemorrhage between 30-70 mL was obviously better than that of patients with hemorrhage above 70 mL. Conclusion The punch drainage combined with ventricle puncture and hematoma dissolution with urokinase is an effective treatment method for patients with senile hypertensive intracerebral hematoma.     

Prognosis in prolonged coma patients with diffuse axonal injury assessed by somatosensory evoked potential

A total of 43 prolonged coma patients with diffuse axonal injury received the somatosensory evoked potential examination one month after injury in the First Affiliated Hospital, School of Medicine, Zhejiang University in China. Somatosensory evoked potentials were graded as normal, abnormal or absent (grades Ⅰ-Ⅲ) according to N20 amplitude and central conduction time. The outcome in patients with grade Ⅲ somatosensory evoked potential was in each case unfavorable. The prognostic accuracy of grade Ⅲ somatosensory evoked potential for unfavorable and non-awakening outcome was 100% and 80%, respectively. The prognostic accuracy of grade Ⅰ somatosensory evoked potential for favorable and wakening outcome was 86% and 100%, respectively. These results suggest that somatosensory evoked potential grade is closely correlated with coma severity and degree of recovery. Somatosensory evoked potential is a valuable diagnostic tool to assess prognosis in prolonged coma patients with diffuse axonal injury.     

神经内镜辅助眶上锁孔入路早期夹闭前交通动脉瘤

目的 探讨应用神经内镜辅助眶上锁孔入路早期手术夹闭前交通动脉瘤的疗效.方法中南大学湘雅医学院附属海口医院神经外科自2002年1月至2010年1月采用神经内镜辅助眶上锁孔入路在出血早期(72 h内)手术治疗前交通动脉瘤(Hunt-Hess分级1～3级)患者35例,回顾性分析患者的临床资料和疗效.结果 35例患者均顺利完成动脉瘤夹闭.2例患者术中动脉瘤破裂,经临时阻断载瘤动脉快速解剖瘤颈后夹闭;患者均无入路相关的严重并发症;术后复查DSA或CTA证实动脉瘤夹闭完全,载瘤动脉无狭窄,远端动脉通畅良好.术后3个月复诊时,30例(85.7%)患者恢复良好(GOS评分4～5分),所有患者切口美容效果良好.结论 出血早期(72 h内)经神经内镜辅助眶上锁孔入路手术处理Hunt-Hess分级Ⅰ～Ⅲ级前交通动脉瘤患者安全、有效.

Abstract：

Objective To evaluate the effectiveness of the endoscope-assisted supraorbital keyhole approach in the early surgical treatment of patients with ruptured anterior communicating artery aneurysms (AcoA). Methods Thirty-five patients with ruptured AcoA, admitted to our hospital from January 2002 to January 2010, adopted clipping via endoscope-assisted supraorbital keyhole approach within 72 h of onset. The neurostatus of these patients were ranged from grade 1 to 3 (Hunt-Hiss Scale scores). The surgical details were described, and the clinical results were assessed according to the scores of Glasgow Outcome Scale.Results Operations were successfully finished in all patients; the endoscope-assisted supraorbital keyhole approach offered sufficient exposure of neurovascular structures for clipping AcoA. Intraoperative accidental aneurysm rupture occurred in 2 patients, but these events were managed successfully by blocking-up the parent artery and performing quick aneurysm neck dissection; no serious complications caused by the surgical approach occurred; postoperative DSA or CTA indicated that the aneurysm was totally clipped and the parent artery appeared no stenosis, and distal artery was unobstructed. Three months after the operation, 30 patients (85.7%) achieved very good outcomes (GOS:4-5 scores). All the patients achieved good cosmetic results. Conclusion In selected AcoA patients with grade 1-3, the endoscope-assisted supraorbital keyhole approach is safe and effective for gaining access to and treating the aneurysms on early hemorrhage stage.     

改良翼点入路显微切除鞍结节脑膜瘤

Objective To summarize the experience with modified transpterygoid craniotomy for microsurgical resection of tuberculum sellae meningiomas. Methods The clinical data were retrospectively analyzed in 26 patients with tuberculum sellae meningiomas admitted between January, 2001 and April, 2007 in our hospital to receive microsurgical meningioma removal using a modified transpterional approach. The basal part of the tumor was firstly coagulated and dissected to control the blood supply of the lesion. Through the cerebral cisterns in the sellar region and the interfaces between the tumor and the adjacent structures, the tumor was removed to the greatest possible extent with minimal invasiveness to the neighboring structures. Results Simpson grade Ⅰ resection was achieved in 11 patients, grade Ⅱ resection in 14 patients, and grade Ⅲ resection in 1 patient. The visual acuity and the optic field were improved in 23 patients, and remained unchanged in 1 patient after the operation. Two patients had postoperative visual acuity deterioration, which was improved after appropriate treatment. Seven patients developed diabetes insipidus after the operation, and gradually recovered after symptomatic treatments for about 10 days without fatal consequences. Follow-up for 6 months to 5 years found no recurrence of meningiomas in these patients. Conclusions The modified transpterional approach provides excellent exposure of the middle fossa, anterior cranial fossa, saddle and parasellar areas, and is effective for different types of tuberculum seilae meningiomas with increased total resection rate and reduced postoperative complications.     

Treatment for arteriovenous malformation of the brain——Comparison between microsurgery and gamma knife

BACKGROUND: Microsurgery and gamma knife are the mainly ways to treat arteriovenous malformation of brain in grade Spetzler-Martin Ⅰ–Ⅲ; however, therapeutic effects of them need to be further studied. OBJECTIVE: To compare the therapeutic effects between microsurgery and gamma knife on the treatment of arteriovenous malformation of brain in grade Spetzler-Martin Ⅰ–Ⅲ. DESIGN: Retrospective analysis. SETTING: Department of Neurosurgery, the Third Hospital Affiliated to Sun Yat-sen University; Guangdong Microinvasion Center. PARTICIPANTS: A total of 86 patients with arteriovenous malformation of the brain were selected from the Department of Neurosurgery, the Third Hospital Affiliated to Sun Yat-sen University and Guangdong Microinvasion Center from January 1997 to February 2007. After DSA, CT and/or MRI examinations, patients were evaluated in grade Spetzler-Martin Ⅰ–Ⅲ. All patients were divided into microsurgery group (n = 34) and gamma knife group (n =52). There were 22 males and 12 females in the microsurgery group and their mean age was 26 years, while there were 34 males and 18 females in the gamma knife group and their mean age was 28 years. The grade of Spetzler-Martin was comparable in the two groups. All their relatives provided the confirmed consent and the study was allowed by ethics committee of our hospital. METHODS: Under complete anesthesia, patients were given microsurgery and the operative approach was chosen based on diseased regions. Firstly, feeding artery was blocked; secondly, it was separated along band of gliosis between malformation vessel mass and brain tissue; finally, draining vein was cut off and malformation vessel mass was resected. On the other hand, patients in the gamma knife group received Leksell-2300B gamma knife treatment. Leksell-G stereotaxis headframe was installed; GE1.5TMR scanning device was used for localization; r-Plan5.2 workstation was used for target design and dosage program; Leksell B gamma knife was used during the whole operative procedure. The target was 1–4 and peripheral dosage was 12–28 Gy. At 0.5, 1 and 2 years after operation, angiography was used to detect vascular occlusion in the two groups. Meanwhile, focal hemorrhage and new neurological function defect (including hemiplegic paralysis, language disorder, cerebellar function disorder, increasing frequency of epilepsy, etc.) were also observed. MAIN OUTCOME MEASURES: Rate of vascular occlusion, focal hemorrhage and neurological function defect at different time points after operation. RESULTS: All 86 patients were involved in the final analysis. Vascular nest of patients in the microsurgery group disappeared completely; while, two patients (6%, 2/34) had new neurological function defect but did not have rehaemorrhagia and death after operation. On the other hand, vascular nest of 43 patients (83%, 43/52) in the gamma knife group disappeared completely, and 8 (15%, 8/52) had new neurological function defect. There was significant difference between the two groups (χ2=2.63, P < 0.05). Six patients (12%, 6/52) in the gamma knife group had rehaemorrhagia after operation, and one (2%, 1/52) died. CONCLUSION: Both microsurgery and gamma knife have great effects on the treatment of arteriovenous malformation of brain in grade Spetzler-Martin Ⅰ–Ⅲ; however, the therapeutic effects of microsurgery are superior to those of gamma knife.     

脑梗死患者颅内大动脉支架置入术前后vWF水平变化与血管狭窄程度的关系研究

Objective To understand the correlation between plasma von Wilebrand factor (vWF) changes after stenting and the degree of preoperative intracranial major artery stenosis in patients with acute atherosclerotie cerebral infarction. Methods This study involved 38 consecutive patients with acute cerebral infarction due to intracranial major artery atherosclerosis, who were admitted between February and October 2008 and underwent stent placement in the stenotic arteries. Thirty healthy volunteers were also recruited to serve as the control group. The patients were divided into severe stenosis group (with stenosis of the intracranial major artery≥70%) and non-severe stenosis groups. Venous blood samples were obtained from the subjects on the morning of the first and 7th days after admission to measure the plasma levels of vWF using sandwich enzyme-linked immunosorbent assay. Results The plasma levels of vWF were significantly higher in patients with acute cerebral infarction than in the control group(P=0.000). Compared with those with non-severe stenosis, the patients with severe stenosis exhibited significantly higher plasma levels of vWF (P=0.015) and greater vWF variation after stent placement (P=0.000). Conclusions In patients with acute atherosclerotic cerebral infarction due to severe intracranial major artery stenosis, the plasma levels of vWF and its postoperative variation are positively correlated to the degree of senosis of the culprit arteries, and severer stenosis is associated with greater postoperative damage of the vascular endothelium.     

脑梗死患者颅内大动脉支架置入术前后vWF水平变化与血管狭窄程度的关系研究

Objective To understand the correlation between plasma von Wilebrand factor (vWF) changes after stenting and the degree of preoperative intracranial major artery stenosis in patients with acute atherosclerotie cerebral infarction. Methods This study involved 38 consecutive patients with acute cerebral infarction due to intracranial major artery atherosclerosis, who were admitted between February and October 2008 and underwent stent placement in the stenotic arteries. Thirty healthy volunteers were also recruited to serve as the control group. The patients were divided into severe stenosis group (with stenosis of the intracranial major artery≥70%) and non-severe stenosis groups. Venous blood samples were obtained from the subjects on the morning of the first and 7th days after admission to measure the plasma levels of vWF using sandwich enzyme-linked immunosorbent assay. Results The plasma levels of vWF were significantly higher in patients with acute cerebral infarction than in the control group(P=0.000). Compared with those with non-severe stenosis, the patients with severe stenosis exhibited significantly higher plasma levels of vWF (P=0.015) and greater vWF variation after stent placement (P=0.000). Conclusions In patients with acute atherosclerotic cerebral infarction due to severe intracranial major artery stenosis, the plasma levels of vWF and its postoperative variation are positively correlated to the degree of senosis of the culprit arteries, and severer stenosis is associated with greater postoperative damage of the vascular endothelium.     

脑梗死患者颅内大动脉支架置入术前后vWF水平变化与血管狭窄程度的关系研究

Objective To understand the correlation between plasma von Wilebrand factor (vWF) changes after stenting and the degree of preoperative intracranial major artery stenosis in patients with acute atherosclerotie cerebral infarction. Methods This study involved 38 consecutive patients with acute cerebral infarction due to intracranial major artery atherosclerosis, who were admitted between February and October 2008 and underwent stent placement in the stenotic arteries. Thirty healthy volunteers were also recruited to serve as the control group. The patients were divided into severe stenosis group (with stenosis of the intracranial major artery≥70%) and non-severe stenosis groups. Venous blood samples were obtained from the subjects on the morning of the first and 7th days after admission to measure the plasma levels of vWF using sandwich enzyme-linked immunosorbent assay. Results The plasma levels of vWF were significantly higher in patients with acute cerebral infarction than in the control group(P=0.000). Compared with those with non-severe stenosis, the patients with severe stenosis exhibited significantly higher plasma levels of vWF (P=0.015) and greater vWF variation after stent placement (P=0.000). Conclusions In patients with acute atherosclerotic cerebral infarction due to severe intracranial major artery stenosis, the plasma levels of vWF and its postoperative variation are positively correlated to the degree of senosis of the culprit arteries, and severer stenosis is associated with greater postoperative damage of the vascular endothelium.     

脑梗死患者颅内大动脉支架置入术前后vWF水平变化与血管狭窄程度的关系研究

Objective To understand the correlation between plasma von Wilebrand factor (vWF) changes after stenting and the degree of preoperative intracranial major artery stenosis in patients with acute atherosclerotie cerebral infarction. Methods This study involved 38 consecutive patients with acute cerebral infarction due to intracranial major artery atherosclerosis, who were admitted between February and October 2008 and underwent stent placement in the stenotic arteries. Thirty healthy volunteers were also recruited to serve as the control group. The patients were divided into severe stenosis group (with stenosis of the intracranial major artery≥70%) and non-severe stenosis groups. Venous blood samples were obtained from the subjects on the morning of the first and 7th days after admission to measure the plasma levels of vWF using sandwich enzyme-linked immunosorbent assay. Results The plasma levels of vWF were significantly higher in patients with acute cerebral infarction than in the control group(P=0.000). Compared with those with non-severe stenosis, the patients with severe stenosis exhibited significantly higher plasma levels of vWF (P=0.015) and greater vWF variation after stent placement (P=0.000). Conclusions In patients with acute atherosclerotic cerebral infarction due to severe intracranial major artery stenosis, the plasma levels of vWF and its postoperative variation are positively correlated to the degree of senosis of the culprit arteries, and severer stenosis is associated with greater postoperative damage of the vascular endothelium.     

脑梗死患者颅内大动脉支架置入术前后vWF水平变化与血管狭窄程度的关系研究

Objective To understand the correlation between plasma von Wilebrand factor (vWF) changes after stenting and the degree of preoperative intracranial major artery stenosis in patients with acute atherosclerotie cerebral infarction. Methods This study involved 38 consecutive patients with acute cerebral infarction due to intracranial major artery atherosclerosis, who were admitted between February and October 2008 and underwent stent placement in the stenotic arteries. Thirty healthy volunteers were also recruited to serve as the control group. The patients were divided into severe stenosis group (with stenosis of the intracranial major artery≥70%) and non-severe stenosis groups. Venous blood samples were obtained from the subjects on the morning of the first and 7th days after admission to measure the plasma levels of vWF using sandwich enzyme-linked immunosorbent assay. Results The plasma levels of vWF were significantly higher in patients with acute cerebral infarction than in the control group(P=0.000). Compared with those with non-severe stenosis, the patients with severe stenosis exhibited significantly higher plasma levels of vWF (P=0.015) and greater vWF variation after stent placement (P=0.000). Conclusions In patients with acute atherosclerotic cerebral infarction due to severe intracranial major artery stenosis, the plasma levels of vWF and its postoperative variation are positively correlated to the degree of senosis of the culprit arteries, and severer stenosis is associated with greater postoperative damage of the vascular endothelium.     

迷走神经刺激术治疗顽固性癫痫初步探讨

Objective To investigate the effectiveness of vagus nerve stimulation (VNS) therapy in intractable epilepsy. Methods VNS were performed in twenty - one patients. The generator was turned on 2 weeks after operation. Stimulation parameters were adjusted gradually. The output currents adjusted from 0.25 mA, and less than 3.0 mA. Stimulative time was 30 s ON and 5 min OFF, the frequency was from 20to 30 Hz, and the pulse width was from 250 μs to 1000 μs. The patients were followed up so as to analysis the effectiveness. Results After4 - 16 months of intermittent stimulation of the vagus nerve, grade Ⅰ in 3 patients, grade Ⅱ in 7 patients, grade Ⅲ in 9 patients and grade Ⅴ in 2 patients. Among them, seizure frequency was reduced over 50% occurred in 10 patients. Conclusion VNS can reduce seizure frequency,improve the quality of life in patients with intractable epilepsy, and it is a minimal invasive surgery with few side effects.     

颅内夹层动脉瘤血管内栓塞治疗

Objective To analyze the clinical features of intracranial dissecting aneurysm and summarize the experience of its endovascular embolization. Methods 16 cases of intracranial dissecting aneurysm were treated by endovascular embolization. Among these 16 patients, 3 patients were treated with single stent or double stent placement technique, 9 patients were treated with stent- assisted coil embolization technique, 3 patients were ball artery occluded using the balloon - assisted or coil - assisted technique, and 1 patient was treated by simple coil embolization. Results Out of the 16 patients, 9 cases were completely occluded ( including parent artery occlusion cases ), 3 cases were subtotally occluded, 4 cases were incompletely occluded ( including cases of stent implantation ). Followed up for 6 months to 3 years, in addition to 1 case of early death, GOS evaluation results were respectively: grade Ⅰ 8 cases, grade Ⅱ 4 cases, grade Ⅲ 2 cases, grade Ⅳ 1 case. Cerebral angiography was carried out in 8 follow - up patients. No recurrence was watched in 7 cases, aneurysm neck recanalization was watched in 1 case, follow up was continued. Conclusion According to different localization of intracranial aneurysm and different pathological features, different methods of endovascular embolization are selected. It is the safe and effective treatment of dissecting aneurysm.     

脑梗死患者颅内大动脉支架置入术前后vWF水平变化与血管狭窄程度的关系研究

Objective To understand the correlation between plasma von Wilebrand factor (vWF) changes after stenting and the degree of preoperative intracranial major artery stenosis in patients with acute atherosclerotie cerebral infarction. Methods This study involved 38 consecutive patients with acute cerebral infarction due to intracranial major artery atherosclerosis, who were admitted between February and October 2008 and underwent stent placement in the stenotic arteries. Thirty healthy volunteers were also recruited to serve as the control group. The patients were divided into severe stenosis group (with stenosis of the intracranial major artery≥70%) and non-severe stenosis groups. Venous blood samples were obtained from the subjects on the morning of the first and 7th days after admission to measure the plasma levels of vWF using sandwich enzyme-linked immunosorbent assay. Results The plasma levels of vWF were significantly higher in patients with acute cerebral infarction than in the control group(P=0.000). Compared with those with non-severe stenosis, the patients with severe stenosis exhibited significantly higher plasma levels of vWF (P=0.015) and greater vWF variation after stent placement (P=0.000). Conclusions In patients with acute atherosclerotic cerebral infarction due to severe intracranial major artery stenosis, the plasma levels of vWF and its postoperative variation are positively correlated to the degree of senosis of the culprit arteries, and severer stenosis is associated with greater postoperative damage of the vascular endothelium.     

颅内夹层动脉瘤血管内栓塞治疗

Objective To analyze the clinical features of intracranial dissecting aneurysm and summarize the experience of its endovascular embolization. Methods 16 cases of intracranial dissecting aneurysm were treated by endovascular embolization. Among these 16 patients, 3 patients were treated with single stent or double stent placement technique, 9 patients were treated with stent- assisted coil embolization technique, 3 patients were ball artery occluded using the balloon - assisted or coil - assisted technique, and 1 patient was treated by simple coil embolization. Results Out of the 16 patients, 9 cases were completely occluded ( including parent artery occlusion cases ), 3 cases were subtotally occluded, 4 cases were incompletely occluded ( including cases of stent implantation ). Followed up for 6 months to 3 years, in addition to 1 case of early death, GOS evaluation results were respectively: grade Ⅰ 8 cases, grade Ⅱ 4 cases, grade Ⅲ 2 cases, grade Ⅳ 1 case. Cerebral angiography was carried out in 8 follow - up patients. No recurrence was watched in 7 cases, aneurysm neck recanalization was watched in 1 case, follow up was continued. Conclusion According to different localization of intracranial aneurysm and different pathological features, different methods of endovascular embolization are selected. It is the safe and effective treatment of dissecting aneurysm.     

显微手术治疗颅内动脉瘤后脑血管痉挛和预后的影响因素分析

目的 探讨影响显微手术治疗颅内动脉瘤的预后和脑血管痉挛(CVS)发生的相关因素.方法 收集深圳市第二人民医院神经外科自2006年6月至2009年5月行显微手术治疗的322例颅内动脉瘤患者的临床资料,Logistic回归分析年龄、性别、血压、血糖、手术时机、Fisher's分级、Hunt-Hess分级、感染等因素对患者预后及CVS发生的影响.结果 多因素Logistic回归分析显示年龄、Hunt-Hess分级、Fisher's分级、CVS、感染、腰穿次数是影响患者预后的独立危险因素(P<0.05);Hunt-Hess分级、Fisher's分级、动脉瘤数量、终板造瘘、腰穿次数、感染是影响CVS发生的独立危险因素(P<0.05).结论 年龄、Hunt-Hess分级、Fisher's分级、CVS、腰穿次数、感染影响患者预后,其中CVS是最重要的影响因素.CVS受Hunt-Hess分级、Fisher's分级、动脉瘤数量、终板造瘘、腰穿次数及感染因素影响.

Abstract：

Objective To explore the relevant factors of prognosis of intracranial aneurysms after microsurgical treatment and risk factors of cerebral vasospasm (CVS). Methods Three hundred and twenty-two patients with intracranial aneurysms, admitted to and received surgical treatment in our hospital from June 2006 to May 2009, were chosen in our study; their clinical data were retrospectively analyzed. Logistic regression analysis was employed to analyze the influences of age, gender, blood pressure level, blood sugar level, operation time, Fisher's grade, Hunt Hess grade and infection on the prognosis of patients with intracranial aneurysms and the risk of CVS. Results Multivariate logistic analysis indicated that age, Hunt Hess grade, Fisher's grade, CVS, infection and lumber puncture times were the independent risk factors influencing the prognosis of patients with intracranial aneurysms (P< 0.05). Hunt Hess grade, Fisher's grade, number of aneurysms, endplate colostomy, lumber puncture times and infection were the independent risk factors of CVS (P<0.05). Conclusion Age, Hunt Hess grade, Fisher' s grade, CVS, lumber puncture times and infection are the independent risk factors affecting the prognosis of patients with intracranial aneurysms, among which, CVS is the most important factor. CVS is mainly affected by Hunt Hess grade, Fisher's grade, number of aneurysms, endplate colostomy, lumber puncture times and infection.     

弥散张量成像对胶质瘤手术风险的评估

Objective To elucidate the clinical significance of diffusion tensor imaging (DTI) mainly used for protecting neurological functions in patients with gliomas. Methods Thirty - eight patients with gliomas were recruited to undergo DTI test and assess the status of neurological functions before and after surgery. According to the relationships between gliomas and adjacent white matter(WM) tracts, DTI can be classfied as the following types : type Ⅰ - displacement; type Ⅱ - Infiltration; type Ⅲ - Disruption. The neurological functions before surgery were compared in three groups,as well as the change of neurological functions after surgery was also compared in three groups. Results There were 14 cases in type Ⅰ , 16 cases in type Ⅱ, and 8 cases in type Ⅲ. There were significant difference between DTI types and preoperative neurological functions, as well as between DTI types and the change of postoperative neurological functions ( P < 0. 05 ). Conclusions DTI allows to visualizate the relationships of gliomas and adjacent WM tracts, which represent the different growth patterns of gliomas. It is useful for neurosurgeons to select suitable surgical approaches and determine appropriate extent of resection.     

弥散张量成像对胶质瘤手术风险的评估

Objective To elucidate the clinical significance of diffusion tensor imaging (DTI) mainly used for protecting neurological functions in patients with gliomas. Methods Thirty - eight patients with gliomas were recruited to undergo DTI test and assess the status of neurological functions before and after surgery. According to the relationships between gliomas and adjacent white matter(WM) tracts, DTI can be classfied as the following types : type Ⅰ - displacement; type Ⅱ - Infiltration; type Ⅲ - Disruption. The neurological functions before surgery were compared in three groups,as well as the change of neurological functions after surgery was also compared in three groups. Results There were 14 cases in type Ⅰ , 16 cases in type Ⅱ, and 8 cases in type Ⅲ. There were significant difference between DTI types and preoperative neurological functions, as well as between DTI types and the change of postoperative neurological functions ( P < 0. 05 ). Conclusions DTI allows to visualizate the relationships of gliomas and adjacent WM tracts, which represent the different growth patterns of gliomas. It is useful for neurosurgeons to select suitable surgical approaches and determine appropriate extent of resection.