Management of subarachnoid haemorrhage

Subarachnoid haemorrhage is an acute neurosurgical emergency affecting patients of all ages and with high mortality. It is usually caused by rupture of an aneurysm of an intracranial artery at a point of turbulent blood flow within the circle of Willis. Diagnosis should be made rapidly initially with non-contrast CT of the head. Minimizing secondary neurological injury is the focus of care. Initial stabilization focussing on providing adequate cerebral oxygenation and perfusion should be carried out expediently and this may require intubation and ventilation. Transfer to a specialist neurosciences centre for ongoing management is the next priority. Culprit aneurysms should be secured promptly by endovascular coiling or surgical clipping. Recognition and management of complications is best undertaken in a centre managing high volumes of these patients. Vasospasm is a common and feared complication of subarachnoid haemorrhage. All patients should be given nimodipine for prophylaxis and management of this complication.     

颅底Willis环前部动脉瘤的手术治疗

目的总结采用显微神经外科手术治疗的颅内前循环动脉瘤的经验，以期进一步提高对该病的临床手术及并发症的治疗效果。方法本组16例患者中15例行单侧翼点人路，1例纵裂入路（胼周动脉的动脉瘤），手术夹闭动脉瘤16枚。结果术后因脑积水行V—P分流2例。3例出现精神症状，1周后消失。1例偏瘫，经康复治疗后3个月后遗留轻度偏瘫，生活可自理。本组无手术死亡。结论翼点入路是处理前循环颅内动脉瘤的很好入路，充分的术前准备，耐心细致地解剖脑池显露载瘤动脉和动脉瘤，控制性降压，适当临时阻断载瘤动脉及术后有效防治脑血管痉挛可提高手术的治疗效果。     

Endoleak management and postoperative surveillance following endovascular repair of internal carotid artery vascular diseases using Willis covered stent

BackgroundTo report the clinical results and experiences of endoleak management and postoperative surveillance following endovascular repair of internal carotid artery vascular diseases (ICAVDs) using Willis covered stents. METHODS: Seventy-three patients with ICAVD who received Willis covered stent implantation between November 2013 and September 2018 were retrospectively reviewed. The clinical data of endoleak management and postoperative surveillance were analyzed. RESULTS: Seventy-three cases with ICAVD, including 57 aneurysms, 11 carotid-cavernous sinus fistulas (CCF), and 5 surgical injuries, were all successfully installed with covered stents. Total isolation of ICAVDs was achieved in 59 patients (80.8%), and endoleaks were observed in 14 patients (19.2%). Of the 14 patients with endoleaks, 12 had type I endoleaks and 2 had type II; 13 had aneurysms and one had CCF. 10 patients with type I endoleaks received balloon dilatation, and 7 of them underwent a second stent-graft implantation after then. One patient with type II endoleak received embolization of the branch artery, and another one received follow-up observation. Endoleaks resolved in 6 patients and were minimal in 5 patients after balloon dilatation or the second stent implantation. During the follow-up period, minor endoleaks spontaneously resolved in 4 patients and minimal endoleaks were still demonstrated in 4 patients without enlargement of residual lumen and rupture. CONCLUSIONS: Endoleaks are the major complication after endovascular repair of ICAVDs and represent one of the limitations of this procedure. Improving the understanding and management of endoleaks can be beneficial in the clinical setting, including the popularization and application of this technique.     

多发性脑干梗塞2例病理报告

本文报告了２例多发性脑干梗塞的病理。病理解剖发现：例１双侧后交通动脉狭窄，左侧完全闭锁；例２严重动脉硬化，左侧椎动脉内血栓形成。两例中脑、桥脑及延髓明显软化坏死。进一步研究证实：不同水平的脑干梗塞均可导致自主呼吸障碍；颅底ｗｉｌｌｉｓ’ｓ动脉环的解剖变异可能为多发性脑干梗塞的发病原因之一。     

Closure of a neck incision

A new technique for closure of a wound incision in the neck has been described.     

Brain vasculature and mitochondrial responses to ischemia in gerbils. I. Basic anatomical patterns and biochemical correlates

A unique blood supply to the brain, the 'Circle of Willis' (COW), exists in all mammals except for the Mongolian gerbil (Meriones unguiculatus). This system is capable of compensating for a decrease in blood supply in one of the four arteries, which may occur during pathological conditions. The posterior connection between the basilar artery and the carotid artery system have been found to be missing in most gerbils. Furthermore, in some of the animals, the anterior communication was not complete, thus leading to partial ischemia following unilateral carotid artery occlusion. Due to those peculiar characteristics, the Mongolian gerbil today has become a widespread animal model for cerebral ischemia studies. M. unguiculatus has been used in most of the studies while the level of ischemia has been evaluated by the development of neurological symptoms created by the occlusion of the carotid arteries. In the present study we investigated the vasculature structure of the commonly used gerbil, M. unguiculatus (MU-TF) and compared it to the vasculature of the Israeli gerbil, Meriones tristrami as well as to that of the Albino rat. We determined the correlation between the anatomical pattern and the biochemical responses during partial or complete ischemia and anoxia by monitoring the oxidation-reduction state of the intramitochondrial NADH using an in vivo surface fluorescence technique. The corrected fluorescence signal was found to be inversely correlated with oxygen availability and could thus be used as an indicator for the level of ischemia developed after carotid artery occlusion. This is the first time that the brain vasculature of two lines of M. tristrami (MT-HU, MT-BD) has been investigated.(ABSTRACT TRUNCATED AT 250 WORDS)     

A role for amine accumulation in the syndrome of ingestive deficits following lateral hypothalamic lesions

Lesions of the lateral hypothalamus produce ascending catecholamine neuron degeneration which results in terminal depletion and proximal accumulation above the lesions. The occurrence of deficits in ingestive behaviour has been attributed traditionally to the loss of functional dopamine neurotransmitter in the terminal fields. However, release of functional amines may occur in the lateral hypothalamus at areas of accumulation, to produce at least some of the behavioural symptoms characterizing the lateral hypothalamic syndrome. Recovery from behavioural deficits as a result of various pharmacological treatments, after dopamine-depleting lesions, may be mediated by changes in amine release or modified sensitivity of receptors affected by released amines. We conclude that amine accumulation should be considered when interpreting experiments implicating central catecholamine systems in the control of consumatory behaviour and the regulation of body weight.     

经颅多谱勒对正常人Willis环侧支代偿潜能的评估

目的:应用经颅多谱勒(TCD)了解正常人Willis环侧支循环并评估其代偿潜能。方法:336例健康体检者行常规TCD检测并作颈总动脉压迫试验,观察压迫前后的大脑中动脉、大脑前动脉和大脑后动脉的血流动力学变化。结果:Willis环的5个代偿类型中以前后循环完整的Ⅰ型为主(65.2%),其次是前循环与部分后循环的Ⅱ型(16.6%),其后依次是后循环完整的Ⅳ型(12.5%)、单纯前循环的Ⅲ型(4.8%)和部分后循环的Ⅴ型(0.9%)。代偿潜能以Ⅰ型最好,前循环代偿好于后循环,仅有后循环参与的Ⅳ型、Ⅴ型代偿较差。结论:TCD可以了解Willis环侧支代偿,但代偿功能不仅依赖环的完整性,还取决于侧支的潜在代偿能力。     

Cerebral vascular anatomy and physiology

Knowledge of normal cerebral vascular anatomy and physiology is critical for both recognizing and safely managing a range of neurosurgical conditions through either open or endovascular techniques. In this article we summarize the key features of the arterial supply and venous drainage of the brain along with their main clinical significance.