A meta-analysis of Lateral supraorbital vs mini Pterional approach in the outcome of rupture and unruptured noncomplex aneurysms’ surgery

To determine the characteristics and to compare the functional outcomes and safety of different subfrontal approaches versus mini Pterional (MPT) approaches mainly for the treatment of ruptured noncomplex intracranial aneurysms. This meta-analysis included articles comparing outcomes of brain aneurysms (BAs) – most for the anterior circulation–, using Lateral supraorbital & Supraorbital keyhole (LSO) versus MPT approach. There were six articles left into the final article pool and the total number of patients was 683 (322 in LSO and 361 in the MPT group). In terms of the early and late time of surgery, the LSO seems to be superior over the MPT approach but with heterogeneity (OR −0.21, CI 95% −0.59 to 0.18, and p = 0.04) or (OR −0.21, CI 95% −0.69 to 0.28, and p = 0.05), and (p = 0.02 and I² = 68.97%) or (p = 0.05 and I² = 61.74%) respectively. Regarding the subgroup of patients with the supra-early time of surgery, surgical duration, completed occlusion, technical intraoperative complications, postoperative infection, intraoperative rupture, vasospasm, good and poor neurological outcomes and clinical deterioration, there was no superiority of the one method over the other. Mini or keyhole craniotomy even challenging might be a good option for neurosurgeons. Particularly in ruptured noncomplex aneurysms’ surgery LSO seems to be superior over the MPT approach in terms of the early time and in the late time of surgery but with heterogeneity.     

脑肿瘤切除术后患者血清髓鞘碱性蛋白的改变

目的:探讨脑肿瘤切除术患者血清髓鞘碱性蛋白(MBP)的改变。方法:检测20例脑膜瘤(脑膜瘤组)、23例胶质瘤(胶质瘤组)、18例听神经瘤(听神经瘤组)患者术前及术后第1、3、7天血清MBP水平,另选择健康成年体检者21例(健康对照组)并检测其MBP水平,进行统计分析。结果:3个疾病组术后第1天、第3天血清MBP水平均升高,术后第7天降至或接近术前水平。脑膜瘤组和胶质瘤组不同病灶部位之间血清MBP水平差异无统计学意义(F=0.842,P=1.515;F=0.516,P=0.247)。各疾病组的血清MBP与术前、出院时卡氏功能状态评分(KPS)都不同程度地呈负相关(P<0.05)。胶质瘤组的血清MBP与肿瘤体积、瘤周水肿体积、手术时长等临床指标呈正相关(P<0.05)。结论:术后血清MBP先升高后降低的改变,反映术后脑损伤的进展、愈合的过程。术前血清MBP不能反映脑肿瘤类型,手术前后血清MBP的改变幅度与肿瘤类型、病灶部位无关。     

‘Burr holes in the bush’: Clinician preparedness for undertaking emergency intracranial haematoma evacuation surgery in rural and regional Queensland

Objectives

Delayed inter-hospital transfers of deteriorating neurotrauma patients from rural and regional hospitals to tertiary centres have seen the need for non-neurosurgeons to undertake emergency intracranial haematoma evacuation surgery locally. In the present study, the authors contributed to the paucity in the literature regarding the widespread availability of cranial access equipment in non-tertiary centres and patient outcomes in Queensland.

Methods

We surveyed delegates (senior theatre nurses or surgical service directors) from rural and regional Queensland hospitals if they were located outside the local catchment of a tertiary centre and had a CT scanner. Questions regarded availability, location and storage conditions of mechanical cranial access kits, as well as last usage, and associated patient outcomes.

Results

Twenty-six delegates from eligible hospitals responded. Eighteen hospitals offered surgical services. Eleven hospitals housed complete mechanical cranial access kits. Five hospitals housed incomplete kits. Thirteen hospitals housed their equipment sterile in the operating theatre or ED. Eleven hospitals reported using the equipment, with last usage ranging from 4 months to over 30 years. Two hospitals reported using the equipment within 12 months while a further five reported using it within 10 years. Two hospitals reported ‘good’ outcomes, two ‘ok’ and one ‘poor’.

Conclusions

The availability of cranial access equipment outside Queensland tertiary centres has been limited. Inter-hospital transfers are likely to persist in Queensland and haematoma evacuation surgery has been a life-saving endeavour, so improving access to cranial access equipment in hospitals where it is currently lacking is highly warranted.     

脑电双频指数用于开颅术后患者意识障碍预测

目的探讨开颅术后早期脑电双频指数(BIS)监测对患者远期意识状态预测的准确性,指导护士早期判断患者意识状态。方法对63例开颅术后延迟苏醒拔管患者,记录术后6 h内每小时BIS监测值(BISmax)、道格拉斯昏迷量表中的语言或疼痛刺激体动反应评分(GCS-M)及术后24 h意识状态。根据患者术后24 h是否清醒分组,计算两组BISmax、GCS-M及BISmax对术后24h意识障碍的预测概率(PK)。结果术后24 h清醒患者57例,未清醒6例;清醒者GCS-M评分均为6分,术后6 h内BISmax预测术后24 h意识障碍的PK值为0.69~0.86。结论监测BIS可作为开颅术后患者意识状态的辅助预测方法。     

颅内孤立性纤维瘤侵犯颈静脉孔1例并文献复习

颅内孤立性纤维瘤(ISFT)临床上较为罕见,侵犯颈静脉孔的ISFT更少见。该文报道侵犯颈静脉孔的ISFT 1例,对其病理学、影像学特征、术后复发和转移相关研究进展进行文献复习。     

扩大翼点手术治疗重型颅脑损伤的系统评价

目的 系统评价扩大翼点手术与标准开颅手术治疗重型颅脑损伤的疗效性和安全性.方法 按Cochrane系统评价方法,计算机检索Cochrane协作网创伤组数据库(2011年3期)、MEDLINE(1980.01～2011.12)、EMbase(1984.01～2011.10)、中国生物医学文献光盘数据库(1980.01～2011.12)、中文期刊全文数据库(1980.01～2011.12),并检索临床试验注册网站,寻找已发表或未发表的临床试验；同时手工检索相关文献包括纳入文献的参考文献、杂志增刊及会议摘要；对纳入文献进行质量评价后,采用RevMan4.2软件进行Meta分析.结果 共纳入4个随机对照试验,包括701例患者.Meta分析结果显示:①疗效:扩大翼点手术组病死率低于标准开颅手术组(RR=0.24,95％CI(0.17,0.35),P＜0.05)；扩大翼点手术组的有效生存率(RR=2.49,95％CI(2.10,2.94),P＜0.05)和存活率(OR=0.33,95％CI(0.23,0.48),P＜0.05)高于标准开颅手术组；(②安全性:扩大翼点手术组急性脑膨出的发生率低于标准开颅手术组(OR=0.10,95％CI(0.04,0.26),P＜0.05),差异有显著性.结论 治疗重型颅脑损伤,扩大翼点手术能明显改善患者预后,疗效优于标准开颅手术组,且急性脑膨出的发生率低于标准开颅手术组.