依达拉奉对实验性蛛网膜下隙出血后脑损伤的保护作用

目的观察依达拉奉对蛛网膜下隙出血后脑组织丙二醛（MDA）含量及诱导型一氧化氮合酶（iNOS）表达的影响。方法采用血管内穿刺法建立蛛网膜下隙出血（SAH）模型,将24只雄性成年大鼠随机分为假手术组、SAH组、SAH＋依达拉奉组（依达拉奉组）,72h后处死大鼠。处死前每天统计大鼠神经功能缺损评分;处死后采用硫代巴比妥酸法检测大鼠脑组织中MDA含量,运用Westernblot方法检测大鼠脑组织中iNOS蛋白的表达。结果依达拉奉组大鼠神经功能评分高于SAH组,而MDA含量明显低于SAH组（P〈0.05）;Westernblot检测显示,依达拉奉可降低脑组织iNOS的表达。结论依达拉奉可改善蛛网膜下隙出血后脑损伤,具有一定的神经保护作用。     

三维重建技术在颅内动脉瘤显微外科与血管内治疗中的应用

目的：探讨三维重建技术在颅内动脉瘤显微外科治疗和血管内治疗中的价值。方法：对76例可疑为颅内动脉瘤的患者分别进行常规的脑血管造影、数字减影血管造影（DSA）和三维数字减影血管造影（3D－DSA），共检出66例动脉瘤（共72个动脉瘤），根据影像结果拟定显微外科治疗和血管内治疗的治疗方案。结果：76例可疑为颅内动脉瘤的患者行普通脑血管造影和DSA检查49例，显示脑动脉瘤的阳性率为81．6％；行3D－DSA检查27例，清楚显示动脉瘤的阳性率为96．3％，共检出66例动脉瘤。显微外科治疗组36例，完全夹闭31例（86．1％），死亡2例（5．6％），并发症5例（1．39％）。血管内治疗组23例，完全栓塞者19例（82．6％），90％以上栓塞2例，载瘤动脉闭塞2例，并发症2例（0．87％），无死亡病例。66例动脉瘤中有7例未治疗。结论：3D－DSA能够提高自发性蛛网膜下腔出血（SAH）脑动脉瘤的检出率，清楚显示脑动脉瘤的立体形态、瘤颈和载瘤动脉的关系，对指导颅内动脉瘤的显微外科治疗和血管内治疗有潜在的临床应用。     

动脉瘤性蛛网膜下腔出血脑脊液中NO含量与TCD对症状性脑血管痉挛的诊断价值

目的　评价动脉瘤性SAH后脑脊液 (CSF)中一氧化氮 (NO)含量变化和TCD对症状性脑血管痉挛的诊断价值。方法　MRA检查并经脑血管造影加以证实的动脉瘤性SAH患者 56例 ,所有患者应用 2MHz探头经颞窗探测MCA的血流速度 ,将血管痉挛程度分为轻度痉挛 (12 0～ 14 0cm s)、中度痉挛(14 0～ 2 0 0cm s)、重度痉挛 (>2 0 0cm s) ,并通过高效液相色谱法测定其住院当天、3d、7d、14d脑脊液中NO的代谢产物亚硝酸盐 (NO-2 )和硝酸盐 (NO-3)含量。分析其含量变化与脑血管痉挛的关系。同期收治的意外发现的未破裂的动脉瘤患者 14例作为对照。结果　NO含量测定表明在SAH的第 7天明显增高 (P <0 .0 1)。部分出现症状性痉挛的患者 ,TCD检查MCA血流虽无明显增快 (P >0 .0 5) ,但NO含量却明显增高 (P <0 .0 1)。结论　NO含量变化与脑血管痉挛症状的发生、发展相一致 ,是监测脑血管痉挛的发生、发展的可靠指标 ,与TCD联合应用对症状性脑血管痉挛的诊断意义更大。     

蛛网膜下腔出血病人的护理体会

影响蛛网膜下腔出血（SAH）病人预后的因素很多犤１～６犦。适当的护理措施是消除影响预后因素、降低SAH病人死亡率的重要环节。现将我们对SAH病人护理的体会总结如下：１临床资料１９９２－０２～２０００－０６，我科共收治SAH病人３３６例。男２２６例，女１１０例。年龄１６～６９岁，平均（３６±９．８）岁。均为首次发病、７２h内入院，按各类脑血管疾病诊断要点而确诊的病人犤７犦。病情以意识及精神障碍、体温升高（３７．３～３９℃）、血压升高（＞１２０／９０mmHg）、呼吸快而深（＞２０次／min）和慢而不规则（＜１６次…     

Comparison of biliary atresia with and without intracranial hemorrhage

Background/Purpose

Intracranial hemorrhage (ICH) is a severe complication of biliary atresia (BA). We aimed to compare the clinical data of BA patients with and without ICH.

The combined approach to intracranial aneurysm treatment

Background

A consecutive series of patients with intracranial aneurysms in the practice of one neurovascular surgeon was retrospectively reviewed to illustrate that one physician can become proficient in microneurosurgery as well as endovascular surgery and achieve favorable outcomes in both disciplines. This supports one model of training for cerebrovascular surgeons that includes the complimentary practice of open microneurovascular surgery with endovascular surgery.

Methods

The senior author (HAR) treated 351 patients with 413 aneurysms between July 2001 and March 2007. Of these, 172 patients (216 aneurysms) were treated with open microneurosurgical techniques and 179 patients (197 aneurysms) were treated using endovascular techniques.

Results

Complete obliteration was attained in 94.3% of clipped aneurysms, and 61.9% and 65.9% of coiled aneurysms immediately and after at least 6 months of follow-up, respectively. At latest evaluation, 93% of endovascular patients and 90% of microneurosurgical patients had good clinical outcomes (GOS, 4 or 5; mean follow-up, 23 months; combines ruptured and unruptured cohorts). Procedure-related mortality included 1 surgical patient and 2 endovascular patients.

Conclusions

Because the fields of microvascular and endovascular surgeries are both technically complex, there has been concern that hybrid cerebrovascular surgeons cannot perform each technique with the skill necessary to achieve good outcomes. When compared to clipping and coiling reviews in the neurosurgical literature, we illustrate that one hybrid neurovascular surgeon is capable of attaining great facility in both techniques and that this type of physician will represent one practice model of cerebrovascular specialist in the future. This has potential implications for the training of hybrid cerebrovascular surgeons.     

Dopamine D2-Receptor-Mediated Increase in Vascular and Endothelial NOS Activity Ameliorates Cerebral Vasospasm After Subarachnoid Hemorrhage In Vitro

Introduction  Cerebral vasospasm after subarachnoid hemorrhage (SAH) is a serious complication resulting in delayed neurological deficit, increased morbidity, mortality, longer hospital stays, and rehabilitation time. It afflicts approximately 35 per 100,000 Americans per year, and there is currently no effective therapy. We present in vitro data suggesting that increasing intrinsic nitric oxide relaxation pathways in vascular smooth muscle via dopaminergic agonism ameliorates cerebral vasospasm after SAH. Methods  Cerebrospinal fluid (CSF) from patients with cerebral vasospasm after SAH (CSF_V) was used to induce vasospasm in porcine carotid artery in vitro. Dopamine was added to test its ability to reverse spasm, and specific dopamine receptor antagonists were used to determine which receptor mediated the protection. Immunohistochemical techniques confirmed the presence of dopamine receptor subtypes and the involvement of NOS in the mechanism of dopamine protection. Results  Dopamine receptor 1, 2, and 3 subtypes are all present in porcine carotid artery. Dopamine significantly reversed spasm in vitro (67% relaxation), and this relaxation was prevented by Haloperidol, a D₂R antagonist (10% relaxation, P < 0.05), but not by D₁ or D₃-receptor antagonism. Both eNOS and iNOS expression were increased significantly in response to CSF_V alone, and this was significantly enhanced by addition of dopamine, and blocked by Haloperidol. Conclusion  Cerebral vasospasm is significantly reversed in a functional measure of vasospasm in vitro by dopamine, via a D₂R-mediated pathway. The increase in NOS protein seen in both the endothelium and vascular smooth muscle in response to CSF_V is enhanced by dopamine, also in a D₂R-dependent mechanism.