中华神经外科杂志最新文献

{"title":"Effect of different surgical options for posterior inferior cerebellar artery aneurysms","authors":"Yishen Gao, Caihong Zhang, Kai Wang","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.02.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.02.013","url":null,"abstract":"Objective \u0000To explore the clinical effect of various surgical operations on the treatment of posterior inferior cerebellar aneurysm. \u0000 \u0000 \u0000Methods \u0000The clinical data of 36 patients with a total of 36 posterior inferior cerebellar aneurysms admitted to Department of Neurosurgery, Weihai Central Hospital from October 2014 to May 2017 were retrospectively analyzed. Among all 36 patients, 22 underwent transcatheter embolization, 9 underwent aneurysm clipping using craniotomy, and the remaining 5 underwent cerebral artery bypass surgery combined with transcatheter embolization. The treatment outcome was evaluated using Glasgow outcome scale(GOS) at discharge and modified Rankin scale (mRS) at follow-up. Imaging outcome was evaluated by digital subtraction angiography (DSA) or CT angiography (CTA). \u0000 \u0000 \u0000Results \u0000Of the 22 patients undergoing transcatheter embolization, 21 were completely embolized. Aneurysms in 8 of the 9 patients were successfully clipped. Successful vascular anastomosis and complete embolization were achieved in 5 patients undergoing cerebral artery bypass surgery combined with transcatheter embolization. Among the 36 patients, 9 cases developed non-newly developed postoperative neurological deficits and 1 died. Thirty-five patients were discharged with GOS grade Ⅴ in 18 cases, Ⅳ in 14 cases and Ⅲ in 3 cases. Thirty-five cases were reexamined by CTA or DSA at 2 weeks post operation, which indicated disappearance of aneurysm. At follow-up of 3 months to 1 year post operation, 3 cases(8.6%) of aneurysm recurrence were reported which had undergone interventional embolization, and the rest of 32 patients had no recurrence. Thirty-five patients were followed up for 1 year. The mRS score was 0-1 in 21 cases, 2 in 8, 3 in 3, 4 in 1 and 5 in 1 case. The rate of good outcome were 85.3% (29/34) and there was 1 patient lost to follow-up. \u0000 \u0000 \u0000Conclusions \u0000According to the specific condition, interventional embolization, craniotomy of aneurysm clipping, or cerebral artery bypass surgery combined with transcatheter embolization could be performed to treat the posterior inferior cerebellar aneurysm, which might lead to relatively good clinical outcome with low incidence of aneurysm recurrence. \u0000 \u0000 \u0000Key words: \u0000Incranial aneurysm; Embolization, therapeutic; Microsurgery; Treatment outcome; Inferior cerebellar artery","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"173-176"},"PeriodicalIF":0.0,"publicationDate":"2020-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48607156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of mTOR signaling pathway in glioma-associated seizures","authors":"Yuan Yang, Xiang Wang, Ruo-fei Liang, Jie-wen Luo, Shu Jiang","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.02.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.02.009","url":null,"abstract":"Objective \u0000To investigate the role of mTOR signaling pathway in glioma-associated seizures (GAS). \u0000 \u0000 \u0000Methods \u0000We retrospectively analyzed 12 glioma patients admitted to Department of Neurosurgery, West China Hospital, Sichuan University from January 2016 to June 2016. Among the 12 glioma patients, 9 had glioma GAS and 3 did not. All patients enrolled into this study underwent tumor resection. After surgery, the neuroelectrical activities of tumor tissue, peritumoral tissue and peritumoral normal tissue were documented by patch clamping recording of brain slices to clarify the GAS lesions, followed by Western blotting and immunohistochemical experiments to confirm whether mTOR pathway activation was related to GAS. \u0000 \u0000 \u0000Results \u0000Interictal-like discharges (ILDs) were observed in 7 of 12 peritumoral tissues obtained from patients with glioma who had experienced perioperative seizures. Their peak amplitude ranged from 0.300 mV to -0.429 mV and the slope was 1.502 mV/ms. However, their tumor and normal tissue samples didn′t show ILDs. No ILDs were observed in the tumor tissue, peritumoral or normal tissue of 2 patients with GAS and 3 patients without GAS. The results of Western blotting showed that peritumoral expressions of p-mTOR (relative expression value: 1.002) and p-S6K (relative expression value: 0.926) of patients with GAS were significantly higher than those of patients without GAS (relative expression Value: 0.756 and 0.661, both P 0.05). There was no statistical significance in the expression of p-mTOR, mTOR, p-S6K or S6K in the tumor tissues between patients with GAS and those without GAS (all P>0.05). Immunohistochemical staining results showed that p-S6K and p-mTOR stainings were positive in the peritumoral tissues in 8 of 9 patients with GAS, while they were negative in 3 patients without GAS. Both p-S6K and p-mTOR staining were positive in tumor tissues of patients with GAS and patients without GAS. \u0000 \u0000 \u0000Conclusions \u0000The mTOR pathway expression in peritumoral issues is associated with GAS, which thus provides a potential target for therapeutics aimed at simultaneously controlling gliomas and seizures. \u0000 \u0000 \u0000Key words: \u0000Glioma; Epilepsy; mTOR pathway","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"151-155"},"PeriodicalIF":0.0,"publicationDate":"2020-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49189928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research on the pathological mechanisms of nerve decompression in relieving tactile allodynia in diabetic rats","authors":"Chen Liao, H. Zhou, Xiaosheng Yang, Yi Li","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.02.018","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.02.018","url":null,"abstract":"Objectives \u0000To explore the pathological mechanism of peripheral nerve decompression in relieving tactile allodynia in diabetic rats. \u0000 \u0000 \u0000Methods \u0000Healthy adult male Sprague Dawley rats were randomly divided into 5 groups for different interventions: group Ⅰ (healthy control, n=10), group Ⅱ (diabetes model, n=20), group Ⅲ (diabetes model with latex tube placement, n=10), group Ⅳ (diabetes model with latex tube placement and nerve decompression, n=10), group V (diabetes model with latex placement and merely operational area exposure, n=10). The diabetes model was induced by intraperitoneal injection of streptozotocin (STZ). Nerve decompression was performed by removal of latex tube encircling the sciatic nerve at 3 weeks post model establishment. The paw withdrawal threshold was tested 3 days after modeling with the use of \"up-down\" method. Diabetic rats with tactile allodynia in 4 experimental groups (groups Ⅱ-Ⅳ) were preserved. Morphometric analysis of myelinated and non-myelinated nerve fibers was performed with the use of projection electron microscope. Western blot and immunofluorescence were used to localized and determined the expression of GABAB receptor protein in spinal dorsal horn. \u0000 \u0000 \u0000Results \u0000Three weeks after operation, the incidence of tactile allodynia in STZ-induced rats[55.0%(11/20)] was lower than that in diabetic rats with latex tube placement (groups Ⅲ, Ⅳ and Ⅴ) [86.7%(26/30), χ2=6.254, P=0.012]. The paw withdrawal threshold in group Ⅰ (13.41±1.88 g) was higher than those in groups Ⅱ-Ⅳ (4.06±1.28 g, 3.09±1.43 g, 4.02±1.96 g, 4.15±1.87 g respectively, P<0.05). At 5 weeks post operation, the paw withdrawal threshold in group Ⅳ was higher than those of group Ⅱ, Ⅲ and Ⅴ(all P<0.05). When compared with group Ⅰ, smaller myelinated fibers area and density, as well as higher g-ratio were revealed by electron microscope in each experimental group (all P<0.05). Larger myelinated fiber area and density, as well as lower g-ratio were noted in group Ⅳ when compared with those in group Ⅱ and Ⅴ (all P<0.05). The results of western blot showed that lower expression of GABAB receptor was noted in experimental groups (Ⅱ, Ⅲ, Ⅳ and Ⅴ) when compared with group Ⅰ (all P<0.05), and higher expression of GABAB receptor in both NF-200+ areas and neurons of spinal dorsal horn was noted in group Ⅳ when compared with group V (P<0.05) at 3 weeks post nerve decompression. The results of immunofluorescence showed that lower expression of GABAB receptor in both NF-200+ areas and neurons of spinal dorsal horn was noted in experimental groups (Ⅱ, Ⅲ, Ⅳ and Ⅴ) when compared with group Ⅰ (all P<0.05). \u0000 \u0000 \u0000Conclusions \u0000Peripheral nerve decompression can relieve the tactile allodynia of diabetic rats mainly by removing the compression damage of myelinated nerve fibers, lifting the GABAB receptor downregulation-mediated central sensitivity, thereby relieving the pathological state of elevated spinal excitability. \u0000 \u0000 \u0000Key words: \u0000Diabetes mellitus; Disease models, ","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"194-199"},"PeriodicalIF":0.0,"publicationDate":"2020-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44305569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experimental study on the effect of facial nerve retention on nerve regeneration and reconstruction of orbicularis muscle function","authors":"Yuan Zhuang, W. Binbin, Zhang Shaodong, Jun‐hua Li, H. Wan, Jie Feng, De-zhi Li, Song Liu","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.02.017","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.02.017","url":null,"abstract":"Objective To investigate the effect of the regenerated facial nerve (FN) with varying degrees on the reconstruction of orbicularis function post facial-hypoglossal side-to-side neurorrhaphy (FN-HN) in the incomplete facial palsy model. Methods A total of 40 male adult Sprague Dawley rats were divided into 4 groups randomly. All rats were performed with crushed FN injury and FN-HN anastomosis. Three months later, the 4 groups were performed with FN cross section with different ratios at the proximal end to the injured site: no intervention in group A, 1/3 of cross section in group B, 2/3 of cross section in group C and transection in group D. The degree of closure of the affected-side eyelids in rats was assessed using the eye blink score, the muscle active potentials (MAPs) were used to detect the action potential and the area under the curve (AUC) of the rat′s orbicularis oculi muscle on the affected side, the number of positive neurons in the FN and HN nuclei were revealed by retrograde labeling, and the myelinated axons were counted on semi-thin sections of facial nerves and nerve grafts. Results For the eye blink scores, the 4 groups showed significant difference during the three months (F=12.47, 11.00, 10.61, 19.13, all P<0.05) and after the cross section (F=29.06, P<0.05). Moreover, the score in group D was lower than that in group A and B(both P<0.01). One week after the cross-section of FN, all 4 groups showed significant difference in amplitude and AUC of MAPs when we stimulated the proximal end of anastomosis site of facial nerve and the middle of the nerve graft (F=27.56, 11.86, 6.33, 4.65, all P<0.05). In addition, the amplitude and AUC of MAPs in group D were significantly lower than those in group A (both P<0.05). Among the 4 groups, retrograde labeling indicated significant difference in the number of positive neurons in the FN nucleus (F=6.52, P<0.05), and the neurons in group D were less than those in group A and B (both P<0.05). The counts of myelinated axons in both FN trunk and nerve graft in the 4 groups were significantly different (F=8.33, 6.35, both P<0.05). In particular, group A had less myelinated axons compared with group C and group D (both P<0.05). Conclusion Preserving structural integrity of facial nerve during FN-HN seems to have positive significance. Retention of at least 2/3 regenerated facial nerve is beneficial for the recovery of the orbicularis oculi muscle. Key words: Anastomosis, surgical; Facial nerve; Hypoglossal nerve; Orbicularis; Rats","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"188-193"},"PeriodicalIF":0.0,"publicationDate":"2020-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44910871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of optic nerve decompression through neuroendoscopic transethmoidal-sphenoidal approach in the treatment of traumatic optic neuropathy","authors":"Yuanzhi Xu, Yajun Xue, Junjia Tang, S. Lin, Anke Zhang","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.02.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.02.012","url":null,"abstract":"Objective \u0000To investigate the outcome of optic nerve decompression through neuro-endoscopic transethmoidal-sphenoidal approach in the treatment of traumatic optic neuropathy (TON). \u0000 \u0000 \u0000Methods \u0000The consecutive clinical data of 29 patients (32 sides) with TON who were treated at Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University from December 2013 to February 2018 were retrospectively analyzed. Preoperative visual acuity results were as follows: no light perception (NLP) in 15 sides, light perception in 14 sides, and hand moving in 3 sides. All patients underwent optic nerve decompression through neuroendoscopic transethmoidal-sphenoidal approach assisted with intraoperative neuronavigation. High-resolution skull CT scan was performed before the operation. These aspects were documented including the anatomic landmark observed during operation, visual changes of the patients and operative complications. \u0000 \u0000 \u0000Results \u0000The follow-up periods were 5.2±1.1 months (range: 3 to 6 months). Postoperative visual acuity results were as follows: NLP in 10 sides, light perception in 4 sides, hand moving in 4 sides, counting finger in 5 sides, and logMAR≥0.02 in 9 sides. The effective rate of operation was 59.4% (19/32). No surgical complications such as internal carotid artery injury, cerebrospinal fluid rhinorrhea or anosmia occurred. \u0000 \u0000 \u0000Conclusion \u0000Optic nerve decompression through transethmoidal-sphenoidal approach seems to be an effective method for the treatment of TON. The anatomic landmarks of the surgical approach are clearly defined, and intraoperative neuronavigation contributes to the safety of operation and reduces the occurrence of complications. \u0000 \u0000 \u0000Key words: \u0000Optic nerve injuries; Natural orifice endoscopic surgery; Treatment outcome; Optic nerve decompression; Transethmoidal-sphenoidal approach","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"168-172"},"PeriodicalIF":0.0,"publicationDate":"2020-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41659252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term outcome of percutaneous spinal endoscopic technique of fully visualization foraminoplasty for lumbar disc herniation","authors":"Ye Jiang, Fulin Xu, Yongyan Bi, Yuhang Mao, Lutao Yuan, Chen Li, Chongjing Sun, Yong Yu","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.02.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.02.011","url":null,"abstract":"Objective \u0000To explore the clinical early efficacy of fully visualization foraminoplasty in treatment of lumbar disc herniation with percutaneous spinal endoscope. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was conducted on the clinical data of 32 patients who underwent percutaneous spinal endoscopic operation of fully visualization foraminoplasty for lumbar disc herniation at Department of Neurosurgery, Minhang Hospital, Fudan University (18 cases) and Department of Neurosurgery, Zhongshan Hospital, Fudan University (14 cases) from June 2016 to December 2018. Lumbar MRI was reviewed after surgery and visual analog scale (VAS), Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) were employed for outcome evaluation. Outpatient follow-up was conducted for all patients and included the assessment based on VAS, JOA score, ODI and modified MacNab criteria. \u0000 \u0000 \u0000Results \u0000All 32 patients successfully underwent the operation. No postoperative infection, spinal canal hematoma or neurological dysfunction occurred. Postoperative review of lumbar spine MRI showed satisfactory excision of nucleus pulposus. Compared with preoperative conditions, 32 patients′ VAS score (2.21±1.18 points vs. 6.25±1.46 points) and ODI [(30.28±7.42)% vs. (68.63±11.04)%] were decreased 2 days after surgery (both P<0.001), and the JOA score (16.66±1.58 points vs. 12.43±1.85 points) was increased 2 days after surgery (P<0.001). The follow-up duration of 32 patients was 15±5 months (10-20 months). With the increase of follow-up duration, the VAS score of 32 patients showed a downward trend, the JOA score showed an upward trend, and the ODI showed a downward trend (F=187.43, 72.54, and 564.38, all P <0.001). At 12-month follow-up, the outcomes assessed according to modified MacNab criteria were: excellent in 20 patients, good in 9 patients, fair in 2 patients and poor in 1 patient. The rate of excellent and good outcomes was 90.6 % (29/32). \u0000 \u0000 \u0000Conclusions \u0000Percutaneous spinal endoscopic technique of fully visualization foraminoplasty for lumbar disc herniation could improve pain and nerve function, help patients to resume life and work, and has satisfactory short-term outcome. Its long-term therapeutic effect still needs to be further observed. \u0000 \u0000 \u0000Key words: \u0000Lumbar vertebrae; Intervertebral disc degeneration; Percutaneous endoscopic; Visualization; Treatment outcome","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"162-167"},"PeriodicalIF":0.0,"publicationDate":"2020-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47614930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and prognostic factors of insular glioblastomas","authors":"Yin-yan Wang, Xing Liu, Yiming Li, Jiangfei Wang, Lei Wang, Yongheng Wang","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.02.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.02.003","url":null,"abstract":"Objective \u0000To explore the clinical characteristics and prognostic factors of insular glioblastomas. \u0000 \u0000 \u0000Methods \u0000Clinical data of 44 patients with insular glioblastomas in Chinese Glioma Genome Atlas(CGGA) databases from July 2006 to June 2013 were evaluated. All patients underwent tumor resection. Among them, 27 underwent adjuvant radiochemotherapy and 17 underwent no postoperative adjuvant therapy. Progression-free survival (PFS) and overall survival (OS) of all patients were analyzed by Kaplan-Meier method. Furthermore, multivariate Cox regression analysis was used to investigate the prognostic clinical factors. \u0000 \u0000 \u0000Results \u0000In a total of 44 patients, 33 (75.0%) had a history of epileptic seizure, 11 (25.0%) had isocitrate dehydrogenase 1 (IDH1) mutation, 19 (43.2%) had O6-methy-lguanine-DNA-methyltransferase (MGMT) methylation, and 42 (95.5%) had tumor enhancement.Based on Yasargil′s classification, there were type 3A in 2 cases, type 3B in 27 cases and type 5A/B in 15 cases. Based on Saito′s classification, there were 2 cases confined to the insular cortex, 9 cases with invasion to the frontal lobe via the anterior circumferential sulcus, 16 cases with invasion to the temporal lobe via the lower circumferential sulcus, and 17 cases with invasion to multiple directions via more than 2 circumferential sulci. Based on Moshe′s classification, there were 35 cases with envelopment or invasion of the lenticulostriate artery, while no invasion was reported in the remaining 9 cases. Based on the putamen classification, there were 38 cases with various degrees of putamen invasion, and the remaining 6 cases had no involvement of the putamen. Kaplan-Meier curve showed that the median PFS of all patients was 278 d and the median OS was 435 d. Multivariate Cox regression analysis showed that tumor volume < median (HR = 0.390, 95% CI: 0.189-0.802, P=0.011), IDH1 mutation (HR=0.391, 95% CI: 0.175-0.876, P=0.023) and postoperative radiochemotherapy (HR=0.346, 95% CI: 0.162-0.738, P=0.006) were independent protective factors for PFS. However, MGMT methylation (HR=0.371, 95% CI: 0.181-0.758, P=0.007), tumor resection degree ≥90% (HR=0.412, 95% CI: 0.194-0.875, P=0.021) and postoperative radiochemotherapy (HR=0.347, 95% CI: 0.170-0.708, P=0.004) were independent protective factors for OS. \u0000 \u0000 \u0000Conclusions \u0000Clinical characteristics of insula glioblastomas include relatively lower incidence, stronger invasiveness, lower total resection ratio and poorer prognosis. Maximum resection and standard postoperative radiochemotherapy may lead to a better outcome. \u0000 \u0000 \u0000Key words: \u0000Glioblastoma; Insula; Prognosis; Multivariate analysis","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"119-123"},"PeriodicalIF":0.0,"publicationDate":"2020-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45229980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventriculostomy through straight-incision temporoparietal approach for the resection of meningioma at the trigone of lateral ventricles","authors":"Xiangyu Ma, Shibao Liu, Huaiyong Hao, Wei-guo Li, L. Mu, Shujun Xu, Xin-gang Li","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.01.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.01.003","url":null,"abstract":"Objective \u0000To explore the application of ventriculostomy through straight-incision temporoparietal approach in the resection of meningioma at the trigone of lateral ventricles. \u0000 \u0000 \u0000Methods \u0000A total of 22 patients underwent operation through the straight-incision temporoparietal approach at Department of Neurosurgery, Qilu Hospital of Shandong University from January 2015 to June 2017 and were enrolled into this study. By retrospectively analyzing the intraoperative conditions, postoperative imaging, common complications of patients, we evaluated the reliability and advantages of the operative technique in the treatment of meningioma at the trigone of lateral ventricles. \u0000 \u0000 \u0000Results \u0000Simpson Ⅰ resection was achieved in all 22 patients without death. The operation duration was 140±75 min (60-240 min) and intraoperative blood loss was 300±110 ml (20-800 ml). The total time spend on craniotomy was about 20±4 min(14-31 min), and the blood loss during skull opening and closing periods was <20 ml. One patient (4.5%) developed postoperative intraventricular hemorrhage and good recovery was achieved with lumbar drainage. There was no imaging recurrence during the follow-up lasting for 16±7 months (6-30 months). \u0000 \u0000 \u0000Conclusion \u0000Being able to make effective exposure for maximal safe resection of meningioma at the trigone of lateral ventricles, the straight-incision temporoparietal approach could reduce damage to the vessels and nerves and shorten operative time, which might thus be used as a routine surgical treatment of meningioma at the trigone of lateral ventricles. \u0000 \u0000 \u0000Key words: \u0000Meningioma; Lateral ventricles; Microsurgery; Neuronavigation","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"7-10"},"PeriodicalIF":0.0,"publicationDate":"2020-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45555705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes of cerebral hemodynamics after unilateral carotid endarterectomy for severe stenotic lesions of bilateral internal carotid artery","authors":"Yuanyuan Zheng, P. Hui, Bai Zhang, Ya-suo Ding, Yanhong Yan, Yabo Huang, Chunhong Hu, Q. Fang","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.01.015","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.01.015","url":null,"abstract":"Objective \u0000To investigate the changes of cerebral hemodynamics after unilateral carotid endarterectomy (CEA) for severe stenotic lesions of bilateral internal carotid artery (ICA). \u0000 \u0000 \u0000Methods \u0000The clinical data of 41 consecutive patients with ICA stenosis admitted to Department of Neurosurgery, the First Affiliated Hospital of Soochow University from February 2012 to June 2018 were retrospectively studied. All patients were diagnosed by multi-modal images based on cerebrovascular ultrasound results with severe stenotic lesions of bilateral ICA and underwent unilateral CEA. The patency of anterior communicating arteries (ACoA) and posterior communicating arteries (PCoA) were evaluated by CT angiography (CTA) before and after CEA. According to postoperative CTA revealing whether ACoA was patent or not, 41 cases were divided into ACoA patent group (15 cases) and ACoA non-patent group (26 cases). We used transcranial Doppler (TCD) and CT perfusion imaging (CTP) to evaluate these changes of cerebral hemodynamics after operation in two groups, and analyzed their clinical outcomes. \u0000 \u0000 \u0000Results \u0000(1) Changes of cerebral collateral circulation based on CTA images: After CEA, the opening rate of ACoA increased significantly [pre-operation: 4.9% (2/41), postoperation: 36.6% (15/41)], and all the PCoA on the operated side were closed [pre-operation: 51.2% (21/41), postoperation: 0%]. In contrast, the opening rate of PCoA remained unchanged on the non-operated side [pre-operation: 46.3% (19/41), postoperation: 46.3% (19/41)]. (2) Changes of TCD parameters: Compared with the mean velocity (Vm) and pulsatility index (PI) before surgery, those of the middle cerebral artery (MCA) on the operated side of two groups and on the non-operated side of ACoA patent group were significantly increased (all P 0.05). There was no significant difference in Vm or PI of MCA on the operated side or PI of MCA on non-operated side between two groups after operation (all P>0.05), whereas the Vm of MCA on non-operated side in the ACoA patent group was significantly higher than that in ACoA non-patent group (P 0.05). There were no significant differences in CTP parameters on the operated side between two groups after operation (all P>0.05), whereas the CTP parameters on the non-operated side in ACoA patent group were significantly improved compared with those in ACoA non-patent group (all P<0.05). (4) Clinical outcomes: The neurological function deficits of brain areas supplied by ICA on the operated side improved in both groups. As to the neurological function deficits of brain areas supplied by ICA on the non-operated side, the improvement rate in ACoA patent group was higher than that in ACoA non-patent group (7/15 vs. 5/26, P=0.024). \u0000 \u0000 \u0000Conclusion \u0000After unilateral CEA for severe stenotic lesions of bilateral ICA, the opening of ACoA could simultaneously improve the cerebral perfusion on the non-operated side. \u0000 \u0000 \u0000Key words: \u0000Carotid stenosis; Endarterectomy, carotid; Collat","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"58-63"},"PeriodicalIF":0.0,"publicationDate":"2020-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42290588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between surgical timing and clinical outcomes of carotid endarterectomy for symptomatic carotid stenosis","authors":"Xiangjun Pan, P. Hui, Ya-suo Ding, Yanhong Yan, Bai Zhang, Runchuan Wang, Yi Zhang, Yabo Huang, Chunhong Hu, Q. Fang","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.01.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.01.009","url":null,"abstract":"Objective \u0000To explore the clinical outcomes of carotid endarterectomy (CEA) on patients with symptomatic carotid stenosis and its correlation with the timing of surgery. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was conducted on the clinical data of 146 patients with symptomatic carotid stenosis treated with CEA at Neurosurgery Department of the First Affiliated Hospital of Soochow University from September 2012 to May 2018. All 146 patients were divided into group A (≤14 d, 57 cases) and group B (> 14 d, 89 cases) according to the time from the initial symptoms to CEA. All patients underwent CT computed tomography perfusion (CTP) and transcranial doppler (TCD), and stroke patients were evaluated by the National Institutes of Health stroke scale (NIHSS) at 5 days after surgery. All patients were followed up on an outpatient basis 12 months after discharge, including re-examination of CTP and TCD, NIHSS scores for stroke patients, and observation of surgical-side restenosis. \u0000 \u0000 \u0000Results \u0000Perioperative stroke occurred in 1 (0.7%) of the 146 patients. Compared with preoperative 5 days after surgery, cerebral blood flow and cerebral blood volume were increased, and mean transit time (MTT) and time to peak (TTP) were shortened in the basal ganglia and temporal lobe of 146 patients (all P 0.05). Six patients (4.1%, 6/146) had restenosis on the surgical side. There were no significant differences in age, gender, medical history, smoking history, onset symptoms, or degree of carotid stenosis between the two groups of patients (all P>0.05). The change rate of MVMCA in group A was higher than that in group B at 5 days and 12 months after operation [5 days after operation: 41.0(16.7, 78.1)%, 18.9(4.9, 44.3)%, 12 months after operation: 40.5(13.0, 76.6)%, 15.9(7.2, 38.1)%, both P<0.05]. The rate of change in NIHSS scores of stroke patients in group A was greater than that in group B [5 days after operation: -100.0(-100.0, -60.0)%, -66.7(-100.0, -50.0)%, 12 months after operation: -100.0(-100.0, -58.6)%, -50.0(-100.0, -33.3)%, both P<0.05]. \u0000 \u0000 \u0000Conclusions \u0000Carotid endarterectomy could significantly improve cerebral perfusion, cerebral hemodynamics, and some neurological functions in patients with symptomatic carotid stenosis, and the early surgical prognosis seems better. \u0000 \u0000 \u0000Key words: \u0000Carotid stenosis; Treatment outcome; Carotid endarterectomy; Surgical timing","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"32-37"},"PeriodicalIF":0.0,"publicationDate":"2020-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46972865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}