中华神经外科杂志最新文献

{"title":"Clinical outcome analysis of carotid endarterectomy and carotid artery stenting for internal carotid artery stenosis","authors":"Xu Jianguo, L. Xiaojun, Huang Yabo, L. Bo, Liu Yizhi, C. Gang","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.11.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.11.008","url":null,"abstract":"Objective \u0000To investigate the safety and efficacy of carotid endarterectomy (CEA) and carotid artery stenting (CAS) for the treatment of internal carotid artery stenosis. \u0000 \u0000 \u0000Methods \u0000This study retrospectively analyzed 136 patients who underwent surgical treatment of internal carotid artery stenosis at the First Affiliated Hospital of Soochow University from July 2017 to December 2018. Among those, 78 underwent CEA (CEA group) at Department of Neurosurgery and the other 58 underwent CAS (CAS group) at Department of Interventional Radiology. General data, time of surgery, postoperative complications, postoperative hospital stay, hospitalization cost, and incidence of postoperative restenosis were compared between the 2 groups. \u0000 \u0000 \u0000Results \u0000There was no difference in the age, gender, lesion side, preoperative comorbidity, preoperative complication or preoperative internal carotid artery stenosis rate between 2 groups (all P>0.05). There was no significant difference in operation time, postoperative complications or the incidence of postoperative restenosis between 2 groups (all P>0.05). The follow-up period was 3 to 21 months. The postoperative hospital stay in CEA group was shorter than that in CAS group (6.5±2.3 d vs. 8.3±1.4 d, P<0.01), and the hospitalization cost in CEA group was lower than that in CAS group (57±10 thousand yuans vs. 103±18 thousand yuans, P<0.01). \u0000 \u0000 \u0000Conclusions \u0000For patients with internal carotid artery stenosis, both CEA and CAS seem safe and effective. In terms of hospital length-of-stay and economic factors, CEA has certain advantages over CAS. \u0000 \u0000 \u0000Key words: \u0000Carotid stenosis; Endarterectomy, carotid; Carotid artery stenting; Treatment outcome","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1112-1116"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44166534","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":"Application of microprobe vascular Doppler in the operation of skull base lesions","authors":"Mo Zhixiao, Zhang Qiang, Mao Haifeng, C. Gang, Hui Pin-jing, Wu Jiang, Y. Shuai, Ding Weiwei, Zhengquan Yu","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.11.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.11.016","url":null,"abstract":"Objective \u0000To investigate the effect of microprobe vascular Doppler (MVD) on the operation of skull base lesions. \u0000 \u0000 \u0000Methods \u0000From September 2017 to September 2018, 13 patients with skull base lesions at Neurosurgery Department of the first Affiliated Hospital of Soochow University were retrospectively analyzed. The 13 cases included 6 cases of meningioma in Sellar region, 2 cases of meningioma in petroclival region, 3 cases of pituitary adenoma of Knosp Ⅲ-Ⅳ grade, 1 case of chordoma in Sellar clival region, and 1 case of invasive growth of granulation tissue in intraorbital, skull base, sphenoid and ethmoid sinus after Aspergillus infection. The surgical methods included neuroendoscopic transnasal approach and microsurgical resection under craniotomy microscope. MVD was applied in all operations of this series. Medical imaging examination and follow-up were performed after operation. \u0000 \u0000 \u0000Results \u0000Among the 13 patients, total resection of meningioma in Sellar region was performed in 6 cases and subtotal resection in 2, total resection of Knosp grade Ⅲ-Ⅳ pituitary adenoma was conducted in 2 and subtotal resection in 1. Total resection was performed in 1 case of invasive growth of granulation tissue in intraorbital, skull base, sphenoid and ethmoid sinus after Aspergillus infection and 1 case of chordoma in Sellar base clival region. Uncorrected left eye vision was reported in the patient with Aspergillus infection post surgery. Postoperative symptoms of the other patients were improved. The prolactin level of 1 patient with prolactin adenoma was more than 204 ng/ml before operation. At 2 months post operation, the prolactin level was 105.66 ng/ml after oral bromocriptine combined with radiotherapy. The last reexamination was 11.3 ng/ml without hypophysis dysfunction. Six patients had varying degrees of electrolyte disorder after operation. Four patients had fever after operation and all returned to normal before discharge from hospital after treatment. All patients were followed up for (16.1±3.3) months(10-22 months), and there was no recurrence in imaging examination. \u0000 \u0000 \u0000Conclusion \u0000With the aid of MVD during the surgical resection of invasive growth lesions and large space occupying lesions in the skull base, the important blood vessels invaded, wrapped, pushed and displaced by the lesions can be monitored in real time, which might help avoid the disastrous consequences during and after operation and reduce the risk of surgery. \u0000 \u0000 \u0000Key words: \u0000Skull base neoplasms; Microsurgery; Natural orifice endoscopic surgery; Microprobe vascular Doppler","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1148-1151"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46530447","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":"Gene mutation at chromosome 22 in sporadic patients with spinal schwannomatosis: A preliminary analysis","authors":"Jian-jun Sun, M. Zheng, Xiao-hui Lou, Jun Yang","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.10.019","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.10.019","url":null,"abstract":"Objective \u0000To analyze the correlation on the prominent germline or somatic mutations at chromosome 22 of the sporadic patients with spinal schwannomatosis. \u0000 \u0000 \u0000Methods \u0000From May to November 2015, 9 serial patients with multiple spinal cord tumors underwent open surgery at Neurosurgical Department, the Third Hospital of Peking University. All spinal cord tumors in the 9 patients were removed by operation. The multiple spinal cord tumors were located at lumbar segments in 4 patients, at cervical segments in 4, and at thoracolumbar segments in 1. The samples of tumor and blood were preserved during operation. In order to determine the SNP (single nucleotide polymorphism), SNV (single nucleotide variants) and CNV (copy number variations) of 9 patients, whole-exome targeted enrichment and sequencing were performed on tumor and blood DNA after operation. \u0000 \u0000 \u0000Results \u0000The open surgery was successful performed in 9 patients. Among 9 patients, histological staining showed neurofibromatosis type I (NF1) in 3 cases, ganglioneuroma in 1, ependymoma in 1, and schwannomatosis in 4 (1 case with comorbidity of bilateral acoustic tumors). Among 9 sporadic cases, gene mutation was detected in a large region of chromosome 22 only in 4 cases with spinal schwannomatosis. Among 4 cases, the germline mutation was identified in 2 cases, and somatic mutation in 2 cases. Splice-donor neurofibromatosis type 2 (NF2) germline high frequency mutation (T→C) was identified in the No.1 patient. Frame-shift leucine-zipper-like transcriptional regulator 1 (LZTR1) germline high frequency mutation (G→GT) was identified in the No. 2 patient. Frameshift NF2 somatic mutation (CGA→C) was identified in the No. 3 patient. Stop-gained NF2 somatic mutation was identified in the No. 4 patient. Among 4 cases, chromosome fibrillin 3 (FBN3) intermediate frequency missense mutation was simultaneously found in chromosome 19 in 2 cases, out of which 1 was somatic mutation and the other was germ line mutation. \u0000 \u0000 \u0000Conclusion \u0000The preliminary results have suggested that most of the genes with high frequency mutations in spinal schwannomatosis are on chromosome 22. \u0000 \u0000 \u0000Key words: \u0000Schwannomatosis; Spinal cord; Genetic testing","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1054-1058"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47586446","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":"Predictive values of island signs and blend signs on non-contrast CT in early hematoma enlargement of spontaneous intracerebral hemorrhage","authors":"W. Jia, Changqing Shi, Yalong Liu, Wenyong Li","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.10.015","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.10.015","url":null,"abstract":"Objective \u0000To explore the predictive values of island signs and blend signs on non-contrast CT in early hematoma enlargement of spontaneous intracerebral hemorrhage (sICH). \u0000 \u0000 \u0000Methods \u0000A total of 84 patients with sICH were admitted to Department of Neurosurgery, Wenjiang District People′s Hospital of Chengdu from January 2015 to December 2017 and consecutively enrolled into this study. The time from onset to the first CT examination was ≤6 h, and the second CT examination time was ≤24 h. According to the results of those 2 examinations, the patients were divided into the early hematoma enlargement group (35 cases) and the hematoma non-enlargement group (49 cases). The effects of CT island signs and blend signs on early hematoma enlargement and their diagnostic efficacy for early hematoma enlargement were analyzed. \u0000 \u0000 \u0000Results \u0000Non-contrast CT scan showed that 60.0% (21/35) in the early hematoma enlargement group had island sign, and 71.4% (25/35) had blend sign. Compared with 14.3% (7/49) and 24.5% (12/49) in non-enlargement group, those differences were statistically significant (both P<0.01). Multivariate logistic regression analysis revealed that both island sign (OR=12.720, 95% CI: 3.501-46.218, P<0.01) and blend sign (OR=10.793, 95% CI: 3.172-36.727, P=0.01) were independent predictors of early hematoma enlargement. The sensitivity, specificity, positive predictive value, negative predictive value and Youden index of island sign for early hematoma enlargement were 60.0%, 85.7%, 75.0%, 75.0% and 45.7% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and Youden index of blend sign for early hematoma enlargement were 71.4%, 75.5%, 67.6%, 78.7% and 46.9% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and Youden index of island sign combined with blend sign for early hematoma enlargement were 91.4%, 63.3%, 64.0%, 91.2% and 54.7% respectively. \u0000 \u0000 \u0000Conclusions \u0000Island sign and blend sign are independent predictors of early enlargement of hematoma. The diagnostic performance with the combination of island sign and blend sign seems higher than the that of either single indicator. \u0000 \u0000 \u0000Key words: \u0000Spontaneous intracerebral hemorrhage; X-ray computed tomography; Hematoma enlargement; Island sign; Blend sign","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"33 11","pages":"1036-1040"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41267563","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":"Roles of different methods in measurement of distance between intracranial arteriovenous malforma-tion and eloquent cortex in prediction of postoperative neurological deficits","authors":"Qingyuan Liu, Jun Wu, Pengjun Jiang, Yong Cao","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.10.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.10.012","url":null,"abstract":"Objectives \u0000To explore the predictive values of different methods measuring the distance between lesion and eloquent cortex (LED) in surgery-related functional deficit (SFD) in intracranial arteriovenous malformations (iAVMs). \u0000 \u0000 \u0000Methods \u0000This study retrospectively reviewed and followed up the patients who underwent microsurgical resection of iAVMs at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January to December 2017. Based on the difference (≥1) between the mRS (modified Rankin scale) at 3 months after surgery and that prior to surgery, 17 patients were categorized into the SFD group and 79 into non-SFD group. The eloquent cortex was firstly recognized according to the Spetzler-Martin(S-M)standard. Based on the presurgical T1-weight, T2-weight, time-of-flight, functional and diffuse tensor imaging MR, the LED and modified LED (MLED) were measured. Multivariate logistic analysis was performed to investigate the independent risk factors related to SFD at 3 months post surgery. The ROC (receiver operating characteristic) curve analysis was performed to explore the predicting values of different measuring methods in SFD. \u0000 \u0000 \u0000Results \u0000Multivariate logistic analysis based on 96 patients demonstrated that the S-M grading (OR=3.10), MLED (OR=0.66) and nidus type (diffuse and compact, OR=0.12) were independent risk factors for SFD (all P<0.05). For all iAVMs, both MLED and LED had good predictive value in SFD, and the AUC (area under a curve) values were 0.843 and 0.830 respectively (both P<0.05), while the S-M grading(AUC: 516, P=0.804) did not have predictive value. For compact iAVMs, LED (AUC=0.784) and MLED (AUC=0.726) could effectively predict the risk of SFD(all P<0.05). For diffuse iAVMs, MLED (AUC=0.833) could predict the risk of SFD (P=0.003), whereas LED (AUC=0.583, P=0.665) had poor predicting value. \u0000 \u0000 \u0000Conclusions \u0000The distance between iAVM and eloquent cortex seems to be an important factor to predict the surgical outcome. For compact iAVM, both LED and MLED have good predicting values, while only MLED shows predicting value for diffuse iAVM. \u0000 \u0000 \u0000Key words: \u0000Intracranial arteriovenous malformations; Neurological deficit; Multi-modeimage; Forecasting","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1022-1026"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46722060","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":"Microsurgery for subtentorial cavernous malformations in children","authors":"Zhipeng Shen, H. Zeng, Wujie Shi, Peiliang Zhang, Jianbin Weng, Chao Lin","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.10.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.10.013","url":null,"abstract":"Objective \u0000To investigate the safety and efficacy of microsurgery in the treatment of subtentorial cavernous malformations (CMs) in children. \u0000 \u0000 \u0000Methods \u0000From June 2015 to June 2018, 12 patients (14 lesions) with pathologically proven subtentorial CMs at Department of Neurosurgery, the Children′s Hospital, Zhejiang University School of Medicine, were retrospectively enrolled into this study. The lesions were located in the brainstem in 4 cases and cerebellum in 8 cases (2 of them have 2 lesions in each). The brainstem lesions were examined by diffusion tensor imaging before operation. The safety and effectiveness of the operation were evaluated based on imaging examination, improvement of nervous system symptoms and modified Rankin scale (mRS). \u0000 \u0000 \u0000Results \u0000Of the 14 lesions, 13 were totally resected and 1 was followed up. During hospitalization, 9 of 12 cases with preoperative symptoms were improved, 2 cases kept preoperative symptoms and 1 case died. No new neurological deficits occurred. Eleven cases were followed up for 3 to 34 months. No re-bleeding or recurrence was found in the primary site of the lesion. The mRS scores were 0 in 9 cases, 1 in 1 and 2 in 1. \u0000 \u0000 \u0000Conclusion \u0000Under the premise of safety, surgical treatment of children′s subtentorial CMs is effective. \u0000 \u0000 \u0000Key words: \u0000Hemangioma, cavernous; Central nervous system; Microsurgery; Child; Subtentorial","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1027-1030"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46743880","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":"Deep brain stimulation of bilateral subthalamic nucleus for the treatment of drug-refractory Meige syndrome","authors":"Ning Wang, Xiao-song Wang, Yupeng Guo, Zonghui Fu, Guoqiang Chen","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.10.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.10.008","url":null,"abstract":"Objective \u0000To explore the therapeutic effect of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in the treatment of refractory Meige syndrome (MS). \u0000 \u0000 \u0000Methods \u0000A total of 32 patients with MS who underwent STN-DBS at Department of Functional Neurosurgery, Aviation General Hospital of China Medical University from May 2014 to July 2017 were retrospectively enrolled into this study. The Burke-Fahn-Marsden Dystonia Disorder Scale (BFMDRS) was used to assess the improvement of clinical symptoms. The patient′s programmed parameters were documented as well. \u0000 \u0000 \u0000Results \u0000All 32 patients were successfully operated. No serious complications such as intracranial hemorrhage, wound infection, allergic reaction or electrical stimulator equipment failure occurred during perioperative period. Ten patients (31.3%) had varying degrees of dyskinesia during postoperative programing, which was improved at a certain level after adjustment of programmed parameters. One patient (3.1%) had psychiatric symptoms after surgery, and the mental symptoms disappeared 3 days after treatment. The postoperative follow-up time was >12 months. The improvement rates (median) of BFMDRS scores at 3, 6, and 12 months after surgery were 76.9%, 81.4%, and 82.8%, respectively. Among them, 18 patients were followed up for >24 months, and the improvement rate (median) was 82.5% at 24 months after surgery. All 32 patients were treated with unipolar stimulation mode, which was changed to double negative stimulation mode in 2 cases due to poor effects. The stimulation voltage was 0.8-3.4 V at 12 months postoperatively, the stimulation pulse width was 50-90 μs, and the stimulation frequency was 100-175 Hz. There was no significant increase or decrease in the programmed parameters of 32 patients between 3 and 12 months post operation. \u0000 \u0000 \u0000Conclusions \u0000STN-DBS seems safe and effective for patients with drug-resistant MS. Postoperative programming is relatively easy with parameters varying in a small scope. \u0000 \u0000 \u0000Key words: \u0000Meige syndrome; Dystonia; Subthalamic nucleus; Deep brain stimulation; Prognosis","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1006-1010"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44621941","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":"Accuracy study of electrode implantation of robot-assisted deep brain stimulation based on visual registration","authors":"Huan-Guang Liu, A. Yang, De-Feng Liu","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.10.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.10.003","url":null,"abstract":"Objective \u0000To evaluate the accuracy and safety of electrode implantation of deep brain stimulation (DBS) with visual registration-based robot assistance. \u0000 \u0000 \u0000Methods \u0000The clinical data of 15 patients with Parkinson′s disease (PD) admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from October 2018 to June 2019 were retrospectively analyzed. All those patients underwent DBS assisted with neurosurgical robot (Remebot system). The distance deviations of implanted electrodes in the lateral direction (x-axis) and longitudinal direction (y-axis) were documented according to postoperative CT fused with preoperative imaging of surgical plan. Postoperative complications were documented as well. \u0000 \u0000 \u0000Results \u0000A total of 30 DBS electrodes were successfully implanted in 15 patients. Twenty-six electrodes were implanted into the subthalamic nucleus and 4 into the globus pallidus internus. The x-axis distance deviation between the tip of electrode and planned target ranged from 0.10 mm to 1.34 mm, and the average distance deviation was 0.60±0.33 mm. The y-axis distance deviation ranged from 0.02 mm to 0.83 mm, and the average distance deviation was 0.45±0.24 mm. There were no electrode-related bleeding events, intracranial infection or surgical incision non-healing. \u0000 \u0000 \u0000Conclusion \u0000DBS with assistance of neurosurgical robot seems to be associated with relatively little deviation in electrode implantation and no surgery-related complications. \u0000 \u0000 \u0000Key words: \u0000Deep brain stimulation; Parkinson disease; Robotics; Accuracy","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"981-984"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45338925","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":"Efficacy comparison of subthalamic and globus pallidus internus deep brain stimulation in Parkinson′s disease with dyskinesia","authors":"Shiying Fan, Kailiang Wang, Fangang Meng, Huimin Wang, Huan-Guang Liu, A. Yang, Feng Wang, Jian-Guo Zhang","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.10.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.10.004","url":null,"abstract":"Objective \u0000To compare the therapeutic effects of subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) on Parkinson′s disease (PD) with levodopa-induced dyskinesia (LID), and to explore the possible underlying mechanism. \u0000 \u0000 \u0000Methods \u0000A total of 27 PD patients with LID treated with STN and GPi-DBS from August 2015 to October 2017 at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University were retrospectively enrolled. Among them, 14 underwent STN-DBS and 13 underwent GPi-DBS. Patients were evaluated preoperatively and every 6, 12, 18 months after surgery. The primary outcome was assessed based on the Unified Dyskinesia Rating Scale (UDysRS). The secondary outcome was investigated according to the Unified Parkinson Disease Rating Scale part Ⅲ (UPDRS-Ⅲ), levodopa equivalent dose (LED), stimulation parameters and side effects. \u0000 \u0000 \u0000Results \u0000Both STN-DBS and GPi-DBS group showed significant improvement in LID, while GPi-DBS exerted higher LID improvement (F=15.326, P 0.05). The improvement of UPDRS-Ⅲ at the 18 month follow-up was 44.7%±20.0% and 45.7%±17.1%, respectively for STN and GPi-DBS. The LED reduction rate was higher in STN-DBS group (F=4.693, P<0.05). The LED reduction rate at the 18 month follow-up was[M(P25, P75)] 44.8(26.7, 80.2)%and 14.0(0, 41.3)%, respectively for STN and GPi-DBS.The stimulation voltage and pulse width of the GPi-DBS group were higher than those of the STN-DBS group (F values were 4.435 and 21.415 respectively, P<0.05). In the STN-DBS group, there were 5 cases of stimulation induced dyskinesia (SID), 1 case of electrode fracture, and 1 case of incision infection.There were 1 case of SID and 1 case of bradykinesia in the GPi-DBS group. \u0000 \u0000 \u0000Conclusions \u0000Both STN and GPi-DBS could improve dyskinesia. Compared with STN-DBS, GPi-DBS seems to have a stronger effect on improvement of LID. The anti-dyskinesia effect of STN-DBS may be related to drug reduction and adjustment of stimulation sites, while GPi-DBS might exert a direct anti-dyskinesia effect. \u0000 \u0000 \u0000Key words: \u0000Deep brain stimulation; Subthalamic nucleus; Globus pallidus internus; Levodopa-induced dyskinesia; Levodopa equivalent dose","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"985-990"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41344956","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":"Analysis of intra-operative target location of subthalamic nucleus in deep brain stimulation surgery for Parkinson′s disease with bispectral index monitoring under general anesthesia","authors":"Jiyuan Liu, Hong-Jie Lyu, Rurong Tang, Hongmei Yu, Yan Ren, Shao-Wu Ou, L. Pei, Yun-jie Wang, Jun Wang","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.10.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.10.009","url":null,"abstract":"Objective \u0000To explore the feasibility of using electrophysiology to locate STN targets in the treatment of Parkinson′s disease (PD) by deep brain stimulation (DBS) with bispectral index (BIS) monitoring under general anesthesia. \u0000 \u0000 \u0000Methods \u0000The data of 22 PD patients treated by bilateral STN-DBS at Department of Neurosurgery, the First Hospital of China Medical University from September 2017 to May 2019 were retrospectively analyzed. All patients completed surgery with BIS monitoring under general anesthesia. All STN nuclei were located based on microelectrode recording (MER). Postoperative MRI was fused with preoperative MRI to evaluate the accuracy of electrode implantation. \u0000 \u0000 \u0000Results \u0000The discharge in the sensory-motor area of STN were recorded by MER in all 44 sides during asleep DBS. Microelectrodes were implanted and STN electrophysiological signals were recorded for 40 sides when BIS value was maintained above 70. For the other 4 sides when BIS value was maintained between 30 and 60, and the discharge frequency and amplitude were only about 50% of those when BIS value was maintained above 70. The electrophysiological length of STN was 3.5-7.5(5.2±0.9) mm on the right side and 3.5-7.5(5.5±1.0)mm on the left side, respectively. After intracranial electrode was implanted and when BIS value ≥80, 18 patients could complete the stimulation test for clinical symptoms and side effects, and 4 patients could only complete the test for motor side effects. Postoperative MRI showed that all electrode targets were located in STN nucleus, and the radial error was (1.10±0.45)mm on the right side and (1.24±0.56)mm on the left side. No intracranial hemorrhage, infection or other complications occurred. \u0000 \u0000 \u0000Conclusions \u0000During the surgery of asleep STN-DBS, clear and typical STN discharge could be recorded in MER with BIS (≥70) monitoring. The target localization seems accurate. \u0000 \u0000 \u0000Key words: \u0000Parkinson disease; Anesthesia, general; Deep brain stimulation; Bispectral index; Microelectrode recording","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1011-1014"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46514518","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}