中华神经外科杂志最新文献

{"title":"Intracranial hemangioblastomas with special types of imaging findings: A report of 8 cases","authors":"Dexuan Ma, Zunguo Du, Tie Lyu, Haibo Tan, G. Du","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.10.017","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.10.017","url":null,"abstract":"Objective \u0000To investigate the diagnosis and treatment of intracranial hemangioblastomas (HBs) with special imaging findings in order to improve the clinical diagnostic level of this disease. \u0000 \u0000 \u0000Methods \u0000The clinical data of 8 patients with HBs who had atypical imaging findings admitted to Department of Neurosurgery, Huashan Hospital, Fudan University from May 2014 to April 2018 were retrospectively analyzed. Eight patients underwent CT and MRI, 7 of which underwent magnetic resonance spectroscopy (MRS) and 3 underwent positron emission tomography (PET)-CT. One case was diagnosed as Von Hippel-Lindau (VHL)-HB before surgery due to multiple lesions and the other 7 were misdiagnosed as other intracranial tumors. Eight patients with intracranial HB underwent microsurgery. \u0000 \u0000 \u0000Results \u0000All 8 cases showed atypical imaging findings. Four cases of cystic HBs presented the partial enhanced cystic wall or enhanced ring lesion without the nodules. The other 4 cases of substantial HBs showed severe peritumoral edema surrounding the lesions. Eight tumors were completely resected by microsurgery and HBs were confirmed by the postoperative pathology. The severe edema in 4 patients completely disappeared after dehydration therapy. Seven patients underwent VHL gene test, and 3 were found to be VHL-HB (including the patient with multiple lesions), which were recruited in the management of VHL disease. Postoperative follow-up duration was 32±17.6 months (3-50 months). \u0000 \u0000 \u0000Conclusion \u0000Those intracranial HBs with atypical imaging findings are very rare and misdiagnosis is common based on preoperative MRI results. MRS, PET-CT and other examinations might have supporting value for the diagnosis of HB and its definite diagnosis relies on pathological examination. Microsurgical resection is the main treatment for HB. \u0000 \u0000 \u0000Key words: \u0000Hemangioblastoma; Magnetic resonance imaging; Diagnosis; Treatment outcome","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1044-1048"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44816100","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 parameters of intracranial pressure wave for postoperative global cerebral edema in patients with aneurysmal subarachnoid hemorrhage","authors":"Hui Li, Zhijian Huang, Guojing Liu, Lingjun Qi, Xuangui Xie, Xiaochuan Sun","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.10.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.10.014","url":null,"abstract":"Objective \u0000To investigate the correlation between the parameters of intracranial pressure (ICP) wave and global cerebral edema for providing basis of early prediction and intervention for global cerebral edema after operation in patients with aneurysmal subarachnoid hemorrhage (aSAH). \u0000 \u0000 \u0000Methods \u0000A total of 80 patients with aSAH admitted to Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University from May 2017 to December 2017 were retrospectively enrolled. The parameters of ICP wave and clinical data of 80 patients within 3 days after intracranial aneurysm clipping were collected and analyzed. The aSAH patients were divided into the global cerebral endema (GCE) group (n=13) and NO-GCE group (n=67)to compare the clinical data and parameters of ICP wave. The multivariate logistic regression analysis was used to determine the risk factors that might lead to GCE. According to receiver operating characteristic (ROC) curve, diagnostic threshold values for GCE were evaluated and sensitivity and specificity were calculated for optimal thresholds to investigate the predictive value of parameters of intracranial pressure wave for postoperative GCE. \u0000 \u0000 \u0000Results \u0000The difference of mFisher(modified Fisher) grading, mean ICP wave amplitude (MWA) and R-symbol of correlation between amplitude and pressure (RAP) were significant between NO-GCE group and GCE group (P value: 0.012, 0.005, 0.001, respectively). The result of multivariate logistic regression analysis showed that mFisher grading (OR=8.896, 95%CI: 1.678-47.165, P=0.010), RAP (OR=2.130, 95%CI: 1.155-3.931, P=0.016) were independent risk factors of postoperative GCE. The optimal threshold values of MWA and RAP were 3.853 and 0.480 respectively, which had high diagnostic value in prediction of GCE. The relevant sensitivity and specificity were 84.6% and 70.1% for MWA and 92.3% and 74.6% for RAP. \u0000 \u0000 \u0000Conclusions \u0000The mFisher grading, MWA and RAP might be related to postoperative GCE in patients with aSAH.The mFisher grading and RAP are independent risk factors of postoperative GCE in patients with aSAH. Monitoring of MWA and RAP could help identify the early occurrence of GCE. \u0000 \u0000 \u0000Key words: \u0000Intracranial aneurysm; Subarachnoid hemorrhage; Intracranial pressure; Global cerebral edema; Predictive value","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1031-1035"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42636421","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":"Initial programming of deep brain stimulation of hypothalamic/fornix for severe Alzheimer′s disease","authors":"Xin Xu, Xinguang Yu, J. Jia, Zhiqi Mao, Zhi-qiang Cui, Longsheng Pan, R. Zong, Lin Ma, X. Lou, Zhipei Ling","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.10.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.10.007","url":null,"abstract":"Objective \u0000To explore the initial start-up programming and efficacy of deep brain electrical stimulation (DBS) of the hypothalamic fornix (HF) in the treatment of severe Alzheimer′s disease (AD). \u0000 \u0000 \u0000Methods \u0000A retrospective study was conducted on 9 patients with severe AD who underwent DBS-HF at Department of Neurosurgery, the First Medical Center of Chinese PLA General Hospital from June 2015 to September 2018. Postoperative cranial MRI was performed to determine the electrode position. Four weeks after operation, DBS device was turned on with initial programming set as unipolar stimulation with a frequency of 130 Hz, pulse width 90 μs and voltage of 3 V. The emotion, memory, calculation, language or communication and orientation of the patients were observed based on corresponding function of the brain area where the electrode contacts were located in order to determine the optimal contact and stimulating mode was thus maintained. Outpatient follow-up was conducted for all patients 3 months after the start-up. The follow-up included assessment of the patient′s emotion, memory, calculation, language, communication and orientation evaluated at initial programming. In addition, the patient′s sleep conditions and social skills were documented through consultation with the patient′s families. \u0000 \u0000 \u0000Results \u0000Nine patients were successfully operated. No perioperative complications such as intracerebral hemorrhage, abnormal electrode connection or wound infection occurred after operation. The electrodes of 9 patients were accurately implanted into the preset target position. At initial programming, there were no adverse effects reported including psychiatric and behavioral disorders, cardiovascular events and intolerance of stimulation. Among the 9 patients, memory was improved in 2 and mood was improved in 1. No symptom worsening was observed in the patient with severe psychiatric disorder who underwent bipolar stimulation through optimal contacts. Nine patients were followed up for 3 months. Among them, 7 had improved mood, 5 had improved memory, 7 had improved sleep, 6 had improved language ability, 3 had changed social intercourse, and 4 had changed orientation. However, there was no significant change in calculating power of 9 patients. \u0000 \u0000 \u0000Conclusions \u0000The preliminary results have suggest that the program-controlled startup scheme with functions of test, calculation, memory, emotion and physiology could be a way to ensure the efficacy of HF-DBS in the treatment of severe AD patients. \u0000 \u0000 \u0000Key words: \u0000Alzheimer′s disease; Deep brain stimulation; Fornix, brain; Treatment outcome; Programming","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1001-1005"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47212974","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 robot-assisted stereoencephalography electrode implantation in epilepsy surgery","authors":"Liang Qiao, Tao Yu, Duanyu Ni, Xueyuan Wang, Cuiping Xu, Guojun Zhang","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.10.018","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.10.018","url":null,"abstract":"Objective \u0000To explore the precision, efficiency and safety of robot-assisted stereoencephalography (SEEG) electrode implantation applied in epilepsy surgery. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was conducted on 23 patients of refractory epilepsy who were admitted to Beijing Institute of Functional Neurosurgery, Xuanwu Hospital of Capital Medical University from February 2018 to June 2018 and underwent robot-assisted SEEG electrode implantation ('robot’ group). A total of 25 refractory epilepsy patients admitted from October 2017 to January 2018 underwent CRW stereotactic apparatus-guided SEEG implantation and served as control ('CRW’ group). Continuous thin-slice CT was conducted post operation in each case, based on which the distance between the actual and planned target of each electrode trajectory was measured and set as operational deviation.Operational duration for each electrode implantation and incidences of postoperative complications were documented. The parameters as above were compared between the 2 groups. \u0000 \u0000 \u0000Results \u0000In the 'robot’ group, a total of 179SEEG electrodes with 2 642 contacts were implanted in this series (23 cases), with the median of 8 (5-10) electrodes with 120 (76-136)contacts in each patient.In the 'CRW’ group, 25 patients underwent implantation of 172 electrodes with 2 520 contacts, with the median of 7 (6-9)electrodes with 100 (60-128) contacts in each patient.The operational deviation of each electrode was 1.4 (0.4-9.3) mm ('robot’ group) and 1.4 (0-4.6) mm ('CRW’ group), respectively, which had no statistical difference (P>0.05). Compared with 'CRW’ group, the 'robot’ group had significantly shorter operational duration[8(5.9-12.8) min vs. 14.7 (10.3-18.5) min, P<0.01] for each electrode implantation. In the 'robot’ group, there were 2 cases (8.7%) of asymptomatic intracranial hemorrhage. No cases of infection or other complications were observed. In the 'CRW’ group, there were 1 case (4.0%) of intracerebral hemorrhage causing contralateral paralysis, 1 case (4.0%) of asymptomatic hemorrhage and no cases of other complications. \u0000 \u0000 \u0000Conclusions \u0000Robot-assisted technique seems to be able to remarkedly increase the efficiency of SEEG electrode implantation with relatively good precision and safety, which could thus be recommended for clinical use and promotion. \u0000 \u0000 \u0000Key words: \u0000Epilepsy; Neurosurgical procedures; Robot; Stereotaxic techniques; Intracranial electrode","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1049-1053"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41752558","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 study on treatment of chronic disorders of consciousness by deep brain stimulation: A report of 24 cases","authors":"Yi Yang, Yuan-yuan Dang, Xiaoyu Xia, Xueling Chen, Ruijing Huang, Jie Wu, Xiyu Lin, R. Xu","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.10.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.10.006","url":null,"abstract":"Objective \u0000To investigate the therapeutic effect of deep brain stimulation (DBS) in patients with chronic consciousness disorder (DOC) and its influencing factors. \u0000 \u0000 \u0000Methods \u0000Twenty-four DOC patients admitted to Department of Neurosurgery, the Seventh Medical Center of PLA General Hospital from July 2011 to December 2018 were retrospectively enrolled into this study. All patients were treated with DBS targeting unilateral central nucleus-parafascicular nucleus complex. CT or MRI was performed post operation to determine the electrode position. All patients were clinically followed up post operation. The follow-up included physical examination of the nervous system, assessment of modified coma recovery scale (CRS-R) score and extended Glasgow outcome score (GOS-E). According to the clinical symptoms and assessment scores of the patients, the therapeutic effects were evaluated and categorized into effective and ineffective. Furthermore, univariate and multivariate logistic regression analyses were used to explore the risk factors affecting the efficacy of patients. \u0000 \u0000 \u0000Results \u0000All 24 operations were successful. After reexamination of CT or MRI, the electrodes of all patients were implanted into the preset target position. DBS was turned on at 7 days post surgery in the 24 patients who received unipolar electrical stimulation with the voltage of (3.3±1.2)V (1.0-4.0 V), frequency of 100 Hz and pulse width of 120 μs. At 1-year follow-up, the outcomes of 24 patients were effective in 10 patients, improved in 13 and death in 1. The overall effective rate was 41.7% (10/24). Univariate analysis showed that the age, CRS-R score and recommendation criteria for surgery were influencing factors of the patient′s outcome (all P<0.05). Further multivariate logistic regression analysis showed that recommendation criteria for surgery was the independent risk factor affecting the outcome of patients(OR=4.333, 95%CI: 1.207-519.697, P=0.037). \u0000 \u0000 \u0000Conclusions \u0000DBS seems effective in the treatment of DOC and could be used as one of the feasible schemes for DOC treatment. recommendation criteria for surgery is the independent risk factor affecting the outcome of DOC patients. \u0000 \u0000 \u0000Key words: \u0000Consciousness disorders; Deep brain stimulation; Treatment outcome; Factor analysis, statistical","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"996-1000"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47188315","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 analysis of vagus nerve stimulation for the treatment of drug resistant epilepsy: A report of 110 cases","authors":"Yiming Zhang, R. Qian, Xian-ming Fu, Xiang-pin Wei, Luwei Jiang, Dong Zhang, C. Niu","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.10.020","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.10.020","url":null,"abstract":"Objective \u0000To explore the efficacy of vagus nerve stimulation (VNS) for the treatment of drug resistant epilepsy. \u0000 \u0000 \u0000Methods \u0000The clinical data of 110 patients with drug resistant epilepsy who underwent VNS at Department of Neurosurgery, Provincial Hospital Affiliated to Anhui Medical University (the First Affiliated Hospital of University of Science and Technology of China) from February 2014 to March 2018 were analyzed retrospectively. The frequency and severity of seizures were followed up by outpatient review, and the efficacy was analyzed according to the McHugh seizure outcome classifications. \u0000 \u0000 \u0000Results \u0000The results of McHugh grade of 110 patients were as follows: grade ⅠA in 10 cases, grade ⅠB in 6, grade ⅡA in 25, grade ⅡB in 7, grade ⅢA in 30, grade ⅢB in 8, grade Ⅳ in 1 and grade Ⅴ in 20, and 3 patients were lost to follow-up. There was significant difference in seizure frequency between preoperative and postoperative conditions (P 0.05). In terms of seizure types, there were significant difference in the distribution of the McHugh classifications between patients with seizures of unclassified onset, focal onset and generalized onset (all P<0.05). The frequency of seizures decreased gradually with prolonged VNS stimulation time(P<0.05). \u0000 \u0000 \u0000Conclusions \u0000VNS could significantly reduce the frequency of seizure. VNS has a better effect on seizures with focal onset and generalized onset, while it has a poor effect on seizure types that cannot be classified. With the increase of stimulation time, the therapeutic effect of VNS is gradually improved. However, the age, sex or duration of disease is not related to the effect of VNS. \u0000 \u0000 \u0000Key words: \u0000Epilepsy; Vagus nerve stimulation; Treatment outcome; McHugh seizure outcome classifications","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1059-1063"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43850016","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":"The role of stereoelectroencephalography (SEEG) in repeat epilepsy surgery","authors":"Mengyang Wang, Jing Wang, Zhaofen Yan, Heng Wang, Fei-fei Xu, Yujiao Yang, Q. Deng, Jie Wang, Jian Zhou, Y. Guan, G. Luan","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.09.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.09.012","url":null,"abstract":"Objective \u0000To explore the role of stereoelectroencephalography(SEEG) in evaluation of epilepsy resurgery. \u0000 \u0000 \u0000Methods \u0000Thirty-nine patients with a surgical failure and clinical seizures in the SEEG monitoring were retrospectively included in this study at Department of Founctional Neurosurgery, Sanbo Brain Hospital, Capital Medical University from August 2011 to January 2018. The evaluation results from application of SEEG and efficacy of resurgery were analyzed. \u0000 \u0000 \u0000Results \u0000The seizure onset zone (SOZ) located in the neighboring areas around the initial surgical region in 14 (36%) patients, and in the non-neighboring areas in 25(64%) patients, among whom SOZ located in the same side as the initial surgical region but far apart from it in 21 patients(54%). High frequency discharges were the most common SEEG pattern of seizure onset with a total of 19 cases (49%), followed by the low voltage fast activities with a total of 8 cases (21%). The seizure onset from single brain region was shown in 32 cases (82%), and that from multi brain regions was shown in 7 cases (18%). After SEEG evaluation, 4 patients did not undergo surgical treatment, and the remaining 35 cases were followed by re-surgery. There were 33 cases followed up more than 12 (12-51) months in total, among whom 16 cases (49%) classified as Engel I, 3 cases (9%) Engel Ⅱ, 2 cases (6%) Engel Ⅲ, and 12 cases (36%) Engel Ⅳ. Nineteen cases undergone anterior temporal lobectomy in the first surgery, and 17 cases were re-operated after SEEG evaluation, among whom 16 cases were followed up more than 12 month and 8 cases were classified as Engle Ⅰ. \u0000 \u0000 \u0000Conclusions \u0000Nearly half of patients achieved seizure freedom after repeated surgery by SEEG evaluation. The success rate of epilepsy resurgery is mainly related to the accuracy of localization of epileptogenic zone. \u0000 \u0000 \u0000Key words: \u0000Epilepsy; Stereoelectroencephalography; Reoperation","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"923-927"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42623208","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":"Prognostic value of 11C-methionine PET/CT and MRI in diffuse intrinsic brain stem glioma patients","authors":"Xiaobin Zhao, Kai Wang, Lu Kong, Deling Li, Yuliang Wu, Ya-ming Wang, Z. Qiao, Qian Chen, L. Ai, Liwei Zhang","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.09.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.09.010","url":null,"abstract":"Objective \u0000To explore the prognostic value of 11C-methionine positron emission tomography/CT (MET-PET/CT) combined with MRI in patients with diffuse intrinsic pontine glioma (DIPG). \u0000 \u0000 \u0000Methods \u0000A total of 41 patients clinically suspicious of DIPG admitted to Department of Neurosurgery of Beijing Tiantan Hospital, Capital Medical University from March 2016 to June 2017 were prospectively included and underwent MET-PET/CT scan and brain MRI. The measurements on MET-PET/CT included tumor metabolic volume (MTV), maximum standardized uptake value (SUVmax) and mean standardized uptake value (SUVmean), while those on MRI enhancement volume (EV) and FLAIR displayed volume (FV). The EV/MTV values were also calculated for analysis. Within 2 weeks after imaging, 33 patients underwent tumor resection, and the remaining 8 underwent stereotactic biopsy. Postoperative radiotherapy and/or chemotherapy were performed in 27 patients. Cox regression analysis was used to analyze the effects of MET-PET/CT and MRI measurements on the overall survival (OS) of DIPG patients. \u0000 \u0000 \u0000Results \u0000Of the 41 patients, 24 (58.5%) FLAIR hyperintensity and 39 (95.1%) MRI enhancement presented and all (100.0%) MET-PET/CT uptake increased. The median follow-up time of 41 patients was 9 months (1-27months). The median survival time was 14.4 months (12.0-16.7 months). At the end of follow-up, 20 patients survived and 21 died. Univariate prognostic analysis discovered that age 18 or older and adjuvant therapy were prognostic protective factors, while EV, SUVmax, SUVmean and tumor grade were prognostic risk factors (all P<0.05). Multivariate analysis showed that EV (HR=2.983, 95%CI: 1.074-8.284, P=0.036), tumor grade (HR=7.568, 95% CI: 2.029-28.229, P=0.003) and adjuvant therapy (HR=0.212, 95%CI: 0.078-0.582, P=0.003) were independent prognostic factors. \u0000 \u0000 \u0000Conclusion \u0000MET-PET/CT combined with MR could predict the prognosis of DIPG patients in this prospective cohort study. \u0000 \u0000 \u0000Key words: \u0000Brain stem tumor; Glioma; Positron emission tomography; 11C- methionine","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"914-918"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48141371","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":"Treatment of intracranial aneurysms with Tubridge flow diverter: A single-center experience","authors":"N. Lyu, Y. Zhou, R. Zhao, Qiang Li, Yibin Fang, P. Yang, Qinghai Huang, Yi Xu, B. Hong","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.09.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.09.007","url":null,"abstract":"Objective \u0000To evaluate the safety and efficacy of Tubridge flow diverter (TFD) in the treatment of intracranial aneurysms at a single center. \u0000 \u0000 \u0000Methods \u0000The clinical and angiographic data of 139 patients harboring 143 aneurysms treated with TFD between August 2010 and December 2018 at Department of Neurosurgery, Changhai Hospital, Naval Medical University were retrospectively collected and analyzed. Among them, 127 lesions were located in anterior circulation and 16 in posterior circulation. The size of the aneurysms ranged from 2.8-50.0 mm, with the mean size of 16.4 ± 9.2 mm. Clinical and angiographic follow-up were preformed conventionally after treatment with TFD. The clinical outcomes of the patients were evaluated using modified Rankin Scale (mRS). \u0000 \u0000 \u0000Results \u0000Among the 139 patients with 143 intracranial aneurysms, a total of 163 TFD were delivered and implanted successfully. Three patients had acute ischemic stroke after TFD deploymnet.And there were no bleeding complications and no death. The median clinical follow-up time of 109 patients was 29.6 months (range: 5 to 82 months). The mRS of 0 was obtained in 97 patients, mRS of 1 in 10 and mRS of 2 in 2. Procedure-related complications occurred in 3 patients. Angiographic follow-up data were available in 103 patients. The median follow-up time was 13.0 months (range: 6 to 80 months). The complete occlusion rates at 6 months, 12 months, 24 months and last follow-up were 75.7% (78/103), 83.5% (66/79), 92.3%(48/52) and 82.5% (85/103), respectively. \u0000 \u0000 \u0000Conclusion \u0000Tubridge flow diverter seems safe and effective in the treatment of intracranial aneurysms with relatively high success rate and few complications. \u0000 \u0000 \u0000Key words: \u0000Intracranial aneurysm; Endovascular procedures; Flow diverter; Treatment outcome","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"900-903"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42141489","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":"Pipeline for unruptured aneurysms beyond the circle of Willis","authors":"Chao Ma, P. Yan, Yupeng Zhang, F. Liang, Shikai Liang, Chuhan Jiang","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.09.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.09.004","url":null,"abstract":"Objective \u0000To investigate the efficacy and complications of Pipeline embolization device (PED) in the treatment of unruptured aneurysms beyond the circle of Willis. \u0000 \u0000 \u0000Methods \u0000A retrospective study was conducted on the clinical data of 14 patients with unruptured aneurysms beyond the circle of Willis treated with PED at Department of Interventional Neuroradiology, Beijing Tiantan Hospital , Capital Medical University (n=11) and Department of Neurosurgery, Beijing Tsinghua Changgung Hospital (n=3) from January 2016 to January 2019. Among those, 10 cases underwent PED implantation and 4 underwent PED-assisted coiling. Each case among the 14 patients had a single aneurysm. Eleven cases underwent first treatment and 3 were recurrent cases. Modified Ranking scale (mRS) was used to comprehensively evaluate the patients after surgery. Patients were followed up radiographically at 6, 12 and 24 months post surgery, and the O' kelly-Marotta (OKM) grading was used to evaluate aneurysm embolization. \u0000 \u0000 \u0000Results \u0000A total of 17 PEDs were implanted in 14 patients, all of which were successful. Immediate postoperative cerebral infarction was observed in 2 patients (1 case of ACoA dissecting aneurysm and 1 case of MCA M1 dissecting aneurysm), and the symptoms were improved after medication. One patient with MCA M1 dissecting aneurysm ruptured at 9 h post surgery and died after treatment. At discharge, there were 11 patients with good postoperative neurological function (mRS: 0-1) and 2 patientswith neurological dysfunction (mRS: 3). There were 12 patients who obtained follow-up post operation with an average follow-up duration of 3.0-6.0 (4.7±1.4) months. At last follow-up, the mRS scores were 0 in 11 cases and 1 in 1 case. Angiographic follow-up showed that 9 of the 12 aneurysms in the 12 patients were completely occluded and 3 had residual neck. All the 3 patients with recurrent aneurysms revealed complete embolization at 6-month follow-up post operation. \u0000 \u0000 \u0000Conclusions \u0000PED is generally safe and effective in the treatment of unruptured aneurysms beyond the circle of Willis which could have a good therapeutic effect on recurrent unruptured aneurysms beyond the circle of Willis. However, it might be associated with relatively high risk in treatment of MCA aneurysms. \u0000 \u0000 \u0000Key words: \u0000Intracranial aneurysm; Circle of Willis; Distal; Pipeline embolization device","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"885-889"},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42669015","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}