Volume 04 · Issue 01 · 2018

The Middle cerebral artery (MCA) aneurysm is a common type of craniocerebral aneurysm that is prone to rupture and high mortality. The classic surgical approaches are the Pterional approach and the Lateral Supraorbital (LSO) approach, but there are shortcomings.

This study retrospectively analyzed clinical and imaging data from 181 patients with MCA aneurysm clipping in the Department of Neurosurgery, First Affiliated Hospital of Soochow University between 2011 and 2017. Statistical analysis using parametric and nonparametric tests showed that P values below 0.05 were considered statistically significant.

The preoperative GCS score (P= 0.003), Hunt-Hess scale (P < 0.001) and the operating habits of the surgeon (P < 0.001) affected the surgeon to choose a surgical approach. The choice of two surgical methods on the operation time (P < 0.001), skin incision (P < 0.001), complications (P= 0.026), tracheotomy (P= 0.014), prognosis (P= 0.002) were significantly different. Different surgical approaches (P= 0.002), Hunt-Hess scale (P < 0.001), GCS scale (P < 0.001), GCS sorse (P < 0.001), skin incision (P= 0.031) and complications (P < 0.001) are closely related to the prognosis of patients.

Modified LSO approach provides another surgical approach for MCA aneurysm clipping, while avoiding the drawbacks of the LSO approach in the clipping of MCA distal aneurysm.

Tiny false intracranial rupture aneurysms are particularly rare. It is challenged both to neurosurgery and endovascular treatment.

We present here five rare cases of perforator tiny aneurysms that were diagnosed based on DSA. These patients were found due to SAH, and they decided to treat these aneurysms with endovascular therapy. After numerous attempts, the coiling microcatheter failed to access the aneurysms. As a result, the aneurysms finally were treated with guidewire manipulation.

Mean follow-up time was about 10.4 months. The outcomes of the 5 cases were all surprisingly excellent. The patients were followed up with angiography and telephone till now. No revascularization of aneurysm was found.

This paper demonstrated for the first time to our knowledge that tiny false intracranial aneurysm may be treated with guidewire manipulation. While larger studies with long-term follow-up are required to validate these promising results, guidewire manipulation is a new approach worth considering when microcatheter cannot enter aneurysm.

Intracranial aneurysm is a common cerebrovascular disease, which cause wide concern by neurosurgeons. The 3D–DSA images simulated surgical path may improve the success rate of operation in bridging surgery of emergency ruptured intracranial aneurysms.

Eighteen patients with intracranial ruptured aneurysms that underwent craniotomy clipping surgery from January 2015 to January 2016 were included in this study. All patients were diagnosed with ruptured aneurysm and SAH, and 3 of them had concomitant hematoma. All patients were clipped in 3 days after diagnosis. Before clipping, the relevant information and data of the 3D–DSA images simulated surgical path were observed to guide intracranial aneurysm clipping surgery.

According to the information of the 3D–DSA images simulated surgical path, all aneurysms were clipped successfully. 1 patient died of vessel spasm, and the remaining patients recovered well.

The 3D–DSA images simulated surgical path could provide surgeons with a lot of information in bridging surgery of emergency ruptured intracranial aneurysms,and is significant to improve the success rate of operation.

Spinal dumbbell-shaped epidural cavernous malformation (CM) is a rare, hypervascular entity frequently misdiagnosed for other lesions, leading to unexpected intraoperative bleeding and suboptimal resection. Our study aims to elucidate the demographics, management strategy, and outcome of this vascular disease.

Retrospective review of patients seen in Beijing Tiantan Hospital with symptomatic dumbbell-shaped epidural CM from 2008 to 2013. All lesions were pathologically confirmed after resection. The clinical manifestations, radiographic features, and treatment modalities of these cases were analyzed.

We included 9 consecutive patients. Average age was 58 ± 12 years (range: 34–79 years), with 66.7% male. Locations of the CMs were: thoracic (n = 7, 77.8%), cervical (n = 1, 11.1%), and cervicothoracic junction (n = 1, 11.1%). Only one case presented with acute manifestations while others experienced chronic progressive spinal cord symptoms. The initial clinical diagnoses were: schwannoma (n = 6, 66.7%), cavernous hemangioma (CM) (n = 1, 11. 1%), meningioma (n = 1, 11.1%), and angioma (n = 1, 11.1%). Total resection was achieved in six patients (66.7%), and partial resection in the other three patients (33.3%). Average intraoperative blood loss was 400 ± 300 ml (range: 100–1000 ml). During an average follow-up of 71 ± 21 months (range: 29–94 months), excellent outcome was achieved in seven cases (77.8%), one partially improved (11.1%), and one deteriorated (11.1%). No patients experienced recurrence of symptoms.

Spinal dumbbell-shaped epidural CM is a benign vascular malformation that should be differentiated from other dumbbell-shaped lesions. Accurate preoperative diagnose is challenging as no specific radiographic marker has been established. Total surgical resection should be recommended.

To explore risk factors and the efficacy of treatment strategies for brain metastasis (BM) in squamous cell carcinoma (SCC) of the lung.

The clinical data of 188 pathologically confirmed as squamous cell carcinoma or adenosquamous carcinoma patients were studied retrospectively. Factors including age (<60 vs. ≥60), gender, stage at diagnosis, T status (T1–2 vs. T3–4), N status (N0–1 vs. N2–3), histology (squamous vs. adenosquamous), smoking history (non-smoker vs. current smoker) and serum tumor markers (normal vs. elevated) were analyzed.

The incidence of BM was 19.1% (36/188) in our cohort. Patients who were female (p = 0.005), had advanced disease at diagnosis (p < 0.001), had adenosquamous carcinoma histology (p = 0.033) or had elevated serum level of CEA at diagnosis (p < 0.001) had significantly higher incidence of BM. In multivariate analysis, female (p = 0.034, HR = 18.874) and elevated serum level of CEA at diagnosis (p = 0.009, HR = 19.824) were independent risk factors of BM. BM patients who received additional systemic therapy after local therapy had significantly longer post-BM survival than those who received local therapy only (p = 0.004, HR = 0.058). Gemcitabine/platinum-containing regimen (GP) and taxans/platinum-containing regimen (TP) led to comparable brain-metastasis-free survival (BMFS) (p = 0.10).

Females and patients with elevated serum level of CEA at diagnosis had a higher risk of developing BM. The following systemic therapy after local therapy prolonged the survival of BM patient, but the efficacy of GP and TP was comparable in terms of preventing BM.

Though pituitary adenomas are benign tumors in most cases, a considerable fraction of PAs behave in a malignant-like manner and invade to the adjacent structures in sellar region, especially the cavernous sinuses. Cancer-cell invasion and metastasis remain a great challenge for physicians and surgeons in spite of emerging advances in drug therapy and surgical Treatment. matrix metalloproteinases, as a family of zinc-dependent endopeptidases, have long been known to be associated with tumor invasion and metastasis mainly via breaking down basement membrane in different tissues. Aberrant expression and activation of matrix metalloproteinases have been detected in invasive pituitary adenomas as in malignancy and correlated to tumor invasion. Therefore, matrix metalloproteinases are considered as promising biomarkers for predicting tumor behavior and even drug targets for novel therapeutic strategies. In this review, we give an overview of the expression, function, regulation and clinical prospects of matrix metalloproteinases, especially focusing on the biological network in which matrix metalloproteinases may be abnormally activated in promoting pituitary adenoma invasion.

Treatment of giant basilar aneurysms is extremely challenging, especially recurrences after previous coiling.

A 20-year-old male was referred for a recurrent giant proximal basilar aneurysm 3 months after coiling, with headache, blurred vision, and brainstem compression symptoms. Angiography showed that the previously placed coils were compacted within the caudal portion of the 43 mm × 31 mm aneurysm, with spontaneous occlusion of the right vertebral artery and absence of the posterior communicating arteries. The diameter of the aneurismal neck, the afferent and efferent arteries was 6 mm, 3.5 mm and 4.1 mm, respectively. A balloon-expandable covered-stent of 3.5 mm × 10 mm was selected, matching the above 3 measurements; and deployed precisely across the aneurismal neck, immediately creating the "sub-complete reconstruction with intentional endoleak distal to aneurismal neck" . Subsequently, 2 self-expanding 4.5 mm × 37 mm stents were telescopically implanted within the covered-stent to adjust the angulation of the proximal basilar artery. After the procedure, the patient’s symptoms gradually disappeared. Catheter angiography at 18 days, 3 months and 15 months demonstrated complete aneurismal exclusion from the patent vertebrobasilar artery, with dramatic elimination of aneurismal volume and reconfiguration of the compacted coils. The patient was asymptomatic at 15-month follow-up.

Sub-complete reconstruction with intentional endoleak distal to aneurismal neck can be safely achieved after implantation of a covered-stent and conventional stents in the case of a recurrent post-coiling proximal giant basilar aneurysm, with complete vascular reconstruction subsequently.

The carotid artery is an important blood vessel in the human body. Its ruptures caused by accidents can be lethal cases without timely treatment. Currently, successful rescue cases have rarely been reported, hence we present the following case.

A patient who was a 46-year-old male admitted due to left neck trauma that lasted almost a day. The CT angiography (CTA) of the neck showed two pseudoaneurysms: one on the anterior wall and one on the posterior wall of the carotid artery. In our case, we considered an open approach to reconstruct the carotid artery. After excision of the aneurysm, the internal carotid artery was stitched. Electrophysiological monitoring and shunt were used during the operation. The postoperative course was uneventful, and the patient remains free of symptoms.

Many departments jointly and positive and effective surgical intervention are the key to reduce morbidity and mortality of carotid artery penetrating injury.

Hepatic pseudocysts are not a common complication and "extrahepatic" pseudocysts are rarer complications but may occur in every ventriculo-peritoneal shunt patient.

We present two patients with ventriculo peritoneal shunt induced extrahepatic pseudocysts, who underwent shunt surgery for different etiologies. Etiology, treatment strategies and our choice of treatment have been discussed.

When a ventriculoperitoneal shunt patient is presented with non-specific abdominal symptoms, the possibility of this complication should always be considered. In the treatment of this complication, it is shown that repositioning the catheter is sufficient for cyst regression.

Meningoencephalocele is a rare congenital anomaly that is characterized by herniation of brain tissue through a defect in skull. Generally, it could be divided by anatomical location of defect to occipital and frontoethmoidal. The exact etiology of this condition is unknown but many theories have been postulated. The condition is usually seen at birth but can be identified prenatally.

A newborn was brought to the hospital after a normal non-complicated vaginal delivery done by the ambulance personnel. The newborn had a bulging mass on the posterior aspect of the head. Therefore, he was admitted and neurosurgical consultation was done for further evaluation. Currently the patient is following up in well baby clinic as well as the neurosurgery clinic for normal development and milestones acquisition.

This case presents the opportunity for junior healthcare professionals to learn about a group of congenital neurological disorder in the content of a rare case presentation.