MedNexus
Volume 36 · Issue 01 · 2020
MedNexus
Time must be a straight line, with no beginning and no end. Fortunately, we can still touch the starting point of the Chinese Journal of Neurosurgery in 1985, and we can also recall the 35 years she spent with us like a treasure. On the occasion of this new year, the editorial department sincerely extends its heartfelt thanks and high respect to the leaders of Chinese Medical Association magazine who care and guide us, all the editorial members who work hard, and the authors and readers who support and accompany us.
To investigate the role of neurointerventional technique in the diagnosis and treatment of cranial and spinal rich-vascularized tumor (RVT).
A retrospective analysis was conducted on the clinical data of 234 cases of RVT admitted to Department of Neurosurgery, Shanghai Putuo District People′s Hospital from January 2008 to December 2017. All patients underwent head CT, MRI, CT angiography (CTA) or magnetic resonance angiography (MRA) before surgery, and were initially judged as suspected RVT. Afterwards, digital subtraction angiography (DSA) was performed to evaluate the blood flow, arteriovenous distribution and involvement of the tumor, and further neurological intervention was performed for patients who met the embolization indication. Postoperative DSA was used to evaluate the embolization effect, which was divided into 4 grades (excellent, good, fair, poor). Tumor resection was performed 1 day or 6 to 9 days after embolization. According to whether the patient was treated with interventional therapy, he/she was divided into interventional treatment group and non-intervention treatment group. The intraoperative blood loss, postoperative complication rate and complete tumor resection rate were compared between the two groups.
Of the 234 patients, 56 (23.9%) did not need embolization, and 178 (76.1%) required embolization, of which 127 (71.3%) had vessels suitable for embolization, and 51 (28.7%) had no suitable vessels. The embolization results of 127 patients were excellent in 34 cases (26.7%), 62 cases (48.8%) were good, 26 cases (20.5%) were fair, and 5 cases (4.0%) were poor. The overall embolization rate was 96.1% (122/127). Complications occurred in 3 patients after operation, 2 of which were transient neurological damage and 1 was stroke. Of the 234 patients, 127 were in the interventional group and 107 were in the non-intervention group. There were no significant differences in gender, age, surgical approach or pathological type between the two groups (all P>0.05). Compared with patients without interventional therapy, the intraoperative blood loss was lower in the intervention group (571.3±100.3 mlvs. 1 020.4±267.9 ml, P<0.001), and the postoperative complication rate was lower [4.7%(6/127)vs. 12.1%(13/107), P=0.038] and the tumor resection rate was higher [91.3%(116/127) vs. 80.4%(86/107), P=0.015].
The neurointerventional technique seems safe and effective in the evaluation and treatment of RVT, which could decrease intraoperative blood loss, improve the rate of total resection and reduce related postoperative complications.
To explore the value of multimodal image fusion technique in neuroendoscopic endonasal treatment of anterior skull base tumors.
The clinical data of 9 patients with anterior skull base tumors who underwent endoscopic surgery at Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University from January 2016 to June 2017 were retrospectively analyzed. CT, MRI, and CT angiography (CTA) images of the patient′s skull were fused before surgery, and intraoperative neuronavigation assisted surgical removal of the tumor was performed based on the results of the image fusion. This paper analyzed the effects of multimodal image fusion technology on demonstration of anterior skull base lesions and adjacent anatomical structures.
During operation, multimodal image fusion clearly revealed the anterior skull base tumors together with adjacent neural tissues, blood vessels, bone structures, sphenoid sinus and septations. All 9 patients underwent successful operation. Among them, gross total resection of tumor was achieved in 6 cases and subtotal resection in 3 cases. No serious complications such as delayed hemorrhage, brain infection, and cerebrospinal fluid rhinorrhea occurred postoperatively.
In neuroendoscopic transnasal resection of the anterior skull base tumor, the application of multimodal image fusion technology combined with intraoperative neuronavigation can clearly show the location of tumor and its adjacent important structures, which helps improve the accuracy, safety, and effectiveness of the operation.
To summarize the reconstruction strategy and efficacy for skull base defect in endoscopic endonasal skull base tumor resection.
The clinical outcomes of 202 patients with skull base defect who underwent endoscopic tumor resection at Department of Neurosurgery, Huashan Hospital, Fudan University from April 2011 to February 2016 were retrospectively analyzed. Skull base defects were intraoperatively classified into Ⅰ-Ⅲ grades based on the diameter of dura defect and flow of cerebrospinal fluid (CSF), and corresponding reconstruction strategies were adopted.
The classification result of 202 skull base defects was 15.8%(32 cases) in Grade Ⅰ, 24.3%(49 cases) in Grade Ⅱ and 59.9%(121 cases) in Grade Ⅲ. Six patients (3.0%) had postoperative CSF rhinorrhea, which resolved following secondary endoscopic repair surgery. Four patients (2.0%) had intracranial infection which was finally cured by antibiotics medication. One elderly patient (0.5%) died of pulmonary infection after prolonged bed rest after surgery.
Endoscopic surgery seems safe and effective for the reconstruction of skull base defect. The occurrence of postoperative CSF leakage could be effectively avoided when specific reconstruction strategy is adopted according to the classification of skull base defect.
To explore the diagnosis and treatment of supratentorial tumors with small round cell malignancies diagnosed by intraoperative rapid pathology.
A retrospective analysis was conducted on the clinical data of 36 patients with supratentorial tumors diagnosed as small round cell malignant tumors by intraoperative frozen pathology at Department of Neurosurgery, Nanfang Hospital, Southern Medical University from January 2011 to December 2017. All patients were treated with complete tumor resection according to the principle of glioma operation. After the operation, the MRI of the head was reexamined, and the volume quantitative analysis was used to determine the degree of tumor resection, which was divided into complete resection, subtotal resection and partial resection. All patients were followed up regularly in outpatient department, and MRI was reexamined to explore the recurrence of tumor.
MRI of 36 patients after operation showed that 31 patients (86.1%) had complete resection and 5 patients (13.9%) had subtotal resection. The results of pathological diagnosis were as follows: primary central nervous system lymphoma (10 cases), glioblastoma (6 cases), central neurocytoma (5 cases), primitive neuroectodermal tumors (3 cases), brain metastasis tumor (2 cases), pineal cell tumors(2 cases), ependymoblastoma (2 cases), World Health Organization (WHO) grade Ⅱ glioma (2 cases), pituitary adenoma (1 case), periangioblastoma (1 case), olfactory neuroblastoma(1 case) and desmoplastic small round cell tumor (1 case). Among the 33 patients diagnosed by MRI before operation, 8 (24.2%) had the same pathological results with preoperative diagnosis, including 4 cases of lymphoma, 1 case of central neurocytoma, 1 case of primitive neuroectodermal tumor, 1 case of hemangioblastoma and 1 case of metastasis. The follow-up duration of 36 patients was 28.9±8.1 months and ranged from 6 to 70 months . During the follow-up period, 26 out of 36 patients (72.2%) relapsed.
The supratentorial tumors with small round cell malignant tumor diagnosed by rapid pathology during operation should be resected in the maximal range under the premise of safety, the pathological results are various and its therapeutic effect seems relatively good.
The basal portion of ventral meningiomas (vFMs) in the foramen magnum region is located in front of the dentate ligament and can push the brainstem or cervical spinal cord dorsally or dorsolaterally. Because it is blocked by the medulla oblongata, vertebral artery and posterior cranial nerves, it is difficult to expose vFMs during operation and it is extremely difficult to resect it. Many literature reports have shown that sufficient exposure of the basal part of vFMs is the determinant of surgical success, so the transdistal lateral approach is often used. However, it has the disadvantages of complicated craniotomy, long time consuming, large muscle injury and easy vertebral artery injury. From April 2010 to December 2018, 9 patients with vFMs were treated in the Department of Neurosurgery of the Eastern Theatre General Hospital. Preoperatively, the presence of tumor channels in the lateral side of the cervical spinal cord was confirmed according to the imaging data, and microresection through the suboccipital midline approach was used to treat them. Good curative effect was obtained after operation.
The clinical data of 20 patients with epidermoid cysts in the cerebellopontine angle area treated with simple neuroendoscopic retrosigmoid approach in the Department of Neurosurgery of Qilu Hospital of Shandong University from January 2015 to June 2017 were retrospectively analyzed. Of the 20 patients, 14 had total resection, 4 had near total resection, and 2 had partial resection. None had aseptic meningitis, intracranial infection, or death. Twenty patients were followed up for (20 ± 7) months (12 to 36 months), and reexamination of MRI during follow-up showed no recurrence or progression of the tumor. Epidermoid cyst in cerebellopontine angle was treated by simple neuroendoscopy through retrosigmoid approach with sufficient exposure, clear surgical field, less trauma and good postoperative effect.
To explore the application of ventriculostomy through straight-incision temporoparietal approach in the resection of meningioma at the trigone of lateral ventricles.
A 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.
Simpson 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).
Being 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.
To explore the clinical outcomes of carotid endarterectomy (CEA) on patients with symptomatic carotid stenosis and its correlation with the timing of surgery.
A 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.
Perioperative 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). The mean flow velocity of MCA and pulsatility index (PI) value were increased (bothP<0.001). Eighty-eight patients with stroke had lower NIHSS scores than before surgery [1.0(0, 2.0) pointsvs. 3.0(2.0, 5.8) points, P<0.001]. Up to the last follow-up, there was no significant difference between the above indicators and 5 days after surgery (allP>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 (allP>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)%, bothP<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)%, bothP<0.05].
Carotid 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.
To compare the safety and efficiency of stent assisted coiling (SAC) with non-SAC for the management of ruptured intracranial aneurysms.
A total of 1 217 patients with ruptured intracranial aneurysms who underwent endovascular treatment at Neurointervention Department of the First Affiliated Hospital of Zhengzhou University from January 2011 to January 2018 were retrospectively enrolled. Patients were categorized into SAC (n=631) and non-SAC (n=586) groups. We retrospectively analyzed the immediate postoperative occlusion degree and that at follow-up (based on Raymond scale) as well as perioperative complication rate in the two groups. The difference was considered as significant with P<0.05.
In SAC group, the Raymond grades were grade Ⅰ in 65.0% (n=410), grade II in 29.9% (n=189) and grade Ⅲ in 5.0% (n=32), while those in non-SAC group were grade Ⅰ in 51.4% (n=301), grade Ⅱ in 36.0% (n=211) and grade Ⅲ in 12.6% (n=74), and the inter-group difference was significant (P<0.01). Postoperative rebleeding rate was 2.5% (n=16) in SAC group and 5.1% (n=30) in non-SAC group, and the rate of ischemic event was 6.3% (n=40) in SAC group and 3.1% (n=18) in non-SAC group, and those differences were significant (P<0.05). In both groups, the disability was 1.0% (n=6 in each group) and the mortality was 2.2%(n=14 in SAC and n=13 in non-SAC) without inter-group statistical difference (P>0.05). At 12 months post operation, DSA was performed in 227 cases of SAC group and 102 cases of non-SAC group. In SAC group, the Raymond grades were grade Ⅰ in 71.8% (n=163), grade Ⅱ in 22.9% (n=52) and grade Ⅲ in 5.3% (n=12), while those in non-SAC group were grade Ⅰ in 53.9 % (n=55), grade Ⅱ in 34.3% (n=35) and grade Ⅲ in 11.8% (n=12). The recurrence rate was 11.9% (n=27) in SAC group and 38.2% (n=39) in non-SAC group. Those inter-group differences were significant (P<0.01).
Compared with non-SAC, SAC is associated with higher occlusion rate, lower recurrence rate, lower rebleeding rate and relatively higher rate of ischemic event. However, mortality and disability rate between two groups do not seem to differ.
To explore the feasibility of 3D printing individualized guide plate in the localization and biopsy of intracranial lesion.
A retrospective analysis was conducted on 8 patients with intracranial lesions who underwent puncture and biopsy at Department of Neurosurgery, General Hospital of Ningxia Medical University from November 2016 to December 2018. Using preoperative brain CT and MRI enhancement images as the original data, Mimics 17.0 software was used to reconstruct the 3D image, plan the needle position, design the puncture hole, and calculate the puncture depth. Personalized puncture guide plate was printed. During the operation, puncture needle was inserted into the fitting puncture hole, the puncture depth was controlled, biopsy specimen was taken for histopathological examination, and postoperative brain CT was used to evaluate the success of puncture.
During the operation, the guide plates of the 8 patients were well fitted with the anatomical structure of the puncture site, the orientation and depth of the needle entry were consistent with preoperative design scheme, all puncture operations were completed once and the target tissues were successfully removed, and the average operation duration was 72.0±10.5 min. Brain CT was reexamined 6 hours after operation and no bleeding was found in the puncture trajectory and puncture entry points of 8 patients. None of the patients had intracranial infection or new neurological function deficit related to puncture.
The 3D printed individualized guide plate could simplify the operation procedure of intracranial lesion puncture biopsy and help achieve the purpose of biopsy accurately, safely and efficiently.
To explore the outcome of parallel clipping technique in the treatment of complex middle cerebral aneurysms in hybrid operation rooms.
A retrospective analysis was conducted on the clinical data of 13 patients with MCA complicated aneurysm admitted to Department of Neurosurgery, Nanfang Hospital of Southern Medical University from January 2015 to February 2019. All patients underwent a unilateral craniotomy with transpterional approach in the hybrid operating room. Multiple aneurysm clips were used to clip the aneurysm during the operation. Of the 13 patients, 7 were ruptured aneurysms, 4 were Hunt-Hess grade Ⅰ, 1 were Ⅲ, and 2 were Ⅳ; 6 were unruptured aneurysms. There were 19 aneurysms in 13 patients, of which 5 were single MCA aneurysms, 1 was bilateral MCA aneurysms, and the remaining 7 patients were single MCA aneurysms. The aneurysm embolization was evaluated by Raymond classification, and the clinical outcome was evaluated by modified Rankin Scale (mRS) criteria.
Thirteen patients with 19 aneurysms underwent successful clipping. A total of 60 aneurysm clips were used. For each aneurysm, we used 1 to 6 (3.2 ± 1.6) clips. After aneurysm clipping, intraoperative angiographic review revealed clipping insufficiency (Raymond grade II) in 4 aneurysms, and 2 patients with parent aneurysm stenosis. After adjustment of the aneurysm clip, all aneurysms were completely occluded (Raymond grade Ⅰ) and the parent aneurysm had no stenosis. Only one patient developed postoperative cerebral infarction in the basal ganglia and slight hemiplegia resulting from occlusion of a branch emanating from the aneurysm wall. At discharge, the mRS was 0 in 10 patients, 2 in 2 patients, and 5 in 1 patient. Thirteen patients were followed up for 6 to 36 months (median: 17.3 months). The mRS was 0 in 10 cases, 1 in 2 cases, and 4 in 1 case. In 6 cases of re-examination, none of the aneurysms recurred.
The use of multiple aneurysm clips in the hybrid operating room to shape and clamp MCA complex aneurysms is effective and has few complications.
To evaluate the preliminary application of three dimensional T1-weighted sampling perfection with application-optimized contrasts by using different flip angle evolutions (3D T1-SPACE) combined with three dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA) in the follow-up for the intracranial aneurysm treated with Pipeline Flex embolization device (FD).
A total of 20 patients with 25 intracranial aneurysms were treated with Pipeline Flex embolization at the Department of Cerebrovascular Intervention, People′s Hospital of Zhengzhou University, Henan Provincial People′s Hospital from September 2018 to April 2019 and were prospectively enrolled. All patients were followed up with 3.0T 3D T1-SPACE sequence, 3D-TOF MRA and digital subtraction angiography (DSA) examination. O′kelly-Marotta (OKM) grading scale was used to evaluate the aneurysm residual and the four-point scale was used to evaluate the in-stent lumen visibility.
The follow-up period for all patients was 6.0±0.8 months (range: 4-7 months). The OKM scale of all aneurysms evaluated by DSA indicated 18 patients with grade D, 2 patients with grade C and 5 patients with grade B. For aneurysms evaluated by 3D-TOF MRA combined with source image, the results showed grade D in 19 patients, C in 2 and B in 4. The overall concordance rate between 3D-TOF MRA and DSA was 88.0% (22/25). Taking DSA as standard(grade 4), the four-point scale of in-stent lumen of all 20 patients treated with 23 Pipeline Flex embolization devices and evaluated by 3D-TOF MRA indicated grade 3 in 16 stents, 2 in 6 and 1 in 1. No one showed the same as DSA results. However, grade 4 was revealed in 21 stents and 3 in 2 based on the evaluation by 3D T1-SPACE. The total concordance rate of 3D T1-SPACE and DSA was 91.3% (21/23).
Preliminary observations show that compared with DSA, 3D-TOF MRA could better assess the aneurysmal occlusion after FD treatment of intracranial aneurysms. The 3D T1-SPACE sequence shows the in-stent lumen clearly. The combination of the two sequences can be used for follow-up after FD treatment of intracranial aneurysms.
To investigate the changes of cerebral hemodynamics after unilateral carotid endarterectomy (CEA) for severe stenotic lesions of bilateral internal carotid artery (ICA).
The 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.
(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 (allP<0.05), whereas those parameters on the non-operated side of ACoA non-patent group after surgery had no significant differences compared with those before operation (allP>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 (allP>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<0.001). (3) Changes of CTP parameters: Compared with before surgery, the CTP parameters on the operated side of two groups and on non-operated side of ACoA patent group significantly improved after operation (allP<0.05), while the CTP parameters on the non-operated side of ACoA non-patent group had no significant differences after operation (allP>0.05). There were no significant differences in CTP parameters on the operated side between two groups after operation (allP>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 (allP<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 (7/15vs. 5/26, P=0.024).
After unilateral CEA for severe stenotic lesions of bilateral ICA, the opening of ACoA could simultaneously improve the cerebral perfusion on the non-operated side.
To discuss the anatomical characteristics of posterior cranial fossa and surgical outcomes in patients with Chiari Ⅰ malformation.
Thirty-eight patients diagnosed with Chiari I malformation were admitted to Department of Neurosurgery, General Hospital of Tianjin Medical University from January 2015 to December 2017 and retrospectively enrolled into the patient group of this study, whose clinical data were compared with those of 30 radiologically healthy persons (as controls) admitted to physical examination center of the same hospital during the same period. Two groups of people underwent cervical MRI scan and 3D reconstruction. Clivus length, Mcrae line, Twing line, length of squamousal part of occipital bone, basal angle, Boogard angle, cerebellar volume (CV), posterior cranial fossa volume (PV) and ratio of CV/PV were measured and their anatomical differences were compared between 2 groups according to volume analysis software. Thirty-seven patients were treated with posterior cranial fossa decompression and C1 laminectomy in patient group, and the remaining 1 patient did not undergo relevant treatment. All patients underwent follow-up in outpatient department, an imaging review of cranial-cervical junction MRI and assessment based on cervical Japanese Orthopaedic Association (JOA) scale to assess the improvement of syringomyelia-related symptoms. The outcomes were classified into excellent, good, stable and poor.
There was no significant difference in age or gender (P>0.05). Compared with healthy control group, PV was decreased (170.7±10.7 mm3vs. 186.8±9.8 mm3), ratio of CV/PV was increased 0.755±0.042 vs. 0.682±0.036, clivus length was shortened (3.9±0.3 mm vs. 4.4±0.3 mm), and Boogard angle was increased (124.2±8.2° vs. 116.6±3.6°) in the patient group (all P<0.05). In contrast, there was no significant difference in CV, basal angle, Mcrae line, or length of squamousal part of occipital bone (allP>0.05). All 37 patients underwent successful operation. There were no cases of new neurological deficits or death after operation. At 12 weeks post surgery, the JOA score was improved compared with preoperative conditions (15.20±2.36 pointsvs.11.71±2.92 points. P<0.05). The follow-up duration of 37 patients was 15.2 ± 6.8 months and ranged from 6 to 30 months. At the last follow-up, the improvement rate of syringomyelia-related symptoms was 69.9±29.0%. The outcomes were determined as excellent in 20 (54.1%) patients, good in 11 (29.7%) and stable in 6 (16.2%).
The decrease of posterior fossa volume and increase of ratio of cerebellar volume and posterior cranial fossa volume could be important factors in Chiari Ⅰ malformation contributing to cerebellar tonsillar herniation. The surgery of posterior fossa decompression could effectively improve clinical symptoms.
To investigate the effects of early cranioplasty post decompressive craniectomy on the outcomes of traumatic brain injury in adult patients.
A retrospective analysis was conducted on the clinical data of 72 adult postoperative patients with traumatic brain injury who were admitted to Department of Neurosurgery, Zhongshan Hospital, Xiamen University from January 2015 to June 2017. According to the timing of cranioplasty, the patients were divided into early group (≤3 months after operation, 30 cases) and conventional group (>3 months after operation, 42 cases). The differences in the Glasgow outcome scale (GOS) score, Karnofsky performance scale(KPS) score and mini-mental state examination(MMSE) score between the two groups were compared at 6 months postoperatively, and the rates of postoperative complications were also compared.
Compared with the conventional group, the GOS change values [the median(lower interquartile, upper interquartile): 1.0(1.0, 1.0)points vs. 1.0(0, 1.0)points], postoperative KPS (70.3±23.3 points vs. 58.8±17.3 points) and MMSE scores (21.0±7.7 points vs. 17.5±6.2 points) were significantly improved in the early group, and the differences were statistically significant (all P<0.05). There was no statistical difference in the incidence of infection or epilepsy between the two groups (bothP>0.05).
Compared with cranioplasty at 3 months post operation, early cranioplasty does not seem to increase the incidence of postoperative complications and has more significant improvement in the outcomes of patients.
To explore the accuracy, efficiency and safety of robot-assisted craniotomy system named Cranibot.
The robot system called Cranibot was developed by Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital and Institute of Intelligent Robotics, Beijing Institute of Technology and then employed to carry out randomized controlled experiments on 3 kinds of subjects including 8 3D-printing PVC (polyvinyl chloride) skull models, 5 cadaveric pig heads and 5 living Bama miniature pigs. Both left and right sides were symmetrically selected in each subject to perform craniotomy, and on each side 4 holes were drilled to form a square bone flap. One part of the skull on one side was randomly categorized into the experimental group in which craniotomy was performed by robot system, and its symmetrical part of skull on the other side belonged to the control group in which craniotomy was performed by the same neurosurgeon team. We observed and measured the drilling position error, time spent on craniotomy and incidence of tissue injury in the two groups.
In skull model experiments, the average position error and time spent on craniotomy of "robot" group were 1.87±0.66 mm and 6.64±1.15 min, and those of "surgeon" group were 3.14±0.73 mm and 8.06±1.10 min respectively. The differences were statistically significant (both P<0.05). In experiments on cadaveric pig heads, the average position error and time spent on craniotomy of "robot" group were 3.13±0.35 mm and 7.79±1.21 min, and those of "surgeon" group were 3.83±0.42 mm and 9.05±1.15 min respectively. The differences were statistically significant (bothP<0.05). In experiments on living Bama miniature pigs, the average position error and time spent on craniotomy of "robot" group were 3.26±0.51 mm and 11.83±0.92 min, and those of "surgeon" group were 4.39±0.75 mm and 26.10±1.62 min respectively. The differences were statistically significant (bothP<0.05). The total incidence of tissue injury was 5.6% (2/36) in "robot" groups and 16.7% (6/36) in "surgeon" groups respectively, which had no statistical difference (P>0.05).
The robot-assisted craniotomy system named Cranibot could improve the accuracy and efficiency of craniotomy, while its safety requires further research with large sample size.
Two patients with acute cerebral infarction were treated with micro-catheter aspiration and thrombectomy for 3 distal vascular occlusions (1 middle cerebral artery M3 segment occlusion and 2 anterior cerebral artery A3 segment occlusion). Distal vascular occlusion was caused by thrombus detachment during mechanical thrombectomy for proximal vascular occlusion. All vessels were successfully recanalized after microcatheter aspiration thrombectomy with Excelsior XT-27 microcatheter, and no hemorrhage occurred during and after microcatheter aspiration thrombectomy. Postoperative MRI scan of the head showed scattered patchy fresh infarcts in the blood supply area of the target vessel. The National Institutes of Health Stroke Scale scores were significantly improved after operation compared with those before operation; The 3-month follow-up modified Rankin scale scores were 1 and 3, respectively.
Internal carotid cavernous fistula (CCF) complicated with congestion of blood vessels around the cervical spinal cord is rare. Once it occurs, it can cause high spinal cord injury and limb weakness. In March 2019, the Department of Neurosurgery of the 904th Hospital of the Joint Logistics Support Force of the People's Liberation Army treated a case of traumatic CCF. Due to long-term posterior venous congestion, the patient suffered from progressive limb weakness and dyspnea. The patient recovered well after receiving intracavernous sinus embolization, and no recurrence was seen after 3 months of follow-up.
Parkinson's disease is a degenerative disease of the central nervous system. At present, there are more than 2 million patients with Parkinson's disease in China, accounting for one half of the total number of patients with Parkinson's disease in the world. In addition to the motor symptoms of quiescent tremor, slow movement, muscle stiffness and abnormal posture and gait, Parkinson's disease also has non-motor symptoms such as pain, sleep disturbance, constipation and depression. This article reviews the clinical characteristics, pathogenesis, clinical evaluation and treatment status of Parkinson's disease-related pain, so as to provide help in the diagnosis and treatment of this disease.
Olfactory neuroblastoma is a rare malignant tumor of nasal skull base, with occult onset and difficult to be detected in early stage. The disease has unique clinical and histopathological features. Due to the low incidence and special anatomical site of olfactory neuroblastoma, there is still a lack of unified staging, grading criteria and treatment plan. It is important to determine the pathological stage and tumor grade for the selection of surgical methods, postoperative radiotherapy and chemotherapy strategies, prognosis assessment and risk stratification. Combined with recent research reports, the clinical and pathological features of olfactory neuroblastoma and the related research progress in diagnosis and treatment are reviewed in this paper.
3D printing technology is a new additive manufacturing technology that stacks materials layer by layer on the basis of three-dimensional digital model. It is mainly divided into three main processes: data acquisition, analysis and construction and output printing. The main molding methods are powder curing, liquid curing and extrusion molding. 3D printing technology is widely used in the medical field, and can quickly prepare customized objects adapted to personalized treatment. Currently, this technique is mainly used in spinal surgery for the manufacture of biological models, surgical guidance devices, and implants. It can not only improve preoperative planning, improve the accuracy of hardware placement such as internal fixation, but also personalize the design of the implant to make it more suitable for the patient's anatomy. Although the application of 3D printing in spinal surgery faces many limitations, with the development of digital medicine, tissue engineering, new materials and processes, 3D printing technology will play a wider application value.
Extracellular space is an irregular special space that is interconnected outside the cell membrane and filled with tissue fluid and matrix. It is the micro-environment on which cells depend. The extracellular space of the brain affects the activities of the nervous system and participates in the occurrence and development of various nervous system diseases. However, the role of brain extracellular space in various neurological diseases has been lack of attention and in-depth research for a long time. This research team is the first to develop magnetic tracking technology for extracellular gaps at home and abroad. Extracellular space occupies nearly half of the volume characteristics of high-grade glioma. This paper focuses on the changes of extracellular space in glioma and its application in clinical treatment of glioma, so as to provide reference for clinical exploration of new methods of diagnosis and treatment of glioma.
Cerebral vasospasm after craniocerebral injury (PTV) is one of the serious complications after traumatic craniocerebral injury. Its high incidence and poor prognosis have attracted more and more attention from clinicians. However, the mechanism causing PTV is still unclear, and the current research mainly focuses on endothelin, metabolites of red blood cells and brain tissue, mitochondrial dysfunction and oxidative stress, and extracellular vesicles. There are many clinical methods (represented by nimodipine) to prevent and treat secondary ischemic injury caused by PTV, but these treatment methods are still controversial, and the mechanism of PTV still needs to be studied in depth in order to find a better treatment method, so as to improve the prognosis of patients.
Cerebral hyperperfusion syndrome (CHS) is a common complication after direct cerebrovascular reconstruction of moyamoya disease. Its clinical manifestations are diverse, the severity of the disease is different, and most of them are self-limiting; When CHS is manifested as cerebral hemorrhage, the prognosis is often poor, and its disability rate is high, even fatal. This article reviews the pathogenesis, clinical characteristics and treatment of CHS after direct cerebrovascular reconstruction in moyamoya disease.
From August 1 to 4, 2019, the 11th China-Japan Friendship Neurosurgery Conference and the 3rd China-Japan Neurosurgery Alliance Conference, sponsored by Beijing Wang Zhongcheng Medical Foundation and China-Japan Neurosurgery Alliance, and jointly organized by Yuquan Hospital of Tsinghua University, the First Affiliated Hospital of Xinjiang Medical University and Brain Science Advances magazine, were successfully held in Urumqi, Xinjiang. More than 200 neurosurgical experts from China, including Academician Zhao Jizong (Chinese Honorary Chairman), Professor Zhang Liwei (Chinese Chairman), Professor Zhang Yuqi (Chinese Executive Chairman) and Professor Geng Dangmu Renjiafu (Chinese Organizing Committee Chairman) attended the meeting; More than 50 representatives from the Japanese side, including Prof. Motoaki Teradera (Chairman of the Japanese side), Prof. Toshihiko Wakabayashi (Executive Chairman of the Japanese side), Prof. Takamasa Yashiyama (Consultant of the Japanese side), Prof. Shubin Kawa and Prof. Yoko Kato, attended the meeting. Experts from China and Japan actively exchanged with each other in a harmonious atmosphere and shared friendship. On the basis of fully inheriting the fine traditions of the older generation of neurosurgeons, they jointly focused on new technologies and new developments. More than 70 experts made wonderful speeches at the conference, covering: (1) surgical treatment of complex intracranial aneurysms, brain-heart treatment, sellar tumors, brainstem tumors, skull base tumors, ischemic encephalopathy, functional neurosurgery, spinal spinal diseases, pediatric neurosurgery and prosthetic neurosurgery, etc.; (2) a new classification of glioma based on genetic diagnosis; (3) the therapeutic effect of new drugs for glioma; (4) Introduction to the clinical model of multidisciplinary joint and multimodal imaging; (5) The latest research and development achievements of neurosurgical applied devices.
CURRENT ISSUE
