Volume 37 · Issue 08 · 2021

To preliminarily explore the clinical effect of magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) on patients with brain metastases.

A retrospective analysis was conducted on the clinical data of 5 patients with brain metastases who underwent MRgLITT at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January to June 2021. The ages of the 5 patients ranged from 42 to 80 years. Among those 5 patients, 2 cases were breast cancer brain metastases, 2 cases were lung cancer brain metastases, and 1 case was colon cancer brain metastasis. All patients underwent multi-disciplinary presurgical evaluations. Postoperative evaluation criteria included tumor ablation rate and lesion ablation status one month later. Clinical follow-up results were evaluated by Karnofsky functional status score (KPS). Imaging follow-up was performed to observe tumor progression.

Among the 5 patients with metastatic brain tumors, 3 cases of single lesion were treated with single cannula laser ablation, 1 case with double lesions was treated with two procedures of single cannula laser ablation at the same time, and 1 case with single lesion was treated with double cannula laser ablation. The preoperative tumor volume of the 6 lesions ranged from 746.0 to 11 732.3 mm³. The duration of laser emission was 221-1 552 s, and the duration of ablation was 602-4 444 s. The actual ablation volume was 2 092.8-8 000.0 mm³. Postoperative head MRI reexamination showed that the tumor ablation rate was 68.2%-100.0%. The muscle strength of the limbs of 1 patient further decreased after the operation, and the remaining 4 patients had no new complications. The KPS of 5 patients was 60-90 points. The length of hospital stay for patients after laser ablation was 3 to 7 days. The follow-up time of 5 patients was 1 to 3 months. MRI re-examination showed that 4 cases had no tumor progression, and 1 case had stable residual lesions.

The preliminary results suggest that MRgLITT is safe and effective for the treatment of single and sporadic brain metastases, and it can provide new treatment options to patients with brain metastases who are elderly, have deeply located lesions or cannot tolerate conventional surgical treatment.

To explore the surgical strategy and clinical efficacy of magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) for the treatment of drug-resistant epilepsy.

A retrospective analysis was conducted on the clinical data of 15 patients with drug-resistant epilepsy treated by MRgLITT at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from August to September 2020. Lesions included 2 cases of intracranial tumors, 2 cases of hypothalamic hamartoma, 4 cases of hippocampal sclerosis, 3 cases of focal cortical dysplasia, 2 cases of gray matter heterotopia, 1 case of intracranial cavernous malformation, and 1 case of bilateral occipital lobe gliosis which underwent corpus callosotomy. All patients underwent multidisciplinary evaluation before operation. Postoperative assessment included ablation volume ratio, effective rate of ablation, seizure-free rate, seizure reduction rate, and complication rate at 3 months after surgery.

The MRgLITT treatment of 15 patients was successfully completed with satisfactory results. The planned ablation volume was 785.4-10 716.0 mm^3, the actual ablation volume was 851.4-14 717.8 mm^3, the actual/planned ablation volume ratio was 91.2%-98.1%; the effective rate of ablation was 100%; the ablation time was 136-6 345 s. Two of the patients had postoperative complications, both of which had mild bleeding and recovered well. The postoperative hospital stay of 15 patients was 3 to 6 days. The results of follow-up of 15 patients for 3 months after operation showed that 8 cases remained seizure free, seizures were reduced by more than 50% in 3 cases, seizures were reduced by less than 50% in 3 cases, and seizures remained unchanged in 1 case.

The clinical application of MRgLITT should be strictly screened for indications. Intraoperative techniques such as stereotactic method, real-time temperature monitoring and laser thermal therapy, as well as reasonable planning of the laser fiber trajectory and lesioning range, can be applied to safely and effectively ablate the epileptic foci.

To investigate the long-term efficacy and safety of stereo-electroen-cephalography (SEEG)-guided radiofrequency thermocoagulation (RFTC) in hypothalamic hamartoma related epilepsy.

The clinical data of 15 patients with hypothalamic hamartoma related epilepsy admitted to the Department of Neurosurgery of Beijing Fengtai Hospital, Medical Alliance of Beijing Tiantan Hospital, Capital Medical University from June 2015 to November 2018 were retrospectively analyzed. All patients underwent SEEG electrode placement and video-EEG monitoring. According to the SEEG results and the image post-processing results, the contacts for RFTC lesioning were determined, and the electrode contacts were used for thermal coagulation. The patients were re-examined at clinics or followed up by telephone at 3, 9 and 24 months after surgery. The Engel grading standard was used to evaluate the clinical efficacy, while the long-term complications were observed and documented.

Only 1 patient underwent 2 times of SEEG-guided RFTC, 15 patients completed a total of 16 electrode placements. The seizures disappeared in 11 patients after operation. Six patients had complications of varying degrees. Among them, central fever, diabetes insipidus, electrolyte imbalance and drowsiness were relieved upon discharge. Horner syndrome and decreased muscle strength were relieved at the first follow-up. All 15 patients completed the follow-up for more than 2 years, and the follow-up time was 39.6±13.0 months (25-66 months). At the 3-month follow-up, the results of head MRI re-examination of all patients showed that the tumor pedicle was lesioned to varying degrees, and the EEG results showed that the abnormal discharge disappeared. At the last follow-up, 11 of the 15 patients reported seizure free (Engel Ⅰa), 2 cases were significantly improved (Engel Ⅰb-Ⅲ), and 2 cases had no significant improvement (Engel Ⅳ). Two patients had long-term complications, including weight gain, memory loss, and endocrine disorders.

Long-term follow-up has confirmed that SEEG-guided RFTC is safe and effective in the treatment of hypothalamic hamartoma related epilepsy.

To explore the efficacy and safety of conformal radiofrequency thermocoagulation (RF-TC) guided by stereo-electroencephalography (SEEG) based on three-dimensional images for the treatment of epilepsy caused by focal cortical dysplasia (FCD).

A retrospective study was conducted on the clinical data of 19 patients with drug-refractory epilepsy admitted to the Epilepsy Centre of Guangdong Sanjiu Brain Hospital from September 2017 to December 2019. The lesion in all patients was confirmed to be FCD and had clear boundaries based on preoperative evaluation including imaging and electroencephalography. The maximum diameter of lesions ranged from 1.4 cm to 4.0 cm with an average of 2.3±0.7 cm. All patients underwent SEEG electrode placement. During the design of electrode placement scheme, the software of 3D-Slicer was used to reconstruct the three-dimensional MRI images and the lesions were tried to be covered by the SEEG electrode contacts as much as possible. RF-TC was performed to ablate the lesion. Regular follow-up was performed post operation. The modified Engel classification was used to evaluate the outcome of seizure control.

In 19 patients, 9±2 SEEG electrodes/case (6-12 electrodes/case) were implanted, and the number of electrodes passing through the lesion was 5±2/case (2-8/case). The RF-TC target points during treatment were 25±13/case (6-52/case), and RF-TC was completed in 1 to 4 times/case. Eight patients experienced temporary muscle strength decline after operation, but all recovered completely before being discharged from the hospital. All 19 patients were followed up for 17±8 months (6-33 months). At the last follow-up, there were 16 cases classified as grade Ⅰ, 2 cases as grade Ⅱ, and 1 case as grade Ⅲ based on the modified Engel classification. None of the patients had permanent neurological deficits.

For patients with drug-refractory epilepsy caused by FCD with established epileptogenicity, clear boundaries and limited scope, the SEEG-guided conformal thermocoagulation based on three-dimensional imaging has few complications and a good prognosis.

To evaluate the efficacy of transcranial MR-guided focused ultrasound(TcMRgFUS) in the treatment of patients with refractory essential tremor (ET).

A retrospective analysis was conducted on the clinical data of 19 ET patients who were admitted to the Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital from January 2019 to December 2020. All patients underwent unilateral ablation of the ventrointermediate nucleus (Vim) of the thalamus using TcMRgFUS on the side with main symptoms. Clinical follow-up was performed for all patients at 1, 3, 6, and 12 months after surgery. Postoperative MRI was performed to assess the ablative lesion. Clinical tremor rating scale (CRST) was performed to evaluate the relief of tremor. At the same time, the patients were asked about the occurrence of postoperative adverse events.

The operations of 19 patients were all successful. Immediately after the operation, the head MRI showed ablation lesions, and the average diameter in the X, Y, and Z directions were 5.8±0.9 mm, 6.0±1.3 mm, and 6.1±1.7 mm respectively. After the operation, sensory disturbance was developed in 14 cases, dysgeusia in 5 cases, balance disturbance in 4 cases, and decrease of the right hand muscle strength in 1 case. Eight days later, the patient′s muscle strength returned to normal. At 6 months post operation, 10 patients received head MRI reexamination, and the ablation lesions disappeared. The total CRST scores and CRST scores in the treated hand of the 19 patients showed a tendency to decrease first and then increase with the extension of follow-up time, while they were significantly lower than those before operation (both P<0.001). Patients with adverse reactions basically returned to normal or had only mild symptoms at 3 months post operation.

The use of TcMRgFUS to treat drug-resistant essential tremor has a relatively good effect in controlling tremor post operation, and there are fewer adverse reactions.

To investigate the prediction value of indocyanine green fluorescence video imaging (ICGV)-FLOW 800 technique in the adverse reactions after superficial temporal artery (STA)-middle cerebral artery (MCA) branch anastomosis plus myosynangiosis (combined surgery) in patients with moyamoya disease.

A retrospective study was conducted on the clinical data of 55 patients with moyamoya disease who were admitted to Department of Neurosurgery, Huadong Hospital, Fudan University from October 2019 to July 2020. All patients underwent ICGV examination after combined surgery, and the data of hemodynamic parameters [peak fluorescence intensity (PFI), time to peak (TTP) and time to peak_1/2(TTP_1/2)] at cortical vessels, including STA, proximal MCA of the anastomosis (PMCA), distal MCA (DMCA), and cortical capillaries (CBC) and cortical veins (CV) near the anastomosis, were processed by FLOW 800 technology and TTP difference value between different interest points (△TTP) was calculated. According to whether there were adverse reactions, patients were divided into adverse reaction (AR) group and non-adverse reaction (non-AR) group. The baseline data and hemodynamic parameters in the two groups were compared.

All 55 patients underwent successful combined surgery, and 11 patients developed adverse reactions, including impaired swallowing function, headache, epileptic seizure, decreased contralateral muscle strength, and 1 case with acute cerebral infarction verified by MRI. There were no significant differences in the baseline data including gender, age, history of hypertension, hyperlipidemia and diabetes mellitus, proportion of surgeries performed in the dominant hemisphere, clinical classification, Suzuki stage, systolic and diastolic blood pressures before ICGV between the AR group (11 cases) and the non-ADR group (44 cases) (all P>0.05). There were no significant differences in the TTP values of STA and PMCA or the PFI and TTP_1/2 of each interest point between the AR group and the non-AR group (all P>0.05), while the TTP values of DMCA, CBC and CV in AR group were shorter than those in non-AR group (allP<0.05). The △TTP_CBC-DMCA of the AR group was shorter than that of the non-AR group (Z=-2.651, P=0.008).

Preliminary study has demonstrated that ICGV-FLOW 800 technique could be applied to document the hemodynamic changes from cerebral cortical artery to vein near the anastomosis after combined surgery. The decrease of TTP of DMCA, CBC and CV, as well as the decrease of △TTP_CBC-DMCA seem to be the predictors of adverse reactions.

To explore the application value of high-resolution C-arm CT technology combined with dual volume reconstruction and fusion technology in blood flow diverter (FD) devices.

The clinical data of 67 patients with unruptured intracranial aneurysms (81 in total) treated with FD at the Department of Radiological Intervention, the First Affiliated Hospital of Zhengzhou University from September 2018 to May 2019 were retrospectively analyzed. A total of 71 FDs were placed in 67 patients with aneurysm, and 18 patients were treated with coil embolization. During the operation, a 20-s high-resolution C-arm CT scan was performed on the FD implantation area to observe whether the FD was distorted or not fully expanded. Dual-volume reconstruction and three-dimensional fusion were performed for the original image of the high-resolution C-arm CT scan and 5-s 3D-DSA image of the tumor-bearing artery with a DSA post-processing workstation. For the reconstructed and fused images, post-processing techniques such as maximum intensity projection and three-dimensional volume-rendering were used to dynamically observe the FD adhesion to the wall (referred to as the dual-volume reconstruction method) and compared with the non-subtraction contrast and the 20-s high-resolution C-arm CT scan reconstruction image with diluted contrast agent (referred to as the diluted contrast medium method). The diluted contrast medium method was used as the gold standard to evaluate the accuracy of the dual-volume reconstruction method in the evaluation of FD adherence. We observed and documented the occurrence of adverse events during the operation and within 24 hours after the operation. DSA was rechecked 6 months after operation, and the efficacy was evaluated by O′Kelly-Marotta (OKM) grading standard.

Intraoperative high-resolution flat-panel CT reconstruction images showed that 3 cases of FD were not fully expanded at the tortuous part of the blood vessel, and then they were completely expanded after micro-guidewire looping dilation. The dual-volume reconstruction method and the diluted contrast medium method were used to reveal insufficient adherence of FD in 19 cases and complete adherence of FD in 52 cases. The results of the two methods were completely consistent. The insufficient adherence of FD was resolved by micro-guidewire looping dilation or balloon dilation. One patient with FD implantation developed arterial dissection during the dilute contrast method, and the dissection disappeared after 2 stents were implanted again. No complications such as acute stent thrombosis or bleeding were observed during the operation and within 24 hours after the operation. The DSA results at 6 months after operation showed that of the 81 aneurysms, 4 were classified as class A based on the OKM standard, 17 as class B, 33 as class C, and 27 as class D.

High-resolution C-arm CT combined with dual-volume reconstruction and fusion technology can clearly show whether the FD is fully expanded and its adherence to the vessel wall, so as to assist the surgeon in adjusting clinical decision-making, thereby reducing the potential surgical risk, and has certain clinical application value.

To investigate the incidence and change trend of subarachnoid hemorrhage (SAH) among Tianjin residents from 1999 to 2018, and to provide a basis for key population intervention and corresponding policy formulation.

The Tianjin Non-communicable Disease Surveillance System was used to collect the surveillance data of SAH among Tianjin residents from 1999 to 2018. We then calculated the crude incidence rate of SAH and the standardized incidence rate with the data of the sixth national census in 2010 as the standard population. The Joinpoint regression model and trend χ² test were used to analyze the change trend of the annual incidence rate and calculate the annual percentage change (APC).

The standardized incidence rate of SAH among Tianjin residents changed from 5.10/100, 000 in 1999 to 5.41/100, 000 in 2018, showing no obvious change (P>0.05); the standardized incidence rate of males showed an upward trend (Z=3.15, APC=0.9%, P<0.01), and the standardized incidence rate of women showed a downward trend (Z=-1.73, APC =-0.41%, P=0.04). In the 20 years, the incidence of SAH in men in all age groups showed an upward trend; while the incidence of women and the whole population in the age groups of <35 years, 35-44 years, and 45-54 years showed an upward trend (all P<0.01) and that in the age groups of 55-64 years and ≥65 years showed a downward trend (bothP<0.05). The standardized incidence rate in urban areas showed a downward trend, while that in rural areas showed an upward trend (bothP<0.01).

The incidence of SAH among Tianjin residents from 1999 to 2018 showed a trend of increase at younger age. The incidence of SAH had increased in males and rural areas and decreased in urban areas. Attention needs be paid to key populations. Primary prevention and allocation of medical resources in rural areas should be strengthened.

To observe the effect of microsurgical clipping and endovascular embolization in the treatment of ruptured intracranial aneurysms.

From January 2000 to October 2020, 3, 724 patients with ruptured intracranial aneurysms were treated by Neurosurgery Department at 4 hospitals including the 900^th Hospital of Joint Support Force of the Chinese PLA. Among them, craniotomy and microsurgical clipping were performed in 2 417 cases of aneurysms, and 1 307 cases of aneurysms were embolized by endovascular treatment. The 1 ∶1 propensity score matching method was used select 415 cases in each of the endovascular embolization group and the craniotomy group, and the intraoperative and postoperative complications, follow-up efficacy and aneurysm recurrence rate of the two groups were rostrospetiely compared.

The intraoperative aneurysm rupture rate in the craniotomy group was 22.9% (95/415), which was higher than 17.3% (72/415) in the endovascular treatment group (P=0.046). Except for the incidence of secondary chronic hydrocephalus, there was no statistically significant difference in postoperative complications between the two groups (P>0.05). The incidences of pulmonary infection, poor incision healing, intracranial infection and newly-developed cerebral infarction were all higher in the craniotomy group than the endovascular treatment group (allP<0.05). The median postoperative follow-up time of craniotomy group and endovascular treatment group was 30.0 months and 33.0 months, respectively. The last follow-up showed that the postoperative recurrence rates of the craniotomy group and endovascular treatment group were 0.7% (3/415) and 2.9% (12/415), respectively, and the difference was statistically significant (P<0.05). The results of the Glasgow outcome score showed that the outcome of the endovascular treatment group was better than that of the craniotomy group (P<0.05).

The complication rate and therapeutic effect of endovascular embolization for the treatment of ruptured intracranial aneurysms are better than those of microsurgical clipping, but the recurrence rate of aneurysms associated with endovascular embolization is relatively high.

To preliminarily investigate the safety and effectiveness of Neuroform Atlas stent-assisted coil embolization of ruptured anterior communicating wide-necked aneurysms.

A retrospective analysis was conducted on the clinical data of 14 patients with ruptured anterior communicating wide-necked aneurysms admitted to the Department of Neurosurgery, Tangshan Gongren Hospital of Hebei Medical University from August 2020 to April 2021. All 14 patients underwent preoperative digital subtraction angiography (DSA) to confirm the diagnosis. There were a total of 14 anterior communicating artery wide-necked aneurysms. All patients underwent Neuroform Atlas stent-assisted coil embolization treatment. Among them, the dual catheter system was used in 9 patients and the single catheter system in 5. DSA was performed immediately after the operation, and the Raymond grade was used to assess the embolization of the aneurysm. We observed postoperative complications to assess the safety of treatment. The patients were followed up for 6 months after the operation, and DSA was reviewed to assess whether the aneurysm had recurrence and the stent patency.

The Neuroform Atlas stents of 14 patients were successfully released and the stents were in place satisfactorily during the operation. There were no surgery-related complications such as spasm of the tumor-bearing artery, rupture of aneurysm and hemorrhage, poor stent expansion, and thrombosis in the stent. Immediately after the operation, DSA showed that all 14 aneurysms were completely embolized (Raymond Ⅰ). There was no transient ischemic attack, cerebral infarction or cerebral hemorrhage in any patient after the operation, and no death cases. Of the 14 patients, 8 completed the 6-month follow-up. The DSA results of 8 patients showed complete embolization of the aneurysm (Raymond Ⅰ), no coil compression at the neck of the aneurysm, no recurrence of the aneurysm, good stent patency, no stenosis or thrombosis.

This preliminary study has suggested that the application of Neuroform Atlas stent-assisted coil embolization of ruptured wide-necked aneurysms of the anterior communicating artery seems effective and safe.

To explore the features and influencing factors of aneurysmal wall enhancement (AWE) of unruptured intracranial aneurysms (UIAs) based on high-resolution magnetic resonance vessel wall imaging (HRMR-VWI).

The clinical data of 80 patients with UIAs (103 aneurysms in total) who underwent HRMR-VWI from March 2017 to May 2019 at the Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. HRMR-VWI was used to clarify the characteristics of AWE, and the digital subtraction angiography (DSA) three-dimensional workstation was used to quantify the geometrical parameters of UIAs. Univariate and multivariate logistic regression analyses were used to explore the morphological parameters that affected the AWE of the saccular UIAs.

Among the 103 UIAs in 80 patients, 89 were saccular aneurysms (86.4%) and 14 were non-saccular aneurysms (13.6%). Compared with saccular aneurysms, AWE was more common in non-saccular aneurysms (P<0.001). The results of univariate analysis showed that the AWE of a saccular aneurysm was more common in larger aneurysms (P<0.001), wider neck aneurysms (P<0.001), aneurysms with larger size ratio (P<0.001), larger aspect ratio (P<0.001), larger flow angle (P=0.004) or daughter domes(P=0.004). Multivariate logistic regression analysis showed that the size of aneurysm was an independent factor affecting the AWE of saccular UIA (OR=1.496, 95%CI=1.242-1.800, P<0.001).

AWE is more common in non-saccular UIAs. In saccular UIAs, larger ones are more likely to develop AWE. HRMR-VWI imaging features may help assess the risk of rupture of UIAs.

To investigate the application value of visual evoked potential (VEP) in pituitary adenoma resection under general anesthesia.

A retrospective analysis was performed on 61 spinal cord and spine tumor patients and 10 pituitary adenoma patients who underwent VEP monitoring who were consecutively admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from February 2019 to February 2021. Recording leads of intraoperative VEP included O1-FZ, OZ-FZ, and O2-FZ. Among them, 31 received combined intravenous and inhalation anesthesia (composite group) and 30 received total intravenous anesthesia (intravenous group). By comparing the effects of different montages and different anesthesia methods on VEP, we determined the main observation indicators of VEP. Later, the VEP was applied to 10 cases of pituitary adenoma patients with visual impairment who were treated by surgical resection at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University. Visual acuity and visual field were tested 7 days after operation to determine the correlation between intraoperative observation indexes and postoperative visual function.

In 61 spinal cord and spine tumor patients, the monitor values of VEP at OZ-FZ lead during the operation were higher than those at other two leads (O1-FZ and O2-FZ) when comparing the peak difference between N75-P100 (N1 amplitude) (P<0.05) while similar in the peak difference between N145-P100 (N2 amplitude) (P>0.05). At the OZ-FZ montage, there was no significant difference in the amplitude of N1 or N2 between the two groups of patients undergoing different methods of anesthesia (P>0.05). VEP could be applied during operation in all 10 patients with pituitary adenoma, and the induction rate was 100%. Among them, the N1 wave amplitudes was higher than baseline in 6 cases, and their visual acuity and visual field were improved post operation compared with preoperative conditions. In 3 cases, the N1 wave amplitudes was first reduced and then recovered, of which 2 cases had no significant changes in visual acuity or visual field after operation, and 1 case improved compared to preoperative conditions. In 1 case, N1 wave amplitude did not change significantly compared with baseline, and no obvious change was observed in vision or visual field after surgery.

It is preliminarily found that postoperative change of visual function in patients with sellar tumors can be predicted by observing the changes in the amplitude of N1 at the OZ-FZ montage.

To investigate a novel imaging classification system of insular gliomas and its clinical values.

A retrospective analysis was conducted on the clinical data of 72 patients who were pathologically diagnosed as insular glioma at the Department of Neurosurgery of the First Affiliated Hospital of Nanjing Medical University from March 2011 to June 2020. According to the imaging characteristics, 72 cases of insular gliomas were divided into insular lobe type (9 cases), insular operculum type (14 cases), brain lobe type (32 cases) and medial type (17 cases). According to the vertical line of the interventricular foramen to the plane of the ipsilateral sylvian fissure, the tumor was divided into anterior insular lobe type (36 cases) and posterior insular lobe type (19 cases) (except the medial type). All cases underwent craniotomy and tumor resection, which was performed primarily via transsylvian approach in insular type and operculum type, primarily via transcortical approach in brain lobe type and medial type. We then analyzed and compared the tumor resection rate, postoperative complication and outcome among different types of insular gliomas.

Among 72 patients with insular gliomas, gross total resection was achieved in 19 (26.4%) cases, subtotal resection in 46 (63.9%), and partial resection in 7 (9.7%). All patients were diagnosed pathologically after operation, including 25 cases of WHO grade Ⅱ gliomas, 16 cases of WHO grade Ⅲ and 31 cases of WHO grade Ⅳ. For WHO grade Ⅱ and grade Ⅲ insular gliomas, the tumor resection rates of insular type, operculum type, lobe type and medial type decreased successively (F=16.94, P<0.001). There was no significant difference in the tumor resection rate between insular type and operculum type, or between lobe type and medial type (allP>0.05), while the differences among other types were statistically significant (allP<0.05). For WHO grade Ⅳ insular gliomas, the tumor resection rates of insular type, lobe type and medial type decreased successively (F=17.85, P<0.001), and the differences among those types were statistically significant (allP<0.05). For WHO grade Ⅱ, grade Ⅲ and grade Ⅳ insular gliomas, the tumor resection of the anterior insular type was higher than that of the posterior insular type (allP<0.05). Patients in the posterior insular type had a higher risk of muscle weakness than those in the anterior insular types [26.3% (5/19)vs. 16.7% (6/36), P=0.395]. Patients with insular gliomas had a better outcome following postoperative radiotherapy and chemotherapy.

The novel classification system of insular gliomas based on imaging features could be helpful for the selection of surgical approaches and enhancement of tumor resection rate.

To explore the clinical manifestations, imaging features, treatment methods and prognosis of spontaneous hemorrhage of intracranial meningiomas.

A retrospective analysis was conducted on the clinical data of 497 patients with meningioma who were consecutively admitted and underwent surgical treatment from March 2008 to March 2017 at the Department of Neurosurgery, Li Hui Li Hospital of Ningbo Medical Center, including 15 patients with spontaneous hemorrhage of meningioma (accounting for 3.0%). We summarized the patients′ clinical manifestations, imaging features, treatment methods and outcomes.

The clinical symptoms of 15 patients included the sudden worsening of chronic headache, weakness of one limb, decreased vision or epileptic seizure and other preexisting symptoms (6 cases), and they could also be manifested as sudden severe headache, hemiplegia, seizures and other stroke-like symptoms (9 cases). Head CT and MRI showed signs of hematoma, space-occupying tumor and peritumoral edema. According to the positional relationship between tumor and hematoma, spontaneous hemorrhage of meningioma could be divided into three types: merely intratumoral hemorrhage (7 cases), merely peritumoral hemorrhage (6 cases) and combined intratumoral and peritumoral hemorrhage (2 cases). All patients underwent tumor resection and hematoma removal at the same time. The degree of tumor resection reached Simpson grade Ⅰ in 9 cases, grade Ⅱ in 2 cases, grade Ⅲ in 3 cases, and grade Ⅳ in 1 case. Fifteen patients were followed up for 48 months after operation. Three patients had neurological sequelae, and the remaining 12 patients had no obvious neurological dysfunction. The results of imaging follow-up showed that, of the 15 patients, 2 had tumor progression or recurrence; the remaining 13 had no tumor recurrence.

The incidence of spontaneous bleeding in meningioma is low, and its clinical manifestations are similar to stroke emergencies. Meningioma with hemorrhage can be diagnosed by preoperative CT combined with MRI. According to the imaging characteristics of hemorrhage, it can be divided into merely intratumoral hemorrhage, merely peritumoral hemorrhage and combined intratumoral and peritumoral hemorrhage. The corresponding treatment strategy should be chosen based on the patient′s clinical characteristics, and most patients could achieve a favorable outcome.

To establish the rabbit model of acute intracranial hypertension by the epidural balloon compression method and to determine its limit intracranial hypertension value.

The rabbit model of acute intracranial hypertension was prepared by the epidural balloon compression method. In the first group, intracranial pressure (ICP) was increased to 16 mmHg (1 mmHg=0.133 kPa) and observed for 120 minutes to determine the fluctuation of ICP. Each increase of 10 mmHg was set as a group with 10 animals in each group. When the ICP increased to a certain value, the experimental rabbit′s ICP fluctuated sharply (fluctuation range> 15%) or the mortality rate increased significantly within 24 hours, it was deemed to have reached ICP limit. Then the limit value was added to the previous set of values and averaged as the next set of ICP values, and so on, until the intracranial hypertension value closest to the limit was found. The healthy male New Zealand white rabbits were divided into 2 groups according to the random number table method, namely the experimental group (n=6) and the control group (n=6). The differences in neurological function, imaging, cerebral edema, number of positive neurons in Nissl staining, and expression of Caspase3 were compared between the two groups.

When the ICP was increased to 46 mmHg, the ICP of the experimental rabbit fluctuated greatly (n=5) or the rabbits died (n=5). When the ICP was 16 mmHg, 26 mmHg or 36 mmHg, the ICP of the experimental rabbit did not fluctuate significantly. Further research found that when the ICP was 41 mmHg or 39 mmHg, the ICP of the experimental rabbits fluctuated greatly (n=9 per group) or the rabbits died (n=1 per group). When the ICP was 38 mmHg, the experimental rabbits did not show obvious fluctuation in the ICP. Compared with the rabbits in the control group, those in the experimental group had obvious hematomas in the oppressed area of the brain, and the sulci and gyrus were blurred, and the brain edema was obvious; the neurological function scores (4.17±0.98 points vs. 0.67±0.22 points) were increased; brain water content was significantly increased [(80.8±1.5)% vs. (78.8±1.1)%, P<0.05]; Nissl staining positive cells were fewer [(83.5±11.3vs. 113.8± 17.9, P<0.05]; Caspase-3 expression level was higher (2.04±0.39vs. 0.32±0.27, P<0.05).

For the experimental rabbit model of acute intracranial hypertension prepared by the epidural balloon compression method, its clinical manifestations and pathophysiological changes conform to the characteristics of acute intracranial hypertension, and its limit intracranial hypertension value is 38 mmHg.