MedNexus
Volume 39 · Issue 02 · 2023
MedNexus
Blood flow guidance device (FD) is a new material for the treatment of intracranial aneurysms in recent years. Its treatment concept is to rely on the ability of blood flow guidance to slowly form thrombus in the aneurysm and occlude it. For huge and complicated unruptured internal carotid artery aneurysms, the therapeutic effect is significantly better than that of traditional endovascular embolization. On this basis, the indications of FD for the treatment of intracranial aneurysms have gradually expanded, and there is a trend of becoming a routine treatment for intracranial aneurysms. While affirming the therapeutic effect of FD, it should also be noted that the proportion of complications of FD in the treatment of intracranial aneurysms is high, and its safety evaluation cannot be ignored. Clinicians should comprehensively consider the characteristics, expected treatment effects and risks of each aneurysm, objectively compare other treatment methods, and choose FD reasonably.
To evaluate the safety and effectiveness of Tubridge flow diverter (TFD) in the treatment of intracranial aneurysm (IA).
The clinical and imaging data of patients with intracranial aneurysms treated with TFD from June 2018 to June 2020 at the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University were retrospectively analyzed. A total of 85 cases (100 aneurysms) were enrolled. Aneurysms were located in the anterior circulation in 74 cases and in the posterior circulation in 26 cases. For 62 aneurysms, the TFD alone was implanted. For 38 aneurysms, the TFD combined with coils was implanted. A a total of 92 TFDs were placed. The embolization situation immediately after operation, perioperative complications and follow-up results were documented.
Among 100 IAs, assessed immediately after surgery, 12 (12.0%) had Raymond-Roy grade Ⅰ embolization (complete occlusion), 13 (13.0%) had grade Ⅱ embolization (near total occlusion), and 75(75.0%) grade Ⅲ embolization (partial occlusion). A total of operation-related problems occurred in 8 TFDs (7 patients) during implantation, of which 5 stents were poorly adhered to the wall. after balloon expansion 4 stents were well adhered to the wall, 1 was poorly adhered to the wall. One stent was opened poorly, the end of one stent fell into the IA lumen, one stent fell off during retrieval. Ischemic complications occurred in 3 patients (3.5%) during the perioperative period, and 2 patients (2.4%) died, all of whom were patients with aneurysms of the posterior circulation. A total of 82 cases (98.8%, 82/83) received clinical follow-up for 19.1 ± 3.0 months (12-26 months), and the modified Rankin scale scores at the last follow-up were all 0-2 points. Fifty-nine aneurysms were followed up by imaging, and the follow-up time was 7.1±2.6 months (3-16 months). Among the 59 aneurysms, 36 (61.0%) had Raymond-Roy grade Ⅰ occlusion, 10 (17.0%) had grade Ⅱ occlusion, and 13 (22.0%) had grade Ⅲ occlusion. Among the 50 patients, 6 cases (12.0%) had in-stent stenosis, 5 cases (10.0%) had asymptomatic branch vessel occlusion, and 1 case (2.0%) had symptomatic parent artery occlusion.
TFD has a high technical success rate in the treatment of intracranial aneurysms, a low incidence of serious complications, and a good short-term therapeutic effect.
To explore the safety and efficacy of flow diverter (FD) for the treatment of acutely ruptured intracranial aneurysms.
The clinical data of 27 patients with ruptured intracranial aneurysms who were treated with FD at the Neuro-intervention Department, the First Affiliated Hospital of Zhengzhou University from February 2018 to February 2021 were retrospectively analyzed. There were 27 aneurysms in 27 patients, including 14 anterior circulation aneurysms and 13 posterior circulation aneurysms. Immediately after operation and during follow-up, digital subtraction angiography (DSA) was performed, and O′Kelly-Marotta (OKM) grading was used to evaluate the degree of aneurysm occlusion; the modified Rankin Scale (mRS) was used to evaluate the outcome of patients.
A total of 28 FDs were placed in 27 aneurysms (including 16 FDs of Pipeline, 9 FDs of Tubridge, and 3 FDs of Surpass), and the success rate of stenting was 100%. Immediate postoperative OKM classification of 27 aneurysms were grade A in 3 cases (11.1%), grade B in 15 cases (55.6%), grade C in 5 cases (18.5%), and grade D in 4 cases (14.8%). Among the 27 patients, 5 patients (18.5%) had perioperative complications, including 3 cases of ischemic events (11.1%), 2 cases of hemorrhagic events (7.4%), 2 cases of disability (7.4%), and 1 case of death (3.7%). Twenty-six patients the follow-up time [M (Q1, Q3)] was 8 (7, 19) months. A total of 18 patients (18 aneurysms) underwent DSA follow-up, and the OKM grade B was reported in 1 case (5.6%), grade C in 3 cases (16.7%), grade D in 14 cases (77.7%), and no aneurysm recurrence occurred in any patient. At the last follow-up, there were 25 cases with mRS ≤ 2 points, and 1 case with 3 points.
The application of FD in the treatment of ruptured intracranial aneurysms has a high technical success rate, a high aneurysm occlusion rate in mid-term follow-up, and few perioperative complications. It is a safe and effective treatment method.
To explore the application value of artificial intelligence (AI) for identification of responsible aneurysms and providing therapeutic strategies in patients with multiple intracranial aneurysms (MIAs) who had symptoms of subarachnoid hemorrhage (SAH) or sentinel headache.
From October 2019 to October 2021, 20 patients with MIAs presenting with SAH or sentinel headache were admitted to the Department of Neurosurgery, the First Affiliated Hospital of Soochow University whose clinical data were retrospectively analyzed in this study. The risk of aneurysm rupture was assessed in all patients by AI. According to the hemorrhage pattern, 20 patients were divided into definitive hemorrhage pattern group, non-definitive hemorrhage pattern group, and sentinel headache group. The responsible aneurysm and individualized therapeutic strategies were determined based on the evaluation results of AI. The clinical outcomes of patients were assessed at discharge based on the modified Rankin Scale score (mRS).
Of the 20 patients, 5 were in definitive hemorrhage pattern group, 9 in non-definitive hemorrhage pattern group, and 6 in sentinel headache group. All the responsible aneurysms identified by the AI were confirmed during craniotomy in definitive and non-definitive hemorrhage pattern groups. The development of individualized therapeutic strategies in sentinel headache group was based on the evaluation results and all patients were discharged with the mRS of 0-1.
AI can effectively and accurately identify the responsible aneurysms in patients with MIAs presenting with SAH or sentinel headache. The evaluation results of AI can assist the clinicians in developing reasonable individualized therapeutic strategies.
To explore the risk factors of cerebral hyperperfusion syndrome (CHS) based on intraoperative hemodynamics of parasylvian cortical arteries (PSCAs) measured by microvascular Doppler ultrasound (MDU) in adults with moyamoya disease (MMD) treated by direct bypass.
A consecutive of 92 adult patients (97 hemispheres) underwent the superficial temporal artery-middle cerebral artery (STA-MCA) bypass at the Department of Neurosurgery, Nanjing Drum Tower Hospital Affiliated to Nanjing University between September 2020 and May 2021 and were retrospectively enrolled into this research. Intraoperative MDU was performed to evaluate hemodynamics of PSCAs, including flow direction, mean systolic value (MSV) of recipient artery (RA), MSV value of bypass grafting, and MSV folds of RA. MSV folds was defined as MSVpost / MSVpre. According to the diagnosis of CHS, cases were divided into CHS group and non-CHS group. Clinical data and intraoperative hemodynamics of two groups were compared. The variable of P<0.1 in univariate analysis were included into multivariate logistic regression analysis (step by step) to explore the risk factors of CHS.
A total of 7 (7.2%) cases in 97 hemispheres satisfied the criteria of postoperative CHS (CHS group), and the other 90 cases (92.8%) had no CHS (non-CHS group). Compared to cases without CHS, those with CHS had more advanced Suzuki stage, lower MSV of RA before surgery, and higher MSV change folds of RA both directing sylvian and cortex after surgery (all P<0.05). Multivariate analysis indicated that advanced Suzuki stage (OR=11.82, 95%CI: 2.05-68.19, P=0.006) and high MSV change folds of RA directing sylvian (OR=8.33, 95%CI: 2.01-34.45, P=0.003) were significantly associated with occurrence of CHS.
Advanced Suzuki stage and high MSV change folds of RA directing sylvian are risk factors for postoperative CHS. Quantitative analysis of intraoperative MDU is useful for evaluating hemodynamics and predicting postoperative CHS.
To investigate the application of 4D digital subtraction angiography (DSA) in the evaluation of angioarchitectural characteristics of intracranial arteriovenous malformations (AVMs).
A retrospective study was conducted on the clinical data of 34 patients with intracranial AVMs who were evaluated with 4D-DSA at the Neurovascular Center, the First Affiliated Hospital of Naval Medical University from May 2017 to January 2021. The angioarchitectural characteristics of AVM were evaluated by 4D-DSA and traditional methods (2D-DSA combined with 3D-DSA). The quality of visualization of the two methods in evaluating the feeding artery, dangerous structure, the division of the nidus, drainage vein structure, Spetzler-Martin (S-M) grading was manually rated using a 4-point scale from 0 to 4 points. The higher the score, the better visualized.
The feeding arteries and S-M grades of AVM revealed with 4D-DSA were nearly accordance with the traditional methods (Z value: -1.70 and -0.63, respectively, both P>0.05). The dangerous structure, the division of the nidus, and the drainage vein structure was better visualized with 4D-DSA (Z value: -4.95, -2.99, and -4.14, respectively, all P<0.05).
Compared with traditional method, 4D-DSA is associated with better visualization of the angioarchitecture characteristics including the dangerous structure of intracranial AVM, the division of the nidus, and the drainage vein structure, which can provide more information for choosing treatment strategy.
To investigate the surgical method and therapeutic outcome of neuroendoscopic surgery for hypertensive intracerebral hemorrhage breaking into the ventricle.
A retrospective analysis was conducted on the clinical data of 16 patients with hypertensive intracerebral hemorrhage breaking into the ventricle who were admitted to the Department of Neurosurgery, Tianjin Fifth Central Hospital from January 2017 to January 2021. All patients underwent neuroendoscopic surgery. Outpatient or telephone follow-up was conducted after operation, and the outcome of patients was evaluated by modified Rankin scale (mRS) and Glasgow Outcome scale (GOS). The patients′ complications were observed and documented.
The operation time of 16 patients was 132.8±32.9 min (90-190 min). The hematoma clearance rate at 24 hours after operation was 80.6%±10.6%. One case died after cerebral hemorrhage occurred again after operation. After 6 months of follow-up, the GOS was 3.2±1.1 points (1-5 points), and the mRS was 3.6±1.6 points (1-5 points). One case of hydrocephalus occurred during the follow-up period.
Neuroendoscopic surgery can be an effective treatment for hypertensive intracerebral hemorrhage breaking into the ventricle. The technique is associated with short operation time, high hematoma clearance rate, and low incidence of chronic hydrocephalus.
To preliminarily study the clinical efficacy of intraoperative magnetic resonance(MR)-guided laser interstitial thermal therapy (LITT) in the treatment of brain metastases from lung cancer.
Patients with brain metastases from lung cancer admitted to the Neurosurgery Center of Beijing Tiantan Hospital, Capital Medical University from June 2021 to April 2022 were prospectively included, and all patients had ≤4 intracranial metastatic lesions. In each patient, one major lesion was selected for intraoperative MR-guided LITT treatment. Complications related to LITT treatment were observed, and imaging and clinical follow-up were performed 30, 90, and 180 days after operation to evaluate the tumor control.
A total of 11 patients were included, including 9 cases of non-small cell lung cancer and 2 cases of small cell lung cancer. The median volume of the 11 treated intracranial metastases was 2.97 cm3 (0.70-7.20 cm3), the median laser emission time was 17.23 minutes (2.88-37.15 minutes), and the median ablation operation time was 28.10 minutes (7.68-63.40 minutes). The median ablation rate of lesions was 97.5% (29.2-100.0%). No hemorrhage was found in the postoperative cranial CT examination of the patients, and one of them had a transient decrease in muscle strength. At 30, 90, and 180 days after LITT, MRI showed that the average lesion volume was 2.30 times (1.29-3.52 times), 1.21 times (0.35-2.02 times) and 0.80 times (0.09-2.40 times) the preoperative volume, respectively. During the 90 day follow-up after LITT, 2 patients had recurrence of intracranial metastases; 1 patient died of cerebral hemorrhage 4 months after operation (unrelated to the treatment procedure). At 90 and 180 days after operation, the proportion of patients whose tumor was controlled was 9/11 and 8/10 respectively.
Preliminary observations show that intraoperative MR-guided LITT in the treatment of brain metastases from lung cancer has a low rate of surgery-related complications and a high rate of short-term tumor control.
To investigate the clinical characteristics and surgical outcomes of pituitary prolactin-secreting adenomas invading the sellar floor.
The clinical data of 184 patients with pituitary prolactin-secreting adenomas who underwent transsphenoidal microresection at the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2016 to May 2019 were retrospectively analyzed. According to postoperative pathological results, 184 cases were divided into two groups: sellar-floor invasion group (with invasion of the dura of sellar floor, 106 cases) and control group (without invasion of the dura of sellar floor, 78 cases). Based on the degree of lesion invasion, patients in the sellar floor invasion group were divided into type Ⅰ, Ⅱ and Ⅲ (68 cases, 25 cases and 13 cases respectively). All patients were followed up through outpatient visits or telephone, and the postoperative remission rate was determined based on imaging review and serum prolactin level to compare the surgical effects of patients with or without sellar floor dural invasion and different types of sellar floor invasion.
Compared with the control group, the proportion of males in the sellar floor invasion group was higher [34.9% (37/106) vs. 12.8% (10/78)], the age was older (35.6±11.9 years vs. 30.5±11.5 years), the proportion of Knosp grade Ⅲ-Ⅳ was higher [62.2% (66/106) vs. 9.0% (7/78)], the tumor diameter was larger (2.25±1.12 cm vs. 1.45±0.76 cm), and the differences were statistically significant (all P<0.05). The complete resection rate in the sellar floor invasion group was lower than that in the control group [53.8% (57/106) vs. 83.3% (65/78), P<0.05]. Postoperative remission rate in the sellar floor invasion group was significantly lower than that in the control group [70.7% (75/106) vs. 91.0% (71/78), P<0.05]. There was significant difference in postoperative remission rate among different types of sellar floor invasion [89.7% (61/68), 48.0%(12/25) and 15.4% (2/13) for type Ⅰ, Ⅱ and Ⅲ respectively] (χ2=37.32, P<0.001).
Pituitary prolactin-secreting adenomas invading the sellar floor are most common in young and middle-aged men and often accompanied by invasion of the cavernous sinus. The surgical effect is better in patients without sellar floor invasion and less degree of sellar floor invasion.
To investigate the clinical characteristics and treatment efficacy of medial temporal lobe epilepsy (mTLE) subgroup patients with simple amygdala enlargement. The grouping method is based on the volume of amygdala and hippocampus measured by automatic image segmentation technique.
The data of 107 patients with refractory mTLE diagnosed and treated at the Neurosurgery Department of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from January 2015 to December 2019 were collected, and the data of 195 healthy volunteers who underwent physical examination during the same time period were also collected. A retrospective statistical analysis was performed on those data. Using AccuBrain® the cloud software the volumes of bilateral amygdala and hippocampus and their proportion in the cranial cavity on the head MRI image were automatically measured. The cranial cavity proportion of the amygdala volume greater than the mean value+ 2 times the standard deviation of the ipsilateral proportion of normal people was determined as the standard of amygdala enlargement. The patients with amygdala enlargement without hippocampal atrophy were defined as simple amygdala enlargement group, otherwise they were in control group. The clinical characteristics and therapeutic effects of the two groups were compared. Evaluation of surgical effect was based on the International League Against Epilepsy (ILAE) system.
The proportions of left and right amygdala volumes in the cranial cavities of 195 healthy adults were (0.12±0.01)% and (0.13±0.01)% respectively. The proportion of cranial cavity volume of amygdala in epileptic side and non-epileptic side of 107 patients with mTLE were both (0.13±0.02)%. The amygdala of 9 patients showed simple enlargement, which was on the epileptic side. The seizure process was accompanied by disturbance of consciousness. The median follow-up time of 107 patients with refractory mTLE was 26 months (12-84 months). At the end of follow-up, there were 70 cases (65.4%) of ILAE grade 1, 6 cases (5.6%) of grade 2, 8 cases (7.5%) of grade 3, 17 cases (15.9%) of grade 4, and 6 cases (5.6%) of grade 5; In the simple amygdala enlargement group, there were 8 cases of ILAE grade 1 and 1 case of grade 4. There was no significant difference in age, sex, previous history of febrile convulsions, trauma, abnormal birth history, preoperative course, clinical manifestations, surgical methods, follow-up time, or the ILAE classification at the last follow-up between the simple amygdala enlargement group and the control group (all P>0.05).
Preliminary observations have found that among patients with drug-refractory mTLE, there are patients with simple amygdala enlargement whose seizures are accompanied by disturbance of consciousness, and the surgical treatment effect seems good; however, no differences in clinical characteristics and therapeutic effect have been observed with other mTLE patients.
To investigate the effectiveness and therapeutic experience of endoscopic treatment for Rathke cysts.
The clinical data of 28 patients with Rathke cysts who underwent endoscopic transnasosphenoidal surgery at the Department of Neurosurgery, the Affiliated Hospital of Jiangnan University (9 cases) and Wuxi No.2 People′s Hospital (19 cases) from January 2018 to June 2021 were retrospectively analyzed. All cases were treated by endoscopic transnasosphenoidal surgery with individualized intraoperative removal and multilevel sellar floor reconstruction. The effectiveness of endoscopic treatment for Rathke cyst was analyzed based on the improvement of symptoms, hormone levels and MRI review.
All 28 Rathke cysts were completely resected by endoscopic transna-sosphenoidal surgery. Postoperative relief of headache was achieved in 13 out of 14 patients with headache, improvement was reported in 7 out of 9 patients with visual field disorders and 5 out of 6 patients with endocrine abnormalities. Transient cortisol or hypothyroidism occurred in 5 patients, diabetes insipidus occurred in 6 patients, and significant cerebrospinal fluid leakage occurred in 1 patient. No intracranial infection occurred. The postoperative follow-up time of 28 patients was 18.5±8.8 months (3-36 months). To the last follow-up, no recurrence of Rathke cyst was found in those patients in the re-examination of cranial MRI.
The efficacy and safety of neuroendoscopic transsphenoidal surgery for Rathke cysts are good. Individualized removal of cyst contents and multi-level sellar floors reconstruction are performed during the operation, with less trauma and fewer complications.
To investigate the risk factors of decompressive bleeding after drilling and drainage in patients with chronic subdural hematoma (CSDH) and their predictive role.
The clinical data of 150 CSDH patients admitted to the Department of Neurosurgery, the First People′s Hospital of Huzhou from January 2018 to January 2022 were retrospectively analyzed. The effects of age, gender, history of head trauma, whether the patient had diabetes, preoperative Glasgow coma score (GCS), mean arterial pressure, intracavitary pressure of hematoma, midline recovery rate, hematoma density, hematoma volume, maximum hematoma thickness, preoperative use of anticoagulant and antiplatelet drugs, neurological deficit, length of intraoperative catheterization, and residual massive gas accumulation on postoperative decompressive bleeding were analyzed. The factors with statistical significance were included in the multivariate logistic regression model to analyze the risk factors of postoperative decompressive bleeding. The ROC (receiver operating characteristic) curve was drawn to evaluate the predictive efficacy of related risk factors on decompressive hemorrhage.
A total of 27 (18.0%) of the 150 patients had postoperative decompressive hemorrhage. Compared with those without decompressive hemorrhage, the patients with decompressive hemorrhage had higher intracavitary pressure of hematoma, faster midline recovery rate, higher preoperative mean arterial pressure, mixed density of hematoma and higher proportion of hematoma volume ≥ 100 ml, with statistically significant differences (all P<0.05), while other factors had no significant differences (all P>0.05). Multivariate logistic regression showed that high intracavitary pressure of hematoma (OR=1.04, 95%CI: 1.01-1.08, P=0.021) and fast midline recovery rate (OR=4.17, 95%CI: 1.28-13.58, P=0.018) were the risk factors for decompressive hemorrhage in the CSDH patients after drilling and drainage (all P<0.05). ROC analysis showed that the area under the curve (AUC) of hematoma cavity pressure predicting postoperative decompressive bleeding was 0.99, and the cut-off value was 306 mm H2O (1 mm H2O=0.009 8 kPa). The AUC value predicted by midline recovery rate was 0.98 and the cut-off value was 4.08 mm/d.
High intracavitary pressure of hematoma and rapid midline recovery rate are risk factors for decompressive hemorrhage after drilling and drainage in CSDH patients, which can predict decompressive hemorrhage.
To establish the TERT promotor pyrosequencing method and to validate the feasibility of its mutation detection in gliomas.
Plasmids containing wild-type and mutational TERT promotor DNA were synthesized. Samples with a mixture of different concentrations of mutational DNA (0%, 5%, 10%, 25%, 50% and 100%) were detected with pyrosequencing method for three times. The average was regarded as detected mutational rate. Pearson correlation analysis was used to measure the correlation between preset and detected mutational rates. DNA was extracted in 120 formaldehyde fixed paraffin embedded glioma samples, which were collected during April to June in 2020 at the Molecular Pathology Department, Beijing Neurosurgical Institute. Among those samples, 40 were sequenced with NGS, showed that 17 cases were wild type, 19 were C228T mutational type, and 4 were C250T mutational type. All 120 samples were amplified with PCR method and further sequenced with pyrosequencing method. Mutation of TERT promotor was detected. Mutational rate was detected in glioma samples of different pathological subtypes, i. e. mutational type/(wild type + mutational type). Kappa consistency test was used to compare the sequencing results between pyrosequencing and NGS in 40 samples.
During the process of plasmid sequencing, the position and height of base detection peak were clear. The signal value of each single base peak was over 30. There was a positive correlation between the detected mutational rate and the preset mutational rate(Y=0.843X+ 22.317, r2=0.80, P=0.010)in C228T and C250T detection. The results of pyrosequencing detection in FFPE glioma samples showed that 65 cases were wild type, 55 cases were mutational type, with C228T mutation in 43 cases and C250T mutation in 12 cases. Mutational rate in astrocytoma (IDH mutation) patients was 6.7% (2/30). Mutational rate in oligoden-droglioma (IDH mutation with 1p/19q deletion) was 91.3% (21/23). Mutational rate in glioblastoma (IDH wild type) was 47.8% (32/67). The value of consistency Kappa between pyrosequencing and NGS was 0.96 (39/40, P<0.001).
Pyrosequencing method could be used to detect the TERT promotor mutation in glioma samples. There is good consistency between pyrosequencing method and NGS.
To investigate the feasibility of establishing a side-to-side microvascular anastomosis training model by using the femoral artery and vein in rats.
Twenty male SD rats were used in the study. After left-sided femoral arteries and veins were carefully dissected, side-to-side microvascular anastomosis was performed between femoral artery and vein via continuous suturing technique. The diameter of femora artery and vein, the length of the arteriotomy or venotomy, the distance between the corner of the arteriotomy and the temporary clip and suturing time were documented. Patency of those anastomoses was evaluated immediately, 30 min and 7 days after the procedure.
Twenty side-to-side microvascular anastomoses between femoral artery and vein were successfully performed in 20 rats, and the operation success rate was 100%. The diameter of femoral artery and vein was 0.68±0.11 mm (0.50-0.80 mm) and 1.21±0.18 mm (1.00-1.50 mm) respectively. The length of the arteriotomy or venotomy was 2.32±0.22 mm (2.00-2.60 mm). The distance between the corner of the arteriotomy and the temporary clip was 1.00-2.50 mm. The total suturing time was 29.2±3.0 min (26-34 min). The patency rate of 100% was achieved immediately, 30 min and 7 days after the procedure.
Side-to-side microvascular anastomosis training model between rat femoral artery and vein is a feasible and effective side-to-side microvascular anastomosis training model.
Patients with simultaneous severe coronary and carotid stenosis are clinically difficult and at high risk. Two patients with bilateral proximal occlusive carotid stenosis combined with severe coronary stenosis were treated in the Department of Neurosurgery, General Hospital of Tianjin Medical University from May to July 2020. Patient 1 underwent left carotid stenting in the first stage and right carotid endarterectomy and coronary artery bypass grafting in the second stage. Case 2 patient underwent right carotid stenting in the first stage and left carotid endarterectomy and coronary artery bypass grafting in the second stage. Both patients had no complications after operation and were discharged safely. Carotid stenting in the first stage and contralateral carotid endarterectomy and coronary artery bypass grafting in the second stage may be a safe and feasible treatment for patients with bilateral proximal occlusive carotid stenosis combined with severe coronary artery stenosis.
Contrast agent encephalopathy (CIE) is a neurological complication caused by contrast agents and is relatively rare. From January 2017 to July 2021, 3 601 patients with intracranial aneurysms were treated endovascularly in the Department of Neurointervention of the First Affiliated Hospital of Zhengzhou University, and a total of 2 patients (0.6‰) developed CIE after operation. Diffusion weighted imaging (DWI) showed the characteristics of cortical "lace sign"; After symptomatic treatment such as anti-inflammatory, fluid rehydration and anti-epileptic, the prognosis of patients was good.
Idiopathic hypertrophic meningitis (IHP) is a kind of inflammatory reactive disease with unknown cause and characterized by localized or diffuse dura mater thickening. Symptoms such as headache, diplopia, and cranial nerve involvement are the main clinical manifestations, which need to be differentiated from infections (such as Lyme disease), autoimmune diseases (such as rheumatoid arthritis), tumors (such as meningiomas) and other diseases. In November 2021, a patient with IHP was admitted to the Department of Neurosurgery, Drum Tower Hospital affiliated to Nanjing University School of Medicine. Preoperative imaging showed that the lesion was nodular and occupied space, and the initial diagnosis was meningioma. After admission, the tumor was surgically removed in a limited time, and IHP was confirmed by pathological examination after operation. The patient was followed up for 3 months, and the symptoms of headache improved without signs of recurrence.
Ventral hemangioblastoma of the spinal cord is rare, and resection of ventral hemangioblastoma of the spinal cord by anterior cervical approach is rarely reported. This article retrospectively reports a patient with ventral hemangioblastoma of the cervical spinal cord treated by anterior cervical approach in October 2018 in the Department of Neurosurgery, Beijing Tsinghua Chang Gung Memorial Hospital affiliated to Tsinghua University. Intraoperative O-arm neuronavigation system scanning, neuroelectrophysiological monitoring and indocyanine green fluorescence imaging technique were used to perform C6Subtotal resection of the vertebral body + resection of intramedullary tumors of the spinal cord. Postoperative cervical MRI and CT revealed total resection of hemangioblastoma. After 34 months of follow-up, the patient had no tumor recurrence and the neurological function improved significantly.
Traumatic scalp arteriovenous fistula is a rare vascular malformation, which is rarely reported in literature at home and abroad. In April 2021, the Department of Neurosurgery of Guangzhou Women and Children Medical Center admitted a patient who presented with a local pulsatile mass after right frontotemporal vein puncture and showed progressive enlargement. After admission, the child was diagnosed with scalp arteriovenous fistula by digital subtraction angiography (DSA), with only one fistula. Intraoperative endovascular embolization was performed with Onyx glue. Reexamination of DSA showed that the fistula disappeared. After operation, the right frontotemporal varicose veins were significantly relieved, and there was no recurrence of arteriovenous fistula and no complications after 11 months follow-up.
Primary trigeminal neuralgia is an orofacial neuropathic, pathological pain confined to the area innervated by one or more branches of the trigeminal nerve. Foramen ovale is an important foramen in the middle cranial fossa, and the mandibular branch of the trigeminal nerve penetrates it into the cranium. The diagnosis and treatment of many diseases also requires foramen ovale puncture. Too narrow foramen ovale or anatomical variation may compress the trigeminal nerve, resulting in trigeminal neuralgia; It may also obstruct the access of the puncture needle, resulting in puncture failure. This article aims to make a literature review from the perspective of morphological and anatomical variation of foramen ovale and its role in the etiology and treatment of primary trigeminal neuralgia, in order to provide assistance in the surgical treatment of primary trigeminal neuralgia.
Cathepsin B is a special type of multifunctional cysteine protease. Studies have confirmed that it is significantly highly expressed in adult glioblastoma, and is closely involved in tumor proliferation, apoptosis resistance, migration, invasion, epithelial-mesenchymal transition, tumor stem cell formation and maintenance, tumor neovascularization, immune cell infiltration, immunosuppression, stress and therapy resistance, etc. It is considered as a novel molecular biomarker and potential therapeutic target for malignant pathological features and poor prognosis of adult glioblastoma. This article reviews the effect and mechanism of cathepsin B on adult glioblastoma.
Glioma is the most common primary intracranial malignant tumor, among which glioblastoma has poor prognosis and poor treatment effect. Cyclin-dependent kinases are a group of serine or threonine protein kinases that are mainly involved in the regulation of cell cycle and gene transcription. Cyclin-dependent kinase inhibitors can inhibit abnormal division and proliferation of tumor cells through various pathways, and they play an increasingly important role in cancer treatment. This article reviews cyclin-dependent kinase and its inhibitors in the treatment of glioblastoma, in order to provide reference for the clinical treatment of glioblastoma.
Pituitary granulosa cell tumor is an extremely rare solid tumor, accounting for less than 0.1% of primary intracranial tumors and 0.5% of sellar tumors. It has sex differences and is classified as Grade 1 tumor by the World Health Organization (WHO). Its clinical manifestations and imaging manifestations are not specific. Clinical diagnosis mainly depends on postoperative histopathological and immunohistochemical tests, and the main treatment method is surgical resection. This article mainly summarizes the progress of clinical diagnosis and treatment of pituitary granulosa cell tumor according to the current relevant literature, in order to provide reference for the diagnosis and treatment of this disease.
Intraspinal epidural arachnoid cyst (SEAC) is a rare intraspinal space-occupying lesion. It occurs in adolescence, with an average age of onset of 34.1 years, which is rare in children; More males than females; It is most commonly found on the dorsal side of the thoracolumbar junction. Dural notch is the cause of its formation, which is mostly located at the outlet of nerve roots of thoracic 12 and lumbar 1 vertebral bodies. Gradual expansion of SEAC can produce corresponding clinical symptoms. MRI is the test of choice for the diagnosis of SEAC. Surgical treatment is an effective therapeutic method. Early definite diagnosis and accurate preoperative dura notch localization are helpful to surgical treatment and prognosis.
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