ABSTRACT
Objective To investigate the safety and efficacy of LVIS stent combined with coil embolization of ruptured wide-necked intracranial aneurysms during the acute phase.Methods From May 2014 to August 2017,the clinical and imaging data of 56 patients with ruptured wide-necked intracranial aneurysm treated with LVIS stents for acute phase assisted embolization at the Department of Neurosurgery,the Affiliated Hospital of Southwest Medical University were analyzed retrospectively.All patients were treated with LVIS stent combined with coil embolization.Immediate postoperative angiography,six months after procedure,and follow-up imaging were evaluated by Raymond grade (RS grade).The clinical follow-up results were evaluated by the modified Rankin Scale (mRS) score.Results LVIS stent combined with coil embolization was performed in 56 patients with 60 aneurysms in this group.The success rate of stent release was 100％.Immediate angiography after procedure showed that the complete embolization rate of aneurysms was 80.0％ (48/60),the near complete embolization rate was 13.3 ％ (8/60),and the incomplete embolization rate was 6.7％ (4/60).Postoperative follow-up angiography at 6 monthrevealed that the complete embolization rate of aneurysms was 87.8％ (36/41),nearly complete embolization rate was 7.3％ (3/41),incomplete embolization rate was 4.9％ (2/41).Postoperative follow-up angiography at 12 months revealed that the complete embolization rate of aneurysms was 83.0％ (39/47),and near complete embolization rate was 12.8％ (6/47),and incomplete embolization rate was 4.3％ (2/47).Of the 56 patients,49 were followed up clinically and 7 were lost to follow up.The average follow-up time was 13 ± 4 months.The clinical follow-up showed that the good prognosis (mRS score 0-2) rate was 87.8％ (43/49).Intraoperative complications occurred in 7 cases,5 were intraoperative parent artery thrombosis and 2 were intraoperative aneurysm rupture.Conclusions LVIS stent combined with coil embolization of ruptured wide-necked intracranial aneurysms during the acute phase has good efficacy and safety.Its long-term efficacy remains to be confirmed by long-term follow-up.
ABSTRACT
Objective To explore the risk factors of recurrence of chronic subdural hematoma (CSDH) after drilling and drainage,and to explore the cumulative risk of various risk factors in recurrence.Methods A retrospective analysis of 257 patients with CSDH,admitted to and accepted complete drainage in our hospital from January 2010 to December 2015,was performed;234 patients were without recurrence and 23 patients with recurrence.The risk factors of relapse,including age,hypertension,diabetes,hematoma characteristics,preoperative hematoma thickness,preoperative median deviation,hematoma thickness at discharge,midline deviation at discharge and hematoma density,were analyzed.Logistic regression analysis was performed to conform the independent risk factors and cumulative risk of multiple possible risk factors.Results Univariate analysis showed that age,hypertension,diabetes mellitus,preoperative hematoma thickness,preoperative median deviation,hematoma thickness at discharge,midline deviation at discharge and hematoma density were significantly different between the patients without recurrence and patients with recurrence (P＜0.05).Age,diabetes mellitus,preoperative hematoma thickness,and midline shift at discharge were independent risk factors for postoperative drilling recurrence.The cumulative effect of risk factors was that patients with two independent risk factors had a relapse risk of one 4.22-9.50-fold in patients with or without recurrence-independent risk factors,with a risk of recurrence of up to 38.0-fold in patients with three or four independent risk factors.Conclusions The risk factors of recurrence of chronic subdural hematoma after bile duct drainage are age,diabetes mellitus,preoperative hematoma thickness ≥20 mm and midline deviation ≥ 5 mm at discharge.When more independent risk factors are combined,fold increase of cumulative risk of recurrence is noted.
ABSTRACT
Objective To investigate the clinical features, treatments and prognoses of pediatric intracranial aneurysms. Methods The clinical and follow-up data of 16 consecutive patients with pediatric intracranial aneurysms (≤16 years), admitted to our hospital from January 2003 to December 2014, were analyzed retrospectively. Results Pediatric intracranial aneurysms in this study accounted for 0.78%of all intracranial aneurysms. Of the 16 children, 14 were male, 2 were female. There were 12 anterior circulation aneurysms and 5 posterior circulation aneurysms; there were 4 large aneurysms (diameter 11-25 mm) and 2 giant aneurysms (diameter≥25 mm);there were 14 complex aneurysms. At a mean follow-up duration of 16.8 months, no death was noted. Of the 12 patients received microsurgical therapy, 10 patients had favorable outcomes (modified Rankin scale [mRS] 0-1) and 2 patients had some sequelae: different degrees of disability (mRS 2-4). Of the 4 patients received endovascular therapy, 3 patients had favorable outcomes (mRS 0-1) and one patient had hemiparesis (mRS 2). Conclusions Pediatric intracranial aneurysms are different from adult intracranial aneurysms. The treatment effects and prognosis are relatively well when we select individualized treatment mode according to the clinical features of pediatric intracranial aneurysms.