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Objective To analyze the clinical and imaging features, surgical strategy and prognosis in patients with brainstem gangliogliomas (GG). Methods The clinical data of 46 patients with brainstem GG from February 2010 to August 2017 were retrospectively analyzed. The clinical and imaging features, surgical methods and prognosis were reviewed. Results The age of 46 brainstem GG patients was (22.5 ± 4.6) years, the duration was (38.1 ± 8.9) months, and the most common symptoms were dizziness and headache, accounting for 47.8％(22/46). The MRI results showed that endogeny type was in 5 cases, exogenesis type in 10 cases, and endogeny-exogenesis type in 31 cases. The exogenesis type was enrolled as non-infiltrate brainstem group (10 cases), and the endogeny type and endogeny-exogenesis type were enrolled as infiltrate brainstem group (36 cases). The axial T1WI showed that the crescent sign was in 20 cases (43.5％, 20/46), and the sagittal T1WI showed that the patching sign was in 31 cases (67.4％, 31/46). Among all patients, total resection was achieved in 13 cases, near total resection in 9 cases, subtotal resection in 16 cases, partial resection in 7 cases and biopsy in 1 case. No operative death occurred. The patients were followed up for 3 to 87 (40.6 ± 12.8) months, and 5 patients died (all in infiltrate brainstem group). The progression- free survival in non- infiltrate brainstem group was significantly longer than that in infiltrate brainstem group:(46.0 ± 13.1) months vs. (19.5 ± 8.9) months, and there was statistical difference (P<0.05). Conclusions Most brainstem GG has some unique MRI characteristics. Microsurgical resection might be preferred. Tumors that locate outside the brainstem can be fully removed. The long-term prognosis of brainstem GG is better.
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Objective To compare the therapeutic effect between routine shunting and selective shunting in patients with moderate and severe carotid artery stenosis undergoing carotid endarterectomy (CEA). Methods One hundred and ninety-two patients with moderate and severe carotid artery stenosis undergoing CEA were selected, and the patients were divided into control group (routine shunting) and observation group (selective shunting) according to the random digits table method with 96 cases each. The intraoperative carotid artery occlusion time and incidences of stroke event 30 d after operation were recorded. Results In the observation group, the rate of carotid artery shunting was 35.4％ (34/96), among which the rate of carotid artery shunting in patients with contralateral severe carotid artery stenosis or occlusion was 8/13, the rate of carotid artery shunting in patients with unilateral carotid stenosis was 31.3％ (26/83), and there was statistical difference (χ2 = 13.006, P0.05). In the observation group, the intraoperative carotid artery occlusion time in patients with carotid artery shunting was significantly shorter than that in patients without carotid artery shunting:(4.36 ± 0.48) min vs. (10.15 ± 0.91) min, and there was statistical difference (t=7.884, P0.05). Conclusions The selective shunting during CEA can reduce the incidence of postoperative stroke event in patients with carotid artery stenosis, and especially it can give a good clinical effect in the patients with contralateral severe carotid artery stenosis or occlusion.
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Objective To investigate the correlation between clinical features and prognosis of patients with neurofibromatosis type 2(NF2)after operation.Methods The clinical features and prognosis of sixty patients with neurofibromatosis type 2(NF2)from 2000 to 2013 in Xi′an No.1 Hospital were analyzed.Cox proportional hazards regression model was used for variable analysis.Results The patients were followed up for 1-188 months,53 patients survived(88.3%,53/60),and 7 patients died(11.7%,7/60).Single factor analysis showed that the first symptom age,age of diagnosis,intracranial meningioma and spinal cord tumor were related to the prognosis of the patients(P<0.05).However,gender,genetic factors,skin lesions,eye diseases, postoperative hearing improvement and relief of dizziness after surgery were not correlated with the prognosis of patients(P>0.05).Spinal cord tumors or intracranial meningiomas were the independent risk factors for the prognosis of NF2 patients(P=0.042,0.037,95%CI=0.021-2.069,0.587-2.543,RR=2.475,3.663).The first symptoms age,age of diagnosis,ocular lesions were the risk factors for the occurrence of spinal cord tumors and intracranial meningiomas(P<0.05).Conclusion NF2 has many clinical symptoms,accompanied by spinal cord tumor and intracranial meningioma,which are the important prognostic factors in patients with poor prognosis.
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Objective To investigate the correlation between clinical features and prognosis of patients with neurofibromatosis type 2(NF2)after operation.Methods The clinical features and prognosis of sixty patients with neurofibromatosis type 2(NF2)from 2000 to 2013 in Xi′an No.1 Hospital were analyzed.Cox proportional hazards regression model was used for variable analysis.Results The patients were followed up for 1-188 months,53 patients survived(88.3%,53/60),and 7 patients died(11.7%,7/60).Single factor analysis showed that the first symptom age,age of diagnosis,intracranial meningioma and spinal cord tumor were related to the prognosis of the patients(P<0.05).However,gender,genetic factors,skin lesions,eye diseases, postoperative hearing improvement and relief of dizziness after surgery were not correlated with the prognosis of patients(P>0.05).Spinal cord tumors or intracranial meningiomas were the independent risk factors for the prognosis of NF2 patients(P=0.042,0.037,95%CI=0.021-2.069,0.587-2.543,RR=2.475,3.663).The first symptoms age,age of diagnosis,ocular lesions were the risk factors for the occurrence of spinal cord tumors and intracranial meningiomas(P<0.05).Conclusion NF2 has many clinical symptoms,accompanied by spinal cord tumor and intracranial meningioma,which are the important prognostic factors in patients with poor prognosis.
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Objective To investigate the dynamic changes of endothelial progenitor cells (EPCs) in peripheral blood of patients with hypertensive cerebral hemorrhage.Methods Flow cytometry was used to detect the dynamic changes of EPCs in 79 cases of hypertensive cerebral hemorrhages as the experimental group and 70 cases of normal healthy people as the control group.Results In the acute phase after hemorrhage (3 days),EPCs in experimental group [(51.3 ±9.3) × 103/ml,(52.0 ±6.3) × 103/ml,(53.1 ±9.3) × 103/ml] were significantly lower than the control group [(75.4 ± 15.6) × 103/ml] (P ＜0.05).However,after that the level of EPCs in experimental group [(110.9 ± 12.0) × 103/ml,(132.8 ± 11.8)× 103/ml,(115.3 ±9.9) × 103/ml] increased rapidly and was significantly higher than the control group (P ＜0.05),and approximately two weeks later it reduced to normal levels [(83.1 ±7.9) × 103/ml].Conclusions In patients with hypertensive cerebral hemorrhage,the levels of EPCs in peripheral blood were closely related with the disease and might become a prognostic marker.