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Objective To analyze the clinical manifestations,diagnosis and treatment of cerebral amyloid angiopathy (CAA) associated intracerebral hemorrhage.Methods The clinical manifestations,treatment and prognosis of CAA associated intracerebral hemorrhage were analyzed in 4 patients who were identified as CAA-related hemorrhage (CAAH) by pathology.Results All of the 4 patients showed massive lobar intracranial hemorrhage,and underwent craniotomy evacuation of hematoma.One patient had postoperative hemorrhage,and 2 patients were treated with recombinant activated factor Ⅶ after operation.In the next 6 months,re-hemorrhage was found in 3 patients in whom one patient died due to massive hemorrhage.Conclusions CAAH has varied clinical manifestations with high risk of cerebral hemorrhage,and pathological diagnosis is necessary for a definite diagnosis.The very elderly patients with CAAH can benefit from the craniotomy evacuation of hematoma.Although surgery for massive hemorrhage has risks in very elderly patients,it is a better treatment to save their lives.
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Objective To compare the treatment effect between Duply combined with Duckett and Koyanagi surgical methods in severe hypospadias.Methods Forty-two cases of severe hypospadias were divided into two groups according to the surgical method,23 cases was enrolled in Duply combined with Duckett group while 19 cases in Koyanagi group.The operation time,the incidence rate of urinary fistula,urethral stricture,urethral diverticulum and penis torsion were compared.Results The operation time between two groups had no significant difference (P ＞ 0.05).The incidence rate of urinary fistula,urethral stricture,urethral diverticulum and penis torsion between two groups had no significant difference (x2 =0.04,0.31,0.03,1.16,P ＞ 0.05).The total incidence rate of complications between Duply combined with Duckett group and Koyanagi group had significant difference [69.6％ (16/23) vs.6/19] (x2 =4.59,P ＜ 0.05).Conclusion Each of the two methods can be a choice in treatment of severe hypospadias.
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Objective To investigate the efficacy and safety of microsurgery for trigeminal neuralgia (TN) in elderly patients.Methods Totally 143 patients with intractable primary TN who received microsurgery were retrospectively analyzed.There were 92 cases in the elderly group with age of 65-82 years,and the other 51 cases in control group with age of 40-62 years.All the patients in both groups were classified as American Society of Anesthesiologists (ASA) Scale Grade 1 to 3.After suboccipital retrosigmoid craniotomy,microvascular decompression (MVD) was performed in 136patients and partial sensory trigeminal rhizotomy in 7 patients.The complications and efficacy were compared between the two groups.Results 87 cases in the elderly group and 49 cases in control group underwent MVD procedure,complete and part pain relief were achieved in 78 cases and 9 cases in the elderly group,45 cases and 4 cases in control group,respectively.After an average follow-up period of 2.6 and 2.1 years,4 cases (5.1％) among 79 follow-up cases and 3 cases (6.5％) among 46follow-up cases experienced TN recurrences in the elderly and control groups,respectively.No statistically significant differences existed in the efficacy and recurrence rate between the two groups (P＞0.05).There were 3 cases with aseptic meningitis,1 cases with hearing decrease,1 case with cerebrospinal fluid leakage,1 case with pulmonary infection and 1 cases with deliration in the elderlygroup,meanwhile,1 cases with aseptic meningitis,1 case with tinnitus and 1 case with cerebrospinal fluid leakage after surgery in control group (P＞0.05).No facial hypoesthesia appeared in the patients receiving MVD.5 cases in the elderly and 2 cases in control group underwent partial trigeminal rhizotomy with facial hypoesthesia,but the pain released,and no recurrence was found.There were no dead cases in both groups.Conclusions With cautious and proper treatment,microsurgical procedure can be performed safely and effectively in the elderly TN.
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Objective To explore the diagnosis, treatment strategies and clinical outcomes of spontaneous subarachnoid hemorrhage in elderly patients. Methods A total of 68 patients aged over 60 years presenting with spontaneous subarachnoid hemorrhage underwent cerebral angiography. And 72 intracranial aneurysms were detected in 60 patients, among whom 47 patients with 59 aneurysms underwent endovascular coil embolization, 6 aneurysms in 6 patients were clipped in microneurosurgery operation, and 7 patients chose conservative treatment. Results A total of 57 aneurysms (96.6%) were embolized successfully, among which 40 aneurysms (70.2%) reached dense occlusion and 17 aneurysms (29.8%) reached incomplete occlusion. Among 47 patients undergoing endovascular treatment, 39 patients (83.0%) were evaluated as good, 7 patients (14.9%) were moderately to seriously disabled according to Glasgow Outcome Scale when they were discharged, and one patient died. Conclusions Active treatment such as endovascular coil embolization can acquire good outcome in elderly patients with spontaneous subarachnoid hemorrhage, especially in elderly patients detected with aneurysms.
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<p><b>OBJECTIVE</b>To assess the results of 26 patients with tethered cord syndrome (TCS) after microsurgical operation.</p><p><b>METHODS</b>Twenty-six patients with TCS were treated microsurgically and their clinical data were analyzed retrospectively.</p><p><b>RESULTS</b>72% of the patients with TCS showed significant improvement. Surgical outcome was excellent in relieving pain and sensorimotor deficits, but bladder dysfunction.</p><p><b>CONCLUSION</b>Early diagnosis and adequate surgical release are the keys to a successful outcome.</p>
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Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Microsurgery , Neural Tube Defects , General Surgery , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To evaluate the clinical effect of neuromatosis scoliosis treated by vascularized grafted rib Method The clinical date of 16 cases of neuromatosis scoliosis treated by surgical operation were analysed retrospectively Result Sixteen patients with scolisis caused by neurofibromatosis were treated by this technique The clinical result was satisfactory and solid fusion was observed in all patients within 6 months after operation Conclusion This operation is an effective method for the treatment of neuromatosis scoliosis