ABSTRACT
Objective To preliminarily discuss the safety and efficacy of microvascular decompression for patients with trigeminal neuralgia caused by vertebrobasilar dolichoectasia (VBD).Methods From January 2013 to August 2016,16 patients with trigeminal neuralgia caused by vertebrobasilar dolichoectasia admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively.All patients received preoperative magnetic resonance angiography examination.The anatomical relationship between the trigeminal nerves and the peripheral vessels was identified.Microvascular decompression was conducted via suboccipital retrosigmoid approach.They were followed up for 12-52 months after procedure.The trigeminal neuralgia score standard of Barrow Neurological Institute was used to evaluate the degree of pain of the patients before procedure,after procedure,and during the follow-up period.Results Of the 16 patients,the pain disappeared immediately in 15 after procedure,and the pain was not obviously relieved in 1 case after procedure,and the pain disappeared gradually at 6 months after procedure.One patient had hearing loss after operation compared with pre-operation.The follow-up time ranged from 12 months to 52 months.Three patients had recurrent pain at 6,12,and 36 months,respectively after procedure.Conclusion Microvascular decompression treatment of trigeminal neuralgia caused by VBD has better safety and surgical efficacy,but there was a certain pain recurrence rate,which needed further research.
ABSTRACT
Objective To investigate the treatment measures of having trigeminocardiac reflex (TCR) for the primary trigeminal neuralgia via microvascular decompression.Methods From January 2016 to December 2016,the clinical data and anesthesia records of 79 consecutive patients with primary trigeminal neuralgia admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University and treated the first craniotomy microvascular decompression were analyzed retrospectively.They were divided into a no TCR group (n=63) and a TCR group (n=16) according to the intraoperative anesthesia monitoring.The differences of baseline conditions,preoperative complications and pain involved the trigeminal nerve branches were compared between the two groups.The treatment measures and short-term prognosis of the patients with TCR during operation were summarized.Results (1) The proportion of hypertension in the TCR group was 31.2％ (n=5),it was higher than 7.9％ in the no TCR group (n=5).There was significant difference (χ2=6.273,P<0.05).(2) During the operation of microvascular decompression,16 patients in the TCR group had 19-time TCR.The baseline heart rate was 74±10/min before operation,and the heart rate decreased to 51±6/min at onset of TCR.The mean baseline arterial blood pressure was 102±13 mmHg,and the mean arterial blood pressure decreased to 74±8 mmHg at the onset of TCR.There was significant difference (P<0.05).(3) After the onset of TCR,the operation of was stopped,heart rate and the blood pressure recovered spontaneously (n=4).Fifteen patients were treated with medications,including using atropine (12 times,dose 0.2-0.5 mg) and ephedrine hydrochloride (3 times,dose 5-10 mg).Heart rate and blood pressure returned to the baseline level within 20 seconds or 20 seconds after administration of medications.There was no TCR-related cardiac complication or neurological deficit from after procedure to before discharge.Conclusions In microvascular decompression of primary trigeminal neuralgia,if TCR occurs,the selective use of anticholinergic agents or vasoactive agents is needed as early as possible.The risk factors for the occurrence of TCR need to be further verified.
ABSTRACT
Objective To investigate the key technical points of microvascular decompression (MVD)for the treatment of primary glossopharyngeal neuralgia (GPN)and its efficacy. Methods From July 2011 to October 2016,18 consecutive patients with primary GPN treated with MVD at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. All patients received magnetic resonance angiography (MRA)examination before procedure. The anatomical relationship between glossopharyngeal nerve / vagus nerve and peripheral blood vessels were identified. Seventeen of them were treated via suboccipital retrosigmoid approach,one were treated via far lateral approach. None of the patients were treated with nerve root rhizotomy. Results Eighteen patients had paroxysmal severe pain in tongue,pharynx,tonsil or deep ear canal and other parts before procedure. Preoperative MRA indicated and confirmed in the surgery that the offending vessels were the trunks or their branches of the posterior inferior cerebellar artery in this group of patients. During the operation,the offending vessels were removed from the out brainstem areas of the glossopharyngeal nerves and vagus nerves under the direct vision in order to ensure that the blood vessels and nerves no longer contacted with each other. There were no complications, such as disability and death,cerebrospinal fluid leakage,and intracranial infection. All the patients were followed up after procedure;the mean follow-up period was 1-62 months. The symptom of pain disappeared completely in 17 of them. The Numberical Rating Scale (NRS)score for pain were 0. The pain in one patient was not relieved. The NRS score was 8 at discharge;it was the same as before procedure. Three patients had mild hoarseness,throat discomfort after procedure. They were relieved gradually in the follow-up period. Conclusion MVD is a safe and effective method for the treatment of GPN. Posterior inferior cerebellar artery is the most common offending artery. Preoperative imaging examination and clear decompression during the procedure are very important. The cutting off of glossopharyngeal nerves and vagus nerves needs to be handled with care.
ABSTRACT
Objective To observe the prognostic effects of the patients with intracranial saccular aneurysm (Hunt-Hess grade Ⅳ- Ⅴ)first treated conservatively for 12 hours and then with surgical treatment and endovascular treatment. Methods The clinical data of 32 patients with intracranial saccular aneurysm (grade Ⅳ,n = 24 and gradeⅤ,n = 8)Hunt-Hess grade Ⅳ-Ⅴadmitted from January 2012 to January 2014 were analyzed retrospectively. Sixteen of them were treated conservatively for 12 hours in hospital,and then they were treated with surgery or embolization (postpone surgery group)and 16 underwent emergency surgery or embolization (immediate surgery group). The neurological prognosis of the patients was evaluated at 1,3 and 6 months before and after treatment. Results There was no significant difference in Glasgow outcome scores between the postpone surgery group and immediate surgery group at 1 month after treatment (3. 7 ± 1. 4,3. 8 ± 1. 2;t = 1. 372,P > 0. 05);there was no significant difference in Rankin prognostic scores at 3 months after treatment (3. 7 ± 1. 7,3. 6 ± 1. 5;t = 1. 361,P > 0. 05);But there was significant difference in prognostic scores at 6 months after treatment between the two groups (3. 5 ± 1. 5, 4. 2 ± 1. 8;t = 2. 234,P < 0. 05). Conclusion Patients with high grade cystic aneurysmal subarachnoid hemorrhage can be treated with conservative treatment. After 12 hours,endovascular embolization or surgical treatment may be performed. The prognosis at 6 months is better than emergent direct surgery or embolization.
ABSTRACT
Objective To search for the mechanism of NO and TNOS/iNOS in cerebral vascular stenosis,the changes of these serum factors in different kinds of cerebral vascular stenosis were studied. Methods Biochemistry assays were adopted,to analyze serum NO and TNOS/iNOS in different vascular stenosis group. Results Serum NO contents of ' Mix' (P=0.000) or ' MCA' (P=0.001) significantly increased. INOS activity of ' In' (P=0.004) and ' MCA' (P=0.002) markedly increased. And TNOS activity of ' In' group significantly weakened (P=0.032),but the TNOS activity of ' Mix' (P=0.011) and ' MCA' (P=0.018) group markedly intensified. Conclusion NO and TNOS/ iNOS partly participate in the occurrence mechanism of cerebral vascular stenosis. And the study provided theory basis for studying multiple factors of cerebral vascular stenosis.
ABSTRACT
Objective To assess the diagnosis safety by detecting the biological character of prenatal fetus rats’nervous tissue exposed to diagnostic ultrasound during earlier period. Methods Cell culture, morphology examining, cell proliferation curve measurement and flow cytometry detection were adopted. Results ①After morphology examining, there are no difference between the treated group and control group. ② We can see from the growth curve, the two groups has identical growth tendency. ③Through flow cytometry detection, results show that there are no significance between two groups. Conclusion Diagnostic ultrasound in early pregnancy have no significant effect on prenatal fetus rats’nervous tissue.