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Acute ischemic stroke caused by posterior circulation occlusion is extremely dangerous, with a mortality rate of more than 90%.In recent years, mechanical thrombectomy had become an important method in the treatment of acute anterior circulation ischemic stroke, but whether it is effective and safe in the treatment of posterior circulation acute ischemic stroke is not clear.In this paper, the safety and effectiveness of intravascular treatment of acute ischemic stroke with posterior circulation occlusion were reviewed.
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Objective:Acute ischemic stroke (AIS) has a high incidence rate, high disability rate, high mortality and high medical expenses, which seriously affect the healthy living standard of our residents.Intravenous thrombolysis and mechanical thrombectomy within the time window are important methods for the treatment of AIS.The time window of mechanical embolectomy was extended from the initial 6 hours to 24 hours.The expansion of the time window enabled more patients to accept mechanical thrombectomy.However, some patients with more than 24 h time window have also achieved good results after strict multimodal evaluation.Therefore, there are some limitations in using time window to evaluate the indications of mechanical thrombectomy.In recent years, the way that time window combining with tissue window to evaluate the appropriate population of mechanical thrombectomy has become more and more popular.
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Objective To investigate the application of temporal and frontotemporal puncture or frontotemporal craniotomy for hypertensive intracerebral hemorrhage in basal ganglia region .Methods From January 2013 to April 2017,eighty patients with basal ganglia region hypertensive intracerebral hemorrhage in Shanxi Da Hospital were divided into observation group and control group according to random number table method ,with 40 cases in each group.The two groups were respectively given puncture of temporal and frontal temporal region and craniotomy with frontal and temporal bone flap for evacuation of hematoma and decompression of bone flap .The complications and treatment effect after surgery of the two groups were compared.Results Compared with the control group , the emptying rate of postoperative hematoma 1 day in the observation group was decreased [(60.1 ±9.7)%vs.(81.0 ± 9.9)%,t＝-9.537,P＜0.05];the operation time was shortened [(68.5 ±7.7) min vs.(110.2 ±9.1) min,t＝-22.124,P＜0.05];the use of postoperative mannitol decreased [(672.1 ±84.2) g vs.(1427.2 ±99.6) g,t＝-36.617,P＜0.05];the incidence rate of intracranial pneumatosis in the observation group was increased (7.5%vs. 30.0%,χ2＝6.646,P＜0.05).Conclusion Monitoring of intracranial pressure in lateral ventricles combined with puncture of temporal and frontal temporal region used in hypertensive intracerebral hemorrhage in basal ganglia region is helpful to reduce the surgical trauma and accelerate the recovery of postoperative patients ,and can be widely used.
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Objective To investigate the value of cerebrospinal fluid drainage after aneurysm clipping in patients with intracranial aneurysm complicated with subarachnoid hemorrhage .Methods 84 intracranial aneurysms patients with subarachnoid hemorrhage were selected ,and they were randomly divided into study group (n =42) and control group (n =42).The control group used simple suture after aneurysm clipping ,the study group was given lumbar cistern drainage by implementation of the dural suture tube after aneurysm clipping .Before and after hydro-cephalus and cerebral vasospasm ,treatment changes of serum insulin-like growth factor 1 (IGF-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) levels were compared between the two groups .Results The incidence rate of hydrocephalus of the study gruop was 4.8%,which was significantly lower than the 14.3% of the control group (χ2 =9.743,P <0.05).The incidence rate of cerebral vasospasm of the study group was 7.1%,which was significantly lower than 19.0% of the control group (χ2 =11.802,P <0.05).The incidence rates of intracranial infection,cerebrospinal fluid leakage and other complications between the two groups had no statistically significant differences (χ2 =2.074,2.125,all P >0.05).The serum levels of IGF-1 and sVCAM-1 between the two groups had no statistically significant differences before operation (t =0.417,0.603,all P >0.05).At the 8th day after oper-ation,the serum levels of sVCAM-1 and IGF-1 of the study group were significantly lower than those of the control group (t =7.335,6.856,all P <0.05).Conclusion After aneurysm clipping,the lumbar cistern drainage tube drainage is beneficial to reduce hydrocephalus and cerebral vasospasm incidence ,inhibit the expression of serum IGF-1,sVCAM-1,with less adverse reactions,it is worthy of application.
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Objective To explore the cerebral protective effect of edaravone combined with mild hypothermia in patients with severe craniocerebral injury. Methods 64 patients with severe craniocerebral injury were divided into control groups ( n =21 ) , mild hypothermia groups ( n =22 ) and combination groups ( n =21 ) according to the random number table method. All patients were treated with symptomatic supportive therapy and surgical decompression,and the patients in the mild hypothermia group accepted physical cooling and drugs to maintain a low body temperature, and the patients in the combination group accepted edaravone 30mg on the basis of the mild hypothermia group,1 time every 12 hours,and the course of treatment was lasted for two weeks. The Glasgow coma score(GCS),the degree of brain edema and the Glasgow prognostic score( GOS) were observed in the three groups. Results The GCS scores of the mild hypothermia group and combination group at 7d after admission were (9. 54 ± 1. 26) points and (10. 15 ± 1. 56)points,respectively,which were higher than (7. 58 ± 1. 12) points of the control group,the differences were statistically significant(t=7. 867,12. 232,all P<0. 05),and the GCS score of the combination group was higher than that of the mild hypothermia group(t =7. 986,P <0. 05). The GCS scores of the mild hypothermia group and combination group were (12. 21 ± 1. 47)points and (12. 35 ± 1. 12)points at 14d after admission,which were higher than (10.28 ±2.28)points of the control group,the differences were statistically significant(t=8. 823,9. 066,all P<0. 05). The proportions of mild edema patients in the mild hypothermia group and combination group were 69. 09%,71. 43%,respectively,which were higher than 19. 05% of the control group,the differences were statistically significant(χ2 =9. 019,7. 563,all P<0. 05). The GOS scores of the mild hypothermia group and combination group at discharge were (4. 15 ± 0. 51) points and (4. 51 ± 0. 37) points,respectively,which were higher than (3. 69 ± 0. 61)points of the control group,the differences were statistically significant(t=5. 328,6. 228,all P<0. 05),and the GOS score of the combination group was higher than that of the mild hypothermia group(t=4. 251,P<0. 05). Conclusion The curative effect of edaravone combined with mild hypothermia in the treatment of patients with severe craniocerebral injury is significantly better than conventional therapy and mild hypothermia treatment, and it is conducive to promote the recovery of the nerve function.
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Objective To explore the cerebral protective effect of edaravone combined with mild hypothermia in patients with severe craniocerebral injury. Methods 64 patients with severe craniocerebral injury were divided into control groups ( n =21 ) , mild hypothermia groups ( n =22 ) and combination groups ( n =21 ) according to the random number table method. All patients were treated with symptomatic supportive therapy and surgical decompression,and the patients in the mild hypothermia group accepted physical cooling and drugs to maintain a low body temperature, and the patients in the combination group accepted edaravone 30mg on the basis of the mild hypothermia group,1 time every 12 hours,and the course of treatment was lasted for two weeks. The Glasgow coma score(GCS),the degree of brain edema and the Glasgow prognostic score( GOS) were observed in the three groups. Results The GCS scores of the mild hypothermia group and combination group at 7d after admission were (9. 54 ± 1. 26) points and (10. 15 ± 1. 56)points,respectively,which were higher than (7. 58 ± 1. 12) points of the control group,the differences were statistically significant(t=7. 867,12. 232,all P<0. 05),and the GCS score of the combination group was higher than that of the mild hypothermia group(t =7. 986,P <0. 05). The GCS scores of the mild hypothermia group and combination group were (12. 21 ± 1. 47)points and (12. 35 ± 1. 12)points at 14d after admission,which were higher than (10.28 ±2.28)points of the control group,the differences were statistically significant(t=8. 823,9. 066,all P<0. 05). The proportions of mild edema patients in the mild hypothermia group and combination group were 69. 09%,71. 43%,respectively,which were higher than 19. 05% of the control group,the differences were statistically significant(χ2 =9. 019,7. 563,all P<0. 05). The GOS scores of the mild hypothermia group and combination group at discharge were (4. 15 ± 0. 51) points and (4. 51 ± 0. 37) points,respectively,which were higher than (3. 69 ± 0. 61)points of the control group,the differences were statistically significant(t=5. 328,6. 228,all P<0. 05),and the GOS score of the combination group was higher than that of the mild hypothermia group(t=4. 251,P<0. 05). Conclusion The curative effect of edaravone combined with mild hypothermia in the treatment of patients with severe craniocerebral injury is significantly better than conventional therapy and mild hypothermia treatment, and it is conducive to promote the recovery of the nerve function.
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Objective To investigate the relationship between expression of mucin1 (MUC1) and tumor invasion in pituitary adenomas.Methods The expression of MUC1 was detected by immunohistochemical analysis in 26 tissues of invasive pituitary adenoma and 29 of non-invasive pituitary adenoma.Results The expression of MUC1 in invasive pituitary adenomas tissues was 76.92 ％ (20/26).It was weakly positive or negative in non-invasive pituitary adenoma tissues,and the positive rate was 27.57 ％ (8/29).There was significant difference in two groups (x2 =13.35,P ＜ 0.01).The expression of MUC1 in functional pituitary adenomas was 44.82 ％ (13/35) and was 75.00 ％ (15/20) in non-functional pituitary adenomas.There were no significant difference in two groups (x2 =6.13,P ＞ 0.01).Conclusions Over-expression and aberrant localization of MUC1 in invasive pituitary adenoma may act as distinguishing diagnostic markers of invasive pituitary adenoma.MUC1 might be as the target of immunotherapy of invasive pituitary adenoma.