ABSTRACT
Objective To explore the monitoring of cerebrospinal fluid (CSF) dynamics in a model of brain herniation induced by acute intracranial hypertension in Guangxi Bama-Mini pigs by phasecontrast cine magnetic resonance imaging (PC cine MRI).Methods Femoral artery blood were extracted from 10 pigs,and injected into the frontal and temporal parietal lobe to make a model of brain herniation induced by acute intracranial hypertension.The mean arterial blood pressure (MAP),intracranial pressure (ICP),and cerebral perfusion pressure (CPP) were monitored.Routine T1WI,T2WI,coronal,sagittal and cerebrospinal fluid flow sequence (fast PC cine slice) which positioned on the cervical 3 (C3) vertebral body as the center and perpendicular to the spinal scans were performed on all experimental animals before and after blood injection with 3.0T Magnetic Resonance Imaging.The ICP,MAP,CPP,the absolute values of CSF peak flow velocity and the absolute value of carotid peak flow velocity before and after blood injection were compared.Results The ICP,MAP,CPP,and the absolute value of CSF peak flow velocity before injection of autologous arterial blood were statistically significant as compared with those after blood injection [(6.80±2.044) mmHg vs (52.20±1.619) mmHg,(76.80±7.068) mmHg vs (142.80±12.399) mmHg,(70.00±6.074) mmHg vs (90.50±12.250) mmHg,and the absolute value of CSF peak flow velocity was (243.20±77.671) mm/s vs (201.40±55.482) mm/s,respectively,P＜0.01].The absolute value of the peak velocity of the carotid artery before blood injection was not statistically significant compared with that after blood injection [(876.80±239.908) mm/s vs (799.40±241.829) mm/s,P＞0.05].Conclusion After the formation of brain herniation induced by acute intracranial hypertension,the CSF flow in the C3 level spinal canal showed a low dynamic change,and the CSF flow velocity waveform was disordered and malformed.The non-invasive measurement of CSF dynamics by PC cine MRI can provide an important basis for the change of CSF dynamics in the model of brain herniation induced by acute intracranial hypertension,and provide a theoretical basis for further research on damage control neurosurgery in the future.
ABSTRACT
Objective To study the efficacy of two different modes of surgical intervention for the treatment of hypertensive intracerebral hemorrhage (HICH):YL-1 type hematoma removed by needle aspiration plus bio-enzyme liquefaction versus conventional craniectomy plus hematoma evacuation.Methods Medical records of 23 patients with HICH treated from December 2012 to February 2017 were retrospectively analyzed.The differences in demographics,length of operation time,costs and length of hospital stay,Glasgow Outcome Scale scores and 3-month follow-up results were compared between the YL-1 type hematoma removed by needle aspiration plus bio-enzyme liquefaction in 12 patients and conventional craniectomy plus hematoma evacuation in 11 patients.Results There were no significant differences in the gender (male 58.33％ vs.63.64％,femal 41.67％ vs.36.36％),age (65.5±11.8 years vs.56.8±10.1 years),preoperative GCS (6.83±3.93 vs.5.82±3.40),intracranial hematoma volume (50.52±23.07 mL vs.68.77±11.18 mL) and length of hospital stay (15.58±14.72 days vs.22.45±18.37 days) (P＞0.05);There were statistically significant differences in length of operation time (0.73±0.21 h vs.3.92±0.67 h) and hospitalization costs (45 230.50±36 566.88 yuan of RMB vs.79 857.90±34 916.48 yuan of RMB) between two groups (P＜0.05);Follow-up 3 months,there were no significant differences in rate of good recovery 33.3％ vs.18.1％,severe disability rate (25.0％ vs.27.3％) and mortality rate (41.7％ vs.54.6％) between two groups (P＞0.05).Conclusions The minimally invasive YL-1 type hematoma aspiration procedure with bio-enzyme liquefaction as a minimally invasive surgery may be superior to conventional craniectomy for treating HICH because it can offer shorter operation time,more accurate hematoma localization,lower risk of injury,and lower hospitalization costs.In particular,the procedure is suitable for elderly,frail,and poor general condition patients.It can also be applied as emergency treatment for HICH.
ABSTRACT
Objective To investigate the value of the imaging division and features of CT and MRI in the differential diagnosis of benign and malignant space-occupying lesions.Methods A retrospective analysis of the clinical and imaging data of 201 patients with orbital space-occupying lesions confirmed by pathology was conducted.Four sector method was used to analyze the distribution of the lesions.The shape,border and relationship with surrounding tissues,MRI signal,CT density,and calcification of the orbital wall were also analyzed.Results There was statistical difference in the distribution of lesions in each of the 4-sector between orbital benign lesions and malignant tumors(χ2总=48.93,P=0.000).Lesions located in separate orbital zone including extra-periosteum compartment (18 cases),optic nerve compartment (4 cases),intraconal compartment(39 cases) were benign.Benign lesions (64%, 66/103) were more than malignant lesions (36%,37/103) in 103 lesions located in extraconal compartment.Additionally,there was significance in the distribution in separate and mixed zones between benign and malignant lesions(χ2=25.559,P=0.000).Benign lesions (77%,127/164) were more than malicious lesions(23%,37/164) in 164 cases in separate zone.Malignant lesions (65%,24/37) were more than benignant lesions (35%,13/37) in the 37 lesions located in mixed zone.Signs of CT and MRI:the benign and malignant lesions were 140 and 61,respectively.The features of those lesions are as follows(ratio=benign lesions/ malignant lesions):regular morphology(ratio=93/10),clear boundary(ratio=108/24),eyeball-surrounded (ratio=24/39),bone destruction (ratio=4/11).Features of lesions including shape,border,eyeball-surrounded, bone destruction had significant difference between benign and malignant lesions,whereas no differences was observed in calcification,signal on T1WI or T2WI,displacement of the eyeball and the occurrence of single or bilateral lesions.Conclusion The characteristic distribution of orbital space-occupying lesions based on the 4-sector and the features of CT and MRI has a great value in the diagnosis.