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Objective To study the value of DSI Studio combined with diffusion tensor imaging(DTI)in evaluating the prognosis of postoperative motor function in patients with brain functional area tumors.Methods From January 2018 to August 2022,41 patients with brain functional area tumors who underwent surgical treatment and were pathologically diagnosed in our hospital were included in the study.All patients completed 3.0 T MRI routine sequence and DTI examination.DTI parameters of the corticospinal tract(CST)projection area of posterior limb of the internal capsule on the affected side and the healthy side were measured respectively,and the correlation with MRC muscle strength score and the CST grade was analyzed.Results The FA value of the affected side was significantly lower than that of the healthy side(P＜0.001),and the ADC value of the affected side was significantly higher than that of the healthy side(P＜0.001).The FA value of the affected side and the lateral rFA value were negatively correlated with the CST grade(P＜0.01).ADC value and rADC value were positively correlated with CST grade(P＜0.01).The FA value of the affected side and the partial rFA value were positively correlated with the degree of muscle strength score before and after surgery(P＜0.01).ADC value and rADC value were negatively corre-lated with CST grade(P＜0.01).Preoperative CST grading was negatively correlated with contralateral muscle strength.The area under the ROC curve of FA value,rFA value,ADC value,rADC value,and CST grade were 0.820(P＜0.01),0.796(P＜0.01),0.698(P＜0.05),0.638(P＞0.05)and 0.708(P＜0.05),respectively.Conclusion DTI parameters,muscle strength score and CST grade have certain value in the evaluation of postoperative motor function prognosis in patients with brain functional tumors.
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Objective:To investigate specificity of neurovascular compression in patients with primary trigeminal neuralgia (PTN) by three-dimension reconstruction and computational fluid dynamics.Methods:Clinical characteristics and preoperative magnetic resonance imaging (MRI) data of 20 patients with both PTN and single artery compression (PTN group) and 10 patients without PTN but having neurovascular contact in MRI images (control group) in the Second Affiliated Hospital of Zhengzhou University from January 2018 to December 2019 were collected and analyzed. After three-dimension reconstruction of the MRI images, curvature of the arterial loop, angle between the plane of arterial loop and the trigeminal nerve and location of the compression were observed. Then bidirectional structure-fluid coupling based on the optimized stereolithography models of arterial loop and nerve were processed by ANSYS 19.2 software. In the location of the compression of contact, equivalent stress (ES) of arterial loop on the nerve, shearing stress (SS) of the blood flow and local deformation of the nerve were iteratively computed. All parameters were analyzed and compared between the PTN group and the control group, and the correlation analysis was proceeded between the anatomical parameters and hemodynamical parameters.Results:The curvature of arterial loop [0.21(0.12) mm -1vs 0.13(0.07) mm -1, U=34.00, P<0.05], the angle between vascular loop and nerve [69.70(30.67)° vs 43.40(37.21)°, U=38.00, P<0.05] in the PTN group were significantly greater than those in the control group, and the location of compression was significantly closer to the root of nerve in the PTN group [PTN group: (4.23±1.29) mm vs control group: (5.54±1.85) mm, t=-2.26, P<0.05]. The average SS [15 952.48(5 365.56) Pa vs 12 501.97(6 355.26) Pa, U=53.00, P<0.05], ES [24 965.65(7 693.22) Pa vs 14 992.99(9 824.08) Pa, U=32.00, P<0.05] in the PTN group were significantly greater than those in the control group. The curvature of arterial loop was positively correlated with the SS ( r=0.931, P<0.05) and ES ( r=0.962, P<0.05), and the latter two ( r=0.787, P<0.05; r=0.853, P<0.05) were positively correlated with the local neural deformation. Conclusions:In patients with PTN, offending artery compresses the root of nerve by greater arterial curvature and angle between the arterial loop and nerve. These anatomical differences will cause significantly greater SS, ES and local neural deformation.
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Objective:To investigate the clinical related factors that affecting peritumoral brain edema (PTBE) and its severity in meningiomas.Methods:A total of 139 patients with meningiomas, admitted to and underwent surgery in our hospital from from January 2017 to October 2020 were chosen; their clinical data were analyzed retrospectively. Meningioma volume and edema volume were calculated from drawn regions of interest on preoperative MRI images by 3D-slicer software. Edema index (EI) was used to evaluate the severity of PTBE. The clinical factors affecting PTBE and EI were determined by statistical methods, and the value of meningioma volume in predicting PTBE was further analyzed.Results:(1) The PTBE incidence was 33.8% (47/139), and average EI was 2.47±0.73. (2) Univariate analysis showed that there was significant difference in percentage of patients with benign/malignant meningiomas, meningioma location, meningioma volume, and Ki-67 index between patients from PTBE group ( n=47) and non-PTBE group ( n=92, P<0.05). Multivariate binary Logistic regression analysis showed that benign/malignant meningiomas and meningioma volumes were independent risk factors for PTBE ( P<0.05). (3) There were significant differences in EI values among patients with different gender, WHO grading, KI-67 index and meningioma volumes ( P<0.05). Multivariate linear regression analysis showed meningioma malignant degrees and meningioma volume were independent risk factors for EI ( P<0.05). (4) Receiver operating characteristic curve showed that the area under curve of meningiomas of the cranial base and non-meningiomas of the cranial base in predicting PTBE was 0.824 and 0.825, respectively, with sensitivity of 0.800 and 0.784, and with specificity of 0.818 and 0.729. Conclusions:(1) Malignant degrees and meningioma volumes are the main factors affecting the incidence of PTBE, and are positively correlated with EI. (2) Meningioma volume has high predictive value in PTBE occurrence.
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Objective To compare the treatment effect of surgically clipping anterior circulation aneurysms by lateral supraorbital approach and supraorbital keyhole approach for guiding the selection of surgical approach for anterior circulation aneurysms.Methods The clinical data of 80 patients diagnosed as anterior circulation aneurysms due to spontaneous subarachnoid hemorrhage from January 2011 to January 2016 were retrospectively analyzed,including the operation time,craniotomy time,cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge,GOS scores at discharge were compared between the two groups and the literatures were reviewed.Results The operation time and craniotomy time of the lateral supraorbital approach were less than those of the supraorbital keyhole approach,and the differences between the two groups were statistically significant (P＜0.05);the cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge and GOS scores at discharge had no statistical differences between the two groups (P＞0.05).Conclusion The lateral supraorbital approach has the advantages of shorter operation time and craniotomy time,providing a better surgical field during operation,less intraoperative traction and less postoperative complications,and can serve as an alternative scheme for the supraorbital keyhole approach in clipping anterior circulation aneurysms.
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Objective To compare the treatment effect of surgically clipping anterior circulation aneurysms by lateral supraorbital approach and supraorbital keyhole approach for guiding the selection of surgical approach for anterior circulation aneurysms.Methods The clinical data of 80 patients diagnosed as anterior circulation aneurysms due to spontaneous subarachnoid hemorrhage from January 2011 to January 2016 were retrospectively analyzed,including the operation time,craniotomy time,cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge,GOS scores at discharge were compared between the two groups and the literatures were reviewed.Results The operation time and craniotomy time of the lateral supraorbital approach were less than those of the supraorbital keyhole approach,and the differences between the two groups were statistically significant (P＜0.05);the cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge and GOS scores at discharge had no statistical differences between the two groups (P＞0.05).Conclusion The lateral supraorbital approach has the advantages of shorter operation time and craniotomy time,providing a better surgical field during operation,less intraoperative traction and less postoperative complications,and can serve as an alternative scheme for the supraorbital keyhole approach in clipping anterior circulation aneurysms.
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Objective To analyze the cost-benefit ratio of primary trigeminal neuralgia patients with bad drug control and never accepted the surgical treatment through surgery [including microvascular decompression (MVD) ,percutaneous radiofrequency rhizotomy (RFR) ,stereotactic radiotherapy (SRS)] .Methods A total of 89 patients with primary trigeminal neuralgia who under-went surgical treatment for the first time from 2005 to 2013 were enrolled in this study ,including 27 patients with MVD ,23 patients with RFR and 39 patients with SRS .Evaluation criteria (effect factors) include facial pain (excellent :no pain and no drug treat-ment ;good :no pain but medication ;worse:less than 50% of patients with pain ;worse:more than 50% of patients with facial pain or need to undergo secondary surgery ) ,numbness ,cost and .Results The mean age of the patients treated with MVD was (50 .4 ± 14 .3)years old ,RFR was(73 .2 ± 13 .6) years old SRS was (72 .6 ± 11 .8) years old ,MVD group was younger than RFR and SRS group(P<0 .05);The average total cost of each surgical approach as follows :MVD was 50274 yuan ,RFR was 4539 yuan ,SRS was 38512 yuan (P<0 .05);The postoperative facial numbness proportion of MVD was 1 .1% ,RFR was 52 .2% and SRS was 28 .2% (P<0 .05);The ratio of patients who needed recurrent surgery in two years was MVD 26 .0% ,RFR 73 .9% and SRS 30 .7% (P<0 .05);The mean remission rate of MVD was 1 .6 years ,the RFR was 2 .1 years ,and the SRS was 1 .0 year(P<0 .05);The cost-benefit ratio of MVD was 31618 yuan ,RFR was 1982 yuan ,SRS was 39297 yuan(P<0 .05) .Conclusion The cost-ben-efit ratio of the three surgical from low to high were RFR ,MVD ,SRS ,which means the unit cost of RFR gain the highest ,followed by M VD and SRS .
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Objective To clarify the inhibitory effect of Tripterine combined with Cisplatin on C6 glioma ceils and its apoptosis mechanism.Methods C6 glioma cells were treated with Tripterine,Cisplatin,or Tripterine combined with Cisplatin.CCK-8 assay was used to detect the growth inhibition rate in each group.Flow cytometry analysis was used to test the cell apoptosis rate.The expressions of apoptosis-related proteins including Bcl-2,Bax,XIAP,NF-kB were analyzed by ELISA.Results Compared with Tripterine-or Cisplatin-treated group,the inhibition ratio of cell growth in Tripterine and Cisplatin combination group was (69.76±7.28)％,which could significantly inhibit the growth of C6 glioma cells(t=23.78,P＜0.01).The apoptosis rate was significantly higher (47.75±5.63)％ in combination group than in Tripterine or Cisplatin treated group.The results of ELISA showed that the expression of Bax was significantly higher and Bcl-2,XIAP,NF-κB were obviously lower in the combination group than in Tripterine or Cisplatin treated group (t=35.27,P＜ 0.01).Conclusion The combination of Tripterine and Cisplatin significantly increases the inhibition rate on C6 glioma cells through upregulating Bax and inhibiting Bcl,XIAP and NF-kB to induce the apoptosis of C6 glioma cells.
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Objective To study the application of microelectrode stereotactic functional nucleus lesioning operation in the treatment of Parkinson′s disease(PD) ,and to explore its clinical value .Methods The clinical data in 84 cases of PD treated with‐out using the microelectrode stereotactic functional nucleus lesioning operation(observation group) and 74 cases of PD treated by u‐sing microelectrode guided stereotactic functional nucleus lesioning in our hospital were retrospectively analyzed .At the same time the Unified Parkinson′s Disease Rating Scale (UPDRS) scores before the nucleus lesioning and at postoperative different medication states were obtained in the observation and the control group .Furthermore the difference of the UPDRS motor scores before and af‐ter operation were compared between the two groups .Results The UPDRS motor scores at postoperative 3 ,6 months and 1 year in the observation group were significantly improved compared with before operation(P0 .05) .Conclusion Stereotactic nucleus lesioning in treating PD has satisfactory effect and can significantly improve the UPRDS motor scores .Accurate positioning is the key to the operation success ,whether microelectrode recording can significantly improving the operation accuracy needs further discussion .
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Objective To explore the clinical characteristics of evolutionary type of traumatic subdural hydroma(ETTSH) and experiences of diagnosis and treatment of ETTSH. Methods The clinical data of 37 patients with ETTSH were analyzed retrospectively. Results The patients ages were from 3 months to 75 years old, most of primary craniocerebral injuries were mild, the main clinical manifestation was chronic increased intracranial pressure, and the final diagnosis time by CT scanning was 28 to 110 days after craniocerebral injury. All patients had a good prognosis by surgical drainage. Conclusion Polarized age, mild primary craniocerebral injury and chronic increased intracranial pressure are the main clinical characteristics of ETTSH. Dynamic CT scanning and surgical drainage were the first choice of diagnosis and treatment of ETTSH, respectively.
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Objective To study the diagnosis and treatment of delayed radiation-induced brain injury. Methods 21 patients with delayed radiation-induced brain injury were diagnosed by CT, MRI and MRS, and were treated with dehydration, corticosteroid, neuroprective drugs and hyperbaric oxygen or surgery. Results The symptoms of 66.7% patients were obviously improved, 19.0% patients partly recovered and the symptoms of 14.3% patients were not obviously improved. Conclusion The early diagnosis and reasonable treatment could decrease delayed radiation-induced brain injury to minimal extent. The operative treatment should be performed in the patients who had operative indicators. And it was important to prevent the occurrence of delayed radiation-induced brain injury.