Paracondylar-lateral cervical approach for resection of jugular foramen schwannomas: a retrospective analysis of 15 cases / 中华外科杂志

Objective@#To explore the effects of paracondylar-lateral cervical approach for resection of the jugular foramen schwannoma(JFS).@*Methods@#A total of 15 patients with JFS operated via the paracondylar-lateral cervical approach between December 2011 and March 2016 at Department of Neurosurgery in Xiangya Hospital of Central South University were retrospectively analyzed. There were 7 males and 8 females, aging from 22 to 77 years with a mean age of (41.9±15.8) years.There were 12 patients who accepted primary surgery, 3 patients who accepted secondary surgery. There were 10 patients with tinnitus or hearing loss, 8 patients with dysphagia, 9 patients with hoarseness, 7 patients with tongue hemiparesis, 8 patients with ataxia, 1 patient with Pyramidal signs, 2 patients with facial hypesthesia or pain, 1 patient with facial paresis. According to Samii JFS grading system, 2 patients were type B, 4 were type C and 9 were type D. All patients were followed-up through outpatient and telephone by MRI in 3, 9, 12 months postoperation.@*Results@#Gross total removal of tumors were achieved in 14 patients and subtotal removal in 1 patient. Two patients had new hoarseness, 2 had new dysphagia and 3 had more serious dysphagia, 1 patient had more serious facial paresis after the operation. There were 2 patients with intracranial infection, 2 with pneumonia, 1 with subcutaneous effusion, 1 with cerebrospinal fluid rhinorrhea, 5 with gastric intubation during perioperative period. There were no death, intracranial hematoma and decreased hearing patients. All patients were followed up, the follow-up time were 3 to 33 months with a mean of (26.9±11.2) months. Till to the latest follow up, dysphagia improved in 2 cases, hoarseness and tongue hemiparesis improved in 3 cases, hearing loss and tinnitus improved in 9 cases, balance function improved in 7 cases, facial hypesthesia and pain improved in 2 cases, pyramidal signs disappeared in 1 case, facial nerve function improved to normal in 1 case. There was no recurrence and progressed case.@*Conclusion@#Paracondylar-lateral cervical approach is an alternative approach for both intracranial and extracranial JFS.

Pretemporal transcavernous approach tailored surgery of cavernous sinus tumors: a consecutive series of 31 cases report / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the indications of the pretemporal transcavernous approach for cavernous sinus tumors resection and design individually tailored surgery according to the extent of tumors and operation requirements.</p><p><b>METHODS</b>A retrospective analysis of clinical data, surgical outcomes and complications in a series of 31 cases with cavernous sinus tumor operated via the individually tailored pretemporal transcavernous approach between May 2012 and September 2015 in Department of Neurosurgery, Xiangya Hospital, Central South University. There were 13 male and 18 female patients, aging from 17 to 67 years with a mean of (41±14) years. The patients included 18 cases of shwannomas, 4 cases of meningiomas, 3 cases of cavernous hemangiomas, 2 cases of invasive pituitary adenomas, 1 case of chordoma, 1 case of chondroma, 1 case of recurrent teratoma, 1 case of metastatic nasopharyngeal carcinoma. The first followed-up visit was on the 3(rd) month after surgery, and if tumor progression or recurrence was observed on MRI, the Gamma knife treatment was recommended, the patient was followed up every 6 months, otherwise the patient was followed up again 6 months later, then, every 12 months.</p><p><b>RESULTS</b>Gross total removal of tumors was achieved in 22 cases of 31 patients (71.0%), containing 17 cases of shwannomas, 3 cases of hemangiomas, 1 case of chondroma, 1 case of teratoma; subtotal removal in 6 cases (19.3%), including 3 cases of meningiomas, 1 case of pituitary adenoma, 1 case of chordoma, 1 case of metastatic carcinoma; partial removal in 3 cases (9.7%), comprising 1 case of meningioma, 1 case of recurrent shwannoma, 1 case of recurrent pituitary adenoma. The symptoms of cranial never aggravated in 5 cases, the new postoperative cranial never palsy was observed in 7 cases. There was no surgical mortality, intracranial hematoma, intracranial infection and cerebrospinal fluid leakage cases, ect. Twenty-eight cases were followed up for more than 3 months (3 to 40 months), 1 case of chordoma had tumor progression; the nerve function was restored in 5 cases, among the 12 cases with postoperatively new occurred or deteriorated cranial nerve paralysis.</p><p><b>CONCLUSIONS</b>The pretemporal transcavernous approach can be used to resect tumors limited in cavernous sinus or tumors simultaneously involving the cavernous sinus and its vicinity areas, it can be individually tailored based on the extent and exposure of the tumor. This approach can improve the surgical results in terms of high tumor resection rate, less complication, is an ideal approach for cavernous sinus tumor resection.</p>

Influence of preventive use of vasopressin tannate on diabetes insipidus and serum sodium at the early postoperation of craniopharyngioma / 中南大学学报(医学版)

To explore the influence of preventive use of vasopressin tannate on diabetes insipidus and serum sodium at the early postoperation of craniopharyngioma.
 Methods: The data of 83 patients, who underwent unilateral sub-frontal approach resection of craniopharyngioma between 2010 and 2014 by the same senior neurosurgeon, were retrospectively analyzed. The patients were divided into a vasopressin tannate group (used group) and a control group. The diabetes insipidus and serum sodium changes were compared between the two groups.
 Results: Compared with the control group, the incidence of diabetes insipidus decreased at the early postoperation in the vasopressin tannate group (P<0.05). There was high incidence of diabetes insipidus in patients with pituitary stalk excision and tumor close adhesion to the third ventricle floor at the early postoperation (P<0.05). Under such conditions, the incidence of diabetes insipidus in the vasopressin tannate group was decreased compared with the control group (P<0.05). Postoperative hypernatremia occurred in 37 patients (44.6%), and hyponatremia occurred in 60 patients (72.3%), the average time of the occurrence of hpernatremia and hyponatremia was 1.4 and 3.7 days after surgery. Postoperative high serum sodium and low serum sodium appeared alternately in 19 patients (22.9%). There was significant difference in the serum sodium distribution in the first day after surgery in both groups (P<0.05), and the percent of hpernatremia in the vasopressin tannate group was significantly less than that in the control group (P<0.05).
 Conclusion: Preventive use of vasopressin tannate can effectively reduce diabetes insipidus and hypernatremia incidence at the early postoperative stage after microsurgery for craniopharyngioma.

Microsurgical removal and prognostic analysis of petroclival meningiomas / 中华外科杂志

<p><b>OBJECTIVE</b>To identify factors that predictive of quality of life after microsurgical removal of petroclival meningiomas.</p><p><b>METHODS</b>A consecutive series of 71 cases of petroclival meningiomas received microsurgical removal between July 1991 and April 2010 were analyzed retrospectively. Quality of life was measured using Karnofsky performance scale (KPS). Complete pre-operative, post-operative and follow-up data were obtained from all 71 patients including 18 male and 53 female patients with the mean age of (47 ± 11) years (aging from 15 to 68 years). The duration between onset of symptoms and diagnosis ranged from 1 week to 180 months with the mean duration of (32 ± 30) months. And the tumor size was 15-72 mm with the average of (44 ± 11) mm. Main presentations included headache, unsteady gait, hemiparesis, dysphagia, hoarseness, facial numbness or pain, Bell's palsy, hearing impairment etc. The preoperative KPS was 40-100 with the average of 69 ± 11. The retrosigmoid (-transtentorial) approach was performed in most cases (91.5%). Intergroup χ² test and logistic regression analysis were conducted for prognostic factor characterization.</p><p><b>RESULTS</b>The gross total resection (all were Simpson gradeII) reached in 48 cases (67.6%) and 1 case died postoperatively. The main new neurological dysfunctions were cranial nerve paralysis and hemiplegia with the postoperative KPS of 20-100 with the average of 73 ± 16.Sixty-four cases were followed for 4-132 months with the average of (61 ± 48) months. Seven patients died during follow-up, tumor recurrence and progression were identified in 6 and 8 cases, respectively. The KPS at the last visit ranged from 50 to 100 with the average of 83 ± 13. The extent of tumor resection (OR = 0.280, 95% CI: 0.081-0.967, P = 0.044), preoperative brainstem edema (OR = 0.100, 95% CI: 0.027-0.372, P = 0.001), relationships between tumor and neurovascular structures (OR = 0.288, 95% CI: 0.084-0.985, P = 0.047) and depth of invasion into cavernous sinus (OR = 0.254, 95% CI: 0.061-1.057, P = 0.048) had significant correlations with the prognostic quality of life.</p><p><b>CONCLUSIONS</b>With regard of the choice of surgical approaches, the extent of tumor resection, the protection of neurovascular structures surrounding the tumor and the management of perioperative period, the therapeutic strategies for each patient should be customized to achieve better prognosis.</p>

Combined intervention of preconditioning and postconditioning against cerebral ischemia/reperfusion injury / 中南大学学报(医学版)

OBJECTIVE@#To investigate the protective effect of combined ischemic preconditioning and postconditioning against cerebral ischemia/reperfusion (I/R) injury and the potential mechanism.@*METHODS@#Sixty SD rats were randomized into a sham operation group, a brain I/R group (model group), a brain I/R plus preconditioning group (preconditioning group), a brain I/R plus postconditioning group (postconditioning group), and a brain I/R plus preconditioning and postconditioning group (combined intervention group). The rat brain I/R injury model was created by suture emboli method. Preconditioning was induced by 3 cycles of 15 s occlusion followed by 30 s recanalization of the middle cerebral artery twice respectively at 24 h and 1 h before model creation, and postconditioning was elicited by 3 cycles of 30 s reperfusion followed by 15 s ischemia before long time reperfusion. The rats were sacrificed at 48 h after the reperfusion. The cerebral infarct volume and oxidative stress parameters as well as p-Akt and p-ERK1/2 protein expressions in the brain tissues were determined.@*RESULTS@#The cerebral infarct volumes showed no significant difference between the preconditioning group and the postconditioning group (P>0.05), but both were smaller than that in the model group and larger than that in the combined intervention group (all P values0.05), but p-Akt expression was slightly upregulated and p-ERK1/2 was remarkably down-regulated (P<0.05 and P<0.01) In the postconditioning group, the level of oxidative stress was significantly decreased, and p-Akt expression was dramatically increased with a mild down-regulation of p-ERK1/2 expression (P<0.01 and P<0.05). In the combined intervention group, the oxidative stress decrease the p-Akt expression rise and p-ERK1/2 expression inhibition were significantly greater than those in either the preconditioning group or the postconditioning group (all P values<0.01).@*CONCLUSION@#Combined treatment of preconditioning and postconditioning exerts stronger protective effect against cerebral I/R injury than either preconditioning or postconditioning alone. The mechanism is possibly due to the different but complementary protection of preconditioning and postconditioning against I/R injury.

Preservation of the pituitary stalk and the gland in transsphenoidal microsurgery for pituitary adenomas / 中南大学学报(医学版)

OBJECTIVE@#To improve the surgical outcome of pituitary adenomas by identifying and preserving the pituitary stalk and the gland during surgery.@*METHODS@#From October 2010 to September 2012, the author from the Department of Neurosurgery of Xiangya Hospital, Central South University operated on 51 patients with pituitary adenoma. During the operations, we carefully identified the normal adenohypophysis, pituitary stalk, neurohypophysis and the abnormal tissues either by direct observation or by medical images, aiming to excise the tumor thoroughly, protect the pituitary function and reduce the postoperative complications.@*RESULTS@#Totally 37 patients (72.5%, 37/51) had total resection of the tumor, 12 (23.5%, 12/51) had subtotal tumor resection and the other 2 had major removal. The gland and the pituitary stalk were well identified and reserved. Detection of hormone content proved that the operation had little effect on the free triiodothyronine (FT3) and adrenocorticotropic hormone (ACTH), while for free tetraiodothyronine (FT4) and thyroid stimulating hormone (TSH) and postoperative followup significant alleviation was found. There was no significant fluctuation for the testosterone in the men preoperatively and postoperatively (all the above results were obtained without hormone replacement therapy). The main postoperative complications were as follows: temporary diabetes insipidus in 5 patients (9.8%, 5/51); electrolyte disorder (the appearance of hyponatremia) in 17 (33.3%, 17/51); and cerebrospinal fluid rhinorrhea and postoperative intracranial infection in 1 (2%, 1/51). No one died during the perioperation period.@*CONCLUSION@#Microscopic transsphenoidal surgery is effective for pituitary adenomas including tumors violating the cavernous sinus. Accurate identification of the pituitary stalk, the gland and the abnormal tissue during the microscopic transsphenoidal operation plays a critical role in preserving the pituitary function and promoting postoperative rehabilitation.

Clinical features of 417 patients with chronic subdural hematoma / 中南大学学报(医学版)

OBJECTIVE@#To discuss the clinical features of chronic subdural hematoma (CSDH) in different age groups.@*METHOD@#A total of 417 patients with CSDH were divided into 3 groups: 0 to 39, 40 to 59 and elder than 60 years. We analyzed the clinical features in different groups, including sex, trauma history, potential hemorrhage factors, trauma to symptoms interval, encephalatrophy, onset symptom and hematoma volume.@*RESULTS@#The incidence of trauma, potential hemorrhage factors, encephalatrophy, consciousness disorders and paralysis increased with age, while the incidence of intracranial hypertension symptoms and seizures decreased with age (P<0.001). The trauma to symptom interval in the group elder than 60 was longer than in other groups (P<0.05) and the hematoma volume increased with age(P<0.05).@*CONCLUSION@#The clinical features of CSDH including onset symptoms, trauma history, potential hemorrhage factors, encephalatrophy, trauma to symptoms interval and hematoma volume vary in different age groups.

Protection of the superior petrosal vein in microneurosurgery for acoustic neuroma / 中南大学学报(医学版)

Objective:To explore the clinical signiifcance of the protection of superior petrosal vein (SPV) in the microneurosurgery for acoustic neuroma. Methods:From January 2009 to July 2011, 149 cases of acoustic neuroma microsurgery were observed. hTe difference in hematoma in surgical area, cerebellar hematoma and cerebellar edema were compared between a SPV without protection group (SPVWP group, n=8) and a SPV protection group (SPVP group, n=141). Results:In the 149 patients with acoustic neuroma, the SPV was reserved in 141 patients. In the SPVWP group (8 patients), hematoma in the surgery area occurred in 4 patients, cerebellar edema in 5, and cerebellar hemorrhage in 3. In the SPVP group (141 patients), hematoma in the surgery area occurred in 40 patients, cerebellar edema in 56, and cerebellar hemorrhage in 12. hTere was signiifcant difference in the incidence of cerebellar hemorrhage (χ2=3.84, P=0.05), no signiifcant difference in the incidence of hematoma in the surgical area (χ2=0.646, respectively, P=0.422), and no significant difference in the incidence of cerebellar edema (χ2=0.611, P=0.434) between the SPVWP group and the SPVP group. Conclusion:In acoustic neuroma surgery, the SPV should be protected, which may reduce the risk of cerebellar hemorrhage.

Microsurgery for parasellar menningiomas and impact factors of recurrence / 中南大学学报(医学版)

Objective:To study the effect of microsurgery for parasellar menningiomas and to analyze the impact factors of recurrence. Methods:Clinical and follow-up data in a consecutive series of 134 patients with parasellar meningiomas were retrospectively analyzed. Results:A total of 109 patients (81.3%) had radical removal (Simpson grade I and II), and 116 patients were followed up for an average period of 81.6 months. The mean quality of life score (KPS) was 91.9, 90 patients regained full daily activity and 16 patients were able to take care of themselves. Oculomotor paralysis occurred in 7 patients, epilepsy in 8, and another 9 patients suffered hemispheral paralysis. Tumor recurred atfer the radical removal in 12 out of the 96 follow-up patients (12.5%). Tumor progressed atfer subtotal removal in 12 out of the 20 follow-up patients (60%). Tumor with cavernous sinus (CS) invasion had significantly higher risk of recurrence campared with non-CS invasion (P=0.043). The recurrence rate increased with the pathological grade (P<0.01). Conclusion:Patients with parasellar meningiomas undergoing microsurgical resection may have a good long-term function outcome. For most patients, total removal by microsurgery is the ifrst choice. Careful follow-up is needed if tumor invaded the CS and radiosurgery is proposed for WHO grade 1 and 2.

Effects of different degrees of neuromuscular blockade induced by rocuronium on facial nerve evoked-electromyographic monitoring in patients undergoing resection of acoustic neuroma / 中华麻醉学杂志

Objective To investigate the effects of different degrees of neuromuscular blockade (NMB) induced by rocuronium on facial nerve evoked-electromyographic (EEMG) monitoring in patients undergoing resection of acoustic neuroma.Methods Thirty-five ASA Ⅰ or Ⅱ patients of both sexes,aged 20-64 yr,with body mass index ≤30 kg/m2,scheduled for elective resection of acoustic neuroma under general anesthesia,were included in the study.Anesthesia was induced with midazolam,fentanyl and propofol.The patients were mechanically ventilated after tracheal intubation.Facial nerve EEMG monitoring and peripheral NMB monitoring were performed simultaneously during operation.Facial nerve EEMG was monitored using the Epoch XP2000 multichannel electrophysiological nerve monitoring system (Axon Co.,USA),facial nerve was stimulated and evoked potential of orbicularis oculi was recorded during operation.Peripheral NMB degrees were monitored with TOF-Watch SX monitor (Organon Co.Holland).After rocuronium 0.6 mg/kg was injected intravenously,the facial nerve EEMG responses were monitored when the degree of NMB (T1) was at 100％,75％,50％,25％ and 0 of the control height.The amplitude and latency of EEMG were recorded.The amplitude reservation ratio (the ratio of the amplitude of EEMG monitored to the baseline value) was calculated.Linear correlation of the amplitude reservation ratio or latency of EEMG with the degree of NMB was analyzed.Results No EEMG response was elicited when the degree of NMB was 100％ in 6 patients.The lirear regression equation of the interaction between the degree of NMB (X) and the amplitude reservation ratio (Y) was Y =1 - 0.787 X,the coefficient of determination was 0.898 ( P ＜ 0.05) and the correlation coefficient was - 0.947 ( P ＜ 0.05).The correlation coefficient between the latency of EEMG and the degree of NMB was 0.328 ( P ＜ 0.05).Conclusion When the degree of NMB is maintained at 25 ％-50％,facial nerve EEMG can be monitored effectively and body movement can be avoided during resection of acoustic neuroma.

The prevention cerebrospinal fluid leakage during operating anterior skull base meningioma involving paranasal sinuses / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To introduce a kind of method for skull base reconstruction after resecting anterior skull base tumors involving paranasal sinuses.@*METHOD@#A retrospective analysis was carried out on 13 patients who underwent anterior skull base reconstruction. Pericranial flap were detached with integrity from the frontal bone during craniotomy, after the tumor had been resected partitionedly, the cribriform plate of ethmoid bone which was involved by tumor was resected. Using the fat tissue to fill the skull-base defects and sutured the pedicled pericranial flap with surrounding normal dura mater. Then reinforced at the junction of pericranial flap and dura mater with biogel.@*RESULT@#The pathogenic diagnosis of all cases were meningioma. I grade resection was acquired in 12 cases and II grade in 1 case according to Simpson grading standard of meningioma resection. The postoperative complications were 3 cases aseptic meningitis, 3 cases frontal syndrome. No CSF leakage, intracranial infection, nor death occurred. An average of 3. 4-year follow-up was achieved in all the cases from 9 months to 8 years, no tumor relapse.@*CONCLUSION@#CSF leakage can be effectively prevented by filling the skull-base defects with the fat tissue, suturing the pedicled pericranial flap with surrounding normal dura mater, and reinforcing at the junction of pericranial flap and dura mater with biogel.

The comprehension of preservation for petrosal vein in 147 operative cases with acoustic neuroma / 中华显微外科杂志

Objective To discuss the preservation and clinical significance of petrosal vein in microsurgical operation of acoustic neuroma. Methods 147 patients with acoustic neuroma were operated, with internal decompression of the tumor firstly then dissected the tumor with surrounding structures, the petrosal vein were protected well in 143 cases and failed to protect in 4 cases. Results No hemorrhagic infarction in cerebellar was observed in 143 cases with intact petrosal vein. One case occurred with extensive cerebellar edema, which has gait disturbance after 18 months follow-up. The other three cases occurred with vein infarction and hemorrhagic edema after petrosal vein damage. One was dead and the other two were recovered well after decompression of posterior cranial fossa. One has no significant neurological deficit after 33 months follow-up, while the other has difficulty in line walking after 12 months follow-up. Conclusion Petrosal vein should be well protected in the operation of acoustic neuroma, the decompression of posterior cranial fossa should be considered if petrosal vein failed to protect.

Efficacy of subarachnoid space protection in intracranial operation: a report of 156 cases / 中南大学学报(医学版)

OBJECTIVE@#To determine the efficacy of subarachnoid space protection in intracranial operation.@*METHODS@#Data collected from 156 consecutive cranial operations, in which subarachnoid space protective technology was prophylacticly used, were analyzed.@*RESULTS@#Fourteen patients had a postoperative fever for more than 1 week and 16 patients who required lumbar puncture to release blood contaminated cerebro-spinal fluid (CSF) or exclude meningitis. All except 3 patients were discharged as expected. No patients had symptomatic vasospasm and hydrocephalus.@*CONCLUSION@#The subarachnoid space protective technology has good effect on preventing postoperative fever and improving the outcome of patients.

Clinical characteristics and operative effect of hippocampus lesions / 中南大学学报(医学版)

OBJECTIVE@#To study the clinical characteristics and operative effect of hippocampus lesions.@*METHODS@#We retrospectively analyzed the clinical characteristics and operative outcome of 44 patients with hippocampus lesions between August 2005 and April 2010.@*RESULTS@#Seizure attack was the initial symptom among 40 of the 44 patients. Pathological examinations revealed 18 gliomas, 9 cavernous malformations, 12 hippocampus sclerosis, 2 focal cortical dysplasia, 1 atypical hyperplasia, 1 injury glial scar, and 1 encephalomalacia. Thirteen patients received anterior medial temporal lobectomy and the other 31 received lesionectomy or selective amygdalohippocampectomy via transsylvian approach. An average of 15.7 month follow-up was accomplished in 37 patients. Postoperative epileptic outcomes were evaluated according to Engel classification: Grade I 73.0%(27/37), Grade II 13.5%(5/37), Grade III 10.8%(4/37) and Grade IV 2.7%(1/37). No perioperative death occurred. One patient experienced hemiplegia but recovered 8 months after the operation. Noticeable postoperative visual field deficit was left in 2 patients. Two patients with glioma died of remote tumor recurrence during follow-up.@*CONCLUSION@#Seizure attack is a major complaint of hippocampus lesions. Satisfactory seizure and tumor control may be achieved through anterior medial temporal lobectomy or selective amygdalohippocampectomy with lesionectomy.

Clinical research on 46 cases of microoperation for acoustic neurinomas under the F wave assisted electrophysiological monitoring intraoperatively / 肿瘤研究与临床

ObjectiveTo study the methods of how to protect facial nerve function following complete resection of acoustic neurinomas and the value of the techniques of F wave assisted electrophysiological monitoring intraoperatively.Methods Retrospectivelysummarizing theresultsof combining three electrophysiological monitoring techniques such as nasal muscle F wave recording,online EMG and triggered EMG to monitor 46 cases of microoperations for acoustic neurinomas intraoperatively during the period of Feb.2004 to Dec. 2008. Correlating every intraoperative monitoring index with their follow-up results of facial nerve function 1 day and 6 months after their operations.The tendency of the two continuous monitoring techniques between nasal F wave recording and online EMG of facial muscles has also been studied in this paper. Results Among 46 cases of acoustic neurinomas, 45(97.83 %) tumors have been totally resected, and 1 (2.17 %) tumor subtotally resected,lcase (2.17 %)died after operation,and 2ases occurred the leakage of cerebrospinal fluid(CSF) which have been cured through conservative treatment. The whole anatomic protection rate of facial nerve is 97.83 %,and their functional protection rates 6 months after operation are:HB Ⅰ - Ⅱ,75.56 %;Ⅲ-Ⅳ,22.22 % and Ⅴ-Ⅵ,2.22 %.The completely accordant rate between the intraoperative findings of nasal F wave recording and online EMG is 52.17 %, partially accordant rate is 45.65 %, and totally opposite rate is 2.17 % (x2 趋势= 6.113, P ＜0.05). The intraoperative monitoring indexes in nasal muscle F wave recording are correlated well with the facial nerve function in the 6th month' s follow-up (κ=0.429, P ＜0.001).In triggered EMG monitoring after tumors being resected,the stimulus threshold ratio and maximum amplitude ratio of facial nerve between leaving brain stem part and inner acoustic porus part are also correlated well with the facial nerve function 6 months after operation(κ=0.576, P ＜0.001; κ=0.595, P ＜0.001). ConclusionNasal muscle F wa recording cooperated well with online EMG and triggered EMG intraoperatively and correlates well with the postoperative facial nerve function, so they should be routinely applied together intraoperatively.

Effect of epidural drainage and dural tenting suture on epidural hematoma in 145 cases of craniotomy / 中南大学学报(医学版)

Objective To evaluate the efficacy of dural tenting suture and epidural drainage in craniotomy. Methods In 145 cases of intracranial lesions, dural tenting suture and epidural drainage were performed to prevent epidural hematoma. Results Postoperative computed tomography (CT) showed no epidural hematoma required surgery in both groups. Conclusion Both dural tenting suture and epidural drainage are effective in preventing epidural hematoma. Hemostasis is the key step. Dural tenting suture without epidural drainage relieves psychological stress. It decreases the risk of intracranial infection and avoids some unusual complications.

Experimental study on the relationship between F wave recording, facial nerve function and its pathological changes in the pressure-induced rat model of acoustic neurinoma / 肿瘤研究与临床

Objective To explore the value of F wave recording in evaluating facial nerve function and its pathological changes in the pressure-induced rat models of acoustic neurinoma. Methods 58 rats in different groups were conducted F wave recording and biotinylated dextran amine(BDA) retrograde tracing for their right facial nerve one week after establishing models. Their latencies, amplitudes and F/M rates were analyzed first. 72 hours after BDA was injected into right whisker muscle, the rats were infused with 4% polyoxymethylene, then pontines and facial nerves in the CPA cistern were obtained. Pontiues were cut into frozen sections for histochemical staining with avidin-horseradish peroxidase (HRP)-DAB and Nissl 's counterstaining, calculating the positive BDA neurons ratio(BDA+-N%)in facial nuclear. Facial nerves were cut and stained with toluidine blue for light-micrescope inspection, and/or stained for transmission electron microscope observation. Correlating F/M with BDA+-N% and the facial nerve pathological findings. Results F/M are 97.66 % and 97.48 % in normal and pseudo-operation group, respectively, when stimulus are 1.4 mA; while 77.13 %, 48.91% and 11.54 % in from small to large tumor model groups because F waves were delayed in latencies or increasinglylost (P <0.001). Similarly, BDA+-N% are 98.37 % and 97.96 % in the above two control groups, while 77.28 %, 48.28 % and 11.55 % in from small to large tumor model groups (P < 0.001). Thus F/M are positively correlated with their BDA+-N% in all groups (r =0.996,P <0.001). Facial nerve examinations under light and electron microscope show increasing pathological changes along with increasing "tumor" size. Conclusion The findings of F wave recording in facial nerve may reflect its functional status and pathological changes. Therefore, F wave detection may help electrophysiological monitoring during acoustic neurinoma resection and facial nerve function evaluation after surgery.

The effects of γ-IFN on the expression of HLA-G mRNA in primary cultured astrocytoma cells / 中国医师杂志

Objective To study the effects of γ-IFN on the expression of HLA-G mRNA in primary cultured astrocytoma cells. Methods Different concentrations of γ-IFN were added to primary cultured cells, and HLA-G mRNA were detected by RT-PCR. Results After γ-IFN treatment, HLA-G mRNA can not be determined from HLA-G originally negative astrocytoma cells. The expression of HLA-G are up - regulated in all original HLA-G positive astrocytoma cells in a dose-dependent manner. Conclusion γ-IFN can increase the ex-pression of HLA-G gene in the primary cultured astrocytoma cells which HLA - G are originally positive.

The relationship between brain edema and arginine vasopressin in rat with traumatic brain injury / 中国医师杂志

Objective To observre the change of plasma arginine vasopressin(AVP)in plasma and relationship of AVP with brain edema after traumatic brain injury(TBI).Methods The rat models of mild and severe degree local cerebral cortex injury were caused by free dropping.Radioimmunoassay was used to measure serial concentration of AVP in plasma in 45 rats with acute brain injuries at the 24th,48th,72th hour and the 5th day after brain injury.The content of injury brain water was measured by drying-wetting way.Results AVP levels had positive correlation with the severity of brain edema.The severer brain injury resulted in higher AVP level and longer persistent time of peak brain edema(P＜0.05).Conclusion AVP level is closely associated with edema after TBI.AVP may play a vital role in pathogenesis of brain edema.

Microsurgical treatment of large acoustic neurinoma / 中华显微外科杂志

Objective To discuss microsurgical experience for transsuboccipital retrosigmoid sinus approach of large acoustic neuronomas,and improve the rate of tumor removing,and facial nerve and auditory nerve preserving Methods A retrospective analysis of 39 patients with acoustic neuronomas which were more than 4 cm in diameter were treated by microsurgery between January 1994 and December 2000 Tumor's excision was performed by transsuboccipital retrosigmoid sinus approach The surgical main points of transsuboccipital retrosigmoid sinus approach,and their experience of total removal,and rate of facial nerve and auditory nerve preservation were described Results The tumors were totally removed microsurgically in 34 patients,the total removal rate was 87 2%,and subtotal removal in 5 patients Facial nerve was anatomically preserved in 31 cases,the rate of facial nerve preservation was 79 5%,but the function of facial nerve was recovered in 22 cases (56 4%) The auditory nerve was preserved anatomically in 15 cases (38 5%) and functionally in 7 cases (17 95%) Conclusions An minimally invasive microsurgical treatment are crucial for increasing a satisfactory living quality of the patients It is considered that the total removal rate of tumor,the preservative rate of facial nerve and auditory depend upon microsurgical technique and intraoperative facial nerve monitoring in acoustic neuromas surgery