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Objective:To explore the clinical efficiency evaluation and prognostic factors of aspiration guided by neuronavigation in the treatment of pediatric brain abscess (PBA).Methods:A total of 47 patients with PBA were treated with aspiration guided by neuronavigation between January 2013 and January 2019 at the First Affiliated Hospital of Zhengzhou University.All clinical data were retrospectively analyzed.According to Glasgow Outcome Scale on discharge, all children were divided into 2 groups, namely good prognosis group and poor prognosis group.Prognostic factors were analyzed by using univariate analysis and binary Logistic regression multivariate analysis. Results:Among the 47 children, 38 children (80.9%) were assigned to the good prognosis group, and 9 children (19.1%) were assigned to the poor prognosis group.Univariate analysis proved that abscess volume>4 cm( χ2=5.650, P=0.017), multiple or multilocular abscess ( χ2=3.258, P=0.027), and abscess located in functional areas ( χ2=6.187, P=0.013) were correlated with poor prognosis.Multivariate analysis revealed that abscess volume>4 cm( OR=5.913, 95% CI: 2.241-25.917, P=0.023) and abscess located in functional areas ( OR=10.519, 95% CI: 3.918-62.513, P<0.001) were independent risk factors for poor prognosis. Conclusion:The treatment of PBA with aspiration guided by neuronavigation is safe, effective and minimal invasive, and the clinical efficiency is satisfactory.Abscess volume>4 cm and abscess located in deepbrain/functional areas are independent risk factors for poor prognosis.
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Objective:To investigate the predictive value of high-sensitive C-reactive protein (hs-CRP) for early hematoma enlargement in patients with primary intracerebral hemorrhage.Methods:Patients with intracerebral hemorrhage admitted to the Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University from January 2014 to January 2019 were enrolled retrospectively. The patients were sent to hospital within 6 h after onset, and the diagnosis of cerebral hemorrhage was confirmed by head CT. The head CT was reexamined within 24 h after the first head CT. Hematoma enlargement was defined as hematoma volume increase >6 ml or relative volume increase >33%. Multivariate logistic regression analysis was used to investigate the independent risk factors for influencing early hematoma enlargement. Receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of hs-CRP for hematoma enlargement. Results:A total of 154 patients with intracerebral hemorrhage were included, including 99 males (64.3%), aged 58.7±11.1 years. The median baseline Glasgow Coma Scale score was 13. The time from onset to first CT scan was 2.92±1.35 h. The time from the first CT to the second one was 16.05±4.40 h. The baseline volume of hematoma was 21.82±11.08 ml. Among them, 27 patients (17.5%) had hematoma that broke into the ventricle, 40 (26.0%) had hematoma enlargement. The average hs-CRP level at admission in the enlarged hematoma group was significantly higher than that in the non-enlarged hematoma group (11.56±3.72 mg/L vs. 9.51±4.31 ml; t=-2.669, P=0.008). Multivariate logistic regression analysis showed that hs-CRP at admission (odds ratio [ OR] 1.123, 95% confidence interval [ CI] 1.017-1.241; P=0.022), irregular hematoma shape ( OR 4.160, 95% CI 1.714-10.098; P=0.002) and the time from onset to the first CT scan ( OR 0.510, 95% CI 0.323-0.803; P=0.004) were significantly correlated with hematoma enlargement. Pearson correlation analysis showed that hs-CRP was positively correlated with baseline hematoma volume ( r=0.237, P=0.003). ROC curve analysis showed that the area under the curve of hs-CRP predicting hematoma enlargement was 0.678 (95% CI 0.584-0.772). The optimal cut-off value was 10.55 mg/L. The sensitivity and specificity for predicting hematoma enlargement were 86.9% and 60.0%, respectively. Conclusion:For patients with hs-CRP ≥10.55 mg/L at admission, irregular hematoma shape, and the time from admission to the first CT scan <3 h, should be focused the management and be alert to the occurrence of early hematoma enlargement.
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Objective:To explore the diagnosis, treatment and prognostic of pediatric intracranial atypical teratoid/rhabdoid tumor(AT/RT).Methods:A total of 15 pediatric patients with intracranial AT/RT were treated between January 2012 and June 2019 at the First Affiliated Hospital of Zhengzhou University.The clinical data were retrospectively analyzed.Overall survival (OS) rate and progression free survival (PFS) rate were calculated by adopting Kaplan- Meier method.The differences between the 2 groups were tested by performing Log- rank method, and the prognostic factors were analyzed by COX regression. Results:There were 12 males and 3 females, with the median age of 5.5 years (ranging from 8 months to 17.1 years). All patients underwent surgical resection.Gross-total resection (GTR) was achieved in 10 cases and subtotal resection (STR) was carried out in 5 patients.The conducted treatments were as follows: surgery+ radiotherapy+ chemotherapy+ intrathecal injection in 6 cases, surgery+ chemotherapy+ intrathecal injection in 4 cases, surgery+ radiotherapy in 2 cases, and surgery alone in 3 cases.Until January 2020, the median survival time of all the 15 patients was 18 months (ranged 1-27 months), and the survival rate was 33.3%.The 1-year OS rate and PFS rate for all 15 cases were 71.5% and 49.7%, respectively.The 2-year OS rate and PFS rate were 17.9% and 0, respectively. Log- rank analyses revealed that the 1-year OS rates of children less than 3 years old and those older than 3 years were 87.5% and 57.1%, respectively ( χ2=6.057, P=0.014). The 1-year OS rates of children with GTR and those with STR were 90.0% and 40.0%, respectively ( χ2=6.057, P=0.014). The 1-year OS rates of children with tumor dissemination and those without tumor dissemination were 100.0% and 33.3%, respectively( χ2=9.865, P=0.002). The 1-year OS rates of children in the standard-risk group and those in the high-risk group were 88.9% and 41.7%, respectively ( χ2=5.111, P=0.024). COX regression analyses proved that age, the extent of tumor resection, tumor dissemination and risk stratification are independent risk factors for prognosis [hazard radio( HR)=3.411, 3.795, 5.245, 3.397; P=0.025, 0.011, 0.001, 0.017]. Conclusions:Pediatric intracranial AT/RT is rare.The preliminary diagnosis and prognosis are difficult and poor, respectively.The complete resection of tumors with maximal safety remains the primary treatment.Age, the extent of tumor resection, tumor dissemination and risk stratification are independent prognostic factors for AT/RT children.