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<p><b>OBJECTIVE</b>To investigate the microsurgical tchniques and effects for the resection of anterior clinoid meningioma (ACM).</p><p><b>METHODS</b>Between January 2003 and March 2013, a total of 46 ACM patients were operated on via the pterion approach or lateral subfrontal approach. There were 16 male patients and 30 female patients, their mean age was 48.5 (16-69) years. Symptoms lasted from 1 month to 9 years(average 24.7 months). Preoperative CT and MRI examination showed that the tumors were located in the anterior clinoid process (25 cases on the right side, 21 cases on the left side). The average maximal tumor diameter was 4.4 cm (1.9-7.4 cm). The patients were peroidly followed-up on outpatient on 3 months to 6 months, then every year postoperativelly. The clinical data, radiological findings, surgical records and outcome of patients were retrospectively analyzed, and the prognostic factors were ananlyzed by using of the unpaired data χ(2) test with continuity correction.</p><p><b>RESULTS</b>Of fourty-six patients operated on, apparently complete removal was achieved in 36 patients (78.3%), 10 patients (21.7%) had minimal residual tumors, 5 of which had gamma knife radiosurgery. Preexisting visual deficit improved in 21 of 41 patients (51.2%), unchanged in 16(35.6%), and worsened in 9(20.0%). At 3-6 months after discharge, 37(80.4%) patients had a good recovery, 7(15.6%) patients were moderately disabled, 1(2.2%) presented with severe disability, and 1 (2.2%) patient died of surgery-related causes. The tumor wrapping blood vessels (χ(2) = 4.676, P = 0.031) and violating cavernous sinus(χ(2) = 4.973, P = 0.026) were causes of unfavorable prognosis. During the mean follow-up of 35.1 months (range, 4-107 months) for 40 patients, the average Karnofsky score was 83.2. Tumor recurred in 4 cases: 2 of which required reoperation, and 2 had gamma knife radiosurgery.</p><p><b>CONCLUSIONS</b>Tumor wrapped vessels and invasion of the cavernous sinus are important unfavorable prognostic factors for ACM resection. By using appropriate surgical strategies and techniques, ACM can be removed safely via the pterion approach or lateral subfrontal approach with relatively low morbidity and mortality.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Follow-Up Studies , Meningeal Neoplasms , General Surgery , Meningioma , General Surgery , Microsurgery , Neurosurgical Procedures , Methods , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To explore the relationship of serum levels of β-amyloid precursor protein (β-APP) with degree of traumatic brain injury (TBI) and the traumatic time.Methods Sprague-Dawley (SD) rats were randomly divided into normal control and injury group.The rats in injury groups suffered from TBI after free-falling percussion with different pressure (wild-injury,moderate-injury and severe-injury group).Then serum was collected at 0.5 h,2 h,6 h,and 24 h and subject to β-APP detection by ELISA.All data were analyzed statistically with completely randomized design multiple factor repeated measure of variance analysis and least significant difference (LSD) test.Results The serum levels of β-APP were higher after injury.The serum levels of β-APP were significantly higher in moderate-injury or severe-injury group than those in normal group or slight-injury group (P＜0.05).The serum levels of β-APP were higher in severe-injury group than that in moderate-injury group with no statistical difference (P＞0.05).There was no statistical difference in serum β-APP levels between normal control and slight-injury group (P＞0.05).Conclusion The serum level of P-APP is increasingly higher with traumatic brain injury more serious and could be employed as an indicator of TBI degree.It implies that β-APP has the potential as an early diagnosis marker for TBI.
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Objective To explore the effects of mini-traumatic operation in treatment of HIH. Methods A retrospective analysis of 140 patients with HIH was carried out,who were treated with mini-traumatic operation or only medicine.Results The mortality in operation group was 14.3%,and in medicine group was 34.3%.80% patients in operation group recovered well,and 52% patients in medicine group recovered well.Conclusion Mini-traumatic operation is more effective than only treated with medicine.Six to 48 hours after onset is a good period for mini-traumatic operation.
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Objective To explore the effectiveness and significance of neuronavigation in transsphenoidal approach microneurosurgical treatment of pituitary adenoma.Methods A total of 12 patients with pituitary adenomas underwent transsphenoidal surgery.Before the surgery a continuous CT or MRI scanning was adopted,and then the data were inputted into the neuronavigation system for 3-D reconstruction and registration.During the surgery,real-time positioning of the anatomic midline,the anterior wall of the sphenoidal sinus,and the floor of the sella turcica was employed by using the neuronavigation system,as well as the identification of the cavernous sinus and the internal carotid artery to avoid unexpected injury.The extent of tumor resection was assessed postoperatively.Results The mean fiducial error was 2.13?0.94 mm,and the accuracy of targets was
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BACKGROUND: Traumatic brain injury generates a cascade of arachidonic acid metabolic events that mainly presented by the increment of prostaglandin and oxygen free radicals. Indomethacin can potently inhibit the activity of cyclooxygenase, decrease the synthesis of prostaglandins, and may decrease the production of oxygen free radical, and thus may attenuate the pathological changes of brain injury.OBJECTIVE: To observe the changes of prostaglandin in early brain injury and after indomethacin intervention, so as to explore the pharmacological mechanism of indomethacin.DESIGN: A randomized and controlled trial based on experimental animals.SETTING: Department of neurosurgery and department of cerebral surgery in a university hospital.MATERIALS: This study was carried out at the Laboratory of Neurosurgery Department, Medical College of Southeast University between March and September 2000. Thirty-six hybrid cats were randomly divided into normal control group, brain injury group and indometbacin intervention group, with 12 cats in each group.INTERVENTIONS: Brain injury was simulated according to previously reported grading mechanical traumatic animal model establishment; cats with medium brain injury were enrolled in this study. The ultimate concentrations of prostacyclin (PGI2) and thromboxane A (TXA2) to 6-keto-prostaglandin F 1 alpha(6-keto-PGF1α) and thromboxane B2(TXB2) in brain vein blood, as well as total brain superoxide dismutase(SOD) and cerebral water content were measured 6 hours after trauma.MAIN OUTCOME MEASURES: 6-keto-PGF1α, TXB2, SOD, and cerebral water content.RESULTS: Both 6-keto-PGF1α and TXB2 in brain vein blood remarkably increased in early brain injury[from(0.057±0.010) g/L to (0.264±0. 126) g/L, from(0. 060 ±0. 012) g/L to(0. 134 ±0. 048) g/L respectively], with the increment of the former higher than the latter, the ratio of TXB2/6-keto-PGF1α decreased from 1. 052 ±0. 145 to 0. 545 ±0. 184, and cerebral water content increased from(77.39 ± 0. 36)% to (78.06±0.41)% ; meanwhile, total brain SOD significantly decreased from (94. 869 ± 5. 418) μkat/g to(54. 368 ± 3. 417) μ kat/g( P ＜ 0.01) . In contrast to brain injury group, the concentrations of 6-keto-PGF1α and TXB2 in indomethacin intervention group significantly decreased, which were similar to those of control group, but the total SOD significantly increased from (54. 368 ±3. 417) pkat/g to (81. 433 ±7. 268) μkat/g (P ＜0. 01), and water content lightly decreased without statistical significance( P ＞ 0. 1 ).CONCLUSION: PGI2 and TXA2 increase in early brain injury in experimental cat model, accompanied by free radical synthesis, resulting in the exacerbation of brain injury. Indomethacin may be helpful to relieve posttraumatic secondary brain injury by regulating the imbalance of PGT2 / TXA2 and decreasing the production of free radical.
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Objective To set up an experimental animal model of head injury of deceleration. Methods The decelerating head injury was produced in r abbits by utilizing an impactor consisting of a rotor, elastic strips, a platfor m and a revolving board. Sixty-nine rabbits were used in this experiment: 33 ra bbits were for pre-experiment to establish the correlation of impact force and brain damage, 36 rabbits were divided into a control group (n=12), a mild injur y group (n=12) and a severe injury group (n=12) to elucidate the pathophysiologi cal changes after head injury at different injury levels. Results The physiological responses after impact were observe d in all traumatic animals, which showed a sudden rise or reduction of blood pre ssure, deep and fast breath and apnea, and pain reflects inhibition, etc. The re s ponses were more obvious in the severe injury group than in the mild injury grou p. The water content of the brain increased 6 h after injury and the intracrania l pressure went up 1- 6 h after injury in the severe injury group. The patholog ical lesions were noted at or above the impact force level of (800±50) N. At th e severe injury level of (1 100±100) N,there were almost all kinds of lesions, such as skull fracture, brain contusion ( coup injury and contre-coup injury),b rain stem injury and subdural hematoma. When the impact force rose to or over (1 400±150) N,the animals died of persistent apnea mostly. Conclusions A new practical and simple model of head injury of deceleration in rabbits has been developed with several features similar to t he experience in the clinical setting. This model with the same biomechanical me chanism as the clinical head injury of deceleration is quite useful for further study of the pathophysiological mechanisms of head injury, safe measure of abati ng head injury and investigating the effective therapeutic method for severe hea d injuries.