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Objective:To compare the curative effect of hematoma removal and minimally invasive puncture drainage in hypertensive intracerebral hemorrhage (HICH) under neuroendoscope.Methods:The clinical data of 118 patients with HICH admitted to our hospital from February 2017 to November 2019 were retrospectively analyzed. According to the different surgical methods, the patients were divided into group A ( n=59, minimally invasive puncture and drainage) and group B ( n=59, neuroendoscopic hematoma removal). The perioperative indexes, complications and neurological function indexes [neuron specific enolase (NSE), neurotrophic factor (NGF), substance P (SP)], inflammatory factor index [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)] and related scale scores [National Institutes of Health Stroke Scale (NIHSS), modified Barthel Index (mBI)] were compared between the two groups. Results:The operation time, cerebrospinal fluid recovery time, hematoma removal time and hospitalization time of group B were shorter than those of group A ( P<0.05). On the 7th day after operation, the NSE, SP, IL-6, TNF-α in the two groups were decreased, and the levels of NSE, SP, IL-6 and TNF-α in group B were lower than those in group A ( P<0.05); on the 7th day after operation, the levels of NGF in two groups were increased, and those in group B were higher than those in group A ( P<0.05). 6 months after operation, the NIHSS decreased and mBI increased in both groups ( P<0.05), and NIHSS in group B was lower than that in group A, but mBI was higher than that in group A ( P<0.05). There was no difference in the incidence of complications between the two groups ( P>0.05). Conclusions:Compared with minimally invasive puncture and drainage, neuroendoscope hematoma removal for HICH patients can effectively improve perioperative indicators, reduce neurological damage and body inflammatory stimulation, and improve the self-care ability of patients, which is safe and reliable.
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Objective To explore the feasibility of using bispectral index (BIS)value to assess the degree of acute brain injury (ABI) and study the correlation between Glasgow Coma Scale (GCS)scores and BIS values in ABI patients. Method A prospective and double-blinded study was conducted to assess GCS scores and BIS values in 330 patients with ABI from January 2013 till July 2017. Mean BIS values (BISMEAN) in mild, moderate and severe group of ABI were calculated. Linear regression between BIS values and GCS scores was constructed. Receiver operating characteristic(ROC) curves to predict non-mild ABI (GCS score less than 13) and severe ABI (GCS score less than 9) were plotted respectively. Results BISMEAN were significantly different among mild, moderate and severe ABI group (75.46±12.94、64.30±12.56、50.37±16.90 respectively, P＜0.01). There were a significant positive correlations between GCS scores and BIS values (R2=0.446, F=264.374, P＜0.01). Regression equation was BIS=2.96 GCS+33.77. ROC curve to predict non-mild ABI demonstrated that area under the curve (AUC)was equal to 0.835 and the optimal cut-off point (BIS value) corresponding with the maximum of sensitivity+specificity was 72.7(sensitivity=0.689, specificity=0.840); ROC curve to predict severe ABI demonstrated that AUC was equal to 0.846 and the optimal cut-off point (BIS value) corresponding with the maximum of sensitivity + specificity was 65.8 (sensitivity=0.721, specificity=0.861). Conclusion BIS values significantly correlate with GCS scores in ABI patients, indicating the feasiblity of using BIS value to assess the degree of ABI. Furthermore, continuous and real-time BIS monitoring can assess degree of ABI better than BIS value.
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Computational fluid dynamics (CFD) was used to numerically investigate the blood flow in 3-D models of human preoperative and posteroperative of cerebral aneurysm clip, and the feasibility of surgical operation was evaluated by the calculated hemodynamics parameters. Mimics software was used to reconstruct the models from CT angiograms, and numerical simulation of blood flow at different time in a cardiac circle was performed. Comparison analysis of blood flow in three models of human preoperative and posteroperative of cerebral aneurysm clip was conducted in terms of blood velocity distribution, wall shear stress (WSS) distribution and pressure distribution. The results demonstrated that blood velocity and WSS were significantly increased, and pressure was obviously decreased.
Subject(s)
Humans , Blood Flow Velocity , Cerebrovascular Circulation , Computer Simulation , Hemodynamics , Imaging, Three-Dimensional , Intracranial Aneurysm , Diagnostic Imaging , General Surgery , Models, Cardiovascular , Stress, Mechanical , Tomography, X-Ray ComputedABSTRACT
Objective To examine clinical features, neuroimaging presentation and treatment of intracranial fungal granulomas (ICFG) in order to improve the accuracy rates of diagnosis and cure. Methods Three pathologically proven cases with ICFG were retrospectively analyzed. Cases of ICFG reported in literature were also summarized. Results Among the 3 patients with ICFG, 1 patient had a history of head trauma and craniotomy and 1 had a history of type 2 diabetes mellitus and a long history of exposure to doves. In all 3 patients, the symptoms started with headache and vomiting, accompanied by low-grade fever, convulsion, and cranial nerve deficits. Intracranial mass lesion was revealed on brain computed tomography (CT) scan and (or) magnetic resonance imaging (MRI) with or without intravenous contrast. CT scan showed low-density lesions and granulations with ring and homogenous enhancement, indicating fungal abscesses. MRI in all 3 cases showed one or multiple circumscribed intracranial space-occupying lesion, with ring, heterogeneous contrast enhancement and perilesional edema. The treatments were initiated with craniotomy and surgical resection of granulations followed by intravenous injection of amphotericin B (AMB) combined with fluconazole. The daily administration of AMB was increased gradually from 0.25-1.50 mg/kg and the total dosage of 2-4 g should be achieved within 3 months. The combination therapy with fluconazole (400 mg/d ) was also given by intravenous injection. To increase penetration into cerebrospinal fluid, intrathecal injection of AMB had also been given at the maximum dosage of 1 mg every time, twice a week. Two patients were administered fluconazole (200 mg/d ) orally for 3, 6 months consecutively after completing the combination therapy of AMB with fluconazole, while the other patient refused continuous antifungal treatment 1 month postoperatively. All 3 patients were followed up for a period between 3, 24, 48 months. The 2 patients that completed full antifungal treatment were cured without recurrence. The other patient had improved transiently after operation but died after 3 months. Conclusions Because no distinct chnical and neuroimaging features are presented in ICFG, it is difficult to diagnose preoperatively. Indications for surgery include diagnosis, relief mass effect and increase efficiency of drug treatment. Use of appropriate and completed antifungal treatment decreases mortality. The treatment requires continued and long-term administration of antifungal medication to prevent relapses, whether granulomas are totally removed or not.
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Objective To investigate the change on monoamine neurotransmitter in cerebral cortex motor area of traumatic asphyxia canines and provide scientific basis for its therapy.Methods The model of canine traumatic asphyxia was established,the change on monoamine neurotransmitter in cerebral cortex (motor area) and the products of metabolism during different time were tested with HPLC DC method.Results At 2 h after damage in cerebral cortex 5 hydroxyindolecetic acid (5 HIAA) elevated remarkably; At 8 h after da mage 5 hydroxytryptamine (5 HT), homovanillic acid (HVA) elevated; but there was no obvious change on norepinephrine(NE) and 3,4 dihydroxyphenyl acetic acid (DOPAC).Conclusion The monoamine neurotransmitters might play an important role in the pathological course of secondary brain injury after traumatic asphyxia.The utilization of 5 HT antagonists or compound inhibitor at early stage was a reliable method for treating brain injury after traumatic asphyxia.