Relationship between polymorphism of GDF-15 gene and susceptibility to chronic Keshan disease / 中华地方病学杂志

Objective To explore the relationship between single nucleotide polymorphism (SNP) locus rs1058587,rs1059519 and rs1059369 polymorphisms of growth differentiation factor-15 (GDF-15)gene and susceptibility to chronic Keshan disease in Gansu Province.Methods Using the case-control study method,56 individuals with chronic Keshan disease were taken as case group,and 53 individuals without chronic Keshan disease from the same villages were selected as control group in Gansu Keshan disease areas,venous blood samples were collected,and ethylenediamine tetraacetic acid disodium salt (EDTA) was used for anticoagulation,and the samples were sent for gene sequencing.Univariate and multivariate logistic regression analyses were conducted to analyze the influence of genotypes of rs1058587,rs1059519 and rs1059369 on the prevalence of chronic Keshan disease,and the risk factors for disease were expressed as odds ratio (OR).Results The age of the 56 patients in the case group was (60.93 + 21.99) years old,15 males and 41 females;the age of the 53 residents in control group was (47.49-+ 33.61) years old,26 males and 27 females.There was no significant difference in age between the two groups (t =46.16,P ＞ 0.05);the difference in gender was statistically significant (x2=5.76,P ＜ 0.05).The differences of allele frequencies of case group and control group rs1058587 (C:36.6％,32.1％,G:63.4％,67.9％),rs1059369 (A:61.6％,72.6％,T:38.4％,27.4％) between the two groups were not significantly different (x2 =0.50,3.00,P ＞ 0.05);the differences of allele frequencies of GDF-15 rs1059319 (C:25.0％,40.6％,G:75.0％,59.4％) between the two groups were significantly different (x2 =6.01,P ＜ 0.05).The genotype frequency distribution of GDF-15 gene rs1058587,rs1059519 and rs1059369 in the case group and the control group was not significantly different between the groups (P ＞ 0.05).However,in the case group,the mutant GG frequency of rs1059519 locus was higher than wild type CC (x2 =5.33,P ＜ 0.05).In multivariate logistic regression analysis,women were 3.81 times more likely to suffer from chronic Keshan disease than men,and people aged 45 or older were 5.30 times more likely to suffer from chronic Keshan disease than those younger than 45.The heterozygous and mutant types of GDF-15 gene rs1058587 and rs1059369 were compared with wild type,and the difference was not statistically significant (ORrs1058587 =0.46,0.50,ORrs1059369 =1.30,2.59,P ＞ 0.05);there was no significant difference between the heterozygous type of GDF-15 gene rs1059519 and wild type (OR =3.34,P ＞ 0.05),and the difference between the mutant and wild type was statistically significant (OR =8.58,P ＜ 0.05).Conclusions In this study,we find women of the study population are more likely to have chronic Keshan disease than men,and aged≥45 is a risk factor for chronic Keshan disease.Genetic polymorphisms of GDF-15 gene rs1058587,rs1059369 are not associated with susceptibility to chronic Keshan disease,and a certain correlation between genetic polymorphism of rs1059519 locus and susceptibility to chronic Keshan disease.

Implement of multimodal navigation-based virtual reality in the needle biopsy of intracranial eloquent lesions / 中华外科杂志

Objective@#To investigate the clinical value of multimodal navigation-based virtual reality (MNVR) in the needle biopsy of intracranial eloquent lesions.@*Methods@#From January 2016 to January 2017, 20 patients with intracranial deep-seated lesions involving eloquent brain areas underwent MNVR-aided needle biopsy at Department of Neurosurgery, People′s Liberation Army General Hospital. Preoperatively, MNVR was used to propose and revise the biopsy planning. Intraoperatively, navigation helped trajectory avoid the eloquent structures. Intraoperative MRI (iMRI) was performed to prove the biopsy accuracy and detect the intraoperative complications. Perioperative neurological status, iMRI findings, intraoprative complications, surgical outcome and pathological diagnosis were recorded. Wilcoxon rank-sum test was conducted to compare the preoperative and postoperative neurological scores.@*Results@#MNVR helped revised 45%(9/20) initial biopsy trajectories, which would probably injury the nearby eloquent structures. Navigation helped biopsy trajectories spare the eloquent structures during the operation. No statistical difference was found between postoperative and preoperative neurological status, despite all the lesions were adjacent to eloquent areas. Additionally, 20 patients totally received 21 iMRI scanning. iMRI helped revise incorrect biopsy site in one case and detected intraoperative hemorrhage in another case, both of cases were treated immediately and effectively. No MNVR related adverse events and complications occurred.@*Conclusions@#MNVR-aided needle biopsy of intracranial eloquent lesions is a safe, novel and efficient biopsy modality. This technique is helpful to reduce the incidence of surgery related neurological deficits.

Treatment for giant pituitary adenomas through transcranial approach in a series of 112 consecutive patients / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical features, surgical transcranial approaches and outcomes of giant pituitary adenomas.</p><p><b>METHODS</b>A series of 112 consecutive cases of giant pituitary adenomas underwent microsurgery through transcranial approaches at People' s Liberation Army General Hospital were retrospectively analyzed. Of the 112 patients, 58 were male and 54 were female, with age ranging from 3 to 72 years(mean age 44. 3 years). There were 91 non-functioning adenomas and 21 hormone-secreting adenomas. The maximum tumor diameter varied from 4. 0 to 7. 2 cm, with mean diameter of 4. 8 cm. Unilateral subfrontal approach was chosen in 16 cases, pterional approach in 41 cases, anterior interhemispheric approach in 34 cases, transcallosal-interforniceal approach in 6 cases, transcortical- transventricular approach in 5 cases, combined approach in 6 cases and other approaches in 4 cases. Postoperative MRI and endocrine function were re-examined routinely to evaluate the therapeutic efficacy. Staged operation through transsphenoidal approach or adjuvant treatments including medical and radiation therapies were administered in patients with hormone-secreting adenomas when hormonal excess persisted after surgery and in patients with non-functioning adenomas who had postoperative MRI evidence of residual tumor.</p><p><b>RESULTS</b>Total removal of the lesion was achieved in 57 cases (50. 9%) , 26 patients (23. 2%) underwent subtotal resection, and 29 patients (25. 9%) underwent partial removal. Postoperative mortality occurred in 3 patients (2. 7%). Major surgical morbidity occurred in 38 patients (33. 9%). Vision was preserved or improved in 98 patients (87. 5%). The postsurgical follow-up period varied from 3 to 64 months (mean 19. 5 months) . Nineteen of the 21 patients with hormone-secreting adenomas were considered to be in hormonal remission, and 87. 2% of the cases were capable of normal work and life and 8 patients suffered recurrence during the followed-up period.</p><p><b>CONCLUSIONS</b>Selection of appropriate transcranial approaches is the key to successful microsurgery for giant pituitary adenomas according to the morphological characteristics presented in image examinations and clinical symptoms. Staged transsphenoidal operation and/or adjuvant therapies including medical and radiation therapies offer the best chances to control the residual tumors after the maximal surgical removal of giant adenomas through transcranial approaches.</p>

Intraoperative high-field magnetic resonance imaging combined with functional neuronavigation in resection of low-grade temporal lobe tumors involving optic radiation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical value of high-field-strength intraoperative magnetic resonance imaging (iMRI) combined with optic radiation neuro-navigation for the resection of temporal lobe low-grade gliomas.</p><p><b>METHODS</b>From April 2009 to September 2013, 65 patients with temporal lobe low-grade gliomas (WHO grade II) involving optic radiation were operated with iMRI and functional neuro-navigation. Diffusion tensor imaging (DTI) based fiber tracking was used to delineate optic radiation. The reconstructed optic radiations were integrated into a navigation system, in order to achieve intraoperative microscopic-based functional neuro-navigation. iMRI was used to update the images for both optic radiations and residual tumors. Volumetric analyses were performed using 3D Slicer for pre- and intra-operative tumor volumes in all cases. All patients were evaluated for visual field deficits preoperatively and postoperatively. The Student t test was used to evaluate the average rate of extent of resection between groups. Spearman rank correlation analysis was used to assess correlations between predictors and epilepsy prognosis.</p><p><b>RESULTS</b>Preoperative tumor volumes were (78±40) cm3. In 29 cases, iMRI scan detected residual tumor that could be further resected, and extent of resection were increased from 76.2% to 92.7% (t=7.314, P<0.01). In 19 cases (29.2%), gross total resection was accomplished, and iMRI contributed directly to 8 of these cases. Postsurgical follow-up period varied from 13 months to 59 months, mean (33±13) months. Tumor progression were observed in 3 patients, newly developed or deteriorated visual field defects occurred in 4 patients (6.2%). For patients with pre-operative seizures, Engel Class I were achieved for 89.7% of them. Spearman rank correlation analysis revealed that seizure outcome (Engel Class) was related to increased excision of ratio (r=-0.452, P=0.004, 95% CI: -0.636--0.261) and larger tumors (r=0.391, P=0.014, 95% CI: 0.178-0.484).</p><p><b>CONCLUSIONS</b>With iMRI and functional neuro-navigation, the optic radiation can be accurately located, while extent of resection can be evaluated intra-operatively. This technique is safe and helpful for preservation of visual field for the resection of temporal lobe low-grade gliomas involving optic radiation.</p>

Study on the Accuracy and Reliability of the ABC/2 Formula for Volume Assessment of Intracerebral He-matoma / 中国神经精神疾病杂志

Objective To investigate the accuracy and reliability of the ABC/2 formula for measurement of intrace?rebral hematoma (ICH) volume by comparing it with software 3D-Slicer. Methods Computed tomographic image data of 184 patients with spontaneous ICH were collected. Hematoma volumes were estimated by using the ABC/2 formula and 3D-Slicer. Based on the volume calculated by 3D-Slicer, patients were further divided into three groups. Group 1 con?tained 55 patients with volume less than 30 ml, group 2 contained 68 patients with volume of 30-60 ml, and group 3 con?tained 61 patients with volume larger than 60 mL. Shape of the ICH was divided into regular (59 cases), irregular with frayed margins (107 cases) and multilobular (18 cases). Results of these two methods were compared according to hemato?ma size and shape. Results The estimated hematoma volume was (58.85 ± 37.38) mL in the ABC/2 formula and (50.08 ± 31.10) mL in 3D Slicer. The ABC/2 formula produced a mean overestimation of 8.77 mL and the mean percent deviation was 17.23%. The mean estimation errors were 2.90 mL (16.22%), 5.89 mL (13.55%), and 17.27 mL (18.76%) in groups 1, 2, and 3 when patients were grouped by hematoma size. The estimation errors were 3.46mL (8.76%), 7.99 mL (17.26%), and 30.81 mL (38.26%) in regular, irregular and multilobular hematomas when patients were grouped by shape. Conclusions The ABC/2 formula is a rough method for volume assessment of intracerebral hematoma and produc?es significant estimation errors. The size of estimation errors largely depends on hematoma shape.

The clinical diagnosis and treatment of blood-blister-like cerebral aneurysms in supra-clinoid segment of internal carotid artery / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics, surgical principles and treatment options of blood-blister-like cerebral aneurysms in supra-clinoid segment of internal carotid artery.</p><p><b>METHODS</b>Twelve blood-blister-like aneurysms were retrospectively studied including 4 open-surgery cases and 8 endovascular-treated cases from November 2008 to December 2012. Patients comprised 8 female and 4 male patients, whose mean age was 46.6 (range 38-56) years. Eleven patients presented with severe headache as the primary symptom, and 1 patient was found with aneurysm incidentally. Preoperative Hunt-Hess graded 0 in 1 patient, graded I in 5 patients, graded II in 4 patients, and graded III in 2 patients. By DSA examinations, 4 blood-blister-like aneurysms located in anterior wall and 8 in medial-anterior wall of supra-clinoid segment of internal carotid artery. Open surgical treatment included direct clipping, trapping, or wrapping and interventional treatment included stent-assisted coiling or simple stent placement. Intra-operative electroencephalogram and somatosensory evoked potentials monitoring was regularly used. Microvascular Doppler ultrasonography and indocyanine green videoangiography were used to assess blood flow in parent and branch vessels. The patients were followed up at 6 months by CT angiography (CTA) examination in outpatient clinic.</p><p><b>RESULTS</b>For 4 open surgeries, 2 aneurysms were directly clipped, 1 was trapped and 1 was wrapped. The patient underwent trapping paralyzed postoperatively. For endovascular treatment, 6 patients were coiled assisted with stents and 2 patients were treated with simple stent placement. All the patients were followed with a mean follow-up time of 16 months (range, 6-61 months). At 6 months follow-up, 3 out of 4 surgical treated patients had good outcome and 1 was moderately severe disabled by modified Rankin scale; 1 patient underwent wrapping recurred and was transferred to endovascular treatment. Of the 6 patients treated with stent-assisted coiling, 4 patients were recurrent and coil replacements were performed. Two patients with simple stent placement had no recurrences.</p><p><b>CONCLUSIONS</b>Blood-blister-like aneurysm is a special type of complex cerebral aneurysm. Comprehensive understanding of blood-blister-like aneurysm is the key to successful treatment.Open surgery is difficult procedure with high risk and complications while stent-assisted coiling has a high recurrent rate. To date, neither is the safe and effective treatment option.</p>

The surgery of giant symptomatic cavernous sinus aneurysms / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the management and outcomes in patients with giant symptomatic cavernous sinus aneurysms who underwent aneurysms trapping with bypass, proximal carotid occlusion and aneurysms trapping.</p><p><b>METHODS</b>Twenty-three patients with giant symptomatic cavernous sinus aneurysms underwent surgery between February 2007 and March 2013, 3 cases were male and 20 cases were female patients, the age of the patients ranged between 24 and 68 years, mean age was 54.7 years. The pre-operative digital subtraction angiography (DSA) and ballon occlusion test (BOT) were performed to confirm the diagnosis and identify hemodynamic reserve with carotid occlusion, and the aneurysms trapping with bypass, aneurysms trapping and proximal occlusion of the internal carotid artery were performed according to BOT results. During the surgery, the neurophysiological monitoring and the intraoperative CT perfusion were used. The follow-up by DSA or CT angiography were made.</p><p><b>RESULTS</b>Seventeen patients underwent aneurysms trapping with bypass, 1 underwent aneurysms trapping and 5 underwent proximal occlusion of the internal carotid artery. After surgery, symptom improved in 4 cases, did not change in 10 cases, and new neural function deficit developed in 9 cases. The follow-up period were 3 months to 75 months. Two patients were lost. The Glasgow Outcome Scale of last follow-up were 5 in 19 patients, 3 in 1 patient and 1 in 1 patient.</p><p><b>CONCLUSIONS</b>The aneurysms trapping with bypass and proximal occlusion of the internal carotid artery are effective and reliable procedure for treatment of giant symptomatic cavernous sinus aneurysms in selected patients after evaluation of the pre-operative BOT, intra-operative neurophysiological monitoring and the intraoperative CT perfusion.</p>

Automated proton magnetic resonance spectroscopy imaging guided frameless stereotactic biopsy of intracranial lesions / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility, reliability and accuracy of the automated magnetic resonance spectroscopy ((1)H-MRS) guided frameless brain biopsy with intraoperative magnetic resonance imaging (iMRI).</p><p><b>METHODS</b>Between July 2011 and July 2013, a consecutive series of 93 patients were prospectively enrolled. All the patients had intracranial lesions which need biopsy to confirm the diagnosis. Among them, 48 patients were male, 45 patients were female. Their age range from 7 years to 76 years, the median age was 47 years. All patients underwent MRS examination. With MRS automatic fusion technique, the metabolic images were integrated into a standard navigation system (Vario Guide) to guide frameless biopsy. High-field iMRI (1.5 T) was used for target inspection, brain shift correction, and intra-operative exclusion of intra-cerebral hemorrhage and other complications.</p><p><b>RESULTS</b>For all the 93 patients, (1)H-MRS based metabolic images could be automatically integrated into a standard navigation system and average fusion procedure could be taken 5 minutes 6 seconds. For (1)H-MRS guided stereotactic biopsy of intracranial lesions, the diagnosis yield rate was 94.6% (88/93). Four cases did not get a clear pathological diagnosis, while 1 case did not match the pathological diagnosis result which obtained by following craniotomy. Technical related complication rate was 2.2% (2 cases, intra-cerebral hemorrhage), which were intra-operatively depicted with iMRI, and managed properly. Among them, 1 case with small volume (5 ml) intracerebral hematoma fully recovered 10 days after surgery without second surgical intervention. One case with large volume intracerebral hematoma (32 ml) was depicted with iMRI, followed by craniotomy and hematoma evacuation in the same session. This case had no new or worsened neurologic deficit post-operatively.</p><p><b>CONCLUSIONS</b>(1)H-MRS based metabolic imaging can be automatically integrated into a standard navigation system and used for frameless brain biopsy. The target can be selected according to the metabolic status of the lesion. Hence, the target can be more accurate. And the pathological diagnosis yield rate is higher. With iMRI, the method is safe, and has high clinical efficacy.</p>

Individualized surgical treatment of complex middle cerebral artery aneurysms / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize individualized surgical treatment strategies for complex middle cerebral artery (MCA) aneurysms.</p><p><b>METHODS</b>Twenty patients with complex MCA aneurysms treated by microsurgery in Chinese People's Liberation Army General Hospital between December 2009 and November 2012 were retrospectively analyzed. There were 12 male and 8 female patients, with a mean age of 43 years (range: 14-58 years). Giant aneurysms (size > 2.5 cm) were found in 6 cases, wide-neck aneurysms in 7 cases and serpentine ones in 3 patients. Important perforators were involved in aneurysm neck in 2 cases. Important branches originated from aneurysms in 6 patients. Two patients harbored recurrent aneurysms after coiling. Individualized surgical strategies were planned according to preoperative imaging. A frontotemporal approach was routinely used. Intraoperative somatosensory evoked potential monitoring, indocyanine green videoangiography and microvascular Doppler ultrasonography were regularly used. A postoperative digital subtraction angiography (DSA) or computed tomography angiography (CTA) was performed to verify the efficacy of treatment and patency of bypass vessels.</p><p><b>RESULTS</b>Of the 20 cases, 7 aneurysms were clipped with clipping and reconstruction of parent artery with multiple clips, 3 M1 segment aneurysms were proximally occluded with extra-intracranial high-flow revascularization, 2 aneurysms were treated with aneurysmectomy with superficial temporal artery to middle cerebral artery low-flow revascularization, 1 aneurysm was treated with aneurysmectomy with superficial temporal artery to middle cerebral artery low-flow revascularization and branch side-to-side anastomosis, 2 aneurysms were treated with aneurysmectomy and re-anastomosis of parent artery, 1 aneurysm was treated with aneurysmectomy and re-anastomosis of parent artery and reinplantation of lenticulostriate artery, 3 bilateral MCA aneurysms were clipped by unilateral approach, and 1 was trapped. Nineteen patients were favorable with Glasgow Outcome Scale score 4-5 at discharge, and 1 patient died of cardiac infarction one week after surgery. The mean clinical follow-up was 20 months (range: 6-39 months). During follow-up, no bleeding occurred. DSA or CTA confirmed absence of aneurysm in 14 cases and residual neck in 2 patients. The other 3 patients were lost to follow-up.</p><p><b>CONCLUSIONS</b>Individualized, multi-modality surgical treatment strategies are effective and safe solution for treatment of complex MCA aneurysms. Revascularization remains imperative surgical technique.</p>

Effects of vagus nerve stimulation on neuroprotective mechanism of cerebral ischemia in rats / 中国脑血管病杂志

Objectives To investigate the neuroprotective mechanism of vagus nerve stimulation ( VNS) by stimulating the vagus nerve in ischemic cerebral tissue in a rat model of transient focal cerebral ischemia. Methods Twenty-six adult male Sprague-Dawley ( SD ) rats were randomly divided into sham operation group (n=6),model group (n=10),and VNS-treated group (n=10) . The model of rat transient focal cerebral ischemia was induced by the intraluminal suture method. At 30 min after modeling,the right side neck VNS in the VNS-treated group was stimulated ( stimulus intensity 0. 5 mA, interval 0. 5 ms, frequency 20 Hz),once every 5 min within 1 h,and once for 30 s. The model group repeated the steps of the VNS-treated group,but did not stimulate. The sham operation group repeated the experimental steps,but it neither embolized the vessels nor stimulated nerves. The changes of cerebral blood flow were monitored with a laser Doppler flowmeter. The rats were sacrificed after 24 h. The expressions of interleukin 6(IL-6) and caspase-3 in brain tissue were determined by immunohistochemistry staining. The neuronal apoptosis was observed by the in situ end-labelling technique. Results ( 1 ) Compared with the sham operation group, the number of positive cells of IL-6,caspase-3,and the numbers of neuronal apoptosis in the model group were significantly increased (20. 7 ± 5. 0 cells/HP vs. 2. 3 ± 1. 0 cells/HP,44. 5 ± 9. 5 cells/HP vs. 0,30. 9 ± 9. 0 cells/HP vs.0).Thereweresignificantdifferences(P0. 05). Conclusion The neuroprotective mechanism of VNS for cerebral ischemia may be associated with the inhibition of neuronal apoptosis and decreasing inflammatory response. It may not be associated with the changes of cortical cerebral blood flow.

Cleaning the surveillance data of Keshan disease in 2009, China / 中华地方病学杂志

Objective To investigate potential problems and solutions within the data of national surveillance of Keshan disease(KSD), to improve the quality of surveillance data and the reliability of the results. Methods Four key variables (name, sex, age, and KSD diagnosis) in the national surveillance data of KSD in 2009 were cleaned by SPSS 15.0. Cleaning contents included duplicate records, missing values, outliers and logic errors. Name, sex, age, currently residing in townships and currently residing in villages and other variables were combined into different filters to find duplicate records by the command of Identify Duplicate Cases , then the duplicate records were returned to the data reporting agencies, and finally delete or merge. Data with missing values, outliers, or logical errors were found by commands of Frequencies, Descriptives and Select if, then the duplicate records were returned to the data reporting agencies. Data were revised based on not only the feedback , but also by using the relationship between variables, and by consulting KSD clinical experts. Results Four hundred and sixty-four cases of duplicate records were found and cleaned. The number of missing values was 2 047 (specifically, name 0, sex 3, age 32 and KSD diagnosis 2 012). The number of outliers was 1 988 (specifically, name 6, sex 3, age 10 and KSD diagnosis 1 969). The records of 5 kinds of logic errors of KSD diagnosis were 105 in all. Conclusion There are duplicate records, missing values, outliers and logic errors in the national surveillance data of KSD, cleaning work could improve the quality of surveillance data, ensure the authenticity and rliability of the monitoring data.

Protective effect of vagus nerve stimulation on ischemic brain injury in rats:a preliminary study / 中国脑血管病杂志

Objective To investigate the neuroprotective effect of vagus nerve stimulation ( VNS) on a model rat of focal cerebral ischemia. Methods A total of 42 adult male Sprague-Dawle ( SD) rats were randomly divided into a sham operation group (n=10),a model group (n=16),and a VNS-treated group ( n = 16 ) . Each group was randomly redivided into 2 subgroups:left VNS subgroup and right VNS subgroup. A model of focal cerebral ischemia (2 h) in rats was induced by the intraluminal suture method. At 30 minutes after modeling, the VNS-treated group received cervical VNS, the stimulation intensity was 0. 5 mA,the interval was 0. 5 ms,and the frequency was 20 Hz. Stimulation was once every 5 min within 1 h and each lasted for 30 s. The model group did not give any stimulation. Neither blood vessels were embolized nor were the nerves stimulated in the sham operation group. The changes of somatosensory evoked potentials ( SEP) on the lesion sides during operation were monitored. At 24 h after modeling,the neurobehavioral scores were performed. The rats were sacrificed,and their brain infarct volume was measured. Results (1) During the stimulation of left VNS in rats,the neurobehavioral scores of the sham operation group,model group and VNS-treated group were 0. 4 ± 0. 2,9. 5 ± 0. 4,6. 4 ± 0. 3,respectively;during the stimulation of right VNS in rats,the neurobehavioral scores of the 3 groups were 0. 6 ± 0. 2,9. 3 ± 0. 4,and 6. 9 ± 0. 4,respectively. There were significant differences between the scores of the model group and those of the other 2 groups (P0. 05). Conclusion No matter whether to stimulate the left or right vagus nerves, they both have neuroprotective effects on ischemic brain injury, and there was no significant difference on the action effects.

Outcome of Endoscopic Transsphenoidal Surgery in Combination with Somatostatin Analogues in Patients with Growth Hormone Producing Pituitary Adenoma

OBJECTIVE: To determine the efficacy of endoscopic surgery in combination with long-acting somatostatin analogues (SSAs) in treating patients with growth hormone (GH)-secreting pituitary tumor. METHODS: We performed retrospective analysis of 133 patients with GH producing pituitary adenoma who underwent pure endoscopic transsphenoidal surgery in our center from January 2007 to July 2012. Patients were followed up for a range of 3-48 months. The radiological remission, biochemical remission and complication were evaluated. RESULTS: A total of 110 (82.7%) patients achieved radiological complete resection, 11 (8.2%) subtotal resection, and 12 (9.0%) partial resection. Eighty-eight (66.2%) patients showed nadir GH level less than 1 ng/mL after oral glucose administration. No mortality or severe disability was observed during follow up. Preoperative long-acting SSA successfully improved left ventricle ejection fraction (LVEF) and blood glucose in three patients who subsequently underwent success operation. Long-acting SSA (20 mg every 30 days) achieved biochemical remission in 19 out 23 (82.6%) patients who showed persistent high GH level after surgery. CONCLUSION: Endoscopic transsphenoidal surgery can biochemically cure the majority of GH producing pituitary adenoma. Post-operative use of SSA can improve biochemical remission.

Reliability and accuracy of arcuate fasciculus navigation: analysis of 43 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the reliability and accuracy of arcuate fasciculus (AF) navigation for AF localization and reconstruction.</p><p><b>METHODS</b>Reconstruction of the AF and assessment of the aphasia quotient (AQ) were performed in 43 cases before and after surgical removal of lesions in the language area of the brain. The minimal distance between the AF and the lesion (D(1)), preoperative AQ (AQ(1)), the minimal distance between the AF and the surgical cavity (D(2)), and the postoperative AQ (AQ(2)) were measured. Linear correlation analysis was conducted between D(1) or D(2) and the corresponding AQ(1) or AQ(2) to assess the relationship between the AF and language function. The language function of each patient was evaluated postoperatively.</p><p><b>RESULTS</b>The AF was successfully reconstructed in all the cases. The tractography results of the identical AF generated by 3 different users showed good congruency. A positive linear correlation was demonstrated between D(1) and AQ(1) (P<0.001) and between D(2) and AQ(2) (P=0.001). Only two patients (4.7%) showed language deficits at postoperative follow-up.</p><p><b>CONCLUSION</b>AF navigation is a reliable and accurate technique for AF reconstruction and localization and helps to preserve the language function after surgical removal of lesions in the language area of the brain.</p>

Individualized fluid-solid coupled model of intracranial aneurysms based on computed tomography angiography data / 南方医科大学学报

<p><b>OBJECTIVE</b>To establish an individualized fluid-solid coupled model of intracranial aneurysms based on computed tomography angiography (CTA) image data.</p><p><b>METHODS</b>The original Dicom format image data from a patient with an intracranial aneurysm were imported into Mimics software to construct the 3D model. The fluid-solid coupled model was simulated with ANSYS and CFX software, and the sensitivity of the model was analyzed. The difference between the rigid model and fluid-solid coupled model was also compared.</p><p><b>RESULTS</b>The fluid-solid coupled model of intracranial aneurysm was established successfully, which allowed direct simulation of the blood flow of the intracranial aneurysm and the deformation of the solid wall. The pressure field, stress field, and distribution of Von Mises stress and deformation of the aneurysm could be exported from the model. A small Young's modulus led to an obvious deformation of the vascular wall, and the walls with greater thicknesses had smaller deformations. The rigid model and the fluid-solid coupled model showed more differences in the wall shear stress and blood flow velocity than in pressure.</p><p><b>CONCLUSION</b>The fluid-solid coupled model more accurately represents the actual condition of the intracranial aneurysm than the rigid model. The results of numerical simulation with the model are reliable to study the origin, growth and rupture of the aneurysms.</p>

The cardiac function changes before and after pituitary tumor resection in patients with pituitary adenoma complicated with dilated cardiomyopathy / 中华内科杂志

Objective To evaluate the cardiac function changing before and after resection of pituitary tumor in patients with pituitary adenoma complicated with dilated cardiomyopathy with retrospective analysis method.Methods The clinical data of 14 cases of patients with pituitary adenoma complicated with dilated cardiomyopathy,treated with resection of pituitary tumor,in PLA General Hospital,from 2005 to 2011,were collected and analyzed.Comparative analysis of cardiac function were made in these patients before and after the surgery,also with the postoperative recovery status,using echocardiography and other noninvasive detection means to detect the growth hormone ( GH),left ventricular end-diastolic diameter (LVEDD),septal thickness (ST),left ventricular posterior wall thickness (LVPWT),left ventricular ejection fraction (LVEF) values.Results After the resection of pituitary tumor,the LVEDD,ST,LVPWT,LVEF levels were all significantly better than that before the surgery.Before the surgery the GH,ST,LVPWT,LVEF levels were 93.89 μg/L,11.13 mm,43.92％ and 10.53 mm,while those after the surgery were 5.16 μg/L,10.64 mm,49.28％ and 8.87 mm.The difference of the GH level before and after the surgery was correlated with the difference of ST,LVEDD and LVEF in a linear manner.Conclusions Recection of pituitary tumor can significantly improve the cardiac function in patients with pituitary adenoma complicated with dilated cardiomyopathy,and the cardiac function improving level is correlated with the difference of GH levels before and after the surgery.

Application of Dextroscope operation planning workstation in intracranial lesion operations Preoperative images reconstruction, simulation and dissection / 中国组织工程研究

The data of 30 patients simulated before surgery were analyzed using Dextroscope operation planning system in Department of Neuresurgery,General Hospital of Chinese PLA between August 2004 and September 2005,including 2 patients with basilar artery aneurysm,1 with posterior cerebral artery aneurysm,3 with ophthalmic aneurysm,2 with middle cerebral artery aneurysms,1 with anterior cerebral artery aneurysm,7 atlas-occipital malformation,4 meningioma,5 schwannomas,and 5 deep gliomas. The primary CT and MRI data of 30 patients were input to the workstation of Dextroscope system for 3D reconstruction,reunion,segmentation and simulation the entire process of the operation. The relationship of the cranial nerves,vessels and skull base bone with lesions during operations were similar with that of the preoperative simulation on the workstation. The time of clipping aneurysms was reduced from (37.60±13.43) minutes to (23.51±7.62) minutes following application of Dextroscope system,and time of resections of odontoid processes was shortened from 81 minutes to 50 minutes. The ratios of complications were decreased and the patients' Karnofsky scales were 88.7 scores 3 months after operation. Dextroscope operation planning system can help doctors to analyze the patients' image data on a 3-D view and video outlook. The system can raise a precise and detailed operation plan before operation based on the simulation of the operation process,to well know the difficulty and shorten operation duration.

Spontaneous and evoked facial muscle electromyogram in monitoring nervous function in acoustic neuroma surgery and nervous prognosis: A character analysis in 120 cases / 中国组织工程研究

BACKGROUND: The anatomical position of facial nerve is often abnormal because of the acoustical neuroma growth, so sometimes, the facial nerve injury is inevitable in the surgery treatment for acoustic neuroma.OBJECTIVE: To investigate the technology, veracity and practicality as well as the relationship between intraoperative monitorning and prognosis of facial nerve, and the clinical experiment was summed up of facial nerve function monitoring in 120 cases of acoustic neuroma surgery.DESIGN: Self-control observation.SETTING: Department of Neurosurgery, General Hospital of Chinese PLA.PARTICIPANTS: Totally 120 patients with acoustic neuroma who received treatment in the Department of Neurosurgery, General Hospital of Chinese PLA from May 1996 to February 2000 were recruited. Among them, 3 cases suffered from small-type acoustic neuroma (＜ 2 cm in diameter), 9 cases from middle-type acoustic neuroma (＞ 2 cm in diameter) and 108 from large-type acoustic neuroma (＞ 3 cm in diameter), including 1 case of bilateral acoustic neuroma and 1 cases of recrudescent acoustic neuroma; Suboccipital retromastoid approach was used in 119 cases and transretrolabyrinthine approach in 1 case.METHODS: American Viking-Ⅳ type monitor was used to monitor facial nervous function. When facial nervous function was monitored, recording electrode was put on orbicular muscle of eye, orbicular muscle of mouth or quadrate muscle of upper lip. When trigeminal motor branch was monitored, recording electrode was put on masseter muscle; When accessory nerve was monitored, recording electrode was put on trapezius muscle.Measurement of evoked auditory brainstem potential: recording electrode was positive electrode and was put at the midline in the frontal region (electroencephalogram 10-20 classification system). The recorded waveshape presented upward deflection. Reference electrode A1 or A2 and ground electrode were put in the midline of frontal pole (relevant to root of nose); Recording electrodes were all needle electrodes and were fixed with adhesive tape. Common stimulus intensity was 80 to 90 nHL, and 40 nHL noise was used in contralateral ear. Facial nerve was reserved following intraoperative monitoring. CT (enhancement scanning was necessary) or MRI was rechecked after operation to investigate the cutting degree of tumor; Facial nerve function was evaluated by H-B scoring (at 2 weeks, or 6 to 9 months following operation).MAIN OUTCOME MEASURES: Facial nerve function by H-B scoring before and after acoustic neuroma surgery.RESULTS: Totally 120 patients were enrolled, and no one dropped out.① Facial nerve anatomy was reserved in 117 cases; One case was failure to reserve facial nerve anatomy because pinnate facial nerve lay behind of acoustic neuroma, and electrical stimulation was not given at the beginning of neuroma resecting, then he received anastomosis of hypoglossal and facial nerve. Nerve of 2 cases was pulled and broken carelessly, and its two stumps were long enough that end-to-end anastomosis of facial nerve was performed with 7-0 absorbable suture following trimming. H-B score was Ⅳ to Ⅴ in the 6th month after surgery. ②Grade Ⅰ of facial nervous function at postoperative 2 weeks was found in 10 cases, grade Ⅱ in 57 cases,grade Ⅲ in 44 eases, grade Ⅳ in 4 cases, grade Ⅴ in 2 cases and gradeⅥ in 3 cases. ③Grade Ⅰ of facial nervous function at postoperative 9 weeks was found in 94 cases, grade Ⅱ in 18 cases, grade Ⅲ in 4 cases,grade Ⅳ in 1 case and grade Ⅵ in 2 cases.CONCLUSION: Spontaneous and evoked facial muscle electromyogram may be helpful to make sure the facial nervous position exactly and estimate the prognosis of facial nerve.

EXPOSURE OF THE DISTAL INTERNAL CAROTID ARTERY IN CAROTID ENDARTERECTOMY / 解放军医学杂志

Exposure of the distal internal carotid artery is very important and difficult in carotid endarterectomy for patients with high bifurcations or extension of the atherosclerotic plaque into the distal internal carotid artery. Exposure techniques are introduced based on the surgical experiences of 28 cases.

CAROTID ENDARTERECTOMY FOR PATIENTS WITH CONTRALATERAL CAROTID OCCLUSION / 解放军医学杂志

To assess the indication, intraoperative monitoring with selective shunting and surgical outcomes of carotid endarterectomy for patients with contralateral carotid occlusion, the clinical manifestations, imaging data, surgical methods and results of 16 patients were analysed retrospectively. It was verified that the surgical risk of these patients was not as high as prediction,satisfactory results coold be achieved with intraoperative monitoring, selective shunting and skilled surgical techniques. It is reasonable to offer the following typical treatment examples: Carotid endarterectomy should be performed for patients with symptomatic carotid stenosis irrespective of the contralateral carotid occlusion, while medical therapy should be maintained for patients with asymptomatic carotid stenosis and contralateral carotid occlusion. maintained. If the asymptomatic stenosis is found to be progressing in noninvasive testing, then a prophylactic endarterectomy should be considered.