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Objective:To explore the risk factors of intracranial aneurysm interventional embolization for subarachnoid hemorrhage (SAH) perioperative infection.Methods:A retrospective analysis of the clinical data of 236 SAH patients who underwent aneurysm interventional embolization in the Department of Neurosurgery, Huangshan Shoukang Hospital from May 2018 to December 2019, and statistics of the surgical treatment effects and postoperative conditions of all patients, according to the perioperative Infective status in the early stage, the patients were divided into infected group ( n=44) and non-infected group ( n=192) according to the perioperative infection, and the clinical indicators of the patients were recorded, including age, gender, history of drinking, smoking history, history of diabetes, and whether there was any temporary blockade during the operation, aneurysm location, triacylglycerol, lipoprotein type, CT-Fisher classification, history of hypertension, aneurysm diameter, number, albumin, Hunt-Hess classification, Glasgow coma score (GCS) at admission, number of punctures. Measurement data were expressed as the mean ± standard deviation ( Mean± SD), comparison between groups was by t-test; count data comparison between groups was by Chi-square test. Logistic regression was used to analyze the risk factors of infection in SAH patients during perioperative period. Results:The treatment success rate of all SAH patients was 100%; the results of univariate analysis showed that the history of hypertension, aneurysm diameter, number, albumin, Hunt-Hess classification, GCS score at admission, and number of punctures were compared between infected group and non-infected group, the difference was statistically significant ( P<0.05); the results of multivariate Logistic regression analysis showed that history of hypertension, aneurysm diameter ≥8 mm, a large number of aneurysms, albumin ≤35.12 g/L, Hunt-Hess classification Grade Ⅲ to Ⅳ, GCS score> 5 points at admission, and number of punctures>2 times were risk factors for perioperative infection in SAH treated by interventional embolization of intracranial aneurysm; the total score of all factors in the nomogram prediction model was 314.84 points, the corresponding value was 14.96% of the perioperative infection rate of intracranial aneurysm interventional embolization for SAH. Conclusions:Interventional embolization of intracranial aneurysm for SAH can achieve good clinical results. However, history of hypertension, aneurysm diameter ≥ 8 mm, a large number of aneurysms, albumin ≤ 35.12 g/L, Hunt-Hess grade Ⅲ to Ⅳ, GCS score > 5 points at admission, number of punctures> 2 times are all independent risk factors leading to perioperative infection in patients, and clinical attention should be paid to and actively prevented.
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Objective To investigate the therapeutic effect of the fourth ventricle tumors through lateral wall type of the transcerebellomedullary fissure approach under endoscope.Methods Clinical data of 14 cases with the fourth ventricle lesions were analyzed retrospectively.All the patients were treated by lateral wall type of the transcerebellomedullary fissure approach surgery.The endoscope was used if the lesions develop to the aqueduct and hard to be exposed.Both neurophysiological monitoring and intraoperative ultrasound were used regularly.Results Tumors were totally removed in 12 cases,subtotally in 1,and partially in 1.All the patients were diagnosed in postoperative histopathology,including 4 medulloblastoma,three epidermoid cyst,two ependymoma,two hemangioblastoma,one meningioma,one cavernous hemangioma and 1 astrocytoma.Hypopnea occurred immediate after operation in 1 patient.Ventilatory support was performed by Ventilator,and the respiration was restored 1 day later.Normal cerebrospinal fluid circulation was return in all cases.Neither aggravation of preoperative symptoms nor nuclei injury related complication had been found.The follow-up interval between 3 months to 28 months,one patient was dead with unexplained,and 1 medulloblastoma patient was relapse.Conclusion Lateral wall type of the transeerebellomedullary fissure approach,under endoscope,combined with the usage of neurophysiological monitoring and intraoperative ultrasound,can degrade the surgical related complications such as facial palsy and amblyacousia.
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Objective To investigate the therapeutic effect of the hemilaminectomy approach in intraspinal tumor with the help of intraoperative ultrasound,high-speed drill and ultrasound knife.Methods Clinical data of 35 cases with the intraspinal tumor were analyzed retrospectively.All the patients were treated by hemilaminectomy approach,the position of the lesions were fixed by preoperative X-ray and intraoperative ultrasound,root of the spinous process were removed in order to achieve adequate visual field by high-speed drill and ultrasound knife.Electrophysiologic monitoring were used if the lesions were in the spinal cord.Results Total surgical resection was achieved in 32 cases,gross total resection was in 3 cases.Twenty-eight of the 35 cases were followed up.The symptom alteration of the first period ( 1 - 3 months postoperative):improved in 25 cases,no changed in 2 cases,aggravated in 1 case.The symptom alteration of the second period (6-24 months postoperative):no changed in all cases,no stability change of the vertebral column had been found.Conclusions Followed with the development of the electrophysiologic monitoring,high-speed drill,intraoperative ultrasound,the indication of the hemilaminectomy and have no influence of the spinal stability.However,to spinal meningioma which have a wide base,the hemilaminectomy approach may not adapt.
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Objective To approach operative technique for chronic sub, dural hematoma (CSDH).Method The clinical information including general state of health, operative technique and prognosis of the 250 cases with CSDH were retrospectively analyzed. Results Within the 250 cases, 202 were old people with age over 50 and 176 had definite trauma history. In 25 cases treated by burr hole and drainage, 5 cases who had hematoma recurrence and 10 cases who had pneumocephalus, among whom, 6 had tensional pneumoeephalus, were all cured by second operation while the rest got cured. In 207 cases treated by burr hole, douche and drainage, no pneumocephalus or intracranial infection occurred. Twenty of them relapsed and were cured by second operation. Cerebral contusion eccurred in 1 case for pipe was inserted into the brain tissue by mistake, but it got better after active therapy. The other 18 cases were all cured through eraniotomy,hematomas removal as well as envelope excision. Conclusions CSDH is common in the old with age over 50 and it has relationship with head injury,mostly. The single hole trepanation, douche and drainage is simple, safe ,with minimal trauma and high cure rate. To master the operative technique including douching thoroughly, drainage through a pipe and brain protection is very important to the success of the operation.