ABSTRACT
Objective To investigate the factors affecting the incidence of epilepsy after cranioplasty.Methods A retrospective case control study was conducted on the clinical data of 171 patients with skull defect who underwent cranioplasty between January 2012 and December 2015.There were 126 males and 45 females,with an average age of 50.9 years (range,16-78 years).The patients were divided into epileptic seizure group (61 cases) and non epileptic seizure group (110 cases).The gender,age,defect cause,defect location,defect duration,perioperative antiepileptic drug use,skull defect regional depression volume (Vd),skull defect regional integrity volume (Vf),skull defect regional depression rate (Pd) of two groups were recorded.Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factor of epilepsy after cranioplasty.Results All patients were followed up for 54 months averagely (range,18-90 months).Sixty-one patients (35.7％) had epilepsy after cranioplasty.Univariate analysis suggested that age,defect cause,defect location,defect duration,perioperative antiepileptic drug use,and Vf were not associated with epilepsy after cranioplasty (all P ＞ 0.05);while gender,Vd,and Pd was associated with epilepsy after cranioplasty (P ＜ 0.05).Multivariate logistic regression analysis demonstrated that Pd (OR =0.024,95％ CI 0.001-0.502,P ＜0.05) was independent predictor of epilepsy after cranioplasty.Conclusion Pd is an independent risk factor for epilepsy after cranioplasty and depression degree could significantly affect its incidence.
ABSTRACT
Objective To investigate the main technical points of detachable balloon in management of traumatic carotid-cavernous fistulas (TCCF) and evaluate objectively the clinical outcome.Methods A total of 59 patients with TCCF were treated with detachable balloons,which involved 64 embolization procedures.Follow-up ranged from 3 months to 2 years. Results Forty-eight patients with TCCF (81％) were successfully occluded with patency of internal carotid artery.The rest 11 patients were obstructed in both the fistula and the internal carotid artery.Recurrent TCCF was found within three days after embolization in five patients (with a recurrence rate of 8％ ) who underwent further embolization,of whom one patient went blind after the procedtre and the eyesight showed no recovery even after another embolization with balloon for successful occlusion of the fistula; one patient presented with intracerebral hematoma at day 3 postoperatively and underwent emergency embolization again to occlude the internal carotid artery and fistula,with slight paralysis of the left limb. Conclusions Embolization of TCCF with detachable balloon is a reliable treatment,which is characterized by slight injury and high safety.However,the disease' s development should be strictly observed after the treatment.In the case of recurrence of symptoms,brain angiography and CT scanning should be rechecked timely and emergency treatment should be performed.
ABSTRACT
Objective To investigate whether the macromolecular materials could enter cerebrospinal fluid and brain tissues in craniotomy with incision or non-incision of dura and arachnoid. Methods Adult male SD rats were randomly divided into three groups according to the random number table. The dura and arachnoid of rats in group A were cut open during craniotomy after general anesthesia; epidural craniotomy was done in rats in group B after general anesthesia; rats in group C (control group) were only generally anesthetized. All the rats were injected with Evans blue, a tracer used to detect the results, half an hour before each time point (1,3, 6, 12, 24, 72 hours and 1 week) via vein. The rats were executed at each time point to obtain the specimens of brain. The content of Evans blue in brain tissue was measured by fluorescence spectrophotometer for statistical analysis. The water content in the brain tissue was measured in a part of rats selected in groups A and B preoperatively and at postoperative 3 and 27 hours. Results It was found that some regions of the brain tissue were stained light blue in group A at 1,3, 6 and 24 hours. The blue was much lighter in brain tissue obtained at 72 hours in group A, and no blue stained at 1 week in group A . The contents of Evans blue in the brain tissues of rats in group A at 1,3, 6, 12, 24, 72 hours and 1 week were (18.07±1.25) μg/ml, (36.21±0.78) μg/ml, (25.73±1.14) μg/ml, (16.53±0.84) μg/ml, (23.34±1.91) μg/ml, (43.34±2.25) μg/ml and (25.27±1.88)μg/ml respectively, which were significantly higher than (3.15±0.45)μg/ml, (3.36±0.33)μg/ml, (2.98±0.54)μg/ml, (3.47±0.55)μg/ml, (3.54±0.37) μg/ml, (2.88± 0.42) μg/ml and (2.85±0.22) μg/ml respectively in group B and (2.97±0.37)μg/ml in group C (P<0.01). There was no significant difference in water content in brain tissue before and after operation (P>0.05). Conclusion After craniotomy with incision of dura and arachnoid, some macromolecular materials can enter the subarachnoid space and the brain parenehyma through blood-brain barrier of the wound of the scalp if the dura is sutured loosely.