Microsurgical treatment of solid hemangioblastoma in medulla oblongata / 中华显微外科杂志

Objective To report the clinical features,microsurgical techniques and outcomes of 5 patients admitted in our hospital,who had solid hemangioblastoma in medulla oblongata in the last 5 years.Methods 5 consecutive cases of solid hemangioblastoma in medulla oblongata operated from March,2011 to May,2016 were reviewed and fl lowed up.Results All patients suffered headache,dizziness and cerico-occipital pain from the beginning plus one was found because of obstructive hydrocephalus.The mean duration before operation was 6.7 months.The mean maximum diameter of tumor was (33.7±3.4)mm.The suboccipital posterior midline approach was performed and gross total resection was achieved in all 5 cases.After operation,endotracheal tube was removed in all 5 patients,but 3 received tracheotomy,and all patients can take food freely now through rehabilitation exercise.Followed up until September 2016,all patients lived a normal life.Conclusion The operation of solid hemangioblastoma in medulla oblongata is full of huge risk,but microsurgical resection is the only cure means for the tumor.

Application of simultaneous monitoring of cortical EEG and scalp EEG during anterior circulation aneurysm surgery / 国际脑血管病杂志

Objective To develop a simple and effective method for monitoring cortical ischemia after temporary occlusion of the parent arteries during anterior circulation intracranial aneurysm surgery. Methods Fifty-two patients with anterior circulation aneurysm (58 aneurysms) received craniotomy from April to November 2008, and at the same time,cortical electroencephalograpby (EEG) and scalp EEG were monitored during the surgery.According to the international 10/20 electrode placement system, scalp electrodes were placed on O1, O2, P3, P4, T5, and T6 for monitoring the changes in the depth of anesthesia. A cortical strip electrode was placed on the cortical surface supplied by the artery that was possibly blocked during the operation, which was used to monitor the possible cortical ischemia. For patients who had cortical EEG suppression after the temporary occlusion of the parent arteries Were compared with the changes of scalp EEG. Whether there were ischemic events in the corresponding supply territory after vascular occlusion were observed after surgery. Results Of the 58 aneurysms, 40 aneurysms and 41 major arteries were occluded temporarily. After being occluded temporarily in 19 arteries of 18 patients, cortical EEG changed significantly,while scalp EEG did not change significantly. Only 9 patients had ischemic events in the corresponding supply territories after the occlusion in the cortical EEG significant change group. The changes in the depth of anesthesia had the consistent impact on cortical and scalp EEG. Conelusions Simultaneous monitoring of cortical and scalp EEG is a simple and effective method for monitoring cortical ischemia during anterior circulation intracranial aneurysm surgery, and may effectively identify the effect of anesthesia on EEG.

Surgical treatment of gliomatosis cerebri / 医学研究生学报

Objective:To discuss the diagnosis, treatment and outcome of patients with gliomatosis cerebri (GC). Methods:Retrospectively reviewed the clinical manifestations and radiological appearances of 6 patients with GC, which were diagnosed in our hospital between 1993 and 2003. We employed surgical treatment in three patients, stereotactic biopsy in two, and the other one received both biopsy and surgery. Results: The lesions of GC infiltrated more than two lobes in brain. CT studies showed diffuse hypodensity changes and enhancement was absent in four patients. MRI examinations revealed isointense or hypointense regions on T1WI, and uniformly high signal on T2WI. MRI also disclosed structural enlargement. All patients received radiotherapy after surgery and three patients underwent chemotherapy additionally. Five patients died during follow up with average course of 16.4 months. Conclusion:MRI examination is valuable in the diagnosis and the prognosis of GC is poor.

Classification and surgical approach for tentorial meningiomas / 医学研究生学报

Objective:To explore the classification and the choice of surgical approach for tentorial meningiomas. Methods: 56 patients with tentorial meningiomas operated on between 1992 and 2002 were retrospectively analysed. According to Gkalp , there were 28 cases with medial tumor,17 cases with lateral tumor,11 cases with falcotentorial tumor. The tumors developing mainly supratentorial were approached from modified pteronal, subtemporal, temporooccipital or occipital craniotomy. For tumors developing mainly in the posterior cranial fossa, suboccipital craniectomy or combined occipital- suboccipital craniectomy was performed. The tumors developing both supratentorial and infratentorial the subtemporal-presigmoidal craniotomy were approached . Results: Total removal was achieved in 53 cases and partial removal in 3 cases. Two cases died of severe postoperative complications. The mortality rate was 3.6%. Five had additional neurological deficits postoperatively. Recurrences occurred in 6 cases. Conclusion: Surgical approach for tentorial meningiomas must be individualized for each case. The operators must master well about microanatomy of the tentorium and its specifically regional structures and expertly use microsurgical techniques for obtaining successful surgery and good outcome.

Clinical application of an improved ruler for fixing stereotactic head frame / 中国微创外科杂志

Objective To study a simple, measurable and objective method for fixing stereotactic head frame. Methods A self-made stereotactic head frame ruler was used in the localization in operations of 29 cases of Parkinson's disease and 1 case of intractable cancer pain. Results Of the 30 cases,significant effects were obtained in 29 coses(96.7%) and curative effects in 1 case (3.3%). Conclusions The improved ruler can be fully applicable to the ASA-602S model stereotactic frame, being a simple, measurable and objective method for fixing stereotactic head frame and applying CT scanning orientation.

The change of nitric oxide and superoxide dismutase in cerebral cortex of the rat seizures induced by bemegrides / 临床神经病学杂志

Objective To observe the change of nitric oxide(NO) and superoxide dismutase(SOD) in the epileptic rat brain cortex, and study the effect of the redox states of NO on epilepsy.Methods Using epileptic rat model induced by bemegride, the level of NO and the activity of SOD were measured in rat cerebral motor cortex during and only after seizures.Results The level of NO in rat cerebral motor cortex was significantly increased during and only after seizures than the normal controls. During seizures, SOD activity was decreased; but only after seizures, SOD activity was significantly increased.Conclusion The value of SOD activity than NO content had significantly difference in rat cerebral cortex between during and only after transient seizures. These results suggested that the different redox state of NO would play different role du ring the seizure.