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Objective:To investigate the efficacy of microsurgical treatment in cavernous sinus tumors.Methods:The clinical data of 87 patients with cavernous sinus tumor treated by microsurgery from January, 2010 to August, 2019 were analysed retrospectively. The surgical approaches and microsurgical skills for common tumors in Cavernous Sinus region were discussed. The follow-up included outpatient and telephone follow-ups, and the follow-up results were evaluated by KPS score.Results:Among the 87 cases, 57 were totally resected (65.5%), 14 were subtotal resected (16.1%) and 16 were major resected (18.4%). Hospitalisation ranged from 14 to 98 days, with an average of 29 days. Postoperative complications occurred in 30 cases with cranial nerve injury, 2 brain stem injury, 4 postoperative bleeding, 5 cerebrospinal fluid leakage, 4 infection, 1 Pituitary damage and 1 death. Prognosis and follow-up analysis showed 68 cases with KPS>60 and 66 with KPS>80 at 1 month after surgery; 74 with KPS>70 and 72 with KPS>80 at 3 months after surgery; 78 with KPS>80 by 12 months after surgery. During the follow-up period of 6-120 months, 3 cases died. Recurrence: 6 of incomplete resection of meningioma, were in 1-6 years after the surgery, 4 of incomplete resection of schwannoma in 1-8 years, 2 of pituitary adenoma respectively in 13 and 16 months after the surgery. There was no recurrence after reoperation. Two cases of chondrosarcoma, 3 of chordoma and 3 of germinoma were treated with radiotherapy, and during the follow-up, there was no progress of the focus. No tumor progression or recurrence was found in other cases during follow-up.Conclusion:Surgery of cavernous sinus tumor is difficult due to frequent postoperative complications. Reasonable preoperative plan, surgical approach and precise microsurgical techniques are the keys in reduction of postoperative complications and in the improvement of prognosis.
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Objective:To evaluate the value of intraoperative magnetic resonance imaging (iMRI) combined with neuronavigation for the resection of insular gliomas.Methods:From August 2014 to October 2017 in the First Hospital Affiliated to Sun Yat-sen University,clinical data of 41 patients with insular glioma,who underwent the surgery assisted with 3.0T iMRI and neuronavigation,were analyzed retrospectively,and the resection extent,complications and prognosis were evaluated.Results:Subtotal tumor resection was achieved in 21 patients and partial resection was done in 20 after iMRI scanning.After further resection,total tumor resection was achieved in 16 patients,subtotal resection in 18 and partial resection in 7.There was a statistical significant difference in tumor resection between pre-iMRI and post-iMRI according to the Fisher test (P＜0.05).In the follow-up from 3 months to 3 years,the symptoms of the 41 patients had improved.Conclusion:iMRI corrected the shift of brain.Neuronavigation can accurately and timely assess the degree of resecting tumor.The combination of neuronavigation with surgery can maximally and safely resect insular glioma.
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Objective The present study was to investigate the feasibility of use of high resolution magnetic reso?nance vessel wall imaging(HR-VWI)in evaluation of intracranial aneurysms. Methods We prospectively collected data from patients who had intracranial aneurysms and received HR-VWI scan before surgical treatment or conservative treatment. Aneurysms were divided into ruptured group (n=12) and unruptured group (n=88). Aneurysm site, size, neck, aspect ratio(AR), daughter sac and aneurysmal wall enhancement scale were analyzed in both groups. Univariate and multivariate Logistic regression were performed to evaluate the risk factors of aneurysm rupture. Subgroup analysis was also performed to study symptomatic and asymptomatic unruptured aneurysms. Results Aneurysm size(t=2.187,P=0.031),AR(t=3.164,P=0.002),incidence of daughter sac(P=0.012) and aneurysmal wall enhancement scale(P<0.001)were higher in ruptured aneurysm group. Multivariate Logistic regression showed that aneurysmal wall enhance?ment scale was the only independent risk factor of ruptured aneurysms(P=0.002). Subgroup analysis showed aneurysm wall enhancement scale(P<0.001) and AR(t=3.939,P<0.001) were higher in symptomatic unruptured aneurysms. Conclusion Aneurysm wall enhancement on HR-VWI is more frequently seen in ruptured aneurysms and symptomatic unruptured aneurysms. Histological study is needed for better understanding of the mechanism of aneurysm wall enhance?ment.
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Objective We evaluate if supplementary grading system can refine patient selection and accurately predict neurological outcome in BAVM. Methods We retrospectively study 221 BAVM patients who were treated micro?surgically by our hospital. The score of pre and post operation mRS and relative clinical, radiology data were collected. Two different logistic models (Spetzler-Martin, Supplementary Spetzler-Martin grading model) were constructed to com?pare the area under ROC. Results Some factors are significant different between worse outcome patients and good out?come patients:Non-hemorrhagic presentations prior surgery, AVM bigger than 3cm, diffuse shape of AVM and the elder patients. Predictive accuracy was higher for the supplementary model (ROC area, 0.91), than the Spetzler-Martin model (ROC area, 0.774). So the predictive accuracy of supplementary model was significantly better than that of the Spet?zler-Martin model (P=0.0362). Conclusions Supplementary Spetzler-Martin model can improve preoperative risk pre?diction and subgroup the patients more efficiently. When the score less than 5(including 5) in supplementary Spet?zler-Martin patients seem to have lower risk relative to surgery.
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Objective To evaluate the clinical application of multimodality treatment of brain arteriovenous malformation (BAVM) with Onyx embolization and microsurgery.Methods There were 48 patients with BAVM treated by combination of Onyx embolization and microsurgery.The clinical features,therapeutic process,complications and discharge status (by MRI,DSA and Glasgow outcome scale,GOS) were recorded in detail.The prognosis was estimated by modified Rankin scale (mRS) with 6-42 months' follow-up.Results The total resection rate was 97.9％.The therapy-related complications happened in 8 patients (16.7％).Among them,4 cases had dysfunction of central nervous system (8.3％),2 cases with intra-cerebral hemorrhage (4.2％),and 2 suffered from severe cerebral edema (4.2％).Good recovery was seen in 38 cases (79.2％) evaluated by GOS when discharged from hospital.The follow-up result mRS ＜ 3 was 97.9％.Conclusion Multimodality treatment of BAVM with Onyx embolization and microsurgery should be a good therapeutic strategy.
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Objective T0 investigate the effects of transforming growth factorβ1 ( TGFβ1 ) and its receptorβ2 (TGFβR2) gene single nucleotide polymorphisms on the risk of intracranial hemorrhage in patients with brain arteriovenous malformation (BAVM).Methods Fifty-three BAVM patients of both sexes aged 18-64 yr who were genetically unrelated native HAN of Guangdong province were divided into 2 groups:patients with and without intracranial hemorrhage ( n =30:23).Venous blood samples were collected and anti-coagulated with ethylene diaminetetraacetic acid for genomic DNA extraction.TGFβ1-509C/T (rs1800469) and TGFβR2 875A/G (rs3087465) gene SNPs were genotyped by using PCR-RFLP.Results There were no significant differences in genotype and frequency between the 2 groups.The G carrier frequency of the TGFβR2 genotype was significantly higher in patients with intracranial hemorrhage than in patients without intracranial hemonrhage.The G carrier of the TGFβR2 genotype was associated with intrarcranial hemorrhage in patients with BAVM.Conclusion TGFβ1 gene polymorphism is not relevant to the intracranial hemorrhage in patients with BAVM,but polymorphisms of TGFβR2 could be a risk factor.
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Objective To perform facial nerve monitoring in patients under the low level of neuromuscular blockade during resection of acoustic neurinomas.Methods Twenty-eight patients with large,or medium acoustic neuroma underwent the surgery of acoustic neurinomas resection. During the operation,TOF and EEG monitoring were performed in order to detect the degree of muscle relaxation and the depth of anesthesia. Neuromuscular relaxation was maintained at T_4/T_1=25%～50% by adjusting doses of muscle relaxant and aneasthetic. Free-run EMG and Triggered EMG of orbicularis oris, orbicularis oculi, masseter and trapezius were recordered to monitor the function of the facial, trigeminal and accessory nerves, respectively. The function of the facial nerve was evaluated at first week and half year postoperatively according to House-brackmann classification.Results The facial never was successfully identified and mapped by neurominitoring in all 28 patients. successfully, tThe electrical stimulation was 0.1 mA-0.3 mA and no any involuntary body movement was observed in all patients ne of patients have moved during operation. The preservation of the facial nerve function following surgery was good. Five patients had a HB grade I, 13 a HB grade II, 8 a grade III and 2 a HB grade IV The facial nerve function was HB Grade Ⅰin 5 of 28 patients, HB GradeⅡ in 13, HB Grade Ⅲ in 8 and HB Grade Ⅳ in 2 immediately after operation. Six months after surgery, 10 casespatents showed demonstrated a HB GradeⅠof facial never function, 12 cases exhibited a slight palsy (HB Grade II) , and 5 cases exhibited a HB Grade III palsy and . Another 1 cases a exhibited severe palsy (HB Grade IV).Conclusions Facial nerve monitoring in patients under the low level of neuromuscular blockade can ensure the surgical safety and preserve the facial never function.
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@#Objective To observe the variation of cerebral brain flow (CBF)and pathological characteristics in peripheral brain tissue of nidus after operation of brain arterivenous malformations (BAVM) and explore the mechanism and theaputic strategy of normal perfusion pressure breakdown (NPPB)after microsurgery. Methods 12 cases of BAVM that have received surgical resection were analyzed prospectively, and 8 cases of them were embolized with Onyx. The pathological characteristics of the nidus and peripheral brain tissue was observed with microscope and electron microscope. The variation of CBF in peripheral brain tissue of the nidus following microsurgical resection was observed by using Laser Doppuler Perfusion Imaging (LDPI) system. The monitering result of CBF in little meniugioma(n=6) during surgery was used as the control. Results There was small vessel expantion, neuron necrosis, gliocyte hyperplasia and blood brain barriar (BBB) destruction in peripheral brain tissue of BAVM nidus, the visibal brain tissue edema and inflammatory cell infiltration in peripheral brain tissue of the nidus and the revascularization in the emolized nidus vessels were observed after embolization with Onyx. There was significant change of CBF between pre-and post-operation (P<0.05),and after controlling depressurization during surgery was the increasing CBF step down (P<0.05). Conclusion The BBB breakdown and increasing CBF of peripheral brain tissue of the nidus may be the pathological foundation of brain hemorrhage and edema after BAVM microsurgical resection. So embolization before the operation, controlling depressuriation during and after surgery is the important methods for preventing and curing the NPPB of BAVM after microsurgery.
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Objective To study the clinical characteristics,microsurgical methods and results of treatment of the purely intrinsic third ventricular craniopharyngioma. Methods Eight cases of craniopharyngiomas located purely in intrinsic third ventricula which were treated microsurgically were analyzed retrospectively.Their clinical manifestations,endocrinal examination,CT and MRI images,choice of operactive approaches and post-operative complications were studied.Results Total tumor removals were achieved in 7 cases.and subtatol tumor removal in 1 case.Temporary central diabetes insipidus occurred in 5 cases,and perloperative water and elecctrolyte imbalance in 6 cases. No patient died in this series. Conclusion According to clinical characteristic of purely intrinsic third ventricular craniopharyngioma, microsurgical technique is a safe and effective method for treatment by a resonable surgical approaches.
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BACKGROUND: Dopaminergic neurons differentiated from neural stem cells have been successfully used in the treatment of Parkinson's disease rats; however, the survival rate of transplanted cells has been low. Most cells die of apoptosis as a result of the formation of oxygen free radical and lipid peroxidation.OBJECTIVE: To observe resveratrol (Res) effects on survival of transplanted cells, transplanted efficacy and dopaminergic differentiation from neural stem cells in a rat model of Parkinson's disease.DESIGN, TIME AND SETTING: Randomized controlled animal experiments were performed at the Animal Experiment Center,Sun Yat-sen University from October 2007 to June 2008.MATERIALS: Thirty-two adult, healthy, male Sprague Dawley rats were equally and randomly assigned to model control, dopaminergic neuron, Res and combination groups. Four healthy Sprague Dawley rat embryos at gastational days 14-15 were selected and fetal rats were used for isolation and culture of neural stem cells. Res (Jingmal Biotech, Shenzhen, China) was used for this study.METHODS: Neural stem cells derived from the mesencephalon of embryonic rats were isolated and cultured in vitro, and passaged in serum-free culture medium containing epidermal growth factor and basic fibroblast growth factor, and then differentiated into dopaminergic neurons in differentia.ion medium. Parkinson's disease rat models were established by the injection of 6-hydroxydopamine in each group. Rats in the dopaminergic neuron group was injected with 3 pL cell suspension (1×10 cells/μL) containing dopaminergic neurons in the corpus striatum. Rats in the Res group received 3 μL of Ras (40 mg/L).Rats in the combination group were subjected to 3 μL of Res (40 mg/L) + 3 μL cell suspension (1×105 calls/μL) containing dopaminergic neurons. Rats in the model control group received 3 ×L of DMEM/F12 culture medium.MAIN OUTCOME MEASURES: The percentage of tyrosine hydroxylase-positive neurons in differentiated cells. The alteration of rotational asymmetry and the survival of tyrosine hydroxylase-positive neurons in graft areas of Parkinson's disease rats after transplantation.RESULTS: Flow cytometry demonstrated that survival rate of tyrosine hydroxytase-positive neurons was (17.8 ±4.2)% at 6 days following differentiation. Compared to the model control group, the rotational asymmetry was significantly improved at 10 days (P < 0.01), was significantly decreased at 20 days following transplantation in the combination group (P < 0.01). At 10-60 days following transplantation, the number of rotational asymmetry was significantly lower in the combination group than in the dopaminergic neuron group (P < 0.01). Tyrosine hydroxylase-positive neurons were not determined in the Res and model control groups. The number of tyrosine hydroxylase-positive neurons was significantly more in the combination group than in the dopaminergic neuron group (P < 0.01).CONCLUSION: Res can increase survival rate of transplanted cells in the corpus striatum, and improve rotational asymmetry in rat models of Parkinson's disease following transplantation of dopaminergic neurons differentiated from neural stem cells.Ke CL, Chen BL, Yu ZH, Huang ZS.Effects of resveratrol on the transplantation of neural stem call-derived dopaminergic neurons in a rat model of Parkinson's disease.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2009;13(27): 5281-5285.[http://www.crter.on http://en.zglckf.com]
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Objective To undertake animal experimentation and clinical study on the safety and efficacy of percutaneous transluminal angioplasty (PTA) and intraarterial papaverine (IAP) infusion for treatment of refractory symptomatic cerebral vasospasm (CVS). Methods In the experimental study, vasospasm was induced in rabbits by double injections of blood into the cisterna magna, IAP infusion was given on either the 4th day or the 7th day after occurrence of subarachnoid hemorrhage (SAH), and then neurological observation, angiography, light and electron microscopy were done. In the clinical study, since September 1996, 22 patients with refractory symptomatic CVS involving 50 vascular territories received dilation therapy by PTA and IAP within 24 hours of clinical neurological deterioration. Results In the experimental study, all the rabbits except two in the 'the 4th day' group showed angiographic dilation in all of the spastic basilar arteries, and neurological improvement; in the ' the 7th day' group angiographic dilation appeared in 4 (57. 1% ) out of 7 rabbits. After 24 hours, 1 rabbit in each group had recurrence of neurological deficits and angiographic constriction. In the clinical study after aneurysm clipping or endovascular coil embolization was done, within 72 hours of SAH all patients underwent endovascular treatment: PTA alone in 3 cases, IAP alone in 14 cases, PTA and IAP in the remaining 5 cases. All vessel segments were dilated satisfactorily after endovascular treatment. Clinical improvement was significant in 13 cases,moderate in 7, minimal or none in 2; 2 cases died on the 7th day after endovascular dilation treatment. Conclusion Endovascular dilating techniques, namely, PTA, IAP and a combination of PTA and IAP, are safe and effective for treatment of symptomatic CVS refractory to medical therapy.
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<p><b>OBJECTIVE</b>To assess the embolic effects and biocompatibility of Eudragit mixture, a new liquid embolic agent.</p><p><b>METHODS</b>In vitro, the viscosity and precipitation time of Eudragit mixtures at several concentrations were measured to study the best proportion of components of the mixture. In vivo, a branch of the right external carotid artery was embolized with Eudragit mixture in 12 rabbits, and with n-butyl cyanoacrylate in another 12 rabbits for a comparative study of the general, angiographic and histopathologic changes between the two groups.</p><p><b>RESULTS</b>Eudragit mixture containing 7.5 g Eudragit, 50 ml absolute ethanol and 50 ml iopromide was shown in vitro to have good properties including rapid precipitation and soft elastic sponge formation upon contact with blood; in vivo, to be nontoxic, nonadherent to the microcatheter and able to embolize the vascular lumen completely without later recanalisation.</p><p><b>CONCLUSION</b>Eudragit mixture is an effective, nontoxic, safe and promising liquid embolic agent.</p>
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Animals , Male , Rabbits , Carotid Artery Thrombosis , Pathology , Therapeutics , Cerebral Angiography , Chemical Precipitation , Embolism , Therapeutics , Embolization, Therapeutic , Methods , Enbucrilate , Therapeutic Uses , Polymethacrylic Acids , Chemistry , Therapeutic Uses , ViscosityABSTRACT
Objective To Compare the use of guglielmi detachable coils(GDCs)versus microsurgical clipping for the management of acutely ruptured intracra nial aneurysm. Methods A clinical study included 82 patients with acute (90%. The technique related morbidity rate was 14.2%. In microsurgical group, 92.5% of aneurysms were completely clipped. The technique related morbidity rate was 10%. 2 cases was died. Significantly better total occlusion/embolization results were achieved in microsurgical clipping( n =40) than in GDCs ( n =35)( P 0.05). Six months follow up demonstrates that good prognosis was 95% in both groups. Conclusion In the management of acutely ruptured intracranial aneurysm, both microsurgical clipping and endovascular treatment is effective methods.
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Objective Evaluation of application of looping vascushunt tubes in microsurgical total removal of para sinus meningiomas Methods Eighteen patients harboring para sinus meningiomas were treated in our hospital from Feb,2000 to Mar,2002,Tumors were located in the posterior two thirds superior sagittal sinus in 17 patients and in the congenitally isolated transverse sinus in one patient Looping vascushunt were applied in all cases and tumors were removed under microscope using microsurgical techniques Results Tumors and involved sinus walls were resected (Simpson grade Ⅰ) in all patients Venous sinus reconstruction were achieved in 12 patients using artificial blood vessels,sinus walls were repaired with duramater in 4 patient, venous sinus ligation was applied in two patients because of the sufficent collateral venous drainage All patients recovered and no mortality occurred Conclusions Application of vascushunt tubes is one of the important techniques in microsurgical total resection of para sinus meningiomas
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Objective To report the microsurgical separation of the protruded cerebral tissue in the case of complex craniopagus twins and evaluate the role of the neuronavigation system in this operation Methods After the multiple bone flap were made,register again and then separate the cerebral tissue along the arachnoid plane under the guiding of the neuronavigation system(SNN) until the straight sinus was exposed Results The protruded cerebral hemisphere and cerebellar hemisphere of the twins were successfully separated Unfortunately,part of the occipital lobe of twin B(right) had to be removed because of the brain swelling Conclusion In the case of complicated craniopagus,the neuronavigation system is valuable in positioning the deep common sinus To separate the cerebral tissue along the arachnoid plane under surgical microscope can reduce the cerebral injury
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Objective To explore the importance of the separation and reconstruction of the shared venous sinuses of a craniopagus twins Methods The shared superior sagittal sinus, confluence of sinuses, transverse sinus and straight sinus were separated using microsurgical techniques Meantime, one bypass was established from the superior sagittal sinus and the straight sinus to the internal jugular vein with help of the bypass shunt in twin B (right) The above mentioned sinuses were reconstructed with the artificial vessels The normal superior sagittal sinus and confluence of sinuses were preserved in the twin A (left) Results Twin A recovered with no nervous deficits Unfortunately, twin B died of renal failure and hyperkalemia 22 hours after the operation Conclusion The shunt and reconstruction of the venous sinus are the key techniques for the success of separation of craniopagus twins using the microsurgical techniques
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Objective To investigate the effect of cerebral angiography on separation of craniopagus during the period of preoperation and microsurgical operation Methods There was a case of craniopagus being separated in our hospital recently Cerebral arteriography at 3 months of life, arteriography and venography through femoral vessels at 16 months were performed to analyze the twin vascular circulations of bilateral internal carotid artery, external carotid artery, vertebral artery, and venous sinus Intraoperative cerebral angiography helps to evaluate the cerebral circulations Results Preoperative cerebral angiography showed no intracranial arterial connection in the pontes of craniopagus The posterior 1/3 part of superior sagittal sinus, partial transverse sinus and torcular herophili were confluented in two children Cerebral angiography during operation was significant for monitoring the management of the part of confluent venous sinus Conclusion Cerebral angiography is the best method to investigate the vascular conditions of craniopagus The selective sinus angiography is very important in analyzing the abnormal anatomy and hemodynamics of venous sinus in the pontes Intraoperative angiography can direct the bypass shunt and reconstruction of the sinus
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Objective To study the factors that limited the microsurgical total resection on meningiomas of tentorium and confluence of sinuses Methods Twenty three cases of meningiomas on tentorium and confluence of sinuses,which were removed by application of microsurgery from 1983 to 2001,were analysed retrospectly and reviewed. Results In all 23 cases,tumors in 17 cases were removed totally,and 6 cases were removed subtotally In the 6 cases whose tumors were resected subtotally,there were 4 cases related with major sinus and its venous flow uncompleted compensation, 2 cases related with adhering compactly to the brain stem invaded by tumors,major vessels or cranial nerves Conclusions Heading factors restricting microsurgical total resection of menigiomas on tentorium and confluence of sinuses may be related with major sinus invaded by tumor and its venous flow uncompleted compensation, tumors adhering compactly to the brain stem,major vessels or cranial nerves
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Objective To detect the expression of survivin protein in intramedullary gliomas and evaluated the clinical significance of the survivin expression. Method Seventeen cases of intramedullary gliomas were removed by using microsurgical technique.It composed of 8 cases of ependymomas and 9 ones of astrocytomas.The patients were followed up by MRI scanning periodically.The survivin protein expression of the intramedullary gliomas were examined by immunohistochemical stain (SP). Results Total resection of the tumor was obtained in 7 cases of ependymomas and subtotal resection was undertaken in the other one case.For 9 cases of astrocytomas,total resection of the tumor achieved in 3 cases,subtoal resection in 5 cases and partial resection in one case.Survivin expression was detected in 2 samples of ependymomas and 6 ones of astrocytomas.2 astrocytoma cases were moderate positive staining,who suffering from intracranial and vertebral subarachnoid dissemination of the tumor. Conclusion The result of microsurgical treatment for intramedullary ependymomas is satisfactory.The survivin expression in astrocytoma samples is significantly higher than that in ependymoma.Moderate positive staining may correlated with subarachnoid dissemination of the tumor.