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Objective:To observe the curative effect of stereotactic subtentorial approach for brainstem puncture and drainage on brain stem hemorrhage in elderly patients.Methods:The clinical data of elderly patients with brain stem hemorrhage admitted to the Department of Neurosurgery, Shangqiu First People 's Hospital from April 2018 to April 2022 were retrospectively analyzed.According to the inclusion and exclusion criteria, a total of 65 elderly patients with brainstem hemorrhage who were treated with stereotactic subtentorial approach for brain stem puncture and drainage, and had complete follow-up data within 90 days after operation were selected.The patient's data were reviewed.The operation time, hematoma clearance rate on the first day after operation, the drainage tube extraction of hematoma cavity, and the postoperative complications were recorded.The follow-up results at 30 days and 90 days after the operation were also recorded.The 30-day Glasgow outcome scale(GOS)was used to evaluate the short-term clinical outcomes of surviving patients, while the modified Rankin score was used to evaluate the neurological function recovery of surviving patients at 90 days.Results:The operation time of the 65 patients was 1.1-2.8 h, with an average of(1.9±0.4)h.On the first day after operation, CT scan showed that the hematoma clearance rate was(84.6±13.6)%.The drainage tube in hematoma cavity was removed within 3-5 days, and there was no puncture-related intracerebral hemorrhage or drainage tube-related intracranial infection after operation.During 30 days of follow-up, 9 patients died and 56 patients survived, with a survival rate of 86.2%.Among the surviving patients, 5 were temporarily in vegetative state and 51 were awake, with varoius degrees of disability.The preoperative hematoma volume of the surviving patients was significantly less than that of the dead patients, and the preoperative GCS score was significantly lower than that of the dead patients( Z=2.386, 2.009, P=0.017, 0.045). After 90 days of follow-up, 3 patients died and 53 survived, with a survival rate of 81.54%.Among the surviving patients, the neurological function of 22 patients recovered well, and the effective rate of clinical treatment was 41.51%. Conclusions:Stereotactic subtentorial approach for brain stem puncture and drainage is an effective and relatively safe surgical method for the treatment of brain stem hemorrhage in elderly patients.
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Objective:To investigate the clinical effect of stereotactic radiation therapy combined with sorafenib in the treatment of primary hepatic cancer (PHC).Methods:Ninety-two PHC patients admitted to Cancer Hospital of China Medical University from January 2017 to May 2018 were selected and divided into the observation group and the control group according to the random number table method, with 46 cases in each group. The control group was treated with stereotactic radiation therapy, and the observation group was treated with sorafenib on the basis of the control group. Clinical efficacy and incidence of adverse reactions in the two groups were compared; the scores of Karnofsky performance scale (KPS) and the levels of serum vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), hypoxia-inducing factor (HIF-1α), soluble interleukin-2 receptor (sIL-2R), transforming growth factor (TGF-β1) and alpha-fetoprotein (AFP) before and after the treatment between the two groups were compared. The overall survival (OS) of patients in both groups was recorded after 36 months of follow-up.Results:The total effective rate in the observation group was higher than that in the control group: 84.78%(39/46) vs. 65.22%(30/46), there was statistical difference ( χ2 = 4.70, P<0.05). After the treatment, the score of KPS in the observation group was higher than that in the control group: (85.06 ± 7.19) scores vs. (71.16 ± 7.08) scores; the levels of VEGF, bFGF, HIF-1α, AFP, TGF-β1, sIL-2R in the observation group were lower than those in the control group: (189.52 ± 31.47) ng/L vs. (235.81 ± 35.45) ng/L, (3.89 ± 0.97) ng/L vs. (6.74 ± 1.85) ng/L, (50.17 ± 6.09) ng/L vs. (53.07 ± 6.28) ng/L, (85.76 ± 14.09) μg/L vs. (131.51 ± 18.74) μg/L, (81.07 ± 12.96) μg/L vs. (106.58 ± 15.07) μg/L, (311.58 ± 74.81) kU/L vs. (405.97 ± 85.74) kU/L, there were statistical differences ( P<0.05). The results of 36 months follow-up showed that the 1-year and 3-year OS in the observation group were higher than those in the control group: 69.57% (32/46) vs. 58.70% (27/46), 43.47% (20/46) vs. 28.26 %(13/46), there were significant differences ( χ2 = 4.78, 3.94, P<0.05). Conclusions:Stereotactic radiation therapy combined with sorafenib can effectively improve the efficacy of PHC patients, reduce the expression of VEGF and bFGF, effectively inhibit tumor growth, but also prolong the survival time of patients, with both safety and high effectiveness, and good use value.
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【Objective】 To construct an acute toxoplasma encephalitis mouse model by observing the pathological changes in the hippocampus of mice infected with Toxoplasma gondii strain RH. 【Methods】 The quantitative RH Toxoplasma gondii (100, 500, and 1 000 trophozoites) were injected into the hippocampal CA1 region of mice by the stereotaxic surgery; the survival status of mice was observed. Giemsa staining was used to observe the changes of toxoplasma in mouse ascites and brain tissue homogenates. Nissl staining and HE staining were used to observe the pathological changes of hippocampal nerve tissue. The distribution of Toxoplasma gondii in brain tissue was observed by immunohistochemical ABC method. 【Results】 The RH Toxoplasma gondii infected mice showed obvious symptoms such as arched back, bristling hair, abdominal distension, subtle tremor and hemiplegia on the fourth day of infection. The survival of mice in 100 trophozoites group was longer, no trophozoites of Toxoplasma gondii were found in ascites, a few pseudocysts were found in brain tissue homogenates after infected for 96 hours, and more trophozoites were found after death. Nysl staining and HE staining showed more tissue necrosis foci and loss of nerve cells in CA1 area after infected 144 h. The injury aggravated with the prolongation of infection time. Toxoplasma trophozoites were found in ascites and brain homogenates of mice in 500 and 1000 trophozoites groups. Nissl staining revealed neuronal loss and massive necrosis in the hippocampus. HE staining showed necrosis and inflammatory cell infiltration. The brain tissue injury significantly aggravated compared with 100 trophozoites group. The distribution of Toxoplasma gondii in the necrotic foci was confirmed by immunohistochemistry. 【Conclusion】 The survival of 100 trophozoite mice infected with Toxoplasma gondii strain RH was longer, and the pathological changes of brain tissue gradually aggravated. The damage was relatively confined to the brain tissue, and the mice showed typical symptoms of toxoplasma encephalitis. Therefore, the mouse model of acute toxoplasma encephalitis can be constructed by localized infection of 100 toxoplasma trophozoites, which can lay a foundation for future research on the mechanism of toxoplasma injury to cranial nerves.
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The difficulty of neural localization during operation often leads to the increased risk of nerve injury,which results in neurological dysfunction,so how to accurately locate the nerves in surgeries,such as operations for patients with recurrent parotid tumors and prostate surgery,has become one of the key factors for the success of the operation.There are many methods to locate nerves in real time during operation,among which fluorescence imaging has attracted more and more attention due to its unique advantages of high sensitivity,easy to use,low cost and no radiation.In this article,the related research progresses of fluorescence imaging in neural localization are reviewed.
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The difficulty of neural localization during operation often leads to the increased risk of nerve injury, which results in neurological dysfunction, so how to accurately locate the nerves in surgeries, such as operations for patients with recurrent parotid tumors and prostate surgery, has become one of the key factors for the success of the operation. There are many methods to locate nerves in real time during operation, among which fluorescence imaging has attracted more and more attention due to its unique advantages of high sensitivity, easy to use, low cost and no radiation. In this article, the related research progresses of fluorescence imaging in neural localization are reviewed.
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Objective@#To explore the long-term effect of neuroendoscopy followed by radiotherapy on cystic craniopharyngiomas.@*Methods@#Cystic craniopharyngiomas in 9 patients were treated with neuroendoscopic cyst aspiration and fenestration, followed by fractionated stereotactic radiotherapy (FSRT). The neuroendoscopic procedure focused on widening of cyst fenestration and extensive irrigation of the cyst contents. The collimator of FSRT ranged from 2.5 cm to 3.0 cm, and the target volume 1.1-43.8 cm3, dose per fraction 1.8 Gy, total dose 50.4 Gy.@*Results@#The median follow-up period was 72.9 months. Tumor control was achieved in 8 of 9 patients. Marked tumor volume reduction was obtained with the neuroendoscopic procedure alone at 6 months, 1 year, and 2 years. One recurrent case showed multilobulated cysts, and a second surgery was required 1 year after the treatment. Clinical symptoms such as headache and visual disruption were rapidly alleviated after the neuroendoscopic procedure. No new visual disturbances, endocrinopathy, or hypothalamic dysfunction was observed during follow up.@*Conclusions@#Stereotactic radiotherapy for cystic craniopharyngioma after endoscopic fenestration can effectively control the tumor for a long period of time, improve the clinical symptoms and avoid endocrine diseases.
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Objective To investigate the applicafion value of a simple stereotaxic technology in open biopsy of breast calcification with wire localization guided by X-ray.Methods 36 lesions in 30 cases with calcifications on mammography underwent X-ray guided simple wire stereotaxic localization open biopsy.Results 36 lesions in 30 cases were removed completely after wire localization,among which 24 cases were removed completely by one time,accounting for 80％ (24/30)of the total,and 6 cases were removed completely by two times,accounting for 20％ (6/30)of the total.No case were removed without calcification or removed completely by more than three times.Conclusion The simple stereotaxic technology in open biopsy of breast calcification with wire localization guided by X-ray is easy to learn and safe to do,which is suitable for promotion at the grassroots hospital.
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Objective To explore the long-term effect of neuroendoscopy followed by radiotherapy on cystic craniopharyngiomas.Methods Cystic craniopharyngiomas in 9 patients were treated with neuroendoscopic cyst aspiration and fenestration,followed by fractionated stereotactic radiotherapy (FSRT).The neuroendoscopic procedure focused on widening of cyst fenestration and extensive irrigation of the cyst contents.The collimator of FSRT ranged from 2.5 cm to 3.0 cm,and the target volume 1.1-43.8 cm3,dose per fraction 1.8 Gy,total dose 50.4 Gy.Results The median follow-up period was 72.9 months.Tumor control was achieved in 8 of 9 patients.Marked tumor volume reduction was obtained with the neuroendoscopic procedure alone at 6 months,1 year,and 2 years.One recurrent case showed multilobulated cysts,and a second surgery was required 1 year after the treatment.Clinical symptoms such as headache and visual disruption were rapidly alleviated after the neuroendoscopic procedure.No new visual disturbances,endocrinopathy,or hypothalamic dysfunction was observed during follow up.Conclusions Stereotactic radiotherapy for cystic craniopharyngioma after endoscopic fenestration can effectively control the tumor for a long period of time,improve the clinical symptoms and avoid endocrine diseases.
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Background: Generation of reactive oxygen species together with paucity of antioxidant defense is considered as an important cause for dopaminergic neuronal death. Review of literature indicates that none of the drugs so far studied for preventing the PD were found to be promising for use. Therefore, the present study was planned to evaluate the neuroprotective effect of Paeonia emodi Wall (PEW) in 6-hydroxy dopamine induced Parkinson’s disease (PD) model.Methods: The study was conducted on Wistar rats where Parkinson’s disease was induced by producing the striatal 6-hydroxy dopamine lesions. The test animals received ethanolic extract of PEW at dose of 200 and 300mg/kg for 28 days. Circling behavior, spontaneous locomotor activity, muscular coordination and akinesia were studied. Antioxidant levels were assessed by biochemical estimation and histopathology was carried out for dopaminergic neuronal loss.Results: PEW ethanolic extract showed significant dose dependent recovery in number of circlings, line crossing, muscular coordination and akinesia. A significant increase in MDA levels and decreased GSH level in PEW treated groups was observed in test groups as compared to control group (p<0.05). Normal architecture was retained only in PEW 300mg/Kg (p<0.05). L-Dopa did not showed effect on biochemical and histological parameters.Conclusions: The ethanolic extract of PEW showed neuroprotective activity against 6-hydroxy dopamine induced Parkinson’s disease in rats in both 200 and 300mg/kg doses. The protective action of PEW in PD can be because of its ability to reduce the oxidative stress.
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Introduction: Breast cancer is the neoplasm that most affects women in Brazil and the world, and its incidence has increased steadily over the last decade. Due to screening mammography programs, according to age group, the mortality rate of breast cancer has decreased by 31%. With the increase in the number of screening examinations, there has also been increase in the number of suspicious lesions diagnosed and, consequently, increase in the indication and performance of breast biopsies. With the help of the categorizations that the American College of Radiology published, according to the Breast Imaging Reporting and Data System (BI-RADS®), it was possible to standardize the reports and descriptions of breast lesions, both in mammography and ultrasound, facilitating decision-making in regard to suspicious lesions. Objective: To evaluate the positive predictive value (PPV) of nonpalpable breast lesions biopsied in the Radiodiagnostic Service of Hospital Naval Marcílio Dias. Method: A retrospective and analytical study of 88 patients submitted to stereotaxic guided mammary biopsies from December 2015 to December 2016 with suspected diagnosis of malignant lesions, classified by mammographic BI-RADS in categories 4 and 5 and later correlation with the histopathological reports. Results: PPV was high for category 5 lesions, and for category 4 lesions PPV was low and progressively increased with the subcategories. Conclusion: BIRADS categorization is an effective predictor for the risk of malignancy in suspicious mammographic lesions.
Introdução: O câncer de mama é a neoplasia que mais acomete mulheres no Brasil e no mundo e sua incidência vem aumentando progressivamente ao longo dessa última década. Devido aos programas de rastreamento mamográfico, de acordo com a faixa etária, a taxa de mortalidade por câncer de mama diminuiu em 31%. Com o aumento do número de exames de rastreamento houve aumento, também, da quantidade de lesões suspeitas diagnosticadas e, consequentemente, um aumento na indicação e realização de biópsias mamárias. Com o auxílio das categorizações que o American College of Radiology publicou, segundo o Breast Imaging Reporting and Data System (BI-RADS®), foi possível padronizar os laudos e as descrições das lesões mamárias, tanto na mamografia quanto na ultrassonografia, facilitando a tomada de decisão perante a lesões de aspecto suspeito. Objetivo: Avaliar o valor preditivo positivo (VPP) das lesões mamárias não palpáveis nas quais foi realizada biópsia no Serviço de Radiodiagnóstico do Hospital Naval Marcílio Dias. Método: Estudo retrospectivo e analítico de 88 pacientes submetidas a biópsias mamárias guiadas por estereotaxia no período de dezembro de 2015 a dezembro de 2016 com diagnóstico suspeito de lesões malignas, classificadas no BI-RADS® mamográfico em categorias 4 e 5, com posterior correlação com os laudos histopatológicos. Resultados: Foi encontrado alto valor preditivo positivo na categoria cinco e, nas lesões classificadas como categoria quatro, o VPP foi menor, aumentando progressivamente com as subcategorias. Conclusão: A categorização BI-RADS® é um preditor eficaz para o risco de malignidade nas lesões suspeitas na mamografia.
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To solve the problem of precise positioning of carp brain tissue coordinates, it is proposed in this paper for a method for transforming the coordinates of magnetic resonance imaging of carp brain tissue into the coordinates of electrode implantation using a brain stereotaxic apparatus. In this study, the 3.0T magnetic resonance imaging instrument was used to scan the carp brain. We independently established the three-dimensional positioning coordinate system of the brain, the three-dimensional coordinate assistance system of skull surface and the three-dimensional coordinate assistance system in brain tissue. After two coordinate transformations, the magnetic resonance image coordinates of the brain electrodes implantation sites were converted into the three-dimensional stereotactic coordinate system to guide the electrodes implantation. The experimental groups were divided into two groups, A and B. Group A was the group of magnetic resonance imaging apparatus combining with the brain stereotaxic apparatus, and group B was the group of brain atlas combining with the brain stereotaxic apparatus. Each group had 20 tails of carps ( = 20). This two methods were used to implant the electrodes into the cerebellar motor area. The underwater experiments of the carp robots were carried out to test the two methods. The results showed that the accuracy of the implanted electrodes were 90% in group A and 60% in group B. The success rate of group A was significantly higher than that of group B ( < 0.05). Therefore, the new method in this paper can accurately determine the coordinates of carp brain tissue.
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Objective To investigate the efficacy and safety of stereotactic body radiation therapy (SBRT) for very elderly patients with pancreatic cancer.Methods The clinical data of a total of 149 patients aged from 75 to 90 years with locally advanced or metastatic pancreatic cancer treated by SBRT in Changhai Hospital from January 2012 to December 2016 were retrospectively reviewed.Prescription doses ranged from 3.6-9Gy/fractions,and the total doses were 19.5-49Gy in 3-8 fractions.The level of serum cancer antigen 19-9(CA19-9) before and 3 months after treatment was compared and the radiotherapy biological effective dose (BED10) was calculated.The adverse events of the radiotherapy were observed.Overall survival (OS) and progression-free survival (PFS) were recorded through follow-up,and the factors influencing the patients' survival were investigated by univariate and multivariate analysis.Results All the patients' median OS and PFS were 12.9and 8.3 months,respectively.One-year OS and PFS rate were 55.9％ and 19.5％,respectively.Tumor stage and the decrease of CA19-9 levels ＞50％ at 3 months after treatment and BED10 were independent factors of OS and PFS.No grade 3 or higher toxicities were recorded in all the patients.Conclusions SBRT is safe and effective for very elderly patients with locally advanced or medically inoperable pancreatic cancer.Tumor stage,the decrease of CA19-9 levels after treatment and BED10 were associated with prognosis.
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Objective To assess the cumulative doses and side effects after two courses of stereotactic body radiation therapy (SBRT) for pancreatic cancer. Methods Twenty-four pancreatic cancer patients who received two courses of SBRT were enrolled. Organ endangering dose accumulations were calculated by rigid and non-rigid registration. All doses were recalculated to an equivalent dose of 2 Gy per fraction. Results The median of accumulated maximal dosage (Dmax) and dosage per 1cc(D1cc) of the stomach,duodenum and the bowel were 43.87 and 35.28 Gy 3,35.53 and 26.59 Gy3,45.08 and 36.18 Gy3; and the median volume under the dosage of 10Gy (V10) was 107.40,23.98 and 169.26cc, respectively. The median accumulated Dmaxand the dosage of 35% volume(D0.35) of the spinal cord was 8.42 and 7.83Gy3. The median cumulative Dmeanand D2/3of the left and right kidney were 5.18 and 3.65 Gy3, 3.50 and 2.57 Gy3, respectively. The median cumulative Dmeanand D50%of the liver was 5.18 and 3.64Gy3,respectively. The median summed dose to the overlapping radiation field of the two courses was 93.38 Gy3. No grade 3-4 toxicity occurred. Conclusions The cumulative doses to organs at risk as dose constraints were safe and acceptable,which could be used as a reference to evaluate whether a second SBRT could be done after initial SBRT for pancreatic cancer.
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The role of three-dimensional brachytherapy (3D-BT) in the radical treatment of cervical cancer has been widely recognized. Obtaining the image information through simulated positioning is a key step of 3D-BT.Currently, MRI/CT positioning has been commonly applied in clinical practice, which has respective limitations when applied in radiosurgery. Consequently, it is of necessity to explore an accurate, highly efficient and convenient positioning approach. Besides MRI and CT, ultrasound is a novel positioning method in clinical settings. Through literature review, the application of ultrasound in 3D-BT was summarized, aiming to provide reliable reference for clinicians.
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OBJECTIVE: Minimally invasive techniques such as stereotactic aspiration have been regarded as promising alternative methods to replace craniotomy in the treatment of intracerebral hemorrhage (ICH). The aim of this study was to identify the optimal timing of stereotactic aspiration and analyze the factors affecting the clinical outcome. MATERIALS AND METHODS: This retrospective study included 81 patients who underwent stereotactic aspiration for spontaneous supratentorial ICH at single institution. Volume of hematoma was calculated based on computed tomography scan at admission, just before aspiration, immediately after aspiration, and after continuous drainage. The neurologic outcome was compared with Glasgow outcome scale (GOS) score. RESULTS: The mean volume ratio of residual hematoma was 59.5% and 17.6% immediately after aspiration and after continuous drainage for an average of 2.3 days, respectively. Delayed aspiration group showed significantly lower residual volume ratio immediately after aspiration. However, there was no significant difference in the residual volume ratio after continuous drainage. The favorable outcome of 1-month GOS 4 or 5 was significantly better in the group with delayed aspiration after more than 7 days (p = 0.029), despite no significant difference in postoperative 6-months GOS score. A factor which has significant correlation with postoperative 6-months favorable outcome was the final hematoma volume ratio after drainage (p = 0.028). CONCLUSION: There is no difference in final residual volume of hematoma or 6-months neurologic outcome according to the surgical timing of hematoma aspiration. The only factor affecting the postoperative 6-months
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Humans , Cerebral Hemorrhage , Craniotomy , Drainage , Glasgow Outcome Scale , Hematoma , Minimally Invasive Surgical Procedures , Residual Volume , Retrospective Studies , Stereotaxic TechniquesABSTRACT
Objective To compare the effectiveness of stereotactic hematoma aspiration and conservative treatment for supratentorial hypertensive intracerebral hemorrhage (HICH) with hematoma volume 25-40 ml. Methods Patients with supratentorial HICH admitted to the Department of Neurosurgery, the Fifth Affiliated Hospital of Zhengzhou University from January 2014 to January 2017 were retrospectively enrolled. The incidence of rebleeding, good outcome (defined as the modified Rankin Scale score 0-2 at 3 months after onset) rate, and mortality were compared between the stereotactic hematoma aspiration group and the conservative treatment group. Results A total of 204 patients were enrolled. Their mean age was 61. 3 ±9. 2 years, 114 were males, and their median hematoma volume was 32 ml (interquartile range 25- 39 ml), median baseline Glasgow Coma Scale score was 11 (interquartile range 9-14), and there was no patient with brain herniation. One hundred and twenty patients (58. 8％) underwent stereotactic hematoma aspiration and 84 (41. 2％) received conservative treatment. Compared with the conservative treatment group, the incidence of rebleeding in the stereotactic hematoma aspiration group was significantly lower (2. 5％ vs. 22. 6％, χ2 =20. 788, P < 0. 001), and the rate of good outcome was significantly higher at 3 months after onset (85. 0％ vs. 70. 2％; χ2 = 8. 305, P = 0. 004 ), but there was no significant difference in mortality (5. 0％ vs. 11. 9％, χ2 =3. 259, P =0. 071). Multivariable logistic regression analysis showed that advanced age (odds ratio [OR] 1. 77, 95％ confidence interval [CI] 1. 25-2. 46; P = 0. 006), previous stroke history (OR 1. 36, 95％ CI 1. 12-1. 64; P =0. 032), and conservative treatment (OR 1. 42, 95％ CI 1. 25-1. 78; P = 0. 021) were the independent risk factors for poor outcomes. Conclusions Stereotactic hematoma aspiration can significantly reduce the incidences of rebleeding and risk of the poor outcome in the supratentorial HICH patients with hematoma volume 25-40 ml. Therefore, early active surgical treatment should be considered.
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La Gliomatosis Cerebri (GC) se define como un compromiso infiltrativo difuso de un tumor glial generalmente astrocítico que compromete al menos 3 lóbulos cerebrales de manera bilateral y usualmente la afección se extiende al tallo cerebral. Su incidencia representa aproximadamente el 1% de la totalidad de los tumores encefálicos y se presenta con mayor frecuencia en adultos jóvenes. El diagnóstico se establece por medio de la clínica, la imagenología y confrimación histológica. Las posibilidades terapéuticas son limitadas y la sobrevida cercana a los 2 años mostrando una alta mortalidad. Reportamos el caso de un paciente masculino de 11 años de edad quien fue atendido en el Hospital Militar Central de Bogotá Colombia donde se realizó el diagnóstico y se instauró el tratamiento
Gliomatosis Cerebri (GC) is defined as a diffuse infiltration of a glial tumor generally astrocytic that involves at least 3 cerebral lobes bilaterally and usually the condition extends to the brainstem. Its incidence represents approximately 1% of all brain tumors and occurs more frequently in young adults. The diagnosis is established for the clinic environment, imaging and histological confirmation. The therapeutic possibilities are limited and the survival close to 2 years showing a high mortality. We report the case of an 11-year-old male patient who was treated at the Central Military Hospital of Bogotá Colombia where the diagnosis was made and treatment was instituted
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Humans , Male , Child , Brain Neoplasms/diagnostic imaging , Oculomotor Nerve Diseases/diagnostic imaging , Neoplasms, Neuroepithelial/diagnostic imaging , Magnetic Resonance Spectroscopy , Central Nervous System NeoplasmsABSTRACT
Introducción: Para utilizar un meta-análisis de todos los casos reportados de la estimulación cerebral profunda (DBS) para ladistonía para determinar cuáles son los factores significativos resultados influencia relacionada con el destino. La escala demovimiento Burke-Fahn-Marsden (BFM), la medida más informado, fue elegida como la principal medida de resultado paraeste análisis. Material y Métodos: Una búsqueda en MEDLINE identificaron 137 pacientes que se sometieron a DBS para ladistonía en 24 estudios que tenían puntuaciones individuales BFM. Datos de los pacientes individuales, incluyendo la edad deinicio de la distonía, la edad de la cirugía, el género, la distribución de la distonía, la etiología de la distonía, la presencia decaracterísticas asociadas, anormalidad de las imágenes preoperatorias, cirugías estereotáxica anteriores, el núcleo estimulado,el tipo de anestesia que se utiliza, el tiempo de respuesta a la estimulación, y el momento de la evaluación de resultadosse introdujeron en una base de datos de SPSS para el análisis estadístico. Resultados: La media BFM cambio porcentual(mejora en la puntuación postoperatoria de la línea de base) fue 51,8% (rango - 34% a 100%). Significativamente se lograronmejores resultados con la estimulación del globo pálido interno (GPI) que con la estimulación de la parte posterior del núcleolateral ventral (VLP) del tálamo (p = 0,0001)...
Introduction: To use a meta-analysis on all reported cases of deep brain stimulation (DBS) for dystonia to reevaluate the good effect using the GPi as a target, which factors significant influence outcome related to the target. The Burke-Fahn-Marsden (BFM) movement scale, the most reported measure, was chosen as the primary outcome measure for this analysis. Material and Methods: Computerized MEDLINE searches on English literature search identified 137 patients who underwent BBS for dystonia in 24 studies that had individual BFM scores. The study was done with statistical analysis by intention to treat. Statistical analysis was made with a significant p- value of 0.05. For the comparison of pre- and postoperative scores, a test Wilcoxon signed was used. Results: The mean BFM percentage change (improvement in postoperative score from baseline) was 46.3 percent(range - 34 percent to 100 percent)...
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Humans , Male , Female , Dystonia/etiology , Dystonia/therapy , Deep Brain Stimulation/methods , Stereotaxic Techniques , Stereotypic Movement Disorder , Abnormal Involuntary Movement Scale , Electric Stimulation/methodsABSTRACT
Objective To discuss the application of early time window modified stereotaxic aspiration in converting operation therapy on the specified acute epidural hematoma.Methods 21 patients with the specified acute epidural hematoma were treated with early time window modified stereotaxic aspiration drainage,using YL-1 hematoma puncture needle with silica gel ventricular drainage tube.Results The successful rate of puncture was 100％.Hematoma was completely cleared in 19 cases.A small amount of epidural effusion was remained in 2 cases.1 case had concomitant rebleeding during the puncture,and shifted to craniotomy.Conclusion Early time window modified stereotaxic aspiration drainage is a minimally invasive,safe and effective treatment on the specified acute epidural hematoma when mastering the indications,timing and skills of puncture.
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An 18-year-old left-handed male harbored intractable medial temporal lobe epilepsy (MTLE) underwent fractionated gamma knife surgery (GKS) instead of open surgery, considering the mental retardation and diffuse cerebral dysfunction. GKS treatment parameters were: target volume, 8.8 cm3; total marginal dose, 24 Gy in 3 fractionations at the 50% isodose line. The patient has been free from seizures since 9 months after GKS, with notable improvement in cognitive outcome. Fractionated GKS could be considered as a safe tool for seizure control and neuropsychological improvement in patients with MTLE.