The application of hybrid operation suite in the management of cerebral and spinal vascular diseases and intracranial hypervascular tumors / 中华外科杂志

Objective@#To evaluate the effect of hybrid operation suite in the treatment of cerebral and spinal vascular diseases and intracranial hypervascular tumors.@*Methods@#A retrospective study was conducted on 132 patients with various cerebral and spinal vascular diseases and intracranial hypervascular tumors who were treated by hybrid surgery at Department of Neurosurgery, Huashan Hospital from October 2016 to December 2017.There were 70 male and 62 female patients with a mean age of 48.33 years (range: 14-78 years), including 64 cases of intracranial aneurysm (41 complicated aneurysm cases), 28 cases of brain arteriovenous malformation (BAVM), 12 cases of hypervascular tumor, 12 cases of dural arteriovenous fistula (DAVF), 6 cases of carotid artery stenosis, 5 cases of Moyamoya disease, 3 cases of intracranial aneurysm or BAVM combined with tumor, 1 case of scalp arteriovenous fistula and 1 case of critical brain trauma in which a foreign metal stick approached the basal vascular circuit.Abnormalities were found in 16 cases in intraoperative angiography. The clinical data of all patients was collected as a perspective cohort. The success rate of hybrid surgery, intra-operative and post-operative complications, morbidity, mortality, rate of infection, the length of hospital stay were all analyzed to illustrate the effect of hybrid operation mode to traditional surgical pattern.@*Results@#For 64 cases with intracranial aneurysms, the immediate complete occlusion rate was 90.5%, with a mortality of 4.7% and a morbidity of 14.0%. For 28 cases of BAVM and 12 cases of DAVF, all patients achieved total obliteration and favorable social independent outcomes after hybrid surgery, with no complication.For 6 cases of carotid artery stenosis and 5 cases of Moyamoya, intra-operative confirmed good cerebral reperfusion without any new post-operative neurologic deficits. After tumor vessels embolization, 4 out of 12 cases of hypervascular tumor needed intra-operative blood transfusion, and all patients achieved total tumor resection in a single stage. Only one patient with medulla oblongata hemangioblastoma died 6 months after operation due to respiratory deficit related pneumonia. Compared to traditional surgeries, the hybrid operation pattern did not significantly increase the total infection rate, central nervous system infection rate, hospital stay days and post-operative hospital stay days (all P>0.05) while the in-patient cost increased mildly (119 332 yuan vs.98 215 yuan, t=2.38, P=0.02).@*Conclusions@#The operations of complex cerebral and spinal vascular diseases and intracranial hypervascular tumors can be performed in hybrid operation suite safely.This surgical mode can ensure the quality of operation and promote the development of innovative and complicated surgical procedures.

Nursing cooperation of complex spinal vascular malformation compound surgery in 111 cases / 中华护理杂志

This paper aimed to summarize critical elements in smooth switch between conventional surgery and interventional surgery through nursing cooperation of complex spinal vascular malformation compound surgery.①Before operation,nurses should be familiar with the whole surgical procedure,and anticipate special items which might be used during surgery according to location and size of malformation;②Nurses should understand all medical test results which were important basis for intraoperative medication;③Nurses should complete assessment of physical function for postoperative comparison;④Layout of all medical instruments in operating room should be reasonable,and repeated moving should be avoided.⑤Patient position should satisfy requirements of the surgery as well as functional position simultaneously;⑥Measures to prevent pressure injuries should be taken according to patient's intraoperative position;⑦Thrombogenesis should be prevented via connection of vessel sheath and catheter to the pressure infusion apparatus;⑧Internal length and external length of the vessel sheath should be determined according to patient's body shape and lesion location.

Posterior Spinal Artery Aneurysm Presenting with Leukocytoclastic Vasculitis

Rupture of isolated posterior spinal artery (PSA) aneurysms is a rare cause of subarachnoid hemorrhage (SAH) that presents unique diagnostic challenges owing to a nuanced clinical presentation. Here, we report on the diagnosis and management of the first known case of an isolated PSA aneurysm in the context of leukocytoclastic vasculitis. A 53-year-old male presented to an outside institution with acute bilateral lower extremity paralysis 9 days after admission for recurrent cellulitis. Early magnetic resonance imaging was read as negative and repeat imaging 15 days after presentation revealed SAH and a compressive spinal subdural hematoma. Angiography identified a PSA aneurysm at T9, as well as other areas suspicious for inflammatory or post-hemorrhagic reactive changes. The patient underwent a multilevel laminectomy for clot evacuation and aneurysm resection to prevent future hemorrhage and to establish a diagnosis. The postoperative course was complicated by medical issues and led to the diagnosis of leukocytoclastic vasculitis that may have predisposed the patient to aneurysm development. Literature review reveals greater mortality for cervical lesions than thoracolumbar lesions and that the presence of meningitic symptoms portents better functional outcome than symptoms of cord compression. The outcome obtained in this case is consistent with outcomes reported in the literature.

Características da artéria de Adamkiewicz: comparação entre indivíduos com e sem aortopatia / Adamkiewicz artery characteristics: comparison between patients with and without aortopathy

Introdução: O presente estudo visa elucidar a apresentação anatômica da vasculatura medular em exame angiotomográfico e suas diferenças entre pacientes aortopatas e não aortopatas na população brasileira. Objetivos: Determinar as características da artéria de Adamkiewicz (AKA) e artéria espinhal anterior (ASA) por método não invasivo. Secundariamente, determinaremos a distribuição anatômica da AKA na população brasileira e a influência de determinadas aortopatias e comorbidades na identificação da AKA. Casuística: Cento e quinze angiotomografias elegíveis realizadas no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo foram avaliadas e separadas entre pacientes aortopatas e não aortopatas. Trinta e dois (52,5%) homens e 29 mulheres constituíram o grupo não aortopata e 30 (56,6%) homens e 23 mulheres constituíram o grupo de aortopatas. Método: Análise prospectiva de angiotomografias realizadas em aparelho de 320 detectores através de software open-source OsiriX e identificação da AKA e ASA por reconstrução multiplanar tridimensional. Dados clínicos e sociodemográficos foram estratificados. Resultados: A AKA foi identificada em 78,7% dos integrantes do grupo não aortopata e em 40,7% dos pacientes aortopatas (p =< 0,0001). A ASA foi identificada em 80,3% dos integrantes do grupo não aortopata e em 46,3% dos pacientes aortopatas (p=0,0001). Em 53 (73,6%) casos a AKA originou-se do lado esquerdo. Discussão: A angiotomografia é exame de rotina no pré-operatório de doenças aórticas. O presente trabalho apresentou detecção da AKA em grupo não aortopata equiparável com a literatura, apesar do aumento de detectores no aparelho de tomografia e a identificação da AKA em grupo aortopata pouco abaixo da literatura, mas significativamente diferente do grupo não aortopata: maior proporção de identificação da AKA e ASA em pacientes não aortopatas. Houve diferença na distribuição da AKA em comparação com a literatura...

Introduction: This study investigated differences in spinal vasculature between healthy and diseased aortas among Brazilian population. Objective: The study aimed to identify and describe the spinal vascular anatomy, evaluate Anterior Spinal Artery (ASA) and Adamkiewicz artery (AKA) characteristics using non-invasive multidetector computed tomography (CT), as well as examine differences between groups with and without aortic disease. The secondary aim was to evaluate anatomic distribution of AKA level and side and the influence of clinical factors in its detection. Methods: CT scans of 115 patients from Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo were evaluated in terms of detection rate and AKA level and side. The results were also compared with data compiled from a review of the English language literature on this topic. We analysed 320-detector CT scans using OsiriX open source software. Furthermore, we identified the AKA and ASA using tridimensional multiplannar reconstruction. Clinical and demographics data were retrieved. Results: AKA identification showed higher detection rate in patients with healthy aortas (78.7%) compared to diseased aortas (40.7%) p < 0.0001. ASA was identified in 80.3% of the healthy aortas patients and 46.3% of the diseased aortas patients (p=0.0001). In 53 (76.6%) cases, the AKA originated from a left intercostal artery. Discussion: CT scan is a routine preoperative exam for aorta diseases. We observed a detection rate similar to that reported in previous literature on healthy aortas, in spite of the CT having more detectors. Furthermore, AKA identification in aorta diseased group was below literature, but statistically different from the healthy aorta group, higher AKA and ASA identification was found in healthy aorta group. The results indicated significant difference between previous literatures and our study in AKA detection. Conclusions: AKA...

Clinical application and diagnostic value of non-invasive spinal angiography in spinal vascular malformations / 中华放射学杂志

Objective To explore the value of CT spinal angiography with 256 MSCT and fast dynamic contrast-enhanced 3D MR angiography (CE-MRA) at 3.0 T in the diagnosis of spinal vascular malformations by comparing with results of DSA and operation.MethodsSeventeen patients suspected of spinal vascular diseases by initial MR and clinical manifestations all underwent CT spinal angiography.Of them,10 patients underwent MRA,15 patients underwent DSA within 3-5 days,and 8 patients finally underwent surgical treatment.ResultsCTA examination clearly showed the abnormal vascular lesions in 16 of 17 cases,including 7 cases with the diagnosis of spinal dural arteriovenous fistula,7 cases of perimedullary arteriovenous fistula,and 2 cases of spinal arteriovenous malformations. The results were consistent with the diagnosis of DSA or surgery.One case was poorly diagnosed.The feeding vessels were correctly determined in 12 cases,and the level of fistulas were correctly displayed in 12 cases.The level of fistulas and feeding vessels were accurately showed in 7 of 10 cases with MRA,while the other 3 cases exhibited normal with DSA.ConclusionsSpinal angiography with 256 MSCT and CE-MRA at 3.0 T can clearly show the extent of spinal vascular malformations,feeding arteries and fistula location.They are safe,noninvasive,convinient and can shorten the time of DSA diagnosis and treatment.They play an important role in diagnosis and treatment of spinal vascular malformations and postoperative follow-up.

Intervention of Vascular Diseases of the Spine / 신경중재치료의학

Spinal AVMs consist of various congenital and acquired vascular diseases which may result in spinal neurological deficit. The anigoarchitecture of these diseases are often difficult to analyze while the risk of treatment is high due to the eloquence of the spinal cord. Recently, the understanding of the anatomy of the spinal vessels, the characteristics of the spinal vascular diseases, and the efficacy of endovascular management has grown. The purpose of this review is to introduce the latest understanding of these diseases and its management strategies.