Clipping for large paraclinoid internal carotid artery aneurysms by non-fluoroscopic occlusion via a micro-bone window frontolateral approach / 中华外科杂志

Objective@#To evaluate the clinical value and outcomes of technical improvement of hybrid operatical clipping for large paraclinoid internal carotid artery aneurysms.@*Methods@#A review was conducted on 18 cases of large paraclinoid internal carotid artery aneurysm which were clipped by balloon non-fluoroscopic occlusion of the parent artery via a micro-bone window frontolateral approach in hybrid operating room at Neurosurgery Department of Tianjin Medical University General Hospital from June 2014 to December 2017. There were 8 males and 10 females with age of (63±4) years. There were 6 cases of unruptured aneurysm and 12 cases of ruptured aneurysm of subarachnoid hemorrhage (6 cases of grade Ⅱ, 4 cases of grade Ⅲ and 2 cases of grade Ⅳ in Hunt-Hess classification). Frontolateral approach incision (average length of about 5 cm) and bone window about 3 cm×3 cm were performed. No incision of the neck was needed to expose the internal carotid artery for temporary occlusion. In the operation, the balloon was slowly pushed to the preset position of the internal carotid artery under non-fluoroscopy. The balloon was expanded to block the blood flow of internal carotid artery. Then aneurysm was clipped. The balloon was loosened and retraced to the guiding catheter after clipping. The clipping condition was examined by cerebral angiography. If there was residual aneurysm neck or stenosis of the parent artery, the balloon was pushed under non-fluoroscopy again to temporary occlusion and the clip was adjusted until the aneurysm neck was clamped satisfactorily.@*Results@#Eighteen aneurysms were successfully clipped in hybrid operating room. Fourteen aneurysms showed complete occlusion of the aneurysm neck and no stenosis of the parent artery. Four cases showed residual aneurysm neck after clipping by intraoperative angiography, then aneurysms were clipped satisfy by adjusting the aneurysm clip. The patients were followed up for 3 months to 1 year. Ten patients recovered well (modifed Rankin score (mRS): 0), and 3 patients had no obvious disability (mRS: 1). Two patients with Hunt-Hess grade Ⅲ were slightly disabled (mRS: 2). 1 patients with Hunt-Hess grade Ⅲ were moderately disabled (mRS: 3). 1 patients with Hunt-Hess grade Ⅳ were severely disabled (mRS: 4). One elderly patients with Hunt-Hess grade Ⅳ were seriously disabled (mRS: 5).@*Conclusions@#Application of balloon non-fluoroscopic occlusion clipping for large paraclinoid internal carotid artery aneurysm via a micro-bone window frontolateral approach is safe, effective and minimally invasive.

Multi-mode neural electrophysiological monitoring in carotid endarterectomy / 中华神经医学杂志

Objective To evaluate the clinical application value of motor evoked potential (MEP) combined with somatosensory evoked potential (SEP) and electroencephalogram (EEG) in carotid endarterectomy (CEA) in prevention of cerebral ischemia.Methods The clinical data of 62 patients accepted CEA in our hospital from June 2014 to July 2016 were analyzed retrospectively.During the operation,MEP,SEP and EEG were examined,and the bypass rube would be considered when SEP/MEP amplitude was decreased by 50％,latency was delayed by 10％,or frequency of EEG was changed by 50％.The predictive effects of each method and combined application of 3 methods were compared.Results In 62 patients,MEP changes occurred in 11 patients,SEP changed in 15 patients and EEG changed in 8 patients.Six patients applied bypass tube during operation and a transient neurological dysfunction occurred in 5 patients.The specificity of EEG mode showed no statistical differences as compared with that of SEP+MEP,EEG+MEP,and SEP+EEG modes (P＞0.05),while that of SEP mode or MEP mode was significantly lower as compared with that of SEP+MEP,EEG+MEP,and SEP+EEG modes (P＜0.05).The specificity of SEP+MEP+EEG mode showed no statistical differences as compared with that of SEP+MEP,EEG+MEP,and SEP+EEG modes (P＞0.05).Conclusion Multi-mode neural electrophysiological monitoring is safer and more effective than single mode in CEA;MEP+SEP monitoring mode is the preferred monitoring program in CEA.

Surgical treatment for supratentorial hypertensive intracerebral hematoma by modified minicraniotomy approach and bone fragment reduction / 中国综合临床

Objective To explore the techniques and clinical effects of surgical treatment for supratentorial hypertensive intracerebral hematoma (HICH) by modified minicraniotomy approach and bone fragment reduction.Methods The clinical data of 87 patients with supratentorial HICH in our department from April,2009 to April,2011 who received modified minicraniotomy approach and reduction of bone fragment were retrospectively reviewed.Results Of the 87 patients,three died,and the remaining 84 cases were followed up.According to the ADL( activities of daily living) scale,the patients were classified:Twenty-six cases in grade Ⅰ,28 in grade Ⅱ,22 in grade Ⅲ,6 in grade Ⅳ and 2 in grade Ⅴ.Conclusion The surgical procedure of modified minicraniotomy approach and reduction of bone fragment for treatment of supratentorial HICH has some advantages such as miniinvasion,good exposure,wide visual field,complete clearance of hematoma,integrated skull,and less complications.It is a perfect surgical procedure for supratentorial HICH.

Microsurgical treatment of mesial temporal lobe epilepsy under the guidance of intraoperative magnetic resonance imaging neuronavigation system / 中华显微外科杂志

ObjectiveTo explore the applied effects of microsurgical treatment on mesial temporal lobe epilepsy(MTLE)under the guidance of the intraoperative magnetic resonance imaging neuronavigation system.MethodsThe anterolateral temporal lobe,hippocampus and amygdala was resected by microsurgery under the guidance of the intraoperative magnetic resonance imaging neuronavigation system in 26 patients with intractable MTLE,with the help of electrocorticography monitoring during operation.ResultsAnterolateral temporal lobes were all resected in postoperative MRI and mesial structures certified to have atrophy or cirrhosis by pathology.All the patients were followed up from 3 to 6 months after the surgery.In 26 patients,twenty-three cases (88.5％) belonged in Engel grade I,two cases (7.7％) in grade Ⅱ and 1 case (3.8％) in gradeⅢ.No severe complications occurred and nervous functions were preserved well.ConclusionMicrosurgical treatment on MTLE under the guidance of the intraoperative magnetic resonance imaging neuronavigation system is effective due to epileptic focus all resected and protection for nervous functions,resulting in an accurate and safe improvemention of operation.