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Objective To explore the risk factors of aseptic meningitis (AM) after microvascular decompression (MVD) to provide evidence for preventing the occurrence of AM. Methods One hundred and forty-one patients diagnosed as having trigeminal neuralgia or hemifacial spasm, admitted to our hospital from January 2014 to December 2016, were chosen. A retrospective analysis was performed on these clinical data. Eighteen related factors of AM were analyzed by Logistic regression model. Results The result of single analysis of related factors showed that gender, age, diabetes, operation time, skill level of the operator, injection of dexamethasone, and postoperative dressing time were related to AM after MVD (P<0.05). Multifactor Logistic regression analysis showed that gender (OR=2.920, P=0.015), diabetes (OR=0.200, P=0.026), and non-injection of dexamethasone (OR=7.970, P=0.002) were independent risk factors of postoperative AM. Conclusion The male or diabetic patients have high rate of postoperative AM; and the risk of postoperative AM would be reduced if we inject dexamethasone to the cerebellopontine angle cistern at the end of MVD.
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Objective To evaluate the efficacy of a novel hemostatic material AristaTM in the management of active and local bleeding in neurosurgery, and discuss the indications for its application. Methods Forty-eight patients undergoing elective craniotomy in our department between April, 2008 and May, 2009 were randomized into the test group (n=24) and control group (n=24) with intraoperative hemostatic management using AristaTM and gelatin sponge, respectively. The hemostasis time and efficacy of the two materials were compared. Results Hemostasis was effective in all the 48 patients. The mean hemostasis time in the test group and control group was 1.88±0.74 min and 3.38±0.92 min, respectively, showing a significant difference between them (Z=4.711, P=0.001). Conclusion AristaTM allows more efficient management of active and local bleeding than gelatin sponge during neurosurgeries and has great potential for clinical application.
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Objective To study the clinical efficacy and safety of direct intraventricular administration of recombinant tissue plasminogen activator (rt-PA) in patients with intraventricular hemorrhage (IVH). Methods A series of 10 patients with IVH, admitted to our hospital from November 2005 to October 2007, was studied for the effect of direct intraventricular administration of rt-PA. In all patients, ventriculostomy was performed in unilateral or bilateral ventricles through frontal burr holes as soon as the IVH was diagnosed on CT. Four or 6 h later, 4 to 8 mg rt-PA was slowly injected through the ventricular catheter. The injection was repeated at 12-24 h intervals until serial CT scans showed a substantial reduction of intraventricular blood. CT scan was conducted at 24-48 h after injection of rt-PA. The outcome of patients was evaluated according to Glasgow Outcome Scale (GOS)on day 30 after IVH. Results The total dose of rt-PA per patient ranged from 13 to 24 mg. On day 30after IVH, 4 patients had a good recovery, 3 patients were moderately disabled, 2 were severely disabled,and 1 was in a vegetative state, and no patient died. There were no hemorrhagic and intracranial infectious complications resulted from treatment, and no catheter became obstructed With blood clot.Conclusions Intraventricular administration of rt-PA can speed the resolution of intraventricular blood clot, keep the ventricular drainage catheter open, reduce the space-occupying effect of the blood clot.Intraventricular administration ofrt-PA is effective and safe, and can improve the patients' prognosis.
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<p><b>OBJECTIVE</b>To assess postoperative effects of microelectrode-guided posteroventral pallidotomy (PVP) for Parkinson's disease.</p><p><b>METHODS</b>Intraoperative microelectrode recordings and microstimulation were used to explore the globus pallidus to performance of posteroventral pallidotomy in 48 patients with Parkinson's disease (47 unilateral and 1 bilateral). Assessment was made at baseline preoperatively and at 6 months intervals postoperatively, with unified Parkinson's disease rating scale (UPDRS).</p><p><b>RESULTS</b>All patients were significantly improved on the limbs contralateral to the lesion side 6 - 34 months after operation (mean 24 months). The improvement was seen in the 'on' or 'off' state: UPDRS scores with patients on levodopa were improved by an average of 28.7%, while off medication scores showed reductions (47.6%) at 24 months. There were no deaths and no visual complications, but there were 4 patients (8.3%) of a delayed contralateral limbs dystonia after pallidotomy.</p><p><b>CONCLUSIONS</b>The techniques of microelectrode recording and microstimulation indicate the location of the internal capsule and optic tract, which allow easy identification of these structure and facilitate PVP target in conjunction with radiofrequency microelectrode stimulation.</p>