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Objective:To investigate the efficacy of microscopic decompression in degenerative lumbar spinal stenosis (DLSS) under single percutaneous tubular retractor system.Methods:A retrospective analysis was performed; 117 DLSS patients with imaging manifestations as non-segmental lumbar instability, admitted to Department of Neurosurgery, 900 th Hospital of PLA Joint Logistics Team from October 2018 to April 2023 were enrolled consecutively. These patients failed in strict conservative treatment and then changed to posterior lumbar spinal canal and nerve root decompression by microscopy and percutaneous tubular retractor system. These patients were followed up for 6-50 months. Pain visual analogue score (VAS) and lumbar Oswestry dysfunction index (ODI) were recorded and results of X-rays, CT and MRI of lumbar spines were analyzed 1 d before and 1 week after decompression and at the last follow-up. Modified MacNab criteria were used to evaluate the efficacy at the last follow-up. Results:Among the 117 patients, unilateral laminectomy for unilateral decompression was performed in 56 patients (47.9%) and unilateral laminotomy for bilateral decompression in 61 (52.1%). Single segment decompression was performed in 109 patients (93.2%) and double segment decompression in 8 (6.8%). Dural sac rupture occurred in 4 patients (3.5%), and immediate occlusion was given; no cerebrospinal fluid leakage was noted after decompression. All patients did not experience obvious nerve damage during decompression or intervertebral infection/lumbar instability after decompression. After 18 (13, 24) months of follow-up, VAS scores of the patients at the last follow-up decreased from (5.96±0.85) 1 d before decompression and (1.75±0.61) 1 week after decompression to (1.01±0.59), and lumbar ODI decreased from (63.22±8.33)% 1 d before decompression and (17.66±5.20)% 1 week after decompression to (10.64±3.44)%, with significant differences ( P<0.05). At the last follow-up, modified MacNab criteria indicated 46 patients (39.3%) as excellent, 66 (56.4%) as good, 3 (2.6%) as fair, and 2 (1.7%) as poor, with an excellent/good therapeutic rate of 95.7%. Conclusion:For surgical treatment of DLSS patients without evidenced preoperative spinal instability, personalized unilateral or bilateral spinal canal decompression under microscope by combiningsingle percutaneous tubular retractor system can effectively reduce surgical trauma and achieve satisfactory surgical results.
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Objective:To investigate the efficacy of posterior cervical spinal nerve root decompression under microscope and percutaneous tubular retractor system in cervical spondylotic radiculopathy (CSR).Methods:A total of 38 patients with CSR, admitted to Department of Neurosurgery, 900 th Hospital of PLA Joint Logistics Team from September 2019 to October 2022 were enrolled consecutively. These patients failed in strict conservative treatment and then changed to posterior cervical spinal nerve root decompression under microscope and percutaneous tubular retractor system. The patients were followed up for (15.71±7.50) months, ranging from 3 to 36 months. The pain visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) scores were recorded and the results of X-ray, CT and MRI of cervical spines were analyzed 1 d before decompression, before discharge and at the last follow-up. C 2-7 sagittal vertical axis (SVA) was measured and compared on CT reconstruction images before decompression and at the last follow-up. The clinical efficacy of these patients was determined according to the formula of improvement rate=([JOA at the last follow-up-preoperative JOA]/[17-preoperative JOA])×100%: 100% improvement rate was defined as cure, improvement rate>60% as significant effect, 25%<improvement rate≤60% as valid treatment, and improvement rate≤25% was defined as invalid treatment. Results:The VAS and JOA scores were 5.91±0.90 and 11.37±1.50 before decompression, and 0.37±0.31 and 15.76±1.44 at the last follow-up, respectively, with significant differences ( P<0.05). Among 38 patients, 12 patients (31.6%) were cured, 18 (47.4%) were significantly effective, 7 (18.4%) were valid, and 1 (2.6%) was invalid, enjoying a total effective rate of 97.4%. Neither dural sac tear or obvious nerve injury during decompression nor infection after decompression were noted. The C 2-7 SVA at the last follow-up ([15.82±0.95] mm) was significantly lower than preoperative C 2-7 SVA ([17.07±1.07] mm, P<0.05). Conclusion:Posterior cervical nerve root decompression can obtain satisfactory results in single segment CSR; combined application of microscope and percutaneous tubular retractor system can effectively ensure the cervical spine stability and retain the corresponding motion segments.
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Objective:To investigate the role of NG2 cells in generating and maintaining neuropathic pain in rats after spinal cord injury (SCI).Methods:According to random number table method, 100 healthy adult male SD rats were divided into control group ( n=20, without any intervention), sham-operated group ( n=40, exposed T 10 segment without spinal cord impact) and SCI group ( n=40, exposed T 10 segment and constructed SCI model by improved Allen's method). One d before, and 14, 21 and 28 d after surgery, Von Frey fiber probe was used to detect the rat hindlimb mechanical withdrawal threshold (MWT); immunofluorescent staining was used to detect the proportion of NG2-positive cells in spinal dorsal horn cells; Western blotting was used to detect chondroitin sulfate proteoglycan (CSPG) expression in spinal dorsal horn of rats. Results:Fourteen, 21 and 28 d after surgery, SCI group had significantly lower hindlimb MWT, and significantly higher proportion of NG2-positive cells in spinal dorsal horn cells and CSPG expression in spinal dorsal horn than control group and sham-operated group ( P<0.05). One d before, and 14, 21 and 28 d after surgery, in SCI group, hindlimb MWT decreased firstly and increased secondly, proportion of NG2-positive cells in spinal dorsal horn cells increased firstly and decreased secondly, and CSPG expression in spinal dorsal horn increased firstly and decreased secondly. Except for those 21 and 28 d after surgery, hindlimb MWT, proportion of NG2-positive cells in spinal dorsal horn cells, and CSPG expression in spinal dorsal horn showed significant differences between each two time points ( P<0.05). In SCI group, hindlimb MWT was negatively correlated with proportion of NG2-positive cells in spinal dorsal horn cells ( r=-0.876, P<0.001), and CSPG expression was positively correlated with proportion of NG2-positive cells in spinal dorsal horn cells ( r=0.927, P<0.001). Conclusion:NG2 cell proliferation and increased CSPG expression secreted by NG2 cells in spinal cord tissues after SCI generate and maintain neuropathic pain.
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Objective:To explore the curative efficacy of nerve root sheath plasty under microscope in treatment of patients with Tarlov cysts.Methods:A total of 41 patients with symptomatic Tarlov cysts, admitted to our hospital from March 2016 to December 2019, were collected; these patients received surgical treatment by nerve root sheath plasty under microscope and neuroelectrophysiological monitoring. The microsurgical efficacy was evaluated by changes of pain visual analogue scale (VAS) scores and lumbar Oswestry dysfunction index (ODI) before and one week, 3 months, and 6 (or 12) months after surgery.Results:The VAS scores and lumbar ODI of 41 patients one week, 3 months, and 6 (or 12) months after surgery were significantly reduced as compared with those before surgery, and presented a gradually decreased trend, with statistically significant differences between each time point ( P<0.05). The median of improvement rate of lumbar ODI was 72.7% (58.9%, 79.7%): curative effect was excellent in 19 patients (improvement rate of lumbar ODI>75%), good in 14 patients (51%≤improvement rate of lumbar ODI≤75%), passable in 3 patients (26%≤improvement rate of lumbar ODI≤50%), and poor in 5 patients (improvement rate of lumbar ODI≤25%), enjoying rate of excellent and good curative effect as 80.5% (33/41). Postoperative cerebrospinal fluid leakage occurred in two patients without infection. Cyst recurrence occurred in one patient on the 3 rd d of surgery due to loosening of the suture of the access hole, and no recurrence occurred after the second surgery. Conclusion:The compression of Tarlov cysts on nerve root can be safely and effectively relieved by nerve root sheath plasty under microscope and neuroelectrophysiological monitoring; the symptom relief rate is high and it is not easy to recur.
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Objective To explore the correlation between cervical diffusion tensor imaging (DTI) and median nerve short latency somatosensory evoked potential (MN-SLSEP) parameters in patients with cervical intraspinal tumors.Methods Twenty-two patients suffering from cervical intraspinal tumors treated with surgical resection were enrolled into study group from February 2015 to May 2016;meanwhile,22 age-matched volunteers were selected as control group.Cervical DTI and MN-SLSEP detection were performed 3 d before operation and one month after operation,respectively.The whole cervical spinal cord was divided into 3 areas,the tumor head area,the tumor area,and the tumor tail area;and the fractional anisotropy (FA) values of the 3 areas were calculated.The white matter fiber bundle was reconstructed by diffusion tensor tracking (DTT) to observe its integrity.Study group was further divided into delayed latency group (lat+ group) and normal latency group (lat group)according to the delayed latency of N9-N20 interpeak levels,and the FA values of the 3 groups at different areas were compared.Results Total removal of the tumors was achieved in 19 patients (86.4％) and subtotal in 3 patients (13.6％,two with nerve fibrolipomas and one with intramedullary neurilemmomas) of the study group.One month after the operation,the spinal function was improved in 17 patients (77.3％),and not improved in 5 patients (22.7％).The preoperative N9-N20 interpeak latency in the study group was significantly longer than that in the control group (P＜0.05).In term of preoperative fiber tract morphology of study group,the proportion of delayed N9-N20 interpeak latency in patients with interrupt type (75％) was significantly longer than that in the patients with intact type (21.4 ％,P＜0.05).FA values oflat+ and lat group in the tumor head area,tumor area,and tumor tail area were significantly lower than those in the control group (P＜0.05);and FA values of lat+ group in these three regions were significantly lower than lat group (P＜0.05).Conclusions DTI metrics correlate with MN-SLSEP measures.Through variations of quantitative parameter values and fiber tract morphology,cervical DTI can sensitively and intuitively reflect the electrophysiological changes,which could be served as a important diagnostic tool for cervical intraspinal tumors.
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Objective To discuss the selection of diagnosis for intracranial aneutysms,and to analyze thera-peutic efficacy of microsurgical treatment and endovascular embolizafion in the treatment of intracranial aneurysms.Methods 190 pailents suffeming from intracranial aneurysms experienced brain CT examination.37 cases detected by MRI.31 cases detected by MRA,134 were confirmed by computered tomographic angiography(CTA)or 3D-CTA,and 142 cases were confirmed by digital subtract angiography(DSA).96 patients underwent microsurgical treatment,4 of whom failed in endovascular embolization.92 cases underwent endovascufar therapy,2 of whom were embolized by ONYX,and the other were embolized by guglielmi detachable coil(GDC).Results 9 patients died,2 of whorn died of re-hemorrhage,3 died of severe vasospasm,4 died of pneumonia and other complications,and the others were cured.Conclusion CT is the first choice for the subarachniod hemorrhage;MBA could be a choice for the detection of intracranial aneurysm without hemorrhage,but is not suit for the aneurysm clipping.The size-form,relationship with patent arteries,and even the raptured point of aneurysms can be clearly demonstrated by CTA-and CTA can be used to the operation for intracranial aneurysms directly.DSA-especially 3D-DSA Call display the blood supply of the complicated aneurysms clearly,and can guide the treatment for intracnmial aneurysms directly.Endo-vascular therapy and aneurysm clipping seem like complimentary than competitive,patients with acute cerebral edema should try to undergo endovascular therapy,while the patients with severe vasespasm should be treated with microsur-gical operation immediately and resolutely.The ruptured aneurysms in multiple intracraniul aneurysm should be iden-tified correctly and treated in the early stage.
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Objective:To evaluate the role of positron emission tomography/computer tomography(PET/CT) in localizing the epiletogenic cortex of the temporal lobe epilepsy(TLE) before operation.Methods: Electroencephalogram(EEG) examinations and PET/CT(Discovery LS PET/CT Scanning) scans was performed in 53 patients with clinically confirmed temporal lobe epilepsy.Electrocorticography(ECoG) was performed in 38 of the 53 patients undergoing neurosurgical therapy and pathlogical examination was also performed.Congruence between ECoG,pathological examination and PET/CT images was analyzed.Results: All 53 patients obtained clearly anatomic and functional images.Fifty patients(50/53,94.3%) had abnormal ~(18)F-FDG PET/CT metabolism(hypometabolism in 48 cases and hypermetabolism in 2).Among the 50 patients,42(85.0%)were also found positive by multiple kinds of EEG examinations,but only 32 of 42(64.0%)showed definite location,and 30 of 32 cases(93.8%) were in full accordance with PET/CT results.Thirty-two of the 38 patients undergoing neurosurgical therapy had complete or partial congruence between their ECoG and PET/CT results.All the patients were confirmed to have hippocampal sclerosis and atrophy.According to ECoG localization results,the specificity of PET/CT was 84.2%(32/38) in localizing epilepsy foci.Conclusion: ~(18)F-FDG PET/CT can make anatomic and functional localization of TLE.It is an effective,sensitive and non-invasive method,but its results must be confirmed by EEG before operation.