RÉSUMÉ
Objective To investigate the safety and clinical efficacy of magnetic resonance neuronavigation assisted technique in neurosurgical clipping of pericallosal aneurysms. Methods From January 2010 to January 2017,40 consecutive patients with pericallosal aneurysm treated with neurosurgical clipping at the Department of Neurosurgery,the 175th Hospital of PLA were enrolled retrospectively. They were diagnosed by CT angiography (CTA),magnetic resonance angiography (MRA)or digital subtraction angiography (DSA)before operation. According to the different surgical methods,40 patients were divided into either a routine surgical group (n＝18)or a neuronavigation assistance group (n＝22). On the basis of the conventional longitudinal fissure approach,the neuronavigation assistance group was treated with the magnetic resonance neuronavigation technique. The aneurysms and upper drainage vein,design incision and surgical approaches were accurately located. The operation time,surgical complications (edema or infarction after drainage vein injury and secondary bleeding in the operated area)and proportion of good prognosis (the modified Rankin scale [mRS]score ＜3)were compared. Results (1)Under the microscope,40 patients underwent clipping of pericallosal aneurysms via longitudinal fissure approach. Postoperative CTA or DSA confirmed that they were all completed clipped. The operation time of the neuronavigation assistance group were shorter than that of the routine surgical group (2. 5 ± 0. 5 h vs. 3. 5 ± 0. 4 h,t＝1. 254),and the proportion of edema or venous infarction was less than that of the routine surgical group (4. 5%[1／22]vs. 6／18). The difference between the two groups was statistically significant (all P＜0. 05);there were no significant differences in the incidences of accidental rupture and secondary hemorrhage between the two groups (all P＞0. 05). (2)Both groups of patients completed the 6-month follow-up. There were 12 patients (12／18)with good prognosis in the routine surgery group and 20 (90. 9%)with good prognosis in the neuronavigation assistance group. There was no significant difference in the proportion of good prognosis between the two groups (χ2＝3. 545,P＞0. 05). Conclusions The use of magnetic resonance neuronavigation assisted technique helps the precise intraoperative positioning of the lesions and surgical approach optimization,thereby effectively implementing brain protection,reducing the risk of microsurgery, and improving the accuracy and safety of the surgery. It is an effective auxiliary means of neurosurgical clipping of pericallosal aneurysms.
RÉSUMÉ
Objective To explore the clinical efficacy of large M-shaped craniotomy combined with lobectomy for secondary decompression in patients following severe craniocerebral trauma.Methods The clinical data were retrospectively analyzed of the 76 patients who had undergone secondary decompression following severe craniocerebral trauma from January 2007 to January 2010.The preoperative intracranial pressure (ICP) was 30～40 mmHg in 40 cases and ＞40 mmHg in 36 ones.All the patients received regular lobectomy in primary craniotomy;for secondary decompression some received simple lobectomy and some large M-shaped craniotomy combined with lobectomy.The patients undergoing different surgical procedures were compared in terms of survival rate,changes in intracranial pressure and therapeutic efficacy by the GOS 6 months post-discharge.Results Of the patients with 30～40 mmHg ICP,22 underwent large M-shaped craniotomy combined with lobectomy and 18 simple lobectomy.The survival rate within 7 days after surgery for the former patients (72.7％) was significantly higher than that for the latter ones (38.9％) (P＜0.05).Of the patients with ＞40 mmHg ICP,19 underwent large M-shaped craniotomy combined with lobectomy and 17 simple lobectomy,but all of them died within 7 days after surgery.Of those surviving the secondary decompression,7 received simple lobectomy and 16 large M-shaped craniotomy combined with lobectomy.The ICP in the latter patients was significantly lower at postoperative one day and 3 weeks than that in the former ones (P＜0.05).Compared with those receiving simple lobectomy,the patients receiving combined procedures had significantly higher GOS and significantly better prognosis (P＜0.05).There were no significant differences between the patients receiving two different surgical procedures in such adverse events as traumatic epilepsy,cerebrospinal fluid leakage,softening brain tissue,or wound malunion (P＞0.05).Conclusion For the patients with craniocerebral trauma who still suffer severe brain swelling or infarction after primary decompression,if their ICP is below 40 mmHg,large M-shaped craniotomy combined with lobectomy for secondary decompression can obviously decrease their ICP,increase their survival rate and improve their prognosis compared with simple lobectomy.
RÉSUMÉ
Objective To explore the clinical effectiveness of urokinase perfusion and drainage in patients with hypertension cerebral hemorrhage broken into ventricles.Methods Patients with hypertension cerebral hemorrhage broken into ventricles(35 cases)underwent urokinase perfusion and drainage.Clinical effect was observed and the nursing point was summarized.Results Of the 35 patients,20 cases acquired good recovery,13 cases were mildly disabled,2 case were severely disabled,no death occurred.The complications mostly consisted of secondary hemorrhage,infection,disfunction.Conclusions The early lateral ventricle drilling operation,postoperative urokinase perfusion and drainage,active complications prophylaxis and treatment,rehabilitation training can reduce mortality and improve the quality of patients' life.