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Objective:To investigate the clipping methods of ruptured posterior communicating artery (PCoA) aneurysms of medial posterior inferior type (aneurysms located at the medial posterior inferior part of internal carotid artery or occluded by the internal carotid artery) during conventional pterional craniotomy.Methods:Seven patients with ruptured PCoA aneurysms, admitted to our hospital from January 2004 to January 2020, were chosen in our study. The clinical data and surgical efficacies of these patients were retrospectively analyzed.Results:The anterior choroidal artery (AChA) was accidentally clipped in 2 patients during the surgery, of which one was released after adjustment and one was avoided after multiple adjustments. Due to severe acute brain swelling, the brain tissues of the anterior temporal lobe were removed for about 20 mm in 2 patients, and the anterior temporal lobe was retracted posteriorly by platens in 5 patients. All aneurysms disappeared in the postoperative CTA images, no residual neck was found, and the parent artery remained unobstructed. One patient had cerebral infarction in the AChA supplying area. All patients were followed up for 1-6 years, with an average of 27.6 months. Six patients recovered completely without neurological dysfunction. One patient had contralateral hemiplegia, with muscle strength grading III, walking on crutches, and basic living by himself.Conclusion:It's difficult to clip the ruptured PCoA aneurysms of medial posterior inferior type by conventional pterional craniotomy; so straight and curved aneurysm clips can be used to clip aneurysms by expanding the inter-cisternal space around the aneurysms.
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Objective:To explore the surgical treatment efficacy and experience of intracranial malignant melanoma (IMM).Methods:Seven patients with IMM, including 3 with primary IMM and 4 with secondary IMM, admitted to our hospital from May 2013 to June 2018, were treated with minimally invasive transcranial surgery. The tumors were removed as much as possible during the operation; according to the postoperative condition of these patients, adjuvant therapies such as follow-up or radiotherapy/chemotherapy, or/and reoperation/comprehensive treatment were provided.Results:These 7 patients eventually died; among the 3 patients with primary IMM, one had total resection, one had subtotal resection, and one had partial resection, and the postoperative survival period was 10 months, 7 months and one month, respectively; among the 4 patients with secondary IMM, three had total resection, and one had partial resection, and the postoperative survival period was 32 months, 13 months, 12 months and 5 month, respectively.Conclusion:The overall prognosis of IMM patients is poor, and surgical removal of the primary and intracranial lesions is the key to prolong survival.
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Objective To explore the efficacy and experience of surgical approaches of puncture drainage and urokinase thrombolysis for spontaneous hypertensive pontine hemorrhage.Methods The clinical data of 42 patients with spontaneous pontine hemorrhage, admitted to our hospital from January 2014 to December 2018, were retrospectively analyzed. Craniotomy evacuation of hematoma was performed in 18 patients (control group), and puncture drainage and urokinase thrombolysis assisted by neuronavigation was performed in 24 patients (observation group). The clinical efficacies of the two groups were observed and analyzed.Results There were 24 patients having hematoma clearance rate≥50％, including 7 from control group and 17 from observation group. The hematoma clearance rate≥50％ in the observation group (70.83％) was significantly higher than that in the control group (38.89％,P<0.05). Postoperative Glasgow-Pittsburgh scale scores of the observation group (24.21±4.85) were slightly higher than those of the control group (23.61±5.45), and the mortality of the observation group (66.67％) was lower than that of the control group (72.22％) without statistical significance (P> 0.05).Conclusion The surgical approach of puncture drainage and urokinase thrombolysis can effectively improve hematoma clearance rate for spontaneous hypertensive pontine hemorrhage, but clinical prognoses are not improved due to influence of multiple factors.
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Objective To investigate the value of neuronavigation in microsurgery for medically refractory epilepsy. Methods The clinical data of 137 patients with medically refractory epilepsy who underwent epilepsy surgery with neuronavigation in our hospital from September 2008 to September 2016 were analyzed retrospectively. In these patients, 17 accepted temporal parietal occipital dissection, 23 accepted corpus callosum subtotal dissection, 11 accepted functional cerebral hemispheric dissection, and 86 accepted epilepsy foci resection. The surgical efficacies were analyzed. Results All patients uneventfully underwent the operations as planned. The mean follow-up period was 52 months (12-108 months). Engel grade I was achieved in 71 patients, grade II in 32, grade III in 25, and grade IV in 9 patients. The total satisfaction rate reached to 75.18％ (103/137), including 100％ patients (11/11) accepted functional cerebral hemispheric dissection. There were no severe operative complications. Conclusion Neuronavigation helps to locate intracranial targets, accurately resect the epileptogenic foci or disconnect the epilepsy conduction pathway, preserve the neurologic function, and avoid the operative complications.