CT and CTA 3D-reconstruction of keyhole operation approaches in the saddle area / 中华神经医学杂志

Objective To comprehend the anatomical image data related to the keyhole microsurgery operation approaches in patients with saddle lesions.Methods Fifteen healthy volunteers and 10 patients with intracranial aneurysm were selected in the experiment and 16-slice spiral CT, CT angiography (CTA) and 3D-reconstruction were performed on them. The anatomitical distance and angle were measured through the ways from supraorbital keyhole approach, frontolateral keyhole approach, pterional keyhole approach, and subtemporal keyhole approach to the anterior/posterior clinoid process, the anterior communicating artery and the bifurcation of internal carotid. Results Of the distances between keyhole centre and anterior/posterior clinoid process, the shortest one was the way from subtemporal keyhole approach (4.98±0.54 em; 5.35±0.65 cm) and the longest one was the way from supraorbital keyhole approach (6.44±0.36 cm; 37.68±1.06 cm). Of the angles between the skull sagittal plane and the operation plane from keyhole centre to anterior/posterior clinoid process, the way from subtemporal keyhole approach was better than the way from frontolateral keyhole approach. Of the angles between skull transverse plane and the operation plane from keyhole centre to anterior/posterior clinoid process, that of subtemporal keyhole approach was better than pterional keyhole approach. Distances between keyhole centre and bifurcation of intemal carotid ordered as follows: the way from frontolateral keyhole approach, that from supraorbital keyhole approach, that from subtemporal keyhole approach and that from pterional keyhole approach. Of the angles between cranial sagittal plane and the operation plane from keyhole centre to the anterior communicating artery or the bifurcation of ipsilateral internal carotid,the way of frontolateral keyhole approach was better than that of supraorbital keyhole approach.Conclusion CT and CTA 3D-reconstruction, by demonstrating the distances and angles of each approach,play a significant role in choosing the right keyhole operation approach in different saddle lesions.

Effect of mild hypothermia for treatment of severe head injury: a clinical analysis / 中华神经医学杂志

Objective To compare the prognoses of patients with severe brain injury receiving mild hypothermia and normothermia interventions and evaluate the brain protective effect of mild hypothermia. Methods Seventy-six patients with severe head injury (Glaseow Coma Score≤8) were divided into mild hypothermia group (36 cases) and normothermia group (40 cases). The patients in the normothermia group were managed with measures for reducing the intracranial pressure and controlling the hemorrhage and gastric acid, with also administration of neurotrophic treatment and nutritional support. In addition to these conventional interventions, the patients in mild hypothermia group received mild hypothermia treatment administered using a water blanket to reduce the core body temperature and brain temperature to 32-34℃, which was maintained for 3-14 days as needed. Results The patients receiving mild hypothermia therapy had significantly improved prognosis in comparison with those in normothermia group (P<0.05). Conclusion Mild hypothermia treatment has brain protective effect and improves the prognosis of patients with severe brain injury.

Clinical study of separate interhemispheric subdural effusion / 中华神经医学杂志

Objective To propose the concept of separate interhemispheric subdural effusion, and further study the pathogenesis, diagnosis, treatment and prevention of the disease. Methods 544patients with head injury who were treated by decompressive craniotomy with large bone flap removal (treatment group) or decompressive craniotomy without large bone flap removal (control group) were retrospectively analyzed for understanding the incidence of separate interhemispheric subdural effusion and studying the pathogenesis and risk factors of the disease. Results CT examination showed separate interhemispheric subdural effusion occurred in 38 cases, including 14 of unilateral craniotomy and 24 of bilateral craniotomy, in the treatment group, and 8 cases, including 2 of unilateral craniotomy with disposable bone flap and 6 of bilateral craniotomy with disposable flap, in the control group. The difference in the incidence of separate interhemispheric subdural effusion was significant statistically between treatment and control groups (X2=9.758,P=0.002), but not significant between unilateral and bilateral craniotomies in the two groups (X2=0.053,P=0.818). Conclusions Separate interhemispheric subdural effusion is one type of subdural effusion, and related to brain tissue shift after large bone flap craniotomy. It is one of the most common complications after the craniotomy. It can be diagnosed conveniently by the means of imaging. Early diagnosis and treatment will be beneficial for good prognosis, and to reduce the size of the bone window and to avoid brain tissue shift after operation are the best preventive measures.

Detection of serum S-100B protein in patients with severe head injury receiving mild hypothermia treatment / 中华神经医学杂志

Objective To evaluate the effect of mild hypothermia for brain protection by detecting the changes in serum S-100B protein in patients with severe head injury and investigate the possible mechanism. Methods With 100 healthy volunteers as the control group, 100 patients with severe head injury (Glascow Coma Score ≤ 8) received treatment with mild hypothermia (n=50) or normothermia (n=50). Serum samples were collected from the patients early (2-6 h) after the injury and at 1, 3, 5, 7, and 10 days after the injury to measure the levels of S-100B protein. Results In healthy subjects, the serum level of S-100B protein was not associated with age or gender. Patients with severe head injury receiving mild hypothermia treatment and normothermia treatment showed significant differences in serum S-100B protein level from the control group (P<0.01). The patinets with mild hypothermia treatment had significantly lower serum S-100B level than those treated with normothermia atl, 3, 5, 7, and l0 days after the injury (P<0.05). Conclusion Serum S-100B protein has high sensitivity and specificity in the diagnosis of severe head injury, and may serve as an effective biochemical indicator. Mild hypothermia may protect the brain tissue of patients with severe head injury.

Study of the effects of mild hypothermia on cerebral PO2, PCO2 and pH and body temperature in patients with acute severe head injury / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To study the effects of mild hypothermia on cerebral oxygen partial pressure, carbon dioxide partial pressure, pH and body temperature (PbrO2, PbrCO2, pHbr and BT) in patients with acute severe head injury.</p><p><b>METHODS</b>Thirty-eight patients with acute severe head injury were treated with mild hypothermia, meantime PbrO2, PbrCO2, pHbr and BT were monitored in order to study the changes of PbrO2, PbrCO2, pHbr and BT.</p><p><b>RESULTS</b>In patients with acute head injury, mild hypothermia obviously increased PbrO2, decreased PbrCO2 and CO2 accumulation and acidosis in brain tissue. BT was 1-1.5 deg. higher than rectal temperature (RT) after injury. The BT and RT were decreased when the patients were treated with mild hypothermia, but at the same time the difference between BT and RT was increased.</p><p><b>CONCLUSIONS</b>In patients with acute severe head injury the direct monitoring of PbrO2, PbrCO2, pHbr and BT was safe and reliable, and is helpful in estimating prognosis and mild hypothermia therapy.</p>

Mental Disturbance of Patients with Severe Craniocerebral Injury / 中国心理卫生杂志

Objective:to collect and summary mental disturbance caused by severe craniocerebral injury Method:to compare 150 cases of mental disturbance caused by severe craniocerebral injury with those (20 cases) with similar injury but without mental disturbance Result:1) The rate of those with mental disturbance in patients with severe craniocerebral injuries was 20 8% The rate of that in all patients of head injury was 5 2% 2) 107 of our sample (71 3%, 107/150) had sub-arachnoid hemorrhage 27 had fracture at the base of skull 3) Compared with those without mental disturbance, the occurrence of mental symptoms closely related to severity of injury 4) Delirium was the early symptom, while memory deficiency and affective disorder were common on the later stages Conclusion:Patients with brain contusion with subarachnoid hemorrhage are more likely having mental disturbance