Dooptic canal unroofing and radical resection improve or deteriorate the visual outcome of the patients with tuberculum region meningeal tumors / 中华显微外科杂志

Objective To investigate the influence of the radical resection and the optic canal unroofing on the postoperative vision in the patients with tuberculm region meningeal tumors.Matheods A retrospective analysis was made in 44 patients with tuberculm region meningeal tumors,from January 2010 to October 2012.The clinical data including the Simpson grades,adhesion between tumor and the surrounding structures,optic canal decompression,and postoperative vision were studied,and followed-up.Results In all 44 cases,there were 31 patients with Simpson grade Ⅰ resection,their postoperative vision of 17 patients were improved,eleven unchanged,and 3 worse.Out of them,tumors showed more adhesive in 9 cases,unroofed the optic canal in 17 cases.There were 13 cases in the other group including 8 cases with Simpson grade Ⅱ and 5 cases with Simpson grade Ⅲ,their postoperative vision of 8 patients were improved,four unchanged,and 1 worse.Out of them,tumors showed more adhesive to the surroundings in 10 cases,unroofed the optic canal in 3 cases.There were no different postoperative vision among the Simpson grades by the Chi-Square test (P ＞ 0.05).The less adhesive of the meningeal tumors,the better resection grade would be (P ＜ 0.05).And unroofed the optic canal group showed better postoperative vision than the not unroofed ones (P ＜ 0.05).Conclusion In the tuberculum region meningeal tumors,the Simpson resection grade was related to adhesion between the meningeal tumors and the surroundings,not to postoperative vision.The optic canal decompression can improve their visual outcome in some cases.

The value of microsurgery for acoustic neuromas / 中华显微外科杂志

ObjectiveTo evaluate the value of microsurgery for acoustic neuromas.MethodsThe author performed a retrospective study of 63 consecutive patients after vestibular schwannomas (VSs) microsurgery with the retrosigoid approaches. The tumor was debulked firstly and dissected from surrounding neural and vascular structures by gripping the tumor capsule,and then drilled of the IAC.Intraoperative electrophysiological monitoring of facial nerve function during operation.Results Total tumor resection was achieved in 52 cases, subtotal resection was achieved in 11 cases. The anatomic preservation of facial nerve was achieved in 58 cases,the acoustic nerve was preserved anatomically in 29 cases.Fifty-eight cases received a follow-up, the mean follow-up time was 7.2 years. Two recurrent patients were found and there were no operative deaths. A long term facial nerve status:twenty-three cases were in grade Ⅰ, twenty-nine cases in grade Ⅱ ,five cases in grade Ⅲ , one cases in grade Ⅳ.Hearing level had an improvement in 9 cases and remained unchanged in 8 cases.ConclusionMicrosurgery treatment is the main choice of the treatment of VSs, could achieve better result in control of tumor and facial and acoustic nerve function restoration.

Experimental and clinical study on effect of endovascular dilation on symptomatic cerebral vasospasm / 中国脑血管病杂志

Objective To undertake animal experimentation and clinical study on the safety and efficacy of percutaneous transluminal angioplasty (PTA) and intraarterial papaverine (IAP) infusion for treatment of refractory symptomatic cerebral vasospasm (CVS). Methods In the experimental study, vasospasm was induced in rabbits by double injections of blood into the cisterna magna, IAP infusion was given on either the 4th day or the 7th day after occurrence of subarachnoid hemorrhage (SAH), and then neurological observation, angiography, light and electron microscopy were done. In the clinical study, since September 1996, 22 patients with refractory symptomatic CVS involving 50 vascular territories received dilation therapy by PTA and IAP within 24 hours of clinical neurological deterioration. Results In the experimental study, all the rabbits except two in the 'the 4th day' group showed angiographic dilation in all of the spastic basilar arteries, and neurological improvement; in the ' the 7th day' group angiographic dilation appeared in 4 (57. 1% ) out of 7 rabbits. After 24 hours, 1 rabbit in each group had recurrence of neurological deficits and angiographic constriction. In the clinical study after aneurysm clipping or endovascular coil embolization was done, within 72 hours of SAH all patients underwent endovascular treatment: PTA alone in 3 cases, IAP alone in 14 cases, PTA and IAP in the remaining 5 cases. All vessel segments were dilated satisfactorily after endovascular treatment. Clinical improvement was significant in 13 cases,moderate in 7, minimal or none in 2; 2 cases died on the 7th day after endovascular dilation treatment. Conclusion Endovascular dilating techniques, namely, PTA, IAP and a combination of PTA and IAP, are safe and effective for treatment of symptomatic CVS refractory to medical therapy.

Experimental study of Eudragit mixture as a new nonadhesive liquid embolic material / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To assess the embolic effects and biocompatibility of Eudragit mixture, a new liquid embolic agent.</p><p><b>METHODS</b>In vitro, the viscosity and precipitation time of Eudragit mixtures at several concentrations were measured to study the best proportion of components of the mixture. In vivo, a branch of the right external carotid artery was embolized with Eudragit mixture in 12 rabbits, and with n-butyl cyanoacrylate in another 12 rabbits for a comparative study of the general, angiographic and histopathologic changes between the two groups.</p><p><b>RESULTS</b>Eudragit mixture containing 7.5 g Eudragit, 50 ml absolute ethanol and 50 ml iopromide was shown in vitro to have good properties including rapid precipitation and soft elastic sponge formation upon contact with blood; in vivo, to be nontoxic, nonadherent to the microcatheter and able to embolize the vascular lumen completely without later recanalisation.</p><p><b>CONCLUSION</b>Eudragit mixture is an effective, nontoxic, safe and promising liquid embolic agent.</p>

Comparison of the use of microsurgical clipping and embolization with Guglielmi detachable coils for the management of acutely ruptured intracranial aneurysm / 中华显微外科杂志

Objective To Compare the use of guglielmi detachable coils(GDCs)versus microsurgical clipping for the management of acutely ruptured intracra nial aneurysm. Methods A clinical study included 82 patients with acute (90%. The technique related morbidity rate was 14.2%. In microsurgical group, 92.5% of aneurysms were completely clipped. The technique related morbidity rate was 10%. 2 cases was died. Significantly better total occlusion/embolization results were achieved in microsurgical clipping( n =40) than in GDCs ( n =35)( P 0.05). Six months follow up demonstrates that good prognosis was 95% in both groups. Conclusion In the management of acutely ruptured intracranial aneurysm, both microsurgical clipping and endovascular treatment is effective methods.

Effect of digital subtract cerebral angiography on microsurgical separation of craniopagus / 中华显微外科杂志

Objective To investigate the effect of cerebral angiography on separation of craniopagus during the period of preoperation and microsurgical operation Methods There was a case of craniopagus being separated in our hospital recently Cerebral arteriography at 3 months of life, arteriography and venography through femoral vessels at 16 months were performed to analyze the twin vascular circulations of bilateral internal carotid artery, external carotid artery, vertebral artery, and venous sinus Intraoperative cerebral angiography helps to evaluate the cerebral circulations Results Preoperative cerebral angiography showed no intracranial arterial connection in the pontes of craniopagus The posterior 1/3 part of superior sagittal sinus, partial transverse sinus and torcular herophili were confluented in two children Cerebral angiography during operation was significant for monitoring the management of the part of confluent venous sinus Conclusion Cerebral angiography is the best method to investigate the vascular conditions of craniopagus The selective sinus angiography is very important in analyzing the abnormal anatomy and hemodynamics of venous sinus in the pontes Intraoperative angiography can direct the bypass shunt and reconstruction of the sinus