Clinical analysis of combined direct and indirect extracranial-intracranial bypass in 25 adult patients with Moyamoya disease / 中国神经精神疾病杂志

[Abstrict]Objective To explore the key points and clinical value of combined direct and indirect extracranial-in?tracranial (EC-IC) bypass in patients with adult moyamoya disease. Methods Retrospective analysis of combined revas?cularization surgery in 25 adult patients with moyamoya disease. The frontal branch and parietal branch of the superficial temporal artery (STA) were dissected. Combined revascularization surgery consisted of direct (anastomosis between the su?perficial temporal artery and cortical branch of the middle cerebral artery) and indirect (encephalodurogaleosynan-giosis EDAS) surgeries. Clinical status was evaluated using the modified Rankin Scale and NIHSS score at 1 day before, 1 week and 3 months after surgery. Results Thirty lateralities were successfully performed on 25 patients. Postoperative angiogra?phy or CTA and cranial computer tomography perfusion imaging(CTP) were conducted to examine the patency of the di?rect anastomosis and cerebral blood flow in 23 patientswithin 1 weeks after surgery . The results showed that the anasto?motic vascular patency was excellent and the cerebral blood flow increased in parallel to the relief of the patients’s isch?emic symptoms. The median mRS scores were 3 (1,3) before surgery, 2 (1,3) 1 week and 1 (0,3) 1 month after surgery.The median mRS scores were significantly improved (Z=15.14, P<0.01). The median NIHSS scores was 5 (4,8) preopera?tively and 4(2,7) postoperation 1 week and 3(1,4) 3 months. The median NIHSS scores were also significantly improved (Z=11.36, P<0.01). Unfortunately, two patients had complication and left hemiparesis. One patient complicated with con?tralateral hemisphere infarction and the another one complicated with ipsilateral hemispheric hemorrhage after operation. Conclusions Combined revascularization surgery may result in satisfying improvement in clinical, angiographic, and he?modynamic states and prevention of recurrent stroke. The stabilized hemodynamic is the key point in peroperative period for moyamoya patients.

The Microsurgical Anatomical Study of transcerebellomedullary fissure approach / 中国神经精神疾病杂志

Objective To study transcerebellomedullary fissure approach to the fourth ventricle and the lateral brainstem without splitting vermis and depict its adjacent structure, and provide clinicians with anatomical information.Methods Five cadaveric heads fixed with formaldehyde and perfused with color latex in their arteries and veins were dissected with microsurgical anatomical skills. The composition of cerebellomedullary fissure and the distribution of the tela choroida, the inferior medullary velum and the posterior inferior cerebellar artery, and study anatomic base of this approach.Results Cerebellomedullary fissure is a natural anatomical gap which is located between the cerebellar tonsil, biventral lobule and medulla oblongata. The tela choroida and inferior medullary velum do not contain nerve tissue, and thus can be dissected to expose the fourth ventricle. The tonsil- medulla segment and telovelotonsillar segment of the posterior inferior cerebellar artery are the most important blood vessels of the cerebellomedullary fissure approach.Conclusions The transcerebellomedullary fissure approach can reach the fourth ventricle and dorsal brain stem through normal anatomic spaces without splitting the vermis, thus reducing the post-operative complications.

Microsurgical anatomy of optic canal in Chinese adults / 中国神经精神疾病杂志

Objective 　To investigate the anatomic characteristics of optic canal in chinese adults. Methods　Twenty chinese cadaveric speciments fixed in formalin of chinese patients without intracranial and intraorbital disease. We measured the width and height of the intracranial opening and the intraorbital opening of the optic canal of all cases. The length of roof, floor, medial and lateral wall of the optic canal, and the width, the height of the middle protion were also measured after unroofing the canal with high-speed drilling. The degree of pneumatization of ethmoidal and sphenoidal sinuses was recorded. Results　The intracranial opening of the optic canal was a horizontal oval shape. The width of it was (5.05±0.42) mm and the height was (4.61±0.27) mm. The length of optic roof, optic floor, medial wall and lateral wall of the optic canal was (9.67±1.51) mm, (5.41±0.84) mm, (9.58±0.72) mm and (9.26±0.66) mm, respectively. The intraorbital opening of the optic canal was a vertical oval shape, the height and width of it was (5.30±0.64) mm and (5.62±0.83) mm respectively. Conclusions　The wall of the optic canal is thinner and there is a narrow portion in the middle of it. Depending on the degree of the pneumatization of sphenoidal and ethmoidal sinus, three types were divided into: 1. reversal U shape, 2. C shape, 3. D shape. The dura fold of the optic canal is long and its edge is sharp.