Association of single nucleotide polymorphisms of CSPG2 and HSPG2 genes with intracranial aneurysm in ethnic Han Chinese population / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To assess the association between CSPG2 and HSPG2 gene polymorphisms and intracranial aneurysm (IA) in ethnic Han Chinese population.</p><p><b>METHODS</b>A case-control study was carried out. A total of 537 IA patients and 1071 normal controls with matched age and gender were recruited. Peripheral blood samples were obtained from all subjects. Following extraction, target DNA was amplified with PCR and genotyped with a SNaPshot method. The association between 2 tag SNPs (rs251124 and rs3767137) of CSPG2 and HSPG2 genes and IA was assessed.</p><p><b>RESULTS</b>The genotype frequencies of rs251124 and rs3767137 were both in Hardy-Weinberg equilibrium. No significant difference has been found in the frequencies of rs251124 of CSPG2 between the two groups. Similarly, the frequency of rs3767137 (HSPG2) did not differ between the IA and control groups (P=0.22), albeit with an OR value of greater than 1 (OR=1.12, 95%CI=0.92-1.37). There were no significant difference in genotypic frequencies of the two SNPs between the two groups (P=0.46, 0.53).</p><p><b>CONCLUSION</b>No association has been found between polymorphisms of rs251124 and rs3767137 loci of CSPG2 and HSPG2 genes and IA in the selected population.</p>

Application of far lateral craniocervical approach in the microsurgical treatment of the jugular foramen tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the administration of far lateral craniocervical approach in the jugular foramen (JF) tumors.</p><p><b>METHODS</b>A retrospective analysis was performed in 14 cases of JF tumors (9 neurilemmomas, 3 meningiomas, 1 glomus jugulare tumor, and 1 adenoid cystic carcinoma) surgically treated between January 2009 and January 2012, with focus on the surgical approach. Six patients (6/14) showed hydrocephalus. The tumor type was composed of 5 intracranial and intraforamen tumors with patent or occluded jugular bulb, 1 intracranial tumor with extension into the upper cervical canal, 4 extracranial and intra foramen tumors, 4 intra- and extracranial dumbbell-shaped communicating tumors involving the parapharyngeal space above C2 or extending caudally below C3. Far lateral postcondylar approach (FLPC) was carried out in 2 cases, far lateral tansjugular process approach (FLTJP) in 3 cases, combined FLPC + C1-2 semi-laminectomy approach in 1 case, combined FLTJP + trans-C1 transverse process approach in 7 cases, and combined FLTJP + neck approach with dissection of carotid sheath to the skull base in 1 case. Endovascular embolotherapy prior to surgical resection was performed in 1 glomus jugulare tumor.</p><p><b>RESULTS</b>Total tumor removal was achieved in 12 patients and subtotal removal in 2 patients, with no cerebrospinal fluid leakage or operative mortality. New cranial nerve paresis occurred after surgery in 1 case of facial nerve and 1 case of lower cranial nerve. Transient worsening of preoperative lower cranial nerve deficits was noted in 3 patients. Long-term follow-up study ranging from 5 to 32 months (average 13.7 months) showed 7 patients with lower cranial nerve deficits (6 preexisting and 1 new), with exception of one preoperative lower cranial nerve dysfunction due to the infiltration of an adenoid cystic carcinoma, experienced favorable improvement with recovery of adequate swallowing function, but voice disturbance remained in 4 cases. One patient with new facial nerve deficit presented with partial improvement and the hydrocephalus in 6 patients all spontaneously regressed. There was no tumor recurrence in patients receiving total removal and no tumor progression in patients undergoing subtotal removal.</p><p><b>CONCLUSIONS</b>FLTJP is a basic approach for JF tumors. The combined cranial and cervical approach should be considered in those tumors extending into the upper cervical canal and parapharyngeal space. The associated hydrocephalus seldom requires additional surgical management.</p>

Emergency surgery for cerebral hernia patients with CT manifestations of ruptured anterior circulation aneurysm combined with intracerebral hematoma / 中华神经医学杂志

Objective To evaluate emergency surgery for cerebral hernia patients with CT manifestatious of ruptured anterior circulation aneurysm combined with intracerebral hematoma.Methods A total of 11 cerebral hernia patients underwent emergency operation based on CT manifestations from December 2007 to December 2010 for acute intracerebral hematoma due to suspected aneurysm rupture. Three dimensional computer tomographic angiography (3D-CTA) was performed one week postoperation.The locatious of aneurysms were investigated to analyze relationship between CT manifestations and emergency surgery. Results The cause of intracerebral hematoma in the 11 patients proved to be aneurysms rupture.The aneurysm was located at the anterior communicating artery in 2 cases,at the posterior communicating artery in 3 and at the middle cerebral artery in 6.Of the 2patients who harbored multiple aneurysms, one had a middle artery aneurysm (responsible) plus a homonymy aneurysm at the posterior communicating artery,the other had an aneurysm at the posterior communicating artery (responsible) plus an opposite side aneurysm at the middle artery.Postoperative Glasgow Outcome Scale (GOS) showed grade V in 6 cases,grade Ⅳ in 2,grade Ⅲ in 1,grade Ⅰ in 2.Conclusion CT manifestations are useful indications for emergency surgery, including direct craniotomy, hematoma evacuation and aneurysm clipping, in cerebral hernia patients with ruptured anterior circulation aneurysm combined with intracerebral hematoma.

Clinical application of digitization prototyping titanium meshes in repairing the skull defect / 中华神经医学杂志

Objective To discuss the clinical application and efficacy of digitization prototyping titanium meshes in the repairing of earthquake-induced skull defect. Methods The clinical data of 66patients with skull defect caused by earthquake were analyzed. These patients were divided into group A (treated with traditional handwork shaping titanium meshes, n=1S) and group B (treated with digitization prototyping titanium meshes, n=51). The efficacy and complications were compared.Results Compared to group A, group B had a shorter operation time, a shorter recovery time, a lower postoperative incidence rate of subcutaneous hematocele, hydrops and infection (P＜0.05). The digitization prototyping titanium meshes were significantly superior to handwork shaping titanium meshes (P＜0.05). And patients with skull defect repaired at early stage had a higher recovery rate of neurological function than those at advanced stage (P＜0.05). Conclusion Using digitization prototyping titanium meshes to repair the skull defect can enjoy anatomical reduction, shortened operation time, and fewer postoperative complications. In addition, an early repair in earthquake-induced skull defect can not onlydisburden patients' mind, but also prevent or even reverse secondary brain damage of skull defect,therefore, the patients' neurological function can be improved and their lives can be better.

The significance of computed tomographic angiography image -guided emergent mieroneurosurgical management of intracranial hemorhage of arteriovenous malformations / 中华神经医学杂志

Objective To evaluate the significance of computed tomographic angiography guided emergent microneurosurgical management of intracranial hemorrhage on account of arteriovenous malformations. Methods 21 cases of intracranial hemorrhage on account of the rupture of the arteriovenous malformations received computed tomographie angiography guided emergent microneurosurgical management were analyzed. Diagnosis of AVM could be identified by 3-D reformatted images obtaining from multidetector CT angiography (CTA) .Then the resections of AVM and hematoma were performed with the help of CTA. We got the results of treatment by CTA examination postoperative. Results 15 AVM nests of 21 cases after operations were cut off, 5 got partial resection, except 1 in bulbus medullae, and the clinical symptoms eliminated in 6 patients (5 cases's hematoma in subcortex indomain, 1 in cerebellum), improved in 14 patients (7 cases in subcortex domain, 4 in cerebellum, 3 in basal ganglia), 1 patient died (AVM in bulbus medullae). Conclusion CTA could be used to get the emergency diagnosis of brain AVM hemorrhage and guid the emergent microneurosurgical management.

Analysis of the factors affecting the prognosis of surgical patients with intracranial aneurysm / 中华神经医学杂志

Objective To analyze the factors affecting the clinical outcomes of surgical patients with intracranial aneurysm(IA).Methods The clinical data of 215 patients undergoing surgeries for IA between May,2002 and May,2007 were retrospectively analyzed.In all these cases,the diagnoses were established according to the results of CT,CT angiography(CTA)and digital subtraction angiography(DSA).With the therapeutic effect as the dependent variable,logistic regression analysis was performed to examine 10 factors that potentially affected the outcome of the patients.Results In all the patients,190(87.7%)were cured,22(10.9%)had mild to moderate disabilities,and 4(1.4%)died.Statistical analysis showed that age,aneurysm location,temporary occlusion of the parent artery,intraoperative aneurysm rupture,and the preoperative scores of Hunt-Hess scale and Fisher scale were correlated to the prognosis of the patients.Such factors as gender,operative time,and times of preoperative subarachnoid hemorrhage and aneurysm size were not found to obviously affect the patients' prognosis.Conclusions The prognosis of surgical patients with 1A is affected by multiple factors,and intraoperative aneurysm rupture is directly associated with the surgical outcome.

Diagnosis and mierosurgical intervenfion of small anterior communicating artery aneurysms / 中华神经医学杂志

Objective To explore the diagnosis of small anterior communicating artery aneurysms and discuss the microsurgical techniques and the timing of surgical intervention.Methods Thirty-two cascs of small anterior communicating artery aneurysms were reviewed for the methods for lesion detection,imaging features of the lesions,microsurgical procedures and the patients'clinical outcome. Results CT displayed subarachnoid hemorrhage(SAH)in all the 32 cases.Magnetic resonance angiography(MRA) was performed in 13 cases and computed tomographic angiography (CTA)in 8 cases. All the 32 patients underwem a total of 35 examinations With digital subtract angiography(DSA).The time between operation and aneurysm rupture was less than 3 daysin 6 cases,4 to 14 days in 10 cases.10 to 14 days in 13 cases and over 30 days in 3 cases.Neck clipping of the aneurysm through the pterional approach was performed in all thc cases with tracheal intubation and general anesthesia,and hemorrhage due to ancurysm ruptures occurredin 5 cases during the operation.Death occurred in 1 case after the operation,and 5 patients developed hydrocephalus and received subsequent ventriculoperitoneal shunting.After the operation,22 patients showed good recovery,6 were capable of independent living, 2 needed assistance for walking and in daily activities, and 1 patient remained bed-ridden and needed nursing care.Follow-up of 27 patients for 3 to 12 months found no occurrence of hemorrhage or death.Conclusion DSA Can be the primary choice for diagnosis of small anterior communicating artery aneurysms.Earlyinterventions should be administered for grade I or Ⅱpatients,but for the other patients,the surgeries can be performed 2 or 3 weeks after the hemorrhage.Proficient microsurgical skills can be crucial for successful clipping of the aneurysms and for prevention and effective management of hemorrhage due to aneurysm rupture.