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Objective To investigate the prognostic influence factors of Solitaire stent thrombectomy in patients with acute anterior circulation macrovascular occlusion. Methods From March 2015 to March 2017,222 consecutive patients with acute anterior circulation macrovascular occlusion admitted to the Department of Neurosurgery,the 101stHospital of People′s Liberation Army and the Nanjing Jinling Hospital were enrolled retrospectively.They were all confirmed by DSA and were treated with Solitaire stent thrombectomy. According to the modified Rankin Scale(mRS) scores at 90 d after treatment,they were divided into a good prognosis group (0-2,n=120) and a poor prognosis group (3-6,n =102). The baseline data and clinical data of the two groups of patients were analyzed,including the risk factors for cardiocerebrovascular diseases,baseline National Institutes of Health Stroke Scale (NIHSS) score,occlusion sites (internal carotid artery or middle cerebral artery occlusion),collateral compensatory,onset to puncture time, operation time,onset to recanalization median time,recanalization status,preoperative Alberta stroke programme early CT score(ASPECTS),and symptomatic cerebral hemorrhage,and then further multivariate logistic regression analysis was conducted for the prognostic factors of patients. Results (1) The rate of good prognosis was 54.1% (120/222).There were no significant differences in patients′ age,NIHSS at admission,ASPECTS at admission,sex,hypertension,occlusion site,and rate of good collateral branches in both groups(all P<0.05).There were no significant differences in other baseline data (all P >0. 05). (2) Onset to puncture time and onset to successful recanalization median time of the patients in good prognosis group was lower than that of the poor prognosis group (182 [138,230]min vs.236[170,305]min, 237[175,269]min vs.288[223,367]min).The proportion of successful recanalization was higher than that of the poor prognosis group (98.3% [118/120] vs.78.4% [80/102]).The proportion of postoperative symptomatic intracerebral hemorrhage was lower than that of the poor prognosis group (2.5% [3/120] vs.21.6% [22/102]).There was significant difference between the two groups (all P <0.01). There was no significant difference in operative time between the two groups (P >0.05). (3)In the single factor analysis,the parameter of P <0.05 was used as an independent variable,and prognosis was used as a dependent variable,multivariate logistic regression analysis showed that the increased age (OR,1.096,95% CI 1.050-1.144),history of hypertension (OR,8.401,95% CI 2.960-23.845),increased baseline NIHSS score (OR,1.071,95% CI 1.007-1.138),prolonged onset to successful recanalization time (OR,1.019,95% CI 1.003-1.035),symptomatic intracerebral hemorrhage after procedure (OR,18.110,95% CI 4.656-70.434) were all the risk factors for poor prognosis(all P<0.05);higher ASPECTS score at admission(OR,0.641,95% CI 0.451-0.911) and successful recanalization (OR,0.127,95% CI 0.024-0.664) were all the protective factors of good prognosis (all P<0.05). Conclusions Higher ASPECTS at admission and successful recanalization were the protective factors of poor prognosis of Solitaire stent thrombectomy in patients with acute anterior circulation macrovascular occlusion.Increased age,history of hypertension,increased baseline NIHSS score,prolonged onset to successful recanalization time,and symptomatic intracerebral hemorrhage after procedure were the risk factors for poor prognosis of Solitaire stent thrombectomy in patients with acute anterior circulation macrovascular occlusion.
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Objective To investigate the etiology,clinical manifestations,imaging finding,pathology and treatment of primary bladder schwannoma.Methods A case of bladder schwannoma was reported and discussed in the literature.A 64-year-old male patient with painless gross hematuria for 4 months was admitted on October 5,2016.Enhanced computed tomography (CT) showed left anterior bladder wall lesions with mildly enhancement.Preoperative diagnosis was bladder cancer.The patient underwent transurethral resection of bladder tumor (TURBT).During surgery,a 3 cm × 3 cm polypoid soft tissue was found in the left side of bladder,which convex to the bladder with smooth surface and wide base.Results The bladder neoplasm was resected successfully.The intraoperative bleeding was about 100 ml.Postoperative pathology showed a large number of myloid spindle cells with immunohistochemical S-100 (+),considering source of mesenchymal tissue.No recurrence was noticed during the 3 months' follow-up.Retrieving domestic and foreign literature,we found 17 cases with bladder schwannoma from 1993 to 2016.Bladder schwannoma occurs in the age of 40-69 years old.There is no relationship with the agenda.It is often seen in the top or the side wall of the bladder with single growth and rare malignant.The clinical manifestations was mainly painless gross hematuria,CT and magnetic resonance imaging(MR) showed less specificity than other solid tumors of the bladder,which is difficult to identify.Partial cystectomy or TURBT is the main strategy.Postoperative pathology is the gold standard for diagnosis.The immunohistochemical stainings often showed S-100(+).Conclusions Bladder schwannoma is extremely rare in benign bladder tumor,and it could easily be misdiagnosed.The diagnosis should be performed by histopathological examination.Because it will become malignant,it is suggested that the positive treatment should be done.Treatment methods have not been clearly defined,and the effect of surgical resection is good.