Early surgical treatments of intracranial ruptured aneurysms combined with intracranial hematomas / 中华神经医学杂志

Objective To investigate the microsurgical managements of intracranial ruptured aneurysms combined with intracranial hematomas and to observe their therapeutic efficacy.Methods A total of 32 patients with intracranial ruptured aneurysms combined with intracranial hematomas,treated in our hospital from January 2009 to January 2013,were chosen in our study;18 male and 14 female patients ranged from 32 to 78 years old (mean age of 55 years) were enrolled,with sudden headache,vomiting,disturbance of consciousness as the first symptoms.The preoperative status on admission was Hunt-Hess grade Ⅲ in 7,grade Ⅳ in 20 and grade Ⅴ in 5.Radiographic imaging demonstrated 7 anterior communicating artery aneurysms,3 posterior communicating artery aneurysms,7 internal carotid artery aneurysms,13 middle cerebral artery aneurysms and 2 multiple aneurysms.The associated hematoma was greater than 20 mL.All patients were brought emergently to the operating room and treated with aneurysm clipping within 72 h.Decompressive craniectomy was performed in 19 patients,and external ventricular drainage was performed in 19 patients.Results Postoperative follow up (ranged from 3-24 months) showed good recovery,moderate recovery,severe disability,persistent vegetative state and death in 6,12,11,0 and 2,respectively,graded by Glasgow Outcome Scale;the remaining one patient was lost to follow-up.The percentage of good prognosis in patients with preoperative Hunt-Hess grade of Ⅲ grade (84.6％) was higher than that of patients with Ⅳ-Ⅴ grade (36.8％,P＜0.05).Conclusions Early evacuation of space-occupying hematoma,aneurysm clipping and emergent decompessive cranioctomy could lead to survival with good recovery in some patients.

Value of ventricular peritoneal shunt in treating patients with intracranial hypertension combined with cryptococcal meningitis / 中华神经医学杂志

Objective To explore the feasibility and safety ofventricular peritoneal shunt (VPS) in treating patients with intracranial hypertension combined with cryptococcal meningitis.Methods Twelve patients with cryptococcal meningitis,admitted to our hospital from January 2012 to January 2014 and underwent VPS for intracranial hypertension,were chosen in our study; the clinical manifestations and cerebrospinal fluid (CSF) results before and after operation,and mannitol dosage before and after operation were compared; follow up for 2-25 months was performed.Results Except 1 patient had no improvement of consciousness,the other 11 patients had disappeared or mitigated headache,disappeared vomiting symptoms,and improved vision and hearing; two patients with disturbance of consciousness got improvement; one patient with eyes abduction got recovery; one patient had abnormal tongue and mouth did not achieve improvement.Different degrees of fever were noted in 10 patients after operation,9 recovered after treatment.The mannitol dosage for all patients were significantly reduced or discontinued.Postoperative cerebrospinal fluid pressure,amount of cryptococcus neoformans in 11 patients were decreased significantly (P＜0.05).Conclusion Early aggressive VPS on cryptococcal meningitis patients with intracranial hypertension is effective and safe.

Analysis of full endoscopic transnasal-transphenoidal approach for pituitary adenomas : the summary of 72 patients / 中华显微外科杂志

Objective To investigate and evaluate the clinical value of full endoscopic transnasal transphenoidal approach for the surgery of pituitary adenomas.Methods Seventy-two patients,who underwent full endoscopic transnasal transphenoidal approach for the surgery of pituitary adenomas,were selected from the Medical Center of Pituitary Adenomas of our hospital from January 2009 to March 2012.To retrospectively investigate pre- and post-operation symptoms,hormone levels,images information,operation information,complications,following-up information and so on.Results Among the 72 consecutive patients,there were 22 nonfunctioning adenomas,twenty-four prolactin secreting adenomas,seven somatotropin secreting adenomas,five adrenocorticotropic hormone secreting adenomas,one thyrotropin secreting adenomas,and 13 multi-secreting adenomas.The tumor removal was total in 56(77.8％),subtotal 13(18.0％),and partial 3(4.2％).Five cases had CSF leaks,and 6 diabetes insipidus.After 3-24 months of follow-up,the levels of increasing-hormone declined to normal levels in most patients.Conclusion Full endoscopic transnasal transphenoidal approach for the surgery of pituitary adenomas is a kind of technique which is safe,minimally invasive,having less complications and fast recovery.However,it is necessary for surgeons to accept systematic and specialized training,and own advanced equipments.

Three-dimensional individual digital anatomy for microsurgery of cerebellopontine angle region tumor / 中华显微外科杂志

Objective To summary the microsurgery clinical experience of 21 patients with cerebellopontine angle tumor by the help of three dimensional individual digital anatomy. And to evaluate the value of three dimensional individual anatomy in the treatment of tumors in cerebellopontine angle. Methods Between January 2011 and November 2011,21 patients with various cerebellopontine angle tumor,managed at the Third Affiliated Hospital of Sun Yat-Sen University, underwent CTA scan, and reconstruct the local anatomy by 3D view software. According to the individual anatomical model, the microsurgery program by restrosig moid approach was developed. Results All patients had reposition of the bone flap at original site after craniectomy during the same operative setting mentioned above with retrosigmoid approach. No complication was noted.Patients did not have any delayed postcraniectomy pain at operation site.Postoperative computed tomography of the skull showed good healing and shaping of the suboccipital bone at the surgical region. Conclusion With the help of three dimensional individual anatomy, the microsurgery of cerebellopontine angle tumor underwent less postoperative complications.This study provides a safe and effective individualized microsurgical methods by restrosig moid approach.

CT virtual endoscopy for transsphenoidal microsurgical treatment of pituitary microadenomas / 中华显微外科杂志

@#Objective To evaluate the value of CT virtual endoscopy(CTVE)for microsurgery of pituitary microadenomas via transsphenoidal approach.Methods In 18 patients with pituitary micmadenomas underwent microsurgery via transsphenoidal approach,the presurgical CT data was transfered to work station,the anatomies of the sphenoid sinus were then reconstructed by CTVE.The CTVE images were used to make the preoperative planning and indentify sphenoid sinus, sellar floor,and the position of the tumor during surgery.The CTVE images and the views from intraoperative microscope were compared. Results CTVE could display the anotomoties of sphenoid sinus in a three-dimentional mode.The display rates of superfical antomies such as sphenoid septa,sellar floor,carotid prominence,optic prominence and opticocarotid recess were 344.4%,100%,41.7%,36.1%and 58.3%respectively and the visual fields of these anatomic landmarks were larger than the views from the intraoperative microscope. CTVE could depcit the anatomies of the enhanced carotid ateries and pituitary tissue and some optic canals underlying the sellae by transparent function or heighten the threshold.The sites of the tumor could be marked correctly on CTVE images.CTVE could simulate the operative approach and some operating procedures properatively. Conclusion CTVE can display the anatomies of sphenoid sinus in a three-dimensional mode. In transsphenoidal treatment of pituitary microadenoma,CTVE can help to make preoperative planning,locate the intraoperative structures and make a precise bone window during surgery.

Microsurgical treatment of tumors in cervical spinal canal / 中华显微外科杂志

Objective To report effects of microsurgical treatment for tumors in cervical spinal canal. Methods A total of 32 cases of tumors in cervical spinal canal had received microneurosurgery through a posternmedial approach. 22 cases had received reconstruction of cervical spinal canal stability. Results A total tumor resection was performed in 26 cases (81.25%),a subtotal tumor resection was conducted in 6 cases(18.75%). A cemplete recovery was achieved in 23 cases(71.88%), an improvement of symptoms was achieved in 6 cases(18.75%), and no improvement in 3 cases(9.38%), no death was encountered. Follow up observations were carded out in 30 cases for 3 months to 3 years. MRI examinatious 3 months after operation in 26 cases found no residual or recurrent tumor,recurrence was seen in 3cases of astrocytoma, 1 case was invariable. X-ray radiography in 26 cases showed good vertebral stability ,spinal deformation was found in 4 eases. Conclusion Microsurgery in early period play a key role in treatment of cervical spinal tumors. Reconstruction of spinal canal stability is important to patients.