RESUMO
To summarize our experiences with selective clipping microsurgical treatment and prognoses of 146 cases of intracranial multiple anterior circulation aneurysms. Non-concurrent cohort study. Department of Neurosurgery, first Hospital of Jilin University, Changchun, China. One hundred and forty-six patients with intracranial multiple anterior circulation aneurysms who underwent surgical clipping. These aneurysms in each patient were given selective treatment depending on whether the patients were symptomatic, or had likelihood of rupture if they were asymptomatic. Glasgow outcome scale [GOS] was applied to assess the patients' condition. Among 146 patients, they were 169 asymptomatic and 146 symptomatic aneurysms. Symptomatic aneurysms included 139 ruptured and seven uruptured aneurysms All symptomatic aneurysms were clipped, and asymptomatic aneurysms were treated selectively. A postsurgical GOS of grade 5 was found in 136 cases, grade 4 in 6 cases, grade 3 in 1 case, and grade 1 [death] occurred in 3 cases. At postsurgical follow-up, computed tomography angiography [CTA] revealed completed clipping of all symptomatic aneurysms and no changes in the asymptomatic. Apart from the three cases in which death occurred during hospitalization, we followed up a total of 128 of the remaining 143 cases between 5 and 10 years. The post-surgical mortality rate was 2.1%. Follow-up GOS scores were grade 5 in 123 patients [96.1%], grade 4 [3.1%] in four and grade 3 in one [0.8%]. Satisfactory prognoses were achieved in the selective treatment of intracranial multiple anterior circulation aneurysms
RESUMO
<p><b>OBJECTIVE</b>To evaluate the three-dimensional CT angiography (3D-CTA) assisted suboccipital transtentorial approach (Poppen's approach) in the treatment of pineal region meningioma.</p><p><b>METHODS</b>During the period of January 2005 to January 2010, 8 patients with pineal region meningioma were successfully treated using Poppen's approach through cerebral falx and tentorium. There were three male patients and five female patients were aged at a range of 41 - 64 years, average age was (54 ± 10) years. According to the Karnofsky performance scale (KPS), 5 patients' KPS scores were more than or equal to 80 and 3 were less than 80. MRI was used for the diagnosis of meningioma. 3D-CTA was applied to detect meningioma staining and blood supply. For preoperative concurrent hydrocephalus, follow-up observations were given. If hydrocephalus didn't get better or even became worse, ventriculoperitoneal shunt should be considered.</p><p><b>RESULTS</b>All the surgery were successfully performed, and venous complexes (VC) were well protected according to the CTA images. Out of the eight cases whose meningiomas were removed, one patient had got postoperative intracranial infection and recovered after given antibiotics. All patients were followed up for a period of 6 - 24 months. Preoperative concurrent hydrocephalus in 7 patients were improved. However, there was an aggravation of the hydrocephalus in one patient who was treated with ventriculoperitoneal shunt. The MRIs which were performed at the end of follow-up period, showed no recurrence of meningiomas, and preoperative symptoms were improved to varying degrees, 7 patients' KPS scores were more than or equal to 80 and 1 was less than 80. A χ(2) test was used to analyze and to make comparisons between preoperative and postoperative KPS. The significance was indicated (χ(2) = 1.33, P < 0.05).</p><p><b>CONCLUSIONS</b>For meningiomas in the pineal region, 3D-CTA is of great clinical value to distinguish the anatomic relationship among the meningioma, blood supply and VC. This case study has strongly supported using Poppen's approach assisted by 3D-CTA to proceed with the operation.</p>