Anatomic research of transpetrosal-presigmoidal approach for minimally invasive exposure of jugular foramen region utilizing virtual reality skill / 中华神经医学杂志

Objective To discuss the microanatomy features of jugular foramen region in transpetrosal-presigmoidal minimally invasive approach based on virtual reality image models.Methods CT and MRI scans were performed to fifteen adult cadaver heads,and then,imaging data were inputted into Vitrea virtual reality system to establish three-dimensional anatomy models of jugular foramen region.Different minimally invasive transpetrosal-presigrnoidal approaches exposing superior edge of internal acoustic meatus (route A),anterior edge of jugular foramen (route B),and posterior edge of jugular foramen (route C) were simulated by selecting osseous landmark points.Anatomic exposures in surgical trajectory following alternation of minimally invasive approach were observed,measured and compared.Results Spacial sequence of nerves and vessels in the route simulating transpetrosal-presigmoidal approach for exposure of jugular foramen region was displayed clearly;route A had the highest location and route C was the lowest.Volumes of route and petrosal osseous structure involved in route A was the largest,and then,volumes of route and osseous structure involved in route B was larger than those in route C,with significant differences (P＜0.05).Volumes of involved venous sinus were as follow:route B＞route A＞route C,with significant differences (P＜0.05).Volumes of facial-acoustic nerve complex and anterior inferior cerebellar artery involved in route A were (53.32± 5.54) mm3 and (30.55±3.51) mm3,respectively.Volumes of lower cranial nerves involved in route B were (84.59±9.23) mm3.Conclusion There are different impacts on the osseous structures and venous sinus for the minimally invasive routes of transpetrosal-presigmoidal approach exposing different targets,of which combinations are helpful to utilize respective advantages.

Minimally invasive anatomic research of microvascular decompression for trigeminal nerve utilizing virtual reality technique / 中华神经医学杂志

Objective To discuss the microanatomy features of microvascular decompression for trigeminal nerve through minimally invasive approach based on virtual reality image models.Methods CT and MRI scans were performed to five adult cadaver heads, and then, image data were inputted into vitrea virtual reality system to establish three-dimensional anatomy models of cerebellopontine angle.Suboccipito-retrosigrmoidal approach was simulated by selecting asterion as osseous landmark points of craniotomy and cistern segment of trigeminal nerve as exposed target.Anatomic exposures in surgical trajectory were observed and measured before and after minimally invasive design, respectively.Results Routes simulating microvascular decompression for trigeminal nerve through suboccipito-retrosigmoidal approach passed under the inferior edge of transverse sinus.Spacial relationship among route and surrounding nerves and vessels were displayed clearly.Measurement and comparative analysis among different routes indicated the volumes of routes: route b＞ route c ＞ route a, and involved cerebellar volumes: route a ＞route c ＞ route b.Conclusion Minimally invasive routes of suboccipito-retrosigmoidal approach can reduce surgical injure without sacrifice of anatomic exposure in microvascular decompression for trigeminal nerve.

Application of virtual reality combined with Flair imaging skills in three-dimensional anatomy of nucleus surrounding the lateral ventricle / 中华神经医学杂志

Objective To establish three-dimensional anatomic models of nucleus surrounding the lateral ventricle by utilizing MRI data of Flair sequence and virtual reality system,and then,observe the spacial form and relationships of above anatomic structures.Methods MRI scan of T2 Flair sequence was performed to adult cadaver heads,of which Digital Imaging and Communications in Medicine data was inputted into the Vitrea virtual reality workstation to build interactive three-dimensional anatomic models of lateral ventrical,caudate nucleus,putamen,external segment of globus pallidus,internal segment of globus pallidus,hippocampus,amygdala,mamillary body,thalamus,subthalamus nucleus,red nucleus,and substantia nigra.Anatomic observation was performed for above structures.Results High resolution was achieved to distinguish lateral ventrical and surrounding nucleus from remaining tissues.In the image of Flair sequence,cerebral cortex and other nucleus,except red nucleus and subthalamus nucleus,demonstrated high signal; red nucleus and subthalamus nucleus showed slight low signal oval and len form,respectively; white matter,ventricle and brain sulcus demonstrated low signal.Procedures of image segmentation were convenient.Three-dimensional visualization effect of virtual reality models were well,of which spacial form and relationships displayed clearly.Lateral ventrical and surrounding nucleus were observed with multiple visual angles,multiple levels and non-invasive way by rotating model and modulating transparency.Conclusion Three-dimensional anatomic models of nucleus surrounding lateral ventricle simulated by Flair image combined with virtual reality technique is helpful in observing and understanding the global spacial relationship of nucleus non-invasively and objectively; the procedure is time-and specimen-saving and provides reliable information for relative surgery.

Risk predictors of intracranial infection for relapsing meningioma patients underwent reoperation / 中华神经医学杂志

Objective To clarify the risk factors contributing to postoperative infection in patients with relapsing meningioma.Methods The clinical characteristics of 187 patients with recurrent meningioma,admitted to our hospital from January 1990 to December 2010,were collected and analyzed retrospectively.The risk factors for postoperative intracranial infection were evaluated by chi-square test.The single factor and multivariate logistic regression analyses were employed to define the independent variables.Results Age,tumor malignancy,diabetes,obesity,organ dysfunction,preoperative long-term bed,preoperative radiotherapy,interval between previous operation and recurrence shorter than or equal to 6 months,preoperative Karnofsky performance status (KPS) scale scores,and postoperative intensive care unit (ICU) therapy were the risk factors for postoperative infections.Multivariate logistic analysis showed that diabetes (OR=21.053,95％CI=5.434-81.567,P=0.000),interval between previous operation and recurrence shorter than or equal to 6 months (OR=34.484,95％CI=1.442-824.793,P=0.029) and KPS scale scores (OR=5.615,95％CI=1.613-19.547,P=0.007) were the independent risk factors.Conclusion Patients with relapsing meningioma,having diabetes,interval between previous operation and recurrence shorter than or equal to 6 months and KPS scores smaller than 70 points have high risk of postoperative infections.

Off-line analysis of single-unit neuronal discharge in the globus pallidus region in Parkinson's disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The accuracy of microelectrode-guided localization can make the operation safe and effective, but only experienced neurosurgeons are capable of performing this operation. A good index to identify neuronal discharges between globus pallidus interna and globus pallidus externa is needed. The aim of this research was to establish a good and practical electrophysiologic index to distinguish neuronal discharge in the interior globus pallidus from neuronal discharge in the exterior globus pallidus region of the brain in Parkinson's disease. The effect of neurons having an atypical discharge on successful surgical localization was also quantitatively evaluated.</p><p><b>METHODS</b>The study included 30 patients with primary Parkinson's disease who underwent pallidotomy between September 2000 and October 2002. During each pallidotomy, the neuronal discharges in the pallidum and its vicinity were recorded. The recorded spikes were used to calculate the frequency, burst index, pause index, and pause ratio of the single-unit discharge. The interior and exterior globus pallidus regions were compared in terms of frequency, burst index, pause index, and pause ratio. The sensitivity, specificity, false-negative ratio, false-positive ratio, and accuracy of those indices were then evaluated.</p><p><b>RESULTS</b>The values of frequency, burst index, pause index, and pause ratio in the interior globus pallidus were (96 +/- 43) Hz, 2.31 +/- 1.81, 0.05 +/- 0.05, and 0.27 +/- 0.28, respectively, and in the exterior globus pallidus were (59 +/- 27) Hz, 0.88 +/- 0.63, 0.20 +/- 0.14, and 1.54 +/- 1.17, respectively. Use of the four indices to distinguish the two neuron types produced a sensitivity of 0.84, 0.78, 0.77, and 0.93 with a specificity of 0.64, 0.79, 0.88, and 0.87, respectively. The false-positive ratio was 0.36, 0.21, 0.12, and 0.13 and the false-negative ratio was 0.16, 0.22, 0.23, and 0.07 while the accuracy was 0.72, 0.79, 0.80, and 0.90, respectively.</p><p><b>CONCLUSIONS</b>Pause ratio is a relatively reliable index to distinguish neuronal discharges between the interior and exterior globus pallidus regions in Parkinson's disease. The effect of neurons with atypical discharge on the successful surgical localization would be reduced to 10% when the pause ratio is used as the index.</p>

Effect of urapidil in reducing brain temperature in hot and humid environment / 中华神经医学杂志

Objective To investigate the effect ofurapidil in lowering the brain temperature in hot and humid environment. Methods Ninety soldiers stationed in Chinese Nansha Islands were divided into veteran group, untreated new recruit group and new recruit group with urapidil (tablet) treatment. All the soldiers were asked to complete a running exercise for 3000 m within 20 min in hot and humid environment, and their body temperature before and after the exercise was measured to evaluate the brain temperature changes. Results Before the running exercise, no significant differences was found in the body temperature among the 3 groups. The body temperature of the soldiers showed significant differences after the exercise, and the untreated new recruit had the most obvious elevation of the body temperature, whereas those with urapidil treatment showed the least elevation. Conclusion Veterans and new recruit show different tolerance and adaptability to hot and humid environment, and urapidil tablets can help reduce brain temperature increment induced by hot and humid environment.

Individualized computer-aided design project for cranioplasty:6 case report / 中国康复理论与实践

@#ObjectiveTo study a practical individualized computer-aided design project for cranioplasty in Chinese mainland. Methods6 patients with cranial defect was performed superthin skull CT,three-dimension reconstruction. The template for the skull defected was made simulating the shape and contour of cranial defect. after patient,s consent,silicone rubber terylene patch was made as a substrate for the repair of cranial defect. ResultsThis project provides a good result,especial an excellent cosmetic result. No side-effect appears,operation time is shorter than ever.ConclusionAn individual project for computer-assisted cranioplasty has been finished,which can be popularized for its value.

EFFECT OF PAPAVERINE ON CEREBRAL VASOSPASM FOLLOWING CEREBRAL ANEURYSM OPERATION / 解放军医学杂志

To evaluate the effect of papaverine administered via different routes following cerebral aneurysm operation, 43 cerebral aneurysm patients were divided randomly into two groups: A and B. Patients of group A were placed with a silicagel tube in cerebral ventricle and lavaged repeatedly with papaverine solution during operation and following 3 days after operation, those of group B were intramuscularly injected with papaverine 30mg, 3 times per day,for one week. By analysis of clinical features and TCD data, both A and B could cure cerebral vasospasm, but group A was obviously superior to group B. Our conclusion is that papaverine solution lavaged locally can effectively prevent cerebral vasospasm after cerebral aneurysm operation .

The electrophysiological characteristics of ventralis intermedius nucleus and its role in localizations of Vim-thalamotomy for Parkinson's disease patients / 解放军医学杂志

Objective To investigate the electrophysiological characteristics of the ventralis intermedius nucleus (Vim) in order to find an easy and safe way to confirm the target in Vim-thalamotomy. Method In microelectrode-guided selective Vim-thalamotomy for 23 Parkinson's disease patients, the background activity, amplitude and discharge frequencies of Vim were compared with its surrounding structures. The response of kinesthetic neuron and tremor cell to microstimulation was also compared. Result There were differences in backgroud activity and discharge amplitude for Vim, ventralis lateralis nucleus (VL), ventralis caudalis nucleus (VC), and internal capsule. Based on the response to active or passive movement of contralateral limb tremor cells were divided into two subgroups, which were different in localization. Contralateral tremor showed different response when the two subgroups of tremor cells were mircrostimulated. Conclusion The anterior border of Vim was easily found by microrecording. Only by combining microstimulation with microrecording could the posterior border of Vim and its interior and lateral ordination of target were identified exactly and safely. Kinesthetic neurons and tremor cells which responded to the movement of contralateral limbs should be destroyed.

The analysis of clinical effect of individualized cranioplasty with different materials for 75 skull defect patients / 解放军医学杂志

Objective To summarize the clinical effect of individualized cranioplasty with different materials. Method The clinical data of 75 patients with skull defect were analyzed retrospectively. Ultrathin cranial CT and three-dimension reconstruction were done to delineate the shape and contour of cranial defect. The templet for repair was fabricated with methyl silicone rubber, bone cement or titanium mest according to the condition of the bone defect with laser rapid prototyping technique. With patient's consent, the individualized templet was implanted to repair the cranial defect. Results Methyl silicone rubber or bone cement were used for 40 of 75 patients to fill the defects, and in the other 35 patients titanium mesh was used to cover the defects with overlapping edges. The patches matched cranial defect perfectly without the necessity of revision. The average operation time was 45 minutes. Perfect or excellent cosmetic results was obtained in 63 of the 75 patients (84%). Postoperative complications were as follows: 5 patients complained of headache, which disappeared in there months. Collection of fluid under the scalp was found in 12 patients, among them the fluid was Absorbed 10 days after operation in 8 cases without any treatment, while in 3 patients it disappeared after suction for 1-4 times. In the remaining one patient, the bone cement templet was removed due to infection, and a titanium mesh was implanted one year later. Loosening and displacement of the templet occurred in 2 patients, and silk sufures were used for fixation in both patients. In these two patients, the templet became stable 3 months later, and in the other titanium was used for repair one year later. The incidence of complications was signifieantly different between inlay and onlay methods of repair (P