Application of posterior fossa decompression and reconstruction in adults with the Chiari I malformation / 中华显微外科杂志

Objective To evaluate the results of surgically treated Chiari Ⅰ malformation (CMI) with posterior fossa decompression and reconstruction techniques.Methods Sixty-nine patients with CMI malformation underwent posterior fossa reconstruction.The operation involes dissection soft tissue from the suboccipital region,decompression by removing the posterior rim of the foramen magnum.Then the dura was opened widely with Y shape,as it often acts as a constricting band,particularly at the level of the foramen magnum.After dissecting the subarachnoid adhesions in cisterna magna with microsurgery techniques,dissecting part of the tonsillar hernia,opening the foramen of Magendie into the 4th ventricle and closing the dura using artificial dura mater,cranial bone flaps was repositioned centrally along the inferior edge of the craniectomy defect,so as to support the dura over the cerebellar hemispheres.Results Until the final follow-up,the clinical symptoms were improved in 56 patients,3 had recurrence after 1 year postoperatived,4 had recurrenced after 2 years postoperatived,and 87.5％ patients were stable.The patients took followed-up MRI at least once form 3 months to 6 months,and 13 cases were lost.One case with tension pneumocephalus,and 5 cases with subcutaneous effusion and cerebro-spinal fluid (CSF) incision leakage.There were no death and disability.Thirty-one cases favors the development of syringomyelia,6 showed the stable of syringomyelia,and 2 had an increased size of the cavity.Conclusion Dissecting the subarachnoid adhesions in cisterna magna with microsurgery techniques,dissecting part of the tonsillar hernia,opening the foramen of Magendie into the 4th ventrica,and circulation of CSF pathway are important to improve thetherapeutic effect of CMI.It is also very important to decompression with small cranial bone flaps,closing the dura using artificial dura mater under no tension,and bone structure reconstruction in the clinical practice.

Application of 3.0 T mobile iMRI and neuronavigation in the microsurgical operation for the high grade gliomas in brain functional area / 中华显微外科杂志

Objective To investigate the clinical application of 3.0 T mobile iMRI and neuronavigation in the microsurgical operation for the high grade gliomas in brain functional area.Methods The clinical data of 47 cases which were operated from April,2012 to August,2014 assisted by intraoperative magnetic resonance and neruonavigation system were analyzed retrospectively,including 19 cases of near the frontal motor areas,21 cases of closed to the dominant hemisphere language areas,and 7 cases of involved multiple lobes of the brain.The operative plans were made before the operative day using 3.0 T iMRI for T1-MPRAGE plain and enhancement magnetic resonance imaging sequence,diffusion tensor imaging (DTI) sequence and blood oxygenation level dependent functional MRI (BOLD-fMRI) sequence scanning.Before the start of operation,the margin of the tumor was marked on the scalp,and removed the tumor under the microscopy,according to the need 1-4 iMRI plain scan and enhanced scan were applied to reconstruct the real-time imaging of the residual tumors and corticospinal tract,and gained once more chances to remove the tumor repeatedly,until the tumor was removed totally,accurately and safely.Results The total resection rate increased from 63.8％ (30/47) to 95.7％ (45/47) by repeated resection,and 2 cases (4.3％ lesions) with subtotal resection.The dysfunction of motion and the language barrier got worse in 4 patients (8.5％).No cases with sever complication such as death and severe disability after operation.There were no intracranial hemorrhage,infection and other adverse events.Patients were followed up with nervous system symptoms and head MRI,the follow-up period was 3 months-2 years.Twenty-eight cases (59.6％) ob-tained good clinical efficacy;the dysfunction of motion and the language barrier got worse in 4 cases (8.5％);the symptoms and tumors recurrenced in 15 cases (31.9％).Conclusion The 3.0 T mobile iMRI system combined with functional neuronavigation can accurately display the relationships among the motor and language cortex,tumors and white matter fiber bundles real-timely.The extent of the tumor resection can be assessed accurately by real-time images provided by iMRI,and the residual tumor have chames to be resected repeatedly,until the tumors were resected totally before operation finished.The iMRI system can correct intraoperative brain shift timely.The total resection rate can be improved safely and accurately by one or more times resection.

Expressions of peroxiredoxin 1, peroxiredoxin 6 and GFAP in human brain astrocytoma and their clinical significance / 南方医科大学学报

<p><b>OBJECTIVE</b>To characterize the expressions of peroxiredoxin 1 (Prx1), peroxiredoxin 6 (Prx6) and glial fibrillary acidic protein (GFAP) in human brain astrocytoma and explore their clinical significance.</p><p><b>METHODS</b>The protein and mRNA expression levels of Prx1, Prx6 and GFAP in human brain astrocytoma and normal brain tissue specimens were determined by Western blotting, RT-PCR and immunohistochemistry.</p><p><b>RESULTS</b>The protein and mRNA expressions of Prx1 and Prx6 increased significantly in the order of normal brain tissue, grade II astrocytoma, grade III astrocytoma and grade IV astrocytoma (P<0.05). The protein and mRNA expressions of GFAP decreased significantly in grade III and IV astrocytoma compared with those in grade II astrocytoma and normal brain tissues (P<0.05).</p><p><b>CONCLUSION</b>Prx1 and Prx6 may play important roles in the invasion and malignant development of human brain astrocytoma, and may serve as biomarkers for evaluating the invasiveness, malignancy and prognosis of the tumor as well as potential molecular targets in astrocytoma therapy.</p>

Risk factors for ruptured intracranial aneurysms:a retrospective case series study / 国际脑血管病杂志

Objective To investigate the risk factors for ruptured intracranial aneurysms in order to provide the basis for the clinical decision-making of intracranial aneurysms.Methods The demographic and clinical data of the patients with intracranial aneurysm were collected retrospectively.Three-dimensional cerebral angiography was used to identify the aneurismal location and shape,existing ascus or not,aneurysm length,maximum diameter and neck width.The aspect ratio (AR) of aneurysm was calculated.Results A total of 243 patients with intracranial aneurysms (289 aneurysms) were included,149 patients(171 aneurysms) in the ruptured aneurysm group,94 patients (118 aneurysms) in the unruptured aneurysm group.The proportions of female (71.1％ vs.51.1％ ;x2 =12.13,P ＜ 0.01),hypertension (57.7％ vs.38.3％ ;x2 =8.69,P =0.003),smoking (53.0％ vs.39.5％ ; x2 =4.12,P =0.045),existing ascus (63.7％ vs.39.8％ ; x2 =16.07,P ＜0.01),and the maximum diameter ＞ 5 mm (80.7％ vs.66.9％ ;x2 =7.06,P ＜ 0.01) in the ruptured aneurysm group were significantly higher than those in the unruptured aneurysm group,while the proportion of the maximum diameter ＞ 10 mm (31.6％vs.52.5％ ;x2 =12.77,P ＜0.01) was significantly lower than that in the unruptured aneurysm group; the maximum diameter in the ruptured aneurysm group was less than that in the unruptured aneurysm group (8.68± 5.79 mm vs.10.67± 5.78 mm; t=-2.91,P=0.004),while the aneurysm length (8.27 ± 4.19 mm vs.6.94 ± 4.77 mm; t =2.50,P =0.013) and AR (2.32 ± 1.18 vs.1.42± 1.21; t =634,P ＜ 0.01) were significantly longer and higher than that in the unruptured aneurysm group,respectively.Of the 289 aneurysms,103 were anterior communicating artery aneurysms,84 were posterior communicating artery aneurysms,56 were middle cerebral artery aneurysms,12 were anterior cerebral artery aneurysms,9 were internal carotid artery aneurysms,and 25 were basilar artery aneurysms.There were significant differences in the rupture incidence of intracranial aneurysm at different locations (63.1％,79.8％,41.1％,33.3％,33.3％,and 36.0％,respectively; P ＜0.01).Multivariate logistic regression analysis showed that the female (odds ratio [OR],6.311,95％ confidence interval [OR]3.673-10.844; P ＜ 0.01),existing ascus (OR 2.789,95％ CI 1.624-4.792; P＜0.01),and maximum diameter ＞5 mm (OR 1.866,95％ CI 1.012-3.437; P =0.046) were the independent risk factors for ruptured intracranial aneurysms.Conclusions The incidence and rupture rate in women patients with intracranial aneurysm were higher than those in men.Hypertension,history of smoking existing ascus,aneurysm location,aneurysm maximum diameter,aneurysm length and AR were all the factors that impact ruptured intracranial aneurysms,in which women,existing ascus and the maximum diameter ＞5 mm were the independent risk factors.

The analysis of hypertensive putamen hemorrhage with two different surgical treatment / 中国基层医药

Objective To study the different effects of hypertensive putamen hemorrhage with two different treatments of decompressive craniotomy and small bone window(keyhole) surgery. Methods Retrospective analysis of 120 cases of hypertensive putamen hemorrhage in patients with operation data was carried out. They were randomly divided into two groups according to the different surgical procedure, and then compared the incidence of postoperative complications, close and long-term effects and so on. Results There was no significant difference in early complication rate and postoperative GOS score after a week between two groups(P＞0.05). The difference was significant between two groups in close and long-term effects (P ＜ 0.05 ). Conclusion Small bone window (keyhole)surgery had characteristics such as surgical time-saving ,less damage and more rapid recovery with removal of hematoma, and made played a significant role in promoting the recovery of close and long-term effects with patients.

Effect of dexamethasone by local treatment on cerebral edema and serum myelin basic protein after brain injury in rabbits / 中华创伤杂志(英文版)

OBJECTIVE: To explore the effect of dexamethason e by local treatment on cerebral edema and brain damage after brain injury. METHODS: Twenty-two rabbits were classified into 2 groups, Gro up A (the control group, n=11) and Group B (the treated gr oup, n=11). An rabbit brain contusion model was made by bo ne windowplasty by extradural hitting. Group B was treated by local infiltrating and spraying of dexamethasone at equidistance to lesions. Group A was given nor mal saline in the same way as Group B. The changes of moisture in brain tissues and serum myelin basic protein (MBP) were observed. RESULTS: The percentage of water content in damaged hemisphere in Group A and Group B was 81.75%plus minus0.56% and 79.45%plus minus0.52% respe ctively. There was a significant difference between the 2 groups (P<0.05). The normal level of MBP was 1.66 mug/Lplus minus0.71 mug/L, while the value of MBP in Group A and Group B were 5.98 mug/Lplus minus2.08 mug /L and 3.15 mug/Lplus minus1.09 mug/L separately. The level of MBP in Group A an d Group B were higher than normal level and there was also a significant differe nce between Group A and Group B (P<0.05). CONCLUSIONS: The results of our study showed that the brain moi sture and MBP in serum were increased after brain injury while reduced after tre atment with dexamethasone. It is demonstrated that local treatment of brain inju ry with dexamethasone has an obvious therapeutic effect on cerebral edema and se rum MBP.