Research advances in mechanism of gut microbiota changes after traumatic brain injury / 中华创伤杂志

Traumatic brain injury (TBI) is often accompanied by digestive system dysfunction, such as intestinal dysfunction and dysbacteriosis. The activation of neuroendocrine system after TBI is one of the factors leading to gut microbiota changes. A variety of antimicrobial peptides secreted by Paneth cells are the key factors to maintain intestinal flora homeostasis. The dysfunction of Paneth cells after TBI may be responsible for gut microbiota changes. The authors review the mechanism of gut microbiota changes induced by TBI to provide new ideas for clinical treatment of gut microbiota changes caused by TBI.

The application of hybrid operation suite in the management of cerebral and spinal vascular diseases and intracranial hypervascular tumors / 中华外科杂志

Objective@#To evaluate the effect of hybrid operation suite in the treatment of cerebral and spinal vascular diseases and intracranial hypervascular tumors.@*Methods@#A retrospective study was conducted on 132 patients with various cerebral and spinal vascular diseases and intracranial hypervascular tumors who were treated by hybrid surgery at Department of Neurosurgery, Huashan Hospital from October 2016 to December 2017.There were 70 male and 62 female patients with a mean age of 48.33 years (range: 14-78 years), including 64 cases of intracranial aneurysm (41 complicated aneurysm cases), 28 cases of brain arteriovenous malformation (BAVM), 12 cases of hypervascular tumor, 12 cases of dural arteriovenous fistula (DAVF), 6 cases of carotid artery stenosis, 5 cases of Moyamoya disease, 3 cases of intracranial aneurysm or BAVM combined with tumor, 1 case of scalp arteriovenous fistula and 1 case of critical brain trauma in which a foreign metal stick approached the basal vascular circuit.Abnormalities were found in 16 cases in intraoperative angiography. The clinical data of all patients was collected as a perspective cohort. The success rate of hybrid surgery, intra-operative and post-operative complications, morbidity, mortality, rate of infection, the length of hospital stay were all analyzed to illustrate the effect of hybrid operation mode to traditional surgical pattern.@*Results@#For 64 cases with intracranial aneurysms, the immediate complete occlusion rate was 90.5%, with a mortality of 4.7% and a morbidity of 14.0%. For 28 cases of BAVM and 12 cases of DAVF, all patients achieved total obliteration and favorable social independent outcomes after hybrid surgery, with no complication.For 6 cases of carotid artery stenosis and 5 cases of Moyamoya, intra-operative confirmed good cerebral reperfusion without any new post-operative neurologic deficits. After tumor vessels embolization, 4 out of 12 cases of hypervascular tumor needed intra-operative blood transfusion, and all patients achieved total tumor resection in a single stage. Only one patient with medulla oblongata hemangioblastoma died 6 months after operation due to respiratory deficit related pneumonia. Compared to traditional surgeries, the hybrid operation pattern did not significantly increase the total infection rate, central nervous system infection rate, hospital stay days and post-operative hospital stay days (all P>0.05) while the in-patient cost increased mildly (119 332 yuan vs.98 215 yuan, t=2.38, P=0.02).@*Conclusions@#The operations of complex cerebral and spinal vascular diseases and intracranial hypervascular tumors can be performed in hybrid operation suite safely.This surgical mode can ensure the quality of operation and promote the development of innovative and complicated surgical procedures.

Promoter methylation of coagulation factor Ⅶ in patients with traumatic brain injury and its association with intracranial progressive hemorrhagic injury / 中华创伤杂志

Objective To study the effect of the promoter methylation of coagulation factor Ⅶ (FⅦ) on the coagulation factor Ⅶ activity (FⅦa) in traumatic brain injury (TBI) patients,and the correlation between the promoter methylation in FⅦ and intracranial progressive hemorrhagic injury (PHI).Methods A prospective analysis was conducted on 79 patients with moderate-severe TBI admitted to emergency department from August 2010 to August 2014.The peripheral venous blood samples were collected at admission and then were delivered for measurement of FⅦa.Genomic DNA was isolated from patient blood,and the promoter methylation in FⅦ (CpG2,CpG3,CpG4,CpG5,and CpG6) were analyzed.According to the level of plasma FⅦa,the patients were divided into FⅦa ≥90％ group and FⅦa ＜ 90％ group.Based on the presence of PHI,the patients were divided into PHI group and non-PHI group.The FⅦ promoter methylation,age,gender,systolic blood pressure,Glasgow Coma Scale (GCS),length of stay and mortality between FⅦa≥90％ group and FⅦa ＜ 90％ group,PHI group and non-PHI group were compared.Results There were no significant differences in age,gender,systolic blood pressure,GCS,LOS,and mortality between FⅦa ≥90％ group and FⅦa ＜90％,PHI group and non-PHI group (P ＞ 0.05).The methylation of CpG3 in FⅦa ≥90％ group was less than that in FⅦa ＜90％ group (0.83 ±0.05 vs.0.85 ±0.03) (P＜0.05),while there were no significant differences in other CpG sites between these two groups (P ＞ 0.05).No significant differences in all of methylation levels of the CpG sites between PHI group and non-PHI group were found (P ＞0.05).Conclusions The promoter methylation of FⅦ affects plasma FⅦa concentrations,and higher methylation results in lower FⅦa.The promoter methylation of FⅦ is not associated with PHI in TBI patients.

Research progress of static magnetic field targeting drug delivery system in tumor diagnosis and therapy / 国际生物医学工程杂志

Chemotherapy is one of the traditional tumors treatment solutions.Chemotherapy has the feature of tissue non-specificity,which can cause side effects on normal cells while inhibiting tumor cell growth.Magnetic targeting drug delivery system (MTDDS) employs biocompatible and stable magnetic nanoparticles (MNP) as drug carries to transport and accumulate anticancer drugs to the specific tumor tissues under the guidance of external magnetic field.This technology not only improves the efficiency of drug delivery and antitumor activity,but also reduces the drug dosage and side effects.The properties of drug-loaded MNPs and the applied external magnetic field are the main factors that affecting the MNPs targeting to the tumor tissues.The effectiveness of the targeted delivery of the drug-loaded magnetic nanoparticles mainly depends on the form and strength of the magnetic field at the target site.That is,whether there is sufficient strength to attract and retain NMPs,and to promote antitumor drug release at the tumor region.In this paper,the research progress of static magnetic field targeting drug delivery system in tumor diagnosis and therapy was summarized,which can provide some basic information for the relative scientific researches.

The investigation of early rehabilitation of in -patients with traumatic brain injury in Eastern China / 中国基层医药

Objective To master the rehabilitation in patients with traumatic brain injury in Eastern China, and provide evidence for clinicians to rehabilitate early,correctly and effectively.Methods All sampling of the TBI patients from 80 hospitals in Eastern China were clustered and were analyzed using SPSS 13.0.Results The rate of in -patients in Eastern China with early rehabilitative intervention was 4.68%,and the rate of male was higher than female(male to female ratio was 3.80:1),mean age was (40.10 ±16.33)years old,but there was no difference in gender(χ2 =3.23,P =0.072)and age(t =-0.819,P =0.413)for the early rehabilitative intervention.Local resi-dent patients in early rehabilitative intervention was lower(χ2 =8.28,P <0.05).The average length of stay for the early rehabilitative intervention patients was(39.57 ±34.22)d(t =-17.74,P <0.05),the average cost of hospitali-zation was(42 741.50 ±43 186.69)yuan(t =-18.96,P <0.05).The rate of average length of stay and average cost of hospitalization of the rehabilitative intervention patients were higher and more expensive than the patients who did not obtain early rehabilitative intervention,but did have higher unfavourable prognosis rate(χ2 =85.45,P <0.05). Conclusion We advocate correct and early rehabilitative intervention for traumatic brain injury in patients with different degree,and promote not only the physical and functional rehabilitation,but also comprehensive rehabilitation such as the psychological treatment,family treatment and social regression.

Intracranial pressure monitoring for guiding high coronary craniotomy for clearance of bilateral frontal contusions in 79 cases / 中华创伤杂志

Objective To improve treatment success rate and prognosis for patients with bifrontal contusions by intracranial pressure monitoring.Methods A retrospective analysis was conducted on 79 cases of bifrontal contusions admitted between October 2004 and April 2012.The patients were divided into intracranial pressure monitoring group (n =40) and group without intracranial pressure monitoring (n =39),according to the treatments.Significance of high coronary craniotomy timing,surgical strategy and intracranial pressure monitoring in the diagnosis,treatment and prognosis was analyzed.Results The intracranial pressure monitoring group showed a significantly shorter period concerning osmotic dehydration [(14.24 ± 7.93) days vs (21.61 ± 11.97)days,P＜0.01],ICU stay [(14.38 ±7.56)days vs (24.71-± 17.94)days,P＜0.01] and total hospital stay [(17.20 ±8.09)days vs (33.92 ± 21.70)days,P＜0.01] as well as a better GOS [(4.15 ± 1.22) points vs (3.69 ± 1.56) points,P ＜ 0.05],as compared with group without intracranial pressure monitoring.Conclusions Craniotomy,especially decompressive craniectomy,is one of the most important treatment means to control cranial pressure and ensure cerebral perfusion pressure in patients with bifrontal contusions (in particular the moderate and severe ones).Besides,intracranial pressure monitoring is conducive to selection of surgery timing and is instructive to combined treatment,such as osmotherapy,intracranial pressure controlling and assurance of cerebral perfusion pressure.

Effects of glucose monitoring after traumatic brain injury on predicting prognosis of the patients / 中华急诊医学杂志

Objective To dynamically monitor the blood glucose in traumatic brain injury (TBI) patients within three days after admission, and to assess the impact of hyperglycemia on prognosis. Method Between 2007 and 2008, 62 TBI patients, who were admitted within 6 hours after the ineidence of injury without diahetes or severe combined injuries, were involved in this study. Blood glucose was monitored at 4 time points (instantly, 24 hours, 48 hours, and 72 hours after admission). Patients were classified into the mild, the moderate, or the se-vere TBI group according to GCS (Glasgow Coma Scale) scores, being classified into the survival or the dead group according to prognosis, or into the mile or severe hyperglycemia group depending on whether the blood glucose ex-ceeds 11.1mmol/L on admission. T tests and χ2 tests were applied to analyze the relationship among blood glucose levels, the degrees of injury, and the prognosis of studied patients. Results Patients with mild, moderate, or se-vere TBI showed hyperglycemia with different levels, and the blood glucose levels was consistent with the degree of the injury. The blood glucose of the patients in the dead group were significantly higher at all checked time points than those of the survival group, particularly instantly after admission (8.51±2.01 mmol/L vs. 11.54±2.45 mmol/L, P=0.0001, t=4.988). The mortality of patients with severe hyperglycemia was 64.71%, signifl-candy higher than that of the mild hyperglycemia group 13.95% (P=0.0002, χ2=15.46). The Intensive Care Unit Length of Stay (ICULOS) of the above two groups was 22.6 and 10.2 days,respectively (P=0.021, t= 3.216), but their hospital length of stay (HLOS) showed no statistical difference (P=0.052). Conclusions Hyperglycemia, as an early stress response to TBI, may reflect the degree of the injury. Blood glucose levels that exceed 11.1 mmol/L on admission may imply high mortality of TBI patients, so this could be used as a simple indi-cator to predict prognosis.

The emergency epidemiologic characteristics of casualties cases with head injury in Shanghai / 中华急诊医学杂志

Objective To analyze the emergercy epidemiological characteristics of coeualties with head in-jury in Shanghai. Method By a prospective study,the data of 18 076 casualties with head injury during the whole year 2004 collected from 12 joint hospitals in Shanghai were documented well in the unified survey tables with wide-range items failed in by the attending physician, who got the firsthand information from patients and witness.The data were analyzed by using SPPS version 11.5 software. Results Of 18 076 casualties with head injury,the ratio of male to female was 2.11: 1.The mean age of female was older than that of male (t=10.575, P<0.01).The highest incidence of casualties occurred in people of twenties (24.7 % ). The local residents of Shanghai ac-counted for 34.2% of casualties. More casualties often occurred in December,January,Mareh and August than in he rest. Of 5.1% casualties with head injury were assochted with labour work.The leading cause of injury was dif-ferent in patient cohorts of different ages. Fall was the most main cause of trauma in children cohort (aged<14)and the senile patients cohort (aged > 60). The violert assault and traffic accident caused the most head injuries in the adolescent people cohort ( aged 15～34 years old) and the young people cohort ( aged 35～59 year old). The majority of casualties (85.5%) received CT scan.The scalp laceration (40.2% of patients) was seen more often than other types of injury . The mortality of easualties with traumatic brain injury was 0. 5 % . Conclusions The kmowledge of epidemiologieal aend of emergency deparhnent visitors with head injury is amportant guidance to physicians arranging emergency medical resources rationally and formulating a comprehesive prevention stategy of castahies with head injury.

121 drug-resistance analysis and prevention of MRSA in nenrosurgery intensive care unit / 中国基层医药

Objective To understand the drug-resistance of MRSA patients in neurosurgery intensive care unit,raise the prevention of MRSA and provide doctors the basis for controlling it. Methods The 5 year(20012005) MRSA patients were tested by Kirby-Bauer in neurosurgery intensive care unit of a third-tier general hospital in Shanghai. Statistic and analysis the drug-resistance of the patients. Results The rates of 121 MRSA drug-resistance to penicillin G,erythromycin, ciprofloxacin, amikacin and the cephalosporins are 92.3 % to 100 %, totally senaitire to teicoplanin and vancomycin and lower drug-resistance to rifampin,netilmicin and fosfomycin, but it rapidly raised from 10.0 % (2001 ) to 95.2 % (2005) to sulfamethoxazole. Conclusion It is time to take care of the drug-resistance of MRSA. Prevention and use antibiotics properly are the important ways to decrease the hospital infection and to improve the quality of recovered.

Effect of neural stem cell transplantation on neurological function of cerebral hemorrhage rats / 中国组织工程研究

BACKGROUND: Exogenous neural stem cells (NSCs) can repair nerve and promote recovery of neurofunction following cerebral hemorrhage.OBJECTIVE: To observe the growth and development of NSCs in vitro, to evaluate the survival, migration and differentiation of transplanted NSCs surrounding hematoma and the possible recovery function of NSCs, and to investigate the repairing effect of NSCs on damaged neurofunction in cerebral hemorrhage model rats.DESIGN: Completely randomized grouping design and controlled animal study,SETTING: Department of Neurosurgery, Huashan Hospital, Fudan University.MATERIALS: Eighteen adult healthy male SD rats weighing 280-320 g were provided by Shanghai Animal Center of Chinese Science Academy. BrdU was provided by Neomarkers Company; rat-anti-glial fibrillary acidic protein (GFAP) and rabbit-anti-microtubule-associated protein-2 (MAP-2) by Chemicon Company.METHODS: This study was performed at the Laboratory of Anatomy and Histology & Embryology, Shanghai Medical College,Fudan University from February to December 2006. The NSCs was isolated, cultured, and evaluated from hippocampus of day E14fetal SD rats. Eighteen rats were randomly divided into control group, PBS group and NSC transplantation group. Cerebralhemorrhage rat models were established via injection of autoiogous arterial blood in caudate nucleus. Thirty minutes after model establishment, 5 μ L NSC suspension with the concentration of 2×1011 L-1 was transplanted at four points surrounding hematoma cavity in the NSC transplantation group. Transplantation of PBS and NSCs was the same as autoblood transplantation. Thirty minutes after model establishment, injuries at the four points were performed, and nothing was injected in the control group.MAIN OUTCOME MEASURES: Neurofunction was evaluated with forward limb scale and turning scale just soon after transplantation and at 1, 3, 5, 14, and 28 days after transplantation. Brain was colleted by anesthesia 28 days after model establishment.Differentiation of transplanted NSCs was detected through testing GFAP, MAP-2, and BrdU by using immunohistochemistry.RESULTS: ①Neurofunction scores: There was no significant difference 5 days after model establishment (P＞0.05). However, the scores were significantly improved in the NSC transplantation group 14-28 days after model establishment (P＜0.05).②lmmunofluorescent double labeling: Apoptosis ceils around hemotoma in the NSC transplantation group were less than those in the PBS group. BrdU and MAP-2 or GFAP-positive ceils were observed in cerebral tissue sections, and this suggested that NSCs could survive, migrate and differentiate in host brain and differentiate into neurons or astrocytes.CONCLUSION: NSC Transplantation contributes to the recovery of neurofunction in cerebral hemorrhage rats through differentiation into neurons or astrocytes.

Association between the Apolipoprotein E gene polymorphism and traumatic brain injury / 中国神经精神疾病杂志

Background To explore the relationship between polymorphism of APOE gene in traumatic brain injury(TBI)patients suffering from traffic accident and the outcome of TBI.Methods TBI patients were randomly selected in this study with caxe-wntrol trial. The genotype of APOE allele was tested by a polymerase chain reaction-restriction fragment length polymorphism ( PCR-RFLP), and the association between different genotypes of APOE alleles and outcome of TBI patients, were analyed.Results In TBI group frequency of APOE ε2 allele was 0. 1010, and frequency of APOE ε2/ε3 was 0. 1596.Both of these results were significantly higher than that in normal people (APOE epsilon 2 was 0. 0050, APOE ε2/ε3 was 0. 0100) (P＜0.05). Frequency of APOE ε2 and APOE ε2/ε3 in TBI group who died was 0. 1970 and 0. 2727. These were significantly high compared to TBI patients who had good recovery.Conclusions APOE allele ε2 and APOE genotype ε2/ε3alleles indicate a poor prognosis of traumatic brain injury patients.

Effects of extracellular signal-regulated kinase (ERK) on focal cerebral ischemia / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To determine the role of extracellular signal-regulated kinase (ERK)1/2 during focal cerebral ischemia.</p><p><b>METHODS</b>Left middle cerebral artery occlusion (MCAO) was undergone after the introduction of a nylon suture to the left internal carotid artery in 70 male adult CD-1 mice. ERK 1/2 phosphorylation was detected using Western blot analysis, and the morphological feature was determined by immunohistochemistry. An ERK pathway inhibitor, 1,4-diamino-2,3-dicyano-1,4-bis[2-amino-phenylthio] butadiene (U0126), was administered intravenously 20 minutes before MCAO, and the neurological deficit levels and the infarct volumes were measured 24 hours after MCAO.</p><p><b>RESULTS</b>Phosphorylated ERK 1/2 (pERK 1/2) activity increased after 30 minutes of MCAO and peaked at 2 hours. The immunohistochemical study displayed a large number of pERK 1/2 positive cells in the ischemic basal ganglion and surrounding cortex. Double-labeled fluorescent staining identified the pERK1/2 positive cells as neurons or astrocytes. In U0126 treated mice which had undergone 24 hours of MCAO, the neurological deficit levels and the infarct volumes were 44.6% and 45.8% respectively, less than those of the control mice.</p><p><b>CONCLUSIONS</b>ERK plays an important role in focal cerebral ischemia and inhibition of the ERK pathway can help protect against ischemic brain injury, which may provide a therapeutic approach for cerebral ischemia.</p>

Neuronavigator-guided glioma surgery / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the effectiveness of neuronavigator-guided surgery for the resection of gliomas.</p><p><b>METHODS</b>A total of 80 patients with gliomas underwent surgical treatment under the StealthStation neuronavigator to estimate the extent of the tumors. In 27 cases, the measurements of brain shifts at the dura, cortical surface and lesion margin were recorded during the operations. A technique termed "micro-catheter fence post" was used in superficial gliomas to compensate for brain shift.</p><p><b>RESULTS</b>Mean fiducial error and predicted accuracy in the 80 cases were 2.03 mm +/- 0.89 mm and 2.43 mm +/- 0.99 mm, respectively. The shifts at the dura, cortical surface and lesion margin were 3.44 mm +/- 2.39 mm, 7.58 mm +/- 3.75 mm, and 6.55 mm +/- 3.19 mm, respectively. Although neuronavigation revealed residual tumors, operations were discontinued in 5 cases of deep-seated gliomas. In the other 75 cases, total tumor removals were achieved in 62 (82.7%), and subtotal removals were achieved in 13 (17.3%). Post-operation, neurological symptoms were improved or unchanged in 68 cases (85.0%), and worsened in 12 (15.0%). No deaths occurred during the operations and post-operations.</p><p><b>CONCLUSIONS</b>Intraoperative brain shifts mainly contribute to the fail of spatial accuracy during neuronavigator-guided glioma surgery. The "micro-catheter fence post" technique used for glioma surgery is shown to be useful for compensating for intraoperative brain shifts. This technique, thus, contributes to an increase in total tumor removal and a decrease in surgical complications.</p>

Image-guided resection of cerebral cavernous malformations / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate retrospectively the effectiveness of image-guided navigation techniques in the management of cerebral CMs.</p><p><b>METHODS</b>Between July 1997 and January 2001, 44 patients underwent image-guided resection of cerebral CMs. To counteract brain shift, a small silicon catheter was implanted as a guide in the case of deep-seated lesions (except in the case of brain stem CMs) and before excision of multiple lesions.</p><p><b>RESULTS</b>A total of 27 men and 17 women with a mean age of 35 years underwent surgical procedures (5 patients had multiple lesions). The lesions were located in the frontal (n = 14), lobe temporal lobe (n = 12), parietal lobe (n = 6), cerebellum (n = 6), thalamus (n = 5), pons (n = 5), and orbital region (n = 1). Under the guidance of a StealthStation navigator, total removal of the lesions was achieved in all patients. Follow-up revealed marked improvement of preoperative symptoms in 26 patients and no additional deficits in 13 patients. Five patients suffered from additional neurological deficits, but two of them gradually improved during the follow-up period.</p><p><b>CONCLUSIONS</b>With the assistance of an image-guided surgical system, functional areas can be effectively avoided and surgical injury can be decreased. This system is well suited for accurate localization and safe resection of small, deep-seated CMs.</p>

VEGF-transfected neural stem cells transplantation to striatum of temporary middle cerebral artery occlusion rats / 中华器官移植杂志

Objective To evaluate the effectiveness of VEGF-transfected neural stem cells (NSCs) transplantation to striatum for amelioration of neural damage induced by cerebral ischemia.Methods Temporary middle cerebral artery occlusion (tMCAO) models were established and randomly divided into control group, PBS transplantation group, NSCs transplantation group (n=10) and VEGF-secreting NSCs transplantation group (n=20). The grafts in each group were transplanted into right striatum respectively 3 days after tMCAO model established. NSS was checked in all groups 2, 4, 6, 8, 10, 12 weeks respectively after transplantation. By using immunofluorescent staining, VEGF expression in transfected NSCs was detected 7 days after transplantation. Differentiation of transplanted NSCs was investigated 12 weeks after transplantation. Endothelial cells around the transplantation area were semi-quantitated by using immunohistochemistry staining.Results NSS in VEGF-secreting NSCs transplantation group was lower than in other three groups from 2-12 weeks. There was significant difference in NSS among the groups 12 weeks after transplantation (P

Biomechanical study of human dura and its substitutes / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the biomechanical characters of human dura and its substitutes and to establish guidelines for selection of optimal repair materials for reconstruction of skull base defects.</p><p><b>METHODS</b>A measurement of creep properties of human dura and its substitutes were conducted using biomechanical tests. The dynamic changes of biomechanical properties of canine dura obtained from skull base defects were observed as well.</p><p><b>RESULTS</b>The creep properties of human dura presented a linear-relationship between initial strain and stress, and the creep strain increased slowly with time. The creep compliance formula for human dura and its substitutes was as follows: J (t) = J(0) + Kf (t). The initial compliance of canine dura in skull base defects was reduced by 35%, 46% and 50%, respectively 1, 3 and 6 months after surgery.</p><p><b>CONCLUSION</b>The optimal material for the repair of skull base defects can be estimated using creep compliance analysis. The less the compliance, the better the property of anti-protrusion. Fresh human dura is the least compliant and then in increasing order are lyophilized human dura, fresh human pericranium, Terylene and silicon membranes. The pattern of biomechanical characteristics of the dura mater at skull base defects shows that the strain ability of the dura mater decreases distinctly for 1 - 3 months and then remains almost unchanged for 3 - 6 months after surgery.</p>

Long-term follow-up results of dural reconstruction without bone graft at anterior skull-base defects / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To clarify whether it is necessary to reconstruct bone defects at the anterior skull base.</p><p><b>METHODS</b>A long-term follow-up study of 50 patients with anterior skull-base defects in which the dura was reconstructed without bone grafts was conducted. CT and MRI examinations were taken periodically after surgery.</p><p><b>RESULTS</b>The ordinates of the bone defects averaged 3.5 cm (range, 2 - 6 cm), and the abscissas averaged 2.8 cm (range, 2 - 5 cm). The abscissas of the bone defects measured 2 - 3 cm in 38 patients, 3 - 4 cm in 10 patients, and 4 - 5 cm in 2 patients. The follow-up ranged from 3 months to 5 years (average, 2 years).</p><p><b>CONCLUSIONS</b>At normal intracranial pressure, if the dura mater is repaired properly at the skull-base defects and reinforced with a pedicled pericranial flap, encephalomeningocele and cerebrospinal fluid (CSF) leakage can be prevented. It may not be necessary to make free bone grafts when the size of the cranial base bone defect is smaller than 4 cm.</p>

Surgical management of dumbbell-shaped trigeminal neurinomas / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the best surgical approach for the removal of dumbbell-shaped trigeminal neurinomas (DSTNs).</p><p><b>METHODS</b>The clinical materials of 46 patients with DSTNs surgically treated were analysed retrospectively. The patients were divided into two groups. In the early group (1978 - 1984), a series of conventional intradural approaches were used, and in the late group (1985 - 2000), an epidural approach via the skull-base craniotomy was used.</p><p><b>RESULTS</b>Total tumor removal was achieved in 42% (5/12) of the early group and 85% (29/34) of the late group (chi(2) = 8.8, P < 0.01). Temporary and permanent cranial nerve morbidities were 63% and 47% (chi(2) = 3.4, P > 0.05) in the early group and 48% and 15% in the late group (chi(2) = 6.1, P < 0.05).</p><p><b>CONCLUSION</b>The best microsurgical approach for the removal of DSTNs is epiduro-transduro-transtentorial approach via skull-base craniotomy. It is not necessary to resect the petrous apex.</p>

Peri-operative treatment for the most severe head injury in the elderly patients / 中华老年医学杂志

Objective To summarize the peri operative therapeutic experience from 67 severe traumatic head injuried patients with a score of 3 8 on Glasgow coma scale (GCS). Methods 67 severe head injuried patients with a score of 3 8 on GCS admitted to our department from Feb. 1992 to Oct.1998 were analyzed. Results Forty five (67 2%) out of 67 patients survived and 22 died. Among the surviving patients 34 (50 7%) achieved a good recovery or moderate disability and left other 11 patients severe deficits(16 5%). Conclusions The prognosis of severe head injuried patients could be improved by correct management before hospitalization, early evacuation of intracranial hematoma with large decompressive craniotomies, intracranial pressure monitoring, moderate hypothermia therapy and other effective prevention and treatment of cerebral vasospasm and complications.

Keyhole approach surgery for petroclival meningiomas / 中华显微外科杂志

Objective To evaluate the possibility of keyhole approaches for surgical treatment of petroclival meningiomas. Methods We retrospectively analyzed our experience in 14 cases with petroclival meningiomas surgically treated from May 2003 to January 2004. Eight tumors involved the upper and middle clivus.five tumors were attached to the entire width of clivus and one tumor involved the middle and lower cilvus. The tumors infiltrated into parasella regions or cavernous sinus in six cases simultaneously. Retrosigmoidal keyhole approach was selected to remove the tumors in 6 cases, and subtemporal keyhole approach was selected in 2 cases,while the combined retrosigmoidal and subtemporal keyhole approaches were applied in other six cases. Results Gross total resections of the tumors were achieved in 8 cases, subtotal resections in 4 cases, large resection in two cases who had recurrent tumors. Postoperatively, neurological intact or unchanged were found in 8 cases. The main surgical complications were mild facial palsy (4 cases) , abducent dificits (3 cases) ,temporary oculomotor nerve dificits (2 cases),and lower cranial nerve palsy (1 case). One patient died from disseminated intravascular coagulation (DIC) two weeks after surgey. There were no CSF leakage and infections after surgery in all cases 11 to 19 months follow-up studies demonstrated the great improvement of the Ⅲ and Ⅶ nerve deficits,but minor improvement in the Ⅵ nerve deficits. Conclusion According to the location and extension of the tumors, retrosigmoidal or subtemporal keyhole approaches or their combined can be selected for surgical treatment. These keyhole approaches can expose sufficiently the petroclival region, shorten the surgical time, and minimize the complications. Combined usage of minimally invasive techniques including the keyhole approach and radiosurgey in the treatment of the petroclival meningiomas is suggested.