Treatment of cerebral arteriovenous malformations in children / 国际脑血管病杂志

Brain arteriovenous malformation (bAVM) is a common cerebrovascular disease in clinical practice. Compared with adults, children with bAVM are more prone to rupture and bleeding, and have a higher mortality and disability. Therefore, it is very important to accurately evaluate the bleeding risk of children with bAVM and reasonably select intervention measures to improve the prognosis. The treatment methods of children with bAVM mainly include conservative treatment, microsurgical treatment, endovascular embolization, stereotactic radiosurgery, and multimodal combined treatment. At present, the treatment indications and specific treatment options for children with bAVM are controversial.

Clinical progress of surgical methods for chronic subdural hematoma / 中国医师杂志

Chronic subdural hematoma (CSDH) is a common neurosurgical disease, especially in elderly patients, and its treatment currently includes medication conservation, surgical intervention and combination therapy. Although many cases have achieved good results through drug treatment, as far as the present situation is concerned, surgical intervention is still an irreplaceable treatment, especially for patients with large amounts of hematoma, even those with cerebral hernia or recurrence. However, there are many surgical methods about CSDH, the clinical selection is controversial, what is more, there has been some progress in minimally invasive surgery in recent years. In this paper, the surgical methods of CSDH are summarized as follows. The purpose is to provide for clinical evaluation and selection.

Application of twist drill craniostomy with urokinase in chronic subdual hematoma / 国际外科学杂志

Objective To evaluate the clinical effect of chronic subdual hematoma between surgical procedure twist drill craniostomy with injecting urokinase into hematoma space and only with twist drill craniostomy.Methods Two hundred and twenty-five patients with chronic subdual hematoma patients who were admitted in the Affiliated Hospital of Yangzhou University from January 2011 to April 2017 were retrospectively analyzed.They were divided into two groups according to the different surgical methods,group A for twist drill craniostomy with injecting urokinase into hematoma space (n =116),group B only for twist drill craniostomy (n =109).Then the postoperative drainage volume and residual hematoma was analyzed by repeated measures,while radiographic grading system and recurrence rates after operation were compared between groups with statistical analysis which was done by ANOVA analysis or non-parametric rank sum test.Results The drainage volume 48 hours after surgery was(52.41 ± 7.86) ml in group A,(28.42 ± 4.46) ml in group B as well.The residual volumes which were calculated at 1 month,3 months after surgery was (23.35 ±4.18) ml and (15.31 ±6.15) ml in group A,comparing the volumes of (46.07 ± 5.96) ml and (25.60 ± 5.03) ml in group B.The radiographic grading system was evaluated by grade 1-4.There were 75(64.7％) cases in grade 1,32(27.6％) cases in grade 2,8(6.9％) cases in grade 3,1 (0.9％) cases in grade 4 of group A,as well as 42(38.5％) cases in grade 1,55(50.5％) cases in grade 2,11 (10.1％) cases in grade 3,1 (0.9％) cases in grade 4 of group B.The rate of recurrence for chronic subdural hematoma was 6.0％ in group A,while it was 15.6％ in group B.These data all had significant statistical difference between the two groups (P ＜ 0.05).Conclusion Twist drill craniostomy might be a safe,effective and mini-massive method for treating chronic subdual hematoma,while injecting urokinase into the hematoma space could significantly reduce the rate of recurrence and decrease the volume of hematoma.

Effect of different electric coagulation method for cranioplasty / 中国医师进修杂志

Objective To compare the effect of the bipolar electric coagulation and unipolar electric coagulation on cranioplasty of scalp separation. Methods The clinical data of 67 patients who underwent unilateral frontotemporal cranioplasty from 2014 to 2017 were retrospectively analyzed. According to coagulation method during operation, these patients were divided into two groups, unipolar electric coagulation group (32 cases) and bipolar electric coagulation group (35 cases). The operation time, postoperative intracranial hemorrhage, infection, epilepsy and subcutaneous effusion were compared between two groups. Results The operation time of two groups had no significant difference (P > 0.05). The incidence of intracranial hemorrhage, infection and epilepsy of two groups had no significant differences (P > 0.05). But the incidence of subcutaneous effusion in unipolar electric coagulation group was significantly higher than that in bipolar electric coagulation group: 28.1%(9/32) vs. 5.7%(2/35), P<0.05. Conclusions The use of unipolar electric coagulation during the scalp separation in cranioplasty can reduce operation time in a certain extent, but significantly increase the incidence of postoperative subcutaneous effusion.

Roles of endoplasmic reticulum stress in early brain injury after subarachnoid hemorrhage / 国际脑血管病杂志

Spontaneous subarachnoid hemorrhage (SAH) is a common acute cerebrovascular disease with high morbidity and mortality in clinical practice.Recent studies have shown that early brain injury (EBI)would occur within 72 h after SAH,and is closely associated with the poor outcome in patients with SAH.There are many possible mechanisms resulting in EBI,such as inflammation,autophagy,apoptosis.These damage mechanisms are all associated with endoplasmic reticulum stress.This article reviews the roles of endoplasmic reticulum stress in EBI after SAH.

Curative effect and complication of neuronavigation guided puncture ventricle peritoneal shunt and traditional ventriculoperitoneal shunt for hydrocephalus / 国际外科学杂志

Objective To compare the accuracy of placement of ventricular shunt tube,the efficacy and complications of the neuronavigation-assisted ventriculoperitoneal shunt (group A) and traditional ventriculoperitoneal shunt (group B).Methods A retrospective study was made on 40 cases of hydrocephalus managed with neuronavigation-assisted ventriculoperitoneal shunt or ventriculoperitoneal shunt from January 2012 to June 2016.There were 18 cases [12 males,6 females;(47.5 ±8.5) years of age] in group A and 22 cases [14 males,8 females;(44.5 ± 7.5) years of age] in group B.Therapeutic effect and complications were analyzed postoperatively.The accuracy rate in ventricular end shunt placement that was free from the frontal horn of lateral ventricle and flush the Moro hole had also been studied.Results The position of ventricular shunt of all the patients were postoperative timely review of the CT view,and hospital outpatient follow-up periodical for 3-24 months after discharge from hospital.Patients with postoperative timely review of head CT and found that group A of ventricular end of the shunt tube position reach a set position in 16 cases,2 cases had not reached the set position,the accuracy rate was 88.89％.There were 8 cases in group B reach to the set position and 14 cases did not and the accuracy rate was 36.36％.After the statistical analysis there were significant differences (P ＜ 0.05).The total efficiency of A and B groups (excellent + effective) were 94.4％ and 86.4％ (P ＞ 0.05).Postoperative complications included bleeding,infection,obstruction of the shunt,excessive shunt,shunt insufficiency and so on.During follow-up,group A appeared excessive shunt in 1 case;group B incision infection in 1 case,4 cases of shunt obstruction,excessive shunt in 1 case,2 cases of deficiency of shunt.Two groups of patients were recovery well through the drainage tube pressure adjustment or set it once again.The incidence of complications in group A was 5.56％,group B was 36.36％.There was no significant difference between group A and group B (P ＞ 0.05).In group A,there was no obstruction of shunt tube,ventricular end of the shunt tube blockage occurred in 4 cases in group B,the incidence rate was 18.18％ (P ＞ 0.05).Conclusion Neuronavigation guided ventriculoperitoneal shunt placement to the accuracy of position setting has significant advantages over traditional ventriculoperitoneal shunt in the ventricular end of the shunt tube and it has some advantages in reducing postoperative complications.

Surgical treatment of ruptured middle cerebral artery aneurysms: clinical outcomes and prognostic factors / 国际脑血管病杂志

Objective To investigate the risk factors for clinical poor outcome after microsurgical treatment of ruptured middle cerebral artery aneurysms (MCAA).Methods The patients with ruptured MCAA treated with microsurgery were enrolled retrospectively.The data of demography,medical history,Hunt-Hess grade,imaging characteristics,surgery-related factors,and postoperative complications were collected.Glasgow Outcome Scale (GOS) was used to assess the outcomes.GOS 4-5 was defined as a good outcome and 1-3 was defined as a poor outcome.Results A total of 44 patients with ruptured MCAA were enrolled,including 26 (59.1％) females and 18 (40.9％) males,aged 36-75 years old (mean 58.5 years).The aneurysms were clipped in 42 cases (95.5％) and wrapped in 2 eases (4.5％).They were followed up for 3-6 months,33 (75.0％) had good outcome and 11 (25.0％) had poor outcome.Univariate analysis showed that there were significant differences in the proportions of Hunt-Hess grade,midline shift degree,hematoma volume,intraoperative rupture,decompressive craniectomy,and postoperative pulmonary infection between the good outcome group and the poor outcome group.Multivariatelogistic regression analysis showed that Hunt-Hess grade Ⅳ-Ⅴ (odds ratio [OR] 20.885,95％ confilence interval [CI] 1.342-38.696;P =0.001),intraoperative anenrysm rupture (OR 18.906,95％ CI 2.918-20.915;P=0.011),and complicated with pulmonary infection (OR 38.865,95％ CI 18.718-40.509;P =0.001) were the independent risk factors for poor outcomes.Conclusion The high Hunt-Hess grade,intraoperative aneurysm rupture,and complicated with pulmonary infection after surgery are the independent risk factors for poor outcomes after microsurgical treatment in patients with ruptured MCAA.

Roles of endoplasmic reticulum stress in early brain injury after subarachnoid hemorrhage / 国际脑血管病杂志

Spontaneous subarachnoid hemorrhage (SAH) is a common acute cerebrovascular disease with high morbidity and mortality in clinical practice.Recent studies have shown that early brain injury (EBI)would occur within 72 h after SAH,and is closely associated with the poor outcome in patients with SAH.There are many possible mechanisms resulting in EBI,such as inflammation,autophagy,apoptosis.These damage mechanisms are all associated with endoplasmic reticulum stress.This article reviews the roles of endoplasmic reticulum stress in EBI after SAH.