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Objective To summarize the experience of unilateral endonasal transsphenoidal pituitary adeno-ma resection under neuroendoscopy. Methods 48 patients with pituitary adenoma were treated by unilateral en-donasal transsphenoid under neuroendoscopy. During the dissection of the adenoma, attention should be paid to pro-tect pituitary stalk and gland. Results The postoperative MRI detection revealed that the tumor was totally removed in 40(83.3%) cases,subtotally in 6(12.5%) ,and partially in 2(4.2%). All patients were followed up for 10 -36 months. Among the 38 patients with increased hormone level ,24 recovered to normal hormone level postoperatively; 14 were improved evidently;pituitary insufficiency was not found in 38 cases;7 patients have temporary diabetes in-sipidus but the symptom was released in three weeks. Conclusion The surgical treatment of pituitary adenoma by neuroendoscopic unilateral endonasal transsphenoid has its advantage in achieving both complete resection of tumor and sound protection of pituitary stalk and gland. Neuroendoscopic operation offers greater help in improving the pa-tients' quality of survival.
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Objective To evaluate the therapeutic effects of Lumber continued drainage of cerebrospinal fluid after Key-hole approach operation and craniotomic hematoma elimination on the prognosis of hypertensive in-tracerebral hemorrhage patients. Methods Lumber continued drainage of cerebrospinal fluid after Key-hole ap-proach operation was conducted on 38 hypertensive intracerebral hemorrhage patients. At the 1st month and 6th month after operation, Glasgow coma scale (GCS), Glasgow outcome scale (GOS), Barthel index, language barrier degree evaluation and sports function barrier degree evaluation were measured. The therapeutic effects were observed and compared with 34 patients who were operated by craniotomic hematoma elimination. Results GCS was 6.8± 2.1,6.6±2.3 before operation and 10.5±2.5,8.7±2.2 one week after operation in experimental group and con-trol group respectively; GOS was 3.4±0.3,2.8±0.2 one month after operation and 4.1±0.6,3.2±0.4 six month after operation in experimental group and control group respectively; Bartherl index, language barrier degree and sports function barrier degree were 63.15±11.64,51.76±12.81 and 1.7±0.3,2.3±0.2,2.0±0.3, and 2.6± 0.4 (P<0.05 or P<0.01). Conclusion Lumber continued drainage of cerebrospinal fluid after Key-hole approach operation offers greater help in improving the patients' quality of existence, by which the neurological function recov-ers faster and the patients recover well.
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BACKGROUND: As the selective susceptible region following cerebral injury, hippocampus was found to be more sensitive to the extrinsic stimulation which would stimulate hippocampus region, then result in post-traumatic excessive expression of some immediate early genes, over release of excitatory amino acid and delayed death of nerve cells.OBJECTIVE: To study the relationship between the expression of nitrogen monoxide (NO) and endothelin and the apoptosis of nerve cell in cerebral hippocampus region following brain laceration.DESIGN: A comparative study based on paired t test and multiple linear correlative analysis.SETTING:Neurosurgery Department of Kailuan Hospital Affiliated to Northern China Coal Medical College.MATERIALS:This study was carried out at Molecular Biological Laboratory of Northern China Coal Medical College, from February to June 2003. Totally 126 healthy male Wistar rats, grade two, with body mass of 250-350 g,were randomly divided into three groups: experimental group and control group of 60 rats, normal group of 6 rats, moreover the experimental group and control group were subdivided into 0.5 hour, 1 hour, 3 hours, 6 hours,12 hours, 24 hours, 72 hours, 120 hours, 168 hours, 240 hours time point subgroups with 6 rats in each subgroup.METHODS: Left parietal lobe laceration model was established on experimental rats by modified Feeney's free-drop traumatic method; rats in control group were only subjected to parietal skull opening without injury; rats in normal group were received no treatment. The level of Serum NO and endothelin, as well as the number of apoptosis nerve cell at hippocampus region were detected at each time point by using nitric acid deoxidase method, ELISA and in situ terminal labeled technique(TUNEL).MAIN OUTCOME MEASURES: Level of serum NO and endothelin,apoptosis of nerve cells in hippocampus region following brain laceration.RESULTS: Data of 126 rats were statistically analyzed without loss. ① The expression of serum NO, endothelin and apoptosis of nerve cells in hippocampus region of experimental rats: All amounted to the peak level at post-Iaceration 6 hours [(81.45±2.41) mmol/L, (20.29 ±1.63) ng/L], which began to decline from onset of 12 hours [(66.11±1.97) mmol/L, (20.14±1.63)ng/L]. The level of NO at each time point from post-laceration 0.5 hour to 120 hours, and the level of endothelin of from 0.5 hour to 168 hour were significantly higher in experimental group in contrast with normal group and control group (t=3.33-27.91, P ＜ 0.01). ② The apoptosis of nerve cells in hippocampus region of experimental rats: The apoptosis reached to the top at post-laceration 168 hours (27.33±l.86)x102/mm2, which began to decline at 240 hours (21.67±2.07) ×l02/mm2. No apoptosis cells could be observed in normal hippocampus, and less in control group. ③ The correlation of the level of NO and endothelin with the number of apoptosis of nerve cells in hippocampus region: There was obviously positive correlation (r=0.838, P ＜ 0.01; r=0.281, P ＜ 0.05).CONCLUSION: There are definite correlation between the level of NO and endothelin and the number of nerve cells of apoptosis at hippocampus following cerebral laceration. NO and endothelin interacted each other,which involved in the pathophysiological process of cerebral laceration, and consequently resulted in the apoptosis of nerve cells in hippocampus region.