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Objective:To investigate the difference in efficacy between transsylvian-transinsular approach and transcortical-transtemporal approach for hematoma evacuation in the treatment of severe basal ganglia intracerebral hemorrhage in young adults.Methods:Young adult patients with severe intracerebral hemorrhage in the basal ganglia region underwent craniotomy hematoma removal in Ankang Central Hospital from February 2012 to February 2021 were retrospectively enrolled. The Glasgow Outcome Scale score was used to evaluate the outcome at 6 months after onset. 4-5 were defined as good outcome and 1-3 were defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of the poor outcomes. Results:A total of 51 patients were enrolled. Their median age was 41 (interquartile range 39-43) years, and 29 were men (56.8%). The median Glasgow Coma Scale score at admission was 6.0 (interquartile range 5.5-7.0), and the median baseline hematoma volume was 38.0 ml (34.5-47.5 ml). Twenty-one patients (41.2%) were in the transsylvian-transinsular approach group and 30 (58.8%) were in the transcortical-transtemporal approach group. There were no significant differences in demographics, vascular risk factors and baseline clinical data between the transsylvian-transinsular approach group and the transcortical-transtemporal approach group. Compared with the transcortical-transtemporal approach group, the amount of intraoperative bleeding and hematoma residue in the transsylvian-transinsular approach group were less, the proportion of patients requiring decompressive craniectomy was lower (33.3% vs. 63.3%; χ2=4.449, P=0.035), and the duration of dehydration medication and hospital stay were shorter (all P<0.05). However, there was no significant difference in the good outcome rate between the two groups (66.7% vs. 56.7%; χ2=0.518, P=0.472). Multivariate logistic regression analysis showed that lower scores of Glasgow Coma Scale at admission (odds ratio 0.128, 95% confidence interval 0.017-0.977; P=0.047) and longer hospital stay (odds ratio 1.402, 95% confidence interval 1.065-1.844; P=0.016) were independently associated with the poor outcomes. Conclusion:For young adult patients with severe basal ganglia intracerebral hemorrhage who underwent hematoma removal, although there was no significant difference between the outcomes of patients with transsylvian-transinsular approach and transcortical-transtemporal approach, the former had more advantages.
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Objective To study the correlation between microvessel density (MVD),isocitrate dehydrogenase 1 (IDH1) mutation and the malignancy of glioma,and its clinic significance.Methods The data and specimens of 40 patients with gliomas confirmed by surgery and pathology were collected.The relation between IDH1 mutation (detected by genetic sequence),MVD (detected by immunohistochemical coloration) and the malignancy of glioma was explored.5 cases of normal human brain tissues were used for comparative study.Results In normal brain tissue,Ⅰ,Ⅱ,Ⅲ,Ⅳ glioma,MVD counts were 8.12±1.64,25.10±1.27,27.00±1.98,42.80±10.75 and 56.50±5.23,respectively,and the overall difference was statistically significant (H =35.42,P ＜ 0.05).The MVD counts in low-grade glioma (Ⅰ-Ⅱ) and high-grade glioma (Ⅲ-Ⅳ) were 23.94±8.03 and 45.54±8.19,respectively,and the difference was statistically significant (t =-8.369,P ＜ 0.001).No mutation was found in normal human brain tissue,while in 20 cases of glioma specimens,there was IDH1 mutation with R132 as the mutation site and a MVD count of 31.11±13.47,and the other 20 cases of glioma specimens experienced no IDH1 mutation and the corresponding MVD count was 40.54±12.11.The difference of MVD counts of low-grade glioma and high-grade glioma was statistically significant (t =2.328,P=0.025).Conclusion MVD can be used as one of the histopathological grading metrics for glioma.IDH1 mutation occurs more frequently in grade Ⅱ and Ⅲ gliomas with R132 as the mutation site.