Application of neurosurgical microscopic technology training in medical undergraduate teaching / 中华医学教育探索杂志

There are still many existing problems in the training of medical undergraduates and microsurgery talents in China, such as lack of scientific research ability and scientific literacy of medical undergraduates, insufficient practical ability, short of scientific research opportunities for medical undergraduates, and inadequate talent reserve in microsurgery. In view of the above shortcomings, Wannan Medical College has established a training course on microneurosurgery technology for medical undergraduates, and made a preliminary exploration to solve the above problems. Through the training, undergraduates not only improve their practical ability, but also stimulate their interest in microsurgery, which will help them adapt to clinical and scientific research work at an early stage. Neurosurgical microscopic technology training with emphasis on extracurricular expansion as main content, plays an important role in the cultivation of undergraduate microscopic skills, the establishment of basic theories of neurosurgery, the improvement of scientific research accomplishment and the expansion of extracurricular vision.

Endoscopic anatomy of infraorbital/maxillary nerves in endoscopic transmaxillary approach / 中国神经精神疾病杂志

Objective To explore the localization and guidance value of infraorbital/maxillary nerve in endoscopic transmaxillary approach, and to provide anatomical data for clinical operation. Methods The eight adult cadaver heads were dissected by means of the endoscopic transmaxillary approach to expose the infraorbital/maxillary nerve, and relevant data were collected. Results In 8 cases, 16 maxillary nerves arose from the trigeminal ganglion of the trigeminal nerve and emerged from the foramen rotundum, transited to the infraorbital nerve at the infraorbital fissure, then traveled in the infraorbital canal and out of the infraorbital foramen. The infraorbital/maxillary nerve could be divided into four segments according to the foramen rotundum, infraorbital groove and infraorbital foramen: the terminal segment, the infraorbital nerve and its terminal branches to the face, distal to the infraorbital foramen; the orbitomaxillary segment and the orbitomaxillary segment of the infraorbital nerve within the infraorbital canal from the infraorbital foramen along the infraorbital groove (length 11.7 ±2.5 mm ), which was readily identified in the roof of the maxillary sinus in all specimens. The pterygopalatine segment, the pterygopalatine segment within the pterygopalatine fossa, which started at the infraorbital groove to the foramen rotundum (length 13.4±2.1 mm); The intracranial segment, the intracranial segment from the foramen rotundum to the trigeminal ganglion(length 15.2±3.9 mm). Conclusion The infraorbital nerve can serve as a anatomical landmark for endoscopic transmaxillary approach to get access to infratemporal fossa, pterygopalatine fossa, trigeminal ganglion and lateral wall of the cavernous sinus.

Imaging features and pathological analysis of calvarial cavernous hemangioma / 中国神经精神疾病杂志

Objective To investigate the imaging features of the calvarial cavernous hemangioma and the surgical efficacy to improve diagnosis and treatment of the calvarial cavernous hemangioma.Methods The clinical information,imaging materials and surgical efficacy from ten cases of calvarial cavernous hemangioma confirmed by pathology and the related literature was reviewed.Results The lesion was located in frontal bone in eight cases,in parietal bone in one case and in occipital bone in one case.The lesions were round-shape hypodensity with clear margin in X-ray.The lesions were hyperdensity or slightly hyperdensity on CT scan,and were osteolytic lesions with a characteristic honeycomb or starburst pattern on bone window.The MRI features were complicated and variable.The lesions were heterogenous and unevenly enhanced signal intensity.Nine patients underwent radical resections and reconstructed immediately by titanium mesh.The patient with tumor in occipital bone underwent radical resection only.Macroscopically,the pathologic bone was a huge purple-red blush mass protruding from the skull surface.Histological examination revealed the diploe with large,thin-walled,dilated blood-filled spaces lined by flattened endothelial cells without evidence of malignancy.No recurrence was noted in any case during a follow-up period from 3 to 24 months.All the patients survived well without recurrence.Conclusions The imaging features of calvarial cavernous hemangioma have a high value in the diagnosis and may provide guidance for the treatment.The radical resection and immediate reconstruction treatment for calvarial cavernous hemangioma is satisfied.

Cause analysis and management of the complications of Enterprise stent-assisted embolization of intracranial aneurysms / 中国脑血管病杂志

Objective To analyze the intraoperative and postoperative common complications of Enterprise stent-assisted embolization of intracranial aneurysms and the causes and preventive measures. Methods One hundred forty-three patients with intracranial aneurysm treated with Enterprise stent-assisted embolization at the Department of Neurosurgery,Yijishan Hospital,the First Hospital Affiliated to Wannan Medical College from January 2012 to March 2014 were analyzed retrospectively. The common intraoperative and postoperative complications and its possible causes,as well as the appropriate management were analyzed,and the prognoses were observed. Results A total 143 patients(205 aneurysms)with intracranial aneurysm were enrolled,included 43 with unruptured aneurysm,12 with recurrent aneurysm,and 88 with ruptured aneurysm. A total of 170 Enterprise stents were used. Twenty-two patients (15. 4%)had complications. Among them,2 had intraoperative aneurysm rupture,and they recovered well and discharged after active treatment. Thirteen patients had acute thrombosis,11 of the patients completely restored blood flow immediately after tirofiban and/or urokinase,microcatheter and guidewire-contact thrombolysis. The thrombolysis failed in 1 patient,and the blood flow was slow in 1 patient. Six patients had different degrees of cerebral infarction after procedure,and 1 died (peroperative Hunt-Hess grade Ⅳ). Three patients had vasospasm and they were improved after reducing blood vessel wall irritation and papaverine infusion. The introperative stent guidewire was broken and the stent in place was difficult in 1 case. The last coil packed difficultly during the procedure,and it protruded into the parent artery in 1 case. Two patients had non-aneurysmal hemorrhage after procedure. After conservative treatment,one left unilateral limb muscle strength decline and the other was stable after craniotomy,but leaving aphasia and hemiplegia. Conclusion When using the Enterprise stent-assisted embolization for complex aneurysms,grasping the indications strictly,strengthening the perioperative management and improving the operative skills may reduce or avoid the occurrence of complications.

Occlusion of ruptured vertebral artery dissecting aneurysms via bilateral vertebral artery approach an efficacy analysis / 中国脑血管病杂志

Objective To investigate the effect of endovascular treatment of intracranial ruptured vertebral artery dissecting aneurysms via bilateral vertebral artery approach. Methods The symptoms and imaging results of 5 patients with ruptured vertebral artery dissecting aneurysms were analyzed retrospectively. They were all treated with coil embolization via bilateral vertebral artery approach. The two ends of dissection aneurysms were packed densely,the middle segments were packed loosely,and the arteries were isolated from the blood circulation. Results Of the 5 patients after treated,the clinical symptoms were improved rapidly in 4 patients no abnormal limbs activity and mental disorders. After treatment,the modified Rankin scale (mRS)was 0 in four cases after six-month follow-up. One patient turned clear consciousness after 4 weeks, and their mRS was 3 at 6-month follow-up. Before treatment,DSA showed vertebral artery dilation and stenosis. The mean length of involvement in vertebral arteries was 9. 3 ± 1. 5 mm;after treatment,the dissecting aneurysms of 5 patients did not develop completely,no further bleeding occurred,and no new infarcts were observed. No recurrence of the aneurysms and parent artery recanalization were found at the follow-up after 6 months. Conclusion The occlusion of ruptured vertebral artery dissecting aneurysms via bilateral vertebral artery approach is technically feasible. It may be an effective treatment to prevent rebleeding.