Comparación del tratamiento quirúrgico y endovascular de aneurismas del segmento comunicante posterior / Comparison of surgical and endovascular treatment of posterior communicating segment aneurysms

Introducción: Los aneurismas del segmento comunicante posterior representan aproximadamente 25% de todos los aneurismas intracraneales, y el 50% de los aneurismas de la arteria carótida interna. El objetivo fue evaluar la eficacia del tratamiento quirúrgico y endovascular en el manejo de aneurismas de esta localización. Material y Métodos: Estudio comparativo retrospectivo. Se revisó las historias clínicas de pacientes con aneurisma del segmento comunicante posterior que ingresaron al departamento de Neurocirugía del Hospital Nacional Guillermo Almenara durante el periodo 2010-2017. Se comparó estancia hospitalaria, complicaciones, mortalidad y estado funcional a los 12 meses, en relación al tratamiento recibido, microquirúrgico o endovascular. Resultados: Se evaluaron 256 pacientes, 111 (43,36%) recibieron tratamiento quirúrgico, y 145 (56,64%) endovascular. En el caso de aneurismas rotos, el estado de independencia funcional fue alcanzado por 68 (66,7%) y 69 (70,4%) pacientes que recibieron tratamiento quirúrgico y endovascular, respectivamente (OR:0.84, IC 95%: 0.46­1.53; p=0.505). Se presentaron complicaciones neurológicas en 37 (36,3%) y 34 (34.7%) pacientes sometidos a tratamiento microquirúrgico y endovascular, respectivamente (OR: 1.07, IC 95%: 0.60­1.91; p=0.912). La estancia hospitalaria promedio fue 19,55±13.85 y 14.06±14.97 días, para pacientes con tratamiento quirúrgico y endovascular, respectivamente (p<0.008). La mortalidad fue 11,8% y 11,2%, con ligera predominancia en el grupo tratado quirúrgicamente (OR: 1.05, IC 95%: 0.44­2.52; p=0.904). Conclusiones: No existe diferencia significativa respecto al resultado funcional a los 12 meses, complicaciones y mortalidad entre ambos tipos de tratamiento en el caso de aneurismas rotos. Los pacientes sometidos a terapia endovascular tuvieron de forma significativa menor estancia hospitalaria

Background: Posterior communicating segment aneurysms represent about the 25% of all intracranial aneurysms and the 50% of the internal carotid artery aneurysms. The objective of the study was to evaluate the efficacy of the surgical and endovascular treatments in the management of the aneurysms of this localization. Methods: Comparative and retrospective study. Clinical charts of patients with aneurysms of the posterior communicating segment were reviewed during the period from 2010 to 2017 in the Guillermo Almenara Hospital. Hospital stay, complications, mortality and functional status at 12 months were compared among endovascular and surgical treatment. Results: Two hundred and fifty-six patients were evaluated, 111 (43,36%) were treated with surgery and 145 (54,64%) with endovascular therapy. Among ruptured aneurysms, functional independence status was reached in 68 (66,7%) and 69 (70,4%) of the patients who were treated with surgery and embolization respectively (OR:0.84, IC 95%: 0.46­1.53; p=0.505). Neurological complications were found in 37 (36,3%) and 34 (34,7%) patients treated with surgery and embolization respectively (OR: 1.07, IC 95%: 0.60­1.91; p=0.912). The mean hospital stay was 19,55±13.85 and 14.06±14.97 days of the patients treated with surgery and embolization respectively. Mortality was 11,8% and 11,2%, with a slight predominance in the surgically treated group (OR: 1.05, IC 95%: 0.44­2.52; p=0.904). Conclusions: There is no significant difference according to functional status at 12 months, complications and mortality among both type of treatments in the group of ruptured aneurysms. Patients treated with endovascular therapy had lower hospital stay with statistical difference

Clinical experience of resection for nasal skull-base tumors by microsurgical-assisted technique / 临床耳鼻咽喉头颈外科杂志

OBJECTIVES@#To investigate the application of the microsurgical treatment in nasal skull-base tumors resection.@*METHODS@#In a retrospective study, totally 15 cases with tumors in the nasal skull-base received microsurgical-assisted treatment in our department from February 2012 to June 2017 were analysed. Lateral rhinotomy approach was carried out in 11 patients and posterior wall of the maxillary sinus approach in 4 patients.@*RESULTS@#Tumors of all cases were completely resected under the microscope. Postoperative bleeding, cerebrospinal fluid leakage, infection and meningo-encephalocele did not occur in this series. The postoperative follow-up time were 6 months to 5 years. One case lost follow-up, seven cases were survivor of tumor-free. Seven cases had recurrence or metastasis, with one case died and other six alive with tumor.@*CONCLUSIONS@#Microsurgical-assisted resection for nasal skull-base tumors can obtain clear vision, with high surgical precision and security.

Microsurgical treatment of the brachial plexus cord terminal branch injuries with concomitant major vessel injuries / 中华显微外科杂志

Objective To explore the clinical outcomes of surgical treatment of brachial plexus cord terminal branch injuries combined with rupture of major upper limb vessels and discuss the optimal timing and surgical procedures.Methods From June,2007 to June,2012,there were 9 cases of the brachial plexus cord terminal branch injuries with concomitant major vessel injuries.Two cases had combined subclvian arterial injuries,1 had combined the first part of axillary arterial injuries,1 had the third part of axillary arterial injuries and 5 had brachial arterial injuries.Depending on the region,type and severity of the injuries,nerve and vascular reconstruction was done simultaneously in the acute phase of the injuries in 3 cases and in the subacute phase in another 2 cases.In 4 cases,the vessels were repaired acutely while nerve reconstruction was carried out in a second stage.Results Nine patients were followed-up from 50 to 78 months with an average of 61.8 months.There was no necrosis of the affected limbs.CTA showed that all the artificial blood vessels were patent after surgery.Nerve functions recovered to various extents.The muscle strength was recovered to grade 3 or better in 9 patients,except 3 cases in which the intrinsic muscles were control by ulnar nerve.(S) or better sensory recovery was seen in all repaired nerve area in 4 patients,and S3 or better sensory recovery was seen in part of the repaired nerve area in 5 patients.Conclusion The brachial plexus cord terminal branch injury is rare and complicated,which request a reasonable treatment program.Under the guideline of saving life first,primary and simultaneous reconstruction of both the nerves and vessels should be attempted by microsurgical treatment whenever possible for improving the success rate of surgery and a better functional recovery.

Endovascular Treatment and Microsurgical Treatment of Intracranial Aneurysms in the Elderly / 대한뇌혈관외과학회지

BACKGROUND: The prevalence of intracranial aneurysms in the elderly is increasing. However, most treatment strategies for the elderly is controversial and related research in the elderly has been insufficient. METHODS: Eighty-four patients > 65 years of age with intracranial aneurysms who received definitive treatment at our hospital between March 2007 and June 2010 were subjected to this study. Thirty-seven patients who had undergone endovascular treatment (EVT) were categorized into group I, while 47 patients who had undergone microsurgical treatment (MST) were categorized into group II. RESULTS: When the Glasgow Outcome Scale (GOS) score, which was independent to rupture, was evaluated at the time of discharge there was a trend of acquiring much better GOS scores (GOS> or =4) when the Hunt-Hess grade (HHG) is good (HHG< or =2) and the size of the aneurysm is small (<10 mm; p=0.001 [HHG] and p=0.000 [aneurysm size]). In the two groups in which EVT and MST were performed, the average values of the GOS scores by Student's t-test displayed a significant difference (4.54 [EVT] and 4.13 [MST], respectively, p=0.046). However, univariate and multivariate analyses were not statistically significant. CONCLUSION: If the clinical results are similar in the EVT and MST for intracranial aneurysms, then EVT is less invasive with less post-procedural complications would be considered with priority in elderly patients.

Microsurgical treatment of hypertensive cerebral hemorrhage by keyhole windowed craniotomy / 中华显微外科杂志

Objective To investigate the curative effects of keyhole microsurgical craniotomy to hypertension cerebral hemorrhage. Methods Treatment and curative effects were retrospectively reviewed in 68 patients of hypertension cerebral hemorrhage from Jan. 2008 to Dec. 2010. Results After treatment with keyhole microsurgical craniotomy, in 68 patients, besides 1 case death, in 3-12 month follow-up, level Ⅰ (complete recovery) 22 occupies 32.3%, level Ⅱ (self care) 20 occupies 29.3%, level Ⅲ (requires assistance) 19 occupies 27.9%, level Ⅳ (confined to the bed but conciousness) 4 occupies 5.9%, level Ⅴ (vegitative survival) 2 occupies 2.9%. Conclusion The curative effect of keyhole microsurgical craniotomy to hypertension cerebral hemorrhage is remarkable.

Microsurgical treatment of ruptured intracranial aneurysms in the early and intermediate stage / 中国综合临床

Objective To explore the microsurgical method in treating ruptured aneurysms treatment and evaluating the treatment of the complication during or after the operation.Methods 36 cases of patients with intracranial aneurysm were analyzed retrospectively.All of the patients were subarachnoid hemorrhage (SAH) by CT scan on admission.The intracranial aneurysms were confirmed in 35 cases by DSA examination and A2 aneurysm was confirmed by explorative operation in 1 case.The microsurgical treatment was performed in 36 cases at the early or intermediate stage,22 cases were treated in the early stage,the other 14 cases were treated in the intermediate stage (early stage means within 3 days post SAH;intermediate stage means from 4 days to 10 days post SAH).Results After the operation,21 cases were GOS grade Ⅰ,4 cases were COS grade Ⅱ,4 cases were COS grade Ⅲ,4 cases were GOS grade Ⅳ.Of all the patients,CT scan was done after the operation,finding no intracranial bemorrhage,and cerebral infarction was disclosed in 5 cases.3 cases were dead,one suffered occipital lobe infaret after the PCoA aneurysm clipped,brain hernia occurred at last,one's Hunt Hess grade was Ⅴ,ACoA aneurysm was disclosed by DSA examination,severe brain edema occurred after the operation,the other suffered tonsillar hernia one week after the aneurysm clipping,which ruptured after endovascular treatment of ACoA aneurysm 2 years later.DSA examinations were done in 26 cases after operation,declaring 1 ACoA aneurysm was unclipped,1 PCoA aneurysm was incompletely clipped,and 1 PCoA was sacrificed.Conclusions It is a valuable method to clip the ruptured intracranial aneurysms in early and intermediate stage.The cerebral ischemia is the severe complication after clipping.Especially for the PCoA aneurysms,it is very important to protect the PCoA.Further research should be done for the treatment in the case with mother artery arteriosclerosis and thrombosis within the aneurysms.

Microsurgical treatment of large acoustic neurinoma and facial nerve preservation / 中国综合临床

Objective To explore the microsurgical technique and results of the large acoustic neurinoma and the facial nerve preservation.Methods 35 cases of large acoustic neurinoma treated microsurgically were analyzed retrospectively.Results Total resection was achieved in 33 patients,subtotal in one patient and partial in one patient.The facial nerve was preserved completely in 32 cases (91.4%).One died postsurgery.Conclusion The application of microsurgical techniques and rational selection of operational approach can remarkably increase the total removal rate and facial nerve preservation rate.

Diagnosis and microsurgical treatment of Arnold-Chiari malformation / 重庆医科大学学报

Objective:To study the diagnosis of magnetic resonance imaging(MRI)and the effect of microsurgical treatment for Arnold-Chiari malformation.Methods:Retrospective analysis of clinical data of 35 patients with Arnold-Chiari malformation.Results:Thirty-five cases were diagnosed by MRI.Posterior fossa decompression and plastic operation of cistern magna was performed in 35 cases.30 in all cases were followed up from 3 months to 7 years.Postoperative MRI revealed the size of the syrinx cavity decreased in all cases,disappeared in 5 cases.Conclusion:MRI is the best diagnostic method for Arnold-Chiari malformation.The effect of post fossa decompression and plastic operation of cistern magna for Arnold-Chiari malformation is satisfactory.

Microsurgical Treatment of Middle Cerebral Artery Aneurysms

The authors analyzed 50 microsurgically treated middle cerebral artery(MCA) aneurysms among 266 intracranial aneurysms in the Department of Neurosurgery, Yonsei University Hospital from September 1975 through September 1982, in order to study the differences from those of other intracranial aneurysms, and analyze the surgical outcome versus preoperative clinical status of the patients, surgical timing, and the microsurgical techniques. The results of the analysis were summarized as follows ; 1) The middle cerebral artery aneurysms occupied 19.5% of the microsurgically treated intracranial aneurysms. 2) The brain CT scan showed subarachnoid hemorrhage in 77.5%, hemorrhage in the unilateral Sylvian cistern in 39.7%, and intracranial hematoma in 48.4%. 3) The most common location of middle cerebral artery aneurysms was the M1 M2 junction in 84%, and MCA bifurcation aneurysms occupied 44%, and trifurcation ones 40%. 4) Clipping with reinforcement of the aneurysms were performed in 74% of total cases due to difficult complete clipping of the aneurysmal neck. And the rest were wrapped. 5) The surgical timing was around the 3rd week after the last bleeding in most cases. 6) Patients in Botterell's grade I to III showed no motality and good surgical outcome. Only one case of grade V expired postoperatively, and morbidity was 10%.