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The article describes the epidemiology of spinal cord injury (SCI), the measurement methods and affecting factors of post-traumatic growth of SCI patients and treatment strategy of promoting post-traumatic growth of SCI patients. The purposes of the article are to provide help of promote positive psychological changes and improve the quality of life of SCI patients.
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Objective There are differences in the diagnosis and treatment of primary melanocytoma in central nervous sys -tem.The article was to investigate the experience of its diagnosis and treatment . Methods Retrospective analysis were made on the clinical data of 14 cases with primary melanocytoma in central nervous system ( CNS) from January 1999 to December 2012, among which were 5 males and 9 females.The incidence ages were 14-52, average 32.7.The course of disease ranged from half a month to 19 years, geometric average 7.9 months.5 cases recurred and 9 cases occurred first.10 cases were intracranial and 4 were intraspinal. Results 14 patients underwent surgery and had pathologic diagnosis of melanocytoma .Total resection was performed in 7 patients, subtotal resection in 3, and partial resection in 1.Immunohistochemical study showed , in all cases, S-100 and HMB-45 were positive, GFAP and EMA were negative .Vimentin was positive in 8 cases and MelanA positive in 5 cases.12 cases recovered well and dis-charged except for paraplegia and facial paralysis in 1 case each. Conclusion Primary melanocytoma in CNS is very rare .Diagnosis is based on intraoperative findings , surgical pathology and immunohistochemistry results .Surgery is the primary therapy and early total resection is advocated .Adjuvant radiotherapy can reduce the recurrence rate .
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Objective To investigate the choice of surgical procedures in the treatment of temporal occipital epidural hematomas.Methods From March 2006 to March 2011,176 cases with acute temporal occipital epidural hematomas were treated in our hospital.Their clinical data including preoperative Glasgow Coma Sale (GCS),pupil size,hematoma volume,cerebrospinal fluid leakage,time between injury and operation,cerebral midline shift on CT,and brain beat and brain swelling in the operation were retrospectively analyzed.Results There were significant differences in the choice of surgical treatment and prognosis of temporal occipital epidural hematoma according to the preoperative GCS score,pupillary changes,hematoma volume,length of time before surgery,shift of cerebral midline structures,and brain beat and brain swelling in the operation.Conclusion Appropriate surgical procedures selected according to their preoperative and intraoperative conditions is of significant importance for sound prognosis of the patients with acute temporal occipital epidural hematoma.
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Objective To develop a simple and effective method for monitoring cortical ischemia after temporary occlusion of the parent arteries during anterior circulation intracranial aneurysm surgery. Methods Fifty-two patients with anterior circulation aneurysm (58 aneurysms) received craniotomy from April to November 2008, and at the same time,cortical electroencephalograpby (EEG) and scalp EEG were monitored during the surgery.According to the international 10/20 electrode placement system, scalp electrodes were placed on O1, O2, P3, P4, T5, and T6 for monitoring the changes in the depth of anesthesia. A cortical strip electrode was placed on the cortical surface supplied by the artery that was possibly blocked during the operation, which was used to monitor the possible cortical ischemia. For patients who had cortical EEG suppression after the temporary occlusion of the parent arteries Were compared with the changes of scalp EEG. Whether there were ischemic events in the corresponding supply territory after vascular occlusion were observed after surgery. Results Of the 58 aneurysms, 40 aneurysms and 41 major arteries were occluded temporarily. After being occluded temporarily in 19 arteries of 18 patients, cortical EEG changed significantly,while scalp EEG did not change significantly. Only 9 patients had ischemic events in the corresponding supply territories after the occlusion in the cortical EEG significant change group. The changes in the depth of anesthesia had the consistent impact on cortical and scalp EEG. Conelusions Simultaneous monitoring of cortical and scalp EEG is a simple and effective method for monitoring cortical ischemia during anterior circulation intracranial aneurysm surgery, and may effectively identify the effect of anesthesia on EEG.
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OBJECTIVE: Aneurysmal subarachnoid hemorrhage is mainly due to intracranial aneurysm rupture. Modern techniques enable most survivors to make a good functional recovery Nevertheless,it has been suggested that such patients suffer from a persistent disturbance of cognitive function,which affects their life quality. Therefore,cognitive assessment following aneurysmal subarachnoid hemorrhage has been gradually drawing increasing attention in recent years.DATA SOURCES: Related literature was searched through the computer in PUBMED with key terms of "aneurysmal subarachnoid hemorrhage" and"cognitive deficit" and the language was limited to English. Meanwhile literature between 2001 an.d 2004 was also searched with key terms of"subarachnoid hemorrhage" and "cognitive function" in the Chinese or English language,respectively.STUDY SELECTION: Literature with cognitive assessment as its main index determined by standardized measurement was enrolled in this study.DATA EXTRACTION: A total of 101 related articles were collected,including 15 ones closely related to the present study,while those with cognitive assessment as part of their content and cognitive function determined with new methods were excluded.DATA SYNTHESIS: Cognitive assessment was analyzed in respect of its content,measurement,results and risk factors. Effect of aneurysmal subarachnoid hemorrhage itself and its complications,as well as therapeutic methods on the onset and development of cognitive disturbance were also explored.CONCLUSION: Patients with aneurysmal subarachnoid hemorrhage suffer from cognitive impairment,which also results from operation,anesthesia and drugs.
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BACKGROUND: Neuroprotective role of hypothermia on cerebral ischemic-reperfusional impairment has been long acknowledged. Since general hypothermia is complicated and unfit for observing postoperative consciousness and neurological function, it is of important significance to explore novel methods of focal cerebral hypothermia.OBJECTIVE: To study the neuroprotective effect of lateral ventricle infusion of low-temperature fluid on ischemic neurons of middle cerebral artery (MAC) occlusion models established on New Zealand rabbits.DESIGN: A randomized case-control study based on experimental animal models.SETTING: Neurosurgical department and pathological department of a general military hospital of Chinese PLA.MATERIALS: This study was carried out at Neurosurgical Laboratory of Nanjing General Hospital, Nanjing Military Area Command of Chinese PLA. Altogether 18 healthy New Zealand male rabbits, weighing from 2. 8 to 3.2 kg, were selected 4 - 6 months after birth, and randomly divided into occlusion group, hypothermia group and control group.INTERVENTIONS: Cerebral focal ischemic-reperfusional model was established on the New Zealand rabbits through MCA occlusion for 2 hours followed by reperfusion for 24 hours.MAIN OUTCOME MEASURES: Scores for neurological function, water content in the left and right brain, pathological changes of nerve cells in the left MCA supplying region.pothermia group, significantly higher than that in occlusion group(7.58 ± 0.58 )( P ＜ 0.01 ), but no significant difference could be observed in contrast with brain was(81.64 ± 0.82)% and (79.26 ± 1.30)% in occlusion and hypothermia groups with significant difference between them( P ＜ 0.05), and it was significantly different between the left side [ (81.64 ± 0. 82 )% ] and opyknosis and deep staining could be observed in nerve ganglion cells in occlusion group under optical microscope, but no obvious pathological changes were observed in MCA supplying brain regions in hypothermia group.CONCLUSION: Permanent infusion of low-temperature fluid into the lateral ventricle plays an important neuroprotective role by attenuating cerebral ischemic-reperfusional impairment and improving post-ischemic neurological functions.
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Objective: To explore the effects of continuous trickle of low temperature liquids through the lateral ventricle on neural cell apoptosis after rabbit local cerebral ischemia/reperfusion. Methods:The middle cerebral artery (MCA) of New Zealand rabbit was clipped by micro aneurysm clip for 2 hours and reperfused for 24 hours. Immediately after clipping the MCA, we trickled the left lateral ventricle continuously with low temperature liquids(22℃) to decrease the brain temperature to mild hypothermia (33℃-35℃)and maintained for 2 hours. After reperfusion for 24 hours , we assessed TUNEL method to determine the apoptotic cell rate in the sham-operated group, the control group and the mild hypothermia group respectively. Results:The apoptotic cell rate of the cortex tissues accommodated by MCA in the mild hypothermia group was obviously lower than that in the control group(P0.05). Conclusion:Trickling ventricle with low temperature liquids could decrease the apoptotic cell rate and alleviate cerebral ischemia/reperfusion injury.
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Objective:To explore a simple and effective method of local hypothermia, and to testify its neuroprotective effects . Methods:This experiment adopts twelve adult and healthy New Zealand rabbits as experimental animals. These rabbits were randomly assigned to two groups : ① MCAO (n=6),② MCAO and hypothermia (n=6). The middle cerebral artery (MCA) was exposed through the left orbital approach, and was clipped 2 hours by a 3 mm straight aneurysm clip to establish the MCAO model. We assign 2 cavities ventricle tube to puncture the frontal angle of the lateral ventricle, then 22℃ physiological brine was dropped into the lateral ventricle to reduce the brain temperature in MCAO and hypothermia group. Temperature thermister probes were inserted for measuring the brain and rectal temperatures. The neurological deficits and histological changes of brain tissue were evaluated in all experimental animals.Results: Brain temperature below cortex was descend to 35℃within 20 minutes after hypothermia in MCAO and hypothermia group while rectal temperature has maintained normal. The neurological deficits and histological changes of brain tissue of MCAO and hypothermia group were better than those in MCAO group. Conclusion: The local intra-ventricle hypothermia model is a reliable, cooling rapidly and useful method for selective brain cooling.
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Objective:To discuss the diagnosis, treatment and outcome of patients with gliomatosis cerebri (GC). Methods:Retrospectively reviewed the clinical manifestations and radiological appearances of 6 patients with GC, which were diagnosed in our hospital between 1993 and 2003. We employed surgical treatment in three patients, stereotactic biopsy in two, and the other one received both biopsy and surgery. Results: The lesions of GC infiltrated more than two lobes in brain. CT studies showed diffuse hypodensity changes and enhancement was absent in four patients. MRI examinations revealed isointense or hypointense regions on T1WI, and uniformly high signal on T2WI. MRI also disclosed structural enlargement. All patients received radiotherapy after surgery and three patients underwent chemotherapy additionally. Five patients died during follow up with average course of 16.4 months. Conclusion:MRI examination is valuable in the diagnosis and the prognosis of GC is poor.
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Objective:To study the relationship between the recurrence of benign meningiomas and cell proliferation, and to find some parameters that can predict the recurrence of benign meningiomas. Methods:49 samples from 15 recurrent benign meningiomas and 22 non recurrent benign meningimas were immunohistochemically stained with PCNA antibody and Ki 67 antibody.The ratios of positive tumor cells were calculated,then PCNA LI and Ki 67 LI of different groups were compared. Results:PCNA LI or Ki 67 LI in recurrent benign meningiomas was significantly higher than non recurent benign meningiomas individually( P 0.05). Conclusion:The proliferative potential of recurrent benign meningiomas was higher than that of non recurrent benign meningiomas.When the PCNA LI was greater than 2.0%,the recurrent risk was high.The proliferative potential did not increase when benign meningiomas recurred.
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Objectives:To explore the protective effects of continuous trickle of low temperature liquids through the lateral ventricle on neurons after rabbit local cerebral ischemia reperfusion. Methods: The middle cerebral artery (MCA) of New Zealand rabbit was clipped with micro aneurysm clip for 2 hours and reperfused for 24 hours. Immediately after clipping the MCA, we trickled the left lateral ventricle continuously with low temperature liquids to decrease the brain temperature to mild hypothermia(32-35℃) and maintained for 2 hours. After reperfusion for 24 hours, we assessed the animal's neural deficits, observe the pathology of the ischemic brain tissues dyed by HE and determined the dry wet ratio for brain edema in the sham operated group, the control group and the mild hypothermia group respectively.Results:①The grades of neural deficits in mild hypothermia group were obviously lower than that in the clipping group( P 0.05 );②The dry wet ratios were obviously different in the mild hypothermia group and clipping group;③ Pyknosis and dense dying by HE were observed in the neural nuclei of ischemic cortex tissues of the clipping group, but no obvious changes were observed in the mild hypothermia group. Conclusions:Trickling ventricle with low temperature liquids could alleviate cerebral ischemia reperfusion injury, ameliorated neural deficit after ischemia reperfusion and were protective on the brain.
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Objective:To explore the classification and the choice of surgical approach for tentorial meningiomas. Methods: 56 patients with tentorial meningiomas operated on between 1992 and 2002 were retrospectively analysed. According to Gkalp , there were 28 cases with medial tumor,17 cases with lateral tumor,11 cases with falcotentorial tumor. The tumors developing mainly supratentorial were approached from modified pteronal, subtemporal, temporooccipital or occipital craniotomy. For tumors developing mainly in the posterior cranial fossa, suboccipital craniectomy or combined occipital- suboccipital craniectomy was performed. The tumors developing both supratentorial and infratentorial the subtemporal-presigmoidal craniotomy were approached . Results: Total removal was achieved in 53 cases and partial removal in 3 cases. Two cases died of severe postoperative complications. The mortality rate was 3.6%. Five had additional neurological deficits postoperatively. Recurrences occurred in 6 cases. Conclusion: Surgical approach for tentorial meningiomas must be individualized for each case. The operators must master well about microanatomy of the tentorium and its specifically regional structures and expertly use microsurgical techniques for obtaining successful surgery and good outcome.
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Objective:The aim of the current study was to explore the alterations of TLR4 after traumatic brain injury. Methods: 20 Male ICR rats were randomly divided into four groups(5 rats each group)including control group without brain injury and traumatic brain injury groups(4,24 hours and 7 days).All rats were decapitated at corresponding time point and mid-jejunum samples were taken.The intestinal mucosa structure was detected by histopathological examination.Immunohistochemistry and realtime RNA were used for detection of TLR4 expression in ileum samples.Results: After traumatic brain injury,the histopatholocal alterations of gut mucosa occurred at 4 hours and progressed to a serious state.Compared to control group,TLR4 was significantly up-regulated on the endothelia of microvessels in villous interstitium and lamina propria by 4 h following TBI and maximally expressed at 24 h post-injury.The endothelial TLR4 immunoreactivity in ileum mucosa still remained strong on 7 d post-injury.There was a very low mRNA expression of TLR4 in the gut of control rats and significantly increased at 4 h following TBI(P
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Objective: To determine the frepuency and severity of cognitive impairments associated with aneurysmal subarachnoid hemorrhage. Methods: A series of 37 patients with aneurysmal subarachnoid hemorrhage were examined by means of a battery of cognitive tests before surgical treatment. Results: In 70.3% of the patients, one or more cognitive functions were impaired. Compared with normative data, 2.7% of patients showed impairment on arithmetic, digit symbal and picture complement respectively, 5.4% on digit span, 48.6% on Visual Reproduction , 27%(food) and 18.9% (ordinary tools) on verbal fluency test, 18.9%(part A) and 21.6% (part B) on trail-making test,?18.9% on MMSE (mini mental state examination). Conclusion: The patients have impressive cognitive deficits after aneurysmal subarachnoid hemorrhage. SAH patients were especially impaired in functions that are related to short-term memory, concentration capacity, and frontocortical functions.
