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Objective:To investigate the efficacy of endovascular embolization in the treatment of traumatic carotid cavernous fistula (TCCF) and the influencing factors of outcomes.Methods:Patients with Barrow A type TCCF underwent intravascular embolization in the Department of Neurosurgery, General Hospital of Ningxia Medical University from January 2009 to November 2019 were enrolled. They were treated with detachable balloons or Onyx-18 combined with coils via transarterial approach, and clinical and imaging follow-up were performed after operation. Recurrence was defined as a lesion that was completely embolized immediately, but the original fistula was redeveloped during imaging follow-up. The clinical recovery was defined as the disappearance of intracranial vascular murmur, pulsatile exophthalmos, conjunctival hyperemia and edema, the movement of eyeball without disorder and the restoration of vision loss. Multivariate logistic regression analysis was used to determine the independent risk factors for affecting imaging recurrence and clinical recovery. Results:A total of 54 patients with Barrow A type TCCF were enrolled. Their age was 42.5±10.6 years (range, 28-70 years); 36 were male (66.7%). Clinical manifestations: 40 patients (74.1%) had ocular symptoms (exophthalmos, conjunctival congestion, etc.), 35 (64.8%) had intracranial vascular murmur, 36 (66.7%) had visual impairment (decreased vision, visual field defect), 32 (59.3%) had headache, 15 (28.3%) had abducens nerve palsy, and 4 (9.1%) had epistaxis. Fourty-seven patients (87.0%) had superior ophthalmic vein drainage, 19 (35.2%) had superior and inferior petrosal sinus drainage, and 9 (16.7%) had cortical vein drainage. Twenty-eight patients (51.9%) were treated with Onyx-18 combined with coils, and 26 (48.1%) were treated with detachable balloons. After operation, 47 patients (87.0%) were immediately totally embobilized, 4 of them were totally embolized with Onyx-18 and coils after the failure of balloon embolization; 7 patients (13.0%) achieved subtotal embolization. Forty-seven patients (87.0%) recovered after surgery, and the symptoms of 4 patients were better than before admission but the vision did not fully recover (among them, 3 had the symptoms of abducens nerve palsy), 2 had mild hemiplegia, and no patients died after surgery. At postoperative follow-up, 5 (9.3%) recurred, and then they achieved total embolization with Onyx-18 combined with coils. Multivariate logistic regression analysis showed that subtotal embolization was an independent risk factor for postoperative imaging recurrence (odds ratio 16.63, 95% confidence interval 1.74-159.33; P=0.015), and the presence of cortical venous drainage was an independent risk factor for affecting postoperative clinical recovery (odds ratio 19.08, 95% confidence interval 1.61-226.58; P=0.020). Conclusion:Both of Onyx-18 combined with coils and detachable balloons are safe and effective for the treatment of TCCF. Subtotal embolization is associated with imaging recurrence, and the presence of cortical venous drainage is an independent influencing factor of clinical recovery.
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OBJECTIVE@#To investigate the factors for hydrocephalus secondary to severe traumatic brain injury after surgery, and to explore a new theory and guideline for clinical early prevention and treatment for hydrocephalus. @*METHODS@#The clinical data regarding 107 patients with severe traumatic brain injury, who were admitted to our hospital from June 2010 to June 2013, were analyzed. Logistic multi-factor regression was used to analyze the different factors including ages, gender, the Glasgow coma scale (GCS) score before or after surgery, the situation of ventricular system bleeding secondary to surgery, the situation of midbrain aqueduct and ambient cistern before or after surgery, the relationship between early lumbar puncture and the hydrocephalus. The risk and protective factors for postoperative hydrocephalus were discussed. @*RESULTS@#The results showed that patients with low GCS score in pre/postoperative (OR=0.099, 95%CI: 0.028-0.350)/(OR=0.088, 95%CI: 0.012-0.649), ventricular system bleeding in postoperative (OR=0.168, 95%CI: 0.029-0.979) and dim CT image for midbrain aqueduct and ambient cistern (OR=0.134, 95%CI: 0.038-0.473)/(OR=0.221, 95%CI: 0.055-0.882) are risk factors. Whereas lumbar puncture (OR=75.885, 95%CI: 9.612-599.122) is a protective factor for postoperative hydrocephalus in STBI patients. The secondary hydrocephalus was mainly occurred in 2 weeks and 2 weeks to 3 months after operation. The incidence of the control group that occurred secondary hydrocephalus is higher than that of the lumbar puncture group (P0.05). @*CONCLUSION@#For patients with stable vital signs, early lumbar puncture could significantly reduce the incidence of secondary hydrocephalus in acute and subacute stage after severe traumatic brain injury.
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Humans , Brain Injuries , Cerebral Ventricles , Glasgow Coma Scale , Hydrocephalus , Incidence , Logistic Models , Risk Factors , Spinal Puncture , Treatment OutcomeABSTRACT
Objective To define the three-dimensional relationship of the uncinate fasciculus,anterior commissure, inferior occipitofrontal fasciculus, and optic radiation, to determine the positioning landmarks of these white matter tracts by using the diffusion tensor tractography (DTT). Methods The anatomy was studied in 10 adult human brain specimens (20 hemispheres). DTT of the brain was performed on 10 healthy volunteers. DTT of the white matter tracts in the temporal stem was performed by using of the simple one regions-of-interest (ROI) and muhiple-ROl based on the anatomic knowledge and conventional magnetic resonance imaging (MRI). Results The inferior limiting sulcus averaged (46.3 ± 3.1)mm in length. The shortest distance from the inferior limiting sulcus to the superior floor of the temporal horn averaged (6.5 ± 1.8)mm. The posteroinferior insular point was the anterior extremity of intersection of the Heschl's gyrus and the inferior limiting sulcns. On the inferior limiting sulcns, this point was the posterior border of the optic radiation, and the temporal stem begined at the limen insulae and ended at the posteroinferior insular point. Its length averaged (33.0 ± 2. 9) mm. The distance from the limen insulae to the tip of the temporal horn averaged(10.9 ± 1.7)mm is just one thirds of the length of the temporal stem.The uncinate fasciculus and anterior commissure made up the core of the anterior temporal stem, with the anterior commissure located psoteriorly, and they occupied the anterior one third of the temporal stem together. The inferior occipitofrontal fasciculus passed through the entire temporal stem. The most anterior extension of Meyer's loop was located between the anterior tip of the temporal horn and the limen insulea.However, Most of the optic radiation crossed the postmedian two thirds of the temporal stem. Conclusion On the inferior limiting sulcus, the posteroinferior insular point is a reliable landmark of the posterior border of the optic radiations. The limen insulae, anterior tip of the temporal horn, and posteroinferior insular point may be used to localize the white matter fibers of the temporal stem in analyzing MR imaging or during surgery.
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Objective To investigate the new technique in curing intracranial aneurysms with GDC via intravascular catheter.Methods Thrombosis with GDC were undertaken in 11 cases of intracranial aneurysm,proved with DSA with well depiction of the ancurysms and thcir carrying arteries.Results All except one were thrombosed with only one piece of GDC each,the other one used 3 pieces.All the carrying arteries kept patent after the procedure.Conclusion Thrombosis of intracranial aneurysm with GDC via catheter is proved to be a safe,easy,time-saving and effective method in curing the disease.
