Laser navigation combined with XperCT technology-assisted puncture of basal ganglia intracerebral hemorrhage.

Basal ganglia hemorrhage, which is characterized by excessive incapacity charge and high mortality rates, is surgically treated by minimally invasive hematoma puncture and drainage. We aimed at determining the efficacy of laser-guided minimally invasive hematoma puncture and drainage for treatment of basal ganglia hemorrhage. A total of 61 patients with hypertensive basal ganglia hemorrhage were recruited at the Binzhou Medical University Hospital, between October 2019 and January 2021, and their clinical information retrospectively analyzed. Based on the surgical approach used, patients were assigned into either laser navigation or small bone window groups depending on the surgical approach. Then, we compared the operation times, intraoperative blood loss, clinic stay, Glasgow Outcome Score (GOS) rating at 30 days, Barthel index (BI) rating at 6 months, postoperative pneumonia incidences, and intracranial contamination complications between groups. Intraoperative blood loss, operation time, and sanatorium were significantly low in laser navigation group, relative to the small bone window group. At the same time, there were no significant differences between the groups with regard to postoperative hematoma volume, lung contamination, cerebrospinal fluid (CSF) leak, and intracranial contamination, as well as the 6-month BI and 30-day GOS rating. There were no deaths in either group. Compared with the traditional small bone window surgery, laser-guided puncture and drainage is a low-cost, accurate, and safe method for the treatment of basal ganglia hemorrhage, which is suitable for promotion in developing countries and economically underdeveloped areas.

Efficacy evaluation of neuroendoscopy vs burr hole drainage in the treatment of chronic subdural hematoma: An observational study.

BACKGROUND: Chronic subdural hematoma (CSDH) is a common disease in neurosurgery. The traditional treatment methods include burr hole drainage, bone flap craniectomy and other surgical methods, and there are certain complications such as recurrence, pneumocephalus, infection and so on. With the promotion of neuroendoscopic technology, its treatment effect and advantages need to be further evaluated. AIM: To study the clinical effect of endoscopic small-bone approach in CSDH. METHODS: A total of 122 patients with CSDH admitted to our hospital from August 2018 to August 2021 were randomly divided into two groups using the digital table method: the neuroendoscopy group (n = 61 cases) and the burr hole drainage group (n = 61 cases). The clinical treatment effect of the two groups of patients with CSDH was compared. RESULTS: At the early postoperative stage (1 d and 3 d), the proportion of 1/2 re-expansion of brain tissue in the hematoma cavity and the proportion of complete re-expansion was higher in the neuroendoscopy group than in the burr hole drainage group, and the difference between the two groups was statistically significant (P < 0.05). The recurrence rate of hematoma in the neuroendoscopy group was lower than that in the burr hole drainage group, and the difference between the two groups was statistically significant (P < 0.05). No intracranial hematoma, low cranial pressure, tension pneumocephalus or other complications occurred in the neuroendoscopy group. CONCLUSION: The neuroendoscopic approach for the treatment of CSDH can clear the hematoma under direct vision and separate the mucosal lace-up. The surgical effect is apparent with few complications and definite curative effect, which is worthy of clinical promotion and application.

The Effect Of Small Bone Window Craniotomy Removal on Lactic Acid and CRP in Patients with Hypertensive Intracerebral Hemorrhage in the Basal Ganglia.

Background: Hypertensive intracerebral hemorrhage (HICH) seriously endangers the quality of life of patients and can even lead to death. Craniotomy is a common treatment method for HICH. Objective: The aim of this study was to investigate the efficacy of two different sizes of craniotomy in patients with HICH, as well as to evaluate their effects on C-reactive protein (CRP) and blood lactate levels. Materials and Methods: A total of 72 patients with HICH in the basal ganglia were operated on in our hospital from February 2017 to March 2019 and randomly divided into two groups: the small bone window (SBW) group (n = 37) and the large bone flap group (n = 35). The curative effects of the two kinds of operations were evaluated by the length of operation, the days of hospitalization, the rate of hematoma clearance, the rate of rebleeding, and the incidence of complications. Additionally, the levels of CRP and lactate were compared between the two groups. Results: The results showed that the average intraoperative time, hospital stay, rebleeding rate, and postoperative complications of patients in the SBW group were less than those in the large bone flap group. Moreover, the number of patients in the SBW group with good postoperative recovery, including class V and class IV, was higher than that in the large bone flap group. Minimally invasive craniotomy with SBW reduced the lactic acid and CRP levels more quickly than the large bone flap group. Conclusions: An SBW was superior to a large bone flap in terms of the operative effect and lactate and CRP levels. It is concluded that an SBW has significant advantages over a large bone flap.

Aplicación de la neurocirugía endoscópica en el tratamiento de las hemorragias hipertensivas en los ganglios basales / Application of neuroendoscopic surgery in treatment of hypertensive basal ganglia hemorrhage

Introducción: La relevancia de la neurocirugía endoscópica en el tratamiento de las hemorragias hipertensivas de los ganglios basales no se conoce en buena medida. Objetivo: Comparar la eficacia clínica de la neurocirugía endoscópica mínimamente invasiva con la de la microcirugía con craneotomía de ventana pequeña (SBWC) en el tratamiento de las hemorragias hipertensivas de los ganglios basales. Pacientes y métodos: Análisis retrospectivo de los datos clínicos de 174 pacientes con hemorragia hipertensiva de los ganglios basales tratados en nuestro hospital desde enero de 2018 hasta septiembre de 2020. Los pacientes se dividieron en dos grupos: uno sometido a neurocirugía endoscópica mínimamente invasiva (n = 90) y otro a microcirugía con SBWC (n = 84). Se compararon la duración de la operación, la tasa de eliminación del hematoma, la recidiva hemorrágica y el pronóstico. Resultados: En el grupo sometido a la endoscopia mínimamente invasiva, tanto la duración de la intervención como el tiempo de hemostasia fueron significativamente más breves, y la pérdida de sangre durante la intervención fue significativamente menor que en el grupo de microcirugía con SBWC (p < 0,001). La puntuación preoperatoria de la escala de coma de Glasgow (GCS) era de 8,64 ± 1,04 puntos en el grupo de la endoscopia y de 8,68 ± 1,02 puntos en el de la microcirugía (p > 0,05). A las 24 horas de la intervención, la puntuación de la GCS en los sometidos a la neuroendoscopia aumentó hasta 12,89 ± 1,56, con una diferencia significativa respecto al grupo de la microcirugía, que presentaba 11,18 ± 1,14 puntos (p < 0,001). El volumen del edema cerebral fue de 11,82 ± 3,25 mL en el grupo de la neuroendoscopia mínimamente invasiva y de 18,89 ± 3,15 mL en el de la microcirugía (p < 0,001). En comparación con el grupo sometido a esta última, en el grupo de la endoscopia, la eliminación del hematoma fue más extensa y el pronóstico resultó más favorable.(AU)

Introduction: The influence of Application of neuroendoscopic surgery in treatment of hypertensive basal ganglia hemorrhage remains largely unknown. Aim: To compare the clinical efficacy of minimally invasive neuroendoscopic surgery (NES) and small bone window craniotomy (SBWC) microsurgery on the treatment of patients with hypertensive basal ganglia hemorrhage (HBGH). Patients and methods: The clinical data of 174 HBGH patients treated in our hospital from January 2018 to September 2020 were retrospectively analyzed. They were divided into minimally invasive NES group (n = 90) and SBWC microsurgery group (n = 84). Their operation time, hematoma clearance rate, rebleeding and prognosis were compared. Results: In minimally invasive NES group, the operation time and intraoperative hemostasis time were significantly shorter, and the intraoperative blood loss was significantly less than those in SBWC microsurgery group (p < 0.001). The preoperative Glasgow coma scale (GCS) score was 8.64 ± 1.04 points and 8.68 ± 1.02 points respectively in minimally invasive NES group and SBWC microsurgery group (p > 0.05). At 24 h after operation, the GCS score in minimally invasive NES group rose to 12.89 ± 1.56 points, and it had a significant difference from that in SBWC microsurgery group (11.18 ± 1.14 points, p < 0.001). The volume of brain edema was 11.82 ± 3.25 mL in minimally invasive NES group and 18.89 ± 3.15 mL in SBWC microsurgery group (p < 0.001). In minimally invasive NES group, the clearance of hematoma was superior to that in SBWC microsurgery group, and the prognosis was also better than that in SBWC microsurgery group. Conclusions: Minimally invasive NES has better efficacy than SBWC microsurgery in the treatment of HBGH.(AU)

Clinical effects of neuroendoscopic hematoma evacuation for hypertensive intracerebral hemorrhage.

OBJECTIVE: To analyze the clinical effects of neuroendoscopic hematoma evacuation for the treatment of hypertensive intracerebral hemorrhage (ICH). METHODS: A total of 80 patients with hypertensive ICH who were admitted to our hospital were included as the subjects of this retrospective study. The patients were assigned into a neuroendoscopic hematoma evacuation group (n=35) and a small bone window craniotomy group (n=45). The post-operative hematoma residues and the clearance rate of the hematoma were compared between the two groups. The intraoperative blood loss, duration of the surgery, and Glasgow Coma Scale (GSC) scores before and after surgery were compared between the two groups. The operation time, intraoperative blood loss, the time consumed to stop bleeding, clearance rate of hematoma, manifestation of complications, and the prognosis 6 months after surgery were analyzed statistically. Self-made questionnaires were used to evaluate the satisfaction degree of patients with their lives and to assess the quality of life after surgery. RESULTS: The operation time, blood loss, and the time consumed to stop bleeding were less in the neuroendoscopic hematoma evacuation group than those in the small bone window craniotomy group (all P<0.05). The GCS scores in the neuroendoscopic hematoma evacuation group were significantly higher than those in the small bone window craniotomy group (P<0.05). The clearance rate of hematoma was higher in the neuroendoscopic hematoma evacuation group than that in the small bone window craniotomy group (P<0.05). CONCLUSION: As compared with small bone window craniotomy for removing hematoma, neuroendoscopic hematoma evacuation showed a better outcome in treating patients with hypertensive ICH. It could improve patients' clinical indications, which is worthy of being widely applied in clinical settings.

Comparison of two surgical treatments for hypertensive basal ganglia hemorrhage / 中国基层医药

Objective:To investigate the efficacy of minimally invasive puncture and drainage versus small bone window craniotomy in the treatment of hypertensive basal ganglia hemorrhage. Methods:Seventy-three patients with hypertensive basal ganglia hemorrhage who received treatment in Hequ County People's Hospital from April 2018 to December 2020 were included in this study. They were divided into a minimally invasive puncture and drainage group ( n = 38) and a small bone window craniotomy group ( n = 35) according to surgical methods. Clinical efficacy and postoperative complications were compared between the two groups. Results:At 3 months post-surgery, the National Institutes of Health Stroke Scale score in the minimally invasive puncture and drainage group was significantly lower than that in the small bone window craniotomy group [(3.58 ± 1.23) points vs. (6.87 ± 0.97) points, t = 12.62, P < 0.001]. Barthel index in the minimally invasive puncture and drainage group was significantly higher than that in the small bone window craniotomy group [(62.15 ± 6.78) points vs. (43.15 ± 7.15) points, t = 11.65, P < 0.001]. The total response rate in the minimally invasive puncture and drainage group was significantly higher than that in the small bone window craniotomy group [92.11% (35/38) vs. 74.3% (26/35), χ2 = 4.21, P < 0.05]. The incidence of complications in the minimally invasive puncture and drainage group was significantly lower than that in the small bone window craniotomy group [5.2% (2/38) vs. 25.7% (9/35), χ2 = 6.18, P < 0.05]. Conclusion:Minimally invasive puncture and drainage have better clinical efficacy and fewer postoperative complications in the treatment of hypertensive basal ganglia hemorrhage than small bone window craniotomy. Therefore, minimally invasive puncture and drainage for the treatment of hypertensive basal ganglia hemorrhage are worthy of clinical promotion.

Neuroendoscopic minimally invasive surgery and small bone window craniotomy hematoma clearance in the treatment of hypertensive cerebral hemorrhage.

OBJECTIVE: To analyze the effects of neuroendoscopic minimally invasive surgery and small bone window craniotomy hematoma clearance through comparing clinical indicators of the two operation modes and to provide a reference for selection of proper minimally invasive surgery. METHODS: One hundred and twenty-six patients with hypertensive cerebral hemorrhage who received diagnosis and treatment in our hospital between December 2015 and December 2017 were selected and grouped into an observation group (n=63) and a control group (n=63) using random number table. Patients in the observation group were treated by neuroendoscopic surgery, while patients in the control group were treated by small bone window craniotomy. The surgical condition, clinical effect and prognosis of the two groups were analyzed and compared. RESULTS: Patients in the observation group completed surgery in a shorter time and bled less during operation compared to the control group, and the hematoma clearance rate of the observation group was obviously higher than that of the control group; the differences had statistical significance (P<0.05). The nerve deficiency scale (NDS) scores of the two groups at the postoperative 3rd month were lower than those before surgery (P<0.05), and the activity of daily life (ADL) score at the postoperative 3rd month was higher than that before surgery (P<0.05). The observation group had lower NDS score and higher ADL score compared to the control group, and the differences had statistical significance (P<0.05). The incidence of complications of the observation group was lower than that of the control group after surgery, and the rate of favourable prognosis of the observation group was higher than that of the control group at the postoperative 3rd month (P<0.05). CONCLUSION: Neuroendoscopic surgery is more effective and safe, causes less bleeding and has better prognosis and nerve function recovery compared to small bone window craniotomy in the treatment of hypertensive cerebral hemorrhage.

Efficacies of minimally invasive puncture and small bone window craniotomy for hypertensive intracerebral hemorrhage, evaluation of motor-evoked potentials and comparison of postoperative rehemorrhage between the two methods.

Application value of the minimally invasive puncture and small bone window craniotomy in hypertensive intracerebral hemorrhage was investigated to explore the effects of the above treatment methods on motor-evoked potentials (MEPs) and postoperative rehemorrhage. Patients with hypertensive intracerebral hemorrhage who were admitted to Chengyang People's Hospital from March 2016 to December 2017 were selected and randomly divided into the minimally invasive group (n=40) and the craniotomy group (n=40). The minimally invasive group was treated with minimally invasive puncture and drainage for hematomas, while the craniotomy group received small bone window craniotomy for evacuation of hematomas. The clinical efficacy was compared between the two groups. At 28 days after operation, the Chinese scale of clinical neurological deficit of stroke patients (CSS) score in the minimally invasive group was lower than that in the craniotomy group (p<0.05). At 28 days after operation, the S-100ß level in the minimally invasive group was lower than that in the craniotomy group (p<0.05). At 1 week after operation, 35 patients in the minimally invasive group were able to elicit MEP waveforms, and only 7 patients in the craniotomy group were able to elicit positive waveforms. At 2 weeks after operation, 40 patients in the minimally invasive group and 20 patients in the craniotomy group could elicit MEP waveforms, and the incubation period, central motor conduction time and amplitude in the former were significantly better than those in the latter (p<0.05). The operation time and length of hospital stay were shorter with more total expenses of hospitalization in the minimally invasive group compared to those in the craniotomy group (p<0.05). Compared with small bone window craniotomy, minimally invasive puncture can reduce serum S-100ß level. Its advantages are obvious, so it is worthy of promotion and application.

Comparison of the efficacy of different decompressions treatment combined with posterior cervical fusion and internal fixation treatment on Chiari I malformation associated with syringomyelia and atlantoaxial instability / 中国基层医药

Objective@#To compare the efficacy of different decompressions treatment combined with posterior cervical fusion and internal fixation treatment on Chiari I malformation associated with syringomyelia and atlantoaxial instability.@*Methods@#From January 2016 to October 2017, 36 cases of Chiari I malformation associated with syringomyelia and atlantoaxial instability in Linfen People's Hospital were selected in the research.The patients were divided into two groups according to random number table method, with 18 cases in each group.The observation group was given decompression of posterior fossa of small bone window + cerebellar tonsillectomy + posterior cervical fusion and internal fixation treatment.The control group was given traditional decompression of posterior fossa + posterior cervical fusion and internal fixation treatment.The efficacy, complications occurred within 1 year after operation, JOA score and spinal cord cavity size at different time points before and after operation of the two groups were compared.@*Results@#The total effective rate of the observation group [94.44%(17/18)] was slightly higher than that of the control group [88.89%(16/18)] (χ2=1.957, P>0.05). The total effective rate of the observation group at 1 year after operation was 88.89%(16/18), which was significantly higher than that of the control group [72.22%(13/18)] (χ2=3.498, P<0.05). The incidence rate of complications of the observation group at 1 year after operation was 11.11%(2/18), which was significantly lower than that of the control group [38.89%(7/18)](χ2=11.685, P<0.05). The JOA scores at discharge[(15.97±1.25)point] and 1 year after operation[(15.53±1.19)point] of the observation group were significantly higher than those of the control group[(14.21±1.18)point, (14.06±1.15)point](t=3.815, 3.706, all P<0.05). The spinal cord cavity size at discharge [(2.13±0.64)mm] and 1 year after operation[(2.28±0.69)mm] of the observation group were significantly higher than those of the control group [(3.41±0.76)mm, (3.45±0.78)mm](t=5.743, 5.511, all P<0.05).@*Conclusion@#The long-term efficacy of decompression of posterior fossa of small bone window + cerebellar tonsillectomy + posterior cervical fusion and internal fixation treatment on Chiari I malformation associated with syringomyelia and atlantoaxial instability is remarkable, the recovery of spinal cord function and syringomyelia is well and the postoperative complications incidence is relatively low, which is worthy of popularization and application.

Comparison of the efficacy of different decompressions treatment combined with posterior cervical fusion and internal fixation treatment on Chiari Ⅰ malformation associated with syringomyelia and atlantoaxial instability / 中国基层医药

Objective To compare the efficacy of different decompressions treatment combined with posterior cervical fusion and internal fixation treatment on Chiari Ⅰ malformation associated with syringomyelia and atlantoaxial instability.Methods From January 2016 to October 2017,36 cases of Chiari Ⅰ malformation associated with syringomyelia and atlantoaxial instability in Linfen People's Hospital were selected in the research.The patients were divided into two groups according to random number table method,with 18 cases in each group.The observation group was given decompression of posterior fossa of small bone window + cerebellar tonsillectomy + posterior cervical fusion and internal fixation treatment.The control group was given traditional decompression of posterior fossa + posterior cervical fusion and internal fixation treatment.The efficacy,complications occurred within 1 year after operation,JOA score and spinal cord cavity size at different time points before and after operation of the two groups were compared.Results The total effective rate of the observation group [94.44％ (17/18)] was slightly higher than that of the control group [88.89％ (16/18)] (x2 =1.957,P ＞ 0.05).The total effective rate of the observation group at 1 year after operation was 88.89％ (16/18),which was significantly higher than that of the control group [72.22％ (13/18)] (x2 =3.498,P ＜ 0.05).The incidence rate of complications of the observation group at 1 year after operation was 11.11％ (2/18),which was significantly lower than that of the control group [38.89％ (7/18)] (x2 =11.685,P ＜ 0.05).The JOA scores at discharge[(15.97 ± 1.25) point] and 1 year after operation[(15.53 ± 1.19) point] of the observation group were significantly higher than those of the control group [(14.21 ± 1.18) point,(14.06 ±1.15) point] (t =3.815,3.706,all P ＜ 0.05).The spinal cord cavity size at discharge [(2.13 ± 0.64) mm] and 1 year after operation [(2.28 ± 0.69) mm] of the observation group were significantly higher than those of the control group [(3.41 ±0.76)mm,(3.45 ±0.78)mm] (t =5.743,5.511,all P＜0.05).Conclusion The long-term efficacy of decompression of posterior fossa of small bone window + cerebellar tonsillectomy + posterior cervical fusion and internal fixation treatment on Chiari Ⅰ malformation associated with syringomyelia and atlantoaxial instability is remarkable,the recovery of spinal cord function and syringomyelia is well and the postoperative complications incidence is relatively low,which is worthy of popularization and application.

Risk factors of postoperative rebleeding after hypertensive cerebral hemorrhage / 局解手术学杂志

Objective To analyze the risk factors of postoperative rebleeding after hypertensive cerebral hemorrhage,and provide a basis for clinical prevention of postoperative recurrent hemorrhage. Methods The clinical data of 413 patients with hypertensive intracerebral hemorrhage in our hospital from January 2007 to December 2017 were retrospectively analyzed.The possible correlation factors of postopera-tive recurrent hemorrhage and the high-risk factors were collected and summarized. Results According to univariate unconditional logistic regression analysis, there was a significant correlation between systolic blood pressure, GCS score, bleeding volume, coagulation dysfunction and the use of sedative analgesics with the hypertensive cerebral hemorrhage after surgery(P<0.05);they were also the risk factors of post-operative rebleeding after hypertensive cerebral hemorrhage according to the multivariate unconditional logistic regression analysis (P<0.05). Conclusion The results indicate that there are many factors influencing postoperative rebleeding in patients with hypertensive cerebral hemorrhage.In the perioperative period,higher systolic blood pressure,deeper consciousness disorder,more bleeding,and coagulation dysfunction are independent factors influencing postoperative re-bleeding, and more attention should be paid to it.

Clinical analysis of small skull window craniotomy for hypertensive intracerebral hemorrhage / 中国基层医药

Objective To investigate the effect of small bone window hematoma ventriculoscope for clinical treatment of hypertensive cerebral hemorrhage.Methods From January 2014 to June 2017,80 patients with hypertensive cerebral hemorrhage in Zhejiang Rongjun Hospital were selected and randomly divided into two groups according to the digital table,with 40 cases in each group.The control group underwent conventional craniotomy hematoma removal surgery,the observation group received small bone window hematoma ventriculoscope treatment.The operation situation,hospitalization time,clinical efficacy and nerve function defect score,ADL score,the incidence rate of complications were compared between the two groups.Results There was no statisticall significant difference in operation time between the two groups (t =0.284,P ＞ 0.05).The amount of intraoperative bleeding of the observation group was (35.47 ± 10.69) mL,which was significantly less than (96.85 ± 27.54) mL of the control group (t =13.141,P ＜ 0.05).The hospitalization time of the observation group was significantly shorter than the control group[(8.52 ±2.31) d vs.(11.79 ± 3.05) d] (t =5.405,P ＜ O.05).The total effective rate of observation group was 92.5 ％ (37/40),which was higher than 75.0％ (30/40) in the control group (x2 =4.501,P ＜ 0.05).After treatment,the neural function defect score and daily life ability score of the observation group were (17.59 ± 2.98) points,(82.45 ±6.03) points,respectively,which were significantly higher than those of the control group[(22.17 ± 3.06) points,(73.21 ± 5.12) points] (t =6.782,7.388,all P ＜ 0.05).The incidence rate of complications of the observation group was 5.0％ (2/40),which was significantly lower than 20.0％ (8/40) in the control group (x2 =4.114,P ＜ 0.05).Conclusion Small bone window craniotomy evacuation of hematoma in the treatment of hypertensive cerebral hemorrhage,not only has significant clinical efficacy,but also has the advantages of less intraoperative blood loss,rapid postoperative recovery,less complications and so on.

Pediatric Chiari malformation type I: long-term outcomes following small-bone-window posterior fossa decompression with autologous-fascia duraplasty.

Chiari malformation type I (CM-I) is a common hindbrain disorder that is associated with deformity and elongation of the cerebellar tonsils. Although CM-I occurs in both pediatric and adult patients, its prevalence, clinical features and management in the pediatric population are not well defined. The current study evaluated a consecutive case series of 92 children (38 females and 54 males) who were diagnosed with congenital CM-I. All patients underwent small-bone-window posterior fossa decompression with autologous-fascia duraplasty. Clinical and radiological features were analyzed and long-term follow-up data were recorded. Risk factors associated with clinical outcomes were investigated using comprehensive statistical methods. Out of the 92 children, 11 (12.0%) were asymptomatic. Associated ventricular dilation was observed in 24 children (26.1%) and concomitant syringomyelia was observed in 72 children (78.3%). A total of 44 children (47.8%) showed scoliosis on plain films. Follow-up data (mean duration, 88.6 months) were available for all patients. Syringomyelia was absent or markedly reduced in 56 patients (77.8%). Symptoms were alleviated in 66 patients, remained unchanged in 12 patients and progressed in 3 patients. Statistical analysis indicated that the cerebellar tonsillar descent (CTD) grade, basilar invagination and platybasia influenced the clinical outcome (P<0.05). In conclusion, early recognition and surgical treatment of CM-I in pediatric patients can lead to good outcomes. The current results suggested that small-bone-window posterior fossa decompression with autologous-fascia duraplasty was an effective safe treatment option with a low complication rate. High CTD grade, basilar invagination and platybasia were indicated to be predictors of poor clinical prognosis.

Comparison of therapeutic effects of different surgery methods on early hypertensive intracerebral hemorrhage in basal ganglia region in elderly patients and their prognostic factors analysis / 中华老年医学杂志

Objective To explore the therapeutic effects of different surgery methods on early hypertensive intracerebral hemorrhage(HICH)in basal ganglia region in elderly patients and on prognostic factors analysis.Methods 89 elderly patients with early HICH were randomly divided into four groups according to surgery methods and whether their ICP was monitored.Group A(n=21)was given minimally invasive hematoma drainage,group B(n=23)was given small bone window for removal of hematoma,group C(n=21)and group D(n=24)was given ICP monitoring and corresponding management of ICP on the basis of group A and group B,respectively.The changes of intracranial pressure before and after operation,prognosis and post-operative complications were compared.Results The intracranial pressure was significantly decreased at 3rd day,7th day after operation in group C and D as compared with those in group A and B at the same time points(F=11.76,P<0.05),and the score of GCS was also higher in group C and D at 7th day after operation than in group A,B at the same time points(F=4.72,P<0.05).At 14th and 28th day after operation,the score of GCS was higher in group C than in group A and B(F=19.24,P<0.05),and higher in group C than in group D at 28th day after operation(F=22.26,P<0.05).The dosage of mannitol was significantly lower in group C and group D than in group A and group B(F=18.87,P<0.05).The incidence rate of post-operative complications was 14.3% in group C vs.28.6% in group A(P<0.05)and 20.8% in group D vs.47.8% in group B(χ2=7.04,P<0.05).The proportion of a good recovery and a light disability was significantly higher in group C and D(76.2% and 75.0%)than in group A and B(42.9% and 39.1%)respectively(χ2=14.99,all P<0.05).Conclusions Minimally invasive hematoma drainage shows the advantages of small trauma and a few complications for the treatment of elderly patients with early HICH,and its combination with ICP can early change intracranial pressure and further improves the prognosis.

Long-Term Outcomes After Small-Bone-Window Posterior Fossa Decompression and Duraplasty in Adults with Chiari Malformation Type I.

BACKGROUND: Small-bone-window posterior fossa decompression with duraplasty is one of the popular surgical options for Chiari malformation type I, but its efficacy is controversial and the risk factors of clinical outcome remain unclear. METHODS: The study cohort included 152 patients with Chiari malformation type I who received small-bone-window posterior fossa decompression at Beijing Tiantan hospital from January 2008 to September 2009. All patients underwent combined surgical procedures: a small-bone-window suboccipital decompression (diameter, 2.5-3 cm) and a C1 laminectomy (1.5- to 2-cm wide) followed by a duraplasty with an autologous graft. Clinical manifestations, radiologic features, and follow-up data during a 6-year span were analyzed. Risk factors associated with outcome were investigated by the use of χ(2) analysis and logistic regression analysis. RESULTS: The average follow-up duration was 74 months. Symptoms were improved in 126 patients (82.9%), remained stable in 21 patients (13.8%), and deteriorated in 5 patients (3.3%). There was no mortality. Postoperative magnetic resonance imaging scans were available for all patients. Preoperatively, 112 patients were associated with syringomyelia, and the follow-up magnetic resonance images showed obvious reduction of syringomyelia in 73 patients (65.2%) and no significant change in 39 patients (34.8%). In addition, enlargement of the cistern magna was observed in 92 patients (85.2%). Regression analysis indicates preoperative motor dysfunction, brainstem herniation and basilar invagination may influence the clinical outcome (P < 0.05). CONCLUSIONS: Small-bone-window posterior fossa decompression with duraplasty is an effective and safe treatment option with a low complication rate. Motor dysfunction, brainstem herniation, and basilar invagination are predictors of poor clinical prognosis.

Clinical surgical treatment experience of small bone window in removing the frontal brain contusion and basal ganglia hematoma / 中国医师进修杂志

Objective To explore the surgical indication,key point and curative effect of small bone window in removing the frontal brain contusion and basal ganglia hematoma.Methods The clinical data of 118 patients with frontal cerebral contusion (38 cases) or basal ganglia hematoma (80 cases) were retrospectively analyzed,and the patients were given small bone window surgery.Results The postoperative curative effect was evaluated by daily life activities Barthel index.In 118 patients,56 cases (47.5％) were postoperative independent (Barthel index 100 scores),34 cases (28.8％) were mild dependence (Barthel index 75-95 scores),16 cases (13.6％) were moderate dependence (Barthel index 50-70 scores),10 cases (8.5％) were severe and totally dependence (Barthel index 0-45 scores),and 2 cases (1.7％) were death.Conclusion Small bone window in removing the frontal brain contusion and basal ganglia hematoma has small trauma,fully removed lesions,shorter operation time,fewer complications,quicker recovery,no skull repair,and lower mortality and disability rate.

Twenty-nine cases of resection of suprasellar meningioma through small bone window: an interhemispheric approach.

AIM OF THE STUDY: The present study aims to discuss the value and the effect of resection of suprasellar meningioma through the interhemispheric approach. MATERIAL AND METHODS: Twenty-nine cases of patients with suprasellar meningioma diagnosed through enhanced magnetic resonance imaging (MRI) scans and postoperative histopathological examination underwent resection of tumours (the largest diameter ranged from 3 cm to 6 cm) by the microsurgical technique of a small bone window (about 4 cm × 5 cm) through the interhemispheric approach. RESULTS: Among all cases, 25 (86%) (Simpson I, II) were of total resection of tumours and 4 were of subtotal resection of tumours. 19 (65%) were of improvement of vision and visual field, 2 (7%) were of postoperative diabetes insipidus, and 1 (3%) was of electrolyte imbalance. No operative death occurred. CONCLUSIONS: The small bone window interhemispheric approach can be used to expose tumours, lightly stretch brain tissues, reduce the incidence of complications, and improve the total resection rate of tumours of patients with sellae meningiomas growing forward, upward, and into the sella.

Microsurgical treatment of hypertensive basal ganglia hemorrhage via lateral fissure approach / 中国综合临床

Objective To study the clinical effect of microsurgical treatment via lateral fissure approach on hypertensive basal ganglia hemorrhage.Methods Small bone flap via lateral fissure approach were applied to remove basal ganglia hematoma.Thirty two cases were recruited in the retrospective analysis.Results By head CT scan follow-up 24 h post operation,over 80％ percent of hematoma was successfully removed in 28 cases and over 40％ of hematoma was resided in 4 case.Patients were followed up for 3 - 6 months,according to the ADL (ADL)classification,the outcomes were:Grade Ⅰ in 4 cases( 12.5％ ),grade Ⅱ in 13 cases(40.6％ ),grade Ⅲ in 12 cases (37.5％)and grade Ⅳ in 3 cases (9.4％).No death occurred.Conclusion Small window approach on lateral fissure for microsurgical operation of hypertensive basal ganglia hemorrhage is a less invasive procedure with good surgical exposure and homeostasis.Neurological function was well recovered after surgery.

The analysis of hypertensive putamen hemorrhage with two different surgical treatment / 中国基层医药

Objective To study the different effects of hypertensive putamen hemorrhage with two different treatments of decompressive craniotomy and small bone window(keyhole) surgery. Methods Retrospective analysis of 120 cases of hypertensive putamen hemorrhage in patients with operation data was carried out. They were randomly divided into two groups according to the different surgical procedure, and then compared the incidence of postoperative complications, close and long-term effects and so on. Results There was no significant difference in early complication rate and postoperative GOS score after a week between two groups(P＞0.05). The difference was significant between two groups in close and long-term effects (P ＜ 0.05 ). Conclusion Small bone window (keyhole)surgery had characteristics such as surgical time-saving ,less damage and more rapid recovery with removal of hematoma, and made played a significant role in promoting the recovery of close and long-term effects with patients.