Embolization of Ruptured Aneurysm Arising From Basilar Artery Fenestration Using Hydrocoils.

Aneurysms arising from the basilar artery fenestration are considered among the rare cerebrovascular diseases. Here, we report on a 44-year-old gentleman who presented with the sudden onset of severe headache complicated by several episodes of vomiting and an altered level of consciousness. A subarachnoid hemorrhage in the interpeduncle and ambient cisterns was detected by computed tomography of the head. During left vertebral arteriography, a basilar fenestration with a ruptured aneurysm just above the proximal end of vertebrobasilar junction was identified. The aneurysm was successfully occluded by means of endovascular treatment using Hydrosoft coils. In the 15-month follow-up angiography, 100% occlusion without recurrence and recanalization was observed. Bilateral anterior inferior cerebellar arteries and both channels of the basilar artery fenestration were entirely filled in follow-up angiograms.

Clinical characteristics and therapy of cerebral arteriovenous malformations in elderly patients / 中华神经医学杂志

Objective To explore the clinical characteristics and treatment of cerebral arteriovenous malformations (AVMs) in elderly patients to improve their prognoses.Methods Such clinical data as clinical manifestations,angioarchitecture features,location and therapy of 28 elderly patients (≥60 years old) with AVMs,admitted to our hospital from January 2000 to December 2011,were retrospectively analyzed.Results The elderly patients had 5.4％ (28/511) morbidity of AVMs,with mean age of (62.25±3.46) years; the male patients were slightly more than the female patients.The clinical presentations included hemorrhage in 20 patients,seizure in 4,headache in 2,facial tic in 1 and tinnitus in 1.Supratentorial and infratentorial lesions were noted in 22 and 6,respectively.The maximum diameter of AVMs was smaller than 3 centimeters in 11 patients,ranged from 3 to 6 centimeters in 16,and larger than 6 centimeters in 1.Twenty-one AVMs were located in the functional areas and 7 in non-functional areas.Deep vein drainage was noted in 15,two-way drainage in 1 and superficial drainage in 11.Spetzeler-Martin grading showed grade Ⅰ in 1,grade Ⅱ in 7,grade Ⅲ in 13,grade Ⅳ in 6 and grade V in 1.After operation,endovascular embolization,27 patients had significantly improved symptoms; one patient had no effect on any treatments.Conclusion The elderly patients with cAVMs have low morbidity with hemorrhage as its most common symptom; and the lesions mostly locate in the supratentorial region; active intervention therapy (resection,endovascular embolization and radiotherapy)can obviously improve the prognosis and quality of lives.

Expression of growth factors in rats with focal cerebral ischemia after transplantation of bone marrow stromal cells and endothelial progenitor cells / 中华神经医学杂志

Objective To observe the expression of growth factors (vascular endothelial growth factor [VEGF],stromal cell-derived factor-1 [SDF-1 ],basic fibroblast growth factor [bFGF],insulin-like growth factor [IGF-1],transforming growth factor-β [TGF-β],platelet-derived growth factor [PDGF],brain derived neurotrophic factor [BDNF],glial cell line-derived neurotrophic factor [GDNF] and nerve growth factor [NGF]) in rat ischemic brain tissues after intravenous implantation of bone marrow stromal cells (BMSCs) and/or endothelial progenitor cells (EPCs). Methods Healthy adult Wistar rats were randomly divided into 4 groups:vehicle group,BMSCs transplantation group,EPCs transplantation group and BMSCs combined with EPCs transplantation group (n=20). The rats were subjected to middle cerebral artery occlusion (MCAO),and 24 h after that,they were intravenously transplanted with either 3×106 BMSCs,EPCs,BMSCs/EPCs or 1 mL physiological saline.Seven d after transplantation,real time-PCR and Western blotting were employed to detect the expressions of VEGF,SDF-1,bFGF,IGF-1,TGF-β,PDGF-BB,BDNF,GDNF and NGF. Results The mRNA expressions of bFGF,VEGF and BNDF in the BMSCs/EPCs transplantation group were significantly higher as compared with those in the other groups (P＜0.05).BMSCs transplantation group enjoyed the highest mRNA levels of NGF,GDNF and TGF-β among all the groups, significantly higher as compared with those in the other groups (P＜0.05),followed by BMSCs/EPCs transplantation group.EPCs transplantation group enjoyed the highest mRNA levels of PDGF,IGF-1 and SDF-1,significantly higher as compared with those in the other groups (P＜ 0.05), followed by BMSCs/EPCs transplantation group. Conclusion BMSCs combined with EPCs implantation can promote the functional rehabilitation in rats after focal cerebral ischemia, which provides new way for improving the transplantation success rate.

Human umbilical cord-derived Schwann-like cell transplantation combined with neurotrophin-3 administration in dyskinesia of rats with spinal cord injury.

Mesenchymal stem cells are capable of differentiating into Schwann-like cells. In this study, we induced human umbilical-cord mesenchymal stem cells (HUMSCs) in vitro into neurospheres constituted by neural stem-like cells, and further into cells bearing strong morphological, phenotypic and functional resemblances with Schwann-like cells. These HUMSC-derived Schwann-like cells, after grafting into the injured area of the rats' spinal cord injury (SCI), showed a partial therapeutic effect in terms of improving the motor function. Neurotrophin-3 (NT-3) was reported to improve the local microenvironment of the grafted cells, and we, therefore, further tested the effect of Schwann-like cell grafting combined with NT-3 administration at the site of cell transplantation. The results showed that NT-3 administration significantly promoted the survival of the grafted cells in the host-injured area. Significant improvement in rats treated by Schwann-like cell grafting combined with NT-3 administration was demonstrated in the behavioral test as compared with that in animal models received the cell grafting only. These results suggest that transplantation of the Schwann-like cells combined with NT-3 administration may represent a new strategy of stem cell therapy for spinal cord injury.

Interventional treatment of dural arteriovenous fistula / 中华神经医学杂志

Objective To explore the clinical skills and curative efficacy of endovascular embolization on dural arteriovenous fistula (DAVF). Methods A total of 50 patients with DAVF,admitted to our hospital from 2000 to 2009, underwent endovascular embolization with different materials through a microcatheter under DSA. After embolization, imaging examination was applied and clinical manifestations were noted during the clinical follow-up to evaluate the clinical efficacies.Results Immediate postoperative angiography indicated that the fistulas were totally occluded in 43patients, occluded evidently in 6 and occluded partially in 1. The 6-84 months follow-up found that clinical symptoms of 34 patients disappeared, 6 alleviated evidently, 7 relapsed, and 3 worsened; no complications were noted. Conclusion The endovascular embolization for DAVF is effective; and choosing the right embolic approach and material and improving the technology are the keys of successful treatment.

Correlated factors of bleeding in patients with cerebral arteriovenous malformation / 中华神经医学杂志

Objective To explore the influencing factors of bleeding in patients with cerebral arteriovenous malformation (AVM) through observing the angioarchitecture of AVM with cerebral DSA.Methods The clinical and imaging data of 199 patients with AVM, including 107 with bleeding and 92without bleeding, were retrospectively analyzed. The relationships between bleeding and such factors as the site and size of masses, the type and site of supplying arteries, the number and pathway of venous drainage, having vascular tumor-like changes or not, the relation between AVM and aneurysm in terms of location, and the number and size of concurrent aneurysms were determined by univariate analyses and Binary logistic regression with SPSS13.0. Results Univariate analysis indicated that such factors as micro-sized (0.5-1.0 cra) and small-sized (1.0-2.0 cra) masses ofAVM, AVM underdeep location,having exclusively deep draining veins, fewer draining veins and deep feeding arteries, concurrent small aneurysms (＜5 mm), aneurysms at the end of the blood-supply artery were positively correlated to hemorrhagic presentation. The number of feeding arteries and the number of concurrent aneurysms were not correlated with hemorrhagic presentation. Having vascular tumor-like changes can decreased the risk of bleeding. When stepwise multiple logistic regression analysis was employed, only micro-sized and small-sized masses of AVM, having deep feeding arteries, and aneurysms at the end of the blood-supply artery were dependent predictors of hemorrhagic presentation. Conclusion Micro-sized and small-sized masses of AVM, having deep draining veins and aneurysms at the end of the blood-supply artery are the most powerful risk predictors for hemorrhagic AVM presentation.

Effect of electro-needling at acupoints of the yangming meridian on the expression of PAC-1 and lower limb functions in acute cerebral infarction patients / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effect of electro-needling at acupoints of the yangming meridian on the expression of platelet associated complement-1 (PAC-1) and lower limb functions in acute cerebral infarction (ACI) patients.</p><p><b>METHODS</b>58 ACI patients were randomly assigned to the treatment group and the control group. Conventional therapies were given to all patients. Additionally, the electro-needling at acupoints of the yangming meridian was given to patients in the treatment group. Changes of PAC-1 were detected using flow cytometry. Effect of lower limbs functions of ACI patients before and after electro-needling was assessed using Fugl-Meyer Index. Meanwhile, 20 healthy subjects were selected for reference value.</p><p><b>RESULTS</b>In the acute stage, the PAC-1 level in ACI patients were significantly higher than that in healthy subjects (P<0.05). The PAC-1 level in the electro-needling group was obviously lowered after treatment (P<0.01). There was no significant difference in the control group between before and after treatment. Significant difference was found in Fugl-Meyer index in the same group between before and after two-week treatment (P<0.05). It was higher in the electro-needling group than in the control group, showing significant difference (P<0.01).</p><p><b>CONCLUSIONS</b>Platelet activation exists in the acute stage of ACI. Electro-needling at acupoints of the yangming meridian showed obvious inhibition on PAC-1 levels, could improve lower limbs functions of ACI patients. It was inferred that electro-needling at acupoints of the yangming meridian promoted the recovery of paralyzed lower limbs at the early stage mainly by regulating PAC-1 levels, thus postponing the progress of ACI.</p>

Pathogenesis and prognosis of chronic hydrocephalus following aneurismal subarachnoid hemorrhage treated by endovascular embolization with Guglielmi detachable coils / 中华神经医学杂志

Objective To explore the risk factors and the prognosis of chronic hydrocephalus following aneurysmal subarachnoid hemorrhage (SAH) treated by endovaseular embolization with Guglielmi detachable coils (GDCs). Methods Endovascular embolization with GDCs were performed in 132 patients with aneurysmal subarachnoid hemorrhage that satisfied our research standard. After endovascular embolization, ventricular drainage was conventionally performed in patients who occurred intraventricular hemorrhage combined with obstruction in the ventricular system, while cerebrospinal fluid permutation was performed in other patients. Chronic hydrocephalus was evaluated by CT 1 month after SAH. Ventricle-peritoneal shunt was carried out for patients with severe chronic hydrocephalus while only clinical observation was needed for patients with mild chronic hydrocephalus. Clinical follow-up evaluation was carried out 6 months after SAIl according to the modified Rankin scale score. The risk factors related to chronic hydrocephalus were noted through the statistical analysis of the patients' data and the relation between the appearing of chronic hydrocephalus and clinical prognosis of SAH was analyzed. Results The overall incidence rate of chronic hydrocephalus following aneurysmal subarachnoid hemorrhage was 12.12% and age, Fisher grade and Hunt-Hess grade had important value in the prognosis of chronic hydrocephalus. Clinical prognosis of SAH was not significantly related to chronic hydrocephalus following SAH (P >0.05). Conclusion Chronic hydrocephalus following aneurysmal subarachnoid hemorrhage is not only resulted from one single risk factor and good clinical prognosis can be achieved by promptly performing ventricle-peritoneal shunt in patients with severe chronic hydrocephalus.

A modified endovascular treatment for longitudinal intracranial aneurysm / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the surgical approach and curative effect of the "interlocking basket" technique in interventional therapy for longitudinal intracranial aneurysm.</p><p><b>METHODS</b>Thirty-eight Hunt and Hess Grade I-III patients with longitudinal intracranial aneurysm underwent interventional therapy using the "interlocking basket" technique. During the operation, the aneurysm was divided into two segments based on its length and occluded with two coils. The first coil with a transverse diameter matching that of the aneurysm was deployed to form a "basket", which was densely occluded, and a portion of this coil out of the "basket" was interlocked with the second coil to form another "basket" crossing the aneurysmal neck to prevent the coils from escaping till the neck of the aneurysm was densely occluded.</p><p><b>RESULTS</b>Thirty-five aneurysms (92.1%) were completely embolized, and 3 (7.9%) were 95% embolized. No coil escaping from the aneurysm neck or other complications occurred. Twenty-five patients were discharged with a GOS score of 5 (65.8%), 7 (18.4%) with a score of 4, and 6 (15.8%) had a score of 3. In the follow-up for 3-25 months after the embolization, angiography was performed in 28 cases, and recurrence was found in 2 cases (7.14%).</p><p><b>CONCLUSION</b>The "interlocking basket" technique can increase the coil stability in longitudinal intracranial aneurysm and allows reliable block of the aneurysm neck and dense embolization of the aneurysm to improve the clinical outcomes of the patients.</p>

Risk factors of delayed cerebral vasospnsm following subarachnoid hemorrhage: a clinical analysis / 中华神经医学杂志

Objective To identify the risk factors of delayed cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH). Methods The clinical data of 74 patients with SAH were retrospectively analyzed. The severity of delayed cerebral vasospasm in these patients was assessed according to the findings by digital subtraction angiography, and the risk factors for delayed cerebral vasospasm following SAH were analyzed. Results The patients' age, number of SAH episode, histor yof smoking, Hunt-Hess grade, Fisher grade and peak white blood cell count were found to significantl ycorrelated to the occurrence of delayed cerebral vasospasm. Among these factors, the patients' age, number of SAH, Hunt-Hess grade, and Fisher grade were identified as the independent risk factors of delayed cerebral vasospasm. Conclusions Patients with younger age, SAH more than twice, and Hunt-Hess or Fisher grades over Ⅲ are at higher risk of delayed cerebral vasospasm. Close monitoring fo rearly detection of delayed cerebral vasospasm and timely management are crucial in these patients.

A clinical study of NexusTM coils for endovascular occlusion of intracranial aneurysms / 中华神经医学杂志

Objective To analyze the effect of NexusTM coils for endovascular occlusion of intracranial aneurysms. Methods In 41 patients with intracranial aneurysms, endovascular occlusion of 43 aneurysms was performed using NexusTM coils. The follow-up data of the patients for 6 to 12 months were reviewed, and the imaging data from digital subtraction angiography (DSA), CT angiography (CTA) or magnetic resonance arthrography (MRA) alter the treatment were analyzed. Results In the 41 patients, 1 died, 1 had aneurysm recurrence, 3 had cerebral infarction, 1 showed ocular paralysis, and 2 developed hydrocephalus after the surgery. Evaluation with modified Rankin Scale showed grade 0 in 8 cases, grade 1 in 19 cases, grade 2 in 7 cases, grade 3 in 3 cases, grade 4 in 1 case, grade 5 in 1 ease and grade 6 in 1 case. Conclusion Endovascular embolization with NexusTM coils is effective for treatment of intracranial aneurysms especially in cases of small aneurysms and parent artery occlusion. Caution should be taken with the coil for endovascular occlusion of the neck of anterior and middle cerebral artery aneurysms with thin parent arteries, as the fibers in the coil may cause thrombosis and potential cerebral infarction.

Embolization of cerebral dural arteriovenous fistula of the cavernous sinus through the superior ophthalmic vein approach / 中华神经医学杂志

Objective To evaluate the clinical effect of embolization of cerebral dural atreriovenous fistulas (cDAVF) of the eavemous sinus through the superior ophthalmic vein approach. Methods Twnety-seven patients with eDAVF of the cavernous sinus were embolized through the superior ophthalmic vein approach. Cerebral angiography and follow-up examination of the patients were performed to evaluate the effect ofernbolization. Results The fistulae showed complete angiographic disappearance in 15 patients, and 12 patients had blood velocity flow reduction at the fistula orifice. Ocular proptosis and chemosis deteriorated transiently in 11 patients after the procedure. The patients were followed-op for 3 to 48 months, and clinical cure was achieved in 17 patients, and 10 showed significant symptom relief. Conclusion cDAVF of the cavernous sinus can be effectively embolized through the superior ophthalmic vein approach.

Effect of hypertension on cerebral aneurysms and model production of cerebral aneurysm in a rat / 中华神经医学杂志

Objective To establish a rat model of cerebral aneurysms and explore the impact of hypertension on it. Methods Forty-five rats were randomly divided into hypertensive, normotensive, and normal control groups (n=15). The origin of the right external carotid artery was digested with porcine pancreatic elastase, ligated and cut at 1.5 mm from the carotid bifurcation. Cerebral aneurysm models were established in this stump in the hypertensive and normotensive groups, and then, stenosis of the bilateral renal artery was induced surgically in the hypertensive group. The systolic blood pressures in the 3 groups were measured before and at 6 and 12 weeks after the operation. At 12 weeks after the operation, the aneurysms, after measurement of the size, were fixed by formalin perfusion. The vascular tissues in the aneurysms were isolated for pathological examination using HE staining, Van-Geson staining and Verhoeff staining. Results A significant increase in the blood pressure occurred in the hypertensive group to the level of 197.48±15.44 mm Hg, and the aneurysm was obviously enlarged measuring 2.38±0.31 mm in length and 1.89±0.35 mm in width;no significant changes occurred in the normotensive and normal control groups. Pathological examinations demonstrated the absence of the intima and rupture of the elastin layer in the hypertensive group;the normotensive group retained part of the elastic fibers, and no vascular damage was found in the normal control group. Conclusion This aneurysm model can be prepared conveniently with good stability, and can well simulate the structure and pathology of human cerebral aneurysm. Hypertension significantly affects the elastin and collagen in the blood vessels to contribute to aneurysm enlargement.

Analysis of prognosis factors of craniocerebral traffic injuries / 中华神经医学杂志

Objective To explore the clinical factors affecting the prognosis of craniocerebral traffic injuries to provide scientific evidence for ameliorating the prognosis. Methods We retrospectively analyzed the clinical data of 652 patients treated in our hospital for serious injuries in car accidents (Glascow Coma score [GCS] 3～8) between February, 1998 and February, 2008. According to the Glasgow Outcome Scale (GOS) three months after injury, patients were divided into good prognosis and poor prognosis groups. Their gender, age, type of brain injury, admission time, pupil status, blood oxygen saturation, systolic blood pressure, level of blood sugar, Injury Severity Score (ISS) and GCS were compared. Results As compared with the good prognosis group, the poor prognosis group showed a significant low level of blood oxygen saturation and systolic blood pressure, low GCS and pupils status score (P<0.05);it showed a long admission time, a significant high level of blood sugar and high ISS (P<0.05). Bad prognosis appeared in intracranial hematoma, contusion and laceration of the brain. And the level of blood sugar and oxygen, GCS and ISS were the independent factors affected the prognosis. Conclusion The level of oxygen saturation and blood sugar, ISS and GCS can help to evaluate the prognosis of patients with severe brain injury, effectively.

Estrogen deficiency on growth of intracranial aneurysm in rats / 中华神经医学杂志

Objective To construct an aneurismal model with estrogen deficiency and investigate the mechanism of estrogen deficiency in the formation and development of intracranial aneurysm. Methods Female Wistar rats were randomly divided into experimental, sham-operative and blank control groups (n=10). Rats in the experimental group were ovariectomized and those in the sham-operative group were removed the adipose issue nearby the ovary only; while the rats in the blank control group were done nothing. Two weeks after the ovariectomized or sham operation, elastase dropped around the right external carotid artery and the crotch of the carotid artery and the carotid artery was ligated by two lines at 1.5 mm far from the crotch, and then sheared between the two lines to successfully induce the aneurysm. At 6 weeks of the successful construction of aneurysm model, the estrogen was detected and the aneurysm was harvested for pathological staining. Results The experimental group showed a lower estrogen level (105.00±12.96 pmol/L) than the sham-operative group (178.50±25.96 pmol/L) and the blank control group (180.40±18.70 pmol/L, P<0.05). Aneurismal length dilatation rates in the experimental group and the sham-operative group were (131.31±6.63)% and (109.90±3.44) %, respectively (P<0.05). Aneurismal diameter dilatation rates in the experimental group and sham-operative group were (125.10±5.49) % and (106.82±2.49) %, respectively (P<0.05). Conclusion Estrogen deficiency may promote the formation and development of the intracranial aneurysm. This experiment provides a simple model for investigating the relationship between estrogen deficiency and aneurysm development.

Endovascular embolization treatment of cerebral arteriovenous malformation with Glubran (NBCA-MS) / 中华神经医学杂志

Objective To explore the clinical skills and curative efficacy of Glubran (NBCA-MS) embolization of cerebral arteriovenous malformations. Methods Ninety-six cases of cerebral arteriovenous malformations were treated by 187 endovascular embolizations with different concentrations of Italy GEM company's Glubran (NBCA-MS). Follow-up was performed to 96 cases of cerebral arteriovenous malformation with NBCA-MS embolization. Results During the follow-up in 96 cases, clinical symptoms completely disappeared in 92, were improved in 3 and reoccurred in 1. The malformation was totally got rid of in 44 of 48 cases DSA examinated, and the 80%-90% embolization was achieved in the rest who need further γ-knife therapy. In all cases, γ-knife therapy was performed in 32 cases after embolization, and among them 26 cases received DSA examination 1-2 years after γ-knife therapy, and 21 cases were proved to have no malformation. Conclusions The method ofendovascular emdolization with NBCA-MS is safe, reliable and effective to treat the cerebral arteriovenous malformation.

Clinical follow-up study of intracranial aneurysm occlusion with expandable hydrocoil / 中华神经医学杂志

Objective To study the short-term and long-term effectiveness of intracranial aneurysm occlusion with expandable hydrocoil. Methods Forty-one patients with intracranial aneurysms (n=45) were treated by endovascular occlusion with expandable hydrocoil. Follow-up interviews in the forms of DSA, CTA or MRA were conducted to the 41 patients within 6-24 months after the treatment to find out the tumor recurrence and complications. Results In the 41 patients, 1 died, 1 suffered from recurrence, 3 developed cerebral infarction, 1 got oculomotor paralysis, 2 got hydrocephalus. According to modified Rankin scale, grade 0 in 8 cases, grade 1 in 19, grade 2 in 7, grade 3 in 3, grade 4 in 2, grade 5 in 1 and grade 6 in 1. Conclusions Endovascular embolization with expandable hydrocoil is an effective treatment method for intracranial aneurysms, especially for parent artery occlusion, but it may be able to cause more complications in the treatment of small aneurysms (＜5mm), so the caution should be taken.

Application of virtual imaging technique in diagnosis of intracranial aneurysms / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the value of virtual imaging technique in diagnosis of intracranial aneurysms.</p><p><b>METHODS</b>Fifty-four cases of 54 intracranial aneurysm diagnosed by three-dimensional CT angiography (3D-CTA) examinations were enrolled in this study. Three-dimensional virtual images of the skull and cerebral vessels were acquired by three-dimensional reconstruction of the original CT images using the surgical planning system, and the location, size and shape of the aneurysms and their anatomical relationship with the adjacent tissues were observed and measured from several angles. All the patients underwent surgical planning and simulated surgical operations using the virtual surgical instruments available in the system.</p><p><b>RESULTS</b>All the 54 cases had successful three-dimensional virtual image reconstruction and the surgical planning operations. The virtual imaging system generated clear and vivid three-dimensional virtual images which clearly visualized the location and size of the aneurysms and their precise anatomical relations to the parent arteries and skull. This virtual reality imaging system also allowed simulation of simple surgical procedures.</p><p><b>CONCLUSION</b>The surgical planning system based on the virtual reality imaging can serve as a useful means to assist the diagnosis and provide precise imaging details of intracranial aneurysms.</p>

Combined application of virtual imaging techniques and three-dimensional computed tomographic angiography in diagnosing intracranial aneurysms / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The diagnostic value of virtual imaging combined with three-dimensional computed tomographic angiography (3D-CTA) for intracranial aneurysms has not been fully elucidated yet. This study aimed to evaluate the value of combined application of virtual imaging techniques and 3D-CTA in diagnosing patients with aneurismal subarachnoid hemorrhage (SAH) at the acute stage.</p><p><b>METHODS</b>Eighty patients with non-traumatic SAH received 3D-CTA examinations. The raw CT data of these patients were reconstructed and transferred into the 3D mode through the surgical plan system based on virtual reality (VR) image, and the 3D virtual images of skulls and brain blood vessels were acquired. The location, size and shape of aneurysms and their anatomic relationship with adjacent tissues were measured from many points of view.</p><p><b>RESULTS</b>Seventy-three aneurysms were detected in 68 of the 80 patients, but 2 aneurysms were detected in 2 of the 5 patients who had been found free of aneurysms previously and had received 3D-CTA examinations for a second time one month later. The 3D virtual images produced by the virtual imaging system were clear and vivid, and they could reveal the location and size of the aneurysm and its relations to the parent artery and skull directly.</p><p><b>CONCLUSIONS</b>The imaging of 3D-CTA is convenient, reliable and fast in diagnosing intracranial aneurysms and can be regarded as the first choice for the diagnosis and treatment of ruptured intracranial aneurysms. Combined with the surgical plan system based on the VR image, 3D-CTA may obtain more imaging information about aneurysms.</p>

Evaluation of cerebral vasospasm resulting from subarachnoid hemorrhage with 1H-magnetic resonance spectroscopy / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the value of (1)H-magnetic resonance spectroscopy ((1)H-MRS) in evaluating cerebral vasospasm resulting from subarachnoid hemorrhage (SAH).</p><p><b>METHODS</b>Six dogs were subjected to autologous non-heparinized blood injection via cisternal puncture twice at one-day interval to establish models of SAH, and another 6 received injections with normal saline in an identical manner. (1)H-MRS scan was performed on the 3rd, 7th and 14th days after the injections to measure the changes of N-acetylaspartate (NAA), creatine (Cr) and choline (Cho). After the (1)H-MRS scan, all the dogs underwent brain digital subtraction angiography (DSA) for determining the basilar artery diameter.</p><p><b>RESULTS</b>DSA results on day 3 presented development of obvious vasospasm of the basilar artery, which was most evident on day 7 and recovered obviously on day 14. (1)H-MRS results demonstrated obvious changes of NAA, Cho and Cr on days 3 and 7 in SAH model group, and NAA declined to the lowest level on day 3 followed by gradual ascending till reaching the normal level on day 14. Cho decreased slightly on day 3, then increased and reached the peak level on day 7 and then decreased. Cr rose steadily from day 3 to 14, but since day 7, the rise slowed down obviously and Cr maintain a level not significantly different from that on day 14 (P>0.05). The functional results of (1)H-MRS were consistent with the DSA results.</p><p><b>CONCLUSION</b>(1)H-MRS can be used to monitor the development of cerebral vasospasm resulting from SAH as a good evaluation method for functional imaging.</p>