Combined External Ventricular Drainage and Endoscope-Assisted Microsurgery Using the Middle Frontal Gyrus Approach in Severe Ventricular Hemorrhage with Casting of the Fourth Ventricle.

OBJECTIVE: To investigate combined external ventricular drainage and endoscope-assisted microsurgery using the middle frontal gyrus approach in patients with severe ventricular hemorrhage with casting of the fourth ventricle and patients' recovery after this treatment. METHODS: Patients with severe ventricular hemorrhage with casting of the fourth ventricle (n = 41) were randomly assigned to intervention and control groups. Modified Graeb score was used to assess 3-day hematoma clearance rate before and after surgery, drainage tube extubation time for the 2 groups was compared, and time when blood clot in the fourth ventricle was not blocked with cerebrospinal fluid was compared. Glasgow Coma Scale was used to assess consciousness after surgery; Glasgow Coma Scale scores recorded 1 and 7 days after surgery were also compared. Modified Rankin Scale was used to evaluate patients' recovery 1 and 6 months after surgery. Hydrocephalus and intracranial infections in patients after surgery were recorded for 90 days. RESULTS: The 3-day hematoma clearance rate was dramatically higher in the intervention group. Modified Graeb score showed that more hemorrhage was delimited in 3 days in the intervention group. The intervention group exhibited significantly reduced length of block of the fourth ventricle and drainage tube extubation time. High Glasgow Coma Scale and modified Rankin Scale scores and significantly low incidence of complications (e.g., hydrocephalus and intracranial infection) were observed in patients in the intervention group. CONCLUSIONS: Combined external ventricular drainage and endoscope-assisted microsurgery using the middle frontal gyrus approach can effectively improve severe ventricular hemorrhage with casting of the fourth ventricle and enhance patients' neurological function and recovery.

Relation of thrombus composition with stroke etiology and influence of thrombus composition in prognoses of stroke / 中华神经医学杂志

Objective:The composition of thrombi obtained during mechanical thrombectomy in patients with acute ischemic stroke is analyzed to investigate its relation with stroke etiology and its influence in surgical parameters and clinical prognoses.Methods:The thrombi and clinical data of 41 patients with acute ischemic stroke directly treated by mechanical thrombectomy in our hospital from January 2019 to December 2019 were collected. Hematoxylin-eosin (HE) staining was used to quantitatively analyze the composition of thrombi, and the components of thrombi in patients with different causes of stroke (large artery atherosclerosis [LAA], cardiogenic embolism [CE], and unexplained type) were compared. These patients were divided into erythrocyte-rich group (erythrocyte content>fibrin content) and fibrin-rich group (erythrocyte content<fibrin content) according to thrombus composition, and surgical parameters and clinical prognoses were compared between patients from the two groups.Results:(1) The erythrocyte content in the thrombus of stoke patients with LAA, CE, and unexplained type was 52.1%, 39.6%, and 44.4%, respectively, with significant differences ( χ2=3.763, P=0.032); and that in stoke patients with LAA was significantly increased than that in stoke patients with CE ( P<0.05). (2) As compared with the fibrin-rich group, the erythrocyte-rich group has significantly shorter procedure time and significantly smaller times of thrombectomy ( P<0.05). There were no statistically significant differences in National Institutes of Health Stroke Scale (NIHSS) scores, vascular recanalization rate, postoperative cerebral hemorrhage rate, good prognosis rate and mortality rate 90 d after mechanical thrombectomy between the two groups ( P>0.05). Conclusion:Thrombus composition has influence in surgical parameters, but no influence in clinical prognoses.

Clinical analysis and treatment of severe traumatic cerebral injury patients with paroxysmal sympathetic hyperactivity / 中国医师进修杂志

Objective To discuss the clinical symptoms of severe traumatic cerebral injury patients with paroxysmal sympathetic hyperactivity (PSH). These patients were given positive and effective prevention and treatment to reduce complications in order to improve prognosis. Methods Twenty patients with PSH were selected from October 2010 to October 2014 and were analyzed by gender, age, diagnosis, clinical symptoms, laboratory and equipment inspection to summary the treatment experiences of such patients. Results Of the 20 patients,14 were males and 6 were females,with age of 22-65 (35.4±9.5) years. Sixteen patients underwent unilateral or bilateral intracranial hematoma and decompressive craniectomy,and 4 patients were given conservative treatment. PSH occurred in these patients within 1 week after cerebral injury or surgery. However, the elderly might occur in the course of a few weeks or even months later. Each patient' s seizure frequency and duration had no significant regular pattern. The frequency varied from one time in several days to several times one day. Seizure duration was generally less than half an hour. All of the patients underwent CT and MRI examinations and showed different parts of the brain injury. But the damage of the brain stem, corpus callosum, basal ganglia and lateral ventricles beside sympathetic overactivity could lead to the occurrence of PSH. Most of the patients had a good effect after active drug treatment and symptomatic therapy. Conclusions PSH often occurs in severe traumatic cerebral injury patients. The doctor should pay attention to PSH. Early active and effective prevention and treatment can improve the prognosis of patients with PSH.

A new index in evaluating the embolization degree of aneurysms / 中国医师进修杂志

ObjectiveTo investigate the effect of volume embolization ratio(VER) in evaluating the embolization efficacy of aneurysms.MethodsFifty-three patients who received intracranial aneurysm embolization surgery were all treated with detachable coils endovascular embolization,While fifty-seven intracranial aneurysms were treated.The VER was calculated and the relationships between the VER values and the size,the neck,embolization degree of intracranial aneurysm were analyzed.ResultsThe VER of small,medium,large,and giant aneurysms were (40.8 ± 26.5 )％,( 18.6 ± 16.1 )％,(2.3 ± 2.1 )％,(0.4 ±0.1 )％,respectively,which had statistical significance (F =7.091,P ＜ 0.01 ).The VER of wide-necked and narrow-necked aneurysms were (27.5 ± 23.1 )％,(29.4 ± 26.6)％,which had no statistical significance(P ＞0.05 ).The VER of complete embolization,neck residual and partial embolization were (41.8 ± 29.3 )％,(31.4 ± 21.2)％,( 12.3 ± 15.1 )％,respectively,which had statistical differences (F =7.970,P ＜ 0.01 ).ConclusionsThe VER is an objective index to evaluate the embolization degree of aneurysms.It has certain prediction significance for the efficacy judgement of embolization of aneurysms.

EGFR inhibitor enhances cisplatin sensitivity of human glioma cells / 华中科技大学学报（医学）（英德文版）

Epidermal growth factor receptor (EGFR) is found to express at high levels in a variety of solid tumors including gliomas. This study was to examine the effect of an EGFR-tyrosine kinase inhibitor (AG1478) alone or in combination with cisplatin (CDDP) on the growth of glioma cells (U87). U87 glioma cells were treated with AG1478 (10 μmol/L) or CDDP (25 μmol/L) as a single agent or in combination for 24 or 48 h. The expression of EGFR and the components in its downstream signaling pathway [extracellular signal-regulated kinase (ERK), protein kinase B (AKT)] in U87 glioma cells was detected by Western blotting. Cell growth, cell cycle distribution and cell apoptosis were determined by MTT method and flow cytometry, respectively. The results showed that CDDP could induce the activation of EGFR and the components in its downstream signaling pathways in a concentration-dependent manner. The combined treatment of AG1478 with CDDP could inhibit the proliferation of U87 glioma cells, arrest the cell cycle and promote cell apoptosis. In the EGFR signaling pathway, AG1478 decreased the phosphorylation of ERK, AKT and EGFR in U87 glioma cells. It was concluded that the combined treatment of AG1478 and CDDP may exert synergistic inhibitory effects on the growth of glioma cells by suppressing the activities of EGFR, AKT and ERK.

Iodine-125 implants on operation for Intracavitary radiotherapy to neuroglioma / 中国医师进修杂志

Objective To evaluate the efficacy of surgical excision combined with iodine-125 implants intmcavitary radiotherapy for neumglioma Method After excision,27 patients with nenroglioma were implanted with the iodine-125 into the tumor bed or the residual tumor tissues.Results Of all cases,there were no operative mortality and no serious complication.The survival time of 25 cases exceeded 6 months and 1 glioblastoma recurrence,22 cases exceeded 12 months,3 glioblastoma and 1 astrocytoma Ⅲgrade recurrence.There were 19 cases exceeding 24 months,15 cases no recurrence,3 cases died for cere bral hernia because of giving.up further tremment,1 case surviving.Conclusions Surgical excision Combined with iodine-125 implants intracavitary radiotherapy can improve partial control rate,prolonged the survival time of patients with neuroglioma,and complications is rare.It is an efficient therapy for neu roglioma

Therapeutic embolization of cerebral aneurysms with electro-detachable platinum coil / 介入放射学杂志

Objective To assess the therapeutic effect of cerebral aneurysmal embolization with electro-detachable platinum coils(EDPC), and to discuss the timing of the embolization and points for attention during the procedure. Methods From February 1999 to July 2004, 60 intracranial aneurysms were treated with EDPC in 58 patients, of which 56 cases were subject to subarachnoid hemorrhage (SAH). 36 patients were Hunt & Hess Grade I, 12 Grade II and 8 Grade IV～V. Two of all 58 patients had no SAH. Two sorts of EDPC were used in this group: one is Guglielmi detachable coil from Boston Scientific Corporation and the other is Sapphire detachable coil from Micro Therapeutics Inc. All the sessions of embolization and each detachment of the EDPC were closely monitored both fluoroscopically and angiographically for the accurate and safe embolization of aneurysmal lumen. Results Of all 60 aneurysms, 58 were successfully treated with EDPC and 2 were failed to be embolized due to arterial spasm. The packing degree of aneurismal lumen was complete in 44 cases (75.9%) and incomplete in 12 cases (20.7%). The incidence of non-thrombotic complication was 6.9%. One patient had hemiplegia because of the hernia into the parent artery by EDPC. No death occurred in our group. 41 patients were followed-up during a period of 1～4 years and no SAH onset recurred after embolization. Conclusions Endovascular treatment of intracranial aneurysms with GDC is a better alternative. But the long-term effects should be verified by follow-up in the future.