Pub Date : 2020-01-28DOI: 10.3760/CMA.J.ISSN.1001-2346.2020.01.006
Zhi-yong Li, Guo-zhong Yi, Guang-long Huang, Xi'an Zhang, Ye Song, Hai Wang, Luxiong Fang, Ya-wei Liu, Jun Pan, S. Qi
Objective To explore the diagnosis and treatment of supratentorial tumors with small round cell malignancies diagnosed by intraoperative rapid pathology. Methods A retrospective analysis was conducted on the clinical data of 36 patients with supratentorial tumors diagnosed as small round cell malignant tumors by intraoperative frozen pathology at Department of Neurosurgery, Nanfang Hospital, Southern Medical University from January 2011 to December 2017. All patients were treated with complete tumor resection according to the principle of glioma operation. After the operation, the MRI of the head was reexamined, and the volume quantitative analysis was used to determine the degree of tumor resection, which was divided into complete resection, subtotal resection and partial resection. All patients were followed up regularly in outpatient department, and MRI was reexamined to explore the recurrence of tumor. Results MRI of 36 patients after operation showed that 31 patients (86.1%) had complete resection and 5 patients (13.9%) had subtotal resection. The results of pathological diagnosis were as follows: primary central nervous system lymphoma (10 cases), glioblastoma (6 cases), central neurocytoma (5 cases), primitive neuroectodermal tumors (3 cases), brain metastasis tumor (2 cases), pineal cell tumors(2 cases), ependymoblastoma (2 cases), World Health Organization (WHO) grade Ⅱ glioma (2 cases), pituitary adenoma (1 case), periangioblastoma (1 case), olfactory neuroblastoma(1 case) and desmoplastic small round cell tumor (1 case). Among the 33 patients diagnosed by MRI before operation, 8 (24.2%) had the same pathological results with preoperative diagnosis, including 4 cases of lymphoma, 1 case of central neurocytoma, 1 case of primitive neuroectodermal tumor, 1 case of hemangioblastoma and 1 case of metastasis. The follow-up duration of 36 patients was 28.9±8.1 months and ranged from 6 to 70 months . During the follow-up period, 26 out of 36 patients (72.2%) relapsed. Conclusions The supratentorial tumors with small round cell malignant tumor diagnosed by rapid pathology during operation should be resected in the maximal range under the premise of safety, the pathological results are various and its therapeutic effect seems relatively good. Key words: Supratentorial tumor; Pathology; Treatment outcome; In operation; Small round cell tumor
{"title":"Diagnosis and treatment of supratentorial tumors with small round cell malignancies diagnosed by intraoperative rapid pathology","authors":"Zhi-yong Li, Guo-zhong Yi, Guang-long Huang, Xi'an Zhang, Ye Song, Hai Wang, Luxiong Fang, Ya-wei Liu, Jun Pan, S. Qi","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.01.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.01.006","url":null,"abstract":"Objective \u0000To explore the diagnosis and treatment of supratentorial tumors with small round cell malignancies diagnosed by intraoperative rapid pathology. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was conducted on the clinical data of 36 patients with supratentorial tumors diagnosed as small round cell malignant tumors by intraoperative frozen pathology at Department of Neurosurgery, Nanfang Hospital, Southern Medical University from January 2011 to December 2017. All patients were treated with complete tumor resection according to the principle of glioma operation. After the operation, the MRI of the head was reexamined, and the volume quantitative analysis was used to determine the degree of tumor resection, which was divided into complete resection, subtotal resection and partial resection. All patients were followed up regularly in outpatient department, and MRI was reexamined to explore the recurrence of tumor. \u0000 \u0000 \u0000Results \u0000MRI of 36 patients after operation showed that 31 patients (86.1%) had complete resection and 5 patients (13.9%) had subtotal resection. The results of pathological diagnosis were as follows: primary central nervous system lymphoma (10 cases), glioblastoma (6 cases), central neurocytoma (5 cases), primitive neuroectodermal tumors (3 cases), brain metastasis tumor (2 cases), pineal cell tumors(2 cases), ependymoblastoma (2 cases), World Health Organization (WHO) grade Ⅱ glioma (2 cases), pituitary adenoma (1 case), periangioblastoma (1 case), olfactory neuroblastoma(1 case) and desmoplastic small round cell tumor (1 case). Among the 33 patients diagnosed by MRI before operation, 8 (24.2%) had the same pathological results with preoperative diagnosis, including 4 cases of lymphoma, 1 case of central neurocytoma, 1 case of primitive neuroectodermal tumor, 1 case of hemangioblastoma and 1 case of metastasis. The follow-up duration of 36 patients was 28.9±8.1 months and ranged from 6 to 70 months . During the follow-up period, 26 out of 36 patients (72.2%) relapsed. \u0000 \u0000 \u0000Conclusions \u0000The supratentorial tumors with small round cell malignant tumor diagnosed by rapid pathology during operation should be resected in the maximal range under the premise of safety, the pathological results are various and its therapeutic effect seems relatively good. \u0000 \u0000 \u0000Key words: \u0000Supratentorial tumor; Pathology; Treatment outcome; In operation; Small round cell tumor","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"21-25"},"PeriodicalIF":0.0,"publicationDate":"2020-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48715939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-28DOI: 10.3760/CMA.J.ISSN.1001-2346.2020.01.012
Yiyang Wu, Feng Wang, Zi-mu Song, Yang Liu, Jiang Ji, Yao-jun Chen, Tao Sun
Objective To explore the feasibility of 3D printing individualized guide plate in the localization and biopsy of intracranial lesion. Methods A retrospective analysis was conducted on 8 patients with intracranial lesions who underwent puncture and biopsy at Department of Neurosurgery, General Hospital of Ningxia Medical University from November 2016 to December 2018. Using preoperative brain CT and MRI enhancement images as the original data, Mimics 17.0 software was used to reconstruct the 3D image, plan the needle position, design the puncture hole, and calculate the puncture depth. Personalized puncture guide plate was printed. During the operation, puncture needle was inserted into the fitting puncture hole, the puncture depth was controlled, biopsy specimen was taken for histopathological examination, and postoperative brain CT was used to evaluate the success of puncture. Results During the operation, the guide plates of the 8 patients were well fitted with the anatomical structure of the puncture site, the orientation and depth of the needle entry were consistent with preoperative design scheme, all puncture operations were completed once and the target tissues were successfully removed, and the average operation duration was 72.0±10.5 min. Brain CT was reexamined 6 hours after operation and no bleeding was found in the puncture trajectory and puncture entry points of 8 patients. None of the patients had intracranial infection or new neurological function deficit related to puncture. Conclusion The 3D printed individualized guide plate could simplify the operation procedure of intracranial lesion puncture biopsy and help achieve the purpose of biopsy accurately, safely and efficiently. Key words: Brain diseases; Biopsy; Punctures; 3D printing; Guider
{"title":"Application of 3D printed individualized guide plate in intracranial lesion biopsy","authors":"Yiyang Wu, Feng Wang, Zi-mu Song, Yang Liu, Jiang Ji, Yao-jun Chen, Tao Sun","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.01.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.01.012","url":null,"abstract":"Objective \u0000To explore the feasibility of 3D printing individualized guide plate in the localization and biopsy of intracranial lesion. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was conducted on 8 patients with intracranial lesions who underwent puncture and biopsy at Department of Neurosurgery, General Hospital of Ningxia Medical University from November 2016 to December 2018. Using preoperative brain CT and MRI enhancement images as the original data, Mimics 17.0 software was used to reconstruct the 3D image, plan the needle position, design the puncture hole, and calculate the puncture depth. Personalized puncture guide plate was printed. During the operation, puncture needle was inserted into the fitting puncture hole, the puncture depth was controlled, biopsy specimen was taken for histopathological examination, and postoperative brain CT was used to evaluate the success of puncture. \u0000 \u0000 \u0000Results \u0000During the operation, the guide plates of the 8 patients were well fitted with the anatomical structure of the puncture site, the orientation and depth of the needle entry were consistent with preoperative design scheme, all puncture operations were completed once and the target tissues were successfully removed, and the average operation duration was 72.0±10.5 min. Brain CT was reexamined 6 hours after operation and no bleeding was found in the puncture trajectory and puncture entry points of 8 patients. None of the patients had intracranial infection or new neurological function deficit related to puncture. \u0000 \u0000 \u0000Conclusion \u0000The 3D printed individualized guide plate could simplify the operation procedure of intracranial lesion puncture biopsy and help achieve the purpose of biopsy accurately, safely and efficiently. \u0000 \u0000 \u0000Key words: \u0000Brain diseases; Biopsy; Punctures; 3D printing; Guider","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"44-47"},"PeriodicalIF":0.0,"publicationDate":"2020-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48128997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-28DOI: 10.3760/CMA.J.ISSN.1001-2346.2020.01.013
Gang Wang, Yunyu Wen, Y. Liao, Guo-zhong Zhang, Ming-zhou Li, Siyuan Chen, S. Qi, Wenfeng Feng
Objective To explore the outcome of parallel clipping technique in the treatment of complex middle cerebral aneurysms in hybrid operation rooms. Methods A retrospective analysis was conducted on the clinical data of 13 patients with MCA complicated aneurysm admitted to Department of Neurosurgery, Nanfang Hospital of Southern Medical University from January 2015 to February 2019. All patients underwent a unilateral craniotomy with transpterional approach in the hybrid operating room. Multiple aneurysm clips were used to clip the aneurysm during the operation. Of the 13 patients, 7 were ruptured aneurysms, 4 were Hunt-Hess grade Ⅰ, 1 were Ⅲ, and 2 were Ⅳ; 6 were unruptured aneurysms. There were 19 aneurysms in 13 patients, of which 5 were single MCA aneurysms, 1 was bilateral MCA aneurysms, and the remaining 7 patients were single MCA aneurysms. The aneurysm embolization was evaluated by Raymond classification, and the clinical outcome was evaluated by modified Rankin Scale (mRS) criteria. Results Thirteen patients with 19 aneurysms underwent successful clipping. A total of 60 aneurysm clips were used. For each aneurysm, we used 1 to 6 (3.2 ± 1.6) clips. After aneurysm clipping, intraoperative angiographic review revealed clipping insufficiency (Raymond grade II) in 4 aneurysms, and 2 patients with parent aneurysm stenosis. After adjustment of the aneurysm clip, all aneurysms were completely occluded (Raymond grade Ⅰ) and the parent aneurysm had no stenosis. Only one patient developed postoperative cerebral infarction in the basal ganglia and slight hemiplegia resulting from occlusion of a branch emanating from the aneurysm wall. At discharge, the mRS was 0 in 10 patients, 2 in 2 patients, and 5 in 1 patient. Thirteen patients were followed up for 6 to 36 months (median: 17.3 months). The mRS was 0 in 10 cases, 1 in 2 cases, and 4 in 1 case. In 6 cases of re-examination, none of the aneurysms recurred. Conclusion The use of multiple aneurysm clips in the hybrid operating room to shape and clamp MCA complex aneurysms is effective and has few complications. Key words: Intracranial aneurysm; Middle cerebral artery; Microsurgery; Parallel clipping technique; Hybrid surgery
{"title":"Clinical efficacy of parallel clipping technique in the treatment of complex middle cerebral aneurysms in hybrid operation rooms","authors":"Gang Wang, Yunyu Wen, Y. Liao, Guo-zhong Zhang, Ming-zhou Li, Siyuan Chen, S. Qi, Wenfeng Feng","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.01.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.01.013","url":null,"abstract":"Objective \u0000To explore the outcome of parallel clipping technique in the treatment of complex middle cerebral aneurysms in hybrid operation rooms. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was conducted on the clinical data of 13 patients with MCA complicated aneurysm admitted to Department of Neurosurgery, Nanfang Hospital of Southern Medical University from January 2015 to February 2019. All patients underwent a unilateral craniotomy with transpterional approach in the hybrid operating room. Multiple aneurysm clips were used to clip the aneurysm during the operation. Of the 13 patients, 7 were ruptured aneurysms, 4 were Hunt-Hess grade Ⅰ, 1 were Ⅲ, and 2 were Ⅳ; 6 were unruptured aneurysms. There were 19 aneurysms in 13 patients, of which 5 were single MCA aneurysms, 1 was bilateral MCA aneurysms, and the remaining 7 patients were single MCA aneurysms. The aneurysm embolization was evaluated by Raymond classification, and the clinical outcome was evaluated by modified Rankin Scale (mRS) criteria. \u0000 \u0000 \u0000Results \u0000Thirteen patients with 19 aneurysms underwent successful clipping. A total of 60 aneurysm clips were used. For each aneurysm, we used 1 to 6 (3.2 ± 1.6) clips. After aneurysm clipping, intraoperative angiographic review revealed clipping insufficiency (Raymond grade II) in 4 aneurysms, and 2 patients with parent aneurysm stenosis. After adjustment of the aneurysm clip, all aneurysms were completely occluded (Raymond grade Ⅰ) and the parent aneurysm had no stenosis. Only one patient developed postoperative cerebral infarction in the basal ganglia and slight hemiplegia resulting from occlusion of a branch emanating from the aneurysm wall. At discharge, the mRS was 0 in 10 patients, 2 in 2 patients, and 5 in 1 patient. Thirteen patients were followed up for 6 to 36 months (median: 17.3 months). The mRS was 0 in 10 cases, 1 in 2 cases, and 4 in 1 case. In 6 cases of re-examination, none of the aneurysms recurred. \u0000 \u0000 \u0000Conclusion \u0000The use of multiple aneurysm clips in the hybrid operating room to shape and clamp MCA complex aneurysms is effective and has few complications. \u0000 \u0000 \u0000Key words: \u0000Intracranial aneurysm; Middle cerebral artery; Microsurgery; Parallel clipping technique; Hybrid surgery","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"48-51"},"PeriodicalIF":0.0,"publicationDate":"2020-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42189720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-28DOI: 10.3760/CMA.J.ISSN.1001-2346.2020.01.005
Yuanzhi Xu, Yajun Xue, S. Lin, Anke Zhang, Yaohua Liu, M. Lou
Objective To explore the value of multimodal image fusion technique in neuroendoscopic endonasal treatment of anterior skull base tumors. Methods The clinical data of 9 patients with anterior skull base tumors who underwent endoscopic surgery at Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University from January 2016 to June 2017 were retrospectively analyzed. CT, MRI, and CT angiography (CTA) images of the patient′s skull were fused before surgery, and intraoperative neuronavigation assisted surgical removal of the tumor was performed based on the results of the image fusion. This paper analyzed the effects of multimodal image fusion technology on demonstration of anterior skull base lesions and adjacent anatomical structures. Results During operation, multimodal image fusion clearly revealed the anterior skull base tumors together with adjacent neural tissues, blood vessels, bone structures, sphenoid sinus and septations. All 9 patients underwent successful operation. Among them, gross total resection of tumor was achieved in 6 cases and subtotal resection in 3 cases. No serious complications such as delayed hemorrhage, brain infection, and cerebrospinal fluid rhinorrhea occurred postoperatively. Conclusions In neuroendoscopic transnasal resection of the anterior skull base tumor, the application of multimodal image fusion technology combined with intraoperative neuronavigation can clearly show the location of tumor and its adjacent important structures, which helps improve the accuracy, safety, and effectiveness of the operation. Key words: Skull base neoplasms; Neurosurgical procedures; Neuronavigation; Natural orifice endoscopic surgery; Multimodal
{"title":"Application of multimodal image fusion in neuroendoscopic endonasal treatment of anterior skull base tumors","authors":"Yuanzhi Xu, Yajun Xue, S. Lin, Anke Zhang, Yaohua Liu, M. Lou","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.01.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.01.005","url":null,"abstract":"Objective \u0000To explore the value of multimodal image fusion technique in neuroendoscopic endonasal treatment of anterior skull base tumors. \u0000 \u0000 \u0000Methods \u0000The clinical data of 9 patients with anterior skull base tumors who underwent endoscopic surgery at Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University from January 2016 to June 2017 were retrospectively analyzed. CT, MRI, and CT angiography (CTA) images of the patient′s skull were fused before surgery, and intraoperative neuronavigation assisted surgical removal of the tumor was performed based on the results of the image fusion. This paper analyzed the effects of multimodal image fusion technology on demonstration of anterior skull base lesions and adjacent anatomical structures. \u0000 \u0000 \u0000Results \u0000During operation, multimodal image fusion clearly revealed the anterior skull base tumors together with adjacent neural tissues, blood vessels, bone structures, sphenoid sinus and septations. All 9 patients underwent successful operation. Among them, gross total resection of tumor was achieved in 6 cases and subtotal resection in 3 cases. No serious complications such as delayed hemorrhage, brain infection, and cerebrospinal fluid rhinorrhea occurred postoperatively. \u0000 \u0000 \u0000Conclusions \u0000In neuroendoscopic transnasal resection of the anterior skull base tumor, the application of multimodal image fusion technology combined with intraoperative neuronavigation can clearly show the location of tumor and its adjacent important structures, which helps improve the accuracy, safety, and effectiveness of the operation. \u0000 \u0000 \u0000Key words: \u0000Skull base neoplasms; Neurosurgical procedures; Neuronavigation; Natural orifice endoscopic surgery; Multimodal","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"17-20"},"PeriodicalIF":0.0,"publicationDate":"2020-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46833465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-28DOI: 10.3760/CMA.J.ISSN.1001-2346.2020.01.016
Bo Liu, Yongqing Zong, Xinyu Wang, H. Rong, Shiguang Zhu, T. Zhu, Jian-ning Zhang
Objective To discuss the anatomical characteristics of posterior cranial fossa and surgical outcomes in patients with Chiari Ⅰ malformation. Methods Thirty-eight patients diagnosed with Chiari I malformation were admitted to Department of Neurosurgery, General Hospital of Tianjin Medical University from January 2015 to December 2017 and retrospectively enrolled into the patient group of this study, whose clinical data were compared with those of 30 radiologically healthy persons (as controls) admitted to physical examination center of the same hospital during the same period. Two groups of people underwent cervical MRI scan and 3D reconstruction. Clivus length, Mcrae line, Twing line, length of squamousal part of occipital bone, basal angle, Boogard angle, cerebellar volume (CV), posterior cranial fossa volume (PV) and ratio of CV/PV were measured and their anatomical differences were compared between 2 groups according to volume analysis software. Thirty-seven patients were treated with posterior cranial fossa decompression and C1 laminectomy in patient group, and the remaining 1 patient did not undergo relevant treatment. All patients underwent follow-up in outpatient department, an imaging review of cranial-cervical junction MRI and assessment based on cervical Japanese Orthopaedic Association (JOA) scale to assess the improvement of syringomyelia-related symptoms. The outcomes were classified into excellent, good, stable and poor. Results There was no significant difference in age or gender (P>0.05). Compared with healthy control group, PV was decreased (170.7±10.7 mm3vs. 186.8±9.8 mm3), ratio of CV/PV was increased 0.755±0.042 vs. 0.682±0.036, clivus length was shortened (3.9±0.3 mm vs. 4.4±0.3 mm), and Boogard angle was increased (124.2±8.2° vs. 116.6±3.6°) in the patient group (all P 0.05). All 37 patients underwent successful operation. There were no cases of new neurological deficits or death after operation. At 12 weeks post surgery, the JOA score was improved compared with preoperative conditions (15.20±2.36 points vs.11.71±2.92 points. P<0.05). The follow-up duration of 37 patients was 15.2 ± 6.8 months and ranged from 6 to 30 months. At the last follow-up, the improvement rate of syringomyelia-related symptoms was 69.9±29.0%. The outcomes were determined as excellent in 20 (54.1%) patients, good in 11 (29.7%) and stable in 6 (16.2%). Conclusions The decrease of posterior fossa volume and increase of ratio of cerebellar volume and posterior cranial fossa volume could be important factors in Chiari Ⅰ malformation contributing to cerebellar tonsillar herniation. The surgery of posterior fossa decompression could effectively improve clinical symptoms. Key words: Arnold-Chiari malformation; Cranial fossa, posterior; Anatomy; Neurosurgical procedures; Treatment outcome
目的探讨ChiariⅠ畸形后颅窝的解剖特点及手术治疗效果。方法2015年1月至2017年12月，天津医科大学总医院神经外科收治38例Chiari I畸形患者，将其临床数据与同期入住同一医院体检中心的30名放射学健康人（作为对照）的临床数据进行比较。两组患者接受了颈部MRI扫描和3D重建。根据体积分析软件，测量两组的斜坡长度、Mcrae线、Twing线、枕骨鳞片部长度、基底角、Boogard角、小脑体积（CV）、后颅窝体积（PV）和CV/PV比值，并比较两组的解剖学差异。患者组37例接受后颅窝减压和C1椎板切除术治疗，其余1例未接受相关治疗。所有患者都在门诊接受了随访，对颅颈交界处MRI进行了影像学检查，并根据日本颈椎骨科协会（JOA）量表进行了评估，以评估脊髓空洞症相关症状的改善情况。结果分为优秀、良好、稳定和较差。结果与健康对照组相比，PV降低（170.7±10.7 mm3 vs.186.8±9.8 mm3），CV/PV比值增加0.755±0.042 vs.0.682±0.036，斜坡长度缩短（3.9±0.3 mm vs.4.4±0.3 mm），手术组Boogard角增加（124.2±8.2°vs.116.6±3.6°）（均P＜0.05）。术后无新的神经功能缺损或死亡病例。术后12周，JOA评分较术前有所改善（15.20±2.36分vs.11.71±2.92分，P<0.05）。37例患者的随访时间为15.2±6.8个月，随访时间为6至30个月。最后一次随访时脊髓空洞症相关症状的改善率为69.9±29.0%，良11例（29.7%），稳定6例（16.2%）。后颅窝减压手术能有效改善临床症状。关键词：Arnold-Chiari畸形；颅窝，后部；解剖学；神经外科手术；治疗结果
{"title":"Anatomical characteristics of posterior cranial fossa and surgical outcomes in patients with Chiari I malformation","authors":"Bo Liu, Yongqing Zong, Xinyu Wang, H. Rong, Shiguang Zhu, T. Zhu, Jian-ning Zhang","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.01.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.01.016","url":null,"abstract":"Objective \u0000To discuss the anatomical characteristics of posterior cranial fossa and surgical outcomes in patients with Chiari Ⅰ malformation. \u0000 \u0000 \u0000Methods \u0000Thirty-eight patients diagnosed with Chiari I malformation were admitted to Department of Neurosurgery, General Hospital of Tianjin Medical University from January 2015 to December 2017 and retrospectively enrolled into the patient group of this study, whose clinical data were compared with those of 30 radiologically healthy persons (as controls) admitted to physical examination center of the same hospital during the same period. Two groups of people underwent cervical MRI scan and 3D reconstruction. Clivus length, Mcrae line, Twing line, length of squamousal part of occipital bone, basal angle, Boogard angle, cerebellar volume (CV), posterior cranial fossa volume (PV) and ratio of CV/PV were measured and their anatomical differences were compared between 2 groups according to volume analysis software. Thirty-seven patients were treated with posterior cranial fossa decompression and C1 laminectomy in patient group, and the remaining 1 patient did not undergo relevant treatment. All patients underwent follow-up in outpatient department, an imaging review of cranial-cervical junction MRI and assessment based on cervical Japanese Orthopaedic Association (JOA) scale to assess the improvement of syringomyelia-related symptoms. The outcomes were classified into excellent, good, stable and poor. \u0000 \u0000 \u0000Results \u0000There was no significant difference in age or gender (P>0.05). Compared with healthy control group, PV was decreased (170.7±10.7 mm3vs. 186.8±9.8 mm3), ratio of CV/PV was increased 0.755±0.042 vs. 0.682±0.036, clivus length was shortened (3.9±0.3 mm vs. 4.4±0.3 mm), and Boogard angle was increased (124.2±8.2° vs. 116.6±3.6°) in the patient group (all P 0.05). All 37 patients underwent successful operation. There were no cases of new neurological deficits or death after operation. At 12 weeks post surgery, the JOA score was improved compared with preoperative conditions (15.20±2.36 points vs.11.71±2.92 points. P<0.05). The follow-up duration of 37 patients was 15.2 ± 6.8 months and ranged from 6 to 30 months. At the last follow-up, the improvement rate of syringomyelia-related symptoms was 69.9±29.0%. The outcomes were determined as excellent in 20 (54.1%) patients, good in 11 (29.7%) and stable in 6 (16.2%). \u0000 \u0000 \u0000Conclusions \u0000The decrease of posterior fossa volume and increase of ratio of cerebellar volume and posterior cranial fossa volume could be important factors in Chiari Ⅰ malformation contributing to cerebellar tonsillar herniation. The surgery of posterior fossa decompression could effectively improve clinical symptoms. \u0000 \u0000 \u0000Key words: \u0000Arnold-Chiari malformation; Cranial fossa, posterior; Anatomy; Neurosurgical procedures; Treatment outcome","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"64-68"},"PeriodicalIF":0.0,"publicationDate":"2020-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42486195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-28DOI: 10.3760/CMA.J.ISSN.1001-2346.2020.01.017
Xiaoning Lin, Xinhua Tian, J. Tong, Xiaolin Du, Xiangyang Wang, Luyue Chen, Guijiang Dong, Yanlin Huang
Objective To investigate the effects of early cranioplasty post decompressive craniectomy on the outcomes of traumatic brain injury in adult patients. Methods A retrospective analysis was conducted on the clinical data of 72 adult postoperative patients with traumatic brain injury who were admitted to Department of Neurosurgery, Zhongshan Hospital, Xiamen University from January 2015 to June 2017. According to the timing of cranioplasty, the patients were divided into early group (≤3 months after operation, 30 cases) and conventional group (>3 months after operation, 42 cases). The differences in the Glasgow outcome scale (GOS) score, Karnofsky performance scale(KPS) score and mini-mental state examination(MMSE) score between the two groups were compared at 6 months postoperatively, and the rates of postoperative complications were also compared. Results Compared with the conventional group, the GOS change values [the median(lower interquartile, upper interquartile): 1.0(1.0, 1.0)points vs. 1.0(0, 1.0)points], postoperative KPS (70.3±23.3 points vs. 58.8±17.3 points) and MMSE scores (21.0±7.7 points vs. 17.5±6.2 points) were significantly improved in the early group, and the differences were statistically significant (all P 0.05). Conclusion Compared with cranioplasty at 3 months post operation, early cranioplasty does not seem to increase the incidence of postoperative complications and has more significant improvement in the outcomes of patients. Key words: Craniocerebral trauma; Cranioplasty; Decompressive craniectomy; Early; Prognosis
{"title":"Relationship between early cranioplasty and outcomes of traumatic brain injury in adult patients","authors":"Xiaoning Lin, Xinhua Tian, J. Tong, Xiaolin Du, Xiangyang Wang, Luyue Chen, Guijiang Dong, Yanlin Huang","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.01.017","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.01.017","url":null,"abstract":"Objective \u0000To investigate the effects of early cranioplasty post decompressive craniectomy on the outcomes of traumatic brain injury in adult patients. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was conducted on the clinical data of 72 adult postoperative patients with traumatic brain injury who were admitted to Department of Neurosurgery, Zhongshan Hospital, Xiamen University from January 2015 to June 2017. According to the timing of cranioplasty, the patients were divided into early group (≤3 months after operation, 30 cases) and conventional group (>3 months after operation, 42 cases). The differences in the Glasgow outcome scale (GOS) score, Karnofsky performance scale(KPS) score and mini-mental state examination(MMSE) score between the two groups were compared at 6 months postoperatively, and the rates of postoperative complications were also compared. \u0000 \u0000 \u0000Results \u0000Compared with the conventional group, the GOS change values [the median(lower interquartile, upper interquartile): 1.0(1.0, 1.0)points vs. 1.0(0, 1.0)points], postoperative KPS (70.3±23.3 points vs. 58.8±17.3 points) and MMSE scores (21.0±7.7 points vs. 17.5±6.2 points) were significantly improved in the early group, and the differences were statistically significant (all P 0.05). \u0000 \u0000 \u0000Conclusion \u0000Compared with cranioplasty at 3 months post operation, early cranioplasty does not seem to increase the incidence of postoperative complications and has more significant improvement in the outcomes of patients. \u0000 \u0000 \u0000Key words: \u0000Craniocerebral trauma; Cranioplasty; Decompressive craniectomy; Early; Prognosis","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"69-72"},"PeriodicalIF":0.0,"publicationDate":"2020-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48851801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To evaluate the preliminary application of three dimensional T1-weighted sampling perfection with application-optimized contrasts by using different flip angle evolutions (3D T1-SPACE) combined with three dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA) in the follow-up for the intracranial aneurysm treated with Pipeline Flex embolization device (FD). Methods A total of 20 patients with 25 intracranial aneurysms were treated with Pipeline Flex embolization at the Department of Cerebrovascular Intervention, People′s Hospital of Zhengzhou University, Henan Provincial People′s Hospital from September 2018 to April 2019 and were prospectively enrolled. All patients were followed up with 3.0T 3D T1-SPACE sequence, 3D-TOF MRA and digital subtraction angiography (DSA) examination. O′kelly-Marotta (OKM) grading scale was used to evaluate the aneurysm residual and the four-point scale was used to evaluate the in-stent lumen visibility. Results The follow-up period for all patients was 6.0±0.8 months (range: 4-7 months). The OKM scale of all aneurysms evaluated by DSA indicated 18 patients with grade D, 2 patients with grade C and 5 patients with grade B. For aneurysms evaluated by 3D-TOF MRA combined with source image, the results showed grade D in 19 patients, C in 2 and B in 4. The overall concordance rate between 3D-TOF MRA and DSA was 88.0% (22/25). Taking DSA as standard(grade 4), the four-point scale of in-stent lumen of all 20 patients treated with 23 Pipeline Flex embolization devices and evaluated by 3D-TOF MRA indicated grade 3 in 16 stents, 2 in 6 and 1 in 1. No one showed the same as DSA results. However, grade 4 was revealed in 21 stents and 3 in 2 based on the evaluation by 3D T1-SPACE. The total concordance rate of 3D T1-SPACE and DSA was 91.3% (21/23). Conclusions Preliminary observations show that compared with DSA, 3D-TOF MRA could better assess the aneurysmal occlusion after FD treatment of intracranial aneurysms. The 3D T1-SPACE sequence shows the in-stent lumen clearly. The combination of the two sequences can be used for follow-up after FD treatment of intracranial aneurysms. Key words: Intracranial aneurysm; Magnetic resonance imaging; Follow-up study; Flow diverter device
{"title":"Preliminary study of 3D T1-SPACE combined with 3D-TOF MRA in the follow-up for the intracranial aneurysm treated with Pipeline Flex embolization device","authors":"Qiuji Shao, Qiang Li, Tianxiao Li, Li Li, Kaitao Chang, Qiaowei Wu","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.01.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.01.014","url":null,"abstract":"Objective \u0000To evaluate the preliminary application of three dimensional T1-weighted sampling perfection with application-optimized contrasts by using different flip angle evolutions (3D T1-SPACE) combined with three dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA) in the follow-up for the intracranial aneurysm treated with Pipeline Flex embolization device (FD). \u0000 \u0000 \u0000Methods \u0000A total of 20 patients with 25 intracranial aneurysms were treated with Pipeline Flex embolization at the Department of Cerebrovascular Intervention, People′s Hospital of Zhengzhou University, Henan Provincial People′s Hospital from September 2018 to April 2019 and were prospectively enrolled. All patients were followed up with 3.0T 3D T1-SPACE sequence, 3D-TOF MRA and digital subtraction angiography (DSA) examination. O′kelly-Marotta (OKM) grading scale was used to evaluate the aneurysm residual and the four-point scale was used to evaluate the in-stent lumen visibility. \u0000 \u0000 \u0000Results \u0000The follow-up period for all patients was 6.0±0.8 months (range: 4-7 months). The OKM scale of all aneurysms evaluated by DSA indicated 18 patients with grade D, 2 patients with grade C and 5 patients with grade B. For aneurysms evaluated by 3D-TOF MRA combined with source image, the results showed grade D in 19 patients, C in 2 and B in 4. The overall concordance rate between 3D-TOF MRA and DSA was 88.0% (22/25). Taking DSA as standard(grade 4), the four-point scale of in-stent lumen of all 20 patients treated with 23 Pipeline Flex embolization devices and evaluated by 3D-TOF MRA indicated grade 3 in 16 stents, 2 in 6 and 1 in 1. No one showed the same as DSA results. However, grade 4 was revealed in 21 stents and 3 in 2 based on the evaluation by 3D T1-SPACE. The total concordance rate of 3D T1-SPACE and DSA was 91.3% (21/23). \u0000 \u0000 \u0000Conclusions \u0000Preliminary observations show that compared with DSA, 3D-TOF MRA could better assess the aneurysmal occlusion after FD treatment of intracranial aneurysms. The 3D T1-SPACE sequence shows the in-stent lumen clearly. The combination of the two sequences can be used for follow-up after FD treatment of intracranial aneurysms. \u0000 \u0000 \u0000Key words: \u0000Intracranial aneurysm; Magnetic resonance imaging; Follow-up study; Flow diverter device","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"52-57"},"PeriodicalIF":0.0,"publicationDate":"2020-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44112336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-28DOI: 10.3760/CMA.J.ISSN.1001-2346.2020.01.010
Zhen Chen, Song Zhang, Yazhou Jin, Chao Liu, Dongdong Li, Linyu Wang, Xinbin Guo, Haowen Xu, S. Guan
Objective To compare the safety and efficiency of stent assisted coiling (SAC) with non-SAC for the management of ruptured intracranial aneurysms. Methods A total of 1 217 patients with ruptured intracranial aneurysms who underwent endovascular treatment at Neurointervention Department of the First Affiliated Hospital of Zhengzhou University from January 2011 to January 2018 were retrospectively enrolled. Patients were categorized into SAC (n=631) and non-SAC (n=586) groups. We retrospectively analyzed the immediate postoperative occlusion degree and that at follow-up (based on Raymond scale) as well as perioperative complication rate in the two groups. The difference was considered as significant with P<0.05. Results In SAC group, the Raymond grades were grade Ⅰ in 65.0% (n=410), grade II in 29.9% (n=189) and grade Ⅲ in 5.0% (n=32), while those in non-SAC group were grade Ⅰ in 51.4% (n=301), grade Ⅱ in 36.0% (n=211) and grade Ⅲ in 12.6% (n=74), and the inter-group difference was significant (P 0.05). At 12 months post operation, DSA was performed in 227 cases of SAC group and 102 cases of non-SAC group. In SAC group, the Raymond grades were grade Ⅰ in 71.8% (n=163), grade Ⅱ in 22.9% (n=52) and grade Ⅲ in 5.3% (n=12), while those in non-SAC group were grade Ⅰ in 53.9 % (n=55), grade Ⅱ in 34.3% (n=35) and grade Ⅲ in 11.8% (n=12). The recurrence rate was 11.9% (n=27) in SAC group and 38.2% (n=39) in non-SAC group. Those inter-group differences were significant (P<0.01). Conclusions Compared with non-SAC, SAC is associated with higher occlusion rate, lower recurrence rate, lower rebleeding rate and relatively higher rate of ischemic event. However, mortality and disability rate between two groups do not seem to differ. Key words: Aneurysm, ruptured; Embolization, therapeutic; Stents; Treatment outcome; Coils
{"title":"Stent assisted coiling versus non-stent coiling for the management of ruptured intracranial aneurysms: A outcome comparison study","authors":"Zhen Chen, Song Zhang, Yazhou Jin, Chao Liu, Dongdong Li, Linyu Wang, Xinbin Guo, Haowen Xu, S. Guan","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.01.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.01.010","url":null,"abstract":"Objective \u0000To compare the safety and efficiency of stent assisted coiling (SAC) with non-SAC for the management of ruptured intracranial aneurysms. \u0000 \u0000 \u0000Methods \u0000A total of 1 217 patients with ruptured intracranial aneurysms who underwent endovascular treatment at Neurointervention Department of the First Affiliated Hospital of Zhengzhou University from January 2011 to January 2018 were retrospectively enrolled. Patients were categorized into SAC (n=631) and non-SAC (n=586) groups. We retrospectively analyzed the immediate postoperative occlusion degree and that at follow-up (based on Raymond scale) as well as perioperative complication rate in the two groups. The difference was considered as significant with P<0.05. \u0000 \u0000 \u0000Results \u0000In SAC group, the Raymond grades were grade Ⅰ in 65.0% (n=410), grade II in 29.9% (n=189) and grade Ⅲ in 5.0% (n=32), while those in non-SAC group were grade Ⅰ in 51.4% (n=301), grade Ⅱ in 36.0% (n=211) and grade Ⅲ in 12.6% (n=74), and the inter-group difference was significant (P 0.05). At 12 months post operation, DSA was performed in 227 cases of SAC group and 102 cases of non-SAC group. In SAC group, the Raymond grades were grade Ⅰ in 71.8% (n=163), grade Ⅱ in 22.9% (n=52) and grade Ⅲ in 5.3% (n=12), while those in non-SAC group were grade Ⅰ in 53.9 % (n=55), grade Ⅱ in 34.3% (n=35) and grade Ⅲ in 11.8% (n=12). The recurrence rate was 11.9% (n=27) in SAC group and 38.2% (n=39) in non-SAC group. Those inter-group differences were significant (P<0.01). \u0000 \u0000 \u0000Conclusions \u0000Compared with non-SAC, SAC is associated with higher occlusion rate, lower recurrence rate, lower rebleeding rate and relatively higher rate of ischemic event. However, mortality and disability rate between two groups do not seem to differ. \u0000 \u0000 \u0000Key words: \u0000Aneurysm, ruptured; Embolization, therapeutic; Stents; Treatment outcome; Coils","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"38-43"},"PeriodicalIF":0.0,"publicationDate":"2020-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44887725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-28DOI: 10.3760/CMA.J.ISSN.1001-2346.2020.01.002
Zhengyuan Chen, Xuefei Shou, Ming Shen, Wenqiang He, Keyi Zhang, Yao Zhao, Shiqi Li, P. Zhong, Yongfei Wang
Objective To summarize the reconstruction strategy and efficacy for skull base defect in endoscopic endonasal skull base tumor resection. Methods The clinical outcomes of 202 patients with skull base defect who underwent endoscopic tumor resection at Department of Neurosurgery, Huashan Hospital, Fudan University from April 2011 to February 2016 were retrospectively analyzed. Skull base defects were intraoperatively classified into Ⅰ-Ⅲ grades based on the diameter of dura defect and flow of cerebrospinal fluid (CSF), and corresponding reconstruction strategies were adopted. Results The classification result of 202 skull base defects was 15.8%(32 cases) in Grade Ⅰ, 24.3%(49 cases) in Grade Ⅱ and 59.9%(121 cases) in Grade Ⅲ. Six patients (3.0%) had postoperative CSF rhinorrhea, which resolved following secondary endoscopic repair surgery. Four patients (2.0%) had intracranial infection which was finally cured by antibiotics medication. One elderly patient (0.5%) died of pulmonary infection after prolonged bed rest after surgery. Conclusions Endoscopic surgery seems safe and effective for the reconstruction of skull base defect. The occurrence of postoperative CSF leakage could be effectively avoided when specific reconstruction strategy is adopted according to the classification of skull base defect. Key words: Natural orifice endoscopic surgery; Skull base neoplasms; Reconstructive surgical procedures; Skull base defect
{"title":"Clinical outcomes of intraoperative skull base reconstruction in endoscopic endonasal skull base tumor resection","authors":"Zhengyuan Chen, Xuefei Shou, Ming Shen, Wenqiang He, Keyi Zhang, Yao Zhao, Shiqi Li, P. Zhong, Yongfei Wang","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.01.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.01.002","url":null,"abstract":"Objective \u0000To summarize the reconstruction strategy and efficacy for skull base defect in endoscopic endonasal skull base tumor resection. \u0000 \u0000 \u0000Methods \u0000The clinical outcomes of 202 patients with skull base defect who underwent endoscopic tumor resection at Department of Neurosurgery, Huashan Hospital, Fudan University from April 2011 to February 2016 were retrospectively analyzed. Skull base defects were intraoperatively classified into Ⅰ-Ⅲ grades based on the diameter of dura defect and flow of cerebrospinal fluid (CSF), and corresponding reconstruction strategies were adopted. \u0000 \u0000 \u0000Results \u0000The classification result of 202 skull base defects was 15.8%(32 cases) in Grade Ⅰ, 24.3%(49 cases) in Grade Ⅱ and 59.9%(121 cases) in Grade Ⅲ. Six patients (3.0%) had postoperative CSF rhinorrhea, which resolved following secondary endoscopic repair surgery. Four patients (2.0%) had intracranial infection which was finally cured by antibiotics medication. One elderly patient (0.5%) died of pulmonary infection after prolonged bed rest after surgery. \u0000 \u0000 \u0000Conclusions \u0000Endoscopic surgery seems safe and effective for the reconstruction of skull base defect. The occurrence of postoperative CSF leakage could be effectively avoided when specific reconstruction strategy is adopted according to the classification of skull base defect. \u0000 \u0000 \u0000Key words: \u0000Natural orifice endoscopic surgery; Skull base neoplasms; Reconstructive surgical procedures; Skull base defect","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"2-6"},"PeriodicalIF":0.0,"publicationDate":"2020-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47245331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-28DOI: 10.3760/CMA.J.ISSN.1001-2346.2020.01.004
Gong Chen, Lijun Chen, Minglei Wang, Binbin Xu, Rong-Juan Zhang, B. Leng
Objective To investigate the role of neurointerventional technique in the diagnosis and treatment of cranial and spinal rich-vascularized tumor (RVT). Methods A retrospective analysis was conducted on the clinical data of 234 cases of RVT admitted to Department of Neurosurgery, Shanghai Putuo District People′s Hospital from January 2008 to December 2017. All patients underwent head CT, MRI, CT angiography (CTA) or magnetic resonance angiography (MRA) before surgery, and were initially judged as suspected RVT. Afterwards, digital subtraction angiography (DSA) was performed to evaluate the blood flow, arteriovenous distribution and involvement of the tumor, and further neurological intervention was performed for patients who met the embolization indication. Postoperative DSA was used to evaluate the embolization effect, which was divided into 4 grades (excellent, good, fair, poor). Tumor resection was performed 1 day or 6 to 9 days after embolization. According to whether the patient was treated with interventional therapy, he/she was divided into interventional treatment group and non-intervention treatment group. The intraoperative blood loss, postoperative complication rate and complete tumor resection rate were compared between the two groups. Results Of the 234 patients, 56 (23.9%) did not need embolization, and 178 (76.1%) required embolization, of which 127 (71.3%) had vessels suitable for embolization, and 51 (28.7%) had no suitable vessels. The embolization results of 127 patients were excellent in 34 cases (26.7%), 62 cases (48.8%) were good, 26 cases (20.5%) were fair, and 5 cases (4.0%) were poor. The overall embolization rate was 96.1% (122/127). Complications occurred in 3 patients after operation, 2 of which were transient neurological damage and 1 was stroke. Of the 234 patients, 127 were in the interventional group and 107 were in the non-intervention group. There were no significant differences in gender, age, surgical approach or pathological type between the two groups (all P>0.05). Compared with patients without interventional therapy, the intraoperative blood loss was lower in the intervention group (571.3±100.3 ml vs. 1 020.4±267.9 ml, P<0.001), and the postoperative complication rate was lower [4.7%(6/127) vs. 12.1%(13/107), P=0.038] and the tumor resection rate was higher [91.3%(116/127) vs. 80.4%(86/107), P=0.015]. Conclusions The neurointerventional technique seems safe and effective in the evaluation and treatment of RVT, which could decrease intraoperative blood loss, improve the rate of total resection and reduce related postoperative complications. Key words: Brain; Spine; Embolization, therapeutre; Rich-vascularized tumor
{"title":"Application of neurointerventional technique in treatment of rich-vascularized tumor: A report of 234 cases","authors":"Gong Chen, Lijun Chen, Minglei Wang, Binbin Xu, Rong-Juan Zhang, B. Leng","doi":"10.3760/CMA.J.ISSN.1001-2346.2020.01.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2020.01.004","url":null,"abstract":"Objective \u0000To investigate the role of neurointerventional technique in the diagnosis and treatment of cranial and spinal rich-vascularized tumor (RVT). \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was conducted on the clinical data of 234 cases of RVT admitted to Department of Neurosurgery, Shanghai Putuo District People′s Hospital from January 2008 to December 2017. All patients underwent head CT, MRI, CT angiography (CTA) or magnetic resonance angiography (MRA) before surgery, and were initially judged as suspected RVT. Afterwards, digital subtraction angiography (DSA) was performed to evaluate the blood flow, arteriovenous distribution and involvement of the tumor, and further neurological intervention was performed for patients who met the embolization indication. Postoperative DSA was used to evaluate the embolization effect, which was divided into 4 grades (excellent, good, fair, poor). Tumor resection was performed 1 day or 6 to 9 days after embolization. According to whether the patient was treated with interventional therapy, he/she was divided into interventional treatment group and non-intervention treatment group. The intraoperative blood loss, postoperative complication rate and complete tumor resection rate were compared between the two groups. \u0000 \u0000 \u0000Results \u0000Of the 234 patients, 56 (23.9%) did not need embolization, and 178 (76.1%) required embolization, of which 127 (71.3%) had vessels suitable for embolization, and 51 (28.7%) had no suitable vessels. The embolization results of 127 patients were excellent in 34 cases (26.7%), 62 cases (48.8%) were good, 26 cases (20.5%) were fair, and 5 cases (4.0%) were poor. The overall embolization rate was 96.1% (122/127). Complications occurred in 3 patients after operation, 2 of which were transient neurological damage and 1 was stroke. Of the 234 patients, 127 were in the interventional group and 107 were in the non-intervention group. There were no significant differences in gender, age, surgical approach or pathological type between the two groups (all P>0.05). Compared with patients without interventional therapy, the intraoperative blood loss was lower in the intervention group (571.3±100.3 ml vs. 1 020.4±267.9 ml, P<0.001), and the postoperative complication rate was lower [4.7%(6/127) vs. 12.1%(13/107), P=0.038] and the tumor resection rate was higher [91.3%(116/127) vs. 80.4%(86/107), P=0.015]. \u0000 \u0000 \u0000Conclusions \u0000The neurointerventional technique seems safe and effective in the evaluation and treatment of RVT, which could decrease intraoperative blood loss, improve the rate of total resection and reduce related postoperative complications. \u0000 \u0000 \u0000Key words: \u0000Brain; Spine; Embolization, therapeutre; Rich-vascularized tumor","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"11-16"},"PeriodicalIF":0.0,"publicationDate":"2020-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48064298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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