Pub Date : 2019-11-28DOI: 10.3760/CMA.J.ISSN.1001-2346.2019.11.003
Yu-jun Liao, Ziwei Fang, Zhenwei Yao, Bin Xu
Objective To assess postoperative revascularization of adult patients with Moyamoya disease (MMD) operated on with different surgical methods using the technology of MRI territory arterial spin labeling (T-ASL). Methods The clinical data of 84 adult MMD patients surgically treated at Department of Neurosurgery, Huashan Hospital, Fudan University from June 2018 to December 2018 were reviewed. Seventy patients received superficial temporal artery to middle cerebral artery bypass (STA-MCA bypass) combined with encephalo-duro-myo-synangiosis (EDMS) and were categorized into combined-bypass group. Fourteen patients underwent merely EDMS and categorized into indirect-bypass group. Digital subtraction angiography (DSA) and T-ASL were performed pre- and postoperatively. Matsushima staging system was applied to assess the outcome of revascularization. T-ASL scan used to investigate the revascularization area (RA) and perfusion of deep brain structures by external carotid artery (ECA) on operated side. Results The follow-up period of 84 patients ranged from 4 to 8 months (mean: 6.3±1.2 months). There was no difference in baseline data (sex, age, clinical presentations, and pre-surgical spontaneous collaterals), peri-operative complications, postoperative stroke control rate, Matsushima stage (grade A or B) between 2 groups (P>0.05). The volume of RA in combined-bypass group was larger than that in indirect-bypass group (101.5 ± 35.5 ml vs. 45.3 ± 14.2 ml, P<0.01). In the combined group, 81.4% (57/70) of operated ECA could perfuse deep structures such as basal ganglia and thalamus, compared with 2/14 in the control group (P<0.01). Conclusions The T-ASL results have suggested that RA of combined bypass seems larger and deeper than that of indirect bypass. T-ASL could an objective and sensitive method to evaluate surgical results of adult MMD in terms of RA volume and spatial distribution. Key words: Moyamoya disease; Cerebral revascularization; Territory arterial spin labeling; Treatment outcome
{"title":"Assessment of postoperative revascularization of adult patients with Moyamoya disease using MRI territory arterial spin labeling","authors":"Yu-jun Liao, Ziwei Fang, Zhenwei Yao, Bin Xu","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.11.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.11.003","url":null,"abstract":"Objective \u0000To assess postoperative revascularization of adult patients with Moyamoya disease (MMD) operated on with different surgical methods using the technology of MRI territory arterial spin labeling (T-ASL). \u0000 \u0000 \u0000Methods \u0000The clinical data of 84 adult MMD patients surgically treated at Department of Neurosurgery, Huashan Hospital, Fudan University from June 2018 to December 2018 were reviewed. Seventy patients received superficial temporal artery to middle cerebral artery bypass (STA-MCA bypass) combined with encephalo-duro-myo-synangiosis (EDMS) and were categorized into combined-bypass group. Fourteen patients underwent merely EDMS and categorized into indirect-bypass group. Digital subtraction angiography (DSA) and T-ASL were performed pre- and postoperatively. Matsushima staging system was applied to assess the outcome of revascularization. T-ASL scan used to investigate the revascularization area (RA) and perfusion of deep brain structures by external carotid artery (ECA) on operated side. \u0000 \u0000 \u0000Results \u0000The follow-up period of 84 patients ranged from 4 to 8 months (mean: 6.3±1.2 months). There was no difference in baseline data (sex, age, clinical presentations, and pre-surgical spontaneous collaterals), peri-operative complications, postoperative stroke control rate, Matsushima stage (grade A or B) between 2 groups (P>0.05). The volume of RA in combined-bypass group was larger than that in indirect-bypass group (101.5 ± 35.5 ml vs. 45.3 ± 14.2 ml, P<0.01). In the combined group, 81.4% (57/70) of operated ECA could perfuse deep structures such as basal ganglia and thalamus, compared with 2/14 in the control group (P<0.01). \u0000 \u0000 \u0000Conclusions \u0000The T-ASL results have suggested that RA of combined bypass seems larger and deeper than that of indirect bypass. T-ASL could an objective and sensitive method to evaluate surgical results of adult MMD in terms of RA volume and spatial distribution. \u0000 \u0000 \u0000Key words: \u0000Moyamoya disease; Cerebral revascularization; Territory arterial spin labeling; Treatment outcome","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1089-1093"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44827108","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 : 2019-11-28DOI: 10.3760/CMA.J.ISSN.1001-2346.2019.11.020
Zhang Liang, Li Peidong, Jie Yang, Tong Luqing, Yi Li, Liu Jiabo, Zhang Jinhao, Zhang Yiming, Wang Xuya, Yang Xuejun
Objective To explore the molecular mechanism through which miR-32 affects the proliferation and invasion of glioma cells by targeting KLF4. Methods The expression of miR-32 in glial cell lines (HA) and glioma cell lines (U87, U373MG, U251) was detected by real-time quantitative PCR (RT-qPCR). The effects of miR-32 on U87 glioma cell lines were detected by cell proliferation (MTT), cell invasion and scratch assay. Afterwards, the target gene of miR-32 was found by the Target Scan Human 7.1 online detection system and verified by the dual luciferase reporter assay. After successful verification, the RT-qPCR and Western blot (WB) assay were used to determine the regulation of target gene KLF4 mRNA by miR-32, and the effects of target gene KLF4 on glioma cell lines were detected by MTT, cell invasion and scratch assay. Finally, rescue experiments were used to explore how miR-32 regulated the target gene KLF4 and thus affected the proliferation and invasion of glioma. Results The results of RT-qPCR showed that the expression levels of miR-32 in U87, U373MG and U251 cells were significantly higher than those in HA cells (all P<0.01). Compared with the group transfected with miRNA-NC, the miR-32 expression level, proliferation, invasion and migration ability of U87 cells were significantly up-regulated in the group transfected with miR-32 mimic (all P<0.05). The expression levels of miR-32, proliferation, invasion and migration were significantly down-regulated in the group transfected with miR-32 inhibitor (all P<0.05). The bioinformatics and dual luciferase reporter results showed that KLF4 was a target gene of miR-32, and when miR-32 was overexpressed, the cell luciferase activity was significantly decreased, and the expression of KLF4 was down-regulated. When miR-32 was silenced, the luciferase activity was significantly increased, and the expression of KLF4 was up-regulated. The expression of KLF4 in U87, U373MG and U251 cells was significantly lower than that in HA cell lines (all P<0.01). The proliferation, invasion and migration of glioma cell lines were inhibited when KLF4 was highly expressed. The rescue experiments showed that KLF4 silencing reversed the down-regulation of proliferation and invasion of glioma cell induced by miR-32 silencing. Overexpression of KLF4 reversed the promotion of proliferation and invasion of glioma cells induced by miR-32 overexpression. Conclusion miR-32 promoted proliferation and invasion of glioma cells by inhibiting the expression of its target gene KLF4. Key words: Glioma; Cell proliferation; Neoplasm invasiveness; miR-32; KLF4
目的探讨miR-32靶向KLF4影响胶质瘤细胞增殖和侵袭的分子机制。方法采用实时荧光定量PCR (RT-qPCR)检测miR-32在胶质细胞系(HA)和胶质瘤细胞系(U87、U373MG、U251)中的表达。通过细胞增殖(MTT)、细胞侵袭和划痕实验检测miR-32对U87胶质瘤细胞系的影响。随后，通过target Scan Human 7.1在线检测系统发现miR-32的靶基因，并通过双荧光素酶报告基因实验进行验证。验证成功后，采用RT-qPCR和Western blot (WB)检测miR-32对靶基因KLF4 mRNA的调控作用，并采用MTT、细胞侵袭和划痕实验检测靶基因KLF4对胶质瘤细胞株的影响。最后通过挽救实验探讨miR-32如何调控靶基因KLF4从而影响胶质瘤的增殖和侵袭。结果RT-qPCR结果显示，miR-32在U87、U373MG和U251细胞中的表达水平均显著高于HA细胞(P<0.01)。与转染miRNA-NC组比较，转染miR-32 mimic组U87细胞的miR-32表达水平、增殖、侵袭和迁移能力均显著上调(均P<0.05)。转染miR-32 inhibitor组miR-32的表达水平、增殖、侵袭和迁移水平均显著下调(P<0.05)。生物信息学和双荧光素酶报告结果显示，KLF4是miR-32的靶基因，当miR-32过表达时，细胞荧光素酶活性显著降低，KLF4表达下调。miR-32沉默后，荧光素酶活性显著升高，KLF4表达上调。KLF4在U87、U373MG和U251细胞中的表达均显著低于HA细胞(均P<0.01)。高表达KLF4可抑制胶质瘤细胞系的增殖、侵袭和迁移。拯救实验表明KLF4沉默逆转了miR-32沉默诱导的胶质瘤细胞增殖和侵袭的下调。KLF4过表达逆转了miR-32过表达诱导的胶质瘤细胞增殖和侵袭的促进作用。结论miR-32通过抑制其靶基因KLF4的表达促进胶质瘤细胞的增殖和侵袭。关键词:胶质瘤;细胞增殖;肿瘤侵袭性;miR-32;KLF4
{"title":"miR-32 promotes proliferation and invasion of glioma by inhibiting the target gene KLF4","authors":"Zhang Liang, Li Peidong, Jie Yang, Tong Luqing, Yi Li, Liu Jiabo, Zhang Jinhao, Zhang Yiming, Wang Xuya, Yang Xuejun","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.11.020","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.11.020","url":null,"abstract":"Objective \u0000To explore the molecular mechanism through which miR-32 affects the proliferation and invasion of glioma cells by targeting KLF4. \u0000 \u0000 \u0000Methods \u0000The expression of miR-32 in glial cell lines (HA) and glioma cell lines (U87, U373MG, U251) was detected by real-time quantitative PCR (RT-qPCR). The effects of miR-32 on U87 glioma cell lines were detected by cell proliferation (MTT), cell invasion and scratch assay. Afterwards, the target gene of miR-32 was found by the Target Scan Human 7.1 online detection system and verified by the dual luciferase reporter assay. After successful verification, the RT-qPCR and Western blot (WB) assay were used to determine the regulation of target gene KLF4 mRNA by miR-32, and the effects of target gene KLF4 on glioma cell lines were detected by MTT, cell invasion and scratch assay. Finally, rescue experiments were used to explore how miR-32 regulated the target gene KLF4 and thus affected the proliferation and invasion of glioma. \u0000 \u0000 \u0000Results \u0000The results of RT-qPCR showed that the expression levels of miR-32 in U87, U373MG and U251 cells were significantly higher than those in HA cells (all P<0.01). Compared with the group transfected with miRNA-NC, the miR-32 expression level, proliferation, invasion and migration ability of U87 cells were significantly up-regulated in the group transfected with miR-32 mimic (all P<0.05). The expression levels of miR-32, proliferation, invasion and migration were significantly down-regulated in the group transfected with miR-32 inhibitor (all P<0.05). The bioinformatics and dual luciferase reporter results showed that KLF4 was a target gene of miR-32, and when miR-32 was overexpressed, the cell luciferase activity was significantly decreased, and the expression of KLF4 was down-regulated. When miR-32 was silenced, the luciferase activity was significantly increased, and the expression of KLF4 was up-regulated. The expression of KLF4 in U87, U373MG and U251 cells was significantly lower than that in HA cell lines (all P<0.01). The proliferation, invasion and migration of glioma cell lines were inhibited when KLF4 was highly expressed. The rescue experiments showed that KLF4 silencing reversed the down-regulation of proliferation and invasion of glioma cell induced by miR-32 silencing. Overexpression of KLF4 reversed the promotion of proliferation and invasion of glioma cells induced by miR-32 overexpression. \u0000 \u0000 \u0000Conclusion \u0000miR-32 promoted proliferation and invasion of glioma cells by inhibiting the expression of its target gene KLF4. \u0000 \u0000 \u0000Key words: \u0000Glioma; Cell proliferation; Neoplasm invasiveness; miR-32; KLF4","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1167-1173"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41445214","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 : 2019-11-28DOI: 10.3760/CMA.J.ISSN.1001-2346.2019.11.005
Li Li, Tianxiao Li, Qiuji Shao, Liang-fu Zhu, Jiang-yu Xue, Zi-liang Wang, W. Bai, Du Guangming
Objective To summarize the short-term therapeutic effect and safety of flow diverter (FD) in the treatment of small unruptured intracranial aneurysms. Methods From April 2014 to March 2019, clinical data were collected from 110 patients with 145 small (diameter < 10 mm) unruptured intracranial aneurysms who were admitted to Department of Neurosurgery, People′s Hospital of Zhengzhou University. Among those, 133 aneurysms were treated with FD alone and 12 aneurysms were treated with FD combined with coiling. Radiological outcomes were assessed based on the Raymond grading. Clinical outcomes were assessed based on the modified Rankin scale score (mRS). Results A total of 121 FD were used for 145 aneurysms. The successful rate of stent implantation was 99% (120/121). For 17 FD, balloon dilatation or massage were performed for better cell opening and wall apposition. There were no hemorrhagic complications. Ischemic complications occurred in 5 cases (4.5%). At 6 months post surgery, DSA results showed that Raymond grade Ⅰ embolism rate was 67.6% (50/74). Asymptomatic stenosis of parent artery was found in 2 cases. The 6-month follow-up results showed the mRS score of 0 in 101 cases, 1 in 4 cases, 2 in 3 cases, and 4 in 1 case and 5 in 1 case. Conclusions Treatment of small unruptured intracranial aneurysms with FD is associated with high success rate and safety. The 6-month follow-up results seem satisfactory and the long-term treatment results still need further follow-up. Key words: Intracranial aneurysm; Treatment outcome; Flow diverter; Unruptured; Small
{"title":"Short-term therapeutic effect of flow diverter on small unruptured intracranial aneurysms","authors":"Li Li, Tianxiao Li, Qiuji Shao, Liang-fu Zhu, Jiang-yu Xue, Zi-liang Wang, W. Bai, Du Guangming","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.11.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.11.005","url":null,"abstract":"Objective \u0000To summarize the short-term therapeutic effect and safety of flow diverter (FD) in the treatment of small unruptured intracranial aneurysms. \u0000 \u0000 \u0000Methods \u0000From April 2014 to March 2019, clinical data were collected from 110 patients with 145 small (diameter < 10 mm) unruptured intracranial aneurysms who were admitted to Department of Neurosurgery, People′s Hospital of Zhengzhou University. Among those, 133 aneurysms were treated with FD alone and 12 aneurysms were treated with FD combined with coiling. Radiological outcomes were assessed based on the Raymond grading. Clinical outcomes were assessed based on the modified Rankin scale score (mRS). \u0000 \u0000 \u0000Results \u0000A total of 121 FD were used for 145 aneurysms. The successful rate of stent implantation was 99% (120/121). For 17 FD, balloon dilatation or massage were performed for better cell opening and wall apposition. There were no hemorrhagic complications. Ischemic complications occurred in 5 cases (4.5%). At 6 months post surgery, DSA results showed that Raymond grade Ⅰ embolism rate was 67.6% (50/74). Asymptomatic stenosis of parent artery was found in 2 cases. The 6-month follow-up results showed the mRS score of 0 in 101 cases, 1 in 4 cases, 2 in 3 cases, and 4 in 1 case and 5 in 1 case. \u0000 \u0000 \u0000Conclusions \u0000Treatment of small unruptured intracranial aneurysms with FD is associated with high success rate and safety. The 6-month follow-up results seem satisfactory and the long-term treatment results still need further follow-up. \u0000 \u0000 \u0000Key words: \u0000Intracranial aneurysm; Treatment outcome; Flow diverter; Unruptured; Small","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1099-1102"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41947669","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 analyze the atypical clinical manifestations and clinical prognosis of pediatric diffuse intrinsic pontine glioma (DIPG). Methods A total of 27 patients with complete clinical data of DIPG undergoing clinical treatment at Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University from November 2015 to November 2017 were retrospectively enrolled into this study. All patients were divided into 2 groups according to the presence of atypical manifestations: atypical clinical manifestation group (17 cases) and the control group (10 cases). Among the 27 cases, 16 patients underwent stereotactic biopsy or open cranial biopsy, and the other 11 patients underwent tumor excision through craniotomy. All the children were followed up clinically or by telephone after operation to study the clinical outcomes. Comparative analysis was conducted on those clinical data. Prognosis was compared between the 2 groups through Kaplan-Meier survival analysis. Results Among the 27 cases, 20 were pathologically identified as high grade gliomas (including 4 cases of diffuse midline glioma, 6 cases of glioblastoma, 6 cases of anaplastic oligoastrocytoma, 4 cases of anaplastic astrocytoma) and 7 as low grade glioma (including 4 cases of oligoastrocytoma and 3 cases of astrocytoma). One child suffered from pneumonia and finally recovered postoperatively. No statistically significant difference (all P>0.05) was identified between 2 groups in the age, gender, clinical manifestation (including cranial nerve palsy, long tract dysfunction and cerebellum signs), clinical imaging features (including lesion enhancement, supratentorial ventricle enlargement and brachium pontis involvement), clinical treatment or pathology. Kaplan-Meier survival analysis showed that patients with atypical clinical manifestation had significantly higher cumulative survival rate than those in the control group (P=0.045). Conclusion Atypical clinical manifestation could be identified in some pediatric DIPG patients, which might be predictive of a better prognosis. Key words: Brainstem tumor; Child; Atypical clinical manifestation
{"title":"Atypical clinical manifestations and prognosis analysis of pediatric diffuse intrinsic pontine glioma","authors":"Peng Zhang, Changcun Pan, Yuliang Wu, Xiong Xiao, Lu Kong, Zhen Wu, Junting Zhang, Liwei Zhang","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.11.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.11.011","url":null,"abstract":"Objective \u0000To analyze the atypical clinical manifestations and clinical prognosis of pediatric diffuse intrinsic pontine glioma (DIPG). \u0000 \u0000 \u0000Methods \u0000A total of 27 patients with complete clinical data of DIPG undergoing clinical treatment at Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University from November 2015 to November 2017 were retrospectively enrolled into this study. All patients were divided into 2 groups according to the presence of atypical manifestations: atypical clinical manifestation group (17 cases) and the control group (10 cases). Among the 27 cases, 16 patients underwent stereotactic biopsy or open cranial biopsy, and the other 11 patients underwent tumor excision through craniotomy. All the children were followed up clinically or by telephone after operation to study the clinical outcomes. Comparative analysis was conducted on those clinical data. Prognosis was compared between the 2 groups through Kaplan-Meier survival analysis. \u0000 \u0000 \u0000Results \u0000Among the 27 cases, 20 were pathologically identified as high grade gliomas (including 4 cases of diffuse midline glioma, 6 cases of glioblastoma, 6 cases of anaplastic oligoastrocytoma, 4 cases of anaplastic astrocytoma) and 7 as low grade glioma (including 4 cases of oligoastrocytoma and 3 cases of astrocytoma). One child suffered from pneumonia and finally recovered postoperatively. No statistically significant difference (all P>0.05) was identified between 2 groups in the age, gender, clinical manifestation (including cranial nerve palsy, long tract dysfunction and cerebellum signs), clinical imaging features (including lesion enhancement, supratentorial ventricle enlargement and brachium pontis involvement), clinical treatment or pathology. Kaplan-Meier survival analysis showed that patients with atypical clinical manifestation had significantly higher cumulative survival rate than those in the control group (P=0.045). \u0000 \u0000 \u0000Conclusion \u0000Atypical clinical manifestation could be identified in some pediatric DIPG patients, which might be predictive of a better prognosis. \u0000 \u0000 \u0000Key words: \u0000Brainstem tumor; Child; Atypical clinical manifestation","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1124-1128"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47997797","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 : 2019-11-28DOI: 10.3760/CMA.J.ISSN.1001-2346.2019.11.013
Zhaofen Yan, Mengyang Wang, Jing Wang, Jian Zhou, Y. Guan, G. Luan
Objective To investigate the clinical features and surgical outcomes of posterior cingulate epilepsy (PCE) confirmed by stereotacticelectroencephalogram (SEEG). Methods Eleven patients of PCE were retrospectively enrolled into this study who were identified by SEEG at Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University from June 2014 to August 2018. Among them, 9 underwent epileptogenic zonectomy involving post cingulate gyrus and 2 underwent SEEG-guided radiofrequency thermocoagulation of epileptogenic zone. Retrospective analysis was conducted on the patients′ clinical symptomological characteristics, electroencephalograms, and ictal SEEG. The Engel scale was used to evaluate the surgical outcomes. Results Among the 11 patients, preoperative scalp-EEG showed epileptiform discharges in the posterior temporal-parietal-occipital areas in 7 cases, anterior-middle temporal areas in 2, and no epileptiform discharge in 2 cases. Two patients showed simple partial motor seizures spreading to frontal and parietal areas on SEEG. Nine patients showed dialeptic and automotor seizures spreading to medial temporal areas on SEEG. The mean followed-up time after surgery was 13-48(29±12)months. Among the 9 patients undergoing resection of posterior cingulate gyrus, Engel Ⅰa was achieved in 7 cases, Ⅰc in 1 and Ⅱ in 1 case. Out of the 2 patients undergoing SEEG-guided radiofrequency thermocoagulation, 1 had 50% reduction of seizure frequency (Engel Ⅱ) and the other had 25% seizure reduction (Engel Ⅲ). For the 2 patients with posterior cingulate lesions, the seizure originated from the head of contralateral hippocampus and spread to ipsilateral hippocampus and posterior cingulate lesion. One out of the 2 patients was seizure free after resection of posterior cingulate gyrus. Conclusions The interictal discharges on scalp-EEG of PCE are often localized in posterior regional. The seizure semiology varies due to different spread networks among PCE patients verified by SEEG. SEEG could improve postoperative seizure-free rates in patients with PCE. The symptomatic and epileptogenic zones may be two different areas. Key words: Epilepsy; Disease attributes; Neurosurgical procedures; Prognosis; Posterior cingulated; Stereotacticelectroencephalogram
{"title":"Clinical features and surgical outcomes of posterior cingulate epilepsy","authors":"Zhaofen Yan, Mengyang Wang, Jing Wang, Jian Zhou, Y. Guan, G. Luan","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.11.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.11.013","url":null,"abstract":"Objective \u0000To investigate the clinical features and surgical outcomes of posterior cingulate epilepsy (PCE) confirmed by stereotacticelectroencephalogram (SEEG). \u0000 \u0000 \u0000Methods \u0000Eleven patients of PCE were retrospectively enrolled into this study who were identified by SEEG at Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University from June 2014 to August 2018. Among them, 9 underwent epileptogenic zonectomy involving post cingulate gyrus and 2 underwent SEEG-guided radiofrequency thermocoagulation of epileptogenic zone. Retrospective analysis was conducted on the patients′ clinical symptomological characteristics, electroencephalograms, and ictal SEEG. The Engel scale was used to evaluate the surgical outcomes. \u0000 \u0000 \u0000Results \u0000Among the 11 patients, preoperative scalp-EEG showed epileptiform discharges in the posterior temporal-parietal-occipital areas in 7 cases, anterior-middle temporal areas in 2, and no epileptiform discharge in 2 cases. Two patients showed simple partial motor seizures spreading to frontal and parietal areas on SEEG. Nine patients showed dialeptic and automotor seizures spreading to medial temporal areas on SEEG. The mean followed-up time after surgery was 13-48(29±12)months. Among the 9 patients undergoing resection of posterior cingulate gyrus, Engel Ⅰa was achieved in 7 cases, Ⅰc in 1 and Ⅱ in 1 case. Out of the 2 patients undergoing SEEG-guided radiofrequency thermocoagulation, 1 had 50% reduction of seizure frequency (Engel Ⅱ) and the other had 25% seizure reduction (Engel Ⅲ). For the 2 patients with posterior cingulate lesions, the seizure originated from the head of contralateral hippocampus and spread to ipsilateral hippocampus and posterior cingulate lesion. One out of the 2 patients was seizure free after resection of posterior cingulate gyrus. \u0000 \u0000 \u0000Conclusions \u0000The interictal discharges on scalp-EEG of PCE are often localized in posterior regional. The seizure semiology varies due to different spread networks among PCE patients verified by SEEG. SEEG could improve postoperative seizure-free rates in patients with PCE. The symptomatic and epileptogenic zones may be two different areas. \u0000 \u0000 \u0000Key words: \u0000Epilepsy; Disease attributes; Neurosurgical procedures; Prognosis; Posterior cingulated; Stereotacticelectroencephalogram","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1133-1137"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43014650","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 : 2019-11-28DOI: 10.3760/CMA.J.ISSN.1001-2346.2019.11.012
Ma Yu, Zhou Rongsong, Miao Suhua, Yang Yuan
Objective To study the outcomes of the revision surgeries correcting electrode malposition in deep brain stimulation (DBS) for Parkinson’s disease (PD). Methods A total of 18 PD patients were enrolled who underwent lead revision surgeries due to subthalamic nucleus (STN) DBS lead malposition at Neuromodulation Center, Department of Neurosurgery, Tsinghua University Yuquan Hospital between September 2013 and May 2018. Changes in UPDRS-III scores on and off medication were analyzed at 1 month and 6 months postoperatively compared to those before surgery. MR images were also collected to analyze the lead location change. Results Among the 18 patients, 14 had bilateral lead revision and 4 had unilateral revision. A total of 32 leads were revised, among which 25 were reimplanted and the other 7 were repositioned without reimplantation. Off medication, the average UPDRS-Ⅲ scores before and 1 month and 6 months after surgery were 44.0±10.5, 22.4±7.4 and 25.3±7.7 respectively. On medication, those were 27.3±9.1, 16.7±8.7 and 20.3±8.3 respectively. The analysis of variance and comparisons between groups showed that the on and off medication scores were significantly reduced after the revision surgery (P<0.05). The off medication score at 6 months was averagely improved by (40.7±4.7)%(5.9-79.5%). The average distance between pre-implantation and post-implantation lead locations on the plane 3.5 mm below AC (anterior commissure)-PC (posterior commissure) was (2.8±1.0) mm(1.2-4.5 mm). No adverse events such as hemorrhage or infection were observed after surgery. Conclusion Lead revision surgery could safely and effectively remedy the suboptimal outcomes due to electrode malposition in STN-DBS for PD patients. Key words: Parkinson disease; Deep brain stimulation; Subthalamic nucleus; Electrode malposition; Revision surgery
{"title":"Outcomes of deep brain stimulation lead revision surgeries for Parkinson’s disease","authors":"Ma Yu, Zhou Rongsong, Miao Suhua, Yang Yuan","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.11.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.11.012","url":null,"abstract":"Objective \u0000To study the outcomes of the revision surgeries correcting electrode malposition in deep brain stimulation (DBS) for Parkinson’s disease (PD). \u0000 \u0000 \u0000Methods \u0000A total of 18 PD patients were enrolled who underwent lead revision surgeries due to subthalamic nucleus (STN) DBS lead malposition at Neuromodulation Center, Department of Neurosurgery, Tsinghua University Yuquan Hospital between September 2013 and May 2018. Changes in UPDRS-III scores on and off medication were analyzed at 1 month and 6 months postoperatively compared to those before surgery. MR images were also collected to analyze the lead location change. \u0000 \u0000 \u0000Results \u0000Among the 18 patients, 14 had bilateral lead revision and 4 had unilateral revision. A total of 32 leads were revised, among which 25 were reimplanted and the other 7 were repositioned without reimplantation. Off medication, the average UPDRS-Ⅲ scores before and 1 month and 6 months after surgery were 44.0±10.5, 22.4±7.4 and 25.3±7.7 respectively. On medication, those were 27.3±9.1, 16.7±8.7 and 20.3±8.3 respectively. The analysis of variance and comparisons between groups showed that the on and off medication scores were significantly reduced after the revision surgery (P<0.05). The off medication score at 6 months was averagely improved by (40.7±4.7)%(5.9-79.5%). The average distance between pre-implantation and post-implantation lead locations on the plane 3.5 mm below AC (anterior commissure)-PC (posterior commissure) was (2.8±1.0) mm(1.2-4.5 mm). No adverse events such as hemorrhage or infection were observed after surgery. \u0000 \u0000 \u0000Conclusion \u0000Lead revision surgery could safely and effectively remedy the suboptimal outcomes due to electrode malposition in STN-DBS for PD patients. \u0000 \u0000 \u0000Key words: \u0000Parkinson disease; Deep brain stimulation; Subthalamic nucleus; Electrode malposition; Revision surgery","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1129-1132"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41461598","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 : 2019-11-28DOI: 10.3760/CMA.J.ISSN.1001-2346.2019.11.018
Xinyun Fang, Guangfu Di, Qianxin Hu, Wei Zhou
Objective To explore the localization and protection of the parapharyngeal segment of the internal carotid artery, and to provide anatomical data for clinical surgery. Methods Five adult cranial specimens (10 sides) were dissected by simulating the preauricular sub-temporal fossa approaches under microscope and the endoscopic endonasal transclival approaches, and the relevant data were measured by vernier calipers. Results Microscopically, the parapharyngeal internal carotid artery was located between the levator veli palatini anteriorly and the stylopharyngeal muscle posteriorly. The distance between the two muscles was 14.7±0.4 mm (14.2-15.3 mm). From the endoscopic perspective, the parapharyngeal segment of internal carotid artery was located behind the levator veli palatini muscle, and the distance from its attachment to the anterior border of the carotid canal was 5.1±0.2 mm (4.9-5.5 mm). The parapharyngeal internal carotid artery was located in the sheath of the carotid artery with sympathetic nerve attached on its surface. The posterior group nerves descended behind the sheath of the artery. The hypoglossopharyngeal nerve and hypoglossal nerve crossed the internal carotid artery in the posterior part of the styloid muscle groups and moved forward. There was a constant stylopharyngeal fascia on the surface of the carotid sheath, which extended to the fascia on the surface of the long cephalic muscle in front of the carotid sheath. The parapharyngeal internal carotid artery gradually approached the midline from the external orifice of the carotid artery. At the level of the carotid canal, the level of pharyngeal tubercle, and the level of the atlantooccipital junction, the distances from the anterior border of the parapharyngeal segment of the internal artery to the middle line of the clivus were 23.2±2.5 mm (20.6-25.8 mm), 19.3±1.1 mm (17.9-20.7 mm) and 15.5±1.3 mm (14.1-16.9 mm) respectively. Conclusions The levator veli palatini muscle could act as the landmark of the parapharyngeal segment of internal carotid artery. The stylopharyngeal fascia and the fascia of the longus capitis major are anatomical barriers to protect parapharyngeal segment of internal carotid artery under the endoscopic endonasal approach. Key words: Carotid artery, internal; Neuroanatomy; Natural orifice endoscopic surgery; Levator veli palatini muscle; Stylopharyngeal fascia
目的探讨颈内动脉咽旁段的定位与保护，为临床手术提供解剖学资料。方法采用镜下模拟耳前颞下窝入路和鼻内窥镜经瓣入路解剖成人颅骨标本5例(10侧)，并用游标卡尺测量相关数据。结果镜下咽旁颈内动脉位于前提腭肌和后咽茎突肌之间。两肌间距离14.7±0.4 mm (14.2 ~ 15.3 mm)。内窥镜下，颈内动脉咽旁段位于提腭veli肌后方，其附着处距颈动脉管前缘的距离为5.1±0.2 mm (4.9-5.5 mm)。咽旁颈内动脉位于颈动脉鞘内，交感神经附着于其表面。后组神经在动脉鞘后下降。舌下神经和舌下神经穿过茎突肌群后部的颈内动脉向前移动。颈动脉鞘表面有恒定的茎咽筋膜，延伸至颈动脉鞘前的头长肌表面筋膜。咽旁颈内动脉从颈动脉外孔逐渐接近中线。在颈动脉管水平、咽结节水平和寰枕交界处水平，内动脉咽旁段前缘至斜坡中线的距离分别为23.2±2.5 mm (20.6-25.8 mm)、19.3±1.1 mm (17.9-20.7 mm)和15.5±1.3 mm (14.1-16.9 mm)。结论提腭肌可作为颈内动脉咽旁段的标志。鼻内窥镜入路下，茎咽筋膜和头长肌筋膜是保护颈内动脉咽旁段的解剖屏障。关键词:颈动脉;内部;神经解剖学;自然孔内窥镜手术;提腭veli;Stylopharyngeal筋膜
{"title":"Endoscopic anatomy of parapharyngeal segment of the internal carotid artery","authors":"Xinyun Fang, Guangfu Di, Qianxin Hu, Wei Zhou","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.11.018","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.11.018","url":null,"abstract":"Objective \u0000To explore the localization and protection of the parapharyngeal segment of the internal carotid artery, and to provide anatomical data for clinical surgery. \u0000 \u0000 \u0000Methods \u0000Five adult cranial specimens (10 sides) were dissected by simulating the preauricular sub-temporal fossa approaches under microscope and the endoscopic endonasal transclival approaches, and the relevant data were measured by vernier calipers. \u0000 \u0000 \u0000Results \u0000Microscopically, the parapharyngeal internal carotid artery was located between the levator veli palatini anteriorly and the stylopharyngeal muscle posteriorly. The distance between the two muscles was 14.7±0.4 mm (14.2-15.3 mm). From the endoscopic perspective, the parapharyngeal segment of internal carotid artery was located behind the levator veli palatini muscle, and the distance from its attachment to the anterior border of the carotid canal was 5.1±0.2 mm (4.9-5.5 mm). The parapharyngeal internal carotid artery was located in the sheath of the carotid artery with sympathetic nerve attached on its surface. The posterior group nerves descended behind the sheath of the artery. The hypoglossopharyngeal nerve and hypoglossal nerve crossed the internal carotid artery in the posterior part of the styloid muscle groups and moved forward. There was a constant stylopharyngeal fascia on the surface of the carotid sheath, which extended to the fascia on the surface of the long cephalic muscle in front of the carotid sheath. The parapharyngeal internal carotid artery gradually approached the midline from the external orifice of the carotid artery. At the level of the carotid canal, the level of pharyngeal tubercle, and the level of the atlantooccipital junction, the distances from the anterior border of the parapharyngeal segment of the internal artery to the middle line of the clivus were 23.2±2.5 mm (20.6-25.8 mm), 19.3±1.1 mm (17.9-20.7 mm) and 15.5±1.3 mm (14.1-16.9 mm) respectively. \u0000 \u0000 \u0000Conclusions \u0000The levator veli palatini muscle could act as the landmark of the parapharyngeal segment of internal carotid artery. The stylopharyngeal fascia and the fascia of the longus capitis major are anatomical barriers to protect parapharyngeal segment of internal carotid artery under the endoscopic endonasal approach. \u0000 \u0000 \u0000Key words: \u0000Carotid artery, internal; Neuroanatomy; Natural orifice endoscopic surgery; Levator veli palatini muscle; Stylopharyngeal fascia","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1155-1159"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46733957","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 : 2019-11-28DOI: 10.3760/CMA.J.ISSN.1001-2346.2019.11.014
Xiaoyu Xia, Yi Yang, Yuan-yuan Dang, Xueling Chen, Ruijing Huang, J. Lyv, Kang Wang, Jie Wu, Xiyu Lin
Objective To investigate the efficacy and influencing factors of spinal cord stimulation (SCS) in the treatment of patients with chronic disorders of consciousness (DOC) after brain injury. Methods The clinical data of 110 patients with chronic DOC after brain injury were analyzed retrospectively who were admitted to Department of Neurosurgery, the Seventh Medical Center of Chinese PLA General Hospital from August 2011 to December 2017. CT scan of the cervical spine was performed to show the location of the electrode implanted. All patients underwent clinical follow-up at 3 and 6 months after surgery. The follow-up included neurological physical examination and assessment based on modified coma recovery scale-revised (CRS-R). According to the patient's clinical symptom outcome and CRS-R scores, the surgical outcomes were evaluated and divided into effective and ineffective. Univariate and multivariate logistic regression analysis were used to explore risk factors affecting the patient′s outcomes. Results Cervical CT was performed after operation. The electrodes of 110 patients were implanted at cervical spinal epidural C2-C4 level. Stimulation parameters in 110 patients included the frequency of 5 Hz or 70 Hz, pulse width of 210 μs, voltage of 1-5 V, daily device-on time of 8-12 h, stimulation mode of 15-min stimulation with 15-min interval. At 6 months post surgery in this series of 110 patients, 38 cases were effective (good in 24 and improved in 14), 72 were ineffective (ineffective in 67 and death in 5), and the overall effective rate was 34.5% (38/110). Univariate analysis showed that age, duration of disease, CRS-R score, and preoperative surgical recommendation criterion were clinical factors affecting the patient′s outcome (all P < 0.05). Further multivariate logistic regression analysis showed that preoperative evaluation recommendation criterion was an independent risk factor affecting the patient′s outcome (OR=8.179, 95% CI: 2.171-30.816, P=0.002). CRS high score was an independent protective factor affecting the patient’s outcome (OR=0.304, 95% CI: 0.095-0.978, P=0.046). Conclusion SCS is effective in the treatment of DOC and can be used as one of the feasible treatments for DOC. The preoperative evaluation recommendation criterion is an independent risk factor for the efficacy of patients with DOC. Key words: Consciousness disorders; Treatment outcome; Factor analysis, statistical; Spinal cord stimulation
{"title":"Therapeutic effect of spinal cord stimulation on chronic disorders of consciousness after brain injury: A report of 110 cases","authors":"Xiaoyu Xia, Yi Yang, Yuan-yuan Dang, Xueling Chen, Ruijing Huang, J. Lyv, Kang Wang, Jie Wu, Xiyu Lin","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.11.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.11.014","url":null,"abstract":"Objective \u0000To investigate the efficacy and influencing factors of spinal cord stimulation (SCS) in the treatment of patients with chronic disorders of consciousness (DOC) after brain injury. \u0000 \u0000 \u0000Methods \u0000The clinical data of 110 patients with chronic DOC after brain injury were analyzed retrospectively who were admitted to Department of Neurosurgery, the Seventh Medical Center of Chinese PLA General Hospital from August 2011 to December 2017. CT scan of the cervical spine was performed to show the location of the electrode implanted. All patients underwent clinical follow-up at 3 and 6 months after surgery. The follow-up included neurological physical examination and assessment based on modified coma recovery scale-revised (CRS-R). According to the patient's clinical symptom outcome and CRS-R scores, the surgical outcomes were evaluated and divided into effective and ineffective. Univariate and multivariate logistic regression analysis were used to explore risk factors affecting the patient′s outcomes. \u0000 \u0000 \u0000Results \u0000Cervical CT was performed after operation. The electrodes of 110 patients were implanted at cervical spinal epidural C2-C4 level. Stimulation parameters in 110 patients included the frequency of 5 Hz or 70 Hz, pulse width of 210 μs, voltage of 1-5 V, daily device-on time of 8-12 h, stimulation mode of 15-min stimulation with 15-min interval. At 6 months post surgery in this series of 110 patients, 38 cases were effective (good in 24 and improved in 14), 72 were ineffective (ineffective in 67 and death in 5), and the overall effective rate was 34.5% (38/110). Univariate analysis showed that age, duration of disease, CRS-R score, and preoperative surgical recommendation criterion were clinical factors affecting the patient′s outcome (all P < 0.05). Further multivariate logistic regression analysis showed that preoperative evaluation recommendation criterion was an independent risk factor affecting the patient′s outcome (OR=8.179, 95% CI: 2.171-30.816, P=0.002). CRS high score was an independent protective factor affecting the patient’s outcome (OR=0.304, 95% CI: 0.095-0.978, P=0.046). \u0000 \u0000 \u0000Conclusion \u0000SCS is effective in the treatment of DOC and can be used as one of the feasible treatments for DOC. The preoperative evaluation recommendation criterion is an independent risk factor for the efficacy of patients with DOC. \u0000 \u0000 \u0000Key words: \u0000Consciousness disorders; Treatment outcome; Factor analysis, statistical; Spinal cord stimulation","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1138-1142"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46018389","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 : 2019-11-28DOI: 10.3760/CMA.J.ISSN.1001-2346.2019.11.007
Mingming Zhang, Zhu Ouyang, J. Jia, Yan Cui, Qi Li, Mengqiang Yu
Objective To investigate the strategy and effect of microsurgical treatment of basilar artery bifurcation aneurysms with different surgical approaches. Methods We retrospectively reviewed the clinical data of 43 patients with basilar artery bifurcation aneurysms who underwent microsurgical clipping at Department of Neurosurgery, the Second Xiangya Hospital, Central South University from April 2011 to April 2018. Of all 43 cases, 32 cases had ruptured basilar aneurysms and 11 cases had unruptured basilar aneurysms. According to the different morphological and anatomical locations of aneurysms, 17 cases underwent infraorbital approach, 26 cases underwent transsyvian approach (including the transorbirozygomatic approach, the 'half-half’ approach which combined the subtemporal approach with pterion approach and the simple pterion approach) to conduct microsurgical clipping. Intraoperative monitoring was performed using the combination of multiple technologies. Clinical and imaging follow-up was conducted over 6 months post surgery. Results Of all 43 cases with basilar artery bifurcation aneurysms, 38 cases were completely clipped, 4 cases were partially clipped, and 1 case was wrapped. There were 2 cases (4.7%) of hemiplegia after operation, 1 case (2.3%) of coma, 14 cases (32.6%) of oculomotor nerve palsy and no death during perioperative period. Thirty-seven patients (86.4%) were followed up for 25.0±10.1 months (range: 6 months to 4 years). Among them, 35 patients underwent radiographic review without aneurysm residual and 1 patient with partial clipping was treated with second-stage interventional embolization. In 1 case with wrapped aneurysm, the significantly enlargement of aneurysm was not observed in the follow-up image. Of 14 cases with oculomotor nerve palsy after operations, 11 were followed up and 8 of them improved significantly afterwards. Glasgow′s outcome scale(GOS) showed that grade V was reported in 34, grade IV in 1 case, grade III in 1 case, grade II in 0 and grade I in 1 case who died from severe pulmonary infection at 42 days post operation. Conclusions The superior treatment of the basilar artery bifurcation aneurysm could be achieved through subtemporal and transsyvian approach. Preoperative evaluation of anatomical and morphological characteristics of aneurysm seems important for the choice of surgical approach. The application of various assistive techniques during surgery is an important part of ensuring the safety of surgery. Key words: Intracranial aneurysm; Basilar artery; Microsurgery; Treatment outcome
{"title":"Therapeutic strategy and effect of different approaches for microsurgical treatment of basilar artery bifurcation aneurysms","authors":"Mingming Zhang, Zhu Ouyang, J. Jia, Yan Cui, Qi Li, Mengqiang Yu","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.11.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.11.007","url":null,"abstract":"Objective \u0000To investigate the strategy and effect of microsurgical treatment of basilar artery bifurcation aneurysms with different surgical approaches. \u0000 \u0000 \u0000Methods \u0000We retrospectively reviewed the clinical data of 43 patients with basilar artery bifurcation aneurysms who underwent microsurgical clipping at Department of Neurosurgery, the Second Xiangya Hospital, Central South University from April 2011 to April 2018. Of all 43 cases, 32 cases had ruptured basilar aneurysms and 11 cases had unruptured basilar aneurysms. According to the different morphological and anatomical locations of aneurysms, 17 cases underwent infraorbital approach, 26 cases underwent transsyvian approach (including the transorbirozygomatic approach, the 'half-half’ approach which combined the subtemporal approach with pterion approach and the simple pterion approach) to conduct microsurgical clipping. Intraoperative monitoring was performed using the combination of multiple technologies. Clinical and imaging follow-up was conducted over 6 months post surgery. \u0000 \u0000 \u0000Results \u0000Of all 43 cases with basilar artery bifurcation aneurysms, 38 cases were completely clipped, 4 cases were partially clipped, and 1 case was wrapped. There were 2 cases (4.7%) of hemiplegia after operation, 1 case (2.3%) of coma, 14 cases (32.6%) of oculomotor nerve palsy and no death during perioperative period. Thirty-seven patients (86.4%) were followed up for 25.0±10.1 months (range: 6 months to 4 years). Among them, 35 patients underwent radiographic review without aneurysm residual and 1 patient with partial clipping was treated with second-stage interventional embolization. In 1 case with wrapped aneurysm, the significantly enlargement of aneurysm was not observed in the follow-up image. Of 14 cases with oculomotor nerve palsy after operations, 11 were followed up and 8 of them improved significantly afterwards. Glasgow′s outcome scale(GOS) showed that grade V was reported in 34, grade IV in 1 case, grade III in 1 case, grade II in 0 and grade I in 1 case who died from severe pulmonary infection at 42 days post operation. \u0000 \u0000 \u0000Conclusions \u0000The superior treatment of the basilar artery bifurcation aneurysm could be achieved through subtemporal and transsyvian approach. Preoperative evaluation of anatomical and morphological characteristics of aneurysm seems important for the choice of surgical approach. The application of various assistive techniques during surgery is an important part of ensuring the safety of surgery. \u0000 \u0000 \u0000Key words: \u0000Intracranial aneurysm; Basilar artery; Microsurgery; Treatment outcome","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1107-1111"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47677085","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 : 2019-11-28DOI: 10.3760/CMA.J.ISSN.1001-2346.2019.11.009
Hui Luo, Qianmiao Zhu, Xiefeng Wang, W. Yan, Rui Li
Objective To investigate the diagnosis and treatment of dural arteriovenous fistulas (DAVFs) of anterior skull base. Methods The clinical data of 26 patients with DAVFs of anterior skull base admitted to Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University from January 2011 to January 2019 were studied retrospectively. All the patients underwent operation through subfrontal approach. We focused on their clinical manifestations, imaging features and surgical methods. The therapeutic effects were evaluated by digital subtraction angiography (DSA) after operation and during follow-up. Results The fistulas of all 26 patients were successfully closed. Anosmia was reported in 2 cases and no other serious complications occurred. The complete obliteration of DAVFs was confirmed by postoperative DSA, and no recurrence was observed at follow-up ranging from 3 months to 9 years. Conclusion DSA seems to be an effective method for the diagnosis of anterior skull base DAVFs, for which microsurgical closure of fistulas is the effective treatment. Sufficient preoperative imaging evaluation, skilled microsurgical techniques, exact closure of fistulas are keynotes for the success of operation. Key words: Arteriovenous fistula; Skull base; Diagnosis; Treatment; Dural
{"title":"Diagnosis and treatment of anterior skull base dural arteriovenous fistulas: A report of 26 cases","authors":"Hui Luo, Qianmiao Zhu, Xiefeng Wang, W. Yan, Rui Li","doi":"10.3760/CMA.J.ISSN.1001-2346.2019.11.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-2346.2019.11.009","url":null,"abstract":"Objective \u0000To investigate the diagnosis and treatment of dural arteriovenous fistulas (DAVFs) of anterior skull base. \u0000 \u0000 \u0000Methods \u0000The clinical data of 26 patients with DAVFs of anterior skull base admitted to Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University from January 2011 to January 2019 were studied retrospectively. All the patients underwent operation through subfrontal approach. We focused on their clinical manifestations, imaging features and surgical methods. The therapeutic effects were evaluated by digital subtraction angiography (DSA) after operation and during follow-up. \u0000 \u0000 \u0000Results \u0000The fistulas of all 26 patients were successfully closed. Anosmia was reported in 2 cases and no other serious complications occurred. The complete obliteration of DAVFs was confirmed by postoperative DSA, and no recurrence was observed at follow-up ranging from 3 months to 9 years. \u0000 \u0000 \u0000Conclusion \u0000DSA seems to be an effective method for the diagnosis of anterior skull base DAVFs, for which microsurgical closure of fistulas is the effective treatment. Sufficient preoperative imaging evaluation, skilled microsurgical techniques, exact closure of fistulas are keynotes for the success of operation. \u0000 \u0000 \u0000Key words: \u0000Arteriovenous fistula; Skull base; Diagnosis; Treatment; Dural","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"35 1","pages":"1117-1120"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49328952","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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