Objective To study the methods and techniques of the treatment forextensive suprasellar pituitary adenona and repairing hole.Methods From Feb. 2001 to Mar. 2003, 9 patients with exrensive suporasellar pituitary adenoma underwent resection via suprabital keyhole with endoscope-assisted microneurosurgery. Then the remaining tumor was removed with neuroendoscope via Ⅰand Ⅱ space of optic chiasma. The small bone flap was fixed with Ti clamp. Results After the tumor was removed with microneurosurgery, the remaining tumor was still found with endoscope in 7 cases. Remaining tumor was totally removed in 6 cases, almost removed in 3 cases. The vision improvement was found in 7 cases one week after surgery. In the other 2 cases, the vision remained unchanged. Follow-up was conducted in 6 cases for 6 to 22 months. Neuroradiological recovery of MRI with no recurrence of tumor was observed. No complication of incision was present. Conclusion Enough intra and extra-cranial space can be provided to operate via orbital roof approach to sellar tumors. Endoscope-assisted microneurosurgery can increase the total-resection and successful rate treatment for extensive suprasellar pituitary adenoma, reduce the possibility of complication, and pretect the function of brain from being injured. Fixation of small bone flap with Ti clamp is safe, easy and reliable.
目的 探討顯微手術治療破裂大腦中動脈動脈瘤（MCAA）的適應證、術前評估及手術技巧。 方法 回顧性分析2008年1月－2011年1月經翼點入路行顯微外科手術治療的65例破裂MCAA患者的臨床資料。其中男40例，女25例；年齡22～78歲，平均46.8歲。術前Hunt-Hess分級：Ⅰ級15例，Ⅱ級25例，Ⅲ級13例，Ⅳ級10例，Ⅴ級2例。動脈瘤直徑＜5 mm 10個，5～15 mm 36個，15～25 mm 15個，＞25 mm 4個，平均7.8 mm。其中56例動脈瘤位于大腦中動脈分叉部，5例位于大腦中動脈的M1段，4例位于分叉后M2段。 結果 手術夾閉動脈瘤60例，余5例行動脈瘤夾閉加包裹術。患者術后獲隨訪3～36個月，平均16個月，均無動脈瘤復發或再出血發生。按格拉斯哥預后評分（GOS）結果評定：恢復良好58例（GOS 4～5分），差5例（GOS 2～3分），死亡2例（GOS 1分）。 結論 充分的術前評估，合適的手術入路選擇，以及手術技巧的靈活應用是顯微外科手術成功治療破裂MCAA的保證。
Objective To investigate the therapeutic effects of endovascular covered stent on vertebral dissecting aneurysm and carotid-cavernous fistula (CCF). Methods From March 2006 to May 2007, Jostent coronary stent grafts were used to treat 4 patients with vertebral dissecting aneurysm and 3 patients with CCF. The patients of vertebral dissecting aneurysmwere male and 37-57 years old, the lesion was located on the left vertebral artery in 3 patients and on the right vertebral artery in 1 patient, with the primary symptoms of sudden headache and vomiting; CT scan demonstrated subarachnoid hemorrhage; and the medical history varied from 2 days to 10 years. The patients of CCF were male and 35-51 years old, the lesion was located on the left carotid artery in 2 patients and on the right carotid artery in 1 patient, with the primary symptoms of headache, lateral exophthalmos, eyeball distending pain, conjunctive hyperemia and impaired eyesight; all 3 patients got head injury 2 days to 1 month before the appearance of symptoms and 1 of them had a history of severe nosebleed; and the medical history ranged from 1 week to 2 months. Results For the patients with vertebral dissecting aneurysm, complete obl iteration of aneurysms was achieved, the circulations of the vertebral artery, the adjacent posterior inferior cerebellar artery and the adjacent anterior inferior cerebellar artery were smooth, no compl ications relative to operation occurred, and no recurrence of symptoms and intracranial rehaemorrhagia were observed during the follow-up period of 8 months-2 years. For the patients with CCF, the fistula were completely obl iterated, the circulation of carotid artery was smooth, the exophthalmus and conjunctiva hyperemia were improved obviously 3 days after operation, the eyesight of patient was improved at different levels over the follow-up period of 1-3 months. Conclusion Endovascular covered stent is a new and useful tool for the treatment of vertebral dissecting aneurysm and CCF .
Objective To analyze the trends in the burden of intracerebral hemorrhage (ICH) and its related risk factors in China from 1990 to 2021, providing evidence for targeted prevention and control. Methods Based on public data from the Global Burden of Disease Study 2021, four epidemiological indicators, including incidence, prevalence, deaths, and disability-adjusted life-years (DALYs) were selected to describe the burden of ICH in China in 2021. Change rates and estimated annual percentage changes (EAPC) were calculated to evaluate the trends in disease burden from 1990 to 2021. The Das Gupta method was used to decompose the effects of population growth, population aging and epidemiological changes on the burden during this period. Finally, the attributable burden of risk factors related to ICH was analyzed. Results In 2021, the age-standardized incidence, prevalence, mortality, and DALY rates of ICH in China were 61.2/100000, 222.1/100000, 68.8/100000, and 1351.6/100000, respectively, all higher than global estimates. From 1990 to 2021, although these rates showed a declining trend (EAPC: ?2.24, ?1.26, ?2.38, and ?2.47, respectively), the absolute disease burden, including the absolute number of incidence cases, prevalence cases, deaths, and DALYs, continued to rise, with an increase ranging from 20.57% to 51.59%. In addition, the burden of ICH in China varied by age and sex, with older adults and males experiencing a higher burden. Decomposition analysis indicated that population aging and growth were the primary drivers of the increasing ICH burden in China, while epidemiological changes mitigated this trend. Metabolic factors were the predominant attributable risk factors for ICH. High systolic blood pressure, ambient particulate matter pollution, and diet high in sodium were important risk factors common to both genders. The DALY burden attributable to smoking and alcohol use was higher in men, whereas impaired kidney function and secondhand smoke had a greater impact on women. Conclusions The burden of ICH in China has continued to increase from 1990 to 2021, and it may further escalate in the context of population aging. Risk factor control remains a key priority for prevention. Future strategies should incorporate age- and sex-specific interventions to reduce the ICH burden in China.
ObjectiveTo explore the changes of intraoperative temperature and influencing factors of the short-term prognosis of patients undergoing clipping of posterior communicating artery aneurysms.MethodsThe basic clinic data and intraoperative temperature of patients undergoing elective clipping of posterior communicating artery aneurysms between October 2018 and July 2019 were collected, and the minimum intraoperative temperature was categorized into ≥36.0 and <37.5℃, ≥35.0 and <36.0℃, and <35.0℃. According to the Glasgow outcome scale (GOS) at discharge, the patients were divided into good prognosis group (GOS 4-5) and bad prognosis group (GOS 1-3). Multiple logistic regression analysis was used to obtain the risk factors of short-term prognosis.ResultsA total of 127 cases were involved, and intraoperative hypothermia (<36.0℃) occurred in 64 cases (50.4%). The intraoperative temperature presented classical three-phrase changes, i.e. it dropped rapidly at 1 hour after anesthesia introduction, decreased slowly during 2-3 hours after anesthesia introduction, and then entered the plateau. In the 127 cases, 93 (73.2%) had good prognosis, with an intraoperative hypothermia proportion of 44.1% (41/93); and 34 (26.8%) had bad prognosis, with an intraoperative hypothermia proportion of 67.6% (23/34). Univariate analysis showed that Hunt-Hess grade (χ2=18.999, P<0.001), intraoperative bleeding (χ2=7.074, P=0.008), minimum intraoperative temperature (Z=?3.473, P=0.001), and postoperative complications (χ2=43.060, P<0.001) were related to the short-term prognosis of patients undergoing clipping of posterior communicating artery aneurysms. Multiple logistic regression analysis presented that high Hunt-Hess grade (Ⅳ, Ⅴ) [odds ratio (OR)=6.456, 95% confidence interval (CI) (1.141, 36.532), P=0.035], the minimum intraoperative temperature <35.0℃ [OR=7.552, 95%CI (1.450, 39.345), P=0.016], and postoperative complications [OR=22.866, 95%CI (6.778, 77.142), P<0.001] were independent risk factors of the short-term prognosis. The difference in short-term prognosis between patients with the minimum intraoperative temperature ≥35.0 and <36.0℃ and the ones with the minimum intraoperative temperature ≥36.0 and <37.5℃ was not statistically significant (P>0.05).ConclusionsThe minimum intraoperative temperature<35.0℃ and postoperative complications were changeable factors to effect progonosis of patients undergoing elective clipping of posterior communicating artery aneurysms. Clinical staff should set medical intervention measures based on the individual conditions of patients to improve patients’ quality of life.
Objective To assess the results of microvascular decompression (MVD) in treating cranial nervehyperactive dysfunction. Methods From October 2002 to January 2007, 106 patients with cranial never hyperactivedysfunction were treated with MVD. Among them, there were 47 males and 59 females with an average age of 62 years (42-85 years), including 56 cases of trigeminal neuralgia, 33 cases of hemifacial spasm and 17 cases of spasmodic torticoll is. MRI showed obvious nerve root compression in 60 patients (56.6%), suspected nerve root compression in 33 patients (31.1%) and no nerve root compression in 13 patients (12.3%). The disease course was 2-300 months with median course of 54 months. The typical manifestations before operation were pain and myospasm in corresponding innervation region. Results The superior cerebellar artery was the most common offending vessel in trigeminal neuralgia (44.6%, 25/56), the anterior inferior cerebellar artery in hemifacial spasm (33.3%, 11/33), and the vertebra-basilar artery in spasmodic torticol is (82.4%, 14/17). Compl ications of facial paralysis, hypoacusia, facial numbness, dizziness, pain of neck and shoulder, muscles weakness of neck and subcutaneous dropsy occurred in 31 patients (29.2%). All patients were followed up for 6-42 months. The total response rate was 90.6%. The curative rate of MVD was 83.9% (47/56) in trigeminal neuralgia, 81.8% (27/33) in hemifacial spasm and 41.2% (7/17) in spasmodic torticol is, respectively. Five patients failed to response (4.7%), 2 of them were cured after re-operation and 3 abandoned further treatrment. Five patients suffered recurrence 3-8 months after operation (4.7%), 2 of them recovered after re-operation, 1 got rel ief by Gamma-knife treatment, and 2 abandoned further treatment. Conclusion MVD has a good therapeutic effect on the disease caused by vascular compression of cranial nerve. Comprehensive preoperative evaluation, skillful operational technique and intraoperative electrophysiological monitoring should be implemented to enhance the therapeutic effects of MVD and to prevent possible compl ications.
As the intensity of clinical and research work is high, teaching is gradually paid less attention to and the quality of education cannot be ensured. In this context, a full-time teaching position is set up in West China Hospital which is taken responsibility by qualified clinicians, to improve the teaching quality by strict management and omni-directional teaching. We introduce the setting and running of the full-time teaching position in West China Hospital in this paper.
【摘要】 目的 探討腦干海綿狀血管瘤患者臨床表現及影響預后的相關因素。 方法 回顧分析2008年9月-2010年9月27例腦干海綿狀血管瘤患者臨床資料。 結果 20例（74.1%）患者CT顯示出血及血腫。急性或突然神經功能廢損22例，漸進性功能障礙15例，病情平穩4例。顯微手術12例，放射治療6例，保守觀察9例。長期隨訪25例，2例再次出血，無新發病灶，無患者死亡。手術組患者年齡（Plt;0.05）、術前病情嚴重程度（Plt;0.05）與術后KPS評分相關。非手術組不良預后評分與患者高齡及再出血有關。 結論 展神經麻痹和面癱患者功能恢復較差。年齡、術前病情嚴重程度及手術時機影響患者預后，術中全切病灶對復發和并發癥發生起主要作用，如何處理合并發生的靜脈畸形有待討論。立體定向放射治療明顯降低再出血風險，但其適應證尚有爭議。【Abstract】 Objective To discuss the clinical manifestations and prognostic factors of brain stem cavernous hemangioma. Methods Based on the literature, the clinical data of 27 patients having brain stem cavernous hemangioma from September 2008 to September 2010 were reviewed and analyzed. Results Twenty patients (74.1%) presented with hemorrhage and hematoma in CT scan. Acute or sudden neurological deterioration occurred to 22 patients, progressive in 15 and stable in 4. Twelve patients underwent surgical removal of the lesion; 6 underwent radiosurgery; and 9 continued with conservative management. Twenty-five patients were followed up. Two patients had rehaemorrhagia. There were no de novo lesions or death. The risk factors indicative of a possible poor postoperative KPS score in the operative group included age (Plt;0.05) and the initial clinical condition (Plt;0.05). In the non-operative group, old age and rehaemorrhagia were obviously related to the poor outcome. Conclusions Patients with abducens and facial palsy have poor functional recovery. Age, the initial clinical condition and timing of operation are the major factors correlated to surgical outcome. The factor that affects recurrence and the occurrence of complications is complete resection during the operation. How to deal with the concomitant venous malformation should be further studied. The indications for stereotactic radiosurgery are still controversial, although it has confered a reduction in the risk of rehaemorrhagia.
ObjectiveTo investigate the effect of microsurgical therapy and the key techniques in resection of large bilateral olfactory groove meningiomas via unilateral subfrontal approach.MethodsThe clinical data and follow-up results of 181 patients with large bilateral olfactory groove meningiomas who underwent microsurgical removal between June 2007 and May 2014 were retrospectively analyzed. The initial symptom was headache or (and) dizzy in 95 cases, hyposmia or anosmia in 53, impairment of visual function or (and) visual field deficits in 26, cognitive deficits in 3, epilepsy in 2, and accidentally discovered in 2. Unilateral subfrontal approach was applied in all patients (neuroendoscopy was applied in some cases in the later period); incision of falxcerebri, and when necessary, ligation of superior sagittal sinus to resect contralateral tumor were performed. Simultaneous or staged period resection of tumors invading skull base such as ethmoid sinus and superior meatus and reconstruction of the skull base were performed.ResultsThere was no perioperative mortality. Simpson grade Ⅰ resection was obtained in 33 cases, grade Ⅱ resection was in 141, grade Ⅲ resection was in 4, and grade Ⅳ resection was in 3. Among the 229 eyes with preoperative visual impairment, postoperative visual improvement was found in 215 eyes, unimproved was in 12, and aggravation was in 2. The 59 sides which lost their function of olfactory nerve before surgery obtained no recoveries after surgery, while olfactory nerve with residual function preoperative still kept sensing after surgery in 149 lateral sides (149/303). The patients were followed up for (76.9±43.8) months, and postoperative recurrence or residual tumor growth were found in 21 cases.ConclusionsBecause of the contralateral ocular and (or) nasal compensation, early discovery is very difficult for patients with olfactory groove meningioma. The unilateral subfrontal approach can provide sufficient exposure for resection of large bilateral olfactory groove meningiomas and improve the visual acuity and visual field deficits. But it is poor at the preservation of olfactory function. The approach, better with the aid of neuroendoscopy, can improve the total cutting rate, with the advantages of minimally invasion and fewer complications. It is a worthy priority for these tumors.
