Keyhole Approach Endoscopic Surgery versus Stereotactic Aspiration plus Urokinase in Treating Basal Ganglia Hypertensive Intracerebral Hemorrhage / 中国医学科学院学报

To compare the short-and long-term effect of two minimal invasive surgical therapies including keyhole approach endoscopic surgery(KAES)and stereotactic aspiration plus urokinase(SAU)in treating basal ganglia hypertensive intracerebral hemorrhage(hICH). The clinical data of 117 hICH patients(63 received KAES and 54 received SAU)were retrospectively analyzed.The operation time,blood loss during surgery,and drainage time were compared between two groups.The residual hematoma volume,hematoma clearance rate(HCR),Glasgow coma scale(GCS)score,and National Institute of Health Stroke Scale(NIHSS)score were recorded at baseline and in the ultra-early stage,early stage,and sub-early stage after surgery.The 30-day mortality and serious adverse events were assessed and the 6-month modified Rankin scale(mRS)score was rated. Baseline data showed no significant difference between these two groups.Compared with the SAU group,the KAES group had significantly longer operation time,more intraoperative blood loss,and shorter drainage time(all 0.05).In the ultra-early and early stage,the GCS and NIHSS scores showed no significant differences between two groups(all >0.05),whereas in the sub-early stage,the NIHSS score was better in the SAU group(=0.034).The 30-day mortality and incidences of serious adverse events showed no significant difference(all >0.05).The good recovery(mRS≤3)at 6-months follow-up showed no significant difference between the two groups(=0.413). Both KAES and SAU are safe and effective in treating basal ganglia hICH.In the ultra-early stage after surgery,KAES achieves better residual hematoma volume and HCR,and patients undergoing SAU quickly catch up.The short-and long-term effectiveness of SAU is comparable or even superior to KAES.

Relationship of sphenoid intersinus septa with transsphenoidal resection of sellar area tumor / 中华神经医学杂志

Objective To study the relationship of sphenoidal intersinus septa with transsphenoidal resection of sellar area tumor. Methods The pre-operative MRI and CT images of the sphenoid intersinus septa and its importance in transsphenoidal resection of sellar area tumor were studied in 107 patients, admitted to our hospital from January 2008 to December 2010. The amounts, locations, anatomic specialties of the septa and its relationships with the floor of selle, the internal carotid artery canals and the tumors were analyzed to guide the operative procedures during the operation. Results Total removal of the tumors in seller region was obtained in 67 patients, subtotal removal in 21 and partial removal in 19. According to the MRI and CT images of the sphenoid intersinus septa, the location of the tumor and the carotid artery in 47 patients were quickly determined; complex sphenoid intersinus septa was noted in 11 patients, and the relation of sellar floor with the septa was quickly determined and the scope and direction of removal were determined too. Rupture of the internal carotid artery occurred in 1 patient, and damages of the cavernous sinuses occurred in 4. Conclusion Careful study of the pre-operative MRI or CT images of the sphenoidal intersinus septa and its relationship with the floor of seller, the internal carotid artery and the tumor will assure the transspenoidal surgery more precisely and safely, and the complication can be efficiently prevented and decreased.

Transcranial Doppler-assisted intra-arterial thrombolysis for patients with acute ischemic stroke / 中华神经医学杂志

Objective To investigate the clinical efficacy of transcranial Doppler(TCD)-assisted interventional intra-arterial thrombosis in patients with acute ischemic stroke.Methods This clinical trial enrolled 22 patients with acute ischemic stroke(13 with occlusion of the middle cerebral artery within 6 h of symptom onset; 9 with occlusion of the base artery within 12 h of symptom onset); occlusive arterial cannula was performed and recombinant tissue plasminogen activator(rt-PA,20 mg)was injected to perform interventional intra-arterial thrombosis; and TCD ultrasonography of low frequency(2 MHz)and low intensity(0.25 W/cm2)was performed to assist the thrombosis.Cranial CT was performed again right after the operation and 24 h after the operation to observe the recanalization rate and intracranial hemorrhage; NIHSS scores and Barthel index scores were compared before and after the operation.Results The percentage ofrecanalization was 77.27％(17/22),including 22.73％(5/22)complete recanalization and 54.55％(12/22)partial recanalization; non-symptomatic intracerebral hemorrhage occurred in 3 patients and no symptomatic intracerebral hemorrhage was noted.NIHSS and Barthel index scores after the operation were obviously higher than those before the operation,indicating that favorable outcomes were achieved after thrombosis.Conclusion TCD-assited interventional intra-arterial thrombosis with rt-PA,significantly improving the recanalization rate of occlusive artery and remarkably reducing the happening ofintracerebral hemorrhage,can improve the prognosis and enjoy good clinical efficacy and safety in treatment of acute ischemic stroke.

Microsurgical treatment of multiple intracranial aneurysms / 中华神经医学杂志

Objective To explore the problems of microsurgical treatment of multiple intracranial aneurysms with regard to the indications,surgical timing,operative approaches and the prevention of complications, and improve their diagnoses and treatments. Methods We retrospectively reviewed the data of 33 patients with multiple intracranial aneurysms admitted to our hospital from Jan.2000 to Dec.2008 and their clinical manifestations,imaging features and microsurgical treatments were summarized. Results In the 33 cases of multiple intracranial aneurysms,the male-to-female sex ratio was 1:1.75 and the average age at onset of symptoms was 56.52.Twenty-four patients showed good postoperative prognosis(Glasgow Outcome Scale IV-V) with 2 deaths.Conclusion Individual treatment should be adopted in the treatment of differently localized multiple intracranial aneurysms with different sizes and clinical classifications,and the utilization of temporary blockade and ultrasound during the operation can improve the therapeutic effects and reduce the postoperative complication rates.