High-Throughput Sequencing-Based Identification of Serum Exosomal Differential miRNAs in High-Grade Glioma and Intracranial Lymphoma.

OBJECTIVE: At present, no effective noninvasive method is currently available for the differential diagnosis of high-grade glioma and intracranial lymphoma. In the present study, we aimed to screen microRNA (miRNA) markers in serum exosomes for differential diagnosis of high-grade glioma and intracranial lymphoma using high-throughput sequencing technology. METHODS: Patients with intracranial lymphoma or high-grade glioma and healthy controls were included in this study (training cohort (n = 10) and validation cohort: intracranial lymphoma (n = 10), high-grade glioma (n = 32), and healthy controls (n = 20)). After RNA was extracted from serum exosomes, the high-throughput sequencing was used to determine the expression profiles of serum exosomal miRNAs and screen the differentially expressed miRNAs. RT-qPCR was used to verify the expressions of the selected miRNAs. The differences of miRNA expressions between groups were assessed by the Kruskal-Wallis test. The diagnostic value was analyzed using the receiver operating characteristic (ROC) curve. RESULTS: High-throughput sequencing demonstrated that 170 miRNAs, including 109 upregulated ones and 61 downregulated ones, were differentially expressed in serum exosomes between the patients with intracranial lymphoma and high-grade glioma. Compared with the healthy controls, the number of differential serum exosomal miRNAs in the high-grade glioma group and intracranial lymphoma group was 130 and 173, respectively. RT-qPCR proved that both miR-766-5p and miR-376b-5p were significantly downregulated in high-grade glioma and intracranial lymphoma patients compared with the healthy controls (all p < 0.001), and the expression of serum exosomal miR-766-5p in the intracranial lymphoma group was lower compared with the high-grade glioma group (p < 0.05). The areas under ROC curve (AUCs) of serum exosomal miR-766-5p and miR-376b-5p for the diagnosis of glioma were 0.8883 (p < 0.001) and 0.7688 (p = 0.001), respectively, and they were 0.9271 (p < 0.001) and 0.8542 (p < 0.001), respectively, for the diagnosis of intracranial lymphoma. Moreover, the AUC value of serum exosomal miR-766-5p for the differential diagnosis of glioma and intracranial lymphoma was 0.7201 (p = 0.026). CONCLUSIONS: miR-766-5p and miR-376b-5p in serum exosomes might be used as auxiliary diagnostic indicators for high-grade glioma and intracranial lymphoma, and miR-766-5p might be used as a differential diagnostic marker for both diseases.

Efficacy of microvascular decompression in patients with trigeminal neuralgia with negative neurovascular relationship shown by magnetic resonance tomography.

OBJECTIVE: To explore the surgical efficacy of microvascular decompression(MVD) when the recent magnetic resonance tomography angiography(MRA) is unable to determine the relationship between blood vessels and nerves in patients with trigeminal neuralgia(TN). MATERIALS AND METHODS: The MRI images of 146 patients with TN who underwent MVD from January 2016 to December 2019 were analyzed retrospectively. The relationship between nerves and vessels was categorized as no contact, suspicious contact, and clear contact. Suspicious contact and clear contact were both defined as positive neurovascular relationship, whereas no contact was defined as negative neurovascular relationship. The efficacy of MVD in positive and negative groups was compared. RESULTS: 1. A total of 146 TN patients underwent MVD. Intraoperative examination revealed that out of 146, 143 patients exhibited contacts, including 110 cases with arterial contact, 22 cases with combined arterial and venous contact, and 11 cases with venous contact. Considering the surgical result as a gold standard, the sensitivity of three-dimensional time leap angiography (3D-TOF-MRA) in assessing vascular compression in TN was 74.0 %; and the sensitivity of three-dimensional steady-state precession rapid imaging sequence (3D-FIESTA) in determining vascular compression was 82.2 %. Out of a total of 17 cases demonstrating negative neurovascular relationship by 3D-TOF-MRA together with 3D-FIESTA, 14 cases were found to have vascular contact during the surgery, and the sensitivity was determined to be 88.4 %. 2.Among the 38 patients with a negative neurovascular relationship demonstrated by 3D-TOF, postoperative efficacy was noted as a cure: 30 cases, improved: 5 cases, no effect: 3 cases. 3D-FIESTA showed 26 cases of negative neurovascular relationship, among them, cured: 20 cases, improved: 3 cases, no effect: 3 cases. A total of 17 patients with negative neurovascular relationships were established by 3D-TOF-MRA together with 3D-FIESTA, and the postoperative effects were found to be cure: 13 cases, improvement: 2 cases, and no effect: 2 cases. There was no statistically significant difference between the negative group and the positive group (x2 test; p > 0.05). CONCLUSION: To conclude, 3D-TOF-MRA, together with 3D-FIESTA, can illustrate the large blood vessels surrounding the trigeminal nerve efficiently, and determine whether it is the offending blood vessel. The interpretation would help reproduce the local anatomical spatial structure of the site before surgery, yet it is impossible to assess the peripheral anatomical relationship of the trigeminal nerve cistern comprehensively and accurately. This hints that a perfect prediction of the surgical effect of MVD is not possible at present. Thus, typical symptoms of TN are the most critical indicators for MVD surgery.

Study on the Therapeutic Effects of Trigeminal Neuralgia With Microvascular Decompression and Stereotactic Gamma Knife Surgery in the Elderly.

OBJECTIVE: The aim of the study was to evaluate the efficacy of microvascular decompression (MVD) and stereotactic gamma knife surgery (GKS) in the treatment of trigeminal neuralgia (TN) in the elderly. PATIENTS AND METHODS: Retrospective analysis of 137 elderly cases with TN underwent MVD, partial sensory rhizotomy (PR) treatment from August 2007 to March 2017 and 56 cases underwent GKS treatment from May 2014 to February 2017 was made, compared the efficacy of MVD and GKS in different age groups. RESULTS: In 125 patients of MVD alone, the responsible vessels included 60 cases of superior cerebellar artery, 55 cases of anterior inferior cerebellar artery, 4 cases of venous vascular compression, 13 cases of mixed arteriovenous compression and 3 cases of vertebral artery, and 2 cases of no responsible vessel. Operation methods: MVD 125 cases, MVD + PR 10 cases, PR 1 cases, simple exploration in 1 case. Results of MVD surgery: Among 125 patients of MVD alone, 95 cases were cured, 15 cases improved, and 15 cases were ineffective. Among 10 cases of MVD + PR, cured in 9 cases and improved in 1 case. PR and simple exploration in 2 cases got pain disappeared. Postoperative complications of MVD: No deaths, CSF leakage in 2 cases, intracranial infection in 3 cases, ipsilateral hearing loss in 1 case, and ipsilateral facial paralysis in 1 case, delayed intracranial hematoma in 2 cases. After GKS treatment, the shortest onset time was from 9 days up to 6 months, an average of 2.2 months. Among 56 patients, 30 cases were cured, accounting for 53.6%, 20 cases improved, accounting for 35.7%, 6 cases were ineffective, accounting for 10.7%. Postoperative complications were facial numbness and dysesthesia, 7 cases, the incidence was 12.5%. In the group of 60 to 70 years old and the group of 70 to 80 years old, the treatment effect of MVD was better than that of GKS (χ test, P < 0.05); there was no significant difference between MVD and GKS in >80 years old group (χ test, P > 0.05). There was no significant difference in the therapeutic effect of TN underwent GKS among all age groups (χ test, P > 0.05). CONCLUSION: Microvascular decompression should be performed more prudently in elderly patients (>80 years old), and the indications for PR should be relatively relaxed. MVD + PR could improve the curative effect in patients with trigeminal neuralgia >80 years. Gamma knife treatment of trigeminal neuralgia had high safety, less complications, and positive curative effect, especially suitable for patients >80 years.

Does Glossopharyngeal Neuralgia Need Rhizotomy in Neurovascular Decompression Surgery?

OBJECTIVE: To evaluate and compare the long-term efficacy and safety of microvascular decompression (MVD) and glossopharyngeal nerve roots rhizotomy (GNR) in the treatment of glossopharyngeal neuralgia (GN). PATIENTS AND METHODS: The data of 37 patients with glossopharyngeal neuralgia undergoing MVD alone and MVD + GNR from July 2004 to March 2017 were analyzed retrospectively. Among them, 22 were MVD alone and 15 were MVD + GNR. All patients underwent preoperative cocaine experiments to verify diagnoses, preoperative magnetic resonance imaging examinations to detect compressing vessels near the root entry zone of the glossopharyngeal nerve. Operation via retrosigmoid approach, keyhole craniotomy, and postoperative efficacy was followed up. RESULTS: Efficacy: In the 22 patients with MVD alone, 19 patients were cured and 3 patients improved. In the 15 patients with MVD + GNR, 14 patients were cured and 1 patient improved. There was no significant difference between the 2 groups (χ test, P > 0.05). COMPLICATIONS: Postoperative complications in MVD group: 2 patients had short-term hoarseness and drinking cough, 1 patient with cerebrospinal fluid leakage, 1 patient with intracranial infection, 1 patient with ipsilateral hearing loss, and no deaths; postoperative complications in MVD + GNR group: permanent hoarseness in 2 patients, short-term drinking cough and hoarseness in 4 patients, ipsilateral facial paralysis in 1 patient, 1 patient with cerebrospinal fluid leakage, no intracranial infection and death. The incidence of postoperative hoarseness and drinking cough in MVD + GNR group was higher than that in MVD group (χ test, P < 0.05). CONCLUSION: The MVD alone was a safe and effective method for the treatment of primary glossopharyngeal neuralgia, the efficacy was equivalent to MVD + GNR, and had low incidence of hoarseness and drinking cough.

Immunohistochemical characterization of lymphangiogenesis-related biomarkers in primary and recurrent gliomas: A STROBE compliant article.

Glial tumors constitute the majority of primary intracranial brain tumors. The expression of specific markers of lymphangiogenesis in gliomas still remains unclear.A total of 40 surgical specimens from 20 patients with recurrent gliomas were included in the study. The expression of D2-40, vascular endothelial growth factor (VEGF)-C, VEGF-D, and VEGF receptor-3 (VEGR-3) was detected by immunohistochemistry (IHC). The clinicopathologic data (p53 and Ki67) were also collected and analyzed.At relapse malignant transformation rate was 65% (13/20 cases). D2-40, VEGF-C, VEGF-D, and VEGFR-3 were expressed in 20%, 30%, 60%, and 20% of primary and 45%, 30%, 75%, and 35% of recurrent glioma tumors (P < .01, P = 1.00, P = .03, P = .03). In 13 cases with increased malignancy grade, the expression of Ki67 and p53 were higher at relapse compared with the primary tumors (P = .001, P = .045). Multivariate survival analysis showed VEGF-D was an independent prognostic factor for malignant transformation (HR = 0.376, P = .045).Glioma is easy to relapse with tumor progression. VEGF-D was an independent prognostic factor for malignant transformation.

Predictive value of serum pregnancy-associated plasma protein A for patients with ischemic cerebrovascular disease.

BACKGROUND: To investigate the role of pregnancy-associated plasma protein A (PAPP-A) in the outcome of ischemic cerebrovascular disease. METHODS: We analyzed the levels of PAPP-A in the transient ischemic attack (TIA) patients, ischemic stroke (IS) patients and normal control, and followed up the outcome of the patients in the following 2 years. Blood samples were drawn at admission, prior to treatment with heparins. RESULTS: The levels of PAPP-A in TIA patients, IS patients and normal control were 4.91 (2.11, 6.48) mIU/L, 6.77 (3.31, 10.23) mIU/L and 4.25 (1.76, 5.22) mIU/L, respectively. The follow-up results of TIA patients and IS patients indicated the PAPP-A concentration in the poor prognosis group were higher than those in the good prognosis group (5.90 vs 4.46 mIU/L, P<.05, 10.06 vs 5.12 mIU/L, P<.05, respectively). Serum PAPP-A concentration emerged as a predictor of risk stratification with an OR of 1.41 and 1.25 (P<.05, P<.05). CONCLUSIONS: Higher PAPP-A concentration has a forecasting value on prognosis in ischemic cerebrovascular disease.

[Intraoperative decisions and surgical efficacies of trigeminal neuralgia responsible vessels].

OBJECTIVE: To explore the types of primary trigeminal neuralgia (TN) responsible vessels and curative efficacies of microscopic vascular decompression (MVD). METHODS: A total of 162 primary TN patients underwent MVD from August 2004 to the present at our hospital.Their clinical data were collected and analyzed. There were 69 males and 93 females with an age range of 22-88 years. RESULTS: The most common responsible vessels were superior cerebellar artery (n = 65, 40.12%), anteroinferior cerebellar artery (n = 45, 27.78%), multiple vessels (n = 26, 16.05%), posteroinferior cerebellar artery (n = 16, 9.88%), veins (n = 6, 3.70%) and vertebral artery (n = 4, 2.47%). And the pressure points were at the root of trigeminal nerve (n = 139, 85.80%), distal part (n = 16, 9.88%) and root and distal part (n = 7, 4.32%). Postoperatively pain disappeared in all patients (including one case on second surgery). Postoperative follow-ups were conducted for 132 cases.Two cases recurred over 8 years and the recurrence rate was 1.52%. CONCLUSION: MVD is preferred method for primary TN non-responsive to pharmacotherapy. Identification and treatment of responsible vessels remain a key. Venous and distal pressure points should be taken care.

[Clinical analysis of 42 cases of chronic expanding intracerebral hematoma].

OBJECTIVE: To summarize our own experiences of managing chronic expanding intracerebral hematoma (CEICH) and discuss its diagnosis and treatment. METHODS: The courses of CEICH, clinical and imaging features, intraoperative findings, pathological examinations and follow-up outcomes were reviewed retrospectively. The relevant literatures were reviewed simultaneously. RESULTS: The course of CEICHs ranged from 22 days to 10 years. Twenty-three cases (54.8%) were misdiagnosed as cystic gliomas, cystic gliomas, brain cysticercoses, brain abscesses and tumor strokes, etc. The misdiagnostic rate had decreased to 19.0% since June 1997. Thirty-eight patients underwent surgical operations and 4 had puncture drainage of hematoma. There was no operative death. Thirty-three cases achieved an excellent recovery and 9 cases had varying degrees of nervous dysfunctions. The follow-up period was 1-21 years. One patient had recurrence after 10 years. Among the cases of multiple CEICH, two lesions underwent no surgical treatment. One increased obviously after 7 years and another disappeared. CONCLUSION: The following five points may be used as the diagnostic criteria of CEICH: (1) intracerebral cystic space-occupying lesions on brain images; (2) circular or circle-like enhancement around lesions; (3) a mixed signal of concentric circular lamellar structures on MRI T1WI; (4) abnormal vascular lesions on CTA, MRA or DSA; (5) clinical signs and symptoms of slow progress of intracranial pressure. CEICHs with clinical symptoms of local mass effect shall be obliterated surgically. The abnormal tissues in cyst wall of hematoma should be resected. Small hematomas (< 2 cm) may be followed up.

[Rapid pore cranial drilling and ventricular drainage in the treatment of ventricular hemorrhage caused by thalamic hemorrhage: an analysis of 401 cases].

OBJECTIVE: To summarize the clinical efficacies and experiences of using rapid pore cranial drilling and external ventricular drainage (EVD) in the treatment of ventricular hemorrhage caused by thalamic hemorrhage. METHODS: Retrospective analysis was conducted for 401 patients at 5 hospitals from May 1983 to December 2010. They underwent EVD with an infusion of urokinase for intraventricular hemorrhage caused by thalamic hemorrhage. There were 212 males and 189 females with an age range of 19 - 78 years. RESULTS: After a 1-month therapy, the outcomes were cure 147/401 (36.7%), improvement 192/401 (47.9%) and others (death and against-advice discharge) 62/401 (15.4%). After 1-3-month treatment, their prognoses were evaluated by activity of daily living (ADL): ADLI 147/401, ADLII 82/401, ADLIII 76/401, ADLIV 19/401, ADLV 15/401, death 43/401 and against-advice discharge 19/401. During a follow-up period of 1 - 3 years, 274 patients showed the following outcomes: ADLI 122/243, ADLII 63/243, ADLIII 58/243 while 31 patients died from pulmonary infection. CONCLUSION: The procedure of EVD (including an infusion of urokinase) with rapid pore cranial drilling is preferred treatment for ventricular hemorrhage caused by thalamic hemorrhage.

[Clinical experiences of normal saline pressed injection via lumbar puncture in the treatment of apnea due to acute tonsillar hernia].

OBJECTIVE: To summarize the clinical experiences of normal saline pressed injection via lumbar puncture in the treatment of acute tonsillar hernia induced apnea. This procedure was routinely carried out after external ventricular drainage and/or lesion removal via open craniotomy. METHODS: During the period of 1969 to 2005, a total of 43 patients failed to regain respiratory after external ventricular drainage using rapid small hole cranio-puncture apparatus or lesion removal via open craniotomy. They underwent lumbar puncture and normal saline was pressed injected via a lumbar puncture needle. The patient data were retrospectively analyzed. RESULTS: Eleven of 43 patients had spontaneous respiration and fully recovered (25.6%), 16 patients regained respiration but died eventually (37.2%) and 16 patients failed to regain respiration (37.2%). The effective rate was 62.8%. CONCLUSION: For the patients failing to regain respiration after external ventricular drainage or supratentorial lesion removal via open craniotomy, the conservative treatment should not be the first choice. The pressed injection of normal saline via lumbar puncture may rescue some patients.

Preoperative demonstration of neurovascular relationship in trigeminal neuralgia by using 3D FIESTA sequence.

PURPOSE: The purpose of the study was to evaluate the value of high-resolution three-dimensional fast imaging employing steady-state acquisition (3D FIESTA) imaging in the visualization of neurovascular relationship in patients with trigeminal neuralgia (TN). METHODS: Thirty-seven patients with unilateral typical TN underwent 3D FIESTA imaging. Neurovascular relationship at the trigeminal root entry zone was reviewed by an experienced neuroradiologist, who was blinded to the clinical details. The imaging results were compared with the operative findings in all patients. RESULTS: In 37 patients with TN, 3D FIESTA imaging identified surgically verified neurovascular contact in 35 of 36 symptomatic nerves. Based on surgical findings, the sensitivity and specificity of magnetic resonance (MR) imaging were 97.2% and 100%, respectively. Agreement between the position (medial, lateral, superior and inferior) of the compressing vessel relative to the trigeminal nerve identified by MR imaging and surgery was excellent (K=0.81; 95% confidence interval, 0.56-1.00). A statistically significant difference was found between the site of neurovascular contact and the clinical symptom related to the trigeminal branch (Fisher's Exact Test, P<.001). CONCLUSIONS: Use of 3D FIESTA sequence enables accurate visualization of neurovascular contact in patients with TN. Anatomic relationships defined by this method can be useful in surgical planning and predicting surgical findings.

Preoperative evaluation of neurovascular relationship by using contrast-enhanced and unenhanced 3D time-of-flight MR angiography in patients with trigeminal neuralgia.

BACKGROUND: Microvascular decompression is an etiological strategy for the therapy of trigeminal neuralgia (TN). Preoperative identification of neurovascular compression, therefore, could have an impact on the determination of appropriate treatment for TN. PURPOSE: To evaluate the value of contrast-enhanced and unenhanced three-dimensional (3D) time-of-flight (TOF) MR angiography in the visualization of neurovascular relationship in patients with TN. MATERIAL AND METHODS: Thirty-seven patients with unilateral TN underwent unenhanced and contrast-enhanced 3D TOF MR angiography with a 3.0-T MR system. Images were reviewed by a radiologist blinded to clinical details. Vascular contact with the trigeminal nerve was identified, and the nature of the involved vessels (artery or vein) was determined. All patients underwent microvascular decompression. RESULTS: In 37 patients with TN, contrast-enhanced 3D TOF MR angiography identified surgically verified neurovascular contact in 35 of 36 symptomatic nerves, and there was no false-positive. Based on surgical findings, the sensitivity of MR imaging was 97.2% and specificity 100%. The nature of the offending vessel was correctly identified in 94.4% of the patients by using the combination of contrast-enhanced and unenhanced MR angiography. CONCLUSION: Contrast-enhanced 3D TOF MR angiography is useful in the detection of vascular contact with the trigeminal nerve in patients with TN, and this MR imaging in combination with unenhanced MR angiography could help in the identification of the nature of the responsible vessels.

[Clinical analysis of acute encephalocele during operation in 21 patients with severe craniocerebral injury].

OBJECTIVE: To analyze the clinical features of acute intra-operative encephalocele and the proper prophylactic-therapeutic measures for severe craniocerebral injury. METHODS: The clinical data were collected and analyzed for 21 patients with severe head injuries who suffered acute intra-operative encephalocele from June 2008 to May 2010. There were 12 males and 9 females with an age range of 18 - 69 years old. RESULTS: Among these patients, 6 died with a mortality rate of 28.5%. It was lower than that reported in literatures. One patient died post-operatively of severe brain swelling and intracranial infection secondary to leakage of cerebrospinal fluid. Four patients died of severe craniocerebral injury, brain swelling and brain stem failure. And 1 patient died after his guardian abandoned the treatment. The follow-up period for the remaining 15 surviving patients was 3 - 6 months. According to the Glasgow outcome score (GOS), there were a favorable prognosis (n = 9), moderate disabilities (n = 5) and severe disability (n = 1). CONCLUSION: The probability of acute intra-operative encephalocele may be predicted in advance with a combination of clinical features and computed tomographic scans. The therapeutic success rate of acute encephalocele will be boosted by taking protective and therapeutic measures pre- and intra-operatively.

Improved ventriculoatrial shunt for cerebrospinal fluid diversion after multiple ventriculoperitoneal shunt failures.

BACKGROUND: Hydrocephalus provides challenging management decisions because of multiple VP shunt failures. Ventriculoperitoneal shunt failure requires urgent management and surgical intervention. We reviewed the outcome of 6 patients who received a conversion from VP to IVA shunt with 8F percutaneous catheter introducer set after previous multiple VP failures to evaluate its efficacy. METHODS: We conducted a retrospective review of 6 patients with multiple previous VP shunt failures treated with an IVA shunt with interventional device 8F percutaneous catheter introducer set at the Second Hospital of Shandong University between May 2005 and July 2007. In this study, clinical manifestation and feasibility of this kind of improved method were analyzed before and after operation. RESULTS: The results of CSF diversion after IVA shunt are generally good in terms of improved clinical improvement and reduced ventricular size as shown in the CT scans. All 6 patients successfully underwent conversion from VP to IVA shunt and obtained a functioning VA shunt; no shunt malfunctions occurred during the follow-up period of 3 to 20 months. CONCLUSION: Although small, this study indicates that it is feasible to consider converting from VP to IVA shunt systems in patients with multiple previous VP shunt failures with 8F percutaneous catheter introducer set. This method is a new technique combined with interventional device in the treatment of hydrocephalus, which can relieve hydrocephalic patients of their sufferings.

HydroCoil occlusion for treatment of traumatic carotid-cavernous fistula: preliminary experience.

OBJECTIVE: To summarize our preliminary experiences regarding HydroCoil occlusion for the treatment of carotid-cavernous fistula (CCF), and to evaluate the effectiveness of this treatment. METHODS: From January 2006 to June 2007, 15 patients with traumatic CCF who were treated using HydroCoil occlusion were included in this study. All the patients presented with symptoms such as intracranial pulsatile noise, bulbar conjunctival hyperemia, and pulsatile exophthalmia. Cerebral angiography revealed that the fistula was located in the right internal carotid-cavernous segment in 6 cases, in the left internal carotid-cavernous segment in 8 cases, and on both sides in 1 case. RESULTS: After CCF procedure, in 15 patients, the fistula was no longer visualized, the internal carotid artery on the affected side remained patent, and intracranial noise disappeared immediately. The preoperative symptoms exophthalmia, bulbar conjunctival hyperemia, etc., returned to normal 1 week after the operation. Vision recovered to varying extents. In the 9 patients who underwent 1-3 months of follow-up cerebral angiography, CCF recurrences and neurological complications were not observed. CONCLUSION: Intravascular occlusion has been widely used for CCF treatment, and detachable balloon embolization remains the preferred treatment. In the case of failure of detachable balloon embolization because the patient cannot tolerate the procedure or internal carotid artery occlusion on the affected side is contraindicated, HydroCoil occlusion is a safe and effective though expensive alternative and a stable method of maintaining high carotid artery patency.

[Recurrence of intracranial aneurysms after endovascular embolization: study of 70 cases].

OBJECTIVE: To evaluate the factors of recurrence of intracranial aneurysm after endovascular embolization. METHODS: Seventy patients with 74 intracranial aneurysms, 37 males and 33 females, aged 47 (37-63), underwent endovascular embolization. Cerebral angiography was conducted 3 months to 1 year after the endovascular embolization on 37 patients. The geometric forms of aneurysm, method and material of endovascular embolization, and digital subtraction angiography (DSA) images before and after the recurrence were analyzed. geometry form, method and material of endovascular embolization and image. RESULTS: Nine recurrent aneurysms were discovered in 8 patients of which 5 were located in the posterior communicating artery; 2 in the anterior communicating artery;and 2 in the first crotch of the right middle cerebral artery. Four of the recurrent aneurysms were wide-necked aneurysms; and 5 were of irregular forms. Before recurrence, complete aneurysm occlusion was achieved in 3 aneurysms and incomplete occlusion was achieved in 6. CONCLUSION: The percentage of complete aneurysm occlusion is related to the location, size, geometric form, method and material of endovascular embolization and density of coil packing. Intracranial aneurysms located in crotch of artery, with wide-neck, large, with irregular forms, and embolized incompletely are liable to recur.

[Diagnosis and treatment of chronic expanding intracerebral hematoma].

OBJECTIVE: To explore the diagnosis, therapeutic strategy, and pathogenetic mechanism of chronic expanding intracerebral hematoma (CEICH). METHODS: The clinical presentation, radiological characteristics, d pathology, and treatment of 22 cases of CEICH, 15 males and 7 females, aged 29. 3, all treated with craniotomy and removal of the wall of the capsule and hematoma, were analyzed retrospectively. RESULTS: The clinical presentation and radiological characteristics of CEICH were atypical. After surgery, 18 patients recovered quite well, 3 patients suffered from hemiplegia, and 1 patient died from rebleeding. The diagnosis of CEICH of all the cases was confirmed by intraoperative finding and pathological results. CONCLUSION: CEICH can be found in any part of the brain that has 2 major characteristics: its clinical symptoms always develop slowly, and the typical radiological characteristic is intracerebral hematoma-form image. Surgery to evacuate the hematoma and remove the capsule is necessary and can be with good outcome.