Effect of operation combined with recombinant human erythropoietin on patients with severe intracerebral hemorrhage / 中国医师进修杂志

Objective To observe the curative effect and safety of operation combined with recombinant human erythropoietin on patients with severe intracerebral hemorrhage. Methods Seventy-six surgery patients with severe intracerebral hemorrhage were divided into rHu-EPO group (40 cases) and control group (36 cases) by random digits table method. The rHu-EPO group was injected subcutaneously with rHu-EPO, and the control group was treated with placebo. Neurologic impairment (National Institute of Health Stroke Scale, NIHSS score) and activities of daily living (Barthel index) were evaluated 1 month and 3 months after treatment respectively. Moreover, blood pressure, hemoglobin, and adverse reaction were also observed. Results The scores of NIHSS and Barthel index in two groups before treatment had no significant differences (P>0.05). One month and 3 months after treatment, the scores of NIHSS and Barthel index in rHu-EPO group were significantly better: (12.27±5.26) scores vs. (15.36±4.34) scores and (8.17±2.40) scores vs. (13.90±2.54) scores, (54.36±21.87) scores vs. (43.47±20.29) scores and (69.71±23.08) scores vs. (52.56±21.32) scores, there were statistical differences(P0.05). There were no apparente adverse reactions such as fever, erythra, itching and deep venous thrombosis in rHu-EPO group. Conclusions Operation combined with recombinant human erythropoietin has nerve protective effect, and might be an effective and safe therapy target in severe intracerebral hemorrhage.

Intraventricular epidermoids.

To study the clinical characteristics of intraventricular epidermoids, we analysed retrospectively 12 patients treated in our hospital and reviewed the literature with regard to clinical manifestations, imaging features, diagnosis, surgical procedures and prognosis. Four patients with lateral ventricle epidermoid and eight in the fourth ventricle were included in this group. Intraventricular epidermoids are characteristically hypodense non-enhancing lesions on CT scans. MRI reveals them to have long T1 and T2 relaxation times with slight mass effect. Total removal is ideal, but special attention should be paid to preservation of important neurovascular structures. Close proximity of tumours to cranial nerves and the brain stem pose technical difficulties in total removal. Cranial nerve dysfunction and aseptic meningitis are the main postoperative complications. Long-term prognosis for patients with intraventricular epidermoids and well-preserved neurological conditions is good, even in the case of subtotal excision. Clinical follow-up and MRI allow earlier diagnosis of recurrence.

Cerebellopontine angle epidermoids presenting with trigeminal neuralgia.

We studied the clinical characteristics of cerebellopontine angle (CPA) epidermoids presenting with trigeminal neuralgia (TN). Twenty-four patients were analyzed retrospectively and the literature reviewed with regard to clinical manifestation, imaging features, surgical procedures and prognosis. TN may be the initial symptom of CPA epidermoid, particularly in young patients. Epidermoids are characteristically hypodense nonenhancing lesions on CT scans, while on MRI they exhibit long T1 and T2 relaxation times. Although complete removal is ideal in the surgical management of CPA epidermoid, proximity to cranial nerves and the brain stem may pose technical difficulties in complete resection. In addition to complete resection of the tumour, arterial compression at the root entry zone (REZ) of the trigeminal nerve should be sought, and if found, a microvascular decompression (MVD) should be performed. Cranial nerve dysfunction and aseptic meningitis are the most common operative complications.

Cystic acoustic neuroma.

To define the clinical characteristics of cystic acoustic neuroma, we retrospectively analyzed 22 patients with cystic acoustic neuroma and reviewed the literature with regard to clinical manifestation, imaging features, diagnosis, surgical procedures and prognosis. An acoustic neuroma was defined as cystic according to the following criteria: the presence of hypodense/hypointense areas on CT or MRI, the identification of cystic elements at operation and histological verification. At the end of surgery, the facial nerve was anatomically intact in 86.4% of cystic acoustic neuromas. Complete removal of the tumor was achieved in 18 cases (81.8%). We conclude that patients with cystic acoustic neuroma need prompt surgery with special attention paid to the preservation of the facial nerve.

Neuroendoscopic anatomy and surgery of the cerebellopontine angle.

To probe the feasibility and utility of neuroendoscopic inspection of the anatomy of the cerebellopontine angle (CPA) and of neuroendoscopic assisted microneurosurgery (NEAMN) for CPA lesions via a retrosigmoid approach, we used retrosigmoid NEAMN in 28 patients with CPA lesions. Prior to this, we undertook anatomical observation of bilateral CPA in two adult cadaver heads using the neuroendoscope. NEAMN tumour resection was performed in eight acoustic neuromas, one meningioma and 14 cholesteatomas and NEAMN vascular decompression was performed in five patients with trigeminal neuralgia. Both the neurovascular structures of the CPA and the ventral surface of the pons, as well as the clivus, can be inspected using the neuroendoscope through a retrosigmoid approach with a 2-3 cm diameter bony opening. Complete excision of the tumour with preservation of the facial nerve was achieved in all eight acoustic neuromas. Likewise, total resection of the tumour was possible in the 14 cholesteatomas and one meningioma. Paroxysmal facial pain resolved after NEAMN vascular decompression in the five patients with trigeminal neuralgia. There were no postoperative complications or deaths in this series. The CPA can be divided into three levels - the cranial, medial, and caudal, and each level contains specific neurovascular structures as seen through the neuroendoscope. Knowledge of these divisions is useful to master the common NEAMN procedures of the CPA. NEAMN for CPA lesions via a retrosigmoid approach is a useful adjunct to standard microneurosurgical techniques effect and may decrease the operative risk.

Rerupture of intracranial aneurysms during cerebral angiography.

Three cases of re-rupture of intracranial aneurysms during cerebral angiography (RIADCA) between June and September, 2001 are reported. All cases underwent emergency craniotomy and aneurysm clipping. The subarachnoid blood and the extravasating contrast medium were removed intraoperatively as completely as possible. There was no mortality in this series. The incidence, timing, sex, age, inducing factors, risk factors, prevention measures and prognosis are discussed and reviewed in conjunction with the literature.

Chronic expanding intracerebral hematoma.

In order to study the clinical characteristics of chronic expanding intracerebral hematoma (CEICH), we analyzed retrospectively 21 patients with CEICH and reviewed the literature with regard to clinical manifestations, medical imaging features, surgical findings, pathological examinations, diagnoses, treatments and prognoses, etc. All patients recovered well and did not recur 1-2 months after operation, except one, who died of contralateral intracerebral hemorrhage three months later. Patients were followed-up by computerized tomographic (CT) scanning. MRI was useful for the preoperative diagnosis.

Intracranial tumoural haemorrhage--a report of 58 cases.

In order to study the computerized tomographic (CT) appearances and clinical characteristics of intracranial tumoural haemorrhage (ITH), we analyzed retrospectively fifty-eight patients with ITH and reviewed the literature. As a result, 91% patients had acute or subacute onset and 26% manifested haemorrhage as their first symptoms. CT scanning indicated that intratumoural bleeding occurred in 23 cases, bleeding into parenchyma 18 cases, subarachnoid space 6 cases, ventricle 3 cases and subdural space 8 cases. Thirty-eight patients had emergency operations and the others had selective operations. Both tumours and haematomas were removed all together in all patients. Fifty-five patients were cured or improved and three died during the perioperative stage in our series. Among the patients with ITH, there were 21 metastatic tumours, 19 gliomas, 10 meningiomas, 6 pituitary adenomas, 1 melanoma and 1 acoustic neurilemoma. The onset of most ITH resembled that of cerebrovascular diseases. The location of ITH and the CT appearances of ITH varied in different cerebral tumours. Radical removal of brain tumours with haemorrhage is an effective treatment for ITH, which can greatly decrease the perioperative mortality rate and improve the prognoses of patients.

Clinical characteristics of chronic subdural hematoma evolving from traumatic subdural effusion / 中华外科杂志

<p><b>OBJECTIVE</b>To probe into the incidence, mechanism and clinical characteristics of chronic subdural hematoma (CSDH) evolving from traumatic subdural effusion (TSE).</p><p><b>METHODS</b>The clinical materials of 32 patients with CSDH evolving from TSH were analyzed retrospectively and the correlative literature was reviewed.</p><p><b>RESULTS</b>16.7% of the patients with TSH evolved into CSDH. The time of evolution was 22 - 100 days after head injury. All patients were cured with hematoma drainage.</p><p><b>CONCLUSIONS</b>TSE is one of the origins of CSDH. The clinical characteristics of TSE evolving into CSDH include polarization of patient age, and chronic small effusion. The patients are usually injured deceleratedly and accompanied with mild cerebral damage.</p>