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Objective:To investigate the safety and efficacy of intravascular intervention in ruptured intracranial vertebral artery dissecting aneurysm (IVADA).Methods:A retrospective analysis was performed; 25 patients with ruptured IVADA (25 aneurysms) admitted to Department of Neurosurgery, First Affiliated Hospital of University of Science and Technology of China from January 2020 to June 2023, were chosen. Aneurysm and parent artery occlusion or stent-assisted spring coil embolization were performed according to location of the aneurysms, degrees of aneurysm immediate embolization were evaluated by Raymond grading, and perioperative adverse events were recorded. The patients were followed up for 6-48 months, and aneurysm recurrence was determined according to DSA results; prognoses were assessed by modified Rankin Scale (mRS), with scores of 0-2 as good prognosis and scores of 3-6 as poor prognosis.Results:All 25 patients had unilateral ruptured IVADA, 10 (40%) received aneurysm and parent artery occlusion (occlusion of dissection segment) and 15 (60%) received stent-assisted embolization. Immediately after surgery, 19 patients (76%) had grading I embolization, 4 (16%) grading II embolization, and 2 (8%) grading III embolization. No aneurysm rupture or stent related thrombosis was observed during procedure; 3 patients (12%) died after procedure, with postoperative rebleeding in 1, postoperative cerebellar infarction with respiratory failure in 1, and severe pneumonia in 1. In the 22 survivals, 18 had good prognosis and 4 had poor prognosis. In the 5 relapsed patients (all accepted stent-assisted embolization), 4 underwent re-intervention, and one with visualization at aneurysm neck was relatively stable on re-examination and accepted regular follow up.Conclusion:Aneurysm and parent artery occlusion can be used for non-dominant vertebral artery aneurysms not involving posterior inferior cerebellar artery, whose recurrence rate is lower than that of stent-assisted coil embolization.
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Objective:To observe the short-term efficacy and complications of intracranial wide-necked aneurysms treated by Neuroform Atlas stent-assisted coil embolization, and preliminary explore its safety and effectiveness.Methods:A retrospective analysis was performed. The clinical data of 33 patients with intracranial wide-necked aneurysms, admitted to our hospital from September 2020 to August 2021, were collected. All patients underwent Neuroform Atlas stent -assisted coil embolization, including 28 patients with single stent assisted coil embolization and 5 with double stent assisted embolization. Raymond grading was used to evaluate the degrees of immediate postoperative aneurysm embolization. Modified Rankin scale (mRS) was used to assess the prognoses 3-6 months after surgery. DSA was performed to recheck the recurrence of aneurysms and the patency of the parent artery.Results:DSA immediately after surgery showed that all aneurysms were tightly embolized (Raymond grading I). One patient developed intraoperative thrombosis, and blood flow was restored after tirofiban thrombolytic therapy, without new neurological dysfunction after surgery. Three-6 months after surgery, all patients had a good prognosis; DSA recheck was completed in 21 patients (63.6%), and no stenosis or thrombosis were found in the parent artery and no aneurysm recurrence was noted.Conclusion:The Neuroform Atlas stent-assisted coil embolization in treatment of intracranial wide-necked aneurysms has good efficacy and high safety.
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Objective:To explore the influencing factors for pulmonary complications of patients with Parkinson's disease (PD) after deep brain stimulation (DBS), and to construct a nomogram model for predicting pulmonary complications after DBS.Methods:Two hundred and seventy-two patients with PD accepted DBS, admitted to our hospital from March 2015 to December 2019, were chosen in our study; they were divided into pulmonary complication group ( n=56) and non-pulmonary complication group ( n=216). The clinical data of patients from the two groups were compared retrospectively. Multivariate Logistic regression was used to analyze the risk factors for pulmonary complications of patients with PD after DBS, and a nomogram model was established to predict the risk of pulmonary complications; receiver operating characteristic (ROC) curve was used to analyze the prediction performance of the model. Results:As compared with non-pulmonary complication group, the pulmonary complication group had significantly higher percentages of patients with history of pulmonary disease, preoperative albumin<35 g/L, preoperative forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC)<60%, operation time≥180 min, and age≥70 years, and significantly lower Parkinson's disease sleep scale (PDSS) scores, unified Parkinson's disease rating scale Ⅲ (UPDRS Ⅲ) scores, and preoperative albumin level, and statistically longer postoperative hospital stays ( P<0.05). Multivariate Logistic regression analysis results showed that history of pulmonary disease ( OR=4.230, 95%CI: 2.035-8.207), preoperative albumin<35 g/L ( OR=6.159, 95%CI: 2.570-5.091), preoperative FEV1/FVC<60% ( OR=31.771, 95%CI: 6.702-66.412), operation time≥180 min ( OR=3.550, 95%CI: 2.261-10.065), age≥70 years ( OR=3.714, 95%CI: 1.451-4.827), and PDSS scores ( OR=1.017, 95%CI: 1.351-13.880) were the independent risk factors for pulmonary complications of patients with PD after DBS. Nomogram model established by using the above indicators showed that area under the curve for predicting pulmonary complications of patients with PD after DBS was 0.841 ( 95%CI: 0.774-0.904, P=0.000), with sensitivity of 84.03% and specificity of 75.06%. Conclusion:PD patients with history of pulmonary disease, preoperative albumin<35 g/L, preoperative FEV1/FVC<60%, operation time≥180 min, age≥70 years, and low PDSS scores are trend to have pulmonary complications after DBS; the nomogram model based on the above variables is highly effective in predicting the risk of postoperative pulmonary complications.
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Objective:To investigate the application value of electroencephalogram (EEG) combined with regional cerebral oxygen saturation (rSO 2) in monitoring cerebral perfusion during carotid endarterectomy (CEA). Methods:A retrospective analysis of clinical data of 42 patients with atherosclerotic carotid artery stenosis admitted to and accepted CEA in our hospital from January 2018 to December 2019 was performed. CEA was performed under EEG combined with rSO 2 monitoring. The efficacy and safety of EEG combined with rSO 2 in monitoring cerebral perfusion abnormalities during CEA were analyzed. Results:After carotid artery occlusion, 24 patients (57.1%) had normal EEG and rSO 2; 15 (35.7%) had abnormal changes of EEG, among whom 13 (31.0%) were accompanied by rSO 2 anomaly; 16 (38.1%) had abnormal rSO 2, among whom 13 (31.0%) were accompanied by EEG anomaly. Of these 18 patients with abnormal EEG and/or rSO 2 monitoring, 17 patients recovered after increasing their blood pressure and 1 patient recovered after diverter tube usage. Intraoperative EEG and rSO 2 monitoring results were consistent (Kappa=0.745, P=0.000). The positive rates of combined monitoring, EEG alone or rSO 2 alone were 42.9%, 35.7% and 38.1%, respectively. All patients were evaluated clinically and radiologically before discharge, and no new ischemic lesions or clinical symptoms were found. Conclusions:EEG and rSO 2 monitoring are well consistent in CEA; the combined monitoring can make up for the deficiency of single monitoring to increase surgical safety.
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Objective:To observe the short-term efficacy and complications of flow diverter device Tubridge in the treatment of complex intracranial aneurysms, and to summarize the indications and experience of Tubridge in treatment of complex intracranial aneurysms.Methods:Thirty-one patients with complex intracranial aneurysms accepted treatment with assistance of Tubridge in our hospital from January 2020 to December 2020 were enrolled. Raymond grading was used to evaluate the degrees of aneurysm embolization immediately after surgery. Modified Rankin scale (mRS) was used to evaluate the prognoses 6 months after surgery. The embolization of aneurysms was determined in these patients by DSA 6 and 12 months after surgery.Results:Thirty-seven aneurysms were noted in these 31 patients. A total of 32 diverters (Turbridge) were implanted into these 37 aneurysms, and all of which were successfully delivered and released. Thirteen aneurysms were filled with spring coils (8 with Raymond grading I, 2 with Raymond grading II, 3 with Raymond grading III by DSA immediately after surgery), and 24 aneurysms were not filled with spring coils. Postoperative ischemic complications occurred in 1 patient, and no hemorrhagic complications or death were noted. All 31 patients had good prognosis at follow-up. Six months after surgery, DSA re-examination in 24 patients (77.4%) showed that complete occlusion of aneurysms was achieved in 17 patients (70.8%). DSA re-examination 12 months after surgery showed complete occlusion of aneurysms in 19 of the 25 patients (76%).Conclusion:The new domestic flow diverter device Tubridge has a high success rate, less perioperative complications, high safety, and good recovery in the treatment of complex intracranial aneurysm.
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Objective To explore the efficacy of moderate dose bromocriptine by one-off oral administration in treatment of patients with non-acute prolactin (PRL) type pituitary adenoma.Methods Forty-three patients with definite diagnosis of non-acute prolactin type pituitary adenoma,admitted to our hospital from January 2016 to December 2017,were chosen in our study.All patients were administrated with 5 mg bromocriptine at 18 pm;the serum PRL levels were examined at 2,3 and 12 h after bromocriptine administration.The curative effects of these patients were judged by decline rate of PRL,and the curative effects of patients with different genders,different initial PRL levels and different ages were compared.Results In these 43 patients,bromocriptine showed excellent effect in 20 patients,obvious effect in 18 and invalid effect in 5.There were statistically significant differences in the efficacy of bromocriptine between different genders (P＜0.05).There were statistically significant differences in efficacy of patients with different genders after taking bromocriptine (P＜0.05).The female patients had obviously higher rate of obvious effect than the male patients.Patients with different initial PRL values had statistically significant differences in efficacy after taking bromocriptine (P＜0.05).Patients with PRL initial value of 40-200 ng/mL had significantly higher rate of obvious effect than patients with PRL initial value of ＞200 ng/mL.There was no significant difference in efficacy between patients ＜ 45 years old and patients＞45 years old (P＞0.05).Conclusion The treatment ofhyperprolactin caused by prolactin type pituitary adenoma with moderate dose bromocriptine by one-off oral administration is effective;female patients have obviously better effect than male patients;and for patients with initial prolactin＞200 ng/mL,the effect is better.
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Objective To understand the clinical nutritional status and malnutrition risk factors of Parkinson's disease (PD) patients and construct their risk scoring system.Methods A total of 221 patients with PD admitted to our hospital from January 2015 to January 2019 were enrolled. The nutritional status of the patients was assessed by Mini Nutrition Assessment (MNA), and according to the MNA scores, these patients were divided into well-nourished groups (n=176) and malnourished group (including patients having malnutrition and malnutrition risk,n=45). Single factor analysis and Logistic regression analysis were used to analyze the risk factors; their scoring systems were constructed and Hosmer-Lemeshow goodness of fit test was used. Accuracy and discrimination of evaluation scoring systems were evaluated by area under receiver operating characteristic (ROC) curve.Results A total of 45 patients (20.36％) had malnutrition or risk of malnutrition. Multivariate regression analysis suggested that the course of disease≥9 years, motor symptoms (unified PD rating scale Ⅲ scores≥54), Hoehn-Yahr (H-Y) staging≥4, daily levodopa equivalent dose≥600 mg, scores of non-motor symptom scale (NMSS) scores≥101, and quality of life (39-item PD questionnaire scores≥81) were independent risk factors for malnutrition in PD patients (P<0.05). The constructed risk scoring system scored from 0 to 30, and Hosmer-Lemeshow goodness of fit test were:χ2=6.259,P=0.618; the area under ROC curve was0.830 (95％CI: 0.801-0.860); when the predicted score was 14, Yoden index was the largest (0.517), and the sensitivity and specificity were 75.70％ and 76.00％, respectively.Conclusion sPD patients have a high risk of malnutrition or malnutrition. The risk scoring system based on risk factors has high predictive ability and discriminating ability, and can be used as an important tool for malnutrition risk assessment in PD patients.
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Hemifacial spasm (HFS) is a common cranial nerve disease,which seriously affects the beauty,visual function and quality of life of patients.The pathogenesis of the disease is still unclear and no effective drug therapy is found.Surgical treatment is the only way now.In this paper,the progress of etiology and pathophysiology,three dimensional imaging evaluation,electrophysiological evaluation,endoscopic application and microvascular decompression of HFS are discussed.
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Objective To explore prevention and treatment of complications following resection of pineal lesions via the modified Poppen approach.Methods From January 2008 to December 2017,62 patients received resection of pineal region lesions via the modified Poppen approach at Department of Neurosurgery,Anhui Provincial Hospital.Their clinical data and outcomes were reviewed.The incidences of postoperative complications were compared between the patients with differences in lesion diameter,tentorial angle and preoperative hydrocephalus.Results Of this cohort,total tumor resection was performed in 48,subtotal resection in 10 and partial resection in 4.Follow-ups from 3 to 12 months revealed 2 cases of hemianopia which were recovered 3 months later,7 cases of occipital lobe contusion,2 cases of monoparesis and 2 cases of intracranial infection.Of the 7 cases of occipital lobe contusion,3 had intracranial hematoma which had been removed by secondary surgery and 4 had ataxia.The incidences of postoperative hemianopia and monoparesis for the patients with a lesion ＞4.5 cm in diameter were significantly higher than for those with a lesion ≤4.5 cm in diameter (P＜0.05).The incidence of postoperative hemianopia for the patients with a tentorial angle ＞60° was significantly higher than for those with a tentorial angle ≤ 60° (P＜0.05).Conclusions Size and tentorial angle of the lesion may be closely associated with the complications following resection of pineal lesions via the modified Poppen approach.The key to reducing the postoperative complications lies in comprehensive preoperative assessments,familiarity with clinical anatomy of the Poppen approach,sophisticated surgical skills and an individualized surgical protocol.
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Objective To analyze the risk factors related to incidence of shunt dependent hydrocephalus in patients with intracranial aneurysmal subarachnoid hemorrhage so as to provide guidance for clinical diagnosis and treatment.Methods The clinical data were retrospectively analyzed of the 451 patients who had been treated in our hospital for ruptured intracranial aneurysmal subarachnoid hemorrhage from January 2013 to December 2016.Of them,67 were complicated with shunt dependent hydrocephalus and 384 were not.The 2 groups were compared in terms of related clinical variables.Multivariate Logistic regression was conducted to analyze risk factors associated with incidence of shunt dependent hydrocephalus.Results The proportions of patients ＞60 years old,intraventricular hemorrhage,posterior circulation aneurysm,acute hydrocephalus and central nervous system infection were significantly higher in the patients with complicated shunt dependent hydrocephalus than in those without (P＜0.05).There were significant differences between the 2 groups in Hunt-Hess grade and Fisher grade at admission (P＜0.05).Multivariate Logistic regression analysis revealed that posterior circulation aneurysm,acute hydrocephalus and central nervous system infection were independent risk factors for incidence of shunt dependent hydrocephalus in patients with intracranial aneurysmal subarachnoid hemorrhage.Conclusion If the patients with intracranial aneurysmal subarachnoid hemorrhage are complicated with posterior circulation aneurysm,acute hydrocephalus and central nervous system infection,they are more likely to develop shunt dependent hydrocephalus.
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Objective Transient brain function inhibition is a common symptom after mild brain injury,but some patients show persistent post-concussional syndrome (PCS).The aims of this study are to assess functional and causal connectivity of attention and default mode network using resting-state functional MR imaging (fMRI) to investigate the abnormal connectivity and its significance in PCS patients.Methods Resting-state fMRI data were collected from 23 PCS patients with attention disorders,admitted to our hospital from November 2015 to October 2016 and 21 age-,gender,and education-matched healthy controls recruited at the same period.The fMRI data were analyzed by group independent component analysis (ICA) toolbox to attention networks and default mode network (DMN).The components of the selected networks were compared in PCS and healthy controls to explore the changes of functional connectivity (FC).Granger causality analysis (GCA) was performed by taking the above significant brain areas as regions of interest (ROIs) to calculate bivariate coefficient of each pair of ROIs.Comparisons were performed to find the significant different causal connectivity of the two groups.Results In attention networks,the FC value of left frontal eye field (FEF),bilateral intraparietal sulcus (IPS),bilateral ventral prefrontal cortex (vPFC) and bilateral temporo-parietal junction (TPJ) was decreased.In DMN,the FC value of bilateral medial prefrontal cortex (mPFC) was reduced and bilateral precuneus (PCUN) was enhanced.Correlating GCA value,it was increased significantly from left FEF to left PCUN and IPS,while it was reduced from left PCUN and IPS to left FEF;and it was decreased from left IPS to left vPFC and increased from left TPJ to left PCUN.Conclusion The attention networks are restrained in resting state,which may influence the attention function in PCS patients;and the causal connection is altered in the above ROIs,and these changes may be related to inhibition of activation of default network to compensate for the loss of attention function by antagonistic effects in PCS patients.
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Objective To investigate the clinical effect of endovascular interventional treatment of intracranial peripheral aneurysms. Methods From January 2013 to December 2016,the clinical data of 31 patients with intracranial peripheral aneurysm admitted to the Department of Neurosurgery,Anhui Provincial Hospital were analyzed retrospectively.Among them,12 patients had saccular aneurysms,10 had narrow-neck aneurysms,and 2 lacked clear aneurysm necks;19 patients had fusiform aneurysms,they all lacked clear aneurysm necks.Ten patients with narrow-neck saccular aneurysm were treated with coil embolization, of the 2 lacked clear neck saccular aneurysms,1 was treated with stent-assisted coil embolization,1 was treated with coil occlusion of the aneurysm and parent artery;4 patients with fusiform aneurysm were treated with coil occlusion of the aneurysms and parent arteries,11 with fusiform aneurysm were treated with Onyx glue occlusion of the aneurysms and parent arteries,and 4 with fusiform aneurysm were treated with coils in combination with Onyx glue occlusion of the aneurysms and parent arteries.They were followed up for 6 to 36 months after procedure. Results All patients were successfully treated with endovascular intervention,no rebleeding cases were found.Immediate postoperative angiography showed that 11 patients with saccular aneurysm were totally occluded.The aneurysms and parent arteries in 1 patient with saccular aneurysm and 19 with fusiform aneurysm were totally occluded.The aneurysms and parent arteries of 8 patients were occluded with Onyx glue,cranial CT revealed different degrees of cerebral infarction (6 patients without new neurological deficits,2 new neurologic deficits).CT revealed cerebral infarction in 1 patient treated with coils in combination with Onyx glue for occlusion of the aneurysm and parent artery(no new neurologic deficit),other patients did not have cerebral infarction and new neurologic deficits.DSA follow-up revealed aneurysm neck recurrence in 1 patient with saccular aneurysm,no obvious aneurysm recurrence was observed in all other patients. Conclusions Endovascular treatment of intracranial peripheral aneurysms is safe and effective.Choose what specific intervention therapy base on the aneurysm morphology,location, tortuous degree of the parent artery,and the importance of the blood supply area.
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ObjectiveTo explore the changes of degree attribute values and its significance of post-concussion syndrome (PCS) patients with tinnitus by the brain network research method based on graph theory.Methods34 PCS patients were chosen,including 17 PCS patients with bilateral tinnitus (PCS tinnitus group) and 17 PCS patients without tinnitus (PCS non-tinnitus group).Meanwhile,17 healthy individuals with the matched age,gender and educational background were recruited as the control.Degree attribute values of PCS patients with tinnitus were figured out with the brain network research method based on graph theory.Results(1)The degree attribute values of PCS patients without tinnitus at left orbital middle frontal gyrus (3.13±1.07),left thalamus (2.51±1.03),left superior temporal gyrus (3.67±1.31),right anterior cingulate cortex (3.13±1.25),right posterior cingulate cortex (2.13±1.08) and right supramarginal gyrus (4.46±1.35) were reduced compared with the control group (4.41±1.47,3.71±1.08,5.27±2.13,5.51±0.67,5.63±2.16 and 5.64±1.30) (P<0.05).The degree attribute values of PCS patients without tinnitus at left posterior cingulate cortex (5.87±1.06) and left gyrus lingualis (4.67±1.48) increased compared with the control group (4.41±1.46,3.21±1.27) (P<0.05).(2) The degree attribute values of PCS patients with tinnitus at left posterior cingulate cortex (3.37±1.54),left parahippocampal gyrus (3.41±1.62),left amygdala (2.25±1.43),left angular gyrus (4.17±1.02),left superior temporal gyrus (3.25±1.02),right thalamus (2.35±1.34),right Heschl gyri (3.97±1.62),right superior temporal gyrus (3.26±1.22),right cuneus (3.18±1.32) and right lingular lobe (3.26±1.42) were decreased,compared with the control group (4.41±1.46,5.27±2.13,3.71±1.08,5.63±2.61,5.64±1.30,3.43±1.33,5.63±2.16,5.13±1.64,5.51±0.67,4.24±0.63) (P<0.05).The degree attribute values of PCS patients with tinnitus at right posterior cingulate cortex (5.76±1.83),left MPFC (6.08±1.62) and right precuneus (6.08±1.06) were increased,compared with the control group (4.47±1.26,4.41±1.47,4.81±0.62) (P<0.05).(3)The degree attribute values of PCS patients with tinnitus at left MPFC,left amygdale,left parahippocampal gyrus,right Heschl gyri,right superior temporal gyrus,right cuneus and right lingular lobe were decreased,compared with PCS patients without tinnitus (P<0.05).The degree attribute values of PCS patients with tinnitus at right posterior cingulate cortex and left insular lobe increased,compared with PCS patients without tinnitus (P<0.05).ConclusionsPCS patients with tinnitus present the alteration of degree attribute in related brain network structure.The alteration in degree attribute of relevant brain zones in auditory system,limbic system and default network system may be important factors which result in tinnitus of PCS patients.
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Objective To analyze the influence factors for complete embolization of intracranial aneurysms. Methods The clinical data of 546 inpatients with single intracranial aneurysm underwent interventional embolization at the Department of Neurosurgery,Anhui Provincial Hospital Affiliated to Anhui Medical University from January 2013 to January 2017 were analyzed retrospectively. They were divided into either a complete embolization group (n=255) or a incomplete embolization group (n=291) according to the immediate embolism degree of aneurysms. Single factor,multiple factors logistic regression analyses were used to analyze the factors associated with complete embolization of intracranial aneurysms. Results Univariate analysis showed that there were significant differences in the rupture status,anatomical morphology,Hunt-Hess grade, aneurysm size and neck width, different treatment regimens, and aneurysm angle between the patients in the complete embolism group and the incomplete embolism group ( all P<0. 05). The results of multivariate regression analysis showed that aneurysm size ( OR,0. 344,95%CI 0. 204-0. 578,P<0. 01),aneurysm rupture status (OR,0. 568,95%CI 0. 314-0. 947,P=0. 030), embolism ways (OR,3. 699,95%CI 2. 223-6. 153,P<0. 01),neck width of aneurysm (OR,0. 326, 95%CI 0. 198-0. 539,P=0. 003),aneurysm angle (OR,0. 647,95%CI 0. 451-0. 928,P=0. 018),and aneurysm morphology (OR,1. 689,95%CI 1. 118-2. 552,P =0. 013) were the independent factors of affecting the complete embolization of intracranial aneurysms. Conclusion Tiny, unruptured, narrow-neck, small inclination angle,regular-shaped aneurysms,stent-assisted or balloon-assisted embolization of intracranial aneurysms are easier to embolize the aneurysms completely.
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Objective To analyze the influence factors for complete embolization of intracranial aneurysms. Methods The clinical data of 546 inpatients with single intracranial aneurysm underwent interventional embolization at the Department of Neurosurgery,Anhui Provincial Hospital Affiliated to Anhui Medical University from January 2013 to January 2017 were analyzed retrospectively. They were divided into either a complete embolization group (n=255) or a incomplete embolization group (n=291) according to the immediate embolism degree of aneurysms. Single factor,multiple factors logistic regression analyses were used to analyze the factors associated with complete embolization of intracranial aneurysms. Results Univariate analysis showed that there were significant differences in the rupture status,anatomical morphology,Hunt-Hess grade, aneurysm size and neck width, different treatment regimens, and aneurysm angle between the patients in the complete embolism group and the incomplete embolism group ( all P<0. 05). The results of multivariate regression analysis showed that aneurysm size ( OR,0. 344,95%CI 0. 204-0. 578,P<0. 01),aneurysm rupture status (OR,0. 568,95%CI 0. 314-0. 947,P=0. 030), embolism ways (OR,3. 699,95%CI 2. 223-6. 153,P<0. 01),neck width of aneurysm (OR,0. 326, 95%CI 0. 198-0. 539,P=0. 003),aneurysm angle (OR,0. 647,95%CI 0. 451-0. 928,P=0. 018),and aneurysm morphology (OR,1. 689,95%CI 1. 118-2. 552,P =0. 013) were the independent factors of affecting the complete embolization of intracranial aneurysms. Conclusion Tiny, unruptured, narrow-neck, small inclination angle,regular-shaped aneurysms,stent-assisted or balloon-assisted embolization of intracranial aneurysms are easier to embolize the aneurysms completely.
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Objective To evaluate the application values of diffusion tensor tractography (DTT) combined with neuronavigation in microsurgery of insular gliomas. Methods The clinical data of 27 patients with insular gliomas, admitted to our hospital from March 2013 to October 2017, were analyzed retrospectively. All DTT images were transferred to the neuronavigation system, and the three-dimensional location of tumors and pyramidal tracts were re-constructed. Surgical approaches were designed and excision scopes were defined before the surgery. Techniques on how to distinguish and protect the key blood vessels and pyramidal tracts were discussed. The treatment efficacies were analyzed. Results Total lesion resection was achieved in 22 patients (81.5％), subtotal resection in 4 (14.8％ ), and partial resection in one (3.7％ ). Postoperative pathology indicated 7 were oligodendrogliomas, and 20 were astrocytomas, including WHO grade I in one, grade II in 18, and grade III in one. One patient had transient aphasia (recovery after two weeks), 2 experienced worsened hemiplegia on opposite side of their bodies (normal after one month), and the left 24 patients remained intact function after operation. Conclusions The combination of DTT and neuronavigation is safe and effective in surgical treatment for insular gliomas, which can protect the brain function at greatest degree and maximize lesion resection, and improve the postoperative quality of life.
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Objective To investigate the influence of focal insular glioma on risky decision-making and to verify the causal relationship between insular and risky decision-making cognitive process.Methods 12 patients with focal insular glioma,15 healthy individuals and 15 lesion controls with brain glioma predominantly affecting non-insular lobes were tested with a risky decision-making task.The results were compared by statistical methods.Results The bet time (BT),report time (RT) and bet or report failure (F) of insular glioma patients were (1.61±0.06) s,(1.61±0.10) s and (2(2,3.75)) respectively.BT,RT and F of lesion controls were (0.70±0.11) s,(0.69±0.11s) and (0(0,0)) respectively and those of healthy group were (0.71 ±0.10) s,(0.68 ±0.11) s and (0(0,1)) respectively.Compared with normal subjects and lesion controls,BT and RT of insular glioma patients were significantly extended,and F was observably increased (P＜0.01).BT,RT and F of lesion controls had no significant difference compared with those of healthy group (P＞0.05).Conclusion The risky decision-making cognitive process may be influenced by insular glioma.The insular region plays a necessary role in decision-making under risk and insular causally is involved in risky decision making.
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Objective To obsevre the peptidyl-prolyi isomerase 1 (PIN1) and Nanog expreesions in glioma tissues and the effect of PIN1 inhibitor polyiso-butylene (PiB) on their expressions and U87 cell proliferation.Methods Eighty-four glioma samples (15 with WHO graded Ⅱ,27 with WHO graded Ⅲ and 42 with WHO graded Ⅳ),collected in our hospital from March 2013 to August 2014,were chosen in our study; their expressions of PIN1 and Nanog were detected by immunohistochemical staining; U87 glioblastoma cell lines were cultured; 0.2,0.5,1.0 and 2.0 μg/mL PiB was given to the cells for 24 and 48 h,and then,MTT assay was employed to detect the inhibited effect and inhibition ratio was calculated; 1.0 μmol/L PiB group (U87 cells treated with 1.0 μmol/L PiB for 24 h) and control group (U87 cells without any treatment) were chosen,immunofluorescence staining was used to detect the PIN1 and Nanog protein expressions,and real time-PCR and Western blotting were employed to observe the mRNA and protein expressions of PIN1 and Nanog.Results The positive protein expression rate of PIN1 and Nanog in gliomas of different grades (WHO graded Ⅱ,Ⅲ and Ⅳ) was significantly different (P＜0.05):the higher the malignancy grade,the higher the rate of positive protein expression of PIN1 and Nanog.MTT assay indicated that PiB could inhibit the cell proliferation in dose-and concentration-dependent manners; as compared with the control group,1.0 μmol/L PiB group had significantly decreased percentages of PIN1+,Nanog+ and PIN1+/Nanog+ cells (P＜0.05); the mRNA PIN1 expression quantity in the control group and 1.0 μmol/L PiB group was 1.82±0.03 and 0.94±0.20,and that of Nanog was 1.47±0.04 and 0.82±0.19,with significant differences (P＜0.05); the protein PIN1 expression quantity in the control group and 1.0 μmol/L PiB group was 2.96±0.05 and 1.15±0.26,and that of Nanog was 1.52±0.16 and 0.75±0.05,with significant differences (P＜0.05).Conclusion PIN1 and Nanog play important roles in the pathogenesis of human gliomas and are related to the glioma malignancy; PIN1 may participate in the regulation of Nanog,and there is a pathway between the two genes; the glioma cell proliferation ability is suppressed by down-regulating the PIN1-Nanog expression.
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Objective To explore the functional imaging alteration of dorsal attention network (DAN) between heroin addicts and heroin abstainers and probe into its influence on attentional function.Methods Attention-related neuropsychological assessments were applied to evaluate the difference of attentional function between heroin addicts and heroin abstainers.With the functional magnetic resonance imaging (fMRI) data obtained from 17 heroin addicts and 15 heroin abstainers at resting state,we extracted the DANs of heroin withdrawal group and heroin dependence group respectively by using independent component analysis (ICA) and analysed the differences of intra-group and inter-group,then correlation analysis was performed among brain areas which have significant difference between groups and Stroop interference effect test.Results Compared with the heroin dependence group,there was a better result of attentional function in the heroin withdrawal group (P＜0.05),especially at the digit span test(backward) (P=0.0363),digit symbol test (writing) (P =0.0195),Stroop test C (reaction) (P =0.0379),Stroop test C (error) (P=0.0014) and Stroop interference effect test (P=0.0002).Neuroimaging findings demonstrated that there was a similar DAN in the heroin withdrawal group and heroin dependence group which mainly included the bilateral intraparietal suleus,postcentral gyrus and frontal eye field.Compared with the DAN of heroin addicts,significantly enhanced functional connectivity within the DAN of heroin abstainers was observed in the left superior parietal lobule (MIN:-24,-75,48),right inferior parietal lobule (MIN:39,-54,45) and left inferior parietal lobule (MIN:-33,-51,57).Significant negative correlations were observed between these brain areas and Stroop interference effect test in the heroin dependence group (r=-0.79,-0.69,-0.64,P＜0.01),but not in the heroin withdrawal group.Conclusions Heroin addiction can impair attentional function,compared with the DAN of heroin addicts,significantly enhanced functional connectivity in the left superior parietal lobule as well as bilateral inferior parietal lobule are observed in the heroin abstainers at resting state,which may be one of the neural mechanisms of attentional function improvement.
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Objective To conclude the application experience of intraoperative ultrasound added with neuronavigation in resection of intracranial gliomas.Methods A retrospective analysis was performed on the clinical data of 60 patients with intracranial gliomas,performed resection in our hospital from January 2010 to June 2013 by intraoperative ultrasound added with neuronavigation; 32 of them had high-grade gliomas and 28 low-grade ones.Ultrasonoscopy of different grade gliomas was studied.Results The accuracy of localization was 100％ in 60 patients with intracranial gliomas.Ultrasonic image of high-grade gliomas enjoyed obvious hyperechogenicity and the boundaries were clear usually; ultrasonic image of low-grade ones were slightly hyperechogenic or isoechogenic and the boundaries were indistinct usually.Inhomogeneous hyperechogenic of the ultrasonoscopy of intracranial gliomas before resection and hypoechogenic of residual cavity after resection were noted,respectively.Total removal was achieved in 50 patients,subtotal resection in 6 and partial resection in 4.Brain swelling happened postoperatively in 1 and was remitted by decompressive craniectomy.Hemiplegia happened in 2,and no death occurred postoperatively.Conclusions Intraoperative ultrasound is important to the correct of brain shift,and has clear and important value to the choice of operation approach and incising cortex.Ultrasonic image of high-grade gliomas and calcified lesions enjoys the best view.Intraoperative ultrasound added with neuronavigation can raise resection rate of intracranial gliomas.