Objective To investigate the value of the treatment for intracranial tumor with endoscope assisted microneu-rosurgey.Methods 15 patients with intracranial tumors including acoustic neuromas,epidermoid cists,angioreticulomas and ependymomas were treated by endoscope-assisted microneurosurgey in recent 3 years. Rusults 7 cases with acoustic neuromas underwent total resection, and the enlarged internal auditory canal was not be destroyed after operation. The facial nerves within internal auditory canal were preserved (7/7) ,and which located in the intracranial part acquired preservation (5/7) in 5 cases. 2 cases with epidermoid cists underwent total resection (2/3) and 1 subtotal resection (1/3). 3 cases with angioreticulomas including 6 nodes underwent total resection.1 case with ependymoma acquired total resection(1/2), another acquired subtotal resection(1/2) .With the follow-up from 6 to 24 months on 13 patients,the results was well. Conclusion Using the endoscope, it is possible to resect the tumor that can not be observed under the microscope.
Objective To evaluate the effect of computer-aided design of composite materials with epoxide acrylate maleic （E） and hydroxyapatite （H） in cranioplasty. Methods A total of 45 patients with cranium defects were treated with cranioplasty by using skull bone flaps made of composite materials including epoxide acrylate maleic （E） and hydroxyapatite （H） ,which was designed with computer aid according to individual requirements. The patients were followed up for 6-36 months. Results After cranioplasty with composite EH, there occurred subcutaneous fluid in one patient and mild bone collapse in one. The composite EH showed good histocompatibility, with no infection or rejection. Conclusion During cranioplasty, use of computer-aided design of composite EH takes advantages of good accuracy, short operation time, good biocompatibility and good clinical efficiency.
Key words:
Skull fractures; Biocompatible materials; Computer-assisted design
Objective To discuss the reasons of false judgments of localization of the rupture aneurysms and find the way to fix this problem in patients with multiple intracranial aneurysms. Methods The clinical data of 25 consecutive patients, who presented with their first spontaneous subarachnoid hemorrhage and had multiple intracranial aneurysms from 2003 to 2009 in our hospital, were analyzed retrospectively. The rupture aneurysms were determined according to Nehls' method that reported before, and the supposed responsible rupture aneurysms w0ere clipped within 48 hours after hemorrhage in all patients. More aneurysms that could not be accessed in the same surgical session were surgically terated later. Results The location of the rupture aneurysm was verified at the time of surgery in all 25 patients. The concordance rate of the prediction and the reality of the rupture aneurysm was 80% (20/25). Four patients ( 16% ) ,in whom the ruptured aneurysm was not correctly identified,rebled after surgery,and 2 patients died as a result of the rebleeding One patients had no clear diagnosis at the end. Conclusion In the reported cases, about 80% rupture aneurysms could be correctly diagnosed before treatment according to the CT and DSA examinations. If clear diagnosis couldn't be made,additional examinations should be considered, such as CTA or MRI. Rupture aneurysms must be confirmed during the operation and the other aneurysms should be checked to exclude additional responsible aneurysms in all cases.
Key words:
Spontaneous subarachnoid hemorrhage; Multiple cerebral aneurysms; Cerebral angiography
Objective:To identify the characteristics and extent of orbitocranial tumor for the selection of operative methods.Methods:According to the valuation of the patients'age,eye's site,course of disease,sight,pain,protruding eyes,movement of eyes,and imageological examination.Localization and identification could of tumors be made.Results:Benign tumors have painless protruding eyes.On the early stage the patients'sight were good,but in the late stage the sight had different level barrier.Painful protruding eyes or painful mass,develop fast,sight drop earlier and distinguighed.Even in short time the patients go blind,which usually prompt clinical manifestation of malignant tumors.In the orbit tumors which infect sight,most of that are neurogenous tumors.Malignant tumors in the orbit,and benign tumors in the top of orbit Because it press nerves.Conclusion:Proceed from ophthalmic operations resected tumors in the orbit aren't thoroughly.Because of its operative field are too small to exopse.Particularly the tumors towards into cranium spread,still more can't get complete resection.Only if pass through cranial-orbito operation is of great abvantage to the tumors whole resection.The Key of via cranial-orbito operation is low site of forehead bone value or low site of forehead tempera bone valve.
To develop and validate an effective method for the removal of residual intracerebral hematoma, we prepared a recombinant tissue-type plasminogen activator (rtPA)-loaded Pluronic F127 (NP-rtPA) delivery system to evaluate the neurological response of the ICH rat model.
To observe the impact of positive end-expiratory pressure (PEEP) on central venous pressure (CVP) in mechanically ventilated patients with severe craniocerebral injury.A prospective, interventional, self-control study was conducted. Thirty severe craniocerebral injury patients with central respiratory failure were enrolled. The changes in CVP, mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation [SpO2] were monitored at different PEEP levels [0, 3, 6, 9, 12, 15 cm H2O; 1 cm H2O=0.098 kPa] during mechanical ventilation and after weaning of mechanical ventilation. The influences of PEEP and its discontinuance on haemodynamics and oxygenation were analyzed.The values of CVP [cm H2O] were increased when PEEP increased (from 7.9±3.1 to 13.1±3.7), a linear correlation was found (R=0.509, P=0.000), and linear regression equation was CVP [cm H2O]=7.774+0.368×PEEP [cm H2O]; CVP was elevated about 0.368 cm H2O when PEEP increased 1 cm H2O. CVP values significantly decreased during discontinuance of mechanical ventilation, as compared to those measured at different PEEP levels during mechanical ventilation (F=24.429, P=0.000). The values of MAP, HR and SpO2 showed no significant change with increase of PEEP levels [MAP (mm Hg, 1 mm Hg=0.133 kPa): from 81.6±10.4 to 85.6±10.6; HR (beats per minute): from 79.9±13.5 to 88.1±15.4; SpO2: from 0.968±0.036 to 0.975±0.033, all P>0.05] in mechanically ventilated patients, but discontinuance of mechanical ventilation could significantly increase the levels of MAP and HR (95.3±8.4 and 94.9±10.3, respectively) and lower SpO2 levels (0.928±0.036, all P=0.000).CVP values were overestimated during an increase in PEEP in mechanically ventilated patients with severe craniocerebral injury. CVP was increased about 0.368 cm H2O following an increase of PEEP of 1 cm H2O, whereas the values of MAP, HR and SpO2 showed no significant change with increase in PEEP levels. This study could offer a theoretical base in the correct assessment of CVP values at different PEEP levels without discontinuation of mechanical ventilation.
BACKGROUND The partial pressure of arterial oxygen (PaO₂) is critical to the outcome of patients with traumatic brain injury (TBI). However, it is not clear what range of PaO2 should be maintained to improve patient outcome. The aim of this study was to explore the PaO2 value needed in the acute phase of TBI and provide new evidence for clinical practice. MATERIAL AND METHODS A total of 153 patients with TBI were enrolled retrospectively. Univariate and multivariate logistic regression analyses were conducted on sex, Glasgow Coma Scale (GCS) score on admission, PaO₂ within 6 h of admission, oxygenation index, and other factors. The Glasgow Outcome Score (GOS) of the patient at discharge was used as an indicator of outcome. The good outcome group had GOS ≥4, and the poor outcome group had GOS <4. RESULTS The 153 patients were divided into a good outcome group (n=62) and poor outcome group (n=91). There was a significant difference in sex, admission GCS, surgery, airway status, PaO₂, and oxygen index within 6 h of admission between the 2 groups. Logistic regression analysis showed that PaO₂ <60 mmHg, male sex, and admission GCS score of 3 to 12 were independent risk factors for a poor outcome. CONCLUSIONS Patients with TBI having PaO₂ <60 mmHg within 6 h after admission were more likely to have poor outcomes. The upper limit value of PaO₂ that affects the outcome of TBI in patients has not been found.
Objective To explore the relationship of the serum magnesium level with the injurious severity and its effect on prognoses in patients with traumatic brain injury(TBI).Methods The serum levels of magnesium and neuron specific enolase(NSE) were determined immediately after admission into hospital and its relationship with the injurious severity was analyzed in 231 patients with TBI.One hundred and sixteen patients with severe TBI were randomly divided into MgSO4 group(58 patients), where the patients were treated by MgSO4 besides routine treatment, and control group(58 patients), where the patients were routinely treated.The serum levels of magnesium 3 days after TBI and the serum level of NSE 7 days after TBI were determined in both the groups.The prognoses which were assessed by GOS 6 months after TBI was compared between both the groups.Results There was insignificant difference in the serum levels of magnesium between the patients with severe TBI and ones with mild and medium TBI(P0.05).There were insignificant differences in the serum levels of NSE 7 days after TBI and in GOS 6 months after TBI between both MgSO4 group and the control group(P0.05).Conclusion It is suggested that there is insignificant relativity of the serum levels of magnesium with the injurious severity in the patients with TBI.There is insignificant effect of treatment with MgSO4 early after TBI on the prognoses in the patients with TBI.
Mild hypothermia combined with minimally invasive hematoma evacuation was evaluated in the treatment of hypertensive intracerebral hemorrhage to reduce inflammatory response of brain tissue around hematoma and ameliorate brain function, and to investigate its safety, effectiveness and feasibility. A total of 206 patients with acute spontaneous hypertensive intracerebral hemorrhage were collected clinically and randomly divided into minimally invasive hematoma evacuation group (group A) and mild hypothermia combined with minimally invasive hematoma evacuation (group B). The National Institutes of Health Stroke Scale (NIHSS) score was used before and after treatment. Group A was treated with minimally invasive intracranial hematoma evacuation using intracranial hematoma grinding puncture needle while group B received whole body water circulation type cooling blanket plus local cerebral mild hypothermia therapy with ice cap on the basis of minimally invasive surgery. Patients' brain tissue fragments around hematoma taken out with rinsing during operation and at postoperative 1, 3 and 7 days were investigated. The contents of tumor necrosis factor-α (TNF-α) in serum at postoperative 1, 3 and 7 days were evaluated by enzyme-linked immunosorbent assay (ELISA). For the degree of nerve function defect of patients in the two groups, NIHSS score was lower in group B than that in group A at days 3 and 7, and the differences were statistically significant (P<0.05). The serum TNF-α content and expression of nuclear factor-κB (NF-κB) in brain tissue around hematoma reached the peak on the 3rd day. The TNF-α content and NF-κB expression were lower in group B than those in group A at each time‑point (P<0.05). Mild hypothermia combined with minimally invasive hematoma evacuation can reduce the damage of hematoma to the surrounding brain tissue, effectively alleviate inflammatory response and decrease brain tissue injury, thus ameliorating brain function.
Background: Acute atelectasis is common after traumatic brain injury (TBI), but the related factors and treatment are still unclear. This study is to analyze the independent risk factors for acute atelectasis after TBI and propose an interventional nursing strategy, in order to correct respiratory function and improve the prognosis of patients.Methods: The clinical data of 93 patients with TBI admitted to our hospital from April 2015 to October 2019 were retrospectively analyzed. Clinical data were analyzed by single factor analysis, the cutoff value of influencing factors was obtained by receiver operating characteristic (ROC) curve analysis, and the influencing factors for acute atelectasis after TBI were examined by multi-factor logistic regression.Results: Twenty-two patients (23.66%) were complicated with acute atelectasis during the observation period, while the remaining 71 patients (76.34%) did not have acute atelectasis. Univariate analysis showed that there were significant differences in the Glasgow Coma Scale (GCS), history of vomiting and aspiration, mannitol use, mechanical ventilation, hypoalbuminemia, and serum hypoxia-inducible factor-1α (HIF-1α) between the acute atelectasis group and the non-acute atelectasis group (P<0.05). The AUC area of HIF-1α level predicting acute atelectasis was 0.896 [95% confidence interval (CI): 0.814–0.978, P=0.042], and the cut-off value was 2.12 mmol/L, with a sensitivity of 76.9% and a specificity of 93.3%. Logistic regression analysis showed that a history of vomiting and aspiration [odds ratio (OR) 3.908, 95% confidence interval (CI): 1.201–12.712], mechanical ventilation (OR 3.250, 95% CI: 1.139–9.271), hypoalbuminemia (OR 5.741, 95% Cl: 1.926–17.113), and HIF-1α ≥2.12 mmol/L (OR 6.623, 95% CI: 2.364–16.346) were independent risk factors for acute atelectasis after TBI.Conclusions: A history of vomiting and aspiration, mechanical ventilation, hypoalbuminemia, and high expression of HIF-1α are all independent risk factors for postoperative acute atelectasis in patients with TBI. In clinical practice, patients should be guided to swallow properly, breathe smoothly, eat well, and regularly check the relevant indexes.
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