Lin X.,Tianjin Huanhu Hospital
Chinese Journal of Traumatology - English Edition | Year: 2011
The surgical management of chronic subdural hematoma (CSDH) is still a controversial issue, and a standard therapy has not been established because of the unclear pathogenic mechanisms in CSDH. The intention of this paper is to find a simple and efficient surgical procedure for CSDH. A retrospective study of 448 patients with CSDH by surgical treatment during 2005 to 2009 was conducted in order to compare the efficiency between two different primary surgical methods, i.e. twist-drill drainage with-out irrigation in Group A (n=178) and one burr-hole with irrigation in Group B (n=270). The results were statistically analyzed. The reoperation rates in Group A and Group B were 7.9 and 11.9 respectively. The good outcome rate was 88.8 and 75.5, the complication was 7.9 and 20.7 in Group A and Group B, respectively. The burr-hole drainage with irrigation of the hematoma cavity is not beneficial to the outcome and prognosis. Irrigation is not important in the surgical treatment for C S D H. Thus in initial treatment, twist-drill drainage without irrigation of the hematoma cavity is recommended because it is relatively safe, time-saving and cost-effective. © 2011 The Editorial Board of Biomedical and Environmental Sciences.
Tong X.-G.,Tianjin Huanhu Hospital
Chinese Journal of Contemporary Neurology and Neurosurgery | Year: 2012
Objective: To explore the selection and indication of intracranial-extracranial vascular anastomosis or bypass and trapping treatment for complex giant intracranial aneurysms. Methods: The preoperative assessment and surgical procedure of 12 patients with giant intracranial aneurysm admitted from Feb. 2008 to Dec. 2011 were analysed. Results: There were 6 patients with internal carotid aneurysm (4 at cavernous sinus and clinoid process segment, and 2 at communicating branch), 3 with middle cerebral artery aneurysms, and 3 with posterior circulation aneurysms. Seven patients whose pre - operative MR perfusion imaging (MRP) showed obvious ischemia at the distal region of parent artery underwent superfical temporal artery-middle cerebral artery (STA-MCA) low flow vascular anastomosis. Five patients with rather long grafting vessel (≥ 15 cm) presented normal blood supply at the distal region of parent artery, preoperative balloon occlusion test (BOT) negative, and insufficient filling of collateral circulation on cerebral angiography after compressed the neck of the affected side. These patients underwent intracranial -extracranial high flow vascular bypass. The outcome of 11 patients was good (modified Rankin Scale, 0-3), while the other was poor (modified Rankin Scale, 4). Conclusion: Intracranial - extracranial vascular anastomosis or bypass and trapping treatment sometimes is the final option for complex intracranial aneurysms. Whether the blood supply at distal region of parent artery is normal or not will be the key to the selection for different flow vascular bypass (or anastomosis). Occipital artery, superfical temporal artery, and radial artery are commonly used as grafting vessels.
Guo X.-B.,Zhengzhou University |
Guan S.,Zhengzhou University |
Fan Y.,Tianjin Huanhu Hospital |
Song L.-J.,Zhengzhou University
American Journal of Neuroradiology | Year: 2012
BACKGROUND AND PURPOSE: Cerebral venous thrombosis is a rare entity that can be difficult to manage. Most patients with cerebral sinus thrombosis recover after treatment with heparin, but a subgroup of severe cerebral venous sinus thrombosis has a poor prognosis. Those patients may benefit from intrasinus thrombolysis. The purpose of this research was to carry out a retrospective analysis of patients with severe cerebral venous sinus thrombosis, and to study the safety and efficacy of intrasinus thrombolysis in patients with cerebral venous sinus thrombosis unresponsive to conventional heparin therapy. MATERIALS AND METHODS: Thirty-seven patients with cerebral venous sinus thrombosis who received intrasinus thrombolysis during a 3-year period (January 2007 to December 2009) were included in this study. Urokinase was infused into the sinus via a microcatheter. Data regarding demographic, clinical, and radiologic features were collected. Follow-up data were obtained at 6 months. MRV was repeated to assess the recanalization of the venous sinus. RESULTS: Twenty-seven patients (73%) had good outcome and 7 patients (19%) who were independent for activities of daily life had only mild deficits. One patient survived with severe neurologic deficits and 2 patients died. Complete recanalization of the superior sagittal sinus was seen in 35 patients (97%). At a follow-up of 6 months, 34 patients (92%) were either asymptomatic or had only minor subjective symptoms. CONCLUSIONS: Intrasinus thrombolysis is safe and effective in patients with severe cerebral venous sinus thrombosis. However, the subgroup of patients that is likely to benefit the most from this procedure is not clear from our data. Large randomized controlled trials are required to further clarify this issue.
Yong J.,Tianjin Huanhu Hospital
Chinese Journal of Contemporary Neurology and Neurosurgery | Year: 2014
The word "dementia" originates with Dr. Philippe Pinel of France. Back in 1801, Pinel reported a young female patient, aged 34, who was exhibiting some strange symptoms for someone in her age group. Pinel described this woman's condition as "demence", or an incoherence of mental faculties. It was believed that the term "dementia" came from this association. More than a century later (1906), Dr. Alois Alzheimer published a paper on one of his patients who had very similar symptoms and behaviors as Pinel's patient. This description, of a woman known as Auguste D, was the first scientific report of the disease now known as Alzheimer's disease. It is now clear that Alzheimer's disease is a major cause of dementia in elderly people as well as in relatively young adults. Research in the last two centuries has led to a greatly improved understanding of what Alzheimer's disease is, who gets it, and how it develops and affects the brain. Those works are beginning to pay off with better diagnostic techniques, improved treatments, and even potential ways of preventing these diseases.
Liu W.,Tianjin Huanhu Hospital
Chinese Journal of Contemporary Neurology and Neurosurgery | Year: 2013
Objective To evaluate the replantation of lamina and spinous process and autogenous bone fusion after resection of intraspinal tumors. Methods Twenty-two cases of intraspinal canal tumors, including 5 cervical, 5 thoracic and 12 lumbar, were operated through posterior median approach with removing 2-3 segments of spinous process and lamina complex in the lesion area. During operation, the spinous process and lamina complex was replanted in situ after the intraspinal tumor was removed, and was fixed by titanium bar and titanium screw, along with autogenous bone fusion to restore the normal anatomy of spinal canal. Japanese Orthopedic Association (JOA) scale was used to evaluate the spinal function before and after operation. Results Tumors were totally removed in all of the cases, and 2-3 (2.50 on average) laminae were removed in each case. After 3-17 months (10 months on average) follow-up, imaging findings showed good reposition of replanted lamina and spinous process with partly bony fusion in all cases. No syndromes of spinal stenosis or compression on spinal dura mater owing to canal cicatrix were seen. Conclusion Replantation of lamina and spinous process and autogenous bone fusion can keep the anatomic integrality of the spine, reconstruct the spinal canal structure, maintain the spinal stability and avoid nerve root compression due to spinal canal scar.