BACKGROUND: Although improvement could be achieved after the first operation, limb symptoms of patients would aggravate with the progress or reoccurrence of Parkinson disease (PD), thereby second operation would become necessary if symptom could not be controllel by medication.OBJECTIVE: To investigate the improving rate of symptoms and complications of patients with PD after the second operation.DESIGN: Case analysisSETTING: Neurosurgery Department of 153th Military Central Hospital and Neurosurgery Department of Tangdu Hospital Affiliated to the Fourth Military Medical University of Chinese PLA.PARTICIPANTS: Totally 387 primary PD patients were collected from Neurosurgery Department of 153th Military Central Hospital and Neurosurgery Department of Tangdu Hospital Affiliated to the Fourth Military Medical College of Chinese PLA from October 1997 to December 2002.Totally 350 patients received two operations in the same hospital, and other 37 patients received the first operation at other hospital and the second operation in our hospital. The intervals of two operations were within half a year in 36 cases, 0.5-0.9 year in 72 cases, 1.0-1.9 years in 108 cases and 2.0-5.0 years in 171 cases respectively.METHODS: Under the stereotactic microelectrode-guidance, the targets of all patients were subjected to iconographical orientation, microelectrode record, microelectrode stimulation and exploration and radio frequency microelectrode verification before just stage bilateral posteroventral pallidotomy (PVP) or thalamus ventral intermediate nucleus damage(TVIND),unified Parkinson's disease rating scale (UPDRS) was used at preoperative and postoperative "on" state (at the beginning of medication, patients move freely and stays in "on" state) as well as "off" state (when medication loss function, patients displays moving disability and stays in "off" state).complication between two operation .RESULTS: Data of 387 patients were remained in the results analysis.operation was lower than that of first operation (tremor 95.4%, 96.9%;rigidity 94.6%, 95.1%; bradykinesia 88.9%, 92.3%; gait 62.3%, 67.1%;balance 65.1%, 69.4%, akinesia and cramp 95.8%, 98.0%), but no diffor UPDRS were lower than that of preoperative scores (P ＜ 0.01). The mean total UPDRS scores improved by 46.8% in the "on" state and 53.5% in the "off" state after second operation, lower than that of first tive complications: The occurrenceof complications that was specific for the second operation including fatigue, salivation, reduced voice, fake bulbar paralysis, lethargy, hiccough, urinary incontinence, urinary retention were found higher than that of after the first operation (P ＜ 0.05).The occurrence of cerebral hemorrhage was also lower than that of after first operation.UPDRS were lower in the second operation, which may be due to that PD of postoperative complications which was specific for the second operation was obviously increased, which possibly associated with age, state of illness, constitution, operation type and interval between operations. But occurrence of non-specific postoperative complications was basically the same in two operations (cerebral hemorrhage and inflammation), suggesting that hemorrhage risk did not increased due to the second operation.

Objective To investigate the early physiologic and pathologic changes of primary explosive injury to brain in dogs.Methods Thirty mongrel male dogs were randomly divided into 13 mm detonated injury group (n=10),9 mm detonated injury group (n=10) and 5 mm detonated injury group (n=10); a spherical explosive with explosive energy of 1 g TNT was used to detonate at different distances (13,9 and 5 mm) to dogs' head to cause the severe,moderate and slight degrees of craniocerebral primary explosive injury in these dogs,respectively.Changes of respiratory frequency (RF),heart rate (HR) and mean arterial blood pressure (MABP),survival time and behavior in these dogs were observed; HE staining and electron microscopy were used to observe the pathological and ultrastructural changes of the brain tissues.Results The RF,HR and MABP levels after cerebral explosive injury were decreased in dogs of three groups; the decreased extent was increased following the increase of injury extent,with significant difference among the three groups (13 mm detonated injury group＞9 mm detonated injury group＞5 mm detonated injury group,P＜0.05).The server the injury,the more obvious the changes of dog behaviors (13 mm detonated injury group＞9 mm detonated injury group＞5 mm detonated injury group,P＜0.05).There were different extents of contusion and laceration of the brains,brain hemorrhage,and subdural hematoma in the three groups.Conclusions RF,HR and BP levels are decreased in three groups after cerebral primary explosive injury in dogs; the more obvious the physiologic and pathologic changes,the severer degrees of craniocerebral explosive injury.The severer injury dogs have more obvious behavioral changes.The survival time in dogs with the severer degrees of craniocerebral explosive injury is shorter than that in slight injury one.

Objective To establish new experimental models of primary explosive injury to brain in dogs and investigate the effect of early treatment on primary explosive injury in dogs by using two doses of 20％ mannitol.Methods Thirty-six mongrel male dogs were randomly divided into three groups: model group, high-dose treatment group and low-dose treatment group (n=12).Models of primary craniocerebral explosive injury were established in all the groups.Dogs in the high-dose treatment group and low-dose treatment group were given 1.0 g/kg and 0.5 g/kg 20％ mannitol 6 h after injury, and these treatments were given every 6 h;0, 3, 6, 12, 24 and 48 h after injury, respiratory frequency, heart rate, blood pressure (BP), intracranial pressure (ICP), CT of skull, urea nitrogen (BUN), creatinine (Cr) and survival time were observed and compared.Results The levels of respiratory frequency and heart rate were significantly increased, and the levels of BP and ICP were significantly decreased in the high-dose treatment group and low-dose treatment group as compared with those in the model group 12, 24 and 48 h after injury (P＜0.05);24 and 48 h after injury, as compared with those in the model group and high-dose treatment group, the levels of BUN and Cr in the low-dose treatment group were significantly lower (P＜0.05).The midline shift in the high-dose treatment group ([3.5±0.41] mm) and low-dose treatment group ([3.3±0.22] mm) was significantly decreased than that in the model group ([6.4±0.50] mm) 48 h after injury (P＜0.05).The survival time in both high-dose treatment group (131.6±8.73 h) and low-dose treatment group (133.7±9.31 h) was significantly longer than that in control group (96.0±3.0 h,P＜0.05).Conclusion Early proper treatment for primary craniocerebral explosive injury by using mannitol can relieve the indexes of respiratory frequency, heart rate, BP and ICP, and relieve the severities of cerebral edema, prolong the survival time in dogs, but high-dose 20％ mannitol might aggravate the kidney damage of the injured dogs.

Objective:To investigate the imaging and electrophysiological characteristics, surgical methods and efficacies of preschoolers with refractory temporal lobe epilepsy.Methods:A retrospective data study was conducted on 27 patients with refractory temporal lobe epilepsy accepted surgical treatment in our hospital from June 2014 to January 2019. By combined with clinical manifestations, preoperative epileptogenic zones were evaluated by imaging data, such as MR imaging, MR spectroscopy and positron emission tomography-CT, and interictal and ictal video-electroencephalogram (VEEG) data. During the surgery, cortical electroencephalography (ECoG) and deep electrode monitoring were used to monitor and locate the abnormal discharge areas to guide the surgical excision of epileptic zone. Engel grading was used to evaluate the efficacy after surgery.Results:All children had typical clinical manifestations of temporal lobe epilepsy; abnormal signal images were found in one side of the temporal lobe and the hippocampus in MR imaging; epileptic discharges were originated from one side frontotemporal region in interictal and ictal VEEG. Obviously persistent or paroxysmal spike waves, spike waves and slow spikes and spike composite waves were intraoperatively discovered by ECoG and depth electrode electroencephalography in the temporal lobe. All patients accepted standard anterior temporal lobectomy+lesion resection+peripheral abnormal discharge resection of the temporal lobe cortex; partial insular lobe was excised and frontal cortex was performed low power thermal coagulation in two patients. Follow-up was performed for 6 months; Engel grading I was reported in 22 patients (81.5%), Engel grading II in 3 patients (11.1%), and Engel grading III in 2 patients (7.4%).Conclusion:Early surgery and moderate extension of resection under intraoperative ECoG and deep electrode monitoring are the key factors to improve the surgical efficacy of preschoolers with refractory temporal lobe epilepsy.

Objective:To summarize the clinical characteristics and efficacy of hemorrhage resulted from cortical venous infarction with seizure as the first symptom after craniotomy.Methods:Eleven patients with hemorrhage resulted from cortical venous infarction with seizure as the first symptom after craniotomy admitted to Neurosurgical Center, 988 th Hospital of PLA Joint Logistic Support Force from June 2011 to September 2019 were chosen in our study; primary diseases included meningioma in 7 patients, contusion and laceration of frontal lobe in 2, hypertensive cerebral hemorrhage in 1, and obsessive-compulsive disorder in 1 patient. Epilepsy was the first symptom after craniotomy. Clinical characteristics and efficacy of these patients were analyzed retrospectively; seizure control efficacy was evaluated by Engel grading. Results:First seizure occurred 4 h-7 d after craniotomy in these 11 patients, including 2 with focal sensory retention seizure, 3 with focal bilateral tonic-clonic seizure, and 6 with general tonic-clonic seizure. Follow-up cranial CT revealed hematoma in surgical region, adjacent cortex or subcortex in 9 patients (hematoma volume: 15-50 mL); emergency craniotomy (hematoma clearance) and decompressive craniectomy was performed in 5 patients; only emergency craniotomy (hematoma clearance) was performed in 3 patients; conservative treatment was performed in 1 patient. A small amount of diffuse bleeding with severe cerebral edema in the surgical region appeared in 2 patients, and the transient limb paralysis gradually recovered after 2 months of conservative treatment. Follow-up was performed for (4.5±1.7) years ([2.3-7.0] years). During the last follow-up, 4 patients were normal, 5 patients had mild to moderate hemiplegia, 1 had mild decreased vision in the right eye, and 1 had long-term coma. Epileptic control efficacy analysis indicated that 8 had Engel grading I and 3 grading II.Conclusion:Complete removal of hematoma and inactivated brain tissues can effectively control seizures and rebleeding in patients with hemorrhage resulted from cortical venous infarction.