Objective To summarize the management experiences of pancreatic injuries during laparoscopic urologic surgery.Methods From June 2003 to August 2008,395 laparoscopic operations for upper urinary or adrenal diseases were performed.4 cases of pancreatic injuries which all occurred in left side introperiotoneal procedures were identified with the incidence of 1%.2 men and 2women were involved with the mean age of 45.3(range 32~76y).2 injuries occurred during left radical nephrectomy and 2 during left adrenalectomy.All the injuries located at tail of pancreas with transaction injuries in 2 cases,and mild laceration in 2 cases.Only 1 case had received open surgery for pancreatic debridement,another 3 cases had received clamp and endo-GIA occlusion laparoscopically with local styptic powder aspersing and drainage.Absolute diet,gastrointestinal decompression,,transvenous-use of Somatostatin and hyperalimentation were given routinely.Results The mean blood,urine and drainage fluid diastase that were(648?136)U、(1278.6?368.4)U and(1368.5?428.2)U respectively elevated in all 4 cases postoperatively.Only 1 case had high fever and blood WBC after operation.The mean drainage and hospital stay was 14.2 and 24.6 days.No sequelae was found.Conclusion The tail of pancreas is the most predilecting location of pancreatic injury in laparoscopic urological surgery.The key of ensuring a good prognosis is early detection and suitable management.A severe laceration of the main excretory pancreatic duct need a open surgical management,conservative managements are suitable for a small tear and mild contusion of pancreas.

Objective To evaluate the video urodynamic abnormalities of women with lower urinary tract symptoms.Methods 38 females with lower urinary tract symptoms underwent video urodynamic test.Filling cystometry was done with 15% urographin saline fluid.A diagnosis was made in each case based on cystometrography finding,voiding pressure flow study,EMG and fluoroscopic appearance.Results Video urodynamic showed abnormalities in 23 cases(60.5%),including sensory urgency in 6,detrusor instability(DI) in 5,pseudodyssynergia(PDS) in 4,PDS+DI in 2,urethral orifice stricture in 2,DI+urgency incontinence in 1,impaired compliance in 1,bladder neck stricture in 1 and urethral diverticulum in 1.Conclusion Video urodynamic is useful not only for understanding the abnormalities of functions and morphology of women with lower urinary tract symptoms,but also for properly diagnosing and treating such cases.

The recently described supplementary grading scale may be superior to the widely used Spetzler-Martin grading scale in the prediction of microsurgical outcomes for cerebellar arteriovenous malformations (AVM). We report two cases of ruptured cerebellar AVMs with the same Spetzler-Martin grade but different supplementary grades treated with microsurgical resection. Both patients had symptomatic brainstem compression from cerebellar hematomas and subsequently underwent uncomplicated surgeries; however, their outcomes were significantly different. It has previously been proposed that AVMs distort cerebellar anatomy in a different manner than supratentorial cerebral anatomy thereby potentially resulting in misrepresentation when utilizing the Spetzler-Martin grading scale. However, the components of the supplementary grading scale are independent of cerebellar anatomy, which may explain why it has been shown to be better than the Spetzler-Martin grading scale for prediction of surgical outcomes. In addition, due to the smaller volume of the posterior fossa compared to the supratentorial compartment, rupture of cerebellar AVMs may result in rapid and catastrophic neurological compromise. Therefore, the role of microsurgery may be more critical for AVMs of the cerebellar than for those located elsewhere. Simple and effective grading systems are invaluable tools for clinical and surgical decision-making, although the decisions rendered should always be made in conjunction with the patient's presentation and the physician's experience.
Arteriovenous Malformations* ; Brain Stem ; Cerebellum ; Hematoma ; Humans ; Intracranial Arteriovenous Malformations ; Intracranial Hemorrhages ; Microsurgery ; Rupture ; Stroke

The Pipeline Embolization Device (PED) is an effective treatment approach for complex intracranial aneurysms. Intraprocedural complications during PED deployment are seldom reported. We report a rare complication of a PED malfunction identified immediately following complete deployment during endovascular treatment of a giant middle cerebral artery (MCA) bifurcation aneurysm. After multiple failed attempts at endovascular retrieval of the malfunctioned PED, the patient was taken for microsurgical extraction due to accumulation of thrombus on the proximal unopened portion of the stent and widespread distal dissemination of emboli. After removing the PED from the vessel lumen and resecting the giant aneurysm, we could not reanastamose the proximal MCA to the distal segment. The management of PED malfunction is poorly understood. While removal of an incompletely deployed PED may be undertaken with limited adverse effects, retrieval of a fully deployed PED is associated with a much higher risk of morbidity. Until larger case series of such complications better define the risks and benefits of endovascular or microsurgical retrieval of malfunctioned PEDs, the management of these rare intraprocedural complications will be based on the unique aspects of each individual case and the expertise of the treating neurointerventionalist.
Aneurysm ; Endovascular Procedures ; Glycosaminoglycans ; Humans ; Intracranial Aneurysm ; Intraoperative Complications ; Middle Cerebral Artery ; Risk Assessment ; Stents ; Stroke ; Thrombosis

Treatment of giant posterior circulation aneurysms, via endovascular or microsurgical approaches, carries a high risk of morbidity and mortality. While flow-diverting stents (FDSs) represent a potent therapy for endovascular reconstruction of complex aneurysms, they are also associated with novel complications for which effective salvage techniques are lacking. We present a unique complication from failed treatment with a FDS. A 51 year-old male presented with increasing headaches secondary to a giant, fusiform aneurysm of the left posterior cerebral artery, which was largely thrombosed. Due to progressive enlargement of the aneurysm corresponding to worsening clinical symptoms, the lesion was treated with two Pipeline embolization devices (ev3, Plymouth, MN, United States). Three months after Pipeline embolization device treatment, complete posterior cerebral artery occlusion was observed at the origin of the proximal stent. Despite the lack of arterial inflow, the aneurysm dome continued to grow, resulting in obstructive hydrocephalus. Therefore microsurgical intervention was undertaken to trap and excise the aneurysm. The patient's postoperative course was complicated by multiple venous infarcts, ultimately resulting in death. Successful microsurgical obliteration of aneurysms previously treated with FDSs is extremely difficult. A combination of judicious preoperative planning and meticulous intraoperative surgical technique are requisite for effective management of these complicated cases.
Aneurysm ; Endovascular Procedures ; Headache ; Humans ; Hydrocephalus ; Intracranial Aneurysm* ; Male ; Microsurgery ; Middle Aged ; Mortality ; Posterior Cerebral Artery* ; Stents ; Stroke

OBJECTIVE: Surgical resection of thalamic and brainstem cerebral cavernous malformations (CCMs) is associated with significant operative morbidity, but it may be outweighed, in some cases, by the neurological damage from recurrent hemorrhage in these eloquent areas. The goals of this retrospective cohort study are to describe the technical nuances of surgical approaches and determine the postoperative outcomes for CCMs of the thalamus and brainstem. MATERIALS AND METHODS: We reviewed an institutional database of patients harboring thalamic or brainstem CCMs, who underwent surgical resection from 2010 to 2014. The baseline and follow-up neuroimaging and clinical findings of each patient and the operative details of each case were evaluated. RESULTS: A total of eight patients, including two with thalamic and six with brainstem CCMs, were included in the study cohort. All patients had progressive neurological deterioration from recurrent CCM hemorrhage, and the median modified Rankin Scale (mRS) at presentation was 3. The median CCM maximum diameter and volume were 1.7 cm and 1.8 cm³, respectively. The thalamic CCMs were resected using the anterior transcallosal transchoroidal and supracerebellar infratentorial approaches each in one case (13%). The brainstem CCMs were resected using the retrosigmoid and suboccipital trans-cerebellomedullary fissure approaches each in three cases (38%). After a median follow-up of 11.5 months, all patients were neurologically stable or improved, with a median mRS of 2. The rate of functional independence (mRS 0-2) was 63%. CONCLUSION: Microneurosurgical techniques and approaches can be safely and effectively employed for the management of thalamic and brainstem CCMs in appropriately selected patients.
Brain Stem* ; Cohort Studies ; Follow-Up Studies ; Hemangioma, Cavernous, Central Nervous System* ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Microsurgery ; Neuroimaging ; Retrospective Studies ; Thalamus* ; Vascular Malformations

Treatment of giant intracranial aneurysms, via either surgical or endovascular approaches, is associated with a high level of technical difficulty as well as a high rate of treatment-related morbidity and mortality. Flow-diverting stents, such as the Pipeline embolization device (PED), have drastically altered the therapeutic strategies for the treatment of giant aneurysms. Gaining endovascular access using a microcatheter to the portion of the parent artery distal to the aneurysm neck is requisite for safe and effective stent deployment. Giant aneurysms are often associated with vascular tortuosity, which necessitates significant catheter support systems to enable maneuvering of PEDs across the aneurysm neck. This is also required in order to reduce the probability of stent herniation within giant aneurysms. We report on a case of a giant supraclinoid internal carotid artery (ICA) aneurysm which was treated successfully with a PED utilizing a balloon anchor technique to facilitate direct microcatheter access across the aneurysm neck.
Aneurysm ; Arteries ; Carotid Artery, Internal ; Catheters ; Endovascular Procedures ; Humans ; Intracranial Aneurysm* ; Mortality ; Neck* ; Parents ; Stents ; Stroke ; Subarachnoid Hemorrhage

Large lobar intracerebral hemorrhages (ICHs) can cause rapid neurological deterioration, and affected patients have low rates of survival and functional independence. Currently, the role of surgical intervention in the management patients with lobar ICHs is controversial. Minimally invasive technologies have been developed which may potentially decrease the operative morbidity of ICH surgery. The aim of this case report is to describe the technical aspects of the use of a novel minimally invasive endoport system, the BrainPath (NICO, Indianapolis, IN, USA), through an eyebrow incision for evacuation of a large lobar hematoma. An 84-year-old female presented with a left frontal ICH, measuring 7.5 cm in maximal diameter and 81 cm³ in volume, secondary to cerebral amyloid angiopathy. Through a left eyebrow incision, a miniature modified orbitozygomatic craniotomy was performed, which allowed endoport cannulation of the hematoma from a lateral subfrontal cortical entry point. Endoport-assisted hematoma evacuation resulted in nearly 90% volume reduction and improvement of the patient's functional status at clinical follow-up. We found that minimally invasive endoport technology can be employed in conjunction with conventional neurosurgical skull base principles to achieve safe and effective evacuation of large lobar hematomas in carefully selected patients.
Aged, 80 and over ; Catheterization ; Cerebral Amyloid Angiopathy ; Cerebral Hemorrhage ; Craniotomy ; Eyebrows* ; Female ; Follow-Up Studies ; Hematoma* ; Humans ; Intracranial Hemorrhages ; Microsurgery ; Skull Base ; Stroke

Penicillium oxalicum strain can be isolated from the Bletilla striata (Thunb.) Reichb. f. tubers.Its solid-state fermentation products are concentrated by percolation extraction. Separation and purification have been conducted to the ethyl acetate extracts by preparative HPLC.Based on the use of spectrometry, we have determined 17 known compounds, 12,13-dihydroxy-fumitremorgin C (1), pseurotin A (2), tyrosol (3), cyclo-(L-Pro-L-Val) (4), cis-4-hydroxy-8-O-methylmellein (5), uracil (6), cyclo-(L-Pro-L-Ala) (7), 1,2,3,4-tetrahydro-4-hydroxy-4-quinolin carboxylic acid (8), cyclo-(Gly-L-Pro) (9), 2’-deoxyuridine (10), 1-(β-D-ribofuranosyl)thymine (11), cyclo-(L-Val-Gly) (12), 2’-deoxythymidine (13), cyclo-(Gly-D-Phe) (14), cyclo-L-(4-hydroxyprolinyl)-D-leucine (15), cyclo-(L)-4-hydroxy-Pro-(L)-Phe (16), uridine (17). Here, we report compounds 1–3, 5, 7–8, 11–12, 14–17 are first found and isolated from this endophyte.

Oculomotor nerve palsy resulting from non-aneurysmal vascular compression is extremely rare. Microvascular decompression (MVD) has been previously shown to improve oculomotor nerve palsy (ONP) secondary to arterial compression. A 71-year-old female, with a history of Cushing’s disease previously treated with two transsphenoidal resections and Gamma Knife radiosurgery, presented with one year of progressive left eye diplopia and was diagnosed with a partial left oculomotor nerve palsy. We performed an orbitozygomatic craniotomy for MVD of the left posterior cerebral artery, which was found to be compressing the oculomotor nerve against the tentorium. Unfortunately, the patient’s partial ONP remained unchanged at one year follow-up. The present case suggests inconsistent outcomes of MVD for ONP. Patients with prior sellar or parasellar irradiation may be less likely to benefit from this treatment approach.