Intracranial aneurysm often result from congenital defects of regional cerebral artery wall and increased endovascular pressure.Its occurrence and development are associated with several risk factors including genetics,smoking,hypertension,cerebral atherosclerosis and vasculitis.With the application of gene chip technology for the past few years,the research of pathogenic genes associated with intracranial aneurysms was further deepened,and some susceptibility genes closely associated with the occurrence of intracranial aneurysms have been found,and this suggests that intracranial aneurysm may be a polygenic disease caused by the combined action of multiple genes.

Intracranial aneurysm is a cerebral vascular system's trend of rupture of focal patho-expansion, the rupture can result in brain subarachnoid hemorrhage. It's study of etiology can be expected to reveal the biological mechanism for early prevention and treatment. The purpose of this article is to give a review on the status of aneurysmal etiology.

BACKGROUND: There is yet no evidence about whether internal carotid artery stenting with cerebral protection devices is beneficial to reducing neurological complications. OBJECTIVE: To explore the safety and efficacy of carotid angioplasty and stenting with cerebral protection devices for carotid stenosis. DESIGN, TIME AND SETTING: Non-randomized concurrent control trial was performed at Hospital Affiliated to Medical College of Chinese People’s Armed Police Force from June 2005 to January 2007. PARTICIPANTS: Seventy-four patients with carotid artery stenosis underwent stenting, including 21 with cerebral protection devices (16 males and 5 females; average age of 66.4 years, range 50-79 years), and 53 with no protection devices (36 males and 17 females; average age of 69.2 years, range 52-83 years). METHODS: Size of cerebral protection devices was confirmed according to the diameter of normal vessel at distal carotid artery stenosis. The guide wire was sent into distal stenosis under guidance of pathway picture followed by cerebral protection device release. The stent passed over the stenosis and released to appropriate site. The protection device was removed when the stenosis was relieved confirmed by routine angiography. MAIN OUTCOME MEASURES: Features of stenting process; frequency of stroke attack perioperatively and during 12-month follow-up. All of them took periprocedual anticoagulation treatment, cerebral vascular angiograpgy. RESULTS: Seventy-six self-expandable stents were delivered in 74 patients with carotid stenosis. Twenty-one cerebral protection devices were employed including 8 Angioguard and 13 Filterwire. The patients without cerebral protection devices were predilated 20 times (37.7%) with the balloons, and all were postdilated; 3 cases (5.6%) developed brief decreased heart rate and hypotension after stent release. The patients with cerebral protection devices were predilated 6 times (28.5%) with balloons, and all were postdilated; 2 cased (9.5%) developed brief decreased heart rate and hypotension after stent release and 2 (9.5%) developed angiospasm. One patient (4.7%) with cerebral protection devices had cerebral infarction (4.7%) perioperatively and another had cerebral infarction (4.7%) during the follow up. While four patients in the group without cerebral protection devices had cerebral infarction (7.5%) perioperatively, and five had cerebral infarction (9.4%) during the follow up. There were no significant differences between two groups. CONCLUSION: The results of the study show that cerebral protection devices are not helpful to reduce neurological complications in patients with carotid artery stenosis after stenting.

Objective To evaluate the effect of endovascular embolotherapy treatment of carotid cavernous fistulas(CCF) via superior ophthalmic vein(SOV).Methods From June 1996 to June 2006,a total of 32 patients(16 female) with complex CCF underwent endovascular embolotherapy treatment through the SOV.All of the patients visited doctor due to ocular signs and symptoms.Nine patients with direct CCF had previously undergone partial arterial balloons embolotherapy.The other 23 patients were hard mater CCF,and of which 3 had underwent NBCA,embolotherapy with line section or PVA particle.In the angiographic suite all patients underwent general anesthesia,SOV was catheterized through the eyebrow incision.Cavernous sinus was packed with free coils,detachable coils or balloons and NBCA.Results Complete embolism of the arteriovenous shunt was achieved in 81.3%(26/32).A minor residual shunt(without cortical or ocular drainage) remained in 12.5%(4/32).Only SOV was occluded in 6.2%(2/32).All patients were clinical improvement without complications.No death and permanent disability occurred.No recurrence was observed during follow-up of mean time of 3.5 years in 22 outpatients.Conclusion The operative approach to SOV is straightforward and several kind of embolic materials can be used to embolize the cavernous sinus.Endovascular occlusion of cavernous sinus through the SOV is an efficient and safe treatment in CCF.

Objectire:To explore and evaluate the predictors for the prognosis of acute besilar artery occlusion(BAO)and the clinical efficacy of intra-arterial thrombolysis and stenting for BAO.Methods:Intra-arterial thrombolysis was administered with recombinant tissue plasminogen activator or urokinase in 52 patients with BAO within 3 to 48 hours.Stenting was performed in patients whose partial recanalization of residual stenosis＞50%after the thrombolysis.National Institutes of Health Stroke Scale(NIHSS)score was measured before the procedure,and the modifled Rankin scale(mRS)score was obtained at 3 months after the procedure.The clinical data were evaluated with the multivariable stepwise logistic regression analysis and Fisher's exact test.Results:Complete recanalization achieved in 24 patients(46.2%),partial recanalization in 16 patients(30.7%),and non-recanalization in 12 patients(23.1%).mRS scores:22 patients(42.3%)had a favorable outcome,32 survived(61.5%),and 20 died (38.5%).The prognosis of BAO was significantly correlated with the NIHSS score(P＜0.01),therapeutic time window (P ＜0.05) and recanalization level (after the thrombolysis and stenting)(P＜0.01 );the good recanalization after the intra-arterial thrombolysis was significantly correlated with the NIHSS score (P ＜0.01) and therapeutic time window (P ＜0.05).Multivariate analysis showed that the NIHSS score ＜ 14 (P ＜ 0.01 ) and good recanalization could independently predict the favorable prognosis of BAO.Conclusions:The NIHSS score ＜ 14 and good recanalization were the independent predictors for good prognosis of BAO.The rapid and timely treatment of BAO with intra-arterial thrombolysis and stenting is a safe and effective measure.

Objective To investigate the effectiveness of treatment of primary orbital varix via venous embolization therapy approach. Methods From January 2007 to January 2015,the clinical data of 12 patients with primary orbital varix were analyzed retrospectively. All the micro-catheters were implanted via the inferior petrosal sinus approach. The microcoils and Onyx18 were used to embolize the primary orbital varix. Four patients were embolized with micro-coils only, three were embolized with Onyx, and five were embolized with microcoil + Onyx. Results After successful catheterization, the lesions were totally embolized in 12 patients. The symptoms of postural exophthalmos disappeared and the pain was relieved,the depressed symptom of eyeball disappeared in 10 cases, and two patients were relieved partially ( single material embolization) . Nine patients were followed up for 6 to 24 months. The orbital DSA,MRI or CT re-examination was performed. The thrombosis of orbital varices within the lesions was observed and no cavity was found. One of the patients suffered from limited lateral eyeball abduction. Another three were lost to follow up. Conclusion The embolization treatment of primary orbital varix is safe, effective, and convenient via inferior petrosal sinus approach.

Objective:To detect the enhancer of zeste 2 polycomb repressive complex 2 subunit ( EZH2) in glioma patients and analyze its value in disease and prognosis evaluation. Methods:Patients with glioma (glioma group, 90 cases) and patients with benign brain diseases (control group, 45 cases) in Beichen District Hospital of Traditional Chinese Medicine from January 2017 to December 2018 were selected as the research subjects. Methyl-specific PCR was employed to detect the methylation status of the EZH2 gene of the patients in the glioma group (tumor tissue, adjacent normal tissue), the control group (brain tissue), and in glioma cell lines (SHG-44, U251, U87, and CRT). The relationship between EZH2 gene unmethylation and clinicopathological factors was analyzed. The survival difference between the unmethylated and methylated EZH2 gene in tumor tissue of glioma patients was analyzed by Kaplan-Meier survival analysis. Results:The unmethylated rate of the EZH2 gene in the tumor tissue of the glioma group (68.9%) is significantly higher than that of the control group (5.6%) and in the normal tissue adjacent to the tumor (4.4%), and the differences are statistically significant (all P < 0.05). The EZH2 gene of glioma cell lines such as SHG-44, U251, U87, and CRT is unmethylated. There are significant differences in the unmethylated rate of the EZH2 gene in the tumor tissue of the glioma group in terms of intracranial hypertension, maximum tumor diameter, tumor number, and WHO grade (all P < 0.05). The unmethylated rate of the EZH2 gene in patients with intracranial hypertension, tumor maximum diameter ≥ 5 cm, multiple and grade Ⅲ + Ⅳ gliomas is significantly higher than that without intracranial hypertension, tumor maximum diameter < 5 cm, single and grade Ⅰ + Ⅱ gliomas, and the difference is statistically significant (all P < 0.05). The median survival time of EZH2 unmethylated patients is (13.45 ± 3.15) months, and the median survival time of EZH2 methylated patients is (19.45 ± 3.56) months. The median survival time of EZH2 methylated patients is significantly higher than that of unmethylated patients (Logrank = 30.084, P < 0.05). Conclusions:EZH2 is hypomethylated in glioma tumor tissue and can be used as a molecular marker for glioma disease and prognosis assessment