Carotid atheroscleorotic stenosis is one of the most common causes of cerebral ischemic stroke. In China, unfortunately, Its importance has not been fully stressed,and carotid endarterectomy hasn't been used widely so far. Therefore, noninvasive studies on carotid atheroscleorotic stenosis are introduced. The surgical and intravascular interventional therapies are emphasized again.

Objective To study the advantages and procedure of telovelar approach for resection of the lesion in the fourth ventricle. Methods Telovelar approach to the fourth ventricle was executed in 17 cases. Among these patients, seven were females and 10 were males. The age ranged from 5 years to 49 years with mean age of 26.6 years. Pathologically, there were 5 medulloblastomas, 5 ependymomas, 2 epidermoids, 2 brain cysticercosis, and 3 choroid plexus papillomas. During the operation, the medullotonsillar space of the cerebellomedullary fissure and the urulotonsillar space were sharply dissected to release the tonsils from uvula and medullar oblongata bilaterally. According to the size of the neoplasm, the tela or both tela and velum were incised. The fourth ventricle was exposed adequately and the lesion was removed. All operations were performed with the help of microscope. The dura was sutured securely. Results The space occupying lesions were removed totally in all cases and all patients recovered very well, and threre was no mortality or serious disability. With 3 to 21-month follow-up in 11 cases, no death or serious disability was found, and the CT or MRI in 8 patients showed no recurrence. Conclusion The telovelar approach can provide adequate exposure to remove the lesion in the fourth venticle. The inferior vermis need not be incised, so a minimum amount of brain tissue was injured, and postoperative complication is decreased.

Objective To study the role of VEGF on the growth of hypertensional saccular aneurysm and its mechanism. Methods Twenty-four SD rats were divided into 2 groups randomly (A and B, each with 12 rats). Saccular aneurysms of the carotid artery were reproduced by treatment of initial segment of the external carotid artery (1mm long) with elastase. In group A, the posterior branches of both renal arteries were ligated in order to produce marked elevation of blood pressure. In Group B hypertension was not produced to serve as the control group. After 8 weeks, the blood pressure and the size of the aneurysms were measured. Then formalin was infused into the arteries for fixation, and aneurysms were resected. The expression of vascular endothelial growth factors (VEGF) in aneurysmal wall was assessed with immunohistochemical analysis. Results The size of aneurysms: after 8W, significant difference was found between A and B group (P

s Objective To observe the changes in the expression of ?-amyloid precursor protein (?-APP) in selected brain areas in early stage of diffuse axonal injury (DAI) in rats. Methods DAI was induced in SD rats by a self-made rotating injury device. 16 rats in injury group were sacrificed by decapitation at 3 hours and 6 hours post-trauma, while the other 8 rats in sham injury group were put to death after 24 hours. The samples of the rat brain were stained with ?-APP for immunohistochemistry in order to detect the early stage pathological changes in subcortex white matter, hippocampus, corpus callosum and brain stem at different time points. Results The ?-APP expression was positive at 3 hours and was particularly strong at 6 hours after injury. The results of semi-quantitative analysis showed a significant differentiation of 3 hours and 6 hours in the immuno-positive expression of brain stem, corpus callosum and hippocampus. Histological results demonstrated that DAI occurred in all rats of injury group. Conclusion ?-APP is a kind of sensitive and useful immunochemical marker for early DAI diagnosis, and it indicates axonal lesion or breakage.

Objective To observe the dynamic changes in neuroglobin (NGB) expression in cerebral cortex and hippocampus after cerebral ischemia-reperfusion injury in gerbils. Methods The global cerebral ischemia of gerbils was induced by clamping bilateral carotid arteries for 20 minutes, then they were released to allow reperfusion for 2h, 8h, 16h, 24h, 48h and 72h. The NGB expression in cerebral cortex and hippocampus was measured with immunohistochemical methods coupled with computer-assisted image analysis. Results The changes in NGB expression were different in cerebral cortex and in the hippocampus. NGB protein was up-regulated from 16h to 48h after ischemia-reperfusion insult to cerebral cortex, whereas it was down-regulated hippocampus. Conclusion The different expressions of NGB in cerebral cortex and hippocampus are suggestive of compensatory and repair mechanisms in ischemia-damaged neurons after transient global cerebral ischemia. The increased expression of endogenous NGB in the brain after ischemia-reperfusion may be associated with the protective response to ischemic damage.

Objective To observe the expression of neuroglobin (Ngb) in cerebral cortex of traumatic brain injury rats, and investigate the role of neuroglobin in brain injuries. Methods A traumatic brain injury rat model was constructed with Feeney's method. Fifiteen experiment animals were divided randomly into normal control group, 12h-post-trauma group and 36h-post-trauma group (5 each). Immunohistochemistry and image analysis techniques were used to measure the area, optic density (OD) value and integrated optic density (IOD) value of Ngb immunoreactive products in primary somatosensory cortex (S1) and retrosplenial granular b cortex (RSGb), which was located in the inner side and out side of traumatic brain injury cavity in coronal section of rat brain respectively. Results Ngb immunoreactive products were significantly increased after brain trauma, especially in 36h-post-trauma group. The image analysis showed that there was no significant difference of immunoreactive product area in the 3 groups (P

To evaluate clinical effect of transcranial optic nerve decompression on fronto orbito sphenoidal fibrous dysplasia with progressive vision loss, 25 cases were studied retrospectively. All patients had undergone transcranial optic nerve decompression. One week after operation, 21 patients experienced improvement or stability in vision, but 4 patients complained reduction in vision. Before operation, the vision of the affected eye was near blindness in 3 cases among the 4 cases who failed to gain improvement in vision after operation. Effective follow up was achieved in 18 cases, and the follow up period was from two to twenty two years (average six years). Among them, only 3 paticnts showed recurrence of visual disturbance. The results showed that transcranial optic nerve decompression was effective in rescuing vision in fronto orbito sphenoidal fibrous dysplasia with progressive vision loss. Once the patient was near blind before the operation, the surgical result was unsatisfactory.

Objective To study the efficacy and safety of nanometer perfluorocarbon (PFC) in the treatment of hemorrhagic shock, and its role in protecting cerebral cortex nerve cells.Methods Hemorrhagic shock was induced in New Zealand rabbits by arterial bleeding. In the course of the experiment, heart rate, respiratory rate, blood pressure, blood gases, hepatic and renal function, and pathological changes in cerebral cortex were observed. Results The survival rate of animals in the experimental group at 12 hours was higher than that of control group, respiration was deeper and respiratory rate was faster, blood pressure and PaO 2 were significantly higher than that in animals of the control group. There was a tendency of acidosis in the control group. Pupil reflex was more sensitive in the experimental group, and hepatic and renal functions were better in the experimental group than that in control group. Pathological observation showed the cerebral cortex was less damaged in the treatment group than that in control group. Conclusions Nanometer PFC was effective in combating hemorrhagic shock, showing no toxicity to liver and kidney, and it could also be used as an effective neuroprotective agent.

Objective To serially observe carotid arteriosclerosis in rabbit model before and after CEA using high-resolution MRI. Methods Using New Zealand rabbits, lesions were created by air-drying an isolated segment of common carotid artery (120ml/min for 15min) and feeding the rabbits with a diet of 2% cholesterol, 6% peanut oil mixed with normal diet for 2 months. High-resolution MRI examinations were performed for 1 normal rabbit, 4 rabbits with replicated arteriosclerosis before CEA, and 2 rabbits with arteriosclerosis 10 days after CEA, and the results were compared with pathological findings. Results High-resolution MRI revealed the contour and shape of the type II to type IV lesions of rabbit carotid arteriosclerosis model. The MRI images of the lesions corresponded well with the pathological findings. The fibrous plaques were showed as low signals on TOF film, gray images on T 1, T 2, and PDW film, and were obviously enhanced by Gd-DTPA. The MRI images obtained 10 days after CEA also corresponded well with the neo-intima. Conclusion High-resolution MRI can be used as an effective non-invasive method to serially observe the arteriosclerosis lesion of rabbit carotid artery before and after CEA.

Objective To evaluate the value of the StealthStation neuronavigation in the operation of intracranial lesions. Methods 22 patients with different intracranial lesions, including 14 cases of glioma, 2 cases of meningioma,4 cases of cavernous angioma,1 case of lymphoma and 1 case of metastatic cancer, were operated on with the aid of StealthStation neuronavigational system. The neuronavigational accuracy and surgical effect were analysed. Results All intracranial lesions were found accurately with StealthStation neuronavigational system, the predicted accuracy (PA) value was 2.53?0.73mm, accuracy sphere of intracranial lesions in the neuronavigational system was within 2mm in all patients. 13 cases out of 14 gliomas were totally removed under microscope, in 1 case removal was subtotal. In 2 patients, neurological symptoms became worse immediately after the operation but improved within 3 months after the operation. The other 12 patients recovered very well. In another 8 cases total removal under microscopy was successful, but one lymphoma patient showed exacerbation of neurological symptoms immediately after operation, but improved within 1 week after operation. The other 7 cases recovered very well. Conclusion The StealthStation neuronavigational system is reliable and accurate in neurosurgical operation, thus it is helpful to facilitate total resection of intracranial lesions with less operative complications.