Objective To evaluate the diagnostic value of dual-source CT angiography (DSCTA) for intracranial aneurysms.Methods The data of DSCTA and digital subtraction angiography (DSA) were collected from 95 patients with subarachnoid hemorrhage (SAH).The efficacies of detection and description of morphologic features of intracranial aneurysms were analyzed retrospectively.Results A total of 117 aneurysms in 88 patients were detected with DSCTA.Two patients were suspected of having aneurysms,and no aneurysrms were detected in 5 patients.These patients were reexamined with DSA,4 were diagnosed as having aneurysm,and the aneurysms were not detected in 3 patients.DSA results were considered as gold standard,the specificity,sensitivity and accuracy of DSCTA for the detection of intracranial aneurysms were 100％,96.7％and 96.8％,respectively.The larger volume of intracranial aneurysm was,the higher the sensitivity of DSCTA diagnosis would be.Even for small aneurysms,the sensitivity of DSCTA diagnose was more than 90％.In addition,tmeasurement results of the maximum diameter and neck width of aneurysms measured by DSCTA were almost consistent with DSA.Condclusions SCTA is a non-invasive,quick,reliable,and effective method,and can provide accurate imaging information for surgery.The specificity and sensitivity of the diagnosis of aneurysms with DSCTA are almost the same with DSA.It has more advantages than DSA in the emergency operation of intracranial aneurysms.

Objective: To disclose the effects of booster immunization of human diploid cell rabies vaccine (HDCV) after eight years of primary vaccination. Methods: Sixty subjects who had participated the phase Ⅲ clinical trial of freeze-dried HDCV were selected and gaven booster immunization after eight years of primary vaccination. The side effects of booster immunization were observed. The serum before and after 14 days of booster immunization were collected and detected the rabies virus neutralizing antibody (RVNA) by rapid fluorescent focus inhibition test (RFFIT). The positive rate and geometric mean titer (GMT) of RVNA before and after booster immunization were made statistical analysis. Results: Total 54 subjects finished the follow-up and RVNA detection. No sever side-effects were observed in 30 min or 15 days of follow-up after booster immunization. The positive rate of RVNA before and after booster immunization were 51.85% (28/54) and 96.30% (52/54). The GMT of RVNA before and after booster immunization were 1.42 IU/ml and 30.61 IU/ml. Conclusions The freeze-dried HDCV has good immune effects with one-dose of booster immunization after eight years of primary vaccination.

Objective To investigate the clinical characteristics and risk factors of intra- and post-operative reperfusion injury following surgical evacuation of epidural hematoma. Methods Clinical and radiographic data of 206 patients with cerebral herniation presented with an epidural hematoma and underwent surgical evacuation in our hospital from June 2009 to June 2015, were retrospectively analyzed; risk factors of intra- and post-operative reperfusion injury were analyzed by multi-factor and non-conditional Logistic regression analyses. Results A total of 12 patients with acute epidural hematoma and concurrent cerebral herniation developed reperfusion injury after hematoma evacuation; 7 patients (58.3%) were within 15-30 min after surgical evacuation intraoperatively and 5 patients (41.7%) were at an early stage within 6 h after operation. Local vascular cerebral edema, effusion, or even spot and patchy hemorrhage in the compressed cerebral parenchyma underneath the epidural hematoma were depicted by craniocerebral CT/MR imaging examination and further CT perfusion examination confirmed the local hyperperfusion-induced lesions. These 12 patients had an unsatisfactory clinical outcome with a high ratio of bad prognosis (58.3%, 7/12). Regression analyses indicated that the described surgical complication was significantly associated with duration of preoperative cerebral herniation (≥120 min, odds ratio [OR]=61.617, P=0.001), hematoma thickness (≥40 mm, OR=10.051, P=0.018). Conclusions Cerebral herniation longer than 120 min and hematoma thickness greater than 40 mm are high-risk factors associated with intra- and post-operative reperfusion injury. Controlled decompressive surgical strategy is helpful for a good recovery of cerebrovascular autoregulation function and thereby reduces the occurrence of reperfusion injury.

Objective To develop and validate a novel preoperative risk evaluating system for surgical decision on decompressive craniectomy for patients with massive cerebral infarction (MCI) secondary to acute epidural hematoma (EDH) and concurrent cerebral herniation.Methods Clinical data of a retrospective patient cohort (from January 2006 to January 2012,n=151) were analyzed by multivariate Logistic regression analysis for the risk factors correlated with postoperative MCI so as to establish a preoperative risk scoring system,whose clinical accuracy of surgical decision-making were validated in another prospective patient cohort (from February 2012 to December 2014,n=97).Results Incidences of secondary cerebral infarction were 19.2％ (29/151) and 18.6％ (18/97) in the retrospective and prospective patient cohorts,respectively.Regression analyses indicated that 6 clinical factors were identified to be independently correlated with postoperative MCI,including temporal hematoma (P=0.005),preoperative hemorrhagic shock (P=0.003),hematoma volume greater than 100 mL (P=0.003),bilateral mydriasis (P=0.015),duration of cerebral herniation longer than 90 min (P=0.001),and Glasgow Coma Scale (GCS) scores ≤ 5 (P=0.070).A novel preoperative risk scoring system was established by totting-up the standardized partial regression coefficients of each identified risk factor (EDH-MCI scale,with total scores of 0-18).Results suggested that the incidence and mean volume of cerebral infarction increased along with risk scores in a stair-stepping manner.Therefore,three intervals were divided into low (0-9),borderline (10-12),and high risk intervals (13-18) according to the EDH-MCI scores.Clinical reliability of surgical decision-making guided by novel EDH-MCI scale was validated by a prospective clinical study.As compared with traditional empirical surgical strategy,EDH-MCI scale-guided prospective surgical strategy exhibited remarkable superiority that it significantly increased the accuracy of surgical decision (low risk interval,100.00％ vs.91.92％,P=0.046;borderline risk interval,77.78％ vs.46.67％,P=0.034;high risk interval,100.00％ vs.68.18％,P=0.023;overall accuracy,95.88％ vs.79.47％,P=0.000).Conclusion The established preoperative risk scoring system can make a precise judgment on the clinical risks of postoperative massive cerebral infarction secondary to cerebral herniation from isolated acute epidural hernatoma and thereby provide a reliable reference on the surgical decision of decompressive craniectomy.

Objective To explore the clinical efficacy of large M-shaped craniotomy combined with lobectomy for secondary decompression in patients following severe craniocerebral trauma.Methods The clinical data were retrospectively analyzed of the 76 patients who had undergone secondary decompression following severe craniocerebral trauma from January 2007 to January 2010.The preoperative intracranial pressure (ICP) was 30～40 mmHg in 40 cases and ＞40 mmHg in 36 ones.All the patients received regular lobectomy in primary craniotomy;for secondary decompression some received simple lobectomy and some large M-shaped craniotomy combined with lobectomy.The patients undergoing different surgical procedures were compared in terms of survival rate,changes in intracranial pressure and therapeutic efficacy by the GOS 6 months post-discharge.Results Of the patients with 30～40 mmHg ICP,22 underwent large M-shaped craniotomy combined with lobectomy and 18 simple lobectomy.The survival rate within 7 days after surgery for the former patients (72.7％) was significantly higher than that for the latter ones (38.9％) (P＜0.05).Of the patients with ＞40 mmHg ICP,19 underwent large M-shaped craniotomy combined with lobectomy and 17 simple lobectomy,but all of them died within 7 days after surgery.Of those surviving the secondary decompression,7 received simple lobectomy and 16 large M-shaped craniotomy combined with lobectomy.The ICP in the latter patients was significantly lower at postoperative one day and 3 weeks than that in the former ones (P＜0.05).Compared with those receiving simple lobectomy,the patients receiving combined procedures had significantly higher GOS and significantly better prognosis (P＜0.05).There were no significant differences between the patients receiving two different surgical procedures in such adverse events as traumatic epilepsy,cerebrospinal fluid leakage,softening brain tissue,or wound malunion (P＞0.05).Conclusion For the patients with craniocerebral trauma who still suffer severe brain swelling or infarction after primary decompression,if their ICP is below 40 mmHg,large M-shaped craniotomy combined with lobectomy for secondary decompression can obviously decrease their ICP,increase their survival rate and improve their prognosis compared with simple lobectomy.