Objective To study the surgical techniques of the extended subfrontal epidual approach to resect chordoma in skull base.Methods 18 cases of chordoma in skull base treated mierosurgically were analyzed retrospectively.Results Total resection were achieved in 15 patients(83%),gross resection in 3 patients(17%).There was no complication in all cases.Conclusion The microsurgery for chordoma in skull base via the extended subfrontal epidual approach is of the benefits such as clear and wide fields of vision,and minimize brain trauma.Lumber drain placement and the skull base reconstruction could improve the rate of total tumor removal and reduce complications.

Objective To investigate the treatment effection of cranial decompression under temporal muscle in very-low position with large bone flap for severe cranial trauma.Methods 53 cases of severs cranial traumatic brain herniation were derided into two groups.22 cases with unilateral dilated pupil,and 31 cases of bilateral dilated pupil,all the patients were treated with cranial decompression under temporal muscle in very low position with large bone-flap.The ICP,appearance rate of cisternal,pupil contraction rate and GCS evaluation were observed,recorded and statistiely analysised.Results According to the intraeranial pressure monitoring,the rate of 24h ICP＜20mmHg was increased significantly,and the rate of 72h ICP＞40mmHg was decreased in both groups.The occurance rate of cisternal:81.82% in unilateral dilated pupil group,and 51.61% in bilateral dilated pupil group.The recoverance rate of pupil in 24h:77.2% in unilateral dilated pupil group,and 32.26% in bilateral dilated pupil group.GCS evaluation:All of the patient's average mark of GCS after operation wag(8.02±3.03)which increased(3.92±2.21)compared with the mark of GCS before operation,which was(4.10±0.82),with a significant difference(P＜0.01).Treat outcome:well/moderate disability:64.15%,severe/long-term coma:7.55%,and death:28.30%.Conclusion Cranial decompression under temporal muscle in very-low position with large bone-flap for severe cranial trauma can enlarge the cranial capacity effectively,increase the decompression space in dorsolateral cranium,which can alleviate the intracranial pressure in axial centre of brain truak,promote the effeetion of the brain herniation restore and the recover of the brain trauma.

ObjectiveTo explore the effect of different methods of drainage tube and catheter drainage in the treatment of intraventricular hematoma.MethodsThe analysis was conducted in 83 cases,who were randomly divided into two groups,the treatment group with 48 cases adopting lateral venticle catheterization combined with bulletshaped tube,and the control group with 35 cases adopting conventional catheterization.The contrasted study was conducted on the clearance rate of cerebroventricular hematoma and the effect of the different drainages.ResultsThe clearance rate in treatment group was 27.1％ ( 13/48 ),50.0％ (24/48),14.6％ (7/48),at the time of ＜ 24h,24 ～72h,＞ 72h after the operation,and 5.7 ％ ( 2/35 ),17.1％ ( 6/35 ),48.6％ ( 17/35 ) in the control group.It showed statistical significance(x2 =6.2425,9.4678,11.3757,all P ＜0.01 ).The cases with type Ⅰ of ADL stage in treatment group (47.9％)were more than control group( x2 =6.8347,P ＜0.01 ).The morbidity in treatment group was 12.5％,which was lower than control group( x2 =6.9636,P ＜0.01 ).ConclusionThe lateral venticle catheterization drainage combined with bullet-shaped tube could avoid the obstruction,reduce the morbidity,and improve the therapeutic effect.

Objective To investigate the clinical features and surgical treatment of cerebral amyloid angiopathy hemorrhage (CAAH) caused by cerebral vascular amyloidosis.Methods The clinical data,radiological diagnoses,pathology results and treatment efficacies of 76 patients with CAAH,admitted to and performed surgery in our hospital from August 2010 to September 2015,were retrospectively analyzed.Results The first preoperative CT indicated that prompt hematomas were located in the cerebral hemisphere brain cortex,forming lobulated or irregular shape;2 or more lesions of recurrent hemorrhage were noted in 14 (18.4％);34 (44.7％) were with subarachnoid hemorrhage,16 (21.1％) were with intraventricular hemorrhage.Histopathological examination supported the diagnosis.Sixteen patients (21.1％) underwent second operation during hospitalization due to large amount of bleeding.During hospitalization,18 (23.7％) died,and 20 (26.3％) had long-term coma.During the follow-up period,23 patients (30.3％) had recurrent intracranial hemorrhage,of which,6 patients (7.9％) underwent surgical treatment,and 17 patients (22.4％) died.Conclusion The bleeding sites of CAAH mainly locate in the lobes of the brain surface,with lobulated or irregular shape,which is easily complicated with subarachnoid hemorrhage or intraventricular hemorrhage,with multiple features;diagnostic rate of CAAH can be improved by pathological examination of brain tissues and blood vessels;CAAH after surgery has high relapse rate and poor surgical results.

OBJECTIVETo evaluate the efficacy and safety of high-dose intravenous mecobalamin (HDIME) for the treatment of bortezomib-induced peripheral neuropathy(BIPN) in the patients with multiple myeloma (MM).

METHODSA total of 65 newly diagonsed patients with multiple myeloma receiving bortezomib in Tianjin Medical University General Hospital were enrolled in this single-centre randomized clinical trial from July 2012 to May 2016. Out of 65 patients 38 in control group received bortezomib-based chemotherapy and 27 patients in HDIME group received the additional high-dose intravenous mecobalamin.

RESULTSThe incidence of BIPN in HDIME group was lower than that in control group(29.63% vs 55.26%, χ=4.197,P<0.05). Whether the BIPN rate of Grade 2 or 3 and above in HDIME group significantly decreased as compared with control group(18.52% vs 47.37%,χ=5.746,P<0.05) (3.71% vs 21.05%, χ=3.983,P<0.05). The BIPN rate of less than 5 cycles of bortezomib was not significantly different between HDIME and control groups(χ=2.714,P>0.05). Overall effective rate of HDIME group and control group was 77.78% and 73.68%(P>0.05) respectively. Neither PFS nor OS was significantly different between HDIME group and control group(P>0.05). Treatment-related toxicity was only mild rash in 1 case. No other side-effects including nausea, abdominal pain, and hypotension occurred.

CONCLUSIONHDIME has a good efficacy for the prophylaxis BIPN and and without serious side effects.