Objective To discuss the therapeutic methods and strategies of fractionated embolization in treating large cerebral arteriovenous malformation (cAVM). Methods During the period from May 2005 to May 2013 at authors’ hospital, endovascular fractionated embolization was performed in 35 cases with large cAVM. The lesions were located in the frontal lobe (n = 11), the parietal lobe(n = 8), the temporal lobe (n = 6), the occipital lobe (n = 4), the lateral temporal area (n = 2) and the deep white matter and basal ganglia (n = 4). The longest diameter of the lesions was 6 - 12 cm, with a mean of 7.23 cm. The number of supply vessels was 2 - 5. The lesions were drained by superficial veins in 13 cases, by deep veins in 9 cases and by both superficial and deep veins in 17 cases. The exit stenosis of the draining vein was seen in 3 cases, while the dilatation of the draining vein was found in 6 cases. Angiography showed that the lesions were situated at the right side in 16 cases and at the left side in 19 cases. Results A total of 297 times of embolization operating-process were carried out in the 35 patients, of which NBCA was used in 107, ONYX in 153 with, FuAiLe medical adhesive in 15, combination use of NBCA and ONYX in 9 and combination use of ONYX and FuAiLe medical adhesive in 13. No death occurred after treatment. After the first embolization, the residual malformation volume usually decreased to < 50%. The interval between the first and the second embolization was 1 - 3 months. Generally, two to four times of embolization were performed in each patient. Complete occlusion of the lesion was obtained in 26 cases, and sub - complete occlusion of the lesion (> 80%embolization) in 9 patients. Good recovery was achieved in all patients. After fractionated embolization, the volume of the cAVMs was decreased gradually and ultimate clinical cure was achieved, which laid the foundation for conducting further micro - neruosurgery or radiation therapy. Conclusion For the treatment of large cerebral arteriovenous malformation, fractionated embolization has reliable therapeutic effect. Therefore, this technique should be recommended in clinical practice.

Objective To explore the therapeutic effect of dual microcatheter technology on patients with intracranial wide necked aneurysms and its impact on their neurological function.Method This article adopts a prospective randomized controlled study,collect clinical data of 55 patients with intracranial wide neck aneurysms from the First People's Hospital of Suzhou City from March 2017 to March 2022.According to different treatment methods,divided treatment group 28 cases and control group 27 cases.The control group patients received stent assisted therapy,while the treatment group patients received dual microcatheter intervention therapy.Compare efficacy and complications two groups;changes in NIHSS score and ADL score before and 6 months after surgery;Postoperative prognosis at 6 months.Result The total effective rate of the treatment group was 100.00％,while the total effective rate of the control group was 96.30％;two groups of patients with intracranial wide necked aneurysms treatment efficacy no significant difference(P＞0.05).The treatment group complications in patients with intracranial wide necked aneurysms(7.14％)less control group(33.33％)(P＜0.05).The two groups NIHSS score of patients with intracranial wide necked aneurysms lower before surgery at 6 months after surgery,while the ADL score higher before surgery(P＜0.05);the treatment group NIHSS score of patients with intracranial wide necked aneurysms(8.76±0.87)score lower control group(9.82±0.96)score after 6 months of treatment,while the ADL score(57.82±5.43)score higher control group(64.52±5.16)score(P＜0.05).There was no significant difference in mRS Scores between the two groups(P＞0.05).Conclusion The dual microcatheter technology has a good therapeutic effect on IWNA patients,can reduce the occurrence of complications,improve patient neurological function.

Objective To explore the clinical efficacy and prognostic factors of YL-1 type hard channel trepanation and drainage combined with stereotactic treatment for hypertensive intracerebral hemorrhage.Methods A retrospective study was conducted on 110 patients with hypertensive intracerebral hemorrhage at the Cerebrovascular Disease Center of the First People's Hospital of Suzhou from August 2019 to October 2022.The observation group(55 cases)received YL-1 type hard channel drilling and drainage combined with stereotactic treatment,while the control group(55 cases)received simple YL-1 type hard channel drilling and drainage.The perioperative indicators,neurological damage,and prognosis of the two groups of patients were compared;Using multiple Logistic regression analysis to identify the prognostic factors affecting patients.Results The perioperative indicators,neurological damage,and prognosis of the observation group were better than those of the control group(P＜0.05);The admission NIHSS score(OR=2.504,P＜0.05),simple minimally invasive drilling and drainage(OR=1.881,P＜0.05),disease duration＞24 hours(OR=2.782,P＜0.001),and ventricular rupture(OR=2.252,P＜0.05)are risk factors for poor prognosis in patients.Conclusion The prolongation of the patient's disease course,ventricular rupture,and severe neurological damage are associated with poor prognosis.Combining stereotactic minimally invasive surgery has a positive significance for improving the prognosis of patients with cerebral hemorrhage.