Objective To study the factors that limited the microsurgical total resection on meningiomas of tentorium and confluence of sinuses Methods Twenty three cases of meningiomas on tentorium and confluence of sinuses,which were removed by application of microsurgery from 1983 to 2001,were analysed retrospectly and reviewed. Results In all 23 cases,tumors in 17 cases were removed totally,and 6 cases were removed subtotally In the 6 cases whose tumors were resected subtotally,there were 4 cases related with major sinus and its venous flow uncompleted compensation, 2 cases related with adhering compactly to the brain stem invaded by tumors,major vessels or cranial nerves Conclusions Heading factors restricting microsurgical total resection of menigiomas on tentorium and confluence of sinuses may be related with major sinus invaded by tumor and its venous flow uncompleted compensation, tumors adhering compactly to the brain stem,major vessels or cranial nerves

Objective Evaluation of application of looping vascushunt tubes in microsurgical total removal of para sinus meningiomas Methods Eighteen patients harboring para sinus meningiomas were treated in our hospital from Feb,2000 to Mar,2002,Tumors were located in the posterior two thirds superior sagittal sinus in 17 patients and in the congenitally isolated transverse sinus in one patient Looping vascushunt were applied in all cases and tumors were removed under microscope using microsurgical techniques Results Tumors and involved sinus walls were resected (Simpson grade Ⅰ) in all patients Venous sinus reconstruction were achieved in 12 patients using artificial blood vessels,sinus walls were repaired with duramater in 4 patient, venous sinus ligation was applied in two patients because of the sufficent collateral venous drainage All patients recovered and no mortality occurred Conclusions Application of vascushunt tubes is one of the important techniques in microsurgical total resection of para sinus meningiomas

Objective To investigate the effect of cerebral angiography on separation of craniopagus during the period of preoperation and microsurgical operation Methods There was a case of craniopagus being separated in our hospital recently Cerebral arteriography at 3 months of life, arteriography and venography through femoral vessels at 16 months were performed to analyze the twin vascular circulations of bilateral internal carotid artery, external carotid artery, vertebral artery, and venous sinus Intraoperative cerebral angiography helps to evaluate the cerebral circulations Results Preoperative cerebral angiography showed no intracranial arterial connection in the pontes of craniopagus The posterior 1/3 part of superior sagittal sinus, partial transverse sinus and torcular herophili were confluented in two children Cerebral angiography during operation was significant for monitoring the management of the part of confluent venous sinus Conclusion Cerebral angiography is the best method to investigate the vascular conditions of craniopagus The selective sinus angiography is very important in analyzing the abnormal anatomy and hemodynamics of venous sinus in the pontes Intraoperative angiography can direct the bypass shunt and reconstruction of the sinus

Objective To explore the importance of the separation and reconstruction of the shared venous sinuses of a craniopagus twins Methods The shared superior sagittal sinus, confluence of sinuses, transverse sinus and straight sinus were separated using microsurgical techniques Meantime, one bypass was established from the superior sagittal sinus and the straight sinus to the internal jugular vein with help of the bypass shunt in twin B (right) The above mentioned sinuses were reconstructed with the artificial vessels The normal superior sagittal sinus and confluence of sinuses were preserved in the twin A (left) Results Twin A recovered with no nervous deficits Unfortunately, twin B died of renal failure and hyperkalemia 22 hours after the operation Conclusion The shunt and reconstruction of the venous sinus are the key techniques for the success of separation of craniopagus twins using the microsurgical techniques

Objective To report the microsurgical separation of the protruded cerebral tissue in the case of complex craniopagus twins and evaluate the role of the neuronavigation system in this operation Methods After the multiple bone flap were made,register again and then separate the cerebral tissue along the arachnoid plane under the guiding of the neuronavigation system(SNN) until the straight sinus was exposed Results The protruded cerebral hemisphere and cerebellar hemisphere of the twins were successfully separated Unfortunately,part of the occipital lobe of twin B(right) had to be removed because of the brain swelling Conclusion In the case of complicated craniopagus,the neuronavigation system is valuable in positioning the deep common sinus To separate the cerebral tissue along the arachnoid plane under surgical microscope can reduce the cerebral injury

Objective To undertake animal experimentation and clinical study on the safety and efficacy of percutaneous transluminal angioplasty (PTA) and intraarterial papaverine (IAP) infusion for treatment of refractory symptomatic cerebral vasospasm (CVS). Methods In the experimental study, vasospasm was induced in rabbits by double injections of blood into the cisterna magna, IAP infusion was given on either the 4th day or the 7th day after occurrence of subarachnoid hemorrhage (SAH), and then neurological observation, angiography, light and electron microscopy were done. In the clinical study, since September 1996, 22 patients with refractory symptomatic CVS involving 50 vascular territories received dilation therapy by PTA and IAP within 24 hours of clinical neurological deterioration. Results In the experimental study, all the rabbits except two in the 'the 4th day' group showed angiographic dilation in all of the spastic basilar arteries, and neurological improvement; in the ' the 7th day' group angiographic dilation appeared in 4 (57. 1% ) out of 7 rabbits. After 24 hours, 1 rabbit in each group had recurrence of neurological deficits and angiographic constriction. In the clinical study after aneurysm clipping or endovascular coil embolization was done, within 72 hours of SAH all patients underwent endovascular treatment: PTA alone in 3 cases, IAP alone in 14 cases, PTA and IAP in the remaining 5 cases. All vessel segments were dilated satisfactorily after endovascular treatment. Clinical improvement was significant in 13 cases,moderate in 7, minimal or none in 2; 2 cases died on the 7th day after endovascular dilation treatment. Conclusion Endovascular dilating techniques, namely, PTA, IAP and a combination of PTA and IAP, are safe and effective for treatment of symptomatic CVS refractory to medical therapy.

BACKGROUND: Dopaminergic neurons differentiated from neural stem cells have been successfully used in the treatment of Parkinson's disease rats; however, the survival rate of transplanted cells has been low. Most cells die of apoptosis as a result of the formation of oxygen free radical and lipid peroxidation.OBJECTIVE: To observe resveratrol (Res) effects on survival of transplanted cells, transplanted efficacy and dopaminergic differentiation from neural stem cells in a rat model of Parkinson's disease.DESIGN, TIME AND SETTING: Randomized controlled animal experiments were performed at the Animal Experiment Center,Sun Yat-sen University from October 2007 to June 2008.MATERIALS: Thirty-two adult, healthy, male Sprague Dawley rats were equally and randomly assigned to model control, dopaminergic neuron, Res and combination groups. Four healthy Sprague Dawley rat embryos at gastational days 14-15 were selected and fetal rats were used for isolation and culture of neural stem cells. Res (Jingmal Biotech, Shenzhen, China) was used for this study.METHODS: Neural stem cells derived from the mesencephalon of embryonic rats were isolated and cultured in vitro, and passaged in serum-free culture medium containing epidermal growth factor and basic fibroblast growth factor, and then differentiated into dopaminergic neurons in differentia.ion medium. Parkinson's disease rat models were established by the injection of 6-hydroxydopamine in each group. Rats in the dopaminergic neuron group was injected with 3 pL cell suspension (1×10 cells/μL) containing dopaminergic neurons in the corpus striatum. Rats in the Res group received 3 μL of Ras (40 mg/L).Rats in the combination group were subjected to 3 μL of Res (40 mg/L) + 3 μL cell suspension (1×105 calls/μL) containing dopaminergic neurons. Rats in the model control group received 3 ×L of DMEM/F12 culture medium.MAIN OUTCOME MEASURES: The percentage of tyrosine hydroxylase-positive neurons in differentiated cells. The alteration of rotational asymmetry and the survival of tyrosine hydroxylase-positive neurons in graft areas of Parkinson's disease rats after transplantation.RESULTS: Flow cytometry demonstrated that survival rate of tyrosine hydroxytase-positive neurons was (17.8 ±4.2)% at 6 days following differentiation. Compared to the model control group, the rotational asymmetry was significantly improved at 10 days (P < 0.01), was significantly decreased at 20 days following transplantation in the combination group (P < 0.01). At 10-60 days following transplantation, the number of rotational asymmetry was significantly lower in the combination group than in the dopaminergic neuron group (P < 0.01). Tyrosine hydroxylase-positive neurons were not determined in the Res and model control groups. The number of tyrosine hydroxylase-positive neurons was significantly more in the combination group than in the dopaminergic neuron group (P < 0.01).CONCLUSION: Res can increase survival rate of transplanted cells in the corpus striatum, and improve rotational asymmetry in rat models of Parkinson's disease following transplantation of dopaminergic neurons differentiated from neural stem cells.Ke CL, Chen BL, Yu ZH, Huang ZS.Effects of resveratrol on the transplantation of neural stem call-derived dopaminergic neurons in a rat model of Parkinson's disease.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2009;13(27): 5281-5285.[http://www.crter.on http://en.zglckf.com]

Objective To Compare the use of guglielmi detachable coils(GDCs)versus microsurgical clipping for the management of acutely ruptured intracra nial aneurysm. Methods A clinical study included 82 patients with acute (90%. The technique related morbidity rate was 14.2%. In microsurgical group, 92.5% of aneurysms were completely clipped. The technique related morbidity rate was 10%. 2 cases was died. Significantly better total occlusion/embolization results were achieved in microsurgical clipping( n =40) than in GDCs ( n =35)( P 0.05). Six months follow up demonstrates that good prognosis was 95% in both groups. Conclusion In the management of acutely ruptured intracranial aneurysm, both microsurgical clipping and endovascular treatment is effective methods.

Objective To detect the expression of survivin protein in intramedullary gliomas and evaluated the clinical significance of the survivin expression. Method Seventeen cases of intramedullary gliomas were removed by using microsurgical technique.It composed of 8 cases of ependymomas and 9 ones of astrocytomas.The patients were followed up by MRI scanning periodically.The survivin protein expression of the intramedullary gliomas were examined by immunohistochemical stain (SP). Results Total resection of the tumor was obtained in 7 cases of ependymomas and subtotal resection was undertaken in the other one case.For 9 cases of astrocytomas,total resection of the tumor achieved in 3 cases,subtoal resection in 5 cases and partial resection in one case.Survivin expression was detected in 2 samples of ependymomas and 6 ones of astrocytomas.2 astrocytoma cases were moderate positive staining,who suffering from intracranial and vertebral subarachnoid dissemination of the tumor. Conclusion The result of microsurgical treatment for intramedullary ependymomas is satisfactory.The survivin expression in astrocytoma samples is significantly higher than that in ependymoma.Moderate positive staining may correlated with subarachnoid dissemination of the tumor.

Objective To study the clinical characteristics,microsurgical methods and results of treatment of the purely intrinsic third ventricular craniopharyngioma. Methods Eight cases of craniopharyngiomas located purely in intrinsic third ventricula which were treated microsurgically were analyzed retrospectively.Their clinical manifestations,endocrinal examination,CT and MRI images,choice of operactive approaches and post-operative complications were studied.Results Total tumor removals were achieved in 7 cases.and subtatol tumor removal in 1 case.Temporary central diabetes insipidus occurred in 5 cases,and perloperative water and elecctrolyte imbalance in 6 cases. No patient died in this series. Conclusion According to clinical characteristic of purely intrinsic third ventricular craniopharyngioma, microsurgical technique is a safe and effective method for treatment by a resonable surgical approaches.