Objective To evaluate the functional and oncological outcomes of patients with locally advanced prostate cancer (PCa) treated by hormone therapy combined with extra-fascia1 laparoscopic radical prostatectomy (LRP) plus extended lymph node dissection (ePLND).Methods From January 2004 to June 2016,a total of 255 PCa cases (pT3-4NxM0) who received LRP plus ePLND were enrolled into our study.The mean age of the patients was 67 (range 44-88) years,and median PSA level was 21.2 (range 0.6-454.0) ng/ml.The patients were divided into earlier group (from January 2004 to December 2011,160 cases) and later group (from January 2012 to June 2016,95 cases) according to different treatment periods.The baseline demographics between the two groups were similar.All patients routinely received adjuvant hormone therapy (AHT) postoperatively.The patients in the later group underwent collapsin response mediator protein 4 (CRMP4) methylation study on the prostatic biopsy preoperatively.Those with a CRMP4 methylation level ＞ 15％ or rectum/bladder neck invasion,were treated by neoadjuvant hormone therapy (NHT) for 3-6 months.Positive surgical margin (PSM),progression-free survival (PFS),cancer-specific survival (CSS),overall survival (OS) and postoperative continence rates between the two groups were analyzed and compared.Results The mean operative time of the earlier and later group were (239 ±65) min and (203±51) min,mean blood loss were (109-±65) ml and (96-±44) ml,mean dissected nodes were (19 ± 5) and (21 ± 7),respectively (all P ＞ 0.05).The total PSM rate was 19.2％,and PSM rates of the two groups were 23.1％ and 12.6％ (P =0.04).All the 255 cases received AHT and 25 cases in the later group underwent NHT.The median follow-up time was 73 months (range 10-152 months).The total 5-year PFS,CSS and OS rates were 77.7％,94.3％ and 87.1％,respectively,and the rates between groups were 73.8％ vs.86.1％ (P=0.03),93.1％ vs.98.6％ (P=0.07),and 85.0％ vs.92.8％ (P =0.11),respectively.The 1-year postoperative continence rates were 91.9％ vs.97.9％ (P =0.09).Conclusions Hormone therapy combined with LRP plus ePLND represents an oncological and functional effective option in patients with locally advanced PCa,and improved PFS might be acquired by preoperative tumor staging.

Objective To investigate the efficacy and clinical value of balloon-assisted clipping for the treatment of giant unruptured intracranial aneurysms of internal carotid artery. Methods Patients with giant unruptured intracranial aneurysm of intracranial segment of internal carotid artery treated with balloon-assisted clipping in the Department of Neurosurgery, Xiangya Hospital, Central South University from September 2017 to May 2018 were enrolled retrospectively. The proximal internal carotid artery or the aneurysm neck were temporarily blocked by balloon, and then the aneurysm was clipped in the hybrid operating room. Demographic data, preoperative symptoms, aneurysm characteristics, position of balloon placement, intraoperative angiography, complications, and follow-up results were collected. Results A total of 12 patients with giant (diameter >2 cm) unruptured intracranial aneurysm of intracranial segment of internal carotid artery were enrolled. They were all successfully clipped using balloon-assisted clipping in the hybrid operating room. Among them, 1 was located in the ophthalmic segment, 3 in the supraclinoid segment, 4 in the posterior communicating segment, 2 in the anterior choroidal artery segment, and 2 in the bifurcation of the internal carotid artery. The balloons were placed in the proximal end of internal carotid artery in 9 cases and in the neck of aneurysm in 3 cases. Intraoperative angiography showed that 12 aneurysms were completely occluded; 1 had severe stenosis of parent artery, and 1 had mild stenosis. Postoperative complications included cerebral infarction in 1 case, temporary diabetes insipidus in 1 case (returned to normal 1 week after operation), hemiplegia in 1 case, and epilepsy in 1 case. Glasgow Outcome Scale score at discharge showed 5 in 9 cases, 4 in 2 cases, and 3 in 1 case. The patients were followed up for 2.3 to 12 months after operation (median 7.5 months). Reexamination of CT angiography showed no recurrence of aneurysm. Glasgow Outcome Scale score was 5 in 11 cases and 4 in 1 case. Conclusions The use of balloon-assisted clipping technique in the hybrid operating room for the treatment of giant intracranial segmental aneurysms of the internal carotid artery is safe and effective, and has a good long-term outcome.

Objective To investigate the clinical effects and influencing factors of the outcomes of early microsurgical treatment in patients with intracerebral hematoma from ruptured intracranial aneurysm. Methods From 2010 to 2016, patients with intracerebral hematoma from ruptured intracranial aneurysm admitted to the Department of Neurosurgery, Xinyu People's Hospital were enrolled retrospectively. The demographic data, Hunt-Hess grade,Glasgow coma scale(GCS)score,imaging data,and procedure-related complications were collected. Glasgow outcome scale (GOS) score was used to evaluate the outcomes. Four to 5 were defined as good outcome and 1 to 3 were defined as poor outcome. The Hunt-Hess gradesⅡ-Ⅲ were used as the low-grade group and the Ⅳ-Ⅴ grades were used as the high-grade group. The survival rate and quality of life of both groups of patients were compared according to the GOS scores. Results A total of 36 patients were enrolled during the study, including 32 with subarachnoid hemorrhage and intracerebral hematoma and 4 with simple intracerebral hematoma. Hunt-Hess grade was grade Ⅱ in 2 cases, Ⅲ in 18 cases, Ⅳ in 14 cases, and Ⅴ in 2 cases. Distribution of responsible aneurysms:18 patients in middle cerebral artery, 9 in anterior communicating artery, 6 in anterior cerebral artery, 3 in posterior communicating artery, including 4 patients with multiple aneurysms. All patients underwent aneurysm clipping+hematoma removal under the general anesthesia within 36 h after onset,24 of them were treated with decompressive craniectomy. One patient died of severe brain swelling after intraoperative reruptureof the aneurysm,1 died of postoperative massive cerebral infarction, and 1 died of severe pulmonary infection and diabetes after giving up further treatment. Thirty-three survivors were followed up for 1 year, 29 had good outcome(80.5％) and 7 had poor outcome (19.5％). There were significant differences in survival rate and quality of life between the low-grade group and the high-grade group (P=0.001). There were significant differences in the Hunt-Hess grade, baseline GCS score, and proportion of patients receiving decompressive craniectomy between the good outcome group and the poor outcome group.Conclusion The Hunt-Hess grade, baseline GCS score, and decompressive craniectomy were the influencing factors of the outcomes in patients with intracerebral hematoma from ruptured intracranial aneurysm. Removal of hematoma and aneurysm clipping should be performed as early as possible,and decompressive craniectomy should be performed if necessary.