Objective To investigate the method of handmade microwire lasso device for the management of coil migration during intracranial aneurysm embolization. Methods Two migration coils were removed from intracranial arteries using handmade microwire lasso rings. The first coil prolapsed completely from an aneurysm sac and flowed to the middle cerebral artery M2 segment. The second coil partially prolapsed out into a parent artery. The microwire lasso device was made of 4-0 silk thread and fixed using 0. 36 mm (0. 014 inch)microwire and 0. 43 mm (0. 017 inch)microcatheter. Results After removing 2 migration coils from intracranial arteries,angiography did not reveal vascular injury and thrombosis. There was no aneurysm rupture. After awaking from anesthesia,the patient did not have neurological deficit. The patient was followed up for 3 months after procedure. MR angiography confirmed the patency of related arteries. Conclusion The handmade microwire lasso device for the management of coil migration in the process of aneurysm embolization is a simple,effective,and economical method.

Objective To evaluate the treatment effect of using preoperative embolization combined with microsurgery for the treatment of intracranial arteriovenous malformation.Methods From January 2005 to December 2015,57 consecutive patients with intracranial arteriovenous malformation (AVM ) admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. They were diagnosed by magnetic resonance imaging (MRI)and digital subtraction angiography (DSA). Glubran and/or Onyx embolization was used before the microsurgery. The clinical features,treatment, and occurrence of complications were recorded.Results In 57 patients,the Spetzler-Martin grade in 35 patients were gradeⅠ-Ⅱ,in 18 were Ⅲ,and in 4 were Ⅳ. The complications occurred in 11 patients (19. 3%),including 5 with Onyx,5 with Glubran,and 1 with Onyx+Glubran. After embilization,4 patients had hemorrhage,2 had intracranial hemorrhage,1 had postoperative intracranial infection,1 had postoperative neuro-logical dysfunction,and 3 had other systemic complications after procedure. The complication rates were 14. 3%(5/35)and 22. 2%(4/18)respectively according to the Spetzler-Martin grade Ⅰ-Ⅱ and Ⅲ. Two patients of Spetzler-Martin gradeⅣhad complications. The incidence of complications in the functional areas was 20. 0%(4/20)and that in non-functional areas was 18. 9%(7/37). One patient died. DSA revealed that 4 patients had residual lesions before discharge. The cure rate was 93. 0%. The mean modified Rankin scale (mRS)score at discharge was 1. 6 ± 1. 0. The patients of mRS 0-1 accounted for 59. 6%(34/57).The mRS scores in 7 patients at discharge were higher than before treatment.Conclusion For the high-grade AVM foci with larger volume and in the deep part of brain,the treatment with microsurgery combined with embolization can be considered.

Enormous progresses have been made in recent years for the involvement of nervous system in particular the vagus nerve in inflammatory responses. The parasympathetic nerve can be activated by “inflammatory reflex” to inhibit macrophages, via their specific nicotinic receptor ?-7 subunit, and hence to reduce the production of tumor necrosis factor (TNF) that plays a pivotal role in many inflammatory reactions and is a key mediator for septic shock. This cholinergic anti-inflammatory pathway has been utilized, with positive outcomes, by means of either pharmacological or electrical stimulation in animal models against inflammatory responses and septic shock. Monoclonal antibodies against TNF and other pro-inflammatory cytokines have also been developed and used against inflammation experimentally and clinically. Although clinical use of these new treatments have yielded primitive and only limited results, these new research findings and concepts are important for the advance of modern medicine, as well as for better comprehension of some theories and practices in traditional medicine. Future directions are discussed herewith. [

Objective To analyze stenting and dual catheter technique in protection of posterior inferior cerebellar artery and its imaging and clinical follow-up results in the endovascular treatment of vertebral artery dissecting aneurysms. Methods From January 2012 to December 2014,the clinical data of 4 patients with vertebral artery dissecting aneurysm involving posterior inferior cerebellar artery treated with endovascular method and admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. The whole brain DSA examinations were performed at 6 months after procedure. The clinical follow-up period ranged from 12 to 24 months. Results Three of the 4 patients were treated with posterior inferior cerebellar artery-vertebral artery stenting,one patient was treated by using bidirectional dual catheter technique to protect posterior inferior cerebellar artery. The interventional therapy of 4 patients were all successful. Immediately after procedure,angiography revealed that the posterior inferior cerebellar arteries were patent,no ischemic symptoms were observed. The angiography at 6 months after procedure revealed no recurrence of aneurysms;the posterior inferior cerebellar arteries were patent without in-stent stenosis. No new symptoms of neurological deficit were observed during 12 to 24-month follow-up. Conclusion In the interventional treatment of vertebral artery dissecting aneurysms of posterior inferior cerebellar artery,using the posterior inferior cerebellar artery-vertebral artery stenting technique and bidirectional dual catheter technique may safely and effectively protect the posterior inferior cerebellar artery.

Electrical vagus nerve stimulation (VNS) has been approved by FDA and is widely used in recent years for the treatment of epilepsy and possibly other medical conditions such as depression. The current success rate of VNS for epilepsy is about 50%, but there are complications, potential risks and cost concerns. One of the major limitations for this new therapy is that its antiseizure mechanisms are by no means clear. In particular, it is not known whether the therapeutic effect is vagal specific, what types of nerve fibers in the vagus nerve are contributing to the therapeutic effects, or what individual patients would benefit from the use of the expensive and invasive VNS implantation. There are controversies regarding how and where the VNS takes effect on epilepsy in the central nervous system. The poor understanding of VNS has inevitably limited the application and success of the therapy. The current review analyses the pros and cons of VNS for epilepsy in vis-?-vis other available therapies including Chinese medical methods, and explores the possible mechanisms in order to stimulate further improvement of this new technology.

Classical description of central pathways has been that there are segregated routes for visceral and somatic inputs, for pain and tactile processing. Ample evidence in recent studies however calls for a revision of this traditional view. It has been demonstrated that visceral nociceptive inputs may travel in the dorsal column-medial lemnicus system along with skin tactile inputs, and convergence and interactions between the two distinct modalities have been demonstrated in route to the high brain centers. In the spinal cord and thalamus, skin inputs may inhibit noxious colorectal inputs; on the other hand pre-existing visceral nociception may cause abnormally high discharge of single neurons. These recent findings shine light on mechanisms of central processing of visceral nociception and its associated allodynia and referred pain, as well as for the effects of some traditional therapies such as acupuncture and massage.

[Objective]To investigate whether syrinx should by treated before correction in patients with scoliosis complicated by syringomyelia without neurologic impairment. [Method]Thirty-five cases were divided into experimental group(group A,without preoperative surgical intervention to syrinx,15 cases)and control group(group B,with preoperative surgical intervention,20 cases) randomly. The coronal plane Cobb's angle,the length of syrinx,the position of syrinx,the biggest diameter of syrinx and S/C ratio were measured and compared between 2 groups.[Result]There was no significant difference in the correction rate and loss rate between two groups.The postoperative syrinx index(biggest diameter of syrinx,syrinx length and S/C ratio) was significantly smaller than that of preoperation(P

0.05) at the latest follow up. All the cases achieved solid fusion within 12 months. Nineteen cases with incomplete paraplegia obtained an average improvement of 1.26 grades by Frankel neurological classification. The major complications in this group included one case with temporary deterioration of neurological function. Another case with pulmonary atelectasis on the operation side, but cured with appropriate treatment. Conclusion One stage surgical treatment for multiple-level tuberculosis of the upper thoracic spine by combined anterior and posterior spine fusion with posterior instrumentation is feasible and effective without major complications. Early surgical intervention should be emphasized for the treatment of progressive tuberculosis of the upper thoracic spine.

Objective In this paper,major issues for all those who have been selected in China national treatment program for patients with chronic Keshan disease (CNTP-CKD) were uncovered through evaluation of the annually reported data from participating provinces,in order to improve the performance quality of the program.Methods The datasets 2005-2012 were merged after cleaning them,and the composition of the treated patients was statistically analyzed,including gender and age distribution,diagnosis evidence for chronic Keshan disease (ECG,cardiothoracic ratio by X-ray,heart function grade of NYHA),and proportion of cases who had received treatment more than once.Results ①A total of 2 649 patients participated in the treatment,of them 1 115 patients were males accounting for 42.1％ (1 115/2 649),1 534 patients were females accounting for 57.9％ (1 534/2 649).Age of the patients were mainly distributed in 41 to 70 years old,and 24 CKD patients under 10 years accounting for 0.9％ (24/2 649).②2 313 cases of the involved patients were diagnosed with sufficient evidence,accounting for 81.9％ (2 313/2 823) and 121 cases with full misdiagnosis,accounting for 18.1％ (121/2 823).③There were 881 patients been treated for more than once,accounting for 38.3％ (881/2 301) of the number of treatment.Conclusions ① Diagnosis for CKD remains a key problem,suggesting that medical record for each patient diagnosed by province-level doctors' needs to be built up as early as possible.The rate of patient treatment for more than once is low which is not beneficial to the patients.② Treatment period for CKD patients is highly recommended to expand to at least one year,and the disease should be enrolled in the free cost list of the new rural cooperative medical system (NCMS).

Objective To evaluate the effect of surgical treatment in ischemic cerebrovascular disease using perfusion-weighted magnetic resonance imaging (PWI) technique.Methods The clinical and imaging data of 24 patients with ischemic cerebrovascular disease were analyzed retrospectively. Cerebral perfusion was compared before and after operation by PWI.Results In our series, there were 9 cases of stenosis or occlusion of unilateral internal carotid artery (ICA), 8 cases of unilateral stenosis or occlusion of middle cerebral artery (MCA), 5 cases of multiple stenoses of intra- or extracranial artery system, 2 cases of moyamoya disease. PWI revealed 1 case of normal regional cerebral blood flow (rCBF) and mean transit time (MTT), 15cases of normal rCBF with increased MTT, and 8 cases of decreased rCBF with increased MTT. 23 patients received surgical treatment. There were 13 patients performed by stent angioplasty, 4 patients by endarterectomy, and 6 patients by STA-MCA bypass surgery. Cerebral perfusion improved in 19 cases (82.6%), which included 12 cases (92.3%) performed with stent angioplasty, 4 cases (100%) with endarterectomy and 3 cases (50%) with STA-MCA bypass surgery.Conclusions Being a new type of examination, PWI is helpful to evaluate the status of cerebral perfusion. Surgical methods are effective in treatment of ischemic cerebrovascular disease.