Objective To investigate the efficacy of foramen magnum decompression alone and foramen magnum decompression + Syrinx-shunt in the treatment of Chiari anomalies with syringomyelia.Methods Forty-nine Chiari anomalies with syringomyelia patients were selected,28 patients performed foramen magnum decompression alone (surgical method Ⅰ group),21 patients performed foramen magnum decompression + Syrinx-shunt (surgical method Ⅱ group).The treatment efficacy was evaluated by postoperative clinical effect and MRI review.Results In surgical method Ⅰ group,effective in 18 cases,invalid in 10 cases,the effective rate was 64.3％ (18/28).In surgical method Ⅱ group,effective in 19 cases,invalid in 2 cases,the effective rate was 90.5％(19/21).There was statistical difference (x2 =4.45,P =0.034).Conclusion Foramen magnum decompression + Syrinx-shunt is effective in the treatment of Chiari anomalies with syringomyelia,which is applicable for these patients and has a more precise consequence than foramen magnum decompression alone.

Objective To analyze the complications ofventriculoperitoneal shunt in the treatment of pediatric hydrocephalus,and improve operative method,in order to reduce postoperative complications and improve the clinical curative effect.Methods A total of 39 infants with hydrocephalus who underwent adjustable shunt were retrospectively analyzed,including surgical methods,results,and complications,and put forward counter measures.Results Thirty cases of postoperative clinical symptoms obviously improved compared with preoperative,head CT review were clearly seen with ventricle retraction.Nine cases suffered with complications after operation.Obstruction of shunt tube was found in 4 cases,shunt exposed in 3 cases,and postoperative infection in 2 cases.Conclusions Ventriculoperitoneal shunt complications related to surgery itself.Improved surgical techniques,and taking appropriate treatment measures can effectively reduce the incidence of complications.

ObjectiveTo investigate the effect of endovascular stent with or without coil graft on intracranial wide-necked aneurysms. Methods12 cases with intracranial wide-necked aneurysms, among whom, 10 cases were treated with stents and coils, 2 C4 aneurysms were treated with graft stent, were analyzed retrospectively. ResultsOf the 10 cases who were treated with stents and coils, 8 patients were completely occluded and other 2 patients were incompletely (>95%) occluded. 2 cases accepted graft stent were obliterated. Follow-up with angiography in 10 patients for 3～12 months revealed that all the aneurysms were completely occluded. 1 patient among them died. ConclusionEndovascular stent with or without coil graft is effective on intracranial wide-necked aneurysms.

Objective To investigate the value of serum D-dimer in evaluating the severity and the prognosis of patients with acute spontaneous subrachnoid hemorrhage.Methods The clinical data of 157 patients with acute spontaneous subrachnoid hemorrhage were collected,and the level of D-dimer in elbow vein serum were measured.The severity of the disease was judged by Hunt-Hess classification,and the patients,brain CT scans were scored according to the modified Fisher scale.The patients were followed up for 3 months.Based on the modified RANKIN scale (mRS scale),patients were divided into unfavorable prognosis group (3≤ mRS ≤5) and good prognosis control group (1 ≤ mRS ≤2).Results In the 157 cases of spontaneous subrachnoid hemorrhage patients,there were 45 cases in the unfavorable prognosis group and 112 cases in the good prognosis control group.The level of D-dimer in the unfavorable prognosis group was significantly higher than the level of control group and there were significant differences between them (P ＜ 0.01).By the Spearman correlation analysis,the level of D-dimer was positively correlated with Hunt-Hess score (r =0.831,P ＜0.01),and it was also positively correlated with unfavourable prognosis mRS scale (r =0.834,P ＜0.01).Furthermore,regression analysis showed that high level of D-dimer was an independent risk factor for the poor prognosis of patients (OR =1.011,95％ CI:1.007-1.016,P ＜ 0.01).Through the receiver operating characteristic curve (ROC) analysis of the D-dimer in patients with poor prognosis,the area under ROC curve was 0.964 (95％ CI:0.93-0.98,P ＜ 0.01),sensitivity and specificity were 88.9％ and 99.1％,respectively.The cut-off point of D-dimer content was 739 μg/L.Conclusions The level of D-dimer in patients with acute spontaneous subrachnoid hemorrhage was closely related to the severity of the diseases,and high level of D-dimer was an independent risk factor for the prognosis of patients.

Objective To retrospectively analyze and compare the intraoperative and postoperative clinical efficacies between the interhemispheric approach and pterional approach in craniotomy anterior communicating aneurysm clipping surgery.Methods A total of 21 cases of anterior communicating artery aneurysms with subarachnoid hemorrhage undergoing surgery of craniotomy clipping from January 2012 to December 2016 in the Department of Neurosurgery of Shengjing Hospital of China Medical University,in which 13 cases were treated by pterional approach and 8 cases were treated by interhemispheric approach.Two kinds of operation approaches were compared in operation time,intraoperative aneurysm rupture rate,intraoperative bleeding volume,average length of stay,incidence rate of postoperative fection,and Glasgow Outcome Scale (GOS).Results There were no significant difference in intraoperative aneurysm rupture rate,intraoperative bleeding volume,inicidence rate of postoperative infection rate,and GOS scores (P ＞ 0.05).But the opreration time and average length of stay in interhemispheric approach group were significantly shorter than the pterional approach group (P ＜ 0.05).Conclusions Approach of interhemispheric was a safe,effective,and convenient approach for the craniotomy of clipping in anterior communicating artery aneurysm.