Along with the continuous publication of a series of large-scale clinical trials results,endovascular thrombolytic therapy (or combined with intravenous thrombolysis) has been recommended as the treatment of first choice for acute ischemic stroke caused by large intracranial artery occlusion.Nevertheless,there are a variety of factors that may affect the clinical outcome of endovascular recanalization procedure.This article aims to make a comprehensive review about the factors that may affect the prognosis of patients with acute ischemic stroke who are receiving endovascular treatment.

Objective To summarize the peri operative therapeutic experience from 67 severe traumatic head injuried patients with a score of 3 8 on Glasgow coma scale (GCS). Methods 67 severe head injuried patients with a score of 3 8 on GCS admitted to our department from Feb. 1992 to Oct.1998 were analyzed. Results Forty five (67 2%) out of 67 patients survived and 22 died. Among the surviving patients 34 (50 7%) achieved a good recovery or moderate disability and left other 11 patients severe deficits(16 5%). Conclusions The prognosis of severe head injuried patients could be improved by correct management before hospitalization, early evacuation of intracranial hematoma with large decompressive craniotomies, intracranial pressure monitoring, moderate hypothermia therapy and other effective prevention and treatment of cerebral vasospasm and complications.

Objective To assess the behavior of rat by suction traumatic brain injury model. Methods Suction traumatic brain injury (TBI) models were created in SD rats. Twenty-four rats were divided into two groups: suction TBI group (n=12) and sham operation group (n=12). Modified neurological severity score (mNSS) test and Morris water maze test were employed to assess the animal behavior in both groups. Results One rat was died of suction trauma. Success rate of modeling for those survivors was one hundred per cent. Cortical and subcortical contusion, hemorrhage and tissue loss were seen in paraffin section by HE staining one week after suction impact. Abnormal mNSS persisted no more than twenty-five days. Morris water maze test suggested that abnormal mean escape latency period last no more than three days. Conclusion Rat suction traumatic brain injury model is suitable for the research about neurological sensory-motor function which last relatively short period.

Objective To evaluate the effectiveness of VEGF-transfected neural stem cells (NSCs) transplantation to striatum for amelioration of neural damage induced by cerebral ischemia.Methods Temporary middle cerebral artery occlusion (tMCAO) models were established and randomly divided into control group, PBS transplantation group, NSCs transplantation group (n=10) and VEGF-secreting NSCs transplantation group (n=20). The grafts in each group were transplanted into right striatum respectively 3 days after tMCAO model established. NSS was checked in all groups 2, 4, 6, 8, 10, 12 weeks respectively after transplantation. By using immunofluorescent staining, VEGF expression in transfected NSCs was detected 7 days after transplantation. Differentiation of transplanted NSCs was investigated 12 weeks after transplantation. Endothelial cells around the transplantation area were semi-quantitated by using immunohistochemistry staining.Results NSS in VEGF-secreting NSCs transplantation group was lower than in other three groups from 2-12 weeks. There was significant difference in NSS among the groups 12 weeks after transplantation (P

Background and purpose:Glioblastoma is one of the most common intracranial tumors, the morbidity and mortality are both high, and the molecular biological mechanism of the disease is still unclear. In this study, we detected the gene expression of tyrosine kinase receptor (TKR) pathway in primary glioblastoma(GBM) with low-density array, furthermore we analyzed the significance of the gene expression change. Methods:We detected 26 genes of RTK pathway in 10 primary GBM tissues and 9 normal brain tissues (gained from the decompression operation of brain trauma), and analyzed the different expressions of these two kinds of tissues by statistic method.Results:The Ct values of MAP2K1 and MAP2K4 in normal brain tissues were 1.6?1.7 and 2.2?2.1, the Ct values of MAP2K1 and MAP2K4 in primary GBM tissues were 3.9?1.5 and 5.0?2.0, and the Ct different values between normal brain tissues and primary GBM tissues of both genes were -2.3 and -2.8(P

Objective To understand the drug-resistance of MRSA patients in neurosurgery intensive care unit,raise the prevention of MRSA and provide doctors the basis for controlling it. Methods The 5 year(20012005) MRSA patients were tested by Kirby-Bauer in neurosurgery intensive care unit of a third-tier general hospital in Shanghai. Statistic and analysis the drug-resistance of the patients. Results The rates of 121 MRSA drug-resistance to penicillin G,erythromycin, ciprofloxacin, amikacin and the cephalosporins are 92.3 % to 100 %, totally senaitire to teicoplanin and vancomycin and lower drug-resistance to rifampin,netilmicin and fosfomycin, but it rapidly raised from 10.0 % (2001 ) to 95.2 % (2005) to sulfamethoxazole. Conclusion It is time to take care of the drug-resistance of MRSA. Prevention and use antibiotics properly are the important ways to decrease the hospital infection and to improve the quality of recovered.

Objective To evaluate the possibility of keyhole approaches for surgical treatment of petroclival meningiomas. Methods We retrospectively analyzed our experience in 14 cases with petroclival meningiomas surgically treated from May 2003 to January 2004. Eight tumors involved the upper and middle clivus.five tumors were attached to the entire width of clivus and one tumor involved the middle and lower cilvus. The tumors infiltrated into parasella regions or cavernous sinus in six cases simultaneously. Retrosigmoidal keyhole approach was selected to remove the tumors in 6 cases, and subtemporal keyhole approach was selected in 2 cases,while the combined retrosigmoidal and subtemporal keyhole approaches were applied in other six cases. Results Gross total resections of the tumors were achieved in 8 cases, subtotal resections in 4 cases, large resection in two cases who had recurrent tumors. Postoperatively, neurological intact or unchanged were found in 8 cases. The main surgical complications were mild facial palsy (4 cases) , abducent dificits (3 cases) ,temporary oculomotor nerve dificits (2 cases),and lower cranial nerve palsy (1 case). One patient died from disseminated intravascular coagulation (DIC) two weeks after surgey. There were no CSF leakage and infections after surgery in all cases 11 to 19 months follow-up studies demonstrated the great improvement of the Ⅲ and Ⅶ nerve deficits,but minor improvement in the Ⅵ nerve deficits. Conclusion According to the location and extension of the tumors, retrosigmoidal or subtemporal keyhole approaches or their combined can be selected for surgical treatment. These keyhole approaches can expose sufficiently the petroclival region, shorten the surgical time, and minimize the complications. Combined usage of minimally invasive techniques including the keyhole approach and radiosurgey in the treatment of the petroclival meningiomas is suggested.

Objective To master the rehabilitation in patients with traumatic brain injury in Eastern China, and provide evidence for clinicians to rehabilitate early,correctly and effectively.Methods All sampling of the TBI patients from 80 hospitals in Eastern China were clustered and were analyzed using SPSS 13.0.Results The rate of in -patients in Eastern China with early rehabilitative intervention was 4.68%,and the rate of male was higher than female(male to female ratio was 3.80:1),mean age was (40.10 ±16.33)years old,but there was no difference in gender(χ2 =3.23,P =0.072)and age(t =-0.819,P =0.413)for the early rehabilitative intervention.Local resi-dent patients in early rehabilitative intervention was lower(χ2 =8.28,P <0.05).The average length of stay for the early rehabilitative intervention patients was(39.57 ±34.22)d(t =-17.74,P <0.05),the average cost of hospitali-zation was(42 741.50 ±43 186.69)yuan(t =-18.96,P <0.05).The rate of average length of stay and average cost of hospitalization of the rehabilitative intervention patients were higher and more expensive than the patients who did not obtain early rehabilitative intervention,but did have higher unfavourable prognosis rate(χ2 =85.45,P <0.05). Conclusion We advocate correct and early rehabilitative intervention for traumatic brain injury in patients with different degree,and promote not only the physical and functional rehabilitation,but also comprehensive rehabilitation such as the psychological treatment,family treatment and social regression.

Objective　To discuss the surgical strategy for giant petroclival meningioma.　Methods　Retrospective analysis of operation and prognosis of 32 patients with petroclival meningioma with a diameter of more than 4.5 cm was carried out.The patients were divided into two groups: suboccipital retromastoid approach and skull base surgical presigmoid sinus approach. Duration of surgery, degree of tumor removal, and postoperative neurological complications were compared between the two groups.　Results　The percentages of radical and subtotal tumor removal in the two groups were not statistically significant. Less time of operations in the presigmoid sinus approach group and mild postoperative neurological sequelae in the suboccipital retromastoid approach group were observed. Karnofsky prognosis scale of the patients at the dismiss time was higher in the suboccipital retromastoid approach group (P＜0.01).　Conclusions　The degree of dissection of giant petroclival meningioma is correlated with tumor nature, blood supply, and adherence to the brain stem. Suboccipital retromastoid approach is suitable for giant petroclival meningioma. Total tumor removal should not increase neurological impairment; if radical dissection is impossible, the tumour may be reduced to less than 3 cm in diameter so as to achieve good results of postoperative radio therapy.

Objective　To discuss the surgical strategy for giant petroclival meningioma.　Methods　Retrospective analysis of operation and prognosis of 32 patients with petroclival meningioma with a diameter of more than 4.5 cm was carried out.The patients were divided into two groups: suboccipital retromastoid approach and skull base surgical presigmoid sinus approach. Duration of surgery, degree of tumor removal, and postoperative neurological complications were compared between the two groups.　Results　The percentages of radical and subtotal tumor removal in the two groups were not statistically significant. Less time of operations in the presigmoid sinus approach group and mild postoperative neurological sequelae in the suboccipital retromastoid approach group were observed. Karnofsky prognosis scale of the patients at the dismiss time was higher in the suboccipital retromastoid approach group (P＜0.01).　Conclusions　The degree of dissection of giant petroclival meningioma is correlated with tumor nature, blood supply, and adherence to the brain stem. Suboccipital retromastoid approach is suitable for giant petroclival meningioma. Total tumor removal should not increase neurological impairment; if radical dissection is impossible, the tumour may be reduced to less than 3 cm in diameter so as to achieve good results of postoperative radio therapy.