OBJECTIVETo study the treatment strategies and operative principles of complex cerebral arteriovenous malformation (CAVM).

METHODSTotal 27 cases of complex CAVM were microsurgically resected from June 2004 to May 2011. These account for 67.5% of CAVMs in the same time. Of the CAVM, 25 were eloquent CAVMs and 2 were non-eloquent CAVM. Among the 27 cases, the size of CAVM was large in 12 cases, median in 8, and small in 7. According to Spetzler-Martin CAVM grading, 8 cases were grade II, 5 cases were grade III, 9 cases were grade IV, and 5 cases were grade V. Pre-operative endovascular embolizations were carried out in 2 large CAVMs. All CAVMs were resected by microsurgical techniques.

RESULTSThere were 23 cases of complex CAVMs totally removed. The total resection rate was 85.2%. The residual CAVMs were found in postoperative digital subtraction angiography (DSA) in 4 cases. Three of these residual cases were treated with gamma knife. Nineteen cases recovered very well after operation. The main complications were hemianopsia in 2 cases, moderate weakness in 4 cases. Two patients in coma before operation were still comatose after operation. The follow-up period were 2 months to 6 years. Twenty-two cases were Glasgow outcome scale (GOS) 5, 3 cases were GOS 4, and 2 comatose patients were improved a little during the follow-up.

CONCLUSIONSThe microsurgical total resection of the CAVMs is the most effective method to cure the disease. With the use of microsurgical technique skillfully, mose complex CAVMs can achieve good outcomes. Preoperative embolization and radiosurgery on the residual nidus are good supplementary methods to treat the complex CAVMs.

Adolescent ; Adult ; Child ; Female ; Follow-Up Studies ; Humans ; Intracranial Arteriovenous Malformations ; surgery ; Male ; Microsurgery ; methods ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the operative modalities and outcomes of 28 cases of ophthalmic segment aneurysms of internal carotid artery.

METHODSTwenty-eight cases of ophthalmic segment aneurysms of internal carotid artery were operated on from May 2004 to August 2009. Of all 28 cases, 20 were large or giant. Nineteen aneurysms were directly clipped or resected with internal carotid artery revascularization. Since 2006, high-flow extracranial-intracranial (EC-IC) bypass were available and performed in 9 patients of large or giant aneurysms and then the aneurysms were resected or trapped.

RESULTSSeventeen patients underwent digital subtraction angiography (DSA), computed tomography angiography (CTA) or magnetic resonance angiography (MRA) postoperatively. The images demonstrated that 5 grafts of bypass were in patency, and 2 were occluded. Only 1 aneurysm was partially clipped and the others disappeared on imaging. The 78% of these cases had good results (GOS 4-5). One patient died after EC-IC bypass due to neck hematoma.

CONCLUSIONSThe treatment of ophthalmic segment aneurysms of internal carotid artery, especially the large and giant ones, remains a challenge for neurovascular neurosurgeon. The accessory high-flow EC-IC bypass procedures and selection of suitable aneurysm clips are very important to improve the effectiveness of the operation.

Adolescent ; Adult ; Child ; Female ; Humans ; Intracranial Aneurysm ; surgery ; Male ; Microsurgery ; Middle Aged ; Ophthalmic Artery ; Retrospective Studies ; Treatment Outcome ; Vascular Surgical Procedures ; methods ; Young Adult

OBJECTIVE: The Jidong Women Health Cohort Study is a prospective cohort study on female-specific characteristics and risks of chronic diseases in Chinese women and focuses on the potential association between menopause and risks of cardiovascular disease (CVD). METHODS: The study includes 4,179 female participants with an age of older than 18 years from Caofeidian district, Tangshan city, northern China. Baseline information on female-specific characteristics and potential cardiovascular risk factors was collected and all the participants underwent a physical examination with blood samples collected in 2013. To establish a better risk assessment tool of female CVD, updated information from questionnaire investigation, physical examinations and occurrence of outcome events will be collected through a longitudinal follow-up annually up to the year 2024. RESULTS: At baseline, Mean age of the participants was 42.3 ± 12.8 years. Reproduction occurred in 2,948 participants (70.5%), menopausal transition in 173 (4.3%), and postmenopause in 1,058 (25.3%). The incidence of arterial hypertension, dyslipidemia, and diabetes showed significant difference across different groups stratified by Stage of Reproductive Aging Workshop (STRAW) system (P < 0.05). CONCLUSION The Jidong Women Health Cohort Study will contribute to the scientific evidence on association between female-specific characteristics and cardiovascular risks, and will also be helpful to provide a new path for early detection and prevention of CVD.
Adult ; Cardiovascular Diseases ; epidemiology ; China ; epidemiology ; Cohort Studies ; Female ; Humans ; Menopause ; Middle Aged ; Research Design ; Risk Factors ; Women's Health

OBJECTIVE: This study aimed to investigate the relationship between alkaline phosphatase (ALP) and common carotid intima media thickness (IMT), carotid plaque, and extracranial carotid artery stenosis (ECAS). METHODS: A total of 3,237 participants aged ⪖ 40 years were recruited from Jidong community in 2013-2014. Participants were divided into five quintile groups based on their serum ALP levels. Carotid atherosclerosis was assessed using ultrasound. Abnormal IMT, carotid plaque, and ECAS were defined as IMT > 0.9 mm, IMT > 1.5 mm, and ⪖ 50% stenosis in at least one extracranial carotid artery, respectively. RESULTS: Common carotid IMT values and the prevalence of carotid plaque increased across serum ALP quintiles. Higher ALP quintiles were correlated with an increased risk of abnormal IMT [fourth quintile: odds ratio (OR) 1.78, 95% confidence interval (CI) 1.13-2.82, P = 0.0135; fifth quintile: OR = 1.82, 95% CI: 1.15-2.87, P = 0.0110] and ECAS compared to the lowest quintile (fifth quintile: OR = 1.47, 95% CI: 1.09-1.97, P = 0.0106). The association between ALP and prevalence of carotid plaque became insignificant after adjustment for confounders. CONCLUSION Serum ALP levels were independently associated with abnormal common carotid IMT and ECAS. These conclusions need to be further corroborated in future prospective cohort studies.
Adult ; Aged ; Alkaline Phosphatase ; blood ; Carotid Artery Diseases ; blood ; diagnostic imaging ; Carotid Intima-Media Thickness ; Carotid Stenosis ; blood ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged

OBJECTIVETo study the exposure of suboccipital far-lateral approach and postauricular transtemporal approach to the jugular foramen region based on quantitative measurements, and provide reliable anatomic data for selecting surgical approach individually and protecting the function of important structures.

METHODSThe complete approach of the suboccipital far-lateral approach and the postauricular transtemporal approach were reproduced in twelve (twenty-four sides) head-neck specimens of adults be fixed in 10% formalin. The exposure area to the jugular foramen region was obtained using a stereotactic device, and the length of exposure of the clivus and the trigeminal nerve were measured using a vernier caliper.

RESULTSIn the suboccipital far-lateral approach, the significant increase in exposure was noted after removal of the jugular process and partial resection of occipital condyle. In the postauricular transtemporal approach, the exposure increased significantly after complete retrolabyrinthine approach, partial labyrinthectomy and transcochlear approach.

CONCLUSIONSResection of jugular process is the key to expose the jugular foramen through the far-lateral approach. The infralabyrinthine approach and the partial labyrinthectomy approach are ideal approaches to expose the jugular foramen region laterally.

Adult ; Cadaver ; Craniotomy ; methods ; Humans ; Jugular Veins ; Occipital Bone ; anatomy & histology ; innervation ; surgery ; Skull Base ; anatomy & histology ; innervation ; surgery ; Temporal Bone ; anatomy & histology ; innervation ; surgery

Objective: To investigate the clinicopathologic characteristics of intractable epilepsy. Methods: Based on the classification criteria proposed by the International League Against Epilepsy (ILAE), a retrospective analysis of the pathological characteristics was done in 822 patients who underwent epilepsy surgery in Sanbo Brain Hospital, Capital Medical University, from June 2008 to December 2012. Results: The mean age of epilepsy onset was 9.9 years, mean duration of epilepsy was 11.9 years. Complex partial seizures were the main presenting features. Histopathological study showed 33 cases (4.01%) with mild forms of cortical malformations, 690 cases (83.94%) with focal cortical dysplasia (FCD) and 99 cases with others (including 39 pure hippocampal sclerosis, 20 cystosclerosis, 19 Sturge-Weber syndrome, 8 tuberous sclerosis complex, 6 without significant pathological changes, 5 gyral malformations and 2 hamartoma). Among the 690 FCD cases, 106 were FCD typeⅠ, 91 were FCD typeⅡ and 493 were FCDⅢ(Ⅲa: 160, Ⅲb: 106, Ⅲc: 26 and Ⅲd: 201). Conclusions FCDⅢd is the most common histopathological subtype causing intractable epilepsy, mainly due to focal hypoxia/ischemia in the perinatal period, which results in scarring of local brain tissue; this is followed by other isolated forms of FCD (FCDⅠand FCDⅡ), and then FCD Ⅲa and FCD Ⅲb. The reason to distinguish isolated forms of FCD (types Ⅰ and Ⅱ) from FCD Ⅲ and to subclassify FCD Ⅲ is to allow better definition of cortical dyslamination. Therefore, the pathogenic factors of intractable epilepsy can be grouped in greater details, and facilitate the diagnosis and potential curative treatment of intractable epilepsy.

Child ; China ; Evidence-Based Medicine ; Humans

OBJECTIVE: Increased carotid artery intima-media thickness (CIMT) and carotid plaque as manifestations of carotid atherosclerosis have been used as markers of cardiovascular disease (CVD). The components of metabolic syndrome (MetS) are linked to CVD, but the association between MetS and CVD is controversial. METHODS: A total of 8,933 Chinese adults aged 40 years or older from 2010 to 2014 were selected from the Jidong and Kailuan communities. MetS was defined by the International Diabetes Federation criteria. CIMT and carotid plaque were measured using color Doppler ultrasound. Logistic regression models were used to assess the association of MetS with carotid plaque and CIMT. RESULTS: MetS was found among 3,461 (3,461/8,933) participants. The odds ratio and 95% confidence internal (CI) for carotid plaques in participants with MetS was 1.16 (1.03-1.30). The risk of carotid plaques increased with the number of MetS components. The average CIMT was higher in participants with MetS (β = 0.020, 95% CI, 0.014-0.027) and in participants with more MetS components. CONCLUSION Individuals with MetS are at an increased risk for carotid atherosclerosis compared to those without MetS.

OBJECTIVE: Traditional epidemiological studies have shown that C-reactive protein (CRP) is associated with the risk of cardiovascular diseases (CVDs). However, whether this association is causal remains unclear. Therefore, Mendelian randomization (MR) was used to explore the causal relationship of CRP with cardiovascular outcomes including ischemic stroke, atrial fibrillation, arrhythmia and congestive heart failure. METHODS: We performed two-sample MR by using summary-level data obtained from Japanese Encyclopedia of Genetic association by Riken (JENGER), and we selected four single-nucleotide polymorphisms associated with CRP level as instrumental variables. MR estimates were calculated with the inverse-variance weighted (IVW), penalized weighted median and weighted median. MR-Egger regression was used to explore pleiotropy. RESULTS: No significant causal association of genetically determined CRP level with ischemic stroke, atrial fibrillation or arrhythmia was found with all four MR methods (all Ps > 0.05). The IVW method indicated suggestive evidence of a causal association between CRP and congestive heart failure ( OR: 1.337, 95% CI: 1.005-1.780, P = 0.046), whereas the other three methods did not. No clear pleiotropy or heterogeneity were observed. CONCLUSIONS Suggestive evidence was found only in analysis of congestive heart failure; therefore, further studies are necessary. Furthermore, no causal association was found between CRP and the other three cardiovascular outcomes.
C-Reactive Protein/metabolism* ; Cardiovascular Diseases/metabolism* ; Genetic Predisposition to Disease ; Genotype ; Humans ; Japan ; Mendelian Randomization Analysis ; Polymorphism, Single Nucleotide ; Risk Factors