OBJECTIVE:To investigate the molecular mechanism of cerebral vasospasm (CVS) from the perspectives of the basic molecular biology of cerebrovascular regulation, vascular cell proliferation, inflammatory reactions of vascular cells, and gene activation.DATA SOURCE: By using the key words "subarachnoid hemorrhage","cerebral ischemia", "temporal", and "molecular biology", we retrieved the related articles between January 1998 and December 2004 in Medline,and the language was limited to English.STUDY SELECTION: All articles related to our study purpose were setal subjects. Exclusion criteria: Duplicated experiments. The rest of articles were searched for the full text.DATA EXTRACTION: Totally 20 articles related to the molecular mechanism of CVS induced by subarachnoid hemorrhage (SAH) with or without randomized studies were selected, and 14 of them accorded with the inclusion criteria. The other 6 papers of duplicated study were excluded.oxygen radicals damage both cerebral endothelial and smooth muscle cells through the following possible mechanism: increasing endothelial permeability, increasing intracellular calcium and inositol 1,4,5-triphosphate levlarize and show impaired relaxation after SAH. This may be due to a depletion of the energy metabolism causing a dysfunction of ion pumps or inhibition of potassium channels, which leads to membrane depolarization gene activation can relieve CVS.CONCLUSION: The patbogenesis of SAH-induced CVS may be related to a number of pathological processes, including endothelial damage, smooth muscle cell contraction resulting from dysfunction of ion pumps or PKC activation, vascular cell proliferation, inflammatory reaction of the vascular wall, and gene activation.

ObjectiveTo compare the effect of the neurosurgical clipping and endovascular for treating intracranial aneurysm.MethodsRetrospectively analyzed the clinical data of 110 cases with intracranial aneurysms.The patients were divided into intervention group(55 patients with endovascular treatment) and surgery group(55 patients with neurosurgical clipping treatment) according to different methods,followed forup 1 ～4 months,and immediately evaluated the efficacy.The Chinese stroke scale(CSS) and activities of daily living(ADL) score were used for prognostic evaluation.ResultsThe immediate effect:the marked efficacy in 40 cases,efficacy in 10 cases and inefficacy in 5 cases,and the total effective rate in the intervention group was 90.9％,while the surgery group were 32 cases,10 cases,13 cases,and the total effective rate was 76.4％.There was significantl differences between the two groups ( x2 =3.96,P ＜ 0.05 ) ; the CSS and ADL scores significantly lower than pre-treatment ( t =9.12,8.05,P ＜0.05).ConclusionEndovascular treatment for intracranial aneurysms could improve the clinical efficacy and improve patients self-care ability,and significantly improve the prognosis.

Objective To investigate the value of neuronavigation system in resection of pituitary adenoma through the endonasal transsphenoidal approach. Methods Twenty-one patients with pituitary adenomas underwent magnetic resonance imaging (MRI) or CT scans studies. The image datasets were transported into the neuronavigation system. The anatomic information of approach was reconstructed for three-dimensional visualization and the best approach was designed. The midline structure and internal carotid artery were displayed in real-time intraoperatively, the anterior-wall of sphenoidal sinus and the floor of sella were accurately opened and the tumor was resected guiding by neuronavigation system. Results All the operations were smoothly and accurately performed under the neuronavigation by transsphenoidal approach. No injury occurred in the internal carotid artery and cavernous sinus. After surgery, 13 patients got better vision and visual field. Postoperative transient diabetes insipidus was found in 11 cases, and CSF leak in 1 and serious hyponatremia in 2 cases. Total tumor removal was achieved in 17 patients and subtotal removal in 2 cases during operations, which were confirmed by postoperative MRI. Three-month follow-up data showed only one recurrence case (subtotal tumor removal), the recurrence rate was 4.8%. Conclusion Neuronavigation system provided real-time localization with three-dimensional anatomic information of the endonasal transsphenoidal approach during pituitary adenomas surgery. As a result, the approach proceeds more smoothly and accurately, the tumor can be resected more completely, the surgical injury and complications can also be reduced.

ObjectiveTo discuss the role of neuronavigaition technique in localizing and facilliating microsurgical resection of intracranial ateriovenous malformations (AVM) .Methods Forty-three cases with intracranial AVM treated microneurosurgically asisting by Stryker Leibinger neuronavigation system were retrospectively analyzed.Results After reaching neuronavigation calculated technical accuracy (less than 2 mm) and continual intraoperative navigating accuracy, all of the 43 AVM lesions were completely resected.In 41 patients, syptoms were significantly improved (95.4％) at discharge, new neurofuntion defection were found in 2 patients(4.6％) , no death occured.ConclusionNeuronavigation techniques helps the surgery in planning a precise surgical approach to the targeted AVM lesion and tracing the neurovascular structures ,improves the safety of the surgery and the functional outcome of the patients, contribute to lesion resection and reduce operative complications.

objective To explore the application of navigation-assited microsurgery resection of posterior fossa solid hemangioblastoma.Methods The data of 16 patients with posterior fossa solid hemangioblastoma treated by navigation-assited microsurgery were analyzed retrospectively,compared with 19 patiems treated by microsurgery who suffered the same disease in the similar location(control group).Results The tumors were totally resected successfully acompanied by minimal blood loss and shortening of the operation time,compared with the control group.Manipulation and removal of these tumors were actually easier,in addition,adjacent structures can avoid damage.Conclusions Navigation-assited microsurgery is useful technique to surgical resection of fossa solid hemangioblastoma by significantly reducing blood loss at the time of surgery and operation procedure time,avoiding damage to the adjacent structures,and reducing the surgery complications and mortality.

Objective To study the effect of exogenous rhBMP-2(recombinant human bone morpho- genetic protein-2)on the expression of endogenous TGF-?1 during osteogenesis in rabbits.Methods After successfully duplicating experimental rabbit skull defect model,we detected and analyzed the expression of en- dogenous TGF-?1 of the pericranium in different stages by using immunohistochemieal method in both the ex- perimental group and the control group.Results In the experimental group a lot of mesenchymal cells with positive expression of endogenous TGF-?1 of the pericranium aggregated in duramater in the early stage after operation,and the expression level increased rapidly with the differentiation of mesenchymal cells,and reached the peak at 17,19 day postoperation.Positive cell number of TGF-?1 of pericranium was statistically analyzed in both groups at 7,15,21 days,showing significant difference(t-test,P＜0.01 ).Conclusion Exogenous rhBMP-2 can induce and enhance the expression of endogenous TGF-?1 during osteogenesis.