Objective To investigate the safety and effectiveness of digital subtraction angiography (DSA) in the surgical treatment of intracranial arteriovenous malformations (AVMs) in children.Methods Between December 2015 and February 2017,the clinical and imaging data of 9 children with AVM (2-14 years) underwent hybrid surgery at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively.According to the Spetzler-Martin grade,there were 2 patients with grade Ⅰ,3 with grade Ⅱ,2 with grade Ⅲ,and 2 with grade Ⅳ.All the children were treated with microsurgery,and their AVMs were removed by real-time assistance using DSA technique during the operation.The imaging cure rate of surgical treatment and the complications of intraoperative angiography of the children were analyzed.The children were followed up clinically after procedure.According to the modified Rankin scale (mRS) score,their prognoses were evaluated.Results Intraoperative angiography revealed that the AVMs in 8 of 9 children were resected completely,and 1 had a residual lesion,then it was resected completely.Immediately after the resection of the nidi,the angiography confirmed that the nidi of 9 children were resected completely.No related complications caused by intraoperative angiography were observed.Nominal aphasia occurred in 1 child after procedure,and he recovered gradually after 6 months.Pulmonary infection occurred in 2 children,and they were cured after anti-infection treatments.Postoperative follow-up mRS scores were 0-1 in 8 children,2 in 1 child,and no rebleeding was observed.Conclusions In children undergoing AVM surgery,initial observation of DSA is safe and effective.Intraoperative angiography can guide the complete resection of the lesions in real time,improve the surgical cure rate of AVMs,and improve the prognosis of children.

Objective Toanalyzetheclinicalcharacteristicsandtreatmentoutcomesofspinalfilum terminalevascularmalformation.Methods Theclinicaldataof6patientswithfilumterminalevascular malformation diagnosed and treated from January 2008 to December. 2013 were analyzed retrospectively. The definition of filum terminale vascular malformation is anterior/posterior spinal artery feeding arteriovenous fistula or arteriovenous malformation and located below conus medullaris,and does not complicate with spinal vascular lesions in the other part. The Aminoff & Logue score and MRI of spinal cord function were performedatoneyearaftermicroneurosurgeryand/orendovascularembolization.Results Allpatients were males. Their clinical presentations were the weakness of both lower extremities and sphincter disturbance. The mean course of disease was 17. 1 ± 5. 2 months. The pathological type of the 6 patients were all arteriovenous fistulas. The feeding arteries included lumbar artery,internal iliac artery,and median sacral artery. Two of the 6 patients underwent Onyx glue embolization,3 were treated with microneurosurgery,and 1 was treated with embolization in combination with microneurosurgery. They were all achieved anatomic cure. The Aminoff & Logue scores were improved after 1 year (3. 8 ± 1. 9 scores before procedure,2. 8 ± 2. 0 scores after procedure),there was no significant difference (P >0. 05). The myodynamia scores were improved in 3 patients,2 did not change,1 got worse. The urinary and bowel functions were improved in 2 patients,and4didnotchange.Conclusion Filumterminalevascularmalformationisararevascular malformation of spinal cord. Both embolization and surgical treatment can achieve anatomic cure. Although the spinal cord function can be only partially restored,but continuous deterioration can be prevented.

OBJECTIVETo study the classification and individualized treatment of the terminal phalanx of thumb duplication.

METHODSFrom Apr. 2003 to Dec. 2012, 76 patients with 77 involved thumbs duplication at the level which is distal to the interphalangeal joint were retrospectively studied. Based on the morphology (the nail width and the thumb circumference) and the deviation of the thumb, we classified the terminal phalanx of thumb duplication into 5 types as Type A (no bony connection called floating thumb), Type B(asymmetry and no deviation), Type C(asymmetry and deviation), Type D (symmetry and no deviation) and Type E(symmetry and deviation). Different surgical procedures were selected according to different types. Simple excision of the smaller thumb was adopted for Type A case. Removement of the smaller thumb (usually the radial) and of the collateral ligament of the interphalangeal joint were selected for Type B. Removement of the smaller thumb (usually the radial) and reconstruction of the collateral ligament of the interphalangeal joint, as well as corrective osteotomies at the neck of the proximal phalanx were performed for Type C. The modified Bilhaut-Cloquet procedure with reconstruction of the collateral ligament of the interphalangeal joint were adopted in Type D. The classical Bilhaut-Cloquet procedure, or the modified Bilhaut-Cloquet procedure with reconstruction of the collateral ligament of the interphalangeal joint and corrective osteotomies at the neck of the proximal phalanx were performed in Type E. The results were assessed by an evaluation form for thumb duplication by the Japanese Society for Surgery of the Hand.

RESULTSAccording to our new classification standard, there were 3 cases with Type A duplicated thumbs, 36 with Type B, 13 with Type C, 15 with Type D, 10 with Type E. All the 76 patients underwent the individualized surgical treatment. The patients were followed up for 6-60 months. According to the evaluation form, excellent results were achieved in 66 thumbs, good in 9 thumbs and fair in 2 thumbs.

CONCLUSIONSThe new classification could comprehensively describe the clinical features of the terminal phalanx of congenital thumb duplication. Individualized therapy, including basic and repeated surgical procedure could be adopted for each type with satisfactory results.

Child ; Collateral Ligaments ; surgery ; Finger Phalanges ; surgery ; Humans ; Orthopedic Procedures ; methods ; Osteotomy ; methods ; Polydactyly ; classification ; surgery ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Thumb ; abnormalities

OBJECTIVETo investigate the diagnosis and treatment of patients with spinal cord cavernous angioma.

METHODSClinical data on 23 patients with intramedually cavernous angiomas were analyzed. The function of the spinal cord was evaluated before and after treatment using the Aminoff & Logue scale.

RESULTSAll patients underwent resection of spinal cord cavernous angioma except two patients who refused surgical treatment. Complete removal was achieved in 18 patients, and subtotal removal in 3. Twenty-one patients with spinal cavernous angioma were confirmed pathologically. The postoperative neurological status was improved in 15 patients, remained unchanged in 4, and aggravated in 2. No deaths occurred.

CONCLUSIONSMRI is specific in diagnosis of intramedually cavernous angioma. The outcome of surgical treatment is better. Surgical treatment is suitable for patients with symptoms.

Adolescent ; Adult ; Female ; Hemangioma, Cavernous ; diagnosis ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Cord Neoplasms ; diagnosis ; surgery ; Treatment Outcome

Objective To evaluate 64-slice CT angiography in diagnosing spinal vascular malformations. Methods Fifteen patients,who were suggestive of spinal vascular malformations bv clinical manifestation and MRI,underwent CT angiography with a 64-slice spiral CT(GE lightspeed VCT).DSA were performed later within 1 week in all the patients and four of them were treated with operation as well.We evaluated CTA images in displaying the lesions according to the following aspects:the type of malformation,lesion range,feeding artery,draining vein and possible fistula.and compared those details with DSA and operation findings.Results All 15 patients acquired their final diagnosis by DSA and operation,which were intramedullary axteriovenous malformation in 6 cases,perimedullary arteriovenous fistula in 2,spinal dural arteriovenous fistula in 3 and Cobb syndrome in 4 cases. CTA was consistent with DSA in the classification of lesions and in the determination of the involved regions and it reveaIed the main feeding arteries and draining veins in all patients.CTA showed four arteriovenous fistulae confinned bv DSA.but it failed in a complex arteriovcnous fistula.In Cobb syndrome patients,not only the intramedullary but also paravertebral and subcutenous vascular malformation could be clearly seen on CTA images.Conclusion 64-slice CT angiography can be a preliminary method in spinal vascular malformation because it can determine the classification and reveal almost all the main lesions quickly,atraumatically.

OBJECTIVE:To study the safety and efficacy of Neuroform self-expanding stent for symptomatic intracranial artery stenosis.METHODS:A total of 37 patients with symptomatic intracranial artery stenosis received treatment at the Department of Neurosurgery,Affiliated Hospital of Behua University and Xuanwu Hospital were selected,who were ineffective to anticoagulation and antiplatelet treatment,including 24 males and 13 females,aged from 49 to 72 years,mean aged 64 years.All patients were received Neuroform self-expanding stent following angiography.RESULTS:All patients underwent PTAS with mean preoperative stenosis were reduced from 64% to 24% after percutaneous transluminal angioplasty (PTAS).The technically successful rate was 100%.All the patients were received a 6-22 month follow-up (average 13 months).The average artery stents was retrieved by 50%-90% after stent deployment.There was no arterial dissection,acute occlusion of the target artery or symptomatic distal emboli.Within the follow-up period,1 patient endured asymptomatical artery full occlusion.Two stents were implanted simultaneously in 3 patients,1 of them suffered bilateral vertebral artery stenosis,and 2 had right vertebral arterial and basilar artery stenosis.One patient suffered acute in-stent thrombosis and recovered after thrombolytic therapy.No pathogenetic condition was aggravated in the follow-up.CONCLUSION:The application of Neuroform self-expanding stent can alleviate the ischemic symptoms of patients with vertebrobasilar stenosis and elevate the operative safety and effectiveness.However,further study is needed to evaluate the long-term therapeutic effect.

Objective To review the experience of multiple modality endovascular treatment for intracranial venous thrombosis, and to evaluate the efficacy and risk of endovascular thrombolysis for intracranial venous thrombosis.Methods From October, 2000 to October, 2001, 12 patients with intracranial venous thrombosis confirmed by CT, MRI, MRV, and/or DSA were treated with multiple modality endovascular thrombolysis including intravenous thrombolysis, mechanical thrombus maceration, intraarterial thrombolysis, and stenting.After thrombolysis, treatment aimed at the primary diseases was continued and warfarin was used for 6 months.The patients were followed-up for 17-29 months, averaged 23 months.Results Of the twelve patients, all underwent transvenous thrombolysis, ten underwent combined transvenous thrombolysis and clot maceration, seven underwent transvenous infusion of urokinase combined with transarterial infusion of urokinase.Two underwent transvenous infusion of urokinase combined with transarterial infusion of urokinase.The thrombolysis duration was from one to three days.The infusion dose of urokinase was 800 000 to 2 900 000 IU, the averaging dosage of urokinase was less than 1 000 000 IU per day.All patients achieved from recanalization of sinuses as confirmed on postprocedural angiography, MRI, and MRV studies prior to hospital discharge.At discharge, all the patients improved neurologically, and GCS improved from averaged 12 of pre-operation to 14 of post-operation.During the averaging 23 months follow-up, no patient recurred. Conclusion Combined multiple modality endovascular treatment is an effective and safe procedure for potentially catastrophic intracranial venous thrombosis.