Background Although remarkable progress has been made in microsurgery, surgery of intracranial aneurysm still encounters various complications. Cerebral ischemia and postoperative disorders of nervous system could be induced by various specific operation procedures. To improve the outcomes in intracranial aneurysm surgery and to minimize the occurrence of postoperative ischemic complications, it is necessary to perform real-time monitoring on ischemic damages for the corresponding functional areas. To elevate the sensitivity of Eps changes for the detection of cerebral ischemia induced by operation, we monitored Motion Evoked Potential ( MEPs), Somatosensory Evoked Potential (SSEPs)and Brainstem Auditory Evoked Potential (BAEPs) in microsurgical operations of intracranial aneurysms. And then the correlation between Eps changes and clinical outcome was investigated.Methods MEPs, SSEPs, and BAEPs were recorded intra-operatively for 25 cases in intracranial aneurysms. Monitored results and clinical outcome were analyzed in a prospective observational design.Results The MEPs in 5 of 21 cases, the SSEPs in 5 of 25 cases and the BAEPs in 1 of 3 cases showed inadequate temporary clipping, inadvertent occlusion, inadequate retraction, vasospasm, or compromise to perforating vessels. 3 patients developed advanced weakness, which showed abnormal SSEPs in only one patient while showed abnormal MEPs in all 3 cases.Conclusions The MEPs is more sensitive than SSEPs in monitoring the motor ischemic impairments. The monitoring results were correlated to the clinical outcome closely. Monitoring Eps in keyhole microsurgery of intracranial aneurysms could improve the sensitivity in detecting insufficient distal collateral flow. And then successful completion of potentially hazardous maneuvers would be attained.

Objective: To retrospectively analyze the efficacy and prognostic factors of postoperative intensity modulated radiotherapy for grade Ⅱ gliomas. Methods: Retrospective analysis was conducted on patients with postoperative grade Ⅱ glioma in our hospital from Jan. 2010 to Dec. 2018. The primary endpoint was progression-free survival, and the secondary endpoint was overall survival. Correlative analyses of prognosis by age, gender, initial resection status, the maximum diameter of the lesions, bi-hemisphere, astrocytoma, chemoradiation, adjuvant chemotherapy were conducted. Results: A total of 109 cases with grade Ⅱ glioma were enrolled. The follow-up rate was 91.75%, including 10 cases dead and 27 relapsed. There were 24 cases (88.9%) of in-field failure, and 3 cases (11.1%) of out-field failure. 14 cases of recurrence occurred in 81 cases of total resection group, accounting for 17.3%, and 13 in 28 cases of subtotal resection group, accounting for 46.4%. The recurrence rate in the subtotal resection group was significantly higher than that in the total resection group (χ ²=9.484, P<0.05). The 1-, 2-, 3-, 4- and 5-year progression-free survival rates were 92.5%, 86.0%, 80.6%, 77.5% and 66.8%, respectively. The 2-, 3-, 4- and 5-year overall survival rates were 97.2%, 90.8%, 87.7% and 84.5%, respectively. Multivariate analysis showed that patients with subtotal resection(HR=3.608, P<0.05) and bi-hemisphere(HR=3.183, P<0.05)were significantly correlated with the progression free survival. Conclusions Postoperative intensity modulated radiotherapy for grade Ⅱ gliomas can achieve a better PFS. Recurrence in the radiation field is the main failure mode. Initial resection status and bi-hemisphere of tumor are important influential factors for PFS of grade Ⅱ gliomas patients.