Objective:To evaluate the efficacy and safety of intrasaccular flow disruptor in wide-necked intracranial aneurysms.Methods:One hundred and seventeen patients with wide-necked intracranial aneurysms treated with intrasaccular flow disruptor were collected from Department of Neurointervention (First Affiliated Hospital of Zhengzhou University), Department of Neurosurgery (Beijing Tiantan Hospital, Capital Medical University), Department of Cerebrovascular Surgery, Neurosurgery Center (Zhujiang Hospital, Southern Medical University), and Department of Neurosurgery (First Affiliated Hospital of Harbin Medical University) from August 2022 to March 2024. Raymond-Roy Occlusion Classification (RROC) was employed to evaluate aneurysm embolization immediately after procedure; cranial CT or MRI within 48 hours of embolization were performed to identify any new intracranial hemorrhage, subarachnoid hemorrhage, or new symptomatic cerebral infarction related to the intracranial aneurysms. Modified Rankin Scale (mRS) was used to assess the neurological function at discharge. Imaging follow-up and outpatient follow-up were performed at 6 months after embolization to evaluate the aneurysm occlusion degree and complications.Results:A total of 117 intrasaccular flow disruptors were implanted in 117 patients, with a technical success rate of 100%; 115 patients (98.3%) enjoyed successful one-time release of their disruptors, and 2 patients (1.7%) required retrieval and redirection of the disruptors before second successful attempt. Flow disruptor plus stent was performed in 13 patients (11.1%). Immediately after procedure, RROC grading I was noted in 3 patients, grading II in 51 patients and grading III in 63 patients. Cranial CT or MRI within 48 hours of embolization indicated no new intracranial hemorrhage, subarachnoid hemorrhage, or symptomatic cerebral infarction related to the intracranial aneurysms. All patients had mRS score of 0 at discharge. Eighty-three patients completed a 6-month follow-up (RROC grading I in 41 patients, grading II in 33 patients and grading III in 9 patients), without ischemic or hemorrhagic adverse events.Conclusion:The results of this study preliminarily suggest that intrasaccular flow disruptor is effective and safe in wide-necked intracranial aneurysms.

Objective:To evaluate the efficacy and safety of Neuroform Atlas stent-assisted coil embolization in patients with middle cerebral artery bifurcation aneurysms.Methods:A retrospective analysis was performed; the clinical data of 46 patients with middle cerebral artery bifurcation aneurysms accepted Neuroform Atlas stent-assisted coil embolization in First Affiliated Hospital of Zhengzhou University, Beijing Tiantan Hospital Affiliated to Capital Medical University, First Affiliated Hospital of Harbin Medical University, Zhujiang Hospital of Southern Medical University and First Affiliated Hospital of Chongqing Medical University from January 2022 to March 2024 were collected. There were 28 ruptured aneurysms (60.87%) and 18 unruptured aneurysms (39.13%). Follow-up was performed for more than 3 months; Raymond-Roy grading was used to evaluate the aneurysm embolization immediately after embolization and during follow-up; perioperative hemorrhagic or ischemic complications were recorded; modified Rankin Scale (mRS) was used to evaluate the prognosis of the patients at discharge and during follow-up (mRS score≤2: good prognosis, and mRS score>2: poor prognosis).Results:Coil embolization was successful in all 46 patients. DSA immediately after embolization showed that 41 patients (89.13%) had completely occluded aneurysms (Raymond-Roy grading I), 2 patients (4.35%) had residual aneurysm neck (Raymond-Roy grading Ⅱ) and 3 patients (6.52%) had partially occluded aneurysms (Raymond-Roy grading Ⅲ). Perioperative complications occurred in 5 patients, including 2 with postoperative cerebral infarction, 1 with hydrocephalus, 1 with postoperative pneumonia leading to respiratory failure, and 1 with stent thrombosis during embolization. Both at discharge and 3 months after embolization, 43 patients (93.48%) had good prognosis and 3 patients (6.52%) had poor prognosis. No obvious ischemic complications (such as stent restenosis) or hemorrhagic complications (such as re-rupture of the aneurysms) were found in all patients. Thirty patients (65.22%) had imaging follow-up for 6-12 months: 26 (86.67%) had Raymond-Roy grading I, 3 (10.00%) had Raymond-Roy grading II, and 1 (3.33%) had Raymond-Roy grading III.Conclusion:Neuroform Atlas stent-assisted coil embolization has good short-term efficacy and high safety in middle cerebral artery bifurcation aneurysms, but long-term follow-up observation is still needed to verify its efficacy.

Objective:Persistent proatlantal intersegmental artery (PPIA) is a rare variant of persistent carotid-vertebrobasilar anastomoses and mostly discovered incidentally. To explore the clinical features of PPIA, and enhance the understanding of this rare cerebrovascular variation.Methods:A retrospective analysis was performed. The clinical data of 6 patients with PPIA admitted to Department of Neurointervention, First Affiliated Hospital of Zhengzhou University from June 2018 to June 2024 were analyzed. The imaging features, associated cerebrovascular diseases, treatments and follow-up results were summarized.Results:Among the 6 PPIA patients, 4 were with type I and 2 were with type II; 5 were with left PPIA and 1 patient was with right PPIA; 5 patients had bilateral vertebral artery hypoplasia or absence, and 1 patient had absence of the ipsilateral vertebral artery and normal development of the contralateral vertebral artery. Four PPIA patients were combined with intracranial aneurysms: 2 patients received dual stent-assisted embolization and flow diverter device combined with covered stent implantation, respectively (after 6 months of follow-up, modified Rankin scale score of 0 indicating good prognosis and healed intracranial aneurysms), and the other 2 patients with micro-aneurysms were not treated. One patient was combined with internal carotid artery stenosis and accepted stent placement (good prognosis at 6 months after follow-up). One patient was combined with acute basilar artery tip occlusion and accepted aspiration thrombectomy (died of brain herniation 7 days after thrombectomy).Conclusions:PPIA is often accompanied by vertebral artery developmental abnormalities and prone to have concurrent intracranial aneurysms or ischemic stroke. When performing surgical treatment for cerebrovascular diseases associated with PPIA, PPIA protection to ensure blood supply of the posterior circulation is essential.

Objective:To investigate the effects of oxycodone on perioperative pain and cognitive function in elderly patients with colorectal cancer.Methods:A prospective randomized-controlled trial was conducted. A total of 88 elderly patients with colorectal cancer who underwent elective laparoscopic surgery at Benxi Central Hospital from June 2022 to December 2023 were selected. According to random number table method, all patients were randomly divided to the experimental group and the control group, with 44 cases in each group. Anesthesia in the experimental group was induced with oxycodone 0.2-0.3 mg/kg, intraoperative oxycodone was maintained at 0.1-0.15 mg·kg -1·h -1; oxycodone was intravenously injected with analgesia pump after surgery. In the control group, anesthesia was induced with sufentanil 0.2-0.3 μg/kg, remifentanil was intraoperatively maintained at 0.1-0.3 μg·kg -1·min -1, sufentanil was intravenously injected with analgesia pump after surgery. Blood pressure and heart rate before anesthesia induction (T 0), at tracheal intubation (T 1), at skin incision (T 2), and at extubation (T 3) of both groups were compared; numerical rating scale (NRS) at 30 minutes, 6 h, 24 h, and 48 h after surgery were scored, the confusion assessment method (CAM) and the mini-mental state examination (MMSE) score at day 1, 3, 7 after surgery were used to assess the postoperative early cognitive decline and other adverse reactions. Results:Finally, 81 patients were included in the study. There were 41 cases in the experimental group including 20 males and 21 females with the age of (76±3) years, and 40 cases in the control group including 19 males and 21 females with the age of (75±2) years. There were no statistically significant differences in gender composition, age, body mass index, operative time, intraoperative blood loss (all P > 0.05). There were statistically differences in blood pressure [(91±8) mmHg (1 mmHg = 0.133 kPa) vs. (89±10) mmHg at T 0, (92±9) mmHg vs. (90±8) mmHg at T 2, (93±9) mmHg vs. (92±9) mmHg at T 3] and heart rate [(70± 15) times/min vs.(69±16) times/min at T 0, (68±12) times/min vs. (67±12) times /min at T 2, (70± 15) times/min vs. (69±14) times/min at T 3] between the experimental group and the control group (all P > 0.05). Blood pressure and heart rate [(101±9) mmHg, (83±15) times /min] at T 1 in the experimental group were higher than those in the control group [(93±11) mmHg, (70±17) times /min], and the differences were statistically significant ( t values were 3.73, 3.77; all P < 0.001). There were no statistically significant differences in NRS scores [(2.6±1.2) scores vs. (2.8±1.1) scores at 30 min, (2.8±1.6) scores vs. (2.9±1.3) scores at 6 h, (1.8±1.2) scores vs. (2.1±1.3) scores at 24 h, and (1.5±0.7) scores vs. (1.5±0.7) scores at 48 h after surgery] between the experimental group and the control group (all P > 0.05). The incidence of postoperative early cognitive decline [4.9% (2/41) vs. 22.5% (9/40)], nausea and vomiting after surgery [7.3% (3/41) vs. 25.0% (10/40)] in the experimental group was lower than that in the control group, and the difference was statistically significant ( χ2 values were 5.36, 4.70; P values were 0.021, 0.030, respectively). Conclusions:The application of oxycodone during laparoscopic surgery can meet the needs of perioperative analgesia and improve the postoperative early cognitive function of elderly patients with colorectal cancer.

BACKGROUND:Adolescent lumbar disc herniation is the main cause of low back pain in adolescents. At present,most of them are treated by conservativetreatment. When long-term non-surgical treatment attempts,surgery may be necessary to prevent further injury when the patient's symptoms are notsufficiently relieved or when the patient has symptoms of single nerve paralysis or compression of the cauda equina,it is very important to choose a suitable interbody fusion device for the surgical treatment of the patients.OBJECTIVE:To explore the effects of minimally invasive interbody fusion with different heights on lumbar biomechanics in patients with adolescent lumbar disc herniation.METHODS:CT scans of a 17-year-old male patient with adolescent lumbar disc herniation (L4-5 segment herniation) were collected. After the three-dimensional reconstruction of MIMICS,the interbody fusion device equal to and 3 mm higher than the intervertebral space was selected for analysis,so two expandablemixed material interbody fusion devices were designed and reconstructed. Fusion device L:11 mm high front,9 mm high posterior,9 mm wide,28 mmlong,and fusion device H:14 mm high front,11 mm high posterior,11 mm wide,28 mm long and the lumbar fusion device was modeled. The fusion deviceand lumbar spine model were optimized,inversely modeled,and then imported into ABAQUS,and finally the 3D model of lumbar fusion was obtained.The physiological activities of the human body were simulated,such as lumbar extension,forward bending,right bending,and left bending,to obtain thecorresponding stress contours. The biomechanical characteristics of the L4-5 vertebra under seven different working conditions were observed.RESULTS AND CONCLUSION:(1) The maximum stress of the two kinds of fuses was in the condition of forward bending and backward extension,the stress value of H fuses was (18.27±3.80) Mpa and (15.02±3.24) Mpa;the stress value of L fuses was (9.16±0.05) Mpa and (9.17±1.83) Mpa. The stress values of the end plate of the H-fusion in the extension station were (19.11±4.03) Mpa and (16.32±3.72) Mpa respectively. The stress values of the L-fusion end plate were (9.13±0.01) Mpa and (4.92±1.01) Mpa respectively. (2) The stress of H-type fusing end plate was higher than that of L-type fusing end plate except for L-5 end plate at neutral position (P<0.05). (3) Choosing an interbody fusion device with a height of more than 3 mm in the same intervertebral space has a more stable biomechanics.

BACKGROUND:Adolescent lumbar disc herniation is the main cause of low back pain in adolescents. At present,most of them are treated by conservativetreatment. When long-term non-surgical treatment attempts,surgery may be necessary to prevent further injury when the patient's symptoms are notsufficiently relieved or when the patient has symptoms of single nerve paralysis or compression of the cauda equina,it is very important to choose a suitable interbody fusion device for the surgical treatment of the patients.OBJECTIVE:To explore the effects of minimally invasive interbody fusion with different heights on lumbar biomechanics in patients with adolescent lumbar disc herniation.METHODS:CT scans of a 17-year-old male patient with adolescent lumbar disc herniation (L4-5 segment herniation) were collected. After the three-dimensional reconstruction of MIMICS,the interbody fusion device equal to and 3 mm higher than the intervertebral space was selected for analysis,so two expandablemixed material interbody fusion devices were designed and reconstructed. Fusion device L:11 mm high front,9 mm high posterior,9 mm wide,28 mmlong,and fusion device H:14 mm high front,11 mm high posterior,11 mm wide,28 mm long and the lumbar fusion device was modeled. The fusion deviceand lumbar spine model were optimized,inversely modeled,and then imported into ABAQUS,and finally the 3D model of lumbar fusion was obtained.The physiological activities of the human body were simulated,such as lumbar extension,forward bending,right bending,and left bending,to obtain thecorresponding stress contours. The biomechanical characteristics of the L4-5 vertebra under seven different working conditions were observed.RESULTS AND CONCLUSION:(1) The maximum stress of the two kinds of fuses was in the condition of forward bending and backward extension,the stress value of H fuses was (18.27±3.80) Mpa and (15.02±3.24) Mpa;the stress value of L fuses was (9.16±0.05) Mpa and (9.17±1.83) Mpa. The stress values of the end plate of the H-fusion in the extension station were (19.11±4.03) Mpa and (16.32±3.72) Mpa respectively. The stress values of the L-fusion end plate were (9.13±0.01) Mpa and (4.92±1.01) Mpa respectively. (2) The stress of H-type fusing end plate was higher than that of L-type fusing end plate except for L-5 end plate at neutral position (P<0.05). (3) Choosing an interbody fusion device with a height of more than 3 mm in the same intervertebral space has a more stable biomechanics.

Objective:To evaluate the efficacy and safety of intrasaccular flow disruptor in wide-necked intracranial aneurysms.Methods:One hundred and seventeen patients with wide-necked intracranial aneurysms treated with intrasaccular flow disruptor were collected from Department of Neurointervention (First Affiliated Hospital of Zhengzhou University), Department of Neurosurgery (Beijing Tiantan Hospital, Capital Medical University), Department of Cerebrovascular Surgery, Neurosurgery Center (Zhujiang Hospital, Southern Medical University), and Department of Neurosurgery (First Affiliated Hospital of Harbin Medical University) from August 2022 to March 2024. Raymond-Roy Occlusion Classification (RROC) was employed to evaluate aneurysm embolization immediately after procedure; cranial CT or MRI within 48 hours of embolization were performed to identify any new intracranial hemorrhage, subarachnoid hemorrhage, or new symptomatic cerebral infarction related to the intracranial aneurysms. Modified Rankin Scale (mRS) was used to assess the neurological function at discharge. Imaging follow-up and outpatient follow-up were performed at 6 months after embolization to evaluate the aneurysm occlusion degree and complications.Results:A total of 117 intrasaccular flow disruptors were implanted in 117 patients, with a technical success rate of 100%; 115 patients (98.3%) enjoyed successful one-time release of their disruptors, and 2 patients (1.7%) required retrieval and redirection of the disruptors before second successful attempt. Flow disruptor plus stent was performed in 13 patients (11.1%). Immediately after procedure, RROC grading I was noted in 3 patients, grading II in 51 patients and grading III in 63 patients. Cranial CT or MRI within 48 hours of embolization indicated no new intracranial hemorrhage, subarachnoid hemorrhage, or symptomatic cerebral infarction related to the intracranial aneurysms. All patients had mRS score of 0 at discharge. Eighty-three patients completed a 6-month follow-up (RROC grading I in 41 patients, grading II in 33 patients and grading III in 9 patients), without ischemic or hemorrhagic adverse events.Conclusion:The results of this study preliminarily suggest that intrasaccular flow disruptor is effective and safe in wide-necked intracranial aneurysms.

Objective:To evaluate the efficacy and safety of Neuroform Atlas stent-assisted coil embolization in patients with middle cerebral artery bifurcation aneurysms.Methods:A retrospective analysis was performed; the clinical data of 46 patients with middle cerebral artery bifurcation aneurysms accepted Neuroform Atlas stent-assisted coil embolization in First Affiliated Hospital of Zhengzhou University, Beijing Tiantan Hospital Affiliated to Capital Medical University, First Affiliated Hospital of Harbin Medical University, Zhujiang Hospital of Southern Medical University and First Affiliated Hospital of Chongqing Medical University from January 2022 to March 2024 were collected. There were 28 ruptured aneurysms (60.87%) and 18 unruptured aneurysms (39.13%). Follow-up was performed for more than 3 months; Raymond-Roy grading was used to evaluate the aneurysm embolization immediately after embolization and during follow-up; perioperative hemorrhagic or ischemic complications were recorded; modified Rankin Scale (mRS) was used to evaluate the prognosis of the patients at discharge and during follow-up (mRS score≤2: good prognosis, and mRS score>2: poor prognosis).Results:Coil embolization was successful in all 46 patients. DSA immediately after embolization showed that 41 patients (89.13%) had completely occluded aneurysms (Raymond-Roy grading I), 2 patients (4.35%) had residual aneurysm neck (Raymond-Roy grading Ⅱ) and 3 patients (6.52%) had partially occluded aneurysms (Raymond-Roy grading Ⅲ). Perioperative complications occurred in 5 patients, including 2 with postoperative cerebral infarction, 1 with hydrocephalus, 1 with postoperative pneumonia leading to respiratory failure, and 1 with stent thrombosis during embolization. Both at discharge and 3 months after embolization, 43 patients (93.48%) had good prognosis and 3 patients (6.52%) had poor prognosis. No obvious ischemic complications (such as stent restenosis) or hemorrhagic complications (such as re-rupture of the aneurysms) were found in all patients. Thirty patients (65.22%) had imaging follow-up for 6-12 months: 26 (86.67%) had Raymond-Roy grading I, 3 (10.00%) had Raymond-Roy grading II, and 1 (3.33%) had Raymond-Roy grading III.Conclusion:Neuroform Atlas stent-assisted coil embolization has good short-term efficacy and high safety in middle cerebral artery bifurcation aneurysms, but long-term follow-up observation is still needed to verify its efficacy.

Objective:Persistent proatlantal intersegmental artery (PPIA) is a rare variant of persistent carotid-vertebrobasilar anastomoses and mostly discovered incidentally. To explore the clinical features of PPIA, and enhance the understanding of this rare cerebrovascular variation.Methods:A retrospective analysis was performed. The clinical data of 6 patients with PPIA admitted to Department of Neurointervention, First Affiliated Hospital of Zhengzhou University from June 2018 to June 2024 were analyzed. The imaging features, associated cerebrovascular diseases, treatments and follow-up results were summarized.Results:Among the 6 PPIA patients, 4 were with type I and 2 were with type II; 5 were with left PPIA and 1 patient was with right PPIA; 5 patients had bilateral vertebral artery hypoplasia or absence, and 1 patient had absence of the ipsilateral vertebral artery and normal development of the contralateral vertebral artery. Four PPIA patients were combined with intracranial aneurysms: 2 patients received dual stent-assisted embolization and flow diverter device combined with covered stent implantation, respectively (after 6 months of follow-up, modified Rankin scale score of 0 indicating good prognosis and healed intracranial aneurysms), and the other 2 patients with micro-aneurysms were not treated. One patient was combined with internal carotid artery stenosis and accepted stent placement (good prognosis at 6 months after follow-up). One patient was combined with acute basilar artery tip occlusion and accepted aspiration thrombectomy (died of brain herniation 7 days after thrombectomy).Conclusions:PPIA is often accompanied by vertebral artery developmental abnormalities and prone to have concurrent intracranial aneurysms or ischemic stroke. When performing surgical treatment for cerebrovascular diseases associated with PPIA, PPIA protection to ensure blood supply of the posterior circulation is essential.

Objective:To investigate the effects of oxycodone on perioperative pain and cognitive function in elderly patients with colorectal cancer.Methods:A prospective randomized-controlled trial was conducted. A total of 88 elderly patients with colorectal cancer who underwent elective laparoscopic surgery at Benxi Central Hospital from June 2022 to December 2023 were selected. According to random number table method, all patients were randomly divided to the experimental group and the control group, with 44 cases in each group. Anesthesia in the experimental group was induced with oxycodone 0.2-0.3 mg/kg, intraoperative oxycodone was maintained at 0.1-0.15 mg·kg -1·h -1; oxycodone was intravenously injected with analgesia pump after surgery. In the control group, anesthesia was induced with sufentanil 0.2-0.3 μg/kg, remifentanil was intraoperatively maintained at 0.1-0.3 μg·kg -1·min -1, sufentanil was intravenously injected with analgesia pump after surgery. Blood pressure and heart rate before anesthesia induction (T 0), at tracheal intubation (T 1), at skin incision (T 2), and at extubation (T 3) of both groups were compared; numerical rating scale (NRS) at 30 minutes, 6 h, 24 h, and 48 h after surgery were scored, the confusion assessment method (CAM) and the mini-mental state examination (MMSE) score at day 1, 3, 7 after surgery were used to assess the postoperative early cognitive decline and other adverse reactions. Results:Finally, 81 patients were included in the study. There were 41 cases in the experimental group including 20 males and 21 females with the age of (76±3) years, and 40 cases in the control group including 19 males and 21 females with the age of (75±2) years. There were no statistically significant differences in gender composition, age, body mass index, operative time, intraoperative blood loss (all P > 0.05). There were statistically differences in blood pressure [(91±8) mmHg (1 mmHg = 0.133 kPa) vs. (89±10) mmHg at T 0, (92±9) mmHg vs. (90±8) mmHg at T 2, (93±9) mmHg vs. (92±9) mmHg at T 3] and heart rate [(70± 15) times/min vs.(69±16) times/min at T 0, (68±12) times/min vs. (67±12) times /min at T 2, (70± 15) times/min vs. (69±14) times/min at T 3] between the experimental group and the control group (all P > 0.05). Blood pressure and heart rate [(101±9) mmHg, (83±15) times /min] at T 1 in the experimental group were higher than those in the control group [(93±11) mmHg, (70±17) times /min], and the differences were statistically significant ( t values were 3.73, 3.77; all P < 0.001). There were no statistically significant differences in NRS scores [(2.6±1.2) scores vs. (2.8±1.1) scores at 30 min, (2.8±1.6) scores vs. (2.9±1.3) scores at 6 h, (1.8±1.2) scores vs. (2.1±1.3) scores at 24 h, and (1.5±0.7) scores vs. (1.5±0.7) scores at 48 h after surgery] between the experimental group and the control group (all P > 0.05). The incidence of postoperative early cognitive decline [4.9% (2/41) vs. 22.5% (9/40)], nausea and vomiting after surgery [7.3% (3/41) vs. 25.0% (10/40)] in the experimental group was lower than that in the control group, and the difference was statistically significant ( χ2 values were 5.36, 4.70; P values were 0.021, 0.030, respectively). Conclusions:The application of oxycodone during laparoscopic surgery can meet the needs of perioperative analgesia and improve the postoperative early cognitive function of elderly patients with colorectal cancer.