Objective To investigate the application of endovascular distal parent artery occlusion in vertebral artery dissecting aneurysms involving the posterior inferior cerebellar artery.Methods The clinical and follow-up data of 5 patients with vertebral artery dissecting aneurysms involving the posterior inferior cerebellar artery who received the endovascular distal parent artery occlusion were retrospectively analyzed.Results Complete occlusion of dissected arterial and aneurysm segments was achieved in 4 patients.After followed up 6-12 months,angiography showed no recurrence or neurological deficit.Continued filling of the dissected aneurysm was observed in 1 patient's follow-up angiography,but without rehaemorrhagia or neurological deficit.Conclusions The endovascular distal parent artery occlusion is a safe and efficient choice for treating vertebral artery dissecting aneurysms involving the posterior inferior cerebellar artery,which keeps the posterior inferior cerebellar artery flowing unobstructed while clipping the dissecting aneurysm.

Objective To investigate the surgical treatment and clinical outcome of patients with intracranial posterior circulation poor-grade aneurysms. Methods The clinical data of 35 patients with intracranial posterior circulation poor-grade aneurysms were collected. Seventeen patients were World Federation of Neurosurgical Societies (WFNS) grade IV and 18 patients were WFNS grade V. Twenty- nine patients were definitively treated with open microsurgery treatment(2 patients) and endovascular treatment (27 patients). Six patients received conservative treatment, including 4 patients only receiving external ventricular drainage to decrease intracranial pressure and 2 patients only receiving medical treatment. The nerve function were evaluated by Glasgow outcome scale (GOS) at discharge from hospital and 1 and 12 months after operation. Results In the patients who received conservative treatment, 5 patients were dead in hospital, and 1 patient got good outcome after 12 months. In the patients who received surgical treatment, at discharge from hospital good outcome were achieved in 15 patients (51.7%), poor outcome in 9 patients (31.0%), and death happened in 5 patients (17.2%). At 1 month after operation, good outcomes were achieved in 14 patients (48.3%), poor outcome in 9 patients (31.0%), and death happened in 6 patients (20.7%). At 12 months after operation, good outcome were achieved in 18 patients (62.1%), poor outcome in 5 patients (17.2%), and death happened in 6 patients (20.7%). Conclusions Patients with posterior circulation poor-grade aneurysms have better prognosis after positive surgical treatment.

Objective To analyze the accuracy,sensitivity and safety of multidetector CT angiography(MDCTA) and DSA;furthermore to explore the clinical value of MDCTA in studying the delayed cerebral vasospasm(DCVS) .Methods Delayed cerebral vasospasm was induced in 17 rabbits by injection of autologuous blood into the cisterna magna and followed by a second injection 24 hours later.MDCTA and DSA were carried out at the 7th day before and after the procedure in order to obtain the data of vascular diameter changes for comparative study.Results The basilar artery diameters detected by MDCTA were shown preoperatively as(1.55 ? 0.14) mm and postoperatively as(0.95 ? 0.20) mm;and detected by DSA as(1.61 ? 0.19) mm and(1.00 ? 0.17) mm postoperatively;showing statistically equivalence between the two methods.Conclusions MDCTA is recommended as a reliable,rapid,and minimally invasive diagnostic method,providing a new technique for the delayed cerebral vasospasm research.

Objective To explore the clinical therapeutic efficacy and value of endovascular embolization treatment for Hunt-Hess poor-grade intracranial aneurysms. Methods Eighty-seven patients with Hunt-Hess grade Ⅳ - Ⅴ intracranial aneurysrns were treated with endovascular embolization from May 2001 to February 2010,77 patients were grade Ⅳ and 10 patients were grade Ⅴ. Outcomes were assessed by using the Glasgow outcome scale (GOS). Results Follow-up time was from 3 months to 9 years. The therapeutic efficacy was as following according to GOS: 25 patients were grade Ⅰ , 5 patients were grade Ⅱ , 9 patients were grade Ⅲ , 12 patients were grade Ⅳ ,and 36 patients were grade Ⅴ. There were 55.17%(48/87) favorable outcome rate and 28.74% (25/87) mortality rate in all patients. There were 61.70%(29/47) favorable outcome rate and 25.53%(12/47) mortality rate in early stage treatment patients (diseased within 3 d), otherwise there were 47.50% (19/40) favorable outcome rate and 32.50%(13/40) mortality rate in medium and late stage treatment patients (diseased 3 d or later). There were no statistically significance in favorable outcome rate and mortality rate between them (P > 0.05). All the patients were embolized successfully ,technical complications occurred in 8 patients, 10 patients were found angiographic evidence of vasospasm. Conclusions Endovascular embolization is an effective method for treating Hunt-Hess poorgrade intracranial aneurysms. Early stage treatment is a feasible option because it can improve prognosis by reducing rebleeding and vasospasm.

Objective To study the methods and results of endovascular treatment of posterior inferior cerebellar artery (PICA) aneurysms. Methods Twenty-one patients with PICA aneurysms were treated with endovascular treatment. The locations of aneurysm on PICA were evaluated through the DSA. Eight patients received single coil embolization, 5 received liquid Glue embolization, 2 received coil embolization combined with liquid Glue, 2 received coil embolization assisted with stents, and 4 underwent ocelasion of the parent PICA. Outcome was evaluated with the Glasgow outcome scale (COS). Results There were complete (100%) occlusion in 5 patients, near complete (>90% ) occlusion in 2, and incomplete (85%) occlusion in 1 in single coil embolization. Seven patients with Glue embolization (n = 5 ) or combination with coils ( n = 2 ) exhibited complete ( 100% ) occlusion. There were near complete ( >90% ) occlusion in 2 cases with coil assisted with stents. Complete occlusion of the parent PICA was achieved in 3 patients, and near complete occlusion of PICA in one case. One patient suffered from new neurological deficits, and one patient treated with coils and stents died. None of the patients suffered from re-bleeding. These patients received follow-up during a mean period of (22±8) months. Overall long-term outcome was good ( GOS score 4 or 5 ) in 17 patients, poor ( COS score 2 or 3) in 3, and fatal ( GOS score 1 ) in one case. Conclusions According to the location of aneurysms on PICA, aneurysms can be effectively and safely treated with endovaecular embolization.

Objective To review the three-dimensional characteristics and configuration of cranial base arteries of patients with intracranial berry aneurysms. Methods All the 70 patients with intracranial berry aneurysms (83 cases)were admitted from January to December in 2007. Their images of spiral computer angiography (CT) were presented and analyzed retrospectively. The site, size and figures of aneurysms were recorded, especially the variations of cranial base arteries were analyzed. Results Cerebral anterior communicating artery (ACoA) was the frequent site where aneurysms located. Incidence of ACoA aneurysms was 43.37%(36/83), that of posterior communicating artery (PCoA) was 28.92%(24/83), that of internal carotid artery was 9.64% (8/83), that of middle cerebral artery was 6.02% (5/83), that of A1-A3 was 3.61% (3/83), that of basilar artery was 3.61% (3/83), that of posterior cerebral artery was 2.41% (2/83), that of posterior inferior cerebellar artery was 1.20% (1/83),that of anterior choroidal artery was 1.20% (1/83).The shape of many berry aneurysms was regular. Mutational rate of cranial base arteries among aneurysms were 56.63% (47/83) and ACoA ancurysms with A1 dysplasia rate was 72.22% (26/36). Conclusions The solid shape and vascular variation of intracranial berry aneuryams can be optimally identified by spiral computer angiography. The occurrence of berry aneurysms might be associated with variation of cranial base arteries.

Objective To assess the application of three-dimensional digital subtraction angiography (3D-DSA) in evaluation of ruptured intracranial aneurysm after clipping and to discuss the different variable use of vol-ume rendering(VR), gradient rendering (GR) and maximum intensity projection (MIP). Methods From January 2011 to December 2012 , 88 patients with 92 ruptured intracranial aneurysms were treated with clipping using titani-um clips in our hospital and followed up by both 2D-DSA and 3D-DSA. Residual aneurysms , Clips place, clips and parent arteries and stenosis of parent arteries were evaluated by volume rendering (VR), gradient rendering (GR) and maximum intensity projection (MIP). Results Among 92 clipped aneurysms, 23 residual aneurysms were found by 3D-DSA. Residual aneurysms were recorded according to the Sindou grade: 15 of gradeⅠ, 3 of gradeⅡ, 4 of grade Ⅲand 1 of grade Ⅳ. Three patients of grade Ⅲand 1 of grade Ⅳwith residual aneurysms were retreated by clipping or coiling, and 1 patient of grade Ⅲ was dead with rupture of residual aneurysm. The clips and number of clips were clearly visualized , and relationship between the clips and the aneurysms was well demonstrated by VR, GR and MIP images. VR, GR images showed the remnants clearly. Three-dimensional digital subtraction angiography did not showed accurate details of the stenosis of parent arties which required an analysis of 2D-DSA. Conclusion Three-dimensional digital subtraction angiography can be used for definite evaluation of resid-ual aneurysms after clipping, especially by VR, GR images. It is helpful to manage the residual ruptured aneurysms.

Objective To compare the effectiveness and safety of different intracranial stents assisted coil embolization of intracranial aneurysms and to discuss the selection of different stent assisted embolization of intracranial aneurysm.Methods From 2007 April to 2012 April,118 cases (a total of 128 wide-neck aneurysms) with intracranial aneurysms were analyzed retrospectively.This included the use of 70 neuroform,38 Enterprise,and 20 Solitaire AB stents forthe treatment of intracranial aneurysms.The successful use,aneurysm occlusion at the immediate post-operation,and early period of peri-operative complications were recorded from those clinical data in order to assess the effectiveness and safety of the different intracranial stents,which assisted coil embolization of intracranial aneurysms.Rank sum test and x2 test were used for statistics.Results Three aneurysms assisted with Neuroform stent were planted unsuccessfully,and the Enterprise and Solitaire stents were placed successfully.The embolism results of three stents after immediate postoperative angiography aneurysm: Neuroform stent occlusion rate was 40.0％ (28/ 70),the tumor residual rate was 38.6 ％ (27/70),and the partial embolization rate was 21.4 ％ (15/70) ; The Enterprise stent occlusion rate was 42.1％ (16/38),the tumor residual rate was 36.8 ％ (14/38),and the partial embolization rate was 21.1％ (8/38).The Solitaire AB stent occlusion rate was 40.0 ％ (8/20),the tumor residual rate was 35.0 ％ (7/20),and the partial embolization rate was 25.0 ％ (5/20).There were not significant differences in aneurismal occlusion (H =0.12,P ＞ 0.05).Early peri-operative complications results were: Neuroform stent occurred in 7,Enterprise frame in 4,and Solitaire AB stent occurred in 2.There were no significant differences in the incidence of complications in the early period after coiling (x2 =0,P ＞ 0.05).Conclusions Three kinds of intracranial stents assisted embolization of intracranial aneurysms are applied safely and effectively.The stent may be chosen according to morphology of parent artery and stent biological character.

Antiviral Agents ; adverse effects ; therapeutic use ; Female ; Hepatitis C, Chronic ; complications ; drug therapy ; psychology ; Humans ; Interferon-alpha ; adverse effects ; therapeutic use ; Mental Disorders ; complications ; Middle Aged

Objective To investigate the value of multi-slice computed tomography angiography (MSCTA)in the detection of intracranial micro-aneurysms(aneurysm≤3 mm in maximal diameter, IMA).Methods The clinical history and images of 826 patients with suspected intracranial aneurysms were retrospectively analyzed.All patients underwent MSCTA on 16-slice row CT before hospitalization(from 2 h to 4 d after symtom onset).All intracranial aneurysms were confirmed by digital subtraction angiography (DSA), three-dimensional rotational angiography (3DRA) or surgery.Two independent radiologists assessed all the images.The MSCTA findings were compared with the DSA/3DRA results.The sensitivity, specificity, and accuracy of MSCTA for diagnosis of IMA was calculated.The diagnostic consistency between DSA/3 DRA and MSCTA was determined by Kappa statistics.The prevalence of multiple aneurysms between the group of patients with IMA and the group of patients without IMA was evaluated by Chi-square test Results A total of 889 aneurysms in 788 of the 826 patients were detected.Among them, 706 patients had single aneurysm and 82 patients had multiple aneurysms.No aneurysms were detected in 38 patients.Among the 212 patients who underwent DSA/3 DRA, 271 aneurysms were found and 232 were IMA.MSCTAdetected 229 IMA.There was 1 false-positive finding and 4 false-negative findings by MSCTA.The sensitivity, specificity and accuracy of MSCTA for IMA was 98.3% (228/232), 97.4% (38/39), 98.2% (266/271).There was excellent agreement between two techniques (Kappa=0.927, P<0.05).The prevalence of multiple aneurysms was 21.2% (45/212) in the patient group with IMA and 6.4% (37/576) in the group without IMA.There was statistically significant difference between the two groups (X~2=36.421, P<0.01).Conclusions The detection value of IMA by MSCTA was high.The cutoff level of diameter of intracranial IMA should be adjusted from 4-5 mm to ≤3 mm.