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Study on the treatment of severe hypertensive cerebral hemorrhage by the operation with integrative needle and drill

Chinese Journal of Postgraduates of Medicine.2009;32(35):28-31. doi:10.3760/cma.j.issn.1673-4904.2009.35.010

Objective To observe the effect of severe hypertensive cerebral hemorrhage with minimally invasive technology. Method Fifty patients of severe hypertensive cerebral hemorrhage treated by minimally invasive puncture combined early systemic rehabilitation (treatment group), and 49 patients with conventional treatment as control group. Results (1)The survival number were 37 cases in treatment group and 28 cases in control group. The survival patients with GCS after 4 weeks in treatment group was significantly higher than that in control group (P < 0.01). (2) FIM score of treatment group and control group on admission [(58±12) scores vs (60±11) scores] and the 14 th day [(64±13) scores vs (62±12) scores] after treatment, there was no significant difference (P > 0.05), but the FIM score of treatment group at the first month [(76±16) scores vs (65±14) scores] and the third month [(90±22) scores vs (69±18) scores] after treatment were significantly superior to eontrol group (P < 0.05). (3) NIHSS score of treatment group and control group on admission were (17.5±3.5) scores and (16.9±3.4) scores (P > 0.05), the NIHSS score of treatment group at the 14th day,the first month and the third month were significantly superior to control group [(14.3±3.3) scores vs (16.2±3.5) scores, (12.1±2.4) scores vs (15.7±3.4) scores, (9.0±3.4) scores vs(12.2±23.6) scores, respectively] (P< 0.05). Conclusion The treatment of severe hypertensive cerebral hemorrhage with minimally invasive percutaneous is safe and effective, the effect is superior to conventional medical treatment.

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Comparison between microinvasive puncture and small bone window craniotomy in the treatment of moderate cerebral hemorrhage

Wenxue WANG ; Jun WANG ; Dezhong ZHAI ; Yuliang LIU ; Dianqin SHI ; Guanghui FU ; Fengli LI

Chinese Journal of Postgraduates of Medicine.2009;32(35):7-10. doi:10.3760/cma.j.issn.1673-4904.2009.35.003

Objective To evaluate and compare the curative effect between the microinvasive craniopuncture therapy and the clearance of hematoma by craniotomy with small bone flap in treating patients with moderate cerebral hemorrhage (30-60 ml)in the basal ganglion part of the brain. Methods Ninety-five patients with intracerebral hemorrhage were randomly divided into treatment group (microinvasive craniopuncture therapy) and control group (the clearance of hematoma by craniotomy with small bone flap). The main indexes of evaluation were the neurological impairment degree (NID) on the 14th day after treatment, activities of daily living (ADL) by the end of the third month, the incidence rate of complications, and the case fatality during 3 months. Results On the 14th day after treatment, there was no significant difference between the two groups in the NID and the ADL of patients. The incidence rate of respiratory tract infection, gastrointestinal hemorrhage, electrolyte disorder in treatment group [16.33% (8/49), 6.12% (3/49), 6.12% (3/49), respectively] was significantly reduced than those of control group [56.52% (26/46), 21.74%(10/46), 21.74% (10/46),respectively] during hospitalization (P < 0.05). By the end of the third month, there was significant difference in favorable outcomes (Barthel index 95-100) (χ~2 = 18.7524,P =0.0009) and in improving the ADL (MRS)(t =5.2723,P =0.0001) between the two groups [39.13% (18/46), 4.65% (2/43),respectively]. In ease fatality, there was no significant difference between the two groups [6.12% (3/49),6.52% (3/46),respectively]. Conclusion As compared with the clearance of hematoma by craniotomy with small bone flap, the microinvasive craniopuncture therapy can remarkably reduce the incidence of complications, and improve the ADL of patients with moderate cerebral hemorrhage (30-60 ml) in the basal ganglion, and decrease disability without increasing fatality.

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Correlative analysis of secondary brain injury in high-risk factors and brain malignant encephalocele during surgical operation for severe traumatic brain injury

Zhen CHEN ; Aimin LI ; Xiguang LIU ; Ning LI ; Shiwei YAN ; Kui MA ; Hui ZHOU ; Yongben XIA ; Qiang LUO

Chinese Journal of Postgraduates of Medicine.2009;32(35):1-3. doi:10.3760/cma.j.issn.1673-4904.2009.35.001

Objective To explore the effect of secondary brain injury(SBI) in high-risk factors and brain malignant encephaiocele during surgical operation for severe traumatic brain injury. Methods Carried on the grouping graduation to 112 patients with severe traumatic brain injury according to SBI's high-risk factors:non-high-risk factors group (pure group) 23 cases, high-risk factors group (SBI group) 89 cases, 1 level of high-risk factors group had 27 cases, 2 level of high-risk factors group had 28 cases, 3 level of high-risk factors group had 34 cases. Results Carried on the comprehensive therapy regarding the above patients, the brain malignant encephalocele rate in the SBI group and the pure group was 59.55% (53/89) and 13.04%(3/23) respectively, there was significant statistics differences in the two groups,1 level and 2 level of high-risk factors group of brain malignant encephalocele rate was 40.74% (11/27) and 53.57% (15/28) respectively, the difference was not obvious statistics significance, 2 level and 3 level of high-risk factors group of brain malignant eneephalocele rate was 53.57%(15/28) and 79.41%(27/34) respectively, the difference was obvious statistics significance. Conclusions The SBI's high-risk factors are the important factors affecting severe craniocerebral injury encephalocele. Taking adequate pre-operative assessment, carrying a comprehensive treatment on the patients combine with high-risk factors of SBI can greatly reduced the incidence of brain malignant encephalocele during surgical operation if the high-risk factors of SBI is controlled.

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The value of configuration of the fourth ventricle to indicate surgical treatment in patients with spontaneous cerebellar hemorrhage

Jianqiang XU ; Xin HUANG ; Yongdong SUN

Chinese Journal of Postgraduates of Medicine.2009;32(35):31-33. doi:10.3760/cma.j.issn.1673-4904.2009.35.011

Objective To study the value of configuration of the fourth ventricle to indicate, surgical treatment in patients with spontaneous cerebellar hemorrhage. Methods The data of 52 patients with spontaneous cerebellar hemorrhage were retrospectively analyzed. The relationship between configuration of the fourth ventricle and consciousness, volume of the hematoma, frequence of hydrocephalus and incidence of deterioration of consciousness was investigated. Results The correlations between the degree of the fourth ventricular compression and the consciousness, the volume of the hematoma were strong (r= -0.881,P <0.01; r=0.808,P < 0.01, respectively). The more the degree of the fourth ventricular compression was severe,the more GCS score was low and the volume of the hematoma was large. The incidence of hydrocephalus in patients with composed the fourth ventricle[57.7%(15/26)] was significantly higher than that in patients with normal configuration of the fourth ventricle [16.7% (3/18)] (χ~2= 7.406, P < 0.01). The incidence of deterioration of consciousness in patients with compressed the fourth ventricle who accepted conservative therapy initially [72.7% (8/11)]was significantly higher than that in patients with normal configuration of the fourth ventricle [12.5%(2/16)] (P= 0.003). Conclusions The configuration of the fourth ventricle is an useful indicator for surgical treatment in patients with spontaneous cerebellar hemorrhage. When making decision whether surgical treatment was used or not in patients with spontaneous cerebellar hemorrhage, the configuration of the fourth ventricle should be take into account.

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Application value of susceptibility weighted imaging in brain vascular malformations

Dawei REN ; Yongmeng ZHU ; Guoping HUANG ; Jialing KONG

Chinese Journal of Postgraduates of Medicine.2009;32(35):20-22. doi:10.3760/cma.j.issn.1673-4904.2009.35.007

Objective To discuss the clinical value of susceptibility weighted imaging (SWI) in the brain vascular malformations. Methods Imaging data of 34 patients with brain vascular malformations proved by digital subtraction angiography (DSA) or pathology obtained on Siemens Sonata 1.5T MR system were studied prospectively, and compared with those of conventional MRI (cMRI) and SWI. Results All 41 lesions of 34 patients with brain vascular malformations showed clearly by SWI. These patients were diagnosed by surgical findings or DSA. These nidus comprised 19 cavernous angiomas, 9 arteriovenous malformations and 6 cerebral venous malformations. Conclusion SWI should be used for clinical diagnosis of brain vascular malformations, and providing more complete and detailed information combining with other sequence.

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Multi-segmental cervical spondylotic myelopathy with anterior or posterior joint surgery before and after the clinical efficacy and complications

Moxue WANG ; Jianjie GE ; Jinna WANG ; Guofeng BI

Chinese Journal of Postgraduates of Medicine.2009;32(35):15-19. doi:10.3760/cma.j.issn.1673-4904.2009.35.006

Objective To observe the multi-segmental cervical spondylotic myelopathy with simple anterior or posterior joint pre-and post-operative prognosis of spinal cord function improved and the status, explore co-operation after the clinical efficacy and complications. Methods The clinical data of 298 cases of multi-segmental cervical spondylotic myelopathy with anterior or posterior of the simple pre-and post-joint surgery from January 2001 to January 2008 were retrospectively analyzed. The clinical efficacy, titanium anterior cervical decompression and fusion surgery net implanted titanium plate fixation 121 cases, posterior open-door laminoplasty 112 cases, 65 cases of combined surgery before and after. JOA score line of spinal cord function and somatosensory evoked potential, as compared 3 groups after surgical efficacy. Results All patients were followed-up 1- 7 years, averaged (4.7±1.4) years. The anterior cervical decompression and fusion surgery titanium mesh implanted titanium plate fixation to improve the rate was 78.1%, excellent and good rate was 72.7%(88/121). Posterior open-door laminoplasty to improve the rate was 70.6%, excellent and good rate was 66.1% (74/112), there was statistically significant between them (P < 0.05). After anterior surgery, improving rate was 86.7%, excellent and good rate was 83.1% (54/65). Anterior and posterior combined surgery before and after comparison was significant (P < 0.05), regardless of near-term results, long-term effects were better than that of anterior or posterior surgery. Conclusions The spinal cord in the treatment of multi-segmental operation of cervical spondylosis after anterior surgery is obviously superior to the efficacy of anterior or posterior surgery alone. Spinal stability anterior, posterior, after a joint operation before the lower one by one.

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Approach on diagnosis and treatment of acute infrarenal abdominal aortic occlusion

Bin LIU ; Changjun YU ; Huagang ZHU ; Yusheng YE ; Shengyun WAN ; Haiping SONG

Chinese Journal of Postgraduates of Medicine.2009;32(35):13-15. doi:10.3760/cma.j.issn.1673-4904.2009.35.005

Objective To discuss rational diagnosis and treatment of acute infrarenal abdominal aortic occlusion. Methods Retrospective analysis was made on 6 cases with acute infrarenal abdominal aortic occlusion from January 2005 to December 2008. Emergency operations of retrograde catheter were done on 3 cases, 2 cases received transaortic embolectomy, 1 case received anticoagulation therapy successfully. Results Two cases were cured, 2 cases with 3 legs received amputation, 2 cases died. The time in hospital was 4 hours to 122 days, averaged (24±55) days. Conclusions A prompt thrombolytic, anticoagulation therapy and operation are suggested. It is emphasized to prevent reperfusion injury after arterial ischemia during the peri-and post-operation. Conservative treatment may be used in the patients incorporated with seriously multiple organ failure.

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A control study on functional magnetic resonance imaging brain map in health adult undergoing clenching and relaxing the fist

Shaoqin ZHENG ; Dong WANG ; Yankai XU ; Bo YUAN ; Qiulin WU ; Zhuangwei XIAO

Chinese Journal of Postgraduates of Medicine.2009;32(35):4-6. doi:10.3760/cnm.j.issn.1673-4904.2009.35.002

Objective To observe the characteristic of the functional magnetic resonance imaging (fMRI) brain map in health adult undergoing clenching and relaxing the fist, for exploring the essence of the fMRI brain map in patients suffering from motor dysfunction by cerebrovascular accidents. Methods Twelve healthy volunteers had been chosen to partake the experience. Everyone had accomplished the following three actions separately: (1) Only clenching and relaxing the fist of left hand. (2) Only clenching and relaxing the fist of right hand. (3) Clenching and relaxing the fist of both hands at one time. The data had been analyzed statistically using analysis of functional neuroimages (AFNI) software. Results Under condition of F (6,1121), P = 0.005. Only clenching and relaxing the fist of left hand had gained the following brain functional area: right precentral gyms, left parietal,right superior temporal gyrus,right parietal, right parahippocampal gyrus, right superior frontal gyrus, right medial frontal gyrus, left precuneus, right superior parietal lobule, right middle frontal gyrus, left superior frontal gyrus. Only clenching and relaxing the fist of right hand had gained the following brain functional area: left precentral gyms, left postcentral gyrus right parietal, right medial frontal gyrus. Clenching and relaxing the fist of beth hands simultaneously had gained the following brain functional area: left precentral gyms,left postcentral gyrus, right precentral gyrus, right postcentral gyrus. Conclusions Hand movement (clenching and relaxing the fist) has its own specific brain activated areas. The brain areas activated by clenching and relaxing the fist of both hands simultaneously concentrate in the motor area of both cerebral hemisphere. The brain areas activated by clenching and relaxing the fist of single hand contain not only the motor area, but also the supplementary motor area. As compared with the right handedness, the brain areas activated by clenching and relaxing the fist of left hand is more widespread.

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Treatment of carotid atherosclerosis stenosis with eversion carotid endarterectomy

Dong CHEN ; Junwei SHI ; Zhiqun WU ; Xiaolei LENG ; Wende XIONG

Chinese Journal of Postgraduates of Medicine.2009;32(35):26-28. doi:10.3760/cma.j.issn.1673-4904.2009.35.009

Objective To evaluate the clinical value of eversion carotid endarterectomy in patients with carotid atherosclerosis stenosis. Method Summarized the clinical data of 20 patients who accepted eversiou carotid endarterectomy from March 2009 to August 2009, compared the outcomes with preoperative and postoperative image learnt materials and clinical symptoms. Results All cases finished successfully. All clinical symptoms were improved after operation. The stenosis were all improved completely on the image after operation. Conclusions Eversion carotid endarterectomy is safe, effective, and shortening operative time and hospitalization time. It has low restenosis rate, thicken endometrium and plaque can be stripped completely.

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Microsurgical treatment of epilepsy induced by the medial temporal lobe lesion

Deming XU ; Jiwen XU ; Fengqiang LIU ; Jiadong QIAN ; Yifeng RUI

Chinese Journal of Postgraduates of Medicine.2009;32(35):23-25. doi:10.3760/cma.j.issn.1673-4904.2009.35.008

Objective To evaluate the surgical effect of the surgical removal of both medial temporal lobe lesion and hippocampus amygdala for treating epilepsy. Methods Retrospectively analyzed 18 cases of epilepsy induced by the medial temporal lobe lesion and their hippocampal epileptic discharge was recorded by the deep electrode. Removed both medial temporal lobe lesion and hippocampus amygdala through medial temporal gyrus by modified pterional approach. The lesion had been totally removed in all of these 18 cases in naked eye. Evaluated the effect of surgery for epilepsy by Engel grading scale. Results These cases were followed up for average 2.8 years. Engel Ⅰ for 13 cases, Engel Ⅱ for 4 cases, Engel Ⅲ for 1 cases, Engel Ⅳ for none after operation. But there were lateral 1/4 quadrantanopsia in 2 cases, recent memory decreasing in 3 cases and none of death or any other complication. Conclusion Surgical removal of both medial temporal lobe lesion and hippocampus amygdala is a safe and effective method for treating epilepsy with less complication.

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