Objectives:To summarize the disease characteristics of thoracolumbar adhesive spinal arach-noiditis.Methods:The clinical data of 35 patients with thoracoland lumbar adhesive spinal arachnoiditis treated in our hospital from May 2012 to July 2023 were retrospectively analyzed,including 26 males and 9 females,aged 34 to 80 years(56.0±10.4 years).There were 17 cases secondary to thoracolumbar fracture,12 cases of lumbar disc herniation or combined with lumbar spinal stenosis,3 cases of thoracic spinal stenosis,and 3 cases of intradural tumor.14 cases were primarily characterized by persistent burning pain in the trunk or lower limbs,or accompanied by limb spasms.Another 17 cases mainly presented with numbness and weakness.Additionally,13 cases experienced urinary dysfunction,and 4 cases lost the ability to walk.Com-puted tomography myelography(CTM)and MRI were used to determine the location and imaging features of thoracolumbar adhesive spinal arachnoiditis.The treatment plans of patients were recorded,and the visual analogue scale(VAS)for lumbar and leg pain and Oswestry disability index(ODI)were observed before treat-ment,at 3 months after treatment and final follow-up.The McCormick grading was used to assess the recov-ery of patients who underwent surgery at the final follow-up.Results:The lesions were located in the tho-racic spinal cord in 11 cases,the conus medullaris in 7 cases,the cauda equina in 14 cases,and long seg-ments from the thoracic spinal cord to conus medullaris or cauda equina in 3 cases.11 patients received conservative treatment,and the VAS score was 7(7,8)and ODI was 54％(32％,64％).Only 3 patients showed mild alleviation of pain symptoms after conservative treatment,with a final follow-up VAS score of 7(6,8)and an ODI of 50％(32％,64％).24 patients underwent surgical treatment,and 9 of whom showed no significant improvement in symptoms at the final follow-up,with preoperative and final follow-up VAS scores of 8(8,9)and ODI of 72％(60％,85％),and McCormick grade Ⅲ;5 patients had a significant long-term im-provement in symptoms after operation,who could walk independently or with the aid of assistive devices and recovered to some extent in bowel and bladder functions,with preoperative VAS score of 7(6,8)and ODI of 58％(33％,68％)improving to 4(3,4)and 32％(19％,35％)respectively at final follow-up,and McCormick grade Ⅰ;3 patients recovered to grade Ⅰ postoperatively,and worsened to grade Ⅱ between 2 and 6 months;6 patients recovered to grade Ⅰ to Ⅱ postoperatively,with symptoms worsening to preoperative level(grade Ⅲ)between 2 weeks and 2 years;1 patient was implanted with electrical spinal cord stimulation de-vice,who was recovered in symptoms(grade Ⅱ).Conclusions:Conservative treatment for thoracolumbar adhesive spinal arachnoiditis is relatively limited in efficacy.While surgical treatment can achieve significant clinical improvement in some patients,its effects vary significantly among individuals.Some patients show no significant improvement in symptoms after surgery,and there are even cases where symptoms recur or worsen over time.

Objectives:To summarize the disease characteristics of thoracolumbar adhesive spinal arach-noiditis.Methods:The clinical data of 35 patients with thoracoland lumbar adhesive spinal arachnoiditis treated in our hospital from May 2012 to July 2023 were retrospectively analyzed,including 26 males and 9 females,aged 34 to 80 years(56.0±10.4 years).There were 17 cases secondary to thoracolumbar fracture,12 cases of lumbar disc herniation or combined with lumbar spinal stenosis,3 cases of thoracic spinal stenosis,and 3 cases of intradural tumor.14 cases were primarily characterized by persistent burning pain in the trunk or lower limbs,or accompanied by limb spasms.Another 17 cases mainly presented with numbness and weakness.Additionally,13 cases experienced urinary dysfunction,and 4 cases lost the ability to walk.Com-puted tomography myelography(CTM)and MRI were used to determine the location and imaging features of thoracolumbar adhesive spinal arachnoiditis.The treatment plans of patients were recorded,and the visual analogue scale(VAS)for lumbar and leg pain and Oswestry disability index(ODI)were observed before treat-ment,at 3 months after treatment and final follow-up.The McCormick grading was used to assess the recov-ery of patients who underwent surgery at the final follow-up.Results:The lesions were located in the tho-racic spinal cord in 11 cases,the conus medullaris in 7 cases,the cauda equina in 14 cases,and long seg-ments from the thoracic spinal cord to conus medullaris or cauda equina in 3 cases.11 patients received conservative treatment,and the VAS score was 7(7,8)and ODI was 54％(32％,64％).Only 3 patients showed mild alleviation of pain symptoms after conservative treatment,with a final follow-up VAS score of 7(6,8)and an ODI of 50％(32％,64％).24 patients underwent surgical treatment,and 9 of whom showed no significant improvement in symptoms at the final follow-up,with preoperative and final follow-up VAS scores of 8(8,9)and ODI of 72％(60％,85％),and McCormick grade Ⅲ;5 patients had a significant long-term im-provement in symptoms after operation,who could walk independently or with the aid of assistive devices and recovered to some extent in bowel and bladder functions,with preoperative VAS score of 7(6,8)and ODI of 58％(33％,68％)improving to 4(3,4)and 32％(19％,35％)respectively at final follow-up,and McCormick grade Ⅰ;3 patients recovered to grade Ⅰ postoperatively,and worsened to grade Ⅱ between 2 and 6 months;6 patients recovered to grade Ⅰ to Ⅱ postoperatively,with symptoms worsening to preoperative level(grade Ⅲ)between 2 weeks and 2 years;1 patient was implanted with electrical spinal cord stimulation de-vice,who was recovered in symptoms(grade Ⅱ).Conclusions:Conservative treatment for thoracolumbar adhesive spinal arachnoiditis is relatively limited in efficacy.While surgical treatment can achieve significant clinical improvement in some patients,its effects vary significantly among individuals.Some patients show no significant improvement in symptoms after surgery,and there are even cases where symptoms recur or worsen over time.

Objective A preliminary study of the safety and efficacy of the Pipeline embolization device(PED)for the treatment of vertebral artery dissecting aneurysm(VADA).Methods Clinical data of 21 patients with VADA treated with PED in the Department of Neurosurgery of the First Affiliated Hospital of Xinjiang Medical University from January 2019 to June 2023 were retrospectively collected,and the surgical approach,perioperative complications,and imaging results were recorded and followed up.Patients'prognosis was assessed by modified Rankin Scale score(mRS),and Kamran grading was used for imaging follow-up.Results Of the 21 patients,17 had unruptured aneurysms and 4 had ruptured aneurysms.A total of 22 PEDs were placed,of which 13 patients underwent PED placement alone and 8 patients underwent PED combined with coil embolization,with a technical success rate of 100% .Three patients with ruptured aneurysms had combined stenosis proximal to the aneurysm,and 1 patient with>50% stenosis received an additional Solitaire stent for in-stent posterior dilatation.Immediate postoperative Kamran grading was grade 1 in 16 patients,grade 2 in 1 patient,and grade 3 in 4 patients.There were 2 perioperative complications,including postoperative aneurysm rupture in 1 patient and severe pulmonary infection in 1 patient who eventually died.At the time of discharge,15 patients had an mRS score of 1,2 patients had a score of 2,1 patient had a score of 3,1 patient had a score of 4,and 2 patient had a score of 6.Eighteen patients were followed up with a median follow-up time of 12.5(6-30)months,of which 13 patients had an mRS score of 0,4 patients had a score of 1,and 1 patient had a score of 2.There were 2 patients with a Kamran grade of 2,4 patients with a grade of 3,and 12 patients with a grade of 4.Conclusion The surgical success rate and safety of VADA treatment with PED is high,but perioperative complications and postoperative care should not be ignored either and a large number of samples are still needed for further study in the future.

Objective:To explore the clinical efficacy of open-door laminoplasty in treatment of cervical spinal hyperextension injury accompanied with or without spinal cord-canal mismatch.Methods:A retrospective case-control study was performed to analyze the clinical data of 42 patients with cervical spine hyperextension in Shanghai Ninth People’s Hospital，Shanghai Jiaotong University School of Medicine from January 2016 to June 2019. There were 31 males and 11 females at age range of 40-78 years［（59.7 ± 9.9）years］. All patients underwent open-door laminoplasty.Preoperative Japanese Orthopaedic Association score（JOA）was（10.2 ± 3.8）points，and American Spinal Injury Association（ASIA）spinal cord injury score was（260.4 ± 47.5）points. Those with spinal cord occupation rate（SCOR）equal to or more than 70% were classified as spinal cord-canal mismatched group（n=21），and those with SCOR less than 70% were classified as spinal cord-canal matched group（n=21）. ASIA total score，ASIA upper and lower limb motor scores，ASIA sensory score，JOA score，surgical improvement rates and complications were compared between the two groups before operation，at postoperative one week and at the latest follow-up.Results:All patients were followed up for 12-26 months［（19.1 ± 2.3）months］. Both groups had significantly improved ASIA total score at postoperative one week and at the latest follow-up，compared with that before operation（ P < 0.05）. The two groups showed no significant difference in ASIA total score at postoperative one week（ P > 0.05）. ASIA total score in unmatched group was（307.6 ± 9.9）points at the latest follow-up，significantly lower than that in matched group［（315.4 ± 8.7）points］（ P < 0.01）. ASIA upper limb motor score in mismatched group was（29.1 ± 7.0）points and（36.6 ± 6.5）points at postoperative one week and at the latest follow-up，significantly lower than that in matched group［（42.0 ± 5.7）points，（47.4 ± 2.5）points］（ P < 0.01），while there was no significant difference in ASIA lower limb motor score and sensory score between the two groups（ P > 0.05）. Both groups showed significantly improved JOA score at postoperative one week and at the latest follow-up，compared with that before operation（ P < 0.05）. JOA score in mismatched group was（11.5 ± 3.0）points and（12.5 ± 3.0）points at postoperative one week and at the latest follow-up，significantly lower than that in matched group［（13.5 ± 2.4）points，（15.0 ± 2.0）points］（ P < 0.01）. Postoperative improvement rate in matched group was 95%（20/21），and was 85%（18/21）in mismatched group（ P < 0.05）. Cervical axial pain occurred in 3 patients in each group and C 5 nerve root palsy in 2 patients in matched group，all of which were relieved after conservative treatment. No implant loosening or breakage occurred during follow-up. Conclusions:Open-door laminoplasty can improve part of the nerve function of patients with cervical hyperextension injury. However，the overall improvement degree of nerve function especially recovery of upper limb motor function in patients with spinal cord-canal mismatch is inferior to those in spinal cord-canal matched patients.

Objective:To investigate the efficacy and safety of endovascular recanalization in the treatment of chronically occluded internal carotid artery (COICA).Methods:From January 2014 to January 2019, patients over 50 years of age with symptomatic COICA underwent endovascular recanalization in the Department of Neurosurgery of the First Affiliated Hospital of Xinjiang Medical University were enrolled retrospectively. The modified Rankin Scale (mRS) was used to evaluate the improvement of neurological function.Results:A total of 19 patients with symptomatic COICA were enrolled, of which 16 (84.21%) were successfully recanalized. None of the patients had severe neurological deficits during the periprocedural period and after procedure. The neurological function of patients with successful recanalization gradually improved over time. The neurological function improved in 4 patients (25.0%) at 24 h after endovascular treatment and 9 (56.3%) at 18 months postprocedural follow-up. The follow-up of CT angiography showed that the internal carotid artery in patients with successful recanalization was unobstructed, and there was no obvious in-stent stenosis.Conclusion:Endovascular recanalization is feasible, safe and effective in patients with symptomatic COICA.

Objective:To investigate the correlation between serum cystatin C (CysC), blood lipids and the risk of intracranial aneurysm (IA) rupture.Methods:Patients with saccular IA admitted to the First Affiliated Hospital of Xinjiang Medical University from December 2017 to May 2019 were enrolled retrospectively. The patients were divided into the ruptured group and the unruptured group. The correlation between CysC, lipids and IA rupture was identified by univariate and multivariate logistic regression analyses. Results:A total of 392 patients were enrolled, including 143 (36.5%) males and 249 (63.5%) females. Two hundred and seventy-eight patients (70.9%) were ruptured IAs, 114 (29.1%) were unruptured IAs. Univariate analysis showed that triglyceride (1.26±0.94 mmol/L vs. 2.12±1.45 mmol/L; t=5.872, P<0.001), apolipoprotein A-Ⅰ (0.95±0.29 g/L vs. 1.08±0.34 g/L; t=3.744, P<0.001 ), CysC (0.63±0.20 mg/L vs. 0.80±0.48 mg/L; t=3.650, P<0.001) level, and the proportions of hypertension (46.8% vs. 61.4%; χ2=6.938, P=0.008), hyperlipidemia (19.4% vs. 48.2%; χ2=32.493, P<0.001) and aneurysm diameter >7 mm (24.4% vs. 41.2%; χ2=11.504, P<0.001) of the ruptured group were significantly lower than those of the unruptured group, while the level of apolipoprotein B was significantly higher than that of the unruptured group (1.07±0.29 g/L vs. 0.99±0.30 g/L; t=2.417, P=0.016). Multivariate logistic regression analysis showed that aneurysm diameter ≤7 mm (odds ratio [ OR] 2.281, 95% confidence interval [ CI] 1.342-3.876; P=0.002), and the serum levels of triacylglycerol ( OR 0.484, 95% CI 0.333-0.705; P<0.001), apolipoprotein A-Ⅰ ( OR 0.248, 95% CI 0.105-0.587; P=0.002) and CysC ( OR 0.130, 95% CI 0.038-0.444; P=0.001) were significantly independently correlated with the risk of IA rupture. Conclusions:CysC, apolipoprotein A-Ⅰ and triacylglycerol are protective markers for IA rupture, and aneurysm diameter ≤7 mmis associated with IA rupture.

BACKGROUND:Matrix protein is an essential component of the vascular wal , provides a necessary frame for the integrity of the vessel wal and physiological function of vascular wal cel s, and regulates cel s and smooth muscle. OBJECTIVE:To construct rat model of early aneurysm, and to evaluate differences in the expression of matrix structural proteins during cerebral aneurysm formation. METHODS:Twenty-eight healthy male Sprague-Dawley rats were randomized into control group (n=8) and model group (n=20). Aneurysm model was established by ligation of the left common carotid artery and right renal artery-induced hypertension in the model group. In the control group, only the left carotid artery bifurcation and bilateral carotid were exposed in rats. Rats in the model group were sacrificed at 15 and 30 days after model establishment. Right anterior cerebral artery in rats and olfactory artery bifurcation received immunohistochemical staining. The expressions of fibronectin,α-smooth muscle actin and col agen III were analyzed. RESULTS AND CONCLUSION:Compared with the control group, no significant difference in fibronectin expression was detected in right anterior cerebral artery and olfactory artery bifurcation in rats of the model group at 30 days after model establishment (P>0.05). However,α-smooth muscle actin and col agen III expressions were significantly reduced (P<0.05). These data confirmed that expression of structural proteins had differences and dynamic changes during early aneurysm formation in rats. Degradation of matrix structural protein in cerebral artery may be one of the key mechanism of aneurysm formation.

Objective To investigate the outcome of endovascular treatment of large or giant intracranial aneu?rysm by long-term angiographic follow-up. Methods Clinical data of 72 patients with large or giant intracranial aneu?rysms receiving endovascular treatment were analyzed retrospectively. Thirty aneurysms were treated with coil emboliza?tion alone, 14 with stent-assisted coiling, 15 with covered stent-deployment and 13 with parent artery occlusion. Results complete occlusion was achieved in 10 cases of pure coil embolization, 7 cases of stent assisted coil embolization,11 cas?es of completely covered stent-deployment and,13 cases of parent artery occlusion. The postoperative immediate com?plete embolism rate was 56.9%. Nearly completely occlusion was achieved in 17 cases of pure coil embolization, in 6 cas?es of stent auxiliary coil embolization, 4 cases of covered stent-deloyment and zero case of parent artery occlusion. The total postoperative immediate nearly completely embolism rate was 37.5%. Incomplete occlusion was achieved in 3 cases of pure coil thrombosis, 1 case of stent assisted coil, zero case of ,covered stent-deloyment and zero case of parent artery occlusion. The total immediate postoperative incomplete embolization rate was 5.6%. Patients were followed up for 6 to 72 months, with an average follow-up of 24.2 months . All patients had no bleeding. The total periprocedural complica?tion rate was 9.7%and there were no death cases. The recurrence of aneurysm in pure spring coil embolization treatment was higher compared with other treatments. The overall recurrence rate was 23.6%. The recurrent 14 aneurysms were suc?cessfully treated endovascularly. Conclusions Endovascular embolization treatment of intracranial large or giant aneu?rysm is safe and effective but its long-term recurrence rate is high. Thus a close follow-up is needed. Endovascular inter?ventional therapy based on the location of aneurysm and shape characteristics can improve treatment effectiveness and re?duce recurrence rate.

Objective To investigate the risk factors of aneurysmal subarachnoid hemorrhage (aneuryismal sub?arachnoid hemorrhage, aSAH) vasospasm (cerebral vasospasm, CVS) and provide the basis for the clinical prevention and treatment of CVS. Methods A retrospective analysis of clinical data was conducted on 255 cases aSAH patients receiving treatment between March 2012 and March 2014 in First Affiliated Hospital of Xinjiang Medical University Department of Neurosurgery, s treated. The clinical data included admission age, gender, ethnicity, history of hypertension, smoking his?tory, arterial tumor site, improved Fisher grading, admission Hunt-Hess grade, the dosage of Nimodipine, dehydrating agent, white blood cell count, blood glucose, blood lipids, blood calcium levels, platelet count. Univariate analysis and multivariate Logistic retrospective analysis were used to analyze the association between above-mentioned factors and the occurrence of CVS. Results A total of 73 cases developed CVS after aSAH and incidence rate of CVS was 28.6%. Uni?variate analysis showed that there were significant differences between patients with and without CVS in history of hyper? tension, smoking history, improved Fisher grade, admission Hunt-Hess grade, small doses of nimodipine, white blood cell count and blood glucose (P<0.05). The Logistic regression analysis showed that the history of hypertension, smoking history, improved Fisher grade, admission Hunt-Hess grade, a small dose of Nimodipine and white blood cell count were risk factors of CVS after aSAH (P<0.05). Conclusions the History of hypertension, smoking history, improved high Fish?er grade, high admission Hunt-Hess grade are independent risk factors of CVS after aSAH. A small dose of Nimodipine is a protective factor while increase in white blood cell count is a risk predictor, which should be controlled by enhancing clinical prevention.

Objective To investigate the effect of prosthetic replacement for senior patients with unstable intertrochanteric fractures of the femur.Methods Fifty-three senior patients with comminuted intertrochanteric fracture of the femur were subjected to total hip arthroplasty (n =23) and bipolar artificial femoral head replacement (n =30).Uncemented long-stem prostheses were used in 50 patients and cemented long-stem prostheses in 3.Time interval between admission and surgery was 3-13 days (mean 6 days).Results The total hip arthroplasty had the operation time for mean 90 minutes (range,80-110 minutes) and blood loss for mean 350 ml (range,260-410 ml).While the hemiarthroplasty had operation time for mean 65 minutes (range,50-90 minutes) and blood loss for mean 230 ml (range,180-290 ml).Fifty-one patients were available to mean 49.6-month follow-up (range,13-65 months).Four patients presented with frequent hip pain at a tolerable level after hemiarthroplasty and the symptom was relieved after oral non-steroidal anti-inflammatory drug therapy.One patient with postoperative infection was cured by timely debridement.Seven patients were died of heart and brain disorders in 5 years,with no relation to surgical complications.The period for fracture healing was mean 10 months,with excellence rate of 96％ for hip function but with no acetabulum abrasion,implant loosening or submersion.Conclusion Early prosthetic replacement is an effective treatment for unstable intertrochanteric femoral fractures in the elderly.