Objective:To investigate the relevant factors for rupture of basilar tip aneurysms.Methods:This is a retrospective cohort study. Patients who underwent cerebrovascular digital subtraction angiography at Department of Cerebrovascular Disease Surgery,Zhujiang Hospital of Southern Medical University from July 2008 to February 2023 and were confirmed to have basilar tip aneurysms were retrospectively analyzed. There were 45 males and 56 females, aged (57.5±10.2) years (range: 36 to 76 years); the maximum diameter of the basilar tip aneurysm ( M(IQR)) was 6.85 (5.79) mm (range: 1.28 to 27.48 mm). Finally, 101 basilar tip aneurysms were included, and divided into two groups based on whether the basilar tip aneurysm ruptured or not. There were 37 cases (36.6%) in the ruptured group and 64 cases (63.4%) in the unruptured group. Data were analyzed using independent t-test, Mann-Whitney U test, chi-square test, or Fisher′s exact test, as appropriate, and predictive factors for rupture of basilar tip aneurysms were explored by Logistic regression analysis. Variance inflation factors was used for analysis of collinearity. Results:The univariate results showed statistically significant differences between the ruptured and unruptured groups in terms of aneurysm neck width, basilar artery diameter, mean diameter of the parental artery, the ratio of neck width to parent artery diameter, aneurysm width and maximum diameter of the aneurysm (all P<0.05). In multivariate analysis, basilar artery diameter ( OR=0.347, 95% CI:0.176 to 0.687, P=0.002), and NRP ( OR=0.366, 95% CI:0.192 to 0.696, P=0.002) were predictive factors for rupture of aneurysms occurring at the basilar tip. There was no multiple covariance between NRP and basilar artery diameter in the analysis of covariance (VIF=1). Conclusion:Smaller basilar artery diameter and smaller NRP are relevant factors for rupture of basilar tip aneurysms.

Objective:To investigate the efficacy and safety of off-label use of flow diverters (FDs) in aneurysms beyond the circle of Willis.Methods:Seventy-one patients with aneurysms beyond the circle of Willis treated with FDs from January 2016 to September 2023 at Department of Cerebrovascular Surgery, Neurosurgery Center (Zhujiang Hospital of Southern Medical University), Department of Neurosurgery (Guangdong Provincial People's Hospital), Department of Neurosurgery (First Affiliated Hospital of Chongqing Medical University), and Department of Neurosurgery (Beijing Tiantan Hospital, Capital Medical University) were selected. The clinical and imaging data of these patients were analyzed retrospectively, and the clinical characteristics, aneurysm characteristics, endovascular treatments, perioperative complications, and clinical and imaging follow-up results were summarized and analyzed.Results:Among the 71 patients, 22 (31.0%) had ischemic stroke history and 43 (60.6%) had hypertension history. A total of 76 aneurysms were found, including 5 aneurysms (6.6%) at the anterior communicating artery, 10 (13.2%) at the anterior cerebral artery, 53 (69.7%) at the middle cerebral artery, and 8 (10.5%) at the posterior cerebral artery. The median aneurysm size (Inter Quartile Range) was 5.65 (3.63, 10.12) mm, and mean diameter of the parent artery was (2.70±0.57) mm. A total of 80 FDs were used, including 38 (47.5%) Pipeline embolization devices and 42 (52.5%) Tubridge embolization devices; the implantation success rate was 98.8% (79/80). Seven patients (9.9%) had perioperative complications, of which 2 (2.8%) were permanent (1 patient with visual field defect and 1 patient with intracranial hemorrhage). Seventy-one patients had clinical follow-up for (19.73±11.90) months, of which 68 patients (95.8%) had good outcome (modified Rankin scale score of 0-2), 10 patients (14.1%) had ischemic complications, and one patient (1.4%) had hemorrhage complications. Sixty-seven aneurysms (88.2%) underwent angiographic follow-up for 7 (6-12) months, of which 44 aneurysms (65.7%) were completely occluded and 10 (14.9%) had in-stent stenosis.Conclusion:The results of this study preliminarily confirm that off-label use of FDs is relatively safe and effective in aneurysms beyond the circle of Willis.

Objective:To investigate the safety and efficacy of Pipeline embolization device (PED) Shield in intracranial unruptured saccular aneurysms.Methods:This is a retrospective cohort study; 124 patients with intracranial unruptured saccular aneurysms treated with PED Shield at Department of Cerebrovascular Surgery, Neurosurgery Center, Zhujiang Hospital, Southern Medical University from July 2023 to October 2024 were enrolled. Intraoperative device-related complications and occurrence of hemorrhagic and ischemic complications within 30 days of the procedure were recorded. The clinical results and imaging results (degrees of stent patency and aneurysm occlusion rate) 6 months after follow-up were statistically analyzed. Modified Rankin scale (mRS) score>2 was defined as poor prognosis in clinical follow-up, and grade D according to O'Kelly Marotta (OKM) classification was considered as complete aneurysm occlusion in imaging follow-up.Results:Eighty-seven females and 37 males, aged (56.44±12.17) years (ranging from 27 to 80 years) were enrolled, with a maximum aneurysm diameter of 5.12 (3.73, 7.24) mm. Among the 124 patients, incidence of intraoperative instrument-related complications was 6.5% (8/124); and within 30 days of the procedure, incidence of ischemic complications was 4.8% (6/124) and that of hemorrhagic complications was 1.6% (2/124). Eighty-four patients had a 6-month clinical follow-up, with 1 patient (1.2%) having poor prognosis. Eighty-four patients (67.7%) completed a 6-month imaging follow-up: complete occlusion rate of aneurysms was 82.1% (69/84), incidence of in-stent stenosis (stenosis degree ≥25%) was 4.8% (4/84), and no symptomatic in-stent stenosis was found.Conclusion:Result of this study shows that PED Shield may be an effective and safe clinical option for intracranial unruptured saccular aneurysms.

Objective:To investigate the efficacy and safety of off-label use of flow diverters (FDs) in aneurysms beyond the circle of Willis.Methods:Seventy-one patients with aneurysms beyond the circle of Willis treated with FDs from January 2016 to September 2023 at Department of Cerebrovascular Surgery, Neurosurgery Center (Zhujiang Hospital of Southern Medical University), Department of Neurosurgery (Guangdong Provincial People's Hospital), Department of Neurosurgery (First Affiliated Hospital of Chongqing Medical University), and Department of Neurosurgery (Beijing Tiantan Hospital, Capital Medical University) were selected. The clinical and imaging data of these patients were analyzed retrospectively, and the clinical characteristics, aneurysm characteristics, endovascular treatments, perioperative complications, and clinical and imaging follow-up results were summarized and analyzed.Results:Among the 71 patients, 22 (31.0%) had ischemic stroke history and 43 (60.6%) had hypertension history. A total of 76 aneurysms were found, including 5 aneurysms (6.6%) at the anterior communicating artery, 10 (13.2%) at the anterior cerebral artery, 53 (69.7%) at the middle cerebral artery, and 8 (10.5%) at the posterior cerebral artery. The median aneurysm size (Inter Quartile Range) was 5.65 (3.63, 10.12) mm, and mean diameter of the parent artery was (2.70±0.57) mm. A total of 80 FDs were used, including 38 (47.5%) Pipeline embolization devices and 42 (52.5%) Tubridge embolization devices; the implantation success rate was 98.8% (79/80). Seven patients (9.9%) had perioperative complications, of which 2 (2.8%) were permanent (1 patient with visual field defect and 1 patient with intracranial hemorrhage). Seventy-one patients had clinical follow-up for (19.73±11.90) months, of which 68 patients (95.8%) had good outcome (modified Rankin scale score of 0-2), 10 patients (14.1%) had ischemic complications, and one patient (1.4%) had hemorrhage complications. Sixty-seven aneurysms (88.2%) underwent angiographic follow-up for 7 (6-12) months, of which 44 aneurysms (65.7%) were completely occluded and 10 (14.9%) had in-stent stenosis.Conclusion:The results of this study preliminarily confirm that off-label use of FDs is relatively safe and effective in aneurysms beyond the circle of Willis.

Objective:To investigate the safety and efficacy of Pipeline embolization device (PED) Shield in intracranial unruptured saccular aneurysms.Methods:This is a retrospective cohort study; 124 patients with intracranial unruptured saccular aneurysms treated with PED Shield at Department of Cerebrovascular Surgery, Neurosurgery Center, Zhujiang Hospital, Southern Medical University from July 2023 to October 2024 were enrolled. Intraoperative device-related complications and occurrence of hemorrhagic and ischemic complications within 30 days of the procedure were recorded. The clinical results and imaging results (degrees of stent patency and aneurysm occlusion rate) 6 months after follow-up were statistically analyzed. Modified Rankin scale (mRS) score>2 was defined as poor prognosis in clinical follow-up, and grade D according to O'Kelly Marotta (OKM) classification was considered as complete aneurysm occlusion in imaging follow-up.Results:Eighty-seven females and 37 males, aged (56.44±12.17) years (ranging from 27 to 80 years) were enrolled, with a maximum aneurysm diameter of 5.12 (3.73, 7.24) mm. Among the 124 patients, incidence of intraoperative instrument-related complications was 6.5% (8/124); and within 30 days of the procedure, incidence of ischemic complications was 4.8% (6/124) and that of hemorrhagic complications was 1.6% (2/124). Eighty-four patients had a 6-month clinical follow-up, with 1 patient (1.2%) having poor prognosis. Eighty-four patients (67.7%) completed a 6-month imaging follow-up: complete occlusion rate of aneurysms was 82.1% (69/84), incidence of in-stent stenosis (stenosis degree ≥25%) was 4.8% (4/84), and no symptomatic in-stent stenosis was found.Conclusion:Result of this study shows that PED Shield may be an effective and safe clinical option for intracranial unruptured saccular aneurysms.

Objective:To investigate the relevant factors for rupture of basilar tip aneurysms.Methods:This is a retrospective cohort study. Patients who underwent cerebrovascular digital subtraction angiography at Department of Cerebrovascular Disease Surgery,Zhujiang Hospital of Southern Medical University from July 2008 to February 2023 and were confirmed to have basilar tip aneurysms were retrospectively analyzed. There were 45 males and 56 females, aged (57.5±10.2) years (range: 36 to 76 years); the maximum diameter of the basilar tip aneurysm ( M(IQR)) was 6.85 (5.79) mm (range: 1.28 to 27.48 mm). Finally, 101 basilar tip aneurysms were included, and divided into two groups based on whether the basilar tip aneurysm ruptured or not. There were 37 cases (36.6%) in the ruptured group and 64 cases (63.4%) in the unruptured group. Data were analyzed using independent t-test, Mann-Whitney U test, chi-square test, or Fisher′s exact test, as appropriate, and predictive factors for rupture of basilar tip aneurysms were explored by Logistic regression analysis. Variance inflation factors was used for analysis of collinearity. Results:The univariate results showed statistically significant differences between the ruptured and unruptured groups in terms of aneurysm neck width, basilar artery diameter, mean diameter of the parental artery, the ratio of neck width to parent artery diameter, aneurysm width and maximum diameter of the aneurysm (all P<0.05). In multivariate analysis, basilar artery diameter ( OR=0.347, 95% CI:0.176 to 0.687, P=0.002), and NRP ( OR=0.366, 95% CI:0.192 to 0.696, P=0.002) were predictive factors for rupture of aneurysms occurring at the basilar tip. There was no multiple covariance between NRP and basilar artery diameter in the analysis of covariance (VIF=1). Conclusion:Smaller basilar artery diameter and smaller NRP are relevant factors for rupture of basilar tip aneurysms.

Vertebrobasilar dolichoectasia is a rare and challenging disorder. Vertebrobasilar dolichoectasia is closely related to enzyme action and hemodynamic changes, and is characterized by ischemic stroke, neurological compression symptoms, hydrocephalus, and other clinical symptoms. With development of interventional techniques and materials in recent years, endovascular treatment of vertebrobasilar dolichoectasia has become the focus. This article summarizes the current endovascular treatment of vertebrobasilar dolichoectasia, aiming to provide references for clinicians.

Objective:To investigate a new method for the reconstruction of hemifacial microsomia by sagittal osteotomy of the affected mandibular outer cortex combined with bone graft of mandibular outer cortex from healthy side.Methods:From March 2006 to March 2023, the clinical data of patients with hemifacial microsomia admitted to the Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences were analyzed retrospectively. Preoperative diagnosis and surgical design were performed based on clinical manifestations and imaging findings. All cases were operated under general anesthesia. The affected mandibular outer cortex was previously split by an intraoral approach, and then the mandibular outer cortex of appropriate shape and size on the healthy side was harvested and grafted into the split bone space according to the preoperative design, following by internal rigid fixation. Complications, facial appearance improvement, and patient satisfaction were followed up. Photographs were taken preoperative, immediately postoperative and at the long-term(last) postoperative follow-up, and the severity of the deformity was analyzed. CT data from preoperative, immediate postoperative, and long-term follow-up visits were imported into Surgicase Proplan medical three-dimensional image workstation in Dicom format. The mandible was reconstructed using Segmentation, and the thickness of the mandible was measured during pre-operative, immediate post-operative and long-term follow-up visits. Anova with repeated measurement design was used to compare measurements and LSD test was used for multiple comparisons. The Kruskal-Wallis rank sum test were used to statistically analyze malformation severity. P< 0.05 is considered statistically significant. Results:A total of 39 patients were included in this study, including 13 females and 26 males, with an average age of (22.21±4.57) years (15-27 years). All patients were followed up for an average of (45.56±39.41) months (6-153 months) after surgery. The grafted mandibular outer cortex grows well with the adjacent bone tissue, and the mandibular angle and mandibular body are significantly wider. Of the 39 cases, 1 developed an infection 1 year after surgery, the titanium plate was exposed, and the patient healed after debridement and removal of the immobilizing splint. The facial appearance of the other patients improved significantly. Preoperative, immediate postoperative and long term follow up of mandibular thickness measurements were compared in pairs, and the differences were statistically significant (all P<0.05). The patient’s appearance satisfaction score: the preoperative score was [2.0(1.5, 2.0)] points, the immediate postoperative score was [4.0(4.0, 4.0)] points, the score of the last postoperative follow up was [4.0(4.0, 4.0)] points. There was statistical difference in satisfaction among the three groups ( P<0.01). The preoperative scores were compared with the scores of the immediate postoperative and the last postoperative follow-up respectively, and the differences were statistically significant( P<0.01). There was no statistical significance in satisfaction between the immediate postoperative score and the score of the last postoperative follow up ( P>0.05). Conclusion:The sagittal splitting osteotomy of the mandibular outer cortex is consistent with the features of mandibular anatomy, and provides a good condition for the grafting and healing of autogenous bone. Removing the outer cortex of the mandible on the healthy side not only increases the thickness of the affected side, but also decreases the width of the angle of the mandible on the healthy side, so as to effectively correct the asymmetric deformity of the mandible. The method is simple, with few complications and good results, and is one of the ideal treatments to correct hemofacial microsomia.

OBJECTIVE To investigate the effects of sacubitril/valsartan on renal function in patients with primary hypertension. METHODS A retrospective study was conducted among patients with primary hypertension who were admitted to PLA Strategic Support Force Characteristic Medical Center from January 2018 to June 2023. Based on their medication， they were divided into two groups： sacubitril/valsartan group and valsartan group. Propensity score matching was used to match baseline data between the two groups. Patients were treated with antihypertensive drugs based on improving their lifestyle. Sacubitril/valsartan group additionally received oral administration of 200 mg Sacubitril/valsartan tablets once daily， while valsartan group additionally received oral administration of 80 mg Valsartan capsules once daily. The increase amplitude of serum creatinine from baseline， the proportion of patients with elevated serum creatinine ＞30%-50% or ＞50%， and the proportion of patients with hyperkalemia （serum potassium ≥5.5 mmol/L） were compared between two groups at 2 months and 6 months after treatment. The trends of changes in serum creatinine， serum potassium and estimated glomerular filtration rate （eGFR） were compared between the two groups before treatment （at baseline）， 2 months and 6 months after treatment. RESULTS After propensity score matching， there were 62 patients in sacubitril/valsartan group and 61 patients in valsartan group； there were no significant differences in baseline characteristics between the two groups before treatment （P＞0.05）， indicating comparability. After 6 months of treatment， the increase of serum creatinine in the sacubitril/valsartan group was significantly lower than that in the valsartan group （P＝0.003）； the proportion of patients with elevated serum creatinine ＞30%-50% in the sacubitril/valsartan group was significantly lower than that in the valsartan group （P＝0.045）. None of the patients experienced hyperkalemia events after 2 months and 6 months of treatment. Repeated measures analysis of variance showed significantly statistical differences in serum creatinine and eGFR between the two groups within 6 months of treatment （P＜0.001）. Patients taking valsartan experienced a continuous increase in serum creatinine levels and a decrease in eGFR， while patients taking sacubitril/valsartan showed a first increase and then a decrease in serum creatinine levels， and a first decrease and then an increase in eGFR with a prolonged duration of medication. CONCLUSIONS Sacubitril/valsartan can delay or even reverse the decline in renal function levels， and limit the deterioration of renal function in patients with primary hypertension， without increasing the risk of hyperkalemia.

Objective:To investigate a new method for the reconstruction of hemifacial microsomia by sagittal osteotomy of the affected mandibular outer cortex combined with bone graft of mandibular outer cortex from healthy side.Methods:From March 2006 to March 2023, the clinical data of patients with hemifacial microsomia admitted to the Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences were analyzed retrospectively. Preoperative diagnosis and surgical design were performed based on clinical manifestations and imaging findings. All cases were operated under general anesthesia. The affected mandibular outer cortex was previously split by an intraoral approach, and then the mandibular outer cortex of appropriate shape and size on the healthy side was harvested and grafted into the split bone space according to the preoperative design, following by internal rigid fixation. Complications, facial appearance improvement, and patient satisfaction were followed up. Photographs were taken preoperative, immediately postoperative and at the long-term(last) postoperative follow-up, and the severity of the deformity was analyzed. CT data from preoperative, immediate postoperative, and long-term follow-up visits were imported into Surgicase Proplan medical three-dimensional image workstation in Dicom format. The mandible was reconstructed using Segmentation, and the thickness of the mandible was measured during pre-operative, immediate post-operative and long-term follow-up visits. Anova with repeated measurement design was used to compare measurements and LSD test was used for multiple comparisons. The Kruskal-Wallis rank sum test were used to statistically analyze malformation severity. P< 0.05 is considered statistically significant. Results:A total of 39 patients were included in this study, including 13 females and 26 males, with an average age of (22.21±4.57) years (15-27 years). All patients were followed up for an average of (45.56±39.41) months (6-153 months) after surgery. The grafted mandibular outer cortex grows well with the adjacent bone tissue, and the mandibular angle and mandibular body are significantly wider. Of the 39 cases, 1 developed an infection 1 year after surgery, the titanium plate was exposed, and the patient healed after debridement and removal of the immobilizing splint. The facial appearance of the other patients improved significantly. Preoperative, immediate postoperative and long term follow up of mandibular thickness measurements were compared in pairs, and the differences were statistically significant (all P<0.05). The patient’s appearance satisfaction score: the preoperative score was [2.0(1.5, 2.0)] points, the immediate postoperative score was [4.0(4.0, 4.0)] points, the score of the last postoperative follow up was [4.0(4.0, 4.0)] points. There was statistical difference in satisfaction among the three groups ( P<0.01). The preoperative scores were compared with the scores of the immediate postoperative and the last postoperative follow-up respectively, and the differences were statistically significant( P<0.01). There was no statistical significance in satisfaction between the immediate postoperative score and the score of the last postoperative follow up ( P>0.05). Conclusion:The sagittal splitting osteotomy of the mandibular outer cortex is consistent with the features of mandibular anatomy, and provides a good condition for the grafting and healing of autogenous bone. Removing the outer cortex of the mandible on the healthy side not only increases the thickness of the affected side, but also decreases the width of the angle of the mandible on the healthy side, so as to effectively correct the asymmetric deformity of the mandible. The method is simple, with few complications and good results, and is one of the ideal treatments to correct hemofacial microsomia.