ObjectiveTo investigate the value of head boneless CT angiography (CTA) for surface shaded display (SSD) (hereinafter referred to as the SSD-CTA technology) and volume computed tomographic digital subtraction angiography (VCTDSA) in diagnosing intracranial aneurysms. MethodsWe collected the clinical data of 35 patients diagnosed to have intracranial aneurysm by VCTDSA between April 2013 and November 2014 from the First Affiliated Hospital of Chongqing Medical University. The original data were imported into the CT workstation of the First People's Hospital of Chengdu. Then, SSD-CTA technology was performed for bone reconstruction. We compared the results of these two technologies. In addition, we selected another 27 patients diagnosed with intracranial aneurysm by SSDCTA and DSA examination at the same time between June 2012 and November 2014 in the First People's Hospital of Chengdu for comparison. ResultsThe quality score of SSD-CTA reconstructed image was lower than that of VCTDSA, but the diagnosis of the two technologies for intracranial aneurysm was not statistically different (P>0.05). Compared with DSA, the sensitivity and specificity of the diagnosis for intracranial aneurysms by SSD-CTA were both 100%. ConclusionSSD-CTA is valuable in diagnosing intracranial aneurysms.
ObjectiveTo summarize the clinical features of an adult patient with occult cerebral alveolar echinococcosis with liver and lung infection. MethodsA Tibetan male patient in his middle age from the epidemic area of echinococcosis infection was diagnosed to have liver, lung and cerebral alveolar echinococcosis infection in Ganzi People's Hospital. He had the resection surgery, and the pathological result confirmed the primary diagnosis. We searched the literatures from January 1985 to December 2015 for occult cerebral alveolar echinococcosis and reviewed all the full texts in China Journal Full-text Database. Seventeen articles were qualified and 42 patients were reported. Combining with the relevant English literature using Medline, we analyzed the epidemic, pathophysiological and clinical manifestations of cerebral alveolar echinococcosis infection and explored the methods of prevention and treatment. ResultsAccording to the results of literature analysis, cerebral alveolar echinococcosis appeared often secondary to infection of other organs. Nervous system symptom concealed or progressed slowly; imaging and pathological tests were important for diagnosis. Resection surgery was the essential method of cure. ConclusionAlveolar echinococcosis can affect multiple organs. In patients without neurological symptoms, if other organs are found to be infected, it is important to screen patients with intracranial involvement. Because this kind of patients with intracranial lesions with hydatid are often secondary to other organ infection, active treatment in early phase is necessary in order to avoid further expansion of lesions and metastasis.
ObjectiveTo analyze the clinical characteristics of acquired immune deficiency syndrome (AIDS) complicated with intracranial infection and to explore the nursing countermeasures. MethodsWe retrospectively analyzed the clinical features, laboratory examination indexes, and nursing methods of 12 AIDS patients complicated with intracranial infection between January and December 2010. ResultsIn the 12 patients, 8 were male, 4 were female; 11 were married and 1 was unmarried. The first symptom of headache occurred in 8 patients, and feverin 4 patients. Detection of HIV-1P24 antigen in all the 12 patients with HIV was positive for nucleic acid analysis. After treatment and symptomatic care, 3 cases were cured, 3 quit the treatment voluntarily, 2 improved patients were transferred to a higher-level hospital, 3 patients were readmitted to our hospital after improvement of the situation, and 1 patient died. ConclusionThe most common symptom of AIDS was neural disease. The diagnosis should be based on clinical manifestations, and the epidemiological data should be used as reference. At the same time, attention should be paid to the admission assessment and good occupation protection, health education promotion, improvement of patients' quality of life, and reduction of the incidence of complications and mortality rate.
ObjectiveTo investigate the efficacy of stellate ganglion block (SGB) on postoperative palpebral edema in patients undergoing intracranial aneurysm surgery. MethodsSixty patients who were scheduled to undergo intracranial aneurysm surgery between September 2012 and Novermber 2014 were recruited, and were assigned into 2 groups randomly with 30 in each:SGB group and control group. Patients in SGB group were administered SGB by injecting 0.3% ropivacaine on the operative side under the ultrasound guidance after surgery completed, while patients in the control group received injection of saline on the operative side under the ultrasound guidance. Incidence of postoperative palpebral edema at hour 24, 48, and 72 after surgery were measured. Numerical rating scale (NRS) was used to detect the severity of uncomfortable symptoms for palpebral swelling during rest state. The severity of palpebral edema was evaluated with continuous rating scale (0-5, 0 indicated normal palpebral, and higher score indicated more serious palpebral edema). Complications related with SGB were recorded. ResultsThe overall incidence of palpebral edema at hour 24 after surgery in SGB group was lower than that in the control group (P<0.05). There was no statistically significant difference in the overall incidence of palpebral edema at hour 48 and 72 after surgery between the two groups (P>0.05). The palpebral edema rating scores of the SGB group at hour 24 after surgery were lower than those of the control group (P<0.01).The incidence of palpebral edema which was scored 3 or more at hour 24 and 48 after surgery in SGB group was lower than that in the control group (P<0.05). No statistically significant difference was found in the incidence of palpebral edema which was scored 3 or more at hour 72 after surgery between the two groups (P>0.05). No complication related with SGB was found. ConclusionSGB can safely reduce the incidence of postoperative palpebral edema in patients undergoing intracranial aneurysm surgery, and reduce the severity of palpebral edema.
ObjectiveTo systematically review the safety and validity of the treatment of intracranial atherosclerosis diseases (ICAD) by using Wingspan stents, and to provide the reference for clinical practice and research. MethodsDatabases such as the PubMed, The Cochrane Library, EMbase, Cochrane Central Register of Controlled Trials, CBM, CNKI and VIP were searched for studies concerning the safety and validity of the treatment of intracranial atherosclerosis diseases (ICAD) by using Wingspan stents from January 1st, 2005 to January 10th, 2014. Randomized controlled trials (RCTs), non-randomized controlled trials, case-control studies, cohort studies and case series were all included. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data. Then, meta-analysis was performed by using the R software. ResultsA total of 34 studies (2 RCTs, 22 cohort studies, and 10 case-control studies) involving 2 511 patients were included. The results of meta-analysis showed that:operation success rates was 96.75% (95%CI 95.82% to 97.48%), 30 day rates of the end point events was 8.75% (95%CI 7.61% to 10.04%), 1 year rates of the end point events was 13% (95%CI 11.47% to 14.70%), total mortality was 2.98% (95%CI 2.16% to 4.10%), incidence of in-stent restenosis was 21.76% (95%CI 18.27% to 25.71%), the ratio of the patients with symptomatic restenosis and total patients was 6.50% (95%CI 4.89% to 8.60%), and the ratio of the patients with symptomatic restenosis and total patients with restenosis was 26.06% (95%CI 19.94% to 33.29%). ConclusionCurrent evidence shows that treatment of ICAD by using Wingspan stents is effective and safe. However, this conclusion should be approved by further higher quality RCTs.
Transcranial magnetic stimulation (TMS), a widely used neuroregulatory technique, has been proven to be effective in treating neurological and psychiatric disorders. The therapeutic effect is closely related to the intracranial electric field caused by TMS, thus accurate measurement of the intracranial electric field generated by TMS is of great significance. However, direct intracranial measurement in human brain faces various technical, safety, ethical and other limitations. Therefore, we have constructed a brain phantom that can simulate the electrical conductivity and anatomical structure of the real brain, in order to replace the clinical trial to achieve intracranial electric field measurement. We selected and prepared suitable conductive materials based on the electrical conductivity of various layers of the real brain tissue, and performed image segmentation, three-dimensional reconstruction and three-dimensional printing processes on each layer of tissue based on magnetic resonance images. The production of each layer of tissue in the brain phantom was completed, and each layer of tissue was combined to form a complete brain phantom. The induced electric field generated by the TMS coil applied to the brain phantom was measured to further verify the conductivity of the brain phantom. Our study provides an effective experimental tool for studying the distribution of intracranial electric fields caused by TMS.
Intracranial Acinetobacter baumannii infection is a rare clinical disease with a gradual increase in incidence and extremely high mortality. With the continuous enhancement of bacterial resistance, more and more intracranial infections of multidrug-resistant and extensively drug-resistant Acinetobacter baumannii have appeared in the clinic, and its treatment has become a major challenge and problem faced by neurosurgeons. The treatment difficulties include the selection, usage and dosage of antimicrobial agents, as well as whether cerebrospinal fluid drainage is needed. A standardized treatment plan is still needed. In this paper, combining domestic and foreign literature, the treatment of intracranial infection of multidrug-resistant and extensively drug-resistant Acinetobacter baumannii will be reviewed in order to provide a reference for clinical treatment.
ObjectiveTo summarize the experience of microsurgery in primary hospital for the posterior communicating artery aneurysms (PCOAan). MethodsThe clinical data of 48 patients with PCOAan who underwent microsurgery from January 2008 to December 2012 were retrospectively analyzed. ResultsAll the necks of aneurysms of 48 cases were successfully clipped, Acording to the Glasgow outcome score (GOS), the early curative effects were good in 36 cases (75.0%, GOS 4-5) poor in 10 cases (20.8%, GOS 2-3) and death in 3 cases (2.1%, GOS 1). After the operation was carried out, the operation time was shorten, aneurysm intraoperative rupture rate was lower, postoperative complications were lower, and the average medical expense was reduced; the difference was significant in 24 cases before and after the operation (P<0.05). ConclusionMicrosurgery for PCOAan is an effective method which should be popularized in primary hospitals.
Objective To study the MRI features of intracranial solitary fibrous tumor (ISFT). Methods MRI features of 8 patients with ISFT treated between December 2010 and December 2015 were retrospectively analyzed and relavent literatures about its neuroimaging were reviewed. Results All the 8 cases were single solitary fibrous tumor (SFT), among which 4 arose from and beneath the tentorium, 2 in the left cerebellopontine angle, 1 in jugular foramen region and 1 in saddle area. All tumors had clear boundary, 3 were oval or round, 2 were irregular-shaped, 2 were lobulated and 1 was dumb-bell shaped. Tumor size ranged from 35 to 65 mm. On pre-contrast MRI, 5 cases were mixed with hypo to hyperintense signals on (T1 weighted image) T1WI and heterogeneous on (T2 weighted image) T2WI. The rest 3 cases were featured by solid and cystic components; the solid component was hypo to isotense on T1WI and hypointense on T2WI while the cystic areas, which were not enhanced in the postcontrast images, were hypo and hyperintense on T1WI and T2WI, respectively. All the areas with low T2 signal intensity were strongly enhanced after gadolinium administration. Flow-empty actions, peritumoral edema and “dural tail” sign was found in 6, 3 and 0 cases, respectively. All the 3 cystic cases were confirmed as malignant ISFT while the rest 5 were benign. Conclusions MRI manifestation of ISFT has some characteristics. There may exist some correlations between the intratumoral cyst and malignant potential. However, the diagnosis of ISFT remains dependent on histopathology.
ObjectiveTo observe the neuro-ophthalmological features of intracranial aneurysm. Methods169 patients with intracranial aneurysm were retrospectively studied. 45 patients, including 18 men and 27 women, had neuro-ophthalmological symptoms or signs. Their average age was (56.21±16.11) years and 32 (71.11%)patients' age was more than 50 years. The onset time ranged from 30 minutes to 20 years. 20 (44.44%) patients' onset time was among 24 hours. CT, CT angiography, MRI, MRI angiography and cerebral digital subtraction angiography were performed alone or combined in all 45 patients. Visual acuity, pupil reflex and eye movement were examined. Clinical data including general condition, initial symptoms, neuro-ophthalmological changes, imaging data and treatment effects were recorded. Results26.63% of the 169 patients had neuro-ophthalmological symptoms or signs. There were 6 patients (13.33%) with neuro-ophthalmological changes as their first manifestation and 39 patients (86.67%) with neurologic changes as first manifestation. Neuro-ophthalmological symptoms included vision loss (10 patients, 22.22%), diplopia (4 patients, 8.89%) and ocular pain (2 patients, 4.44%). The most common neuro-ophthalmological sign was pupil abnormality which was found in 31 patients (68.89%). The second most common sign was eye movement disorder (16 patients, 35.56%).The other signs included ptosis (8 patients, 17.78%), nystagmus (2 patients, 4.44%), exophthalmos (1 patient, 2.22%) and disappeared corneal reflection (1 patient, 2.22%). Imaging examination indicated that intracranial hemorrhage happened in 29 patients (64.44%). The most common neuro-ophthalmological features were pupil abnormality, eye movement disorder and vision loss in both patients with or without intracranial hemorrhage. The incidence of pupil abnormality was higher in patients with intracranial hemorrhage than that without intracranial hemorrhage, the difference was statistically significant(χ2=7.321, P=0.007). Pupil abnormality and vision loss were common in patients with internal carotid artery aneurysm, and eye movement disorder was common in patients with internal carotid artery aneurysm and posterior communicating aneurysms. ConclusionsPatients with intracranial aneurysm have different neuro-ophthalmological features. The most common features are pupil abnormality, eye movement disorder and vision loss.