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To investigate the expression of matrix metalloproteinase-9 (MMP-9) in the arachnoid membrane around posterior communicating artery aneurysms.Twelve patients with posterior communicating artery aneurysms undergoing surgical intervention in our hospital between November, 2010 and November, 2011 were enrolled as the case group along with 6 concurrent patients with severely head trauma or epilepsy as controls. The expression of MMP-9 in the aneurysmal walls and the arachnoid membrane was examined in immunohistochemistry, and HE staining and Sirus red staining were performed to examine the pathological changes.The perianeurysmal arachnoid membrane showed tissue destruction and disruption of the connections between the membrane and the artery wall with local detachment. Compared with that in the control group, the level of MMP-9 in the arachnoid membrane was significantly higher in the case group (P0.05), but significantly lower than that in the aneurysm wall within the same sample (P0.05). No differences were found in the levels of MMP-9 in the aneurysm patients with different ages or Hunt-Hess scale scores.MMP-9 is closely related with the formation of posterior communicating artery aneurysms by causing degradation of extracellular matrix of the vascular wall and the arachnoid membrane.

To explore the imaging features, diagnosis and treatment strategies of intracranial lageniform aneurysms.The clinical characteristics and therapeutic outcomes of 6 patients with intracranial lageniform aneurysms were retrospectively analyzed.All the 6 aneurysms, including 5 anterior communicating artery aneurysms and 1 middle cerebral artery (MCA) aneurysm, were diagnosed by CT, DSA and (or) MRA. Pretreatment CT revealed subarachnoid hemorrhage and intracranial hematoma surrounding the ruptured aneurysm. Three dimensional DSA showed that all the lageniform aneurysms contained two parts, the larger false aneurysm and the smaller true aneurysms. All the 5 Acom aneurysms were coiled and the MCA aneurysm was clipped. Two patients with coiling developed serious brain edema, and acute decompressive craniectomy was performed to 1 of them. Pathological examination of the surgical specimens confirmed that pseudoaneurysm formed the larger part of the lageniform aneurysm. One patient died of brain hernia, and the other 5 patients were discharged with good GOS. All the patients showed stable neurological status during the 3-month follow-up.Lageniform aneurysm is a complex aneurysm consisting in larger part of false aneurysm and in smaller part of true aneurysm, and early intervention with individualized surgeries is recommended.

To evaluate the feasibility, efficacy and safety of a new method for distant injection of Onyx for treatment of intracranial arteriovenous malformations (AVMs).The clinical data of 26 patients with AVMs receiving distant injection of Onyx using the new method were retrospectively analyzed. Onyx was injected by the surgeon in the control room through a pressure transmission system.The 26 patients received a total of 31 embolization procedures, with an average estimated size reduction of AVMs of (61.48 ± 26.85)%. Total obliteration was achieved in 3 AVMs. In one case, Onyx leakage occurred during the operation resulting from a broken microcatheter, and the patient developed hemiparesis after the operation.Endovascular treatment of intracranial AVMs with Onyx embolization using this new distant injection method is feasible, safe and effective. This method minimizes potential radiation exposure of the surgeons without increasing the risks of related complications.

To study the surgical timing, strategy and outcome of intracranial giant aneurysms.The clinical and surgical data of 15 cases of intracranial giant aneurysms treated between January, 2001 and January, 2010 were analyzed. Aneurysm clipping was performed in 8 cases, aneurysm trapping with extracranial-intracranial (EC-IC) bypass in 1 case, parent artery occlusion with EC-IC bypass using great saphenous vein graft in 3 cases, aneurysm resection with aneurysm wall suture in 1 case, and exclusive aneurysm trapping in 2 cases.Deaths occurred in 2 (13%) of the cases. Good surgical outcomes were achieved in 12 cases (80%), and poor outcome was found in 1 case (7%) after the surgery.Individualized surgical planning is suggested for microsurgical management of intracranial giant aneurysms, and the operation should be performed by surgeons having sufficient microsurgical experience and capable of vessel reconstruction.