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Objective: To investigate the strategy and the clinical effect of single stage treatment for intracranial or extracranial artery stenosis with intracranial aneurysm. Methods: The clinical data of 15 patients with intracranial aneurysms and extracranial or intracranial artery stenosis treated by one-stage endovascular therapy at Department of Neurosurgery of Peking University First Hospital from April 2013 to September 2018 were analyzed,respectively.There were 6 males and 9 females,aged (63.9±9.1)years (range:43 to 79 years).Fifteen arterial stenosis were found, including 8 in anterior circulatiion and 7 in posterior circulation, and the stenosis rates ranged from 75% to 95%. There were 17 aneurysms, among which 11 in the anterior circulation and 6 in the posterior.The maximal diameter was (5.3±1.2)mm (range:3 to 7 mm).All patients were treated with stenting and embolization at one stage. The operation choices, perioperative and postoperative symptoms,imaging data and complications were recorded. Results: Stents were successfully implanted into arterial stenosis of 15 cases, reducing the stenosis rates to less than 30%.Among the 17 aneurysms,10 cases were treated by coil embolization alone,7 cases by stenting and coil embolization. Eventually all the 17 aneurysms reached complete embolization.One patient had mild symptoms of the cerebral infarction during the perioperative period,and the rest had not shown surgical complications.The follow-up time was (43.8±8.2)months (range:24 to 85 months). All the patients underwent digital subtraction angiography 6 to 12 months after operation.Among them,2 cases had asymptomatic in-stent restenosis,and no recurrence was found in aneurysms.Up to the last follow-up,no patients had showed new symptoms or signs of intracranial hemorrhage or ischemic stroke. Conclusions: For patients suffered from both stenosis and aneurysms,individualized treatment should be made based on the location and severity of the vascular stenosis and aneurysms.With careful preoperative evaluation and surgical planning,the single stage endovascular treatment for intracranial or extracranial artery stenosis combined with intracranial aneurysm is safe,feasible and effective for selected patients.

Objective: To establish a rat model of focal lymphatic encephalopathy by partial ligation of the cerebral superficial artery for observation of the changes of Virchow-Robin spaces (VRS)., Methods: Thirty male SD rats were randomized into 3 groups (n=10), including two model groups and a sham-operated group. The rats in the model groups were subjected to partial ligation of the cerebral superficial arteries under EEG monitoring to induce focal lymphatic encephalopathy, and those in the sham-operated group underwent only dissociation of the cerebral superficial artery without ligation. The rats in the two model groups were executed at 24 and 48 h, and those in the sham-operated group at 48 h following the operation, respectively. Frozen sections of the brain tissues were prepared for microscopic morphological observation and quantitative analysis of the VRS using HE staining and an image analysis system, respectively., Results: EEG remained normal during the operations suggesting intact brain function. Partial ligation of the cerebral superficial arteries resulted in obvious dilation of the VRS in the cerebral cortex and subcortical medulla, and the tissues around the dilated VRSs appeared pale and structurally loosened. The two model groups showed significantly enlarged VRS areas as compared to the sham-operated group (P<0.01), but no significant differences were found in the mean VRS areas between the two model groups., Conclusion: Partial dilation of the cerebral superficial artery is effective and convenient to induce focal lymphatic encephalopathy in rats, and this model can be ideal for studying focal cerebral lymph circulation.

Objective: To evaluate the effectiveness of cerebral revascularization in the treatment of intractable aneurysms and to discuss the indications, surgical techniques, and the outcome of the revascularization., Methods: During the recent 4-year period, 9 radical artery grafts were performed in patients with intractable or giant internal carotid artery (ICA) aneurysms. The indications for cerebral revascularization included parent vessel occlusion during the treatment of the intractable aneurysms with poor collateral circulation or the young patients. Modified techniques were taken to use the main trunk of superficial temporal artery (STA) as donor, while M3 branches near the bifurcation of the M2 segment of the middle cerebral artery (MCA) were chosen as the recipient arteries. STA-Radial artery (RA)-MCA bypass was followed by parent vessel occlusion via chronic cervical ICA ligation or balloon occlusion., Results: Postoperative angiography demonstrated the patency of the grafts in eight cases. The procedure of the parent vessels occlusion was uneventful in these patients. Follow-up showed the patients were in excellent conditions after successful treatment of aneurysms. Significantly delayed filling of the graft was revealed in one patient, who could not tolerate balloon occlusion test and occlusion of parent artery failed., Conclusions: Extracranial-to-intracranial bypass followed by parent vessel occlusion is a safe and effective method to treat intractable ICA aneurysms. Radical artery as graft can offer high-flow revascularization with less complications. Combined surgical and endovascular treatment might be the future direction for the treatment of the difficult aneurysms.

Seventeen cases of vascular malformation of posterior cerebral artery in supertentorium from 1973 to 1991 are reported. These patients accounted for 8.8% of the total supertentorial vascular malformations during the same period. Their ages ranged from ten to forty-eight years with an average of thirty-one years. The vascular malformation was located in the occipital lobe or under the temporal lobe. Its main blood supply was from the basilar artery. Headache and hemorrhage were common clinical manifestations. Some cases had a defect of the visual field. Vertebral angiography is necessary for diagnosis of this disease. All the seventeen cases were operated without any death. The operative approach and experience in seeking for the vascular malformation during the operation are discussed.