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Objective To investigate the basic clinical characteristics of intracranial aneurysms patients and grasp the incidence of intracranial aneurysm, improve the treatment effect of intracranial aneurysm patients. Methods A total of 229 patients with intracranial aneurysms admitted to the General Hospital of Northern Theater Command from June 2020 to December 2022 were selected by random sampling, and their clinical data were collected and analyzed. According to whether the aneurysms were ruptured, they were divided into ruptured intracranial aneurysm group (n = 116 cases) and unruptured intracranial aneurysm group (n = 113 cases). The baseline characteristics, basic medical history, lifestyle and basic characteristics of aneurysms of patients were analyzed. Results The proportion of females increased significantly with age(x² = 38.314, P<0.001). The prevalence of hypertension and diabetes was 65.9% and 11.4%, respectively. Patients with a history of smoking accounted for 47.2% and 34.9% of patients had a history of drinking. Anterior cerebral circulation aneurysms accounted for about 82.9% of the total. The mean size of ruptured aneurysms was (5.88±4.37)mm, and the mean size of unruptured aneurysms was (7.50±7.37) mm. Conclusions People with a history of hypertension, smoking and alcohol consumption have a higher probability of intracranial aneurysms. The most common location of intracranial aneurysms is the anterior cerebral circulation. Aneurysm size is not directly related to rupture. [ABSTRACT FROM AUTHOR]

Cerebral vascular bypass is a key method for the treatment of complex intracranial aneurysms. After nearly 60 years of exploration, its application range now covers the whole cerebral vascular region. With the advent of detachable coils and the mature application of related assistance techniques, endovascular intervention treatment is highly favored in the treatment of routine intracranial aneurysms due to its minimally invasive and rapid characteristics. The introduction of flow diverter (FD) has further ushered in a new era in the treatment of intracranial aneurysms. This article reviews the history and development of cerebral vascular bypass in the treatment of intracranial aneurysms, elaborates on the application and promotion of flow diverter, and discusses the limitations of endovascular intervention treatment in the flow diversion era. It also explores the application and prospects of a comprehensive cerebral vascular bypass system, reaffirming the application value of the whole - region cerebral vascular bypass technique. [ABSTRACT FROM AUTHOR]

Objective To explore the surgical procedures and indications of intracranial-intracranial bypass for the treatment of complex aneurysms in the basilar artery (BA). Methods and Results A retrospective analysis was conducted on the clinical data and treatment process of 6 patients with complex BA aneurysms who underwent intracranial-intracranial bypass from April 2017 to April 2023 in Tianjin Huanhu Hospital. Among the 6 aneurysms, 3 were vertebro basilar dolichoectasia aneurysms, one was an aneurysm in the upper segment of BA combined with severe stenosis at the proximal of the aneurysm, and 2 were giant dissecting aneurysms of the BA. Among them, 5 were ruptured aneurysms, with one case of Hunt-Hess grade V, one case of grade IV, 2 cases of grade IE, and one case of grade II, while the remaining one case was an unruptured aneurysm. One patient underwent petrous segment of internal carotid artery (ICA) - radial artery (RA) - posterior cerebral artery (PCA) bypass combined with aneurysm clipping, 4 patients underwent V3 segment of vertebral artery (VA) - RA - PCA bypass combined with aneurysm trapping, and one patient underwent middle cerebral artery (MCA)-RA-PCA bypass combined with aneurysm trapping. Four patients had good prognosis, with modified Rankin Scale (mRS) 0 to 3, one case scored 4 and one case died one week after surgery. Conclusions For complex aneurysms of the BA that cannot be treated with conventional methods, intracranial-intracranial bypass provides a good option. It is necessary to select the appropriate surgical procedure based on the actual situation in clinical practice. [ABSTRACT FROM AUTHOR]

Cerebral revascularization is constantly being updated and iterated, but there are still many challenges: how to regulate the bypass flow quantitatively, how to reconstruct cerebral artery perforator vessels with diameter less than 0.5 mm, etc. This paper reviews the birth of revascularization and the development of cerebral revascularization, focusing on the basic principle and innovative technology of cerebral revascularization, application and effect of cerebral revascularization in the treatment of complex intracranial aneurysms, current situation and development trend of cerebral revascularization iteration. The aim is to promote the iteration of cerebral revascularization and its application in the treatment of complex intracranial aneurysms. [ABSTRACT FROM AUTHOR]

Objective To analyze the clinical prognosis of high - grade aneurysmal subarachnoid hemorrhage (aSAH) patients with different amounts of hematoma. Methods A total of 211 patients with high - grade aSAH hospitalized in Norhern Jiangsu People's Hospital from September 2013 to December 2020 were included. According to the intracerebral hematoma volume, they were divided into non - hematoma group (n = 105), hematoma volume < 50 ml group (n = 69) and hematoma volume ≥ 50 ml group (n = 37). All of them underwent aneurysm clipping or embolization. The modified Rankin Scale (mRS) was used to evaluate the clinical prognosis 6 months after surgery. Results Among 211 cases, 139 (65.87%) underwent aneurysm clipping and 72 (34.12%) underwent aneurysm embolization. Except for 3 patients who failed to successfully clamp and underwent decompression with bone flap due to intraoperative malignant encephaloceles, the remaining 208 patients were successfully clipped, and no aneurysms ruptured and bled again after surgery. There were 58 patients (27.49%) with good prognosis, 59 patients (27.96%) with poor prognosis, and 94 patients (44.55%) with death. The difference in neurological function prognosis among the 3 groups was statistically significant (χ² = 7.424, P = 0.024). Among them, the mortality rate in incidence of complication was 95.73% (202/211) in all patients, including 95.24% (100/105) in non - hematoma group, 95.65% (66/69) in hematoma volume < 50 ml group, and 97.30% (36/37) in hematoma volume ≥ 50 ml group. The difference in complication among the 3 groups was not statistically significant (χ² = 0.284, P = 0.867). Conclusions The prognosis of high - grade aSAH patients with intracerebral hematoma is poorer, especially in high-grade aSAH patients with hematoma volume ≥ 50 ml, and have a higher mortality rate. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To investigate the relationship between serum interleukin-6 (IL-6), homocysteine (Hcy) and soluble Fms-like tyrosine kinase 1 (sFlt-1) and cerebral vasospasm (CVS) after clipping operation in patients with intracranial aneurysms (IAs). 185 patients who underwent intracranial aneurysm clipping operation in the Affiliated Hospital of Xuzhou Medical University from July 2021 to July 2023 were selected as research objects, patients were divided into non-CVS group and CVS group according to the occurrence of CVS after operation. The levels of IL-6, Hcy and sFlt-1 were detected by enzyme-linked immunosorbent assay. The risk factors of CVS after IAs clipping operation were analyzed by multivariate Logistic regression, the predictive value of serum IL-6, Hcy and sFlt-1 for CVS after IAs clipping operation were analyzed by receiver operating characteristic (ROC) curve. 43 patients had CVS after IAs clipping operation, and the incidence of CVS was 23.24%. The levels of serum IL-6, Hcy and sFlt-1 in CVS group were significantly higher than those in non-CVS group (all P<0.05). Multivariate Logistic regression analysis showed that elevated serum IL-6, Hcy and sFlt-1, Hunt-Hess grade II-III, large aneurysm diameter and subarachnoid hemorrhage times≥ 2 were independent risk factors for CVS after IAs clipping operation (P<0.05). ROC curve results showed that the area under the curve (AUC) of serum IL-6, Hcy and sFlt-1 in predicting CVS after IAs clipping operation was 0.939, which was higher than 0.768, 0.825 and 0.826 predicted by serum IL-6, Hcy and sFlt-1 alone. The levels of serum IL-6, Hcy and sFlt-1 in patients with CVS after IAs clipping operation are significantly increase, and they are independent risk factors for postoperative CVS. The combine detection of serum IL-6, Hcy and sFlt-1 has a high predictive value for CVS after IAs clipping operation. [ABSTRACT FROM AUTHOR]

Objective To investigate the mechanism of ADAMTS-5 in accelerating the formation of neutro‑ phil extracellular traps (NETs) and worsening the progression of intracranial aneurysm (IA) . Methods IA mouse model was constructed. Adenovirus-mediated overexpression or knockdown ADAMTS-5 in arterial wall of the circle of Willis in the right cisterna of mice brain was conducted. Sixty mice were randomly divided into six groups of sham group, model group, shRNA-NT group, shRNA-ADAMTS-5 group, OE-vector group and OE-ADAMTS-5 group, with ten mice in each. H&E staining was used to analyze the infiltration of immune cells in arterial wall of the circle of Willis； and immunohistochemistry (IHC) to detect the expression of neutrophil markers MPO, neutro‑ phil extracellular trap (NETs) markers H3Cit and ADAMTS-5 protein expression level in arterial wall of the circle of Willis. qPCR and western blot were used to analyze the expression of ADAMTS-5 mRNA and protein in arterial wall of the circle of Willis in sham group and model group. The expression of MPO, H3Cit, ADAMTS-5 and Collagen Ⅳ in arterial wall of the circle of Willis was detected by western blot. Results H&E staining showed that there were a large number of immune cells infiltrated in arterial wall of the circle of Willis in the model group, and IHCMPO staining, IHC-H3Cit staining and IHC-ADAMTS-5 staining showed a large number of neutrophils infiltrated and NETs formed. ADAMTS-5 staining positive area overlapped with H3Cit staining positive area. Compared with that in the sham group, the expression of ADAMTS-5 mRNA and protein was higher in the model group (P < 0.05) . Compared with the model group, knocking down/ overexpression ADAMTS-5 in arterial wall of the circle of Willis decreased/increased NETs formation (P < 0.05) . Conclusion ADAMTS-5 plays an important role in driving formation of NETs and promoting disease progression of IA in mouse models. [ABSTRACT FROM AUTHOR]

Objective To investigate whether precise surgical planning based on multimodal image fusion and 3D reconstruction technology can reduce adverse events during clipping in patients suffered from ruptured intracranial anterior circulation aneurysm with severe subarachnoid or intracephalic hematoma. Methods Using 3D Slicer 4.10.2, multimodal image fusion and 3D reconstruction were performed basing on preoperative CT and CTA images of 23 patients with high-grade Hunt-Hess grade anterior circulation ruptured aneurysms. According to personalized surgical plan its guiding to craniotomy aneurysm clipping, we compare the consistency of preoperative three-dimensional imaging results with the actual observation during operation, and evaluate its pros and cons for reducing intraoperative adverse events. Results Accurately guided by the preoperative simulated the head position and craniotomy, we can significantly reduce the adjustment of the patient′s head position during the operation and the secondary grinding off the sphenoid ridge due to poor exposure of the sylvian fissure. According to the intraoperative observation, the sensitivities of the aneurysm neck shape, the poor parts of the transition zone of the aneurysm′s neck to body, and the small perforating vessels beside the neck displayed in the 3D images were 90%, 50%, and 75%, respectively, and the specificities were 100%, 100%, and 75%, respectively. Kappa coefficients were 0.701, 0.623 and 0.732, respectively. The sensitivity and the specificity of preoperative simulated clipping for the actual intraoperative clipping was 100% and 25% respectively, and the Kappa coefficient was 0.355. Conclusion The precise plan based on preoperative multimodal image fusion and 3D reconstruction technology can effectively help the surgeon to accurately individualize the craniotomy clipping of ruptured anterior circulation aneurysm with severe subarachnoid hemorrhage or intracephalic hematoma and reduce the incidence of intraoperative adverse events. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Modern Laboratory Medicine is the property of Journal of Modern Laboratory Medicine Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To investigate the effects of dexmedetomidine combined with sevoflurane under bispectral index (BIS) monitoring on quality of awakening serum oxidative stress indexes and nerve injury markers in patients undergoing interventional embolization for intracranial aneurysms. Methods: Using the random number table method, 80 patients with interventional embolization for intracranial aneurysms who were admitted to our hospital from March 2019 to June 2021 were divided into the study group (dexmedetomidine combined with sevoflurane under BIS monitoring, n = 40 ) and the control group (sevoflurane under BIS monitoring, n = 40 . The changes of hemodynamics, recovery quality, serum oxidative stress indexes and nerve injury markers in the two groups were observed. The occurrence of adverse reactions during perioperative period in the two groups was recorded. Results: From 1 min after endotracheal intubation (T1) to 10 min after extubation (T4), the mean arterial pressure (MAP) and heart rate (HR) in the two groups increased and then decreased, but the study group was lower than the control group at the same time (P < 0.05) . Compared with the control group, the awakening time, recovery breathing time and extubation time in the study group were shorter (P < 0.05) At T1~T4, the levels of superoxide dismutase (SOD) and catalase (CAT) in the two groups decreased and then increased, but the study group was higher than the control group at the same time point (P < 0.05) 1 d after operation, the levels of myelin basic protein (MBP), neuron-specific enolase (NSE) and $100ẞ in the two groups were increased, but the study group was lower than the control group at the same time (P < 0.05) . There was no significant difference in the incidence of adverse reactions in the control group and the study group (P > 0.05) Conclusion: Sevoflurane combined with dexmedetomidine under BIS monitoring can improve the quality of awakening, reduce the level of oxidative stress and the degree of nerve injury, and stabilize hemodynamic fluctuations in patients undergoing interventional embolization for intracranial aneurysms [ABSTRACT FROM AUTHOR]

Objective: To investigate the safety and effectiveness of endovascular intervention in the treatment of intracranial aneurysm (IA) complicated with ischemic cerebrovascular disease. Methods: The clinical data of 32 patients with IA complicated with ischemic cerebrovascular disease treated by endovascular intervention from January 2018 to December 2020 were retrospectively analyzed. Results: A total of 35 IA and 37 stenoses were found in 32 patients. The average size of IA was (5.17.3.12)mm Among them, 26 aneurysms (74%) were located in the internal carotid artery, 9 aneurysms (26%) were located in the vertebrobasilar artery, and 7 patients (22%) were found to have two intracranial aneurysms before operation. Among 37 stenosis, 9 (24%) were located in the vertebrobasilar artery, 8 (22%) were located in the extracranial segment, and the remaining 20 (54%) were located in the internal carotid artery. The average stenosis rate was 75.7% before operation. 31 aneurysms (89%) were completely occluded and 4 aneurysms (11%) remained in the neck. Among 37 stenoses, the average stenosis rate after operation was 8.8%, and the distal cerebral vessels of all patients were unobstructed after operation. During the treatment, there was 1 case of in-stent restenosis and 1 case of cerebral vasospasm. The modified Rankin scale (mRS) was less than 2 in all patients at discharge. All the 32 patients were followed up by digital subtract angiography (DSA) for 6 to 18 months (average 8.8 months). During the follow-up, 1 case had in-stent restenosis. Conclusions: Endovascular intervention is safe and effective in the treatment of IA complicated with ischemic cerebrovascular diseases, which is worthy of clinical reference. [ABSTRACT FROM AUTHOR]

Objective: To explore the mechanism of aspirin inhibiting intracranial aneurysm formation in rats by regulating Hippo pathway. Methods: Forty healthy SD rats were selected and divided into control group (without any treatment), sham operation group (exposing the posterior branches of bilateral renal arteries and left common carotid artery, but without ligation), aneurysm group (perfusing normal saline after ligating the posterior branches of bilateral renal arteries and left common carotid artery) and aspirin group (perfusing aspirin after artery ligation), with 10 rats in each group. Detection of serum inflammatory factors [tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1), interleukin-6 (IL-6), IL-10)] and vascular endothelial injury markers [nitric oxide (NO), endothelin-1 (ET-1), vascular endothelial growth factor (VEGF)] 12 weeks after intragastric administration. After the rats were killed, the aneurysm size, wall thickness ratio, lumen area and thinning length of the middle membrane were detected. The expression of Yes-associated protein (YAP) was detected. Results: 1) There were obvious bulges on the Willis ring in the aneurysm group and aspirin group, and the bulges in the aspirin group were smaller than those in the aneurysm group. The aneurysm size, lumen area and thinning length of middle membrane in aspirin group were smaller than those in aneurysm group, and the wall thickness ratio was greater than that in aneurysm group (P<0.05). (2) The serum levels of TNF-α, MCP-1 and IL-6 of rats in aneurysm group and aspirin group were higher than those in the control group and sham operation group, while the levels of IL-10 were lower than those in the control group and sham operation group (P<0.05); The serum levels of TNF-α, MCP-1 and IL-6 of rats in aspirin group were lower than those in aneurysm group, while the levels of IL-10 were higher than those in aneurysm group (P<0.05). (3) The levels of serum NO, ET-1 and VEGF in aneurysm group and aspirin group were lower than those in control group and sham operation group (P<0.05); The level of serum NO in aspirin group was higher than that in aneurysm group, and the levels of ET-1 and VEGF were higher than that in aneurysm group (P<0.05). (4) The relative absorbance value of YAP protein expression in aneurysm group and aspirin group was significantly higher than that in control group and sham operation group (P<0.05). The relative light absorption value of YAP protein expression in aspirin group was lower than that in aneurysm group (P<0.05). Conclusion: Aspirin can significantly reduce the inflammatory reaction of rats with intracranial aneurysms, improve vascular endothelial function, and inhibit the formation of intracranial aneurysms, which may be related to the regulation of Hippo signal pathway by inhibiting YAP. [ABSTRACT FROM AUTHOR]

Objective: To discuss the diagnosis and treatment of one patient with ruptured intracranial aneurysm complicated with acute myocardial infarction (AMI), and to provide the reference for the clinical diagnosis, treatment, and anesthesia of the disease. Methods: The clinical data, imaging findings, and anesthesia methods of one patient with ruptured intracranial aneurysm complicated with AMI were retrospectively analyzed, and the analysis was performed combined with the relevant literatures. Results: The patient was admitted to hospital due to sudden severe headache with nausea and vomiting for 4 h. A total of 1 h and 10 min after admission, the multi-slice CT results showed subarachnoid hemorrhage (SAH). There was little bilateral ventricular effusion, and the intracranial angiography results showed a tumor in the posterior communicating segment of the right internal carotid artery. A total of 2 h 52 min after admission, the myoglobin was 483. 6 μ g·L-1, the troponin I was 4. 990 μg·L-1, the creatine kinase isoenzyme-MB (CK-MB) was 45. 70 μg·L-1. A total of 16 h 31 min after admission, the ECG results showed sinus bradycardia, left ventricular hypertrophy, and ST-T segment changes. The initial diagnosis of the patient was SAH, AMI, and hypertension grade 3 (very high risk). After early comprehensive treatment, the patient underwent emergency clipping of cerebral aneurysm after 3 d. The anesthesia method was tracheal intubation ansthesia, and the anesthetic drugs were carefully selected to achieve the best blood flow and anesthesia effect. The vital signs of the patient were stable during the operation, and the condition of the patient was improved and discharged after 7 d. Conclusion: For the patients with intracranial aneurysm rupture complicated with AMI, CT, intracranial angiography, and myocardial markers are the important examinations for the diagnosis and differential diagnosis; controlling the blood pressure is the key point for the treatment and anesthesia. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of sevoflurane combined with remifentanil on neurologic function, cognitive function and inflammatory factors in patients with intracranial aneurysms undergoing interventional therapy. Methods: 80 patients with intracranial aneurysms who underwent interventional surgery in our hospital from January 2020 to June 2022 were selected and divided into group A(sevoflurane combined with remifentanil) and group B(propofol combined with remifentanil) according to different anesthesia methods, with 40 patients in each group. Neurological function, cognitive function and inflammatory factor level were compared between the two groups. Results: The heart rate(HR) and mean arterial pressure(MAP) of group A were better than those of group B from T1 to T3(P＜0.05). The national institutes of health stroke scale(NIHSS) score of group A was significantly lower than that of group B at 24 h and 7 d after operation(P＜0.05), and the mini-mental state examination(MMSE) score was higher than that of group B(P＜0.05).Serum tumor necrosis factor-α(TNF-α), C-reactive protein(CRP), and interleukin-6(IL-6) levels at 24 h and 3 d after operation in group A were lower than those in group B(P＜0.05). The recovery time of spontaneous respiration, recovery time, extubation time and the incidence of agitation after extubation in group A were lower than those in group B(P＜0.05). The adverse effects were not different(P＞0.05).Conclusion: The application of sevoflurane combined with remifentanil maintenance anesthesia in interventional IA patients can smooth hemodynamics, improve postoperative neurological function and cognitive function, reduce inflammatory response, and improve the quality of anesthesia awakening. [ABSTRACT FROM AUTHOR]

Objective To explore the risk factors for the prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH) after clipping, and to construct a predictive model based on machine learning algorithms to guide early identification of high risk patients. Methods A total of 182 patients with aSAH who underwent clipping in Tianjin Huanhu Hospital from October 2020 to July 2021 were reviewed. According to the ratio of 7:3, all the data were randomly divided into training set (to construct the prediction model) and test set (to evaluate the prediction model). Synthetic minority oversampling technique (SMOTE) was used to deal with imbalance data. Recursive feature elimination method, Spearman rank correlation analysis and XGBoost feature importance analysis were used to select the optimal variables. Logistic regression (LR), random forest (RF), support vector machine (SVM), decision tree (DT), K near neighbor (KNN) and naive Bayesian (NB) algorithms based on machine learning were used to construct a prediction model. Receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated, as well as accuracy, precision, recall and F1 values. Results All 182 patients were randomly divided into a training set of 127 cases according to the ratio of 7:3, including 103 cases with good prognosis [Glasgow Outcome Scale (GOS) grade 4-5] and 24 cases with poor prognosis (GOS grade 1-3). The data was balanced by generating 79 cases of poor prognosis by SMOTE technique (103 cases of good prognosis and 103 cases of poor prognosis). The test set consisted of 55 cases, including 44 cases with good prognosis and 11 cases with poor prognosis. A total of 17 optimal features were obtained by feature selection and feature importance analysis, the number of aneurysms, alkaline phosphatase, creatinine, application of lysine, sodium heparin and nitroglycerin tend to be positive correlated with good prognosis, while age, Hunt-Hess score, mature neutrophil count, serum sodium, uric acid, total bilirubin, basophilic granulocyte basophil count, creatine kinase, application of furosemide, human albumin, and length of hospital stay tend to be negative correlated with good prognosis. The AUC of LR model was 0.75 ± 0.08 (95%CI: 0.615-0.857, P = 0.001), an accuracy of 0.764, a precision of 0.919, a recall of 0.773, and an F1 value of 0.840; the RF model was 0.57 ± 0.08 (95%CI: 0.428-0.701, P = 0.283), an accuracy of 0.745, a precision of 0.826, a recall of 0.864, and an F1 value of 0.845; the SVM model was 0.65 ± 0.08 (95%CI: 0.507-0.772, P = 0.034), an accuracy of 0.764, a precision of 0.860, a recall of 0.841, an F1 value of 0.850; the DT model was 0.61 ± 0.09 (95%CI: 0.473-0.742, P = 0.135), an accuracy of 0.709, a precision of 0.850, a recall of 0.773, an F1 value of 0.810; the KNN model was 0.66 ± 0.08 (95%CI: 0.519-0.782, P = 0.060), an accuracy of 0.618, a precision of 0.897, a recall of 0.591, and F1 value of 0.712; and the NB model was 0.56 ± 0.08 (95%CI: 0.417-0.691, P = 0.458), an accuracy of 0.673, a precision of 0.825, a recall of 0.750, and an F1 value of 0.786. In particular, the LR model has the best prediction performance (P < 0.05, for all). Conclusions Machine learning algorithms performed well in predicting the prognosis of aSAH clipping, among which the LR model had the best prediction performance and could be used for preoperative prediction to help neurosurgeons make better clinical decisions. [ABSTRACT FROM AUTHOR]

Objective To investigate the effectiveness and safety of hybrid surgery (microsurgery combined with intraoperative DSA) in the treatment of acute hemorrhagic cerebral vascular disease. Methods The clinical data, imaging data, treatment and prognosis of 11 patients with acute hemorrhagic cerebral vascular disease treated by hybrid operation from April 2020 to February 2021 in the Anqing First People's Hospital of Anhui Medical University were analyzed. The results showed 3 cases of cerebral arteriovenous malformation (CAVM), including 2 cases located in temporoparietal lobe and one case in right lateral fissure; 2 cases of dural arteriovenous fistula (DAVF) at the base of anterior cranial fossa while fistulaes located in sieve plate; 6 cases of intracranial aneurysms, including 3 cases in the middle cerebral artery (MCA) bifurcation, one case in the pericallosal artery, and 2 cases in the communicating segment of internal carotid artery (ICA). Results All 11 patients completed the surgery successfully, and the success rate was 100%. CAVM resection combined with hematoma removal were performed in 3 cases of CAVM, including one case that intraoperative DSA suggested a little residual malformed mass after initial resection, while DSA reexamination suggested total resection after supplementary resection. Dural arteriovenous fistula resection combined with hematoma removal were performed in 2 cases of anterior fossa, after the fistula was closed, DSA reexamination suggested the arteriovenous fistula disappeared completely. Intracranial aneurysm clipping was performed in 6 cases, DSA showed complete clipping in 4 cases, and complete clipping in 2 cases of aneurysm neck residual after adjustment or aneurysm clip supplement. DynaCT indicated satisfactory final removal of intracranial hematoma in all patients with intracranial hematoma. No patient had serious complications such as rebleeding and cerebral infarction. After a mean follow-up of 8.45 months, modified Rankin Scale (mRS) was 1 in 4 cases and 1 in 2 cases, and 0 in the other 9 cases. All patients underwent at least one CTA or DSA reexamination, and no residual or recurrent vascular lesions were found. Conclusions Hybrid operation as a new treatment mode for acute hemorrhagic cerebral vascular disease is safe and effective, and further accumulation of cases and experience are needed. [ABSTRACT FROM AUTHOR]

Objective To analyze compensatory ability of the cerebral collateral circulation and relevant factors affecting cerebral ischemic tolerance for internal carotid artery (ICA) occlusion by Balloon Test Occlusion (BTO), providing reference basis for the selection of treatment methods in tumors or complicated aneurysms with ICA involved. Methods The clinical data of 87 cases BTO (85 patients, two of whom underwent bilateral BTO) of ICA in Tianjin Huanhu Hospital from June 2016 to September 2021 were analyzed retrospectively. The integrity of anterior or posterior of circulation structure, collateral compensatory capacity, tolerance to ICA occlusion and its influencing factors were analyzed. Results There were 8 [9.20% (8/87)] BTO positive cases. The positive rate was of cases with incomplete anterior communicating artery was higher than those with complete anterior communicating artery [3/5 vs. 6.10% (5/82); Fisher's exact probability: P = 0.005]. The positive rate of cases with complete fetal posterior cerebral artery (fPCA) which was higher than those without complete fPCA [3/7 vs. 6.25% (5/80); Fisher's exact probability: P = 0.015]. The positive rate of cases with non-open anterior circulation which was higher than those cases with open anterior circulation [3/6 vs. 6.17% (5/81); Fisher's exact probability: P = 0.009]. The positive rate of cases with non - open posterior circulation which was higher than those cases with open posterior circulation [20% (5/25) vs. 0 (0/59); Fisher's exact probability: P = 0.002]. Only the positive rate of patients with anterior circulation opening was higher than that of patients with open anterior circulation and open posterior circulation [13.04% (3/23) vs. 0 (0/3); Fisher's exact probability: P = 0.022], neither anterior nor posterior circulation opening were significantly higher than those with only anterior circulation opening [2/2 vs. 13.04% (3/23); Fisher's exact probability: P = 0.033] and both anterior and posterior circulation opening [2/2 vs. 0 (0/56); Fisher's exact probability: P = 0.001]. Once the ICA occluded, the anterior circulation, the posterior circulation, both of anterior and posterior circulation could provide anterior cerebral artery (ACA) supplied area with compensatory blood flow for 88.10% (74/84), 3.57% (3/84), 5.95% (5/84) cases, respectively. The anterior circulation, the posterior circulation, both anterior and posterior circulation could provide middle cerebral artery (MCA) supplied area with compensatory blood flow for 27.38% (23/84), 16.67% (14/84), 53.57% (45/84) cases, respectively. There were statistically significant differences in the compensatory capacity between ACA (χ² = 53.000, P = 0.000) and MCA (χ² = 54.244, P = 0.000). The combined compensatory capacity of both anterior and posterior circulation was higher than that of single anterior circulation (Z = 6.754, P = 0.000; Z = 6.180, P = 0.000), single posterior circulation (Z = 2.277, P = 0.023; Z = 5.065, P = 0.000) and neither anterior nor posterior circulation (Z = 1.991, P = 0.047; Z = 2.478, P = 0.013). Conclusions The anterior circle is functionally much more important than the posterior circle. Non-open anterior circulation, especial absence of anterior communicating artery, complete fPCA, neither anterior nor posterior circulation were highly predictive for intolerance to ICA occlusion. For these cases, attention should be paid to the protection of ICA or active blood flow reconstruction technology to reduce the occurrence of cerebral ischemia. Those cases with both opened anterior circulation and opened posterior circulation provided higher compensatory ability than those with single circulation. For those cases, the ICA of could be sacrificed. [ABSTRACT FROM AUTHOR]

Cerebrovascular bypass has been developed for more than 50 years. With various surgical methods and complex classification, cerebrovascular bypass has become an indispensable treatment in the field of cerebral vascular disease, especially ischemic cerebral vascular disease and intracranial complex aneurysms. In order to provide some guidance for related clinical work, this article intends to review the classification and clinical application of cerebrovascular bypass. [ABSTRACT FROM AUTHOR]

Objective: To study and compare the diagnostic value of cranial computed tomography angiography (CTA) and cranial magnetic resonance angiography (MRA) in intracranial aneurysms. Methods: Data of 60 patients with suspected intracranial aneurysms who were admitted to our hospital from January 2, 2019 to December 15, 2020 were retrospectively analyzed. CTA examination, MRA examination and digital subtraction angiography (DSA) examination were performed on all subjects. Using the results of DSA as the gold standard, the efficacy of cranial CTA and cranial MRA in the diagnosis of intracranial aneurysms were compared. In addition, the coincidence rate of cranial CTA and cranial MRA in different grades and different locations of intracranial aneurysms were compared. Results: DAS examination results showed 48 patients with confirmed aneurysm, a total of 74 aneurysms were detected, 65 aneurysms were detected by CTA, and 51 aneurysms were detected by MRA, and the detection rate of CTA aneurysms was higher than that of MRA (all P＜0.05). Taking DSA results as the gold standard, the sensitivity, specificity and accuracy of CTA in the diagnosis of intracranial aneurysms were 94.20% (65/69), 60.00% (3/5) and 91.89% (68/74), respectively, which were higher than 82.26% (51/62), 41.67% (5/12), 75.68% (56/74) in MRA (all P＜0.05). The coincidence rate of CTA in diagnosis of grade 1 intracranial aneurysm was 13.85% (9/65), which was higher than 7.84% (4/51) of MRA (P＜0.05). There was no significant difference in the coincidence rate of different examination methods in the diagnosis of intracranial aneurysm in different locations (all P＞0.05). Conclusion: The sensitivity, specificity and accuracy of CTA in the diagnosis of intracranial aneurysms are higher than those of MRA, and can improve the detection rate of small diameter tumors. However, MRA has the advantages of no radiation, low test cost and high safety, so a reasonable examination method can be comprehensively selected in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy of endovascular interventional embolization on intracranial aneurysms at different times and its influence on prognosis, neurological function and serum inflammatory factors. 80 patients with intracranial aneurysms who were admitted to our hospital from March 2019 to December 2020 were selected. According to the different operation time, the patients were divided into early group and delayed group, among early group had 36 cases, with the time from onset to operation ≤ 72 h. Delayed group had 44 cases, the time from onset to operation＞72 h. The efficacy, prognosis, neurological function, inflammatory factors and the incidence rate of complications were compared between the two groups. The complete embolization rate of the early group was higher than that of the delayed group, and the basic embolization rate was lower than that of the delayed group (P<0.05). The scores of National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale at 3 months after operation in the two groups were lower than those before operation, and the scores in the early group were lower than those in the delayed group (P<0.05). The good prognosis rate of the early group was higher than that of the delayed group (P<0.05). The levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in two groups decreased at 3d after operation, and the early group was lower than the delay group (P<0.05), and the level of interleukin-10 (IL-10) increased, and the early group was higher than the delayed group (P<0.05). The incidence rate of complications in the early group was lower than that in the delayed group (P<0.05). Early endovascular interventional embolization for intracranial aneurysms can improve the complete embolization degree, reduce neurological and inflammation damage, reduce the risk of complications, and improve the prognosis and quality of life. [ABSTRACT FROM AUTHOR]

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Objective: To explore the efficacy and safety of self expanding stent assisted coil embolization in the treatment of intracranial aneurysms. Methods: From January 2014 to January 2019,159 patients with intracranial aneurysms were treated with self expanding stent assisted coil embolization (group A) and 178 patients with intracranial aneurysms (group B) were treated with simple coil embolization. The operative time, postoperative hospital stay, follow-up time and complications of the two methods were compared, and the safety and efficacy of the two methods were compared by Glasgow(GOS) prognosis score and Raymond score. Results: There was no significant difference in operation time, postoperative hospitalization time and follow-up time between the two groups (P>0.05). There was significant difference in the incidence of postoperative bleeding and ischemic events between the two groups (P<0.05), but there was no significant difference in the incidence of hydrocephalus, pneumonia, mortality and disability between the two groups(P=1 after continuous correction). The GOS score of group A was higher than that of group B within 1 month and 12 months after operation, the difference was statistically significant (P<0.05); the Raymond grade of group A was better than that of group B within 1 month and 12 months after operation, the difference was statistically significant (P<0.05). Conclusion: Self expanding stent assisted coil embolization is effective for intracranial aneurysm embolization and has few postoperative complications. For patients with intracranial aneurysms, self expanding stent assisted coil embolization can improve the safety of operation and the efficacy of embolization. [ABSTRACT FROM AUTHOR]

Objective: To investigate the biological function of miR-181c-5p in the phenotypic regulation of intracranial aneurysm vascular smooth muscle cells (VSMC) and its potential regulatory mechanism. Methods: Real time fluorescent quantitative polymerase chain reaction (RT-qPCR) was carried out to determine the miR-181c-5p and PTPN4 mRNA expression levels in serum of patients with intracranial aneurysm (IA). The changes overexpression of miR-181c-5p-mediated VSMC cell phenotypes were used to detect by cell counting Kit-8 (CCK8), colony formation, transwell migration and flow cytometry. Double luciferase reporter gene was performed to examine the potential target of miR-181c-5p. The expression of miR-181c-5p in the serum of IA patients was higher than that of healthy subjects (P<0.05). Results: The overexpression of miR-181c-5p significantly inhibited the proliferation, clone formation and migration of VSMC, and stimulated apoptosis (P<0.05). PTPN4 was proved to be a direct target of miR-181c-5p, and overexpression of miR-181c-5p resulted in low expression of PTPN4 in VSMC. Conclusion: miR-181c-5p/PTPN4-mediated VSMC phenotypic regulation may partially lead to IA lesions. [ABSTRACT FROM AUTHOR]

Objective: To explore the application effect of neuroelectrophysiology combined with intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring in intracranial aneurysm clipping. Methods: A total of 60 patients with intracranial aneurysm who underwent craniotomy in our hospital from December 2018 to January 2020 were selected and divided into two groups by a simple randomization method, with 30 cases in each group. The control group performed intracranial aneurysm clipping surgery, and the observation group was based on the control group with intraoperative neuroelectrophysiology, ICP, and CPP monitoring. Comparison of the aneurysm clipping between the two groups, the new neurological deficits on the first day after the operation, the Glasgow Coma Score (GCS) before the operation, 1 day after the operation, and 3 months after the operation, and the National Institutes of Health Stroke Scale ( NIHSS) score and good prognosis rate 3 months after operation. Results: Both groups of aneurysms were completely clipped. The rate of new neurological deficits in the observation group was 6.67% (2/30) on the first day after surgery, which was lower than 26.67% (8/30) in the control group (P<0.05); The GCS score of the observation group was higher than that of the control group on the 1st day, and the NIHSS score was lower than that of the control group (P<0.05); after excluding cases lost to follow-up, the excellent and good rates of GOS classification and mRS classification in the observation group were 88.89% and 88.89%, respectively. Compared with 88.00% and 84.00% of the control group, the difference was not statistically significant (P>0.05). Conclusion: The use of neuroelectrophysiology combined with ICP and CPP monitoring can grasp the blood flow of the brain tissue of patients undergoing intracranial aneurysm clipping in real time. According to the monitoring results, timely corresponding intervention measures can be taken to prevent irreversible cerebral ischemia changes and improve postoperative changes. Early patient's state of consciousness reduces the occurrence of early postoperative neurological deficits. [ABSTRACT FROM AUTHOR]

The intracranial blood blister-like aneurysms (BBA) arising from the supraclinoid segment of internal carotid artery are very rary, and grow aggressively with high reruptured rate and mortality. Currently, the treatment methods of BBA are various but achieve no consensus, although including microsurgery and interventional therapy. The article collects the recent research and makes a review of the therapeutic progress of BBA, in order to provide clinical basis for the treatment of BBA and improve its therapeutic effect. [ABSTRACT FROM AUTHOR]

Objective: To explore the effectiveness and safety of balloon-assisted embolization in the treatment of unruptured intracranial aneurysms. Methods: From January 2014 to January 2019, 540 patients who received interventional therapy in the interventional department of our hospital were selected as the research subjects. According to the treatment plan, it was divided into two groups, namely, balloon-assisted embolization group(340 cases) and simple embolization group(200 cases). We retrospectively analyzed the general information, clinical data, and surgical complications of all patients. Results: The balloon-assisted embolization group and the simple embolization group were not statistically significant in terms of gender composition, age, nature, location of intracranial aneurysm,Hunt-Hess classification(P>0.05). The results of angiography immediately after operation and 6 months after operation showed that the embolization degree of the balloon-assisted embolization group was significantly better than that of the simple embolization group, the difference was statistically significant(P<0.05). The modified Rankin of the balloon-assisted embolization group The scale score was significantly better than the simple embolization group, the difference was statistically significant(P=0.005). The prognosis rate of the balloon-assisted embolization group was significantly higher than that of the simple embolization group, the difference was statistically significant(P<0.001). During the operation In the balloon-assisted embolization group, 2 cases of rupture and bleeding, 2 cases of cerebral vasospasm, and 1 case of coil displacement occurred. In the simple embolization group, 2 cases of rupture and bleeding, 1 case of embolization, 2 cases of cerebral vasospasm, and 3 cases of coil displacement. The incidence of complications in the balloon-assisted embolization group was significantly lower than that in the simple embolization group, and the difference was statistically significant(P<0.001). Conclusion: In the treatment of unruptured intracranial aneurysms, the effectiveness and safety of balloon-assisted embolization technology is significantly better than simple embolization interventional therapy, and it is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

The mechanism of occurrence and rupture of intracranial aneurysm is complex and may involve various environmental and genetic factors. Histopathological studies of intracranial aneurysm suggest a possible relationship between intracranial aneurysm and connective tissue diseases. Clinical studies have shown that patients suffering from hereditary connective tissue diseases are at significantly increased risk of multiple cerebrovascular diseases such as intracranial aneurysm. Further studies have found that mutations in associated gene loci involved in these hereditary diseases are closely related to the occurrence and development of intracranial aneurysm. Based on previous literatures, this study aims to review intracranial aneurysm related hereditary connective tissue diseases and important gene loci involved. [ABSTRACT FROM AUTHOR]

目的 本文旨在探讨动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage，aSAH）患者血压 变异性对预后的影响。 方法 北京天坛医院2015年11月-2016年11月收治的123例经数字减影血管造影证实为原发性颅内动 脉瘤破裂所致的SAH患者纳入此研究。回顾性分析123例患者的病历资料，对患者的年龄、性别、入院 美国国立卫生研究院卒中量表（National Institutes of Health stroke scale，NIHSS）评分、入院格拉斯哥 昏迷量表（Glasgow coma scale，GCS）评分、Hunt-Huss分级、Fi sher分级、世界神经外科学会联盟（Worl d Federation of Neurosurgical Societies，WFNS）分级、血压变异性等进行单因素的分析。根据随访患者发病 3个月时改良Rankin量表评分作为临床预后评价的指标，1～3分为预后良好组，4～5分为预后不良组。 结果 123例患者3个月后随访结果显示：预后不良17例，预后良好患者的入院NIHSS评分（P =0.007）、 入院GCS评分（P =0.001）、WFNS分级（P =0.001）、血压变异系数（P =0.001），与预后不良患者相比，差 异有统计学意义。单因素回归分析显示，仅血压变异系数与3个月后预后相关。Spearman相关性分析结 果显示，血压变异系数、入院GCS评分和WFNS分级与3个月后预后相关。 结论 血压变异性是影响aSAH患者预后的重要因素，保持血压相对平稳是改善aSAH患者预后的重 要途径之一。 Abstract: Objective To investigate the effect of blood pressure variability on the prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods This retrospective study included 123 aSAH patients caused by primary intracranial aneurysm rupture confirmed by DSA from Beijing Tian Tan Hospital from November 2015 to November 2016. A single factor analysis of age, gender, National Institutes of Health stroke scale (NIHSS) score on admission, Glasgow coma scale (GCS) score on admission, Hunt-Huss scale, Fisher scale, World Federation of Neurosurgical Societies (WFNS) scale and blood pressure variability (BPV) was made. The prognosis was evaluated by 90-day modified Rankin scale (mRS) score, with good prognosis defined as mRS 1-3 score and poor prognosis defined as mRS 4-5 score. Results The 3-month follow-up result showed that 106 patients (106/123) had good prognosis and there were significant difference in NIHSS score on admission (P =0.007), GCS score on admission (P =0.001), WFNS grade (P =0.001) and BPV (P =0.001) between the two groups. The single factor regression analysis showed that only BPV were associated with 3-month prognosis of aSAH patients. Spearman correlation analysis showed that BPV, GCS score on admission and WFNS grade were associated with 3-month prognosis. Conclusions BPV is an important factor affecting the prognosis of aSAH patients. Keeping blood pressure relatively stable is an important way of improving the prognosis of aSAH patients.

血流导向装置（flow diverter，FD）是近年来产生的血管内治疗颅内复杂动脉瘤的新材料。 FD设计是通过改建血流的方式将动脉瘤排除在循环系统之外从而重建载瘤动脉，因此FD为复杂动 脉瘤的治疗提供了新的思路和手段。临床报道该治疗方式的动脉瘤完全栓塞率可达90%以上。目前 FD应用逐渐广泛，本文从血流动力学角度出发针对FD的血流导向能力，以及颅内动脉瘤经FD治疗后 影响预后的因素进行了总结。 Abstract: Flow diverter (FD) is a kind of new device for endovascular treatment of complex intracranial aneurysms. FD is designed to reconstruct parent artery by removing aneurysms from circulatory system through blood flow remodeling. This concept innovation brings new ideas and methods for treating complex aneurysms. It is reported that the complete occlusion rate of aneurysms using FD could achieve over 90%, so currently the FD application is becoming increasingly wider. This article reviewed that the effect of using FD on hemodynamics in treating intracranial aneurysms, and effect of this treatment approach on outcome of intracranial aneurysms, to provide reference for aneurysms treatment decision-making.

目的 探讨LVIS支架在囊状动脉瘤、夹层动脉瘤支架辅助栓塞术中的安全性及有效性。 方法 回顾性纳入中国人民解放军总医院神经内科2016年7月-2017年7月收治的71例应用LVIS支架 行动脉瘤支架辅助栓塞的颅内动脉瘤患者。根据数字减影血管造影（digital subtraction angiography， DSA）术后即刻图像及复查DSA图像，评估LVIS支架在动脉瘤支架辅助术中的安全性及有效性。 结果 71例颅内动脉瘤患者中，破裂动脉瘤20个（28.2%），未破裂51个（71.8%）；前循环动脉瘤56 个（78.9%），后循环动脉瘤15个（21.1%）；术中血栓事件4例（5.6%）。栓塞后即刻改良Raymond分 级：1级39个（54.9%），2级13个（18.3%），3a级11个（15.5%），3b级8个（11.2%）；其中破裂动脉瘤改 良Raymond分级1级14个（70.0%），未破裂动脉瘤改良Raymond分级1级25个（49.0%），前循环动脉瘤 改良Raymond分级1级33个（58.9%），后循环动脉瘤改良Raymond分级1级6个（40.0%）。术后半年DSA 复查29例（40.8%），其中改良Raymond分级较栓塞后即刻造影级别改善7个，占2级、3级动脉瘤（32个） 40.6%（3b级→1级4个，3a级→1级1个，2级→1级2个），变差2个（2级→3a级1个，2级→3b级1个）。术中 发生血栓事件共4例（5.6%），术后复查DSA发现载瘤动脉狭窄2例，占复查例数6.8%。 结论 LVIS支架在颅内动脉瘤支架辅助栓塞术中安全、有效，但术中血栓事件及术后载瘤动脉再狭 窄亦应引起重视。 Abstract: Objective To investigate the safety and effectiveness of the low profile visualized intraluminal support (LVIS) devices in stent-assisted coil embolization of intracranial saccular aneurysms and dissecting aneurysms. Methods 71 patients with intracranial aneurysms treated with stent-assisted coil embolization using LVIS devices in department of neurology in PLA general hospital from July 2016 to July 2017 were consecutively included in this study. The digital subtraction angiography (DSA) immediately after the procedure and at 6-month fowllow-up were reviewed to evaluate the safety and effectiveness of the LVIS devices in the treatment of intracranial aneurysms. Results Among all 71 patients, 20 (28.2%) cases with ruptured aneurysms and 51 (71.8%) with unruptured aneurysms, 56 (78.9%) cases with anterior circulation aneurysms and 15 (21.1%) cases with posterior circulation aneurysms. Thrombotic events occurred in 4 (5.6%) cases during the treatment. Immediate angiography after the embolization, the results of modified Raymond scale showed that 39 (54.9%) grade I, 13 (18.3%) grade II, 11 (15.5%) grade IIIa and 8 (11.2%) grade IIIb. The modified Raymond grade I occlusion were achieved in the following aneurysms: 14 (70.0%) ruptured aneurysms, 25 (49.0%) unruptured aneurysms, 33 (58.9%) anterior circulation aneurysms and 6 (40.0%) posterior circulation aneurysms. 29 (40.8%) patients were reassessed with DSA at 6-month follow-up, comparing with immediate angiography after the embolization, the modified Raymond grade improved in 7 aneurysms (4 Raymond IIIb to I, 1 Raymond IIIa to I, 2 Raymond II to I) and the angiography got worse in 2 aneurysms (1 Raymond II to IIIa and 1 II to IIIb). Thrombotic events occurred in 4 (5.6%) patients during the surgery, and in-stent restenosis occurred in 2 (6.8%) patients in DSA reexamination after the embolization. Conclusions The LVIS endovascular devices are safe and effective in the treatment of intracranial aneurysms. However, immediate thrombosis during operation and delayed in-stent stenosis should be paid more attention.

BACKGROUND: Interventional treatment can also be used as a palliative treatment for patients who cannot be surgically removed. However, the positioning of the lesion at the beginning of the operation or the catheter during the interventional treatment can only be accurately and clearly displayed through the two-dimensional image, and is related to the operator’s own experience and understanding of the image. The 3D printing model is a physical model with high simulation and individualized features, and has the advantages of individualization and precision in the medical field. It is currently widely used in orthopedics, oral and maxillofacial surgery, but the application in the treatment of craniocerebral aneurysms is rarely reported. OBJECTIVE: To summarize the classification and treatment status of cerebral aneurysms, and to prospect the application prospect of 3D printing technology in the treatment of cerebral aneurysms. METHODS: The authors retrieved CNKI, WanFang, PubMed, and EI database. The search terms were “cerebral aneurysm, clinical classification, treatment, 3D printing”. A total of 96 relevant literatures were retrieved, and 51 articles were summarized according to the inclusion and exclusion criteria. Specifically, it included the classification of cerebral aneurysms, craniotomy and interventional therapy, and the application status of 3D printing technology. RESULTS AND CONCLUSION: At present, the treatment methods of cerebral aneurysms commonly used in clinical practice have their own advantages and limitations. In this case, 3D visualization and 3D printing technology are proposed, which is an important supplement for the clinical treatment of patients with cerebral aneurysms. It can display organ anatomy and spatial structure more intuitively and accurately through operations such as enlargement, rotation and transparency. At the same time, it can accurately locate the aneurysm site, calculate the aneurysm size and volume, and define the aneurysm morphology. This is significant in preoperative diagnosis, planning of surgery, precise operation during surgery, and improvement of surgical success rate for the brain aneurysm. Simultaneously, the solid model of 3D printing is also widely used in the aspects of disease communication and training of resident surgical operations. By summarizing the research progress of 3D printing technology in the treatment of cerebral aneurysms, we have a clearer understanding of the application of 3D visualization and 3D printing technology. Whether it is combined with fluid mechanics for hemodynamic research or refined treatment based on existing treatment schemes, it has promoted the development of clinical research. [ABSTRACT FROM AUTHOR]

Objective : To investigate the effect of endovascular embolization on the quality of life and prognosis of cerebral aneurysms. Method : The clinical data of 80 patients with cerebral aneurysms who were admitted to our hospital from January 2014 to March 2019 were retrospectively analyzed. The patients were divided into group A (n=38, craniotomy clipping) and group B (n=42, endovascular embolization) according to the different surgical methods. The clinical efficacy, quality of life, prognosis, recurrence rate, incidence of complications and perioperative indicators were compared between the two groups. Results : The total effective rate of group B was 85.71% (36/42) at 6 months after operation, which was higher than 65.79% (25/38) of the control group (P<0.05). The scores of somatic function, social function, cognitive function, emotional function and role function were increased between two groups at 6 months after operation, and those of group B were higher than those of group A (P<0.05). There was no significant difference in mild disability, severe disability, plant survival, mortality and recurrence rate between the two groups (P>0.05). The good prognosis rate of group B was significantly higher than that of group A (P<0.05). There was no significant difference in the incidence of complications between two groups during the follow-up period (P>0.05). The operation time, hospitalization days and incision length of group B were shorter than those pf group A, but the hospitalization expenses were higher than those of group A (P<0.05). Conclusion : Compared with craniotomy, endovascular embolization for cerebral aneurysms has definite curative effect, it can effectively improve the quality of life and prognosis of patients, and it does not increase the recurrence rate and the incidence of complications. It has high clinical value. [ABSTRACT FROM AUTHOR]

Objective : To explore the operative time of interventional embolization and the influencing factors of prognosis in patients with intracranial aneurysm. Method : 130 patients with intracranial aneurysm who were admitted to Fuyang Hospital Affiliated to Anhui Medical University and the First Affiliated Hospital of Anhui Medical University from May 2015 to may 2017 were selected, they were treated with interventional embolization. The patients were divided into early group (n=78) and delayed group (n=52) according to the operative time. The early group was operated within 3 days after the onset of the disease, and the delayed group was operated after the onset of the disease>3 days. The degree of arterial embolism, complications and prognosis within 2 years were compared between the two groups. According to the prognosis, the patients were divided into the good group and the bad group. Multivariate logistic regression was used to analyze the influencing factors of patients' prognosis. Results : The complete embolism rate of early group was 88.46%, which was higher than 73.08% of delayed group, the difference was statistically significant (P<0.05). There were no significant differences between the two groups in the incidence of aneurysm hemorrhage, limb disorder, consciousness disorder, infection at puncture site, hydrocephalus and electrolyte disorder (P>0.05). The good prognosis rate of early group was 79.49%, which was significantly higher than 63.46% of delayed group (P<0.05). Bad group of preoperative Glasgow outcome scale (GOS)≤ 3 points, delay surgery, tumors located in the posterior circulation, hypertension, diabetes, Hunt-Hess grade 3~5, Fisher grade Ⅲ~Ⅳ proportion were significantly higher than those of the good group (P<0.05). Multivariate logistic regression analysis showed that GOS score≤ 3 before operation, delayed operation, tumor location in the posterior circulation, hypertension, diabetes, hunt Hess grade 3-5, Fisher grade Ⅲ-Ⅳ were the influencing factors of poor prognosis (P<0.05). Conclusion : Early interventional embolization can improve the complete embolization rate and prognosis of patients with intracranial aneurysm. The poor prognosis are mainly related to preoperative GOS score, operative time, tumor location, hypertension, diabetes, hunt Hess grade and Fisher grade. [ABSTRACT FROM AUTHOR]

Objective To analyze risk factors related to acute ischemic stroke after intracranial aneurysm clipping. Methods From January 2013 to January 2018, 267 cases of intracranial ruptured aneurysm in our hospital were collected retrospectively. All patients were given intracranial aneurysm clipping, ventricular drainage and decompression with bone flap vemova. Univariate and multivariate backward Logistic regression analysis were used to analyze the risk factors for ischemic stroke after intracranial aneurysm clipping. Results There were 62 patients (23.22%) with acute ischemic stroke after intracranial aneurysm clipping. Logistic regression analysis showed that hypertension (OR = 1.695, 95%CI: 1.247-2.631; P = 0.006), blood glucose (OR = 4.206, 95%CI: 2.771-6.284; P = 0.000), Hunt-Hess grade ≥ III (OR = 1.443, 95%CI: 1.205-1.872; P = 0.017), ventricular hemorrhage (OR = 1.947, 95%CI: 1.465-2.973; P = 0.001) and acute hydrocephalus (OR = 3.221, 95%CI: 2.218-4.960; P = 0.000) were risk factors for acute ischemic stroke after intracranial aneurysm clipping. Conclusions The hypertension, blood glucose increased on admission, preoperative Hunt - Hess grade ≥ III, ventricular hemorrhage and acute hydrocephalus were risk factors for acute ischemic stroke after clipping of intracranial aneurysm rupture. [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy and safety of intracranial aneurysm clipping and endovascular embolization for intracranial aneurysms. Methods: Clinical data of 76 patients with intracranial aneurysm who underwent surgical treatment from September 2016 to January 2019 were retrospectively analyzed. They were divided into 40 patients in group A who received intracranial aneurysm clipping and 36 patients in group B who received endovascular embolization according to different surgical methods. The complete aneurysm closure rate, hospitalization cost, serum inflammatory factors [CRP, interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α)], brain oxygen saturation level and daily living ability scale (ADL) score value were compared between the two groups, occurrence of complications were recorded. Results: There was no significant difference in the complete aneurysm closure rate between two groups (χ²=0 .515, P=0.473). The hospitalization cost of group A was lower than that of control group (t=17.732, P=0.000). Postoperative levels of serum CRP, IL-1β, IL-6 and TNF-α of group A were higher than those of group B (t=10.580, 12.904, 9.355, 19.176, all P=0.000). Postoperative brain oxygen saturation level of group A was lower than that of group B (t=2.113, P=0.019). There was no significant difference in ADL score between the two groups (t= 1.211, P=0.115). The incidence of intraoperative re-rupture and cerebral vasospasm of group A were higher than those of group B (χ² = 4.817, 5.383, P=0.028, 0.020). Conclusion: Early intracranial aneurysm clipping is applied to patients with intracranial aneurysms. The complete aneurysm closure rate and intravascular embolization have no significantly different, and the hospitalization cost is lower, but the stimulation to target vessels is greater, which may lead to the risk of intraoperative re-rupture and cerebral vasospasm. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of remifentanil combined with propofol on anesthesia effect and serum levels of central nerve specific protein (S100β) and neuron specific enolase (NSE) in patients undergoing general anesthesia for intracranial aneurysm clipping. Methods: 103 patients undergoing general anesthesia for intracranial aneurysm clipping who were treated in our hospital from February 2017 to January 2019 were selected, and they were divided into control group (n=51) and study group (n=52) according to random number table method. The control group was given isoflurane combined with propofol under anesthesia, and the study group was given remifentanil combined with propofol under anesthesia. The anesthetic effect, rebleeding rate, serum levels of S100β, NSE were compared between the two groups. Results: Heart rate (HR) and central venous pressure (MAP) in the study group from before dural incision (T2) to immediately after aneurysm clipping (T4) were lower than those in the control group (P<0.05). The recovery time of spontaneous breathing, recovery time of orientation, time of opening eyes after breathing, time of tracheal extubation and time of leaving the operating room in the study group were shorter than those in the control group (P<0.05). The levels of serum S100β and NSE in the study group from T2 to the end of operation (T5) were lower than those in the control group (P<0.05). There was no significant difference in the rebleeding rate between the two groups (P>0.05). Conclusion: Remifentanil combined with propofol for patients undergoing general anesthesia for intracranial aneurysm clipping can improve the postoperative indicators of patients, maintain stable hemodynamics, alleviate brain damage. [ABSTRACT FROM AUTHOR]

The mortality and morbidity rate of subarachnoid hemorrhage is quite high. The incidence of intracranial aneurysmal subarachnoid hemorrhage in women, especially in postmenopausal women, is significantly higher than that in men, which is related to estrogen deficiency. Estrogen replacement therapy can reduce the risk of developing it. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of interventional embolization on the related factors of aneurysm rupture, nerve and brain injury in patients with intracranial aneurysms. Methods: 98 patients with ntracranial aneurysms in our hospital were randomly divided into 50 cases of the observation group and 48 cases of the control group. The observation group was treated with intravascular interventional operation, while the control group was treated by microsurgical clipping. The expression levels of cystatin C (Cys-C), cysteine containing aspartate proteinase 3 (Caspase3), neuron specific enolase (NSE), astrocyte derived protein (S100β), interleukin-6 (IL-6), endothelin-1 (ET-1) and matrix metalloproteinase-9 (MMP-9) of the two groups were observed and compared between two groups. Results: Before treatment, there was no significant change in the levels of indicators in the two groups (P>0.05). After treatment, the levels of Cys-C, Caspase 3, IL-6, ET-1 and MMP-9 in both groups were significantly lower than those before treatment (P<0.05), and the levels of above indexes in the observation group were significantly lower than those in the control group (P<0.05). While there was no significant difference in the serum NSE and S100 beta levels inter group and intra group (P >0.05). Conclusions: Interventional embolization for intracranial aneurysms may reduce the possibility of ruptured intracranial aneurysms, reduce the degree of brain injury, and has little effect on the central nervous system. [ABSTRACT FROM AUTHOR]

Cerebral microbleeds (CMBs) is one of the most important neuroimaging markers of cerebral small vessel disease (cSVD). It has been validated that the number and spatial distribution of CMBs are closely related to the risk of first - ever and recurrence of spontaneous cerebral hemorrhage. CMBs account ≥ 5 and strictly limited in brain lobar are risk factors for increased incidence of spontaneous cerebral hemorrhage. In addition, CMBs could also serve as a potential predictive factor for the risk of rupture of cerebral aneurysms and the occurrence of Moyamoya disease - related spontaneous cerebral hemorrhage. Thus, CMBs would be very important for stratification of cerebral hemorrhage patients in clinical studies, and could provide complementary information for neurosurgeons to make surgical decisions. [ABSTRACT FROM AUTHOR]

Objective To investigate the influence of endovascular embolization and surgical clipping on long - term prognosis, quality of life and postoperative complications of patients with anterior circulation intracranial aneurysms. Methods A total of 128 patients with anterior circulation intracranial aneurysms were chosen from January 2016 to October 2017 and randomly divided into 2 groups including group A (N = 64) treated with endovascular embolization and group B (N = 64) treated with surgical clipping. The hospitalization time, total treatment cost, laboratory indexes before and after operation including S-100B protein (S - 100B), matrix metalloproteinase - 9 (MMP - 9) and interleukin - 6 (IL - 6), postoperative neurological function [Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS)], life quality [Medical Outcomes Study 36 - item Short - Form Health Survey (SF - 36) and Activities of Daily Living (ADL)J and postoperative complications incidence of both groups were compared and analyzed. Results Compared with group B, group A had shorter hospitalization time (t = 4.712, P = 0.000), significantly lower levels of S - 100B (F = 4.276, P = 0.000), MMP-9 (F =3.576, P = 0.000) and iL-6 (F =3.897, P = 0.000), better SF-36 (t = 4.673, P = 0.000) and ADL (t = 3.816, P = 0.000) scores, better GOS (χ² = 4.726, P = 0.019) and mRS (t = 3.816, P = 0.000) scores 6 months after operation. However, the total treatment cost of group A was significantly higher than group B (t = 5.046, P = 0.000). The evaluation of postoperative complications incidence 30 d after operation showed group A had significantly lower infection incidence (x2 = 9.195, P = 0.002) than group B, while there was no significant difference in the incidence of aneurysm rupture, cerebral ischemia, and vasospasm incidence between 2 groups (P > 0.05, for all). Conclusions Endovascular embolization in the treatment of anterior circulation intracranial aneurysms can efficiently shorten hospitalization time, improve long-term prognosis, reduce the levels of S- 100B, MMP-9 and IL-6, improve patients' quality of life and be helpful to prevent the infection risk. Surgical clipping has the advantage of reducing the economic burden of patients. [ABSTRACT FROM AUTHOR]

Objective To systematically review the risk of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms by microsurgical clipping versus endovascular coiling. Methods A comprehensive literature search from January 1990 to September 2015 was conducted in electronic databases, such as PubMed, EMBASE/SCOPUS, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI) and Wanfang data, for randomized controlled trials (RCTs) or observational studies. Key words were defined as hydrocephalus, shunt, clipping, coiling, surgical, endovascular, embolization, treatment, intracranial aneurysm, cerebral aneurysm, subarachnoid hemorrhage both in Chinese and English. Manual search was also conducted on several relevant journals, such as Chinese Journal of Neurosurgery, Chinese Journal of Contemporary Neurology and Neurosurgery, Chinese Journal of Cerebrovascular Diseases, and so on. Data were extracted and evaluated by two reviewers independently. Jadad Scale was used to assess the quality of RCTs. Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of nonrandomized controlled trials. RevMan 5.3 and Stata 13.1 were used for Meta-analysis. Results Eighteen observational studies were finally included, involving 15 920 patients with ruptured intracranial aneurysms, among whom 10 038 patients underwent clipping and 5882 underwent coiling. The result of Meta-analysis indicated that there was no statistical significance on the incidence of shunt-dependent hydrocephalus between clipping and coiling (OR = 0.860, 95%CI: 0.720-1.030; P = 0.110). However, the findings showed low stability as the results of fixed effects model and random effects model were different. The result of Egger's test indicated no publication bias (P = 0.795). Conclusions The frequency of shunt-dependent hydrocephalus was not significantly different between clipping and coiling. However, the conclusion still needs to be further verified by high-quality studies. DOI: 10.3969/j.issn.1672-6731.2016.02.003

Objective To explore and evaluate the surgical technique and clinical effect of anterior communicating artery via-supraorbital keyhole approach. Methods The clinical data of 27 patients with anterior communicating artery aneurysm for microsurgery clipping via-supraorbital keyhole were analyzed retrospectively. Preoperative imaging features, intraoperative aneurysm dissection and clipping process and postoperative follow-up were analyzed. Glasgow outcome scale(GOS) was used to evaluate the therapeutic effect. Results 27 cases were successfully operated via-supraorbital keyhole and no residual or recurrence of aneurysm was confirmed by CTA or DSA. According to GOS grade,24 cases(88.89%) recovered with good outcome, 2(7.41%) of mild disability and 1(3.70%) case of severe disability with the follow-up from 6 months to 2 years. Conclusion Exposure and clipping for anterior communicating artery aneurysm via-supraorbital keyhole approach is safe and effective and it has less trauma and complications. [ABSTRACT FROM AUTHOR]

Objective: To analyze the application effect and safety of cerebral vascular intervention after puncture vascular local vascular closed. Methods: A retrospective analysis 80 cases of intracranial aneurysm patients who received therapy from May 2016 to December 2017 in our hospital, according to different hemostatic methods, those patients were divided into 43 cases in the control group and 37 cases in research group. Control group was subjected to manual compression and hemostasis, research group to local vascular closed to stop bleeding. operation success rate, blood vessel wound processing time, the bleeding time, braking time, length of hospital stay, blood vessel diameter, blood velocity, stress reaction, Kolcaba comfortable rating scale, the complications occurrence between two group was compared. Results: The operation success rate in control group and research group was 97.30%(36/37) and 100.00%(43/43),there was a statistical difference(P<0.05). Treatment time, hemostasis time, braking time and hospitalization time in research group all lower than those in the control group(P<0.05). Before surgery, blood vessel diameter and blood flow rate between the two groups was no difference(P>0.05). After surgery, the blood vessel diameter in the control group was no significant changes(P>0.05), blood vessel diameter in research group was lower than the control group(P <0.05). After surgery, cortisol and blood glucose in two group was increased, and there was no difference between the groups(P >0.05). Complication rate in research group was lower than the control group(P <0.05). Conclusion: Local vascular closed can achieve the same effect as traditional surgical compression, with less complications, higher safety and worth promoting. [ABSTRACT FROM AUTHOR]

Objective: To study the efficacy and safety of microsurgery in the treatment of intracranial aneurysms as well as the effect on cerebrospinal fluid interleukin-1(IL-1), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) and endothelin-1(ET-1) levels.Methods: 96 patients with intracranial aneurysms in our hospital from August 2014 to January 2016 were selected and randomly divided into the control group and the observation group with 48 cases in each group. Patients in the control group were treated with endovascular interventional therapy, and the patients in the observation group were treated with microsurgery. The operation time, intraoperative bleeding, hospitalization time, incidence of complications, changes of cerebrospinal fluid IL-1, IL-6, TNF-α and ET-1 levels before and after the treatment, Glasgow outcome score at 1 year after surgery were compared between the two groups. Results: The operation time, bleeding volume, hospitalization time and the incidence of complications was significantly lower in the observation group(P<0.01) than those of the control group; On the 7th d after treatment, the cerebrospinal fluid IL-1, IL-6, TNF-α and ET-1 levels were significantly lower in the observation group than those of the control group(P<0.01); no obvious difference was found in the incidence of complications between the two groups(P>0.05); at one year after treatment, the Glasgow outcome score(GOS) showed no significant difference between two groups(P>0.05). Conclusion: Microsurgery had a significant effect on intracranial aneurysms, it can significantly reduce the IL-1,IL-6, TNF-α and ET-1 levels in the cerebrospinal fluid, improve the prognosis. [ABSTRACT FROM AUTHOR]

Objective To explore the mechanism and intervention effects of diammonium glycyrrhizinate (DG) on the formation of intracranial aneurysm (IA) in rabbits. Methods Forty New Zealand rabbits were randomly divided into four groups: control group, IA group, normal saline (NS) group and DG group, 10 rabbits for each group. Except for the control group, rabbits in other three groups were operated with bilateral common carotid artery ligation to produce basilar artery aneurysm formation model. DG group was injected intravenously with DG［20 mg/(kg·d)］from the first day to the seventh day after operation, NS group was given same volume of normal saline, while IA group was injected nothing. The expressions of NF-κB and MMP-9 were detected by immunohistochemical staining, while α-SMA was stained with immunofluorescence. Results The expressions of NF-κB and MMP-9 were significantly higher in IA group and NS group than those of control group, while α-SMA expression was significantly lower than that of control group (P < 0.01). There were no significant differences in expressions of NF-κB and MMP-9 between IA group and NS group (P＞ 0.05). The expressions of NF-κB and MMP-9 were significantly lower in DG group than those of IA group and NS group (P＜ 0.05). The expression of α-SMA was significantly higher in DG group than that of IA group and NS group (P＜0.05). Conclusion DG can downregulate the expression levels of NF- κB and MMP- 9 in intracranial aneurysm, suppress inflammatory in artery wall and reduce the pathological changes and have intervention effect on intracranial aneurysm formation. [ABSTRACT FROM AUTHOR]

Objective To analyze the associations of the interleukin-10 (IL-10) promoter-1082G/A and -819C/T single nucleotide polymorphism (SNP) and serum level of IL- 10 with intracranial aneurysm (IAs). Methods The polymerase chain reaction (PCR) and DNA direct sequencing methods were used to detect IL-10 gene promoter district two SNP site, －1082G/A and -819C/T genotype frequency and allele frequency in 206 patients with IAs and 187 controls. Chisquare test was used to analyze differences between two groups. The serum level of IL-10 was analyzed by ELISA, and ttest was used to analyze significant differences between two groups. Results There were significant differences in genotypes of GG and GA+AA, as well as the alleles G and A, in -1082G/A locus between IAs group and control group (P＜ 0.01). There were higher frequencies of genotype GA+AA and the allele A in IAs group than those in control group (P＜ 0.01). There was higher risk of suffering IAs in patients with genotype GA+AA (OR=4.137, 95%CI: 2.476-6.914) and the allele A (OR=3.368, 95%CI: 2.476-4.583). There were higher frequencies of the genotype CT+TT and the allele T in -819C/ T locus in IAs group than those of control group (P＜0.01). There was higher risk of suffering IAs in patients with genotype CT＋TT (OR=3.393, 95%CI: 1.952 -5.900) and the allele T (OR=3.764, 95%CI: 2.730-5.192). The serum level of IL-10 was significantly lower in IAs group than that of control group (P＜0.01). Conclusion The IL-10 promoter SNP influences the expression of IL-10. IL-10 promoter -1082G/A and -819C/T polymorphisms are correlated with the formation of IAs. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical efficacy and prognosis of patients in the prevention of cerebral vasospasm after intracranial aneurysm operation between lidocaine and nimodipine combined treatment and nimodipine single drug treatment. Methods: Selected 65 cases of patients with intracranial aneurysm treated in our hospital from January 2012 to June 2015. and were divided into treatment group and control group by microsurgical clipping of aneurysm. The control group were treated with routine nimodipine. and treatment group were treated with lidocaine on the basis of control group. Observed and compared the changes of the blood flow velocity in the middle cerebral artery between the two groups, analyzed the situation of CVS, cerebral infarction, clinical death and prognosis of patients in two groups. Results: Flow velocity of middle cerebral artery in treatment group were 133.81± 12.35 m/s. 7S.88± 5.05 m/s and 77.28± 4.78 m/s. which were significantly lower than 136.02± 11.67 m/s, 96.74± 4.25 m/s and 85.96± 7.87 m/s control group before treatment and 7th, 14th after treatment, the differences were statistically significant (P=0.000), there were 3 cases of patients occurred CVS. in treatment group, and 9 cases of patients in control group (P=0.026). But there were no significant differences in the number of cerebral infarction and deaths and the final outcome. Conclusion: The clinical operation of nimodipine combined with lidocaine in the prevention of intracranial aneurysm clipping surgery is significantly better than that of the single chug group,and it can be used as an effective treatment for postoperative patients with CVS. [ABSTRACT FROM AUTHOR]

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