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Optic nerve sheath diameter (ONSD) measurement is one of the non-invasive methods recommended for increased intracranial pressure (ICP) monitoring.This study aimed to evaluate the roles of optic nerve sheath diameter (ONSD) and ONSD/eyeball transverse diameter (ETD) ratio in predicting prognosis of death in comatose patients with acute stroke during their hospitalization.A total of 67 comatose patients with acute stroke were retrospectively recruited. The ONSD and ETD were measured by cranial computed tomography (CT) scan. All patients underwent cranial CT scan within 24 h after coma onset. Patients were divided into death group and survival group according to their survival status at discharge. The differences of the ONSD and ONSD/ETD ratio between the two groups and their prognostic values were compared.The ONSD and ONSD/ETD ratio were 6.07 ± 0.72 mm and 0.27 ± 0.03 in the comatose patients, respectively. The ONSD was significantly greater in the death group than that in the survival group (6.32 ± 0.67 mmThe mortality increased in comatose patients with acute stroke when the ONSD was5.7 mm or the ONSD/ETD ratio was0.25. Both indexes could be used as prognostic tools for comatose patients with acute stroke. The ONSD/ETD ratio was more stable than the ONSD alone, which would be preferred in clinical practice.

Glioma stem cells (GSCs) are considered the source for development, recurrence, and poor prognosis of glioma, so treatment targeted GSCs is of great interest. The frequently rearranged in advanced T cell lymphomas-1 (FRAT1) gene is an important member of the Wnt/β-catenin signaling transduction pathway, and aberrantly activation of Wnt signaling has been identified to contribute to the tumorigenesis, proliferation, invasion of a variety kinds of cancer stem cells. However, correlations between FRAT1 and GSCs and the specific mechanisms remain unclear. In this study, we aimed to investigate the effect of FRAT1 on GSCs proliferation, colony formation, sphere formation and tumorigenesity in vitro and in vivo and its underlying mechanism. Lentiviral transfection was used to construct GSCs with low FRAT1 expression. The expression of FRAT1 on GSCs proliferation in vitro was assessed by cell counting kit-8(CCK-8). Colony formation and sphere formation assays were conducted to assess the colony and sphere formation ability of GSCs. Then, an intracranial glioma nude mouse model was built to measure the effect of low FRAT1 expression on GSCs proliferation and tumorigenesity in vivo. Real-time PCR, Western blot, and Immunohistochemistry were processed to detect the mRNA and protein expressions of FRAT1, β-catenin in the glioma tissue of xenograft mice to study their correlations. The functional assays verifed that low FRAT1 expression inhibited CD133+Nestin+ GSCs proliferation, colony formation, sphere formation ability in vitro. In vivo GSCs xenograft mice model showed that low FRAT1 expression suppressed the proliferation and tumorigenesity of CD133+Nestin+ GSCs and reduced β-catenin mRNA and protein expression. Furthermore, the expression of FRAT1 and β-catenin were positively correlated. Altogether, results indicate that FRAT1 enhances the proliferation, colony formation, sphere formation and tumorigenesity of CD133+Nestin+ glioma stem cells in vitro and in vivo as well as the expression of β-catenin. Therefore, inhibiting proliferation of GSCs and FRAT1 may be a molecular target to GSCs in treating human glioma in the future.

Brain arteriovenous malformation (BAVM) is an important risk factor for intracranial hemorrhage, especially in children and young adults. Inflammation has been implicated in BAVM lesion progression. Among various inflammatory components, macrophage is one of the major inflammatory cells present in human ruptured and unruptured BAVM and in the BAVM lesions of animal models. The role of macrophage in BAVM pathogenesis is not fully understood. In this review, we summarize recent studies on macrophages and introduce a non-invasive imaging protocol as a potential tool for detecting macrophage in BAVM and predicting the risk of BAVM rupture.

Background and Purpose— Silent microhemorrhage (hemosiderin) has been observed in resected brain arteriovenous malformations (bAVM) tissue and may represent a subgroup at increased risk for clinical hemorrhage. Previous studies suggest that ruptured bAVMs have faster flow and shorter mean transit time of contrast in blood vessels than unruptured bAVMs. We hypothesized that flow would be faster in unruptured AVMs with hemosiderin compared with those without hemosiderin. Methods— We selected unruptured, supratentorial bAVMs >3.5 cc with pathology specimens. Hemodynamic features were evaluated using color-coding angiography, including contrast mean transit time of AVM nidus, time to peak (TTP) of feeding artery (FA) and draining vein (DV), and the ratio (TTP DV/FA). Characteristics of 9 cases with hemosiderin and 16 without hemosiderin were compared using 2-sample t tests and Fisher exact tests. Results— No difference in FA TTP and DV TTP was observed between groups. However, cases with hemosiderin had significantly shorter mean transit time compared with those without hemosiderin (1.11±0.28 versus 1.64±0.55 seconds; P =0.013) and a lower ratio of DV TTP/FA TTP (1.48±0.32 versus 1.94±0.61; P =0.045). Presence of venous varix was significantly associated with hemosiderin ( P =0.003). No other clinical or angioarchitectural factors were associated with hemosiderin. Conclusions— Shorter mean transit time through the AVM nidus, lower DV TTP/FA TTP, and the high prevalence of venous varices suggests that high flow is an important feature of unruptured bAVMs with hemosiderin.

Background: Children with untreated brain arteriovenous malformations (bAVM) are at risk of encountering life-threatening hemorrhage very early in their lives. The primary aim of invasive treatment is to reduce unfavorable outcome associated with a bAVM rupture. A better understanding of the morbidity of bAVM hemorrhage might be helpful for weighing the risks of untreated bAVM and invasive treatment. Our aim was to assess the clinical outcome after bAVM rupture and identify features to predict severe hemorrhage in children. Methods: We identified all consecutive children admitted to our institution for bAVMs between July 2009 and December 2014. Clinical outcome after hemorrhagic presentation and subsequent hemorrhage was evaluated using the modified Rankin Scale (mRS) for children. The association of demographic characteristics and bAVM morphology with severe hemorrhage (mRS >3 or requiring emergency hematoma evacuation) was studied using univariate and multivariable regression analyses. A nomogram based on multivariable analysis was formulated to predict severe hemorrhage risk for individual patients. Results: A total of 134 patients were identified with a mean treatment-free follow-up period of 2.1 years. bAVM ruptured in 83 (62%) children: 82 had a hemorrhage at presentation and 6 of them experienced a recurrent hemorrhage during follow-up; 1 patient had other diagnostic symptoms but bled during follow-up. Among them, 49% (41/83) had a severe hemorrhage; emergency hematoma evacuation was required in 28% of them (23/83), and 24% (20/83) remained as disabled (mRS ≥3) at last follow-up. Forty-six percent (38/82) of children with hemorrhagic presentation were severely disabled (mRS >3). Forty-three percent (3/7) were severely disabled after subsequent hemorrhage. The annual rate of severe subsequent hemorrhage was 1% in the overall cohort and 3.3% in children with ruptured presentation. All the subsequent severe hemorrhage events occurred in children with severe hemorrhage history (7%, 3/41). Periventricular location, non-temporal lobe location, and long draining vein were predictors for severe hemorrhage in pediatric untreated bAVMs. A nomogram based on bAVM morphology was contracted to predict severe hemorrhage risk for individual patients, which was well calibrated and had a good discriminative ability (adjusted C-statistic, 0.72). Conclusions: Evaluating bAVM morbidity and morphology might be helpful for weighing the risks of untreated bAVM in pediatric patients.

Brain arteriovenous malformation (BAVM) is an important risk factor for intracranial hemorrhage, especially in children and young adults. Inflammation has been implicated in BAVM lesion progression. Among various inflammatory components, macrophage is one of the major inflammatory cells present in human ruptured and unruptured BAVM and in the BAVM lesions of animal models. The role of macrophage in BAVM pathogenesis is not fully understood. In this review, we summarize recent studies on macrophages and introduce a non-invasive imaging protocol as a potential tool for detecting macrophage in BAVM and predicting the risk of BAVM rupture.

Glioma is the most common malignancy of the central nervous system. Approximately 40 percent of intracranial tumors are diagnosed as gliomas. Difficulties in treatment are associated closely with the malignant phenotype, which is characterized by excessive proliferation, relentless invasion, and angiogenesis. Although the comprehensive treatment level of brain glioma is continuously progressing, the outcome of this malignancy has not been improved drastically. Therefore, the identification of new biomarkers for diagnosis and therapy of this malignancy is of significant scientific and clinical value. FRAT1 is a positive regulator of the Wnt/β-catenin signaling pathway and is overexpressed in many human tumors. In the present study, we investigated the expression status of FRAT1 in 68 patients with human gliomas and its correlation with the pathologic grade, proliferation, invasion, angiogenesis, and prognostic significance. These findings suggest that FRAT1 may be an important factor in the tumorigenesis and progression of glioma and could be explored as a potential biomarker for pathological diagnosis, an indicator for prognosis, and a target for biological therapy of malignancy.

Intracranial infection is one of the most common complications of open craniocerebral injury and of conventional craniotomy in neurosurgery. The presence of blood-brain barrier leads to lower drug concentrations in the cerebrospinal fluid than in the venous blood. Increasing the intravenous dosage or frequency carries the risk of systemic adverse reactions or infections in other parts of the body. Developing an artificial dura mater (ADM) for sustained antibiotic release for use during neurosurgery can solve the problems perfectly.Three types of drug-loaded ADMs made of collagen and containing cefuroxime sodium, ceftriaxone sodium, or norvancomycin were prepared. The antibacterial activity and sustained release characteristics of the ADMs were examined using bacteriostatic and release tests.Single-layered collagen based ADMs (40 mm×50 mm×5 mm) containing 18 mg cefuroxime sodium or ceftriaxone sodium were not suitable for continued development because of drug preservation and stability issues. Using smaller ADMs (20 mm×30 mm×7 mm), containing 4.86 mg of norvancomycin, with increased collagen density and a three-layered film with two outer drug-free films above and below the antibiotic layer resulted in sustained cumulative release of 2.91 mg (59.9%) of norvancomycin over 72 hours. The similar factor (f2) comparison method proved that products from a same batch were statistically significant similar (f250).Artificial ADMs made of collagen can be processed to provide a mature dural repair material for the sustained release of norvancomycin. This system may provide a basis for developing sustained release materials for other drugs.

To explore the changes of regional cerebral blood flow at the site of anastomosis of superficial temporal artery-middle cerebral artery (STA-MCA) to guide the preventive treatment of symptomatic hyperperfusion.A total of 35 patients with Moyamoya disease were recruited from Beijing Tiantan Hospital. There were 22 males and 13 females with an average age of 29 years (range: 5 - 55). And there were 10 children. Regional cortical blood flow (rCBF) was measured by Laser Doppler flowmeter (LDF) before, after and at Day 1, 2, 3, 4, 5 and 6 postoperation of STA-MCA anastomosis. The probe of LDF was implanted adjacent to the area of anastomosis for 144 hours to record the values of rCBF.The baseline LDF values of cortical rCBF near the area of anastomosis were (69 ± 24) PU before anastomosis, (66 ± 74) PU immediately after anastomosis, (123 ± 23) PU at the conscious time after anesthesia postoperation, (297 ± 17) PU at Day 1 postoperation. And the LDF values of the following 5 days were (302 ± 31), (317 ± 26), (272 ± 46), (363 ± 54) and (367 ± 24) PU respectively.As a safe and effective treatment for Moyamoya disease, STA-MCA anastomosis has great risks for symptomatic hyperperfusion. The highest risk time for hyperperfusion is identified after STA-MCA.

To explore the relationship between angio-architectures of cerebral arteriovenous malformations (AVM) and hemorrhage.A total of 55 consecutive surgical cases of AVM were collected in August 2010 to May 2011 at Beijing Tiantan Hospital. There were 34 males and 21 females with an average age of 32.5 years (range: 3 - 59). The initial symptoms included bleeding (n = 20), epilepsy (n = 21), headache (n = 7), neurological dysfunctions (n = 6) and others (n = 1). The relationship between size, location, type of feeding artery, type of draining vein, complicated venous aneurysm and hemorrhage was analyzed by single factor test.The cases of AVM fed by perforators, located in basal ganglia and post-cranial fossa, with small size, exclusively deep drainage and complicated venous aneurysm were more likely to present with hemorrhage.The hemorrhage of AVM is significantly correlated with many factors, such as the type of feeding artery, size and location of AVM, the type of draining vein and complicated venous aneurysm. But the number of draining vein is irrelevant.

To explore the medium and long-term outcomes of patients with Moyamoya disease (MD) undergoing surgery and conservative treatment at a single institution and analyze the related prognostic factors.A retrospective review was conducted for 97 MD patients at Beijing Tiantan Hospital from January 2000 to December 2007. They were divided into 3 groups according to treatments: superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis (n = 31), indirect vascular revascularization group (n = 38) and conservative treatment group (n = 28). The primary follow-up events included death, recurrent cerebral hemorrhage, new cerebral infarction and transient ischemic attack (TIA).All were available for analysis with the complete follow-up data. The average follow-up period of was 85 ± 38 months. In total, there were 6 deaths with all-cause mortality (6.1%). Among them, 5 (5.1%) patients died from recurrent cerebral hemorrhage. And 17 episodes of rebleeding occurred in 11 patients. Two episodes of intracranial hemorrhage were found in 4 patients. The risk of rebleeding was 17.5%. In the STA-MCA group, 23(74%) cases had excellent recovery, 5 cases fared worse and there was no death case. Among the patients undergoing indirect vascular revascularization, 28 cases recovered favorably, 4 cases progressed and 3 cases died. In the conservative treatment group, 17 patients recovered favorably, 7 progressed, 9 experienced 15 episodes of rebleeding and 3 died. Multivariate Cox regression analysis showed that the method of treatment was an independent prognostic factor for MD and surgical revascularization was superior to conservative treatment. No correlation was found between the patient age, gender, familial history, unilateral or bilateral and prognosis (P0.05). Kaplan-Meier stroke risk analysis showed the risk of recurrent hemorrhage in the revascularization surgery group was lower than that in the conservative group. And no difference existed between STA-MCA and indirect arterial anastomoses.Rebleeding is a major cause of poor prognosis, mobility and mortality in MD patients. Surgical revascularization offers better long-term outcomes than conservative treatment. And direct arterial anastomoses may decrease recurrent hemorrhage effectively.

To preliminarily explore the clinical characteristics and surgical outcomes of intracranial aneurysm.The data of 3322 cases of intracranial aneurysm from January 1955 to July 2009 were collected at our hospital for analysis. The clinical characteristics and surgical outcomes of patients with intracranial aneurysm were assessed. The surgical patients were divided into 2 groups by the date of admission: group A and group B. Such clinical characteristics as age, gender and Hunt-Hess grade at admission and first presentations were analyzed. The surgical outcomes were assessed by comparing the surgical complications between two groups.Intracranial aneurysms were commonly diagnosed between 38 and 54 years old. Hemorrhage (84.89%), mass effect (8.13%) and non-hemorrhagic headache (5.18%) were the three initial common presentations and the male-to-female ratio was 0.875:1. There was no significant statistical difference in age distribution and gender ratio between two groups. According to the Hunt-Hess grade, the percentage of grades II, III and IV was lower in group B while the percentage of grades 0 and I higher than group A. No significant difference was found in the overall incidence of major post-operative complications between two groups (P0.05).The major presentations of intracranial aneurysm are hemorrhage, mass effect and non-hemorrhagic headache. And the Hunt-Hess grades I and II patients account for a majority of aneurysms. Three most common locations of aneurysm are ICA-PCoA (internal carotid artery-posterior communicating artery), ACoA (anterior communicating artery) and MCA (middle cerebral artery). Giant aneurysm should be treated in the light of concrete conditions by choosing such a surgical approach as bypass.

To evaluate the clinical practicability of integration of functional magnetic resonance imaging (fMRI) data into neuronavigation as a tool to localize the language area and their relationship with the lesion for the preoperative planning, intraoperative guidance and postoperative follow-up study of brain functions during minimally invasive surgeries in or adjacent to functional areas.Eighty eight patients with intracranial lesions located in or adjacent to the functional language area underwent fMRI (including examinations of lingual and visual function, and motor functions of the limbs and tongue). fMRI data was entered into a neuronavigation system for image fusion and preoperative registration and correction; minimally invasive neurosurgery was performed with fMRI navigation.The shortest distance between the lesion and the functional cortex was less than 5 mm in 6 patients and was more than 5 mm but less than 10 mm in another 10 patients, respectively. 10 patients were recovered and improved in another 6 between 3 - 6 months after surgery, The follow-up time was between 3 months and 1 year. The morbidity rate was 6.8% (6/88). There was no postoperative mortality. Various brain areas were widely activated when the patients were reading and understanding the Chinese words. The unilateral speech functional maps were located in left Brodmann's 9, 46, 17, 18 and 19 areas.fMRI-integrated neuronavigation can locate functional language areas and played an important role in intraoperative protection of functional lingual areas, execution of individualized therapeutic regimens, minimization of surgical complications and determination of prognosis. Total surgical resection was safe for lesions10 mm from functional lingual areas.

Objectives: Transient postoperative hyperperfusion may be the cause of the temporary neurologic deterioration (TND) frequently observed following superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery. The purpose of this study is to investigate the possible factors influencing postoperative temporary neurologic deterioration. Methods: The STA-MCA bypass surgery was performed in 13 patients with moyamoya disease and 9 patients with cerebrovascular occlusive disease. The diameter of the STA and MCA for anastomosis was measured and analyzed. Computed tomographic perfusion (CTP) was performed prior to the operation and on the third post-operative day to assess improvements in regional cerebral perfusion. Results: After surgery, five patients (22.7 %) with improvement of perfusion suffered TND such as dysphasia, motor deficit and sensory disturbance after surgery and 11 (50 %) patients with improvement of perfusion did not show temporary neurologic deterioration after surgery. There were six patients (27.3 %) without improvement of perfusion after surgery. The D-STA was 1.48 ± 0.92 mm in patients with TND, which was larger than the D-STA of 1.10 ± 0.14 mm in patients with improvement of perfusion and 1.08 ± 0.26 mm in patients without improvement of perfusion (P 0.05). Conclusions: The D-STA and D-MCA may influence the development of TND after STA-MCA bypass, but the TOT of the recipient arteries was not related to temporary neurologic deterioration.

AIM We hypothesized that the loss of structural integrity in vessels of brain arteriovenous malformations (bAVM) is associated with abnormal expression of collagen subtypes. MATERIAL AND METHODS We retrospectively obtained the nidus tissue specimens from 24 bAVM patients and structurally normal cerebral cortex from six surgical epilepsy patients. The samples were paraffin-embedded and stained with Victoria blue and picrosirius red and examined by light microscopy. RESULTS Light microscopy showed that collagen fibers became disorganized, and the internal elastic lamina was duplicated or interrupted in the arteries from the nidus tissue of bAVM. In some vessels in the nidus, Col I was the only collagen component and the interstitial tissue was mainly comprised of Col I. bAVM patients showed significantly higher Col I levels (86.25% ±13.92) and lower Col III levels (13.75% ±13.92) in the vasculature in the nidus tissue than those of otherwise normal surgical epilepsy patients (Col I, 80.78% ±18.03; Col III, 19.22% ±18.03) (p < 0.001). Additionally, bAVM patients showed a higher Col I / Col III ratio (24.71±40.47) than that of normal controls (16.04 ±31.28) (p < 0.001). CONCLUSION bAVM patients exhibit changes in the Col I/Col III ratio and elastic fibers in the vasculature, which may compromise the structural integrity of cerebral vessels.

To evaluate the microsurgical treatment for sylvian fissure arteriovenous malformations (AVMs).The clinical data of 94 sylvian fissure AVMs treated microsurgically was retrospectively collected. They were classified as medial, lateral, deep, anterior and simple AVMs according to the anatomic location of nidus in sylvian fissure.Total lesion removal was achieved in all patients and it was confirmed by postoperative digital subtraction angiography. Transient neurological deficits, including slight hemiparesis (n = 5, 5.3%) and aphasia (n = 4, 4.3%), were documented. Another 2 patients (2.1%) presented with a postoperative epidural and an intracranial hematoma respectively. However, an excellent outcome was observed in all patients as indicated by the Karnofsky performance scale90.The microsurgical treatment for sylvian fissure AVMs has been greatly restrained by the involvement of multiple brain functional regions and its anatomic complexity. A more aggressive approach is recommended.

To describe the clinical manifestations of intracranial aneurysm in children and to evaluate the efficacy and safety of different therapeutic approaches for children with intracranial aneurysms.Clinical data of 23 pediatric patients with intracranial aneurysms diagnosed and treated at our hospital over the past 18 years were retrospectively reviewed. Follow-up data were also collected and analyzed.Two patients received no further treatment. Surgery was performed in 16 patients. Among them, 15 achieved an excellent recovery and 1 died. 5 patients were treated with Guglielmi detachable coil (GDC). Aneurysm was successfully sealed off in one case and an excellent recovery achieved; remnant aneurysm was detected in two cases. One received trapping while another underwent aneurysmectomy. The patient died postoperatively. Another received neck clipping and resection. And the patient recovered well; two cases experienced aneurysm recanalization after interventional therapy. Among them, one received a second embolotherapy but it became recanalized again. And it was finally cured by aneurysmectomy.Aneurysm surgery is proved to be a safe and effective treatment for children with intracranial aneurysm. Endovascular treatment of intracranial aneurysms with GDC is also shown to be effective and safe for pediatric patient with acute SAH. But a long-term follow-up study is required to determine the clinical outcome. Once a aneurysm remnant or recanalization occurs, a microsurgical management is recommended.

To evaluate the surgical effects of such adjuvant techniques as type B ultrasound, neuronavigation and intraoperative indocyanine green video-angiography (ICGA) on intracranial arteriovenous malformation (AVM) surgery.From January to October 2009, 43 AVM patients treated at our center were retrospectively studied, including 26 males and 17 females with an age range of 8 to 53 years old (mean: 26.51). Type B ultrasound, neuronavigation or ICGA were employed during surgical procedures in all cases. Intraoperative findings were compared with those of postoperative digital subtraction angiography (DSA) or computed tomography angiography (CTA). And the clinical outcomes were evaluated.As confirmed by postoperative DSA or CTA, the lesions of all 43 patients were totally removed. Only 3 patients (7.0%) suffered from new neurological deficits, including homonymous hemianopia in 2 patients and diplopia in 1. And the Karnofsky performance scale was higher than 80 for each patient.The feeding arteries and draining veins can be differentiated by intraoperative type B ultrasound, neuronavigation and ICGA. All three adjuvant techniques can define the lesion boundary. However, each of them has its own benefits and drawbacks. It indicates that the combination of two or more techniques may help to improve the quality and outcome of surgical procedures.

To identify the causes and risk factors of postoperative complications in elderly patients receiving meningioma removal.A total of 320 elderly patients received meningioma removal at our hospital between 1998 to 2007. Among them, 90 patients, aged 65 to 82 years old, developed postoperative complications.The diagnoses were confirmed by pathological findings. The average diameter of tumors was 5 cm. The average operative duration was 4.8 hours. Local or systemic complications occurring in this group of patients included new-onset neurological deficit (n = 37), prolonged coma (n = 16), central nervous system infection (n = 14), postoperative hematoma (n = 10), cerebral infarction (n = 7), CSF leakage (n = 12), pulmonary infection (n = 18), deep vein thrombosis or pulmonary embolism (n = 15), gastrointestinal bleeding (n = 3) and myocardial infarction (n = 2). Twelve patients died within 30 days after operation. Postoperative complications prolonged hospitalization and increased medical costs.Large size of tumors, difficulties in resection and preexisting conditions are primary causes of a high rate of operative morbidity in elderly patients receiving meningioma removal.

Standard superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery is an effective treatment for moyamoya disease, but recent evidence suggests that postoperative cerebral hyperperfusion can occur. In this study, the trendline of changes in regional cerebral blood flow (rCBF) after surgery were continually monitored near the site of anastomosis in order to investigate both the efficacy of the procedure for improving rCBF and the possible risk of hyperperfusion.Standard STA-MCA bypass surgery was performed on 13 patients. rCBF was measured continually using laser Doppler flowmetry (LDF) until the 5th day after the operation with the LDF probe implanted adjacent to the area of the anastomosis. The trendline of rCBF changes postoperatively was recorded for the analysis performed using SPSS 13.0.The baseline LDF value of cortical rCBF was (84.68 + or - 14.39) perfusion unit (PU), which was linear relative to absolute perfusion volume before anastomosis and (88.90 + or - 11.26) PU immediately after anastomosis (P0.05). The value changed significantly from before to after anastomosis (P0.05); it was (417.72 + or - 21.35) PU on the 1st day after surgery, and (358.99 + or - 18.01) PU, (323.46 + or - 17.38) PU, (261.60 + or - 16.38) PU and (375.72 + or - 18.45) PU on the following 4 days, respectively. The rCBF decreased gradually from the 2nd day until the 4th postoperative day, but still was at a high level (P0.05). However, on the 5th postoperative day the rCBF increased again to the second highest level, which was significantly different compared with the baseline value (P0.05), but not significantly different compared with the values on the other 4 days (P0.05).STA-MCA anastomosis improves the cerebral blood supply significantly in the early stage after surgery, however, the risk of symptomatic hyperperfusion may exist, which may possibly occur on the 1st day and 5th day after surgery. A LDF is useful for postoperative monitoring for both the efficacy of bypass and possible risk of neurologic deterioration or bleeding from hyperperfusion.

To summarize the experience in surgical treatment for middle cerebral aneurysm (MCAA), and results and prognosis thereof.The clinical data, including location, size, main presentations, and HuntHess grade, of 55 consecutive MCAA patients were prospectively analyzed. The surgical outcome was evaluated by Glasgow Outcome Scale (GOS). Follow-up was conducted for 23 (11-19) months.According to the HuntHess classification, there were 9 cases in grade 0, 12 cases in grade I, 23 cases in grade II, 8 cases in grade III, 2 cases in grade IV, and 1 case in grade V at admission. Headache (42 cases), vomiting (22 cases), and hemiplegia (11 cases) were the top 3 common presentations. Pterional craniotomy was adopted in all cases. Proximal to distal lateral fissure approach was used in 23 cases, distal to proximal approach in 27 cases, and trans-hematoma approach in 5 cases. There were 45 cases treated by direct neck-clipping (clipping and resecting in 6 cases), 7 cases by parent artery reconstruction, and 3 cases by wrapping by muscle. The location of MCAA was at the bifurcation in 37 cases (37.2%), at proximal middle cerebral artery (MCA) in 13 cases (23.6%), and at distal MCA in 5 cases (9.1%). The largest diameter was 15.5 (3-70) mm. The main postoperative complications included hemiplegia (12 cases), aphasia (3 cases), and seizure (2 cases). Follow-up showed good recovery in 45 cases, moderate disability in 5, and severe disability in 5 according to GOS. There was no vegetative state, death, and recurrence.With modern imaging techniques, perfect surgical plan, appropriate surgical approach, and careful microsurgical techniques, treatment of MCAA can be perfected and achieve satisfying outcome.

To compare the effects of surgical and non-surgical treatments for high-grade intracranial arteriovenous malformation (AVM), identify the determinants of neurological function deterioration after surgery, and calculate the annual hemorrhage rate.98 high-grade intracranial AVM patients underwent surgery, and 44 high-grade intracranial AVM patients underwent conservative treatment. Follow-up was conducted on 141 of these 142 patients for (54+/-36) (6-118) months. MRI and DSA were conducted before and/or after treatment on most of the patients. Glasgow outcome score (GOS) was used to evaluate the neurological functions early and more then 6 months after discharge. The clinical data of these 142 patients were retrospectively analyzed. The annual hemorrhage rate associated with these lesions was calculated.The annual hemorrhage rate of these 142 patients was 2.1%. The integrated rate of late disability and mortality of the operative group was 10.1%, remarkably higher than that of the non-operative group (25.0%). AVM size, adjacent brain functional region, Spetzler-Martin grade, deep perforating arterial supply, and intra-operative bleeding volume were significantly correlated with early and permanent neurological function deficits.The long-term outcome of operatively managed intracranial high-grade AVMs is superior to that of the non-operatively treated ones. Spetzler-Martin grade and deep arterial perforating supply are the most important determinants of neurological deficit after microsurgical resection of AVM.

To analyze the characteristics of aneurysms difficult to be treated by endovascular interventional therapy and report the results of operation.27 patients with 33 intracranial aneurysms transferred from the ward of interventional therapy, 7 males and 20 females, aged 47 (27-67), accepted microsurgical operation, The neck, volume, aspect ratio and blood vessel condition of the aneurysms were analyzed.The aneurysms difficult to be treated by endovascular interventional therapy included those with wide neck (4 mm), large volume (maximal diameteror=8 mm), and failure in endovascular maneuvers (because of flexed blood vessel and severe vasospasm). The total outcome of operation was good and no death occurred.Some aneurysms difficult to be treated by endovascular interventional therapy should be treated by microsurgical operation, which will get a better result.

To evaluate the effects of surgical microscope-based indocyanine green videoangiography (ICGA) in aneurysm surgery and compare the values of ICGA and postoperative digital subtraction angiography (DSA).101 patients with intracranial aneurysm underwent clipping of 113 aneurysms. A microscope-integrated light source containing infrared excitation light illuminated the operating field. The dye ICG was injected intravenously, and the intravascular fluorescence was recorded by a video camera attached to the microscope with optical filtering to block ambient and laser light for collection of only ICG-induced fluorescence. All patients underwent DSA 6-13 days post-operatively. The results of patency of parent, branching, and perforating arteries and documentation of aneurysm obliteration shown by ICGA and DSA were compared.219 times of ICGA was performed in these 101 patients with excellent image quality and resolution, allowing intra-operative real-time assessment of the cerebral circulation. The ICG angiographic results could be divided into arterial, capillary, and venous phases, comparable to those observed with DSA. In all cases, the postoperative angiographic results corresponded to the intraoperative ICG video angiographic findings. In 3 cases, the information provided by intraoperative ICGA significantly changed the surgical procedure.Simple and repeatable, microscope-based ICGA provides real-time information about vessels and aneurysm sac. This technique may be useful during routine aneurysm surgery as an adjunct to intraoperative microvascular Doppler ultrasonography and DSA.

To investigate the probable relationship between the genetic polymorphisms of III collagen alphal ( COL3A1) gene and sporadic intracranial aneurysm patients in China of Han nationality.Peripheral blood samples were collected from 56 randomly selected sporadic intracranial aneurysm patients and 57 control cases without intracranial aneurysm, related risk factors, subarachnoid hemorrhage, and stroke history. Genomic DNA was extracted. PCR and sequencing were performed to evaluate the frequency discrepancy of the single nucleotide polymorphisms (SNPs). After statistical analysis the polymorphism site correlated with intracranial aneurysm was further investigated with bioinformatics methods to explore the influence of the mutations of polymorphic sites on the stability of type III collagen.Both the genotype and allele frequencies of rs1800255 between the intracranial aneurysm and control group were statistically significant. There were no significant differences in the genotype and allele frequencies of thee SNPs rs2271683, rs151446, and nt2346. Data showed that the amino acid change induced by the polymorphism site could sabotage the stability of type III collagen.There is significant correlation between rs1800255 of COL3A1 gene and Chinese sporadic intracranial aneurysm patients of Han nationality, which confirms the COL3A1 gene is one of the susceptible genes of Chinese sporadic intracranial aneurysm patients of Han nationality.

To investigate the reliability and clinical value of functional magnetic resonance imaging (fMRI)-integrated neuronavigation in minimally invasive neurosurgery and protection of brain function. We demonstrate the correlation between the lesion-to-fMRI activation distance and occurrence of new postoperative deficit.fMRI-integrated neuronavigation was used for minimally invasive neurosurgery in 20 patients with intracranial lesions located in or near eloquent brain areas. During standardized paradigms for hand, foot, and tongue movement, language and visual activation, echo-planar imaging T2 blood oxygen level dependent sequences were acquired by Siemens Medical Systems Trio 3.0 T and processed with SPM2. Neuronavigation was performed with Stealth station.fMRI data was integrated into neuronavigation successfully in all cases, functional neuronavigation with integration of fMRI allowed easy and precise identification of the eloquent brain areas and lesions except for 1 case for brain shift because of tumor stroke just before the operation. The localization of the tumor was corrected by intraoperative ultrasonography. Gross total resection was achieved in 18 patients, 2 patients had a subtotal resection. Neurological deterioration was seen in 4 patients, tumors all located in eloquent brain areas, 2 patients were recovered in 3 months the morbidity was 10.0%. The distance of a lesion to fMRI activation was more than 10 mm in 14 cases. The functional maps were located in left Brodmann's 9, 46, 17, 18 and 19 areas in 11 cases when the patients reading and understanding the Chinese words.Functional neuronavigation with integration of fMRI allows precise identification of the eloquent brain areas protects the brain function and decreases the morbidity especially for Chinese patients because of our special functional area of language. Our data suggest that the distance of a lesion to fMRI activation was more than 10 mm, complete resection can be achieved safely.

To evaluate the reliability of intraoperative microvascular Doppler ultrasonography (MDU) in cerebral aneurysm surgery.MDU was conducted among 46 patients with 51 cerebral aneurysms undergoing 47 operations to examine the blood flow velocity in the aneurysmal sac and in the adjacent vessels before and after aneurysm clipping.MDU verified 6 cases of stenosis or occlusion of an adjacent vessel induced by clip positioning that had escaped detection by visual inspection (12.76%, 6/47). In addition, MDU demonstrated that one out of the 51 aneurysms failed to be occluded (1.96%). The incidence of stenosis, occlusion of adjacent vessel, and aneurysm failing to be occluded was closely correlated with the size of aneurysm, and such conditions were prone to occur in anterior communicating artery (ACoA) and internal carotid artery (ICA) aneurysms.MDU should be used routinely in cerebral aneurysm surgery, especially in cases of giant aneurysms and aneurysms without obvious neck. In cases of ACoA and ICA aneurysms, MDU is more useful.

To study the clinical and neuroimaging predictors of hematoma enlargement in spontaneous intracerebral hemorrhage (ICH).Ninety-eight patients with ICH within 4 hours of onset, 60 males and 38 females, aged 56+/-16, underwent the first CT examination at admission and the second CT examination 24 hours later to evaluate the occurrence of hematoma enlargement. Multivariate analysis was performed to assess the possible predictors.Twenty-six of the 98 ICH patients (26.5%) developed hematoma enlargement. Multivariate analysis revealed that the following 4 factors were independently associated with hematoma enlargement: interval between first CT and onset, aniso-density hematoma, consciousness level at admission, and the history of cerebral infarction. A characteristic feature indicating the hematoma enlargement- "hematoma enlargement border" was found and named.Hematoma enlargement after ICH has some clinical and neuroimaging predictors. The concepts and diagnostic criteria of aniso-density hematoma and hematoma enlargement border have been defined for the first time.

To investigate the effects and prospect of application of diffusion tensor imaging (DTI) fractography in minimally invasive surgery of brain tumors.DTI fractography was performed in 52 patients with malignant brain tumors. Based on the DTI fractography results, 34 of the 52 patients underwent operation under neuro-navigation, and 18 of the 52 patients underwent operation routine minimally invasive craniotomy and tumor resection without neuro-navigation.The rate of total tumor resection was 86.5% (45/52). The mortality was 1.9% (1/52). The disability rate was 11.5% (6/52). No case needed the second operation.DTI fractography has raised the minimally invasive neurosurgery to the level of protecting the nuclei and nerve tracts and guiding intra-operative management of infiltration of deep-seated tumors, especially when combined with neuro-navigation and interventional MRI.

To evaluate and compare the effectiveness of different types of surgical therapy for patients with hypertensive cerebral hemorrhage, and analyze the major risk factors of prognosis.2464 patients with hypertensive cerebral hemorrhage in 92 hospitals in different areas of China underwent different types of surgical treatment: Group I (n = 639), undergoing traditional craniotomy as control; Group II (n = 409), receiving minimally invasive hematoma evacuation; and Group III (n = 1416), receiving CT guided stereotaxic hematoma aspiration. The clinical data were collected and underwent multianalysis.The factors influencing the short-term prognosis were Glasgow coma scale (GCS) score before surgery and the incidence of postoperative complications in Group II; GCS score before surgery and the incidence of postoperative complications and volume of hemorrhage, duration between ictus and surgery, use of urokinase in Group III; and GCS score before surgery, muscle power before surgery, diastolic pressure at admission and postoperative complications in Group III.Analysis of prognosis related factors of cerebral hemorrhage plays a very important role in the selection of therapeutic strategy. It may be beneficial for standardizing surgical indications, further designing large scale clinical trial, helping the doctors select appropriate strategy of treatment, and serving the social population better.

To compare the efficacy and indications of the 3 approaches: conventional open craniotomy (COC), computed-tomography guided aspiration (CTGA), and key-hole approach (KHA) in neurosurgical management for hypertensive intracerebral hemorrhage (HICH).The clinical data of HICH 2464 patients, aged 14 - 75, operated on within 24 hours after stroke, with a Glasgow coma scoreor= 5, hospitalized in 135 hospitals all over the mainland of China, were collected and underwent single-blind study.Among the 2464 patients 639 underwent COC, 1416 underwent CTGA, and 409 were operated on via KHA. The overall mortality rates within one and three months after operation were 19.3% and 21.1% respectively. The mortality rate within 3 months after operation (M3m) of the patient with a GCSor= 8 was 3.5 times as much as the M3m of the patients with a GCSor= 8. The M3m of the patients with complications was 4.4 times as much as that of the patients without complications. The M3m of the patients with hemorrhage in thalamus was 2.4 times as much as that of the patients with cortical hemorrhage. The M3m of the COC group was 24.6%, higher than those of the KHA group (17.6%) and CTGA group (20,6%). The postoperative complication rate of the COC group was 29.9%, significantly higher than that of the CTGA group (24.8%, P = 0.015). There were no significant differences in postoperative complication rate between the COC and KHA groups and between the CTGA and KHA groups (both P0.05).KHA and CTGA are both better than COC in treatment of HICH with more favorable outcome and less postoperative mortality and morbidity.

To investigate the value of intraoperative real-time ultrasound during surgery of cerebral arteriovenous malformations (AVMs).Thirteen patients with cerebral AVMs, 12 supratentorial and 1 infratentorial, underwent microsurgical treatment. Intraoperative ultrasound (IOUS) with multimodality was performed before the starting of resection in order to: (1) localize and delineate the AVM, (2) differentiate the embolized and perfused parts of AVM, and (3) identify the feeding arteries and draining veins. After removal of the lesion, sonographic examination was repeated to detect the residual AVM tissue and the findings were compared with the intra- and/or post-operative angiographic finding.Total resection was achieved in all 13 patients with AVM under real-time ultrasonographic navigation. The niduses of AVM were localized and defined precisely by IOUS due to their dichromatic flow pattern. The embolized parts of AVM exhibited hyperechogenicity without blood signals. The feeding and draining vessels were distinguished from normal ones morphologically and hemodynamically. Complete removal of the AVM determined sonographically was then confirmed by angiography.Intraoperative real-time ultrasound allows accurate localization and navigation of the cerebral AVMs, provides valuable information during surgery, and helps determine the degree of removal of the cerebral AVM.

To investigate the indications, technical considerations, and effects of neuronavigation and electrocorticography (ECOG) monitoring in resection of brain cavernous malformations (CM).From 1997 to 2003, 70 patients with CM, 53 males and 17 females, aged 33 (8 - 62), underwent resection of CM using neuronavigation and neurophysiological monitoring. The first episodes included hemorrhage (31 cases, 44.3%), seizure (29 cases, 41.4%), headache (5 cases, 7.1%), and focal neurological deficit (4 cases, 5.7%). One case was asymptomatic (1.4%), only discovered during physical examination. The size of CM focus was 21 mm (5-50 mm). The depth of tumor measured from the surface was 3-70 mm. Six patients had multiple lesions. The foci were located deep in the white matter of hemispheres in 39 cases, within the brainstem in 9 cases, within the basal ganglia or thalamus in 11 cases, within the cerebellum in 5 cases, and within the optic nerve in 1 case. Preoperatively a MRI procedure using 5 skin markers was performed with the data transferred to a neuronavigation workstation, thus reconstructing a three-dimensional image of the tumor. Supratentorial subcortical lobar cavernomas underwent microsurgery through sulcus and fissure approach. ECOG monitoring was performed on 29 patients with seizure during the operation and bipolar electrocoagulation on functional cortex was conducted. Follow-up was conducted for 19.4 months (6-24 months).No intraoperative death was found. Postoperative disability rate was 8.6%. Complete removal of the lesion demonstrated by postoperative MRI was obtained in all patients. New transitory neurological deficits occurred in 4 patients after operation and recovered within 1 month. Hemiparesis developed in 1 patient with thalamus CM (1.4%) and facial paralysis developed in 1 patient with pons CM, and both recovered in 6 mouths. Nineteen out of the 24 patients with preoperative seizure history (79.2%) were postoperatively free of seizure, five (20.8%) of them showed improvement.Patients with asymptomatic CM can be kept under observation. CM deep in brain after the first bleeding is the indication of surgical treatment. Combination of neuronavigation and neurophysiological monitoring contributes to safety of operation and decrease of postoperative disability rate.

To discuss the efficacy, accuracy, and safety of computer-assistant neuronavigation in operation of vertebrae and spinal cord.The data of computer-assistant neuronavigation used in the operation for 41 cases, including 9 cases of neurinoma, 10 cases of ependymoma, 5 cases of angioreticuloma, 7 cases of spinal meningioma, 4 cases of astrocytoma, and 1 case of cysticercosis, and 1 case of osteoblastoma. from March 2001 to December 2003 were reviewed.Twenty-six screws were fixed in 4 patients. Total removal was succeeded in 33 of the 37 cases of 37 spinal tumors and all patients survived after operation.Image-guided navigation for spinal surgery is able to save time and reduce operational lesion. More importantly, it improves neurosurgeon's comprehension of spinal anatomy.