Objective: The aim of this article was to comprehensively examine the current and project burden of hypertensive cerebral hemorrhage in southwest region of China.Methods: Summary and analysis of the data of the patients from the Sichuan Province Forestry Centre Hospital, the Second Affiliated Hospital of Kunming Medical University, the West China Hospital of Sichuan University, the Yunnan University of Traditional Chinese Medicine, 2010-2017.Results: The medical cost of patients with hypertensive intracerebral hemorrhage was estimated at RMB 12196.00(USD 1896.73) per person per year.The total costs of intracerebral hemorrhage were higher in surgery group (RMB 36632.50 or USD 5697.12)than non-surgery group (RMB 6333.00 or USD 984.91).The direct medical costs of surgery group were RMB 32534.00(USD 5059.72), in contrast with the costs of non-surgery treatments, which were RMB 3781.75 (USD 588.14).Conclusion: In this paper, all 1640 cases of hypertensive intracerebral hemorrhage research data and follow-up data, we learned that the economic burden of hypertensive cerebral hemorrhage is heavy for the Chinese people and the nation.

Objective To investigate the epidemiological characteristics,clinical manifestations and treatment of intracranial aneurysms in infants.Methods From January 2010 to December 2016,6 256 cases of intracranial aneurysms were consecutively admitted to Neurosurgery Department of West China Hospital of Sichuan University,6 (0.1％o) of whom were less than 1 years old.Among them,the youngest was 2 months old and the oldest was 11 months old.We retrospectively analyzed medical records of the 6 patients with ruptured intracranial aneurysms.In those 6 cases,5 patients were female,and 1 was male.The time of diagnosis in 6 cases was from 8 to 144 hours,and the primary symptom was vomiting in 4 cases.Convulsions were reported in 3 cases.All 6 cases had single aneurysms with mean diameter of 0.4-1.5 cm and included 1 with vertebrobasilar fusiform aneurysms (untreated) and 5 cases with cystic aneurysms from middle cerebral artery (MCA).Those 5 patients included 2 cases of pseudoaneurysms and all underwent craniotomy for aneurysm clipping.Results All aneurysms were successfully clipped in 5 cases with MCA aneurysms.None of them had complications such as cerebral vasospasm,cerebral infarction,hydrocephalus,intracranial infarction or cerebrospinal fluid leakage.The postoperative follow-up lasted for 7-68 months and no residual or recurrent aneurysm was found in CTA examination.Their intellectual development was normal and the muscle strength in the limbs recovered obviously in 5 patients,of which 1 was grade Ⅳ and 4 were grade Ⅴ.The Glasgow outcome scale was used to assess the outcome which revealed Ⅳ-Ⅴ in the 5 patients.Conclusions The incidence of infantile intracranial aneurysms is very low which mostly occurs in MCA.Due to lack of specific demonstrations,delayed diagnosis might be common for ruptured intracranial aneurysms in infants.In addition,infants with ruptured intracranial aneurysms might have good outcomes following surgical treatment.

33 BACKGROUND: Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are 34 challenging lesions with high morbidity and mortality. Currently, both surgical and endovascular 35 approaches have been used to treat the BBAs; however, little is known about their safety and 36 efficacy. 37 OBJECTIVE: To review our experience with the treatment of BBAs and explore the optimal 38 treatment strategy. 39 METHODS: A total of 83 patients with BBAs were reviewed retrospectively. The characteristics 40 of the patients and the aneurysms, treatment results, and follow-up outcomes were analyzed. 41 RESULTS: The cohort comprised of 52 females and 31 males with a mean age of 46.6 years, 33 42 patients were assigned to the microsurgical therapy. Subsequently, 27/33 patients underwent 43 surgical clipping, 4/33 underwent trapping without bypass, and 2/33 underwent wrapping; 44 whereas, the 50 patients underwent endovascular therapy, including stent-assisted coiling (49 45 cases) and coiling (1case). The intraoperative rupture occurred in 14 and 4 cases in the 46 microsurgical and endovascular groups, respectively. Ischemic events occurred in 16 and 8 cases 47 in the microsurgical and endovascular groups, respectively. At 1-year follow-up, a favorable 48 clinical outcome was achieved in 18 (54.5%) and 38 (76.0%) patients in the microsurgical and 49 endovascular groups, respectively. The multivariate regression model showed that the treatment 50 strategies, Fisher grade, and vasospasm contributed significantly to the prediction of outcome for 51 1 year 52 CONCLUSION: BBAs are challenging vascular lesions with poor prognosis. Endovascular 53 treatment may be more effective and safe with better outcomes than the surgical approaches. 54

Aim: To analyze the direct medical costs of hospitalized spontaneous intracerebral hemorrhage patients, and investigate the characteristics of cost distribution and its influencing factors in southwest China.Material and Methods: Clinical data and medical cost of spontaneous intracerebral hemorrhage patients were prospectively enrolled in the database from Jan 2009 to Dec 2010, followed by statistical analysis. Various factors affecting the economic burden of spontaneous intracerebral hemorrhage patients were analyzed in a multivariate linear regression model.Results: A total of 328 spontaneous intracerebral hemorrhage patients were enrolled in this study. The mean direct medical cost during hospitalization was 17028 RMB. The proportions of medication cost and surgery cost were the highest, accounting for 41.8% and 30.2% respectively. Hospitalization duration (P < 0.001), treatment methods (surgery vs. non-urgery, P < 0.001; conventional craniotomy vs. endoscopic surgery, P < 0.001), pulmonary infection (P < 0.001), rehemorrhage (P < 0.001) and Glasgow coma scale score at admission (P = 0.042) were main factors affecting per capita direct medical costs.Conclusion: Direct medical costs of spontaneous intracerebral hemorrhage patients depend on the disease severity, hospitalization duration, treatment methods and complications. For those spontaneous intracerebral hemorrhages without clear surgical indication, hasty surgery will greatly increase the direct medical costs. For most cases needing hematoma evacuation, the endoscopic surgery may help to reduce the hospitalization cost and enhance the costbenefit ratio.

AimTo determine an optimal head elevation degree to decrease intracranial pressure in postcraniotomy patients by meta-analysis.BackgroundA change in head position can lead to a change in intracranial pressure; however, there are conflicting data regarding the optimal degree of elevation that decreases intracranial pressure in postcraniotomy patients.DesignQuantitative systematic review with meta-analysis following Cochrane methods.Data sourcesThe data were collected during 2014; three databases (PubMed, Embase and China National Knowledge Internet) were searched for published and unpublished studies in English. The bibliographies of the articles were also reviewed. The inclusion criteria referred to different elevation degrees and effects on intracranial pressure in postcraniotomy patients.Review methodsAccording to pre-determined inclusion criteria and exclusion criteria, two reviewers extracted the eligible studies using a standard data form.ResultsThese included a total of 237 participants who were included in the meta-analysis. (1) Compared with 0 degree: 10, 15, 30 and 45 degrees of head elevation resulted in lower intracranial pressure. (2) Intracranial pressure at 30 degrees was not significantly different in comparison to 45 degrees and was lower than that at 10 and 15 degrees.ConclusionPatients with increased intracranial pressure significantly benefitted from a head elevation of 10, 15, 30 and 45 degrees compared with 0 degrees. A head elevation of 30 or 45 degrees is optimal for decreasing intracranial pressure. Research about the relationship of position changes and the outcomes of patient primary diseases is absent.

Objective To investigate the clinical characteristics and outcomes in very elderly patients with primary intracerebral hemorrhage (PICH).Methods Patients with PICH,who were admitted to the Department of Neurosurgery and Department of Neurology,West China Hospital,Sichuan University between January,2009 and December,2010,were consecutively and prospectively enrolled in this study.Data on PICH patients were collected which included demographics,risk factors,blood pressure and GCS on admission,treatment and neurological imaging results.Patients were divided into two groups:the very elderly (≥80 years old) group and the control group.Patients were followed up at time points of 1-month,3-month and 6-month to verify their death and disability.Results Of the 909 cases,60 patients were in very elderly group.The very elderly patients had apparently lower diastolic pressure than patients in control group on admissi on (89.5 mm Hg vs 99.5 mm Hg,P ＜ 0.001),and had lower proportion of recieving surgery treatment (13.3％vs 28.6％,P =0.01).Compared to the control group,the very elderly patients had a lower frequency of basal ganglia hemorrhage (30.0％ vs 54.2％,P ＜ 0.001),but a higher proportion of cerebellar hemorrhage(15.0％ vs 6.8％,P =0.035).Moreover,the very elderly patients had higher rates of death and disability in 1-month,3-month and 6-month follow-up,but the difference was not statistically significant.Multivariate logistic regression determined that age and GCS score were the independent factor for the 6-month death of very elderly patients with PICH (P =0.025,P =0.004).Conclusions There were some differences in clinical characteristics,intracerebral hemorrhage location and treatment between the very elderly patients and yonger people with PICH,however,these differences do not seem to influence long-term outcome.

Rationale Seizures after intracerebral hemorrhage are a common complication and may adversely affect neurological outcome. However, studies are inadequate on the utility of prophylactic anticonvulsant therapy in patients with hemorrhagic stroke, and the results remains controversial. Aims This study aims to determine if short-duration sodium valproate prevents seizure onset or improves the survival and neurological outcome in adults after acute spontaneous supratentorial intracerebral hemorrhage. Design In this randomized, double blinded, placebo-controlled trial, 258 patients meeting the inclusion criteria will be enrolled in the Department of Neurosurgery, West China Hospital. In addition to standard care, patients will be randomly assigned to receive seven-day prophylaxis of sodium valproate 500 mg daily (alternatively 400 mg daily by intravenous infusion in 250 ml 0·9% normal saline) or matching placebo. Patients will be followed up at seven-days, 3, 6, and 12 months. Study outcomes The primary outcomes are early (≤7 days) and late onset seizures (>7 days). Secondary outcomes include midline shift, enlargement of hematoma, death (all cause), adverse effects, and functional outcome assessed by Glasgow Outcome Scale and modified Rankin Scale. Discussion Given the lack of evidence for seizure prophylaxis in patients with acute supratentorial intracerebral hemorrhage, randomized controlled trials are desperately needed. The results from our study are believed to directly influence future prophylactic anticonvulsant therapy of intracerebral hemorrhage.

Objective To study the treatment strategies and surgical indications of hypertensive brainstem hemorrhage.Methods A retrospective analysis of the clinical data in 77 cases with hypertensive brainstem hemorrhage (HBH)from January 2010 to January 2012 in West China Hospital of Sichuan University was carried out.The treatment and efficacy between the different levels of groups of HBH were compared.Results Of the 77 patients,25 hemorrhage located in the midbrain,33 in the pons and 19 in the medulla oblongata.22 patients underwent surgery;55 patients received conservative treatment.According to percentage of the maximum level of brainstem hemorrhage area and the brainstem area,there were 43 patients in small hematoma group (≤50％),and 34 cases in large hematoma group (＞ 50％).In small hematoma group,all cases received conservative treatment;In large hematoma group,22 patients received craniotomy to remove the hematoma,and conservative treatment of 12 cases.The mortality of conservative treatment during the hospitalization was 20.0％ (11/55) ; and mortality of surgical treatment was1 8.2％ (4/22).The mortality of small hematoma group was 4.7％ (2/43) ;large hematoma was 38.2％ (13/34).The difference of two groups had statistical significance (P ＜ 0.05).In large hematoma group,the mortality of surgical group18.2％(4/22) was significantly lower than conservative group75.0％ (9/12) (P ＜ 0.05).Conclusions Patients with small hematoma (≤ 50％) of HBH preferred the conservative treatment.The efficacy and prognosis of surgical treatment were significantly better than conservative treatment in large hematoma group (＞ 50％)Follow the surgical indication for HBH,it can effectively reduce the mortality of HBH.

脑出血是神经科最为常见的急重症,近半个世纪以来,尽管众多学者对该疾病进行了广泛研究,但不少问题仍未解决.在此前笔者所发表的相关述评及文章中,已对脑出血手术指征、手术技巧及血压管理等重要问题进行了介绍,但仍有不少尚无定论之处,值得重视和争鸣,如命名、病因及术后各种处理等. 一、命名 脑出血即国内传统所称的高血压脑出血,是指排除了肿瘤、动静脉畸形(AVM)、动脉瘤、血液病等继发因素的脑内出血,部位以基底节区和丘脑最常见,也可发生在脑室、脑叶、脑干及小脑等部位.脑出血在亚洲发生率较高,约占卒中患者的25％～50％,欧美仅占卒中患者的5％ ～15％[1-3].在国内外的文献中,对脑出血至今缺乏公认的命名和分型,有欧洲学者将脑出血分为原发性脑出血、继发性脑出血和原因不明性脑出血[4-5],在美国将脑出血命名为非动脉瘤性、非AVM性、非肿瘤性自发性脑出血[6].

Objective To fully understand influencial factors,etiology and risk factors of IVH in Sichuan province for providing evidence and establishing foundation for the future clinical research on measures of prevention and cure of IVH.Methods This study included patients from 3 Third grade hospitals of Sichuan province based on collaborative multi-center registration of stroke patients.Data collection in IVH patients,including demographic factors,risk factors,clinical manifestations,and auxillary examination reports.Data were inserted,managed and statistically treated and analysed using PASW For Windows 18.0 software pakage.Results Altogether 660 hospitalized IVH patients fulfilling the inclusion criteria were consequetively registered in the three study centre.Among them,416 cases (63.0％) were male and 224 cases (37.0％) were female.Age ranged from 17 to 93 years with a mean age of 60.4 ± 13.8years.Causes of PIVH included hypertension in 31 patients (31.3％),aneurysm in 13 cases (13.1％),vascular malformations in 18 cases (18.2％),moyamoya disease in 24 patients (24.2％) and idiopathic in 13 cases (13.1％).While causes of SIVH included hypertension in 391 patients (69.7％),idiopathic in 162 patients (28.9％),aneurysms in 3 cases (0.5％),vascular malformations in 3 cases (0.5％) and cerebral amyloid angiopathy 2 cases (0.4％).There was significant difference in GCS score distribution during admission between PIVH and SIVH,P ＜ 0.05.IVH scores between groups was not statistically different.In PIVH:47 cases (47.5％) underwent surgery,32 cases (32.3％) had conservative management,18 cases (18.2％) had GKS and 2 cases (2.0％) had endovascular intervention.While in SIVH:175 cases (31.2％) underwent surgery,383 cases (68.3％) had conservative management and 3 cases(0.5％) had endovascular intervention.There was statistical significance between groups having surgical,conservative and GKS management,P ＜ 0.05.Multivariate logistic regression analysis showed age and hypertension were independent risk factors for SIVH.Conclusions Among the similar study of IVH in China or abroad,this prospective research had the largest sample size.It was the first consecutive observational study of high research quality and reliable conclusion.This study provided evidence and established foundation for the future clinical research on measures of prevention and cure of IVH.

Objective To investigate the treatment strategies, efficacy and surgical indications of hypertensive thalamic hemorrhage.Methods A retrospective analysis of the clinical data of 137 cases with hypertensive thalamic hemorrhage (HTH) from January 2008 to January 2010 in West China Hospital of Sichuan University were performed to compare the efficacy and prognosis between surgical treatment group and conservative treatment group.Results Of the 137 patients, 62 patients underwent surgery and 75 patients receivedconservative treatment.In small hematoma group, 22 patients underwent borehole and drainage and 55 cases received conservative treatment.In large hematoma group, 40 patients received craniotomy to remove

根据世界卫生组织(WHO)关于年龄划分的最新标准,18～44岁为青年[1].青年高血压脑出血是指年龄≤44岁的成人由于高血压和脑动脉硬化自发出现的脑实质内出血,其在发病率、危险因素及临床诊治等方面均与中老年高血压脑出血有所不同,具有发病急骤、进展快、致残率高等特点.为此,作者对我院收治的73例青年高血压脑出血患者的临床资料进行回顾性分析,为临床诊治提供依据和参考。

Objective The Objective of the present study is to determine whether the time of onset of the hemorrhage is associated with seasonality and to find out a possible relationship between its incidence in a determined area and meteorological variables.Methods Data were obtained from 10 medical centers in two of downtown districts of Chengdu, From November 1, 2005, to October 30, 2009, all consecutive adult patients with a spontaneous primary cerebral hemorrhage, were examined in this retrospective study.Seasonal variation was calculated for the whole period.The correlation between ICH incidence and meteorological variables was also investigated.Results Among the seasons, seasonal ICH incidence per 100,000 person-years was highest in winter (45.3,95% CI:39.1 ～51.5) and lowest in summer (24.1,95% CI:20.8～27.4) with significant difference.Winter incidence was highest in both men and women,and in subjects younger than 60 years as well as subjects 60 or older.The seasonal variation showed a high correlation with with temperature, air pressure , humidity, sunshine and wind.Conclusions The incidence of spontaneous cerebral hemorrhage showed a seasonal variation which induced a correlation with meteorological variables.ICH incidences appear to be highest in the cold winter among the population.Factors that explain this excess need further investigation.

Objective To analyze the clinical characteristics, risk factors and therapy of extremely elder patients with intracerebral hemorrhage.Methods The clinical data , therapeutic efficacy and prognosis of 35 extremely elder patients( ≥80 years old) with intracerebral hemorrhage in our hospital from September 2009 to October 2010 were reviewed.Results 31 cases (88%) received conservative treatment, 4 cases( 11% ) received craniotomy.The incidence of complications was 97% (34/35), and the mortality was 11% (4/35).The Glasgow Outcome Scale (GOS) were ranged from 2 to 5 (3.25 ± 1.44) in 31 discharged patients.6 cases were died during follow - up period (3 - 6 months ) .Conclusions Compared with elder patients, the clinical characteristics, site of hemorrhage and therapy of extremely elder patients with intracerebral hemorrhage are specific.For their treatment, conservative method should be prefered.

Objective To investigate the skills and efficacy of microsurgery in the treatment of giant intracranial aneurysms.Methods The clinical data of 80 patients with giant intracranial aneurysms treated with microsurgery were analyzed retrospectively,77 of them underwent performed aneurysm neck clipping,2 aneurysms were isolated,and 1 had vascular bypass graft and aneurysm resection.The results were monitored routinely with intra-operative indocyanine green angiography after the procedures.The prognosis was observed on the basis of the Hunt-Hess grading,the different location of aneurysms,and the timings of operation,and assessed according to the Glasgow outcome scale ( GOS ) .Results Of the 80 patients,67 (83.8%) had good GOS score,9 ( 11.2 %) had poor GOS score at discharge and 4(5% ) died.①Of the 73 patients with Hunt-Hess grade O - Ⅲ,65 (89.0% ) had good prognosis.Of the 7 patients with Hunt-Hess grade IV only 2 had good prognosis.There was significant difference (χ~2 = 13.006,P 0.001).②The rates of good result of posterior communicating artery aneurysms,middle cerebral aneurysms,paraclinoid aneurysms and vertebral - basilar artery aneurysms were 92.8% ,91.7% ,60% and 70% respectively;In view of the number of cases is few in each group,there were no significant differences in comparison (χ~2 =5.599 ,P 0.05).③In 56 patients with subarachnoid hemorrhage,the rate of good result was higher in patients whose surgery timing was 3 days as compared with≤3 days.There was significant difference (χ~2 =9.088,P 0.05).Conclusion The key to successful operation for giant intracranial aneurysm is sufficient operative exposure,temporary occlusion of the parent artery,adjust the aneurysm clips for good remodeling of the aneurysmal neck,and making preparations for vascular bypass graft if necessary. The surgical efficacy is associated with the Hunt-Hess grading and the timing of surgery.

高血压脑出血起病急骤,预后差,死亡率较高.目前,内科尚缺乏有效的治疗手段[1-2].随着神经影像学的进步和显微外科、微创理念技术的发展,外科治疗高血压脑出血的优势逐渐显现.但是,需要注意和解决的问题仍很多,有待于进一步强化和规范。

Objective To define the clinical features, risk factors, etiology and prognosis of primary intraventricular hemorrhage (PIVH).Methods We prospectively formulated strict inclusive criteria and consecutively collected patients with diagnosis and treatment for PIVH in our hospital from September 2008 to October 2010.The clinical information, laboratory examinations, treatment and prognosis were analyzed.Results 47patients(27 males and 20 females, a ratio of 1.35: 1, with an average age of 52.6 ± 12.6 years old) were internalized in the study.The initial symptoms were headache in 24 cases, and disturbance of consciousness in 23 cases.The GCS score was 10.8 ± 2.6 and Graeb score was 5.8 ± 2.6.Combined obstructive hydrocephalus was found in 22 cases (47%).The diagnosis of moyamoya disease was confirmed in 12 patients (26%), while vascular malformations in 10 (21%) and aneurysm in 5( 11% ).The other 20 patients had unknown etiology (43%).Craniotomy was performed in 12 cases (26%), craniotomy combined EDAMS in 6(13%), EDAMS in 5(11% ), EDAMS combined with anastomosis in 1(2% ), ventricular drainage in 3(6% ), γ-knife in 8( 17% ), interventional therapy in 2(4% ), and conservative treatment in 10 patients (21%).All patients were followed - up for 6 months.7 cases of hospital mortality (15%) were found.31 patients (66%) got less than 3 points of mRS score at the end of the 6th month, and 9 patients ( 19% ) had greater than or equal to 3 points.After discharge there was no death.Conclusion PIVH is relatively rare in clinical practice.The age of onset for PIVH is relatively small.Moyamoya disease, AVM and aneurysm are ranked the top three causes, and hypertension is the most important risk factor.Through reasonable treatment, patients with PIVH could get better prognosis.Age, hypertension, diabetes, smoking history and admission GCS score could predict hospital mortality in varying degrees.