BACKGROUND:This study was designed to investigate the anatomical feasibility and operative safety of contralateral C7 nerve transfer through a posterior keyhole approach assisted by a tubular retractor under microscopy. METHODS:Microsurgical dissection was performed on 10 fresh adult head and neck specimens. With the specimens positioned in a prone neck-flexed posture, bilateral 2 cm incisions were simulated for the insertion of the operative channel. Stepwise dissection was carried out to expose and mobilize the contralateral and ipsilateral C7 nerve roots. A laminar-underlying epidural corridor was established to achieve direct end-to-end neurorrhaphy. RESULTS:Tension-free coaptation of bilateral C7 nerves was successfully achieved in all specimens. Measurements revealed that the prone neck-flexed position significantly increased the area of zone V by 20.73 ± 8.12 mm2, thereby improving surgical exposure. The nerve transposition distance was 30.30 ± 4.20 mm, while the obtainable length of the contralateral C7 nerve was 52.40 ± 3.10 mm, which permitted direct anastomosis without the need for nerve grafting. Furthermore, the distance from point V to the C7 nerve root was 2.45 ± 0.72 mm, and the distance from the medial edge of the facet joint to the nerve root was 2.28 ± 0.98 mm, indicating that adequate nerve root exposure could be attained without facetectomy, thus preserving cervical stability. The diameter of the mobilized contralateral C7 nerve stump was 3.60 ± 0.45 mm, and the width of the transposition pathway was 4.12 ± 0.41 mm, suggesting no risk of nerve compression by the lamina. CONCLUSION:The posterior keyhole approach is demonstrated to be anatomically sound and technically reliable for contralateral C7 nerve transfer. Its advantages-minimal invasiveness, short trajectory, favorable operative space, and elimination of nerve grafting-provide a robust anatomical foundation for clinical application.

This meta-analysis evaluates the efficacy and safety of middle meningeal artery embolization (MMAE) combined with surgery versus surgery alone in chronic subdural hematoma (CSDH). We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing MMAE combined with surgery to surgery alone. And outcomes were pooled using a random-effects model. Primary efficacy outcome was treatment failure (recurrence or reoperation). Trial sequential analysis (TSA) employed to assess the robustness of the evidence for treatment failure. Primary safety outcomes included serious adverse events. Secondary efficacy outcomes included changes in hematoma volume, hematoma thickness, and functional independence (modified Rankin Scale [mRS] 0–2). Secondary safety outcome was all-cause mortality. A total of six RCTs, involving 1,222 patients, were included in the analysis. MMAE combined with surgery significantly reduced treatment failure risk (RR 0.56, 95

OBJECTIVE:To investigate the functional connectivity (FC) characteristics of Ascending Reticular Activating System (ARAS) in patients with disorders of consciousness (DOC) following severe traumatic brain injury (sTBI), while introducing the Linear support vector machine (LSVM) to predict the recovery of consciousness. METHODS:Resting-state MRI was used to measure FC changes between the brainstem ARAS nuclei and whole-brain voxels. We compared the differences in FC between sTBI patients and healthy controls, as well as between the wake and DOC groups. Furthermore, the LSVM model for consciousness recovery was developed based on the Z-values of regions of interest (ROIs) and/or scale to distinguish the prognosis of sTBI patients. RESULTS:A total of 28 sTBI patients with DOC and 30 healthy controls were included, with no significant baseline differences (p > 0.05). Using the brainstem ARAS nuclei as the ROI, we observed increased FC in the subcortical regions compared to healthy controls. The strength of FC was significantly different between patients who recovered consciousness and those who did not at 6 months post-sTBI (AlphaSim corrected, p < 0.05, Cluster > 154). Furthermore, the LSVM model demonstrated strong predictive performance, with an area under the receiver operating characteristic curve of 0.81-0.98. CONCLUSIONS:Our study suggest that the disruption FC of ARAS from the subcortex to the cortex may be associated with DOC and prognosis in sTBI patients. Furthermore, the LSVM model shows potential value in distinguishing the recovery of consciousness.

OBJECTIVE:The aim of this study was to incorporate biomarkers into an inflammatory score to improve risk prediction of coagulopathy and hemorrhagic progression of a contusion (HPC) in patients with traumatic intraparenchymal hemorrhage (tIPH), and to further explore the interaction and mediation effects within the chain of events. METHODS:In this retrospective study, the medical records of patients with tIPH who received treatment at two centers from January 2019 to December 2021 were reviewed. Machine learning algorithms were applied for biomarker selection, and an inflammatory score was constructed. Multivariate logistic regression was used to assess the association between the inflammatory score, coagulopathy, and HPC. Measures on multiplicative and additive scales, as well as mediation effects, were subsequently estimated. Finally, by incorporating the inflammatory score, a hybrid model of HPC occurrence was established and validated. RESULTS:A total of 451 patients (median age 54 years [IQR 45-66 years]) with tIPH were included in this study. The inflammatory score was developed using a combination of parameters, including the mean platelet volume, lactate dehydrogenase level, pan-immune-inflammation value, hemoglobin-to-red blood cell distribution width ratio, and C-reactive protein-to-albumin ratio. The multivariate analysis confirmed that the inflammatory score was independently associated with both coagulopathy and HPC. Additionally, the effect of a high inflammatory score on HPC occurrence was partially mediated by coagulopathy, demonstrating both direct mediation and mediated interaction effects. As a key mediator, coagulopathy accounted for 9.6% of the positive associations. Furthermore, incorporating the inflammatory score into the hybrid model demonstrated significant incremental predictive value across the training, internal, and external test sets. CONCLUSIONS:The inflammatory score was significantly associated with HPC, and this relationship was partially mediated by coagulopathy, with a potential synergistic interaction observed. The hybrid model improved HPC risk prediction.

INTRODUCTION:For patients with acute ischaemic stroke caused by large vessel occlusion (LVO), there is limited evidence regarding the long-term outcomes of endovascular treatment (EVT) compared with best medical treatment (BMT). The objective of this study was to evaluate the long-term efficacy and safety of EVT in LVO stroke patients. METHODS:This study systematically searched electronic databases from January 2015 to August 2024 and included seven eligible trials. These studies reported 1-2 year of follow-up data on functional independence (modified Rankin Scale [mRS] score 0-2), distribution of mRS on shift analysis, quality of life (European Quality of Life 5-Dimensions Questionnaire score), and mortality. RESULTS:A total of 1,236 patients who received EVT and 1,122 who received BMT were included in the analysis. Compared with BMT, EVT was associated with a significantly greater likelihood of functional independence (odds ratio [OR] 2.55, 95% confidence interval [CI], 1.76-3.70), improved distribution of mRS scores on shift analysis (common OR 1.67, 95% CI, 1.37-2.02), and a better quality of life (beta coefficient 0.13, 95% CI, 0.07-0.19) at 1-2 years of follow-up. Compared with BMT, EVT was also associated with lower rates of all-cause mortality (OR 0.67, 95% CI, 0.56-0.81). Compared with 90-day follow-up, long-term follow-up demonstrated an improvement in functional independence among LVO stroke patients (1.7% vs. 0.2%), whereas the increase in mortality was slower (9.3% vs. 11.3%). CONCLUSIONS:This meta-analysis indicated that LVO stroke patients can achieve long-term benefits following EVT. The findings provide valuable evidence to inform clinical decision-making.

BACKGROUND:This study aims to investigate a safer and more minimally invasive method for transferring the contralateral C7 nerve in the treatment of central spastic paralysis of the upper limb, while also providing anatomic data to support this approach. METHODS:Eight anatomic specimens from the head and neck were utilized: 4 dry specimens were used to measure anatomic data, whereas the other 4 fresh specimens were used to simulate the transposition of the contralateral C7 nerve for observing bilateral nerve anastomosis. Relevant anatomic landmarks and their surrounding relationships were examined using a neuroendoscope, and anatomic data were subsequently measured and analyzed. RESULTS:The modified anterior vertebral approach, assisted by a neuroendoscope, can expose both the affected and contralateral C7 nerve roots, vertebral arteries, and the middle trunk of the brachial plexus on the contralateral side. It can also facilitate the completion of bilateral C7 nerve transfer within the affected side's longus colli muscle tunnel, with tension-free suturing achieved without the need for nerve bridging. Measurement results from dry specimens: The angle between the C7 nerve and the spine was 63.6±3.8 degrees, the horizontal distance from the vertebral artery to the midline of the spine was 2.44±0.54 cm, and the horizontal distance from the C7 horizontal vertebral artery to the midline of the spine, as measured by imaging, was 2.46±0.14 cm. The difference between the 2 measurements was not statistically significant ( P >0.05). The measured nerve displacement in fresh specimens was 4.62±0.37 cm, and the length of the C7 nerve was 7.87±0.55 cm. CONCLUSION:The experiments confirmed that the neuroendoscopy-assisted modified anterior vertebral approach is a simple, effective, and safe method for contralateral C7 nerve transfer. This approach involves a short nerve transfer distance and does not necessitate nerve transplantation. It may serve as a safe and effective surgical method for treating central upper limb spastic paralysis. The anatomic parameters obtained in this study will aid in the implementation of this procedure.

Acute spinal cord injury (SCI) induces mitochondrial oxidative stress, cellular bioenergetic crises, impaired protein degradation, and subsequent degeneration, resulting in increased neuronal vulnerability. Transplantation of exogenous mitochondria to the injury site mitigates cellular energy crises and counteracts neurodegeneration; however, the limited efficacy of mitochondrial transplantation alone constrains its therapeutic potential. In this study, we established a right-sided spinal cord hemisection model at the T10 thoracic segment in rats and transplanted a methacrylate-based gelatin (GelMA) hydrogel containing active mitochondria at the injury site to assess its therapeutic effects and underlying mechanisms. Our findings indicate that GelMA hydrogel combined with mitochondrial transplantation provides superior therapeutic benefits for SCI compared to mitochondrial transplantation alone. GelMA hydrogel enables sustained mitochondrial release at the injury site, supplying energy, upregulating NF200 expression, and promoting axonal regeneration. Additionally, it enhances M2 macrophage accumulation and improves the local inflammatory microenvironment. The structural framework of GelMA hydrogel further supports axonal regeneration. Footprint gait analysis and Basso, Beattie, and Bresnahan (BBB) motor scoring demonstrated that GelMA hydrogel combined with mitochondrial transplantation significantly improves motor function in the right hind limb of rats with SCI. Consequently, GelMA hydrogel combined with mitochondrial transplantation offers a viable and promising approach for treating spinal cord injury.

Patients diagnosed with glioblastoma (GBM) have the most aggressive tumor progression and lethal recurrence. Research on the immune microenvironment landscape of tumor and cerebrospinal fluid (CSF) is limited. At the single-cell level, we aim to reveal the recurrent immune microenvironment of GBM and the potential CSF biomarkers and compare tumor locations. We collected four clinical samples from two patients: malignant samples from one recurrent GBM patient and non-malignant samples from a patient with brain tumor. We performed single-cell RNA sequencing (scRNA-seq) to reveal the immune landscape of recurrent GBM and CSF. T cells were enriched in the malignant tumors, while Treg cells were predominately found in malignant CSF, which indicated an inhibitory microenvironment in recurrent GBM. Moreover, macrophages and neutrophils were significantly enriched in malignant CSF. This indicates that they an important role in GBM progression. S100A9, extensively expressed in malignant CSF, is a promising biomarker for GBM diagnosis and recurrence. Our study reveals GBM’s recurrent immune microenvironment after chemoradiotherapy and compares malignant and non-malignant CSF samples. We provide novel targets and confirm the promise of liquid CSF biopsy for patients with GBM.

BackgroundPsychiatric traits have been associated with intracerebral hemorrhage (ICH) in observational studies, although their causal relationships remain uncertain. We used Mendelian randomization analyses to infer causality between psychiatric traits and ICH. MethodsWe collected data from genome-wide association studies of ICH (n = 361,194) and eight psychiatric traits among Europeans, including mood swings (n = 451,619), major depressive disorder (n = 480,359), attention-deficit/hyperactivity disorder (n = 53,293), anxiety (n = 459,560), insomnia (n = 462,341), schizophrenia (n = 77,096), neuroticism (n = 374,323), and bipolar disorder (n = 51,710). We performed a series of bidirectional two-sample Mendelian randomization and related sensitivity analyses. A Bonferroni corrected threshold of p < 0.00625 (0.05/8) was considered to be significant, and p < 0.05 was considered suggestive of evidence for a potential association. ResultsMendelian randomization analyses revealed suggestive positive causality of mood swings on ICH (odds ratio = 1.006, 95% confidence interval = 1.001-1.012, p = 0.046), and the result was consistent after sensitivity analysis. However, major depressive disorder (p = 0.415), attention-deficit/hyperactivity disorder (p = 0.456), anxiety (p = 0.664), insomnia (p = 0.699), schizophrenia (p = 0.799), neuroticism (p = 0.140), and bipolar disorder (p = 0.443) are not significantly associated with the incidence of ICH. In the reverse Mendelian randomization analyses, no causal effects of ICH on mood swings (p = 0.565), major depressive disorder (p = 0.630), attention-deficit/hyperactivity disorder (p = 0.346), anxiety (p = 0.266), insomnia (p = 0.102), schizophrenia (p = 0.463), neuroticism (p = 0.261), or bipolar disorder (p = 0.985) were found. ConclusionOur study revealed that mood swings are suggestively causal of ICH and increase the risk of ICH. These results suggest the clinical significance of controlling mood swings for ICH prevention.

Objective:To investigate the surgical outcome and prognostic factors of para-split laminotomy for removal of lumbar spinal canal tumors.Methods:Retrospectively review the clinical data of 35 patients suffering lumbar spinal canal tumors, who underwent the para-split laminotomy for tumor resection in Department of Neurosurgery, Clinical Medical College of Yangzhou University from October 2016 to August 2019, including 16 males and 19 females, and the age was(40.1±10.6)years. Intraoperative blood loss, operation time, tumor resection, tumor pathological results, perioperative complications were observed. Follow-up situations, including tumor recurrence, bony fusion of laminae and spinal stability. Follow-up using outpatient examination and telephone interview was performed by the end of August 2022. The JOA back pain scoring system was used to evaluate the neurological function of the spinal cord, and paired t-test were performed to compare the overall preoperative and postoperative spinal cord neurological function scores. Linear regression and multiple linear regression were used to analyze the prognostic factors. Measurement data of normal distribution were expressed as mean±standard deviation ( ± s), and the comparison before and after operation was performed by paired t-test. Mearsurement data of skewed distribution were expressed as M( Q1, Q3). Count data were expressed as cases. Results:The tumors of 35 patients were resected completely. The median blood loss was 100(75, 140)mL and the average operative duration was (181.1±42.7) min. The postoperative pathological results were as follows: 24 neurilemmomas, 6 meningiomas, 4 ependymomas and 1 neurofibroma. There were no surgery-related complications occurred. The postoperative follow-up ranged from 36 to 69 months, with no tumor recurrence or spinal instability, and bony fusion of laminae seen in some patients on CT imaging. The overall spinal cord neurological function scores of pre and post operation were(19.5±3.4)versus(25.4±2.2), Paired t-test analysis revealed a significant difference between the overall postoperative spinal cord neurological function scores and the preoperative scores, and the postoperative scores were better than the preoperative scores( P<0.05). Multiple linear regression analysis showed a positive correlation between preoperative JOA scores and postoperative JOA scores, and postoperative JOA scores has negative correlation with tumor volume and the age at the time of operation ( P<0.05). Conclusion:Para-split laminotomy with less damage to the posterior spinal structures can effectively improve the neurological function of the spinal cord and protect the stability of the lumbar spine in patients with lumbar spinal canal tumors, and the better the preoperative neurological function of the spinal cord, the better the prognosis of patients, and the smaller the tumor volume, the better the prognosis.

This study aimed to evaluate the safety and accuracy of the endoscopic transethmoid-sphenoid approach for optic canal decompression. Twelve sides of 6 adult cadaveric heads fixed in formalin were selected to simulate optic canal decompression using the endoscopic transethmoid-sphenoid approach. Furthermore, this approach was used for optic canal decompression in 10 patients (11 eyes) with optic nerve canal injury. Related anatomical structures were observed using a 0-degree endoscope, and the anatomical characteristics as well as the surgical data were collected. The maximum effective widths of the cranial opening, orbital opening, and middle segment of the canal that could be drilled open endoscopically were 7.82±2.63, 8.05±2.77, and 6.92±2.01 mm, respectively. The angle between the line linking the center point of the tubercular recess with the midpoint of the cranial opening of the optic canal and the horizontal coordinate was 17.23±1.34 degrees. At the orbital opening of the optic canal, the ophthalmic artery was located directly inferior to the optic nerve in 2 cases (16.7%) and laterally inferior to the optic nerve in 10 cases (83.3%). Six of the operational eyes were effective while the remaining 5 were ineffective. No postoperative complications such as bleeding, infection, or cerebrospinal fluid leakage were observed during the follow-up period (6–12 mo). In conclusion, optic canal decompression positively impacts the prognosis of partial traumatic optic neuropathy. Furthermore, the endoscopic transethmoid-sphenoid approach for optic canal decompression is a minimally invasive procedure that provides direct access and adequate decompression. This technique is easy to master and suitable for clinical applications.

Objective:To assess the clinical efficacy and safety of cranioplasty combined with ipsilateral ventricular shunt in the treatment of skull defect with hydrocephalus.Methods:The clinical data of 78 patients with skull defect and hydrocephalus were analyzed retrospectively. All patients were treated by cranioplasty and ventriculoperitonea shunt in one stage, including 35 cases of cranioplasty combined with ipsilateral ventriculoperitonea shunt and 43 cases of contralateral operation.Results:The incision length [(28.97±4.55) cm], operation time [(139.00±42.27) min], and intraoperative hemorrhage [(174.57±79.35) ml] in the ipsilateral operation group were significantly better than those in the contralateral operation group [(37.15±5.83) cm, (214.07±34.35) min, and (257.21±72.02) ml, respectively] (t=6.786, 8.656 and 4.815, respectively; P＜0.001).The degree of postoperative hydrocephalus in the two groups was significantly improved (P＜0.001), but there was no significant difference between the two groups (P＞0.05). Among the postoperative complications, there was no significant difference in infection, epilepsy, subdural effusion, titanium plate effusion, or excessive cerebrospinal fluid drainage between the two groups (P＞0.05). The incidence of intracranial hemorrhage in the ipsilateral operation group (2.86%) was significantly lower than that in the contralateral operation group (20.93%; χ2=4.138, P=0.042). The postoperative Glasgow coma scale (GCS) scores of the two groups were improved compared with those before surgery (P＜0.05), but there was no significant difference in the postoperative GCS scores between the two groups (P＞0.05). At 6 months after surgery, there was no statistically significant difference in Glasgow outcome scale score between the two groups (χ2=0.005, P=0.944).Conclusion:Cranioplasty combined with ipsilateral ventriculoperitoneal shunt has the same therapeutic effect as contralateral operation, but it has the advantages of shorter operation time, less trauma, less bleeding, and less risk of intracranial hemorrhage.

Background: Postoperative seizures (Sz) following surgical resection of intracranial meningiomas negatively impacts the quality of life of patients. However, there is still unclear with respect to the risk factors of and long-term freedom to Sz in patients with meningiomas. This study aimed to identify independent predictors and develop a nomogram model of late postoperative Sz to optimize postoperative surveillance. Methods: We retrospectively analyzed 318 meningioma patients who underwent surgical resection at the Subei People's Hospital of Jiangsu province from January 2014 to December 2018. Then, clinical data were collected for further analysis and nomogram construction. Results: In our cohort, 62 patients (19.50%) experienced preoperative Sz, 12 patients (3.77%) experienced early postoperative Sz, and 56 patients (17.61%) experienced late preoperative Sz. Multivariate logistic regression analysis revealed that preoperative Sz, convexity location, tumor maximal size >= 3.5 cm, medical/surgical complications and tumor recurrence/progression were independent predictors of late postoperative Sz. A nomogram was developed by employing these five significant predictive factors. Statistical analysis showed that this model had a good discrimination performance. Among 32 patients who had more than one year follow up period form first late postoperative Sz, 17 (53.13%) patients experienced good Sz control. The probability of Sz freedom in the 2-year follow-up was roughly 75.2% among patients with preoperative Sz, and 84.8% among patients without preoperative Sz. Conclusions: This nomogram model will be useful to assist clinicians to assess late postoperative Sz occurrence, identify high-risk patients early and schedule AEDs treatment, but further external validations are needed. (C) 2020 Elsevier Ltd. All rights reserved.

Objective To investigate the prognostic value of inflammatory markers, including neutrophil/lymphocyte ratio (NLR), derived neutrophil/lymphocyte ratio (dNLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), prognostic nutritional index (PNI), and systemic inflammation response index (SIRI) in patients with aneurismal subarachnoid hemorrhage (aSAH), and then develop a Nomogram prognostic model. Methods We analysed 178 aSAH patients who underwent surgery at Subei People's Hospital of Jiangsu province from January 2015 to December 2017. Patients were divided into two groups according to Glasgow outcome scale (GOS) score at 3 months. Univariate and multivariate analysis were used to identify the association between inflammatory markers and prognosis. Subsequently, we identified the best cutoff of SIRI for unfavorable outcome using receiver operating characteristic (ROC) curve analysis and compared the clinical data between high and low SIRI levels. We further evaluated the additive value of SIRI by comparing prognostic nomogram models with and without it. Results A total of 47 (26.4%) patients had a poor outcome. Multivariate logistic regression analysis showed that SIRI was an independent risk factor of poor outcome. The SIRI of 4.105 x 10(9)/L was identified as the optimal cutoff value, patients with high SIRI levels had worse clinical status and higher rates of unfavorable outcome. ROC analysis showed that a nomogram model combining the SIRI and other conventional factors showed more favorable predictive ability than the model without the SIRI. Conclusions SIRI was independently correlated with unfavorable outcome in SAH patients, and the nomogram model combining the SIRI had more favorable discrimination ability.

目的 探讨炎症反应指数结合其他临床指标构建的Nomogram模型,对动脉瘤性蛛网膜下腔出血(aSAH)患者预后预测的价值.方法 分析2015年1月—2017年12月收治的178例aSAH患者的临床资料;以及炎症反应指数,包括血中性粒细胞/淋巴细胞比值(NLR)、间接中性粒细胞/淋巴细胞比值(dNLR)、血小板/淋巴细胞比值(PLR)、单核细胞/淋巴细胞比值(MLR)、预后营养指数(PNI)、全身炎症反应指数(SIRI).根据GOS评分将患者分为预后良好组与不良组.通过单因素、多因素分析筛选出影响预后的独立危险因素;应用Nomogram法对各个因素进行评分,构建预后模型.用ROC评判模型对aSAH患者预后预测的准确性.结果 本组患者中,131例患者(73.6％)为预后良好,47例患者(26.4％)为预后不良.单因素分析显示吸烟、高血压、Hunt-Hess分级、改良Fisher分级、脑血管痉挛、中性粒细胞、单核细胞、NLR、dNLR、MLR及SIRI与预后有显著关系(P<0.05-0.001).多因素Logistic回归分析显示,吸烟(P=0.006)、高血压(P<0.001)、Hunt-Hess分级(P=0.016)、改良Fisher分级(P=0.018)、脑血管痉挛(P=0.017)、SIRI(P=0.043)是影响预后的独立危险因素.将上述指标纳入Nomogram预后模型,经验证该模型的一致性指数良好(C-指数=0.782,P<0.01).ROC曲线显示,结合SIRI和其他指标的模型(AUC=0.836,95％CI:0.760～0.911,P<0.001),比没有SIRI的模型(AUC=0.798,95％CI:0.722～0.875,P<0.001)和仅有SIRI的模型(AUC=0.671,95％CI:0.579～0.763,P=0.001),对aSAH患者的预后预测更准确.结论 炎症反应指数与aSAH预后密切相关;其中SIRI对预后的预测价值更大,为其预后不良的一个独立危险因素.且结合SIRI构建的Nomogram模型对aSAH预后具有更佳的预测价值,有助于预判aSAH患者的预后.

目前随着对慢性硬膜下血肿(CSDH)发病机制、病理生理的不断深入研究,凝血功能障碍及抗凝、抗血小板药物的广泛使用与CSDH的发生发展及预后转归的相互关系越来越受到关注.因此,本文拟从CSDH与凝血、抗凝的关系;凝血异常对CSDH发生发展、术后复发、预后的影响;凝血异常的诊断和治疗及术后该如何重启抗凝等多个方面的问题作一综述,以期为临床提供参考.

目的 探讨脑膜瘤术后癫疒间发生的危险因素,并建立风险预警模型.方法 回顾性分析148例脑膜瘤病人的临床资料,根据术后有无癫疒间发作分组.通过单因素和多因素分析确定癫疒间发作的危险因素,并建立预警模型,同时应用拟合优度检验和ROC曲线评价模型效能.结果 脑膜瘤术后癫疒间发作共32例,其中疒间性新发18例,疒间性再发14例.多因素统计分析示:饮酒﹑肿瘤MRI强化﹑脑膜尾征﹑肿瘤直径﹑水肿程度﹑肿瘤黏连是术后癫疒间发作的独立危险因素(P<0.05).亚组分析示:饮酒﹑肿瘤直径﹑水肿程度﹑肿瘤黏连是术后疒间性新发的独立危险因素(P<0.05);而肿瘤直径﹑术前癫疒间发作类型是术后疒间性再发的独立危险因素(P<0.05).拟合优度检验和ROC曲线分析示:术后癫疒间发作﹑疒间性新发﹑疒间性再发的Logit(P)模型预警效能良好(P<0.001).结论 脑膜瘤癫疒间发作与多种危险因素有关,且各种危险因素在不同癫疒间发作特点的病人间存在差异.临床上可依据上述风险因素构建预警模型,提高脑膜瘤管理.

Objective To investigate the clinical value of improved incisions ventriculoperitoneal shunt assisted with ventriculoscope.Methods The clinical data of 10 patients with hydrocephalus undergoing improved incision ventriculoperitoneal shunt assisted with ventriculoscope were analyzed retrospectively.Results The hydrocephalus symptoms were relieved to varying degrees in 10 cases.The operation time was 35-60 minutes,an average of(45.0 ± 1.2) min.Compared with the traditional shunt,the operation time was significantly shorter.The terminal position of shunt in ventricle was accurate,there were no complications associated with ventriculoscope and no death.Conclusions The ventriculoperitoneal shunt incision improved by means of a ventriculoscope is safe,accurate,minimally invasive and fast with a low complication rate and application value.

OBJECTIVE:This study aimed to observe the range of exposure, indications, and feasibility of the retromastoid keyhole approach via grinding partial petrous ridge to the middle fossa. METHODS:Simulated endoscopic surgeries via grinding suprameatal tubercle and petrous ridge to expose the middle fossa in retromastoid keyhole approach were performed on 8 adult cadaver heads (16 sides) fixed by formalin. The maximum exposure range in endoscope was observed. The boundaries of Parkinson triangle and the anatomic structures contained by Meckel cave and cavernous sinus (CS) lateral wall were revealed. The distances from midpoint of sigmoid sinus posterior border to every important anatomic structures in the middle fossa and the length of all sides of Parkinson triangle were measured. RESULTS:By using endoscope, the exposure of the cerebellopontine angle, ventrolateral brainstem, incisure of tentorium, petroclival region, and CS lateral wall were satisfactory. Many important anatomic structures in middle fossa were exposed well. The distances from midpoint of posterior border of sigmoid sinus to suprameatal tubercle, trigeminal semilunar ganglion, posterior curve segment of internal carotid artery were 34.42 ± 2.14, 54.52 ± 2.87, and 65.15 ± 3.13 mm. The lengths of all sides of Parkinson triangle were 18.97 ± 2.93, 16.23 ± 2.02, and 8.04 ± 2.34 mm. CONCLUSION:The retromastoid keyhole approach via grinding partial petrous ridge to the middle fossa by using endoscope can increase the exposure of middle fossa effectively, which is proper for most lesions in posterior cranial fossa while some parts extend to middle fossa.

Objective To explore the differences of curative effect and short-term prognosis to severe traumatic brain injury patients with three different early postoperative nutritional supports.Methods A retrospective study was performed on 60 severe traumatic brain injury patients received in Neurosurgical Intensive Care Unit of Northern Jiangsu People's Hospital from July 2014 to July 2016.A total of 60 cases were randomly divided into the early enteral nutrition support therapy group,the early parenteral nutrition group,and the early compound nutrition group.The clinical indicators such as basic clinical characteristics before treatment,the nutrition data in two weeks,the length of stay in the Neurosurgical Intensive Care Unit,complications and GCS scores between the three groups were observed and analyzed.Results The indicators of early compound nutrition group were fasting blood-glucose (5.74 ± 0.64) mmol/L,prealbumin(203.80 ± 10.45) mg/L,total serum protein(61.99 ± 1.34) g/L,blood hemoglobin (114.53 ± 2.69) g/L,C-reactive protein(0.37 ± 0.06) mg/dl.The length of stay in Neurosurgical Intensive Care Unit was (11.6 ± 0.42) days in the compound nutrition group while those in the early enteral nutrition group was (13.20 ±0.42) days and those in the early parenteral nutrition group was(14.65 ± 0.42) days.The postoperative complications of the compound nutrition group were significantly lower than other two groups.The GCS scores of early compound nutrition group was(11.40 ± 1.60),which was the best in three groups.The differences were statistically significant (P ＜ 0.05).Conclusions Early compound nutrition support has an exact curative effect on postoperative severe traumatic brain injury patients in Neurosurgical Intensive Care Unit.It can obviously improve the nutrition status of patients with less complications,shorter length of stay in Neurosurgical Intensive Care Unit,higher safety and lower degree of coma,worth clinical promotion.