Objective:To analyze the therapeutic effect of mechanical thrombectomy in patients with acute ischemic strokes with low National Institute of Health stroke scale (NIHSS) scores and large vessel occlusions.Methods:The clinical data of acute ischemic stroke patients with mechanical thrombectomy admitted to the Neurointerventional Department of You'anmen Hospital from January 2020 to June 2022 were collected. Among them, 25 patients presented with low NIHSS scores and large vessel occlusions. The clinical characteristics of these patients were retrospectively analyzed and summarized. Wilcoxon rank-sum test was used to compare the difference between baseline NIHSS scores and postoperative NIHSS scores at 24 hours and 90 days after the operation.Results:Among the 25 patients, 19 were male (76.0%), aged (61±13) years. Hypertension was a common comorbidity (56.0%, 14/25). Patients with Alberta stroke program early CT score 10 accounted for 56.0% (14/25). The main etiological type was large-artery atherosclerosis (84.0%, 21/25). 22 patients (88.0%, 22/25) were successfully recanalized and 2 patients (8.0%, 2/25) had asymptomatic intracranial hemorrhage. The NIHSS score at 90 days was lower than the baseline NIHSS score [1 (0, 2) score vs 4 (3, 4) score], with a statistically significant difference (Z=-2.335, P=0.020). The good prognosis rate was 92.0% (23/25) at 90 days follow-up.Conclusion:Mechanical thrombectomy is feasible as a treatment for patients with low NIHSS scores and large vessel occlusions, and has high safety and vessel recanalization rate.

目的 探讨神经内镜辅助手术治疗高血压性基底核区脑出血破入脑室的技术特点及治疗效果.方法 回顾性分析18例行神经内镜手术治疗高血压性基底核[脑出血破入脑室病人的临床资料,统计病人平均手术时间、术后血肿清除率、术后意识状态及并发症情况.结果 神经内镜操作时间为46～120 min,平均(58.0 ±8.2)min;血肿清除率为65.6％～100％,平均(92.5 ±6.2)％;术后GCS评分平均(9.5 ±4.6)分.术后行气管切开术9例,再出血3例,脑积水2例,肺部感染10例;均经治疗后好转;术后颅内感染1例,最终病人呈植物状态;脑干功能衰竭死亡2例.结论 神经内镜辅助高血压性基底核区脑出血破入脑室的手术治疗,具有操作时间短、血肿清除率高、术后意识恢复良好的特点,值得临床推广.

目的 探讨鞍区占位性病变的手术治疗方法及疗效.方法 回顾性分析2017年10月至2019年10月手术治疗的23例鞍区占位性病变的临床资料.结果 采用额底外侧入路12例,额底纵裂入路7例,眉弓入路4例.病灶全切除19例(82.6％),次全切除4例.术后病理结果示垂体腺瘤7例、鞍结节脑膜瘤5例、颅咽管瘤6例、嗅沟脑膜瘤1例、嗅神经鞘瘤1例、Rathke囊肿3例.21例术后恢复良好.术后出现发热10例、电解质紊乱15例、尿崩8例,无死亡病例.23例术后3个月至1年;肿瘤复发4例,其中2例垂体腺瘤、1例颅咽管瘤,再次手术效果良好.结论 对于鞍区占位性病变,良好的手术入路及解剖暴露可提高手术全切除率,减少术后并发症.

目的 总结两种外科分流手术方法治疗HIV相关性新型隐球菌性脑膜炎所致颅内高压的疗效.方法 采用回顾性研究方法,选取2015年1月至2018年8月首都医科大学附属北京地坛医院收治的HIV相关新型隐球菌性脑膜炎所致颅内高压患者34例,总结分析患者症状、体征及实验室检查,比较导航下脑室-腹腔分流术、腰大池-腹腔分流术的疗效.结果 34例患者表现为头痛,20例患者有呕吐症状,3例出现视力下降、2例癫痫发作.所有患者经内科治疗效果不佳,14例行导航下脑室-腹腔分流术,术后头痛及恶心、呕吐症状全部明显缓解.20例行腰大池-腹腔分流术,1例术后第2天头痛症状再次加重,6例患者出现体位性不适,与脑室-腹腔分流术比较有统计学差异(P<0.05).所有患者均无围手术期颅内出血、感染及脑疝发生.两种手术方式治疗效果无统计学差异(P=0.501).结论 导航下脑室-腹腔分流术与腰大池-腹腔分流术均可明显改善HIV相关新型隐球菌性脑膜炎所致颅内高压,导航下脑室腹腔分流术术后并发症相对更少,潜在脑疝风险较小.

Objective To explore the clinical characteristics, diagnostic method of epilepsy caused by acquired immunodeficiency syndrome( AIDS)-related encephalopathy and the value of surgical treatment. Methods A retrospective analysis was conducted on 12 patients with epilepsy caused by AIDS-related encephalopathy admitted to Department of Neurosurgery, Beijing Ditan Hospital,Capital Medical University from June 2012 to January 2018. Of the 12 patients, 4 had intracranial lymphoma, 4 had intracranial tuberculoma, 2 had cryptococcal meningitis with intracranial hypertension and 2 had Toxoplasma encephalopathy. Three of them had intracranial multiple occupancies. Ten patients underwent pathological excision and 2 of them with hydrocephalus underwent ventriculo-peritoneal shunt simultaneously. Twelve patients received regular drug therapy and highly active antiretroviral therapy treatment before and after operation. Results The symptoms of epilepsy were significantly improved after 6 months to 2 years of follow-up except for 1 case who died of brain edema on the 6th day after operation. Among them, Engel gradeⅠ was achieved in 7 cases, Engel grade Ⅱ in 3, Engel grade Ⅲ in 1. Conclusions The seizure types and pathogenic factors of AIDS-related epilepsy patients are complex and diverse. Comprehensive treatment should be carried out according to clinical manifestations, laboratory examinations, imaging characteristics, electroencephalogram and medical treatment. Under the condition of full preoperative evaluation and mastery of indications, surgery could effectively control AIDS-related epilepsy.

目的 探索获得性免疫缺陷综合征(AIDS)患者合并神经外科疾病时进行手术治疗的可行性、时效性、安全性、并发症及是否影响预后的治疗经验.方法 对2012年4月至2017年6月首都医科大学附属北京地坛医院收治的52例AIDS合并神经外科疾病患者的入院情况、神经外科疾病种类、手术治疗方法、术后并发症、检验结果及术后临床症状改善情况进行分析总结.结果 52例AIDS患者均接受了神经外科手术治疗,术前住院时间(5.6±1.2)d,术后住院时间(12.0±1.5)d;血CD4+细胞计数及病毒载量数值对术后并发症未见明显影响,术后并发症无明显增加;不同部位、病理类型及手术方式对AIDS患者预后不同,手术可改善AIDS合并神经外科疾病患者预后.52例患者术后无中枢神经系统感染或手术切口感染,同时未见患者其他机会性感染情况增加.术后随访12个月,52例患者中临床症状缓解(减轻或消失)38例(73.0％),症状持续11例(21.1％),临床症状进展3例(5.7％).结论 AIDS不是神经外科疾病手术的禁忌证,及时、有效、安全、适当的手术治疗对AIDS合并神经外科疾病患者有益.

Objective To explore the clinic characteristics of paraclinoid aneurysms and evaluate the value of different endovascular treatment for it. Methods The clinical data, image data and follow-up results of 98 patients (104 paraclinoid aneurysms) underwent endovascular treatment at Department of Neurosurgery, Beijing Ditan Hospital and Department of Neurosurgery, Beijing Tsinghua ChangGung Hospital from July 2014 to Janurary 2018, were analyzed retrospectively. Results Of the 98 patients (104 aneurysms) , 2 (2 aneurysms) failed, immediate angiogram after procedure of the other 96 (102 aneurysms) showed complete occlusion in 90 aneurysms, residual necks were left in 4 aneurysms, residual aneurysm were left in 3. There were 22 patients experienced periprocedual complications, 6 aneurismal perforations during the procedure, 3 in-stent thromboses, 2 blurred vision, 1 intractable headache and 1 pain behind the eye. Clinical follow-up showed all the patients'' Rankin scale was 0-5, 2 patients died. 11 of the 98 aneurysm experienced retreatment. The follow-up was continued. Conclusions This study indicates that the new interventional therapy material has some limation in treating ruptured and unruptured paraclinoid aneurysms, and addional evidence is needed to support their efficacy and safety. The conventional endovascular treatment is still a safe and effective therapeutic alternative. But most of the aneurysms need stent assisted coiling because of the high recurrence rate.

Objective To analyze the clinical features of patients suffering from tumefactive demyelinating diseases as well as the impacts and efficiency of the administration of glucocorticoids.Methods A retrospective review was conducted on 7 cases of tumefactive demyelinating diseases that were treated at Department of Neurosurgery,Beijing Ditan Hospital,Capital Medical University and Department of Neurosurgery,Beijing Navy General Hospital from January 2007 to April 2017.Among them,6 underwent brain biopsy and craniotomy was performed in 1.After the surgery,we analyzed and classified the impacts of glucocorticoids on the treatment.All cases were clinically followed up,and the MRI results and symptomatic improvement were analyzed.Results Post surgery,the conditions in all 7 diseases did not deteriorate.The CT scan did not show any signs of bleeding or infarct.The average duration of hospitalization was 10-20 days.Pathological study confirmed tumefactive demyelinating diseases in all cases.The follow-up lasted 1-34 months and 6 cases reported significant postoperative improvement in terms of symptoms and MRI results.The other patient's conditions worsened at about 6 months following surgery.The MRI showed a slight increase in the size of lesion compared with the result at 3 month post operation.That patient was then administered hormone therapy and his conditions were significantly improved.Conclusions It is difficult to differentiate the clinical characteristics of tumefactive demyelinating diseases and some intracranial tumors,cerebrovascular disease,cerebral abscess,etc.However,certain characteristic imaging manifestations could the associated with the former and specific examinations of blood and cerebrospinal fluid could facilitate the differential diagnosis.The glucocorticoid therapy might be considerably effective and helpful for early diagnosis.

目的 探讨神经电生理监测下成熟型脊髓畸胎瘤的显微外科手术治疗效果.方法 回顾性分析在神经电生理监测下经显微外科治疗的7例脊髓畸胎瘤病人的临床资料,同时复习相关文献.结果 1例脊髓圆锥处肿瘤予以大部分切除,3例原发于终丝的肿瘤予以全切,余3例均予以近全切除.病理诊断均为成熟型脊髓畸胎瘤,术后随访3～38个月,症状明显改善6例,无改善1例.术后McCormick分级:Ⅰ级4例,Ⅱ级2例,Ⅲ级1例.结论 在神经电生理监测下最大程度切除成熟型脊髓畸胎瘤,有助于减少手术损伤,改善病人预后.

Objective To analyzes the lumboperitoneal shunt in the treatment of AIDS complicated with cryptococcus neoformans meningitis caused by non-hydrocephalus high intracranial pressure .Methods From October 2011 to December 2014 , 12 AIDS patients complicated with new cryptococcus neoformans meningitis caused by non -hydrocephalus and increased intracranial pressure were enrolled , with medical conservative treatment to reduce intracranial pressure invalid , used lumbo-peritoneal shunt for treatment and at the same time with regular anti fungal treatment , the curative effect were followed up .Re-sults 12 patients were 11males and 1 female, aged 18 to 45 years, median age was 26 years old, the course of disease was 3 d to 1 month.12 cases were found with increased intracranial pressure symptoms , among them,10 cases with headache , dizziness in 8 cases, 8 cases with anorexia and nausea , frequent vomiting in 1 cases, diplopia in 2 cases, hearing loss in 3 ca-ses, decreased visual acuity in 8 cases;8 cases with intermittent , median or low fever;psychiatric symptoms in 1 case.After lumbar peritoneal shunt treatment , high intracranial pressure symptoms disappeared in 9 cases, 3 cases were improved, and without causing cryptococcus neoformans infection spread .Conclusion Lumboperitoneal shunt can significantly improve clini-cal symptoms of AIDS patients complicated with cryptococcus neoformans meningitis caused by non -hydrocephalus high in-tracranial pressure .