Introduction In confronting the sudden COVID-19 epidemic, China and other countries have been under great pressure to block virus transmission and reduce fatalities. Converting large-scale public venues into makeshift hospitals is a popular response. This addresses the outbreak and can maintain smooth operation of a country or region's healthcare system during a pandemic. However, large makeshift hospitals, such as the Shanghai New International Expo Center (SNIEC) makeshift hospital, which was one of the largest makeshift hospitals in the world, face two major problems: Effective and precise transfer of patients and heterogeneity of the medical care teams. Methods To solve these problems, this study presents the medical practices of the SNIEC makeshift hospital in Shanghai, China. The experiences include constructing two groups, developing a medical management protocol, implementing a multi-dimensional management mode to screen patients, transferring them effectively, and achieving homogeneous quality of medical care. To evaluate the medical practice performance of the SNIEC makeshift hospital, 41,941 infected patients were retrospectively reviewed from March 31 to May 23, 2022. Multivariate logistic regression method and a tree-augmented naive (TAN) Bayesian network mode were used. Results We identified that the three most important variables were chronic disease, age, and type of cabin, with importance values of 0.63, 0.15, and 0.11, respectively. The constructed TAN Bayesian network model had good predictive values; the overall correct rates of the model-training dataset partition and test dataset partition were 99.19 and 99.05%, respectively, and the respective values for the area under the receiver operating characteristic curve were 0.939 and 0.957. Conclusion The medical practice in the SNIEC makeshift hospital was implemented well, had good medical care performance, and could be copied worldwide as a practical intervention to fight the epidemic in China and other developing countries.

Objective:To explore the meaning of cycle threshold (Ct) value fluctuation and the appropriateness of setting the discharge Ct value to 35, which is the current standard in Chinese guidelines.Method:A retrospective study was conducted on 95 patients with Ct value fluctuation (Ct value below 35 on day 3; group A) and 97 patients with a normal discharge process (control; group B). Their clinical characteristics and follow-up data were collected.Results:(1) There was no significant difference between the groups in age, gender distribution, number of vaccinations, initial ORF-Ct value, and initial N-Ct value. The proportion of patients complicated with chronic internal disorders, respiratory symptoms, and abnormal chest radiology in group A was significantly higher than that in group B. (2) Between the two groups, there was no significant difference in the ORF-Ct or N-Ct value on day 1, but the ORF-Ct and N-Ct values of group B on days 2 to 4 were significantly higher than those of group A. (3) There was no significant difference between the groups in the ORF-Ct value at discharge, but there was a significant difference in the N-Ct value at discharge. Seven days after discharge, almost 100% of the patients had been cured. The mean negative conversion interval of nucleic acid of the patients in group A was 14.5 ± 4.6 days, which was longer than that of the patients in group B (11.8 ± 4 days). (4) Logistic regression analysis showed that the ORF-Ct value on day 2 was the key factor influencing the Ct value fluctuation.Conclusion:The fluctuation of Ct value is only a normal phenomenon in the recovery period of the disease, and there is no need for excessive intervention. It is reasonable to set the Ct value of the discharge standard to 35 and retest the nucleic acid on the 10th day after discharge for patients with underlying diseases or symptoms.

Introduction Omicron is more contagious and stealthier than the previous strains.The basic reproduction number of Omicron is around 8-12,whereas that of the previous mainstream strain Delta is only 5-8[1].Omicron's symptoms are relatively mild[2]compared with Delta's symptoms;however,Omicron's transmission ability is very strong,and its risk to children and the elderly remains high[3].In addition,the vaccine's preventive effect on Omicron has weakened.Therefore,Omicron can easily cause a rapid outbreak in a city.The population density of megacities and the limited public health resources fuirther exacerbate the difficulty of Omicron prevention and control.

MicroRNA (miRNA) dysfunction has been confirmed as a key event of ischemic stroke appearance. This study is aimed at revealing the role of miR-429 in the angiogenesis of HBMECs. The HBMECs were treated with oxygen and glucose deprivation (OGD) to establish the ischemic cell model. The qRT-PCR was used to measure the expression levels of the miR-429 in the serums of the patients or cells, and CCK-8, wound healing assay, and tube formation assay were used to observe the effects of miR-429 on the phenotype of HBMECs. Moreover, the Targetscan, dual-luciferase reporter assay, and Western blot were used to reveal the downstream target and regulation mechanism of miR-429 in OGD-induced HBMECs. The results showed that miR-429 was significantly upregulated in the serums of the patients, and overexpressed miR-429 could extremely inhibit the viability, migration, and tube formation of OGD-induced HBMECs. Furthermore, it was found that SNAI2 was a downstream factor of miR-429, and SNAI2 could rescue the effects of miR-429 on OGD-induced HBMECs. Besides, the Western blot showed that miR-429 could affect the activity of GSK-3β/β-catenin pathway via inhibiting the expression of SNAI2. In conclusion, this study suggests that miR-429 inhibits the angiogenesis of HBMECs through SNAI2-mediated GSK-3β/β-catenin pathway.

Objective To investigate the clinical effects of different operative forms on ophthalmic segment aneurysms (OSAs). Methods The clinical data of 88 patients with 109 OSAs including with 57 unruptured OSAs and 31 with ruptured OSAs, who were treated in Renji Hospital from August, 2005 to December, 2015, were analyzed respectively. Of 88 patients with 109 OSAs, 77 with 98 OSAs were treated by endovascular embolization, and 11 with 11 OSAs by microsurgical clipping. All the patients were followed up with MRA or CTA or DSA and received the assessment of prognosis with modified Rankin scale (mRS) 3, 6 and 12 months after the operation. The improvements of ophthalmic symptoms were followed up 3, 6 and 12 after the operations in the patients with visual deficit caused by OSAs. Results Of 69 small OSAs in 65 patients without ophthalmic symptoms, 49 received stent-assisted coiling embolization and 20 only by coiling embolization. OSAs recurred in 2 (3.1%) aneurysms during the following-up. Of 17 large or giant OSAs in 17 of these 65 patients without ophthalmic symptoms, 2 were treated by balloon-assisted coiling embolization, 13 by stent-assisted coiling embolization, and 2 by balloon combined with stent-assisted coiling embolization. OSAs recurred in 5 (29.4% , 5/17) during the following-up. Of 23 patients with visual deficit caused by OSAs including 12 patients with small OSAs and 11 patients with large or giant OSAs, 12 were treated by interventional embolization, and 11 by microsurgical clipping of OSAs. The following-up after the operation showed that the ophthalmic symptoms were improved in 6, unchanged in 3 and worsen in 3 of 12 patients with visual deficit undergoing the interventional embolization. The ophthalmic symptoms were improved in 7, unchanged in 3 and worsen in 1 of 11 patients with visual deficit undergoing the microsurgical clipping during the following up. Conclusions The endovascular embolization is a minimally-invasive, safe, and effective method to treat OSAs, but the microsurgical clipping is superior in the improvement of visual deficit to interventional embolization in the patients with OSAs.

Summary Aims Nerve growth factor ( NGF ) has been reported to prevent neuronal damage and contributes to the functional recovery in animal brain injury models and human ischemic disease as well. We aimed to investigate a potential therapeutic effect of NGF gene treatment in ischemic stroke and to estimate the functional recovery both at the cellular and cognitive levels in an ischemia rat model. Methods After microinjection of pseudolentivirus‐delivered β‐ NGF into an established ischemic stroke model in rats ( tMCAO ), we estimated neuronal cell apoptosis with TUNEL labeling and neurogenesis by cell proliferation marker Ki67 staining in both ischemic core and penumbra of striatum. Furthermore, we used behavioral functional tests, Morris water maze performance, to evaluate cognitive functional recovery in vivo and propose a potential underlying mechanism. Results We found that pseudolentivirus‐mediated delivery of β‐ NGF gene into the brain induced high expression in striatum of the infarct core area after ischemia in rats. The β‐ NGF overexpression in the striatal infarction core after ischemia not only improved neuronal survival by reducing cell apoptosis and increasing cell proliferation, but also rescued cognitive functional impairment through upregulation of GAP ‐43 protein expression in tMCAO rat model of ischemia. Conclusion This study demonstrates a potential β‐ NGF gene therapy by utilization of pseudolentivirus in ischemia and indicates future applications of NGF gene treatment in ischemic patients.

Ischemic stroke is the leading cause of disabilities worldwide. MicroRNA-377 (miR-377) plays important roles in ischemic injury. The present study focused on the mechanisms of miR-377 in protecting ischemic brain injury in rats. Cerebral ischemia was induced by middle cerebral artery occlusion (MCAO) in rats. Primary rat microglial cells and brain microvascular endothelial cells (BMECs) were exposed to oxygen-glucose deprivation (OGD). The concentrations of cytokines (TNF-, IL-1, IL-6, IFN-, TGF-, MMP2, COX2, and iNOS) in the culture medium were measured by specific ELISA. Tube formation assay was for the in vitro study of angiogenesis. Luciferase reporter assay was performed to confirm whether VEGF and EGR2 were direct targets of miR-377. The MCAO rats were intracerebroventricular (ICV) injection of miR-377 inhibitor to assess its protective effects in vivo. MiR-377 levels were decreased in the rat brain tissues at 1, 3, and 7d after MCAO. Both microglia cells and BMECs under OGD showed markedly lower expression levels of miR-377 while higher expression levels of EGR2 and VEGF compared to those under normoxia conditions. Knockdown of miR-377 inhibited microglial activation and the release of pro-inflammatory cytokines after OGD. Suppression of miR-377 promoted the capillary-like tube formation and cell proliferation and migration of BMECs. The anti-inflammation effect of EGR2 and the angiogenesis effect of VEGF were regulated by miR-377 after OGD. Inhibition of miR-377 decreased cerebral infarct volume and suppressed cerebral inflammation but promoted angiogenesis in MCAO rats. Knockdown of miR-377 lessened the ischemic brain injury through promoting angiogenesis and suppressing cerebral inflammation. J. Cell. Biochem. 119: 327-337, 2018. (c) 2017 Wiley Periodicals, Inc.

Objective To analyze the feasibility and safety of endovascular stenting for subacute and chronic vertebrobasilar artery occlusion and its curative effect. Method The clinical data of 18 patients with subacute or chronic vertebrobasilar artery occlusion undergoing endovascular stenting in Renji Hospital from October, 2012 to August, 2016 were analyzed retrospectively, including the perioperative complications, clinical effect, recurrent events during the following-up, pre- and post-operative modified Rankin scale (mRS) scores, Makel scale score and so on. Results Of 18 patients with vertebrobasilar artery occlusion, 16 had recanalization of the occluded arteries and 2 not after the endovascular stenting. Of 16 patients with vertebrobasilar artery recanalization, 6 were improved in the clinical symptoms, 9 had unchanged clinical symptoms and 1 died of intracranial hemorrhage. The following-up 1 year after the operation showed that of 15 patients, 11 were improved in mRS scores and 4 not. Malek scale score was 1 point in 12 patients and 2 points in 3. DSA 1 year after the operation showed that the vertebrobasilar artery had restenosis (stenosis degree>50%) in 1 patient who underwent balloon angioplasty and 14 not. Conclusions Endovascular stenting for the recanalization of symptomatic subacute and chronic vertebrobasilar artery occlusion is technically feasible and safe, and its mid-or long- term curative effect is satisfactory.

Atherosclerosis is a chronic disease of the arterial wall and a leading cause of death worldwide. Though the pathophysiology of atherosclerotic lesion formation has been studied, we still lack evidence of the global changes in the artery during atherosclerosis. In this report, we induced atherosclerosis in rats and conducted GeneChip analysis on carotid arteries with or without plaque formation. We found that molecular pathways underlying plaque formation in atherosclerosis were related to immune response, angiogenesis, cell proliferation, apoptosis and hypoxic microenvironments, suggesting that the pathophysiology of atherosclerosis is varied. In addition, we showed that three lncRNAs, GAS5, SNHG6 and Zfas1, were significantly increased in the plaque of atherosclerosis patients compared to normal people. A complex interaction of mRNA and lncRNA was identified in atherosclerosis. Our results provide a global transcriptomic network of atherosclerosis development in rats and possible targets that could lead to new clinical applications in the future.

Traumatic injuries to the brain and spinal cord affect a large percentage of the world's population. However, there are currently no effective treatments for these central nervous system (CNS) injuries. In our study, we evaluated the neuroprotective role of functionalized multi-walled carbon nanotubes (MWCNTs) carrying brain derived neurotrophic factor (BNDF), nogo-66 receptor (NgR) and Ras homolog gene family member A (RhoA) in spinal cord injury (SCI). Our results showed that transfection into rat cortical neurons with BDNF-DNA significantly elevated the expression of BDNF both in vitro and in vivo. Meanwhile, transfection with NgR-siRNA and RhoA-siRNA resulted in an obvious down-regulation of NgR and RhoA in neuron cells and in injured spinal cords. In addition, the functionalized MWCNTs carrying BDNF-DNA, NgR-siRNA and RhoA-siRNA exhibited remarkable therapeutic effects on injured spinal cord. Taken together, our study demonstrates that functionalized MWCNTs have a potential therapeutic application on repair and regeneration of the CNS.

Traumatic brain injury (TBI) treatment is a long-term process and requires repeated medicine administration, which, however, can cause high expense, infection, and hemorrhage to patients. To investigate how a long-term expression of nerve growth factor (Ngf) gene affects the injured hippocampus function post-TBI, in this study, a pseudo lentivirus carrying the β-Ngf fusion gene, with green fluorescence protein (GFP) gene, was constructed to show the gene expression and its ability of protecting cells from oxidative damage in vitro. Then, the pseudo lentivirus-carried β-Ngf fusion gene was directly injected into the injured brain to evaluate its influence on the injured hippocampus function post-TBI in vivo. We found that the expression of the pseudo lentivirus-delivered β-Ngf fusion gene lasted more than four-week after the cell transduction and the encoded β-NGF fusion protein could induce the neuron-like PC12 cell differentiation. Moreover, the hippocampal injection of the pseudo lentivirus-carried β-Ngf fusion gene sped the injured cognitive function recovery of the rat subjected to TBI. Together, our findings indicate that the long-term expression of the β-Ngf fusion gene, delivered by the pseudo lentivirus, can promote the neurite outgrowth of the neuron-like cells and protect the cells from the oxidative damage in vitro, and that the direct and single dose hippocampal injection of the pseudo lentivirus-carried β-Ngf fusion gene is able to rescue the hippocampus function after the TBI in the rat.

Objective To investigate the changes of circulating endothelial progenitor cells (EPCs) in patients with acute cerebral infarction or chronic cerebral ischemia and discuss the related clinical significance.Methods Circulating EPCs were isolated using staining markers of CD34,CD133,and kinase insert domain receptor (KDR).Peripheral venous blood was collected from patients with acute cerebral infarction within 24 hours of onset (infarction group,n =30),with chronic cerebral ischemia (ischemia group,n =20),and without cerebral ischemia (control group,n =10) to quantify circulating level of EPCs using flow cytometry and measure parameters of systolic pressure,glycosylated hemoglobin (HbAlc),total cholesterol (TC),and triglyceride (TG),and low density lipoprotein-cholesterol (LDL-C),and high density lipoprotein-cholesterol (HDL-C).Results CD34-,CD34/CD133-,and CD34/KDR-positive cells counted (14.2 ± 8.1)‰,(7.1 ± 4.1)‰ and (5.0 ± 3.7)‰ in infarction group,(28.5 ± 9.9)‰,(15.2 ± 3.7)‰ and (6.8 ± 2.0)‰ in ischemia group,and (44.8 ± 9.5) ‰,(22.1 ± 6.6) ‰ and (16.7 ± 6.9) ‰ in control group.Taken together,circulating level of EPCs lowered substantially in infarction and ischemia groups compared to control group (P ＜ 0.05) and a far lower level was observed in infarction group (P ＜ 0.05).Circulating level of EPCs in infarction group was in a moderate negative correlation with systolic pressure,TC,TG,and LDL-C (P ＜ 0.05).Conclusions Decreased circulating level of EPCs may be a risk factor to the development of cerebral ischemia in acute cerebral infarction patients.Therefore,level of EPCs is vital for prediction,prevention and treatment of acute cerebral infarction.

Objective To investigate the efficacy of endovascular stenting for aortic arch artery stenosis after nasopharyngeal carcinoma radiotherapy. Methods The clinical data of 8 patients with symptomatic severe aortic arch artery stenosis after nasopharyngeal carcinoma radiotherapy were analyzed retrospectively. The patients were all received endovascular stenting,and their improvement of cerebral ischemic symptoms was observed. They were followed up by cervical color Doppler ultrasound.Results The whole brain vascular DSA confirmed that there were 24 severe arterial stenoses on the aortic arch arteries of extracranial segments in 8 patients,including 11 in internal carotid artery,2 in common carotid artery,10 in vertebral artery and 1 in subclavian artery. The patients were treated with vascular angioplasty and stenting respectively. All the patients were followed up for 1 year;there were no recurrence of cerebral ischemic symptoms.Cervical color Doppler ultrasound did not reveal any obvious restenosis. Conclusion Endovascular stent angioplasty for the treatment of aortic arch artery stenosis after nasopharyngeal carcinoma radiotherapy is relatively safe and feasible.

Here we aimed to investigate the effects of atorvastatin on accelerated reendothelialization after carotid balloon injury. A mouse model of carotid arterial injury was established, followed by intragastric administration of atorvastatin at a dose of 0.6 mg·(kg body mass)(-1)·d(-1). Pathological sections of carotid artery stained with hematoxylin and eosin were observed under light microscopy. Expression levels of eNOS mRNA and protein were detected with real-time quantitative PCR and Western blot analysis, respectively. Proliferation and differentiation of endothelial progenitor cells (EPCs) were observed after treatment, in vitro. Reendothelialization appeared on the neovascular surface, while intimal hyperplasia was inhibited after treatment with atorvastatin. Numbers of CD31-positive cells increased after atorvastatin treatment, as did the number of leucocyte antigen positive cells. The expression of cell markers, such as CD34, eNOS, and VEGF-R, were higher in the atorvastatin-treated group of mononuclear cells. EPC numbers increased with the concentration of atorvastatin. The expression of eNOS mRNA was reduced in the mice with carotid artery injury that were treated with normal saline. The expression levels of eNOS protein were increased in atorvastatin treatment group. In conclusion, atorvastatin stimulates EPCs to differentiate into endothelial cells and promotes the repair of carotid arterial injury.

Symptomatic internal carotid artery (ICA) occlusion with hemodynamic impairment remains a dismal disease when untreated. In this prospective, single-center, controlled study, we investigated the feasibility, safety, and long-term outcome of stenting by endovascular recanalization for patients with chronic ICA occlusion. Forty patients with symptomatic chronically occluded ICA were assigned to receive endovascular recanalization (group A, n = 18) or conservative management (group B, n = 22). The primary end point was 100% complete recanalization of the primary occlusion at 60 minutes, and secondary end points were improvement in neurologic function and cognitive function. Patients in the 2 groups were comparable in demographic and baseline characteristics. Successful recanalization was achieved in 88.9% (16 of 18) of patients with the restoration of Thrombolysis in Myocardial Ischemia/Thrombolysis in Cerebral Ischemia 2 or 3 flow. There was no procedural or new cerebral ischemic event. Improvement in brain perfusion was observed in 12 (12 of 18, 75%) patients on single-photon emission computed tomography. Improvement in neurologic function defined as a reduction of ≥4 points on the National Institutes of Health Stroke Scale (NIHSS) at 6 months was observed in group A (baseline, 6.83 ± 3.01 vs 6 months, 2.61 ± 1.20; P < .01) and group B (baseline, 6.05 ± 2.75 vs 6 months, 4.77 ± 1.69; P < .05). A significant difference in NIHSS scores was noted between group A and B at 1, 3, and 6 months ( P < .05 or .001). Improvement in cognitive function defined as an increase of ≥8 on the Montreal Cognitive Assessment (MoCA) was observed in group A at 3 and 6 months (baseline, 14.67 ± 3.56 vs 3 months, 24.17 ± 3.55 and 6 months, 24.72 ± 2.85; P < .01). Significant improvement in MoCA was also observed in group B ( P < .01). Furthermore, a significant difference in MoCA scores was noted between group A and B at 1, 3, and 6 months ( P < .05 or .001). Endovascular recanalization is feasible and safe for patients with symptomatic chronic carotid artery occlusion. Successful carotid artery stenting can improve neurological function and global cognitive function than nonrevascularization.

Objective To evaluate the value of 3D black-blood MR imaging (3D-BB-MRI) in evaluation of atherosclerosis by comparing with DSA.Methods Forty patients with carotid stenosis underwent 3D-BB-MRI and DSA.The degree of stenosis,lesion length and plaque ulcer on DSA and 3D -BB-MRI were independently assessed and compared.Results Compared with DSA,3D-BB-MRI showed a good consistency of stenosis with Spearman's r of 0.965.The diagnostic sensitivity,specificity,accuracy and positive predictive value were 93.1％,100％,95.6％ and 100％,respectively,when the 70％ stenosis was used as the cut-off value.3D-BB-MRI was proved to have high sensitivity (100％),specificity (93.9％),accuracy (95.6％) and positive predictive value (85.7％) for plaque ulcer.3 D-BB-MRI shown a larger lesion length measurement than DSA (18.4 ± 8.2) mm vs (14.0 ± 6.2) mm,P ＜0.05.Conclusions 3D-BB-MRI could provide an accurate depiction of carotid stenosis and plaque ulcer,and it is superior to DSA in detecting lesion length,which will be beneficial for clinical assessment with DSA.

PPP2R2C encodes a gamma isoform of the subunit B55 subfamily, which is a regulatory subunit of Protein phosphatase type 2A (PP2A). Our study shows that PPP2R2C is downregulated in glioma cells and human brain cancer patient samples. Overexpression of PPP2R2C inhibited cancer cell proliferation both in vitro and in vivo through the suppression of the activity of S6K in the mTOR pathway. Moreover, exogenous expression of PPP2R2C promoted the formation of a complex with the PP2A-C subunit to further enhance the binding of PP2A-C with S6K. Our results suggest that PPP2R2C is a potential tumor suppressor gene in human brain cancers. This study will provide novel insight into the development of therapeutic strategies in the treatment of human brain tumors.

<正>患儿男,3岁。因家长叙述"头痛1个多月",于2011年3月收入上海交通大学附属仁济医院。入院体检:意识清楚,头围约50 cm,无明显智力和神经功能障碍,无头皮静脉扩张。胸X线片及心脏彩超示心脏轻度扩大,心功能基本正常。患儿系第1胎第1产,足月剖宫产。产前检查未见

Objective To compare the effectiveness of the JASPER electrolytically detachable coil and Platinum coil system for embolization of intracranial aneurysms.Methods Sixty-two patients with intracranial aneurysms were treated by JASPER coils(30 patients,the JASPER group) or by MicroVention coils(32 patients,the control group) for the embolization of aneurysms.All procedures were operated by the same surgeon with same type of microcatheter.The visibility of both coils,easiness of deployment through microcatheter,uncoiling,flexibility,effect of forming a basket,dense packing,and the time needed for detachment were observed under the fluoroscopy during the procedures.The patients were followed up by telephone,outpatient appointment,and angiography.Results A total of 95 JASPER coils and 108 MicroVention coils were used.Friction was observed(8/95) in the JASPER group during pushing of the microcatheter,while none was found in the control group.5 coils in the JASPER group and 1 coil in the control group were stretched during the repositioning.Electrolytically detaching time was more than 45 s in the JASPER group but only 1 s in the control group.There was no significant difference between two groups in the percentages of densely packed,neck remnant,and incompletely packed aneurysm.All patients were followed up from 3 to 22 months(mean 7 months),and no rebleeding happened.48 patients were followed up with digital subtraction angiography(DSA),and each group had one recurrence of aneurysm.Conclusion It is safe and effective for treating intracranial aneurysm by JASPER coil.

Objective To studythe method and therapeutic effectiveness of microsurgical treatmentfor large hemangioblastomas of the posterior fossa.Methods During the 10-year period from January 2000to June2010,a retrospective study of 48 patients with intracranial hemangioblastomas revealed 16 patients presented with large solid lesions of the posterior fossa.There were 11males (73.3％) and 5females (26.7％ ) with a mean age 36.4 year (range,14 ～62yr).There were concomitant findings associated with VHL disease in eightcases.Diagnostic imaging including CT,MRI and DSA showed large vascular lesions.Preoperative embolization was observedin 7cases.All 16 patients underwent surgery through a suboccipital ipsilateral,modified far-lateral,suboccipital midlineor suboccipital superior cerebellar approach.Microvascular Doppler probe was used to guide dissection of the tumor.Results Complete removal of the tumor was performed in all patients.An overall neurological improvement was observed in 12of the 16patients,corresponding to 75％.No patients died of surgery.During follow-up,six patients,all with VHL disease,showed relapse.Two patients died of renal cell carcinoma.Conclusions With improved microsurgical technique and a better understanding of the vascular pattern of the tumor,total microsurgical removal couldbe performed with low mortality.Surgical resection is an optimal option for patients with large hemangioblastomas of the posterior fossa.