ObjectiveTo summarize the experience of microsurgery in primary hospital for the posterior communicating artery aneurysms (PCOAan). MethodsThe clinical data of 48 patients with PCOAan who underwent microsurgery from January 2008 to December 2012 were retrospectively analyzed. ResultsAll the necks of aneurysms of 48 cases were successfully clipped, Acording to the Glasgow outcome score (GOS), the early curative effects were good in 36 cases (75.0%, GOS 4-5) poor in 10 cases (20.8%, GOS 2-3) and death in 3 cases (2.1%, GOS 1). After the operation was carried out, the operation time was shorten, aneurysm intraoperative rupture rate was lower, postoperative complications were lower, and the average medical expense was reduced; the difference was significant in 24 cases before and after the operation (P<0.05). ConclusionMicrosurgery for PCOAan is an effective method which should be popularized in primary hospitals.
ObjectiveTo investigate the efficacy of stellate ganglion block (SGB) on postoperative palpebral edema in patients undergoing intracranial aneurysm surgery. MethodsSixty patients who were scheduled to undergo intracranial aneurysm surgery between September 2012 and Novermber 2014 were recruited, and were assigned into 2 groups randomly with 30 in each:SGB group and control group. Patients in SGB group were administered SGB by injecting 0.3% ropivacaine on the operative side under the ultrasound guidance after surgery completed, while patients in the control group received injection of saline on the operative side under the ultrasound guidance. Incidence of postoperative palpebral edema at hour 24, 48, and 72 after surgery were measured. Numerical rating scale (NRS) was used to detect the severity of uncomfortable symptoms for palpebral swelling during rest state. The severity of palpebral edema was evaluated with continuous rating scale (0-5, 0 indicated normal palpebral, and higher score indicated more serious palpebral edema). Complications related with SGB were recorded. ResultsThe overall incidence of palpebral edema at hour 24 after surgery in SGB group was lower than that in the control group (P<0.05). There was no statistically significant difference in the overall incidence of palpebral edema at hour 48 and 72 after surgery between the two groups (P>0.05). The palpebral edema rating scores of the SGB group at hour 24 after surgery were lower than those of the control group (P<0.01).The incidence of palpebral edema which was scored 3 or more at hour 24 and 48 after surgery in SGB group was lower than that in the control group (P<0.05). No statistically significant difference was found in the incidence of palpebral edema which was scored 3 or more at hour 72 after surgery between the two groups (P>0.05). No complication related with SGB was found. ConclusionSGB can safely reduce the incidence of postoperative palpebral edema in patients undergoing intracranial aneurysm surgery, and reduce the severity of palpebral edema.
ObjectiveTo investigate the value of head boneless CT angiography (CTA) for surface shaded display (SSD) (hereinafter referred to as the SSD-CTA technology) and volume computed tomographic digital subtraction angiography (VCTDSA) in diagnosing intracranial aneurysms. MethodsWe collected the clinical data of 35 patients diagnosed to have intracranial aneurysm by VCTDSA between April 2013 and November 2014 from the First Affiliated Hospital of Chongqing Medical University. The original data were imported into the CT workstation of the First People's Hospital of Chengdu. Then, SSD-CTA technology was performed for bone reconstruction. We compared the results of these two technologies. In addition, we selected another 27 patients diagnosed with intracranial aneurysm by SSDCTA and DSA examination at the same time between June 2012 and November 2014 in the First People's Hospital of Chengdu for comparison. ResultsThe quality score of SSD-CTA reconstructed image was lower than that of VCTDSA, but the diagnosis of the two technologies for intracranial aneurysm was not statistically different (P>0.05). Compared with DSA, the sensitivity and specificity of the diagnosis for intracranial aneurysms by SSD-CTA were both 100%. ConclusionSSD-CTA is valuable in diagnosing intracranial aneurysms.
ObjectiveTo explore the nursing method to avoid rupture of intracranial aneurysm during induction of anesthesia. MethodWe retrospectively analyzed the nursing method for 428 patients with aneurysm during the induction of anesthesia between October 2012 and October 2013. According to the causes of rupture of intracranial aneurysm (anxiety, tension, excitement, sudden elevation of blood pressure, physical labor), we adopted nursing methods to avoid those causes, and implemented targeted nursing methods during induction of anesthesia. ResultsNo intracranial aneurysm rupture occurred in these 428 aneurysm patients during induction of anesthesia. Two patients' absolute value of systolic blood pressure was below 80 mm Hg (1 mm Hg=0.133 kPa) during induction of anesthesia, and the vital signs of other patients kept normal. The number of intraoperative rupture cases was 3. When discharged from hospital, there were 385 patients with good prognosis, 39 patients with bad prognosis, and 4 death cases. ConclusionsTargeted nursing method based on patients' particular situation during induction of anesthesia can effectively control patients' emotion, stabilize fluctuations in hemodynamic indexes, decrease the incidence of aneurysm rupture, improve surgery treatment effect of intracranial aneurysm clipping, decrease complications, and improve patients' prognosis.
ObjectiveTo observe the neuro-ophthalmological features of intracranial aneurysm. Methods169 patients with intracranial aneurysm were retrospectively studied. 45 patients, including 18 men and 27 women, had neuro-ophthalmological symptoms or signs. Their average age was (56.21±16.11) years and 32 (71.11%)patients' age was more than 50 years. The onset time ranged from 30 minutes to 20 years. 20 (44.44%) patients' onset time was among 24 hours. CT, CT angiography, MRI, MRI angiography and cerebral digital subtraction angiography were performed alone or combined in all 45 patients. Visual acuity, pupil reflex and eye movement were examined. Clinical data including general condition, initial symptoms, neuro-ophthalmological changes, imaging data and treatment effects were recorded. Results26.63% of the 169 patients had neuro-ophthalmological symptoms or signs. There were 6 patients (13.33%) with neuro-ophthalmological changes as their first manifestation and 39 patients (86.67%) with neurologic changes as first manifestation. Neuro-ophthalmological symptoms included vision loss (10 patients, 22.22%), diplopia (4 patients, 8.89%) and ocular pain (2 patients, 4.44%). The most common neuro-ophthalmological sign was pupil abnormality which was found in 31 patients (68.89%). The second most common sign was eye movement disorder (16 patients, 35.56%).The other signs included ptosis (8 patients, 17.78%), nystagmus (2 patients, 4.44%), exophthalmos (1 patient, 2.22%) and disappeared corneal reflection (1 patient, 2.22%). Imaging examination indicated that intracranial hemorrhage happened in 29 patients (64.44%). The most common neuro-ophthalmological features were pupil abnormality, eye movement disorder and vision loss in both patients with or without intracranial hemorrhage. The incidence of pupil abnormality was higher in patients with intracranial hemorrhage than that without intracranial hemorrhage, the difference was statistically significant(χ2=7.321, P=0.007). Pupil abnormality and vision loss were common in patients with internal carotid artery aneurysm, and eye movement disorder was common in patients with internal carotid artery aneurysm and posterior communicating aneurysms. ConclusionsPatients with intracranial aneurysm have different neuro-ophthalmological features. The most common features are pupil abnormality, eye movement disorder and vision loss.
Central nervous system vascular disease can be combined with a variety of ocular signs, such as orbital pain, flash, visual field defects, vision loss, eye muscle paralysis. Therefore, some patients were first diagnosed in ophthalmology, including aneurysm rupture, arterial dissection, cerebral apoplexy and other critical nervous system diseases that need rapid treatment. If the doctors didn't know enough, the diagnosis and treatment might be delayed. Most of the vascular diseases of the central nervous system related to ophthalmology have clinical manifestations that cannot be explained by ophthalmology. In the face of chronic conjunctivitis, unexplained visual field defect or cranial nerve paralysis with local ineffective treatment, it is necessary to broaden the thinking of differential diagnosis. To understand the characteristics of vascular diseases of the central nervous system that are prone to ocular manifestations can provide references for the clinical diagnosis and treatment of ophthalmology.
ObjectiveTo explore the risk factors for cerebral thrombosis due to interventional embolization of intracranial aneurysms.MethodsThe clinical data of 240 patients with intracranial aneurysms treated by interventional embolization in Department of Neurosurgery, Renmin Hospital of Wuhan University between January 2015 and December 2019 were collected retrospectively. According to whether cerebral thrombosis occurred after embolization, the patients were divided into the cerebral thrombosis group and the non-cerebral thrombosis group. Univariate analyses and multivariate logistic regression analysis were used to analyze the independent risk factors for cerebral thrombosis due to interventional embolization of intracranial aneurysms.ResultsOf the 240 patients, 55 (22.9%) had postoperative cerebral thrombosis confirmed by MRI, and 15 (6.2%) had neurological symptoms. There were significant differences in age, hypertension, hyperlipidemia, operative duration, and procedure methods (simple coiling, balloon or stent-assisted coiling) between the cerebral thrombosis group and the non-cerebral thrombosis group after embolization of intracranial aneurysms (P<0.05). Multivariate logistic regression analysis showed that only operative duration [odds ratio=1.036, 95% confidence interval (1.018, 1.054), P<0.001] was the independent risk factor for cerebral thrombosis after interventional embolization of aneurysms.ConclusionsOperative duration is the independent and adjustable risk factor for cerebral thrombosis after embolization of intracranial aneurysms. Improving the surgical skills of neurointerventional surgeons and shortening the procedure time will be helpful to reduce the occurrence of cerebral thrombosis after interventional treatment of aneurysms and improve the prognosis of patients.
Conventional maximum intensity projection (MIP) images tend to ignore some morphological features in the detection of intracranial aneurysms, resulting in missed detection and misdetection. To solve this problem, a new method for intracranial aneurysm detection based on omni-directional MIP image is proposed in this paper. Firstly, the three-dimensional magnetic resonance angiography (MRA) images were projected with the maximum density in all directions to obtain the MIP images. Then, the region of intracranial aneurysm was prepositioned by matching filter. Finally, the Squeeze and Excitation (SE) module was used to improve the CaraNet model. Excitation and the improved model were used to detect the predetermined location in the omni-directional MIP image to determine whether there was intracranial aneurysm. In this paper, 245 cases of images were collected to test the proposed method. The results showed that the accuracy and specificity of the proposed method could reach 93.75% and 93.86%, respectively, significantly improved the detection performance of intracranial aneurysms in MIP images.