Background Precise diagnosis and rapid treatment for acute complex intracranial hemorrhage(ICH)are crucial.The neurosurgical hybrid operating platform integrates traditional open neurosurgery operating room functional...Background Precise diagnosis and rapid treatment for acute complex intracranial hemorrhage(ICH)are crucial.The neurosurgical hybrid operating platform integrates traditional open neurosurgery operating room functionalities with endovascular therapy capabilities and is developing in the neurosurgical practice.However,its effect on the emergent complicated neurovascular cases needs pilot exploration.Methods In this prospective study,a total of 103 cases of both spontaneous and non-spontaneous ICH were consecutively recruited between June 2019 and June 2023.Demographic data,including age,gender distribution,and types of hemorrhage,were collected.Surgical interventions were tailored based on DSA,including spontaneous and non-spontaneous hemorrhages.Functional outcomes were assessed using the modified Rankin Scale(mRS)preoperatively and postoperatively.Results Over the study period from June 2019 to June 2023,a cohort of 103 ICH cases underwent emergency hybrid surgical treatment utilizing the E-HOPE platform.Among these cases,88 were classified as spontaneous ICH,while 15 were non-spontaneous.The mean age at diagnosis for the entire cohort was 54.0±3.7 years,with a slight predominance of male patients.Spontaneous ICH encompassed a diverse spectrum of etiologies,including arteriovenous malformations,aneurysms,arteriovenous fistulas,cavernous malformations,moyamoya disease,and cryptogenic hemorrhages.Surgical interventions were tailored to address the specific pathology.Notably,improvements in mRS scores were observed in a majority of cases,with some patients experiencing stabilization or deterioration postoperatively.Non-spontaneous cases(n=15)were primarily iatrogenic(n=13)due to tumors adjacent to the internal carotid artery,necessitating stent graft deployment.Surgical approaches,including stent graft deployment and middle meningeal artery embolization,were effective in managing these cases.Postoperative functional outcomes varied depending on the nature of the hemorrhage,with a subset of patients demonstrating improvement in mRS scores while others showed no significant change.Conclusions Emergency hybrid surgical treatment utilizing the E-HOPE platform offers promising outcomes for ICH patients.Tailored surgical approaches result in favorable postoperative functional outcomes,highlighting the importance of a multidisciplinary approach in managing these complex cases.展开更多
Background Moyamoya disease(MMD)is a rare and complex cerebrovascular disorder characterized by the progressive narrowing of the internal carotid arteries and the formation of compensatory collateral vessels.The etiol...Background Moyamoya disease(MMD)is a rare and complex cerebrovascular disorder characterized by the progressive narrowing of the internal carotid arteries and the formation of compensatory collateral vessels.The etiology of MMD remains enigmatic,making diagnosis and management challenging.The MOYAOMICS project was initiated to investigate the molecular underpinnings of MMD and explore potential diagnostic and therapeutic strategies.Methods The MOYAOMICS project employs a multidisciplinary approach,integrating various omics technologies,including genomics,transcriptomics,proteomics,and metabolomics,to comprehensively examine the molecular signatures associated with MMD pathogenesis.Additionally,we will investigate the potential influence of gut microbiota and brain-gut peptides on MMD development,assessing their suitability as targets for therapeutic strategies and dietary interventions.Radiomics,a specialized field in medical imaging,is utilized to analyze neuroimaging data for early detection and characterization of MMD-related brain changes.Deep learning algorithms are employed to differentiate MMD from other conditions,automating the diagnostic process.We also employ single-cellomics and mass cytometry to precisely study cellular heterogeneity in peripheral blood samples from MMD patients.Conclusions The MOYAOMICS project represents a significant step toward comprehending MMD’s molecular underpinnings.This multidisciplinary approach has the potential to revolutionize early diagnosis,patient stratification,and the development of targeted therapies for MMD.The identification of blood-based biomarkers and the integration of multiple omics data are critical for improving the clinical management of MMD and enhancing patient outcomes for this complex disease.展开更多
background Evidence on the natural angiographic course of moyamoya disease(MMD)is lacking.It takes about 6 months for waiting for revascularisation surgery.The issue of when to perform subtraction angiography(DSA)for ...background Evidence on the natural angiographic course of moyamoya disease(MMD)is lacking.It takes about 6 months for waiting for revascularisation surgery.The issue of when to perform subtraction angiography(DSA)for follow-up remains unclear.We investigated the natural course of MMD by DSA and attempted to determine the best interval to perform the follow-up DSA.Methods This is a single-centre cohort study of Chinese MMD inpatients treated from 1 January 2015 to 31 August 2019.Their angiographic findings were evaluated on Suzuki stage and collateral circulation between two follow-ups of the same hemisphere.results A total of 110 patients who met the criteria were enrolled in this study.After a median 6 months follow-up,five patients(4.5%)had progression,four females and one male.Time interval of progression ranged from 4 to 137 months with a mean of 61.4 months.Of five patients with progression,four had unilateral lesion(two ipsilateral and two contralateral)and one had bilateral lesions.Collateral circulation was changed in three of five patients.Conclusions The angiographic evidence of progression in MMD was rare in the short-term follow-up,and most patients with progression had initial unilateral involvement.DSA re-examination may be not needed in patients with bilateral MMD,but needed in unilateral MMD.展开更多
Background: Ankylosing spondylitis was reported to associate with an increased risk of cerebrovascular diseases. In this article, we aimed to report the first case of ankylosing spondylitis associated with moyamoya di...Background: Ankylosing spondylitis was reported to associate with an increased risk of cerebrovascular diseases. In this article, we aimed to report the first case of ankylosing spondylitis associated with moyamoya disease treated with encephalo-duroarterio-synangiosis. Case presentation: A 9-year-old boy with ankylosing spondylitis appeared a symptom of repeated transient ischemic attacks which performed as left hemiparesis. Magnetic resonance angiography showed a typical finding of left anterior cerebral artery, bilateral middle cerebral arteries and the supraclinoid portion of the right internal carotid artery stenosis with an abnormal vascular network at the base of the brain, diagnosed with moyamoya disease. He received a medication treatment but did not underwent revascularization surgery. After three months, ankylosing spondylitis symptoms got some relief, whereas transient ischemic attacks was more frequency. Due to the bad cerebral blood flow on acetazolamide computed tomography perfusion and poor clinical manifestation, he underwent a right encephalo-duroarterio-synangiosis. Postoperatively, the symptoms of transient ischemic attacks disappeared. Conclusions: We reported the first case of ankylosing spondylitis associated with moyamoya disease. Moyamoya disease could appear in patients with ankylosing spondylitis. Revascularization surgery probably is an effective treatment for preventing preoperative ischemic events recurrence.展开更多
基金supported by the National Key Research and Development Program of China(2016YFC1301800).
文摘Background Precise diagnosis and rapid treatment for acute complex intracranial hemorrhage(ICH)are crucial.The neurosurgical hybrid operating platform integrates traditional open neurosurgery operating room functionalities with endovascular therapy capabilities and is developing in the neurosurgical practice.However,its effect on the emergent complicated neurovascular cases needs pilot exploration.Methods In this prospective study,a total of 103 cases of both spontaneous and non-spontaneous ICH were consecutively recruited between June 2019 and June 2023.Demographic data,including age,gender distribution,and types of hemorrhage,were collected.Surgical interventions were tailored based on DSA,including spontaneous and non-spontaneous hemorrhages.Functional outcomes were assessed using the modified Rankin Scale(mRS)preoperatively and postoperatively.Results Over the study period from June 2019 to June 2023,a cohort of 103 ICH cases underwent emergency hybrid surgical treatment utilizing the E-HOPE platform.Among these cases,88 were classified as spontaneous ICH,while 15 were non-spontaneous.The mean age at diagnosis for the entire cohort was 54.0±3.7 years,with a slight predominance of male patients.Spontaneous ICH encompassed a diverse spectrum of etiologies,including arteriovenous malformations,aneurysms,arteriovenous fistulas,cavernous malformations,moyamoya disease,and cryptogenic hemorrhages.Surgical interventions were tailored to address the specific pathology.Notably,improvements in mRS scores were observed in a majority of cases,with some patients experiencing stabilization or deterioration postoperatively.Non-spontaneous cases(n=15)were primarily iatrogenic(n=13)due to tumors adjacent to the internal carotid artery,necessitating stent graft deployment.Surgical approaches,including stent graft deployment and middle meningeal artery embolization,were effective in managing these cases.Postoperative functional outcomes varied depending on the nature of the hemorrhage,with a subset of patients demonstrating improvement in mRS scores while others showed no significant change.Conclusions Emergency hybrid surgical treatment utilizing the E-HOPE platform offers promising outcomes for ICH patients.Tailored surgical approaches result in favorable postoperative functional outcomes,highlighting the importance of a multidisciplinary approach in managing these complex cases.
基金supported by the National Natural Science Foundation of China(82301451)the National Key Research and Development Program of China(2021YFC2500502).
文摘Background Moyamoya disease(MMD)is a rare and complex cerebrovascular disorder characterized by the progressive narrowing of the internal carotid arteries and the formation of compensatory collateral vessels.The etiology of MMD remains enigmatic,making diagnosis and management challenging.The MOYAOMICS project was initiated to investigate the molecular underpinnings of MMD and explore potential diagnostic and therapeutic strategies.Methods The MOYAOMICS project employs a multidisciplinary approach,integrating various omics technologies,including genomics,transcriptomics,proteomics,and metabolomics,to comprehensively examine the molecular signatures associated with MMD pathogenesis.Additionally,we will investigate the potential influence of gut microbiota and brain-gut peptides on MMD development,assessing their suitability as targets for therapeutic strategies and dietary interventions.Radiomics,a specialized field in medical imaging,is utilized to analyze neuroimaging data for early detection and characterization of MMD-related brain changes.Deep learning algorithms are employed to differentiate MMD from other conditions,automating the diagnostic process.We also employ single-cellomics and mass cytometry to precisely study cellular heterogeneity in peripheral blood samples from MMD patients.Conclusions The MOYAOMICS project represents a significant step toward comprehending MMD’s molecular underpinnings.This multidisciplinary approach has the potential to revolutionize early diagnosis,patient stratification,and the development of targeted therapies for MMD.The identification of blood-based biomarkers and the integration of multiple omics data are critical for improving the clinical management of MMD and enhancing patient outcomes for this complex disease.
基金supported by the National Key Technology Research and Development Programme of the Ministry of Science and Technology of China(grants 2006BAI01A13 and 2015BAI12B04)Beijing Municipal Organisation Department Talents Project(grant 2015000021469 G219)+1 种基金Beijing Municipal ST Commission(grant D161100003816005)National Natural Science Foundation of China(grant 81701137).
文摘background Evidence on the natural angiographic course of moyamoya disease(MMD)is lacking.It takes about 6 months for waiting for revascularisation surgery.The issue of when to perform subtraction angiography(DSA)for follow-up remains unclear.We investigated the natural course of MMD by DSA and attempted to determine the best interval to perform the follow-up DSA.Methods This is a single-centre cohort study of Chinese MMD inpatients treated from 1 January 2015 to 31 August 2019.Their angiographic findings were evaluated on Suzuki stage and collateral circulation between two follow-ups of the same hemisphere.results A total of 110 patients who met the criteria were enrolled in this study.After a median 6 months follow-up,five patients(4.5%)had progression,four females and one male.Time interval of progression ranged from 4 to 137 months with a mean of 61.4 months.Of five patients with progression,four had unilateral lesion(two ipsilateral and two contralateral)and one had bilateral lesions.Collateral circulation was changed in three of five patients.Conclusions The angiographic evidence of progression in MMD was rare in the short-term follow-up,and most patients with progression had initial unilateral involvement.DSA re-examination may be not needed in patients with bilateral MMD,but needed in unilateral MMD.
文摘Background: Ankylosing spondylitis was reported to associate with an increased risk of cerebrovascular diseases. In this article, we aimed to report the first case of ankylosing spondylitis associated with moyamoya disease treated with encephalo-duroarterio-synangiosis. Case presentation: A 9-year-old boy with ankylosing spondylitis appeared a symptom of repeated transient ischemic attacks which performed as left hemiparesis. Magnetic resonance angiography showed a typical finding of left anterior cerebral artery, bilateral middle cerebral arteries and the supraclinoid portion of the right internal carotid artery stenosis with an abnormal vascular network at the base of the brain, diagnosed with moyamoya disease. He received a medication treatment but did not underwent revascularization surgery. After three months, ankylosing spondylitis symptoms got some relief, whereas transient ischemic attacks was more frequency. Due to the bad cerebral blood flow on acetazolamide computed tomography perfusion and poor clinical manifestation, he underwent a right encephalo-duroarterio-synangiosis. Postoperatively, the symptoms of transient ischemic attacks disappeared. Conclusions: We reported the first case of ankylosing spondylitis associated with moyamoya disease. Moyamoya disease could appear in patients with ankylosing spondylitis. Revascularization surgery probably is an effective treatment for preventing preoperative ischemic events recurrence.
