Introduction: Malignant sylvian infarction (MSI) is a type of ischemic stroke (ICS) usually affecting the entire territory of the middle cerebral artery (MCA) associated with significant cerebral edema and a mass. It ...Introduction: Malignant sylvian infarction (MSI) is a type of ischemic stroke (ICS) usually affecting the entire territory of the middle cerebral artery (MCA) associated with significant cerebral edema and a mass. It represents about 10% of all AICs, with a mortality of up to 80%. The objectives of our study were to describe the sociodemographic profile and the main clinical manifestations and identify the prognostic factors of ISM. Material and Methods: We conducted a retrospective descriptive study over a 2-year period. It included patients hospitalized for cerebral infarction involving 2/3 of the ACM territory with a NIHSS score ≥ 17 and/or a Glasgow score Results: We collected 223 patients hospitalized for ischemic stroke, of whom 21 patients (9.4%) presented with ISM. The mean age was 57.43 ± 24.24 years with a male predominance (52.4%). The mean admission time was 47 ± 0.87 hours, and hemiplegia was the frequent neurological sign (85.7%). HBP was the common cardiovascular risk factor (76.2%). The mean NIHSS at admission was 18.38 ± 12.29. Respiratory distress (p-value = 0.00015), aspiration pneumonia (p-value = 0.015) and brain herniation (p-value = 0.014) were the main complications associated with mortality. Conclusion: ISM is associated with poor prognosis in the absence of surgical treatment. Respiratory distress, aspiration pneumonia and brain herniation are associated with high mortality.展开更多
The clinical characteristics of patients who presented in poor clinical grade due to ruptured middle cerebral artery aneurysms （MCAAs） associated with large sylvian hematomas （SylH） were ana- lyzed and an ingeniou...The clinical characteristics of patients who presented in poor clinical grade due to ruptured middle cerebral artery aneurysms （MCAAs） associated with large sylvian hematomas （SylH） were ana- lyzed and an ingenious designed prophylactic hinged craniectomy was introduced. Twenty-eight pa- tients were graded into Hunt-Hess grades IV-V and emergency standard micro-neurosurgeries （aneu- rysm clipping, hematoma evacuation and prophylactic hinged craniectomy） were performed, and their clinical data were retrospectively analyzed. 46.43% of the patients reached encouraged favorable out- comes on discharge. The favorable outcome group and the poor outcome group significantly differed in terms of patients＇ anisocoria, Hunt-Hess grade before surgery, extent of the midline shift and time to the surgery after bleeding （P〈0.05）. There were no significant differences in age, sex, volume and location of the hematoma, size of aneurysm between the favorable and poor groups （P〉0.05）. However, ingen- ious designed prophylactic hinged craniectomy efficiently reduced the patients＇ intracranial pressure （ICP） after surgery. It was suggested that preoperative conditions such as Hunt-Hess grading, extent of the midline shift and the occurrence of cerebral hernia affect the prognosis of patients, but time to the surgery after bleeding and prophylactic hinged craniectomy are of significant importance for optimizing the prognosis ofMCAA oatients 19resenting with large SylH.展开更多
BACKGROUND Deep Sylvian meningiomas are rare and difficult to diagnose when small tumours lead to various symptoms.The difficulty associated with surgery is underestimated.Our case involved a mass(11 mm×12 mm...BACKGROUND Deep Sylvian meningiomas are rare and difficult to diagnose when small tumours lead to various symptoms.The difficulty associated with surgery is underestimated.Our case involved a mass(11 mm×12 mm×12 mm in size)in the right Sylvian fissure.It is the smallest deep Sylvian meningioma known and might be more easily misdiagnosed than previous examples.CASE SUMMARY A well-enhanced mass in the right Sylvian fissure of a 26-year-old male with a three-month history of seizure was identified via magnetic resonance imaging.The patient underwent operations twice for seizure control.During the first operation,the tumour was surrounded by the second segment of the middle cerebral artery and its numerous perforators.Partial resection had to be selected due to mild arterial damage.After the first operation,the patient presented with simple partial seizure.During reoperation,we isolated the anatomical structure near the tumour and the tumour over and removed it from its dorsal side by piecemeal resection.CONCLUSION This case reported the smallest deep Sylvian meningioma according to a literature review.Preoperative diagnosis is a crucial step due to deep Sylvian meningioma firmly adhering to the middle cerebral artery and its perforators.Adequate preparation is crucial to ensure the success of surgery.展开更多
目的对比显微镜下经外侧裂-岛叶入路血肿清除术与神经内镜辅助经外侧裂-岛叶入路血肿清除术治疗基底核区脑出血的临床疗效。方法纳入204例自发性基底核区脑出血患者,按随机数字表分为神经内镜组(行神经内镜辅助经外侧裂-岛叶入路血肿清...目的对比显微镜下经外侧裂-岛叶入路血肿清除术与神经内镜辅助经外侧裂-岛叶入路血肿清除术治疗基底核区脑出血的临床疗效。方法纳入204例自发性基底核区脑出血患者,按随机数字表分为神经内镜组(行神经内镜辅助经外侧裂-岛叶入路血肿清除术,n=96)和显微镜组(行显微镜下经外侧裂-岛叶入路血肿清除术,n=108)。比较两组患者的手术时间、住院时间、血肿清除率及术后并发症发生情况(包括颅内感染、再出血、脑梗死、癫痫、消化道出血及肺部感染)。采用美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评估神经功能,格拉斯哥昏迷量表(Glasgow coma scale,GCS)评估意识状态,Barthel指数评估日常生活能力,术后6个月采用格拉斯哥预后量表(Glasgow outcome scale,GOS)评估总体恢复情况。结果两组患者术前血肿量与发病至手术时间差异无统计学意义(均P>0.05)。神经内镜组术后残余血肿量明显少于显微镜组,而血肿清除率明显高于显微镜组(均P<0.05)。神经内镜组手术时间与住院时间明显少于显微镜组,差异具有统计学意义(均P<0.05)。两组术后并发症发生率差异均无统计学意义(均P>0.05)。术后4周神经内镜组患者GCS评分高于显微镜组,而NIHSS评分低于显微镜组(均P<0.05)。术后3个月时,神经内镜组Barthel指数较显微镜组明显升高,差异具有统计学意义(P<0.05)。两组患者术后GOS评分恢复优良率差异无统计学意义(P>0.05)。结论神经内镜辅助经外侧裂-岛叶入路可更有效治疗基底核区脑出血,实现精准止血,减轻术后脑水肿,有助于改善患者短期神经功能及日常生活能力。然而,其在长期预后改善方面与显微镜辅助手术相比无显著优势。展开更多
Objective To summarize the clinical feature and our experience of surgical skills on the insula lesions. Methods The clinical manifestation and pathological characters of 30 cases of insula lesion were studied retrosp...Objective To summarize the clinical feature and our experience of surgical skills on the insula lesions. Methods The clinical manifestation and pathological characters of 30 cases of insula lesion were studied retrospectively. Results In the 30 cases of insula lesion, 21 lesions located in the dominant hemisphere. Seizure occurred as an initial symptom in 29 cases. Pathology examination found glioma in 26 cases, AVM in 1 case and cavernous angioma in 3 cases. Conclusion Seizure is usually the initial manifestation of insula lesion. Low-grade glioma and other benign lesions are the major pathological findings in the insula area.展开更多
文摘Introduction: Malignant sylvian infarction (MSI) is a type of ischemic stroke (ICS) usually affecting the entire territory of the middle cerebral artery (MCA) associated with significant cerebral edema and a mass. It represents about 10% of all AICs, with a mortality of up to 80%. The objectives of our study were to describe the sociodemographic profile and the main clinical manifestations and identify the prognostic factors of ISM. Material and Methods: We conducted a retrospective descriptive study over a 2-year period. It included patients hospitalized for cerebral infarction involving 2/3 of the ACM territory with a NIHSS score ≥ 17 and/or a Glasgow score Results: We collected 223 patients hospitalized for ischemic stroke, of whom 21 patients (9.4%) presented with ISM. The mean age was 57.43 ± 24.24 years with a male predominance (52.4%). The mean admission time was 47 ± 0.87 hours, and hemiplegia was the frequent neurological sign (85.7%). HBP was the common cardiovascular risk factor (76.2%). The mean NIHSS at admission was 18.38 ± 12.29. Respiratory distress (p-value = 0.00015), aspiration pneumonia (p-value = 0.015) and brain herniation (p-value = 0.014) were the main complications associated with mortality. Conclusion: ISM is associated with poor prognosis in the absence of surgical treatment. Respiratory distress, aspiration pneumonia and brain herniation are associated with high mortality.
基金supported by National Natural Science Foundation of China(No.81201026)
文摘The clinical characteristics of patients who presented in poor clinical grade due to ruptured middle cerebral artery aneurysms （MCAAs） associated with large sylvian hematomas （SylH） were ana- lyzed and an ingenious designed prophylactic hinged craniectomy was introduced. Twenty-eight pa- tients were graded into Hunt-Hess grades IV-V and emergency standard micro-neurosurgeries （aneu- rysm clipping, hematoma evacuation and prophylactic hinged craniectomy） were performed, and their clinical data were retrospectively analyzed. 46.43% of the patients reached encouraged favorable out- comes on discharge. The favorable outcome group and the poor outcome group significantly differed in terms of patients＇ anisocoria, Hunt-Hess grade before surgery, extent of the midline shift and time to the surgery after bleeding （P〈0.05）. There were no significant differences in age, sex, volume and location of the hematoma, size of aneurysm between the favorable and poor groups （P〉0.05）. However, ingen- ious designed prophylactic hinged craniectomy efficiently reduced the patients＇ intracranial pressure （ICP） after surgery. It was suggested that preoperative conditions such as Hunt-Hess grading, extent of the midline shift and the occurrence of cerebral hernia affect the prognosis of patients, but time to the surgery after bleeding and prophylactic hinged craniectomy are of significant importance for optimizing the prognosis ofMCAA oatients 19resenting with large SylH.
基金Supported by the key research and development program of Ningxia,No.2018BFG02007.
文摘BACKGROUND Deep Sylvian meningiomas are rare and difficult to diagnose when small tumours lead to various symptoms.The difficulty associated with surgery is underestimated.Our case involved a mass(11 mm×12 mm×12 mm in size)in the right Sylvian fissure.It is the smallest deep Sylvian meningioma known and might be more easily misdiagnosed than previous examples.CASE SUMMARY A well-enhanced mass in the right Sylvian fissure of a 26-year-old male with a three-month history of seizure was identified via magnetic resonance imaging.The patient underwent operations twice for seizure control.During the first operation,the tumour was surrounded by the second segment of the middle cerebral artery and its numerous perforators.Partial resection had to be selected due to mild arterial damage.After the first operation,the patient presented with simple partial seizure.During reoperation,we isolated the anatomical structure near the tumour and the tumour over and removed it from its dorsal side by piecemeal resection.CONCLUSION This case reported the smallest deep Sylvian meningioma according to a literature review.Preoperative diagnosis is a crucial step due to deep Sylvian meningioma firmly adhering to the middle cerebral artery and its perforators.Adequate preparation is crucial to ensure the success of surgery.
文摘目的对比显微镜下经外侧裂-岛叶入路血肿清除术与神经内镜辅助经外侧裂-岛叶入路血肿清除术治疗基底核区脑出血的临床疗效。方法纳入204例自发性基底核区脑出血患者,按随机数字表分为神经内镜组(行神经内镜辅助经外侧裂-岛叶入路血肿清除术,n=96)和显微镜组(行显微镜下经外侧裂-岛叶入路血肿清除术,n=108)。比较两组患者的手术时间、住院时间、血肿清除率及术后并发症发生情况(包括颅内感染、再出血、脑梗死、癫痫、消化道出血及肺部感染)。采用美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评估神经功能,格拉斯哥昏迷量表(Glasgow coma scale,GCS)评估意识状态,Barthel指数评估日常生活能力,术后6个月采用格拉斯哥预后量表(Glasgow outcome scale,GOS)评估总体恢复情况。结果两组患者术前血肿量与发病至手术时间差异无统计学意义(均P>0.05)。神经内镜组术后残余血肿量明显少于显微镜组,而血肿清除率明显高于显微镜组(均P<0.05)。神经内镜组手术时间与住院时间明显少于显微镜组,差异具有统计学意义(均P<0.05)。两组术后并发症发生率差异均无统计学意义(均P>0.05)。术后4周神经内镜组患者GCS评分高于显微镜组,而NIHSS评分低于显微镜组(均P<0.05)。术后3个月时,神经内镜组Barthel指数较显微镜组明显升高,差异具有统计学意义(P<0.05)。两组患者术后GOS评分恢复优良率差异无统计学意义(P>0.05)。结论神经内镜辅助经外侧裂-岛叶入路可更有效治疗基底核区脑出血,实现精准止血,减轻术后脑水肿,有助于改善患者短期神经功能及日常生活能力。然而,其在长期预后改善方面与显微镜辅助手术相比无显著优势。
文摘Objective To summarize the clinical feature and our experience of surgical skills on the insula lesions. Methods The clinical manifestation and pathological characters of 30 cases of insula lesion were studied retrospectively. Results In the 30 cases of insula lesion, 21 lesions located in the dominant hemisphere. Seizure occurred as an initial symptom in 29 cases. Pathology examination found glioma in 26 cases, AVM in 1 case and cavernous angioma in 3 cases. Conclusion Seizure is usually the initial manifestation of insula lesion. Low-grade glioma and other benign lesions are the major pathological findings in the insula area.
