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
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
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.
