Background Surgical interventions for moyamoya disease include direct and indirect revascularizations. This study aimed to evaluate the therapeutic effect of superficial temporal artery-middle cerebral artery bypass c...Background Surgical interventions for moyamoya disease include direct and indirect revascularizations. This study aimed to evaluate the therapeutic effect of superficial temporal artery-middle cerebral artery bypass combined with an indirect revascularization procedure, encephalo-duro-myo-synangiosis, in the treatment of moyamoya disease. Methods From October 2005 to November 2009, we performed this combined revascularization procedure in 111 patients with different types and stages of moyamoya disease. The superficial temporal artery, middle meningeal artery and the deep temporal artery were evaluated for individualized surgical planning in these cases. The integrity of the deep temporal artery and the middle meningeal artery network, and the pre-existing spontaneous anastomoses of the distal branches of the external carotid artery with the cortical arteries were well preserved. The mean follow-up time was 72.5 months, all clinical and radiological data were retrospectively reviewed. Results A total of 198 stomas were performed in 122 hemispheres, all remaining patent until the last follow-up. The encephalo-duro-myo-synangiosis resulted in extensive anastomoses of the deep temporal artery （100%）, the middle meningeal artery （90.9%）, and the sphenopalatine artery （39.8%） with the cortical arteries, respectitvely. The superficial temporal artery, deep temporal artery, and the middle meningeal artery were significantly thickened in 88 patients as determined by digital subtraction angiography at follow-up. The relative cerebral blood flow increased significantly within one week after the operation. At 6 months post the operation, the relative cerebral blood flow was further increased by 15.5% from the gradual formation of anastomoses as a result of indirect revascularization. Transient ischemic attacks were effectively reduced or totally arrested. The neurological deficits significantly improved in 37 patients, with the National Institutes of Health Stroke Scale scores lowered by 2-8. There was no rehemorrhage in hemorrhagic moyamoya disease patients. Conclusion This study showed that the superficial temporal artery-middle cerebral artery bypass combined with encephalo-duro-myo-synangiosis can achieve good therapeutic effect in the treatment of moyamoya disease.展开更多
Objective To review the history, development, and reality of neuronavigation surgery in China and to discuss the future of neuronavigation surgery. Data sources PubMed, the China Knowledge Resource Integrated Database...Objective To review the history, development, and reality of neuronavigation surgery in China and to discuss the future of neuronavigation surgery. Data sources PubMed, the China Knowledge Resource Integrated Database, and the VIP Database for Chinese Technical Periodicals were searched for papers published from 1995 to the present with the key words ＂neuronavigation,＂ ＂functional navigation,＂ ＂image-guided,＂ and ＂stereotaxy.＂ Articles were reviewed for additional citations, and some information was gathered from Web searches. Study selection Articles related to neuronavigation surgery in China were selected, with special attention to application to brain tumors. Results Since the introduction of neurosurgical navigation to China in 1997, this core technique in minimally invasive neurosurgery has seen rapid development. This development has ranged from brain structural localization to functional brain mapping, from static digital models of the brain to dynamic brain-shift compensation models, and from preoperative image-guided surgery to intraoperative real-time image-guided surgery, and from application of imported equipment and technology to use of equipment and technology that possess Chinese independent intellectual property rights. Conclusions The development and application of neuronavigation techniques have made neurological surgeries in China more safe, precise and effective, and less invasive, and promoted the quality of Chinese neurosurgical practice to the rank of the most advance and excellence in the world.展开更多
Background The Dextroscope system by Volume Interactions （Singapore） had been applied to minimally invasive neurosurgery in many units. This system enables the neurosurgeon to interact intuitively with the three-dim...Background The Dextroscope system by Volume Interactions （Singapore） had been applied to minimally invasive neurosurgery in many units. This system enables the neurosurgeon to interact intuitively with the three-dimensional graphics in a direct manner resembling the way one communicates with the real objects. In the paper, we explored its values in pre-operation surgical planning for intracranial meningiomas resection. Methods Brain computed tomography （CT）, magnetic resonance imaging （MRI）, and magnetic resonance venography （MRV） were performed on 10 patients with parasagittal and falcine meningiomas located on central groove area; brain CT, MRI and magnetic resonance angiography （MIRA） were performed on 10 patients with anterior skull base meningiomas and 10 patients with sphenoid ridge meningiomas. All these data were transferred to Dextroscope virtual reality system, and reconstructed. Then meningiomas, skull base, brain tissue, drainage vein and cerebral arteries were displayed within the system, and their anatomic relationships were evaluated. Also, the simulation operations were performed. Results For parasagittal and falcine meningiomas, the relationships of tumor with drainage vein and superior sagittal sinus were clearly displayed in the Dextroscope system. For anterior skull base and sphenoid ridge meningiomas, the relationships of tumor with bilateral internal carotid arteries, anterior cerebral arteries, middle cerebral arteries and skull base were vividly displayed within the virtual reality system. Surgical planning and simulation operation of all cases were performed as well. The real operations of all patients were conducted according to the simulation with well outcomes. Conclusions According to the virtual reality planning, neurosurgeons could get more anatomic information about meningioma and its surrounding structures, especially important vessels, and choose the best approach for tumor resection, which would lead to better prognosis for patients.展开更多
Chordoid meningioma （CM）, characterized by its resemblance to chordoma, was first described by Kepes et al＇ in 1988, and classified histologically as a WHO grade II neoplasm in the 2000 revision of the WHO grading ...Chordoid meningioma （CM）, characterized by its resemblance to chordoma, was first described by Kepes et al＇ in 1988, and classified histologically as a WHO grade II neoplasm in the 2000 revision of the WHO grading system, featured by its aggressive clinical course, great risk of recurrence, and infrequent association with hematological conditions.2 This article describes the clinical course, radiological characteristics, postoperative treatment, and prognosis of 17 patients with CM who underwent surgical treatment at our hospital.展开更多
Background Meningioma is one of the most common primary tumors of the central nervous system, but there are not many detailed studies on the sex, age, subtypes and locations of large series. This study was a retrospec...Background Meningioma is one of the most common primary tumors of the central nervous system, but there are not many detailed studies on the sex, age, subtypes and locations of large series. This study was a retrospective analysis of the characteristics of meningioma cases consecutively operated on at a single institution in China from 2001 to 2010. Methods This study investigated the demographic background of 7084 meningioma cases, and the subtypes and locations of the tumors. Sex and age distributions were analyzed, and the pathological subtypes were classified according to the World Health Organization （WHO） classification. The location of the meningiomas was also categorized. Results The female：male ratio of the 7084 cases was 2.34：1. The mean age was 51.4 years （range, 11 months-86 years）. The mean age of cases of WHO grade I meningioma was significantly older than that of grade II or III meningiomas （P 〈0.001, Fisher＇s Least Significant Digit test）. There was a significantly higher female：male ratio in WHO grade I meningiomas than in grade II or grade III meningiomas （2.57, 1.03 and 0.76, respectively; P 〈0.001, X^2 test）. Meningothelial （n=2061） and fibrous meningiomas （n=3556） were the most common subtypes, comprising 79.3% of all meningiomas. All meningioma cases were classified into 23 locations in this study, with the cerebral convexity the most common site （38.33%, n=2722）. Cases with uncommon locations such as extra-cranial and sylvian fissure meningiomas were also present in this series. Conclusions Female predominance was found for benign meningiomas, while malignant subtypes showed male predominance. The mean age of patients with WHO grade Ⅰ meningiomas was older than that of patients with higher-grade tumors. Meningothelial and fibrous meningiomas were the most common subtypes. The cerebral convexity was the most common menin.qioma location.展开更多
基金grants from the National Natural Science Foundation of China，Natural Science Foundation of Shanghai Science and Technology Committee
文摘Background Surgical interventions for moyamoya disease include direct and indirect revascularizations. This study aimed to evaluate the therapeutic effect of superficial temporal artery-middle cerebral artery bypass combined with an indirect revascularization procedure, encephalo-duro-myo-synangiosis, in the treatment of moyamoya disease. Methods From October 2005 to November 2009, we performed this combined revascularization procedure in 111 patients with different types and stages of moyamoya disease. The superficial temporal artery, middle meningeal artery and the deep temporal artery were evaluated for individualized surgical planning in these cases. The integrity of the deep temporal artery and the middle meningeal artery network, and the pre-existing spontaneous anastomoses of the distal branches of the external carotid artery with the cortical arteries were well preserved. The mean follow-up time was 72.5 months, all clinical and radiological data were retrospectively reviewed. Results A total of 198 stomas were performed in 122 hemispheres, all remaining patent until the last follow-up. The encephalo-duro-myo-synangiosis resulted in extensive anastomoses of the deep temporal artery （100%）, the middle meningeal artery （90.9%）, and the sphenopalatine artery （39.8%） with the cortical arteries, respectitvely. The superficial temporal artery, deep temporal artery, and the middle meningeal artery were significantly thickened in 88 patients as determined by digital subtraction angiography at follow-up. The relative cerebral blood flow increased significantly within one week after the operation. At 6 months post the operation, the relative cerebral blood flow was further increased by 15.5% from the gradual formation of anastomoses as a result of indirect revascularization. Transient ischemic attacks were effectively reduced or totally arrested. The neurological deficits significantly improved in 37 patients, with the National Institutes of Health Stroke Scale scores lowered by 2-8. There was no rehemorrhage in hemorrhagic moyamoya disease patients. Conclusion This study showed that the superficial temporal artery-middle cerebral artery bypass combined with encephalo-duro-myo-synangiosis can achieve good therapeutic effect in the treatment of moyamoya disease.
基金This study was supported by grants from the Ministry of Health of China （2010-2012）, National Natural Science Foundation of China （No. 81071117）, and Shanghai Municipal Health Bureau （No. XBR2011022）.
文摘Objective To review the history, development, and reality of neuronavigation surgery in China and to discuss the future of neuronavigation surgery. Data sources PubMed, the China Knowledge Resource Integrated Database, and the VIP Database for Chinese Technical Periodicals were searched for papers published from 1995 to the present with the key words ＂neuronavigation,＂ ＂functional navigation,＂ ＂image-guided,＂ and ＂stereotaxy.＂ Articles were reviewed for additional citations, and some information was gathered from Web searches. Study selection Articles related to neuronavigation surgery in China were selected, with special attention to application to brain tumors. Results Since the introduction of neurosurgical navigation to China in 1997, this core technique in minimally invasive neurosurgery has seen rapid development. This development has ranged from brain structural localization to functional brain mapping, from static digital models of the brain to dynamic brain-shift compensation models, and from preoperative image-guided surgery to intraoperative real-time image-guided surgery, and from application of imported equipment and technology to use of equipment and technology that possess Chinese independent intellectual property rights. Conclusions The development and application of neuronavigation techniques have made neurological surgeries in China more safe, precise and effective, and less invasive, and promoted the quality of Chinese neurosurgical practice to the rank of the most advance and excellence in the world.
基金This study was supported by grants from the National Natural Science Foundation of China （No. 30872675 and No. 30901549）, Shanghai Committee of Science and Technology （No. 08411965100）, and 2011 Shanghai Medical College Young Scientist Fund of Hehai University （No. 11L-24）.
文摘Background The Dextroscope system by Volume Interactions （Singapore） had been applied to minimally invasive neurosurgery in many units. This system enables the neurosurgeon to interact intuitively with the three-dimensional graphics in a direct manner resembling the way one communicates with the real objects. In the paper, we explored its values in pre-operation surgical planning for intracranial meningiomas resection. Methods Brain computed tomography （CT）, magnetic resonance imaging （MRI）, and magnetic resonance venography （MRV） were performed on 10 patients with parasagittal and falcine meningiomas located on central groove area; brain CT, MRI and magnetic resonance angiography （MIRA） were performed on 10 patients with anterior skull base meningiomas and 10 patients with sphenoid ridge meningiomas. All these data were transferred to Dextroscope virtual reality system, and reconstructed. Then meningiomas, skull base, brain tissue, drainage vein and cerebral arteries were displayed within the system, and their anatomic relationships were evaluated. Also, the simulation operations were performed. Results For parasagittal and falcine meningiomas, the relationships of tumor with drainage vein and superior sagittal sinus were clearly displayed in the Dextroscope system. For anterior skull base and sphenoid ridge meningiomas, the relationships of tumor with bilateral internal carotid arteries, anterior cerebral arteries, middle cerebral arteries and skull base were vividly displayed within the virtual reality system. Surgical planning and simulation operation of all cases were performed as well. The real operations of all patients were conducted according to the simulation with well outcomes. Conclusions According to the virtual reality planning, neurosurgeons could get more anatomic information about meningioma and its surrounding structures, especially important vessels, and choose the best approach for tumor resection, which would lead to better prognosis for patients.
基金This study was supported by-grants from the National Natural Science Foundation of China （No. 30872675 and No. 30901549）, and Science and Technology Commission of Shanghai Municipality （No. 08411965100 and No. 12JC1401800）. There is no conflict of interest in this manuscript and we strictly follow the protocols of ethical board and clinical practice in China.
文摘Chordoid meningioma （CM）, characterized by its resemblance to chordoma, was first described by Kepes et al＇ in 1988, and classified histologically as a WHO grade II neoplasm in the 2000 revision of the WHO grading system, featured by its aggressive clinical course, great risk of recurrence, and infrequent association with hematological conditions.2 This article describes the clinical course, radiological characteristics, postoperative treatment, and prognosis of 17 patients with CM who underwent surgical treatment at our hospital.
基金This work was supported by grants from the National Natural Science Foundation of China （No. 30872675 and No. 30901549）, and Science and Technology Commission of Shanghai Municipality （No. 08411965100 and No. 12JC 1401800）. Conflict of interest： none.
文摘Background Meningioma is one of the most common primary tumors of the central nervous system, but there are not many detailed studies on the sex, age, subtypes and locations of large series. This study was a retrospective analysis of the characteristics of meningioma cases consecutively operated on at a single institution in China from 2001 to 2010. Methods This study investigated the demographic background of 7084 meningioma cases, and the subtypes and locations of the tumors. Sex and age distributions were analyzed, and the pathological subtypes were classified according to the World Health Organization （WHO） classification. The location of the meningiomas was also categorized. Results The female：male ratio of the 7084 cases was 2.34：1. The mean age was 51.4 years （range, 11 months-86 years）. The mean age of cases of WHO grade I meningioma was significantly older than that of grade II or III meningiomas （P 〈0.001, Fisher＇s Least Significant Digit test）. There was a significantly higher female：male ratio in WHO grade I meningiomas than in grade II or grade III meningiomas （2.57, 1.03 and 0.76, respectively; P 〈0.001, X^2 test）. Meningothelial （n=2061） and fibrous meningiomas （n=3556） were the most common subtypes, comprising 79.3% of all meningiomas. All meningioma cases were classified into 23 locations in this study, with the cerebral convexity the most common site （38.33%, n=2722）. Cases with uncommon locations such as extra-cranial and sylvian fissure meningiomas were also present in this series. Conclusions Female predominance was found for benign meningiomas, while malignant subtypes showed male predominance. The mean age of patients with WHO grade Ⅰ meningiomas was older than that of patients with higher-grade tumors. Meningothelial and fibrous meningiomas were the most common subtypes. The cerebral convexity was the most common menin.qioma location.
