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Aim To summarize and calculate the accurate rate of good outcome and the prognosis, using a uniform definition of good outcome, evaluating the long-term effect of surgery. Material and methods Through searching the relevant databases, we included eligible studies measuring outcomes with the modified Rankin Scale (mRS), Glasgow Outcome Scale (GOS) and Kim's category. Single group rates were transformed and synthesized to yield the mean weighted probability. Sensitivity analyses were conducted to check the robustness of overall effect. Subgroup analyses were stratified by study type, population, age phase, presentation, surgical procedure and outcome measurement. Results The overall estimated rate of good outcome was 0.87 (95%CI, 0.84 0.90), with substantial heterogeneity. In the subgroup analyses, the outcome measured with GOS led to the highest rate of 91%, while Kim's category had the lowest rate of 82%. The combined bypass surgery group resulted in a higher good outcome rate of 0.92 (95%CI, 0.89 0.96) than the indirect bypass group of 0.83% (95%CI, 0.78 0.88). Conclusion Moyamoya disease after surgical treatment could achieve a good outcome rate of 87%. Kim's category reflected the functional outcome better, resulting in a good outcome rate of 82%. The combined bypass surgery led to better outcomes than indirect bypass.

Although several studies have suggested perihematomal edema(PHE) is associated with prognosis in intracerebral hemorrhage(ICH), the results are different in other studies. The purpose of this study to evaluate the prognostic role of PHE in ICH. According to PRISMA guidelines, a systematic literature search of PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library was performed. Published clinical studies reporting association between PHE and prognosis in ICH were included. Data were extracted including sample size, patient characteristics, PHE measures, outcome measures and follow-up. A total of 21 studies were included with 6 prospective studies and 15 retrospective studies. PHE measures included perihamatomal edema absolute volume (PHEAV), relative prihematomal edema volume (rPHE), perihematomal edema absolute volume growth (PHEAV growth), perihematomal edema expansion rate(PHEER), relative prihematomal edema growth (relative PHE growth), cytotoxic edema(CE) and perihamatomal edema absolute area (PHEAA). The association of PHEAV/ rPHE /PHEAV growth and outcome are conflicting in different studies. Meta-analysis showed 72h PHEER at 72 hours was significantly associated with poor clinical outcome at 90 days (OR=1.54, 95%CI 1.04-2.22, P 0.001). This study suggests the measures and time points for PHE and outcome are various in previous studies. The prognostic values of PHEAV, rPHE, PHEAV growth and other measures are still controversial. PHEER is likely a prognostic predictor for ICH. Further studies with larger sample size, more accurate measures and more time points are needed to investigate the prognostic role of PHE in ICH and the optimal PHE measure to predict outcome in ICH.

Aim To explore the clinical value of bone flap creation and the sinus protection in the approach of retrosigmoid keyhole craniotomy with the guidance of three-dimensional (3D) sliced computed tomography (CT) reconstruction of the skull transverse sinus and sigmoid sinus groove. Material and methods The scalp tracings of the transverse sinus and sigmoid sinus groove of 108 posterior fossa lesion patients were delineated by gentian violet, which relies on the relationship between its 3D reconstruction location and scalp marker. The craniotomy was executed with the guidance of its surface tracings. The intraoperative findings of exposure and damage of transverse sinus, sigmoid sinus, morphology, stability, complications, and postoperative appearance of bone flap restoration were evaluated. Results Morphological analysis of the transverse-sigmoid sinus groove showed right superiority, left superiority, and balanced type in 61, 18, and 29 cases, respectively and the relationship between the asterion and the transverse-sigmoid sinus groove showed that asterion sites were located in the upper portion, onto, and below the transverse and sigmoid sinus groove in 19, 68, and 21 cases, respectively. Good intraoperative exposure without damage of transverse sinus and sigmoid sinus, good stability and appearance of bone flap restoration, and no postoperative pseudomeningocele were obtained after using this method to locate the transverse sinus and sigmoid sinus. Conclusion The 3D sliced CT reconstruction of the skull transverse sinus and sigmoid sinus groove was helpful in the approach of retrosigmoid craniotomy for sinus exposure, sinus protection, and the prevention of cerebrospinal fluid leakage and pseudomeningocele.

Aim Whether an antiepileptic drug (AED) should be prescribed for intracerebral hemorrhage (ICH) patients is a matter in dispute, and recent studies have come up with different or even opposite views. A meta-analysis on this issue has not been performed. The goal of this meta-analysis was to study antiepileptic drugs" effects on early seizure occurrence and outcome for ICH patients. Material and methods We searched the PubMed, Ovid, and Cochrane library until December 2015 to identify relevant articles. A meta-analysis was conducted to evaluate the overall effect with random-effects or fixed-effects models. Results Four articles consisting of one randomized controlled trial and three cohort studies met the included criteria. For the occurrence of early seizure, antiepileptic drugs showed the ability to reduce the risk, but reached no statistical significance (OR=0.71; 95% CI, 0.38-1.34; test for overall effect Z=1.06, p=0.29). No association between antiepileptic drug use and poor outcome was found (OR=1.95; 95% CI, 0.56-6.79; test for overall effect Z=1.06, P=0.29), but heterogeneity was present. Conclusion Summarizing published studies, the AED use did not reduce early seizure occurrence statistically but a population with high-risk factors of early seizure is likely to benefit from AEDs. Besides, AED use was not associated with poor outcome. We suggest AED use for ICH patients with high-risk factors of seizure, but not generally.

To investigate the imaging features of neurocysticercosis and to provide valuable information about the diagnosis and treatment for clinicians.The data of 71 consecutive cases of neurocysticercosis, diagnosed by computed tomography (CT) and magnetic resonance imaging (MRI) between January 2009 and January 2014 in our institute were collected. Of all the cases, 57 patients met the recognized diagnostic criteria of neurocysticercosis. In this series, enzyme-linked immunosorbent assay (ELISA) examination and Cysticercosis IgG were positive in 55 cases and 3 cases, respectively. Among them, neurocysticercosis was confirmed surgically in 11 cases. Seven cases had CT examinations, including enhanced CT in one case. Fifty-four cases had MRI examinations, including contrast-enhanced MRI in 46 cases. Therapeutically, 32 patients received albendazole, while 25 patients received praziquantel. As a surgical treatment, 9 patients underwent lesionectomy, and 1 patient underwent lesionectomy plus shunt insertion for hydrocephalus.Parenchymal cysticerci in 53 cases (92.9%), subarachnoidal cysticerci in 39 cases (68.4%), ventricular cysticerci in 13 cases (22.8%) and spinal cysticerci in 1 case were demonstrated on CT and MRI scans. In total, the intracranial cysticerci involving multiple locations simultaneously were found in 39 patients. Thirty-five cases had associated leptomeningitis, 10 cases had hydrocephalus. In 1 case, the cysticerci were located outside of the central nervous system.The imaging findings of the cysticerci, including their location, numbers, cystic sizes, capsular thickness, densities and signals of the scolexes, as well as the peripheral edema, have distinct value in making possible timely diagnosis of neurocysticercosis for clinicians.

AIM Tyrosine kinase receptor-B (TrkB), a high-affinity receptor for brain-derived neurotrophic factor (BDNF), functions via specific binding with the BDNF. Although studies have shown that BDNF promotes the expression of glutamate transporter-1 (GLT-1) in the glial cells during neurodegeneration, evidence is lacking regarding whether BDNF/TrkB pathway is associated with the abnormal function of GLT-1.The aim of this study is to analyze the expressions of TrkB and GLT-1 in the brain of pentylenetetrazol (PTZ) kindling model of chronic epilepsy in rats, and to provide evidence for the correlation between the BDNF/TrkB pathway and GLT-1 and clues for the prevention and treatment targets of epilepsy. MATERIAL AND METHODS In total, 40 Sprague-Dawley rats were randomly classified as model (n= 30) and control (n= 10) groups respectively. Western blotting was used for analyzing the expression of TrkB and GLT-1, and double immunofluorescence staining was used for detecting the cells positive for both glial fibrillary acidic protein (GFAP) and TrkB in the hippocampus and temporal cortex 7 days after establishing the kindling model. RESULTS Compared with the control group, protein level expression of TrkB and GLT-1, and mean optical density (OD) value of the cells positive for both GFAP and TrkB in the hippocampus and temporal cortex were significantly increased after the onset of epilepsy (P < 0.05). CONCLUSION The BDNF/TrkB pathway may participate in the epileptogenesis through modulating the biological effect of GLT-1 in the glial cells of PTZ kindling rats, though the specific mechanisms require further investigations.

To implement a surgical technique consisting of simplified incisions that allows all required procedures to be performed in one single operation for the purpose of reducing surgical stress in experimental animals.Experimental animals (rats) were assigned to one of four groups: Group 0 was the (normal) control group, Group 1 consisted of rats that had an operation using multiple incisions, Group 2 consisted of rats who received a midline incision and were raised for 3 months, and Group 3 consisted of rats who also received a midline incision, but had been raised for 6 months. Rat blood pressure was measured by tail cuff method. The surgical characteristics and outcomes of the rats in Groups 1 and 2 were compared. Aneurysmal lesions of both branching and non-branching sites were compared amongst the 4 groups by observation of the cerebral vascular corrosion casts through a scanning electron microscope. Histological analyses of the induced aneurysms were performed.The simplified incision technique significantly reduced the length of surgery and need for anesthesia redose during the operation. No aneurysms formed in the normal control rats. The incidence of saccular aneurysm formation significantly increased in Group 3. Histological analyses confirmed the aneurysms induced in the rats shared the same characteristics as human aneurysms.Our modified surgical method reduced the surgical stress in rats. It also successfully induced both saccular and fusiform cerebral aneurysms. While longer incubation duration for aneurysm formation could be applied in future researches.

Intracranial epidermoid cysts are usually located in the paramedian regions with characteristic imaging features. Intracystic hemorrhage is rarely reported with most in the cerebellopontine angle area. We described a case of hemorrhagic epidermoid cyst in cerebellar vermis. The patient was a 21-year-old male presenting with a first episode of convulsive seizure attack as the initial and sole symptom. Head computed tomography showed a mass lesion in the cerebellar vermis with high density and nodular low density in the back of the lesion. Magnetic resonance imaging revealed most of the lesion was hypointense to isointense, extremely hypointensity on T1-, T2-weighted imaging respectively. The nodule was hyperintense on both T1- and T2-weighted images. The atypical clinical presentation, location and radiological features of intracranial epidermoid cyst make accurate diagnosis quite challenging. In such cases, scrutinized histopathological examination is necessary to exclude the malignancy that may need radio/chemotherapy.

Elevation of blood pressure (BP) is common after intracerebral hemorrhage (ICH). Early BP treatment may be beneficial after ICH, but the effect of intensive BP lowering on ICH outcomes is not known and no systematic review or meta-analysis was published regarding this issue.We conducted a meta-analysis to compare the effect of more versus less intensive BP targets on clinical outcomes in patients with ICH. Mortality, unfavorable outcome and adverse events were analyzed. Meta-analysis was performed in terms of the odds ratio (OR) and 95% confidence interval (CI).Five eligible studies were included and analyzed, involving 3243 patients to use systolic BP (SBP)140 mmHg as target BP and 142 patients to use other BP target in intensive BP target group. The pooled OR of mortality and unfavorable outcome after ICH in intensive BP control group comparing with less intensive BP targets group were 0.99 (95% CI 0.81 to 1.23) and 0.90 (95% CI 0.78 to 1.03) respectively. The pooled OR were 0.97 (95% CI 0.80 to 1.18) for neurological deterioration and 0.83 (95% CI 0.61 to 1.11) for hematoma expansion. There is no difference in other adverse events between two groups.Acute lowering of SBP to 140 mmHg is probably beneficial for functional outcome in patients with ICH, but the evidence is still insufficient. Further large multicenter studies are required to enhance the evidence to guide the BP lowering target following ICH.

Aim To investigate the imaging features of neurocysticercosis and to provide valuable information about the diagnosis and treatment for clinicians. Material and methods The data of 71 consecutive cases of neurocysticercosis, diagnosed by computed tomography (CT) and magnetic resonance imaging (MRI) between January 2009 and January 2014 in our institute were collected. Of all the cases, 57 patients met the recognized diagnostic criteria of neurocysticercosis. In this series, enzyme-linked immunosorbent assay (ELISA) examination and Cysticercosis IgG were positive in 55 cases and 3 cases, respectively. Among them, neurocysticercosis was confirmed surgically in 11 cases. Seven cases had CT examinations, including enhanced CT in one case. Fifty-four cases had MRI examinations, including contrast-enhanced MRI in 46 cases. Therapeutically, 32 patients received albendazole, while 25 patients received praziquantel. As a surgical treatment, 9 patients underwent lesionectomy, and 1 patient underwent lesionectomy plus shunt insertion for hydrocephalus. Results Parenchymal cysticerci in 53 cases (92.9%), subarachnoidal cysticerci in 39 cases (68.4%), ventricular cysticerci in 13 cases (22.8%) and spinal cysticerci in 1 case were demonstrated on CT and MRI scans. In total, the intracranial cysticerci involving multiple locations simultaneously were found in 39 patients. Thirty-five cases had associated leptomeningitis, 10 cases had hydrocephalus. In 1 case, the cysticerci were located outside of the central nervous system. Conclusion The imaging findings of the cysticerci, including their location, numbers, cystic sizes, capsular thickness, densities and signals of the scolexes, as well as the peripheral edema, have distinct value in making possible timely diagnosis of neurocysticercosis for clinicians.

Idiopathic distal anterior choroidal artery (AChoA) aneurysms are particularly rare. Their diagnosis and treatment are difficult because of the particular characteristic of pathological anatomy. Our case mainly presented with intraventricular hemorrhage. His idiopathic aneurysm was located in the trigone of the undilated ventricle. Computed tomographic angiography demonstrated both the precise aneurysm and parent artery even when there was no dilated parent artery for the first time. It is also the first time this tiny aneurysm was resected assisted by frameless stereotactic guidance during operation after absorption of intraventricular blood. Computed tomographic angiography and frameless stereotactic guidance benefit the diagnosis and treatment of this kind of aneurysm. Sacrificing plexual AChoA did not cause any neurologic deficit.

Subarachnoid hemorrhage (SAH) is a devastating neurological injury associated with significant morbidity and mortality. We postulated that lipopolysaccharide (LPS) preconditioning induces neuroprotection against early brain injury (EBI) after experimental SAH.72 male Sprague-Dawley rats (250 to 300 g) were used. SAH was produced by injecting autologous arterial blood into the pre-chiasmatic cistern. Rats were given an intraperitoneal injection of LPS 24 hours prior SAH. Matrix metalloproteinase 9 (MMP-9) protein expression was measured by western blot; apoptosis in the cerebral cortex were studied by terminal deoxynucleotidyl transferasemediated deoxyuridine triphosphate-biotin nick-end labeling (TUNEL) and 4'6-diamidino-2-phenylindole dihydrochloride (DAPI) staining at 24 h after SAH. Brain water content was also examined.MMP-9 expression was increased after SAH and decreased by LPS preconditioning at 24 h after SAH. The number of neuronal death in cortex was increased after SAH and decreased by LPS preconditioning. In addition, brain water content was attenuated by LPS preconditioning.LPS preconditioning could modulate MMP-9 and therefore induce neuroprotection against EBI after experimental SAH.

Aim Computed tomography perfusion (CTP) has recently been used to identify regions of potential ischemia due to cerebral vasospasm, and CTP parameters are able to quantitatively evaluate brain parenchymal perfusion. We performed a meta-analysis as an update of a previous paper published in 2010 and aimed at evaluating the diagnostic accuracy of CTP and CTP parameters for vasospasm after aneurysm rupture. Material and methods Relevant articles published between January 2005 and May 2013 were systematically searched for analysis without language restrictions from the PubMed/MEDLINE, Embase, and Cochrane databases. The data of CTP parameters, including CBV, CBF, MTT and TTP, were extracted for analysis, and the pooled sensitivity, specificity, PLR, NLR, DOR and the sROC curve were determined. Results Three relevant articles and a total of 98 patients were finally involved in the analysis. The pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of CTP for diagnosing cerebral vasospasm were 94%, 90%, 8.22, 0.06, 141.09, and 0.9802, respectively. Through the evaluation of CTP parameters, MTT had a higher sensitivity (91%) while CBF had a higher specificity (93%). Conclusion CT perfusion has a great diagnostic value to detect cerebral vasospasm compared with DSA in patients with aneurysmal subarachnoid hemorrhage (aSAH). As CTP parameters, CBF and MTT quantitatively evaluate brain parenchymal perfusion.

The purpose of this study was to compare the different clinical features, outcome and treatment strategies in patients with perimesencephalic SAH (p-SAH) and diffuse SAH (d-SAH).83 patients with spontaneous SAH and negative initial cerebral angiography were retrospectively reviewed.There were 49 patients with p-SAH and 34 with d-SAH. The patients with d-SAH were likely to be hypertensive and smoking and have elevated cholesterol and lactate dehydrogenase and White blood cells. 95.9% of patients with p-SAH had a HuntHess grade of I-II, whereas 73.5% of patients with d-SAH had Grade I-II, 9 patients had Grade III-IV. All patients with p-SAH had a modified Fisher scale of 1-2 and a favorable outcome, whereas 47 % and 8.8% of the patients with d-SAH had a score of 1-2 and had a poor prognosis, respectively. Hydrocephalus, clinical vasospasm, re-bleeding and pneumonia were common in patients with d-SAH.The initial bleeding pattern was associated with the initial clinical condition and outcome, and d-SAH might lead to a worse clinical course and outcome and might have a high risk of complications. Repeated DSA is recommended to exclude aneurysm in patients with d-SAH, whereas CT angiography was enough in patients with p-SAH.

AIM To implement a surgical technique consisting of simplified incisions that allows all required procedures to be performed in one single operation for the purpose of reducing surgical stress in experimental animals. MATERIAL AND METHODS Experimental animals (rats) were assigned to one of four groups: Group 0 was the (normal) control group, Group 1 consisted of rats that had an operation using multiple incisions, Group 2 consisted of rats who received a midline incision and were raised for 3 months, and Group 3 consisted of rats who also received a midline incision, but had been raised for 6 months. Rat blood pressure was measured by tail cuff method. The surgical characteristics and outcomes of the rats in Groups 1 and 2 were compared. Aneurysmal lesions of both branching and non-branching sites were compared amongst the 4 groups by observation of the cerebral vascular corrosion casts through a scanning electron microscope. Histological analyses of the induced aneurysms were performed. RESULTS The simplified incision technique significantly reduced the length of surgery and need for anesthesia redose during the operation. No aneurysms formed in the normal control rats. The incidence of saccular aneurysm formation significantly increased in Group 3. Histological analyses confirmed the aneurysms induced in the rats shared the same characteristics as human aneurysms. CONCLUSION Our modified surgical method reduced the surgical stress in rats. It also successfully induced both saccular and fusiform cerebral aneurysms. While longer incubation duration for aneurysm formation could be applied in future researches.

To investigate the indications and clinical value of the surgical therapy of neurocysticercosis (NCC).We retrospectively reviewed all 10 patients with NCC treated surgically from January 2009 to January 2014 in our institute. The NCC types included parenchymal cysticerci in 6 cases, subarachnoid cysticerci in 3 and ventricular cysticerci in 1.All 10 patients underwent resection of cysticerci through craniotomy. Parenchymal NCC included an isolated lesion in 4 cases and multi-lesions in 2 cases, who respectively had coexistence of metastasis and cysticerci and a positive history of tuberculosis. In all 3 patients with arachnoid NCC, two cases underwent lesion resection and the other one underwent cyst resection and lamina terminalis fenestration. In one case with intraventricular NCC, a ventriculoperitoneal (VP) shunt was placed as the initial treatment. Due to failure of the shunt, the secondary surgery of cyst excision via open craniotomy and VP shunt placement were performed simultaneously.For parenchymal cysticercosis, the surgical aim is to remove the lesion, treat the medically intractable epilepsy, and establish the diagnosis and subsequent treatment. As for extraparenchymal NCC, surgical therapy is a valuable treatment as an alternative due to its fatal complications. For subarachnoid cysticercosis, because of its higher failure rate in simply VP shunt, the open craniotomy could directly remove the cyst and efficaciously relieve hydrocephalus. For the patient with intraventricular NCC associated with hydrocephalus, the effect of a simple VP shunt seems unsatisfactory, and craniotomy for cyst resection is necessary.

AIM Prediction of outcome for surgical patients with primary pontine hemorrhage (PPH) is seldom reported although many predictors from clinical and radiological features have been identified in conservative patients. The purpose of this study was to assess the prognostic factors affecting the 30-day mortality and 3-month functional outcome in surgical patients after PPH. MATERIAL AND METHODS Forty-five patients with large PPH ( > 5 ml) and Glasgow Coma Scale (GCS) score < 8 were treated surgically at West China Hospital. The demographic, clinical, imaging and follow-up data were collected retrospectively. Factors affecting the mortality and functional outcome were statistically analyzed. RESULTS Fourteen patients (31.1%) died within 30 days and 7 patients (15.6%) gained a favorable functional recovery within 3 months. A multivariate analysis showed that the hematoma volume, GCS score on admission, age, and type of hemorrhage were all significantly related to the 30-day mortality, while the hematoma volume, GCS score on admission, rostrocaudal extension were associated with the 3-month functional outcome. The presence of hydrocephalus was not found responsible for the surgical outcomes. CONCLUSION The identification of these prognostic factors is helpful for selecting the candidates for surgical treatment. Those with younger age, smaller hematoma without rostrocaudal extension, unilateral hemorrhage, and higher GCS score may benefit from surgery.

The chondroma originated in falx cerebri and dural convexity is very rare, less than 30 cases reported so far. Here, we report a case of 26-year old male, with a huge mass at fronto-parietal falx cerebri, who was misdiagnosed as parafalcine meningioma on preoperative MR imaging. After surgery, the diagnosis of chondroma was confirmed pathologically. By reviewing the MR images of the patient, we find that the peripheral ring-like enhancement and intratumoral partial slight coral-like enhancement on contrast-enhanced T1 images might be the valuable MR features to differentiate from parafalcine meningioma. In addition, the tumor's pathogenesis and pathological characteristics were briefly discussed.

Aim To compare the effects of post neurosurgical antimicrobial prophylaxis before and after the adoption of a new protocol in our department, which changed from prolonged prophylaxis to limited usage. Material and methods Two cross-sectional studies were performed to compare the 24-hour antimicrobial use for all the inpatients at the neurosurgical ward 1 day before (June 30, 2011) and 1 year after (June 29, 2012) the beginning of the new rules. Student's t-test or the chisquare test were used to compare baseline characteristics and prophylactic or therapeutic antimicrobial usage between the groups. Results The total of 391 patients enrolled consisted of 221 for June 30, 2011 as group 1 and 170 for June 29, 2012 as group 2. The baseline characteristics of the groups showed no significant difference. The prophylactic use significantly decreased in Group 2 (13.1% vs. 5.9%, p=0.018). However, total therapeutic use (10.9% vs. 18.2%, p=0.041) and the use for nosocomial infection (7.32% vs. 15.9%, p=0.009) both increased significantly in Group 2. Furthermore, therapeutic use for surgical site infections also increased significantly (3.16% vs. 9.41%, p=0.015). Conclusion Shorter antimicrobial prophylaxis may increase post neurosurgical infection. The optimal duration of neurosurgical antimicrobial prophylaxis should be compliant with local hospital conditions and further prospective trials are required to address this issue on a procedure-specific basis.

Bacterial ventriculitis is one of the most difficult diseases of neurosurgery, if not controlled well in the early stage, it will cause empyema, adhesion and separated infectious ventricle locules inside the ventricle. Few studies focus on the relationship between external drainage volume and the occurrence of adhesion and separation of the ventricle. This paper reported a case of ventriculitis, and we propose that excessive external drainage might increase the occurrence rate of the internal separation and adhesion of ventricle in patients with ventriculitis. Choosing an appropriate drainage method and avoiding excessive drainage might be the key to the treatment of ventriculitis.

Aim To explore the surgical effect of cerebellar tonsillectomy with suboccipital decompression and duraplasty by small surgical incision (3~4cm around the foramina magnum) on treating Chiari I Malformation (CM I) patients. Material and methods A retrospective study was undertaken on 76 CM I patients treated by this surgery. The surgical efficacy on clinical symptoms and syringomyelia were overall evaluated and analyzed. Results The study included 76 cases (36 men and 40 women; age range, 5-58 years; mean age at surgery, 38.8 years). Preoperative MRI confirmed 56 cases associated with syringomyelia. The follow-up period ranged from 25 to 58 months (median, 46 months). At the end of follow-up, 61 patients (80.26%) had improved, 12 patients (15.79%) were stabilized, and 3 patients (3.95%) had worsened. In MRI scan, syrinx of 55 patients (98.21%) had improved or stabilized compare with syrinx growth in only one patient (1.79%). Statistical analysis reveal the surgical effect tend to be much better in patients with short duration of preoperative symptoms (P=0.001). Conclusion Cerebellar tonsillectomy with suboccipital decompression and duraplasty can provide long-time cure for most CM I cases. Early diagnosis and surgery is necessary to improve the surgical effect. A 3~4cm incision around foramen magnum is enough for these operations and may be conducive to reduce postoperative complications.

AIM To explore the causes of scalp wound infection, pathogen distribution, characteristics of antimicrobial susceptibility and therapeutic measures following craniocerebral trauma caused by the 2008 Wenchuan earthquake. MATERIAL and METHODS We retrospectively analyzed the microbiology records of patients admitted with craniocerebral trauma to the Department of Neurosurgery, West China Hospital, Sichuan University. Scalp wound infections following craniocerebral trauma were caused by the Wenchuan earthquake. RESULTS A total of 82 patients suffered from scalp trauma in this study, including 52.4% cases (43/82) with wound infections, mostly accompanied by severe foreign body contamination, for which the time of first debridement was significantly delayed. There were 59 strains of infectious pathogenic bacteria. Gram-positive bacteria were the most common organisms found (64.4%), including strains of Staphylococcus aureus (26/59, 44.1%) and strains of Staphylococcus epidermidis (12/59, 20.3%). Gram-negative bacteria accounted for 35.6% of samples: 22.0% (13/59) were strains of Enterobacter cloacae; 5.1% (3/59) were strains of Klebsiella pneumoniae; and 8.5% (5/59) were strains of Serratia rubidaea. CONCLUSION The rate of scalp wound infections following earthquake-induced craniocerebral trauma, which was dominated by Grampositive Staphylococcus aureus infection, has been markedly elevated in recent years. Early debridement and suturing, nutritional support and application of sensitive antibiotics can augment the therapeutic effect.