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Objective Preliminary study on the protective effect of intraoperative direct electrical stimulation motor ⁃ evoked potential (DES ⁃ MEP) on motor function during brainstem tumor surgery. Methods Total 136 patients with brainstem tumor surgery from January 2017 to May 2020 were enrolled, including 68 patients treated with intraoperative routine electrophysiological monitoring combined with neuronavigation and 68 patients with DES ⁃ MEP combined with neuronavigation on the basis of routine electrophysiological monitoring. According to the changes of muscle strength (Lovett Muscle Strength Classification) before and after operation, the patients were judged to have new dyskinesia motor function or not. The true positive, false positive, true negative and false negative were judged by DES ⁃ MEP monitoring and postoperative motor function prognosis. The sensitivity and specificity, positive predictive value and negative predictive value, and accuracy of DES ⁃ MEP monitoring results in predicting postoperative motor function prognosis were calculated. Results Patients undergoing DES⁃MEP combined with routine electrophysiological monitoring had 16.18% (11/68) of severe new dyskinesia (Lovett Muscle Strength Classification reduction ≥ 2 grade) 2 weeks after surgery, which was lower than patients undergoing routine electrophysiological monitoring [32.35% (22/68); χ2 = 4.841, P = 0.028]. There were 44 true positive cases, 4 false positive cases, 7 true negative cases, and 13 false negative cases detected by DES ⁃ MEP. The sensitivity and specificity of DES ⁃ MEP were 77.19% (44/57) and 7/11, the positive predictive value and negative predictive value of DES ⁃ MEP were 91.67% (44/48) and 35% (7/20), and accuracy of DES ⁃ MEP was 75% (51/68), respectively. Conclusions The application of DES ⁃ MEP in brainstem tumor surgery can effectively protect the brainstem motor function and make up for the deficiency of intraoperative neural monitoring technology in the protection of brainstem corticospinal tract function. DOI:10.3969/j.issn.1672⁃6731.2020.11.004

Objective To explore the application value of ultra-high-speed spiral CT angiography (CTA) in the assessment and prognosis of hemorrhagic moyamoya disease (MMD) in emergency department. Methods A total of 187 patients with CT scanning suspected hemorrhagic MMD were all from emergency department from June 2014 to January 2019, and were diagnosed in acute stage (< 72 h) by ultra-high-speed spiral CTA examination and post-image treatment. Internal medicine conservative treatment, hematoma removal or extra ventricular drainage (EVD) were used respectively. The level and prognosis of neurofunctional impairment at 1, 3 and 6 months after onset of patients were evaluated with modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS). Results One hundred and six cases (56.68%) conformed to the imaging characteristics of MMD, showing intra-cervical artery stenosis or obliteration, Willis ring thickened, partial vascular obviously dilated, significantly increased collateral vessels in basal ganglion region, increasing blood vessels at the base of the junction of frontal-temporal lobe, occurrence of small, dense smoke-like angiogenesis at the brain bottom. Compared with DSA, CTA diagnosis accuracywas 95.27% (155/161), false positive rate was 4.76% (3/63), and false negative rate was 3.06% (3/98). Among them, there were 84 cases of CTA showed "millet sign" were positive, and 103 cases were negative. The "millet sign" positive group after onset of 1, 3 and 6 months the mRS score was higher (P = 0.000) and GOS score was lower than those in "millet sign" negative group (P = 0.000). The mRS score of 2 groups decreased gradually (P = 0.000, for all) and the GOS score gradually increased (P = 0.000, for all). Conclusions Ultra-high-speed spiral CTA assisted in the diagnosis of suspected hemorrhagic MMD patients in emergency apartment is safe and convenient with high diagnostic accuracy, and has a certain guiding significance for prognostic assessment. DOI:10.3969/j.issn.1672-6731.2019.09.008

Objective Preliminary study on the protective effect of intraoperative direct electrical stimulation motor - evoked potential (DES - MEP) on motor function during brainstem tumor surgery. Methods Total 136 patients with brainstem tumor surgery from January 2017 to May 2020 were enrolled, including 68 patients treated with intraoperative routine electrophysiological monitoring combined with neuronavigation and 68 patients with DES - MEP combined with neuronavigation on the basis of routine electrophysiological monitoring. According to the changes of muscle strength (Lovett Muscle Strength Classification) before and after operation, the patients were judged to have new dyskinesia motor function or not. The true positive, false positive, true negative and false negative were judged by DES - MEP monitoring and postoperative motor function prognosis. The sensitivity and specificity, positive predictive value and negative predictive value, and accuracy of DES - MEP monitoring results in predicting postoperative motor function prognosis were calculated. Results Patients undergoing DES-MEP combined with routine electrophysiological monitoring had 16.18% (11/68) of severe new dyskinesia (Lovett Muscle Strength Classification reduction ≥ 2 grade) 2 weeks after surgery, which was lower than patients undergoing routine electrophysiological monitoring [32.35% (22/68); χ² = 4.841, P = 0.028]. There were 44 true positive cases, 4 false positive cases, 7 true negative cases, and 13 false negative cases detected by DES - MEP. The sensitivity and specificity of DES - MEP were 77.19% (44/57) and 7/11, the positive predictive value and negative predictive value of DES - MEP were 91.67% (44/48) and 35% (7/20), and accuracy of DES - MEP was 75% (51/68), respectively. Conclusions The application of DES - MEP in brainstem tumor surgery can effectively protect the brainstem motor function and make up for the deficiency of intraoperative neural monitoring technology in the protection of brainstem corticospinal tract function. [ABSTRACT FROM AUTHOR]

To explore the application value of ultra-high-speed spiral CT angiography (CTA) in the assessment and prognosis of hemorrhagic moyamoya disease (MMD) in emergency department. Methods A total of 187 patients with CT scanning suspected hemorrhagic MMD were all from emergency department from June 2014 to January 2019, and were diagnosed in acute stage (< 72 h) by ultra-high-speed spiral CTA examination and post-image treatment. Internal medicine conservative treatment, hematoma removal or extra ventricular drainage (EVD) were used respectively. The level and prognosis of neurofunctional impairment at 1, 3 and 6 months after onset of patients were evaluated with modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS). Results One hundred and six cases (56.68%) conformed to the imaging characteristics of MMD, showing intra-cervical artery stenosis or obliteration, Willis ring thickened, partial vascular obviously dilated, significantly increased collateral vessels in basal ganglion region, increasing blood vessels at the base of the junction of frontal-temporal lobe, occurrence of small, dense smoke-like angiogenesis at the brain bottom. Compared with DSA, CTA diagnosis accuracy was 95.27% (155/161), false positive rate was 4.76% (3/63), and false negative rate was 3.06% (3/98). Among them, there were 84 cases of CTA showed "millet sign" were positive, and 103 cases were negative. The "millet sign" positive group after onset of 1, 3 and 6 months the mRS score was higher (P = 0.000) and GOS score was lower than those in "millet sign" negative group (P = 0.000). The mRS score of 2 groups decreased gradually (P = 0.000, for all) and the GOS score gradually increased (P = 0.000, for all). Conclusions Ultra-high-speed spiral CTA assisted in the diagnosis of suspected hemorrhagic MMD patients in emergency apartment is safe and convenient with high diagnostic accuracy, and has a certain guiding significance for prognostic assessment. [ABSTRACT FROM AUTHOR]