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Objective:To systematically evaluate the efficacy and safety of minimally invasive removal of intracranial hematoma combined with Naoxueshu treatment for spontaneous cerebral hemorrhage. Methods:Computer search was conducted on Chinese and English databases including CNKI, VIP, Wanfang, CBM, PubMed, Embase and the Cochrane Library from the establishment of the database to June 2023, based on inclusion and exclusion criteria to select randomized controlled trials (RCTS) of minimally invasive removal of intracranial hematoma combined with Naoxueshu oral liquid in the treatment of spontaneous intracerebral hemorrhage. The risk of bias was evaluated according to the Cochrane Systematic Review Manual, and meta-analysis was performed using Revman5.4 software, and the GRADE system was used to evaluate the evidence quality of outcome indicators. Results:Totally 9 RCTs were included, and the total sample size was 739 cases. There were 371 cases in the control group and 368 cases in the experimental group. The results of meta-analysis showed that compared with only conventional Western medicine after minimally invasive surgery, combined application of Naoxueshu oral liquid improved the overall clinical effectiveness rate [OR=5.47, 95%CI=2.28, 13.09, P=0.000 1], obviously reduced the score of National Institute of Health Stroke Scale [MD=-3.42, 95%CI=-4.97, -1.87, P<0.000 1], and neurological impairment score Chinese stroke patients [MD=-2.30, 95%CI=-3.01, -1.58, P<0.000 01], improved Glasgow Coma Scale score [MD=1.51, 95%CI=1.13, 1.89, P<0.000 01] and Barthel Index (BI) score [MD=6.88, 95%CI=4.49, 9.27, P<0.000 01], and decreased serum S100 protein [MD=-0.02, 95%CI=-0.03, -0.02, P<0.000 01] and AQP4 levels [MD=-0.02, 95%CI=-0.03, -0.01, P=0.002[. In terms of safety, no serious adverse reactions were reported;gastrointestinal discomfort symptoms including nausea, abdominal distension and diarrhea were reported in 2 studies; no adverse reactions were reported in the remaining studies. Conclusion:Existing evidence shows that minimally invasive removal of intracranial hematoma combined with Naoxueshu oral liquid in the treatment of spontaneous cerebral hemorrhage has obvious effects in reducing the degree of neurological impairment and consciousness disorder, improving patients' daily living ability, ameliorating patients' quality of life and other aspects, and has certain safety. [ABSTRACT FROM AUTHOR]

Objective To summarize the cases of hematoma in remote site after infratentorial craniotomy for tumors, and to explore the early identification methods as well as prevention and treatment strategies. Methods The clinical data of patients who underwent infratentorial craniotomy for tumors from Dec 2019 to Nov 2021 in the skull base subspecialty group of the department of neurosurgery, Huashan Hospital, Fudan University were retrospectively analyzed to summarize the location and type of hematoma in remote sites and its causes，and to explore its early identification methods and prevention strategies. Results Among the 490 patients who underwent infratentorial craniotomy for tumors，18 patients （3.67%） developed hematoma in remote site, including 9 cases with supratentorial subdural hematoma，3 cases with occipital epidural hematoma，2 cases with supratentorial subdural hematoma combined with interhemispheric subdural hematoma，2 cases with intraventricular hematoma，1 cases with interhemispheric subdural hematoma, and 1 patient temporal lobe intracerebral hematoma combined with subarachnoid hemorrhage. Two cases were accurately identified during operation, and the operation was terminated. Intraoperative head CT was performed to determine the type of hematoma, and surgical treatment was performed. All the other 16 cases were identified in the early postoperative period, and head CT was performed to identify the type of hematoma. One patient was treated with surgery and 15 cases were treated conservatively. All the 18 cases were followed up for 2-21 months after operation, and there was no death case. Conclusion The hematoma in remote site after infratentorial craniotomy for tumors is a rare and serious threat to the safety of surgery, mostly manifested as supratentorial subdural hematoma, epidural hematoma, intraventricular hematoma, interhemispheric subdural hematoma and intracerebral hematoma, which can be associated with subarachnoid hemorrhage. Perioperative active prevention, early and accurate identification as well as timely and effective treatment can significantly improve the prognosis of patients. [ABSTRACT FROM AUTHOR]

对脑血管病患者的脑组织氧合情况实施床旁监测，对脑血管病的诊治及预后改善有重要价值。近红外光谱成像（near infrared spectroscopy，NIRS）作为一项新兴的脑成像技术，具有价格低廉、操作便捷、非侵入性等优点，逐渐成为脑血管病研究的焦点。本文介绍了NIRS的基本原理，探讨了NIRS在急性脑梗死早期识别、梗死后再灌注疗效评估、大面积脑梗死继发恶性脑水肿预测等方面的应用价值，预测了NIRS在大脑近皮层出血病情监测中的应用前景。此外，在蛛网膜下腔出血诊疗领域，NIRS通过动态监测脑氧饱和度，在迟发性脑缺血监测及术后功能结局预测等方面也有着较大的应用潜力。最后，本文基于NIRS的优势和不足，展望了未来适合NIRS应用的临床场景。加强NIRS在脑血管病领域的研究，将使实时评估脑血管病院前、院内的精准动态成为可能。 Bedside monitoring of cerebral oxygenation in patients with cerebrovascular diseases is of great value for the diagnosis, treatment and prognosis of cerebrovascular diseases. As a novel brain imaging technology, near infrared spectroscopy (NIRS) has the advantages of low price, good convenience and non-invasiveness. It has gradually become the focus of cerebrovascular disease research. This article introduced the basic principle of NIRS, the application of NIRS in early recognition of acute cerebral infarction, efficacy evaluation of reperfusion after infarction, and prediction of malignant cerebral edema secondary to large cerebral infarction, and also the application prospect of NIRS in monitoring the hemorrhage near cerebral cortex. For patients with subarachnoid hemorrhage, NIRS may play a great potential role in monitoring delayed cerebral ischemia and predicting postoperative functional outcome by dynamical monitoring cerebral oxygen saturation. Finally, based on the advantages and disadvantages of NIRS, we looked forward to the clinical scenarios suitable for NIRS application in the future. Further NIRS research in cerebrovascular disease will make accurate pre-hospital and in-hospital real-time dynamic assessment of cerebrovascular disease possible.

OBJECTIVE: To evaluate the efficacy, safety and economy of tirofiban in the treatment of acute ischemic stroke based on rapid health technology assessment(HTA), so as to provide evidence-based basis for clinical rational drug use. METHODS: Domestic and foreign databases such as PubMed, the Cochrane Library, CNKI and Wanfang Data were retrieved to collect HTA reports, systematic review / Meta-analysis and pharmacoeconomic studies of tirofiban in the treatment of acute ischemic stroke ( the intervention group was treated with tirofiban alone or in combination with other treatment, the control group received placebo or other treatment). The retrieval time was from the establishment of the database to Sept. 2021. Two researchers independently screened the literature according to inclusion and exclusion criteria, extracted data, evaluated the literature quality, summarized the research results and analyzed qualitatively. RESULTS: A total of 15 systematic review / Meta-analysis were included. In terms of effectiveness, compared with the control group, tirofibancan could significantly improve patients’ neurological function and activity of daily living, with statistically significant difference (P< 0. 05); there was no statistically significant difference in the rate of reocclusion between two groups (P>0. 05); in terms of improving 90-day prognosis, vascular revascularization rate and mortality, the results of various studies were inconsistent. In terms of safety, compared with the control group, tirofiban did not increase the incidence of intracranial hemorrhage, the incidence of symptomatic intracranial hemorrhage, the conversion rate of intracranial hemorrhage, the incidence of intracranial parenchymal hematoma type 2 and the incidence of adverse bleeding events at other sites, and there was no statistical significance between two groups ( P > 0. 05); the incidence of fatal intracranial hemorrhage increased significantly in tirofiban group, which might be related to the route and dose of administration. CONCLUSIONS: Tirofiban has significant effectiveness and safety in the treatment of acute ischemic stroke. Due to the significant increase in the incidence of fatal intracranial hemorrhage of tirofiban, more large-scale, multicenter randomized controlled studies can be considered in the future to further confirm the safety of tirofiban in the treatment of ischemic stroke and provide reference for clinical and decision-makers. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To observe the clinical effect of step decompression strategy to remove bone flap decompression in severe traumatic brain injury, and to analyze the influencing factors of intraoperative acute encephalocele. Methods: 103 patients with severe traumatic brain injury treated in our hospital from January 2020 to August 2021 were retrospectively selected. According to the different operation methods, the patients were divided into group A (conventional bone flap decompression, n=50) and group B (step decompression strategy, bone flap decompression, (n=53). The operation related indexes, the incidence of complications and the prognosis of the two groups were compared. In addition, according to whether there was acute encephalocele during craniotomy, the patients were divided into bulge group (n=41) and non bulge group (n=62). Multivariate logistic regression was used to analyze the influencing factors of intraoperative acute encephalocele in patients with severe traumatic brain injury. Results: The operation time of group B was shorter than that of group A, the amount of intraoperative bleeding was less than that of group A, and the incidence of acute encephalocele and delayed intracranial hematoma was lower than that of group A (P<0.05). The good prognosis rate of group B was higher than that of group A (P<0.05). Univariate analysis showed that intraoperative acute encephalocele in patients with severe traumatic brain injury was related to age, time from injury to operation, DTIH, contralateral skull fracture, first GCS score after admission, PADBS, history of hypertension, preoperative body temperature, preoperative intracranial pressure, PLT and Pt (P<0.05). Multivariate logistic regression analysis showed that combined with contralateral skull fracture, DTIH, PADBS, injury to operation time < 3 h, first GCS score < 6 after admission, high preoperative intracranial pressure and high preoperative temperature were the risk factors of intraoperative acute encephalocele in patients with severe traumatic brain injury (P<0.05), while the step decompression strategy of bone flap decompression was the protective factor (P<0.05). Conclusion: Using step decompression strategy to remove bone flap decompression in the treatment of severe traumatic brain injury can reduce the amount of intraoperative bleeding, shorten the operation time, reduce the incidence of complications and improve the prognosis of patients. Whether intraoperative acute encephalocele in patients with severe traumatic brain injury is affected by combined with contralateral skull fracture, DTIH, PADBS, time from injury to operation, first GCS score after admission, preoperative body temperature, preoperative intracranial pressure and other factors. [ABSTRACT FROM AUTHOR]

BACKGROUND: There are many kinds of skull repair materials, but there is still no one material in high biocompatibility, high cost-effective and low incidence of complications in all aspects of clinical needs. OBJECTIVE: To analyze the difference in postoperative complications of 3D printed plastic polyetherketone and titanium mesh cranioplasty, and point out the improvement directions. METHODS: Data of 207 patients undergoing cranioplasty in Huanggang Central Hospital of Yangtze University from June 2014 to June 2021 were retrospectively analyzed, including 157 males and 50 females, at the age of 16-68 years old. Among them, 42 patients were treated with polyetheretherketone and 165 patients were treated with titanium mesh. The satisfaction survey of the reconstruction of the frontotemporal parietal defect area was carried out at 3 weeks after the operation. Complications were analyzed during postoperative follow-up. RESULTS AND CONCLUSION: (1) There were 32 cases of skull defect repaired with polyetheretherketone, with shaping satisfaction of 56.3%, and 117 cases of skull defect repaired with titanium mesh, with shaping satisfaction of 75.2%. Significant differences in shaping satisfaction were found between the two groups (P < 0.05). (2) Complications occurred in 14 of 42 cases in the polyetheretherketone group, including 12 cases of subcutaneous hydrops (28.6%), 1 case of epilepsy, and 1 case of forehead screw fixation swelling pain; with a complication rate of 33.3%. Among the 165 cases in the titanium mesh group, 28 cases had complications, including 15 cases of subcutaneous hydrops (9.1%), 7 cases of epilepsy, 2 cases of intracranial infection, 2 cases of material exposure, 1 case of intracranial hematoma, 1 case of material loosening, with a complications rate of 17.0%. There was a significant difference in the incidence of subcutaneous hydrops and total complication rate between the two groups (P < 0.05). (3) It is concluded that titanium mesh was better than polyetherketone mesh in repairing bone defect of frontotemporal parietal region, with a high satisfaction. The main improvement direction of polyetheretherketone in cranioplasty is to reduce the incidence of postoperative subcutaneous hydrops. [ABSTRACT FROM AUTHOR]

Objective To assess the efficacy of early hybrid surgery for treatment of complex anterior circulation aneurysm with hematoma but without cerebral hernia. Methods We retrospectively analyzed the clinical data of 11 patients with complex anterior circulation aneurysm with hematomas, who underwent early hybrid surgery in our hospital between November, 2014 and November, 2017. In all the cases, the aneurysms were managed and the hematomas were removed by a hybrid approach combining intraoperative digital subtraction angiography (DSA), temporary balloon occlusion and microsurgery. Five of these patients underwent superficial temporal artery (STA)-middle cerebral artery (MCA) bypass combined with aneurysm isolation, in which endovascular balloon occlusion was performed for trapping the aneurysms after intraoperative DSA for verifying the patency of the bridge vessel; in 6 cases, intraoperative angiography and temporary balloon occlusion-assisted aneurysm shaping and clipping were performed, and the clipping effect was verified with intraoperative DSA. The outcomes of the patients following the surgeries were evaluated with modified Rankin scale (mRS). Results In all the 11 cases, emergency microsurgery and hematoma evacuation were completed successfully in the hybrid operation room within 72 h after onset. In the 5 patients receiving STA-MCA bypass, intraoperative angiography verified the patency of the blood vessels and the aneurysms were trapped successfully in the one-stage operation. In the 6 patients treated with aneurysm shaping and clipping, intraoperative DSA showed that the aneurysm clips needed to be adjusted in 4 patients, including 3 with mistaken clipping of the perforator vessels and 1 with incomplete clipping; the clipping effect was satisfactory after adjustment. Focal cerebral infarction occurred in 1 patient and epilepsy in another after the operation, and all the other patients showed no new neurological dysfunction after the operation. The 11 patients were followed up for 3-24 months postoperatively, during which new neurological dysfunctions, relapse or rupture of the aneurysms did not occur. The postoperative mRS score was 0 in 3 cases (27.3%), 1 in 6 cases (54.5%), 3 in 1 case (9.1%) and 4 in 1 case (9.1%). Conclusion Hybrid operation can be a safe and effective approach to treatment of complex anterior circulation aneurysms with hematomas that can not be managed by direct surgical clipping or endovascular intervention.

bjective: To study the effect of minimally invasive drilling and drainage on the short-term curative effect of patients with hypertensive cerebral hemorrhage, intracranial infection and hematoma re-enlargement. Methods: 81 patients with hypertensive intracerebral hemorrhage from March 2017 to February 2019 were selected. According to the random number table, they were divided into observation group (n=42) and control group (n=39). The control group was treated with conventional craniotomy and hematoma removal, and the observation group was treated with minimally invasive drilling and drainage. Observe the therapeutic effects of the two groups, the amount of hematoma, myelin basic protein (MBP), central nervous system specific protein S100 levels, NIHSS, GCS scores, and adverse reactions. Results: After treatment, the total effective rate of the observation group was significantly higher than that of the control group [92.86% (39/42) vs 69.23% (27/39)] (P<0.05); hematoma volume, MBP, and S100 levels were significantly lower Control group [(9.32±2.70) m L vs (15.51±3.01) m L, (3.65±0.52) μg/L vs (4.20±0.71) μg/L, (0.98±0.26) μg/L vs (1.39±0.35) )Μg/L] (P<0.05); NIHSS score was significantly lower than the control group [(3.90±2.71) points vs (6.34±1.42) points (P<0.05); GCS score was significantly higher than the control group [(14.84±3.52) ) Points vs (10.69±3.98) points] (P<0.05); the total incidence of adverse reactions was significantly lower than that of the control group [9.52% (4/42) vs 38.46% (15/39)] (P<0.05). Conclusion: The short-term curative effect of minimally invasive drilling and drainage in the treatment of patients with hypertensive cerebral hemorrhage is significant. The hematoma is completely removed, which can effectively improve the brain nerve defect, reduce intracranial infection, and promote the recovery of the prognosis. [ABSTRACT FROM AUTHOR]

Copyright of Imaging Science & Photochemistry is the property of Imaging Science & Photochemistry Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To investigate the effects of neurophysiological stimulation on spinal motor neurons in stroke patients. Methods: From September 2015 to February 2018, 160 patients with stroke who were treated in the neurology department of our hospital were randomly divided into the study group and control group accorded to the order of admission, 80 cases each. The control group received routine treatment, and the study group received neuroelectrophysiological stimulation on the basis of the control group. Two groups were treated for 14 d, and the changes of spinal motor nerve function were recorded. Results: At 14 d after treatment, the cognitive impairment, anxiety and depression, weakness of both lower limbs, and gait instability were improved. The improvement of the general situation of the study group was more obvious, mainly in terms of cognition and emotion. The spinal motor nerve scores of the two groups after treatment for 14 d were significantly higher than those before treatment (P<0.05), and the study group was significantly higher than the control group (P<0.05). The EEG evoked potential amplitudes of the two groups after treatment were significantly higher than those before treatment (P<0.05), and the study group was also significantly higher than the control group (P<0.05). There were no statistical difference in latency between the two groups before and after treatment (P>0.05). The incidence of complications such as pulmonary infection, intracranial infection, and delayed intracranial hematoma was 3.8 % in the study group and 5.0 % in the control group, there was no significant difference between the two groups (P>0.05). After the followed-up (August 2019), the prognosis of the study group were significantly better than the control group (P<0.05). Conclusion: The application of neuroelectrophysiological stimulation in stroke patients can promote the recovery of spinal motor neuron function, improve the function of EEG activity, improve cognitive function, reduce the occurrence of complications and anxiety, and improve the prognosis of patients. [ABSTRACT FROM AUTHOR]

Objective To investigate the surgical diagnosis and treatment of late vitamin K deficiency intracranial hemorrhage caused by biliary atresia. Methods Clinical data of six cases of biliary atresia with late vitamin K deficiency intracranial hemorrhage were collected in the Department of Neurosurgery of Tianjin Children's Hospital from January 2000 to December 2013. Data were analyzed to identify the biliary atresia as soon as possible in the treatment of intracranial hemorrhage and prolonged jaundice in children. Results Six cases (1 male, 5 female), mean age was (16.0±2.6) days, and were treated with external drainage of intracranial hematoma and infusion therapy. In the treatment, children were found jaundice exacerbation and doubted about biliary atresia. After consultation by general surgeons, children were transferred to the department of general surgery for further treatment at an average age of (29.1±1.2) days, and were diagnosed as biliary atresia by intraoperative cholangiography. Conclusion Pediatric neurosurgeon should have a sufficient understanding and make an early diagnosis to late vitamin K deficiency intracranial hemorrhage caused by biliary atresia, to avoid delaying the optimal treatment time of biliary atresia. [ABSTRACT FROM AUTHOR]

Objective:To study the effect of the minimally invasive puncture drainage on patients with intracranial hematoma. Methods:100 patients with intracranial hematoma were selected, and treated with minimally invasive puncture drainage and followed up for a year. The ADL score, postoperative complications, hematoma clearance rate, survival rate and mortality was recorded. Results:① One year after treatment, for the ADL score of patients, there were 43 cases of grade I, 31 cases of grade II, III 14 cases, 4 cases of grade IV, 3 cases of grade V; ② One week after operation, the hematoma clearance rate in 91 patients was more than 90%, and 7 cases of hematoma clearance rate was between 60%and 90%, and 2 cases of hematoma clearance rate was below 60%; ③for the postoperative complications, there was 6 patients with pneumonia in 100 patients, 4 cases with cerebral infarction, 5 cases with stress ulcer; ④Within one year after operation, 5 patients died and 95 patients survived. Conclusion: Minimally invasive surgery can effectively reduce the complications of patientswith intracranial hematoma, and recover the neural function, decrease the mortality and improve the survival rate, worthy of clinical application and promotion. [ABSTRACT FROM AUTHOR]

Objective To discuss method and clinical effect of microsurgery on ruptured intracranial aneurysms in anterior circulation. Methods Imageological and operational data of 100 patients with ruptured intracranial aneurysms in anterior circulation, who were admitted to our hospital, were analyzed retrospectively. The intracranial aneurysms were all treated with microsurgical clipping. Results According to the GOS, good recovery happened in 80 cases(80%), poor recovery in 13 (13%)and death in 7 (7%). Of 7 dead cases, 4 were Grade IV of Hunt-Hess and 3 were Grade V. 1 case was persistent vegetative state(PVS) in 2 alive cases which were divided into Grade V. In 23 alive cases that were GradeIVof Hunt-Hess, 2 were persistent vegetative state(PVS), 2 could take care of themselves partly and 1 could not take care of himself(herself). Conclusions The microsurgical clipping for ruptured intracranial aneurysms in anterior circulation has a curative effect. For spontaneous intracranial hematoma which is highly doubted resulting from ruptured intracranial aneurysms, a preoperative 3D-CTA examination can make clear the reason of bleeding and be a guidance of indicator of emergency operation; And if a patient can not take a 3D-CTA examination because of herniation of brain, possible feeding artery surrounding the hematoma should be explored in craniotomy evacuation of hematoma. So the rate of missed diagnosis can be reduced and recovery can be improved. [ABSTRACT FROM AUTHOR]