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Prevention of Postoperative Palpebral Edema by Stellate Ganglion Block in Patients Undergoing Intracranial Aneurysm Surgery

ObjectiveTo investigate the efficacy of stellate ganglion block (SGB) on postoperative palpebral edema in patients undergoing intracranial aneurysm surgery. MethodsSixty patients who were scheduled to undergo intracranial aneurysm surgery between September 2012 and Novermber 2014 were recruited, and were assigned into 2 groups randomly with 30 in each:SGB group and control group. Patients in SGB group were administered SGB by injecting 0.3% ropivacaine on the operative side under the ultrasound guidance after surgery completed, while patients in the control group received injection of saline on the operative side under the ultrasound guidance. Incidence of postoperative palpebral edema at hour 24, 48, and 72 after surgery were measured. Numerical rating scale (NRS) was used to detect the severity of uncomfortable symptoms for palpebral swelling during rest state. The severity of palpebral edema was evaluated with continuous rating scale (0-5, 0 indicated normal palpebral, and higher score indicated more serious palpebral edema). Complications related with SGB were recorded. ResultsThe overall incidence of palpebral edema at hour 24 after surgery in SGB group was lower than that in the control group (P<0.05). There was no statistically significant difference in the overall incidence of palpebral edema at hour 48 and 72 after surgery between the two groups (P>0.05). The palpebral edema rating scores of the SGB group at hour 24 after surgery were lower than those of the control group (P<0.01).The incidence of palpebral edema which was scored 3 or more at hour 24 and 48 after surgery in SGB group was lower than that in the control group (P<0.05). No statistically significant difference was found in the incidence of palpebral edema which was scored 3 or more at hour 72 after surgery between the two groups (P>0.05). No complication related with SGB was found. ConclusionSGB can safely reduce the incidence of postoperative palpebral edema in patients undergoing intracranial aneurysm surgery, and reduce the severity of palpebral edema.

急性颅内动脉瘤破裂出血术后患者在重症医学科的血压管理

目的 探讨严格的血压管理对急性颅内动脉瘤破裂出血术后患者目标血压的控制效果。 方法 对 2015 年 1 月—9 月 28 例颅内动脉瘤破裂出血术后患者进行严格的血压调控和监护。 结果 28 例患者的血压经专科对症治疗及综合的血压管理，均得到较好控制。21 例单个动脉瘤术后患者平均动脉压控制在 90～110 mm Hg（1 mm Hg=0.133 kPa），收缩压控制在 135～160 mm Hg；7 例多个动脉瘤术后患者平均动脉压控制在 80～100 mm Hg，收缩压控制在 135～150 mm Hg。21 例患者血压在 24 h 内降至理想水平，7 例患者血压在 48 h 内降至理想水平，患者未出现颅内再出血。27 例患者呼吸机辅助呼吸 5～7 d 后顺利停机拔管，转入神经外科病房继续治疗；1 例患者于术后第 2 天自动出院。 结论 对急性颅内动脉瘤破裂出血术后患者采取有效的血压管理，可以减少患者术后并发症。

Automatic detection method of intracranial aneurysms on maximum intensity projection images based on SE-CaraNet

Conventional maximum intensity projection (MIP) images tend to ignore some morphological features in the detection of intracranial aneurysms, resulting in missed detection and misdetection. To solve this problem, a new method for intracranial aneurysm detection based on omni-directional MIP image is proposed in this paper. Firstly, the three-dimensional magnetic resonance angiography (MRA) images were projected with the maximum density in all directions to obtain the MIP images. Then, the region of intracranial aneurysm was prepositioned by matching filter. Finally, the Squeeze and Excitation (SE) module was used to improve the CaraNet model. Excitation and the improved model were used to detect the predetermined location in the omni-directional MIP image to determine whether there was intracranial aneurysm. In this paper, 245 cases of images were collected to test the proposed method. The results showed that the accuracy and specificity of the proposed method could reach 93.75% and 93.86%, respectively, significantly improved the detection performance of intracranial aneurysms in MIP images.

单侧后交通动脉瘤患者眼部表现观察

Treatment of Complex Intracranial Aneurysms with Neuroform Stent Implantation and Coil Placement

目的：探讨血管内Neuroform支架置入联合弹簧圈栓塞治疗颅内复杂动脉瘤的疗效、技术要点、安全性及并发症防治。方法:　研究对象为20例颅内复杂动脉瘤患者，其中颈内动脉海绵窦段4例，眼动脉段3例，后交通动脉段7例，脉络膜前动脉起始部1例，大脑中动脉M1段1例，椎动脉颅内段4例。首先将微导管置入瘤腔，然后跨瘤颈释放支架，栓塞弹簧圈。结果:　所有病例栓塞操作均顺利完成。其中致密栓塞13例，大部分栓塞7例;术后脑梗塞1例，1个月后恢复;2例弹簧圈尾端疝入载瘤动脉，均未引起相应的临床症状。随访3～24个月，平均13个月，无再出血及血栓栓塞症状。结论:　血管内支架植入联合弹簧圈治疗颅内复杂动脉瘤安全有效。

颅内动脉瘤再破裂风险评估和防治方法

颅内动脉瘤破裂导致的蛛网膜下腔出血是神经外科常见的急症之一。近年来，随着开颅显微手术及血管内介入治疗的发展，对颅内动脉瘤的处理有了很大进步，但是再破裂出血仍是其最严重的并发症，有很高的发生率及死亡率。本研究就颅内动脉瘤再破裂出血的临床表现、相关危险因素、防治等方面内容进行回顾、总结及展望，为临床实践提供建议。

Comparison of Effects and Complications between Craniotomy Clipping and Endovascular Embolization in the Treatment of Intracranial Aneurysms

目的:探讨开颅夹闭和血管内栓塞治疗颅内动脉瘤的效果比较及并发症。方法:从2003～2008年近五年来我院收治的颅内动脉瘤54例,其中开颅夹闭24例(Hunt Hess分级Ⅰ～Ⅱ级20例,Ⅲ级2例,Ⅳ级2例),共26个动脉瘤。血管内栓塞30例(HuntHess分级Ⅰ～Ⅱ级23例,Ⅲ级5例,Ⅳ级2例),共31个动脉瘤。临床结果按GOS进行评价。结果:两组的良好率、并发症及死亡率无显著差别(Pgt;0.05)。随访平均12月,Ⅰ～Ⅱ级动脉瘤患者治疗良好率为100.0％(43/43),并发症发生率为4.7％(2/43),Ⅲ～Ⅳ级者分别为18.2％(2/11)和90.9％(10/11),两者相差显著(Plt;0.05)。结论:开颅夹闭和血管内栓塞治疗颅内动脉瘤,二者疗效相仿,各有优缺点。动脉瘤患者病情级别越高,治疗效果越差。

全身麻醉下介入治疗低级别颅内动脉瘤术前不留置尿管的可行性研究

目的　探讨颅内低级别（Hunt-Hess分级为0～Ⅲ级）动脉瘤患者在介入治疗围手术期不留置导尿管的可行性，为临床实践提供指导。 方法　2010年6月－2011年6月，对符合纳入标准的132 例颅内动脉瘤患者，术前经患者及家属知情同意并根据自愿原则，按是否留置导尿管分为两组。观察组（n=67）术前不安置尿管，对照组（n=65）则在全身麻醉下留置尿管，观察两组术中躁动对手术的影响及术后排尿情况。 结果　两组术中均未发生因尿急引起的躁动。术后观察组2 h内自行排尿58 例，2～4 h内排尿6例，需放置尿管3例（4%）；对照组 24 h内拔出尿管52 例，其余24 h后拔出，最长留置12 d，3例出现肉眼血尿（4%），12例出现尿路感染（12%）。 结论　颅内低级别动脉瘤患者介入围手术期可不留置导尿，既可提高患者舒适度，又能较好降低泌尿道感染率。

Nursing to Avoid Rupture of Intracranial Aneurysm during Induction of Anesthesia

ObjectiveTo explore the nursing method to avoid rupture of intracranial aneurysm during induction of anesthesia. MethodWe retrospectively analyzed the nursing method for 428 patients with aneurysm during the induction of anesthesia between October 2012 and October 2013. According to the causes of rupture of intracranial aneurysm (anxiety, tension, excitement, sudden elevation of blood pressure, physical labor), we adopted nursing methods to avoid those causes, and implemented targeted nursing methods during induction of anesthesia. ResultsNo intracranial aneurysm rupture occurred in these 428 aneurysm patients during induction of anesthesia. Two patients' absolute value of systolic blood pressure was below 80 mm Hg (1 mm Hg=0.133 kPa) during induction of anesthesia, and the vital signs of other patients kept normal. The number of intraoperative rupture cases was 3. When discharged from hospital, there were 385 patients with good prognosis, 39 patients with bad prognosis, and 4 death cases. ConclusionsTargeted nursing method based on patients' particular situation during induction of anesthesia can effectively control patients' emotion, stabilize fluctuations in hemodynamic indexes, decrease the incidence of aneurysm rupture, improve surgery treatment effect of intracranial aneurysm clipping, decrease complications, and improve patients' prognosis.

Control Study on the Value of Head Boneless CT Angiography for Surface Shaded Display and Volume Computed Tomographic Digital Subtraction Angiography in Diagnosing Intracranial Aneurysms

ObjectiveTo investigate the value of head boneless CT angiography (CTA) for surface shaded display (SSD) (hereinafter referred to as the SSD-CTA technology) and volume computed tomographic digital subtraction angiography (VCTDSA) in diagnosing intracranial aneurysms. MethodsWe collected the clinical data of 35 patients diagnosed to have intracranial aneurysm by VCTDSA between April 2013 and November 2014 from the First Affiliated Hospital of Chongqing Medical University. The original data were imported into the CT workstation of the First People's Hospital of Chengdu. Then, SSD-CTA technology was performed for bone reconstruction. We compared the results of these two technologies. In addition, we selected another 27 patients diagnosed with intracranial aneurysm by SSDCTA and DSA examination at the same time between June 2012 and November 2014 in the First People's Hospital of Chengdu for comparison. ResultsThe quality score of SSD-CTA reconstructed image was lower than that of VCTDSA, but the diagnosis of the two technologies for intracranial aneurysm was not statistically different (P>0.05). Compared with DSA, the sensitivity and specificity of the diagnosis for intracranial aneurysms by SSD-CTA were both 100%. ConclusionSSD-CTA is valuable in diagnosing intracranial aneurysms.