Microsurgery has always been the main treatment for large vestibular schwannomas. With the progress of microsurgical technique and neuroimaging, the application of the intraoperative physiological monitoring technology, as well as the popularization of the concept of minimally invasive neurosurgery, the current development trend of surgery for vestibular schwannomas is to realize both the maximal tumoral resection and the maximal preservation of facial nerve function, which puts more emphasis on the improvement of quality of life. It is still a challenge for neurosurgeons to resect the tumor to the maximum extent and preserve the nerve function as well. In view of this background, the strategy of " near-total resection” and " subtotal resection” combined with stereotactic radiotherapy has been more and more accepted in the past years. However, as a neurosurgeon, the ultimate goal should be " gross-total resection of tumor” and preservation of the nerve function as well. For those tumors severely adherent to neurovascular structure, " near total resection” might be a rational choice. Meanwhile, long-term follow-up should be conducted to clarify the biological behavior of tumor residues, as well as the necessity and long-term effect of stereotactic radiotherapy.
ObjectiveTo explore the risk factors of stroke-associated pneumonia (SAP) in the patients with acute ischemic stroke, in order to provide effective guidance for clinical prevention and treatment.MethodsFrom November 2016 to November 2019, 330 patients with acute ischemic stroke admitted to the Department of Neurology of West China Hospital of Sichuan University and the Department of Neurology of the Sixth People’s Hospital of Chengdu were selected as the research object. The clinical data of the patients were analyzed retrospectively. According to whether SAP occurred, they were divided into infected group and non-infected group. Multivariate logistic regression model was used to analyze the risk factors of SAP.ResultsA total of 71 cases of SAP occurred in patients with acute ischemic stroke, accounting for 21.52%. Logistic regression analysis showed that age≥70 years old [odds ratio (OR)=3.677, 95% confidence interval (CI) (1.452, 9.311), P=0.006], chronic lung disease [OR=4.985, 95%CI (1.558, 15.952), P=0.007], disturbance of consciousness [OR=7.147, 95%CI (1.617, 31.587), P=0.009], bulbar palsy [OR=5.909, 95%CI (2.668, 13.089), P<0.001], the use of nasal feeding tube [OR=7.427, 95%CI (1.681, 32.812), P=0.008] were independent risk factors for SAP in patients with acute ischemic stroke.ConclusionsAge≥70 years old, chronic lung disease, disturbance of consciousness, bulbar paralysis and use of nasal feeding tube are independent risk factors for SAP. It is necessary to strengthen the management of these risk factors in order to identify high-risk patients with SAP early, and develop intervention strategies for risk factors, so as to improve the prognosis.
Endovascular treatment for acute ischemic stroke has become the main therapy for large vessel occlusion. In addition to stent thrombectomy, in recent years, the application of aspiration thrombectomy is becoming more and more common. The physical principles of aspiration and stent thrombectomy extraction are different. The thrombus is captured by the negative pressure generated by suction through the contact between the reperfusion catheter and the thrombus, thus achieving cerebrovascular recanalization. Currently, more and more researches support the application of aspiration thrombectomy. What are the advantages and disadvantages of the aspiration thrombectomy compared with the stent thrombectomy and how to apply the aspiration technology reasonably are the hot issues concerned by everyone. This paper reviews the application and research progress of aspirating thrombectomy in order to provide reference for clinical treatment decisions.
Stroke with hereditary cerebral small vessel diseases is a rare disease. Its clinical manifestations include early-onset ischemic lacunar or hemorrhagic stroke with high disability. Its typical imaging markers include lacunes, white matter hyperintensities, microbleeds, intracerebral hemorrhages located in deep or lobe of brain, crotical microinfarcts, and enlarged perivascular spaces. As the clinical and neuroimaging signs and symptoms of hereditary cerebral small vessel diseases often overlap with sporadic cerebral small vessel diseases, it is hard to diagnose. This article summarizes the clinical features, importance of obtaining valuable family history, genetic diagnosis, and management of stroke with hereditary cerebral small vessel disease to improve its accuracy diagnosis.
Objective To collect evidence of treatment for the patients with ocular myasthenia gravis. Methods We searched The Cochrane Library (Issue 1, 2010), PubMed (1966 to April, 2010), CNKI (1979 to April, 2010) and VIP (1989 to April 2010) to identify systematic reviews, randomized controlled trials, controlled clinical trials and prospective avaicohort studies about efficacy and safety of treatment for ocular myasthenia gravis. Results We identified 2 guidelines, 5 systematic reviews and 4 observational studies on inhibitor of acetylcholinesterase, immunosuppressive agents, intravenous immunoglobulin, corticosteroids, and thymectomy for ocular myasthenia gravis. The first choice for ocular myasthenia gravis was inhibitor of acetylcholinesterase. When the symptom could not be remitted, the corticosteroids should be considered. Immunosuppressive agents might be added if the effect of corticosteroids was not good. Plasma exchange was not recommended. Thymectomy should be performed if the patients suffered from thymoma. Conclusion The best clinical evidence can be available by the evidence-based method.
Objective To learn if appropriate methods and clinically relevant outcomes were used by analyzing methods of outcome assessment in Chinese acute stroke trials. Method Randomised and quasi-randomised controlled trials on acute stroke published before March 2003 in 6 Chinese neurological journals were included. Types of outcome measures, blinding of outcome assessment, duration of follow up, statistical methods used for data analysis and the significance of the results were evaluated. Types of outcomes were classified as death and four levels: ① Pathology. ② Impairment. ③ Disability. ④ Handicap/quality of life. Results Two hundreds and ten trials were included in this analysis. 57% of the trials used outcomes in pathology level, 77% in impairment level, 12% in disability level and none in the quality of life level. No dichotomous data was analyzed for disability measures. Only 16% of the trials reported number of death but few of them designed death as an outcome measure. Duration of follow up ranged from 3h to 3 years (median 17 d, interquartile range 14-30 d). Most trials did not assess outcomes blindly. Results in 95% of the trials were favorable to the tested interventions. Conclusions In Chinese acute stroke trials, outcome measures used were mainly in pathology and impairment levels and very few trials used functional outcome or death. Blinding of outcome assessment was not commonly used. The average duration of follow up was short.
Objective To assess the appropriateness of Barthel Index (BI) and Modified Rankin Scales (MRS) used as long-term outcome measures in a stroke data register and to investigate the correlation between cutoff points of the two scales in different stroke patients with and without disability. Methods Nine hundred and twelve patients were registered prospectively. BI and MRS were evaluated at the end of 1, 3, 6 and 12 months after stroke onset. The distribution, ceiling effects and floor effects of the two scales were evaluated. A logistic regression model was established to investigate correlation of cutoff points of BI and MRS. Results There were a total of 2 829 evaluation points of BI and MRS. The percentages of patients reaching the maximum scores of BI at the end of 3, 6 and 12 months (54.8％, 62.2％ and 68.3％, respectively) were higher than those of MRS. There was significant correlation between the two scales (Spearman’s correlation coefficient 0.887, P＜0.05), when MRS scores of ≤1 and ≤2 were taken as cutoff points, the corresponding cutoff points of BI score were ≥90 and ≥85, respectively. Conclusions BI has significant ceiling effects when used as long-term outcome measurement in a stroke data register. There was significant correlation between BI and MRS scores. In future clinical studies, an MRS score ≤2 or BI score ≥85 could be used as cutoff points in predicting stroke patients with and without disability.
Objective The primary objective was to determine whether Danshen agents can improve functional outcome without causing undue harm in patients with acute ischaemic stroke. Secondary objectives were to assess the effect of Danshen agents on impairment and on the quality of life. Methods Searches were performed in the Cochrane Stroke Group Specialized Trial Register, Trials Register of the Cochrane Complementary Medicine Field, Chinese Stroke Trials Register and data from the pharmaceutical company. In addition, we searched the electronic bibliographic databases: Cochrane Controlled Trials Register (CENTRAL/CCTR) Issue 1, 2002, MEDLINE (1996 to 2002), EMBASE (1980 to 2002), China Biological Medicine Database (1978 to 2002). We handsearched ten Chinese journals potentially related to our question. Two reviewers selected studies, assessed quality of studies, extracted data independently. The primary outcomes of death or dependency at the end of long term follow-up(at least three months) and adverse events were assessed. Secondary outcome measures included: measures of neurological deficit at the end of treatment, death from all causes within the first two weeks of treatment and during the whole follow-up period and quality of life. Results Eight potentially eligible trials were identified, of which three trials (304 patients) were included. Two trials were excluded and three trials were waiting for assessment. Number of death and dependency at the end of long term follow-up (at least three months) were not reported in the three included trials. Only one trial reported the adverse events. Three trials measured neurological deficit at the end of treatment. Danshen agents were associated with a significant improvement in neurological deficit (RR 1.07, 95%CI 1.01 to 1.14). There was no death and during the whole treatment period and there was no assessment on quality of life. Conlusions There were too few patients and outcome events to draw reliable conclusions from the present data. The methodological quality of all included studies was poor. Further high quality randomised controlled trials should be performed.
Angiotensin converting enzyme inhibitor (ACEI) is an important type of antihypertensive drug. Much evidence shows that ACEI not only decreases the blood pressure but also has the protective effect on the cardiac and cerebral vessels. ACEI may prevent the stroke. To provide the best evidence for the clinical practice, we electronically searched RCTs and systematic reviews from MEDLINE and The Cochrane Library to evaluate the mechanisms and the effects of ACEI in stroke treatment and prevention.
Objective To make an evidence-based remedy for a patient with cerebral veins and sinuses thrombosis (CVST), who had an unsatisfactory response to routine treatment. Methods We searched the Cochrane Library (Issue 3, 2005), PubMed (1966 to 2005), CNKI (1979 to 2005) and VIP (1989 to 2005) to identify systematic reviews (SRs), randomized controlled trials (RCTs), controlled clinical trials (CCTs) and prospective cohort studies about efficacy and safety of anticoagulants and thrombolysis therapy for CVST. Results We found 1 systematic review, 3 RCTs and 8 prospective cohort studies about anticoagulation therapy and 2 SRs and 1 CCT about thrombolysis therapy. Routine anticoagulation and thrombolysis for patients with CVST are not recommended due to insufficient evidence. Anticoagulation appeared to be safer and could prevent pulmonary embolism. According to the current evidence, the patient’s status and will, anticoagulants were given. His symptoms relieved and he had no subsequent hemorrhages or pulmonary embolism. Conclusion Patients with CVST should receive anticoagulation treatment with monitoring of de novo hemorrhages and the index of hemostasis and coagulation. Large-sample RCTs comparing the effect and safety of anticoagulant with placebo and RCTs comparing the effect and safety of anticoagulation therapy with that of endovascular thrombolysis therapy in high-risk patients are needed.