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Quantitative angiographic haemodynamic evaluation of bypasses for complex aneurysms: a preliminary study

Stroke & Vascular Neurology 2022年第1期7卷 54-61页

作者： Junlin Lu Chao Xue Xulin Hu Yuanli zhao Dong Zhang Xiaolin Chen ji zong zhao Neurosurgery Beijing Tiantan HospitalBeijingPeople's Republic of China Department of Industrial Engineering Tsinghua UniversityBeijingPeople's Republic of China Chengdu Institute of Organic Chemistry Chinese Academy of SciencesChengduPeople's Republic of China University of the Chinese Academy of Sciences BeijingPeople's Republic of China China National Clinical Research Center for Neurological Diseases BeijingPeople's Republic of China Stroke Center Beijing Institute for Brain DisordersBeijingPeople's Republic of China Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease BeijingPeople's Republic of China Beijing Translational Engineering Enter for 3D Printer in Clinical Neuroscience BeijingPeople's Republic of China

Objective Open microsurgery,often with bypass techniques,is indispensable for complex *** date,it remains unknown whether arterial anatomy or quantitative blood flow measurements can predict insufficient flow-related stroke(IRS).The present study aimed to evaluate the risk factors for IRS in patients treated with open microsurgery with bypass procedures for complex internal carotid artery *** Patients with complex aneurysms undergoing bypass surgery were retrospectively *** recipient/donor flow index(RDFI)was preoperatively evaluated using colour-coding *** was defined as the ratio of the cerebral blood volume of the recipient and donor *** sizes of the recipient and donor arteries were *** recipient/donor diameter index(RDDI)was then *** was defined as the presence of new postoperative neurological deficits and infarction on postoperative CT *** assessed the association between RDFI and other variables and the *** Twenty patients(38±12 years)were *** was observed in 12 patients(60%).Patients with postoperative IRS had a higher RDFI than those without postoperative IRS(p2.3 were more likely to develop IRS(p2.3,rather than RDDI,was significantly associated with postoperative *** preoperative evaluation allows appropriate decisions regarding the treatment strategy for preventing postoperative IRS.

关键词： bypass anatomy aneurysm

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Effects and safety of aspirin use in patients after cerebrovascular bypass procedures

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Stroke & Vascular Neurology 2021年第4期6卷 624-630页

作者： Junlin Lu Guangchao Shi Yuanli zhao Rong Wang Dong Zhang Xiaolin Chen Hao Wang ji zong zhao Neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Neurosurgery Peking University International HospitalBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina Stroke Center Beijing Institute for Brain DisordersBeijingChina Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease BeijingChina Beijing Translational Engineering Enter for 3D Printer in Clinical Neuroscience BeijingChina

Object Superficial temporal artery to middle cerebral artery(STA-MCA)bypass is the most effective treatment for Moyamoya disease(MMD).In this study,we aimed to assess whether aspirin improves STA-MCA bypass patency and is safe in patients with *** We performed a retrospective medical record review of patients with ischaemic-onset MMD who had undergone STA-MCA bypass at two hospitals between January 2011 and August 2018,to clarify the effects and safety of aspirin following STA-MCA *** neurological status at the last follow-up(FU)was compared between patients with FU bypass patency and *** Among 217 identified patients(238 hemispheres),the mean age was 41.4±10.2 years,and 51.8%were male;the indications for STA-MCA bypass were stroke(48.2%),followed by a transient ischaemic attack(44.0%).Immediate bypass patency was confirmed in all *** the FU period(1.5±1.5 y),15 cases were occluded at FU imaging,resulting in an overall cumulative patency rate of 94%.The patency rates were 93%and 94%in the short-term FU group(n=131,mean FU time 0.5±0.2 years)and long-term FU group(n=107,mean FU time 4.1±3.5 years),*** STA-MCA bypass patency rate in the aspirin group was higher than that in the non-aspirin group(98.7%vs 89.7%;HR 1.57;95%CI 1.106 to 2.235;p=0.012).No significant difference in the FU haemorrhagic events was observed between the aspirin and non-aspirin *** Among adult patients with ischaemic-onset MMD undergoing STA-MCA bypass procedures,aspirin might increase the bypass patency rate,without increasing the bleeding *** bypass patency may be associated with a better *** studies,especially carefully designed prospective studies,are needed to address the role of aspirin after bypass procedures.

关键词： bypass aspirin patients

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Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of intracerebral haemorrhage

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Stroke & Vascular Neurology 2020年第4期5卷 396-402页

作者： Yong Cao Songlin Yu Qian Zhang Tao Yu Yanfang Liu Zhenghui Sun Meng zhao Wen Wang ji zong zhao Department of Neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases Beijing Tiantan HospitalBeijingChina Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Department of Neurosurgery Chinese PLA General HospitalBeijingChina

Aim This evidence-based guideline aims to present current and comprehensive recommendations for the diagnosis and management of spontaneous intracerebral haemorrhage(ICH).Methods A formal literature search was conducted on MEDLINE(1 January 1990 to 30 June 2019).Data were synthesised using evidence *** members of the working group met by teleconference to update and formulate data-based *** recommendations are graded according to levels of evidence grading algorithm of the Chinese Stroke *** guideline draft has been reviewed by Chinese Stroke Association Stroke Council Guideline Writing *** Evidence-based guideline is proposed for the management of patients with *** focus of the guideline is divided into the diagnosis and aetiology of ICH,management of ICH in emergency department,surgical treatment for removal of hematoma,management of complications and prevention of secondary *** This guideline provides a framework for ICH *** active and reasonable treatment may improve the clinical outcome of patients.

关键词： clinical diagnosis prevention

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Three-dimensional Fluoroscopy-based Navigation for the Pedicle Screw Placement in Patients with Primary Invasive Spinal Tumors

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Chinese Medical Journal 2016年第21期129卷 2552-2558页

作者： Bo jin ,Yi-Bing Su ji-zong zhao Department of Neurosurgery Beijing Tiantan Hospital Capital Medical University Beijing 100050 China China National Clinical Research Center for Neurological Diseases Beijing 100050 China Department of Neurosurgery Beijing Jishuitan Hospital Fourth Medical College of Peking University Beijing 100035 China

Background：Although pedicle screw placement （PSP） is a well-established technique for spine surgery,the treatment of patients with primary invasive spinal tumor （PIST） has high surgical risks secondary to destroyed *** three-dimensional fluoroscopy-based navigation （ITFN） system permits safe and accurate instrumentation of the spine with the advantage of obtaining intraoperative real-time three-dimensional images and automatic *** aim of this study is to evaluate the feasibility and accuracy of PSP using ITFN system for patients afflicted with PIST in the thoracic ***：Fifty-one patients diagnosed with PISTs were retrospectively analyzed,and 157 pedicles screws were implanted in 23 patients using the free-hand technique （free-hand group） and 197 pedicle screws were implanted in 28 patients using the ITFN system （ITFN group）.Modified classification of Gertzbein and Robbins was used to evaluate the accuracy of PSP,and McCormick classification was applied for assessment of neurological *** data and factors affecting accuracy of screw insertion were compared using independent t-test while comparison of accuracy of screw insertion between the two groups was analyzed with Chi-square ***：Of 51 patients,39 demonstrated improved neurological status and the other 12 patients reported that symptoms remained the *** the free-hand group,145 screws （92.4%） were Grade Ⅰ,9 screws （5.7%） were Grade Ⅱ,and 3 screws （1.9%） were Grade Ⅲ.In the ITFN group,192 screws （97.4%） were Grade Ⅰ,5 screws （2.6%） were Grade Ⅱ,and no Grade Ⅲ screw was *** analysis showed that the accuracies of pedicle screws in the two groups are significantly different （χ^2 =4.981,P =0.026）.Conclusions：The treatments of PISTs include total tumor resection and reconstruction of spine *** ITFN system provides a high accuracy of pedicle screw placement.

关键词： Navigation Pedicle Screw Placement Spinal Cord Tumor Three-dimensional Fluoroscopy

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Classification of brain arteriovenous malformations located in motor-related areas based on location and anterior choroidal artery feeding

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Stroke & Vascular Neurology 2021年第3期6卷 441-448,I0073-I0075页

作者： Yuming jiao Hao Li Weilun Fu jiancong Weng Ran Huo Yinyan Wang Shuo Wang Tao jiang Yong Cao ji zong zhao Department of Neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina Center of Stroke Beijing Institute for Brain DisordersBeijingChina Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease BeijingChina Beijing Neurosurgical Institute Capital Medical UniversityBeijingChina

Objective Surgical management of arteriovenous malformations(AVMs)involving motor cortex or fibre tracts(M-AVMs)is *** study aimed to construct a classification system based on nidus locations and anterior choroidal artery(AChA)feeding to pre-surgically evaluate motor-related and seizure-related outcomes in patients undergoing resection of *** and materials A total of 125 patients who underwent microsurgical resection of M-AVMs were retrospectively *** subtypes were identified based on nidus location:(I)nidus involving the premotor area and/or supplementary motor areas;(II)nidus involving the precentral gyrus;(III)nidus involving the corticospinal tract(CST)and superior to the posterior limb of the internal capsule;(IV)nidus involving the CST at or inferior to the level of posterior limb of the internal *** addition,we divided type IV into type IVa and type IVb according to the AChA ***-related motor deficit(MD)evaluations were performed 1 week(short-term)and 6 months(long-term)after *** The type I patients exhibited the highest incidence(62.0%)of pre-surgical epilepsy among the four *** analysis showed that motor-related area subtypes(p=0.004)and diffuse nidus(p=0.014)were significantly associated with long-term ***-term MDs were significantly less frequent in type I than in the other *** IV patients acquired the highest proportion(four patients,25.0%)of long-term poor outcomes(mRS>2).Type IVb patients showed a significantly higher incidence of post-surgical MDs than type IVa patients(p=0.041).The MDs of type III or IV patients required more recovery *** the 62 patients who had pre-surgical seizures,90.3%(56/62)controlled their seizures well and reached Engel class I after *** Combining the consideration of location and AChA feeding,the classification for M-AVMs is a useful approach for predicting post-surgical motor function and decision-making.

关键词： capsule epilepsy Surgical

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Carotid endarterectomy for treatment of carotid in-stent restenosis:longterm follow-up results and surgery experiences from one single centre

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Stroke & Vascular Neurology 2017年第3期2卷 140-146页

作者： Le-Bao Yu Wei Yan Qian Zhang ji-zong zhao Yan Zhang Rong Wang Jun-Shi Shao Dong Zhang Department of Neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases(NCRC-ND) BeijingChina Center of Stroke Beijing Institute for Brain DisordersBeijingChina Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease BeijingChina Department of Neurosurgery Beijing Mi Yun HospitalCapital Medical UniversityBeijingChina

Objective Few studies have reported the surgical treatment of carotid in-stent restenosis(ISR),more data and longer follow-up are *** describe the surgical treatment of ISR by standard carotid endarterectomy(CEA)with stent removal,including long-term follow-up in 10 patients from our *** Ten patients from our centre who underwent CEA with stent removal for ISR were retrospectively analysed,including nine symptomatic and one asymptomatic ISR of at least 70%with mean age 67.3,the median time between carotid artery stenting and CEA was 17 months(range,2-54 months).results Standard CEA with stent removal was performed in all 10 patients without much technical difficulty(9 male and 1 female,mean age 67.3).Two cases were performed in hybrid operation *** were a total of three complications that happened in three patients(30%)*** asymptomatic dissecting aneurysm was formed on the petrous internal carotid artery in one patient who was followed up without *** the second case,dissection occurred in the arterial wall distal to the site of the stent after stent removal revealed by intraoperative angiography,and another stent was *** patient sustained temporary hypoglossal nerve dysfunction *** third patient suffered cerebral hyperperfusion with complete recovery when *** neurological complications occurred in other seven *** follow-up of 25 months(range,11-54 months),one patient died of rectal cancer without ischaemic attack and restenosis 4 years postoperation;in one patient occurred recurrent symptomatic restenosis(90%)1 year later;all other patients remained asymptomatic and without recurrent restenosis(>50%)by follow-up carotid ultrasound or CT *** It seems that CEA with stent removal is a reasonable choice,by experienced hand,for symptomatic ISR with higher but acceptable *** indication of stent removal for asymptomatic ISR needs further observati

关键词： carotid restenosis sustained

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Digital subtraction angiographic characteristics of progression of moyamoya disease 6 months prior to surgical revascularisation

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Stroke & Vascular Neurology 2020年第1期5卷 97-102页

作者： Peicong Ge Qian Zhang Xun Ye Xingju Liu Xiaofeng Deng jia Wang Rong Wang Yan Zhang Dong Zhang ji zong zhao Department of Neurosurgery Beijing Tiantan HospitalBeijingChina

background Evidence on the natural angiographic course of moyamoya disease(MMD)is *** takes about 6 months for waiting for revascularisation *** issue of when to perform subtraction angiography(DSA)for follow-up remains *** investigated the natural course of MMD by DSA and attempted to determine the best interval to perform the follow-up *** This is a single-centre cohort study of Chinese MMD inpatients treated from 1 January 2015 to 31 August *** angiographic findings were evaluated on Suzuki stage and collateral circulation between two follow-ups of the same *** A total of 110 patients who met the criteria were enrolled in this *** a median 6 months follow-up,five patients(4.5%)had progression,four females and one *** interval of progression ranged from 4 to 137 months with a mean of 61.4 *** five patients with progression,four had unilateral lesion(two ipsilateral and two contralateral)and one had bilateral *** circulation was changed in three of five *** The angiographic evidence of progression in MMD was rare in the short-term follow-up,and most patients with progression had initial unilateral *** re-examination may be not needed in patients with bilateral MMD,but needed in unilateral MMD.

关键词： involvement progression characteristics

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Role of Ring Finger Protein 213 in Moyamoya Disease

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Chinese Medical Journal 2016年第20期129卷 2497-2501页

作者： Yong-Gang Ma Qian Zhang Le-Bao Yu ji-zong zhao Department of Neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijing 100050China China National Clinical Research Center for Neurological Diseases Beijing 100050China

Objective：The aim of this study was to help people comprehensively understand the research advances related to ring finger protein 213 （RNF213） in moyamoya disease （MMD） and to understand the disease at the molecular level to provide a new perspective of the diagnosis of the *** Sources：This review was based on data in articles published between 2005 and 2015 that were retrieved from the PubMed *** search terms included RNF213,MMD,intracranial major artery stenosis/occlusion （ICASO）,genotype,phenotype,mutant and variants,and the combinations of these *** Selection：Articles related to MMD and RNF213 were selected for review,and we also reviewed publications related to ***：RNF213 is not only associated with MMD but also associated with intracranial major artery *** addition,RNF213 variants exhibit apparent ethnic diversity;specifically,the c.14576G〉A variant is mainly detected in Korean,Chinese,and Japanese populations,particularly the latter *** genotypes of RNF213 correlate with the phenotypes of MMD;for example,the homozygous c.14576G〉A variant is associated with early-onset,severe symptoms,and an unfavorable ***,the RNF213 c.14576G〉A variant should be considered during the diagnosis of MMD because no patients with quasi-MMD have been reported to carry the RNF213 c.14576G〉A variant whereas 66 of 78 patients with definite MMD have been found to carry this ***：The growing literature demonstrates that MMD is primarily caused by the synergy of genetic and environmental factors,and unknown genetic modifiers might play roles in the etiology of *** research should be conducted to clarify the pathogenic mechanism of MMD.

关键词： Moyamoya Disease Research Progress Ring Finger Protein 213 Variant

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Somatic GJA4 mutation in intracranial extra-axial cavernous hemangiomas

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Stroke & Vascular Neurology 2023年第6期8卷 453-462,I0003-I0037页

作者： Ran Huo Yingxi Yang Hongyuan Xu Shaozhi zhao Dong Song jiancong Weng Ruochen Ma Yingfan Sun jie Wang Yuming jiao Junze Zhang Qiheng He Ruolei Wu Shuo Wang ji-zong zhao Junting Zhang jiguang Wang Yong Cao Department of Neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina Department of Chemical and Biological Engineering The Hong Kong University of Science and TechnologyHong KongChina Division of Life Science Center for Systems Biology and Human Health and State Key Laboratory of Molecular NeuroscienceThe Hong Kong University of Science and TechnologyHong KongChina Department of Neurosurgery China-Japan Friendship HospitalBeijingChina School of Medical Technology Beijing Institute of TechnologyBeijingChina Hong Kong Center for Neurodegenerative Diseases InnoHKHong Kong SARChina Beijing Neurosurgical Institute Capital Medical UniversityBeijingChina

Objective Extra-axial cavernous hemangiomas(ECHs)are sporadic and rare intracranial occupational lesions that usually occur within the cavernous *** aetiology of ECHs remains *** Whole-exome sequencing was performed on ECH lesions from 12 patients(discovery cohort)and droplet digital polymerase-chain reaction(ddPCR)was used to confirm the identified mutation in 46 additional cases(validation cohort).Laser capture microdissection(LCM)was carried out to capture and characterise subgroups of tissue *** and functional investigations were carried out in human umbilical vein endothelial cells and a newly established mouse *** We detected somatic GJA4 mutation(c.121G>T,p.G41C)in 5/12 patients with ECH in the discovery cohort and confirmed the finding in the validation cohort(16/46).LCM followed by ddPCR revealed that the mutation was enriched in lesional *** vitro experiments in endothelial cells demonstrated that the GJA4 mutation activated SGK-1 signalling that in turn upregulated key genes involved in cell hyperproliferation and the loss of arterial *** with wild-type littermates,mice overexpressing the GJA4 mutation developed ECH-like pathological morphological characteristics(dilated venous lumen and elevated vascular density)in the retinal superficial vascular plexus at the postnatal 3 weeks,which were reversed by an SGK1 inhibitor,*** We identified a somatic GJA4 mutation that presents in over one-third of ECH lesions and proposed that ECHs are vascular malformations due to GJA4-induced activation of the SGK1 signalling pathway in brain endothelial cells.

关键词： intracranial superficial hemangioma

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A New Technique for Transvenous Embolization of Brain Arteriovenous Malformations in Hybrid Operation

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Chinese Medical Journal 2018年第24期131卷 2993-2996页

作者： Ming-Ze Wang Han-Cheng Qiu Shuo Wang Yong Cao Meng zhao ji-zong zhao Department of Neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijing 100070China China National Clinical Research Center for Neurological Diseases Beijing 100070China Center of Stroke Beijing Institute for Brain DisordersBeijing 100070China Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing 100070China

To the Editor:Eliminating a nidus was deemed to be the key to curing brain arteriovenous malformations (bAVMs).When conducting interventional embolization,it was suggested to superselect the microcatheter close to the nidus before injecting embolic *** traditional embolization was conducted via arterial approaches,which required the accessibility of arterial *** and risks increased in the cases with lesions with narrow calibers,tortuous courses,or "en passage" arterial *** approaches were proved to be safe and effective accesses in bAVM embolization without the limitations of arteries, The current transvenous approaches were established through femoral and cervical veins.

关键词： Transvenous Embolization Brain Arteriovenous Malformations Hybrid Operation

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