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PMID:28858100
Author:Ye Z; Ai X; Hu X; Fang F; You C
Address:Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Title:Comparison of neuroendoscopic surgery and craniotomy for supratentorial hypertensive intracerebral hemorrhage: A meta-analysis.
Source:Medicine (Baltimore); 96(35):e7876, 2017 Sep.
ISSN:1536-5964
Country of publication:United States
Language:eng
Abstract:BACKGROUND: In recent years, neuroendoscopy has been used as a method for treating intracerebral hemorrhages (ICHs). However, the efficacy and safety of neuroendoscopic surgery is still controversial compared with that of craniotomy. Our aim was to compare the outcomes of neuroendoscopic surgery and craniotomy in patients with supratentorial hypertensive ICH using a meta-analysis. METHODS: We searched on PubMed, EMBASE, and Cochrane Central Register of Controlled Trials to identify relevant studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality of eligible studies was evaluated and the related data were extracted by 2 reviewers independently. This study assessed clinical outcomes, evacuation rates, complications, operation time, and hospital stay for patients who underwent neuroendoscopic surgery (NE group) or craniotomy (craniotomy group). RESULTS: Meta-analysis included 1327 subjects from verified studies of acceptable quality. There was no significant heterogeneity between the included studies based on clinical outcomes. Compared with craniotomy, neuroendoscopic surgery significantly improved clinical outcomes in both randomized controlled studies (RCTs) group (relative risk: 0.62; 95% confidence interval [CI], 0.47-0.81, P < .001) and non-RCTs group (relative risk: 0.84; 95% CI: 0.75-0.95, P = .005); decreased the rate of death (relative risk: 0.53; 95% CI, 0.37-0.76, P < .001) in non-RCTs group but not in RCTs group (relative risk: 0.58; 95% CI, 0.26-1.29, P = .18); increased evacuation rates in non-RCTs group (standard mean differences: 0.75; 95% CI, 0.24-1.26, P = .004) and had a tendency of higher evacuation rates in RCTs group (standard mean differences: 1.34; 95% CI, 0.01-2.68, P = .05); reduced the total risk of complications in non-RCTs group (relative risk: 0.45; 95% CI, 0.25-0.83, P = .01) and RCTs group (relative risk: 0.37; 95% CI, 0.28-0.49, P < .001); reduced the operation time in non-RCTs group (standard mean differences: 3.26; 95% CI: 1.20-5.33, P < .001) and RCTs group (standard mean differences: 4.37; 95% CI: 3.32-5.41, P < .001). CONCLUSIONS: Our results suggested that the NE group showed better clinical outcomes than the craniotomy group for patients with supratentorial hypertensive ICH. Moreover, the patients who underwent neuroendoscopy had a higher evacuation rate, lower risk of complications, and shorter operation time compared with those that underwent a craniotomy.
Publication type:JOURNAL ARTICLE; META-ANALYSIS


  2 / 300 MEDLINE  
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PMID:28602881
Author:Wang W; Zhou N; Wang C
Address:Department of Neurosurgery, Qiannan People's Hospital, Qiannan, Guizhou, China. Electronic address: 751829615@qq.com.
Title:Minimally Invasive Surgery for Patients with Hypertensive Intracerebral Hemorrhage with Large Hematoma Volume: A Retrospective Study.
Source:World Neurosurg; 105:348-358, 2017 Sep.
ISSN:1878-8769
Country of publication:United States
Language:eng
Abstract:OBJECTIVE: Therapeutic efficacy of patients with hypertensive intracerebral hemorrhage (HICH) with large hematoma volume is poor. This study aimed to explore the efficacy of minimally invasive surgery for patients with HICH with large hematoma volume. METHODS: A total of 104 patients with HICH with a hematoma volume >50 mL were treated with different surgical approaches. The patients were allotted to a minimally invasive surgery group (minimally invasive, n=70) and conventional craniotomy group (craniotomy group, n= 34). Patients were followed-up for 30 days postoperatively, and their clinical data were compared. RESULTS: No statistically significant differences were found in age, sex, hematoma volume, and preoperative Glasgow Coma Scale score between the 2 groups (P > 0.05), whereas patient age was slightly greater in the minimally invasive group than the craniotomy group (P < 0.05). Postoperative mortality and complication rates in the minimally invasive group were significantly lower than those in thecraniotomy group (20% vs. 44.1% and 15.2% vs. 29.4%, P< 0.05), and a better Glasgow Outcome Scale score at 30 days postoperatively was found in the minimally invasive group than the craniotomy group (P < 0.05). No significant differences were observed between the 2 groups in terms of mortality rate in patients with brain herniation and complication rates of postoperative renal failure, pulmonary infection, and cerebral infarction (P > 0.05). CONCLUSIONS: Minimally invasive surgery is safe and effective in patients with HICH with a hematoma volume >50 mL. Because of its minimal invasiveness, better recovery rate, lower mortality rate, and less complications, this approach is considered superior to craniotomy. However, further validation on a larger sample size is required.
Publication type:JOURNAL ARTICLE


  3 / 300 MEDLINE  
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PMID:28495529
Author:Kurauchi Y; Kinoshita R; Mori A; Sakamoto K; Nakahara T; Ishii K
Address:Department of Molecular Pharmacology, Kitasato University School of Pharmaceutical Sciences, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan. Electronic address: kurauchy@kumamoto-u.ac.jp.
Title:MEK/ERK- and calcineurin/NFAT-mediated mechanism of cerebral hyperemia and brain injury following NMDA receptor activation.
Source:Biochem Biophys Res Commun; 488(2):329-334, 2017 Jun 24.
ISSN:1090-2104
Country of publication:United States
Language:eng
Abstract:N-methyl-d-aspartate (NMDA) receptor activation increases regional cerebral blood flow (rCBF) and induces neuronal injury, but similarities between these processes are poorly understood. In this study, by measuring rCBF invivo, we identified a clear correlation between cerebral hyperemia and brain injury. NMDA receptor activation induced brain injury as a result of rCBF increase, which was attenuated by an inhibitor of mitogen-activated protein kinase or calcineurin. Moreover, NMDA induced phosphorylation of extracellular signal-regulated kinase (ERK) and nuclear translocation of nuclear factor of activated T-cell (NFAT) in neurons. Therefore, a MEK/ERK- and calcineurin/NFAT-mediated mechanism of neurovascular coupling underlies the pathophysiology of neurovascular disorders.
Publication type:JOURNAL ARTICLE
Name of substance:0 (NFATC Transcription Factors); 0 (Receptors, N-Methyl-D-Aspartate); EC 2.7.11.24 (Extracellular Signal-Regulated MAP Kinases); EC 3.1.3.16 (Calcineurin)


  4 / 300 MEDLINE  
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PMID:28323179
Author:Fu C; Liu L; Chen B; Wang N; Tan Z; Chen H; Liu X; Dang Y
Address:Department of Neurosurgery, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China. Electronic address: nianbeifch@163.com.
Title:Risk Factors for Poor Outcome in Hypertensive Intraventricular Hemorrhage Treated by External Ventricular Drainage with Intraventricular Fibrinolysis.
Source:World Neurosurg; 102:240-245, 2017 Jun.
ISSN:1878-8769
Country of publication:United States
Language:eng
Abstract:OBJECTIVE: External ventricular drainage (EVD) combined with intraventricular fibrinolysis (IVF) is a commonly accepted surgical approach for some cases of hypertensive intraventricular hemorrhage (HIVH). We aimed to investigate the association between preoperative factors and outcome in patients with HIVH treated by EVD plus IVF. METHODS: Records from March 2010 to March 2016 were searched for HIVH treated by EVD plus IVF. We divided this population into the favorable outcome group and the unfavorable outcome group according to the Glasgow Outcome Scale. Preoperative demographic data, radiologic findings, and clinical factors were compared in each group. Univariate and multivariable logistic regression were used to assess the relationship between factors and outcome in HIVH. RESULTS: Of 267 patients included in this study, 136 had a favorable outcome and 131 had a poor outcome. Multivariate analyses showed that age (odds ratio [OR], 18.229; 95% confidence interval [CI], 1.503-221.16), Glasgow Coma Scale score (OR, 12.686; 95% CI, 1.5-107.312), blood neuron specific enolase (OR, 9.463; 95% CI, 1.178-76.012), third ventricle hematoma (OR, 15.311; 95% CI, 1.287-497.914), and fourth ventricle hematoma (OR, 25.258; 95% CI, 1.851-125.767) were associated with poor outcome of EVD in patients with HIVH. CONCLUSIONS: Fourth ventricle hematoma, third ventricle hematoma, high blood neuron specific enolase value, low Glasgow Coma Scale score, and old age were risk factors for poor outcome in HIVH treated with EVD plus IVF. EVD was not suitable, particularly in patients with brainstem compression caused by fourth ventricle hemorrhage, regardless of use of IVF.
Publication type:JOURNAL ARTICLE
Name of substance:0 (Fibrinolytic Agents)


  5 / 300 MEDLINE  
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PMID:28190323
Author:Ding R; Lin C; Wei S; Zhang N; Tang L; Lin Y; Chen Z; Xie T; Chen X; Feng Y; Wu L
Address:Department of Neurosurgery, Jingmen No. 1 People's Hospital, Jingmen 448000, Hubei, China.
Title:Therapeutic Benefits of Mesenchymal Stromal Cells in a Rat Model of Hemoglobin-Induced Hypertensive Intracerebral Hemorrhage.
Source:Mol Cells; 40(2):133-142, 2017 Feb.
ISSN:0219-1032
Country of publication:Korea (South)
Language:eng
Abstract:Previous studies have shown that bone marrow mesenchymal stromal cell (MSC) transplantation significantly improves the recovery of neurological function in a rat model of intracerebral hemorrhage. Potential repair mechanisms involve anti-inflammation, anti-apoptosis and angiogenesis. However, few studies have focused on the effects of MSCs on inducible nitric oxide synthase (iNOS) expression and subsequent peroxynitrite formation after hypertensive intracerebral hemorrhage (HICH). In this study, MSCs were transplanted intracerebrally into rats 6 hours after HICH. The modified neurological severity score and the modified limb placing test were used to measure behavioral outcomes. Blood-brain barrier disruption and neuronal loss were measured by zonula occludens-1 (ZO-1) and neuronal nucleus (NeuN) expression, respectively. Concomitant edema formation was evaluated by H&E staining and brain water content. The effect of MSCs treatment on neuroinflammation was analyzed by immunohistochemical analysis or polymerase chain reaction of CD68, Iba1, iNOS expression and subsequent peroxynitrite formation, and by an enzyme-linked immunosorbent assay of pro-inflammatory factors (IL-1 and TNF-α). The MSCs-treated HICH group showed better performance on behavioral scores and lower brain water content compared to controls. Moreover, the MSC injection increased NeuN and ZO-1 expression measured by immunochemistry/immunofluorescence. Furthermore, MSCs reduced not only levels of CD68, Iba1 and pro-inflammatory factors, but it also inhibited iNOS expression and peroxynitrite formation in perihematomal regions. The results suggest that intracerebral administration of MSCs accelerates neurological function recovery in HICH rats. This may result from the ability of MSCs to suppress inflammation, at least in part, by inhibiting iNOS expression and subsequent peroxynitrite formation.
Publication type:JOURNAL ARTICLE
Name of substance:0 (Hemoglobins)


  6 / 300 MEDLINE  
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PMID:28010884
Author:Chen QH; Lin D; Yu QG; Zhou J
Address:Department of Neurosurgery, The First People's Hospital of Tonglu County, No.338 Xuesheng Road, Hangzhou, 311500 Zhejiang, China. Electronic address: qihanchencn@163.com.
Title:Efficacy of lumbar cistern drainage combined with intrathecal antibiotherapy for the treatment of ventriculo-subarachnoid infections following surgery for hypertensive intracerebral hemorrhage.
Source:Neurochirurgie; 63(1):13-16, 2017 Mar.
ISSN:1773-0619
Country of publication:France
Language:eng
Abstract:OBJECTIVE: The aim of this study was to investigate the efficacy of lumbar cistern drainage combined with intrathecal injection of antibiotics (LCD-ITI) in treating postoperative intracranial infections of hypertensive intracerebral hemorrhage (pHIH-ICI). METHODS: Sixty pHIH-ICI patients were randomly divided into the control group and the treatment group, with 30 patients in each group. Conventional treatment was performed in the control group, while LCD-ITI was performed in the treatment group. The clinical outcomes, Glasgow Outcome Score (GOS), activities of daily living (ADL) scores, incidence rates of hydrocephalus and other indicators were compared. RESULTS: The improvement time of clinical symptoms, infection control time and hydrocephalus incidence of the treatment group were significantly lower than the control group (P<0.05). Also the infection control rate, GOS score and ADL score of the treatment group were significantly higher or better than the control group (P<0.05). CONCLUSION: LCD-ITI could improve clinical treatment and prognosis of pHIH-ICI patients.
Publication type:JOURNAL ARTICLE
Name of substance:0 (Anti-Bacterial Agents)


  7 / 300 MEDLINE  
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PMID:27760466
Author:Wang X; Wang J; Zhao H; Li N; Ge S; Chen L; Li J; Jing J; Su M; Zheng Z; Zhang J; Gao G; Wang X
Address:a Department of Neurosurgery , Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
Title:Clinical analysis and treatment of symptomatic intracranial hemorrhage after deep brain stimulation surgery.
Source:Br J Neurosurg; 31(2):217-222, 2017 Apr.
ISSN:1360-046X
Country of publication:England
Language:eng
Abstract:BACKGROUND: Symptomatic intracranial hemorrhage (ICH) may lead to permanent neurological disability of patients and has impeded the extensive clinical application of deep brain stimulation (DBS). The present study was conducted to discuss the incidence, prevention, and treatment of symptomatic ICH after DBS surgery. METHODS: From January 2009 to December 2014, 396 patients underwent DBS with a total of 691 implanted leads. In all, 10 patients had symptomatic ICH. We analyzed these cases' clinical characteristics, including comorbid diagnoses and coagulation profile. We described the onset of ICH, imaging features, clinical manifestations, treatment, neurological impairment, and outcome of DBS. RESULTS: Of the 10 patients with symptomatic ICH, 2 had hypertension. Three cases of ICH occurred within 12 h of the procedure; four cases within 24 h. Five experienced grand mal seizures concurrently with hemorrhage. Unilateral frontal lobe hemorrhage occurred in all cases. In seven cases, hematomas occurred around the electrodes. Some hematomas were not well-circumscribed and had perihematomal edema. Conservative therapy was administered to 8 patients, and 2 patients underwent craniotomy and hematoma evacuation. All electrodes were successfully preserved. Neurological dysfunction in all patients gradually improved. Nine patients ultimately experienced effective symptom relief of Parkinson's disease with DBS. CONCLUSIONS: Symptomatic ICH should be identified as soon as possible after implantation surgery and treated effectively to limit neurological deficit and preserve DBS leads.
Publication type:JOURNAL ARTICLE


  8 / 300 MEDLINE  
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PMID:27235128
Author:Moussa WM; Khedr W
Address:Department of Neurosurgery, Faculty of Medicine, Alexandria University, Champolion Street, Khartoum Square, Azareeta, Alexandria, Egypt. waelmmosa@yahoo.com.
Title:Decompressive craniectomy and expansive duraplasty with evacuation of hypertensive intracerebral hematoma, a randomized controlled trial.
Source:Neurosurg Rev; 40(1):115-127, 2017 Jan.
ISSN:1437-2320
Country of publication:Germany
Language:eng
Abstract:Hypertensive intracerebral hemorrhage (ICH) has high morbidity and mortality rates. Decompressive craniectomy (DC) is generally used for the treatment of cases associated with refractory increased intracranial pressure (ICP). In this study, we investigated the beneficial effects of adding DC and expansive duraplasty (ED) to hematoma evacuation in patients who underwent surgery for large hypertensive ICH. A prospective randomized controlled clinical trial where 40 patients diagnosed having large hypertensive ICH was randomly allocated to either group A or B, each comprised 20 patients. Group A patients, the treatment group, were submitted to hematoma evacuation together with DC and ED, whereas group B patients, the control group, were submitted only to hematoma evacuation. Twenty-three (57.5%) of the patients were males, with an overall age range of 34-79years (mean 59.3years). Preoperative Glasgow Coma Scale (GCS) scores in group A ranged from 4 to 13 (mean 7.1), while in group B it ranged from 4 to 12 (mean 6.8). Postoperative hydrocephalus occurred in 3 (15%) patients in group A and in 4 (20%) patients in group B, whereas meningitis occurred in one patient (5%) in group A. The mortality rate was 2 (10%) patients in group A as compared to 5 (25%) patients in group B (p = 0.407). High admission GCS (p = 0.0032), younger age (p = 0.0023), smaller hematoma volume (p = 0.044), subcortical hematoma location (p = 0.041), absent or minimal preoperative (p = 0.0068), and postoperative (p = 0.0031) midline shift as well as absent intraventricular extension of the hematoma (p = 0.036) contributed significantly to a better outcome. Selected patients' subgroups who benefited from adding DC and ED to ICH evacuation were age category of 30 to less than 50 (p = 0.0015) and from 50 to less than 70 (p = 0.00619) as well as immediate preoperative GCS from 6 to 8 (p = 0.000436) and from 9 to 12 (p = 0.00774). At 6months' follow-up, 14 (70%) patients of group A had favorable outcome as compared to 4 (20%) patients of group B (p = 0.0015). Adding DC with ED to evacuation of a large hypertensive hemispheric ICH might improve the outcome in selected group of patients.
Publication type:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL


  9 / 300 MEDLINE  
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PMID:27906426
Author:Yu SX; Zhang QS; Yin Y; Liu Z; Wu JM; Yang MX
Address:Department of Neurosurgery, The Second People's Hospital of Longgang District, Shenzhen, China. nt1492028yashanhu@163.com.
Title:Continuous monitoring of intracranial pressure for prediction of postoperative complications of hypertensive intracerebral hemorrhage.
Source:Eur Rev Med Pharmacol Sci; 20(22):4750-4755, 2016 Nov.
ISSN:2284-0729
Country of publication:Italy
Language:eng
Abstract:OBJECTIVE: This study evaluates the value of continuous dynamic monitoring of intracranial pressure (ICP) in patients with hypertensive intracerebral hemorrhage to predict early postoperative complications. PATIENTS AND METHODS: Data from 80 patients treated in our hospital from February 2014 to February 2015 were analyzed. The patients all underwent decompressive craniectomies, and their ICP changes were monitored invasively and continuously for 1 to 7 days after surgery. The average blood loss during surgery for the group of patients was 65.3 12.4 ml and the mean GCS score 8.7 2.4. Cases were divided into three groups according to ICP values to compare early postoperative complications of the groups: a normal and mildly increased group (51 cases), a moderately increased group (19 cases) and a severely increased group (10 cases). RESULTS: To validate the analysis we first showed that comparisons among groups based on gender, age, systolic pressure, diastolic pressure, bleeding time, blood loss, operation time, craniectomy localization, and preoperative mannitol dosage yielded no statistically significant differences. In contrast, the following comparisons produced statistically significant differences: the comparison of postoperative Glasgow Coma Scale (GCS) scores showing that the lower intracranial pressure, the higher the GCS score; the postoperative rehemorrhage, cerebral edema and death ratios showing the higher the intracranial pressure, the higher the rehemorrhage ratio; the average ICP and the time to occurrence of rehemorrhage, cerebral edema or cerebral infarction, showing the relationship between the average ICP and the time to a complication. Patients with higher ICP averages suffered a complication of rehemorrhage within the first 9.6 2.5 hours on average. Nevertheless, the comparison of GCS scores in those patients and the others showed no significant differences. CONCLUSIONS: Based on the findings, the dynamic monitoring of intracranial pressure can early and sensitively predict postoperative complications of patients with hypertensive cerebral hemorrhage, and guide the clinical intervention actively to improve the surgery outcome.
Publication type:JOURNAL ARTICLE


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Clinical Trials Registry
PMID:27737957
Author:Walsh KB; Woo D; Sekar P; Osborne J; Moomaw CJ; Langefeld CD; Adeoye O
Address:From Department of Emergency Medicine, University of Cincinnati, OH (K.B.W., O.A.); Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (D.W., P.S., J.O., C.J.M.); Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest School of Medicin
Title:Untreated Hypertension: A Powerful Risk Factor for Lobar and Nonlobar Intracerebral Hemorrhage in Whites, Blacks, and Hispanics.
Source:Circulation; 134(19):1444-1452, 2016 Nov 08.
ISSN:1524-4539
Country of publication:United States
Language:eng
Abstract:BACKGROUND: Hypertension is a significant risk factor for intracerebral hemorrhage (ICH). Although ethnic/racial disparities related to hypertension and ICH have been reported, these previous studies were limited by a lack of Hispanics and inadequate power to analyze by ICH location. In the current study, while overcoming these prior limitations, we investigated whether there was variation by ethnicity/race of treated and untreated hypertension as risk factors for ICH. METHODS: The ERICH study (Ethnic/Racial Variations of Intracerebral Hemorrhage) is a prospective, multicenter, case-control study of ICH among whites, blacks, and Hispanics. Cases were enrolled from 42 recruitment sites. Controls matched to cases 1:1 by age (5 years), sex, ethnicity/race, and metropolitan area were identified by random-digit dialing. Subjects were interviewed to determine history of hypertension and use of antihypertensive medications. Cases and controls within ethnic groups were compared by using conditional logistic regression. Multivariable conditional logistic regression models were computed for ICH as an overall group and separately for the location subcategories deep, lobar, and infratentorial (brainstem/cerebellar). RESULTS: Nine hundred fifty-eight white, 880 black, and 766 Hispanic ICH patients were enrolled. For ICH cases, untreated hypertension was higher in blacks (43.6%, P<0.0001) and Hispanics (46.9%, P<0.0001) versus whites (32.7%). In multivariable analyses adjusted for alcohol use, anticoagulation, hypercholesterolemia, education, and medical insurance status, treated hypertension was a significant risk factor across all locations of ICH in whites (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.24-1.98; P<0.0001), blacks (OR, 3.02; 95% CI, 2.16-4.22; P<0.0001), and Hispanics (OR, 2.50; 95% CI, 1.73-3.62; P<0.0001). Untreated hypertension was a substantially greater risk factor for all 3 racial/ethnic groups across all locations of ICH: whites (OR, 8.79; 95% CI, 5.66-13.66; P<0.0001), blacks (OR, 12.46; 95% CI, 8.08-19.20; P<0.0001), and Hispanics (OR, 10.95; 95% CI, 6.58-18.23; P<0.0001). There was an interaction between race/ethnicity and ICH risk (P<0.0001). CONCLUSIONS: Untreated hypertension confers a greater ICH risk in blacks and Hispanics relative to whites across all anatomic locations of ICH. Accelerated research efforts are needed to improve overall hypertension treatment rates and to monitor the impact of such efforts on racial/ethnic disparities in stroke. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01202864.
Publication type:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL



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