引言 基底动脉尖综合征(top of the basilar svndrome,To-BS)的概念最早由Caplan在1980年提出,他将TOBS从椎一基底动脉系统缺血性疾病中分离出来,并对其在临床及影像学等方面的表现进行了首次阐述。TOBS是指由于各种病因所致的以基底动...引言 基底动脉尖综合征(top of the basilar svndrome,To-BS)的概念最早由Caplan在1980年提出,他将TOBS从椎一基底动脉系统缺血性疾病中分离出来,并对其在临床及影像学等方面的表现进行了首次阐述。TOBS是指由于各种病因所致的以基底动脉顶端为中心组成“干”字形结构的5条血管(即双侧小脑上动脉。展开更多
Background： There are few studies for evaluating plaque characteristics of nonstenotic basilar arteries （BA）. Our aim was to determine entire BA plaques with a three-dimensional volumetric isotropic turbo spin-echo...Background： There are few studies for evaluating plaque characteristics of nonstenotic basilar arteries （BA）. Our aim was to determine entire BA plaques with a three-dimensional volumetric isotropic turbo spin-echo acquisition （VISTA） and investigate the differences between the patients with and without isolated pontine infarction （IPI）. Methods： Twenty-four consecutive symptomatic patients with nonstenotic BA on time of flight magnetic resonance angiography （TOF MRA） were enrolled from China-Japan Friendship Hospital between January 2014 and December 2014. BA was classified as ＂normal＂ or ＂irregular＂ based on TOF MRA, and ＂normal wall＂, ＂slight wall-thickening＂, and ＂plaque＂ based on three-dimensional VISTA images. Outcomes from MRA and VISTA were compared. Patients were categorized as IPI and non-lPl groups based on the diffusion-weighted imaging. Clinical and plaque characteristics were compared between the two groups. Results： A total of 1024 image slices including 311 （30.37%） plaque slices, 427 （41.70%） slight wall-thickening slices, and 286 （27.93%） normal wall slices for the entire BA from 23 patients were finally included for analysis. VISTA images detected plaques in all the 9 （100%） irregular MRA patients and 7 of 14 （50%） normal MRA patients. IPl was found in 11 （47.83%） patients. Compared to non-IPI group, the IPI group had a higher percentage of plaque slices （P = 0.001 ） and lower percentage of normal wall slices （P = 0.014） than non-IPl group. Conclusions： Three-dimensional V1STA images enable detection of BA plaques not visualized by MRA. BA plaques could be found in both the IPl and non-IPl group. However, IPI group showed plaques more extensively in BA than the non-IPI group.展开更多
background While diffuse atherosclerotic disease affecting the posterior circulation has been described extensively,the prevalence,natural history and angiographic characteristics of isolated symptomatic basilar arter...background While diffuse atherosclerotic disease affecting the posterior circulation has been described extensively,the prevalence,natural history and angiographic characteristics of isolated symptomatic basilar artery stenosis(ISBAS)remain unknown.Methods We reviewed our prospective institutional database to identify patients with≥50% symptomatic basilar artery(BA)stenosis without significant atherosclerotic burden in the vertebral or posterior cerebral arteries.Stroke mechanism,collateral circulation,and degree and length of stenosis were analysed.The primary outcome was time from index event to new transient ischaemic attack(TIA),acute ischaemic stroke(AIS)or death.Other outcome variables included modified Rankin Scale(mRS)score on discharge and last follow-up.results Of 6369 patients with AIS/TIA,91(1.43%)had ISBAS.Seventy-three(80.2%)patients presented with AIS and 18(19.8%)with TIA.Twenty-nine(31.9%)were women and the median age was 66.8±13.6 years.The mean follow-up time was 2.7 years.The most common stroke mechanism was artery-to artery thromboembolism(45.2%),followed by perforator occlusion(28.7%)and flow-dependent/hypoperfusion(15.1%).The percentage of stenosis was lower in patients who had favourable outcome compared with those with mRS 3-6 on discharge(78.3±14.3 vs 86.9±14.5,p=0.007).Kaplan-Meier curves showed higher recurrence/death rates in patients with≥80% stenosis,mid-basilar location and poor collateral circulation.Approximately 13% of patients with ISBAS presented with complete BA occlusion.Conclusion ISBAS is an uncommon(1.43%)cause of TIA and AIS.Men in their 60s are mostly affected,and artery-to artery embolism is the most common stroke mechanism.Mid-basilar location,≥80% stenosis and poor collateral circulation are important factors associated with worse prognosis.展开更多
Progressive motor deficits are relatively common in acute pontine infarction and frequently associated with increased functional disability. However, the factors that affect the progression of clinical motor weakness ...Progressive motor deficits are relatively common in acute pontine infarction and frequently associated with increased functional disability. However, the factors that affect the progression of clinical motor weakness are largely unknown. Previous studies have suggested that pontine infarctions are caused mainly by basilar artery stenosis and penetrating artery disease. Recently, lower pons lesions in patients with acute pontine infarctions have been reported to be related to progressive motor deficits, and ensuing that damage to the corticospinal tracts may be respon- sible for the worsening of neurological symptoms. Here, we review studies on motor weakness progression in pontine infarction and discuss the mechanisms that may underlie the neurologic worsening.展开更多
Normal mammalian ears not only detect but also generate sounds. The ear-generated sounds, i.e., otoacoustic emissions (OAEs), can be measured in the external ear canal using a tiny sensitive microphone. In spite of wi...Normal mammalian ears not only detect but also generate sounds. The ear-generated sounds, i.e., otoacoustic emissions (OAEs), can be measured in the external ear canal using a tiny sensitive microphone. In spite of wide applications of OAEs in diagnosis of hearing disorders and in studies of cochlear functions, the question of how the cochlea emits sounds remains unclear. The current dominating theory is that the OAE reaches the cochlear base through a backward traveling wave. However, recently published works, including experimental data on the spatial pattern of basilar membrane vibrations at the emission frequency, demonstrated only forward traveling waves and no signs of backward traveling waves. These new findings indicate that the cochlea emits sounds through cochlear fluids as compression waves rather than through the basilar membrane as backward traveling waves. This article reviews different mechanisms of the backward propagation of OAEs and summarizes recent experimental results.展开更多
This paper studies the influence of a High-Porosity Mesh （HPM） stent on the hemodynamic characteristics in the intracranial aneurysm based on the Computational Fluid Dynamics （CFD）. An idealized basilar tip aneury...This paper studies the influence of a High-Porosity Mesh （HPM） stent on the hemodynamic characteristics in the intracranial aneurysm based on the Computational Fluid Dynamics （CFD）. An idealized basilar tip aneurysm model and a HPM stent model are built. The pulsating blood flow in a cardiac cycle is computationally simulated for non-stented and stented models, to provide a wealth of information of the spatio-temporally varying blood flow field. The influence of the stent placement on the hemodynamic characteristics is analyzed in terms of distributions of velocity, pressure, Wall Shear Stress （WSS） and Energy Loss （EL）, which are believed to play an important role in the development and rupture of the aneurysm. The numerical results clearly show that the velocity, pressure, WSS and EL of the blood flow in the aneurysm are reduced by 30%-40% when the HPM stent is implanted. These computational results may provide valuable hemodynamic information for clinical neurosurgeon.展开更多
To evaluate the therapeutic efficacy of Yinxing Damo （银杏达莫, YXDM） combined with Betahistine Hydrochloride Injection （BHI） on vertebra basilar artery ischemic vertigo （VBIV）. Methods： Ninety patients with VB...To evaluate the therapeutic efficacy of Yinxing Damo （银杏达莫, YXDM） combined with Betahistine Hydrochloride Injection （BHI） on vertebra basilar artery ischemic vertigo （VBIV）. Methods： Ninety patients with VBIV were randomly divided into two groups; 45 patients （the treated group） were treated with YXDM and BHI intravenous dripping, once a day for 14 days. Another 45 patients （control group） were treated with Xueshuantong （血栓通） and BHI intravenous dripping, once daily for 14 days. The clinical syndromes and the index of the transcranial Doppler （TCD） and hemorheology were observed. Results： The total effective rate was 100% in the treated group, which was better than that in the control group 90.5%, （P〈0. 05）. The indexes of TCD and hemorheology in the treated group were obviously improved after treatment, （P〈0.01）. Conclusion： YXDM combined with BHT injection had better effect in treating patients with VBIV is an ideal drug for VBIV.展开更多
Spontaneous, rhythmical contractions, or vasomotion, can be recorded from cerebral vessels under both normal physiological and pathophysiological conditions. We investigated the cellular mechanisms underlying vasomoti...Spontaneous, rhythmical contractions, or vasomotion, can be recorded from cerebral vessels under both normal physiological and pathophysiological conditions. We investigated the cellular mechanisms underlying vasomotion in the cerebral basilar artery （BA） of Wistar rats. Pressure myograph video microscopy was used to study the changes in cerebral artery vessel diameter. The main results of this study were as follows： （1） The diameters of BA and middle cerebral artery （MCA） were 314.5±15.7 μm （n=15） and 233.3±10.1 μm （n=12） at 10 mmHg working pressure （P〈0.05）, respectively. Pressure-induced vasomotion occurred in BA （22/28, 78.6%）, but not in MCA （4/31, 12.9%） from 0 to 70 mmHg working pressure. As is typical for vasomotion, the contractile phase of the response was more rapid than the relaxation phase; （2） The frequency of vasomotion response and the diameter were gradually increased in BA from 0 to 70 mmHg working pressure. The amplitude of the rhythmic con- tractions was relatively constant once stable conditions were achieved. The frequency of contractions was variable and the highest value was 16.7±4.7 （n=13） per 10 min at 60 mmHg working pressure; （3） The pressure-induced vasomotion of the isolated BA was attenuated by nifedipine, NFA, 181]-GA, TEA or in Ca2＋-free medium. Nifedipine, NFA, 18^-GA or Ca2＋-free medium not only dampened vasomotion, but also kept BA in relaxation state. In contrasts, TEA kept BA in contraction state. These results sug- gest that the pressure-induced vasomotion of the isolated BA results from an interaction between Ca2＋-activated C1- channels （CaCCs） currents and Kca currents. We hypothesize that vasomotion of BA depends on the depolarizing of the vascular smooth muscle cells （VSMCs） to activate CaCCs. Depolarization in turn activates voltage-dependent Ca2＋ channels, synchronizing contractions of adjacent cells through influx of extracellular calcium and the flow of calcium through gap junctions. Subsequent calc展开更多
The miniature pig is an optimal animal model for studying nervous system disease because of its physiologic and pathologic features. However, the rete mirabile composed of arteries and veins at the skull base limits t...The miniature pig is an optimal animal model for studying nervous system disease because of its physiologic and pathologic features. However, the rete mirabile composed of arteries and veins at the skull base limits their application as a model of ischemic stroke by middle cerebral artery occlusion. The present study investigated the possibility of establishing an ischemic stroke model in the miniature pig by blocking the skull base retia with sodium alginate microspheres. Three Bama miniature pigs were used. Using the monitor of C-arm X-ray machine, sodium aiginate microspheres （100-300 pm）, a novel embolic material, were injected through the femoral artery, aortic arch, common carotid artery, ascending pharyngeal artery and the retia. Results were evaluated using carotid arteriography, MRI, behavior observation and histology. The unilateral rete mirabile was completely blocked, resulting in disturbance in blood supply to the basal ganglia, astasia of the dght hind limb and salivation. MRI and hematoxylin-eosin staining showed an evident infarction focus in the basal ganglia. These findings indicate that sodium alginate microspheres are a suitable embolic material for blocking the skull base retia in miniature pigs to establish an ischemic stroke models.展开更多
AIM To evaluate the role of dynamic computed tomography(CT)scan imaging in diagnosing craniovertebral junction(CVJ)instability in patients with congenital CVJ malformations.METHODS Patients with symptomatic congenital...AIM To evaluate the role of dynamic computed tomography(CT)scan imaging in diagnosing craniovertebral junction(CVJ)instability in patients with congenital CVJ malformations.METHODS Patients with symptomatic congenital CVJ malformations who underwent posterior fossa decompression and had a preoperative dynamic CT scan in flexion and extended position were included in this study.Measurements of the following craniometrical parameters were taken in flexed and extended neck position:Atlanto-dental interval(ADI),distance of the odontoid tip to the Chamberlain’s line,and the clivus-canal angle(CCA).Assessment of the facet joints congruence was also performed in both positions.Comparison of the values obtained in flexion and extension were compared using a paired Student’s t-test.RESULTS A total of ten patients with a mean age of 37.9 years were included.In flexion imaging,the mean ADI was1.76 mm,the mean CCA was 125.4°and the mean distance of the odontoid tip to the Chamberlain’s line was+9.62 mm.In extension,the mean ADI was1.46 mm(P=0.29),the mean CCA was 142.2°(P<0.01)and the mean distance of the odontoid tip to the Chamberlain’s line was+7.11 mm(P<0.05).Four patients(40%)had facetary subluxation demonstrated in dynamic imaging,two of them with mobile subluxation(both underwent CVJ fixation).The other two patients with a fixed subluxation were not initially fixed.One patient with atlantoaxial assimilation and C23 fusion without initial facet subluxation developed a latter CVJ instability diagnosed with a dynamic CT scan.Patients with basilar invagination had a lower CCA variation compared to the whole group.CONCLUSION Craniometrical parameters,as well as the visualization of the facets location,may change significantly according to the neck position.Dynamic imaging can provide additional useful information to the diagnosis of CVJ instability.Future studies addressing the relationship between craniometrical changes and neck position are necessary.展开更多
Background Vertebrobasilar artery stenosis is an important cause of ischemic posterior circulation strokes. This study aimed at evaluating the safety and efficacy of treatment including conservative therapy alone and ...Background Vertebrobasilar artery stenosis is an important cause of ischemic posterior circulation strokes. This study aimed at evaluating the safety and efficacy of treatment including conservative therapy alone and conservative plus endovascular therapy for elderly patients with symptomatic vertebrobasilar artery stenosis.Methods Patients older than 60 years with symptomatic vertebrobasilar artery stenosis （ ≥50%） confirmed by cerebral angiography were enrolled. All of them were treated with medical therapy and some with additional stent-assisted angioplasty （the stenting subgroup）. Their clinical, imaging, intervention and follow-up data were analyzed.Results One hundred and seventeen consecutive elderly patients （100 men, mean age （68.1 ±5.1） years） were enrolled and followed up for a mean time of 28.4 months; 81.7% of them were symptomatically resolved or improved; a stroke rate of 5.1% and a stroke-related death rate of 1.7% were found among them during the hospitalization and follow-up. In the stenting subgroup, 78 balloon expandable stents were employed in the 70 patients with a technical success rate of 98.7% and the mean degree of stenosis was significantly reduced from （81.7±14.3）% before stenting to （8.3±4.2）% after stenting （P 〈0.001）. Four （5.7%） periprocedural strokes occurred, of whom two led to death within 30 days after the procedure. During the follow-up （mean 27.7 months）, sixty of the surviving 68 patients in the stenting subgroup were symptomatically resolved or improved. Only one （1.5%） posterior circulation stroke occurred, while duplex ultrasound scan of 34 patients demonstrated 10 （29.4%） in-stent restenosis.Conclusions Appropriate utilization of conservative therapy alone and conservative plus endovascular therapy may improve short-term clinical outcomes for elderly patients with symptomatic vertebrobasilar artery stenosis. Furthermore, stent-assisted angioplasty is technically feasible and relatively safe in elderly patients.展开更多
To the Editor: Acute basilar artery occlusion (BAO) is a catastrophic variant of stroke, which accounts for about 1% of all strokes.[1] Though rare, BAOs are associated with high morbidity and mortality rates.[2] Alth...To the Editor: Acute basilar artery occlusion (BAO) is a catastrophic variant of stroke, which accounts for about 1% of all strokes.[1] Though rare, BAOs are associated with high morbidity and mortality rates.[2] Although treatable, the rate of death or disability associated with BAO is still as high as 80%.[2] Early recanalization either with thrombolysis or intravascular thrombectomy was shown to significantly improve the outcome of patients with BAO.展开更多
BACKGROUND Subarachnoid hemorrhage is a severe neurological condition that requires prompt and appropriate treatment to prevent complications.Aneurysms are the most common cause of spontaneous subarachnoid hemorrhage....BACKGROUND Subarachnoid hemorrhage is a severe neurological condition that requires prompt and appropriate treatment to prevent complications.Aneurysms are the most common cause of spontaneous subarachnoid hemorrhage.Conversely,basilar artery perforator aneurysms(BAPAs)are a rare etiology.There is no consensus on the optimal management of ruptured BAPAs in the acute setting.CASE SUMMARY We present a case series of 3 patients with ruptured BAPAs who were treated at our institution.Two patients had a modified Fisher grade of I,and one had a grade of IV on initial presentation.The aneurysms were detected by computed tomography angiography in two cases and conventional angiography in one case.The 3 patients underwent endovascular treatment with Guglielmi detachable coils.Post-treatment,the patients had good clinical outcomes,and follow-up brain computed tomography scans showed reduced subarachnoid hemorrhage without any new hemorrhage.However,one patient experienced a cerebral infarction 2 months later and eventually succumbed to the condition.The other 2 patients showed progressive recovery,and no aneurysm recurrence was observed at the 2-year follow-up.CONCLUSION Endovascular treatment may be a preferable approach for managing ruptured BAPAs compared with surgical intervention or conservative management.Early detection and prompt treatment is important to achieve favorable patient outcomes.展开更多
Basilar tip aneurysms account for 5% - 8% of all intracranial aneurysms. They are known to rupture more frequently than aneurysms in other locations. Surgical clipping of basilar apex aneurysms however challenging;rem...Basilar tip aneurysms account for 5% - 8% of all intracranial aneurysms. They are known to rupture more frequently than aneurysms in other locations. Surgical clipping of basilar apex aneurysms however challenging;remains the treatment of choice in Ivory Coast due in part, to multiple technical barriers. A 60-year-old right-handed patient presented to our Neurosurgical Unit in February 2nd 2013 after a sudden onset of altered consciousness. Neurological examination revealed both an upper motor neuron and meningeal syndromes with a Glasgow Coma Scale of 12. Brain NECT scan and a subsequent brain CT angiography showed a subarachnoid haemorrhage and a 3.8 mm (height) × 5.2 mm (width) basilar tip aneurysm respectively. Surgical clipping of the aneurysm was indicated but due to multiple technical barriers, surgery was delayed and the patient underwent surgery after the critical vasospasm period. The patient developed a hospital acquired pneumonia after surgery and was successfully treated with antibiotics. Since her discharge, she has been asymptomatic. We sought to report this case of a basilar apex aneurysm successfully occluded with non-ferromagnetic SUGITA clips and to share our experience of clipping these lesions through the frontotemporal approach. The patient was informed that non identifying information from the case would be submitted for publication, and she provided consent.展开更多
BACKGROUND： Propofol has been shown to attenuate neuronal injury in a number of experimental conditions. However, its effect in models of cerebral ischemia after subarachnoid hemorrhage （SAH） remains controversial....BACKGROUND： Propofol has been shown to attenuate neuronal injury in a number of experimental conditions. However, its effect in models of cerebral ischemia after subarachnoid hemorrhage （SAH） remains controversial. OBJECTIVE： To explore the effects of intracisternal injection of HX0507, a water-soluble propofol prodrug, on basilar artery vasospasm and brain tissue injury in a rabbit model of SAH. DESIGN, TIME AND SETTING： A randomized, controlled, in vivo animal experiment based on behavior and morphology. The study was performed at the Laboratory of Anesthesiology and Critical Care Medicine, West China Hospital, Sichuan University from April to December 2007. MATERIALS： HX0507 was provided by the Laboratory of Anesthesiology and Critical Care Medicine, West China Hospital of Sichuan University. METHODS： A total of 30 healthy, male, New Zealand rabbits were randomly assigned to sham-operation, SAH-control, and SAH-HX0507 groups, with 10 animals in each group. The single-hemorrhage SAH model was established by injecting autologous arterial blood （1.0 mL/kg） into the cisterna magna in the SAH-control and SAH-HX0507 groups, while the sham-operation group was injected with normal saline （1.0 mL/kg）. Thirty minutes after injection, the sham-operation and SAH-control groups were injected with normal saline （0.1 mL/kg） into the cisterna magna, while the SAH-HX0507 group received an injection of HX0507 （4.8 mg/kg）. MAIN OUTCOME MEASURES： The cross-sectional area and corrugation coefficients of basilar arteries and hippocampal CA1 neuronal densities were measured 48 hours after SAH （peak stage of vasospasm） using the Computer-Assisted Stereological Toolbox system. The ultrastructural structure of the basilar artery wall was examined by transmission electron microscopy. In addition, neurological behavioral impairment was evaluated by appetite score at pre-SAH, and 1 and 2 days after SAH. RESULTS： The cross-sectional area of basilar arteries and hippocampal CA1 neuronal densities, as we展开更多
Objective The aim of this study is to investigate the effect of transfected hTERT gene on cell apoptosis of newborn rat cochlear basilar membrane cells (CBMCs). Methods CBMCs isolated from newborn rat cochlear were tr...Objective The aim of this study is to investigate the effect of transfected hTERT gene on cell apoptosis of newborn rat cochlear basilar membrane cells (CBMCs). Methods CBMCs isolated from newborn rat cochlear were transfected using a plasmid containing human telomerase reverase transcriptase gene (pCI-neo-hTERT) , and were screened using G418 to obtain stable transfected cell lines. Cell apoptosis rate was analyzed by flow cytometry. hTERT and apoptosis related genes expression were detected by reverse transcriptase polymerase chain reaction (RT-PCR). Results hTERT gene expression was detected 72 hours after gene transfection in transfected cells. The apoptotic rate of transfected CBMCs significantly reduced. Expression of apoptosis related genes correspondingly changed. Conclusion Transfection of hTERT gene leads to reduced apoptosis rate in newborn rat CBMCs.and lower expression of apaf1, Caspase3 and BCL2 in transfected cells as compared to that of normal CBMCs.展开更多
Objective and Importance—Vertebrobasilar artery aneurysms can be very challenging to treat and are preferentially dealt with using endovascular tech-niques, since they are associated with lower risk than surgical cli...Objective and Importance—Vertebrobasilar artery aneurysms can be very challenging to treat and are preferentially dealt with using endovascular tech-niques, since they are associated with lower risk than surgical clipping. Small aneurysms located on perfo-rating arteries can pose problems though, as their dimensions may not be favorable for coiling and leave the endovascular surgeon without many options. We present a basilar perforating artery aneurysm that was successfully embolized using a stent-within-stent technique. Clinical Presentation—A 47 year old fe-male presented with a Hunt-Hess 3, Fisher Grade-3 subarachnoid hemorrhage with blood in the pre-pontine cistern. Initial imaging (CT angiogram and digital subtraction angiography) did not reveal an aneurysm. Follow-up angiography on post-bleed day eight demonstrated a three-millimeter basilar perforating artery aneurysm. After an unsuccessful coiling attempt a closed-cell stent-within-stent tech-nique was used to divert flow away from the aneu-rysm neck to induce aneurysm thrombosis. Interven-tion (or Technique)—Multiple attempts were made to access and stabilize a microcatheter in the small basilar perforator artery aneurysm in order to de-liver coils for endovascular embolization;this could not be done safely. Therefore a closed-cell 4.5 × 22 mm Enterprise stent (Cordis Neurovascular, Inc., Miami Lakes, Florida) was deployed in the basilar artery across the origin of the perforator aneurysm in order for the stent tines to divert flow away from the aneurysm neck and induce thrombosis. Persistant brisk flow within the aneurysm continued however, and a second closedcell 4.5 × 22 mm Enterprise stent was placed within the first one to increase the stent metal surface area across the aneurysm neck to further reduce flow into the aneurysm. Subsequently, angiography demonstrated stagnant blood flow in the aneurysm dome and the aneurysm spontaneously thrombosed, sparing all associated vessels. Conclu-sion—Stent-within-stent technique should be consid-ered展开更多
Background Unclippable fusiform basilar trunk aneurysm is a formidable condition for surgical treatment.The aim of this study was to establish a computational model and to investigate the hemodynamic characteristics i...Background Unclippable fusiform basilar trunk aneurysm is a formidable condition for surgical treatment.The aim of this study was to establish a computational model and to investigate the hemodynamic characteristics in a fusiform basilar trunk aneurysm.Methods The three-dimensional digital model of a fusiform basilar trunk aneurysm was constructed using MIMICS,ANSYS and CFX software.Different hemodynamic modalities and border conditions were assigned to the model.Thirty points were selected randomly on the wall and within the aneurysm.Wall total pressure （WTP）,wall shear stress （WSS）,and blood flow velocity of each point were calculated and hemodynamic status was compared between different modalities.Results The quantitative average values of the 30 points on the wall and within the aneurysm were obtained by computational calculation point by point.The velocity and WSS in modalities A and B were different from those of the remaining 5 modalities; and the WTP in modalities A,E and F were higher than those of the remaining 4 modalities.Conclusions The digital model of a fusiform basilar artery aneurysm is feasible and reliable.This model could provide some important information to clinical treatment options.展开更多
文摘引言 基底动脉尖综合征(top of the basilar svndrome,To-BS)的概念最早由Caplan在1980年提出,他将TOBS从椎一基底动脉系统缺血性疾病中分离出来,并对其在临床及影像学等方面的表现进行了首次阐述。TOBS是指由于各种病因所致的以基底动脉顶端为中心组成“干”字形结构的5条血管(即双侧小脑上动脉。
基金This study was supported by grants from China- Japan Friendship Hospital Youth Science and Technology Excellence Project （No. 2014-QNYC-A-04）, National Natural Science Foundation of China （No. 81173595, No. 30670731, No. 81070925 and No. 81471767）, and National Basic Research Program （973 Program） of China （No. 2013CB733805）.
文摘Background： There are few studies for evaluating plaque characteristics of nonstenotic basilar arteries （BA）. Our aim was to determine entire BA plaques with a three-dimensional volumetric isotropic turbo spin-echo acquisition （VISTA） and investigate the differences between the patients with and without isolated pontine infarction （IPI）. Methods： Twenty-four consecutive symptomatic patients with nonstenotic BA on time of flight magnetic resonance angiography （TOF MRA） were enrolled from China-Japan Friendship Hospital between January 2014 and December 2014. BA was classified as ＂normal＂ or ＂irregular＂ based on TOF MRA, and ＂normal wall＂, ＂slight wall-thickening＂, and ＂plaque＂ based on three-dimensional VISTA images. Outcomes from MRA and VISTA were compared. Patients were categorized as IPI and non-lPl groups based on the diffusion-weighted imaging. Clinical and plaque characteristics were compared between the two groups. Results： A total of 1024 image slices including 311 （30.37%） plaque slices, 427 （41.70%） slight wall-thickening slices, and 286 （27.93%） normal wall slices for the entire BA from 23 patients were finally included for analysis. VISTA images detected plaques in all the 9 （100%） irregular MRA patients and 7 of 14 （50%） normal MRA patients. IPl was found in 11 （47.83%） patients. Compared to non-IPI group, the IPI group had a higher percentage of plaque slices （P = 0.001 ） and lower percentage of normal wall slices （P = 0.014） than non-IPl group. Conclusions： Three-dimensional V1STA images enable detection of BA plaques not visualized by MRA. BA plaques could be found in both the IPl and non-IPl group. However, IPI group showed plaques more extensively in BA than the non-IPI group.
文摘background While diffuse atherosclerotic disease affecting the posterior circulation has been described extensively,the prevalence,natural history and angiographic characteristics of isolated symptomatic basilar artery stenosis(ISBAS)remain unknown.Methods We reviewed our prospective institutional database to identify patients with≥50% symptomatic basilar artery(BA)stenosis without significant atherosclerotic burden in the vertebral or posterior cerebral arteries.Stroke mechanism,collateral circulation,and degree and length of stenosis were analysed.The primary outcome was time from index event to new transient ischaemic attack(TIA),acute ischaemic stroke(AIS)or death.Other outcome variables included modified Rankin Scale(mRS)score on discharge and last follow-up.results Of 6369 patients with AIS/TIA,91(1.43%)had ISBAS.Seventy-three(80.2%)patients presented with AIS and 18(19.8%)with TIA.Twenty-nine(31.9%)were women and the median age was 66.8±13.6 years.The mean follow-up time was 2.7 years.The most common stroke mechanism was artery-to artery thromboembolism(45.2%),followed by perforator occlusion(28.7%)and flow-dependent/hypoperfusion(15.1%).The percentage of stenosis was lower in patients who had favourable outcome compared with those with mRS 3-6 on discharge(78.3±14.3 vs 86.9±14.5,p=0.007).Kaplan-Meier curves showed higher recurrence/death rates in patients with≥80% stenosis,mid-basilar location and poor collateral circulation.Approximately 13% of patients with ISBAS presented with complete BA occlusion.Conclusion ISBAS is an uncommon(1.43%)cause of TIA and AIS.Men in their 60s are mostly affected,and artery-to artery embolism is the most common stroke mechanism.Mid-basilar location,≥80% stenosis and poor collateral circulation are important factors associated with worse prognosis.
文摘Progressive motor deficits are relatively common in acute pontine infarction and frequently associated with increased functional disability. However, the factors that affect the progression of clinical motor weakness are largely unknown. Previous studies have suggested that pontine infarctions are caused mainly by basilar artery stenosis and penetrating artery disease. Recently, lower pons lesions in patients with acute pontine infarctions have been reported to be related to progressive motor deficits, and ensuing that damage to the corticospinal tracts may be respon- sible for the worsening of neurological symptoms. Here, we review studies on motor weakness progression in pontine infarction and discuss the mechanisms that may underlie the neurologic worsening.
文摘Normal mammalian ears not only detect but also generate sounds. The ear-generated sounds, i.e., otoacoustic emissions (OAEs), can be measured in the external ear canal using a tiny sensitive microphone. In spite of wide applications of OAEs in diagnosis of hearing disorders and in studies of cochlear functions, the question of how the cochlea emits sounds remains unclear. The current dominating theory is that the OAE reaches the cochlear base through a backward traveling wave. However, recently published works, including experimental data on the spatial pattern of basilar membrane vibrations at the emission frequency, demonstrated only forward traveling waves and no signs of backward traveling waves. These new findings indicate that the cochlea emits sounds through cochlear fluids as compression waves rather than through the basilar membrane as backward traveling waves. This article reviews different mechanisms of the backward propagation of OAEs and summarizes recent experimental results.
基金Project supported by the Science and Technology Committee of Shanghai Municipality(Grant No.08JC1411200)the Chinese Medical Association Program(Grant No.09010200175)
文摘This paper studies the influence of a High-Porosity Mesh （HPM） stent on the hemodynamic characteristics in the intracranial aneurysm based on the Computational Fluid Dynamics （CFD）. An idealized basilar tip aneurysm model and a HPM stent model are built. The pulsating blood flow in a cardiac cycle is computationally simulated for non-stented and stented models, to provide a wealth of information of the spatio-temporally varying blood flow field. The influence of the stent placement on the hemodynamic characteristics is analyzed in terms of distributions of velocity, pressure, Wall Shear Stress （WSS） and Energy Loss （EL）, which are believed to play an important role in the development and rupture of the aneurysm. The numerical results clearly show that the velocity, pressure, WSS and EL of the blood flow in the aneurysm are reduced by 30%-40% when the HPM stent is implanted. These computational results may provide valuable hemodynamic information for clinical neurosurgeon.
文摘To evaluate the therapeutic efficacy of Yinxing Damo （银杏达莫, YXDM） combined with Betahistine Hydrochloride Injection （BHI） on vertebra basilar artery ischemic vertigo （VBIV）. Methods： Ninety patients with VBIV were randomly divided into two groups; 45 patients （the treated group） were treated with YXDM and BHI intravenous dripping, once a day for 14 days. Another 45 patients （control group） were treated with Xueshuantong （血栓通） and BHI intravenous dripping, once daily for 14 days. The clinical syndromes and the index of the transcranial Doppler （TCD） and hemorheology were observed. Results： The total effective rate was 100% in the treated group, which was better than that in the control group 90.5%, （P〈0. 05）. The indexes of TCD and hemorheology in the treated group were obviously improved after treatment, （P〈0.01）. Conclusion： YXDM combined with BHT injection had better effect in treating patients with VBIV is an ideal drug for VBIV.
基金supported by grants from National Basic Research Program of China(No.2012CB52660000)National Natural Science Foundation of China(No.81000411,No.31100829,and No.31260247)
文摘Spontaneous, rhythmical contractions, or vasomotion, can be recorded from cerebral vessels under both normal physiological and pathophysiological conditions. We investigated the cellular mechanisms underlying vasomotion in the cerebral basilar artery （BA） of Wistar rats. Pressure myograph video microscopy was used to study the changes in cerebral artery vessel diameter. The main results of this study were as follows： （1） The diameters of BA and middle cerebral artery （MCA） were 314.5±15.7 μm （n=15） and 233.3±10.1 μm （n=12） at 10 mmHg working pressure （P〈0.05）, respectively. Pressure-induced vasomotion occurred in BA （22/28, 78.6%）, but not in MCA （4/31, 12.9%） from 0 to 70 mmHg working pressure. As is typical for vasomotion, the contractile phase of the response was more rapid than the relaxation phase; （2） The frequency of vasomotion response and the diameter were gradually increased in BA from 0 to 70 mmHg working pressure. The amplitude of the rhythmic con- tractions was relatively constant once stable conditions were achieved. The frequency of contractions was variable and the highest value was 16.7±4.7 （n=13） per 10 min at 60 mmHg working pressure; （3） The pressure-induced vasomotion of the isolated BA was attenuated by nifedipine, NFA, 181]-GA, TEA or in Ca2＋-free medium. Nifedipine, NFA, 18^-GA or Ca2＋-free medium not only dampened vasomotion, but also kept BA in relaxation state. In contrasts, TEA kept BA in contraction state. These results sug- gest that the pressure-induced vasomotion of the isolated BA results from an interaction between Ca2＋-activated C1- channels （CaCCs） currents and Kca currents. We hypothesize that vasomotion of BA depends on the depolarizing of the vascular smooth muscle cells （VSMCs） to activate CaCCs. Depolarization in turn activates voltage-dependent Ca2＋ channels, synchronizing contractions of adjacent cells through influx of extracellular calcium and the flow of calcium through gap junctions. Subsequent calc
基金supported by the Science and Technology Support Program of Beijing Science and Technology Committee,No.Z101107052210004
文摘The miniature pig is an optimal animal model for studying nervous system disease because of its physiologic and pathologic features. However, the rete mirabile composed of arteries and veins at the skull base limits their application as a model of ischemic stroke by middle cerebral artery occlusion. The present study investigated the possibility of establishing an ischemic stroke model in the miniature pig by blocking the skull base retia with sodium alginate microspheres. Three Bama miniature pigs were used. Using the monitor of C-arm X-ray machine, sodium aiginate microspheres （100-300 pm）, a novel embolic material, were injected through the femoral artery, aortic arch, common carotid artery, ascending pharyngeal artery and the retia. Results were evaluated using carotid arteriography, MRI, behavior observation and histology. The unilateral rete mirabile was completely blocked, resulting in disturbance in blood supply to the basal ganglia, astasia of the dght hind limb and salivation. MRI and hematoxylin-eosin staining showed an evident infarction focus in the basal ganglia. These findings indicate that sodium alginate microspheres are a suitable embolic material for blocking the skull base retia in miniature pigs to establish an ischemic stroke models.
文摘AIM To evaluate the role of dynamic computed tomography(CT)scan imaging in diagnosing craniovertebral junction(CVJ)instability in patients with congenital CVJ malformations.METHODS Patients with symptomatic congenital CVJ malformations who underwent posterior fossa decompression and had a preoperative dynamic CT scan in flexion and extended position were included in this study.Measurements of the following craniometrical parameters were taken in flexed and extended neck position:Atlanto-dental interval(ADI),distance of the odontoid tip to the Chamberlain’s line,and the clivus-canal angle(CCA).Assessment of the facet joints congruence was also performed in both positions.Comparison of the values obtained in flexion and extension were compared using a paired Student’s t-test.RESULTS A total of ten patients with a mean age of 37.9 years were included.In flexion imaging,the mean ADI was1.76 mm,the mean CCA was 125.4°and the mean distance of the odontoid tip to the Chamberlain’s line was+9.62 mm.In extension,the mean ADI was1.46 mm(P=0.29),the mean CCA was 142.2°(P<0.01)and the mean distance of the odontoid tip to the Chamberlain’s line was+7.11 mm(P<0.05).Four patients(40%)had facetary subluxation demonstrated in dynamic imaging,two of them with mobile subluxation(both underwent CVJ fixation).The other two patients with a fixed subluxation were not initially fixed.One patient with atlantoaxial assimilation and C23 fusion without initial facet subluxation developed a latter CVJ instability diagnosed with a dynamic CT scan.Patients with basilar invagination had a lower CCA variation compared to the whole group.CONCLUSION Craniometrical parameters,as well as the visualization of the facets location,may change significantly according to the neck position.Dynamic imaging can provide additional useful information to the diagnosis of CVJ instability.Future studies addressing the relationship between craniometrical changes and neck position are necessary.
文摘Background Vertebrobasilar artery stenosis is an important cause of ischemic posterior circulation strokes. This study aimed at evaluating the safety and efficacy of treatment including conservative therapy alone and conservative plus endovascular therapy for elderly patients with symptomatic vertebrobasilar artery stenosis.Methods Patients older than 60 years with symptomatic vertebrobasilar artery stenosis （ ≥50%） confirmed by cerebral angiography were enrolled. All of them were treated with medical therapy and some with additional stent-assisted angioplasty （the stenting subgroup）. Their clinical, imaging, intervention and follow-up data were analyzed.Results One hundred and seventeen consecutive elderly patients （100 men, mean age （68.1 ±5.1） years） were enrolled and followed up for a mean time of 28.4 months; 81.7% of them were symptomatically resolved or improved; a stroke rate of 5.1% and a stroke-related death rate of 1.7% were found among them during the hospitalization and follow-up. In the stenting subgroup, 78 balloon expandable stents were employed in the 70 patients with a technical success rate of 98.7% and the mean degree of stenosis was significantly reduced from （81.7±14.3）% before stenting to （8.3±4.2）% after stenting （P 〈0.001）. Four （5.7%） periprocedural strokes occurred, of whom two led to death within 30 days after the procedure. During the follow-up （mean 27.7 months）, sixty of the surviving 68 patients in the stenting subgroup were symptomatically resolved or improved. Only one （1.5%） posterior circulation stroke occurred, while duplex ultrasound scan of 34 patients demonstrated 10 （29.4%） in-stent restenosis.Conclusions Appropriate utilization of conservative therapy alone and conservative plus endovascular therapy may improve short-term clinical outcomes for elderly patients with symptomatic vertebrobasilar artery stenosis. Furthermore, stent-assisted angioplasty is technically feasible and relatively safe in elderly patients.
文摘To the Editor: Acute basilar artery occlusion (BAO) is a catastrophic variant of stroke, which accounts for about 1% of all strokes.[1] Though rare, BAOs are associated with high morbidity and mortality rates.[2] Although treatable, the rate of death or disability associated with BAO is still as high as 80%.[2] Early recanalization either with thrombolysis or intravascular thrombectomy was shown to significantly improve the outcome of patients with BAO.
文摘BACKGROUND Subarachnoid hemorrhage is a severe neurological condition that requires prompt and appropriate treatment to prevent complications.Aneurysms are the most common cause of spontaneous subarachnoid hemorrhage.Conversely,basilar artery perforator aneurysms(BAPAs)are a rare etiology.There is no consensus on the optimal management of ruptured BAPAs in the acute setting.CASE SUMMARY We present a case series of 3 patients with ruptured BAPAs who were treated at our institution.Two patients had a modified Fisher grade of I,and one had a grade of IV on initial presentation.The aneurysms were detected by computed tomography angiography in two cases and conventional angiography in one case.The 3 patients underwent endovascular treatment with Guglielmi detachable coils.Post-treatment,the patients had good clinical outcomes,and follow-up brain computed tomography scans showed reduced subarachnoid hemorrhage without any new hemorrhage.However,one patient experienced a cerebral infarction 2 months later and eventually succumbed to the condition.The other 2 patients showed progressive recovery,and no aneurysm recurrence was observed at the 2-year follow-up.CONCLUSION Endovascular treatment may be a preferable approach for managing ruptured BAPAs compared with surgical intervention or conservative management.Early detection and prompt treatment is important to achieve favorable patient outcomes.
文摘Basilar tip aneurysms account for 5% - 8% of all intracranial aneurysms. They are known to rupture more frequently than aneurysms in other locations. Surgical clipping of basilar apex aneurysms however challenging;remains the treatment of choice in Ivory Coast due in part, to multiple technical barriers. A 60-year-old right-handed patient presented to our Neurosurgical Unit in February 2nd 2013 after a sudden onset of altered consciousness. Neurological examination revealed both an upper motor neuron and meningeal syndromes with a Glasgow Coma Scale of 12. Brain NECT scan and a subsequent brain CT angiography showed a subarachnoid haemorrhage and a 3.8 mm (height) × 5.2 mm (width) basilar tip aneurysm respectively. Surgical clipping of the aneurysm was indicated but due to multiple technical barriers, surgery was delayed and the patient underwent surgery after the critical vasospasm period. The patient developed a hospital acquired pneumonia after surgery and was successfully treated with antibiotics. Since her discharge, she has been asymptomatic. We sought to report this case of a basilar apex aneurysm successfully occluded with non-ferromagnetic SUGITA clips and to share our experience of clipping these lesions through the frontotemporal approach. The patient was informed that non identifying information from the case would be submitted for publication, and she provided consent.
文摘BACKGROUND： Propofol has been shown to attenuate neuronal injury in a number of experimental conditions. However, its effect in models of cerebral ischemia after subarachnoid hemorrhage （SAH） remains controversial. OBJECTIVE： To explore the effects of intracisternal injection of HX0507, a water-soluble propofol prodrug, on basilar artery vasospasm and brain tissue injury in a rabbit model of SAH. DESIGN, TIME AND SETTING： A randomized, controlled, in vivo animal experiment based on behavior and morphology. The study was performed at the Laboratory of Anesthesiology and Critical Care Medicine, West China Hospital, Sichuan University from April to December 2007. MATERIALS： HX0507 was provided by the Laboratory of Anesthesiology and Critical Care Medicine, West China Hospital of Sichuan University. METHODS： A total of 30 healthy, male, New Zealand rabbits were randomly assigned to sham-operation, SAH-control, and SAH-HX0507 groups, with 10 animals in each group. The single-hemorrhage SAH model was established by injecting autologous arterial blood （1.0 mL/kg） into the cisterna magna in the SAH-control and SAH-HX0507 groups, while the sham-operation group was injected with normal saline （1.0 mL/kg）. Thirty minutes after injection, the sham-operation and SAH-control groups were injected with normal saline （0.1 mL/kg） into the cisterna magna, while the SAH-HX0507 group received an injection of HX0507 （4.8 mg/kg）. MAIN OUTCOME MEASURES： The cross-sectional area and corrugation coefficients of basilar arteries and hippocampal CA1 neuronal densities were measured 48 hours after SAH （peak stage of vasospasm） using the Computer-Assisted Stereological Toolbox system. The ultrastructural structure of the basilar artery wall was examined by transmission electron microscopy. In addition, neurological behavioral impairment was evaluated by appetite score at pre-SAH, and 1 and 2 days after SAH. RESULTS： The cross-sectional area of basilar arteries and hippocampal CA1 neuronal densities, as we
文摘Objective The aim of this study is to investigate the effect of transfected hTERT gene on cell apoptosis of newborn rat cochlear basilar membrane cells (CBMCs). Methods CBMCs isolated from newborn rat cochlear were transfected using a plasmid containing human telomerase reverase transcriptase gene (pCI-neo-hTERT) , and were screened using G418 to obtain stable transfected cell lines. Cell apoptosis rate was analyzed by flow cytometry. hTERT and apoptosis related genes expression were detected by reverse transcriptase polymerase chain reaction (RT-PCR). Results hTERT gene expression was detected 72 hours after gene transfection in transfected cells. The apoptotic rate of transfected CBMCs significantly reduced. Expression of apoptosis related genes correspondingly changed. Conclusion Transfection of hTERT gene leads to reduced apoptosis rate in newborn rat CBMCs.and lower expression of apaf1, Caspase3 and BCL2 in transfected cells as compared to that of normal CBMCs.
文摘Objective and Importance—Vertebrobasilar artery aneurysms can be very challenging to treat and are preferentially dealt with using endovascular tech-niques, since they are associated with lower risk than surgical clipping. Small aneurysms located on perfo-rating arteries can pose problems though, as their dimensions may not be favorable for coiling and leave the endovascular surgeon without many options. We present a basilar perforating artery aneurysm that was successfully embolized using a stent-within-stent technique. Clinical Presentation—A 47 year old fe-male presented with a Hunt-Hess 3, Fisher Grade-3 subarachnoid hemorrhage with blood in the pre-pontine cistern. Initial imaging (CT angiogram and digital subtraction angiography) did not reveal an aneurysm. Follow-up angiography on post-bleed day eight demonstrated a three-millimeter basilar perforating artery aneurysm. After an unsuccessful coiling attempt a closed-cell stent-within-stent tech-nique was used to divert flow away from the aneu-rysm neck to induce aneurysm thrombosis. Interven-tion (or Technique)—Multiple attempts were made to access and stabilize a microcatheter in the small basilar perforator artery aneurysm in order to de-liver coils for endovascular embolization;this could not be done safely. Therefore a closed-cell 4.5 × 22 mm Enterprise stent (Cordis Neurovascular, Inc., Miami Lakes, Florida) was deployed in the basilar artery across the origin of the perforator aneurysm in order for the stent tines to divert flow away from the aneurysm neck and induce thrombosis. Persistant brisk flow within the aneurysm continued however, and a second closedcell 4.5 × 22 mm Enterprise stent was placed within the first one to increase the stent metal surface area across the aneurysm neck to further reduce flow into the aneurysm. Subsequently, angiography demonstrated stagnant blood flow in the aneurysm dome and the aneurysm spontaneously thrombosed, sparing all associated vessels. Conclu-sion—Stent-within-stent technique should be consid-ered
基金This study was supported by a grant from Beijing Natural Science Foundation （No. 7093133）.
文摘Background Unclippable fusiform basilar trunk aneurysm is a formidable condition for surgical treatment.The aim of this study was to establish a computational model and to investigate the hemodynamic characteristics in a fusiform basilar trunk aneurysm.Methods The three-dimensional digital model of a fusiform basilar trunk aneurysm was constructed using MIMICS,ANSYS and CFX software.Different hemodynamic modalities and border conditions were assigned to the model.Thirty points were selected randomly on the wall and within the aneurysm.Wall total pressure （WTP）,wall shear stress （WSS）,and blood flow velocity of each point were calculated and hemodynamic status was compared between different modalities.Results The quantitative average values of the 30 points on the wall and within the aneurysm were obtained by computational calculation point by point.The velocity and WSS in modalities A and B were different from those of the remaining 5 modalities; and the WTP in modalities A,E and F were higher than those of the remaining 4 modalities.Conclusions The digital model of a fusiform basilar artery aneurysm is feasible and reliable.This model could provide some important information to clinical treatment options.
