Intraventricular hemorrhage (IVH) is a dangerous acute cerebrovascular disease. The 30-day mortality rate of patients with IVH is 5 times that of patients with cerebral hemorrhage. In recent years, more and more studies have shown that timely clearance of intraventricular hematoma is closely related to good prognosis. The advantages of surgical intervention in patient management are impressive. This article briefly reviews the positive advances in the surgical treatment of IVH such as external ventricular drainage (EVD) combined with intraventricular fibrinolysis (IVF) and continuous lumbar cistern drainage (LCD), as well as their safety and efficacy, especially the remarkable role of neuroendoscopy in the removal of intraventricular hematomas.

Objective: to compare the methods of petrous apical bone removal and to explore the applicable scope of Kawase approach and retrosigmoid sinus-internal auditory canal approach. Methods: one group of cadaveric head specimens simulated Kawase approach to measure the data of “Kawase triangle”, the other group simulated retrosigmoid sinus-internal auditory canal approach to measure the safety range of the grinding bone window. Then we explored the clinical indications of the two surgical approaches. Result: the grinding depth of Kawase triangle was 11.6±0.14mm, and the range of clival exposed after grinding Kawase triangle was 22.4±1.22mm, which could effectively expose the ventrolateral brainstem, the midline of clivus and the area above the facial acoustic nerve. The diameter of the anterior and posterior of the grinding bone window in the retrosigmoid sinus-internal auditory canal approach was 21.95±2.23mm. In front of the exposure area were the internal carotid artery, the cavernous sinus, and the upper trigeminal nerve; the lower part was the connection between the facial acoustic nerve and the abducent nerve. Conclusion: Kawase approach is suitable for lesions of ventrolateral brainstem, middle superior clivus, with or without invasion of middle cranial fossa; the retrosigmoid sinus-superior internal auditory canal approach is suitable for lesions mainly in cerebellopontine angle area and only slightly invading Meckel’s cavity.

Objective: to explore the changes of the F-wave in the posterior tibial nerve of rabbits after different levels of lumbar spinal cord ischaemic injury and its correlation with motor function and the extent of lumbar spinal cord pathological damage. Methods: thirty New Zealand rabbits were randomly divided into 6 groups. The control group (n=5) was used to exclude the influence of anaesthesia and surgery on the F-wave. Different levels of lumbar arteries were ligated in the five experimental groups (n=5). The F-wave was recorded to observe the changes in the acute phase of spinal cord ischaemia. The correlation between the changes of the F-wave in the acute reversible phase and the motor function of the spinal cord was analysed. Motor functions were assessed after surgery and 2 d after vascular ligation. The specimens were taken 2 d after ligation for histopathologic observation. Results: the results for the control group indicated that anaesthesia and surgery did not affect the F-wave results. There was no statistically significant difference in the F-wave amplitudes and latency before and after ligation in the 1 and 2 level ligation groups. The F-wave changed immediately after ligation in the 3, 4 and 5 ligation groups. The latency of the F-wave gradually extended, the amplitude of the F-wave gradually reduced. The amplitude variations of the F-wave were positively correlated with the motor function 2 d after ligation, there was a statistically significant difference. With the increase in the number of vascular ligation, the degree of destruction of the motor neurons in the anterior horn of the spinal cord in the pathological specimens increased. Conclusion: the F-waves in the posterior tibial nerve of rabbits were found to be sensitive to the lumbar spinal cord ischaemic injury and specific to predict motor function.

Fibromuscular dysplasia (FMD) is a rare disease with a typical clinical manifestations. This article will describe the clinical features of a FMD case with severe headache misdiagnosed as cerebral artery dissection (CAD). Treatment remedies: we collected the clinical data of a patient with severe headache and performed brain MRI (magnetic resonance imaging) and cerebral arteriovenous MRA (magnetic resonance angiography). The preliminary diagnosis was considered as right vertebral artery dissection, and then cerebral DSA (digital subtraction angiography) was performed for further diagnosis. Post treatment evaluating: cerebral angiography showed that the vessel wall was stiff, with multiple (insect phagocytic)-like changes, and severe stenosis of local long segments. Some vessels showed “double lumen sign”, which was consistent with the performance of FMD. After anticoagulant treatment, the patient’s condition was improved. Conclusions: for severe headache, in addition to common diseases, the possibility of FMD should also be paid great attention. Early cerebrovascular screening is conducive to early diagnosis and timely treatment.

This article describes the clinical characteristics of a case of cerebral infarction complicated with pulmonary embolism (PE), and elaborates the therapeutic strategies of intravenous thrombolysis and anticoagulation. Treatment remedies: the medical history and examination data of a patient with aphasia and right hemiplegia were collected. After intravenous thrombolysis and pulmonary artery CTA (computed tomographic angiography), the patient was found to have low blood oxygen saturation and PE. And the patient was treated with anticoagulant therapy. Post treatment evaluating: cerebral hemorrhage was excluded by craniocerebral CT (computed tomographic), and left basal ganglia infarction was diagnosed. After thrombolysis, the symptoms of aphasia and hemiplegia were significantly improved. For PE, after anticoagulant therapy, the patient’s breathing was stable and blood oxygen saturation was normal. For deep venous thrombosis of both lower extremities, anticoagulant therapy was continued. Conclusion: patients with thrombophilia are prone to cerebral embolism, PE and deep venous thrombosis of lower limbs. Intravenous thrombolytic therapy in acute phase and heparin anticoagulant therapy in recovery period can effectively control the disease.