Clinical Study On The Ruptured And Complex Intracranial Aneurysms And Experimental Study On The Remote Organs Injury After Spontaneous Subarachnoid Hemorrhage

OBJECTIVE:Part 1:To analyze the characteristic of ruptured intracranial microaneurysm and evaluating the outcome of clipping and endovascular treatment. To analyze the clinical efficacy of clipping and endouvascular treatment for ruptured wide-necked aneurysm. To explore endovascular treatment of intracranial aneurysms associated with Moyamoya disease. Part 2:To investigate the relationships between the variance of TNF-αand sTNFR-P75 in plasma and the multiple organ dysfunction syndrome (MODS) of the rats who suffered with subarachnoid hemorrhage (SAH). Part 3:To study the expression of vascular endothelial growth factor-c(VEGF-C) in remote organs after SAH and to evaluate the protection of interferon-β(INF-β).METHOD:Part 1:45 patients with ruptured intracranial microaneurysm were treated by clipping (n=28) or endovascular treatment (n=17). Their complications, recurrence rate and the Glasgow outcome scale score at discharge were evaluated.143 patients with ruptured wide-necked aneurysm were treated by clipping (n=83) or endovascular treatment (n=60). Their complication rate,recurrence rate and the modified Rankin scale score at six months after leaving hospital were evaluated. The clinical data of five cases with intracranial aneurysm associated with Moyamoya disease treated by embolization were analyzed retrospectively.Part 2:To establish rat SAH model with MODS by injecting blood into the cerebellomedullary cistern according to the animal MODS diagnosis standard. The rats were divided into the MODS group (group A) and un-MODS group (group B), meanwhile, we established the control group and sham operation group. We observed the temperature,breath rate and heart rate of the tested rats and checked the blood routine examination,hepatic function tes,kidney function test and cardiac enzymes. We checked content of the plasma TNF-αand sTNFR-P75 at the different time by ELISA method. Part 3:To establish rat SAH model. The rats were divided into the control group, sham operation group, the SAH therapy group and the SAH without therapy group. To detect the expression of VEGF-C in the heart, lung, liver, kidney, stomach and jejunum.RESULT:Part 1:There were 45 aneurysms and 84.44 percent of them were wide-necked aneurysm. Among the 28 aneurysms which were clipped,11 aneurysms ruptured during operation,3 patients had procedure complications and 1 patient died.1 aneurysm relapsed and accepted reoperative,16 patients had excellent outcome in the midterm follow-up. Among the 17 aneurysms which were coiled,6 aneurysms ruptured intraoperative.1 patient had procedure complications and 1 patient died. 1 aneurysms relapsed and accepted reoperative.14 patients had excellent outcome in the midterm follow-up.SAS demonstrates no statistically differences in complication, recurrence rate, Hunt-Hess grade and GOS score between clipping group and endovascular treatment group. The complication rate in endovasular treatment group were significantly less than in clipping group (P<0.05). The recurrence rate in clipping group were significantly less than in endovasular treatment group (P<0.05). The modified Rankin scale in endovasular embolization group were significantly less than in clipping group (P<0.05).Endovascular treatment group had higher recurrence rate and lower complication rate. Patients accepted endovascular treatment had better prognosis. There were five cases, four cases presented by subarachnoid hemorrhage and one cases presented by intraventricular hemorrhage. Four cases were major artery type and one case was periphery artery type. All of the aneurysms were successfully embolized. All patients showed excellent clinical outcomes. Part 2:There is no significant difference (P>0.05) between control group and sham operation group and there is significant difference (P<0.01) between MODS group and un-MODS group on the temperature,breath rate,heart rate and white blood cells. There is no significant difference (P>0.05) among control group, sham operation group and un-MODS group and there is significant difference (P<0.01) between sham operation group and MODS group on the blood routine examination,hepatic function test,kidney function test and cardiac enzymes. There is no significant difference (P>0.05) between the control group and the sham operation group on TNF-αand sTNFR-P75. The level of the TNF-αand sTNFR-P75 on the MODS group and the un-MODS group all increased compared with the sham operation group, but the MODS group is more obvious. The ratio of sTNFR-P75/TNF-αdecreased significantly (P<0.01) in MODS group. Part 3:The VEGF-C expression in multiple organs of SAH theray group and SAH without therapy group is higher than sham operation group. The VEGF-C expression in multiple organs of SAH without therapy group is lower than SAH therapy group.CONCLUSION:Most of the ruptured intracranial microaneurysms were wide-necked aneurysms. Clipping and endovascular treatment were feasible methods to heal the ruptured intracranial microaneuryams. Endovascular treatment for ruptured wide-necked aneurysm is efficient and securely. Patients acquired better quality of life. Endovascular treatment is feasible for the aneurysms associated with Moyamoya disease. Part 2:The TNF-αlevel increased and the ratio of sTNFR-P75/TNF-αdecreased maybe the important factors of the MODS of the rats who suffered with SAH. Part 3:SAH lead to remote organs' ischemia through systemic inf lammatorome. The INF-βprotect the organs by restraining the systemic inflammatorome.