| Objective: To investigate the factors influenced decision-making in the treatment of intracranial aneurysms, indication of microsurgery and endovascular therapy, security, and the relevant factors to the prognosis for aneurysmal subarachnoid hemorrhage patients within the clinical treatment.Methods: We retrospectively analysis 1537 intracranial aneurysm patients of the General Hospital of Shenyang Military and the Southwest Hospital of the Third Military Medical University from January 2000 to December 2007, 659 cases of male, 878 cases of female, aged 17-84 years old , the average age of 60.8 years old. Preoperative Hunt-Hess grade 0 22 cases, grade I 207 cases, 437 cases of grade II and grade III 760 cases, 76 cases of grade IV, V-35 cases. 377 cases have a history of hypertension, 221 patients with a history of diabetes, 17 patients with cerebral infarction. CT scans were performed before patients were admitted to hospital, 1515 patients with acute severe headache or lumbar puncture confirmed subarachnoid hemorrhage, which Fisher grade I-36 cases, Fisher grade II-397 cases, 891 cases of Fisher grade III, Fisher grade IV - 213 cases. The 1532 patients performed routine cerebral vascular angiography, three-dimensional reconstruction clear parallel aneurysm and the parent artery and its branches in 3D space relations. All data were reviewed by experienced neurosurgeons and interventional neuroradiology doctors, the treatment plan was decided according to aneurysm shape, location and clinical status, with patients and their families willings. Of whom 621 patients were treated with endovascular therapy,893 patients were treated with microsurgery,23 patients underwent expectant treatment. Three cases of ipsilateral series of multiple aneurysms and one case of CT and angiography to determine the responsibility of the bilateral lesions of the posterior communicating artery with the same period a microsurgical clipping of aneurysms, and the remaining Surgical Treatment of patients with lesions responsibility. In endovascular treatment group: narrow-necked aneurysms using simple micro-coil embolization, a wide-necked aneurysm stent-assisted coil embolization, balloon-assisted coil embolization alone stent forming part of multiple cases of aneurysm embolization over the same period; 27 conservative routine (non) treatment (due to the economic, technical, risk and other reasons). Follow-up modified Rankin score, rebleeding rate, 48 cases of micro-surgery patients and 35 patients in the treatment of patients with vascular review cerebral angiography.Mortality, morbidity, recurrence rate and rebleeding rate were concerned.RESULTS: In patients treated with endovascular therapy, 589 patients received good recovery(modified Rankin score 0-2),22patients received dysfunction (modified Rankin score 3-5),10 patients died. In patients treated with microsurgery, 796 patients received good recovery(Rankin score 0-2),61 patients received bad recovery(Rankin score 3-5),32 patients died. 11 patients died of rebleeding in expectant treatment group. 349 cases of endovascular treatment group were followed-up with 7 cases of rebleeding (Cerebral angiography revealed that four cases of aneurysms after embolization recurrence, two cases to other parts of the aneurysm, one case of unknown cause); 571 cases of patients Microsurgery were followed-up, nine cases of rebleeding (cerebral angiography showed that after seven cases of aneurysm recurrence, two cases to other parts of the aneurysm). Microsurgery 48 cases of patients performed cerebral angiography review (6 m ~ 3Y), revealed that two cases of residual neck, one case of recurrent aneurysms; 35 cases of endovascular treatment group followed up with cerebral angiography (6 m ~ 27m), indicating that further aneurysm - 4 cases.Conclusion:1. Most of the intracranial aneurysms were suitable to both microsurgery and endovascular therapy. The prognosis is better in Endovascular Therapy than microsurgery. Endovascular therapy should be the first choice in most of intracranial aneurysms.2. The prognosis become worse in high grade aneurysms, especially in patients older than 60 years old,endovascular therapy is better than microsurgery in old patients,it should be the first choice. In high grade patients with cerebral hernia,microsurgery should be the first choice, and surgery should be performed as soon as ossible. 3. The prognosis is worse in patients who were treated 0-14 days after SAH either microsurgery or endovascular therapy, treatment should be performed in 3 days or 14 days later after SAH. When a patient need to be treated in 3-14 days after SAH,endovascular therapy should be the first choice.4. Age is a important factor in the choice of treatment methods,the prognosis would be worse in elder patients,endovascular therapy should be the first choice in patients older than 60.5. The size of aneurysms also influenced treatment choice,endovascular therapy should be the first choice in giant intracranial aneurysm;intracranial stent has potential superiority in small aneurysms;6. The location is also important,middle cerebral aneurysms should be treated with microsurgery,endovascular therapy should be the first choice in other locations.7. Multiple aneurysms and unruptured aneurysms should be treated with endovascular therapy;8. Onyx has superiority in the treatment of aneurysms located in distal posterior circulation .9. Neither microsurgery nor endovascular therapy can avoid vasospasm and ischemic disease,and the occurrence has nothing with the method of treatment,anti-spasm treatment should be performed as soon as possible;10. Clinical decision should be made according to aneurysm location, shape, size aneurysm, clinical grade, whether or not the merger aneurysm thrombosis, calcification, narrow, whether involved or branch perforator blood vessels, aneurysms and multiple single and doctors experience a variety of factors to consider Individualized treatment options. Objectives: To evaluate the effect of hepatoprophyrin derivative(HpD) mediated photodynamic therapy (PDT) on the expression change of vascular endothelial growth factors(VEGF) in C6 gliomas of nude mice so as to discuss the meaning of neovascularization after PDT and provide the further evidence for the clinical application.Methods: The suspension of C6 glioma cells was injected into subcutaneousness of the nude mice, after 15 days the glioma was took out and divided into1×1×lmm3 which was implanted in double armpit and groin subcutaneousness of the nude mice. When the volume of implantation tumor was grown to 5-7 mm, the implantation tumors in one side of the nude mice were begun to PDT(HpD), and all of the contralateral implantation tumors were set up as control groups. C6 glioma cells were irradiated by Lumacare-051 irradiator at 628 nm, 20 mW/cm2 for 5 min afrer being given different concentration of HpD (5, 10, 20 and 30 mg/kg) respectively.The tumor suppressive rate was calculated and HE staining were observed after the nude mice sacrificed. Apoptosis of C6 glioma cells were detected by terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick-end labeling (TUNEL) assay in differernt groups. VEGF was observed by immunohistostaining.Results:1. The tumor volume of therapy group was obviously increased in 2-3 days and has a slight change in 3-10 days after PDT. The control group has a stabile increase after PDT. Subcutaneousness hemorrhage could be examined in the therapy group at PDT 3 days.2. The expression of VEGF which reached the peak in C6 gliomas in 5 mg/kg group 24 hours after PDT was significantly higher than that in the control group 1,3,7 and 10 days after the treatment and in 5 mg/kg group3,7 and 10 days after PDT(P<0.01).The expression of VEGF which also reached the peak in the other dose groups 24 hours after PDT was insignicantly higher than that 3,7 and 10 days after PDT(P>0.05). 3. TUNEL detection showed: Some rather typical apoptotic cells(cell shrinkage, Butty granulas in cell nucleus, chromatin margination as luniform,lubiform as well as irregular shape, apoptotic bodies formation and so on) were observed in all grops with a proportionate of 33.5%, 52.8%, 56.4% and 63.2% in different concentration of HpD (5, 10, 20 and 30 mg/kg) group respectively . No obvious morphologic changes of the C6 glioma cells was found in the control group.Conclusions:1. HpD-PDT has lethal effective on C6 glioma cells, and this effect was correlated with the concentration of HpD.2.The peak of VEGF expression is reached 24 hours afeter PDT,the expression of VEGF may have self-protect function and play important point in tumor recurrence.3. Anti-neovascularization therapy may enganced the effect of PDT, Anti-neovascularization cooperate with PDT in cure glioma may become a new strategy of anti-glioma therapy.
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