2016年 · 第02卷第03期

Background: The development of three-dimensional (3D) printing technology provides a new method for surgical treatment, but currently there are few reports on its application in the treatment of aneurysm. The aim of the present study was to explore the materials and methods of fabricating 3D printed individual aneurysm model and its value in the treatment of intracranial aneurysm. Methods: Twenty-four patients with intracranial aneurysm diagnosed by CTA who had undergone operation in our hospital were analyzed retrospectively. CTA Data collected at the time of surgery was used for reconstruction. Soft Mimics 17.0 was used to reconstruct the thin layer CTA scan data into 3D image and the final data was sent to the 3D printer for fabricating the model. We compared the proposed 3D printed model-based preoperative plan and the actual approach used in the surgery based on CTA data to evaluate the value of the 3D printed model in preoperative planning, and picked out the materials which were more suitable for the clinic. Results: Twenty-four aneurysm models with high degree of reality were fabricated successfully with 3D-printing technology. The patients’ blood vessels, skulls and aneurysms were printed into the reality model at a ratio of 1:1. It is reported that the soft material-based, 3D printed vascular and aneurysm model more closely resembled the characteristics of the real blood vessels, thus provides a better simulation compared to the plaster-based model. Compared with the original operation plan, 3D printed model could be used for pre-operative aneurysm clip selection, and provide more intuitive information in selection of operational approach. Conclusions: 3D printed model can be used as an operational physical model to design operative schemes, choose the best operative paths and select suitable aneurysm clips by its high simulation degree and individualized characteristics. The model is helpful for surgical planning, especially for the preoperative plan of treating refractory multiple aneurysms and giant aneurysms.

Background: Mild cognitive impairment (MCI) is a common non-motor symptom of early Parkinson’s disease (PD), but the neural mechanisms underlying it remain poorly understood. The aim of the present study was to investigate the characteristics of cognition-related brain activities in the PD patients with MCI. Methods: The brain fMRIs and cognition tests were acquired in 39 PD patients and 22 healthy controls (HC) from September 2013 to January 2015. The patients were divided into two groups: PD-MCI (n = 18) and PD with normal cognition (PDNC, n = 19). we used resting state fMRI and a regional homogeneity (ReHo) method to explore patterns of intrinsic brain activity in patients with PD-MCI as compared with PDNC subjects and HC. Results: Compared with the PDNC group, the PD-MCI group exhibited significantly increased ReHo in parts of the prefrontal cortex regions (e.g. right superior frontal gyrus, right middle frontal gyrus and orbitofrontal cortex). Compared to the HC group, a decrease of ReHo value in left thalamus was found in PD-MCI. However, this reduction was not found in the left thalamus of PDNC group, but in the above prefrontal regions (p < 0.05, with Bonferroni correction). Conclusions: These results demonstrate that the ReHo of prefrontal cortex in resting state is changed in PD patients with MCI. The presence of MCI in PD may be attributed to abnormal regional activity in prefrontal cortex regions.

Background: Cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) is a serious and significant health problem in the worldwide. There are still no effective therapies for treatment of CVS in patients suffering from SAH. Our early studies have demonstrated that the expression of connexin43 (Cx43, a member of gap junctional proteins) in cerebral spastic vessel is significantly up-regulated, and knocking down Cx43 with specific siRNA interference can significantly alleviate CVS after SAH. Therefore, Cx43 in cerebral vessel is a potential target in the treatment of CVS. However, Cx43 is widely distributed in many organs, particularly in the heart, and plays an important role in the physiological function. This study is aimed at identify whether OPN, TNC or E-selectin can be used as a target protein to be recognized in spastic cerebral vessels, then we can produce a carrier containing Cx43 siRNA or other inhibitors as a new potential treatment for CVS. Methods: Twenty eight male Sprague Dawley rats (weighing 300–350 g) were randomly divided into either SAH (n = 16) or sham group (n = 12). The double hemorrhage model was performed on day 0 and 1. All animals were sacrificed after performing India ink angiography on day 5. Initially, the expression of E-selectin, TNC and OPN in cerebral arteries, thoracic aorta and abdominal aorta were analyzed respectively by immunohistochemical staining, western blot in both groups. Then, only those with less expression in thoracic aorta, abdominal aorta and normal cerebral arteries, but higher expression in cerebral spastic arteries were further detected in the spinal cord, heart, kidney, liver, spleen, lung, pancreas, mesenteric and pulmonary arteries, retina and brain tissue, respectively. Results: TNC, OPN and E-selectin were markedly elevated in the spastic cerebral arteries in SAH group but not in control group. The expression of TNC, but not OPN and E-selectin, is abundant in both groups of thoracic aorta and abdominal aorta. Further study demonstrated that expression of OPN, but not E-selecting, in both groups is relatively rich in brain tissue, kidney, pancreas, mesenteric artery, spinal cord and retina, but in heart, liver, lung and pulmonary artery. However, the positive expression of E-selectin was detected in spleen in both groups. Conclusions: TNC is highly expressed in thoracic aorta and abdominal aorta, so it is unsuitable for being a recognition protein. Although OPN, unlike TNC, does not express much in vascular system, but it expresses in many other organs or tissues. However, E-selecting could be considered as a potential recognition protein because it is not so widely distributed in the organs or tissues detected.

Epilepsy surgery has been accepted as an effective treatment in drug-resistant focal epilepsy. However, the number of epilepsy neurosurgeons is not enough in China compared with the huge demand. The content of epilepsy neurosurgeon cultivation includes surgery itself as well as presurgical evaluation. In this article, we review not only different categories of epilepsy surgeries but also the presurgical evaluation approaches including non-invasive methods, such as semiology analysis, high-resolution structural and functional imaging techniques, scalp electroencephalography monitoring as well as invasive methods, such as electrocorticography (ECoG) and stereotactic electroencephalography (SEEG). We also discuss the importance of learning each method briefly. In addition, we suggest that epilepsy neurosurgeons should have a solid structural and functional anatomy basis as it plays pivotal role in localizing epileptogenic zone. Epilepsy neurosurgeons should also be familiar with the staged presurgical evaluation starting from the most preliminary examinations and progressing to more complex and invasive methods. During the diagnosis and therapeutic procedures, collaboration between epilepsy neurosurgeons and other specialists is essential. At last, the necessity of epilepsy neurosurgeon cultivation has been emphasized.

Background: Since the introduction of neuro-endoscopy by Walter Dandy and his colleagues in the early 1920's, several efforts has been made to improve this tool for treatment of hydrocephalus, brain tumors, arachnoid cysts, etc and has largely substituted craniotomy procedures. Several complications such as CSF leakage, intraventicular hemorrhage, infectious complications and transient and permanent psycho-neurologic deficits have been reported for neuro-endoscopic procedures in children. Here in, two cases of transient mutism following neuroendoscopy in children were reported, with special focus on pathophysiology, management and clinical course. Knowledge about the possible complications of a procedures, empowers the pediatric neurosurgeon with the ability to avoid them and also to successfully handle them once they take place. Case presentation: We report two patients who underwent neuro-endoscopy,first for treatment of arachnoid cyst via cystoventriculostomy and second for endoscopic third ventriculostomy(ETV) to treat hydrocephalus. Both children developed apathy and mutism following the procedure. However, this condition was transient and both children improved after a course of 5-6 days with conservative management. Conclusions: Mutism following neuro-endoscopic procedures in children may result from excessive traction on paraventricular white matter and disruption of fronto-subcortical circuits. It can be avoided with less intra-procedural dilation of venricles and less traction on white matter tracts with choosing a more accurate trajectory. However, this condition is transient and spontaneous resolution wil ensue in several days wth conservative management.

Background: Acute lymphoblastic leukemia is a rare hematological malignancy. Pure subdural hemorrhages in a patient with acute lymphoblastic leukemia patient are extremely rare. Case presentation: This case presented acute spontaneous subdural hemorrhage without head trauma at first, and acute lymphoblastic leukemia was diagnosed later. The second time, the patient was admitted with multiple pure subdural hemorrhages in different locations and periods with a history of slight head trauma. Conclusions: Pure subdural hemorrhages can occur in a patient with acute lymphoblastic leukemia. More care would be needed for pure subdural hemorrhages without obvious head trauma, and patients with hematological malignancies should be protected from even mild head trauma.

Background: Nocardial brain abscesses are associated with significant morbidity and mortality rates. The optimal management remains unclear. Case presentation: We report a case of 49-year-old woman presented with dizziness, progressive headache for 3 days, accompanied with left arm twitched for twice. The patient underwent a right parietal craniotomy for resection of the lesion. Gross total resection of the lesion was achieved. There were no new neurological deficits post-operatively, and no lesions was demonstrated on Gd-enhanced MRI images at six months follow-up. Conclusions: After review of the literature and experience learned from our case, we suggest that craniotomy and surgical resection of the lesions, instead of aspiration, is a safe, efficacious treatment for the patient with nocardial brain abscesses. Long-term chemotherapy and follow-up is mandatory in all cases.

Background: Supratentorial primitive neuroectodermal tumors (sPNET) are rarely occurred in adults. Only 39 cases have been reported in the past decade. The transformation from low grade to aggressive astrocytoma is well known. However, such convert from a low-grade astrocytoma (LGA) into a sPNET between two completely different tumors is rarer. Case Presentation: This report discussed a 36-year-old male, who presented with the chief complaint of partial seizures and left limbs dysfunction and Magnetic resonance imaging (MRI) of whom revealed right frontal lesions which was operated to resect accompanied by the histological diagnosis of sPNET. The patient underwent operation 2.5 years ago because of seizures and was diagnosed with right frontal astrocytoma confirmed by pathology. However, radiotherapy was not preformed on him after the primary surgery. Histology now revealed high grade PNET. Conclusion: It is exactly uncertain that reports revelant to transformation from low-grade astrocytoma to a new kind of tumor or neoplasm induced by radiotation have been published. This case report is accompanied by a review of 39 cases of adult sPNET in the past decade, especially discussing about the transformation of low grade glioma into sPNET.

Objective: To investigate therapeutic effect of surgery that removes an intracranial foreign body through the intracranial sagittal sinus with help of intraoperative navigation and intraoperative fluorescein angiography. Methods: We performed operation on a patient with intracranial foreign body. Under guidance of intraoperative navigation, combined with intraoperative fluorescein angiography to avoid sagittal sinus damage, we opened the dura mater and removed the foreign body with minimally invasive technique. Results: Surgical positioning was very accurate with neuronavigation, intraoperative fluorescein angiography displayed the venous drainage along the sagittal sinus in order to prevent its rupture; the intracranial foreign body was removed successfully without any post-operative complications. Conclusion: Intraoperative navigation and intraoperative fluorescein angiography technologies to guide the removal of the foreign metal body inserted through the sagittal sinus have the following advantages: Accurate positioning, minimally invasive, reliable curative effect, quick postoperative recovery and overall fewer complications.

Ruptured aneurysms with a presentation of intracerebral hemorrhage (ICH) and/or intraventricular hemorrhage (IVH) without subarachnoid hemorrhage (SAH) are rarely reported. Issues on the clinical characteristics, mechanism, diagnosis, treatment and prognosis of this rare entity are obscure to us. We present two cases of ruptured aneurysms with a presentation of isolated ICH. A systematic review of the literature was also conducted. There were 21 cases plus our cases. Good recovery was achieved in 10 patients (47.6 %). Pertaining to location, 38 % of presenting aneurysms were on the right side, 52 % were on the left side, and 10 % were midline. Anterior circulation aneurysms were identified in 81 % of patients (7 PComA, 8 MCA, 1 ICA, 1 AComA) and posterior in 19 % of patients (3 PCA, 1 BA). Sizes of the aneurysms ranged from 3 mm to 40 mm (16.21 ± 8.45). Ruptured aneurysms at the main trunks of the Willis cycle with a presentation of isolated ICH and/or IVH without SAH is extremely rare. The cause of this rare entity is multifactorial. The diagnosis and management of this entity pose a great challenge to us. The prognosis was discouraging based on the now available data.