Volume 02 · Issue 04 · 2016

Endonasal transphenoidal approach by neuroendoscopy has its own advantage, such as direct access, invasive, better visualization of the anterior communicating artery aneurysm and so on. The study is to provide anatomical knowledge for anterior communicating artery aneurysm surgery by endonasal transphenoidal approach with neuroendoscopy.

Take 10 skull base specimens, observe and measure the anatomical structures around anterior communicating artery. Take 10 cadaveric heads, simulate the anterior communicating artery aneurysm surgery with neuroendoscopy by endonasal transphenoidal approach. Find the natural opening of sphenoid sinus, then open the skull base, expand bone window in anterior skull base. After that, cut off the dura, find the optic nerve, optic chiasm, cisterna lamina terminalis, anterior cerebral artery, a portion of frontal lobe, anterior communicating artery complex and its important branches, such as heubner artery, hypothalamic artery, orbitofrontal artery and so on. Lift up anterior communicating artery complex and seperate arachnoid in cisterna lamina terminalis, the lamina terminalis is exposed. Block bilateral A1 of anterior cerebral artery with aneurysm clip, the anterior communicating artery complex and its important branches are in view, so we can clip anterior communicating artery aneurysm safely.

Anterior communicating artery aneurysm surgery can be finished with neuroendoscopy by endonasal transphenoidal approach. The vital structures can be clearly observed with neuroendoscopy. The rhombus anatomic region formed by bilateral olfactory nerve and optic nerve is a safe surgical area. According to the calculation, the safe surgical area is about 161.48 ± 12.78 mm². Measure the distance between the important anatomic structures in the rhombus anatomic region. By means of SPSS 17 Statistical analysis software, the measuring distance is expressed with (x ± S)mm.

The anterior communicating aneurysm surgery by endonasal transphenoidal approach with neuroendoscopy has its own advantage, such as direct access, minimally invasive, less bleeding, light pain, quick recovery, better visualization of the anterior communicating artery aneurysm and so on. This operation approach needs further study and exploration to clinical application, in order to become a mature approach of anterior communicating artery aneurysm surgery.

Deep brain stimulation (DBS) surgery is usually performed with the patients located in a half-sitting position. Therefore, complications associated with such position accompany, such as venous air embolism (VAE), et al. However, because the patients are fully conscious during the surgery, they may have observable manifestations related to the complications that are otherwise inconspicuous in generally anesthetic surgeries. Thus, we designed this study to investigate the intraoperative manifestations of the potentially dangerous complication of VAE in the DBS surgery.

The medical records of a series of 705 consecutive patients who underwent DBS surgery in our hospital have been retrospectively reviewed. The clinical features, intraoperative manifestations and treatment of these patients were analyzed for evidence of VAE. The correlation between the cough intensity and other clinical features were investigated.

Evidence of VAE were found in 16 patients. Statistical analyses showed that severe cough is associated with greater age (p = 0.045), longer coughing time (p = 0.001), more intensive tremor (p = 0.032), more complaints (p = 0.036), greater influences (p = 0.009), more treatment (p = 0.003) and longer hospitalization (p = 0.003).

Intraoperative intense and unremitting cough may be a noticeable indicator of possible VAE. Early recognition and effective management are essential to prevent unfavorable outcomes in such cases.

Decompressive craniectomy (DC) in traumatic brain injury (TBI) patients has been subject of debate for neurosurgeons since long time. Our goal in this study is to evaluate the quality of life of these patients and to look at the problem from their point of view.

Quality of Life after Traumatic Brain injury (QOLIBRI) instrument is was applied to 105 TBI patients who performed DC. Age, gender, the mode of injury and level of education, time from TBI to DC, lowest GCS score post-injury, presence of a corneal reflex, whether patients performed reconstructive cranioplasty or not, blood pressure, patient temperature, midline shift on CT scan, fasting blood glucose, whether patients performed rehabilitation therapy, days of use of mannitol and barbiturates sedation were recorded.

Sex of the patient, educational background, time between TBI to perform DC surgery, pupillary response of patient before surgery, systolic and diastolic blood pressures, fasting blood glucose, rehabilitation and use of barbiturates did not prove to have any statistical significant impact on the patient’s QOLIBRI score. Young patients were found to be scoring more in the social domain (p = 0.02). Higher Glasgow Coma Score (GCS) patients scored statistically better in the cognitive (p = 0.00), self (0.00), daily life (p = 0.00), social (p = 0.00), emotion (p = 0.00) and total QOLIBRI (p= 0.00) score. Interestingly, the longer the time interval between TBI and time at QOLIBRI instrument application, the lower the score for cognitive (p= 0.00), self (p= 0.04), daily life (p= 0.02), emotion (p= 0. 05) and total QOLIBRI (p = 0.02) score. Reconstructive cranioplasty proved to positively affect the emotion (p = 0.05), social life (p = 0.01) and total QOLIBRI (p = 0.05) score. Temperature had a negative influence on the cognitive (p = 0. 01), self (p= 0.01) and daily life score (p= 0.01). Midline shift on CT imaging had a negative influence on cognitive (p = 0.00), self (p = 0.00), daily life (p = 0.00), social (p = 0.00), emotion (p = 0.05) and total QOLIBRI (p = 0.00) score.

QOLIBRI proves to be an excellent tool for evaluation of TBI patients who undergone DC. Regular assessment comparisons can help to tailor personalized rehabilitation treatment strategies for patients.

Hypothalamic hamartoma (HH) is a rare developmental malformation often characterized by gelastic seizures. Recent advances in treating HH have led to dramatic improvements. However, clinical protocol of HH is poorly understood. Since 2002, department Pediatric Neurosurgery of Xinhua Hospital has maintained a multidisciplinary clinical program to evaluate and treat children with HH. This program has provided the opportunity to investigate the management of HH. In this review, we summarize the clinical progress and propose a clear management principle for different HH patients.

Stem cell therapy or "cell therapy" has been demonstrated to be a potent treatment intervention in animal models of acute ischemic stroke, and recently has been introduced as an experimental therapy in early phase clinical trials. Among the many stem cells, the bone marrow adherent cell type known as mesenchymal stem cells have emerged in laboratory studies as a safe and effective therapy for ischemic stroke and other brain diseases. In particular, a unique population of adherent bone marrow-derived cells, called MultiStem cells, display immunomodulatory effects and are a promising allogeneic cell therapy in acute ischemic stroke. Here, we describe the preclinical evidence supporting the use of MultiStem in the acute setting of ischemic stroke and the translation into an early phase clinical trial in ischemic stroke.

MicroRNA (miRNA) is a type of endogenous non-coding RNA that can regulate cell proliferation, differentiation, invasion, apoptosis and several other biological activities by specially inducing gene silencing, and thereby is related to development and disease in life course. In recent years, researchers have found that miRNAs are closely related with refractory epilepsy. MiRNAs can intervene in the modification of mRNAs, the synthesis of proteins and some the connectivity of signal pathways in pathogenesis of epilepsy. Furthermore, some miRNAs in neurons are of great importance in neuronal differentiation. Therefore, miRNA may play a very important role in the occurrence, development and episodes of refractory epilepsy. These discoveries can provide a new direction for the research of pathogenesis, diagnostic methods and therapeutic approach of refractory epilepsy. Although research about miRNA and intractable epilepsy has progressed, more remains to be done before miRNA can be used in clinical diagnosis and treatment strategies. This paper focuses on the research progress of molecular diagnosis about miRNA in intractable epilepsy.

Several experimental therapeutics have been demonstrated to be safe and effective in animal models of neurological disorders, but have failed when they reached the clinic. Postulated factors that affected the poor clinical outcomes include the lack of proper treatment controls and clinically relevant animal models. This failure of lab-to-clinic translation has plagued many neuroprotective drugs for stroke. With this in mind, the stem cell therapy field has cautiously approached translating stem cell products for clinical application, in that a negative clinical trial may hinder the entire regenerative medicine therapeutics. Here, we discuss the many translational challenges associated with stem cell therapy in the setting of stroke.

Ischemic stroke represents a major, worldwide health burden with increasing incidence. Patients affected by ischemic strokes currently have few clinically approved treatment options available. Most currently approved treatments for ischemic stroke have narrow therapeutic windows, severely limiting the number of patients able to be treated. Mesenchymal stem cells represent a promising novel treatment for ischemic stroke. Numerous studies have demonstrated that mesenchymal stem cells functionally improve outcomes in rodent models of ischemic stroke. Recent studies have also shown that exosomes secreted by mesenchymal stem cells mediate much of this effect. In the present review, we summarize the current literature on the use of mesenchymal stem cells to treat ischemic stroke. Further studies investigating the mechanisms underlying mesenchymal stem cells tissue healing effects are warranted and would be of benefit to the field.

Ganglioneuroma is a rare benign tumor, which is usually located in the posterior mediastinum and retroperitoneum. Occasionally, it involves the paraspinal region with intraspinal extension and becomes dumbbell shaped. Dumbbell ganglioneuromas rarely affect the lumbar spine, and only nine cases of dumbbell lumbar ganglioneuromas have been reported previously.

We are reporting an extremely rare case of a giant dumbbell tumor in the lumbar spine. We performed a one stage total resection of the tumor with posterior approach and long-segment fixation and fusion. This approach is different from previous methods. Histopathological examination of the surgical specimen confirmed the diagnosis of ganglioneuroma. Thirty months follow up showed a satisfactory outcome.

Single-stage posterior tumor resection with fixation and fusion is effective and an appropriate choice for the treatments of lumbar dumbbell ganglioneuromas.

Common B cell lymphoma locations are lymph nodes, skin, bone, mediastinum and it accounts for 2 % of NHL. Giant solitary spinal B-LBL has not yet been described.

A 15-years old boy was admitted for a painful swelling of the thoracolumbar spine and paraplegia. MRI showed a voluminous mass of the thoracolumbar spine. Initial treatment consisted of surgical decompression and stabilization, followed by chemotherapy and radiotherapy. Histological examination showed a B-LBL. The quality of life improved significantly.

To the best of our knowledge, this is the first case of giant solitary spinal B-LBL ever reported. Indication to choose a treatment method over another should weigh on individual priorities. Surgery should be considered as initial treatment option in this atypical lesion.

A paper was published in a Chinese medical journal that suggested that the placing of an intact vascularized omental pedicle would increase cerebral blood flow and could decelerate the development of Alzheimer’s disease. However, the paper showed limited support for the operation. The purpose of this paper is to suggest that the lack of enthusiasm for the operation may deserve re-evaluation.

The operation that was evaluated required an intact omental pedicle to be placed directly on the brain in order to increase the blood flow to the brain. The omentum is brought from the abdominal cavity up to the brain where it is simply laid resulting in a large volume of blood to flow into the cerebral tissue.

The Chinese paper demonstrated relatively poor results in the Alzheimer patients. It is believed that the poor results were probably due to the results of the patients age, the length of time they had Alzheimer disease (5 or more years), but especially their low mini-mental state examination results – some as low as 2.

The paper being presented will suggest the possible benefit of omental transposition in Alzheimer patients when there is a successful choice of suitable candidates for the procedure.