Volume 03 · Issue 01 · 2017

Hemodynamic factors are considered to play an important role in the initiation and recurrence of cerebral aneurysms. However, hemodynamic characteristics leading to the recurrence of aneurysms is not well recognized. This study analyzes the hemodynamics of simple-coiling and remnant-neck aneurysms, and discusses the impact of hemodynamic factors on the recurrence of cerebral aneurysms.

This study selected three simple-coiled and remnant-neck aneurysms with at least once angiographic follow-up. The follow-up was conducted by 3D rotational DSA and the 3D reconstruction of the vessel. The aneurysms located on ophthalmic segment of ICA, including one recurrent case and two stable cases. We used a porous medium model to simulate and analyze the hemodynamics of aneurysms.

For the recanalized aneurysm, in the immediate post-operative period, the WSS at the remnant neck decreased, low blood flow velocity and stagnant regions were found in the aneurysm sac. In the first follow-up, compared to immediately post-operative, at the residual neck, the WSS was higher, the flow impingement was stronger. In the sac, the stagnation area decreased and its contour limit shrank into the aneurysm. However, in the second follow-up, compared to the previous follow-up, at the remnant neck, the WSS was lower, the flow impingement weaker, while in the sac the stagnant region expanded.

Aneurysm recurrence could occur in two phases: early coil compaction resulting from blood flow impingement and later vessel remodeling due to hemodynamic effects.

Petroclival meningiomas (PCMs) are technically challenging lesions. Although the standard retrosigmoid approach is one of the most effective approaches, this route may have some limitations for the tumors extending into the supratentorial region and middle cranial fossa. We provide a modified surgical technique called retrosigmoid-transtentorial approach (RTTA) to solve these problems. The feasibility and efficacy of the RTTA were studied, by analyzing neurological outcomes and considerations of surgical strategies.

We analyzed 64 of 71 PCM patients (90.1 %). All 64 patients had epicenter of tumor in the posterior fossa with varying degrees of extension into the supratentorial area and/or the middle fossa. A conventional retrosigmoid craniotomy was performed following which the tentorium was incised from the attachment of tumor toward the free edge, which improved exposure to the petroclival region by offering additional operative room without resection of the adjacent part of the petrous bone.

The rate of gross total resection was 71.9 %. There was no incidence of intraoperative death. One patient died in the postoperative phase. The postoperative permanent morbidity rate was 25.4 %. Follow-up was done with the mean time of 60.7 ± 47.5 months. There were 6 recurrence, 8 progression and 7 death cases and the mean KPS score was 83.2 ± 13.4 in the last follow up.

The RTTA achieves the goal of applying a safe, quick, uncomplicated, and lesser invasive access to the petroclival region which is indicated for tumors located in the posterior fossa with some extension into the supratentorial area and/or the middle fossa.

Much still remains unknown about the pathogenesis of brain arteriovenous malformations (AVMs). Previous studies have revealed the abnormal expression of various angiogenesis-related genes in AVMs. To further understand this disease, we sought to identify genes differently expressed in AVMs by means of the gene microarray technique.

Nine AVMs specimen and nine samples of normal vessels are collected. Total RNA isolated from these specimen is hybridized with Oligonucleotide array and gene analysis was conducted. Analyzing data with the help of significance analysis of microarrays (SAM) and a free web-based molecular annotation system 3.0 (MAS 3.0).

The SAM method identify 37 gene significantly up-regulated and 10 genes down-regulated in AVMs.

Among those genes, VACN, SPARK and ARHGAP18 seem to play a facilitating role during the genesis of AVMs. Multiple pathways, as MAPK pathway, may also be involved.

The use of biomaterials, such as hydrogels, as a scaffold to deliver cells and drugs is becoming increasingly common to treat neurological conditions, including stroke. With a limited intrinsic ability to regenerate after injury, innovative tissue engineering strategies have shown the potential of biomaterials in facilitating neural tissue regeneration and functional recovery. Using biomaterials can not only promote the survival and integration of transplanted cells in the existing circuitry, but also support controlled site specific delivery of therapeutic drugs. This review aims to provide the reader an understanding of the brain tissue microenvironment after injury, biomaterial criteria that support tissue repair, commonly used natural and synthetic biomaterials, benefits of incorporating cells and neurotrophic factors, as well as the potential of endogenous neurogenesis in repairing the injured brain.

This article discusses possible applications of cells derived from human amniotic fluid in regenerative medicine, specifically in stroke therapy. Recent studies have evaluated amniotic fluid as a viable source for mesenchymal stem cells in the expansion of cell-based transplantation. Laboratory data have demonstrated the ability of amniotic fluid stem cells (AFSC) to act as biobridges or subdural patch-like networks when treating traumatic brain injury (TBI). Also AFSCs have been shown to differentiate along the neuronal lineage following transplantation in animal models of brain disorders. In addition to the cells’ many clinical applications, AFSCs can be harvested without raising any ethical concern. This paper evaluates the characteristics of AFSCs, along with the functional benefits of using the cells in animal stroke models, reinforcing the potential advantages of deriving stem cells from amniotic fluid, for stroke treatment.

There may be a pathological connection between cardiac failure and ischemic stroke. In this article we describe pertinent research that demonstrates subsequent death of cardiac and neural myocytes in the post ischemic stroke brain. Current stroke therapy overlooks the connection between cardiac and cerebrovascular events and fails to address the shared risk factors. Current pre-clinical stroke investigations have provided evidence that suggests the presence of an indirect cell death pathway in which toxic molecules emanate from the stroke brain and trigger cardiac cell death. On the other hand, other studies highlight the presence of a reverse cell death cascade in which toxic molecules from the heart, following cardiac arrest, travel to the brain and induce ischemic cell death. Further examination of these putative cell death pathways between ischemic stroke and cardiac arrest will prompt the advancement of innovative treatments specifically targeting both diseases, leading to ameliorated clinical results of patients diagnosed with heart failure and ischemic stroke.

The aim of the present meta-analysis was to identify whether there was a relationship between mobile phone use and risk of brain tumor. A comprehensive search strategy was developed, and studies were eliminated in a stepwise manner, based on the inclusion criteria. The current meta-analysis collected data from the 24 eligible studies to investigate the relationship between mobile phone use and risk of brain tumor, while a detailed analysis of different classification was also conducted in order to identify the risk of mobile phone use. From the results, the relationship between cell phone use and brain tumor incidence had no significant difference between men and women. Cell phone use can increase the RF energy absorbed in the brain and apoptosis genes expression level, but glioma cell line cells were not significantly affected. Most calculations of laterality show a trend of increasing risk for time since first use, cumulative duration of subscriptions, cumulative duration of calls, and cumulative number of calls. In Asian people’s, cell phone use and glioma had certain relations, while has very little relationship with meningioma incidence. This result seems to be no racial difference. In children and teenagers, cell phone use is associated with the incidence of brain tumors. We need longer time observation to supervise longer time (>20 years) mobile phone use whether has severe effects on incidence of brain tumor.

Intracranial supratentorial neuroenteric cysts are very rare lesions in the central nervous system. We described a neuroenteric cyst of the left lateral ventricle in a 38-year old male, which had been confirmed by using immunohistochemistry. To date,this was the first reported case in which the neuroenteric cyst was located in the lateral ventricle.

The patient had paroxysmal headache for half a year which exacerbated in the recent two months. MRI showed a 3cm*3cm*2.5cm cyst in the left lateral ventricle. We reported the first case, where the NC in the lateral ventricle was partly resected, provided new evidence to develop the hypothesis on NC etiology. The cyst was left partly due to the strong adherence to the surrounding structures. The final diagnosis was confirmed on histopathological and immunohistochemical analysis of the cyst.

Lacking in characterization of the specific imaging features, neuroenteric cyst may be misdiagnosed as other types of cysts preoperatively. At present, surgical excision is the only effective treatment for neuroenteric cysts. Early diagnosis and more treatment options may be available in the future with more cases of neuroenteric cyst being reported and its pathogenesis being understood further. we hope the first reporting of the lateral ventricle NC by now can provide new evidence to NC etiology.

Ventriculo-peritoneal shunting is an effective treatment for hydrocephalus, bowel perforation by peritoneal catheters is an extremely rare complications associated with this procedure.

We report a 9-year-old girl who had anal VP shunt protrusion two months following surgery and review the literature to understand the diagnosis and treatment for this rare complication. A PubMed search using the keywords 'bowel perforation' and 'Escherichia coli ventriculitis' was performed and citations were reviewed.

Neurosurgeons should be alert to early diagnosis and appropriate treatment of this condition to prevent infectious and neurological complications.

Tumor-like demyelinating lesion is a rare form of IP, often indistinguishable from brain tumors on CT or MR imaging.

We report here a case of pathologically confirmed tumor-like demyelinating lesions. The clinical manifestations, image feature and pathology of this case are also discussed together with a review of the relevant literature.

The correct diagnosis of tumor-like demyelinating lesion mainly depends on the postsurgical histopathologic examinations. We suggest complete resection of the intracranial lesion and involved dura, followed by administration of short term oral prednisolone therapy will be good for preventing recurrence.