Volume 03 · Issue 03 · 2017

Mitochondrial Ca²⁺ uptake is a pivotal pathophysiological process for neuronal survival when subjected to ischemic insult. Mitochondrial calcium uptake 1 (MICU1) has been demonstrated as a key regulator of the mitochondrial calcium uniporter (MCU), identified as a tetrameric highly specific channel that modulates mitochondrial Ca²⁺ uptake.

Adult male Sprague–Dawley (SD) rats underwent middle cerebral artery occlusion (MCAO) to create the standard focal cerebral ischemia model. The permanent MCAO approach utilized the intraluminal approach. Neurological examination, and subsequent histological characterization of cerebral infarcts using triphenyltetrazolium chloride staining, as well as Western blot, immunohistochemical staining, and real-time quantitative polymerase chain reaction assays were employed to assess the functional effects of MICU1 and its expression in the brain.

Animals exposed to MCAO displayed the typical neurological deficit accompanied by cortical and subcortical infarction at 72 h post-stroke. The expression of MICU1, with co-localization with neurons, was detected at different time points (6 h and 12 h) after ischemic damage. Altogether, these observations revealed an up-regulation of MICU1 expression in the early stages of cerebral ischemia.

The results demonstrated that MICU1 was upregulated in neurons at the acute phase of ischemic stroke. Because MICU1 has been previously shown to participate in mitochondrial Ca²⁺ uptake mediated by MCU, our study further implicates the involvement of MICU1 in calcium overload-induced cell death which is closely associated with stroke.

Pituitary adenoma (PA) is a common intracranial tumor and surgical treatment is considered to be the best treatment for most patients. The extended endoscopic endonasal approach (EEEA) has been used to treat increasing numbers of patients with PA in recent years. We conducted this study to evaluate the safety and efficacy of this approach for PA resection.

We performed a retrospective analysis of all patients who underwent an EEEA to remove PA by a binostril, four-handed technique between October 2013 and April 2016 in our department. The medical information of the patients including gender, age, tumor size, hormone level, clinical outcome, and complications were collected and analyzed.

From a total of 593 pituitary adenoma surgeries, 171 patients (101 male and 70 female, mean age 47.4 ± 12.8 years) underwent EEEA, including 96 with functional adenomas (56.14%) and 75 with nonfunctional adenomas (43.86%). The most common symptoms were headache and vision change. Gross total resection was achieved in 126 patients (73.68%). Common complications were hyposmia or anosmia, diabetes insipidus, hypopituitarism, postoperative cerebrospinal fluid leak, cerebral hemorrhage, and epistaxis. The mean duration of follow-up was 14.6 months (range: 6–31 months).Conclusions: The application of EEEA for PA resection by a binostril, four-handed technique provided great surgical freedom with minimal invasion, and resulted in few complications. EEEA is a secure and effective surgical method that could be used for the majority of PAs.

Decompressive craniectomy (DC) has been the classical management for malignant middle cerebral artery infarctions (mMCAI) in clinical practice. However, the association between DC and mMCAI remains unclear. This review went to evaluate the efficacy of DC in treating mMCAI patients.

Studies were entirely searched since the foundation dates of multiple databases to June 2016. All major databases were involved, including Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, and other sources. the bias risk of studies involved were evaluated. Modified Rankin Scale was defined as Primary outcome, Odds Ratio and 95% confidence intervals was taken as measurements. T2 (tau-squared) test, I2 test, and chi-square tests were used for statistical heterogeneity evaluation for each meta-analysis result, followed by fixed-effect model. Mantel-haenszel method was used in the process of summary estimations. All of the meta-analysis was conducted by Review Manager 5.3.

One thousand one hundred forty-five records of data were critically identified and collected through databases and 14 studies were finally involved. Result suggested that DC can ameliorate the suboptimal outcome of mMCAI patients.

The information about paediatric meningiomas is poor. The purpose of this study was to review the clinical characteristic, treatment considerations and prognosis of paediatric meningiomas.

We retrospectively reviewed a series of 32 paediatric patients with meningiomas who received surgical resection at the Affiliated Hospital of Qingdao University between January 2002 and December 2010.

The study group included 17 boys and 15 girls (range: 2–18 years, mean: 13.7 years). Thirteen patients were in the first decade of life and 19 patients were in the second decade. The most common symptoms were headache (33. 3%) and epilepsy (25%), followed by cranial nerve dysfunction: distortion of commissure, vision disorder, acoasma and unconsciousness. The size of lesions was ranged 35–65 mm (mean 42.3 mm). Of these 32 patients, 16 were revealed WHO class I meningiomas, 5 were WHO class II, and 11 manifested WHO class III. Nine of 32 patients met the criteria that had tumor recurrence within follow-up.Conclusions: Paediatric meningiomas usually have larger size, higher pathologic grade and unusual location. The influential factors for recurrence include lesion location, histological features and extent of removal. Complete tumor resection is the best choice to prevent recurrence and improve the prognosis.

Human leukocyte antigen (HLA)-DR is a classical major histocompatibility complex (MHC) class II molecule encoded by five genes: HLA-DRA, HLA-DRB1, HLA-DRB3, HLA-DRB4 and HLA-DRB5. The current study aimed to investigate the role of these genes in gliomas by analyzing microarray data.

We enrolled 305 patients with histologically confirmed gliomas, and performed microarray data analysis along with studying their clinical characteristics. A new variable, termed HLA-DR score, was defined to explain the expression information of all five HLA-DR genes by factor analysis. HLA-DR scores in each grade of glioma and normal brain tissue were compared using one-way ANOVA. Lastly, correlations of HLA-DR scores with progression-free survival (PFS) and overall survival (OS) were analyzed with Kaplan-Meier and Cox analysis.

Our study indicated that an increased HLA-DR score, i.e. overexpression of HLA-DR genes, was correlated with a more aggressive glioma tumor grade (p < 0.001, One-way ANOVA). Moreover, the HLA-DR score was significantly higher in astrocytic tumors than oligodendroglial tumors (−0.718 ± 3.177 versus −2.975 ± 2.662, t-test) in low-grade gliomas (LGGs). Kaplan-Meier analysis of both PFS (p = 0.046, log-rank test; p = 0.021, Breslow test) and OS (p = 0.029, Breslow test) showed significant differences in the clinical outcomes between LGG patients with high versus low HLA-DR scores. Finally, the HLA-DR score was further identified to be an independent prognostic factor of clinical outcomes by multivariate analysis (p = 0.042 and p = 0.025, for PFS and OS, respectively) in LGG patients.

Expression of HLA-DR genes can be used to predict the tumor grade in gliomas, and the histological subtype in LGG. Furthermore, they are also an independent predictor for LGG patient survival.

Epithelial-mesenchymal transformation(EMT) is a coordinated process in which polarized epithelial cells are induced to lose adhesion from the basement membrane and obtain the properties of mesenchymal cells, including invasion and metastasis. It has been proved that EMT greatly contributes to the invasion and therapeutic resistance of various solid human cancers. However, the role of EMT in brain glioma has not yet been fully clarified. So in this review, we mainly elaborate the latest progression about the related regulatory transcription factors, key signaling pathways and microRNAs (miRNAs) of EMT in gliomas.

Although technically regarded as a simple procedure, titanium mesh cranioplasty could lead to various surgical complications, including postoperative implant exposure. However, there is little data available on the occurrence and risk factors of this complication in the pediatric population.

Two pediatric male patients, one 12-year-old and one 7-year-old, had decompressive craniectomy after traumatic brain injuries and subsequent cranioplasty with titanium mesh. However, both patients had skin defects developed gradually at the scalp adjacent to the surgical incisions, 11 and 7 months after cranioplasty, respectively. Implants removal surgeries were then delivered and, during the operation, some bone debris were found just beneath the skin defects in both patients. Because microbiological culture results of the exudations were negative, in addition to the long interval between cranioplasty and developments of skin defects, surgical infections might not be major causes of the observed titanium implants exposures. On the other hand, local osteogenesis and impaired scalp blood supply might contribute to their occurrence.

Efforts should be made to achieve complete clearance of bone debris and protect scalp blood supply during the initial decompressive craniectomy in order to minimize the risks of subsequent titanium mesh exposures.

Tuberculum sellae meningioma associated with aneurysm is extremely rare with a limited number of individual cases previously reported. Because of the complicated anatomical structure of the skull base, comorbid disease in the sellae region is a challenging problem and is associated with high mortality in neurosurgery.

This case report describes a rare case of comorbid bilateral internal carotid artery aneurysms and tuberculum sellae meningioma. This 58-year-old female presented with headache and nausea. She had lost her light perception in the right eye, and the right optic disc was degenerated. She also had a 5-year history of hypertension. This patient underwent a right pterional craniotomy, and we accomplished to clip the bilateral intracranial aneurysms and concurrently remove the tumor. After the surgery, we confirmed that both of the aneurysms were completely isolated, and the tumor was adequately resected. This patient had not suffered other neurological deficits. Unfortunately, her visual acuity had not recovered.

As we know, this is the first report of a unilateral surgical approach to clip the bilateral intracranial aneurysms and concurrently remove the tumor. It may provide a reference for clinical treatment of the similar disease.

The authors introduced a rare case of intracranial malignant melanoma.

A 32 year-old male patient presented to the hospital with signs and symptoms commonly seen in the presentation of a hemorrhagic stroke. The patient was diagnosed as having an Arteriovenous Malformation (AVM) after a thorough history, physical examination and radiographic imaging were performed and assessed. However, intraoperative findings and postoperative histopathology findings revealed that the supposed AVM was in fact a malignant melanoma, appearing as an AVM of the brain, on radiographic imaging.

After reviewing related literature, our team realized that it was a rare finding for a melanoma pretending as a brain AVM.

We aim to present an unique case of inflammatory myofibroblastic tumor (IMT) of the brain parenchyma and study the clinical presentation, imagine characteristic, intraoperative findings, and histopathology features of IMT in the brain parenchyma.

A 36-year-old female with IMT come to see doctor presented with a 3-month history of progressively worsening weakness in the left upper limb along with alalia. Serial magnetic resonance imaging studies revealed a lesion within the right frontal lobe. The lesions were locally clear boundary with peripheral tissues. A right frontotemporal craniotomy was performed and the specimens were detected by immunohistochemical staining and light microscopy. Through the microscope, the tumor was composed of large number of chronic inflammatory cells and spindle cells. From immunohistochemical stains, it demonstrated CD34 (+), SMA (+), Vimentin (+), and actin (+) were positive meanwhile S-100(-) was negative.

IMT of the right frontal lobe is a rare lesions. Surgical resection is the best and the most effective treatment.

Ankylosing spondylitis was reported to associate with an increased risk of cerebrovascular diseases. In this article, we aimed to report the first case of ankylosing spondylitis associated with moyamoya disease treated with encephalo-duroarterio-synangiosis.

A 9-year-old boy with ankylosing spondylitis appeared a symptom of repeated transient ischemic attacks which performed as left hemiparesis. Magnetic resonance angiography showed a typical finding of left anterior cerebral artery, bilateral middle cerebral arteries and the supraclinoid portion of the right internal carotid artery stenosis with an abnormal vascular network at the base of the brain, diagnosed with moyamoya disease. He received a medication treatment but did not underwent revascularization surgery. After three months, ankylosing spondylitis symptoms got some relief, whereas transient ischemic attacks was more frequency. Due to the bad cerebral blood flow on acetazolamide computed tomography perfusion and poor clinical manifestation, he underwent a right encephalo-duroarterio-synangiosis. Postoperatively, the symptoms of transient ischemic attacks disappeared.

We reported the first case of ankylosing spondylitis associated with moyamoya disease. Moyamoya disease could appear in patients with ankylosing spondylitis. Revascularization surgery probably is an effective treatment for preventing preoperative ischemic events recurrence.