Volume 03 · Issue 04 · 2017

Aneurysmal subarachnoid hemorrhage (aSAH) is an acute neurosurgical emergency with a significant fatality rate. In addition to acute brain injury, a considerable part of patients suffering from aSAH develops secondary brain damage such as cerebral vasospasm (CVS). CVS exacerbates the mortality. Therefore, it is urgently needed to find a biomarker, which could predict secondary brain and lead to operation by physicians more promptly. S100B, produced and released by astrocytes, has proven to be an important biomarker for brain injury.

In this present study, 51 patients with aSAH were included. Five CSF samples from each patient were obtained via lumbar puncture and were detected using electrochemiluminescence immunoassay (ECLIA).

It indicated that S100B had a higher concentration in CSF of patients treated by surgical clipping after aSAH than that treated with endovascular coiling. In addition, the mean CSF S100B level in patients without CVS was much lower compared with patients with CVS. And, the expression of S100B increased along with the Fisher Grade at the same day after aSAH attacked and decreased as time went on. Moreover, the CSF S100B level of different time points and the mean CSF S100B level can predict the risk of CVS.

These data suggest that CSF S100B can be served as a predictor of CVS, which triggers an immediate management by clinicians to prevent secondary exacerbation.

Glioma stem cells (GSCs) represent a subpopulation of cells within glioma that are characterized by chemotherapy resistance and tumor recurrence. GSCs are therefore important therapeutic target for glioma therapy. Long non-coding RNAs (lncRNAs) have been shown to regulate important functions in cancer. HOXA11-AS is one such lncRNA and has been shown to regulate cell proliferation via promotion of cell cycle progression in glioblastoma (GBM) cells. However, the specific roles of HOXA11-AS in GSCs remain unclear.

Here we investigated the role of HOXA11-AS in driving GSC stemness properties via sphere-forming and protein chip assays.

Gain-of-function as well as loss-of-function results showed that the HOXA11-AS maybe a critical modulator in GBM recurrence as demonstrated by cell sphere-forming ability. Furthermore, we showed that induced expression of HOXA11-AS does increase the levels of stemness-related transcription factors (Oct4/Sox17/Sox2) in U87MG cells. In vivo xenograft experiments using the HOXA11-AS knockdown U87MG cells revealed that downregulation of HOXA11-AS could strongly inhibit tumor growth. Furthermore, we found that HOXA11-AS knockdown decreased the expression of cancer stemness markers in vivo.

Collectively, these data suggests that HOXA11-AS is involved in GSC stemness and supports its clinical significance as a important therapeutic target in glioma.

While the optimal combination of whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS) and surgical resection in the treatment of brain metastases, is controversial, the addition of SRS to surgical resction of solitary metastasis may enhance local control while potentially minimizing toxicity associated with adjuvant WBRT. This study seeks to determine whether pre-operative SRS to the lesion versus post-operative SRS to the resection bed may reduce irradiation of adjacent normal brain tissue.

A retrospective study of 12 patients with 13 surgically resected cerebral metastases was performed. The pre-operative contrast-enhancing tumors and post-operative resection cavities plus any enhancing residual disease were contoured to yield the gross target volume (GTV). In turn these GTV’s were uniformly expanded by 3-mm to generate the pre-operative, as well as post-operative planning target volume (PTV.) For each lesion, a 7-staticconformal-beam, non-coplanar plan utilizing 6 MV photons was generated to encompass the PTV within the 85% isodose line. Excess normal brain volume irradiated was defined as the volume outside the GTV receiving the prescribed dose.

When lesions were divided into two groups- Group A (pre-operative GTV’s < 15 cc, n = 9) and Group B (pre-operative GTV’s > 15 cc, n = 4) - the average volume of normal brain irradiated was significantly smaller if preoperative SRS was used for treatment of lesions in Group A (9.5 vs. 16.8 cc, paired t-test, p = 0.0045). In contrast, this volume was smaller for Group B lesions if post-operative SRS was used for treatment of these lesions (27.6 vs. 51.2 cc, p = 0.252). A comparison of groups with respect to mean volume differences between pre- and post-operative SRS was significantly different (two-sample t-test p = 0.016). GTV and the difference between pre- and postoperative volume were highly correlated (Pearson correlation= −0.875, p < 0.0001).

Pre-operative treatment of smaller metastases may result in reduced radiation dose to normal tissue and, thus, reduced treatment-related morbidity compared to post-operative irradiation of the resection cavity.

Research on the etiology and pathophysiology of fusiform aneurysm has been impeded due to the inability to collect fusiform aneurysm specimens. We aim to resolve this through the development of a novel fusiform aneurysm model in rabbits.

Sixty New Zealand White rabbits were divided into ten groups (n = 6 per group): groups A, B, C, D, E and groups a, b, c, d, e. Elastase, at a concentration of 0, 0.5, 1, 2.5 and 5 U/μL respectively was administered to each rabbit to incubate their carotid arteries. Three weeks later, angiography, histomorphometry, immunohistochemistry and immunofluorescent were performed.

Heparin administration is indispensable. No thrombosis was observed in groups A, B, C, D and E, whereas, increased thromboembolism occurred in groups a, b, c, d and e. Based on the size and wall thickness of aneurysms specimens, 5 U/μL was the optimal concentration of elastase to induce fusiform aneurysms. At 5 U/μL, the intraluminal carotid diameter increased significantly from 2.50 ± 0.32 mm to 3.11 ± 0.55 mm (p < 0.01). The wall thickness significantly reduced from 176.0 ± 39.8 μm to 39.7 ± 14.6 μm (p < 0.01) post aneurysm induction. The histolopathological evaluation revealed the elastic lamina and the smooth muscle cell’s lamina were markedly attenuated and the intimal endothelial lamina became thin or even absent.

Our research demonstrates that intracranial fusiform aneurysm could be modeled in rabbit carotid artery adventitia incubation by porcine pancreatic elastase.

Different gene expression profiles are observed in intracranial aneurysm tissue. Understanding these genes and what regulates their expression will help us to understand intracranial aneurysm pathogenesis. We investigated whether differences in gene expression in intracranial aneurysms.

Sixteen intracranial aneurysm tissues were compared with 16 matched samples from the superficial temporal artery as controls. We detected the gene expression profiles in these samples with the Human U133 Plus 2.0 GeneChip.

A total of 2142 differentially expressed gene transcripts were detected based on the gene expression profile. Verification analysis showed that the VCAM1, MAGI2, PPP2R2B, PPP2R3A genes were associated with the occurrence and development of intracranial aneurysm. These genes mainly encode cell adhesion molecules (CAMs) and ERK/JNK signaling pathways.

Changes of genes expression involved in immune and inflammatory reactions, cell adhesion molecules may be associated with the development of aneurysms.

Intracranial arterial dissection is an important cause of stroke in young and middle-aged adults, but there are no domestic or globally-accepted criteria for the diagnosis and classification of intracranial arterial dissections. The evidence base for the benefits of diagnostic and interventional angiography techniques is lacking, and the imaging features of intracranial arterial dissections are not yet universally recognized or understood by clinicians. These issues influence the diagnosis and treatment of intracranial arterial dissection. Therefore, a consensus conference was convened by Neurointerventional Expert Committee of Chinese Congress of Neurological Surgeons, Chinese Interventional Neuroradiology Society of Chinese Stroke Association and Young Physicians Committee of Chinese Congress of Neurological Surgeons. The aim of this document is to report an expert consensus on the imaging diagnosis of intracranial arterial dissection. The participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. The expert consensus was intended to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician.

Pleomorphic xanthoastrocytoma (PXA) is usually considered a relatively benign and localized entity. However, cases of PXA with anaplastic features have been reported in recent years. Anaplastic pleomorphic xanthoastrocytoma has been added to the 2016 WHO classification of CNS tumors as a distinct entity.

We describe a rare case of PXA with dissemination, both at the time of diagnosis and after treatment. The 20-year-old male presented with signs of high intracranial pressure and sudden-onset transient seizures. Imaging examinations showed diffuse lesions widely distributed in the left hemisphere, and on histopathological examination, he was diagnosed with anaplastic PXA. The patient underwent surgical treatment and adjuvant concurrent chemoradiation. Follow-up MRI revealed early recurrence and distant spread of the tumor.

Anaplastic PXA usually has unique characteristics, including dissemination, early recurrence, and chemoresistance. A strategy based on early diagnosis and aggressive treatment is warranted. However, sufficiently powered studies are required to generate evidence-based guidelines.

Fourth ventricle isolated Magendie’s foramen primitive obstruction is rare. The etiology and the pathophysiology of the constitution of this obstruction in congenital cases remain elusive. We report a case of congenital obstruction of Magendie’s foramen in an adult patient and discuss the embryogenic mechanism and our management of this rare pathology.

A 20 years old female patient without any medical history was referred for headaches and vomiting. Emergency CT scan revealed major hydrocephalus subsequently she underwent a ventriculoperitoneal shunt as initial treatment. The diagnosis of fourth ventricle obstruction was made 5 months later when the patient came back complaining of headaches, cerebellar signs and cystic dilatation of the fourth ventricle on CT scan and MRI. Fourth ventricle Magendie’s foraminoplasty via classic posterior fossa surgery brings complete cure.

Magendie’s foramen obstruction is rare. The embryological development of the posterior fossa and its content could explain the primitive obstruction which can be managed by classic surgery in case of unavaibility of endoscopy.

Elderly patients with primary intracranial osteolytic and externally growing atypical meningiomas are rare and easy to be misdiagnosed. Recently, a patient with an atypical meningioma was treated in our department and analyzed the case by reviewing the historical literature.

We describe a 63-year-old female with primary intracranial osteolytic atypical meningioma at our neurosurgery department, and retrospectively reviewed previous literatures about its diagnosis, surgical treatment, pathological results, and clinical outcome. Simpson grade I resection was accomplished through a pterional approach. First-stage skull reconstruction was performed, and the patient underwent an uneventful recovery.

The final diagnosis of the primary osteolytic atypical meningioma is dependent on a pathological examination. First-stage skull reconstruction could avoid a secondary lesion and improve the patient’s quality of life.