MedNexus
Volume 33 · Issue 06 · 2017
MedNexus
Moyamoya disease is a kind of cerebrovascular disease with unknown etiology, characterized by chronic progressive stenosis or occlusion of the ends of bilateral internal carotid arteries and the initiation of anterior cerebral arteries and middle cerebral arteries, and secondary to the formation of abnormal vascular network at the skull base. In 1969, by Japanese scholars Suzuki and Takaku[
Microscopic neurosurgery began in the early 1960s. The application of microscopic technology has greatly improved the curative effect of neurosurgery, and the surgical trauma is greatly reduced compared with open-eyed surgery. Therefore, microscopic surgery has been widely used and has become a basic technology of neurosurgery. Over the past 50 years, with the accumulation of experience in microsurgery, the improvement of microscopic technology, the improvement of microscopic instruments and the advancement of neuroimaging technology, it is possible and necessary to further minimally invasive microsurgery, thus the emergence of keyhole microneurosurgery technology. Therefore, keyhole neurosurgery is the product of the combination of modern microsurgery technology, neuroimaging technology, neuroendoscopy technology and modern minimally invasive surgery concept, and it is one of the representative technologies of microsurgery towards minimally invasive neurosurgery.
To analyze the properties and difference of small world network in patients with concussion and diffuse axonal injury by resting-state functional MRI (rs-fMRI).
A prospective study was conducted, in which 13 patients with brain concussion and 9 patients with diffuse axonal injury were admitted to Neurosurgery Department of Wuhan General Hospital of PLA from December 2013 to December 2015, and 14 healthy people were set as controls. The rs-fMRI data in those 3 groups were collected and preprocessed. Brain areas were labeled by AAL90 and Dosenbach160. The correlation coefficients of the brain regions were calculated. The small world was assessed and network parameters were compared between the 3 groups.
The brain network of patients with brain concussion, diffuse axonal injury and normal subjects were in line with the characteristics of small world. Compared with controls, a higher situation of clustering coefficient, global efficiency, local efficiency and average connectivity degree (all P<0.05) were presented in patients with brain concussion and the same parameters were lower (allP<0.05) in patients with diffuse axonal injury.
The patients with brain concussion and diffuse axonal injury both have small world networks, but the parameters might vary, which could be due to compensation or decompensation of brain functions.
To evaluate the role of PET-MRI coregistration in presurgical evaluation of MRI-negative drug-resistant epilepsy.
A retrospective study was conducted on the clinical data of 34 patients with MRI-negative refractory epilepsy who underwent presurgical evaluation at Epilepsy Center of Fengtai Hospital, Medical Alliance of Beijing Tiantan Hospital, Capital Medical University from January 2015 to June 2016. All patients received non-invasive (such as Scalp video-EEG, MRI, PET-CT and PET-MRI coregistration) and invasive (stereo-electroencephalography, SEEG) examinations during presurgical evaluation. A total of 30 patients underwent resection surgery subsequently and 4 patients underwent conservative therapy. The Engel scale was used to assess the surgery outcomes. The results of PET-CT and PET-MRI coregistration were compared with respect to the localization consistency of epileptogenic focus. Seizure frequency, interictal scalp EEG, PET-MRI coregistration and surgical location were included in the prognostic factor analysis by means of binary Logistic regression.
The mean postoperative follow-up period was 12.5 months (4~20 months). The Engel Class Ⅰ rate was 23/30 (77%). The rate of consistency between PET-MRI coregistration results and epileptogenic focus was significantly higher than that of PET-CT (83% vs. 37%, P<0.01). Prognostic factor analysis suggested that PET-MRI results without showing localized hypometabolism predicted seizure recurrence (P=0.042).
PET-MRI coregistration could significantly improve the localizing value of PET for epileptogenic focus. Patients without localized hypometabolism on PET-MRI coregistration images might be more likely to expreience seizure recurrence.
To evaluate the treatment effects of hypoglossal-facial 'side’-to-side neurorrhaphy using a predegenerated sural nerve autograft for facial paralysis following tumor resection in cerebellopontine angle (CPA) area.
We followed up 48 patients who developed facial paralysis as a result of CPA tumor removal and underwent hypoglossal-facial 'side’-to-side neurorrhaphy using a predegenerated sural nerve autograft between June 2013 to February 2016 at Neurosurgery Department of Beijing Tiantian Hospital, Capital Medical University. Eight other patients who served as controls did not receive any repair treatment. Patients in both groups received rehabilitation exercises and their static and dynamic facial images were collected. Electrophysiological tests of the facial nerve were conducted including electromyography, motor nerve conduction and F wave. The patients' facial nerve functions were assessed according to House-Brackmann grading scale(H-B scale). The follow-up lasted 2-36 months with an average of (12.1±13.4) months.
In the surgical treatment group, 24/48 patients were found postoperatively to have significant facial function improvement on H-B scale, 21/48 patients to have improvement, and 3/48 remained unchanged. In the control group, 1/8 patient was found to have significant facial function improvement on H-B scale, 2/8 had improvement and 5/8 remained unchanged associated with marked atrophy of paralyzed facial muscles. Significant difference was identified in the facial function improvement on H-B scale between the surgical treatment and control groups (P<0.01). The improvement of facial nerve function was most evident if the surgical repair treatment was performed within the 6 months after the onset of facial paralysis.
Hypoglossal-facial 'side’-to-side neurorrhaphy may effectively treat facial paralysis resulting from CPA tumor resection. Better recovery of facial nerve function could be achieved when the surgical treatment is performed within the 6 months after the onset of the facial paralysis.
To explore the lateralizing value of stereotactic electroencephalography (SEEG) in bilateral temporal lobe epilepsy (BTLE) suggested by scalp EEG and to assess the surgical outcomes.
A retrospective study was conducted on the clinical features and SEEG monitoring results of 10 patients who were diagnosed as BTLE based on scalp EEG and underwent SEEG implantation from January 2014 to December 2015 at Renji Hospital, School of Medicine, Shanghai Jiaotong University. According to the SEEG results, anterior temporal lobectomy with amygdalohippocampectomy (ATL-AH) was performed for unilateral temporal lobe epilepsy (UTLE) and BTLE with unilaterally dominant epileptic focus, and neuromodulation was performed for BTLE without unilaterally dominant epileptic focus.
SEEG monitoring data revealed UTLE in 7 out of the 10 patients and BTLE in the other 3 patients including 1 with unilaterally dominant epileptic focus. Among the 8 patients undergoing ATL-AH, 6 patients were classified as Engel I and 2 as Engel Ⅱ post surgery. Neuromodulation was performed in 2 patients and both reported an Engel class III outcome.
In patients with BTLE suggested by scalp EEG, unilateral onset might be identified in most cases which could achieve good surgical outcomes following ATL-AH. SEEG seems to be a safe and effective method to lateralize BTLE as indicated by scalp EEG. Patients with UTLE and BTLE with unilaterally dominant epileptic focus could obtain good outcomes (Engel class I and II) post ATL-AH. Moreover, neuromodulation seems to be an effective therapy for BTLE without unilaterally dominant epileptic focus.
To explore the correlation between cranial infection and the timing of epileptogenic zonectomy following intracranial electrode implantation assisted by robotized stereotactic assistant (ROSA).
The clinical data of 132 epilepsy patients admitted to Beijing Sanbo Brain Hospital from March 2012 to December 2015 who underwent implantation of intracranial electrodes assisted by ROSA and resection of epileptogenic zones, including 5 cases undergoing epileptogenic zonectomy combined with bipolar electro-coagulation on functional cortex (BCFC), were collected and retrospectively analyzed.
Sixteen patients (12.1%) underwent surgical resection on the day of electrode removal; 10 patients (7.6%) received surgical resection within 1 week post intracranial electrode removal; 33 patients(25%)underwent surgical resection from 1 week to 1 month following intracranial electrodes removal; 27 patients (20.5%) experienced surgical resection from 1 to 3 months post electrode removal; and the remaining 46 patients (34.8%) underwent epileptogenic zonectomy 3 months post electrode removal. Postoperative intracranial infection was noted in 4 patients (3.0%), who underwent surgical resection 16, 65, 109 and 120 days after electrode removal, respectively. The infection was subsequently cured in all cases with conservative therapy. There was no statistical difference in the infection rate between groups varying in timing of epileptogenic zonectomy (P=0.839).
There seems to be no statistical correlation between cranial infection and the timing of epileptogenic zone resection following intracranial electrode removal.
To investigate the value of intraoperative microelectrode recording (MER) and macrostimulation for targeting subthalamic nucleus (STN) in deep brain stimulation (DBS) for Parkinson’s disease (PD).
A total of 109 PD patients undergoing STN-DBS from June 2012 to March 2016 at Neurosurgery Department of General Hospital of Shenyang Military Region were enrolled into this retrospective study. All patients underwent stereotactically guided DBS procedures based on coregistration of preoperative MRI and CT images and microelectrode recording with/without intraoperative testing for localizing STN. Positions of electrodes were identified by postoperative MRI and/or CT. MER was performed in 69 cases (control group), and MER combined with macrostimulation were performed in 40 cases (experimental group). Postoperative programming and parameter adjustment were conducted to achieve optimal clinical efficacy. The Unified Parkinson's Disease Rating Scale (UPDRS) was applied to evaluate the treatment outcomes. The follow-up lasted for 1.0-4.5 year.
The electrode location and duration of operation (implantation) in two groups had no significant difference (both P>0.05). Average postoperative programming voltage in control group was 2.5±1.1 V, which was significantly higher than that in experimental group (2.1±0.7 V,P<0.05). The increase rate of UPDRS score in experimental group was (43.7±6.9)%, which was significantly higher than in control group (33.7±4.9)% (P<0.01).
Intraoperative MER and macrostimulation during DBS seemed to be safe and effective, and they could facilitate localization of STN assisted by preoperative images.
To explore the seizure originating pattern, high-frequency activity and surgical outcome of mesial temporal lobe epilepsy.
A total of 12 patients with intractable epilepsy were retrospectively enrolled in this study, who were admitted to Epilepsy Center of Yuquan Hospital, Tsinghua University, and underwent mesial temporal lobectomy from January 2014 to December 2015. Stereotactic electroencephalography (SEEG) electrodes were implanted and the diagnosis of mesial temporal lobe was confirmed. All patients were divided into hypersynchronous (HYP) group and low voltage fast (LVF) group based on the seizure onset pattern on SEEG. Selective amygdalohippocampectomy (SAH) was performed in 11 cases and standard anterior temporal lobectomy (ATL) in 1 case. Postoperative follow-up was performed and surgical outcomes were evaluated according to the Engel scale.
A total of 139 electrodes were implanted in 12 patients with an average of (11.6±0.7) electrodes in each, which had 1 705 contacts with an average of (142.1±9.8) contacts in each case. In total, 60 seizures were recorded, among which seizures started as HYP in 7 cases, LVF in 4 cases and poly spikes in 1 case. Compared with HYP group, LVF involved more contacts (23 vs.28, P<0.05) and propagated faster (11.2±2.3 svs. 7.1±1.0 s, P<0.05). High frequency oscillation existed before both HYP and LVF occurred. Postsurgical follow-up lasted 12~24 months with an average of (14.7±3.5)months. All patients in HYP group became seizure free and were classified as Engel Ⅰ. In LVF group, 1 case reported 2 severe attacks in total and 2~3 mild attacks per month; and 1 case had 1~2 severe attacks per month, and both were classified as Engel Ⅲ. Postoperative outcome in HYP group was better than that in LVF group (χ2=4.278, P<0.05).
The discharge patterns of seizure onset in mesial temporal lobe epilepsy include HYP and LVF. Patients with HYP as seizure onset pattern seemed to have better surgical outcomes. High frequency activity might start prior to HYP and LVF and serve as electrophysiological evidence and clinical assistance.
To explore the relationship between removal of areas where high frequency oscillations (HFOs) were detected by a new automatic detector and the prognosis of epilepsy surgical.
In this study, 7 patients with intractable epilepsy were enrolled and their clinical data were retrospectively studied, who underwent intracranial electroencephalography (EEG) monitoring and subsequent epileptogenic zone resection from January 2013 and December 2014 at Epilepsy Center of Beijing Haidian Hospital. An automatic detector of HFOs was employed using maximum distributed peak points to calculate baseline. Then the relationship between the removal ratio of HFOs and surgical outcomes was investigated.
Among the 7 cases of refractory epilepsy, the resection ratio of ripple area was 19.4% ~ 96.4% and that of fast ripple area was 29.3% ~ 96.0% . The surgical removal ratio of HFO areas was higher than 50% in 5 cases, 4 out of whom achieved good outcomes after surgery. In the other 2 patients whose removal ratio of HFO area was lower than 50%, poor surgical outcome was reported in 1 and good outcome was obtained in the other who had extensive area demonstrating suspicious physiological HFOs in the occipital lobe.
The automatic detector of HFOs using maximum distributed peak points to calculate baseline seems to be accurate for detection of HFOs. The ratio of resection in areas with HFOs might be closely related to the surgical outcomes.
To summarize the common complications of chemical lumbar sympathectomy (CLS) and corresponding preventive measures.
A retrospective study was conducted on 258 cases of CT-guided CLS(injection of anhydrous alcohol) performed between September 2011 and September 2016 at Department of Pain Medicine, the First Hospital of Jiaxing City, and the complications and corresponding measures of prevention and treatment were analyzed.
Surgical targets were successfully reached following the preplanned trajectories in all 258 cases (516 sides) undergoing CLS. In 16 cases (single side), a small amount of blood was observed when the plunger was pulled back and the position of needle tip was adjusted(3.1%, 16/516). In 29 cases (single side), some anhydrous alcohol leaked along the needle tract into the psoas major muscle and caused numbness in the area innervated by unilateral genital nerve in 7 cases and numbness and muscle weakness in unilateral lower limb in 1 case whose muscle strength recovered at 1 month post injection of diluted saline into the psoas major muscle. In 9 cases, anhydrous alcohol spread along the anterolateral margin of vertebral body upward to the level of L1 unilaterally(1.7%, 9/516), among which 4 male(1.6%, 4/258) patients developed ejaculatory dysfunction post surgery. Postoperative CT scan revealed unilateral swelling of psoas major muscle in 2 cases, unilateral swelling of erector spinae muscle in 3 cases. No retroperitoneal hematoma occurred.
The most severe complication of CT-guided CLS seems to be neurological dysfunctions following injection of anhydrous alcohol affecting the lumbar plexus and L1 sympathetic ganglia in male. Test with local anesthetics could be useful for preventing and early detection of those complications, and implementation of saline dilution might serve as an effective treatment.
deep brain stimulation (DBS) has become an effective treatment for central dyskinesia because of its minimally invasive, adjustable and reversible nature. Bleeding, infection, skin ulceration and program-controlled adverse reactions have been reported in the literature[
To detect the expression and significance of β-catenin and BRAF V600E in craniopharyngiomas.
Craniopharyngioma specimens were collected from 51 patients who underwent surgical operations at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2008 to December 2010. HE staining was employed to observe morphological characteristics of different types of craniopharyngiomas, and immunohistochemical staining was used to detect the expression of β-catenin, BRAF V600E and Ki-67.
In 39 out of 42 (93%) cases of adamantinomatous craniopharyngioma (ACP), β-catenin was positive in the nuclei of whirl-like cell clusters, transitional cells by the ghost cells, and/or sporadic single cells, while papillary craniopharyngioma (PCP) showed β-catenin immunoreactivity merely in the membrane rather than the nucleus. Expression of BRAF V600E was detected in 7 out of 8 cases with PCP and absent in ACP. There were 3 cases with untypical morphology of craniopharyngiomas. Among them, 2 cases showed accumulation of nuclear β-catenin protein and conformed to ACP; and the other 1 was BRAF V600E positive in the ciliate on epithelial surface and classified as Rathke’s cleft cyst with squamous metaplasia. In cases of ACP, Ki-67 was negative in cells with nuclear accumulation of β-catenin. Furthermore, the counts of β-catenin positive cell clusters had no significant difference between specimens collected from two operations performed in 8 patients with recurrent ACPs( P<0.05).
The proteins of β-catenin and BRAF V600E are two specific markers for ACP and PCP, respectively, which may be helpful in classification and differential diagnosis of craniopharyngiomas with untypical morphology.
To conduct the comparative observational study of serum neoplastic biomarker and immunohistochemistry in intracranial germ cell tumors (GCTs).
A retrospective study was conducted on clinical data of 28 cases of germ cell tumors undergoing surgery from March 2013 to July 2016 at Tsinghua University Yuquan Hospital. Presurgical serum neoplastic biomarkers including α-fetoprotein (AFP), β-human chorionic gonadotropin (β-HCG) and alkaline phosphatase (ALP) were measured and compared with postsurgical immunohistochemistry results of tumor specimens.
Among the 28 cases of GCTs, germinoma was identified in 5 cases, teratoma in 2 cases, immature teratoma in 5 cases, choriocarcinoma in 1 case and mixed germ cell tumor in 15 cases. AFP was inconsisent in 8/28 cases, being positive in serum biomarker and negative in immunohistochemistry, and included 4 cases of immature teratoma and 4 mixed GCTs. β-HCG was incongruent in 5 cases (positive in serum and negative in immunohistochemistry). Among the 18 cases with pure germinoma component, placenta ALP (PLAP) immunohistochemistry revealed positive results in 15 cases, while serum ALP was significantly increased in only 4 cases and not detected in the remaining 14 cases.
The treatment and prognosis of intracranial GCTs might be correlated with different neoplastic components. Immunohistochemistry combined with serum biomarker could help demonstrate those neoplastic components more accurately and completely.
To study the expression change of estrogen receptor 1 (ESR1) in growth hormone-secreting pituitary adenoma (GHomas) and analyze its relationship to clinical features and prognosis and the potential as a therapeutic target.
The technology of issue microarray was employed in 24 cases of invasive GHomas and 52 cases of noninvasive GHomas. Immunohistochemistry was used to detect the expression of ESR1 protein. Furthermore, the relationship between ESR1 and pathological characteristics was explored. Cell proliferation and invasion ability of GH3 cells were detected by MTS experiment, Annexin V experiment and Transwells experiment after fulvestrant and hesperetin treatment.
The positive rate was 50% (19/38) in the age group under 40 and 76% (29/38) in the age group of at least 40, and the difference was significant (P=0.017). The positive rate was 79% (19/24) and 56% (29/52) in invasive and non-invasive groups, respectively, and the difference was significant (P=0.049). Following fulvestrant and hesperetin treatment, the viability of GH3 cell was decreased by 53% and 49% respectively. The apoptotic cells in the treated group were significantly increased (P<0.01), and the number of invasive cells decreased significantly (P<0.01).
ESR1 was highly expressed in GHomas and elevated significantly with the increase in age. Estrogen receptor antagonist fulvestrant and hesperetin could significantly inhibit the proliferation and invasion of GH3 cells.
To analyze preventive measures and therapeutic methods of postoperative complications of endoscopic transsphenoidal pituitary adenoma resection.
A retrospective analysis was conducted on 175 cases of endoscopic transsphenoidal resections of pituitary adenoma between January 2014 and June 2016 at Neurosurgery Department of the First Affiliated Hospital of Zhengzhou University. A follow-up was performed on all cases at 3 to 24 months post surgery to observe postoperative complications.
Among the 175 cases of endoscopic transsphenoidal resection of pituitary adenoma, gross total resection was achieved in 152 patients (86.8 %), subtotal resection in 18 patients (10.3 %), and partial resection in 5 patients (2.9 %). Complications included 2 (1.1 %) cases of transient postoperative visual worsening due to compression of the optic nerve by hematoma in 1 case and tamponade in the other, 20 (11.4%) cases of postoperative pituitary dysfunction, 39 (22.3 %) cases of transient diabetes insipidus, 7 (4.0 %) cases of cerebrospinal fluid rhinorrhea, 3 (1.7%) cases of intracranial infection, 2 (1.1%) cases of permanent loss of smell and 1 (0.6%) case of sphenoid sinus cyst. Intraoperative and postoperative cerebrospinal fluid leakage occurred in 71 cases and 6 cases (8.5%), respectively. Among the 104 patients without cerebrospinal fluid leakage during surgery, 1 case (1.0%) developed cerebrospinal fluid leakage post operation, and the difference was statistically significant (P=0.037). Out of 9 cases of tumor recurrence undergoing secondary surgery, 3 cases developed postoperative cerebrospinal fluid leakage. Among the 166 cases undergoing one operation, the cerebrospinal fluid leakage occurred in 4 (2.4%) cases, and the difference was statistically significant (P=0.000). There was no death in this series.
Endoscopic transsphenoidal resection of pituitary adenoma seems to have relatively low incidence of complications and their majority could be prevented.
To study the clinicopathological features of malignant transformation of craniopharyngioma.
Two cases of craniopharyngioma with malignant transformation were operated in Beijing Tiantan Hospital, Capital Medical University and were confirmed at Beijing Neurosurgical Institute during the period from January 2015 to December 2016, whose clinical data and histopathological features were retrospectively analyzed. The histological features of 1 case were compared before and after appearance of malignance. The immunohistochemical results of the malignant cases were compared with those of 10 cases of ameloblastic craniopharyngioma enrolled to the study during the same study period.
The 2 cases with malignant transformation included 1 male and 1 female, and they were both 25 years old. They had both received radiotherapy before malignant transformation. They were both ameloblastic craniopharyngioma and squamous cell carcinoma before and after malignant transformation, respectively. After malignant transformation, large hyperchromatism nuclei with clear nucleolus, increased nuclear-cytoplasmic ratios, and increased mitotic activities were seen in the malignance. The tumor cells were arranged in solid sheets, and the stellate reticulum was rare. The wet keratins were frequently found in the cancer nests and in the stroma. The tumor cells infiltrated the brain tissue. The basement membranes were destroyed or disappeared. Compared with the pre-malignance, the tumors had higher cell density, more cellular polymorphism and more mitotic activity. All cases showed immunoreactivity for CK and CK5/6. Compared with the pre-malignant condition, the Ki-67 index was significantly elevated after appearance of malignance(50% vs.5%). The Ki-67 indexes of malignant transformation were significantly higher than those of ameloblastic craniopharyngiomas(50% vs.2%~10%).
The malignant transformation of craniopharyngioma seems to have an obvious malignant tendency, but it may still keep some features of craniopharyngioma, which is helpful for the differential diagnosis with similar tumors.
To investigate the role of vascular ultrasonography in presurgical risk assessment of carotid endarterectomy (CEA).
A total of 562 patients with severe (70-99%) stenosis of carotid artery underwent CEA at Xuanwu Hospital from January 2013 to December 2015 and were enrolled into this retrospective study. Before CEA, the patient's vascular structures on surgical side and intracranial-external arterial hemodynamics were evaluated by the carotid color Doppler flow imaging (CDFI), transcranial color coded sonography (TCCS)and/or transcranial Doppler (TCD) at Department of Vascular Ultrasonography. The factors related to postoperative (within 30 days) complications, including hyperperfusion, newly developed cerebral infarction and hemorrhage, were analyzed.
The overall rate of postoperative complications including hyperperfusion(n=42), newly developed cerebral infarction(n=23) and hemorrhage(n=7) was 10.7% (60/562 cases). Assessed by multivariate logistic analysis, closed anterior and posterior communicating arteries (OR=7.02, 95% CI: 1.97-24.94, P=0.003)、closed anterior communicating artery (OR=4.23, 95% CI: 1.14-15.74, P=0.032), peak systolic velocity of the middle cerebral artery less than 60 cm/s (OR=5.49, 95% CI: 2.99-10.10, P<0.0001), at least 60 years of age (OR=5.29, 95% CI: 2.14-13.05, P<0.0001), common carotid artery bifurcation higher than the level of C2 (OR=3.29, 95% CI: 1.01-10.97, P=0.049), severe stenosis or occlusion of contralateral carotid artery were identified to be independent risk factors for postoperative complications within 30 days.
Comprehensive presurgical evaluation of vascular structures on the surgical side and hemodynamics by CDFI, TCCS, and/or TCD would help select patient candidates suitable for CEA and prevent postsurgical complications.
To investigate the treatment effect of tolvaptan (vasopressin-2 receptor antagonist) on central neurogenic syndrome of inappropriate antidiuretic hormone secretion (SIADH).
A total of 56 patients with SIADH were admitted to Department of Neurosurgery, Henan Provincial People's Hospital from March 2013 to January 2015 and enrolled in this study. By using a random number table, all cases were divided into 2 groups including tolvaptan group (n=28) and conventional treatment group (n=28). In order to assess the efficacy and safety of tolvaptan, the increased level of plasma sodium following treatment, medication time and rate of adverse events were compared with the 2 groups.
At 72 h and 96 h post treatment, the increased levels of plasma sodium in tolvaptan group (15.38±2.45 mmol/L, 16.75±2.89 mmol/L) were both significantly higher than those in conventional group (10.89±1.91 mmol/L, 14.39±2.45 mmol/L) (P<0.05). The medication period before plasma sodium level recovered to normal in tolvaptan group (72 h) was significantly shorter than that in conventional group (120 h) (P<0.05). And the incidence rate of adverse events was similar between the 2 groups(P>0.05).
Tolvaptan seems to be able to correct SIADH-induced hyponatremia in relatively short time with little limits of fluid intake, wide range of application and low incidence of adverse events.
cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular disease. In 1946, Ecker first described that blunt craniocerebral trauma can cause sigmoid sinus thrombosis. Since then, only a few cases of CVST have been reported, and clinicians know little about the clinical characteristics, treatment and prognosis of the disease. From March 2013 to March 2016, five children with lateral sinus thrombosis after closed craniocerebral trauma were admitted to the Department of Neurosurgery of Shanxi Children's Hospital. Now, their clinical manifestations, imaging manifestations, treatment methods and prognosis are discussed in combination with literature reports.
To explore the role of extracellular signal regulated protein kinase (ERK) in sphingosine-1-phosphate receptor 1 (S1PR1)-mediated neural stem cell (NSC) proliferation in hippocampus following traumatic brain injury (TBI).
Rat model of TBI was induced by a controlled cortical impact device. A total of 112 Sprague Dawley rats were randomly and evenly divided into sham, TBI, TBI+ VPC and TBI+ U0126 groups according to random number table. Rats in TBI+ VPC group received 7 intraperitoneal injections of VPC23019 (S1PR1 antagonist) at scheduled time points following TBI. Rats in TBI+ U0126 group were intravenously administrated with U0126 (ERK inhibitor) via tail vein at 20 min before TBI. The levels of S1PR1, phosphate ERK (pERK) and total ERK (tERK) in hippocampus were determined by Western blot. NSC proliferation in subgranular zone of hippocampus was assessed by double-labeled immunofluorescence.
Compared with sham group, the expressions of hippocampal S1PR1 and pERK in TBI group were significantly increased, and the proliferation of NSCs in subgranular zone was activated at 7, 14 and 21 days after TBI (all P<0.05). However, compared with TBI group, both proteins were down-regulated and NSC proliferation was evidently inhibited in TBI+ VPC group (allP<0.05). In particular, the pERK expression and NSC proliferation in TBI+ U0126 group were significantly decreased (allP<0.05), whereas the level of S1PR1 maintained at the same level compared with TBI group (allP>0.05). In addition, the difference in tERK expression between the 4 groups was not statistically significant (allP>0.05).
Increased S1PR1 could trigger up-regulation of pERK expression and enhance NSC proliferation in hippocampus after TBI. Inhibition of ERK cascade could prevent S1PR1-mediated NSC proliferation in hippocampus. It is suggested that S1PR1 might regulate the proliferation of endogenous NSCs via ERK signaling pathway post trauma.
In 1988, vagus nerve stimulation (VNS) was first applied in clinical treatment of drug-refractory epilepsy. VNS is an intermittent vagus nerve stimulation by placing a nerve control assist system to achieve the therapeutic purpose. As a new technology, VNS has been paid more and more attention by neurosurgeons at home and abroad for its unique safety, long-term efficacy and tolerability[
Case 1 male, 78 years old. The main cause of right roof mass was admitted for 2 months. Physical examination showed a round-like mass with a diameter of about 3 cm on the top of the right skin, which was hard, reddish and movable. Local hair loss, hair follicles, sweat gland openings can be seen. The pupils on both sides are large and equally round, and they are sensitive to light reflection. Physical movement is normal. Chest CT showed left lung cancer and bronchitis (
moyamoya disease (MMD) is a common disease in neurosurgery. When MMD occurs clinically, even patients with intracranial blood supply in compensatory balance and no clinical symptoms are prone to cerebral ischemia or cerebral hemorrhage. Studies have found that cerebral hemorrhage in patients with MMD is mostly caused by rupture of intracranial aneurysm combined with MMD, and such cases were reported as early as 1973[
tardive dystonia (TD) is a dyskinesia caused by patients taking dopamine receptor antagonists. Its symptoms are persistent and irreversible, which seriously affects the quality of life of patients and may even cause disability. At present, drugs are mostly used to treat this disease, but the long-term efficacy of drugs is not ideal, and the adverse reactions are large and there is a risk of further aggravation of dystonia. At present, studies at home and abroad have pointed out that stereotactic surgery can obtain long-term and stable curative effect. This surgery can significantly improve the motor function and quality of life of patients with TD, and at the same time, it is also beneficial to improve the mental symptoms of patients. Therefore, stereotactic surgery may be a better treatment option for TD.
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