MedNexus
Volume 34 · Issue 05 · 2018
MedNexus
The "complexity and refractory treatment" of intracranial aneurysm is a relative concept, which depends on the cognition degree and the technical level of diagnosis and treatment of intracranial aneurysm in medical circles in different eras. From the earliest simple morphological description of Imhotep to today's in-depth mechanism research in molecular pathology and hemodynamics; From the simple carotid artery ligation for the treatment of intracranial aneurysms to the establishment of advanced multimodal treatment strategies and technological platforms today, the concept and type of "complex and refractory" intracranial aneurysms in the past have changed, and now they have become routine and general surgery. Nevertheless, the complexity and difficulty of treatment in the modern sense still lie ahead and need us to constantly challenge.
To investigate the epidemiological characteristics, clinical manifestations and treatment of intracranial aneurysms in infants.
From January 2010 to December 2016, 6 256 cases of intracranial aneurysms were consecutively admitted to Neurosurgery Department of West China Hospital of Sichuan University, 6 (0.1‰) of whom were less than 1 years old. Among them, the youngest was 2 months old and the oldest was 11 months old. We retrospectively analyzed medical records of the 6 patients with ruptured intracranial aneurysms. In those 6 cases, 5 patients were female, and 1 was male. The time of diagnosis in 6 cases was from 8 to 144 hours, and the primary symptom was vomiting in 4 cases. Convulsions were reported in 3 cases. All 6 cases had single aneurysms with mean diameter of 0.4-1.5 cm and included 1 with vertebrobasilar fusiform aneurysms (untreated) and 5 cases with cystic aneurysms from middle cerebral artery (MCA). Those 5 patients included 2 cases of pseudoaneurysms and all underwent craniotomy for aneurysm clipping.
All aneurysms were successfully clipped in 5 cases with MCA aneurysms. None of them had complications such as cerebral vasospasm, cerebral infarction, hydrocephalus, intracranial infarction or cerebrospinal fluid leakage. The postoperative follow-up lasted for 7-68 months and no residual or recurrent aneurysm was found in CTA examination. Their intellectual development was normal and the muscle strength in the limbs recovered obviously in 5 patients, of which 1 was grade Ⅳ and 4 were grade Ⅴ. The Glasgow outcome scale was used to assess the outcome which revealed Ⅳ-Ⅴ in the 5 patients.
The incidence of infantile intracranial aneurysms is very low which mostly occurs in MCA. Due to lack of specific demonstrations, delayed diagnosis might be common for ruptured intracranial aneurysms in infants. In addition, infants with ruptured intracranial aneurysms might have good outcomes following surgical treatment.
To evaluate the mid-term safety and efficacy of Pipeline embolization device (PED) in the treatment of complex intracranial aneurysms.
A retrospective analysis was conducted on the clinical data of 53 patients with 70 complex intracranial aneurysms who underwent endovascular interventional treatment at the Cerebrovascular Division of Interventional Department, People＇s Hospital of Zhengzhou University from January 2015 to October 2016. All patients were implanted with PED through the femoral artery under general anesthesia. Digital subtraction angiography (DSA) was performed at the end of the operation to examine the position and possible malposition of PED, and the CT scans were performed to assess intracranial hemorrhage. The CT or MRI scans were performed on day 5-7 post operation if necessary, and the modified Rankin Scores (mRS) were used to evaluate the prognosis of the patients. Clinical follow-up was performed at 3, 6, 12 and 24 months post operation and the prognosis was evaluated based on the mRS scores. The imaging follow-up was performed at 6, 12 months post operation, and the degree of aneurysm occlusion was graded by OKM (O＇ Kelly-Marotta) grading scale.
All 53 patients with 70 aneurysms were successfully implanted with 58 PEDs. Among them, 45 aneurysms were treated with PED alone and 25 aneurysms were treated with PED-assisted coil embolization. At the end of the operation, the DSA examination showed that PEDs were all accurately covered with the aneurysm necks and complete stent apposition was observed. No intracranial hemorrhage was revealed by CT scan. Perioperative complications occurred in 5 patients (9.4%, 5/53). At 5-7 days post operation, the CT or MRI scan showed subarachnoid hemorrhage in 1 patient, cerebral hemispherical swelling at PED-implanted side in 1 and acute cerebral infarction in 1. The mRS scores were assessed and they were 0 in 25 patients, 1 in 23, 2 in 1, 4 in 3 and 6 in 1. A total of 47 patients obtained clinical follow-up 10-30 months post operation with a median of 16 (14, 20) months. The mRS scores were 0 in 38 patients, 1 in 6, 2 in 1, 3 in 1 and 4 in 1. There were 43 patients (58 aneurysms) who obtained imaging follow-up 3-19 months post operation with a median of 6 (4.5, 10.0) months. The OKM scale of 58 aneurysms in 43 patients were assessed which indicated grade D in 34 patients, C in 9 and B in 15. Complete and subtotal occlusion was conducted for 43 out of 58 aneurysms (74.1%, 43/58) with no recurrence.
The treatment of complex intracranial aneurysms with PED seems safe and effective in mid-term follow-up and serious complications remain to be noted. Long-term safety and efficacy needs to be further studied.
To investigate the safety and efficacy of Pipeline embolization device (PED) in the treatment of large or giant intracranial carotid aneurysms.
A retrospective analysis was conducted on the clinical data of 12 consecutive patients with 13 intracranial carotid aneurysms who were treated with PED at Department of Neurosurgery, Sichuan Provincial People's Hospital from September 2015 to June 2016. Among them, 11 patients had 1 aneurysm and 1 had multiple aneurysms. The diameters of 13 aneurysms were 11.5-28.0 mm (18.6±5.1 mm). The aneurysm neck in all patients was manipulated with 1 PED, and 6 out of them were combined with coil embolization.
The Pipelines were successfully implanted in 12 patients with 13 aneurysms. Among them, PED was implanted in 7 aneurysms and PED combined with coil embolization was applied in 6. No procedure-related complications occurred during follow-up which demonstrated symptomatic relief in all cases. The angiography immediately after PED implantation showed Raymond grade Ⅱ in 4 aneurysms and grade Ⅲ in 9. Imaging follow-up was conducted for 10 patients at 6-12 months post surgery. MRA was performed in 2 patients 6 months and indicated no residual arterial aneurysm and remote patency. Eight patients with 9 aneurysms underwent DSA showing no relapse of arterial aneurysm. Based on the modified Rankin scale (mRS), the scores at discharge were 0 in 2 cases and 1 in 10 and the scores at last follow-up were 0 in 9 cases and 1 in 3. There was no disability or death reported in this series.
PED is safe and effective in the treatment of large and giant intracranial carotid aneurysms. The long-term efficacy remains to be confirmed by large-scale studies with longer follow-up.
To evaluate the effectiveness of revascularization in the treatment of complex anterior circulation aneurysms.
A retrospective analysis was conducted on 24 cases of complex anterior circulation aneurysms (29 aneurysms) who were admitted to Neurosurgery Department of Tianjin Huanhu Hospital from August 2011 to April 2017. Various techniques of revascularization were applied based on the positions of aneurysms. The internal carotid artery (ICA) occlusion and superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis were conducted in 8 cases, ICA constriction and STA-MCA anastomosis in 2 cases, external carotid artery (ECA)-radial artery (RA)-MCA anastomosis in 8 cases, MCA aneurysm resection and RA in situ anastomosis in 4 cases, and internal maxillary artery (IMA)-RA-MCA anastomosis plus aneurysm trapping in 2 cases. The patency of anastomotic vessels and postoperative complications were observed and the patients' prognosis are evaluated with modified Rankin scale (mRS).
All 24 cases successfully achieved the blood flow reconstruction. Among them, 6 cases had cerebral infarction after anastomosis and 1 case died of massive cerebral infarction. A total of 23 cases were followed up effectively. The follow-up lasted for 3-68 months post operation. No recurrence or rupture of aneurysms was found in the follow-up period. All the anastomotic vessels were patent and all aneurysms were shrunken or dissappeared.The score of mRS was 0 in 18 cases (78.3%), 1 in 3 cases (13.1%), 3 in 1 case (4.3%) and 6 in 1 case (4.3%).
Depending on the positions of aneurysms and collateral circulations, different revascularization techniques should be selected. Appropriate revascularization seems an effective method for treatment of complex anterior circulation aneurysms.
To investigate the microsurgical strategy and efficacy of paraclinoid aneurysms.
The clinical data of 20 patients with paraclinoid aneurysms were retrospectively reviewed who underwent microsurgical clipping from November 2015 to March 2017 at Neurosurgery Department of the First Affiliated Hospital of Chongqing Medical University. The operative methods included simple clipping and clipping of aneurismal neck and parent artery reconstruction. After the operation, the aneurysm clipping was examined by CTA or DSA, and the Glasgow prognosis score (GOS) was used to evaluate the clinical effect. All patients were followed up by outpatient clinic or telephone, and the GOS scale was used to assess the patient's prognosis.
All patients achieved satisfactory results. There was no aneurysm recurrence or rebleeding in this series detected by CTA or DSA. Only 1 case of unruptured aneurysm had a small residual neck after treatment. There was no death during the perioperative period. The GOS grade was Ⅴ in 13 cases, Ⅳ in 6 and Ⅲ in 1 at discharge. All patients were followed up for a period of 1-18 months, with an average of 10±6 months. The GOS grade was Ⅴ in 16 cases and Ⅳ in 4 cases.
Microsurgical clipping of paraclinoid aneurysm seems to be safe and feasible, which could have a favorable outcome.
To investigate the safety and efficacy of microsurgical clipping of ruptured fetal-type posterior cerebral artery (FPCA) aneurysms using supraorbital lateral approach.
Fifty-five patients were enrolled into this retrospective study and included 41 cases with aneurysms of regular shape, 11 with aneurysms of irregular shape and 3 with fusiform aneurysms. All those patients underwent microsurgical clipping of ruptured FPCA aneurysm using supraorbital lateral approach from July 2011 to June 2016 at Department of Neurosurgery, Affiliated Hospital of Southwest Medical University.
Fifty-five patients underwent microsurgical clipping of ruptured fetal PCoA aneurysm, of which 49 (89.1%) obtained complete clipping, 5 (9.1%) had residual neck and 1 (1.8%) had resicual sac. Six (10.9%) patients developed ischemic complications, of which 4 harbored sac aneurysms and 2 patients had irregular aneurysms. Three patients had poor outcome [5.5%, 3/55, modified Rankin Scale (mRS): 2-5]. Fifty patients received angiographic follow-up at 5-9 (6.7±1.0) months post operation and the results indicated recurrence in 2 patients. Fifty-two patients received clinical follow-up, of which 38 patients had the mRS of 0, 10 reported the mRS of 1, 3 reported 2 and 1 reported 4. The good outcome in our series was 92.3% (48/52). A total of 29 patients suffered from oculomotor paralysis including 13 with full recovery at the follow-up, 9 with partial recovery and 7 with no recovery at the final follow-up.
Microsurgical clipping of ruptured FPCA aneurysms using supraorbital lateral approach demonstrates safety and efficacy. The recurrence and procedure-related complications seem more frequent in patients with aneurysms of irregular shape than in those with aneurysms of regular shape.
To evaluate the risk factors in recurrence after embolization of anterior communicating artery (ACoA) aneurysms.
A total of 218 patients with ACoA aneurysms were enrolled into this retrospective study who were treated at Department of Neurosurgery, General Hospital of Shenyang Military Region from January 2014 to June 2016. Among them, 17 cases were treated with stent assisted embolization and 201 cases were treated with coil embolization. All patients were followed up at 3, 6, 12, 24 and 36 months post operation. The patients were followed up by cerebral angiography or CT angiography (CTA). Intracranial aneurysm embolization and recurrence rate were evaluated.
Out of 218 patients, 215 cases underwent complete embolization (no contrast agent filling in aneurysm) and 3 cases received subtotal embolization (contrast agent filling in the neck of the aneurysm). All 218 patients were followed up from 6 months to 3 years, with an average of 20.0±3.4 months. During the follow-up period, 17 cases (7.8%, 17/218) developed recurrence. Eleven cases received re-embolization. Two cases developed recurrence in the aneurysmal body and the families refused surgery. Four cases developed recurrence in the aneurysm neck and were followed-up with operation. There were 4 cases of hemorrhage reported in the patients with recurrence. Univariate analysis showed that the age, aneurysm size and unilateral advantage of blood supply or unilateral blood supply were related to the recurrence (all P<0.05).
Recurrence of ACoA aneurysm could be related to the patient’s age, size of aneurysm and unilateral advantage of blood supply or unilateral blood supply in the brain.
To investigate the anatomic classification and therapeutic strategy of the middle cerebral artery (MCA) bifurcation aneurysms.
A retrospective analysis was conducted about the clinical data of 118 patients with MCA bifurcation aneurysms treated at Department of Neurosurgery, Linyi People's Hospital from January 2013 to July 2016. According to the way of treatment, all subjects were divided into the ligation group (66 cases) and intervention group (52 cases). Based on the imaging data, the patients were divided into classical type (46 cases), unilateral type (49 cases) and double- or multiple-trunks-involved type (23 cases). The treatment outcome was assessed using the modified Rankin scale (mRS) and compared between different groups.
Among the 46 patients with classical type of MCA bifurcation aneurysms, 27 underwent ligation and the mRS scores were 0-2 in 20 cases and 3-5 in 7; 19 patients accepted interventional embolization and their mRS scores were 0-2 in 14 cases and 3-5 in 5. There was no statistically significant difference in clinical outcomes between the groups of surgical ligation and endovascular treatment (P >0.05). Among the 49 patients with unilateral type of MCA bifurcation aneurysms, 21 underwent surgical ligation and the mRS scores were 0-2 in 11 cases and 3-5 in 10; 28 underwent interventional embolization and their mRS scores were 0-2 in 23 cases and 3-5 in 5. The clinical outcome of interventional embolization was better than that of surgical clipping ( P<0.05). Among the 23 patients with double- or multiple-trunks-involved type of aneurysms, 14 patients underwent surgical clipping and the mRS scores were 0-2 in 7 cases and points and 3-5 in 7; 9 patients underwent endovascular embolization and the mRS scores were 0-2 in 4 cases and 3-5 in 5. The clinical effect of surgical clipping was better than that of interventional embolization (P<0.05).
For classical type of MCA bifurcation aneurysms, the 2 treatment methods had not significantly difference in the outcome. For unilateral type of MCA bifurcation aneurysms, the prognosis of interventional embolization seems better than that of surgical clipping. Surgical clipping might be more advantageous for double- or multiple-trunks-involved type aneurysms.
To investigate the safety and efficacy of endovascular treatment of distal inferior cerebellar artery (PICA) aneurysms.
This retrospective study included 42 cases of distal PICA aneurysms admitted to Department of Neurosurgery, West China Hospital of Sichuan University from January 2008 to June 2015. Among those, 38 cases had ruptured aneurysms and were graded I-III at admission based on the Hunt-Hess classification. Narrow-necked saccular aneurysms were reported in 28 cases, wide-neck saccular aneurysms in 6 and fusiform aneurysms in 8 cases. In 37 cases, aneurysms were treated with coiling and 5 cases were occluded with Onyx.
All 42 patients were successfully treated. Among the 37 patients with coil embolization, 31 (83.8%) had complete embolization and 6 (16.2%) had subtotal embolization. One patient died of rebleeding 2 days after surgery. Three patients had dysphagia after surgery and recovered at 6 months. In 1 case, asymptomatic localized medullar infarction occurred with obstruction of the distal trunk by Onyx. Follow-up imaging was performed in 28 patients and lasted for 3-15 months (median duration: 8.2 months). Aneurysms recurred in 3 (7.1%) patients.
Endovascular treatment seems an effective and safe way for distal PICA aneurysms.
To investigate the surgical strategy and evaluate the surgical results of acoustic neuroma resection through suboccipital retrosigmoid approach.
A total of 319 cases of acoustic neuromas underwent surgical resection through suboccipital retrosigmoid approach at Neurosurgery Department, Changzheng Hospital, Naval Military Medical University from January 2007 to December 2017 and retrospectively reviewed and analyzed in this study. Electroneurophysiological monitoring was conducted during the whole course of operation. Postoperative facial nerve function was assessed based on House-Brackmann (H-B) scale.
Among all 319 cases, 291 (91.2%) tumors were totally or subtotally resected and 28 (8.8%) were partially resected. 221 (69.3%) patients did not develop any postoperative complications and 39 (12.2%) had intracranial infections, 11 (3.5%) reported intracranial hematoma, 10 (3.1%) had choke on water, 10 (3.1%) had cerebrospinal fluid leakage, and 3 (0.9%) died. A total of 262 patients were followed up for 3-89 months (median: 42 months). At 3-6 months post operation, the assessment of facial nerve function indicated grade Ⅰ in 148 (56.5%) cases, grade Ⅱ in 72 (27.5%) cases, grade Ⅲ in 26 (9.9%) cases and grade Ⅳ in 16 (6.1%) cases. There were 5 (1.9%) cases of tumor recurrence and 1 death reported during follow-up.
Microsurgical resection through suboccipital retrosigmoid approach combined with electroneurophysiological monitoring appears to be safe and effective for the treatment of acoustic neuromas with a relative low recurrence rate.
To investigate the role of iFlow and PBV (perfusion blood volume) imaging in preoperative embolization of hypervascular meningiomas.
A total of 21 cases of hypervascular meningiomas were admitted to Department of Neurosurgery, Nanjing General Hospital of PLA from June 2015 to June 2017 and were retrospectively reviewed. All patients underwent digital subtraction angiography (DSA). The iFlow and PBV softwares were used for imaging post-processing to evaluate the blood supply of tumors. Among them the cases, classified as Manelfe type Ⅰ or type Ⅱ, underwent embolization, while the remaining cases, classified as Manelfe type Ⅲ did not undergo embolization. The tumor resection was performed 1-3 days post interventional therapy.
The iFlow and PBV imaging in 21 patients showed that the blood supply was extremely rich in the tumors. Among them, 17 cases had no obvious arterial blood supply or staining within the tumor after selective vascular embolization, while the other 4 patients did not undergo embolization. The average amount of bleeding was 544±276 ml in the patients with embolization and 975±171 ml in those without embolization. The difference was statistically significant (P=0.008). Multiple linear regression analysis revealed that preoperative embolization was an independent factor in intraoperative blood loss (F=8.774, R2=0.316, P=0.008). All 21 cases achieved total excision (Simpson grade Ⅰ). None of the patients had serious complications associated with embolization or tumor resection.
The application of iFlow and PBV imaging helps to clearly show the blood supply of hypervascular meningiomas which could facilitate the decision making of preoperative embolization, improve the rate of total resection and reduce the incidence of complications.
To evaluate the clinical outcomes of patients with lumbar disc herniation undergoing percutaneous endoscopic interlaminar discectomy (PEID).
A retrospective study was conducted on the clinical outcomes of 20 patients with lumbar disc herniation who underwent PEID at Department of Functional Neurosurgery, Xuanwu Hospital of Capital Medical University from August 2015 to December 2016. The visual analog scale (VAS), Oswestry disability index (ODI) and MacNab criteria were applied to evaluate the surgical effects.
The operation was successfully completed in all patients.The follow-up duration was 12 months. Postoperative VAS and ODI at 1 week, 1 month, 3 months, 6 months, 12 months were all significantly decreased compared to preoperative levels(all P<0.001). According to MacNab criterion, the excellent-to-good ratio was 80% (16/20). One patient presented transient postoperative numbness. No infection, recurrence, nerve root injury or other complications occurred. MRI was performed after operation to confirm that the protruding nucleus pulposus was removed completely.
Percutaneous endoscopic interlaminar lumbar discectomy could treat lumbar disc herniation safely and effectively.
To investigate the clinical efficacy of carotid endarterectomy (CEA) in the treatment of extremely severe symptomatic carotid artery stenosis (stenosis rate 95%-99%).
The clinical data of 30 patients with extremely severe symptomatic carotid artery stenosis were analyzed retrospectively. Those patients were admitted to Department of Neurosurgery, the First Affiliated Hospital of Soochow University between January 2013 and December 2016. Among them, 14 cases underwent conventional CEA, 11 cases received patch CEA and 5 cases underwent eversion CEA. Cerebral hemisphere perfusion was evaluated with CT Perfusion (CTP) and cerebrovascular collateral circulation was evaluated with DSA or CTA.
All 30 cases of CEA were performed successfully. CTP was reviewed at 1 week post surgery and all patients had a higher CBF (cerebral blood flow) compared with presurgical states (65.1±8.9 ml·100 g-1·min-1vs. 48.5±5.1 ml·100 g-1·min-1,P<0.05), and the TTP (time-to-peak) was significantly shorter than that prior to surgery (9.8±2.8 s vs. 13.4±1.6 s, P<0.05). After operation, 3 cases suffered from hyperperfusion syndrome. There was no perioperative stroke or death. The duration of follow-up was 3-48 months (mean: 20±12 months). No patient developed a new stroke.No reocclusion was detected.
CEA seems to be a safe and effective treatment for extremely severe symptomatic carotid artery stenosis.
To identify the influencing factors of residual stenosis after carotid artery stenting (CAS).
A total of 568 patients with severe carotid stenosis (stenosis rate ≥70%) underwent CAS with 568 stents at Xuanwu Hospital of Capital Medical University from January 2013 to December 2015 and were retrospectively enrolled into this study. All patients were examined by CDFI (color Doppler flow imaging) within 1 month before CAS and 1 week after stenting. The residual stenosis was defined as the rate of stenosis greater than or equal to 30% by DSA and CDFI. The influencing factors of residual stenosis such as the location of carotid stenosis, characters of plaque (morphologically regular or not, with calcification or not), types of carotid stents (closed or open cell), rate of stent expansion (ratio of radial and axial expansion) were analyzed.
The incidence of residual stenosis post procedure was 22.5% (128/568). Multiple logistic regression analysis showed that irregularly shaped plaques (odd ratios: 6.77, 95% CI: 3.85-11.89, P=0.00), the plaques with calcification (odd ratios: 3.42, 95% CI: 2.09-5.59, P=0.00) and closed loop stent (odd ratios: 1.62, 95% CI: 1.06-2.47, P=0.02) were independent risk factors for residual stenosis after CAS. The radial expansion rate was also the independent risk factor of residual stenosis after CAS (odd ratios: 0.15, 95% CI: 0.10-0.23, P=0.00). The larger radial expansion rate, smaller residual stenosis after CAS, location of carotid stenosis, length and axial expansion rate of stent had no correlation with residual stenosis after CAS (all P>0.05).
This study suggests that choosing more adaptable stents based on the stent types and characteristics of plaques and trying to increase the radial expansion of stenting may help decrease the incidence rate of residual stenosis.
To investigate the value of intraoperative MRI (iMRI) and microelectrode recording (MER) in the deep brain stimulation (DBS) of subthalamic nucleus (STN) for the treatment of Parkinson＇s disease.
A total of 65 patients with Parkinson’s disease treated with STN-DBS were enrolled in this retrospective study including 54 cases of bilateral operations and 11 cases of unilateral operations. A total of 119 leads were implanted. The iMRI and 1-week postoperative MRI as well as intraoperative MER were applied.
Two leads were found to be obviously deviated from the planned targets by iMRI and were then re-implanted. No intracranial hemorrhage was found by iMRI scanning. The MRI taken 1 week post operation showed that 50 of 119 (42.0%) leads were away from planned targets (1-2 mm) in X axis and Y axis and 12 (10.1%) leads were as deep as 3 mm in the z axis. Minor hemorrhage in 5 sides and localized brain edema in 14 sides were found near the lead tips. Obvious brain edema on 1 side was found surrounding the lead by the MRI taken 1 week post operation. In bilateral operation, the number of MER tracks at the first operation side (right) were 1~3 tracks (63 tracks in total), and the number of MER track at the posterior operation side (left) were 1~5 tracks (90 tracks in total) (P=0.018). There was no significant difference in start-up voltage and UPDRS-III improvement rate between different groups in terms of electrode deviation at 1 month after operation(P=0.964, P=0.130), and there was no correlation between electrode deviation and UPDRS-III improvement rate(r=0.006, P=0.968). There was a correlation trend between the electrode deviation and the start-up voltage.
The techniques of iMRI and MER can be safely applied in DBS procedures. The iMRI could help discover apparent lead shift and complications timely and MER may facilitate the real-time fine adjustment of lead position. The electrode deviation of less than 2 mm might not affect the therapeutic effect, which, however, might needs higher stimulation voltage.
To create a three-dimensional model of the craniocervical junction region for physicians to learn the regional anatomy.
Continuous thin sections on coronary plane were performed with freezing milling technique on a cadaveric head. Following segmenting, labeling and extracting in serial sections, we completed the three-dimensional reconstruction of the craniocervical junction region.
A total of 750 thin coronary sections were obtained. Based on 750 thin coronary sections, the three-dimensional reconstruction of the craniocervical junction region was completed, which was very realistic and could be rotated, zoomed and segmented.
The three-dimensional model of the craniocervical junction region can display the anatomical characteristics, which is useful for surgeons to understand its anatomy and serve as a base for approach choice and a tool for operative simulation.
To investigate changes of hippocampus-related brain functions in children following resection of the third ventricle tumors through transcallosal interforniceal approach.
Nine children with the third ventricle tumors were randomly selected at Department of Neurosurgery, Tsinghua University Yuquan Hospital. Resting state functional MRI (rs-fMRI) was scanned for all patients before and after operation. Multiple aspects, including regional homogeneity (ReHo), ALFF (amplitude of low frequency fluctuations), fALFF (fractional ALFF) and changes of function connectivity [DMN (default mode network) and hippocampus as ROI (region of interest)] were compared before pre- and post-operative states.
(1) At 1 month post operation, the decreased ReHo was observed in the left superior frontal cortex, while the elevated ReHo was seen in the right middle occipital gyrus, middle temporal gyrus and left central gyrus compared with pre-operative conditions. The elevated ReHo was in the left superior temporal gyrus and right central frontal gyrus at 2 months post operation compared with that at 1 month after operation. There was no difference of ReHo between 2 months after operation and preoperative state. (2) At 1 month post operation, decreased ALFF was in occipital lobe, while increased ALFF was observed in regions around surgical pathway. ALFF restored to preoperative state at 3 months post operation. (3) Decreased fALFF was shown in frontal lobe and occipital lobe after operation. At 3 months post operation, the fALFF restored to preoperative state. (4) The contact between bilateral frontal gyri and other brain areas was elevated at 1 month post operation and recovered to preoperative state at 3 months. Surgery had an effect on the connections between hippocampus and the whole brain.
The short-term effect of transcallosal interforniceal operations on ReHo, ALFF and fALFF in the brain regions of patients could recover to preoperative state with time. The operation may not interrupt the connections between DMN and hippocampus-related brain areas.
To explore the quality of life and its influencing factors in patients with unruptured cerebral arteriovenous malformation (UCAVM).
A retrospective inclusion was conducted to analyze 34 patients of untreated UCAVM who were admitted to Department of Neurosurgery, General Hospital of Shenyang Military Command from January 2005 to December 2015 (UCAVM group). During the same period, 40 health controls undergoing physical examination at our hospital were enrolled to this study (control group). All subjects were investigated in the form of face-to-face interviews with the same physician. The content of survey was based on SF-36 health survey scale to assess the quality of life of all subjects. The difference in the quality of life between the UCAVM and control groups was studied and multivariate linear regression was used to analyze the clinical factors affecting the patients’ quality of life in UCAVM group.
There was no statistical significance in age, sex, years of education or monthly household per capita income between the 2 groups (P>0.05). The scores of vitality (P<0.001), social functioning (P=0.001), emotional functions (P=0.024), mental health (P<0.001) and mental component summary (P<0.001) in UCAVM group were all lower than those in control group, which suggested that the patient’s mental health was damaged. There was no statistical significance in the difference of physical functioning (P=0.114), role physical (P=0.845), bodily pain (P=0.356), general health (P=0.512) or physical component summary (P=0.299) between the 2 groups, which suggested that there was no obvious change in physical health. Multiple linear regression analysis showed that headache and epilepsy were main factors affecting the mental health score of UCAVM group (both P<0.001).
Patients harboring untreated UCAVM may have reduced quality of life which was mainly reflected in mental health and involved headache and epilepsy as main influencing factors.
To investigate the effect of xanthohumol on the biological activity of prolactinoma MMQ cells.
MMQ cells were divided into drug group and control group. The cells in drug group were treated with various concentrations of xanthohumol (low dose: 0.1μmol/L, middle dose: 1μmol/L, high dose: 10 μmol/L), and those in control group was treated with equal volume of dimethyl sulfoxide (DMSO). The proliferation of MMQ cells was determined by MTS experiment, and the apoptosis levels by Annexin V/PI and reactive oxygen species (ROS) levels by DCFH-DA experiment. The expressions of genes and proteins related to invasion were measured by RT-PCR and western blot.
Xanthohumol effectively inhibited the proliferation of MMQ in a dose-dependent and time-dependent manner. The cell viability was reduced 4%, 15% and 19% after 24 hours of xanthohumol treatment, and 8%, 18% and 36% after 48 hours, and 17%, 38% and 52% after 72 hours. After 24 hours of xanthohumal treatment, Annexin V positive cells accounted for 4.2%, 12.1% and 16.7% among total cells, and propidium iodide (PI) positive cells were 3.8%, 6.7% and 9.2%. The mRNA levels of E-Cadherin in drug group were 1.34±0.43, 2.93±0.78 and 5.33±1.21 folds of those in control group, and protein levels of E-Cadherin were 1.80±0.16, 3.20±0.45 and 3.6±0.53 times higher than those in control (P<0.01). The mRNA levels of VEGF (vascular endothelial growth factor) in drug group was 0.79±0.37, 0.33±0.17 and 0.18±0.12 folds of those in control group, and the protein levels were 0.52±0.11, 0.43±0.13 and 0.22±0.07 folds of those in control (P<0.01). Xanthohumol significantly increased ROS in MMQ cells, and the mean fluorescence intensity in high-dose group was approximately 3.40±0.56 folds of that in control (P<0.01).
Xanthohumol could induce apoptosis and inhibit the expression of genes related to invasion of MMQ cells, which involves the mitochondrial dysfunction.
To investigate the influence of age on prognosis of intracerebral hemorrhage (ICH) in the mouse model.
Male C57 mice of 8 weeks old and 52 weeks old were divided into 4 groups: ICH group and sham-operated group for each age stage (n=6 in each group). Blood pressure was measured by noninvasive tail-cuff method. Experimental ICH was induced in mice by injection of autologous blood in the corpus striatum, the sham-operated group required only a needle injection into the corpus striatum. MRI scan was implemented 1 day and 3 days post operation to determine whether the model was successful. Modified neurologic severity scores (mNSS) were used to evaluate the neurological deficits of mice at 1, 3, 7 and 14 days post ICH. The survival of the 4 groups of mice was documented and Kaplan-Meier survival analysis was performed. HE (haematoxylin & eosin) staining was performed on the 4 groups of mice at 1 day and 3 days post modeling. Texas Red dye-labeled dextran was injected through the tail of the mice. The area of dye exudation in the brain was used to reflect the permeability of the blood brain barrier (BBB).
The pulse pressure of 52-week-old mice was significantly higher than that of 8-week-old mice [41.6±5.9 mmHg vs. 26.8±5.0 mmHg, P=0.003]. MRI scan revealed hematoma in the striatum of ICH group at 1 day and 3 days post modeling. The volume of hematoma was significantly increased compared with sham-operated group (P<0.05), which indicated that the model of ICH was successful. HE staining showed that hematoma was present at 1 day and 3 days post ICH modeling and there were different degrees of inflammatory cell infiltration in surrounding areas. Texas Red dye-labeled dextran exudation area at 1 day post ICH modeling was larger than that at 3 days post modeling (P=0.002). The differences in hematoma volume shown by MRI scan, neurological function scores at different time points, survival time, hematoma area assessed by HE staining and Texas Red dye-labeled dextran exudation area reflecting BBB permeability between the 2 age groups were not statistically significant (all P>0.05).
The age might not be associated with the prognosis of ICH in the mouse model.
eating epilepsy (EE) belongs to reflex epilepsy (RE) and is a rare epileptic syndrome. EE has a poor response to anti-epileptic drugs, and the risk of hemiplegia caused by surgical treatment of EE of central tegus origin is high. EE is a difficult treatment point in epilepsy surgery. The Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University treated a patient with EE in March 2014, and was treated with vagus nerve stimulation (VNS). The follow-up was 3 years and 6 months, and the postoperative epilepsy remission rate reached 87.5%. Combined with relevant literature, the symptomatic characteristics, pathogenic mechanism and neuromodulation therapeutic effect of EE are summarized and reported as follows.
A distal anterior choroidal artery (AChA) aneurysm refers to an AChA aneurysm that is entirely located in the AChA, not the internal carotid artery. The aneurysms are mostly secondary aneurysms, usually combined with moyamoya disease or local cerebrovascular malformation[
The rapid development of modern neurosurgery is closely related to high-tech innovation. From the advent of CT and surgical microscope in the 1970s, to magnetic resonance imaging (MRI) in the 1980s, and surgical navigation technology in the 1990s, they are all great driving forces to promote the development of neurosurgery. Due to the particularity of nervous system diseases and the non-regenerability of nervous tissue, neurosurgeons have always pursued the accuracy and minimally invasive nature of surgery for a long time; At the same time, neurosurgeons are a new force in transforming high-tech into clinical medicine. Some high-tech new technologies have been quickly adopted clinically once they appear, such as surgical microscope, surgical navigation, etc. In contrast, the application and development of spinal spinal surgical navigation is relatively slow, which is related to the following factors: (1) Poor accuracy of surgical navigation. (2) Surgical login is time-consuming. (3) Real-time X-ray verification is still needed during operation. (4) Increased cost and prolonged operation time, etc. This article reviews the progress in the application of surgical navigation in spinal cord diseases.
Epilepsy is a central nervous system disease caused by abnormal neuronal discharge. It has the characteristics of seizure, transience, repetition and stereotype, which seriously endangers the physical and mental health of patients[
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