MedNexus
Volume 35 · Issue 09 · 2019
MedNexus
Endovascular therapy has become an important method for the treatment of intracranial aneurysms in recent 20 years. With the in-depth research on the healing mechanism of aneurysm, the concept of aneurysm treatment has changed from simple "intratumoral tamponade" to "vascular remodeling" and "blood flow remodeling" of tumor-bearing artery. Among them, "blood flow remodeling" has shown great advantages in the treatment of aneurysms by improving the hemodynamics of the tumor neck to promote the repair of the tumor-bearing artery and the healing of aneurysms. With the improvement of the performance of blood flow guiding devices, the progress of technology and the accumulation of experience, "blood flow remodeling" will be an inevitable trend in the treatment of aneurysm.
Stroke is one of the major diseases that cause human death and disability. The incidence of stroke in China is increasing year by year. According to the national stroke screening data, the standardized incidence of first-time stroke among residents aged 40-74 increased from 189/100,000 in 2002 to 379/100,000 in 2013, with an average annual increase of 8.3%[
To clarify the indications, technical essentials and complication preventing strategies concerning the telescoping flow diverter devices technique by summarizing our premilitary experience in treatment of cervical and intracranial aneurysms using this technique.
Fifteen cases with 15 cervical and intracranial aneurysms treated with telescoping flow diverter devices at Department of Neurosurgery, Changhai Hospital, Navy Military Medical University from August 2010 to April 2019 were retrospectively reviewed. Five aneurysms were treated with Pipeline embolization devices (PED) and 10 with Tubridge flow diverters using telescoping technique. Among all aneurysms, 7 were treated in intended manner, while 8 aneurysms were treated in salvaging purpose. In 9 patients, the first flow diverter was deployed distally, followed by a second flow diverter deployed proximally in the parent artery (D-P manner), while in the remaining 6 patients, the first flow diverter was deployed proximally, followed by deployment of a second flow diverter (P-D manner). Coiling was also performed in 11 patients. Modified Rankin scale (mRS) was used to comprehensively evaluate the patients after surgery, and O′kelly-Marotta (OKM) grading scale was to evaluate aneurysm embolization.
The techniques were succeeded performed in all patients. Contrast stasis was observed in 14 aneurysms immediately post procedure. According to OKM grading scale, 7 were categorized as OKM grade A, 7 as grade B and 1 as grade C. No procedure-related complications were encountered. In 10 patients who had DSA follow-up lasting for 6-30 (median: 12) months, 7 aneurysms were totally occluded (OKM grade D), while further thrombosis was observed in the other 3 aneurysms (OKM grade B in 1 and grade C in 2). The parent arteries were patent in all except for 1 patient who developed occlusion at 9 months postoperatively. All patients were clinically followed up for 2-30 (median: 12) months. During that period, no new neurological deficits were revealed (mRS: 0-2), except for that 1 patient developing contralateral hemiplegia (mRS: 3).
Telescoping flow diverter devices could be used to treat complicated cervical and intracranial aneurysms safely with good short-term effect. It should be considered with priority in treatment of large, giant or fusiform aneurysms with extremely wide neck.
To investigate the efficacy and complications of Pipeline embolization device (PED) in the treatment of unruptured aneurysms beyond the circle of Willis.
A retrospective study was conducted on the clinical data of 14 patients with unruptured aneurysms beyond the circle of Willis treated with PED at Department of Interventional Neuroradiology, Beijing Tiantan Hospital , Capital Medical University (n=11) and Department of Neurosurgery, Beijing Tsinghua Changgung Hospital (n=3) from January 2016 to January 2019. Among those, 10 cases underwent PED implantation and 4 underwent PED-assisted coiling. Each case among the 14 patients had a single aneurysm. Eleven cases underwent first treatment and 3 were recurrent cases. Modified Ranking scale (mRS) was used to comprehensively evaluate the patients after surgery. Patients were followed up radiographically at 6, 12 and 24 months post surgery, and the O' kelly-Marotta (OKM) grading was used to evaluate aneurysm embolization.
A total of 17 PEDs were implanted in 14 patients, all of which were successful. Immediate postoperative cerebral infarction was observed in 2 patients (1 case of ACoA dissecting aneurysm and 1 case of MCA M1 dissecting aneurysm), and the symptoms were improved after medication. One patient with MCA M1 dissecting aneurysm ruptured at 9 h post surgery and died after treatment. At discharge, there were 11 patients with good postoperative neurological function (mRS: 0-1) and 2 patientswith neurological dysfunction (mRS: 3). There were 12 patients who obtained follow-up post operation with an average follow-up duration of 3.0-6.0 (4.7±1.4) months. At last follow-up, the mRS scores were 0 in 11 cases and 1 in 1 case. Angiographic follow-up showed that 9 of the 12 aneurysms in the 12 patients were completely occluded and 3 had residual neck. All the 3 patients with recurrent aneurysms revealed complete embolization at 6-month follow-up post operation.
PED is generally safe and effective in the treatment of unruptured aneurysms beyond the circle of Willis which could have a good therapeutic effect on recurrent unruptured aneurysms beyond the circle of Willis. However, it might be associated with relatively high risk in treatment of MCA aneurysms.
To evaluate the safety and efficacy of flow diverter (FD) in the treatment of vertebral artery dissecting aneurysms (VADA).
The clinical and imaging data of perioperative period and follow-up were retrospectively collected and analyzed from 22 patients with VADA treated with FD at Department of Neurosurgery, Changhai Hospital, Navy Medical University from August 2010 to March 2019. Of the 22 aneurysms, 4 were recurrent aneurysms, 1 was acute ruptured aneurysm and 17 were unruptured aneurysms. Modified Rankin scale (mRS) was used to comprehensively evaluate the patients after surgery, and O＇kelly-Marotta (OKM) grading scale was to evaluate aneurysm embolization.
All 24 FDs were implanted successfully in 22 VADA (with 19 Tubridge FDs and 5 Pipeline FDs). The technical success rate was 100%. Ten aneurysms were treated with FD combined with coil embolization. The immediate results of embolization were classified according to Raymond′s classification, with 2 cases of grade Ⅱ and 8 cases of grade Ⅲ. Twelve aneurysms were treated with only FD and significant intra-aneurysmal contrast hemostasis was retained immediately after operation in all 12 cases. No procedure-related hemorrhagic or ischemic complications occurred during the perioperative period. As for clinical follow-up 13.0(8.3-67.9)months, 22 patients had the mRS score of 0. No novel neurological deficits were reported. The short-term imaging follow-up at 6.0(4.7-7.1)months involved 20 cases and the complete occlusion rate was 13/20. The complete occlusion rates were 17/20 for last follow-up at 7.7(6.0-24.4) months and 8/8 for long-term follow-up at 26.5(23.3-31.4) months, respectively. No recurrence was demonstrated. Eight PICAs covered by FD and 3 PICAs harboring aneurysms were all patent during follow-up. One case developed severe in-stent stenosis at 3.5-month follow-up post FD placement in which balloon dilatation and angioplasty with stenting was performed. Twenty-two months later, the stenosis of the lumen returned to normal and the aneurysm was completely occluded.
FD treatment of VADA seems to have high surgical safety and satisfactory results. Long-term efficacy needs to be further evaluated in large case series.
To evaluate risk factors for acute ischemic stroke following treatment of paraclinoid aneurysms using flow diverters.
Between September 2015 and July 2018, 205 consecutive patients with 229 paraclinoid aneurysms were treated with Pipeline embolization device (PED) at Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University. The aneurysm size and parent artery size were measured. According to the length, proximal and distal diameter of the parent artery, appropriate size of PED was deployed with or without coiling. Various potential risk factors associated with acute ischemic stroke following PED treatment were documented. Univariate and multivariate logistic regression analyses were applied to identify risk factors.
Among the 205 patients with 229 paraclinoid aneurysms, 110 aneurysms were treated by PED and 119 aneurysms received PED with coiling, all PED were delivered and implanted successfully. Eighteen (8.8%) patients with 20 aneurysms had acute ischemic stroke after PED deployment. Univariate analysis suggested that ADP inhibition, high MA-ADP value, clopidogrel non-response, application of complex intraoperative techniques, and long operation time were associated with the acute ischemic stroke following PED treatment (all P<0.05). Further multivariate logistic regression analysis showed the clopidogrel non-response (OR=6.161, 95% CI: 1.480-25.649, P=0.012), application of complex intraoperative techniques (OR=8.405, 95% CI: 1.437-49.146, P=0.018) and operation time (OR=1.011, 95% CI: 1.002-1.020, P=0.022) were independent factors for acute ischemic stroke following PED treatment.
Clopidogrel non-response, application of complex intraoperative techniques and long operation time may increase the risk of ischemic events.
To evaluate the safety and efficacy of Tubridge flow diverter (TFD) in the treatment of intracranial aneurysms at a single center.
The clinical and angiographic data of 139 patients harboring 143 aneurysms treated with TFD between August 2010 and December 2018 at Department of Neurosurgery, Changhai Hospital, Naval Medical University were retrospectively collected and analyzed. Among them, 127 lesions were located in anterior circulation and 16 in posterior circulation. The size of the aneurysms ranged from 2.8-50.0 mm, with the mean size of 16.4 ± 9.2 mm. Clinical and angiographic follow-up were preformed conventionally after treatment with TFD. The clinical outcomes of the patients were evaluated using modified Rankin Scale (mRS).
Among the 139 patients with 143 intracranial aneurysms, a total of 163 TFD were delivered and implanted successfully. Three patients had acute ischemic stroke after TFD deploymnet.And there were no bleeding complications and no death. The median clinical follow-up time of 109 patients was 29.6 months (range: 5 to 82 months). The mRS of 0 was obtained in 97 patients, mRS of 1 in 10 and mRS of 2 in 2. Procedure-related complications occurred in 3 patients. Angiographic follow-up data were available in 103 patients. The median follow-up time was 13.0 months (range: 6 to 80 months). The complete occlusion rates at 6 months, 12 months, 24 months and last follow-up were 75.7% (78/103), 83.5% (66/79), 92.3%(48/52) and 82.5% (85/103), respectively.
Tubridge flow diverter seems safe and effective in the treatment of intracranial aneurysms with relatively high success rate and few complications.
To investigate the short-term efficacy of Pipeline embolization device (PED) in the treatment of complex intracranial aneurysms.
A retrospective analysis of clinical data was conducted on 37 patients who underwent endovascular treatment with PEDs at Neurosurgery Department of Nanfang Hospital, Southern Medical University from January 2018 to March 2019. There were 45 aneurysms in 37 patients (including 7 cases with tandem wide-necked small aneurysms) which were distributed in internal carotid artery (38 cases), vertebral artery (3 cases), middle cerebral artery (3 cases) and anterior cerebral artery (1 case). The maximum diameter of aneurysm ranged from 2.0 to 34.8 mm. In this series, the diameters in 22 aneurysms were no longer than 10 mm and those in the other 23 aneurysms were larger than 10 mm. The modified Rankin scale (mRS) was used to evaluate the prognosis.
A total of 37 PEDs were placed for 37 patients with 45 intracranial aneurysms in this study (Pipeline Flex stent-assisted embolization performed in 13 cases and stent-only treatment in 24). Retentions of contrast agent in the aneurysm cavity were detected by immediate postoperative radiography for 37 aneurysms, which showed that the aneurysm-bearing arteries were smooth and had no stenosis. All PEDs were well attached according to DynaCT fusion 3D reconstruction. Perioperative complications occurred in 11 patients, among whom 2 died. There were 35 patients followed-up for 1 month after discharge and no neurological symptoms were observed.
The treatment of complex intracranial aneurysms with PEDs is relatively safe and effective. Further optimization may still be needed for the perioperative anti-platelet aggregation regimen.
To investigate the efficacy and safety of domestic Tubridge flow diverter in the treatment of unruptured intracranial aneurysms.
From April 2018 to January 2019, data were collected from 23 patients with 33 unruptured intracranial aneurysms admitted to Department of Neurosurgery, People′s Hospital of Zhengzhou University. All patients were treated with domestic Tubridge flow diverter. Among them, 28 aneurysms were treated with Tubridge alone and 5 were treated with Tubridge combined with coiling. Digital subtraction angiography (DSA) was used to evaluate the conditions of stent implantation. The efficacy of emobolization was evaluated by Raymond classification.Clinical outcomes were assessed based on the modified Rankin scale (mRS).
The success rate of stent implantation was 96% (26/27). Ischemic postoperative complications occurred in 2 cases. All patients were followed up for 6 months. DSA results from 5 patients with 11 aneurysms showed that 8 aneurysms were completely occluded and non-symptomatic stenosis of parent artery was found in 1 case. The mRS score was 0 in 21 cases, 1 in 1 case and 2 in 1 case.
The short-term effect of Tubridge flow diverter in the treatment of unruptured intracranial aneurysms seems to be satisfactory with low postoperative complication rate.
To explore the prognostic value of 11C-methionine positron emission tomography/CT (MET-PET/CT) combined with MRI in patients with diffuse intrinsic pontine glioma (DIPG).
A total of 41 patients clinically suspicious of DIPG admitted to Department of Neurosurgery of Beijing Tiantan Hospital, Capital Medical University from March 2016 to June 2017 were prospectively included and underwent MET-PET/CT scan and brain MRI. The measurements on MET-PET/CT included tumor metabolic volume (MTV), maximum standardized uptake value (SUVmax) and mean standardized uptake value (SUVmean), while those on MRI enhancement volume (EV) and FLAIR displayed volume (FV). The EV/MTV values were also calculated for analysis. Within 2 weeks after imaging, 33 patients underwent tumor resection, and the remaining 8 underwent stereotactic biopsy. Postoperative radiotherapy and/or chemotherapy were performed in 27 patients. Cox regression analysis was used to analyze the effects of MET-PET/CT and MRI measurements on the overall survival (OS) of DIPG patients.
Of the 41 patients, 24 (58.5%) FLAIR hyperintensity and 39 (95.1%) MRI enhancement presented and all (100.0%) MET-PET/CT uptake increased. The median follow-up time of 41 patients was 9 months (1-27months). The median survival time was 14.4 months (12.0-16.7 months). At the end of follow-up, 20 patients survived and 21 died. Univariate prognostic analysis discovered that age 18 or older and adjuvant therapy were prognostic protective factors, while EV, SUVmax, SUVmean and tumor grade were prognostic risk factors (all P<0.05). Multivariate analysis showed that EV (HR=2.983, 95%CI: 1.074-8.284, P=0.036), tumor grade (HR=7.568, 95% CI: 2.029-28.229, P=0.003) and adjuvant therapy (HR=0.212, 95%CI: 0.078-0.582, P=0.003) were independent prognostic factors.
MET-PET/CT combined with MR could predict the prognosis of DIPG patients in this prospective cohort study.
To explore the effect of neuronavigation-assisted endoscopic transsphenoidal surgery for invasive pituitary adenomas.
A retrospective analysis was conducted on 40 patients with invasive pituitary adenomas admitted to Department of Neurosurgery, Affiliated Dalian Municipal Central Hospital, Dalian Medical University from January 2010 to March 2018. Among those patients, 20 were treated with neuronavigation-assisted endoscopic transnasal sphenoidal surgery (endoscopic group) and the other 20 were treated with traditional transnasal microsurgery (control group). The complete tumor resection rate, postoperative complication rate and tumor recurrence rate were compared between the 2 groups.
There were no significant differences in gender, age, clinical manifestations, endocrine examination results, Knosp classification of pituitary adenomas or maximum diameter of tumors between the 2 groups (all P>0.05). The total resection rate of endoscopic group was higher than that in the control group[65.0% (13/20)vs. 20.0% (4/20), P<0.05]. The tumor recurrence rate in endoscopic group was significantly lower than that of the control group[15.0% (3/20)vs. 50.0% (10/20), P<0.05]. However, the incidence of postoperative complications in the 2 groups [65.0% (13/20)vs. 85.0% (17/20), respectively] was not statistically significant (P>0.05).
Neuronavigation-assisted endoscopic transnasal sphenoidal surgery for invasive pituitary adenomas is associated with higher total resection rate and lower recurrence rate compared with traditional transnasal sphenoidal microsurgery.
To explore the role of stereoelectroencephalography(SEEG) in evaluation of epilepsy resurgery.
Thirty-nine patients with a surgical failure and clinical seizures in the SEEG monitoring were retrospectively included in this study at Department of Founctional Neurosurgery, Sanbo Brain Hospital, Capital Medical University from August 2011 to January 2018. The evaluation results from application of SEEG and efficacy of resurgery were analyzed.
The seizure onset zone (SOZ) located in the neighboring areas around the initial surgical region in 14 (36%) patients, and in the non-neighboring areas in 25(64%) patients, among whom SOZ located in the same side as the initial surgical region but far apart from it in 21 patients(54%). High frequency discharges were the most common SEEG pattern of seizure onset with a total of 19 cases (49%), followed by the low voltage fast activities with a total of 8 cases (21%). The seizure onset from single brain region was shown in 32 cases (82%), and that from multi brain regions was shown in 7 cases (18%). After SEEG evaluation, 4 patients did not undergo surgical treatment, and the remaining 35 cases were followed by re-surgery. There were 33 cases followed up more than 12 (12-51) months in total, among whom 16 cases (49%) classified as Engel I, 3 cases (9%) Engel Ⅱ, 2 cases (6%) Engel Ⅲ, and 12 cases (36%) Engel Ⅳ. Nineteen cases undergone anterior temporal lobectomy in the first surgery, and 17 cases were re-operated after SEEG evaluation, among whom 16 cases were followed up more than 12 month and 8 cases were classified as Engle Ⅰ.
Nearly half of patients achieved seizure freedom after repeated surgery by SEEG evaluation. The success rate of epilepsy resurgery is mainly related to the accuracy of localization of epileptogenic zone.
To investigate the value of three-dimensional time-flying magnetic resonance angiography (3D-TOF-MRA) and three-dimensional fast imaging employing steady-state acquisition sequence (3D-FIESTA) fusion three-dimensional image in identification of offending vessels of primary trigeminal neuralgia (PTN).
A total of 48 patients with PTN who underwent microvascular decompression (MVD) from January 2016 to June 2019 at Department of Neurosurgery, Affiliated Hospital of Qingdao University were retrospectively enrolled into this study. All patients underwent 3D-TOF-MRA and 3D-FIESTA sequence examinations before operation. The 3D-slicer software was used to fuse 3D-TOF-MRA and 3D-FIESTA sequence images and conduct three-dimensional reconstruction. Using MVD as a standard, 3D-TOF-MRA, 3D-FIESTA and fused images were evaluated to determine the offending vessels and their compressive degree on the nerves.
In MVD, except for 1 patient who had no offending vessel, the other 47 patients had clear offending vessels. The offending vessels were merely arteries in 40 cases, veins in 2, and both arteries and veins in 5. The 3D-TOF-MRA results showed that 5 patients had no offending vessels, and the remaining 43 patients had arteries as offending vessels. The 3D-FIESTA showed that 4 cases had no offending vessels; the offending vessels were arteries in 36 cases, veins in 3 cases, and both arteries and veins in 5 cases. The fused images showed that there were 2 cases without offending vessels; the offending vessels were arteries in 39 cases, veins in 2 cases, and both arteries and veins in 5 cases. Using the MVD as the standard, the accuracy of 3D-TOF-MRA, 3D-FIEST and fusion 3D images for determining the presence/absence offending vessels was 91.7% (44/48), 93.8% (45/48) and 97.9%(45/48), respectively. The accuracy of correct identification of offending vessels by 3D-TOF-MRA, 3D-FIEST and fused images was 54.2% (26/48), 89.6% (43/48) and 93.8% (45/48), respectively. Compared with intraoperative findings, those 3 types of images commonly showed lighter degree of nerve compression, and the differences were statistically significant (all P<0.05).
Compared with 3D-TOF-MRA and 3D-FIESTA single sequences, the fused images seem to be more accurate in identification of the offending vessels of PTN, which, however, is still associated with underestimation of the nerve compression degree.
To explore the efficacy of surgical removal of intracranial arteriovenous malformation (AVM) immediately after embolization according to the results of Lawton-Young supplementary grading scale (LYS).
We retrospectively analyzed the data of 9 patients with intracranial AVM admitted to Department of Neurosurgery, Shanghai Punan Hospital of Pudong New Area from June 2016 to December 2017, accounting for 10.6% of all AVM patients admitted during the same period (85 cases). Nine patients were assessed by LYS grading and a surgical plan was developed based on the results of the assessment. LYS scores were grade 4 in 2 cases, grade 5 in 3 cases, grade 6 in 3 cases and grade 7 in 1 case. All patients underwent surgical resection of AVM immediately after interventional embolization. Digital subtraction angiography (DSA) was performed for imaging evaluation and the clinical efficacy was evaluated based on the modified Rankin Scale (mRS) after operation.
All malformations of the 9 patients were resected successfully. Seven cases underwent elective microsurgery following partial embolization, 1 case underwent immediate surgery after embolization because the drainage vein was clogged, and 1 case underwent immediate surgery due to bleeding after embolization. The postoperative complications occurred in 3 cases, including 1 patient with hemianopia and 2 patients with intracranial infection. All patients were followed up for 6-15 months(median time: 7 months), DSA results showed that all the malformations completely disappeared, the cure rate was 100%. The mRS score was 0-1 in 8 cases and 2 in 1 case.
According to preoperative risk assessment based on LYS grading, selective endovascular embolization combined with subsequent microsurgery could provide a new surgical treatment approach for intracranial AVM patients with a relatively high cure rate.
To confirm that hypoxia can induce reverse differentiation of glioma cells or maintain the stemness of glioma cells, leading to chemotherapeutic resistance and to explore its mechanism by in vitro studies.
U87 and GL261 cells were considered as glioma cells line in this study. CD133+ CD15+ Nestin+ and CD133-CD15-Nestin- glioma cells were sorted through magnetic activated cell sorting and cultured in normoxia and hypoxia environments. CD133+ CD15+ Nestin+ and CD133-CD15-Nestin- glioma cells were cultured in hypoxia to detect the expressions of CD133, CD15, Nestin and hypoxia-inducible factor (HIF) 1α by Western blot and immunofluorescence assay. Cell apoptosis and half maximal inhibitory concentration (IC50) values were assessed after temozolomide (TMZ) treatment. HIF1α knocked-out glioma cells were cultured in hypoxia and the expressions of CD133, CD15 and Nestin were determined by Western blot. Besides, we compared cells apoptosis rate and IC50 values after TMZ treatment between HIF1α knocked-out glioma cells and control group.
GL261 CD133+ CD15+ Nestin+ cells showed lower cells apoptosis and higher IC50 value compared with Gl261 CD133-CD15-Nestin- cells after TMZ treatment (both P<0.05). The results of Western blot showed that the expression levels of CD133, CD15, Nestin and HIF1α in CD133+ CD15+ Nestin+ and CD133-CD15-Nestin- U87 cells in hypoxia were higher than those in control group cultured in normoxia, which were barely expressed in the latter (all P<0.05). There were lower cells apoptosis and higher IC50 value after TMZ treatment in hypoxia in CD133+ CD15+ Nestin+ and CD133-CD15-Nestin- U87 and GL261 glioma cells (all P<0.05). The expressions of CD133, CD15 and Nestin were decreased in HIF1α knocked-out glioma cells compared with those in cells without knocking out HIF1α. Higher cells apoptosis rate and lower IC50 value were reported for HIF1α knocked-out glioma cells after TMZ treatment (allP<0.05).
Hypoxia could induce chemotherapy resistance by maintaining the stemness of glioma stem cells or promoting the reverse differentiation of normally differentiated glioma cells.
Schwann cell tumor is the third subtype of neurofibromatosis. Because the tumor is multiple and easy to relapse, and the clinical characteristics are not obvious, it is easy to be misdiagnosed as type 2 neurofibromatosis and other diseases, which brings challenges to clinical diagnosis and follow-up treatment. The study found that,SMARCB1 andLZTR1 gene is closely related to its pathogenesis. This paper reports a case of neurofibromatosis with multiple masses in the whole body and space-occupying lesions in the cranium. The patient underwent resection of the space-occupying lesions in the cranium. The pathological diagnosis was schwannoma after operation. The peripheral blood was taken for gene detection, and the results showedLZTR1 strongly positive, consistent with the diagnostic characteristics of Schwann cell tumorosis.
Deep cerebral arteriovenous malformation (AVM) is a difficult point in clinical treatment. The author successfully performed 2 cases of deep brain AVM with curative embolization by intravenous approach. Both AVM cases were completely cured without surgery-related complications, and the prognosis was good. For AVM with deep brain diameter ≤3 cm, ruptured, single vein drainage, transvenous approach may achieve the purpose of curative embolization.
Traumatic craniocerebral injury (TBI) is the leading cause of disability and death in infants and young children, and its injury mechanism is closely related to microglia. In the developmental brain, microglia can maintain the survival and death of neurons, and at the same time help the formation of synapses and participate in their modification, so that the immature brain can develop normally. As a core member of craniocerebral injury mechanism, microglia mainly play a neuroprotective role on the injured brain in the acute phase of developmental brain TBI, and its overactivation will aggravate brain injury, seriously affect the normal development of neurons and synapses, and eventually interfere with the normal establishment of neural circuits. Children's brain is still developing, so this damage may even affect children's long-term brain function. Reducing overactivated microglia is the main way to treat TBI, and how to control overactivation of microglia without affecting its role in developmental brain is one of the main difficulties in the future treatment of pediatric TBI.
As the inherent immune cells of the central nervous system, microglia participate in a series of immune inflammatory responses during the early brain injury of subarachnoid hemorrhage (SAH), and play an immunomodulatory role in the secondary brain injury and/or nerve repair after SAH. In this paper, the role of microglia after SAH was reviewed. According to its research progress, the activation and polarization of microglia, the potential regulatory factors and its interaction with other cells were analyzed, which provided a reference for clinical exploration of the treatment of brain injury after SAH.
At present, more and more patients with acute ischemic stroke of anterior circulation have obtained good prognosis by mechanical thrombectomy, but some patients still have poor prognosis after mechanical thrombectomy. There is growing evidence that metabolic syndrome affects the prognosis of patients with acute ischemic stroke. This article reviews the relationship between metabolic syndrome and poor prognosis of anterior circulation mechanical thrombectomy.
Stroke is a kind of central nervous system disease with poor prognosis and difficult to diagnose and treat. With the advancement of modern high technology, the prognosis of stroke has been greatly improved, but its mortality and disability rate are still high. Therefore, the core of clinical expectations is the accuracy of stroke prediction. This article focuses on advances in high technologies such as 3D and 4D central nervous angiography for diagnosis, as well as the feasibility and further research directions that can be used for clinical prediction.
Chronic subdural hematoma (CSDH) is one of the most common diseases of the central nervous system, which mostly occurs in the elderly, and is often combined with a variety of basic diseases. Traditional treatment methods include drilling and drainage, craniotomy for hematoma evacuation and conservative drug treatment. Some patients are prone to recurrence after surgery or conservative treatment, and need to undergo surgery again. In recent years, it has been found that the middle meningeal artery (MMA) is closely related to the occurrence and development of CSDH, and the goal of curing recurrent CSDH can be achieved by embolizing MMA. Therefore, this article reviews the research status of MMA embolization in the treatment of CSDH.
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