Volume 36 · Issue 12 · 2020

Clinical diagnosis, injury judgment, surgical indication, treatment plan, management effect evaluation and prognosis judgment of traumatic brain injury (TBI) patients need close clinical observation, supplemented by various brain monitoring techniques. At present, there are a variety of TBI monitoring technologies in clinic, including imaging examination, pathophysiological parameter monitoring, biochemical indicators and biomarker detection, etc. Based on the existing clinical evidence, the clinical experience and summary of domestic experts, the craniocerebral trauma professional group of Neurosurgery Branch of Chinese Medical Association and the nerve injury professional group of Trauma Branch of Chinese Medical Association divide the brain monitoring technology of TBI patients into three categories: strongly recommended, recommended and not recommended, in order to correctly guide clinical application.

To investigate the the clinical characteristics and prognosis of pediatric comorbid Moyamoya disease (MMD) and intracranial aneurysm.

Between October 2002 and October 2017, 11 pediatric MMD patients with intracranial aneurysms were treated at Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University(two cases) and the Fifth Medial Center of PLA General Hospital(nine cases) and enrolled into this study. We retrospectively analyzed the patients′ clinical features and followed up their outcomes.

Among 11 patients in our series, 8 were male and 3 were female, with a median age of 9 years (5-16 years). Initial manifestations included transient ischemic attack (TIA) in two patients, cerebral infarction in one and intracranial hemorrhage in eight patients. Among all 11 aneurysms, three were located at the main artery and 8 at the peripheral artery. Onyx embolization was performed in three children with peripheral artery aneurysms, out of whom success was achieved in two and failures were reported in one. The other eight patients underwent no surgical treatment. Ten children underwent the operation of encephalo-duro-arterio-synangiosis (EDAS), and one did not undergo EDAS due to good collateral circulation of bilateral meningeal arteries. Postoperative imaging follow-up lasted for 6-36 months with a median of 12 months. Intracranial blood supply by collateral circulation of superficial temporal artery was observed in 10 patients. Among them, the evaluation of transdural collaterals after EDAS revealed Matsushima grade 1 in eight patients and grade 2 in two. Among ten patients undergoing EDAS, peripheral artery aneurysms regressed spontaneously in four, main artery aneurysms were enlarged in two, main artery remained stable in one, and peripheral artery aneurysm remained stable in one. Two cases with peripheral artery aneurysms reported no recurrence after onyx embolization. The main artery aneurysm remained stable in one patient without undergoing EDAS surgery. Clinical follow-up lasted for 3-14 years with a median of 10 years. The eight patients with hemorrhage reported no rebleeding during follow-up. Among three patients with ischemia, one developed TIA for two times and the other two reported no ischemic symptoms post operation.

EDAS could effectively improve the intracranial cerebral blood flow, facilitate the regress of peripheral artery aneurysms, and prevent rebleeding in children with comorbid MMD and intracranial aneurysm. The efficacy of interventional therapy for aneurysms in children with MMD still requires clinical study with large sample size.

To investigate the efficacy of Willis covered stent in the treatment of internal carotid artery siphon aneurysms.

The data of 62 cases with 62 internal carotid artery siphon aneurysms treated with Willis covered stent at Department of Interventional Radiology, Tongji Hospital Affiliated to Tongji University from October 2015 to December 2018 were retrospectively analyzed. Among them, 33 were ruptured and 29 were unruptured aneurysms. Single covered stent was employed in 45 aneurysms, double covered stents in 2, single covered stents plus coil embolization in 12, and double covered stents plus coil embolization in 3. All patients were followed up clinically after discharge. Cerebral digital subtraction angiography (DSA) was performed after 3 months, and the modified Rankin scale (mRS) was used to assess the neurological status of the patients.

All 62 patients were successfully treated with covered stents. Immediate postoperative angiography revealed complete occlusion of aneurysm in 53 (85%) cases and endoleak in 9 (15%) cases, 7 of which presented mind retention of contrast agent in the aneurysm cavity. Out of 62 cases, procedure-related complications occurred in 3 (4.8%) and included stent displacement in 1, acute in-stent thrombosis in 1 and intracranial hemorrhage due to intraoperative vessel rupture which resulted in death in 1. Ophthalmic artery occlusion occurred in 6 (9.7%) patients, while no defect of visual acuity or visual field was observed. The follow-up duration of 61 patients was 9.0±4.7 months and ranged from 3 to 24 months, during which there was no ischemic, hemorrhagic event or aneurysm recurrence. The DSA follow-up was performed in 49 patients after 3 months, which demonstrated that complete aneurysm occlusion was reported in 46 (94%) patients and endoleak occurred in 3(6%). The mRS score was 0-2 in 60 patients and 4 in 1.

This preliminary study suggests that Willis covered stent used to treat internal carotid siphonal aneurysms is associated with a relatively high rate of complete occlusion of aneurysm, a relatively low rate of endoleak, and good improvement of neurological function as well.

To explore the clinical efficacy of dural wrapping and clipping technique in the treatment of blood blister-like aneurysms (BBA) of internal carotid artery (ICA).

Between October 1996 and December 2019, 17 cases of ruptured BBA were treated with autologous dura mater and clipping technique at Department of Neurosurgery, Affiliated Hospital of Qingdao University. The clinical data (including 17 associated aneurysms and 2 non-associated aneurysms) were retrospectively analyzed. There were 11 cases of Hunt-Hess grade Ⅱ and 6 cases of grade Ⅲ. BBA was classified according to the location of aneurysms. Different dural wrapping techniques were used for different types of lesions. All patients underwent CTA or DSA 1 month after operation and 5 months after discharge. Glasgow Outcome Scale (GOS) was used to assess the clinical efficacy.

All 19 aneurysms of 17 patients were successfully clipped. Seven cases of aneurysm rupture occurred during the placement of aneurysm clips during operation, and no serious complications occurred. Postoperative CT examination showed that one case had a partial infarction in the temporal lobe, which resulted in dysfunction of the left limb, and one case had a small infarction in the knee of ipsilateral internal capsule, which resulted in moderate paresis of contralateral lower limb. The follow-up duration of 17 patients ranged from 1 to 100 months with a median of 36 months. The follow-up results showed that there were 15 cases with GOS grade Ⅴ. GOS grade Ⅳ was reported in two patients who developed cerebral infarction after surgery and underwent rehabilitation. No recurrence of aneurysm was identified based on review of CTA or DSA.

Microsurgical dural wrapping with autologous dura and clipping technique is associated with low complication rate and can result in good outcomes for the treatment of BBA.

To compare the clinical and imaging efficacy between stent-assisted coiling (SAC) and flow diverter (FD)in the treatment of large and giant intracranial aneurysms.

Clinical data of 64 patients with large and giant intracranial aneurysms (diameter≥20 mm) admitted to Department of Neurointervention, the First Affiliated Hospital of Zhengzhou University from January 2014 to January 2019 were retrospectively analyzed. Patients were categorized into the SAC group(n=23) and FD group(n=41). We compared the immediate occlusion rate, overall perioperative complication rate, and clinical as well as imaging follow-up results.

In the SAC group and according to the immediate postoperative imaging results, the Raymond grade Ⅰ was reported in 34.8% (8/23) of the patients, grade Ⅱ in 21.7% (5/23), grade Ⅲ in 43.5% (10/23), while in FD group grade Ⅰ was reported in 19.5% (8/41) of the patients, grade Ⅱ in 17.1% (7/41), grade Ⅲ in 63.4% (26/41), and there was no significant difference between two groups (P>0.05). Incidence of overall postoperative adverse events was 30.4% (7/23) in SAC group and 7.3% (3/41) in FD group, and there was significant inter-group difference (P<0.05). The disability rate was 26.1% (6/23) in SAC group and 4.9% (2/41) in FD group (P<0.05), whereas the mortality rate was 13.0% (3/23) in SAC group and 2.4% (1/41)in FD group (P>0.05). At 12 months post operation, DSA was performed in 16 cases in SAC group and 35 cases in FD group. The ratios of Raymond grade Ⅰ, Ⅱ, Ⅲ in SAC group were 4/16, 8/16, 4/16 respectively , while those in FD group were 71.4% (25/35), 22.9% (8/35), 5.7% (2/35) respectively (P<0.05). The recurrence rate was 4/16 in SAC group and 0/35 in FD group, and there was significant difference between two groups (P<0.05). Sixty patients underwent clinical follow-up revealing favorable outcomes (modified Rankin Scale≤2) in all, including 20 cases in SAC group and 40 cases in FD group. The difference between two groups in the proportion of favorable outcome was not significant (P>0.05).

Compared with SAC, FD is associated with better efficacy at follow-up and a lower rate of perioperative complications in the treatment of large and giant intracranial aneurysms.

To explore the characteristics and treatment of hematoma caused by intracranial ruptured aneurysms.

A retrospective analysis was conducted to investigate the clinical data of 632 patients with a total of 678 intracranial aneurysms who were admitted to Department of Neurosurgery, Xing′an League People′s Hospital from July 2007 to January 2019. The 678 aneurysms included 259 anterior communicating artery aneurysms, 197 middle cerebral artery aneurysms, 136 posterior communicating artery aneurysms, 63 internal carotid artery aneurysms, and 23 basilar artery aneurysms. In this series, 135 cases (139 aneurysms) underwent conservative treatment, while the remaining 497 cases (539 aneurysms) underwent surgical treatment (surgical clipping in 427 aneurysms and endovascular treatment in 112 aneurysms). The outcomes of patients were assessed using the Glasgow outcome score (GOS). Imaging follow-up was performed to evaluate the recurrence of aneurysms.

Among the 610 patients with subarachnoid hemorrhage (SAH), temporal lobe hematoma coexisted in 52 cases, intracisternal hematoma in 368 cases, corpus callosum hematoma in 25 cases, intraventricular hemorrhage in 69 cases, frontal lobe hematoma in 15 cases, hydrocephalus in 73 cases and subdural hematoma in 6 cases. Among the remaining 22 patients, 1 case had subdural hematoma only, and 21 cases only presented with temporal lobe hemorrhage. The follow-up period was 0.5-3.0 years. Among the 497 patients who underwent surgery, delayed cerebral infarction occurred in 13 cases after operation (including massive cerebral infarction in 6 cases and death in 2 cases), while persistent vegetative state occurred in 6 cases. In the group with conservative treatment, rebleeding caused by aneurysm rupture occurred in 3 cases, death occurred in 2 cases. GOS score was grade Ⅴ in 347 cases, Ⅳ in 253 cases, Ⅲ in 20 cases, Ⅱ in 7 cases and Ⅰ in 5 cases.426 cases(526 aneurysms) underwent imaging follow-up and recurrence was only reported in 2 aneurysms.

Ruptured intracranial aneurysms lead to a variety of types of hemorrhage. The location of hematoma can help locate the intracranial aneurysms. Individualized treatment regimens can be applied in accordance with specific conditions which could lead to a favorable prognosis.

To compare the clinical efficacy of microsurgical clipping and endovascular treatment for middle cerebral artery bifurcation aneurysms (MbifAs).

A retrospective study was conducted on the clinical data of 190 patients with MbifAs admitted to Department of Neurosurgery, General Hospital of Ningxia Medical University from January 2015 to June 2019 were enrolled into this study. All those patients were divided into endovascular treatment group (52 cases) and microsurgical clipping group (138 cases) based on treatment modalities. The clinical efficacy of treatment was evaluated according to the incidence of complications, rate of aneurysm recurrence and re-rupture rate of aneurysm. All patients were followed up through telephone or at outpatient clinic post discharge. At the latest follow-up, the outcome was evaluated according to the modified Rankin Scale (mRS). Outcomes with the mRS score of 0-2 were considered as favorable and those with the mRS score of 3-6 as unfavorable.

All 190 patients underwent operations successfully. Postoperative complications included lung infection in 70 (36.8%) cases, intracranial infection in 92 (48.4%), and brain hernia in 14 (7.4%). The follow-up time of all patients was 16.2±6.3 months and ranged from 1 month to 52 months. At the latest follow-up, 151 cases (79.5%) had favorable outcomes, while 39 (20.5%) had unfavorable outcomes. There was no statistically significant difference in gender, age, smoking history, history of blood hypertension, Glasgow coma score at admission, modified Fisher classification, or size of intracranial aneurysm between the two groups (all P>0.05). Compared with the clipping group, the coiling group had a lower proportion of wide-neck aneurysms [15.4% (8/52)vs. 38.4% (53/138)], lower proportion of ruptured aneurysms [67.3% (35/52) vs. 82.6% (114/138)] and lower rate of combined conduction of decompressive craniectomy [3.8% (2/52) vs. 33.3% (46/138)] (all P<0.05), lower incidences of postoperative lung infection [21.2% (11/52)vs. 42.8% (59/138)] and intracranial infection [3.8% (2/52) vs. 65.2% (90/138)] were lower (both P<0.05), shorter length of hospital stay [median (range): 17.5 (13.3-23.5) dvs. 22.5 (18.0-30.0) d, P<0.05], and a higher rate of recurrence [9.6% (5/52)vs. 0.8% (1/138), P<0.05]. There was no significant difference in the outcome between the two groups (P>0.05).

Endovascular therapy has the advantages of lower postoperative incidences of lung infection and intracranial infection as well as shorter hospital stay than microsurgical clipping. However, it should be noted that the recurrence rate in the embolization group seems higher than that in the clipping group and similar outcomes are associated with both modalities.

To investigate the application value of the neuronavigation-assisted tubular retractor system in surgical treatment of trigone ventricular meningiomas.

A total of 114 patients with trigone ventricular meningiomas who underwent surgical treatment from January 2012 to December 2019 at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University were retrospectively analyzed. Neuronavigation-assisted tubular retractor system (referred to as tubular retractor group) was employed in 21 cases and ultrasound-assisted traditional flat-blade retractor (referred to as traditional flat-blade retractor group) in 93 cases. The surgical trauma, postoperative complications, postoperative MRI changes, hospital stay length, recurrence rate and overall survival rate were compared between two groups.

The tumor total resection rate in both groups reached 100%, and no patients died during the perioperative period. Compared with the traditional flat-blade retractor group, the tubular retractor group had smaller size of the bone flap (39.9 cm²vs. 49.0 cm², respectively), shorter cortical incision (2.9 cm vs. 3.7 cm, respectively) and shorter length of hospital stay (11.1 d vs.15.7 d, respectively) (all P<0.001). Postoperative diffusion-weighted imaging (DWI) showed that cerebral ischemia around the operation field in the tubular retractor group was significantly reduced [19.0% (4/21)vs. 43.0% (40/93) respectively, P=0.042]. At the same time, the incidence of postoperative complications (including hemianopia, aphasia and trapped temporal horn syndrome) in the tubular retractor group tended to decrease, while the difference was not statistically significant [9.5% (2/21) vs. 28.0% (26/93), P=0.076]. Among 114 patients, 98 patients (85.9%) were followed up successfully. The median follow-up time of 98 patients was 16 months (1-94 months). During the follow-up period, 4 patients in the traditional flat-blade retractor group had tumor recurrence and underwent reoperation. The overall survival rate in both groups was 100%.

Neuronavigation-assisted tubular retractor system used in microsurgical resection could accurately locate the deep brain lesions, reduce surgical trauma and postoperative complications effectively.

To explore the efficacy of neuroendoscopic treatment of intraventricular tumors assisted with Neuro-Endoport technology.

A retrospective study was conducted on the clinical data of 15 patients with intraventricular tumors who underwent neuroendoscopic treatment assisted with Neuro-Endoport technology from January 2018 to December 2019 at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University. We documented the operation duration, tumor resection degree, intraoperative blood loss, postoperative complications and follow-up results.

Of the 15 patients, 12 had total tumor resection and 3 had near-total resection. The operation duration was 2.5-7.0 (4.2±1.6) hours, and intraoperative blood loss was 100-1 000 (352±73) ml. Ventriculostomy was performed during operation in 10 cases. No intraoperative complications occurred. The length of hospital stay was 8-20 (12.3±4.3) days. There were two cases of intracranial infection, four cases of cerebral edema, two cases of seizures, and one case of hydrocephalus after operation. The follow-up duration of 15 patients was 3-12 (8±2) months. During the follow-up period, the symptoms of 10 patients with preoperative hydrocephalus were significantly relieved; two patients with previous seizures did not report new events of seizures; four patients with cerebral edema and two patients with intracranial infection recovered well; head MRI showed that the ventricles of 10 patients with ventriculostomy shrank to varying degrees, four patients without ventriculostomy showed no obvious hydrocephalus, and one patient with postoperative hydrocephalus had a smaller ventricle than that before discharge. None of the patients had tumor recurrence.

Neuroendoscopic surgery assisted with Neuro-Endoport technology seems safe and effective for the treatment of intraventricular tumors.

To investigate the influencing factors of central nervous system (CNS) infection post neurosurgery related to intraoperative opening of frontal sinus.

The clinical data of 159 patients who underwent neurosurgery involving frontal sinus opening at Department of Neurosurgery, the First Hospital of Shanxi Medical University from January 2007 to December 2019 were retrospectively analyzed. Following opening of frontal sinus in all those patients, removal of frontal sinus mucosa was performed in 77 patients, electrocoagulation of frontal sinus inner wall in 35, drilling of frontal sinus inner wall in 7, packing of frontal sinus in 96, sealing of frontal sinus with bone wax in 159, and covering of frontal sinus with pedicled periosteum flap in 95. Based on to the patient's clinical symptoms, cerebrospinal fluid laboratory examination results, blood cell analysis and others, a comprehensive judgment was made regarding whether the patient had the CNS infection. Univariate and multivariate logistic regression analysis were used to determine whether the operative procedure regarding frontal sinus was an independent risk factor of postoperative CNS infection.

The median area of intraoperative opening of frontal sinus in 159 patients was 95.9 mm² (11.8-706.6 mm²), and operative duration was 6.3±1.9 h. Postoperative CNS infection was diagnosed in 34 cases (21.4%), and no infection occurred in 125 cases (78.6%). The results of univariate analysis showed that gender, dealing with frontal sinus before dural incision, opening area of frontal sinus, duration of operation, drainage tube placement, and number of days of drainage tube placement were influencing factors of postoperative CNS infection (all P<0.05). Further backward multivariate logistic regression analysis results showed that male (OR=3.326, 95%CI: 1.337-8.269, P=0.010), operative duration >7 h ( OR=2.935, 95%CI: 1.143-7.535, P=0.025), opening area of frontal sinus ≥ 95.9 mm² (OR=3.767, 95%CI: 1.418-10.007, P=0.008), and drainage tube placement length >1 day ( OR=3.152, 95%CI: 1.193-8.327, P=0.021) were independent risk factors for postoperative CNS infection, while closure of frontal sinus before dural incision (OR=0.244, 95% CI: 0.068-0.871, P=0.030) and covering frontal sinus with a pedicled preriosteum flap(OR=0.387, 95%CI: 0.156-0.962, P=0.041) were independent protective factors for postoperative CNS infection.

For male neurosurgical patients with surgical duration of > 7 h, opening area of frontal sinus ≥ 95.9 mm ², and drainage tube placement length >1 d, the risk of postoperative CNS infection is higher. In contrast, sealing frontal sinus before dural incision and covering frontal sinus with a pedicled periosteum flap could reduce the incidence of postoperative CNS infection.

To investigate the postoperative complications of cranioplasty using autologous bone for traumatic skull defect.

Between January 2011 and December 2018, a total of 758 consecutive patients with traumatic skull defect underwent cranioplasty using autologous bone at Department of Neurosurgery, Linyi People′s Hospital. Their clinical data were retrospectively analyzed in this study. The outcomes of cranioplasty, postoperative complications and their occurrence time were documented.

All 758 patients underwent cranioplasty successfully. One patient (0.13%) died of massive cerebral infarction. One patient (0.13%) developed delayed epidural hematoma on the second day post operation. The follow-up duration of 757 patients were 12-36 months with a median of 14 months. During the follow-up period, 16 cases (2.11%) reported infection in the surgical site resulting in removal of bone flap, among which infection occurred at 8-72 days post operation (median: 21 days) in 13 cases, and the remaining 3 cases reported infection at 4, 11 and 30 months post operation respectively. Seven cases (0.92%) had severe bone resorption. Bone resorption began to appear at 4-6 months after operation, and severe bone resorption occurred about 1 year after operation.

The rates of severe complications and surgical failures can be controlled at relatively low levels in cranioplasty using autologous bone for traumatic skull defect, so autologous skull bone is still a suitable choice for cranioplasty. It is necessary to pay attention to the prevention and control of postoperative infection, especially early infection, and bone resorption needs to be followed up.

To explore the clinical effects and safety of neuroendoscopic aspiration of early hypertensive hematoma in the basal ganglia (EHHBG).

A retrospective analysis was conducted on the clinical data of 90 patients with EHHBG who underwent surgical treatment at Department of Neurosurgery, Zhangjiakou First Hospital from March 2016 to March 2019. Among them, neuroendoscopic surgery was performed in 47 cases and microscopic surgery in 43. Differences were compared between the two groups in operative duration, intraoperative blood loss, clearance rate of hematoma, incidence of complication (intracranial infection) and scores of modified Rankin Scale (mRS) at 6 months post operation.

Compared with microscopic surgery group, neuroendoscopic surgery group had shorter operative duration (93.5±10.7 h vs. 193.1±15.4 h, P<0.05) and less intraoperative blood loss in operation (30.9±5.8 mlvs. 119.0±17.9 ml, P<0.05) and elevated clearance rate of hematoma[(96.8±4.5)%vs. (88.3±6.2)%, P<0.05], and there were statistical differences between those two groups (allP<0.05). There was no significant difference in the rate of postoperative intracranial infection between two groups (P>0.05). In terms of mRS at 6 months post operation, the rate of favorable outcome in neuroendoscopic surgery group was better than that in microscopic surgery group with significant difference[25.5% (12/47)vs. 11.6% (5/43), P<0.05].

Neuroendoscopic removal of EHHBG has the advantages of clear and direct vision, little invasiveness, short operation time and good prognosis, and is a safe and effective surgical method for cerebral hemorrhage in the basal ganglia.

To investigate the influencing factors of intracranial hematoma volume in acute brain trauma patients.

A retrospective study was conducted to analyze the clinical data of 97 patients with acute brain trauma who were admitted to Department of Neurosurgery, Changzhou No.2 People′s Hospital Affiliated to Nanjing Medical University (60 cases) and Department of Neurosurgery, Jintan People′s Hospital Affiliated to Jiangsu University (37 cases) from January 2018 to December 2018. First, rank sum test was used to screen candidate influencing factors of intracranial hematoma volume. Multiple linear regression was further performed to confirm the independent factors.

Results of univariate analysis showed that gender, Glasgow coma scale (GCS) score and plasma fibrinogen level at admission were correlated with volume of intracranial hematoma in acute brain trauma patients (all P<0.05). There was no significant difference in the volume of hematoma among patients with different ages, trauma mechanisms, status of consciousness, values of blood pressure, plasma levels of hemoglobin, plasma levels of triglyceride, prothrombin time, international normalized ratios, activated partial thromboplastin time and plasma levels of D-dimer (allP>0.05). The result of Pearson correlation analysis implicated that GCS score at admission was negatively correlated with the volume of hematoma (r=-0.47, P<0.001). Multiple linear regression results demonstrated that plasma fibrinogen level was an independent influencing factor for the volume of hematoma in patients with acute brain trauma (t=-3.40, P<0.001).

Patients with acute brain trauma who have relatively higher plasma fibrinogen level at admission have smaller volume of intracranial hematoma.

To investigate the anatomical characteristics of the middle meningeal artery (MMA) in the frontotemporal region of the skull and the effect of two-bone-flap craniotomy for preserving MMA.

Five specimens (10 sides) were prepared for surgical simulation. Bone window was exposed as in the conventional pterional approach. In addition, a bone hole centered around the point of 5 mm in front of the sphenosquamosal suture in the pterional region was drilled. First, a concave frontotemporal sphenoid bone flap was formed by milling cutter. Second, dura and MMA were separated from the inner side of skull and a "V" shaped bone flap was formed around the great wing of sphenoid bone. The morphological characteristics of the MMA in the frontotemporal region of the skull were observed and its diameter at the pterional point was measured.

The anterior branch of the MMA mainly ran along the sphenosquamosal suture in the pterional region, where the diameter of the MMA was 1.4±0.2 mm, and its forefront main branch was located about 13.3±1.5 mm behind the coronal suture when running up to the level of the temporal line. The two-bone-flap craniotomy avoided the damage of MMA in 9 out of the 10 sides of the specimens.

According to the anatomical characteristics of the MMA, MMA can be effectively preserved by two-bone-flap craniotomy via pterional approach.

To explore the function and mechanism of microRNA-9a-5p (miR-9a-5p) targets serine palmitoyltransferase long chain base subunit 2 (SPTLC2) in the apoptosis inhibition of rat primary neurons after injury.

Rat primary neurons were cultured in vitro and were divided into control group (n=9), negative transfection control (NC) group (n=9) and miR-9a-5p mimic transfection (mimic) group (n=9) before mechanical scratch model was set up. Transfection, RT-qPCR, Western blot and TUNEL staining were used to observe the effects of miR-9a-5p on apoptosis of rat primary neurons. Bioinformatics prediction, luciferase report gene system and rescue experiment were used to verify the relationship between SPTLC2 and miR-9a-5p. Protein interaction database and co-immunoprecipitation experiment were used to identify the proteins which interacted with SPTLC2.

RT-qPCR showed that the relative expression level of miR-9a-5p was increased significantly in mimic group (6.162±0.184) compared with that in the control group (0.938±0.058) or NC group (1.010±0.095) (both P<0.05). Western blot showed that the relative expression level of SPTLC2 in mimic group (0.272±0.034) was reduced significantly compared with that in control group (0.855±0.037) or NC group (0.880±0.040) (bothP<0.05). Measurement of apoptosis related proteins indicated that the degree of neuronal apoptosis in mimic group was significantly reduced compared with that in control group or NC group (bothP<0.05). TUNEL staining showed that miR-9a-5p inhibited apoptosis. The proportion of apoptosis cells in mimic group (0.165±0.004) was reduced markedly compared with that in control group (0.239±0.008) or NC group (0.229±0.010) (bothP<0.05). Luciferase report gene system and rescue experiment verified that SPTLC2 was the direct target of miR-9a-5p. Co-immunoprecipitation and Western blot showed that SPTLC2 interacted with TLR4 and NF-κB1 respectively, while SPTLC2 would not affect the expression levels of TLR4 and NF-κB1 (bothP>0.05). MiR-9a-5p could affect the expression of TLR4 (P<0.05) rather than NF-κB1 (P>0.05).

SPTLC2 is a novel target of miR-9a-5p in protective effect of neurons apoptosis. The miR-9a-5p reduces SPTLC2 expression to inhibit neuron apoptosis through TLR4 /NF-κB signaling pathway after injury.

To explore the effects of titanium mesh on the skull development of young sheep.

According to the random number table, healthy female small-tailed Han sheep were divided into three groups, namely titanium mesh group (n=3), titanium nail group (n=3) and sham operation group (n=3). In the titanium mesh group, standard titanium mesh was vertically covered on the skull of young sheep with the sagittal suture as the midline, and titanium nails were implanted at the fixation points (a, b, c, d, e, f). In the titanium nail group, only titanium nails were implanted at fixation points. In the sham operation group, the skin was cut to the depth of periosteum without any treatment. The three groups were assessed 30 min after surgery and every six months for their posture and motor ability, feeding behavior and rumination behavior. The head circumferences of the three groups of sheep were measured before and 24 months after operation. CT scanning was performed on the heads of three groups of experimental sheep at 24 months after implantation of titanium screws, and the titanium nail spacing from titanium mesh group to titanium nail group was measured. The space distances between titanium nails in the titanium mesh group and the titanium nail group were measured with a vernier caliper after surgical implantation of the Titanium Nail and 24 months after operation. Three groups of experimental sheep were sacrificed 24 months after operation, and their brain weights and brain volumes were measured.

The operations of three groups of young sheep were successful, and there was no death. At 30 minutes, 6, 12, 18, and 24 months post operation, there was no statistically significant difference between the three groups in the sheep′s appearance, mobility, feeding behavior and ruminating behavior (all P>0.05). The head circumferences of three groups of experimental sheep were increased post operation compared with those prior to operation (allP<0.05), while there was no significant difference in the head circumference among three groups either before or 24 months post operation (allP>0.05). The results of head CT and vernier caliper measurement showed that there was no statistically significant difference in the distance between every two titanium nails in the titanium mesh group or titanium nail group during operation (allP>0.05). At 24 months post operation, the distances between the titanium nails bc, de, af, ad, ae, fb, fc, ce, bd, and be in the titanium nail group were all larger than those in the titanium mesh group (allP<0.05). In the titanium mesh group, there was no statistically significant difference in the distance between every two titanium screws during surgery and 24 months after surgery (allP>0.05). At 24 months post operation in the titanium nail group, the distances between the titanium nails bc, de, af, ad, ae, fb, fc, ce, bd, and be were all increased compared with those during operation (allP<0.05). At 24 months post surgery, there was no significant difference in brain weight or brain volume among three groups of experimental sheep (bothP>0.05).

The fixation of titanium mesh repair material to the skull of young sheep does not seem to affect their growth and development, and has no significant effect on its behavior or brain volume. Meanwhile, it is suggested that the titanium nails fixing titanium mesh "slide" with the growth of skull without titanium, while those restricted by the mesh "follows the flow" as the skull grows.