MedNexus
Volume 37 · Issue 10 · 2021
MedNexus
Spinal spinal neurosurgery is an important branch of neurosurgery, which has its own disciplinary advantages. In recent years, with the improvement of imaging and surgical technology, the improvement of treatment concepts and the progress of intraoperative neurological function monitoring technology, spinal neurosurgery has shown a rapid development trend, and the volume and quality of surgery have been greatly improved, and the types of diseases covered have also become more and more extensive. With the rapid development of spinal cord subspecialty, the existing problems have gradually become prominent. This article focuses on the development and existing problems of spinal neurosurgery.
To investigate the clinical effect of hybrid surgery (artificial cervical disc combined with zero-profile fusion cage) in the treatment of multi-segment cervical spondylotic myelopathy (MCSM).
A retrospective analysis was conducted on the clinical data of 16 patients with MCSM treated with hybrid surgery under the microscope at the Department of Neurosurgery, the First Affiliated Hospital of Shanxi Medical University from March 2017 to October 2019. We observed the postoperative complications. Clinical and imaging follow-up was performed at 6 and 12 months post surgery. Visual analogue score (VAS), Japanese Orthopedic Association (JOA) score, Oswestry disability index (ODI), and modified MacNab evaluation criteria were used to evaluate surgical efficacy. Imaging examination was performed to evaluate the intervertebral height, range of motion (ROM) and Cobb angle of the patient′s cervical segment with artificial disc. We checked the position of the cervical artificial disc and the zero-profile fusion cage for looseness, slippage, displacement, etc. We used the Bridwell standard to assess the fusion of the zero-profile fusion cage and the Kellgren grading standard to evaluate the degeneration of the adjacent segments of the cervical artificial disc.
A total of 32 zero-profile fusion cages and 16 artificial discs were used in 16 patients. Postoperative review of plain radiographs showed that the cervical artificial disc and the zero-profile fusion cage were in good positions. There were 3 cases of dysphagia and 2 cases of hoarseness after operation. All 16 patients completed follow-up. As time went on, the VAS and ODI of 16 patients showed a downward trend, JOA scores showed an upward trend, and the Cobb angle of cervical spine showed an upward trend (all P<0.01); while there was no statistically significant difference in the intervertebral height or ROM at the segment with cervical artificial disc between before and after operation (allP>0.05). At the 12-month follow-up, the results of modified MacNab evaluation were excellent in 9 cases, good in 4 cases, and fair in 3 cases, and the ratio of favorable outcome was 13 ∶16; none of the cases had loosening, slippage, or displacement of cervical artificial disc or fusion cage. Among 32 surgical segments with the zero-profile fusion cage, the Bridwell grade Ⅰ fusion was reported in 25 segments and grade Ⅱ fusion in 7 segments. For the adjacent segments of the cervical artificial disc, Kellgren grade Ⅰ degeneration was reported in 1 case, grade Ⅱ degeneration in 2 cases, and no obvious heterotopic ossification was revealed in 16 cases.
Hybrid surgery has a good clinical effect in the treatment of MCSM. It can partially preserve cervical spine mobility, reduce the occurrence of adjacent vertebral body degeneration, and achieve good decompression and stabilization effects.
To explore the application of the whole exposure technique of the ligamentum flavum in the treatment of central lumbar spinal stenosis by percutaneous minimally invasive decompression.
A retrospective analysis was conducted on the clinical data of 24 patients with central lumbar spinal stenosis treated with bilateral decompression using percutaneous minimally invasive channel through unilateral paravertebral approach from March 2019 to June 2020 at the Department of Neurosurgery, the 904th Hospital of Joint Logistic Support Force of the PLA. The technique of whole exposure of the ligamentum flavum was used for all patients during the operation. We documented the changes of the facet joints and the transverse and sagittal diameters of dural sac after the operation. At 1 d, 7 d, 1 month, 3 months, and 6 months post operation, the improvement of Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS), and Oswestry disability index (ODI) compared with presurgical conditions were assessed.
None of the 24 patients had nerve damage, cerebrospinal fluid leakage, or infection related to surgery. The operation time for a single segment of the lumbar spine was 72.0±16.1 min. Postoperative CT showed that the facet joints were well protected. MRI showed that the ligamentum flavum was completely removed, the transverse diameter of the dural sac increased from 9.4±2.6 mm before the operation to 16.0±3.0 mm, the sagittal diameter of the dural sac was increased from 10.2±1.9 mm before the operation to 15.1±1.9 mm, and the differences were statistically significant (all P<0.05). At 6-month follow-up post operation, the JOA score changed from 14.8±3.6 before surgery to 26.9±1.3, the VAS score decreased from 7.1 ±1.5 before surgery to 0.5±0.2, and the ODI decreased from preoperative 68.4 ± 11.8% to 12.7 ± 7.5%, and the differences were statistically significant (allP<0.05).
Microscopic percutaneous minimally invasive bilateral decompression through unilateral paravertebral approach using the whole exposure technique of the ligamentum flavum has a definite effect in the treatment of central lumbar spinal stenosis, which is associated with sufficient decompression of the spinal canal, small damage to the facet joints, and no impact on postoperative lumbar stability or mobility.
To explore the neuroendoscopic surgery for the treatment of tethered cord syndrome (TCS) in the near and long terms and its influence on urodynamic indexes.
The clinical data of 62 patients with TCS admitted to the Department of Neurosurgery, Hainan Provincial People′s Hospital from January 2016 to April 2018 were retrospectively analyzed. According to the treatment method, all patients are divided into neuroendoscopy group (n=32) and microscopy group (n=30). We then compared the baseline data of the two groups of patients, intraoperative spinal cord loosening and other surgical indicators, clinical efficacy at 3 months after surgery, and long-term follow-up of spinal cord retethering, lumbar instability, and minor nerve injury at 3 years after surgery. The urodynamic indexes before and after the operation were compared between the two groups, including safety bladder capacity (SBC), postvoid residual urine volume (PRUV) and detrusor leak point pressure (DLPP).
There were no significant differences in age, gender, course of disease, or 3 preoperative urodynamic indexes between the two groups (all P>0.05). The operations of the two groups of patients were successfully completed. No postoperative complications such as nerve injury, hematoma in the operation area, or intracranial infection occurred. Comparing between the neuroendoscopy group and the microscopy group, there was no statistically significant difference in the proportion of patients with complete spinal cord loosening [93.8%(30/32)vs. 90.0%(27/30), P>0.05]; the neuroendoscopy group had less intraoperative blood loss than the microscopy group (281.4±30.3 mlvs. 333.9±35.7 ml), shorter operation time (81.5±10.1 min vs. 96.7±8.3 min), shorter hospital stay (12.9±2.5 d vs. 14.7±1.4 d), and the differences were statistically significant (all P<0.05). Both groups of patients completed the 3-year follow-up after surgery. At 3 months post operation, 8 patients in the neuroendoscopy group were cured, 15 were markedly effective, 6 were improved, and 3 were ineffective. There was no significant difference in clinical efficacy between the neuroendoscopy and microscopy groups (P>0.05). Three years after operation, there was no significant difference in the proportion of patients with spinal cord retethering, lumbar instability, and minor nerve injury between the two groups (allP>0.05). Compared with the microscopy group, the neuroendoscopy group had a larger SBC (264.4±28.7 ml vs. 245.8±25.8 ml), lower PRUV (106.3±16.5 mlvs. 118.5±22.7 ml), lower DIPP (30.5±9.1 cmH2O vs. 36.4±9.1 cmH2O, 1 cmH2O = 0.098 kPa), and the differences were statistically significant (all P<0.05). Compared with preoperative conditions, both groups reported larger SBC, lower PRUV and DIPP at 3 years post operation, and the differences were statistically significant (allP<0.05).
Neuroendoscopic surgery has good short-term and long-term clinical effects for TCS patients, and no difference in therapeutic effect from microscopic surgery has been observed. However, neuroendoscopic surgery has a shorter operation time, less intraoperative bleeding, and shorter hospital stay and the patient′s urodynamic indexes recover better.
The pathogenesis of low-energy fracture-dislocation-free spinal cord injury (SCIWORA) in children is unknown. This paper reports 8 children with low energy SCIWORA, aged from 5 years to 8 years and 9 months; Seven cases were caused by lower waist movement during dance training, and one case was caused by fall injury; MRI showed that all 8 cases were complicated with terminal filament tethered spinal cord. Among them, 4 cases underwent tethered cord release surgery through unilateral intervertebral space approach, 3 cases underwent tethered cord release + spinal canal decompression, and 1 case was treated conservatively. After 8~33 months follow-up, muscle strength and/or sensory function, urine and stool function were recovered to some extent in 5 cases, and no improvement was found in 3 cases. The results of the study suggest that the combined terminal filament tethering may be related to low energy SCIWORA in children, and early terminal filament dissection may reduce the reinjury of spinal cord.
Intramedullary bronchogenic cysts are rare in clinical practice and are easily misdiagnosed before operation. This article retrospectively analyzed the clinical data of 5 patients with intramedullary bronchogenic cysts admitted to the Department of Neurosurgery of Henan Provincial People's Hospital from February 2015 to October 2020. All 5 patients underwent total cystectomy by posterior median approach under neuroelectrophysiological monitoring, and postoperative pathology confirmed that they were bronchogenic cysts. The postoperative follow-up of 6 to 24 months showed that 4 patients (the other one was lost to follow-up) had numbness, pain and paresthesia of varying duration after operation, but no new neurological dysfunction and cyst recurrence were observed.
To preliminarily explore the role of diffusion tensor imaging (DTI) in determining the degree of surgical resection of cervical spinal intramedullary tumors.
A retrospective analysis was conducted on the clinical and imaging data of 15 patients with cervical spinal intramedullary tumors who were treated at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from October 2018 to August 2020. The degree of tumor resection was evaluated according to DTI before operation, and the degree of tumor resection during operation was determined according to the observation under the microscope (whether there was a tumor-spinal cord interface) and neuroelectrophysiological monitoring. At 1 week after the operation, the tumor resection was assessed according to the results of cervical MRI examination. The McCormick grading system was used to assess the changes of the patient′s neurological function.
Preoperative DTI showed 8 cases of type Ⅰ tumors, all of which could be totally resected; postoperative MRI showed complete resection in all those 8 cases. DTI showed 3 cases of type Ⅱ tumors, all of which could be completely resected; postoperative MRI showed complete resection in 1 case and near-total resection in 2 cases. None of the above 11 patients had any neurological damage related to surgery. Preoperative DTI showed 4 cases of type Ⅲ tumors, none of which could be completely resected; postoperative MRI showed near-total resection in 3 cases and subtotal resection in 1 case, of which 2 patients had neurological damage related to surgery. Fifteen patients were followed up for 12.5±1.5 months post operation. At the end of the latest follow-up, 10 patients were graded as grade Ⅰ and Ⅱ and 5 patients as grade Ⅲ and Ⅳ based on the McCormick system.
The preoperative DTI evaluation results of patients with cervical spinal intramedullary tumors are in good agreement with the actual degree of resection.
To explore the treatment strategy, clinical efficacy and influencing factors of postoperative neurological function associated with spinal intramedullary hemangioblastomas.
A retrospective analysis was conducted on the clinical data of 69 patients with spinal intramedullary hemangioblastomas who underwent surgical treatment at the Department of Neurosurgery of Huashan Hospital Affiliated to Fudan University from January 2013 to December 2018. Among them, 21 cases (30.4%) were diagnosed with VHL (Von Hippel-Lindau) disease. All 69 cases underwent tumor resection via posterior median approach. Before the operation, 2 patients underwent embolization of the tumor supplying artery. The modified McCormick classification was used to evaluate the neurological function of patients. Logistic regression analysis method was used to explore the influencing factors of postoperative neurological function of patients.
Total tumor resection was achieved in all 69 patients. Postoperative complications included cerebrospinal fluid leakage in 2 cases(2.9%), poor healing of incision in 2 cases(2.9%), epidural hematoma in 1 case(1.4%) and infection in 4 cases(5.8%). Among 69 patients, 52 (75.4%) had no change in the modified McCormick classification, 12 (17.4%) improved, and 5 (7.2%) deteriorated. Logistic analysis showed that only the preoperative modified McCormick classification was the influencing factor of postoperative neurological function in patients with spinal intramedullary hemangioblastomas (OR: 4.77, 95% CI: 1.21-18.79, P=0.026). Sixty-one patients were followed up for 61.2±20.1 months (30-95 months). At the last follow-up, 47 cases (77.0%) had no change in the modified McCormick classification, 9 (14.8%) improved, and 5 (8.2%) deteriorated.
Microsurgery can be applied to effectively treat spinal intramedullary hemangioblastomas. Patients with lower modified McCormick grades before surgery have better neurological functions after surgery.
To explore the clinical and imaging effects of stand-alone oblique lateral lumbar interbody fusion (OLIF) in the treatment of adjacent segment degeneration (ASD) following lumbar fusion.
A retrospective analysis was conducted on the clinical data of 13 patients with ASD after lumbar fusion who underwent stand-alone OLIF treatment at the Department of Neurosurgery, Xuanwu Hospital of Capital Medical University from December 2016 to January 2019. The clinical efficacy was evaluated through assessment of low back pain and leg pain using visual analogue scale (VAS) and Oswestry disability index (ODI). The radiographic efficacy was evaluated by comparing the results of imaging examinations before operation and at the last follow-up.
All 13 patients were successfully treated with stand-alone OLIF. There was no paresthesia, pain or weakness in the lower limbs after the operation. The follow-up time was 17.7±8.3 months (8-33 months). Compared with preoperative conditions, the VAS scores of both low back pain (6.2±1.0 points vs. 2.0±1.1 points, P<0.001) and leg pain (7.0±1.9 pointsvs. 1.0±0.9 points, P<0.001) at the last follow-up decreased; ODI also significantly decreased (28.0±7.5vs. 10.8±4.0, P<0.001). At the last follow-up, the intervertebral height increased from 9±2 mm before surgery to 12±2 mm (P<0.001), and the cross-sectional area (CSA) of central canal increased from 85±26 mm2 before surgery to 132±24 mm2 (P<0.01), the height of the intervertebral foramen increased from 17±2 mm before surgery to 21±3 mm (P<0.05), and the CSA of the intervertebral foramen increased from preoperative 95±25 mm2 to 155±36 mm2 (P<0.001). Among the 13 patients, 2 cases had degree Ⅰ subsidence of intervertebral fusion cage.
Application of stand-alone OLIF in the treatment of ASD following lumbar fusion is reliable and has few complications.
To preliminarily explore the clinical application of prenatal ultrasound and fetal MRI in positioning the conus medullaris for lipoma-type tethered cord syndrome (TCS).
A retrospective analysis was conducted on the prenatal and postnatal imaging data of 17 fetuses with prenatal diagnosis of TCS and confirmed diagnosis of lipoma-type TCS based on postnatal MRI follow-up who visited the outpatient clinic of Neurosurgery Department, the First Medical Center of PLA General Hospital from August 2018 to January 2021. Based on the results of MRI examination after birth, Fisher's exact test was used to analyze and compare the accuracy of prenatal ultrasound with fetal MRI in locating the conus medullaris in lipoma-type TCS.
Among 17 cases of lipoma-type TCS, 4 cases were terminal, 2 cases were dorsal, 2 cases were transitional, 8 cases were chaotic, and 1 case was lipomyelomeningocele. In 5 cases, both prenatal ultrasound examination and fetal MRI examination demonstrated accurate location of the conus medullaris, of which 1 case was terminal and 4 cases were chaotic. In 8 cases, neither prenatal ultrasound nor fetal MRI result was accurate, of which 2 cases were terminal, 2 cases were transitional, 3 cases were chaotic, and 1 case was lipomyelomeningocele. An MRI examination at 1 month after birth revealed that the accuracy ratio of prenatal ultrasound examination in positioning the conus medullaris was 5/17 and that of fetal MRI examination was 9/17; the difference was statistically significant (P=0.029).
Positioning of the conus medullaris in lipoma-type TCS using fetal MRI is more accurate than that based on ultrasound.
To develop and validate the LASSO-logistic regression prediction model for the health-related quality of life (HRQOL) of patients after reduction of basilar invagination (BI) based on the radiographic sagittal parameters and clinical characteristics.
A retrospective analysis was conducted on the clinical data of 94 patients with BI treated by reduction surgery at the Department of Neurosurgery, Tangdu Hospital, Air Force Medical University from August 2015 to August 2020. Based on the patient′s age, weight, pre- and post-operative numerical rating scale (NRS) score, neck disability index (NDI), and related radiographic sagittal parameters, the most robust variables were screened out by LASSO-logistic regression and a predictive model was developed for HRQOL of patients with BI after reduction. The receiver operating characteristic (ROC) curve was drawn, and the predictive value of the model was estimated based on the area under the curve (AUC). The Bootstrap method was used to carry out 500 repeated sampling for internal validation.
The analysis results of LASSO-logistic regression showed that a total of 9 factors were included in the prediction model, namely: age, weight, preoperative NRS, preoperative NDI, preoperative head and neck flexion angle (HNFA), postoperative clivoaxial angle (pCXA), postoperative clivus angle (pCS), postoperative cervicomedullary angle (pCMA), postoperative Boogaard′s angle (pBoA). By drawing the ROC curve, it is found that the AUC of the prediction model was 0.893, the sensitivity was 79.4%, the specificity was 84.6%, the positive likelihood ratio was 5.162, and the negative likelihood ratio was 0.243. The internal validation results showed that the AUC was 0.885, the sensitivity was 81.3%, the specificity was 82.6%, the positive likelihood ratio was 5.153, and the negative likelihood ratio was 0.237.
Based on age, weight, preoperative NRS score, preoperative NDI, HNFA, pCXA, pCS, pCMA and pBoA, the LASSO-logistic predictive model for HRQOL of patients with BI after reduction has a high goodness of fit.
To evaluate the efficiency and safety of deep brain stimulation of the caudal zona incerta (cZI-DBS) for the treatment of movement disorders.
A retrospective analysis was conducted on the clinical data of 10 patients with movement disorders (including 4 patients with tremor-dominant Parkinson′s disease and 6 patients with essential tremor) who underwent cZI-DBS at the Department of Neurosurgery of Beijing Tiantan Hospital, Capital Medical University from September to December 2020. The third part of the Unified Parkinson′s Disease Rating Scale (UPDRS-Ⅲ) and the Fahn-Tolosa-Marin Tremor Rating Scale (FTMTRS) were used to evaluate the patient′s motor symptoms before and after the operation, and to compare the patients′ motor symptoms before and after the operation. The improvement rate of motor symptoms was calculated. Postoperative head CT examination was performed to identify the position of the electrode and rule out complications such as cerebral infarction and hemorrhage.
The UPDRS-Ⅲ, tremor, rigidity, and bradykinesia scores of 4 patients with Parkinson′s disease before and after surgery were significantly different (all P<0.05); the postoperative improvement rates were (61.9±11.8)%, (66.9±9.0)%, (61.2±16.2)% and (57.2±14.4)% respectively. The scores of FTMTRS, resting tremor, motor tremor and postural tremor before and after surgery in 6 patients with essential tremor were statistically significant (allP<0.05); the postoperative improvement rates were (64.8±23.1)%, (77.9±10.2)%, (62.4±26.2)% and (70.4±13.4)%. Among the 10 patients, 3 had transient limb numbness after operation, 1 had headache, and the symptoms disappeared within 1 week. None of the patients had serious complications such as dysarthria, bleeding, infarction, or balance disorders. The postoperative follow-up time of 10 patients was 1 month, and the results of the last follow-up showed that there was no significant deviation in the electrode position of any patient in this series.
The operation of cZI-DBS can improve the clinical symptoms of patients with tremor-dominant Parkinson′s disease and essential tremor, and it is safe and feasible with few surgical complications.
To preliminarily explore the functional damage of facial nerve and its influencing factors in the treatment of posterior petrous face meningiomas (PPFMs) invading the internal auditory canal (IAC) through suboccipital retrosigmoid approach.
This study enrolled 45 cases of PPFMs invading the IAC who were treated with the suboccipital-retrosigmoid approach from December 2015 to December 2019 at the Department of Neurosurgery of the First Affiliated Hospital of Xinjiang Medical University. The clinical and imaging data of the patients were retrospectively analyzed, and the House-Brackmann (H-B) grading standard was used to evaluate the facial nerve function damage, and the related factors affecting the facial nerve function damage were preliminarily discussed.
In 45 patients, the tumor resection assessed based on Simpson classification system was grade Ⅰ in 5 cases, grade Ⅱ in 26 cases, grade Ⅲ in 13 cases, and grade Ⅳ in 1 case. The facial nerve function was assessed using H-B classification at 1 week post operation, which revealed grade Ⅰ in 11 cases, grade Ⅱ in 19 cases, grade Ⅲ in 11 cases, and grade Ⅳ in 4 cases. Compared with the H-B grade Ⅰ+ Ⅱ groups, the H-B grade ≥Ⅲ group had larger maximum diameter of the tumor (38.6±11.7 mm vs. 31.3±9.6 mm), larger proportion of PPFMs anterior to the IAC [53.3%(8/15) vs. 16.7%(5/30)], larger proportion of complete invasion of IAC [9/15 (60%) vs. 8/30 (26.7%)], larger chance of the facial nerve located on the dorsal side of tumor [53.3%(8/15) vs. 26.7%(8/30)] and larger ratio of Simpson grade Ⅲ-Ⅳ resection [60%(9/15) vs. 16.7%(5/30)]. The differences were statistically significant (all P<0.05), while there was no significant difference between the two groups in age, gender, or whether the IAC was opened during the operation (allP>0.05). At 6 months post operation, 17 cases had significant recovery of facial nerve function, 11 cases had mild improvement, and 6 cases had no change.
The damage of facial nerve function in the treatment of PPFMs that invade the ICA may be related to the size and growth pattern of tumor, the degree of invasion of the IAC, the course of the facial and auditory nerves, and the degree of tumor resection.
To explore the clinical application of novel decompressive hemicraniectomy in middle cerebral artery occlusive cerebral infarction.
A retrospective analysis was conducted on the clinical data of 96 patients with middle cerebral artery occlusive cerebral infarction admitted to the Department of Neurosurgery, Xinxiang Central Hospital, the Fourth Clinical College of Xinxiang Medical College from October 2019 to September 2020. Among them, 49 patients were treated with conventional decompressive craniectomy (conventional surgery group), and 47 patients were treated with novel decompressive craniectomy (novel surgery group). Clinical follow-up was performed for all patients 3 months after surgery. The content of the follow-up included: the use of modified Rankin scale (mRS) to assess the outcomes of the patients, of which 0 to 3 were classified as favorable outcomes, 4 to 6 were classified as poor outcomes; at the same time, the patients were asked about the atrophy of their temporal muscles. The clinical data, operation time, incidences of postoperative cerebrospinal fluid leakage and incision infection, the incidence of temporal muscle atrophy and its outcome were compared between the two groups of patients.
The age, gender, comorbidity of essential hypertension, diabetes, hyperlipidemia, coronary atherosclerotic heart disease or atrial fibrillation, smoking history, body mass index, time from onset of symptoms to operation, severity of preoperative symptoms, and the preoperative National Institutes of Health Stroke Scale (NIHSS) score were not statistically different between two groups (all P>0.05), and their baseline situations were basically similar and comparable. The operation time of the novel operation group was shorter than that of the conventional operation group (68±7 minvs. 82±8 min, P<0.05), the incidences of postoperative cerebrospinal fluid leakage[0%(0/47)vs. 4.1%(2/49)] and incision infection[2.1%(1/47) vs. 10.2%(5/49)] were lower than those of the conventional surgery group (both P<0.05). At 3 months after surgery, the difference in the mRS score between the two groups was not statistically significant (P>0.05), while the rate of temporal muscle atrophy in the novel surgery group was significantly lower than that in the conventional surgery group [0%(0/47)vs. 8.2%(4/49), P<0.05].
Compared with conventional decompressive craniectomy, the novel decompressive craniectomy for the treatment of middle cerebral artery occlusive cerebral infarction has the advantages of short operation time and low incidences of postoperative cerebrospinal fluid leakage, incision infection as well as temporal muscle atrophy.
Necrosis of nasal septal mucosal flap is one of the rare complications after neuroendoscopic enlarged nasal approach. This study included 6 patients with skull base tumors admitted to the Department of Neurosurgery of the First Affiliated People's Hospital of Shanghai Jiaotong University from December 2013 to January 2019. All of them had been resected by neuroendoscopic expanded nasal approach. Postoperative enhanced MRI showed necrosis of nasal septal mucosal flap, and related clinical symptoms such as cerebrospinal fluid rhinorrhea and intracranial infection. All 6 patients admitted to the hospital were repaired by surgery. After 3 months follow-up, cerebrospinal fluid leakage and intracranial infection were cured. History of multiple nasal surgery and insufficient sphenoid mouth abrasion may be the cause of necrosis of nasal septal mucosal flap, and timely repair can effectively treat this complication.
To explore the resistance mechanism of PTPRZ1-MET fusion gene (ZM)-positive glioma cells (U87-ZM) to the MET-targeted inhibitor PLB-1001.
The cells of U87-ZM were cultured in the medium containing PLB-1001 for 48 hours to obtain U87-ZM+ PLB-1001 cells; after 4 months of culture, U87-ZM-LT cells were obtained. The CCK-8 method was used to detect the sensitivity of cells to PLB-1001 in the U87-ZM and U87-ZM-LT groups, and the EdU cell proliferation method was used to evaluate the proliferation activity of the cells in the U87-ZM+ PLB-1001 and U87-ZM-LT groups. Western blot (WB) was used to evaluate the inhibitory effect of PLB-1001 on U87-ZM and U87-ZM+ PLB-1001 cells and the expression of cyclin D1 protein in each group. The transcriptional levels of Cyclin D1 in each group was detected by real-time fluorescence quantitative PCR (polymerase chain reaction).
WB results showed that the relative expression of p-MET protein in U87-ZM group and U87-ZM+ PLB-1001 group were 1.22±0.06 and 0 (P<0.05), and the relative expression of total MET protein was 1.00±0.06 and 0.98±0.09 (P=0.810) respectively. The results of CCK-8 showed that PLB-1001 inhibited the growth of U87-ZM cells and U87-ZM-LT cells, and the inhibition increased with the enhancement of PLB-1001 concentration. The half inhibitory concentration (IC50) of U87-ZM cells was 13.42±0.74 μmol/L, the IC 50 of U87-ZM-LT cells was 40.76±1.20 μmol/L, and the difference was statistically significant ( P<0.05). The results of EdU showed that the percentages of EdU positive cells in the U87-ZM group and U87-ZM-LT group was (23.10±4.32) % and (21.28±1.22) % respectively, which were higher than in the U87-ZM+ PLB-1001 group [(10.25±3.40)%], and the differences were statistically significant (bothP<0.05). WB results showed that the relative expression levels of Cyclin D1 protein in U87-ZM and U87-ZM-LT groups were 1.08±0.06 and 0.94±0.15, respectively, which were statistically different compared with 0.66±0.08 in U87-ZM+ PLB-1001 group (bothP<0.05). PCR detection showed that the relative expression of Cyclin D1 mRNA in the U87-ZM and U87-ZM-LT groups were 1.01±0.00 and 1.14±0.21, respectively, which had no significant difference compared with 0.92±0.15 in the U87-ZM+ PLB-100 group (bothP>0.05).
Compared with U87-ZM cells treated with PLB-1001 for a short period of time, U87-ZM cells treated with PLB-1001 for a long period of time have stronger DNA synthesis activity. The resistance mechanism of U87-ZM cells to MET-targeted inhibitors may be related to the increase of Cyclin D1 protein, and a feasible solution for reversing tumor resistance could be explored according to that pathway.
To explore the effect of G protein coupled receptor 30 (GPR30) on reducing neuronal apoptosis after subarachnoid hemorrhage (SAH) by inhibiting TLR4/NF-κB pathway and its mechanism.
SD male rats were randomly divided into three groups: sham operation group (sham group, n=24; sham 2 group, n=21), SAH model group (SAH group, n=24; SAH 2 group, n=21) and SAH model + G1 agonist group (G1 group, n=24). The SAH model was established by internal carotid artery puncture. Sugawara score was used to evaluate the severity of SAH in rats. Garcia score and balance beam test were used to evaluate the degree of neurological impairment 24 hours after SAH. After 24 hours of successful modeling, the wet weight and dry weight of brain tissue were measured, and the water content of brain tissue was calculated. Evans blue standard curve was drawn to evaluate the permeability of blood-brain barrier. The activation of microglia in each group was assessed by immunofluorescence staining. Western blot (WB) was used to detect the expression of GPR30, TLR4 and NF-κB protein, enzyme-linked immunosorbent assay (ELISA) was used to detect the expression of TNF-α, IL-1β and IL-6 pro-inflammatory cytokines in peripheral blood, and TUNEL method was used to detect neuronal apoptosis.
Compared with SAH group, Sugawara score decreased, balanced wood test score and Garcia score increased, brain water content and Evans blue exudation rate decreased in G1 group (all P<0.05). As time went on, the expression of GPR30 in sham 2 group had no significant change(P>0.05). The expression of GPR30 in SAH 2 group was higher than that in sham 2 group at 6 h, 12 h, 24 h, 48 h and 72 h after modeling(allP<0.05). The expression of GPR30 in SAH 2 group was the highest at 24 h, and then decreased(P<0.05). There were significant differences in the expressions of GPR30, TLR4 and NF-κB among sham group, SAH group and G1 group, and the expressions of TLR4 and NF-κB in G1 group were lower than those in SAH group(P<0.05). The results of immunofluorescence staining showed that the number of microglia in SAH group was more than that in sham group, while the number of microglia in G1 group was less than that in SAH group. The results of ELISA showed that there were significant differences in the expression of TNF-α, IL-1β and IL-6 among SAH group, sham group and G1 group(allP<0.05). Compared with SAH group, the expression of TNF-α, IL-1β and IL-6 in G1 group decreased(allP<0.05). The results of TUNEL staining showed that the number of TUNEL positive cells in SAH group was higher than that in sham group, while the number of TUNEL positive cells in G1 group was lower than that in SAH group.
Activation of GPR30 may reduce neuronal apoptosis after SAH by inhibiting TLR4/NF-κB pathway, improve early brain injury after SAH and protect neurological function.
Inflammatory myofibroblastoma (IMT) is a type of tumor from mesenchymal tissue, which is considered by most studies to be potentially malignant; It occurs most often in the lungs, followed by the abdominal cavity, retroperitoneal cavity and pelvic cavity, and it is extremely rare to occur in the central nervous system. A 5-year-old 8-month-old male child with frontal lobe IMT recovered well after surgical treatment. No tumor recurrence was observed after 2 years follow-up.
Gloid cyst is a rare intracranial space-occupying lesion. This paper reports a case of colloid cyst in the subsellary region. The clinical manifestations of this patient were headache, nausea, vomiting, and the imaging manifestations were oblique and left anterior space occupation with local bone involvement and destruction. The patient was misdiagnosed as a dermoid cyst before operation and underwent neuroendoscopic transnasosphenoidal approach surgery. Postoperative pathology confirmed that it was a colloid cyst, and recovered after routine symptomatic treatment.
The periosteal sinus of the skull is a rare malformation of intracranial and extracranial communicating vessels near the midline, and it is more rare for those located on the lateral side of the supraorbit. In March 2021, a child with periosteal sinus of the right supraorbital lateral skull was admitted to the Department of Pediatric Neurosurgery of Gansu Maternal and Child Health Hospital, and the lesion was completely removed by surgery. After 3 months follow-up, the child recovered well without recurrence of mass.
Gliomas can occur in the brain and spinal cord and are the most common primary central nervous system malignancies. MRI and biopsy are mainly used to diagnose glioma and monitor tumor recurrence. However, the sensitivity of MRI is insufficient, and biopsy is invasive, which is often difficult to meet the clinical needs. Liquid biopsy is a convenient and minimally invasive detection method, which can reflect the genetic information and characteristics of tumors, and is expected to be an important supplement to existing monitoring methods. Gliomas, especially spinal gliomas, are closely related to cerebrospinal fluid, which makes cerebrospinal fluid biopsy advantageous. This article reviews the progress of liquid biopsy in the diagnosis and treatment of glioma.
Glioma, the most common primary malignancy of the central nervous system, has a poor prognosis, and standard treatment of surgical resection with concurrent chemoradiotherapy has little effect in improving patient survival. It has been found that in the microenvironment of glioma, there are different types and numerous cells recruited by glioma, and these cells play an important role in the occurrence, development, treatment and recurrence of glioma. This paper reviews the functions of various cells in the microenvironment of glioma and the interaction between them.
Pituitary adenoma is a common intracranial tumor. Some pituitary adenomas are still difficult to treat due to drug resistance or multiple recurrences after surgery, conventional drugs and radiotherapy. With the in-depth study of tumor immune microenvironment, researchers have found that the infiltration of immune cells may have a positive impact on the treatment and prognosis of pituitary adenoma. However, intestinal flora can interact with the human immune system, affect the immune microenvironment of tumors, and affect brain health through the two-way information exchange of the "brain-intestine axis". At present, it has been increasingly used as a biomarker to monitor systemic disease status and predict disease progression and emerging therapeutic methods. This article reviews the research progress of the relationship between intestinal flora and immune microenvironment of pituitary adenoma through literature review.
In recent years, it has been found that microRNA (miRNA) plays an important role in maintaining the integrity of blood-brain barrier and regulating neuroinflammatory response. It can resist the degradation of enzymes, is stable in nature, and can completely pass through cells and blood-brain barrier. This article focuses on the research progress of miRNA in the diagnosis and classification of traumatic brain injury (TBI).
External ventricular drainage is a commonly used invasive operation in neurosurgery. Although relevant guidelines have been issued for the surgical indications of external ventricular drainage, there is a lack of high-quality research evidence for complications related to drainage tube infection. Therefore, this article summarizes the time, location and operator of the external ventricular drainage tube, the use of prophylactic antibiotics, the frequency of cerebrospinal fluid sampling during catheterization, and the treatment of drainage tube-related infections, and expounds the key problems of external ventricular drainage tube-related infections, and puts forward the countermeasures to prevent external ventricular drainage tube infections, so as to provide the basis for clinical treatment decision-making of medical staff.
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