Volume 38 · Issue 02 · 2022

To investigate the clinical effect of neuroendoscopic extended transnasal approach for resection of tuberculum sella meningiomas (TSMs).

A retrospective analysis was conducted on the clinical data of 39 patients with TSMs resected through neuroendoscopic extended transnasal approach in the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from October 2018 to December 2020. On the 1st postoperative day, the patient′s endocrine function was rechecked; on the 7th postoperative day, the enhanced head MRI and ophthalmological examinations were reperformed. All patients were followed up at outpatient clinics. The content of the follow-up included re-examination of the head MRI to determine the recurrence of tumors, ophthalmological re-examination to determine the improvement of the patient′s vision and visual field and endocrine function re-examination to determine the the recovery of the patients with endocrine.

The operations of 39 patients were all successful. Among them, 1 case (2.6%) had cerebrospinal fluid leakage, 1 case (2.6%) had central nervous system infection and they healed after aggressive treatment; none died or developed coma. The endocrine function results at 1 day after operation showed that 5 patients (12.8%) had transient hypocortisolism. Re-examination of head MRI 7 days after operation showed that Simpson grade Ⅰ resection was achieved in 37 patients (94.9%) and grade Ⅱ resection in the other 2 cases (5.1%). There were 33 patients with impaired vision and visual field before operation, 31 cases(93.9%) improved after operation, and 2 cases (6.1%) did not improve. The median follow-up time of 39 patients was 17 months (6-32 months). During the follow-up period, none of the patients had tumor recurrence, and the results of the ophthalmological re-examination remained the same to postoperative conditions, 5 patients with decreased cortisol levels, they returned to normal 3 months or 6 months after surgery.

The postoperative complication rate of neuroendoscopic extended transnasal resection of TSMs is low, and most patients with visual acuity and visual field defects can be improved after surgery.

To investigate the application value of intraoperative microvascular Doppler (MVD) ultrasound in neuroendoscopic transnasal resection of sellar region tumors.

A retrospective analysis was conducted on the clinical data of 29 patients with sellar tumors who underwent neurosurgery with application of MVD at the Department of Neurosurgery, the First Affiliated Hospital of Soochow University from September 2017 to April 2021. Among them, 14 patients underwent neuroendoscopic transnasal tumor resection (neuroendoscopic group) and 15 patients underwent craniotomy for tumor resection (craniotomy group). After lesion resection, the internal carotid arteries (ICA) were clearly exposed, and then the results detected by MVD ultrasound accurate or not were judged by the operators. To evaluate the degree of tumor resection and intracranial vascular injury, head MRI, cranial enhanced CT and CT angiography (CTA) of head and neck were performed within 48 h after operation. The baseline data and hemodynamic parameters of ICA detected by MVD were compared between the two groups, which included the peak systolic velocity (Vp), end diastolic velocity (Vd), mean velocity (Vm), pulsatility index (PI), resistance index (RI), blood pressures (including systolic and diastolic blood pressures), the times of MVD measurements, and the adjustment rate of resection direction according to the detection results during surgery.

Among the 29 patients, the blood flow spectrum of ICA was detected in 28 (96.6%), and the location of ICA guided by MVD was confirmed to be accurate after tumor resection, the accuracy is 100%(28/28). Postoperative CT showed that 26 patients (89.7%) had complete tumor resection, and 3 patients (10.3%) had subtotal resection. Reexamination of CTA indicated no damage to intracranial blood vessels in those patients. None of the cases experienced bleeding or ischemic stroke after surgery. Postoperative pathological results revealed meningioma in 10 cases, pituitary adenoma in 12 cases, chordoma in 5 cases and teratoma in 2 cases. There were no statistically significant differences in age, gender, history of hypertension, diabetes, hyperlipidemia, smoking history, C-reactive protein, body mass index, clinical manifestations, maximum diameter of lesion, shape, wrapping and/or pushing condition of ICA or findings after MRI enhancement between the two groups (all P>0.05), which indicated that the baseline data of the two groups were consistent and comparable. During the operations, the times of MVD measurements, adjustment rate of tumor resection direction, and hemodynamic parameters of ICA monitored by MVD were not significantly different between the two groups (all P>0.05). Furthermore, there was no significant difference in the rate of total tumor resection or postoperative complication rate between the neuroendoscopy group and craniotomy group (both P>0.05).

The application of MVD in neuroendoscopic transnasal resection of sellar region tumors, like craniotomy, can effectively detect the location and course of ICA so as to guide the surgeon to remove the tumors safely with relatively good postoperative efficacy.

To preliminarily explore the effect of three-dimensional(3D) endoscopy in transnasal skull base surgery.

A retrospective analysis was conducted on the clinical data of 28 patients who underwent transnasal skull base surgery with 3D endoscopy in the Department of Neurosurgery, the First Affiliated Hospital of Nanchang University from February 2021 to May 2021. Those cases included 18 cases of pituitary adenomas (11 cases of non-invasive pituitary adenomas and 7 cases of invasive pituitary adenomas), 6 cases of craniopharyngiomas, 2 cases of tuberculum sellae meningiomas, 1 case of suprasellar Rathke cyst and 1 case of chordoma. According to the specific lesion, different approaches were adopted and included transsellar approach (12 cases), transsellar tubercle sphenoid platform approach (8 cases), transclival approach (2 cases) and transpterygopalatine fossa cavernous sinus approach (6 cases). Follow-up imaging was performed to evaluate the extent of tumor resection and the reconstruction of the skull base.

Among the 28 patients, complete resection was achieved in 26 and subtotal resection in 2. Visual acuity decreased in 20 cases before operation, 18 cases improved after operation, and 2 cases got worse after operation. There were 8 cases reporting headache before operation and all were relieved after operation. There were 2 cases of amenorrhea before operation and their menstruation returned to normal after operation. There were 4 cases of diabetes insipidus before operation, none of which showed obvious relief after operation. There were 3 cases of newly-developed diabetes insipidus after operation, all of which were transient and improved after drug treatment. There was 1 case of newly-developed abducens nerve palsy. There were no patients with cerebrospinal fluid rhinorrhea or intracranial infection. There were no deaths related to surgery. The follow-up time of 28 patients was 4.7±1.1 months (3-6 months). Re-examination of MRI showed no tumor recurrence and no delayed cerebrospinal fluid leakage.

The 3D neuroendoscopy can be used in transnasal skull base surgery to display the spatial relationship between normal tissues or lesions and important nerves or blood vessels in a three-dimensional manner, thereby reducing damage and improving tumor resection rate.

To investigate the safety, effectiveness and efficiency of intranasal knotting for dural suturing during skull base reconstruction through endoscopic transnasal approach.

This study enrolled a total of 44 patients who underwent neuroendoscopic transnasal surgery involving intranasal knotting for dural suturing during skull base reconstruction at the Department of Neurosurgery, Tangdu Hospital of Air Force Military Medical University from November 2018 to January 2021. Two curved needle holders were used for intranasal knotting in all cases. Among them, rotatable angled microscopic needle holders and non-rotatable angled bayonet needle holders (initial group) were used in 13 cases; double rotatable angled microscopic needle holders were used in 31 cases (improved group). We retrospectively analyzed the incidence of postoperative cerebrospinal fluid leakage and suturing-related vascular and nerve damage, evaluated the effectiveness and safety of intranasal knotting for dural suturing, compared the differences in the safety, effectiveness and efficiencies of the two knotting methods.

Among the 44 patients, 1 case (2.3%) had postoperative cerebrospinal fluid leakage, which was in the initial group of patients. None of the patients had suturing-related vascular or nerve damage. There was no significant difference in the incidence of postoperative cerebrospinal fluid leakage between the two groups (P>0.05). The suturing time per stitch of the patients in the improved group and the initial group was 5.6±1.7 min and 10.8±4.7 min, respectively, the number of grasping times per stitch was 21.0±6.0 and 45.4±20.6, respectively, and both differences were statistically significant (both P<0.001). The grasping accuracy rates were 90.3±4.9% and 88.0±3.4%, respectively, and the difference was not statistically significant (P=0.121).

The intranasal knotting for dural suturing used in neuroendoscopic transnasal skull base reconstruction is safe and effective. Moreover, the effect of intranasal knotting using double rotatable angled microscopic needle holder is better than that using a rotatable angled microscopic needle holder and a non-rotatable angled bayonet needle holder.

To explore the anatomical basis, surgical techniques, and clinical outcomes of neuroendoscopic transnasal anterior lateral approach for resection of tumors in the jugular foramen area.

We collected 3 dry skull specimens and 3 wet cadaver head specimens, and then conducted bilateral layer-by-layer dissection on the wet cadaver head specimens, and measured the relevant data of the specimens. Clinical data of 13 patients with tumors in the jugular foramen area who were admitted to the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from November 2018 to February 2021 was retrospectively analyzed. All 13 patients underwent tumor resection through the neuroendoscopic transnasal anterior lateral approach. The extent of surgical resection was evaluated based on postoperative MRI. According to clinical symptoms and imaging follow-up results, clinical outcomes of the patients were assessed.

Anatomical studies confirmed that the transnasal approach of neuroendoscopy could clearly reveal the jugular foramen area. The distance between the lower edge of the hypoglossal nerve canal and the articular surface of the occipital condyle was 8.36±1.77 mm, and the distance between hypoglossal nerve canal to the jugular nodule was 7.08±2.23 mm. Eighteen operations were performed in 13 patients. Total resection was achieved in 10 cases, subtotal resection in 6 cases and major resection in 2 cases. The results of pathological diagnosis revealed chordoma in 9 cases, chondrosarcoma in 2 cases and schwannoma in 2 cases. The symptoms involving neurological function deficits improved after surgery in all 13 cases. The symptoms and their improvement proportion were as follows: hoarseness (3/6), bucking (2/5), shrugging weakness (2/3), hearing loss (5/9), pulsating tinnitus (5/7), balance disorder (2/4), tongue deviation (2/5) and peripheral facial paralysis (4/7). Postoperative complications included eustachian tube dysfunction (5 cases), transient palatal numbness (2 cases), cerebrospinal fluid rhinorrhea (1 case) and cranial nerve function deterioration (3 cases). The median follow-up time of 13 patients was 16 months (range: 3-30 months). The imaging follow-up results indicated that at the last follow-up, 4 patients had tumor recurrence and the remaining 9 patients were stable.

For part of the patients with jugular foramen area tumors, neuroendoscopic transnasal anterior lateral approach can provide a safe choice which leads to a relatively good clinical outcome.

To compare the application effect of in situ bone flap (ISBF) combined with pedicled nasal septum flap (PNSF) and that of ISBF combined with free middle turbinate mucosal flap (FMTMF) in neuroendoscopic extended transnasal surgery for skull base reconstruction.

A retrospective analysis was conducted on the clinical data of patients undergoing skull base reconstruction by using ISBF combined with PNSF (ISBF+ PNSF group, n=86) or ISBF combined with FMTMF (ISBF+ FMTMF group, n=40) at the Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University from January 2016 to September 2020. There was no statistically significant difference in the baseline data of the two groups of patients, such as gender, age, body mass index, maximum diameter of the lesion, and pathological type (all P>0.05). All patients underwent outpatient follow-up at 3, 6 months after surgery, and re-examination of the sellar area enhanced MRI and sellar area thin-slice CT to observe the postoperative healing of ISBF and mucosal flap. The quality of life in nasal cavity was evaluated by sino-nasal outcome test-22 (SNOT-22) at 6 months after operation. The operation time, postoperative bed rest time, intracranial infection rate, cerebrospinal fluid leakage rate, and lumbar cistern drainage rate were compared between the two groups.

All 126 patients underwent successful skull base reconstruction. The thin-slice CT scan of the sellar area showed that ISBF was in place. The imaging review results of 126 patients at 3, 6 months after surgery showed that the ISBF and mucosal flaps healed completely. Patients in the ISBF+ PNSF group and ISBF+ FMTMF group had no significant differences in the length of operation (median: 210 min vs. 190 min), postoperative bed rest time (median: 14 d vs. 13 d), intracranial infection rate [8.1% (7/86) vs. 5.0% (2/40)], the incidence of cerebrospinal fluid leakage [11.6% (10/86) vs. 7.5% (3/40)], or the rate of lumbar cistern catheterization and drainage [26.7% (23/86) vs. 22.5% (9/40)] (all P>0.05). At 6 months after surgery, the SNOT-22 score of the ISBF+ PNSF group was higher than that of the ISBF+ FMTMF group, and the difference was statistically significant (median: 15 vs. 13, P=0.029).

Both ISBF+ PNSF and ISBF+ FMTMF could achieve the anatomical reconstruction of skull base. The method of ISBF+ FMTMF is associated with less nasal trauma and better sino-nasal outcomes after surgery. The risks of cerebrospinal fluid leakage and intracranial infection are similar between the two methods.

To investigate the efficacy and safety of using free middle turbinate mucosal flap in transnasosphenoidal neuroendoscopic treatment of low-flow cerebrospinal fluid (CSF) rhinorrhea.

This study retrospectively enrolled a total of 168 patients who underwent neuroendoscopic transnasosphenoidal repair of low-flow CSF rhinorrhea at the Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2015 to December 2018. Among them, 82 patients were repaired with free middle turbinate mucosal flap (FMTMF group) and 86 patients with vascularized nasoseptal flap (VNF group). The success rate of first repair and the incidence of surgical complications were compared between the two groups.

In the FMTMF group, the success rate of first repair was 95.1% (78/82), and no postoperative intracranial infection occurred. In the VNF group, the success rate of first repair was 95.3% (82/86), and the incidence of postoperative intracranial infection was 2.3% (2/86). There was no significant difference in the success rate of first repair or incidence of intracranial infection between the two groups (both P>0.05). At 6 months after surgery, the incidences of nasal obstruction and pain in the FMTMF group was 8.5% (7/82) and 7.3% (6/82) respectively, and which did not significantly differ from those in the VNF group [9.3% (8/86) and 15.1% (13/86), respectively] (all P>0.05). The incidence of olfactory dysfunction in the FMTMF group was significantly lower than that of VNF group [12.2% (10/82) vs. 29.1% (25/86)], and the difference was statistically significant (P=0.012).

The use of FMTMF to repair low-flow CSF rhinorrhea can achieve the same effect as that of VNF and reduce the incidence of postoperative nasal complications.

To observe the effect of neuroendoscopic transnasal dural suturing combined with multi-layer skull base reconstruction in the treatment of high-flow cerebrospinal fluid (CSF) leakage during brain tumor resection.

This study enrolled patients with high-flow CSF leakage during neuroendoscopic transnasal intracranial tumor resection from June 2015 to July 2021 at the Department of Neurosurgery of the First People′s Hospital of Yancheng (26 cases) and Affiliated Nanjing Brain Hospital, Nanjing Medical University(34 cases). Among them, dural suturing combined with multi-layer skull base reconstruction was performed in 32 cases (dural suturing group), multi-layer skull base reconstruction without dural suturing was performed in 28 cases (control group). We retrospectively analyzed the incidences of postoperative intracranial infection, CSF leakage, a second operation, the rate of lumbar cistern drainage, and the differences in the postoperative ambulation time and the length of hospital stay in the two groups.

In the dural suturing group, the incidences of CSF leakage and a second operation were 6.3% (2/32) and 3.1% (1/32) respectively. The rate of lumbar cistern drainage was 31.5% (10/32), and the median postoperative ambulation time and hospital stay were 8 d and 11 d respectively. In the control group, the incidences of CSF leakage and a second operation were 28.6% (8/28) and 21.4% (6/28) respectively, and the rate of lumbar cistern drainage was 89.2% (25/28). The median postoperative ambulation time and hospital stay were 12 d and 16 d respectively. There were statistically significant differences in the above indexes between the two groups (all P<0.05). There was no significant difference in the incidence of intracranial infection between the two groups (P=0.281).

The effect of dural suturing combined with multi-layer skull base reconstruction for the treatment of high-flow CSF leakage during intracranial tumor resection is better than that of multi-layer reconstruction without dural suturing, which could also shorten the time of ambulation and hospital stay.

To preliminarily evaluate the efficacy and safety of Surpass Streamline flow diverting device (FD) in the treatment of intracranial aneurysms.

A retrospective analysis was conducted on the clinical data of 46 patients with intracranial aneurysms treated with Surpass Streamline FD at the Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University from November 2020 to March 2021. There were 57 aneurysms in 46 patients. Among them, there were 28 ophthalmic segment aneurysms, 8 communicating segment aneurysms, 19 cavernous sinus segment aneurysms, 1 carotid segment aneurysm and 1 vertebral V4 segment aneurysm. The O′Kelly-Marotta (OKM) grading scale was used to assess the degree of embolization of aneurysms immediately after surgery and during follow-up. The modified Rankin scale (mRS) was used to evaluate the neurological function of patients during the perioperative period and during follow-up. At 6 months after surgery, digital subtraction angiography (DSA) or CT angiography (CTA) was performed to review the occlusion of the aneurysm.

A total of 46 FDs were implanted in 57 intracranial aneurysms in 46 patients. Among them, 42 FDs (91.3%) were successfully released at one time; the other 4 FDs were not successfully released at one time, but after bridging, overlapping and balloon dilation, satisfactory release effects were achieved. Forty-three patients were treated with FD implantation alone, and three patients were treated with FD combined with coiling. The DSA of 57 aneurysms immediately after the operation showed that the contrast agent was well filled in the aneurysm, and the OKM grades were grade A in 30 cases, grade B in 19, grade C in 5, and grade D in 3. After the operation, 43 patients (93.5%) had a good outcome (mRS ≤2 points); the remaining 3 patients (6.5%) had various degrees of ischemic complications. A total of 32 patients (37 aneurysms) underwent DSA or CTA follow-up, the follow-up time was 6.6±1.8 months (3-10 months), and 32 aneurysms (86.5%) were completely occluded (OKM grade D in all). At the last follow-up, 32 patients had no new ischemic or bleeding complications, and their mRS were all ≤2 points.

The immediate effect of Surpass Streamline FD in the treatment of intracranial aneurysms is satisfactory. The aneurysm occlusion rate in the mid-term follow-up seems high and the incidence of complications is low. However, the long-term efficacy and safety need to be further observed.

To investigate the clinical efficacy of combined endovascular and microsurgical treatment of complex intracranial vascular diseases.

A retrospective analysis was conducted on the clinical data of 76 patients with complex intracranial vascular diseases treated by combined endovascular and microsurgical operations at the Department of Neurosurgery, Nanjing Drum Tower Hospital, Nanjing University School of Medicine from September 2018 to December 2019. Among them, 22 patients had intracranial aneurysms, 21 had intracranial arteriovenous malformations (AVM), 25 had carotid artery stenosis/occlusion, 6 had spinal dural arteriovenous fistula, 1 had intracranial dural arteriovenous fistula and 1 case had cavernous malformation (CM) of the cavernous sinus. After surgery, one patient with CM was re-examined with head MRI, and the remaining 75 cases were re-examined with digital subtraction angiography (DSA) or CT angiography (CTA) to evaluate the efficacy of the operation. Clinical follow-up was performed for all patients 3 months after surgery and included re-examination of head DSA, CTA or MRI to assess the progress of the disease after surgery. In addition, the outcomes were assessed using Glasgow outcome scale (GOS), the point of ≥ 4 was defined as good outcome, and that of 1-3 was defined as poor outcome.

The operations of 76 patients were successful. Postoperative re-examination of head DSA, CTA or MRI showed that there was no residual lesion in those patients. Intracranial infections occurred in 14 patients(18.4%) after operation, including 9 cases of intracranial aneurysms and 5 case of cerebral AVM. After active treatment, 12 cases were cured and the other 2 (both with posterior circulation aneurysms) died. Seventy-four patients were followed up for 3.4±0.8 months (2-6 months). At 3 months post operation, the head DSA, CTA or MRI were re-examined, and there was no recurrence or residual lesion. The assessment using GOS showed that 73 patients(98.6%) had a good outcome and the other 1(1.4%) had a poor outcome.

Combined endovascular and microsurgical treatment of complex intracranial vascular diseases is associated with a low incidence of postoperative complications, a low recurrence rate, and a good outcome in most cases.

To compare the short-term efficacy and complications of superficial temporal artery to middle cerebral artery bypass combined encephalo-myo-synangiosis (STA-MCA+ EMS) and encephalo-duro-arterio-synangiosis (STA-MCA+ EDAS) in the treatment of Moyamoya disease.

A retrospective analysis was conducted on the clinical data of adult patients with Moyamoya disease who underwent STA-MCA+ EMS (n=75, EMS group) or STA-MCA+ EDAS (n=176, EDAS group) in the Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University from January 2016 to June 2021. The modified Rankin scale score (mRS) was evaluated at discharge. At 3 and 6 months after surgery, follow-up by telephone or outpatient service was conducted to assess mRS and the presence or absence of recent complications, and re-examination of imaging examinations was performed to assess the bypass vessel patency rate and Matsushima grade. We compared the baseline data, clinical efficacy and complications of the two groups of patients.

Intraoperative indocyanine green angiography of 251 patients revealed the patency of bypass vessels. There was 1 death in the EMS group and 2 deaths in the EDAS group. The median follow-up time (quartiles) of 248 patients was 5 (4, 8) months. The first postoperative angiography showed that the bypass vessels of 1 patient in each group were not developed, and the bypass vessel patency rate was 99.2% (246/248). At the last follow-up, among the 248 patients, the mRS score of 0 was reported in 210 cases, 1 in 25 cases, 2 in 7 cases, 3 in 3 cases, 4 in 2 cases, and 5 in 1 case. Matsushima grade A was reported in 96 cases, grade B in 115 cases, and grade C in 37 cases. There were no statistically significant differences in age, gender, underlying disease, clinical type, Suzuki stage, mRS score at admission, or the surgical side between the two groups of patients (all P>0.05). There were no significant differences in the mRS at discharge, follow-up time, bypass patency rate, Matsushima grade, or the mRS at the last follow-up between the two groups of patients (all P>0.05). Compared with the EDAS group, the EMS group had higher incidences of perioperative cerebral infarction [10.8% (8/74) vs. 4.0% (7/174)], cerebral hemorrhage [8.1% (6/74) vs. 1.1% (2/174)], epilepsy [5.4% (4/74) vs. 0.6% (1/174)], and subdural effusion [14.9% (11/74) vs. 5.7% (10/174)] (all P<0.05). In terms of postoperative recent complications, the incidence of cerebral infarction in the EMS group was higher than that in the EDAS group [5.4% (4/74) vs. 0.6% (1/174), P=0.029].

Both types of bypass surgery have relatively high patency rates and favorable short-term therapeutic outcomes. The risk of cerebral infarction, cerebral hemorrhage, epilepsy, subdural effusion during perioperative period and postoperative recent cerebral infarction of STA-MCA+ EDAS seems lower.

To explore the influencing factors of the recurrence of Cushing′s disease (CD) after transsphenoidal surgery.

A retrospective analysis was conducted on the clinical data of 164 patients with CD who were treated with microscopy or neuroendoscopic transsphenoidal surgery from May 2013 to July 2020 in the Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University and reached remission standards after surgery. We collected the data including the patient′s gender, age, smoking history, drinking history, history of hypertension, history of diabetes, history of abnormal lipid metabolism, systolic and diastolic blood pressures at admission, preoperative body mass index (BMI), imaging examination results (tumor diameter, saddle progression and invasiveness), the operation method, whether it was a second operation, and the follow-up time. The serum adrenocorticotropic hormone (ACTH), cortisol and 24 h urinary free cortisol levels on the preoperative and postoperative day one (POD1) mornings were documented. Recurrence was defined as the presence of typical clinical symptoms and hypercortisolemia during the follow-up period after postoperative remission. According to the presence or absence of recurrence, the patients were divided into recurrence group (n=25) and non-recurrence group (n=139). We compared the clinical data of the two groups of patients. Multivariate logistic regression analysis was used to determine the influencing factors of postoperative recurrence.

Compared with those in the non-recurrence group, the patients in the recurrence group had significantly higher proportion of dyslipidemia, higher preoperative BMI and preoperative morning serum ACTH level, higher proportions of macroadenoma and invasive adenomas, higher POD1 morning serum ACTH and cortisol levels, and shorter follow-up time (all P<0.05). There was no statistical significance in other indicators between the two groups of CD patients (all P>0.05). Multivariate logistic regression analysis indicated that higher preoperative BMI (OR=1.39, 95%CI: 1.012-1.910, P=0.042), higher POD1 morning serum ACTH (OR=1.02, 95%CI: 1.002-1.037, P=0.027) and cortisol levels (OR=1.01, 95%CI: 1.003-1.020, P=0.010) were risk factors for postoperative recurrence.

Patients with CD who have a higher preoperative BMI and higher POD1 morning serum ACTH and cortisol levels after transsphenoidal tumor resection seem to have a higher risk of postoperative recurrence.

To investigate the efficacy and influencing factors of gamma knife radiosurgery (GKRS) for the treatment of drug-refractory trigeminal neuralgia (TN).

A retrospective analysis was conducted on the clinical data of 91 patients with drug-refractory TN who were treated with GKRS for the first time at the Department of Neurosurgery, Zhongshan Hospital of Xiamen University from October 2014 to December 2018. After treatment, all patients were followed up in outpatient clinics or by telephone. The content of follow-up included evaluation of the patient′s pain relief, complications and recurrence. According to the Barrow Neurology Institute (BNI) pain intensity scale, the patient′s pain relief was evaluated. Among them, grades Ⅰ-Ⅲ indicated effectiveness of treatment, and grades Ⅳ, Ⅴ indicated ineffectiveness. Univariate analysis and multivariate Cox regression analysis were used to determine the risk factors that affected the effectiveness of GKRS treatment in patients with drug-refractory TN.

The median follow-up time of 91 patients was 32 months (10-60 months). During the follow-up period, 19 patients (20.9%) relapsed; 14 cases (15.4%) had facial numbness, 1 case (1.1%) had masticatory muscle weakness, 2 cases (2.2%) had herpes labialis, 1 case (1.1%) had dry eye and corneal ulcer, 3 cases (3.3%) had paresthesia, and 2 cases (2.2%) had masseter muscle weakness. At the last follow-up, 78 of 91 patients achieved effectiveness (treatment-effective group) and 13 patients reported ineffectiveness (treatment-ineffective group); the pain relief rate was 85.7% (78/91). The median effective time for pain relief in 91 patients was 7 months (1-36 months). Compared with the treatment-ineffective group, the treatment-effective group had a lower proportion of patients with a history of hypertension and a preoperative BNI pain intensity scale rating of grade Ⅴ (both P<0.05). There were no significant differences in gender, age, course of disease, pain involvement of trigeminal nerve branches, pain side or central radiation dose between the two groups (all P>0.05). Multivariate Cox regression analysis showed that history of hypertension (HR=1.83, 95%CI: 1.35-2.34) and preoperative BNI pain intensity scale rating of grade Ⅴ (HR=2.13, 95%CI: 1.54-2.66) were risk factors that affected the effectiveness of GKRS treatment in TN patients (both P<0.05).

GKRS for the first treatment of drug-refractory TN has a relatively high pain relief rate, a relatively low postoperative recurrence rate and a relatively low incidence of complications. However, patients with a history of hypertension and preoperative BNI pain intensity scale rating of grade Ⅴ have a lower pain relief rate following GKRS treatment.

To study the effects of B cell lymphoma/leukemia 11A (BCL11A) on the proliferation, migration and invasion of glioblastoma (GBM) cell line, and to explore its possible mechanisms.

In this study, the expression levels of BCL11A in different World Health Organization(WHO) grades of glioma tissues and different GBM cell lines were detected by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot. Short hairpin RNA lentivirus was infected into GBM cell lines with high expression of BCL11A to construct GBM cell lines with stable knockdown of BCL11A. Negative control (NC) group (with only scrambled shRNA transfected) and BCL11A knock-down (BCL11A-KD) group were established. The knockdown efficiency of BCL11A was detected by qRT-PCR and Western blot. Then we used cell counting kit-8 (CCK-8), colony formation assay and transwell cell migration and invasion assay to examine the cell proliferation, migration and invasion ability of GBM cells after BCL11A knockdown. Subsequently, Western blot experiment was used to detect the expression changes of downstream signal molecules after BCL11A knockdown.

Compared with low-grade gliomas (WHO grade Ⅰ and Ⅱ ) and normal brain tissues, the expression level of BCL11A was higher in high-grade gliomas (WHO grade Ⅲ and Ⅳ) (both P<0.05). BCL11A were highly expressed in primary glioma cell PT2, GBM cell lines U251 and TG-905, but nearly not expressed in A172, SF295 or U87-MG cell lines. The experiments of qRT-PCR and Western blot revealed that stable knockdown of BCL11A through shRNA lentiviral infection was achieved in U251 and TG-905 cell lines. CCK-8 experiment showed that the absorbance values of U251 and TG-905 cells in NC group were 1.72±0.05 and 1.87±0.05 respectively, which were higher than those in BCL11A-KD group (1.15±0.05 and 1.18±0.05 respectively) (both P<0.001). Colony formation assay showed that the numbers of clones in NC group of U251 and TG-905 were 15.3±1.5 and 9.0±1.0 respectively, which were higher than those in BCL11A-KD group (8.8±1.0 and 2.3±0.6 respectively) (both P<0.001). Transwell chamber experiment showed that in NC and BCL11A-KD group of U251, the counts of migrated cells were 111.0±10.2 and 55.3±5.5 respectively, and the invasive cells were 85.3±7.8 and 35.0±4.6 respectively, and there was statistical differences between the two groups (both P<0.01). Similarly in NC and BCL11A-KD group of TG-905, the numbers of migrated cells were 95.0±5.0 and 66.7±7.0 respectively, and those of invasive cells were 93.0±3.6 and 46.7±7.4 respectively, and there were statistical differences between the two groups (both P<0.01). Western blot experiment revealed that silencing of BCL11A reduced the protein levels of vimentin in U251和TG-905 cell lines.

BCL11A affects the proliferation, migration, and invasion of GBM by regulating vimentin in U251 and TG-905 cells. The BCL11A-vimentin regulatory pathway may provide a basis for molecular targeted therapy of GBM.