Comparison of the Outcomes after Intralesional, Intracisternal, and Intravenous Transplantation of Human Bone Marrow Derived Mesenchymal Stem Cells for Spinal Cord Injured Rat

OBJECTIVE: Mesenchymal stem cells (MSCs) have shown promise in potentially repairing injured spinal cord. These and similar cell types are being tested clinically, but the understanding about delivering method and subsequent results is lacking. This study was designed to compare the MSCs engraftment results after intralesional, intracisternal, or intravenous injection in a rat with spinal cord injury (SCI). METHODS: A total of 48 male Sprague-Dawley rats (300-350 g in size) were used with 12 in each group. Allogenic MSCs were cultured from human bone marrow aspirates. The SCI was induced using an NYU (New York University) impactor and MSCs were transplanted 1 week after the SCI. Behavioral testing was performed weekly for 6 weeks. The recipients were analyzed histologically to evaluate the extent of cell delivery and survival at the injury site. RESULTS: All three experimental groups showed better behavioral recovery compared with the control group since 6 weeks after stem cell injection (p<0.05). The intracisternal injection group showed the best functional improvement (p<0.05). The intralesional injection group showed the best engraftment until 4 weeks after stem cell injection (p<0.05). A number of the injected MSCs were trapped in the spleen in the intravenous injection group. CONCLUSION: Transplantation of stem cells by a variety of routes can deliver cells with the potential to repair injured spinal cord. Intracisternal injection can easily be translated to patients after some modifications, thus accelerating clinical application of cell therapies.

Surgical Outcomes of Spine Disorders in Patients with Parkinson's Disease

PURPOSE: Patients with Parkinson's disease also commonly have movement disorders, osteoporosis, and other comorbidities. These patients are more likely to have complications after spinal surgery. The aim of the present study is to show the relation ship between complications of spinal surgery and Parkinson's disease. METHODS: A computerized search using diagnostic and procedural codes identified 13 patients with Parkinson's disease who underwent spinal surgery between January 1998 and December 2010. Their medical records and imaging studies were reviewed and recent updatesfor all patients were done by telephone interview. RESULTS: Retrospectively, 13 consecutive patients were reviewed. The mean age was 63.8 (range 44~87) years old and the mean durationof Parkinson's disease was 7.6 (range 1~22) years at the time of the index procedure. The mean T score of the lumbar spine on Dual-energy X-ray absorptiometry (DEXA) scan bone mineral density (BMD) was -2.5 (range -1.0~-5.1). These patients had nine lumbar lesions, two thoracic lesions, one cervical lesion, and one thoracolumbar lesion. Nine patients required no more surgical treatment for lesions which had been previously operated on (index level). However, four patients (30.8%) needed at least one more operation related to their index procedure; segmental degeneration on the adjacent levels in two, retropulsion of an intervertebral cage with screw loosening in one, and pedicle fracture in one. CONCLUSION: It has been reported that patients with Parkinson's disease have high complication rates in spinal surgery. Spine surgeons should be aware of the risk of complications and need to conduct careful follow-up after the surgery.

Surgical Outcome of Infectious Cerebral Aneurysms / 대한뇌혈관외과학회지

OBJECTIVES: This study was to define the clinical characteristics and formulate the management strategies of the patients with infectious cerebral aneurysms. METHODS: During the past 30 years, among 2,830 patients who were treated with intracranial aneurysms, 11 patients had infectious cerebral aneurysms. The authors reviewed the database and the imaging studies as sources for identification and analysis. RESULTS: Nine patients had ruptured lesions: Five patients presented with subarachnoid hemorrhage (SAH) and 4 patients presented with intracerebral hemorrhage (ICH). Two patients were Hunt and Hess Grade I, 1 Grade II, 2 Grade III, 3 Grade IV, and 1 Grade V. Seven aneurysms were located at middle cerebral artery, 2 at anterior cerebral artery, 1 at internal carotid artery, and 1 at posterior circulation. Ten aneurysms were small ((8 mm). Seven aneurysms were fusiform, and the remaining 4 aneurysms were saccular. Five of the 11 patients (44.4%) had multiple aneurysms. All patient were treated by microsurgery. The obliteration methods of the aneurysms were trapping in 7 patients, and neck clipping in 4 patients. Nine patients showed favorable outcome (good : 7, fair : 2) and 2 patients showed unfavorable outcome (poor : 1, dead : 1). CONCLUSION: Infectious cerebral aneurysms had high frequency of ICH, fusiform-shape, multiple aneurysms, and initial poor clinical grade. Surgery was necessary for ruptured lesion and unruptured lesions which size was increased at follow up angiography. The ultimate management outcome was satisfactory. Co-work with cardiologist and cardiovascular surgeon is necessary.

Management Outcome and Prognostic Factors of Patients who Underwent Decompressive Craniectomy for Space-Occupying Cerebral Infarction / 대한뇌혈관외과학회지

OBJECTIVES: This study was to assess management outcome of patient undergoing decompressive craniectomy for space-occupying cerebral infarction refractory to medical treatment and to identify risk factors associated with unfavorable outcomes. PATIENTS AND METHODS: Between January 1999 and June 2004, total 20 patients were analyzed. The preoperative consciousness was rated using Glasgow Coma Scale (GCS). The clinical outcome was rated using Glasgow Outcome Scale (GOS) at 3 months follow up and divided into 2 groups;favorable outcome group (GOS> or =3) and unfavorable outcome group (GOS<3). The prognostic factors were analyzed multivariately. RESULTS: Fourteen patients were men and six patients were women (mean age, 58.7 yrs). Seventeen patients had right hemispheric infarction, and three patients had left hemispheric infarction. 16 patients had only middle cerebral artery (MCA) infarction, and 2 patients had combined anterior cerebral artery (ACA) or posterior cerebral artery (PCA) infarction respectively. Eleven patients showed anisocoria preoperatively. The mean time interval between symptom onset of infarction and operation was 61.5 hrs. 8 patients showed favorable outcome, and 12 patients showed unfavorable outcome. CONCLUSIONS: The existence of preoperative anisocoria and low preoperative GCS score were statistically significant prognostic factor related to unfavorable outcome.