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Objective Reports are rarely seen on the clinical studies of pituicytomas. This article discusses the clinical diagnosis, treatment strategies, pathological features and postoperative complications of pituicytomas. Methods This retrospective study included 10 cases of pituicytomas treated in our hospital from July 2008 to July 2018. All the patients underwent microsurgery, gross total resection of the tumor in 6 cases and subtotal resection in the other 4. We analyzed the histopathological features, postoperative complications and follow-up data of the patients. Results The tumors were tightly organized morphologically, consisting of bipolar spindle-shaped cells, arranged like crosswise-woven fiber bundles or in a storiform pattern, the cytoplasm stained red and eosinophilic, the nuclei medium-sized, round, oval or spindle shaped, mildly heterotypical, with visible microencapsulation and abundant interstitial blood vessels. The main postoperative complications included insipidus in 8 cases, hyponatremia in 4, decreased visual acuity in 3, hypopituitarism in 2, and intracranial infection in 1. Of the 9 patients followed up, 1 experienced recurrence at 2 years postoperatively and received another surgery, with no more recurrence hitherto. Conclusion Definite diagnosis of pituicytoma depends on pathological examination, and adequate attention should be paid to the prevention and management of such postoperative complications as insipidus and hyponatremia.
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Objective The long non-coding RNA (lncRNA) MTHFD2 gene is expressed differentially in glioblastoma (GBM) and normal brain tissues, but its biological role in tumors, and particularly in GBM, remains unclear. This study aims to investigate the expression of lncRNA MTHFD2 in the GBM tissue and four GBM cell lines, and explore the effect of its down-regulated expression on the biological function of GBM cells. Methods Specimens of GBM and the paracancerous tissue (as normal control) were collected from 9 patients treated by surgical resection in our Department of Neurosurgery between September and December 2017 LV-MTHFD2-shRNA (U251 shRNA and U-87MG shRNA groups) and empty LV-control solution (U251 shRNA and U-87MG control groups) were transfected into the U251 and U-87MG cell lines. The expressions of lncRNA MTHFD2 in the GBM tissue and the GBM cell lines were detected by qRT-PCR, the chemosensitivity and proliferation of the cells after transfection measured by CCK-8 assay, and the changes in the cell migration ability determined by Transwell assay. Results The relative expression of lncRNA MTHFD2 was significantly higher in the GBM than in the normal tissue (5.13 ± 3.96 vs 1.27 ± 0.58, P < 0.05), while that of MTHFD2 was remarkably lower in the U251 shRNA than in the U251 control group (0.05 ± 0.01 vs 1.00 ± 0.00, P < 0.01), and so was that in the U-87MG shRNA than in the U-87MG control (P < 0.05). The number of cells penetrating the Transwell membrane was markedly lower in the U251 shRNA group than in the U251 control (41.4 ± 6.99 vs 125.8 ± 25.27 per field of view, P < 0.01), and so was that in the U-87MG shRNA than in the U-87MG control (P < 0.05). CCK-8 assay showed that, at 4 days after transfection, the A value was significantly decreased in the U251 shRNA and U-87MG shRNA groups as compared with the U251 control and U-87MG control groups (P < 0.05). Cellular drug resistance test manifested remarkably reduced fifty percent inhibitory concentrations (IC50) in the U251 shRNA and U-87MG shRNA groups as compared with the U251 control and U-87MG control groups (P < 0.05). Conclusion DDown-regulation of the expression of lncRNA MTHFD2 can inhibit the proliferation and migration of U251 and U-87MG cells and enhance the chemosensitivity of the cells to temozolomide, which suggests that lncRNA MTHFD2 could be a potential therapeutic target against GBM.
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<p><b>Background</b>The increasing frequency of explosive injuries has increased interest in blast-induced traumatic brain injury (bTBI). Various shock tube models have been used to study bTBI. Mild-to-moderate explosions are often overlooked because of the slow onset or mildness of the symptoms. However, heavy gas cylinders and large volume chambers in the model may increase the complexity and danger. This study sought to design a modified model to explore the effect of moderate explosion on brain injury in mice.</p><p><b>Methods</b>Pathology scoring system (PSS) was used to distinguish the graded intensity by the modified model. A total of 160 mice were randomly divided into control, sham, and bTBI groups with different time points. The clinical features, imaging features, neurobehavior, and neuropathology were detected after moderate explosion. One-way analysis of variance followed by Fisher's least significant difference posttest or Dunnett's t 3-test was performed for data analyses.</p><p><b>Results</b>PSS of mild, moderate, and severe explosion was 13.4 ± 2.2, 32.6 ± 2.7 (t = 13.92, P < 0.001; vs. mild group), and 56.6 ± 2.8 (t = 31.37, P < 0.001; vs. mild group), respectively. After moderate explosion, mice showed varied symptoms of malaise, anorexia, incontinence, apnea, or seizure. After bTBI, brain edema reached the highest peak at day 3 (82.5% ± 2.1% vs. 73.8% ± 0.6%, t = 7.76, P < 0.001), while the most serious neurological outcomes occurred at day 1 (Y-maze: 8.25 ± 2.36 vs. 20.00 ± 4.55, t = -4.59, P = 0.048; 29.58% ± 2.84% vs. 49.09% ± 11.63%, t = -3.08, P = 0.008; neurologic severity score: 2.50 ± 0.58 vs. 0.00 ± 0.00, t = 8.65, P = 0.016). We also found that apoptotic neurons (52.76% ± 1.99% vs. 1.30% ± 0.11%, t = 57.20, P < 0.001) and gliosis (2.98 ± 0.24 vs. 1.00 ± 0.00, t = 14.42, P = 0.021) in the frontal were significantly higher at day 3 post-bTBI than sham bTBI.</p><p><b>Conclusions</b>We provide a reliable, reproducible bTBI model in mice that can produce a graded explosive waveform similar to the free-field shock wave in a controlled laboratory environment. Moderate explosion can trigger mild-to-moderate blast damage of the brain.</p>
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Objective It is difficult to conduct the intravascular interventional treatment of A1 segment anterior cerebral ar-tery aneurysms. This article aimed to investigate the effect of stent-assisted coil embolization for the treatment of A1 segment anterior cerebral artery aneurysms. Methods Retrospective analysis was made on the clinical data of 8 patients with A1 segment anterior cer-ebral artery aneurysms who were treated in Department of Neurosurgery in Nanjing General Hospital of Nanjing Military Command from June 2015 to July 2017. All the patients underwent endovascular intervention under static inhalation combined with general anesthesia. Immediately after the operation,angiography was performed to observe the embolization of the aneurysm and imaging follow-up was per-formed. The follow-up period was 6 to 30 months,with an average of (13±9) months,followed by Glasgow Outcome Scale (GOS) sco-ring. Results Immediate postoperative angiography showed that all 8 aneurysms were completely embolized and the parent artery re-mained. Seven patients had no ruptured hemorrhage and no new neu-rological dysfunction,with 5 points of GOS score and good prognosis. Five patients underwent DSA follow-up after surgery with no developed aneurysm. Conclusion Stent-assisted coil embolization is techni-cally feasible in treating A1 segment anterior cerebral artery aneu-rysms,which is a choice worthy of clinical promotion.
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Objective Intravascular interventional embolization has become the preferred method for the treatment of anterior communicating artery aneurysms.The purpose of this paper was to study the guiding significance of dual vessel fusion technique for in -terventional surgery of complex anterior communicating artery aneurysms. Methods A retrospective analysis was conducted on the clinical data of 31 patients with complicated anterior communicating artery aneurysms in our department from March 2015 to June 2016. All patients underwent two-vessel fusion, DSA angiography, and three-dimensional reconstruction of unilateral internal carotid artery and the images were compared to identify whether the aneurysm met the true size,the exact convergence point of bilateral A 1 and ante-rior communicating artery, anterior communicating artery aneurysm and anterior communicating artery and so on. Results There were 31 cases identified by dual vessel fusion technique on the consistency of aneurysms to true volume and 28 cases by three-dimensional reconstruction of unilateral internal carotid artery.There were 31 cases identified by dual vessel fusion technique on the exact convergence point of bilateral A 1 and anterior communicating artery and 9 cases by DSA angiography.There were 31 cases identified by dual vessel fusion technique on variations of anterior communicating artery complex and 24 cases by DSA angiography.There were 27 pa-tients who attained the optimal DSA machine projection angle by the dual vessel fusion technique which was the same as that of the unilateral internal carotid artery,in addition,the other 4 cases got better optimal DSA machine projection angle than those by three-dimensional reconstruction of unilateral internal carotid artery. Conclusion The dual vessel fusion technique helps surgeons to fully understand the anatomical relationship between anterior communicating artery complex and aneurysm,which has important guiding significance in making surgical strategies for complicated anterior communicating artery aneurysms,selecting embolization work angles and real-time observation during embolization.
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Objective The stent-assisted technique is widely applied in the treatment of subarachnoid hemorrhage caused by ruptured vertebral artery dissecting aneurysm(VADA). This study investigated the perioperative complications and long-term clinical effect of stent-assisted coiling in the management of VADA-induced subarachnoid hemorrhage. Methods The clinical data on 19 cases of VADA-induced subarachnoid hemorrhage were analyzed retrospec-tively. All the patients underwent digital subtraction angiography (DSA)and stent-assisted coiling within 24 hours after admission.Two of the patients were diagnosed with bilateral VADA and treated with double stents,4 with a single stent,2 with the low-profile visualized intraluminal support device(LVIS),and 11 with double Enter-prise stents. Results Operations were successfully performed in all the cases. Three of the patients died within 2 weeks after surger-y,2 from post-operative rebleeding and the other 1 from some unknown cause;1 patient developed severe postoperative cognitive dys-function,while the other 15 were well recovered. The survived patients were followed up for 6 to 36 months,during which no obvious new neurological deficits were observed. Follow-up DSA revealed 2 cases of recurrence,1 case of stenosis in the stent,and 2 cases of vertebral artery occlusion. Conclusion Stent-assisted coiling is a safe and effective method for the management of VADA-induced subarachnoid hemorrhage,and double-stent implantation may achieve an even better effect.
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Objective The management of poor-grade ruptured aneurysm is important and challenging in intravascular inter-vention. This study aimed to investigate the safety of external ventricular drainage(EVD)after stent-assisted embolization for patients with poor-grade ruptured aneurysm in the acute stage. Methods From January 2015 to July 2017,27 patients with poor-grade rup-tured aneurysm underwent EVD after endovascular embolization by stent-assisted coiling(n=14)or simple coiling(n=13). We com-pared the clinical data about and the postoperative complications between the two groups of patients. Results There were no statisti-cally significant differences in the patients'age,gender,Glasgow Coma Scale(GCS)scores before embolization and discharge,the in-terval between EVD and the end of embolization,preoperative intraventricular hemorrhage and hydrocephalus,puncture-related bleed-ing after EVD,catheter-indwelling time,perioperative bleeding in other parts,or poor prognosis between the stent-assisted coiling and simple coiling groups(all P>0.05). Conclusion EVD after stent-assisted embolization is a relatively safe strategy for the treatment of poor-grade ruptured aneurysm in the acute stage.
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Objective Distal anterior cerebral artery aneurysm(DACAA)is rare and difficult to be treated. The aim of this study was to investigate the clinical effect of stent-assisted coiling in the treatment of DACAA. Methods We retrospectively analyzed the clinical data about 15 patients with 15 DACAAs treated by stent-assisted coiling,with all the aneurysms occluded and the parent ar-teries preserved,including 4 ruptured and 11 unruptured aneurysm,8 in the A2 and 7 in the A3 segment. The follow-up ranged from 6 to 33 months,during which we evaluated the prognosis of the patients by radiological and clinical examinations. Results There were no operation-related complications in any of the cases. One patient died of subarachnoid hemorrhage-induced cerebral vasospasm. Fol-low-up angiogram revealed complete occlusion of the aneurysms in 9 cases. The last follow-up Glasgow Outcome Scale score was 5 in all the 14 survived patients. No rupture,rebleeding or fresh neurologic deficits was observed in any of the patients. Conclusion Stent-assisted coiling is safe and effective,with a low short-term recurrence rate,in the treatment of distal anterior cerebral artery aneurysm.
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Objective Reports are rarely seen on the treatment of blood blister-like aneurysm(BBA)of the internal carotid artery with the overlapping low-profile visualized intraluminal support device(LVIS)stent. This study was to investigate the effects of overlapping versus non-overlapping LVIS stent-assisted coiling in the treatment of BBA. Methods We retrospectively analyzed the clinical data about 15 cases of BBA of the internal carotid artery treated in our hospital from February 2015 to February 2017,11 by o-verlapping and the other 4 by non-overlapping LVIS stent-assisted coiling. Using Raymond-Roy Occlusion Classification(RROC),we evaluated the effects of treatment immediately and at 1 week after operation. We followed up the patients from April 2015 to October 2017 and analyzed the results of follow-up digital subtraction angiogra-phy(DSA)and modified Rankin Scale scores(mRS)of the patients. Results RROC showed 10 cases of grade Ⅰ and 1 case of grade Ⅲocclusion in the overlapping group and 3 cases of gradeⅠand 1 case of gradeⅡin the non-overlapping group right after operation. In com-parison,there were 11 cases of gradeⅠin the overlapping group and 2 cases of grade Ⅰ and 2 cases of grade Ⅱ in the non-overlapping group at 1 week postoperatively.DSA at the end of the follow-up exhibited 9 cases of gradeⅠand 1 case of gradeⅡin the overlapping group and 1 case of grade Ⅰ,2 cases of grade Ⅱ and 1 case of gradeⅢin the non-overlapping group. Satisfactory prognosis was ob-served in all the 15 cases,with mRS=0 in 9 cases and mRS = 1 in 2 cases in the overlapping group and with mRS=0 in 3 cases in mRS=1 in 1 case in the non-overlapping group. Conclusion Overlapping LVIS stent-assisted coiling is safe and effective for treat-ment of BBA of the internal carotid artery.
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Intracranial aneurysm is a focal lesion of the intracranial arterial wall induced by congenital abnormalities or trau-ma,and its rupture leads to an extremely high mortality. Microsurgical clipping and intravascular intervention are the two main treat-ment options for intracranial aneurysms,and each has its advantages and disadvantages. Hybrid surgery combines the advantages of the two strategies to solve some of the problems that defy a single surgical technique or interventional therapy. This article introduces the concept of hybrid surgery,the history of its development,and its advantages,disadvantages and prospects in the treatment of intracra-nial aneurysm.
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Objective Meningiomas in the trigone of the lateral ventricle are characterized by deep location and low inci-dence. A few studies have been done on its treatment at home and abroad. This study was to explore the access,techniques,and clini-cal effect of microsurgery for lateral ventricular trigone meningiomas (LVTM). Methods We retrospectively analyzed the clinical data about 36 cases of LVTM treated by microsurgery in our hospital from December 2011 to December 2015. The operation involved lumbar cistern tube drainage, intraoperative drainage of cerebrospinal fluid, a unilateral parieto-occipital U-shaped cut, approach through the interparietal fissure,a sagittal incision about 3 cm long at the interparietal fissure for exposure and resection of the tumor. We followed up the patients for a mean of 17 months postoperatively and analyzed the results and complications. Results Simpson grade I removal of the tumors was achieved in all the 36 cases. Postoperative complications included homonymous hemianopia in 4 cases, central nervous system infections in 3,secondary epilepsy in 2,subcutaneous hydrops in 2,and intratumoral hemorrhage in 1 (which necessitated a second operation). Extended temporal horn of the right lateral ventricle occurred at 32 months after surgery,which was treated by fistulation. Homonymous hemianopia was improved in 2 of the 4 ca-ses. All the patients were capable of daily life activities and none experienced recurrence. Conclusion Sufficient preoperative evalu-ation of the tumor characteristics,rational selection of surgical approach,and expert operation techniques are the key factors for the mi-crosurgical treatment of meningiomas in the trigone of the lateral ventricle.
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Dural ateriovenous fistula (DAVF) at the craniocervical junction is rare. We report a patient presenting with brainstem dysfunction as an uncommon onset. Brainstem lesion was suggested by magnetic resonance image study. Angiogram revealed a DAVF at a high cervical segment supplied by the meningeal branch of the right vertebral artery, with ascending and descending venous drainage. Complete obliteration of the fistula was achieved via transarterial Onyx embolization. Clinical cure was achieved in the follow-up period; meanwhile, imaging abnormalities of this case disappeared. Accordingly, we hypothesize that a brainstem lesion of this case was caused by craniocervical DAVF, which induced venous hypertension. Thus, venous drainage patterns should be paid attention to because they are important for diagnosis and theraputic strategy.
Subject(s)
Humans , Brain Stem , Central Nervous System Vascular Malformations , Diagnosis , Drainage , Estrogens, Conjugated (USP) , Fistula , Follow-Up Studies , Hyperemia , Hypertension , Vertebral ArteryABSTRACT
<p><b>OBJECTIVE</b>To investigate the role of nuclear factor erythroid 2-related factor 2 (Nrf2) as a key transcription factor of cytoprotection against inflammation in the spinal cord upregulation of matrix metalloproteinase-9 (MMP-9), tumor necrosis factor-α(TNF-α) after spinal cord injury (SCI).</p><p><b>METHODS</b>Wild-type Nrf2(+/+) and Nrf2(-/-)-deficient mice were subjected to a murine SCI model induced by the application of vascular clips (force of 10 g) to the dura after a three-level T8-T10 laminectomy. The wet/dry weight ratio was used to reflect the percentage of water content of impaired spinal cord tissue at 48 h after SCI. The mRNA levels of MMP-9 were determined using reverse-transcriptase polymerase chain reaction (RT-PCR), and the protein levels of TNF-α and MMP-9 were detected by enzyme-linked immunosorbent assay at 24 h after SCI. Furthermore, gelatin zymography analysis was used to show MMP-9 activity of spinal cord tissue at 24 h after SCI. Software SPSS 16.0 was used for the statistical analysis.</p><p><b>RESULTS</b>After SCI, spinal cord water content, the expression of TNF-α and MMP-9 all increased in both injured Nrf2(+/+) and Nrf2(-/-) mice compared with their respective sham-operated mice. However, Nrf2(-/-) mice were shown to have more severe spinal cord edema, more TNF-α expression, more production and activity of MMP-9 compared with their wild-type Nrf2(+/+) counterparts after SCI (P < 0.05).</p><p><b>CONCLUSIONS</b>The results suggest that Nrf2 plays an important protective role in limiting the spinal cord upregulation of TNF-α and MMP-9 after SCI. It may be a new therapeutic target of SCI.</p>
Subject(s)
Animals , Female , Male , Mice , Disease Models, Animal , Genotype , Matrix Metalloproteinase 9 , Metabolism , Mice, Inbred ICR , Mice, Knockout , NF-E2-Related Factor 2 , Genetics , Spinal Cord , Metabolism , Spinal Cord Injuries , Genetics , Metabolism , Tumor Necrosis Factor-alpha , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To analyze the complications of the surgical treatment on primary brain stem diseases.</p><p><b>METHODS</b>From January 2000 to December 2005, 38 patients with primary brain stem diseases underwent surgical operation. The data of the patients were retrospectively analyzed.</p><p><b>RESULTS</b>The incidence of complication was 97% (37/38), and the mortality rate was 3% (1/38). The rate of hypesthesia was 37% (14/38), and 43% (6/14) improved 3 month after operation. Hemiplegia rate was 55% (21/38), and the recovery rate was 57% (12/21), the others improved. Disturbance of eyes movement happened in 7 patients among 8 diencephalon disease patients, 5 patients recovered. The rate of facial paresis among pons disease patients was 77% (10/13), 4 patients recovered. Severe complication such as disturbance of consciousness, breath and circulation failure were very low, and the outcome was very good.</p><p><b>CONCLUSIONS</b>The rate of complication that affects living quality is low, most of complications are improved. It means that the complication of brain stem operation is acceptable, so the brain stem disease should be treated actively.</p>