ABSTRACT
<p><b>BACKGROUND</b>Cerebral arteriovenous malformation (cAVM) is a type of vascular malformation associated with vascular remodeling, hemodynamic imbalance, and inflammation. We detected four angioarchitecture-related cytokines to make a better understanding of the potential aberrant signaling in the pathogenesis of cAVM and found useful proteins in predicting the risk of cerebral hemorrhage.</p><p><b>METHODS</b>Immunohistochemical analysis was conducted on specimens from twenty patients with cAVM diagnosed via magnetic resonance imaging and digital subtraction angiography and twenty primary epilepsy controls using antibodies against vascular endothelial growth factor receptor-2 (VEGFR-2), matrix metalloproteinase-9 (MMP-9), vascular cell adhesion molecule (VCAM-1), and endothelial nitric oxide synthase (eNOS). Western blotting and real-time fluorescent quantitative polymerase chain reaction (PCR) were performed to determine protein and mRNA expression levels. Student's t-test was used for statistical analysis.</p><p><b>RESULTS</b>VEGFR-2, MMP-9, VCAM-1, and eNOS expression levels increased in patients with cAVM compared with those in normal cerebral vascular tissue, as determined by immunohistochemical analysis. In addition, Western blotting and real-time PCR showed that the protein and mRNA expression levels of VEGFR-2, MMP-9, VCAM-1, and eNOS were higher in the cAVM group than in the control group, all the differences mentioned were statistically significant (P < 0.05).</p><p><b>CONCLUSIONS</b>VEGFR-2, MMP-9, VCAM-1, and eNOS are upregulated in patients with cAVM and might play important roles in angiogenesis, vascular remodeling, and migration in patients with cAVM. MMP-9, VEGFR-2, VCAM-1, and eNOS might be potential excellent group proteins in predicting the risk of cerebral hemorrhage at arteriovenous malformation.</p>
ABSTRACT
Objective To study the clinical characteristics and digital subtract angiography (DSA) manifestations of the hemorrhagic moyamoya disease in adults. Methods A retrospective study was conducted to analyze the clinical data and DSA imaging of 68 adult patients who had been diagnosed with intracerebral hemorrhage on CT and with moyamoya on DSA. Results They were 23 males and 45 females with an average of 37.8 years. Their DSA manifestations included bilateral lesions on the anterior cerebral circulation in 57 cases, 19 of whom had combined lesions on the posterior cerebral circulation; unilateral lesion on the anterior cerebral circulation in 9 cases, 6 of whom had combined lesions on the posterior cerebral circulation; simple lesions on the posterior cerebral circulation in 2 cases;simple lesions on the anterior cerebral circulation in 41 cases.Intracranial aneurysm was complicated in 11 cases, 7 of whom underwent aneurysm embolization or clipping of the aneurysm neck. Cerebral infarction was complicated in 13 cases. Repeated hemorrhage for twice or more occurred in 17 cases.Ventricle hemorrhage occurred in 59 cases, parenchymal hemorrhage in 7 cases, and subarachnoid hemorrhage in 2 cases. Craniotomy was performed in 6 cases of massive intracranial bleeding.Conclusions Adult patients with hemorrhagic moyamoya disease, particular middle-aged women,usually have a major manifestation of intraventricular hemorrhage. Surgical interventions for combined aneurysms and symptoms can achieve a good therapeutic effect, but it is difficult to prevent re-hemorrhage.DSA is the primary method to determine specific characteristics of moyamoya lesions and consequently to choose a proper treatment.
ABSTRACT
Objective To investigate the efficacy of transvenous embolization in the management of cavernous dural arteriovenous fistulas. Methods Nine patients with cavernous dural arteriovenous fistulas diagnosed by digital subtraction angiography (DSA) were treated by transvenous embolization. Results Eight of the 9 patients were cured and 1 patient showed symptomatic improvement after the operations. No deterioration or death occurred in these cases. Follow-up of the patients for 2 to 96 months found no cases of relapse or exacerbation. Conclusion Transvenous embolization is effective and safe in the management of cerebral dural arteriovenous fistulas.
ABSTRACT
Objective To analyze the therapeutic effects of microvaseular decompression on primary trigeminal neuralgia. Methods The general clinical data,culprit vessels and therapeutic effects of the surgical interventions were analyzed in 181 patients(aged from 24 to 79 years with a mean of54.9 years,including 78 male and 103 female patients)with established diagnosis of primary trigeminal neuralgia admitted from January,2000 to Deceber,2007. Results Blood type O was present in 43.65%of the 181 patients with trigeminal neuralgia,which had an increasing tendency compared to the national norm(33.8%).The morbidity ratio between the right and left side was 1.8:l in these patients.Forty-five patients(24.86%)were identified to have more than 2 culprit vessels.The culprit vessels included the superior cerebellar artery(96 cases),posterior inferior cerebellar artery(7 cases),anterior inferior cerebellar artery(25 cases),arteries communicated with veins(25 cases),internal auditory artery (13 cases),basilar artery(15 cases),vertical artery(9 cases),exclusive veins(15 cases,mainly vena pelrosa and bridging vein)and unknown vessels(9 cases).of the 181 cases,171(94.48%)were cured within one month,9(4.97%)showed relieved symptoms but required drug therapy,and 1 was in vegetative state(0.55%). Conclusions Patients with blood type O may have greater chance of developing primary trigeminal neuralgia.Microvascular decompression is an ideal treatment for primary trigeminal neuralgia,and clear identification of the culprit vessels can be crucial for decreasing the postoperative recurrence.