Alterations of cholinergic and monoamine neurotransmitters in cerebrospinal fluid in patients with postoperative delirium / 中华行为医学与脑科学杂志

Objective:To investigate the alterations of cholinergic and monoamine neurotransmitters in cerebrospinal fluid in patients with postoperative delirium.Methods:Sixty-eight patients with normal preoperative cognitive functions were enrolled.They were diagnosed with spinal extramedullary intradural space-occupying lesion and underwent surgical resection.Among these patients, 18 developed postoperative delirium (delirium group), 46 had no postoperative delirium (control group), and the diagnosis of delirium was unclear in four cases (excluded). Cerebrospinal fluid (CSF) was collected before the surgical resection of lesions and on the third day postoperatively.The concentrations of acetylcholine (Ach), norepinephrine (NE), adrenaline (E), dopamine (DA) and serotonin (5-HT) were measured using the high-performance liquid chromatography/electrochemical method.Results:Prior to the surgical resection, there were no significant differences in the Ach, NE, E, DA or 5-HT baseline levels in the CSF between the delirium group and the control group (all P>0.05). After surgery, the Ach level in the delirium group ((0.63±0.26) μmol/L) was significantly lower than that in the control group ((0.77±0.19) μmol/L) ( P=0.032), and there were no significant differences in other neurotransmitter levels (all P>0.05). In the delirium group, the level of Ach in the CSF after surgery ((0.63±0.26) μmol/L) was significantly lower than the baseline level ((0.75±0.19) μmol/L) ( P=0.021). The postoperative NE level ((1.58±0.28) μmol/L) was significantly higher than the baseline level ((1.49±0.21) μmol/L) ( P=0.036). There was no significant difference in the adrenaline level ( P=0.497). The postoperative DA level ((0.86±0.18) μmol/L) was significantly higher than the baseline level ((0.82±0.15) μmol/L) ( P=0.045), and the postoperative 5-HT level ((2.94±0.28) μmol/L) was also significantly higher than the baseline level ((2.75±0.35) μmol/L) ( P=0.022). In the control group, only the postoperative 5-HT level ((2.90±0.31) μmol/L) was significantly higher than the baseline level ((2.76±0.26) μmol/L) ( P=0.016), while the postoperative levels of other neurotransmitters were not significantly changed when compared to the baseline levels (all P>0.05). Conclusion:The cholinergic neurotransmitter levels were reduced while the monoamine neurotransmitter levels were increased in the cerebrospinal fluid in patients with postoperative delirium, which suggests that cholinergic hypoactivity and monoaminergic hyperexcitability may be important pathophysiological processes in the occurrence and development of postoperative delirium.

Experience in the treatment of postoperative cerebrospinal fluid leakage followed by surgical management of a spinal meningocele combined with infection / 中华整形外科杂志

A 37-year-old woman presented with a congenital spinal meningocele for 37 years and ruptured for 6 months. She was admitted to the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences in March 2018. The diameter of the lesion was about 10 cm, with purulent secretion and malodor. The superior gluteal artery perforator propeller flap was used to reconstruct the defect after the lesion resection. Part of the wound didn’t heal and cerebrospinal fluid leaked from the wound postoperatively. The wound eventually healed after wound debridement and drainage changing. Cerebrospinal fluid retention under the flap could result in wound dehiscence and cerebrospinal fluid leakage. The author introduced the treatment process and operative method. The preliminary experience in treating cerebrospinal fluid leakage after surgical management of the spinal meningocele was also summarized.

Spinal hemangioblastomas: microsurgical treatment and long-term follow-up / 肿瘤研究与临床

Objective To summarize the treatment experiences and long-term surgical efficacy of spinal hemangioblastomas.Methods The surgical experiences of 46 patients with spinal hemangioblastomas were analyzed retrospectively.All patients underwent microsurgical resection without preoperative embolization, and 52 operations were performed and 58 tumors were resected.McCormick classification was used to evaluate the function of spinal cord.The mean follow-up time was 8 years.Results Total tumor resection was achieved in 55 tumors and subtotal ones in 3.A week later, improvement was obtained in 11 cases, no changes in 29 and aggravation in 6.No patients died.During a follow-up period from 7 to 9 years, the spinal function was improved in 18 patients, remained stable in 21 and deteriorated in 7.No tumor recurrence was found.The subtotal resection affected the prognosis (P =0.08, OR =10.8, 95 ％ CI 2.1-60.8).Conclusions The spinal hemangioblastomas are highly vascularized benign tumors that can be surgically cured under microscope.Subtotal resection is a risk factor of prognosis.