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Objective To determine the characteristics of treatment and diagnosis,surgical timing and surgical methods in severely head-injured patients with central herniation.Methods Twenty patients with central herniation caused by contusions and lacerations of the bilateral frontal lobes hospitalized from July 2010 to December 2012 were retrospectively reviewed.There were 11 males and 9 females,at mean age of 42 years (range,18-70 years).Injury was caused by traffic accidents in 15 patients,falls in 3 and fighting events in 2.Eight patients were treated immediately on admission and twelve patients underwent emergency operation.All the operations involved simultaneous bilateral craniectomy for decompression,including bilateral decompressive craniectomy in 6 patients and unilateral decompressive craniectomy in 14 patients.Glasgow Outcome Scale (GOS) and Montreal Cognitive Assessment were used to evaluated outcome evaluation and cognitive impairment respectively.Complications were recorded.Results All patients were followed up for 6-12 months (mean,8 months).According to GOS,good recovery was presented in 10 patients,moderate disability occurred in 6,severe disability in 2,vegetative state in 1,and death in 1.Eleven patients suffered severe mental disorders especially personality change and disturbance of intelligence,and restored after 12 months.Five patients were complicated by epilepsy and two hydrocephalus.Conclusions For central herniation in patients with severe head injury,an emergent surgery is necessary if there exist conscious disturbance and pupil aggravations,hematoma enlargement and significant displacement of midline structure.Timely bilateral balance decompressive craniectomy is effective to reduce the mortality and disability and improve quality of life.
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Objective To analyze the feasibility of incorporation of tracking visual pathway fiber bundles by diffusion tensor imaging ( DTI) in computed tomography ( CT) simulation to develop a protective radiotherapy regimen for cerebral gliomas.Methods A total of 31 patients with cerebral gliomas who were admitted to our hospital from 2013 to 2015 and planed to receive postoperative radiotherapy were enrolled as subjects.All patients underwent CT simulation, conventional or contrast-enhanced magnetic resonance imaging, and DTI.The obtained DTI images of visual pathway fiber bundles were fused with 3DT1 anatomical scans and then imported into the treatment planning system.A protective treatment plan ( setting the entire visual pathway fiber bundles as organs at risk (OARs)) and a conventional treatment plan were made for intensity-modulated radiotherapy ( IMRT) .Comparison of treatment outcomes was made by paired t test.Results There were no significant differences in the conformity index and heterogeneity index of the planning target volume between the two treatment plans ( P=0.875,0.597), both of which had sufficient radiation doses to the target volume and conventional OARs protected.For the patients undergoing the protective treatment plan, the Dmax and Dmean values were reduced to 9.01%and 9.05%, respectively, in the ipsilateral optic tract and to 17.96%and 15.52%, respectively, in the contralateral optic tract;the Dmax and Dmean values were reduced to 5.37%and 5.48%(P=0.000), respectively, in the ipsilateral optic radiation tract and to 12.89%and 11.21%( P=0.000) , respectively, in the contralateral optic radiation tract.Conclusions The protective treatment plan based on CT simulation combined with the display of visual pathway fiber bundles by DTI can reduce the radiation dose to the entire visual pathway fiber bundles, which keeps the risk of visual dysfunction after radiotherapy as low as possible.
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Objective:To evaluate the application value of diffusion tensor imaging (DTI) in guiding the postoperative radiothera-py plan of the gliomas adjacent to the corticospinal tract (CST). Methods:Thirty patients with gliomas adjacent to the CST underwent routine magnetic resonance imaging (MRI) contrast-enhanced scanning and DTI after radiotherapy. Tractography data sets were ac-quired and were fused with the images of corresponding anatomical MRI and computed tomography. The acquired data sets of radio-therapy planning system were imported to assist with the delineation of the target volume, organs at risk, and CST. Two sets of radio-therapy plan, which considered or did not consider the dose protective effect of the CST, were formulated and compared using the treat-ment technique of intensity modulated radiotherapy. Results:The protective radiotherapy and unprotected plans both achieved the thera-peutic dose to the target volume and the protection of the routine organs at risk. In the protective dose (with an optimization program that considered the dose reduction of CST), the maximum and mean radiation doses suffered by the patients' ipsilateral and contra-later-al CSTs were lower compared with the unprotected plan (P<0.05). Conclusion:DTI can identify the location and shape of CSTs, and their relationship with the postoperative radiotherapy target of gliomas. These findings contribute to the formulation of a protective ra-diotherapeutic regimen to keep the CST from the maximum and the mean radiation doses to the largest extent, thereby decreasing the possibility of nerve damage after radiotherapy.
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Objective Neurological diseases are closely associated with the apoptosis of neuronal cells .This article aims to study the inhibitory effect of taurine on the apoptosis of hippocampal neurons by activating Caspase 9 as well as its protective effect on the nervous system and its mechanisms . Methods Mouse hippocampal neuronal cells were randomly divided into four groups:control, injury and apoptosis, low-dose taurine protection, and high-dose taurine protection.The proliferation of the neuronalcells was observed, their apoptosis examined by MTT colorimetric assay, and the expression of Caspase 9 in different groups detected by immunofluorescence and Western blot. Results The injury and apoptosis group showed a poor proliferation of the hippocampal neuronal cells and decreased cell viability (A=0.102 ±0.025), significantly lower than the control group (relative A=0.643 ± 0.013), the low-dose taurine group (relative A=0.504 ±0.072), and the high-dose taurine group (relative A=0.452 ±0.029) ( all P<0 .05 ) .Immunofluorescence assay revealed significantly increased Caspase 9 activation in the injury and apoptosis group (A=61386.8 ±10083.6) compared with the control (A=4502.2 ±2518.1), the low-dose taurine (A=20077.4 ±4187.5), and the high-dose taurine group (A=13976.2 ±7044.1) (all P<0.05).Western blot showed a remarkably higher expression of Caspase 9 in in the injury and apoptosis group (A=1.23) than in the control (relative A=0.17), the low-dose taurine (A=0.21), and the high-dose taurine group (A=0.19) (all P<0.05). Conclusion Taurine can protect neuronal cells by inhibi-ting Caspase 9 activation.
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Objective To explore the microsurgical technique and results of the large acoustic neurinoma and the facial nerve preservation.Methods 35 cases of large acoustic neurinoma treated microsurgically were analyzed retrospectively.Results Total resection was achieved in 33 patients,subtotal in one patient and partial in one patient.The facial nerve was preserved completely in 32 cases (91.4%).One died postsurgery.Conclusion The application of microsurgical techniques and rational selection of operational approach can remarkably increase the total removal rate and facial nerve preservation rate.