Clinical curative effect analysis and predictors of prognosis in patients with temporal lobe epilepsy after anterior temporal lobectomy: results after five years / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Anterior temporal lobectomy (ATL) is the most common surgical treatment for temporal lobe epilepsy (TLE), although long-term prognosis is often less favorable than short-term outcomes. This study aimed to examine the outcomes of patients with TLE 5 years after undergoing ATL, and to seek possible predictors of prognosis.</p><p><b>METHODS</b>We examined the clinical records of 121 patients with TLE who underwent ATL in our institution between January 2005 and December 2008. The Engel seizure classification was used to divide patients into "seizure free" and "non-seizure free" groups. Univariate and multivariate Logistic regression analyses were used to identify potential prognostic indicators, including history, clinical features of seizures, and magnetic resonance imaging (MRI) and video-electroencephalography (EEG) findings.</p><p><b>RESULTS</b>The majority of patients were seizure free during the follow-up period: 71.9% 1 year after surgery; 71.6% after 2 years; 75.8% after 3 years; 78.8% after 4 years after surgery and 68.8% after 5 years. There were significant differences between seizure-free and non-seizure-free groups in terms of preoperative seizure duration, history of febrile seizures, type of seizure, and MRI and video-EEG findings (P < 0.05), but not in terms of sex, age at seizure onset, age at surgery, side of surgery, auras, family history of seizure, or history of traumatic brain injury, perinatal anoxia or intracranial infection history (P > 0.05). Multivariate Logistic regression analysis showed that a preoperative seizure duration <10 years, a history of febrile seizures, simple complex partial seizures, positive MRI findings, hippocampal sclerosis and unilateral localized video-EEG spikes predicted better outcome (P < 0.05).</p><p><b>CONCLUSIONS</b>ATL appears to be an effective means of treating TLE. Patients undergoing ATL for TLE require careful and comprehensive assessment to ensure optimal outcomes and to allow patients to make informed decisions about their treatment.</p>

Effects of extract of Ginkgo biloba on apoptosis of neurocytes and expression of inducible nitricoxide synthuse after spinal cord injury in rats / 中华创伤杂志

Objective To investigate the effect of extract of Ginkgo biloba (Egb) on apoptosis of nerve cells and its mechanism after spinal cord injury (SCI) in rats. Methods Forty eight adult SD rats weighing 200-230 g were divided equally and randomly into Egb group and normal saline (NS) group. After hemisectian of spinal cord at T9 vertebrae level, rats in Egb group were lavaged with 2 ml EGB (20 mg) daily and those in NS group with 2 ml NS daily. Tissue sections were collected and stained with Nissl's staining, myelin sheath staining, and inducible nitric oxide synthase (iNOS) immunohisto-chemistry as well as terminal deoxynueleotidyl transferase-mediated dUTP nick end lebeling (TUNEL) at days 1,7, 14 and 21 respectively to evaluate the injured spinal cord tissues after six rats from each group were sacrificed Results Nissl's staining manifested less swelling of the nerve cells near the injury epi-center ( rostral and caudal ), smaller cavity and demyelinated area and higher ratio of bilateral anterior horn neurons of transection side to normal side in Egb group, compared with NS group ( P <0.05). Ap-optotie index (AI) and expression of iNOS in NS group were higher than those in Egb group ( P <0.01 or P <0. 05). Furthermore, the rate of iNOS-positive cells was positively correlated with the AI (r = 0.729, P<0.01) after SCI. Conclusion Egb can prevent nerve cells from apoptosis after SCI in rats, as may be related with inhibition of expression of iNOS.

The facial nevi associated with hydrocephalus and intracranial anomalous venous return of 3 case reports / 中华神经科杂志

Objective To study the clinical manifestation of intracranial anomalous venous return associated with the facial nevi and hydrocephalus. Methods Along with reviewing of the literatures, the clinical records of 3 patients suffered from the facial nevi and hydrocephalus were analyzed. Results All of 3 patients also have sinovenous occlusion, which affect cerebral venous return. Conclusions Intracranial anomalous venous return, which is induced by extensive sinovenous occlusion, has been considered to be the main cause of hydrocephalus in the facial nevi. The formation of sinovenous occlusion and anomalous venous return may be due to developmental defect in the embryonic stage.

Theory and clinical application of olfactory ensheathing cell transplantation in treatment of central nervous system injury / 中国组织工程研究

The candidate donor cells for repairing the central nervous system included olfactory ensheathing cells,oligodendrocyte progenitor cells and Schwann cells. Among them,oligodendrocyte progenitor cells are difficult to collect in a large amount; Schwann cells are difficult to traverse glial scar,so olfactory ensheathing cells were the most appropriate groups. Olfactory ensheathing cells in vitro were flexible and of plasticity,thus were capable of adapting to the transplantation microenviroment and benefit for the neural regeneration. Olfactory ensheathing cells could improve the function after injury of spinal dorsal roots,which were probably related to the component of grafts. The proper preparation and mixed olfactory ensheathing cells could contribute to recovery of function. Although the low immunogen of fetal brain,the administration of immunosuppressant would be necessary. In spite of reconstruction of damaged pathway of nervous system,olfactory ensheathing cells were able to promoting sprout of fibers,release neurotransmitters at the non-synaptic sites and improve microenvironment of damaged sites as well,which compensated for the dysfunction in central nervous system injury. Insight into cell biological property and behavior after transplantation would help understand and exert theoretical influence on the repair of spinal cord injury.

Direct transsphenoidal pituitary adenoma resection under endoscope / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the primary experience and possibility of direct transsphenoidal pituitary adenoma resection under endoscopic assistance.</p><p><b>METHODS</b>From March 2000 to March 2001, 22 patients with pituitary adenoma were treated by direct transsphenoidal pituitary adenoma surgery under endoscope. During direct transsphenoidal approach, no incision of the nasal mucosa was made without the dissection of the nasal septum and median nasal conchae. Under endoscopic assistance, the anterior wall of the sphnoidal sinus and sellae base was opened directly and adenoma resection was performed.</p><p><b>RESULTS</b>All the patients were followed up for 1 approximately 12 months. The increased hormone level in 17 patients were decreased to normal postoperatively. By postoperative MRI detection, adenomas in 15 patients were removed completely, but part of the adenomas were left in the carvernous sinuses in 7 patients. Temporary diabetes insipidus was observed in 4 patients.</p><p><b>CONCLUSIONS</b>The direct transsphenoidal approach in pituitary adenoma resection under endoscopic assistance is time saving, and safe, with good exposure of operative field. The injury to the patient and postoperative reaction are less. The effects were satisfactory without severe complications.</p>

Transmaxillary approach for surgical removal of the invasive skull base tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the capable use of transmaxillary approach for surgical removal of invasive skull base tumors, the indications and the key points of this approach.</p><p><b>METHODS</b>From November 1998 to July 2001, 27 consecutive patients with skull base tumor were operated through transmaxillary approach, including 6 patients with nasopharyngeal carcinoma, 5 with nasopharyngeal angiofibroma, 5 with nasopharyngeal cystadenocarcinoma, 2 with olfactory neuroblastoma, 2 with poorly differentiated carcinoma, 2 with sarcoma, 1 with maxillary carcinoma, 2 with schwannoma, and 2 with chordoma. Most of them (18/27) were recurrent tumor and 17/27 tumors involved important intracranial structures. All patients were followed up 2 - 33 months (average 16 months) and the clinical data was reviewed.</p><p><b>RESULTS</b>The tumors could be totally removed in all patients. There were no operative mortality and morbidity. After operation, 2 patients died of cancer recurrence in 5 and 8 months separately. One patient had metastasis to the lungs 11 months after operation. Two patients had local recurrence in 7 and 12 months postoperation seperately and live with the tumor now. The rest patients are back to their routine life.</p><p><b>CONCLUSIONS</b>Transmaxillary approach facilitates the surgical removal of invasive skull base tumors. The exposure is wide. The lesion as well as the important anatomy structures can be viewed directly and clearly. The tumor removal could be done more thoroughly and safely. This approach is suitable for the patients in whom tumor involves the skull base extensively and may be difficult to deal with by other approaches.</p>