Surgical cannulation of the superior ophthalmic vein for the treatment of previously embolized cavernous sinus dural arteriovenous fistulas: serial studies and angiographic follow-up.

OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of transorbital puncture for the retreatment of previously embolized cavernous sinus dural arteriovenous fistulas (DAVFs) via a superior ophthalmic vein (SOV) approach. MATERIALS AND METHODS: During a 12-year period, 9 consecutive patients with previously embolized cavernous sinus DAVFs underwent retreatment via the transorbital SOV approach. RESULTS: All of the nine cases of previously embolized cavernous sinus DAVFs were successfully embolized. Clinical follow-ups were conducted in all nine cases at the duration of 17-141 months (61.22 ± 39.13 months). No recanalization occurred during the follow-up period. A subtle ptosis appeared in two patients and disappeared in one of the two cases after a 4-year follow-up. One patient suffered from paroxysmal positional vertigo and bruit for nearly 2 years after the treatment, but the follow-up angiography demonstrated no recurrence. One patient had persistent visual impairment caused by the initial venous stasis retinopathy. One patient with a history of a procedure-related transient decrease in visual acuity had it return to the normal level. The remaining four cases had clear improvement in the ocular symptoms and became completely asymptomatic during the follow-up period. No patient worsened or developed new symptoms. CONCLUSION: The approach of surgical cannulation of the SOV for the retreatment of previously embolized cavernous sinus DAVFs was proved feasible and efficient, especially when the transarterial and transfemoral venous approaches were inaccessible. However, if the SOV is not dilated enough or is located deeply in the orbit, transorbital venous puncture access may not be possible.

[Expression of TGFbeta1 and its type I receptors ALK1 and ALK5 mRNA in brain arteriovenous malformation].

OBJECTIVE: To explore the expression of transforming growth factor beta1 (TGFbeta1) and its type I receptors activin-like kinase 1 (ALK1) and ALK5 mRNA in the development of brain arteriovenous malformation (BAVM). METHODS: The mRNA expressions of TGFbeta1, ALK1and ALK5 were detected with semiquantitative RT-PCR in patients with BAVM. RESULTS: The expressions of TGFbeta1 and ALK5 mRNA increased significantly in BAVM, and their relative expression quantity were 0.777-/+0.047 and 0.585-/+0.074, respectively. However, ALK1 mRNA expression declined significantlies with a relative expression of 0.173-/+0.044 in comparison with the control group (0.720-/+0.098, P<0.01). CONCLUSION: The balance of TGFbeta1 and its type I receptors ALK1 and ALK5 mRNA expressions may play important role in the development of BAVM.

[Morphological characteristics of internal carotid artery atherosclerotic lesions in digital subtracted angiography].

OBJECTIVE: To illustrate the morphological characteristics of atherosclerotic lesions of the internal carotid artery. METHODS: The morphological characteristics of cervicocerebral atherosclerotic lesions in digital subtracted angiography were retrospectively reviewed in 120 cases. RESULTS: Totally 217 atherosclerotic lesions were detected. Of all the lesions, moderately and severely stenosed lesions accounted for 62.21% and mild stenosed lesions for 37.79%; long lesions were found in 18.89% and short ones in 81.11%; 37.33% of the lesions were ulcerated while 62.67% were non-ulcerated; 13.36% were angulated lesions and 86.64% non-angulated; 50.23% were eccentric lesions and 49.77% were concentric; lesions with adjacent artery dilation were found in 9.22%, and lesions without with adjacent artery dilation in 90.78%. CONCLUSION: The atherosclerotic lesions are characterized by moderate to severe stenosis and non-ulcerated, non-angulated, eccentric lesions without adjacent artery dilation.

[Evaluation of cerebral vasospasm resulting from subarachnoid hemorrhage with 1H-magnetic resonance spectroscopy].

OBJECTIVE: To assess the value of (1)H-magnetic resonance spectroscopy ((1)H-MRS) in evaluating cerebral vasospasm resulting from subarachnoid hemorrhage (SAH). METHODS: Six dogs were subjected to autologous non-heparinized blood injection via cisternal puncture twice at one-day interval to establish models of SAH, and another 6 received injections with normal saline in an identical manner. (1)H-MRS scan was performed on the 3rd, 7th and 14th days after the injections to measure the changes of N-acetylaspartate (NAA), creatine (Cr) and choline (Cho). After the (1)H-MRS scan, all the dogs underwent brain digital subtraction angiography (DSA) for determining the basilar artery diameter. RESULTS: DSA results on day 3 presented development of obvious vasospasm of the basilar artery, which was most evident on day 7 and recovered obviously on day 14. (1)H-MRS results demonstrated obvious changes of NAA, Cho and Cr on days 3 and 7 in SAH model group, and NAA declined to the lowest level on day 3 followed by gradual ascending till reaching the normal level on day 14. Cho decreased slightly on day 3, then increased and reached the peak level on day 7 and then decreased. Cr rose steadily from day 3 to 14, but since day 7, the rise slowed down obviously and Cr maintain a level not significantly different from that on day 14 (P>0.05). The functional results of (1)H-MRS were consistent with the DSA results. CONCLUSION: (1)H-MRS can be used to monitor the development of cerebral vasospasm resulting from SAH as a good evaluation method for functional imaging.

[Digital subtraction angiography and preoperative embolization for meningiomas].

OBJECTIVE: To investigate the diagnostic value of digital subtraction angiography (DSA) and the clinical efficacy of preoperative embolization for miningiomas. METHODS: Fifty-eight patients with meningioma were examined by DSA, and preoperative embolization was performed in patients whose miningiomas were supplied predominantly by the external carotid artery (ECA). RESULTS: In 43 patients, the meningiomas was exclusively or predominantly supplied by ECA, and the feeding arteries were embolized with particles of 250-350 microm through catherization of ECA. The blood supply of the tumor in 31 patients was completely blocked, and partial occlusion through embolization was performed in 12 patients. No complications in relation to the embolization occurred. Fifty-three patients underwent total removal of the meningiomas and the others had partial removal 1-7 days following DSA and embolization, with tumor-associated intraoperative hemorrhage of 600 ml on average. CONCLUSION: DSA has important diagnostic value for meningiomas, and preoperative embolization can be safe and effective to reduce bleeding, shorten the operation time and prevent postoperative complications.

[Mechanism of Ca2+ on the hyperthermia-induced apoptosis of rat hippocampal neurons in vitro].

OBJECTIVE: To study the mechanism of Ca(2+) on the apoptosis induced by hyperthermia in neonate rat hippocampal neurons to provide the applicative evidence of dantrolene for preventing brain injuries. METHODS: Dantrolene, Ca(2+) specific blocking agent, was used in the hyperthermia-induced apoptosis of primary hippocampal neurons in vitro to observe its effect on the apoptosis, fluorescent intensity, and dynamic change of Ca(2+) by flowcytometry and laser confocal microscopy. RESULTS: The rate of apoptosis was decreased significantly after hyperthermia treatment by dantrolene sodium. The intracellular Ca(2+) fluorescent intensity in 42 degrees C treatment group (107.35 +/- 6.0) was significantly lower than that in control group (159.12 +/- 33.8). The concentration of Ca(2+) began to decrease 20 approximately 25 s after adding dantrolene sodium, and reached the lowest level about 50 s later, and then kept lower than the basal level. CONCLUSION: Dantrolene sodium has an important protective effect on hippocampal neurons apoptosis induced by hyperthermia and may have some applicative value of preventing heat-induced brain injury.

[Clinical efficiency of interventional therapy on internal carotid-posterior communicating artery aneurysm].

OBJECTIVE: To evaluate the effect of endovascular embolization of internal carotid-posterior communicating artery (IC-PC) aneurysm. METHODS: 145 patients with IC-PC aneurysms underwent endovascular embolization through the microcatheter under digital subtraction angiography (DSA). Of the 145 cases, 55 patients with 62 aneurysms were embolized by mechanical detachable spiral (MDS) and 90 patients with 106 aneurysms were embolized by Guglielmi detachable coil (GDC) or electrical detachable coil (EDC). RESULTS: 168 aneurysms in 145 patients, 96 of which with 100% embolization, 45 with 95% embolization, 15 with 90% embolization, and 12 with less than 90% embolization, were embolized successfully. During the surgery, aneurysm rupture occurred in 3 cases, cerebral vasospasm in 5, and cerebral infarction in 1 case. 118 cases were cured, 23 improved, and 3 died. 17 patients were followed-up by DSA, 3 aneurysms recurred and 2 were totally embolized with EDC for the second time. CONCLUSION: Endovascular embolization is a safe and effective therapeutic method for IC-PC aneurysm.

[Differentiation of bone marrow-derived stem cells in injured rat brain tissue].

OBJECTIVE: To investigate the differentiation of bone marrow-derived stem cells (BMDSCs) migrated from blood circulation and resided in the injured brain tissue. METHODS: Brain injury model was established by iridectomy in the right cerebral cortex of female SD rats. Twenty-four hours after brain injury, the female rats received the implantation of green fluorescence protein (GFP)-labeled BMDSCs from male SD rats and were sacrificed at 2, 4 and 8 weeks after the implantation. Fluorescent immunohistochemistry for CD11b and glial fibrillary acidic protein (GFAP) on the brain sections was used to detect the GFP-positive cells. RESULTS: One week after the transplantation of the GFP-labeled BMDSCs, 3.53% of the peripheral blood white cells were GFP-positive; at 4 weeks and 8 weeks, a significant number of GFP-positive cells were found at the injury sites, some of which expressed CD11b and others expressed GFAP. CONCLUSION: GFP-labeled BMDSCs can migrate to the injured brain tissue and differentiate into cells that express microglia- and astrocytes-specific antigens.

[Endovascular embolization for traumatic carotid-cavernous fistula].

OBJECTIVE: To evaluate the choice of approaches, surgical techniques and clinical outcome of endovascular embolization for treating traumatic carotid cavernous fistula (TCCF). METHODS: A retrospective analysis of 119 patients with TCCF was conducted, in whom totally 128 embolizations were performed. In these procedures, the femoral artery approach was adopted in 112 cases, femoral vein approach in 5 cases, and superior ophthalmic vein approach in 2 cases. For the embolization materials, balloons were used in 101 cases, microcoils in 13 cases, both materials in 2 cases, and lyophilized dura mater in 3 cases. After the embolization procedures, 110 patients were followed-up for 3 months to 10 years, and 29 patients reexamined with angiography. RESULTS: Successful embolization for TCCF in a single procedure was achieved in 111 cases, and failure occurred due to balloon leakage in 8 cases, all embolized successfully in a second attempt. The total success rate was 100% in these cases, with a rate of internal carotid artery patency of 90.8% (108/119). No perioperative mortality or complication occurred, nor was TCCF recurrence seen during the follow-up. CONCLUSIONS: In general, TCCF can be successfully treated by balloon embolization via the femoral artery, while microcoil embolization has better performance for small fistula. Embolization can be done through venous approach when the internal carotid artery is ligated or occluded, and no procedure should be performed at the convenient expense of the internal carotid artery. Right choices of the approaches and embolization materials are key to the success of the procedure.

[Changes in Ca2+ concentration mediated by N-methyl-D-aspartate receptor in PO/AH neurons of anoxic SD rats].

OBJECTIVE: To study the changes of Ca2+ concentration mediated by N-methyl-D-aspartate (NMDA) receptor in the neurons in the preoptic area/anterior hypothalamus (PO/AH) of anoxic SD rats by investigating the properties of NMDA receptor. METHODS: The effects of NMDA receptor agonist NMDA and antagonist vaproic acid (VPA) on the [Ca2+]i in PO/AH neurons were observed in SD rats with anoxia. RESULTS: Under normal condition, the fluorescencet ratio was 0.95, which increased obviously in response to treatment with NMDA at 40 s and reached the peak value, 2.054, after 25 s with an increment of (109+/-52) %. After the addition of the agonist, the peak value reached 3.783 in 30 s and maintained the high level. The concentration of Ca2+ increased by (286+/-91) % after the treatment with NMDA. While in the anoxia group, the concentration of Ca2+ decreased by (103+/-45)% after the addition of VPA. CONCLUSIONS: The increase in the concentration of Ca2+ results predominantly from the opening of NMDA receptor channel which allows Ca2+ influx. VPA may decrease the activity of NMDA receptor to reduce the Ca2+ concentration for the protection of the neurons against anoxia.

[Three-dimensional CT angiography with volume rendering for the detection of intracranial aneurysms].

OBJECTIVE: To evaluate the value of three-dimensional CT angiography (3D-CTA) with volume rendering (VR) for the detection of intracranial aneurysm. METHODS: Axial CT images were obtained by helical CT scanning on 45 patients with intracranial aneurysms, 15 males and 30 females, aged 63.9 (33-79 years). The primitive data were entered into the Silicon Graphics O2 board to be treated. VR technique was adopted to reconstruct 3D-CTA imaging, aided by multiplanar reformation to obtain the total volume of aneurysm. Among the 45 patients 25 underwent DSA simultaneously, 21 underwent clamping of aneurysm, and 3 underwent GDC thrombosis. RESULTS: Fifty-nine intracranial aneurysms were detected in 45 patients by 3D-CTA, including 32 small aneurysms (< or = 5 mm). 3D-CTA with VR well demonstrated aneurysms and provided useful information including the site, shape, size and spatial relationship to the surrounding vessels and bony structures. CONCLUSION: A quick, reliable, and relatively noninvasive diagnostic tool for intracranial aneurysms, 3D-CTA with VR delineates the aneurysmal morphology in detail, and provides useful information for choosing and planning microsurgical or endovascular treatment.

[Structural features of the smooth muscle cells in the medial layer of the bifurcation of fetal cerebral arteries].

OBJECTIVE: To study the structural and histogenetic features of the smooth muscle cells (SMCs) in the medial layer of the bifurcation of human cerebral arteries in fetus. METHOD: Segments of the cerebral arteries from the circle of Willis including the bifurcations of normal human fetuses were sectioned in 1 of the 3 orthogonal planes, wherein the three- dimensional medial layer structure composed of SMCs was observed with light microscope. RESULT: Microscopic observation identified 1.1 to 9.0 SMC layers in the medial layer of the cerebral arteries from the circle of Willis in the fetuses at different weeks before birth, and 30.3% of the specimens were found to have focal defects of the medial SMC layers at the bifurcation of the developing arteries. CONCLUSION: The number of SMC layers consisted in the medial layers of the cerebral arteries develops with the fetal growth, and the identification of congenital anomaly of the medial SMCs may help verify the hypothetical pathogenesis for cerebral saccular aneurysms.

[Recurrence of cerebral aneurysm after embolization by mechanical detachable spiral: report of one case].

A patient with cerebral aneurysm received embolism therapy using mechanical detachable spiral, but the aneurysm recurred because of absorption of the coil. Secondary embolism therapy was successfully implemented using Guglielmi detachable coil.

[Traumatic basilar-cavernous fistula complicated by basilar artery aneurysm: report of one case].

A 19-years-old boy was admitted after brain trauma with subarachnoid hemorrhage, left oculomotor nerve palsy, elevated pressure in the cavernous sinus and intracranial noise. The diagnosis of traumatic basilar-cavernous fistula complicated with basilar artery aneurysm was established by digital subtraction angiography. After endovascular occlusion of the vessels twice using detachable coils, the patient was cured without relapse during the 2-year follow-up. It is at the time being second report globally and the first one in China.