Individualized stereoelectroencephalography evaluation and navigated resection in medically refractory pediatric epilepsy.

Pediatric patients frequently require invasive exploration with intracranial electrodes to achieve high-resolution delineation of the epileptogenic zones (EZ). We intend to discuss the efficacy and safety of stereoelectroencephalophraphy (SEEG) monitoring in pediatric patients with difficulty to localize the EZ. We retrospectively analyzed presurgical findings, SEEG data, resections, and outcomes of a series of 72 consecutive pediatric patients (<18 yrs) who had medically refractory epilepsy and received SEEG recording between January 2015 and September 2019. There were 20 girls and 52 boys with a mean age of 10.13 ±â€¯4.11 years old (range: 1.8-18 years). Twenty-seven patients (37.5%) had nonlesional magnetic resonance imagings (MRIs). In total, 744 electrodes were implanted for an average of 10.33 ±â€¯2.53 (range: 3-18) electrodes per patient. Twenty-eight explorations were unilateral (17 left and 11 right), and 44 explorations were bilateral (12 of which was predominately one side). The average monitoring period in days for the SEEG was 8.99 ±â€¯5.79 (range: 3-25) days. The EZ could be located in 67 (94.4%) patients for the initial implantation according to SEEG monitoring. Lobectomy was performed in 12 patients (17.9%), of those anterior temporal lobectomy (ATL) was performed in 8 cases (11.9%) and insular plus was 2 cases (3.0%), multilobectomy resections in 15 cases (22.4%), tailored cortical resections in 37 cases (55.2%), and corpus callosotomy plus in 2 cases (3.0%). The average follow-up was 18.1 ±â€¯7.53 months (range: 6-54). Forty-three of 67 patients (64.2%) were Engel class I, 12 patients (17.9%) were Engel class II, 10 patients (14.9%) were Engel class III, and an additional 2 patients (3.0%) were Engel class IV. In the SEEG implantation series, no child experienced serious or permanent morbidity. One patient (1.4%) experienced symptomatic intracranial hemorrhage (ICH), and 3 patients (4.2%) experienced asymptomatic ICH. There were no postimplantation infections or other postoperative complications associated with the SEEG. Several common complications related to resection surgery were included in this series with zero mortality. Of the 6 patients in whom we performed a second surgery, 4 of them subsequently became seizure-free (66.7%) after undergoing the second resection with SEEG evaluation. Stereoelectroencephalophraphy is a safe and efficient methodology to identify the EZ in particularly complex cases of focal medically refractory epilepsy for pediatric patients, even in infancy and early childhood. Seizure outcomes of SEEG-guided resection surgery are desirable. We recommend SEEG evaluations and even a more aggressive resection in certain pediatric patients who failed initial resection with realistic chances to benefit from reoperation.

Microsurgical Treatment for Complex Basilar Artery Aneurysms with Long-Term Follow-Up in a Series of 35 Cases.

BACKGROUND: There has been a massive shift in the balance toward endovascular therapy for basilar artery (BA) aneurysms in the modern era. METHODS: We retrospectively reviewed clinical and radiologic data from patients with BA aneurysms who were treated in a single medical center during a 10-year period from August 2006 to May 2016. RESULTS: Thirty-five consecutive patients with 46 aneurysms during the 10-year period were included. The rate of complete aneurysm occlusion in 35 cases using a 1-stage operation was 58.8% (20/34). The graft patency rates of 13 bypass surgeries were 84.6% (11/13) within 1 week and 69.2% (9/13) at 3 months after surgery. The cut flow index for all bypass cases was 0.79. The overall survival was 94% at discharge (2 patients died). The 3-month outcome was favorable (modified Rankin Scale score 0-2) for 27 patients (77.1%) and poor (modified Rankin Scale score 3-5) for 5 patients (14.2%), and 3 patients died (8.6%). The survival for patients with BA apex aneurysms was higher than the survival observed for patients with BA trunk/vertebrobasilar junction aneurysms. CONCLUSIONS: Microsurgical treatments for BA aneurysms can be effective, with good patient outcomes in the early stage after operation. Patients with wide-necked, fusiform, or dolichoectatic aneurysms seem to exclude the aneurysm, preventing unnecessary retreatments with bypass techniques. The potential for a poor prognosis of patients with BA trunk/vertebrobasilar junction aneurysms was higher than that for patients with basilar apex aneurysms who presented with unfavorable subsequent events.

Bilateral cavernous carotid aneurysms treated by two-stage extracranial-intracranial bypass followed by parent artery occlusion: case report and literature review.

Bilateral cavernous carotid aneurysms (CCAs) are often not amenable to neurosurgical clipping or endovascular coiling. Here, we report the case of a 50-year-old female who presented with a 1-year history of gradual severe headache. Preoperative angiograms revealed bilateral CCAs. Among these findings, the right giant CCA had been trapped after the external carotid artery-saphenous vein-middle cerebral artery (ECA-SV-MCA) bypass 8 years prior. Additionally, the left CCA was again trapped after the internal maxillary artery-radial artery-middle cerebral artery (IMA-RA-MCA) bypass, followed by parent artery occlusion (PAO), because of the enlargement of a 0.4-cm aneurysm to a 1.3-cm aneurysm during the 5th to 8th years following surgery. Postoperative radiologic findings proved that the aneurysms disappeared with good graft patency of the bilateral anastomoses and excellent filling of the bilateral MCA territories. This is the first case of bilateral CCAs treated with two stages of bilateral high-flow extracranial-intracranial (EC-IC) bypass, including an IMA-RA-MCA bypass.

Aberrant Expression of miR-323a-5p in Patients with Refractory Epilepsy Caused by Focal Cortical Dysplasia.

BACKGROUND: Epilepsy remains one of the most common clinical neurological disorders. About a third of patients with epilepsy are refractory to drug treatment, mainly as a result of focal cortical dysplasia (FCD). In this study, we analyzed the aberrant expression of microRNAs (miRNAs) in the cortex and plasma of FCD patients. METHODS: Cortical samples were collected from nine patients with refractory epilepsy caused by FCD who underwent surgery, and from eight volunteers (control group) undergoing emergency surgery for hypertensive cerebral hemorrhage. miRNA expression in the cortex was detected by microarray analysis and miR-323a-5p expression levels in the cortex were analyzed by quantitative real-time polymerase chain reaction (qRT-PCR). We also collected plasma samples from 30 patients with refractory epilepsy caused by FCD and from 23 healthy controls, and compared differential expression of miR-323a-5p in the plasma using qRT-PCR. RESULTS: miRNA microarray analysis showed that expression of miR-323a-5p was upregulated in the FCD group compared with the control group, and miR-323a-5p expression levels in the cortex analyzed by qRT-PCR supported those obtained by microarray analysis. Plasma levels of miR-323a-5p were significantly higher in patient plasma compared with the healthy controls, as determined by qRT-PCR. Furthermore, expression of miR-323a-5p was positively correlated with the duration of epilepsy (p = 0.014) and seizure frequency (p = 0.043). The effectiveness of surgery in patients with FCD was significantly poorer in patients with high plasma levels of miR-323a-5p compared with those with low levels. CONCLUSIONS: The expression of miR-323a-5p was significantly elevated in the cortex and plasma of FCD patients. These results suggest that abnormal expression of miR-323a-5p could be used for improving the current diagnosis of FCD and monitoring treatment responses in patients with FCD.

Globose, cystic olfactory ensheathing cell tumor: A case report and literature review.

Olfactory ensheathing cell tumor (OECT) is one of the most rare intracranial, extra-axial tumors located in the anterior cranial fossa. The present study reports a case of a 34-year-old female patient who presented with a history of hyposmia for 1 year, as well as a gradual dizziness and emotional lability for 2 months. Magnetic resonance imaging of the brain revealed a globose, well-defined cystic mass at the midline of the anterior cranial fossa, which was confirmed as an OECT by histology and was completely resected by bifrontal craniotomy. According to the immunostaining results, the tumor was positive for vimentin and S100 protein, and negative for epithelial membrane antigen, glial fibrillary acidic protein and cluster of differentiation 57 (also known as Leu-7). The presentation, imaging findings, histopathological examination and histogenesis of OECT are discussed in the present study, along with a literature review.

Expression of microRNA-129-2-3p and microRNA-935 in plasma and brain tissue of human refractory epilepsy.

OBJECTIVE: Numerous microRNAs (miRNAs) are differentially expressed in specific diseases, suggesting possible use as diagnostic or prognostic biomarkers. The purpose of this study is to investigate the expression levels of miR-129-2-3p and miR-935 in cortical brain tissue and plasma samples from controls and refractory temporal lobe epilepsy (TLE) patients to evaluate the utility of these measures as diagnostic biomarkers. METHODS: The study was divided into three phases. First, cortical brain tissue samples from nine refractory TLE patients and eight controls were screened for differential miRNA expression using the Affymetrix miRNA 4.0 microarray. Second, real-time quantitative PCR (qRT-PCR) was used to verify the microarray results in brain tissue samples from 13 refractory TLE patients and 13 healthy controls (including those studied by microarray analysis). Third, we tested the expression levels of selected miRNAs in plasma samples from 25 refractory TLE patients and 25 healthy volunteers by qRT-PCR. The capacity of miR-129-2-3p and miR-935 expression to distinguish refractory TLE from health controls was tested by receiver operator characteristics (ROC) curve analysis. RESULTS: (1) High-resolution miRNA arrays indicated that miR-129-2-3p and miR-935 were significantly upregulated in the cortical brain tissues of TLE patients compared to controls. (2) qRT-PCR confirmed upregulated miR-129-2-3p expression in the brain tissue(P<0.0001) and plasma samples(P=0.0008) of refractory TLE patients. (3) The expression of miR-935 in epilepsy patients was higher than control group, however, there are no significant statistical differences between them whether in plasma samples(P=0.644) or in tissue samples(P=0.258). (4) ROC analysis of miRNA-129-2-3p showed that the area under the curve (AUC) was 0.929 (95% CI: 0.833-1.000; p=0.000) for brain tissue and 0.778 (95% CI: 0.640-0.915; p=0.001) for plasma. CONCLUSION: Expression of miRNA-129-2-3p was upregulated in cortical brain tissue and plasma samples from patients with refractory TLE, but miR-935 not. Plasma miRNA-129-2-3p has great potential as a non-invasive biomarker for early detection and clinical evaluation of refractory TLE.

Serum MicroRNA-4521 is a Potential Biomarker for Focal Cortical Dysplasia with Refractory Epilepsy.

Early biomarker-based diagnosis of focal cortical dysplasia (FCD) represents a major clinical challenge. The aim of this study was to identify novel brain microRNAs (miRNAs) in patients with refractory epilepsy and FCD as potential biomarkers. We evaluated serum hsa-miR-4521 as a promising novel biomarker in patients with FCD. Tissue for microarray was obtained from nine patients with temporal lobe refractory epilepsy who underwent surgery to remove epileptic foci identified by cortical video electroencephalogram monitoring. Control tissue was collected from eight patients with hypertension who required emergency surgery to remove an intracranial hematoma. The Affymetrix® GeneChip® Command Console® Software (Affymetrix miRNA 4.0) was used to compare miRNA expression in the cerebral cortex of experimental and control patients. Temporal cortex tissue and serum samples were taken from the same patients for verification of hsa-miR-4521 expression by real-time quantitative polymerase chain reaction (RT-qPCR). The experimental and control patients did not differ significantly in terms of age and gender. 19.4 % (148/764) of the total miRNAs were differentially expressed in experimental and control tissue, which is in agreement with the existing literature. We selected miRNA-4521 for further analysis; the fold-change in expression was 14.4707 and the q value was almost 0, which confirmed up-regulation. Significant up-regulation of hsa-miR-4521 was further validated by RT-qPCR. miRNA microarrays can efficiently and conveniently identify differentially expressed miRNAs in epilepsy brain tissue. This is the first study to identify differential expression of hsa-miR-4521 in brain tissue and serum of refractory epilepsy patients and suggests that serum hsa-miR-4521 may represent a potential diagnostic biomarker for FCD with refractory epilepsy.

Neural overexpression of multidrug resistance-associated protein 1 and refractory epilepsy: a meta-analysis of nine studies.

OBJECTIVE: Overexpression of adenosine triphosphate-binding cassette (ATP-binding cassette (ABC)) transporters may contribute to intractable epilepsy (IE) by reducing brain accumulation of antiepileptic drugs (AEDs). We conducted a meta-analysis of studies on expression and cellular distribution of multidrug resistance-associated protein 1 (MRP1) in IE patients to evaluate the contribution of this protein to AED resistance. In addition, we summarize experiments examining MRP1 expression and substrates in animal models of IE. METHODS: The literature search based on pre-established inclusion and exclusion criteria, as well as quality assessment, data extraction and statistical analyses were conducted concurrently by two independent researchers. We identified nine high-quality studies (Jadad score ≥3) published between 2000 and 2014 on the expression and cellular distribution of MRP1 in IE patients. A fixed effect model was used to calculate pooled odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs). Forest and funnel plots were constructed to assess study heterogeneity and publication bias, respectively. RESULTS: MRP1 expression was significantly higher in both astrocytes (OR = 17.04, 95% CI: 7.69-37.76, P < 0.00001) and neurons (OR = 22.13, 95% CI: 8.52-57.46, P < 0.00001) of IE patients compared to controls, while there was no significant difference in endothelial cell MRP1 expression (OR: 1.47, 95% CI: 0.09-1.79, P = 0.48). Funnel plot symmetry indicated no substantial publication bias. Most relevant preclinical studies from 2000 to 2014 found higher MRP1 expression in IE model rodents. Furthermore, MRP1 overexpression reduced the extracellular concentration of AEDs in brain, while MRP1 inhibitors enhanced brain AED concentrations. CONCLUSION: Pooled results strongly suggest that MRP1 is overexpressed in both neurons and astrocytes of IE patients. Inhibition of MRP1 may enhance AED efficacy by increasing local drug availability.

A case of mushroom-shaped anaplastic oligodendroglioma resembling meningioma and arteriovenous malformation: Inadequacies of diagnostic imaging.

Magnetic resonance imaging (MRI) is the most widely discussed and clinically employed method for the differential diagnosis of oligodendrogliomas; however, MRI occasionally produces unclear results that can hinder a definitive oligodendroglioma diagnosis. The present study describes the case of a 34-year-old man that suffered from headache and right upper-extremity weakness for 2 months. Based on the presurgical evaluation, it was suggested that the patient had a World Health Organization (WHO) grade II-II glioma, meningioma or arteriovenous malformation (AVM), with unclear radiological manifestations. Postsurgical pathological assessment confirmed the tumor to be an anaplastic oligodendroglioma (WHO grade III). This case is notable due to the confusing radiological manifestation of a mushroom-shaped anaplastic oligodendroglioma in the parietal-temporal-occipital region, which provided a potential source of misdiagnosis for meningioma and AVM.

The effect of pineapple core fiber on dough rheology and the quality of mantou.

The consumption of dietary fiber offers the health benefit of lowering the risk of many chronic diseases. Pineapple core fiber (PCF) in this study was extracted and incorporated into dough and mantou (i.e., steamed bread). The effects of PCF substitution and fiber size on textural and rheological properties of dough and mantou were evaluated by a texture analyzer. The substitution of wheat flour by PCF resulted in a stiffer and less extensible dough with or without fermentation. The hardness and gumminess of mantou significantly increased as the PCF substitution increased from 0% to 15%, but the cohesiveness, specific volume, and elasticity significantly decreased with the fiber substitution. Ten percent PCF-enriched dough and mantou with various fiber sizes had similar rheological and textural properties, except for the k1 and k2 values. By sensory evaluation, 5% PCF-enriched mantou and the control bread had better acceptability in texture, color, odor, and overall acceptability, compared to mantous enriched with 10% or 15% PCF. Significant correlations existed between the rheological properties of dough and textural parameters of mantou and between the sensory quality and textural parameters of mantou. Therefore, we suggest that fiber-enriched mantou can be prepared with 5% PCF substitution to increase the intake of dietary fiber and maintain the quality of mantou.