Prognostic value of apolipoprotein E epsilon4 allele in patients with traumatic brain injury: a meta-analysis and meta-regression.

AIMS: Current scientific evidence suggests that the apolipoprotein E epsilon4 (APOE4) allele may be associated with a good prognosis for patients with traumatic brain injury (TBI); however, many existing studies have yielded inconclusive results. This meta-analysis aims to obtain a more precise estimation of the association between APOE4 allele and prognosis of TBI patients. METHODS: A literature search of PubMed, Embase, Web of Science, Cochrane Library, CISCOM, CINAHL, Google Scholar, CNKI and CBM databases was conducted for articles published before July 1st, 2013. Crude odds ratios (OR) with 95% confidence intervals (CI) were calculated. RESULTS: Thirteen cohort studies were included with a total of 662 TBI patients with APOE4 (+) and 1614 TBI patients with APOE4 (-). The meta-analysis results revealed that the APOE4 allele was associated with a poor prognosis in TBI patients (OR=0.68, 95% CI: 0.48-0.96, p=0.027). Subgroup analysis by ethnicity indicated that TBI patients with APOE4 (+) had a worse prognosis than those with APOE4 (-) in Asian populations (OR=0.46, 95% CI: 0.21-0.99, p=0.046), but not in Caucasian populations (OR=0.75, 95% CI: 0.53-1.08, p=0.120). A further subgroup analysis by TBI grade showed that the APOE4 allele was associated with poor prognosis in severe TBI patients (OR=0.43, 95% CI: 0.21-0.87, p=0.020). However, there was no evidence for any association between the APOE4 allele and poor prognosis in patients with other grades of TBI (all p>0.05). CONCLUSION: The current meta-analysis indicates that the APOE4 allele may be associated with a poor prognosis in severe TBI patients and in Asian populations. The APOE4 allele may be used as a biomarker in predicting the prognosis of TBI patients.

Comparison between transsylvian-transinsular and transcortical-transtemporal approach for evacuation of intracerebral hematoma.

PURPOSE: Hypertensive cerebral hemorrhage in the basal ganglia is a potentially life-threatening cerebrovascular disease with high mortality. Surgical evacuation is an important treatment for intracerebral hemorrhage. However, little is reported about the comparison on the efficacy of various approaches on the prognosis. METHODS: Clinical data of 80 cases of intracerebral hemorrhage which surgically treated via transsylvian-transinsular approach or transcortical-transtemporal approach were collected. The proportion of post-surgery tracheostomy, incidence of digestive tract hemorrhage, revision surgery, the average length of hospital stay, and the six-month efficacy (defined by an ADL score) rate between these two groups were compared. RESULTS: The six-month efficacy rates were 75% and 50% in patients receiving transsylvian-transinsular and transcortical-transtemporal surgery, respectively (p<0.05). Compared to the transcortical-transtemporal group, the proportion of revision surgery was statistically significantly lower in the transsylvian-transinsular group, (p<0.05). The proportion of post-surgery tracheostomy, the incidence of digestive tract hemorrhage, and the average length of hospital stay were lower in the transsylvian-transinsular group, compared to the transcortical-transtemporal group, but no statistically significant differences were noted in them between the two groups. CONCLUSION: The transsylvian-transinsular approach for evacuation of intracerebral hematoma demonstrates limited complications, shorter length of hospital stay, and improved long-term efficacy and prognosis. These findings suggest this operative approach has potential for wider application.

Comparison between transsylvian-transinsular and transcortical-transtemporal approach for evacuation of intracerebral hematoma

PURPOSE: Hypertensive cerebral hemorrhage in the basal ganglia is a potentially life-threatening cerebrovascular disease with high mortality. Surgical evacuation is an important treatment for intracerebral hemorrhage. However, little is reported about the comparison on the efficacy of various approaches on the prognosis. METHODS: Clinical data of 80 cases of intracerebral hemorrhage which surgically treated via transsylvian-transinsular approach or transcortical-transtemporal approach were collected. The proportion of post-surgery tracheostomy, incidence of digestive tract hemorrhage, revision surgery, the average length of hospital stay, and the six-month efficacy (defined by an ADL score) rate between these two groups were compared. RESULTS: The six-month efficacy rates were 75% and 50% in patients receiving transsylvian-transinsular and transcortical-transtemporal surgery, respectively (p<0.05). Compared to the transcortical-transtemporal group, the proportion of revision surgery was statistically significantly lower in the transsylvian-transinsular group, (p<0.05). The proportion of post-surgery tracheostomy, the incidence of digestive tract hemorrhage, and the average length of hospital stay were lower in the transsylvian-transinsular group, compared to the transcortical-transtemporal group, but no statistically significant differences were noted in them between the two groups. CONCLUSION: The transsylvian-transinsular approach for evacuation of intracerebral hematoma demonstrates limited complications, shorter length of hospital stay, and improved long-term efficacy and prognosis. These findings suggest this operative approach has potential for wider application.

1H-MR spectroscopy guided gamma knife radiosurgery for treatment of glioma.

AIM: To observe the outcomes of 1H- MR-spectroscopy (MRS) guided gamma knife surgery for treatment of glioma. MATERIAL AND METHODS: Twenty patients with glioma diagnosed pathologically were randomly divided into MRI group and MRI plus MRS group. The target volume was defined as the tumor enhanced area plus the surrounding area with a short T1 and a long T2 in the MRI group, while the tumor enhanced area plus the surrounding area with a short T1 and a long T2 and choline: N-acetyl aspartate index (CNI) ≥ 1.6 in the MRI plus MRS group.12 months after surgery were set as the endpoint. RESULTS: Thirteen (65%) patients were successfully treated, of whom 6 were in the MRI group and 7 in the MRI plus MRS group. Ten patients suffered from cerebral edema during treatment, including 8 in the MRI group and 2 in the other group. The cases of cerebral edema were significantly fewer in the MRI plus MRS group than the MRI group. The average maximum diameter of the target volume was smaller in the MRI plus MRS group. CONCLUSION: The MRS-guided gamma knife radiosurgery helps to identify and remove the lesion of glioma and reduce complications due to extended surgical scope.

An efficacy analysis of posterior fossa decompression techniques in the treatment of Chiari malformation with associated syringomyelia.

A retrospective study of the efficacy of posterior fossa decompression (PFD) was carried out in 132 patients with Chiari malformation (CM) with associated syringomyelia (SM). Of these 132 patients, 69 received extended PFD (large craniotomy group), and the other 63 patients received only local PFD (small craniotomy group). At the short-term postoperative evaluation (1-4 weeks) the extended PFD appeared to be more effective than the local PFD (p<0.05). However, there was no significant difference in long-term analysis (6 months-11 years) (p>0.05). In the large craniotomy group, there was no difference between the short-term and long-term efficacy (p>0.05). However, in the small craniotomy group, long-term efficacy clearly improved (p<0.05). Furthermore, patients who had undergone local PFD exhibited more obvious radiological improvement of SM (p<0.05) and fewer postoperative complications compared to patients undergoing extended PFD (p<0.05). Therefore, local PFD is preferable for the surgical treatment of CM with associated SM.