Endoscopic cadaveric analysis of the origin of the ophthalmic artery.

PURPOSE: The ophthalmic artery is often involved in suprasellar and parasellar surgeries, but the anatomical structure where the ophthalmic artery originates has not been fully clarified from the perspective of an endoscopic endonasal approach (EEA). METHODS: A total of 10 fresh cadaveric heads (20 sides) were dissected through an EEA, and the origin of the bilateral ophthalmic arteries and their adjacent structures were observed from a ventral view. The origin of the ophthalmic artery in 50 healthy people was retrospectively studied on computed tomography angiography imaging. RESULTS: The ophthalmic artery originated from the intradural segment (75%), paraclinoid segment (15%), or parasellar segment (10%) of the internal carotid artery. The cross-sectional view of the internal carotid artery through the EEA showed that the ophthalmic artery originated from the middle 1/3 (75%) or medial 1/3 (25%) of the upper surface of the internal carotid artery. On computed tomography angiography, the ophthalmic artery originated from the middle 1/3 (77%) and medial 1/3 (22%) of the upper surface of the internal carotid artery. All ophthalmic arteries were near the level of the distal dural ring (DDR) of the internal carotid artery, that is, within 3 mm above or below the DDR. CONCLUSIONS: The ophthalmic artery usually originates in the middle 1/3 of the upper surface of the intradural segment of the internal carotid artery within 3 mm of the DDR. The ophthalmic artery can be protected to the utmost extent after its origin is identified through an EEA.

The risk factors of hemorrhage in stereotactic needle biopsy for brain lesions in a large cohort: 10 years of experience in a single center.

BACKGROUND: This study aimed to identify the risk factors for hemorrhage from a large cohort who underwent stereotactic needle biopsy for brain lesions at a single center over a 10-year period. METHODS: We performed a retrospective chart review of consecutive patients who underwent stereotactic biopsy at our institute between January 2010 and December 2019. Demographic characteristics and clinical variables were collected and analyzed to identify risk factors for postbiopsy hemorrhage using the chi-square test and univariable and multivariable logistic regression analyses. RESULTS: A total of 3196 patients were included in this study; of these, a histological diagnosis was eventually made for 2938 (91.93%) patients. Hemorrhage occurred in 149 (4.66%) patients, and symptomatic hemorrhage occurred in 46 (1.44%) patients. In multivariable logistic regression analyses, the presence of deep-seated lesions (OR 1.272, p = 0.035), concomitant edema and enhancement on MR imaging scans (OR 1.827, p = 0.002), intraoperative hypertension without a past history (OR 1.012, p = 0.024), and the presence of high-grade glioma (OR 0.306, p = 0.003) were identified as independent predictors of hemorrhage after biopsy. CONCLUSION: Stereotactic needle biopsy is a safe and effective way to obtain tissue from brain lesions for histological diagnosis. The presence of deep-seated lesions, concomitant edema, and enhancement on MR imaging scans and the presence of high-grade glioma are independent predictors of hemorrhage after stereotactic biopsy.

Central nervous system tumefactive demyelinating lesions: Risk factors of relapse and follow-up observations.

Objective: To track the clinical outcomes in patients who initially presented with tumefactive demyelinating lesions (TDLs), we summarized the clinical characteristics of various etiologies, and identified possible relapse risk factors for TDLs. Methods: Between 2001 and 2021, 116 patients initially presented with TDLs in our hospital were retrospectively evaluated. Patients were followed for relapse and clinical outcomes, and grouped according to various etiologies. Demographic information, clinical data, imaging data, and laboratory results of patients were obtained and analyzed. The risk factors of relapse were analyzed by the Log-Rank test and the Cox proportional hazard model in multivariate analysis. Result: During a median follow-up period of 72 months, 33 patients were diagnosed with multiple sclerosis (MS), 6 patients with Balo, 6 patients with neuromyelitis optica spectrum disorders (NMOSD), 10 patients with myelin oligodendrocyte glycoprotein antibody-associated demyelination (MOGAD), 1 patient with acute disseminated encephalomyelitis (ADEM), and the remaining 60 patients still have no clear etiology. These individuals with an unknown etiology were categorized independently and placed to the other etiology group. In the other etiology group, 13 patients had recurrent demyelinating phases, while 47 patients did not suffer any more clinical events. Approximately 46.6% of TDLs had relapses which were associated with multiple functional system involvement, first-phase Expanded Disability Status Scale score, lesions morphology, number of lesions, and lesions location (P<0.05). And diffuse infiltrative lesions (P=0.003, HR=6.045, 95%CI:1.860-19.652), multiple lesions (P=0.001, HR=3.262, 95%CI:1.654-6.435) and infratentorial involvement (P=0.006, HR=2.289, 95%CI:1.064-3.853) may be independent risk factors for recurrence. Relapse free survival was assessed to be 36 months. Conclusions: In clinical practice, around 46.6% of TDLs relapsed, with the MS group showing the highest recurrence rate, and lesions location, diffuse infiltrative lesions, and multiple lesions might be independent risk factors for relapse. Nevertheless, despite extensive diagnostic work and long-term follow-up, the etiology of TDLs in some patients was still unclear. And these patients tend to have monophase course and a low rate of relapse.

Induction of ligustrazine apoptosis of A549 cells through activation of death receptor pathway.

Background: The aim of this study was to evaluate the effect of ligustrazine on the apoptosis of A549 cells and clarify the mechanism of ligustrazine-induced apoptosis. Methods: Ligustrazine was prepared with medium according to the gradient concentration. Based on a cytotoxicity test, 3 different concentrations of ligustrazine were selected to form low, medium, and high groups, with a 0 mg/mL dose used as the control. The apoptosis degree and Fas (Fas cell surface death receptor) and Fas-L (Fas Ligand) expression were detected by flow cytometry and quantitative polymerase chain reaction (qPCR), respectively; meanwhile, the activity of caspase 8 and caspase 3 was analyzed by enzyme-linked immunosorbent assay (ELISA) and qPCR, respectively. Results: After 24 hours of ligustrazine administration, the survival rate of A549 cells decreased with the increase of drug concentration, while the rate of apoptosis increased with the increase of drug concentration. Meanwhile, Fas and Fas-L expression was found to be significantly increased at both the gene and protein level, which was positively correlated with drug concentration. Furthermore, the expression of caspase 8 and caspase 3 was positively correlated with the concentration of ligustrazine, and there was significant difference compared with the control group. Conclusions: Ligustrazine can induce the apoptosis of A549 cells via the upregulation of Fas- and caspase-activating death receptor pathway expression.

Extracellular α-synuclein--a possible initiator of inflammation in Parkinson's disease.

Parkinson's disease (PD) is a progressive neurodegenerative disease involving the loss of dopamine-producing neurons of the substantia nigra and the presence of Lewy bodies which contain high levels of α-synuclein. Although the causative factors of PD remain unclear, the progression of PD is accompanied by a highly localized inflammatory response mediated by reactive microglia. Recently, attention has focused on the relationship between α-synuclein and microglial activation. This review examines the role of α-synuclein on microglia in PD pathogenesis and progression, we also discuss the way of α-synuclein induced microglial activation.

[Mixed craniopharyngioma: long-term results after gamma knife combined with stereotactic brachytherapy].

OBJECTIVE: To evaluate the long-term results of combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy for mixed cystic and solid craniopharyngiomas. METHODS: Sixty-seven consecutive patients with mixed cystic and solid craniopharyngioma treated by Gamma Knife radiosurgery combined with stereotactic brachytherapy from October 1996 to December 2005 were selected for retrospective analysis. The inclusion criterion was the patients who survived for at least 5 years after combined treatment. There were 39 male and 28 female patients and the mean age was 31.5 years (ranged from 3 to 70 years). The clinical evaluations including neurological, neuro-ophthalmological, and neuro-endocrinological examinations, assessment of comprehensive quality of life and neuroimaging examinations were performed periodically. The actuarial survival rates and the mean survival time were calculated by using Kaplan-Meier product limit method. The rates were compared using the χ(2) test. RESULTS: Follow-up period varied from 60 to 168 months, with an average of 114 months. The tumor response rate gained from combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy for predominantly solid and cystic craniopharyngiomas were 10/12 and 90.9% respectively, and 89.6% in all. Mean survival after combination treatment was (110 ± 9) months. The mean survival of patients with predominantly solid and cystic craniopharyngioma were (97 ± 12) months and (120 ± 14) months and the actuarial 10-year survival rates were 7/12 and 69.1%. There was no statistics difference in tumor response rate and 10-year survival rate between 2 groups of patients with predominantly solid and cystic craniopharyngioma. The actuarial 5-, 6-, 7-, 8-, 9- and 10-year survival rates were 90.5%, 85.7%, 83.3%, 76.4%, 69.4% and 60.0% respectively. The decreased visual acuity had improved in 68.3% at 6 months postoperatively and in 70.0% in long term results. Comprehensive quality of life in long term follow-up of 67 patients was excellent in 28 cases(41.8%), good in 19 cases(28.4%), fair in 17 cases(25.4%) and poor in 3 cases(4.5%), respectively. The side effects that occurred 6 to 12 months after treatment were worsening of visual acuity (4 patients), dysfunction of hypothalam (4 patients) and third nerve palsy was found in 1 patents 5 years after treatment. The rate of complications was 13.4%. CONCLUSION: Combination treatment with Gamma Knife radiosurgery and stereotactic intracavitary brachytherapy is highly effective and safety in the treatment of mixed cystic and solid craniopharyngiomas.

Stereotactic radiosurgery for trigeminal schwannoma: a clinical retrospective study in 52 cases.

OBJECTIVE: To evaluate the radiological and clinical outcomes in a series of patients in whom stereotactic radiosurgery (SRS) was used to treat trigeminal schwannomas. METHODS: The records of 52 patients who underwent SRS for trigeminal schwannoma were reviewed using a retrospective study. The median patient age was 47.1 years (range, 18-77); 20 patients (38.5%) had undergone prior tumor resection and 32 (61.5%) underwent radiosurgery on the basis of imaging diagnosis only. The most frequent presenting symptoms were facial numbness (29 patients), jaw weakness (11 patients), facial pain (10 patients) and diplopia (4 patients). Fifty-two cases with solid tumors were mainly solid in 44 cases (84.6%), mostly cystic in 2 cases (3.8%), and cystic and solid mixed in 6 cases (11.5%). Two cases of mostly cystic tumor first underwent stereotactic cystic fluid aspiration and intracavitary irradiation, and then had MRI localization scan again for gamma knife treatment. The mean tumor volume was 7.2 ml (range, 0.5-38.2). The mean prescription radiation dose was 13.9 Gy (range, 11-17), and the mean prescription isodose configuration was 47.9%. RESULTS: At a mean follow-up of 61 months (range, 12-156), neurological symptoms or signs improved in 35 patients (67.3%), 14 patients (26.9%) had a stable lesion, and worsening of the disease occurred in 2 patients (3.8%). On imaging, the schwannomas almost disappeared in 8 (15.4%), shrank in 32 (61.5%), remained stable in 5 (9.6%), and increased in size in 7 patients (13.5%). Tumor growth control was achieved in 45 (86.5%) of the 52 patients. CONCLUSIONS: SRS is an effective and minimally invasive management option for patients with residual or newly diagnosed trigeminal schwannomas. The use of SRS to treat trigeminal schwannomas resulted in good tumor control and functional improvement.

[Diagnosis and radiotherapy of germinomas arising in basal ganglia and thalamus].

OBJECTIVE: To summarize the clinical characteristic and radiotherapeutic effect of germinomas arising in basal ganglia and thalamus. METHODS: The clinical data of 13 cases were reviewed retrospectively. All cases were pathologic diagnosis through stereotactic biopsy. Gamma-knife or ordinary irradiation were 2 cases respectively and the combined therapy with interstitial brachytherapy as foundation were 9 cases. RESULT: All cases were male, median age of 16.1 years. Hemiparesis and ataxia were major symptoms, some cases were accompanied with precocious puberty. Imaging manifested intratumoral cystic components represented 76.9% of all lesions, calcification represented 30.8%, ipsilateral cerebral and brain stem hemiatrophy represented 46.2%, cerebral white matter invasion through internal capsule or corpus callosum represented 30.8%. One case died because of late complication and 12 cases had achieved satisfied therapeutic effect (the mean followed-up period was 40.6 months). Tumor-control were effective. CONCLUSIONS: The clinical manifestation and imaging characteristics are helpful to diagnosis. Stereotactic biopsy make the affirmatory diagnosis. Operative total-removal is impossible because of deep location, neighbour of vital structure and invasion. The combined therapy with interstitial brachytherapy was effective.

Influence of patients' age on functional recovery after transplantation of olfactory ensheathing cells into injured spinal cord injury.

OBJECTIVE: To evaluate the restoration of function after spinal cord injury (SCI) in patients of different ages who have underwent intraspinal transplantation of olfactory ensheathing cells (OECs). METHODS: One hundred and seventy-one SCI patients were included in this study. Of them, 139 were male and 32 were female, with age ranging from 2 to 64 years (mean, 34.9 years). In all SCI patients the lesions were injected at the time of operation with OECs. According to their ages, the patients were divided into 5 groups: 51 years group (n = 14). The spinal cord function was assessed based on the American Spinal Injury Association (ASIA) Classification System before and 2 - 8 weeks after OECs transplantation. One-way ANOVA and q test were used for statistical analysis, and the data were expressed as mean +/- SD. RESULTS: After surgery, the motor scores increased by 5.2 +/- 4.8, 8.6 +/- 8.0, 8.3 +/- 8.8, 5.7 +/- 7.3 and 8.2 +/- 7.6 in 5 age groups respectively (F = 1.009, P = 0.404); light touch scores increased by 13.9 +/- 8.1, 15.5 +/- 14.3, 12.0 +/- 14.4, 14.1 +/- 18.5 and 24.8 +/- 25.3 respectively (F = 1.837, P = 0.124); and pin prick scores increased by 11.1 +/- 7.9, 17.2 +/- 14.3, 13.2 +/- 11.8, 13.6 +/- 13.9 and 25.4 +/- 24.3 respectively (F = 2.651, P = 0.035). Restoration of pin prick in > 51 years group was better than other age groups except 21 - 30 years group. CONCLUSION: OECs transplantation can improve the neurological function of spinal cord of SCI patients regardless of their ages. Further research into the long-term outcomes of the treatment will be required.