Establishment and Evaluation of a Novel High-Efficiency Model of Graded Traumatic Brain Injury in Mice.

BACKGROUND: Although previous studies have made significant contributions to establishing animal traumatic brain injury (TBI) models for simulation of human TBI, the accuracy, controllability, and modeling efficiency of animal TBI models need to be further improved. This study established a novel high-efficiency graded mouse TBI model induced by shock wave. METHODS: A total of 125 mice were randomly divided into sham, 0.7 mm, 0.6 mm, and 0.5 mm groups according to the depth of the cross groove of the aluminum sheets. The stability and repeatability of apparatus were evaluated, and the integrity of the blood-brain barrier, cerebral edema, neuropathologic immunohistochemistry, apoptosis-related protein, and behavioral tests of neurologic function were used to validate this new model. RESULTS: The results showed that 4 mice were injured simultaneously in 1 experiment. They received the same intensity of shock waves. Moreover, the mortality rates caused by 3 different aluminum sheets were consistent with the mortality rates of mild TBI, moderate TBI, and severe TBI. Compared with the sham group, mice in different injured groups significantly increased brain water content, blood-brain barrier permeability, and neuronal apoptosis. And the mice in all injured groups showed poor motor ability, balancing, spatial learning, and memory abilities. CONCLUSIONS: The novel TBI apparatus has advantages in its small size, simple operation, high repeatability, high efficiency, and graded severity. Our TBI apparatus provides a novel tool to investigate the neuropathologic changes and underlying mechanisms of TBI with various levels of severities.

Neurosurgery medical robot Remebot for the treatment of 17 patients with hypertensive intracerebral hemorrhage.

OBJECTIVE: To verify the minimally invasive surgical approach and therapeutic effects of using the medical neurosurgery robot Remebot to treat hypertensive intracerebral hemorrhage (HICH). METHODS: Clinical data for 17 HICH patients were analyzed retrospectively. Hematoma evacuation and tube drainage using Remebot frameless stereotaxic techniques were performed for all patients, and urokinase was injected into the hematomas after the operations. RESULTS: Robot-assisted stereotactic techniques can accurately guide hematoma punctures, and no deaths occurred among these patients. The average positioning error was 1.28 ± 0.49 mm. The average drainage duration was 3.4 days. The 3-month postoperative follow-up revealed improved neurological functions and quality of life for all patients. CONCLUSIONS: The medical neurosurgery robot Remebot is minimally invasive, has high positional accuracy, and facilitates surgical planning according to the shape of the hematoma. Therefore, robot-assisted surgery using Remebot represents a safe and effective treatment method for hematoma evacuation and tube drainage in HICH patients.

Transplantation of human retinal pigment epithelium cells in the treatment for Parkinson disease.

BACKGROUND AND PURPOSE: To assess the clinical effect of transplantation of human retinal pigment epithelial (hRPE) cells into the unilateral postcommissural putamen for treatment for Parkinson disease (PD). METHODS AND RESULTS: Cells from postmortem human eye tissue (10-20 weeks of gestation) were cultured in vitro. Cells from -generation passage were implanted in PD postcommissural putamen with stereotactic operation in 12 patients with PD. All patients tolerated surgery well, and no major adverse events occurred. Eleven patients showed improvement in the primary outcome measure at 3 months post-treatment, particularly the Unified Parkinson's Disease Rating Scale-M score in the off state. Response reached a peak at 12 months and declined during the next 24 months. At the 36-month endpoint, there were eight patients who felt better than at baseline. Positron emission tomography (PET) showed a trend with increased dopamine (DA) release during the first 6 months. CONCLUSION: Human retinal pigment epithelial cells have the characteristics of neural progenitor cells and can be induced to differentiate into DA neurons. The results of this clinical trial suggest that the treatment of transplanted hRPE cells could improve symptoms of PD. These cells might serve as a useful source of DA neurons for neural graft in the treatment for PD.

[Clinical experience of stereotactic biopsy for the brain lesions].

OBJECTIVES: To investigate the methodology of diversified advanced image-guided stereotactic biopsy for the brain lesions, and its diagnostic significance and experience in nervous system diseases. METHODS: Retrospectively reviewed 1187 cases of brain lesions underwent image-guided stereotactic biopsy from December 1987 to January 2009. There were 694 male (58.5%) and 493 female (41.5%) patients, aged from 1 to 85 years (average 39.7 years). There were 607 cases in CT-guided, including positron emission computed tomography (PET) guided stereotactic biopsy; 580 cases in MRI-guided, including proton magnetic resonance spectroscopy ((1)H-MRS) guided stereotactic biopsy. Routine frame was used in 726 cases and frameless stereotactic biopsy in 461 cases, including neuroendoscopic biopsy in 28 cases, guided by computer assisted surgery (CAS) computer-assistant robot. In the early 450 cases, CT/MRI images films were employed to measure the coordinates of the target by hand, while in the late 737 cases, computer-assistant planning software rebuilt the CT/MRI images and figured out the optimal neurosurgical path for biopsy. RESULTS: The positive diagnosis rate of biopsy was 97.4%, 983 (82.8%) cases were diagnosed pathologically as brain tumors, and 173 (14.6%) cases as non-tumor diseases. The tumors mainly including neuroglioma, metastatic tumor, primary central nervous system lymphoma and germ cell tumors. In non-tumor diseases, mainly including multiple sclerosis, tumefactive demyelinating lesion, neurodegenerative disease, inflammation and parasite. The biopsy operation caused small hematoma without neurological deficits in 20 cases (1.7%), and caused large hematoma (> 10 ml) which need neurosurgical treatment (catheterization or craniotomy evacuation of hematoma) in 9 cases (0.8%). Hemorrhage associated with biopsy caused 3 cases (0.3%) death. There were no severe intracranial infection cases. CONCLUSIONS: The stereotactic biopsy with advanced image-guided technique represents a safe, reliable and minimally invasive method for pathological diagnosis of intracranial lesions. Moreover, the developments of biochemical imaging gives a new concept to the stereotactic biopsy.

[Clinical analysis of 1434 cases of frameless stereotactic operation].

OBJECTIVE: Stereotactic operations were performed using a frameless stereotactic instrument manufactured by CAS-R-2 instead of traditional stereotactic frame. The aim of this study was to assess the clinical usefulness, accuracy and safety of frameless stereotactic instrument. METHODS: The clinical data of 1434 patients was retrospectively reviewed. The mean age was 30.7 years (from 0.2 to 89.0 years). Each patient underwent frameless CT/MRI image-guided stereotactic surgery by this robot system from January 1997 to January 2006. The accuracy of position and improvement of symptom were observed. The averaged period of followed-up was 24 months (from 3 to 48 months). RESULTS: The surgical procedures were performed successfully in all cases. All targets were pointed accurately at first time during the operation. The total effective rate was 93.3% without serious operation related complications. CONCLUSIONS: Compared with the traditional stereotactic operations, this method has some advantages, such as releasing the patient's pain, convenience the doctors, extending the range of indications and increasing the safety and effective of operation.

[Clinical application of robotic tele-manipulation system in stereotactic surgery].

OBJECTIVE: To assess the clinical usefulness, accuracy, and safety of tele-manipulation for frameless stereotactic surgery using the CAS-R-5 robot system. METHODS: We prospectively evaluated 32 patients underwent tele-manipulation of frameless stereotactic operations from Sep. 2005 to Sep. 2006. Tele-manipulations were performed via a digital data network by a neurosurgeon in Beijing while the patients were located in Yan'an. The distance is 1300 kilometers away. The accuracy of location and improvement of symptom were observed after operation. The period of follow-up was from 3 to 14 months (the average was 12 months). RESULTS: The surgical operations in 32 cases were successful. Remote fiducial registration was performed with a mean accuracy of 1. 50 mm and the standard difference were 0.32 mm between the planned and actual target. There were no complications. CONCLUSIONS: Diagnosis and treatment for intracranial disease by tele-manipulation frameless stereotactic surgeries are reliable and safe.