Analysis of Prognostic Factors for the Indirect Traumatic Optic Neuropathy Underwent Endoscopic Transnasal Optic Canal Decompression.

OBJECTIVE: This study aimed to investigate the clinical outcomes of endoscopic transnasal optic canal decompression (ETOCD) for patients with indirect traumatic optic neuropathy (TON) and identify the relevant prognostic factors. METHODS: Seventy-two indirect TON patients who underwent ETOCD surgery from August 2017 to May 2019 were analyzed retrospectively. The paired t-test was used to compare the visual acuity (VA) before and after ETOCD, and multiple linear regression analysis was used to distinguish the potential prognostic factors. RESULTS: Among the patients analyzed, postoperative VA (-2.87 ±â€Š0.19) was significantly higher than the preoperative VA (-3.92 ±â€Š0.13) (P < 0.05). Multiple linear regression analysis models showed that poor initial VA and longer time to surgery were independent risk factors for VA prognosis (P < 0.05), but surgical time alone was significantly associated with the improvement degree of visual acuity (IDVA) (P < 0.05). Optic canal fracture, orbital fracture, and hemorrhage within the ethmoid and/or sphenoid sinus were not significantly correlated with IDVA and VA prognosis (P > 0.05). CONCLUSIONS: ETOCD surgery could salvage VA impairment in patients with indirect TON. A better initial VA indicates better final VA outcomes after surgery. Additionally, shorter time to surgery implies better VA prognosis and higher IDVA.

Experience Using the Pterional Keyhole Approach for the Treatment of Ruptured Intracranial Aneurysms of the Anterior Circulation.

BACKGROUND: The pterional keyhole approach is a more recently introduced minimally invasive version of the traditional pterional approach for treating aneurysms of the anterior circulation. METHODS: In this study, we compared operative parameters and clinical outcomes in patients treated with the pterional keyhole approach and historical controls in whom the traditional pterional approach was used. We reviewer records of 356 patients treated with the pterional keyhole approach between 2009 and 2016, along with those of 301 patients treated via the traditional pterional approach at the same period who served as a control group. The clinical manifestations, surgical details, postoperative complications, and modified Rankin Scale scores in the 2 groups were retrospectively compared. RESULTS: There were 408 aneurysms in the study group and 362 aneurysms in the control group. In the pterional keyhole group, the total clipping ratio was 93.6%, leaving a remnant/wrapping rate of 6.37%, compared with 93.9% and 6.08%, respectively, in the standard pterional group. In the patients treated via the keyhole approach, the mean bone flap diameter was 4 × 3 cm, mean blood loss was 204 ± 100 mL, mean operation time was 160 ± 57 minutes, and mean length of stay was 8.32 ± 2.72 days, compared with control group parameters of 5 × 6 cm, 284 ± 150 mL, 180 ± 49 minutes, and 11.32 ± 2.48 days, respectively. At a 6-month follow-up, 71.1% had a favorable outcome, 25.8% had a poor outcome, and the mortality was 3.09%, compared with 68.1%, 29.9% and 1.99%, respectively, in the control group. CONCLUSIONS: The pterional keyhole approach offers shorter operative times, less blood loss, shorter length of stay, and improved cosmesis without sacrificing outcomes compared with traditional pterional craniotomy.

The K(+)-Cl(-) Cotransporter KCC2 and Chloride Homeostasis: Potential Therapeutic Target in Acute Central Nervous System Injury.

The K(+)-Cl(-) cotransporter-2 (KCC2) is a well-known member of the electroneutral cation-chloride cotransporters with a restricted expression pattern to neurons. This transmembrane protein mediates the efflux of Cl(-) out of neurons and exerts a critical role in inhibitory γ-aminobutyric acidergic (GABAergic) and glycinergic neurotransmission. Moreover, KCC2 participates in the regulation of various physiological processes of neurons, including cell migration, dendritic outgrowth, spine morphology, and dendritic synaptogenesis. It is important to note that down-regulation of KCC2 is associated with the pathogenesis of multiple neurological diseases, which is of particular relevance to acute central nervous system (CNS) injury. In this review, we aim to survey the pathogenic significance of KCC2 down-regulation under the condition of acute CNS injuries. We propose that further elucidation of the molecular mechanisms regarding KCC2 down-regulation after acute CNS injuries is necessary because of potential promising avenues for prevention and treatment of acute CNS injury.

Identification of the soluble form of tyrosine kinase receptor Axl as a potential biomarker for intracranial aneurysm rupture.

BACKGROUND: Subarachnoid hemorrhage caused by a ruptured intracranial aneurysm (RIA) is a devastating condition with significant morbidity and mortality. Despite the fact that RIAs can be prevented by microsurgical clipping or endovascular coiling, there are no reliable means of effectively predicting IA patients at risk for rupture. The purpose of our study was to discover differentially-expressed glycoproteins in IAs with or without rupture as potential biomarkers to predict rupture. METHODS: Forty age/gender-matched patients with RIA, unruptured IA (UIA), healthy controls (HCs) and disease controls (DCs) (discovery cohort, n = 10 per group) were recruited and a multiplex quantitative proteomic method, iTRAQ (isobaric Tagging for Relative and Absolute protein Quantification), was used to quantify relative changes in the lectin-purified glycoproteins in CSF from RIAs and UIAs compared to HCs and DCs. Then we verified the proteomic results in an independent set of samples (validation cohort, n = 20 per group) by enzyme-linked immunosorbent assay. Finally, we evaluated the specificity and sensitivity of the candidate marker with receiver operating characteristic (ROC) curve methods. RESULTS: The proteomic findings identified 294 proteins, 40 of which displayed quantitative changes unique to RIA, 13 to UIA, and 20 to IA. One of these proteins, receptor tyrosine kinase Axl, was significantly increased in RIA, as confirmed in CSF from the discovery cohort as well as in CSF and plasma from the validation cohort (p <0.05). Spearman's correlation analysis revealed that the CSF and plasma Axl levels were strongly correlated (r = 0.93, p <0.0001). The ROC curve indicated an optimal CSF Axl threshold of 0.12 nM for discriminating RIA from UIA with corresponding sensitivity/specificity of 73.33%/90% and an area under the curve (AUC) of 0.89 (95% CI: 0.80-0.97, p < 0.0001). The optimal threshold for plasma Axl was 1.7 nM with corresponding sensitivity/specificity of 50%/80% and an AUC of 0.71 (95% CI: 0.54-0.87, p = 0.027). CONCLUSIONS: Both CSF and plasma Axl levels are significantly elevated in RIA patients. Axl might serve as a promising biomarker to predict the rupture of IA.

Optogenetic control of thalamus as a tool for interrupting penicillin induced seizures.

Penicillin epilepsy model, whose discharge resembles that of human absence epilepsy, is one of the most useful acute experimental epilepsy models. Though closed-loop optogenetic strategy of interrupting seizures was proved sufficient to switch off epilepsy by controlling thalamus in the post-lesion partial chronic epilepsy model, doubts still exist in absence epilepsy attenuation through silencing thalamus. Here we directly arrested the thalamus to modulate penicillin-induced absence seizures through pseudorandom responsive stimulation on eNpHR-transfected rats. Our data suggested that the duration of epileptiform bursts under light conditions, compared with no light conditions, did not increase or decrease when modulated specific eNpHR-expressing neurons in thalamus.