Neurological Disturbance of the Upper Extremities After Cervical Laminoplasty: A Morphological Assessment Focused on the Intervertebral Foramen.

STUDY DESIGN: A retrospective study. OBJECTIVE: The aim of this study was to explore the relationship between postoperative neurological disturbance of the upper extremities (NDUE) after cervical laminoplasty and intervertebral foraminal stenosis. SUMMARY OF BACKGROUND DATA: The relationship between foraminal stenosis and neurological disturbance in the C5 segment (C5 palsy) has been reported, but the relationship at other levels has not been examined before. We evaluated foraminal stenosis morphologically using three-dimensional computed tomography (3D-CT), alongside other risk factors for NDUE. METHODS: We retrospectively reviewed patients treated by open-door laminoplasty at the authors' institution between January and June 2016. NDUE was defined as postoperative motor deterioration and/or newly emerged sensory disturbance within 2 weeks of surgery. Radiological measurements were performed in bilateral intervertebral foramina from C5 to C8, using 3D-CT. Investigation using magnetic resonance imaging (MRI) was also performed. RESULTS: Thirty-one patients were reviewed, and 10 (32.3%) developed NDUE. Nineteen NDUE were observed: seven were in the C5 segment, five in the C6 segment, three in the C7 segment, and four in the C8 segment. Four patients (40%) had NDUE from multiple segments. The mean width of the foramen was 2.60 ±â€Š1.26 mm and 3.66 ±â€Š1.66 mm (P = 0.007), and cross-sectional area was 32.8 ±â€Š10.8 mm and 41.6 ±â€Š12.4 mm (P = 0.003), in symptomatic (n = 19) and nonsymptomatic (n = 187) foramina, respectively. The mean transverse diameter of bony spurs and the maximum shift of the spinal cord on MRI was significantly larger in the NDUE group. The odds ratio of having a foraminal cross-sectional area under 28.0 mm in combination with a maximum spinal shift over 3.10 mm was 14.6 (P < 0.001). CONCLUSION: Stenosis of the intervertebral foramen could be a risk factor for NDUE after cervical laminoplasty, and could be aggravated by excessive posterior spinal cord shift. LEVEL OF EVIDENCE: 3.

[Case of jugular foramen schwannoma associated with tuberous sclerosis].

We report a case of jugular foramen schwannoma associated with tuberous sclerosis. A 28-year-old female with tuberous sclerosis presented to Hikone Municipal Hospital with subacute onset of somnolence, ataxic gait and frequent vomiting. Her tuberous sclerosis was diagnosed at the age of 9, when she developed hydrocephalus caused by subependymal giant cell astrocytoma near the foramen of Monro, which was treated by surgical resection and VP shunt placement followed by radiation and chemotherapy. Brain MR images revealed a 3 cm enhancing mass extending from the left jugular foramen to the cerebellopontine cistern, accompanied by perifocal edema of the brain stem and cerebellar hemisphere. The tumor was partially removed via suboccipital craniotomy and histologically diagnosed as a schwannoma. After surgery her symptoms promptly improved and 4 months later she underwent additional stereotactic radiosurgery. No tumor regrowth has been observed at 94 months. Intracranial schwannoma complicating tuberous sclerosis is very rare. Only one other case has been reported in the literature.

Linear deposition of immunoglobulins and complement components on the dura in normal pressure hydrocephalus complicating systemic lupus erythematosus.

We present a case of normal pressure hydrocephalus in a 70-year-old man with previously diagnosed systemic lupus erythematosus. Histological examination demonstrated the linear deposition of IgG, IgA, IgM, C(3) and C(1q) on the dura in the absence of inflammation or thrombosis that has previously been implicated in the aetiology of elevated pressure hydrocephalus in systemic lupus erythematosus. Our results suggest that the deposition of immunoglobulins and complement may play a pivotal role in an insidious manner in the pathogenesis of normal pressure hydrocephalus in systemic lupus erythematosus.

In vitro growth suppression of human glioma cells by a 16-mer oligopeptide: a potential new treatment modality for malignant glioma.

Fibroblast growth factor-2 (FGF-2) is involved as an autocrine growth factor in the autonomous proliferation of glioma cells. To develop a new strategy for treating patients with glioma, we studied the effect on human glioma cells of a 16-mer oligopeptide with conformational similarity to the putative receptor-binding domain of FGF-2. A synthesized oligonucleotide was assessed its receptor-binding activity by BIAcore instrument. Its biological effect on glioma cell lines was examined in vitro by MTT assay. The peptide suppressed the in vitro growth of human glioma cells U87MG, T98G and U251MG cells, but not of A431 cells whose growth is not dependent on FGF-2. Apoptotic bodies were noted after 24-h incubation in the presence of the peptide; Ac-YVAD-CHO, a caspase-3 inhibitor, suppressed apoptosis. Furthermore, we examined the modulation of the cytotoxic effect of anticancer drugs by the oligopeptide. The addition of this oligopeptide to the chemotherapeutic agents CDDP, ACNU and VP16 had additive effects in vitro. These results suggest that the pathway of the FGF-2 autocrine loop through the FGF receptor plays an important role in the proliferation of glioma cells. New drugs targeting this loop may be highly effective in treating FGF-2-dependent tumors. Our results suggest that its addition to the therapeutic arsenal may lead to improved treatment regimens for patients with FGF-2-dependent tumors.