Strategy for facial nerve management during surgical removal of benign jugular foramen tumors: Outcomes and indications.

OBJECTIVE: Classical surgical management of jugular foramen (JF) tumors usually requires facial nerve rerouting which results in permanent facial palsy in most patients. The purpose of the article is to study the outcomes of different rerouting techniques, and to discuss their indications. MATERIAL AND METHODS: We retrospectively reviewed 98 patients with JF tumors operated at our center between January 2008 and December 2016 using different surgical approaches with the following procedures for facial nerve management: total anterior rerouting (TR), partial anterior rerouting (PR), and fallopian bridge (FB) technique. The data for facial nerve management, surgical outcome and postoperative facial nerve function were collected from the medical records. RESULTS: In the study, there were 48 males and 50 females. Of them, 61 (62.2%) were jugular paragangliomas, 22 (22.4%) schwannomas, and 15 (15.3%) meningiomas. Total tumor removal was achieved in 95 (96.9%) patients, while near-total removal was achieved in 3 (3.1%) paragangliomas. TR was applied in 31 (31.6%) patients with PR in 26 (26.5%) patients, and FB in 41 (41.8%) patients. The mean follow-up duration was 39.4±22.6 months, and 2 recurrences of paragangliomas were observed. Seventy-five patients (76.5%) had good facial function (HB I-II) at 1 year after surgery, the patients who received a TR approach presented significantly less HB I-II FN function (48.4%) than those with PR (82.6%, P<0.05) or those with FB technique (95.1%, P<0.001). 21 patients (21.4%) presented new-onset lower cranial nerve dysfunction of which 13 recovered at 1 year after surgery. CONCLUSION: Facial nerve management in JF tumors should be tailored individually. No-rerouting methods, such as the fallopian bridge technique, bring significantly better results in terms of facial nerve function, which might be performed first during surgery; its indication is based mainly on the tumor type and extent.

Serum miR-199a as a potential diagnostic biomarker for detection of colorectal cancer.

OBJECTIVE: MicroRNAs (miRNAs) play an essential role in the development and progression of colorectal cancer (CRC). Aberrant expression of miR-199a was associated with cancer development in many cancers. However, little was known about the clinical value of miR-199a in CRC. This study aimed to investigate the potential relationship between miR-199a expression and CRC prognosis. PATIENTS AND METHODS: Quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) was carried out to detect miR-199a expression level in serum from 107 CRC patients and 60 healthy controls. RESULTS: Serum miR-199a levels were significantly lower in CRC patients, particularly in advanced stage CRC subjects. MiR-199a expression in patients with distant metastasis and lymph node metastasis was markedly reduced compared to those without. Moreover, low serum miR-199a expression was associated with various CRC clinicopathological parameters. The serum miR-199a levels in CRC patients were increased significantly after their treatment. Furthermore, the patients in low serum miR-199a expression group had both worse overall survival and disease-free survival. In the multivariate analysis, serum miR-199a was identified as an independent prognostic marker. CONCLUSIONS: Reduced serum miR-199a was associated with poor prognosis in CRC and it might be useful as a marker for diagnosis and prognosis in CRC.

Simultaneous supervision by microscope of endoscope-assisted microsurgery via presigmoid retrolabyrinthine approach: A pilot study.

OBJECTIVE: To examine the impact of integrated hybrid operating rooms for endoscope-assisted microsurgery using the presigmoid retrolabyrinthine (RL) approach, and to determine the value of simultaneous supervision of skull base endoscopic procedures by microscope. MATERIAL AND METHODS: We retrospectively reviewed endoscope-assisted surgery using the RL approach at our institution between September 2013 and January 2017. The simultaneous supervision of endoscopic procedures by microscope was realized using the integrated hybrid system. Intra- or postoperative complications and surgical outcomes were analyzed. All patients were followed for at least 1 year. RESULTS: In total, 32 patients were studied: 4 vestibular schwannomas, 5 cholesteatomas, 8 hemifacial spasms, 5 glossopharyngeal neuralgias, and 10 Ménière's disease. In patients with vestibular schwannoma or cholesteatoma, complete removal was performed in all patients. In patients with Ménière's disease, hemifacial spasm or glossopharyngeal neuralgia, satisfactory symptom relief was achieved in all patients. Two (6.3%) patients had hearing loss after surgery which did not recover. One (3.1%) patient with vestibular schwannoma had mild facial palsy (HB III) at 2 weeks after the operation and recovered to near normal facial nerve function (HB II) at 1 year after surgery. No permanent or transient dysfunction of the trigeminal nerve or the lower cranial nerves was observed during follow-up. No complications such as cerebrospinal fluid (CSF) leakage or meningitis were observed. CONCLUSION: The endoscope provided a clearer and larger view, which solved the limitations of surgery using the RL approach. Endoscopic surgery under simultaneous supervision by microscope was safe and efficient in hearing preservation as well as in preservation of facial nerve function. An integrated operation room provided better support and the ability to switch quickly between these various complex devices.

Autophagy-induced RelB/p52 activation mediates tumour-associated macrophage repolarisation and suppression of hepatocellular carcinoma by natural compound baicalin.

The plasticity of tumour-associated macrophages (TAMs) has implicated an influential role in hepatocellular carcinoma (HCC). Repolarisation of TAM towards M1 phenotype characterises an immune-competent microenvironment that favours tumour regression. To investigate the role and mechanism of TAM repolarisation in suppression of HCC by a natural compound baicalin, Orthotopic HCC implantation model was used to investigate the effect of baicalin on HCC; liposome-clodronate was introduced to suppress macrophage populations in mice; bone marrow-derived monocytes (BMDMs) were induced to unpolarised, M1-like, M2-like macrophages and TAM using different conditioned medium. We observed that oral administration of baicalin (50 mg/kg) completely blocked orthotopic growth of implanted HCC. Suppression of HCC by baicalin was diminished when mice macrophage was removed by clodronate treatment. Baicalin induced repolarisation of TAM to M1-like phenotype without specific toxicity to either phenotype of macrophages. Baicalin initiated TAM reprogramming to M1-like macrophage, and promoted pro-inflammatory cytokines production. Co-culturing of HCC cells with baicalin-treated TAMs resulted in reduced proliferation and motility in HCC. Baicalin had minimal effect on derivation of macrophage polarisation factors by HCC cells, while directly induced repolarisation of TAM and M2-like macrophage. This effect was associated with elevated autophagy, and transcriptional activation of RelB/p52 pathway. Suppression of autophagy or RelB abolished skewing of baicalin-treated TAM. Autophagic degradation of TRAF2 in baicalin-treated TAM might be responsible for RelB/p52 activation. Our findings unveil the essential role of TAM repolarisation in suppressive effect of baicalin on HCC, which requires autophagy-associated activation of RelB/p52.

Spinal epidural Rosai-Dorfman disease preceding by relapsing uveitis: a case report with literature review.

STUDY DESIGN: Case report. SETTING: Tertiary referral center hospital in Taiwan. OBJECTIVES: To report a case of spinal Rosai-Dorfman disease (RDD) presenting with paraparesis and also preceding by relapsing uveitis for 6 months. A thoracic laminectomy was performed to remove the solid mass. The pathological diagnosis reveals infiltrating histiocytes, emperipolesis and positivity for S-100. There is no recurrence 1 year later with MR imaging. CONCLUSIONS: The relapsing idiopathic uveitis may be a prodrome for this unusual disease, because RDD is associated closely to defective immunogical response. Early and accurate diagnosis of CNS RDD may reverse the neurologic deficits by early decompression.