Minimally invasive puncture with twist intraosseous drill needle combined with hematoma drainage in the treatment of acute epidural hematoma in pediatric patients: A technical note.

OBJECTIVE: The current neurosurgical intervention for treatment of acute epidural hematoma (AEDH) usually involves a craniotomy. Despite its effectiveness, open surgical decompression has several limitations. The twist intraosseous drill needle (TIDN) is considered a feasible alternative in adult patients with AEDH. AEDH treatment with TIDN in pediatric patients has not yet been described. The study aimed to report the efficacy and safety of minimally invasive puncture with a TIDN combined with hematoma drainage for the treatment of AEDH in pediatric patients. METHODS: We retrospectively collected medical records of children with AEDH who underwent TIDN surgery at our institution from January 2017 to May 2021, and analyzed their clinical and imaging results. A detailed step-by-step surgical guide was provided. RESULTS: Three pediatric patients with AEDH received TIDN treatment (including two males and one female; average age 7.66 years, range from 5 to 11 years). There were no intraoperative or postoperative complications in any case; 1 day after the operation, the AEDH was cleared in one of the three patients, and a slight hematoma remained in two patients. The remaining hematoma was evacuated after injecting urokinase into the hematoma cavity during indwelling drainage. CONCLUSION: For pediatric patients with AEDH in a stable condition with a clear consciousness, TIDN puncture combined with hematoma drainage is safe, effective, and less invasive, and may present a viable surgical alternative option.

Expression of Histone H1 in Rats with Traumatic Brain Injury and the Effect of the NLRP3 Inflammasome Pathway.

OBJECTIVE: To explore expression of histone H1 after traumatic brain injury (TBI) and the effect of the nucleotide-binding domain and leucine-rich repeat protein 3 (NLRP3) inflammasome pathway on its expression. METHODS: Of 24 rats, 15 were randomly divided into a sham and 4 TBI groups, with 3 rats in each group; the remaining 9 rats were randomly divided into sham group, TBI group, and TBI+CY-09 group, with 3 rats in each group. The expression of histone H1 in rat serum was detected by enzyme-linked immunosorbent assay; Western blot was used to detect the expression of target protein in the injured brain tissue of rats. RESULTS: On the 3rd day after TBI, compared with the sham group, the expression of histone H1 was decreased (P < 0.05). After inhibiting the NLRP3 inflammasome pathway with CY-09, expressions of IL-1ß, IL-18, and histone H1 in rat-injured brain tissue in the TBI+CY-09 group were decreased compared with the TBI group (P < 0.05). CONCLUSIONS: The expression of histone H1 decreased significantly from the 3rd day after TBI. Inhibiting the NLRP3 inflammasome pathway may reduce the expression of histone H1. The expression of histone H1 was affected by the microglia-related central nervous system inflammatory response.

Application of stem cells and exosomes in the treatment of intracerebral hemorrhage: an update.

Non-traumatic intracerebral hemorrhage is a highly destructive intracranial disease with high mortality and morbidity rates. The main risk factors for cerebral hemorrhage include hypertension, amyloidosis, vasculitis, drug abuse, coagulation dysfunction, and genetic factors. Clinically, surviving patients with intracerebral hemorrhage exhibit different degrees of neurological deficits after discharge. In recent years, with the development of regenerative medicine, an increasing number of researchers have begun to pay attention to stem cell and exosome therapy as a new method for the treatment of intracerebral hemorrhage, owing to their intrinsic potential in neuroprotection and neurorestoration. Many animal studies have shown that stem cells can directly or indirectly participate in the treatment of intracerebral hemorrhage through regeneration, differentiation, or secretion. However, considering the uncertainty of its safety and efficacy, clinical studies are still lacking. This article reviews the treatment of intracerebral hemorrhage using stem cells and exosomes from both preclinical and clinical studies and summarizes the possible mechanisms of stem cell therapy. This review aims to provide a reference for future research and new strategies for clinical treatment.

Analysis of the Causes and Experience in the Diagnosis and Treatment of Intravertebral Mobile Nerve Sheath Tumors-Case Report and Review of the Literature.

BACKGROUND: We sought to analyze the clinical data and imaging features from a rare case presenting an intravertebral mobile nerve sheath tumor of the lumbar spine, review the relevant literature, discuss the imaging features and possible causes of the tumor, and propose preventive measures and solutions. CASE DESCRIPTION: The clinical data and imaging data of a patient with a lumbar spinal canal mobile nerve sheath tumor were retrospectively analyzed in conjunction with the relevant literature. The first preoperative lumbar spine magnetic resonance imaging (MRI) showed the tumor located at level L1-2. Further lumbar spine MRI, which was performed 5 days later, showed the tumor was at level L3-4, with a range of motion of 8 cm. End spinal resection of the tumor was performed under general anesthesia, and a tumor, which was cystic solid, was found to be located at level L3-4. The tumor originated from a distinctly twisted and elongated posterior root of the spinal cord, with complete fusion of the tumor-bearing nerve. Both the tumor and tumor-carrying nerve were removed. Postoperative pathologic examination confirmed that the tumor was a nerve sheath tumor. Lumbar MRI on postoperative day 10 showed complete resection of the tumor in the L3-4 spinal canal. The patient was discharged with normal urination and defecation, normal sensation in both lower extremities, grade 5 muscle strength, normal muscle tone, and normal reflexes in both knee and Achilles tendons. CONCLUSIONS: Intravertebral mobile nerve sheath tumors are rare, and the marked distortion and elongation of the carrier nerve seen on MRI are important imaging features of this disease. The possible causes of tumor movement include tumor texture, location, positional changes, and altered cerebrospinal fluid dynamics. Acute changes in intraabdominal pressure caused by forceful defecation may be a high-risk factor for tumor migration. Multiple preoperative MRIs to localize the tumor are particularly important.

Silencing of Mig-7 expression inhibits in-vitro invasiveness and vasculogenic mimicry of human glioma U87 Cells.

Gliomas are the most common malignant primary brain tumors with poor prognosis. The migration-inducing gene-7 (Mig-7) protein is a cysteine-rich protein. Vasculogenic mimicry can replace endothelium-dependent blood vessels and supply blood to tumors, thus promoting tumor invasion and metastasis. They have also been shown to play critical roles in the development and progression of various cancers. We attempted to explore the role of Mig-7 and vasculogenic mimicry in glioma progression. We demonstrated that Mig-7 and vasculogenic mimicry were not expressed in normal tissues. In glioma, Mig-7 expression was positively associated with vasculogenic mimicry formation, the expression of both increased with increasing glioma pathological grade. In-vitro, Mig-7 silencing may inhibit the in-vitro invasiveness and formation of vasculogenic mimicry in human glioma U87 cells by inhibiting the phosphatidylinositol 3-kinase/AKT/ matrix metalloproteinases 2 and matrix metalloproteinases 9 signaling pathway. The present study thus indicates a potential role for Mig-7 as a target in the treatment of glioma.