[Clinical application of minimally invasive neuroendoscopic techniques].

OBJECTIVE: To summarize and analyze the application of neuroendoscopic techniques in neurosurgery, and to discuss the role and significance of neuroendoscopic techniques in the diagnosis and treatment of neurosurgical diseases. METHODS: We treated 1300 patients with different neurosurgical diseases by performing endoscopic neurosurgery (EN) and endoscopy-assisted microneurosurgery (EAM). Among 1300 paitents, 522 were treated with pure endoscopic neurosurgery, 260 with endoscopy-assisted microneurosurgery, 79 with endoscope-controlled bur hole trephination neurosurgery, 434 with endoscope transsphenoidial surgery, and 5 with other techniques through which an endoscope was used in conjunction with stereotactic guidance. RESULTS: Totally 362 hydrocephalus patients were treated using EN. Among them, 190 were treated by third ventriculostomy, 30 by V-P shunt, and 142 patients with complicated hydrocephalus and unsymmetry hydrocephalus by endoscopy-controlled pathologic septum fenestration, septum pellucidum fenestration, and treatment of inventricula inflammation. Clinical symptomatic improvement was achieved in 341 of 362 patients (94.2%). Also 160 intracranial cyst patients were treated using EN for resection and partial resection. Eighty-two patients were performed through cyst-ventricula fenestration. Clinical symptomatic improvement was achieved in 76 of 82 patients (92.7%). Seventy patients treated with endoscopy-controlled bur hole neurosurgery and 8 cases with endoscopy-assisted microneurosurgery got better recovery after operation. Among 260 patients with brain tumors, 252 patients were operated with EAM (190 patients with epidermoid cyst), 8 patients with EN (all brain tumors with diameters < 2.5 cm in inventricular). Clinical symptomatic improvement was achieved in 228 of 260 patients (87.7%). Among 49 patients with inventricular and cistern cyst, 40 patients who were treated by EN and 9 patients by endoscopy-controlled bur hole neurosurgery were resected and their clinical symptoms were improved after operation. Among 434 patients with sellar region lesions, 387 patients with pituitary adenomas, 19 patients with repair for CSF leaks, 9 patients with chordoma, and 19 patients with other neurosurgical diseases were performed with endoscopy-controlled transsphenoidial surgery. Clinical symptoms in 88.9% (386/434) of these patients were improved. Another 5 patients were treated with endoscopy combined with navigation and stereotatic guidance with good results. The complications related to operation were found in only 2% of all the patients including hemorrhage, infection, and damage of important structure. CONCLUSIONS: Clinical application of neuroendoscopic techniques can decrease the damage caused by pure open surgery operation. It is possible to resect lesions at the utmost and protect normal tissue from lesions for using EN and EAM or endoscopy-controlled microneurosurgery (ECM). It is also helpful to enhance surgical quality and, reduce the complications.

PCSK9 regulates apoptosis in human neuroglioma u251 cells via mitochondrial signaling pathways.

Proprotein convertase subtilisin/kexin type 9 (PCSK9), belongs to a family of proprotein convertases (PCs), encodes a neural apoptosis-regulated convertase 1. However, the precise role of PCSK9 during glioma cells apoptosis has not been reported. Therefore, we examined the effects of knockdown and overexpression of PCSK9 on apoptosis of human neuroglioma U251 cells, and investigated the underlying mechanisms of apoptosis. We found that PCSK9 regulated cells proliferation as determined by CCK-8 and Hoechst staining analysis. In addition, western blot results showed that PCSK9 siRNA promote apoptosis via activation of caspase-3 and down-regulation of the anti-apoptotic proteins, XIAP and p-Akt, while PCSK9 overexpression inhibited apoptosis. Moreover, PCSK9 siRNA improved the ratio of Bax/Bcl-2 which leads to the release of cytochrome c, while PCSK9 overexpression decreased it. Taken together, these data demonstrate that PCSK9 may regulate apoptosis through mitochondrial pathway and is expected to be a promising therapeutic strategy for the malignant glioma.