Real-time augmented reality application in presurgical planning and lesion scalp localization by a smartphone.

OBJECTIVE: A smartphone augmented reality (AR) application (app) was explored for clinical use in presurgical planning and lesion scalp localization. METHODS: We programmed an AR App on a smartphone. The accuracy of the AR app was tested on a 3D-printed head model, using the Euclidean distance of displacement of virtual objects. For clinical validation, 14 patients with brain tumors were included in the study. Preoperative MRI images were used to generate 3D models for AR contents. The 3D models were then transferred to the smartphone AR app. Tumor scalp localization was marked, and a surgical corridor was planned on the patient's head by viewing AR images on the smartphone screen. Standard neuronavigation was applied to evaluate the accuracy of the smartphone. Max-margin distance (MMD) and area overlap ratio (AOR) were measured to quantitatively validate the clinical accuracy of the smartphone AR technique. RESULTS: In model validation, the total mean Euclidean distance of virtual object displacement using the smartphone AR app was 4.7 ± 2.3 mm. In clinical validation, the mean duration of AR app usage was 168.5 ± 73.9 s. The total mean MMD was 6.7 ± 3.7 mm, and total mean AOR was 79%. CONCLUSIONS: The smartphone AR app provides a new way of experience to observe intracranial anatomy in situ, and it makes surgical planning more intuitive and efficient. Localization accuracy is satisfactory with lesions larger than 15 mm.

Facial and Cochlear Nerve Complications following Microsurgical Resection of Vestibular Schwannomas in a Series of 221 Cases.

BACKGROUND: Despite improvements in microsurgical technique and the use of intraoperative electrophysiological monitoring, the potential for facial and cochlear nerve injury remains a possibility in the resection of vestibular schwannomas (VS). We reviewed a series of 221 cases of VS resected via a retrosigmoid approach at our institution from October 2008 to April 2014 and determined the incidence of postoperative facial and cochlear deficits. MATERIAL AND METHODS: A total of 221 patients - 105 (47.5%) male and 116 (52.5%) female - with a mean age of 46.1 years (range 29-73 years), with VS ≥3 cm (n=183, 82.8%) and <3 cm (n=38, 17.2%) underwent surgical resection via a retrosigmoid approach and were evaluated for postoperative facial and cochlear nerve deficits. RESULTS: Near-total resection (>95% removal) was achieved in 199 cases (90%) and subtotal resection (>90% removal) in 22 cases (10%). At 6 month follow-up, House-Brackmann grades I-III were observed in 183 cases (82.8%), grade IV in 16 cases (7.2%), and grade V in 22 cases (10%). Of the 10 patients that had preoperative functional hearing, 3 (33%) retained hearing postoperatively. Cerebrospinal fluid leakage occurred in 6 patients (2.7%), lower cranial nerve palsies in 9 patients (4.1%), and intracranial hematomas 3 cases (1.4%). CONCLUSIONS: The observed incidence of persistent postoperative nerve deficits is very low. Meticulous microsurgical dissection of and around the facial and cochlear nerves with the aid of intraoperative electrophysiological nerve monitoring in the retrosigmoid approach allows for near-total resection of medium and large VS with the possibility of preservation of facial and cochlear nerve function.

Paraventricular or centrum ovale cavernous hemangioma involving the pyramidal tract in children: intraoperative MRI and functional neuronavigation-guided resection.

OBJECTIVES: In this study, we investigated whether visualization of the pyramidal tract and intraoperative MRI combined with functional navigation was helpful in the resection of paraventricular or centrum ovale cavernous hemangioma in children. METHODS: Twelve patients with cavernous hemangioma located in the paraventricular area or in the centrum ovale adjacent to the pyramidal tract were prospectively enrolled in the study. The pyramidal tract of all patients was visualized preoperatively, and all patients underwent tailored craniotomy with white matter trajectory to resect the lesion, with the help of intraoperative MRI and microscope-based functional neuronavigation. RESULTS: In our study, of the total of 12 patients (nine males and three females), five patients had lesions on the left side, and seven had lesions located in the right hemisphere. The lesion volume varied from 0.2 to 11.45 cm(3). In seven cases, the distance of the lesion from the pyramidal tract was 0-5 mm (the 0-5 mm group), and five cases were in the 5-10 mm group. The 3D visualization of the lesion and the pyramidal tract helped the surgeon design the optimal surgical approach and trajectory. Intraoperative functional neuronavigation allowed them to obtain access to the lesion accurately and precisely. All lesions had been removed totally at the end of the surgery. Compared with the preoperative level, muscle strength at 2 weeks had decreased in six cases, was unchanged in four cases, and improved in two cases; at 3 months, it was improved in five cases, unchanged in six cases, and decreased in one case. CONCLUSIONS: Pyramidal tract visualization and intraoperative MRI combined with functional neuronavigation can aid in safe removal of paraventricular or centrum ovale cavernous hemangioma involving the pyramidal tract.

Intraoperative high-field magnetic resonance imaging combined with functional neuronavigation in resection of low-grade temporal lobe tumors.

BACKGROUND: The aim of this study is to investigate the role of intraoperative MR imaging in temporal lobe low-grade glioma (LGG) surgery and to report the surgical outcome in our series with regard to seizures, neurological defects, and quality of life. METHODS: Patients with temporal lobe contrast-nonenhancing gliomas who presented with seizures in the course of their disease were enrolled in our prospective study. We non-randomly assigned patients to undergo intraoperative magnetic resonance imaging (iMRI)-guided surgery or conventional surgery. Extent of resection (EOR) and surgical outcomes were compared between the two groups. RESULTS: Forty-one patients were allocated in the iMRI group, and 14 were in the conventional group. Comparable EOR was achieved for the two groups (p = 0.634) although preoperative tumor volumes were significantly larger for the iMRI group. Seizure outcome tended to be better for the iMRI group (Engel class I achieved for 89.7% (35/39) vs 75% (9/12)) although this difference was not statistically different. Newly developed neurological deficits were observed in four patients (10.3%) and two patients (16.7%), respectively (p = 0.928). Free of seizures and neurological morbidity led to a return-to-work or return-to-school rate of 84.6% (33/39) vs 75% (9/12), respectively (p = 0.741). CONCLUSIONS: Our study provided evidence that iMRI was a safe and useful tool in temporal lobe LGG surgery. Optimal extent of resection contributed to favorable seizure outcome in our series with low morbidity rate, which led to a high return-to-work rate.

Microsurgical management of posterior cerebral artery aneurysms: A report of thirty cases in modern era.

OBJECTIVE: We reviewed a series of 30 cases of posterior cerebral artery (PCA) aneurysms to examine the outcomes of microsurgical techniques, which is an important alternative to endovascular interventions in localities where access to the latter renders practical difficulty. We also aimed to introduce the initial experience about the clinical application of intraoperative computed tomography (CT) in treatment of PCA aneurysm. METHODS: Thirty patients with PCA aneurysm treated using microsurgery in our department between January 1996 and July 2014 were reviewed retrospectively. RESULTS: The case series included 13 females and 17 males with a mean age of 44 years, ranging from 8 to 78 years. Eighteen aneurysms were ruptured, five aneurysms caused a direct mass effect, and the remaining seven aneurysms were found incidentally. Most aneurysms were located in the P1 segment or the P1-P2 junction of the PCA (63%). Eighteen aneurysms (60%) were large or giant in size (≥ 10 mm). Seventeen aneurysms were directly clipped, six trapped, one wrapped, one electrocoagulated and resected, and five trapped or proximal clipped with a bypass. Intraoperative perfusion CT (PCT) and CT angiography (CTA) were applied to provide immediate information regarding cerebral hemodynamics and anatomy of vessels in six patients. Twenty-six patients (87%) showed good clinical outcomes according to the modified Rankin Scale score (≤ 2) at the mean clinical follow-up period of 34 (range: 1-78) months, including the patients using intraoperative CT, and one (3%) patient was dead. CONCLUSION: Microsurgical therapy for patients with PCA aneurysms can have a positive outcome with correctly selected techniques. Personalized microsurgical treatment paradigms are determined by the anatomical location, shape and size of the PCA aneurysm, and the clinical features of the patient. Intraoperative PCT and CTA can improve the efficacy of the surgical treatment.

Mig-2 attenuates cisplatin-induced apoptosis of human glioma cells in vitro through AKT/JNK and AKT/p38 signaling pathways.

AIM: Mig-2 (also known as Kindlin-2 and FERMT2) is an important regulator of integrin activation and cell-extracellular matrix adhesion, and involved in carcinogenesis and tumor progression. The aim of this study was to investigate the role of mig-2 in cisplatin-induced apoptosis of human glioma cells in vitro. METHODS: The expression of mig-2 was modulated in human glioma H4, HS 683 and U-87 MG cells by transfection with a plasmid carrying mig-2 or mig-2 siRNA. Cisplatin-induced apoptosis was detected using Annexin V/PI staining and flow cytometry, as well as MTS analyses. The expression of apoptosis-related or signaling proteins was examined using Western blotting analysis. H4 cells were transfected with plasmids carrying mig-2 mutants to determine the functional domain of mig-2. RESULTS: In the 3 glioma cell lines tested, overexpression of mig-2 significantly attenuated cisplatin-induced apoptosis, whereas knock-down of mig-2 potentiated the apoptosis. The mechanisms of action of mig-2 were further addressed in H4 cells: overexpression of mig-2 markedly reduced cleaved caspase-9, caspase-8, caspase-3 and PARP, as well as p-JNK and p-p38, and increased p-AKT in cisplatin-treated H4 cells, whereas mig-2 siRNA reversely changed these apoptosis-related and signaling proteins. Furthermore, pretreatment with JNK inhibitor SP600125 and p38 inhibitor SB203580, or with AKT inhibitor LY294002 abolished the effects of mig-2 on cisplaxtin-induced apoptosis. In H4 cells, GFP-mig-2 F3 plasmid that contained only the F3 subdomain showed the same efficiency in attenuating cisplatin-induced apoptosis, as the mig-2 wild-type vector did, whereas GFP-mig-2 (1-541) plasmid that lacked the F3 subdomain was inactive. CONCLUSION: Mig-2 significantly attenuates the antitumor action of cisplatin against human glioma cells in vitro through AKT/JNK and AKT/p38 signaling pathways. The F3 subdomain of mig-2 is necessary and sufficient for this effect.

Operative management of trigeminal neuromas: an analysis of a surgical experience with 55 cases.

BACKGROUND: The trigeminal schwannoma is the second most common intracranial schwannoma. Their proximity to the critical skull base neural and vascular structures increases the complexity of surgical treatment. The aim of this study was to better understand the surgical approaches and the prognosis, as well as to assess the optimum therapeutic schedule. METHODS: This was a retrospective study of 55 patients with trigeminal schwannomas who visited our department between Jan 2007 and Jan 2012. We analyzed the clinical and radiological presentation, tumor characteristics, surgical approaches, the prognosis. RESULTS: The patients were 30 women and 25 men of mean age 36 years (range, 6-66 years) who received postoperative neurological and neuroradiological follow-up. The tumor was located in the middle fossa (type A) in 13 cases, in the posterior fossa (type B) in ten cases, in the middle and posterior fossae (type C) in 21 cases, and in the branches of the trigeminal nerve (type D) in 11 cases. The most common symptom was facial hypesthesia or numbness in 36 patients (65 %) . Total and nearly total tumor resection was achieved in 51 cases (93 %). Three patients (5 %) had worsening of preexisting deficits and there was no perioperative mortality. With an average follow-up period of 35 months, facial hypesthesia persisted in 26 patients (72 %),and improved in ten patients (28 %). Facial pain was relieved in 11 patients (100 %). There has been a recurrence in one case (2 %) and all patients resumed independent and social reintegration. CONCLUSION: This study demonstrates radical surgery with excellent neurological outcomes is the primary treatment of trigeminal schwannomas. Appropriate selection of surgical approach according to tumor types is highly important and necessary. The preoperative facial pain could be relieved, hypesthesia frequently remains or could even be worsened after surgery.

[Surgical management of intracranial mirror aneurysms].

OBJECTIVE: To study the clinical characteristics and treatment strategies of mirror aneurysms. METHODS: Nineteen patients with 20 pairs of mirror aneurysms from November 2007 to November 2012 were retrospectively analysed. Among the 19 patients, 13 were female and 6 were male, mean age was 56 years (ranged 32-75 years). Distribution of the lesions included 11 bilateral posterior communicating artery aneurysms (one with a pair of anterior choroidal artery aneurysm), 4 bilateral middle cerebral artery aneurysms, 3 bilateral paraclinoidal aneurysms, and 1 bilateral pericallosal-callosomarginal artery aneurysm. Surgical strategies were selected according to location of hemorrhage, Hunt-Hess grade, location and size of aneurysm, etc. RESULTS: Four mirror aneurysms were clipped at one stage, 3 mirror aneurysms were clipped at two stages, 2 were treated with combination of clipping and coiling and remaining 10 were clipped unilaterally. At discharge, 15 out of 19 patients had a Glasgow Outcome Scale score of 5, 4 patients had a score of 4. The mean clinical follow-up was 18.6 months (range 3-50 months). Two patients had oculomotor nerve palsy postoperatively. At 3-month follow-up, 1 improved and 1 unchanged. In 10 patients with unilateral clipping, contralateral aneurysms were unruptured, small ( < 5 mm) and regular. No remnant or recurrence of aneurysm were found in other 9 patients whose bilateral aneurysms had been treated. CONCLUSIONS: The mirror aneurysms are rare kinds of multiple aneurysms. The aneurysm responsible for hemorrhage should be treated with first priority. The contralateral unruptured aneurysm could be observed, clipped or coiled in one stage, or treated in two separate stages.

[Application of intraoperative magnetic resonance imaging and multimodal navigation in surgical resection of glioblastoma].

OBJECTIVE: To evaluate the efficacy of intraoperative magnetic resonance imaging (iMRI) and multimodal navigation in surgical resection of glioblastoma. METHODS: Between February 2009 and July 2010, 76 glioblastoma patients underwent surgical resection guided by iMRI and multimodal navigation. The cohort consisted of 43 male and 33 female patients, with a mean age of 49 years (range: 14-79 years). Rates of gross total resection (GTR) and extent of resection (EoR) were calculated at first and final iMRI scans.Pearson χ(2) test was used to compare the rates of GTR. RESULTS: iMRI and multimodal navigation were successfully implemented in all cases. Rates of GTR were misestimated by neurosurgeons in 24 cases (31.6%), which were confirmed by first iMRI. Total tumor resection were achieved in 20 cases (26.3%) as a result of iMRI scan, increasing the rates of gross total resection from 52.6% to 78.9% (χ(2) = 11.692, P = 0.001). Extent of resection in 28 patients who underwent further tumor resection were increased from 81.5% to 98.1%, leading to the overall extent of resection improved from 92.3% to 98.4%. At 3-month follow-up, 3 cases (3.9%) developed permanent neurologic deficits. The mean clinical follow-up was 15.6 months (range 3.0-45.0 months). The 2-year overall survival rate was 19.7%. The median progression-free survival of gross total resection group was 12 months (95% CI: 10.1-13.9 months), compared with 9 months (95%CI: 7.9-10.1 months) of the subtotal resection group (χ(2) = 4.756, P = 0.029). The overall survival of gross total resection group was 16 months (95% CI: 13.7-18.3 months), compared with 12 months (95% CI: 9.7-14.3 months) of the subtotal resection group (χ(2) = 7.885, P = 0.005). CONCLUSION: Combined with multimodal navigation, iMRI helps maximize surgical resection of glioblastoma, preserving neurological function while increasing progression-free survival and overall survival.

[Integration of metabolism images into multimodal neuronavigation for frameless stereotaxy].

OBJECTIVES: To evaluate the efficacy of integration of metabolism images into multimodal neuronavigation for frameless stereotactic biopsy. METHODS: From January to December 2012, 32 patients with brain lesions underwent frameless stereotactic biopsy guided by positron emission tomograph (PET) and proton magnetic resonance spectroscopy ((1)H-MRS)-based multimodal neuronavigation and intraoperative magnetic resonance imaging (iMRI). The cohort consisted of 16 male and 16 female patients, with a mean age of 45 years (range: 7 - 62 years). Biopsy targets were identified according to PET and (1)H-MRS. Biopsy was performed with Varioguide frameless biopsy system. Diagnostic yield and complications were assessed. RESULTS: Metabolism images-based multimodal neuronavigation and iMRI were successfully implemented in all cases. iMRI confirmed accuracy of biopsy targets. All the specimens obtained pathological diagnosis, the diagnostic yield was 100%. In 1 patient, iMRI found small hematoma (< 5 ml), surgical evacuation wasn't needed with intraoperative complication rate 3.1%. With the help of multimodal neuronavigation, no patients had new or worsened neurologic deficits. CONCLUSIONS: Integration of metabolism images into multimodal neuronavigation provide not only anatomical, but also metabolic and functional information for frameless stereotaxy, increasing diagnostic yield and avoiding postoperative neurologic deficits.

Dual-room 1.5-T intraoperative magnetic resonance imaging suite with a movable magnet: implementation and preliminary experience.

We hereby report our initial clinical experience of a dual-room intraoperative magnetic resonance imaging (iMRI) suite with a movable 1.5-T magnet for both neurosurgical and independent diagnostic uses. The findings from the first 45 patients who underwent scheduled neurosurgical procedures with iMRI in this suite (mean age, 41.3 ± 12.0 years; intracranial tumors, 39 patients; cerebral vascular lesions, 5 patients; epilepsy surgery, 1 patient) were reported. The extent of resection depicted at intraoperative imaging, the surgical consequences of iMRI, and the clinical practicability of the suite were analyzed. Fourteen resections with a trans-sphenoidal/transoral approach and 31 craniotomies were performed. Eighty-two iMRI examinations were performed in the operating room, while during the same period of time, 430 diagnostic scans were finished in the diagnostic room. In 22 (48.9%) of 45 patients, iMRI revealed accessible residual tumors leading to further resection. No iMRI-related adverse event occurred. Complete lesion removal was achieved in 36 (80%) of all 45 cases. It is concluded that the dual-room 1.5-T iMRI suite can be successfully integrated into standard neurosurgical workflow. The layout of the dual-room suite can enable the maximum use of the system and save costs by sharing use of the 1.5-T magnet between neurosurgical and diagnostic use. Intraoperative MR imaging may provide valuable information that allows intraoperative modification of the surgical strategy.

[The cardiac function changes before and after pituitary tumor resection in patients with pituitary adenoma complicated with dilated cardiomyopathy].

OBJECTIVE: To evaluate the cardiac function changing before and after resection of pituitary tumor in patients with pituitary adenoma complicated with dilated cardiomyopathy with retrospective analysis method. METHODS: The clinical data of 14 cases of patients with pituitary adenoma complicated with dilated cardiomyopathy, treated with resection of pituitary tumor, in PLA General Hospital, from 2005 to 2011, were collected and analyzed. Comparative analysis of cardiac function were made in these patients before and after the surgery, also with the postoperative recovery status, using echocardiography and other noninvasive detection means to detect the growth hormone (GH), left ventricular end-diastolic diameter (LVEDD), septal thickness (ST), left ventricular posterior wall thickness (LVPWT), left ventricular ejection fraction (LVEF) values. RESULTS: After the resection of pituitary tumor, the LVEDD, ST, LVPWT, LVEF levels were all significantly better than that before the surgery. Before the surgery the GH, ST, LVPWT, LVEF levels were 93.89 µg/L, 11.13 mm, 43.92% and 10.53 mm, while those after the surgery were 5.16 µg/L, 10.64 mm, 49.28% and 8.87 mm. The difference of the GH level before and after the surgery was correlated with the difference of ST, LVEDD and LVEF in a linear manner. CONCLUSIONS: Resection of pituitary tumor can significantly improve the cardiac function in patients with pituitary adenoma complicated with dilated cardiomyopathy, and the cardiac function improving level is correlated with the difference of GH levels before and after the surgery.

[Influences of high-field intraoperative magnetic resonance imaging on the extent of resection in low-grade gliomas].

OBJECTIVE: To evaluate the influences of high-field intraoperative magnetic resonance imaging (iMRI) on the extent of resection (EoR) in low-grade gliomas. METHODS: Fifty-nine patients with low-grade gliomas underwent microsurgeries under the guidance of high-field iMRI and functional neuro-navigation. The rates of gross total removal and EoR were recorded after initial and final iMRI scans and neurological performances were evaluated peri-operatively and at follow-up. RESULTS: iMRI and functional neuronavigation were successfully performed in all patients. Initial iMRI found that the rates of gross total removal were misestimated in 21 cases (35.6%). In 17 cases (28.8%), initial iMRI revealed resectable residual tumors and further resection achieved gross total removal in 8 cases (13.6%). iMRI boosted the level of EoR from 90% ± 15% to 94% ± 12% (P < 0.001) in all cases and from 78% ± 17% to 91% ± 12% in 17 cases undergoing further tumor resections. At 3-month follow-up, 2 cases (3.4%) developed neurological deficits. CONCLUSION: The combination of iMRI and functional neuronavigation helped maximize safe tumor resection in low-grade gliomas.

[Implementation of VarioGuide in stereotactic brain biopsy: a preliminary experience].

OBJECTIVE: To evaluate the clinical value of VarioGuide in stereotactic brain biopsy. METHODS: Fifteen patients with brain lesions underwent frameless stereotactic brain biopsy guided by VarioGuide and multimodal neuronavigation. Intraoperative magnetic resonance imaging (iMRI) was used to confirm the accuracy of biopsy. And the VarioGuide-related adverse events, operative duration, surgical outcomes and postoperative complications were recorded respectively. RESULTS: In all patients, VarioGuide and multimodal neuronavigation were successfully integrated into the biopsy procedure. No VarioGuide-related adverse events were reported. The mean operative duration was (65 ± 8) min. The biopsy accuracy was confirmed by iMRI in all cases. And the postoperative histological diagnostic rate was 100%. No mortality and morbidity occurred postoperatively. CONCLUSION: The combined approach of VarioGuide and multimodal neuronavigation is accurate, safe and efficient. It may improve the histological diagnostic rate without postoperative neurological deficits in stereotactic brain biopsy.

[Microsurgery assisted by intraoperative magnetic resonance imaging and neuronavigation for small lesions in deep brain].

OBJECTIVE: To explore the practicability of resecting small lesions in deep brain by intraoperative magnetic resonance imaging (iMRI) and neuronavigator-assisted microsurgery and its clinical efficacies. METHODS: A total of 42 cases with small lesions in deep brain underwent intraoperative MRI and neuronavigator-assisted microsurgery. The drifting of neuronavigation was corrected by images acquired from intraoperative MR rescanning. RESULTS: All lesions were successfully identified and 40 cases totally removed without mortality. Only 3 cases developed new neurological deficits post-operatively while 2 of them returned to normal neurological functions after a follow-up duration of 3 months to 2 years. CONCLUSION: The application of intraoperative MRI can effectively correct the drifting of neuronavigation and enhance the accuracy of microsurgical neuronavigation for small lesions in deep brain.

Resection of Insular Glioma Through the Transfrontal Limiting Sulcus Approach.

BACKGROUND: The current transsylvian or transopercular approaches make access difficult because of the limited exposure of insular tumors. Hence, maximal and safe removal of insular gliomas is challenging. In this article, a new approach to resect insular gliomas is presented. OBJECTIVE: To determine whether the new transfrontal limiting sulcus approach is helpful for maximal and safe removal of insular gliomas. METHODS: The authors reported surgical techniques for insular gliomas resected through the transfrontal limiting sulcus approach. The authors evaluated the surgical resections of 69 insular gliomas performed through the new approach in their department. The extents of resection and postoperative neurological outcomes were analyzed to determine the value of this new approach. RESULTS: Based on the Berger-Sanai classification, most insular gliomas were giant tumors (59.42%), followed by zone I + IV tumors (24.64%). The median (interquartile range) extent of resection of all patients was 100% (91%, 100%). The total resection rate for all gliomas was (55 of 69, 79.7%), and the total resection rate for low-grade gliomas was (28 of 40, 70%), which was significantly lower than that for high-grade gliomas (27 of 29, 93.1%) (P = .019). All patients had muscle strength greater than grade 4 3 months after surgery. Only 1 patient had a speech disorder 3 months after surgery. The median Karnofsky Performance Status score at the time of the 3-month follow-up was 90. CONCLUSION: The transfrontal limiting sulcus approach can help to achieve maximal and safe removal of insular gliomas.

Long-term efficacy, prognostic factors, and safety of deep brain stimulation in patients with refractory Tourette syndrome: A single center, single target, retrospective study.

BACKGROUND: To evaluate the long-term efficacy, prognostic factors, and safety of posteroventral globus pallidus internus deep brain stimulation (DBS) in patients with refractory Tourette syndrome (RTS). METHODS: This retrospective study recruited 61 patients with RTS who underwent posteroventral globus pallidus internus (GPi) DBS from January 2010 to December 2020 at the Chinese People's Liberation Army General Hospital. The Yale Global Tic Severity Scale (YGTSS), Yale-Brown Obsessive-Compulsive Scale (YBOCS), Beck Depression Inventory (BDI), Gilles de la Tourette Syndrome Quality-of-Life Scale (GTS-QOL) were used to evaluate the preoperative and postoperative clinical condition in all patients. Prognostic factors and adverse events following surgery were analyzed. RESULTS: Patient follow up was conducted for an average of 73.33 ± 28.44 months. The final postoperative YGTSS (32.39 ± 22.34 vs 76.61 ± 17.07), YBOCS (11.26 ± 5.57 vs 18.31 ± 8.55), BDI (14.36 ± 8.16 vs 24.79 ± 11.03) and GTS-QOL (39.69 ± 18.29 vs 78.08 ± 14.52) scores at the end of the follow-up period were significantly lower than those before the surgery (p < 0.05). While age and the duration of follow-up were closely related to prognosis, the disease duration and gender were not. No serious adverse events were observed and only one patient exhibited symptomatic deterioration. CONCLUSIONS: Posteroventral-GPI DBS provides long-term effectiveness, acceptable safety and can improve the quality of life in RTS patients. Moreover, DBS is more successful among younger patients and with longer treatment duration.

Deep Learning model-based approach for preoperative prediction of Ki67 labeling index status in a noninvasive way using magnetic resonance images: A single-center study.

OBJECTIVES: Ki67 is an important biomarker of pituitary adenoma (PA) aggressiveness. In this study, PA invasion of surrounding structures is investigated and deep learning (DL) models are established for preoperative prediction of Ki67 labeling index (Ki67LI) status using conventional magnetic resonance (MR) images. METHODS: We reviewed 362 consecutive patients with PAs who underwent endoscopic transsphenoidal surgery, of which 246 patients with primary PA are selected for PA invasion analysis. MRI data from 234 of these PA patients are collected to develop DL models to predict Ki67LI status, and DL models were tested on 27 PA patients in the clinical setting. RESULTS: PA invasion is observed in 46.8% of cases in the Ki67 ≥ 3% group and 33.3% of cases in the Ki67 < 3% group. Three deep-learning models are developed using contrast-enhanced T1-weighted images (ceT1WI), T2-weighted images (T2WI), and multimodal images (ceT1WI+T2WI), respectively. On the validation dataset, the prediction accuracy of the ceT1WI model, T2WI model, and multimodal model were 87.4%, 89.4%, and 89.2%, respectively. In the clinical test, 27 MR slices with the largest tumors from 27 PA patients were tested using the ceT1WI model, T2WI model, and multimodal model, the average accuracy of Ki67LI status prediction was 63%, 77.8%, and 70.4%, respectively. CONCLUSION: Preoperative prediction of PA Ki67LI status in a noninvasive way was realized with the DL model by using MRI. T2WI model outperformed the ceT1WI model and multimodal model. This end-to-end model-based approach only requires a single slice of T2WI to predict Ki67LI status and provides a new tool to help clinicians make better PA treatment decisions.

In vitro and in vivo magnetic resonance tracking of Sinerem-labeled human umbilical mesenchymal stromal cell-derived Schwann cells.

Tracking of ultrasmall superparamagnetic iron oxide (USPIO) nanoparticles-labeled embryonic stem cells, neural stem cells, or adult mesenchymal stem cells in vitro and in vivo by using magnetic resonance (MR) imaging have been reported. However, whether the transdifferentiated cells can be effectively labeled by USPIO has not yet been investigated. The requirement for nerve donor material evokes additional morbidity and inability to generate a sufficiently large number of cells in a short time to hamper the clinic application of Schwann cells (SCs) transplantation. These limitations may be avoided if SCs can be generated from clinically accessible sources, such as bone marrow and umbilical cord. However, a reliable means of inducing the selective differentiation of human mesenchymal stromal cells isolated from the umbilical cord (HUMSCs) into SCs in vitro has not yet been established. In this study, we induce HUMSCs into Schwann-like cells in terms of morphology, phenotype, and function by an improved protocol basing on our previous studies. Furthermore, HUMSCs-derived SCs are labeled efficiently in vitro with ultrasmall superparamagnetic iron oxide contrast agent (USPIO) Sinerem and poly-L-lysine (PLL) without affecting morphology, cell cycle, proliferation, and differentiation ability of the labeled cells between the concentration of 200 to 800 µg/ml. Importantly, when grafted into the intact cerebral cortex and striatum, the survival and migration of these Sinerem-labeled cells were observed using MRI. Our study suggest the effective concentration field for Sinerem use in tracking transdifferentiated HUMSCs, and Sinerem labeling transdifferentiated HUMSCs is feasible, efficient, and safe for MRI tracing following grafting into nervous system.

Revascularization for complex cerebral aneurysms.

BACKGROUND AND PURPOSE: Complex cerebral aneurysms may require indirect treatment with revascularization. This manuscript describes various surgical revascularization techniques together with clinical outcomes. METHODS: Thirty-two consecutive patients with complex cerebral aneurysm were managed from November 2005 to October 2008. Techniques used for revascularization were high-flow bypass, low-flow bypass, branch artery reimplantion, and primary reanastomosis. Physiologic and anatomic monitoring technologies, including electroencephalography, somatosensory evoked potential monitoring, microvascular doppler ultrasonography, and/or indocyanine green videoangiography were used intraoperatively to assess both brain physiology and vascular anatomy. Patient outcome was determined using the Glasgow Outcome Scale at discharge and at a mean of 12 months post operation (range 6-25 months). RESULTS: Two cervical carotid aneurysms (6%) were resected followed by primary reanastomosis, 21 aneurysms (66%) were trapped following saphenous vein high-flow bypasses, five (16%) were clipped after superficial temporal or occipital artery low-flow bypasses, and four (12%) middle cerebral branch arteries were reimplanted. Of the 32 patients at discharge, 29 (91%) had a Glasgow Outcome Scale of four or five, two (6%) had severe disability, and one (3%) died. CONCLUSION: Cerebral revascularization remains an effective and reliable procedure for treatment of complex cerebral aneurysms. Low morbidity and mortality rates reflect the maturity of patient selection and surgical technique in the management of these lesions.