Indication for and Limitation of the Facial Dismasking Flap Approach for Skull Base Surgery to Achieve the Best Esthetical and Functional Results.

BACKGROUND: The facial dismasking flap (FDF) approach to operations on the deep skull base region consists of a coronal incision and a circumpalpebral incision. This approach provides a wide surgical field for extirpation of deep extended craniofacial tumors without leaving any undesirable scars on the face. Therefore, the FDF approach can provide satisfactory esthetical and functional results. Meanwhile, in some cases, especially in patients with a history of skull base surgery or orbital extension, patients are not fully satisfied even when the FDF approach is used. In this study, we evaluated the indication for and limitation of the FDF approach. METHODS: We reviewed 26 patients who underwent the FDF approach for skull base surgery. The patients were 16 men and 10 women, and average age was 37 years. Of these patients, 21 were treated using a hemi-FDF approach, and the remaining 5 were subjected to a bilateral FDF approach. Patients were divided into 2 groups in this study: group A (11 patients), patients with no history of skull base surgery and orbital extension; and group B (15 patients), patients with a history of skull base surgery and/or orbital extension. RESULTS: There was no FDF loss or facial palsy in either group A or group B. In group A, there was no lagophthalmos or scar contracture of the eyelid. In group B, there were 5 cases (33%) of ectropion and lagophthalmos and 7 of eyelid scar contracture (46%). As for esthetical evaluation, group B showed a significantly higher rate of facial asymmetry than group A. Moreover, in group A, the total ratings for above average reached 90.9%, whereas in group B, nearly half of the patients (48.9%) gave ratings of fair and poor. CONCLUSIONS: The FDF approach could be a good option for skull base surgery. In particular, patients without a history of skull base surgery and orbital extension could obtain satisfactory esthetical and functional outcomes. However, the procedure had limited effectiveness for patients with a history of skull base surgery or orbital extension because esthetical and functional outcomes inevitably became worse.

Lipid Nanotube Tailored Fabrication of Uniquely Shaped Polydopamine Nanofibers as Photothermal Converters.

Helically coiled and linear polydopamine (PDA) nanofibers were selectively fabricated with two different types of lipid nanotubes (LNTs) that acted as templates. The obtained coiled PDA-LNT hybrid showed morphological advantages such as higher light absorbance and photothermal conversion effect compared to a linear counterpart. Laser irradiation of the coiled PDA-LNT hybrid induced a morphological change and subsequent release of the encapsulated guest molecule. In cellular experiments, the coiled PDA-LNT efficiently eliminated HeLa cells because of its strong affinity with the tumor cells. This work illustrates the first approach to construct characteristic morphologies of PDA nanofibers using LNTs as simple templates, and the coiled PDA-LNT hybrid exhibits attractive photothermal features derived from its unique coiled shape.

Use of Intraoperative Fluorescent Indocyanine Green Angiography for Real-Time Vascular Evaluation of Pericranial Flaps.

BACKGROUND: Pericranial flaps (PCFs) have been widely used for skull base reconstruction. The key to successful skull base reconstruction using PCF depends on flap vascularity, but there have been no reports describing the real-time vascularity of PCF. In this study, we performed intraoperative fluorescent indocyanine green angiography to evaluate the real-time vascularity and viability of PCF and to estimate the reliability of this flap. METHODS: Eleven anteriorly based PCF (with a bilateral pedicle, ipsilateral pedicle, and random-pattern flap) and 11 laterally based PCF (with and without temporal muscle) were included in this study. The flap vascularity of each flap type considering the patients' background was evaluated using indocyanine green angiography intraoperatively. RESULTS: Anteriorly based PCF had significantly better vascularity compared to laterally based PCF. In anteriorly based PCF, there was no significant difference in vascularity between PCF with bilateral pedicles and an ipsilateral pedicle. In laterally based PCF, PCF without temporal muscle showed a wider vascular area compared to PCF with temporal muscle. As for the patient background, those older than 45 years, body mass index more than 25, and who were smokers tended to have lower vascularity. Preoperative radiation therapy did not show any significant differences in terms of flap vascularity. CONCLUSIONS: Anteriorly based PCF had significantly better vascularity compared to laterally based PCF and seemed safer to harvest regardless of flap pedicle type. Also, the feasibility of harvesting muscle sparing laterally based PCF was indicated. Finally, being older than 45 years, a body mass index more than 25, or being a smoker might increase the risk of reducing flap vascularity.

Feasibility and Advantage of a Muscle-Sparing Laterally Based Pericranial Flap.

BACKGROUND: For a safe and reliable middle skull base reconstruction, the temporalis muscle flaps or pericranial-temporalis muscle flaps have usually been used as the first-choice in clinical practice. But these flaps have an inevitable disadvantage, namely, temporal hollowing. To address this problem, in this study, the authors describe the feasibility and advantages of using a muscle-sparing laterally based pericranial flap. METHOD: The authors reviewed 19 patients who had undergone middle skull base reconstruction using laterally based pericranial flaps. There were two types of these flaps. One was the conventional type: a laterally based pericranial flap combined with the temporoparietal fascia and temporal muscle, that is a conventional laterally based pericranial flap (C-PCF). The other was the muscle-sparing type: a laterally based pericranial flap combined with the temporoparietal fascia, but sparing and preserving the temporal muscle (MS-PCF). The first 9 patients were reconstructed with a C-PCF and the latter 10 patients were reconstructed with an MS-PCF. RESULTS: There was no significant difference between C-PCF and MS-PCF as regards reconstructive time and postoperative hospital stay. In addition, there was no significant difference between C-PCF and MS-PCF in regard to perioperative complications. The rate of temporal hollowing did not reach a significant difference; MS-PCF patients tended to have less temporal hollowing (10%) compared with C-PCF patients (55.6%). DISCUSSION: An MS-PCF could provide safe and reliable skull base reconstruction without lengthening reconstructive time or increasing complications. Moreover, an MS-PCF improves the esthetical results of surgery on skull base patients and provides an extra option for other reconstructive procedures by preserving the temporal muscle.

Simulation of metal-organic framework self-assembly.

Spontaneous growth of metal-organic frameworks (MOFs) composed of metal ions and 4,4'-bipyridine ligands was successfully demonstrated by molecular dynamics simulations, starting from a random initial placement of the metals and the ligands. The effect of the metal-ligand binding strength upon the MOF self-assembly was investigated. We found that the metal-ligand binding strength should be within a window around the optimum values for the regular MOF growth.

Retraction: Enhancement of the photocatalytic activity of rhenium(I) complexes by encapsulation in light-harvesting soft nanotubes.

Retraction of 'Enhancement of the photocatalytic activity of rhenium(I) complexes by encapsulation in light-harvesting soft nanotubes' by Naohiro Kameta et al., Chem. Commun., 2017, 53, 10116-10119, https://doi.org/10.1039/C7CC05337A.

Two Acute Stroke Patients Whose Lower Back and Lower Limb Pain Hampered Their Rehabilitation: The Effectiveness of Peripheral Nerve Blocks.

Lower back and lower limb pain can hamper the rehabilitation of cerebral stroke patients. We report that peripheral nerve blocks enabled two patients to continue rehabilitation. Case 1 was an 83-year-old female with left hemiparesis due to cerebral infarction of the right basal ganglia. Rehabilitation started on the day after the stroke onset. On the 7th post-stroke day, she reported right buttock and dorsal thigh pain. Lumbar MRI demonstrated no lumbar spinal canal stenosis and no nerve impingement. The middle cluneal nerve block alleviated her buttock pain. On the 29th post-stroke day, she suffered severe pain on the medial side of the right knee. Blocking the infrapatellar branch of the saphenous nerve lessened that pain, she was able to walk without assistance, and rehabilitation was resumed. Case 2 was an 87-year-old female with sudden-onset left hemiparesis due to cardiogenic cerebral infarction. Intravenous thrombolysis and mechanical thrombectomy were performed. She presented with left hemiparesis due to infarcts at the right basal ganglia and the right temporal and parietal lobes. Her chronic low back pain worsened after admission and walking was difficult. Bilateral superior and middle cluneal nerve blocks improved her right lower back pain. Left low back pain was alleviated by sacroiliac joint blockage and rehabilitation was possible due to the absence of back pain. The strain on the lower back and lower limbs attributable to paresis due to stroke may lead to entrapment neuropathy. Peripheral nerve blockage is relatively simple and safe and may be useful in acute stroke patients whose rehabilitation is difficult due to pain.

Surface-enhanced optical-mid-infrared photothermal microscopy using shortened colloidal silver nanowires: a noble approach for mid-infrared surface sensing.

We propose surface-enhanced optical-mid-infrared photothermal (MIP) microscopy using highly crystalline silver nanowires, acting as a Fabry-Perot resonator, and demonstrate its applicability to enhanced mid-infrared surface sensing of thin polymer layers as thin as 20 nm.

Chronic encapsulated expanding hematoma in nonfunctioning pituitary adenoma.

The diagnosis and treatment of pituitary macroadenomas with entire hematoma fluid accumulation are problematic. Such lesions are often difficult to completely resect, and recurrence is not uncommon. We present five cases of pituitary macroadenomas entirely composed of hematoma fluid and investigated their histopathology to clarify the mechanism of the hematoma fluid accumulation. Five patients with pituitary adenoma and significant intra-tumor hematoma underwent transsphenoidal resection and were retrospectively reviewed for their clinical status, findings on magnetic resonance imaging (MRI), intraoperative findings, and histopathology. The specific surgical techniques used to address these cases were also reviewed. All patients were diagnosed with nonfunctioning pituitary adenomas by histopathological examination. MRI showed all tumors extended to the cavernous sinus. Histopathology showed tumor tissues were located between the thick granulation tissue and the pseudocapsule of the tumor. The thick granulation tissues were composed of collagenous layers, neovascular vessels, and necrotic red blood cells, indicating repeat hemorrhage from the granulation tissues. The boundary between adenoma and normal pituitary gland was identified during surgical removal in four patients and was not identified in the other patient who showed a recurrence 2 years later. Clinical and histopathological findings indicate hematoma fluid accumulation in the present cases is caused by repeat hemorrhage from the reactive granulation tissues and can be regarded as a chronic encapsulated expanding hematoma. In these cases, the boundary between adenoma and normal pituitary gland should be identified before puncturing the hematoma fluid to minimize the risk of tumor recurrence.

Combined extradural subtemporal and anterior transpetrosal approach to tumors located in the interpeduncular fossa and the upper clivus.

BACKGROUND: Central skull base lesions in the interpeduncular fossa and the upper clival regions can be challenging to access because of their location anterior to the brainstem. We have modified the anterior transpetrosal approach by combination with the extradural subtemporal route to increase the surgical corridor. METHODS: Thirty-seven patients underwent surgical treatment via the anterior transpetrosal approach from 2002 to 2012. The combined surgical approach was primarily applied when the tumors arose from the upper clival portion and extended to the interpeduncular fossa. The combined approach was used in seven of these patients, comprising four patients with petroclival meningiomas, one patient with sphenoclival meningiomas, one patient with trigeminal schwannoma, and one patient with an epidermoid cyst extending from the interpeduncular fossa to the prepontine cistern. RESULTS: The combined approach permitted excellent visualization of the interpeduncular fossa in addition to the upper clivus and the lateral aspect of the brain stem. Mobilization of the temporal lobe by the entire epidural dissection of the lateral wall of the cavernous sinus facilitates access via the subtemporal route. The transient symptom of the temporal lobe in the dominant site may be the only drawback for this combined approach, although it may disappear immediately after the surgery. CONCLUSION: The present approach combines Dolenc's approach and Kawase's approach, providing a wide exposure to lesions of the interpeduncular fossa and the clivus.

Influence of Bilateral Cerebellar Infarction on Functional Outcome After Endovascular Treatment for Basilar Artery Occlusion.

BACKGROUND AND PURPOSE: To measure the magnitude of the effect of the infarct location measured using the posterior circulation Alberta Stroke Program Early Computed Tomographic Score (pc-ASPECTS) on the functional outcome at 90 days in patients with basilar artery (BA) occlusion undergoing endovascular therapy (EVT). METHODS: Of the acute ischemic stroke patients undergoing EVT for acute posterior circulation large vessel occlusion enrolled in the multicenter observational registry from December 2013 to February 2021, patients with BA occlusion were included. A favorable outcome was defined as achieving a modified Rankin Scale score of 0-3 at 90 days. The effect of pc-ASPECTS including the distribution on favorable outcomes was evaluated. RESULTS: One hundred patients were analyzed. Fifty-one patients (51%) achieved favorable outcome. Patients achieving a favorable outcome were younger, had a lower National Institutes of Health Stroke Scale score before EVT, and had a higher pc-ASPECTS before EVT than those not achieving a favorable outcome. Multivariable logistic analysis showed a significant association between higher pc-ASPECTS and a favorable outcome (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.02-1.52; P = 0.028). Considering the infarct location, bilateral cerebellar infarction was significantly associated with a lower frequency of favorable outcomes than those without cerebellar infarction (OR 0.16; 95% CI 0.04-0.51; P = 0.002). CONCLUSIONS: A higher pc-ASPECTS before EVT could be a predictor of a favorable outcome after EVT for BA occlusion. In particular, the presence of bilateral cerebellar infarction before EVT was significantly associated with a lower likelihood of a favorable outcome.

Phase I study of a novel glioblastoma radiation therapy schedule exploiting cell-state plasticity.

BACKGROUND: Glioblastomas comprise heterogeneous cell populations with dynamic, bidirectional plasticity between treatment-resistant stem-like and treatment-sensitive differentiated states, with treatment influencing this process. However, current treatment protocols do not account for this plasticity. Previously, we generated a mathematical model based on preclinical experiments to describe this process and optimize a radiation therapy fractionation schedule that substantially increased survival relative to standard fractionation in a murine glioblastoma model. METHODS: We developed statistical models to predict the survival benefit of interventions to glioblastoma patients based on the corresponding survival benefit in the mouse model used in our preclinical study. We applied our mathematical model of glioblastoma radiation response to optimize a radiation therapy fractionation schedule for patients undergoing re-irradiation for glioblastoma and developed a first-in-human trial (NCT03557372) to assess the feasibility and safety of administering our schedule. RESULTS: Our statistical modeling predicted that the hazard ratio when comparing our novel radiation schedule with a standard schedule would be 0.74. Our mathematical modeling suggested that a practical, near-optimal schedule for re-irradiation of recurrent glioblastoma patients was 3.96 Gy × 7 (1 fraction/day) followed by 1.0 Gy × 9 (3 fractions/day). Our optimized schedule was successfully administered to 14/14 (100%) patients. CONCLUSIONS: A novel radiation therapy schedule based on mathematical modeling of cell-state plasticity is feasible and safe to administer to glioblastoma patients.

NMDA receptor-mediated Ca(2+) influx triggers nucleocytoplasmic translocation of diacylglycerol kinase ζ under oxygen-glucose deprivation conditions, an in vitro model of ischemia, in rat hippocampal slices.

Diacylglycerol kinase (DGK) plays a key role in pathophysiological cellular responses by regulating the levels of a lipid messenger diacylglycerol. Of DGK isozymes, DGKζ localizes to the nucleus in various cells such as neurons. We previously reported that DGKζ translocates from the nucleus to the cytoplasm in hippocampal CA1 pyramidal neurons after 20 min of transient forebrain ischemia. In this study, we examined the underlying mechanism of DGKζ translocation using hippocampal slices exposed to oxygen-glucose deprivation (OGD) to simulate an ischemic model of the brain. DGKζ-immunoreactivity gradually changed from the nucleus to the cytoplasm in CA1 pyramidal neurons after 20 min of OGD and was never detected in the nucleus after reoxygenation. Intriguingly, DGKζ was detected in the nucleus at 10 min OGD whereas the following 60 min reoxygenation induced complete cytoplasmic translocation of DGKζ. Morphometric analysis revealed that DGKζ cytoplasmic translocation correlated with nuclear shrinkage indicative of an early process of neuronal degeneration. The translocation under OGD conditions was blocked by NMDA receptor (NMDAR) inhibitor, and was induced by activation of NMDAR. Chelation of the extracellular Ca(2+) blocked the translocation under OGD conditions. These results show that DGKζ cytoplasmic translocation is triggered by activation of NMDAR with subsequent extracellular Ca(2+) influx. Furthermore, inhibition of PKC activity under OGD conditions led to nuclear retention of DGKζ in about one-third of the neurons, suggesting that PKC activity partially regulates DGKζ cytoplasmic translocation. These findings provide clues to guide further investigation of glutamate excitotoxicity mechanisms in hippocampal neurons.

[Efficacy of early combined high-dose steroid + PGE1 treatment for sudden deafness].

The efficacy of combined high-dose steroid and PGE1 treatment initiated immediately after the onset of sudden deafness was analyzed with the outcome of 174 patients begun on treatment within 7 days of the onset of sudden deafness. Four potential prognostic factors (days from onset to treatment, age, initial hearing level, presence of vertigo) and hearing outcome were examined with a multiple logistic regression analysis. Days from onset to treatment and age significantly correlated with hearing improvement. The efficacy of the treatment of patients begun on treatment within 3 days of the onset was significantly better than that of patients on treatment 4-7 days after the onset (p < 0.001). In the examination of patients younger than 50 years, the efficacy of the treatment of patients begun on treatment within 3 days of the onset didn't differ significantly from that of patients on treatment 4-7 days after the onset. On the other hand, in the examination of patients aged 50 years and older, the efficacy of the treatment of patients begun on treatment within 3 days of the onset was significantly better than that of patients on treatment 4-7 days after the onset (p < 0.001). These results suggest that significant efficacy may be expected from the combined high-dose steroid + PGE1 treatment, if its use is started within 7 days of the onset of sudden deafness, and started within 3 days of the onset of sudden deafness in patients 50 years old and older.

Nanodiamond (ND)-based polyamide (PA) 66 nanocomposite studied with infrared (IR) microscopy and time-domain nuclear magnetic resonance (TD-NMR) combined with two-trace two-dimensional (2T2D) correlation analysis.

Nanodiamond/polyamide (ND/PA) nanocomposite was examined with infrared (IR) microscopy and time-domain nuclear magnetic resonance (TD-NMR) to elucidate in detail the interphase between amino functionalized ND (ND-NH2) and PA 66. An IR image of the ND/PA nanocomposite suggested the uniform nanoscale distribution of the ND-NH2 particles thanks to the spherical shape and accessible external surface of ND terminated with reactive amino groups. On the other hand, a substantial level of change was observed in T2 decay curves when the ND-NH2 particles were incorporated in the PA 66. The fine features of the thermally induced changes in the decay curves were readily analyzed with the two-trace two-dimensional (2T2D) correlation method. The variation in the asynchronous correlation intensity indicated that the changes observed in the mechanical properties of the ND/NH2 may be attributed to the development of crosslinking between tie chains in the amorphous region via the interaction between the ND-NH2 and PA 66. Accordingly, such firm links have a substantial effect in preventing the displacement of the amorphous domain, which eventually increases the Young's modulus but reduces the ductility of the PA.

Effect of Oligomer Segregation on the Aggregation State and Strength at the Polystyrene/Substrate Interface.

The interfacial strength of polystyrene (PS) with and without PS oligomers in contact with a glass substrate was examined to determine the relationship between the interfacial aggregation state and adhesion. The shear bond strength and adsorbed layer thickness of neat PS exhibited a similar dependence on the thermal annealing time: they increased to constant values within almost the same time. This implies that the adhesion of the polymer is closely related to the formation of an adsorbed layer at the adhesion interface. Nevertheless, in the case of PS with a small amount of oligomer, the shear bond strength decreased, while the adsorbed layer thickness was almost the same as that of neat PS. Based on the results of interfacial analyses, we propose that the interfacial segregation of the oligomer reduced the entanglement between the interfacial free chains in the adsorbed layer and the bulk chains.

Microsurgical Resection of a Large Dumbbell-Shaped Jugular Foramen Schwannoma via Infralabyrinthine, Retrofacial, and Transjugular Approach.

Surgical removal of large jugular foramen schwannomas with intra- and extracranial extension is challenging. The treatment goal is a gross total resection of the tumor without causing surgical complications, including facial nerve paresis, hearing disturbance, dysphagia, hoarseness, and cerebrospinal fluid (CSF) leakage, in addition to the brain stem injury. We present a surgical video in a patient with a dumbbell-shaped glossopharyngeal schwannoma. The combination of posterior fossa craniotomy, mastoidectomy, and unroofing of the jugular foramen with high cervical exposure was selected. Although transposition of the mastoid segment of the facial nerve provides an excellent surgical corridor, it may affect normal facial nerve function. Sufficient drilling of the infralabyrinthine, retrofacial area of the mastoid without facial nerve transposition is important for the safe gross total removal of the tumor. Subcapsular removal behind the jugular vein is also important for preservation of the lower cranial nerve functions. The patient underwent a gross total removal of the tumor ( Figs. 1 and 2 ). Facial nerve function was preserved and hearing disturbance improved. Although dysphagia and hoarseness complicated postoperatively, he became able to take foods orally 16 days after the surgery. In summary, successful removal of a large dumbbell-shaped jugular foramen tumor can be completed via infralabyrinthine, retrofacial, and transjugular approach without facial nerve transposition. The link to the video can be found at: https://youtu.be/U4CwOW78id4 .

[Case of ruptured multiple cerebral aneurysms associated with primary aldosteronism].

Primary aldosteronism (PA) has been recognized as a relatively benign form of hypertension associated with a low incidence of vascular complications. Recent reports, however, indicate that cerebrovascular accidents are common in PA. We report a case of multiple aneurysms with PA in a middle-aged woman who presented with subarachnoid hemorrhage. A 47-year-old woman with a history of untreated hypertension was referred to our hospital for subarachnoid hemorrhage. Cerebral angiography showed multiple small aneurysms. The initial intervention was aneurysm clipping for a ruptured aneurysm at the bifurcation of the right middle cerebral artery. Despite medication, she continued to suffer from uncontrolled hypertension and hypokalemia. She was diagnosed with PA on the basis of elevated plasma aldosterone, suppressed plasma rennin, and a right adrenal tumor detected by abdominal CT scanning. She underwent several more neck clippings for the remaining aneurysms (unruptured), followed by a total right adrenectomy. Histological examination revealed an adrenal adenoma. After the operation, her blood pressure returned to normal without any vasodepressors. Recent studies have demonstrated that hyperaldosteronism might have direct vasculo-toxic actions, including remodeling, fibrosis, and proliferation. Cerebrovascular accidents caused by PA are reported to have high rates of mortality and recurrence when the PA is overlooked or untreated. Physicians must be alert to the possibility of PA in patients with hypertension and persistent hypokalemia, especially in those who are young or middle-aged. We also recommend screening for intracranial aneurysms by low-invasive magnetic resonance angiography.

Brain Abscess as a Rare Complication of Primary Extranodal Nasal-type Natural Killer/T-cell Lymphoma.

We present the case of a 58-year-old Japanese woman with a natural killer T (NK/T)-cell lymphoma complicated by brain abscess. NK/T-cell lymphomas represent a rare type of lymphoma derived from either activated NK cells or, rarely, cytotoxic T cells. They are aggressive Epstein-Barr virus (EBV)-associated lymphomas that involve mainly the nasal cavity. Brain abscess associated with primary extranodal nasal-type NK/T-cell lymphoma is extremely uncommon: to our knowledge, this is the first reported case of this lymphoma with brain abscess as the initial clinical manifestation. Endoscopic surgery was performed for definitive diagnosis under intraoperative navigation system. Chemotherapy followed by radiotherapy was performed and was effective: 72 months later the tumor has not recurred. Recommendations of endoscopic management for diagnosis and treatment of this rare neoplasm are discussed.

Measuring the length distribution of self-assembled lipid nanotubes by orientation control with a high-frequency alternating current electric field in aqueous solutions.

The present work addresses the length distribution of self-assembled lipid nanotubes (LNTs) by controlling the orientation of the LNTs using an alternating current (ac) electric field in aqueous solutions. The effect of the ac field on the orientation and rotation of individual LNTs was examined to evaluate the optimum orientation frequency by visualizing the individual LNTs in real time. By using the high-frequency ac field, we have successfully measured the length distribution for two different types of LNTs and have quantitatively analyzed the maximum occurrences of the length distribution as well as the extension of the longer length region.