How I do it: direct pressure measurement in moyamoya bypass.

BACKGROUND: The direct quantitative measurement of donor and recipient pressures in patients with moyamoya vasculopathy (MMV) during superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery has yet to be reported in academic literature. METHOD: Using a wireless pressure wire, we describe our approach to measuring seven pressure parameters in MMV patients step-by-step. CONCLUSION: Direct intraluminal pressure measurement of donor and recipient arteries provides a practical and accurate means to quantify cerebral hemodynamic parameters in MMV patients, enhancing understanding of individualized hemodynamic changes pre- and post-surgery.

Brain perfusion, cognition, and plasma Alzheimer's biomarkers in moyamoya disease.

INTRODUCTION: Because growing interest has been focusing on cerebral blood flow (CBF) to predict, prevent, and treat Alzheimer's disease (AD), it is important to clarify the role of CBF in AD pathology and cognitive decline. METHODS: In a moyamoya disease (MMD) cohort, we examined CBF, specific cognitive domains, and plasma AD biomarkers, as well as correlations among these variables. RESULTS: CBF was significantly reduced in newly diagnosed MMD patients, while plasma phosphorylated tau181 was elevated and positively correlated with hypoperfusion accumulation. MMD patients scored significantly lower than controls in multiple cognitive tests. Revascularization increased CBF to the recipient brain territories as well as cognitive performance but produced no significant change in AD biomarker levels. DISCUSSION: These data suggest a link between accumulated reductions in CBF and cognitive decline, as well as a possible role of AD-like pathological burden. Further studies in MMD will provide opportunities to explore new treatment strategies.

How I do it: superficial temporal artery to middle cerebral artery bypass for moyamoya disease.

BACKGROUND: Moyamoya disease (MMD) is a chronic progressive disease leading to recurrent stroke due to occlusion of the terminal internal carotid arteries. Surgical revascularization for symptomatic MMD is an effective treatment for preventing further stroke. However, direct revascularization of advanced MMD remains challenging due to small caliber of the recipient vessel and perforators. METHODS: We introduce our technique of superficial temporal artery (STA) to middle cerebral artery (MCA) bypass with figures and video to illustrate the procedure. CONCLUSION: Surgical nuances of STA to MCA anastomosis will help cerebrovascular neurosurgeons to master low-flow bypass for MMD.

The Smart Class Teaching Module for Rehabilitation Medicine English Education in China.

BACKGROUND Learning medical English is particularly challenging for non-native English-speaking medical students. The Smart Class teaching module is a new online teaching module for rehabilitation-related medical English, the efficacy of which has yet to be established in the literature. Gender differences should also not be ignored in our study, taking into account the proven performance differences between males and females in language learning. MATERIAL AND METHODS First-year physiotherapy students in Grade 2018 and Grade 2019 at Guangzhou Medical University were recruited to participate in this study. Grade 2019, as the experimental group, completed the Smart Class teaching module, while Grade 2018, as the control group, completed the Traditional Class teaching module. The efficacy of both modules was assessed objectively using the students' medical English exam scores and subjectively using the students' responses to a questionnaire. RESULTS In total, 242 questionnaires were distributed, and 210 valid questionnaires were returned, of which 119 were from the Smart Class teaching module group and 91 were from the Traditional Class teaching module group. There was no statistically significant difference between the medical English exam scores of the 2 groups (P=0.324). However, the subjective assessment revealed that the students experienced a significantly greater burden from the workload in the Smart Class teaching module group (P<0.001). CONCLUSIONS We found both the Smart Class teaching module and the Traditional Class teaching module achieved similar teaching outcomes. Therefore, the former represents a viable alternative teaching option for situations where traditional class teaching is not possible.

A Study of Blended Learning Using the Smart Class Teaching Module on Psychosocial Dysfunction Course During the Training of Undergraduate Occupational Therapy Students in China.

BACKGROUND Online blended learning, also known as "smart classes", has benefits when compared with traditional teaching methods that use books and lectures. This study aimed to compare the use of the Smart Class teaching module with traditional teaching on the topic of psychosocial dysfunction during the training of undergraduate occupational therapy (OT) students in China. MATERIAL AND METHODS We recruited Grade 2017 OT students as the Smart Class teaching module group and Grade 2016 OT students as the Traditional Class teaching module group to participate in the study. The objective evaluation (assignment score, practical exam score, written exam score, and final score) and subjective evaluation (data from student questionnaires and information from interviews with the lead teacher and assistant teachers) were performed in both groups. RESULTS No significant difference was found in the final scores (P=0.874) and students' questionnaire results between the 2 groups. However, data from the student questionnaires and teacher interviews indicated a preference for combining the Smart Class teaching module and the Traditional Class teaching module. CONCLUSIONS The advantage of the Smart Class teaching module is that it can effectively integrate excellent teaching resources across geographical restrictions and it is conducive to promoting independent learning for students and all-around supervision for teaching. The Smart Class teaching module was comparable to traditional teaching methods for the training of undergraduate OT students in China, but was preferred by the students.

Hypoxia-induced lncRNA ANRIL promotes cisplatin resistance in retinoblastoma cells through regulating ABCG2 expression.

Cisplatin (DDP) resistance limits its efficacy for retinoblastoma (Rb). Hypoxia-inducible factor-1α (HIF-1α) has been shown to contribute to chemotherapy resistance in tumours under hypoxic conditions. This study was designed to explore the role and mechanism of long non-coding RNA (lncRNA) antisense non-coding RNA in the INK4 locus (ANRIL) in regulating DDP resistance in Rb cells under hypoxia and to validate whether HIF-1α was involved in this process. The interaction between HIF-1α and the promoter of ANRIL was analyzed using ChIP assay. Cell proliferation and apoptosis, as well as protein levels of drug resistance-related proteins (ABCG2 and MDR1) were examined to evaluate DDP resistance in Rb cells. The interactions between miR-328 and ANRIL as well as miR-328 and ABCG2 were analyzed using dual-luciferase reporter assays. Upon hypoxia, HIF-1α directly bound to the ANRIL promoter region to transcriptionally activate ANRIL. The hypoxia-induced ANRIL promoted Rb cell resistance to DDP, as evidenced by facilitation of cell proliferation, inhibition of cell apoptosis and upregulation of ABCG2 and MDR1. Mechanistically, ANRIL promoted Rb cell resistance to DDP by acting as a sponge of miR-328 to upregulate expression of ABCG2, which was confirmed as a direct target of miR-328. Collectively, hypoxia-induced ANRIL promotes DDP resistance in Rb cells by sponging miR-328 to upregulate ABCG2 expression.

PRC1 gene silencing inhibits proliferation, invasion, and angiogenesis of retinoblastoma cells through the inhibition of the Wnt/ß-catenin signaling pathway.

Retinoblastoma is an ocular malignancy occurring in childhood. The current study evaluates the ability of silenced PRC1 on retinoblastoma cell proliferation, and angiogenesis via the Wnt/ß-catenin signaling pathway. A total of 36 cases of retinoblastoma tissues (n = 36) and normal retinal tissues (n = 10) were selected in the current study. Retinoblastoma cells presenting with the high PRC1 messenger RNA (mRNA) expression were selected among the WERI-Rb-1, HXO-RB44, Y79, SO-Rb50, and SO-Rb70 cells lines, and were transfected with siRNA-PRC1 and LiCl (the activator of the Wnt/ß-catenin pathway). The expressions of PRC1, VEGF, Wnt1, ß-catenin, CyclinD1, extent of ß-catenin, and GSK-3ß phosphorylation were evaluated. Cell proliferation, cell-cycle distribution, and cell invasion of retinoblastoma cells were evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, flow cytometry, and Transwell assay. The angiogenesis of retinoblastoma cells was detected by tube formation assay. HXO-RB44 and WERI-Rb-1 cells were selected owing to the highest PRC1 mRNA expression. Meanwhile, PRC2 gene silencing presented lower expression levels of PRC1, VEGF, Wnt1, ß-catenin, CyclinD1, extent of ß-catenin and GSK-3ß phosphorylation, decreased proliferation and invasion abilities, extended G0/G1 phase, and shortened S and G2/M phases of HXO-RB44 and WERI-Rb-1 cells, suggesting the silenced PRC2 inactivated Wnt/ß-catenin pathway, so as to further restrain the retinoblastoma cell proliferation, invasion, and angiogenesis. These results support the view that PRC1 gene silencing could suppress the proliferation, and angiogenesis of retinoblastoma cells by repressing the Wnt/ß-catenin pathway.

Association of CD40 SNPs with Moyamoya in a Chinese children population.

Background: The etiology of Moyamoya disease (MMD) remains unknown to a large extent. Immune and inflammation dysfunction may play a role in the pathogenesis of this rare disease. Coexisting Kawasaki disease (KD) with MMD were reported and both diseases have a feature of vasculopathy, raising the hypothesis that there may be some common pathologic factors. We investigated single nucleotide polymorphisms (SNPs) previously identified in KD and performed a genetic analysis among Chinese pediatric patients with MMD. Results: We analyzed patients' DNA for the SNPs in B lymphoid tyrosine kinase, CD40, and coatomer protein complex beta-2 subunit, which had been associated with KD by literatures. Genotyping was performed by sequencing the genetic regions containing the SNPs with customized primers. A total of 5 genotype polymorphisms were examined among 48 pediatric MMD cases and 50 healthy controls. The mean age of MMD children was 6.72 ± 3.63 years old, while 7.31 ± 3.79 in controls. We found two SNPs of CD40 were associated with MMD. Polymorphisms rs4813003 major allele CC and rs1535045 minor allele TT were significantly higher in MMD cases. The other SNPs showed no statistical difference between MMD cases and controls. Conclusions: Our findings provide evidence that there may be a relationship between MMD and auto-immune dysfunction. We hypothesize that these genetic features may lead to the pathogenesis within the vascular wall. Further study regarding whether CD40 can function as the personalized target of MMD should be investigated in future.

Preoperative evaluation of moyamoya spontaneous anastomosis of combined revascularization donor vessels in adults by duplex ultrasonography.

OBJECTIVE: To evaluate the preoperative diagnostic value of duplex ultrasonography in moyamoya spontaneous anastomosis of combined revascularization donor vessels in adults. METHODS: A total of 99 preoperative adult patients who underwent superficial temporal artery-to-middle cerebral artery (STA-MCA) anastomosis were retrospectively analyzed. Each side of the cerebral hemisphere was examined as a separate procedure. A total of 198 cerebral hemispheres were divided into three groups: a collateral, non-collateral, and control group based on digital subtraction angiography (DSA). Hemodynamic parameters, including peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) were analyzed. RESULTS: There were only four of cases (5%, 4/198) of STA spontaneous anastomosis, whereas those of maxillary artery (MA) anastomosis were 44 (23.7%, 44/186). Compared with the control group, MA PSV and EDV of the collateral group increased significantly, while RI decreased significantly (p < .05). The area under the curve (AUC) of MA RI was 0.654. As a predictor of MA spontaneous anastomosis, duplex ultrasonography had high specificity but poor sensitivity. In collateral group, PSV and EDV detected two weeks post-surgery were significantly higher than those detected pre-operatively (PSV: p = .018, EDV: p = .025). By contrast, there were no significant difference of the PSV and EDV detected six months post-surgery compared with pre-operation (PSV: p = .450, EDV: p = .099). Additionally, MA RI in two weeks after the surgery was comparable with preoperative values. CONCLUSIONS: Duplex ultrasonography could be applied to evaluate the adult moyamoya spontaneous anastomoses of MA preoperatively. Despite its poor sensitivity, this diagnostic modality is still reliable and specific. STA-MCA anastomosis combined with EDMS did not affect MA pre-operative spontaneous anastomosis.

Hemodynamic study with duplex ultrasonography on combined (direct/indirect) revascularization in adult moyamoya disease.

BACKGROUND: To evaluate the hemodynamic changes by duplex ultrasonography in adult moyamoya disease (MMD) patients who underwent combined direct and indirect revascularization surgery. METHODS: Seventeen adult patients underwent direct and indirect revascularization surgery in our hospital. Hemodynamic parameters, peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistance index (RI), were determined by color Doppler at the baseline, 2 weeks, and 6 months after bypass. RESULTS: Both the PSV and EDV of direct bypass were lower at 6 months after surgery compared with those at 2 weeks postoperatively. The EDV of indirect revascularization surgery of the maxillary artery (MA) at 6 months after surgery was higher and the RI of the MA lower compared with the baseline levels. Decreased PSV and EDV in the bypass vessel did not significantly correlate with increased EDV or decreased RI of the MA. CONCLUSIONS: Duplex ultrasonography is a reliable, noninvasive tool to assess hemodynamic changes and evaluate the therapeutic performance of combined bypass surgery in adult MMD.

Assessing donor-recipient arterial pressure dynamics in STA-MCA bypass for moyamoya disease.

BACKGROUND: In bypass surgery for moyamoya disease (MMD), the superficial temporal artery's (STA) pressure needs to surpass that of the cortical M4 recipient of the middle cerebral artery (MCA), boosting cerebral blood flow into the MCA and enhancing cerebral circulation. This study investigates the STA-MCA arterial pressure parameters and gradients during bypass surgery, aiming to deepen our understanding of hemodynamic shifts pre- and post-operation. METHODS: DSA imaging data were prospectively collected from patients diagnosed with bilateral MMD who underwent STA-MCA bypass surgery between 2022 and 2023 and stratified according to the Suzuki stage. The mean arterial pressure (MAP) of the donor and recipient arteries was directly measured during the STA-MCA bypass procedure, and these data were statistically analyzed and evaluated. RESULTS: Among 48 MMD patients, Suzuki grading revealed that 43.8% were in early stages (II and III), while 56.2% were in advanced stages (IV, V, and VI). Predominantly, 77.1% presented with ischemic-type MMD and 22.9% with hemorrhagic type. Pre-bypass assessments showed that 62.5% exhibited antegrade blood flow direction, and 37.5% had retrograde. The mean recipient artery pressure was 35.0 ± 2.3 mmHg, with a mean donor-recipient pressure gradient (δP) of 46.4 ± 2.5 mmHg between donor and recipient arteries. Post-bypass, mean recipient artery pressure increased to 73.3 ± 1.6 mmHg. No significant correlation (r = 0.18, P = 0.21) was noted between δP and Suzuki staging. CONCLUSION: Our study elucidated that cerebral blood pressure significantly decreases beyond the moyamoya network at the distal M4 segment. Furthermore, we observed bidirectional flow in MCA territories and a significant positive pressure gradient between the STA and M4 segments. The lack of correlation between Suzuki stages and M4 pressures indicates that angiographic severity may not reflect hemodynamic conditions before surgery, highlighting the need for customized surgical approaches.

Preliminary experience of 256-row multidetector computed tomographic angiography for detecting cerebral aneurysms.

OBJECT: Multidetector computed tomographic angiography (MDCTA) has played an increasing role in detecting cerebral aneurysms. This study was performed to investigate the diagnostic accuracy of the upgraded 256-row MDCTA in the detection of cerebral aneurysms. METHODS: We identified 93 patients who had undergone both MDCTA and digital subtraction angiography (DSA) before surgery for the detection of cerebral aneurysms. Two and one independent blinded readers reviewed the MDCTA images and DSA images, respectively. The sensitivity, specificity, accuracy, and positive and negative predictive values were calculated for the image interpretation from the two CTA readers and one DSA reader using the combination of DSA and intraoperative findings as the reference standard. RESULTS: A total of 77 intracranial aneurysms were detected in 67 of the 93 patients. The overall sensitivity, specificity, and accuracy of the 256-row MDCTA in the detection of cerebral aneurysms were 96.10%, 92.31%, and 94.23%, respectively. For aneurysms larger than 5 mm, the overall sensitivity, specificity, and accuracy were 100%, 92.31%, and 96.83%, respectively. For aneurysms smaller than 5 mm, the overall sensitivity, specificity, and accuracy were 92.50%, 92.31%, and 92.42%, respectively. There was no significant difference for the sensitivity, specificity, and accuracy of 256-row MDCTA to detect cerebral aneurysm according to the conscious level of the patients. CONCLUSIONS: To detect cerebral aneurysms larger than 5 mm, 256-row MDCTA is an imaging method with a satisfactory diagnostic performance equal to that of DSA. However, its diagnostic performance for aneurysms smaller than 5 mm is still inferior to that of DSA.

The Treatment Outcomes of Radiotherapy and Surgical Treatment for Patients with Cavernous Sinus Hemangioma: A Meta-Analysis.

OBJECTIVE: Cavernous sinus hemangiomas (CSHs) are infrequent benign neoplasms. This meta-analysis was conducted with the objective of examining the prognostic outcomes of surgical interventions and radiotherapy (RT) in patients diagnosed with CSHs. METHODS: A comprehensive literature search was performed across PubMed, Embase, and Web of Science databases, with traceability up to June 22, 2021. The evaluation of continuous variables was conducted by applying the weighted mean difference (WMD) and 95% confidence interval. A one-arm meta-analysis was used to scrutinize the tumor control rate, clinical improvement rate, recovery rates of abducens nerve palsy and visual disturbance, total resection rate, and the incidence rate of permanent nerve palsy post-treatment. RESULTS: In total, 29 articles were incorporated into the meta-analysis. Post-RT for CSHs, a significant reduction in tumor volume was observed (WMD [95% confidence interval] = -17.16 [-21.52, -12.80] cm3). The tumor control rate, clinical improvement rate, recovery rate of abducens nerve palsy, and the recovery rate of visual disturbance were 97.1% (92.9, 99.7), 91.9% (82.3, 98.5), 95.6% (83.2, 100.0), and 86.3% (65.0, 99.5), respectively. Following surgical treatment, the total resection rate, mean intraoperative blood loss, recovery rate of visual disturbance, incidence rate of permanent nerve palsy, and recovery rate of abducens nerve palsy were 73.2% (57.1, 86.9), 971.17 mL (584.07, 1358.27), 66.4% (32.4, 0.942), 16.0% (4.6, 31.1), and 70.6% (51.0, 87.7), respectively. Notably, the recovery rate of abducens nerve palsy post-RT was markedly higher than postsurgical treatment. CONCLUSIONS: The results of this meta-analysis underscore that RT is an effective and safe treatment modality for CSHs. Furthermore, the prognostic outcomes of RT demonstrated superiority over surgical intervention.

Effect of high-frequency repetitive transcranial magnetic stimulation over M1 for consciousness recovery after traumatic brain injury.

BACKGROUND: The brain area stimulated during repetitive transcranial magnetic stimulation (rTMS) treatment is important in altered states of consciousness. However, the functional contribution of the M1 region during the treatment of high-frequency rTMS remains unclear. OBJECTIVE: The aim of this study was to examine the clinical [the Glasgow coma scale (GCS) and the coma recovery scale-revised (CRS-R)] and neurophysiological (EEG reactivity and SSEP) responses in vegetative state (VS) patients following traumatic brain injury (TBI) before and after a protocol of high-frequency rTMS over the M1 region. METHODS: Ninety-nine patients in a VS following TBI were recruited so that their clinical and neurophysiological responses could be evaluated in this study. These patients were randomly allocated into three experimental groups: rTMS over the M1 region (test group; n = 33), rTMS over the left dorsolateral prefrontal cortex (DLPFC) (control group; n = 33) and placebo rTMS over the M1 region (placebo group; n = 33). Each rTMS treatment lasted 20 min and was carried out once a day. The duration of this protocol was a month with 20 treatments (5 times per week) occurring with that time. RESULTS: We found that the clinical and neurophysiological responses improved after treatment in the test, control, and placebo groups; the improvement was highest in the test group compared to that in the control and placebo groups. CONCLUSIONS: Our results demonstrate an effective method of high-frequency rTMS over the M1 region for consciousness recovery after severe brain injury.

Simultaneous Clipping and Superficial Temporal Artery-Middle Cerebral Artery Bypass for Unruptured Middle Cerebral Artery Aneurysm Concomitant with Proximal Stenosis.

Management of unruptured intracranial aneurysms concomitant with proximal stenosis remains challenging. Video 1 demonstrates simultaneous clipping and superficial temporal artery (STA)-middle cerebral artery (MCA) bypass for unruptured MCA aneurysm concomitant with proximal stenosis. A 56-year-old man presented with paroxysmal left limb weakness for 2 years. Magnetic resonance angiography and digital subtraction angiography showed a right MCA bifurcation aneurysm concomitant with severity of proximal M1 stenosis. Arterial spin labeling imaging revealed decreased perfusion in the right frontal and parietal lobe. A frontotemporal craniotomy was performed, and the parietal branch of the STA was dissected as a donor artery.1-3 The MCA (M4) branch with the largest diameter was chosen as the recipient. STA-MCA bypass was performed using end-to-side anastomosis with interrupted 10-0 sutures. Next, the sylvian fissure was opened from distal to proximal dissection. The MCA bifurcation aneurysm with atherosclerosis of the M1 was exposed. A curved clip was used to occlude the aneurysm without temporary occlusion of the parent artery. The patient recovered well without any complications. Six-month follow-up angiography confirmed complete obliteration of the aneurysm and patent STA-MCA anastomosis. For unruptured MCA aneurysms concomitant with proximal stenosis, 1-stage surgical treatment with simultaneous clipping and STA-MCA bypass is a feasible alternative. Further studies are needed to compare the safety and efficacy of 1-stage surgical treatment and endovascular embolization of intracranial aneurysms concomitant with proximal stenosis.

The Long-Term Outcome in a Cohort of 52 Patients With Symptomatic Intramedullary Spinal Cavernous Hemangioma After Microsurgery and Emergency Rescue Surgery.

Background: Surgery is the mainstay treatment for patients with symptomatic intramedullary spinal cavernous hemangioma (ISCH), however the time of surgical intervention remains controversial. In this study, we proposed emergency rescue surgery (ERS) for patients in deteriorative type. The prognostic factors of patients with ISCH after microsurgery and the clinical effect of ERS were analyzed. Methods: From January 2013 to November 2019, 52 patients with symptomatic ISCH treated by microsurgical treatment were collected, ranging in age from 17 to 66 years old (mean: 45.8 ± 13.5 years). The course of the disease ranged from 2 days to 20 years. Of 52 lesions, 17 lesions were in the cervical segment, 25 in the thoracic segment, and 10 in the lumbosacral segment; while seven cases were at the ventral surface, 25 cases at the dorsal surface, and 20 cases at the central spinal cord. The sagittal diameter ranged from 1 to 58 mm (median: 17.3 mm). The transverse diameter ratio ranged from 20 to 80% (median: 50.7%). Thirty-two patients were diagnosed as deteriorative type and 22 were treated by ERS. Results: At 12 months after surgery, all patients were followed up, and no residual or recurrence was found in all patients. Twenty-five patients (48.1%) showed spinal cord functional improvement after surgery; 25 (48.1%) had no functional change; 2 (3.8%) got worse. For deteriorative patients, ERS group had a significantly higher improvement rate than the non-ERS group (χ2 = 5.393, P = 0.02); For all 52 patients, the factors as a lesion at the ventral surface (Z = 10.453, P = 0.015), or lumbosacral segment (χ2 = 9.259, P = 0.010) and longer course of disease (Z = -2.021, P = 0.043) were potential risks in functional recovery in univariate analysis; and in multiple-factor analysis, the lesion at the lumbosacral segment (OR = 4.004, 95% CI: 1.341~11.961, P = 0.013) was the independent risk factors for the functional recovery. Conclusions: Microsurgical resection is safe and effective for symptomatic ISCH. The ERS is an effective way to improve deteriorative patients' spinal cord function at long-term follow-up. The lesion at the lumbosacral segment is one of the poor prognostic factors.

Self-Supervised Learning Across Domains.

Human adaptability relies crucially on learning and merging knowledge from both supervised and unsupervised tasks: the parents point out few important concepts, but then the children fill in the gaps on their own. This is particularly effective, because supervised learning can never be exhaustive and thus learning autonomously allows to discover invariances and regularities that help to generalize. In this paper we propose to apply a similar approach to the problem of object recognition across domains: our model learns the semantic labels in a supervised fashion, and broadens its understanding of the data by learning from self-supervised signals on the same images. This secondary task helps the network to focus on object shapes, learning concepts like spatial orientation and part correlation, while acting as a regularizer for the classification task over multiple visual domains. Extensive experiments confirm our intuition and show that our multi-task method, combining supervised and self-supervised knowledge, provides competitive results with respect to more complex domain generalization and adaptation solutions. It also proves its potential in the novel and challenging predictive and partial domain adaptation scenarios.

Moyamoya disease: A human model for chronic hypoperfusion and intervention in Alzheimer's disease.

Introduction: Chronic cerebral hypoperfusion has been considered the etiology for sporadic Alzheimer's disease (AD). However, no valid clinical evidence exists due to the similar risk factors between cerebrovascular disease and AD. Methods: We used moyamoya disease (MMD) as a model of chronic hypoperfusion and cognitive impairment, without other etiology interference. Results: Based on the previous reports and preliminary findings, we hypothesized that chronic cerebral hypoperfusion could be an independent upstream crucial variable, resulting in AD, and induce pathological hallmarks such as amyloid beta peptide and hyperphosphorylated tau accumulation. Discussion: Timely intervention with revascularisation would help reverse the brain damage with AD hallmarks and lead to cognitive improvement.

Cavernoma-Associated Epilepsy Within the Mesial Temporal Lobe: Surgical Management and Seizure Outcome.

OBJECTIVE: We sought to explore a treatment protocol for patients with mesial temporal cerebral cavernoma (MTC)-associated epilepsy. METHODS: All MTC-associated epilepsy patients admitted to our center between January 2005 and December 2013 were analyzed. Seizure outcome for each presurgical epilepsy type was reported. The modified Engel classification was used to assess outcome. The neurologic outcome was scored by the modified Rankin Scale. RESULTS: Fifty-three patients admitted to the center were seen by a functional electrocortigraphy (ECoG group) or vascular (non-ECoG group) neurosurgery team. There were 21 patients with drug-resistant epilepsy (DRE), 20 patients with chronic epilepsy (CE), and 12 patients with sporadic epilepsy (SE). The neurovascular team treated 37 (69.8%) patients, and the ECoG group treated 16 (30.2%) patients. All patients underwent a mean follow-up of 106.5 ± 29.1 months. Almost all SE patients (11/12, 91.7%) in both teams achieved seizure-free status at follow-up. In the CE group, the long-term seizure-free probability among patients in the ECoG and non-ECoG groups was (66.7%) and (52.9%), respectively. DRE patients in the ECoG group had a lower seizure relapse rate after surgery than those who underwent non-ECoG surgery (P = 0.042). Fifty-two patients (98.1%) complained of postsurgery memory loss. Seizure outcome in the first postoperative year was a reasonable predictor of long-term outcome. CONCLUSIONS: A comprehensive preoperative and intraoperative assessment could help the patient with MTC-associated epilepsy choose a suitable surgical time and maximize the benefit between seizure control and cognition protection. The characters of intraoperative ECoG and postoperative seizure outcome at 1-year follow-up can predict a long-term epilepsy prognosis.

Onyx embolization for the treatment of brain arteriovenous malformations.

BACKGROUND: Onyx has emerged in recent years for the endovascular treatment of brain arteriovenous malformations (AVMs). However, the role of Onyx embolization is still under discussion. We report our initial experiences in the treatment of brain AVMs with Onyx embolization. METHODS: Between January 2004 and December 2007, 86 patients with brain AVMs were embolized with Onyx. Clinical presentation included intracerebral hemorrhage in 32 patients, seizures in 25 patients, headaches in 20 patients, neurologic deficits in 3 patients, and in 6 patients the AVM was an incidental finding. According to the Spetzler-Martin scale, three AVMs were grade I, 13 were grade II, 45 were grade III, 19 were grade IV, and 6 were grade V. Seventy-four AVMs were located in eloquent regions. RESULTS: Initial complete obliteration after final embolization was achieved in 16 patients (18.6%), with an average of 80.5% (range, 30-100%) volume reduction. Partial embolization was followed by surgery in 18 patients, whereas 17 AVMs were cured. In 48 patients treated by embolization and radiosurgery, four patients were lost to follow-up. Three-year follow-up angiography was performed on 30 patients and showed complete obliteration after radiosurgery in 23 patients. The remaining 14 patients are awaiting 3-year postradiosurgery results. Embolization-related permanent morbidity was 3.5%, whereas mortality was 1.2%. CONCLUSIONS: Although Onyx allows moderate obliteration rates, combined management, such as adjunctive embolization with microsurgery or radiosurgery, may be effective for selected large AVMs.