Lenvatinib in hepatocellular carcinoma: Resistance mechanisms and strategies for improved efficacy.

Hepatocellular carcinoma (HCC), one of the most prevalent and destructive causes of cancer-related deaths worldwide, approximately 70% of patients with HCC exhibit advanced disease at diagnosis, limiting the potential for radical treatment. For such patients, lenvatinib, a long-awaited alternative to sorafenib for first-line targeted therapy, has become a key treatment. Unfortunately, despite some progress, the prognosis for advanced HCC remains poor because of drug resistance development. However, the molecular mechanisms underlying lenvatinib resistance and ways to relief drug resistance in HCC are largely unknown and lack of systematic summary; thus, this review not only aims to explore factors contributing to lenvatinib resistance in HCC, but more importantly, summary potential methods to conquer or mitigate the resistance. The results suggest that abnormal activation of pathways, drug transport, epigenetics, tumour microenvironment, cancer stem cells, regulated cell death, epithelial-mesenchymal transition, and other mechanisms are involved in the development of lenvatinib resistance in HCC and subsequent HCC progression. To improve the therapeutic outcomes of lenvatinib, inhibiting acquired resistance, combined therapies, and nano-delivery carriers may be possible approaches.

Hepatic artery infusion chemotherapy combined with the FOLFOX regimen for the treatment of hepatocellular carcinoma: recent advances and literature review.

INTRODUCTION: The incidence of primary liver cancer (PLC) has experienced a significant global increase, primarily attributed to the rise in hepatocellular carcinoma (HCC). Unfortunately, HCC is often diagnosed in advanced stages, leaving patients with limited treatment options. Therefore, transformation therapy is a crucial approach for long-term survival and radical resection in patients with advanced HCC. Conversion therapy has demonstrated promise in the treatment of advanced HCC. When integrated with the FOLFOX regimen, hepatic artery infusion chemotherapy (HAIC) can significantly improve tumor response efficiency, leading to high conversion and resection rates. AREAS COVERED: We reviewed landmark trials of HAIC in combination with different drugs or means for the treatment of HCC to determine the clinical value of HAIC-centric translational therapies in HCC treatment. Furthermore, we specifically emphasize the advantages associated with employing FOLFOX-HAIC in the treatment of advanced HCC. EXPERT OPINION: The combination of HAIC with the FOLFOX regimen can help prevent the low intratumoral accumulation and high adverse reaction rate caused by the FOLFOX alone, holding significant potential in the comprehensive treatment of future HCC patients.

Cancer diagnosis and treatment platform based on manganese-based nanomaterials.

Cancer is a leading cause of death worldwide, and the development of new diagnostic and treatment methods is crucial. Manganese-based nanomaterials (MnNMs) have emerged as a focal point in the field of cancer diagnosis and treatment due to their multifunctional properties. These nanomaterials have been extensively explored as contrast agents for various imaging technologies such as magnetic resonance imaging (MRI), photoacoustic imaging (PAI), and near-infrared fluorescence imaging (NIR-FL). The use of these nanomaterials has significantly enhanced the contrast for precise tumor detection and localization. Moreover, MnNMs have shown responsiveness to the tumor microenvironment (TME), enabling innovative approaches to cancer treatment. This review provides an overview of the latest developments of MnNMs and their potential applications in tumor diagnosis and therapy. Finally, potential challenges and prospects of MnNMs in clinical applications are discussed. We believe that this review would serve as a valuable resource for guiding further research on the application of manganese nanomaterials in cancer diagnosis and treatment, addressing the current limitations, and proposing future research directions.

Betulinic acid attenuates T-2 toxin-induced lung injury by activating Nrf2 signaling pathway and inhibiting MAPK/NF-κB signaling pathway.

T-2 toxin, a type-A trichothecene mycotoxin, exists ubiquitously in mildewed foods and feeds. Betulinic acid (BA), a pentacyclic triterpenoid derived from plants, has the effect of relieving inflammation and oxidative stress. The purpose of this study was to investigate whether BA mitigates lung impairment caused by T-2 toxin and elucidate the underlying mechanism. The results indicated that T-2 toxin triggered the inflammatory cell infiltration, morphological alterations and cell apoptosis in the lungs. It is gratifying that BA ameliorated T-2 toxin-caused lung injury. The protein expression of nuclear factor erythrocyte 2-related factor 2 (Nrf2) pathway and the markers of antioxidative capability were improved in T-2 toxin induced lung injury by BA mediated protection. Simultaneously, BA supplementation could suppress T-2 toxin-induced mitogen-activated protein kinase (MAPK)/nuclear factor-kappa B (NF-κB)-dependent inflammatory response and mitochondrial apoptotic pathway. Therefore, T-2 toxin gave rise to pulmonary toxicity, but these changes were moderated by BA administration through regulation of the Nrf2/MAPK/NF-κB pathway, which maybe offer a viable alternative for mitigating the lung impairments caused by the mycotoxin.

[Determination of 8-oxo-2'-deoxyguanosine and Cotinine in Urine by Hydrophilic Chromatography-tandem Mass Spectrometry with Isotope Dilution].

OBJECTIVE: To develop an assay for determination of 8-oxo-2'-deoxyguanosine and cotinine in human urine by hydrophilic chromatography tandem mass spectrometry (HILIC-MS/MS) with isotope dilution. METHODS: The urine supernatant was 1∶5 diluted with 3 mmol/L ammonium formate aqueous solution containing 15N 5-8-OHdG and D 3-cotinine as internal standard. After being filtered through a 0.22 µm water filter, the sample solution was injected into ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) for analysis. Separation was performed on ACQUITY UPLC® BEH HILIC column (50 mm×3.0 mm, 1.7 µm) with isocratic elution (A∶B=10∶90) at 40 ℃. The mobile phase was composed with acetonitrile (B) and 3 mmol/L ammonium formate water soulution (A). The flow rate was 0.3 mL/min. Positive ion scan-multiple reaction monitoring (MRM) mode were used for monitoring and internal standard curves were applied for quantification. RESULTS: Good linearity was obtained under the optimal conditions. Detection limits for 8-OHdG and cotinine were 0.064 µg/L and 0.035 µg/L respectively, the quantitation limits were 0.21 µg/L and 0.12 µg/L respectively, and the recoveries of the spiked urine samples were 92.6%-102% and 102%-106% respectively. Statistical analysis of 40 urine sample determination results obtained by using the above assay showed that there were significant differences in tobacco smoke exposure and tobacco-specific nitrosamine intake between active and passive smoker ( P<0.05). The concentration of NNAL and cotinine were higher in urine samples of active smoker. Tobacco smoke exposure was positively correlated with tobacco specific nitrosamine intake in both active and passive smokers (the correlation coefficients were 0.487 and 0.786 respectively, P<0.05). CONCLUSION: We successfully established a simple and fast assay for simultaneously detecting 8-oxo-2'-deoxyguanosine and cotinine in human urine. It was sensitive and accurate for quntification via the calibration by the isotope internal standards, and can meet the needs of batch analysis.

[Detecting Nicotine and Cortinine in Hair by Hydrophilic Interaction Liquid Chromatography Tandem Mass Spectrometry].

OBJECTIVE: To develop a method for detecting nicotine and cotinine in hair by hydrophilic interaction chromatography tandem mass spectrometry. METHODS: Hair samples were hydrolyzed in sodium hydroxide solution before extraction with dichloromethane. The samples were blown to dry with nitrogen and dissolved with mobile phase. The filtrate of the samples was injected into a chromatographic-mass spectrometry system for analysis. The separation was performed by a hydrophilic column, with which methanol-0.1% ammonia was used as the mobile phase. The quantitative detection of Nicotine and Cortinine was carried out with electron spray ionization-triple quadrupole mass spectrometry. The established method was used for detecting nicotine and cotinine in 602 hair samples of pregnant women and 31 hair and urine samples of volunteers. RESULTS: A standard curve was drawn for the established method of hydrophilic liquid chromatography tandem mass spectrometry. Good linearity was obtained for detecting nicotine and cotinine in the range of 0.030-100.000 µg/L, with a detection limit (MDL) of 0.007 6 µg/g and 0.004 4 µg/g, respectively. The inter-day and intra-day precisions reached a level of less than 10%. The recoveries of the spiked samples ranged from 81.0% to 102.0%. About 0.020-0.260 µg/g nicotine and 0.004 8-0.069 0 µg/g cotinine were detected in the pregnant women without exposure to secondhand smoking (SHS), compared with 0.029-0.350 µg/g nicotine and 0.005 6-0.085 0 µg/g cotinine in those exposed to SHS. Nicotine and cotinine were also found in the hair and urine samples of volunteers, which were correlated with smoking (P < 0.05). A dose-response relationship were found between smoking and hair nicotine. CONCLUSIONS: The proposed method is accurate and sensitive for detecting nicotine and cotinine in hair samples. Hair nicotine can be a specific biomarker for assessing exposure to tobacco smoking.

Application of response surface methodology to vortex-assisted dispersive liquid-liquid extraction for the determination of nicotine and cotinine in urine by gas chromatography-tandem mass spectrometry.

A method of vortex-assisted dispersive liquid-liquid extraction coupled with gas chromatography and tandem mass spectrometry for the determination of nicotine and cotinine in urine was developed. Response surface methodology was applied to obtain the optimum extraction conditions. In this method, Plackett-Burman design was utilized to evaluate the impact of five selected factors on pretreatment procedure. Then, three main factors were optimized using a Box-Behnken design. The optimized method showed good linearities at 1-2000 µg/L with correlation coefficients of 0.9998 for nicotine and 0.9986 for cotinine. Recovery was 91.4-106 and 91.7-108% for nicotine and cotinine, respectively. The intraday relative standard derivations of determination were 1.47-4.06% for nicotine and 0.41-3.16% for cotinine, and interday relative standard derivations were 3.03-6.70% for nicotine and 1.64-6.38% for cotinine. The method detection limits for nicotine and cotinine were 0.33 and 0.34 µg/L, respectively. A total of 87 urine samples from smokers and nonsmokers were tested with the proposed method. Urinary nicotine and cotinine were 23.0-6.67 × 103 and 18.4-4.17 × 103  µg/(g·cr) for smokers and 1.31-286 and 1.39-131 µg/(g·cr) for nonsmokers, respectively. The method is sensitive, suitable and reliable for the determination of nicotine and cotinine in urine and meets the requirements for evaluating short-term tobacco exposure.

[The clinical application of retractorless surgical technique in neurosurgical operation].

OBJECTIVE: A retrospective study was conducted to analyze the clinical data of patients treated by retractorless surgery and explore the clinical feasibility and practical application of this strategy. METHODS: A total of 194 patients undergone retractorless surgery in Beijing Tiantan Hospital from Nov 2013 to Oct 2014 were retrospectively reviewed. Complications related to microsurgical approaches, disease types, neurological function score and intraoperative compression or stretching were analyzed. RESULTS: Of the 194 cases, there were 127 (65%) patients with cerebrovascular diseases and 67 (35%) patients with intracranial tumors. Sixty patients had anterior circulation aneurysms, of them, 21 aneurysms were accessed through frontal-lateral approaches and 39 reached via pterional approaches. Two patients with posterior inferior cerebellar artery (PICA) aneurysms were treated by far-lateral approaches. Fifteen patients with cerebellopontine angle (CPA) tumors were treated by retrosigmoid approaches. Elven patients with supratentorial tumors were treated by anterior and posterior interhemispheric approaches. Twenty patients with posterior fossa tumors were treated by suboccipital posterior median and paramedian approaches. Two patients with petroclival region lesions were treated by subtemporal approaches. Damage of tissues surrounding the approach occurred in 4 cases (2%). One patient received secondary procedures (0.52%) and 2 patients died after operation (1%). No change of postoperative neurological function was seen in 62.3% of cases, improvement of postoperative neurological function was seen in 29.4% and neurological function deterioration 8.24%. CONCLUSIONS: Compared with the retractor surgery, retractorless surgery does not increase the rate of damage of tissues surrounding the approach. With the proficiency in micro-neurosurgery methods, retractorless surgery can reduce the postoperative complications.

TALE nickase-mediated SP110 knockin endows cattle with increased resistance to tuberculosis.

Transcription activator-like effector nuclease (TALEN)-mediated genome modification has been applied successfully to create transgenic animals in various species, such as mouse, pig, and even monkey. However, transgenic cattle with gene knockin have yet to be created using TALENs. Here, we report site-specific knockin of the transcription activator-like effector (TALE) nickase-mediated SP110 nuclear body protein gene (SP110) via homologous recombination to produce tuberculosis-resistant cattle. In vitro and in vivo challenge and transmission experiments proved that the transgenic cattle are able to control the growth and multiplication of Mycobacterium bovis, turn on the apoptotic pathway of cell death instead of necrosis after infection, and efficiently resist the low dose of M. bovis transmitted from tuberculous cattle in nature. In this study, we developed TALE nickases to modify the genome of Holstein-Friesian cattle, thereby engineering a heritable genome modification that facilitates resistance to tuberculosis.

The reference dose for subchronic exposure of pigs to cadmium leading to early renal damage by benchmark dose method.

Pigs were exposed to cadmium (Cd) (in the form of CdCl(2)) concentrations ranging from 0 to 32mg Cd/kg feed for 100 days. Urinary cadmium (U-Cd) and blood cadmium (B-Cd) levels were determined as indicators of Cd exposure. Urinary levels of ß(2)-microglobulin (ß(2)-MG), α(1)-microglobulin (α(1)-MG), N-acetyl-ß-D-glucosaminidase (NAG), cadmium-metallothionein (Cd-MT), and retinol binding protein (RBP) were determined as biomarkers of tubular dysfunction. U-Cd concentrations were increased linearly with time and dose, whereas B-Cd reached two peaks at 40 days and 100 days in the group exposed to 32mg Cd/kg. Hyper-metallothionein-urinary (HyperMTuria) and hyper-N-acetyl-ß-D-glucosaminidase-urinary (hyperNAGuria) emerged from 80 days onwards in the group exposed to 32mg Cd/kg feed, followed by hyper-ß2-microglobulin-urinary (hyperß2-MGuria) and hyper-retinol-binding-protein-urinary (hyperRBPuria) from 100 days onwards. The relationships between the Cd exposure dose and biomarkers of exposure (as well as the biomarkers of effect) were examined, and significant correlations were found between them (except for α(1)-MG). Dose-response relationships between Cd exposure dose and biomarkers of tubular dysfunction were studied. The critical concentration of Cd exposure dose was calculated by the benchmark dose (BMD) method. The BMD(10)/BMDL(10) was estimated to be 1.34/0.67, 1.21/0.88, 2.75/1.00, and 3.73/3.08mg Cd/kg feed based on urinary RBP, NAG, Cd-MT, and ß(2)-MG, respectively. The calculated tolerable weekly intake of Cd for humans was 1.4 µg/kg body weight based on a safety factor of 100. This value is lower than the currently available values set by several different countries. This indicates a need for further studies on the effects of Cd and a re-evaluation of the human health risk assessment for the metal.

[The application of functional magnetic resonance imaging integrated neuronavigation in localization and lingual function protection].

OBJECTIVE: To evaluate the clinical practicability of integration of functional magnetic resonance imaging (fMRI) data into neuronavigation as a tool to localize the language area and their relationship with the lesion for the preoperative planning, intraoperative guidance and postoperative follow-up study of brain functions during minimally invasive surgeries in or adjacent to functional areas. METHODS: Eighty eight patients with intracranial lesions located in or adjacent to the functional language area underwent fMRI (including examinations of lingual and visual function, and motor functions of the limbs and tongue). fMRI data was entered into a neuronavigation system for image fusion and preoperative registration and correction; minimally invasive neurosurgery was performed with fMRI navigation. RESULTS: The shortest distance between the lesion and the functional cortex was less than 5 mm in 6 patients and was more than 5 mm but less than 10 mm in another 10 patients, respectively. 10 patients were recovered and improved in another 6 between 3 - 6 months after surgery, The follow-up time was between 3 months and 1 year. The morbidity rate was 6.8% (6/88). There was no postoperative mortality. Various brain areas were widely activated when the patients were reading and understanding the Chinese words. The unilateral speech functional maps were located in left Brodmann's 9, 46, 17, 18 and 19 areas. CONCLUSION: fMRI-integrated neuronavigation can locate functional language areas and played an important role in intraoperative protection of functional lingual areas, execution of individualized therapeutic regimens, minimization of surgical complications and determination of prognosis. Total surgical resection was safe for lesions > 10 mm from functional lingual areas.

Lack of the cerebral peduncle involvement in a series of adult supratentorial AVM: a diffusion tensor imaging study.

Congenital as arteriovenous malformation(AVM) is, most patients with AVM would be asymptomatic until adults. During the past 2 years, 23 cases of adult supratentorial AVM patients had DTI after admission. The region of interest was placed in the cerebral peduncle. Their FA value and fiber number was compared with those of cavernous malformation (CM) and tumor (glioma and meningioma). In the AVM group, there was no significant difference in FA of the cerebral peduncle (ipsilateral 0.758±0.055 versus contralateral 0.755±0.049; P>0.05) and fiber number (319.6±82.9 versus 304.7±89.1; P>0.05). In the CM group, FA of the cerebral peduncle on ipsilateral side (0.711±0.092) was significantly lower than that of contralateral side (0.768±0.043) (P<0.01). Similar result was in fiber number of the CM group (251±82.1 versus 307.3±77.0; P<0.05). In tumor group, FA of ipsilateral side (0.713±0.084) was lower than that of contralateral (0.751±0.052) without significant difference. There was no significant difference in fiber number between ipsilateral and contralateral sides in the tumor group (308.9±112.4 versus 287.9±62.4). Unlike non-AVM lesions (CM and tumor), FA value and fiber number of the ipsilateral cerebral peduncle is less influenced in the AVM group. The lack of the cerebral peduncle involvement indicates that there is plasticity of white matter in AVM.

[Diagnosis and management of intracranial aneurysm in children].

OBJECTIVE: To describe the clinical manifestations of intracranial aneurysm in children and to evaluate the efficacy and safety of different therapeutic approaches for children with intracranial aneurysms. METHODS: Clinical data of 23 pediatric patients with intracranial aneurysms diagnosed and treated at our hospital over the past 18 years were retrospectively reviewed. Follow-up data were also collected and analyzed. RESULTS: Two patients received no further treatment. Surgery was performed in 16 patients. Among them, 15 achieved an excellent recovery and 1 died. 5 patients were treated with Guglielmi detachable coil (GDC). Aneurysm was successfully sealed off in one case and an excellent recovery achieved; remnant aneurysm was detected in two cases. One received trapping while another underwent aneurysmectomy. The patient died postoperatively. Another received neck clipping and resection. And the patient recovered well; two cases experienced aneurysm recanalization after interventional therapy. Among them, one received a second embolotherapy but it became recanalized again. And it was finally cured by aneurysmectomy. CONCLUSION: Aneurysm surgery is proved to be a safe and effective treatment for children with intracranial aneurysm. Endovascular treatment of intracranial aneurysms with GDC is also shown to be effective and safe for pediatric patient with acute SAH. But a long-term follow-up study is required to determine the clinical outcome. Once a aneurysm remnant or recanalization occurs, a microsurgical management is recommended.

Evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery.

The primary aim of this study is to assess the value of intraoperative near-infrared indocyanine green videoangiography (ICGA) during intracranial aneurysm surgery. Altogether, 129 patients harboring 152 intracranial aneurysms were recruited in this study between March 2007 and December 2008 and the clinical data were retrospectively analyzed. Intraoperative ICGA was performed to examine the completeness of the aneurysm clipping and the patency of the parent arteries in all cases. The intraoperative findings were compared with that of postoperative digital subtraction angiography (DSA). On all of the patients, 276 successful ICGA investigations were performed intraoperatively. The image quality and resolution were excellent, allowing real-time assessment of the cerebral circulation. Indocyanine green (ICG) angiographic results could be divided into arterial, capillary, and venous phases, comparable to those observed with postoperative DSA. In all cases, the postoperative angiographic results corresponded to the intraoperative ICGA findings. In three cases, the information provided by intraoperative ICG angiography significantly changed the surgical procedure. Intraoperative ICG videoangiography may be a useful tool in real-time evaluation of the aneurysm clipping. Its simplicity and easy reproducibility all suggest it to be carried out as a routine procedure during aneurysm surgery.

[Effects of surgical microscope-based indocyanine green videoangiography during aneurysm surgery].

OBJECTIVE: To evaluate the effects of surgical microscope-based indocyanine green videoangiography (ICGA) in aneurysm surgery and compare the values of ICGA and postoperative digital subtraction angiography (DSA). METHODS: 101 patients with intracranial aneurysm underwent clipping of 113 aneurysms. A microscope-integrated light source containing infrared excitation light illuminated the operating field. The dye ICG was injected intravenously, and the intravascular fluorescence was recorded by a video camera attached to the microscope with optical filtering to block ambient and laser light for collection of only ICG-induced fluorescence. All patients underwent DSA 6-13 days post-operatively. The results of patency of parent, branching, and perforating arteries and documentation of aneurysm obliteration shown by ICGA and DSA were compared. RESULT: 219 times of ICGA was performed in these 101 patients with excellent image quality and resolution, allowing intra-operative real-time assessment of the cerebral circulation. The ICG angiographic results could be divided into arterial, capillary, and venous phases, comparable to those observed with DSA. In all cases, the postoperative angiographic results corresponded to the intraoperative ICG video angiographic findings. In 3 cases, the information provided by intraoperative ICGA significantly changed the surgical procedure. CONCLUSION: Simple and repeatable, microscope-based ICGA provides real-time information about vessels and aneurysm sac. This technique may be useful during routine aneurysm surgery as an adjunct to intraoperative microvascular Doppler ultrasonography and DSA.

[Advances in the expression and regulation of MnSOD gene].

MnSOD, which is an important oxygen free radical scavenger in organisms, has an effect to resist oxidative stress and tumor. The expression and regulation of MnSOD gene is a complicated process, which includes many kinds of transcription factors, cell signal molecules and cell signal pathways. It refers to three aspects including transcription regulation, post-transcription regulation and translation regulation. Transcription regulation is the primary step for MnSOD gene expression and plays a key role during the expression of MnSOD gene. The activity of transcription factors, which controls MnSOD gene expression, such as SP-1, AP-2, AP-1, NF-kB and so on, can be changed in the course of transcription regulation. Drugs and metalions can also affect those transcription factors' activity. Furthermore some genes mutation and depletion also have an influence on the activity of those transcription factors. Post-transcription regulation is in a way of changing the stability of mRNA and its translation. Translation regulation is a process to regulate edition, modification, binding to metalion and site-specific of MnSOD polypeptide. Recently a kind of manganese trafficking factor for mitochondrial MnSOD called MTMl which is very important for activation of MnSOD has been discovered. Here, we review the advances in this field with an emphasis on transcription regulation and translation regulation of MnSOD gene. And at last, we discussed the prospect of MnSOD gene expression and regulation.

Postoperative recovery from posterior communicating aneurysm complicated by oculomotor palsy.

BACKGROUND: Oculomotor palsy is a common complication in patients with posterior communicating aneurysm. This study was conducted to investigate the postoperative recovery of patients with posterior communicating aneurysm complicated with oculomotor palsy and to analyze the factors influencing length of recovery. METHODS: From 2000 to 2006, 148 patients with posterior communicating aneurysm were treated at our hospital, with 74 of them having concurrent unilateral oculomotor palsy. All of the patients underwent craniotomy after the diagnosis by means of whole-brain digital subtraction angiography (DSA). The patients were divided into two groups for observation of postoperative recovery during the follow-up period. Patients in group A were treated with simple pedicle clipping of the aneurysm while patients in group B were treated with pedicle clipping of the aneurysm and decompression of the oculomotor nerve. RESULTS: Of the 40 patients in group A, 20 underwent surgery within 14 days and completely recovered from oculomotor palsy in 10 - 40 days. Fourteen patients underwent surgery within 14 - 30 days, of whom 12 completely recovered within 30 - 90 days and 2 cases recovered incompletely. The remaining six patients underwent surgery after more than 30 days; of these, four patients recovered completely and two recovered incompletely. Of the 34 cases in group B, 15 underwent surgery within 14 days and completely recovered from oculomotor palsy in 10 - 40 days. Sixteen patients underwent surgery in 14 - 30 days, of whom 14 completely recovered in 30 - 90 days and 2 recovered incompletely. The remaining three patients underwent surgery after more than 30 days, of whom two patients recovered completely and one recovered incompletely. CONCLUSIONS: Early diagnosis and surgical treatment of patients with unilateral oculomotor palsy induced by posterior communicating aneurysm are important to full postoperative recovery of the oculomotor nerve. No correlation was found, however, between decompression of the oculomotor nerve, such as excision or puncture of the aneurysm, and postoperative recovery time.

Management of intracranial aneurysm in children: clipped and coiled.

OBJECTIVES: The objective was to describe the clinical features of intracranial aneurysm in children and evaluate the efficacy and safety of different treatment approaches for children with intracranial aneurysms. MATERIALS AND METHODS: Clinical data of 13 child patients with intracranial aneurysms that were diagnosed and treated in our hospital in the past 16 years were reviewed. Long-term follow-up data were also collected and reported. RESULTS: Direct surgical treatment was performed on eight out of all 13 patients; among them, seven achieved good recovery and one died. The remaining five patients were treated with Guglielmi detachable coils (GDC). The aneurysm was successfully sealed off in one case and achieved good postoperative recovery. Residual aneurysm was detected in two cases; a second resection surgery was performed on one patient who died after the operation and on another with neck occlusion who recovered well. Two cases experienced aneurysm recanalization after interventional therapy; among them, one was treated with a second embolotherapy but had recanalization once again and was finally cured by aneurysm resection surgery. CONCLUSION: Aneurysmal surgery is proved to be a safe and effective treatment for children with intracranial aneurysm. Although requiring a long-term follow-up period to determine the clinical outcome, GDC is also shown to be safe for a child having acute bleeding. Once a residual aneurysm or recanalization occurs, microsurgery is recommended.

[Functional magnetic resonance imaging-integrated neuronavigation and protection of brain function].

OBJECTIVE: To investigate the reliability and clinical value of functional magnetic resonance imaging (fMRI)-integrated neuronavigation in minimally invasive neurosurgery and protection of brain function. We demonstrate the correlation between the lesion-to-fMRI activation distance and occurrence of new postoperative deficit. METHODS: fMRI-integrated neuronavigation was used for minimally invasive neurosurgery in 20 patients with intracranial lesions located in or near eloquent brain areas. During standardized paradigms for hand, foot, and tongue movement, language and visual activation, echo-planar imaging T2 blood oxygen level dependent sequences were acquired by Siemens Medical Systems Trio 3.0 T and processed with SPM2. Neuronavigation was performed with Stealth station. RESULTS: fMRI data was integrated into neuronavigation successfully in all cases, functional neuronavigation with integration of fMRI allowed easy and precise identification of the eloquent brain areas and lesions except for 1 case for brain shift because of tumor stroke just before the operation. The localization of the tumor was corrected by intraoperative ultrasonography. Gross total resection was achieved in 18 patients, 2 patients had a subtotal resection. Neurological deterioration was seen in 4 patients, tumors all located in eloquent brain areas, 2 patients were recovered in 3 months the morbidity was 10.0%. The distance of a lesion to fMRI activation was more than 10 mm in 14 cases. The functional maps were located in left Brodmann's 9, 46, 17, 18 and 19 areas in 11 cases when the patients reading and understanding the Chinese words. CONCLUSIONS: Functional neuronavigation with integration of fMRI allows precise identification of the eloquent brain areas protects the brain function and decreases the morbidity especially for Chinese patients because of our special functional area of language. Our data suggest that the distance of a lesion to fMRI activation was more than 10 mm, complete resection can be achieved safely.

[Postoperative recovery of aneurysm of posterior communicating artery-induced oculomotor palsy: clinical observation of 52 cases].

OBJECTIVE: To explore the prognosis of aneurysm of posterior communicating artery-induced oculomotor palsy after surgery. METHODS: Fifty-two patients with aneurysm of posterior communicating artery-induced oculomotor palsy, 12 males and 40 females, aged 57, diagnosed by CT, MRI, and digital subtraction angiography, were divided into 2 groups: group A (n = 20, receiving simple clipping of the aneurysmal neck) and group B (n = 32, undergoing clipping of the aneurysmal neck followed by nerve decompression such as resection or puncture of the aneurysmal sac), and were followed up for 12 months (2-48 months). RESULTS: In the group A 10 patients were operated on within 14 days after the onset of oculomotor palsy showed complete recovery of the oculomotor nerve function within 40 days after operation; 8 patients were operated on within 14-30 days after the onset of oculomotor palsy showed complete recovery within 30-90 days after operation in 7 patients and incomplete recovery in 1 patient; and 2 patients were operated on 30 days after the onset of oculomotor palsy showed complete recovery within 6 months after operation in 1 patient and incomplete recovery in the other patient. In the group B 15 patients were operated on within 14 days after the onset of oculomotor palsy all showed complete recovery within 40 days after operation; 14 patients were operated on within 14-30 days after the onset of oculomotor palsy showed complete recovery within 30-90 days after operation in 12 patients and incomplete recovery in 2 patients; and 3 patients were operated on 30 days after the onset of oculomotor palsy showed complete recovery within 6 months after operation in 2 patients and incomplete recovery in the other one patient. There was no significant difference in the recovery rate between these 2 groups. Recovery of the oculomotor nerve function was remarkably correlated with the time of operation after the onset. CONCLUSION: Early diagnosis and treatment help recover the oculomotor nerve function. The recovery of the oculomotor nerve function is not related to the operation protocols.