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Objective To explore the diagnosis and treatment strategies of Rathke's cleft cysts (RCC) in the sellar region through analyzing their imaging characteristics.Methods Thirty-two patients with RCC in the sellar region,including two also with concomitant pituitary adenoma,admitted to and performed surgery in our hospital from January 2005 to August 2011,were chosen in our study.The clinical features,especially MRI and histological appearances,were retrospectively reviewed.The experiences on their diagnosis and treatment were summarized.Results Preoperatively,only 3 patients were diagnosed or suspected as RCC.MR images revealed 10 intracystic nodules in 9 patients; their MR signal intensity was variable; not all nodules on T2-weighted images were visualized.Two nodules had bull' s eyelike changes.The hyper-intense content on T1-weighted images was not definitely associated with serious symptoms.Postoperative MRI revealed recurrence or residual lesion in 5 of 26 patients.Conclusion Intracystic nodules with homogenous intensity and non-enhancement under MRI are unique for sellar RCC; Bull's eyelike changes in the intracystic nodule under MRI might have value for confirming the diagnosis.Pituitary inflammation should not be neglected when the clinical symptoms and MRI findings of RCC are being explained.
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Objective To explore the strategies of repeat transsphenoidal surgery (TSS) for pituitary adenomas.Methods Surgical techniques and treatment outcomes of 23 patients with pituitary adenomas,performed repeat TSS in our hospital from January 2003 to October 2012,were retrospectively analyzed.Results All repeat TSS were done under a microscope; four patients were performed navigation-guided surgery and one patient used C-arm fluoroscopy.The tumor heights were 15-45 mm,and the tumors were total removed in 12 cases,subtotal resection or most resection in 10 cases and partial removal in 1 case.There were 10 cases of cerebrospinal fluid leakage during operation.Eighteen cases were followed up,with postoperative abducens nerve palsy and long-term diabetes insipidus in one each case,and one case needed the hormone replacement therapy.Conclusion Repeat TSS should correct surgical approach as much as possible and enlarge the tumor' s exposure,and should be alert to the occurrence of cerebrospinal fluid leakage.
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Objective To explore the effect of olfactory ensheathing cells (OECs) on the proliferation and differentiation of neural stem cells (NSCs). Methods The cells from the embryonic rat brain were primarily cultured and identified by immunofluorescence and immunocytochemistry. NSCs in the experimental group shared medium with OECs were cultured and induced to differentiate. Simultaneously, NSCs in the control group were cultured alone. The effect of OECs on the proliferation and differentiation of NSCs was observed by immunocytochemistry. Results Nerve growth factor receptor (P75NGFR) was observed in the primarily cultured OECs; nestin was expressed in the primarily cultured neurosphere and the cells differentiated from the neurosphere expressed neurofilament 200 (NF200) and glial fibrillary acidic protein (GFAP). Compared with that in the control group, the number of NSCs in the experimental group was significantly increased (P<0.05). On the 4~(th) and 7~(th) day of differentiation, the percentage of NF200-positive cell was higher in the experimental group than that in the control group (P<0.05), indicating that the appearance of OECs increased the differentiation of NSCs into NF200-positive cells. Conclusion OECs can promote the proliferation of NSCs and induce the differentiation of NSCs into neurons.
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Objective To explore the effects of the minimally invasive hematoma aspiration on the repair of the pyramidal tract and improvement of neurological function. Methods Forty-eight SD male rats were equally randomized into normal control group, sham-operated group, cerebral hemorrhage group (model), model + minimally invasive hematoma aspiration at the 6th, 12th, and 24th h groups (n=8).Intracerebral hemorrhage in the later 4 groups was induced by injection of type IV collagenase + heparin into the caudate nucleus of rats, and the same amount of normal saline was injected into the sham-operated group. And then, the hematoma was lysed by injection of urokinase into the hematoma center 6, 12 and 24 h after intracerebral hemorrhage in the later 3 groups, respectively. Animals were sacrificed after behavioral function evaluation 14 d after collagenase injection. Immunohistochemistry was performed to observe the expressions of neurofilament (NF) and growth associated protein-43(GAP-43) in the posterior limb of internal capsule. Results The snatch ability of left forelimb among all the groups showed no significant differences before the success of model making (P＞0.05). The snatch ability of left forelimb in each hematoma aspiration group was much higher than that in the model group on the 14th d of collagenase injection (P＜0.05). Within the hematoma aspiration groups, the snatch ability in the group performed hematoma aspiration at the 6th h was higher than those group at the 12th and 24th h (P＜0.05). The number of NF positive fibers and the expression of GAP-43 in the 3hematoma aspiration groups were much larger or higher than those in the model group (P＜0.05); the number of NF positive fibers in the group performed hematoma aspiration at the 6th h was larger than that in those group at the 12th and 24th h (P ＜0.05); The expression of GAP-43 in the group performed hematoma aspiration at the 6th and 12th h was higher than that in the group at the 24th h (P＜0.05).Conclusion The minimally invasive hematoma aspiration performed within 24 h of intracerebral hemorrhage, especially those within 6 h, would reduce the pyramidal tract's injury, promote the repair of pyramidal tract and improve the neurological function.
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ObJective To summarize the microsurgieal techniques through direct Sylvian fissure approach. Methods A retrospective analysis was conducted in 62 patients undergoing microsurgeries through direct Sylvian fissure approach, including 4 with cavernous angioma in the Sylvian fissure, 5 with insular lobe tumors, 33 with middle cerebral artery aneurysms, 15 with glioma spanning or invading the Sylvian fissure, 1 with metastatic tumor, 2 with arteriovenous malformations, and 2 with temporal lobe epilepsy. Results All the vascular lesions were exposed satisfactorily and managed appropriately. Of the 19 cases ofgliomas and metastatic tumors, total resection was achieved in 13 cases, and subtotal resection in 6 cases. Transient aphasia or hemiparesis occurred postoperatively in a few patients but all recovered within 1 or two months. Conclusions The Sylvian fissure provides a good surgical route as a subarachnoid space between the frontal, parietal, temporal and insular lobes. The Sylvian fissure should be carefully separated under the operating microscope with high-power magnification, and tension-free retaction is critical in important language areas. In the management of tumors involving the Sylvian fissure, we recommend that extended resection be performed after exposure and appropriate preservation of important blood vessels in the fissure.
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Objective To explore the surgical skills, therapeutic effects and complications of selective amygdalohippocampectomy via the inferior temporal gyrus approach for treatment of mesial temporal lobe epilepsy (MTLE). Methods Sixty-two patients with medically intractable MTLE underwent selective amygdalohippocampectomy. Temporal keyhole craniotomy was performed, and the mid-anterior segment of the inferior temporal gyrus was resected to access the anterolateral floor of the temporal horn. The mesial temporal structures such as the amygdale and the parahippocampal gyrus were selectively resected. Results All the patients were followed up for at least 2 years (range 24-80 months) after the surgery. Obvious improvement of the neuropsychological function was achieved in these patients after the operation, without serious surgical complications. Forty-five patients (72.6%) had Engel's Class Ⅰ, 12 (19.4%) had class Ⅱ, and 5 (8.0%) had class Ⅲ outcomes after the operation. Conclusion The inferior temporal gyms approach allows minimally invasive amygdalohippocampectomy that preserves both the optic radiation and the language area, and can be especially effective in patients with epileptic lesions limited to the mid-anterior temporal lobe.
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Objective To study the treatment effect of linear accelerator radiosurgery (X knife) on trigeminal neuralgia and the complications. Methods Follow-up was conducted in 42 cases of trigeminal neuralgia treated with linear accelerator radiosurgery in our department, and their complications and degree of pain relief were recorded. Results Outcomes were excellent in 14 (33.3%), good in 22 (52.4%), effective in 4 (9.5%) and poor in 2 (4.8%). The mean time of pain relief was 2.1 months. Seven (16.7%) cases experienced increased facial paresthesia. Conclusion Linear accelerator radiosurgery is a precise and effective treatment for trigeminal neuralgia.