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Objective@#To examine the effect of posterior reduction in atlantoaxial dislocation (AAD) associated with basilar invagination(BI) using Xuanwu occipital-cervical fusion system in single stage.@*Methods@#Thirty-seven AAD accompanied with BI cases treated at Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy and the Second Hospital of Hebei Medical University were retrospective analyzed. There were 15 males and 22 females with age of (42.3±12.3) years (range: 18-69 years). All the cases had congenital osseous abnormalities, such as assimilation of atlas and abnormal cervical fusion. Anterior tissue was released through posterior route followed by cage implantation into facet joint and occipital-cervical fixation with cantilever technique. The clinical results were evaluated using Japanese Orthopedic Association scale(JOA) and the main radiological measurements including anterior atlantodental interval (ADI), the distance of odontoid tip above Chamberlain line, clivus-canal angle(CCA) and the length of syrinx were collected. The preoperative and postoperative JOA score and radiological measurements were compared by paired t-test.@*Results@#The mean JOA score of the patients increased from 10.5 to 14.4 at the one-year follow-up(t=14.3, P=0.00). Complete reduction of AAD and BI was achieved in 34 patients.The mean clivus-canal angle improved from (118.0±6.5) degrees preoperative to (143.7±5.0) degrees postoperative(t=6.2, P=0.00). Shrinkage of the syrinx was observed 1 week after surgery in 24 patients, and 6 months in 31 patients.Twenty-eight patients achieved bone fusion 6 months after surgery. All the patients achieved bone fusion 12 months after surgery. One-side vertebral artery occlusion was diagnosed in 1 case postoperatively for transient dizziness, and relieved in 2 weeks.Two patients developed moderate neck pain after surgery, and relieved in 1 month. No implant failure, spacer subsidence or infection was observed.@*Conclusions@#The treatment of AAD associated with BI using Xuanwu occipital-cervical fusion system from posterior approach in single stage is effective and safe. Cage implantation intraarticularly and fixation with cantilever technique achieve complete reduction in most cases.
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Moyamoya disease is a cerebrovascular disease w hich is characterized by progressive cerebrovascular stenosis and occlusion. The direct and indirect revascularizations modalities are the preferred methods for the treatment of moyamoya disease now . This article review s the surgical modalities of moyamoya disease.
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Objective To observe dynamically the influence of Insulin-like growth factor-1 (IGF-1) on the nerve function and expression of bFGF protein and Basic fibroblast growth factor(bFGF) mRNA after cerebral ischemic reperfusion in rats.Methods Seventy-two SD rats were randomly divided into sham-operated group,cerebral ischemia group,and IGF-1 treated group.The rat model of middle cerebral artery occlusion (MCAO) and reperfusion was performed.The evaluation of etiology was performed with mNSS at 12 h,24 h,3 d,7 d after ischemia-reperfusion,expression of bFGF protein was determined with immunohistochemical technique and expression of bFGF mRNA was determined with RT-PCR.Results The ratings of mNSS in IGF-1 treated group((8.67± 1.21),(7.50± 1.52),(4.33± 1.03),(3.67± 1.37)) were lower than those in ischemia group((11.0±1.26),(9.83±1.33),(7.83±1.17),(7.17±1.72) at 12 h,24 h,3 d or7 d after reperfusion(P＜0.05).For the IGF-1 treated group,the expression level of bFGF protein was higher than that of the cerebral ischemia group (P＜0.05),especially at 12 h after reperfusion (P＜0.01).The expression level of bFGF mRNA in the IGF-1 treated group was higher than that of the cerebral ischemia group (P＜ 0.05),especially at 24h after reperfusion (P＜ 0.01).Conclusion IGF-1 treatment has a protective effects on cerebral ischemia injury,which may contribute to its action on regulating expression of bFGF protein and bFGF mRNA.
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Objective To investigate the effects of rapamycin on the expression of glioma patients tumor helicase RECQ1.Methods 50 glioma patients admitted to the department of neurosurgery in second hospital of hebei medical university were selected and randomly divided into 2 groups,25 patients in control group,were treated with routine admission surgical treatment;25 cases in the experimental group,firstly were given rapamycin capsule 1 mg,1 times/day orally,took 14 days in a row,and had surgical treatment after stopping drug a week.Glioma tissue samples were taken during the operation,mRNA and protein expression of tumor helicase RECQ1 were detected by reverse transcriptase polymerase chain reaction(RT-PCR)and Western blot.Results Glioma tumor helicase RECQ1 mRNA expression in the control group increased more significantly than experimental group,the optical density value in control group was(1.657 ±0.748),while the experimental group optical density value was(1.059 ±0.894),and the difference was statistically significant(P<0.05 );all organizations had the expression of tumor helicase RECQ1 protein,but gliomas tumor helicase RECQ1 protein expression in the experimental group patients(0.952 ±0.021)was significantly lower than that in the control group(1.211 ±0.024),and the difference was statistically significant(P<0.05).Conclusion Rapamycin capsule could reduce the expression of mRNA helicase RECQ1,inhibit DNA glial tumor cells of brain replication,effectively kill cancer cells,control the the progress of brain glioma,and improve prognosis,worth clinical promotion.
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Objective To investigate the expression of Toll-like receptor 4 (TLR4),and explore its relationship with neurological function after fluid percussion brain injury in rats.Methods 56 adult rats were randomly divided into traumatic brain injury group(TBI group,n=48) and sham operation group(SO group,n=8).The experimental models were established.The water content of edematous brain and the expression of TLR4 were measured with dry-wet measure,immunohistochemistry and Western Blot at 1 h,6 h,12 h,24 h,3 d,7 d after shock respectively.Results Compared with SO group,neuronal function score decreased in TBI group from 6 h(3.86±0.42),reached to the lowest level at 24 h(2.65±0.32),and gradually rose at 3rd day (3.25±0.17).TLR4 immunoreactive expression increased from 6 h,reached its maxmum at 24 h,lasted to 3rd day,and then began to drop at 7th day.The linear regression analysis indicated that expression of TLR4 had negative correlation with change of neuronal function score (r 1 =-0.824,r w =-0.867,P＜0.05).Conclusion TLR4 expression is upregulated following fluid percussion injury in rats and involved in neurological function impairment by inducing secondary inflammatory brain injury.
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Objective To investigate the expression of inflanmatory cytokines such as interlukin-1β (IL-1 β),interlukin-6 (IL-6),tumor necrosis factor-α (TNF-α) and intercelluar adhesion molecule-1 (ICAM-1),and explore their relationships with neuronal function score after fluid percussion brain injury in rats.Methods The experimental models were established in 48 adult rats.The water content of edematous brain and the expression of IL-Iβ,IL-6,TNF-α and ICAM-1 were measured with dry-wet measure,immunohistochemistry at 6 h,12 h,24 h,3 d,7 d after operation respectively.Results Compared with animals of shame operation (SO) group,neuronal function score decreased in TBI group from 6h (3.78±0.84),reached to the lowest level at 24h (2.65±0.32),and gradually increased at 3d (4.75±0.71).IL-6,IL-1β,TNF-α and ICAM-limmunoreactive expression increased from 6h,reached its maxmum at 24h,lasted to 3th day,and began to decrease at 7d.The linear regression analysis indicated that expression of IL-1β,IL-6,TNF-α and ICAM-1 had negative correlations with change of neuronal function score(r=-0.912,r=-0.892,r=-0.794,r=-0.887 respectively,P＜0.05).Conclusion IL-6,IL-1β,TNF-α and ICAM-1 expression is upregulated following fluid percussion injury in rats,and shows negative correlations with neuronal function score.The possible mechanisms is that inflammatory cytokines are involved in nerve function impairment by inducing secondary brain injury.
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ObjectiveTo observe the relationship between neuronal function score and pathological changes of fluid percussion brain injury in rats and to explore their clinical significances.MethodsThe fluid percussion models of brain injury in rats were established by using the improved device with three kinds impact pressure such as 0.1 MPa,0.2 MPa,0.3 MPa,and vital signs and mortality rate were observed.Behavior changes,brain water content,histological changes were observed by Shapira and Wahld method,dry-wet measure,light microscopy at 1 h,6 h,12 h,24 h,3 d and 7 d after operation respectively.ResultsThe animals accepted impact pressure of 0.1 MPa showed temporary hypopnea with mortality rate of 2.08％,those of 0.2 MPa suffered apnoea of ( 10.88 ±2.69 ) s with mortality rate of 4.17％ and those of 0.3 MPa suffered apnoea of ( 20.60 ± 3.02 ) s with mortality rate of 16.67％.As the impact pressure increased,nervous function score minimumly decreased to (7.17 ±0.75) of 0.1 MPa group,(4.83 ± 0.75 ) of 0.2 MPa group and (2.67 ± 0.52) of 0.3 MPa group respectively,and recovered more slowly.Brain water content maximumly reached to (81.12 ± 0.03 )％,(82.74 ± 1.11 )％ and (83.89± 0.04) ％ at time point of 24 h respectively.The brain injury was involved in the outer layer of cerebral cortex,hippocampal formation and brain stem respectively and histological observation verified above findings.Conclusion Light,moderate and heavy fluid percussion brain injury in rats have more and more low nervous function scores,which have positive relationship with more and more serious pathological changes.
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ObjectiveTo observe the relationship between neuronal function score,brain edema and aquaporin4(AQP4) expression of fluid percussion brain injury in rats.MethodsThe fluid percussion models of brain injury of rats were established by using the improved device.Nervous function score,brain water content,histological changes,AQP4 expression were observed by Shapira and Wahld method,dry-wet measure,light microscopy,immunohistochemistry and western blot at 1 h,6 h,12 h,24 h,3 d and 7 d after operation respectively.ResultsNervous function score in TBI group decreased at 12 h( 11.17 ± 1.32),reached its minimum at 24 h( 10.17± 0.75),and recoved partially at 3rd day( 10.66 ± 1.37 ).The water content obviusly increased in those of TBI group at 12h( (80.27 ±1.47)％ ),reached its peak at 24h( (82.19 ±0.97)％ ),and then began to drop at 3d ( (8 1.74 ± 1.69 ) ％ ),while Western blot showed that AQP4 immunoreactive expression obviusly increased at 12 h (OD:0.65 ±0.05),reached its maximum at 24h( OD:0.72 ±0.08),and decreased at 3d( OD:0.56 ±0.07),and immunohistochemistry showed the same trendency of AQP4 expression as that of Western blot.The linear regression analysis indicated that nervous function score had a negtive correlation with expression of AQP4 in edematous brain and change of brain water content respectively ( r =- 0.615,P ＜ 0.01 ; r =- 0.605,P ＜ 0.05 ).ConclusionNervous function score of fluid percussion brain injury in rats decrease,has negative relationship with brain edema and AQP4 expression,and possible mechanisms is that AQP4 is indirectly involed in nerve function impairment by mediating brain edema.