How to deal with cerebral palsy in 21st century--a new epoch in clinic treatment / 中国应用生理学杂志

The aims of this paper were to define (1) criteria of cerebral palsy; (2) classification of cerebral palsy; (3) etiology, neuroimaging, and epidemiology of cerebral palsy; (4) different kinds of treatments of cerebral palsy. Data were drawn from an international survey of PUBMED (1994-2014) and CNKI (1994-2014). An expert panel used a consensus building technique. The10-point Jadad scale was used to assess the quality of the trials based on the following items, including allocation sequence generation, randomization concealment, methods of blinding, and descriptions of withdrawals and dropouts. Our clinical experience was also summarized. Below is a summary. (1) Further work is warranted to reach agreement for the classification of cerebral palsy. (2) A worldwide prevalence of 1.5-4.0 per 1 000 live births, with an average lifetime cost of 1 million dollars per person in the United States, while it is 1.8-6.0 per 1000 live births in China. (3) Comparison of clinical efficacy of different treatments. In this review, the current advances in different kind of treatments of brain injury are discussed with specific relevance to cerebral palsy.

Magnetic resonance spectroscopy-guided stereotactic biopsy for brain lesion / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical value of magnetic resonance spectroscopy (MRS) image in stereotactic biopsy for brain lesion.</p><p><b>METHODS</b>From April 2008 to April 2010, 126 cases (72 male and 54 female, aged from 10 to 82 years, mean 45 years) of brain lesion which were difficult to diagnose were divided into two groups by random number table, 62 cases were executed for MRI-guided frameless stereotactic biopsy (MRI group), 64 cases were executed for MRI and MRS-guided frameless stereotactic biopsy (MRS group). Operation used MRI and Three-dimensional MRS image to locate, and used frameless CAS-R-2 robots to carry out the positioning operating.</p><p><b>RESULTS</b>No surgery-related deaths and infections. Pathological diagnosis was 106 cases of brain tumors, 6 cases of inflammatory disease, 4 cases of tumor-like demyelinating disease and multiple sclerosis, 3 cases of neurodegenerative disease, 7 cases failed to obtain positive pathological diagnosis. The total rate of positive diagnosis was 94.4%, the positive rate in MRS-guided stereotactic biopsy group was 98.4% (63/64), the positive rate of conventional MRI-guided biopsy group was 90.3% (56/62), and there was statistically significant difference between the two groups (χ(2) = 3.92, P = 0.047). Four cases presented with postoperative complications, the complication rate was 3.2% (4/126); the complications were cerebral hemorrhage associated with aphasia, epilepsy, subcutaneous hematoma, gastrointestinal bleeding, which were improved after treatment.</p><p><b>CONCLUSIONS</b>MRS-guided stereotactic biopsy group has a higher positive rate than MRI-guided stereotactic biopsy group, indicating that this method can improve the positive rate of diagnosis, and thus will help to formulate treatment plan for brain lesion.</p>

Experimental study of angiography using vascular interventional robot-2(VIR-2) / 中华外科杂志

<p><b>OBJECTIVE</b>To verify the feasibility and safety of new vascular interventional robot system used in vascular interventional procedures.</p><p><b>METHODS</b>Vascular interventional robot type-2 (VIR-2) included master-slave parts of body propulsion system, image navigation systems and force feedback system, the catheter movement could achieve under automatic control and navigation, force feedback was integrated real-time, followed by in vitro pre-test in vascular model and cerebral angiography in dog. Surgeon controlled vascular interventional robot remotely, the catheter was inserted into the intended target, the catheter positioning error and the operation time would be evaluated.</p><p><b>RESULTS</b>In vitro pre-test and animal experiment went well; the catheter can enter any branch of vascular. Catheter positioning error was less than 1 mm. The angiography operation in animal was carried out smoothly without complication; the success rate of the operation was 100% and the entire experiment took 26 and 30 minutes, efficiency was slightly improved compared with the VIR-1, and the time what staff exposed to the DSA machine was 0 minute. The resistance of force sensor can be displayed to the operator to provide a security guarantee for the operation. No surgical complications.</p><p><b>CONCLUSIONS</b>VIR-2 is safe and feasible, and can achieve the catheter remote operation and angiography; the master-slave system meets the characteristics of traditional procedure. The three-dimensional image can guide the operation more smoothly; force feedback device provides remote real-time haptic information to provide security for the operation.</p>

Clinical experience of stereotactic biopsy for the brain lesions / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the methodology of diversified advanced image-guided stereotactic biopsy for the brain lesions, and its diagnostic significance and experience in nervous system diseases.</p><p><b>METHODS</b>Retrospectively reviewed 1187 cases of brain lesions underwent image-guided stereotactic biopsy from December 1987 to January 2009. There were 694 male (58.5%) and 493 female (41.5%) patients, aged from 1 to 85 years (average 39.7 years). There were 607 cases in CT-guided, including positron emission computed tomography (PET) guided stereotactic biopsy; 580 cases in MRI-guided, including proton magnetic resonance spectroscopy ((1)H-MRS) guided stereotactic biopsy. Routine frame was used in 726 cases and frameless stereotactic biopsy in 461 cases, including neuroendoscopic biopsy in 28 cases, guided by computer assisted surgery (CAS) computer-assistant robot. In the early 450 cases, CT/MRI images films were employed to measure the coordinates of the target by hand, while in the late 737 cases, computer-assistant planning software rebuilt the CT/MRI images and figured out the optimal neurosurgical path for biopsy.</p><p><b>RESULTS</b>The positive diagnosis rate of biopsy was 97.4%, 983 (82.8%) cases were diagnosed pathologically as brain tumors, and 173 (14.6%) cases as non-tumor diseases. The tumors mainly including neuroglioma, metastatic tumor, primary central nervous system lymphoma and germ cell tumors. In non-tumor diseases, mainly including multiple sclerosis, tumefactive demyelinating lesion, neurodegenerative disease, inflammation and parasite. The biopsy operation caused small hematoma without neurological deficits in 20 cases (1.7%), and caused large hematoma (> 10 ml) which need neurosurgical treatment (catheterization or craniotomy evacuation of hematoma) in 9 cases (0.8%). Hemorrhage associated with biopsy caused 3 cases (0.3%) death. There were no severe intracranial infection cases.</p><p><b>CONCLUSIONS</b>The stereotactic biopsy with advanced image-guided technique represents a safe, reliable and minimally invasive method for pathological diagnosis of intracranial lesions. Moreover, the developments of biochemical imaging gives a new concept to the stereotactic biopsy.</p>

Experimental study of angiography using vascular interventional robot / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the feasibility and safety of vascular interventional surgery by using vascular interventional robot system (VIRS).</p><p><b>METHODS</b>VIRS included image navigation systems and body propulsion systems, and adopted a master-slave structure. The surgeon sat at the master site, sending controlling instructions to the robot fixed at the slave site, and then the robot translated these instructions into catheter motion. A 3D vascular model was reconstructed so that the surgeon can perform surgical planning easily. In glass model and animal experiments, the surgeon remotely controlled VIRS, which inserted a catheter into predefined targets, and the catheter positioning error and robotic surgery time were measured.</p><p><b>RESULTS</b>The robot was initially tested on a glass vascular model. Under robotic manipulation, the catheter could enter an arbitrary branch of the vascular model. The catheter positioning error was less than 1 mm. Then robotic interventional surgery was performed successfully in ten adult dogs. The renal artery and the vertebral artery angiography carried out smoothly without complication. Experiment took 35 minutes, and the time what staff exposed to the digital subtraction angiography (DSA) machine was 0 minute.</p><p><b>CONCLUSION</b>Vascular interventional surgical robot system is safe and feasible, and can achieve the catheter remote operation, meet the requirements of angiography basically.</p>

Application of endoscopic biopsy and third ventriculostomy in the diagnosis and treatment of pineal germ cell tumor / 中华神经医学杂志

Objective To investigate the value of endoscopic biopsy and third ventriculostomy in the diagnosis and treatment of pineal germ cell tumors. Methods Endoscopic biopsy and third ventricuiostomy were performed in 20 patients with pineal tumors to relieve obstructive hydrocephalus and determine the nature of the neoplasms. Results CT and magnetic resonance imaging confirmed successful third ventriculostomy and biopsy in the 20 cases with total relief of obstructive hydrocephalus. The diagnoses of germ cell tumors were established in all this cases. Conclusions Endoscopic biopsy and third ventriculostomy are effective and safe neuroendoscopic procedures in minimally invasive management of pineal region germ cell tumors.

The expressional alterations of CSF-1R after ischemic injury of cerebral cortex / 中国应用生理学杂志

<p><b>AIM</b>To observe the expressional alterations of colony stimulating factor-1 receptor (CSF-1R) after ischemic injury of cerebral cortex, and study the function of colony stimulating factor-1 (CSF-1)/CSF-1R signal during the process of ischemic injury and repair of central nervous system (CNS).</p><p><b>METHODS</b>We examined the distribution and expression of CSF-1R in normal brain tissues and ischemic brain tissues by immunohistology and Western blot analysis.</p><p><b>RESULTS</b>The expression of CSF-1R in neurons could be up-regulated by ischemic injury in CNS.</p><p><b>CONCLUSION</b>CSF-1/CSF-1R might take part in the process of ischemic injury and repair.</p>

Identification of novel genes related to glioma by oligonucleotide microarray / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To identify the genes differentially expressed in development of human glioma, and to study the expression of some genes in different grade gliomas.</p><p><b>METHODS</b>Oligonucleotide microarray (including 218 genes related to neural system development) was adopted and hybridized with probes which were prepared from the total RNAs of glioma specimens and normal brain tissues. Differentially expressed genes between the normal tissues and glioma tissues were assayed after scanning oligonuceltide microarray with ScanArray 4000, and some of these genes such as smad1, Hmp19 and TRIP3 were verified by real-time quantitative PCR(real-time-Q-PCR) method.</p><p><b>RESULTS</b>In comparison with the genes in the normal brain tissue, 5 down-regulated and 5 up-regulated genes in glioma specimens were revealed by means of microarrays, and the expression of smad1, Hmp19 and TRIP3 were verified by real-time-Q-PCR assay.</p><p><b>CONCLUSION</b>Multiple genes play important roles in development of glioma. cDNA microarray technology is a powerful technique in screening for differentially expressed genes between glioma tissues and normal brain tissues. This study is helpful for judgement of invasion and prognosis of gliomas, and provides more target genes for targeted therapy.</p>

Diagnosis and radiotherapy of germinomas arising in basal ganglia and thalamus / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the clinical characteristic and radiotherapeutic effect of germinomas arising in basal ganglia and thalamus.</p><p><b>METHODS</b>The clinical data of 13 cases were reviewed retrospectively. All cases were pathologic diagnosis through stereotactic biopsy. Gamma-knife or ordinary irradiation were 2 cases respectively and the combined therapy with interstitial brachytherapy as foundation were 9 cases.</p><p><b>RESULT</b>All cases were male, median age of 16.1 years. Hemiparesis and ataxia were major symptoms, some cases were accompanied with precocious puberty. Imaging manifested intratumoral cystic components represented 76.9% of all lesions, calcification represented 30.8%, ipsilateral cerebral and brain stem hemiatrophy represented 46.2%, cerebral white matter invasion through internal capsule or corpus callosum represented 30.8%. One case died because of late complication and 12 cases had achieved satisfied therapeutic effect (the mean followed-up period was 40.6 months). Tumor-control were effective.</p><p><b>CONCLUSIONS</b>The clinical manifestation and imaging characteristics are helpful to diagnosis. Stereotactic biopsy make the affirmatory diagnosis. Operative total-removal is impossible because of deep location, neighbour of vital structure and invasion. The combined therapy with interstitial brachytherapy was effective.</p>

Clinical analysis of 1434 cases of frameless stereotactic operation / 中华外科杂志

<p><b>OBJECTIVE</b>Stereotactic operations were performed using a frameless stereotactic instrument manufactured by CAS-R-2 instead of traditional stereotactic frame. The aim of this study was to assess the clinical usefulness, accuracy and safety of frameless stereotactic instrument.</p><p><b>METHODS</b>The clinical data of 1434 patients was retrospectively reviewed. The mean age was 30.7 years (from 0.2 to 89.0 years). Each patient underwent frameless CT/MRI image-guided stereotactic surgery by this robot system from January 1997 to January 2006. The accuracy of position and improvement of symptom were observed. The averaged period of followed-up was 24 months (from 3 to 48 months).</p><p><b>RESULTS</b>The surgical procedures were performed successfully in all cases. All targets were pointed accurately at first time during the operation. The total effective rate was 93.3% without serious operation related complications.</p><p><b>CONCLUSIONS</b>Compared with the traditional stereotactic operations, this method has some advantages, such as releasing the patient's pain, convenience the doctors, extending the range of indications and increasing the safety and effective of operation.</p>

Clinical application of robotic tele-manipulation system in stereotactic surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the clinical usefulness, accuracy, and safety of tele-manipulation for frameless stereotactic surgery using the CAS-R-5 robot system.</p><p><b>METHODS</b>We prospectively evaluated 32 patients underwent tele-manipulation of frameless stereotactic operations from Sep. 2005 to Sep. 2006. Tele-manipulations were performed via a digital data network by a neurosurgeon in Beijing while the patients were located in Yan'an. The distance is 1300 kilometers away. The accuracy of location and improvement of symptom were observed after operation. The period of follow-up was from 3 to 14 months (the average was 12 months).</p><p><b>RESULTS</b>The surgical operations in 32 cases were successful. Remote fiducial registration was performed with a mean accuracy of 1. 50 mm and the standard difference were 0.32 mm between the planned and actual target. There were no complications.</p><p><b>CONCLUSIONS</b>Diagnosis and treatment for intracranial disease by tele-manipulation frameless stereotactic surgeries are reliable and safe.</p>