Characteristics of collateral circulation in adult moyamoya disease based on modified Suzuki staging / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the characteristics of collateral circulation in adult moyamoya disease (MMD).</p><p><b>METHODS</b>The clinical data were collected from all adult patients with MMD undergoing digital subtractive angiography (DSA) in our department from 2006 to 2016. Based on the imaging findings, the patients were divided into ischemia group and bleeding group. A double-blind analysis was conducted of the CT or magnetic resonance imaging findings and the severity of the disease was graded using the modified Suzuki score (mSS). We classified the anastomotic networks in MMD into the superficial meningeal type and deep parenchymal type. The superficial meningeal type was further classified into the leptomeningeal and the durocortical networks, and the deep parenchymal networks into subependymal networks and the inner striatal and inner thalamic networks.</p><p><b>RESULTS</b>No significant difference was found in the distribution of mSS scores between the hemorrhage group and the ischemic group (Χ=5.812, v=5, P=0.325), but the posterior communicating artery and internal carotid artery diameter ratio (Pcom/ICA ratio) was significantly greater in the hemorrhage group (t=2.119, v=108, P=0.036). The Pcom/ICA ratio differed significantly among the groups with different mSS scores (f=8.924, P=0.00), higher in groups with mSS scores of 3, 4 and 5. The incidence of anterior choroidal artery dilation differed significantly between hemorrhage and ischemic groups (Χ=11.79, P=0.001). The incidences of durocortical networks (Χ=0.327, P=0.567) and subependymal networks (Χ=0.011, P=0.917) were comparable between hemorrhage group and ischemic groups, but the incidence of leptomeningeal networks (P=0.018) and inner striatal and inner thalamic networks (Χ=7.551, P=0.006) differed significantly between the two groups.</p><p><b>CONCLUSION</b>The collateral circulation vascular system is an important component of cerebral blood flow in MMD patients and varies from patient to patient. Patients with MMD exhibit increased Pcom/ICA ratio with abnormal expansion of the anterior choroidal artery, and the leptomeningeal networks and the inner striatal and inner thalamic networks are independent risk factors for cerebral hemorrhage.</p>

MACF1 knockdown in glioblastoma multiforme cells increases temozolomide-induced cytotoxicity / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the role of microtubule-actin crosslinking factor 1 (MACF1) in the response of glioma cells to temozolomide (TMZ).</p><p><b>METHODS</b>TMZ was applied to a human gliomablastoma cell line (U87) and changes in the protein expression and cellular localization were determined with Western blot, RT-PCR, and immunofluorescence. The responses of the cells with MACF1 expression knockdown by RNA interference to TMZ were assessed. TMZ-induced effects on MACF1 expression were also assessed by immunohistochemistry in a nude mouse model bearing human glioblastoma xenografts.</p><p><b>RESULTS</b>TMZ resulted in significantly increased MACF1 expression (by about 2 folds) and changes in its localization in the gliomablastoma cells both in vitro and in vivo (P<0.01). Knockdown of MACF1 reduced the proliferation (by 45%) of human glioma cell lines treated with TMZ (P<0.01). TMZ-induced changes in MACF1 expression was accompanied by cytoskeletal rearrangement.</p><p><b>CONCLUSION</b>MACF1 may be a potential therapeutic target for glioblastoma.</p>

An improved method for stereotactic location of the supraoptic nucleus with oblique stereotactic puncture in rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To establish an improved method for stereotactic location of the supraoptic nucleus in rats.</p><p><b>METHODS</b>Twenty-four SD rats were randomly divided into experimental group (12 rats) and control group (12 rats) for oblique (20° to the left) stereotactic puncture (OSP group) and vertical stereotactic puncture (VSP group), respectively, both targeting the supraoptic nucleus (SON). The surgical data and postoperative (within 24) mortality of the rats were compared between the two groups.</p><p><b>RESULTS</b>The nucleus locating time was longer in OSP group than in VSP group (59.55∓3.64s vs 27.44∓2.18 s, P=0.000), and the postoperative mortality rate of the rats did not differ significantly between the groups (0 vs 44.4%, P=0.082). In OSP group, compared with VSP group, the procedure was associated with a lowered rupture rate of the superior sagittal sinus (11.1% vs 88.9%, P=0.003), a shortened hemostatic time after craniotomy (52.89∓24.05 s vs 157.445 ime a s, P=0.000) and after puncture (24.33 reas 45 s vs 133.89∓28.81 s, P=0.000), and also a shortened operation time (178.89 on tims vs 362.44 timees, P=0.000).</p><p><b>CONCLUSION</b>The improved method for locating supraoptic nucleus in rats is convenient, stable and reproducible, and helps to avoid important blood vessels and specific nuclei according to the needs of different experiments and allows the operators to choose different surgical paths.</p>

Onyx embolization for treatment of dural arteriovenous fistula: comparison of long- distance versus routine injection method / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the efficacy, clinical characteristics, safety, injection time and radiation exposure of Onyx embolization using a long-distance injection method and routine injection method for management of dural arteriovenous fistula (DAVF).</p><p><b>METHODS</b>The clinical data were retrospectively analyzed in 59 patients with DAVF treated with Onyx embolization using long-distance injection method (28 patients) and routine injection method (31 patients). The efficacy, safety, injection time and radiation exposure during Onyx embolization were compared between the two injections methods.</p><p><b>RESULTS</b>The average radiation dose exposure to the surgeon per procedure was significantly lower in the long-distance injection group than in the routine group. The injection time (P=0.53), injection volume (P=0.78), number of supply arteries (P=0.80), Cognard types (P=0.67), and effect of embolization (P=0.88) were all similar between the two groups.</p><p><b>CONCLUSION</b>Endovaseular treatment of intracranial DAVF with Onyx embolization using the long-distance injection method is feasible, safe and effective and can reduce the radiation exposure to the surgeon.</p>

Efficacy and safety of Willis covered stent for treatment of blood blister-like aneurysm / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the safety and short-term efficacy of Willis covered stent for treatment of blood blister-like aneurysms (BBA).</p><p><b>METHODS</b>Eight patients with BBA were treated with Willis covered stent system during the period from December 2014 to February 2016. The guiding catheter was placed as high as possible to facilitate the delivery of the covered stent system.</p><p><b>RESULTS</b>s Nine covered stents were implanted in the aneurysms of 8 patients (8 aneurysms), and 8 stents were released successfully in the parent arteries. In 6 patients, angiography immediately after stent release showed complete disappearance of the aneurysm and the parent arteries remained patent. One patient experienced a minor endoleak after stent implantation, and another stent was implanted to eliminate the endoleak. Iatrogeniccarotid-cavernous fistula occurred in 1 patient due to tortuosity of the parent artery, for which superficial temporal artery-to-middle cerebral artery bypass combined with parent artery occlusion was performed instead; the patient recovered smoothly and the bypass remained patent at 6 months after the operation. No other periprocedural complications occurred in these patients. Follow-up study showed no new-onset neurological deficits in these 8 patients, who had mRS score of 0 in 6 patients and of 1 in 2 patients. Digital subtractive angiography at 6 months after the operation demonstrated no aneurysm in these patients, and only one patient showed mild stenosis in the parent artery.</p><p><b>CONCLUSION</b>Willis covered stents are effective for treatment of BBA with good safety and short-term outcomes.</p>

RNA interference of PC4 and SFRS1 interacting protein 1 inhibits invasion and migration of U87 glioma cells / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of small interfering RNA (siRNA)-mediated silencing of PC4 and SFRS1 interacting protein 1 (PSIP1) on invasion and migration of human glioma U87 cells.</p><p><b>METHODS</b>Chemically synthesized siRNA targeting PSIP1 gene was transfected into U87 cells via lipofectamine, and the gene silencing effect was determined using real-time PCR. The changes in the invasion and migration abilities of the transfected cells were assessed with Transwell assay and wound healing assay, respectively. Western blotting was used to analyze the expression of N-cadherin, β-catenin and the transcription factor Slug.</p><p><b>RESULTS</b>The mRNA and protein level of PSIP1 was significantly reduced in U87 cells after transfection with PSIP1 siRNA (P<0.0001). PSIP1 knockdown in U87 cells resulted in significant suppression of cell invasion and migration abilities (P<0.01) and also reduced N-cadherin, β-catenin and Slug expressions.</p><p><b>CONCLUSION</b>s Silencing of PSIP1 impairs the invasion and migration abilities of glioma cells and lowers the expressions of N-cadherin, β-catenin and Slug, suggesting that PSIP1 may regulate Slug by classical Wnt/β-catenin signaling pathway to modulate epithelial-mesenchymal transition and promote the invasion and migration of glioma cells.</p>

Does Early Postsurgical Temozolomide Plus Concomitant Radiochemotherapy Regimen Have Any Benefit in Newly-diagnosed Glioblastoma Patients? A Multi-center, Randomized, Parallel, Open-label, Phase II Clinical Trial / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The radiochemotherapy regimen concomitantly employing temozolomide (TMZ) chemotherapy and radiotherapy (RT) 4 weeks after surgery, followed by 6 cycles of TMZ is a common treatment for glioblastoma (GBM). However, its median overall survival (OS) is only 14.6 months. This study was to explore the effectiveness and safety of early TMZ chemotherapy between surgery and chemoradiotherapy plus the standard concomitant radiochemotherapy regimen.</p><p><b>METHODS</b>A randomized, parallel group, open-label study of 99 newly diagnosed GBM patients was conducted at 10 independent Chinese neurosurgical departments from June 2008 to June 2012. Patients were treated with concomitant radiochemotherapy regimen plus early postsurgical temozolomide (early TMZ group) or standard concomitant radiochemotherapy regimen (control group). Overall response was assessed based on objective tumor assessments, administration of corticosteroid and neurological status test. Hematological, biochemical, laboratory, adverse event (AE), and neurological condition were measured for 24 months of follow-up. The primary efficacy endpoint of this study was overall survival (OS). The secondary endpoint was progression free survival (PFS).</p><p><b>RESULTS</b>The median OS time in the early TMZ group was 17.6 months, compared with 13.2 months in the control group (log-rank test P = 0.021). In addition, the OS rate in the early TMZ group was higher at 6, 12, and 18 months than in the control group, respectively (P < 0.05). The median PFS time was 8.7 months in the early TMZ group and 10.4 months in the control group (log-rank test P = 0.695). AEs occurred in 29 (55.8%) and 31(73.8%) patients respectively in early and control groups, including nausea (15.4% vs. 33.3%), vomiting (7.7% vs. 28.6%), fever (7.7% vs. 11.9%), and headache (3.8% vs. 23.8%). Only 30.8% and 33.3% were drug-related, respectively.</p><p><b>CONCLUSIONS</b>Addition of TMZ chemotherapy in the early break of the standard concomitant radiochemotherapy regimen was well tolerated and significantly improved the OS of the GBM patients, compared with standard concomitant radiochemotherapy regimen. However, a larger randomized trial is warranted to verify these results.</p>

Diagnosis and treatment of multiple intracranial aneurysms / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the diagnosis and treatment strategy of multiple intracranial aneurysms (MIA).</p><p><b>METHODS</b>We retrospectively analyzed 96 patients with MIA (234 aneurysms). The rupture site was determined on the basis of computed tomographic and angiographic findings, and the supposed ruptured aneurysm was treated with coiling OR clipping. All the patients' records were reviewed including all computed tomographic scans and angiograms.</p><p><b>RESULTS</b>Twelve patients received conservative treatment, 56 patients were treated by endovascular embolization, and 28 patients received clipping; 44 patients received one-stage treatment, and 4 patients needed a second therapy. In 36 patients, only the ruptured aneurysm was eliminated. The clinical outcomes of these 84 patients evaluated by Glasgow Outcome Scale grades were: absence of deficits in 62 patients, minor deficits in 12 patients, major deficit in 8 patients; death occurred in 2 cases. Thirty patients were available for a 6-month follow-up with DSA, which revealed stable occlusion of the aneurysms in 29 patients and the need of a retreatment due to recanalization in only one patient.</p><p><b>CONCLUSION</b>Correct localization of the rupture aneurysm based on a comprehensive diagnosis is key to MIA treatment. All the aneurysms should be treated in one session whenever possible to protect the patient from rebleeding.</p>

Dynamic changes of inflammation parameters in patients after neurosurgery / 中华神经医学杂志

Objective To observe the postoperative dynamic changes of body temperature (BT),C-reactive protein (CRP) and white blood cell (WBC) count.Methods One hundred and two consecutive patients with surgically treated intracranial or spinal lesions,admitted to our hospital from July 2011 to February 2012,were chosen and divided into group A (non infection) and group B (infection) depending on whether postoperative bacterial infections (POBIs) were occurred.Evaluation of postoperative BT and CRP levels,as well as WBC count,was performed.Results WBC and BT levels would elevate in majority of patients with or without POBIs one day after the operation; the difference between the two groups showed no significant difference (P＞0.05).Elevation of BT and WBC levels was noted in 23.8％ and 21.4％ patients from group A and in 88.9％ and 83.3％ patients from group B five days after the operation,with significant difference between the two groups (P＜0.05).Similar results were seen seven day after the operation.Five and seven days after the operation,78 patients (92.8％) and 68 patients (80.9％) still had abnormal CRP level in group A.ROC curve revealed that better diagnostic performance five and seven days after the operation could be found as compared with that one and three days after the operation.Conclusion Elevation of serum CRP,WBC and BT levels can occur in patients with or without POBIs on the first three days of neurosurgical operation; persistent anomalies or secondary elevation could indicate ongoing infection,which needs attention from clinic.

Reconstruction of frontal sinus and repair of cerebrospinal fluid leakage with complex of shapememory alloy brace and artificial dura in dog models / 中华神经医学杂志

Objective To explore the therapeutic effect of a new material--complex of shape-memory alloy brace and artificial dura (nitinol brace and NormalGEN) on reconstruction of frontal sinus and repair of cerebrospinal fluid leakage on dog models of lateral media skull base defect.Methods Seven adult healthy dogs were induced into models of frontal sinus defect and cerebrospinal fluid leakage; complex of nitinol brace and NormalGEN assisted by its corresponding apparatus was employed to reconstruct the defect and repair the leakage.The cranial profile,wound healing and leakage after operation were observed. Three months after the operation, cranial projections of X-ray,three-dimensional reconstruction of CT and 1.5T MRI were detected,and the histopathalogical outcome was noted. Results Seven dog models of frontal sinus defect and cerebrospinal fluid leakage were successfully established; 6 received reconstruction of frontal sinus and repair of cerebrospinal fluid leakage and survived without any complications as continuous leakage of cerebrospinal fluid,local tissue eminence and neurological function defect; 1 dead 5 d after the operation.The imaging detection showed that the nitinol brace was clear with satisfactory position without shift and artifact. Histopathalogical outcome showed that granulation tissue,which substituted NormalGEN,grew around the brace with a great quantity of fibroblast. Conclusion The complex of nitinol brace and NormalGEN assisted by its corresponding apparatus is suitable for reconstructing frontal sinus and repairing cerebrospinal fluid leakage in dog models.

Stereotactic lesioning of the amygadala and hippocampus in patients with epilepsy of the mesial temporal lobe / 中华神经医学杂志

Objective To investigate the efficacy of stereotactic lesioning of the amygadala and hippocampus for treatment of epilepsy in the mesial temporal lobe, and explore the accuracy of lateralization and localization of interictal epileptic discharge recorded by depth electrode. Methods Twenty-one patients with intractable epilepsy of the temporal lobe,admitted to our hospital from July 1998 to October 2003 and underwent stereotactic lesioning of the amygadala and hippocampus,were chosen in our study. The frequentcy of Interictal epileptic discharge recorded by depth electrode and occurred preoperatively and postoperatively were compared Results Follow-up was performed in 21patients:6 with Engel Ⅰ,2 with Engel Ⅱ,5 with Engel Ⅲ,3 with Engel Ⅳ and 5 with Engel V.Thirteen patients enjoyed good effect and ineffective result was noted in 8,with an effective rate reaching 62％.No consistent changes of interictal epileptic discharge recorded by depth electrode occurred preoperatively.Conclusion Stereotactic lesioning of the amygadala and hippocampus is safe and effective in treating patients with epilepsy in the mesial temporal lobe.The interictal epileptic discharge can supply useful lateralizing information,but has little localizing value.

Diagnostic characteristics of optic chiasm-hypothalamic glioma and its high misdiagnosis rate / 中华神经医学杂志

[Objective]To investigate the diagnostic characteristics of optic chiasm-hypothalamic glioma (OCHG) and the reasons for its high misdiagnosis rate.[Methods]Retrospective analysis was performed on the clinical features and imaging findings of 32 patients with OCHG,admitted to our hospitals from October 1999 to December 2011 and proved by pathology.Being compared with those features of other diseases in the sellar region,the reasons for high misdiagnosis rate of OCHG were analyzed.[Results] Among the 32 patients,18 were diagnosed correctly before surgery.However,in the other 14,lesions were misdiagnosed as craniopharyngioma in 8,germ cell tumor in 4,pituitary adenoma in 1,and chordoma in 1 with a total misdiagnosis rate reaching 43％.All patients suffered craniotomy surgery for tumor removal.Among the 4 patients misdiagnosed as having germinoma,2 underwent preoperative radiotherapy and 2 performed preoperative EP regimen chemotherapy.According to the features of the CT and MR images,the OCHG were divided into 3 presentations:solid,solid and cyst mixture and round enhanced tumors.The solid lesions (n=10) were easily misdiagnosed as germinoma (4/10,40％);however,the round enhanced tumors (n=5),especially combined with huge calcification (n=4),were extremely easily misdiagnosed as craniopharyngioma (4/5,80％ ).[Conclusion] Comprehensive understanding the growth and image features of OCHG and summing up the misdiagnosis points when comparing to the other diseases in the sellar region are indispensable in improving the presurgical diagnosis accuracy for OCHG.

Pathological features and origin of primary pineal mixed germ cell tumors / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the origin of mixed germ cell tumors in the pineal region based on the image data, surgical findings and pathological examination of the tumor.</p><p><b>METHODS</b>The preoperative CT and magnetic resonance imaging (MRI) findings and tumor specimens were retrospectively analyzed in 15 cases of pineal mixed germ cell tumors confirmed by postoperative histological examination between January 2000 and September 2010.</p><p><b>RESULTS</b>Radiographic examination of the tumor revealed calcification in 12 cases, cystic changes in 10 cases, and the presence of lipid in 5 cases. On the anteroposterior images, the tumors appeared round or elliptic with smooth edge in 6 cases, and showed irregular shape with multiple processes on the edge in 9 cases. Surgical exploration found all the tumors located in the the suprapineal recess enclosed by the arachnoidal envelope of the Galen vein. Pathologically, 13 specimens contained germinoma component, 9 contained teratoma component, 4 had embryonic carcinoma component, 3 had choriocarcinoma component, 7 showed yolk sac tumor component, and 3 showed rhabdomyoma component. Germinoma components were found on the tumor margin in 7 specimens, and intermingled germinoma and other components were found in 10 specimens.</p><p><b>CONCLUSION</b>Pineal mixed germ cell tumor originates from the residue germ cells around the pineal gland, and most likely evolves from single primordial germ cells.</p>

Surgical management of a complex intracranial dural ateriovenous fistula with deep hypothermia circulatory arrest: a case report and literature review / 南方医科大学学报

Hypothermia and cardiopulmonary bypass has been used for difficult lesions of the brain such as giant aneurysms. We reported a case of complex intracranial dural arteriovenous fistula (DAVF) undergoing surgery with deep hypothermic circulatory arrest (DHCA). The advantages and disadvantages of this operation were discussed. This is the first report describing the use of DHCA in the surgical management of complex intracranial DAVF. We also reviewed the literature documenting the treatment of DAVF and the history of deep hypothermia and circulatory arrest in cerebrovascular surgery.

Protective function of nimodipine on facial nerve injury and its effect on expression of glial cell line-derived neurotrophic factor / 中华神经医学杂志

Objective To study the protective function of nimodipine on facial nerve injury and its effect on the expression of glial cell line-derived neurotrophic factor (GDNF). Methods Ninety-six SD rats were randomly divided into sham-operated group, facial nerve injury group, nimodipine pretreatment group, and nimodipine post-treatment group. Rat models of facial nerve injury in thc later 3groups were established. The dynamic changes of expression of GDNF were observed by HE staining and Western blotting in different treatment groups and at different time points (1, 3 and 6 months after the injury). Restdts Compared with the facial nerve injury group, the nimodipine pretreatment and post-treatment groups had significantly less severe nerve damage and significantly up-rcgulated expression of GDNF (P＜0.05). The expression of GDNF in the nimodipine pretreatment group was statistically higher than that in the nimodipine post-treatment group (P＜0.05). However, the expression of GDNF in the nimodipine post-treatment group was not statistically different from that in the facial nerve injury group 3 and 6 months after the injury (P＞0.05). Conclusion Nimodipine has significant facial nerve protective effect, and one of the mechanisms of nimodipine to protect the facial nerve is to regulate the GDNF expression.

Neuroendoscopic therapy for hydrocephalus caused by cysts of the posterior fossa / 中华神经医学杂志

Objective To explore the process and technique ofneuroendoscopic operation in obstructive hydrocephalus caused by cysts of the posterior fossa. Methods An analysis of 31 patients with obstractive hydrocephalus caused by cysts of the posterior fossa, admitted to our hospital from April 2004 to August 2010, was performed; CT and MRI were performed on these patients. Among all the 31patients, 19 had arachnoid cyst of the posterior fossa, 5 Dandy-Walker malformations, 2 Blake' s pouch cyst, and 5 cysts after resection of the tumor. Treatment efficacy was determined according to the improvement of clinical symptoms, imaging manifestations and appearing of relative complications.Results Endoscopic management (n=14), microsurgery (n=9) and ventriculoperitoneal shunt (n=8) were performed. All the patients' postoperative hydrocephalus was alleviated in early stage of treatnent.Subsequent follow-up, ranged from 0.6 to 6 years, revealed a sharp reduction of sizes of the cyst and ventricle system under MRI in 28 patients, with a total effective rate of 87.1％. The effective rate and incidence of complications were 92.9％ and 14.3％ in patients performed endoscopic management, 88.9％and 33.3％ in patients performed microsurgery, and 75％ and 50％ in patients performed ventriculoperitoneal shunt, respectively.Conclusion Neuroendoscopic procedure is a safe and effective technique for hydrocephalus caused by cysts of the posterior fossa; as compared with those with microsurgery and ventriculoperitoneal shunt, higher success rate and less operative complications are achieved in patients with endoscopic management.

Intraoperative EMG monitoring in surgery of tumor in the floor of the fourth ventricle / 中华神经医学杂志

Objective To analyze the protective role of intraoperative EMG monitoring in surgical removal of tumors related to the floor of the fourth ventricle and its influencing factors.Methods Intraoperative EMG monitoring was performed during the surgical removal of 32 patients with brain tumor, admitted to our hospital from January 2007 to December 2010; among these 32patients, 11 was conformed as having medulloblastoma, 9 ependymoma, 6 brain stem cavernous hemangioma, 4 brain stem exogenous glioma and 2 hemangioblastoma of the dorsal brain stem. The influencing factors of intraoperative EMG monitoring and the possible damage of cranial nerve nuclei caused by these surgical procedures were analyzed.Results Twenty-one patients enjoyed total removal, 9 sub-total removal and 2 partial removal. Good function protection of patient's posterior cranial nerves was noted in 9 patients, mild impairment in 18 patients, and moderate dysfunction in 5 patients.The influencing factors of EMG monitoring included leaking electric current caused by bipolar coagulation, excessive use of muscle relaxant drugs, changes in depth of anesthesia, and rapid changes of patient′s temperature, saline temperature and blood pressure. Conclusion The intraoperative EMG monitoring can provide evidence about the location of the cranial motor nuclei during the surgical removal of the tumor related to the floor of the fourth ventricle and the function protection of patient’s posterior cranial nerves.

Expression of afamin in serum of patients with unruptured intracrauial aneurysm and its significance / 中华神经医学杂志

Objective To search the differenially expressed proteins in the serum of patients with unruptured intracranial aneurysm.Methods Eight patients with unruptured intracranial aneurysm,admitted to our hospital from July 2007 to September 2009,and 8 healthy adults(controls)were recruited in our study; two-dimensional differential in-gel electrophoresis(2D DIGE)and matrix-assisted laser desorption/ionization-time of flight mass spectrometry(MALDI-TOF-MS)were employed to analyze and identify the differentially expressed proteins in the serum of these patients and controls.Results As compared with the control group,patients with unruptured intracranial aneurysm had 29 differentially expressed proteins those enjoyed more than 1.5 folds differences; protein at spot 579was expressed as low as 1.81 folds in the serum of patients with unruptured intracranial aneurysm as compared with that in controls(P=0.008); the protein was identified as afamin using MALDI-TOF-MS.Conclusion The low expression of afamin in patients with unruptured intracranial aneurysm probably contributes to the formation and expansion of intracranial aneurysm.

Clinical study of pineal region tumors: experience with 132 patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To review the clinical manifestations, imaging, tumor markers, treatment methods, pathology results and clinical curative effects of pineal region tumors and to evaluate the characteristics and intervention strategies for those tumors.</p><p><b>METHODS</b>The clinicopathological data of 132 patients with pineal region tumor treated in our department between January 2000 and May 2008 were retrospectively studied.</p><p><b>RESULTS</b>A moderate predominance in males was presented. The clinical manifestations of the disease included increased intracranial pressure and ocular movement impairment. There were some features but no regularity and specific appearance on imaging including CT and MRI. 88.6% of patients associated with hydrocephalus. A high serum level of alpha-fetoprotein (AFP) was presented in 14 cases and high HCG in 9 cases. Eighteen cases received direct radiation therapy and 7 had radiotherapy post biopsy. 107 cases were treated surgically and 63 cases received postoperative adjuvant treatment. 114 cases had pathology results including 56 germ cell tumors. The patients were followed up for 12 approximately 132 months. Recurrence developed in 23 cases and 12 cases died. The 5-year survival rate was 89.3%.</p><p><b>CONCLUSION</b>Pineal region tumors are often associated with hydrocephalus and this makes preoperative diagnosis difficult. Imaging examination may help diagnosis but less specific. Germ cell tumors may diagnosed by some tumor markers. Radiation therapy is the choice of treatment for pure germinomas. Other types of pineal region tumors should receive surgical treatment. Postoperative adjuvant treatment based on pathology can provide a good prognosis in pineal region tumor.</p>

Microsurgical removal of huge tuberculum sellae meningiomas through bi-subfrontal anterior longitudinal fission approach / 南方医科大学学报

<p><b>OBJECTIVE</b>To summary the microsurgical techniques for removal of huge tuberculum sellae meningiomas through the bi-subfrontal anterior longitudinal fission approach.</p><p><b>METHODS</b>Eleven patients with huge tuberculum sellae meningiomas underwent microsurgical removal of the meningiomas between January, 2005 and November, 2009. The microsurgical techniques were summarized, and the factors affecting the prognosis were analyzed.</p><p><b>RESULTS</b>Among all the patients, 5 had Simpson grade I meningioma removal and the other patients had Simpson grade II removal. No death occurred in these patients. Nine patients showed vision improvement after the surgery, one had no significant improvement, and the other one experienced worsening of vision. Transient postoperative diabetes insipidus occurred in 5 cases.</p><p><b>CONCLUSION</b>With satisfactory exposure of Dorsum sellae, bottom of the third ventricle and cavernous sinus, the bi-subfrontal anterior longitudinal fission approach is suggested for treatment of tuberculum sellae meningiomas. The key to improve the GTR and reduce the complication lies in the sequence of the operation, namely resection of the tumoral basement before dissection of the potential arachnoidal space and tuberculum.</p>