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Objective To study the clinical efficacy of modified posterior occipital fusion in atlantooccipital and atlantoaxial dislocation in children and adolescents. Methods The clinical data of 11 children or adolescents with atlantooccipital and atlantoaxial dislocation, admitted to and accepted modified posterior occipital fusion in our hospital from November 2013 to March 2018, were retrospectively analyzed. Before and after the surgery, Japanese orthopedic association (JOA) scale was used to evaluate the cervical vertebral function of the patients, the atlanto-dens interval (ADI) was measured by CT images to evaluate the dislocation and reduction of joints, and the medulla bulbar cervical medulla angle (CMA) of the patients was measured by MR imaging to evaluate the degrees of spinal cord compression. Results The clinical symptoms of 11 patients improved in different degrees. No postoperative complications occurred. JOA scale scores after operation were significantly higher than those before operation (15.0±1.0 vs. 12.2±1.6). Significantly decreased of ADI and significantly increased CMA after operation were noted as compared with those before operation (P<0.05). Conclusion Modified posterior occipital fusion is safe and effective for treatment of atlantooccipital and atlantoaxial dislocation in children and adolescents.
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Objective To explore the pathogenic gene for the family with central nervous system hemangioblastoma (CNS-HB) in Luodian County,Guizhou Province and the pathologic features of familial and sporadic CNS-HB.Methods The peripheral blood from 42 members of the family with CNS-HB was obtained for DNA extraction.The exons 1,2 and 3 of VHL gene were amplified and sequenced by PCR.Light microscopy and immunohistochemical staining were applied for pathological observation of the tumor tissues harvested intraoperatively from 6 cases of the familial CNS-HB and from another 9 cases of sporadic CNS-HB as controls.A total of 9 specimens of familial CNS-HB (6 cystic and 3 solid) and 9 specimens of sporadic CNS-HB (8 cystic and one solid) were harvested.Results VHL gene mutations were not detected among the 42 members of familial CNS-HB.HE staining showed that the tumors were made up of capillary network and large vacuolated interstitial cells with abundant cytoplasm which were pale eosinophilic,polygon-shaped,foamy or ground-glass opaque,and scattered between the capillary network.No nucleus fission or necrosis was observed.Immunohistochemical staining showed the positive expression of Inhibin-α was 11/18 and that of Ki-67 was 14/18 in the interstitial cells and the positive expression of CD31 in the endothelial cells was 17/18.There were no significant differences between familial and sporadic CNS-HB in the positive expression of Inhibin-α,Ki-67 or CD31 (P＞0.05).Conclusions The pathogenesis of familial CNS-HB may be associated with not only VHL gene mutation but also other factors.Familial and sporadic CNS-HB may be similar in pathological features.
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Objective To investigate changes of relative pituitary hormones in adults with traumatic brain injury (TBI) and the related clinical significance.Methods Quantitative analysis and dynamic observation of relative pituitary hormones were performed in 158 TBI patients by electrochemical luminescence method.Measured indices included plasma total cortisol (PTC),free triiodothyronine (lT3),free thyroxine (FT4),thyrotropin (TSH),growth hormone,follicle stimulating hormone (FSH),luteinizing hormone (LH),estradiol,testosterone,and prolactin.Results Prolactin and PTC increased in the acute phase,but gradually reduced three days after trauma.TSH,FT3,and FT4 slightly decreased after trauma,followed by a gradual return.While there were no significant changes in FSH,LH,estradiol,testosterone,and growth hormone after trauma.Changes in relative pituitary hormones were more profound in patients with a lower GCS.Some patients presented different degree of reduced hormones in recovery period and needed hormone replacement therapy.Among the patients with poor activity of daily living (ADL),lvothyroxine replacement therapy was applied in 2 patients (2/6),prednisone acetate in 1 (1/6),and eleven acid testosterone in 2 (2/6).Among patients with mild ADL,levothyroxine replacement therapy was applied in 2 patients (11％),prednisone acetate in 1 (6％),and eleven acid testosterone in 3 (17％).Among patients with good ADL,levothyroxine replacement therapy was applied in 2 patients (4％) and eleven acid testosterone in 3 (6％).Persistent prolactin elevation was found in patients with poor outcome.Conclusions Changes of relative pituitary hormones in adult patients with TBI are associated with severity and duration of trauma.Abnormal prolactin level can affect outcome of the patients.
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Objective To explore the dynamic changes and clinical significance of relative pituitary hormones in children after craniocerebral injury.Methods The quantitative analysis and dynamic observation were performed in 125 children after craniocerebral injury and 20 voluntary healthy children of relative pituitary hormones including serum prolactin(PRL),cortisol(PTC),three free triiodothyronine (FT3),free thyroxine (FT4),thyroid stimulating hormone (TSH),growth hormone (GH) by applying electrochemical luminescence method.Tbe hormone variational characteristics were analyzed according to posttraumatic time,Glasgow Coma Scale(GCS) scores on admission and Glasgow Outcome Scale (GOS) scores on discharge,and the relationship between hormone variational characteristics of 58 cases was followed up over 2 years and the activities of daily living (ADL) were also investigated.Results The serum PRL was significantly increased on the first,third and fifth day compared with the healthy control group (P =0.000 0,0.000 0,0.006 7),respectively.There was significant difference between mild,moderate and severe groups within 30 days after suffering from craniocerebral injury (P ＜ 0.05).PTC was heavily increased within 3 days,and significant difference existed among mild and moderate groups mild and severe groups (all P ＜ 0.05) ; TSH,FT3,FT4 decreased slightly after injury and gradually rose in later;GH change wasn't significant;and the larger variation of relative pituitary hormones was responsible for lower GCS scores;FT3,FT4,TSH,and GH decreased in different degrees,which were found in parts of children with craniocerebral injury,and the significant difference of serum PRL existed between GOS scores 4-5 and GOS scores 1-3 groups (P =0.000 1).Conclusions The changes of relative pituitary hormones were associated with the posttraumatic time and the severity of craniocerebral injury.The PRL in serum can aid in prediction of outcome for the children with craniocerebral injury.
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Objective To investigate the localization and surgical outcome of epileptogenic nidus of post-traumatic epilepsy. Methods A retrospective analysis was performed on clinical data of 62 patients with post-traumatic epilepsy treated microsurgicallly from November 2005 to May 2009. There were 48 males and 14 females, at age range from 11 to 48 years old (average 28.8 years old). The epileptogenic nidus in 59 patients was localized based on clinical manifestations, visual electroencephalography (V-EEC) imaging and electrophysiological findings and that in three patients localized by implanted intracranial electrodes. Under electrocorticogram (ECoG) monitoring, we resected cerebral malacia in 36 patients, removed both malacia and epileptogenic nidus in 15, and partially resected cerebral malacia combined with cortex thermocoagulation in 11. Results The follow-up for 6-33 months showed that there were 32 patients at grade Ⅰ , 17 at grade Ⅱ , nine at grade Ⅲ and four at grade Ⅳ according to Engel classification system. Conclusion V-EEG is an important method for pre-operative localization of epileptogenic nidus of post-traumatic epilepsy. Microsurgical management can attain favorable outcome under ECoG monitoring.