Trans-foramen ovale biopsy of a parasellar lesion guided by intraoperative CT neuronavigation with MRI fusion: a case report.

A 23-year-old male presented with a parasellar lesion which was suspected as disseminated intracranial germ cell tumour. The diagnosis of germinoma was made using immunohistochemistry from percutaneous trans-foramen ovale biopsy. This report describes the role of neuronavigation-guided biopsy through the foramen ovale for lesions in the parasellar region.

BMP-2 suppresses renal interstitial fibrosis by regulating epithelial-mesenchymal transition.

Dysregulation of epithelial-to-mesenchymal transition (EMT) may contribute to renal fibrogenesis. Our previous study indicated that bone morphogenetic protein-2 (BMP-2) significantly reversed transforming growth factor (TGF)-ß1-induced renal interstitial fibrosis. In this study, we examined the underlying mechanism and elucidate the regulation of EMT process under BMP-2 treatment. Cultured renal interstitial fibroblast (NRK-49F) was treated with TGF-ß1 (10 ng/ml) with or without BMP-2 (10-250 ng/ml) for 24 h. The expression of α-smooth muscle actin (α-SMA), E-cadherin, fibronectin, or Snail transcriptional factors was analyzed by immunofluorescence staining or Western blotting. Cell migration was analyzed by wound-healing assay. NRK-49F treated with TGF-ß1 induced significant EMT including upregulatioin of α-SMA, fibronectin, and snail proteins and down-regulation of E-cadherin. Interestingly, co-treatment with BMP-2 dose-dependently reversed TGF-ß1-induced cellular fibrosis, cell migration, and above EMT change. The above effect was closely correlated with Snail since BMP-2 dose- and time-course dependently induced a significant decrease in the level of Snail. Moreover, Snail siRNA significantly reversed TGF-ß1-induced increases in the level of α-SMA and fibronectin (intracellular and extracellular). We suppose that BMP-2 have the potential to attenuate TGF-ß1-induced renal interstitial fibrosis by attenuating Snail expression and reversing EMT process.

Safety of the nonabsorbable dural substitute in decompressive craniectomy for severe traumatic brain injury.

BACKGROUND: Artificial dural substitutes are increasingly being used in decompressive craniectomy to prevent peridural fibrosis and facilitate cranioplasty for patients with head injury. The safety of the dural substitute should be systemically evaluated. We focus on Neuro-Patch (B. Braun, Boulogne, France), a nonabsorbable substitute and commonly used by neurosurgeons. METHODS: In this retrospective study, 132 patients undergoing 135 craniectomies and cranioplasties for traumatic brain injury were enrolled. We subdivided the operations into two groups on the basis of whether Neuro-Patch was used (N = 50) or not (N = 85). Risk factors of neurosurgical site infection were assessed first. Then, we compared the occurrence of infective, hemorrhagic, and hydrodynamic morbidities after craniectomy and cranioplasty between the two groups. RESULTS: The incidence of neurosurgical site infection after craniectomy or cranioplasty showed no intergroup difference (p = 1.000). Postoperatively, extra-axial hematoma, which consists of subdural or epidural hematoma, occurred in 9 of 50 craniectomies (18.00%) with Neuro-Patch and 3 of 85 craniectomies (3.53%) without Neuro-patch, which was significantly different (p = 0.009). The rates of hydrodynamic morbidities (subdural hygroma or cerebrospinal fluid leakage) after the procedures were similar between the two groups. CONCLUSIONS: The use of Neuro-Patch does not increase the incidence of neurosurgical site infection and hydrodynamic complications, including subdural hygroma and cerebrospinal fluid leakage, after decompressive craniectomy or cranioplasty for severe traumatic brain injury. However, extra-axial hematoma at the site of craniectomy is more often encountered in patients with Neuro-Patch and forms a compressive lesion on the adjacent brain.

Hyperosmolarity enhanced susceptibility to renal tubular fibrosis by modulating catabolism of type I transforming growth factor-beta receptors.

Hyperosmolarity plays an essential role in the pathogenesis of diabetic tubular fibrosis. However, the mechanism of the involvement of hyperosmolarity remains unclear. In this study, mannitol was used to evaluate the effects of hyperosmolarity on a renal distal tubule cell line (MDCK). We investigated transforming growth factor-beta receptors and their downstream fibrogenic signal proteins. We show that hyperosmolarity significantly enhances the susceptibility to exogenous transforming growth factor (TGF)-beta1, as mannitol (27.5 mM) significantly enhanced the TGF-beta1-induced increase in fibronectin levels compared with control experiments (5.5 mM). Specifically, hyperosmolarity induced tyrosine phosphorylation on TGF-beta RII at 336 residues in a time (0-24 h) and dose (5.5-38.5 mM) dependent manner. In addition, hyperosmolarity increased the level of TGF-beta RI in a dose- and time-course dependent manner. These observations may be closely related to decreased catabolism of TGF-beta RI. Hyperosmolarity significantly downregulated the expression of an inhibitory Smad (Smad7), decreased the level of Smurf 1, and reduced ubiquitination of TGF-beta RI. In addition, through the use of cycloheximide and the proteasome inhibitor MG132, we showed that hyperosmolarity significantly increased the half-life and inhibited the protein level of TGF-beta RI by polyubiquitination and proteasomal degradation. Taken together, our data suggest that hyperosmolarity enhances cellular susceptibility to renal tubular fibrosis by activating the Smad7 pathway and increasing the stability of type I TGF-beta receptors by retarding proteasomal degradation of TGF-beta RI. This study clarifies the mechanism underlying hyperosmotic-induced renal fibrosis in renal distal tubule cells.

Bone morphogenetic protein-2 expression in spinal fusion masses enhanced by extracorporeal shock wave treatment: a rabbit experiment.

PURPOSE: Extracorporeal shock wave (ESW) has been introduced to enhance spinal fusion. This study was conducted to assess the effect of ESW on bone morphogenetic protein-2 (BMP-2) expression in a spinal fusion experiment. METHODS: Twelve rabbits underwent fusion at bilateral L5-6 intertransverse spaces. They were evenly divided into two groups. In the study group, bilateral L5 and L6 transverse processes were treated with 1,000 impulses of ESW at 14 kV at 12 weeks. In the control group, the rabbits did not receive ESW treatment. All rabbits were sacrificed at 16 weeks, and their lumbar spines were harvested for radiographic and molecular biological study. RESULTS: In the study group (n = 6), the radiographs showed good fusion in all six rabbits, while in the control group (n = 6), good fusion was found only in three rabbits (50%). Although more rabbits in the study group had a good fusion result, the inter-group difference was not statistically significant (P = 0.182). In the molecular biological examination, the mean value of the normalized expression of BMP-2 mRNA in the fusion masses of the study group was 90 ± 8.4 while that of the control group was 77.33 ± 6.74. Statistical analysis showed the study group had a significantly higher BMP-2 mRNA expression in the fusion masses than the control group (P = 0.018). CONCLUSIONS: The current study showed that ESW treatment enhances BMP-2 mRNA expression in spinal fusion masses.

Impact of hyperglycemia on neuronal apoptosis after subarachnoid hemorrhage in rodent brain: An experimental research.

BACKGROUND: Hyperglycemia, a derangement after subarachnoid hemorrhage (SAH), is known to be associated with unfavorable outcomes. Whether the connection between hyperglycemia and poor prognosis results from severe neuronal apoptosis is unknown, and we aim at investigating their relationship. MATERIAL AND METHODS: Streptozotocin (STZ) was administrated to trigger hyperglycemia before SAH induction in Sprague-Dawley rats that were assigned to one of four groups: control, SAH only, hyperglycemia only, and SAH with hyperglycemia. The severity of neuronal apoptosis was analyzed by terminal deoxynucleotidyl transferase-mediated dUTP nickend labelling (TUNEL) staining of cerebral cortex. RESULTS: When subjected to SAH, hyperglycemic animals had worse neurobehavioral functions than normoglycemic ones. Hyperglycemia-exacerbated apoptosis was evident by greater increases in cleaved caspase-3 expression and TUNEL-positive cell density in the SAH with hyperglycemia group than those in the SAH only group, whereas there was no significant difference in cleaved caspase-9 expression and Bax/Bcl-2 ratio between the two groups. Furthermore, there was a remarkable decrease in the ratio of phosphorylated extracellular regulated kinase (ERK)/total ERK in the hyperglycemic rats after SAH. CONCLUSION: Hyperglycemia aggravated neuronal apoptosis after SAH and was associated with impaired neurological outcomes. Activation of the extrinsic caspase cascade through the ERK signal pathway may contribute to hyperglycemia-mediated apoptosis.

The prognosis of acute blunt cervical spinal cord injury.

BACKGROUND: Cervical spinal cord injury (SCI) is a devastating event for the patient and family. It has a huge impact on society because of the intensive resources required to manage the patient in both the acute and rehabilitation phases. There is a need for better delineation of potential prognostic factors and outcomes in patients with acute cervical SCI. METHODS: In this 5-year retrospective study, 75 adult patients diagnosed with acute nonfracture and nondislocation cervical SCI were enrolled into this study. Cervical X-ray and magnetic resonance imaging were available for all patients at admission and discharge. Epidemiologic data, management, complications, neurologic status, and change were assessed. Neurologic recovery from acute cervical SCI was determined by changes in the Japanese Orthopaedic Association score. RESULTS: Thirty-eight patients had surgical intervention, accounting for 50.67% (38 of 75) of the episodes. The Japanese Orthopaedic Association outcome score between the two groups, with or without surgical intervention, was statistically significant (p = 0.035). Statistical analysis of the clinical manifestations and neurologic images of the two patient groups revealed the following significant findings: limb weakness (p = 0.025) and days of hospitalization (p = 0.039). CONCLUSIONS: The treatment of acute nonfracture and nondislocation cervical SCI is still controversial and presents therapeutic challenges. A careful neurologic examination and high-resolution magnetic resonance imaging evaluation are necessary to determine whether surgical intervention is indicated. According to our data, when patients present with acute limb weakness, surgical intervention is necessary to improve the outcome.

Acute thrombosis and recanalization of a ruptured anterior communicating artery aneurysm.

A 35-year-old man sustained a subarachnoid hemorrhage due to the rupture of an anterior communicating artery aneurysm. A second angiogram taken 8 hours later demonstrated that the ruptured aneurysm had thrombosed spontaneously with a small residual aneurysm stump at the neck. CT scans and conventional angiograms taken 2 days later demonstrated recanalization of the aneurysm, which was successfully treated by endovascular coiling. This case differs from previous reports of spontaneously thrombosed ruptured aneurysms because the aneurysm recanalized within 2 days. Thus a thrombosed ruptured aneurysm has the potential for recanalization, and should be considered at risk of further hemorrhage.

Safflower extract: a novel renal fibrosis antagonist that functions by suppressing autocrine TGF-beta.

Progressive renal disease is characterized by the accumulation of extracellular matrix proteins in the renal interstitium. Hence, developing agents that antagonize fibrogenic signals is a critical issue facing researchers. The present study investigated the blood-circulation-promoting Chinese herb, safflower, on fibrosis status in NRK-49F cells, a normal rat kidney interstitial fibroblast, to evaluate the underlying signal transduction mechanism of transforming growth factor-beta (TGF-beta), a potent fibrogenic growth factor. Safflower was characterized and extracted using water. Renal fibrosis model was established both in vitro with fibroblast cells treated with beta-hydroxybutyrate and in vivo using rats undergone unilateral ureteral obstruction (UUO). Western blotting was used to examine protein expression in TGF-beta-related signal proteins such as type I and type II TGF-beta receptor, Smads2/3, pSmad2/3, Smads4, and Smads7. ELISA was used to analyze bioactive TGF-beta1 and fibronectin levels in the culture media. Safflower extract (SE) significantly inhibited beta-HB-induced fibrosis in NRK cells concomitantly with dose-dependent inhibition of the type I TGF-beta1 receptor and its down-stream signals (i.e., Smad). Moreover, SE dose-dependently enhanced inhibitory Smad7. Thus, SE can suppress renal cellular fibrosis by inhibiting the TGF-beta autocrine loop. Moreover, remarkably lower levels of tissue collagen were noted in the nephron and serum TGF-beta1 of UUO rats receiving oral SE (0.15 g/3 ml/0.25 kg/day) compared with the untreated controls. Hence, SE is a potential inhibitor of renal fibrosis. We suggest that safflower is a novel renal fibrosis antagonist that functions by down-regulating TGF-beta signals.

Contralateral acute epidural hematoma after decompressive surgery of acute subdural hematoma: clinical features and outcome.

BACKGROUND: Delayed contralateral epidural hematoma (EDH) after decompressive surgery for acute subdural hematoma (SDH) is uncommon. If unrecognized, this delayed hematoma can cause devastating consequences. We present our experience with this group of patients and discuss the diagnosis and management of this dangerous condition. METHODS: This study included 12 traumatic patients with acute SDH who developed delayed contralateral EDH after acute SDH evacuation. Clinical and radiographic information was obtained through a retrospective review of the medical records and the radiographs. RESULTS: There were seven males and five females. Nine patients had severe head injury (Glasgow Coma Scale {GCS} score < or = 8). Ten patients underwent acute SDH evacuation within 4 hours after the trauma. Intraoperative brain swelling during SDH evacuation was noted in 10 patients. A skull fracture at the site of the EDH on computed tomography (CT) was noted only in 10 patients. However, a skull fracture overlying the EDH was found during EDH evacuation in all patients. Only three patients with less severe head injury (GCS > 8) had good recovery. Other patients with severe head injury (GCS < or = 8) had poor outcome. CONCLUSIONS: Severe head injury, a skull fracture contralateral to the original hematoma, intraoperative brain protrusion, and a poor outcome are typical clinical findings in this disorder. In patients with acute SDH and a contralateral skull fracture, immediate postoperative CT scan is indicated to evaluate this rare but potentially lethal complication. According to the findings of the postoperative CT scan, the neurosurgeon can make an appropriate strategy of treatment promptly. Early detection and prompt treatment may improve the poor outcome in this group of patients.

Computer-assisted pedicle screw placement for thoracolumbar spine fracture with separate spinal reference clamp placement and registration.

BACKGROUND: The objective of the study was to improve the accuracy of computer-assisted pedicle screw installation in the spine. This study evaluates the accuracy of computer-assisted pedicle screw placement with separate spinal reference clamp placement and registration on each instrumented vertebra for thoracolumbar spine fractures. METHODS: Postoperative radiographs and CT scans assessed the accuracy of pedicle screw placement in 21 adult patients on each instrumented vertebra. Screw placements were graded as good if the screws were placed in the central core of the pedicle and the cancellous portion of the body. Screw placements were graded as fair if the screws were placed slightly eccentrically, causing erosion of the pedicular cortex, and with less than a 2-mm perforation of the pedicular cortex. Screw placements were graded as poor if screws were placed eccentrically with a large portion of the screw extending outside the cortical margin of the pedicle and with more than a 2-mm perforation of the pedicular cortex. RESULTS: A total of 140 image-guided pedicle screws were placed in 21 patients: 78 in the thoracic and 62 in the lumbar spine. Of the 140 pedicle screw placements, 96.4% (135/140) were categorized as good; 3.6% (5/140), fair; and 0% were poor. All 5 fair placement screws were placed in the thoracic spine without any mobility. CONCLUSION: Separate registration increases accuracy of screw placement in thoracolumbar pedicle instrumentation. Separate spinal reference clamp placement in the instrumented vertebra provides real-time virtual imaging that decreases the possibility of downward displacement during manual installation of the screw.

Application of extracorporeal shock wave treatment to enhance spinal fusion: a rabbit experiment.

BACKGROUND: Extracorporeal shock wave treatment has been used to treat many orthopedic disorders. However, the effect of extracorporeal shock waves on spinal fusion has not been reported. METHODS: Fifteen rabbits were used in this study. Spinal fusion was performed with decortication of bilateral L5 and L6 transverse processes, and placement of the bone chips onto the ipsilateral L5-L6 intertransverse space. The right L5 and L6 transverse processes in all animals were treated with 1000 impulses of ESWT at 14 kV (equivalent to 0.18 mJ/mm(2)) at 3 and 6 weeks after surgery. The left transverse processes did not receive ESWT, and were served as controls. Radiographic examinations of the spines were performed at 3, 6, and 12 weeks. Computed tomography was performed at 12 weeks. The rabbits were killed at 12 weeks, and the spinal segments were harvested for histomorphological examination. RESULTS: Radiographs of the tested rabbits taken at different post-ESWT stages demonstrated repairing effect of ESWT on the fusion gap of the treated (right) sides. Statistical analysis of the image studies indicated that 11 (73%) of 15 rabbits showed superior fusion mass on the ESWT (right) side than that of control (left) side (P < .001). The remaining 4 (27%) rabbits showed no discernable fusion difference between the ESWT side and the control side. Histomorphological examination showed good new bone formation in 9 fusion masses. All of these cases were noted on the ESWT (right) sides. Statistical analysis showed that ESWT sides had better new bone formation than the control sides (P = .001). CONCLUSIONS: Results of this study demonstrated that ESWT is effective in promoting spinal fusion in rabbits.

Gene transfer of insulin-like growth factor-I providing neuroprotection after spinal cord injury in rats.

OBJECT: Insulin-like growth factor-I (IGF-I) has been shown to be a potent neurotrophic factor that promotes the growth of projection neurons, dendritic arborization, and synaptogenesis. Its neuroprotective roles may be coordinated by activation of Akt, inhibition of glycogen synthase kinase-3beta (GSK-3beta), and thus inhibition of tau phosphorylation. The authors investigated the role and mechanism of IGF-I gene transfer after spinal cord injury (SCI). METHODS: Studies were performed in 40 male Sprague-Dawley rats after spinal cord hemisection. The authors conducted hydrodynamics-based gene transfection in which an IGF-I plasmid was rapidly injected into the rat's tail vein 30 minutes after SCI. The animals were randomly divided into four groups: Group I, sham operated; Group II, SCI treated with pCMV-IGF-I gene; Group III, SCI treated with vehicle pCMV-LacZ gene; and Group IV, SCI only. The results showed that IGF-I gene transfer promoted motor recovery, antiinflammatory responses, and antiapoptotic effects after SCI. Using techniques of Western blotting and immunohistochemistry, the authors assessed the mechanism of IGF-I gene transfer after SCI in terms of activation of Akt, inhibition of GSK-3beta, attenuation of p35, and inhibition of tau phosphorylation. Moreover, they found that IGF-I gene transfer could block caspase-9 cleavage, increase Bcl-2 formation, and thus inhibit apoptosis after SCI. CONCLUSIONS: The intravenous administration of IGF-I after SCI activated Akt, attenuated GSK-3beta, inhibited p35 activation, diminished tau hyperphosphorylation, ended microglia and astrocyte activation, inhibited neuron loss, and significantly improved neurological dysfunction. Furthermore, IGF-I attenuated caspase-9 cleavage, increased Bcl2, and thus inhibited apoptosis after SCI.

Vulnerability of the spinal cord to injury from extracorporeal shock waves in rabbits.

We studied the vulnerability of the spinal cord to extracorporeal shock wave treatment (ESWT). In this experiment, 12 rabbits were divided into three groups (4 in each group). All animals underwent a preceding lumbar laminectomy at L4 1 week before ESWT. In group 1, 2000 impulses of high dose (0.62 mJ/mm2 energy flux density) shockwave energy were applied to the spinal cord at the laminectomy site. In group 2, 2000 impulses of low dose (0.18 mJ/mm2 energy flux density) shockwave energy were applied to the same site as group 1. Group 3 did not receive ESWT and served as a control. None of the rabbits in the study groups (groups 1 and 2) showed weakness or paralysis of the hind limbs throughout the entire post-ESWT period. The spinal cord at the L4 level of all animals was harvested on day 13 after laminectomy. On gross morphology, the cord from the study groups and the control group showed normal surface appearance. On microscopic examination, the cord from the control group was normal, whereas the cords from the study groups showed varying degrees of myelin damage and neuronal loss. These microscopic findings were dose-dependent. For the low-energy group (group 2), neuronal loss was insignificant compared to that in the control group. ESWT produced varying degrees of microscopic changes of the treated cords, but no neurological symptoms. The neuronal injury was dose-dependent and mild in the low-energy group.

Hyperglycemia Aggravates Cerebral Vasospasm after Subarachnoid Hemorrhage in a Rat Model.

BACKGROUND: Hyperglycemia is common and showed to be risky for poor prognosis in patients with subarachnoid hemorrhage (SAH). However, the causality and mechanism underlying this observation are not well established. OBJECTIVE: To investigate the relationship between hyperglycemia and cerebral vasospasm with its pathogenesis in a rat model of SAH. METHODS: One-shot SAH model was employed in male Sprague-Dawley rats. Hyperglycemia was triggered by intraperitoneal streptozotocin administration (50 mg/kg) 7 days before SAH induction. The severity of cerebral vasospasm was determined by the cross-sectional area of basilar artery (BA) in male rats randomly assigned to 1 of 4 groups: control, hyperglycemia only, SAH only, and SAH with hyperglycemia. The expression of endothelial nitric oxide synthase (eNOS) and induced nitric oxide synthase (iNOS) in the BA were analyzed by immunohistochemistry. RESULTS: The mean (standard deviation) blood glucose level was 433.0 (98.3) and 156.5 (31.7) mg/dL in streptozotocin -treated and untreated rats, respectively. Hyperglycemic rats exhibited poorer neurobehavioral performance than normoglycemic rats when subjected to SAH. Hyperglycemia-mediated exacerbation of vasospasm was evident by the greater decrease in the BA cross-sectional area in the hyperglycemic SAH group than in the SAH only group. Furthermore, there was more decreased expression of eNOS and increased expression of iNOS within the vessels of the hyperglycemic SAH rats. CONCLUSION: Hyperglycemia exacerbated cerebral vasospasm and was associated with poorer neurological outcomes following SAH. Our findings also suggested the nitric oxide pathway as a potential underlying mechanism via the dysregulation of eNOS and iNOS.

Treatment of empty sella syndrome with ventriculoperitoneal shunt.

A symptomatic empty sella developed in a female patient undergoing bromocriptine therapy for microprolactinoma. Placement of a ventriculoperitoneal shunt dramatically improved the symptoms of headache and blurred vision. The post-operative imaging showed resolution of the empty sella. She was able to resume bromocriptine therapy without recurrence of her previous symptoms and give birth to a baby 20 months later. An MRI 44 months after surgery and on bromocriptine therapy showed no recurrence of the empty sella. We conclude that ventriculoperitoneal shunt may be a simple, and durable treatment for drug induced empty sella and allows resumption of bromocriptine therapy for preexisting microprolactinoma.

Impact of body mass index on adjacent segment disease after lumbar fusion for degenerative spine disease.

BACKGROUND: Adjacent segment disease is an important complication after fusion of degenerative lumbar spines. However, the role of body mass index (BMI) in adjacent segment disease has been addressed less. OBJECTIVE: To examine the relationship between BMI and adjacent segment disease after lumbar fusion for degenerative spine diseases. METHODS: For this retrospective study, we enrolled 190 patients undergoing lumbar fusion surgery for degeneration. BMI at admission was documented. Adjacent segment disease was defined by integration of the clinical presentations and radiographic criteria based on the morphology of the dural sac on magnetic resonance images. RESULTS: Adjacent segment disease was identified in 13 of the 190 patients, accounting for 6.8%. The interval between surgery and diagnosis as adjacent segment disease ranged from 21 to 66 months. Five of the 13 patients required subsequent surgical intervention for clinically relevant adjacent segment disease. In the logistic regression model, BMI was a risk factor for adjacent segment disease after lumbar fusion for degenerative spine diseases (odds ratio, 1.68; 95% confidence interval, 1.27-2.21; P < .001). Any increase of 1 mean value in BMI would increase the adjacent segment disease rate by 67.6%. The patients were subdivided into 2 groups based on BMI, and up to 11.9% of patients with BMI ≥ 25 kg/m were diagnosed as having adjacent segment disease at the last follow-up. CONCLUSION: BMI is a risk factor for adjacent segment disease in patients undergoing lumbar fusion for degenerative spine diseases. Because BMI is clinically objective and modifiable, controlling body weight before or after surgery may provide opportunities to reduce the rate of adjacent segment disease and to improve the outcome of fusion surgery.

Motor outcome of deep intracerebral haemorrhage in diffusion tensor imaging: comparison of data from different locations along the corticospinal tract.

OBJECTIVES: Although diffusion tensor imaging (DTI) is widely studied to assess the motor outcome after ischaemic stroke, there is paucity of data regarding outcomes of intracerebral haemorrhage (ICH). The aim of this study was to determine the DTI data from different locations along the corticospinal tract (CST) and association to motor outcome. METHODS: We prospectively recruited patients with deep ICH admitted to our hospital from November 2010 to July 2012.Diffusion tensor imaging was performed within 14  days after the onset of ICH. Fractional anisotropy (FA) was measured along the CST at corona radiata, perihaematomal oedema, cerebral peduncle and pons. Corticospinal tract integrity was classified into three types by diffusion tensor tractography (DTT): type A with preserved CST, type B with partially interrupted CST and type C with completely interrupted CST. Motor outcome was assessed by Motricity index (MI) at admission, after 1 and 3  months. RESULTS: Forty-eight patients were enrolled with a mean age of 62  years. The median time interval from onset of ICH to DTI study was 7  days. The patients in type C had significantly worse MI at admission (P < 0.001), after 1  month (P < 0.001) and after 3  months (P < 0.001) as compared to those with type A and type B. Lower rFA at the corona radiata was significantly correlated with poorer motor outcome at admission, after 1  month and after 3  months. DISCUSSION: Clinical motor outcome of ICH within 2  weeks can be identified with a statistically significant decrease in rFA at the corona radiata.

Treatment outcomes and prognostic factors of patients with supratentorial low-grade oligodendroglioma.

PURPOSE: Oligodendroglioma is a relatively rare central nervous system tumor. Currently, surgical intervention is the mainstay of treatment, and the role of postoperative radiotherapy (RT) remains a subject of controversy. The objective of this study was to investigate the prognostic factors, evaluate the treatment outcomes, and assess whether postoperative RT has a benefit on local control and overall survival rates. METHODS AND MATERIALS: This was a retrospective review of 52 consecutive adult patients with supratentorial low-grade oligodendrogliomas diagnosed at our institution between September 1980 and September 1998. Thirty-two received postoperative RT. Data were analyzed retrospectively to survey the significant prognostic factors for local control and overall survival. RESULTS: The 5-year overall and progression-free survival rate was 80% and 67%, respectively. Twenty-five patients experienced local disease progression during the follow-up period. In multivariate analysis, postoperative RT and age at diagnosis showed independent prognostic significance for overall survival. For progression-free survival, postoperative RT was the only independent prognostic factor. CONCLUSION: On the basis of the results of this study, we recommend considering postoperative RT as one of the standard adjuvant treatment modalities for patients with supratentorial low-grade oligodendroglioma, regardless of the extent of surgical resection. The optimal treatment strategy to maximize the treatment outcome should still be explored.

Multiloculated pyogenic brain abscess: experience in 25 patients.

OBJECTIVE: To report our experience in treating multiloculated pyogenic brain abscess and determine whether there are differences in the bacteriology, predisposing factors, treatment choices, and outcomes between multiloculated and uniloculated brain abscesses. METHODS: We studied clinical data collected during a 16-year period from 124 patients with pyogenic brain abscess, including 25 cases of multiloculated abscess. RESULTS: The incidence of multiloculated brain abscess was 20%. In these 25 patients, hematogenous spread from a remote infectious focus was the most common cause of infection, as it was for the cases of uniloculated abscess. Headache and hemiparesis were the most common symptoms in patients with multiloculated abscess. In patients with uniloculated abscess, fever was the most common symptom. Viridans streptococci were the most commonly isolated pathogens. Bacteroides fragilis was the most common anaerobe in multiloculated abscess, and aerobic gram-negative bacilli were the most common pathogens in patients with uniloculated abscess. Of the patients with multiloculated abscess, 21 were treated surgically and 4 were treated with antibiotics only. Overall, eight patients (38%) needed another operation because of abscess recurrence after the initial operation. In uniloculated abscess, the rate of abscess recurrence after initial surgery was 13.1%. Mortality was 16% in multiloculated abscess and 17.1% in uniloculated abscess. CONCLUSION: Multiloculated abscesses accounted for 20% of our patients with pyogenic brain abscess. Excision seems to be the more appropriate surgical choice in multiloculated abscess. Prognosis for patients with multiloculated abscess can be as good as that for patients with uniloculated abscess. However, clinicians must carefully monitor these patients because the possibility of recurrence after surgery is significantly higher in patients with multiloculated abscess than in those with uniloculated abscess.