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Objective: To examine the feasibility, safety, and efficacy of mobilization of the vertebral artery for C2 pedicle screws in cases with high-riding vertebral artery (HRVA). Methods: The clinical data of 12 patients with basilar invagination and atlantoaxial dislocation underwent atlantoaxial reduction and fixation in the Department of Neurosurgery, the First Affiliated Hospital of University of Science and Technology of China between January 2020 and November 2021 were retrospectively analyzed. All patients had high-riding vertebral artery on at least one side that prohibited the insertion of C2 pedicle screws. There were 2 males and 10 females aged (48.0±12.8) years (range: 17 to 67 years). After correction of vertical dislocation during the operation, the C2 pedicle screw insertion and occipitocervical fixation and fusion were performed using the vertebral artery mobilization technique. Neurological function was assessed using the Japanese Orthopedic Association (JOA) scale. The preoperative and postoperative JOA score and the main radiological measurements, including the anterior atlantodental interval (ADI), the distance of the odontoid tip above the Chamberlain line, the clivus-canal angle, were collected and compared by paired t-test. Results: Mobilization of the high-riding vertebral artery was successfully completed, and C2 pedicle screws were then fulfilled after the vertebral artery was protected. There was no injury to the vertebral artery during the operation. Meanwhile, no severe surgical complications such as cerebral infarction or aggravated neurological dysfunction occurred during the perioperative period. Satisfactory C2 pedicle screw placement and reduction were achieved in all 12 patients. All patients achieved bone fusion 6 months after surgery. No looseness and shift in internal fixation or reduction loss was observed during the follow-up period. Compared to the preoperative, the postoperative ADI decreased from (6.1±1.9) mm to (2.0±1.2) mm (t=6.73, P<0.01), the distance of the odontoid tip above the Chamberlain line decreased from (10.4±2.5) mm to (5.5±2.3) mm (t=7.12, P<0.01), the clivus-canal angle increased from (123.4±11.1) ° to (134.7±9.6) ° (t=2.50, P=0.032), the JOA score increased from 13.3±2.1 to 15.6±1.2 (t=6.99, P<0.01). Conclusion: The C2 pedicle screw insertion assisted by mobilization of the vertebral artery is safe and considerably effective, providing a choice for internal fixation in cases with high-riding vertebral arteries.
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Objective To study the subcellular location of HAUSP and NANOG in glioma cells and their expressions in glioma tissues,and explore their significance in the pathogenesis of gliomas.Methods Seventy-two glioma samples (19 with WHO graded Ⅱ,25 with WHO graded Ⅲ and 28 with WHO graded Ⅳ),collected in our hospital from January 2010 to November 2010,were chosen in our study; protein expressions of HAUSP and NANOG in the glioma tissues were detected by immunohistochemical staining; the subcellular location of HAUSP and NANOG in human glioma cell line U87 was detected by double immunofluorescence staining.Results The positive rate of HAUSP protein in gliomas with different grades was significantly different (F=15.926,P=0.000); the higher the malignancy grade,the higher the positive rate of HAUSP protein (P＜0.05); the malignancy grade of gliomas was positively correlated with the protein expression of HAUSP (r=0.726,P=0.000).The positive rate of NANOG protein in gliomas with different grades was significantly different (F=14.768,P=0.000);the higher the malignancy grade,the higher the positive rate of NANOG protein (P＜0.05); the malignancy grade ofgliomas was positively correlated with the protein expression of NANOG (r=0.685,P=0.000).Both NANOG and HAUSP expressed in U87,and co-located in the nucleus.Conclusion HAUSP and NANOG play important roles in the pathogenesis of human gliomas and are related to the malignancy; NANOG,as the marker of glioma stem cells in undifferentiated state,plays a vital role in maintaining the cancer stem cells in undifferentiated state through deubiquitinylation of HAUSP.
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Objective To investigate the effect ofhistone deacetylase inhibitor apicidin induced Nanog repression on proliferation,migration and invasion of glioma stem cells (GSCs).Methods GSCs were isolated from glioma cell line U87 and cultured in simplified serum-free neural stem cell medium by nanosphere suspension culture method,and purified continuously through the monoclonal formation experiment.The immunofluorescence staining of cells was employed to detect the CD133 and Nestin expressions to identify GSCs.Apicidin treatment group (GSCs treated with 0.5 μmol/L apicidin for 48 h) and blank control group were employed.Nanog mRNA and protein expressions were detected by real time-PCR and Western blotting,respectively.Double immunofluorescence staining was used to detect the co-expressions ofNanog/CD133.MTT assay was used to detect the proliferation modification of GSCs,while migration and invasion of GSCs were detected by Transwell migration and invasion assay after 0.2,0.5,1.0 and 2.0 μg/mL apicidin of treatment.Results GSCs were isolated,cultured and purified from glioblastoma cell line U87; as compared with those in the blank control group,the mRNA and protein expressions of Nanog were significantly repressed and Nanog+,CD133+ and Nanog+/CD133+ cells were obviously reduced in the apicidin treatment group (P＜0.05).The migration and invasion in the apicidin treatment group were inhibited dramatically as compared with those in the blank control group (cell number of migration:[87.50±4.65]/field vs.[128.50±6.14]/field; cell number of transmembrane:[55.75±4.79]/field vs.[81.50±5.45]/field,P＜0.05).MTT assay indicated that the absorbance value of the apicidin treatment group was significantly lower as compared with that in the blank control group (P＜0.05); the higher the apicidin concentration,the lower the absorbance value and the more obvious the proliferation inhibition.Conclusion Histone deacetylase inhibitor apicidin could inhibit the mRNA and protein expressions of Nanog,and sequentially repress the proliferation,migration and invasion of GSCs.
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Objective To detect the neuronal network activity of specific brain areas in heroin addicts under craving state induced by heroin related cues with independent component analysis (ICA) of functional MRI (fMRI) data. Methods Fifteen heroin addicts,admitted to our hospital from February 2010 to December 2010, and 15 healthy controls were recruited in the case-control study; they were performed whole brain scan with 3.0Tesla MR scanner when being presented with heroin related cues.ICA was performed on these data and their neuronal network activities were compared. Results As compared with those in the controls,the bilateral prefrontal cortex,the left anterior cingulated cortex,the bilateral posterior cingulated cortex, the left inferior temporal gyrus and the left parietal lobe enjoyed obviously decreased activity, while bilateral nucleus accumbens, the right hippocampus, part of the temporal lobe and the occipital lobe enjoyed significantly increased activity (P＜0.05). Conclusion ICA is an advanced approach to identify fMRI data induced by related cues; the specific neuroanatomy mediated to cue-elicited heroin craving mostly locates in the learn-memory system and reward system,which involves the frontal cortex,the parietal lobe,the anterior eingulate,the posterior cingulate,the hippocampus and the nucleus accumbens.
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Objective To investigate the efficacy and safety of staged bilateral thalamus and globus pallidus stereotactic lesioning in patients with idiopathic Parkinson's disease (PD). Methods Nineteen PD patients,admitted to our hospital from February 1998 to May 2008 and received staged bilateral thalamus and globus pallidus stereotactic lesioning under the stereotactic microelectrode-guidance,were chosen in our study; 16 of them had a primary operation with ventral intermediate (Vim) stereotactic lesioning,and other 3 had globus pallidus-intemal segment (Gpi)stereotactic lesioning; second-staged operation with contralateral Gpi and small focal of Vim nucleus stereotactic lesioning was performed on all patients.The unified Parkinson disease rating scale (UPDRS)was used to estimate the "switch-on" and "switch-off" states of each patient before operation and 1 week after operation.The improvement of symptoms and the happening of complications after the operation were analyzed. Results Improvements were observed in all the 19 patients postoperatively in terms of stiffness and tremor.Stiffness was significantly alleviated after lesioning of Gpi,and tremor was markedly relieved after the Vim nucleus small focal lesioning.Two patients had dysarthria postoperatively,and 1 of them had dysphagia; the symptoms were alleviated 3 months after the operation. Conclusion Staged bilateral thalamus and globus pallidus stereotactic lesioning is a safe and effective surgical treatment for PD patients with bilateral severe symptoms.Controlling the indications and the size of lesioning strictly,and selecting the targets appropriately are of vital importance to the operation.
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Objective To explore the changes of functional connectivity of anterior cingulate cortex (ACC) in online game addicts during the resting state,and to analyze the function of ACC in the pathogenesis of online game addiction from a perspective of resting-state functional connectivity.Methods Seventeen online game addicts treated in our hospital from March 2011 to October 2011 were recruited as addiction group and 17 healthy controls at the same period were recruited as HC group.The baseline characteristics of all 34 subjects were investigated and compared between the addiction group and the HC group.All fMRI data were preprocessed after a resting-state fMRI scan,and then,the left and right anterior cingulate cortexes were selected as regions of interest (ROIs) to calculate the linear correlation between the ACC and the entire brain to compare the differences between the online game addicts and normal controls.Results Obvious differences between the addiction group and HC group were noted in hours and days of online game using and degree of thirst to play online games (P＜0.05);within the functional connectivity of ACC during the resting state,in contrast to the controls,the online game addicts showed increased connectivity with posterior cingulate,medium cingulate,midbrain,nucleus accumbens and supplementary motor area,but reduced connectivity with prefrontal cortex,temporal lobe and occipital lobe (P＜0.05).Conclusion Altered functional connectivity of the ACC reflects the dysfunction in ACC of online game addicts,which may be linked to the forming and maintaining of the online game addiction.
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Objective To explore the changes of functional connectivity of the prefrontal cortex in chronic heroin addicts under resting-state functional MRI (fMRI). Methods Resting fMRI examination was performed on 13 chronic heroin addicts and 14 healthy volunteers. After pre-processing the resting-state fMRI data, the prefrontal cortex was selected as the seed region, with which a whole-brain voxel temporal correlation in Iow frequency fMRI fluctuations was analyzed and the changes of functional connectivity of the prefrontal lobe in both chronic heroin addicts and healthy volunteers were calculated with SPM5 software. Results Compared with that in the control group, the functional connectivity between the left prefrontal cortex and the left hippocampus, right anterior cingulate, left middle frontal gyrus, right middle frontal gyrus, right precuneus in the heroin addiction group was significantly decreased. The functional connectivity between the right prefrontal cortex and the left orbital frontal cortex, left middle frontal gyrus in thc heroin addiction group was also significantly decreased as compared with that in the control group. Conclusion Functional connectivity of prefrontal cortex in chronic heroin addicts decreases, indicating that the prefrontal cortex may be involved in the maintenance of heroin addiction and relapse after withdrawal.
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Objective To study the co-expressions of human glioma transcription factor (Nanog gene) with brain tumor stem cell marker (CD133) and glioma differentiation marker (GFAP), and demonstrate the significance of Nanog gene in the development of glioma. Methods The double-labeled of Nanog/CD133 and Nanog/GFAP were detected by immunohistochemical double staining in 60 cases of human gliomas (19 with grade Ⅱ, 23 with grade Ⅲ and 18 with grade Ⅳ according to WHO 2000 classification of nervous system tumors). The percentages of Nanog+ cells, CD133+ cells,GFAP+ cells, Nanog+/CD133+ cells and Nanog+/GFAP+ cells in glioma tissues of different grades were calculated and compared. Results The percentages of Nanog+, CD133+, and Nanog+/CD133+ cells in different pathological levels of gliomas were significantly different (P＜0.05), and the expressions of Nanog+, CD133+, and Nanog+/CD133+ in gliomas of grade Ⅲ and Ⅳ were significantly higher than those in glioma of grade Ⅱ (P＜0.05). The Nanog+ expression and CD133+ expression were positively correlated (r=0.904, P=0.000), and the Nanog+/CD133+ expression and CD133+ expression were positively related too (r=0.823, P=0.000). The percentages of GFAP+ cells in different pathological levels of gliomas were significantly different (P＜0.05), and the expression of GFAP+ in gliomas of grade Ⅲ and Ⅳ were significantly higher than that in glioma of grade Ⅱ (P＜0.05). No statistical significance of percentage of Nanog+/GFAP+ cells was noted in different pathological levels of gliomas (P＞0.05).Conclusion The Nanog gene and stem cell marker CD 133 has a significant correlation, and they enjoy significant co-expressions in cellular level. Nanog gene may be a marker of glioma stem cells, and plays a vital role in maintaining the cancer stem cells under the undifferentiated state.
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Objective To discuss the common complications of large acoustic neuromas performed surgery via suboccipital retrosigmoid approach under neurophysiological monitoring, and the prevention of postsurgical complications. Methods One hundred and sixteen patients with large acoustic neuromas, admitted to our hospital from May 2006 to April 2010, were performed surgery via suboccipital retrosigmoid approach under neurophysiological monitoring; clinical data and follow-up data (3-12 months) of these patients were collected and analyzed retrospectively; the influence of tumor dimension on short- and long-term postoperative complications after the surgery were compared.Results Total tumor resection was achieved in 107 patients, subtotal resection in 7 patients, and partial resection in 2 patients. After the operation, the facial nerve was preserved anatomically in 101 patients (87.07%); and the functional valuation of facial nerve according to postoperative House-Brackman showed 89 patients (76.72%) in grade Ⅰ-Ⅱ, 13 patients (11.21%) in gradeⅢ-Ⅳ and 14 patients (12.07%) in grade Ⅴ-Ⅵ. Short-term postoperative complications included hoarse voice in 16 patients and herpes catarrhalis of injured side in 20 patients. Long-term postoperative complications included loss of hearing (n=83) and permanent facial paralysis (n=23). Patients with tumor dimension larger than 5 cm had a significantly higher incidence of short-term postoperative complications than those within 3-5 cm (P< 0.05). No patient died. Conclusion The keys to avoiding the complications are to master the clinical anatomy of the approach, accumulate surgical experiences, preoperatively study the individual imaging and clinical data, and use intraoperative nerve monitoring.
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Objective To study the variational features of the brainstem auditory evoked potential (BAEP) and the preservation of the facial and auditory nerves during the microsurgery in patients with acoustic neuromas (AN). Methods We retrospectively analyzed the data of 76 patients with AN, admitted to our hospital fi'om May 2006 to May 2009: preoperative BAEP were examined; the peak latency (PL) of Ⅰ, Ⅲ and Ⅴ waves and their interpeak latency (IPL) were noted and compared. The tumors were microsurgically removed under intraoperative electrophysiologic monitoring to preserve the facial and auditory nerves. The relationships between the preservation of facial and auditory nerves and both the tumor size and the utilization of intraoperative monitoring were discussed. Results Before the operation, the 100% abnormal rate of BAEP was showed on the diseased side with the disappearance of Ⅲ and Ⅴ waves as its main features, while 82.9% (63/76) of that was noted on the contralateral side with the IPL ratio of Ⅲ-Ⅴ / Ⅰ-Ⅲ greater than or equal to 1 as its main features; the BAEP features between the 2 sides had statistical significance (P<0.05). Seventy patients (92.1%) were found abnormal of BAEP on the contralateral side during the operation; the BAEP features of the contralateral side had statistical significance between preoperation and intraoperation (P<0.05). The tumors were totally removed in 69 (90.8%), subtotally removed in 6 (7.9%) and partially removed in 2 (1.3%). The preservation of facial and auditory nerves increased obviously through monitoring the response of BAEP during the surgery and a positive correlation was observed between the preservation of facial and auditory nerves and the response of BAEP in the contralateral side(r=0.912, P=0.000; r=0.613, P=0.000). However, an inverse correlation was observed between the preservation of facial and auditory nerves and the size of AN (r=-0.869, P=0.000; r=-0.738, P=0.000). Conclusion Preoperative BAEP can help to make an exact diagnosis on patients with AN and the preservation of facial and auditory nerves can increase obviously through monitoring the normal response of BAEP during the surgery. The anatomy preservation of facial and auditory nerves depends on the size of AN.
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Objective To explore the functional location of brain regions related to internet game addiction using clue-reaction model and functional magnetic resonance imaging (fMRI). Methods Twenty participants with internet game addiction and 20 control subjects without addiction were tested. They were presented with different internet game videos and the paired common life videos while undergoing fMRI. Questionnaire survey was employed to investigate their emotion changes after watching the game video; the activation data produced by the stimulations were collected through the measurement of blood-oxygen-level dependent signals in the brain. Subtraction algorithm was adopted to analyze the corresponding regions of interest. The activated brain areas stimulated by the internet game videos were determined. Results Compared with the common life video watching, the interact game video watching showed significantly different results of psychological assessments, including emotional states, degree of thirst, degree of liking and wishing to re-watch in the addiction group (P<0.05); while the interact game video watching only had a strong degree of re-watching as compared with the common life video watching in the control group. As compared with the common life videos, internet game videos could induce significantly high activation in the parietal lobe and visual cortex of the temporal lobe of the left brain region in the control group (P<0.05);while significantly activation of all the brain regions, except the nucleus accumbens and the caudate nucleus of the left brain region, was found in the internet game video watching as compared with those in the common life video watching in the addiction group (P<0.05). Conclusion The regions of brain activation of the internet game addiction can be determined by fMRI and these areas may be involved in the generation and maintenance of the internet game addiction.
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Objective To investigate the expressions of the putative brain tumor stem cell (BTSC) marker CD133, nestin and proliferating cell nuclear antigen (PCNA) in formalin-fixed and paraffin-embedded gliomas, and discuss the BTSC microenvironment: the composition, morphology and distribution of the niche. Methods The samples of 74 patients performed resection of the glioma in our hospital from January 2007 and October 2008 were chosen. According to WHO 2008 classification of nervous system tumors, they were assigned into low-grade glioma group (grade Ⅱ, 22) and high-grade glioma group(grade Ⅲ, 27 and grade Ⅳ,25). Immunohistochemistry was used to detect the expression of CD 133 in 74 cases of brain gliomas. Double immunofluorescence staining was employed to detect the co-expressions of CD133/nestin or CD133/PCNA. The percentages of the CD133+cells, CD133+ blood vessels and CD 133+ niches were calculated, and correlation analysis was also performed on their percentage and the pathological grading of the tumor. Results Accumulated CD 133+ cells grew in the niches. CD 133+ niches could be observed in all grade gliomas; low-grade group showed lower level expression of the CD 133+ niches, fewer proliferating cells, clearer boundary between the 2 neighboring niches and fewer surrounding blood vessels as compared with high-grade group. Besides CD113+/nestin+ BTSCs, some subsets as CD133+/nestin-cells and CD133-/PCNA+ cells were noted in the niches in the high-grade group. The percentages of CD 133+ cells, CD 133+ blood vessels and CD 133+ niches were different in different grades of gliomas and the higher the grade of gliomas was, the higher their expressions were. Positive correlation was observed between the percentage of CD 133+ niches and the percentage of CD133+ blood vessels (r=0.425, P=0.000). The expression of CD133+ niches in high-grade glioma were higher than that in low-grade tumors (F=5.324, P=0.002). Conclusion Glioma tissues have niche structures, which composed of CD133+/nestin+ BTSCs and some subsets. CD133+ blood vessels were playing a key role in maintaining the niche structure, and the expression of CD133+ niches is statistically different in different pathological grading tumors.
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Objective To construct and identify a recombinant baculovirus transfer vector of mouse conserved dopamine neurotrophic factor (mCDNF): pFastBacHTb-mCDNF. Methods Mouse total RNA was isolated by using Trizol reagent, and then, first-strand cDNAs were synthesized by reverse transcriptase. Overall length of CDNF (564 bp) was amplified by two rounds of PCR introducing appropriate restriction sites (BamH Ⅰ, Xho Ⅰ). The PCR products were cloned into pGEM-T vector and sequenced to confirm PCR fidelity. The mCDNF was sub-cloned into pFastBacHTb vector to create pFastBacHTb-mCDNF vector, then the vector was transferred into the E. coli DH5α competent cells. The clone was selected using amicillin resistance and then this vector was sequenced and identified by double digests. Results Agarose gel electrophoresis after RT-PCR showed a 564 bp band being consistent with the anticipation size. Positive clone of pGEM-T-CDNF was screened by blue/white and antibiotic resistance selection. Recombinant plasmid pGEM-T-mCDNF was identified by PCR and sequence.Recombinant plsmid pGEM-T-mCDNF and pFastBacHTb vector were cut by BamH Ⅰ and XhoⅠ restriction enzyme, and then, recombinant plasmid pFastBacHTb-mCDNF was constructed and successfully identified by double digestion of Xho Ⅰ and BamH Ⅰ restriction enzyme or single digestion of BamH Ⅰ, PCR and sequence. Conclusion We successfully constructe the recombinant baculovirus transfer vector pFastBacHTb-mCDNF, laying the foundation for further research of this neurotrophic factor.
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Objective To investigate the brain areas having functional connectivity with nucleus accumbens in heroin addicts with resting-state functional magnetic resonance imaging (fMRI), and explore the reward system of heroin addiction. Methods Fifteen participants with heroin addiction,voluntarily admitted to our drug rehabilitation center from June 2009 to March 2010, and 15 healthy controls at the same period were chosen in our study. Resting-state fMRI was performed on these patients; and then, the resting-state brain functional connectivity was also concluded by analyzing the left and right nucleus accumbens selected as regions of interests (ROIs). The corresponding brain areas having functional connections with ROIs were defined in the resting-state and the changes of functional connectivity were observed in heroin addicts. Results In the addiction group, the areas having functional connectivity with double nucleus accumbens included bilateral thalamus, the basal ganglia, the hippocampus, the midbrain and contralateral nucleus accumbens; and anterior cingulate cortex was also significantly correlated with left nucleus accumbens. However, in the control group, only the hippocampus and contralateral nucleus accumbens had these connection and their activity was much weaker than that in the addiction group. Conclusion In the resting-state, reward system of heroin addiction is constituted by the brain areas having functional connectivity with nucleus accumbens. And fMRI can be used to study the functional connections between the brain areas related to the heroin addiction from neuroimaging perspectives.
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Objective To investigate the effect of all-trans retinoic acid (ATRA) on the proliferation and differentiation of brain tumor stem cells (BTSCs) in vitro. Methods Freshly resected glioblastoma multiforme tissues were obtained from 3 surgical patients, and BTSCs were isolated by limited dilution and clonogenic assay. The BTSCs obtained were cultured in serum-free medium and divided into control group, ATRA group, growth factor group, and ATRA/growth factor group with corresponding treatments. The proliferation of the treated BTSCs was evaluated using MTT assay. The BTSCs were induced in serum-containing medium and treated with ATRA or diluted solvent, and the expression of CD133 and glial fibrillary acidic protein (GFAP) in the cells were detected by immunofluorescence on day 10 of induction. The differentiated BTSCs were cultured in serum-flee medium, and the percentage of and time needed for cell sphere formation were observed. Results The proliferation of BTSCs in ATRA group was faster than that in the control group and slower than that in growth factor group and ATRA/growth factor group, and the size of brain tumor sphere (BTS) in ATRA group was smaller than that in the latter two groups. The percentage of CD133 and GFAP-positive differentiated BTSCs were (2.29±0.27)% and (75.60±4.03)% in ATRA group, and (7.05±0.49)% and (12.51±0.77)% in the control group, respectively. The differentiation rate of BTSCs was significantly higher in ATRA group than in the control group (P<0.05), and some of the differentiated BTSCs expressed CD133. The differentiated BTSCs could form BTS in serum-free medium, and in ATRA group, the percentage of BTS formation was significantly lower and time need for BTS formation was significantly longer than those in the control group [(4.84±0.32)% vs (17.71±0.78)%, P<0.05;10.07±1.03 vs 4.08±0.35 days, P<0.05]. Conclusion ATRA can promote the proliferation and induce the differentiation of BTSCs, but the differentiated BTSCs can not achieve terminal differentiation and tend to form BTS again.
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Objective To investigate the effect ofplatelet-derived growth factor (PDGF) and conditional medium of U87 glioma cells on the migration ability of human mesenchymal stem cells (hMSCs) to understand the possible role of PDGF in the directional migration of hMSCs toward gliomas. Methods hMSCs were isolated from the whole bone marrow by adherent culture, and the expression of PDGF receptor (PDGFR-α, β) in the cells was examined by RT-PCR. In vitro migration assay was performed using transwell inserts to observe the effect of PDGF (0, 5, 50, and 125 ng/mL) and the conditional medium on the directional migration ability ofhMSCs. The changes in the migration ability of hMSCs in response to addition of anti-PDGF antibody in the conditional medium were investigated. Results RT-PCR detected the expression of PDGFR- αand PDGFR-β mRNA in the isolated hMSCs. In the cell migration assay, both PDGF and the conditional medium induced directional migration of hMSCs (P<0.05), which was significantly suppressed by anti-PDGF antibody P<0.05). Conclusion With chemokine-like activities, PDGF concentration-dependently enhances the directional migration of hMSCs toward gliomas in vitro.
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Objective To evaluate the application of intraoperative real-time ultrasound combined with neuronavigation in surgical resection of deep intracranial lesions. Methods Fifteen patients with deep intracranial lesions underwent surgical resection of the lesions with guidance by Brain-Lab neuronavigation and intraoperative real-time ultrasound. The lesions were localized by ultrasound, and in cases of brain shift, intraoperative real-time ultrasound was used for lesion relocalization, surgical guidance, and monitoring of the tumor remnants during the operation. Results The lesions and their surrounding structures were accurately localized. Intraoperative real-time ultrasound identified brain shift of varying degrees, which was corrected under ultrasound guidance. Total resection of the lesions was achieved in 12 cases, and subtotal resection was performed in 2 cases. In the other case, the inflammatory lesion was identified as chronic granuloma by biopsy. All the patients showed improvements of the clinical symptoms after the operations. Conclusion Intraoperative real-time ultrasound during neuronavigation allows accurate localization of deep intracranial lesions and facilitates preoperative surgical planning to define the scope of resection, avoid the cortical brain tissue and important deep structures, and help evaluate the lesion residues for a second operation. Intraoperative real-time ultrasound may help improve the therapeutic effects and reduce the surgical complications.
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Objective To explore the best target position and range of lesion for magnetic resonance image (MRI)-guided stereotactic cingulotomy. Methods We retrospectively analyzed the data of 71 patients underwent MRI-guided stereotactic cingulotomy, including 7 with chronic pain and 64 with psychiatric disorders. The cingulate gyrus target chose were 5 mm as X, 10-20 mm posterior tip of the lateral ventricle as Y, 2 mm above the roof of the lateral ventricle as Z. The target position and range of lesion were determined and revised by routine sagittal, axial and coronal stereotactic MRI scans. Radiofrequency thermocoagulation lesions were produced by inserting an electrode (1.6 mm diameter and 4 mm uninsulated tip) and heating them at a temperature of 75℃ for 100 seconds with a volume of lesion reaching 15 mm×10 mm×10 mm. Early postoperative MR or CT scans and long-term followed up examination were available for all cases. Results Postoperative images showed that the lesions were all in the anterior cingulate gyrus. Two patients reported transient urinary incontinence without permanent complications; significant pain relief appeared in all patients with chronic pain; In 64 with intractable psychiatric disorders, cure was showed in 3 obvious improvements in 35, improvement in 22, and no change in 4. Conclusion MRI-guided stereotactic cingulotomy offers substantial advantages by allowing direct visualization of the cingulate gyrus and surrounding structures and the best range of lesion is 10-25 mm from the anterior point of the corpus callosum, 10 mm above the bottle of cingulate gyrus and 10 mm in width.
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Objective To study the impairnlent of cognitive function and the change of P300 event-related potential(ERP)parameters in the patients with tumor in frontal lobe so as to investigate the role of the front lobe in cognitive function and the P300 production. Methods P300 examination and neuropsychological tests for cognition,including Stroop Test,Symbol Digit Modalities Test,and Verbal Fluency Test,et al,were performed in 31 patients with tumor in front lobe(left 15 and right 16)and 30 healthy controls. Results Compared with healthy controls, in the patients with front lobe tumor,cognitive function was degraded(P＜0.05),the latency of N3,P3 of P300 was significantly longer,and the amplitude of P3 was significantly lower(P＜0.05).Funhermore,the patients with tumor in right front lobe had signmcantly lower scores in cognitive tests compared with healthy controls (P＜0.05), but the ones with tumor in left front lobe were demonstrated obviously impaired only in Verbal Fluency Test(P＜0.05).Compared with healthy controls, the patients with tumor in eimer right or left flront lobe, the latency of N3,P3 of P300 was significantly longer,the amplitude of P3 was significantly lower(P＜0.05),while in the comparison of two sides, there was no statistically significantly difference in P300 (P＞0.05).Conclusions The cognitive function is obviously impaired in the patients with tumor in frontal lobe,and the impainnent is more serious in the ones with right frontal lobe tumor. Frontal lobe may be related to the generation and transmission of P300,and it is not significantly different in between left and right frontal lobes.
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Objective To study the relationship between the biological behavior of gliomas and the state of adjacent fiber tract. Methods Regular MRI and DTI were performed in 24 patients with histologically confirmed brain gliomas. The fiber tracts adjacent gliomas reconstructed with 3-dimensional, the state of fiber tracts were evaluated with displaced, infiltrated or destroyed. Reflection the infiltration of glioma of MMP-9 、CD44 and the proliferative activity of VEGF and Ki-67 expression were evaluated by SP immunohistochemical staining method in surgical specimens. Results The expression of VEGF or Ki-67 was higher in high grade gliomas than low grade (P＜0.05) and a negative correlation (P＞0.05) between MMP-9 or CD44 expression and the grade of gliomas was found. The states of fiber tracts were damaged greatly in the periphery of high grade gliomas than low grade (P＜0.05).Further, the states of fiber tracts were destroyed heavily in the periphery of gliomas that had higher expression of VEGF or Ki-67 (P＜0.05). But there were poor correlation (P＞0.05) between MMP-9 or CD44 expression and the state of fiber tracts adjacent to gliomas. Conclusions The grade of and proliferation of gliomas can influence the state of fiber tracts in the periphery of gliomas but the infiltration did not. It was helpful to estimate the biological behavior of gliomas on imagines and useful in deciding the therapeutic regimen.