[Diagnostic value of high frequency oscillation in localization of type â ¡ focal cortical dysplasia epilepsy].

Retrospective analysis was conducted on 9 patients with type Ⅱ focal cortical dysplasia (FCD) who underwent stereo-electroencephalography (SEEG) implantation in the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical University from November 2020 to February 2023. The onset area, onset time, and frequency of high-frequency oscillations (HFO) were analyzed and the correlation of HFOs with interictal, preictal, and ictal periods. SEEG recordings of 80-500 Hz HFOs were observed in both interictal and ictal periods in 9 patients, with 6 patients exhibiting fast ripples (FR) in the range of 250-500 Hz. Surgical resection of the seizure onset area and FR-generating electrodes was performed, and postoperative follow-up for over 2 years indicated Engel I in 5 cases. 6 patients showed continuous discharge during the preictal period, and the distribution index of continuous discharge was positively correlated with seizure frequency. HFOs in the range of 80-500 Hz were present in all four seizure onset patterns during the ictal period. The onset area and FR-emitting electrode were surgically removed in 6 patients with continuous discharge and overlapping HFOs during the preictal period, with 5 cases of Engel I. Type Ⅱ FCD discharges exhibited complexity, high discharge indices, and a close association with HFOs. Compared with the spike wave, the electrode range of HF is more limited, and the incidence of HF before attack is significantly increased, which is closely correlated with the onset area. The simultaneous occurrence of HFO and the spike waves has higher diagnostic value than the individual occurrence, effectively enhancing surgical efficacy.

[Postoperative outcomes and influencing factors of diffuse low-grade glioma-related epilepsy].

The clinical and pathological features and postoperative outcomes of 49 patients with diffuse low-grade glioma -related epilepsy who were admitted to the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical University from January 2015 to December 2018 were analyzed. After 1-year follow-up, 33 patients (67.3%) in the good prognosis group and 16 patients (32.7%) in the poor prognosis group were enrolled. Multivariate logistic regression analysis indicatedthat subtotal tumor resection (OR=5.56, 95%CI:1.21-25.44,P=0.027) and no postoperative radiotherapy (OR=9.24, 95%CI:2.05-41.75, P=0.004) were the risk factors for poor prognosis of postoperative epilepsy. Therefore, for patients with diffuse low-grade glioma-related epilepsy, total tumor resection and postoperative radiotherapy are beneficial to the control of epilepsy.

[Clinicopathologic characteristics and causes of difficulty in locating the "difficult to locate" intractable epilepsy].

Objective: To summarize the clinicopathological characteristics of "difficult to locate" intractable epilepsy patients, and investigate the causes of difficulty in their location. Method: Retrospective analysis was performed on the clinical data of 58 patients who underwent resection of the epileptogenic zones after intracranial electroencephalography (iEEG) detection at the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical University from January 2010 to December 2018. Clinicopathological characteristics and lesion lobes of "difficult to locate" intractable epilepsy were summarized. The prognosis of patients was assessed according to Engel grading.Univariate and multivariate logistic regression analysis were used to investigate the relevant factors affecting the prognosis of patients with "difficult to locate" intractable epilepsy related to malformation of cortical development(MCD). Results: Among the 58 patients, there were 47 cases of MCD (12 cases with mild malformation of cortical development (mMCD), 35 cases with focal cortical dysplasia (FCD)), and 11 cases of other types. Among the 47 MCD cases, univariate analysis showed that patients with preoperative magnetic resonance imaging(MRI) positive and completed resection of the epileptogenic zones had better prognosis (P<0.05). Multivariate analysis indicated that completed resection of epileptogenic zones was an independent factor affecting the postoperative efficacy of MCD (P=0.013,Wald χ(2)=6.149, 95%CI: 0.07-0.56). And among the 47 MCD cases, 18 cases were with mono-lobar lesions and 29 cases were with multi-lobar lesions, however, there was no significant difference of the efficacy between the two groups (P=0.511). Conclusions: MCD, especially FCD, is the main pathological types of patients with "difficult to locate" intractable epilepsy. Multi-lobar pathological changes, especially multi-lobar MCD, are the main reasons of being difficult to locate, however, accurate locating of epileptogenic zones and functional areas via effective use of iEEG can achieve satisfactory efficacy in these patients after resection of the epileptogenic zones.

New scheme for the preparation and use of artificial cerebrospinal fluid.

This study aimed to explore a set of simplified schemes for the preparation and application of artificial cerebrospinal fluid (ACSF) to improve the experiment efficiency and neurosafety of ACSF. We prepared ACSF into parts A and B, according to the cerebrospinal fluid (CSF) data in rabbits. They were mixed in equal volumes to form ACSF, continous foaming with mixture gas (95% O2 and 5% CO2). Sampling inspection showed the chemical stability of ACSF in the three months after preparation. However, it needed to be kept continous foaming, as pH is correlated to the solubility of CO2. We further improved the application scheme by sealing the foamed ACSF in infusion bags filled with mixture gas, which could keep the pH stable for 24 hours. It was helpful in promoting the progress of clinical and experimental research relating to ACSF.

[Neuronavigation-assisted percutaneous radiofrequency thermocoagulation of trigeminal gasserian ganglion for refractory craniofacial pain].

Objective: Percutaneous radiofrequency thermocoagulation (RFT) of the Gasserian ganglion is an effective treatment for refractory trigeminal craniofacial pain.In the present study, we assessed the feasibility of accessing the Gasserian ganglion through the foramen ovale with neuronavigation guidance in the patients of trigeminal craniofacial pain. Method: We retrospectively analyzed forty-four patients with type Ⅰ trigeminal neuralgia who had undergone percutaneous RFT treatment in our hospital from June 2014 to December 2016.The patients were divided into fluoroscopy group and navigation group according to the intraoperative guiding manners for foramen ovale cannulation.We compared groups in terms of the duration of the whole RFT procedure and times of intraoperative fluoroscopy.We also analyzed the immediate and late outcome accessing by Barrow Neurological Institute (BNI) pain scale, as well as the complication rates in groups. Result: There were 32 patients in the fluoroscopy group and 12 in the navigation group.The duration of the surgical procedure in navigation group was less than that in fluoroscopy group (46±12 min versus 67±16 min, P=0.00), and times of intraoperative fluoroscopy was reduced (6.3±2.2 versus 1.3±1.6, P=0.00). The learning curve of navigation-aid RFT was not steep in the present study overall.There was no significant difference between groups regarding pain reduction at the immediate (P=0.07) or late follow-up (P=0.400) time points.However, the rate of pain reduction to BNI-Ⅰ grade was greater in navigation group (P=0.026). No significant difference in the complication rate between both groups, and no serious complications were observed in the both groups. Conclusion: Neuronavigation may be encouraged in trigeminal Gasserian ganglion RFT with better operating efficiency and less radiation exposure.The immediate and late therapeutic effects for craniofacial pain control were positive, whereas further studies are necessary.

[Investigation of short-term resolution as a predictor of long-term cure of microvascular decompression in hemifacial spasm].

Objective: To investigate whether the short-term relief of spasm (within 7 days) after microvascular decompression (MVD) for hemifacial spasm (HFS) can be used as a prognostic factor of long-term outcome (>6 months). Methods: The clinical characteristics and follow-up data (completely recorded) of 159 patients who had HFS and underwent microvascular decompression surgery in the first Affiliated Hospital of Fujian Medical University from August 2008 to May 2016 were analyzed retrospectively. The collected data focus on symptom relief in a time course: immediately after MVD, 7 days after MVD and the last follow-up (>6 months) by using Cohen-Albert grading. Results: In a total of 159 patients underwent MVD were followed up for more than 6 months.Compared to persist spasm group within 7 days after MVD, the cure rate was significantly higher in the spasm symptom relief group within 7 days after MVD (P<0.05). The cure rate of MVD (y) and the number of days within 7 days of relief (x) were highly relevant, y=-0.707x(2)+ 9.724x+ 67.442 (P<0.05). By using univariate Logistic regression analysis, we found that the prognostic factors of long-term curative effect were the symptom scale immediately after MVD and the average symptom scale in the 7 days after MVD (P<0.001). The incidence of delayed cure was 41.5%(66/159). Conclusion: In the 7 days after MVD, at least 1 day of symptom remission can predict the cure of HFS.

Label-free detection of fibrillar collagen deposition associated with vascular elements in glioblastoma multiforme by using multiphoton microscopy.

Glioblastoma multiforme (GBM-WHO grade IV) is the most common and the most aggressive form of brain tumors in adults with the median survival of 10-12 months. The diagnostic detection of extracellular matrix (ECM) component in the tumour microenvironment is of prognostic value. In this paper, the fibrillar collagen deposition associated with vascular elements in GBM were investigated in the fresh specimens and unstained histological slices by using multiphoton microscopy (MPM) based on two-photon excited fluorescence (TPEF) and second harmonic generation (SHG). Our study revealed the existence of fibrillar collagen deposition in the adventitia of remodelled large blood vessels and in glomeruloid vascular structures in GBM. The degree of fibrillar collagen deposition can be quantitatively evaluated by measuring the adventitial thickness of blood vessels or calculating the ratio of SHG pixel to the whole pixel of glomeruloid vascular structure in MPM images. These results indicated that MPM can not only be employed to perform a retrospective study in unstained histological slices but also has the potential to apply for in vivo brain imaging to understand correlations between malignancy of gliomas and fibrillar collagen deposition.

[Factors associated with the surgical efficacy and prognosis of seizures in patients with low-grade glioma].

OBJECTIVE: To explore the relevant factors associated with the surgical efficacy and prognosis of seizures in patients with low-grade glioma (LGG). METHODS: The clinical cases of seizures in patients with LGG admitted to our department were retrospectively collected from January 2010 to December 2014. A total of 45 cases were studied to analyze the relevant factors associated with the surgical efficacy and prognosis. RESULTS: During a follow-up period of 1 to 5 years after surgery, Engel classⅠ to Ⅱ were achieved in 36 patients (80%) and Engel class Ⅲ to Ⅳ in 9 cases (20%). The preoperative epilepsy frequency and the use of intraoperative electrocardiograph (ECoG) were correlated with the surgical efficacy and prognosis (P<0.05). The other factors, such as age, gender, duration of epilepsy, and tumor characteristics, had no significant statistical difference. CONCLUSIONS: The surgical efficacy of seizures in patients with LGG is favorable. Our results suggest that preoperative epilepsy frequency and intraoperative ECoG are important factors for surgical efficacy and prognosis. Consequently, based on gross total resection for seizures in patients with LGG, epileptogenic zones should be considered and dealt with by use of ECoG.

PI3K-AKT pathway polymerase chain reaction (PCR) array analysis of epilepsy induced by type II focal cortical dysplasia.

The aims of this study were to observe the differential expression of PI3K-AKT pathway-related genes in seizure-inducing brain lesions in type II focal cortical dysplasia, and to explore the relationship between gene expression and histological changes in dysplastic foci and their epileptogenic mechanism. Typical lesions in brain tissue from three patients with epilepsy induced by type II focal cortical dysplasia were selected for analysis, along with normal brain tissue from two control group individuals. Following quantitative expression analysis using the RT2 Profiler(TM) PI3K-AKT PCR Array, differential expression of the pathway related genes was detected in the focal brain tissue lesions, and gene function queries were performed. Compared with the control group, thirteen related genes appeared to exhibit marked differences in expression in epileptic lesions from patients with type II focal cortical dysplasia; those genes were found to be involved in regulation of cell size, morphology, adhesion, migration, and apoptosis, and in immunity, inflammation, and many other domains. The differential expression of multiple genes in the PI3K-AKT signaling pathway in type II focal cortical dysplasia may be an important molecular mechanism underlying histological changes and recurrent seizures.