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Objective To investigate the related anatomical parameters of single-nostril transsphenoidal approach in adults.Methods Two hundred and ninty-four adults,performed head-neck CTA in our hospital from October 2011 to January 2012,were prospectively collected; and their CT data were collected,and the following anatomical parameters were measured through the multi-planar reconstruction of the CTA images:the angle of sella lowest point-anterior nasal spine root-the bottom of nasal cavity (∠ 1),the angle of the connection of Maxillary central incisors bottom to auditory canal crossing with the bottom of nasal cavity(∠ 2),the angle of tuberculum sellae-anterior nasal spine root-the bottom of nasal cavity(∠3),the angle ofdorsum sellae-anterior nasal spine root-the bottom of nasal cavity (∠4),and the angles of right / left sphenoid sinus mouth-maxillary ridge-the bottom of nasal cavity(∠5 / ∠6).Results ∠1(29.7±3.1°),∠2(29.5±3.1°),∠3(33.6±3.8°),∠4(28.8±3.6°),∠5(33.9±4.2°) and ∠6(33.6±4.5°) were calculated; significant differences were noted between each two angles (P＜0.05); ∠ 1 and ∠2 had a positive linear correlation (r=0.78,P＜0.05).Conclusion Preoperative multi-planar reconstruction images of CT facilitates safe opening of the anterior wall of spheniodal sinus and the sellar floor,and the operative position refers to the orientation that the virtual plane of Maxillary central incisors bottom to bilateral auditory canal erects the ground.
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Objective To investigate the effect of hemoglobin on structure and function of blood-brain barrier (BBB) in rat models after intracerebral hemorrhage.Methods One hundred and eight male SD rats were randomized into normal control group (n=12),intracerebral hemoglobin injection group (Hb group,n=48) and sham-operated group (n=48); according to the different observation time points,rats in the Hb group and sham-operated group were divided into 4 subgroups (6 and 24 h,3 and 7 d after the injection,n=1 2).Histological changes and iron deposition of the brain tissues were examined with HE staining and iron staining,respectively.BBB permeability was evaluated by the permeation of Evens blue.The expressions of claudin-5 and ZO-1 in perihematomal brain tissues were detected by immunofluorescence staining and real-time fluorescence quantitative PCR.Results Evident edema and necrosis were observed in the perihematomal zone of Hb group,and iron deposition was found 3 and 7 days after the injection.The permeation of Evens blue in Hb group was significantly increased as compared with that in sham-operated group (P＜0.05).Immunofluorescence staining indicated that expressions ofclaudin-5 and ZO-1 were low and discontinuous in Hb group; the mRNA expression levels of claudin-5 and ZO-1 in Hb group were significantly lower than those in the sham-operated group (P＜0.05).Conclusion After intracerebral hemorrhage,Hb may induce the damage of BBB and participate in the course of brain edema.
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Objective To explore the effects of hemoglobin level on Rho kinase Ⅱ of endothelial cells and tight junction protein clandin-5 in blood-brain barrier (BBB) of rats after intracerebral hemorrhage (ICH).Methods Male SD rats were randomized into normal control group (n=18) and hemoglobin inducement group (n=72); hemoglobin inducement group was divided into 4 subgroups (24 and 48 h,and 3 and 7 d after surgery,n=18).Rat ICH models in the hemoglobin inducement group were established by hemoglobin injection into the brain tissues.The expression ofRho kinase Ⅱ of endothelial cells and phosphorylated myosin light chain protein in BBB were observed by immunohistochemical staining,and BBB permeability was evaluated by Evans Blue dye; The protein and mRNA expressions of claudin-5 in the perihematomal brain tissues were detected by immunofluorescence staining and real-time quantitative PCR.Results Immunohistochemical staining indicated that expressions of Rho kinase Ⅱ of endothelial cells and phosphorylated myosin light chain in BBB of normal control group were rare,and those in the hemoglobin inducement group were high; as compared with that in the normal control group,mean optical density of Rho kinase Ⅱ and phosphorylated myosin light chain proteins in the endothelial cells of BBB in hemoglobin inducement group increased significantly at 48 h and 3 d after inducement (P＜0.05).The permeation of Evans Blue in hemoglobin inducement group significantly increased (P＜0.05).Immunofluorescence staining showed that the expression of clandin-5 in hemoglobin inducement group was uncontinuous and low as compared with that in the normal control group at 24 and 48 h and 3 d after inducement.PCR showed that the mRNA expression of claudin-5 in hemoglobin inducement group was significantly lower than that in the normal control group at 24 and 48 h and 3 and 7 d after the inducement (P＜0.05).Conclusion After intracerebral hemorrhage,hemoglobin can lead to increased expression of phosphorylated myosin light chain,and reduce the expression of tight junction protein claudin-5 of BBB by increasing the expression ofRho kinase Ⅱ in endothelial cells of BBB,which may be an important mechanism in the disruption of BBB and the occurrence of brain edema after intracerebral hemorrhage.
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Objective To investigate the changes of tight junction (TJ) protein occludin expression between the mierovascular endothelial cells of the blood-brain barrier (BBB) of rats after intracerebral hemorrhage (ICH). Methods Ninety-three male SD rats were randomly divided into normal control group and experimental group; rats of the experimental group were divided into 6 subgroups (6, 24, 48 and 72 h, and 7 and 14 d after intraeerebral hemorrhage). Rat models of intracerebral hemorrhage in the experimental group were established by autologous blood injection.Morphology of the brain tissues was detected by hematoxylin-eosin (HE) staining.The tight junctions between the microvascular endothelial cells of the BBB were sampled for ultrastructural observation using electron microcopy.Immunofluorescence and quantitative real time-PCR were used to analyze the protein and mRNA expressions of occludin,respectively. Results The brain edema was found in brain tissues around the hematoma. Necrosis and inflammatory infiltration could be found in perihematomal brain tissues and it was most obvious at 48 h after intracerebral hemorrhage. Obvious paracellular clefts were found between the adjacent endothelial cells in experimental groups. Strong expression of occludin was noted in the normal brain tissue; expression of occludin was positive 6 h after the injection and weak positive at 24, 48 and 72 h after the injection in the experimental groups.Quantitative real time-PCR showed that the mRNA expression of occludin in the experimental group was significantly reduced as compared with the normal brain tissue at 6,24,48 and 72 h after the injection with statistically significant difference (P＜0.05). Conclusion After intra-cerebral hemorrhage,as a major component of TJ of the BBB,occludin expression is down-regulated,which may be one of the most impotant molecular basis of disruption of BBB.
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Objective To develop a three-dimensional visual neurosurgical tool enjoying simple,fast and accurate characteristics at moderate cost for visual positioning and imaging information storage and processing. Methods Seven patients with epidural hematoma or depressed fracture resulted from severe craniocerebral trauma, 8 patients with hypophysoma, 5 with glioma and 3 with meningeoma were chosen in our study; CT three-dimensional reconstruction of their imaging data were performed and used for preoperative planning before surgery assisted by neurosurgical station.According to CT three-dimensional reconstruction results, appropriate neurosurgical approach was planned and patients were treated by surgery. Results Neurosurgical station performed three-dimensional reconstruction could show three-dimensional quantitative relationship between the above lesions and anatomical landmarks directly,which could help direct positioning and designing the best-individualized approach to improve the surgical accuracy and efficacy. Neurosurgical station could improve the efficiency of scientific research and clinical work by managing,storing,editing and using the imaging and video of the patients. Conclusion Neurosurgical station, which can show three-dimensional quantitative relationship between the above lesions and anatomical landmarks directly, is a simple, fast and accurate preoperative planning and information processing tool for clinical neurosurgical practice.
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[Objective]To explore the distribution and expression changes of tight junctional protein JAM-1 in rat models after intracerebral hemorrhage (ICH) and their significance.[Methods]One hundred and twenty-eighty healthy male SD rats were randomly divided into normal control group (n=16) and ICH group (n=112),and the ICH models were induced by stereotactically injecting 75 uL autologous blood into the right caudate nucleus.Seven time points after ICH (6,12,24 and 48 h,and 3,7 and 14 d after ICH,16 rats for each time point) were chosen.BBB permeability was evaluated by Evans blue dye extravasation.The distribution and expression of JAM-1 were detected by immunofluorescence and real-time quantitative PCR.[Results] As compared with that in the normal control group,BBB permeability in the ICH group significantly increased at 24 and 48 h,and 3 and 7 d after ICH (P＜0.05).JAM-1 expression decreased at blood vessels at 12,24 and 48 h after ICH,and JAM-1 expressed at the circulatingleukocytes3 dafterlCH,and abundant JAM-1 positive cells around hematoma were noted in the ED-l-positve macrophages 7 d after ICH.JAM-I mRNA significantly decreased at 12,24 and 48 h after ICH,and significantly increased 7 d after ICH as compared with that in the normal control group (P＜0.05).[Conclusion] JAM-1 experssion changes not only participate in regulation of BBB permeability but also play roles in inflammatory insult after ICH.
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Objective To observe the anatomical structure via endonasal transsphenoidal approach with virtual endoscopy (VE) and explore the clinical applications of VE in endoscopic pituitary tumor resection through the endonasal transsphenoidal approach. Methods The VE was applied to the reconstruction of the pre-surgical 64-slice CT scanning of the 21 patients with pituitary adenoma received the endoscopic endonasal transsphenoidal surgery. A comparative study and a correlation analysis of cumulative scores of the anatomical structure were performed between the reconstructed VE images and the intraoperative endoscopic ones. Results Preoperative VE images and intraoperative endoscope images are very similar. The correlation of cumulative scores of the anatomical structure between the VE images of anatomical findings and the intraoperative images was positively noted (r=0.923, P=0.001),indicating that VE can be applied to simulately observe the anatomical structure before the endoscopic endonasal transsphenoidal pituitary surgery, and observe the anatomical structure through the endonasal transsphenoidal approach. Conclusion Being able to display the important anatomical structure and its varieties before the endoscopic endonasal transsphenoidal pituitary surgery, VE proves to be a valuable approach to the preoperative planning, increases the surgical efficiency and improves the safety of the surgery.
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Objective To explore the correlation between brainstem auditory evoked potential (BAEP) findings and outcome in long-term unconscious patients with severe traumatic brain injury (TBI).Methods BAEP findings were recorded and analyzed in 63 patients suffering from severe TBI with duration of disturbance of unconsciousness for more than 2 weeks. The peak latency (PL) of wave Ⅰ, Ⅲ and Ⅴ, the interpeak latency (IPL) of wave Ⅰ-Ⅲ and Ⅲ-Ⅴ and the amplitude ratio of wave Ⅰ and Ⅴ were analyzed. Conscious or unconscious at 6 months after the injury was considered as the outcome criterion,and based on these, the patients were divided into conscious and unconscious groups; the significant indicators were chosen in the 2 groups using independent-sample t test. Results The probabilities of awakening in these patients were 34.9% (22/63) with abnormal index of BAEP indicators reaching 66.7%. Sixteen patients were sober at last in 21 patients with normal PL of wave Ⅰ, Ⅲ and Ⅴ, IPL of wave Ⅰ-Ⅲ and Ⅲ-Ⅴ, and amplitude ratio of wave Ⅰ and Ⅴ in bilateral side (the probabilities of awakening were 76.2%); 8 patients having abnormal PL of wave Ⅴ in bilateral side and 7 having abnormal IPL of wave Ⅲ-Ⅴ in bilateral side were unconscious; 2 patients having disappeared wave Ⅴ in unilateral side were unconscious. PL of wave Ⅴ and IPL of wave Ⅲ-Ⅴ in bilateral side were significantly different between the conscious group and the unconscious group. (P＜0.05). Conclusion BAEP findings (PL of wave Ⅴ and IPL of wave Ⅲ-Ⅴ in bilateral side) can objectively and accurately demonstrate the cerebral dysfunction and predict the outcome of the patients.
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Objective To develop a simple, fast and accurate preoperative planning method for endoscopic surgery of patients with hypertensive intracerebral hemorrhage (HICH).Methods Eighteen patients with HICH, admitted to our hospital from June 2008 to August 2010, were performed endoscopic minimally invasive surgery; CT three-dimensional reconstruction was employed to locate the intracerebral hematoma and select the appropriate endoscopic approach before the endoscopic surgery.The clinical data and treatmem efficacy were analyzed.Results According to the results of CT three-dimensional reconstruction, our neurosurgeons could design the best endoscopic approach; the three-dimensional relationship between intracerebral hematoma and scalp markers was shown directly and accurate positioning of the location of drilling was achieved; therefore, the time for preoperative preparation, anesthesia and operation was shortened. The mean operating time of these 18 patients was about 1.5 h; the volume of blood loss was only 30-40 mL; and the evacuation ratio was about 89.2%.After the elimination of hematoma, the brain tissues were flabby, so decompressive craniectomy was not needed. Conclusion CT three-dimensional reconstruction is a simple, fast and accurate preoperative planning method for endoscopic surgery of patients with HICH.
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Objective To explore the correlation between magnetic resonance imaging(MRI)manifestations and the prognosis in long-term consciousness disorder patients with severe traumatic brain injury(TBI).Methods MRI data were collected in 66 patients with a duration of disturbance of unconsciousness for more than 2 weeks.These patients suffered from severe TBI and were admitted to our hospital from January 2003 to August 2008.The data about regions of abnormal signal in T2WI in the brain stem,the thalamus,the basal forebrain,the corpus callosum,the cerebral cortex and the subcortical area were recorded and analyzed.The patients were divided into conscious and unconscious groups based on the outcome 6 months after the injury.Logistic regression analysis was used to calculate the OR value between the lesions and the poor outcome of the patients.Results The lesions of the dorsal upper brain stein,the thalamus and the corpus callosum between the conscious and unconscious groups were significantly different.The lesions of the dorsal upper brain stem,the corpus callosum and the thalamic by MRI predict the poor outcomes.Conclusion The MRI manifestations can demonstrate the cerebral dysfunction and probabilities of patients' outcome objectively and accurately.
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Objective To study the relationship between O6-methylguanine-DNA-methyltransferase(MGMT)expression in gliomas and the efficacy of teniposide(VM-26)combined with somustine(Me-CCNU). Methods A retrospective chart review was performed on 47 patients diagnosed by pathology as having gliomas.The expression of MGMT in all paraffin sections of the patients were determined by immunohistochemical technique.The clinical efficacy was observed and the overall survival rates were analyzed. Results The positive rate of MGMT in all the 47 patients was 40.4%.Three-year survival rate of the negative group was 66.7%and that of the positive group was 52.6%without statistical significance(P>0.05).The average OS of the negative group was 67.861±10.094 and that of the positive group was 47.263±7.983 without statistical significance(P>0.05).Bone marrow suppression of grade I was found in 11 patients with 6 appearing stomach discomfort,vomiting,diarrhea,loss of appetite and digestive symptoms.Conclusions MGMT is one agent of drug resistance of nitrosourea.VM-26 combined with Me-CCNU chemotherapy can overcome the resistance effect of MGMT with little side effects.
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Objective To investigate the changes and the molecular mechanism of tight junctions of blood-brain barrier (BBB) in human glioma. Methods A retrospective analysis was conducted in 21 patients with glioma of different grades and 6 healthy adults and thus we divided them into normal tissue group (n=6), low-grade glioma group (n=11) and high-grade glioma group (n=10).Each group was sampled for ultrastructural observation of the tight junctions of BBB using transmission electron microscope. Double immunofluorescence staining and RT-PCR were used to observe andanalyze the protein and mRNA expressions of Claudin-5 in the glioma, respectively. Results In normal brain tissues, the para-cellular cleft between the adjacent endothelial cells was sealed by continuous strands of tight junctions. In low-grade glioma, most of the tight junctions were intact and no fenestration was found in the endothelium. In high-grade glioma, the amount of pinocytosis vesicle was increased and significant paracellular cleft was found between the adjacent endothelial cells; in addition,typical fenestrations were found in the endothelial cells. Double immunofluorescence staining showedstrong expression of Claudin-5 in the microvascular endothelial cells in the normal brain tissues but weakexpression of that in the high-grade glioma. In the low-grade glioma, expression of Claudin-5 wasdecreased slightly in the microvascular endothelial cells. Compared with the high-grade glioma, the low-grade glioma and normal brain tissues showed significantly higher mRNA expression level of Claudin-5 (P<0.05). Conclusion In the development of brain glioma, glioma cells can decrease the expressions of Claudin-5 and interrupt the continuity of the tight junctions in BBB; and the decrease of Claudin-5 may be one of the important molecular mechanisms explaining the paracellular cleft of tight junction in BBB.
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Objective To develop a minimally invasive operating technique for the treatment of hypertensive thalamic hemorrhage. Methods The clinical data of 15 patients with hypertensive thalamic hemorrhage performed neuroendoscope-assisted micro-invasive surgical treatment in our hospitals from July 2007 to June 2010 were retrospectively analyzed; their treatment efficacy were also concluded. Results The mean operation time of these patients was (1.5±0.4) h and the amount of blood loss was 30-40 mL; the mean clearance rate of hematoma in the thalamus was (86.2 ±7.9)percentage. Patients were followed up and evaluated by Glasgow outcome scale for at least 3 months.Three patients (21.4%) showed good recovery, 4 (28.6%) moderate disability, 4(28.6%) severe disability and 2 (14.3%) vegetative survival; 1 patient (7.1%) died. Conclusion Neuroendoscope-assisted micro-invasive surgical treatment is a fast and minimally invasive operating technique with little blood loss in the treatment of hypertensive thalamic hemorrhage.
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Objective To explore the somatosensory evoked potential grading in prediction of awakening in unconscious patients after severe traumatic brain injury. Methods SEPs were recorded and analyzed in 46 patients suffering from severe TBI with duration of disturbance of unconsciousness more than one week. SEPs were classified as following according to the existence of N20-P25 and the central conduction time (CCT): Ⅰ bilateral N20-P25 are normal; Ⅰ a bilateral CCT are normal and symetrical; Ⅰ b bilateral CCT are normal,but asymmetrical, Ⅱ unilateral N20-P25 exist. The other side is absent, Ⅲ bilateral N20-P25 are absent. The awakening after the sixth month from injury was used as the criterion. Results SEP grading has significant correlation with the probabilities of awakening (P< 0.05): The higher the SEP grades, the lower the probabilities of awakening is. Conclusion SEP grading can objectively and accurately demonstrate cerebral dysfunction and probabilities of patients' awakening.
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Objective To investigate the establishment of synapses between the cortical neurons and the neuron-like cells difierentiated from the marrow stromal cells(BMSCs)in a simulated transplantation system in vitro.Methods The BMSCs from green fluorescent protein(GFP)transgenic mice(GFP-GM-BMSCs) were isolated, cultured and purified in vitro.The third passage of GFP-GM-BMSCs were co-cultured with primary cultured cortical neurons and gliai cells in a simulated transplantation system in serum-free medium conmining 2%B27 supplemented with 20 ng/mL basic fibroblast growth factor(bFGF)and 20 ng/mL epidermal growth factor(EGF).On day 10 of the co-culture,FM1-43,a fluorescent dye specific to active synaptic vesicles,was used to observe synapses formation between the cells under fluorescence microscope. Results The GFP.GM-BMSCsco-cultured with the neural cells in the Serum-free medium containing bFGF and EGF differentiated into neuron-like cells 7 days after the co-culture.On day 10 ofthe co-culture,FM1-43 dye-positive synaptic vesicles were foundin the cell culture,locating mostly in the cell body,processes and terminal sffuctures ofthe neuron-like cells. Conclusions The neuron-like cells derived from GFP-GM-BMSCs can form synapses with the coRical neurons in the simulated cell transplantation system in vitro.
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Objective To investigate the changes in the tight junctions of the blood-brain barrier (BBB) in a rat model bearing C6 glioma. Methods Rat models bearing C6 glioma were established in 30 male Wistar rats by stereotactic injection of C6 glioma cells into the caudate nuclei, with another 30 rats as the normal control group. Twenty-one days after the injection, magnetic resonance imaging (MRI) was performed, and the normal brain tissue, tumor core, tumor margin and the ipsilateral hemisphere tissues 2 mm from the tumor margin were sampled for ultrastructural observation of the BBB using electron microscopy, Immunohistochcmistry and RT-PCR were used to analyze the expression of claudin-5 protein and mRNA in these tissues, respectively. Results MRI revealed tumor formation in the brain 21 days after C6 cell injection. In normal control brain tissues, the paracellular cleft between the adjacent endothelial cells was sealed by continuous tight junction strands, which were found in only 22.23% of the microvesscls in the core of the brain gliomas, and obvious paracellular clefs were found between the adjacent endothelial cells in other microvessels. In the tissues on the tumor margin, intercellular tight junctions were found in 57.15% of the microvessels with the rest microvesseis having obvious paracellular clefts. Immunohistochemistry showed strong claudin-5 positivity in the control brain tissue but yielded negative results in the core of the gliomas. Compared with the core of the gliomas, the tissues on the tumor margin, those 2 mm from the tumor margin and the control brain tissues showed significantly increased claudin-5 expression (P<0.05,respectively). Conclusion In C6 glioma-bearing rats, the continuity of the tight junctions in the BBB is interrupted due to decreased expression of claudin-5 in the brain gliomas.
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Objective To assess the effect of D-JNKI1, an inhibitor of c-Jun N-terminal kinase (JNK), on delayed neuronal death (DND) in a gerbil model of transient global cerebral ischemia, so as to further study the roles of JNK activation in mediating neuronal cell death in brain ischemia. Methods Fifty-five Mongolian gerbils were randomly divided into 11 groups. Animals (n=35) assigned into 7 groups (n=5 per group) were subjected to 5-min occlusion of bilateral common carotid arteries (BCCAO);among the 7 groups, different doses of D-JNKI1 (0.00012, 0.0012, 0.012, 0.12, 1.2 μmol/L in 2 μL PBS,n=5 each) were administered stereotaxically into right lateral ventricles 3 h after reperfusion; the control group (n=5) received 2 μL PBS; and another group (n=5) received 1.2 μmol/L of D-JNKI1 in 0.5 mL PBS intraperitoneally. Sham-operated animals (n=5) only received the exposure of bilateral common carotid arteries without occlusion. Three groups (n=5 in each) were pretreated with D-JNKI1 (0.00012,0.0012 μmol/L in 2 μL PBS) or only 2 μL PBS 30 min before 2-min BCCAO, and subjected to 5-min BCCAO 48 h after the first ischemic insult. All animals were sacrificed 4 d after 5-min BCCAO and prepared for frozen section and Nissl staining. Results The treatment with D-JNKI 3 h after 5-min ischemia was neuroprotective with a maximum effect at a dose of 0.0012 μmol/L. Pretreatment with D-JNKI augmented ischemic tolerance induced by 2-min ischemia. Conclusion D-JNKI1 has a potential neuroprotective effect on DND in CA1 of hippocampus in gerbils with global cerebral ischemia-reperfusion injury.