神经导航系统在颅内病变显微手术中的应用

应用神经导航系统进行颅内病变显微手术50例.本组颅内病变及其周围解剖结构定位准确,平均注册误差 2.4±0.4 mm.术后近期复查颅脑MR证实肿瘤全切率92%,手术并发症10%,手术时间和住院日较常规开颅手术缩短.结果表明:1)神经导航系统术前计划定位精确;2)实时导航下颅内病变显微手术,有助于达到微侵袭效果和提高肿瘤全切除率

神经导航在颅内胶质瘤显微手术的应用

目的　评价神经导航在颅内胶质瘤显微手术的应用价值。方法　应用神经导航系统进行颅内胶质瘤显微手术 30例。结果　用神经导航系统进行胶质瘤及其周围解剖结构定位准确 ,平均注册误差 (2 .5± 0 .4 )mm。术后近期复查CT或MR证实胶质瘤全切率 83.3% ,手术时间和住院日较常规开颅手术缩短。结论　 (1)神经导航定位精确 ,有助于手术计划的精确实施。 (2 )实时导航颅内胶质瘤显微手术 ,有助于达到微侵袭效果和提高胶质瘤全切除率。 (3)摸索一套减少靶点漂移的经验

A prospective study of nonfunctioning pituitary adenomas: presentation, management, and clinical outcome

State Administration of Foreign Experts Affairs of ChinaA prospective study was performed to evaluate the presentation, therapeutic management, and clinical outcome of nonfunctioning pituitary adenomas (NFPAs). In most of 385 consecutive patients, NFPAs were macroadenomas. The mean follow-up duration was 5.5 +/- A 1.4 years. Presentation was dominated by headache, visual disturbance, and hypopituitarism. Pituitary apoplexy (clinical and subclinical) was observed in 88 patients. Appropriate steroids replacement was given before surgery. Endoscope-assisted transsphenoidal surgery (TSS) was performed, and was well tolerated by all patients. At discharge, visual disturbances were improved in 215 (87.6%) patients who had complained of visual impairment preoperatively. The shorter the time from presentation of pituitary apoplexy to surgery, the better the outcome in visual function. Seventy-two (18.7%) patients developed transient diabetes insipidus (DI) and 85 (22.1%) patients developed hyponatremia, but all these improved within six weeks. Hypocortisolism was confirmed in 84 (21.8%) patients with an abnormal postoperative day 2 (POD2) 0800 serum cortisol level and in 122 (31.7%) patients with an abnormal POD6 0800 serum cortisol level. Hypothyroidism occurred in 135 (35.1%) patients. Steroids replacement was thus given immediately. Eight (2.1%) patients needed lifetime hormone substitution. No adrenal crisis occurred. Five (1.3%) patients died within six weeks. Residual tumors were confirmed in 79 patients (20.8%) by postoperative four-month enhanced MR imaging. Tumor recurrence or regrowth occurred in 56 patients (14.7%) during the follow-up period. These patients required repeat TSS or radiosurgery. The findings of this study support the use of TSS as a feasible initial treatment for NFPAs. With appropriate perioperative management of abnormal fluid, electrolyte, and endocrinological function, TSS was associated with minimum morbidity and was well tolerated by patients regardless of age. However, close screening of pituitary function and adequate neuroradiological follow-up should be performed after surgery for detection of tumor recurrence or regrowth. The indications for repeat TSS and postoperative radiosurgery in residual or recurrent NFPAs should be better defined

Transnasal transsphenoid approach: a minimally invasive approach for removal of cavernous haemangiomas located at inferomedial part of orbital apex

P>Ten patients complaining of visual impairment, proptosis or ocular pain, were selected for transnasal transsphenoid microsurgical approach to address cavernous haemangiomas located at inferomedial part of orbital apex. Via this approach, the contents of orbital apex were clearly illuminated and exposed as large as the surgical removal required. All tumours were identified under frameless image-guided neuronavigation and removed completely without any complications and recurrence in a mean of 12.2 months follow-up. It is concluded that a transnasal transsphenoid microsurgical approach is a minimally invasive surgery for cavernous haemangiomas located at inferomedial part of orbital apex

Expression and structure of interleukin 4 receptor (IL-4R) complex in human invasive pituitary adenomas

Pituitary adenomas are frequently invasive of surrounding tissues, which adversely affects the surgical outcome and the disease-free survival of patients. In the present study, Interleukin 4 receptor (IL-4R) complex has been investigated to figure out whether the three subunits are overexpressed in human invasive pituitary adenomas. Reverse transcription-polymerise chain reaction (RT-PCR) analysis for interleukin 4 receptor a (IL-4R alpha), interleukin 13 receptor alpha 1 (IL-13R alpha 1), interleukin 2 receptor gamma c (IL-2R gamma c) were performed on total RNA extracted from 10 non-invasive pituitary adenomas, 30 invasive pituitary adenomas, one glioblastoma multiforme, one normal human pituitary tissue sample and one normal human brain tissue sample. Quantitative real-time PCR and in situ immunofluorescence assay were performed in five invasive functioning pituitary adenoma samples and five invasive nonfunctioning pituitary adenoma samples. RT-PCR analysis for IL-4Ra, IL-13R alpha 1 and IL-2R gamma c chains were overexpressed in invasive pituitary adenomas. The transcripts for three subunits were not/weakly expressed in normal pituitary tissue and normal brain tissue. The quantitative real-time PCR and in situ immunofluorescence assay confirmed the results of the RT-PCR analysis. Our results indicate that human invasive pituitary adenomas express type III IL-4R complex. These receptors may serve as a novel target for immunotoxin therapy in patients with invasive pituitary adenomas who are not amenable to total surgical resection or for recurrent cases. (c) 2007 Elsevier Ireland Ltd. All rights reserved

A Markov model to compare the long-term effect of aspirin, clopidogrel and clopidogrel plus aspirin on prevention of recurrent ischemic stroke due to intracranial artery stenosis

Background: Given the importance of intracranial stenosis as a cause of recurrent ischemic stroke and the lack of evidence supporting a clear choice for prevention of recurrent ischemic events, a computer simulation model for prognostic prediction could be used to improve decision making. Aims: The aim of the following study is to compare the long-term effect of aspirin, clopidogrel and clopidogrel plus aspirin for prevention of recurrent stroke due to atherosclerotic intracranial artery stenosis. Setting and Design: The cohort consisted of 206 patients from 2006 to 2011. Materials and Methods: A two-state Markov model was used to predict the prognosis of patients with stroke or transient ischemic attack (TIA) caused by angiographically verified 50-99% stenosis of a major intracranial artery to receive aspirin, clopidogrel, or dual therapy. Statistical Analysis: Two tests were used: Pearson Chi-square test or Fisher's exact test (for percentages) and Kruskal Wallis test (for rank order data). Results: In the 10-year Markov cohort analysis, 36.24% of patients who were treated with clopidogrel plus aspirin developed to recurrent stroke while the probability for patients in the aspirin group and clopidogrel group was 42.60% and 48.39% respectively. Patients with clopidogrel plus aspirin had the highest quality-adjusted life years, followed by aspirin and clopidogrel. Conclusion: To prevent recurrent stroke in patients with intracranial artery stenosis, especially in those patients with a history of TIA or coronary artery disease, medical therapy with clopidogrel plus aspirin should be considered in preference to aspirin alone

Detection of ischemia in endovascular therapy of cerebral aneurysms: a perspective in the era of neurophysiological monitoring

State Administration of Foreign Experts Affairs of ChinaA prospective study was performed to evaluate the efficacy of neurophysiological monitoring (NPM) techniques in the detection of ischemic changes that may be seen during endovascular treatment of cerebral aneurysms. Sixty three patients underwent NPM during first-stage endovascular treatment of cerebral aneurysms. The endovascular procedures included coil embolization (26 patients), balloon-remodeling coiling (16 patients), stent-assisted coiling (ten patients), balloon-stent-assisted coiling (nine patients), and balloon test occlusion (two patients). NPM included electroencephalography, somatosensory evoked potentials, and brain stem auditory evoked potentials, depending on the location of the aneurysm and its associated vascular territory. NPM changes were seen in three patients (4.8%), and the procedures were altered immediately. No neurological changes were found postendovascularly. Ten patients demonstrated abnormal angiographic findings without concurrent NPM changes, of which five patients developed visual disturbance or hemiparesis. It is concluded that NPM is a valuable monitoring tool for endovascular treatment of cerebral aneurysms

神经导航在幕上肿瘤锁孔手术的应用(附35例报告)

目的评价神经导航在幕上肿瘤锁孔手术的应用价值。方法分析应用神经导航系统进行幕上肿瘤锁孔手术35例病人的临床资料。结果肿瘤及周围解剖结构定位准确,平均注册误差(2.8 ±0.4)mm。肿瘤全切率85.7%,手术时间和住院日较常规开颅手术缩短。结论①神经导航定位精确,有助于手术计划的精确实施。②导航颅内肿瘤锁孔手术有助于达到微侵袭效果,提高肿瘤全切除率。③摸索了一套减少靶点漂移的经验

Role of aneurysm projection in "A2" fork orientation for determining the side of surgical approach

To determine factors that help decide the side of approach for anterior communicating artery (AComA) aneurysms, based on a prospective study. Between January 2004 and January 2006, 93 cases with AComA aneurysms were treated through pterional approach. They were classified as Type I, II (IIa, IIb), III and IV, based on the various projections and size of aneurysm. The principle for the choice of operative side was designed based on the type of aneurysm and the A2 fork orientation (the interrelations between the plane of bilateral A2, AComA, and mid-saggital plane). There were 55 aneurysms of Type I, 10 of Type IIa, 14 of Type IIb, 12 of Type III, and 2 of Type IV. In Types I and IIa, the side posteriorly placed to A2 was chosen for the approach. In Type IIb, the side of the dominant A1 was selected. In Type III, the side anteriorly placed to A2 was chosen. Type IV aneurysms were difficult to handle even if approached from the dominant A1. There were 11 cases treated from the side of non-dominant A1. The overall outcome in the treatment of AComA aneurysms were considered excellent in 90.8% of cases according to the Glasgow Outcome Scale, with complete occlusion of aneurysms and complete patency of parent or perforating arteries. Applying three-dimensional computed tomography and magnetic resonance angiography, we classified AComA aneurysms as four types and undertook surgical clipping from the chosen side of approach, according to the type of aneurysm and the A2 fork orientation. The selective side of approach on the basis of individual decision-making has led to favourable outcomes

Inhibitory Effect of Neuropilin-1 Monoclonal Antibody (NRP-1 MAb) on Glioma Tumor in Mice

Science and Technology Foundation of Fujian Province of China [2011R1039-1]; [NSFC81172970]This article reports the effect of Neuropilin-1 monoclonal antibody (NRP-1 MAb) on glioma cell lines in vitro and the effect on nude mice bearing glioma tumor (U87) in vivo. MTT, the scratch test and transwell test were used to evaluate the inhibitory effect of NRP-1 MAb on glioma cell lines. The tissue distribution and tumor targeting capability of NRP-1 MAb in U87 Xenografts nude mice was determined in Optical Imaging. Anti-glioma experiment was carried out by NRP-1 MAb on U87 Xenografts nude mice. NRP-1 MAb was showed to inhibit the proliferation, migration and invasion of glioma cells. NRP-1 MAb can specifically target the tumor in U87 Xenografts nude mice and reduce the proliferation activity of the tumor. The results of this study indicate that NRP-1 MAb can inhibit the proliferation, migration and metastasis of glioma cell lines and can target the glioma tumor to reduce tumor growth. Therefore, NRP-1 MAb may be an effective agent for glioma-targeted therapy