The dynamics of inter-Sertoli (SC) tight junctions (TJ) are regulated by transforming growth factor-beta 3 (TGF-beta 3) via the p38 mitogen-activated protein (MAP) kinase signaling pathway

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Primary endovascular treatment of post-irradiated carotid pseudoaneurysm at the skull base with the Pipeline embolization device

Background A post-irradiated carotid pseudoaneurysm at the skull base can cause life-threatening blowout syndrome. Conventional treatments include parent vessel occlusion, endovascular coiling or covered stenting. Use of the Pipeline embolization device (PED) for pseudoaneurysm exclusion at the skull base is not well described. Objective To report the clinical and angiographic outcome after using multiple PEDs to treat recently ruptured radiation-induced carotid pseudoaneurysms at the skull base. Methods Retrospective review of the clinical and angiographic records of patients who received PEDs as primary treatment for skull base carotid pseudoaneurysm between April 1, 2011 to March 31, 2013. Results Seven patients (five men, two women) with a mean age of 58 years (range 47–65) were treated in the study period. Primary treatment with the PED alone, with adjunct coil embolization in two patients, achieved immediate hemostasis in all patients, with no pseudoaneurysm rebleeding after a mean follow-up of 15.3 months (range 4–24 months). One patient had periprocedural cerebral infarction. Delayed internal carotid artery occlusion secondary to in-stent thrombosis occurred in three patients, one of whom had lacunar infarct and two remained asymptomatic. Conclusions Endovascular treatment with the PED was effective in excluding skull base post-irradiated carotid pseudoaneurysms and preventing recurrent blowout. However, the risk of ischemic complications in this group of patients was high and our experience did not support the use of flow diverters as a first-line treatment for this condition.postprin

Intraoperative direct embolization with N-butyl cyanoacrylate (NBCA) for vascular tumours of the spinal cord: a technical report

Oral-Poster Presentation 1Meeting Theme: Degenerative Lumbar SpineINTRODUCTION: Intramedullary vascular tumors such as hemangioma or hemangioblastoma in the cervical cord are challenging lesions to remove surgically. The vascularity of the lesion can cause significant bleeding and difficulties during tumor debulking and dissection, and increase the risk of spinal cord damage. Pre-operative endovascular embolization is well described for intra-cranial lesions, but seldom used in intraspinal intramedullary tumors due to the technical difficulties and risk of spinal cord ischemia. We describe our experience of intra-operative direct embolization of difficult cervical cord vascular tumors with N-butyl cyanoacrylate (NBCA) glue in achieving prompt hemostasis and facilitating tumor removal …published_or_final_versio

Bilateral aberrant C1/2 intradural vertebral arteries: a rare cause of cervical myelopathy

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Use of local temporalis fascia graft for the repair of cerebrospinal fluid leak in patients with skull base surgery involving the cavernous sinus

Theme: Brain Attack: A New EraFree Paper IVOBJECTIVES: Cerebrospinal fluid (CSF) leaks are common after extensive skull base surgery. We aim to provide a novel method for reconstruction of the skull base for repair of CSF fistula in this study ...postprin

Combined simultaneous transcranial and transsphenoidal resection of large-to-giant pituitary adenomas

Background: While large-to-giant pituitary adenomas (PAs) may be safely removed by experienced surgeons through a single route, the procedure is technically challenging. We present the outcome of a simultaneous combined transcranial and transsphenoidal approach and discuss its applications. Methods: A retrospective review was conducted on 12 consecutive patients. Surgical complications, visual and endocrinological functions, and tumour control were reviewed. Results: There were four men and eight women, with a mean age of 47.6 years. All but one patient had non-functioning PAs. The mean tumour height was 4.1 cm (range: 2.3-5.5). The predominant presenting symptoms were visual field loss in eight patients, headache in three patients and mental confusion in one patient. There was no operative mortality. Post-operative cerebrospinal fluid leakage occurred in one patient. Five of the eight patients who presented with visual field loss achieved full recovery, and three had partial improvement. Two patients developed permanent diabetes insipidus after surgery. Panhypopituitarism occurred in one patient. Gross total removal (GTR) was achieved in five, and subtotal removal (STR) in seven patients. Seven patients received post-operative external irradiation. All patients who had GTR remained tumour-free and all those with STR had stable diseases after a mean follow-up period of 53.1 months (range: 14.1-92.1). Conclusion: The simultaneous 'above and below' approach is a safe and effective surgical strategy for large-to-giant PAs, particularly when expertise in endoscopic transsphenoidal surgery is unavailable. Its use, however, should be limited to a carefully selected group of patients, and tailored to individual user's expertise and experience. © 2011 The Author(s).published_or_final_versio

Sequential approaches for resection of clival chordoma

Free Paper 7Conference Theme: Degenerative Lumbar SpineINTRODUCTION: Chordomas are extra-axial tumours that originate from the primitive notochord. They are rare diseases that present mostly between the third and the fifth decades of life with an incidence rate of 0.08 per 100,000 in the United States. Approximately 35% of chordomas arise in the clivus of the skull base (clival chordoma). In spite of their slow-growing and non-malignant histopathological appearance, they are potentially life threatening due to their locally destructive and invasive nature. Clival chordomas are located near the spheno-occipital junction at the base of the skull, behind the sphenoid sinuses. Involvement of the surrounding cranial nerves accounts for their symptomatology. It is notorious for its high tendency of recurrence following treatment, with a reported recurrence rate of 68%. Therefore, gross total resection in combination with adjuvant radiotherapy is the standard mode of treatment …published_or_final_versio

X-knife stereotactic radiosurgery for cerebral AVM: Queen Mary Hospital experience

Meeting Theme: Degenerative Lumbar SpineOral-Poster Presentation 1INTRODUCTION: This is a retrospective review of the effectiveness, safety, complications of LINAC based X-knife stereotactic radiosurgery for the treatment of cerebral AVM in Queen Mary Hospital, Hong Kong. METHODS: Retrospective search through medical records of a single institution. From 2003-2013, all patients who received X-knife stereotactic radiosurgery for cerebral AVM were included. Demographics, presenting symptoms, size of AVM, Spetzler-Martin grading, dosages, complications, follow-up …published_or_final_versio

Management of pseudoaneurysms of the internal carotid artery in postirradiated nasopharyngeal carcinoma patients

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Managing malignant pleural effusion with an indwelling pleural catheter: factors associated with spontaneous pleurodesis

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