Bowen Cai

Experience of microsurgical treatment of brainstem cavernomas: Report of 37 cases

BACKGROUND Cavernomas are rare in the brainstem and account for 18-35% of central nervous cavernomas and can cause recurrent hemorrhages, devastating neurological deficits and mortality. OBJECTIVES To summarize the experience of microsurgical treatment of brainstem cavernomas and to investigate curative effect of microsurgical treatment of brainstem cavernomas. MATERIALS AND METHODS A retrospective analysis clinical data of 37 patients with brainstem cavernomas seen between 2003 and 2007. The analysis included age distribution, hemorrhage rates, clinical presentation, location of the lesions, and preoperative and postoperative Karnofsky Performance Scale (KPS) scores. The surgical indications, the timing of surgery and the surgical techniques were also assessed. RESULTS All the 37 patients received microsurgical resections, there was no surgery-related mortality. Histopathological examination confirmed the diagnosis of cavernoma. Postoperatively, 20 patients had functional improvement, 15 patients had no change in the neurological status, and two patients deteriorated. Early surgery was associated with better outcomes. Mean followed up period was 21.5 months (range 6-36 months). During the follow-up 20 patients had resumed activities of daily living (KPS scores of 90-100), 10 patients were able to self-care with some efforts (KPS scores of 70-80), five patients needed considerable assistance (KPS score of 50-60) and two patients suffered hemiparesis (KPS scores of 40). None of the patient had recurrent hemorrhage. CONCLUSIONS Brainstem cavernomas can safely be resected. Successful resection of brainstem cavernomas can be achieved by optimal surgical approaches, feasible entry zone and meticulous microsurgical techniques. The goal of surgical intervention should be the total resection of the lesion without any deteriorative in the neurological deficits.

Successful treatment of sellar aspergillus abscess.

A sellar aspergillus abscess is a rare fungal infection of the central nervous system (CNS). A retrospective analysis of three patients with sellar aspergillus abscess was conducted from 2006 to 2008. Data were retrieved from patient records at our hospital. Clinical findings, pathological data and final outcomes were reviewed and analysed. All patients underwent transsphenoidal surgery with the operating microscope and histopathologic examination revealed aspergillosis in all cases. Postoperatively, all patients received medical treatment with voriconazole and caspofungin. During the 3-6-month follow-up period, the patients were symptom free with no recurrences. Therefore, sellar aspergillus abscess should be included in the differential diagnosis of a sellar mass. Early and correct diagnosis via surgery can improve the prognosis. A combination of surgical resection and antifungal therapy has a good outcome. The importance of early treatment for sellar aspergillus abscesses is emphasised.

Symptomatic Rathke cleft cyst

Rathke cleft cysts (RCC) are uncommon intrasellar lesions. Although their clinical manifestations, radiological features and treatment are frequently reported, controversy remains as a result of their rarity. We reviewed the preoperative clinical manifestations, neurological examination findings, visual acuity and fields, endocrinological function, radiographic study findings, surgical and pathological records, and prognosis of 45 patients with RCC (21 males, 24 females, average age: 47 years) admitted to our department between January 2002 and January 2011. The most common clinical manifestations included headaches, and visual and hormonal disturbances. Most RCC were intrasellar with a suprasellar extension. The most common MRI patterns were hypointense on T1-weighted and hyperintense on T2-weighted images, isointense on T1-weighted and hyperintense on T2-weighted images, and hyperintense on T1-weighted and hyperintense on T2-weighted images. Aspiration and biopsy of the cyst wall were performed in most patients. Most patients experienced improved headaches and visual disturbance, but the hormonal disturbance rarely returned to normal, especially in those patients with a serious preoperative hormonal disturbance. The recurrence rate was 14%, which was associated with the extent of cyst removal, inflammation and rim enhancement, as well as the surgical approach. Aspiration and biopsy of the cyst wall still seems to be an effective treatment for most RCC for its low morbidity and good prognosis. Conservative treatment and close follow-up may be suitable for small cysts with subtle clinical manifestations.

Surgical treatment options for cerebral alveolar echinococcosis: Experience in six patients

BACKGROUND Cerebral alveolar echinococcosis (AE) is a rare but lethal parasitic disease. Its pathogenesis remains poorly understood. Currently there is no widely accepted methods for its surgical treatment. AIMS To discuss the surgical treatment options. SETTINGS AND DESIGN Hospital-based observational study. MATERIALS AND METHODS Patients who had surgery for cerebral AE during 2001 and 2007 were the subjects of the study. According to the lesion location and volume, patients have been allocated to either massive resection group or radical piecemeal resection group. Postoperatively, all patients received long-term aldendazole therapy in view of the associated hepatic involvement and were follow-up in the clinic. RESULTS Of the six patients with cerebral AE who were operated during the study period, four had massive resection and two had radical piece meal resection. None of the patients had postoperative neurological worsening and there was improvement in the neurological status in all the patients except for the patient with blindness. Of the 4 patients in massive resection group, two patients died during the follow-up, one because of liver failure and the other due to hydrocephalus. The remaining four patients were back to their normal activities and none had recurrence of the disease during the follow-up. CONCLUSIONS Although radical massive resection is generally regarded as the surgical method treatment for cerebral AE, radical piecemeal resection can be a reasonable, effective alternative management option, especially when massive resection might result in unavoidable morbidity and mortality.

Microneurosurgical management of the clinoid and paraclinoid aneurysms.

Abstract Objective: To evaluate the management of clinoid and paraclinoid aneurysms with modern microneurosurgical techniques and instruments. Methods: The data of 38 patients with clinoid and paraclinoid aneurysms who underwent microsurgical clipping in the Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China, from 2000 to 2005, were analysed retrospectively. Results: All 40 aneurysms were treated microneurosurgically, among which 97.5% were completely obliterated. The overall mortality is 5.2% and 76.3% patients had a good recovery (GOS 4–5) at discharge. Conclusion: For patients with clinoid and paraclinoid aneurysms, satisfying outcomes can be achieved by microneurosurgical management, using particular preoperative assessment and planning and careful maneuvering with refined microsurgical instruments. Microneurosurgical techniques are optimal for the management of clinoid and paralinoid aneurysms.

Craniopharyngiomas in the posterior fossa: a rare subgroup, diagnosis, management and outcomes

Objective: Craniopharyngiomas with predominant pars in the posterior fossa are very rare and extremely overlooked. The clinical features, diagnosis and management are different from their sellar/suprasellar counterparts. The purpose of this study was to explore the differing characteristics of posterior fossa craniopharyngiomas. Methods: Seven patients with pathologically proven craniopharyngiomas located in the posterior fossa were retrospectively investigated. The clinical data and radiographic findings were presented and analysed. Results: The primary presentations included headache, diplopia, ataxia and hearing loss. All tumours were located in the retrochiasmatic area, and five of seven displayed a retroinfundibulum growth pattern. The predominant components of the tumours were located in the unilateral cerebellopontine angle (CPA) in six cases, and the bilateral CPA in one case. Total tumour resection was accomplished in five patients. There were transient cranial nerve deficits in three patients, and CSF leakage in one patient. Six patients fully recovered to normal conditions, but one patient had tumour regrowth and had to undergo a secondary resection. Conclusions: Posterior fossa craniopharyngiomas are rare and may be considered an independent subgroup of classifications. Tumours arising from the sellar region and extending to the posterior fossa present with their own unusual set of characteristics. These tumours can be radically and safely removed with a combined supra- and intratentorial approach.

Huge primary myxoma of skull base: a report of an uncommon case

SummaryWe report a 27-year-old male who presented with paroxysmal headache, stuffy nose, epistaxis and impairment of vision in each eye. A huge chondrosarcoma, arising from the skull base with extension into the middle cranial fossa and nasal cavity was suspected. The patient underwent craniotomy and endoscope-assisted transnasal resection and a satisfactory removal was achieved. Postoperative immunohistochemical examination confirmed the diagnosis of myxoma rather than chondrosarcoma. The patient remained neurologically intact except for poor vision in the left eye at six-month follow-up. The relevant literature was reviewed and discussed. The main treatment of myxomas of cranial base is by surgery.

Intracystic bleomycin for cystic craniopharyngiomas in children (abridged republication of cochrane systematic review).

BACKGROUND Craniopharyngiomas are the most common benign histological tumors to involve the hypothalamopituitary region in childhood. When the tumor location is unfavorable, a gross total or partial resection followed by radiotherapy is the main treatment option in adults. However, it presents the risk of morbidity, especially for children. Intracystic bleomycin has been used to potentially delay the use of radiotherapy or radical resection to decrease morbidity. OBJECTIVE To determine the benefit and harm of intracystic bleomycin vs other treatments for cystic craniopharyngiomas in children. METHODS We searched the electronic databases of CENTRAL, MEDLINE/PubMed, and EMBASE/Ovid with prespecified terms. In addition, we searched reference lists of relevant articles and reviews, conference proceedings, and ongoing trial databases. RESULTS We could not identify any studies in which the only difference between the treatment groups was the use of intracystic bleomycin. We did identify a randomized, controlled trial comparing intracystic bleomycin with intracystic P (n = 7 children). The trial had a high risk of bias. Survival could not be evaluated. There was no evidence of a significant difference in cyst reduction, neurological status, third nerve paralysis, fever, or total adverse effects between the treatment groups. There was a significant difference in favor of the P group for the occurrence of headache and vomiting. CONCLUSION Based on the currently available evidence, we are not able to give recommendations for the use of intracystic bleomycin in the treatment of cystic craniopharyngiomas in children. High-quality randomized, controlled trials are needed.

WITHDRAWN: Activation of TLR4/NF-kappaB signaling pathway in early brain injury after subarachnoid hemorrhage.

Ahead of Print article withdrawn by publisher.

Association between functional polymorphisms in the promoter of the miR-143/145 cluster and risk of intracranial aneurysm

MicroRNAs (miRs)-143/145 are involved in various biological processes related to aneurysm formation and are downregulated in patients with intracranial aneurysm (IA). We aimed to determine whether two functional polymorphisms (i.e. rs4705342 and rs4705343) in the promoter of miR-143/145 are related to IA risk. A case-control study was undertaken to examine the association of rs4705342 and rs4705343 with IA risk, including 565 patients with IA and 622 age- and gender-matched controls. rs4705342 was analysed by TaqMan Assay, and rs4705343 was genotyped using polymerase chain reaction-restriction fragment length polymorphism. miR-143/145 expression was quantified using RT-PCR. rs4705342 was associated with a significantly lower risk of IA, with adjusted ORs of 0.74 (95% CI: 0.58–0.95) for TC genotype carriers and 0.74 (95% CI: 0.59–0.94) for TC/CC genotypes carriers. Individuals carrying the rs4705342 C allele had a reduced risk of IA (adjusted OR = 0.82; 95% CI: 0.68–0.98). Haplotype of the two loci of rs4705342 and rs4705343 showed that the CT haplotype carried a lower IA risk and higher miR-143 level. Moreover, the rs4705342 CC/CT genotypes were associated with higher miR-143 levels. Thus, the rs4705342C-rs4705343T haplotype in the promoter of miR-143/145 cluster may be related to IA development.