Chao You

Assessment of microscope-integrated indocyanine green angiography during intracranial aneurysm surgery: a retrospective study of 120 patients.

AIMSnThe purpose of this study was to assess the clinical value of indocyanine green angiography (ICG) in intracranial aneurysm surgery by comparing the findings with postoperative angiographic results.nnnMATERIALS AND METHODSnOne hundred and twenty patients with 148 intracranial aneurysms were included. ICG angiography was performed before and/or after the aneurysm clipping. A near-infrared excitation light illuminated the operation field, ICG was injected intravenously. The intravenous fluorescence was imaged with a video camera integrated into the microscope.nnnRESULTSnA total of 208 investigations of ICG angiography were performed. Aneurysm clipping was applied in 120 patients. Incomplete clipping was detected in four patients. Parent and/or branching artery stenosis was found in five patients. Delayed perfusion of ICG was detected in one patient. Postoperative digital subtraction angiography (DSA) was performed in 108 patients. The postoperative angiographic results were consistent with findings on intraoperative ICG angiograms in 100 patients (92.6%). In three cases, a mild stenosis was seen on DSA, which was not detected intraoperatively using ICG angiogram. In one patient, middle cerebral artery stenosis was found. Three patients had small residual aneurysms found by postoperative DSA. The remaining one developed a severe cerebral vasospasm.nnnCONCLUSIONSnICG angiography is a simple, reliable and cost-effective method. It provides real-time information in detecting the patency of parent, branching, perforating arteries and residual aneurysm. This technique may be a useful adjunct to improve the quality of intracranial aneurysm surgery.

Isoform-specific expression and characterization of 14-3-3 proteins in human glioma tissues discovered by stable isotope labeling with amino acids in cell culture-based proteomic analysis.

Human 14‐3‐3 proteins have isoform‐specific expression and functions in different kinds of normal or tumor cells and tissues. However, the expression profiling of 14‐3‐3 proteins and isoform‐specific biological functions are unclear in human glioma so far. In our study, the expression levels and characterization of 14‐3‐3 isoforms in human glioma tissues were investigated by a sensitive, accurate stable isotope labeling with amino acids in cell culture‐based quantitative proteomic strategy. As a result, except unexpressed 14‐3‐3σ, the other six isoforms, with different expression levels, were existed in glioma tissues and para‐cancerous brain tissues (PBTs). 14‐3‐3β and η were upregulated, whereas 14‐3‐3ζ was downregulated in glioma tissues compared with that in PBTs. And the other three isoforms 14‐3‐3ε, θ, and γ had similar expression levels in human glioma tissues and PBTs. Western blot and immunohistochemistry analysis were both consistent with the quantitative proteomic data. The loss of expression of 14‐3‐3σ was further discovered due to DNA high methylation in its coding region in glioma by methylation‐specific PCR analysis. These results indicated that the four isoforms, including 14‐3‐3β, η, ζ, and σ, may play important roles in tumorigenesis of human glioma, which is probably used as potential biomarkers for diagnosis and targets for treatment of human gliomas in future.

Endovascular Treatment of Traumatic Pseudoaneurysm Presenting as Intractable Epistaxis

Objective To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudoaneurysms presenting as intractable epistaxis. Materials and Methods For 14 consecutive patients with traumatic pseudoaneurysm presenting as refractory epistaxes, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudoaneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (ICA); out of which, two were managed with detachable balloons, two with covered stents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography. Results Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from ICA pseudoaneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention. Conclusion In patients presenting with a history of craniocerebral trauma, traumatic pseudoaneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudoaneurysms.

Traumatic Carotid-Cavernous Fistulas Treated with Covered Stents: Experience of 12 Cases

OBJECTIVEnCovered stents have recently become available for intracranial use, such as aneurysms, arterial dissections and carotid-cavernous fistulas (CCFs). However, there have been few reports of the successful application of covered stents for the treatment of traumatic CCFs (TCCFs). The purpose of this study is to investigate the efficacy and safety of endovascular treatment of TCCFs with covered stent.nnnMETHODSnTwelve consecutive patients with TCCFs treated with covered stent after initial failure of traditional techniques are presented. All the patients were followed up both clinically and angiographically for a mean of 22.5 months.nnnRESULTSnEleven of the 12 patients had covered stents placed successfully. In one case, the covered stent placement failed after multiple attempts because of the tortuous anatomy of the internal carotid artery (ICA). Complete occlusion was achieved in nine cases immediately after stent deployment. Endoleak was observed in case 4 and redilation was performed to avoid the endoleak. In case 8, improved symptoms recurred the next morning, and cerebral angiogram revealed a small endoleak; redilation was performed to eliminate the endoleak successfully. Spasm of the ICA was observed in six cases, but angioplasty was not required. Symptoms improved in all cases after stent placement. Angiographic follow-up demonstrated complete occlusion of the TCCFs and patency of ICA, and no intra-stent stenosis or embolization occurred in the 11 patients who received successful stent placement.nnnCONCLUSIONnAlthough larger sample and long-term follow-up are required, our series shows that covered stent is an effective, safe, and microinvasive method to treat TCCFs.

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

BACKGROUNDnCavernomas are rare in the brainstem and account for 18-35% of central nervous cavernomas and can cause recurrent hemorrhages, devastating neurological deficits and mortality.nnnOBJECTIVESnTo summarize the experience of microsurgical treatment of brainstem cavernomas and to investigate curative effect of microsurgical treatment of brainstem cavernomas.nnnMATERIALS AND METHODSnA 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.nnnRESULTSnAll 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.nnnCONCLUSIONSnBrainstem 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.

Surgical treatment for large spontaneous basal ganglia hemorrhage: retrospective analysis of 253 cases

Abstract Objectives. Spontaneous intracerebral hemorrhage (ICH) is a challenge to both neurologists and neurosurgeons. We aim to summarize the surgical treatment of ICH based on retrospective analysis of our patients. Methods. Two hundred and fifty-three patients with spontaneous ICH from August 2008 to August 2011 were retrospectively analyzed. Clinical data, including preoperative ICH score, pre- and postoperative GCS score, hematoma volume, postoperative brain infarction, 30-day mortality, and GOS 3 months postictus, were collected. One hundred and fifty patients had their intracranial pressure (ICP) monitored, and data were recorded and analyzed. All patients underwent craniotomy and clot removal under general anesthesia. Outcome analysis was stratified using hematoma volume, ICH score, preoperative GCS score, and decompressive craniectomy (DC). Results. The mean hematoma volume was 70.8 mL, and 68 patients (26.9%) underwent DC. The mean postoperative ICP was 28.8 ± 6.7 mmHg for patients without DC, and only 17.5 ± 8.6 mmHg for patients with DC. Twenty-five patients (9.9%) died within 30 days of operation, and 88 patients (34.8%, GOS ≥ 4) had good outcome 3 months after surgery. ICH volume > 50 mL, preoperative GCS score ≤ 8, and ICH score ≥ 3 are risk factors for unfavorable outcomes. Conclusions. DC can be used for patients with low preoperative GCS score, and it effectively reduces ICP and 30-day mortality. Hematoma volume, preoperative GCS score, and ICH score are of predictive value for surgical outcome of large basal ganglia hemorrhage.

Downregulated expression of HSP27 in human low-grade glioma tissues discovered by a quantitative proteomic analysis

BackgroundHeat shock proteins (HSPs), including mainly HSP110, HSP90, HSP70, HSP60 and small HSP families, are evolutionary conserved proteins involved in various cellular processes. Abnormal expression of HSPs has been detected in several tumor types, which indicates that specific HSPs have different prognostic significance for different tumors. In the current studies, the expression profiling of HSPs in human low-grade glioma tissues (HGTs) were investigated using a sensitive, accurate SILAC (stable isotope labeling with amino acids in cell culture)-based quantitative proteomic strategy.ResultsThe five HSP family members were detected and quantified in both HGTs and autologous para-cancerous brain tissues (PBTs) by the SILAC-based mass spectrometry (MS) simultaneously. HSP90 AB1, HSP A5(70 KDa), and especially HSP27 were significantly downregulated in HGTs, whereas the expression level of HSPA9 (70 KDa) was little higher in HGTs than that in PBTs. It was noted that the downregulation ratio of HSP27 was 0.48-fold in HGTs versus PBTs, which was further validated by results from RT-PCR, western blotting and immunohistochemistry. Furthermore, we detected HSP27 expression changes along with cell growth under heat shock treatment in glioma H4 cells.ConclusionThe SILAC-MS technique is an applicable and efficient novel method, with a high-throughput manner, to quantitatively compare the relative expression level of HSPs in brain tumors. Different HSP family members have specific protein expression levels in human low-grade glioma discovered by SILAC-MS analysis. HSP27 expression was obviously downregulated in HGTs versus PBTs, and it exhibited temporal and spatial variation under heat shock treatment (43°C/0-3 h) in vitro. HSP27s rapid upregulation was probably correlated with the temporary resistance to heat shock in order to maintain the survival of human glioma cells.

Infectious intracranial aneurysm: endovascular treatment with onyx case report and review of the literature.

Intracranial infectious (mycotic) aneurysms are very rare, but continue to be challenging and technically demanding, which need careful diagnosis and therapy. We present an 18-year-old man with an intracranial infectious aneurysm located on the left posterior cerebral artery who was successfully treated with endovascular embolization by a liquid embolic agent (onyx) and who recovered well.

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

BACKGROUNDnCerebral 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.nnnAIMSnTo discuss the surgical treatment options.nnnSETTINGS AND DESIGNnHospital-based observational study.nnnMATERIALS AND METHODSnPatients 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.nnnRESULTSnOf 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.nnnCONCLUSIONSnAlthough 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.