Lei She

miRNA microarray reveals specific expression in the peripheral blood of glioblastoma patients

MicroRNAs (miRNAs) are frequently dysregulated in glioblastoma (GBM) patients. It has been discovered that highly stable extracellular miRNAs circulate in the blood of both healthy individuals and patients. miRNAs in serum of patients with GBM and normal controls were analyzed by microarray analysis. The relevant bioinformatic analysis of the predicted target genes (gene ontology, pathway, gene network analysis) were performed. The miRNA microarray reveals differentially expressed miRNAs in serum between the GBM and normal controls. Of the 752 miRNAs, 115 miRNAs were upregulated in the GBM group, and 24 miRNAs were downregulated (fold change ≥2.0, P<0.01). By further analysis, we found that miR-576-5p, miR-340 and miR-626 were significantly overexpressed, but miR-320, let-7g-5p and miR-7-5P showed significantly low expression in GBM patients. By further bioinformatic analysis, we found that they possibly play important roles in the regulation of glioma signaling pathways. In summary, the six miRNAs are significant distinct in the peripheral blood of patients with GBM pathologies. These data suggest that the miRNA profile of the peripheral blood may serve as a new biomarker for glioma diagnosis with high specificity and sensitivity.

Neuroendoscopic Surgery versus External Ventricular Drainage Alone or with Intraventricular Fibrinolysis for Intraventricular Hemorrhage Secondary to Spontaneous Supratentorial Hemorrhage: A Systematic Review and Meta-Analysis

Background and Purpose Although neuroendoscopy (NE) has been applied to many cerebral diseases, the effect of NE for intraventricular hemorrhage (IVH) secondary to spontaneous supratentorial hemorrhage remains controversial. The purpose of this study was to analyze the effect of NE compared with external ventricular drainage (EVD) alone or with intraventricular fibrinolysis (IVF) on the management of IVH secondary to spontaneous supratentorial hemorrhage. Methodology/ Principal Findings A systematic search of electronic databases (PubMed, EMBASE, OVID, Web of Science, The Cochrane Library, CBM, VIP, CNKI, and Wan Fang database) was performed to identify related studies published from 1970 to 2013. Randomized controlled trials (RCTs) or observational studies (OS) comparing NE with EVD alone or with IVF for the treatment of IVH were included. The quality of the included trials was assessed by Jaded scale and the Newcastle-Ottawa Scale (NOS). RevMan 5.1 software was used to conduct the meta-analysis. Results Eleven trials (5 RCTs and 6 ORs) involving 680 patients were included. The odds ratio (OR) showed a statistically significant difference between the NE + EVD and EVD + IVF groups in terms of mortality (OR, 0.31; 95% CI, 0.16-0.59; P=0.0004), effective hematoma evacuation rate (OR, 25.50, 95%CI; 14.30, 45.45; P<0.00001), good functional outcome (GFO) (OR, 4.51; (95%CI, 2.81-7.72; P<0.00001), and the ventriculo-peritoneal (VP) shunt dependence rate (OR, 0.16; 95%CI; 0.06, 0.40; P<0.0001). Conclusion Applying neuroendoscopic approach with EVD may be a better management for IVH secondary to spontaneous supratentorial hemorrhage than NE + IVF. However, there is still no concluive evidence regarding the preference of NE vs. EVD alone in the case of IVH, because insufficient data has been published thus far. This study suggests that the NE approach with EVD could become an alternative to EVD + IVF for IVH in the future.

Endoscopic evacuation of basal ganglia hemorrhage via keyhole approach using an adjustable cannula in comparison with craniotomy.

Neuroendoscopic (NE) surgery as a minimal invasive treatment for basal ganglia hemorrhage is a promising approach. The present study aims to evaluate the efficacy and safety of NE approach using an adjustable cannula to treat basal ganglia hemorrhage. In this study, we analysed the clinical and radiographic outcomes between NE group (21 cases) and craniotomy group (30 cases). The results indicated that NE surgery might be an effective and safe approach for basal ganglia haemorrhage, and it is also suggested that NE approach may improve good functional recovery. However, NE approach only suits the selected patient, and the usefulness of NE approach needs further randomized controlled trials (RCTs) to evaluate.

Naloxone for severe traumatic brain injury: a meta-analysis.

Objective The efficiency of naloxone for the management of secondary brain injury after severe traumatic brain injury (sTBI) remains undefined. The aim of this study is to evaluate the current evidence regarding the clinical efficiency and safety of naloxone as a treatment for sTBI in mainland China. Methodology/Principal Findings A systematic search of the China Biology Medicine disc (CBM), China Science and Technology Journal Database (VIP), China National Knowledge Internet (CNKI), and Wan Fang Database was performed to identify randomized controlled trials (RCTs) of naloxone treatment for patients with sTBI in mainland China. The quality of the included trials was assessed, and the RevMan 5.1 software was employed to conduct this meta-analysis. Nineteen RCTs including 2332 patients were included in this study. The odds ratio (OR) showed statistically significant differences between the naloxone group and the control group (placebo) in terms of mortality at 18 months after treatment (OR, 0.51, 95%CI: 0.38–0.67; p<0.00001), prevalence of abnormal heart rates (OR, 0.30, 95%CI: 0.21–0.43; p<0.00001), abnormal breathing rate (OR, 0.25, 95%CI: 0.17–0.36; p<0.00001) at discharge, the level of intracranial pressure at discharge (OR, 2.00, 95%CI: 1.41–2.83; p = 0.0001), verbal or physical dysfunction rate (OR, 0.65, 95%CI: 0.43–0.98; p = 0.04), and severe disability rate (OR, 0.47, 95%CI: 0.30–0.73; p = 0.0001) at 18 months after the treatment. The mean difference (MD) showed statistically significant differences in awakening time at discharge (MD, −4.81, 95%CI: −5.49 to −4.12; p<0.00001), and GCS at 3 days (MD, 1.00, 95%CI: 0.70–1.30; p<0.00001) and 10 days (MD, 1.76, 95%CI: 1.55–1.97; p<0.00001) after treatment comparing naloxone with placebo group. Conclusions/Significance This study indicated that applying naloxone in the early stage for sTBI patients might effectively reduce mortality, control intracranial pressure (ICP), and significantly improve the prognosis.

Primary extramedullary spinal melanoma mimicking spinal meningioma: A case report and literature review

Primary spinal melanoma is a rare lesion, which occurs throughout the cranial and spinal regions, however, is primarily observed in the middle or lower thoracic spine. The clinical features of primary spinal melanoma are complex and unspecific, resulting in a high misdiagnosis rate. In the present case report, a rare case of spinal melanoma exhibiting the dural tail sign and mimicking spinal meningioma is reported. The initial diagnosis, using magnetic resonance imaging (MRI), was unclear. Thus, melanin-containing tumors and spinal meningioma should have been considered in the differential diagnosis. The tumor was completely resected using a standard posterior midline approach, which was followed by chemotherapy. Subsequent to the surgery, the patient was discharged with improved motor capacity and a follow-up MRI scan showed no recurrence after six months. The present study demonstrates that it is critical for neurosurgeons to focus on increasing the accuracy of initial diagnoses in order to make informed decisions regarding the requirement for surgical resection. The present case report presents the clinical, radiological and pathological features of primary extramedullary spinal melanoma mimicking spinal meningioma to emphasize the importance of early identification and diagnosis.

Endoscopic Intradural Subtemporal Keyhole Kawase Approach to the Petroclival and Ventrolateral Brainstem Regions.

Objective: To study the endoscope anatomy of the petroclival and ventrolateral brainstem regions via the intradural subtemporal keyhole Kawase approach and discuss the feasibility and indications of this approach to the regions. Materials and Methods: Craniotomy procedures performed via the intradural subtemporal keyhole Kawase approach were simulated on 16 sides of 8 adult cadaveric heads fixed by formalin, and the related anatomical structures were observed through the 0-degree endoscope or alternatively 30-degree one. Measurements of the shortest distances from the highest point of arcuate eminence to the 4 anatomic marks and the lengths of the Kawase rhombus were recorded, and the 2 kinds of milled ranges of petrous apex were compared. Result: Most of the related anatomical structures could be clearly observed under the endoscope. The shortest distances from the highest point of arcuate eminence to the foramen spinosum, the greater superficial petrosal nerve hiatus, the intersection of the greater superficial petrosal nerve and mandibular nerve, and the outside edge of the trigeminal impression are 22.90 ± 2.34, 14.05 ± 2.09, 24.94 ± 1.98, 23.49 ± 2.38 mm. The area of routine milled Kawase rhombus is 3.04 ± 0.47 cm2, which would increase 0.66 cm2 on average after the maximum drilling of the petrous apex. Conclusions: The intradural subtemporal keyhole Kawase approach can provide an ideal exposure to the petroclival and ventrolateral brainstem regions via the endoscope with less damaging of the normal structures. It can be used to treat the lesions located in those areas through the natural gap combined with the drilling of petrous apex bone.

Combined monitoring of intracranial pressure and bispectral index in patients with severe craniocerebral trauma post-operatively.

OBJECTIVE To investigate the value of simultaneous bispectral index (BIS) and intracranial pressure (ICP) monitoring to evaluate postoperative consciousness and short-term prognosis in patients with severe traumatic brain injury. METHODS We evaluated 30 brain trauma coma patients in the Peoples Hospital of Northern Jiangsu Province from January 2014 to December 2014 and evaluated Glasgow Coma Scale (GCS) scores at 8-h intervals for 3days after surgery. BIS and ICP values were recorded at the same time. Based on the GCS score, patients were divided into two groups: group A (GCS score 3-≤5) and group B (>5-≤8). Natural survival rates were analyzed statistically and compared between groups. RESULTS Chi-square testing revealed a significant difference in survival rates between the groups (P<0.05). Spearmans rank correlation analysis revealed that BIS value was positively correlated with coma degree post-operatively in patients with severe traumatic brain injury, and negatively correlated with ICP values (r=0.532, P<0.05; r=0.521, P<0.05, respectively). CONCLUSION In patients with severe craniocerebral injury, higher severity, higher ICP, and lower BIS were associated with a worse prognosis. Combined monitoring of BIS and ICP is very useful when evaluating the coma degree and prognosis of patients with severe craniocerebral injury post-operatively.

Rare giant bilateral calvarial hyperostosis across the superior sagittal sinus secondary to brain meningioma: A case report

The current study presents a case of a 43-year-old female with giant bilateral calvarial hyperostosis across the superior sagittal sinus, secondary to brain meningioma. The patient presented with a huge mass in the bilateral calvarial region, and diagnoses of huge skull hyperplasia and meningioma were strongly suggested by computed tomography and magnetic resonance imaging examination. In addition, digital subtraction angiography demonstrated that the left middle meningeal artery and branches of the left superficial temporal artery were the major sources of blood supply to the tumor, with the little involvement of the right middle meningeal artery and branches of the right superficial temporal artery. The patient successfully underwent simultaneous embolization of the tumor-supplying vessels, total resection of the giant calvarial hyperostosis and intracranial tumor and skull cranioplasty. Additionally, histological study of the mass revealed a meningioma. The management of such a case presents a surgical challenge, however, the current study provides a good reference for the future treatment of similar diseases.

Primary carcinoma of the frontal sinus with extensive intracranial invasion: A case report and review of the literature

Primary carcinoma of the frontal sinus is quite rare, with an incidence of 0.3–1.0% of all paranasal sinus carcinomas. The early diagnosis is often difficult and the condition is often mistakenly considered to involve mucoceles, pyoceles or osteomyelitis. The present study reports the case of a 66-year-old male with squamous cell carcinoma originating in the frontal sinus. The presenting symptoms were a cutaneous nodule on the left side of the forehead and a gradually progressive headache. Magnetic resonance imaging (MRI) demonstrated erosion of the ethmoid sinus, frontal lobe and orbit. The radical resection under frontal craniotomy was performed followed by post-operative radiotherapy. Six months after the surgery, the MRI examinations did not find any recurrence, and the patient currently lives symptom-free. The present study illustrates that frontal sinus cancer should be diagnosed early with caution. Total surgical resection followed by radiotherapy and chemotherapy, used singly or in combination, may result in favorable outcomes. The current study discusses the diagnosis, treatment and prognosis of the present case and reviews the associated literature to emphasize the importance of an early identification of this rare disease.

Characterization of pituitary tumor transforming gene in meningiomas

BACKGROUND Pituitary tumor transforming gene (PTTG) is an oncogene and has been detected in several tumors of unrelated histological origin. However, its role in meningiomas is unknown so far. We aim to investigate PTTG expression in intracranial meningiomas, and clarify the relationship between PTTG and the histopathological types of tumors. MATERIALS AND METHODS Over a 7-year period, 195 meningioma specimens were collected from 195 patients. Seventeen nonneoplastic meningeal tissues were used as controls. We analyze PTTG expression by tissue microarray with immunohistochemistry. RESULTS Immunoexpression of PTTG was identified in 172 of 195 meningiomas, accounting for 88.2%. All of immunoexpression of tumors were found to be cytoplasmic, and no nuclear expression was observed. In the control group, there were 3 of 17 specimens (17.6%) with positive PTTG expression. The percentage of high expression WHO subtypes of meningiomas ranged from 0% to 95.7%. We further stratified the tumors into 3 subgroups based on pathological grading (WHO grade I, WHO grade II and III, control), and there was significant intergroup difference in PTTG expression (p<0.001). CONCLUSION This study demonstrated that PTTG was expressed in most of meningioma tissues, and the degree of PTTG immunostaining was variable in the subtypes of tumors. Further investigations into PTTG expression are required to broaden the pathogenesis research of meningiomas.