Seok Ho Hong

One-piece frontoorbital advancement with distraction but without a supraorbital bar for coronal craniosynostosis

Traditional frontoorbital advancement with a supraorbital bar is the standard technique for correcting coronal craniosynostosis. However, several recent reports indicate that cranioplasty using distraction osteogenesis may be an alternative. To maximize the advantages of distraction, preservation of the dura attachment to the frontal bone appears to be important. Therefore, we designed a novel procedure for coronal craniosynostosis involving a one-piece frontoorbital advancement with distraction but without a supraorbital bar using only a small temporal burr hole. The novel one-piece frontoorbital advancement technique was used in 10 coronal craniosynostotic patients. Follow-up ranged from 8-28 months (mean 16.2 months). Osteotomy on the fronto-parietal area was performed using a saw, and a burr hole of <1.5 cm was made at the pterion. While referring to a rapid prototype model, osteotomies in the orbital roof, zygomatico-frontal, nasion areas and pterion were performed using a guarded osteotome to protect the dura mater. Distraction devices were applied without detachment of the bone flap from the dura (standard cranial distraction protocols were used). The present technique resulted in minimal bleeding, shorter surgery time and minimization of the bony defect with preservation of the dural attachment. The 1.5 cm burr hole allowed visualization of the greater and lesser sphenoid bone wings, which is necessary for a safe osteotomy. The average length of distractions was 17 mm. This approach was less invasive than the traditional approach and resulted in satisfactory correction. Transfusions were not required for six patients, while the remaining four patients received a mean 37.3 ml packed red cells. The average cephalic index decreased from 96 to 86. There were no complications other than a case of meningitis which resolved following intravenous antibiotic administration. The present novel technique appears to be a good alternative surgical approach for treating non-complex forms of single suture coronal craniosyntosis.

Influence of Transforming Growth Factor-α on Expression of Matrix Metalloproteinase-2, Matrix Metalloproteinase-9, and Epidermal Growth Factor Receptor Gene in the Mouse Blastocysts

AbstractPurpose: This study was carried out to investigate the influence of transforming growth factor-α (TGF-α) on the expression of mRNA for matrix metalloproteinase-2 (MMP-2), MMP-9, and epidermal growth factor receptor (EGFR) in mouse blastocysts and the effect on the production and activation of MMP-2 and MMP- 9 during blastocyst outgrowth.nMethods: Two-cell mouse embryos were cultured for 96 h in the presence or absence of various concentrations of TGF-α. Reverse transcription–polymerase chain reaction (RT-PCR) was used to examine the expression of mRNA for MMP-2, MMP-9, and EGFR in in vitro cultured blastocysts. To investigate the effect on the production and activation of MMP-2 and MMP-9 during blastocyst outgrowth, the conditioned medium collected after 3 and 5 days of embryo culture were assayed for MMP activity by gelatin zymography.nResults: The relative mRNA levels of MMP-2 and MMP-9 in blastocysts treated with TGF-α were higher than that of the control in a concentration-dependent manner. The relative mRNA level of EGFR in blastocysts treated with TGF-α was higher than that of the control. In conditioned medium collected after 3 days of embryo culture, TGF-α induced the gelatinase activities of proMMP-9 in all groups and activated MMP-2 in the 10 and 100 ng/mL TGF-α treated groups. In conditioned medium collected after 5 days, TGF-α induced the gelatinase activities of proMMP-9 in all groups and activated MMP-9 in the TGF-α treated group. TGF-α also induced the gelatinase activities of activated MMP-2 in the 1 and 10 ng/mL TGF-α treated groups and the control.nConclusions: These results suggest that the addition of TGF-α to in vitro culture medium is proper to create a favorable environment for preimplantation embryo development and implantation.

Is the Complete Resection of Craniopharyngiomas in Adults Feasible Considering Both the Oncologic and Functional Outcomes

Objective To assess the impact of the complete resection of craniopharyngioma (CP) in adults on oncologic and functional outcomes. Methods We retrospectively analyzed 82 patients with CP who were surgically treated by the same neurosurgeon at our institution between January 1994 and December 2012. Results Gross total resection (GTR) was achieved in 71 patients (86.6%), near total resection (NTR) in 7 patients (8.5%), and subtotal resection (STR) in 3 patients (3.7%). The disease-specific overall survival rate was 100% with the exclusion of 2 surgery-related mortalities. The overall recurrence rate was 12.2% (10 of 82 patients), however the recurrence rate according to extent of resection (EOR) was 9.9% (7 of 71 patients) after GTR, 14.3% (1 of 7 patients) after NTR, and 66.7% (2 of 3 patients) after STR. The overall recurrence-free survival (RFS) rates at 5 and 10 years were 87.0% and 76.8%, respectively. Postoperatively, most patients (86.3%) needed hormone replacement for at least 1 hypothalamic-pituitary axis. Vision improved in 56.4% of the patients with preoperative abnormal vision, but deteriorated in 27.4% of patients. Hypothalamic dysfunction developed in 32.9% of patients. There were no significant differences in the risks of pituitary dysfunction, visual deterioration, or hypothalamic dysfunction between the groups with complete vs. incomplete removal. The overall rate of postoperative complications was 22.0%, which did not differ between groups (p=0.053). Conclusion The complete removal of a CP at first surgery can provide a chance for a cure with acceptable morbidity and mortality risks.

Estrogen-regulated Expression and Distribution of Id-1 in the Mouse Uterus

Id genes are involved in proliferation and differentiation in various cell types. However, it remains to be fully investigated how Id genes are regulated in highly dynamic uterine tissue. Using cDNA microarray, we previously observed that Id-1 was upregulated in uteri from ovariectomized (OVX) mice exposed to 17beta-estradiol (E2). Here, we further examined the expression pattern of Id-1 and its regulation of by E2 and progesterone (P4) in the mouse uterus. Increased Id-1 transcripts in OVX mice uterus exposed to E2 were efficiently reduced by pretreatment with ICI 182,780 (an antagonist for nuclear estrogen receptor), suggesting that E2 induced expression of Id-1 is mediated via classical estrogen receptor (ER). In contrast, P4 treatment did not enhance or antagonize the action of E2 on Id-1 expression. Laser capture microdissection revealed that Id-1 is exclusively expressed in luminal epithelial cells. Notably, Id-1 was significantly upregulated at implantation sites on day 4.5 of pregnancy due to strong expression of Id-1 in blastocyst stage embryos. The present results show that the expression of Id-1 in the mouse uterus is tightly regulated by E2 via classical ER genomic pathway, not P4 suggesting an important role in uterine physiological events such as the estrous cycle and implantation process.

Anatomical Origin of Tuberculum Sellae Meningioma: Off-Midline Location and Its Clinical Implications

OBJECTIVEnTuberculum sellae meningiomas (TSM) arise from the dura mater of tuberculum sellae, limbus sphenoidale, and chiasmatic sulcus and cause asymmetric visual disturbances. In this study, we analyzed the laterality of the origin of TSM and discussed its clinical implications on immediate and long-term visual outcomes.nnnMETHODSnBetween 1994 and 2013, TSM was diagnosed in 100 patients after microsurgical resection. The medical records, radiologic features, and operative findings were retrospectively reviewed and analyzed in these patients.nnnRESULTSnVisual disturbances were evident in 95 patients (95%) after neuro-ophthalmologic testing. Among them, 89 patients (89%) showed marked asymmetric visual field defect, and 6 patients (6%) had relatively symmetric visual field defect. On intraoperative inspection, the origin of TSM was at the one lateral end portion of the tuberculum sellae in 85 patients (85%). In 15 patients (15%), the TSM originated from the midline region, including the central portion of the tuberculum sellae (nxa0= 13) and diaphragm sellae (nxa0= 2). Optic canal involvement was observed in 73 patients (73%). Preexisting visual field defects were improved in 70 patients (70%), were stationary in 25 patients (25%), and aggravated in 5 patients (5%) during postoperative follow-up (mean 58 months, 24∼122 months). The preoperative symptom duration, the laterality of the origin of TSM, and optic disc atrophy were associated with long-term poor visual outcomes.nnnCONCLUSIONSnMost TSMs that originated from the dura of one lateral end portion of the tuberculum sellae correlated with asymmetric visual symptoms and poor visual outcomes. This microsurgical feature should be considered in the planning of optimal surgical strategy to achieve favorable outcomes.