Yinghui Bao

Traumatic subdural effusion evolves into chronic subdural hematoma: Two stages of the same inflammatory reaction?

Traumatic subdural effusion (TSE) is one of the main associated complications of brain trauma. About half of the asymptomatic TSEs ultimately evolve into chronic subdural hematomas (CSDHs), most of which will be inevitably treated by surgical evacuation. With the emergence of subdural hydroma (SDH), rupture of bridge-veins, bleeding of the hydroma wall, hyperfunction of fibrinolysis and increasing protein content in the hydroma are some of the traditionally cited explanations of the pathogenesis of TSE evolving into CSHD. Despite intensive research and subsequent advances in surgical techniques of CSDH, a single treatment with measurable clinical impact on the evolution interruption has yet to be investigated. Compared with peripheral venous blood, inflammatory cytokines were elevated in TSE and CSDH demonstrated by a number of investigators. Neoformation of capillaries, vascular hyper-permeability, serum protein exudation and other characteristics of aseptic inflammatory reaction were observed. Meanwhile, steroid was applied to treat CSDH in several groups, which was generally used as an effective anti-inflammatory agent. Based on systemic thinking, we hypothesize that TSE and CSDH are different stages, with different appearances, of the same inflammatory reaction. The evolution from TSE into CSDH and propagation of CSDH seem to be the results of local aseptic inflammation. Our hypothesis holds potential as a target for therapeutic intervention.

Therapeutic hypothermia attenuates tissue damage and cytokine expression after traumatic brain injury by inhibiting necroptosis in the rat

Necroptosis has been shown as an alternative form of cell death in many diseases, but the detailed mechanisms of the neuron loss after traumatic brain injury (TBI) in rodents remain unclear. To investigate whether necroptosis is induced after TBI and gets involved in the neuroprotecton of therapeutic hypothermia on the TBI, we observed the pathological and biochemical change of the necroptosis in the fluid percussion brain injury (FPI) model of the rats. We found that receptor-interacting protein (RIP) 1 and 3, and mixed lineage kinase domain-like protein (MLKL), the critical downstream mediators of necroptosis recently identified in vivo, as well as HMGB1 and the pro-inflammation cytokines TNF-α, IL-6 and IL-18, were increased at an early phase (6 h) in cortex after TBI. Posttraumatic hypothermia (33 °C) led to the decreases in the necroptosis regulators, inflammatory factors and brain tissue damage in rats compared with normothermia-treated TBI animals. Immunohistochemistry studies showed that posttraumatic hypothermia also decreased the necroptosis-associated proteins staining in injured cortex and hippocampal CA1. Therefore, we conclude that the RIP1/RIP3-MLKL-mediated necroptosis occurs after experimental TBI and therapeutic hypothermia may protect the injured central nervous system from tissue damage and the inflammatory responses by targeting the necroptosis signaling after TBI.

Endovascular Treatment of the Extracranial Carotid Pseudoaneurysms Resulting From Stab Penetrating Injury Using Overlapping Bare Stents

Injury pertaining to the common carotid artery may result in complete or partial arterial transection, pseudoaneurysms, or arteriovenous connections. Endovascular treatment option of the pseudoaneurysm has already been established with favorable success rate and minimal morbidity. Our purpose is to report one 18-year-old male patient having 2 traumatic pseudoaneurysms as a result of penetrating stab injury in the extracranial common carotid. The patient was successfully treated using 2 overlapping bare-metal stents. The 2 common carotid pseudoaneurysms had different degree inflow angles defined as the space between the lines indicating the direction of blood flow from the parent artery and through the aneurysmal neck to the dome. Computed tomography angiography was utilized to follow the evolution of the pseudoaneurysms until total occlusion was demonstrated. The treatment modality used in this report represents an alternative approach of the endovascular treatment for the extracranial carotid pseudoaneurysm.

Extended Suboccipital Retrosigmoid Surgical Approach Is Effective for Resection of Petrous Apex Meningioma.

Objective:The aim of this study was to evaluate the clinical features, treatment strategies, and outcomes of patients presented with petrous apex meningiomas. Methods:In this retrospective clinical study, 17 patients with petrous apex meningiomas were treated microsurgically via an extended suboccipital retrosigmoid approach. Data regarding the general characteristics of the patients, surgical management, and surgery-related outcomes were obtained by reviewing patients’ medical records. Results:In the authors’ study, the authors report that the use of an extended suboccipital retrosigmoid approach and careful microneurosurgical technique can be used to achieve improved surgical and functional outcomes. This was evidenced by gross tumor resection, which was confirmed in 12 (70.6%) patients, and by partial tumor resection, achieved in the remaining 5 patients. Using this surgical approach, the petrosal vein was preserved in 15 (88.2%) patients. In the remaining 2 (11.8%) patients, this vein was sacrificed. Postsurgical improvement of neurological deficits was consequently observed in 12 (70.6%) patients. Though 3 patients (17.6%) demonstrated a postoperative decline in neurological function, 1 patient significantly recovered facial function at follow-up. One patient with sacrificed petrosal vein experienced loss of functional hearing surgery with no recovery during the follow-up period. No operative mortality was observed. Total resection of petrous apex meningiomas is achievable using an extended suboccipital retrosigmoid approach without permanent surgery-associated neurological deficits in a majority of patients. Conclusion:Our primary surgical goal was to achieve maximal tumor resection while maintaining or improving neurological function. Intraoperative protection of the petrosal vein should also be a surgical focus to avoid postoperative complications. Finally, stereotactic radiosurgery can also be useful as a supplemental treatment for postoperative tumor residuals.

Surgical management and outcomes of non-missile open head injury: Report of 44 cases from a single trauma centre

Abstract Objective: To retrospectively analyse the surgical management and outcomes of non-missile open head injuries (NMOHI). Methods: Forty-four patients who suffered from NMOHI were included. The Glasgow outcome score (GOS), computed tomography (CT), aetiology and outcomes and complications at discharge and during a 6-month follow-up were analysed. All patients underwent debridement. Intracranial haematoma evacuation, decompressive craniectomy (DC) or replacement were performed. Results: Motor vehicle accident and struck by/against were the most common causes (43.2% each). At admission, 33 patients had Glasgow coma scores (GCS) > 8 and 27 of them had a GCS score of > 13. Mean follow-up was 8.7 ± 4.3 months. All patients underwent debridement, 20 underwent bone fracture replacement and 27 underwent haematoma evacuation; 11 patients underwent haematoma evacuation and DC and one had bilateral DC. Twenty-seven patients showed good recovery; 11 patients had moderate disability; three patients had severe disability; and three patients died. After 6 months, 32 patients had good recovery and the morbidity of severe disability had decreased to 13.6%. Thirteen patients developed intracranial infection. Post-traumatic epilepsy and hydrocephalus was detected in three patients. Cerebrospinal fluid fistula was found in five patients. Only one patient developed a brain abscess after 6 months. Conclusions: NMOHI yielded satisfactory recovery and achieved good outcomes.

Meningioma in the elderly: Characteristics, prognostic factors, and surgical strategy

Meningioma is one of the most common intracranial tumors. It has the features of benign and slow growing. We focused on the meningioma in the elderly, retrospectively analyzed 528 valid meningioma patients, including 115 (21.8%) patients older than 65 years old. The elderly patients were shown to have significantly larger tumor diameter (mean [±SD] 43.4 ± 18.0 mm) comparing with the young group (mean [±SD] 37.6 ± 16.5 mm, p < 0.01). Post-operative KPS was significantly lower in the elderly group (mean [±SD] 79.64 ± 26.37) than the young group (mean [±SD] 88.81 ± 17.36, p < 0.01). Multivariate regression of post-operative KPS scales at discharge and 6 months follow-up showed operative complications, pre-operative comorbidities, tumor diameter, and challenging location had a significant impact on the outcome. However, tumor blood supply, Simpson grades, pathology, and pre-operative symptoms were shown to have less impact on the post-operative KPS scale. The outcome for meningioma in elderly patients was affected by factors related more to the safety of the operation than characteristics of the tumor. Therefore, rather than achieving total resection, conservative and safety preferential treatment strategies should be regarded as a higher priority for better quality of life.

Improved neurite outgrowth on central nervous system myelin substrate by siRNA-mediated knockdown of Nogo receptor

Purpose To investigate the in vitro effect of short interfering RNAs (siRNAs) against Nogo receptor (NgR) on neurite outgrowth under an inhibitory substrate of central nervous system (CNS) myelin. Methods Three siRNA sequences against NgR were designed and transfected into cerebellar granule cells (CGCs) to screen for the most efficient sequence of NgR siRNA by using reverse transcription polymerase chain reaction (RT-PCR) and immunofluorescence staining. NgR siRNA sequence 1 was found the most efficient which was then transfected into the CGCs grown on CNS myelin substrate to observe its disinhibition for neurite outgrowth. Results Compared with the scrambled control sequence of siRNA, the NgR siRNA sequence 1 significantly decreased NgR mRNA level at 24 h and 48 h (p < 0.05), which was recovered by 96 h after transfection. NgR immunoreactivity was also markedly reduced at 24 and 48 h after the transfection of siRNA sequence 1 compared with that before transfection (p < 0.05). The NgR immunoreactivity was recovered after 72 h post-transfection. Moreover, the neurite outgrowth on the myelin substrate was greatly improved within 72 h after the transfection with siRNA sequence 1 compared with the scrambled sequence-transfected group or non-transfected group (p < 0.05). Conclusion : siRNA-mediated knockdown of NgR expression contributes to neurite outgrowth in vitro.