Search

Background The endoscopic endonasal approach (EEA) and the endoscopic supraorbital keyhole approach (eSKA) provide minimally invasive access to tuberculum sellae (TS) tumors. Evaluation of the operating maneuverability is helpful for approach selection. Herein, we compared the two approaches and aimed to provide quantitative anatomic data for surgical decision-making in the management of TS lesions. Methods Fifteen dissections were performed on five silicone-injected cadaveric heads. The EEA and eSKA (both right and left) were performed on each head. Surgical freedom and working angles in the axial and sagittal planes were calculated using the stereotactic navigation system in the selected six targets: the midpoint of the leading edge of the sphenoid sinus (leSS), the midpoint of the edge of the dorsum sellae (eDS), the ipsilateral medial opticocarotid recess (imOCR), the contralateral medial opticocarotid recess (cmOCR), the ipsilateral lateral opticocarotid recess (ilOCR), and the contralateral lateral opticocarotid recess (clOCR). Results The surgical freedom at the ilOCR and the axial working angles at the leSS, ilOCR, and imOCR (imOCR with excessive manipulation of the optic apparatus) were greater in the eSKA. The EEA provided greater surgical freedom and/or working angles at most targets than eSKA (the surgical freedom at the imOCR, cmOCR, clOCR, and eDS; the axial working angles at the cmOCR and clOCR; and the sagittal working angles at the leSS, imOCR, cmOCR, clOCR, and eDS). Conclusion The EEA provides greater surgical freedom and working angles for paramedian lesions, whereas the eSKA provides better surgical maneuverability for lesions with lateral extension.

Objective Biochemical remission rates of endoscopic endonasal transsphenoidal surgery (EETS) and its associated predictive factors were evaluated in patients with somatotrophin pituitary adenomas. Methods The patients who underwent EETS in Jinling Hospital were identified between 2011 and 2020. The surgeons' experience, preoperative insulin-like growth factor 1 (IGF-1), basal growth hormone (GH) levels, nadir GH levels, and the tumor characteristics were analyzed for their relationships with endocrine outcomes. Total 98 patients were included for single factor analysis and regression analysis. They were divided into three groups according to the admission chronologic order. Results The overall remission rate of the patients was 57% (56/98) for all the patients over 10 years. In the single factor analysis, we found that the tumor size, cavernous invasion, and sellar invasion were valuable to predict the endocrine outcome after surgery. As for the suprasellar invasion, no significant difference was found between the noninvasive group and the invasive group. The preoperative IGF-1 level (p = 0.166), basal GH level (p = 0.001), and nadir GH level (p = 0.004) were also different between the remission group and the nonremission group in the single factor analysis. The logistic regression analysis indicated that the preoperative nadir GH (odds ratio = 0.930, 95% confidence interval = 0.891–0.972, p = 0.001) was a significant predictor for the endocrine outcomes after surgery. Conclusion The surgeons' experience is an important factor that can affect the patients' endocrine outcomes after surgery. The macroadenomas with lateral invasion are more difficult to cure. Patients with higher preoperative nadir GH levels are less likely to achieve remission.

Injuries to the central nervous system (CNS) often lead to severe neurological dysfunction and even death. However, there are still no effective measures to improve functional recovery following CNS injuries. Optogenetics, an ideal method to modulate neural activity, has shown various advantages in controlling neural circuits, promoting neural remapping, and improving cell survival. In particular, the emerging optogenetics has exhibited promising therapeutic methods for CNS injuries. In this review, we introduced the light-sensitive proteins and light stimulation system which are important components of optogenetic technology in detail and summarized the development trends. Meanwhile, we constructed a comprehensive picture of the current application of optogenetics in CNS injuries and highlighted recent advances for the treatment and functional recovery of neurological deficits. Finally, we discussed the therapeutic challenges and prospective uses of optogenetics therapy by photostimulation/photoinhibition modalities that would be suitable for clinical applications.

Introduction: Intracerebral hemorrhage (ICH) is the most fatal type of stroke worldwide. Herein, we aim to develop a predictive model based on computed tomography (CT) markers in an ICH cohort and validate it in another cohort. Methods: This retrospective observational cohort study was conducted in 3 medical centers in China. The values of CT markers, including hypodensities, hematoma density, blend sign, black hole sign, island sign, midline shift, baseline hematoma volume, and satellite sign, in predicting poor outcome were analyzed by logistic regression analysis. A nomogram was developed based on the results of multivariate logistic regression analysis in development cohort. Area under curve (AUC) and calibration plot were used to assess the accuracy of nomogram in this development cohort and validate in another cohort. Results: A total of 1,498 patients were included in this study. Multivariate logistic regression analysis indicated that hypodensities, black hole sign, island sign, midline shift, and baseline hematoma volume were independently associated with poor outcome in development cohort. The AUC was 0.75 (95% confidence interval [CI]: 0.73–0.76) in the internal validation with development cohort and 0.74 (95% CI: 0.72–0.75) in the external validation with validation cohort. The calibration plot in development and validation cohort indicated that the nomogram was well calibrated. Conclusions: CT markers of hypodensities, black hole sign, and island sign might predict poor outcome of ICH patients within 90 days.

Glioblastoma multiforme (GBM) is a common and aggressive form of brain tumor. The NSingle-cell and bulk RNA-sequencing data were acquired from the GEO and TCGA databases, respectively. We used bioinformatics and statistical tools to analyze associations between mAt the single-cell level, m

Purpose: To summarize the experience of diagnosis and treatment of echinococcosis in nervous system in Qinghai-Tibet Plateau.Methods: Patients with echinococcosis of nervous system treated in Qinghai Provincial People's Hospital from January 2010 to September 2018 were selected. All patients were examined by enzyme linked immunosorbent assay and imaging examination. During the hospital, all patients received surgery. After operation, patients exanimated regularly and followed up for one year.Results: A total of 13 patients were included in this study. The average age was 38.8±13.7 and seven cases (54%) were male. Among these patients, six cases had cystic echinococcosis and seven cases with alveolar echinococcosis, meanwhile, eight patients had cerebral echinococcosis and five patients with spinal echinococcosis. The enzyme linked immunosorbent assay indicated positive results in 8 cases and one patient was misdiagnosed as vertebral metastases by imaging examination before operation. One patient recurred after operation but refused treatment. After follow-up for one year, the mRS (Modified Rankin Scale) of cerebral echinococcosis improved from 3.3±0.5 to 2.1±0.4, four cases of spinal echinococcosis improved in ASIA (American Spinal Injury Association).Conclusion: Current evidence indicated that early surgical treatment and oral albendazole might improve the outcome of patients with nervous system echinococcosis in short time.

Ambient fine particulate matter of 2.5 μm or less in diameter (PM2.5) of environment contamination is deemed as a risk factor of cerebrovascular diseases. Yet there is still no explicit evidence strongly supporting that PM2.5 with per unit increment can increase the risk of hemorrhagic stroke (HS). Literatures were searched from PubMed, Cochrane, and Embase. After the systemic review of relevant studies, random effects model was used to perform meta-analysis and to evaluate the association between PM2.5 and risk of HS. Seven cohort studies were finally included, involving more than 6 million people and 37,667 endpoint events (incidence or mortality of HS). Total scores of quality assessment were 50. Pooled hazard ratio (HR) for crude HRs was 1.13 (95%CI: 1.09–1.17) (CI for confidence interval). Pooled HR of subgroup analysis for current smoking with exposure to growing PM2.5 was 1.14 (95%CI: 0.92–2.15) and for never and former smoking was 1.04 (95%CI: 0.74–1.46). Ambient PM2.5 level is significantly associated with the risk of HS, which might be a potential risk factor of HS. Smoking does not further increase the risk of HS under exposure of PM2.5.

To conduct a systematic review and meta-analysis and evaluate the effect of tranexamic acid in patients with traumatic brain injury. PubMed, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched to identify randomized controlled trials and evaluate the effect of tranexamic acid in traumatic brain injury patients. The primary outcome was mortality. Two reviewers extracted the data independently. The random effect meta-analysis was used to estimate the aggregate effect size of 95% confidence intervals. Six randomized controlled trials investigating tranexamic acid versus placebo and 30073 patients were included. Compared with placebo, tranexamic acid decreased the mortality (RR = 0.92; 95% CI, 0.87–0.96; p < 0.001) and growth of hemorrhagic mass (RR = 0.78; 95% CI, 0.61–0.99; p = 0.04). However, tranexamic acid could not decrease disability or independent, neurosurgery, vascular embolism, and stroke. Current evidence suggested that compared with placebo, tranexamic acid could reduce mortality and growth of hemorrhagic mass. This finding indicated that patients with traumatic brain injury should be treated with tranexamic acid.

Background: A case of primary alveolar echinococcosis (AE) in the liver with kidney and brain metastases was treated at our hospital. The analysis of this case might provide suggestions for the diagnosis and treatment of other cases of AE in the brain. Methods : To determine the disease status of AE in the liver and brain in this patient, computed tomography (CT) of the abdomen and head magnetic resonance imaging (MRI) were performed before surgery. Additionally, the serum of the patient was analyzed using an enzyme linked immunosorbent assay (ELISA) for antibodies against echinococcus. The left pterional approach was selected for head surgery. Along the edema zone around the lesion, complete excision was performed encompassing an area of about 5 mm surrounding the lesion. After surgery, pathological and immunohistochemical examinations of the lesion were performed, and deoxyribonucleic acid (DNA) was extracted for molecular identification. This patient was followed up regularly post-discharge to evaluate the outcome. Results: Anti-echinococcus antibodies were strongly positive in the patient’s serum, and the eosinophil ratio was 20%. The head MRI showed a single lesion in the left temporal lobe. Multiple nodular and small cystic long T 1 short T 2 signals were seen in the lesions. An enhanced scan indicated multiple ring-enhancements, the boundary was unclear, and the size of lesion was 3.2 mm×1.8 mm. Neurological symptoms improved after the surgery. The result of histopathological examination was consistent with the characteristics of AE. Immunohistochemistry showed that the peripheral glial cells were positive for glial fibrillary acidic protein (GFAP) and the Ki-67 index was

To determine the prognostic risk factors of patients with acute epidural hematoma (AEDH), a scoring system was established based on gray–white matter ratio (GWR) and internal verification was performed. All patients with AEDH who underwent surgical treatment in Qinghai Provincial People's Hospital from January 2013 to June 2019 were continuously collected. The clinical and imaging data of the patients were collected. According to Glasgow Outcome Scale at 3 months after operation, the patients were divided into poor and good prognosis groups, respectively. The GWR value of the nonhematoma side was measured at the inner capsule area. Univariate and multivariate analyses were used. Independent predictors significantly related to the prognosis of AEDH were screened out and a nomogram was established based on these factors. A total of 170 cases were included in this study, the Glasgow Coma Score (severe and moderate), cerebral hernia, midline shift, preoperative GWR, postoperative GWR, hematoma thickness/midline shift, time from coma to surgery, and decompression of bone flap were the independent risk factors for predicting the poor prognosis of AEDH. Moreover, the prediction ability of nomogram was higher than any other independent predictive factors. The nomogram model established represents the most effective factor to predict the prognosis of operated AEDH. The scoring system is characterized by high accuracy, simplicity and feasibility, with a wide range of clinical application prospects.

To establish a new nomogram model and provide a new theoretical basis for the diagnosis and treatment of spontaneous intracerebral hemorrhage.The clinical data and noncontrast computed tomography images of patients with spontaneous intracerebral hemorrhage in 3 tertiary medical centers were collected continuously. Univariate and binary logistic regression analysis were performed to screen out the independent predictors that were significantly associated with hematoma expansion. The nomogram model was drawn by R programming language. According to the related risk factors of nomogram, decision curve analysis and clinical impact curve were established.The numbers of the 3 cooperative units were 554, 582, and 202, respectively. Island sign, blend sign, swirl sign, intraventricular hemorrhage, history of diabetes, time to baseline computed tomography scan, and baseline hematoma volume were independent predictors of hematoma expansion. Baseline hematoma volume20 mL (odds ratio, 4.088; 95% confidence interval, 2.802-5.964; P0.0001) was the most dangerous factor for predicting hematoma expansion, followed by the time to baseline computed tomography scan ≤1 hour (odds ratio, 4.188; 95% confidence interval, 2.598-6.750; P0.0001). Decision curve analysis showed that the net benefit of patients was the highest when nomogram score existed. When the threshold probability was40%, the prediction probability of hematoma expansion was close to the actual probability.This nomogram model could accurately predict hematoma expansion of spontaneous intracerebral hemorrhage, which provided a theoretical basis for clinicians to intervene in the early stage.

Objective The latest World Health Organization data showed that stroke was the highest mortality in China, accounting for 23.7% of the total mortality from 2000 to 2012. Intracerebral hemorrhage (ICH) was the most deadly and incurable type of stroke. In the Qinghai-Tibetan Plateau, the incidence of stroke was relatively higher. Several studies showed that the shape and heterogeneity of hematoma and image markers on brain computed tomography scan had predictive effects on hematoma expansion (HE). The study aimed to find relative factors and established a nomogram model to predict the HE of ICH. Methods All patients with ICH in Qinghai Provincial People's Hospital from January 1, 2012, to May 22, 2018, were continuously collected. A total of 402 patients were included in the study. This was a single-center retrospective study. Univariate and binary logistic regression analysis were performed to screen out the independent predictors that were significantly associated with HE. Results The total incidence of HE in ICH was 30.9%, whereas the incidence of HE in the basal ganglia and nonbasal ganglia was 36.4% and 17.2%, respectively. Diabetes, basal ganglia hemorrhage, time of onset to baseline computed tomography, island sign, blend sign, black hole sign, and swirl sign were independent predictors of HE. Based on these predictors, a nomogram model was established and the accuracy was 81.6%, the sensitivity was 91.1%, and the specificity was 70.5%. Conclusions This model had a high accuracy of predicting HE in the Qinghai-Tibetan Plateau. Because this model is noninvasive, rapid, and low cost, it is easy to promote and has wide application prospects in clinical practice.