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Glioblastoma multiforme (GBM) is a primary brain tumor with devastating prognosis. Although the OThe function of Down syndrome critical region protein 3 (DSCR3) on MGMT-deficient GBM was investigated in vitro and in an orthotopic brain tumor model in mice. Purification of plasma membrane proteins by membrane-cytoplasmic separation and subsequent label free-based quantitative proteomics were used to identified potential protein partners for DSCR3. Immunofluorescence was performed to show the reverse transport of solute carrier family 38 member 1 (SLC38A1) mediated by DSCR3.DSCR3 is upregulated in MGMT-deficient GBM cells during TMZ treatment. Both DSCR3 and SLC38A1 were highly expressed in recurrent GBM patients. Silencing DSCR3 or SLC38A1 expression can increase TMZ sensitivity in MGMT-deficient GBM cells. Combination of proteomics and in vitro experiments show that DSCR3 directly binds internalized SLC38A1 to mediate its sorting into recycling pathway, which maintains the abundance on plasma membrane and enhances uptake of glutamine in MGMT-deficient GBM cells.DSCR3 is a crucial regulator of acquired TMZ resistance in MGMT-deficient GBM. The DSCR3-dependent recycling of SLC38A1 maintains its abundance on plasma membrane, leading to tumor progression and acquired TMZ resistance in MGMT-deficient GBM.

Craniopharyngioma represents a troublesome tumor of the intracranial sellar region. There are currently no available well-characterized craniopharyngioma cell lines. This lack of reliable, immortal cell lines is a major reason for the slow progress in fundamental research related to craniopharyngioma.We describe the development of an immortal papillary craniopharyngioma (PCP) cell line by transfecting primary PCP cells with the pLenti-simian virus 40 large T antigen(SV40LT).Three clones have been cultured for more than 14 months so far, while non-transfected cells ceased proliferation within three months of isolation. The established immortal PCP cell lines were identified to have BRAFWe successfully developed PCP cell lines by SV40LT-mediated immortalization. These cell lines represent a powerful tool for fundamental and therapeutical studies on craniopharyngioma.

Adamantinomatous craniopharyngioma (ACP) is a benign epithelial tumor of the sellar region. Whether primary human cell cultures can be used as a stable research model has yet to be determined. The characteristics of three cultured craniopharyngioma primary cell (CPC) lines were identified using immunofluorescence. The culture duration for each CPC line was 10, 20 and 30 days. Cell lines and paired parental tumor tissues were subsequently analyzed using transcriptome sequencing (RNA-Seq). Transcriptomic differences between ACP tissues and CPC lines were compared. CPCs maintained the original epithelial lineage markers, including pan-cytokeratin and epithelial cell adhesion molecule. However, the Pearson's correlation coefficient of transcriptomes between each pair of CPC lines and ACP tissues decreased from 0.657 (cultured for 10 days) to 0.61 (cultured for 20 days) and further to 0.547 (cultured for 30 days). The number of differentially expressed genes between ACP tissues and CPCs was increased from 1,247 (cultured for 10 days) to 1,643 (cultured for 20 days) and then to 1,949 (cultured for 30 days). The results of Gene Set Enrichment Analysis demonstrated that the diversity of gene sets increased with longer culture time. Significant differences in the majority of signature gene sets were not observed between ACP tissues and CPCs, with the exception of keratinization phenotype [normalized enrichment score (NES)=−2.02, false discovery rate (FDR)=0.0038] and epithelial cell phenotype (NES=−1.82, FDR=0.032). Cell proliferation (NES=1.78, FDR=0.028) and mitosis (NES=1.93, FDR=0.012) were enhanced in CPCs. Therefore, primary human cell cultures can be used as a suitable research platform for ACP, however further experiments are required.

Front cover: The cover image, by Ming‐Feng Zhou et al., is based on the ORIGINAL ARTICLE Endoplasmic reticulum stress induces apoptosis of arginine vasopressin neurons in central diabetes insipidus via PI3K/Akt pathway. DOI: https://doi.org/10.1111/cns.13089. [Image: see text]

Objective To explore the applied value of modified enzyme digestion method in primary culture of human glioma cells. Methods A traditional enzyme digestion method was modified based on literatures and our work experience. The glioma cells from 32 glioma patients with different grades were primarily cultured by the modified enzyme digestion method. The morphological features of these cells were observed under an inverted phase contrast microscope. The primary cells were purified by differential adhesion during passage. The primary cells were identified by immunofluorescence technique, and the growth curves were drawn by cell proliferation assays (CCK-8 method) for investigating the proliferation of the cells cultured in vitro. Results The primary human glioma cells were successfully cultured and transferred by the new method, with a success rate of 87.5%. The cells cultured successfully in vitro showed good adherent growth, stable morphologies, thus can be passaged. Fluoroimmunoassay showed positive expression of glial fibrillary acidic protein, which confirms the cultured cells were glioma cells. Cell proliferation assays revealed active cell proliferation in vitro, the higher the tumor grade, the higher the proliferative capacity. Conclusion The modified enzyme digestion method is simpler and more efficient for primary culture of human glioma cells, and the success rate is also higher, thus being able to provide a good guarantee for fundamental research of glioma. DOI: 10.11855/j.issn.0577-7402.2016.06.06

Background: The radiochemotherapy regimen concomitantly employing temozolomide (TMZ) chemotherapy and radiotherapy (RT) 4 weeks after surgery, followed by 6 cycles of TMZ is a common treatment for glioblastoma (GBM). However, its median overall survival (OS) is only 14.6 months. This study was to explore the effectiveness and safety of early TMZ chemotherapy between surgery and chemoradiotherapy plus the standard concomitant radiochemotherapy regimen. Methods: A randomized, parallel group, open-label study of 99 newly diagnosed GBM patients was conducted at 10 independent Chinese neurosurgical departments from June 2008 to June 2012. Patients were treated with concomitant radiochemotherapy regimen plus early postsurgical temozolomide (early TMZ group) or standard concomitant radiochemotherapy regimen (control group). Overall response was assessed based on objective tumor assessments, administration of corticosteroid and neurological status test. Hematological, biochemical, laboratory, adverse event (AE), and neurological condition were measured for 24 months of follow-up. The primary efficacy endpoint of this study was overall survival (OS). The secondary endpoint was progression free survival (PFS). Results: The median OS time in the early TMZ group was 17.6 months, compared with 13.2 months in the control group (log-rank test P = 0.021). In addition, the OS rate in the early TMZ group was higher at 6, 12, and 18 months than in the control group, respectively (P < 0.05). The median PFS time was 8.7 months in the early TMZ group and 10.4 months in the control group (log-rank test P = 0.695). AEs occurred in 29 (55.8%) and 31(73.8%) patients respectively in early and control groups, including nausea (15.4% vs. 33.3%), vomiting (7.7% vs. 28.6%), fever (7.7% vs. 11.9%), and headache (3.8% vs. 23.8%). Only 30.8% and 33.3% were drug-related, respectively. Conclusions: Addition of TMZ chemotherapy in the early break of the standard concomitant radiochemotherapy regimen was well tolerated and significantly improved the OS of the GBM patients, compared with standard concomitant radiochemotherapy regimen. However, a larger randomized trial is warranted to verify these results.

This meta-analysis was undertaken to identify the relationships between genetic polymorphisms in the LDLR gene and the risk of cerebral infarction. The Web of Science (1945-2013), the Cochrane Library Database (Issue 12, 2013), PubMed (1966-2013), EMBASE (1980-2013), CINAHL (1982-2013) and the Chinese Biomedical Database (CBM) (1982-2013) were searched for relevant articles without language restrictions. Meta-analysis was conducted using the STATA 12.0 software. Crude odds ratios (OR) with their corresponding 95% confidence interval (CI) were calculated. Eight case-control studies with a total of 4,655 patients with cerebral infarction and 15,920 healthy control subjects were included in our meta-analysis. Five common polymorphisms in the LDLR gene were evaluated, including rs11669576 A > T, rs1433099 C > T, rs5925 C > T, rs688 C > T, rs1122608 T > G in the LDLR gene. The results of this meta-analysis revealed that cerebral infarction patients had a higher frequency of LDLR genetic polymorphisms than that of healthy controls (allele model: OR 1.17, 95% CI 1.05-1.30, P = 0.004; dominant model: OR 1.18, 95% CI 1.05-1.33, P = 0.007; homozygous model: OR 1.50, 95% CI 1.03-2.16, P = 0.032; respectively), especially for the rs11669576 A > T, rs1433099 C > T and rs5925 C > T polymorphisms. Among different ethnic subgroups, the results demonstrated positive correlations between LDLR genetic polymorphisms and an increased risk of cerebral infarction among both Asians and Caucasians under the allele and dominant models (all P T, rs1433099 C > T, rs5925 C > T polymorphisms.

To evaluate the safety and short-term efficacy of Willis covered stent for treatment of blood blister-like aneurysms (BBA).Eight patients with BBA were treated with Willis covered stent system during the period from December 2014 to February 2016. The guiding catheter was placed as high as possible to facilitate the delivery of the covered stent system.s Nine covered stents were implanted in the aneurysms of 8 patients (8 aneurysms), and 8 stents were released successfully in the parent arteries. In 6 patients, angiography immediately after stent release showed complete disappearance of the aneurysm and the parent arteries remained patent. One patient experienced a minor endoleak after stent implantation, and another stent was implanted to eliminate the endoleak. Iatrogeniccarotid-cavernous fistula occurred in 1 patient due to tortuosity of the parent artery, for which superficial temporal artery-to-middle cerebral artery bypass combined with parent artery occlusion was performed instead; the patient recovered smoothly and the bypass remained patent at 6 months after the operation. No other periprocedural complications occurred in these patients. Follow-up study showed no new-onset neurological deficits in these 8 patients, who had mRS score of 0 in 6 patients and of 1 in 2 patients. Digital subtractive angiography at 6 months after the operation demonstrated no aneurysm in these patients, and only one patient showed mild stenosis in the parent artery.Willis covered stents are effective for treatment of BBA with good safety and short-term outcomes.

To investigate the effect of small interfering RNA (siRNA)-mediated silencing of PC4 and SFRS1 interacting protein 1 (PSIP1) on invasion and migration of human glioma U87 cells.Chemically synthesized siRNA targeting PSIP1 gene was transfected into U87 cells via lipofectamine, and the gene silencing effect was determined using real-time PCR. The changes in the invasion and migration abilities of the transfected cells were assessed with Transwell assay and wound healing assay, respectively. Western blotting was used to analyze the expression of N-cadherin, β-catenin and the transcription factor Slug.The mRNA and protein level of PSIP1 was significantly reduced in U87 cells after transfection with PSIP1 siRNA (P0.0001). PSIP1 knockdown in U87 cells resulted in significant suppression of cell invasion and migration abilities (P0.01) and also reduced N-cadherin, β-catenin and Slug expressions.s Silencing of PSIP1 impairs the invasion and migration abilities of glioma cells and lowers the expressions of N-cadherin, β-catenin and Slug, suggesting that PSIP1 may regulate Slug by classical Wnt/β-catenin signaling pathway to modulate epithelial-mesenchymal transition and promote the invasion and migration of glioma cells.

To compare the efficacy, clinical characteristics, safety, injection time and radiation exposure of Onyx embolization using a long-distance injection method and routine injection method for management of dural arteriovenous fistula (DAVF).The clinical data were retrospectively analyzed in 59 patients with DAVF treated with Onyx embolization using long-distance injection method (28 patients) and routine injection method (31 patients). The efficacy, safety, injection time and radiation exposure during Onyx embolization were compared between the two injections methods.The average radiation dose exposure to the surgeon per procedure was significantly lower in the long-distance injection group than in the routine group. The injection time (P=0.53), injection volume (P=0.78), number of supply arteries (P=0.80), Cognard types (P=0.67), and effect of embolization (P=0.88) were all similar between the two groups.Endovaseular treatment of intracranial DAVF with Onyx embolization using the long-distance injection method is feasible, safe and effective and can reduce the radiation exposure to the surgeon.

Total resection of adamantinomatous craniopharyngioma (ACP) is complex and often leads to postoperative recurrence. This is due to the tendency of the tumor to invade the surrounding brain tissue and the generation of a local inflammatory state between the tumor cells and parenchyma. While there is evidence to suggest that interleukin‑6 (IL‑6) induces craniopharyngioma (CP)‑associated inflammation, particularly in ACP, the role of IL‑6 in the progression of ACP remains unclear. The results of the present study demonstrated that CP inflammation was associated with pathological classification, extent of surgery, degree of calcification and postoperative hypothalamic status scale. Cytokine antibody arrays were conducted to measure the expression of IL‑6 and other inflammatory factors in tumor tissues in response to various levels of inflammatory exposure. IL‑6, IL‑6 receptor (IL‑6R) and glycoprotein 130 expression was detected by immunohistochemistry. In addition, an ELISA was performed to quantify the levels of soluble IL‑6R (sIL‑6R) in the cystic fluid and supernatants of ACP cells and tumor‑associated fibroblasts. These measurements demonstrated that ACP cells produce IL‑6 and its associated proteins. In addition, the results revealed that while the viability of ACP cells was not affected, the migration of ACP cells was promoted by IL‑6 treatment in a concentration‑dependent manner. Conversely, treatment with an IL‑6‑blocking monoclonal antibody significantly decreased the migration of ACP cells. In addition, IL‑6 treatment increased the expression of vimentin and decreased the expression of E‑cadherin in a dose‑dependent manner. The findings of the present study demonstrate that IL‑6 may promote migration in vitro via the classic‑ and trans‑signaling pathways by inducing epithelial‑mesenchymal transition in ACP cell cultures.

To explore the diagnosis and treatment strategy of multiple intracranial aneurysms (MIA).We retrospectively analyzed 96 patients with MIA (234 aneurysms). The rupture site was determined on the basis of computed tomographic and angiographic findings, and the supposed ruptured aneurysm was treated with coiling OR clipping. All the patients' records were reviewed including all computed tomographic scans and angiograms.Twelve patients received conservative treatment, 56 patients were treated by endovascular embolization, and 28 patients received clipping; 44 patients received one-stage treatment, and 4 patients needed a second therapy. In 36 patients, only the ruptured aneurysm was eliminated. The clinical outcomes of these 84 patients evaluated by Glasgow Outcome Scale grades were: absence of deficits in 62 patients, minor deficits in 12 patients, major deficit in 8 patients; death occurred in 2 cases. Thirty patients were available for a 6-month follow-up with DSA, which revealed stable occlusion of the aneurysms in 29 patients and the need of a retreatment due to recanalization in only one patient.Correct localization of the rupture aneurysm based on a comprehensive diagnosis is key to MIA treatment. All the aneurysms should be treated in one session whenever possible to protect the patient from rebleeding.

The aim of this study was to describe the similarity of configuration between the arachnoid complex in the posterior half of the incisural space and the Liliequist membrane.Microsurgical dissection and anatomical observation were performed in 20 formalin-fixed adult cadaver heads. The origin, distribution, and configuration of the arachnoid membranes and their relationships with the vascular structures in the posterior half of the incisural space were examined.The posterior perimesencephalic membrane and the cerebellar precentral membrane have a common origin at the tentorial edge and form an arachnoid complex strikingly resembling an inverted Liliequist membrane. Asymmetry between sides is not uncommon. If the cerebellar precentral membrane is hypoplastic on one side or both, the well-developed quadrigeminal membrane plays a prominent part in partitioning the subarachnoid space in the posterior half of the incisural space.The arachnoid complex in the posterior half of the incisural space can be regarded as an inverted Liliequist membrane. This concept can help neurosurgeons to gain better understanding of the surgical anatomy at the level of the tentorial incisura.

This meta-analysis was undertaken to identify the relationships between genetic polymorphisms in the LDLR gene and the risk of cerebral infarction. The Web of Science (1945-2013), the Cochrane Library Database (Issue 12, 2013), PubMed (1966-2013), EMBASE (1980-2013), CINAHL (1982-2013) and the Chinese Biomedical Database (CBM) (1982-2013) were searched for relevant articles without language restrictions. Meta-analysis was conducted using the STATA 12.0 software. Crude odds ratios (OR) with their corresponding 95% confidence interval (CI) were calculated. Eight case-control studies with a total of 4,655 patients with cerebral infarction and 15,920 healthy control subjects were included in our meta-analysis. Five common polymorphisms in the LDLR gene were evaluated, including rs11669576 AT, rs1433099 CT, rs5925 CT, rs688 CT, rs1122608 TG in the LDLR gene. The results of this meta-analysis revealed that cerebral infarction patients had a higher frequency of LDLR genetic polymorphisms than that of healthy controls (allele model: OR 1.17, 95% CI 1.05-1.30, P = 0.004; dominant model: OR 1.18, 95% CI 1.05-1.33, P = 0.007; homozygous model: OR 1.50, 95% CI 1.03-2.16, P = 0.032; respectively), especially for the rs11669576 AT, rs1433099 CT and rs5925 CT polymorphisms. Among different ethnic subgroups, the results demonstrated positive correlations between LDLR genetic polymorphisms and an increased risk of cerebral infarction among both Asians and Caucasians under the allele and dominant models (all P0.05). Our findings indicate that LDLR genetic polymorphisms may be strongly involved in the pathogenesis of cerebral infarction, especially the rs11669576 AT, rs1433099 CT, rs5925 CT polymorphisms.

To explore the operative strategies for bilateral brain contusion and laceration and evaluate their clinical significance.Based on the clinical manifestations, computed tomography (CT) and intracranial pressure (ICP), different operative strategies were applied to 25 cases of bilateral brain contusion and laceration. The strategies were classified into 6 types according to the principles of decompression and brain protection.All cases received routine treatments at neurosurgical intensive care unit (ICU) ward. And the occurrences of operative complications and 6-month Glasgow outcome scale (GOS) were statistically analyzed.Type 1:4 cases of unilateral decompressive craniectomy without resection of contusion focus; Type 2:8 cases of unilateral decompressive craniectomy with resection of bilateral contusion focus; Type 3:5 cases of bilateral decompressive craniectomy with resection of unilateral brain contusion; Type 4:5 cases of bilateral decompressive craniectomy; Type 5:1 case of bilateral brain contusion resection; Type 6:2 cases of bilateral decompressive craniectomy and brain contusion resection.Postoperative complications such as epilepsy, expanding contusion foci, brain infarction, encephalocele, incisional CSF leakage, intracranial infection, subdural hydroma and hydrocephalus were rare. The 6-month GOS revealed 6 cases of good outcome (n = 6), moderate disability (n = 8), severe disability (n = 3) and vegetative status (n = 5) and death (n = 3).Different operative strategies may be applied for severe brain contusion and laceration according to their clinical manifestations, CT findings and ICP values. And the efficacies are improved by operative strategies based on the principles of ICP control, prevention of secondary injury and brain function preservation.

To assess the immunophenotypic changes associated with epithelial-mesenchymal transition (EMT) in craniopharyngioma, especially at the tumour invasive front, and to correlate the findings with clinicopathological features and patient outcomes.Forty-two craniopharyngiomas were investigated for the presence of EMT markers (vimentin, E-cadherin and β-catenin) by immunohistochemistry and western blot. The relationships between expression of these markers and various clinicopathological indicators and clinical outcomes of the tumours were analysed. There were statistically significant differences in the expression of vimentin and E-cadherin-β-catenin between adamantinomatous and papillary variants. The expression of vimentin and E-cadherin (but not that of β-catenin) in whole tumour sections was associated with tumour recurrence, and with postoperative weight and hypothalamic disturbances; the expression of vimentin and E-cadherin-β-catenin at the tumour invasive front was also associated with tumour recurrence, postoperative weight, and hypothalamic disturbances. The results from western blotting closely matched those of immunohistochemistry.Our study demonstrates, for the first time, the potential prognostic implications of vimentin, E-cadherin and β-catenin expression in craniopharyngiomas. EMT may represent a crucial mechanism in the progression of craniopharyngiomas.

The completeness of meningioma resection depends on the resection of dura mater invaded by the tumor. The pathological changes of the dura around the tumor can be interpreted by evaluating the dural tail sign (DTS) on MRI studies. The goal of this study was to clarify the pathological characteristics of the DTSs, propose a classification based on the histopathological and radiological correlation, and identify the invasive range of tumor cells in different types of DTS.The authors retrospectively reviewed 179 patients with convexity meningiomas who underwent Simpson Grade I resection. All patients underwent an enhanced MRI examination preoperatively. The convexity meningiomas were dichotomized into various subtypes in accordance with the 2007 WHO classification of tumors of the CNS, and the DTS was identified based on the Goldsher criteria. The range of resection of the involved dura was 3 cm from the base of the tumor, which corresponded with the length of DTS on MRI studies. Histopathological examination of dura at 0.5, 1.0, 1.5, 2.0, 2.5, and 3.0 cm from the base of the tumor was conducted, and the findings were correlated with the preoperative MRI appearance of the DTS.A total of 154 (86%) of 179 convexity meningiomas were classified into WHO Grade I subtype, including transitional (44 [28.6%] of 154), meningothelial (36 [23.4%] of 154), fibrous (23 [14.9%] of 154), psammomatous (22 [14.3%] of 154), secretory (10 [6.5%] of 154), and angiomatous (19 [12.3%] of 154). The other 25 (14%) were non-Grade I (WHO) tumors, including atypical (12 [48%] of 25), anaplastic (5 [20%] of 25), and papillary (8 [32%] of 25). The DTS was classified into 5 types: smooth (16 [8.9%] of 179), nodular (36 [20.1%] of 179), mixed (57 [31.8%] of 179), symmetrical multipolar (15 [8.4%] of 179), and asymmetrical multipolar (55 [30.7%] of 179). There was a significant difference in distribution of DTS type between Grade I and non-Grade I tumors (p = 0.004), whereas the difference was not significant among Grade I tumors (0.841) or among non-Grade I tumors (p = 0.818). All smooth-type DTSs were encountered in Grade I tumors, and the mixed DTS (52 [33.8%] of 154) was the most common type in these tumors. Nodular-type DTS was more commonly seen in non-Grade I tumors (12 [48%] of 25). Tumor invasion was found in 88.3% (158 of 179) of convexity meningiomas, of which the range of invasion in 82.3% (130 of 158) was within 2 cm and that in 94.9% (150 of 158) was within 2.5 cm. The incidence of invasion and the range invaded by tumor cells varied in different types of DTS, and differences were statistically significant (p0.001).Nodular-type DTS on MRI studies might be associated with non-Grade I tumors. The range of dural resection for convexity meningiomas should be 2.5 cm from the tumor base, and if this extent of resection is not feasible, the type of DTS should be considered. However, for skull base meningiomas, in which mostly Simpson Grade II resection is achieved, the use of this classification should be further validated. The classification of DTS enables the surgeon to predict preoperatively and then to achieve the optimal range of dural resection that might significantly reduce the recurrence rate of meningiomas.

To explore the therapeutic efficacy of a novel complex material of shape-memory alloy brace and artificial dura (nitinol brace and NormalGEN) for the reconstruction of skull base in a canine model with lateral media skull base defect.The complex of nitinol brace and NormalGEN was developed with corresponding apparatus. A common adult dog model with lateral media skull base defect was established and then reconstructed with the complex. At Month 3 post-operation, cranial lateral radiographic projection, three-dimensional reconstruction of computer tomography, 1.5T magnetic resonance imaging and histopathological examination were detected.Five animal models and cranial reconstructions were made. All survived without any complication, such as leakage of cerebrospinal fluid, local tissue eminence and neurological function defect. The imaging detection showed that nitinol brace was distinct and satisfactorily positioned without shift and artifact. And histopathological examination showed that granulation tissue substituted NormalGEN and grew around the brace with numerous fibroblasts.The complex of shape-memory alloy brace and artificial is suitable for the reconstruction of skull base on dog model with lateral media skull base defect.

To highlight recent researches which may show promise for histomolecular classification and new treatments for gliomas.All articles cited in this review were mainly searched from PubMed, which were published in English from 1996 to 2010.Original articles and critical reviews selected were relevant to the isocitrate dehydrogenase-1/2 mutation in gliomas and other tumors.Extraordinary high rates of somatic mutations in isocitrate dehydrogenase-1/2 occur in the majority of World Health Organization grade II and grade III gliomas as well as grade IV secondary glioblastomas. Isocitrate dehydrogenase-1/2 mutations are associated with younger age at diagnosis and a better prognosis in patients with mutated tumors. The functional role of isocitrate dehydrogenase-1/2 mutations in the pathogenesis of gliomas is still unclear.Isocitrate dehydrogenase-1/2 mutations define a specific subtype of gliomas and may have great significance in the diagnosis, prognosis, and treatment of patients with these tumors.

Hypothermia and cardiopulmonary bypass has been used for difficult lesions of the brain such as giant aneurysms. We reported a case of complex intracranial dural arteriovenous fistula (DAVF) undergoing surgery with deep hypothermic circulatory arrest (DHCA). The advantages and disadvantages of this operation were discussed. This is the first report describing the use of DHCA in the surgical management of complex intracranial DAVF. We also reviewed the literature documenting the treatment of DAVF and the history of deep hypothermia and circulatory arrest in cerebrovascular surgery.

To investigate the origin of mixed germ cell tumors in the pineal region based on the image data, surgical findings and pathological examination of the tumor.The preoperative CT and magnetic resonance imaging (MRI) findings and tumor specimens were retrospectively analyzed in 15 cases of pineal mixed germ cell tumors confirmed by postoperative histological examination between January 2000 and September 2010.Radiographic examination of the tumor revealed calcification in 12 cases, cystic changes in 10 cases, and the presence of lipid in 5 cases. On the anteroposterior images, the tumors appeared round or elliptic with smooth edge in 6 cases, and showed irregular shape with multiple processes on the edge in 9 cases. Surgical exploration found all the tumors located in the the suprapineal recess enclosed by the arachnoidal envelope of the Galen vein. Pathologically, 13 specimens contained germinoma component, 9 contained teratoma component, 4 had embryonic carcinoma component, 3 had choriocarcinoma component, 7 showed yolk sac tumor component, and 3 showed rhabdomyoma component. Germinoma components were found on the tumor margin in 7 specimens, and intermingled germinoma and other components were found in 10 specimens.Pineal mixed germ cell tumor originates from the residue germ cells around the pineal gland, and most likely evolves from single primordial germ cells.

A precise understanding of the ambient cistern and its associated arachnoid membranes is helpful for accessing perimesencephalic lesions. However, few studies of the arachnoid membranes related to the ambient cistern have been published, and, additionally, some aspects of the ambient cistern also require further examination. The goal of this study was to reinvestigate and expound on the anatomical features of the cistern and membranes.The ambient cisterns and its associated arachnoid membranes were examined in 20 adult cadaveric brains using an operative microscope.The perimesencephalic membrane is a set of inner arachnoid membranes surrounding the midbrain at the level of the tentorial incisura. It arises from the outer arachnoidal membranes covering the tentorial edge and the dorsum sellae and can be subdivided into anterior and posterior portions. The anterior membrane is actually the mesencephalic leaf of Liliequist membrane, which is divided into medial and lateral parts by the oculomotor nerve. The posterior membrane can be divided into horizontal and ascending parts. The ambient cistern is located above the perimesencephalic membrane and contains the anterior choroidal arteries, the posterior cerebral arteries, the basal vein, and sometimes the segments of the superior cerebellar arteries. It communicates with the carotid cistern, the interpeduncular cistern, the oculomotor cistern, the cerebellopontine and cerebellomesencephalic cistern, and the quadrigeminal cistern.This study updates some information about the ambient cistern and its arachnoid membranes. The perimesencephalic membrane was identified and described in detail. The ambient cistern was verified to be a supratentorial cistern above the perimesencephalic membrane. The borders and contents of this cistern, as well as its relationship with adjacent cisterns, were also redefined.

To evaluate the feasibility for confirming the preservation of the parasymphathetic nerve pathway innervating the bladder during nerve-sparing radical hysterectomy (RH). A total of 20 patients underwent nerve-sparing RH. Intraoperative electrical stimulation (IES) were performed on the root of pelvic splanchnic nerve (PSN) trunk while recording the electromyographic (EMG) activity of the vesical detrusor. The average duration achieving residual urine ≤50 mL and urodynamic study (UDS) was observed. Evoked potentials were recorded when stimulating, in 18 patients who were referred IES-positive. Its duration was 9.89 days. The UDS results indicated that all voided normally. The remaining 2 IES-negative cases with no evoked potentials had longer duration and the micturitions were performed using abdominal pressure. During nerve-sparing RH, IES based on the measurement of EMG activity is a useful tool for confirmation of the preservation of parasymphathetic nerve pathway innervating the bladder and prediction of the postoperative bladder function.

To review the clinical manifestations, imaging, tumor markers, treatment methods, pathology results and clinical curative effects of pineal region tumors and to evaluate the characteristics and intervention strategies for those tumors.The clinicopathological data of 132 patients with pineal region tumor treated in our department between January 2000 and May 2008 were retrospectively studied.A moderate predominance in males was presented. The clinical manifestations of the disease included increased intracranial pressure and ocular movement impairment. There were some features but no regularity and specific appearance on imaging including CT and MRI. 88.6% of patients associated with hydrocephalus. A high serum level of alpha-fetoprotein (AFP) was presented in 14 cases and high HCG in 9 cases. Eighteen cases received direct radiation therapy and 7 had radiotherapy post biopsy. 107 cases were treated surgically and 63 cases received postoperative adjuvant treatment. 114 cases had pathology results including 56 germ cell tumors. The patients were followed up for 12 approximately 132 months. Recurrence developed in 23 cases and 12 cases died. The 5-year survival rate was 89.3%.Pineal region tumors are often associated with hydrocephalus and this makes preoperative diagnosis difficult. Imaging examination may help diagnosis but less specific. Germ cell tumors may diagnosed by some tumor markers. Radiation therapy is the choice of treatment for pure germinomas. Other types of pineal region tumors should receive surgical treatment. Postoperative adjuvant treatment based on pathology can provide a good prognosis in pineal region tumor.

To summary the microsurgical techniques for removal of huge tuberculum sellae meningiomas through the bi-subfrontal anterior longitudinal fission approach.Eleven patients with huge tuberculum sellae meningiomas underwent microsurgical removal of the meningiomas between January, 2005 and November, 2009. The microsurgical techniques were summarized, and the factors affecting the prognosis were analyzed.Among all the patients, 5 had Simpson grade I meningioma removal and the other patients had Simpson grade II removal. No death occurred in these patients. Nine patients showed vision improvement after the surgery, one had no significant improvement, and the other one experienced worsening of vision. Transient postoperative diabetes insipidus occurred in 5 cases.With satisfactory exposure of Dorsum sellae, bottom of the third ventricle and cavernous sinus, the bi-subfrontal anterior longitudinal fission approach is suggested for treatment of tuberculum sellae meningiomas. The key to improve the GTR and reduce the complication lies in the sequence of the operation, namely resection of the tumoral basement before dissection of the potential arachnoidal space and tuberculum.

To construct the delta-pIRES2-EGFP plasmid and investigate its expression in HEK293 cells.Full length cDNA of rat delta opioid receptor gene amplified from rat brain tissues using reverse transcription and nested PCR was cloned into pMD20 T vector. The delta cDNA was inserted into pIRES2-EGFP plasmid to construct the recombinant eukaryotic plasmid delta-pIRES2-EGFP, which was transfected into HEK293 cells via Lipofectamine2000. The expression of delta was examined under fluorescence microscope.The recombinant delta-pIRES2-EGFP plasmid was successfully constructed, and high expression of delta was detected in HEK293 cells transfected by the plasmid.delta-pIRES2-EGFP has been successfully cloned, which shows high expression of delta in HEK293 cells.

To analyze the factors contributing to the occurrence of diabetes insipidus after operations for craniopharyngiomas.A total of 121 cases of diabetes insipidus following surgeries for craniopharyngiomas were retrospectively analyzed and the factors associated with postoperative diabetes insipidus were analyzed.The incidence of diabetes insipidus was 27.3% (33/121 cases) before the operation, 89.9% (107/1119) early after the operation and 39.8%(37/93) in later stages after the operation. The occurrence of early postoperative diabetes insipidus showed a significant relation to the classification and calcification of the craniopharyngioma. Patients with supradiaphragmatic and extraventricular tumors had the lowest incidence of postoperative diabetes insipidus. Late postoperative diabetes insipidus was closely correlated to such factors as age, classification of craniopharyngioma, and intraoperative treatment of the pituitary stalk, but not to the scope of tumor resection or tumor calcification. Late diabetes insipidus was more frequent in children and patients with severed pituitary stalk. The incidence of late postoperative diabetes insipidus was significantly higher in patients with supradiaphragmatic and extra-intraventricular tumors than in those with tumors beneath the diaphragma sellae and extraventricular tumors.Postoperative diabetes insipidus following surgeries for craniopharyngiomas is closely related to the tumor classification, calcification and pituitary stalk protection.

To study angiogenesis patterns in the edematous area and the center of human astrocytomas by histological observation, and to reveal histological basis of vasculogenic mimicry.Tissue samples were drawn from the tumor center and the edematous area in 51 patients with human astrocytomas during operation MR and were examined by CD34 endothelial marker periodic acid-Schiff (PAS) dual staining.Vessels or capillaries stained by both PAS and CD34 were found in edematous areas of human astrocytomas. Besides vessels or capillaries stained by both PAS and CD34, vasculogenic mimicries (PAS-positive and CD34-negative tubes containing red blood cells and lined by neoplastic cells), PAS-positive and CD34-negative tubes containing red blood cells and without cells around, PAS-positive and partial CD34-positive vessels or capillaries, and PAS-positive and CD34-negtive vessels or capillaries were detected in the center of tumor of 4 human glioblastomas.Vasculogenic mimicries in the center of some high-grade astrocytomas may be caused by blood capillary dysplasia, while angiogenesis patterns are vessels or capillaries in the edematus area and the center of most human astrocytomas.

To explore the surgical approaches, microsurgical techniques and therapeutic effect of modified cistern magna reconstruction for treating of syringomyelia with Chiari malformations.The clinical data of 35 patients with syringomyelia complicated by Chiari malformations were retrospectively reviewed, and the patients' chief complaints, presenting symptoms, neurological and radiographic findings, surgical approaches, outcomes, and complications were analyzed.The radiographs revealed type I Chiari in 18 and type II Chiari malformations in these patients. Surgical treatment resulted in symptomatic improvements in 29 patients, and 6 patients showed no obvious changes in the symptoms after the surgery; 3 patients received subarachnoid shunting for syringomyelia. During the follow-up for a mean of 2 years, 32 patients showed obvious clinical improvement, and magnetic resonance imaging demonstrated complete spontaneous resolution of syringobulbia in 25 patients.Modified cistern magna reconstruction relieves brainstem compression and restores the pulsatile flow of the cerebrospinal fluid at the cervicomedullary junction. Cerebellar tonsil reduction is performed chiefly by electric coagulation and cauterization combined with subpial resection, and the integrity of the pia mater should be maintained as much as possible to avoid potential adhesion and recurrence. The median foramens and Luschka of the fourth ventricle have to be opened to recover normal CSF circulation. Arachnoidal suspension and placement of a patulous dural graft are also important. Modified reconstruction of the cistern magna can be a good option for treatment of syringomyelia complicated by Chiari malformations.

To study the findings in radionuclide cisternography in patients with obstructive hydrocephalus following third ventriculostomy.Lumbar radionuclide cisternography was performed in 15 patients with obstructive hydro- cephalus before and after third ventriculostomy.The postoperative cisternography identified radiopharmaceutical reflux into the lateral cerebral ventricles with delayed clearance for 24 h, similar to the findings by cisternography of communicating hydrocephalus.The cause of ventricular radiopharmaceutical reflux is not yet understood, possibly in association with the reversal of normal cerebrospinal fluid flow though the fenestration on the third ventrical floor.

We report two rare cases of primary choriocarcinoma in the pineal region verified histologically. In both cases, the pre-operative serum level of human chorionic gonadotropin (HCG) was significantly elevated to 128-/+935.7 and 9 -/+088.9 mIU/ml, respectively, and serum alpha-fetoprotein (AFP) was negative. The tumors were microsurgically removed, and postoperative hydrocephalus were treated by endoscopic third ventriculostomy. Both patients underwent chemotherapy and radiotherapy. After adjunctive treatment, the serum HCG decreased within normal range. During the two-year-long follow-up, no radiological (MRI) evidence was found to suggest recurrence in MR imaging, and the serum HCG was normal in one patient, but mildly elevated in the other. HCG measurement can be crucial to the diagnosis and post-treatment monitoring of choriocarcinoma, and radical surgical tumor removal and combined modality therapy including chemotherapy and radiotherapy may ensure good results.