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Objective To explore the feasibility of a modified micro-cannula for intra-cerebral administration of 6-hydroxydopamine(6-OHDA) in order to establish a Parkinsonian mouse model. Methods Twenty female mice(C57BL/6J) were randomly divided into 2 groups with 10 in each: experimental group (new micro-cannula) and control group (regular Hamilton syringe). Following unilateral injection of 6-OHDA, the behavioral test and histological microscopy were performed. Results All mice in experimental group showed the morphology of apomorphine-induced rotational asymmetry, but the same results were found in only 5 mice from control group. Total number of rotations away from the lesion side in 30 minutes showed 6-OHDA-induced motor deficits at day 7 in both groups, which was significantly attenuated at day 28 in control group (P＜0.05). After 28 days of 6-OHDA injection, significant reduction in the number of rotations was observed in control mice as compared with that of experimental group (P＜0.05). As immunohistochemistry showed that the total number of remaining dopaminergic neurons significantly decreased in the substantial nigra of the experimental mice as compared with the control mice(P＜0.05). Moreover, more local astrocytes underwent activation, part of which acquired the properties of neural precursor cells in control mice. Conclusions Intrastriatal injection of 6-OHDA using the new micro-cannula is a feasible technology in the development of a more reliable Parkinsonian model of mice.

Background Deep-seated clival varied malignancies represent a surgical challenge because of complex anatomy and surgical procedures posing great risks to adjacent neurovascular structures. To investigate effects of diagnosis and treatment of clival region lesions, review experience of individualized surgical procedures and comprehensive therapy. Methods and Results A total of 56 patients with clival malignancies from July 2007 to December 2018 were included. The patients mainly presented with headache and cranial nerve paresis. After multidisciplinary consultation, radical resection were performed in 45 cases different kinds of surgical approaches including endonasal (15 cases, 33.33% ), intraoral accompanied by intraoral and endonasal combined (7 cases, 15.56%), Derome (8 cases, 17.78%), maxillary swing (9 cases, 20%), and infratemporal (6 cases, 13.33%) approaches were chosen according to clinical and radiographic findings, and biopsies were performed in 11 patients to confirm the pathological diagnosis. The primary pathological finding was chordoma (28 cases, 50%). Total resection was achieved in 21 cases (46.67%), and 17 cases (37.78%) underwent subtotal resection. Besides, partial resection was performed in 7 cases (15.56%). The complications developed in 28 patients, including cranial nerve deficits (13 cases, 23.21%), cerebrospinal fluid leakage (14 cases, 25%), intracranial infection (8 cases, 14.29%), pneumonitis (2 cases, 3.57% ), postoperative hematoma (2 cases, 3.57% ), and mental disorder (1 cases, 1.79% ). Adjuvant chemoradiotherapy was provided by the oncologists depending on the pathological findings. The average follow-up was 59.90 months, but 8 patients (14.29%) were lost. The progression-free survival was achieved in 16 patients (28.57%), whereas the disease progression occurred in 13 patients (23.21%). The mortality was 33.93% (19/56). Conclusions Although malignancies occupy a larger subset of clival tumors, not all are needed to be radically resected. Our preliminary results suggest that multidisciplinary consultation is indispensable to clarify the therapeutic purpose and provide individualized surgical approaches. Postoperative comprehensive therapy may reduce the surgical complications and improve the outcomes of patients. [ABSTRACT FROM AUTHOR]

Objective To review experience of diagnosis, surgical procedures and comprehensive therapeutic strategies for skull base bone tumors. Methods and Results Clinical data of 76 patients with skull base bone tumors were retrospectively analyzed from September 2006 to March 2018. After preoperative assessment, different kinds of surgical approaches including endonasal, intraoral, maxillary swing, craniocervical transjugular, Derome, frontotemporal and infratemporal approaches were chosen according to clinical and radiographic findings. In comparison with 24 patients receiving the endoscopic surgery, other 52 patients were operated on under microscopic visualization. Total resection was achieved in 38 cases, and 22 patients underwent subtotal resection. In addition, 14 cases received partial resection while biopsies were performed in 2 cases to confirm histological findings. Tumor pathology included chordoma (28 cases), osteosarcoma (19 cases), chondrosarcoma (11 cases), fibrous dysplasia (8 cases), giant cell tumor of bone (5 cases), osteoblastoma (3 cases), osteochondroma (1 case), and chondromyxiod fibroma (1 case). Complications included cranial nerve deficits (19 cases), hemiparesis (3 cases), cerebrospinal fluid leakage (12 cases), intracranial infection (8 cases), pneumonitis (4 cases), and wound dehiscence (4 cases). During a 20 to 158 months follow-up, 11 cases were lost and 21 patients died in the study period. The disease-free survival was achieved in 34 cases while 10 patients experienced tumor progression. Conclusions Malignant bone tumors invading the skull base is much more common comparing with the benign lesions. Multidisciplinary consultation may improve diagnostic reliability and clarify the therapeutic purpose. Radical resection using the individualized approaches accompanied by comprehensive therapy should be considered to improve the outcomes of patients. [ABSTRACT FROM AUTHOR]

Objective To investigate the reasons and management of repair failure of high - flow cerebrospinal fluid rhinorrhea (HFCSFR) after endoscopic resection of skull base tumors. Methods We retrospectively reviewed 5 patients with repair failure of HFCSFR after endoscopic removal of skull base tumors in our center from December 2012 to June 2016. The patients underwent reoperations for skull base repair. The reasons of repair failure and management strategies were analyzed. Results The reconstruction methods of skull base in the reoperation for HFCSFR included autologous fat inlay and autologous pedicled nasal septal flap onlay in one patient, autologous fat inlay and autologous fascia lata onlay in one patient, and autologous fat inlay and autologous fascia lata onlay and autologous pedicled nasal septal flap in 3 patients. The skull base was reconstructed well in 5 patients. The mean follow - up period was 20 months, and no HFCSFR reoccurred in 5 patients. Conclusions Repair of HFCSFR and reconstruction of skull base are the key to endoscopic removal of skull base tumors. The reasons of repair failure included improperly employing synthetic dura mater, failing to obliterate the dead space left behind by removal of tumors with fat grafts or fat liquefaction, non - healing of middle turbinate and dura mater, failing to cover the dural defect onlay with fascia lata, displacement of the repair grafts, ischemia and necrosis of nasal septal flap. The surgeons should pay more attention to the repairment of HFCSFR after endoscopic removal of skull base tumors. Reconstruction with multilayer grafts and vascularized autologous flaps is an effective and safe strategy. Formulating detailed operation plan and strictly following surgical procedure could avoid repair failure. [ABSTRACT FROM AUTHOR]

Aim: To identify biomarkers for accurate classification of glioma., Patients and Methods: We evaluated the heat shock protein 27 (Hsp27), phosphorylated Hsp27 (p-Hsp27), ATRX and IDH1 R132H proteins using immunohistochemistry in 421 glioma tissues. The χ 2 test was used to assess the relationship between molecular alterations and clinico-pathological parameters. Kaplan-Meier survival curves were constructed, and differences were detected by the log-rank test., Results: We found that Hsp27 and p-Hsp27 were mainly expressed in aggressive astrocytic gliomas. However, neither Hsp27 nor p-Hsp27 expression was related to survival time for any grade of glioma. Interestingly, p-Hsp27 was mutually exclusive with ATRX loss (ATRX - ) and the IDH1 R132H mutation, except for one case of anaplastic astrocytoma. We classified glioblastomas (GBMs) into three subtypes: ATRX - /IDH1 R132H , high p-Hsp27 expression (p-Hsp27 + ) and none of these three markers. ATRX - /IDH1 R132H showed the longest median survival (19.6 months). The prognostic difference between p-Hsp27 + and none of these three markers was significant (15.0 vs 13.1 months, P=0.045). Moreover, p-Hsp27 + predicted better sensitivity for standard therapy among GBMs without the IDH1 mutation and ATRX loss (26.3 vs 15.5 months, P=0.008)., Conclusion: p-Hsp27 is a novel biomarker of glioma and might have important clinical value for further classification of patients with wild-type IDH1 and normal ATRX expression, for evaluating prognosis and for guidance for adjuvant therapy., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: To study the indication and character of the lateral-cervical approach for treating dumble-shape neurogenic tumors in cervical spine., Methods: Retrospectively review the clinical data of 14 dumble-shape neurogenic tumors in cervical spine, from October 2005 to October 2011. Among them 8 were males and 6 were females, range from 11 to 60 years old. The maximum tumor diameter range from 3.0 to 8.0 cm, with an average of 4.8 cm; the intraspinal tumor diameter range from 1.3 to 3.8 cm, with an average of 2.1 cm. According to Asazuma classification, 9 cases were type IIc, 2 cases were type IIIb, 2 cases were type IV, 1 case was type VI. Involving the neck segment C(1)-C(2) in 1 case, C(2)-C(3) in 1 case, C(3)-C(4) in 2 cases, C(4)-C(5) in 2 cases, C(5)-C(6) in 3 cases, C(6)-C(7) in 4 cases and C(2)-C(4) in 1 case. All cases performed surgery with general anethesia. The head and neck surgeon performed surgery with lateral cervical approach, in the space between the anterior and the medius scalenus, exposed the transverse process and the intervertebral foramen as the anatomy marker, resected the extraspinal tumor part. The neurosurgery expanded the intervertebral foramen, and resected the intraspinal tumor with microscope, and repaired the dura. Then head and neck surgeon closed the wounds., Results: Pathology proved 3 neurolimmoas and 11 Schwannomas, 12 cases received gross total resection, 2 cases received subtotal resection, the average blood loss during operation was 292 ml, the average operation time was 129 minutes, the average stay in hospital days was 7.1 days. The vertebral artery were exposed in 2 cases, and no vertebral artery injury occurred, there were 3 cases dissect the cervical nerve roots. No cerebrospinal fluid leakage, hematoma, newly branchial plexus injury, sympathic nerve injury or tracheal edema occurred. In 3 to 24 months, with an average of 13.5 months follow-up period, 2 cases with subtotal resection had no tumor progression, and 12 cases with gross total resection had no tumor recurrence., Conclusions: Lateral-cervical approach is minimal invasive, easily to perform and recovery fine. It can be adopt for Asazuma type IIc, IIIb and IV tumors which not grow over the midline in spine and expand to deep layer of the deep cervical fascia out spine.

Objective: To summarize the characteristics of the pathological anatomy and blood supply model of massive tuberculum sellae meningiomas (MTSM) and explore its corresponding microneurosurgical strategies., Methods: The clinical data of 16 MTSM patients were reviewed retrospectively. From January 1998 to January 2010, according to their unique pathological anatomy and blood supply model, all patients underwent microneurosurgical removal with induced hypotension through tumor corridor by the bi-subfrontal anterior longitudinal fission (n = 14), right frontolateral approach (n = 1) and pterional approach (n = 1). There were 5 males and 11 females with a mean age of 48.5 years old (range: 26 - 65). But the mean follow-up period was 74.9 months (range: 4 - 132) in 2/4 cases., Results: Among all cases, the mean tumor diameter was 58.9 mm (range: 51.1 - 76.2 mm). Simpson grade I, II, III, IV removal of MTSMs were accomplished in 3, 9, 3 and 1 case respectively. One case died within 4 postoperative days. Visual acuity improved in 10 patients, remained unchanged in 2 and deteriorated in 2. Transient postoperative diabetes insipidus occurred in 9 cases., Conclusion: It is critical to understand the unique characteristics of pathological anatomy and blood supply model of MTSM so as to adopt proper microneurosurgical strategies to remove it in situ.

Objective: To analyze the results and the indications of free flaps in the skull base reconstruction., Methods: A retrospective review was performed of 25 free flaps reconstructions for skull base tumor ablation defects between March of 1999 and March of 2009. There were 9 latissimus dorsi flaps, 6 rectus abdominis flaps, 4 deep inferior epigastric artery perforator flaps, 3 anterolateral thigh flaps, 2 radial forearm flaps and 1 fibular flap. The defects were classified as cranial bone (100%), dura (40%), brain (12%), sino-nasal cavity (52%), mucosa (56%) and skin (80%)., Results: Twenty-three of 25(92%) free flaps survived. One total flap failure and 1 partial flap failure occurred. Five patients (20%) had central nervous system related postoperative complications which including 1 mortality, 2 central nerve system infection and 2 cerebrospinal fluid fistula., Conclusions: Free flaps transfer is a reliable reconstruction technique for cranial base surgery. This provides a solution to the select advances disease otherwise surgical contraindications. Free flap is the choice for reconstruction of advanced oncological defects, especially when skin and mucosa are violated.

Objective: To present the experience and advantage of cooperation management by head and neck surgery and neurosurgery for communicating skull base tumors., Methods: A review of 54 communicating skull base tumors (benign tumor 21, malignant tumor 33) cooperation resection by head and neck surgery and neurosurgery from July 2005 to July 2008 in the Cancer Hospital of Chinese Academy of Medical Sciences was presented. The tumor originated in the anterior skull base in 19 cases, originated in the lateral skull base in 12, in the central skull base in 17, and in the posterior skull base in 6., Results: All procedures were conducted in a single stage by a multidisciplinary team. Total resection of tumor was achieved in 45 cases, and subtotal resection was achieved in 9. There was no operative death. There were 2 cases postoperative hemorrhage. All cases except 3 were followed up with a period of 8 to 43 months (median, 19.1 months for benign tumor and 21.0 months for malignant tumor). Three patients with malignant tumor were lost. Twelve cases of malignant tumor and one case of benign tumor recurred postoperatively. Nine patients with malignant tumor had died (one of these died from heart trouble). Three-year disease-free survival rates and overall survival rates of malignant tumor were 52.7% and 53.0%, respectively., Conclusions: It suggested that a special operative team constituted of head and neck surgeon and neurosurgeon may improve the outcome of the difficult skull base tumors.

Objective: To summarize and analyze the surgical treatment of lateral sellar compartment cavernoma (LSCC)., Methods: The clinical data of 102 patients with LSCC who underwent surgical treatment from 1958 to 2006, 2 males and 80 females, aged 43.5 (11 approximately 69), were collected and analyzed. The operation patterns were divided into 4 stages based on the understanding of LSCC: first stage (1958 approximately 1988, with 32 cases) during which diagnosis was mainly bases on X-ray plain films, CT, and ordinary cerebral angiography, and most of the tumors were partially excised; second stage (1989 approximately 1997, with 18 cases) during which MRI, DSA, and microsurgery were widely used; third stage (1998 approximately 2003, with 36 cases) during which the neurological anatomy of the LSC and pathology of LSCC made headway, however, intra-operational bleeding was still a problem, and fourth stage (2004 approximately 2006, with 16 cases) during which relevant models were basically understood., Results: Post-operative MRI shed that the tumor complete resection rates of the 4 stages were 4/32, 5/18, 17/36, and 12/16, and the subtotal resection rates were 3/32, 4/18, 10/36, and 2/16 respectively. The rest of the tumors were all partially removed. Not only the intra-operative blood loss but also the cranial nerve morbidity rate decreased dramatically in the 4th stage. The main postoperative complications included oculomotor nerve paralysis, abducent nerve palsy, and trigeminal nerve damages. No operation-related death occurred., Conclusion: Following the progress of LSCC study, the treatment of LSCC becomes mature. Radical removal of LSCC may be the best choice for LSCC patients by epidural approach via the skull base craniotomy with induced hypotension.

Objective: In order to improve the safety of skull base surgery and to completely resect the skull base tumors, the anatomical landmarks of skull base were studied., Methods: 29 cases of skull base surgery were performed between 1992 and 2002, and their clinical data were retrospectively analysed. The anatomical landmarks of cranial base, such as comb, pterygoid process, spine of temporal bone, styloid process, and internal caroid artery, were analysed in preoperative diagnosis and operative treatment of various kinds of skull base tumors., Results: In the early stages, because of lacking the knowledge of anatomical landmarks of the skull base, the surgery lasted longer, part of skull base tumors remained and operative blood lose was much more than that in later stage. In the later stage, no operative death and severe complications were found in 26 cases which underwent various kinds of skull base surgery. The survival rates at 3 and 5 years were 72.2% and 35.7% respectively for malignant tumors., Conclusions: Comb, pterygoid process, spine of temporal bone, styloid process, internal caroid artery and their adjacent structures were important anatomical landmarks for operative treatment of anterior, middle and lateral cranial base tumors. It was important to know the anatomical landmarks to ensure the safety of the skull base surgery.