HomeStrokeAhead of PrintInsights on Moyamoya Disease: Vascular Inflammation and Nuclear Autoschizis in Cranial Arteries No AccessCase ReportRequest AccessAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessCase ReportRequest AccessInsights on Moyamoya Disease: Vascular Inflammation and Nuclear Autoschizis in Cranial Arteries Xiaoling Ruan, Ting Lei, Xin Xiang, Fangjun Liu and Xiang’en Shi Xiaoling RuanXiaoling Ruan https://orcid.org/0009-0000-7219-384X Department of Neurosurgery, University of Pavia, Italy (X.R.). Search for more papers by this author , Ting LeiTing Lei https://orcid.org/0000-0001-8970-1986 Department of Neurosurgery, Sanbo Brain Hospital (T.L., X.X., F.L.) Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing, China (T.L., X.S.). Search for more papers by this author , Xin XiangXin Xiang https://orcid.org/0009-0000-1897-7539 Department of Neurosurgery, Sanbo Brain Hospital (T.L., X.X., F.L.) Search for more papers by this author , Fangjun LiuFangjun Liu https://orcid.org/0000-0003-2428-6456 Department of Neurosurgery, Sanbo Brain Hospital (T.L., X.X., F.L.) Search for more papers by this author and Xiang’en ShiXiang’en Shi Correspondence to: Xiang’en Shi, MD, PhD, Department of Neurosurgery, Fuxing Hospital, Capital Medical University, No. 20, Fuxingmen Wai St, Xicheng, Beijing 100045, China. Email E-mail Address: [email protected] https://orcid.org/0000-0002-9491-0499 Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing, China (T.L., X.S.). Search for more papers by this author Originally published29 Nov 2023https://doi.org/10.1161/STROKEAHA.123.045064Stroke. 2023;0FootnotesFor Sources of Funding and Disclosures, see page xxx.Correspondence to: Xiang’en Shi, MD, PhD, Department of Neurosurgery, Fuxing Hospital, Capital Medical University, No. 20, Fuxingmen Wai St, Xicheng, Beijing 100045, China. Email shixen@ccmu.edu.cn eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.123.045064PMID: 38018829 Originally publishedNovember 29, 2023 KeywordsCTLA4 proteinelectron microscopyhumanimmunohistochemistryinflammationmoyamoya diseasetumor necrosis factor-alphaPDF download Advertisement SubjectsGrowth Factors/CytokinesSmooth Muscle Proliferation and DifferentiationStenosisVascular Disease

BACKGROUND:Marfan syndrome, a connective tissue disorder, poses unique challenges in neurosurgery, given the fragility of vascular structures. Superior cerebellar artery (SCA) aneurysms in patients with the syndrome are rare and present distinct surgical difficulties, necessitating innovative approaches.OBSERVATIONS:A 29-year-old male with Marfan syndrome presented with a subarachnoid hemorrhage from a ruptured SCA aneurysm. Given the lack of a defined aneurysm neck and the small diameter of the SCA, standard clipping and endovascular therapies were unsuitable. A microsurgical approach using microsutures was successfully employed, effectively managing the aneurysm while preserving the parent artery.LESSONS:This case underscores the efficacy of the microsuture technique in complex neurosurgical scenarios, particularly in patients with connective tissue disorders such as Marfan syndrome. The adaptability of surgical strategies, as demonstrated in this case, is crucial for achieving successful outcomes in patients with unique anatomical challenges.

尽管近年来胶质母细胞瘤的辅助治疗取得了一系列进展，但仍未能有效延长患者的远期生存时间，并使许多患者失去了再次手术的机会。随着当前新技术新方法的出现，在尽可能保证患者生命质量的前提下，通过手术最大程度切除病变以控制肿瘤进展是提高患者远期生存率的有效方法，结合临床实际，通过示例说明胶质母细胞瘤治疗的根本及基石在于手术切除。

Craniopharyngioma (CP) is a mostly benign tumor that is nonetheless one of most formidable skull base lesions. CP tends to recur, and scarce clinical results are available regarding its long-term outcomes. From February 1996 to April 2002, craniopharyngiomas primarily resected by open surgery in a single-center and single-surgeon practice were screened. Medical information regarding patients’ baseline, tumor parameters, endocrinological results, complications, and quality of life in those patients with a follow-up longer than 20 years were reviewed. Nineteen out of 187 patients who met the inclusion criteria were eligible, and 78.9

T淋巴细胞耗竭在慢性感染和恶性肿瘤的发生和发展中有着重要作用。在了解T淋巴细胞生物学表现和特征的基础上，明白T淋巴细胞耗竭的生物学表现、特征及影响T淋巴细胞耗竭的因素，可为相关人体免疫研究、治疗慢性感染和恶性肿瘤提供参考。

In genetic studies of cerebrovascular diseases, the optimal vessels to use as controls remain unclear. Our goal is to compare the transcriptomic profiles among 3 different types of control vessels: superficial temporal artery (STA), middle cerebral arteries (MCA), and arteries from the circle of Willis obtained from autopsies (AU). We examined the transcriptomic profiles of STA, MCA, and AU using RNAseq. We also investigated the effects of using these control groups on the results of the comparisons between aneurysms and the control arteries. Our study showed that when comparing pathological cerebral arteries to control groups, all control groups presented similar responses in the activation of immunological processes, the regulation of intracellular signaling pathways, and extracellular matrix productions, despite their intrinsic biological differences. When compared to STA, AU exhibited upregulation of stress and apoptosis genes, whereas MCA showed upregulation of genes associated with tRNA/rRNA processing. Moreover, our results suggest that the matched case-control study design, which involves control STA samples collected from the same subjects of matched aneurysm samples in our study, can improve the identification of non-inherited disease-associated genes. Given the challenges associated with obtaining fresh intracranial arteries from healthy individuals, our study suggests that using MCA, AU, or paired STA samples as controls are feasible strategies for future large-scale studies investigating cerebral vasculopathies. However, the intrinsic differences of each type of control should be taken into consideration when interpreting the results. With the limitations of each control type, it may be most optimal to use multiple tissues as controls.

HomeStrokeVol. 54, No. 12Unveiling Bacterial Autophagosomes in Human Intracranial Aneurysm Wall Tissue: A Rare Insight No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessCase ReportRequest AccessFull TextUnveiling Bacterial Autophagosomes in Human Intracranial Aneurysm Wall Tissue: A Rare Insight Ting Lei, Xiang’en Shi, Xiaoling Ruan, Fangjun Liu and Xin Xiang Ting LeiTing Lei https://orcid.org/0000-0001-8970-1986 Department of Neurosurgery, Fuxing Hospital (T.L., X.S., X.X.), Capital Medical University, Beijing, People’s Republic of China. Department of Neurosurgery, Sanbo Brain Hospital (T.L., X.S., F.L., X.X.), Capital Medical University, Beijing, People’s Republic of China. Search for more papers by this author , Xiang’en ShiXiang’en Shi Correspondence to: Xiang’en Shi, MD, PhD, Department of Neurosurgery, Fuxing Hospital, Capital Medical University, No. 20, Fuxingmen Wai St, Xicheng District, Beijing 100045, People’s Republic of China. Email E-mail Address: [email protected] https://orcid.org/0000-0002-9491-0499 Department of Neurosurgery, Fuxing Hospital (T.L., X.S., X.X.), Capital Medical University, Beijing, People’s Republic of China. Department of Neurosurgery, Sanbo Brain Hospital (T.L., X.S., F.L., X.X.), Capital Medical University, Beijing, People’s Republic of China. Search for more papers by this author , Xiaoling RuanXiaoling Ruan University of Pavia, Milan, Italy (X.R.). Search for more papers by this author , Fangjun LiuFangjun Liu https://orcid.org/0000-0003-2428-6456 Department of Neurosurgery, Sanbo Brain Hospital (T.L., X.S., F.L., X.X.), Capital Medical University, Beijing, People’s Republic of China. Search for more papers by this author and Xin XiangXin Xiang https://orcid.org/0009-0000-1897-7539 Department of Neurosurgery, Fuxing Hospital (T.L., X.S., X.X.), Capital Medical University, Beijing, People’s Republic of China. Department of Neurosurgery, Sanbo Brain Hospital (T.L., X.S., F.L., X.X.), Capital Medical University, Beijing, People’s Republic of China. Search for more papers by this author Originally published12 Oct 2023https://doi.org/10.1161/STROKEAHA.123.044829Stroke. 2023;54:e498–e499"Unveiling Bacterial Autophagosomes in Human Intracranial Aneurysm Wall Tissue: A Rare Insight." Stroke, 54(12), pp. e498–e499FootnotesFor Sources of Funding and Disclosures, see page e499.Correspondence to: Xiang’en Shi, MD, PhD, Department of Neurosurgery, Fuxing Hospital, Capital Medical University, No. 20, Fuxingmen Wai St, Xicheng District, Beijing 100045, People’s Republic of China. Email shixen@ccmu.edu.cnREFERENCES1. Hallikainen J, Pyysalo M, Keränen S, Kellokoski J, Koivisto T, Suominen AL, Pussinen P, Pessi T, Frösen J. Systemic immune response against the oral pathogens Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans is associated with the formation and rupture of intracranial aneurysms.Eur J Neurol. 2021; 28:3089–3099. doi: 10.1111/ene.14986CrossrefGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails December 2023Vol 54, Issue 12 Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.123.044829PMID: 37823306 Originally publishedOctober 12, 2023 KeywordsDNADNA probeselectronshumanspolymerase chain reactionPDF download Advertisement SubjectsAneurysm

The treatment of wide-necked complex intracranial aneurysms is full of challenges. We report a 72-year-old woman with subarachnoid hemorrhage and three intracranial aneurysms. According to the location of the hemorrhage, we chose the left side Pterional approach to clip the left side aneurysms and remove the hematoma. After clipping the left posterior communicating artery aneurysm, we found a small bifurcation aneurysm associated with dysplastic bulging of the nearby wall which together formed a wide-necked complex aneurysm. We used a novel suture combined with clipping technique to treat this complex aneurysm. Indocyanine green arteriography showed intact vascular patency in distal vessels, and the patient has achieved a good prognosis. It may provide a new idea for treating wide-necked complex intracranial aneurysms.

Objective:To retrospectively summarize the imaging and clinical features of craniopharyngioma in order to improve the preoperative diagnosis level.Methods:One hundred and twenty-seven patients with craniopharyngioma diagnosed by pathology in Sanbo Brain Hospital, Capital Medical University from March 2019 to June 2021 were selected and the pathological coincidence rate of imaging diagnosis were analyzed.Results:The coincidence rate of MRI diagnosis was 89.3%. The coincidence rate of CT diagnosis was 71.5%. On T 2WI and T 1WI enhanced sequences, the solid portion of the tumor may showed uneven hyperintensity, diffuse striation and spotty hyperintensity. MRI sagittal view was helpful in showing small tumors, but less sensitive to calcification than CT. MRI enhancement was very important, especially for patients with solid lesions. Conclusions:The imaging findings of craniopharyngioma are diverse. Some characteristic manifestations provide important information for the diagnosis and differential diagnosis of craniopharyngioma, which can improve the diagnostic accuracy combined with clinical data.

目的:探讨经额底纵裂入路切除经鼻蝶术后复发或残留颅咽管瘤的技术要点并分析治疗效果。方法:回顾性分析2015年4月至2020年6月首都医科大学三博脑科医院诊治的10例首次经鼻蝶手术后复发或残留的颅咽管瘤患者再次手术治疗后的临床资料。男6例，女4例，年龄13 ~ 44岁。其中5例患者首次手术采用经鼻显微镜手术，5例患者采用经鼻内镜手术。10例患者再次手术中全部采用经额底纵裂入路切除肿瘤，其中6例患者在手术中用磨钻磨除鞍结节或蝶骨平台骨质。结果:肿瘤全切除者6例，近全切除3例，大部分切除者1例。术后视力改善者3例，无显著变化者6例，视力下降者1例。围手术期无死亡病例。术后脑脊液鼻漏2例，分别行经鼻内镜手术修补脑脊液鼻漏，得以治愈。颅内感染者1例，该例患者并发脑积水，在颅内感染治愈后行脑室-腹腔分流术。随访时间22 ~ 83个月，中位随访时间49个月。随访期内无死亡病例，2例患者复发。9例患者有垂体前叶功能低下，7例有尿崩症。按Karnofsky生活质量量表评分，90分7例，80分3例。结论:经额底纵裂入路手术切除经鼻蝶手术后复发或残留的颅咽管瘤可以取得良好效果。

Background and Objectives While somatic mutations have been well-studied in cancer, their roles in other complex traits are much less understood. Our goal is to identify somatic variants that may contribute to the formation of saccular cerebral aneurysms. Methods We performed whole-exome sequencing on aneurysm tissues and paired peripheral blood. RNA sequencing and the CRISPR/Cas9 system were then used to perform functional validation of our results. Results Somatic variants involved in supervillin (SVIL) or its regulation were found in 17% of aneurysm tissues. In the presence of a mutation in the SVIL gene, the expression level of SVIL was downregulated in the aneurysm tissue compared with normal control vessels. Downstream signaling pathways that were induced by knockdown of SVIL via the CRISPR/Cas9 system in vascular smooth muscle cells (vSMCs) were determined by evaluating changes in gene expression and protein kinase phosphorylation. We found that SVIL regulated the phenotypic modulation of vSMCs to the synthetic phenotype via Krüppel-like factor 4 and platelet-derived growth factor and affected cell migration of vSMCs via the RhoA/ROCK pathway. Discussion We propose that somatic variants form a novel mechanism for the development of cerebral aneurysms. Specifically, somatic variants in SVIL result in the phenotypic modulation of vSMCs, which increases the susceptibility to aneurysm formation. This finding suggests a new avenue for the therapeutic intervention and prevention of cerebral aneurysms.

Background This research explores whether pathogenic microorganisms are present in the intracranial aneurysmal wall and whether they are involved in the chronic inflammation associated with aneurysms. Methods Multiple tests were performed on the specimens; aneurysms were assessed through quantitative real-time polymerase chain reaction, immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), and correlative light and electron microscopy (CLEM). Subsequently, the correlation between the levels of pathogenic microorganisms and inflammation-related indicators (CD14, TLR-2, TLR-4 and CD68) was verified according to the microbial testing results. The revised average optical density (rAOD) method was applied for semiquantitative analysis of immunohistochemical images. Results The presence of bacteria in the aneurysmal walls was revealed by immunohistochemical detection of the bacterial-specific endotoxins lipopolysaccharide (LPS) and lipoteichoic acid (LTA). A positive reaction for LPS occurred in 70.6% of the 51 specimens, and a positive reaction for LTA occurred in 52.9%. The rAOD based on IHC showed that CD14 expression was significantly greater in LPS-positive aneurysm specimens than in LPS-negative aneurysm specimens (P = 0.0003 < 0.05), while CD68 expression was not significantly different between LPS-positive and LPS-negative aneurysmatic specimens (P = 0.513 > 0.05). LPS expression was positively correlated with CD14 expression, r = 0.4405, P = 0.0354 < 0.05. The presence of bacteria in intracranial aneurysms was confirmed by FISH and CLEM. Conclusions The existence of bacteria in the intracranial aneurysm wall was demonstrated with immunohistochemical detection of bacterial-specific endotoxins, LPS and LTA, and further verified through FISH and CLEM observations.