[This corrects the article DOI: 10.3892/ol.2015.3893.].

Transcription factors encoded by HOX genes are vital in the determination of cell fate and identity during embryonic development. In certain malignancies, HOX genes also behave as oncogenes. The present study demonstrated suppression of the invasive tendency of glioblastoma multiforme U-118 and U-138 cells by the introduction of the antisense fragments of HOXA6 and B13 genes using electroporation. The invasion index indicated 79 and 72% reductions in the invasive ability of antisense HOXA6 and B13, respectively. No significant differences in the invasive index of the parental and mock cells of each HOX gene were observed (invasive index, 0.75-0.91; P=0.05). A reduction in invasion tendency was also observed following betulinic acid (BA) treatment: The results from the matrigel assay analysis clearly demonstrated a significant inhibition in the invasive behaviour of U-118 and U-138 cell lines from day 15 following BA treatment, with a maximum effect on day 30. The invasion index demonstrated 62 and 65% reductions in invasion ability in the U-118 and U-138 cell lines, respectively. The suppression of HOXC6 and B13 expression by the introduction of the corresponding antisense fragments in addition to BA reduced invasion tendency in U-118 and U-138 cell lines. The mechanism underlying the association between the HOX gene and invasive behavior in glioma cells is yet to be understood. However, the anti-invasive behavior of BA may aid understanding of the mechanism in future studies.

Intracranial internal carotid artery (ICA) bifurcation region aneurysms are uncommon. When treatment is necessary for ICA, endovascular treatment (EVT) can be a useful option. Due to the complexity of these aneurysms and the variability of EVT techniques, EVT for ICA bifurcation aneurysms is challenging. Currently, it is necessary to perform a review to explore this issue further. In this review, the following issues were discussed: the anatomy of the ICA bifurcation region; the classification, natural history and EVT status of ICA bifurcation region aneurysms; the technique used for identifying ICA bifurcation region aneurysms; and the prognosis and complications of EVT for ICA bifurcation region aneurysms. According to the review and our experience, traditional coiling is currently the preferred therapy for ICA bifurcation region aneurysms. In addition, in select cases, new devices, such as flow diverters and Woven EndoBridge devices, can also be used to treat ICA bifurcation region aneurysms. Generally, EVT is an alternative treatment option for ICA bifurcation region aneurysms.

Background Flow-related aneurysms (FRAs) associated with cerebellar arteriovenous malformations (AVMs) are complicated, and their management is difficult. We performed a retrospective study to explore the efficacy and outcome of parent artery occlusion (PAO) for FRAs at the proximal segment of the main feeding arteries of cerebellar AVMs. Materials and methods A retrospective study was performed for patients admitted for a cerebellar AVM between January 2015 and December 2019. Patients were included if (a) they presented with a ruptured or symptomatic FRA at the proximal segment of the main feeding arteries of the cerebellar AVM, (b) the cerebellar AVM did not bleed before admission, (c) the FRA was secured via PAO of the parent feeding artery, and (d) the cerebellar AVM was not intentionally managed or embolized through other feeding arteries during hospitalization. Results Eight patients aged between 27 and 72 (48.6 +/- 14.3) years were identified. Eight ruptured and symptomatic FRAs at the proximal segment of the main feeding arteries of the cerebellar AVMs underwent PAO with coils or Onyx while preserving the arteries distal to the aneurysms. All the patients achieved a favorable recovery after treatment in a follow-up ranged from 8 to 48 months. One patient experienced FRA recurrence and underwent a second PAO. Conclusions PAO for FRAs at the proximal segment of the main feeding arteries of cerebellar AVMs is a feasible option. This method is effective in preventing re-rupture of the FRAs and relieving the symptoms in the short term, allowing sufficient time for the patients to receive subsequent treatment.

Background Glioma is a kind of tumor that easily deteriorates and originates from glial cells in nerve tissue. Honokiol is a bisphenol compound that is an essential monomeric compound extracted from the roots and bark of Magnoliaceae plants. It also has anti-infection, antitumor, and immunomodulatory effects. In this study, we found that honokiol induces cell apoptosis in the human glioma cell lines U87-MG and U251-MG. However, the mechanism through which honokiol regulates glioma cell apoptosis is still unknown. Methods We performed RNA-seq analysis of U251-MG cells treated with honokiol and control cells. Protein-protein interaction (PPI) network analysis was performed, and the 10 top hub unigenes were examined via real-time quantitative PCR. Furthermore, MAPK signaling and ferroptosis were detected via western blotting. Results 332 differentially expressed genes (DEGs) were found, comprising 163 increased and 169 decreased genes. Analysis of the DEGs revealed that various biological processes were enriched, including ‘response to hypoxia’, ‘cerebellum development cellular response to hypoxia,’ ‘iron ion binding,’ ‘oxygen transporter activity,’ ‘oxygen binding,’ ‘ferric iron binding,’ and ‘structural constituent of cytoskeleton.’ Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis revealed that the DEGs were enriched in the following pathways: ‘mitogen-activated protein kinases (MAPK)’, ‘Hypoxia-inducible factor 1 (HIF-1)’, ‘ferroptosis,’ ‘Peroxisome proliferator-activated receptor (PPAR),’ ‘Phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K)- protein kinase B (Akt),’ and ‘phagosome.’ Among these pathways, the MAPK signaling pathway and ferroptosis were verified. Conclusion This study revealed the potential mechanism by which honokiol induces apoptosis and provided a comprehensive analysis of DEGs in honokiol-treated U251-MG cells and the associated signaling pathways. These data could lead to new ideas for future research and therapy for patients with glioma.

Vascular interventional surgical robots (VISR) assisted doctors in surgery can not only protect doctors from X-ray radiation, but also improve the accuracy of surgery. The catheter and guidewire operating systems with master-slave operation mode play an important role in VISR. In recent years, the operating systems have gradually become a research hotspot. After nearly two decades of development, they have made great progress, but there are still some problems to be solved. This review first introduces the research necessity and development history of these operating systems. Then, we summarize the research direction of operating systems from the perspective of hardware devices and algorithms. In the hardware devices, we analyzed the catheter and guidewire operating mechanisms, contact force detection devices, master operating mechanisms and master force feedback devices. In the algorithm, we introduce the bilateral control methods, security strategies and skill evaluation methods. Next, we discuss the actual performance and shortcomings of the operating systems from the perspective of clinical application. Finally, we summarize the current problems of the operating systems and propose the future development direction. This review is helpful for researchers to understand the current situation, and provides a reference framework of catheter and guidewire operating system.

Background This is the first report of a direct acquired arteriovenous fistula (AVF) between an intracranial aneurysm and its adjacent pial vein. Case description A 33-year-old male suffered subarachnoid hemorrhage. Computed tomography angiography revealed an aneurysm of the supraclinoid internal carotid artery (ICA). Digital subtraction angiography (DSA) showed that the aneurysm of the supraclinoid ICA was blister-like and that one large vessel crossing the aneurysm provided two draining paths into the bilateral cavernous sinuses and superior sagittal sinus. Microsurgery confirmed the presence of a blister-like aneurysm and proved the vessel crossing and connected to the aneurysm to be a pial vein, resulting in a direct AVF between the aneurysm and its adjacent vein. The blister-like aneurysm together with some of the ICA wall was clipped to reconstruct the ICA and preserve the anterior choroidal artery (AchA). Postoperative DSA showed the following: the blister-like aneurysm had been completely clipped; the ICA was narrow, but the blood flow was sufficient; and the AchA was intact. After discharge, the patient recovered uneventfully without neurological deficits. Conclusions Exceptionally, an intracranial ruptured aneurysm can hijack its adjacent pial vein as its draining path, forming a direct AVF. Microsurgery can be used to confirm the angioarchitecture of the AVF, and clipping is a good treatment choice.

Traumatic internal carotid-cavernous fistulas (TICCF) are uncommon, and endovascular treatment (EVT) is the first-line treatment for most TICCF cases. The EVT techniques for TICCF need a complete understanding. Therefore, we performed a review. At the same time, some illusive educational cases were provided. In this review, the following were discussed: the angioarchitecture of TICCF, the EVT principle, the transarterial EVT technique, the transvenous or combined transarterial EVT techniques, the EVT of bilateral and recurrent TICCFs, and the complications and prognosis of EVT. We considered that a deep understanding of the EVT strategy for TICCF was necessary and that a good prognosis could be obtained.

Spinal filum terminale pial arteriovenous fistulas (FT PAVFs) are uncommon. Most FT PAVFs are located in the lumbar region; far fewer are located in the sacral region. Due to the rarity of sacral FT PAVFs, the precise surgical dissection and removal of these lesions are challenging. Here, we report an FT PAVF in the sacral region. The patient was a 45-year-old male who suffered from progressive weakness and numbness of the bilateral lower limbs; his symptoms gradually worsened. Digital subtraction angiography (DSA) showed an AVF at the sacral canal at the S3-4 level. Microsurgical treatment with intraoperative DSA was performed, and the FT PAVF was resected. After the operation, the patient gradually recovered. Follow-up magnetic resonance imaging revealed a recession in the dilation of the spinal cord venous plexuses. A literature review was also performed, and a total of 14 FT PAVFs of the sacral region were identified. The patients identified in the literature review had an average age of 58.9 ± 12.9 years, and 92.9% of the patients were male. Spinal cord edema was present in 85.7% of the FT PAVF patients. Regarding treatment, 64.3% of the FT PAVF patients underwent microsurgical resection, 28.6% patients underwent endovascular treatment, and 7.1% patients underwent a hybrid operation; good outcomes were achieved with all three methods. Therefore, FT PAVF of the sacral region is a unique lesion whose angioarchitecture needs to be identified carefully; prompt treatment is necessary, and microsurgery can yield good outcomes.

Objective: To investigate the advantages of intracranial arteriovenous malformation (AVM) treatment in a hybrid operating room (OR) Design: Retrospective analyses of prospectively recorded data Setting: Department of Neurosurgery, The First Hospital of Jilin University, Jilin Province, China Subject: We continuously collected the data of 15 AVM patients treated with surgical resection assisted by intraoperative digital subtraction angiography (DSA). Intervention: The AVM treatments were divided into two categories: in Type I, intraoperative DSA was mainly used to embolize difficult-to-expose feeding arteries and part of the AVM to reduce intraoperative bleeding. In Type II, intraoperative DSA was mainly used to simplify determination of the AVM position and check for residuals after surgical removal. Main outcome measure: The Hunt-Hess (HH) scale was used to determine the preoperative patient status. The prognosis was evaluated with the Glasgow Outcome Scale (GOS). Results: The distribution of patients according to the HH scale was as follows: grade I in one case, grade II in 11 cases and grade III in three cases. In seven patients with Type I AVM, the AVM was completely removed after embolization. In eight patients with Type II AVM, DSA confirmed complete removal of the AVM. Ten patients had a GOS score of 5 points, and five patients had a score of 4 points. Conclusions: DSAis the most promising method to surgically remove an AVM in a hybrid OR. AVMs can reasonably be classified as Type I and Type II for further treatment.

Aneurysms originating along the peripheral portion of the anterior inferior cerebellar artery (AICA) are rare entities. As a result of the small diameter of the AICA, it is very challenging to preserve the parent artery during endovascular treatment for a peripheral AICA aneurysm. In this report, we present a rare case of aneurysm in the a2 segment of the right AICA. During surgery, the aneurysm was found to be a dissecting aneurysm. As the tissue of the aneurysm neck had a similar thickness to that of the adjacent normal vessel, interrupted suturing of the vessel was performed after partial removal and trimming of the aneurysm wall. The patient experienced an uneventful postoperative recovery. No other neurological deficit was noted. Magnetic resonance imaging three days after surgery revealed no acute ischaemia in the brainstem and cerebellum. Catheter angiography nine months later showed no recurrence of the aneurysm or stenosis of the AICA. The a2 segment of the AICA runs tortuously along the subarachnoid space of the cerebellopontine angle, which permits higher vascular mobility. In selected cases, in situ suturing or re-anastomosis could be considered for a2 segment aneurysms.

Background: In rare circumstances, brain arteriovenous malformations (BAVMs) can recruit a transdural blood supply (TBS). The clinical and radiologic characteristics of BAVMs with a TBS are poorly understood. Methods: A retrospective review of the medical records was conducted for adult patients who were admitted for BAVMs from Jan 2013 to Dec 2019. TBSs for BAVMs were divided into 3 types: (1) unilateral TBSs from the external carotid artery (ECA) and/or meningeal branch of the vertebral artery (VA); (2) bilateral TBSs from the ECA and/or meningeal branch of the VA; and (3) meningohypophyseal trunk TBSs of the internal carotid artery. Results: Four hundred and twenty-eight patients were diagnosed with BAVMs during the study period, of whom 30 (7.0%, 30/428) were identified as having a TBS. Type 1, type 2, and type 3 TBSs were identified in 21 (70%, 21/30), 7 (23.3%, 7/30), and 2 (6.7%, 2/30) patients, respectively. Six (20%, 6/30) patients were conservatively managed. Twelve (40%, 12/30) patients underwent endovascular treatment (EVT) of the BAVM through non-TBS feeders. Eight (26.8%, 8/30) patients underwent EVT of the BAVM both through the TBS and non-TBS feeders. The modified Rankin Scale scores at the 3-month follow-up were 0, 1, 2, 4, and 5 in 24 (80%, 24/30), 2 (6.7%, 2/30), 2 (6.7%, 2/30), 1 (3.3%, 1/30), and 1 (3.3%, 1/30) patients, respectively. Good short-term recovery was achieved in 86.7% (26/30) of the patients. The size of the BAVMs with a TBS was larger than that of BAVMs without a TBS. Patients with higher Spetzler-Martin grades tended to have a TBS. No statistical difference was noted between the patients with and without a TBS with regard to age, sex, location, or concurrent aneurysms. Conclusions: This study showed that a TBS was likely to develop in patients with larger BAVMs and that a TBS was likely to be located in the temporal lobe in patients BAVMs with higher SM grades. Weak structures were the primary targets of management. In addition, a BAVM could be embolized via the TBS.

BACKGROUND:The anterior inferior cerebellar artery (AICA) is a very slender and anatomically variable artery that gives off many important perforating arteries that feed the brainstem and nerve-related arteries that feed the inner ear and labyrinth. AICA trunk aneurysms are rare entities that are also difficult to manage. At present, endovascular treatment (EVT) is the preferred choice; however, the understanding of EVT for AICA trunk aneurysms is limited.METHODS:In this article, we present a literature review on EVT for AICA trunk aneurysms. To promote understanding, we would also provide some illustrative educational cases of our institute.RESULTS:Aneurysms along the AICA trunk can occur alone (isolated AICA aneurysm) or secondary to cerebrovascular shunts (flow-related AICA aneurysm). According to their anatomical location, they can also be divided into proximal and distal types. At present, EVT is the mainstream treatment, mainly including selective coiling with parent artery preservation and parent artery occlusion. Both coils and liquid embolization materials can be used.CONCLUSIONS:For AICA trunk aneurysms, EVT is a reasonable choice and should be based on the specific anatomical location, pathology, and collateral circulation. However, there is still controversy as to the specific type of treatment that should be chosen.

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1007/s12035-021-02334-9

Intracranial fusiform and circumferential aneurysms (IFCAs), especially those located on the main trunk, are uncommon and difficult to manage. Currently, literature focused on IFCAs on the main trunk of cerebral arteries is lacking. The treatment of IFCAs is still under debate. Therefore, in this review, we further explore the treatment of this complicated entity. In addition, we also present some interesting cases. Based on the literature review and our experience, we found that IFCAs are often located in the vertebrobasilar system and that ruptured or large symptomatic IFCAs are associated with increased mortality and higher rebleeding rates. The treatment strategies for IFCAs can be classified as deconstructive and reconstructive methods via open surgery and/or endovascular treatment (EVT). Currently, EVT is a popular method and the main therapeutic choice. In particular, flow diversion has revolutionized the treatment of IFCAs. Parent artery occlusion (PAO) with or without revascularization may still be considered a suitable choice. Complex IFCAs that cannot be resolved by EVT can also be treated via open surgery with or without extracranial–intracranial bypass. Targeted embolization for the weak points of IFCAs is a temporary or palliative choice that is rarely used. In summary, despite complications, both surgical treatment and EVT are effective options for appropriately selected cases. Due to the development of endovascular implants, EVT will have better prospects in the future.

Dissecting aneurysm located at the trunk of the anterior temporal artery (ATA) is an extremely rare entity of which only a few cases have ever been reported. As a result of the small caliber and supposed non-competency of the ATA, sacrificing of the artery distal to the aneurysm is the mainstay of treatment. In this report, we present a 28-year-old man who was admitted for a ruptured fusiform aneurysm of the left ATA. He underwent resection of the aneurysm combined with superficial temporal artery (STA)-ATA anastomosis. Histopathological study showed that the aneurysm was compliant with an artery dissection. The postoperative process was unremarkable and he was discharged with no neurological deficit. Follow-up angiography showed the anastomosis was patent. ATA is considered a non-competent intracranial artery. Although recently some investigators have conducted cadaveric studies using the ATA as a donor vessel for intracranial-intracranial (IC-IC) bypass, clinical consequences of ATA occlusion have not been reported yet. The supposed safety of ligation of ATA for IC-IC bypass was based on the fact that the anterior temporal lobectomy for temporal lobe epilepsy does not lead to major neurological deficits. This extrapolation could not be arbitrarily used in ATA occlusion for IC-IC bypass. STA-ATA anastomosis is a reasonable option in case of the ATA dissecting aneurysm.

In brain arteriovenous malformations (BAVMs) and dural arteriovenous fistulas (DAVFs), when too much blood is drained into the venous system, extensive venous congestive encephalopathy (EVCE) can appear. EVCE in BAVMs and DAVFs can be divided into acute and chronic stages. BAVMs and DAVFs have their own classification systems, but EVCE is not considered in these classification systems and needs to be emphasized. EVCE in BAVMs and DAVFs has unique clinical and imaging features. The clinical presentations usually consist of headache, cognitive impairment, and focal deficits. EVCE in BAVMs and DAVFs has several imaging features, and the venous congestion seen on computed tomography angiography and magnetic resonance angiography can present with the angiographic features of venous reflux and pseudophlebitic pattern. Digital subtraction angiography is the gold standard for the diagnosis. Delayed circulation time is observed. Tortuous, dilated, and engorged veins can be seen. For EVCE from BAVMs and DAVFs, prompt treatment is warranted due to the impairment of extensive brain tissue. Treatments include endovascular treatment (EVT), open surgery, and radiosurgery. EVT is often the primary treatment. Complete elimination in one stage is often difficult. Most of the time, staged treatment has to be chosen. No matter at the acute or chronic stage, aggressive treatment is recommended.

Aneurysms located at the A1 segment of the anterior cerebral artery are considered rare and unique entities. Endovascular treatment (EVT) is effective in preventing aneurysmal bleeding. However, EVT for A1 aneurysms is difficult due to their distinctive configurations. A current review of EVT for A1 aneurysms is lacking. Therefore, we focused on the available literature on this specific issue. To more clearly expound this entity, we also provided some illustrative cases. The A1 segment can be equally divided into the proximal, middle, and distal segments. Proximal aneurysms are most common and difficult to treat via EVT. The A1 segment has a complex anatomy and many important branches. Due to the small size, predominant posterior direction, and sharp upturn of the microcatheter from the parent artery, microcatheter positioning and support is difficult for A1 aneurysms. EVT for A1 aneurysms mainly includes reconstructive and deconstructive strategies. The complications of EVT for A1 aneurysms include aneurysmal perforation, thromboembolic events, and coil protrusion related to stent-assisted embolization. A1 aneurysms represent rare and difficult vascular lesions. EVT is quite challenging for A1 aneurysms due to their distinctive configurations. The outcomes are acceptable.

Unlike its parietal, temporal, and occipital counterparts, the frontal lobe has a broad basal surface directly facing the anterior cranial fossa dura mater which could permit establishment of transdural collaterals (TDCs) with the frontal lobe. Studies on the TDCs from the anterior cranial fossa in moyamoya disease (MMD) are scarce and inadequately investigated. A retrospective study of 100 hemispheres in 50 patients who were diagnosed with MMD by catheter angiography between January 2015 and June 2019 was performed in our institution. TDCs through the anterior ethmoid artery (AEA) or posterior ethmoid artery (PEA) were divided into 3 types respectively based on their respective angioarchitecture. Furthermore, we also studied TDCs to the temporal, parietal, and occipital lobes and collaterals from the posterior circulation to the territory of the anterior cerebral artery. TDCs through the AEA and PEA were identified in 89 (89/100, 89%) and 73 (73/100, 73%) of the hemispheres. The vascularization state of the frontal lobe was good in 89 (89/100, 89%) hemispheres. Rete mirabile and TDCs through the PEA were statistically different among patients with different Suzuki stages. No statistical difference was noted in TDCs through the AEA, frontal TDCs from other sources, and the vascularization state of the frontal lobe with regard to different Suzuki stages. TDCs through the AEA and PEA at the anterior cranial fossa play a very important role in compensating the ischemic frontal lobe. The frontal lobe could be well compensated in most of the patients with TDCs at the anterior cranial fossa.