Abstract To report the results of a consecutive series of pituitary adenomas resected through endoscopic endonasal approach (EEA) with minimal nasal injury. Retrospectively review tumor characteristics and surgical outcomes of a consecutive series of EEA pituitary adenomas resection performed mainly by a single author between March 2018 and June 2019. A total of 75 endoscopic endonasal approach pituitary adenoma resections were performed by the authors’ team. Of the 75 patients, 28 through mononostril EEA, 47 through Binonostril EEA. Hadad-Bassagasteguy vascularized nasoseptal flap was harvested in only 4 (5.3%) patients with a high risk of postoperative cerebrospinal fluid leak, and one side middle turbinate only been resected in 2 (2.7%) patients, other patients preserved bilateral middle turbinate. Of the 75 patients, gross total resection is 74.7%, near-total resection is 16.0%. Endocrinological remission was achieved in 76.9% of GH-secreting adenomas, 61.5% of prolactin-secreting adenomas. The postoperative cerebrospinal fluid leak rate was 2.7%. Two patients had suprasellar hemorrhage, 1 patient had perioperative stroke, 2 patients had permanent diabetes insipidus, no cranial nerve deficits, internal carotid artery injury, anosmia, and death. The sino-nasal function was measured with the Sino-Nasal Outcome Test-22 and visual analog scale for olfaction preoperatively and postoperatively, and there was no statistically significant difference. The EEA is an effective approach to resect pituitary adenomas, the gross total resection and near-total resection rate and endocrinological remission rate are satisfactory. The EEA is a safe approach, as the complication rate is acceptable compared with those reported in the previous series of microscopic and endoscopic approaches. These results can be achieved with minimal nasal injury.

Objective: Glioblastoma (GBM) remains one of the most lethal types of cancer, and is the most common brain tumor in adults. The purpose of this study was to determine the role of miR-876-5p in regulation of epithelial mesenchymal transition (EMT) and metastasis of GBM cells. Materials and methods: TWIST1 and miR-876-5p expression was analyzed by real-time PCR and Western blot assays. We confirmed the association between miR-876-5p and TWIST1 by dual luciferase reporter assay. The roles of the miR-876-5p/TWIST1 pathway in migration and invasion were examined in vitro. The effects of miR-876-5p on EMT-related molecules E-cadherin, N-cadherin and vimentin were evaluated by real-time PCR and Western blot. Results: miR-876-5p expression levels were decreased while TWIST1 expression levels were increased in detected GBM tissue samples and all of the GBM cell lines. In addition, ectopic expression of miR-876-5p suppressed and miR-876-5p-in promoted EMT, migration, and invasion in T98G cells. Bioinformatics coupled with luciferase and Western blot assays also revealed that miR-876-5p inhibited expression of TWIST1, one of the master regulators of tumor metastasis. Conclusions: This study first indicates that miR-876-5p functions as a suppressor in regulating of GBM EMT by targeting TWSIT1, and it promise as a therapeutic target and prognostic marker for metastatic GBM.

目的 探讨腹腔镜技术用于治疗侧脑室-腹腔分流术后分流管堵塞的有效性以及相比传统手术方式的优势.方法 2013年11月到2018年1月,我科利用腹腔镜技术治疗分流管腹腔端堵塞患者8例,回顾和分析这些患者的临床、影像学资料.结果 8例患者术后当日脑积水症状均明显减轻,术后一天复查头颅CT可见脑室系统回缩,间质水肿较术前减轻.8例患者随访三个月以上未见脑积水加重,复查CT脑室系统大小维持稳定.结论 腹腔镜技术用于治疗侧脑室-腹腔分流术后分流管堵塞具有创伤小、视野广、精确度高等特点,能有效避免患者再次行侧脑室-腹腔分流及其他方式手术,减少二次手术创伤,节约治疗费用.

目的 研究江苏省人民医院近10年来中枢神经系统肿瘤的流行病学特点.方法 统计分析江苏省人民医院近10年来,经手术治疗并取得病理学诊断的4553例中枢神经系统肿瘤患者的临床资料.结果 按WHO 2016年新分类标准分型,本组患者以脑膜瘤(28.05％)、鞍区肿瘤(25.98％)、弥漫性星形细胞和少突胶质细胞肿瘤(18.52％)、椎管内神经肿瘤(13.33％)、间质,非脑膜上皮性肿瘤(6.35％)为主.低级别肿瘤占86.43％,幕上肿瘤占71.47％,男女性别比为1∶1.32,发病率峰值为50 ～59岁.结论 中枢神经系统肿瘤的临床特征与患者来源区域的地理环境、产业结构、经济发展、化工污染、人口性别比、医疗条件,以及患者职业等有着紧密联系.

OBJECTIVE: To assess association between champagne bottle neck sign (CBNS) in carotid artery and intracranial hemorrhage in patients with moyamoya disease (MMD). METHODS: This retrospective study included 76 consecutive patients with MMD without definite risk factors associated with intracranial hemorrhage who underwent preoperative angiography from January 2016 to December 2017. CBNS was defined as luminal diameter ratio of internal carotid artery/common carotid artery <= 0.5 on angiography. The right and left cerebral hemisphere in each patient was separately identified as hemorrhagic and nonhemorrhagic. Association between CBNS and intracranial hemorrhage was analyzed. RESULTS: Of 76 patients with MMD, intracranial hemorrhage was found in 44 of 152 (28.9%) hemispheres, and 6.8% (3/44) had multiple events. Comparing carotid arteries without intracranial hemorrhage in ipsilateral hemispheres, patients with intracranial hemorrhage in the ipsilateral hemisphere had significantly smaller luminal diameter ratio of internal carotid artery/common carotid artery (0.49 +/- 0.11 vs. 0.55 +/- 0.12, P < 0.01) and higher prevalence of CBNS (63.7% vs. 41.7%, P = 0.01). Comparing hemispheres with intracranial hemorrhage, patients with ipsilateral carotid artery CBNS had significantly higher prevalence of hemorrhage in posterior territories than patients without CBNS (57.1% vs. 23.1%, P = 0.05). Logistic regression revealed that CBNS was significantly associated with ipsilateral intracranial hemorrhage before (odds ratio = 2.45; 95% confidence interval, 1.19-5.05; P = 0.02) and after (odds ratio = 3.43; 95% confidence interval, 1.50-7.87; P < 0.01) adjusting for female sex, lenticulostriate anastomosis, and choroidal anastomosis. CONCLUSIONS: CBNS is significantly associated with intracranial hemorrhage in the ipsilateral hemisphere in patients with MMD, particularly intracranial hemorrhage in posterior territories.

Objective To summarize the clinical outcomes of pituitary adenoma resection by single-nostril transsphenoidal approach .Methods Clinical data of 136 cases with pituitary adenoma resected through single-nostril transsphenoidal approach were analyzed retrospectively .Results Among all cases ,124 cases accepted gross total resection ,10 cases nearly total resection and 2 cases subtotal resection .Endocrine functions recovered in 61 cases after surgery ,while vision and visual field were improved significantly in 29 cases .A total of 16 cases were complicated with postoperative transient diabetes insipidus ,and another one with intractable diabetes insipidus .MRI scanning taken in three months after surgery revealed that residual tumors occurred in 8 cases ,including 2 cases of invasive tumors .There was no infection or death .Conclusion Pituitary adenoma resection through single-nostril transsphenoidal approach has the advantages of minimal invasion ,complete removal of tumors ,less postoperative reaction and quick recovery .

目的 总结天幕裂孔镰幕结合区脑膜瘤的手术入路及治疗经验.方法 天幕裂孔镰幕结合区脑膜瘤11例,实施显微外科手术治疗.根据术前MRI及磁共振静脉成像(MRV)确定肿瘤具体位置、肿瘤与周围血管毗邻关系以及静脉窦通畅程度并设计手术入路.术后病理证实脑膜瘤诊断.结果 肿瘤Simpson Ⅰ级切除1例,SimpsonⅡ级切除7例,SimpsonⅢ级切除2例,SimpsonⅣ级切除1例,无Simpson Ⅴ级病例.术后2例行伽马刀治疗.手术并发症:静脉窦闭塞1例,术中静脉窦破裂2例,皮下积液2例,脑脊液漏1例,脑积水1例.无肢体功能障碍及死亡病例.5例获术后随访,复发1例.结论 对天幕裂孔镰幕结合区脑膜瘤患者,术前应行MRV确定肿瘤与周围血管关系及静脉窦通畅程度,选择合理的手术人路及治疗方案是提高患者手术疗效的关键.联合术后放疗可提高疗效.

In the present study, we investigated the role of endogenous neurotrophin-3 in nerve terminal sprouting 2 months after spinal cord dorsal root rhizotomy. The left L1-5 and L7-S2 dorsal root ganglia in adult cats were exposed and removed, preserving the L6 dorsal root ganglia. Neurotrophin-3 was mainly expressed in large neurons in the dorsal root ganglia and in some neurons in spinal lamina II. Two months after rhizotomy, the number of neurotrophin-3-positive neurons in the spared dorsal root ganglia and the density of neurite sprouts emerging from these ganglia were increased. Intraperitoneal injection of an antibody against neurotrophin-3 decreased the density of neurite sprouts. These findings suggest that endogenous neurotrophin-3 is involved in spinal cord plasticity and regeneration, and that it promotes axonal sprouting from the dorsal root ganglia after spinal cord dorsal root rhizotomy.

OBJECTIVE To investigate the neuroprotective effects of glycyrrhizin (Gly) as well as its effect on expression of high-mobility group box 1 (HMGB1) in rats after traumatic brain injury (TBI). METHODS Male Sprague-Dawley rats were randomly divided into three groups: sham group, TBI group, and TBI+Gly group (n=36 per group). Rat TBI model was made by using the modified Feeney's method. In TBI+Gly group, Gly was administered intravenously at a dosage of 10 mg/kg 30 min after TBI. At 24 h after TBI, motor function and brain water content were evaluated. Meanwhile, HMGB1/HMGB1 receptors including toll-like receptor 4 (TLR4) and receptor for advanced glycation end products (RAGE)/nuclear factor-κB(NF-κB) signaling pathway and inflammatory cytokines in the injured brain tissues were detected using quantitative real-time polymerase chain reaction, western blot, electrophoretic mobility shift assay and enzyme-linked immunosorbent assay. Furthermore, HMGB1, RAGE and TLR4 immunohistochemistry and apoptosis were analyzed. RESULTS Beam walking performance impairment and brain edema were significantly reduced in TBI+Gly group compared with TBI group; meanwhile, the over-expressions of HMGB1/HMGB1 receptors (TLR4 and RAGE)/NF-κB DNA-binding activity and inflammatory cytokines were inhibited. The percentages of HMGB1, RAGE and TLR4-positive cells and apoptotic cells were respectively 58.37% ± 5.06%, 54.15% ± 4.65%, 65.50% ± 4.83%, 52.02% ± 4.63% in TBI group and 39.99% ± 4.99%, 34.87% ± 5.02%, 43.33% ± 4.54%, 37.84% ± 5.16% in TBI+Gly group (all P<0.01 compared with TBI group). CONCLUSION Gly can reduce secondary brain injury and improve outcomes in rat following TBI by down-regulation of HMGB1/HMGB1 receptors (TLR4 and RAGE)/NF-κB-mediated inflammatory responses in the injured rat brain.

Objective To investigate the role of radiofrequency thermocoagulation treatment system combined with neuronavigation in resection of giant intracranial hypervascular tumors. Methods 13 patients with giant intracranial hypervascular tumors were microsurgically resected with thermocoagulation treatment system under the guidance of the neuronavigation system which accurately determined the coagulation area.Summarizing the positioning accuracy assisted by the neuronavigation and the effect of treatment.Results Of 13 patients with giant intracranial hypervascular tumors, total lesions removal were achieved in 9, subtotoal removal in 3 and partial resection in 1.Blood transfusion was performed in 1 case with 600 ml and none in the other cases. No dead case occurred.Conclusion The neuronavigation system can provide preoperative evaluation of intracranial tumors and the real-time navigation in the operation.With its guidance, the radiofrequency thermocoagulation positioning could be more accurate and reliable, which contribute to the total tumor resection and reducing operation complications.

Objective To explore the application of spiral CT angiography and three- dimensional reconstruction( 3D-CTA) in the microsurgery of tumors in deep brain. Methods The clinical data of 27 patients with tumors in deep brain,treated by microsurgery assisted with 3D- CTA,were analyzed retrospectively to evaluate the preoperative 3D reconstruction effect and the effect after operation. Results The preoperative 3D images of all tumors can clearly demonstrate the site,size,shape and adjacent vessels and bone,which were in accord with the facts observed during the operation. In the 27 cases,23 patients achieved gross total resection,3 patients achieved subtotal resection and 1 patients achieved partial resection; After the operation,25 patients relieved or remain the same,while 2 patients became worsen. No dead case occurred. 22 cases were good during the follow up 1 month after the operation. Conclusion 3D-CTA can provide 3D images of tumor and adjacent vessels and the skull, which can also be subject to adjustment, measurement and Simulation of operation approach. It provides a visual basis for individual treatment of the tumors in deep brain to choose the best operation approach and reduce the intraoperative risk.

Objective To discuss the reasonable preoperative risk assessment,clinical classification and surgical approaches for the petroclival tumors.Methods The clinical data of 62 patients with petroclival tumors treated by microsurgery were analyzed retrospectively.On the basis of the imaging characteristics and clinical features,62 cases with petroclival tumors were classified,preoperatively evaluated in terms of the risk for surgery.The outcomes of different surgical approaches for pertroclival tumors were compared.Results Gross total resection was achieved in 38(61%) cases,of whom 3 cases were via extended pterional approach,8 cases via subtemporal transtentorial approach,6 cases via transpetrosal presigmoid approach and 21 cases via retrosigmoid approach.The new cranial nerve deficits occurred in 26(42%) patients after operation.No dead case occurred.Conclusion Surgical approaches should be chosen according to the preoperative risk assessment and classification of the tumors.Relatively simple and minimally invasive surgical approaches such as presigmoid approach or subtemporal transtentorial approach should be chosen for those with high risk in the preoperative risk assessment.

Objective To study the clinical characteristics of tumors at the place between pons and oblongata,the methods of microsurgical treatment,and treatment for complications of microsurgery.Methods The 23 patients undergoing surgical treatment of tumors originated from pons and medullary were reviewed retrospectively.Preoperative clinical presentation and lesion characteristics,adopted surgical approach and complications were analyzed.Results All cases in this group were accepted microsurgical treatment.Numbers of total resection,subtotal resection,and partial resection of tumors were 15,4 and 4,respectively.Cases of glioma,cavernous malformation,hemangioblastoma,and lymphoma were 15,3,4 and 1,respectively.Perioperative complications of worsening original symptoms,new neurological symptoms,intracranial infection,and neurogenic pulmonary edema and bulbar paralysis occupied 6,4,1,1,respectively.There was no death in perioperative.Conclusions There are many kinds of tumors at the place between pons and oblongata,and many patients had severe perioperative complications.Appropriate surgical indications and approaches,microsurgical operation,the prevention and treatment to the postoperative complications,contribute to improve the treatment effect of tumors at the place of pons and oblongata.

Glioblastoma is one of the most malignant brain tumors. Current treatments for glioblastoma usually make poor responses, and novel treatment strategies are extremely imperative. Cytochalasin E was reported to inhibit angiogenesis and tumor growth in some studies, but its effects on gliomas are still unknown. In this study, we found cytochalasin E inhibits U87 human glioblastoma cell growth in a very low concentration range of 10(-8) to 10(-6) M in a time and concentration dependent manner, and the IC50 were 1.17 +/- 032 x 10(-7) M for 48 h treatment, 6.65 +/- 1.12 x 10(-8) M for 72 h and 3.78 +/- 130 x 10(-8) M for 96 h. We also found cytochalasin E induces cell-cycle G2/M phase arrest (72 h-treatment of 10(-6) M cytochalasin E caused 56.2 +/- 6.1% cells arrest in G2/M phase) and cell apoptosis (96 h-treatment of 10(-6) M cytochalasin E induced 24.1 +/- 4.2% cells apoptosis). Thus, cytochalasin E is proposed as a potential agent for glioblastoma chemotherapy.

To examine the effects of anisomycin on glioma cells and the related mechanisms in vitro. The U251 and U87 human glioblastoma cell lines were tested. The growth of the cells was analyzed using a CCK-8 cell viability assay. Apoptosis was detected using a flow cytometry assay. The expression of proteins and phosphorylated kinases was detected using Western blotting. Treatment of U251 and U87 cells with anisomycin (0.01–8 μmol/L) inhibited the cell growth in time- and concentration-dependent manners (the IC50 values at 48 h were 0.233±0.021 and 0.192±0.018 μmol/L, respectively). Anisomycin (4 μmol/L) caused 21.5%±2.2% and 25.3%±3.1% of apoptosis proportion, respectively, in U251 and U87 cells. In the two cell lines, anisomycin (4 μmol/L) activated p38 MAPK and JNK, and inactivated ERK1/2. However, neither the p38 MAPK inhibitor SB203580 (10 μmol/L) nor the JNK inhibitor SP600125 (10 μmol/L) prevented anisomycin-induced cell death. On the other hand, anisomycin (4 μmol/L) reduced the level of PP2A/C subunit (catalytic subunit) in a time-dependent manner in the two cell lines. Treatment of the two cell lines with the PP2A inhibitor okadaic acid (100 nmol/L) caused marked cell death. Anisomycin induces glioma cell death via down-regulation of PP2A catalytic subunit. The regulation of PP2A/C exression by anisomycin provides a clue to further study on its role in glioma therapy.

Although sEH inhibitors are well studied in inflammatory and cardiovascular diseases, their effects on gliomas are unclear. In this study, we investigated the effects of t-AUCB, a more potent and selective sEH inhibitor, on U251 and U87 human glioblastoma cell lines and the HepG2 human hepatocellular carcinoma cell line. Our results showed that t-AUCB efficiently inhibited sEH activities in all three cell lines (the inhibition rate was more than 80% in each) and suppressed U251 and U87 cell growth in a dose-dependent manner, but exhibited no cell growth inhibition on HepG2. We detected high levels of phosphorylated NF-κB-p65 (Ser536) in t-AUCB-treated U251 and U87 cells, and then found that the NF-κB inhibitor PDTC can completely abolish t-AUCB-induced growth inhibition. This indicated that t-AUCB suppresses U251 and U87 cell growth by activating NF-κB-p65. Moreover, we found that t-AUCB induces cell-cycle G0/G1 phase arrest by regulating Cyclin D1 mRNA and protein levels and CDC2 (Thr161) phosphorylation level. We propose to further test this promising reagent for its anti-glioma activity in clinical relevant orthotopic brain glioma models.

Objective To study the anatomical features of endoscopic endonasal approach for the lesions of midline anterior skull base area and suprasellar.Methods Ten human cadaver heads were dissected to perform the endoscopic endonasal approach for the lesions of midline anterior skull base area and suprasellar.A route through two nostrils and nasal septum mucosa was taken.The anterior and posterior ethmoid sinus,superior and middle turbinate suposed to be selectively removed as needed.The anatomical landmarks useful in guiding surgery through this approach were recorded.Results After making a line between two sides of the optocarotid recess (OCR),the skull base bone was opened in the tuberculum sellae and sphenoid platform.And then the midline anterior skull base area was exposed including both sides of the medial orbital wall and the frontal sinus.In the suprasellar area,the suprasellar cistern,cistern of the lamina terminalis,chiasmatic cistern,and the important structures within them could be exposed.The third ventricle could be entered through the lamina terminalis and the data of the length between nasal columella and sphenoid sinus ostia,sellar floor,tuberculum sellae,inner edge of optocarotid recess,posterior ethmoid artery,anterior ethmoid artery and the length between inner edge of the bilateral OCR were determined.Conclusion Endoscopic endonasal approach can significantly expand the view and explore more areas for the operation with the advantages of directly reching the lesions,avoiding to drag brain tissue and vessels.

This study was designed to assess the potential therapeutic efficacy of gene-modified mesenchymal stem cells (MSCs), MSCs-TH and MSCs-GDNF, in PD rats. Fifty-nine PD rat models were divided into five groups and then the gene-modified MSCs were transplanted into the striatum of rats according to the design. Apomorphine-induced rotational behavior in rats was observed weekly; rats which received both MSCs-TH and MSCs-GDNF showed the most significant improvement compared with those in other groups (P < 0.01). Three weeks later, immunohistochemistry analysis found TH-positive cells and GDNF-positive cells in striatal. Eight weeks later, PD rats were killed. HPLC and ELISA results showed DA and GDNF content in striatum of rats which received both MSCs-TH, and MSCs-GDNF was considerably higher compared with those of other groups (P < 0.01),respectively. In conclusion, our results suggest that combined transplantation of MSCs expressing TH and GDNF can lead to remarkable therapeutic effects in a rat model of PD.

Objective To explore a new approach for improving therapeutic effects and minimizing complications of ventriculoperitoneal shunt (VPS).Methods The length of and lower edge of the greater omentum were measured and analyzed in 28 autopsies (16 adults and 12 children) and laparoscopic surgeries.95 cases of hydrocephalus treated by MIVPS( minimally invasive ventriculoperitoneal shunt) were retrospectively reviewed.The depth and positions of puncture into ventricles were confirmed by CT scanning.And then distal ventriculoperitoneal shunt was navigated into left pelvic area by the assistance of laparoscopy and the special abdominal puncture device.Results The findings of autopsies demonstrated that the percentage of upper and middle abdominal types of greater omentum position was 81.3％ in adults.There was no lower abdominal type in children.These cases were followed up from 3 to 45 months.The Salmon' s classification rate was 95.7％.Complications were found in 9 cases ( 9.5％ ):infection in 3 cases (3.2％),obstruction in 5 cases (5.3％),and 1 case of unknown pneumocephalus (1.0％).Conclusions MIVPS is better than previous VPS.It is helpful to reduce complications and should be considered for advanced clinical application.