Background: Surgery of parasagittal meningiomas (PSMs) is still technically challenging, for the balance between radical resection and preservation of venous circulation. In this article, we'd systemically introduce the technical nuances of a simplified strategy for radical resection of all types of PSMs. All the cases were operated by one single neurosurgeon from a single institution.Methods: Clinical charts of patients with PSMs between 2014 and 2020were retrospectively reviewed. A simplified classification method was adopted, which was based on the relationship between the tumor and superior sagittal sinus (SSS). Surgery aiming at radical resection and venous flow preservation was performed. Only in case of total occlusion of SSS, we performed tumor resection without reconstruction of the venous sinus.Results: Clinical data obtained in 55 consecutive patients (47 primary and 8 recurrent cases) were analyzed, among which 20 were with patent sinus, 27 were with partially occluded sinus and 8 were with completely occluded sinus. Forty-two (76.4%) and 13 patients (23.6%) had the same and improved functional status as compared to that of pre-operation, respectively. Four patients (7.3%) experienced transient neurological deterioration but improved to the normal level in the long-term follow-up. All patients achieved Simpson I/II radical resection. No patients suffered from post-operative recurrence in the follow-up duration of 27.05 ± 19.55 (2-91) months.Conclusion: Radical and safe resection of all types of PSMs is achievable and not difficult if the simplified surgical strategy mentioned in the article is adopted, no matter to which extent the sinus is invaded.
Objective
To explore the value of application of intravascular ultrasound (IVUS) guidance and analyze the limitations of coronary angiography in the assessment and to provide valuable information for percutaneous coronary intervention (PCI) treatment of left main (LM) lesion.
Methods
The 60 patients with LM lesion were enrolled in this study.The patients were divided into two groups: ostium and trunk lesion of LM group and distal or bifurcation lesion of LM group, 30 cases in each group.Combined coronary angiography (CAG) and IVUS was used to assess the lesion, guide the PCI treatment and evaluate the immediate effect of PCI after stent implantation.Differences of two groups were compared.
Results
The mean reference diameter, the minimum lumen diameter and the minimum lumen area of LM lesion measured by coronary angiography were significantly smaller than that by IVUS (all P<0.05). In 8 cases (26.7%) of the ostium and trunk of LM lesion group, the measurement parameters of were significantly different between those CAG and IVUS results.CAG and IVUS guidance for distal left main bifurcation stent policy show larger differences, those who do not match were up to 30%.The proportion of post-dilation was significantly higher in IVUS guided group than in angiography guided group (P<0.05).
Conclusions
Compared with IVUS, CAG cannot accurately diagnose coronary artery disease with left main disease, treatment with PCI CAG guidance accuracy is also limited.We recommend the routine application of IVUS in the PCI treatment of LM lesion.
Key words:
Left main coronary artery; Angioplasty, transluminal, percutaneous coronary; Coronary artery angiography; Ultrasonography, interventional
The pathogenesis and development of Moyamoya disease are still unclear. This study aimed to investigate the effect of desmoglein-2 (DSG2) on Moyamoya disease and determine the inhibitory effect of DSG2 in vascular remodeling in Moyamoya disease.RNA sequencing, immunohistochemistry (IHC), and western blotting were used to detect the expression of DSG2 in the superficial temporal artery (STA) tissues of Moyamoya disease. The association between DSG2 and endothelial cells' biological activities was investigated by cell counting kit-8 (CCK-8), migration assay, tube formation assay, flow cytometry with Annexin V-FITC/PI staining, and TUNEL apoptotic cell detection kit. Pathways affected by overexpression or knockdown of DSG2 were identified in endothelial cells.The expression of DSG2 in the STA tissues of Moyamoya disease was lower than that in normal controls. Overexpression of DSG2 inhibits the proliferation and migration but promotes apoptosis in endothelial cells, and low DSG2 levels result in impaired angiogenesis. In addition, there was an interaction between DSG2 and MMP-9, and DSG2 acted through the PI3K signaling in endothelial cells.Our results indicate that DSG2 affects PI3K signaling in vascular endothelial cells, and MMP-9 is involved in DSG2-mediated vascular changes in Moyamoya disease.
<i>Objective:</i> To investigate the clinical features and treatment outcome of pediatric cavernous malformation (CM) in the central nervous system. <i>Patients and Methods:</i> Retrospective review of clinical data and treatment outcome for 66 pediatric patients under the age of 18 treated for CM at Huashan Hospital within the past 10 years from January 1998 to December 2007. <i>Results:</i> In our consecutive series, the mean age at onset of the CM was 11.6 years (age from 15 months to 17.8 years), and the boy-to-girl ratio was 1.54:1 (40:26). Main initial clinical manifestations in cerebral CM (CCM) included: seizures (47.7%, 31/65), headache (46.2%, 30/65), intracranial hemorrhage (20%, 13/65), and focal neurological deficits (12.3%, 8/65). There were 59 children with single CM and 7 children with multiple CMs: 55 (83.3%) with supratentorial CM, 6 (9.1%) with infratentorial CM, 4 (6.1%) with supra- and infratentorial CM, and 1 (1.5%) with intramedullary CM. Sixty-two (93.9%; 62/64) children underwent microsurgical operations, and with the help of neuronavigation (19 cases), intraoperative ultrasonography (6 cases), and neuronavigation combined with intraoperative ultrasonography (3 cases). And 4 (6.1%; 4/66) children did not undergo any surgical intervention. There was no major morbidity or mortality from surgical procedures. Follow-up data of 50 children was available with a mean follow-up time of 39.1 months (range from 5 to 112 months), including 46 operated children and 4 children managed without operation. In the 46 operated children, the overall long-term post-treatment results were satisfactory: 73.9% no sign or symptom associated with CMs, 19.6% improved obviously, only 1 (2.2%) boy with unrestored paraplegia incurred by spinal cord CM, and 2 boys (4.3%) with controllable seizures occurring after initial 5 symptom-free years (one without need of antiepileptic drugs, AEDs). Of 24 children followed-up with preoperative seizures, only 1 boy needed therapeutic AEDs and the others did not need any after resections of the CMs. Three children managed without operations (2 with headache and 1 with seizures) had spontaneous disappearance of symptoms and stable intracerebral lesions at follow-up MRI images. <i>Conclusions:</i> For symptomatic solitary CM, the treatment of choice is complete microsurgical excision preceded by careful anatomical and functional evaluation, and the risk of operation can be decreased to lower level with the help of neuronavigation and intraoperative ultrasonography. For multiple CM, the treatment modalities must be considered cautiously. A much longer follow-up remains mandatory for appropriate treatment strategies.
To investigate the clinical features of pediatric cerebrovascular disorders.The clinical data of 204 cases of pediatric cerebrovascular disease, 134 male and 70 female (1.91: 1), aged 12.7 (32 d - 17.9 years), hospitalized in the past 13 years were analyzed retrospectively. The diagnosis of intracranial hemorrhage was mainly based on CT, Digital subtraction angiography was conducted on 130 cases and pathological examination was conducted on 78 cases.Intracranial hemorrhage was seen in 195 cases. The onset of symptoms was acute or subacute in 73.5% of the patients (150/204). The main manifestations included headache (70.6%), vomiting (50%), loss of consciousness (22.5%), convulsion (21.6%), and focal neurological deficits (13.2%). The causes included arteriovenous malformation (42.2%, 86/204), cavernoma (16.2%, 33/204), aneurysm (8.8%, 18/204), and moyamoya disease (5.9%, 12/204), and the cause remained unknown in 43 of the patients (21%).The epidemiology of pediatric cerebrovascular diseases has its own specificity. Therefore, it is crucial to deal timely with it according to the characteristics of the cerebrovascular diseases in children's.
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