Objectives To study the composition of the Galen venous system and explore effects of its anatomical variance on microsurgery for the lesions in the region in the back of tentorial incisure space.Methods The transoccipito-supratentorial and infratentorial supracerebellar approaches were simulated in 20(40 hemispheres) formalin fixed adult cadaveric brains in which the cerebral arteries and veins had been perfused respectively with red and blue latex.The tributaries of Galen venous system, which interfered in entering the region in the back of the incisural space, were observed under an operating microscope.The composition of Galen venous system and datums related to it were analyzed and measured.Results Galen venous system was divided into five types according its composition.The thick medial occipital veins, of which, the outer diameter was(2.5±0.4)mm, were identified in 9(22.5%, 9/40) sides of the hemispheres.The thick precentral cerebellar veins, of which, the outer diameter was(2.0±0.2)mm, were also identified in 5(25.0%, 5/20) brains.The defect of anterior or middle or posterior segments of the basal veins of Rosenthal was observed in some dissected specimens.The medial occipital veins and the basal vein of Rosenthal interfered in entering the region in the back of the tentorial incisural space when microsurgery through the transoccipito-supratentorial approach was performed, and the precentral cerebellar veins possibly interfered in entering the region of the back of the tentorial incisural space when the microsurgery the infratentorial supracerebellar approach was performed.Conclusions Galen venous system and its tributaries are highly variable anatomically.The anatomical variance of the Galen venous system, its tributaries and their relationship with the lesions should be preoperatively estimated by computerized tomographic angiography or MR venography of brain, and the optimal operative approach should be selected to reduce intraoperative bleeding and the postoperative complications.
Malignant glioma is the most common intracranial tumor with poor prognosis. It is well believed that glioma stem cells (GSCs) are responsible for the initiation and progression of glioma. Janus kinase/signal transducer and activator of transcription (Jak/STAT3) pathway plays a key role in the functions of GSCs. However, the regulatory mechanism of Jak/STAT3 pathway has not been completely elucidated. This study employed multidisciplinary approaches to investigate the upstream regulators of Jak/STAT3 signaling in GSCs. miR-30 was found to be overexpressed in the GSCs derived from U-87 MG and primary glioma cells, compared with non-stem-cell-like glioma cells and normal cells. Downregulation of miR-30 was able to suppress Jak/STAT3 pathway and reduce the tumorigenecity of GSCs. miR-30 decreased the expression of suppressor of cytokine signaling 3 (SOCS3) expression by targeting 3′UTR of its mRNA. The silencing of SOCS3 abolished the effect of miR-30 downregulation on GSCs. Collectively, there is a regulatory pathway consisting of miR-30, SOCS3, and Jak/STAT3 in GSCs, and targeting this pathway may be a promising strategy to treat glioma.
Objective
To investigate the value of three-dimensional time-flying magnetic resonance angiography (3D-TOF-MRA) and three-dimensional fast imaging employing steady-state acquisition sequence (3D-FIESTA) fusion three-dimensional image in identification of offending vessels of primary trigeminal neuralgia (PTN).
Methods
A total of 48 patients with PTN who underwent microvascular decompression (MVD) from January 2016 to June 2019 at Department of Neurosurgery, Affiliated Hospital of Qingdao University were retrospectively enrolled into this study. All patients underwent 3D-TOF-MRA and 3D-FIESTA sequence examinations before operation. The 3D-slicer software was used to fuse 3D-TOF-MRA and 3D-FIESTA sequence images and conduct three-dimensional reconstruction. Using MVD as a standard, 3D-TOF-MRA, 3D-FIESTA and fused images were evaluated to determine the offending vessels and their compressive degree on the nerves.
Results
In MVD, except for 1 patient who had no offending vessel, the other 47 patients had clear offending vessels. The offending vessels were merely arteries in 40 cases, veins in 2, and both arteries and veins in 5. The 3D-TOF-MRA results showed that 5 patients had no offending vessels, and the remaining 43 patients had arteries as offending vessels. The 3D-FIESTA showed that 4 cases had no offending vessels; the offending vessels were arteries in 36 cases, veins in 3 cases, and both arteries and veins in 5 cases. The fused images showed that there were 2 cases without offending vessels; the offending vessels were arteries in 39 cases, veins in 2 cases, and both arteries and veins in 5 cases. Using the MVD as the standard, the accuracy of 3D-TOF-MRA, 3D-FIEST and fusion 3D images for determining the presence/absence offending vessels was 91.7% (44/48), 93.8% (45/48) and 97.9%(45/48), respectively. The accuracy of correct identification of offending vessels by 3D-TOF-MRA, 3D-FIEST and fused images was 54.2% (26/48), 89.6% (43/48) and 93.8% (45/48), respectively. Compared with intraoperative findings, those 3 types of images commonly showed lighter degree of nerve compression, and the differences were statistically significant (all P<0.05).
Conclusion
Compared with 3D-TOF-MRA and 3D-FIESTA single sequences, the fused images seem to be more accurate in identification of the offending vessels of PTN, which, however, is still associated with underestimation of the nerve compression degree.
Key words:
Trigeminal neuralgia; Offending vessel; Three-dimensional time-of-flight magnetic resonance angiography; Three-dimensional fast imaging employing steady-state acquisition; Microva-scular decompression
Objective
To explore the consistency of neurovascular relationships between multimodal image fusion 3D reconstruction and intraoperative findings in microvascular decompression (MVD) for primary trigeminal neuralgia (PTN).
Methods
A retrospective analysis was conducted on the clinical data of 50 PTN patients treated with MVD at Department of Neurosurgery, Qingdao University Hospital from January to November 2018. All subjects underwent three-dimensional time-flying magnetic resonance angiography (3D-TOF-MRA) and three-dimensional cyclic phase steady-state acquisition rapid imaging (3D-FIESTA) sequences. Then, the 3D-slicer software was used to reconstruct the multimodal fusion 3D image. Multimodal image fusion 3D reconstruction images and surgical video were analyzed to determine the offending vessels responsible for trigeminal neuralgia. At the same time, the direction of compression, compression site and compression degree of the trigeminal nerve were analyzed. Kappa consistency test method was used to judge the consistency of the two approaches above.
Results
With MVD set as the standard, the accuracies of multimodal image fusion 3D reconstruction images in determining the offending vessels, direction of compression, compression site and the degree of compression were 92.0% (46/50), 92.0% (46/50), 96.0% (48/50) and 58.0% (29/50), respectively. Multimodal image fusion 3D reconstruction images and MVD showed high consistency in judging offending vessels, compression direction and compression position (Kappa values: 0.729, 0.903 and 0.955 respectively, all P<0.001). However, the consistency was poor in judging the degree of compression of offending vessels to the trigeminal nerve (Kappa value=0.227, P=0.002). The degree of compression was higher in intraoperative findings of MVD than that revealed by multimodal image fusion three-dimensional reconstruction (mean values: 2.57 and 1.58 respectively, Z=-4.499, P<0.001).
Conclusions
Preoperative multi-modal image fusion 3D reconstruction could help accurately determine the offending vessel, compression direction and compression position of PTN, which seems highly consistent with intraoperative findings of MVD. Preliminary speculation could be used as one of the methods facilitating preoperative diagnosis.
Key words:
Trigeminal neuralgia; Multimodal image fusion; Microvascular decompression; Neurovascular relationship; Computer-aided diagnosis
Objective To explore the efficacy ofmicrovascular decompression (MVD) for trigeminal neuralgia and the anatomical characteristics of the responsible blood vessels.Methods In a study of using MVD for the treatment of 136 cases with trigeminal neuralgia,the origins of the responsible blood vessels and sites of compression at the trigeminal root were observed and determined, and the anatomical characteristics of the responsible blood vessels and their efficacy correlation were analyzed.Results The number of the responsible blood vessels of superior cerebellar artery (SCA) lateral branches compressing the upper surface of the trigeminal nerve was 80 sides (58.8%),which was mostly frequently observed;the number of anterior inferior cerebellar artery (AICA) branches compressing the lower surface of the trigeminal nerve was 20 sides (14.7%),which was not so frequently observed;the number of two arteries respectively compressing the upper and lower surfaces of the trigeminal nerve was 18 sides (13.2%);the number of sole veins compressing the trigeminal root was 12 sides (8.8%);and,the number with no vascular compression but evident increase in the thickness of the trigeminal-coated arachnoid mater was 6 sides (4.4%).In the 136 cases,neuralgia of 134 cases disappeared after decompression,namely,the curative rate was 98.5% and MVD failed in two cases.The follow-up study for the 112 cases,with the average of 4.3 year,found that neuralgia of 102 cases disappeared completely,of 4 cases,was partially alleviated and of the other 6 cases,recurred or made no progress at all.□Conclusion Compression of the adjacent blood vessels is one of the primary etiological factors for trigeminal neuralgia and microvascular compression is by far the most effective therapy for the treatment of this disease,the efficacy of which depending on the mastery of professional microsurgical anatomy knowledge and microsurgical techniques.The key to enhancing the efficacy and reducing postoperative complications is carefully searching and assuredly isolating all the responsible blood vessels,and protecting the nerves and blood vessels in adjacent areas.
<b><i>Background:</i></b> Traumatic brain injury (TBI) is considered a major burden across the globe affecting both individuals and their families. Therefore, the present study was conducted to determine the protective effect of diphenhydramine (DPM) against TBI in experimental rats. <b><i>Methods:</i></b> The effect of DPM was evaluated on the cerebral edema (CE) and neuronal degeneration after the induction of experimental brain injury in rats. The effect of DPM was also investigated on the inflammatory cytokines, for example, tumor necrosis factor-α and interleukin 1β and oxidative stress markers, such as malondialdehyde, superoxide dismutase, and glutathione peroxidase. Western blot analysis was used to investigate the effect of DPM on B-cell lymphoma 2 (Bcl-2), Bcl-2-associated X protein (Bax) and cleaved caspase-3. <b><i>Results:</i></b> Results of the study suggest that DPM causes reduction in CE and prevents neuronal degeneration. It also causes reduction in inflammation and oxidative stress in a dose-dependent manner. The level of Bax was found to be elevated, together with reduction in the Bcl-2 level in the DPM-treated group. <b><i>Conclusion:</i></b> DPM exerts a neuroprotective effect after TBI via the attenuation of oxidative stress, inflammation, and mitochondrial apoptosis pathways.
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