Background Surgical interventions for moyamoya disease include direct and indirect revascularizations. This study aimed to evaluate the therapeutic effect of superficial temporal artery-middle cerebral artery bypass c...Background Surgical interventions for moyamoya disease include direct and indirect revascularizations. This study aimed to evaluate the therapeutic effect of superficial temporal artery-middle cerebral artery bypass combined with an indirect revascularization procedure, encephalo-duro-myo-synangiosis, in the treatment of moyamoya disease. Methods From October 2005 to November 2009, we performed this combined revascularization procedure in 111 patients with different types and stages of moyamoya disease. The superficial temporal artery, middle meningeal artery and the deep temporal artery were evaluated for individualized surgical planning in these cases. The integrity of the deep temporal artery and the middle meningeal artery network, and the pre-existing spontaneous anastomoses of the distal branches of the external carotid artery with the cortical arteries were well preserved. The mean follow-up time was 72.5 months, all clinical and radiological data were retrospectively reviewed. Results A total of 198 stomas were performed in 122 hemispheres, all remaining patent until the last follow-up. The encephalo-duro-myo-synangiosis resulted in extensive anastomoses of the deep temporal artery （100%）, the middle meningeal artery （90.9%）, and the sphenopalatine artery （39.8%） with the cortical arteries, respectitvely. The superficial temporal artery, deep temporal artery, and the middle meningeal artery were significantly thickened in 88 patients as determined by digital subtraction angiography at follow-up. The relative cerebral blood flow increased significantly within one week after the operation. At 6 months post the operation, the relative cerebral blood flow was further increased by 15.5% from the gradual formation of anastomoses as a result of indirect revascularization. Transient ischemic attacks were effectively reduced or totally arrested. The neurological deficits significantly improved in 37 patients, with the National Institutes of Health Stroke Scale scores lowered by 2-8. There was no rehemorrhage in hemorrhagic moyamoya disease patients. Conclusion This study showed that the superficial temporal artery-middle cerebral artery bypass combined with encephalo-duro-myo-synangiosis can achieve good therapeutic effect in the treatment of moyamoya disease.展开更多
Chordoid meningioma （CM）, characterized by its resemblance to chordoma, was first described by Kepes et al＇ in 1988, and classified histologically as a WHO grade II neoplasm in the 2000 revision of the WHO grading ...Chordoid meningioma （CM）, characterized by its resemblance to chordoma, was first described by Kepes et al＇ in 1988, and classified histologically as a WHO grade II neoplasm in the 2000 revision of the WHO grading system, featured by its aggressive clinical course, great risk of recurrence, and infrequent association with hematological conditions.2 This article describes the clinical course, radiological characteristics, postoperative treatment, and prognosis of 17 patients with CM who underwent surgical treatment at our hospital.展开更多
Background Meningioma is one of the most common primary tumors of the central nervous system, but there are not many detailed studies on the sex, age, subtypes and locations of large series. This study was a retrospec...Background Meningioma is one of the most common primary tumors of the central nervous system, but there are not many detailed studies on the sex, age, subtypes and locations of large series. This study was a retrospective analysis of the characteristics of meningioma cases consecutively operated on at a single institution in China from 2001 to 2010. Methods This study investigated the demographic background of 7084 meningioma cases, and the subtypes and locations of the tumors. Sex and age distributions were analyzed, and the pathological subtypes were classified according to the World Health Organization （WHO） classification. The location of the meningiomas was also categorized. Results The female：male ratio of the 7084 cases was 2.34：1. The mean age was 51.4 years （range, 11 months-86 years）. The mean age of cases of WHO grade I meningioma was significantly older than that of grade II or III meningiomas （P 〈0.001, Fisher＇s Least Significant Digit test）. There was a significantly higher female：male ratio in WHO grade I meningiomas than in grade II or grade III meningiomas （2.57, 1.03 and 0.76, respectively; P 〈0.001, X^2 test）. Meningothelial （n=2061） and fibrous meningiomas （n=3556） were the most common subtypes, comprising 79.3% of all meningiomas. All meningioma cases were classified into 23 locations in this study, with the cerebral convexity the most common site （38.33%, n=2722）. Cases with uncommon locations such as extra-cranial and sylvian fissure meningiomas were also present in this series. Conclusions Female predominance was found for benign meningiomas, while malignant subtypes showed male predominance. The mean age of patients with WHO grade Ⅰ meningiomas was older than that of patients with higher-grade tumors. Meningothelial and fibrous meningiomas were the most common subtypes. The cerebral convexity was the most common menin.qioma location.展开更多
Background The precise mechanisms responsible for the development and growth of intracranial arteriovenous malformations （AVMs） remain unclear. Osteopontin （OPN） is a phosphorylated glycoprotein with diverse funct...Background The precise mechanisms responsible for the development and growth of intracranial arteriovenous malformations （AVMs） remain unclear. Osteopontin （OPN） is a phosphorylated glycoprotein with diverse functions. This study aimed to analyze the expression of OPN in human brain AVMs. Methods The AVM nidus was surgically obtained from patients with AVM, whereas control brain artery specimens were surgically obtained from patients with epilepsy. Reverse transcription-polymerase chain reaction （RT-PCR） was used to examine the expression of OPN mRNA in biopsy specimens. OPN protein expression was localized by immunohistochemistry. The statistical differences between different groups were assessed by two-way analysis of variance （ANOVA）. Results We analyzed 36 brain AVM specimens and 8 control brain artery specimens. Eleven patients with brain AVM received embolization treatment, and five underwent gamma knife radiotherapy before resection. Nineteen patients with brain AVM had a history of hemorrhage from AVMs. The expression of OPN mRNA was significantly higher in AVMs than that in the control specimens （25.76＋2.71 vs. 21.46＋2.01, P 〈0.01）. There was no statistically significant difference in the extent of OPN mRNA expression between the AVM group with and that without history of hemorrhage （26.13＋2.45 vs. 25.34＋2.99） or gamma knife radiotherapy （24.39：1：2.10 vs. 24.53＋1.85）, However, the difference between the AVM group with and that without embolization treatment history was statistically significant （24.39＋2.10 vs. 28.80＋1.13, P 〈0.01）. In the group with gamma knife radiotherapy history, OPN expression was found in arteries with early-stage radio-effect. Conclusions OPN may contribute to the vascular instability of brain AVMs. It may play an important role in the pathophysiological process related to embolization treatment.展开更多
基金grants from the National Natural Science Foundation of China，Natural Science Foundation of Shanghai Science and Technology Committee
文摘Background Surgical interventions for moyamoya disease include direct and indirect revascularizations. This study aimed to evaluate the therapeutic effect of superficial temporal artery-middle cerebral artery bypass combined with an indirect revascularization procedure, encephalo-duro-myo-synangiosis, in the treatment of moyamoya disease. Methods From October 2005 to November 2009, we performed this combined revascularization procedure in 111 patients with different types and stages of moyamoya disease. The superficial temporal artery, middle meningeal artery and the deep temporal artery were evaluated for individualized surgical planning in these cases. The integrity of the deep temporal artery and the middle meningeal artery network, and the pre-existing spontaneous anastomoses of the distal branches of the external carotid artery with the cortical arteries were well preserved. The mean follow-up time was 72.5 months, all clinical and radiological data were retrospectively reviewed. Results A total of 198 stomas were performed in 122 hemispheres, all remaining patent until the last follow-up. The encephalo-duro-myo-synangiosis resulted in extensive anastomoses of the deep temporal artery （100%）, the middle meningeal artery （90.9%）, and the sphenopalatine artery （39.8%） with the cortical arteries, respectitvely. The superficial temporal artery, deep temporal artery, and the middle meningeal artery were significantly thickened in 88 patients as determined by digital subtraction angiography at follow-up. The relative cerebral blood flow increased significantly within one week after the operation. At 6 months post the operation, the relative cerebral blood flow was further increased by 15.5% from the gradual formation of anastomoses as a result of indirect revascularization. Transient ischemic attacks were effectively reduced or totally arrested. The neurological deficits significantly improved in 37 patients, with the National Institutes of Health Stroke Scale scores lowered by 2-8. There was no rehemorrhage in hemorrhagic moyamoya disease patients. Conclusion This study showed that the superficial temporal artery-middle cerebral artery bypass combined with encephalo-duro-myo-synangiosis can achieve good therapeutic effect in the treatment of moyamoya disease.
基金This study was supported by-grants from the National Natural Science Foundation of China （No. 30872675 and No. 30901549）, and Science and Technology Commission of Shanghai Municipality （No. 08411965100 and No. 12JC1401800）. There is no conflict of interest in this manuscript and we strictly follow the protocols of ethical board and clinical practice in China.
文摘Chordoid meningioma （CM）, characterized by its resemblance to chordoma, was first described by Kepes et al＇ in 1988, and classified histologically as a WHO grade II neoplasm in the 2000 revision of the WHO grading system, featured by its aggressive clinical course, great risk of recurrence, and infrequent association with hematological conditions.2 This article describes the clinical course, radiological characteristics, postoperative treatment, and prognosis of 17 patients with CM who underwent surgical treatment at our hospital.
基金This work was supported by grants from the National Natural Science Foundation of China （No. 30872675 and No. 30901549）, and Science and Technology Commission of Shanghai Municipality （No. 08411965100 and No. 12JC 1401800）. Conflict of interest： none.
文摘Background Meningioma is one of the most common primary tumors of the central nervous system, but there are not many detailed studies on the sex, age, subtypes and locations of large series. This study was a retrospective analysis of the characteristics of meningioma cases consecutively operated on at a single institution in China from 2001 to 2010. Methods This study investigated the demographic background of 7084 meningioma cases, and the subtypes and locations of the tumors. Sex and age distributions were analyzed, and the pathological subtypes were classified according to the World Health Organization （WHO） classification. The location of the meningiomas was also categorized. Results The female：male ratio of the 7084 cases was 2.34：1. The mean age was 51.4 years （range, 11 months-86 years）. The mean age of cases of WHO grade I meningioma was significantly older than that of grade II or III meningiomas （P 〈0.001, Fisher＇s Least Significant Digit test）. There was a significantly higher female：male ratio in WHO grade I meningiomas than in grade II or grade III meningiomas （2.57, 1.03 and 0.76, respectively; P 〈0.001, X^2 test）. Meningothelial （n=2061） and fibrous meningiomas （n=3556） were the most common subtypes, comprising 79.3% of all meningiomas. All meningioma cases were classified into 23 locations in this study, with the cerebral convexity the most common site （38.33%, n=2722）. Cases with uncommon locations such as extra-cranial and sylvian fissure meningiomas were also present in this series. Conclusions Female predominance was found for benign meningiomas, while malignant subtypes showed male predominance. The mean age of patients with WHO grade Ⅰ meningiomas was older than that of patients with higher-grade tumors. Meningothelial and fibrous meningiomas were the most common subtypes. The cerebral convexity was the most common menin.qioma location.
基金This study was supported by a grant of the National Natural Science Foundation of China （No. 81000489）.
文摘Background The precise mechanisms responsible for the development and growth of intracranial arteriovenous malformations （AVMs） remain unclear. Osteopontin （OPN） is a phosphorylated glycoprotein with diverse functions. This study aimed to analyze the expression of OPN in human brain AVMs. Methods The AVM nidus was surgically obtained from patients with AVM, whereas control brain artery specimens were surgically obtained from patients with epilepsy. Reverse transcription-polymerase chain reaction （RT-PCR） was used to examine the expression of OPN mRNA in biopsy specimens. OPN protein expression was localized by immunohistochemistry. The statistical differences between different groups were assessed by two-way analysis of variance （ANOVA）. Results We analyzed 36 brain AVM specimens and 8 control brain artery specimens. Eleven patients with brain AVM received embolization treatment, and five underwent gamma knife radiotherapy before resection. Nineteen patients with brain AVM had a history of hemorrhage from AVMs. The expression of OPN mRNA was significantly higher in AVMs than that in the control specimens （25.76＋2.71 vs. 21.46＋2.01, P 〈0.01）. There was no statistically significant difference in the extent of OPN mRNA expression between the AVM group with and that without history of hemorrhage （26.13＋2.45 vs. 25.34＋2.99） or gamma knife radiotherapy （24.39：1：2.10 vs. 24.53＋1.85）, However, the difference between the AVM group with and that without embolization treatment history was statistically significant （24.39＋2.10 vs. 28.80＋1.13, P 〈0.01）. In the group with gamma knife radiotherapy history, OPN expression was found in arteries with early-stage radio-effect. Conclusions OPN may contribute to the vascular instability of brain AVMs. It may play an important role in the pathophysiological process related to embolization treatment.
