Application of robotic-assisted endoscopic third ventriculostomy

Objective:This case series study explored the application of ROSA(robot of stereotactic assistant)robotic-assisted endoscopic third ventriculostomy(ETV)in the treatment of hydrocephalus.Methods:Three patients(January2016-October2017)diagnosed with hydrocephalus based on preoperative computed tomograph(CT)and magnetic resonance imaging(MRI)scans were recruited.Navigation planning scan was performed before operation.ROSA robot localization program was used to simulate and analyze the path planning of hydrocephalus ETV and store it in the system.All the three patients underwent robotic-assisted ETV.The patients'clinical symptoms,imaging manifestations and related complications were evaluated,and a3-month follow-up survey was conducted.Prognostic factors were also analyzed.Results:ETV under the guidance of ROSA robot was successfully performed on the three patients.CT,MRI and cerebrospinal fluid(CSF)cine showed that the ventricles were narrowed,that the velocity and flow of the stoma were normal,and that the CSF flow was smooth.After discharge,the symptoms of hydrocephalus were significantly improved.Localization of the robot and design of the surgical path were key to success of the operation.Conclusions:ROSA robotic-assisted ETV is a feasible procedure.The patients recovered well,and the symptoms relieved.More efforts are needed to optimize artificial intelligence and the application of precision treatment in the nervous system.

Role of EGFL7/EGFR-signaling pathway in migration and invasion of growth hormone-producing pituitary adenomas

Currently, the primary therapeutic strategy for most growth hormone-producing pituitary adenomas(GHPA) is surgery. Due to the invasiveness of GHPA, high recurrence has limited the benefit of complete adenoma removal surgery. Epidermal growth factor-like domain 7(EGFL7) is a secreted factor implicated in tumor angiogenesis, growth, invasiveness and metastasis in GHPA. Herein, we observed that the expression level of EGFL7 and p-EGFR in invasive GHPAwas much higher than that of non-invasive GHPA. The overexpression of EGFL7 was positively correlated with activation of EGFR(p-EGFR). Noticeably, EGFL7 knockdown significantly inhibited activation of EGFR signaling cascades, including p-ERGR, p-AKT and p-ERK. Further studies showed that EGFL7 knockdown or pharmacological inhibition of EGFR-pathway, using EGFR inhibitor Tyrphostin AG-1478, significantly suppressed migration and invasion of GH3 and GT1-1 cells. In summary, our findings suggest that EGFL7 is a key factor for regulation of EGFR signaling pathway and plays an important role in migration and invasion of invasive GHPA.

Application of endoscopic endonasal approach in skull base surgeries: summary of 1886 cases in a single center for 10 consecutive years

Background:Endonasal endoscopic skull base surgery has undergone rapid technological developments and is now widely performed,but its strengths and weaknesses deserve further investigation and deliberation.This study was performed to investigate the surgical indications,complications,and technical advantages and disadvantages of endonasal endoscopic skull base surgery.Methods:The clinical data of 1886 endoscopic endonasal skull base surgeries performed in our ward at Beijing Tiantan Hospital from June 2006 to June 2016 were retrospectively analyzed.Results:One thousand ninety-three(73.4%,1490)pituitary adenomas,54(24.9%,217)chordomas,28(80.0%,35)craniopharyngiomas,and 15(83.3%,18)meningiomas underwent total resection.Two patients died postoperatively,both having pituitary adenomas.Other postoperative complications included olfactory disorders(n=226,11.9%),postoperative cerebrospinal fluid leakage(n=78,4.1%),hypopituitarism(n=74,3.9%),diabetes insipidus(n=64,3.4%),intracranial infection(n=36,1.9%),epistaxis(n=24,1.3%),vascular injury(n=8,0.4%),optic nerve injury(n=8,0.4%),and oculomotor movement impairment(n=4,0.2%).In total,1517(80.4%)patients were followed up for 6 to 126 months(average,42.5 months)postoperatively.A total of 196(13.2%)pituitary adenomas and 13(37.1%)craniopharyngiomas recurred but no meningiomas recurred.Chordomas recurred in 97(44.7%)patients,in whom 5-year survival rate was 65%.Conclusion:Endoscopic surgery is an innovative surgical technique and the first choice for most midline extradural lesions such as chordomas,and an excellent choice for pituitary adenomas.It probably will be a good technique for many kinds of craniopharyngiomas and a common technique for most of skull base meningiomas,so the surgical indications of these cases should be chosen carefully to make good use of its respective advantages.