Isotropic volumetric MRI for displaying cranial perineural spread of cranial nerve in nasopharyngeal carcinoma

Objective To observe the value of isotropic volumetric MRI for displaying perineural spread(PNS)of cranial nerve(CN)in nasopharyngeal carcinoma.Methods Eighty-seven patients with pathologically proven nasopharyngeal carcinoma were prospectively enrolled.MR scanning,including three-dimensional liver acquisition with volume acceleration-flexible(3D LAVA_Flex)image,T2WI with fat suppression(T2WI-FS),T1WI,contrast enhancement(CE)T1WI-FS of nasopharynx and neck region were performed.The displaying rates of CN PNS were evaluated and compared between 3D LAVA_Flex and T2WI-FS,T1WI,CE-T1WI-FS at patient level,CN group level and neural level,respectively.Results The displaying rate of CN PNS in all 87 nasopharyngeal carcinoma patients by 3D LAVA_Flex sequence was 49.43%(43/87),higher than that of conventional MRI(30/87,34.48%,P=0.001).Among 59 patients with advanced nasopharyngeal carcinoma diagnosed with conventional sequences,the displaying rate of CN PNS was 71.19%(42/59)by 3D LAVA-Flex sequence,higher than that of conventional MRI(30/59,50.85%,P=0.001).At both patient level and posterior CN level,significant differences of the displaying rate of CN PNS were found between 3D LAVA-Flex sequence and T2WI-FS,T1WI,CE-T1WI-FS,while at CN level,the displaying rates of mandibular nerve PNS,CNⅨ—ⅪPNS in jugular foramen(P<0.05)and CNⅨ—ⅫPNS in carotid space of 3D LAVA_Flex sequence were all significantly higher than that of T2WI-FS,T1WI and CE-T1WI-FS(all P<0.05),of PNS of CNⅢ—Ⅴin cavernous sinus were higher than that of T2WI-FS(P<0.05),while of PNS of hypoglossal nerve were significantly higher than that of T2WI-FS and T1WI(both P<0.05).Conclusion 3D LAVA_Flex sequence could be used to effectively display CN PNS of nasopharyngeal carcinoma.

Skull Base Osteomyelitis: A Rare Cause of Multiple Cranial Nerve Palsies—A Case Report from Ghana

Introduction: Skull Base Osteomyelitis (SBO) is an infectious inflammation of the skull bones that is often caused by malignant otitis externa (MOE) and affects the temporal bone. This condition commonly affects immunocompromised individuals and the elderly, particularly those with a history of diabetes mellitus. Diagnosis is challenging because of non-specific symptoms that lead to late detection and complications. This report discusses a case of SBO with multiple bilateral cranial nerve abnormalities and highlights the diagnostic and management challenges in high-risk individuals with subtle clinical signs. Case presentation: This report describes a 63-year-old patient with hypertension and diabetes who underwent surgical debridement of the left ear due to malignant otitis externa 4 months prior to presentation. The patient presented with significant dysarthria, dysphagia, ptosis of the left eye with double vision, and hearing impairment in the left ear. Examination revealed bilateral CN VI palsy, right CN VII palsy, left CN VIII palsy, and a right CN XII deficit. Initial tests were unremarkable, but a high Fungitell assay and a second review of the CT scan and MRI revealed a pathological process in the base of the skull involving bony structures and cranial nerves bilaterally, which helped diagnose SBO. The patient was subsequently discharged with oral voriconazole and continued his usual medications. The patient requested further management abroad, because he did not notice resolution of his symptoms. Surgical treatment was employed abroad to relieve his symptoms, as he recovered slowly. Conclusion: This case report underscores the importance of a multidisciplinary approach to address SBO. Collaboration between specialists in infectious diseases, otolaryngology, radiology, and neurology plays a pivotal role in achieving an accurate diagnosis and developing a tailored treatment plan. Although SBO may be infrequent, this case report highlights the need to maintain heightened clinical suspicion in high-risk individuals.

Bone Defect of the Cranial Vault: Difficulty of the Diagnostic about a Case, and Revew of Literature

The bone defects of the cranial vault encompassed rare malformations including acalvaria, hypocalvaria, acrania, hypocrania, anencephaly and exencephaly. They are also described in some pathological entities such as aplasia cutis congenita of the scalp. We report an unusual case of cephalic malformation which combine defects of the skin, the dura mater, and the bones of the vault, with a malformation of the central nervous system. This unique case emphasizes a problem of nosological definition between the terms mentioned above. acalvaria, the acrania, the hypocalvaria and the aplasia cutis congenita. Thus, herein, we proceed to a literature review of bone defects of the skull and their differential diagnosis.

Cranial morphometric study of four giant flying squirrels(Petaurista)(Rodentia:Sciuridae) from China

The present study revisited the controversial taxonomic status ofPetaurista yunanensis, P. philippensis, P. hainana, and P. petaurista by using a considerably extended set of morphometrical characters （26 cranial variables from 60 adult specimen skulls）. The results revealed no sexual dimorphism in any of the four species but confirmed significant craniometric differences among the four species in both the principal components analysis （PCA） and discriminant function analysis （DFA）, with the greatest distinction observed between P. petaurista and other Petaurista species. Both univariate and multivariate analysis indicated that the morphological differences between P. yunanensis and P. philippensis were less than that between P. philippensis and P. hainana. The morphometric results were concordant in geographic patterns with mtDNA data from previous studies and indicated that P. petaurista, P. hainana, P. philippensis, and P. yunanensis could be recognized as valid species.

Imaging of the Extra-axial Tumors and Tumor-like Lesions Involving both Middle and Posterior Cranial Fossae: Classification and Diagnosis

Objective: To study the imaging features of extra-axial tumors and tumor-likelesions involving both middle and posterior cranial fossae and to make a classification. Methods:Sixty cases of pathologically confirmed extra-axil tumors and tumor-like lesions involving bothmiddle and posterior cranial fossae were analyzed. They were divided into central and lateral types,the latter of which were subdivided into three types: middle cranial fossae type, posterior cranialfossae type and the over-riding type. The constitution and imaging features of each type wereanalyzed. Results: There were 12 cases of central type, including chordoma (n=5), pituitary adenoma(n=3), nasopharyngeal carcinoma (n=2), craniopharyn-gioma (n=1) and meningioma (n=l). 48 cases oflateral type including trigeminal nerve tumors (n=14), meningioma (n=12), epidermoid cyst (n=11),dural cavernous hemangioma (n=4), dermoid cyst (n=2), metastasis (n=2), hemangiopericytoma (n=1),paraganglioma of glonius jugular (n=1) and nasopharyngeal carcinoma (n=1). Each type of the lesionshad its own shape features, some of which were characteristic for some specific tumors. Most of thetumors and tumor-like lesions could be qualitatively diagnosed according to their imagingcharacteristics and the extent of the lesions could be defined definitely. Conclusion: It is helpfulto categorize extra-axial tumors and tumor-like lesions involving both middle and posterior cranialfossae according to their location for qualitative diagnosis and description of the extent of theselesions. It is of great clinical value in providing more precise and thorough imaging informationfor planning therapeutic methods and route of operation.

Management of an intracranial hypotension patient with diplopia as the primary symptom:A case report

BACKGROUND Intracranial hypotension(IH)is a disorder involving cerebrospinal fluid(CSF)hypovolemia due to spontaneous or traumatic spinal CSF leakage and is easily being misdiagnosed or missed,especially in these patients without the prototypical manifestation of an orthostatic headache.At present,the management of IH with both cranial nerve VI palsy and bilateral subdural hematomas(SDHs)is still unclear.CASE SUMMARY A 67-year-old male Chinese patient complained of diplopia on the left side for one and a half mo.Computed tomography revealed bilateral SDHs and a midline shift.However,neurotrophic drugs were not effective,and 3 d after admission,he developed a non-orthostatic headache and neck stiffness.Enhanced magnetic resonance imaging revealed dural enhancement as an additional feature,and IH was suspected.Magnetic resonance myelography was then adopted and showed CSF leakage at multiple sites in the spine,confirming the diagnosis of having IH.The patient fully recovered following multiple targeted epidural blood patch(EBP)procedures.CONCLUSION IH is a rare disease,and to the best of our knowledge,IH with diplopia as its initial and primary symptom has never been reported.In this study,we also elucidated that it could be safe and effective to treat IH patients with associated cranial nerve VI palsy and bilateral SDHs using repeated EBP therapy.

Tirobot Cranial立体定向手术机器人辅助脑深部电极植入定位精度的研究

目的目前,国外研发的Neuromate、Rosa等立体定向手术机器人已通过美国FDA、欧洲CE标准认证,从而使得立体定向电极植入术逐渐在神经外科展开使用。北京天坛医院充分利用立体定向手术技术的优势,与北京天智航公司合作开展应用,研究Tirobot Cranial机器人辅助颅内电极植入定位的精准性,并分析影响电极植入定位精确度的相关因素。方法北京天坛医院神经外科与北京天智航公司合作,以家猪头颅为实验对象,进行Tirobot Cranial机器人辅助脑深部电极植入实验。术后复查CBCT验证入颅点及靶点的偏差,计算平均值及标准差,以评价机器人定位精准性;并进行误差影响因素分析。结果共进行7次实验,计划植入电极35根,术中实际植入电极35根,成功率达100%。电极平均植入长度(43.17±6.64)mm,植入电极平均入颅点误差为(0.63±0.23)mm,平均靶点定位误差为(0.96±0.41)mm。误差影响因素分析显示,入颅点偏离与靶点偏离的误差呈正相关(r=0.399,P<0.05)。结论通过修正电极植入工具参数的偏差,以及预先使用螺纹针钻孔,防止打滑等措施;Tirobot Cranial系统辅助颅内电极植入整体最佳的定位精度达到0.5 mm,具有良好的精准性及稳定性;电极植入的准确性可基本满足临床定位的需求。

Management of Intracranial Complications of Sinusitis

Intracranial complications of sinusitis are rare. However, they have an important morbidity and mortality rate, and can be a source of disabling neurological sequelae in the absence of a rapid diagnosis and adequate treatment. We carry a retrospective study of 23 patients having sinusitis with intracranial complications, treated between 1996 and 2011. All patients underwent complete ENT and neurological examination, biological investigations and sinonasal and cerebral CT. An intraveinous large-spectrum antibiotherapy was administered to all patients. Twenty patients underwent surgery. It included evacuation of the intracranial collection, sinus drainage, with or without cranialization of the frontal sinus. Evolution was assessed on clinical biological and radiological criteria. Mean age was 25 years and sex-ratio was 3.6. Neurological signs were the most frequent symptoms. Rhinological signs were essentially purulent rhinorrhea (14 cases) and nasal obstruction (12 cases). Nasal endoscopy showed pus in the middle meatus in 10 cases. On CT, intracranial complications included subdural empyema (11 cases), extradural empyema (7 cases) and brain abscess (5 cases). Associated cerebral thrombophlebitis was noted in 4 cases. Three patients with extradural empyema had had an exclusive medical treatment. All other patients (20 cases) were operated. Clinical and radiological evolution was favorable after initial treatment in 14 cases (60.8%). Six patients required secondary surgery. Two patients have died despite intensive care. The intracranial complications of sinusitis are serious and source of important morbidity and mortality. Management should rapid and adequate, combining effective antibiotic therapy and eventually neurosurgical treatment.

STUDY OF NEONATAL INTRACRANIAL HAEMORRHAGE AND HYPOXIC ISCHEMIC ENCEPHALOPATHY

A series of 100 cases of newborn babies of Apgar scores ≤7 or gestationage ≤32 weeks were studied by head ultrasonography (US) and CT scans. Forty-twopoint four percent of the cerebral lesions observed was subependymal-intraventricularhaemorrhage (SEH-IVH), 24.1% of which was in preterm infants and 18. 3% infull-terms, 7. 6% had subdural haemorrhage (SDH), 6. 3% had intraparenchymalhaemorrhage (IPH), 2.5% had subarachnoid haemorrhage (SAH) and 1.9% hadintracerebellar haemorrhage (ICEH). Sixteen point five percent were diagnosed ashypoxic-ischemic encephalopathy (HIE). The diagnostic accuracy of cerebralultrasonography was 82.8% by comparing with necropsy findings in 14 infants. Agreementbetween US and CT scan was 63.3%. The study shows that it was not easy to distinguishHIE from intracranial haemorrhage (ICH) clinically, the US and CT scans may be neces-sary. We revealed that the clinical severity of HIE did not follow the degree of CTchanges, and US was more sensitive in SEH-IVH, however, SDH was more sensitive inCT scans. Neurodevelopmental follow-ups were performed at 1.5-24 months (mean 7.5months) in 76 survival infants. Twenty-three of these infants (30. 3%) hadventriculomegaly. The mental and psychomotor performances on the Bayley scales were ab-normal in 33.3% (12/36) infants. Eight infants were noted to have major handicapsincluding impaired vision, diplegia, epilepsy or/and severe developmental delay.

Clinical Analysis of Lumbar Pool Drainage Combined with Antibiotics in the Treatment of Intracranial Infection

Objective: To explore the clinical effect of lumbar pool drainage combined with antibiotics in the treatment of patients with intracranial infections, and to provide a reference basis for clinical treatment. Methods: To collect and select patients admitted to the First People’s Hospital of Jingzhou City for craniotomy from January 2016 to June 2022, the infected were 20 cases, and continuous drainage of the lumbar pool was used under the premise of systemic application of sensitive antibiotics. Results: Twenty cases in this group were discharged cured. Conclusion: Lumbar pool placement drainage combined with systemic application of antibiotics for intracranial infection is a safe and effective treatment method.

Minimally Invasive Pericranial Flap for Reconstruction after Endonasal Endoscopic Surgery of 30 Consecutive Patients

Objectives/Hypothesis: The introduction of intranasal pedicled flaps has reduced the incidence of postoperative cerebrospinal fluid (CSF) leaks to less than 5%. Nevertheless, in malignant tumors those flaps are not always available because of nasal septum invasion. Minimally invasive pericranial flaps (PCF) are associated with minimal adverse effects and good cosmetic appearance. In spite of that, there are only a few reports of this reconstructive technic limited to short surgical series and radio-anatomical analysis. Clinical results of a surgical cohort are presented. Study Design: Cohort prospective study. Methods: Clinical data, including age, gender, stage, histopathological findings, rate of complications and appearance of PCF at fifth day and two months postoperative were recorded. Postoperative morbidities were recorded as wound abnormalities, nasosinusal, orbital and central nervous system complications. Chi-squared test was used to correlate qualitative variables and Student-t-test to correlated qualitative and quantitative variables. Items were considered statistically significant with a p value of less than 0.05 (confidence Interval of 95%). Results: Thirty patients (18 males and 12 females) were registered. Mean age was 51.5 years ± 23.0 and range between 20 and 71 years. Most common histologic subtypes were adenocarcinoma, epidermoid carcinoma and squamous cell carcinoma. Complete resection of the tumor was achieved in all patients including surgical margins. Length of the PCF varies between 9.9 cm and 13.9 cm with a mean of 11.8 cm. There was an association between length of the flaps and the covering structure with the nose apex relation. None patient experienced postoperative cerebrospinal fluid (CSF) leak, frontal sinusitis or other complications. Conclusions: Minimally invasive PCF constitute a good and inexpensive reconstructive option in patients with malignant anterior cranial base tumors in whose nasoseptal flap was not a feasible option.

Undiagnosed Anterior Cranial Fossa Dural Arteriovenous Fistula with Intracranial Hematoma: Case Report and Review of the Literature about Its Natural History

Dural arteriovenous fistulas (dAVFs) of an anterior cranial fossa are rare. Because of the high risk of intracranial hemorrhage and relatively easy access for direct surgery, aggressive treatment has been recommended. The natural history of anterior cranial fossa dAVFs (ACF dAVFs) is unclear in spite of many reports for the natural history of general dAVFs. To treat ACF dAVFs, direct surgery has traditionally been performed and endovascular surgery has recently been introduced. A 74-year-old man was transferred with severe consciousness disturbance and presented with devastating intracerebral hemorrhage on the CT scan. Digital subtraction angiography revealed the ACF dAVFs with a large venous pouch. The patient received direct surgery, nevertheless he became vegetative state. Later on, a smaller venous pouch was recognized on the CT scan when he had suffered from the thalamic hemorrhage sixteen months before. There are twelve cases including our case which was treated for a certain period and documented in detail. Eleven of twelve cases were asymptomatic. Three of the six cases with a venous pouch had some events possibly related to the disease, though none of the six cases without a venous pouch had any events during observation. In conclusion, an ACF dAVF with a venous pouch should be treated by direct surgery or endovascular surgery even if it is incidentally found. By contrast, careful observation might be a possible therapeutic option for an ACF dAVF without a venous pouch if there is mild reflux flow.

Current landscape in motoneuron regeneration and reconstruction for motor cranial nerve injuries

The intricate anatomy and physiology of cranial nerves have inspired clinicians and scientists to study their roles in the nervous system. Damage to motor cranial nerves may result from a variety of organic or iatrogenic insults and causes devastating functional impairment and disfigurement. Surgical innovations directed towards restoring function to injured motor cranial nerves and their associated organs have evolved to include nerve repair, grafting, substitution, and muscle transposition. In parallel with this progress, research on tissue-engineered constructs, development of bioelectrical interfaces, and modulation of the regenerative milieu through cellular, immunomodulatory, or neurotrophic mechanisms has proliferated to enhance the available repertoire of clinically applicable reconstructive options. Despite these advances, patients continue to suffer from functional limitations relating to inadequate cranial nerve regeneration, aberrant reinnervation, or incomplete recovery of neuromuscular function. These shortfalls have profound quality of life ramifications and provide an impetus to further elucidate mechanisms underlying cranial nerve denervation and to improve repair. In this review, we summarize the literature on reconstruction and regeneration of motor cranial nerves following various injury patterns. We focus on seven cranial nerves with predominantly efferent functions and highlight shared patterns of injuries and clinical manifestations. We also present an overview of the existing reconstructive approaches, from facial reanimation, laryngeal reinnervation, to variations of interposition nerve grafts for reconstruction. We discuss ongoing endeavors to promote nerve regeneration and to suppress aberrant reinnervation and the development of synkinesis. Insights from these studies will shed light on recent progress and new horizons in understanding the biomechanics of peripheral nerve neurobiology, with emphasis on promising strategies for optimizing neural regeneration and identifying future directions in the field of motor cranial neuron research.

Gardner's syndrome:Genetic testing and colonoscopy are indicated in adolescents and young adults with cranial osteomas:A case report

We present a case of a 25-year-old female with diagnosed familial adenomatous polyposis and elevated carcinoembryonic antigen with negative family history. The suspicion of Gardner's syndrome was raised because extirpation of an osteoma of the left temporo-occipital region was made 10 years ago. Restorative procto-colectomy and ileal pouch anal anastomosis was made but histology delineated adenocarcinoma of the rectum (Dukes C stage). We conclude that cranial osteomas often precede gastrointestinal manifestations of familial adenomatous polyposis or Gardner's syndrome and such patients should be evaluated with genetic testing followed by colonoscopy if results are positive to prevent the development of colorectal carcinoma. If the diagnosis is positive all family members should be evaluated for familial adenomatous polyposis.

Cranial variation in allactagine jerboas(Allactaginae,Dipodidae, Rodentia): a geometric morphometric study

Allactaginae is a subfamily of dipodids consisting of four-and five-toed jerboas(Allactaga, Allactodipus,Orientallactaga, Pygeretmus, Scarturus) found in open habitats of Asia and North Africa. Recent molecular phylogenies have upended our understanding of this group's systematics across taxonomic scales. Here, I used cranial geometric morphometrics to examine variation across 219 specimens of 14 allactagine species(Allactaga major, A. severtzovi, Orientallactaga balikunica, O.bullata, O. sibirica, Pygeretmus platyurus, P. pumilio,P. shitkovi, Scarturus aralychensis, S. euphraticus,S. hotsoni, S. indicus, S. tetradactylus, S. williamsi)in light of their revised taxonomy. Results showed no significant sexual size or shape dimorphism. Species significantly differed in cranial size and shape both overall and as species pairs. Species identity had a strong effect on both cranial size and shape. Only a small part of cranial shape variation was allometric,with no evidence of unique species allometries, and most specimens fit closely to the common allometric regression vector. Allactaga was the largest,followed by Orientallactaga, Scarturus, and finally Pygeretmus. Principal component 1(PC1) separated O. bullata+O. balikunica+S. hotsoni(with inflated bullae along with reduced zygomatic arches and rostra) from A. major+A. severtzovi+O. sibirica(with converse patterns), while PC2 differentiated Orientallactaga(with enlarged cranial bases and rostra along with reduced zygomatic arches and foramina magna) from Scarturus+Pygeretmus(with the opposite patterns). Clustering based on the unweighted pair group method with arithmetic mean(UPGMA) contained the four genera, but S. hotsoni clustered with O. bullata+O. balikunica and O.sibirica clustered with A. major+A. severtzovi, likely due to convergence and allometry, respectively.

Gα_s signaling controls intramembranous ossification during cranial bone development by regulating both Hedgehog and Wnt/β-catenin signaling

How osteoblast cells are induced is a central question for understanding skeletal formation. Abnormal osteoblast differentiation leads to a broad range of devastating craniofacial diseases. Here we have investigated intramembranous ossification during cranial bone development in mouse models of skeletal genetic diseases that exhibit craniofacial bone defects. The GNAS gene encodes Gαs that transduces GPCR signaling. GNAS activation or loss-of-function mutations in humans cause fibrous dysplasia(FD) or progressive osseous heteroplasia(POH) that shows craniofacial hyperostosis or craniosynostosis, respectively. We find here that, while Hh ligand-dependent Hh signaling is essential for endochondral ossification, it is dispensable for intramembranous ossification, where Gαsregulates Hh signaling in a ligand-independent manner. We further show that Gαscontrols intramembranous ossification by regulating both Hh and Wnt/β-catenin signaling. In addition, Gαsactivation in the developing cranial bone leads to reduced ossification but increased cartilage presence due to reduced cartilage dissolution, not cell fate switch. Small molecule inhibitors of Hh and Wnt signaling can effectively ameliorate cranial bone phenotypes in mice caused by loss or gain of Gnas function mutations, respectively. Our work shows that studies of genetic diseases provide invaluable insights in both pathological bone defects and normal bone development, understanding both leads to better diagnosis and therapeutic treatment of bone diseases.

The Flight Dynamics of Tapejara,a Pterosaur From the Early Cretaceous of Brazil with a Large Cranial Crest

Tapejara wellnhoferi, a small azhdarchoid pterodactyloid from the Early Cretaceous Santana Formation of Brazil, provides critical information about the aerodynamic function of its spectacular head crest. The cranial crests in pterodactyloids were sexually dimorphic and are thought to have evolved in adult males in response to female mate choice. However, the location of cranial crests in front of the center of gravity would create instability in the yaw axis during flight and may seem like a handicap. Vertically aligned webbed feet probably suppressed the yawing rotations and instability from the crest. Here we show that the crest functioned as a front rudder to make agile turn and mediate flight control. A computer simulation model suggests that Tapejara had a large excess of muscle power available above the power required for continuous flapping flight. It could easily takeoff from a perch, ground, or water surface and land safely on the ground. It was an excellent glider with a gliding angle close to 4~ and a cruising speed of 27 km/h. Tapejara could soar efficiently on the windward side of cliffs or circle on rising thermals over tropical waters for efficient long-distance flight. Various control surfaces in the wings of Tapejara analogous to the slat, aileron, elevator, fin, rudder, and horizontal stabilizer of an aircraft made pterodactyloids versatile flyers.

Active fraction combination from Liuwei Dihuang decoction improves adult hippocampal neurogenesis and neurogenic microenvironment in cranially irradiated mice

OBJECTIVE Cranial radiotherapy is clinically used in the treatment of brain tumors;however,the consequent cognitive and emotional dysfunctions seriously impair the life quality of patients.LW-AFC,an active fraction combination extracted from classical traditional Chinese medicine prescription Liuwei Dihuang decoction,can improve cognitive and emotional dysfunctions in many animal models;however,the protective effect of LW-AFC on cranial irradiation-induced cognitive and emotional dysfunctions has not been reported.Recent studies indicate that impairment of adult hippocampal neurogenesis(AHN)and alterations of the neurogenic microenvironment in the hippocampus constitute critical factors in cognitive and emotional dysfunctions following cranial irradiation.Here,our research further investigated the potential protective effects and mechanisms of LW-AFC on cranial irradiation-induced cognitive and emotional dysfunctions in mice.METHODS LW-AFC(1.6 g·kg^(-1))was intragastrically administered to mice for 14 d before cranial irradiation(7 Gyγ-ray).AHN was examined by quantifying the number of proliferative neural stem cells and immature neurons in the dorsal and ventral hippocampus.The contextual fear conditioning test,open field test,and tail suspension test were used to assess cognitive and emotional functions in mice.To detect the change of the neurogenic microenvironment,colorimetry and multiplex bead analysis were performed to measure the level of oxidative stress,neurotrophic and growth factors,and inflammation in the hippocampus.RESULTS LW-AFC exerted beneficial effects on the contextual fear memory,anxiety behavior,and depression behavior in irradiated mice.Moreover,LW-AFC increased the number of proliferative neural stem cells and immature neurons in the dorsal hippocampus,displaying a regional specificity of neurogenic response.For the neurogenic microenvironment,LW-AFC significantly increased the contents of superoxide dismutase,glutathione peroxidase,glutathione,and catalase and decreased the content of malondialdehyde in the hippocampus of irradiated mice,accompanied by the increase in brain-derived neurotrophic factor,insulin-like growth factor-1,and interleukin-4 content.Together,LW-AFC improved cognitive and emotional dysfunctions,promoted AHN preferentially in the dorsal hippocampus,and ameliorated disturbance in the neurogenic microenvironment in irradiated mice.CONCLUSION LW-AFC ameliorates cranial irradiation-induced cognitive and emotional dysfunctions,and the underlying mechanisms are mediated by promoting AHN in the dorsal hippocampus and improving the neurogenic microenvironment.LW-AFC might be a promising therapeutic agent to treat cognitive and emotional dysfunctions in patients receiving cranial radiotherapy.

Effective administration of cranial drilling therapy in the treatment of fourth degree temporal,facial and upper limb burns at high altitude:A case report

BACKGROUND Fourth degree burns damage the full thickness of the skin and affect underlying tissues.Skin grafting after debridement is often used to cover the wounds of salvageable severe burns.A granulation wound can be formed by drilling the skull to the barrier layer to solve the problem of skull exposure.Low oxygen levels present at high altitudes aggravate ischemia and hypoxia which can negatively impact wound healing.The impaired healing in such cases can be ameliorated by hyperbaric oxygen therapy.CASE SUMMARY We describe a patient who presented with fourth degree burns to the left temporal and facial regions upon admission in December 2018.The periosteum of the skull and the deep fascia of the face were exposed.After the first stage of debridement and skin grafting,the temporal skin did not survive well.Granulation was induced by cranial drilling,and then a local flap was transferred to cover the wound.The left temporal and facial wounds were completely covered and the patient recovered well.CONCLUSION Skin grafting and flap transfer after early debridement to cover the wound and control infection were of great significance.In the later stages of the patient's treatment,survival of the skin graft and skin flap was observed.The second stage repair was performed to achieve successful skin grafting by cranial granulation.Granulation was formed by drilling the skull,and then the wound was closed,which is suitable for cases with skull exposure and wounds with poor blood supply.We consider that hyperbaric oxygen treatment and improving tissue oxygen supply were beneficial in this patient.

Hepatocellular carcinoma metastasizing to the skull base involving multiple cranial nerves

We describe a rare case of HCV-related recurrent multiple hepatocellular carcinoma （HCC） metastasizing to the skull base involving multiple cranial nerves in a 50-year-old woman. The patient presented with symptoms of ptosis, fixation of the right eyeball, and left abducens palsy, indicating disturbances of the right oculomotor and trochlear nerves and bilateral abducens nerves. Brain contrast-enhanced computed tomography （CT） revealed an ill-defined mass with abnormal enhancement around the sella turcica. Brain magnetic resonance imaging （HR/） disclosed that the mass involved the clivus, cavernous sinus, and petrous apex. On contrast-enhanced HRI with gadolinium-chelated contrast medium, the mass showed inhomogeneous intermediate enhancement. The diagnosis of metastatic HCC to the skull base was made on the basis of neurological findings and imaging studies including CT and MRI, without histological examinations, Further studies may provide insights into various methods for diagnosing HCC metastasizing to the craniospinal area.