Intracranial malignant meningioma with cerebrospinal fluid dissemination: a case report

Malignant meningiomas are uncommon intracranial tumors. The metastasis of malignant meningiomas to distant extracranial sites are well known. However, dissemination of the tumours in the cerebrospinal fluid (CSF) is rare and few cases have been reported. We present a case of histologically proven malignant meningioma with CSF dissemination at the remote intracranial area and into the spinal canal detected with magnetic resonance imaging.

     

Syringomyelia after operation： diagnosis and its formational mechanism

Objective： To describe the MRI findings and discuss the pathogenesis formation mechanism of syringomyelia in the patients after spine surgical operation. Methods： Totally 13 patients were been enrolled in the study. Before operation, none of our patients presented with spinal cord syringomyelia. The mean follow-up duration was 6 years （range 2-10 months） by MRI. Four of the 13 patients after spinal cord tumor removed operation, 3 patients after spinal trauma operation, 2 cases had scoliosis before, 2 cases were cervical spondylotic myelopathy and 2 cases had tethered cord syndrome before operation. MR features of pre- and post-operation on all patients were been studied in contrast with surgical results and clinical symptoms. The radiology diagnostic was made by 3 different radiologists respectively. The characteristics of length, width, signals, shape of cavity and spinal cord position as well as subarachnoid shape were focused on. Results： All the patients had no syringomyelia on MRI before operation. The spinal cord of 7 patients showed persist compression and 2 patients had tethered cord before operation. MRI features of syringomyelia after operation in our cases showed longitudinal cavity with syrinx fluid had T1 and T2 relation characteristics of cerebrospinal fluid （CSF）. The mean length was 5.5 spinal segment, 4 cord of 13 patients presented cord compressed from anterior materials, 4 occurred postoperative adhesion to the back of lumbar spinal canal and spinal cord of 1 cases clung to the front wall of cervical spinal canal. Conclusion： The mechanism of syringomyelia in the patients after spinal surgical intervention may be the persisting compression or intention of the spinal cord in the period of pre- or post-operation. The edema, cyst, malacia of spinal cord are the most important lesions and risk factors resulted in the syringomyelia.     

Changes of p38 Mitogen-activated Protein Kinase and Apoptosis after Spinal Cord Injury

There were very few studies about signal transductionof apoptosis of the spinal cord injury (SCI). We appliedspinal cord compression rats model (Nystrom's method) tostudy the changes of p38 mitogen-activated protein kinase(MAPK) and its relationship with apoptosis.A specific inhibitor of p38 MAPK, SB203580 (5 mg/mL), was immediately injected into the subarachnoid space(0.3 mg/kg) using micro-injection after the compressiveinjury of the spinal cord. For control group, SCI modelwas only i…     

Materials for neuro-transplantation and the amnion

Though tens thousands of people are suffering from spinal cord injury （the majority are young people）, effective treatments are rare. To patients doctors may say ＂we have done our best, let＇s wait and see if some miracle will happen.＂ It is glad that decades＇ researches have shed some light on the mechanism of spinal cord damage and identified several targets for intervention. The successful transplants in mammal animals in particular get our hopes up for the repair of human spinal cord injury.     

Progress in Intraoperative Neurophysiological Monitoring for the Surgical Treatment of Thoracic Spinal Stenosis

Thoracic spinal stenosis (TSS) is a group of clinical syndromes caused by thoracic spinal cord compression, which always results in severe clinical complications. The incidence of TSS is relatively low compared with lumbar spinal stenosis, while the incidence of spinal cord injury during thoracic decompression is relatively high. The reported incidence of neurological deficits after thoracic decompression reached 13.9%. Intraoperative neurophysiological monitoring (IONM) can timely provide information regarding the function status of the spinal cord, and help surgeons with appropriate performance during operation. This article illustrates the theoretical basis of applying IONM in thoracic decompression surgery, and elaborates on the relationship between signal changes in IONM and postoperative neurological function recovery of the spinal cord. It also introduces updated information in multimodality IONM, the factors influencing evoked potentials, and remedial measures to improve the prognosis.     

症状性成人脊髓栓系综合症

Tethered spinal cord syndrome （TCS） is a condition of overstretching or compression of the caudal part of the spinal cord caused by various spinal lesions, such as a tight filum terminale or an intraspinal lipoma.l-9 Though it is a well-recognized cause of neurological deterioration in childhood, its symptomatic onset in adulthood is uncommon. Eleven cases of TCS are presented here. In addition, their related clinical features, surgical procedures and outcomes are investigated.     

Magnetic resonance imaging and microsurgical treatment of intramedullary hemangioblastoma of the spinal cord.

Thirteen cases of intramedullary hemangioblastoma of the spinal cord were studied radiologically, especially with magnetic resonance imaging (MRI). Microsurgery was used to remove the tumors in all cases. Signs and symptoms were improved in 84.6% of the cases after operation. The diagnosis and microsurgical techniques for excision of intramedullary hemangioblastoma of the spinal cord are discussed. This dis-ease should be differentiated from hydromyelia, intramedullary ependymoma, and vascular malformation of the spinal cord. Total removal of the tumor is recommened.     

Influence of neurotrophin-3 on Bcl-2 and Bax expressions in spinal cord injury of rats

Objective： To study the protective mechanisms of neurotrophin-3 （NT-3） on the spinal cord injury. Methods：Totally 105 SD rats were randomly divided into 3 groups： control group, experimental group and sham operation group. Rats from the former 2 groups were inflicted to animal model of acute spinal cord injury according to Allen＇s （WD） by situating a thin plastic tube in the subarachnoid space below the injury level for perfusion. Rats in experimental group received 20 ul NT-3 （200 ng） from the tube at 0, 4, 8, 12, 24 h and 3, 7 d after injury, and those in control group got an equal volume of normal saline at the same time. The animals in sham operation group only received opening vertebral plate and tube was put in subarachnoid space. The rats were sacrificed at 4, 8, 12, 24 h and 3, 7, 14 d post injury （n=5）. The expression levels of Bcl-2 and Bax proteins in spinal cord of rats were detected by immunohistochemistry assay. Results： The level of Bax protein in control group significantly increased as compared with those in sham operation group, and the peak reached at 8 h after spinal cord injury. The Bcl-2 proteins were always weakly positive. The Bax proteins in NT-3 group significantly decreased but the Bcl-2 proteins obviously increased as compared with those in control group. Conclusion： NT-3 can protect spinal cord from injury in vivo. One of the mechanisms is that NT-3 can inhibit abnormal expression of Pax protein, and increase the expression of Bcl-2 protein, then inhibit apoptosis after spinal cord injury.     

Pleomorphic xanthoastrocytoma in the lateral ventricle with extensive subarachnoid dissemination: report of a case and review of the literature

Pleomorphic xanthoastrocytoma (PXA) is a rare benign tumor that is usually located in the superficial cerebral hemisphere. Most reports of PXAs have included only a single case or small series. Therefore, the data with respect to the natural history of this tumor are fragmentary. We report a case of a PXA in the unusual location of the right lateral ventricle with extensive subarachnoid dissemination. To our knowledge, this is a rare case of PXA in the lateral ventricle. In addition, extensive subarachnoid space dissemination of this distinctly benign type of glioma is exceedingly rare. In our case, there was meningeal dissemination and metastases to the bilateral trigeminal nerves and oculomotor nerves. The neuroradiographic features, tumor location, and dissemination were reviewed.

     

THE TREATMENT OF SPINAL CORD INJURY CASES BY MEANS OF SPINAL OMENTUM TRANSPOSITION

Omentum transposition to cervical spinal cord for the treatment of traumatic cervical spinal cord myelopathy.In treating spinal cord injury, the clinic of cervical spinal cord injury has to face the problems of tetraplegia and control of Respiration. The application of various kins of treatment include skull traction, laminectomy, intervebral bone graft fusion and omen turn spinal cord transposition. We have treated 10 cases in the period from June, 1986 to June, 1983. The discussion will focus on the Oinentum transposition to cervical spinal cord and the related problems of cervical spinal cord injury.     

Diagnosis and treatment of primary diffuse-type tenosynovial giant cell tumors of the cervical spine

Diffuse-type tenosynovial giant cell tumor （D-TGCT） belongs to a group of lesions believed to arise from tendon sheaths,bursae,or the synovium of diarthrodial joints.The etiology of D-TGCT is unknown.Because it shares histological characteristics with pigmented villonodular synovitis,however,D-TGCT is also termed extra-articular pigmented villonodular synovitis.D-TGCT,which occurs mainly in middle-aged women （20-50 years of age1）,usually involves large load-bearing joints （e.g.,knee,ankle,and hip）.Clinical case reports of D-TGCT involving the spine are rare.2 We retrospectively analyzed a series of three patients diagnosed with cervical D-TGCT in our department over a 10-year period.     

Vascular stent as a treatment for refractory cervical stenosis

Cervical stenosis is a clinical condition involving partial or complete obstruction of the endocervical canal.In 1996,Bauldauf proposed that the definition of cervical stenosis is a cervical canal into which a 2.5# Hegar dilator cannot be inserted.1 Acquired cervical stenosis can be a complication of surgical procedures such as conization,trachelectomy,and curettage.It is a serious complication because of the clinical repercussions,which can include amenorrhea,hematometra,dysmenorrhea,infertility,infection,and endometriosis.Various surgical techniques are used in dilation and cervix reconstruction.However,in some cases,unsuccessful dilation with refractory recurrent stenosis may lead to hysterectomy.A successful case in which a self-expanding nitinol vascular stent was used to treat cervical stenosis was described by Grund et al.2 Here we report two additional cases in which vascular stents were used to treat patients with recurrent cervical stenosis after cervical surgeries.     

HPV16 E5 peptide vaccine in treatment of cervical cancer in vitro and in vivo

Human papillomavirus （HPV）-induced cervical cancer is the second most common cancer among women worldwide. Despite the encouraging development of the preventive vaccine for HPV, a vaccine for both prevention and therapy or pre-cancerous lesions remains in high priority. Thus far, most of the HPV therapeutic vaccines are focused on HPV E6 and E7 oncogene. However these vaccines could not completely eradicate the lesions. Recently, HPV E5, which is considered as an oncogene, is getting more and more attention. In this study, we predicted the epitopes of HPV16 E5 by bioinformat- ics as candidate peptide, then, evaluated the efficacy and chose an effective one to do the further test. To evaluate the effect of vaccine, rTC-1 （TC-1 cells infected by rAAV-HPV16E5） served as cell tumor model and rTC-1 loading mice as an ectopic tumor model. We prepared vaccine by muscle injection. The vaccine effects were determined by evaluating the function of tumor-specific T cells by cell prolif- eration assay and ELISPOT, calculating the tumor volume in mice and estimating the survival time of mice. Our in vitro and in vivo studies revealed that injection of E5 peptide＋CpG resulted in strong cell-mediated immunity （CMI） and protected mice from tumor growth, meanwhile, prolonged the sur- vival time after tumor cell loading. This study provides new insights into HPV16 E5 as a possible target on the therapeutic strategies about cervical cancer.     

Correlation between magnetic resonance T2 image signal intensity ratio and cell apoptosis in a rabbit spinal cord cervical myelopathy model

Background Cervical spondylotic myelopathy （CSM） is a common cause of disability in elderly patients.Previous studies have shown that spinal cord cell apoptosis due to spinal cord compression plays an important role in the pathology of myelopathy.Although changes in magnetic resonance imaging （MRI） T2 signal intensity ratio （SIR） are considered to be an indicator of CSM,little information is published supporting the correlation between changes in MRI signal and pathological changes.This study aims to testify the correlation between MRI T2 SIR changes and cell apoptosis using a CSM animal model.Methods Forty-eight rabbits were randomly assigned to four groups：one control group and three experimental chronic compression groups,with each group containing 12 animals.Chronic compression of the cervical spinal cord was implemented in the experimental groups by implanting a screw in the C3 vertebra.The control group underwent sham surgery.Experimental groups were observed for 3,6,or 9 months after surgery.MRI T2-weighted SIR Tarlov motor scores and cortical somatosensory-evoked potentials （CSEPs） were periodically monitored.At each time point,rabbits from one group were sacrificed to determine the level of apoptosis by histology （n=6） and Western blotting （n=6）.Results Tarlov motor scores in the compression groups were lower at all time points than the control group scores,with the lowest score at 9 months （P ＜0.001）.Electrophysiological testing showed a significantly prolonged latency in CSEP in the compression groups compared with the control group.All rabbits in the compression groups showed higher MRI T2 SIR in the injury epicenter compared with controls,and higher SIR was also found at 9 months compared with 3 or 6 months.Histological analysis showed significant apoptosis in the spinal cord tissue in the compression groups,but not in the control group.There were significant differences in apoptosis degree over time （P ＜0.001）,with the 9-month group displaying the most severe spinal cord apoptosis.Spearman＇s rank correlation test showed that there was close relation between MRI SIR and degree of caspase-3 expression in Western blotting （r=0.824.P ＜0.001）.Conclusions Clear apoptosis of spinal cord tissue was observed during chronic focal spinal compression.Changes in MRI T2 SIR mav be related to the severity of the apoptosis in cervical spinal cord.     

Anomalous vertebral artery not passing through the transverse foramen of the atlas

Ssually the vertebral artery （VA） arises from the first part of the subclavian artery and enters the transverse foramen of the C-6 vertebra （first segment） and then ascends through the transverse foramen from C-6 to the atlas （second segment）. In its third segment, the artery emerges on the superior surface of the atlas and curves horizontally over the lateral and posterior surfaces of the superior articular process of C-1 and then passes medially in front of the posterior atlanto-occipital membrane. In its fourth segment, the artery pierces the dura mater and arachnoid between the occipital bone and atlas then enters the cranial cavity through the foramen magnum. To identify and preserve the VA is vital in the surgery of the craniaocervical and cervical region. However, the variations of the VA complicate the procedures of VA identification. It is valuable to know the course of VA preoperatively. Some anatomical variations of the VA occur due to its abnormal development process.     

Saffron （Crocus sativus L.） and major depressive disorder： a meta-analysis of randomized clinical trials

Due to safety concerns and side effects of many antidepressant medications, herbal psychopharmacology research has increased, and herbal remedies are becoming increasingly popular as alternatives to prescribed medications for the treatment of major depressive disorder （MDD）. Of these, accumulating trials reveal positive effects of the spice saffron （Crocus sativus L.） for the treatment of depression. A comprehensive and statistical review of the clinical trials examining the effects of saffron for treatment of MDD is warranted. OBJECTIVE： The purpose of this study was to conduct a meta-analysis of published randomized controlled trials examining the effects of saffron supplementation on symptoms of depression among participants with MDD. SEARCH STRATEGY： We conducted electronic and non-electronic searches to identify all relevant randomized, double-blind controlled trials. Reference lists of all retrieved articles were searched for relevant studies. INCLUSION CRITERIA： The criteria for study selection included the following： （1） adults （aged 18 and older） with symptoms of depression, （2） randomized controlled trial, （3） effects of saffron supplementation on depressive symptoms examined, and （4） study had either a placebo control or antidepressant comparison group. DATA EXTRACTION AND ANALYSIS： Using random effects modeling procedures, we calculated weighted mean effect sizes separately for the saffron supplementation vs placebo control groups, and for the saffron supplementation vs antidepressant groups. The methodological quality of all studies was assessed using the Jadad score. The computer software Comprehensive Meta- analysis 2 was used to analyze the data. RESULTS： Based on our pre-specified criteria, five randomized controlled trials （n = 2 placebo controlled trials, n = 3 antidepressant controlled trials） were included in our review. A large effect size was found for saffron supplementation vs placebo control in treating depressive symptoms （M ES = 1.62, P 〈 0.001）, revealing that saffron supplementation significantly reduced depression symptoms compared to the placebo control. A null effect size was evidenced between saffron supplementation and the antidepressant groups （M ES = -0.15） indicating that both treatments were similarly effective in reducing depression symptoms. The mean Jadad score was 5 indicating high quality of trials. CONCLUSION： Findings from clinical trials conducted to date indicate that saffron supplementation can improve symptoms of depression in adults with MDD. Larger clinical trials, conducted by research teams outside of Iran, with long-term follow-ups are needed before firm conclusions can be made regarding saffron＇s efficacy and safety for treating depressive symptoms.     

Association between intervertebral disc degeneration and disturbances of blood supply to the vertebrae

Low back pain is a common public health problem in western industrialized societies and the world as well.Studies indicate that the prevalence rate ranges to 35%, with around 10% of patients from 12% becoming chronically disabled. It also places an enormous economic burden on society. Although the exact cause of low back pain has yet to be defined, intervertebral disc degeneration is considered a major source of it. Since patients with degenerative discs are often asymptomatic, the mechanisms of it are still unclear.     

Relevance of muscle biopsy for diagnosing multifocal motor neuropathy

Multifocal motor neuropathy （MMN） is a rare,.focal,inflammatory,demyelinating disease of the peripheral nerves with pure motor involvementJ MMN is clinically characterized by slowly progressive,asymmetric,distal,upper limb predominant weakness,in the absence of sensory disturbances） Weakness is usually multifocal and connected to a distinct motor nerve,such as the musculocutaneous nerve resulting in biceps weakness,the posterior interosseus nerve resulting in finger drop,the median,ulnar,or radial nerve resulting in dexterity problems or grip weakness,or the peroneal nerve resulting in a foot drop.Onset of clinical manifestations is between 20 and 50 years of age.The prevalence of MMN is reported as 1-2 per 100 000.2 MMN is three times more frequent in men as compared to women.