Intraventricular and subarachnoid basal cisterns neurocysticercosis: a comparative study between traditional treatment versus neuroendoscopic surgery

Objective  

The purpose of this study was to evaluate the efficacy of traditional treatment and minimal invasive flexible endoscopy surgery (MIFNES) in the treatment of intraventricular and subarachnoid basal cisterns neurocysticercosis (NCC).     

Garcin syndrome resulting from a giant cell tumor of the skull base in a child

Garcin syndrome is characterized by a progressive ipsilateral involvement of cranial nerves, culminating in paralysis of all or at least seven of them, without sensory or motor long-tract disturbance, with no intracranial hypertension, and with osteoclastic involvement in the skull base on radiographic computed tomography. Giant cell tumor is a primary bone tumor rarely affecting the skull base. An 8-year-old female presented with a 3-month history of increasingly worsening right otalgia, tinnitus, hearing loss, right facial numbness, and diplopia. She was admitted with a 2-week history of swallowing difficulties, voice change, and right shoulder pain. Neurologic examination disclosed unilateral paralysis of the right fifth through twelfth cranial nerves, with no other abnormal neurologic findings. Skull radiographic computed tomography revealed lytic lesions in the right temporal petrous portion. Computed tomographic scan indicated a destructive mass involving the right greater wing of the sphenoid bone and temporal petrous apex. Magnetic resonance imaging demonstrated a tumor arising from the temporosphenoidal region, infiltrating neither the brain nor the brainstem. No hydrocephalus was observed. Biopsy revealed giant cell tumor. Posterior treatment consisted of radiotherapy. At an 8-year follow-up, the patient was well but with functional sequelae. There is no magnetic resonance imaging evidence of tumor growth. No other giant cell tumor presenting as Garcin syndrome is known to have been reported.     

颅骨巨细胞瘤的诊断和治疗

目的探讨颅骨巨细胞瘤的诊断和治疗原则。方法对2001年6月至2004年5月间手术治疗经病理证实的颅骨巨细胞瘤11例进行总结。结果11例患者5例肿瘤位于颞骨，5例位于蝶骨，1例位于额骨，临床表现以第Ⅱ～Ⅷ颅神经受累多见，CT上可见局部颅骨的破坏，MRI上肿瘤在T1像和他像上多呈混杂信号，尤其是T2像上的低信号多见。手术则分别采用额颞开颅、颞部人路、经蝶人路和经额人路，3例全切除，5例近全切除，3例大部分切除。手术并发症包括视力减退和脑脊液耳漏各1例。术后9例患者经过11个月至4年的随访，其中6例接受了放疗，结果所有患者肿瘤均无明显复发，能够恢复正常工作和学习。结论颅骨巨细胞瘤可根据其特有的临床、影像学特点诊断，手术是首选的治疗方法，术后放疗的效果有待进一步探讨。     

Obesity treatment: The role of surgery

Obesity, defined as an excess in body fat, constitutes one of the most common and significant health problems in the United States today. The current prevalence of overweight is 33.4% of US adults. Obesity has been shown to be an independent risk factor for the development of cardiovascular diseases such as hypertension, dyslipidemia, myocardial infarction and stroke. Death from cardiovascular causes increases significantly with body weight. This article will review the modalities of treatment available with particular attention to surgical treatment of obesity. The indications, associated risks, current procedures, and expected results of surgical treatment of obesity will be discussed.     

Russel's syndrome: diencephalic tumor in a child

The case of a male child with Russel's syndrome due to a pilocytic astrocytoma located in the diencephalic region is presented. The diagnosis was made in the 16th month of age, but symptoms began in the 4th months of life, when he started losing weight. By the time he was admitted weight was 6150g and he was 74cm tall, with an emaciated aspect, no panniculus adiposus, irritated, and with symptoms of intracranial hypertension. There was convergent strabismus, vertical nystagmus of the left eye and bilateral papilledema. Tendinous reflexes were exacerbated and he had spastic tetraparesis. The endocrine evaluation showed a basal raise of GH (23ng/ml), TSH (6.2mUI/1) and prolactin (26ng/ml). The first two hormones did not respond to the acute test with TRH, while prolactin had a poor response. He was submitted to radiotherapy with linear acceleration (total dose of 4000 rads) and surgery, during which the tumor could not be completely removed due to its large size. After 9 months, the child is doing well, with a considerable weight gain (2500g).     

Endovascular treatment of a giant aneurysm of the internal carotid artery in a child with visual loss: case report

We report on a case of a giant aneurysm of the internal carotid artery in a 11-year old boy presenting with gradual unilateral visual loss, combined with slight headache and retro-orbital pain. Endovascular balloon occlusion of the internal carotid artery combined with monitoring of somatosensory evoked potentials was performed. Follow-up MR imaging six months after balloon occlusion revealed complete thrombosis and considerable retraction of the aneurysm. However, visual loss persisted, since therapy was initiated too late and optic nerve atrophy had already occurred. It is important to emphasize that visual disturbance should be considered as an emergency, and, although rare, aneurysms do occur in the pediatric population.     

巨大型颈静脉球瘤的诊断和治疗

目的探讨巨大型颈静脉球瘤的诊断和治疗经验。方法对７例病人行临床影像学检查和手术治疗，３例术后辅以放疗和／或γ刀治疗。结果颈静脉球瘤病人症状多不典型。肿瘤全切除４例，次全或大部切除３例，死亡１例。６例随访１～３５年，预后良好。结论要重视本病发病隐蔽的特点，及时进行影像学检查。扩大的后外侧枕下入路利于全切除肿瘤及提高疗效     

Current status of neuroendoscopic surgery in Japan and discussion on the training system

Objectives The objectives of this study was to investigate the current status of neuroendoscopic surgery in Japan and to discuss the issue disclosed by the survey. Methods We delivered questionnaires about neuroendoscopic surgeries to 1,237 of Japan Neurosurgical Society certified training institutions. Results Of these institutions, 592 (47.9%) returned completed questionnaires, and 316 (53.4%) among them experienced neuroendoscopic surgeries in the past. Two hundred seventy-six institutions had at least one procedure in the year 2003, but 208 (75.5%) had only one to ten procedures per year. Total number of procedures was 2,796, and trans-sphenoidal surgery was performed most frequently (705). Aneurysmal neck clipping (637) was second, and the third place was third ventriculostomy (ETV, 357). ETV was performed at 126 institutions, and 112 (88.9%) of them had only five cases or under per year. Discussion Neuroendoscopic surgeries are performed at many institutions, but little experience per institution was reported. We refer to the on-going project of the Japanese Society for Neuroendoscopy on establishing training system of neuroendoscopic surgeries. Presented at the Third World Conference of the International Study Group on Neuroendoscopy (ISGNE), Marburg, Germany, 15–18 June 2005.     

神经内镜与开颅手术治疗高血压脑出血的疗效比较

目的 比较神经内镜手术与开颅手术两种方法治疗高血压脑出血的疗效.方法 回顾性分析2011年5月至2013年6月期间收治的54例接受手术治疗的高血压脑出血患者,将其分为神经内镜治疗组和开颅手术治疗组,其中神经内镜组28例,开颅手术组26例.术后随访3个月以上,观察两组患者的日常生活能力(ADL)评分,ADL评分Ⅰ～Ⅲ级为预后良好,ADL评分Ⅳ～Ⅴ级及死亡患者为预后不良.结果 神经内镜治疗组死亡1例,开颅手术治疗组死亡2例,差异无统计学意义(P＞0.05).ADL评价神经内镜治疗组良好率82.1％ (23/28),开颅手术治疗组53.9％(14/26),神经内镜治疗组疗效优于开颅手术治疗组,差异有统计学意义(P＜0.05).结论 应用神经内镜技术治疗高血压脑出血具有创伤小、疗效好等优点.     

The role of EC-IC in the treatment of giant intracranial aneurysms

Extracranial to intracranial bypass surgery was used in 27 cases of intracranial giant aneurysm to prevent ischemic complications. In 19 of 21 patients the aneurysm was considered unfit for a direct clipping or ligation, and an EC-IC bypass was done in conjunction with staged clipping of the internal carotid artery or occlusion of the middle cerebral artery. All bypass grafts have remained patent postoperatively. None of the patients have developed ischemic complications in the 6--14 month period of follow-up.     

Bobble-head doll syndrome due to a suprasellar arachnoid cyst: endoscopic treatment in two cases

Object We report two cases of bobble-head doll syndrome associated with a large suprasellar arachnoid cyst successfully treated with a minimally invasive endoscopic approach.Methods The clinical history, surgical treatment and results of two children, a 9-year-old boy and a 1-year-old girl, both presenting the clinical features of the bobble-head doll syndrome, are described. As a first procedure, a ventriculo-cystostomy was endoscopically performed in both patients, obtaining either resolution of the symptoms or notable cyst reduction. In the girl, a re-closure of the stoma, with cyst re-expansion, was observed after 18 months. She then underwent a second procedure, a ventriculo-cysto-cisternostomy, with a good result. After 3 years follow-up, the neurological condition of both patients remains good with complete resolution of abnormal head movement.Conclusion In our opinion, endoscopic treatment is the procedure of choice for this condition, as it involves few complications and gives good results.     

术中超声引导神经内镜手术与脑室外引流术治疗脑室内血肿伴铸型的对比分析研究

目的 对比分析术中超声引导神经内镜手术和脑室外引流术治疗脑室血肿伴铸型的安全性及有效性。方法 选取我科2016年5月至2018年11月间脑室血肿伴铸型的患者60例,根据脑室血肿伴铸型的类型分为三型,采取分层数字随机法将患者分成两组,对照组（n=30）采取传统的脑室外引流术治疗,实验组（n=30）则采取术中超声引导神经内镜下脑室内血肿清除术,比较两组临床疗效。结果 实验组术后24 h血肿清除率、术后24小时GCS评分、术后6月Barthel日常生活能力评分均明显高于对照组（P<0.05）,实验组引流管带管时间、住院时间较对照组缩短,同时降低死亡率（P<0.05）;实验组术区再出血、分流依赖性脑积水、颅内感染与对照组比较无统计学差异（P>0.05）。结论 术中超声引导下神经内镜手术治疗脑室血肿伴铸型是安全、有效的,该治疗方案优于脑室外引流术。     

术中超声引导神经内镜手术与脑室外引流术治疗脑室内血肿伴铸型的对比分析研究

目的对比分析术中超声引导神经内镜手术和脑室外引流术治疗脑室血肿伴铸型的安全性及有效性。方法选取我科2016年5月至2018年11月间脑室血肿伴铸型的患者60例,根据脑室血肿伴铸型的类型分为三型,采取分层数字随机法将患者分成两组,对照组(n=30)采取传统的脑室外引流术治疗,实验组(n=30)则采取术中超声引导神经内镜下脑室内血肿清除术,比较两组临床疗效。结果实验组术后24 h血肿清除率、术后24小时GCS评分、术后6月Barthel日常生活能力评分均明显高于对照组(P0.05),实验组引流管带管时间、住院时间较对照组缩短,同时降低死亡率(P0.05);实验组术区再出血、分流依赖性脑积水、颅内感染与对照组比较无统计学差异(P 0.05)。结论术中超声引导下神经内镜手术治疗脑室血肿伴铸型是安全、有效的,该治疗方案优于脑室外引流术。     

Leech giant glial cell: functional role in a simple nervous system

The giant glial cell in the central nervous system of the leech Hirudo medicinalis has been the subject of a series of studies trying to link its physiological properties with its role in neuron-glia interactions. Isolated ventral cord ganglia of this annelid offer several advantages for these studies. First, single giant glial cells can easily be identified and are quite accessible to electrophysiological and microfluorometric studies. Second, only two giant macroglial cells are located in the neuropil of each ganglion, rendering them well suited for studying neuron-glia interactions. Third, many neurons can be identified and are well known with respect to their physiology and their roles in controlling simple behaviors in the leech. This review briefly outlines the major recent findings gained by studying this preparation and its contributions to our knowledge of the functional role of glia in nervous systems. Emphasis is directed to glial responses during neuronal activity and to the analysis of intracellular Ca(2+) and H(+) transients mediated by neurotransmitter receptors and ion-driven carriers. Among its numerous properties, the leech giant glial cell prominently expresses a large K(+) conductance, voltage-dependent Ca(2+) channels, ionotropic non-NMDA glutamate receptors, and an electrogenic, reversible Na(+)-HCO(3)(-) cotransporter.