原发于眼眶脑膜瘤的CT图像分析

目的分析原发于眼眶脑膜瘤的常见CT图像特征,探讨CT影像对原发于眼眶脑膜瘤的诊断价值。方法回顾性分析51例经病理确诊的原发于眼眶脑膜瘤患者的临床资料和CT图像表现。探讨CT对脑膜瘤的诊断及鉴别诊断价值。结果 51例原发于眼眶脑膜瘤患者中视神经鞘脑膜瘤43例,眶骨膜脑膜瘤8例。视神经鞘脑膜瘤43例中肿瘤形状呈管状20例,块状12例,其他形状11例;呈现车轨征16例,钙化斑6例。8例眶骨膜脑膜瘤均有蝶骨大翼和(或)小翼骨膜增厚及眶外壁骨质增生,其中视神经向内移位6例。所有病例中肿瘤蔓延者8例,双眼眶发病2例。结论 CT图像可清晰显示肿瘤的位置、形状、范围,尤其是眶骨壁改变,对于原发于眼眶脑膜瘤的诊断及治疗具有重要的临床指导意义。     

Intracranial Arterial Compression of the Anterior Visual Pathway

Compression of anterior visual pathway (AVP) structures by intracranial arteries is observed not infrequently on neuroimaging. Whether or not such compression results in damage to these structures, however, remains unclear. This information is important to define as AVP compression by intracranial arteries may be a causative factor in patients with otherwise unexplained visual dysfunction. In a single centre, 37 patients with evidence of intracranial artery AVP compression demonstrated on magnetic resonance imaging were identified by retrospective review of case records over the period 2011–2017. Variables were collected, including patient demographics, visual acuity, visual fields, pupillary reactions and optic disc appearance for patients in the case series. Visual field deficits correlated with compression sites in the 37 patients examined. Internal carotid artery-optic nerve compression was the most frequent (unilateral compression n = 9, bilateral compression n = 14), followed by chiasmal compression by the anterior cerebral artery (n = 8) and a combination of optic nerve and chiasmal compression (n = 5). Visual acuity and visual fields were stable on follow-up (mean 4 years) in 24 of 26 cases (93%). We conclude that AVP compression by intracranial arteries may be a causative factor in unexplained visual dysfunction. The visual defects are largely non-progressive.     

Analysis of the Activation of the Nrf2-ARE Pathway Following Optic Nerve Injury in Mice

 Purpose:Nrf2-ARE pathway plays a cytoprotective role in many tissues,but its protective function in the optic nerve is unclear. The purpose of the study is to investigate the changes of the activation of Nrf2-ARE pathway following optic nerve injury (ONI) in mice. Methods:Using ONI mice models, the expression levels of Nrf2 in optic nerves were determined by real-time PCR at various time points. Results:The expression of Nrf2mRNA was significantly upregulated at 1 d after ONI, peaking at 30min after ONI. Conlusions: Nrf2-ARE pathway was activated after ONI, providing evidence for the study of the protection and underlying mechanism of Nrf2-ARE pathway on optic nerves.     

Acute Retrobulbar Optic Neuropathy as the Sole Manifestation of Subarachnoid Haemorrhage from a Ruptured Anterior Communicating Artery Aneurysm

Abstract

Anterior communicating artery aneurysm is the most common form of intracranial aneurysm and subarachnoid haemorrhage (SAH) is the common presenting feature of anterior communicating artery aneurysms. In general, patients with SAH from anterior communicating artery aneurysm present with neurological deficit. We report an interesting case of a 60-year-old man who presented with acute monocular vision loss accompanied by periorbital pain without any neurological deficit, finally diagnosed with SAH from ruptured anterior communicating artery aneurysm. Five months after immediate craniotomy with aneurysm neck clipping, his visual acuity was improved to 20/63 with a pale optic disc appearance. Acute retrobulbar optic neuropathy may be the sole manifestation of SAH from ruptured anterior communicating artery aneurysm. Unilateral decrease of visual acuity with periorbital pain, in the absence of other neurological change, may be the initial and isolated sign.     

Whole-body fluorine-18 fluordeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in staging of advanced uveal melanoma

Fluorine-18 fluordeoxyglucose positron emission tomography (FDG-PET) is an useful tool in diagnosing and monitoring of malignant cutaneous melanoma. However, the feasibility and usefulness of FDG-PET in uveal melanoma is not yet established. We present a patient with suspected advanced uveal melanoma who underwent combined FDG-PET/computed tomography (CT) for staging. FDG-PET/CT images demonstrated vital intraocular tumor. Anatomical assignment of the malignancy to the choroid was possible by means of the coregistered computed tomography. Furthermore, PET revealed an unknown otherwise undetected vital liver metastasis. We conclude that combined FDG-PET/CT has potential to further improve staging and therapy planning in patients with advanced uveal melanoma.     

常见鞍区肿瘤的磁共振成像分析

目的：介绍鞍区肿瘤的磁共振成像的特点。方法：回顾性分析86例经临床病理确诊的颅内鞍区常见肿瘤的磁共振成像图像资料。结果：鞍区肿瘤中以脑垂体瘤为多见,垂体大腺瘤影响视功能,垂体微腺瘤一般不影响视功能,其它鞍区肿瘤的磁共振成像有其各自的相应特点。结论：磁共振成像是鞍区肿瘤早期诊断的有效方法。     

消朦灵对糖尿病大鼠视网膜TNF-α及JAK/STAT信号转导通路的调控作用

目的：探讨消朦灵片对肿瘤坏死因子α（TNF-α）和Janus激酶2/信号转导与转录激活子途径5（JAK2/ STAT5）信号通路的调控作用,及防治糖尿病视网膜病变的机理。方法：实验研究。选取50 只SD雄性大鼠,随机抽取8只作为空白组。余42只以链脲佐菌素（STZ）腹腔注射诱导制作糖尿病大鼠模型;造模成功40 只,随机分成模型组、低剂量组、中剂量组和高剂量组,每组10 只。模型组不予处理,低剂量组、中剂量组和高剂量组分别给予消朦灵片0.1 g/100 g、0.2 g/100 g、0.3 g/100 g进行治疗。治疗4 个月后观察各组大鼠体质量、血糖变化。通过光学显微镜及透射电子显微镜观察视网膜超微结构变化。采用Western Blot法检测TNF-α、JAK2/STAT5 蛋白表达的变化。对相关数据行重复测量资料的方差分析及单因素方差分析。结果：空白组大鼠视网膜中TNF-α、JAK/STAT有少量表达,模型组表达较多,消朦灵低剂量、中剂量、高剂量组表达依次减少,其中高剂量组表达明显下降,差异有统计学意义（F=4.61、4.23、3.28,P<0.05）。生物光学显微镜下大鼠视网膜结构,空白组结构正常;模型组各层组织排列紊乱,视网膜水肿,毛细血管扩张明显,神经节细胞数量减少,细胞核固缩,内核层空泡变性;高剂量组视网膜各层排列欠规则,轻度水肿,神经节细胞及内核层数量减少。透射电镜下空白组大鼠视网膜结构正常;模型组外节膜盘中段断裂、溶解、溃变,线粒体嵴消失,排列不规则,视锥细胞形态不规则,核中染色质分布不均匀,毛细血管基底膜增厚,管腔狭窄;高剂量组视网膜外节膜盘间隙扩大,排列欠整齐,部分线粒体肿胀变形,视锥细胞核染色欠均匀,毛细血管基底膜厚度不均匀。结论：消朦灵对糖尿病大鼠视网膜中TNF-α、JAK/STAT信号通路有显著的调控作用,能有效防止糖尿病视网膜微血管病变,延缓糖尿病视网膜病变的进程。     

Recurrent Optic Neuropathy Caused by a Mucocele of the Anterior Clinoid Process after a 5-Year Remission: A Case Report and Literature Review

A 32-year-old male presented with acute left vision loss during a second recurrence of optic neuropathy. Steroid pulse therapy had been effective in both the first episode 9 years previously and the first recurrence 5 years previously. Magnetic resonance imaging demonstrated an anterior clinoid process mucocele compressing the optic nerve. Although surgical treatment was performed, improvement was limited. This report indicates that steroid pulse therapy could be an alternative treatment to obtain temporary remission, but surgical treatment should be considered to prevent irreversible neurological deficits. This paper also presents a review of the literature on anterior clinoid process mucoceles.     

Tumors of the optic nerve head

A variety of primary and secondary tumors can involve the optic nerve head. Examples of primary optic disc tumors include capillary, cavernous and racemose hemangiomas, astrocytomas, and melanocytomas. Secondary optic disc tumors include metastatic carcinoma, leukemia, and those which invade the nerve head from adjacent structures (choroidal melanoma, retinoblastoma, and meningioma). These tumors may produce a variety of clinical features and are discussed in this review. Included also are histopathologic correlations and guidelines for management of the individual entities.     

Optic nerve sheath fenestration for treating papilloedema in the era of cerebral venous sinus stenting

Background

Pseudotumour cerebri (PTC) is the syndrome of intracranial hypertension without intracranial mass or hydrocephalus and is the commonest cause of papilloedema seen in many eye clinics. In the last 10 years, we have increasingly used TSS in patients whose papilloedema was not well controlled with medical treatment and have done fewer ONSFs. Here, we review our experience at Royal Prince Alfred Hospital Sydney with ONSF in 35 patients over the period 2002–2021.

Methods

Retrospective case series of 35 patients, 30 of whom had primary PTC [i.e., idiopathic intracranial hypertension (IIH)] and 5 with secondary PTC.

Results

Eighteen patients had bilateral ONSF and 17 patients unilateral ONSF, in each case of the worse eye. Thirteen patients then underwent transverse sinus stenting (TSS), in each case following ONSF. The primary outcome measures were visual acuity (VA) and mean deviation (MD) on visual field (VF) testing. MD improved by 5 dB or more in 34 of 70 total eyes (48.6%); VA improved by 0.2 logMAR (two lines on Snellen chart) or more in 21 eyes (30%), and by both in 15 eyes (21.4%). Final MD was −10 dB or better in 38 eyes (54.3%); final VA was 0.3 (6/12) or better in 54 eyes (77.1%), and both in 39 eyes (55.7%).

Conclusions

The results confirm that ONSF can relieve papilloedoema in both eyes and improve both VF and VA, even in cases of fulminant PTC with severe acute visual impairment.     

Rho/ROCK pathway and neural regeneration: a potential therapeutic target for central nervous system and optic nerve damage

Rho-associated kinase (ROCK) is a serine/threonine kinase and one of the major downstream effectors of the small GTPase RhoA. The Rho/ROCK pathway is closely related to the pathogenesis of several central nervous system (CNS) disorders, and involved in many aspects of neuronal functions including neurite outgrowth and retraction. In the adult CNS, the damaged neuron regeneration is very difficult due to the presence of myelin-associated axon growth inhibitors such as Nogo, myelin-associated glycoprotein (MAG) and oligodendrocyte-myelin glycoprotein (Omgp), etc. The effects of these axon growth inhibitors are reversed by blocking the Rho/ROCK pathway in vitro, and the inhibition of Rho/ROCK pathway can promote axon regeneration and functional recovery in the injured CNS in vivo. In addition, the therapeutic effects of the Rho/ROCK inhibitors have also been demonstrated in some animal models and the Rho/ROCK pathway becomes an attractive target for the development of drugs for treating CNS disorders. In this review, we summarized on the effect of the Rho and the downstream factor ROCK in neural regeneration, and the potential therapeutic effect of Rho/ROCK inhibitors in the survival and axonal regeneration of retinal ganglion cells was also discussed.     

Genetic Testing for Wolfram Syndrome Mutations in a Sample of 71 Patients with Hereditary Optic Neuropathy and Negative Genetic Test Results for OPA1/OPA3/LHON

In this study, the authors present a sample of 71 patients with hereditary optic neuropathy and negative genetic test results for OPA1/OPA3/LHON. All of these patients later underwent genetic testing to rule out WFS. As a result, 53 patients (74.7%) were negative and 18 patients (25.3%) were positive for some type of mutation or variation in the WFS gene. The authors believe that this study is interesting because it shows that a sizeable percentage (25.3%) of patients with hereditary optic 25 neuropathy and negative genetic test results for OPA1/OPA3/LHON had WFS mutations or variants.     

The Protective Effects of KAT5 Inhibition on Ocular Inflammation by Mediating the PI3K/AKT Pathway in a Murine Model of Allergic Conjunctivitis

PurposeWe aimed to explore the effect of lysine acetyltransferase KAT5 on allergic conjunctivitis (AC).MethodsThe effect of KAT5 on inflammatory response during AC progression was analyzed in the experimental allergic conjunctivitis (EAC) mouse model.ResultsThe clinical score, permeability, total IgE, ovalbumin (OVA)-specific IgE, and IgG1/IgG2a were induced in the EAC mice, in which the overexpression of KAT5 could further enhance but KAT5 inhibitor NU9056 reduce the phenotypes. The eosinophilic infiltration was induced in EAC mice, in which the overexpression of KAT5 was able to further promote but NU9056 attenuate the phenotype. The expression of Eotaxin and RANTES and the inflammatory factors were upregulated in EAC mice and KAT5 overexpression increased, but NU9056 decreased the expression in the model. Significantly, the CD11c+ dendritic cells and CD4+ T cells infiltration in the conjunctiva was enhanced in EAC mice, whereas KAT5 overexpression induced but NU9056 suppressed the effect in the model. Mechanically, the phosphorylation of PI3K and Akt and the levels of histone H3 lysine 27 acetylation (H3K27ac) were enhanced in EAC mice, whereas the overexpression of KAT5 promoted and NU9056 repressed the phenotype in the mice. The enrichment of KAT5 and H3K27ac on PI3K promoter was increased in EAC mice, and the overexpression of KAT5 further enhanced the enrichment in the mice. Significantly, we observed similar results in the KAT5 knockout mice as well. Moreover, PI3K/AKT signaling inhibitor LY294002 reversed KAT5 overexpression-mediated phenotypes and inflammatory response after induction AC in vivo.ConclusionsTherefore we concluded that KAT5 inhibition protected against ocular inflammation by mediating the PI3K/AKT pathway in EAC mouse model.     

Controversies: Optic nerve sheath fenestration versus shunt placement for the treatment of idiopathic intracranial hypertension

Background:Idiopathic intracranial hypertension (IIH) has been increasing in prevalence in the past decade, following the obesity epidemic. When medical treatment fails, surgical treatment options must be considered. However, controversy remains as to which surgical procedure is the preferred surgical option – optic nerve sheath fenestration (ONSF) or cerebrospinal fluid (CSF) shunting – for the long-term treatment of this syndrome.Purpose:To provide a clinical update of the pros and cons of ONSF versus shunt placement for the treatment of IIH.Design:This was a retrospective review of the current literature in the English language indexed in PubMed.Methods:The authors conducted a PubMed search using the following terms: Idiopathic IIH, pseudotumor cerebri, ONSF, CSF shunts, vetriculo-peritoneal shunting, and lumbo-peritoneal shunting. The authors included pertinent and significant original articles, review articles, and case reports, which revealed the new aspects and updates in these topics.Results:The treatment of IIH remains controversial and lacks randomized controlled clinical trial data. Treatment of IIH rests with the determination of the severity of IIH-related visual loss and headache.Conclusion:The decision for ONSF versus shunting is somewhat institution and surgeon dependent. ONSF is preferred for patients with visual symptoms whereas shunting is reserved for patients with headache. There are positive and negative aspects of both procedures, and a prospective, randomized, controlled trial is needed (currently underway). This article will hopefully be helpful in allowing the reader to make a more informed decision until that time.     

PI3K/Akt信号通路在眼科疾病发生发展过程中的调控作用研究进展

眼科疾病的发生发展与眼组织的异常发育和功能障碍有关,其中相关信号通路的活化在眼科疾病的发生和发展过程中发挥重要作用.PI3 K/Akt信号通路(磷脂酰肌醇3激酶/蛋白激酶B信号通路)广泛存在于各类细胞中,是参与细胞生长、增殖、分化调节的重要信号转导通路.研究发现,PI3 K/Akt信号通路在白内障、糖尿病视网膜病变等多...