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Conventional craniotomy versus conservative treatment in patients with minor spontaneous intracerebral hemorrhage in the Basal ganglia

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Chinese Neurosurgical Journal 2022年第4期8卷 258-267页

作者： Ning Wang Weiwei Lin Xuanhao Zhu Qi Tu Daqian Zhu Shuai Qu Jianjing Yang Linhui Ruan Qichuan Zhuge Brain Center Affiliated Zhejiang HospitalZhejiang University School of MedicineHangzhou 310000China Department of Neurosurgery Second Affiliated Hospital of Zhejiang University School of MedicineZhejiang University88 Jiefang RoadHangzhou 310009ZhejiangChina Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou 325000China Department of Neurosurgery The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou 325000ZhejiangChina

Background:The treatment for spontaneous intracerebral hemorrhage(ICH)is still controversial,especially for hematomas in the Basal ganglia.A retrospective case-control study with propensity score matching was performed to compare the outcomes of conventional craniotomy and conservative treatment for patients with minor ICH in the Basal ganglia.Methods:We retrospectively collected the data of consecutive patients with minor Basal ganglia hemorrhage from January 2018 to August 2019.We compared clinical outcomes of two groups using propensity score matching.The extended Glasgow outcome scale obtained by phone interviews based on questionnaires at a 12-month follow-up was used as the primary outcome measure.According to a previous prognosis algorithm,patients were divided into good and poor prognosis groups to obtain a dichotomized(favorable or unfavorable)outcome as the primary outcome.Secondary outcomes included hospitalized complications,mortality,and modified Rankin score at 12 months.Results:A total of 54 patients were analyzed,and the baseline characteristics of patients in the surgery and conservative treatment groups were well matched.The primary favorable outcome at 12 months was significantly higher in the conservative treatment group than in the surgery group(81%vs 44%;OR 1.833,95%CI 1.159-2.900;P=0.005).The incidence of pneumonia in the surgery group was significantly higher than that in the conservative treatment group(P=0.005).Conclusions:It is not recommended to undertake conventional craniotomy for patients with a minor hematoma(25-40 ml)in the Basal ganglia.An open craniotomy might induce worse long-term functional outcomes than the conservative treatment.

关键词： Basal ganglia Conservative treatment Craniotomy Intracerebral hemorrhage

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Sonographic Alteration of Basal ganglia in Different Forms of Primary Focal Dystonia： A Cross-sectional Study

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Chinese Medical Journal 2016年第8期129卷 942-945页

作者： Ying Zhang Ying-Chun Zhang Yu-Jing Sheng Xiao-Fang Chen Cai-Shan Wang Qi Ma Han-Bing Chen Li-Fang Yu Cheng-Jie Mao Kang-Ping Xiong Wei-Feng Luo Chun-Feng Liu Department of Ultrasound The Second Affiliated Hospital of Soochow University Suzhou Jiangsu 215004 China Department of Neurology The Second Affiliated Hospital of Soochow University Suzhou Jiangsu 215004 China

Background：Few studies have addressed whether abnormalities in the lenticular nucleus （LN） are characteristic transcranial sonography （TCS） echo features in patients with primary dystonia.This study aimed to explore alterations in the Basal ganglia in different forms of primary focal dystonia.Methods：A cross-sectional observational study was performed between December 2013 and December 20 1 4 in 80 patients with different forms of primary focal dystonia and 55 neurologically normal control subjects.TCS was performed in patients and control subjects.Multiple comparisons of multiple rates were used to compare LN hyperechogenicity ratios between control and patient groups.Results：Thirteen individuals were excluded due to poor temporal bone windows,and two subjects were excluded due to disagreement in evaluation by sonologists.Totally,70 patients （cervical dystonia,n =30;blepharospasm,n =30;oromandibular dystonia,n =10） and 50 normal controls were included in the final analysis.LN hyperechogenicity was observed in 51% （36/70） of patients with primary focal dystonia,compared with 12% （6/50） of controls （P 〈 0.001）.Substantia nigra hyperechogenicity did not differ between the two groups.LN hyperechogenicity was observed in 73% （22/30） of patients with cervical dystonia,a greater prevalence than in patients withblepharospasm （33%,10/30,P =0.002） and oromandibular dystonia （40%,4/10,P =0.126）.LN hyperechogenicity was more frequently observed in patients with cervical dystonia compared with controls （73% vs.12%,P 〈 0.001）;however,no significant difference was detected in patients with blepharospasm （33% vs.12%,P =0.021） or oromandibular dystonia （40% vs.12%,P =0.088）.Conclusions：LN hyperechogenicity is more frequently observed in patients with primary focal dystonia than in controls.It does not appear to be a characteristic TCS echo feature in patients with blepharospasm or oromandibular dystonia.

关键词： Basal ganglia Lenticular Nucleus Primary Focal Dystonia Transcranial Sonography

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The right inferior frontal gyrus as pivotal node and effective regulator of the Basal ganglia-thalamocortical response inhibition circuit

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Psychoradiology 2023年第1期3卷 242-253页

作者： Qian Zhuang Lei Qiao Lei Xu Shuxia Yao Shuaiyu Chen Xiaoxiao Zheng Jialin Li Meina Fu Keshuang Li Deniz Vatansever Stefania Ferraro Keith M.Kendrick Benjamin Becker The Center of Psychosomatia Medicine Sichuan Provincial Center for Mental HealthSichuan Provincial People's HospitalThe University of Eectronic Science and Technology of ChinaChengduSichuan Province 611731China Center for Cognition and Brain Disorders The Affliated Hospital of Hangzhou Normal UniversityHangzhouZhejiang Province 11121 China School of Psychology Shenzhen UniversityShenzhen 518060China Institute of Brain and Psychological Sciences Sichuan Normal UniversityChengdu610068China Brain Cognition and Brain Disease Institute(BCBDI) Shenzhen Institute of Advanced TechnologyChinese Academy of SciencesShenzhen 518055China School of Psychology and Cognitive Science East China Normal UniversityShanghai 200062China Institute of Science and Technology for Brain-Inspired Itelligence Fudan UniversityShanghai 200433China State Key Laboratory of Brain and Cognitive Sciences The University of Hong KongHong Kong 99077 China Department of Psychology The University of Hong Kong Hong Kong 990777 China

Background:The involvement of specific Basal ganglia-thalamocortical circuits in response inhibition has been extensively mapped in animal models.However,the pivotal nodes and directed causal regulation within this inhibitory circuit in humans remains con-troversial.Objective:The main aim of the present study was to determine the causal information flow and critical nodes in the Basal ganglia-thalamocortical inhibitory circuits and also to examine whether these are modulated by biological factors(i.***.sex)and behavioral performance.Methods:Here,we capitalize on the recent progress in robust and biologically plausible directed causal modeling(DCM-PEB)and a large response inhibition dataset(n=250)acquired with concomitant functional magnetic resonance imaging to determine key nodes,their causal regulation and modulation via biological variables(sex)and inhibitory performance in the inhibitory circuit encompassing the right inferior frontal gyrus(rIFG),caudate nucleus(rCau),globus pallidum(rGP),and thalamus(rThal).Results:The entire neural circuit exhibited high intrinsic connectivity and response inhibition critically increased causal projections from the rIFG to both rCau and rThal.Direct comparison further demonstrated that response inhibition induced an increasing rIFG inflow and increased the causal regulation of this region over the rCau and rThal.In addition,sex and performance influenced the functional architecture of the regulatory circuits such that women displayed increased rThal self-inhibition and decreased rThal to GP modulation,while better inhibitory performance was associated with stronger rThal to rIFG communication.Furthermore,control analyses did not reveal a similar key communication in a left lateralized model.Conclusions:Together,these findings indicate a pivotal role of the rIFG as input and causal regulator of subcortical response inhibition nodes.

关键词： response inhibition Basal ganglia inferior frontal gyrus effective connectivity DCM

Germinomas of the Basal ganglia and thalamus: Four case reports

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World Journal of Clinical Cases 2020年第19期8卷 4558-4564页

作者： Zhen-Chao Huang Qing Dong En-Peng Song Zhi-Jie Chen Jin-Hua Zhang Bo Hou Zheng-Qi Lu Feng Qin Department of Neurosurgery The Third Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510630Guangdong ProvinceChina Department of Neurology The Third Affiliated Hospital of Sun YatSen UniversityGuangzhou 510630Guangdong ProvinceChina

BACKGROUND The early diagnosis of Basal ganglia and thalamus germinomas is often difficult due to the absence of elevated tumor markers,and atypical clinical symptoms and neuroimaging features.CASE SUMMARY Four male children aged 8 to 15 years were diagnosed with germinomas in the Basal ganglia and thalamus by stereotactic biopsy from 2017 to 2019.All patients developed hemiplegia except patient 4 who also had cognitive decline,speech disturbance,nocturnal enuresis,polydipsia,polyuria,precocious puberty and abnormalities of thermoregulation.All four cases were alpha-fetoprotein and beta-human chorionic gonadotrophin(p-HCG)negative except patient 3 who had slightly elevated p-HCG in cerebrospinal fluid(CSF).No malignant cells were detected in the patients'CSF.Brain magnetic resonance imaging findings were diverse in these patients with the exception of the unique and common characteristics of ipsilateral hemisphere atrophy,especially in the cerebral peduncle.All patients were diagnosed with germinomas of the Basal ganglia and thalamus by stereotactic brain biopsy.CONCLUSION Stereotactic brain biopsy is necessary to confirm the diagnosis of ectopic germinomas.Serial neuroimaging studies can not only differentiate disease but also determine the biopsy site.

关键词： Intracranial germinoma Stereotactic brain biopsy Basal ganglia Thalamus Tumor marker Case report

Properties of oscillatory neuronal activity in the Basal ganglia and thalamus in patients with Parkinson’s disease

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Translational Neurodegeneration 2018年第1期7卷 154-166页

作者： G.Du P.Zhuang M.Hallett Y.-Q.Zhang J.-Y.Li Y.-J.Li Beijing Institute of Functional Neurosurgery Xuanwu HospitalCapital Medical UniversityNo.45 Changchun StreetXicheng DistrictBeijing 100053China Human Motor Control Section Medical Neurology BranchNINDSNIHBethesdaMDUSA Center of Parkinson’s disease Beijing Institute for Brain DisordersBeijingChina Key Laboratory of Neurodegenerative Diseases(Capital Medical University) Ministry of EducationBeijingChina

Background:The cardinal features of Parkinson’s disease(PD)are bradykinesia,rigidity and rest tremor.Abnormal activity in the Basal ganglia is predicted to underlie the mechanism of motor symptoms.This study aims to characterize properties of oscillatory activity in the Basal ganglia and motor thalamus in patients with PD.Methods:Twenty-nine patients with PD who underwent bilateral or unilateral electrode implantation for subthalamic nucleus(STN)DBS(n=11),unilateral pallidotomy(n=9)and unilateral thalamotomy(n=9)were studied.Microelectrode recordings in the STN,globus pallidus internus(GPi)and ventral oral posterior/ventral intermediate of thalamus(Vop/Vim)were performed.Electromyography of the contralateral limbs was recorded.Single unit characteristics including interspike intervals were analyzed.Spectral and coherence analyses were assessed.Mean spontaneous firing rate(MSFR)of neurons was calculated.Analysis of variance and χ^(2) test were performed.Results:Of 76 STN neurons,39.5% were 4–6 Hz band oscillatory neurons and 28.9% were β frequency band(βFB)oscillatory neurons.The MSFR was 44.2±7.6 Hz.Of 62 GPi neurons,37.1% were 4–6 Hz band oscillatory neurons and 27.4% were βFB neurons.The MSFR was 80.9±9.6 Hz.Of 44 Vop neurons,65.9% were 4–6 Hz band oscillatory neurons and 9%were βFB neurons.The MSFR was 24.4±4.2 Hz.Of 30 Vim oscillatory neurons,70% were 4–6 Hz band oscillatory neurons and 13.3% were β FB neurons.The MSFR was 30.3±3.6 Hz.Further analysis indicated that proportion of βFB oscillatory neurons in STN and GPi was higher than that of similar neurons in the Vop and Vim(PBasal ganglia play a critical role in generation of parkinsonism.β oscillatory activity is more prominent in basal ga

关键词： Parkinson’s disease Basal ganglia The subthalamic nucleus The globus pallidus internus The ventrolateral thalamus Oscillatory activity Microelectrode recordings

Roles of the Basal ganglia in Physiological SleepWake Cycles and Sleep Disorders of Parkinson's Disease

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神经药理学报 2019年第Z1期 21-22页

作者：黄志力中国睡眠研究会生理与药理专委会复旦大学基础医学院复旦大学药理学系

Sleep disorders are frequent in Parkinson’s disease and their prevalence increases with disease progression. Previous studies demonstrated that sleep disorders could appear as an initial manifestation of Parkinson’s disease even decades before motor signs,which highlight their clinical association in these early stages. Dysfunction of dopaminergic transmission in Basal ganglia involves in the pathogenesis of Parkinson’s disease and sleep disorders. The Basal ganglia(BG) act as a cohesive functional unit that regulates motor function,habit formation,and reward/addictive behaviors. However,it is still not well understood how the BG maintains wakefulness and suppresses sleep to achieve all these fundamental functions until genetically engineered systems developed these years. We focused on the adenosine A2 A and dopamine D1 Receptors(R) in the BG and obtained following 4 findings:(1) Nucleus accumbens(NAc) dopamine D1 R-expressing neurons are essential in controlling wakefulness and are involved in physiological arousal via the lateral hypothalamus and midbrain circuits;(2) The rostromedial tegmental nucleus(RMTg),also called the GABAergic tail of the ventral tegmental area,projects to the midbrain dopaminergic system and other regions. Our findings reveal an essential role of the RMTg in the promotion of non-rapid eye movement(non-REM,NREM) sleep and homeostatic regulation;(3) Opposite to the D1 R in the NAc,A2 AR made a prominent contribution to sleep control associated with motivation.(4) Striatal adenosine A2 AR neurons control activeperiod sleep via parvalbumin neurons in external globus pallidus. Taken together,we proposed a plausible model in which the caudate-putamen and NAc integrate behavioral processes with sleep/wakefulness through adenosine and dopamine receptors. The impacts of the BG in physiological sleep and insomnia in Parkinson’s patients will be discussed.

关键词： adeno-associated virus optogenetics DREADD Basal ganglia sleep-wake regulation

Intact Strategic Learning despite Impaired Reward Learning Capacity after Basal ganglia Damage

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Intact Strategic Learning despite Impaired Reward Learning C...

Closing the loop between understanding and treatment of Basal ganglia related disorders

中国神经科学学会第十二届全国学术会议

作者： Lusha Zhu Yaomin Jiang Donatella Scabini Robert T.Knight Ming Hsu School of Psychological and Cognitive Sciences IDG/McGovern Institute for Brain Research Peking-Tsinghua Center for Life Sciences Beijing Key Laboratory of Behavior and Mental Health Peking University Helen Wills Neuroscience Program University of California Department of Psychology University of California Haas School of Business University of California

Objective Both Basal ganglia（BG） and orbitofrontal cortex（OFC） have been widely implicated in decision-making across both social and nonsocial contexts. However, unlike OFC damage, BG pathology is not typically associated with disturbances in social functioning, and causal evidence of its involvement in social decision-making remains lacking. Methods Here we studied behavior of patients with focal lesions to either BG or OFC in a multi-strategy competitive game previously shown to engage these regions. Results We found that whereas OFC patients were significantly impaired, BG patients showed intact learning in the economic game. In striking contrast, when information about the strategic context was absent, both cohorts were significantly impaired. Computational modeling results further suggest that BG patients might compensate the impairment by invoking computations beyond simple reward reinforcement, potentially through strategies such as belief-based learning that anticipates and responds to behavior of others when the incentive structure was available. Conclusion These results shed light on the respective causal contributions of the BG and OFC in decision-making.

关键词： Basal ganglia orbitofrontal cortex brain lesion strategic learning reinforcement learning value-based decisions social behavior

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Closing the loop between understanding and treatment of basa...

Genetically engineered systems revealed the roles of Basal ganglia in sleep-wake regulation

中国神经科学学会第十二届全国学术会议

作者： Hagai Bergman Department of Medical Neurobiology （Physiology） and Neurosurgery Edmond and Lily Safra center （ELSC） for Brain research The Hebrew University – Hadassah medical center

The Basal ganglia（BG） main axis is built as three layers neural network, where the striatum and the subthalamic nucleus（STN） constitute the BG inputs and together innervate the BG downstream structures using GABA and glutamate, respectively. However, the respective contribution of these two distinct inputs in shaping BG downstream activity in health and parkinsonism is still unknown. Comparison of the neuronal activity in BG input and downstream structures reveals that after striatal dopamine depletion and induction of parkinsonism with MPTP, abnormal low beta（8-15 Hz） spiking and local field potential（LFP） oscillations emerge and resonate across the STN and downstream BG network. The synchronized beta oscillations are episodic, and good（normal） episodes can be discriminated from bad（Parkinsonian） episodes by their duration. Together, these results highlight the pivotal role of STN glutamatergic and divergent projections in BG physiology and pathophysiology and provide sound explanation for the widespread choice of the STN as the prime target along the BG network for DBS in patients suffering from Parkinson’s disease. Future, closed loop deep brain stimulation methods can be triggered by long duration beta episodes.

关键词： Basal ganglia Parkinson’s disease DBS Oscillations

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中国药理学与毒理学杂志 2017年第5期31卷 470-470页

作者：黄志力上海医学院药理学系

The Basal ganglia(BG) act as a cohesive functional unit that regulates motor function,habit formation,and reward/addictive behaviors. However,it is still not well understood how the BG maintains wakefulness and suppresses sleep to achieve al these fundamental functions until genetical y engineered systems developed these years. Significant research efforts have recently been directed at developing genetic-molecular tools to achieve reversible and cell-type specific in vivo silencing or activation of neurons in behaving animals. Optogenetic tools can be used both to specifically activate or inhibit neurons of interest and identify functional synaptic connectivity between specific neuronal populations,both in vivo and in brain slices. Another recently developed system by Roth and colleagues permits the selective and ″remote″ manipulation(activation and silencing) of neuronal activity via all 3 major GPCR signaling pathways(G_i,G_s and G_q). These so-called ″ designer receptors exclusively activated by designer drugs″(DREADD) involve mutant GPCRs that do not respond to their endogenous ligands but are responsive to otherwise inert biological compounds. Recently,we demonstrated the essential roles and the neural pathways of the neurons expressing adenosine A_(2A) receptors or dopamine D_1 receptors in the BG for sleep-wake regulation using the genetically engineered systems including optogenetics and DREADD. We proposed a plausible model in which the caudate-putamen and the nucleus accumbens integrates behavioral processes with sleep/wakefulness through adenosine and dopamine receptors.

关键词： adeno-associated virus optogenetics DREADD Basal ganglia sleep-wake regulation

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