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Early cisternal fibrinolysis is more effective than rescue spasmolysis for the prevention of delayed infarction after subarachnoid haemorrhage

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Stroke & Vascular Neurology 2022年第2期7卷 108-113页

作者： Roland Roelz Christian Scheiwe Jürgen Grauvogel Istvan Csok Volker Arnd Coenen Jürgen Beck Peter C Reinacher department of neurosurgery Medical Center-University of FreiburgFreiburgGermany Department of Stereotactic and Functional Neurosurgery Medical Center-University of FreiburgFaculty of MedicineFreiburgGermany Fraunhofer Institute for Laser Technology(ILT) AachenGermany

Background To compare the efficacy of two different concepts of cisternal therapy—PREVENTIVE fibrinolysis plus on-demand spasmolysis versus RESCUE spasmolysis—for the prevention of cerebral vasospasm(CVS)and delayed cerebral infarction(DCI)in patients with aneurysmal subarachnoid haemorrhage(aSAH).Methods Retrospective analysis of 84 aSAH patients selected for cisternal therapy for DCI prevention.66 high-risk patients received PREVENTIVE cisternal therapy to enhance blood clearance.Either stereotactic catheter ventriculocisternostomy(STX-VCS)or intraoperative placement of a cisterno-ventriculostomy catheter(CVC),followed by fibrinolytic cisternal lavage using urokinase was performed.In case of vasospasm,nimodipine was applied intrathecally.22 low-risk patients who developed CVS against expectations were selected for STX-VCS as RESCUE intervention for cisternal spasmolysis with nimodipine.Rates of DCI and mean flow velocities of daily transcranial Doppler(TCD)ultrasonographies were evaluated.Results Despite a higher prespecified DCI risk,patients selected for PREVENTIVE intervention primarily aiming at blood clearance had a lower DCI rate compared with patients selected for intrathecal spasmolysis as a RESCUE therapy(11.3%vs 18.2%).After intrathecal treatment onset,CVS(TCD>160 cm/s)occurred in 45%of patients with PREVENTIVE and 77%of patients with RESCUE therapy(p=0.013).A stronger response of CVS to intrathecal nimodipine was observed in patients with PREVENTIVE intervention as the mean CVS duration after start of intrathecal nimodipine was 3.2 days compared with 5.8 days in patients with RESCUE therapy(p=0.026).Conclusions PREVENTIVE cisternal therapy directed at blood clearance is more effective for the prevention of CVS and delayed infarction compared with cisternal RESCUE spasmolysis.

关键词： prevention spasmolysis infarction

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Cholinergic input from the pedunculopontine nucleus to the cerebellum: implications for deep brain stimulation in Parkinson's disease

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Neural Regeneration Research 2016年第5期11卷 729-730页

作者： Eugenio Scarnati Flora Vitale Annamaria Capozzo Paolo Mazzone department of Biotechnological and Applied Medical Sciences (DISCAB) University of L’Aquila-L’Aquila Operative Unit for stereotactic and functional neurosurgery RegionalCenter for Functional Neurosurgery and DBS

Deep brain stimulation（DBS）is a well established electrophysiological treatment initially applied to treat medication-refractory motor symptoms in Parkinson＇s disease（PD）,and is now being explored for several neurological and psychiatric disorders.The specific physiological mechanisms underlying the effectiveness of DBS are not fully understood.

关键词： Cholinergic input from the pedunculopontine nucleus to the cerebellum implications for deep brain stimulation in Parkinson’s disease deep

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Diagnosis and Treatment of Clear Cell Hidradenocarcinoma of the Scalp

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2012年第6期32卷 931-936页

作者：舒凯肖群根 Fabian Büchele 张所军蒋伟雷霆 department of neurosurgery Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Lab of Molecular neurosurgery Stereotactic and Functional Neurosurgery of Albert-Ludwigs University

Clear cell hidradenocarcinoma (CCH) is an exceedingly rare and highly malignant tumor of the eccrine sweat glands. Its treatment is extremely difficult due to the characteristically aggressive clinical course including repeated local recurrence and uncontrollable distal metastasis coming along with a very poor prognosis. Most published case studies recommend a wide surgical excision followed by adjuvant conservative therapy, which is generally considered to be the standard treatment. Two cases of nodular CCH of the scalp either presenting as a singular primary lesion or at an already metastatic stage were analyzed retrospectively. Wide local excision of the tumor couldn’t prevent the primary carcinoma from recurring and metastasizing. Both cases received various therapies but the results were unsatisfactory. Although most authors have recommended that early wide surgical excision of the tumor is a feasible therapeutic measurement, our results raise doubts on the efficacy of this treatment strategy. As alternative approaches (i.e. chemotherapy, radiotherapy) are similarly controversial, further studies and a wide exchange of clinical experiences are crucial.

关键词： hidradenocarcinoma scalp diagnosis treatment

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Behavioral Effects of Deep Brain Stimulation of the Anterior Nucleus of Thalamus, Entorhinal Cortex and Fornix in a Rat Model of Alzheimer＇s Disease

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Chinese Medical Journal 2015年第9期128卷 1190-1195页

作者： Chao Zhang Wen-Han Hu De-Long Wu Kai Zhang Jian-Guo Zhang department of neurosurgery Beijing Tian Tan Hospital Capital Medical University Beijing 100050 China Beijing Key Laboratory of Neurostimulation Beijing 100050 China stereotactic and functional neurosurgery Laboratory Beijing Neurosurgical Institute Capital Medical University Beijing 100050 China department of neurosurgery Xiamen Fifth Hospital Xiamen University Xiamen Fujian 361101 China

Background：Recent clinical and preclinical studies have suggested that deep brain stimulation （DBS） can be used as a tool to enhance cognitive functions.The aim of the present study was to investigate the impact of DBS at three separate targets in the Papez circuit,including the anterior nucleus of thalamus （ANT）,the entorhinal cortex （EC）,and the fornix （FX）,on cognitive behaviors in an Alzheimer＇s disease （AD） rat model.Methods：Forty-eight rats were subjected to an intrahippocampal injection ofamyloid peptides 1-42 to induce an AD model.Rats were divided into six groups：DBS and sham DBS groups of ANT,EC,and FX.Spatial learning and memory were assessed by the Morris water maze （MWM）.Recognition memory was investigated by the novel object recognition memory test （NORM）.Locomotor and anxiety-related behaviors were detected by the open field test （OF）.By using two-way analysis of variance （ANOVA）,behavior differences between the six groups were analyzed.Results：In the MWM,the ANT,EC,and FX DBS groups performed differently in terms of the time spent in the platform zone （F（2.23） =6.04,P ＜ 0.01）,the frequency of platform crossing （F（2,23） =11.53,P ＜ 0.001）,and the percent time spent within the platform quadrant （F（2,23） =6.29,P ＜ 0.01）.In the NORM,the EC and FX DBS groups spent more time with the novel object,although the ANT DBS group did not （F（2,23） =10.03,P ＜ 0.001）.In the OF,all of the groups showed a similar total distance moved （F（1.42） =1.14,P =0.29）and relative time spent in the center （F（2,42） =0.56,P =0.58）.Conclusions：Our results demonstrated that DBS of the EC and FX facilitated hippocampus-dependent spatial memory more prominently thanANT DBS.In addition,hippocampus-independent recognition memory was enhanced by EC and FX DBS.None of the targets showed side-effects of anxiety or locomotor behaviors.

关键词： Anterior Thalamic Nuclei Deep Brain Stimulation Entorhinal Cortex Fornix Memory

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Is intracranial electroencephalography mandatory for MRI-negative neocortical epilepsy surgery?

Is intracranial electroencephalography mandatory for MRI-neg...

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第十六届中国医师协会神经外科医师年会

作者： Zhihao Guo Chao Zhang Xiu Wang Chang Liu Baotian Zhao Jiajie Mo Zhong Zheng Xiaoqiu Shao Jianguo Zhang Kai Zhang Wenhan Hu department of neurosurgery Beijing Tiantan HospitalCapital Medical University department of neurosurgery Beijing Fengtai Hospital department of Neurology Beijing Tiantan HospitalCapital Medical University stereotactic and functional neurosurgery Laboratory Beijing Neurosurgical InstituteCapital Medical University Beijing Key Laboratory of Neurostimulation

Objective:MRI-negative focal epilepsy is one of the most challenging cases in epilepsy surgical treatment.Many epilepsy centers recommend intracranial electroencephalography for MRI-negative cases,especially neocortical epilepsy.This retrospective study aimed to explore whether intracranial monitoring is mandatory in MRI-negative neocortical epilepsy surgery and the factors that significantly influence the decision to perform intracranial recording or not.Methods:In this study,consecutive surgical patients with focal MRI-negative neocortical epilepsy were recruited.All patients underwent routine preoperative evaluation according to the dedicated protocol of our epilepsy center to determine the treatment plan.Patients were divided into two groups according to the surgical strategy:a direct group and a stereo-encephalography(SEEG)-guided group.History of epilepsy,seizure frequency,interictal and ictal EEG data,PET data,PET/MRI co-registration data,neuropathological findings,and surgical outcomes were compared between the two groups.Multivariate analysis was performed to identify factors influencing the decision to implement SEEG monitoring.Results:Sixty-four patients were included in this study,of whom 19 and 45 underwent direct and SEEG-guided cortical resection,respectively.At an average follow-up of 3.9 years postoperatively,56 patients(87.5%) had Engel class I results without permanent neurological deficits.Surgical outcomes were not significantly different between the direct and SEEG-guided groups(94.7% vs.84.4%).There were significant differences between the two groups in the degree of hypometabolism(focal vs.non-focal,p<0.01) and pathological subtype(FCD II vs.others,p=0.03).Multivariate analysis revealed that the degree of hypometabolism(OR 0.01,95% CI 0.00-0.15,p=0.001) was the only independent factor affecting surgical strategy.Conclusions:Careful selection of patients with MRI-negative neocortical epilepsy may yield favorable outcomes with direct cortical resection without intracranial monitoring;PET/MRI

关键词： Neocortical epilepsy MRI-negative FDG-PET Intracranial electroencephalography Stereo-electroencephalography

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Acute Fornix Deep Brain Stimulation Improves Hippocampal Glucose Metabolism in Aged Mice

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Chinese Medical Journal 2018年第5期131卷 594-599页

作者： Xiu Wang Wen-Hart HU Kai Zhang Jun-Jian Zhou De-Feng Liu Mei-Yu Zhang Jian-Guo Zhang department of neurosurgery Beijing Tian Tan Hospital Capital Medical University Beijing 100050 China stereotactic and functional neurosurgery Laboratory Beijing Neurosurgical Institute Capital Medical University Beijing 100050 China Beijing Key Laboratory of Neurostimulation Beijing 100050 China Experimental Research Center China Academy of Traditional Chinese Medicine Beijing 100700 China

Background： A beneficial memory effect of acute formix deep brain stimulation （DBS） has been reported in clinical studies. The aim of this study was to investigate the acute changes in glucose metabolism induced by fornix DBS. Methods： First, the Morris water maze test and novel object recognition memory test were used to confirm declined memory in aged mice （C57BL/6, 20-22 months old）. Then, four groups of mice were used as follows： aged mice with stimulation （n = 12）, aged mice with sham-stimulation （n = 8）, adult mice （3-4 months old） with stimulation （n = 12）, and adult mice with sham-stimulation （n = 8）. lpsilateral hippocampal glucose metabolism and glutamate levels were measured in vivo by microdialysis before, during, and after fornix DBS treatment. Histological staining was used to verify the localization of electrodes and mice with inaccurate placement were excluded from subsequent analyses. The effects of fornix DBS on extracellular glucose, lactate, pyruvate, and glutamate levels over time were analyzed by repeated-measures analysis of variance followed by Fisher＇s least significant difference post hoc test. Results： The aged mice had a higher basal lactate/pyruvate ratio （LPR） and lactate/glucose ratio （LGR） than the adult mice （LPR： 0.34 ± 0.04 vs. 0.13 ± 0.02, t = 4.626, P 〈 0.0001 ; LGR： 6.06± 0.59 vs. 4.14 ± 0.36, t = 2.823, P 〈 0.01 ）. Fomix DBS decreased the ipsilateral hippocampal pyruvate and lactate levels （P 〈 0.05）, but the glucose levels were not obviously changed in aged mice. Similarly, the LGR and LPR also decreased in aged mice after fornix DBS treatment （P 〈 0.05）. Glucose metabolism in adult mice was not significantly influenced by tbrnix DBS. In addition, fornix DBS significantly decreased the ipsilateral hippocampal extracellular levels of glutamate in aged mice （P 〈 0.05）, while significant alterations were not found in the adult mice. Conclusions： The present study provides experimental evidence that fornix DBS could significantly improve bippocampal glucose metabolism in aged m

关键词： Deep Brain Stimulation Fornix Glucose Metabolism Memory Decline

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Deep Brain Stimulation of the Globus Pallidus Internus in Patients with Intractable Tourette Syndrome： A 1-year Follow-up Study

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Chinese Medical Journal 2016年第9期129卷 1022-1027页

作者： Xiao-Hua Zhang Jian-Yu Li Yu-Qing Zhang Yong-Jie Li department of functional neurosurgery Beijing Institute of Functional Neurosurgery Xuanwu Hospital Capital Medical University Beijing 100053 China

Background： Deep brain stimulation （DBS） has been a promising treatment for patients with refractory Tourette syndrome （TS） for more than a decade. Despite successful DBS treatment of TS in more than 100 patients worldwide, studies with a large patient sample and long-term follow-up assessments are still scarce. Accordingly, we investigated the clinical efficacy and safety of globus pallidus internus （GPi） DBS in the treatment of intractable TS in 24 patients with a 1-year follow-up assessment. Methods： Bilateral/unilateral GPi-DBS was performed in 24 patients with TS. We evaluated symptoms of tics and obsessive-compulsive disorder （OCD） through the Yale Global Tic Severity Scale （YGTSS） and Yale-Brown Obsessive-compulsive Scale （Y-BOCS）. We used the Wechsler Adult Intelligence Scale-Revised in China （WAIS-RC） to evaluate the safety of the treatment. We conducted follow-up assessments of all patients for at least 12 months （12-99 months）. Results： Symptoms of tics and OCD were significantly relieved at a 12-month follow-up assessment. The mean YGTSS score was 74.04 ± 11.52, 49.83 ± 10.91, 32.58 ± 7.97, and 31.21 ± 8.87 at baseline, 3, 6, and 12 months, respectively. The mean YGTSS scores obtained at the follow-up assessments were significantly different from the baseline （P 〈 0.05）. The improvement in motor tics was superior to that in phonic tics. The mean Y-BOCS scores were 21.61 ± 4.97, 18 ± 4.58, 14.39 ± 3.99, and 13.78 ± 4.56 at baseline, 3, 6, and 12 months, respectively （P 〈 0.05）. We observed a remarkable improvement in psychiatric comorbidities, such as OCD and attention-deficit hyperactivity disorder, after the procedure. WAIS-RC scores were comparable before and after the operation. There were no severe postoperative complications. Conclusion： GPi-DBS appears to comprehensively alleviate tic symptoms and psychiatric comorbidities in patients with TS, thus significantly improving patients＇ quality of life.

关键词： Deep Brain Stimulation Tourette Syndrome Treatment

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Error Analysis and Some Suggestions on Animal stereotactic Experiment from Inaccuracy of Rhesus Macaques Atlas

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Chinese Medical Journal 2016年第13期129卷 1621-1624页

作者： Guan-Yu Zhu Ying-Chuan Chen Lin Shi An-Chao Yang Yin Jiang Xin Zhang Jian-Guo Zhang department of neurosurgery Beijing Tiantan Hospital Capital Medical University Beijing 100050 China department of functional Neurosurgeiy Beijing Tianan Hospital Capital Medical University Beijing 100050 China department of functional neurosurgery Beijing Neurosurgical Institute Capital Medical UniversityBeijing 100050 China Beijing Key Laboratory of Neurostimulation Beijing 100050 China

The application ofstereotactic technique is rapidly growing. For instance, deep brain stimulation （DBS）, an important neurostimulation technique in the treatment of Parkinson＇s disease, dystonia, essential tremor, ... 详细信息

关键词： Animal Experiment Atlas Rhesus Monkey stereotactic Technique

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中国功能神经外科的发展历史和现状

中国功能神经外科的发展历史和现状

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中国医师协会神经外科医师分会首届全国代表大会

作者：吴承远汪业汉孟凡刚刘玉光 department of neurosurgery QiLu Hospital of Shandong University Anhui stereotactic and functional Neurosurgical Institute department of neurosurgery QiLu Hospital of Shandong University .department of neurosurgery QiLu Hospital of Shandong University

＜正＞AS A BRIEF reflection on the development of stereotactic neurosurgery, this article reviews its founding and early history in China.

关键词： China Development stereotactic neurosurgery

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Anti-epileptic effects of neuropeptide Y gene transfection into the rat brain

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Neural Regeneration Research 2013年第14期8卷 1307-1315页

作者： Changzheng Dong Wenqing Zhao Wenling Li Peiyuan Lv Xiufang Dong Faculty of Graduate Studies Hebei Medical University department of functional neurosurgery Hebei General Hospital department of Neurology Hebei General Hospital department of Neurology First Hospital of Xingtai

Neuropeptide Y gene transfection into normal rat brain tissue can provide gene overexpression, which can attenuate the severity of kainic acid-induced seizures. In this study, a recombinant adeno-associated virus carrying the neuropeptide Y gene was transfected into brain tissue of rats with kainic acid-induced epilepsy through stereotactic methods. Following these transfections, we verified overexpression of the neuropeptide Y gene in the epileptic brain. Electroencephalograms showed that seizure severity was significantly inhibited and seizure latency was significantly prolonged up to 4 weeks after gene transfection. Moreover, quantitative fluorescent PCR and western blot assays revealed that the mRNA and protein expression of the N-methyI-D-aspartate receptor subunits NR1, NR2A, and NR2B was inhibited in the hippocampus of epileptic rats. These findings indicate that neuropeptide Y may inhibit seizures via down-regulation of the functional expression of N-methyI-D-aspartate receptors.

关键词： neural regeneration brain injury gene therapy adeno-associated virus neuropeptide Y epilepsy N-methyI-D-aspartate receptor kainic acid seizures neuroregeneration

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