Background Vestibular schwannoma, the commonest form of intracranial schwannoma, arises from the Schwann cells investing the vestibular nerve. At present, the surgery for vestibular schwannoma remains one of the most ...Background Vestibular schwannoma, the commonest form of intracranial schwannoma, arises from the Schwann cells investing the vestibular nerve. At present, the surgery for vestibular schwannoma remains one of the most complicated operations demanding for surgical skills in neurosurgery. And the trend of minimal invasion should also be the major influence on the management of patients with vestibular schwannomas. We summarized the microsurgical removal experience in a recent series of vestibular schwannomas and presented the operative technique and cranial nerve preservation in order to improve the rates of total tumor removal and facial nerve preservation. Methods A retrospective analysis was performed in 145 patients over a 7-year period who suffered from vestibular schwannomas that had been microsurgically removed by suboccipital retrosigmoid transmeatus approach with small craniotomy. CT thinner scans revealed the tumor size in the internal auditory meatus and the relationship of the posterior wall of the internal acoustic meatus to the bone labyrinths preoperatively. Brain stem evoked potential was monitored intraoperatively. The posterior wall of the internal acoustic meatus was designedly drilled off. Patient records and operative reports, including data from the^electrophysiological monitoring, follow-up audiometric examinations, and neuroradiological findings were analyzed. Results Total tumor resection was achieved in 140 cases （96.6%） and subtotal resection in 5 cases. The anatomical integrity of the facial nerve was preserved in 91.0% （132/145） of the cases. Intracranial end-to-end anastomosis of the facial nerve was performed in 7 cases. Functional preservation of the facial nerve was achieved in 115 patients （Grade ! and Grade ]I, 79.3%）. No patient died in this series. Preservation of nerves and vessels were as important as tumor removal during the operation. CT thinner scan could show the relationship between the posterior wall of the internal acoustic meatus and bone labyrinths, that is展开更多
Background Image-guided neurosurgery, endoscopic-assisted neurosurgery and the keyhole approach are three important parts of minimally invasive neurosurgery and have played a significant role in treating skull base le...Background Image-guided neurosurgery, endoscopic-assisted neurosurgery and the keyhole approach are three important parts of minimally invasive neurosurgery and have played a significant role in treating skull base lesions. This study aimed to investigate the potential usefulness of coupling of the endoscope with the far lateral keyhole approach and image guidance at the ventral craniocervical junction in a cadaver model. Methods We simulated far lateral keyhole approach bilaterally in five cadaveric head specimens （10 cranial hemispheres）. Computed tomography-based image guidance was used for intraoperative navigation and for quantitative measurements. Skull base structures were observed using both an operating microscope and a rigid endoscope. The jugular tubercle and one-third of the occipital condyle were then drilled, and all specimens were observed under the microscope again. We measured and compared the exposure of the petroclivus area provided by the endoscope and by the operating microscope. Statistical analysis was performed by analysis of variance followed by the Student-Newman-Keuls test. Results With endoscope assistance and image guidance, it was possible to observe the deep ventral craniocervical junction structures through three nerve gaps （among facial-acoustical nerves and the lower cranial nerves） and structures normally obstructed by the jugular tubercle and occipital condyle in the far lateral keyhole approach. The surgical area exposed in the petroclival region was significantly improved using the 0° endoscope （1147.80 mm2） compared with the operating microscope （（756.28±50.73） mm2）. The far lateral retrocondylar keyhole approach, using both 0° and 30° endoscopes, provided an exposure area （（1147.80±159.57） mm2 and （1409.94±155.18） mm2, respectively） greater than that of the far lateral transcondylar transtubercular keyhole approach （（1066.26±165.06） mm2） （P 〈0.05）. Conclusions With the aid of the endoscope and image guidance, it is possib展开更多
cerebrovascular disease of genetic origin characterized by abnormally dilated capillaries and a wide spectrum of symptoms,including headaches,seizures,neurological deficits,and intracerebral hemorrhage.Its unpredictab...cerebrovascular disease of genetic origin characterized by abnormally dilated capillaries and a wide spectrum of symptoms,including headaches,seizures,neurological deficits,and intracerebral hemorrhage.Its unpredictable clinical course and the current lack of therapies make the identification of prognostic and predictive biomarkers an imperative research challenge.1 Herein,we provide evidence that galectin-3(Gal-3),a major tissue and circulating biomarker of oxidative stress and inflammation,is significantly up-regulated both in CCM patients and experimentalmodels.Specifically,wholetranscriptome sequencing,qRT-PCR,and Western blotting studies demonstrated a significant up-regulation of Gal-3 expression levels both in surgical CCM specimens and in blood samples of CCM patients.展开更多
Stroke is the most common complication of atrial fibrillation(AF).Guidelines recommend anticoagulant treatment in patients with CHA2DS2VASc scores of>2.Registry data suggests that almost half of patients who should...Stroke is the most common complication of atrial fibrillation(AF).Guidelines recommend anticoagulant treatment in patients with CHA2DS2VASc scores of>2.Registry data suggests that almost half of patients who should be on therapeutic anticoagulation for stroke prevention in AF(SPAF)are not.Warfarin and more recently developed agents,the"novel anticoagulants"(NOACs)reduce the risk of embolic strokes.In addition,the NOACs also reduce intracranial hemorrhage(ICH)by over 50% compared to warfarin.Anticoagulation and bridging strategies involving cardioversion,catheter ablation,and invasive/surgical procedures are reviewed.The development of reversal agents for NOACs and the introduction of left atrial appendage occluding devices will evolve the use of newer strategies for preventing stroke in high risk AF patients.展开更多
Bortezomib is a novel agent for the treatment of patients with multiple myeloma. Several cutaneous lesions have been associated with its use and chalazia have been reported in a few cases with a delayed appearance ran...Bortezomib is a novel agent for the treatment of patients with multiple myeloma. Several cutaneous lesions have been associated with its use and chalazia have been reported in a few cases with a delayed appearance ranging from 1 to 6 months. We describe the case of a 59-year-old man with multiple myeloma IgG kappa, ISS2, who developed a chalazion induced by bortezomib. Following the failure of conservative treatment, a biopsy was performed to exclude extramedullary plasmocytoma. Bortezomib was discontinued due to the persistence of lesions and a therapeutic approach combining systemic antibiotics with incision and curettage was adopted. An active inflammatory lesion developed after 1 month, similar to that observed under bortezomib therapy. Symptoms resolved only 5 months later and the patient remained free of any ocular manifestation. Physicians should be aware that chalazia may be resistant to conventional treatment and lead to local complications, such as cellulitis.展开更多
Background: Patients with stem cell myeloproliferative disorders have a particularly poor prognosis and limited treatment options, i.e. mainly aggressive chemotherapy or allogeneic stem cell transplantation. In 2004, ...Background: Patients with stem cell myeloproliferative disorders have a particularly poor prognosis and limited treatment options, i.e. mainly aggressive chemotherapy or allogeneic stem cell transplantation. In 2004, Chen et al. reported a patient presenting a t(8;13) (p11;q12) cytogenic anomaly who responded positively to treatment with PKC412 (midostaurin), an oral multi-targeted tyrosine kinase inhibitor. Here, we report a second case treated with the above-mentioned drug. Patient: A 71-year-old woman was diagnosed as having chronic myelogenous leukaemia with eosinophilia secondary to t(8;13) with FGFR1 involvement. Due to her age, an allogeneic stem cell transplantation was not possible. Treatment: A treatment combining aggressive chemotherapy and midostaurin was explored. The patient received one cycle of hyper-CVAD chemotherapy followed by maintenance therapy with midostaurin. A relapse occurred after six months, and she was treated with four more cycles of hyper-CVAD chemotherapy. The patient entered a complete clinical, haematological and cytogenetic remission. A maintenance therapy with midostaurin continued for four months until she developed a chemoresistant relapse followed by acute leukaemia. Conclusion: This is the second case of a t(8;13) myeloid and lymphoid neoplasm with FGFR1 abnormalities treated successfully with midostaurin. Midostaurin is administered orally, allows for outpatient care and in this case showed only occasional and minimal side effects. The combination of hyper-CVAD and midostaurin extended survival by 21 months without allogeneic transplantation. This case further supports the possibility of using midostaurin for the treatment of other diseases with FGFR1 dysregulations;however, specific clinical trials are needed to confirm this hypothesis.展开更多
文摘Background Vestibular schwannoma, the commonest form of intracranial schwannoma, arises from the Schwann cells investing the vestibular nerve. At present, the surgery for vestibular schwannoma remains one of the most complicated operations demanding for surgical skills in neurosurgery. And the trend of minimal invasion should also be the major influence on the management of patients with vestibular schwannomas. We summarized the microsurgical removal experience in a recent series of vestibular schwannomas and presented the operative technique and cranial nerve preservation in order to improve the rates of total tumor removal and facial nerve preservation. Methods A retrospective analysis was performed in 145 patients over a 7-year period who suffered from vestibular schwannomas that had been microsurgically removed by suboccipital retrosigmoid transmeatus approach with small craniotomy. CT thinner scans revealed the tumor size in the internal auditory meatus and the relationship of the posterior wall of the internal acoustic meatus to the bone labyrinths preoperatively. Brain stem evoked potential was monitored intraoperatively. The posterior wall of the internal acoustic meatus was designedly drilled off. Patient records and operative reports, including data from the^electrophysiological monitoring, follow-up audiometric examinations, and neuroradiological findings were analyzed. Results Total tumor resection was achieved in 140 cases （96.6%） and subtotal resection in 5 cases. The anatomical integrity of the facial nerve was preserved in 91.0% （132/145） of the cases. Intracranial end-to-end anastomosis of the facial nerve was performed in 7 cases. Functional preservation of the facial nerve was achieved in 115 patients （Grade ! and Grade ]I, 79.3%）. No patient died in this series. Preservation of nerves and vessels were as important as tumor removal during the operation. CT thinner scan could show the relationship between the posterior wall of the internal acoustic meatus and bone labyrinths, that is
文摘Background Image-guided neurosurgery, endoscopic-assisted neurosurgery and the keyhole approach are three important parts of minimally invasive neurosurgery and have played a significant role in treating skull base lesions. This study aimed to investigate the potential usefulness of coupling of the endoscope with the far lateral keyhole approach and image guidance at the ventral craniocervical junction in a cadaver model. Methods We simulated far lateral keyhole approach bilaterally in five cadaveric head specimens （10 cranial hemispheres）. Computed tomography-based image guidance was used for intraoperative navigation and for quantitative measurements. Skull base structures were observed using both an operating microscope and a rigid endoscope. The jugular tubercle and one-third of the occipital condyle were then drilled, and all specimens were observed under the microscope again. We measured and compared the exposure of the petroclivus area provided by the endoscope and by the operating microscope. Statistical analysis was performed by analysis of variance followed by the Student-Newman-Keuls test. Results With endoscope assistance and image guidance, it was possible to observe the deep ventral craniocervical junction structures through three nerve gaps （among facial-acoustical nerves and the lower cranial nerves） and structures normally obstructed by the jugular tubercle and occipital condyle in the far lateral keyhole approach. The surgical area exposed in the petroclival region was significantly improved using the 0° endoscope （1147.80 mm2） compared with the operating microscope （（756.28±50.73） mm2）. The far lateral retrocondylar keyhole approach, using both 0° and 30° endoscopes, provided an exposure area （（1147.80±159.57） mm2 and （1409.94±155.18） mm2, respectively） greater than that of the far lateral transcondylar transtubercular keyhole approach （（1066.26±165.06） mm2） （P 〈0.05）. Conclusions With the aid of the endoscope and image guidance, it is possib
基金supported by the Telethon Foundation(No.GGP15219 to S.F.R.)the Fondazione CRT(Cassa di Risparmio di Torino)(project grant"Cerebro-NGS.TO"to S.F.R.)the Universita degli Studi di Torino(Local Research Funding2018-21to R.M.andS.F.R.).
文摘cerebrovascular disease of genetic origin characterized by abnormally dilated capillaries and a wide spectrum of symptoms,including headaches,seizures,neurological deficits,and intracerebral hemorrhage.Its unpredictable clinical course and the current lack of therapies make the identification of prognostic and predictive biomarkers an imperative research challenge.1 Herein,we provide evidence that galectin-3(Gal-3),a major tissue and circulating biomarker of oxidative stress and inflammation,is significantly up-regulated both in CCM patients and experimentalmodels.Specifically,wholetranscriptome sequencing,qRT-PCR,and Western blotting studies demonstrated a significant up-regulation of Gal-3 expression levels both in surgical CCM specimens and in blood samples of CCM patients.
文摘Stroke is the most common complication of atrial fibrillation(AF).Guidelines recommend anticoagulant treatment in patients with CHA2DS2VASc scores of>2.Registry data suggests that almost half of patients who should be on therapeutic anticoagulation for stroke prevention in AF(SPAF)are not.Warfarin and more recently developed agents,the"novel anticoagulants"(NOACs)reduce the risk of embolic strokes.In addition,the NOACs also reduce intracranial hemorrhage(ICH)by over 50% compared to warfarin.Anticoagulation and bridging strategies involving cardioversion,catheter ablation,and invasive/surgical procedures are reviewed.The development of reversal agents for NOACs and the introduction of left atrial appendage occluding devices will evolve the use of newer strategies for preventing stroke in high risk AF patients.
文摘Bortezomib is a novel agent for the treatment of patients with multiple myeloma. Several cutaneous lesions have been associated with its use and chalazia have been reported in a few cases with a delayed appearance ranging from 1 to 6 months. We describe the case of a 59-year-old man with multiple myeloma IgG kappa, ISS2, who developed a chalazion induced by bortezomib. Following the failure of conservative treatment, a biopsy was performed to exclude extramedullary plasmocytoma. Bortezomib was discontinued due to the persistence of lesions and a therapeutic approach combining systemic antibiotics with incision and curettage was adopted. An active inflammatory lesion developed after 1 month, similar to that observed under bortezomib therapy. Symptoms resolved only 5 months later and the patient remained free of any ocular manifestation. Physicians should be aware that chalazia may be resistant to conventional treatment and lead to local complications, such as cellulitis.
文摘Background: Patients with stem cell myeloproliferative disorders have a particularly poor prognosis and limited treatment options, i.e. mainly aggressive chemotherapy or allogeneic stem cell transplantation. In 2004, Chen et al. reported a patient presenting a t(8;13) (p11;q12) cytogenic anomaly who responded positively to treatment with PKC412 (midostaurin), an oral multi-targeted tyrosine kinase inhibitor. Here, we report a second case treated with the above-mentioned drug. Patient: A 71-year-old woman was diagnosed as having chronic myelogenous leukaemia with eosinophilia secondary to t(8;13) with FGFR1 involvement. Due to her age, an allogeneic stem cell transplantation was not possible. Treatment: A treatment combining aggressive chemotherapy and midostaurin was explored. The patient received one cycle of hyper-CVAD chemotherapy followed by maintenance therapy with midostaurin. A relapse occurred after six months, and she was treated with four more cycles of hyper-CVAD chemotherapy. The patient entered a complete clinical, haematological and cytogenetic remission. A maintenance therapy with midostaurin continued for four months until she developed a chemoresistant relapse followed by acute leukaemia. Conclusion: This is the second case of a t(8;13) myeloid and lymphoid neoplasm with FGFR1 abnormalities treated successfully with midostaurin. Midostaurin is administered orally, allows for outpatient care and in this case showed only occasional and minimal side effects. The combination of hyper-CVAD and midostaurin extended survival by 21 months without allogeneic transplantation. This case further supports the possibility of using midostaurin for the treatment of other diseases with FGFR1 dysregulations;however, specific clinical trials are needed to confirm this hypothesis.
