[Impact of all-trans retinoic acid on gene expression profile of glioblastoma cell line SHG-44]

BACKGROUND & OBJECTIVE

Astrocytoma has the trend of malignant progression. Differentiation-inducing therapy can induce tumor differentiation and make tumor cells become less malignant or even normal. This study was to investigate the impact of all-trans retinoic acid (ATRA) on the gene expression profile of glioblastoma cell line SHG-44, and to provide basic data for further research on gene therapy for human astrocytoma.

METHODS

After treatment of 10 micromol/L ATRA, total RNA was extracted from SHG-44 cells for reverse transcription-polymerase chain reaction, and cDNA product was marked with fluorochromes Cy3 and Cy5. The gene expression profiles of SHG-44 cells before and after treatment of ATRA were detected by chip hybridization to identify differentially expressed genes. Some differentially expressed genes were selected randomly for Northern blot analysis.

RESULTS

Forty-two differentially expressed genes were found by cDNA microarray: 28 were up-regulated and 14 were down-regulated in ATRA-treated SHG-44 cells as compared with those in untreated SHG-44 cells. These genes were functionally classified into several groups as follow: apoptosis, cell mobility and metastasis, cell cycle and growth regulation, cytoskeleton, differentiation, metabolic pathway, oncogene, oxidative phosphorylation, receptors and signal transduction, ribosome, ubiquitin-proteasome system, growth factor and cytokine, and so on.

CONCLUSIONS

ATRA can result in the changes of gene expression profiles in SHG-44 cells. These differentially expressed genes may mediate the mechanism of ATRA-induced differentiation of SHG-44 cells, and regulate tumor progression.

[Microsurgery for intracranial aneurysm:analysis of 438 cases]

OBJECTIVE

To summarize the experience of surgical therapy in a series of 438 patients with intracranial aneurysms.

METHODS

A retrospective analysis was made on the clinical data of 438 patients, in terms of the perioperative management, timing of surgery, surgical skills, and The HUNT-HESS grade.

RESULTS

438 patients with 476 aneurysms underwent microsurgery, in which 450 aneurysms were clipped, 14 were wrapped, 8 were isolated,4 were cut. 32 aneurysms were ruptured (6.72%) during the operation. The relation between Hunt-Hess scale and mortality is significant postpone operation (> or =7 d) has got a better curative effect than the early.

CONCLUSIONS

Microsurgical treatment is a confirmed effective method with intracranial aneurysms. The higher of HUNT-HESS grade will result to the worse clinical outcome.

Microsurgical management of lateral ventricular meningiomas: a report of 51 cases

BACKGROUND

Lateral ventricular meningiomas are notably rare and the optimal surgical management for them remains a challenge. We made a retrospective study of patients with these lesions and analyzed the clinical findings, radiological features and especially the surgical treatment on the basis of surgical approaches and techniques.

MATERIALS AND METHODS

A total of 51 patients with lateral ventricular meningiomas were operated on between 1996 and 2006 in our institution. The mean patient age was 44 years (range: 14-75 years). The most common presenting symptoms were related to the gradually increasing high cranial pressure (82.4%) rather than the location of the tumor. The transcortical parieto-occipital approach was used in 38 patients, the temporal approach was used in 9 patients and the transcallosal approach was used in 4 patients.

RESULTS

The total surgical excision was complete in 48 patients (94.1%), and 3 patients with subtotal excision received radiotherapy after the operation. The previous visual fields deficits in two patients worsened and a new visual disturbance or sensory aphasia appeared in two patients. One patient died of postoperative hypothalamus complications. Thirty-eight patients underwent follow-up (range: 6 months-10 years). The conditions of 35 of these were excellent or good. No recurrence has been seen in any patient.

CONCLUSIONS

Understanding the features of lateral ventricular meningiomas will help one to select an appropriate surgical approach. An individualized approach is needed, and the transcortical parieto-occipital approach or transtemporal approach is advantageous for most cases in our opinion. Also, it is possible to achieve a good surgical outcome with little neurological morbidity if we take wise strategies and techniques during excision.

Nontraumatic and noninfectious pseudoaneurysms on the circle of Willis: 2 case reports and review of the literature

BACKGROUND

Nontraumatic and noninfectious pseudoaneurysms with similar shape of true saccular aneurysm on the circle of Willis are rare.

CASE DESCRIPTIONS

Two patients with such pseudoaneurysms are reported, one is a 37-year-old man, the other is a 50-year-old woman. They presented with sudden headache; CT scan showed subarachnoid hemorrhage in both. Thorough medical history had been reviewed; physical and laboratory examination had been made but demonstrated no evidence of craniocerebral injury and intracranial or systematic infection. On the cerebroangiogram, they represented the same imageologic changes of true saccular aneurysm, but subsequent operation and pathologic examination revealed that they were pseudoaneurysms consisting of blood clot enclosed with a layer of connective tissue; degenerative changes may have contributed to their formation.

CONCLUSION

Careful attention should be given in classifying these saccular pseudoaneurysm from true saccular aneurysms because of their friable nature, tendency of rupture, and different pathologic findings.

Spontaneous spinal epidural hematoma: analysis of 23 cases

BACKGROUND

Spontaneous spinal epidural hematoma is a rare but disabling disease. To explore its characters and find out what factors influence the prognosis, we gave a retrospective analysis of 23 patients in our department in the past 8 years.

METHODS

Spontaneous spinal epidural hematoma was diagnosed by taking MRIs of patients without surgical management or by histopathological examination. We registered patient's case history, laboratory examination, radiological image, treatment, pathological result, and prognosis after 3 months and gave them nonparameter analysis.

RESULTS

Primary neurological status and progressive intervals have correlation with prognosis (P< .01), and the latter less than 12 hours predict worse prognosis (P= .032). Spinal edema in MRI predicts pessimistic prognosis (P= .013). Long hematoma predicts worse prognosis (P= .02). Preoperative interval, emphasized by other authors, has no statistical correlation with prognosis in this study (P= .832). Finally, patients with a single hematoma or hematoma mingled with other spinal disturbance have the same prognosis (P= .065).

CONCLUSIONS

The primary neurological status, progressive interval, spinal edema, and size of hematoma will influence the prognosis of the patient with SSEH. The major treatment is surgical intervention, and it should be operated as soon as possible to avoid the aggravation of neurological status. Conservative treatment is not considered unless patient's neurological deficiency has relieved in the early period.

Huge primary myxoma of skull base: a report of an uncommon case

We report a 27-year-old male who presented with paroxysmal headache, stuffy nose, epistaxis and impairment of vision in each eye. A huge chondrosarcoma, arising from the skull base with extension into the middle cranial fossa and nasal cavity was suspected. The patient underwent craniotomy and endoscope-assisted transnasal resection and a satisfactory removal was achieved. Postoperative immunohistochemical examination confirmed the diagnosis of myxoma rather than chondrosarcoma. The patient remained neurologically intact except for poor vision in the left eye at six-month follow-up. The relevant literature was reviewed and discussed. The main treatment of myxomas of cranial base is by surgery.

Autofluorescence lifetime measurement on oral carcinogenesis

Normal and cancerous tissues have distinct autofluorescence lifetime because of their biophysical and biochemical differences. Protoporphyrin IX (PplX) is a useful fluorophore, which generally accumulates more in cancerous cells than in normal cells due to heme synthesis pathway, is often employed in photodynamic detection and therapy. Under 410nm excitation, the main emission peak of PplX is at 630nm. Autofluorescence lifetime at 630nm emission would be elongated if PplX gathered more in cells. In this study, we tried to find if there exist significant differences of autofluorescence lifetime at 630nm (under 410nm excitation) between normal and cancerous tissues for in vivo measurement. The result shows that normal tissues in general have shorter lifetime (about 2.8 approximately 3.5 ns) than that of abnormal tissues. The measured data suggest that lifetime would get longer in accordance with the degree of carcinogenesis. For cancer tissues, the average autofluorescence lifetime was extended to be about 10ns. Furthermore, the efficiency of treatment could also be defined refer to the time-series of lifetime decline.

Increased apoptosis and cysteinyl aspartate specific protease-3 gene expression in human intracranial aneurysm

OBJECTIVE

To investigate apoptosis in vascular smooth muscle cells (VSMCs) and caspase-3 expression in ruptured intracranial aneurysm.

METHODS

Tissue samples of 15 ruptured intracranial aneurysms, 6 abdominal aortic aneurysms (AAA) and 6 normal vessels were evaluated. Apoptosis in VSMCs was determined on transmission electron microscopy. Immunohistochemistry for alpha-SMC actin and direct cell counts (medial VSMCs per high-power field (HPF)) were employed to determine medial VSMC density. Additionally, gene expression of caspase-3 was determined using real-time RT-PCR.

RESULTS

We demonstrated medial VSMCs exhibiting morphological apoptotic changes in cerebral aneurysm and AAA. Medial VSMC density was significantly decreased in intracranial aneurysm (43.9+/-4.3 SMCs/HPF) and AAA (53.2+/-9.4 SMCs/HPF) compared with the normal arteries (222.8+/-12.1 SMCs/HPF; p<0.01). An 8.94-fold and 6.73-fold increase in expression of caspase-3mRNA in intracranial aneurysm and AAA, respectively, were obtained relative to the normal vessels.

CONCLUSIONS

These results suggest that real time RT-PCR provides a useful tool to test gene expression in small samples, and may contribute to a better understanding of the role of apoptosis in ruptured intracranial aneurysm.

Influencing factors for posttraumatic hydrocephalus in patients suffering from severe traumatic brain injuries

OBJECTIVE

To detect the influencing factors for posttraumatic hydrocephalus in patients with severe traumatic brain injuries and provide theoretical reference for clinical treatment.

METHODS

Retrospective study was made on 139 patients with severe traumatic brain injuries in our hospital. The patients were divided into two groups: hydrocephalus group and non-hydrocephalus group. Single factor analysis and multiple factor analysis were used to determine the related factors and hydrocephalus. Multiple factor analysis was conducted with logistic regression.

RESULTS

Posttraumatic hydrocephalus was found in 19.42% of patients. Age(OR equal to 1.050, 95%CI: 1.012-1.090), decompressive craniectomy (OR equal to 4.312, 95%CI: 1.127-16.503), subarachnoid hemorrhage(OR equal to 43.421, 95%CI: 7.835-240.652) and continuous lumbar drainage of cerebrospinal fluid (OR equal to 0.045, 95%CI: 0.011-0.175) were screened out from nine factors as the influencing factors for posttraumatic hydrocephalus.

CONCLUSIONS

Risk factors for PTH are as follows: age, decompressive craniectomy and subarachnoid hemorrhage (SAH). Continuous lumbar drainage of cerebrospinal fluid can greatly reduce posttraumatic hydrocephalus.

Expression of human MCM6 and DNA Topo II alpha in craniopharyngiomas and its correlation with recurrence of the tumor

Craniopharyngioma often recurs after resection resulting in poor outcome for the affected patients. The reliable criteria for predicting the tumor behavior are still lacking. It has been suggested that proliferative potential of the tumor cells is necessary for recurrence. Present study evaluated the cell multiplication activity, which is possibly related to relapse in 32 patients with adamantine epithelioma (AE) and 31 patients with squamous papillary tumor (SP). For this tissue specimens from their primary and recurring tumors were collected and immunohistochemical analysis of the expression of minichromosome maintenance protein 6 (MCM6) and DNA topoisomerase II alphalpha (DNA Topo II alpha) in the tumor sections was performed by quantitative microscopy. It was found that the MCM6 label index (LI) was significantly higher in AE than that of SP, and in the primary tumors of both subtypes the LIs of tumors with recurrence were higher than those without recurrence. There was a strong linear positive correlation between MCM6 LI and DNA Topo II alpha LI (r = 0.713; p = 0.000) in the craniopharyngiomas studied. The median MCM6 LI of the total 20 recurrent craniopharyngiomas (31.49%) was not significantly different from that of their primary tumors (29.65%). The long term risk of tumor recurrence is higher in AE than SP and it is associated with MCM6 and DNA Topo II alpha expression.

Angiogenesis and cell proliferation in human craniopharyngioma xenografts in nude mice

OBJECT

Craniopharyngioma is one of the most common congenital tumors of the sellar and suprasellar regions and accounts for between 4 and 6% of all intracranial tumors. Its oncogenesis and biological behavior have not been well studied, and neither a cell line nor an animal model have been established. To better understand the tumor and improve its clinical management, the authors investigated the angiogenesis and cellular proliferation in subcutaneous craniopharyngioma xenografts obtained by implanting human tumor cells into athymic nude mice.

METHODS

Human craniopharyngioma cells obtained from surgical specimens were subcutaneously implanted into BALB/c-nu/nu nude mice to establish a preliminary animal model of a transplanted tumor. Immunohistochemical staining with streptavidin-peroxidase complex was used to identify the cell phenotype and to evaluate the angiogenesis and proliferation in the xenografts. Expression of cytokeratin, minichromosome maintenance deficient 6 (MCM6) protein, and endothelial cell marker CD34 on the xenograft sections were assayed quantitatively by computer-assisted microscopy. Twenty-seven surviving subcutaneous xenografts were obtained in 15 nude mice. The total implantation success rate was 28.12% (adamantine epithelioma [AE], 37.50%; squamous papillary tumor [SPT], 18.75%). Formation of capillaries and cell proliferation were observed in all of these xenografts. Microvessel density and degree of MCM6 immunostaining were positively correlated in the surviving grafts (r = 0.410, p < 0.05), but there was no significant difference in these variables between the AE and SPT groups (p > 0.05).

CONCLUSIONS

A preliminary animal model of human craniopharyngioma was established in the nude mouse by heterotopic implantation. Surviving xenografts maintained their vascularization and proliferation activities until harvesting at 12 weeks.

Genetically distinct astrocytic and oligodendroglial components in oligoastrocytomas

Oligoastrocytomas are glial tumours consisting of a mixture of neoplastic astrocytic and oligodendroglial cells. Genetic alterations of oligoastrocytomas include loss of heterozygosity of chromosomes 1p and/or 19q (LOH 1p/19q), typically occurring in oligodendrogliomas, and mutations of TP53, frequently occurring in astrocytomas. To investigate whether these neoplastic cell types in oligoastrocytomas have different genetic profiles, we examined the two different components of oligoastrocytomas in comparison with the histological diagnosis of the specific tumour area for LOH 1p/19q and TP53 mutations by using microdissection technique. We found a variety of lost markers for 1p and 19q, and the presence of two different TP53 mutations in the tumour samples. In the majority of cases (9/11), the oligodendroglial and astrocytic components of an individual oligoastrocytoma displayed the same genotype. We present two cases of biphasic oligoastrocytomas with aberrant findings, suggesting the coexistence of genetically and morphologically distinct tumour cell clones in these tumours. In one case, the oligodendroglial part of the tumour showed LOH19q, whereas the astrocytic part showed TP53 mutation (codon 273). In another case, we found LOH 1p/19q in the oligodendroglial component, but two retained areas on chromosome 1p in the astrocytic component of the tumour. No evidence was found for the coexistence of tumour cells with the two genotypical changes within the same morphological region of one individual tumour. The two cases of biphasic oligoastrocytomas in our sample that display a different genotype in the astrocytic and oligodendroglial part of the tumour show that different components of an oligoastrocytoma may be derived from different cell clones during neoplastic transformation.

[Expression of minichromosome maintenance protein 6 in craniopharyngioma and its correlation with prognosis]

OBJECTIVE

To investigate the expression of minichromosome maintenance protein 6 (MCM6) in tissue sections of craniopharyngioma and observe its relation with the outcome of patients with craniopharyngiomas.

METHODS

Prospective cohorts were composed of 32 adamantine epithelioma (AE) patients and 31 squamous papillary tumor (SP) patients. The average of follow-up phase was 84. 26 months, of 60 patients with craniopharyngioma, 20 suffered from recurrence and underwent operation again for removal of tumor, and the specimens of the tumors patients were collected. MCM6 as proliferative marker expression in the specimen sections was measured by immunohistochemical method (avidin-biotin-peroxidase); quantitatively, scoring for MCM6 protein variation was performed by TE2000-U inverted biological microscope and Image-Pro Plus professional image analysis software. Oncocyte proliferation potential was evaluated for inter-group comparison in three pair of groups, including AE/SP, recurrence/recurrence-free, and primary/relapse groups.

RESULTS

14 of 32 AE patients and 6 of 31 SP patients had recurrence during follow-up. MCM6 protein expression showed significant difference between AE/SP groups and between recurrence/recurrence-free groups (P < 0.05, two-tailed), but there was no statistically significant difference between primary and recurrent craniopharyngiomas.

CONCLUSION

The subtype and MCM6 protein expression in craniopharyngiomas are related to the prognosis of tumor and thus may be useful in predicting the risk of tumor relapse.

HBV genes induce cytotoxic T-lymphocyte response upon adeno-associated virus (AAV) vector delivery into dendritic cells

Hepatitis B virus (HBV) has been an increasing problem throughout the world and remains difficult to treat. But immunotherapeutic approaches offer new, effective treatments. Three recombinant adeno-associated virus (AAV) type 2 vectors, carrying one of the HBV S, C or X gene, were used to load (transduce) professional antigen-presenting dendritic cells (DC) for the purpose of stimulating cytotoxic T lymphocytes (CTL) in vitro. It was found that all three recombinant AAV/HBV antigen virus loaded DC at approximately 90% transduction efficiency. Most importantly, all three AAV-loaded DC stimulated rapid, antigen-specific and major histocompatibility complex (MHC)-restricted CTL. In vitro, these CTL killed (30-50%) synthetic antigen-positive autologous targets as well as HepG2 liver cell targets. In comparing the three antigens, it was found that AAV/HBV-C-derived CTL consistently had the highest killing efficiency. CTL derived from AAV/HBV-C-loaded DC also showed significantly higher killing of targets than that from bacterially generated C-protein-loaded DC. Further studies showed that AAV/HBV-C-derived CTL had higher interferon (IFN)-gamma. These data suggest that AAV/HBV antigen gene-loading of DC may be useful for immunotherapeutic protocols against HBV infection and that the HBV C antigen may be the most useful for this purpose.

Microvascular density and vascular endothelial growth factor have little correlation with prognosis of craniopharyngioma

BACKGROUND

Craniopharyngioma is histologically a benign epithelial tumor located in the supersellar cistern that often presents aggressive growth and repeated recurrence. The authors hypothesized that craniopharyngioma recurrence and invasive growth are angiogenesis dependent and evaluated the significance of vascularization in the prognosis of craniopharyngioma by a prospective cohort study.

METHODS

The cohorts consisted of 32 patients with AE and 31 patients with SP tumor. The primary and recurrence removal specimens of the cohort patients were gathered. Microvascular density and VEGF protein in the recurrence group and recurrence-free group were detected by the immunohistochemistry avidin-biotin-peroxidase method and analyzed quantitatively through computer-assisted microscopy to evaluate the correlation of MVD and VEGF with prognosis of craniopharyngiomas.

RESULTS

The average follow-up phase was 63.34 months; 14 of 32 patients with AE and 6 of 31 patients with SP had recurrence and underwent operation again. Although MVD and VEGF have significant difference between AE and SP (P=.000, P=.018, respectively), MVD and VEGF have no statistical difference between the recurrence group and recurrence-free group (P>.05).

CONCLUSIONS

Microvascular density and VEGF in craniopharyngioma tissue have no correlation with prognosis of the tumor, which may be explained by the minimal blood circulation in the craniopharyngioma. Adamantine epithelioma showed more tendency to recur than SP.

Effect of hyperbaric oxygen on cytochrome C, Bcl-2 and Bax expression after experimental traumatic brain injury in rats

OBJECTIVE

To explore the effects of hyperbaric oxygen (HBO) treatment on the neuronal apoptosis at an earlier stage and the expressions of Cytochrome C (Cyt C), Bcl-2 (B-cell lymphoma-2 family) and Bax (Bcl-2 associated X protein) in rat brain tissues after traumatic brain injury (TBI).

METHODS

Forty adult rats were divided into two groups, i.e., Group A (the rats with untreated TBI) and Group B (rats with HBO treatment after TBI). Sections of brain tissues of these two groups were then detected at 3, 6, 12, 24, 72 hours after TBI by immunohistochemistry and electronmicroscope, respectively.

RESULTS

HBO treatment could up-regulate the expression of Bcl-2 within 72 hours, reduce the release of Cyt C from mitochondria, attenuate the formation of dimeric Bax and alleviate the mitochondrial edema within 24 hours after TBI.

CONCLUSIONS

HBO treatment can alleviate neuronal apoptosis after TBI by reducing the release of Cyt C and the dimers of Bax and up-regulating the expression of Bcl-2.

[Changes in P-selectin expression after brain injury in rats]

OBJECTIVE

To explore the relationship between expression thange of P-selectin after brain injury and secondary brain damage.

METHODS

Sixty SD rats were randomized into 3 equal groups, namely the control group, mild injury group and severe injury group and animal models of brain injury were established in SD rats according to the method of Feeney. P-selectin expression in the brain tissues were determined at 6 h and l, 3, and 7 days following brain injury (n=5 for each time point). Imaging analysis was performed using computerized imaging technique.

RESULTS

P-selectin expression and neutrophil infiltration in the brain tissues increased significantly 6 h after brain injury (P<0.05), reaching the peak level at postoperative 24 h and then gradually decreased.

CONCLUSION

P-selectin expression and neutrophil infiltration increase significantly following brain injury, and the time course and distribution of P-selectin expression are consistent with the secondary damage of the brain, strongly suggesting the involvement of P-selectin upregulation in the secondary insult after brain injury.

Intramedullary spinal tuberculoma: report of three cases

BACKGROUND

Intramedullary spinal tuberculoma is a rare form of central nervous system tuberculosis. This article describes the successful management of intramedullary spinal tuberculoma in 3 patients who received treatment between 2000 and 2003.

CASE DESCRIPTION

The character of 3 cases was analyzed retrospectively, including clinical manifestation and magnetic resonance imaging findings. All masses were excised totally under microscope. Histopathologic examination revealed tuberculoma. Postoperatively, all patients received a 6 to 9 month course of ATT. The outcome was favorable.

CONCLUSIONS

The intramedullary spinal tuberculoma must be considered in the differential diagnosis of the spinal cord compression in patients with a history of tuberculosis. When confronted with a progressing neurologic deficit and poor response to ATT, surgical intervention should be considered. The optimal treatment is a combination of microsurgical resection and ATT.

[Modified hemispherectomy for intractable epilepsy in patients with infantile hemiplegia]

OBJECTIVE

To explore the effectiveness of modified hemispherectomy for intractable epilepsy in patients with infantile hemiplegia.

METHODS

Eighteen cases of patients were treated with modified hemispherectomy and the effectiveness was studied and followed up.

RESULTS

The seizures in all 18 cases of patients were controlled effectively and stopped completely in 16 cases of them, without nervous disfunction worsened. The patients' cerebral peduncles on healthy side were much thicker than those on sick side (t = 58.32, P < 0.001) and healthy peoples' (t = 14.63, P < 0.001) and the patients' cerebral peduncles on sick side were much thinner than those of healthy peoples' (t = 51.27, P < 0.001).

CONCLUSION

The modified hemispherectomy can effectively control the seizures of patients with infantile hemiplegia without superficial cerebral hemosiderosis happened.

[Effects of extract of Ginkgo biloba on intercellular adhesion molecule-1 and mRNA expression in rats with cerebral injury]

OBJECTIVE

To investigate the effects of Extract of Ginkgo biloba on ICAM-1 and mRNA expression in rats with cerebral injury, and discuss its protective mechanism.

METHODS

The acute closed brain injury model was set up in rats according Feeney's method. Seventy-two rats were randomly divided into four groups. The levels of ICAM-1 expression were observed using immunohistochemistry and computerized imaging technique and the expression of mRNA were studied using RT-PCR techniques.

RESULTS

ICAM-1 positive cells located in the transitional zone between the necrotic core and normal cortex. ICAM-1 protein and mRNA expression began to show 6 hours after cerebral injury, peaked at 24 hours. As compared with the model group, ICAM-1 and mRNA expression was significantly reduced in the group EGb (P < 0.01).

CONCLUSION

EGb can markedly reduce the injury of nerve cell in the transitional zone, alleviate rat cerebral injury, and decrease ICAM-1 and mRNA expression and neutrophils infiltration. The protection may be related with its inhibition on ICAM-1 and mRNA expression.

Microsurgical resection of craniopharyngioma of the third ventricle via an improved transventricular approach

BACKGROUND

Craniopharyngioma of the third ventricle is difficult to treat and its therapeutic regimens and operative approaches have been controversial. This study was undertaken to probe indications for microsurgical resection of craniopharyngioma of the third ventricle via an improved transventricular approach, its surgical procedures and therapeutic effects, and prevention of postoperative complications.

METHODS

Fifty-one patients with craniopharyngioma of the third ventricle were treated from January 2000 to October 2004 by an improved transventricular approach for removing the tumor via the interventricular foramen, the intermedius of the septum pellucidum or choroid fissure. Symptoms and signs of the patients, and results of imaging, operation, and follow-up were analyzed.

RESULTS

Of the 51 patients who had received the improved transventricular resection, 4 underwent a combined approach with an entrance of the pterion. Forty patients (78.43%) underwent total resection and others subtotal resection, without an operative death. Epileptic seizures were found in 3 patients (5.88%) and subdural effusion in the operative field in 4 (7.84%). All patients showed good general conditions after operation, and follow-up for an average of 27.52 months showed relapse of the tumour in 8 patients (15.69%).

CONCLUSIONS

Microsurgical resection of craniopharyngioma of the third ventricle by an improved transventricular approach has advantages of operative safety and efficacy, lower mortality and disability, and less complications.

[Resection of extensive pituitary adenoma via supraorbital keyhole with endoscope-assisted microneurosurgery]

OBJECTIVE

To study the methods and techniques of the treatment for extensive suprasellar pituitary adenoma and repairing hole.

METHODS

From Feb. 2001 to Mar. 2003, 9 patients with extensive suprasellar pituitary adenoma underwent resection via supraorbital keyhole with endoscope-assisted microneurosurgery. Then the remaining tumor was removed with neuro-endoscopy via I and II space of optic chiasma. The small bone flap was fixed with Ti clamp.

RESULTS

After the tumor was removed with microneurosurgery, the remaining tumor was still found with endoscope in 7 cases. Remaining tumor was totally removed in 6 cases, almost removed in 3 cases. The vision improvement was found in 7 cases one week after surgery. In the other 2 cases, the vision remained unchanged. Follow-up was conducted in 6 cases for 6 to 22 months. Neuroradiological recovery of MRI with no recurrence of tumor was observed. No complication of incision was present.

CONCLUSION

Enough intra and extra-cranial space can be provided to operate via orbital roof approach to sellar tumors. Endoscope-assisted microneurosurgery can increase the total-resection and successful rate treatment for extensive suprasellar pituitary adenoma, reduce the possibility of complication, and protect the function of brain from being injured. Fixation of small bone flap with Ti clamp is safe, easy and reliable.