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Suarez CF, Harb OA, Robledo A, Largoza G, Ahn JJ, Alley EK, Wu T, Veeraragavan S, McClugage ST, Iacobas I, Fish JE, Kan PT, Marrelli SP, Wythe JD. MEK signaling represents a viable therapeutic vulnerability of KRAS-driven somatic brain arteriovenous malformations. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.15.594335. [PMID: 38766159 PMCID: PMC11101126 DOI: 10.1101/2024.05.15.594335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Brain arteriovenous malformations (bAVMs) are direct connections between arteries and veins that remodel into a complex nidus susceptible to rupture and hemorrhage. Most sporadic bAVMs feature somatic activating mutations within KRAS, and endothelial-specific expression of the constitutively active variant KRASG12D models sporadic bAVM in mice. By leveraging 3D-based micro-CT imaging, we demonstrate that KRASG12D-driven bAVMs arise in stereotypical anatomical locations within the murine brain, which coincide with high endogenous Kras expression. We extend these analyses to show that a distinct variant, KRASG12C, also generates bAVMs in predictable locations. Analysis of 15,000 human patients revealed that, similar to murine models, bAVMs preferentially occur in distinct regions of the adult brain. Furthermore, bAVM location correlates with hemorrhagic frequency. Quantification of 3D imaging revealed that G12D and G12C alter vessel density, tortuosity, and diameter within the mouse brain. Notably, aged G12D mice feature increased lethality, as well as impaired cognition and motor function. Critically, we show that pharmacological blockade of the downstream kinase, MEK, after lesion formation ameliorates KRASG12D-driven changes in the murine cerebrovasculature and may also impede bAVM progression in human pediatric patients. Collectively, these data show that distinct KRAS variants drive bAVMs in similar patterns and suggest MEK inhibition represents a non-surgical alternative therapy for sporadic bAVM.
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Riedel K, Thudium M, Boström A, Schramm J, Soehle M. Controlled arterial hypotension during resection of cerebral arteriovenous malformations. BMC Neurol 2021; 21:339. [PMID: 34488658 PMCID: PMC8420011 DOI: 10.1186/s12883-021-02362-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background Resection of cerebral arteriovenous malformations (AVM) is technically demanding because of size, eloquent location or diffuse nidus. Controlled arterial hypotension (CAH) could facilitate haemostasis. We performed a study to characterize the duration and degree of CAH and to investigate its association with blood loss and outcome. Methods We retrospectively analysed intraoperative arterial blood pressure of 56 patients that underwent AVM-resection performed by the same neurosurgeon between 2003 and 2012. Degree of CAH, AVM size, grading and neurological outcome were studied. Patients were divided into two groups, depending on whether CAH was performed (hypotension group) or not (control group). Results The hypotension group consisted of 28 patients, which presented with riskier to treat AVMs and a higher Spetzler-Martin grading. CAH was achieved by application of urapidil, increasing anaesthetic depth or a combination thereof. Systolic and mean arterial blood pressure were lowered to 82 ± 7 and 57 ± 7 mmHg, respectively, for a median duration of 58 min [25% percentile: 26 min.; 75% percentile: 107 min]. In the hypotension group, duration of surgery (4.4 ± 1.3 h) was significantly (p < 0.001) longer, and median blood loss (500 ml) was significantly (p = 0.002) higher than in the control group (3.3 ± 0.9 h and 200 ml, respectively). No case fatalities occurred. CAH was associated with a higher amount of postoperative neurological deficits. Conclusions Whether CAH caused neurological deficits or prevented worse outcomes could be clarified by a prospective randomised study, which is regarded as ethically problematic in the context of bleeding. CAH should only be used after strict indication and should be applied as mild and short as possible.
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Affiliation(s)
- Katharina Riedel
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Marcus Thudium
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Azize Boström
- Medical Faculty, University Hospital Bonn, Bonn, Germany.,MEDICLIN Robert Janker Hospital, Bonn, Germany
| | | | - Martin Soehle
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
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Affiliation(s)
- Kia J Jones
- Emory University and Atlanta VA Medical Center, Atlanta, Georgia
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Marín-Ramos NI, Thein TZ, Ghaghada KB, Chen TC, Giannotta SL, Hofman FM. miR-18a Inhibits BMP4 and HIF-1α Normalizing Brain Arteriovenous Malformations. Circ Res 2020; 127:e210-e231. [PMID: 32755283 DOI: 10.1161/circresaha.119.316317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
RATIONALE Brain arteriovenous malformations (AVMs) are abnormal tangles of vessels where arteries and veins directly connect without intervening capillary nets, increasing the risk of intracerebral hemorrhage and stroke. Current treatments are highly invasive and often not feasible. Thus, effective noninvasive treatments are needed. We previously showed that AVM-brain endothelial cells (BECs) secreted higher VEGF (vascular endothelial growth factor) and lower TSP-1 (thrombospondin-1) levels than control BEC; and that microRNA-18a (miR-18a) normalized AVM-BEC function and phenotype, although its mechanism remained unclear. OBJECTIVE To elucidate the mechanism of action and potential clinical application of miR-18a as an effective noninvasive treatment to selectively restore the phenotype and functionality of AVM vasculature. METHODS AND RESULTS The molecular pathways affected by miR-18a in patient-derived BECs and AVM-BECs were determined by Western blot, RT-qPCR (quantitative reverse transcription polymerase chain reaction), ELISA, co-IP, immunostaining, knockdown and overexpression studies, flow cytometry, and luciferase reporter assays. miR-18a was shown to increase TSP-1 and decrease VEGF by reducing PAI-1 (plasminogen activator inhibitor-1/SERPINE1) levels. Furthermore, miR-18a decreased the expression of BMP4 (bone morphogenetic protein 4) and HIF-1α (hypoxia-inducible factor 1α), blocking the BMP4/ALK (activin-like kinase) 2/ALK1/ALK5 and Notch signaling pathways. As determined by Boyden chamber assays, miR-18a also reduced the abnormal AVM-BEC invasiveness, which correlated with a decrease in MMP2 (matrix metalloproteinase 2), MMP9, and ADAM10 (ADAM metallopeptidase domain 10) levels. In vivo pharmacokinetic studies showed that miR-18a reaches the brain following intravenous and intranasal administration. Intranasal co-delivery of miR-18a and NEO100, a good manufacturing practices-quality form of perillyl alcohol, improved the pharmacokinetic profile of miR-18a in the brain without affecting its pharmacological properties. Ultra-high-resolution computed tomography angiography and immunostaining studies in an Mgp-/- AVM mouse model showed that miR-18a decreased abnormal cerebral vasculature and restored the functionality of the bone marrow, lungs, spleen, and liver. CONCLUSIONS miR-18a may have significant clinical value in preventing, reducing, and potentially reversing AVM.
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Affiliation(s)
- Nagore I Marín-Ramos
- Departments of Neurosurgery (N.I.M.-R., T.Z.T., T.C.C., S.L.G.), Keck School of Medicine, University of Southern California, Los Angeles
| | - Thu Zan Thein
- Departments of Neurosurgery (N.I.M.-R., T.Z.T., T.C.C., S.L.G.), Keck School of Medicine, University of Southern California, Los Angeles
| | - Ketan B Ghaghada
- Department of Pediatric Radiology, Texas Children's Hospital, Houston (K.B.G.)
| | - Thomas C Chen
- Departments of Neurosurgery (N.I.M.-R., T.Z.T., T.C.C., S.L.G.), Keck School of Medicine, University of Southern California, Los Angeles.,Departments of Pathology (T.C.C., F.M.H.), Keck School of Medicine, University of Southern California, Los Angeles
| | - Steven L Giannotta
- Departments of Neurosurgery (N.I.M.-R., T.Z.T., T.C.C., S.L.G.), Keck School of Medicine, University of Southern California, Los Angeles
| | - Florence M Hofman
- Departments of Pathology (T.C.C., F.M.H.), Keck School of Medicine, University of Southern California, Los Angeles
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Hernández-Quintanar L, Fabila-Bustos DA, Hernández-Chávez M, Valor A, de la Rosa JM, Stolik S. Fiber-optic pulseoximeter for local oxygen saturation determination using a Monte Carlo multi-layer model for calibration. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 187:105237. [PMID: 31790944 DOI: 10.1016/j.cmpb.2019.105237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/28/2019] [Accepted: 11/20/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Local tissue oxygenation determines the relationship between the supply and the demand for oxygen by the tissue and it is an important indicator of the physiological or pathological condition of the tissue. Moreover, some therapeutic methods strongly depend on the oxygen content of the tissue. In photodynamic therapy, when molecular oxygen is present, the irradiation of the photosensitizer with light triggers the generation of reactive oxygen species that kill the target diseased cells within the treated tissue. To ensure the best possible therapy response, the tissue must be well oxygenated; hence, oxygen concentration measurement becomes a decisive factor. In this work, the design, construction and calibration of a module to locally measure the blood oxygen saturation in tissue is presented. METHODS The system is built using a red (660-nm) and an infrared (940-nm) light emitting diodes as light sources, a photodiode as a detector, and a homemade handheld fiber optic-based reflectance pulse oximetry sensor. In addition, the developed sensor was modeled by means of multilayered Monte Carlo simulations, to study its behavior when used in different thickness and melanin content skin. RESULTS From the simulation reflectance values, the oxygen saturation calibration curves considering different melanin concentrations and skin thicknesses were obtained for two different skin models, one comprising three skin layers and the second, assuming seven different layers for the skin. A comparison of the performances of the developed pulse oximeter sensor with a commercial one is also presented. CONCLUSIONS A new pulseoximeter for the measurement of local oxygenation in tissue was developed. Its calibration strongly depends on the site of measurement due to the influence of tissue thickness, vascularization, and melanin content. A three-layer skin model is proved to be suitable for the calibration of the pulseoximeter in thin and medium thickness skin.
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Affiliation(s)
- Luis Hernández-Quintanar
- Laboratorio de Biofotónica, ESIME ZAC, Instituto Politécnico Nacional, Ciudad de México, 07738, Mexico; Laboratorio de Espectroscopía, UPIIH, Instituto Politécnico Nacional, Ciudad del Conocimiento y la Cultura, San Agustín Tlaxiaca, Hidalgo, 42162, Mexico
| | - Diego A Fabila-Bustos
- Laboratorio de Biofotónica, ESIME ZAC, Instituto Politécnico Nacional, Ciudad de México, 07738, Mexico; Laboratorio de Espectroscopía, UPIIH, Instituto Politécnico Nacional, Ciudad del Conocimiento y la Cultura, San Agustín Tlaxiaca, Hidalgo, 42162, Mexico
| | - Macaria Hernández-Chávez
- Laboratorio de Espectroscopía, UPIIH, Instituto Politécnico Nacional, Ciudad del Conocimiento y la Cultura, San Agustín Tlaxiaca, Hidalgo, 42162, Mexico
| | - Alma Valor
- Laboratorio de Biofotónica, ESIME ZAC, Instituto Politécnico Nacional, Ciudad de México, 07738, Mexico
| | - José M de la Rosa
- Laboratorio de Biofotónica, ESIME ZAC, Instituto Politécnico Nacional, Ciudad de México, 07738, Mexico
| | - Suren Stolik
- Laboratorio de Biofotónica, ESIME ZAC, Instituto Politécnico Nacional, Ciudad de México, 07738, Mexico.
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Ghasemi E, Afkhami Aghda F, Rezvani ME, Shahrokhi Raeini A, Hafizibarjin Z, Zare Mehrjerdi F. Effect of endogenous sulfur dioxide on spatial learning and memory and hippocampal damages in the experimental model of chronic cerebral hypoperfusion. J Basic Clin Physiol Pharmacol 2020; 31:/j/jbcpp.ahead-of-print/jbcpp-2019-0227/jbcpp-2019-0227.xml. [PMID: 32004146 DOI: 10.1515/jbcpp-2019-0227] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/15/2019] [Indexed: 12/27/2022]
Abstract
Background The vascular changes due to cerebrovascular damage, especially on the capillaries, play a vital role in causing vascular dementia. Increasing oxidative stress can lead to tissue damage while reducing brain blood flow. The use of factors reducing the oxidative stress level can decrease the brain damages. Sulfur dioxide (SO2) is one of the most important air pollutants that lead to the development of severe brain damage in large quantities. However, studies have recently confirmed the protective effect of SO2 in cardiac ischemic injury, atherosclerosis and pulmonary infections. Methods The permanent bilateral common carotid artery occlusion (BCAO) method was used to induce chronic cerebral hypoperfusion (CCH). Two treatment groups of SO2 were studied. The animal cognitive performance was evaluated using the Morris water maze. Hippocampal tissue damage was examined after 2 months of BCAO. In the biochemical analysis, the activity of catalase and lipid peroxidation of the hippocampus was studied. Results Neuronal damage in hippocampus, as well as cognitive impairment in ischemia groups treated with SO2 showed a significant improvement. Catalase activity was also significantly increased in the hippocampus of treated groups. Conclusions According to the results, SO2 is likely to be effective in reducing the CCH-caused damages by increasing the antioxidant capacity of the hippocampus.
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Affiliation(s)
- Elaheh Ghasemi
- International Campus, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Faezeh Afkhami Aghda
- Neurobiomedical Research Center, School of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Mohammad Ebrahim Rezvani
- Neurobiomedical Research Center, School of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Azadeh Shahrokhi Raeini
- Neurobiomedical Research Center, School of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Zeynab Hafizibarjin
- Neurobiomedical Research Center, School of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Fatemeh Zare Mehrjerdi
- Department of Physiology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Phone: +98-35-38203412, Fax: +98-35-38203412
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Kleiser S, Ostojic D, Andresen B, Nasseri N, Isler H, Scholkmann F, Karen T, Greisen G, Wolf M. Comparison of tissue oximeters on a liquid phantom with adjustable optical properties: an extension. BIOMEDICAL OPTICS EXPRESS 2018; 9:86-101. [PMID: 29359089 PMCID: PMC5772591 DOI: 10.1364/boe.9.000086] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/14/2017] [Accepted: 11/19/2017] [Indexed: 05/02/2023]
Abstract
Cerebral near-infrared spectroscopy (NIRS) oximetry may help clinicians to improve patient treatment. However, the application of NIRS oximeters is increasingly causing confusion to the users due to the inconsistency of tissue oxygen haemoglobin saturation (StO2) readings provided by different oximeters. To establish a comparability of oximeters, in our study we performed simultaneous measurements on the liquid phantom mimicking properties of neonatal heads and compared the tested device to a reference NIRS oximeter (OxiplexTS). We evaluated the NIRS oximeters FORE-SIGHT, NIRO and SenSmart, and reproduced previous results with the INVOS and OxyPrem v1.3 oximeters. In general, linear relationships of the StO2 values with respect to the reference were obtained. Device specific hypoxic and hyperoxic thresholds (as used in the SafeBoosC study, www.safeboosc.eu) and a table allowing for conversion of StO2 values are provided.
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Affiliation(s)
- S. Kleiser
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich,
Switzerland
| | - D. Ostojic
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich,
Switzerland
| | - B. Andresen
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen,
Denmark
| | - N. Nasseri
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich,
Switzerland
- Institute of Complementary Medicine, University of Bern, Bern,
Switzerland
| | - H. Isler
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich,
Switzerland
| | - F. Scholkmann
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich,
Switzerland
- Institute of Complementary Medicine, University of Bern, Bern,
Switzerland
| | - T. Karen
- Department of Neonatology, University Hospital Zurich, Zurich,
Switzerland
| | - G. Greisen
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen,
Denmark
| | - M. Wolf
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich,
Switzerland
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Ozpinar A, Mendez G, Abla AA. Epidemiology, genetics, pathophysiology, and prognostic classifications of cerebral arteriovenous malformations. HANDBOOK OF CLINICAL NEUROLOGY 2017; 143:5-13. [PMID: 28552158 DOI: 10.1016/b978-0-444-63640-9.00001-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Arteriovenous malformations (AVMs) are vascular deformities involving fistula formation of arterial to venous structures without an intervening capillary bed. Such anomalies can prove fatal as the high arterial flow can disrupt the integrity of venous walls, thus leading to dangerous sequelae such as hemorrhage. Diagnosis of these lesions in the central nervous system can often prove challenging as intracranial AVMs represent a heterogeneous vascular pathology with various presentations and symptomatology. The literature suggests that most brain AVMs (bAVMs) are identified following evaluation of the etiology of acute cerebral hemorrhage, or incidentally on imaging associated with seizure or headache workup. Given the low incidence of this disease, most of the data accrued on this pathology comes from single-center experiences. This chapter aims to distill the most important information from these studies as well as examine meta-analyses on bAVMs in order to provide a comprehensive introduction into the natural history, classification, genetic underpinnings of disease, and proposed pathophysiology. While there is yet much to be elucidated about AVMs of the central nervous system, we aim to provide an overview of bAVM etiology, classification, genetics, and pathophysiology inherent to the disease process.
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Affiliation(s)
- Alp Ozpinar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Gustavo Mendez
- Department of General Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Adib A Abla
- Department of Neurological Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Shah MN, Smith SE, Dierker DL, Herbert JP, Coalson TS, Bruck BS, Zipfel GJ, Van Essen DC, Dacey RG. The relationship of cortical folding and brain arteriovenous malformations. NEUROVASCULAR IMAGING (LONDON) 2016; 2. [PMID: 28009020 PMCID: PMC5167380 DOI: 10.1186/s40809-016-0024-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background The pathogenesis of human intracranial arteriovenous malformations (AVMs) is not well understood; this study aims to quantitatively assess cortical folding in patients with these lesions. Methods Seven adult participants, 4 male and 3 female, with unruptured, surgically unresectable intracranial AVMs were prospectively enrolled in the study, with a mean age of 42.1 years and Spetzler-Martin grade range of II–IV. High-resolution brain MRI T1 and T2 sequences were obtained. After standard preprocessing, segmentation and registration techniques, three measures of cortical folding, the depth difference index (DDI), coordinate distance index (CDI) and gyrification index (GI)), were calculated for the affected and unaffected hemispheres of each subject as well as a healthy control subject set. Results Of the three metrics, CDI, DDI and GI, used for cortical folding assessment, none demonstrated significant differences between the participants and previously studied healthy adults. There was a significant negative correlation between the DDI ratio between affected and unaffected hemispheres and AVM volume (correlation coefficient r = −0.74, p = 0.04). Conclusion This study is the first to quantitatively assess human brain cortical folding in the presence of intracranial AVMs and no significant differences between AVM-affected versus unaffected hemispheres were found in a small dataset. We suggest longitudinal, larger human MRI-based cortical folding studies to assess whether AVMs are congenital lesions of vascular development or de novo, dynamic lesions.
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Affiliation(s)
- Manish N Shah
- Departments of Pediatric Surgery and Neurosurgery, McGovern Medical School at UT Health and UT MD Anderson Cancer Center, Pediatric Neurosurgery, 6431 Fannin St., MSB 5.144, Houston, TX 77030, USA
| | - Sarah E Smith
- Department of Neuroscience, Washington University, 660 S. Euclid Ave, St. Louis, MO 63110, USA
| | - Donna L Dierker
- Department of Neuroscience, Washington University, 660 S. Euclid Ave, St. Louis, MO 63110, USA
| | - Joseph P Herbert
- Division of Neurosurgery, University of Missouri-Columbia, One Hospital Drive, 314 McHaney Hall, Columbia, MO 65212, USA
| | - Timothy S Coalson
- Department of Neuroscience, Washington University, 660 S. Euclid Ave, St. Louis, MO 63110, USA
| | - Brent S Bruck
- Department of Neurological Surgery, Washington University, 660 S. Euclid Ave, St. Louis, MO 63110, USA
| | - Gregory J Zipfel
- Department of Neurological Surgery, Washington University, 660 S. Euclid Ave, St. Louis, MO 63110, USA
| | - David C Van Essen
- Department of Neuroscience, Washington University, 660 S. Euclid Ave, St. Louis, MO 63110, USA
| | - Ralph G Dacey
- Department of Neurological Surgery, Washington University, 660 S. Euclid Ave, St. Louis, MO 63110, USA
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Su SH, Wang YQ, Wu YF, Wang DP, Lin Q, Hai J. Cannabinoid receptor agonist WIN55,212-2 and fatty acid amide hydrolase inhibitor URB597 may protect against cognitive impairment in rats of chronic cerebral hypoperfusion via PI3K/AKT signaling. Behav Brain Res 2016; 313:334-344. [DOI: 10.1016/j.bbr.2016.07.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/03/2016] [Accepted: 07/06/2016] [Indexed: 02/06/2023]
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Kleiser S, Nasseri N, Andresen B, Greisen G, Wolf M. Comparison of tissue oximeters on a liquid phantom with adjustable optical properties. BIOMEDICAL OPTICS EXPRESS 2016; 7:2973-92. [PMID: 27570691 PMCID: PMC4986807 DOI: 10.1364/boe.7.002973] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/31/2016] [Accepted: 06/07/2016] [Indexed: 05/18/2023]
Abstract
The SafeBoosC trial showed that cerebral oximetry combined with a treatment guideline can reduce the the burden of hypoxia in neonates by 50% [Brit. Med. J.350, g7635 (2015)]. However, guidelines based on oximetry by one oximeter are not directly usable by other oximeters. We made a blood-lipid phantom simulating the neonatal head to determine the relation between oxygenation values obtained by different oximeters. We calculated coefficients for easy conversion from one oximeter to the other. We additionally determined the corresponding SafeBoosC intervention thresholds at which we measured an uncertainty of up to 9.2% when varying hemoglobin content from 25μM to 70μM. In conclusion, this paper makes the comparison of absolute values obtained by different oximeters possible.
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Affiliation(s)
- S. Kleiser
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, Zurich,
Switzerland
- equal contribution
| | - N. Nasseri
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, Zurich,
Switzerland
- equal contribution
| | - B. Andresen
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen,
Denmark
| | - G. Greisen
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen,
Denmark
| | - M. Wolf
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, Zurich,
Switzerland
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Su SH, Wu YF, Lin Q, Yu F, Hai J. Cannabinoid receptor agonist WIN55,212-2 and fatty acid amide hydrolase inhibitor URB597 suppress chronic cerebral hypoperfusion-induced neuronal apoptosis by inhibiting c-Jun N-terminal kinase signaling. Neuroscience 2015; 301:563-75. [DOI: 10.1016/j.neuroscience.2015.03.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/13/2015] [Accepted: 03/11/2015] [Indexed: 11/15/2022]
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Intraoperative Monitoring of Brain Tissue Oxygenation During Arteriovenous Malformation Resection. J Neurosurg Anesthesiol 2014; 26:328-41. [DOI: 10.1097/ana.0000000000000033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hai J, Lin Q, Deng DF, Pan QG, Ding MX. The pre-treatment effect on brain injury during restoration of normal perfusion pressure with hemodilution in a new rat model of chronic cerebral hypoperfusion. Neurol Res 2013; 29:583-7. [PMID: 17535558 DOI: 10.1179/016164107x166254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES To investigate the effect of hemodilution with high-concentration human serum albumin (HSA) on brain injury in a rat model of chronic cerebral hypoperfusion associated with arteriovenous malformations. METHODS The animal model was established by creating a fistula through an end-to-side anastomosis between the right distal external jugular vein and the ipsilateral common carotid artery, followed by ligation of the left vein draining the transverse sinus and bilateral external carotid arteries. The agent (20% HSA) or control solution (0.9% sodium chloride) was administered intravenously at a dosage of 1% body weight 24 hours before ligation of the fistula. Blood-brain barrier (BBB) disruption was judged by extravasation of Evans blue (EB) dye. EB, water content and the changes of myeloperoxidase (MPO) activity and superoxide dismutase (SOD) activity in rat brains 24 hours after ligation of the fistula were determined. RESULTS EB and water content in rat brains of the pre-treated group were significantly decreased compared with the control group accompanied by reduction of MPO activity and enhancement of SOD activity. DISCUSSION Hemodilution with high-concentration HSA has a certain pre-treatment effect on brain injury after ligation of the fistula in rat model of chronic cerebral hypoperfusion, which may be resulted from improved microcirculation, decrease in inflammatory cell infiltration and inactivation of oxygen free radicals.
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Affiliation(s)
- Jian Hai
- Department of Neurosurgery, Tongji Hospital, Tongji University, 389 XinCun Rd, Shanghai 200065, China.
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Novakovic RL, Lazzaro MA, Castonguay AC, Zaidat OO. The diagnosis and management of brain arteriovenous malformations. Neurol Clin 2013; 31:749-63. [PMID: 23896503 DOI: 10.1016/j.ncl.2013.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although uncommon in the general population, cerebral arteriovenous malformations (AVMs) can pose a significant health risk if a rupture occurs. Advances in noninvasive imaging have led to an increase in the identification of unruptured AVMs, presenting new challenges in management, given their poorly understood natural history. Over the past decade, there have been significant developments in the management and treatment of intracranial AVMs. This article discusses the pathophysiology, natural history, clinical presentations, and current treatment options, including multimodal approaches, for these vascular malformations.
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Affiliation(s)
- Roberta L Novakovic
- Neuroradiology Division, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9178, USA
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Hai J, Lin Q, Wu YF, Huang XS, Zhang GY, Wang F. Effects of N-stearoyl-L-tyrosine on the hippocampal ubiquitin-proteasome system in rats with chronic cerebral hypoperfusion. Neurol Res 2013; 35:734-43. [PMID: 23562289 DOI: 10.1179/1743132812y.0000000154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Chronic cerebral hypoperfusion (CCH) leads to neurodegeneration and cognitive impairment. Ubiquitinated protein aggregates are commonly present in neurodegenerative disorders and are believed to cause neuronal degeneration. Here, we investigated the effects of N-stearoyl-L-tyrosine (NSTyr) on the hippocampal ubiquitin-proteasome system (UPS) in rats with CCH. METHODS After induction of CCH, NSTyr was intraperitoneally administered daily for 3 months. Protein aggregation was analyzed by ethanolic phosphotungstic acid (EPTA) electron microscopy (EM), immunogold EM, laser-scanning confocal microscopy, and Western blot. Proteasome peptidase activity was measured by peptidase activity assays. RESULTS By using EPTA EM, immunogold EM and high-resolution laser-scanning confocal microscopy, we found that CCH resulted in the accumulation of ubiquitinated protein aggregates in rat hippocampal CA1 neurons. Western blot revealed that the levels of free ubiquitin were significantly reduced and that the levels of ubiquitinated proteins were markedly increased in the hippocampus of CCH rats. Direct activity measurements demonstrated that proteasome peptidase activity in the hippocampal region of rats was decreased after CCH induction. In the hippocampal tissue of CCH rats treated with NSTyr, however, ubiquitinated protein aggregates decreased and proteasome peptidase activity increased. DISCUSSION These data indicate that NSTyr may exert protective effects on rat hippocampal UPS function via endogenous regulation.
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Affiliation(s)
- Jian Hai
- Tongji University, Shanghai, China
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Comparison of CT and MR imaging in ischemic stroke. Insights Imaging 2012; 3:619-27. [PMID: 23055115 PMCID: PMC3505566 DOI: 10.1007/s13244-012-0185-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 07/03/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cerebrovascular disease represents a major source of global mortality and morbidity. Imaging examinations play a critical role in the management of stroke patients, from establishing the initial diagnosis to determining and guiding further treatment. METHODS In this article, current CT and MRI methods employed in the management of stroke patients are reviewed, with an emphasis on ischemic stroke. RESULTS The advantages and disadvantages of these techniques are discussed, a number of cases emphasizing key points are presented, and a comparison between modern CT and MRI techniques is outlined. CONCLUSION The major drawback of CT is the high radiation dose, while in MRI it is the more complicated and time-consuming aspect of the examination. MAIN MESSAGES • Cerebrovascular disease represents a major source of global mortality and morbidity • Imaging examinations play a critical role in the management of stroke patients • The penumbra may be seen with both CT and MRI; however, this concept may be overly simplistic • The major drawback of CT is the high radiation dose, while MRI is a more complicated examination.
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Lee KW, Lin YC, Lo CP, Liu CC. Intracerebral hemorrhage following endovascular embolization of brain arteriovenous malformation with a combination of Onyx and n-butyl cyanoacrylate: a case report. Clin Imaging 2012; 36:375-8. [PMID: 22726978 DOI: 10.1016/j.clinimag.2011.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Accepted: 09/14/2011] [Indexed: 10/28/2022]
Abstract
We report a 29-year-old female patient who developed intracerebral hemorrhage 16 h after endovascular embolization of a brain arteriovenous malformation with a combination of liquid embolic agents of Onyx and n-butyl cyanoacrylate. After emergent craniectomy with evacuation of the hematoma, the patient recovered consciousness with mild expressive aphasia. The possible etiology of postembolization brain hemorrhage was discussed, and the literature was reviewed.
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Affiliation(s)
- Kwo-Whei Lee
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
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Cechetti F, Worm PV, Lovatel G, Moysés F, Siqueira IR, Netto CA. Environmental enrichment prevents behavioral deficits and oxidative stress caused by chronic cerebral hypoperfusion in the rat. Life Sci 2012; 91:29-36. [PMID: 22683434 DOI: 10.1016/j.lfs.2012.05.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 04/25/2012] [Accepted: 05/19/2012] [Indexed: 12/31/2022]
Abstract
AIMS The aim of the present study was to evaluate the neuroprotective effects of environmental enrichment (EE), assessed by cognitive activity in the Morris water maze, and on brain oxidative status, through measurement of macromolecules damage, lipid peroxidation levels, total cellular thiols and antioxidant enzymes in hippocampus, striatum and cerebral cortex. MAIN METHODS Adult male Wistar rats were submitted to the modified permanent bilateral occlusion of the common carotid arteries (2VO) method, with right common carotid artery being first occluded, and tested three months after the ischemic event. Cognitive and physical stimulation, named Environmental Enrichment, consisted of one-hour sessions run 3 times per week during 12weeks, following two different stimulation protocols: pre-ischemia and pre+post-ischemia. Rats were then tested for both reference and working spatial memory tasks in the water maze and later sacrificed for measurement of oxidative stress parameters. KEY FINDINGS A significant cognitive deficit was found in both spatial tasks after hypoperfusion; this effect was reversed in the 2VO enriched group. Moreover, hippocampal oxidative damage and antioxidant enzyme activity were decreased by environmental enrichment. SIGNIFICANCE These results suggest that both stimulation protocols exert a neuroprotective effect against the cognitive impairment and the reduction of biomarkers for oxidative damage caused by chronic cerebral hypoperfusion.
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Affiliation(s)
- Fernanda Cechetti
- Programa de Pós-graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Brazil.
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The changes of signal transduction pathways in hippocampal regions and postsynaptic densities after chronic cerebral hypoperfusion in rats. Brain Res 2012; 1429:9-17. [DOI: 10.1016/j.brainres.2011.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 10/11/2011] [Accepted: 10/12/2011] [Indexed: 11/15/2022]
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Klein K, Fukui K, Schramm P, Stadie A, Fischer G, Werner C, Oertel J, Engelhard K. Human cerebral microcirculation and oxygen saturation during propofol-induced reduction of bispectral index †. Br J Anaesth 2011; 107:735-41. [DOI: 10.1093/bja/aer227] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chen PC, Lin WC. Spectral-profile-based algorithm for hemoglobin oxygen saturation determination from diffuse reflectance spectra. BIOMEDICAL OPTICS EXPRESS 2011; 2:1082-96. [PMID: 21559121 PMCID: PMC3087566 DOI: 10.1364/boe.2.001082] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/29/2011] [Accepted: 04/01/2011] [Indexed: 05/26/2023]
Abstract
Variations of hemoglobin (Hb) oxygenation in tissue provide important indications concerning the physiological conditions of tissue, and the data related to these variations are of intense interest in medical research as well as in clinical care. In this study, we derived a new algorithm to estimate Hb oxygenation from diffuse reflectance spectra. The algorithm was developed based on the unique spectral profile differences between the extinction coefficient spectra of oxy-Hb and deoxy-Hb within the visible wavelength region. Using differential wavelet transformation, these differences were quantified using the locations of certain spectral features, and, then, they were related to the oxygenation saturation level of Hb. The applicability of the algorithm was evaluated using a set of diffuse reflectance spectra produced by a Monte Carlo simulation model of photon migration and by tissue phantoms experimentally. The algorithm was further applied to the diffuse reflectance spectra acquired from in vivo experiments to demonstrate its clinical utility. The validation and evaluation results concluded that the algorithm is applicable to various tissue types (i.e., scattering properties) and can be easily used in conjunction with a diverse range of probe geometries for real-time monitoring of Hb oxygenation.
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Affiliation(s)
- Po-Ching Chen
- Department of Biomedical Engineering, Florida International University, 10555 West Flagler Street, EAS 2673, Miami, Florida 33176, USA
| | - Wei-Chiang Lin
- Department of Biomedical Engineering, Florida International University, 10555 West Flagler Street, EAS 2673, Miami, Florida 33176, USA
- Brain Institute, Miami Children’s Hospital, 3100 SW 62 Ave, Miami, FL 33155, USA
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Hai J, Lin Q, Su SH, Zhang L, Wan JF, Lu Y. Chronic cerebral hypoperfusion in rats causes proteasome dysfunction and aggregation of ubiquitinated proteins. Brain Res 2010; 1374:73-81. [PMID: 21167821 DOI: 10.1016/j.brainres.2010.12.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 11/30/2010] [Accepted: 12/10/2010] [Indexed: 11/18/2022]
Abstract
The deposition of abnormal protein aggregates is a feature of several neurodegenerative diseases. We have employed a rat model to investigate whether chronic cerebral hypoperfusion (CCH) induces proteasome dysfunction and the accumulation of ubiquitinated proteins and aggregates in the CNS. Protein aggregation was analyzed by ethanolic phosphotungstic acid (EPTA) electron microscopy (EM), immunogold EM, laser-scanning confocal microscopy, and Western blotting. Proteasome peptidase activity was studied by peptidase activity assays. EPTA EM and immunogold EM revealed that CCH led to the accumulation of protein aggregates in rat hippocampal CA1 neurons. High-resolution confocal microscopy demonstrated the presence of ubiquitin-positive protein aggregates surrounding nuclei and along dendrites. Western blotting revealed that levels of free ubiquitin were significantly reduced and that levels of ubiquitinated proteins were markedly increased in the hippocampus of CCH rats. Direct activity measurements revealed that proteasome peptidase activity in the hippocampal region of rats was decreased after CCH induction. These data suggest that reduced proteasome activity following CCH could impair the removal of abnormally folded proteins via the ubiquitin-proteasome pathway, leading to the accumulation of potentially toxic protein aggregates that could contribute to neurodegeneration.
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Affiliation(s)
- Jian Hai
- Department of Neurosurgery, Tongji Hospital, Tongji University, Shanghai 200065, China.
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Diagnosis influences response of cerebral near infrared spectroscopy to intracranial hypertension in children. Pediatr Crit Care Med 2010; 11:514-22. [PMID: 19935441 PMCID: PMC3675803 DOI: 10.1097/pcc.0b013e3181c51cf1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe cerebral regional oxygen saturation measured by near infrared spectroscopy in the setting of normal and increased intracranial pressure in children to evaluate the association between cerebral regional oxygen saturation and intracranial pressure in comparison with other clinical variables. DESIGN Prospective observational cohort study. SETTING Two academic tertiary care centers' pediatric intensive care units. PATIENTS Thirty patients with intracranial pressure and near infrared spectroscopy monitoring (median age, 11.5 yrs; interquartile range, 5.2-13 yrs) for a range of neurologic diagnoses, including brain tumor, trauma, intracerebral hemorrhage, and hydrocephalus. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Temporally correlated cerebral regional oxygen saturation with hematologic (hematocrit), biochemical (pH), and physiological (intracranial pressure, mean arterial pressure, cerebral perfusion pressure, temperature, heart rate, pulse oximetry and end-tidal carbon dioxide) variables. Cerebral regional oxygen saturation during episodes of increased intracranial pressure was lower than with normal intracranial pressure (mean +/- sd intracranial pressure >20 = 71% +/- 13% vs. intracranial pressure <20 = 75% +/- 10%), although the mean difference (-4%) is small compared with variability in the measurement. Neither isolated values nor change in cerebral regional oxygen saturation were significantly associated with intracranial pressure or cerebral perfusion pressure in the overall population. Isolated values and change in end-tidal CO2 were significantly correlated with cerebral regional oxygen saturation and change in cerebral regional oxygen saturation (all p < 0.01). In exploratory analyses, the diagnostic group significantly modified the effect of intracranial hypertension on regional oxygen saturation: regional oxygen saturation decreased during intracranial hypertension in patients with brain tumors (p = .05) and hydrocephalus (p < .001) but increased during intracranial hypertension in those with intracranial hemorrhage (p < .001). CONCLUSIONS These data suggest that cerebral regional oxygen saturation is lower with intracranial hypertension. However, the relationship between cerebral regional oxygen saturation and intracranial pressure is strongly influenced by diagnosis.
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Dynamic Autoregulation Testing Does Not Indicate Changes of Cerebral Blood Flow Before and After Resection of Small- and Medium-Sized Cerebral AVM. Transl Stroke Res 2010; 2:60-6. [DOI: 10.1007/s12975-010-0031-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Evidence for a predominant intrinsic sympathetic control of cerebral blood flow alterations in an animal model of cerebral arteriovenous malformation. Transl Stroke Res 2010; 1:210-9. [PMID: 24323523 DOI: 10.1007/s12975-010-0021-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 02/18/2010] [Accepted: 03/22/2010] [Indexed: 10/19/2022]
Abstract
In terms of neurogenic cerebral blood flow (CBF) control, the activity of the sympathetic nervous system (SNS) has a regulating effect. The impact of a manipulation of both the peripheral (via the perivascular sympathetic net) and central components (via the intracortical noradrenergic terminals originating from the locus coeruleus) on CBF-and especially on hyperperfusion syndromes-is unclear. To test the specific patterns following such alterations, cortical oxygen saturation (rSO2), regional CBF (rCBF), and cortical interstitial norepinephrine (NE) concentrations were measured. Twelve weeks after either the creation of an extracranial AV fistula or sham operation, 80 male Sprague-Dawley rats underwent one of the following procedures: (1) no SNS manipulation, (2) peripheral SNS inhibition via bilateral sympathectomy, (3) central SNS inhibition via the neurotoxin DSP-4, or (4) complete SNS inhibition. Norepinephrine concentrations were lowest after complete inhibition (NE [nmol]: pre, 1.8 ± 1.2; post, 2.4 ± 1.8) and highest following peripheral inhibition (NE [nmol]: pre, 3.6 ± 1.9; post, 6.6 ± 4.4). Following fistula occlusion, rCBF (laser Doppler unit [LDU]) and rSO2 (%SO2) increases were highest after complete inhibition (pre: 204 ± 14 LDU, 34 ± 3%SO2; post: 228 ± 18 LDU, 39 ± 3%SO2) and lowest after peripheral inhibition (pre: 221 ± 18 LDU, 41 ± 2%SO2; post: 226 ± 14 LDU, 47 ± 2%SO2). Thus, a complete inhibition down-regulates SNS activity and provokes a cortical hyperperfusion condition. With this, the hitherto unknown predominant role of the intrinsic component could be demonstrated for the first time in vivo.
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Lin Q, Hai J, Yao LY, Lu Y. Neuroprotective effects of NSTyr on cognitive function and neuronal plasticity in rats of chronic cerebral hypoperfusion. Brain Res 2010; 1325:183-90. [DOI: 10.1016/j.brainres.2010.02.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 02/07/2010] [Accepted: 02/08/2010] [Indexed: 02/01/2023]
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Intraoperative monitoring of cerebral microcirculation and oxygenation--a feasibility study using a novel photo-spectrometric laser-Doppler flowmetry. J Neurosurg Anesthesiol 2010; 22:38-45. [PMID: 19816204 DOI: 10.1097/ana.0b013e3181bea439] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The present study assesses the utility of a novel invasive device (O2C-, oxygen-to-see-device) for intraoperative measurement of the cerebral microcirculation. CO2 vasoreactivity during 2 different propofol concentrations was used to investigate changes of capillary venous cerebral blood flow (rvCBF), oxygen saturation (srvO2), and hemoglobin concentration (rvHb) during craniotomy. METHODS Thirty-four patients were randomly assigned to a low propofol (4 mg/kg/h) versus a high propofol (6 mg/kg/h) group. A fiberoptic probe was applied on the cortex next to the surgical site. Measurements were performed during lower (35 mm Hg) and higher (45 mm Hg) levels of partial pressure of carbon dioxide (paCO2). Arterio-venous difference in oxygen concentration (avDO2) and approximated cerebral metabolic rate of oxygen (aCMRO2) were calculated for each paCO2 state. Linear models were fitted to test changes of end points in response to paCO2 and propofol concentration. RESULTS In comparison to the lower levels of paCO2, higher levels of paCO2 increased rvCBF (P<0.001), and srvO2 (P=0.002). RvHb remained unchanged during measurements (P=0.325). Calculated avDO2 decreased with increasing paCO2 (P<0.001), whereas aCMRO2 did not change during the study (P=0.999). Propofol concentration had no effect on measured or calculated end points. CONCLUSIONS Increase of rvCBF by paCO2 indicates a preserved CO2 reactivity independent of propofol anesthesia. The consecutive rise in srvO2 implies enhanced oxygen availability due to vasodilatation. Unchanged rvHb represents constant venous hemoglobin concentration. As expected, calculated avDO2 decreases with increased paCO2, whereas aCMRO2 remains unchanged. Despite the promising technical approach, the technology needs validation and further investigation for usage during neurosurgery.
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Weerakkody RA, Trivedi R, Santarius T, Kirollos RW. Arteriovenous malformations. Br J Neurosurg 2009; 23:494-8. [DOI: 10.1080/02688690802527195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cognitive dysfunction induced by chronic cerebral hypoperfusion in a rat model associated with arteriovenous malformations. Brain Res 2009; 1301:80-8. [PMID: 19761762 DOI: 10.1016/j.brainres.2009.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 08/27/2009] [Accepted: 09/02/2009] [Indexed: 11/23/2022]
Abstract
The relationship between chronic cerebral hypoperfusion and cognitive function has not been completely delineated. In the present studies, we developed an experimental model associated with arteriovenous malformation to investigate the effects of chronic cerebral hypoperfusion on cognitive function and neuropathological changes. The rat model was established by creating a fistula through an end-to-side anastomosis between the right distal external jugular vein and the ipsilateral common carotid artery, followed by ligation of the left vein draining the transverse sinus and bilateral external carotid arteries. Age-matched rats comprised a control group. Three months after surgery, cognitive functions were evaluated by the Morris water maze and hippocampal long-term potentiation (LTP). Neuropathological changes were examined using light and electron microscopic techniques. We found that both learning capacity and spatial memory were significantly impaired in rats with chronic cerebral hypoperfusion concomitant with LTP inhibition and neurodegeneration in the hippocampal CA1 region of model rats compared with control rats. In addition, model rats showed a decrease at the protein level of cyclic AMP response element binding (CREB) phosphorylation in hippocampal tissues. Therefore, cognitive impairment caused by chronic cerebral hypoperfusion associated with arteriovenous malformations may be partially explained by the neurodegeneration and reduction of CREB phosphorylation in rat hippocampus.
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Choi JH, Mast H, Hartmann A, Marshall RS, Pile-Spellman J, Mohr JP, Stapf C. Clinical and morphological determinants of focal neurological deficits in patients with unruptured brain arteriovenous malformation. J Neurol Sci 2009; 287:126-30. [PMID: 19729171 DOI: 10.1016/j.jns.2009.08.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 05/12/2009] [Accepted: 08/10/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Some patients with brain arteriovenous malformation (BAVM) present with focal neurological deficits (FNDs) unrelated to clinically discernable seizure activity or hemorrhage. The aim of this study is to determine demographic and morphological AVM characteristics associated with FNDs. METHODS The 735 patients of the prospective Columbia AVM Databank were analyzed. Univariate and multivariate statistical models were used to test the association of demographic (age, gender), and morphological characteristics (BAVM size, anatomic location, arterial supply, venous drainage pattern, venous ectasia) with the occurrence of FNDs at the time of initial BAVM diagnosis. RESULTS Fifty-three patients (7%, mean age 40+/-16years, 70% women) presented with FNDs. The multivariate logistic regression model revealed an independent association of FNDs with increasing age (OR 1.03; 95%-CI 1.00-1.05), female gender (OR 2.14; 95%-CI 1.15-3.97), deep brain location (OR 2.46; 95%-CI 1.24-4.88), brainstem location (OR 5.62; 95%-CI 1.65-19.23), and venous ectasia (OR 1.91; 95%-CI 1.01-3.64). No association was found for BAVM size, lobar location, arterial supply and venous drainage pattern. INTERPRETATION Focal neurologic deficits unrelated to seizures or hemorrhage are a rare initial presentation of BAVMs. The predominance of FNDs among brainstem and deeply located BAVMs and the lack of a significant association of BAVM size with FNDs indicate selective white matter pathway-specific vulnerability, the association with patient age a time dependent effect. The higher frequency of FNDs among women suggests gender-specificity of brain tissue vulnerability.
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Affiliation(s)
- J H Choi
- Stroke Center, The Neurological Institute, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, United States.
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Youn SW, Han MH, Kwon BJ, Kang HS, Chang HW, Kim BS. Coil-based endovascular treatment of single-hole cerebral arteriovenous fistulae: experiences in 11 patients. World Neurosurg 2009; 73:2-10; discussion e1. [PMID: 20452863 DOI: 10.1016/j.surneu.2009.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 06/04/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND An SHF is rare pial arteriovenous shunt with no nidal component, of which the feeder drains directly into a single venous channel. Casting with NBCA was described previously, but its control demands operator to accumulate a considerable learning curve. We are to present our experiences of coil-based endovascular treatment of SHF. METHODS Eleven patients harbored 12 SHFs (5 men, 6 women; mean age, 28.4 years; age range, 4-73 years), and they presented with hemorrhage, seizure, collapse, orbital mass, and as an incidental lesion. The location was frontal for 3, temporal for 5, parietal in 2, and occipital in 2 patients. The angioarchitectures, the methods of endovascular treatment, and outcomes were analyzed. RESULTS Fifteen feeders arose from 4 anterior, 8 middle, and 3 posterior cerebral arteries. The coil framework was constructed at the fistula before the penetration of a low concentrated NBCA. Nine fistulae were occluded completely, and 3 fistulae were occluded to near-completion with micro-AVM. There was no recanalization of SHF, either growth of a micro-AVM during follow-up period (mean, 48.3 months; range, 6-120 months). One patient with postprocedure hemorrhage developed hemiplegia, but 1 patient with seizure and the other 9 asymptomatic patients were uneventful. CONCLUSIONS The coil-based endovascular treatment can achieve safe and stable occlusion of SHF, and the preventions against venous thrombosis and perfusion breakthrough should be essential.
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Affiliation(s)
- Sung Won Youn
- Department of Radiology, Korea University Anam Hospital, Seoul, South Korea.
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Klein KU, Glaser M, Reisch R, Tresch A, Werner C, Engelhard K. The Effects of Arterial Carbon Dioxide Partial Pressure and Sevoflurane on Capillary Venous Cerebral Blood Flow and Oxygen Saturation During Craniotomy. Anesth Analg 2009; 109:199-204. [DOI: 10.1213/ane.0b013e3181a800e5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Moftakhar P, Hauptman JS, Malkasian D, Martin NA. Cerebral arteriovenous malformations. Part 2: physiology. Neurosurg Focus 2009; 26:E11. [PMID: 19408989 DOI: 10.3171/2009.2.focus09317] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ObjectThe scientific understanding of the nature of arteriovenous malformations (AVMs) in the brain is evolving. It is clear from current work that AVMs can undergo a variety of phenomena, including growth, remodeling, and/or regression—and the responsible processes are both molecular and physiological. A review of these complex processes is critical to directing future therapeutic approaches. The authors performed a comprehensive review of the literature to evaluate current information regarding the genetics, pathophysiology, and behavior of AVMs.MethodsA comprehensive literature review was conducted using PubMed to reveal the angioarchitecture and cerebral hemodynamics of AVMS as they relate to lesion development.ResultsFeeding artery pressures, brain AVM compartmentalization, venous drainage, flow phenomena, and vascular steal are discussed.ConclusionsThe dynamic nature of brain AVMs is at least in part attributable to hemodynamic and flow-related phenomena. These forces acting on an evolving structure are critical to understanding the challenges in endovascular and surgical therapy. As knowledge in this field continues to progress, the natural history and predicted behavior of these AVMs will become more clearly elucidated.
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Affiliation(s)
| | - Jason S. Hauptman
- 2Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Dennis Malkasian
- 2Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Neil A. Martin
- 2Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, California
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Stüer C, Ikeda T, Stoffel M, Luippold G, Sakowitz O, Schaller K, Meyer B. NOREPINEPHRINE AND CEREBRAL BLOOD FLOW REGULATION IN PATIENTS WITH ARTERIOVENOUS MALFORMATIONS. Neurosurgery 2008. [DOI: 10.1227/01.neu.0000317275.65174.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Stüer C, Ikeda T, Stoffel M, Luippold G, Sakowitz O, Schaller K, Meyer B. NOREPINEPHRINE AND CEREBRAL BLOOD FLOW REGULATION IN PATIENTS WITH ARTERIOVENOUS MALFORMATIONS. Neurosurgery 2008; 62:1254-60; discussion 1260-1. [DOI: 10.1227/01.neu.0000333296.41813.74] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Hoshino T, Katayama Y, Sakatani K, Kano T, Murata Y. Intraoperative monitoring of cerebral blood oxygenation and hemodynamics during extracranial-intracranial bypass surgery by a newly developed visible light spectroscopy system. ACTA ACUST UNITED AC 2006; 65:569-76; discussion 576. [PMID: 16720176 DOI: 10.1016/j.surneu.2005.09.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Revised: 08/08/2005] [Accepted: 09/06/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cerebrovascular reconstruction procedures run the risk of changing the balance between oxygen supply and consumption during surgery. We assessed the value of visual light spectroscopy for detecting changes in cerebral blood oxygenation (CBO) during superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. METHODS We developed a VLS monitoring system which permits continuous monitoring of CBO changes during surgery. Using the VLS, we evaluated the CBO changes in the MCA territory on the lesion side in 18 patients who underwent STA-MCA anastomosis. RESULTS Temporary occlusion of the MCA (M4 portion) did not change the CBO in 17 patients. However, in the patient with dissecting aneurysm, it caused decreases of oxyhemoglobin and cortical oxygen saturation (CoSo(2)) associated with an increase of deoxyhemoglobin, although these CBO changes were normalized by STA blood flow. In 5 patients, STA blood flow increased the oxyhemoglobin and CoSo(2) and decreased the deoxyhemoglobin, indicating that cortical blood flow (CoBF) was increased. The CoSo(2) before anastomosis was significantly low in the patients who showed an increase of CoSo(2) by STA blood flow (63.0% +/- 2.5%) as compared with those who did not (72.0 +/- 6.1%, P = .024). CONCLUSION Temporary occlusion of a cortical artery during bypass surgery did not affect the CBO in patients who had chronic cerebral ischemia, but caused acute ischemia in the patient who did not. STA blood flow increased the CoBF during surgery more frequently in patients who showed a low perfusion pressure. The VLS monitoring system is considered useful for evaluating bypass function and facilitates safe and accurate bypass surgery.
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Affiliation(s)
- Tatsuya Hoshino
- Department of Neurological Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo 173-8610, Japan
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Hoshino T, Sakatani K, Kano T, Murata Y, Katayama Y. Cerebral blood oxygenation changes induced by bypass blood flow in moyamoya disease and non-moyamoya cerebral ischaemic disease. Acta Neurochir (Wien) 2006; 148:551-7; discussion 557. [PMID: 16467961 DOI: 10.1007/s00701-006-0733-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2005] [Accepted: 12/06/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis has been used to prevent stroke in patients with moyamoya disease (MD) and non-moyamoya ischaemic disease (non-MD). However, little is yet known regarding the difference between these groups of patients in the extent to which the bypass contributes to maintaining adequate cerebral blood oxygenation (CBO), or the temporal changes after surgery. In the present study, we evaluated the CBO changes induced by bypass blood flow in patients with MD and non-MD during the peri-operative periods employing optical spectroscopy. METHODS We investigated 13 patients who underwent STA-MCA anastomosis, including 5 MD and 8 non-MD patients. We evaluated the effects of STA blood flow on the CBO in the MCA territory on the anastomosis side, employing visual light spectroscopy during surgery and near infrared spectroscopy (NIRS) at one week after surgery. FINDINGS In 4 MD patients and one non-MD patient, the STA blood flow increased the oxyhaemoglobin and cortical oxygen saturation (CoSO2), indicating that the bypass supplied blood flow to the ischaemic brain; the CBO changes were observed more frequently in MD than in non-MD patients (p<0.02). The pre-anastomosis CoSO2 (65.4+/-5.4%) in MD was significantly lower than that (72.8+/-7.6%) in non-MD (p<0.05). Postoperative NIRS demonstrated that the bypass began to supply blood flow to the brain in 5 non-MD patients whose bypass did not supply blood flow during surgery. CONCLUSIONS Although MD has vessels of small diameter as compared to non-MD, the bypass begins to supply blood flow to the ischaemic brain earlier in MD than in non-MD after anastomosis. The fact that the CoSO2 in MD was lower than that in non-MD suggested that the perfusion pressure in MD was lower than that in non-MD, and this might account for the difference in the bypass blood supply after anastomosis between MD and non-MD. Our data suggest that, even if the bypass does not supply blood to the brain during surgery in non-MD, the bypass blood flow gradually increases after surgery.
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Affiliation(s)
- T Hoshino
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
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Nakagawa I, Kawaguchi S, Iida J, Hirabayashi H, Sakaki T. Postoperative hyperperfusion associated with steal phenomenon caused by a small arteriovenous malformation. Neurol Med Chir (Tokyo) 2005; 45:363-6. [PMID: 16041183 DOI: 10.2176/nmc.45.363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 41-year-old woman presented with a small occipital arteriovenous malformation (AVM) manifesting as headache. Cerebral angiography showed an AVM in the right occipital lobe fed by the right temporooccipital artery and draining into the superior sagittal sinus and right transverse sinus. Single photon emission computed tomography showed the steal phenomenon in the ipsilateral temporal cortex fed by the main feeding artery preoperatively, and hyperperfusion in the same cortex after removal of the AVM. Postoperative systolic blood pressure was maintained between 100 and 120 mmHg to avoid disastrous hemorrhagic complications. Cerebral blood flow evaluation before and after surgery is important to avoid postoperative disastrous complications even in patients with small AVM.
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Abstract
Arteriovenous malformations of the brain (AMB) can cause stroke when they rupture. Epidemiological and imaging research has found that about 50% of patients with AMB present with haemorrhage, and the other 50% either present with non-focal symptoms, such as headache, seizure, or focal neurological deficit, or have no symptoms and the lesion is found during unrelated investigations. Treatment for arteriovenous malformations aims to prevent and resolve haemorrhage and is a growing interdisciplinary challenge. Although treatment uses enormous resources, there have been few studies on the risk-benefit ratios for treatment of unruptured AMB and the best approaches.
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Hai J, Lin Q, Li ST, Pan QG. Chronic cerebral hypoperfusion and reperfusion injury of restoration of normal perfusion pressure contributes to the neuropathological changes in rat brain. ACTA ACUST UNITED AC 2004; 126:137-45. [PMID: 15249137 DOI: 10.1016/j.molbrainres.2004.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2004] [Indexed: 10/26/2022]
Abstract
Restoration of normal perfusion pressure after resection of cerebral arteriovenous malformations (AVMs) is sometimes complicated by unexplained postoperative brain swelling and/or intracranial hemorrhage, which has been termed normal perfusion pressure breakthrough (NPPB). The precise mechanism of NPPB is still unclear. In this study, we investigated the time courses of blood-brain barrier (BBB) disruption, water content, neuronal apoptosis, myeloperoxidase (MPO) activity and superoxide dismutase (SOD) activity in the brain during restoration of normal perfusion pressure in a new rat model of chronic cerebral hypoperfusion associated with AVMs. Male Sprague-Dawley rats were randomly divided into either a sham-operated group, a control group, or a model group with reperfusion assessed at 1, 12, 24 and 72 h after restoration of normal perfusion pressure. BBB disruption was judged by extravasation of Evans blue (EB) dye. We observed that EB and water content in rat brains of the model group with reperfusion were significantly increased compared with the other groups. The most predominant increase occurred at 1 h after reperfusion, and the next at 24 h after reperfusion, representing biphasic changes which are similar to the pathological processes of acute cerebral ischemia/reperfusion injury. There was no difference of the percentage of apoptotic cells in rat brains between the sham-operated group and the control group using flow cytometry. No prominent apoptotic cells were found in the model group with reperfusion at 1 h. However, the percentage of apoptotic cells increased significantly in rat brains of the model group with reperfusion at 12 h, peaked at 24 h, and decreased at 72 h after reperfusion. Apoptotic cells were confirmed with electron microscopy and terminal deoxynuleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL). A significant enhancement of MPO activity in combination with reduction of SOD activity was seen at 12, 24 and 72 h in rat brains of the model group with reperfusion. Our data indicates that reperfusion after restoration of normal perfusion pressure with chronic cerebral hypoperfusion lead to secondary neuronal damage which may associate with cerebral ischemia/reperfusion injury.
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Affiliation(s)
- Jian Hai
- Department of Neurosurgery, Tongji Hospital, Tongji University, 389 XinCun Rd., Shanghai 200065, China.
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Ducreux D, Desal H, Bittoun J, Mikulis D, Terbrugge K, Lasjaunias P. [Diffusion, perfusion and activation functional MRI studies of brain arteriovenous malformations]. J Neuroradiol 2004; 31:25-34. [PMID: 15026729 DOI: 10.1016/s0150-9861(04)96876-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The management of Brain Arteriovenous Malformations continues to be challenged by a lack of understanding and control of pathophysiological processes implied in the clinical symptoms. New data from functional MRI with diffusion-weighted, perfusion-weighted and neuronal activation highlight abnormal brain areas near or remote to the AVM nidus. Moreover, these techniques are able to show hemodynamic and neuronal adaptative phenomena involved in brain plasticity. They reflect the instantaneous hemodynamic brain conditions that may help to correlate the clinical symptoms with the anatomical and functional substratum and to influence any invasive therapy.
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Affiliation(s)
- D Ducreux
- Service de Neuroradiologie, CHU de Bicêtre, Université Paris XI, Le Kremlin Bicêtre, France.
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Ducreux D, Meder JF, Fredy D, Bittoun J, Lasjaunias P. MR perfusion imaging in proliferative angiopathy. Neuroradiology 2004; 46:105-12. [PMID: 14726982 DOI: 10.1007/s00234-003-1045-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2002] [Accepted: 03/20/2003] [Indexed: 12/01/2022]
Abstract
Seizures, which may be the main expression of cerebral arteriovenous malformations (CAVM) can be difficult to control medically. Our goal was to use perfusion-weighted imaging (PWI) in correlation with clinical data to detect abnormal areas of the cerebrum related to a particular type of CAVM (proliferative angiopathy) and to study the pathophysiology. We use PWI, with a bolus injection of contrast medium, to investigate seven patients with proliferative angiopathy and fits producing language disturbance. Perfusion parameters were calculated using the first-pass moment theory. Five patients had perimalformative and/or contralateral abnormal areas with relative hyperperfusion (cerebral blood volume +20.7+/-16.2%, blood flow 92.5+/-68.8 ml/min/100 g). Areas of hypoperfusion and venous congestion were detected in two patients. One patient who underwent MRI after a severe focal deficit had no significant haemodynamic abnormality.
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Affiliation(s)
- D Ducreux
- Neuroradiology Department, CHU de Bicêtre, Paris XI University, 78 rue du Gènèral Leclerc, 94270, Le Kremlin Bicêtre, France.
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Kristof RA, Aliashkevich AF, Hans V, Haun D, Meyer B, Thees C, Schramm J. The regional oxygen saturation of pituitary adenomas is lower than that of the pituitary gland: microspectrophotometric study with potential clinical implications. Neurosurgery 2003; 53:880-5; discussion 885-6. [PMID: 14519220 DOI: 10.1227/01.neu.0000083604.09901.f6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2003] [Accepted: 06/04/2003] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To study the regional oxygen saturation (rSO(2)) of pituitary adenomas, in comparison with that of the pituitary gland. METHODS Microspectrophotometric (MSP) measurements of rSO(2) in adenomas and pituitary tissue were performed for a series of patients undergoing first-time transsphenoidal pituitary adenoma surgery, in a standardized anesthesia setting. The areas of measured tissue were sampled for histopathological and immunohistochemical (CD34 and CD45) assessments. The results of MSP measurements were compared with the results of the histopathological and immunohistochemical assessments. RESULTS Thirty-six MSP measurements and tissue samples were obtained among 22 patients with pituitary macroadenomas, including 14 from adenoma tissue, 17 from the anterior pituitary lobe, and 5 from the posterior pituitary lobe. The rSO(2) of adenoma tissue (mean +/- standard deviation, 43.3 +/- 23.2%) was statistically significantly (P = 0.001) lower than the values for the anterior pituitary lobe (mean +/- standard deviation, 71.8 +/- 18.3%) and posterior pituitary lobe (mean +/- standard deviation, 74.9 +/- 4.8%). The difference between the rSO(2) values for the anterior pituitary lobe and posterior pituitary lobe was not significant. There were no statistically significant differences in microvessel density (as assessed with CD34 staining) or lymphocyte density (as assessed with CD45 staining) among the three tissue types. CONCLUSION As assessed with MSP measurements, the rSO(2) of adenoma tissue was significantly lower than that of the pituitary gland, indicating differences in their blood supply and/or metabolism in pituitary macroadenomas. Further studies are needed to determine whether MSP measurements can reliably facilitate intraoperative delineation of adenoma and pituitary tissue, in the effort to achieve complete tumor removal with minimal injury to pituitary tissue.
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Asgari S, Röhrborn HJ, Engelhorn T, Fauser B, Stolke D. Intraoperative measurement of cortical oxygen saturation and blood volume adjacent to cerebral arteriovenous malformations using near-infrared spectroscopy. Neurosurgery 2003; 52:1298-304; discussion 1304-6. [PMID: 12762875 DOI: 10.1227/01.neu.0000064801.78895.86] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2002] [Accepted: 02/10/2003] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Both cortical oxygen saturation (SaO(2)) and cortical blood volume (BV) are related to regional cerebral blood flow. Among a series of patients with cerebral arteriovenous malformations, we examined the problem of hyperemia after embolization/resection or resection with the intraoperative application of near-infrared spectroscopy. METHODS Cortical SaO(2) and BV (intracapillary total hemoglobin concentrations) were measured, with near-infrared spectroscopy, in areas adjacent to the arteriovenous malformation for 20 patients, before and after resection. The absolute values for both parameters and postexcision/preexcision ratios (P-P ratios) were determined. Data were correlated with multiple clinical and preoperative angiographic parameters. RESULTS Before resection, the mean SaO(2) was 49 +/- 16% and the mean BV was 12.65 +/- 7.41 mg/ml. After resection, SaO(2) increased for 17 of 20 patients and BV increased for 18 of 20 patients. The differences between pre- and postexcision values for both parameters were observed to be statistically significant (P < 0.01). The average P-P ratios were 1.5 +/- 0.4 for SaO(2) and 1.7 +/- 0.4 for BV. Correlation between the P-P ratios for the two parameters was good. The initial BV and the P-P ratios for both SaO(2) and BV were exclusively dependent on the extent of preoperative embolization. Postoperatively, two patients developed intracerebral hemorrhage or severe edema. Both demonstrated high P-P ratios for SaO(2) (2.3 and 2.1) and BV (1.6 and 2.1). CONCLUSION Intraoperative near-infrared spectroscopy is able to detect the hyperemic status of adjacent cortex after arteriovenous malformation resection. However, staged therapy with embolization and surgery results in less hyperemia after resection. While two patients with hyperemic complications exhibited very large increases in SaO(2) and BV, we cannot refute the normal-perfusion pressure breakthrough theory.
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Affiliation(s)
- Siamak Asgari
- Department of Neurosurgery, University Hospital, Hufelandstrasse 55, 45147 Essen, Germany.
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Hai J, Ding M, Guo Z, Wang B. A new rat model of chronic cerebral hypoperfusion associated with arteriovenous malformations. J Neurosurg 2002; 97:1198-202. [PMID: 12450044 DOI: 10.3171/jns.2002.97.5.1198] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT A new experimental model of chronic cerebral hypoperfusion was developed to study the effects of systemic arterial shunting and obstruction of the primary vessel that drains intracranial venous blood on cerebral perfusion pressure (CPP), as well as cerebral pathological changes during restoration of normal perfusion pressure. METHODS Twenty-four Sprague-Dawley rats were randomly assigned to either a sham-operated group, an arteriovenous fistula (AVF) group, or a model group (eight rats each). The animal model was readied by creating a fistula through an end-to-side anastomosis between the right distal external jugular vein (EJV) and the ipsilateral common carotid artery (CCA), followed by ligation of the left vein draining the transverse sinus and bilateral external carotid arteries. Systemic mean arterial pressure (MAP), draining vein pressure (DVP), and CPP were monitored and compared among the three groups preoperatively, immediately postoperatively, and again 90 days later. Following occlusion of the fistula after a 90-day interval, blood-brain barrier (BBB) disruption and water content in the right cortical tissues of the middle cerebral artery territory were confirmed and also quantified with transmission electron microscopy. Formation of a fistula resulted in significant decreases in MAP and CPP, and a significant increase in DVP in the AVF and model groups. Ninety days later, there were still significant increases in DVP and decreases in CPP in the model group compared with the other groups (p < 0.05). Damage to the BBB and brain edema were noted in animals in the model group during restoration of normal perfusion pressure by occlusion of the fistula. Electron microscopy studies revealed cerebral vasogenic edema and/or hemorrhage in various amounts, which correlated with absent astrocytic foot processes surrounding some cerebral capillaries. CONCLUSIONS The results demonstrated that an end-to-side anastomosis between the distal EJV and CCA can induce a decrease in CPP, whereas a further chronic state of cerebral hypoperfusion may be caused by venous outflow restriction, which is associated with perfusion pressure breakthrough. This animal model conforms to the basic hemodynamic characteristics of human cerebral arteriovenous malformations.
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Affiliation(s)
- Jian Hai
- Department of Neurosurgery, Tongji Hospital, Tongji University, Shanghai, People's Republic of China.
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Schaller C, Urbach H, Schramm J, Meyer B. Role of Venous Drainage in Cerebral Arteriovenous Malformation Surgery, as Related to the Development of Postoperative Hyperperfusion Injury. Neurosurgery 2002. [DOI: 10.1227/00006123-200210000-00012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Schaller C, Urbach H, Schramm J, Meyer B. Role of venous drainage in cerebral arteriovenous malformation surgery, as related to the development of postoperative hyperperfusion injury. Neurosurgery 2002; 51:921-7; discussion 927-9. [PMID: 12234398 DOI: 10.1097/00006123-200210000-00012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2001] [Accepted: 06/12/2002] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To elucidate the role of venous drainage in cerebral arteriovenous malformation (AVM) surgery, with respect to the development of postoperative hyperperfusion injury. METHODS For 52 patients with supratentorial AVMs, cortical capillary oxygenation (SaO(2)) was assessed intraoperatively, before and after resection, in the vicinity of the AVMs, by using a microspectrophotometric method. Assessed areas were defined as being related to feeding arteries or draining veins or as distant areas. Patients were divided into three groups on the basis of postoperative angiographic findings, as follows: Group 1, all former draining veins preserved (8 patients); Group 2, > or =1 former draining vein visible (12 patients); Group 3, no former draining veins visible (32 patients). Patients and SaO(2) values were pooled and compared by using paired and unpaired t tests (P < 0.05). Venous circulation times were calculated from digital subtraction angiography films. RESULTS The postresectional relative increases in SaO(2) values were highest in draining vein areas (+40.8%, compared with +25% in feeder areas and +25.5% in distant areas). Five postoperative hyperemic complications occurred (9.6%), none in Group 1 (with all draining veins preserved), two (16.7%) in Group 2, and three (9.4%) in Group 3 (with all draining veins occluded). The lowest preresectional SaO(2) values (31.7 +/- 6.2%) were measured in the drainer areas of the five patients who subsequently developed hyperperfusion injuries. Among those patients, postresectional increases in SaO(2) values were significantly greater in drainer areas (+167.8%) than in feeder areas (+28.3%) or distant areas (+25.8%). Postoperative venous circulation times in former draining veins in Group 2 were significantly greater than those in Group 1 (8.9 +/- 1.5 s versus 6.3 +/- 0.6 s). Circulation times in normal veins in the five patients with hyperperfusion injury increased from 5.6 +/- 1.0 seconds (preoperatively) to 8.4 +/- 1.9 seconds (postoperatively). CONCLUSION Postoperative hyperperfusion injury after resection of cerebral AVMs can be explained on the basis of unconstrained arterial inflow into cortical areas, which are rendered hypoxic/ischemic by longstanding preoperative venous hypertension. The risk for postoperative breakthrough complications seems higher in the presence of multiple draining veins, which also participate in the physiological venous drainage system of the ipsilateral hemisphere.
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Meyer B, Stoffel M, Stuer C, Schaller C, Muhlbauer B, Schramm J. Norepinephrine in the Rat Cortex before and after Occlusion of Chronic Arteriovenous Fistulae: A Microdialysis Study in an Animal Model of Cerebral Arteriovenous Malformations. Neurosurgery 2002. [DOI: 10.1227/00006123-200209000-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Norepinephrine in the Rat Cortex before and after Occlusion of Chronic Arteriovenous Fistulae: A Microdialysis Study in an Animal Model of Cerebral Arteriovenous Malformations. Neurosurgery 2002. [DOI: 10.1097/00006123-200209000-00028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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