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Wang A, Wang R, Cui D, Huang X, Yuan L, Liu H, Fu Y, Liang L, Wang W, He Q, Shi C, Guan X, Teng Z, Zhao G, Li Y, Gao Y, Han H. The Drainage of Interstitial Fluid in the Deep Brain is Controlled by the Integrity of Myelination. Aging Dis 2019; 10:937-948. [PMID: 31595193 PMCID: PMC6764732 DOI: 10.14336/ad.2018.1206] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/26/2018] [Indexed: 12/17/2022] Open
Abstract
In searching for the drainage route of the interstitial fluid (ISF) in the deep brain, we discovered a regionalized ISF drainage system as well as a new function of myelin in regulating the drainage. The traced ISF from the caudate nucleus drained to the ipsilateral cortex along myelin fiber tracts, while in the opposite direction, its movement to the adjacent thalamus was completely impeded by a barrier structure, which was identified as the converged, compact myelin fascicle. The regulating and the barrier effects of myelin were unchanged in AQP4-knockout rats but were impaired as the integrity of boundary structure of drainage system was destroyed in a demyelinated rat model. We thus proposed that the brain homeostasis was maintained within each ISF drainage division locally, rather than across the brain as a whole. A new brain division system and a new pathogenic mechanism of demyelination are therefore proposed.
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Affiliation(s)
- Aibo Wang
- Department of Radiology, Peking University Third Hospital, Beijing, China.
- Key Laboratory of Magnetic Resonance Imaging Equipment and Technique, Beijing, China.
| | - Rui Wang
- Department of Radiology, Peking University Third Hospital, Beijing, China.
- Key Laboratory of Magnetic Resonance Imaging Equipment and Technique, Beijing, China.
| | - Dehua Cui
- Key Laboratory of Magnetic Resonance Imaging Equipment and Technique, Beijing, China.
| | - Xinrui Huang
- Department of Biophysics, School of Basic Medical Sciences, Peking University, Beijing, China.
| | - Lan Yuan
- Peking University Medical and Health Analysis Center, Peking University Health Science Center, Beijing, China.
| | - Huipo Liu
- Institute of Applied Physics and Computational Mathematics, Beijing, China.
| | - Yu Fu
- Department of Neurology, Peking University Third Hospital, Beijing, China.
| | - Lei Liang
- Department of Medical Chemistry, School of Pharmaceutical Sciences, Peking University, Beijing, China.
| | - Wei Wang
- Department of Radiology, Peking University Third Hospital, Beijing, China.
- Key Laboratory of Magnetic Resonance Imaging Equipment and Technique, Beijing, China.
| | - Qingyuan He
- Department of Radiology, Peking University Third Hospital, Beijing, China.
- Key Laboratory of Magnetic Resonance Imaging Equipment and Technique, Beijing, China.
| | - Chunyan Shi
- Department of Radiology, Peking University Third Hospital, Beijing, China.
- Key Laboratory of Magnetic Resonance Imaging Equipment and Technique, Beijing, China.
| | - Xiangping Guan
- Department of Radiology, Peking University Third Hospital, Beijing, China.
- Key Laboratory of Magnetic Resonance Imaging Equipment and Technique, Beijing, China.
| | - Ze Teng
- Department of Radiology, Peking University Third Hospital, Beijing, China.
- Key Laboratory of Magnetic Resonance Imaging Equipment and Technique, Beijing, China.
| | - Guomei Zhao
- Department of Radiology, Peking University Third Hospital, Beijing, China.
- Key Laboratory of Magnetic Resonance Imaging Equipment and Technique, Beijing, China.
| | - Yuanyuan Li
- Department of Radiology, Peking University Third Hospital, Beijing, China.
- Key Laboratory of Magnetic Resonance Imaging Equipment and Technique, Beijing, China.
| | - Yajuan Gao
- Key Laboratory of Magnetic Resonance Imaging Equipment and Technique, Beijing, China.
| | - Hongbin Han
- Department of Radiology, Peking University Third Hospital, Beijing, China.
- Key Laboratory of Magnetic Resonance Imaging Equipment and Technique, Beijing, China.
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Bajwa ZH, Smith SS, Khawaja SN, Scrivani SJ. Cranial Neuralgias. Oral Maxillofac Surg Clin North Am 2016; 28:351-70. [DOI: 10.1016/j.coms.2016.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Apuzzo MLJ. Next: allegro con brio and the neurosurgical id. World Neurosurg 2014; 82:243-5. [PMID: 25267377 DOI: 10.1016/j.wneu.2014.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Reddy R, Duong TTH, Fairhall JM, Smee RI, Stoodley MA. Durable thrombosis in a rat model of arteriovenous malformation treated with radiosurgery and vascular targeting. J Neurosurg 2013; 120:113-9. [PMID: 24180569 DOI: 10.3171/2013.9.jns122056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Radiosurgical treatment of brain arteriovenous malformations (AVMs) has the significant shortcomings of being limited to lesions smaller than 3 cm in diameter and of a latency-to-cure time of up to 3 years. A possible method of overcoming these limitations is stimulation of thrombosis by using vascular targeting. Using an animal model of AVM, the authors examined the durability of the thrombosis induced by the vascular-targeting agents lipopolysaccharide and soluble tissue factor conjugate (LPS/sTF). METHODS Stereotactic radiosurgery or sham radiation was administered to 32 male Sprague-Dawley rats serving as an animal model of AVM; 24 hours after this intervention, the rats received an intravenous injection of LPS/sTF or normal saline. The animals were killed at 1, 7, 30, or 90 days after treatment. Immediately beforehand, angiography was performed, and model AVM tissue was harvested for histological analysis to assess rates of vessel thrombosis. RESULTS Among rats that received radiosurgery and LPS/sTF, induced thrombosis occurred in 58% of small AVM vessels; among those that received radiosurgery and saline, thrombosis occurred in 12% of small AVM vessels (diameter < 200 μm); and among those that received LPS/sTF but no radiosurgery, thrombosis occurred at an intermediate rate of 43%. No systemic toxicity or intravascular thrombosis remote from the target region was detected in any of the animals. CONCLUSIONS Vascular targeting can increase intravascular thrombosis after radiosurgery, and the vessel occlusion is durable. Further work is needed to refine this approach to AVM treatment, which shows promise as a way to overcome the limitations of radiosurgery.
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Nguyen T, Hsu W, Lim M, Naff N. Delivery of stereotactic radiosurgery: a cross-platform comparison. Neurol Res 2013; 33:787-91. [DOI: 10.1179/016164111x13123658647409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Apuzzo MLJ, Pagán VM, Faccio R, Liu CY. A Bosphorus submarine passage and the reinvention of neurosurgery. World Neurosurg 2012. [PMID: 23177761 DOI: 10.1016/j.wneu.2012.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
One of the major themes characterizing the emergence of modern neurosurgery has been the concept of technology transfer and the application of a broad spectrum of revolutionary elements of technology from both physical and biological science. These transference applications are now apparent in modern neurosurgery as it is practiced on all continents of the globe. More than 3 decades ago, these ideas that now have come to fruition were in states of formulation. This article describes and further documents one such fertile cauldron of ideas and practical realities--the United States Navy Nuclear Submarine Service and its role and affect on the life and professional career of an academic neurosurgeon who was active in areas of progress as modernity was established for the early 21st century.
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Affiliation(s)
- Michael L J Apuzzo
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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Rahman M, Murad GJA, Bova F, Friedman WA, Mocco J. Stereotactic radiosurgery and the linear accelerator: accelerating electrons in neurosurgery. Neurosurg Focus 2009; 27:E13. [PMID: 19722815 DOI: 10.3171/2009.7.focus09116] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The search for efficacious, minimally invasive neurosurgical treatment has led to the development of the operating microscope, endovascular treatment, and endoscopic surgery. One of the most minimally invasive and exciting discoveries is the use of targeted, high-dose radiation for neurosurgical disorders. Radiosurgery is truly minimally invasive, delivering therapeutic energy to an accurately defined target without an incision, and has been used to treat a wide variety of pathological conditions, including benign and malignant brain tumors, vascular lesions such as arteriovenous malformations, and pain syndromes such as trigeminal neuralgia. Over the last 50 years, a tremendous amount of knowledge has been garnered, both about target volume and radiation delivery. This review covers the intense study of these concepts and the development of linear accelerators to deliver stereotactic radiosurgery. The fascinating history of stereotactic neurosurgery is reviewed, and a detailed account is given of the development of linear accelerators and their subsequent modification for radiosurgery.
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Affiliation(s)
- Maryam Rahman
- Department of Neurosurgery, University of Florida, Gainesville, Florida 32610, USA.
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Delayed toxicity from gamma knife radiosurgery to lesions in and adjacent to the brainstem. J Clin Neurosci 2009; 16:1139-47. [PMID: 19576781 DOI: 10.1016/j.jocn.2009.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 03/05/2009] [Accepted: 03/05/2009] [Indexed: 11/20/2022]
Abstract
The aims of this study were to assess the incidence of, and risk factors for, delayed toxicity following gamma knife stereotactic radiosurgery (GKRS) to lesions in and adjacent to the brainstem. We retrospectively evaluated the delayed toxicity of GKRS following the treatment of 114 lesions in and adjacent to the brainstem in 107 patients. The median tumor volume was 6.2 cm(3) and the median dose to the tumor margin was 16Gy. The mean follow-up was 40 months. Thirteen patients (12%) demonstrated clinical evidence of delayed toxicity, with a median latency to the development of toxicity of 6 months. The actuarial incidence of toxicity at 1 year and 5 years was 10.2% and 13.8%. Larger tumor volume (p=0.02) and larger treatment volume (p=0.04) were associated with an increased incidence of delayed toxicity. Large lesions adjacent to the brainstem have a higher than previously suspected rate of delayed toxicity.
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Apuzzo ML, Elder JB, Liu CY. THE METAMORPHOSIS OF NEUROLOGICAL SURGERY AND THE REINVENTION OF THE NEUROSURGEON. Neurosurgery 2009; 64:788-94; discussion 794-5. [DOI: 10.1227/01.neu.0000346651.35266.65] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Michael L.J. Apuzzo
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - James B. Elder
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Charles Y. Liu
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, and Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, California
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Elder JB, Hoh DJ, Oh BC, Heller AC, Liu CY, Apuzzo ML. THE FUTURE OF CEREBRAL SURGERY. Neurosurgery 2008; 62:1555-79; discussion 1579-82. [DOI: 10.1227/01.neu.0000333820.33143.0d] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Hoh DJ, Liu CY, Chen JC, Pagnini PG, Yu C, Wang MY, Apuzzo ML. CHAINED LIGHTNING. Neurosurgery 2007; 61:1111-29; discussion 1129-30. [DOI: 10.1227/01.neu.0000306089.22894.4e] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Abstract
RADIOSURGERY IS FUNDAMENTALLY the harnessing of energy and delivering it to a focal target for a therapeutic effect. The evolution of radiosurgical technology and practice has served toward refining methodologies for better conformal energy delivery. In the past, this has resulted in developing strategies for improved beam generation and delivery. Ultimately, however, our current instrumentation and treatment modalities may be approaching a practical limit with regard to further optimizing energy containment.
In looking forward, several strategies are emerging to circumvent these limitations and improve conformal radiosurgery. Refinement of imaging techniques through functional imaging and nanoprobes for cancer detection may benefit lesion localization and targeting. Methods for enhancing the biological effect while reducing radiation-induced changes are being examined through dose fractionation schedules. Radiosensitizers and photosensitizers are being investigated as agents for modulating the biological response of tissues to radiation and alternative energy forms. Discovery of new energy modalities is being pursued through development of microplanar beams, free electron lasers, and high-intensity focused ultrasound. The exploration of these future possibilities will provide the tools for radiosurgical treatment of a broader spectrum of diseases for the next generation.
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Affiliation(s)
- Daniel J. Hoh
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Charles Y. Liu
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joseph C.T. Chen
- Departments of Radiation Oncology and Neurological Surgery, Southern California Permanente Medical Group, Los Angeles, California
| | - Paul G. Pagnini
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Cheng Yu
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Michael Y. Wang
- Miller School of Medicine, University of Miami, Miami, Florida
| | - Michael L.J. Apuzzo
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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