{"title":"Biochemical alteration in cerebrospinal fluid precedes behavioral deficits in Parkinsonian rats induced by 6-hydroxydopamine","authors":"Jia-Wei Lin MD, PhD , Chwen-Ming Shih PhD , Yen-Chou Chen PhD , Chien-Min Lin MD , Jo-Ting Tsai MD , Yung-Hsiao Chiang MD, PhD , Raymond Shih BS , Pei-Ling Chiu BS , Kuo-Sheng Hung MD, PhD , Yi-Shian Yeh MD , Li Wei MD , Wen-Ta Chiu MD, PhD , Liang-Yo Yang DVM, PhD","doi":"10.1016/j.wneu.2009.09.005","DOIUrl":"10.1016/j.wneu.2009.09.005","url":null,"abstract":"<div><h3>Background</h3><p>Parkinson's disease, affecting at least 1% of population older than 65 years, is the most common neurodegenerative movement disorder. Up to now, no evidence has demonstrated that biochemical changes in CSF occur preceding the onset of Parkinson's symptoms. In this study, we tested the hypothesis that biochemical changes in CSF precede behavioral deficits in Parkinsonian animals.</p></div><div><h3>Methods</h3><p>We infused different doses of 6-OHDA into the MFB of rats bilaterally and examined the animals' movement behaviors, biochemical alterations in CSF, and dopaminergic neuronal number in the SNpc 1 week later.</p></div><div><h3>Results</h3><p>Our results indicated that animals with over 70% dopaminergic neuronal loss in the SNpc exhibited behavioral bradykinesia and rigidity, and a decrease of HVA in CSF. In contrast, animals with about 42% dopaminergic neuronal loss in the SNpc showed normal movement behaviors, but displayed a drastic decline of HVA in CSF. Furthermore, the number of dopaminergic neurons in the SNpc was positively correlated with the HVA level in CSF.</p></div><div><h3>Conclusions</h3><p>Our findings demonstrate that biochemical alteration in CSF foreruns behavioral deficits and the HVA level in CSF is positively correlated with the number of dopaminergic neurons in the SNpc of Parkinsonian rats induced by 6-OHDA. Our results strongly suggest that additional studies are needed to evaluate usefulness of monitoring the HVA level in CSF for early detection of the loss of dopaminergic neurons in the SNpc that precedes the onset of Parkinsonian symptoms in humans.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 ","pages":"Pages S55-S65"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.wneu.2009.09.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28534050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Surgical NeurologyPub Date : 2009-12-01Epub Date: 2009-03-27DOI: 10.1016/j.surneu.2008.09.027
Yong Li MD, Xiang-Yu Hou MD, Zheng-Wei Yuan MD, Wei-Lin Wang MD
{"title":"Quantitative analysis of motor neurons of the levator ani muscle in fetal rats with spina bifida occulta","authors":"Yong Li MD, Xiang-Yu Hou MD, Zheng-Wei Yuan MD, Wei-Lin Wang MD","doi":"10.1016/j.surneu.2008.09.027","DOIUrl":"10.1016/j.surneu.2008.09.027","url":null,"abstract":"<div><h3>Background</h3><p>With the combination of microsurgery and microinjection techniques, we investigated the development of motor neurons in the spinal cord of fetal rats with spina bifida occulta by injecting the retrograde trace FG into the levator ani muscle.</p></div><div><h3>Methods</h3><p>The fetal rats were divided into 3 groups. On the day 9 of gestation, 6 mature Wistar rats (weighing 250-300 g) in the control group (group 1) were subcutaneously injected with 0.5 mL of normal saline at their hind limbs at 9:00 <span>am</span> and 4:00 <span>pm</span>. At these 2 time points, 15 rats in the treatment group (group 2 and group 3) were subcutaneously injected with 20% sodium valproate solution (400 mg/kg of body weight) at their hind limbs, too. On the day 20 of gestation, pregnant rats were anesthetized with 10% chloral hydrate (300 mg/kg of body weight) intraperitoneally, and then fetal microsurgery and microinjection were performed to expose the levator ani muscle, whereas 5% FG was administered with microinjector. Twenty-four hours later, transcardial perfusion of 4% paraformaldehyde in phosphate-buffered saline (PBS) was given to the operated fetus. After the spine sample was stained with Alcian blue GX, the image of stained spine was measured using a computer system for the distance of the 2 cartilaginous ends of the vertebra arch. Then, the lumbosacral spinal cord was cryopreserved in 20% sucrose in PBS for a later serial transverse cryosection after 24 hours. The FG-labeled motor neurons were visualized with a wide-band ultraviolet-fluorescent filter, and the number of the FG-labeled motor neurons was recorded. Nine fetal rats survived in group 1. Eighteen fetal rats survived in the treatment group, including 7 (with no malformation) of 18 fetuses in group 2 and 11 fetuses with spina bifida occulta in group 3.</p></div><div><h3>Results</h3><p>The FG-labeled motor neurons in the ventral horn of normal spinal cord clustered at the dorsolateral and dorsomedial corner of the ventral horn. The FG-labeled motor neurons in the ventral horn of deformed spinal cord were less than that of normal spinal cord, and the motor neurons were scattered around the space between the dorsomedial and dorsolateral corners. The number of FG-labeled motor neurons was 244 ± 41 in group 3, 426 ± 36 in group 1, and 397 ± 20 in group 2. The data were stastistically significant if <em>P</em> < .05.</p></div><div><h3>Conclusion</h3><p>The motor neurons that innervate the levator ani muscle in fetal rats with spina bifida occulta are fewer than the normal fetal rats, and they are arranged in abnormal distribution.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 652-656"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2008.09.027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28079259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical practice guidelines in severe traumatic brain injury in Taiwan","authors":"Kuo-Hsing Liao MD , Cheng-Kuei Chang MD, PhD , Hong-Chang Chang MD , Kun-Chuan Chang MD , Chieh-Feng Chen MD , Tzu-Yung Chen MD , Chi-Wen Chou MD , Wen-Yu Chung MD , Yung-Hsiao Chiang MD, PhD , Kuo-Sheng Hong MD, PhD , Sheng-Huang Hsiao MD, PhD , Yu-Hone Hsu MD , Hsu-Lin Huang MD, PhD , Sheng-Chien Huang MD , Ching-Chang Hung MD , Sui-Sum Kung MD , Ken N. Kuo MD, PhD , Kun-Hsing Li MD , Jia-Wei Lin MD, PhD , Tzu-Gan Lin MD , Wen-Ta Chiu MD, PhD","doi":"10.1016/j.surneu.2009.07.004","DOIUrl":"10.1016/j.surneu.2009.07.004","url":null,"abstract":"<div><h3>Background</h3><p><span>Severe TBIs are major causes of disability and death in accidents. The Brain Trauma Foundation supported the first edition of the </span><em>Guidelines for the Management of Severe Traumatic Brain Injury</em> in 1995 and revised it in 2000. The recommendations in these guidelines are well accepted in the world.</p><p>There are still some different views on trauma mechanisms, pathogenesis, and managements in different areas. Individualized guidelines for different countries would be necessary, and Taiwan is no exception.</p></div><div><h3>Methods</h3><p><span>In November 2005, we organized the severe TBI guidelines committee and selected 9 topics, including ER treatment, ICP monitoring, CPP, fluid therapy, use of sedatives, nutrition, intracranial hypertension, </span>seizure prophylaxis, and second-tier therapy. We have since searched key questions in these topics on Medline. References are classified into 8 levels of evidence: 1++, 1+, 1−, 2++, 2+, 2−, 3, and 4 based on the criteria of the SIGN.</p></div><div><h3>Results</h3><p>Recommendations are formed and graded as A, B, C, and D. Grade A means that at least one piece of evidence is rated as 1++, whereas grade B means inclusion of studies rated as 2++. Grade C means inclusion of references rated as 2+, and grade D means levels of evidence rated as 3 or 4.</p><p>Overall, 42 recommendations are formed. Three of these are rated as grade A, 13 as grade B, 21 as grade C, and 5 as grade D.</p></div><div><h3>Conclusions</h3><p>We have completed the first evidence-based, clinical practice guidelines for severe TBIs. It is hoped that the guidelines will provide concepts and recommendations to promote the quality of care for severe TBIs in Taiwan.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 ","pages":"Pages S66-S73"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.07.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28428924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Surgical NeurologyPub Date : 2009-12-01Epub Date: 2009-12-16DOI: 10.1016/j.surneu.2009.06.017
Zhen-Wei Zhao MD, Jian-Ping Deng MD, Shi-Ming He MD, Huai-Zhou Qin MD, Li Gao MD, Guo-Dong Gao MD
{"title":"Intracranial angioplasty with Gateway-Wingspan system for symptomatic atherosclerotic stenosis: preliminary results of 27 Chinese patients","authors":"Zhen-Wei Zhao MD, Jian-Ping Deng MD, Shi-Ming He MD, Huai-Zhou Qin MD, Li Gao MD, Guo-Dong Gao MD","doi":"10.1016/j.surneu.2009.06.017","DOIUrl":"10.1016/j.surneu.2009.06.017","url":null,"abstract":"<div><h3>Background</h3><p>We investigated the safety of treatment of symptomatic intracranial atherosclerotic stenoses with the Gateway-Wingspan system and its initial effect on prevention of ischemic events.</p></div><div><h3>Methods</h3><p>Twenty-seven cases of symptomatic intracranial atherosclerotic stenoses were treated with angioplasty with a Wingspan stent. Location of stenoses, extent of stenoses before and after angioplasty, success rate of treatment, occurrence of procedural complications, and changes in recurrence of symptoms of ischemic events 30 days after treatment were recorded.</p></div><div><h3>Results</h3><p>Twenty-nine angioplasties with the Wingspan system were successfully carried out in 29 stenoses in 27 patients. Of 29 stenoses, 17 were in the posterior circulation, and 12, in the anterior circulation. The degree of stenoses was reduced from baseline 71.8% (56%-87.8%) to 24.9% (0%-45%) after stenting. Complications were seen in four patients (14.8%), 3 of which were lesion-related infarction of a perforated artery, and 1 was a non-lesion-related infarction. Two complications led to transient neurologic dysfunction, one led to defect of the visual field, and one led to hemiplegia. The prevalence of morbidity and serious morbidity were 7.4% and 3.7%, respectively, and no death occurred. No new ischemic events happened during 30 days after stenting.</p></div><div><h3>Conclusion</h3><p>Angioplasty with the Wingspan system to treat symptomatic intracranial atherosclerotic stenoses appears to be safe. Its initial effect on prevention of ischemic events is acceptable.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 607-611"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.06.017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28654348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Surgical NeurologyPub Date : 2009-12-01Epub Date: 2009-08-07DOI: 10.1016/j.surneu.2009.05.031
Mark Garrett MD, Robert F. Spetzler MD
{"title":"Surgical treatment of brainstem cavernous malformations","authors":"Mark Garrett MD, Robert F. Spetzler MD","doi":"10.1016/j.surneu.2009.05.031","DOIUrl":"10.1016/j.surneu.2009.05.031","url":null,"abstract":"<div><h3>Background</h3><p>The contemporary neurosurgeon is often confronted by cavernous malformations. Those located in the brainstem are particularly challenging</p></div><div><h3>Methods</h3><p>This article reviews published series on the natural history and surgical outcomes of these lesions and discusses the surgical approaches used at our institution for their resection.</p></div><div><h3>Results</h3><p>Despite their challenging location in the brainstem, appropriately selected lesions can be resected surgically with acceptable rates of morbidity and mortality.</p></div><div><h3>Conclusions</h3><p>Our institutional philosophy on the surgical treatment of brainstem cavernous malformations reflects the substantial surgical experience of the senior author.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 ","pages":"Pages S3-S9"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.05.031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40020895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Attempting homicide by inserting sewing needle into the brain","authors":"Abbas Amirjamshidi MD, MPH , Arman Rakan Ghasvini MD , Maysam Alimohammadi MD , Kazem Abbassioun MD","doi":"10.1016/j.surneu.2009.02.029","DOIUrl":"10.1016/j.surneu.2009.02.029","url":null,"abstract":"<div><h3>Background and objectives</h3><p>Child abuse with sewing needle is a rare but well-known homicide attempt threatening the life of victims. Information about diagnosis and treatment of such cases either in the acute or chronic phases is lacking and ambiguous in the literature. This study intends to report the experience of 6 victims of homicide attempt who presented to the authors in different decades of life and were managed in different ways. This may deliver some evidences to the literature regarding management of further cases encountered by neurosurgeons.</p></div><div><h3>Material and methods</h3><p>The authors had the chance of managing 6 patients referred to their trauma center harboring one or more sewing needles within their cranium. There were 3 male and 3 female patients, with 2 patients in their first decade of life, and the others, each in either decade of life. The youngest was 6, and the eldest 51 year old. The elder patients were having vague headaches, for which a plain skull x-ray or CT of the brain lead to the diagnosis of persisting intracranial foreign bodies. Chronic headache was the main complaint of the patients. Four patients underwent surgical removal of the sewing needle, and 2 are being followed.</p></div><div><h3>Results</h3><p>Among the 4 patients who underwent surgery, 1 died after a short period of ‘akinetic mutism.’ Headache and limb paresthesia improved 6 months after the operation in 2 cases, and the other 1 remained unchanged. The cases under observation have been doing well. Biochemical analysis of the rusted needle showed a composite of oxidant form of some of the elements of needle such as Fe, Mn, and Cr.</p></div><div><h3>Conclusion</h3><p>In spite of standard algorithms proposed for management of penetrating head wounds, selection of the best treatment in the victims harboring sewing needles in their brain needs close cooperation between neurosurgeons, pediatricians, psychiatrists, and social workers. Furthermore, there is no absolute indication for removing sewing intracranial needles detected in the later decades of life.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 6","pages":"Pages 635-641"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.02.029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40021330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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