Nerve Grafting is a New Treatment Option for Stroke Patients

Recently, New England Journal of Medicine published an article by the famous hand surgery specialists, Yudong Gu. The important medical achievements of Gu's team include transposition of C7 nerve root of the unaffected side on the upper limbs in stroke hemiplegia, changing the brain central dominance region, and rebuilding the function of hands with spastic paralysis. These achievements are admirable because worldwide medical problems, such as stroke sequela hemiplegia, require long-term arduous efforts for any progress to be made. Any result that improves the survival quality of patients has significant social value. Their success has enabled me to feel that I am no longer alone in my years of exploration, and I am grateful to them from the bottom of my heart. At this time, I am reminded of the 40 years of my experience in this field. It has taken the efforts of many people to make this happen: Limb sequelae of stroke, especially spasmodic paralysis of upper limbs, often result in patients losing their ability to self-care, which can cause a great burden to their family and society. The need to rebuild and improve functions in such patients is urgent.

Hemodynamic Consideration of Intracranial Aneurysm

We reviewed basic considerations in fluid dynamics of cerebral aneurysms and applied these in surgery on the three most common types: internal carotid-posterior communicating artery, middle cerebral artery, and anterior communicating artery. It was found that aneurysmal initiation and growth do not occur at symmetric bifurcations. As blood flow always obeys the law of inertia, jet flow into the aneurysm will disperse along the wall; assuming the aneurysmal wall strength is even, the shape of the aneurysm becomes round or oval. When neurosurgeons encounter an aneurysm that is not round or oval, the wall may be fragile and requires great care during surgical manipulation.

Neural Matrix and Its Role in Preoperative Evaluation of Partial Epilepsy

The network characteristic of the central neural system has been widely accepted as a basic fabric form. However, the matrix characteristics of neural network are still not fully understood. If we ignore the matrix characteristics of the neural networks and just pay close attention to its connection mode, we are likely to fall into the theory of mechanical reductionism. This can lead to a problem in representing consciousness in a disadvantageous situation. It can also be a barrier to further improving the global workspace theory. Incomplete elucidation of the mechanisms of consciousness representation can also affect the assessment of the surgical outcome of partial epilepsy with conscious injury. Therefore, this paper reviews the epistemological development of neuroscience. We will initially describe the matrix characteristics of the neural system and their significance to the information processing mechanism, and further explore the role of neural matrix in identifying cases of partial epilepsy with little effect on the resection of the lesion.

Spinal Capillary Hemangioma: Report of Five Surgical Cases and Literature Review

Objective Capillary hemangioma is a benign vascular malformation that is usually encountered in soft-tissue. Rarely, it may occur in the neuraxis, and spinal capillary hemangioma (SCH) is a rare variant of it. Existing literature on SCH is limited because of its rarity. As a result, epidemiological and clinical characteristics as well as management strategy for SCH are still lacking. Here, we present a report on five patients with pathologically proven SCH, treated in Beijing Tiantan Hospital between 2013 and 2015. Methods Patients' age, gender, clinical manifestations, radiological features, operative methods, and surgical outcomes were retrospectively reviewed, and an updated review of the literature was also provided. Results Four patients were men and one was a woman, with a median age at presentation of 43 years (range: 15–66 years). Two lesions were intramedullary, two epidural, and one intradural extramedullary. The thoracic segment was most commonly affected (n = 3, 60%), followed by the cervical (n = 1, 20%) and lumbar (n = 1, 20%) segments. Common symptoms, in descending order, were numbness and paresthesia, limb weakness, and pain. The surgical procedure was successfully performed with total resection of the tumor achieved in 4 patients and subtotal in 1 patient. During an average follow-up period of 32 months (range: 27–43 months), recovery of the clinical symptoms was observed in all five patients. Conclusions SCH is a rare benign vascular disease, for which surgical resection of the lesion, by the en bloc method, is recommended. Clinically, it usually manifests with progressive myelopathy, but early surgical intervention usually produces good results and may prevent permanent neurological deficits.

Neuronavigation Combined with Nerve Electrophysiology in Excision of Brain Abscess: A Case Report and Literature Review

A brain abscess is a parenchymal infection, which is a severe intracranial infectious disease. Although the incidence is low, it causes serious inflammation and neurological deficits. The current treatments for brain abscesses are primarily surgical, including abscess resection or puncture and drainage. In recent years, extensive application of neuronavigation and electrophysiological monitoring technology have improved the safety and reliability of neurosurgery. To explore the application and curative effect of neuronavigation combined with neurophysiological techniques in the treatment of brain abscesses, we retrospectively analyzed a female patient who had undergone neurological monitoring and neuronavigation-assisted surgery to remove an abscess in 2015. Diagnosis and treatment are reported.

Using Nerve Segment Insert Grafting to Reconstruct Neural Pathways of Brain-Derived Paralysis

Since 1992, task groups have used free nerve auto grafts to bridge partially transected nerves from the dominant area of the normal cerebral cortex to nerves that innervate spastic muscles from a diseased cerebral cortex, using transplanting sutures to alleviate the muscle spasm of cerebral palsy caused by different diseases. This has facilitated rebuilding of some of its neurological function. In this study, 80 such patients were followed up, including 20 patients with traumatic brain injury, 32 patients with stroke, and 28 pediatric patients with cerebral palsy. After postoperative follow-up of 3 to 21 years, the efficacy rate of this operation was 100% and the excellent and good spasm relief rate was 82.5%.

Review of Insulin-Like Growth Factor 1 Signaling Pathway and Its Role in Protection against Brain Diseases

Insulin-like growth factor 1 (IGF-1) is a pluripotent growth factor, with multiple functions in the peripheral and central nervous systems. Increasing evidence suggests that IGF-1 fine-tunes the development of the central nervous system, ensuring proper neuronal differentiation, maturation, and connectivity. It supports neuronal survival and axon growth, and acts on myelinating Schwann cells and oligodendroglia. The biological functions of IGF-1 are modulated by the IGF-1 signaling pathway. Recent studies have proposed the modulation of the members of the IGF-1/IGF-1 signaling pathway as treatment for neuropathologies. In this study, we introduce the structure of IGF-1/2 and its receptors, with the intra-cellular interactions. Further, we review the therapeutic effects of IGF-1 in different models of brain diseases, via activation of different cellular mechanisms.

Effects of Degenerative Autologous Nucleus Pulposus on the Lumbar Sympathetic Trunk: Sympathetic Inflammation in Rats

Objective We have reported the presence of discogenic visceral pain secondary to anterior herniation of the lumbar disc. The aim of this study was to observe the inflammatory response of the sympathetic trunk to an autologous degenerative nucleus pulposus (NP) injection under fluoroscopy. Methods A total of 72 rats were used. In 24 rats, the autologous NP suspension was injected into the right sympathetic trunk. Next, food intake and body weight of each rat were monitored for 14 days. Fourteen days after the injection, the right lumbar sympathetic trunk was harvested for histological assessment, and protein levels of IL-1 β, IL-6, and TNF-α were quantified via ELISA. Results In the NP-treated group, endoneural hyperemia and intensive infiltration of inflammatory cells could be identified in sections of the sympathetic trunk by the hematoxylin and eosin (H&E) stain. Meanwhile, elevated concentrations of IL-1 β, IL-6, and TNF-α were determined in the sympathetic trunk of the NP group as compared to that of the naïve and control groups, which indicated the development of an inflammatory response. Furthermore, food intake and body weight of rats in the NP group decreased significantly. Conclusions The results indicated that an inflammatory response in the sympathetic trunk can be caused by anterior herniation of the lumbar disc, which can generate a sympathetic inflammatory pain response.

Calcified Chronic Subdural Hematoma: A Case Report and Literature Review

Calcified chronic subdural hematoma (CCSDH) is a rare disease that accounts for approximately 0.3%–2.7% of all chronic subdural hematomas (CSDHs). The clinical features of CCSDH are very similar to those of noncalcified CSDH and include headache, decreased alertness, weakness, numbness, gait disturbance, seizures, memory impairment, confusion, and unconsciousness. All symptomatic CCSDH should be treated surgically. Majority of these patients recover well following surgery. In this report, we present the case of a patient with CCSDH who developed severe cerebral edema following its removal, necessitating decompressive craniectomy. Although there were no abnormal findings in laboratory blood tests, and no signs of brain herniation or epilepsy was found the following day after surgery, the patient's family refused all treatment and a postoperative brain computed tomography (CT) scan. The patient was discharged and died at home. Cerebral hematoma and normal perfusion pressure breakthrough (NPPB) may cause severe cerebral edema following the total removal of a CCSDH.

Surgical Treatment of Congenital Basilar Invagination with Different Pathological Characteristics: Report of 139 Cases

Objective To describe the different pathological characteristics of congenital basilar invaginations and discuss the surgical treatment of such cases. Methods A total of 139 patients diagnosed with basilar invaginations underwent surgical treatment from 2008 to 2015. Based on Atul Goel's classification and simultaneous consideration of atlantoaxial dislocation or syringomyelia, the cases were subdivided into four groups. Individualized posterior surgical decompression and/or atlantoaxial reset procedures were performed to correct atlantoaxial dislocation, decompress the brain stem, or resolve syringomyelia. The indications and critical points of each procedure were documented. Results All 139 patients were surgically treated; 27 patients (19.4%) had underwent at least one decompression surgery previously. On an average, there was gratifying clinical improvement based on the Japanese Orthopaedic Association score analysis. One patient exhibited severe postoperative infection, and the fusion instrument was removed. One patient experienced fracture of internal fixation. Two patients exhibited persistent respiratory symptoms at early stages after the surgery. Four patients felt worse at the latest follow-up. There was no surgical mortality. The poor outcome/ morbidity in this series was 5.8% (8/139). Conclusion The different pathological image characteristics of congenital basilar invaginations based on the presence or absence of syringomyelia and/or atlantoaxial dislocation, reflected the pathological features of complicated basilar invaginations more accurately. Based on these features, different posterior decompression and/or reset procedures, combined with occipitocervical fusion and C1-2 fusion, could be tailored to different patients. These individualized surgeries could reduce surgical complications, decrease morbidity and mortality, and further promote positive outcomes.