Feng Ling

Capital Medical University, Peping, Beijing, China

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Publications (124)213.76 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare the incidence of retinal arterial embolism after carotid endarterectomy (CEA) or carotid artery stenting (CAS) as a treatment for carotid artery stenosis and to determine the risk factors for retinal artery embolization, this study included all consecutive severe carotid artery stenosis patients (70-99%), diagnosed by digital subtraction angiography, who underwent CEA or CAS between February 2014 and July 2014. The study included 61 patients in the CEA group and 71 patients in the CAS group. None of the patients developed a stroke or myocardial infarction or died within 7days of the surgery. A total of 15 patients exhibited retinal embolization including three patients who underwent CEA. None of these emboli caused symptoms. After undergoing CAS, 12 patients exhibited retinal embolization and one of the 12 patients suffered a decrease in visual acuity and visual field after CAS. The retinal embolization rate was 4.9% in the CEA group which was lower than the 16.9% rate in the CAS group (p=0.031). In addition, the retinal embolization rate in the ulcerated plaque group was higher than that in the non-ulcerated plaque group (p=0.007). Ulcerated plaques (odds ratio [OR] 5.043; 95% confidence interval [CI] 1.476-17.225; p=0.010) and CAS (OR 4.248; 95% CI 1.104-16.343; p=0.035) were independent predictors of retinal embolization. Although retinal embolization during CEA and CAS is common at our center, symptomatic embolization is not. The presence of ulcerated plaques and CAS were independent predictors of retinal embolization. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of Clinical Neuroscience 05/2015; 22(8). DOI:10.1016/j.jocn.2015.01.033 · 1.32 Impact Factor
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    ABSTRACT: It is essential to collapse giant carotid-ophthalmic (OA) segment aneurysms for successful microsurgical clipping. We present a trapping-evacuation technique utilising hybrid operating theater capabilities to soften OA aneurysms. The patients were prepared for both microsurgical and endovascular procedures. After the majority of the aneurysm was exposed, a balloon was placed at the orifice of the aneurysm to fully block the blood flow. When the balloon was inflated, blood was evacuated from the aneurysm sac to eliminate the space occupying effect. Subsequently, the aneurysm neck was clearly exposed which greatly facilitated clip placement. A control angiogram was obtained prior to closing the wound to ensure complete aneurysm obliteration. After the establishment of a hybrid operating theater in our hospital, two aneurysms were successfully clipped using this technique. Although postoperative complications occurred in both patients, none of the events were related to the endovascular procedure or the trapping-evacuation technique. As a well-organized procedure designed for use in a hybrid operating theater, the current trapping-evacuation technique is an option for the surgical clipping of giant OA aneurysms. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of Clinical Neuroscience 05/2015; 22(7). DOI:10.1016/j.jocn.2015.02.014 · 1.32 Impact Factor
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    ABSTRACT: The preservation of the facial nerve (FN) and acoustic function in large vestibular schwannoma (VS) surgery is challenging because of nerve course uncertainties and morphological deviations. Preoperative diffusion tensor tractography (DTT) has been proposed to predict the FN location. This study was conducted to evaluate the effectiveness of this technique for identifying the FN, cochlear nerve (CN) and trigeminal nerve (TN) in large VSs. The study included 23 consecutive patients with VS of Hannover classification T3b to T4b from November 2013 through May 2014. Diffusion tensor images and anatomical images were acquired. The DTT images of the cranial nerves were extracted before surgery for each patient to determine the relationships of these nerves with the tumor. The results were then validated during the tumorectomy. In 21 (91.30 %) patients, the location of the FN on the DTT images agreed with the intraoperative findings, including in 2 patients in whom the FN passed through the interface between the parenchyma and the cystic changes and in 3 patients with a membranoid FN. The CN or fibers of unclear function were observed on DTT images in four patients with functional hearing. One penetrating fiber of unknown function was effectively constructed. The TN was accurately detected on the DTT images for all patients. DTT effectively revealed the location of the FN, including cases in which the FN was membranoid or passed through the interface between an area exhibiting cystic changes and the tumor nodule. Fibers aside from the FN and the TN were revealed by DTT in patients who retained functional hearing. Penetrating fibers were also found using DTT. This technique can be useful during VS resection.
    Acta Neurochirurgica 05/2015; DOI:10.1007/s00701-015-2431-7 · 1.79 Impact Factor
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    ABSTRACT: Background Patients with symptomatic stenosis of intradural arteries are at high risk for subsequent stroke. Since the SAMMPRIS trial, stenting is no longer recommended as primary treatment; however, the results of this trial, its inclusion criteria and its center selection received significant criticism and did not appear to reflect our experience regarding natural history nor treatment complications rate. As intracranial atherosclerosis (ICAS) is the most common cause for stroke in Asian countries, we are hereby proposing a refined prospective, randomized, multicenter study in an Asian population with strictly defined patient and participating center inclusion criteria.
    Interventional Neuroradiology 05/2015; 21(2). DOI:10.1177/1591019915581778 · 0.73 Impact Factor
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    ABSTRACT: Small side branches related brain infarction remains one of the major concerns for flow-diverter devices. However, among several factors, whether this high-profile stent would significantly block blood flow into small side branches remains unclear. The authors quantitatively evaluate blood flow reduction due to the deployment of flow-diverter devices using computational fluid dynamics approach. Thirty one patient-specific anterior inferior cerebellar artery geometries were employed. The flow-diverter device was hypothetically embedded into the basilar trunk, and to cover the anterior inferior cerebellar arteries. The blood flow reduction of each anterior inferior cerebellar artery following flow-diverter device deployment was calculated, with independent validations for both inflow and outflow conditions. Efficient diameters of the anterior inferior cerebellar arteries were calculated to evaluate any correlation with blood flow reduction after flow-diverter devices. The blood flow reduction ratio was shown to be 3.61±1.94%. There was moreover no significant difference of either inflow or outflow boundary conditions during the simulation. The results were calculated approximately as a modest linear correlation between the blood flow reduction ratio and the size of anterior anterior inferior cerebellar arteries which had a mean efficient diameter of 1.12±0.36mm (range from 0.31mm to 1.91mm), and the R(2) was 0.361. When covered by flow-diverter devices, the mechanical blood flow reduction in anterior inferior cerebellar arteries was found to be low with a maximum value estimated to be less than 8%. Therefore, mechanical blood flow reduction is probably not the leading factor contributing to small side branches related brain infarction. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of Biomechanics 02/2015; 48(6). DOI:10.1016/j.jbiomech.2015.02.015 · 2.50 Impact Factor
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    ABSTRACT: Anterior communicating artery (ACoA) aneurysms are well documented to have a higher rupture risk compared with aneurysms at other locations. However, the risk predicting factors for these aneurysms still remain unclear due to the complex arteries geometries and flow patterns involved. The authors introduce a comprehensive method to quantitatively illustrate the development of ACoA aneurysms using a computational fluid dynamics (CFD) approach. Seven ACoA aneurysms, which included 2 ruptured and 5 unruptured aneurysms, were employed. Patient-specific whole anterior circulation geometries were segmented to simulate the real circumstances in vivo. The energy losses (EL) and flow architectures of these 7 aneurysms were evaluated using an algorithm modality. Overall, the 2 ruptured aneurysms, along with 1 unruptured aneurysm that was defined as highly likely to rupture due to ACoA location and a bleb sitting at the top of the dome, had a significantly larger EL and more complex and unstable flow architecture than the others. Two aneurysms had a negative value of EL indicating that the geometries with aneurysms of the anterior communicating complex (ACC) had a smaller loss of energy than the geometries without aneurysms. Despite a small sample size resulting in a low statistical significance, EL may serve as a development predictor of ACoA aneurysms.
    International Journal of Clinical and Experimental Medicine 01/2015; 8(3):4128-33. · 1.42 Impact Factor
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    ABSTRACT: Endovascular surgery is advantageous in experimentally induced ischemic stroke because it causes fewer cranial traumatic lesions than invasive surgery and can closely mimic the pathophysiology in stroke patients. However, the outcomes are highly variable, which limits the accuracy of evaluations of ischemic stroke studies. In this study, eight healthy adult rhesus monkeys were randomized into two groups with four monkeys in each group: middle cerebral artery occlusion at origin segment (M1) and middle cerebral artery occlusion at M2 segment. The blood flow in the middle cerebral artery was blocked completely for 2 hours using the endovascular microcoil placement technique (1 mm × 10 cm) (undetachable), to establish a model of cerebral ischemia. The microcoil was withdrawn and the middle cerebral artery blood flow was restored. A reversible middle cerebral artery occlusion model was identified by hematoxylin-eosin staining, digital subtraction angiography, magnetic resonance angiography, magnetic resonance imaging, and neurological evaluation. The results showed that the middle cerebral artery occlusion model was successfully established in eight adult healthy rhesus monkeys, and ischemic lesions were apparent in the brain tissue of rhesus monkeys at 24 hours after occlusion. The rhesus monkeys had symptoms of neurological deficits. Compared with the M1 occlusion group, the M2 occlusion group had lower infarction volume and higher neurological scores. These experimental findings indicate that reversible middle cerebral artery occlusion can be produced with the endovascular microcoil technique in rhesus monkeys. The M2 occluded model had less infarction and less neurological impairment, which offers the potential for application in the field of brain injury research.
    Neural Regeneration Research 12/2014; 9(23):2087-94. DOI:10.4103/1673-5374.147936 · 0.23 Impact Factor
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    ABSTRACT: Cerebral aneurysm (CA) is a life-threatening condition with a pathogenesis that remains unclear. Previous hypotheses have primarily been based on in vitro examinations of animal models. Therefore, we attempted to observe CA in living rats and to establish a multi-level evaluation system. The rat model was produced by deoxycorticosterone-acetate (DOCA; Sigma Aldrich, St. Louis, MO, USA) induced hypertension and a single injection of elastase into the basal cistern. The animals were assessed 35 days later. At the endpoint, we induced well-developed CA in 41.7% of the surviving rats. Using synchrotron radiation angiography (SRA), we observed the experimental aneurysms and their surrounding arteries dynamically in the living model. Further anatomical and histological analyses demonstrated the typical degenerative changes of the mural structure and a major infiltration of macrophages into the aneurysmal wall. In conclusion, we visualised well-developed experimental CA in living rats using SRA and demonstrated the associated degenerative histological changes and macrophage involvement; thus, we have provided an effective model for the study of dynamic multi-level changes associated with CA in a rat model.
    Journal of Clinical Neuroscience 11/2014; 22(2). DOI:10.1016/j.jocn.2014.05.044 · 1.32 Impact Factor
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    ABSTRACT: Objective The effects of growth hormone on cognitive dysfunction were observed in a controlled cortical impact (CCI) rat model and the underlying mechanism was explored. Method Three-month-old male SD rats were randomly divided into sham (n = 10), control (n = 10), and CCI groups (n = 40) The parameters were set as follows: striking speed, 3.5 m/s; impact depth, 1.5 mm; and dwell time, 400 msec. Eight and ten weeks post-injury, the GH levels were measured the water maze test and novel object recognition test were performed. CCI rats were divided into normal and decreased GH groups, and further randomly divided into two sub-groups (rhGH treatment and saline vehicle groups). All rats were tested for SYN, BDNF, and TrkB mRNA in the prefrontal cortex and hippocampus by RT-PCR. Results CCI rats 8 weeks post-injury had cognitive dysfunction regardless of the GH level (P<0.05). rhGH treatment improved cognitive function in CCI rats. There was a positive correlation between the expression of prefrontal BDNF and SYN mRNA in CCI rats after rhGH therapy and the water maze test score (r = 0.773 and 0.534, respectively; P<0.05). Furthermore, the expression of BDNF, TrkB, and SYN mRNA in the hippocampus was negatively correlated with the water maze test score (r = 0.602, 0.773, 0.672, and 0.783, respectively; P<0.05). There was a difference in the expression of hippocampal and prefrontal BDNF, TrkB, and SYN mRNA (P<0.05) Conclusion rhGH treatment had a positive effect on cognitive function, which was more evident in GH-deficient rats. The increased expression of hippocampal and prefrontal BDNF and TrkB mRNA is implicated in rhGH therapy to improve cognitive function. Changes in the expression of hippocampal SYN mRNA following rhGH therapy may also play a role in improving cognitive function.
    PLoS ONE 09/2014; 9(9):e108518. DOI:10.1371/journal.pone.0108518 · 3.53 Impact Factor
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    ABSTRACT: Objective: This retrospective study aimed to evaluate our initial experience with carotid endarterectomy in a Chinese population. Methods: Four hundred and thirty-three patients who underwent carotid endarterectomies at Xuan Wu Hospital Capital Medical University between January 1, 2001, and December 31, 2012, were reviewed. The postoperative 30-day complications were analyzed. Univariate and multivariate logistic regression analyses were used to analyze the factors associated with perioperative stroke and death. Results: The overall 30-day complication rates after surgery were 4.08% for death and stroke, 3.63% for cranial nerve injuries, and 3.63% for heart complications. The mean follow-up time was 32.99 months, and only 11 cases required restenosis, including two that were symptomatic (experiencing transient ischemic attacks). In the univariate analysis, a history of cerebral infarction was present preoperatively in 179 patients, of whom 12 (6.70%) had a postoperative stroke or died (P = 0.021). Thirty-two patients had a modified Ranking score (mRS) >= 3, and six (18.75%) of these patients had a postoperative stroke or died (P < 0.001). In the multivariate logistic regression, female gender (OR: 4.669; 95% CI: 1.238-17.602; P=0.023), current smoking habits (OR: 3.826; 95% CI: 1.298-11.277; P=0.015), and an mRS >= 3 (OR: 1.540; 95% CI: 3.844-40.909; P < 0.001) were independent risk factors for perioperative stroke and death. Conclusions: In our single-center study, carotid endarterectomies appeared to effectively prevent and treat the carotid artery stenosis that leads to stroke. Female gender, current smoking habits, and neurological deficits (mRS >= 3) increased the perioperative stroke and death rates.
    Clinical Neurology and Neurosurgery 08/2014; 126C:88-92. DOI:10.1016/j.clineuro.2014.08.025 · 1.25 Impact Factor
  • Neural Regeneration Research 03/2014; 9(5):500-1. DOI:10.4103/1673-5374.130070 · 0.23 Impact Factor
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    ABSTRACT: Chronic subdural hematoma (cSDH) is a common neurosurgical disease. It is often considered to be a rather benign entity. In spite of well established surgical procedures cSDH is complicated by a recurrence rate up to 30%. Since glucocorticoids have been used for treatment of cSDH in 1962 their role is still discussed controversially in lack of evident data. On the basis of the ascertained inflammation cycle in cSDH dexamethasone will be an ideal substance for a short lasting, concomitant treatment protocol. to test the efficacy of dexamethasone on reduction inthe reoperation rate of cSDH. The study is designed as a double-blind randomized placebo-controlled trial 820 patients who are operated for cSDH and from the age of 25 years are included after obtaining informed consent. They are randomized for administration of dexamethasone (16-16-12-12-8-4 mg/d) or placebo (maltodextrin) during the first 48 hours after surgery. The type I error is 5% and the type II error is 20%. The primary endpoint is the reoperation within 12 weeks postoperative. This study tests whether dexamethasone administered over 6 days is a safe and potent agent in relapse prevention for evacuated cSDH.Trial registration: EudraCT 201100354442.
    Trials 01/2014; 15(1):6. DOI:10.1186/1745-6215-15-6 · 2.12 Impact Factor
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    ABSTRACT: Neurofibromatosis type I (NF1) is a hereditary, autosomal dominant, neurocutaneous syndrome that is attributed to NF1 gene mutation. NF1 has been associated with scoliosis, macrocephaly, pseudoarthrosis, short stature, mental retardation, and malignancies. NF1-associated vasculopathy is an uncommon and easily-overlooked presentation. Examination of a Chinese family affected by NF1 combined with cerebral vessel stenosis and/ or abnormality suggested a possible relationship between NF1 and vessel stenosis. To determine which NF1 gene mutation is associated with vascular lesions, particularly cerebral vessel stenosis, we examined one rare family with combined cerebral vessel lesions or maldevelopment. Vascular lesions were detected using transcranial Doppler sonography and digital subtraction angiography in family members. Next, denaturing high-performance liquid chromatography and sequencing were used to screen for NF1 gene mutations. The results revealed a nonsense mutation, c.541C>T, in the NF1 gene. This mutation truncated the NF1 protein by 2659 aminoacid residues at the C-terminus and co-segregated with all of the patients, but was not present in unaffected individuals in the family. Exceptionally, three novel mutations were identified in unaffected family members, but these did not affect the product of the NF1 gene. Thus the nonsense mutation, c.541C>T, located in the NF1 gene could constitute one genetic factor for cerebral vessel lesions.
    Neuroscience Bulletin 11/2013; 29(6). DOI:10.1007/s12264-013-1388-x · 1.83 Impact Factor
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    ABSTRACT: Abstract Superior sagittal sinus thrombosis (SSST) is a form of cerebral venous sinus thrombosis (CVST) routinely treated with anticoagulation therapy. Anticoagulation and thrombolysis treatment effects on neurological function, venous recanalization, and brain edema were compared after SSST in rats. Male Sprague-Dawley rats underwent non-fatal SSST induction and were divided into no treatment (control), anticoagulation (heparin), carotid artery thrombolysis, and local thrombolysis groups (each n = 50). Within each group, an equal number of rats (n=10) were treated with anticoagulation and thrombolysis at day 3 or weeks 1, 2, 3, or 4 following SSST. Magnetic resonance venography (MRV) was conducted within 24 h of anticoagulation and thrombolysis treatments to determine recanalization, structural abnormalities, and cerebral edema quantitated by wet-dry methods. Neurological function (Rotarod test) and histological abnormalities were compared. Severe brain edema, flattened gyri, and coronal swelling were observed following SSST. Recanalization rates in carotid artery and local thrombolysis were higher than in anticoagulation (both P < 0.001). Carotid artery and local thrombolysis brain water contents were 79.6±0.1% and 79.2±0.1%, respectively, significantly lower than 83.9±0.1% and 84±0.1% in anticoagulation and controls, respectively (all P < 0.05), after treatments at day 3 following SSST. Increasing SSST onset to treatment time worsened neurological function (P < 0.05). Maximum treatment benefits were observed <2 weeks post-SSST using local thrombolysis and, to a lesser extent, carotid artery thrombolysis. Thrombolysis may produce better functional outcomes if employed early rather than as a second-line treatment following anticoagulant failure.
    The International journal of neuroscience 11/2013; DOI:10.3109/00207454.2013.862245 · 1.53 Impact Factor
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    ABSTRACT: Carotid artery stenting (CAS) as a competing treatment modality has had to adhere to limits to gain widespread acceptance in some studies. This study analyzed the clinical data of 1700 consecutive patients after CAS to retrospectively evaluate the 30-day outcome of CAS for internal carotid artery stenosis in a Chinese population. Medical records of 1700 patients who underwent CAS at Xuanwu Hospital affiliated to Capital Medical University between January 2001 and August 2012 were reviewed. Postoperative 30-day complication rates were analyzed and compared with those of other studies. Univariate and multivariate Logistic regression analyses were used to identify factors associated with perioperation myocardial infarction (MI), stroke, and death. The overall 30-day rate of MI, stroke, and death after CAS was 2.53%. In univariate analysis, patients who were symptomatic, had a neurological deficit (modified Rankin score (mRS) ≥3; P = 0.001), and who were not taking statins experienced a significantly increased rate of MI, stroke, and death (P = 0.017). In multivariate Logistic regression analysis, the presence of symptoms (odds ratio (OR) = 2.485; 95% confidence interval (CI) = 1.267-4.876; P = 0.008) and a neurological deficit (mRS ≥3) (OR = 3.025; 95% CI = 1.353-6.763; P = 0.007) were independent risk factors for perioperative MI, stroke, and death. According to this single-center experience, CAS may effectively prevent and treat carotid artery stenosis that would otherwise lead to stroke. Being symptomatic and having a neurological deficit (mRS ≥3) increased the risk of perioperative MI, stroke, and death.
    Chinese medical journal 10/2013; 126(20):3915-20. · 1.02 Impact Factor
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    ABSTRACT: The early experience of treating anterior skull base meningiomas with intra-extracranial extension via pure endoscopic endonasal approach (EEA) was presented, the safety, feasibility and preliminary treatment outcomes were investigated. Eight patients with intra-extradural meningiomas who were admitted from October 2006 to October 2010 were operated on via EEA in one stage in Xuanwu hospital. In this study, the operative technique was described, the degree of resection, complications and the early clinical outcomes were discussed. The complete resection of meningiomas with intra-extracranial extension was achieved in all patients using EEA in one stage. Preoperative visual symptoms were improved or resolved in all cases who presented with preoperative visual complaints. No patient in our series experienced a new neurological deficit after surgery or recurrence and death related meningiomas in the follow-up period (33-75 months). One patient experienced postoperative cerebrospinal fluid leak, delayed meningitis and secondary hydrocephalus which responded to therapy. After treatment, the patient was cure. Our limited experience indicates that EEA is feasible and safe for the complete resection of anterior skull base meningiomas with intra- and extracranial extension in one stage in selected cases.
    Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese journal of otorhinolaryngology head and neck surgery 10/2013; 48(10):807-13.
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    ABSTRACT: Object The authors undertook this study to establish an animal model to investigate the pathophysiological changes of venous hypertensive myelopathy (VHM). Methods This study was a randomized control animal study with blinded evaluation. The VHM model was developed in 24 adult New Zealand white rabbits by means of renal artery and vein anastomosis and trapping of the posterior vena cava; 12 rabbits were subjected to sham surgery. The rabbits were investigated by spinal function evaluation, abdominal aortic angiography, spinal MRI, and pathological examination of the spinal cord at different follow-up stages. Results Twenty-two (91.67%) of 24 model rabbits survived the surgery and postoperative period. The patency rate of the arteriovenous fistula was 95.45% in these 22 animals. The model rabbits had significantly decreased motor and sensory hindlimb function as well as abnormalities at the corresponding segments of the spinal cord. Pathological examination showed dilation and hyalinization of the small blood vessels, perivascular and intraparenchymal lymphocyte infiltration, proliferation of glial cells, and neuronal degeneration. Electron microscopic examination showed loose lamellar structure of the myelin sheath, increased numbers of mitochondria in the thin myelinated fibers, and pyknotic neurons. Conclusions This model of VHM is stable and repeatable. Exploration of the sequential changes in spinal cord and blood vessels has provided improved understanding of this pathology, and the model may have potential for improving therapeutic results.
    Journal of neurosurgery. Spine 08/2013; DOI:10.3171/2013.6.SPINE11860 · 2.36 Impact Factor
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    ABSTRACT: This study aimed to summarize therapy experience of carotid endarterectomy, carotid endarterectomy combined with Fogarty catheter embolectomy, and hybrid surgery for the treatment of extracranial internal carotid artery occlusion. The study included 65 patients with extracranial internal carotid artery occlusion who underwent carotid endarterectomy, carotid endarterectomy combined with Fogarty catheter embolectomy, or hybrid surgery in the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China between January 2006 and December 2012. Prior to surgery, all patients underwent perfusion CT or xenon CT to evaluate the occlusion. The procedure for each patient was chosen according to digital subtraction angiography data. The carotid artery was successfully recanalized in 46 of 51 patients who underwent carotid endarterectomy, 9 of 10 patients who underwent carotid endarterectomy combined with Fogarty catheter embolectomy, and 3 of 4 patients who underwent hybrid surgery. In patients with symptomatic carotid artery occlusion, the carotid artery can be recanalized by choosing a treatment procedure based on imaging examination findings.
    Neural Regeneration Research 08/2013; 8(23):2204-6. DOI:10.3969/j.issn.1673-5374.2013.23.011 · 0.23 Impact Factor
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    ABSTRACT: The effect of normobaric oxygen (NBO) on apoptosis remains controversial. The present study evaluated the effect of NBO on ischemia-induced apoptosis and assessed the potential for improved outcomes by combining NBO administration with another neuroprotective agent, ethanol, in a rat stroke model. Rats were subjected to right middle cerebral artery occlusion (MCAO) for 2hours. At the onset of reperfusion, ischemic animals received either: NBO (2hour duration), an intraperitoneal injection of ethanol (1.0g/kg), or both NBO and ethanol. Extent of brain injury was determined by infarct volume, neurological deficit, and apoptotic cell death. Expression of pro- and anti-apoptotic proteins was evaluated through Western immunoblotting. Given alone, NBO and ethanol each slightly (p<0.05) reduced infarct volume to 38% and 37%, respectively, as compared to the impressive reduction of 51% (p<0.01) seen with combined NBO-ethanol administration. Neurologic deficits were also significantly reduced by 48% with combined NBO-ethanol therapy, as compared to lesser reductions of 24% and 23% with NBO or ethanol, respectively. Combined NBO-ethanol therapy decreased apoptotic cell death by 49%, as compared to 31% with NBO and 30% with ethanol. Similarly, combination therapy significantly increased expression of anti-apoptotic factors (Bcl-2 and Bcl-xL) and significantly reduced expression of pro-apoptotic proteins (BAX, Caspase-3, and AIF), as compared to the minimal or nil protein expression changes elicited by NBO or ethanol alone. In rats subjected to ischemic stroke, NBO administration salvages ischemic brain tissue through evidenced decrease in apoptotic cell death. Combined NBO therapy with ethanol administration greatly improves both degree of neuroprotection and associated apoptosis.
    Brain research 08/2013; 1531. DOI:10.1016/j.brainres.2013.07.051 · 2.83 Impact Factor
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    ABSTRACT: The authors describe a pterional transsylvian transtentorial approach to the ventrolateral pons based on its clinical application to cavernomas. Consecutive patients in their database with brain stem cavernomas who underwent surgical removal from April 2009 to December 2012 were retrospectively analyzed. Four patients who underwent anterolateral pontine cavernoma removal via the pterional transsylvian transtentorial approach were included in the current study. The surgical indications, techniques, exposure, and feasibility were analyzed. To make a comprehensive illustration of surgical feasibility and exposure, a fresh, colored-latex-injected cadaveric head specimen was used. The cavernomas of these four paitents were confirmed successful removal by both surgeon's intraoperative views and follow-up MRIs. Cranial nerve IV was inadvertently transected in one patient, and transient muscle power decrease occurred in another patient. Based on the surgeons' experiences and anatomy illustration, the pterional transsylvian transtentorial approach enables a wide exposure of the upper ventral pons inferolaterally to the CN V REZ, inferiorly to the CN V REZ horizontal level, and medially to the basilar artery. Although a comprehensive comparison with other approaches needs a large patient volume and a prospective designed study, the pterional transsylvian transtentorial approach could be an alternative for ventrolateral pontine cavernomas. The principle for this approach to ventrolateral pontine cavernomas is that if the thinnest parenchyma layer over the cavernoma could be defined in the ipsilateral upper ventrolateral pons, facilitated by an oblique multi-angled working space, cavernomas in even the entire ventrolateral pons could be removed.
    World Neurosurgery 07/2013; 82(6). DOI:10.1016/j.wneu.2013.06.011 · 2.42 Impact Factor

Publication Stats

571 Citations
213.76 Total Impact Points

Institutions

  • 2003–2015
    • Capital Medical University
      • Department of Neurosurgery
      Peping, Beijing, China
  • 2002–2015
    • Xuanwu hospital
      Baizhifang, Beijing, China
  • 2012
    • Guangdong Academy of Medical Sciences and General Hospital
      Shengcheng, Guangdong, China
  • 2006–2011
    • Tongji University
      Shanghai, Shanghai Shi, China
  • 2009
    • Jilin University
      Yung-chi, Jilin Sheng, China
  • 1999
    • Guiyang Medical University
      Kuei-yang, Guizhou Sheng, China