I-Chang Su

Cathay General Hospital · Division of Neurosurgery, Department of Surgery

Background: Hybrid operating room (OR) allows a combination of three-dimensional (3D) robotic fluoroscopy with navigation to be performed intraoperatively for minimally invasive surgery (MIS) of the spine. We aimed to investigate the accuracy and radiation exposure of surgeons and OR staffs when the navigation system is engaged for percutaneous ped...

Purpose Craniofacial arteriovenous malformations (CF-AVMs) are locally aggressive extracranial lesions. When CF-AVMs involve cavernous sinus (CS) as their draining vein, they represent a special subgroup which may interfere intracranial venous system. In this study, we aimed to analyze the venous drainage patterns of CF-AVMs with CS drainage and to...

Purpose Among the different arterial accesses, the femoral access is the main approach for intraoperative angiography (IOA) performed in a prone position. Without a standardized protocol, however, the application of prone IOAs in intracranial arteriovenous malformation (AVM) or arteriovenous fistula (AVF) surgery remains limited by its procedural c...

Human pluripotent stem cells have the potential assist in the identification of genes involved in mammalian development. The human placenta is considered a repository of stem cells, termed placenta‑derived multipotent cells (PDMCs), which are able to differentiate into cells with an osteoblastic phenotype. This plasticity of PDMCs maybe applied cli...

Purpose: To assess the accuracy and safety of self-developed customized guiding templates used for cervical pedicle screw (CSP) insertion surgery. Materials and methods: A total of 57 screws were implanted in 9 patients with the assistance of the customized guiding templates from July 2016 to December 2017. The customized guiding templates were...

Arteriovenous malformations (AVMs) are fast-flow vascular malformations that mostly occur in the head and neck region. They are typically progressive and their spontaneous regression is almost never seen. We present a case with pulsatile tinnitus and a parapharyngeal AVM. It resolved completely after diagnostic catheter-based angiography alone.

Objective: mThree-dimensional (3D) rotational angiography (RA), a gold-standard imaging tool for the post-clipping evaluation of cerebral aneurysms, can currently be performed intraoperatively in a hybrid operating room (OR). However, its role in intraoperative aneurysmal surgery is unclear. We aimed to study the value of intraoperative two-dimens...

Spontaneous regression of cerebral arteriovenous malformation (AVM) is a rare phenomenon, but its occurrence is an important consideration in treatment planning. A 58-year-old male was found to have a high-flow AVM of Spetzler–Martin Grade III. Before his scheduled treatment, the AVM ruptured with a large parenchymal hemorrhage. Following emergency...

Background: Full visualization of the aneurysm neck is usually impossible in a classical pterional craniotomy when a paraclinoid aneurysm is located on the opposite side of the internal carotid artery (ICA). Optic nerve (ON) retraction is required for better aneurysmal exposure, but ON injuries may occur. Clinical description: In a case of a 70-...

Chronic subdural hematoma (CSDH) is one of the most common neurological diseases. However, bilateral CSDH is more infrequent than unilateral CSDH, and the clinical and radiological characteristics are not well-defined. We aimed to investigate the clinical and radiological differences between bilateral and unilateral CSDH. A retrospective study was...

Background: Temozolomide (TMZ) plays an important role in the treatment of glioblastoma multiforme (GBM). O 6-methylguanine-DNA methyltransferase (MGMT) gene promoter methylation has been described as a prognostic factor in patients with GBM treated by TMZ. However, the prognostic value of MGMT gene promoter meth-ylation in GBM, as investigated by...

Dynesys (Dynamic Neutralization System) was designed to overcome the shortcomings of fusion. The Dynesys top loading (DTL) system is a new alternative Dynesys system that can be applied via a minimally invasive procedure. This study aimed to ascertain whether DTL is a suitable device for motion preservation and prevention of instability, and to com...

A 20-year-old female with moyamoya disease presented with acute intraventricular hemorrhage. Cerebral angiography demonstrated that the anterior choroidal artery (AChA) was responsible for the bleeding, but the precise point of rupture was unpredictable, because multiple angiographic weak spots were found on the artery. As direct targeting of the r...

Patients harboring arteriovenous malformations (AVMs) may present with focal neurological deficit, seizures, hemorrhage or be completely asymptomatic. This diversity in manifestation of AVM is related to the individual characteristics of AVMs such as size, location, configuration of feeding arteries, and drainage veins. Treating the AVMs with high-...

As of now, the role of extracorporeal shockwave therapy (ESWT) in the treatment of atrophic non-unions is inconclusive. The purpose of the study was to investigate the effectiveness of ESWT and the role of this technology in the treatment of atrophic non-union of femurs. We retrospectively analyzed 22 patients treated in between July 1999 and Septe...

INTRODUCTION: Cerebral cavernous malformations (CCM) are the second commonest incidental finding on brain MRI and may cause symptomatic intracranial hemorrhage (ICH). However, the risk and predictors of ICH from CCM remain uncertain. HYPOTHESIS: Presentation with ICH or non-hemorrhagic focal neurological deficit (FND) attributable to CCM, brainstem...

Background: Cerebral cavernous malformations (CCMs) can cause symptomatic intracranial haemorrhage (ICH), but the estimated risks are imprecise and predictors remain uncertain. We aimed to obtain precise estimates and predictors of the risk of ICH during untreated follow-up in an individual patient data meta-analysis. Methods: We invited investigat...

According to McCormick’s classification scheme, intracranial vascular malformations of the central nervous systems are originally categorized into four types: cavernous malformations, capillary telangiectasias, developmental venous anomalies (DVAs, formerly known as venous angiomas), and arteriovenous malformations (McCormick 1966). In this chapter...

Proceedings: AACR Annual Meeting 2014; April 5-9, 2014; San Diego, CA PiggyBac is a prevalent transposon system used to deliver transgenes into and to functionally explore the mammalian untouched genomic territory. Efforts to increase its transposition efficiency in mammals through engineering the corresponding transposase (PBase) codon usage to i...

Direct carotid-cavernous fistulas (CCFs) secondary to a ruptured intracavernous carotid aneurysm (ICCA) are usually high-flow lesions. On very rare occasions, a ruptured ICCA may present as a low-flow CCF, which poses a diagnostic and therapeutic dilemma whether the aneurysm and the observed fistula are causally related. Herein, we describe a rare...

Percutaneous vertebroplasty (PVP) is considered technically difficult in patients with severe vertebral body compression, especially in the cervical spine. In this study, PVP was successfully performed with the use of an 18-gauge angiographic needle in four patients with severe cervical compression fractures from metastatic disease. There were no c...

An animal spinal tumor model is needed to better simulate the clinical situation and to allow percutaneous puncture, which may provide an experimental platform for the new nonvascular interventional therapies. We established a rabbit spinal tumor model through a CT-guided percutaneous puncture inoculation technique for nonvascular interventional th...

Perianeurysmal edema and aneurysm wall enhancement are previously described phenomenon after coil embolization attributed to inflammatory reaction. We aimed to demonstrate the prevalence and natural course of these phenomena in unruptured aneurysms after endovascular treatment and to identify factors that contributed to their development. We perfor...

PiggyBac is a prevalent transposon system used to deliver transgenes and functionally explore the mammalian untouched genomic territory. The important features of piggyBac transposon are the relatively low insertion site preference and the ability of seamless removal from genome, which allow its potential uses in functional genomics and regenerativ...

Background: Cerebral cavernous malformations (CCMs) can cause symptomatic intracranial haemorrhage (ICH), but the estimated risks are imprecise and predictors remain uncertain. We aimed to obtain precise estimates and predictors of the risk of ICH during untreated follow-up in an individual patient data meta-analysis. Methods: We invited investi...

Despite improvements of embolization agents and techniques, endovascular treatment of spinal dural arterovenous fistula (SDAVF) is still limited by inconsistent success. The aim of embolization is to occlude initial portion of the draining vein by liquid embolic materials. This study investigates factors that contribute to the success of embolizati...

Background and importance: Mechanisms that lead to de novo formations of nonfamilial-type cavernomas are not well understood. One of the interesting hypotheses is the causative relationship between developmental venous anomaly (DVA) and cavernoma formation. We report a unique case in which serial imaging demonstrated the evolution of de novo forma...

Green fluorescent protein (GFP) and its derivatives are the most widely used molecular reporters for live cell imagining. The development of organelle-specific fusion fluorescent proteins improves the labeling resolution to a higher level. Here we generate a R26 dual fluorescent protein reporter mouse, activated by Cre-mediated DNA recombination, l...

Sequence analysis of an in vivo Cre-mediated GR reporter activation event. The Cre-mediated reporter activation event was examined by a PCR reaction using primer sequences anneal to the loxP flanking region of a R26-GR allele (P1 and P6) (A). Only the successfully recombined R26-GR allele will result in a 914 bp PCR product (B). The P1–P5 amplified...

Ubiquitous expression of the dual fluorescent reporter in six major organs of an adult mouse. Scale bar: B panels, 50 µm. (TIF)

Western blotting results indicate that the 2A peptide effectively dissociates the two moieties of the dual fluorescent reporter protein. To demonstrate that the self-cleavable 2A peptide sequence allows the dissociation of the H2B-EGFP and mCherry-GPI moieties that they can appear in different subcellular localizations, antibodies against EGFP and...

A long PCR approach to check the integrity of the 3′genomic region of the R26R-GR allele. The R26 targeting event was reconfirmed by a long PCR experiment using primer sequences from the report construct (P4) and a 3′external genomic region (P5) (A). Only the successfully targeted R26R-GR allele will result in a 9.4 Kb PCR product (B). Genomic DNA...

Distinct mCherry-GPI distributions in different R26-GR/+ adult tissues. (A) cardiac muscle (B) back skin (C) acinar cells in salivary gland (D) intestinal epithelia (E) skeletal muscle. Scale bars: 50 µm. (TIF)

Ubiquitous dual fluorescent reporter expression in the hind limb of an E10.5 Sox2CreERT2/+; R26R-GR/+ compound heterozygotes embryo. Note that the mCherry signal is increased in the ectoderm-mesenchyme boundary and a ventral mesenchymal mass of the hind limb bud. Scale bar: 75 µm. (TIF)

H2B-EGFP images of R26-GR embryonic stem cells at different cell cycle stages. Live imaging of identical mES cells with nuclei expressing H2B-GFPat different cell cycle stages. The results were obtained by a Leica TSC SP5 Confocal Microscopy System equipped with a 63× oil objective. (A) Interphase (right-bottom), in which nuclear membrane was still...

3D reconstruction of a R26-GR blastocyst. Scale bar: 100 µm. (MP4)

Conditional induction of R26R-GR in adult tissues. (A,B,C,D) Dual fluorescent protein reporter labeled cells are found in the back skin hair follicle of a K15CrePR/+; R26R-GR/+ adult mouse three weeks after an RU486 treatment. (E) Putative Sox2+ neural progenitors emit nuclear GFP signals were detected in the subgranular layer of the dentate gyrus...

Time-lapse imaging of MEFs isolated from an E14.5 R26-GR embryo. (MP4)

The object of this study was to identify the clinical features and outcomes of a subgroup of patients with aneurysmal subarachnoid hemorrhage (SAH) who had active contrast extravasation from a ruptured aneurysm during initial cerebral CT angiography (CTA). The authors performed a retrospective study of spontaneous SAH cases involving patients treat...

Nontraumatic intracranial subdural hemorrhage may result from disorders at remote anatomic sites. Here, we report a young adult who suffered from bilateral subdural hematoma without antecedent head injury. The subdural hematoma did not resolve after surgical drainage. The symptom of postural headache prompted a contrast-enhanced magnetic resonance...

Acute subdural hematoma (SDH) normally appears as a panhemispheric collection of blood with a crescent configuration. However, a number of SDH show lentiform appearances, mimicking acute epidural hematoma (EDH). In this study, we reported our experiences with this special disease entity. Radiological features that aided in the accurate localization...

The development of secondary complications following spontaneous subarachnoid hemorrhage (SAH) largely depends on sympathetic overexcitation. The roles of vagal activities, however, are poorly defined. Because both components of the autonomic nervous system can be explored in the frequency domain of heart rate variability (HRV), the present study a...

The authors present a rare case of an infarction complication 15 days following acute intraventricular bleeding due to moyamoya disease. Before the infarction occurred, perfusion CT imaging disclosed early but reversible ischemic injury on the day of hemorrhage. Dehydration and hypotension are both possibly contributing factors of progressive injur...

The standard surgical treatment of hemorrhagic cerebral contusion is craniotomy with evacuation of the focal lesion. We assessed the safety and feasibility of performing decompressive craniectomy and duraplasty as the primary surgical intervention in this group of patients. Fifty-four consecutive patients with Glasgow Coma Scale (GCS) scores of les...

Cisterna chyli is prone to injury in any retroperitoneal surgery. However, retroperitoneal chylous leakage is a rare complication after anterior spinal surgery. To the best of our knowledge, only ten cases have been reported in the English literature. We present a case of a 49-year-old man who had lumbar metastasis and associated radiculopathy. He...

Development of primary brain PTLD after kidney transplantation is uncommon, and the incidence of T-cell phenotypes is much more rarely reported in the previous literature. However, prognosis of T-cell PTLD is typically grave, so early diagnosis and treatment are crucial to patient survival. A 60-year-old woman, who had received a kidney transplant...