Objective To assess clinical curative effect of three types of combined posterior atlantoaxial internal fixation techniques in treatment of atlantoaxial instability. Methods The study involved 68 patients with atlantoaxial instability treated with different fixation techniques from August 2002 to March 2008. ( 1 ) Transpedicular fixation was performed in 32 patients including 20 patients with Anderson Ⅱ odontoid fractures (seven with old odontoid fracture and 13 with fresh fractures), six with type Anderson Ⅲ fresh odontoid fractures, four with disrupt of transverse ligament of the atlas and two with congenital loose odontoid process combined with atlantoaxial instability. (2) Transpedicular internal fixation with screws of atlas incorporating C2 laminar screws was performed in 20 patients with upper cervical injury including eight with type Ⅱ odontoid process fractures combined with atlantoaxial backward dislocation,four with type Ⅱ odontoid process fractures combined with atlantoaxial forward dislocation, two with nonunion of odontoid process fractures, three with type Ⅲ odontoid process fractures combined with atlantoaxial unsteadiness and three with atlantoaxial dislocation combined with disrupt of transverse ligament of atlas. (3)A total of 16 patients with traumatic atlantoaxial instability, reducible atlantoaxial dislocation and irreducible atlantoaxial dislocation were treated with four-point internal fixation technique using autologous iliac bone grafts. Results (1) A total of 120 screws were implanted in 32 patients, with no spinal cord or vertebral artery injury after surgery. Atlas lateral mass fixation was adopted in three patients because of broken posterior arch of the atlas. Postoperative CT showed that two screws were inserted into the vertebral artery hole and that one screw was inserted medially into the spinal canal and caused medial correx rupture, but both with no clinical symptoms. All 32 patients were followed up for 6-42 months ( average 26 months), which showed solid fusion in all patients. The postoperative JOA scores ranged from 13.2 points to 16.8 points (average 14. 8 points). (2) Thirty-two screws were implanted in 20 patients,with no spinal cord or vertebral artery injury. The patients were followed up for mean six months ( range 6-14 months). Postoperative X-ray showed sound bone fusion, with no cervical instability, loosening or breakage of the screws. (3) The symptoms of all the patients were improved at different degrees, with no neurological deterioration or severe complications, such as nerve blood vessel injury. All 16 patients were followed up for 8-26 months ( average 16 months), which showed bony fusion in all patients at 3-6 months after surgery. The spinal cord function was improved markedly in five patients, good in eight, mild in two but unchanged in one. Conclusions Three types of combined posterior atlantoaxial internal fixation techniques have advantages of rigid, short-segmental and three-dimensional fixation and hence are effective methods for treatment of upper cervical injuries. The combination mode can be varied according to specific condition of the patients.

Objective To evaluate the clinical effect and safety of the occiput-cervicle or C1-C2 internal fixation and bone graft fusion in treatment of the unstable atlas fracture.Methods A retrospective study was performed in 38 patients with unstable atlas fractures treated by the occiput-cervicle or C1-C2 internal fixation and bone graft fusion from October 2004 to March 2009.Six patients with comminuted atlas fracture combined with instability of the occipito-atlantoid articulations were treated with occiput-C2 fusion(five patients)and with occiput-C3 fusion(one patient).There were seven patients with typical Jefferson fractures,three with semiring fractures,eight with atlas fractures combined with Anderson type Ⅱ odontoid process fractures,three with atlas fractures combined with Hangman's fractures (two patients with Levine and Edwards type Ⅲ Hangman's fractures were treated with occiput-C3 fusion and one patient Levine and Edwards type Ⅱ Hangman's fracture was treated with C1-C2 fusion),three with atlas fracture combined with lower cervicle injury,six with rupture of transverse ligament combined with instability of atlanto-axial joint(Dickman transverse ligament type Ⅰ injury)and two with comminuted fracture of the lateral mass associated with bony avulsion of the medial tubercle and transverse ligament(Dickman transverse ligament type Ⅱ injury).Of all,five patients were treated with occiput-C2 fusion,three treated with occiput-C3 fusion and 30 treated with C1-C2 fusion.Results All the patients were followed up for a range of 12-46 months(average 28 months),which showed improvement of clinical symptoms in some extent postoperatively.The operation time ranged from 80 to 190 min ates(average 135 minates),with intraoperative blood loss for 200-3 300 ml(average 460 ml)and average fluoroscopic time for 60 seconds.There were no neurological deficits,vertebral artery related complications or other complications in all the patients during the surgical operation.No neurological deficit was aggravated after the patient's mobilization with brace three days after operation.The enous plexus of blood vessel at C1-C2 rupture induced by the use of electrocautery was found in three patients who showed no cerebral hemodynamic deficit after hemostasis with hemostatic sponge and cotton piece.The follow-up X-ray and CT manifested osseous fusion in all the patients,with no looseness or breakage of the screws.The late follow-up showed pain associated with movement and limited range of motion in four patients(11%)and occipital neuralgia in one.Conclusions An occiput-cervicle fixation fusion or a C1-C2 fixation fusion combined with short external fixation can reestablish the upper cervical stability and prevent further injury of the spinal cord and nerve function and hence is an ideal option for C1 burst fracture with or without rupture of the transverse ligament.

Objective To investigate the operation key points and therapeutic effect using the pressure cooker technique (PCT)for embolization of the dural arteriovenous fistula (DAVF)at the petrous apex region. Methods The clinical data of 4 patients with DAVF at the petrous apex region admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University from October 2015 to February 2016 were analyzed retrospectively. The PCT technique was used to conduct embolization therapy. Results DSA confirmed that 4 patients had DAVF at the petrous apex region with the multi-branch artery blood supply and they were drained via the superior petrosal veins. The patients were embolized by using PCT. DSA confirmed that they were embolized completely after procedure. They were followed up at 3months after surgery and their symptoms were improved. Conclusion For DAVF at the petrous apex region with the multi-branch artery blood supply,the preliminary experience shows that PCT technique may improve the efficiency of embolization,thereby obtaining anatomical cure.

Objective:To explore the expression of aquaporin1 (AQP1) in human glioma tissues and its relationship with the clini-copathological parameters and prognosis of this tumor. This study also observed the function of AQP1 in the proliferation and invasion of LN229 glioblastoma cells. Methods:The expression of AQP1 in 135 cases of glioma was detected by immunohistochemical meth-od, and the correlation between AQP1 and pathological features of glioma was analyzed. The relationship of AQP1 with survival was al-so investigated using 103 specimens with complete clinical data. AQP1 was successfully transfected into LN229 cells with lentiviral vector, and the expression of AQP1 protein was tested by Western blot. Cell proliferation was detected by using methyl thiazolyl tetrazo-lium assay, whereas cell invasion was determined by Transwell assay. Results:The expression of AQP1 was positively correlated with pathological grading. High AQP1 expression was associated with poor prognosis (P<0.05). Moreover, the overexpression of AQP1 can significantly increase the proliferation and invasion of LN229 cells (P<0.05). Conclusion:AQP1 is closely associated with the progres-sion of glioma. Upregulation of the AQP1 expression promoted the proliferation and metastasis of glioma cells. These findings indicat-ed that AQP1 can function as a therapeutic target for glioma in future research.

Aquaporin 1 (AQP1) is a specific protein that transports water molecules through the cell membrane. AQP1 mainly ex-presses in the choroid plexus epithelial cells of the central nervous system and participates in the formation of cerebrospinal fluid. In gli-omas, AQP1 expresses in neoplastic astrocytes and vascular endothelial cells. AQP1 expression is increased in parallel with histological grade in gliomas. AQP1 expression in gliosarcoma cell line is induced by dexamethasone, platelet-derived growth factor, sodium chlo-ride, hypoxia, D-glucose, and fructose. AQP1 mRNA expression is upregulated with increasing dosage. Through the expression of AQP1 in gliomas and the existing research on its function, we suggest that AQP1 may participate in tumor angiogenesis and tumor-relat-ed edema. AQP1 is closely associated with glioma cell migration. The function of AQP1 and its mechanism has been elucidated. Thus, this protein can be used as a new therapeutic target to inhibit the metastasis and recurrence of gliomas.

Objective:To investigate the functions of the ITSN1-S SH3 domains in U87 glioblastoma cell proliferation and to de-termine the underlying molecular mechanism. Methods: A recombinant lentiviral vector with an mGFP label was constructed. EH1-EH2, EH1-EH2-CC, and ITSN1-S genes were amplified using polymerase chain reaction and then cloned into recombinant lenti-viral vectors. The four lentiviral plasmids were packaged using HEK 293T cells and subsequently used to infect U87 cells. Stable cells were screened using puromycin and separately labeled as vector/U87, EH1-EH2/U87, EH1-EH2-CC/U87, and ITSN1-S/U87. Western blotting was used to detect the expression of each protein. Proliferation and soft agar assays were performed to detect cell proliferation. Results:In the proliferation and soft agar assays, the proliferation capacity of the ITSN1-S/U87 cells was clearly enhanced compared with those of the vector/U87, EH1-EH2/U87, and EH1-EH2-CC/U87 cells (P<0.05). Moreover, the proliferation capacity of the latter three groups showed no observable difference (P>0.05). On the 6th day, the vector/U87, EH1-EH2/U87, EH1-EH2-CC/U87, and ITSN1-S/U87 cell numbers were (29.16 ± 1.19) × 104, (22.82 ± 0.94) × 104, (22.17 ± 0.90) × 104, and (21.93 ± 1.15) × 104, respectively. On the 21st day, the number of colony formation in vector/U87, EH1-EH2/U87, EH1-EH2-CC/U87, and ITSN1-S/U87 was (6.37±0.41)×103, (2.65±0.34)×103, (2.23±0.31)×103, and (2.1±0.29)×103, respectively . Conclusion:ITSN1-S overexpression significantly promotes U87 cell proliferation. Specifically, the SH3 domains possibly serve vital functions in glioma cell proliferation.

BACKGROUND: Researches are recently focus on topography and image dissection of nasolacrimal duct, but it is lack of systemically contrast researches between sectional anatomy and image anatomy on bone nasolacrimal duct by using dry cranium samples.OBJ ECTIVE: To investigate the characteristics of sectional anatomy and image anatomy on bone nasolacrimal duct and provide evidences for related operations of nasolacrimal duct.DESrGN: Self controlled study.SETTING: Office of Teaching Supplies, Chengdu Medical College.MATERIALS: The experiment was carried out in the Topography Laboratory, Department of Human Anatomy, Chengdu Medical College from September 2005 to September 2006. Non-injured dry cranium was randomly selected from 34 adults (68 sides), including 34 sides on males and 34 sides on females.METHODS: ① Based on OM line, a routine scanning base line, which was regarded as the axial scanning baseline,samples were scanned at flat level with SHIMADZU CT device. Bone nasolacrimal duct was factitiously divided into three parts, including 1/3 superior segment, 1/3 middle segment and 1/3 inferior segment. The means at each related layer were determined as the final results. ② Cranium samples were signed based on image scanning baseline, and then they were cut into sections at cross section fault along scanning baseline at flat level with section razor. In addition, related indexes of bone nasolacrimal duct were measured and compared with image results.MAIN OUTCOME MEASURES: ① Anterior, posterior, left and right diameters of superior aperture, 1/3 superior segment,1/3 middle segment, 1/3 inferior segment and inferior aperture of bone nasolacrimal duct; ② depth of internal bone wall and posterior bone wall in superior aperture, 1/3 superior segment, 1/3 middle segment, 1/3 inferior segment and inferior aperture if bone nasolacrimal duct; ③ position and form of inferior aperture of bone nasolacrimal duct; ④ comparisons of bone nasolacrimal duct between image anatomy and sectional anatomy.RESULTS: ① Anterior, posterior, left and right diameters of cross section of bone nasolacrimal duct: Superior aperture of bone nasolacrimal duct was narrow, but inferior aperture was changed obviously. Diameter was increased from top to bottom. In addition, anterior and posterior diameters were more than left and right ones. There was significant difference in internal diameter of superior aperture and 1/3 inferior segment of bone nasolacrimal duct between male and females (t =2.458, 2.227, P ＜ 0.05). However, there was no significant difference in internal diameter of 1/3 superior segment, 1/3 middle segment and inferior aperture of bone nasolacrimal duct between male and female (P ＞ 0.05). ② Depth of internal bone wall and posterior bone wall of bone nasolacrimal duct at cross section: Depths of internal bone wall and posterior bone wall of bone nasolacrimal duct were (0.87±0.23) mm and (0.21±0.19) mm, respectively. In addition, there was significant difference between them (t =2.547, P ＜ 0.05). However, there was no significant difference in depth of internal bone wall and related posterior bone wall of superior aperture, 1/3 superior segment, 1/3 middle segment, 1/3 inferior segment and inferior aperture of bone nasolacrimal duct between male and female (P ＞ 0.05). ③ Position and form of inferior aperture of bone nasolacrimal duct changed remarkably. Results of image anatomy of bone nasolacrimal duct were as the same as those of sectional anatomy.CONCLUSION: Perfection of normal sectional anatomy and image anatomy of bone nasolacrimal duct is beneficial for successfully performing related operations of nasolacrimal duct and reducing complications.

ObjectiveTo evaluate the clinical effects of transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion(PLIF) using microendoscopic discectomy under X-Tube system in treatment of lumbar degenerative disc diseases.MethodsFrom December 2007 to April 2008,32 patients with low back disorders were treated by microendoscopic discectomy TLIF or PLIF under X-Tube system,including 19 cases in TLIF and 13 in PLIF.Etiologies including lumbar disc herniation combined with segmental instability in 21 cases,and spondylolisthesis in 11 cases.All patients were under regular postoperative follow-up and radiological examination.The clinical functional outcomes were evaluated according to Oswestry disability questionnaire.ResultsThe mean operation time was 120 min(range,90-180),and the average blood loss was 190 ml (range,100-400).There were no complications,such as infection and internal fixation failure.Bony fusion was achieved in all patients.The follow-up was from 14 months to 41 months with 21 months in the average.The average 0swestry scores decreased from preoperative 40.1％±4.1％ to 9.5％±3.7％ three months after the operation.The outcomes of this operation were rated as excellent.ConclusionMicroendoscopic discectomy TLIF or PLIF under X-Tube system in treatment of lumbar degenerative disc diseases has the characteristics of less blood loss,tissue trauma and quick recovery.

Objective To investigate the clinical manifestations and imaging features of dural arterio-venous fistula of super petrosal venous drainage and treatment. Methods From May 2013 to September 2014,9 patients with petrosal vein drained dural arteriovenous fistula at the Department of Neurosurgery, Xuanwu Hospital,Capital Medical University and the Department of Neurosurgery,Beijing Haidian Hospital were enrolled retrospectively. The patients were treated with endovascular embolization or microsurgery,and the MRI and DSA examinations were improved,and the scores of the modified Aminoff&Logue scale (ALS) were performed before and after treatment. Results In the 9 patients,there were 3 females and 6 males. They all had different degrees of limb sensory and motor abnormalities,7 of them also had urination and/or bowel disorders,4 had cranial nerve dysfunction,including hoarseness,bucking,hiccup,and paralysis. Six patients received embolization treatment,3 received microsurgery,and they all achieved anatomic cure. The preoperative ALS score was 6. 0 ± 2. 7,and the score at 3 months after procedure was 2. 8 ± 1. 7. There was significant difference between before and after treatment (t=4. 816,P<0. 05). Conclusions The petrosal vein drained dural arteriovenous fistula is a kind of rare cerebrovascular malformation. The lesion involves a wide range. The clinical manifestations are severe. Both endovascular embolization and microsurgery can achieve a more ideal therapeutic effect. If the vascular condition is permitted,the interventional embolization treatment should be preferred.

Objective To investigate feasibility and safety of anterior pedicle screw fixation tunnel in the axis so as to provide theoretic evidence for further clinical application.Methods Thirty-two dry axis specimens were used for anterior pedicle screw placement,and the length of pedicle crews tunnel was measured by a digital caliper.The extraversion angle and the downslope angle were determined by CT cross-sectional scanning and reconstruction.Results All the anterior pedicle screws were positioned well,with no perforation of the pedicle.The anchoring point was at the vertex between the vertebral body and the superior articular process,with axis pedicle length of(28.4 ± 2.5)mm,the extraversion angle of (28.5 ±2.3)°and the downslope angle of(15.5 ±2.0)°.Conclusions Anterior pedicle screw fixation tunnel is feasible in the axis and can keep away from some important anatomy structures including transverse foramen,vertebral artery groove and vertebral canal to provide large safety space.