Junction Pathology Research Articles

Mini-Open Lateral Corpectomy for Thoracolumbar Junction Lesions.

Neoplastic, traumatic, infectious, and degenerative pathologies affecting the thoracolumbar junction pose a unique challenge to spine surgeons. Posterior or anterior approaches have traditionally been utilized to treat these lesions. Although minimally invasive surgeries through a lateral approach to the thoracic or lumbar spine have gained popularity, lateral access to the thoracolumbar junction remains technically challenging due to the overlying diaphragm positioned at the interface of the peritoneum and pleura. To describe a mini-open lateral retropleural retroperitoneal approach for pathologies with spinal cord/cauda equina compression at the thoracolumbar junction. A mini-open lateral corpectomy is described in detail in a patient with an L1 metastatic tumor. Satisfactory decompression and spinal column reconstruction were achieved. The patient obtained neural function recovery following the procedure with no intra- or postoperative complications. The morbidities associated with traditional posterior or anterior approaches to thoracolumbar junction pathologies have led to a growing interest in minimally invasive alternatives. The mini-open lateral approach allows for a safe and efficacious corpectomy and reconstruction for thoracolumbar junction pathologies. Thorough understanding of the anatomy, particularly of the diaphragm, is critical. This approach will have expanded roles in the management of patients with thoracolumbar neoplasms, fractures, infections, deformities, or degenerative diseases.

Anatomical evaluation of the craniovertebral junction on cone-beam computed tomography images.

There are many craniometric measurements that are used in evaluating craniovertebral junction (CVJ) pathologies such as basilar invagination, atlantoaxial dislocation and platybasia. Therefore, it is important to determine the normal reference range of the craniometric measurements. This study aims to determine the morphometric reference values of the bony structures in the CVJ from cone-beam computed tomography (CBCT) images of a group of South Eastern Anatolian population. The CBCT images of 300 individuals were retrospectively evaluated. 14 parameters on midsagittal and 2 parameters on the coronal plane were studied. The data were statistically evaluated. Measurement results were found as follows; the distances between odontoid process (OP) and McGregor line as 0.31 ± 3.22mm, OP and Chamberlain line 1.06 ± 3.22mm, OP and McRae line 5.30 ± 1.59mm, OP and Fischgold digastric line 8.70 ± 4.12mm, OP and Fischgold bimastoid line - 5.15 ± 4.86mm, length of McRae line 35.58 ± 2.52mm, atlantodental interval 1.28 ± 0.48mm, posterior atlantodental interval 19.54 ± 2.24mm, basion axial interval 4.01 ± 1.83mm, basion dental interval 4.92 ± 1.77mm, length of Modified Ranawat line 28.66 ± 2.38mm, length of Redlund-Johnell line 35.11 ± 4.09mm, clivus canal angle 157.62° ± 11.85°, Welcher basal angle 130.83° ± 6.29°, craniocervical tilt 126.98° ± 12.24° and Powers ratio as 0.72 ± 0.06. In this study, the morphometric values were evaluated according to age and gender in individuals who did not have any radiologic anomalies. The normal reference ranges may be useful for researchers who are researching pathology in this region. It is recommended to conduct further studies with different populations to determine the normal reference range.

Computed tomography-based morphometric measurements of the atlas (C1) posterior arc

Study design: Single-center retrospective study
 Objectives: This study is performed to determine the anatomic feasibility of the C1 posterior arc screw and help select an optimal screw trajectory in treating patients with craniovertebral junction pathologies.
 Material and Methods: We reported a single-centre retrospective study. Forty patients (20 male and 20 female) who underwent cervical computed tomography (CT) were chosen from the hospital records. Based on CT images, we measured left laminar length (LLL), right laminar length (RLL), left laminar angle (LLA), right laminar angle (RLA), left laminar axial thickness (LLAT), right laminar axial thickness (RLAT), left laminar coronal thickness (LLCT), right laminar coronal thickness (RLCT), and craniocaudal angle (CCA) of the C1 posterior arc.
 Results: The mean values and standard deviations (SD) for nine parameters at the C1 posterior arc were determined. LLL, RLL, LLCT, and RLCT were statistically longer in men than women. RLAT was bigger in men but there was no statistical difference. RLA was statistically wider in women than men. LLA and CCA were wider in women but there was no statistical difference, LLAT was bigger in women but there was no statistical difference. There was no statistical difference in measurements by age.
 Conclusion: The results of this study are important to avoid neurovascular injury and pedicle breakage because of choosing large screw while performing C1 laminar screw fixation.

Recent advances in understanding connexin gap junction pathology in demyelinating diseases

AbstractMultiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD) and Baló’s disease (BD) are inflammatory demyelinating diseases of the central nervous system. We previously reported that aquaporin‐4 antibody‐independent astrocytopathy can occur in heterogeneous demyelinating conditions. We focused on connexins (Cxs), which form gap junctions between astrocytes and oligodendrocytes to form the glial syncytium of the central nervous system. We investigated the pathological expression pattern of Cx43/Cx30 in astrocytes, and Cx47/Cx32 in oligodendrocytes in autopsied samples from MS, NMOSD and BD. Astrocytic Cx43 and oligodendrocytic Cx32/Cx47 were extensively diminished in both demyelinated and myelinated layers in all BD cases. Half of the NMOSD and MS cases showed preferential loss of astrocytic Cx43 in active demyelinating and chronic active lesions, where heterotypic Cx43/Cx47 astrocyte‐oligodendrocyte gap junctions were widely lost. Loss of Cx43 was frequently accompanied by distal oligodendrogliopathy, which is characterized by a preferential loss of myelin‐associated glycoprotein and apoptotic‐like oligodendrocytes. Isolated perivascular lesions in the spinal cord of NMOSD cases showed loss of aquaporin‐4 and Cx43, indicating early involvement of Cx43 in NMOSD. Neuronal and glial Cxs were affected in gray matter demyelination in MS and neurodegenerative diseases. Our findings show that Cx43 astrocytopathy and Cx47/Cx32 oligodendrogliopathy can be seen in MS, BD and NMOSD. Furthermore, the loss of astrocytic Cx43 might be associated with disease aggressiveness and distal oligodendrogliopathy in demyelinating conditions. Early disruption of glial gap junctions might disturb the glial syncytium and disrupt intercell communication, thereby inducing oligodendroglial injury and subsequent demyelination.

Neural stem cell therapy of foetal onset hydrocephalus using the HTx rat as experimental model.

Foetal onset hydrocephalus is a disease starting early in embryonic life; in many cases it results from a cell junction pathology of neural stem (NSC) and neural progenitor (NPC) cells forming the ventricular zone (VZ) and sub-ventricular zone (SVZ) of the developing brain. This pathology results in disassembling of VZ and loss of NSC/NPC, a phenomenon known as VZ disruption. At the cerebral aqueduct, VZ disruption triggers hydrocephalus while in the telencephalon, it results in abnormal neurogenesis. This may explain why derivative surgery does not cure hydrocephalus. NSC grafting appears as a therapeutic opportunity. The present investigation was designed to find out whether this is a likely possibility. HTx rats develop hereditary hydrocephalus; 30-40% of newborns are hydrocephalic (hyHTx) while their littermates are not (nHTx). NSC/NPC from the VZ/SVZ of nHTx rats were cultured into neurospheres that were then grafted into a lateral ventricle of 1-, 2- or 7-day-old hyHTx. Once in the cerebrospinal fluid, neurospheres disassembled and the freed NSC homed at the areas of VZ disruption. A population of homed cells generated new multiciliated ependyma at the sites where the ependyma was missing due to the inherited pathology. Another population of NSC homed at the disrupted VZ differentiated into βIII-tubulin+ spherical cells likely corresponding to neuroblasts that progressed into the parenchyma. The final fate of these cells could not be established due to the protocol used to label the grafted cells. The functional outcomes of NSC grafting in hydrocephalus remain open. The present study establishes an experimental paradigm of NSC/NPC therapy of foetal onset hydrocephalus, at the etiologic level that needs to be further explored with more analytical methodologies.

Clinical Outcomes of Endoscopic Endonasal Odontoidectomy: A Single-Center Experience

Odontoidectomy for basilar invagination and craniovertebral junction pathology traditionally has been performed using a transoral route. However, the endoscopic endonasal approach to the anterior craniovertebral junction may offer safer and more effective access when compared with transoral approaches. The objective of this study is to review the surgical outcomes and complications associated with endoscopic endonasal odontoidectomy. This study is a retrospective chart review of all adult patients who underwent an endoscopic endonasal odontoidectomy at a single tertiary care center between January 2011 and May2019. Seventeen patients who underwent endoscopic endonasal odontoidectomy were included. The median age at admission was 67 years (range: 33-84 years) and 65% of the patients were female. One patient (1/17, 6%) had vertebral artery injury, which had to be coiled with no neurologic deficits, and 4 patients (4/17, 24%) had intraoperative CSF leaks with no postoperative leak. Fourteen (14/17, 82%) patients were extubated by postoperative day 1. Three patients (3/17, 18%) developed postoperative sinus infections and required antibiotics. Eight patients (8/17, 47%) developed transient postoperative dysphagia. One patient (1/17, 6%) had postoperative epistaxis and 1 patient (1/17, 6%) had postoperative lower cranial nerve symptoms. The median length of hospital stay was 13 days (range: 2-44 days). Although the transoral approach has been the traditional route for anterior decompression of the craniovertebral junction, endoscopic endonasal odontoidectomy is a feasible and well-tolerated procedure associated with satisfactory patient outcomes and low morbidity.

Ocular myasthenia gravis: A case series

Aim: To report the clinical profile of patients with myasthenia gravis (MG) at a tertiary eye care center in Tamil Nadu. Material and Methods: This is a retrospective case series of patients in a single center between February 2019 and March 2020. Result: We present a series of five cases of ocular myasthenia in the pediatric age group (0–16 years), comprising three males and two females. The patients had varied presentations on the initial examination. Conclusion: It is important to differentiate MG from other diagnostic mimics such as neurological causes such as cranial nerve palsy, myopathies, ocular pathologies, and neuromuscular junction pathologies such as botulism and brainstem tumors. Diagnosis and treatment of myasthenia is done as a team effort of ophthalmologist and neurologist. This study is to reinforce a vigilant lookout for this great masquerader.

Functional characterization of SMN evolution in mouse models of SMA

Spinal Muscular Atrophy (SMA) is a monogenic neurodegenerative disorder and the leading genetic cause of infantile mortality. While several functions have been ascribed to the SMN (survival motor neuron) protein, their specific contribution to the disease has yet to be fully elucidated. We hypothesized that some, but not all, SMN homologues would rescue the SMA phenotype in mouse models, thereby identifying disease-relevant domains. Using AAV9 to deliver Smn homologs to SMA mice, we identified a conservation threshold that marks the boundary at which homologs can rescue the SMA phenotype. Smn from Danio rerio and Xenopus laevis significantly prevent disease, whereas Smn from Drosophila melanogaster, Caenorhabditis elegans, and Schizosaccharomyces pombe was significantly less efficacious. This phenotypic rescue correlated with correction of RNA processing defects induced by SMN deficiency and neuromuscular junction pathology. Based upon the sequence conservation in the rescuing homologs, a minimal SMN construct was designed consisting of exons 2, 3, and 6, which showed a partial rescue of the SMA phenotype. While a significant extension in survival was observed, the absence of a complete rescue suggests that while the core conserved region is essential, additional sequences contribute to the overall ability of the SMN protein to rescue disease pathology.

AAV9-mediated delivery of miR-23a reduces disease severity in Smn2B/-SMA model mice.

Spinal muscular atrophy (SMA) is a neuromuscular disease caused by deletions or mutations in survival motor neuron 1 (SMN1). The molecular mechanisms underlying motor neuron degeneration in SMA remain elusive, as global cellular dysfunction obscures the identification and characterization of disease-relevant pathways and potential therapeutic targets. Recent reports have implicated microRNA (miRNA) dysregulation as a potential contributor to the pathological mechanism in SMA. To characterize miRNAs that are differentially regulated in SMA, we profiled miRNA levels in SMA induced pluripotent stem cell (iPSC)-derived motor neurons. From this array, miR-23a downregulation was identified selectively in SMA motor neurons, consistent with previous reports where miR-23a functioned in neuroprotective and muscle atrophy-antagonizing roles. Reintroduction of miR-23a expression in SMA patient iPSC-derived motor neurons protected against degeneration, suggesting a potential miR-23a-specific disease-modifying effect. To assess this activity in vivo, miR-23a was expressed using a self-complementary adeno-associated virus serotype 9 (scAAV9) viral vector in the Smn2B/- SMA mouse model. scAAV9-miR-23a significantly reduced the pathology in SMA mice, including increased motor neuron size, reduced neuromuscular junction pathology, increased muscle fiber area, and extended survival. These experiments demonstrate that miR-23a is a novel protective modifier of SMA, warranting further characterization of miRNA dysfunction in SMA.

Retrospective audit of airway management practices in children with craniocervical pathology.

Craniocervical immobilization using halo body orthoses may be required in the management of children with craniocervical junction pathology. To date, the effect of such immobilization on perioperative anesthetic management has not been addressed in large series. The aim of this study was to review the airway management of children requiring halo body orthoses undergoing general anesthesia. The study was a retrospective case note review from a single institution. The neurosurgical database was interrogated to identify all patients less than 16years of age that required a halo body orthosis from 1996 to 2015. We used the electronic patient record to identify all procedures performed under general anesthesia for these patients, either for halo application, or with the halo in situ. Details of techniques used for airway management were recorded, and paired data between individuals pre- and post-halo application were compared. Demographic data, diagnosis, and perioperative complications were also recorded. We identified 90 children that underwent placement of a halo body orthosis. A total of 269 anesthetic records from these patients were analyzed and classified as pre-halo application, or halo in situ. Facemask ventilation was achieved in all patients, though some required simple airway adjuncts and may have been more difficult in the presence of the halo. Supraglottic airways were used successfully in many patients. There was a significant increase in the number of patients classed as Cormack and Lehane grades 3 or 4 on direct laryngoscopy with the halo in situ compared with before the halo was applied. The incidence of intubation using fiberoptic or videolaryngoscopy was higher with the halo in situ. Multiple intubation attempts were required in 3.4% (1/29) of patients undergoing anesthesia for halo placement compared with 15.1% (11/73) undergoing anesthesia with a halo in situ. Airway management in children with cervical spine pathology should be anticipated to be more difficult than the general pediatric population. This is likely to be due to co-existing pathology associated with cervical spine disease in children, limitation of neck movement to prevent further neurological injury, and the halo itself limiting access to the head. We recommend advanced preparation, and ensuring the immediate availability of an anesthetist with skills in managing the pediatric difficult airway to avoid complications in this patient population.

Selective loss of cortical endothelial tight junction proteins during Alzheimer's disease progression.

While the accumulation and aggregation of amyloid-β and tau are central events in the pathogenesis of Alzheimer's disease, there is increasing evidence that cerebrovascular pathology is also abundant in Alzheimer's disease brains. In brain capillaries, endothelial cells are connected closely with one another through transmembrane tight junction proteins forming the blood-brain barrier. Because the blood-brain barrier tightly regulates the exchange of molecules between brain and blood and maintains brain homeostasis, its impairment is increasingly recognized as a critical factor contributing to Alzheimer's disease pathogenesis. However, the pathological relationship between blood-brain barrier properties and Alzheimer's disease progression in the human brain is not fully understood. In this study, we show that the loss of cortical tight junction proteins is a common event in Alzheimer's disease, and is correlated with synaptic degeneration. By quantifying the amounts of major tight junction proteins, claudin-5 and occludin, in 12 brain regions dissected from post-mortem brains of normal ageing (n = 10), pathological ageing (n = 14) and Alzheimer's disease patients (n = 19), we found that they were selectively decreased in cortical areas in Alzheimer's disease. Cortical tight junction proteins were decreased in association with the Braak neurofibrillary tangle stage. There was also a negative correlation between the amount of tight junction proteins and the amounts of insoluble Alzheimer's disease-related proteins, in particular amyloid-β40, in cortical areas. In addition, the amount of tight junction proteins in these areas correlated positively with those of synaptic markers. Thus, loss of cortical tight junction proteins in Alzheimer's disease is associated with insoluble amyloid-β40 and loss of synaptic markers. Importantly, the positive correlation between claudin-5 and synaptic markers, in particular synaptophysin, was present independent of insoluble amyloid-β40, amyloid-β42 and tau values, suggesting that loss of cortical tight junction proteins and synaptic degeneration is present, at least in part, independent of insoluble Alzheimer's disease-related proteins. Collectively, these results indicate that loss of tight junction proteins occurs predominantly in the neocortex during Alzheimer's disease progression. Further, our findings provide a neuropathological clue as to how endothelial tight junction pathology may contribute to Alzheimer's disease pathogenesis in both synergistic and additive manners to typical amyloid-β and tau pathologies.

The Endoscopic Endonasal Approach for Treatment of Craniovertebral Junction Pathologies: A Minimally Invasive but not Minimal-Risk Approach.

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Drop attacks of the elderly

Falls are frequent in the elderly, often leading to significant injury, transfer to residential care or death. Well-recognised risk factors include medications (particularly polypharmacy and the use of psychotropic agents),...

The use of intraoperative traction for achieving reduction of irreducible atlantoaxial dislocation caused by different craniovertebral junction pathologies

ObjectiveTo investigate the usefulness of intraoperative traction in the selection of the surgical procedure for irreducible atlantoaxial dislocation (IAAD) caused by different craniovertebral junction (CVJ) pathologies.Patients and methods: Forty-three patients who were diagnosed with IAAD and who underwent surgery between January 2008 and May 2017 in our hospital were included in the study. All of the patients received skull traction under general anesthesia. Based on the traction results, the patients underwent one of the following surgeries: posterior fixation and fusion only, posterior atlantoaxial lateral mass joint release followed by fixation and fusion, or anterior release followed by posterior fixation and fusion. The classification system was defined accordingly. The treatment efficacy was evaluated based on the improvement of clinical symptoms and radiological findings. ResultsFour patients were categorized as Type A, twenty patients as Type B1, twelve patients as Type B2, and seven patients as Type C. Thirty-seven patients (86.0%) achieved complete reduction and six patients (14.0%) achieved greater than 50% reduction. Bony fusion was achieved in all patients at 6 months after the operation. The average Japanese Orthopaedic Association (JOA) score improved from 10.2 ± 2.1 before surgery to 15.0 ± 1.2 at the final follow-up. According to the Symon clinical standard, the total effectiveness rate was 97.7%, and 72.1% of the patients showed excellent clinical outcomes. ConclusionIntraoperative traction is an effective and safe method to assist the selection of surgical methods for patients with IAAD caused by different CVJ etiologies.

Hybrid transgastric approach for the treatment of gastroesophageal junction pathologies.

Flexible endoscopy has evolved to the point that it includes many endoluminal procedures that once required open or laparoscopic surgery, for instance, antireflux surgery, pyloromyotomy, mucosal and submucosal tumor resections, and even full-thickness resection. However, these procedures remain technically demanding due to flexible technology issues: difficult imaging, limited energy devices, lack of staplers, unsatisfactory suturing abilities, and so on. Transgastric laparoscopy or hybrid laparoscopy/flex endoscopy has been described for almost two decades as an alternative to a pure endoluminal approach, mainly for pancreatic pseudocyst drainage and full-thickness and mucosal resection of various lesions. The approach has never been widely adopted mostly due to cumbersome and difficult to maintain methods of gastric access. We propose to expand the indications of transgastric laparoscopy by using novel endoscopically placed ports to replicate endoscopic procedures particularly in the difficult to access proximal stomach such as endoluminal antireflux surgery. Under general anesthesia, five female pigs (mean weight: 27.6 kg) had endoscopic placement of 3, 5 mm intragastric ports (Endo-TAGSS, Leakwood KS, USA) using a technique similar to percutaneous endoscopic gastrostomy. A 5-mm laparoscope was used for visualization. Laparoendoscopic-assisted plication of the gastroesophageal junction (GEJ) was performed using 3-0 interrupted sutures (Polysorb®, Covidien, Mansfield, MA, USA). A functional lumen imagine probe (EndoFLIP®, Crospon, Inc., Galway, Ireland) was used to measure diameter, cross sectional area (CSA), distensibility, and compliance of GEJ before and after intervention. Once the TAGSS ports were removed, the gastrotomies were closed by using endoscopic over-the-scope clips. At the end of the procedure, animals were euthanized. Five laparoendoscopic-assisted endoluminal plications were performed. The mean operative time was 65.6 min (Endoscopic evaluation: 3.2 min, TAGSS Insertion: 11 min, EndoFLIP evaluation+GEJ Plication: 43.25 min, gastric wall closure: 15 minutes). In all cases, this technique was effective and allowed to achieve an adequate GEJ plication by endoscopic grading and EndoFLIP measurements. Median pre-plication GEJ diameter (D) and median pre-plication GEJ cross-sectional area (CSA) were 11.42 mm (8.6-13.6 mm) and 104.8 mm2 (58-146 mm2). After the procedure, these values were decreased to 6.14 mm (5.7-6.6 mm) and 29.8 mm2 (25-34 mm2) respectively (p=0.0079). Median pre-plication distensibility (d) and compliance (C) were 7.87 mm2/mmHg (2.4-22.69 mm2/mmHg) and 190.56 mm3/mmHg (70.9-502.8 mm3/mmHg). After the procedure, these values decreased to 1.5 mm2/mmHg (0.7-2.2 mm2/mmHg) and 52.17 mm3/mmHg (21.9-98.7 mm3/mmHg) respectively (p=0.0317). No intraoperative events were observed. Endoscopically, all valves were felt to be transitioned from a Hill grade 3 (normal state for the animal model) to a Hill grade 1 at the procedure completion. A hybrid laparoendoscopic approach is a feasible alternative for performing intragastric procedures with the assistance of conventional laparoscopic instruments; especially in cases where the intervention location limits the access to standard endoscopy or where endoscopic technology is inadequate. Further evaluation is planned in survival models and clinical trials.

Friday, September 28, 2018 10:30 AM–12:00 PM abstracts: innovation, surface technology and biomechanics: 179. Alignment targets, curve proportion and mechanical loading: preliminary analysis of an ideal shape toward reducing proximal junctional kyphosis

BACKGROUND CONTEXT PJK is a common problem following ASD surgery. When significant junctional pathology develops, patients commonly recruit compensatory mechanisms, and this can lead not only to suboptimal clinical outcome but also a distortion of how postoperative alignment is assessed. Recent articles have demonstrated the validity of a numerical model to remove PJK influence from postoperative alignment by combining postoperative alignment of fused segments with alignment of preoperative unfused segments PURPOSE Investigate the offset from alignment targets (radiographic and mechanical loading) in PJK patients using a validated model to remove PJK compensation. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE A total of 373 pts from 501 (74.5%) eligible with minimum 2 years follow-up. OUTCOME MEASURES Real and virtual postoperative alignment. METHODS Pts with a complete fusion of the lumbar spine and 2 years follow-up were included on this analysis. Patients were categorized into non-PJK, PJK or PJF group based on the Glattes criteria; PJF patients were those undergoing revision surgery. Alignment targets were derived from recent publications on age-alignment objectives (Spine, 2016), theoretical values of thoracic kyphosis based on lordosis, and normative mechanical loading at each vertebra (SRS, 2016). Using the virtual alignment, offsets from alignment targets were compared across PJK groups and a sub-stratification by UIV position was conducted (upper thoracic – UT versus Lower thoracic – LT). Multilinear logistic regression was conducted to identify independent predictor of PJK and/or PJF. RESULTS From 373 pts included (62.7 yo±9.9; 81%F), 172 (46.1%) were identified as PJK, and 21 (5.6%) as PJF 2 years after surgery. Significant difference were found in terms of PI-LL (5.7°, 1.6°, and −4.9) and TK (−47.8, −56.3, −65.0) and Bending moment at the UIV (all p CONCLUSIONS By removing the effect of PJK on compensatory mechanisms and global alignment, the analysis highlighted a significantly more posterior correction in PJK patients Analysis of offset from targets (age adjusted value, proportionality between curves, and mechanical loading) demonstrated an over correction versus age alignment, under correction of TK (smaller), and under loading of the UIV to reduce reciprocal change.

Significance of Multimodal Intraoperative Monitoring During Surgery in Patients with Craniovertebral Junction Pathology

Although many studies have investigated the benefits of multimodal intraoperative monitoring (MIOM) during cervical spine surgery, the benefits of MIOM in craniovertebral junction (CVJ) surgery remain unclear. The objectives of the present study were to report our clinical experience in CVJ surgery with the use of MIOM and to identify risk factors that could affect MIOM changes during surgery of CVJ pathology. We reviewed the MIOM records of 146 patients who had undergone high cervical spinal surgery. The patients were grouped by the MIOM data recorded during surgery; the patients were included in either the MIOM or non-MIOM change group. The analyzed risk factors included demographic, myelopathy, preoperative Japanese Orthopedic Association (JOA) score, spinal cord diameter, and surgical factors. Univariate and multivariate analyses were performed to identify the risk factors for changes in MIOM data during surgery and postoperative neurological deficits. Our results revealed that the incidence of postoperative neurological complications was 4.1% after CVJ surgery; this rate was significantly greater in the MIOM change group than in the non-MIOM change group (21.7% vs. 0.8%; P < 0.01). Multiple regression analysis revealed that preoperative myelopathy, preoperative JOA score, and congenital anomaly/tumor were independently associated with MIOM changes during surgery. Postoperative neurological complications are not uncommon after CVJ surgery, and the incidence was significantly greater in the MIOM change group. Preoperative myelopathy, preoperative JOA score, and CVJ pathology related to congenital anomaly or tumor were independent risk factors for changes in MIOM data during surgery.

Neurospheres from neural stem/neural progenitor cells (NSPCs) of non-hydrocephalic HTx rats produce neurons, astrocytes and multiciliated ependyma: the cerebrospinal fluid of normal and hydrocephalic rats supports such a differentiation.

Fetal onset hydrocephalus and abnormal neurogenesis are two inseparable phenomena turned on by a cell junction pathology first affecting neural stem/progenitor cells (NSPCs) and later the multiciliated ependyma. The neurological impairment of children born with hydrocephalus is not reverted by derivative surgery. NSPCs and neurosphere (NE) grafting into the cerebrospinal fluid (CSF) of hydrocephalic fetuses thus appears as a promising therapeutic procedure. There is little information about the cell lineages actually forming the NE as they grow throughout their days in vitro (DIV). Furthermore, there is no information on how good a host the CSF is for grafted NE. Here, we use the HTx rat, a model with hereditary hydrocephalus, with the mutation expressed in about 30% of the litter (hyHTx), while the littermates develop normally (nHTx). The investigation was designed (i) to establish the nature of the cells forming 4 and 6-DIV NE grown from NSPCs collected from PN1/nHTx rats and (ii) to study the effects on these NEs of CSF collected from nHTx and hyHTx. Immunofluorescence analyses showed that 90% of cells forming 4-DIV NEs were non-committed multipotential NSPCs, while in 6-DIV NE, 40% of the NSPCs were already committed into neuronal, glial and ependymal lineages. Six-DIV NE further cultured for 3weeks in the presence of fetal bovine serum, CSF from nHTx or CSF from hyHTx, differentiated into neurons, astrocytes and βIV-tubulin+ multiciliated ependymal cells that were joined together by adherent junctions and displayed synchronized cilia beating. This supports the possibility that ependymal cells are born from subpopulations of NSC with their own time table of differentiation. As a whole, the findings indicate that the CSF is a supportive medium to host NE and that NE grafted into the CSF have the potential to produce neurons, glia and ependyma.

Endoscopic endonasal approaches to craniovertebral junction pathologies: a single-center experience

Endoscopic endonasal approaches to craniovertebral junction pathologies: a single-center experience

Endoscopic Endonasal Approaches to Craniovertebral Junction Pathologies: A Single-Center Experience.

The craniovertebral junction is a remarkable anatomical area with unique anatomical and functional relationships, which present difficult challenges for surgeons. The traditional approach to addressing pathologies in this area is microscopic transoral resection with posterior fixation; however, endoscopic endonasal clivus and odontoid surgeries now currently gaining interest as alternative approaches. We reviewed our experience of using the endoscopic endonasal approach at our institution. We retrospectively evaluated 41 patients (21 male, 20 female; age range, 2-65 years) who underwent endoscopic endonasal procedures for craniovertebral junction pathologies between 2008 and 2017. Of the 41 patients, 27 had clivus lesions, 7 had odontoid lesions, 6 had basilar invagination and 1 had rhinorrhea repair. Six patients underwent an additional posterior decompression/fusion either before or after the endonasal procedure. None of the patients required tracheostomy and cerebrospinal fluid leakage was detected in one patient postoperatively. The patients' mean modified Rankin scale and visual analog scale scores were 3 and 4 respectively. The follow-up period ranged from 12 to 50 months. Although the microscopic transoral approach has been considered the gold standard for craniovertebral junction surgical management, endoscopic approaches are feasible, safe, and effective for addressing pathologies in this region, with developing technique and experience.