✓ Basic fibroblast growth factor (FGF) is a mitogen, a differentiation factor for neuroectoderm-derived cells, and a potent angiogenic factor. The authors have previously demonstrated that the messenger ribonucleic acid of basic FGF is expressed in more than 90% of human gliomas. In the present study, they examined the expression of basic FGF in human glioma tissues using immunohistochemical techniques with a mouse monoclonal antibody against human basic FGF. They also correlated the basic FGF level with the histological grades of malignancy assessed by the number of nucleolar organizer regions (NOR's). Basic FGF was detected in 18 of 19 gliomas, whereas it was undetectable in two normal brains. The expression level of basic FGF peptide increased proportionally with the degree of malignancy. There was also a tendency for the number of NOR's in glioma cells to increase in glioma samples with a high level of basic FGF expression. Furthermore, most of the cases with increased vascularity demonstrated on cerebral angiograms showed a relatively high level of basic FGF expression of tumor cells and a large number of NOR's in endothelial cells in tumor tissues. These results suggest that basic FGF is actually produced in most gliomas and is involved in tumorigenesis and malignant progression as an autocrine growth factor. Moreover, basic FGF may play an important role in tumor neovascularization as a paracrine angiogenic factor.
Jun A. Takahashi, Manabu Fukumoto, Koichi Igarashi, Yoshifumi Oda, Haruhiko Kikuchi and Masakazu Hatanaka
Tao Yang, Yoshifumi Higashino, Hiroharu Kataoka, Eika Hamano, Daisuke Maruyama, Koji Iihara and Jun C. Takahashi
Hyperperfusion syndrome (HPS) is a notable complication that causes various neurological symptoms after superficial temporal artery (STA)–middle cerebral artery (MCA) bypass surgery for moyamoya disease (MMD). The authors used intraoperative indocyanine green (ICG) videoangiography to measure the change in microvascular transit time (MVTT) after bypass surgery. An analysis was then conducted to identify the correlation between change in MVTT and presence of postoperative HPS.
This study included 105 hemispheres of 81 patients with MMD who underwent STA-MCA single bypass surgery between January 2010 and January 2015. Intraoperative ICG videoangiography was performed before and after bypass surgery. The MVTT was calculated from the ICG time intensity curve recorded in the pial arterioles and venules. Multivariate logistic regression analysis was conducted to test the effect of multiple variables, including the change in MVTT after bypass surgery, on postoperative HPS.
Postoperative HPS developed in 28 (26.7%) of the 105 hemispheres operated on. MVTT was reduced significantly after bypass surgery (prebypass 5.34 ± 2.00 sec vs postbypass 4.12 ± 1.60 sec; p < 0.001). The difference between prebypass and postbypass MVTT values, defined as ΔMVTT, was significantly greater in the HPS group than in the non-HPS group (2.55 ± 2.66 sec vs 0.75 ± 1.78 sec; p < 0.001). Receiver operating characteristic curve analysis revealed that the optimal cutoff point of ΔMVTT was 2.6 seconds (sensitivity 46.4% and specificity 85.7% as a predictor of postoperative HPS). A ΔMVTT > 2.6 seconds was an independent predictor of HPS in multivariate analysis (hazard ratio 4.88, 95% CI 1.76–13.57; p = 0.002).
MVTT in patients with MMD was reduced significantly after bypass surgery. Patients with a ΔMVTT > 2.6 seconds tended to develop postoperative HPS. Because ΔMVTT can be easily measured during surgery, it is a useful diagnostic tool for identifying patients at high risk for HPS after STA-MCA bypass surgery for MMD.
Yoshifumi Takahashi, Shinya Okuda, Yukitaka Nagamoto, Tomiya Matsumoto, Tsuyoshi Sugiura and Motoki Iwasaki
Although the importance of spinopelvic sagittal balance and its implications for clinical outcomes of spinal fusion surgery have been described, to the authors’ knowledge there have been no reports of the relationship between spinopelvic alignment and clinical outcomes for 2-level posterior lumbar interbody fusion (PLIF). The purpose of this study was to elucidate the relationship between clinical outcomes and spinopelvic sagittal parameters after 2-level PLIF for 2-level degenerative spondylolisthesis (DS).
This study was limited to patients who were treated with 2-level PLIF for 2-level DS at L3–4-5. Between 2005 and 2014, 33 patients who could be followed up for at least 2 years were included in this study. The average age at the time of surgery was 72 years, and the average follow-up period was 5.6 years. Based on clinical assessments, the Japanese Orthopaedic Association (JOA) score and recovery rate were evaluated. The patients were divided into 2 groups based on the recovery rate: the good outcome group (G group; n = 19), with recovery rate ≥ 50%, and the poor outcome group (P group; n = 14) with recovery rate < 50%. Spinopelvic parameters were measured using lateral standing radiographs of the whole spine as follows: sagittal vertical axis (SVA), thoracic kyphosis (TK), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), and segmental lordosis (SL) at L3–4-5. The clinical outcomes and radiological parameters were assessed preoperatively and at the final follow-up. Radiological parameters were compared between the 2 groups.
The mean JOA score improved significantly in all patients from 10.8 points before surgery to 19.6 points at the latest follow-up (mean recovery rate 47.7%). For radiological outcomes, no difference was observed from preoperative assessment to final follow-up in any of the spinopelvic parameters except SVA. Although no significant difference between the 2 groups was detected in any of the spinopelvic parameters, there were significant differences in the change in SL and LL (ΔSL 3.7° vs −2.1° and ΔLL 1.2° vs −5.6° for the G and P groups, respectively). In addition, the number of patients in the G group was significantly larger for the patients with ΔSL-plus than those with ΔSL-minus (p = 0.008).
The clinical outcomes of 2-level PLIF for 2-level DS limited at L3–4-5 appeared to be satisfactory. The results indicate that acquisition of increased SL in surgery might lead to better clinical outcomes.