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OBJECTIVE: To investigate the clinical value of surgical treatment for cerebral schistosomiasis. METHODS: The clinical data of 42 patients with cerebral schistosomiasis caused by Schistosoma japonicum undergoing surgical therapy were analyzed retrospectively. RESULTS: There were 25 cases undergoing total resection of schistosomal granulomas and 17 cases undergoing partial resection of the lesions involving the functional areas or more than 2 lobes, and none died of the surgery. The post-surgical follow-up showed that 31 cases recovered completely and returned to the normal work and life, 2 developed mild weaknesses of all extremities, 3 had post-surgical epileptic seizures, 2 died of schistosomal hepatic cirrhosis, and 1 died naturally. CONCLUSION: Surgical treatment is an effective approach for cerebral schistosomiasis.

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OBJECTIVE: To establish an experimental model of neuroschistosomiasis and investigate the model establishment factors. METHODS: Rabbits were used for the animal model and Schistosoma japonicum eggs (1 mg/ml) were directly injected into the brain by two ways of a bone drill or needle. The symptoms were observed and in the first and second week and later, the rabbits' brains were removed for pathological examinations. RESULTS: One to two weeks after the injection of schistosome eggs, the rabbits had various neurological symptoms such as loss of appetite, hemiparesis, seizure, etc. The pathological analysis showed the schistosome egg granuloma inflammatory reaction among 90% rabbits. CONCLUSION: This new method of direct injection of S. japonicum eggs through skull into the brain provides a good and easy animal model of neuroschistosomiasis.

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OBJECTIVE: To investigate the clinical characteristics, operative methods, and diffusion tensor imaging (DTI) in the resection of intrinsic insular gliomas via transsylvian approach. METHODS: From June 2008 to June 2010, 12 patients with intrinsic insular gliomas were treated via transsylvian microsurgical approach, with preoperative magnetic resonance imaging diffusion tensor imaging (MR DTI) evaluation. The data of these patients were retrospectively analyzed. RESULTS: All patients had astrocytoma, including 8 patients of Grades I to II, 2 patients of Grades III to IV, and 2 patients of mixed glial tumors. The insular tumors were completely removed in 9 patients, whereas they were only partially removed from 3 patients. No death was related to the operations. Two patients had transient aphasia, 2 experienced worsened hemiplegia on opposite sides of their bodies, and 2 had mild hemiplegia and language function disturbance. CONCLUSIONS: Most of the insular gliomas are of low grade. By evaluating the damage of the corticospinal tract through DTI and using ultrasonography to locate the tumors during operation, microsurgery treatment removes the lesions as much as possible, protects the surrounding areas, reduces the mobility rate, and improves the postoperative quality of life.

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OBJECTIVE: The present study aimed to establish a cerebral schistosomiasis model in rabbits, to provide a valuable tool for morphological analysis, clinical manifestation observation, as well as investigations into immunological reactions and pathogenesis of focal inflammatory reaction in neuroschistosomiasis (NS). METHODS: Sixty New Zealand rabbits were randomly assigned into operation, sham-operation and normal groups. Rabbits in the operation group received direct injection of dead schistosome eggs into the brain, while their counterparts in the sham-operation group received saline injection. Rabbits in the normal group received no treatment. Base on the clinical manifestations, rabbits were sacrificed on days 3, 5, 7, 10, 20, and 30 post injection, and brain samples were sectioned and stained with hematoxylin-eosin. Sections were observed under the microscope. RESULTS: The rabbits in the operation group exhibited various neurological symptoms, including anorexy, partial and general seizures, and paralysis. The morphological analysis showed several schistosome eggs in the nervous tissue on day 3 post operation, with very mild inflammation. On days 7-10 post operation, several schistosome eggs were localized in proximity to red blood cells with many neutrophilic granulocytes and eosinophilic granulocytes around them. The schistosome eggs developed into the productive granuloma stage on days 14-20 post operation. On day 30, the schistosome eggs were found to be in the healing-by-fibrosis stage, and the granuloma area was replaced by fibrillary glia through astrocytosis. The sham-operation group and the normal group showed negative results. CONCLUSION: This method might be used to establish the cerebral schistosomiasis experimental model. Several factors need to be considered in establishing this model, such as the antigenic property of eggs, the time of scarification, and the clinical manifestations.

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The infection of the central nervous system (CNS) by schistosome may or may not have clinical manifestations. When symptomatic, neuroschistosomiasis (NS) is one of the most severe presentations of schistosome infection. Among the NS symptoms, cerebral invasion is mostly caused by Schistosoma japonicum (S. japonicum), and the spinal cord symptoms are mainly caused by S. mansoni or S. haematobium. There are 2 main pathways by which schistosomes cause NS: egg embolism and worm migration, via either artery or vein system, especially the valveless perivertebral Batson's plexus. The adult worm migrates anomalously through the above pathways to the CNS where they lay eggs. Due to the differences in species of schistosomes and stages of infection, mechanisms vary greatly. The portal hypertension with hepatosplenic schistosomiasis also plays an important role in the pathogenesis. Here the pathways through which NS occurs in the CNS were reviewed.

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Clinical data from 48 cases with cerebral schistosomiasis, who received surgery, were analyzed retrospectively. Surgical treatment was performed when the patient had the following conditions: mass focus confirmed by CT scanning, cranial hypertension, or ineffective drug therapy, or indistinguishable from glioma by iconographic diagnosis. Treatment of praziquantel was given when the patients got improved. Among the 48 patients with surgical treatment, 35 cases recovered, 8 showed an exacerbation of hemiparalysis, 5 had hemianesthesia, and epilepsy occurred in 2 cases, no cases died during or after the operation. Surgery combined with praziquantel therapy has been an effective way for the treatment of cerebral schistosomiasis.

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OBJECTIVE: To investigate the clinical characteristics of intracranial hematoma and the mechanism involved in its rapid natural resolution. METHODS: Seventeen cases of intracranial hematoma with typical clinical and CT manifestations were retrospectively studied. RESULTS: Intracranial hematoma was found obviously decreased in size within 72 h after its occurrence in 8 cases. The rest 9 cases presented complete resolution. CONCLUSIONS: Rapid natural resolution of acute epidural hematoma is mostly found in teenagers and the resolution is correlated with cranial fracture at the hematoma site. As for acute subdural hematoma, its rapid resolution is associated with the transfer of cerebrospinal fluid toward subdural space, the lavage effect, and the compression caused by the increased intracranial pressure or the space left resulting from redistribution of the hematoma in brain atrophy.

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