Role of Artificial Cerebrospinal Fluid as Perfusate in Neuroendoscopic Surgery: A Basic Investigation
Neuroendoscopic surgery is distinct from usual craniotomy as it is performed in water. We have previously reported that the use of artificial cerebrospinal fluid (CSF) as perfusate in third ventriculostomy is more efficacious in minimizing severe host rea
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Abstract Neuroendoscopic surgery is distinct from usual craniotomy as it is performed in water. We have previously reported that the use of artificial cerebrospinal fluid (CSF) as perfusate in third ventriculostomy is more efficacious in minimizing severe host reaction than normal saline or lactated Ringer’s solution. In this study, we investigated the effects of different perfusion solutions in human cultured astrocytes. We cultured human astrocytes in growth medium. Then each of them was further cultured for 6 h in artificial CSF, lactated Ringer’s solution, or normal saline. Using DNA microarray, RNAs were extracted from each of the cells and were comprehensively analyzed to identify differences in patterns of gene manifestation. Compared to the use of artificial CSF, in cases where lactated Ringer’s solution or normal saline was used, there was little difference in the pattern of gene manifestation, but there was an increase in gene manifestation related to apoptosis and inflammatory reaction. For neuroendoscopic surgery, the use of artificial CSF as a perfusate is considered effective in maintaining brain homeostasis compared to the use of normal saline or lactated Ringer’s solution. Keywords Neuroendoscope • Artificial cerebrospinal fluid • DNA microarray • Lactated Ringer’s solution • Saline
M. Miyajima (), K. Shimoji, M. Watanabe, M. Nakajima, I. Ogino, and H. Arai Department of Neurosurgery, Juntendo University, Tokyo, Japan e-mail: [email protected]
Introduction The use of artificial cerebrospinal fluid as a perfusate for neuroendoscopic surgery was first reported by Griffith et al. in 1990 [3]. They reported on the treatment of infantile hydrocephalus, during which they induced coagulation of the choroid plexus and then perfused it with artificial cerebrospinal fluid. The first to report on the significance of the use of artificial cerebrospinal fluid in neuroendoscopic surgery were Oka et al. [6]. According to that report by Oka et al., a comparison was conducted between two groups that used either normal saline solution or an artificial cerebrospinal fluid. In the normal saline solution group, clinical symptoms, including headache, high fever, and neck stiffness resulting from meningeal irritation, were present in all cases. In contrast, in the artificial cerebrospinal fluid group, while headache and high fever were present in one of the five cases, there were no apparent cases of neck stiffness. Furthermore, compared to the artificial cerebrospinal fluid group, an increased number of cells were apparent in the cerebrospinal fluid of the normal saline solution group. In addition, body temperature transitions tended to be higher for the normal saline solution group than the artificial cerebrospinal fluid group. These results suggested the possibility that the use of artificial cerebrospinal fluid as a perfusate during neuroendoscopic surgery could minimize the effects caused by the use of normal saline. From the report by Oka et al., it is clear that the use of normal saline solution as a perfusat
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