2016年 · 第02卷第01期

Background: Although primary hypophysitis is not uncommon, a granulomatous etiology of hypophysitis is relatively rare. Radiological and diagnostic characteristics of several isolated cases have been described to date. However, to the best of our knowledge, surgical treatment of eight cases of granulomatous hypophysitis confirmed by histopathology has not yet been reported. Methods: A retrospective study was performed to review cases of granulomatous hypophysitis from November 2003 to November 2013 in our neurosurgical department. Only eight out of 1345 operations were diagnosed with granulomatous hypophysitis. Results: The cohort included two men and six women. The most common manifestations reported were headache, fatigue and polyuria. All six female patients presented with either menstrual disorders or amenorrhea. Seven of eight patients suffered polyuria. Two patients suffered bitemporal hemianopsia. One was accompanied with eosinophilic granuloma of the skull. Prolactin levels were increased in six patients, four of them were noted to have thyroid axis imbalances, one was noted to be deficient in the gonadotropin axis and two were deficient in the adrenal axis. The lesion demonstrated homogenous enhancement and an abnormally thickened pituitary stalk. A histological diagnosis of granulomatous hypophysitis was established in all eight patients, who were treated surgically. Characteristic granulomas formed by epithelioid histiocytes and multinucleated giant cells were observed. Conclusions: Pure glucocorticoid therapy is less effective than surgical intervention and has not been recommended for the treatment of granulomatous hypophysitis. Although replacement therapy can relieve associated symptoms, we conclude surgical intervention, particularly minimally invasive surgery via a transsphenoidal approach, to be mandatory in establishing a diagnosis and reducing the size of the inflammatory mass. Adjuvant corticosteroids therapy is recommended.

Background: Neurosurgery in China has made great progress. The aim of this study was to analyze neurosurgical publications by Chinese authors using the Web of Science database as a way to illustrate the current state of neurosurgery in China. Methods: We searched the Web of Science core database for articles containing "neurosurg*" with or without an author address in "China" to obtain the set of neurosurgical publications in China and worldwide. We then extracted data from the search results to obtain information such as document type, countries/territories, organizations, publication year, title and research area. Then, we analyzed the search results of articles (document type) to generate a citation report. We identified publications by Chinese neurosurgeons that were cited more than 100 times. Results: A total of 165,365 neurosurgical publications were identified. Among them, 10,770 were published by Chinese neurosurgeons. Chinese neurosurgical publications have increased year by year, accounting for 2 % of neurosurgical publications before 2010 and rising to 13 % from 2010 to the present. The most frequent journals for Chinese neurosurgeons differ from the most frequent journals worldwide. We identified 34 Chinese organizations that published more than 100 publications. We also identified 19 studies written by Chinese neurosurgeons that were cited more than 100 times. Basic research represents a large proportion of Chinese publications in this area, while clinical research remains a weak area. Cooperative studies were overrepresented among Chinese studies. Conclusion: While China's publication output in the area of neurosurgery has made great progress, significant room for improvement remains. The next step is to strengthen Chinese neurosurgical clinical studies and improve the publishing environment for Chinese neurosurgeons.

Background: Accurately mapping the pyramidal tracts preoperatively and intraoperatively is the primary concern when operating on cavernous malformations (CMS) in the basal ganglia. We have conducted new methods for preoperative planning and have tailored lesion resection to prevent the damage of pyramidal tracts. Patients and methods: Eleven patients harboring cavernous malformations in basal ganglia were treated surgically from April 2008 to January 2015. Surgical planning was based on three-dimensional diffusion tensor pyramidal tractography and Virtual Reality system. Intraoperative detecting of pyramidal tracts with subcortical stimulation mapping and motor evoked potential monitoring were performed. The extent of resection and postoperative neurological function were assessed in each case. Results: Total removal of the cavernous malformations were achieved in each case. Four of the total eleven cases presented temporary neurological deficits, including one occurrence of hemiparesis and three occurrences of hemianesthesia. No permanent neurological deficit was developed in this series of cases. Conclusion: Three-dimensional diffusion tensor pyramidal tractography is quite helpful for preoperative planning of basal ganglia cavernous malformations, especially in choosing a suitable surgical approach. Intraoperative detection of pyramidal tracts with subcortical stimulation mapping and motor evoked potential monitoring play important roles in preventing damage to pyramidal tracts during lesion resection.

Background: Parkinson's disease (PD) is a common neurodegenerative disease. Most studies have found that the histopathological lesion is not only localized at the extrapyramidal area (basal ganglia) but also at the cortex in PD patients. Voxel-based morphometry (VBM) based on the voxel as a unit is described for quantitative detection of density and volume of brain tissue. In this study, VBM was used to investigate the brain gray matter changes associated with motor symptoms in PD patients. Methods: Twelve outpatients with PD and 12 healthy controls were recruited in our hospital from September 2013 to March 2014. VBM was performed on the whole brain of all subjects. Image processing and statistical analysis were performed using SPM8. A two-sample t test and multiple regression analysis were performed. Results were displayed with a threshold of P < 0.01, corrected by false discovery rate (FDR) correction and cluster size >30 voxels. Results: Comparing control healthy subjects with the patients, the data showed that PD patients had reduced gray matter volume in the postcentral gyrus, the right supramarginal center, superior temporal gyrus, precentral gyrus, Brodmann area 41, transverse temporal gyrus, Brodmann area 3, and inferior parietal lobule. The data also found that between gray matter volume and UPDRSIII in PD patients, there were negative correlations in the right middle frontal gyrus, BA06, right precentral gyrus, right superior frontal gyrus, and medial frontal gyrus, and between gray matter volume and Hoehn-Yahr (HY) in PD patients, there were negative correlations in the right middle frontal gyrus, right superior frontal gyrus, BA6, and right precentral gyrus. Conclusions: These data supported that extensive changes associated with motor symptoms in the gray matter volume was mainly located in the related area of movement, which had obvious relevance with the progression of PD.

Background: Chorionic carcinoma is a highly malignant gynecological tumor, frequently originating from trophoblastic cells in the uterus after fertilization. Early erosion releases cancerous cells into the circulation to invade surrounding organs without primary symptoms and signs. Methods: One case of choriocarcinoma sellar region metastasis was analyzed, utilizing clinical data, MRI and pathological examinations, and clinical characteristics were summarized. Results: Choriocarcinoma sellar region metastasis is easily misdiagnosed. We examined the literature and original resources to summarize the clinical characteristics of choriocarcinoma sellar region metastasis and discuss available therapies. Conclusion: This case study of a metastasis of choriocarcinoma to the sellar region provides important new data on the incidence and pathology of this rare disease.

Background: Primary spinal cord oligodendroglioma is extremely rare. In an extensive review of this disease, 53 cases were reported. Furthermore, the authors summarize the characteristics of the primary spinal cord oligodendroglioma; chronological presentation , neurological imaging, treatment and the outcome obtained in the present case as well as review the literature. Case Presentation: A 46-year-old male who had progressive neck pain for a year. Magnetic resonance imaging showed an intramedullary mass from level C2 to T4. A radical resection was performed. Histology revealed oligodendroglioma. Thereafter, the patient was treated with adjuvant radiotherapy. A year later, tumor developed recurrence. The patinet died in 3 years and 6 months. Conclusions: The available data of this disease was limited. Base on 11 published papers and the present case, surgical resection is the treatment of choice although recurrence of the tumor tends to occur after partial resection with or without radiotherapy. From the literature, the management of the recurrent disease is still surgery. Moreover, Temozolomide may be an advantage in recurrent situations.

Background: Vancomycin-resistant Enterococcus faecium ventriculitis is one of the most severe events in postneurosurgical intracranial infections. There are no guidelines recommending an appropriate treatment before. Case presentation: This case presents a successful linezolid treatment for post-neurosurgical vancomycin-resistant Enterococcus faecium ventriculitis of a 24-year-old man in the department of neurosurgery, Beijing Tiantan Hospital. Conclusions: Linezolid should be considered as one of the important methods for the treatment of post-neurosurgical intracranial infections caused by vancomycin-resistant Enterococcus.

Blood blister-like aneurysms (BBLAs) are aneurysms from the non-branching sites of the internal carotid artery (ICA). Though rare lesions, they pose a high risk of intraoperative aneurysmal rupture. Definite treatment of these types of aneurysms has been debatable, but surgical approach is the ultimate rescue treatment. Microsuture of the intraoperative ruptured BBLA has been reported scarcely in literature, but no review of these cases has ever been reported. We here present our experience of a case of BBLA intraoperative rupture requiring microsuture of the ICA and conduct meticulous review of all similar cases.

Epidural localization of myeloid leukaemia is rarely reported. Spinal cord compression as an initial presentation of acute myeloid leukaemia is extremely rare. This is a report of a 17-year-old black boy who presented to emergency department with neurological symptoms of spinal cord compression. Imaging modalities showed multiple soft tissue masses in the epidural space. After surgical treatment, histopathological examination of the epidural mass showed myeloid leukaemia cells infiltration. Literature review on Medline and "scholar Google" database was done. The characteristics and management of extra-medullary leukaemia are discussed. Granulocytic sarcoma, myeloid sarcoma or chloroma with acute myeloid leukaemia should be considered as part of epidural spinal cord compression. Therefore surgery is indicated on an emergent basis.

Gliomas are the most common primary tumors of the central nervous system, around 70 % of the malignant brain tumors are gliomas. In the NCCN Guideline Ver.1 2015, the assessment before systemic treatment, treatment principles and prognosis factors of gliomas has significantly changed based on the researches up to date, we try to analyze the reason and the effect of these changes. The most important change is the reintroduction of PCV chemotherapy in systemic treatment, which narrows the gap of prognosis between WHO II and III gliomas. Other changes including the assessment before systemic treatment, usage of RT and the promotion of evidence level about the Tumor Treating Fields.