Volume 30 · Issue 06 · 2014

Objective To summarize the clinical features of primary intracranial germ cell tumors (GCTs).Methods Based on the WHO 2007 classification criteria for CNS tumors,we retrospectively analyzed 162 cases of primary intracranial GCTs admitted into Nanfang Hospital from Jan.2004 to Oct.2013.Results There were 135 cases of single-focus tumors and 27 multi-focus tumors.70.4％ of tumors were originated in pineal region,20.4％ in supra-sellar region,7.4％ in basal ganglion region,and 1.8％ in other regions.The average age of all cases,pineal region cases,supra-sellar region,and basal ganglion region cases,was 14.4 years,14.5 years,14.9 years,and 12.6 years,respectively.The male/female ratio was 7.1∶1 in all cases,and 18∶1 in pineal region cases,1.4∶1 in supra-sellar region cases,and 5∶1 in basal ganglion region cases.The positive rate of tumor markers was 42.5％,and germinomas accounted for 46.9％ of all cases.Conclusions The clinical features of GCTs are special,and detailed analysis of clinical data is helpful for the diagnosis.More than a half of patients will achieve ideal therapeutic results through timely diagnosis and reasonable treatment.

Objective To discuss the effects of the application of preauricular straight incision through subtemporal approach in the microsurgical treatment of cavernous sinus meningioma.Methods 36 cavernous sinus meningiomas were resected with preauricular straight incision through subtemporal approach.The clinical data and follow-up results were retrospectively summarized.Results The total resection was achieved in 24 cases,subtotal in 8,and partial in 4.The follow-up duration was 6-30 months.Two of the total resection cases were given Gamma Knife (GK) radio-surgery because of recurrences.Six of the subtotal resection cases also were given GK treatment because of tumor progression.All the 4 partial resection cases were given postoperative GK treatment,and the results showed that there was no significant progress in 2 tumors,and slow growth in 2.Conclusions he preauricular-subtemporal straight incision approach could achieve good result when dealing with the cavernous sinus meningioma.This approach could fully expose the cavernous sinus,reserve the zygomatic arch and reduce the surgical trauma.

Objective To study the clinical characteristics,surgical treatment and outcome of pineal parenchymal tumors(PPT) in adult patients.Methods The adult patients (≥18 years old) with PPT diagnosed between 2007 and 2013 were retrospectively studied and their surgical results were followed-up.Results 37 PPT tumors were surgically removed,including 19 total removal,12 subtotal removal and 6 partial removal.The biopsy was made in 2 patients.The pathological type of 14 cases was pineocytoma,15 pineal parenchymal tumors of intermediate differentiation,and 10 pinealoblastoma.In 32 patients of follow-up,there were 5 patients died because of tumor recurrence.The median overall survival was 34.5 months for intermediate differentiation and 29.8 months for pinealoblastoma.Conclusions Pineocytomas' patients have good survival prognosis after surgical treatment.Microsurgery is the most effective therapy for pineal parenchymal tumor of intermediate differentiation and pineoblastoma.The role of adjuvant radiotherapy and chemotherapy remains to be defined.

Objective To study the clinical features and treatment strategy of intracranial malignant fibrous histiocytoma (MFH).Methods Between 2004 and 2013,there were 7 MFH patients who were surgically treated in Beijing Tiantan Hospital.There were 5 males and 2 females,aged 33 ～ 69 years old.The lesions located in frontal lobe (4 cases),basal ganglia (1 case),parietal-occipital lobe (1 case) and occipital lobe (1 case).The CT scan showed calcification in two cases.MRI revealed lesions to be 2 ～ 6 cm in diameter.Most of the tumors showed peripheral edema.After injection of Gd-DTPA,the tumors showed nodular homogenous or heterogenous enhancement.After surgery,4 patients received radiotherapy.The histopathology study showed 3 low-malignant and 4 malignant MFH.Results 5 cases were found to be intracerebral and 2 related to the meningial during the operation.Surgical resection was achieved GTR in 5 cases and STR in 2 cases.The mean follow-up time was 67 months.The median survival time was 15 months.3 patients died because of the tumor recurrence.The GTR of tumors and low pathological grade were tended to be related with longer survival time (P =0.057 and P =0.075,respectively).Conclusions The pre-operative diagnosis of intracranial MFH was difficult and lack of specific radiological features.Surgical resection was the most effective method for treatment.The prognosis of intracranial MFH was poor because of high recurrence rate.

Objective To explore the skills and surgical approaches of foramen magnum neurilemmoma.Methods A retrospective analysis was performed for 21 surgically treated patients with neurilemmoma involving the foramen magnum.According to the sites of the tumors,the classification was divided to type Ⅰ (located at ventral) and type Ⅱ (located at dorsal).The far-lateral approach was used in 4 cases of Type Ⅰ,while the midline approach for 17 cases of Type Ⅱ.Results Total resection was achieved in 18 cases (85.7％) and subtotal in 3 cases.17 patients had improvement in their neurological status,3 unchanged,and 1 aggravation.10 patients developed new postoperative neurological deficits and other complications.The patients were followed-up from 3 months to 2 years,and the neurological functions were found to recover in varying degrees.Conclusions The surgical approaches and microsurgery skills were the keys to improve the efficacy of the treatment of foramen magnum neurilemmoma.

Objective To monitor the whole operation process of microsurgical resection of intraventricular lesions by intraoperative ultrasound (IOUS),and to discuss the value of IOUS in neurosurgery intraventricular surgery.Methods 80 patients of intracranial ventricular lesions by preoperative CT and/or MRI and accepted operation were collected in the study between Mar 2009 and December 2012.IOUS monitoring was performed during the operation.Results 80 lesions were showed clearly by IOUS and had their own characteristics in IOUS images.Conclusions IOUS could provide exact position of intraventricular lesions and real-time intraoperative images.It could also conduct the operation path and its process to avoid the injury of important structures,thus improve the safety and accuracy of the neurosurgical procedures.It also could reduce the intraoperative bleeding volume,shorten the operation time,improve the total resection rate and reduce the postoperative complications.

Objective To explore the characteristics,surgical indications,methods and outcomes of the resection of invasive pituitary adenomas through transsphenoidal approach.Methods The clinical data of patients with pituitary adenomas invading cavernous sinus underwent surgery through transsphenoidal approach wcrc analyzed retrospectively.The extent of tumor removal,the change of hormone levels and the postoperative complications were analyzed.Results In 23 cascs,total tumor removal was achieved in 7 cases,subtotal in 12,and partial in 4.There were 12 cases of non-functioning adenomas,10 prolactinomas and 1 growth hormone adenoma.The postoperative PRL levels were decreased to normal in 4 cases,≥80％ in 4,＜ 80％ in 2.The postoperative GH level was decreased to ＞ 50％ in 1 case.The postoperative complications included 3 cases of hypopituitarism,l cerebrospinal fluid fistulae,1 deterioration of vision,2 transient cranial nerve palsy,5 transient diabetes insipidus and 4 electrolyte unbalance.18 cases had been followed-up from 3 months to 2 years,5 cases of recurrence.Conclusions The pituitary adenomas invading cavernous sinus could be revealed and removed satisfactorily with fewer surgical complications through the transsphenoidal approach.

Objective To investigate the association of single nucleotide polymorphisms in Galectin -3 gene and the susceptibility of skull base chordomas in Chinese.Methods Two candidate genetic variants (rs4644 and rs4652) in Galectin-3 gene were chosen based on the previous study.The distribution of genotype and allele were investigated in 51 patients with skull base chordomas and 102 healthy subjects.The genomic DNA was prepared from peripheral blood leukocytes of the subjects.Polymerase chain reaction and the following sequencing were performed for genotyping.Statistical analysis was performed using the SPSS software (IBM SPSS Statistics Version 20).Results There was significant difference for the distribution of genotypes in SNP rs4652 between the cases and control subjects (P =0.046).Through the stratification of gender,there was significant difference for the distribution of genotypes in SNP rs4652 between cases and control subjects in female (additive model,CC/AC/AA,P =0.020 ; dominant model,CC + AC/AA,P =0.009).Subjects with CC and AC genotypes were more susceptible to skull base chordomas (OR =4.5;95％ CI =1.365-14.833).There was no difference in the distribution of genotypes and alleles at galectin-3 gene rs4644 between cases and control subjects (P ＞ 0.05).Conclusions The SNP rs4652 in Galectin-3 gcnc might be associated with the susceptibility of skull base chordomas in female.In female,persons carrying CC or AC genotype might have an increased risk for skull base chordomas.

Objective To establish human chordoma cell lines.Methods The tumor tissue samples were obtained from surgery.The tumor cells were mechanically dissociated and purified based on the different rates of attachment among various cell types.The cells were cultured in DMEM/F-12 medium and passaged in vitro.The morphology and ultrastructure of tumor cells (passage 15) were observed by microscope and electron microscope.The proteins S100,Galectin-3,Fascin-1and Brachyury were measured by histochemical staining.Four phases of the cell cycle was analyzed by the flow cytometer.The karyotype analysis of tumor cells was performed.The tumor cells were subcutaneously injected into the nude mice.Results The HBC2 cell line was characterized by prominent vacuoles of mucus pushing the nuclei to the side.The proteins S100,Galectin-3,Fascin-1 and Brachyury were positively stained in the cell line.The flow cytometer showed 51.3％ of the cells were at G1 phase,23.6％ at S,and 25.0％ at G2-M.The value of G2/G1 was almost 2.The heteroploid karyotype of the cells was indicated.The tumor formation in nude mice was found by HBC2 cells thansplantation.Conclusions Human chordoma cell line HBC2 was successfully established and cultured in vitro on the basis of maintaining its characteristics of chordoma in the process of passage.

epidermal growth factor receptor variant Ⅲ (EGFRV Ⅲ) is the most common type of epidermal growth factor receptor (EGFR) mutation. Recent studies have shown that EGFRV Ⅲ plays an important role in the occurrence and development of glioblastoma [2-3].

Objective To investigate the fcasibility and efficacy of resection of orbital apex lesions through transnasal endoscopic approach.Methods From January 2009 to June 2013,18 patients with orbital apex lesions were analyzed retrospectively,of which the main symptoms were proptosis and vision loss.In this series,6 cases were orbital foreign body,4 cavernous hemangioma,3 trans-nasal-orbital mucinous cyst,2 inflammatory pseudotumor,1 cholesteatoma,1 neurofibroma,and 1 fibrodysplasia.All the patients underwent operation through ethmoid sinus with endoscopic techniques into orbit or orbital apex.Results All the foreign bodies were taken out by one operation.4 cavernous hemangiomas in orbital apex were totally removed,in two of them the postoperative visions were improved and another two unchanged.In 8 trans-nasal-orbital tumors,4 were totally removed,3 partially removed,of which the proptosis and eyeball movement were improved.All the patients were followed-up from 3 months to 4 years.1 inflammatory pseudotumor recurred and was removed again.There was no recurrence in the rest of cases,and the symptoms were disappeared.Conclusions In carefully selected cases,the lesions in orbit and orbital apex could be removed feasibly through transnasal endoscopic approach.

Objective To explore the treatment of intracranial infection due to drug-resistant Acinetobacter Baumannii in neurosurgical ICU.Methods The clinical data,including general status,primary diseases,infection sites,infection causes,drug sensitivity,therapeutic strategies and therapeutic effects,of 13 cases of intracranial infection due to drug-resistant Acinetobacter Baumannii in neurosurgical ICU (NSICU) of our hospital were retrospectively analyzed.Results The 13 cases,including 4 cascs of meningitis and 9 cases of ventriculitis,were all infected by drug-resistant Acinetobacter Baumannii.The causes of infection included 7 cases of CSF leakage,3 external ventricular drainage,2 retrograde hematogenous infection,and 1 lumbar cistern drainage.There were 4 cases of multi-drug resistant Acinetobacter Baumannii (MDRAB) and 9 cases of extensively drug resistant Acinetobacter Baumannii (XDRAB).The curative rate and mortality rate was 61.5％ and 38.5％,respectively.The curative rate of MDRAB was 100％,while the mortality rate of XDRAB was 55.6％.Conclusions The mortality rate of intracranial infection due to drug-resistant Acinetobacter Baumannii in NSICU was high.The main causes of infection were CSF leakage of incision and external ventricular drainage.Effective CSF drainage and reasonable choice of antibiotics were the keypoints for successful treatment.Combined treatment based on Meropenem for MDRAB,and treatment based on Polymyxin or Tigecycline combined with Sulbactam sodium for XDRAB could raise the curative rate.

Objective To study the anatomical relationship between C1-2 and Vertebral artery.Methods Ten adult cadaveric specimens were studied.The veins and arteries were injected with silicon pigments.We followed the nomenclature clarified by Cacciola.The artery during its course from the transverse process of C3 to the transverse process of axis was named after V1 segment,the artery during its course from the axis transverse process to the atlas transverse process was named after V2 segment and the segment of the artery after its exit from the transverse foramen of atlas to the point of its dural entry was named after V3 segment.The relationship of the artery to the atlanto-axial joint and facets,distance of the location of the artery from the midline,from the C2 ganglion and from the other surgical landmarks were researched.The extent of occupancy of the artery into the vertebral artery groove on the inferior surface of the superior facet of the axis,and over the posterior arch of the atlas were studied.Results The V1 segment of the vertebral artery took a varying degree of loop inside the vertebral artery foramen on the inferior aspect of the superior facet of the axis.The loop extended towards the midline and was at an average distance of 14.6 mm from the midline of the vertebral body.The V2 segment of the artery took an initial lateral loop after its exit from the transverse process of the axis.The average distance of the artery from the lateral end of the C2 ganglion was 7.7 mm and from the dural tube was 15.6 mm.The vertebral artery groove in the superior facet of axis and the groove over the posterior arch of the atlas were completely occupied by the vertebral artery only in six sides and in none respectively,suggesting the possibility of the dynamic nature of the relationship of the artery to the bone.Conclusions The vertebral artery adopts a serpentine course in relationship to the axis,making it susceptible to be injured during the surgical procedures in this region.The foundation of reducing the possibility of vertebral artery injury is to be familiar with its anatomy characteristic.

Objective To analyze the cilinical characteristics of a chinese family with Crouzon syndrome,combined with disease genes (FGFR2) identification of gene mutations,understanding the characteristics of the clinical onset of the disease and molecular genetic basis.Methods A single family underwent complete examinations,and three patients were diagnosed with Crouzon syndrome.The genomic DNA was extracted from the peripheral blood collected from members of the family.Exons 3、4、5、6、7、8、10、11、12、13、14、15、16、17、18、19、21 of FGFR 2 were amplified by polymerase chain reaction (PCR) and directly sequenced.Results A W290R mutation of FGFR2 was found in three members of this Crouzon syndrome family.Conclusions This mutation might cause ligand-independent activation of FGFR2 signaling pathway,which could result in abnormal ossification and excessive ossification.The W290R mutation may be one of the reasons that cause the Crouzon syndrome in Chinese.

Objective To study the changes of total cortisol、cortisol binding globulin、free cortisol and free cortisol index in spontaneous cerebral hemorrhage patients,and to discuss the relationship between the changes and disease severity and the prognosis.Methods 92 patients with spontaneous intracerebral hemorrhage were enrolled in this study.The serum were collected at 6 am at the 1st day、3rd day、7th day、10th day and 14th day.The total cortisol、cortisol binding globulin and free cortisol were analyzed using of immunity method.The free cortisol index was calculated by Coolens equation.The data were analyzed with SPSS 16.0.Results The levels of total cortisol、free cortisol and free cortisol index showed significantly increased and got peak at the 1st day (P ＜ 0.001),and then gradually declined.The cortisol binding protein at the onset had no obvious difference (P ＞ 0.05),and then gradually increased.To compare the low cortisol spontaneous cerebral hemorrhage patients and the nomal cortisol spontaneous cerebral hemorrhage patients,the prognosis of the former was worse with statistical significance (P ＜ 0.05).Conclusions Quick activation of HPA axis could be caused by spontaneous cerebral hemorrhage.So the stress hormone levels in spontaneous cerebral hemorrhage patients were increased.When in a critical condition,the body's stress response was too strong and leaded to HPA axis failure,the cortisol was insufficient,and ultimately affected the prognosis of patients.

Objective To screen differential genes expression in brain arteriovenous malformations (AVMs) with the help of genome microarray techniques in order to identify the pathogenesis of AVMs.Methods 9 samples taking from AVMs patients received surgical therapy and 9 control brain vessel samples from temporal lobectomy for the treatment of medically intractable seizures were collected.The total RNA was isolated and transcribed into cDNA reversely.And the synthesized cRNA was hybridized with human genome oligo microarray after labeling with Cy3.The SAM (Significant Analysis of Microarray) software was used to screen the differentially expressed gene and those genes were analyzed by molecule annotation system (MAS) 3.0.RT-PCR technique was used to test the differentially expressed genes.Results 47 genes met the statistical significance criteria,and were identified as differentially expressed.Among them 37 genes were up-regulated and 10 genes were down-regulated.Those genes were majorly involved in the process such as cell adhcsion molecules,tight junction,regulation of actin cytoskeleton and MAKP signaling pathway.Conclusions Brain AVMs have significant differentially expressed genes in contrast to vessels from the control samples.Multiple genes and signaling pathways may be involved in the process of AVMs' genesis and development.The up-regulated genes VCAN,SPARC,ARHGAP18 and down-regulated gene DUSP2 may have an important significance in the process of AVM's genesis and development.

Objective To investigate the value of the cerebral blood flow SPECT used for localization of epileptogenic zone in patients with intractable epilepsy,which was performed under the videoelectroencephalogram (VEEG) monitoring combined with the semi-quantitative analysis.Methods Ccrcbral blood flow SPECT was performed under VEEG monitoring and seizures were captured either by sleep-deprived or by reducing dose or by withholding of antiepileptic drugs (AEDs).Neurogam analysis was used in the procedure of image interpretation.Results 19 inter-ictal combined with ictal images and 62 only inter-ictal images were obtained in this study.The detection rates of the pathological focus for SPECT,VEEG and MRI were 95％、98％ and 42％,respectively.There was no significant difference between SPECT and VEEG,but both methods were significant higher than MRI (x2 =52.913,P ＜ 0.001 ; x2 =59.247,P ＜ 0.001).The accordance rate of localization of pathological focus between SPECT and VEEG (69％) was significant higher than the accordance rate between SPECT and MRI (25％;x2 =26.905,P ＜0.001) and between VEEG and MRI (27％;x2 =26.905,P ＜0.001).The localization accuracy of SPECT,VEEG and MRI were 83％ 、74％ and 52％,rcspectively.Of the 14 patients who had an Engel class Ⅰ or Ⅱ outcome after surgery,there were 11 cases came from its coincidence between SPECT and VEEG.Conclusions The cerebral SPECT imaging method applied in this study was relatively simple and convenient and could play an important role in the localization of epileptogenic zone.It could be used as a routine test in patients with intractable epilepsy.

Objective To study the feasibility and efficacy of different endovascular embolization methods for the treatment of very small intracranial aneursms.Methods A retrospective analysis was made on the basis of the clinical data of 43 patients with very small intracranial aneurysms (51 lesions) from 686 cases of patients with intracranial aneurysms.There were 19 male cases and 24 female.Among them,5 cases were multiple aneurysms.Endovascular interventional treatments,such as simple coil embolization,stent-assisted coil embolization and Onyx glue embolization,were performed.All patients were followed-up.Results In 51 aneurysm lesions,27 received simple coil embolization,9 stent-assisted coil embolization,3 simple stent placement within the parent artery and 12 Onyx glue embolization.In these cases,except 3 lesions with simple stent placement within the parent artery,30 aneurysms to grade zero embolism,11 to grade Ⅰ,7 to grade Ⅱ.1 patient had acute thrombosis and received urokinase thrombolytic recanalization.1 patient had intraoperative bleeding and postoperative coma,and got 4 of GOS score after treatment.The postoperative vasospasm was observed in 3 cases and transient hemiplegia occurred.All patients were followed-up for an average of 40.6 months (3-72 months).Rebleeding occurred in 1 patient.36 cases underwent reexamination of angiography and had no recurrence.In 1 case,the coils partially prolapsed to the parent artery.Conclusions The accurate diagnosis of mirco-intracranial aneurysms requires high rows of CTA and/or 3D-DSA.The endovascular treatment is effective for the treatment.For those mirco-intracranial aneurysms which locate beyond stage Ⅳ,Onyx glue aneurysm embolization is recommended,but its long-term effect still needs further follow-up for more accurate conclusions.

Objective To investigate the effect of mechanical thrombectomy with Solitaire AB stent in the treatment of acute cerebral artery occlusion.Methods The clinical data of 96 patients with acute cerebral artery occlusion (onset time ＜ 6 hours)treated by mechanical thrombectomy with Solitaire AB stent in the department of neurosurgery of the fifth central hospital of Tianjin from Octobe 2010 to March 2012 were analyzed retrospectively.Results Thrombectomy with Solitaire stent was successful in 59 patients with complete revascularization.26 patients with partial stenosis after thrombectomy were treated with stenting and 6 patients were completed revascularized.11 patients were failed in thc trcatmcnt of thrombectomy.65 patients were completed revascularized and achieved TICI scored 3 in all of successful cases.20 patients achieved TICI scores 2b.Intracranial hemorrhage on follow-up CT was noted in 16.7％ (16 of 96) of patients.15 patients suffered slight hemorrhage and there was 1 moderate hemorrhage case.The National Institutes of Health Stroke Scale(NIHSS) score was 6.87 ± 4.56 at one week after procedure compared to 11.34 ± 5.48 before procedure.There was significant difference (P ＜ 0.05).The follow-up modified Rankin Scale (mRS) was less than 2 in 46 cases.Conclusions The application of Solitaire stent in acute stroke was safe and time-efficient,which could improve the recanalization rate,decrease or even avoid the application of thrombolytic drugs and reduce the rate of intracranial hemorrhage.

Objective To investigate the safety of combination of coils and Onyx 18 for the treatment of large sidewall aneurysms of internal carotid artery.Methods Ten patients with ten large sidewall aneurysms of intemal carotid artery were treated with combination of coils and Onyx 18,and the clinical data were recorded.The immediate occlusion of aneurysms,complications and outcomes were reviewed.Results Seven aneurysms were completely occluded.Two aneurysms with neck remnants and one with dome remnant were shown at the immediate angiography.Two patients had transient neurological deficits.All of the patients were followed-up with 16 months of median duration.Good outcomes were achieved in all the patients without neurological deficits.Eight patients received DSA examination during the follow-up period.One aneurysm was recanalization,and one remained stable.There was no recanalization in five aneurysms,but one patient had the occluded parent artery.Conclusions Combination of coils and Onyx 18 could be used for the treatment of large sidewall aneurysms of internal carotid artery.

Objective To investigate the expression of hippocampal toll-like receptors 4 (TLR4) and the proliferation of neural progenitor cells (NPCs) in mouse model of traumatic brain injury (TBI).Methods Adult male Balb/c mice were randomly divided into the sham groups and the 1st,3rd,7th,14th,21st days post-traumatic groups.The TBI mouse model was induced by Mamarou weight-drop device.NPCs were labeled with thymidine analog 5-Bromo-2-deoxyUridine (BrdU).The expression and distribution of BrdU and TLR4 in hippocampus were observed by inmmunofluorescence.The expression of TLR4 in protein level was detected by Western-blot.Results It was observed that TLR4 expressed on the NPCs in hippocampus by double-labeling inmmunofluorescence,and the expression of TLR4 protein in hippocampus raised at the 1st day,got to the peak around the 3rd day,then decreased over the 7th day,14th day,and 21st day to a lower value but still higher than the sham group(P ＜ 0.05).NPCs increased at the 1st post-traumatic day,reached the peak at the 3rd day,followed by a gradual reduction from the 3rd day to the 21st day when maintained a higher number than that of the sham group (P ＜ 0.05).Conclusions TLR4 expressed on the NPCs in hippocampus,and the expression of hippocampal TLR4 varied in a similar temporal pattern with the proliferation of NPCs after injury.It suggested that hippocampal TLR4 might play a potential role in the endogenous neurogenesis after TBI.

Objective To explore Terahertz time-domain spectra of ischemic brain tissue in different time on rats.Methods The model of middle cerebral artery occlusion (MACO) was established and transmissive Terahertz time-domain spectroscopy of the brain tissue of occlusive lesions was measured.The Peaks-Valley difference (PVD) in absorption coefficient curve was analyzed.Results The ischemia brain tissues in 3,6,12 and 24 hours had significant differences with normal brain tissue.The PVD value was decreased significantly in 1.4,1.5,1.6,1.7,1.8,1.9 THz frequencies(P ＜ 0.05).The cell density of ischemic brain tissue was significantly reduced and the brain water content was significantly higher.Conclusions erahertz time-domain spectroscopy could detect ischemia within 3 hours after artery occlusion.PVD value is positively related to the severity of brain tissue ischemia.

Rathke's cyst, also known as pituitary cyst, is formed by the residual craniobuccal cleft sac between the anterior and posterior lobes of the pituitary gland in the embryonic period, which is covered with some cubic epithelial space, and this space does not disappear and continues to expand after birth [1]. Recently, with the development of imaging technology, the diagnosis rate of Rathke's cyst has increased, including those who are found accidentally by physical examination without clinical symptoms [2]. Because the disease has similar imaging and clinical manifestations to other cystic lesions in the sellar region, the preoperative misdiagnosis rate of Rathke's cyst is still high, which is as high as 78.9% [1]. This paper briefly reviews the progress of diagnosis and treatment of Rathke's cyst in recent years.

Traumatic carotid-cavernous fistula (TCCF) refers to the abnormal arteriovenous communication between the cavernous sinus segment or its branches of the internal carotid artery and the cavernous sinus caused by trauma, which causes a series of clinical symptoms and signs such as exophthalmos, bulbar conjunctiva congestion and edema, intracranial murmur, visual loss, and ocular fixation [1-2]. The incidence of this disease in craniocerebral trauma is about 2.5%. If not treated in time, it can cause serious complications such as permanent vision loss, hemiplegia, aphasia and even intracranial hemorrhage [3-5]. At present, the treatment and prognosis of TCCF are getting better and better. Currently, the embolization materials used mainly include balloon, coil, Onyx glue, NBCA glue, covered stent, etc.

1. DATA AND METHODS 1. General data: From January 2003 to December 2012, 61 cases of preoperative ruptured aneurysms were operated and interventionally treated, 41 males and 20 females, aged 35-80 years, with an average age of 53.5 years. Preoperative Hunt-Hess classification was grade Ⅱ-Ⅲ in 52 cases, and grade Ⅳ-Ⅴ in 9 cases. Bilateral pupils were dilated and light response disappeared in 9 cases, one pupil was dilated and light response was attenuated in 32 cases, and bilateral pupils were normal in 20 cases. DSA examination time: 18 cases were within 6 h, 35 cases were within 7-36 h, and 8 cases had time to undergo DSA examination. 2. Imaging examination: CT scan: 36 cases were mainly hemorrhaged in the longitudinal fissure cistern and suprasellar cistern, a small amount of hemorrhaged in the circular cistern, 5 cases were mainly hemorrhaged in the lateral fissure cistern, partial sulcus hemorrhaged, 12 cases were mainly hemorrhaged in the circular cistern, and a small amount of hemorrhaged in the longitudinal fissure cistern. 8 cases had hemorrhaged in the longitudinal fissure cistern, suprasellar cistern, circular cistern, interpedal cistern and sulcus, and were accompanied by hematoma in the frontal or temporal lobe, with hematoma volume>30 ml. Fifty-three cases were examined by DSA: 28 cases of anterior communicating branch artery aneurysm, 15 cases of posterior communicating branch artery aneurysm, 7 cases of middle cerebral artery aneurysm, 1 case of apical basilar artery aneurysm, 1 case of posterior inferior cerebellar artery aneurysm was diagnosed by secondary angiography, and 8 cases were diagnosed by posterior inferior cerebellar artery aneurysm.