Volume 30 · Issue 07 · 2014

Before the founding of New China (1949), only a few surgeons (Guan Songtao, Zhao Yicheng, Zhang Charlie, etc.) performed neurosurgery simultaneously in China. After the founding of New China, neurosurgery, a branch of surgery, developed from scratch and from small to large due to the needs of patients and the attention of the government. At that time, the diagnosis and treatment focus was on three major diseases that seriously threatened people's lives, namely: craniocerebral tumor, craniocerebral trauma and hemorrhagic cerebrovascular disease. Because of the large population and the large number of cases, neurosurgeons have many practice opportunities, rich experience and dexterous skills, at present, if only from the clinical diagnosis and treatment level, China is not inferior to the international advanced level, and some are even in a leading position. However, the internationally recognized connotation of neurosurgery is the medicine for diagnosing and treating the central, peripheral and autonomic nervous system and its supporting structures, including not only the brain, but also the spine, spinal cord and peripheral nerves. Therefore, from the perspective of the scope of disease treatment, It has not been fully integrated with international neurosurgery, and there is still a big gap.

Objective To provide more epidemiological knowledge and understand the epidemiological characteristics for intraspinal tumors.Methods During a 5-years period,from January 2009 to December 2013,2 447 spinal cord tumors who accepted surgical treatment with clear histopathologic diagnosis in Beijing Tiantan hospital were retrospectively ananlyzed.The age,gender,tumor site and histology were studied to summarize the epidemiological characteristics of intraspinal tumors.Results Of the 2 447 patients in our study,1 268 patients were male and 1 179 were female.The overall male/female ratio was 1.075∶ 1.000.Meningiomas were more common in women,with a female to male ratio of 4.06∶ 1.00.The mean age at surgery was 39.7 years.The most common site (35.02％) of the spinal cord tumors was cervical segment.The most common spinal cord tumors were schwannoma(31.95％),ependymoma(18.19％),and meningioma(10.13％).Our data indicated a higher proportion of nerve sheath cell tumors,and a lower proportion of meningiomas,compared with reports from the western countries.Compared with adult,the most common pediatric spinal cord tumor (36.50％) was embryonal residual tumors.Conclusions There was pathological diversity between pediatrics and adults,the eastern population and western population,intraspinal and intracranial tumors.The present study reflected the domestic epidemiology of intraspinal tumors.

Objective To investigate the classification,personalized operative plan and therapeutic evaluation of basilar invagination.Methods The clinical data of 103 patients who accepted microsurgical treatment in our hospital were retrospectively analyzed.Based on Atul Goel classification,the basilar invagination were diagnosed and divided into four categories.The selected personalized operative plans,imaging features,clinical characteristics and surgical methods were evaluated.Results 101 of 103 cases achieved good outcomes.The main Japanese Orthopaedic Association (JOA)scale was increased from 9.54 ±3.43 to 12.76 ±2.53(t =4.732,P =0.036) after the procedures.A complete reduction or partial reduction was achieved in all patients who had increased atlantodental interval.In 71 patients with syringomyelia,the syringomyelia was obviously shrinked in 49 cases (＞ 50％),shrinked in 21,and unchanged in 1.81 cases were followed-up from 12 to 72 months.The JOA scale was improved from 9.20±2.47 to 13.82 ±2.37(t =4.823,P =0.028)after follow-up.Conclusions According to the existence of syringomyelia and(or) atlantoaxial dislocation,all the basilar invagination could be divided into four types,which chould accurately reflect the pathological features of complicated basilar invagination.Through the comprehensive assessment of clinical manifestation and imaging features,a personalized surgical procedure could be selected to improve the effects of treatment of congenital basilar invagination.

Objective To explore the clinical features and surgical treatment of cervical,thoracic and lumbar spinal extradural arachnoid cysts.Methods The clinical data of 15 patients with cervical,thoracic and lumbarspinal extradural arachnoid cysts in our department from Jan 2011 to Nov 2013 were analyzed respectively.Of 15 patients,1 case occurred in cervical segment,12 in thoracolumbar segment,and 2 in lumbar segment.The symptom was given priority to the pain of lumbosacral region,followed by intermittent claudication and sensory dysfunction.Results 15 patients were treated by microsurgical operation to remove the cysts,explore and close the access hole between the cyst and dural sac.In early postoperative period,the symptoms were relieved significantly.15 patients were followed-up from 1 to 32 months (mean duration:19 months) and there was no cyst recurrence.The symptoms of 11 patients were disappeared,and 4 with relief of symptoms and without influence on their daily life.Conclusions Microsurgery was recommended for the patients with spinal extradural arachnoid cysts who suffered from significant symptoms,which included the cyst resection,access hole closure and lamina replacement.Excellent or good clinical effect could be achieved.

Objective To discuss the clinical significance of indocaynine green (ICG) videography in the surgical treatment of spinal hemangioblastoma (SH).Method Nine patients with SH underwent posterior midline approach to remove the tumors.By taking the ICG videoangiography,the boundary of the tumors,the feeding arteries and the draining veins were observed,and then the feeding arteries,the tumors and the draining veins were resected sequentially.Results The tumors were located in the cervical cord in six cases and thoracic cord in three.Three of the nine cases were diagnosed as yon Hippel-Lindau's syndrome.With the assistance of intraoperative 1CG videoangiography,the feeding arteries were confirmed quantitatively in all the nine cases,two of which were fed by multiple arteries accompanying with clear boundary of the tumors and the draining veins.Total tumor resection was achieved in eight cases and subtotal removal in one.McCormick grade was compared between pre-operation and post-operation.No additional neurological deficit was found.Conclusions The ICG Videography was a real-time and dynamic technique,which could accurately identify the feeding arteries,the boundary of the tumors and the draining veins.This angiography could improve the safety and effects of such operation.

Objective The purpose of this study was to investigate the feasibihty and operative outcome of the different approaches for different types of lumbar paravertebral neurilemmoma.Methods 27 cases of lumbar paravertebral nerve sheath tumors from 2000 to 2013 were retrospectively analyzed,According to MRI and CT,the tumors were divided into three types as type Ⅰ,Ⅱ and Ⅲ.Results There were 18 males and 9 females,aging from 28 -64 years old(average 52.9 years old).According to MRI,the tumors were divided into three types as type Ⅰ,Ⅱ and Ⅲ.There were 6 cases of type Ⅰ,9 type Ⅱ and 12 type Ⅲ.9 cases were operated through midline approaches,10paramidline arc incision line and laminectomy approaches,and 8 para-midline inter-musculature approaches.All the tumors were resected totally through operation.There was no operative comphcation.During the follow-up period,there was no neurological disorder except 5 patients with sensory dysfunction of innervations.Conclusions Surgical approaches should be planned according to the classifications of lumbar paravertebral nerve sheath tumors,which could make tumors be satisfactorily exposed and totally removed.

Objective To explore the microsurgical management and prognosis of primary intramedullary glioblastoma.Methods The clinical datas of 15 patients with primary intramedullary glioblastoma who accepted microsurgical treatment were analyzed retrospectively.Results Mostly resection was performed in 5 cases,and partial resection in 10.14 patients were treated with postoperative radiotherapy and/or chemotherapy.All patients died during the follow-up period.3 of 11 cases with clear cause of death died of postoperative complications,8 cases died of spinal cord and brain metastases.By Kaplan-Meier analysis,the median survival for all patients,Mostly resection subgroup and partial resection subgroup was 11 months,12 months and 11 months,respectively.The difference in the survival duration between mostly and partial resection did not reach statistical significance (P ＞ 0.05).Conclusions Primary spinal glioblastoma is a rare disease,with an aggressive course and poor prognosis.The purpose of operation is to confirm the pathologic diagnosis,reduce tumor burden,and relieve the symptoms.An aggressive comprehensive treatment (such as postoperative radiotherapy,chemotherapy protocols) should be performed to extend the patient's survival duration with better quality of life.

Objective To compare the microinvasive effects between paraspinal approach and posterior median approach for the treatment of lumbar intervertebral disc herniation under microscope.Methods 49 cases of lumbar disc herniation were divided into one group of paraspinal approach with tubular retractor system (n =28) and the other group (n =21) with posterior median approach.We compared the associated parameters of two groups preoperatively and postoperatively.Results In operation time,intraoperative blood loss,bed time,length of admission and local wound pain,parspinal approach was superior to those of posterior median approach.The average value of the creatine phosphokinase (CPK) at the 1st,3rd,and 5th days after the operation was lower than those of posterior median approach.The improvement rate of JOA score in 1 week and 6 months after operation in paraspinal approach was greater than those of posterior median approach (P ＜ 0.05).The VAS score of paraspinal approach at the 1 st and 7th days after operation was lower than those of posterior median approach (P ＜ 0.05).Conclusions In terms of intraoperative blood loss,muscle trauma and clinical symptoms remission,the paraspinal approach using tubular retractor system is superior to the posterior median approach.

Objective To discuss the effects of surgical treatment on adult tethered cord syndrome.Methods The data of 41 adult tethered cord syndrome patients who had been treated with surgery in neurosurgery department of Peking Union Medical College Hospital from 2005 to 2013 were retrospectively analyzed.There were 17(41％) male patients and 24(59％) female.The mean age of the patients was 31.6 years old and the mean history of the disease was 6.7 years.41 patients had all been treated with microsurgery under neurophysiological monitoring.All patients had been followed-up with a mean duration of 2.5 years and the surgical effects were judged according to Hoffman grading system.Results All patients were followed-up.According to Hoffman grading system,the neurologic symptoms were improved in 11 patients (27％),maintained in 30 (73 ％).Of 5 cases with lipoma tethered spinal cord,the symptoms were improved in 1 cases.Of 16 cases with tethered spinal cord caused by dermoid cyst and epidermoid cyst,the symptoms were improved in 3 cases.Of 20 cases without occupying lesions of tethered spinal cord,the symptoms were improved in 7 cases.And there was no deteriorated case.Conclusions Surgical treatment on patients who had adult tethered cord syndrome could improve the neurologic deficits.The effects were related to the history of disease.Better prognosis could be gained by earlier treatment.

Objective To explore the significance of laminoplasty in the surgical treatment of spinal extradural arachnoid cyst (SEAC).Methods 24 patients with SEAC,who were admitted and operated in the department of neurosurgery in Beijing Jishuitan hospital from May 2011 to June 2013 were retrospectively analyzed.According to the different surgical methods,all the patients were divided into two groups:non-laminoplasty group (group A) and laminoplasty group (group B).The data of patients in each group involving operative time,blood loss,preoperative and postoperative JOA scores and neurological function recovery rate,preoperative and postoperative spine Kyphotic angle were analyzed retrospectively.Results The surgical bleeding in group B was (111.1 ± 48.6) ml,which was significantly less than the (513.3± 131.6)ml in group A (t =-8.755,P =0.000).The operative duration time in group B was (45.4 ± 5.3) rman,which was significantly shorter than the (89.8 ± 19.1) min in group A (t =-8.443,P =0.000).The group B Kyphotic angle of 6.8° ± 1.2°was significantly lower than the 10.1° ± 1.2°in group A (t =-6.388,P =0.000).There was no statistical difference of the data of Kyphotic angle,preoperative JOA score,postoperative JOA score and the neurological recovery rate between two groups(t =-8.443,P ＞ 0.05).Conclusions Laminoplasty with craniotome was an effective and safe method with low recurrence for the treatment of SEAC.

Objective To explore the clinical features and microsurgical treatment of symptomatic sacral canal cyst.Methods 18 cases with symptomatic sacral canal cyst were operated through different surgical modes according to the classifications.According to the relationship with communicating foramen,these cysts were divided into two types:perineural cyst and nerve root sleeve expansion.While the latter was divided into two subtypes:simple communicating and the sleeve of the nerve root.For perineural cyst,we performed subtotal or total resection of the cyst wall under the protection of nerve roots.For the simple communicating cyst,we performed purse-string suture in the neck of cyst.For the cyst with sleeve of the nerve root,we performed partial cyst excision,plication of the cyst wall,purse-string suture in the neck of cyst and remodel the sleeve of the nerve root.The residual cavity area was tamped by a fascial fat with pedicle.Results 18 patients were followed-up for 6-36 months (an average of 18 months) and there was no cyst recurrence.16 out of 18 patients experienced complete or substantial resolution of the preoperative local and radicular pain.Two patients still complained of mildly pain and numbness but could be tolerated without influence on their daily life.Conclusions Microsurgical treatment should be selected for patients with symptomatic sacral canal cysts according to the different types of cysts,including total or partial cyst excision combined with direct dural closure,purse-string suture in the neck of cyst,remodeling the sleeve of the nerve root and pedicled fat filling the cavity under the protection of nerve roots.Effective and safe treatment of symptomatic sacral canal cyst with low recurrence could be achieved.

Objective To investigate the efficacy of domestic rechargeable neurostimulator system for the treatment of patients with Parkinson's disease (PD).Methods Totally 31 patients with PD were enrolled in this clinical trial who were treated with domestic rechargeable neurostimulator system.The PD patients were divided into treatment group (n =15) and sham group (n =16) randomly.The neurostimulator of treatment group was turned on and the stimulus parameter (amplitude,pulse width and frequency) were modulated at 1 month after the operation,whereas the sham group was turned on without stimulation.Scores on the Unified Parkinson's Disease Rating Scale,part Ⅲ (UPDRS-Ⅲ),for the assessment of motor function (on/off medication),scores on the UPDRS-Ⅱ,for the assessment of activities of daily living (on/off medication) and the number of hours per day spent in the "on" state were assessed at 1,3,and 6 month of follow-up with stimulation in the absence or presence of medicatior.The changes of temperature were detected during battery charging,and the recharging ability and stability of the rechargeable neurostimulator was assessed during the stage.Results UPDRS-Ⅲ and UPDRS-Ⅱ scores (on/off medication) and the number of hours per day spent in the "on" state in the treatment group were improved significantly than baseline at 1,3 month post operation (P ＜ 0.05),whereas the sham group was similar with baseline (P ＞ 0.05).The scores in the sham group were similar with treatment group at 6 month post-operation,both groups were improved significantly than baseline (P ＜ 0.05).Conclusions The domestic rechargeable neurostimulator system could improve the UPDRS-Ⅲ,UPDRS-]Ⅱ scores (on/off medication) significantly and the number of hours per day spent in the "on" state.The system was efficacy for the treatment of patients with PD.

Objective To explore the clinical classification,microsurgical operation methods and techniques of the tumors located at foramen magnum region.Methods 102 cases of foramen magnum tumors were resected by microsurgical operations in neurosurgery department of West China Hospital of Sichuan University from September 2005 to September 2013,and the clinical data of all cases were retrospectively analyzed.According to the results of clinical imaging,these cases with foramen magnum tumors were classified into 3 clinical types as follows:(1) Ventral type:tumor was located at ventral of medulla oblongata-cervical spinal cord,and there were 3 cases (2.9％) of meningioma belonging to such type; (2) Lateral type:tumor was located at lateral,ventrolateral or dorsolateral of medulla oblongata-cervical spinal cord,and there were 85 cases (83.3％) belonging to such type,including 35 cases of meningioma,48 cases of schwannoma and 2 cases of epidermoid cyst; (3)Intramedullary type:tumor was located in medulla of medulla oblongata-cervical spinal cord,and there were 14 cases (13.7％) belonging to such type,including 5 cases of ependymoma,7 cases of hemangioblastom a,and 2 cases of cavernous hemangioma.All cases of these foramen magnum tumors were resected in one-stage,and these tumors were resected by different microsurgical operation methods according to clinical classification.The tumors of ventral and intramedullary types were reseeted by posterior occipitocervical bilateral approach,while the lateral type by posterior occipitocervical unilateral approach.Results 96(94.1％) cases of foramen magnum tumors were totally resected,4 subtotally resected,and 2 partially resected.The follow-up period ranged from 3 months to 8 years (mean duration:3.6 years).The clinical manifestation was improved in 97(95.1％)cases,aggravated in 5,4 recurred and there was no spinal deformity.Conclusions Using the clinical classification of foramen magnum tumors to guide the choice of surgical approach not only improved the totally removal rate of tumors,but also helped to reduce the surgical trauma.Furthermore,it could maximally maintain the stability of the occipital-cervical junction area.

Objective To evaluate the application of Solitaire AB stent in assisting coiling embolization for intracranial tiny aneurysms.Methods A total of 9 consecutive patients with intracranial tiny aneurysm were treated with Solitaire AB stent-assisted coiling embolization.The intracranial aneurysms were located at posterior communicating artery (n =4),ophthalmic artery (n =3),top of the basilar artery (n =1) and middle cerebral artery (n =2).Results All the Solitaire AB stent were successfully placed in 9 aneurysms.Of the 9 patients,complete embolization of the lesion was achieved in 6 and partial embolization in 3 without rupture of the aneurysms during the performance.During the follow-up period,no new attack was seen.There was no in-stent stenosis or recurrence of aneurysms in 9 patients who were followed-up by the cerebral angiography from 8 to 13 months.Condusions The endovascular treatment of ruptured and tiny intracranial aneurysms by the stent-assisted coiling technique was safe and feasible.The long-term curative effects of the endovascular emholization on tiny aneurysms might be further improved by increasing the packing density and diverting blood flow.

Objective To analyze the effect of stereotactic radiotherapy(SRT) with or without whole brain radiotherapy(WBRT) in the treatment of hmited number brain metastases of non-small cell lung cancer (NSGLC).Methods 75 NSCLC patients with brain metastases within 4 lesions were retrospectively analyzed.35cases were treated with SRT alone and 40 cases were treated with SRT + WBRT.The therapeutic effects,overall survival and radiotherapeufic side effects of the two groups were compared.Results The total effective rate of SRT group and WBRT + SRT group were 91.5％ and 87.5％ respectively.There was no significant difference between the two groups (P ＞0.05).For all the patients,the median overall survival time was 14.7 months.There was no difference between SRT alone group and SRT + WBRT group (13.7 months vs 15.4 months,P =0.180).There was no serious side effectin in two groups.Conclusions Stereotactic radiotherapy was an effective and safe treatment for limited number brain metastases of NSCLC.The patients who accepted SRT alone or SRT + WBRT had the similar overall survival time.

Objective To evaluate the effects of the dynamic changes of serum sex hormones on the injury severity and prognosis of acute craniocerebral injury.Methods The injury severity (light,medium,and heavy) was evaluated through GCS score and the prognosis was evaluated with GOS.Intravenous blood was collected respectively from 153 patients with light,medium,and heavy injury at the first day and the 7th day after acute head injury.The quantitative method was used dynamically to determine the sexual hormone contents (serum E2,P,and T) in the serum.The relationships among the dynamic changes of serum sex hormones,the severity of injury and the prognosis after acute craniocerebral injury were analyzed.Results The contents of the serum E2,P,and T at the first day after injury were increased significantly than those at the seventh day in the patients with all types of acute head injury.Meanwhile,the changes showed that the contents of the serum E2,P,and T were increased with the decrease of GCS score at both time points.There was a negative correlation between the contents of serum E2,P,and T and the GCS score and GOS score (P ＜ 0.05).Conclusions Early dynamically monitoring the changes of sexal hormone contents in serum of patients with acute traumatic craniocerebral injury could be used as the early indicators of rapid judgment of injury severity and prognosis.It could provide the basis for intervene therapy (proper application of sex hormones) in patients with acute craniocerebral injury.

At present, there are many methods for the treatment of cerebral arteriovenous malformation (AVM), such as microsurgery, endovascular embolization, stereotactic radiotherapy and combination therapy, among which surgical resection is the most important and thorough treatment method [1-2]. Accurate understanding of the lesion boundary and distinguishing the vascular nature during operation are the key to successful AVM surgery. From January 2010 to January 2013, 12 cases of cerebral AVM were resected by intraoperative ultrasound combined with intraoperative fluorescence angiography in the Department of Neurosurgery of the Third Affiliated Hospital of Sun Yat-sen University, with satisfactory results, and the results are reported below.

From March 2010 to December 2013, a total of 52 patients with severe craniocerebral injury were treated, including 27 patients with primary injury combined with contrast injury, accounting for 51.9%; Among the patients with burst injury, 13 cases (48.1%) underwent acute subdural hematoma on one side, brain contusion and laceration craniotomy and then the primary epidural hematoma evacuation and comminuted skull fracture evacuation. For these patients, some domestic scholars [1] used the method of autologous skull metastasis to achieve good clinical results. We referred to this method to surgically treat 13 cases of this type of patients, and achieved satisfactory clinical results.

Objective To explore the effect of endostatin and angiostatin (Endo-Angio) fusion gene modified herpes simplex virus (VAE) on glioma stem cells (GSCs) in vivo.Methods Isolated stable GSC-enriched cultures were obtained from human glioblastoma specimens.After that we established orthotopic nude mice models carrying GSCs.The tumor volumes variation was detected by MRI scan.The expression of Endo-Angio fusion gene at mRNA and protein level was detected by RT-PCR and Western blot.At last,the efficacy of fusion protein to microvessel density (MVD) was detected by immunohistochemistry of CD31 after infected by VAE.Results (1) 6 GSCs isolated from 36 surgical specimens could suspend growth and had the ability of self-renewal and multipotential differentiation,and could express neural stem cells marker,CD133.(2) 10 days after treatment with VAE,the intracranial gliomas derived from GSCs showed significant expression of Endo-Angio fusion gene and reduction in microvessel density (MVD) (P ＜0.05).(3)MRI showed that the tumor volumes of intracranial gliomas generated by GSCs were dramatically reduced at 10 days after treatment with VAE compared with controls.(4) There was a significant improvement in the survival time of mice with intracranial gliomas treated with VAE compared with controls (P ＜ 0.05).Conclusions VAE showed an oncolytic therapeutic efficacy in animal models of human glioblastoma stem cells and expressed endostatin-angiostatin fusion gene,which enhanced antitumor efficacy by reducing the blood supply for tumors.VAE could be used as a novel virus-gene therapy strategy.

Objective To promote cell rapid proliferation and differentiation of glioma side population cells by inducing redistribution of Par-6/atypical protein kinase C (aPKC) polarity proteins.Methods The experiments was divided into control group,non-antisense group and siR-PKCξ group.The cellular immunofluorescence staining was used to detect the distribution of aPKC,Par-6 and tripartite motif-containing protein 32 gene (TRIM32) in cells.The growth curves were drawn,and the nuclear proliferation was detected by immunofluorescence for Ki67.The expression of cell markers was detected by immunofluorescence method.Results Compared with the control group and non-antisense group,the expression level of siR-PKCξ in siR-PKCξ group were significantly lower (0.07-± 0.03,P ＜ 0.01),accompanied by loss of Par-6 polarity and TRIM32 nuclear transfer.At 24h after gene transfection,Ki67 positive percentage was (48.65 ± 11.34)％,which was higher than those in the other two groups (P ＜ 0.05).At 72h after gene transfection,there were lower expression of CD133 and nestin,and higher expression of GFAP (P ＜ 0.05),but there was no significant changes of 3-tubulin Ⅲ and myelin in siR -PKCξ group (P ＞ 0.05).Conclusion Rearrangement of Par-6/aPKC polarity protein could promote rapid proliferation and differentiation of glioma side population cells.

1. Fracture classification and surgical indications Thoracolumbar fracture is a common type of spinal trauma. More than 70% of spinal fractures in the United States involve the thoracolumbar spine [1]. The number of spinal fractures in the world reaches about 5 million every year [2-3]. Especially at the junction of the thoracolumbar spine, traumatic fractures are especially prone to occurrence.In addition, the height of the anterior arch of the lumbar spine and the sagittal structure of the lumbar spine joints also determine that the lumbar spine is a high incidence area of spinal trauma. Although it is quite common in clinic, its treatment mode and surgical indications are still controversial. When should conservative or surgical treatment be selected? Which surgical approach is the best option? Is direct surgical decompression required? How many spinal stages should internal fixation be extended to? The above problems have been the topic of discussion among spine surgeons. This article summarizes the analysis of the above problems as follows.

Medulloblastoma is one of the most common malignant tumors in childhood. It is easy to spread and implant along the subarachnoid space, accounting for about 20% of all central nervous system tumors and 40% of all posterior cranial fossa tumors in childhood.

cerebral palsy (CP), referred to as cerebral palsy for short, refers to a group of syndromes that occur in the developing fetus or infant brain non-progressive defect or damage caused by movement disturbance and posture abnormality. The spastic type accounts for about 60% to 70% of cerebral palsy, and its treatment methods include rehabilitation therapy, intrathecai baclofen (ITB) injection, orthopedic surgery, selective peripheral neurotomy (SPN) and selective posterior rhizotomy (SPR), etc. [1]. Kan et al. [2] showed that SPR and ITB can effectively alleviate the symptoms of moderate or above spasticity mainly in the lower limbs, but SPR is more effective than ITB in reducing the degree of spasticity and improving motor function. Since this operation was launched in 1990s, it has been rapidly popularized in China and has been developed for more than 20 years. However, as a kind of invasive operation, its postoperative complications have gradually attracted people's attention.

brainstem cavernous malformation (BSCM) is a kind of benign vascular disease. Although Dandy [1] reported a case of brainstem cavernous malformation with surgical resection and hemorrhage in 1928, the research on it mainly began in the 1980s and 1990s, its natural history, clinical manifestations, diagnosis and treatment principles have not been completely defined.About 20% of cavernous malformation (CM) is distributed in the brainstem, and the incidence of brainstem cavernous malformation in the population is about 0.04% ~0.40%, and its annual hemorrhage rate is about 2.7% ~5.0%, which is much higher than that of other parts of cavernous malformation [2-3].

Explosive injury is the most common type of injury for soldiers in wartime. According to statistics, 64% and 47% of soldiers suffered from craniocerebral explosive injury in Iraq and Afghanistan, respectively [1]. In China, there are many casualties due to explosions (such as chemical, fireworks or explosive explosions, industrial accidents, etc.) every year, among which craniocerebral explosive injury is not only one of the decisive factors leading to the death of patients, but also causes a large number of patients to produce long-term neurological dysfunction.

hypothalamic hamartoma (HH) was first reported in the Chinese Journal of Neurosurgery in 1998. Previously, neither neurosurgeons nor neuroradiologists knew much about it, but it was first reported by Marqaund in 1934 in foreign literature, and dozens of articles have been published since then. In fact, HH is not a real tumor, but an ectopic "brain tissue" existing in the hypothalamus during the embryonic period. Its pathological manifestation is similar to the gray matter of the cerebral cortex, so WHO later classified it as a congenital brain malformation.

A 58-year-old female was admitted to hospital for more than 2 years due to dizziness and hearing loss. The patient developed dizziness without obvious inducement 2 years ago, accompanied by hearing loss, and gradually aggravated. Six months ago, she felt an increase in skull weight, obvious hearing loss, and weakness of both upper limbs. Physical examination showed that she was clear, poor hearing, palpable multiple masses in the skull, and dysplasia of the minor fish muscles in both palms, but there were no positive signs. Skull MRI showed: (1) cervical degeneration, C4-5 to C6-7 disc herniation; (2) Flat skull base, Chiari deformity type I. CT of the skull showed that the skull plate and plate barrier were obviously thickened (Figure 1); X-ray showed that the skull was obviously thickened, about 3 times that of the normal skull. The skull structure was disordered and the density was uneven, and the "cotton ball" bone density increased (Figure 2). The alkaline phosphatase was 978 μ/L, (normal value 40~150 μ/L). It was planned to perform right frontotemporal craniotomy for partial skull removal and decompression. During the operation, the whole layer of bone flap was pale red osteoporotic, 2.2 cm thick, and the dura mater was rich in blood vessels. The postoperative pathology was cranial osteitis deformity (Figure 3).

The patient was a 75-year-old male with cerebral hemorrhage in the right basal ganglia area (Figure 1a). Physical examination showed coma, GCS score 6, bilateral pupils were equal in size, 3 mm in diameter, light emission on the left side was slow, and the right side disappeared, and the left side had positive pathological signs. After admission, he underwent right craniotomy for hematoma evacuation and decompressive craniectomy, and the hematoma was evacuated about 50 ml. Postoperative GCS score 9, bilateral pupils were equal in size, 3 mm in diameter, and light reflex was sensitive. He was treated with dehydration and systemic support. The head CT was re-examined on the first day after operation (Figure 1b). On the fourth day after operation, cerebrospinal fluid wound leakage appeared, and local suture was performed. High fever and meningeal irritation appeared 2 days later, which was considered to be complicated with intracranial infection. Lumbar puncture showed intracranial infection and continuous lumbar cistern drainage was performed. Four days before drainage, the daily drainage volume was 200~250 ml, and on the fifth day, the drainage volume was about 350 ml. The disturbance of consciousness was aggravated, GCS score 6, bilateral pupils were equal in size, 3 mm in diameter, light reflex on the left side was sensitive, the right side was slow, and the bone window flap collapsed. CT showed subdural effusion on the right forehead and epidural effusion on the temporal side, with the midline deviating to the left.

With the bright sunshine in early June, the 6th China Pediatric Neurosurgery Forum (CPNF) held by Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine from June 6 to 8, 2014 came to a successful end. This forum also hosted the 2014 World Pediatric Neurosurgery Continuing Education Course (ISPN Course) and the 5th Shanghai International Neuroendoscopic Operation Course (SINEHOW), which was a successful conference and a far-reaching conference.

1. DATA AND METHODS 1. General data: From May 2008 to December 2012, 102 patients were treated with bone fragment markers during decompressive craniectomy and temporal muscle flap during cranioplasty for temporal muscle reconstruction, including 77 males and 25 females; The average age ranged from 14 to 63 years (34.0±10.6) years. The operative side: 60 cases on the left side and 42 cases on the right side; Among them, 16 cases underwent bilateral surgery; There were 82 cases of craniocerebral trauma and 20 cases of hypertensive cerebral hemorrhage. The patients had the following characteristics: (1) craniocerebral trauma and hypertensive cerebral hemorrhage; (2) Acute brain swelling was performed by decompression of frontotemporal parietal bone flap, the area of operation bone window was about 12 cm ×15 cm; (3) Skull repair within 3 months after operation; (4) Titanium plate covering method under temporal muscle; (5) Three-dimensional titanium mesh is selected as the repair material.