Volume 30 · Issue 08 · 2014

1. Overview post-traumatic hydrocephalus (PTH) is one of the common complications after craniocerebral trauma. It is caused by abnormal changes in cerebrospinal fluid circulation dynamics due to increased secretion of cerebrospinal fluid, or (and) absorption disorder, or (and) circulation disorder, which causes abnormal accumulation of cerebrospinal fluid in the ventricle or (and) intracranial subarachnoid space, and makes some or all of it abnormally enlarge [1-10]. The incidence rate of PTH is reported to be very different, and with the improvement of the success rate of treatment for patients with severe craniocerebral trauma, the incidence rate of PTH is also significantly increased [1-2, 6-10]. 2. Classification of PTH According to the time of occurrence, the pressure site, the presence or absence of obstruction in the ventricular system and the clinical state, PTH is classified as follows [1-4, 11-12]: (1) Classification according to the time of occurrence: ① Acute: within 3 days after injury; ② Subacute: 4~13 days after injury; ③ Chronic: ≥14 days after injury. (2) Classification according to pressure: according to the measured pressure (lumbar puncture), it is divided into high pressure (>normal range) and normal pressure (within normal range). (3) Classification according to the accumulation site of cerebrospinal fluid: ① Intraventricular hydrocephalus: simple ventricular system enlargement; ② Extraventricular hydrocephalus: cerebrospinal fluid accumulates in the cavity outside the ventricle, which may be accompanied by (or without) ventricular enlargement. In the latter, there are two types: direct communication between effusion and cerebrospinal fluid circulation and limitation, also called subdural effusion. Hydrocephalus is usually considered in clinic to refer to intraventricular hydrocephalus. (4) Classification according to the presence or absence of obstruction in the ventricular system: ① Obstruction: Obstruction in any part of the ventricular system including interventricular foramen, third ventricle, midbrain aqueduct and fourth ventricle may lead to obstructive PTH; ② Communication: There is no obstruction in the ventricular system, which is caused by arachnoid adhesion of the convex surface of the brain or (and) the base of the skull, or (and) the obstruction of intracranial reflux vein leading to cerebrospinal fluid reabsorption disorder. (5) Classification according to clinical status: ① Perform: The patient has PTH-related clinical manifestations, which are progressive; ② Occult: although the patient's ventricles were enlarged, there were no clinical manifestations related to PTH; ③ Stationarity: the abnormal accumulation of cerebrospinal fluid in the patient stopped, the ventricular system stopped enlarging, and the clinical manifestations related to PTH did not progress.

Objective To evaluate the therapeutic effect of superficial temporal artery-middle cerebral artery(STA-MCA) bypass in the treatment of Moyamoya disease.Methods From April 2009 to June 2013,STAMCA bypass operatioas were performed in 28 patients (15 females/13 males,age 6-49 years) with Moyamoya disease.The frontal and parital branches of the superficial temporal artery were separated under the microscope,then anastomosed with the M3 or M4 segment of middle cerebral artery.All clinical and radiological data were retrospectively reviewed.Results All of the operations were successful.Postoperative CT angiography or DSA imaging demonstrated patency of the bypass in all patients.CT perfusion obviously demonstrated improvement of cerebral perfusion.The ischemic symptoms were relieved in most of the patients.3 patients suffered transient ischemic attack (TIA).In 4 patients,the incision showed small amount of exudate and wound healing delayed.During the follow-up period,no cerebral homorrhage or infarction was observed.Conclusion This study showed that the superficial temporal artery-middle cerebral artery bypass could achieve good therapeutic effect in the treatment of Moyamoya disease during the short-term follow-up,but its long-term outcome needs further study.

Objective To evaluate safety and efficacy of endovascular treatment for paraclinoid aneurysms and explore the factors influencing the long-term outcome.Methods The medical records and radiologic images of 129 patients with paraclinoid aneurysms during 2010 Jan to 2011 Dec treated by endovascular embolization in Changhai hospital were reviewed retrospectively.We analyzed the factors affecting the long-term outcomes of endovascular treatment,including clinical status,treatment strategy,selection of the equipment and aneurysmal morphology.Results In univariate analysis,hypertension,ruptured aneurysms,maximum diameter,dome-to-neck ratio and immediate result showed significant difference between the 2 groups (P ＜ 0.05).Multivariate logistic regression analysis found hypertension (P =0.0094),ruptured aneurysms (P =0.0108) and larger maximum diameter (P =0.0197) are predictors of recanalization.Conclusions Endovascular treatment of paraclinoid aneurysm has a risk of recurrence.Hypertension,ruptured aneurysms and larger maximum diameter are independent risk factors of recurrence.

Objective To evaluate the risk of rehemorrage after surgical evacuation,neurological outcome,and prognostic factors of surgically treated brainstem cavernous malformations (CMs) with longterm follow-up.Methods Clinical data from 242 surgically treated patients with CMs between 1999 and 2010 were reviewed retrospectively.Results The study consisted of 242 patients with a male-to-female ratio of 1.3 and mean age of 32.6 years.The mean modified Rankin scales on admission,at discharge,and at recent evaluation were 2.2,2.6 and 1.5,respectively.The preoperative calculated annual hemorrhage and rehemorrhage rates were 5.0％ and 60.9％,respectively.Complete resection rate was 95.0％.After a mean follow-up of (89.4 ± 42.8) months,147 patients (60.7％) improved,70 (28.9％) were unchanged,and 25 (10.3％) worsened.A total of 8 rehemorrhages occurred in 6 patients,and the postoperative annual rehemorrhage rate was 0.4％.Permanent neurological deficits remained in 65 patients (26.9％).Postoperative rehemorrhage risk factors were developmental venous anomaly and incomplete resection.The independent factors for poor long-term outcome were increased age (P =0.025),multiple hemorrhages (P =0.017),ventral-seated lesions (P =0.048),and poor preoperative status (P =0.001).Conclusions Favorable long-term outcomes and significantly low postoperative annual hemorrhage rates can be achieved by appropriate surgical evacuation of brainstem CMs in patients.Total resection should be pursued with minimal injury to neurological function; however.The postoperative deficits can restore during the follow up course.

Objective Explore the application of microsurgical technique via transcallosal approach in the treatment of thalamic hemorrhage.Methods the clinical data of 25 patients with thalamic hemorrhage who were treated by haematoma evacuation by microscope via transcallosal approach in neurosurgery of our department from January 2010 to January 2013,the operation result and prognosis were collected.Results There is no patient suffered from intracranial infection and rebleeding after operation.20 patients survived after 3 months.The Barthel Index evaluation:BI ＞ 60(independent living) in 5 cases; 40 ＜ BI ＜ 60 (severe dysfunction) in 9 cases; 40 ＜ BI ＜ 20 (Moderate dysfunction) in 4 cases ; BI ＜ 20 (total disability)in 2 cases.Conclusion The microsurgical technique via transcallosal approach can remove thalamic hemorrhage effectively,and cause low postoperative complications.It is a feasible surgical technique for treatment of thalamic hemorrhage.

Hypertensive cerebral hemorrhage (HICH) is a common clinical disease, among which basal ganglia hemorrhage accounts for 70%, and the mortality and disability rate are high. It is extremely important to find effective treatment methods to improve the curative effect of cerebral hemorrhage and reduce the mortality and disability rate. According to the current domestic and foreign literature reports, the surgical treatment of HICH is superior to that of internal medicine [1-2], and improving the surgical effect is the current development direction of surgical treatment. We compared the clinical efficacy of 50 cases of HICH patients treated in our hospital from January 2009 to May 2013 with corticostomy and hematoma evacuation via lateral fissure-insular approach.

"tandem carotid artery stenosis" (TCAS) refers to the simultaneous stenosis of the carotid artery at different levels, with an incidence of about 4.8%, which can cause hemodynamic changes such as cerebral infarction or cerebral insufficiency due to the detachment of microembolus [1]. The combination of carotid endarterectomy and stent implantation is a safe and effective treatment for tandem carotid artery stenosis [2]. From July 2008 to June 2013, more than 300 patients with carotid artery stenosis were treated by surgery, among which 4 patients with tandem internal carotid artery stenosis were treated with carotid endarterectomy and stent implantation, with satisfactory results.

Stenosis or occlusion of middle cerebral artery is a common factor leading to insufficient perfusion in the corresponding blood supply area, and extracranial-intracranial artery bypass grafting can be performed for these patients to improve blood flow. XeCT cerebral blood flow (CBF) perfusion imaging can quantitatively detect blood perfusion of brain tissue, and has the advantages of accurate data and good repeatability compared with other semi-quantitative techniques. This study reviewed the clinical data of 11 cases of superficial temporal artery-middle cerebral artery (STA-MCA) bypass grafting in our neurosurgery department from August 2010 to November 2011, and analyzed the effect of XeCT cerebral blood flow perfusion imaging on the evaluation of blood flow changes before and after operation.

Surgery is the most important method for the treatment of arteriovenous malformations at present, but the operation is difficult and there are many postoperative complications. How to accurately distinguish the drainage vein of the supply artery from the normal blood vessel in the malformed vascular mass during the operation, avoid the residual arteriovenous malformations after operation, and accurately locate the deep and small AVM is still an insurmountable problem [1-4]. In recent years, our department has applied intraoperative ultrasound to localize brain AVM in real time and monitor the related hemodynamics, which has improved the operative effect. The results are reported as follows. DATA AND METHODS 1. General data: From October 2009 to May 2013, 12 patients with brain AVM were treated by intraoperative ultrasound color Doppler assisted microsurgery in the Department of Neurosurgery of Yancheng First People's Hospital, including 8 males and 4 females.

Objective To study factors impacting on the outcome of surgery in intractable temporal lobe epilepsy with hippocampal sclerosis in children.Methods Between June 2010 and June 2012,clinical data of 25 pediatric patients with temporal lobe epilepsy haboring hippocampal sclerosis were collected in neurosurgical department of Beijing Tiantan Hospital.Seizure outcome was evaluated with Engel class.The correlation among age at seizure onset,sex,seizure frequency,duration of seizure,age at operation,MRI findings,pathological features and seizure outcome were assessed.Results Seven patients were confirmed as FCD Ⅲ a by neuropathology and others were hippocampal sclerosis only.Duration of seizure is a risk factor to affect the outcome of operation (P ＜ 0.05),but other factors have minor impact on the outcome of operation(P ＞ 0.05).Conclusion Early operation of temporal lobe epilepsy with hippocampal sclerosis in children predicts a better outcome.The correlation between the pathological lesions and surgical effects should be paid more attention for further study.

Objective To retrospectively summarize the clinical manifestations,treatment and prognosis of intracranial hemangiopericytomas(HPCs),and to optimize process of diagnosis and treatment.Methods The data of 10 cases of HPCs were reviewed,including their clinical characteristics,imaging display,treatment process,pathology and prognosis.Results The onset lesions included 4 cases in supratentorial falx,3 in middle cranial fcssa,3 in posterior cranial fossa.The tumors grew across the cerebral falx or adjacent venous sinus.The imaging examinations showed that there was no calcification both inside and on margin of the lesions.The adjacent skull could be eroded but there was no thickening.Part of phyllodes tumors were found to be with narrow necks and lack of dural tail signs.All the patients were performed operation,6 cases achieved total removal and 4 subtotal.The pathological examinations after operation showed 7 cases of WHO Ⅱ and 3 WHO Ⅲ.All the recurring cases were WHO Ⅲ in both onset and recurrence lesions.All the cases accepted radiation therapy,and 1 recurring case was given chemotherapy after the removal of relapse lesion.The follow-up period was from 13 months to 137 months (mean duration:62.5 months).There were 2 recurred cases with second surgery and local radiation for metastasis.Conclusions Although HPCs are extremely rare and easily misdiagncsed as meningiomas,there were still some characteristic features in clinical manifestation and imagings.The adjuvant radiotherapy should be given after operation.When the tumor recurrence was confirmed,surgery and radiosurgery,which could be performed repeatedly,should be recommended in order to control the recurrence or metastasis of tumors.

Objective To summarize the characteristics of the metabolic changes detected by 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in patients suffering from Rasmussen encephalitis (RE) and to study the roles of 18F-FDG PET in the clinical diagnosis.Methods The clinical data and PET images of 13 patients who had underwent resection and been pathologically confirmed as RE from 2008 to 2013 were retrospectively analyzed,and the abnormally metabolic region identified by PET and lesions' locations identified by MRI were compared and evaluated respectively.Results The metabolism level of PET was categorized as hypometabolism,hypermetabolism and hybrid metabolic abnormalities (showing both hypometabolism and hypermetabolism).In the thirteen patients,seven of them manifested only hypometabolism,and six hybrid metabolic abnormalities.Three patients underwent ictal PET and ten underwent interictal PET.Hypometabolism was detected in all of the thirteen patients,and in 11 patients more than three lobes were involved.The regions involved most were temporal lobe (12/13),frontal lobe (9/13),and insula lobe (8/13).In the six patients with hypermetabolism,central region was involved in two patients,temporal lobe in two,frontal and insular lobe in one,and parietal and occipital lobe in one.After comparasion with MRI lesions,it was found that the hypometabolic regions were inconsistent with those lesions' locations detected by MRI.On the contrary,in the six patients with hypermetabolic regions,the MRI lesions' locations were found as being corresponding to the hypermetabolic regions.Conclusions The characteristic manifestation on PET imaging in RE is unilaterally diffuse hypometabolism or hybrid metabolic abnormalities with hypermetabolism on diffuse hypometabolic background.The most involved regions of metabolic abnormalities were temporal lobe,frontal lobe and insular lobe.All the characteristics could support the diagnosis of RE.The consistency between hypermetabolic regions and MRI lesions' locations indicated encephalitis or epileptic active regions,which might also be helpful for the brain biopsy.

Objective To report the experience on application of intraoperatvie direct electrical stimulation(DES) and continuous electrocorticography (ECoG) monitoring in surgical treatment of lesional epilepsy involving eloquent areas.Methods 49 consecutive epilepsy patients with structural lesions adjacent to eloquent areas from our institute between April 2007 and July 2012 were included.The patients were processed one-stage surgery with combined application of intraoperative DES and continuous ECoG monitoring.Results 48 patients successfully identified the eloquent area.One week after surgery,12 patients suffered worsened neurological dysfunction.At 6 months follow-up,3 patients had persistent worsened neurological dysfunction.Following up 1.5-6.0 years (mean 40.0 ± 14.4 months) in 47 patients,34 patients with Engels class Ⅰ,6 with class Ⅱ,3 with class Ⅲ,1 with class Ⅳ,and the total effective rate(patients in Engle's class Ⅰ and Ⅱ)was 81.6％.Conclusion Combined application of intraoperative DES and continuous ECoG monitoring can identify the eloquent area precisely,safely and reliably,and also can assist to localize epileptogenic foci.This technique can achieve good seizure outcome meanwhile decreasing incidence of neurological dysfunction for lesional epilepsy involving eloquent areas.

Objective To investigate the clinical characteristics,risk factors and potential mechanism of cerebral infarction post severe traumatic brain injury(TBI).Method Clinical records of 24 patients suffering cerebral infarction and 46 patients without cerebral infarction after severe TBI were reviewed retrospectively.Results patients with cerebral infarction got a survival rate at 58％,lower than patients without cerebral infarction (83％).The maximal body temperature (38.1 ± 0.8) ℃ in the first 24hrs,incidence of coagulating dysfunction (75％) and middle cerebral artery spasm(75％) were much higher in infarction group than the non-infarction group (P ＜ 0.05).Conclusion Cerebral infarction exerts a tremendous influence on the prognosis of severe TBI.Cerebral vessel spasm,devastation and compression of the vessel structure are the high risk factors for cerebral infarction after severe TBI.

Objective Non-functioning pituitary adenomas (NFPAs) may be locally invasive.Surgery is a treatment option,but unlike the case for functional pituitary adenomas,there are almost no drug treatments available for NFPAs.To identify the relationship of ENC1 gene with invasiveness in NFPAs and to observe whether the ENC1 expression level was different between invasive null cell adenomas and invasive oncocytomas.Methods In this study,we selected 23 null cell adenomas (14 invasive and 9 non-invasive tumors),20 oncocytomas (10 invasive and 10 non-invasive tumors) and 3 normal pituitary glands.ENC1 mRNA and protein expression level in all pituitary tumors and normal pituitary glands was detected by QPCR and western-blot.ENC1 protein expression level was observed by immunohistochemistry (IHC).Results Low levels of ENC1 were found in null cell adenomas and oncocytoma,while high levels were detected in normal pituitary glands.ENC1 mRNA expression level was reduced in invasive null cell adenomas compared to non-invasive null cell adenomas (P ＜ 0.0001) but the results were not found between invasive and non-invasive oncocytomas.Western blot analyses showed that ENC1 expression was significantly lower in invasive null cell adenomas compared with non-invasive null cell adenomas (P ＜ 0.005) and normal pituitary glands.The immunostaining results indicated the ENC1 staining was lighter in invasive null cell adenomas than in non-invasive null cell adenomas,and it was darker in normal pituitary tissues.Conclusion ENC1 may play an important role in invasive null cell adenomas.It could be a specific biomarker for invasive null cell adenomas.

Objective To provide the microanatomy for surgical operation for spastic torticollis.Methods Through the anatomy research of adult embalmed cadaver (8 cases,16 sides) to description the layer、course、beginning and ending points of muscle and the ramification course、distribution and diameter of spinal nerve dorsal rami nerve.Results Neck back muscles can be divided into four layers.The first layer are trapezius muscle and sternocleidomastoid; The second are splenius capitis muscle、splenius cervicis and levator scapulae muscle; The third layer are semispinalis capitis muscle、semispinalis cervicis muscle and longissimus capitis muscle; The last layer are obliquus capitis superior、obliquus capitis inferior、rectus capitis posterior major and rectus capitis posterior minor.Except C1 、C2 the others dorsal branch of spinal nerve are traveling backward.The diameter of the dorsal branch(mm):Left C1:0.87-1.62 mm(1.28 ±0.33) mm;C2:2.64-3.92 mm(3.12 ±0.49) mm;C3:1.56-2.11 mm(1.79 ±0.20) mm;C4:0.91-1.98 mm(1.41 ±0.46)mm;C5:0.92-1.39 mm(1.16 ±0.19)mm;C6:0.93-1.36 mm (1.14 ±0.24)mm.Right C1:0.92-1.49 mm(1.23 ±0.23) mm;C2:2.81-3.93 mm(3.19 ±0.43) mm; C3:1.52-1.92 mm (1.72 ± 0.17) mm ; C4:1.02-2.01 mm (1.42 ± 0.39) mm ; C5:0.89-1.63 mm (1.17 ± 0.31) mm; C6:0.81-1.39 mm (1.17 ± 0.23) mm.The C2-6 spinal nerve dorsal rami can be observed in the gap between semispinalis capitis and semispinalis cervicis muscle.Accessory nerve at a distance about 2 cm where great auricular nerve pierce the back edge of stemocleidomastoid muscle,the accessory nerve appear in the posterior cervical triangle.The diameter of accessory nerve which pierce the back edge of stemocleidomastoid muscle is 1.93-2.37 mm(2.10 0.18)mm (Left) ; 1.89-2.23 mm (2.09 0.14)mm (Right).Conclusions The above-mentioned anatomic relations of neck back muscles and spinal nerves can be provided foundation for post-cranial and neck surgery.Especially for the spinal nerve dorsal branch cut to treatment spastic torticollis provide an important reference.

Objective To investigate the brain functional connectivity network's small world' characteristics and evaluate the relationship between cognitive dysfunction and functional brain connectivity network.Methods Magnetoencephalography(MEG) recording were conducted during eyes-closed resting -state in 20 glioma patients and 20 healthy controls.The clustering coefficient,average path length and "small world" index were calculated in six frequency bands.All of them underwent 6 neuropsychological tests(including attention,verbal fluency,memory,sports ability,visual space ability and intelligence).Results In health controls,there were positive correlations between lower gamma frequency band "small world" index and attention,visual space,calculation and similar test results (P =0.049,0.006,0.040,0.000),there were positive correlations between upper gamma frequency band "small world" index and visual space,calculation and mapping test results (P =0.040,0.040,0.023).There were positive correlations between alpha frequency band "small world" index and similar test results (P =0.04).Compared to health controls,patients performed poorer Z scores in attention,verbal fluency,calculation,digit symbol and mapping tests (P =0.030,0.000,0.007,0.030,0.008),the lower gamma and upper gamma frequency band "small world" features disappeared.In glioma patients,upper gamma frequency band "small world" index and verbal fluency test results were positively correlated (P =0.030),alpha frequency band "small world" index and computation and mapping test results were positively correlated(P =0.020).Conclusions Lowed gamma frequency band and upper gamma frequency band "small world" index in functional connected network is widely correlated with cognitive functions.upper gamma and lower gamma frequency band functional connectivity network "small world" characteristic is disminished in patients with gliomas,and is significantly correlated with cognitive dysfunction.

Objective To study the methods and the curative effect of revision operation for Chiari I malformation complicated with syringomyelia followed surgical treatment.Methods The clinical data of 15 patients underwent revision operation for Chiari Ⅰ malformation complicated with syringomyelia followed surgical treatment from May 2004 to April 2013 were retrospectively reviewed,they still had symptoms and signs or/and suffered from symptoms aggravated.In the prior operation there were the enlargement decompression posterior cranial fossa in 8 cases,the decompression with resection of outer layer of the dura in 3 cases,the small bone window craniotomy decompression of posterior cranial fossa and resection of the hernia of cerebella tonsil in 2 cases,the decompression of posterior cranial fossa and dura plastic repair in 2 cases.The resection of the hernia of cerebella tonsil and exploration the fourth ventricle outlet were performed in the revision operation of 15 cases,reconstruction of the fourth ventricle outlet in 3 cases.Results The follow-up study from 4 months to 47 months (average 24.1 months) shown that symptoms were disappeared in 8 cases,significantly improved in 3 cases,improved in 4 cases,and syringomyelia decreased in all cases.Conclusions The resection of the hernia of cerebella tonsil and reconstruction of the fourth ventricle outlet is a safe,reliable and effective treatment for patients with failure surgical management of Chiari Ⅰ malformation complicated with syringomyelia.

Objective To discuss the operation approaches and long-term outcome of the intraspinal tumor.Methods To evaluate the clinical effect of different operative methods through a retrospective analysis of 423 cases of intraspinal tumors and follow-up analysis.Results 205 cases were with valid follow-up:135 cases were treated with the posterior median approach laminectomy,including 7 cases with postoperative bone structure deletion and spinal degeneration aggravated,2 cases recurred after operation,2 cases of lower limbs pain;45 cases with posterior median approach total laminectomy and lamina complex reduction and reconstruction operation,follow-up no discomfort; 20 cases with posterior median approach total laminectomy and pedicle screw internal fixation operation,including 1 cases of postoperative lower limbs dragging pain,gradually easing after two months; 5 cases with semi-laminectomy operation,postoperative recovery.Conclusions Operation is the preferred treatment strategy,and the main aim is to keep the preservation of neurological function and the stability of spine.Individual treatment should be preferred.

Objective To determine the pathological responses in tissue around the deep brain stimulation (DBS) leads in 1.5 T,3.0 T and 7.0 T magnetic resonance imaging (MRI).Methods Eighteen male Newzealand rabbits were randomly assigned to ultra-high field 7.0 T group (n =6),ultra-high field 3.0 T group (n =6) and the routine 1.5 T group (n =6).DBS devices were implanted into the rabbit brains of each group targeting the left VPN of thalamus.MRI scanning of corresponding field strength was conducted.After 24 hours,the brains were processed for HE staining and transmission electron microscopy (TEM).The results were semiquantified using our scoring system.All data were shown as mean deviation,and processed by one-way ANOVA analysis using SPSS 19.0 software.A P value less than 0.05 was considered statistically significant.Results In HE staining and TEM,the difference between the ultra-high field groups and the routine 1.5 T group was not significant (P ＞ 0.05).Conclusions In this study,the heating of DBS lead in ultra-high field MRI scanning failed to induce more injury than in the routine 1.5 T MRI,indicating that the ultra-high magnitude MRI scanning might not be as dangerous to the patients with DBS devices as we thought.

Objective To investigate the proliferation,apoptosis and migration of boron neutron capture therapy(BNCT) for C6 rat glioma cell-line.Methods The C6 cells,cultured by 10 B-DMEM and with irradiation by in-hospital neutron irradiator (IHNI),were divided into three groups:BNCT 3 Gy (Group Ⅰ),BNCT 6 Gy (Group Ⅱ),untreated control (Group lⅢ).The MTT assay was used to indentified the cell proliferation and draw the cell growth curve at 1-7 days of post-irradiation.The apoptosis rate was detected by flow cytometer (FCM) after 72 h of irradiation.Cell scratch test was performed to investigate the cell migration at 72 h of post-irradiation.Results One-well cell number of each group accounts to (7.90 ± 0.23) × 105,(5.40 ± 0.35) × 105 and (9.42 ± 0.23) × 106.Both Group Ⅰ and Ⅱ were with significant difference from Group Ⅲ(P ＜0.01).The apoptosis rates of three groups after 72 h of irradiation were (37.3 ± 0.7) ％、(84.7 ± 2.3) ％ and (23.1 ± 1.4) ％,each group showed statistic significancant difference to the others (P ＜ 0.01).Moreover,the C6 cells showed decreased migrating ability at 72 h after irradiation.Conclusions By using boron neutron capture therapy,it can effectively inhibit glioma cells' proliferation,induce apoptosis and weaken its migrating ability.

Glioma is the most common tumor in the central nervous system, accounting for about 45% of the primary tumors in the brain. Traditional methods such as surgery, radiotherapy and chemotherapy have not significantly improved the prognosis of glioma patients. Therefore, some new therapeutic methods are urgently needed to improve the clinical efficacy of glioma. In recent years, with the increase of research on the family of platelet derived growth factors (PDGFs), the expression, signaling pathway, tumor angiogenesis and gene methylation of PDGF-B in glioma have received more and more attention. PDGF-B and its receptors as targets to regulate glioma-related signaling pathway or inhibit tumor angiogenesis may become a new approach to glioma treatment. This article will review the above aspects.

Magnetic resonance imaging (MRI) is an important non-invasive examination method for neurologists to evaluate craniocerebral diseases. Nowadays, MRI equipment has been widely used in large and medium-sized cities in China. With the development of MRI scanning technology, some hospitals have begun to popularize the use of ultra-high field strength magnetic resonance scanning (static magnetic field strength>1.5T), and larger hospitals or medical centers have purchased 7.0T magnetic resonance scanner for medical research. Compared with high-field MRI and ordinary MRI, ultra-high field strength MRI has many advantages in imaging resolution and scanning time, and many lesions and nuclei that are difficult to distinguish by conventional field strength MRI can be clearly identified under ultra-high field strength MRI. Therefore, the application of ultra-high field strength nuclear magnetic resonance is of great significance to improve medical quality [1-2]. With the wide application of deep brain stimulation (DBS) technology in China, The safety of patients implanted with DBS equipment in magnetic resonance environment has become the focus of neuroimaging doctors. Studies have found that under certain conditions, MRI examination can cause a large amount of heat production from DBS electrodes and cause thermal damage to brain tissue. This article summarizes the problem of heat production from DBS electrodes caused by MRI.

Since the Italian scholar Guglielmi et al. [1] introduced the electrolytic platinum coil technology into the field of neurosurgery in 1991, the endovascular treatment of intracranial aneurysm has pioneered the milestone treatment of coil embolization. Although this technology has been continuously improved and perfected, the reports of various cases with unsatisfactory treatment effect during and after operation have gradually increased and become a treatment problem. In 1995, Gurian et al. [2] of the University of California in the United States first reported the surgical treatment of 21 patients after intracranial aneurysm embolization, and then similar cases have been reported continuously, but most of them are dozens of small cases. In 2011, Romani et al. [3] reported 81 such cases treated by Helsinki University Central Hospital in Finland, which is also the research institution with the largest number of reported cases so far. The author found that there are very few such documents for reference in China, and there is no relevant review, so the author has sorted out the main documents at home and abroad as follows.

For a long time, research on the molecular mechanism of the occurrence and development of pituitary adenoma has never stopped, trying to understand this high-incidence tumor from the level of genes and proteins, in order to obtain better early diagnosis, prognosis evaluation and treatment. As a non-coding RNA, miRNA participates in the post-transcriptional regulation of target genes, thus affecting the biological processes of cell proliferation, cell cycle regulation, apoptosis, cell differentiation and migration [1]. In recent years, miRNA has become a hot spot in the field of tumor research. The research progress of miRNA related to pituitary adenoma is summarized as follows.

There are many reasons leading to olfactory disorders, about 2/3 of them are caused by upper respiratory tract infections, trauma and paranasal sinus diseases that damage olfactory neuroepithelial cells. Other factors include age, neurodegenerative diseases, smoking, iatrogenic injury, etc. [1-2]. In the field of neurosurgery, olfactory disorders after transnasal sphenoidal sinus pituitary adenoma resection are not uncommon, but they are often easily ignored. There are few epidemiological data and related mechanisms of olfactory disorders after transnasal sphenoidal sinus pituitary adenoma resection at home and even internationally. However, olfactory sense plays a very important role in human life activities, which not only plays an alarming role, but also is closely related to the quality of life. People will reflexively avoid pungent odors such as gas, alcohol or strong acid when they smell, and then reflexively secrete gastric juice when they smell the aroma of delicious food. Therefore, in today's society, which pays more and more attention to the quality of life, olfactory disorders should be paid enough attention.

Anaplastic glioma is a common intracranial malignant tumor, mainly including anaplastic astrocytoma, anaplastic oligodendroglioma, anaplastic oligodendroastrocytoma and anaplastic ependymoma, etc. Recent studies have found that there are obvious differences in clinical treatment plan and effect between anaplastic glioma and glioblastoma multiforme (GBM), which should be treated differently. 1. Pathology 1. Histological characteristics: The pathological characteristics of typical anaplastic glioma are moderate cell proliferation, moderate cell morphology and nuclear atypia, enhanced mitotic activity, and microscopic vascular proliferation. Except for anaplastic ependymoma, the other three types are not accompanied by necrosis. The difference between the latter and lower grade glioma is that the latter has low mitotic activity, and the difference between the latter and higher grade glioma is that the latter has significant vascular proliferation and necrosis [1].

In 2014, the Chinese Journal of Neurosurgery published the preliminary statistical results of the Chinese Craniocerebral Trauma Database led by me: Among the 11,937 inpatients with acute craniocerebral trauma in 47 hospitals, the mortality rate of patients with severe craniocerebral trauma was 27.23%, and the death and severe disability rate was>53.17% [1-2], which is similar to the results reported recently in large numbers of craniocerebral trauma cases worldwide [3]. I have been engaged in clinical treatment of craniocerebral trauma for 31 years, and put forward some opinions on how to further improve the success rate of craniocerebral trauma treatment in my country for peers' reference. First, it is necessary to establish the on-site rescue, transportation and standardized diagnosis and treatment process of craniocerebral trauma in most areas of China, which has made great progress in on-site first aid and transportation of all kinds of craniocerebral trauma patients. County-level hospitals and even township hospitals in developed areas have been equipped with CT equipment, so that craniocerebral trauma patients can be diagnosed in time and accurately, which provides a reliable basis for rescuing patients and defining treatment plans.

The patient, a 32-year-old male, was admitted to hospital due to "coma for more than 5 hours after head accident trauma". More than 5 hours before hospitalization, the patient collided with a van while riding a motorcycle, resulting in head injury, immediate ether, traumatic hemorrhage of right forehead skin, hemorrhage of left external auditory canal, and non-jet vomiting of gastric contents. Skull CT: bilateral basal ganglia and left parietal lobe hematoma, brain swelling, cerebral edema, subarachnoid hemorrhage (Figure 1a). No previous history of hypertension, headache, epileptic seizures, and taking anticoagulants. Physical examination: coma, bilateral pupil diameter about 2 mm, light reflex disappeared, bleeding was seen in the left external auditory canal, multiple skin lacerations on the left face, a little exudation, and stinging pain and hyperextension of the limbs. On the same day, bilateral small bone window hematoma evacuation was performed in the emergency department under local anesthesia microscope, and tracheotomy was performed. After part of the hematoma was removed during the operation, a tube was placed in the bilateral hematoma cavity for drainage. After the operation, 5ml normal saline +20,000 units of urokinase was injected into the hematoma cavity on each side every day, and the tube was clamped for 4 hours and then released for drainage. Conventional dehydration, anti-inflammatory, cooling, supportive treatment, etc. The diagnostic opinions of head CT reexamination 2d after operation: postoperative manifestations of brain trauma, bilateral basal ganglia and left parietal lobe hematoma, brain swelling, cerebral edema, subarachnoid hemorrhage, intraventricular hemorrhage, and a small amount of intracranial gas accumulation (Figure 1b). One month after the operation, the patient continued to be in coma, body temperature 38~39℃, no vomiting or convulsion.Physical examination: GCS 7 scores, bilateral pupil diameter about 2mm, obtuse to light reflex.The breathing sound of both lungs was coarse, a few wet rales could be heard, the abdomen was soft, mobile voiced sound (-), and the limbs were tingling and hyperextension.Due to economic reasons, DSA or CTA examination was not performed, and the patient was transferred to the local area for treatment 40 days after the operation.

30% ~50% of children's cerebral hemorrhage is caused by rupture of cerebral vascular malformations [1]. Many reports report that 50% ~70% of children's cerebral vascular malformations are clinically manifested as cerebral hemorrhage [2]. Cerebellar hemorrhage is an emergency that seriously threatens children's lives. From January 2012 to January 2014, 3 children with cerebellar vascular malformation hemorrhage were treated in our hospital, and the reports are as follows. Case report: 1 female, 11 years old, with sudden headache and vomiting as the first symptoms. Deep coma, GCS: 1+1+2=4 points, pupil of equal size, diameter 2 mm, weakened light reflex, irregular breathing and unequal rhythm. Bilateral pyramidal tract sign (+). Imaging examination: CT showed intracerebral hematoma in the cerebellar vermis, with a volume of about 8~10 ml, the fourth ventricle disappeared, and mild supratentorial ventricular dilatation. CTA showed abnormal vascular shadows in the cerebellar vermis. Posterior cranial fossa craniotomy and hematoma resection were performed in the emergency department. During the operation, there were malformed vascular masses below the cerebellar vermis and the right cerebellar tonsil. Osteectomy and decompression of the median occipital squamous region, the posterior foramen magnum and the posterior arch C1 were performed. There was no abnormal bleeding and intracranial pressure change during the operation. Tracheal intubation was performed after the operation to ensure the stability of respiratory and other vital indexes. After the operation, the patient was hospitalized for 21 days and recovered smoothly. After 5 months after discharge, the patient had intermittent mild dizziness and took care of himself.

low pressure hydrocephalus (LPH) is rare in clinic. In 1994, 12 cases of LPH after shunt surgery were systematically reported for the first time, and the concept and diagnostic criteria of LPH were put forward [1]. Recently, several cases of LPH have been reported internationally, but few in China [2]. The imaging manifestations of LPH are ventricular enlargement, but the intracranial pressure is lower than normal intracranial pressure, often lower than 80 mmH2O. This contradictory phenomenon, namely intracranial depression and ventricular enlargement, often causes confusion among neurosurgeons. Three cases of LPH admitted to our hospital from 2010 to 2013 are reported as follows. Case report: 1 male, 42 years old. He was admitted to hospital due to "unconsciousness caused by car accident for 2h" and underwent left frontotemporal craniotomy to remove subdural hematoma plus decompressive craniectomy. After operation, he was unconscious and could only stay in bed. He raised his hand according to the instructions, could make a voice, and the bone window was obviously depressed. CT examination showed mild hydrocephalus.

The Meckel sac is located on the medial side of the middle cranial fossa and below the posterior and lateral side of the cavernous sinus. It is a non-sealed space formed by the dura mater protrusion from the posterior cranial fossa to the middle cranial fossa, and there are trigeminal nerve roots and semilunar ganglia in it [1]. In the past, craniotomy was used for tumors in this area, which required brain tissue to be pulled and could not completely expose the anterior and medial side of the trigeminal nerve, so the tumors were easily retained [2]. Two cases of left Meckel sac tumors were effectively resected by endoscopic approach through nasal, maxillary sinus and pterygoid process. Case report: A 49-year-old male with "left facial numbness and chewing weakness for 4 months" was admitted to hospital.

The patient, a 60-year-old man, accidentally fell from the fourth floor on the construction site of the hospital on May 20, 2012. His head directly hit the steel pipe scaffold on the second floor, and he suffered occipital bleeding and coma. After on-site treatment, he was urgently transferred to the emergency room of the hospital. The scalp in the parieto-occipital area was cracked and bleeded. The wound was 5 cm long, and there was bone friction in the local area. The wound was connected with the fracture site, and the wound was sutured and bandaged immediately. The mouth and nose bleeding was foamy, and the patient was in a deep coma. Breathing difficulty, facial cyanosis, increased heart rate, unstable blood pressure, and blood oxygen saturation dropped below 70%. The blood fluid in the nasal cavity was continuously sucked out with an aspirator, but the state could not be improved. The symptoms were improved after urgent tracheal intubation assisted artificial respiration. CT examination of the head, neck and chest was performed.