Volume 30 · Issue 09 · 2014

In 1966, Jannetta initiated microvascular decompression (MVD) in the treatment of cranial nerve diseases. Its theoretical basis is that the responsible vessels in the cerebellopontine angle (CPA) compress the root entry/exit zoon (REZ) of different cranial nerve roots, which can lead to the corresponding syndrome, namely neurovascular compression (NVC) syndrome. MVD achieves the therapeutic purpose by pushing the responsible vessels away from REZ. MVD has been rapidly spread in clinic because of its safety and effectiveness, and was introduced into China around 1985. Nearly half a century has passed since the establishment of MVD, as the best therapeutic effect in the field of functional neurosurgery, it is still not widespread in China, and there is still a great imbalance in its development between regions, so the treatment level needs to be improved urgently. China has a huge population base, and there are many patients with cranial nerve diseases waiting for treatment. As a kind of functional neurosurgery with extremely high degree of precision, the standardized operation technique of MVD still needs to be further promoted. It is of great significance to organize domestic experts and scholars in the treatment of cranial neurological diseases with MVD to discuss and write expert consensus for improving the overall treatment level of MVD in China.

Objective To evaluate the experience of endovascular treatment in patients with horizontal segment aneurysms (A1 segment) of anterior cerebral artery.Methods The clinical data,angiographic results,embolizaition techniques and follow-up results of 16 A1 segnent aneurysms treated by embolization were retrospectively reviewed.Results All the patients were treated by selective embolization including five patients with balloon-assisted coiling (BAC) or stent-assisted coiling (SAC).According to the location and direction of aneurysms,the microcatheter tips' shaping was used for the microcatheter's position and stabilization.All patients showed excellent clinical outcomes.The complete aneurysm occlusion was obtained in all the patients.Conclusions Endovascular treatment of A1 aneurysms was feasible and effective.The application of BAC or SAC might be required.Microcatheter tip shaping technique was very important for coiling.

Objective To study different vascular structure between cavernous malformations (CMs) and arteriovenous malformations(AVMs) and different changes of CMs and AVMs after radiosurgery.Methods 33 specimens,among them three irradiated CMs,three postradiation AVMs,six nonirradiated CMs,seventeen nonirradiated AVMs,and four normal controls were processed for ultrastructural study immediately after removal.Results compared with AVMs,CMs showed a higher ratio of intraluminal diameter to vessel wall thickness and a lack of subendothelial fibroblasts,myofibroblasts and smooth muscle cells.Partial proteinaceous clots(19％-22％ of lumen) formed in CMs sinusoids after radiosurgery but complete vaso-occlusion did not occur for up to 6 years after radiosurgery.In contrast,complete vaso-occlusion(91％-98％ of lumen) by fibrin thrombi that are permanent clots was observed in AVMs vessels.Radiation-induced neuronal loss,neurofibrillary degeneration of neurons and myelin fragmentation were typical in the surrounding brain tissue of the irradiated lesions.Conclusion The different structure and cellular compositions of CMs and AVMs are likely to influence their responses to radiosurgery.

Objective To explore the surgical strategy for insular cavernous malformations (CMs).Methods Between Dec.2007 and Aug.2013,4 patients with insular CMs were treated surgically through transsylvian approach by using image guidance system (neuronavigation in two cases,ultrasound in four cases).Results The seizure was the initial symptom in 4 patients with insular CMs.The image guidance system provided high-quality intraoperative imaging and guided the perfect operative approach of insular cortex dissection.All CMs were completely removed via transsylvian-transinsular approach.The mean follow-up period was 36.75 months (ranged from 3 to 72 months).Permanent neurologic morbidity after surgery was observed in 1 patient.One patient with dominant hemisphere lesion had temporary dysphonia,and the language function was recovered after 1 week.4 patients were Engel class Ⅰ.Conclusions Surgical resection of insular CMs through transsylvian approach was safe.Neuronavigation and intraoperative ultrasound were recommended,especially for patients whose lesion was located in the dominant hemisphere.

Objective To analyze the guiding significance of 3D-DSA images of simulated pterional approach before craniotomy clipping surgery of intracranial aneurysms.Methods 45 cases of intracranial aneurysms and craniotomy clipping surgery patients were included in this study.The data of preoperative rotating angiography to target vessels were transferred to AW4.5 computer workstation for data reconstruction.The reconstructed images were rotated to simulated pterional approach.The relevant information and data of the 3D-DSA images of simulated pterional approach were observed and measured to guide intracranial aneurysm clipping surgery and were compared with the data of surgery.Results The information and data in the 3D-DSA images of simulated pterional approach was accord with the actual condition in operation.The preoperative choice of aneurysm clips was in accord with that during operation.Conclusions Rotating the 3D-DSA images to simulated pterional approach before the operation could make the surgeon to obtain a lot of information,and had important significance to improve the success rate of operation,and to reduce operation complication rate to improve the prognosis of patients.

Objective To discuss the value of 4D-CTA using 320-row area detector in diagnosis of cerebral arteriovenous malformations (CAVMs) from the aspects of nidus detection and angioarchitecture.Methods 20 suspected CAVM patients were enrolled.4D-CTA was performed before digital silhouette angiography (DSA).Location and size of niduses and numbers of feeding arteries and draining veins shown in this two imaging methods were Abserved.Results All patients were diagnosed as CAVMs by 4D-CTA and 1 case was confirmed as arteriovenous fistula by DSA.In this 19 CAVMs,the location and size of nidus and the numbers of feeding arteries and draining veins shown by 4D-CTA were sufficiently accurate when compared to DSA (P ＞ 0.05).Conclusions Non-Invasive 4D-CTA was able to detect CAVMs and display the dynamic blood flow.It can be a useful option in the diagnosis of CAVMs.

With the increasing maturity of microsurgery for intracranial aneurysm and the continuous improvement of microscopic instruments, the surgical approach for aneurysm should not only have good surgical field exposure and sufficient operating space, so as to successfully clip the aneurysm and control the rupture and bleeding of the aneurysm during operation, but also implement the concept of minimally invasive surgery throughout all aspects of its treatment, so as to maximize the treatment effect and reduce the occurrence of complications [1]. At present, the main surgical approaches for microsurgery of anterior circulation artery aneurysm include traditional pterional approach [2] and eyebrow arch keyhole approach [3]. This paper retrospectively analyzed the microsurgical clipping of 60 cases of 65 aneurysms in the acute phase of rupture in our hospital from October 2010 to June 2011. The purpose was to explore the application and operation skills of lateral supraorbital approach in microsurgery of anterior circulation artery aneurysm in the acute phase of rupture.

In recent years, more and more intracranial aneurysms have been treated with endovascular embolization, but there are still challenges in the endovascular treatment of ruptured intracranial microaneurysms (maximum diameter ≤3 mm). This article retrospectively analyzed 37 cases of ruptured intracranial microaneurysms treated with endovascular coil embolization in our department from January 2007 to March 2013, accounting for 11.3% (37/326) of the endovascular treated aneurysms in the same period.

The incidence of intracerebral cavernous vascular malformations is 0.4% ~0.6% [1-3], accounting for 10% ~15% of central system vascular diseases [2]. The clinical manifestations include epilepsy, headache and neurological deficit, and severe neurological deficit, hydrocephalus and fatal massive hemorrhage are rarely occurred [4-7]. Spontaneous repeated hemorrhage is the basic characteristic, and surgical resection is the first choice for cavernous vascular malformations [4, 8]. However, most cavernous vascular malformations are small in size and deep in location, and intraoperative localization is difficult. Therefore, high-precision localization is very important for resection of cavernous vascular malformations. From September 2010 to October 2011, 16 cases of small cavernous vascular malformations in the deep supratentorial brain were resected by frameless neuronavigation-assisted microsurgery in the Department of Neurosurgery, West China Hospital, Sichuan University. The summary report is as follows.

Objective To investigate the clinical manifestation and radiological features of hypothalamic glioma (HG),and to evaluate the surgical efficacy and prognosis.Methods 36 cases of HG presenting in the department of neurosurgery of Nanfang hospital were respectively analyzed.The long term follow-up was performed through recheck in outpatient department,telephone and letter.Results Solid and cystic mixed tumor was more common in pilocytic astrocytoma (PAS).However,fiber astrocytoma was predominantly solid.The calcification of tumor was more common in astrocytoma or oligodendroglioma.The postoperative endocrinological deterioration in varying degrees was found in all patients.Between GTR group and STR + PTR group,there was no significant difference of the incidence of multi-axial hormone deficiency (P =0.474) and diabetes insipidus after surgery (P =0.366).During the follow-up period,among 7 recurrence cases,three occurred in GTR group (18.7％),was slightly lower than STR + PTR group (P =0.022).Moreover,there was no difference about the quality of life of two groups (P =0.216).Conclusions It was useful to make the clinical diagnosis better with well understanding the clinical characteristics of HG.Surgical treatment remained the first choice of treatment.GTR won't deteriorate the incidence of diabetes insipidus and endocrine levels more than STR + PTR.For unclear interface and close adherence to hypothalamus,STR based on sufficient decompression reduced the perioperative incidence of death,and meanwhile obtained the satisfying clinical effects.

Objective To evaluate the surgical methods and treatment effects of the parasagittal meningiomas in central area.Methods 36 cases with parasagittal meningiomas in the central area were treated with microsurgery.The imaging data,surgical approaches,surgical techniques and strategies of the tumor were analyzed retrospectively.Results Simpson Ⅰ,lⅡ,and Ⅳgrades resection were achieved in 4,15,and 17 patients respectively.There was no death.Two patients developed cerebral edema and infarction and surgical decompression was performed.The cranioplasty was carried out after 3 months and all the 3 patients returned to normal life.The limb muscle strength of 5 cases were improved.Hemiparalysis was deteriorated in 10 patients,7 of them recovered spontaneously within 1 to 8 weeks,and the other 3 developed hemiparesis.17 cases (Simpson Ⅳ resection) underwent the radiotherapy within one month.25 patients were followed-up from 3 months to 3 years.3 patients had recurrent meningiomas in 1 to 3 years after the operation and underwent surgery again.Conclusions Sufficient preoperative evaluation,choosing appropriate surgical approaches,avoiding injury of brain cortex,central sulcus vein,venous drainage and superior sagittal sinus were the keys for ensuring and improving the curative effects of the operation.The pursuit of total resection should be avoided when the tumor with close brain tissue adhesion,close central sulcus vein and around tumor venous drainage adhesion,and the invasion to superior sagittal sinus.

Objective To study the protective effects of intraoperative waken-up and central sulcus location on motor function for patients with gliomas locating in motor areas.Methods 56 patients with gliomas in motor areas were intubated with laryngeal mask,rapidly underwent craniotomy without scalp clips,waken-up,localized the central sulcus by somatosensory evoked potential.On the condition of protecting the brain function,the greatest degree of tumor resection was performed and then the close-skull under awake state or general anesthesia was finished.Results All the patients underwent operation successfully.Except for the emergence of new nervous dysfunction in four patients,most patients' neurological functions were not deteriorated or even had improved.Besides,there was no complication and postoperative painful memories for the patients.Conclusions Resection of gliomas in motor areas with intraoperative waken-up and localization of central sulcus could ensure the largest degree of tumor resection on the premise of protection of the brain function.As a result,it could improve the prognosis of the patients.

Objective To investigate the surgery strategy of patients with epileptogenic dysembryoplastic neuroepithelial tumors (DNTs).Methods The retrospective analysis of surgical experiences of 14 patients with DNTs in our hospital was performed.The tumors and epileptic foci were evaluated preoperatively by MRI and VEEG as routine.Using EcoG monitoring during the operation,we performed the resection of tumors and epileptic foci together.Results The tumors were cut off completely in all the patients.The histological examination confirmed that all lesions were DNTs.Radiotherapy or chemotherapy was not performed after the operation.There was no recurrence of tumors.Engel Ⅰ outcome (seizure-free) was noted in 10 patients and Engel Ⅱ outcome(rare seizure) in 4.Conclusions The DNT is low grade neurons to glial cell tumor.It is common in teenagers and always compares with intractable epilepsy.Management of epileptic foci around the tumor showed favorable results in the controlling of epilepsy.

Objective To explore the relationship between tumor location of low grade gliomas in motor area and motor dysfunction by drawing the dyskinesia risk map.Methods All of images of patient were registered to T1 weighted brain atlas (MNI152; Montreal Neurological Institute),calculating the overlay layer of motor dysfunction account for the total number of overlay for each voxel,in order to draw the dyskinesia risk map.Results The dyskinesia risk map was acquired by quantitive neuroimage analysis.The medial part of the hand knot had more effects on motor strength than the lateral part.The risk values of the lateral part of hand knot and secondary motor areas were lowest.From the lateral part to the medial,the risk values increased gradually from 40％ to 80％.Conclusions The dyskinesia risk map could demonstrate the relationship between low grade gliomas in motor area and motor dysfunction effectively,and predictively evaluate the motor dysfunction.

Objective Selective posterior rhizotomy (SPR) of lumbosacral region was a well-recognized treatment for spasticity of lower limbs in spastic cerebral palsy (CP).However,there was still no agreement on long-term outcome of SPR.The purpose of this study was to assess the long-term outcome in a large amount of patients by using quantitative,standardized assessment tools.Methods 141 patients who had undergone SPR from Jan.2001 to Dec.2006 were followed-up with integrated clinical data for at least 9 years averagely.The outcomes were assessed at the time points of 1 year,5 years and final trace after operation respectively with quantitative,standardized assessment tools,including Modified Ashworth Scale (MAS),Gross Motor Function Classification System (GMFCS) and performance of Activities of Daily Living Scale(ADL).Combined with the subsequent treatment which was required by those patients,statistical analysis was performed to evaluate the long term effects of SPR.Results MAS scores in hip adductors,knee flexors and ankle plantar flexors were reduced persistently until the final follow-up visit and the differences were statistically significant (P ＜ 0.01).The overall improvement rate of muscle tone during follow-up was 90.7％.The distribution of GMFCS was statistically different compared with preoperative levels(P ＜ 0.01).The overall improvement rate of gross motor function compared with preoperative was 80.1％.ADL scores were statistically different when compared with preoperative group(P ＜0.01).The overall improvement rate of quality of life was 88.9％.When stratified by the preoperative GMFCS,the ADL Scores of GMFCS Group Ⅱ and Ⅲ continued to increase after SPR.The proportion of patients who received subsequent procedures including selective peripheral neurotomy (SPN),Achilles tendon lengthening,orthopedic surgery and botulinum toxin treatment was 27.7％ at final follow-up.The independent-samples T test showed that the necessary subsequent surgical treatments after operation significantly increased the last follow-up ADL score improvement(P ＜ 0.01).Conclusions The benefits of SPR were persistent in the majority of patients.These benefits were mainly improved muscle tone,gross motor function,and performance of ADL.Patients in preoperative GMFCS Groups Ⅱ and Ⅲ were most likely to display these long-term benefits.Postoperative necessary subsequent surgical treatments contributed to maintaining and improving motor function,and eventually improved the performance of activities of daily living.

Objective To discuss the microsurgery treatment of lipoma tethered cord syndrome in infants.Methods 125 infants with lipoma tethered cord syndrome were followed-up from Jan.2004 to Jan.2012 in Yuquan hospital of Tsinghua university.The neurological examinations,MRI image,bladder post void residual and electrophysiological examination were conducted preoperatively.The microsurgical treatment with intraoperative electrophysiological monitoring was performed in all the cases.The evaluation methods were divided into short-term efficacy and long-term efficacy.The indexes of short-term efficacy included Hoffman grading system,Kirollos grading system and complication evaluation.The indexes of long-term efficacy included clinical symptoms,bladder post void residual and electrophysiological examination.SPSS 16.0 was used to analyze data.Results The degree of untethering at microsurgery which was based on Kirollos grading system was assessed:GradeⅠin 108 cases (86.4％),GradeⅡin 13 (10.4％),and GradeⅢ in 4 (3.2％).14 cases (11.2％) ocurred complications.According to Hoffman grading system,there was significant difference in group of non-symptom and mild-symptom between pre-operation and post-operation (P ＜ 0.05).While there was no significant difference in group of moderate-symptom and severe-symptom between pre-operation and post-operation (P ＞0.05).There was significant difference in bladder post void residual between pre-operation and post-operation.There was no recurrent case by MRI image in follow-up period.There was significant difference in clectrophysiological examination indexes between pre-operation and post-operation.Conclusions Good efficacy was obtained by microsurgery in infants with lipoma tethered cord syndrome.The intraoperative electrophysiological monitoring might improve the safety of operation.

Objective To study the pathological features and the timing and effects of epilepsy surgery in children with intractable epilepsy.Methods The outcomes of 71 pediatric cases that underwent epilepsy surgery in our department were collected.All the patients had at least 1 year of follow-up.The effects of operation were evaluated with Engel class.Results Seizure freedom (Engel Class Ⅰ outcome) was achieved in 45 cases (63％),26 patients (37％) continued to have seizures (Engel Class Ⅱ ～ Ⅳ outcome) (P ＜ 0.05).The major pathological findings in these patients included:focal cortical dysplasia in 31 cases,low grade neoplasm in 18,ulegyria in 13,polymicrogyia malformation in 6,tuberous sclerosis in 3,and dual pathology in 9.There was no death or permanent disability.Conclusions Early surgical intervention was safe and effective for the treatment of intractable epilepsy in children.The relation between the pathological features and surgical effects should be paid attention for further study.

Objective To discuss the value of the hanging techniques in microvascular decompression (MVD) of hemifacial spasm (HFS) caused by the complex vasculature.Methods The conflict artery in 24 cases involve 3 types:the first was the large offending vessel with compression much more heavily such as the vertebral artery (VA) combined with the branch vessels;the second was multiple vessels with more compression points or with short and small perforating arteries;the third was an elongated loop of the conflict artery or more compression points between the loop and the nerve.Those complex vasculatures were difficult to be maneuvered in permanent and complete transposition.So a sling piece of Teflon sponge was used to wrap and hang the offending vessel and then the vessel was adhered to the petrous dura with fibrin glue.Results The large heavy compressed conflicting vessel was found in 18 cases:11 cases of VA associated with anterior inferior cerebellar artery (AICA);3 cases with posterior inferior cerebellar artery(PICA);4 cases with AICA and PICA.The multiple vessels were found in 4 cases:AICA associated with PICA.An elongated loop was found in 2 cases:AICA combined with the labyrinthine artery.Using the hanging technique,the permanent and complete transposition of the offending vessel was achieved.The mean follow-up period was 2 years.All patients experienced complete spasm resolution without complication.Conclusions In the treatment of HFS by MVD,insufficient decompression might occur with complex vasculature.The hanging technique was a safe and effective method which could provide complete and permanent transposition of the offending artery.

primary intracranial extradural meningiomas (PIEMs) refer to meningiomas originating from the intracranial epidural space, including meningiomas originating from the outer layer of the dura mater and growing to the epidural space or skull meningiomas breaking through the inner plate and developing to the epidural space, but not invading the subdural space and its structure [1-3]. Epidural development and long-distance metastasis of intracranial meningiomas are not included. PIEMs originate from the outer layer of the dura mater [4-6], or from the skull plate barrier or inner plate, invading the subdural space and growing [1, 3, 7-12]. Since Rao reported the first case of epidural meningioma originating from the outer layer of the dura mater in 1971 [4], only 12 cases have been reported in the literature [3-12], and few are reported in China. From May 2007 to October 2012, we confirmed 5 cases of PIEMs by surgery and pathology, accounting for 0.14% of meningiomas in the same period. The following is reported in combination with the literature.

Objective To study the Effects of Flt-1 gene on the expression of VEGF and proliferation in BT325 cells.Methods The total RNA was extracted from human umbilical vein endothelial cells as the template and Flt-1 gene was amplified by reverse transcription polymerase chain reaction(RT-PCR).By using gene recombination technique,the Flt-1 cDNA was inserted into eukaryotic expression vector pEGFP-C1.The recombinant plasmid was identified by restriction enzyme digestion and sequence analysis.It was infected into BT325 cells.The quantity of VEGF protein in supernatant was detected by ELISA.The proliferation abilities were measured by MTT and FCM.Results The Flt-1 gene could be obtained by RT-PCR.The restriction enzyme digestion and PCR suggested that the recombinant plasmids were constructed successfully.72 hours after transfection,the VEGF protein levels were decreased (transfection group (56.3 ±41.2) pg/ml,untransfection group (95.5 ±35.3) pg/ml(P ＜0.05) and the proliferation rate of cells was inhibited transfection group (42.6 ± 3.7) ％ and untransfection group (92.8 ± 6.6) ％ (P ＜ 0.05).Conclusions Flt-1 gene could inhibit the expression of VEGF and BT325 cells proliferation and induce their apoptosis in vitro.

Objective To study the electrophysiology and pharmacology of voltage-dependent calcium channels (VDCCs) currents in cerebral artery myocytes of rats specifically to help for related arterial physiology or pathology research.Methods Myocytes were isolated enzymatically and patch clamp was used to test the resting potential and VDCCs currems in whole model,as well as effects of extracellular divalent cations concentration and Nifedipine on VDCCs currents.Results The resting potential was (50.42 ±0.26) mV,step protocol at 10 mV and ramp protocol at (9.80±0.92) mmol/L elicited maximum VDCCs currents density in (-5.22±0.51)pA/pF and (-4.89 ±0.65) pA/pF (10 mmol/L BaCl2).The maximum VDCCs currents consisted of high-voltage activation (HVA) VDCCs exclusively (P =0.17),however,denying the existence of low-voltage activation (LVA) VDCCs currents.Furthermore,the VDCCs currents density correlated with extracellular Ba2+ concentration positively (P ＜ 0.05),and of the VDCCs currents,Nifedipine was able to inhibit 86.13 0.76％ maximally with the IC50 6.02 mmol/L Conclusions Our study confirmed that HVA-VDCCs accounted for all the VDCCs currents and Nifedipine-insensitive calcium currents (NICCs) in cerebral artery myocytes of rats.Accordingly,further studies in term of ion channel (s) accounting for NICCs and its significance for myogenic tone of cerebral artery and cerebral autoregulation are required.

Primary glossopharyngeal neuralgia (GPN) mainly manifests as paroxysmal pain in the pharynx, tonsil area and tongue base, which brings great pain to patients in severe cases, and a considerable number of patients need surgical intervention [1]. At present, microvascular decompression (MVD) by posterior sigmoid approach has become the first choice for surgical treatment [2]. This article reviews the progress of surgical treatment of primary GPN in recent years.

Moyamoya disease (MMD) is a common neurosurgical disease, which is characterized by progressive stenosis until occlusion of the end of the internal carotid artery, which forms compensatory proliferation and expansion of smoke-like blood vessels at the base of the skull. These abnormal blood vessels are mostly expanded and thickened perforating vessels at the base of the brain, except for some new blood vessels. At the same time, the external carotid system gradually undergoes intracranial compensation to form communication [1-3].

Oligodendrocytic tumor is a common type of glioma in the cranium, accounting for about 4% ~15% of the incidence of glioma [1]. Histopathological types include oligodendrocytoma (OD) and anaplastic oligodendrocytoma (AOD), which have significant molecular pathological features and better prognosis than astrocytic tumors of the same grade and mixed tumors [2-3], but the specific mechanism is unknown.Proteomics through high-throughput research methods to study proteins and related molecular biological mechanisms, it is possible to discover specific molecular and pathological mechanisms related to glioma, and reveal the biological characteristics of tumor hidden behind clinical phenomenon.Since Hanash et al. [4] reported glioma proteomics in 2002, researchers have carried out in-depth and detailed research through different tissue sources.

bacterial meningitis (BM) after craniotomy is a serious complication after neurosurgery. It is reported that BM can occur in 0.8% ~1.5% of patients after craniotomy [1]. Early treatment of BM is very important for the survival and prognosis of patients, and the mortality rate of patients without timely treatment is 20% [2]. Early recognition of postoperative BM and timely application of antibiotics will reduce the risk of death and disability of patients.

From May 2011 to April 2014, we performed a total of 7 cases of depressed and comminuted fractures of the forehead in the acute phase, reconstruction of anterior skull base and repair of cerebrospinal fluid leakage. The treatment experience is reported as follows. 1. Materials and methods 1. General data: There were 7 cases in the group, aged 23-47 years, with an average age of 36 years. There were 5 males and 2 females. There were 6 cases of car accident, 1 case of fall injury, 5 cases of clarity, 2 cases of coma, 4 cases of open wound on the forehead, 2 cases of optic nerve injury, and 7 cases of cerebrospinal fluid rhinorrhea.

Radiotherapy is one of the conventional treatment methods for craniocerebral diseases, especially for intracranial malignant tumors. Since Albert et al. first reported that radiotherapy can induce intracranial tumors, there have been continuous reports of intracranial tumors induced by radiotherapy [1]. This paper reports 3 cases of intracranial tumors with different tissue types after radiotherapy and reviews the literature.

Cavernous vascular malformation is a common benign tumor, belonging to a kind of congenital vascular malformation, mainly involving the cerebral hemisphere, cerebellum, brainstem and spinal cord. Cavernous vascular malformation occurring in the spinal canal and epidural is very rare, accounting for 5% ~12% of intraspinal vascular lesions [1]. A case of simple epidural cavernous vascular malformation in the lumbar spinal canal was treated in the Department of Neurosurgery of Xiangyang Central Hospital of Hubei Province, and the report is as follows.

Epidural hematoma is a common disease in neurosurgery, and its main components are mostly blood clots and blood [1], and cerebrospinal fluid is the main component. Two cases of acute epidural hematoma with liquid components as the main component were treated in our department, and the report is as follows. Case report 1 male, 18 years old, was admitted to hospital due to headache 1h after head trauma, and fell injury. Physical examination: skin contusion was seen in the left occipital region, and there were no positive signs in neurological examination. Brain CT showed acute epidural hematoma (Figure 1a), with the midline position in the middle, and routine treatment was given. After 3 hours of admission, brain CT reexamination showed that the acute epidural hematoma was enlarged, mainly with liquid components, and the liquid level was visible (Figure 1b), and the midline structure was in the middle. After 19 hours of admission, brain CT reexamination showed that the acute epidural hematoma was reduced, and the liquid components disappeared (Figure 1c). After continuing conservative treatment, the patient's condition gradually improved, and he was cured and discharged.

Cerebral cysticercosis is a common parasitic infectious disease in the central nervous system, however, intraspinal cysticercosis is very rare, accounting for about 1.2% ~5.8% of cerebral cysticercosis [1-2]. According to the location of cysticercosis, intraspinal cysticercosis can be divided into intramedullary cysticercosis, subarachnoid cysticercosis and epidural cysticercosis, among which intramedullary cysticercosis is more rare, and only 53 cases have been reported in literature at home and abroad.

A 37-year-old male was admitted to the hospital for more than 1 year because of acromegaly and headache. Five years ago, the patient was found to have enlarged hands and feet, enlarged mouth and nose, protruding zygomatic arch, and thick skin. One year ago, he began to have headache without obvious trigger, with intermittent attacks, more obvious on the left side, without obvious time rule at the attack, and gradually appeared sexual hypofunction. Growth hormone increased.

A 39-year-old male was admitted to the hospital due to headache for half a year, aggravated with weakness in his right upper limb for 1 month. Physical examination showed clear consciousness, negative cranial nerves, clear breathing sounds in both lungs, no dry or wet rales, muscle strength at the distal end of his right upper limb grade IV, normal tendon reflex, and negative pathological signs. The patient had subcutaneous mass surgery in his left lower limb 10 years ago, and the mass in his left lower limb recurred 5 years ago, and was resected again. No pathological examination was performed in both times. CT of the head showed a high-density lesion in the left frontal and posterior part, CT value 52 Hu, low-density water zone around it (Figure 1a), and the bone window resembled the skull without abnormal changes; MRI of the brain: the left frontal lobe was irregular mass-like isometric T1-long T2 signal, the lesion was obviously enhanced (Figure 1b), the surrounding curved cord-like empty blood vessel shadow, and there was no enhanced edema area around it; There was no obvious abnormality in the whole body skeletal imaging by SPECT-CT; Multiple nodules in both lungs on chest X-ray and multiple nodules in both lungs on chest CT (Figure 1c).