Volume 30 · Issue 10 · 2014

big data refers to a collection of data with huge volume, diverse types and complicated structure, which is difficult to effectively analyze and utilize by traditional data processing methods [1]. At present, the value of big data has attracted people's attention, and the collection and information processing platform for big data is becoming more and more perfect. It has become an important trend in the development of information science and technology to collect, sort and analyze big data scientifically to make it efficiently utilized. In China's military, transportation, energy, biology, information industry and other fields, big data analysis and processing technology has been widely used. In the medical field, many big data projects related to clinical resources and biomedical resources led by the government have been started one after another, and the basic and clinical research of neurotumor is an important part of it, which provides new ideas and methods for neurotumor research. In the era of big data, neurotumor research has its distinctive characteristics, which are different from traditional scientific research models, which make neurotumor research face rare opportunities, and at the same time, it will meet huge challenges, which are embodied in the following aspects.

I. Introduction In the past 10 years, neuroendoscopic technology has developed rapidly, and its application scope has been continuously expanded. It basically covers all fields of neurosurgery, and has become a powerful tool for neurosurgeons. Among them, skull base endoscopic technology has developed particularly rapidly. Skull base lesions are deeply located, complex anatomical relationships, many important structures, and involve multi-disciplinary fields, which is one of the most challenging fields in neurosurgery. Neuroendoscopic technology has been widely used in the treatment of various lesions that originated or invaded the skull base due to its advantages such as broad visual field, clear imaging, small surgical trauma and thorough lesion treatment. With the development of new neurosurgical technologies such as neuroimaging, neuromonitoring and neuronavigation, and the improvement of new equipment such as high-speed grinding drill, laser, super-suction and support arm, the quality of skull base endoscopic surgery has been further improved and the indications have been further broadened.

Objective To analyze the treatment strategies of obstructive hydrocephalus caused by giant nonfunctioning pituitary adenomas (NFPA).Methods The clinical data of 41 cases of NFPA with obstructive hydrocephalus were analyzed retrospectively.Twenty-eight cases were treated through transsphenoidal approach.36 transsphenoidal procedures were carried out,including 19 sub-lip nasal septum sphenoidal sinus approach procedures and 17 nasal septum sphenoidal sinus approach procedures.The pterional craniotomies were used in 13 cases.Results Twenty-five tumors were totally removed,and the overall resection rate was 61％.The total resection rate was 61％ (17/28) in transsphenoidal approach and 62％ (8/13) in pterional craniotomy approach,respectively.The total resection rate was 50％ (4/8) in two-stage of transsphenoidal approach.The external ventricular drainage was used in 8 cases.Among them,4 procedures were performed preoperatively before 2007.The obstructive hydrocephalus was relieved in 3 cases after extracting the external ventricular drainage,and ventricles-peritoneal shunt was used in the other case because of the residual tumor.Another 4 cases were done postoperatively after 2007,including 2 cases of transsphenoidal approach and 2 cases of pterional craniotomy approach.The obstructive hydrocephalus was unrelieved in these 4 cases,including 2 cases were tumor cavity hematoma and 2 cases were tumor residual.Of all the cases,the cerebral ventricles-peritoneal shunt was used in 5 cases.Conclusions The treatment strategies of NFPA with obstructive hydrocephalus should select suitable operative approaches according to the shape and size of sellar floor,growth pattern,texture and blood supply of tumors.The transsphenoidal microsurgery was the primitive approach and could get good surgical effects.The pterional craniotomy,combined with the transsphenoidal and craniotomy,and two-stage of transsphenoidal approach were used in unsuitable transsphenoidal approach cases.The preoperative external ventricular drainage and cerebral ventricles-peritoneal shunt should be used reasonably according to the degree of hydrocephalus and the clinical symptoms and shouldn't be used in every case routinely.

Objective To investigate the clinical features and surgical treatment of pituitary adenoma with cerebral spinal fluid (CSF) rhinorrhea.Methods The clinical characteristics,uniformity of removal of the tumor and repair techniques of the CSF rhinorrhea of 18 cases of pituitary adenoma patients combined with CSF rhinorrhea in nearly four years were studied and the patterns of repair ways for CSF rhinorrhea to the specific circumstances of different patients were determined.Results In all 18 patients,total tumor resection were obtained in 12 cases and subtotal resection in 6 cases.All patients' rhinorrhea repair was successful,including one case of secondary surgical repair.Pathology analysis:prolactinomas in 8 cases,GH in 3,and non-functioning in 7.11 patients were dynamically observed postoperatively through MRI scans.Some patients underwent medication or stereotactic radiotherapy to control the residual tumors.Conclusions CSF rhinorrhea in pituitary adenoma patients was rare.Once it was diagnosed in pituitary adenoma patient,surgical treatment was necessary.The tumor should be removed and the reconstruction of the skull base defect should be performed.It was essential to choose the right way to repair CSF leakage depending on the specific circumstances.

Objective This study was designed to evaluate the CT-MRI co-localization in Gamma Knife radiosurgery treatment of pituitary neoplasms.Methods There were 31 patients who were diagnosed as pituitary adenomas based on MRI and endocrine disorders without microsurgical history enlisted in the study.All these patients were treated with Leksell Perfexion Gamma Knife System (GKS) and localized with CT-MRI images.Two experienced treatment plan-designers were asked to perform treatment planning based on MRI only (control group) or CT-MRI co-localization images (experiment group).The plans' parameters such as coverage,selectivity and gradient index were compared using paired t-test to evaluate the planning style differences between two plan-designers.The treatment volume (TV),12 Gy volume,average dose of TV and the maximal dose of optical structure (OS) were compared between two groups.Results There was no difference of planning style between two plan-designers.The TVs were 4.3 cm3 in the control group and 3.4 cm3 in the experiment group (P ＜0.0001).The 12 Gy volumes were 8.0 cm3 in the control group and 7.3 cm3 in the experiment group (P =0.042).The multiple factors analysis indicated that the miss definition of osseous structure of optical canal was the only statistical significant factor.Conclusion CT-MRI co-localization was a useful way to define the boundary of pituitary neoplasms.It was more accurate and could minimize the target volume / 12 Gy volume.

Objective To explore the surgical techniques and prevention of complications of endoscopic transphenoidal surgery (ETS) for pituitary adrenocorticotropic hormone (ACTH) adenoma.Methods Forty-seven patients with pituitary ACTH adenoma were selected in our department from examinations like high dose dexamethasone suppression test,bilateral inferior petrosal sinus sampling (BIPSS),neuroimaging examination and so on.Then ETS via single nostril was carried out in these patients.Results Total resection was achieved in 43 (91.5％) cases and partial in 4 (8.5％).After surgery,the endocrinal function was improved in 44 (93.6％) patients while 3 (16.4％) showed no obvious amelioration.The postoperative complications occurred in 6 patients (12.8％),including 3 cases of hypopituitarism,2 cerebrospinal fluid rhinorrhea,1 case of brain stem infarction.After the follow-up of 4-52 months,the complications were obviously improved in 3 patients.4 patients without total resection demonstrated no recurrence by enhanced pituitary MRI.Conclusions Patients with ACTH adenoma tended to have more internal medical complications like hypertension,diabetes,and so on.And the higher proportion of micro-adenoma in these patients made the identification of anatomical structures difficult.Besides,as some patients needed partial hypophysectomy,they might have a higher possibility of diaphragma sellae and arachnoid membrane rupture.On the whole,the risks during perioperative period for ACTH adenoma was greater than those of other kinds of adenomas.While ETS had a bright surgical field,and could make direct resection of the lesion and sellar floor reconstruction possible.As a result,ETS was a safe and effective method for the surgical treatment of pituitary ACTH adenoma.

Objective To study the clinical significance of pseudocapsule in the transsphenoidal microsurgery for pituitary microprolactinoma.Methods From March 2012 to May 2013,61 patients with microprolactinoma were prospectively grouped and treated with pseudocapsule-based extracapsular transsphenoidal microsurgery,and the clinical and follow-up data were retrospectively analyzed.Results All the patients were followedup for 10 months in average.59 cases (96 ％) regained regular menstruation,33 (94％) with galactorrhea had relieved,15 experienced postoperative pregnancy.The preoperative mean value of serum prolactin was 7.66 nmol/L and the postoperative was 0.42 nmol/L.According to the comprehensive evaluation of symptomatic,endocrinological and radiological indexes,the early total remission rate achieved to 96％.There was no severe complication.Conclusions The outcome of pseudocapusle-based extracapsular microsurgery for pituitary microprolactinoma was significant,and the complication was rare.Transshpenoidal microsurgery was the first line treatment for microprolactinoma with poor response or intolerance to bromocriptine.

Objective To study the roles of MRI,intraoperative exploration and pathology in the diagnosis of invasive pituitary adenoma(IPA).Methods An analysis of the clinical data of MRI,surgery and pathology was taken in 125 cases of pituitary adenoma with the growth towards cavernous sinus,to determine their invasiveness and to group them respectively on the basis of MRI,intraoperative exploration and pathology.MRI group:Knosp-Steiner grading scales Ⅲ or Ⅳ as a inclusion criteria for IPA; Operation group:a hole or worn discovered in medial wall of the cavernous sinus by intraoperative observation as a criteria; Pathology group:Ki-67 labeling index ＞ 3％ as a criteria.The relevant statistical analysis was performed on them.Results MRI group:104 cases were identified as IPA.Operation group:92 cases were determined.Pathology group:14 cases were defined as IPA.The three groups were significantly different in determining IPA (P =0.000),and the pathology group compared with the operation and MRI groups respectively were also significantly different (P =0.000,P =0.000,respectively),whereas the comparision between the MRI and operation group was not significantly different(P ＞ 0.05).MRIdemonstrated good diagnostic value on IPA (sensitivity 100％,specificity 63.6％,positive predictive value 88.5％,negative predictive value 100％) and had obviously higher accuracy than pathology(sensitivity 20.7％,specificity84.8％,positive predictive value 79.2％,negative predictive value 27.7％).Conclusions In the diagnosis of IPA,MRIand intraoperative exploration had higher accuracy than pathology.

Objective To evaluate the clinical effectiveness of microscopic and neuroendoscopic endonasal transsphenoidal pituitary adenoma resection in China.Methods The case-controlled trials of microscopic and neuroendoscopic endonasal transsphenoidal pituitary adenoma surgery were collected,and the systematic review and Meta-Analysis were conducted by revman 5.2 software.Results A total of 8 case-control trials involving 525 patients were included.As for the total resection rate and postoperative complications,significant differences were found between microscopic and neuroendoscopic endonasal transsphenoidal surgery (OR =0.41,95％ CI:0.25-0.67,P =0.0004; OR =1.90,95％ CI:1.24-2.91,P =0.003) respectively.Conclusions According to the available data,endoscopic transsphenoidal surgery provided favorable results in both tumour resection and control of complications in comparison with microscopic surgery.

Objective To investigate the effects of endoscopic endonasal transphenoidal approach in the treatment of pituitary adenomas invading the cavernous sinus (CS).Methods A retrospective analysis was performed in 135 pituitary adenomas extending to CS treated via endoscopic endonasal transphenoidal approach between April 2008 and April 2013.The most common adenoma type was non-functioning pituitary adenomas (NFPAs) (86 cases,63.7％),followed by PRL-secreting adenomas (28 cases,20.7％),growth hormone (GH)-secreting adenomas (18 cases,13.3％),ACTH-secreting adenomas (2 cases,1.5％),and TSH-secreting adenomas(1 cases,0.7％).The average diameter of the tumors was (30.0 ± 1.1)mm(10-69 mm).The shapes of the tumors were as the following:round (97 cases,72.6％),dumb bell (8 cases,5.9％),and multi-lobe (30 cases,21.5％).The patients were divided into two groups according to the Knosp classification:third grade (57 cases,42.2％) and fourth grade (78 cases,57.8％).Results Gross total resection was achieved in 40 patients (29.6％),subtotal (＞90％) in 45 (33.3％),partial (＞70％) in 42 (31.1％),and decompression (＜70％) in 8 (5.9％).There were 4 patients (3.0％) accompanied with postoperative cerebraospinal fluid leak,2 with visual decrease,and 5 with transient diabetes insipidus.One paient died due to postoperative intracranial hematoma.In 18 patients with GH-secreting adenomas,4 achieved endocrinological remission after surgery,and 9 significant GH decrease.In 28 patients with PRL-secreting adenomas,6 had a normal serum PRL level within one week postoperatively,and 21 remarkable PRL decrease.Conclusions The endoscopic endonasal transphenoidal approach was a safe and effective option for the resection of pituitary adenomas invading the CS.

Objective To study the surgical techniques and analyze the related factors affecting the tumor total removal and postoperative endocrinological remission for endoscopic endonasal pituitary adenomas surgery.Methods The cases of endoscopic endonasal pituitary adenomas surgery from March 2011 to August 2013 were retrospectively analyze.The endonasal approaches included the routine transnasal-sphenoidal approach,transnasal-maxillary sinus approach in 4 cases and transnasal-clivus approach in one case.Results According to the postoperative imaging data and endocrine examination results,the total removal of tumors was achieved in 108 patients (78.3％),and the endocrinological remission was achieved in 31 patients (44％) with functional adenomas.The serious postoperative complications included four cases of intracranial infection and one case of intracranial hemorrhage.Conclusions The tumor size and invasiveness of cavernous sinus were related to the total removal rate and endocrinological remission rate.The direction and degree of tumor invasion,and the surgeon's experience were the key influence factors of the endocrinological remission rate for invasive functional pituitary adenomas.

Objective To study the surgical indications and techniques of reoperation of pituitary for the treatment of recurrent/persistent pituitary Cushing's disease after the first surgery.Method Sixteen patients with recurrent (n =8)/persistent (n =8) Cushing's disease,who underwent the reoperation of pituitary from Jan.2006 to Apr.2014 were retrospectively analyzed.Before the reoperation,all the patients were diagnosed as Cushing's disease by endocrine assessment.Then,the transsphenoid surgery was performed and the pituitary was explored completely with wide exposure of sellar.If the tumor was identified,tumor resection with low frequency coagulation of the pituitary adjacent to the tumor was performed.Whereas there was no tumor,but the tumor was identified at the first surgery,hemihypophysectomy at the original tumor site was recommended.On the other hand,if there was no tumor,and the original pathology suggested hyperplasia or normal pituitary tissue,hypophysectomy or subtotal hypophysectomy was recommended.Results Immediate postoperative remission was achieved in 11 patients (69％).There was no difference of remission rate between persistent and recurrent cases,and between whether the preoperative pituitary MRI indicated tumor or not (P ＞ 0.05).Conclusions The endocrine evaluation for recurrent/persistent pituitary Cushing's disease before reoperation was important.Reoperation was the choice of treatment for persistent/recurrence pituitary Cushing's disease.It was recommended that reoperation should be carried out in a professional pituitary center,with perfect diagnosis of endocrine conditions and rich experience in the surgical treatment of pituitary adenoma.

Objective To describe the techniques for the reconstruction of skull base defects after minimally invasive endoscopic resection of skull base chordomas.Methods The records of 146 patients who presented with skull base chordomas between Aug.2007 and Oct.2013 were retrospectively reviewed.The skull base defects after endoscopic endonasal resection of the chordomas were classified according to the dimensions of the dural defects as the following:(Type Ⅰ) The dura of skull base was intact after the tumour resection (113 cases) ; (Type Ⅱ) The dural defect was equal or less than 1 cm (12 cases) ; (Type Ⅲ) The dural defect was greater than 1 cm (21 cases).Three different reconstruction methods were utilized according to the classification of the skull base defects.The reconstruction of the type Ⅰ defect was performed mainly using artificial material; type Ⅱ in a multilayer fashion,mainly using an array of autologous free material including fat,muscle,muscle fascia and artificial material; type Ⅲ using vascular pedicle nasoseptal flap and autologous free material.Results There was no case of postoperative cerebrospinal fluid (CSF) leakage occurred following the reconstruction of type Ⅰ.One case of postoperative CSF leak (8.3％) occurred following the reconstruction of type Ⅱ and two (9.5％) occurred following the reconstruction of type Ⅲ.The rate of postoperative CSF leakage of all the cases is 2.1％.Conclusions Different reconstruction methods should be chosen according to different types of skull base defects.Reducing the use of vascular pedicle nasoseptal flap as much as possible could minimize the trauma of nasal cavity,increase the degree of comfort of the patients and offer convenience for the next skull base reconstruction after the resection of recurrent chordomas.

Objective The mechanism of tumor-related epilepsy was still far from clear.The objective of this study was to investigate the relationship between the tumor location and postoperative control of epilepsy in patients with pathologically diagnosed WHO grade Ⅱ low-grade gliomas.Methods We retrospectively collected 351 patients who were pathologically diagnosed as low-grade gliomas and underwent primary surgical treatment.The preoperative incidences of tumor-related epilepsy and postoperative incidences of tumor-related epilepsy at six months of follow-up were analyzed and were compared between patients harboring tumors in various brain regions.The rate of seizure control was calculated in patients underwent gross-total tumor resection.Results 66.4％ of patients included in this study had a history of preoperative seizures.The low-grade gliomas located in the motor areas,including primary motor area,supplementary motor area and premotor area,caused relatively higher incidence of epilepsy (87.9％) compared with tumors located in other brain regions.Following surgical resection,up to 71.8％ of patients with tumors that located in the motor areas achieved a satisfied control of tumor-related epilepsy at sixth month after the tumor resection.This percentage was higher than that in cases with low-grade gliomas locating at other brain regions.Conclusion The gross-total resection was an effective treatment in reducing the incidence of epilepsy induced by low-grade gliomas.Patients with tumors that located in the motor areas acquired the greatest benefit of seizure control from the surgical resection.

Objective To analyze the MRI features and surgical strategy of angiomatous meningioma (AM).Methods The MRI findings and pathological data of 51 cases with AM and 50 cases with other subtypes of meningiomas were retrospectively analyzed.Two groups of cases had been confirmed by surgery and pathology.Results Thirty-one tumors were found beside convexity,8 in sphenoidal crest,5 in petroclival region,3 in tentorium of cerebellum,2 in saddle area,and 2 in cerebellopontine angle area.The max diameter of AM ranged from 1.5 cm to 6.2 cm (3.7 cm in average).42 tumors showed the shape of oval or similar to the oval,3 nodular lobulated and 6 irregular shape.38 tumors showed a broad-based attachment with meninges and 39 displayed dural tail sign.The signal voids of vessels were found in 46 tumors.Only 4 cases of cystic change and necrosis were found.The homogeneous hypointense on T1WI and hyperintense on T2WI were found.The striking enhancement was showed,except several cystic changed ones.The periturnoral brain edema (PTBE) was appeared in 42 tumors.The meningeal tail sign,tumor diameter,calcification rate,PTBE,edema index (EI) and signal voids of vessels of AMs were compared with those of other subtypes of meningiomas.The differences were statistically significant except the first item (P ＜0.05).38 cases achieved Simpson gradeItumor excision,9 gradeⅡ,and 4 grade Ⅲ-Ⅳ excision.There was no patient death.All patients were followed-up for 2 month to 3 years.There were 2 cases of recurrence.Conclusions The MRI findings of AMs had the certain characteristics of homogeneous hypointense on T1WI and homogeneous hyperintense on T2WI.AMs often had wide PTBE and the signal voids of vessels were common.It's characteristics might be helpful in differential diagnosis with other subtypes of meningiomas and malignant tumors.A reasonable surgical approach combined with DSA before the operation was the key to the success of surgery.

Objective To investigate the efficacy and safety of rapamycin treatment in subependymal giant cell astrocytoma (SEGA) patients associated with tuberous sclerosis complex (TSC).Method Four patients who were diagnosed with SEGA associated with TSC in Beijing Tiantan hospital received rapamycin treatment.One case had facial angiofibromas,epilepsy,and kidney lesions; one epilepsy,trunk plaque,et al; one facial angiofibromas and kidney lesions; one facial angiofibromas and kidney lesions whose SEGA was operated three years before.They were definitely diagnosed as TSC according to diagnostic criteria.Results SEGAs in three out of four patients were shrunk after the rapamycin treatment.The frequency of epileptic seizures in two patients was also decreased.There was also positive response of facial angiofibromas in three patients.The adverse events were mild with oral ulcer,acute tonsillitis,hyperlipidemia and hyperglycemia.The rapamycin treatment was well tolerated in four patients.Conclusion Rapamycin was safe and effective in the treatment of SEGA associated with TSC with mild adverse events.It was also effective in the treatment of TSC related epilepsy and other diseases.When and who should receive rapamycin treatment in TSC patients were still unknown.

Objective To analyze the clinical characteristics,surgical strategies and effectiveness of nervus intermedius neuralgia.Methods Eighteen patients of nervus intermedius neuralgia admitted to our hospital from September 1999 to August 2009 were analyzed retrospectively.The clinical symptoms,admitting diagnosis,surgical strategies and effectiveness of those patients were compiled and analyzed in combined with literature review.Results All patients of accepted microvascular decompression (MVD).Among them,16 cases' pain completely disappeared after MVD.2 cases had occasional seizures.The total efficiency was 100％.The follow-up lasted 23-60 months (35 months in average).The total efficiency was 100％.The complications,included 3 cases of transient mild facial paralysis and 2 cases of mild hearing dysfunction,were completely relieved within 3 months.Conclusion Nervus intermedius neuralgia was rare.It should be differentiated with other neuralgia diseases,such as trigeminal neuralgia and glossopharyngeal neuralgia.For patients who had poor effect with conservative treatment,MVD was a safe and effective surgical method.

Objective To evaluate the related factors of the recurrence of primary trigeminal neuralgia after microvascular decompression(MVD).Methods 147 patients with initial primary trigeminal neuralgia treated with MVD in our departerment were retrospectively analyzed.The preoperative treatment,clinical presentation,operative findings and postoperative outcomes were recorded.The related factors of recurrence were statically analyzed.Results The mean follow-up time was 39.5 months and the recurrence rate was 11.6％ (17/147).The univariate analysis showed that the duration of disease(x2 =8.226,P =0.016),clinical presentation (x2 =4.940,P =0.026),offending artery (x2 =45.759,P =0.000),compression degree(x2 =13.811,P =0.003),decompression degree (x2 =39.910,P =0.000),outer arachnoid(x2 =33.117,P =0.000),arachnoidcompression (x2 =27.245,P =0.000) and arachnoid adhesion(x2 =20.710,P =0.000)were statically related to the recurrence of neuralgia.After the Logistic regression analysis,the outer arachnoid (P =0.033),arachnoid trabecula compression (P =0.008),offending artery (P =0.002) and decompression degree (P =0.004) were the predictors of the recurrence.Conclusions MVD was effective in the treatment of primary trigeminal neuralgia.The arachnoid factors might play an important role in the pathogenesis of trigeminal neuralgia and MVD.

Objective To study the semiological characteristics of mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis(HS).Methods The semiology of 14 patients with MTLS,who had seizures-free at least for one year after selective hippocampus-amygadala resection from January 2011 to June 2012 were retrospectively analyzed.Results Fifty-seven epileptic seizures were recorded in 14 patients.11 seizures occurred in sleep,while 46 in awake.10 patients had auras seizures.All patients had automatism seizure.13 patients had autonomic seizures with tachycardia.6 patients'head and eyes deviated to the ipsilateral side.2 patients'head and eyes deviated to the contralateral side.12 patients had contralateral upper limb tonic.4 patients had contralateral version.5 patients had secondary generalized tonic-clonic seizures.3 patients used ipsilateral hand touching nasal or facial postictal.Conclusions The main seizures of MTLE with HS manifested:aura seizure→automatism seizure→autonomic seizure(tachycardia) →contralateral limb tonic seizures,rarely secondarily GTCS.The unilateral upper limbic automotor during the ictal period was located ipsilateral to epileptogenic side.The unilateral limb tonic and head version was often located contralateral to the epileptogenic side.Head and eyes' deviation were mainly seen at the same side of the epileptogenic focus.Aura seizures had no lateralized value.

Objective Study the quantity of increased procoagulant microparticles in patients'blood at the acute phase of hypertensive cerebral hemorrhage(HICH) and the MPs-origin cells in HICH patients,try to discuss the significance of lactadherin on treatment to HICH.Methods Thirty healthy controls and 45 patients with acute HICH (6-72 h))were recruited.peripheral blood samples were obtained on admission and at 6 h,days 1、2 and day 3 after ICH.Flow cytometry instrument for qualitative and quantitative analysis of coagulant microparticles.Results MPs at Acute phase of hypertensive cerebral hemorrhage dedrive from Red blood cells,platelets endothelial cells and gial cell,which is given priority to with platelets and red blood cells,the procoagulant MPs begin to rise at 6 h(P =0.021),and to be peak at 24 h(P =0.024),which are significantly higher than normal control group.Conclusion the acute phase of HICH patients with peripheral blood coagulant MPs arising obviously,it can promot thromboembolism and complications such as edema around the hematoma.the MPs-origin cells were obviously activated.

Decompressive craniectomy is a commonly used surgical method in neurosurgery for severe craniocerebral injury, hypertensive cerebral hemorrhage and large-area cerebral infarction. It can quickly and effectively reduce intracranial pressure, improve cerebral perfusion, and save patients' lives to the greatest extent, but at the same time, it can produce many complications, some of which are serious or even fatal [1-2]. Among them, large-area necrosis of brain tissue bulging from the bone window area is one of the serious complications, which often causes extensive brain function damage, greatly affects the quality of life of patients, and even endangers patients' lives. For a long time, neurosurgeons have conducted a lot of research on this problem, but so far, no effective and reliable prevention and treatment method has been obtained [3-4]. From January to June 2013, we used the groove-shaped method of cerebral venous return at the edge of the skull window to prevent incarceration and ischemic necrosis of bulging brain tissue caused by venous compression and obstruction, and achieved satisfactory results. And it is considered that it is worth clinical promotion, and the summary report is as follows.

Case 1: A 64-year-old female was admitted to hospital on February 11, 2011 due to "right forehead mass with right eyelid ptosis for 1 month". Physical examination showed a subcutaneous mass on the right forehead, about 3 cm in diameter. It was difficult to open the eyes on the right side. CT showed a massive slightly high-density shadow on the right forehead, and the frontal bone was eroded and significantly enhanced (Figure 1a ~ c). MRI showed that the right forehead was occupied by isot1 and isot2 signals, showing obvious uniform enhancement. The tumor eroded the frontal bone and orbital roof during the operation. The postoperative pathology was plasmacytoma (Figure 1d), immunohistochemistry: CD38 (+), CD138 (+), GFAP (-), EMA (-), Ki-67 (20%). Serum IgG 6.57 g/L (7.51~15.60 g/L), IgM 0.28 g/L (0.82~4.53 g/L), κ light chain 552 mg/dl (629~1 350 mg/dI), λ Light chain was 276 mg/dl (313~723 mg/dI). Morphological examination of bone marrow cells showed abnormal plasma cells in 56%.

Objective To study the safety and feasibility in the embolization of swine rete mirabile (REM) as cerebral arteriovenous malformation (cAVM) with Chitosan/Glycerophosphate(C/GP).To study the method of injectable Chitosan/Glycerophosphate through micmcatheters into swine rete mirabile.To study the embolic effect and the histological changes of rete mirabile.Methods Twenty-four swines were divided into two groups:One group was twelve swines of direct embolism on one side of the REM ; The other group was twelve swines of embolism on two sides of the REM after common carotid artery and internal jugular vein anastomosis.We handled microcatheter into REM,injected chitosan/glycerophosphate until REM occluded.Twenty-four swines were oprerated angiography after two weeks and six weeks.After six weeks the histopathological evaluation of rete mirabile was made.Results The embolism of 24 swines was successful except one swine because of convulsions,stoppage of breathing and death in interventional procedure.The angiography after embolization of REM confirmed that the embolism operation was successful and there was no microcatheter lumen blockage or adhesion.Twenty-four swines were oprerated angiography after two weeks and six weeks and the rete mirabile was still embolized.The histopathological evaluation of the rete mirabile showed that the hydrogels in REM was uniform dispersion and the embolized REM had a hard property.The hydrogel filled lumen of REM.The vascular intima was clearly visible and the smooth muscle layer was intact without vascular wall necrosis and stripped.There was no inflammatory reaction around the blood vessels.Conclusion C/GP hydrogel had the characteristics of nonadhensive catheter,non -toxic,embolism REM,easy to completely through different specifications of the catheter.It was feasible that C/GP with thermosensitive nonadhensive catheter embolize cAVM and it was an ideal embolic material for the treatment of cAVM.

Objective To investigate the expression and significance of Neuropilin-1 (NRP-1) mRNA and CD4 + CD25 + Treg in human glioma tissues.Methods The specimens of 41 patients with gliomas,including 11 cases of grade Ⅰ,12 grade Ⅱ,8 grade Ⅲ and 8 grade Ⅳ,were studied in the present study.11 cases of normal brain tissues from patients performed decompression operation resulting from cerebral hernia were selected as the control group.The expression of NRP-1 mRNA was investigated by reverse transcription polymerase chain reaction (RT-PCR) and the contents of CD4 + CD25 + Treg by flow cytometer in the glioma tissues and normal brain tissues.Results NRP-1 mRNA and CD4 + CD25 + Treg were expressed in different degrees in normal brain tissues and gliomas.The expression level in tumor tissues was higher than that in the normal brain tissues.The expression was related to the pathological grades of gliomas.The NRP-1 expression was significantly positively related with the CD4 + CD25 + Treg expression (P ＜ 0.05).Conslusions The mRNA expression levels of NRP-1 and CD4 + CD25 + Treg were significantly higher in human gliomas which were positively associated with the grades of gliomas.NRP-1 and CD4 + CD25 + Treg might be related to the immunological tolerance in tumor microenvironment of human gliomas.

Insulin-like growth factor-1 (IGF-1) is a sensitive index to reflect the biological function of growth hormone (GH), and it is an important basis for evaluating the function of GH-IGF axis [1]. Because GH is secreted in pulse mode, with short half-life, and is greatly influenced by factors such as diet, exercise, stress and blood glucose, in contrast, IGF-1 is a small molecule polypeptide, which binds with high affinity calcin in peripheral blood, and has a long half-life. Many interfering factors affecting GH level have little influence on IGF-1 level [1]. Therefore, IGF-1 level is relatively more stable and is the most important medium to evaluate the function of GH-IGF axis, and the clinical value of IGF-1 detection is more important than that of GH. This paper reviews the detection methods of IGF-1, the influencing factors, the relationship between IGF-1 and GH measured values and the interpretation methods, in order to help guide the clinical diagnosis and treatment of adult acromegaly and adult GH deficiency (AGHD).

With the development of science and technology and the improvement of medical technology, some new biomedical materials are gradually developed and applied by various medical disciplines, and these new biomedical materials also provide new therapeutic methods for doctors and new choices for patients. Among these new materials, chitosan belongs to a widely used one with remarkable curative effect, especially in the field of neurosurgery in recent years, the application of chitosan has been gradually paid attention to.

"Insular epilepsy" is a concept put forward for a long time. At that time, it was found that stimulation of insular lobe can produce symptoms similar to those of temporal lobe epilepsy, and the clinical symptoms of the two are similar, which is very easy to confuse. However, due to the particularity of insular anatomy, surgical operation is very difficult, which restricts the study of insular epilepsy. In recent years, with the application of various new technologies, more and more studies have confirmed that insular involvement is an important reason for the failure of surgical treatment of temporal lobe epilepsy [1]. Therefore, the role of insular lobe in refractory epilepsy, especially in temporal lobe epilepsy, has been paid more and more attention.