Volume 30 · Issue 11 · 2014

Objective To evaluate the efficacy of ization in endovascular embolization of the ruptured intracranial aneurysms at acute stage.Methods Between April 2011 and September 2011,127 patients with ruptured intracranial aneurysms treated with endovascular embolization at acute stage (＜ 14 days) were retrospectively reviewed to evaluate the efficacy of ization (3 IU/ml heparin saline was dropped into the guiding catheter at 3 ml/min.).Results Total 148 aneurysms were observed in 127 patients and 135 aneurysms were treated with endovascular coil embolization under ization at acute stage,aneurysm perforation related to manipulation occurred in 5 patients (3.9％) which caused 4 deaths and 1 disability.The distal part of the parent artery was not filled well in 11 cases (8.7％),vasospasm in 2 cases without any neurological sequelae,over embolization in 7 cases resulted in 1 severe disability.Thromboembolic complication occurred in 2 cases causing 1 neurological deficit.Clinical outcomes at3.5 years were:GOS 5 in 107 cases (84.3％),4 in 7 cases (5.5％),3 in 6 cases (4.7％),2 in 0 cases (0％) and 1 in 7 cases (5.5％).Conclusions Local heparinizqtion may not increase the incidence of thromboernbolic or hemorrhagic complications compared to systemic heparin.ization could be effective for coil embolization of ruptured aneurysm at acute stage.

Objective To further identify the differentially expressed proteins (TM9SF1and AZU1) screened in our previous study in order to explore their roles in formation and rupture of intracranial aneurysms (IAs).Methods Twenty ruptured IAs underwent microsurgical clipping.During the procedure,a segment of the aneurysm dome was resected and immunostained with monoclonal antibodies for TM9SF1 and AZU1.A segment of the superficial temporal artery from the same patient was also removed and used as control group.Western blot analysis was performed to confirm the expression profile of two proteins.Results All 20 aneurysm tissues stained positive for TM9SF1 and AZU1,while negative or poor positive in STA tissues.Their expression was more abundant (P ＜ 0.05) in ruptured IA tissues than STA tissues,based on a semiquantitative grading.According to western blot analysis,relative expression of TM9SF1 and AZU1 was 4.2 and 5.6 respectively in IA tissues compared with STA tissues.Conclusions TM9SF1/AZU1 are more abundantly expressed in the wall of human ruptured IAs than in STA tissues.We speculate that the proteins may participate in formation and rupture of IAs.

Objective To explore the methods of early diagnosis of traumatic optic neuropathies combined with internal carotid artery injury.Methods A retrospective study of 1 081 cases of traumatic optic neuropathy from Apr.2007 to Apr.2012 was performed.The CT angiography and/or magnetic resonance angiography were used as screening tools for the suspicious patients.The mechanisms of injury,clinical manifestations and neuroradiological features of internal carotid artery injury patients were discussed.Results In 1 081 cases of traumatic optic neuropathy,26 cases(2.4％)combined with internal carotid artery injury:12 cases were traumatic pseudoaneurysm,9 traumatic carotid cavernous fistula,4 traumatic pseudoaneurysm combined with carotid cavernous fistula,1 dural arteriovenous fistula.17 cases were treated by endovascular embolization,including detachable balloon technique in 10 cases,microcoils embolization in 7,and Onyx embolization in 1.The internal carotid artery was occluded in 7 cases.One intraorbital traumatic ophthalmic artery aneurysm was resected by cranio-orbital craniotomy.In the untreated team,2 cases died of hemorrhage.Conclusions For patients of traumatic optic neuropathies with unilateral blindness and posttraumatc epistaxis,if CT scan showed traumatic subarachnoid hemorrhage and fracture of the lateral wall of sphenoid sinus,CTA and/or MRA should be performed as the initial screening examination for internal carotid artery injury.As soon as a traumatic pseudoaneurysm was found,endovascular management should be initiated promptly.

Objective To investigate the experiences and efficacy of intraoperative fluorescence angiography in treating brain and spinal arteriovenous fistulas by intravenous or intraarterial injection of indocyanine green (ICG).Methods Seven patients underwent microsurgical treatment for brain or spinal arteriovenous fistulas with the assistance of ICG fluorescence angiography.Among these 7 patients,there were three with anterior cranial dual arteriovenous fistulae,three with spinal dural arteriovenous fistulae,and one with perimedullary arteriovenous fistulae.For fluorescence angiography,ICG was injected intravenously in six patients,and intraarterially in the remaining patient of complex perimedullary arteriovenous fistulae after selective catheterization.Then surgical obliteration of the fistulas were obtained and confirmed by ICG fluorescence angiography.Results Intraoperative ICG fluorescence angiography confirmed the obliteration of the fistulous points in all patients.In follow-up,complete occlusion of the fistulas were found by digital subtraction angiography in six patients.Obvious resolution of the vascular flow voids and spinal code edema was observed by MRI in one patient.Conclusions Intraoperative ICG fluorescence angiography for surgery was useful for brain and spinal arteriovenous fistulas by providing information on vascular dynamics directly.Selective intraarterial ICG fluorescence angiography may be more valuable in treating complex lesions for feasibility of multiple repeated injections angiography and clear images.

Objective To investigate the expression of STAT3 (signal transducers and activators of transcription-3) and phosphorylated STAT3 in patients of cerebral arteriovenous malformation (AVM).Methods 35 patients who underwent cerebral AVM removal had been enrolled in this study.Five patients who underwent decompression for brain trauma were normal control.The resected AVM nidus and control tissue were under immunohistochemisty analysis for STAT3,P-STAT3(Tyr705) and P-STAT3(Ser727).Results The expression of STAT3,P-STAT3 (Tyr705) and P-STAT3 (Ser727) were 100％ (35/35),74％ (24/35) and 77％ (24/35) respectively in AVM group.except weakly positive express of STAT3 in two patient,P-STAT3 (Tyr705) and P-STAT3 (Ser727) were all negative in control group.the expression of P-STAT3 (Tyr705) showed more intensive level in thrombosis group than unthrombosis group (P ＜ 0.05).Conclusions STAT3 was overexpressed and activated in cerebral AVM.The activation of STAT3 signal transduction way may mediate the blood vessels remolding and neovasculization in cerebral AVM.Thrombosis maybe increase STAT3 phosphorylation.

Objective To study was aimed to explore the significant risk factors associated with delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.Methods Collect the chnical data about the patients with aneurysmal subarachnoid hemorrhage from July 2011 to July 2012 in Department of Neurosurgery,the Second Hospital of Hebei Medical University.Analysis the age,sex,smoking history,blood pressure on admission,aneurysm site,the size of the aneurysm,glasgow com a scale,Hunt-Hess classification,Fisher grade,treatment modalities,timing of surgery,blood glucose,potassium,sodium and other related indicators retrospectivly.Group patients depending on whether the delayed cerebral ischemia occured,analysis datas using univariate and multivariate Logistic regression,determine the correlation factors about delayed cerebral ischemia.Results One hundred and ninety-three patients met the study criteria,66 patients occured ddayed cerebral ischemia,the incidence rate is 34.2％.Univariate analysis show that later surgery,with smoking history,ECG abnormalities,hyponatremia,low Glasgow Coma Scale score,high Hunt-Hess grade and high modified Fisher grade has much probabity ty (P ＜ 0.05) of occurring delayed cerebral ischemia Multivariate Logistic regression analysis showed that:with smoking history(OR =9.462,95％ CI:2782,32 180),hyponatremia(OR =2285,95％ CI:1.232,4.235),high Hunt-Hess grade (OR =2223,95％ CI:1.011,4.891) regression coefficient b ＞0,OR ＞1,indicates an independent risk factor for delayed cerebral ischemia (P ＜ 0.05).Conclusion Smoking history,hyponatremia,high Hunt-Hess grade were independent risk factors for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.

Objective To summarize multi-center clinical experiences of surgical techniques and perioperative management of 3 226 cases of carotid endarterectomy (CEA) to treat extracranial carotid atherosclerotic stenosis.Methods Retrospective analysis to explore the operation plan and skill and summarize the key point of peri-operation management was performed for experience of 3 226 cases of CEA performed in multicenter during eight years from May 2005 to May 2013.Results All of 3 226 cases of CEA performed successfully.Among which,2 910 cases (90.2％) were EEA,and 316 cases (9.8％) were pCEA.The average carotid clamping time was (15.5 ± 2.0) min.The average operation time was (50.5 ± 5.0) min.There were 3 case of death after CEA,2 cases of cerebral infarction,ipsilateral cerebral hemorrhage in 1 case,28 cases of incision hematoma,1 case of patients with postoperative severe nerve mental symptoms and cognitive impairment,1 case of small jaw joint dislocation ; cranial nerve injury in 6 cases,including 4 cases of hypoglossal nerve injury,facial nerve mandible injury in 2 cases.There were no serious postoperative complications and death occurred in 81 patients with high-risk factors.Conclusions CEA is a safe and effective treatment to cure extracranial carotid atherosclerotic stenosis.Perfect perioperative management and principles of "4 S + 1 D" are the key to the success of the CEA.EEA is worth promoting because of its simplicity of operation,operation and blocking time is short,don't need shunt and patch,cost is low.

Objective To improve the efficacy of pterional approach combined with longitudinal fissure exposure for superiorly protruding anterior communicating artery aneurysms (ACoAA).Methods Eighteen patients with superior ACoAA underwent microsurgery through the pterional approach combined with longitudinal fissure approach.The skull base should be fully exposed with proper coronal incision.Results Totally 18 patients with superior ACoAA were studied,including posterior-superior type,for 10 and anterior-superior type for 8.According to Hunt-Hess grading scale,patients were classified into Ⅰ grade (5 cases),Ⅱ (8 cases),Ⅲ (3 cases) and Ⅳ (2 cases).All of the patients underwent the pterional approach combined with longitudinal fissureexposure by aneurysm clipping surgery and all of the aneurysms were completely clipped.The patients were followed up for 6-18 months postoperatively.Their Glasgow outcome scale (GOS) were 5 score in16 cases and 4 score in 2 cases.Memory deterioration was found in 3 cases,minor hemiplegia was found in 2 cases.Conclusions Treating superiorly protruding ACoAA through the have the advantage of good operating field exposure and less damage of frontal lobe.For superior ACoAA,especially for the posterior-superior type,the pterional approach combined with longitudinal fissure exposure provides a good surgical exposure and less frontal brain harassment.

Objective To explore the role of puncturing the aneurysm to decompress in clipping intracranial large and giant aneurysms.Methods Different methods were used according to the different location of 25 cases of large and giant aneurysms.Cervical carotid internal artery was exposed and the pterional craniotomy was used for carotid-ophthalmic aneurysm,and direct pterion craniotomy used in the carotid-post communicating artery aneurysm.Temporary occluded the exposed the cervical internal carotid artery or the intracranial proximal segment of parent artery and distal segment of parent artery and its branches,then punctured aneurysm body and suck gushing blood with suction.When aneurysm body collapsed,remodel the parent artery and clipped aneurysm.As a thrombotic giant aneurysm which was incised then removed thrombus and clipped aneurysm after parent artery and its branches have been occluded provisionally.Microvascular doppler (MVD) was used to monitor before and after clipped aneurysms.Results The time of temporary occlusion vessels was 9-15 minutes.,the average time was 11 minutes.MVD monitor showed vortex flow disappearance of aneurysm and the bloodstream amplitude of the parent artery and its branches were not changed before and after clip.Postoperative DSA or CTA showed aneurysms disappeared and the bloodstream of the parent artery and its branches were normal after operation.Conclusions The temporary occlusion of the parent artery and its branches and the direct puncture of aneurysm body (or incise aneurysm and remove thrombus) to decompress are indicated for the most large and giant aneurysms (including thrombotic aneurysm).MVD is of benefit in providing operative safe and improving treatment effects in aneurysm surgery.

Objective To summary and analyze the clinical characteristics and acute phase prognosis of brain injury patients complicated by intracranial infection.Methods The clinical data of brain injury patients with intracranial infection confirmed by cerebrospinal fluid culture in Huashan hospital trauma center during January 2008 to December 2012 were collected and retrospectively analyzed.Risk factors of Glasgow coma scale (GCS) at discharge,multiple microbial infection and G-/G+ infection were investigated.Results From January 2008 to December 2012 there are 82 patients with intracranial infection secondary to brain injury.Total of 97 bacterial strains were identified by CSF culture,of which A.Baumannii was the most common pathogenic bacteria (28.9％).GCS at admission (OR:7.44,95％ CI:2.80-19.76,P ＜0.0001),extra-ventricular drainage(EVD) (OR:0.31,95％ CI:0.12-0.79,P =0.0220),G-infection (OR:0.21,95％ CI:0.07-0.62,P =0.0062) and pneumonia (OR:0.33,95％ CI:0.12-0.85,P =0.0352) were the main risk factors for poor GCS at discharge; there was significant difference in in-hospital mortality (OR:10.95,95％ CI:0.6234-192.2,P =0.0327) between G-and G + bacterial infectious group; hospital expense was higher in patients with intracranial infections caused by multiple bacterial species than that caused by single bacterial species (P =0.0347).Conclusions Low GCS at admission,EVD,G infection and pneumonia were the risk factors associated with the low GCS at discharge.Intracranial infection caused by G bacterial was the high risk factor for inhospital mortality.Active treatment should be adopted for those patients at high risk to lower the mortality and morbidity,alleviating their financial burden.

Objective To evaluate the meaning of the application of joint monitoring of the somatosensory evoked potential(SEP) and motion evoked potential(MEP) in the vertebral canal decompression surgery of acute spinal cord injury.Methods Twenty-four cases of acute spinal cord injury who had been undergoing spinal canal decompression surgery were enrolled as the intraoperative monitoring group.The authors also evaluated and marked respectively spinal cord functional grade according the grading system presented by McCormick during preoperative and postoperative 3 months.Twenty-four cases of acute spinal cord injury who were given the same marks during usual preoperative,were selected as control group.According to monitoring data,the authors also analyzed nerve function changes by two groups of patients.Results In the intraoperative monitoring group,the postoperative spinal cord function of 10 cases has been improved; no change was observed in 12 cases; the function of 2 cases were declined.While,in control group,the spinal cord function in 6 cases has been improved; no change was observed in 14 cases; the function in 4 cases was declined.In the intraoperative monitoring group,the change trends of the P40 latency and amplitude of SEP and the larency of MEP of abductor hallucis brevis (AHB) before and after decompression surgery were basically consistent with the outcome of spinal nerve function in patients.As for P40 latency,amplitude and AHB latency of MEP in cases whose spinal cord function were improved after surgery,the differences between the two goups was statistically significant (P ＜ 0.01).However,for P40 latency,arnplitude and AHB latency in cases with no change in spinal cord function,there was no statistically significant difference by comparing the two goups (P ＞ 0.05).Conclusions In the vertebral canal decompression surgery after acute spinal cord injury,the application of joint monitoring can timely reflect the change of the spinal cord function.And also the intraoperative electrophysiological index changes were consistent with the postoperative changes of nerve function in patients.

Objective To analyze the causes and treatment of cerebrospinal fluid leak during transsphenoidal pituitary adenoma surgery.Methods Retrospective study of 355 cases of microscopic transsphenoidal surgery for resection of the pituitary adenomas was performed,and cerebrospinal fluid leak occurred in 18 cases during surgery.The sellar floors were sealed by artificial dura mater or autogenous fat and biological glue for the cerebrospinal fluid leak during surgery.Continued lumbar cerebrospinal fluid drainage should be performed appropriately after surgery.Results In the 18 patients with cerebrospinal fluid leak during surgery,no case occurred cerebrospinal fluid rhinorrhea postoperatively.Three patients occurred intracranial infection,cured with continued lumbar drainage and strong antibiotic therapy.18 patients were followed up from 8 to 30 months,no case occurred cerebrospinal fluid rhinorrhea again.Conclusion The cerebrospinal fluid leak during transsphenoidal pituitary adenoma surgery can be prevented by careful reasonable surgical operation.Using artificial dura mater or autogenous fat and biological glue to repaired the site of cerebrospinal fluid leak is an effective method.Continued lumbar cerebrospinal fluid drainage should be used for patients with severe cerebrospinal fluid leak during surgery or intracranial infection after surgery.

Objective to evaluate the usefulness of virtual reality technique in preoperative planning of sellar tumor.Methods Multiple medical imaging data collected from 87 patients who suffered sellar tumor,were transferred to Dextroscope system.A stereoscopic 3-D object displayed after reconstructing the data with the Radiodexter software in virtual reality environment.A suite of 3-D tools accessible inside the Dextroscope workspace enabled users to obtain measurement and simulated intraoperative viewpoint about the lesion and adjacent anatomic structure A sophisticated preoperative plan was defined.Operative time,total resection rate,complication rate,KPS score and visual recovery rate of 87 cases were compared with control group 20 cases suffered from sellar tumor without virtual preoperative plan.Results 3-D stereoscopic virtual reality images of 87 cases were reconstructed successfully,and of coincidence with real situation in operations.Virtual preoperative plan could shorten operative time,reduce the complication rate,increase the visual recovery rate (P ＜005),but could not improve the total resection rate and the KPS score(P ＞0.1),compared with control group.Conclusions VR technique in Dextroscope system can integrate multiple medical imaging data quickly,intuitively and overall,offer a comprehensive information about the sellar lesions and related structure anatomy,give a hand in optimizing the operative project and might potentially increase the safety of operation.

Objective To evaluate the radiological factors about the recurrence of primary prosopalgia treated by microvascular decompression (MVD).Methods To analyze the relationship between postoperative recurrence and preoperative MRI features of the 107 patients who were treated by MVD in Nanfang hospital.The radiological characteristics of trigeminal nerve (TGN) included the sectional area ratio,length ratio,intersection angle ratio,compression distance and orientation of TGN.Besides that,the radiological features also included the area of cerebellopontine angle (CPA),location of basilar artery and the types of offending vascular.Results The result of Kaplan-Meier analysis showed the duration of disease(P =0.039),clinical presentation(P =0.049),the area ratio of cerebellopontine angle (P =0.003),types of offending vascular (P =0.000),sectional area ratio of TGN (P =0.036) and compression distance of TGN (P =0.045) were related to the postoperative recurrence(P ＜0.05).The Cox Regression showed that the area ratio of CPA (P =0.049),duration of disease (P =0.002),offending vascular types (P =0.000) and sectional area ratio of TGN (P =0.019) were the main influencing factors of postoperative recurrence(P ＜ 0.05).Conclusions The MRI characteristics of TGN demonstrated that the CPA cistern without stenosis,the offending vascular being artery and the nerve root without atrophy will not easily lead to the postoperative recurrence of MVD.

Objective To analyze microsurgical treatment of minimally invasive transforaminal interbody fusion (MIS-TLIF) through bilateral Wiltse approach for spondylolisthesis.Methods Between May 2012 and November 2013,13 patients diagnosed lumbar spondylolisthesis (Myerding Grade Ⅰ-Ⅱ) were included.With the assistant of neurophysiological monitoring and microscope,all patients were treated by MIS-TLIF through bilateral Wiltse approach (gap between the multifidus and the longissimus).Operation time,blood loss,postoperative wound pain duration and Lumbocrural pain relief time were analyzed.Creatine phosphokinase (CPK-MM) level was recorded preoperatively,1 day,3 days and 7 days postoperatively.Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) score were analyzed preoperatively,1 week,3 months and 6 months postoperatively.X-ray examination and MR imaging of lumbar spine were achieved preoperatively and 6 months postoperatively to assess slippage reset and nerve decompression.Lumbar CT three-dimensional reconstruction was used to confirm pedicle placement and spinal stability.Results All patients accepted successful operation without nerve injury.The blood loss was (185.3 ±26.3) ml,and operating time was (186.0 ±23.0) min.Postoperative lumbar X-ray examination and MRI scan demonstrated good slippage reset and complete nerve decompression.Postoperative lumbar CT three dimensional reconstruction showed accurate pedicle placement and good spinal stability.VAS,JOA score obviously improved in postoperative 1 week,3 months and 6 months compared with that before operation(P ＜0.05).CPK-MM level peaked at postoperative 1 day,then gradually reduced,and almost descended to preoperative level at postoperative 7 day.Conclusions MIS-TLIF technique has obvious advantages over operating time,blood loss,paraspinal muscle protection and improvement of clinical symptoms.It is feasible and clinically effective of MIS-TLIF through bilateral Wiltse approach for lumbar spondylolisthesis with the assistance of microscope and neurophysiological monitoring.

Objective To explore the risk factors of acute intraoperative encephalocele in craniotomy of brain injury patients.Methods Gender,age,history of hypertension,hypotension,hypoxemia,primary brainstem injury,cerebral hernia,brain edema,time from injury to surgery,skull surgery distant sites fractur and bleeding situation were recorded and analyzed in 190 patients with acute intraoperative encephalocele and 506 patients without encephalocele.Results Distant sites fractured and bleeding,brain edema,cerebral hernia,hypoxemia,primary brainstem injury,time from injury to surgery,were closely related to the acute intraoperative encephalocele(P ＜ 0.05).Conclusions Skull surgery distant sites fracture,hypoxemia,primary brainstem injury,cerebral hernia,brain edema,and surgery distant sites bleeding situation (epidural hematoma) are the risk factors for the acute intraoperative encephalocele,that the time from injury to surgery is a protective factor.Actively correct hypoxia,primary brainstem injury and prevent secondary damage,prevention of distant sites bleeding situation can effectively reduce intraoperative encephalocele.

Objective To explore the relationship among histone deacety lases 3 (HDAC3),tumor grade and prognosis of children's gliomas.Methods The samples (n =70) were randomly collected from children with glioma and underwent microneurosurgery resection in the pediatric neurosurgery ward in Beijing Tiantan Hospital from 2009 to 2012.Normal brain tissues (n =7) as control groups were collected from adult patients with epilepsy who underwent temporal lobe resection in functional neurosurgery ward in Beijing Tiantan Hospital in 2012.Western blot and RT-PCR were used to detect the expression of HDAC3 and the relationship between the expression of HDAC3 and the tumor grade of glioma.Results Data showed that HDAC3 was significantly elevated in children's gliomas,following the glioma grade (WHO2007),with almost no expression in normal human brain tissues.Ectopic HDAC3 expression was correlated with a poor prognosis of children with glioma.Conclusion The level of HDAC3 expression was associated with tumor stages and survival time.

Objective To obtain structural and functional visualization of facial nerve (FN)by preoperative identification with diffusion tensor tracking (DTT) and intraoperative electrophysical monitoring (IOM) and explore the effect of these techniques on preservation of facial nerve in large vestibular schwannoma (extrameatal diameter≥ 30 mm,VS) surgery.Methods Fifteen patients habouring large VS were adopted in this retrospective study.Structural and functional visualization of FN was conducted in each patient.Correlation of FN location between preoperative identification and intraoperative inspection was analysed.Postoperative FN function was evaluated in each patient periodically.Results FN was identified by DTT in 13 cases.Seven FNs located at the anterior middle third of the tumor,3 at the anterior inferior third,2 at the anterior superior third,and 1 at the inferior pole.The locations agreed to intraoperative findings and monitoring in all the 13 cases.Gross total resection was achived in 11 cases and subtotal in the other 4 cases.IOM was helpful to locate and protect the FN.All FNs were anatomically preserved.House-Brackmann grade Ⅰ of FN function was achieved in 8 cases,grade Ⅱ in 6,and grade Ⅳ in one.Conclusion Structural visualization by preoperative DTT and functional visualization by IOM of FN contribute to lacating and preserving FN in large VS surgery.

Objective To study surgical treatment strategies and outcomes of bilateral vestibular schwannomas(VS) in neurofibromatosis (NF)type 2 patients.Methods Retrospective study 90 cases of clinical information,imaging and of neurofibromatosis type 2 patients.Suboccipital approach was taken for 90 cases of VS resection and intraoperative monitoring of the facial and trigeminal nerves and auditory brainstem responses (ABR) was used in all cases.Results Total tumor resection was achieved in 78 cases.Near total and sub-total resection were be done in 9 and 3 cases,as 8 of 12 was the only hearing ear.As more than 1-year follow-up,the anatomical integrity of the facial nerve was preserved in 85 cases.59 cases had Ⅰ-Ⅲ grade of H-B Score.Postoperative hearing level Analysis according to AAO-HNS grade showed that hearing was preserved in 20 of 90 cases for Class B,12 cases for Class C and in 58 cases for Class D.Conclusion Vestibular schwannomas in NF2 can be successfully treated with microsurgical treatment.Neurological function should be presevered as good as possible for the patients's quality of life.

Objective To investigate the role of gap junction in the pathomechanism and treatment of cerebral vasospasm after experimental subarachnoid hemorrhage.Methods HE dyed was used to identify the model.The diameters of basilar arteries were determined by pressure myograph.The connexins in the basilar arteries of different groups were examined by western blot.Results The diameters,connexins in basilar arteries were compared in and between groups respectively.There are more significant differences in operation group compared with control,sham and treatment group(P ＜ 0.01),that is Cx40 and basilar arteries diameters are reduced,Cx43 and Cx45 are elevated.But the differences in and between Control,sham and treatment group are not obvious (P ＞ 0.05); Cx37 can't examined; Cx40 and basilar arteries diameters are positive correlation(P ＜0.01,r =0.823),with Cx43 and Cx45 are negative correlation(P ＜0.01,r =-0.840; P ＜0.01,r =-0.839).Cx43 and Cx45 with basilar arteries diameters are negative(P ＜0.01,r =-0.828;P ＜0.01,r =-0.823).Cx43 and Cx45 are positive correlation(P ＜ 0.01,r =0.939).Conclusions Cx43 and Cx45 proteins play an important role which is promotion in the pathomechanism of cerebral vasospasm after experimental subarachnoid hemorrhage,but Cx40 is opposite; There are correlation among Cx40 and Cx43 Cx45,Cx43 and Cx45 are positively correlated,Cx40 and Cx43,Cx45 are negatively correlated,respectively.Gap junction inhibitor 18β-glycyrrhetinic-acid can relieve cerebral vasospasm after experimental subarachnoid hemorrhage in rats in vivo.

Objective To clarify the mediating role and mechanism of Wnt/PCP-JNK pathway in prevention of neural malformation of taurine.Methods Kunming mouse model of embryonic neural tube defects were induced by using retinoic acid and the animal models of these defects were established by using taurine.Immunohistochemistry,Western Blotting were used to detect Dvl,RhoA,p-JNK/JNK expression of Wnt/PCP-JNK pathway in the neural tube during embryonic development and the relationships among expression changes of various proteins.Results In the control group,no embryos with neural tube defects were observed and low expressions of Dvl,RhoA and p-JNK/JNK were detected by using immunohistochemistry and Western blotting.In the teratogenic group,the incidence of neurological malformation (57.1％) was significantly higher than that in the control group (P ＜ 0.05).Compared with the control group,the expressions of Dvl,RhoA and p-JNK/JNK significantly increased (P ＜ 0.05).The incidence of neurological malformation following taurine treatment was 31.7％,significant lower than that in the teratogenic group (P ＜0.05).The expressions of Dvl,RhoA and p-JNK/ JNK following taurine intervention significantly decreased compared to the teratogenic group (P ＜ 0.05).Conclusion Wnt/PCP-JNK pathway mediates the process for the taurine to prevent the occurrence of neural malformation.

translation medicine (translation medicine) has been an important research direction in the international medical field in the past decade. The concept has been highly valued by the world once it was put forward in Lancet magazine in 1996. Its purpose is to break the barrier between basic medicine and clinical medicine and drug research and development, and quickly and effectively transform the rapidly changing basic medical research achievements into technologies, methods and drugs for disease prevention, diagnosis, treatment and prognosis assessment to improve human health. At the same time, the clinical conclusions or questions are fed back to basic research, that is, "a continuous two-way research process from bench to bedside and bedside to bench (B2B)" 1.

Neurosurgery Department of Beijing Tiantan Hospital affiliated to Capital Medical University is a national key discipline. In the past five years, it has made continuous explorations and attempts in how to turn clinical advantages into scientific research advantages and build a research-oriented department, which continuously leads the overall development of medicine, teaching and research in the hospital. Building a research-oriented discipline is a strategic choice for comprehensive tertiary hospitals to grasp the development opportunities and change the development mode. It is also an inevitable trend for departments to adapt to the fierce medical competition environment, realize the synchronous development of scale and connotation, and catch up with the international level [1-2]. It is also the necessary mission of national key disciplines, and it is also the only way for neurosurgery to occupy the commanding heights of discipline development under the new situation. Accurately grasping the connotation of research-oriented departments is the prerequisite for construction. The standards of research-oriented departments are three points: every patient should be included in the research, every doctor should do research, and research funds should exceed clinical income. In this paper, the scientific research fund of neurosurgery project of Tiantan Hospital in the past five years is statistically analyzed from multiple dimensions, and the practice of team building and platform building of neurosurgery is summarized, and the development law, existing problems and solutions are found, so as to inject impetus into the development of discipline and provide experience for clinical discipline construction. Taking the winning research projects of neurosurgery from 2009 to 2013 as the basic data, the data is statistically analyzed from five dimensions: project establishment year, funding source, research type, personnel structure and research direction.

Glioma is a common primary brain tumor, accounting for about 35% ~45% of intracranial tumors, among which malignant glioma has poor prognosis and high disability rate. Although the current standard treatment regimen-surgery combined with radiotherapy and temozolomide chemotherapy can increase the average survival time of glioblastoma (GBM) to 14.6 months, the overall prognosis is still far behind that of other tumors. 1. However, there are many genetic and epigenetic changes in the development of glioma, which can affect the biological behavior of tumor cells, and also make it possible to treat glioma against these changes. In recent years, due to the vigorous development of molecular biology, molecular targeted drugs have made great progress in various types of tumors. epidermal growth factor receptor (EGFR) is the expression product of proto-oncogene C-erb-B1, which is highly expressed not only in normal human cells, but also in many malignant tumors, while epidermal growth factor receptor type Ⅲvariant (EGFRvⅢ) is only highly expressed in malignant tumors

Congenital hydrocephalus is the most common neurosurgical disease in infants and young children.CRASH syndrome is the only definite single gene-induced hydrocephalus.It is manifested as X-linked inheritance, and the gene is localized to the cell adhsion molecule L1 (L1CAM) in the long arm 2 and 8 bands of the X chromosome [1]. In this paper, a case of CRASH syndrome is reported, and the clinical manifestations, genetic basis and diagnosis and treatment measures of this disease are reviewed in combination with the literature to improve the understanding of this disease.

A 49-year-old female was diagnosed with non-aneurysmal subarachnoid hemorrhage (PNSH) around the midbrain. After 2 months of conservative treatment, the local hospital reexamined CTA and suspected basilar artery perforator microaneurysm. For further diagnosis and treatment, she went to our hospital. The patient denied the history of infectious diseases, diabetes, hypertension and cardiovascular diseases, surgery and drug allergy. After admission, DSA reexamined the existence of basilar artery microaneurysm (Figure 2).