Volume 30 · Issue 12 · 2014

Objective To discuss the value and significance of risk factors early warning system of endoscopic skull base surgery (RFEWS) in the trans-nasal skull base chordoma surgery.Methods RFEWS was comprised of neuronavigation,intra-operative neurophysiologic monitoring equipments,intra-operative ultrasound and Doppler probe.The application of RFEWS in 48 chordoma patients who received endoscopic trans-nasal surgery was analyzed.RFEWS was used to recognize the intra -operation risk factors consisting of the crucial blood vessels or nerves damage and tumor residual.Results RFEWScould recognize and protect skull base main arteries in 16 cases,cranial nerves in 5,brain stems in 2 and guide residual tumor resection in 4.The total,subtotal and partial resection were performed in 11,25 and 12 patient respectively.After a follow-up of 48 patients for 12-18 months,2 patients were recurrent,there was no other severe complication.Conclusion Using RFEWS in skull base chordoma surgery was in favor of recognizing and locating important vessels and tissues and was helpful to raise the operation safety and excision rates.

Objective To explore the possibility and strategy of maximally removal of low-grade gliomas which involved the motor areas on the premise of protecting the patient' motor function.Methods The neurosurgical plans and procedures of 30 patients with low-grade gliomas involving the motor areas in Beijing Tiantan Hospital from December 2011 to May 2013 were analyzed retrospectively.Preoperative head magnetic resonance imaging (MRI) was performed in all patients.A ω-shaped or inverted Ω-shaped hand-knob as a logo was used to confirm the precentral gyrus (primary motor area,M1).Intraoperative somatosensory evoked potential (SEP) was used to confirm the central sulcus,M1 and premotor area (PMA).MEP was used to monitor the function of motor pathway.The extent of tumor resection was evaluated by intraoperative B-mode ultrasound at the same time.Postoperative head MRI within 72 hours was used to evaluate the extent of tumor resection.The muscular power was determined instantly after waking up,2 weeks and 3 months following operation separately.Results The M1 was involved in 3 cases,the supplementary motor area (SMA) in 3,the PMA in 11,and the SMA and PMA were simultaneously involved in 13.Subtotal resection was achieved in 27 cases (90％) while partial resection in 3 (10％).The histological results of all patients revealed oligodendroglioma in 2 cases,astrocytoma in 9 and oligo-astrocytoma in 19.Preoperative muscle power was normal in 25 cases,4 of them had one hand less flexible and could not perform accurately,and 2 of them felt trample empty while walking,and 5 cases had grade Ⅳ muscle power.After the surgery,part of patients had transient muscle disorders.Three months after the surgery,muscle power was normal in 23 cases,9 of them had one hand less flexible and could not perform accurately,3 of them felt trample empty while walking.7 cases had grade Ⅲ-Ⅳ muscle power of upper or lower limbs.Conclusions Motor area is consisted of M1,PMA,SMA,corticonuclear tract and corticospinal tract started from them.The position of low-grade gliomas involving the motor areas should be confirmed accurately before surgery.Under the use of some technologies such as intraoperative electrophysiology,B-mode ultrasonography and delicate microneurosurgical techniques,subtotal resection of tumors without causing permanent motor deficits might be achieved.

Objective To investigate the clinical features and treatment of intracranial clear cell meningioma.Methods We retrospectively reviewed 21 cases of intracranial clear cell meningioma hospitalized in our institute between 2003 and 2013.The clinical data included the images,surgical treatment,immunohistochemistry and the results of follow-up.Results The 21 patients who constituted 0.23％ of the total 9 167 intracranial meningiomas included 7 males and 14 females.The average age was 27 years old.The edema rate of the 10 cases in the superior tentorium region was 80％,and the damage rate of the 11 skull base tumors to the surrounding bone and periosteom was 73％.Resection of Simpson Ⅰ grade was achieved in 7 patients,Simpson Ⅱ in 3,Simpson Ⅲ in 3 cases and Simpson Ⅳ in 8.The average Ki-67 index was 11.25％.The mean follow-up period was 41 months,and 20 cases were followed-up.3cases died.5 cases were treated with gamma knife after the first operation,and 1 case accepted Cyberknife.Conclusions Intracranial CCM was a rare subtype of the intracranial meningiomas.Its imaging and histopathologic characteristics were different from those of benign meningiomas.Surgical resection was the main treatment,but it is difficult to reach entirely total resection.A high recurrence rate was found in intracranial CCM.Gamma knife surgery for the residual tumor could prolong the recurrence time and reduce the recurrence rate.

Objective To discuss the safety and guiding effect of contrast-enhanced ultrasound(CEUS) in the resection of brain tumors.Methods Forty-three patients who were doubted brain tumors by computed tomography(CT) or magnetic resonance (MR) imaging were included in this study.All cases received microsurgical operation to remove the tumors using CEUS.Surgeon could determine the malignancy degree of the tumor and identify the tumor boundary according to the characteristics of ultrasound contrast imaging.After the resection of the tumor,CEUS was performed again in the surgical cavity to judge residual tumor.The suspicious tissues were removed and did pathological examination to clarify the nature of the tumor.Results Total tumor resection was achieved in thirty-five cases,subtotal in eight.The boundary of all lesions was well displayed under CEUS.Each tumor had different ultrasound performance in lesion morphology,boundary,internal echo,peripheral edema,internal flow and other aspects.All tumors after injecting ultrasound contrast agent (UCA) appeared different levels of enhancement and had different intensifying time,intensity,and distribution(P ＜ 0.05).Eighteen residual tumors were judged through CEUS after the resection,which were confirmed by pathology tests later.Conclusion CEUS in brain tumors microsurgery could help to estimate tumor grade,identify tumor boundary accurately,and find residual tumor,which could guide to remove the tumor maximally.

Objective To assess outcomes after gamma knife radiosurgery for chondrosarcomas of the skull base.Methods Six patients (one female and five male) with skull base chondrosarcomas were reviewed who underwent gamma knife treatment between 2007 and 2013.The mean patient age was 45.6 years (range 28-65 years).All patients were diagnosed as chondrosarcoma by histological confirmation.All patients had no radiation therapy experience.The mean tumor volume was 16.8 cm(range 4.7-62.4 cm) and mean/median margin dose was 13.3/13.5 Gy (range 10-14 Gy),and the mean/median tumor maximum dose was 29.1/28.6 Gy(range 26-31 Gy).The mean/median followed up time was 29.3/27.0 months (range 6-51 months).Results One paitent who was diagnosisd as mesenchymal chondrosareoma dead at 15 months after gamma knife treatment because of tumor progression at 27 months,one patient underwent repeat gamma knife treatment,and the tumor progression free until now.Other 4 patient keep tumor progression free.No symptomatic adverse radiation effects occurred.Conclusion Stereotactic radiosurgery provide a benefit to patients as a adjuvant therapy for skull base chondrosarcoma.

Objective To report our experience of intraoperative subcortical napping by direct electrical stimulation in surgery of diffuse low-grade gliomas in supratentorial eloquent areas.Methods We conducted a retrospective analysis of clinical data of 57 patients with diffuse low-grade gliomas who were underwent awake craniotomy with the direct electrical stinulation for subcortical mapping of the eloquent fibers.The maximal resection of the tumors and minimal damage of the eloquent fibers were the surgical goal of all patients.Results The operation was stopped by individual functional boundaries as intra-operatively identification of the cortico-spinal pathways,or superior thalamic radiation,or language-related pathways in all patients.Post-operative MRI showed that 20 patients (35％) were achieved total resection,26(46％) subtotal and 11 partial(19％).11 patients (19％) had no postoperative deficits,while 46 patients (81％) had early post-operative neurologic deficits,including 15 patients with mild neurologic deficits,21 with moderate,and 10 with severe.Four patients experienced late post-operative neurologic deficits,including 3 patients with mild deficits,1 moderate.No one experienced severe late post -operative sequelae.Among 55 patients with pre-operative epilepsy,48 patients (87％) were seizure-free with taking anti-epilepsy drugs during seven days to three months after surgery,The frequency of post-surgical seizure attack in the remaining seven patients was decreased by 50％ compared with that of pre-operation.Conclusion Intraoperative subcortical mapping of the functional fibers by direct electrical stimulation under awake craniotomy allowed neurosurgeons to remove diffuse low-grade gliomas in supratentorial eloquent areas according to individual functional boundaries without increasing the late post-operative neurological deficits.However,frequent early postoperative neurological deficits often necessitated rehabilitation therapy.

Objective To verify the accuracy of magnetic resonance elastography (MRE) in assessing the elasticity of meningioma,and to provide a more reliable way to evaluate the consistency of meningioma for neurosurgeon.Methods Fourtecn consecutive patients with meningioma hospitalized in neurosurgical department of Beijing Tiantan hospital from September,2009 to March,2010 were involved.All the subjects underwent head MRE.After postprocessing raw images by computer,the shear modulus of grey matter and white matter of normal brain tissue,and shear modulus of tumors were seperatively messured.The assessment of tumor stiffness by MRE was compared to that by neurosurgeons.Results All the shear modulus of grey matter and white matter of normal brain tissue,and shear modulus of tumors were successfully obtained.The shear modulus of grey matter and white matter was(4.839 ± 0.971) kPa and (10.249 ± 1.870) kPa respectively.Among all patients,3 tumors were soft with shear modulus smaller than that of white matter,8 tumors were medium with shear modulus equal to that of white matter,and 3 were hard with shear modulus larger than that of white matter.The elasticity of tumors was agreed with those given by neurosurgeons in all cases.Conclusion The accuracy of assessment of meningioma stiffness by MRE was preliminarily proved.MRE could provide important information for the and prognosis.

pleomorphic xanthoastrocytoma (PXA) is a rare tumor of the central nervous system, accounting for 1% of brain tumors. It was first named in 1979 [1] and belongs to WHO grade II tumor [2-3]. This disease tends to occur in young patients without gender differences. It mostly starts with epilepsy, hypertension and focal localization signs. It mainly occurs in the cerebral hemisphere, especially in the temporal and parietal lobes, and is rare in other parts. CT and MRI manifestations are mostly cystic tumors with wall nodules or solid tumors with intratumoral cystic degeneration [4-7]. In March 2014, a patient with PXA was diagnosed in the Department of Neurosurgery of Beijing Ditan Hospital affiliated to Capital Medical University. The growth site and CT and MRI manifestations are rare. The report is as follows.

Objective To explore the hemodynamics of internal maxillary artery (IMA)-intracranial arterial bypasses via intraoperative duplex ultrasonography.Methods The hemodynamic parameters (flow volume,inside diameter,mean flow velocity,pulse index and resistance index) were compared between normal IMA (n =15),IMA-radial artery (RA)-MCA (n =35) bypass,IMA-RA-PCA (n =7) bypass and superficial temporal artery(STA)-MCA bypass (n =10) by measuring the flow via intraoperative duplex ultrasonography.Results There was no significant difference in inside diameter between IMA and RA (2.49 ±0.31)mm vs (2.47 ±0.26)mm,P =0.812).The average flow was (81.8 ±19.0)ml/min for normal IMA,(69.6± 163)ml/min for IMA -RA-MCA bypass and (48.0 ± 8.8) ml/min for IMA-RA-PCA bypass,which were significantly higher than that of STA-MCA bypass (31.0 ± 8.4) ml/min (P =0.000,0.000 and 0.001).The donor vessel (IMA vs STA) and recipient vessel (MCA vs PCA) could impact the flow through bypasses.Condusions IMA could deliver a short segment high blood flow as a donor vessel for extracranial-intracranial bypass.The suitable inside diameter of IMA and RA could make an end-to-end anastomosis be performed directly.IMA-RA-MCA/PCA bypasses could supply middle to high flow capacity for brain.The donor vessel and recipient vessel might impact the final blood flow volume through extracranial-intracranial bypass.

Objective To investigate the safety and feasibility of intra-aneurysmal looping technique for stent-assisted embolization of complicated intracranial aneurysms.Methods Twenty-one complicated intracranial aneurysms were treated successfully using intra-aneurysmal looping technique for stent-assisted coil embolization.Coil embolization was performed after the microcathetes and stents were implanted to cover the aneurismal neck using exchanging technique.Results Stents were implanted successfully in all of the 21 cases.The success ratio was 100％.Except for 1 case with perforation of distal vessels,none was suffered from rupture of the aneurysm or occlusion of its parent artery.Seven cases were treated using Tubridge flow diverters.Among the other 14 cases treated by conventional stents,the immediate results of dense embolization or neck residual were obtained in 12 cases and partial embolization in the other 2 cases.All cases received both clinical and radiological follow-up.None of the 21 cases developed new neurologic deficit during the follow-up period.Among them,14 cases were followed-up by digital subtraction angiography (DSA) and the results showed no recurrence.While the results of 7 cases followed-up by MRA showed recurrence in 3 cases.Conclusions Intra-aneurysmal looping technique of microcatheters for stent-assisted embolization was safe and feasible in the treatment of endovascular treatment of complicated intracranial aneurysms.Reasonable choice of the patients and materials were the promises of successful application of the technique.

Objective To investigate the effects of combined direct and indirect revascularization in the treatment of ischemic moyamoya disease.Methods Combined superficial temporal artery middle cerebral artery anastomosis and encephalo-duro-myo-synangiosis (EDMS) were performed in 20 adult patients with ischemic moyamoya disease,who were followedup for six months to two years.The postoperative outcomes were evaluated by CTA,DSA,MRI and PWI.Results The postoperative external carotid angiography at 6 months and 12 months revealed that the STA-MCA bypass was patent in 17 patients.12 of 17 patients were also patent at 24 months after the procedure.The extensive development of surgical collaterals from MMA and deep temporal artery through indirect bypass were observed in all patients.18 patients were free of transient ischemic attack within one year.Conclusions Combined STA MCA bypass and EDMS could provide a significant reciprocal benefit.It was a safe and effective option to improve the short-and long-term outcomes in patients with ischemic moyamoya disease.

Objective To compare the advantages and disadvantages of continuous lumbar cerebrospinal fluid drainage and repeated lumbar puncture for ruptured intracranial aneurysm surgery.Methods 295 patients were enrolled who had ruptured intracranial aneurysm and were treated surgically between Jan 2010 and Jan 2011 in department of neurosurgery.Patients were classified into 2 groups:patients who were performed with continuous lumbar cerebrospinal fluid drainage (group A) and patients who were performed with repeated lumbar puncture (group B).The incidence rates of major surgical complications of both groups were compared and analyzed,including delayed cerebral ischemia,postsurgical hydrocephalus and postsurgical intracranial infection.All patients were followed-up for over 6 months and the surgical outcomes were assessed using modified Rankin scale (mRS).Results The incidence rates of delayed cerebral ischemia were 4.38％ (7/160) and 7.41％ (10/135) in group A and B respectively.There was no significant difference between 2 groups.The incidence rates of postsurgical hydrocephalus were 2.50％ (4/160) and 3.70％ (5/135) in group A and B respectively.There was no significant difference between 2 groups.The incidence rates of intracranial infection were 8.13％ (13/160) and 2.22％ (3/135) in group A and B respectively.There was a higher rate of intracranial infection in group A (P ＜ 0.05).There was no significant difference in mRS between 2 groups after 6-months follow-up.Conclusions Continuous lumbar cerebrospinal fluid drainage showed little advantage over repeated lumbar puncture in reducing the occurrence of major surgical complications,including delayed cerebral ischemia and postsurgical hydrocephalus.While continuous lumbar cerebrospinal fluid drainage had a higher incidence rate of intracranial infection.Continuous Lumbar cerebrospinal fluid drainage might enhance the risk of intracranial infection.The therapeutic indications of continuous lumbar cerebrospinal fluid drainage for ruptured intracranial aneurysm surgery should be considered carefully.The standardized surgical operations should be followed strictly and the importance of asepsis during the surgery should be valued.

Objective To explore the therapeutic results of deferoxamine in the treatment of spontaneous intracerebral hemorrhage (SICH).Methods A total of 29 spontaneous intracerebral hemorrhage patients were collected from 4 clinical centers in Shanghai and Ningbo City.Nineteen cases received deferoxamine treatment as the treatment group,and l0 cases received routine therapy as the control group.Deferoxamine was given after the onset of stroke for a consecutive of 3 days.All cases had brain MRI T2WI and T2 * WI scanning at the 1st,7th and 14th days after the onset.The image features were recorded and image analysis was performed by the software of Image J.The neurological function was evaluated at the 7th,14th and 90th days after the stroke.Results Patients in the treatment group didn't show any drug related side effect.The cerebral edema in the treatment group patients with at the 1st、7th and 14th days (1.08 ±0.57、1.37 ±0.68、1.52 ±0.69) were lighter than those in the control group(1.89 ±0.77、2.03 ± 0.71、2.07 ±0.87) (P ＜0.05).The hematoma volumes of the treatment group patients at the 7th and 14th days (0.96 ±0.21、0.89 ±0.23) were smaller than those in the control group (1.16 ±0.23、1.24 ±0.49) (P ＜0.05).The neurological function in the treatment group patients at the 7th and 14th days after SICH (11.7 ± 4.1、7.4 ± 2.6) was better than that in the control group (15.1 ± 4.9、11.8 ± 5.6) (P ＜ 0.05).Conclusion Deferoxamine had obvious therapeutic effect on the clinical treatment of patients with SICH.

Objective To study how to prevent cerebral ischemia and hyperperfusion syndrome during carotid endarterectomy (CEA).Methods Twenty-ninth cases of patients undergoing CEA (35 procedures in total) with carotid artery stenosis were divided into bilateral (group A) and unilateral (group B) stenosis groups.During CEA,the regulation of blood pressure was according to the changes of the ipsilateral middle cerebral artery mean flow velocity (MCA Vm) detected by transcranial Doppler (TCD):if the MCA Vm after carotid artery occlusion was lower than 70％ of that before occlusion,the blood pressure should be increased; and if the MCA Vm after release cross was higher than 100％ of that before carotid artery occlusion,the blood pressure should be decreased.All cases in the study were underwent transcranial Doppler,color Doppler flow imaging,CT angiography,CT perfusion imaging,Magnetic resonance imaging,and/or digital subtraction angiography before and after surgery.Results (1) In the two groups:the MCA Vm of the intraoperation side before carotid artery occlusion was decreased as compared with that before anesthesia (P =0.000).After carotid artery occlusion,the MCA Vm was decreased slightly as compared with that before occlusion (P ＞ 0.05),and the blood pressure was increased (23.76 ±9.15)％ (P =0.000) ; The MCA Vm after release cross was higher than that before occlusion(P =0.000),the blood pressure was decreased (6.70 ±6.89)％ (P =0.000).(2) Between the two groups:After carotid artery occlusion,the MCA Vm of the intraoperation side in group B was decreased than that in group A (P ＜ 0.05).The enhance rate of the blood pressure was higher than that in group A(P ＜0.01).After release cross,the reduce rate of the blood pressure in group B was lower than that group A (P ＜ 0.05).The MCA Vm between the two groups had no statistic difference (P ＞ 0.05).(3) After surgery,the cerebral perfusion of all patients of the intraoperation side was improved versus that before surgery.Conclusion During CEA,TCD could real-time monitor the changes of cerebral hemodynamics,evaluate the cerebral perfusion,guide the to regulate the blood pressure timely,so as to improve the success rate of surgery significantly.

Objective To explore the treatment effect of rapid small hole cranio-puncture apparatus for the chronic subdural hematoma (CSDH) drainage,and povide clinical experiences of CSDH treatment.Methods The clinical data of 510 patients of CSDH treated by rapid small hole cranio-puncture apparatus of self-development and autopsy data of one patient died of CSDH were retrospectively studied.All the cases were diagnosed with cerebral angiography,CT or MRI.The parietal tuber or the thickest site of hematoma was usually used as the puncture point,and the length of drill's forepart was designed by the thickness of scalp and skulls.Continuous low position catheter drainage was adopted for 3 to 5 days after surgery.Accurate length restriction of the drill's forepart,puncturing the thickest site of hematoma,and timely cerebral CT examination should be noticed.Results In all patients treated of rapid small hole cranio-puncture,the operating time was only 3 to 5 minutes with unilateral puncture,while bilateral puntcure needed 6 to 8 minutes.The hemorrhage drainage volume was among 60 to 340 ml,mostly 80 to 120 ml,and the drainage duration was among 2 to 8 days,mostly 3 to 5 days.433 patients (84.9％) patients were cured,75 patients got improvement (14.9％),and 2 patient (0.4％) died.The complications included epidural hematoma (2 cases,0.4％) and little intracerebral hematoma induced by the drainage tube inserted into the brain parenchyma incautiously (1 case,0.2％).Conclusions Drainage of CSDH via rapid small hole cranio-puncture apparatus was effective,safe,simple and fast.

From January 2010 to December 2012, 59 patients with hypertensive cerebral hemorrhage in the basal ganglia area were treated by microscopic translateral fissure insula and temporal cortex approach in the Department of Neurosurgery of Ningxia Medical University General Hospital. Combined with the clinical data and related literature review of the two groups, the report is as follows. DATA AND METHODS 1. General data: According to the different surgical approaches, they were divided into two groups. (1) Translateral fissure insula approach group: 37 cases, including 22 males and 15 females; The age ranged from 37 to 67 years, with an average of 52 years; Consciousness scores (GCS) at admission:<6 scores in 3 cases, 6-8 scores in 8 cases, 9-11 scores in 15 cases, and>11 scores in 11 cases. (2) Transtemporal cortical approach group: 22 cases, including 12 males and 10 females; The age ranged from 33 to 72 years, with an average age of 50 years; GCS scores at admission were<6 scores in 2 cases, 6-8 scores in 7 cases, 9-11 scores in 8 cases, and>12 scores in 5 cases.

Objective To investigate the incidence,risk factors and outcomes of post-craniotomy intracranial infection (PCII) in patients after supratentorial neurosurgical operation in Beijing Tiantan Hospital.Methods Patients who underwent supratentorial neurosurgical operation in our hospital form January 1st,2011 to December 31st,2012 were included.The medical records,imaging findings,and laboratory data were reviewed to investigate the incidence,risk factors,and outcomes of patients of PCII.Results The incidence of PCII was 5.0％.Adiministration of prophylactic antibiotics reduced the incidence of PCII (odds ratio ＜ 1,P ＜ 0.05).Operation time,red blood cell infusion,postoperative drainage tube placement,and intracranial hemorrhage were independent risk factors for PCII (odds ratio ＜ 1,P ＞ 0.05).Patients with PCII had significantly longer hospital stay and higher hospital costs (P ＜ 0.05).The incidence of pneumonia was higher in patients with PCII (P ＜ 0.05).Conclusions The overall incidence of PCII in patients after supratentorial neurosurgical operation was 5.0％.Patients with PCII had longer hospital stay and higher hospital costs,which indicated that patients with PCII should be carefully managed.Prophylactic antibiotics should be considered for patients undergoing supratentorial neurosurgical operation.

Objective To map the basal temporal language area (BTLA) in native Chinese and investigate the functional characteristics of BLTA.Methods Three patients with refractory mesial temporal lobe epilepsy were studied.Due to controversial results from non-invasive methods,the chronic subdural electrodes were implanted.The language function on the basal temporal lobe was investigated by means of electrocortical stimulation.Patients were asked to read sentences aloud and perform specific language task during the test.Any responses to electrocortical stimulation with gradual increased current intensity were recorded.Results Left dominant hemispheres of all patients were revealed by Wada test.With low current intensity (7,5,7 mA),slowing speech was observed when stimulating anterior to middle of fusiform gyrus on the left basal temporal lobe.Meanwhile,stimulation with high intensity (11,11,13 mA)produced global aphasia.Furthermore,semantic errors occurred when stimulating electrode 3 cm from temporal pole,while the impairment of naming and face recognition was elicited by stimulating electrode 4 cm from temporal pole with 9 mA current intensity in all three patients.Conclusions The preliminary study confirmed the BTLA in native Chinese,which localized on anterior to middle basal temporal lobe in the dominant hemisphere and involved in the semantic and naming function.The identification of BTLA would be helpful for the clarification of language mechanism and protection of the language function in the surgical treatment of epilepsy.

Objective To explore the clinical characteristics and treatment of infants growing skull fracture.Methods A retrospective study of 12 cases of infants under 3 years of age of growing skull fracture from 2008 September to 2013 December was performed.Results Five cases were treated with dural repair by artificial dura tendon and autologous bone flap molding shift.The growing skull fracture was healed within three months.The other 4 cases were treated with artificial dura tendon only for dural repair.The results were also satisfactory,but the bone healing time was long.The remaining 3 cases were lost during the followup period.Conclusion When the skull fracture line width was increased and/or dural breakage or brain hernia was found from the observation of dynamic CT/MRI,early surgical intervention should be performed to remove the necrotic foci,repair the dura,and use autogenous bone flap molding shift to fix the fracture,to accelerate the growth and healing of the fracture.

Objective Compared to 18F-FDG PET-CT,to validate the use of interictal 18FFDG PET/MRI registration in the location of epilepsitic lesions and prediction of surgical outcome.Methods Forty-five patients of intractable temporal lobe epilepsy were recruited retrospectively.All patients underwent persurgical evaluation included clinical symptoms,long-term video electroencephalogram(VEEG),PET-CT,and MRI.They were followed-up at least 2 years after surgery and evaluated with Engel's classification.Both volumes of PET and 3D MRI were coregistered into PET/MRI using Siemens 3D volume software to study the relationship between the metabolic patterns of PET/MRI and surgical curative effects.Results The postoperative effect demonstrated that among 37 patients with limited temporal low metabolism detected by PET/MRI,29 cases reached to grade Ⅰ or Ⅱ effects and 22 cases (76％) showed the low metabolism restricted to mesial temporal lobe,while 8 cases reached Engel's grade Ⅲ or Ⅳ and the range of low mechanism in 6 cases beyond the anterior temporal lobe.The significant difference (P ＜ 0.05) was found between the postoperative effects with different metabolic areas by Chi square.Conclusions The temporal hypometabolism over the medial and anterior part of temporal region and the temporal pole might be a better predictor for postoperative seizure control.18F-FDG PET/MRI registration was a more accurate imaging variant in the pediatrion for nonlesional patients.The patterns of PET/MRI metabolic images could further help the surgeon to select patients,plan operation and predict therapy.

Objective To investigate the microsurgical anatomical structures of fornix and provide the anatomical basis for the surgery of transcallosal-interforniceal approach to the third ventricle.Methods (1) The surgery of transcallosal-interforniceal approach was performed on 15 formalin-fixed and dye-injected cadaveric head specimens.The microsurgical anatomy structures of the fornix were observed and measured by microscopes.Subsequently,the measured data was analyzed; (2) The 50 midline sagittal T1-weighted MRI of normal adults with average age of 36 years old and the relationship between the fornix and the corpus callosum were studied.Results (1) The fornix originated from the bottom of the temporal horn and the ventricle surface of the hippocampus and terminated in mammillary body.It presented C shape around the thalamus at the medial side of the medial wall of the lateral ventricle.There were many important nerves and vascular structures surrounding it.(2)The measured data obtained through the surgery of transcallosal-interforniceal approach:the distance between the posterior margin of the incision in corpus callosum and the borderline of fornix connected with corpus callosum was 16.26(11.72-22.04) mm,the height of the septum pellucidum was 13.58 (12.46-14.16) mm,the thickness of the fornix was 3.14(2.86-4.06) mm,the transverse diameter of the foramen of Monro was 3.22(1.86-4.62) mm.(3) The relative position of the fornix and the corpus callosum:type anterior cross,type standard cross and type posterior cross were 14(28％),29(56％) and 9(14％) respectively.Conclusions The anatomical structures of the fornix were complex,morphology and close association with the microstructures of the third ventricle.The understandings of the microanatomy of the fornix and sufficient preoperative evaluation had important significance for surgery of transcallosal-interforniceal approach.

Objective To investigate effects of three operation methods in treatment of Chiari Ⅰ with syringomyelia.Methods Retrospective study of patients betwenJune 2005 and June 2012 in The department of Neurosurgery,People's Hospital of Xinjiang Uygur Autonomous Region for a total of 133 cases patient of Chiari Ⅰ malformation with syrigomyelia.Group A was performed in 20 cases for simple posterior bony decompression; group B was performed in 65 cases for posterior bony decompression + dural enlargement repair;group C was performed in 48 cases for posterior bony decompression + dural enlargement repair + resection of the cerebellar tonsils.To comparison the effect of the operation,syringomyelia resolution and the rate of postoperative complications.Results Outpatient follow up for 6 months-9 years,a total of 118 patients were followed up for.According to the criteria of Tator,A,B,C three groups in the superior,good,poor rate was significant difference (P ＜ 0.05).Promote syringomyelia regression had significant difference(P ＜0.05).Group B and C have the same effect of operation,better than group A.A,B,C three groups of infection were 1 case,2 cases,1 case; postoperative transient headache were 6 cases,30 cases,25 cases;early postoperative cerebrospinal fliud leakage and subcutaneous effusion were 0 case,8 cases,6 cases ; 1 case of death in group C.The total complication rate had no significant difference (P ＞ 0.05).Conclusion Posterior bony decompression plus dural enlargement repair,posterior bony decompression withdural enlargement repair andResection of the cerebellar tonsils were the same effect,arereliable methods for Chiari Ⅰ with syringomyelia,better than soly posterior bony decompression.

With the development of new imaging techniques such as CT and magnetic resonance, the detection rate of ossification of lumbar ligamentum flavum has been greatly improved. When the ossification is further enlarged or combined with clinical symptoms such as intervertebral disc herniation, active surgical treatment should be done [1]. From February 2006 to March 2012, we treated 19 cases of severe ossification of lumbar spinal stenosis with microinvasive endoscopic discectomy (MED), and achieved excellent clinical results, which are reported below.

With the accumulation of experience in endoscopic third ventriculostomy (ETV), more and more patients with hydrocephalus are treated with ETV. At present, studies have confirmed that the imaging evidence of successful implementation of ETV not only includes the smaller lateral ventricle and third ventricle, but also includes the empty signal passing through the floor of the third ventricle, but these changes are not always consistent with the improvement of clinical symptoms, especially in the early postoperative period (e.g. 6 months), it is difficult for doctors to judge whether the operation is effective by conventional ventricular morphology measurement [1-3]. The early postoperative third ventricular morphology index (TVMI) can be used as an index to evaluate the effectiveness of ETV treatment [4-6].

Objective To study the effect and mechanism of boron neutron capture therapy (BNCT) on cell cycle procession in human glioma stem cells (GSCs) in vitro,and to analyze the difference of sensitivity for BNCT on GSCs and glioma cells.Methods Firstly,uptake of boronophenylalarine (BPA) on human GSCs SU2 and glioma cells SHG-44 was detected.Then the cells enriched boron-10 (10B) were irradiated by In-Hospital Neutron Irradiator (IHNI-1).The radiation sensitivity was measured using clonogenic survival assay.The proliferation was examined by MTT assay.The cell cycle procession was determined using flow cytometry.The protein expression of cyclin B1,CDK1 and P21[WAF1] were detected by Western blot.Results 10B concentration of SU2 and SHG-44 cells arrived at (1.76 ±0.28) and (2.50 ±0.12) μg/107cells at 24 h in 5 mMBPA.After radiation by IHNI-1,the survival fraction and viability of cells enriched 10B were decreased significantly (P ＜ 0.05 orP ＜ 0.01),compared with those of 10B-free.The BNCT sensitivity of SU2 cells was lower than that of SHG-44 cells (P ＜ 0.05).The proportion of G2/M phase of SU2 and SHG-44 cells was increased after BNCT compared with that of 10B-free(P ＜ 0.05).The protein levels of cyclin B1 and CDK1 were decreased(P ＜ 0.01),and that of P21[WAF1] was increased(P ＜ 0.01).Conclusions The BNCT sensitivity of GSCs was lower than that of glioma cells.BNCT could inhibite cell regeneration and proliferation and make G2/M to be blocked by inhibition of cell cycle protein formation.

Objective To record the change of anterior thalamic nucleus (ANT) electrical signals before the rhesus monkeys model of temporal lobe epilepsy seizures,use the optimized GOFA algorithm for the prediction of epileptic seizures,and lay the theory foundation for feedback electrical stimulation treatment of intractable epilepsy.Methods ANT deep electrodes were placed in 10 healthy adult male rhesus monkeys by stereotactic method.Normal ANT deep electrical signals were collected as a baseline signal.The rhesus monkeys temporal lobe epilepsy animal models were prepared.The bilateral ANT electrical signals were studied.The mathematical analysis of ANT electrical signals by improved GOFA algorithm was collected.The accuracy,specificity,sensitivity and detection delay time and so on were used to validate the reliability of the detection methods.Results The local electrical signals of ANT of 37 periods and 452.4 minutes were analyzed by the improved GOFA algorithm.According to the different characteristics of every period of EEG signals,different results by different space threshold T and time threshold D were collected.The experiment results showed that when t =22,D =0.84 s,the average detection delay time was 55 seconds,the sensitivity was 93.2％.Conclusions Epilepsy could be predicted through the improved GOFA algorithm.The epileptic prediction of individualized programs could be implemented,according to the different requirements for accuracy and false positive rate of epileptic prediction.The foundation for feedback electrical stimulation personalized therapy for the treatment of refractory epilepsy could be founded.

During frame-based stereotactic surgery, due to the limitation of the effective working range of the orientation instrument, the frame may not be positioned properly, which may hinder the intraoperative operation. The classical method of fixing with earstuds is easy to cause severe pain in the external auditory canal of patients due to the displacement of the frame when the fixing steel nails are tightened. It is more difficult to install the frame for patients who are unconscious or bedridden. We use LEKSELL-G stereotactic instrument and adopt a recumbent installation method to solve this problem better, which is introduced as follows.

Pituitary adenomas are benign intracranial tumors, and their incidence ranks third in intracranial tumors [1]. Pituitary adenomas generally do not metastasize, but some pituitary adenomas will invade the surrounding blood vessels and nerves and show invasive growth. As early as 1971, Folkman [2-3] found that angiogenesis plays a key role in tumor development. At present, studies have shown that angiogenesis is a key step in solid tumor growth and determines tumor behavior [4]. In some endocrine tumors, angiogenesis has been proven to be related to tumor development, metastasis, poor prognosis and reduced survival [5]. However, the pattern of angiogenesis in pituitary adenomas is still controversial. Some experiments have shown that the development of pituitary adenomas is closely related to angiogenesis, but there are also reports that the degree of vascularization of pituitary adenomas is lower than that of normal pituitary tissues [6]. With the rapid development of molecular biology, biochemistry, immunology and histopathology, the research on angiogenesis of pituitary adenomas has been deepened, Some molecular markers, signaling pathways and drugs closely related to angiogenesis of pituitary adenoma were discovered. This article intends to review the research status of related molecular markers, signaling pathways and drugs in anti-angiogenesis treatment of pituitary adenoma.

arachnoid cysts are congenital benign space-occupying lesions, which are arachnoid bag-like structures encapsulated with cerebrospinal fluid-like fluid. According to the location, they can be divided into intracranial arachnoid cysts (IACs) and spinal arachnoid cysts (SACs). IACs accounts for 1% of all intracranial space-occupying lesions, and is the most common in children. However, there have been many controversies about the management strategies of IACs. This article intends to review the new understanding of surgical indications, surgical methods and surgical complications in recent years.

Brainstem metastases have been reported in many literatures [1-11], including pontine metastases [2,5]. The most common source of brainstem metastases is lung cancer, while the pathological types of primary lung cancer reported in previous literatures are lung adenocarcinoma [6-9] or lung squamous cell carcinoma [10]. One case of brainstem (pontine) metastases originating from lung squamous cell carcinoma was treated in our department, and the report is as follows.