Volume 31 · Issue 01 · 2015

To investigate the safety and efficacy of distal filter protection for endovascular recanalization in patients with symptomatic internal carotid artery occlusion (ICAO).

Retrospective analysis was conducted in patients with symptomatic ICAO screened from the prospectively collected database who underwent endovascular recanalization with distal filters from July 2009 to December 2012. Clinical characteristics, procedural results and outcomes were investigated by reviewing medical records and angiographic data. Totally, twenty three patients were included with the median occlusion time of thirty days (range, 8-510 days).

Totally in twenty three patients, technical success rate of 96% was obtained in twenty two patients. One filter failed to arrive in distal lumen due to the tortuosity of internal carotid artery. Successful recanalization (TICI 2b-3) was obtained in 18 patients (78%), including 13 patients (57%) with complete (TICI 3) recanalization. Downstream thrombotic clots were observed in two retrieved filters. After procedure, dotted ischemic lesions were detected on MRI in 9(39%) patients and intracranial hemorrhage occurred in 1 patient without neurologic sequelae. No perioperative death or ischemic stroke occurred. At the radiological follow-up of 19.7± 9.3 months and clinical follow-up of 21.0± 8.4 months, in-stent restenosis occurred in one case four months after the procedure and in-stent stenting was performed without complications, and other patients remain uneventful.

Distal filter protection is safe and feasible for the procedure of endovascular recanalization of symptomatic ICAO. Further clinical investigation and long-term follow-up are warranted to validate its effectiveness.

We studied the clinical characteristics of perinatal cerebral haemorrhage, the clinical features of different treatment methods, and patients with different causes, and to investigate the treatment approaches to perinatal cerebral haemorrhage.

The clinical data of 76 patients with perinatal cerebral haemorrhage were retrospectively analysed. These patients were treated at Beijing Tiantan Hospital, Capital Medical University between January 1997 and December 2012. They were divided into surgery and conservative treatment groups.

Patients with perinatal cerebral haemorrhage were relatively young. Of the 76 total patients, 60 were ≤25 years old, including 6 patients who were 19 years old, which suggests that patients with perinatal cerebral haemorrhage were younger than the general cerebral haemorrhage population. The mortality rate was 32% among this young population, . the causes of cerebral haemorrhage included 30 cases of arteriovenous malformation (AVM), 16 cases of preeclampsia, 8 cases of aneurysm (AN), 8 cases of moyamoya disease (MMD), 4 cases of cavernous haemangioma, 4 cases of venous sinus thrombosis, and 6 case of unknown reasons. The average Glasgow coma score (GCS)of patients on admission was 11.8±4.5, GCS 15-11 included 54 cases, GCS 6-10 included 16 cases, GCS 0-5 included 16 cases. The onset of cerebral haemorrhage caused occurred at an earlier gestational age (27.8±9.1 weeks), primarily during mid-pregnancy; this result might be related to an intolerance of cerebrovascular diseases caused by the changes of blood volume and cerebral blood flow that occur during the second trimester, including arteriovenous malformation, aneurysm and cavernous haemangiomas.Of 76 total cases of perinatal cerebral haemorrhage, 24 resulted in maternal death, 4 resulted in intrauterine death, and 28 resulted in neonatal death. The clinical characteristics and maternal and perinatal prognoses of the surgery group did not significantly differ from the conservative group(P>0.05). The mortality rates between the two groups did not differ (P=0.15).

Pregnancy complicated with hemorrhagic stroke should first terminate the pregnancy and then, neurosurgical treatment should be performed .Patients with a history of cerebrovascular disease should be in intensive care during pregnancy, and terminate pregnancy in a timely manner. General anesthesia is appropriate for cesarean section. At the same time it should prepare well for neonatal rescue.

To explore the microsurgical techniques and therapeutic strategies of intracranial aneurysms in anterior Willis loop.

The clinical data of 585 patients with 612 aneurysms in anterior Willis loop treated by microsurgical clipping in our department were analyzed retrospectively.Before operation, according to Hunt-Hess classification, 32 cases were grade 0, 120 grade, 218 grade Ⅱ, 176 grade Ⅲ, 27 grade Ⅳ and 12 grade Ⅴ. All the patients presented with subarachnoid hemorrhage. All the patients were underwent aneurysm clipping microsurgically, 107 cases within 3 days, 376 cases within 4-14 days and 102 cases 14 days after onset. The prognosis of patients were assessed by Glasgow outcome scale score (GOS). The prognosis and mortality rates were compared among patients treated in different time.

A total of 612 aneurysms were clipped successfully.The postoperative GOS were 1 in 6 cases, 2 in 13 cases, 3 in 28 cases, 4 in 136 cases and 5 in 402 cases. In 412 patients who were followed-up, 396 cases (96.2%) achieved good recovery (GOS 4 or 5). The prognosis and mortality rates of patients treated in different time showed no significant differences (P=0.262 and 0.624).

For patients with aneurysms in anterior Willis loop, favorable outcome should be achieved through microsurgical management.

To investigate the therapeutic effects of neuroendoscopic surgery and craniotomy in the treatment of hypertensive intracerebral hemorrhage(HIH).

A total of 54 patients with hypertensive intracerebral hemorrhage treated by operation between May 2011 and June 2013 were analyzed retrospectively, 28 patients in neuroendoscopy group and 26 patients in craniotomy group.All patients were followed up for 3 months, two groups were estimated by the ADL scores, grade 1-3 of ADL was regarded as good prognosis, grade 4-5 of ADL and dead cases as poor prognosis.

One death case in the neuroendoscopy group and 2 death cases in the craniotomy group, no statistical difference (P>0.05). The good prognosis rate of ADL was 82.1% (23/28) in the neuroendoscopy group and 53.9% (14/26) in the craniotomy group, the therapeutic effects of neuroendoscopy group were better than those of craniotomy group(P>0.05).

Neuroendoscopic surgery is a kind of method with little injury、favorable recovery of neural function in the treatment of hypertensive intracerebral hemorrhage.

To investigate the treatment and prognosis of intracranial aneurysms associated with hemorrhagic moyamoya disease.

Ten patients(12 aneurysms) with aneurysms associated with hemorrhagic moyamoya disease were included. Of the 12 aneurysms diagnosed by DSA, 7 were found distributed around the circle of Willis, 2 in the basal ganglia and 3 on the collateral vessels.Nine aneurysms were ruptured and 3 were unruptured. Six of the 7 aneurysms around the circle of Willis were treated by endovascular embolization or surgical clipping, while the remaining 1 case was treated conservatively.Two aneurysms in the basal ganglia were managed with conservative treatment.Of the 3 aneurysms on the collateral vessels, 2 were occluded by 33% Glubran glue injection, 1 was treated conservatively.

(1)Six aneurysms around the circle of Willis were successfully and completely occluded or clipped.The other 1 patient was managed with conservative treatment and the aneurysm was stable.Two aneurysms in the basal ganglia were followed up conservatively and disappeared 3 and 8 months later, respectively.Two of the 3 aneurysms on the collateral vessels got complete embolization.The patient treated conservatively experienced a second episode of bleeding and died 14 days after the first hemorrhage.(2)Outcome was assessed using the modified Rankin scale (mRS) when patients discharged, 0 point in 5 cases, 1 in 2 cases, 2 in 1 case, 3 in 1 case, 4 in 0 case and 6 in 1 case.(3)The follow-up period of the 9 patients was between 2 to 36 months. Re-examination by DSA revealed no recurrence of the aneurysms occluded or clipped and the aneurysms disappearing spontaneously.The aneurysm treated conservatively remained stationary.

Patients with different types of aneurysms associated with moyamoya disease should undergo different treatments, which may be more appropriate and more effective.

To investigate the therapeutic effect of carotidendarterectomy(CEA) alone or combined with Fogarty catheter embolectomy in the treatment of chronic symptomatic internal carotid artery occlusion.

From April 2008 to December 2013, 12 patients with transient ischemic attack (TIA) or minor stroke underwent digital subtraction angiograph to confirmation t of ICA occlusion. All patients underwent operative exploration with CEA or CEA plus Fogarty thrombectomy. Patients who failed revascularization underwent external CEA and ICA ligation. All clinical and radiological data were retrospectively reviewed.

CEA in 7 patients and CEA plus Fogarty thrombectomy in 3 patients were performed successfully to restore blood flow of internal carotid artery. External CEA and internal carotid artery ligation were performed in 2 patients. Postoperative CT angiography or DSA imaging demonstrated patency of the internal carotid artery in 10 patients. The ischemic symptoms were relieved in most of the patients. Postoperatively, 3 patients suffered from hyperperfusion syndrome, but there were no perioperative stroke or death.The duration of follow-up was 15-66 months. No patient developed a new stroke. No re-occlusion but one mild re-stenosis(40%) was detected. 2 patients suffered from TIA occasionally.One of the two patients failed in recanalization relieved from the symptom, the another still suffered from TIA.

Carotid endarterectomy alone or combined with Fogarty catheter embolectomy to treat chronic symptomatic internal carotid artery occlusion is feasible and safe, but preoperative evaluation and selection of patient should be carefully.

To evaluate the feasibility and efficiency of endovascular treatment for complicated intracranial by using double microcatheter technique.

A retrospective study was applied on 18 cases with complicated intracranial aneurysms which were treated by using double microcatheter method from April 2007 to March 2013. Among them, 9 were wide-necked aneurysms; 8 were irregular aneurysm; and 1 dissecting aneurysm was embolized by using femoral arterial puncture on both sides, on side was assistant by stent placement technology, and the other side was assistant by microcatheter.

All the aneurysms were managed embolization without the parent arteries occlusion. And in the 6 months to 2 year follow-up period, no recanalization was found.

According to the clinical date, double microcatheter technique is an efficient, safety and feasible method for coil embolization of complicated intracranial aneurysms.

Anterior inferior cerebellar artery aneurysms are very rare, accounting for about 0.10% ~0.98% of intracranial aneurysms^[1,2,3]。 Four cases of anterior inferior cerebellar artery aneurysms were treated in the Department of Neurosurgery of the First Affiliated Hospital of Suzhou University from January 2007 to December 2013, accounting for 0.35% (4/1 158) of the aneurysms in the same period. The clinical characteristics, surgical skills and clinical results are reported as follows in combination with the literature.

Intracranial aneurysm is an abnormal bulge of the artery wall caused by the localized abnormal enlargement of the lumen of the intracranial artery. It is a common and serious cerebral hemorrhagic disease^[1]In neurosurgical diseases, it is known as a "time bomb"^[2]。 Its morbidity ranks third among patients with cerebrovascular accidents, second only to cerebral thrombosis and hypertensive cerebral hemorrhage, but its mortality and disability rate are extremely high^[3]。 The surgical treatment of intracranial aneurysms includes two strategies: aneurysm clipping and endovascular interventional surgery. The former is a classic and traditional operation, which has been regarded as the "gold standard" for intracranial aneurysms in recent decades^[4]Vascular interventional surgery is a new technology developed in the past 20 years. In recent years, microsurgical clipping and endovascular intervention techniques have been continuously developed and improved. However, it is still uncertain which of the two treatments is the best in terms of safety and effectiveness. Therefore, this paper incorporates the literature published at home and abroad in the past 15 years on the comparative study of intracranial aneurysm interventional treatment and clipping surgery for meta-analysis, and calculates the odds ratio,OR) and 95% confidence interval (confident interval,CI) to represent the size of the effect. The safety and effectiveness of the two methods were compared from several aspects, so as to provide objective basis and theoretical guidance for the choice of surgical methods for patients with intracranial aneurysm.

Aneurysm rupture is the most common cause of spontaneous subarachnoid hemorrhage (SAH). Surgical treatment of patients with aneurysmal subarachnoid hemorrhage (aSAH) often achieves good results, with no or only minor neurological dysfunction. SAH may affect hypothalamic-pituitary axis function, and various pituitary-related hormone abnormalities may occur in the acute phase^[1]And as the condition improves, pituitary-related hormone disorders also tend to normal. However, persistent hypopituitary-associated hormone secretion may still exist during the chronic phase of the disease^[2]。 In this study, the serum thyroid-related hormones in patients with aSAH in acute and chronic phases were monitored and their changes were studied. At the same time, Montreal Cognitive Assessment (MoCA) and Beck Depression Inventory (BDI) were used to evaluate the Cognitive function of patients with hypothyroidism in the chronic phase of aSAH, and to provide evidence for further hormone replacement therapy.

To discuss the diagnosis and treatment of intracranial infection after endoscopic transsphenoidal surgeries.

From January 2011 to January 2013, 459 patients undergoing endoscopic transsphenoidal surgery were analyzed.9 patients (2.0%) developed intracranial infection. 9 patients treated by CSF lumbar drainage and intravenous vancomycin and meropenem treatment. At the same time, CSF and cranial CT were monitored. 2 of 9 patients were healed by intravenous vancomycin and meropenem and CSF lumbar drainage. Other 7 patients were healed by endoscopic transphenoidal repair of CSF leakage, intrathecal and intravenous injection of vancomycin and meropenem alternately (One case developed subdural empyema and treated by key-hole drainage meanwhile).

All 9 patients were healed according to the above-mentioned methods. During the follow-up period between 12 and 24 months, 8 patients recovered well without any complication. One patient suffered from hydrocephalus after 6 months and healed by V-P shunt.

The treatment of endoscopic transphenoidal repair of CSF leakage, CSF lumbar drainage, intravenous and intrathecal injection of vancomycin and meropenem were effective for intracranial infection after endoscopic transsphenoidal surgery.

To summarize our experience on management of superior petrosal vein (SPV) in microvascular decompression(MVD) surgery for trigeminal neuralgia, the operative notes and photography were retrospectively reviewed on anatomy characteristics of superior petrosal veins and their influence to operation.

The clinical data of the 94 patients with trigeminal neuralgia between January, 2009 and January, 2010 were collected, including the trunks and the braches of SPV, how much were sectioned, the entry position to superior petrosal sinus, the surgery outcome and complications.

For all the 94 patients, we found in operation that SPV can have 1-3 trunks accounted for 22.3%, 62.8%, 14.9%, while the petrosal vein with 1-5 branches respectively accounted for 4.3%, 21.3%, 64.9%, 7.4%, 2.1%. The petrosal vein during the operation was fully preserved in 58 cases (61.7%), the SPV were sectioned completely in 4 patients, while some branches of SPV were sectioned in 32 patients. In total, the offending vessel was identified clearly in 83 patients, while in 11 patients the offending vessel was ambiguous, the SPV was identified as offending vessel in 6 patients. One patient encountered cerebellar infarction (the branch of SPV was sacrificed)and recovered completely at 2 weeks after MVD by using intravenous medication and one patient developed cerebellar hematoma(the trunk of SPV was sectioned), an posterior fossa decompression was performed and the patient complained minor unsteady gait.

The reasonable approach of MVD for trigeminal neuralgia is cerebellar transhorizontal fissure approach, mostly SPV is unnecessary to be resected completely, sometimes small braches of SPV can be sacrificed, very few patients may develop cerebellar infarction or hematoma.

To investigate the clinical factors influencing prognosis of glioblastoma multiforme (GBM).

This study included 198 patients with newly diagnosed primary glioblastoma treated from January 2008 to January 2013 treated at our hospital.Kaplan-Meier method was used to analyze the 11 factors related to prognosis, with Cox multivariate regression analysis.

Following a univariate regression analysis, with no epilepsy before operation, good preoperative Karnofsky performance status, location of tumor, extent of resection, postoperative Concurrent chemoradiotherapy and postoperative intracranial infection associated with better overall survival rates(P<0.05). Multivariate Cox regression analysis found that extent of resection, location of tumor, KPS, postoperative concurrent chemoradiotherapy and postoperative intracranial infection were independent prognostic factors for the survival(P<0.05).

Extent of resection, location of tumor, postoperative KPS, concurrent chemoradiotherapy were independent prognostic factors influencing the survival. It is likely that the patients with intracranial infection postoperatively have more prolonged survival because infection can stimulate immune response to tumor.

To investigate the relevance between the seriousness of acute brain injury and regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV) or mean transition time (MTT); provide a possible method for the early diagnose and prognostic evaluation.

This study included 67 patients of acute brain injury and they were divided into mild, moderate and severe groups based on their glasgow coma scale (GCS) scores. They were examined to detect rCBF, rCBV and MTT by computed tomography perfusion (CTP) imaging after admitted to hospital. The prognoses of them after 6 months of follow-up were also recorded. The relations between the prognosis and rCBF, rCBV or MTT were analyzed.

rCBV and rCBF of severe group were significantly lower than the mild group (P<0.05), and MTT of severe group was significantly higher than that of the mild group (P<0.05). The rCBV and the glasgow outcome scale (GOS) scores were significantly positively correlated(P<0.01), and MTT was significantly negatively correlated with the GOS score(P<0.01). Whereas there was no correlation between rCBF and the GOS score.

rCBF, rCBV and MTT were significantly correlated with the severity as well as the prognosis of patients with acute brain injury and they might be used as potential indicators of the severity and prognosis.

To explore the clinical value of intraoperative ultrasound and neuronavigation in microneurosurgery for resection of insular gliomas.

The clinical materials of 23 cases (13 male and 10 female) with insular gliomas between January 2008 and May 2013 were retrospectively analyzed. All patients received microneurosurgery under the guidance of intraoperative ultrasound and (or) neuronavigation. The extent of tumor resection and postoperative neurological deficits were focused on.

The postoperative imaging showed that total resection of the insular gliomas was achieved in 14 cases, subtotal or partial resection in 9 cases. The tumors were totally removed in 8 of 11 cases in intraoperative ultrasound-assisted neuronavigation group, in 4 of 6 cases in intraoperative ultrasound group and in 2 of 6 cases in neuronavigation group. The postoperative follow-up period had a range of 5 to 52 months (average 22.5 months). The extent of postoperative early and long-term neurological deficits in intraoperative ultrasound-assisted neuronavigation group was lower than that in the other groups.

The technology of intraoperative ultrasound-assisted neuronavigation for the resection of insular gliomas can help improve the rate of total resection of tumor and increase the safety of surgery.

To study the effect of miR-106b inhibitor on glioma cell line growth and invasive ability in vitro.

The miR-106b inhibitor was transfected by liposome to repress the expression of miR-106b. qRT-PCR was taken to measure miR-106b expression after tansfection. The cell cycle kinetics and cell proliferation rate were detected by flowcytometry and MTT assay, the cell malignant proliferative ability was evaluated by soft agar assay, and the invasive ability was detected by transwell assay.

The antisense oligonucleotide of miR-106b effectively down-regulated miR-106b expression in glioma cells. The progression of cell cycle was blocked. The rate of S phase decreased, and the rate of G0/G1 phase increased. The distribution of cell cycle was significantly different in U251 and TJ905 (P<0.05), but not in LN229. After transfection for 48h, the proliferation activity of three cell lines was obviously inhibited. Also, the cell clone formation was repressed[The rate of clone efficiency: U251: (10.6 ± 0.9)%、(10.5 ± 1.2)% vs.(3.3 ± 0.4)%; LN229: (12.5 ± 1.7)%、(11.0 ± 2.4)% vs.(4.1 ± 0.3)%; TJ905: (9.9 ± 1.2)%、(10.2 ± 0.6)% vs.(3.5 ± 0.4)%.P< 0.01]. The invasive ability was also significantly repressed in cells transfected with miR-106b inhibitor as compared to those of the cells transfected with negative control oligonucleotide and control cells[The cell number per view was U251: (90.6±5.7), (85.2±6.1) vs .(27.6±4.0); LN229: (22.6±3.7), (21.2±3.7) vs. (2.4±1.5); TJ905: (79.4±4.4), (76.8±5.9) vs.( 11.8±3.2).P<0.01].

Suppression of miR-106b expression could inhibit the proliferative and invasive ability of glioma cells.

To investigate whether PARP inhibitor, PJ34, participates in the inflammation related to PARP-NF-κB pathway in a mouse model of controlled cortical impact (CCI).

One hundred and thirty-six BALB/c male mice were divided into 3 groups: sham-operated group, vehicle-treated group and PJ34-treated group. Injury to the cerebral cortex was produced with controlled cortical impact.Evaluation of the neurological deficits was performed at 6 h and 24 h after CCI, which included the motor, sensory, reflex testing and beam balance testing.The contusion volumes were measured after HE staining at 6 h and 24 h after CCI.The activities of MPO in contusion cortex were examined by using MPO ELISA kit. Western blot was performed to detect the levels of NF-κB p65 in cytosolic and nuclear fractions and to detect TNF-α and IL-1β in cytosolic fractions.

Neurological severity scores at 6 h and 24 h after CCI in PJ34-treated group(8.20 ±0.25 and 7.80 ±0.25, respectively) are less than those in vehicle-treated group(12.40 ±0.38 and 11.70 ±0.22, respectively)( all P<0.01). The contusion volume at 6 h and 24 h after CCI in PJ34-treated group[(10.25 ±0.61) mm³and (11.55 ±1.16) mm³, respectively] is less than that in vehicle-treated group[(25.07 ±1.45) mm³and (27.24± 1.51) mm³, respectively]( all P<0.01). The activities of MPO at 6 h and 24 h after CCI in PJ34-treated group[(0.013 ±0.001) U/g and (0.018 ±0.001) U/g, respectively] is less than those in vehicle-treated group[(0.024 ±0.001) U/g and (0.023± 0.001) U/g, respectively]( allP<0.05). Moreover, the expression level of NF-κB p65 in cytoplasm at 6 h and 24 h after CCI in PJ34-treated group is less than that in vehicle-treated group ( allP<0.05). Compared with vehicle-treated group, the expression level of NF-κB p65 in cell nuclei at 24 h after CCI in PJ34-treated group is higher (P<0.01). There is no significant difference between the expression level of NF-κB p65 in cell nuclei at 6 h after CCI in PJ34-treated group and in vehicle-treated group. PJ34 also reduced the expression level of TNF-α and IL-1β at 6 h or 24 h after CCI(P<0.05 orP<0.01).

PARP-NF-κB inflammatory pathway plays an important role during the secondary injury after traumatic brain injury(TBI). PJ34 could block the pathway, inhibit inflammatory response and protect the brain against TBI.

To observe the expression and distribution of NLRP3 in rats brain and to explore the significant correlations between NLRP3 and cerebral ischemia/reperfusion(IR) injuries.

Forty Male SD rats were randomly divided into the Sham group, ischemia/reperfusion 12h, 24h, 48h group. The ischemia model was induced by occlusion of the middle cerebral artery (MCAO) with a microfilament in rats. The expression and distribution of NLRP3 in rats brain was explored by immunofluorescence staining. After reperfusion injury, we examined the levels of protein and mRNA by Western blot and real-time PCR, respectively. Another 40 Male SD rats were randomly divided into the sham-control group, IR-control group, sham-glyburine group, IR-glyburine group. Glyburine used as inhibitor of NLRP3 was given to the rats in glyburine group before MCAO model. In order to analyze infarct and assess function of blood-brain barrier (BBB), magnetic resonance imaging(MRI) and Evans blue stain were performed.

NLRP3 was mainly expressed in microglia and endothelial cells by immunofluorescence staining. By real-time PCR and Western blot analyses, NLRP3 expression was markedly enhanced in the ischemic cerebral hemisphere with a peak expression of NLRP3 at 24 hours after reperfusion(P< 0.05). In MRI the area of treatment/reperfusion group was significantly smaller than? control/reperfusion group[(21.7±4.2)% vs. (36.0 ±4.7)%, (P< 0.05). Our results also indicated that the content of Evans blue of treatment/reperfusion? group was significantly lower than control/reperfusion group[(18.7 ± 3.8)μg/g vs. (32.1 ± 5.1)μg/g]by Evans blue stain(P< 0.05).

NLRP3 was mainly expressed in microglia and endothelial cells. NLRP3 contributes to the development of cerebral ischemia/reperfusion injury and ischemia-induced BBB disruption.

To explore the effects of chronic high frequency deep brain stimulation (DBS) of nucleus accumbens shell subregion on food intake and regulation of appetite-related hormones.

High-fat diet induced obesity rats were randomly divided into two groups, namely DBS group and sham-DBS group.Stimulating electrodes were implanted in the bilateral shell subregion of nucleus accumbens. The amount of food intake was measured before and during stimulation.Peripheral concentrations of ghrelin, NPY, and leptin were tested before and after DBS or sham-DBS.

The amount of food intake began to significantly decrease once stimulation was on. After 7 days'continuous stimulation, peripheral concentrations of NPY and leptin decreased significantly (Leptin: pre-DBS: 32±10 vs.post-DBS: 20±10pg/ml,P<0.05; NPY: pre-DBS: 1 302±287 vs. post-DBS: 926±299 pg/ml,P<0.05), and ghrelin increased significantly (Pre-DBS: 1066±310 vs. Post-DBS: 1603±848 pg/ml,P<0.05).

NAc shell subregion is an effective DBS target to decrease food intake in obesity rats. NAc-shell DBS seems to temporarily inhibit the hypothalamic secretion of NPY. Increase of ghrelin levels maybe a second result of decreased food intake caused by NAc-shell stimulation.

To explore the basilar artery morphology and pathology after hemodynamic changes of basilar artery.

New Zealand white rabbits were subjected to bilateral common carotid artery ligation to produce compensatory vertebrobasilar artery flow increase. The basilar artery flow velocity was monitored by transcranial Doppler before the procedure and at 1 day, 1 week and 2 weeks after the procedure. DSA was performed at 1 week and 2 weeks after the procedure respectively and the basilar artery diameter and the extent of tortuosity were measured. The basilar artery tissues were harvested at 1 week and 2 weeks after the procedure and examined histologically by EVG and Masson staining.

The basilar artery flow velocity of New Zealand white rabbit was increased significantly subjected to common carotid artery ligation (10.99 ml/min vs 36.53 ml/min, P<0.001). One or two weeks after surgery, the basilar artery diameter was expanded (0.60 mm vs 0.82 mm; 0.73 mm vs 1.03 mm,P<0.001), and the artery was curved. The internal elastic layer of artery was intact with smooth muscle cells proliferation in response to high flow and shear stress. The basilar artery was bent to the left side in 57.1% of all rabbits and there was significant difference compared with that of preoperation.

The hemodynamic increasing of the basilar artery after bilateral common carotid artery ligation of New Zealand white rabbits resulted in expansion and tortuosity of the basilar artery.

To study the expression level of CD40 and matrix metalloproteinase (MMPs) in vulnerability, stability carotid atherosclerotic plaque. Investigate the relevance of CD40 and MMPs expression and the impact on plaque stability.

Thirty-two cases of specimens with carotid atherosclerotic plaque were collected from carotid endarterectomy(CEA). According to preoperative carotid ultrasound, transcranial doppler (TCD) and the presence of acute ischemic stroke events, all specimens were divided into stable plaque group and vulnerable plaque group, detected the mRNA and protein expression level of CD40 and MMPs in each group using PCR and western blotting assay.

The mRNA and protein expression level of CD40 and MMP-9 in vulnerable plaque group was significantly higher than in stable plaque group respectively(P<0.01). The MMP-2 protein expression level in vulnerable plaque group was distinctly higher than in stable plaque group(P<0.01). There were positive correlation between CD40 mRNA and MMP-2 mRNA (r=0.43, P<0.05), CD40 mRNA and MMP-9 mRNA (r=0.90, P<0.01) respectively.

CD40 is not only involved in the formation of atherosclerotic plaque, but also may influence the stability of atherosclerotic plaques by regulating the expression of MMP-2 and MMP-9.

Patients with internal carotid artery aneurysms are common intracranial aneurysms, and the treatment of large or giant aneurysms in the cavernous sinus segment is relatively difficult. Because of its safety, minimally invasive and effective characteristics, endovascular treatment has become an important way to treat intracranial aneurysms. We used Apollo stent-assisted coil and Onyx18 to embolize a case of unruptured large internal carotid artery cavernous segment aneurysm, and achieved good results, which are reported below.

primary central nervous system lymphoma (PCNSL) accounts for about 7% of intracranial tumors, and most of them are diffuse large B-cell lymphoma. The median survival time after radiotherapy and chemotherapy is about 30~60 months. mucosa-associated lymphoid tissue lymphoma (MALT) originating from the central nervous system is extremely rare. All foreign literatures are case reports, but at present, there are few reports in Chinese literature. One case of primary central nervous system MALT was treated by neurosurgery in our hospital, and the report is as follows.

Male, 37 years old. "Headache and nausea for 1 year" was hospitalized on 21 October 2013. The patient went to the local hospital in August 2012 due to headache and nausea, and the MRI of the head showed hypothalamic hamartoma (FIG. 1A), that is, "gamma knife" treatment, the specific dose is unknown, and the headache symptoms are improved after treatment. In October 2013, the patient experienced headache again, and the reexamination of the head MRI showed that the lesion was larger than before (FIG. 1B)。 Admission physical examination: conscious, cooperative physical examination, both pupils are equal in size, left: right =2.5 mm: 2.5 mm, photoreaction is present, there is no loss of visual acuity in both eyes and no visual field defect in rough measurement. The muscle strength and tone of the limbs were normal, physiological reflexes existed, and pathological signs were not drawn out. Genital development is normal, and 1 child is healthy. After medical history, the patient had normal sexual life, no precocious puberty, no history of ridiculous seizures, and no personality abnormalities. There were no abnormalities in biochemical and endocrine examinations. There were no abnormalities in EEG. After admission, I actively performed preoperative examination. On October 29, 2013, I underwent "right pterional approach hypothalamic hamartoma resection" under general anesthesia. During the operation, it was found that the tumor originated from the papillary body, pointing to the interfoot pool, which was solid, gray-yellow in color, hard in texture, average blood supply, necrosis in the center of the tumor, and hard in texture in the peripheral part. The tumor was removed in blocks under the microscope, and the operation was smooth. Postoperative CT and MRI reexamination showed that the tumor was completely removed (Figure 1C), there was no abnormality in the endocrine examination, and the patient's headache disappeared. Pathological microscopy showed that most tissue was degenerative and necrotic, and a small part was small patchy brain tissue, mainly glial cells, with scattered degenerative disorderly arranged neuronal cells, accompanied by hemosiderin deposition, small blood vessel proliferation, and some blood vessel wall degeneration. Immunohistochemical staining results: GFAP (diffuse +), Olig-2 (scattered +), NeuN (scattered +), SMI32R (scattered +). Consistent with changes after hamartoma radiotherapy (Figure 1D)。 The patient recovered and was discharged on 06 Nov 2013. After 3 months of follow-up, the patient had no symptoms, and there was no recurrence of the tumor on MRI.

The incidence of intraspinal tumors is about 1/10 of the incidence of brain tumors. Tumors can occur in any segment from the cervical spinal cord to the cauda equina. It occurs most in the thoracic segment, accounting for about half. Among them, neurofibroma accounts for about 40%, and meningioma accounts for about 10% ~15%. Most of them are located on the dorsolateral side of the spinal cord, and tumors located on the ventral side of the spinal cord are rare^[1]。 It is difficult to resect ventral spinal cord lesions, especially medium and small lesions. Combined with the literature, the experience of 4 patients with ventral thoracic spinal cord tumors admitted to the Department of Neurosurgery, Wangjing Hospital, Chinese Academy of Chinese Medical Sciences from August 2011 to March 2014 using lateral anterior approach microsurgical resection is summarized as follows.

cerebellar mutism (CM) is a group of temporary clinical syndromes that occur after posterior fossa tumor surgery in children, occasionally secondary to cerebellar hemorrhage, inflammatory reaction and trauma, mainly with language disorder, often combined with oropharyngeal dyskinesia and mental changes. This article reviews its clinical characteristics, pathogenesis, prognosis and prevention.

Intracranial pressure (ICP) is the pressure in the cranial cavity. The ICP in normal adults is 0.8 to 1.8 kP a (80 to 180 mmH₂O), typically exceeding 2.0 kPa (200 mmH₂O) It is called intracranial hypertension. Intracranial hypertension is a reflection of intracranial diseases or secondary intracranial lesions, which can lead to deterioration or even death of patients. Monitoring ICP and selecting treatment measures according to ICP can effectively improve the prognosis of patients with intracranial hypertension^[1]。 At present, there are two methods to detect ICP: direct measurement and indirect measurement. Although direct measurement is reliable, it is invasive, easy to complicate intracranial infection, and its application is limited^[2]。 It is imperative to find a safe, simple and effective non-invasive ICP monitoring method that can be implemented at the bedside to guide the treatment of high ICP. This article reviews the research progress of non-invasive ICP monitoring methods.

subarachnoid hemorrhage (SAH) is the third leading cause of maternal mortality with a mortality rate of 27% ~40%^[1,2,3]。 Studies have reported that the incidence of SAH during pregnancy and maternity is 6.3~13.8 per 100,000 deliveries^[4,5], Bateman et al.^[1]The incidence of maternal SAH derived from a sample of hospitalizations throughout the United States was 5.8 per 100,000 births. The incidence of hemorrhagic stroke during pregnancy and maternity reported by Beijing Tiantan Hospital of Capital Medical University was 53/100,000 deliveries, among which hemorrhage due to intracranial arteriovenous malformation (AVM) accounted for 17%, aneurysm and moyamoya disease each accounted for 16%^[6]The high proportion of hemorrhagic stroke during pregnancy and delivery may be related to the high attendance rate of stroke, intracranial AVM, aneurysm and moyamoya disease in this hospital. Jaigobin and Silver^[3]Fifty 700 maternal findings were summarized, 13 (2.5/10 000) developed cerebral hemorrhage, of which 7 were SAH (1.4/10 000), 6 were intracerebral hemorrhage and 3 died, with a case mortality rate of 23%. In the United States, the hospitalization rate of stroke during pregnancy and puerperium showed an increasing trend from 1994 to 2007^[7]。 Of course, some studies suggest that pregnancy and childbirth do not increase the risk of SAH^[8]。 Dias and sekhar^[9]It was reported that the maternal mortality rate of hemorrhagic intracranial aneurysms and AVM treated conservatively and surgically was 35% in maternity and 15% in fetus. Therefore, SAH during pregnancy and maternity should be paid attention to.

At present, the defined risk factors for carotid stenosis include age, sex, race, smoking, inflammatory reaction, drug abuse, lipid metabolism disorder, hypertension, diabetes, metabolic syndrome and genetics. Randomized clinical trials have shown that both carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS) can reduce the probability of stroke in patients with carotid stenosis^[1]。 However, there is still a lack of authoritative clinical trial guidance for the selection criteria of the two procedures. Although large-scale clinical trials in North America and Europe suggest that the safety of choosing CAS may be higher in young patients with carotid stenosis^[2,3]But other clinical factors are still lacking in randomized clinical trial analysis. And some important populations, such as patients with postoperative restenosis, are often excluded from clinical trials^[4]。 Therefore, the comprehensive assessment of patients' risk factors before CEA and CAS are implemented is particularly important. By reviewing the relevant literature at home and abroad, we analyzed the association of common risk factors before surgery and the risk of death and stroke during the perioperative period of CAS and CEA, so as to provide a reference for the choice of surgical methods for patients with carotid artery stenosis.