Volume 31 · Issue 03 · 2015

The origin of microvascular decompression (MVD) began with clinical studies for the surgical treatment of trigeminal neuralgia (TN). The results of decades of research have shown that the cerebellopontine angle (CPA) responsible vessels compress the root entry/exit zoon (REZ) of different cranial nerve roots, which can lead to the corresponding syndrome, namely neurovascular compression (NVC) syndrome. For patients with primary TN and glossopharyngeal neuralgia (GN) who can tolerate craniotomy, MVD has become the surgical treatment of choice. Combining MVD with CPA partial rhizotomy (PR) to improve the efficiency of operation and reduce the incidence of complications is the main direction of functional neurosurgeons.

To analyze the clinical, radiological and pathological features of papillary glioneuronal tumors (PGNTs).

The clinical charts and radiographs of 16 cases of PGNTs in Beijing Tiantan Hospital, Capital Medical University between January 2006 and January 2013 were retrospectively reviewed. The follow-up evaluations and literature review were performed.

The study included 9 males and 7 females with a mean age of 24 years. Upon admission, the mean preoperative KPS(Karnofsky performance scale)score was 86.3. The radiological results showed that the frontal lobe (4/16) was the most common portion of the brain involved, followed by temporal lobe, lateral ventricle and parieto-occipital lobe, 13 lesions presented with cystic appearance with or without solid elements.Complete resection, subtotal resection, partial resection were achieved in 12, 2 and 1 patients, respectively. One patient underwent biopsy under neuroendoscope.The mean postoperative KPS score was 85.6. Ki-67 staining was positive in <1% of cells present in 8 lesions and varied in the other 8 lesions, with a range of 1% to 13%. During the follow-up period, 3 patients with incomplete removal and 1 with complete resection received radiotherapy.The mean follow-up duration was 56.2 months, the most recent mean KPS score was 92.5, and there was no recurrence.

PGNTs was a rare central nervous system lesion and was more frequently observed in the frontal lobe and in young patients without sex predilection. The preoperative diagnosis was difficult without pathological evidence. Fair outcomes could be achieved by complete resection. Although PGNTs displayed indolent pathobiology, atypical appearances were observed.

To study the clinical characteristics of the perioperative cognitive dysfunction in brain tumor patients.

One hundred and forty cases of brain tumor patients were evaluated by using the Chinese vesion of Montreal Cognitive Assessment Questionnaire before and after surgery. The distribution and clinical features of cognitive dysfunction in different located lesions and pathological types were analyzed and compared.

Among the 140 brain tumor patients, the preoperative cognitive impairment and prevalence rate were 59.2%, the score was 24.2±2.4.The postoperative cognitive impairment and prevalence rate were 80.7%, the score was 20.5±4.1.The postoperative cognitive dysfunction prevalence was significantly higher than the preoperative in benign and malignant with infra or supratentorial brain tumor patients(80.0% vs 98.3%, 71.8% vs 92.2%, all P<0.05).

Vary different extent cognitive impairment was found in brain tumor patients in preoperative period. The postoperative cognitive dysfunction was seriously worse than that in the preoperative period in malignant and supratentorial brain tumors in earlier recovery period.

To summarize the clinical pathological characteristics and treatment of pituitary gangliocytoma.

The clinical, pathological features and follow-up results of 8 patients with pituitary gangliocytoma were retrospectively analyzed.

Total resection was achieved in 5 patients and subtotal in 3. This kind of lesion was pathologically characterized by the coexistence of pituitary gangliocytoma and pituitary adenoma. Four cases were diagnosed as pituitary growth hormone(GH) adenoma with gangliocytoma, 2 pituitary plurihormonal adenoma with gangliocytoma, 1 pituitary hormone-negative adenoma with gangliocytoma, and 1 pituitary gangliocytoma. The mean follow-up period was 4.7 years. Of the 3 patients who failed to achieve total resection, 2 underwent gamma knife surgery, 1 was intimately followe-up. The postoperative MRI examinations showed that the tumors disappeared in 7 cases, the remnant tumor of the patient who did not undergo gamma knife surgery remained unchanged.

The majority of pituitary ganliocytomas coexisted with pituitary adenomas. The endocrine disorders, especially acromegaly, were the most common clinical manifestations. The correct diagnosis of pituitary gangliocytoma should be based on the histopathological and immunohistochemical results. The positive result of GH and growth hormone releasing hormone(GHRH) staining was a key feature of this kind of tumor. Although transsphenoidal microsurgery was the choice of treatment, gamma knife surgery should be considered if the total resection could not be achieved. Pituitary gangliocytoma was a benign tumor with optimistic prognosis.

To explore the feasibility of single-stage total removal of jugular foramen tumors with neck extension via a craniocervical approach.

The clinical and radiological features, operative techniques and outcomes of 18 patients with jugular foramen tumors with neck extension were retrospectively reviewed.

All the patients were surgically treated underwent single-stage tumor resection via a craniocervical approach. Total removal of tumor was achieved in 16 patients and subtotal in 2. Eleven patients harbored schwannomas, 2 meningiomas, 2 neurofibromas, 1 jugular bulb tumor, 1 fibrosarcoma, and an additional patient suffered from chondrosarcoma. There was no operative mortality in this series. Two patients experienced cerebrospinal fluid leakage. Postoperatively, the facial nerve function was improved in 3 cases, but new facial paresis occurred in 2 patients. The lower cranial nerve function was improved in 7 cases and stable in 6, but new deficits occurred in 2 patients. The follow-up was available in 15 patients. There was no clinical or radiological sign of tumor recurrence. While one patient with chondrosarcoma died of distance metastasis 23 months after operation.

Single-stage total resection of jugular foramen tumors with neck extension could be achieved by a multidisciplinary skull base team composed of neurosurgeons and head and neck surgeons via a craniocervical approach.

Brain tumors are the most common solid tumors in children^[1]。 Posterior cranial fossa is a common site of all kinds of childhood tumors, accounting for 54% ~60% of childhood brain tumors, especially medulloblastoma, which can reach 20% of childhood central nervous system tumors^[2]。 The biological characteristics of medulloblastoma lead to a shorter course and a higher rate of misdiagnosis at first diagnosis^[3,4]。 At admission, they were often accompanied by symptoms of intracranial hypertension, cerebellar and cranial nerve damage, and were in a state of electrolyte disorder, malnutrition, and even unstable vital signs. Considering that Xinjiang is located in a frontier area, primary medical units do not have perfect conditions for examination and surgery, and most children need long-distance referral. Only head CT imaging data are available when admitted to hospital, and the general condition of children is already poor. For example, further comprehensive examination such as head enhanced MRI will make it difficult for younger children to cooperate, and there is a possibility of deterioration in the process of waiting for examination. Therefore, formulating a reasonable treatment plan plays an important role in the treatment of childhood medulloblastoma.

glomus jugular tumor (GJT) is a tumor derived from the accessory ganglion tissue of the bulb of the jugular vein. Treatment is very difficult because of the highly vascularized features, involvement of important neurovascular structures, and difficult to reach anatomical locations. At present, microsurgical resection, preoperative vascular embolization, radiotherapy and stereotactic radiosurgery are considered to be effective treatment methods^[1,2]。 Surgical resection is a radical treatment, but the treatment is risky and complications are high. In recent years, studies in multiple treatment centers have shown that gamma knife treatment has a definite effect and complications are rare. The author retrospectively analyzed the case data of 11 patients with GJT from the Second Hospital of Tianjin Medical University and 20 patients with GJT from September 1992 to September 2013, and combined with the long-term follow-up results, to explore the therapeutic effect of surgical treatment and gamma knife treatment on glomus jugular tumor.

Many hemorrhage often leads to difficult surgical resection and many postoperative complications during routine surgical resection of meningioma. From May 2011 to September 2013, our hospital used Habib 4X radiofrequency ablation technique to assist in the resection of 10 cases of larger meningiomas during surgery and achieved satisfactory results, which are reported below.

The craniocervical junction is a special area of skull base. Because of its deep location and the complex anatomical relationship of important vascular and nerve structures around it, surgical resection is very difficult. It has always been the key topic of clinical research in neurosurgery and skull base surgery. Since 1972 Hammon and Kempe^[1]The approach has been continuously improved since a procedure was proposed to expose vertebrobasilar aneurysms from the far-lateral side of the suboccipital side. Sea and Sekhar 1990^[2]Intradural lesions of lower slope and ventral medulla were successfully treated with this approach, and it was advocated that this approach should be popularized as a conventional approach for the treatment of lower slope lesions. With the development of microscopic neurosurgery, clinical research and application of this approach have been carried out in China^[3,4]。 From January 2011 to January 2013, 26 cases of ventral tumors in the craniocervical junction were treated with this approach in our hospital, and the clinical results were good, which are summarized as follows.

To explore the lateral ventricle puncture methods for patients with moderate expansion using computer three-dimensional reconstruction technique.

The CT scan data of 42 cases out of 70 adult patients were selected for this study. The three-dimensional reconstruction techniques were used to establish the skull-lateral ventricle virtual model, and two kinds of different methods were used to simulate the lateral ventricle puncture (Including method one: traditional puncture site and direction: select the position where 2cm in front of the middle point of coronal suture and incise 2.5cm along with the middle line as the puncture position, make the puncture direction parallel to the vertical plane and along with the line of the external auditory canal; method two: puncture direction toward the midpoint of the external auditory canal, the other same to traditional methods).

The two puncture methods were successful for 42 cases in 25 cases, 39 cases, respectively. The statistical results showed that method two had a significantly higher successful rate compared to that of method one. (P=0.0003)

For lateral ventricle puncture in patients with moderate expansion of ventricles, method two was better than method one.

To evaluate and compare the efficacy among posterior fossa decompression, posterior fossa decompression combined with duraplasty and posterior fossa decompression with cerebellar tonsil exploration in the treatment of Chiari Ⅰ malformation(CM Ⅰ).

We retrospectively studied 161 Chiari Ⅰ malformation patients treated between Janurary 1997 and September 2013. 52 patients received pure decompression of posterior cranial fossa, 64 patients underwent posterior fossa decompression with duraplasty , the rest with cerebellar tonsil exploration.

No patients died in three groups after operation.The improvement rate of headache were 81.3%, 79.6% and 80.0%(P>0.05)respectively in three groups. The extremity sensory disturbance was improved in 33.3%, 65.4% and 65.0% patients respectively in three groups. The syringomyelia was decreased in 40.0%, 66.7% and 66.7% patients respectively in three groups.

Posterior fossa decompression was a reasonable option for the treatment of headache pain in Chiari Ⅰ malformation. Posterior fossa decompression with duraplasty and posterior fossa decompression with cerebellar tonsil exploration were good choice in the treatment of extremity sensory disturbance and syringomyelia.

To assess the relation between aneurysm volume, location, rupture statue , stent and packing density in cerebral aneurysms treated with coils.

Two hundred and twenty-one aneurysms in 199 patients were treated with coils in Huashan hospital between December 2009 and November 2011.Those intracranial aneurysm could be graded according to volume into Group I with a volume smaller than 65mm³, Group II between 65mm³ to 523mm³, Group III between 523mm³ to 1726mm³, Group IV smaller than 1726mm³. The results of angiography at follow-up were dichotomized into presence or absence of recurrence.

Large aneurysm volume was associated with low packing and frequent compaction (P<0.05). Ruptured aneurysms had a significant lower packing density than unruptured aneurysms(20.7% VS 24.5%, P=0.029). If the aneurysm volume was packed for 24% or more with coils, compaction did not occur in aneurysms with a volume of less than 523 mm³. In small aneurysms with volumes of less than 65 mm^3, compaction did not occur when packing was above 19%.

Aneurysm volume and rupture statue could influence the packing density. An effective packing density was sensible in trying to avoid aneurysm recurrence after endovascular coil embolization.

To investigate the clinical characteristics, causes and surgical treatment of young onset hemifacial spasm patients.

A total of 982 patients underwent microvascular decompression (MVD) for hemifacial spasm (HFS) in Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School from January, 2010 to December, 2013. 17 patients with the onset age ≤22 years old were analyzed retrospectively.

Among the 17 unilateral HFS patients, 4 were males and 13 were females. The mean age of onset was [19.4±2.3(14-22)] years. The mean duration before operation was [5.5±3.0(1-11)] years. The preoperative MRI showed that the average outside diameter of the offending vessels was (1.66±0.81)mm, the average angle of the posterior fossa was (29.92±4.78)°. The offending arteries were observed in all patients. The local anatomic variations and exceptional arteries were found in 14 patients. 16 patients got a clinical resolution, of which 14 cases were cured immediately, delayed resolution (1, 3 months after surgery) was found in two cases, without recurrence during the follow-up period(1-3 years). One patient relapsed 10 d after the surgery. One case of delayed facial paralysis (14 days after surgery) and one hoarseness were observed.

Young onset HFS patients were rare. Exceptional arteries and anatomic structural variation might be the main causes of this disease. MVD had good effect.

To evaluate the therapeutic effect of encephaloduromyosynangiosis (EDMS) in young children for moyamoya disease(MMD).

Twenty-seven MMD chilidren confirmed by digital subtraction angiography (DSA) or magnetic resonance angiography (MRA) in our center were admitted between January 2011 and September 2013. The clinical manifestation was described as below: 1 with cerebral hemorrhage history, 26 with Ischemic history. Eight left brain hemispheres, 6 right hemispheres and 13 bilateral hemispheres were operated. All the procedures were performed within (136±22) min with (21±3) ml blood loss.

The mean period of follow-up after surgery was 15.8 months, with a range of 6-38 months. (1)The cerebral blood flow in the effected regions was increased 3 months after the operations, all cases got vascularization. The spontaneous revascularization from the deep temporal artery, superficial temporal artery and the middle meningeal artery was found in DSA or MRA.(2)Twenty-seven SPECT reviewed cases had better perfusion after the operation. (3)The ischemic symptoms were relieved in 31 (77.5%) hemispheres, while stabilized in 8 (20.0%) hemispheres. There were 4 cerebral infarctions (10%) within one month after the operation, 1 located in the operated hemisphere, while 3 in the contralateral sites.

EDMS was a safe, effective and secluded treatment for MMD in young children. The extracranial vessels could be revascularized in a multi-layered extensively manner, which significantly improved patients′ neurological function.

To identify the predictors of outcomes in elderly patients undergoing coiling of ruptured cerebral aneurysms.

Ninety consecutive elderly patients (≥60 years)with ruptured aneurysms underwent coiling between January 2012 and November 2013. The potential factors for unfavorable outcome were evaluated by a univariate analysis and multivariate Logistic regression analysis. The outcome was measured by the modified Rankin scale (mRs) and was dichotomized into favorable (mRs 0-2) and unfavorable (3-6). The median follow-up was 10.6 months(range, 1-22 months).

Among the 90 patients, 77 (86%)patients had a favorable outcome. Thirteen patients(14%) had an unfavorable outcome. Seventy-two (91%)of 79 patients with World Federation of Neurosurgical Societies (WFNS) grade Ⅰ-Ⅲ had a favorable outcome. Five (45%)of 11 Patients with WFNS grade Ⅳ-Ⅴ had a favorable outcome. And 2 (3%)of 61 Patients with Fisher grade 1-2 showed the poor clinical recovery, whereas 11(38%)of 29 Patients with Fisher grade 3-4 showed the poor clinical recovery. Six(55%)of 11 Patients with shunt-dependent hydrocephalus had unfavorable outcome. Univariate analysis revealed that age, Ⅳ-Ⅴ WFNS grade, 3-4 Fisher grading, shunt-dependent hydrocephalus, in-hospital complication were potential predictors for poor outcome(mRs 3-6)(P<0.05). Multivariate Logistic regression analysis showed that 3-4 Fisher grading (OR=10.4671, P<0.05) and shunt-dependent hydrocephalus (OR=19.978, P<0.05) were independent risk factors for for poor outcome after endovascular treatment of ruptured cerebral aneurysms.

Fisher grade 3-4, shunt-dependent hydrocephalus were independent predictors of unfavorable outcomes in elderly patients undergoing coiling of ruptured cerebral aneurysms.

To analyze the surgical outcome and relevant surgical parameters including pathological subtype, brain MRI results, the location of epileptogenic zone, resection extent of epileptogenic zone in focal cortical dysplasia (FCD) with intractable epilepsy.

We retrospectively analyzed the surgical outcomes of 61 patients with intractable epilepsy related to FCD, accepted surgery in the First Affiliated Hospital of Xinjiang Medical University from December 2009 to December 2012, with 1-3 years of postoperative follow-up. The relation between pathological subtypes, MRI results, epileptogenic zone located at pure temporal lobe, resection extent of epileptogenic zone and surgical outcomes were statistically evaluated.

Forty-two patients(69%) were Engel class Ⅰ, 10 (16%) class Ⅱ, 5 (8%) class Ⅲ, and 4 (7%) class Ⅳ. The surgical outcome was related with pathological subtype(P<0.05), brain MRI results(P<0.05), whether the epileptogenic zone located at pure temporal lobe(P<0.05), whether complete resection(P<0.05).

The surgical outcome of FCD was favorable. FCD type Ⅲ, positive brain MRI results, epileptogenic zone located at pure temporal lobe, complete resection were correlated with favorable surgical outcome.

To evaluate the effects of sympathectomy of carotid artery on cognitive conditions and brain blood supply in preschool children with cerebral palsy.

A total of 45 preschool children with cerebral palsy were enrolled, they were divided into surgical group and non-surgical group. Twenty-three patients were in surgery group with the mean age of 4.8 years. Twenty-two patients were in non-surgery group with average age of 4.5 years. Two weeks and six months after surgery, the transcranial doppler (TCD) data were collected in surgical group.Meanwhile, the developmental quotient(DQ), intelligence quotient(IQ) and C-factor were also collected in surgery surgical group and non-surgery group.

In surgery group, the average flow velocity, peak velocity, end-diastolic flow velocity at two weeks after the surgery were significantly greater than those before surgery[before surgery vs 2 weeks after surgery, (87.62±6.12) em/s vs (96.34±7.24)em/s, (134.36±10.26 )em/s vs (149.02±11.23)em/s, (54.55±9.22)em/s vs (60.07±10.24)em/s, all P<0.05], the vascular pulsation index and vascular resistance index two weeks after the surgery were significantly lower than those TCD index before surgery (before surgery vs 2 weeks after surgery, 0.97±0.09 vs 0.85±0.17, 0.67±0.02 vs 0.57±0.03, all P<0.05), this difference still existed 6 months after surgery. Two weeks after surgery, the DQ, IQ, C factor in both surgical group and non-surgical group showed no significant difference(surgery group vs non-surgery group, 54.02±8.25 vs 54.66±13.44, 59.02±8.25 vs 60.66±13.44, 8.97±2.66 vs 9.56±2.71, all P>0.05). At 6 months after the surgery, the DQ, IQ, C factor in both surgical group and non-surgical group showed significant difference (surgery group vs non-surgery group, 83.40±11.28 vs 61.43±12.72, 80.40±11.28 vs 67.43±12.72, 12.78±3.89 vs 9.99±3.25, all P<0.01). The cognitive index in the surgery group were significant greater than those in non-surgery group.

Sympathectomy of carotid artery can significantly improve brain blood supply and cognitive development index such as DQ, IQ, C factor in preschool children with cerebral palsy.

Intracranial aneurysm is a very dangerous, potential and fulminant cerebral hemorrhage disease with a high mortality and disability rate in clinic^[1]The hemorrhage after rupture is mostly manifested as subarachnoid hemorrhage (SAH). Choosing the proper surgical method and the best surgical time can not only reduce the mortality of ruptured aneurysm, but also minimize the neurological damage^[2]。 In this study, 62 cases of anterior circulation artery aneurysm treated by craniotomy and microsurgery from June 2010 to March 2012 were retrospectively analyzed. The corresponding results are reported below.

Sturge-Weber syndrome (SWS), also known as encephaotrigeminal angiomatosis or encephlofacial angiomatosis, is a rare and special cerebrovascular malformation, mainly characterized by congenital cerebral hemangioma and telangiectasia in the skin distribution area of the trigeminal nerve^[1]。 In recent years, it is considered to be a vascular abnormality of the skin, brain and eye. From March 2008 to March 2013, 4 patients with SWS were surgically treated in our hospital, which are reported in combination with the literature below.

To investigate the effects of short hairpin RNA (shRNA) targeting Forkhead box P3 (FOXP3) gene on the proliferation and apoptosis of human glioma cells U87 and LN229.

4 plasmids containing different sequences of shRNA targeting FOXP3 gene and 1 plasmids containing random sequences were transfected into human glioma U87 cells and LN229 cells mediated by Lipofectamine 2000. The expression of FOXP3 protein was detected by Western blot to screen the most effective shRNA plasmid. The cell proliferation and apoptosis were detected by CCK-8 assay and flow cytometry, respectively.

At 72 h after transfection, the expression of FOXP3 protein was most obviously suppressed by shRNA-1 sequence compared with other shRNA sequences. The CCK-8 assay results showed that the proliferation rates of U87 cell and LN229 cell tranfected with shRNA-1 plasmid were (122.00±4.32)% and (118.36±2.49)% at 72 h, respectively, which were significantly higher than that transfected with neg-shRNA plasmid (neg-shRNA group) and the non-transfection group (control group) (P<0.05). At 72 h after transfection, the apoptosis rates of U87 cell and LN229 cell in shRNA-1 group were (7.03±3.36)% and (9.40±2.51)%, respectively, which were decreased significantly compared with those of the neg-shRNA group(17.70±4.39)% and (22.63±1.86)%, and the control group (16.57±2.30)% and(21.67±1.93)% (P<0.05).

The shRNA targeting FOXP3 gene could efficiently inhibit the gene expression and hence it could significantly inhibit the apoptosis of glioma cells and promote cell proliferation.

To study the regulation mechanism of hypothermia on small ubiquitin-related modifier (SUMO), and explore the protective mechanism of mild hypothermia therapy on cerebral ischemia.

The hippocampal neurons were obtained from SD rats with gestational age of 18 days. After cultured 12 days, they were randomly divided into three groups: control group, oxygen glucose deprivation (OGD) group and OGD + mild hypothermia group. These OGD neurons were cultured in 37 ℃ and mild hypothermia (33 ℃) condition for 24 hours respectively. And the expression level of SUMO-1 and SUMO-2/3 were detected by western blot method. The lactate dehydrogenase (LDH) content was detected by ELISA, and apoptosis by apoptosis in situ. A total of 36 SD rats were randomly divided into sham operation group, middle cerebral artery occlusion (MCAO) group and MCAO + mild hypothermia group, 12 rats in each group. MCAO model was established with thread embolism method, and their neurologic impairment scores were compared among three groups at 1, 7, 14 and 21day. The expression localization of SUMO-1 and SUMO-2/3 in hippocampus neurons were detected by immunofluorescence assay.

(1) In control group, OGD group and OGD + mild hypothermia group, the LDL levels were (9.85±2.47) μg/L, (586.29±51.56) μg/L, (317.54±42.33) μg/L respectively, and the apoptosis rates were (0.27±0.05)%, (29.25±6.07)%, (17.44±4.59) % respectively. All the P value was <0.01. The SUMO-1, both free and conjugated protein expression level showed no statistically difference among three groups. Compared with OGD group, the expression level of free SUMO-2/3 protein reduced in OGD + mild hypothermia group, but the conjugated SUMO-2/3 level increased. Both free and conjugated SUMO-2/3 protein level in OGD group and OGD + mild hypothermia group were higher than that in the control group (P< 0.01). (2) The neural function defect score of MCAO + in mild hypothermia group at the 7th and 14th day were lower than that in MCAO group (P< 0.05), but there was no statistical significance at the 21th day. The cerebral infarction area of MCAO group was (34.51±7.44) mm^2, the MCAO + mild hypothermia group was (23.67±5.49) mm² (P< 0.05). The SUMO-1 level was not significantly different among the three groups. Compared with sham operation group, the SUMO-2/3 level was significantly higher in the nucleus in MCAO group, and was the highest in MCAO + hypothermia group.

The protective mechanism of mild hypothermia for rat cerebral ischemia might be related to the enhancement of binding ability SUMO-2/3 and their target proteins.

To detect the different gene expression profiles in the process of glioma stem cells'(GSCs) differentiation to endothelial cells(ECs) under hypoxia and to screen the key pathways and genes for offering a new therapeutic target for the treatment of glioblastoma.

GSCs were extracted from U87 glioma cell line and were identified with the stem cell markers SOX2、CD133 and Nestin by immunofluorescence staining. The differentiated cells incubated in the hydrogel under hypoxia were identified with the EC markers CD31 and CD34 by immunofluorescence staining. Total RNA extracted from the GSCs and the differentiated cells were used for gene chip to screen expressed genes. The significant gene function analysis (GO-Analysis) and signal transduction pathway analysis (Pathway-Analysis) were carried out to screen the key signaling pathways and genes.

SOX2、CD133 and Nestin were observed in the GSCs extracted from U87 glioma cell line.CD31 and CD34 were positive in the differentiated cells. Gene chip analysis displayed that 481 genes were up-regulated, while 245 genes were down-regulated. Significant gene function and signal transduction pathways were analyzed and numerous significant signaling pathways and genes were screened such as TGF-β signaling pathway(P<0.01), FASN (fatty acid synthase) (P<0.01) and P4HA1(prolyl4 hydroxylase subunit alpha-1)(P<0.01).

GSCs extracted from U87 glioma cell line could differentiate into ECs under hypoxia in vitro. The significant signaling pathways and genes such as TGF-β signaling pathway, FASN and P4HA1 might be the promising therapeutic targets for the treatment of glioblastoma.

To detect differentially expressed lncRNAs and mRNAs in hippocampus from epileptic rats using microarray and explore the role of lncRNAs in the pathogenesis of epilepsy.

The lithium-pilocarpine-induced status epilepticus model was established in Sprague-Dawley rats. Total RNA samples were isolated from hippocampus of 5 epileptic rats and 5 normal rats 24 hours after the induction of status epilepticus. Rat Gene 2.0 ST microarray was used to detect deregulated lncRNAs and mRNAs in the hippocampus. GO and Pathway analysis was performed. The coding-noncoding gene co-expression network was established.

A total of 198 deregulated lncRNAs and 1 804 deregulated mRNAs were detected in epileptic rats. GO Term enrichment in the differentially expressed mRNAs list included ion transport, response to hydrogen peroxide, cell adhesion, inflammatory response etc. Differentially expressed mRNAs might involve in MAPK signaling pathway, focal adhesion, p53 signaling pathway, apoptosis, etc. Target regulated by lncRNAs was predicted with bioinformatic prediction.

This study explored the lncRNAs and mRNAs expression in epileptic rats using microarray. Differentially expressed lncRNAs might play a role in the pathogenesis of temporal lobe epilepsy.

To investigate the effect of microRNA(miR)-487b on the proliferation and apoptosis of glioma cells by observing the changes of cell proliferation, cell cycle and apoptosis.

The expression of miR-487b in 6 samples of glioma tissues and 6 samples of non-tumor control brain tissues was detected by using real-time PCR (qRT-PCR). After artificially synthesized miR-487b mimics was transiently transfected into LN229 glioma cells, the expression of miRNA-487b was tested by qRT-PCR. MTT assay was applied to detect the cell proliferation. The cell cycle and apoptosis were measured by flow cytometry.

MiR-487b was down-regulated in glioma samples(2.67±0.90)×10^-2 compared with non-tumor samples(1.23±0.22). The transient transfection of miR-487b mimics into LN229 glioma cells significantly increased the expression of miR-487b (compared with normal control, P<0.05). The result of MTT assay showed that miR-487b might inhibit LN229 cells proliferation significantly (compared to normal control P<0.05). The cell cycle analysis detected by flow cytometry assay showed that miR-487b raised the cell proportion in G0/G1 phase (compared to normal control, P<0.05). The apoptosis rate detected by flow cytometry assay showed that miR-487b might promote the cell apoptosis (compared with normal control, P<0.05).

MiR-487b might decrease glioma cells proliferation, block cell cycle, and promote cell apoptosis, which indicated that miR-487b was a new target for the diagnosis and treatment of glioma.

dural arteriovenous fistula (DAVF) combined with blood flow-related aneurysms are rarely reported in the literature at home and abroad. This paper introduces the preliminary experience of two patients of this type who were treated by endovascular embolization combined with craniotomy in December 2013 in the Department of Neurosurgery of Shanghai Deji Hospital, and reviews the relevant literature.

Intracranial infection is a complication with high fatality and disability rate after neurosurgery. Early recognition and targeted treatment can significantly improve the prognosis. Due to the influence of stress, bleeding, implants and other factors, neurosurgery is often accompanied by fever, positive cervical resistance and other manifestations. It is difficult to distinguish between intracranial aseptic inflammatory reaction and infection. If all of them are treated as infection, it will lead to the abuse of antibacterial drugs and excessive medical treatment. Therefore, it is particularly important to select highly specific and highly sensitive indicators with differential significance for infection. procalcitonin (PCT) is a precursor substance of human calcitonin, which is relatively stable in vivo and in vitro.^[1]Since PCT was first reported as an early marker of bacterial infection, PCT has been applied to differential diagnosis, disease assessment and antibiotic efficacy evaluation of various bacterial, fungal or parasitic infectious diseases. The early diagnosis of postoperative intracranial infection is difficult due to the influence of surgery, blood-brain barrier and other factors, so the clinical significance of PCT deserves attention. This article reviews the biological characteristics of PCT and its clinical significance for postoperative intracranial infection.

Bow hunter's syndrome (BHS), also known as Bow hunter's stroke or rotating vertebral artery occlusion, is a rare clinical syndrome of vertebrobasilar insufficiency (VBI) caused by stenosis or occlusion of the vertebral artery caused by head turning within normal physiological ranges^[1,2,3,4]。 BHS can cause circulation disorders in perfusion areas such as brainstem, cerebellum, thalamus, occipital lobe, part of temporal lobe and upper spinal cord related to blood supply to the vertebrobasilar system, which are mainly manifested as dizziness, nystagmus, nausea, vomiting, paresthesia, Horner syndrome, dysphagia, loss of consciousness, ataxia, fall attack, diplopia and dysarthria^[1,5,6]。 DeKlevn and Versteegh, 1933;^[7]The correlation of head rotation with VBI is first reported. 1978, Sorensen^[8]This syndrome was first reported in one patient during archery movement. Earlier reports showed that vertebral artery occlusion associated with head rotation occurred most frequently in C_1～2^[9-10]Later, studies confirmed that the common location of rotating vertebral artery compression is C_1～2(50%) and C_5～7(50%)^[11]。 There are many causes of BHS, mainly caused by congenital stenosis, endogenous compression and exogenous compression^[6]。 The main diseases include: abnormal development and tortuosity of vertebral artery, congenital abnormalities of cervical vertebra, and dura stenosis of vertebral artery entering the cranial segment to compress vertebral artery; Atherosclerosis, arterial dissection, embolus; Traumatic instability (e.g. sports injury accidents), degenerative diseases (e.g. vertebral rigidity) and systemic diseases (e.g. rheumatoid arthritis), contraction of neck muscles, compression of tendons, ligaments, osteophytes and tumors, etc.^{[5,6,12,13,14,15,16,17]}。 Among them, exogenous factors are less common than endogenous factors. Due to the low incidence of BHS and few clinical cases reported, there is currently no clear diagnosis and treatment guideline^[18]。 At the same time, the etiology and pathogenesis of VBI are complex, and it is difficult to form standardized diagnosis and treatment standards. This article summarizes the development of diagnosis and treatment methods of BHS in recent years as follows, which provides theoretical basis for better clinical diagnosis criteria and treatment guidelines.

Intraoperative magnetic resonance (iMRI) technology has brought great help to neurosurgery, improved the effect and safety of surgery. This article reviews the development of iMRI technology and its application in neurosurgery.