Volume 31 · Issue 04 · 2015

To analyze the outcomes of neuro endoscopic and microscopic pituitary adenoma surgery.

A total of 862 cases were enrolled in between October 2010 and October 2011, including 226 cases in endoscopic group and 636 in microscopic group. The extent of tumor resection, visual improvement, operation time and hospitalization days were compared between two groups.

There was no statistical difference in the extent of tumor resection in microadenomas and giant pituitary adenomas between two groups. While endoscopic surgery resulted in superior resection in macroadenomas. Analyzed by Knosp grading, according to the removal rates, there was no significant difference showed at Knosp level 0-2 and level 4, while endoscopic surgery resulted in superior resection at level 3(P<0.05). The visual acuity and visual field were better in the endoscopic group. The operation time and length of stay in hospitals were both shorter in the endoscopic group than those in the microscopic group.

Endoscopic transsphenoidal resection of pituitary tumors was safe, with shorter operation time and length of stay. Endoscopic and microscopic transsphenoidal operations had their own advantages, and the advantage of endoscopic transsphenoidal surgery lied in the treatment of invasive adenoma of Knosp 3 grade.

To report the clinical features of the patients who underwent emergent re-craniotomy after skull base operation.

A serial of 14 cases of reoperation after elective surgery in the Department of Neurosurgery, Beijing Tiantan Hospital between October 2008 and October 2013 were reviewed. Six cases were skull basal meningioma, 3 schwannoma, 1 pituitary adenoma, 1 craniopharyngioma, 1 chondroma, 1 angioleiomyoma, and 1 glomus jugular tumor. The mean length of first operation time was 9.2 h, and the mean amount of bleeding was 2 750 ml. The reason of reoperation was evaluated by the surgeons and experts, and then approved by all doctors.

The clinical features of these reoperation patients included altered level of consciousness in 9 cases, unrecovered from anesthesia in two, abnormal CT scan in two and one sudden bleeding in wound. The mean time of abnormal CT scan was 17 h. As for the reason for reoperation, the tumor cavity bleeding was found in 4 cases, intracerebral hematoma and brain contusion in 4, massive brain infarction in 2, intracerebral hematoma and subdural hematoma in 1, epidural hematoma in 2, and vertebral artery dissection in 1. Six patients lived a normal life after the second operation, 2 moderate disability, 2 severe disability, 1 persistent vegetative state, and 3 died.

For skull base surgery, the perioperative management should be reinforced to decrease the emergency reoperation.

To study the microsurgical modality for lateral ventricular meningiomas with neuronavigation and tubular retractor system and evaluate its long term outcome.

The clinical and follow-up data of 23 lateral ventricular meningioma patients during the past 3 years were collected for a retrospective analysis in our center. 12 patients used neuronavigation and tubular brain retractor system, 11 patients received traditional manual measurement anatomic landmarks with traditional brain retractor. The tumor resection extent, overall survival, recurrence, operation exposure, operation trauma, peri-operative complications and? post-operative quality of life were compared between two groups.

The total tumor resection was achieved at 100% in both groups and the perioperative death or tumor recurrence within the follow-up period was not observed in both groups. The overall survival rate achieved 100%. Neuronavigation combined with tubular brain retractor technology did not increase the overall complications(P=0.414), nor decrease the operative field exposure(P=0.667). Its utility did not extend the operation time(P=0.695), but reduced the occurrence of aphasia and hemianopia after operation and significantly shortened the length of incision(P=0.034), the size of craniotomy(P=0.021) , the cortical incision length(P=0.001)and the days of hospitalization(P=0.037). Importantly, neuronavigation with tubular brain retractor system could significantly improve the postoperative quality of life for lateral ventricular meningioma patients(KPS, P=0.029).

Neuronavigation and tubular brain retractor system used in microsurgical resection of lateral ventricular meningioma doesn't decrease the total tumor resection and the operation exposure, but reduced intra-operative brain trauma and peri-operation complications. For the improvement of post-operative quality of life, it was suitable for lateral ventricular meningiomas.

To explore the clinical features and possible mechanisms of intracranial meningiomas with acute hemorrhage.

Retrospectively studied 7 patients with meningiomas whose acute onset were due to haemorrhage, the clinical data were evaluated and the associated literatures were reviewed.

(1) In this study, 4 patients were male and 3 were female. The age ranged from 32 to 68 years. The haemorrhagic meningiomas were located on the cerebral falx in 2 cases, parasagital areas in 1, skull base in 1, and convexity in 3. All patients experienced a stroke-like onset characterized by the sudden onset of headache, vomiting, hemiparalysis, or disturbance of consciousness; (2) On CT and MRI, the imaging showed extracerebral lesion and associated acute hemorrhage. All lesions were given operations: 4 lesions were totally removed, 2 lesions was subtotally resected, and 1 lesion was grossly removed. Histologically, there were 5 subtypes, angiomatous (n=2), atypical (n=2), fibroblastic (n=1), meningothelial (n=1), and transitional (n=1). The cell proliferation activities and the type of vessels were various in different patients: 1 patient was CD34(-)、CD31(+)、Ki-67 (grade Ⅰ), 1 patient was CD34(-)、CD31(+)、Ki-67 (grade Ⅱ), 4 patients were CD34(+ )、CD31(+)、Ki-67 (grade Ⅰ), and 1 patient was CD34(+)、CD31(+)、Ki-67 (grade Ⅱ); (3) One patient lived with mild paralysis, one with recurrent tumors received the second operation, and one with recurrent tumors was given radiotherapy.

Hemorrhage due to meningiomas is a rare initial presentation and patients would experience a stroke-like onset. The haemorrhagic mechanism is not clear and many factors played roles in the occurrence of haemorrhage in meningiomas.

To determine the significance of the application of high frequency multi-pulse direct cortical-stimulated motor evoked potentials (dcMEPs), subcortical-stimulated motor evoked potentials (scrtMEPs) and continuous dcMEPs monitoring during the resection of motor cortex area diseases.

Between June 2013 and July 2014 in Beijing Tiantan Hospital, Capital Medical University, we used somatosensory evoked potential(SEP) phase reverse to locate the central sulcus, and used dcMEPs to locate the eloquent cortex, scrtMEPs to determine the corticospinal tracts and continuous dcMEPs monitoring in 48 patients during surgery in and around the motor cortex area. The relationship between disability of 3 month after the surgery and the changes of compound muscle action potential (CMEP) were examined.

The CMEP amplitude of 11 patients declined≥50%, of which 9 patients had permanent motor deficit after the operation. The CMEP amplitude of 27 patients declined <50%, of which 3 patients had permanent motor deficit after the operation .Using 50 % of baseline amplitude criteria, the difference in permanent movement deficit between two groups was statistically significant by 2 analysis( P<0.001). When the decline of CMEP amplitude was≥50%, it predicted the permanent postoperative motor deficit and when the decline of CMEP amplitude was<50%, it predict normal or transient motor deficit.

DcMEPs and scrtMEPs could locate the motor cortex and corticospinal tracts. The continuous dcMEPs monitoring could provide continuous monitoring of motor nerve function. The CMEP change could predict motor function after surgery. These methods should be used to assist the resection of motor cortex area diseases.

To analyze the effects of craniocervical junction instability caused by ligament resection on the neutral zones(NEs) and range of motions(ROMs) in C_1-2 motion segment, and the maximum pressure of atlantoaxial lateral joint.

6 cases of fresh cadaver specimens were used. By using the method of repeated measurements, NZs and ROMs in C_1~2 motion segment were measured for normal control group and the craniocervical instability group under 2.0Nm and 1.0Nm pure moment loading of flexion extension, lateral bending and axial rotation, respectively.

The NZs in C_1~2 motion under the loadings of flexion and extension, lateral bending and axial rotation for craniocervical junction instability group were 26.67°±4.70°、9.13°±1.32°and 63.11°±5.87°, respectively. The NZs in C_1~2 motion under the loadings of flexion and extension, lateral bending and axial rotation for craniocervical junction instability group were 14.12°±2.40°, 4.15°±0.75°and 50.75°±5.84°, respectively. The NZs in C_1~2 motion segment for craniocervical instability group in the loadings of flexion and extension, lateral bending and axial rotation were significantly greater than those for intact group (P<0.05). The ROMs in C_1~2 motion under the loadings of flexion and extension, lateral bending and axial rotation for craniocervical junction instability group were 42.37°±3.96°、13.67°±1.10°and 78.50°±4.00°, respectively. The ROMs in C_1~2 motion under the loadings of flexion and extension, lateral bending and axial rotation for craniocervical junction instability group were 27.43°±2.41°、6.97°±0.59°and 65.26°±4.08°, respectively. The ROMs for craniocervical junction instability group in the loadings of flexion and extension, lateral bending and axial rotation significantly were higher than those for the intact group (P<0.05). For flexion, lateral bending and left axial rotation, the maximum stress of the atlantoaxial lateral joints for craniocervical instability group was less than that for the intact group. In the loadings of extension and right axial rotation, the maximum stress of the atlantoaxial right lateral joints for craniocervical instability group was less than that for the intact group, too.Howerer the atlantoaxial right lateral joint was unchanged under the extension laoding , and the left joint is a litte higher than that of the intact group under right axial loading.

Simple ligament resection in craniocervical junction could cause atlantoaxial instability. The range of motion for the loadings of flexion and extension, lateral bending and axial rotation is higher than that of the intact group. Atlantoaxial instability might lead to loss of load-bearing function of atlantoaxial lateral joint, and ultimately result in atlantoaxial dislocation.

To study the clinical, imaging characteristics, surgical treatments and results of spinal tuberculous granuloma.

A total of 15 cases of spinal tuberculous granuloma were retrospectively studied. Laminectomy with partial excision of tuberculous granuloma, open spinal dura mater with communication inside and outside the blood supply, and postoperative continued application of anti-TB drugs≥1 year were performed.

The surgery area covered 1-7 segment, up to the neck pillow, and down to the lumbar segments. The granuloma length was 3-16 cm. The lesions located mainly in extramedullary of subarachnoid cavity, most commonly seen in the lower point of the physiological curvature of the thoracic subarachnoid cavity. The granuloma could be entirely separated from the dura. From the appearance of neurological damage to the surgery, the shortest time was 3 days, the longest time was 1 month. The prognosis of patients with short duration was better than that of those with a long time. Two weeks after surgery, the muscle strength of 2 cases was increased from grade Ⅰ to grade Ⅳ and the Frankel classification changed from C to D-E. The muscle strength of 13 cases was increased from grade Ⅱ to grade Ⅳ, and the Frankel classification changed from C to D. The follow-up duration was from 1 month to 3 years. Varying degrees of neurological recovery were observed in all the patients. After two months, the MRI of 11 cases showed disappearance of granulomas around the surgical area. After six months, the MRI of 9 cases showed that the granulomas of surgical and non-surgical areas were completely disappeared.

Surgical decompression could improve the prognosis of spinal tuberculous granuloma. After neurological damage occurred, the sooner the surgery performed, the better the prognosis.

To analyze the clinical features of patients with focal cortical dysplasia type Ⅰ (FCD type Ⅰ) and explore the prognostic factors for the surgical outcomes.

This article retrospectively analyzed the pre- and surgical data and the outcomes by Engel scale of 99 histopathologically confirmed FCD type Ⅰ patients, including age at surgery, age at seizure onset, seizure related risks like febrile convulsion and pre- or peri-natal adverse events, seizure frequency, response to medicine, inter- and ictal-EEG pattern, lesion discernibility and extension on MRI, site of surgery and completeness of section based on MRI, recurrence of seizure during perioperative period and pathological subtypes rediagnosed by ILAE2011 classification.

FCD subtype Ⅰa was identified in 29, Ⅰb in 54, and Ⅰc in 16. There was no significant difference on clinical features between different subtypes. Engel class Ⅰ was achieved in 64% patients, and was 64%, 67% and 50% in FCD Ⅰa, Ⅰb and Ⅰc (with no significance between subtypes, chi-square test). Those with a history of febrile convulsion or pre- and peri-natal adverse events showed an earlier age of onset than patients without such histories (7.3±6.9 years and 6.5±7.2 years vs 12.6±8.9 years, P=0.035 and P =0.005, LSD method). Patients with age of onset>6 years old presented a higher Engel class Ⅰ rate than those with age of onset≤6 years old (45/63 vs 18/36,P=0.033, chi-square test). The same statistically significantly higher Engel class Ⅰ rates were observed in patient with medically non-refractory seizures than those with refractory seizures (28/36 vs 35/63, P=0.027, chi-square test). The seizure frequency less than and more than once per week (29/37 vs 34/62, P=0.018, chi-square test), focal than non-focal interictal EEG pattern (35/46 vs 28/53, P=0.016, chi-square test), obvious than subtle/negative lesion on MRI (37/49 vs 26/50, P=0.015, chi-square test), and without than with perioperative seizure recurrence (53/73 vs 10/26, P=0.002, chi-square test) were all prognosticators for surgical outcomes.

Subtypes of FCD type Ⅰ were homogenous on clinical features and surgical outcomes. The good outcome prognosticators included age at onset more than six, non-refractory epilepsy, seizure frequency less than once per week, focal EEG pattern, obvious lesion on MRI, and no perioperative recurrence.

To observe the value of high-frequency ultrasonography in the diagnosis and treatment of peripheral nerve injury.

A total of 22 patients with peripheral nerve injury were examined by high-frequency ultrasonography for the cause of nerve injury. The operative decisions were made according the results of ultrasonography and electroneurophysiology examination. The coincidence rate of ultrasongraphy with intraoperative findings was calculated and the nerve function of patients was followed-up for 1 year to estimate the therapy effects.

The causes and positions of nerve injury were found by ultrasonography, which were consisted with the intraoperation findings and the coincidence rate was 100%. The function of lesioned nerves was improved after the surgical treatment. The motor nerve conduction velocities (MCV) of 12 patients with conservative treatment were increased(P<0.01) after 1 year of follow-up, the pre-operation MCV, postoperation MCV and the increased rate were (36.7±12.2) m/s, (48.2±14.4) m/s and 35.0%, respectively. While the MCV of 10 operating patients were increased (P<0.01) too, the pre-operation MCV, postoperation MCV and the increased rate were (20.8±7.9) m/s, (39.6±13.2) m/s and 102.8%, respectively.

High-frequency ultrasonography was a suitable imaging diagnosis tool for peripheral nerve injury. Accompanying with electrophysiological examination, it could explore the causes of nerve injury, determine the treatment and avoid unnecessary operation.

To explore the influencing factors of acute intraoperative encephalocele in craniotomy of brain injury patients.

A retrospective analysis about 168 cases of acute encephalocele in craniotomy surgery in patients with clinical data and follow-up results, according to the Glasgow outcome scale (GOS) group: patients with GOS 1~3 were divided into poor prognosis group (control group), patients with GOS 4~5 were divided into good prognosis group (research group). The second component multiariable Logistic regression analysis method was used for the analysis of patient age, history of heart head blood-vessel, preoperative score (GCS), preoperative pupil, encephalocele reasons, whether reoperation, postoperative GCS score, postoperative pupil, postoperative blood coagulation indexes, blood sugar, etc.

Good prognosis was observed in 33 cases and poor prognosis in 135. The postoperative GCS, reasons of encephalocele and age were closely related with the prognosis (P<0.05).

The overall prognosis of traumatic brain injury patients with acute encephalocele during craniotomy was poor. The postoperative GCS, reasons of encephalocele and age could be used as important indexes for prognosis evaluation.

To investigate the influence of XB130 on the proliferation and apoptosis of glioma cell LN229.

LN229 cells were divided into the control group, nonsense sequence siRNA transfected group and XB130 siRNA transfected group. After siRNAs were transfected into LN229 cells, the expression of XB130 was detected by Western blot and immunofluorescence staining. The phenotypic changes of LN229 cells including proliferation, apoptosis and cell cycle were determined by MTT assay and flow cytometry.

The relative protein expression levels and immunofluorescence intensity of XB130 were respectively 1.00±0.10 and 0.085±0.012 in the control group, 1.00±0.13 and 0.072±0.009 in the nonsense sequence group, 0.52±0.06 and 0.013±0.002 in the XB130 siRNA transfected group. The expression of XB130 in LN229 cells was significantly decreased in the XB130 siRNA transfected group (P<0.05). LN229 cells transfected with XB130 siRNA showed lowering proliferation activity by MTT assay (P<0.05). The results of flow cytometry showed that the apoptotic rate and the proportion of cells in G0/G1 phase were (12.45±0.96) % and (62.85±1.85) % in the control group, (13.64±0.85) % and (63.04±1.74) % in the nonsense sequence group, (20.26±1.42) % and (72.67±1.93) % in the XB130 siRNA transfected group respectively. The apoptotic rate and the proportion of cells in G0/G1 phase in the XB130 siRNA transfected group were significantly higher than those in the other two groups (P<0.05).

Knocking down the expression of XB130 in human glioma cells could significantly inhibit cell proliferation and induce apoptosis, indicating XB130 could promote the proliferation of glioma cells.

To study the protective mechanism of mild hypothermia (MHT) and erythropoietin (EPO) therapy on traumatic brain injury (TBI) rats.

Eighty male Wistar rats were randomly divided into sham-operated group (Sham), normothermic treatment following TBI group (NT), mild hypothermia group (MHT), EPO group (EPO), and combined group (MHT+ EPO), respectively. The TBI animal models were established according to fluid percussion impact (FPI) method. The neurological deficit was evaluated using a modified neurological severity score (mNSS) at 48 h after FPI. The changes of brain water content and permeability of blood-brain barrier were measured by the methods of wet and dry weight and Evans blue stain. The sizes of injury lesion were evaluated by hematoxylin and eosin (HE) stain. Western blotting and RT-PCR were used to analyze the expression of Claudin-5.

Both MHT and EPO treatment lessened the neurological deficit scores. The brain water content, lesion size and attenuate BBB permeability and the expression of Claudin-5 were observed(P<0.05).

Both MHT treatment and EPO treatment could express neuroprotective effect for TBI rats. This protective effect against TBI might be achieved by upregulation of Claudin-5.

To investigate the BMP-2 expression in glioma cell lines and its promotive role and mechanism of proliferation in glioma cells.

Subculture of five glioma cell lines including U8vIII, U87, T98G, LN229 and U373, Semi-quantitative PCR was performed to analyze BMP-2, BMP-2 receptors (BMPR1A, BMPR1B and Alk-2) and Smad1 expression in these glioma cell lines. MTS assay was used to investigate the glioma cell proliferation with BMP-2 (0, 25, 50, 100, 250 and 500 ng/ml) treatment. Western blot was performed to detect activation of canonical BMP pathway (BMP/Smad pathway) and non-canonical BMP pathway (BMP/MAPK pathway) under BMP-2 treatment with different doses and timepoints. At last, the expression of BMP pathway downstream genes cyclin B, cyclin D1, p27 and p21 were explored at 0, 4, 8, 16 or 24 h posttreatment of BMP-2 (100 ng/ml).

The expression of BMP-2, its receptors and Smad1 were significantly different among five glioma cell lines (P<0.01). The MTS assay showed that BMP-2 promoted U87 cell proliferation. It reached the maximum level when the BMP-2 concentration reached 100-250 ng/ml. The Western blot results revealed that BMP-2 activated phosphorylated Smad1/5/8, p38, JNK and ERK in dose and time dependent manners (P<0.01). The expression levels of BMP pathway downstream genes cyclin B and cyclin D1 were higher compared to those of control (P<0.01). However, the levels of p27 and p21 were lower (P<0.01).

BMP-2 could promote glioma cell proliferation via regulation of BMP/Smad and BMP/MAPK pathway.

To explore whether transfer factors can exert suppressive effect on the growth of brainstem gliomas.

C6-Wistar rat brainstem models were used, established by stereotactic implantation of C6 cells into the pons of the rat.Twenty adult rat models were used to extract peripheral blood lymphocytes to prepare transfer factors specific to C6 cells. Twenty juvenile rats were divided into experimental group and control group equally, and were intragastric administered with transfer factors solution and normal saline respectively at the time of 0 hour. Twenty-four hours later rats of the two groups were implanted with C6 cells into its' pons simultaneously.Tumor volumes of the two groups were calculated by diameters measured on T1WI contrast-enhanced MRI image 2 weeks later. The peripheral CD4⁺ T and CD8⁺ T lymphocytes were gauged by flow cytometry at the time of 24 h and 96 h. Neurological signs and overall survival were recorded.

The mean tumor volume of the experimental group (94.6±21.3) mm³ was significantly less than that of the control group(133.6±30.7) mm³, (P<0.05). At the time of 24 h, the proportion of the peripheral CD4⁺ T lymphocytes was (10.4±5.4)% for the experimental group, and(10.0±6.5)% for the control group; while that of CD8⁺ T lymphocytes was (1.9±0.9)% and (2.8±1.3)% for the experimental and control group respectively.At the time of 96 h, the proportion of the peripheral CD4⁺ T lymphocytes was (41.3±4.4)% for the experimental group, and (14.8±1.4)% for the control group; while that of CD8⁺ T lymphocytes was (24.4±2.8)% and (7.5±0.6)% for the experimental and control group respectively.There was no significant difference of the peripheral CD4⁺ T and CD8⁺ T lymphocytes between the two groups at the time of 24 h, While at the 96 h these counts were significantly higher in the experimental group than in the control group(P<0.05). At the time of 96 h, the experimental groups got significantly higher CD4⁺ T and CD8⁺ T lymphocytes than that of 24 h (P<0.05). However for the control group only CD8⁺ T lymphocytes was significantly higher than that of 24 h (P<0.05). Rats of the experimental groups outlived those of the control group(P<0.05).

Transfer factors specific to C6 cells extracted from adult C6-Wistar rat brainstem glioma models can suppress the growth of the tumor of the juvenile brainstem glioma model.This work has laid some theoretical foundation for immnotherapy of brainstem gliomas in the future.

To study the content and distribution characteristics of glioma stem cells (GSC) in human glioma-bearing of nude mice, and to explore the relationship between the content of GSC and tumor size.

The situation of tumor-growth were observed after inoculating subcutaneously to nude mice with cells of SU2 GSC lines. According to the tumor diameter, they were divided into two groups, 5mm group and 10mm group, the content and distribution of GSC were evaluated by flow cytometric and immunohistochemistry, and all data were analyzed by SPSS 16.0 statistical software as statistically significant difference were considered with P<0.05.

(1) On immunohistochemistry, the content of GSC in 5mm group and 10mm group were 4.02%±1.15%and 2.74%±0.51%, respectively. The content of GSC were reduced with the increase of the tumors (t=3.23 , P=0.005). (2) On flow cytometric examination, the number of CD133⁺ cells in 5 mm group and 10 mm group were 5.03%±2.53 % and 2.42%±0.79%, respectively. The content of CD133⁺ cells in 5mm group were more than that of 10mm group(t=3.13, P=0.006). (3) There was no difference with the content of GSC between flow cytometry and immunohistochemistry (5 mm group t=1.15, P=0.27, 10mm group t=1.14, P=0.27).

The GSC was located in the margin of tumor, and nested and gathered around the larger blood vessels. The content of GSC was related with the diameter of tumor, the smaller the diameter, the larger the content.

3-methyl adenine (3-methyladenine, 3-MA) was used to test the effect on cisplatin induced U251 cell apoptosis.

MTT assay was used to test the effect of 3-MA on cisplatin cytotoxicity in U251 cells. Hoechst33342 staining was used to test the effect of 3-MA on cisplatin induced apoptosis. Western bolt was used to detect the expression of ER stress associated proteins, ubiquitinated protein, protein disulfide isomerase (PDI), glucose-regulated protein78 (Grp78), C/EBP homologous protein (CHOP), and activation of caspase-4 and caspase-3. The expression of microtubule-associated protein 1 light chain 3 (LC3) and PDI were observed by immunofluorescence staining and confocal microscopy.

MTT assay showed that 3-MA could enhance cisplatin induced growth inhibition rate in human glioma U251 cells (P=0.00324 cisplatin troup vs. control group; P=0.02249 3-MA+ cisplatin group vs. cisplatin group). Hoechst33342 staining showed that 3-MA could increase cisplatin induced apoptotic effect in U251 cells. Western blot showed that 3-MA increases the expressions of ubiquitinated proteins, ERS marker proteins PDI, Grp78(P=0.00294, 0.0012, 0.00179 cisplatin group vs. control group; P=0.01896, 0.01515, 0.00734 3-MA+ cisplatin group vs cisplatin group), CHOP, and active Caspase-4 and active Caspase-3 (P=0.00081, 0.00017, 0.00018 cisplatin group vs. control group; P=0.00671, 0.00934, 0.01124 3-MA+ cisplatin group vs. cisplatin group). 3-MA could inhibit the expression of LC3II induced by cisplatin in U251 cell (P=0.00447 cisplatin group vs. control group; P=0.01588 3-MA+ cisplatin group vs. cisplatin group). Indirect immunofluorence staining showed that 3-MA inhibited the aggregation of LC3 and increased the expression of PDI.

3-MA combined with cisplatin enhances cisplatin induced apoptosis by increasing ER stress.

intracranial arachnoid cyst (IAC) is mostly a congenital disease. It is a common benign intracranial lesion in children, accounting for about 1% of intracranial lesions^[1]。 Intracranial hypertension caused by cyst compression of surrounding tissues mostly causes headache, epilepsy, skull deformation and protrusion, or secondary hydrocephalus, developmental delay, etc. See a doctor, and find it during head trauma examination. At present, the most commonly used surgical method is arachnoid cyst-peritoneal shunt. However, some complications of shunt surgery cannot be avoided, such as excessive shunt, insufficient shunt, shunt infection, blockage, rupture, shedding, displacement and even entanglement and knotting^[2,3,4,5]。 A case of benign intracranial hypertension caused by subcutaneous tension cyst in the chest wall caused by shunt displacement and entanglement in a child admitted to the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University is reported as follows.

Female, age 35 years. Admitted to hospital due to head trauma caused by car accident for 2 h. The consciousness was basically clear, the GCS score was 13, the bilateral pupil diameter was 2.5 mm, the light response was sensitive, the neck was resistant, the muscle strength and tension of the limbs were normal, the physiological reflex was normal, and the pathological reflex was not drawn out. Scalp contusion in the right temporo-occipital region. The first CT showed a small amount of subdural hematoma on the left side with left frontal brain contusion, with midline centered and coronal suture open. After 4 hours of admission, the patient's consciousness decreased to GCS score of 10. After CT reexamination, the left frontal lobe brain contusion and intracerebral hematoma were significantly enlarged, and the space-occupying effect was obvious, but no epidural hematoma was found (Figure 1)。 Under general anesthesia, left craniotomy was performed to explore hematoma evacuation. The left frontotemporal "?" incision was taken during the operation, and about 50 ml of left frontal lobe brain contusion and intracerebral hematoma were removed during the operation. When the operation was performed for about 1.5 h, encephalocele suddenly appeared, the brain tissue was pushed out of the bone margin about 2 cm, and a large amount of epidural venous blood gushed out. Immediately, bedside CT examination showed a delayed epidural hematoma of the upper riding trans-sagittal sinus, with a hematoma volume of about 150 ml (Figure 2)。 Immediately re-operate, make a transverse incision parallel to the coronal suture in the original incision, open the flap up and down, and drill holes on both sides of the sagittal sinus to form a bone flap. During the operation, the coronal suture was opened, and the bleeding was extensive sagittal sinus bleeding, and the bleeding was fierce. During the operation, the bleeding spot was covered with gelatin sponge, and then an occipital autologous fascia was taken. The fascia size was selected according to the bleeding range, and the autologous fascia was covered with gelatin sponge. Then, it was sutured on the dura mater and maintained a certain tension. Bone flap reduction. Return to the left side again to remove the hematoma, stop the hemorrhage and close the skull, and postoperative CT reexamination showed that the hematoma was cleared (Figure 3，4)。 He was discharged from hospital after 2 months of treatment, and his discharge GCS was 15 points.

Intracranial aneurysm is one of the common types of stroke. subarachnoid hemorrhage (SAH) caused by aneurysm rupture is a neurosurgical emergency, with an overall mortality rate of 50%, which seriously threatens human health and life. Early brain injury after subarachnoid hemorrhage is closely related to delayed brain injury and the prognosis of patients^[1]。 blood-brain barrier (BBB) disruption is an important pathophysiological basis of early brain injury after SAH. Blood-brain barrier In addition to its barrier role, the blood-brain barrier maintains internal environmental stability by strictly controlling the circulation of ions and molecules, providing oxygen and nutrients according to nervous system needs and protecting the brain from toxic substances and pathogens^[2]。 However, the changes and specific mechanisms of blood-brain barrier in early and middle brain injury after SAH are still unclear.

Parkinson's disease (PD) is a common neurodegenerative disease in middle-aged and elderly patients. In addition to motor symptoms such as tremor, myotonia, slow movement and postural disorders as its main clinical manifestations, non-motor symptoms (NMS) such as anosmia, constipation, sleep disorders and depression are also its significant features^[1]。 There is a high incidence of NMS in PD patients, which occurs earlier than motor symptoms, and exists at any time of PD^[2]。 deep brain stimulation (DBS) was first used in China in 1998, and it has been more than ten years since now. It has significantly improved the motor symptoms and improved the quality of life of patients^[3]。 It has been widely used in the treatment of intermediate and advanced PD, and the surgical targets are mainly subthalamic nucleus (STN), globus pallidus (GPi) and ventralis intermedius nucleus (VIM). STN-DBS significantly improved the motor symptoms such as tremor, rigidity, bradykinesia and dyskinesia^[4]。 The effect of DBS on NMS in PD patients is still unclear, but NMS also seriously affects the quality of life of PD patients. In recent years, it has gradually attracted clinicians' attention. NMS is mainly divided into four parts: neurological disorders, autonomic dysfunction, sleep disorders and sensory disorders. This article will make a summary of recent literature as follows.

As a novel tumor suppressor gene, leucine zipper tumor suppressor 2 (LZTS2) is widely involved in the occurrence, proliferation, migration and maintenance of tumor stem cell function of various tumors including glioma. It is an important candidate tumor suppressor gene and can be used as a novel therapeutic target for glioma.

intracranial aneurysm (IA) refers to tumor-like protrusion caused by local cerebral vascular wall abnormalities, including sac aneurysm with neck and fusiform aneurysm without neck^[1]。 Vlak et al.^[2]According to statistics from 1998 to 2011, the incidence of unruptured intracranial aneurysms in healthy people in 21 countries was about 3.2%, among which women were about 1.6 times higher than men; From 2007 to 2011, another researcher selected 4,813 people aged 35-75 in two areas of Shanghai (one in the urban area and one in the suburbs) for a census. The results showed that the prevalence of unruptured intracranial aneurysms was 7%, of which 5.5% were men and 8.4% were women. Most aneurysms are less than 5 mm in diameter^[3]。 Fujinaka et al.^[4]It is reported that the annual incidence of ruptured intracranial aneurysms in Japan is about 20/100,000, and 40% of them have a poor prognosis. 10% to 15% of patients with ruptured intracranial aneurysms have died before receiving effective medical assistance^[5]。 The mortality rate was close to 5% within 24 hours and up to 50% within 30 days after the onset of the disease^[5,6]。 25% to 30% of survivors will be at risk of bleeding again at any time within 4 weeks of onset^[7]。 In view of the high incidence, high disability and mortality of IA, it has always attracted much attention^[2]。 Although the European Stroke Organization has issued the latest guidelines for the diagnosis and treatment of IA and subarachnoid hemorrhage (SAH)^[8]However, the diagnosis and treatment according to the guidelines did not greatly improve the treatment results. This article reviews the risk factors for the formation and rupture of IA.

Craniocerebral injury is the main cause of death and disability in adolescents, and its accurate assessment and effective intervention have always been a concern in the field of neurosurgery. However, the traditional evaluation methods, such as Glasgow coma scale (GCS) and CT examination, are not high in specificity and sensitivity, which can no longer meet the needs of modern medicine. In recent years, the rapid development of neuroimaging, neuroelectrophysiology and detection of craniocerebral injury markers provides more objective and accurate methods for the diagnosis and prognosis of craniocerebral injury, and is also conducive to the study of pathological mechanism of craniocerebral injury and the exploration of new treatment methods. The progress in clinical application of modern evaluation techniques for craniocerebral injury is reviewed.

neurofibromatosis (NF) is a class of autosomal dominant hereditary diseases, which mainly include three subtypes: type 1 NF, type 2 NF and Schwann cell tumorosis. Such diseases have great phenotypic differences, mainly nervous system tumors, skin lesions and peripheral nervous system lesions, causing multiple and progressive damage, which brings great difficulties to treatment. Current reasonable measures include screening of at-risk populations, early diagnosis, close follow-up, and the establishment of a framework for multidisciplinary treatment based on the characteristics of the development of the natural course of NF. In this paper, the latest research on the pathogenesis, genetics, clinical manifestations and treatment of NF is reviewed.