Volume 31 · Issue 05 · 2015

The biological behavior of brainstem cavernous malformations (BSCMs), especially the incidence and dominant hemorrhage rate of lesions calculated in combination with brainstem volume, is very different from that of cavernous malformations (CMs) in other sites. With the popularization of MRI, it has been found that many primary brainstem hemorrhage are caused by BSCMs. Early hemorrhage presents uniform hematoma signal or a little irregular low signal. After 1 to 6 weeks with the liquefaction and absorption of hematoma, it presents typical CMs characteristics under the background of high signal, while a few tiny BSCMs only appear as small nodules attached to the lateral wall of hematoma. The so-called dominant bleeding is mostly manifested as dizziness, vomiting, numbness of limbs or mobility disorders, facial paralysis, swallowing or dysphonia, etc. A few patients may have drowsiness, and very few may be life-threatening^[1]。 These symptoms usually peak within a few days and gradually resolve for weeks thereafter, with sequelae that may be very mild but with a higher risk of re-bleeding, especially within 2 years of the previous bleeding. Some patients may have repeated bleeding in a short period of time, resulting in sustained or wave-like deterioration of neurological function. Some patients can heal themselves in the long term. These advances in understanding have mainly come from the experience of physicians, and there is still a lack of scientifically designed research on the natural history of BSCMs. At present, most scholars believe that the incidence of BSCMs accounts for 9% ~35% of all intracranial CMs, the annual bleeding rate is 0.5% ~6.0%, and the annual re-bleeding rate will increase significantly^[1]。

To investigate the safety and efficacy of endovascular treatment of posterior cerebral artery (PCA) aneurysms.

The clinical data of 27 patients with PCA aneurysm treated with endovascular treatment at the Department of Neurosurgery, Changhai Hospital, the Second Military Medical University from September 1998 to December 2009 were collected. The methods and efficacy of endovascular treatment were analyzed retrospectively.

All patients underwent endovascular treatment. The aneurysms of 4 patients embolized alone were packed densely (aneurysm at P2 segment), and the parent arteries were patent; 3 patients underwent parent artery occlusion alone (aneurysm at P2 segment), the aneurysms and the distal end of parent arteries did not develop. One patient performed stenting alone (at P1 segment), 1 performed stent-assisted coil embolization (at the junction of P1-P2), his aneurysms did not develop, and his parent artery was patent; 18 patients performed aneurysm embolization + parent artery occlusion (1 case at P1 segment, 11 at P2 segment, 2 at the junction of P2-P3 segments, 4 at P3 segment), including 17 performed aneurysm dense packing + parent artery occlusion, and one performed loose aneurysm embolization + parent artery occlusion. Of the 21 patients (77.8%) occluded parent arteries, 5 (23.8%) occurred ischemic events in the occluded blood supply area, and 4 (19.0%) were cerebral infarction. Twenty-three patients were followed up clinically, the follow-up time ranged from 1 month to 5 years, and 2 died. Six patients performed MR angiography (MRA) examination, 12 performed DSA examination, 3 had aneurysm recurrence, and after being treated again, they were cured during the follow-up period. Other patients recovered well.

As for the aneurysm at P1 segment, the embolization of aneurysm and maintaining parent artery patency are the main objectives. The P2 segment and the distal aneurysms should be packed densely. At the same time, the parent artery should be occluded exactly. Endovascular treatment of PCA aneurysms is safe and effective.

To investigate the surgical skills and clinical efficacy of anterior clinoidectomy for the management of paraclinoid aneurysms.

The clinical data of 25 patients with paraclinoid aneurysm treated with anterior clinoidectomy from January 2010 to July 2014 were analyzed retrospectively. Of the 25 patients, 19 were females and 6 were males (mean age 51.4 years). Six patients had multiple intracranial aneurysms, 8 had ruptured aneurysms, and 17 had unruptured aneurysms. The size of paraclinoid aneurysms: 6 were less than 5 mm, 13 were 5 mm to 15 mm, and 6 were more than 15 mm. All the patients performed the removal of the anterior clinoid process in subdural space via pterional approach, 9 aneurysms were clipped directly, and 16 were clipped and shaped. Postoperative digital subtraction angiography (DSA) was performed and the Glasgow outcome scale (GOS) was used to evaluate the efficacy during the follow-up period.

Postoperative DSA indicated that 2 patients had residual aneurysm necks, and 2 had parent artery stenosis. All patients were followed up for 1 to 51 months (mean 22.5 months). Ten patients had good prognosis (GOS 5), 13 had mild disability (GOS 4), and 2 had severe disability (GOS 3).

The removal of the anterior clinoid process, opening the superior wall of optic canal, and isolating the internal carotid artery of clinoid segment may provide better a surgical field for exposing and clipping aneurysms, and thus improve the safety and efficacy of surgical treatment of paraclinoid aneurysms.

To investigate the Contrast enhancement of intracranial atherosclerotic plaque for prediction of ischemic cerebrovascular events with high-resolution MR angiography (HRMRA).

The moderate to severe stenosis patients with symptomatic intracranial atherosclerosis admitted to Chinese PLA General Hospital and Beijing Tiantan Hospital, Capital Medical University from May 2008 to October 2012 were enrolled prospectively. All patients performed HRMRA after grouping, and the enhanced features of guilty vascular plaques were assessed. The occurrence of ischemic cerebrovascular disease was observed after one year regular medical treatment.

Forty-two patients were enrolled in the study, including 20 (47.6%) basilar artery stenoses and 22 (52.4%) middle cerebral artery stenoses, 23 (54.8%) cerebral infarction, and 19 (45.2%) transient ischemic attack (TIA). Four patients had TIA and 4 had cerebral infarction (event group) in one year. There were 34 patients in a non-event group. There were no significant differences in age, gender, risk factors for atherosclerosis, lesion vessels, and last event between the two groups (P>0.05). The time from the last symptom onset to HRMRA was 39.1±16.4 d and 25.0±15.6 d for the event group and the non-event group respectively (P=0.000). HRMRA revealed that 36 patients had plaque enhancement in guilty vessels in both groups, including 7 (87.5%) in the event group and 29 (85.3%) in the non-event group. There was no significant difference in the incidence of plaque enhancement between the two groups (OR, 1.00, 95% CI 0.07-13.87, P=1.00). Five patients had moderate enhancement and 2 had severe enhancement in the event group; 19 had moderate enhancement and 10 had severe enhancement in the non-event group. There was no significant difference in the comparison of enhancement degree between the two groups (OR, 1.32, 95 CI 0.22-8.04, P=0.77).

The plaque enhancement features in patients with moderate to severe intracranial atherosclerotic stenosis may not be the factors of influencing cerebrovascular events for a period of 1 year.

To analyze the risk factors for traumatic cerebral venous sinus occlusion (CVSO) and to investigate the strategies of early diagnosis of traumatic CVSO.

The clinical data of 240 patients with moderate to severe closed traumatic brain injury admitted to the Department of Neurosurgery, Fuzhou General Hospital of Nanjing Military Command from August 2011 to May 2013 were analyzed retrospectively. Logistic regression analysis was used to evaluate the risk factors for traumatic CVSO.

Of the 240 patients with traumatic brain injury, there were 40 patients with CVSO. They were divided into three types: CVSO of thrombotic type (CVSO typeⅠ), CVSO of compression type (CVSO type Ⅱ), and CVSO of mixed type (CVSO type Ⅲ). Skull fracture (OR, 8.03; 95% CI 3.11-20.73) and epidural hematoma (OR, 3.06; 95% CI 1.36-6.92)of crossing venous sinus were the risk factors for CVSO, and the former was more significantly correlated with CVSO. Female gender (OR, 10.31; 95% CI 1.72-61.94) was the risk factor for CVSO typeⅠ; epidural hematoma of crossing venous sinus (OR, 5.65; 95% CI 1.77-18.08) was the risk factor for CVSO type Ⅱ; and the previous history of vein thrombosis (OR, 11.28; 95% CI 1.32-96.66) was the risk factors for CVSO type Ⅲ.

In the early diagnosis of traumatic CVSO, the crossing venous sinus fracture line and epidural hematoma should be given attention. Attention should be paid to tracing the history of venous thrombosis. In addition, MR venography and CT venography contribute to early diagnosis of CVSO.

To investigate the surgical methods and efficacy of extracranial-intracranial (EC-IC) arterial bypass surgery for the treatment of giant anterior circulation aneurysms.

The clinical data of 11 patients with giant anterior circulation aneurysm treated with EC-IC artery bypass surgery at Sichuan Province People's Hospital from March 2010 to June 2014 were analyzed retrospectively. The vascular patency assessment was conducted by CT angiography and digital subtraction angiography (DSA). The selection of graft vessels, surgical methods, and clinical effect were investigated.

Seven patients used external carotid artery-great saphenous vein-middle cerebral artery M2 segment bypass, 2 used external carotid artery-radial artery-middle cerebral artery M2 segment bypass, and 2 used superficial temporal artery-middle cerebral artery M4 segment bypass. The grafted vessels were patent in 9 cases after procedure; the grafted vessels were occluded in 2 cases, and the proportion of vascular patency was 9: 11. One patient performed emergency superficial temporal artery-middle cerebral artery bypass, his blood vessel was occluded at day 3 after procedure. His contralateral limb was paralyzed after surgery and his muscle strength? was grade Ⅲ. One patient had vascular occlusion? at 6 months after surgery,? and he did not have any symptoms of nerve? function? defect. The follow-up period ranged from 6 months to 51 months (mean 18.3 months). The Glasgow outcome scale scores at 6 months after surgery: 10 patients were good (4-5), 1 was poor (3), and no patients died.

EC-IC arterial bypass surgery is a safe and effective method for the treatment of giant anterior circulation aneurysms. The detailed and individualized treatment scheme may improve the surgical results.

To evaluate the value of imaging classification of middle cerebral artery aneurysm on prevention of cerebral infarction during operation.

A total of 87 cases with 89 aneurysms were classified into 3 types according to the angiographical projections: type A with anterior-lateral projection in 52 aneurysms, type B with superior-posterior projection in 28 aneurysms and type C with inferior projection in 9 aneurysms. Eighty-six aneurysms were clipped, while the other 3 micro-aneurysms were coagulated and wrapped. All the lateral lenticulostriate arteries were well identified and protected.

According to Glasgow outcome score, 66 cases were 5, 5 cases were 4, 2 cases were 3 and 1 case was 1.

It was easier to identify and protect the lateral lenticulostriate artery and reduce the incidence of postoperative cerebral infarction by the guidance of preoperative imaging classification combined with the acknowledgement of the recurrent course of lateral lenticulostriate artery.

To investigate the correlation between the in-stent restenosis (IRS) and dominant blood supply side of this vertebral artery and its prognosis after stent angioplasty at vertebral artery origin in patients with cerebral ischemia.

A total of 52 patients treated with stent angioplasty at vertebral artery origin were collected from January 2008 to December 2013, and 54 balloon-expanding stents were implanted. The mean followed up time of the patients was 8.5 months after surgery. The correlation between IRS and the sides of diseased vertebral arteries and their prognosis were analyzed retrospectively.

The symptoms were improved in most patients after implantation of 54 stents. In the vertebral arteries of performing stent angioplasty, the diameters of normal arteries of the stent distal ends of the dominant blood supply (19 branches), the balance blood supply arteries (5 branches), and non-dominant blood supply sides (30 branches) were 4.78±0.86 mm, 4.05±0.67 mm, and 3.27±0.59 mm, respectively (P<0.01). IRS occurred in 13 stents, and they were all on the non-dominant blood supply sides (24.1%). The incidence of IRS on the non-dominance blood supply sides was 43% (13/30 branches). The preoperative and postoperative stenosis rates were 72.5±8.2% and 12.3±9.7% respectively in 13 lesions, the follow-up stenosis rate was 78.7±15.5%, and 2 of them had complete in-stent occlusion. After in-stent balloon dilatation, the follow-up stenosis rate was 25.7±6.1%.

The non-dominance blood supply side is more prone to IRS after stent angioplasty at vertebral artery origin. The prognosis is better for patients with IRS after balloon re-dilatation.

To summarize the technical points of the microcatheter loop technique for the treatment of intracranial aneurysms and to evaluate its feasibility and safety.

Nineteen patients with intracranial aneurysms treated with the microcatheter loop technique were analyzed retrospectively. Different loop techniques were selected according the locations of aneurysms and the anatomical features of the parent arteries. The narrow-necked aneurysms were embolized with simple coils and the wide-neck aneurysms and giant aneurysms were embolized with stents and coils.

Using the loop technique, 18 patients made the microcatheters into place smoothly, 16 performed intravascular loop. The target vessels of 4 patients were the M2 segment of middle cerebral artery, 4 were the A1 segment of anterior cerebral artery, 5 were posterior communicating artery, 2 were posterior inferior cerebellar artery, and 1 was anterior choroidal artery. Two patients performed intra-aneurysm loop, and they were all middle cerebral aneurysms. Solitaire stents were implanted in 12 patients, 6 underwent coil embolization alone. They recovered well after surgery. No loop-related complications were observed. One patient with middle cerebral artery aneurysm died after procedure because his intra-aneurysm loop failed and the aneurysm ruptured.

Microcatheter loop technique induces microcatheters into acute vessels that conventional techniques are difficult to access. It improves the success rate of aneurysm embolization; however, it has the risk of inducing aneurysm rupture. Intra-aneurysm loop is forbidden for the treatment of ruptured aneurysms.

The surgery of bilateral multiple intracranial aneurysms is difficult and the probability of postoperative complications is high. At present, the treatment of multiple intracranial aneurysms is still controversial^[1]。 We analyzed the clinical data of 11 patients with bilateral multiple intracranial aneurysms clipped by unilateral approach in the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2012 and December 2013. The results are summarized as follows.

To investigate the effect of age factor on clinical and biological characteristics and its complications in patients with Cushing's disease.

A total of 169 patients with Cushing's disease admitted to Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from September 2005 to October 2013 were analyzed retrospectively. Using the age of 30 as a standard, they were divided into either a ≤30-year group (n=51) or a >30-year group ( n=118). The differences in clinical symptoms, complications, various endocrine hormone levels, and other biochemical indicators of both groups were analyzed.

The incidences of hypertension, muscle atrophy, ecchymosis, and impaired glucose tolerance of the ≤30-year group were significantly lower than those of the >30-year group (all P<0.05), whereas the incidences of hirsutism, purple striae, and acne of the ≤30-year group were significantly higher than those of the >30-year group (allP<0.05); the mean level of plasma cortisol of the ≤30-year group was significantly higher than that of the >30-year group (P<0.05); the incidences of lipid metabolism disorders and hypokalemia of the >30-year group were significantly higher than those of the ≤30-year group (allP<0.05); the levels of TT3 and FT3 of the >30-year group were significantly higher than those of the ≤30-year group (allP<0.05); and the levels of TT3, TT4, FT4, and albumin were negatively correlated with age (r= -0.310, -0.191, -0.216, and -0.257; all P<0.05), and the levels of total cholesterol and low-density lipoprotein were positively correlated with age (r=0.211, 0.243; all P<0.05).

The clinical and biological characteristics of patients with Cushing's disease are closely associated with age.

To evaluate the application of neurophysiological monitoring in the second modified Foerster-Dandy's operation for the treatment of spasmodic torticollis during perioperative period.

Forty patients with severe spasmodic torticollis treated with the second modified Foerster-Dandy's operation were enrolled retrospectively. Direct electrical stimulation of anterior and posterior roots of spinal nerves was performed during the operation. The proportion of rhizotomy was selected according to the results of electromyography (EMG). Intraoperative somatosensory evoked potential (SEP) was used to monitor the integrity of spinal transduction pathway function. The efficacy was determined according to the EMG results of sternocleidomastoid, trapezius, and splenius capitis before and after surgery.

EMG showed that the turning numbers and amplitudes of sternocleidomastoid, trapezius, and splenius capitis after surgery were decreased compared with before surgery (P<0.01). The decreased degree of sternocleidomastoid was more significantly; the ratios of the turning number and amplitude of sternocleidomastoid were decreased (P<0.01), whereas the ratios of trapezius and splenius capitis did not change obviously. According to the results of intraoperative monitoring, the proportion of bilateral accessory neurectomy was 100%, anterior roots of C₁ was 80%-90%, anterior roots of C₂ was 60%-75%, posterior roots of C₂ was 10%-15%, anterior roots of C₃ was 45%-60%, and posterior roots of C₃ was 50%-70%. The intraoperative SEP amplitude and latency in 2 patients were decreased compared with the warning reference potential. They recovered after adjusting surgical operation mode or stopping operation. No postoperative spinal cord function injury was observed. The patients were followed up for 0.5-2.5 years. The remission rate was 92.5% (37/40) during follow-up period. The spasticity recurred in varying degrees in 3 cases.

The differences of EMG related parameters of the same spastic guilty muscle before and after surgery may objectively assess the efficacy of surgery. The intraoperative electrophysiological monitoring quantifies the proportion of neurectomy and avoids nerve injury. The intraoperative SEP monitoring may effectively reduce the possibility of high cervical cord injury.

To explore the changes of brain function activity under the resting state in patients with hemifacial spasm (HFS).

Thirty patients with HFS (HFS group) and 33 healthy controls (HC group) admitted to the Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine performed blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) examination from July 2013 to December 2013. The regional homogeneity (ReHo) method was used to analyze the differences of spontaneous brain activity between the two groups.

There were no significant differences in age, gender and years of education between the 2 groups. They had comparability. Compared with the HC group, the brain regions of the HFS group included the increased ReHo values of pons, posterior lobe of cerebellum and precentral motor area (adjusted AlphaSim, P<0.01). The largest difference voxel was in the precentral motor area, followed by posterior lobe of cerebellum, and the smallest difference voxel was pons, but the increased ReHo value of the latter was most significant (t=3.83); the ReHo values of the supplementary motor area, superior temporal gyrus, precuneus, middle frontal gyrus, and cingulate gyrus of the HFS group decreased (adjusted AlphaSim, P<0.01). The largest difference voxel and ReHo value was cingulate gyrus. (t=-3.69).

Under the resting state, brains involve in the activation of the cortices of facial muscle movement and the excitability of gray matter nuclei increase in patients with HFS, and the cortices involving in the inhibition of facial muscle movement have function weakening, these changes may involve in the pathological progress of HFS.

To investigate the clinical features and surgical treatment of spontaneous lateral sphenoid sinus recess cerebrospinal fluid rhinorrhea.

The clinical data of 22 patients with spontaneous lateral sphenoid sinus recess cerebrospinal fluid rhinorrhea from August 2003 to August 2014 were analyzed retrospectively. Nineteen of 22 patients underwent surgical repair via nasal and pterygoid process approaches under the endoscope and 3 underwent craniotomy repair.

Repair surgery succeeded once in 20 patients. After endoscopic and craniotomy repair, 2 patients relapsed (2 months and 3 days after repair) and they were repaired again successfully. After procedure, 9 patients had elevated intracranial pressure (verified by lumbar puncture). Of the 19 cases with endoscopic repair, 3 experienced postoperative intracranial infection; 2 had postoperative hemorrhage and they were cure with conservative treatment; 2 had facial numbness, and they relieved gradually after 3 months. The patients were followed up for 2 to 122 months (mean 36.3 months) and no recurrence was observed.

Spontaneous lateral sphenoid sinus recess cerebrospinal fluid rhinorrhea is a rare disease which has typical characteristics and needs to be treated by surgery. Surgical repair via pterygoid process approach under the endoscope is a minimally invasive, safe, and effective treatment modality.

Hydrocephalus and arachnoid cyst in children are common diseases in neurosurgery. Lateral ventricular-peritoneal shunt or arachnoid cyst-peritoneal shunt is widely used in clinical treatment because of its simple operation, less trauma and definite effect. However, a serious complication-shunt dependent syndrome (SDS) may occur after shunt surgery, which can lead to a sharp deterioration of the condition and even irreversible neurological impairment. So far, there are few reports on SDS at home and abroad. Clinicians often don't know enough about its clinical manifestations and imaging features, and sometimes it is difficult to diagnose and treat SDS. For this reason, this article collects 5 patients with SDS admitted to the Department of Neurosurgery of the First Affiliated Hospital of Fujian Medical University from January 2010 to March 2014, and summarizes their clinical manifestations, imaging features and treatment methods.

Chiari I malformation is a common congenital malformation in neurosurgery, and it is often complicated with syringomyelia. The choice of surgical method for such patients is still controversial. From July 2010 to December 2013, the Department of Neurosurgery, Provincial Hospital Affiliated to Anhui Medical University performed surgical treatment on 41 adult patients with Chiari Ⅰ malformation complicated with syringomyelia, and the curative results were satisfactory, which are reported below.

Acute subdural hematoma is caused by cerebral contusion, cerebral cortical arteriovenous hemorrhage and bridge vein rupture^[1]Surgery is a good treatment at present^[2]。 hemoglobin (Hb) was significantly higher in Tibetan plateau than in low altitude or plain area. The optimal concentration of Hb was 147 g/L^[3]While high Hb has obvious damage to multiple organs in the whole body, especially the nervous system^[4]。 The 115th Central Hospital of the People's Liberation Army is located in the plateau area. In this paper, 78 patients with acute subdural hematoma who underwent surgical treatment from January 2006 to December 2013 in the neurosurgery department of this hospital were selected to explore the influence and correlation of postoperative Hb on neurological recovery, which is reported as follows.

decompressive craniectomuy (DC) is an effective method for the treatment of patients with severe craniocerebral trauma and refractory intracranial hypertension^[1]。 Intraoperative controlled decompression can effectively reduce the incidence of intraoperative acute encephalocele and postoperative cerebral infarction^[2,3,4,5]。 From January 2012 to December 2013, 49 patients with severe craniocerebral trauma underwent emergency decompression craniectomy in our department, of which 24 patients underwent progressive controlled decompression with intracranial pressure (ICP) monitoring during the operation, and compared with patients undergoing conventional decompression craniectomy at the same time, which is reported below.

With the gradual popularization of endoscopic skull base surgery, the advantages of neuroendoscopy in skull base tumor surgery are gradually recognized by the industry^[1,2]。 Nowadays, neuroendoscopic surgery can not only solve the space-occupying lesions in the sella turcica, but also complete the resection of lesions from the ethmoid-sellar-slope and even the odontoid level in the anterior frontal sinus group. When the tumor invades the subdural or the surgical operation involves intraarachnoid operation, how to effectively repair the defective skull base dura to avoid the occurrence of postoperative cerebrospinal fluid leakage has always been the key to the success or failure of neuroendoscopic surgery. Traditional methods of muscle fat tamponade combined with bio-glue repair are not very effective^[3]。 From March 2012 to January 2014, our department adopted the internationally respected skull base attachment technique with pedicled nasal septal mucosal flap to repair the defective skull base^[4]。 In this paper, 15 typical cases were reviewed and summarized to explore the anatomy of the pedicled nasal septal mucosal flap under neuroendoscopy (the posterior branch of the sphenopalatine artery) and its application prospect in endoscopic skull base surgery.

extraventricular neurocytoma (EVN) is a rare intracranial tumor. In 2007, WHO classified neuroepithelial tumors into one category independently. After searching by Pubmed and Wanfang databases, nearly 300 cases have been reported worldwide. From January 2000 to January 2014, 9 cases of central neurocytoma were treated in the Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, including 3 cases of EVN. The diagnosis and treatment experience is reported as follows in combination with the literature review, aiming to further improve the understanding of this disease.

To screen the proteins associated with the degree of bone invasion in clivus chordomas.

A total of 35 tumor specimens of patients with clivus chordoma originated from the spheno petrosal junction were collected. Twelve specimens of isobaric tags for relative and absolute quantitation (iTRAQ) proteomics experiment (experimental group) were performed, 23 were validated by immunohistochemical staining (validated group). According to the classification criteria of bone invasive degree, they were classified into endophytic type (Type Ⅰ) or exophytic type (Type Ⅱ) (n=6 in each group) in the experimental group. Type Ⅰ and type Ⅱ in the validated group were 10 and 13 specimens respectively. The iTRAQ technique was used for the detection of the difference proteins. Panther software was used for functional analysis of gene ontology (GO). IPA software was used for protein pathway and network analysis.

A total of 2251 proteins obtained quantitative identification results, 250 proteins had difference expression in typeⅠand type Ⅱ clivus chordomas. Compared with type Ⅱ, 59 proteins were up-regulated and 191 were down-regulated in type Ⅰ. There was significant difference in the expression levels of chordomas cells of the mammalian target of rapamycin (mTOR) pathway between the type Ⅰ and type Ⅱ chordoma cells (P<0.01). The inflammatory activity-associated protein expression of type Ⅰ enhanced. The expression levels of extracellular matrix proteins and cytoskeletal proteins were lower than those of type Ⅱ. Molecular network analysis suggested that the expression levels of transforming growth factor beta 1 (TGFβ1) of regulating the cell matrix protein and cytoskeleton protein expression were low. Immunohistochemistry showed that the expression positive rates of TGFβ1, phosphatase and tensin homolog deleted on chromosome ten (PTEN) in the validated group were 95.6% (22/23) and 69.6% (16/23). Compare with type Ⅰ, the expression intensity of type Ⅱ chordoma TGFβ1 and PTEN was high (P=0.033, P=0.004); the positive expression rate of mTOR in the validated group was 80.7% (20/23). There was no significant difference in the positive expression rate between the type Ⅰ and the type Ⅱ (P=0.092).

TGFβ1 may play an important role in bone invasion of upper-middle clivus chordoma. The mechanisms may be associated with its mediating increased inflammatory cell response and the decreased expression of cytoskeletal proteins. The PI3K-AKt-mTOR signal pathway may be associated with the pathogenesis of bone invasion of chordoma, however, mTOR protein itself may not be associated with the bone invasion degree of chordoma. The expression level of PTEN may be associated with the bone invasion degree of chordoma.

To investigate the folate receptor-targeted cytarabine (FR-Ara-C) for the proliferation inhibition and apoptosis promotion effect of the Daoy medulloblastoma cell lines.

The immunofluorescence and confocal laser scanning techniques were used to detect the expression of folate receptors-α (FRs-α) in Daoy cell lines. Methyl thiazolyl tetrazolium (MTT) colorimetric method was used to detect the proliferation inhibition rate after different concentrations (0.5-100.0×10^-3 mmol/L FR-Ara-C and ordinary cytarabine [Ara-C]) acting on Daoy cells at different times (2-24 h) and their differences were compared. The group with the most obvious difference was selected for conducting AnnexinV-FITC/PI apoptosis detection.

FRs-α expressed in both Daoy cell membrane and nucleus. When the same concentration of FR-Ara-C and Ara-C acted on Daoy cells at different times, the proliferation inhibition rate of FR-Ara-C was higher than that of Ara-C. There was significant difference (P<0.05); when the different concentrations of FR-Ara-C and Ara-C acted on Daoy cells at the same time, the proliferation inhibition rate of FR-Ara-C was higher than that of Ara-C. There was significant difference (P<0.05); when FR-Ara-C acted on for 8 h, the increased inhibition rate was most obvious compared with the Ara-C effect, 50% concentration of inhibition (IC50) at this time point was the optimal action concentration. Flow cytometry analysis showed that when 50×10^-3 mmol/L concentration of FR-Ara-C and Ara-C acted on for 8 h, the apoptosis rates were 92.8±2.3% and 62.3±1.5%; when 10.0×10^-3 mmol/L concentration of FR-Ara-C and Ara-C acted on for 8 h, the apoptosis rates were 87.1±2.4% and 44.7±1.7%; when the concentration was the same, the apoptosis rate was significantly higher than that of Ara-C after the action of FR-Ara-C. There was significant difference (P<0.05).

FR-Ara-C has more significant proliferation inhibition and apoptosis promotion effect on medulloblastoma in vitro.

To compare the differences of microRNA (miRNA) expression profile of multiple and solitary gliomas in formalin-fixed and paraffin embedded (FFPE) tissue and to preliminarily investigate the possible roles in glioma invasion and migration for the significantly different miRNA and its target genes.

FFPE specimens in patients with multiple glioma (n=6) and solitary glioma (n=6) were selected. The total RNA was extracted and detected; the gene chip technology was used to detect miRNA expression profile. The chip analysis software was used to analyze the data of the results. The miRNAs of significant expression differences of the multiple and solitary gliomas were screened. Then the biological information database was used to predict the target genes of miRNA of the most significant expression differences.

The total RNA quality extracted from all the FFPE tissue specimens met the standard of quality control. There were significant differences in 128 different miRNAs in the multiple glioma compared with the solitary glioma (multiple >5 or <0.5), and ten of them were significantly upregulated (multiple >50), they were miR-21, miR-455, miR-199, miR-410, miR-148a, miR-335, miR-34b, miR-664a, miR-542, and miR-4453, respectively. Five miRNAs were significantly downregulated (multiple <0.05), they were miR-200a, miR-451, miR-29a, miR-101, and miR-96. Based on the most significant prediction results of the miR-21 and miR-200a target genes of upregulation and downregulation, their multiple target genes involved in tumor invasion and migration related biological function.

FFPE tissue may meet the subsequent experimental study, such as miRNA chip, etc. and thus provide rich resources for the research of the miRNA biological function and exploration. Multiple glioma has differential expression of miRNA compared with solitary glioma, in which miR-21and miR-200a may be closely associated with the invasion and migration of glioma.

With the improvement of national requirements for biomedical innovation ability, carrying out high-level standardized clinical research and clinical trials is the main demand to ensure innovation ability. China has abundant case resources, and at present, there are an increasing number of clinical research projects independently designed or participating in international cooperation. How to improve the management level of large-scale clinical research and get international recognition is a major issue that we are facing. Clinical trials or clinical studies in China often fall into three categories: The first category is clinical studies sponsored, designed and managed by medical institutions supported by national government departments. This kind of research is mostly purely academic research, with the participation of sub-centers (hospitals). A third-party company, a contract research organization (CRO), is typically requested to assist in project management. The second category is clinical trials managed by pharmacological bases, which are initiated and supported by biomedical companies, approved by the State Food and Drug Administration, and entrusted to medical institutions to design and manage. It also includes some clinical trials initiated abroad. The third category is horizontal joint projects, initiated by medical institutions or pharmaceutical companies, mostly academic research, such as post-marketing research on drugs. In view of the common problems in the process of clinical research project management, I put forward the following suggestions based on my experience in the clinical research management of the national "major new drug creation" project:

Microvascular decompression (MVD) has been widely used as a treatment for trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia, but the translated name of MVD is very confused in the Chinese literature. The most used Chinese name now is "microvascular decompression", which obviously comes from the literal translation of English, while "microvascular" in the Chinese name means something else, which does not have the same meaning as the English microvascular. MVD actually refers to neurovascular decompression under microscopic manipulation. So, is the responsible blood vessel of MVD microvessel? Obviously not!

Brain stereotactic technique is a common neurosurgical technique that uses stereotactic principle to accurately locate intracranial structures in space. It is also the basic technique of deep brain electrical stimulation, intracranial space-occupying biopsy, stereotactic hematoma aspiration, etc. It has become one of the most important locating methods in functional neurosurgery^{[1,2,3,4,5,6,7,8,9]}。 In recent years, foreign scholars have successfully carried out stereotactic hippocampal amygdala damage surgery by combining it with computer navigation technology, high-resolution magnetic resonance technology, intraoperative real-time magnetic resonance technology, radio frequency technology and damage prediction system, which has been used to treat temporal lobe epilepsy and other diseases, and obtained satisfactory therapeutic effect^[10,11,12]。 In this paper, the principle, application, therapeutic effect and complications of this technique are reviewed.

glioma-CpG island methylator phenotype (G-CIMP) is a newly proposed concept that characterizes the abnormal hypermethylation of the promoter CpG island in glioma from a genome-wide perspective. G-CIMP can be found in most WHO grade II and III gliomas and secondary glioblastomas, and has potential clinical application value for the prognosis and molecular classification of gliomas. The research progress of G-CIMP is reviewed.

The clinical manifestations of Parkinson's disease (PD) include motor symptoms and non-motor symptoms. In addition to traditional motor symptoms, dyskinesia caused by long-term administration of levodopa, namely drug-induced dyskinesia and levodopa-induced dyskinesia (LID), can also appear gradually with the progression of the disease. dyskinesia in PD patients can occur after long-term use of dopa preparations or can be generated by electrical stimulation of the implanted brain pacemaker, which is called stimulation-induced dyskinesia (SID). Patients with LID or SID accounted for 15% of all patients. It has been observed that most patients after DBS can still not completely stop taking levodopa. Therefore, a comprehensive review of LID and SID of PD patients is presented to provide medication or surgical recommendations for clinical patients with dyskinesia.

Papilledema is a type of disease in which the optic disc is passively swollen due to increased intracranial pressure. Increased intracranial pressure is a common clinicopathological syndrome of many craniocerebral diseases, and it is an important cause of death caused by neurosurgical diseases^[1]。 Intracranial tumor, craniocerebral trauma, intracranial infection, cerebrovascular disease and some unknown causes can lead to increased intracranial pressure. Because the treatment of intracranial hypertension is mainly aimed at the etiology, while the etiology and pathogenesis of idiopathic intracranial hypertension are still unclear, the treatment is different from other intracranial hypertension with clear etiology. This article only focuses on the progress of surgical treatment of papilledema caused by unexplained intracranial hypertension.

Carotid artery stenosis is a major risk factor for ischemic stroke^[1,2]Which can result in hypoperfusion cerebral infarction or arterial-arterial embolic cerebral infarction^[3]And the risk of ipsilateral stroke increases with the degree of internal carotid artery stenosis^[4,5]。 carotid artery stenting (CAS) has been developed with its minimally invasive advantages^[6]。