Volume 31 · Issue 06 · 2015

Intracranial aneurysm is a disease that seriously endangers people's health. The incidence rate in healthy people can be as high as 4% ~6%. Although great progress has been made in diagnosis and treatment, once an aneurysm ruptures, its disability rate and mortality rate are still very high, and the total mortality rate of this disease is about 40% ~50%. Therefore, the early detection and treatment of intracranial aneurysm is very important for the prevention and treatment of cerebrovascular disease.

To investigate the clinical features and endovascular treatment of pediatric intracranial aneurysms.

The clinical data of 35 consecutive children (≤18 years) with intracranial aneurysm (37 aneurysms) admitted to Intervention Center, Beijing Neurosurgical Institute, Capital Medical University and treated with endovascular treatment from January 2001 to December 2012 were analyzed retrospectively. The imaging characteristics, clinical characteristics, endovascular treatment modalities and immediate results of embolization in 35 children were analyzed and summarized. All 35 patients underwent endovascular treatment. Of the 37 aneurysms, 13 (35%) were treated with coil treatment alone, 8 (22%) were treated with stent assisted coil embolization, 3 (8%) were treated with stents alone, 1 (3%) was treated with balloon-assisted therapy, 6 (16%) were treated with parent artery occlusion alone, and 6 (16%) were treated with parent artery occlusion and coils.

Of the 35 children, 30 (86%) were males, 5 (14%) were females (male∶female=6∶1); there were 15 (41%) anterior circulation aneurysms and 22 (59%) posterior circulation aneurysms (anterior circulation∶posterior circulation=1.00∶1.47); there were 15 (41%) large aneurysms (diameter 10-25 mm) and 7 (19%) giant aneurysms (diameter ≥25 mm). There were 29 (78%) complex aneurysms. Twelve patients had (34%) subarachnoid hemorrhage. Immediate postoperative angiography showed aneurysm embolization. Raymond classification showed that 24 aneurysms (65%) were grade I, 8 (22%) were grade Ⅱ, and 5 (13%) were grade Ⅲ. They were followed up for 3 to 32 months after surgery. Glasgow outcome scale (GOS) and imaging examination were used to evaluate prognosis.Thirty children were followed up with angiography after endovascular treatment and 4 (13%) relapsed. Thirty-two children were followed up by telephone. GOS assessment showed that the postoperative recovery was good in 20 children, 8 had moderate disability, 3 had severe disability, 1 was in a vegetative state, and no one was dead.

Pediatric intracranial aneurysms have male predominance. They often occur in complex aneurysms, such as posterior circulation, large and giant, traumtic, dissection, fusiform, and irregularly aneurysms. The effect of endovascular treatment and prognosis are good.

To investigate the technical methods of embolization of multiple wide-necked intracranial aneurysms on the same artery by using single Solitaire stent assistance in order to provide the clinical support for the minimally invasive treatment of intracranial multiple wide-necked aneurysms.

In patients with multiple aneurysm on a single parent artery, 15 patients with wide-necked aneurysms admitted to the Department of Neurosurgery, Qilu Hospital of Shandong University and the Department of Neurosurgery, People's Hospital of Xinjiang Uygur Autonomous Region from June 2011 to February 2014. Seldinger technique was used for the placement of needle sheaths in femoral artery, the different specifications of Solitaire stents were selected according to the aneurysm neck, distance between the two aneurysms, and the diameter of parent artery. Using the methods of preset stent catheters and embolizing micro-catheters, a single stent covered 2 wide-necked aneurysms on the same parent artery. Microcoils were used to embolize the aneurysms under the assistance of stents.

A total of 15 patients with wide-necked intracranial aneurysms in this group, including 8 in anterior circulation and 7 in posterior circulation. Stent implantation was satisfactory in all patients during the procedure. The aneurysms of 11 patients were embolized completely, 3 had a little residue on aneurysm necks, a part of microcoil in 1 case escaped from a stent during the procedure, 1 occurred thrombosis during the procedure and it was recanalized immediately after thrombolytic treatment. The patients were followed up after 6 months, 12 performed head CTA or DSA examinations, 2 relapsed on the neck, and 1 was reembolized.

Using single Solitaire stent-assisted microcoil embolization of the multiple wide-necked intracranial aneurysms in the same parent artery has the advantages of minimally invasive, easy to operate, and curative effect. It provides an effective option for the minimally invasive treatment of multiple intracranial wide-necked aneurysms.

To investigate the methods and efficacy of microsurgical treatment of complex middle cerebral artery (MCA) aneurysms.

The clinical data of 32 patients with complex MCA aneurysm admitted to Tianjin Huanhu Hospital from January 2011 to January 2014 were analyzed retrospectively. The aneurysm diameter was 24.3 ± 6.3 mm. The aneurysms of 8 patients were located in the M1 segment of MCA (5 proximal aneurysms and 3 distal aneurysms), 15 at the MCA bifurcation, 9 at the M2 segment and distal end.

The aneurysms of 15 patients were clipped directly, 6 had aneurysm resection of parent artery for remodeling, 2 had extra- and intra-cranial arterial bypass assisted aneurysm clipping, and 9 had extra- and intra-cranial arterial bypass and aneurysm trapping. Postoperative recovery was good (Glasgow outcome scale [GOS] Ⅳ-Ⅴ) in 25 cases (78.1%) and poor in 6 cases (18.8%). Five patients had good recovery at discharge, 1 had severe disability (GOS Ⅲ), and 1 died (3.1%). Twenty-five patients were followed up for 6 to 36 months (mean 18 months) and 6 were lost to follow up. None of the 25 patients had aneurysm rebleeding. The GOS score of 22 patients was Ⅴ, 2 was Ⅳ, and 1 was Ⅲ at the last follow-up. After procedure, DSA or CTA of 26 patients showed that the aneurysms of 21 patients disappeared completely, 4 had aneurysm partial residue (no further treatment), and 1 did not have obvious change after aneurysm trapping. The anastomotic vessels were patent in 11 patients treated with extra- and intra-cranial bypass and 4 treated with parent artery remodeling.

Direct surgical clipping is still an important means for the management of complex MCA aneurysms, and for those whose aneurysms can not be clipped directly, parent artery reconstruction or extra- and intra-cranial vascular bypass can be performed. The efficacy of microsurgery for the treatment of complex MCA aneurysms is good and its recurrence rate is low.

To assess the roles of 3D-CTA in the clinical diagnosis of intracranial anterior circulation aneurysm.

The 3D-CTA, 3D-DSA and operation data of 322 patients with anterior circulation aneurysm admitted to the Department of Neurosurgery, the Affiliated Hospital of Xuzhou Medical College from June 2004 to June 2014 were analyzed retrospectively. 3D-CTA in 8 patients showed unclear and had to perform 3D-CTA examination; and 35 patients were examined by using 3D-CTA after procedure. Four processing techniques of 3D-CTA image were used, including multi-planar reconstruction (MPR), maximum signal intensity projection (MIP), volume rendering (VR), and virtual endoscopy (VE).

3D-CTA revealed 317 aneurysms in 314 patients (3 were multiple aneurysms). 3D-CTA showed unclear in the other 8 patients and it clearly showed the aneurysms after they performed 3D-DSA examination. Three hundred twenty-two patients were treated with craniotomy and microsurgical clipping of aneurysms. Surgery and imaging results were consistent. 3D-CTA showed that the aneurysms of 35 patients were clipped completely at 6 month after procedure.

3D-CTA is a highly sensitive non-invasive imaging means for detecting intracranial aneurysms. It can be used as the first choice of imaging diagnosis for aneurysms. 3D-CTA negative patients with subarachnoid hemorrhage should perform DSA examination in order to avoid misdiagnosis. 3D-CTA examination can be used as the preferred method for follow-up after surgery.

To compare and study therapeutic effect and related complications of the right-side craniotomy and conventional dominant-side craniotomy clipping of anterior communicating artery aneurysms and the related complications.

A total of 112 patients with anterior communicating artery aneurysm admitted to the Department of Neurosurgery, Guizhou Provincial People's Hospital from January 2009 to March 2013 were randomly divided into two groups, including a right-side craniotomy group (n=58) and a dominant side craniotomy group (n=54). The former did not consider the anterior cerebral artery predominance, all patients were treated by using the right side craniotomy for aneurysm clipping; the latter considered the conditions of bilateral anterior artery and decide craniotomy clipping on the dominant sides. The patients were followed-up for a mean of 22.1±8.3 months.

There were no significant differences in delayed cognitive dysfunction, intraoperative blood loss, mean hospitalization days, and hospital costs between the two groups (P>0.05); however, transient aphasia was more common in the dominant side craniotomy group. The exposure time and operative time of right-side craniotomy group were longer (P<0.05). The patients with hemiplegia were not found in both groups. CTA or DSA examination after procedure showed that all the anterior communicating artery aneurysms disappeared.

The right-side craniotomy for clipping of the anterior communicating artery aneurysms is not only technically feasible, but also has fewer complications. Therefore, it is worth considering as the conventional surgical sides for the treatment of anterior communicating artery aneurysms.

To analyze the risk factors for posterior communicating artery (PCoA) aneurysm rupture from the clinical and morphological aspects.

Consecutive patients with single PCoA aneurysm admitted to hospital from January 2011 to December 2013 were analyzed retrospectively. The clinical data and imaging characteristics were analyzed with univariate analysis and multivariate logistic regression analysis.

Univariate analysis indicated that there were significant differences in the rupture rate of PCoA aneurysms in the history of hypertension (χ²=23.013, P=0.000) , aspect ratio (AR) ≥1.5 (χ²=8.492, P=0.004), directions of different aneurysm tops (χ²=15.057, P=0.002), and aneurysm blebs (χ²=18.952, P=0.000) between the two groups. The results of multivariate logistic regression analysis were the history of hypertension (OR, 13.240, P=0.000), presence of aneurysm blebs (OR, 12.933, P=0.001), age less than 60 years (OR, 3.766, P=0.010), AR ≥1.5 (OR=4.997, P=0.001), and posterior-inferior-lateral directions of aneurysm tops (OR, 7.584, P=0.038).

The history of hypertension, presence of aneurysm blebs, age less than 60 years, AR ≥1.5 and posterior-inferior-lateral directions of aneurysm tops were the risk factors for PCoA aneurysm rupture.

To investigate the clinical imaging features and methods of endovascular embolization of moyamoya disease with intracranial blood flow-related aneurysms.

The clinical features, imaging features and endovascular embolization treatment of 7 patients with moyamoya disease and intracranial aneurysm diagnosed by digital subtraction angiography (DSA) were analyzed retrospectively. Two of them underwent ventricular drainage after embolization, 1 underwent roofing of temporal muscle, and 1 underwent extra- and intra-cranial vascular bypass and roofing of temporal muscle.

Five of 7 patients showed subarachnoid hemorrhage, 2 showed cerebral parenchymal hemorrhage broken into ventricles; of the 7 patients with 8 aneurysms, 6 were the main artery aneurysms and 2 were peripheral artery aneurysms. They were all treated with endovascular embolization. The clinical symptoms of the patients had different degrees of recovery or improvement, 5 of them could work and learn normally, 1 had mild hemiplegia, but he could take care of himself, 1 patient had severer lower limb movement disorder on one side and he could almost take care of himself. No recurrence and new aneurysms were found after following up with DSA.

Blood flow-related aneurysms cause by moyamoya disease may result in different types of clinical and imaging manifestations. Endovascular technique is an effective method for the treatment of blood flow-related moyamoya disease.

Traumatic extracranial internal carotid artery pseudoaneurysm is a serious complication of head and neck trauma, which is often life-threatening due to its rupture and bleeding, and can also lead to thrombosis and ischemic stroke^[1]。 Traditional surgical repair treatment has some difficulties, and ligation of diseased blood vessels often leads to obvious disability or even death^[2]。 Covered stent, as a new type of intravascular intervention material, can be placed into the blood vessel to cover the lesions and relatively abnormal migrating parts, and isolate the vascular lesions from the blood flow, which provides a new choice for the treatment of traumatic extracranial internal carotid artery pseudoaneurysm^[3]。 From January 2008 to December 2011, the Department of Neurosurgery, Wuhan General Hospital, Guangzhou Military Region, treated 5 cases of traumatic extracranial internal carotid artery pseudoaneurysm with covered stent placement, and the results were satisfactory.

Complex intracranial aneurysms are mainly aneurysms that are difficult to be treated by surgery due to special reasons such as growth site, growth mode, neck width and tumor size. Microsurgery is one of the main methods for treating complex intracranial aneurysms^[1]。 Due to the complexity of aneurysms, they remain a great challenge for neurosurgeons. In recent years, the application of intraoperative CT in neurosurgery has been reported^[2,3]。 This article summarizes the application of CT perfusion imaging (PCT) in the surgical treatment of 8 cases of complex intracranial aneurysm in the Department of Neurosurgery of the People's Liberation Army General Hospital from March 2012 to February 2013, and discusses the application value of intraoperative PCT in the surgery of complex intracranial aneurysm.

With the development of neurointerventional technology and material science, the role of stent in the treatment of intracranial wide-neck aneurysm has become more and more prominent, and intracranial self-expanding stent has played a pivotal role. At present, according to the different design of stent grid, there are mainly two types of self-expanding intracranial stents: one is an open grid stent; The other is a closed grid bracket.

To investigate the operation strategies and clinical prognosis of the different pathological types of intramedullary tumors.

The clinical data of 178 patients with intramedullary tumor whose tumors were resected by microsurgery under the neural electrophysiological assistance at the Department of Neurosurgery, Tianjin Medical University General Hospital from June 2000 to August 2013 were analyzed retrospectively. Klekamp-Samii (KS) score was used to evaluate the spinal cord function before and after procedure. The follow-up time ≥18 months and surgical resection and recurrence in the patients with different pathological types were evaluated.

In 178 patients, the symptoms of 142 were improved at 6 months after procedure, 28 did not have any change, and 8 aggravated. In addition astrocytoma, the KS scores of spinal cord function of other types of tumors at six months after surgery were improved significantly compared with before surgery. There was significant difference (P<0.05). The follow-up time of 157 patients were ≥18 months (18 to 78 months, mean 46.6±5.4 months). In 157 patients, 95 were resected totally, 1 (1.1%) had recurrence, 44 were nearly resected totally, and 5 (11.4%) had recurrence; 18 were resected partially and 17 (94.4%) had recurrence. Sixty-eight of them had ependymoma and 68 were resected totally, and none of them had recurrence. Nineteen patients had astrocytoma, 5 were resected totally, and one had recurrence; 14 were resected partially and all had recurrence; 19 had lipoma, 17 were nearly resected totally, and none of them had recurrence; 2 were resected partially and all had recurrence. A total of 22 patients had hemangioblastoma, cavernous hemangioma, hemangioma, hemangiopericytoma, and intestinal cyst, all were resected totally, none of them had recurrence; 15 had epidermoid cyst, all were nearly resected totally, and 3 had recurrence; 14 had dermoid cyst, 12 were nearly resected totally, and 2 had recurrence; 2 were resected partially and one had recurrence.

Micrographic surgery is safe and effective for the treatment of intramedullary spinal cord tumors. The histological types of the tumors and the range of tumor resection are the important reasons for the decision of the medium- and long-term efficacy.

To investigate the efficacy of transsphenoidal endoscopic surgery for acromegaly.

The clinical data of 210 consecutive patients with acromegaly operated with transsphenoidal endoscopic surgery from January 2007 to January 2014 were analyzed retrospectively. The patients with preoperative higher surgical risk used long-acting somatostatin analogue octreotide. Surgery was conducted in combination with intraoperative high field magnetic vesonance imaging and neuronavigation, postoperative head MRI and endocrine were followed up, including biochemical indicators, such as growth hormone and insulin-like growth factor-1. The patients with residual tumor and without remission of endocrine chose octreotide or radiosurgery according to the specific situation.

There were 129 males and 81 females, their age ranged from 21 to 67 years old (mean 40.7 years). Preoperative MRI revealed that the maximum diameter of the tumors in 183 patients (87.1%) was >1 cm. Three patients were treated with octreotid before procedure. The tumors of 171 patients (81.4%) were resected completely, 22 (10.5%) were resected subtotally, and 17 (8.1%) were resected partially. There were no procedure-related deaths in this group. Postoperative achieved endocrine remission in 148 cases (70.5%). The average growth hormone level before procedure was decreased from 27 ng/mL (range 4 to 150 ng/mL) to 5 ng/mL (range 0 to 32 ng/mL) after procedure. A total of 184 patients were follow-up for 3 to 84 months (mean 27.5 months). During the follow-up period, the subjective symptoms of 161 patients (87.5%) were improved and returned to the daily work and study. In patients who had residual tumors and did not achieve endocrine remission after procedure, 34 were treated with octreotide after procedure and 29 accepted radiosurgery.

Transsphenoidal endoscopic surgery is the preferred treatment option for acromegaly. Patients should regularly examine the head MRI and endocrine after procedure. The treatments of octreotide and radiosurgery may control the residual tumors and improve endocrine.

To explore the neuroendoscopic application in the surgical treatment of thalamic gliomas.

A total of 10 patients with thalamic glioma between December 2009 to December 2013 in Beijing Shijitan Hospital, Capital Medical University were retrospectively analyzed. The 10 cases include 5 cases of medial type, 3 cases of anterior type and 2 cases of abdominal rear type.The operations were performed by using neuroendoscope under the neuronavigation guidance. All the cases were followed up and measured by the Karnofsky performance scale(KPS).

Six cases were totally removed, 3 cases were subtotally removed and 1 case underwent biopsy.2 cases suffered hemiparesis and speech difficulty after operation but recovered within 3 months.2 cases with hemiplegia improved significantly, KPS score increased from 60-70 before operation to 80-90 after operation.1 case was performed reoperation because of tumor cavity effusion.6 cases received postoperative radio-chemotherapy, 1 case was treated without any other therapy, 3 cases were regularly followed up.All cases were followed up from 3 months to 1 year, 1 case died of recurrence, KPS score of other patients increased after operation.

A portion of thalamic gliomas could be effectively removed by using neuroendoscope under the neuronavigation guidance and the incidence of postoperative neurological dysfunction could be reduced.

To investigate the clinical features and efficacy of interstitial radiotherapy for giant posterior fossa cystic craniopharyngiomas (GPFCCPs).

Twenty-six children with GPFCCP admitted to Navy General Hospital in nearly 13 years were analyzed retrospectively, and the related literature reports were reviewed comprehensively. There were 12 females and 14 males. Their age ranged from 3 months to 14 (mean 7.2) years old. The clinical manifestations were stunted body development (n=6), increased intracranial pressure (n=21), decreased visual acuity (n=22), other brain nerves damage (n=19), and polydipsia and polyuria (n=3). The tumor volume ranged from 65 to 215 mL (mean 137.3 ml). The children accepted radioisotope ³²P interstitial radiotherapy and were followed-up for 8 to 144 months (mean 52.5 months) after cyst fluid aspiration or drainage.

A total of 27 surgical procedures were performed and 33 cysts were treated. The intracranial hypertension symptoms of 21 children were relieved immediately after procedure. The tumors completely disappeared in 16 children (19 tumors), the volume of 10 children (14 tumors) was reduced by >75%. In. 22 children with visual loss, 8 were recovered completely, 10 improved, 2 unchanged, and 2 aggravated. In other 25 brain nerves damage, 22 were recovered completely, and 3 unchanged. No serious complication associated with surgical operation and interstitial radiotherapy was found. Seven new cysts were found in 5 children. After repeated treatment, 4 cysts were disappeared completely, 2 reduced significantly, and 1 progressed.

GPFCCPs is a rare tumor type. It is more common in children without sex differences. The major clinical manifestations are increased intracranial pressure and brain nerves damage. Despite the huge volume of tumor, the interstitial radiotherapy of radioisotope still can achieve a relatively ideal tumor control rate, clinical efficacy and quality of life, and the incidence of complications is lower.

To investigate the working memory and attention impairment in adult patients with moyamoya disease.

Forty-eight adult patients with moyamoya disease admitted to the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from April 1, 2014 to September 15, 2014 were enrolled, and the age, sex, education, social background matched 48 normal healthy controls were also enrolled at the same time. N-back and sustaining attention reaction test (SART) were used to assess the visual-spatial working memory and sustained attention of the participants.

(1) The N-back test: the moyamoya disease group compared with the control group, the accuracy rates in the 0-back test were 0.89±0.18 and 0.98±0.04 respectively; the mean response times (RT) were 572±123 and 466±95 ms respectively; the accuracy rates in the 1-back test were 0.55±0.23 and 0.72±0.20 respectively; RT were 763±232 and 750±202 ms respectively; the accuracy rates in the 2-back test were 0.36±0.15 and 0.53±0.22 respectively; RT were 714±312 and 865±282 ms respectively; in addition to RT of 1-back, there were significant differences in other indicators (P<0.05). (2) The SART test: the moyamoya disease group compared with the control group, the hit rats were 0.88±0.19 and 0.98±0.03 respectively; and RT were 458±112 and 382±91 ms respectively. The correct rejection rates were 0.64±0.23 and 0.76±0.25 respectively, and there was significant difference (P<0.05).

Adult patients with moyamoya disease had the visual-spatial working memory and sustaining attention impairment.

To analyze the efficacy and experiences of the diagnosis and treatment of Cushing's disease with a multidisciplinary team.

Forty-five patients with Cushing's syndrome treated under the MDT diagnosis and treatment process mode at Shanghai Huashan Hospital, Fudan University from January to December 2013 were analyzed retrospectively. Among the 45 patients, 22 underwent bilateral inferior petrosal sinus blood sampling, and 40 were diagnosed as Cushing's syndrome. Macroadenomas, microadenomas, and MRI negative were 8, 26, and 6, respectively, 3 of them were invasive. Thirty-two patients were newly diagnosed, 8 relapsed or did not relieve after the first treatment.Their diagnosis, management, efficacy, and room for improvement were summarized.

Thirty-three patients with Cushing's disease received neurosurgery, 32 had transnasal surgery and 1 underwent craniotomy. There was significant difference in the lowest values of serum cortisol at 1 week before and after surgery (869±361 and 60±41 nmol/L respectively;P<0.01). Twenty-two patients had early remission, and 25 had overall remission (76%) at 3 months after surgery; the remission proportions of macroadenoma, microadenoma, MRI negative, and invasive pituitary adenoma were 6/6, 14/18, 3/6, and 2/3, respectively. Of the patients who relapsed or did not relieve after treatment, 6 were reoperated, and 4 were relieved. Of the 27 patients with adrenocorticotropic hormone (ACTH) tumor and 6 with hyperplasia or glandular tissue, 25 and 0 were relieved. Of the 8 patients who were not relieved after surgery, 2 were enrolled into the new drug research of pasireotide, 3 were treated with gamma knife, 1 began to be treated with metyrapone, 1 was waiting for reoperation, and 1 was lost to follow-up. Seven patients had surgical complications.

The factors affecting surgical treatment of Cushing's disease include the pituitary imaging and pathological features, etc. Under the MDT mode, the diagnosis and treatment help patients to timely choose the optimal treatment regimen.

To investigate the comprehensive treatment and prognosis of primary intracranial choriocarcinoma of familial tendency.

Two whole sisters admitted to the Department of Neurosurgery, Yuquan Hospital, Tsing Hua University in June 2013 and confirmed as primary choriocarcinoma in sellar region by pathology were summarized. Their ages of onset were 9 and 11 respectively. The lesion site was in the sellar region. The preoperative tumor markers suggested abnormally increased β-HCG; their choriocarcinomas were resected after giving a course of ICE chemotherapy. The elder sister was operated via interhemispheric fissure-corpus callosum-between the fornices approach and the younger one was operated via crown cut-frontal anterior longitudinal fissure approach. They underwent regular chemotherapy after surgery and did not undergo radiotherapy.

The 2 choriocarcinomas achieved near-total resection under the microscope. They all recovered well after surgery and did not have serious complications in saddle regions, and both were pathologically confirmed as choriocarcinoma. The examination before discharge showed that β-HCG turned to negative. They had 5 regular chemotherapies, and they were followed up to now and their choriocarcinomas did not recur.

Primary intracranial choriocarcinoma is high malignant and it is rare in clinical practice. Its familial predisposition onset is rarely reported. As long as the diagnosis is clear, the use of regular chemotherapy and appropriate surgical approach may achieve a satisfactory efficacy. If it can be studied from genomics, it might be able to achieve a breakthrough on the basis of primary intracranial choriocarcinoma.

To investigate the application of intracranial buried electrode technique for video electroencephalogram(EEG) monitoring and to locate the suspected insular epilepsy in clinical application.

The strip, grid, and depth electrodes were implanted into insula, operculum, and other suspicious positions, and 15 patients with suspected insular epilepsy syndrome were monitored by long-term video EEG. The EEG changes of the interictal and ictal phases were recorded, and the origins of epileptic foci were identified and the epileptic foci were resected by surgery.

The buried time of intracranial electrodes in 15 patients ranged from 5 to 21 days. The epileptogenic foci interictal period and ictal epileptiform discharges were all recorded. Five patients were diagnosed as insular epilepsy, 5 were temporal lobe epilepsy, 3 were frontal lobe epilepsy, and 2 were occipital lobe epilepsy. The patients accepted epileptogenic foci resection. All patients did not have any intracranial buried electrodes caused complications.

Using the intracranial buried electrodes for EEG monitoring, the epileptic foci of suspected insular epilepsy syndrome can be localized accurately and improve the cure rate.

posttraumatic acute diffuse brain swelling (PADBS) is the focus and difficulty of secondary brain damage after craniocerebral injury, which causes disability and fatality. For patients with intracranial pressure (ICP) stubbornly increased in PADBS, the American Association of Neurosurgeons recommends decompressive craniectomy when conventional treatment measures such as sedation, head elevation, hyperventilation, and dehydration are not effective. However, even if bilateral craniotomy is performed, encephalocele is still very likely to occur during the operation, which seriously affects the prognosis of patients. Patients with diffuse brain swelling who also underwent bilateral craniotomy had very different clinical outcomes. Some cases develop acute encephalocele, while others do not. The clinical data of 62 patients undergoing bilateral craniotomy with PADBS admitted to the Department of Neurosurgery of the 101st Hospital of the People's Liberation Army from January 2008 to January 2014 were retrospectively analyzed, with the aim of clarifying their risk factors and providing evidence for reducing intraoperative acute encephalocele.

Cerebral arteriovenous malformations (AVMs) are one of the common vascular diseases causing intracerebral hemorrhage, which consists of supply arteries, malformed vascular masses and drainage veins. Clinically, AVMs with malformed vascular mass ≤1 cm are called microarteriovenous malformations (mAVMs)^[1]Because the lesions are small and prone to bleeding leading to intracerebral hematoma, clinical diagnosis and treatment are quite difficult and challenging. This study retrospectively analyzed the clinical data of 13 patients with cerebral minor arteriovenous malformations admitted to our hospital from January 2008 to December 2013, which are reported below.

To study the effect of knocking down the transcriptional coactivator with PDZ-binding motif (TAZ) expression on the biological characteristics of glioma cell lines.

The TAZ small interfering RNA (TAZ siRNA) was used to knock down TAZ expression in LN229 and SNB19 cells. Real-time quantitative polymerase chain reaction (RealTime-PCR) and Western blot were used to identify the effect of TAZ knockout after transfection. Thiazole blue (MTT) colorimetric assay was used to detect the changes of the proliferation ability of 2 kind cells. Flow cytometry was used to detect the changes of apoptosis. Scratch experiment and Transwell experiment were used to detect the changes of cell invasion ability. Western blot was used detect the expression changes of related proteins including apoptosis, proliferation and invasion, etc.

The transfection of TAZ siRNA significantly knocked down the expression levels of TAZ mRNA and protein in LN229 and SNB19 cells; after TAZ was inhibited in the 2 kinds of cells, the cell proliferation rates were decreased and showed a gradual downward trend, while the apoptosis rates were increased to 12.05%±0.65% and 8.02%±0.66% (LN229: F=414.2, P=0.000; SNB19: F=156.8, P=0.000). Compared with the control and nonsense sequence groups, the cell numbers of the cell-penetrating membrane per field were decreased significantly in the TAZ siRNA group in both cell lines. The fusion capability of scratch gap was also decreased significantly, and there was significant difference (P=0.05). Western blot for the proliferations of cellular proliferative nuclear antigen (Kiel67 antigen, Ki-67) B-cell lymphoma-2 (Bcl-2) and matrix metallopeptidase 9 (MMP-9), apoptosis and invasion-related protein expression were down-regulated significantly.

Knocking down TAZ inhibits proliferations and invasive abilities of LN229 and SNB19 of the glioma cell lines, suggesting TAZ may become a new target for the treatment of gliomas.

To investigate the effects of curcumin on glioma cell proliferation and apoptosis through Wnt/β-catenin signaling pathway.

The research objects were the human glioblastoma U251 cell lines. The experiment was divided into either a blank control group or a curcumin experiment group (the experiment concentrations were 10 μmol/L and 20 μmol/L respectively). The cell toxicity test was used to study cellular toxic effect of curcumin on U251 glioma. Four methyl thiazolyl tetrazolium (MTT) assay was used to observe the cell proliferative capacity; the caspase-3 activity assay and flow cytometry (FCM) test were used to detect cell apoptosis; flow cytometry was used detect the cell cycle; real-time quantitative PCR, Western-blotting, and immunofluorescence assay were used to detect the expression levels of intracellular β-catenin and c-myc. The luciferase assay was used to detect the changes of Wnt/β-catenin signaling pathway activity after the effects of curcumin.

With the increased effect concentration of curcumin, the cytotoxicity of U251 glioma cells enhanced. In the curcumin experimental group, when the concentrations were 5, 10, 20, and 40 μmol/L, the cells activities were 88.55%±2.35%, 62.78%±3.35%, 35.17%±2.05%, and 7.47%±1.92%, respectively ( P<0.05), and the effect of proliferation inhibition enhanced obviously. IC50 of the measured curcumin effect for 24 h was 16.32 μmol/L, therefore, the concentrations of 10 μmol/L and 20 μmol/L in the curcumin experimental group were chosen; the relative activities of caspase-3 in the experimental group (10 μmol/L and 20 μmol/L) were 3.64%±1.49% and 5.41%±0.36% respectively. Compared with the control group 0.91%±0.62%, the activities enhanced significantly (P<0.05). After flow cytometry was used to detect the curcumin effects for 48 h, the U87 apoptotic rates of the experimental group were 14.7%±2.21% and 35.6%±1.37% respectively. Compared with the apoptotic rate of the control group (0.5%±0.67%), there was significant difference (P<0.05). The detection of curcumin with the flow cytometry could block the cell cycle to the G2/M phase. The G2/M phases of the control group and the curcumin experiment group (10 μmol/L and 20 μmol/L) were 7.52%±3.84%, 16.28%±2.73%, and 25.47%±5.61%, respctivelyP<0.05); After curcumin acting on gliomas, the mRNA level of β-catenin was decreased. The test results of fluorescence quantitative PCR were 93.87%±5.73%, 68.83%±7.67%, and 47.46%±8.52%, respectively (P<0.05); and there were significant differences. Westen blotting showed that the expression levels of β-catenin and c-myc protein were decreased. Immunofluorescence assay found that curcumin suppressed β-catenin into the cell nuclei and reduced the formation of its compound at the same time. Luciferase experiment showed that the activity of Wnt/β-catenin signaling pathway was inhibited obviously after curcumin acting on glioma cells (P<0.01).

Curcumin may inhibit glioma cell proliferation and promote apoptosis by downreglating Wnt/β-catenin signaling pathway.

Standardized training of residents is an important part of medical students' graduate medical education, and it is of great significance to improve the level of basic medical services. It has been developed and standardized in developed countries for nearly a hundred years, and a consensus has been reached in China. In January 2014, seven departments including the National Health Planning Commission jointly presided over the issuance of the Guiding Opinions on the Standardized Training System of Residents and the corresponding document interpretation, which made basic institutional arrangements for the mode, content, work foundation, program framework, schedule and financial guarantee of standardized training of residents in China, and became the program to guide the training of residents nationwide. The training protocol for neurosurgeons is still under discussion. Stones from other mountains can be used to attack jade. Here, we briefly interpret the American Neurosurgery Resident Training Plan issued by the Accreditation Council for Graduate Medical Education (ACGME) in July 2013 for your reference. I hope to take the essence and combine the national conditions to establish a Chinese Neurosurgery Resident Training Standard that is more in line with the characteristics and requirements of China's Medical and health care.

Intracranial arteriovenous malformation (AVM) during pregnancy is a complicated disease. The prevalence of intracranial AVM is about 0.01% to 0.50%. Generally, symptoms occur between 20 and 40 years old, and most commonly in those over 30 years old. For women, it is the gestational age^[1]。

Intracranial cavernous malformation is a common disease in neurosurgery, with an incidence of 0.3% ~0.5%. It is more common in young and middle-aged patients aged 20~50 years. It can be divided into familial type and sporadic type. Most of the former are multiple lesions, while the latter are mostly single lesions. The main clinical manifestations of intracranial cavernous malformations are seizures and hemorrhage, but up to 21% of patients can still be asymptomatic^[1]。

Moyamoya disease is a vascular disease with unclear etiology and pathogenesis. It is characterized by chronic and progressive stenosis or even occlusion of the distal ends of bilateral internal carotid arteries, Willis ring, middle cerebral artery and proximal anterior cerebral artery in imaging, and collateral circulation formed by smoke-like small perforating arteries gradually formed at the base of the skull. Clinically, cerebral ischemia is the main manifestation, which may be accompanied by cerebral hemorrhage or other neurological symptoms such as brain dysfunction^[1]。 At present, its treatment is mainly surgical treatment for the purpose of increasing collateral circulation and improving cerebral blood supply. Superficial temporal artery-middle cerebral artery bypass grafting is the most widely used treatment plan, and has good therapeutic effect. Karasawa et al.^[2]17 patients with moyamoya disease were followed up for 1~4 years, and 13 patients with cerebral ischemia disappeared. Quest and Correll^[3]Fourteen patients with moyamoya disease were reported, and the symptoms of 11 patients improved significantly after operation. Superficial temporal artery-middle cerebral artery bypass surgery is a low-flow bypass surgery. In the past, it was thought that the incidence of cerebral hyperperfusion syndrome (CHS) with low-flow bypass surgery was very low. However, recent studies have found that the incidence of CHS after bypass surgery in patients with moyamoya disease is significantly higher than that in patients with non-moyamoya disease bypass or carotid endarterectomy^[4]。 Moreover, the clinical and imaging manifestations of CHS after bypass surgery in moyamoya disease are difficult to distinguish from those of cerebral ischemia, but the treatment options of the two are opposite, so the early detection and treatment of CHS after superficial temporal artery-middle cerebral artery bypass surgery in moyamoya disease is crucial. This article reviews the definition, epidemiology, etiology, clinical symptoms, imaging findings, treatment and prognosis of CHS after bypass surgery for moyamoya disease.

cerebral arteriovenous malformations (AVM) are the most common types of cerebral vascular malformations. AVM often starts with epilepsy or spontaneous cerebral hemorrhage, with high disability and mortality rates. Because of the complexity of vascular architecture and the difficulty of operation, AVM has been paid close attention by neurologists at home and abroad. At present, the main treatment methods of AVM include microsurgery, endovascular embolization and stereotactic radiosurgery (SRS). Each of the three methods has its own advantages and disadvantages, and for most AVMs, it is often impossible to use one method to achieve the goal of cure. With its minimally invasive characteristics, SRS is often used alone or in combination with other methods for deep small AVM. In recent years, rapid progress has been made, which is summarized as follows.

Peripheral nerve injury, especially the repair and reconstruction of long-segment thick nerve defects, is still a difficult problem in clinical medicine. Autologous nerve transplantation is the classic and preferred surgical method for repairing peripheral nerve defects, and it is also the "gold standard" for measuring various nerve bridging materials^[1]。 However, autologous transplantation can often cause nerve dysfunction in donor innervation area, and the source of autologous nerve available for transplantation is limited, the thickness of donor site nerve is not matched with that of recipient site nerve, and the length of donor site nerve is insufficient, which limits its clinical efficacy and indication scope. Therefore, new treatment strategies are urgently needed in clinic. According to the mechanism of peripheral nerve regeneration and the principle of biological histocompatibility, it has become an important research direction to explore the substitute of autologous nerve. Searching, inventing and combining various tissue materials that can be used for repair, preparing bioactive catheter and constructing tissue engineered nerve are the research hotspots in recent years^[2,3,4]。

optic pathway glioma (OPG) is an intracranial tumor that mainly occurs in childhood and grows on the visual pathway, accounting for about 1% of all intracranial tumors^[1,2], accounting for 3% to 5% of intracranial tumors in childhood^[3]。 About 75% of OPGs occur under the age of 10, and 90% can develop clinical symptoms before the age of 20^[4]。 At present, the incidence of the disease is not clear, but there is no obvious gender difference^[3]。 OPG can occur in any part of the visual pathway, such as the optic nerve, optic chiasm, or behind the optic chiasm, but it is more common to involve the optic chiasm structure. OPG occurs mostly scattered, but there are also OPGs associated with neurofibromatosis type 1 (NF1). NF1 is an autosomal genetic disease, and most NF1-related OPG patients can develop the disease before the age of 6 years^[5]Symptoms after 8 years of age are rare^[5,6,7]。 About 1/4 of OPGs involved only the optic nerve, and this was more common in NF1-related OPGs. In the total OPG population, the proportion of NF1-related OPG is about 30% ~58%^[8,9,10,11]。 NF1-related OPG is mostly localized to the optic nerve^[12]。 This disease is more common in low-grade tumors, and the common pathological types are pilocytic astrocytoma (WHO grade I), pilocytic myxoid astrocytoma (WHO grade II), fibroastrocytoma, etc. High-grade tumors are rare^[13]。 At present, the natural course of OPG is unknown, which affects the choice of treatment timing. The treatment methods of OPG include follow-up observation, chemotherapy, surgery and radiotherapy. This article reviews the current treatment modalities of OPG.