Volume 31 · Issue 07 · 2015

Zhang Jianning is a professor of neurosurgery, doctoral supervisor, General Hospital of Tianjin Medical University, an expert with special allowance from the State Council and a young and middle-aged expert with outstanding contributions from the Ministry of Health. He is currently the president of General Hospital of Tianjin Medical University, the director of Tianjin Institute of Neurology, the senior consultant of Montreal Institute of Neurology, Canada, the chairman of Neurosurgery Branch of Chinese Medical Association, the vice president of Neurosurgery Branch of Chinese Medical Physicians Association, the vice president of Tianjin Medical Association, the vice president of Tianjin Medical Physicians Association and the chairman of Tianjin Neurosurgery Society. At the same time, he also serves as the deputy editor-in-chief of Chinese Journal of Neurosurgery and Chinese Journal of Neuropsychiatric Disorders, and the editorial board of more than 10 other academic journals. He has been engaged in the medical teaching and research of neurosurgery for more than 30 years, and has completed more than 2,000 neurosurgical operations. He is good at microsurgical treatment of spinal diseases, cerebrovascular diseases and sellar tumors, and has been devoted to clinical and basic research of craniocerebral trauma treatment for many years. He has successively undertaken a number of national scientific research projects such as key projects of National Natural Science Foundation of China. He translated and co-edited many academic monographs, and published 241 academic papers as the first author and corresponding author, of which nearly 44 were included in SCI, with a cumulative impact factor of over 100 points.

To study the relationship between the clinical features of growth hormone (GH)-secreting pituitary adenomas and surgical treatment.

A total of 167 patients with GH adenoma underwent surgical treatment at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2011 to October 2013 were enrolled. The clinical features of the patients were observed. Its relationship with surgical efficacy was investigated. Immunohistochemical staining was used to observe the hormone expression of adenoma.

In the 170 patients, the ratio of male and female was 1 ∶1.12 (79/88). The patients of 30 to 50 years accounted for 63.7% (n=106). Twenty-two patients (13.2%) had microadenoma, 117 (70.1%) had macroadenoma, and 28 (16.8%) had giant adenoma. Sixty-three patients (37.7%) had invasive adenoma and 104 (62.3%) had non-invasive adenoma. The resection extent of non-invasive adenomas was higher than that of the invasive ones, and there was significant difference (P=0.01). The median preoperative plasma GH level was 27 ng/ml; there were 43 patients (25.8%) the preoperative prolactin >normal value (20 ng/ml). The preoperative GH level was positively correlated with tumor volume ( r=0.285, P<0.01). The preoperative and postoperative GH levels were positively correlated with tumor volume (r=0.541, P<0.01). Immunohistochemistry showed that the plurihormonal positive expression of adenoma accounted for 51.8% (79/164). Single GH hormone positive expression accounted for 48.2% (79/164). There was no significant difference in the invasion and the preoperative GH level between the two groups. The patients were followed up for 0.6 to 4.3 years, 150 of 158 patients with acromegaly were relieved; after procedure, 21.4% of patients with diabetes were cured (9/42) and 21.4% (9/42) were relieved; 16.3% (7/43) of hypertension were cured and 14.0% (6/43) were relieved.

Ghomas are common in young and middle-aged adults. Most of them are macroadenoma when the diagnosis is clear. The preoperative GH level is associated with the tumor volume. Surgical treatment is effective for part of the patients complicating with hypertension and diabetes. The extent of surgical resection of invasive ghomas is not as ideal as non-invasive ones.

To investigate the surgical techniques for neuroendoscopic treatment of intraventricular tumors.

The clinical data and surgical efficacy of 15 patients with intraventricular tumor treated with neuroendoscope at the Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University from July 2005 to February 2013 were analyzed retrospectively. Seven patients had lateral ventricle tumors, 7 had the third ventricle tumors, and 1 had intraventricular multiple tumor. The patients were operated under the guidance of navigation. They were followed up routinely after procedure and were assessed by the Karnofsky scores.

Of the 15 patients, 5 took a biopsy under the neuroendoscope and 3 had a total tumor removal, and 1 had a subtotal resection; 3 had a total tumor removal under a neuroendoscope and a microscope, and 3 had near total resection. Of the 10 tumor patients with hydrocephalus, 9 underwent endoscopic third ventriculostomy and 2 underwent pellucid septostomy simultaneously. The intracranial hypertension symptoms were relieved significantly after procedure. Six patients received chemotherapy and 3 received radiotherapy after procedure. They were followed up for 2 to 36 months (mean 15.8 months) after procedure. The Karnofsky score was >80 in 12 cases, 60 to 80 in 2, and 0 (died) in 1.

The surgical treatment of intraventricular tumors with a neuroendoscope is safe and effective. It can not only clearly identify the pathological nature through biopsy, but also choose a tumor resection alone or tumor resection with a microscope according to the size and nature of tumors.

To study the relationship between magnetic resonance imaging (MRI) signs of glioblastoma (GBM) and the immunohistochemistry of isocitrate dehydrogenase 1 (IDH1), O6-methylguanine-DNA methyltransferase (MGMT).

The patients pathologically diagnosed as GBM were collected from January 2008 to December 2013. The relationship between MRI and immunohistochemistry of IDH1 and MGMT before procedure was analyzed.

A total of 111 patients performed IDH1 and MGMT immunohistochemical examinations for postoperative pathology, 29 patients (26.1%) were IDH1 positive and 60 (54.1%) were MGMT positive. Univariate analysis showed that the maximum diameter of the tumors (χ²=9.400, P=0.009), MRI enhancement (t=2.204, P=0.030), peritumoral edema (PTE) indexed (χ²=6.411, P=0.041), and main invasive sites (t=2.788, P=0.006) were associated with the positive expression of IDH1. Multivariate logistic regression analysis showed that the maximum diameter of the tumors (P=0.015), MRI enhancement (P=0.037), and main invasive sites (P=0.024) were the main factors for predicting IDH1 positive expression, and the maximum diameter of the tumors was the most important predictor (P<0.05). The positive expression of MGMT was associated with the number of lesions (χ²=6.678, P=0.010), magnetic resonance diffusion weighted imaging (DWI) (t= -4.320, P=0.000), cystic change (χ²=16.185, P=0.000), necrosis (χ²=8.325, P=0.004), and main invasion sites (t=2.612, P=0.010). Multivariate logistic regression analysis showed that the number of lesions (P=0.008), cystic change (P=0.000), and DWI (P=0.000) were the major factors for predicting MGMT positive expression, and DWI hyperintensity was the most important predictor (P<0.05).

The results of IDH1and MGMT immunohistochemistry have some correlations with the performance of tumors on conventional MRI. It is conducive to screening and preliminary determination of the biological behavior of tumors and identifying its prognosis by analyzing the correlation between imaging and pathology.

To study the expression and significance of folate receptor (FR) α in pituitary adenomas in order to provide a theoretical basis for targeting the diagnosis and treatment of pituitary adenomas.

RT-PCR, Western blot and immunohistochemistry were used to detect mRNA and protein expression levels of FRα in pituitary adenomas and normal pituitary tissue, and the relationship between the FRα expression and part of the clinical indicators were studied.

Real-time quantitative polymerase chain reaction (RT-PCR) showed that the mRNA expression level of FRα in nonfunctioning (NF) pituitary adenomas was significantly higher than that of pituitary adenomas with endocrine function and normal pituitary tissue (P<0.05). The result of Western blot showed that FRα expressed significantly high in NF pituitary adenomas (P<0.05), while FRα hardly expressed in pituitary adenomas with endocrine function and normal pituitary tissue. Immunohistochemistry assay showed that FRα only expressed in NF pituitary adenomas, and the positive rate of expression was 93.75% (30/32). Furthermore, the expression of FRα in invasive pituitary adenomas was significantly higher than that in non-invasive ones (P<0.05), but there were no significant correlations in the expression levels of the sex, age, tumor diameter and recurrent tumor of the patients (P>0.05).

The expression of FRα in NF pituitary adenomas was significantly higher than that in pituitary adenomas with endocrine function and normal pituitary tissue, and it might be associated with the invasiveness of pituitary adenomas. This provided a certain research foundation for NF adenomas in future molecular targeted diagnosis and treatment.

To investigate the clinical application value of using auditory brainstem response and pure tone audiometry for early diagnosis of acoustic neuroma.

The clinical data, the results of pure tone audiometry, auditory brainstem response, and enhanced MRI in 111 patients with acoustic neuroma were analyzed retrospectively. Linear regression analysis was used to analyze the correlation between the mean value of pure tone audiometry and the neuroma volume or course of disease. Chi-squared test was used to analyze the whether there were differences in the different neuroma volumes on the incidence of abnormal auditory brainstem response.

Acoustic neuroma caused sensorineural deafness. There was a significant correlation between the mean value of pure tone audiometry and the course of disease (P=0.000). The sensitivity and specificity of auditory brainstem response for the diagnosis of acoustic neuroma were 98.2% and 93.6% respectively. The maximum diameters of neuromas were divided into 2 groups: >3 cm or ≤3 cm. There were significant differences on the abnormal incidence of the Ⅲ to Ⅴ wave intervals of the ipsilateral and contralateral ears ( P=0.038 and 0.045 respectively).

Auditory brainstem response in combination with pure tone audiometry is the effective method for early diagnosis of acoustic neuroma.

To investigate the effect of neurological function protection of low-grade glioma resection of central areas in combination with magnetoencephalography (MEG), diffusion tensor imaging (DTI), and neuronavigation technology.

Forty patients with glioma grade Ⅱ involving central areas were randomly divided into either a control group or an experimental group (n=20 in each group). According to the conventional nerve navigation, the gliomas were localized and resected surgically in the control group; the magnetoencephalography, DTI and neural navigation image sequence were fused for intraoperative navigation in the experimental group, and the cerebral cortical functional areas and subcortical tracts were located under the intraoperative visualization in order to achieve the precise excision of the lesions. Within 3 days after procedure, the patients conducted MRI and DTI examinations. The extent of glioma resection, the integrity of nerve tracts, the recovery of neurological function at 1 month after procedure, and the KPS scores in both groups were compared.

The total resection rate of gliomas in the experimental group (85%, 17/20) was significantly higher than that of the control group (55%, 11/20). The postoperative paralyzed rate in the experimental group (25%, 5/20) was significantly lower than that of the control group (60%, 12/20). The mean Karnofsky performance scale (KPS) score (84.50±21.6) at one month after procedure in experimental group was significantly higher than that in the control group (64.05±33.36). There were significant differences in glioma resection rate, fiber tracts (FA value), neurological preservation, and KPS scores between the two groups (P<0.05).

By the combined use of MEG, DTI, and neural navigation technology, the gliomas in central areas can be removed as much as possible and better preserve the neurological function of patients in order to improve their quality of life.

To investigate the preoperative evaluation methods and intraoperative measures of the extent of resection and blood vessel protection in insular glioma resection surgery via transsylvian approach.

The clinical data in 46 patients with glioma mainly in insular lobe treated by surgery at the Department of Neurosurgery, Brain Hospital Affiliated to Nanjing Medical University from January 2008 to July 2014 were analyzed retrospectively. M2 was exposed after separating lateral fissure via the pterion or extended pterional approach. After processing the short perforator from M2, the gliomas were resected piecemeal. The outermost artery of internal capsule did not participate in the insular lobe glioma blood supply, and it was the inner side border for glioma resection.

Under the microscope, the gliomas of 38 patients were resected near totally and were confirmed by the postoperative imaging. The gliomas of 8 patients were resected subtotally, 2 had hemiplegia after procedure, and one had subdural hemorrhage. After procedure, 3 patients had contralateral limb hemiparesis (strength grade IV). One had a transient mixed aphasia.

Preoperative imaging findings, especially 3D-TOF of the relationship in between the gilomas and vessels, have an important guiding role for intraoperative blood vessel protection. The outermost artery of internal capsule is the medial boundary of giloma resection.

To investigate the MRI and CT manifestations of pilomyxoid astrocytoma (PMA).

The MRI and CT findings of 39 patients with PMA confirmed by surgical pathology at the Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University from September 2010 to August 2014 were analyzed retrospectively. Nineteen of them were males and 20 were females. The age ranged from 10 months to 47 years.

There were 25 patients with PMA in the hypothalamic/chiasmatic region. Their median age of onset was 5.83. The mean maximum diameter of the foci was 47.44 mm. There was no obvious peritumoral edema; however, they had varying degrees of hydrocephalus. The banding hypointensities were observed on T2WI in 14 patients. The solid components of PMA showed intralesional multiple-ring enhancement in 22 patients. Diffusion weighted magnetic resonance imaging (DWI) of 3 patients showed that the diffusion was not restricted, and 9 of them showed subarachnoid dissemination. CT examination revealed that 6 patients had calcification and 1 had bleeding. There were 14 patients in the non-hypothalamic/chiasmatic region; their median age of onset was 17. The mean maximum diameter of the foci was 39.43 mm; 6 patients had mild peritumoral edema and 3 had mild hydrocephalus. The banding hypointensities were observed in the hyperintensities on T2WI in 6 patients. The foci of 11 patients showed obviously enhanced. The enhancement pattern was "stellate" enhancement of mural nodule in cystic foci. DWI examination revealed that the diffusion was not restricted in 1 case. No subarachnoid dissemination was observed. Magnetic resonance spectroscopy (MRS) examination was performed in 3 cases; the solid components of the foci met the MRS spectral lines of general glioma. CT examination revealed that 2 patients had calcification and 2 had bleeding.

PMA may occur in all parts of the brain. It shows a cystic and solid mass. The solid components can be enhanced obviously. The age of onset in the hypothalamic/chiasmatic region is younger and subarachnoid dissemination is common. The age of onset in the non-hypothalamic/chiasmatic region is older. The " stellate" enhancement of mural nodule after enhancement has more characteristics.

The sieve plate is the weakest part of the anterior skull base, which is easily destroyed by tumors and forms cranio-nasal communicating tumors. If the involvement in the nasal cavity is less, it can be removed through the tumor channel formed by the anterior skull fossa floor. If the tumor in the nasal cavity is large, it is difficult to total resection in the first stage of conventional surgery^[1]。 From January 2011 to October 2014, the Department of Neurosurgery of the Second Affiliated Hospital of Nanchang University performed extended frontal-floor approach to remove 8 cases of anterior cranial-nasal communication tumors with satisfactory results. The report is as follows.

Hassoun et al.^[1]central neurocytomas (CNC) were first discovered in 1982 and described under electron microscopy as having neuronal characteristics. These rare tumors originate in the septum pellucidum, however their precise origin is unclear. CNC is a benign tumor with World Health Organization Grade II. The final diagnosis of CNC relies on immunohistochemistry and electron microscopy to confirm the neuronal characteristics of the tumor^[2]。 An accurate diagnosis is very important, and for most patients, complete removal of the tumor can cure the disease. However, some atypical CNCs have also been reported with atypical histological features and high mitotic activity, possibly with a poor prognosis and high recurrence rate^[3,4]。 Extraventricular CNC has typical features but poor prognosis. Radiation therapy may be effective in improving patient prognosis^[3,4]。 This article retrospectively analyzed 5 CNC patients who underwent surgical treatment in the neurosurgery department of our hospital between May 2010 and October 2013, and analyzed the clinical characteristics, histopathological examination and surgical treatment methods of tumors.

To investigate the in-hospital death-related factors for acute encephalocele in patients with craniocerebral injury for craniotomy in order to provide evidence for clinical treatment and prognosis determination.

The clinical data of 183 patients with craniocerebral injury occurring acute encephalocele during craniotomy treated at the Department of Neurosurgery, the 101st Hospital of PLA from August 2008 to July 2014 were analyzed retrospectively. The correlations of the factors including sex, age, preoperative hypoxia, preoperative blood pressure, preoperative Glasgow coma scale (GCS) scores, preoperative pupil status, brain swelling, preoperative intracranial pressure (ICP), causes of encephalocele, postoperative pupillary status, postoperative ICP, postoperative GCS, coagulation mechanism, blood glucose, and complications of the patients of in-hospital deaths were analyzed.

The prognosis was assessed according to the Glasgow outcome scale (GOS) scores after procedure; there were 135 patients in a death group (namely death cases) and 48 in a survival group (including good recovery, moderate disability, severe disability, and vegetative cases). The postoperative GCS scores, glucose, causes of encephalocele, and postoperative pupillary status were closely associated with the in-hospital death in patients with acute encephalocele in craniocerebral injury operation (P<0.05). There was significant difference in postoperative ICP between the survival group and the death group (P<0.05).

The postoperative GCS, glucose, causes of encephalocele, postoperative pupillary status, postoperative ICP and postoperative complications could be used as the important indexes for predicting in-hospital death of acute encephalocele in craniocerebral injury for craniotomy.

To investigate the roles of cistern and cisternal hemorrhage in the occurrence of acute hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH).

The clinical data of 306 patients with aSAH diagnosed and treated surgically at the Department of Neurosurgery, Nanfang Hospital, Southern Medical University from May 2011 to January 2014 were analyzed retrospectively. Their clinical variables were analyzed with the univariate analysis and multivariate logistic regression analysis, and the blood volume of each cistern was analyzed quantitatively.

Among of the 306 patients, 112 had acute hydrocephalus, and the incidence was 36.6%. Univariate analysis suggested that there were significant differences in six factors, including Fisher grade, intraventricular hemorrhage, location of aneurysm, sides of aneurysm, rebleeding, and treatment (P<0.05); multivariate logistic regression analysis showed that the location of aneurysm and intraventricular hemorrhage were its independent occurrence factors. In patients without intraventricular hemorrhage, the incidence of acute hydrocephalus was 22.4%, of which the blood volumes of interpeduncular cistern and right sylvian cistern were the maximum in the hydrocephalus group. Compared with the non-hydrocephalus group, there were significant differences (P=0.000; P=0.005).

Acute hydrocephalus after aSAH is the result of multiple factors working together. The location of aneurysm and intraventricular hemorrhage are its independent risk factors. The acute hydrocephalus after aSAH is an obstructive hydrocephalus. The location of cistern and the distribution of cisternal hemorrhage have important influences in the occurrence of acute hydrocephalus after aSAH. In aSAH patients without intraventricular hemorrhage, the larger the hematocele volume of the interpeduncular cistern and right sylvian cistern, the more prone to acute hydrocephalus

To investigate the effect of cranioplasty on cerebral hemodynamics and neurological symptoms in patients with traumatic skull defect.

Before and after skull repair, 14 patients with traumatic skull defects underwent brain perfusion CT examination. The basal ganglia level on the repair side and the basal ganglia region of the lateral ventricle body level and the temporal cortex region in 4 regions of interest were compared. Self-control comparison the mean value difference of rCBF, the mean values at 7 days before and after procedure and at 6-month before and after procedure were compared respectively, and the changes of their neurological symptoms were followed up.

(1) The basal ganglia section of the basal ganglia level: The rCBF was improved at 7 day after procedure compared with before procedure (P=0.044, P<0.05); the rCBF was improved for 6-month follow-up compared with before procedure (P=0.033, P<0.05). (2) The temporal cortex of the basal ganglia level: The rCBF was improved at 7 day after procedure compared with before procedure (P=0.001, P<0.01); the rCBF was improved for 6-month follow-up compared with before procedure (P=0.000, P<0.01). (3) The basal ganglia section of the lateral ventricle body level: The rCBF was not improved significantly at 7 day after procedure compared with before procedure (P=0.275, P>0.05); the rCBF was improved significantly for 6-month follow-up compared with before procedure (P=0.001, P<0.05). (4) The temporal cortex of the lateral ventricle body level: The rCBF was not improved significantly at 7 day after procedure compared with before procedure (P=0.064, P>0.05); the rCBF was not improved for 6-month follow-up compared with before procedure (P=0.174, P>0.05). The degree of cerebral blood flow improvement was found more obviously near the large vessels at the lateral fissure on basal ganglia level because of skull repair. The neurological symptoms of patients were improved after cranioplasty.

In this study, the perfusion CT data have shown that the more intensive cerebral blood flow is, the more obvious recovery of cerebral blood flow will be. It is further enriched and improved the theoretical hypothesis of the improvement of cerebrovascular reserve function after cranioplasty.

To investigate the application value of using reconstruction of the posterior wall of vertebral canal with titantium plate and bone grafting in the thoracolumbar burst fracture surgery.

Twenty-seven patients with thoracolumbar burst fracture with spinal cord injury were treated with posterior pedicle screw fixation+ holo-laminectomy+ titanium plate bending for reconstruction of posterior expansive laminoplasty, and the depressurized lamina process was trimmed into bone grains and were mixed with allogeneic bone for bone grafting along the titanium plate surface. The kyphotic Cobb angle, bone graft fusion, and neurological recovery were of the patients were assessed after procedure.

The postoperative CT and MRI findings in 27 patients suggested that the vertebral canal volume recovered well, the spinal cord compression relieve was satisfactory. The neurological function of 16 patients was improved during the hospitalization. All patients were followed up after discharge. They were followed up for 12 to 30 months (mean 17.8 months). Their final neurological function was improved in 21 patients compare with before procedure (ASIA grade: type A 3 cases, type B 6 cases, type C 8 cases, and type D 10 cases), and 14 of them recovered completely, 7 recovered partially, and 6 did not have any changes (ASIA grade: type A 3 cases, type B 3 cases, type C 3 cases, type D 4 cases, and type E 14 cases). The function improvement rate of the patients was 78% (21/27) after procedure. No symptoms of delayed spinal cord compression were observed during the follow up period. The internal fixation screw rods of 9 patients were removed from 13 to 21 months after procedure because of their personal reasons, but the forming titantium plates were reserved. All patients did not have the phenomena including increased kyphosis angle, titantium plate shift, deformation, and decreased vertebral canal volume. The bone grafting fusion rate was 100%. No spine instability was observed. There was no significant differences in the lost degrees of kyphosis angle and the height change ratio of the injured vertebrae (P>0.05).

Using titanium plate for laminoplasty and bone grafting are simple, safe and reliable after surgical reduction decompression and fixation in the treatment of thoracolumbar burst fractures with spinal cord injury. It is conducive to maintaining the integrity and stability of spines. The recovery of spinal cord function is satisfactory.

To summarize the efficacy of endovascular treatment of posterior cerebral dissecting artery aneurysms.

The clinical data of 8 patients with posterior cerebral dissecting artery aneurysm treated with endovascular treatment at the Department of Neurosurgery, Zhujiang Hospital, Southern Medical University from January 2007 to January 2014 were analyzed retrospectively. Hunt and Hess grade: grade Ⅰ (n=3), grade Ⅱ (n=4), and grade Ⅲ (n=1). The aneurysm of 1 patient located at the P1 segment, 5 at the P2 segment, and 2 at the P3 segment. The aneurysm diameters ranged from 4 mm to 10 mm. Five patients underwent parent artery and aneurysm embolizations and 3 underwent stent-assisted coil embolization.

Postoperative angiography showed that all the aneurysms were packed densely. In addition to one patient experienced the left limb muscle strength decrease, other patients did not have surgery-related complications. Eight patients were followed up for 6 to 12 months, and the aneurysm recurrence was not observed in 7 of them. One patient had aneurysm recurrence after being initially treated in other hospital. After his parent artery and aneurysm being occluded for 6 months in our hospital, DSA revealed the parent artery recanalization. Another 2 coils were inserted again for occluding the parent artery. His aneurysm reoccurred after 6 months and he refused to further treatment. After 12 months, the modified Rankin scale score was 0 in 7 patients and 1 in 1 patient.

Endovascular treatment of posterior cerebral dissecting aneurysm is safe and the short-term efficacy is better.

vertebrobasilar dolichoectasia (VBD) causes related symptoms due to abnormally dilated and tortuous blood vessels that directly compress the brainstem, nerve roots, and the posterior part of the third ventricle, and even causes hemodynamic changes, thrombosis and microembolism, resulting in posterior circulation ischemia symptoms. Some patients may form acute dissecting aneurysms and even cause subarachnoid hemorrhage^[1,2,3]。 The incidence of VBD is relatively low, the clinical symptoms are not specific, and it is easy to miss and misdiagnose. Now, 4 patients admitted to our department in the past 6 years are reported as follows.

vein of Galen aneurysm malformation is a vascular malformation originating from the venous reflux system of the choroid plexus. During the 6th to 11th week of embryonic development, the embryonic Markowski intermediate vein developed abnormally, forming a special vascular malformation with a single intermediate drainage vein and multiple arteriovenous fistulas on the vein wall^[1]。 Because of the impact of high-speed blood flow, the vein expands like a tumor and looks like an aneurysm, so in 1946 Jaeger named it Galen's venous aneurysm-like vascular malformation. Most of the patients are young and have complicated diseases. Before the introduction of endovascular therapy, its treatment is difficult and the mortality rate is high. From January 1995 to December 2013, 192 cases of vascular malformations of the central nervous system under 6 years old were treated in the Department of Neurosurgery, Wuhan General Hospital, Guangzhou Military Region, including 6 cases of Galen venous malformations, with satisfactory treatment results, which are reported as follows.

To increase the sensitivity of glioma stem cells to chemotherapeutic drugs by inducing atypical protein kinase C (aPKC) gene silence and to provide theoretical support for radical cure of glioma stem cells.

The side population cells in rat C6 glioblastoma were isolated by a flow cytometry. The expression of aPKC in C6 side population cells was silenced by RNA interference (RNAi) technology. MTT and trypan blue assay were used to detect the killing effect of herpes simplex virus-thymidine kinase (HSV-tk)/ganciclovir (GCV) on C6 side population cells. A subcutaneous glioma model in nude rats was induced. The volume and weight of glioma were measured. In situ apoptosis assay was used to detect cell apoptosis.

After the aPKC genes in C6 side population cells being effectively silenced, they could significantly increase their sensitivity to HSV-tk/GCV drugs. They showed apoptosis and the number of death increased significantly (P<0.05). The in vivo experiment showed that the volume and weight of glioma decreased significantly compared with the control group (P<0.05). The cell apoptosis increased significantly (P<0.05).

By inducing aPKC gene silencing, it may further increase the glioma stem cells to the sensitivity of chemotherapy drug HSV-tk/GCV and provide a new s election method for gene therapy of glioma stem cells.

To analyze the effects of temozolomide (TMZ) on glioma U251 cells and their stem cell livin, MRP gene expression and cell cycle.

After U251 cells and their stem cells being isolated and cultured, the different concentrations of TMZ (0, 25, 50, 100, 200, and 400 μmol/L) were used to intervene for 72 h. CCK-8 was used to detect the change trend of cell proliferation. Flow cytometry (FCM) was used to detect the changes of cell cycle. RT-PCR technique was used to detect the expression levels of livin, MRP1, and MRP3 mRNA.

Our study successfully isolated stem cells U251from U251 cells. Compared with a non-intervention group, after 25 μmol/L TMZ intervention of U251 cells and their stem cells, the proliferation rate were 0.952±0.011 ( t=-8.219, P=0.001) and 0.937±0.029 (t=-3.822, P=0.019) respectively, and after 100 μmol/L TMZ intervention of U251 cells and their stem cells, the proliferation rate were 0.750±0.018 and 0.887±0.039 ( t=5.480, P=0.005) respectively. Under the normal circumstances, the expression level of livin gene in U251 cells and their stem cells were 0.411±0.025×10^-3 and 0.571±0.040×10^-3 (t=-3.348, P=0.004) respectively; the expression level of MRP1 gene were 0.295±0.018×10^-3 and 0.481±0.034×10^-3 (t=-8.439, P=0.001) respectively; the expression level of MRP3 gene were 1.128±0.117×10^-3 and 0.963±0.059 ×10^-3 (t=2.176, P=0.095) respectively. After 200 μmol/L TMZ intervention of U251 cells and their stem cells, the expression levels of livin mRNA were 0.020±0.002×10 ^-3 (t=27.123, P=0) and 0.066±0.007×10^-3 (t=21.345, P=0) respectively. After the intervention of 200 μmol/L, the expression levels of MRP1 mRNA were 0.556±0.041×10 ^-3 (t=-10.214, P=0.001) and 0.609±0.044×10^-3 (t=-3.98, P=0.016); after the intervention of 200 μmol/L, the expression levels of MRP3 mRNA were 1.397±0.192×10 ^-3 (t=-2.073, P=0.107) and 1.496±0.302×10^-3 (t=-2.993, P=0.040); after the intervention of 100 μmol/L, the percentage of U251 cells in the cell cycle G2/M phase were 11.353±0.516 and 39.1±1.2 ( t=-37.1, P=0), and the percentage of U251 stem cells in S phase were 21.1±1.0 and 30.2±1.7 (t=-8.07, P=0.001).

TMZ can effectively decrease the livin gene expression in U251 and its stem cells, and arrest cell division cycle, decrease cell proliferation rate, and promote cell apoptosis. MRP1 and MRP3 may be respectively one of the main reasons of primary glioma and recurrent glioma resistance.

To investigate the effect of mild hypothermia on gastrointestinal motility after traumatic brain injury (TBI).

A total of 75 adult male SD rats were randomly divided into a sham operation (Sham) group, a traumatic brain injury (TBI) group, and a mild hypothermia (MIH) group according to a random number table. A rat model of TBI was induced by using the electric cortical contusion impactor (eCCI), and then the mild hypothermia intervened for 4 h. The changes of gastric motility, gastric emptying rate, and intestinal propulsive rate in each group were detected. After the animals were sacrificed, the brain, stomach, ileocecal junction, and small intestine tissue 15 cm from ileocecal junction were obtained respectively. HE staining was used to observe its pathological changes.

After TBI in rats, the stomach obviously dilated, the stomach wall became thinner, gastric mucosa was congested and edematous, part of the mucosa had epithelial shedding, there was bleeding in submucosa, there was lumen expansion and flatulence, intestinal mucosa had hemorrhage and necrosis, intestinal villi desquamated, there was neutrophil infiltration, the gaps of intestinal villi increased, and Goblet cells decreased. The blood vessel count of gastric mucosal congestion and the numbers of intestinal mucosa villi fracture showed that there was no significant difference between the 6 h TBI group and the MIH group (P>0.05). Compared with the TBI group, there were significant differences in the 24, 48 and 72 h MIH groups (P<0.05). Gastric motility detection showed that there were no significant differences in gastric motility frequencies among all the groups (P>0.05); the value of gastric motor amplitude of the TBI and MIT groups was higher than that of the sham group (P<0.05). The MIT group was lower than the TBI group after 24 h (P<0.05). There was significant difference (P<0.05). The determination of gastric emptying rate and intestinal propulsion rate showed that there was no significant difference between the 6 h TBI group and the MIH group (P>0.05). Compared with the TBI group, there were significant differences among the 24, 48 and 72 h MIH groups (P<0.05).

TBI had effect on rat gastrointestinal mucosa and gastrointestinal motility. The short-term effect after MIH intervention was not significant, but the long-term efficacy was remarkable.

spontaneous intracranial hypotension (SIH) is a group of clinical syndromes characterized by postural headache and decreased cerebrospinal fluid pressure. To date, the etiology of SIH is unknown. At present, it is generally believed that the pathogenesis of this disease is related to the following factors: (1) cerebrospinal fluid leakage caused by small tears of cerebral (spinal) membranes. At present, most scholars still believe that cerebrospinal fluid leakage is the main cause of SIH. It has been reported in the literature that patients with SIH are often complicated with thyroid dysfunction, and thyroxine is considered to have the function of maintaining normal connective tissue structure. Patients with thyroid dysfunction are often complicated with connective tissue disease, so patients with SIH may have congenital or acquired rupture of meningeal diverticulum^[1]。 Takahashi et al.^[2]The presence of cerebrospinal fluid leakage in patients with SIH was confirmed using radionuclide cisternography and spinal cord scanning techniques. (2) Decreased secretion of cerebrospinal fluid. Mental stimulation, fatigue, lack of sleep, respiratory infection and other factors can affect the hypothalamus-pituitary-adrenocortical system and the sympathetic-catecholamine system in the brain. Through neuroimmune and neuroendocrine effects, the contraction and diastolic function of choroid plexus vessels are disordered, resulting in temporary dysfunction of choroid plexus, thus reducing cerebrospinal fluid secretion.

Brain trauma is an important cause of disability and death among young adults in China. A considerable number of patients with severe brain trauma are difficult to return to society, which brings a huge economic burden to society^[1]。 Throughout the 150-year treatment history of traumatic brain injury, although the mortality rate of traumatic brain injury has decreased significantly, the mortality rate of severe traumatic brain injury still maintains at about 35%^[2]All clinical drug treatment trials for brain trauma have ended in failure, and their current treatment level has entered a "bottleneck period"^[3]。 According to incomplete WHO statistics, brain trauma will surpass cancer and cardiovascular and cerebrovascular diseases as the leading cause of death in the world in 2020^[4]。 In recent years, scholars have paid more and more attention to nutritional support in the acute phase of traumatic brain injury patients. Reasonable early nutritional support may be an effective method to improve the treatment level of traumatic brain injury patients^[5]。

Cushing's disease is a series of substance metabolism disorders and pathological changes caused by the proliferation of pituitary adrenocorticotrophic hormone (ACTH) adenomas or ACTH cells, which leads to excessive secretion of ACTH, which causes adrenal cortical proliferation and produces hypercortisolism. It is clinically manifested as Cushing's syndrome. If not effectively treated, Cushing's disease has a very high rate of disability and mortality^[1]。 Transsphenoidal surgical resection is the first choice for Cushing's disease. However, since most pituitary ACTH adenomas are microadenomas, and some pituitary MRI examinations of Cushing's disease do not have clear tumors, it is difficult to operate totally, and the postoperative remission rate is low. Long-term follow-up found that the postoperative recurrence rate can be as high as 25% ~46%^[2,3,4]。 Although radiotherapy can alleviate symptoms in 50% to 60% of relapsed patients, the safety of radiotherapy has gradually caused much controversy because of its slow onset and often leading to the risk of hypopituitary function and secondary brain tumors^[5]。 Bilateral adrenalectomy may be one of the most effective methods to relieve hypercortisolemia in patients with recurrent Cushing's disease, but it is not widely used because it requires permanent hormone replacement therapy after surgery and often leads to serious complications such as Nelson's syndrome^[6]。

medulloblastoma (MB) is the most common central nervous system tumor in children. The incidence rate in men is 1.5 times that in women, and the prognosis is extremely poor. Traditional classification of MB was classified into classical type, connective tissue-promoting type, extensive nodular type, large cell type and anaplastic type, mainly according to its histopathological characteristics^[1]。 The traditional histopathological classification of MB has great limitations in guiding clinical treatment and suggesting clinical prognosis^[2,3]。 At present, the understanding of MB has entered the molecular field. Each molecular subtype has different gene mutation, epigenetic and cytogenetic characteristics, and is also different in histology, epidemiology and clinical prognosis^[4,5,6,7,8]。 Some molecular markers related to MB survival prognosis have been discovered one after another^[9,10]。 In this paper, the research progress of MB in molecular biology related to molecular typing and prognostic indexes in recent years is reviewed.

Spontaneous atlantoaxial dislocation can be caused by a variety of causes, mainly secondary to rheumatoid arthritis and other lesions in European and American countries, while congenital dysplasia is the main cause in China. With the development of 3D CT and other imaging technologies, people realize that the morphological distortion of the lateral atlantoaxial joint will make it lose its normal load-bearing function, and over time, atlantoaxial dislocation will appear, which will cause the odontoid process to compress the brainstem and upper cervical spinal cord, resulting in clinical symptoms. For the treatment of this disease, through the efforts of several generations, the traditional treatment scheme of oral (nasal) odontoidectomy and decompression and posterior internal fixation and bone grafting fusion has been formed, and certain therapeutic effects have been obtained^[1,2,3]。 However, in the past 10 years, the internal fixation technology in this field has advanced by leaps and bounds, and remarkable progress has been made. The purpose of this article is to review these internal fixation techniques and discuss their indications.

affective disorder (AD) is a common clinical symptom and complication of brain tumor patients, mainly including depression, mania, mania-depression, anxiety disorder, etc. The clinical manifestations include neuropsychological abnormalities such as agitation, impulsivity, psychotic symptoms, intellectual and cognitive impairment, personality changes and affective symptoms^[1]。 Patients with brain tumors with neurological deficit are often accompanied by secondary affective disorders in a long course of disease, and clinically, anxiety and depression disorders are more common. The incidence of depression in glioma patients ranges from 5% to 93%, and 10% to 15% of them commit suicide due to severe depression^[2,3]。 Current research suggests that some neurobiological transmitters and endocrine abnormalities in the body may be related to the occurrence of affective disorders in brain tumors. At the same time, the location of brain tumor, tumor type and pathological changes of brain tissue may also be involved in the occurrence of affective disorder. In this paper, the possible pathogenesis of affective disorder in brain tumors, the relationship between brain tumors, tumor types and neuroimaging changes are reviewed as follows.