Volume 31 · Issue 08 · 2015

Craniocerebral trauma coma is mainly caused by injury factors to the brainstem reticular structure and its projection fibers or diffuse damage to the cortex. Patients with loss of cognition, arousal and perception are called coma, and patients lasting for more than 1 month are called long-term coma. The incidence of long-term coma caused by severe craniocerebral trauma ranged from 0.52% to 7.33%, with an average of 2.90%.

To investigate the feasibility, complications and efficacy of main blood-supply cavernous sinus dural arteriovenous fistulas (CSDAVFs) for the embolization treatment of the branches of external carotid artery with Onyx via artery approach.

The clinical data and follow-up results of 15 patients (13 patients from the Neurointerventional Department of Beijing Tiantan Hospital and 2 patients from the Department of Neurosurgery, the Second Hospital of Yulin) treated with the main blood-supply CSDAVFs for the embolization treatment of the branches of external carotid artery with Onyx from August 2005 to October 2014 were analyzed retrospectively.

Immediately after procedure, angiography revealed that 12 patients were embolized completely, 3 had partially residual fistula. The postoperative ocular symptoms of 14 patients were relieved, 3 complicated with ipsilateral facial numbness, one had facial paralysis, and one had diplopia. They were followed up for 3 to 24 months, angiographic findings revealed that 13 patients were cured completely, one had recurrence and received the second embolization, and the residue did not have any change in one case. The clinical follow-up showed that their ocular symptoms were all relieved, no hemorrhage was observed, and all the complications were relieved.

Microcatheter can reach CSDAVFs of fistula via the branches of external carotid artery approach. Onyx embolization of CSDAVFs is feasible. It is an alternative scheme which the microcatheter can not be in place via venous approach or after treatment failure.

To investigate the methods of using Gore stent graft for minimally invasive treatment of spontaneous extracranial internal carotid artery aneurysms and to evaluate its efficacy.

There were 6 patients in this group, including 2 females and 4 males. Before procedure, the patients orally took clopidogrel bisulfate 75 mg and aspirin 100 mg once a day for 3 days. Using the coaxial technique, loach guidewire guided Neuro catheter through the extracranial segment of internal carotid artery to distal aneurysm during the procedure. Amplatz exchange wire was delivered through a Neuron guiding catheter to the distal internal carotid artery aneurysm as the stent delivery support guidewire. After the withdrawal of the guiding catheter, the Gore stent graft was delivered to the distal aneurysm via the Amplatz exchange wire and the stent was released for internal carotid artery angioplasty of the aneurysmal segment. Angiography was reexamined at 3 months after procedure.

There were 6 patients with 8 aneurysms in this group. They were treated for 7 times. Four patients had intracranial ischemia and one had intracranial hemorrhage. One was found during the physical examination. The lesions in 3 of them were on the left sides, 2 were on the right sides, and 1 had bilateral lesions. The stents of 5 patients were in place satisfactorily in this group. The angiopoiesis was good after stent releasing. There was no aneurysm development. The patients had no recurrence and luminal stenosis after reexamination. The stent of one patient failed in place because of local vascular excessive tortuosity and was treated with surgery.

Gore stent graft for the treatment of extracranial internal carotid artery aneurysms has the advantages of mini-invasion, simple operation, and definite curative effect, especially suitable for the long segment aneurysm and the lesions near the segment of skull base.

To investigate the application values of dual vessel fusion technique in the diagnosis of dural arteriovenous fistula (DAVF) and surgical planning.

Ten patients with DAVF underwent selective cerebral angiography using plate digital subtraction angiography (DSA). The lesion vessels performed three-dimensional angiography. The "double volume reconstruction" technique was used to perform two-vessel three-dimensional image fusion at the three-dimensional workstation. The angioarchitecture of DAVF was investigated.

Ten patients obtained satisfactory "dual vessel fusion" with a good spatial coherence. On the dual vessel fusion images, the blood flow from different feeding arteries flowed together into the same fistula and draining vein (presented as a fusion of red and white blood flow) and the location and shape of the fistula cold be identified clearly. It could be used to guide the choice of treatment strategy, design surgery and surgical intervention plan.

Based on the "dual vessel fusion" of flat panel DSA three-dimensional vascular data, it can obtain accurate vascular fusion, more clearly reveal fistulas, feeding arteries, draining veins and other angioarchitecture information of DAVF, and ultimately be beneficial to the development of surgical planning.

To summarize the operative experiences of anterior circulation artery aneurysms and to investigate the processing methods of rupture during predissection phase in clipping of anterior circulation artery aneurysms.

The data of 13 patients with rupture during predissection phase in anterior circulation aneurysm clipping were analyzed retrospectively. They were divided into either a progressive bleeding group or a stable bleeding group according to the status of intraoperative bleeding. In the progressive bleeding group, the blood immediately came out from the cortex or subdural space after the dura being opened. In the stable bleeding group, the high intracranial pressure was found after the dura being opened, and the preoperative state of consciousness was not consistent, the intraoperative head CT or B ultrasound examination found hematomas. The preoperative and intraoperative management of aneurysms and the postoperative clinical data were analyzed.

Four patients with progressive bleeding: 2 had anterior communicating aneurysm, 1 had posterior communicating aneurysm, and 1 had middle cerebral artery aneurysm. Nine patients with stable bleeding: 3 had anterior communicating aneurysm, their frontal hematoma broke into the ventricles, and the ventricles were casted; 6 had middle cerebral artery aneurysm, they had temporal lobe intracerebral hematoma, and the hematoma volume was 30 to 50 mL. The aneurysms of 13 patients were totally clipped. In the progressive hemorrhage, one patient had intracranial infarction complicated by incomplete paralysis of unilateral limb, one died after procedure, and 1 had diabetes insipidus. No patients with stable bleeding died, 2 had incomplete paralysis of unilateral limb.

It is difficult to manage predissection rupture in the surgical clipping of anterior circulation aneurysm. Fast clipping the rupture and controlling bleeding are the keys of the surgery for the progressive bleeding. For stable bleeding, the intraoperative B ultrasound or head CT may timely detect hematomas and clip them after the removal of hematomas.

anterior communicating artery (ACoA) aneurysms are one of the most common intracranial aneurysms and are more likely to rupture than anterior circulation aneurysms at other sites^[1,2]。 The size, shape, tumor orientation and aneurysm base are important factors affecting the treatment of ACoA aneurysms^[3,4,5]。 We have briefly describe that location of the neck of the ACoA aneurysm^[4]However, this description lacks quantitative criteria, the number of cases is small, and the exact location of the aneurysm base has not been studied. Therefore, through the observation of three-dimensional image data of ACoA aneurysm patients, the image classification of ACoA aneurysm according to the position of the aneurysm base was carried out in this study, and the relationship between this classification and clinical treatment and prognosis was discussed.

To investigate the difference of estrogen receptor (ER) expression of different genders in patients with pituitary prolactin (PRL) adenoma and its relationship with PRL levels and tumor size.

Twenty-six patients with PRL adenoma treated surgically at the Department of Neurosurgery, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital from March 2013 to July 2014 were enrolled, including 19 females and 7 males. The clinical information, including the preoperative PRL levels and tumor sizes of the patients, was collected. Real-time quantitative PCR was used to detect the expression levels of ERα and ERβ mRNA. Immunohistochemistry was used to detect the expression levels of ERα and ERβ. The relationship between the preoperative PRL levels, tumor size and the expression levels of ERα and ERβ were analyzed.

The preoperative median PRL values of the male and female patients were 1574 (224-4305) and 270 (129-1000) ng/ml respectively; their median tumor volumes were 3.496 (0.150-13.13) and 0.832 (0.100-16.20) cm³ respectively, and there were significant differences (all P<0.01). The expression levels of ERα, ERβ mRNA, and protein of the male patients in the tumor samples were significantly higher than those of the female patients, and there was significant difference (allP<0.01). The expression levels of ERα mRNA, ERβ mRNA and the level of preoperative PRL had positive correlation (R²=0.8753 and 0.2601 respectively; all P<0.01), and they also had positive correlation with the tumor size (R²=0.4598 and 0.3740 respectively; all P<0.01).

There is a sex difference in the PRL levels and tumor volumes in patients with PRL adenoma. The mechanisms of causing difference may be associated with ERα and ERβ participating in the proliferation of PRL adenoma through a variety of approaches.

To compare the efficacy of the improved subtemporal approach and traditional frontotemporal-zygomatic arch subtemporal approach in resection of cavernous sinus tumors.

The clinical data of two groups of patients were analyzed retrospectively. There were 26 patients in an improved subtemporal approach (that is preauricular straight incision preserving zygomatic arch) group (group A). There were 14 females and 12 males, and 9 patients had meningioma, and 17 had trigeminal neurinoma. There were 22 patients in a traditional frontotemporal-zygomatic arch subtemporal approach group (group B). There were 13 females and 9 males, 8 patients had meningioma and 14 had trigeminal neurinoma. The incidence of total resection rate, cranial nerve complications of postoperative lateral wall of cavernous sinus in the patients of both groups were compared, and they were followed up regularly after procedure.

There was no significant difference in the complete resection rate and the incidence of complications of the cranial nerves between the two groups; however, preserving the zygomatic arch subtemporal approach, the time of craniotomy was shortened significantly. The incidences of postoperative temporal branch injury of facial nerve and temporal muscle atrophy were reduced significantly.

Preauricular straight incision subtemporal approach can fully expose the cavernous sinus and preserve zygomatic arch. The surgery trauma and complications are less. It is a good choice for the removal of tumors in cavernous sinus areas.

To investigate the effects of the selection of surgical approaches of lateral ventricular meningiomas and microsurgical skills on postoperative efficacy and complication rate.

The clinical data of 47 patients with lateral ventricular meningioma operated at the Department of Neurosurgery, Tianjin Huanhu Hospital from October 1 2006 to October 1 2014 were analyzed retrospectively. The patients were treated via parietooccipital approach (n=38) and temporal gyrus cortex approach (n=9) according to the different locations and directions of tumors. Thirty-two of them used neuronavigation and 26 used intraoperative ultrasound technology.

Thirty-eight patients were treated via parietooccipital approach, the tumors of 37 patients were resected totally (Simpson grade Ⅰ), and 1 was resected subtotally (Simpson grade Ⅳ). Nine patients were treated via temporal gyrus approach and their tumors were resected totally. The symptoms of intracranial hypertension of 30 patients were relieved with varying degrees after procedure; the symptoms of hemianopsia of 9 patients were improved after procedure, 2 aggravated, and 1 was a new case; ataxia and other movement disorders of 8 patients were improved; 2 patients underwent ventricle-peritoneal shunt and puncture drainage respectively because of hydrocephalus. In this group, 29 patients were followed up for 3 months to 8 years (mean 47 months) after procedure. Two patients had recurrence and were reoperated.

Lateral ventricle meningioma prefers surgical treatment. Choosing appropriate surgical approaches with the help of neuronavigation and intraoperative ultrasound and other techniques may decrease the postoperative complication rate and achieve good operation effect.

To evaluate the effects of ultrahigh-field intraoperative magnetic resonance imaging (iMRI) in combination with function neuronavigation on extent of resection of insular glioma and postoperative neurological function.

Thirty-eight patients with insular glioma who received iMRI in combination with functional neuronavigation surgery were enrolled between January 2013 and April 2014. The extent of resection and postoperative complications were evaluated.

Residual tumors in 20 patients (53%) were found by iMRI. They were removed again in 17 patients after scanning. After further resection, the residual tumor volume was decreased from 17.9 ml to 1.1 ml (P=0.0002). The extent of resection increased from 96.9% to 99.2% (P=0.0013). 24% of patients had neurological dysfunction after procedure.

iMRI in combination with functional neuronavigation surgery is safe and effective. It significantly increases the extent of resection of insular glioma and protects neurological function.

To investigate the methods of MRI 3D reconstruction of dural tail sign of meningiomas and its guiding significance for meningioma resection.

Twenty-three patients with convexity meningioma and parasagittal meningioma with dural tail sign on contrast-enhanced MRI-T1 images treated at the Department of Neurosurgery of Linyi People's Hospital, Shandong Province were selected from May 2013 to November 2014. After injection of gadolinium diethylene-trianmine pentaacetic acid (DTPA) enhancer, MR 3D-FLASH T1MPR sequence axial scanning was performed, and the layer thickness was 1.5 mm. the syngo program was used to perform the 3D reconstruction of dural tail sign. The vertical diameter and anteroposterior diameter of meningioma dural tail sign on the enhanced T1 MRI tomographic images and 3D reconstruction images were measured and compared. The surgical incisions were designed by using the 3D reconstruction images of dural tail sign, and their advantages and disadvantages were evaluated under the guidance of navigation.

Dural tail sign performed MRI 3D reconstruction could reveal its overall picture. Most of dural tail signs around the tumors were uneven. The dural tail sign extended farther nearby the dural vessels. The vertical diameters of dural tail sign measured on contrast-enhanced T1-MRI were 2.74-7.54 cm (mean 4.67±1.234 cm); the vertical diameters of dural tail sign measured on 3D reconstruction images were 2.75-7.64 cm (mean 4.70±1.249 cm). There was no significant difference between both of them (P>0.05). The anteroposterior diameters of dural tail sign measured on contrast-enhanced T1-MRI were 2.84-7.61 cm (mean 4.81±1.19 cm); the anteroposterior diameters of dural tail sign measured on 3D reconstruction images were 2.88-7.74 cm (mean 4.85±1.22 cm). There was no significant difference between both of them (P>0.05). Designing surgical incisions referring dural tail sign 3D reconstruction images, the excellent rate was up to 91%.

MRI 3D reconstruction can intuitively and accurately reveal the range and shape of dural tail sign, and thus provide evidence for meningioma incision design and dural resection range.

To investigate the effective surgical methods for the treatment of atypical glossopharyngeal neuralgia.

Thirteen patients with atypical glossopharyngeal neuralgia treated from January 2007 to April 2013 were analyzed retrospectively. The clinical symptoms, intraoperative findings, surgical methods, efficacy, and follow-up results of those patients were summarized and analyzed according to the literature.

Nine patients with vascular compression were treated by the microvascular decompression in combination with rhizotomy of glossopharyngeal nerve root and vagal nerve upper 2 to 3 rootlets. Four patients without clearly vascular compression were treated by rhizotomy of glossopharyngeal nerve root and vagal nerve upper 2 to 3 rootlets. The postoperative pain of the patients disappeared completely. The complications included simple dysphagia (n=1), dysphagia with hoarseness (n=1), hearing loss (n=1), and occasional dry cough with intracranial infection (n=1). They were followed up for 8 months to 7 years. Their complications disappeared completely. No recurrence was observed during the follow-up period.

Atypical glossopharyngeal neuralgia treated by microvascular decompression in combination with rhizotomy of glossopharyngeal nerve root and vagal nerve upper 2 to 3 rootlets may obtain a good efficacy.

To investigate the application value of microneurosurgery in combination with en-bloc idea in the resection of middle-lower sacral chordomas.

The chordomas only involving under S3 (including S3) are known as the middle-lower sacral chordomas. Eleven patients with middle-lower sacral chordoma were treated surgically from October 2007 to December 2012. The en-bloc resection concept was used as a guiding principle during the operation; osteotomy, nerve anatomy, and tumor separation were performed by using microneurosurgical technique in the specific removal process. The effect of operation and complications were observed.

In the case of keeping the capsule intact, the sacral chordomas were totally removed. The mean time of operation was 141 min, and the mean blood loss was 420 ml. The nerves were clearly identified under the microscope. The anterior nerve roots above bilateral S3 were retained completely in 9 cases, and the anterior nerve roots of the unilateral S3 were retained completely in 2 cases. The bowel and bladder functions were preserved completely in 10 cases at 6 months after procedure, and partially preserved in one case. The patients were followed up for a mean of 3.7 years. Two patients had local recurrence.

In the middle-lower sacral chordoma surgery, en-bloc resection in combination with microneurosurgery technique is conducive to en-bloc resection of sacral chordomas and protection of neurological function, and reduction of introperative blood loss. The recurrence rate is low.

To investigate the choice of operation methods for infant purulent meningitis combining subdural effusion.

The clinical data of 170 infants with subdural effusion admitted from June 2000 to June 2012 were analyzed retrospectively. The individualized treatment modalities were selected.

Of the 30 infants underwent intermittent punctures, 15 (50.0%) were cured; of the 30 infants underwent venous indwelling needle tube drainage, 17 (56.7%) were cured; of the 69 infants underwent minimally invasive drilling drainage, 55 (80%) were cured; of the 30 infants underwent minimally invasive drilling drainage + drug lavage, 19 (63.3%) were cured, and 6 (100%) underwent effusion cyst-peritoneal shunt were cured; of the 5 infants underwent craniotomy, 4 (80.0%) were cured, and 1 died because of invalid treatment of recurrent meningitis.

Infant purulent meningitis combining subdural effusion should choose individualized treatment program. The effect of minimally invasive drilling and drainage is certainly. When necessary, the effect of drug flushing is better. Refractory cases for effusion cyst-peritoneal shunt and craniotomy can achieve a satisfactory effect.

To investigate the rebleeding risk after cerebral hemorrhage surgery for oral administration of aspirin and the development of treatment decision.

A total of 306 patients with intracerebral hemorrhage surgery with a history of oral administration of aspirin at the Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University from January 2009 to December 2014 were analyzed retrospectively. The influencing factors of postoperative rebleeding were analyzed by using a case-control study. Preoperative thrombelastography (TEG) was used to examine the arachidonic acid (AA) pathway induced platelet inhibition rate, and the inhibition rate ≥75% was used as the criterion of postponing emergency surgery. The postoperative rebleeding risk differences between the different treatment regimens and between the different surgical procedures were compared.

The postoperative rebleeding rate of the inhibition rate ≥75% group was 26.9%, the delayed surgery group was 4.1% (OR, 8.566, 95% CI 2.279-32.190; P=0.001). The rebleeding rate of the inhibition rate <75% group was 7.6% ( OR, 1.923, 95% CI 0.594-6.224; P=0.275); the inhibition rate ≥75% group compared with the inhibition rate <75% group ( OR, 4.455, 95% CI 1.539-12.891; P=0.006). The emergency craniotomy group compared with the delayed surgery group, the rebleeding rate was 15.9% (OR, 4.399, 95% CI 1.215-15.919; P=0.024).

The platelet inhibition rate ≥75% induced by AA pathway can be used as a predictor for the high risk of postoperative rebleeding in patients with cerebral hemorrhage for oral administration of aspirin. The surgical methods and treatment choice can be chosen reasonably according to the own experiences and technological advantages of surgeons

Intraspinal dural dissection cyst is one of the extremely rare diseases in neurosurgery. At present, most of the clinical reports on dural dissection cyst are case studies^[1,2,3,4]There are few related studies summarizing the clinical and imaging features and treatment methods of this disease. This study retrospectively analyzed the data of 5 patients with intraspinal dural dissection cyst admitted to the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University from January 2003 to May 2014, and discussed their clinical manifestations, imaging features and surgical methods, which are reported as follows.

With the development of skull base surgery technology up to today, there are fixed and relatively mature surgical approaches for tumors in certain specific parts of the cranium. However, for huge intracranial tumors, several important anatomical areas are often involved at the same time. To achieve total or subtotal tumor resection, several surgical approaches are required to be combined at the same time. It goes without saying that although this kind of craniotomy brings hope to patients, its huge trauma and postoperative complications often seriously threaten the quality of life of patients. With the development of neuroendoscopic technology, endoscopic assisted surgery has gradually appeared, which greatly reduces the problems caused by surgery. This paper discusses the microscopic anatomy and surgical scope of the retrosigmoid approach assisted by endoscope in the posterior fossa-cerebellopontine angle (CPA) area.

Epidural hematoma is a common type of craniocerebral trauma in clinic. At present, there are few clinical studies on pediatric epidural hematoma. From January 2002 to December 2013, a total of 106 cases of pediatric epidural hematoma were treated in the Department of Neurosurgery, General Hospital of Ningxia Medical University, and the treatment effect was good. The report is as follows.

To investigate the relationship between the endoplasmic reticulum stress markers GRP78, CHOP expression and the neuronal apoptosis after subarachnoid hemorrhage (SAH).

A total of 108 male SD rats were randomly divided into a control group, a sham operation group, and an operation group. Neurological deficit score was used to score the neuroethology in rats at 1, 6, 12, 24, 48, and 72 h. TUNEL assay was used to detect neuronal apoptosis. Western blot was used to detect the GRP78 and CHOP protein expression.

The neuroethology scores showed that the score of the operation group decreased significantly compared with the control and sham operation groups at 12, 24, 48, and 72 h. There were significant significances (P<0.05). The results of neuronal apoptosis showed that the operation group increased significantly compared with the control and sham operation groups. There were significant differences (P<0.01). The number of apoptotic cells was less at 1 h; it increased at 6 h and reached the peak value at 24 h. There were significant differences in comparison the number of apoptotic cells at different time points (P<0.01). The GRP78 protein expression showed that the operation group increased significantly compared with the control and sham operation groups at 1, 6, 12, 24, and 48 h. There were significant significances (P<0.01). The level in the operation group began to increase at 1 h. There were significant differences in comparison of different time points (P<0.01). The CHOP protein expression showed that the operation group increased significantly compared with the control and sham operation groups. There were significant significances (P<0.05). The level in the operation group increased at 1 h, and it reached the peak value at 24 h. There were significant differences in comparison of the different time points (P<0.01). There was a positive correlation between GRP78, CHOP and neuronal apoptosis (r=0.723, r=0.909, P<0.01).

GRP78 and CHOP play an important role in the pathological process of early brain injury after SAH.

To conduct the phenotypic study for the label-retaining cells in suspension cultured brain glioblastoma stem cell spheres.

Label-retaining assay was used to distinguish the label-retaining cells from label negative cells in the stem cell spheres of glioblastoma. In vitro clonal analysis was used to compare the self-renewal capacity of the above two types of cells. Western blot was used to detect the expression of differentiation markers before and after differentiation, and their in vitro differentiation capacity was assessed. After giving the radiotherapy or chemotherapy treatment, cell proliferation was detected, and their radiotherapy and chemotherapy sensitivities were assessed. Implantation of the tumor cells into the brain of immunocompromised mice was used to assess their tumorigenic ability.

Two weeks after initial DiI fluorescently labeled tracer, the glioblastoma stem cell sphere cells distinguished the slow proliferative DiI retaining cells, their ratio was <10% with the fast proliferative DiI negative cells. After several passages clonal analysis of the DiI retaining cells, the ball forming rate of clone remained constant, while the DiI negative cells were decreased significantly ( P<0.05). After the DiI retaining cells were differentiated, the protein expressions of the differentiation markers GFAP, PDGFRα, and βIII-tubulin were significantly upregulated compared with those before differentiation (P<0.05). After giving an irradiation dose of 10 Gy or being treated with 500 μm/L temozolomide for 72 h, the proliferation of DiI retaining cells did not have any changes compare with that before treatment, while the proliferation of DiI negative cells was decreased significantly (P<0.05). Only about 100 DiI retaining cells could form tumors in the immunodeficient mice brains at the longest follow-up observation of 6 months, whereas a corresponding number of DiI negative cells failed to form tumors.

Relative to the label negative cells, showing the label-retaining cells with slow proliferation properties in the glioblastoma stem cell spheres enriched tumor stem cells.

To study the imaging findings and pathologic changes of early radiation injury of normal brain tissue in rats with gamma ray irradiation.

Seventy adult SD rats were randomly divided into either a radiation group or a control group. Using the self-made rat stereotactic head frame, the right side of rat brain tissue was irradiated by 100 Gy doses. Each observation time point received 7.0 T head MRI and diffusion tensor imaging (DTI) at 1, 2, 3, 4, 5, 6, and 7 weeks after radiation. The values of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were statistically analyzed. Brain tissue samples were obtained for pathological observation at the same time.

(1) The findings of DTI: There were significant differences in rADC values and rFA values from the 4th week between the radiation group and the control group (the ratios at the 4th, 5th, 6th, and 7th weeks were 1.27±0.06 vs. 0.98±0.04 and 0.75±0.05 vs. 1.04±0.05, 1.52±0.08 vs. 0.98±0.03 and 0.64±0.08 vs.1.04±0.05, 1.35±0.09 vs. 1.00±0.02 and 0.63±0.03 vs. 1.04±0.05, and 1.37±0.10 vs. 0.99±0.05 and 0.58±0.04 vs. 1.04±0.03, respectively; all P<0.01). (2) The pathological changes of brain tissue after radiation included two stages: Early microvascular peripheral edema and the structural integrity of blood-brain barrier structure; late target lesions changed significantly, including the decreased number of neurons and glial cells, vasodilatation and deformation, obviously damaged blood-brain barrier structure, and myelin disintegration.

Early change of rat brain tissue radioactivity is mainly vasogenic edema. The changes of neurons, glial cells, microvascular damage, and demyelination appear in late stage, and these significant changes are consistent with the findings of DTI, indicating the value of DTI in the studies of radiation damage.

To investigate the effect of growth hormone (GH) excess on the functions of human umbilical vein endothelial cells (HUVECs) lines incubated in vitro and the intervention effect of fasudil hydrochloride on the related functional changes.

HUVECs were incubated in vitro, and they were divided into a control, a growth hormone excess, and a fasudil hydrochloride group. The changes of cell viability in each group were detected by CCK-8 assay, and the differences of endothelial cell tube formation ability in each group were detected by the matrigel tube formation assay. The changes of nitric oxide (NO) content in each group were detected by the fluorescence method. The changes of total protein of endothelial NO synthase (eNOS) and eNOS (Thr⁴⁹⁵) phosphorylated protein were detected by Western blot.

Compared with the control group, a long-time GH excess level incubation did not have significant inhibitory effect for the endothelial cell proliferation activity, but it inhibited the endothelial cell tube formation ability (P<0.05); while fasudil significantly improved the endothelial cell tube formation ability after GH excess level treatment (P<0.05). Compared with the control group, the protein expression of phosphorylated eNOS (Thr⁴⁹⁵) increased significantly under the GH excess level, the NO release decreased significantly (P<0.05); while fasudil inhibited the GH excess level induced eNOS (Thr⁴⁹⁵) phosphorylation, thereby promoting the release of NO (P<0.05).

The GH excess level may result in diminished the endothelial cell tube formation ability, and reduce the generation of NO through eNOS (Thr⁴⁹⁵) phosphorylation. Fasudil hydrochloride may partially inhibit GH excess level, thereby improving the corresponding function of endothelial cells.

To study the neuroprotection mechanism of mild hypothermia using a neuronal injury model and protein two-dimensional gel electrophoresis.

A neuron damage model was induced by the cell lysates soak assay. Neurons were cultured in temperature-controlled incubator at 33 ℃ and 37 ℃ respectively. The lactic acid dehydrogenase level in the culture supernatant was tested. TUNEL apoptosis assay was use to compare the cell apoptosis under the 2 culture temperatures. The total cellular protein was extracted. The protein two-dimensional gel electrophoresis technique was used to screen the differential protein spots. Mass spectrometry was used to complete the protein identification. Western blot was used to conduct protein confirmation. Statistical methods were used to analyze the test results.

The impaired neuronal lactate dehydrogenase level and the cell numbers of occurring in situ apoptosis were significantly lower than those of the 37 ℃ culture group under the low temperature condition (P<0.05). A total of 14 differential protein spots were screened using the two-dimensional gel electrophoresis, 12 of them were identified effectively. They were involved in a variety of pathophysiological processes, including cellular energy metabolism, regeneration, and oxidative stress.

Mild hypothermia plays a certain neuroprotective effect by intervening and regulating multiple molecular events, including cellular energy metabolism, regeneration, and oxidative stress.

In recent years, vascular bypass technology has been widely used in ischemic cerebrovascular diseases, complex aneurysms and skull base tumors^[1,2,3]。 Low flow (<90 ml/min) of intracranial and extracranial carotid system vascular anastomosis can no longer meet the clinical needs^[4]High-flow (≥90 ml/min) intracranial and extracranial vascular bypass surgery is increasingly used^[5,6]。 However, there are few reports of experimental research on high-flow vascular bypass using canine external carotid artery at home and abroad. The purpose of this study was to establish a high-flow bypass model of common carotid artery-external carotid artery in dogs, so as to provide a simulation platform for related technical training.

pituitary adenoma (PA) is a common intracranial tumor, accounting for about 15% of intracranial tumors. In recent years, with the development of endocrine examination and medical imaging, the detection rate of this tumor has been increasing^[1,2]。 The clinical manifestations of pituitary adenoma are mainly caused by tumor occupying effect and endocrine dysfunction. According to whether they have secretory function, pituitary adenomas are divided into functional (also known as secretory) and non-functional. The former includes prolactinoma, gonadotropin adenoma, growth hormone adenoma, adrenocorticotropin adenoma, thyrotropin tumor and mixed adenoma. Patients with such tumors show symptoms of excessive secretion of corresponding hormones, such as lactation, amenorrhea, infertility, sexual hypofunction, acromegaly, Cushing's disease, etc., which seriously affect the quality of life of patients^[3]However, cognitive function is an important part of quality of life. At present, there is no relevant research in China and relatively few abroad. In order to improve the quality of life of patients with pituitary adenoma, we reviewed the cognitive function of patients with pituitary adenoma and the influence of various treatment methods on it, as well as the possible mechanism of occurrence.

medulloblastoma (MB) is the most common malignant brain tumor in children, with the peak incidence of 4-7 years old. It can also involve infants, young children and the elderly, and is relatively rare in adults^[1]。 MB is a tumor of embryonic origin, and its etiology has not been conclusive. Genetics found that some neuroneoplastic syndromes (such as Gorlin syndrome, Turcot syndrome, Li-Fraumeni syndrome, Rubinstein-Taybi syndrome) are genetically susceptible and positively correlated with MB^[2]。 Approximately 30% of MB patients present with disseminated metastases at the first diagnosis. Clinically, the standard treatment of MB includes surgery, radiotherapy combined with chemotherapy, but the overall effect is not good. Standardized comprehensive treatment can prolong the life of some patients, and iatrogenic collateral injury also seriously affects their quality of life. In the past 20 years, clinicians have divided patients into high-risk groups and standard-risk groups according to the risk of MB recurrence or metastasis (age of onset, tumor dissemination, postoperative residual tumor burden, etc.), and given different degrees of radiotherapy and chemotherapy accordingly. Although radiotherapy and chemotherapy regimens are constantly improving, they have not changed the overall treatment strategy of MB. In recent five years, MB has made great progress in the research of tumor genomics and biological cytology. These achievements have rapidly promoted the development of MB molecular typing, revolutionized clinicians' cognition of MB, and accordingly made molecular targeted therapy an important link in comprehensive therapy^[3]。 This article will review the literature from the study of the origin of MB to the development of molecular typing, expound the influence of basic research progress on clinical treatment, and explore the best treatment options for different molecular subtypes of MB.

disorders of consciousness (DOC) include vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS), mostly due to severe brain injury^[1]。 At present, the diagnosis of these states is relatively clear, but the treatment is quite limited. Although deep brain stimulation (DBS) is invasive, research on this treatment has been steadily increasing in recent years. At present, DBS is used in the treatment of many neurological diseases, especially Parkinson's disease, and the advancement of this technology has benefited many patients. It is because of these advances that DBS has been developed in the therapeutic application of DOC. This article will summarize DBS technology and its clinical application, systematically review the research reports of DBS in the treatment of DOC, and explore the possible mechanism of DBS in the treatment of DOC.