Volume 31 · Issue 09 · 2015

To investigate the influencing factors of transnaso-sphenoidal approach for the treatment of clival chordomas under the neuroendoscope.

One hundred twenty-three patients with clival chordoma treated by the endoscopic professional group with the transnaso-sphenoidal approach at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2009 to August 2014 were analyzed retrospectively. A total of 160 patients underwent endoscopic surgery. The statistical analysis was performed for the possible factors that might affect the total resection.

A total of 123 patients received 160 surgeries. Forty-six clival chordomas were removed completely under the neuroendoscope. The total resection rate was 28.8%. Among the factors analyzed, there were significant differences in the effects of tumor on clival location, its relationship with cavernous sinus, the extent of tumor calcification, tumor volume, tumor hardness, application of navigation, surgery treatment history, radiotherapy history and year of treatment on the total resection rate (P<0.05).

Removal of clivus chordoma with neuroendoscopic techniques is safe and effective. The factors affecting total resection include the tumor on clival location, relationship between tumor and cavernous sinus, extent of calcification, tumor volume, tumor hardness, surgery and radiotherapy history, etc. With the application of new navigation equipment and the accumulation of surgical experiences of neurosurgeons, the total resection rate will be improved significantly.

To investigate the clinical characteristics and treatment methods of delayed epistaxis after neuroendoscopic transnasal transsphenoidal surgery.

The clinical data of 14 patients with delayed epistaxis after neuroendoscopic transnasal transsphenoidal surgery were analyzed retrospectively. The clinical features and treatment of this complication were analyzed.

The incidence of delayed epistaxis after procedure was 1.1% (14/1 224) in this group. Nine patients had nasal bleeding from 7 to 15 d after procedure; 2 had nasal bleeding at ≤2 d after procedure, and 3 had nasal bleeding from 3 to 4 weeks after procedure. The mean nasal bleeding time was 10.3 d after procedure. Of the 14 patients, 9 had active and permeating bleeding in nasal cavity, 4 had nasal hematorrhea, and 1 had nasal hematorrhea with shock and suffocation. Thirteen patients were sphenopalatine artery and its branch bleeding, and 1 was Littlehampton area bleeding. Nine patients used endoscopic surgery for electric coagulation hemostasis; 3 received transnasal endoscopic lower posterior naris packing hemostasis; and 1 underwent nasal packing hemostasis. One patient had asphyxia and caused respiratory arrest because of nasal hematorrhea. He showed a persistent vegetative state after cardiopulmonary resuscitation. The patients were followed up for more than 12 months (mean 15.3 months). Thirteen patients recovered well and no recurrent epistaxis occurred, one died of multiple organ failure at one month after procedure.

Delayed epistaxis is a rare complication of endoscopic transsphenoidal surgery. Early, timely, and correct individualized diagnosis and treatment can effectively control epistaxis and the prognosis is good.

To summarize the surgical techniques of Rathke's cleft cyst resection via the fully endoscopic supraorbital trans-eyebrow keyhole approach and to evaluate its efficacy and the advantages and disadvantages.

Twelve patients with Rathke's cleft cyst confirmed by pathology at the Department of Neurosurgery, Nanfang Hospital, Southern Medical University from May 2012 to October 2014 were analyzed retrospectively. The clinical manifestations included headache, visual impairment, polydipsia, polyuria, and pituitary dysfunction. CT and MRI revealed the cystic masses in saddle areas. The maximum mean diameter was 29.3 mm, in which 4 lesions were located entirely on the suprasellar areas, and 8 were located on intrasellar suprasellar areas. All patients were treated with cyst resection via the fully endoscopic supraorbital trans-eyebrow keyhole approach.

The cyst contents were all removed and part of cyst walls were resected in 12 patients. All were pathologically confirmed as Rathke's cleft cyst. The preoperative symptoms of all patients were cured or improved. Two patients had transient polyuria, and they discharged at 3 to 4 days after procedure. They were followed up for 3 to 24 months after procedure. No recurrence was found on imaging examinations.

The fully endoscopic supraorbital trans-eyebrow keyhole approach is suitable to intrasellar suprasellar Rathke's cleft cyst which is entirely located on the suprasellar area or the main body is located on the suprasellar area. This approach has the advantages of minimal invasiveness, rapid recovery and the absence of cerebrospinal fluid leakage and other complications. The neuroendoscopic technology may further reduce trauma and expand the field of vision, especially beneficial for the observation and removal of intrasellar cyst.

To investigate the application value of neuroendoscope techniques in primary hemifacial spasm of the local complex anatomy aiming to the difficulties of primary hemifacial spasm surgery.

Forty-two patients with hemifacial spasm of the local complex anatomy were treated with neuroendoscope-assisted microvascular decompression at the Department of Neurosurgery, Wuxi No. 2 Hospital Affiliated to Nanjing Medical University from January 2008 to January 2012. When the blind area appeared during the operation, a neuroendoscope was used to perform comprehensive observation of the surgical area, exploring the facial nerves from the brain stem area and distal end, and carefully distinguishing the relationship between the nerves and the blood vessels. The offending vessels were confirmed. After decompression, a neuroendoscope was use to reexamine whether there were omission of offending vessels and vascular excessive stretch, twisting in an angular shape, or formation of a new compression. The clinical and imaging data of all patients were analyzed retrospectively and were followed up after procedure.

All patients were followed for 18-30 months (mean 25 months). Forty-one patients had complete remission after procedure without recurrence (98%), 3 recovered from Shorr grade Ⅰ to grade 0 at discharge, 1 with hearing loss was fully restored within 6 months, and 1 with Shorr grade Ⅱ did not obviously aggravate at the end of follow-up.

Neuroendoscopy is an useful complement to microvascular decompression for the treatment of hemifacial spasm, particularly in patients with local anatomical complex or unusual hemifacial spasm, such as combining the advantages of neuroendoscopy may improve the operation effect under the conditions of small posterior fossa volume, full cerebellum pompoms, rock bone block, local arachnoid adhesions and thickening, and identifying offending vessels with difficulty.

To evaluate the clinical efficacy of transnaso-sphenoidal microsurgery and neuroendoscopic resection of pituitary adenoma.

All the English literature about the randomized controlled trials or case-control studies reporting neuroendoscopy and treatment of pituitary adenoma under the microscope were collected by searching the database, including PubMed, Web of Science, Embase, and the Cochrane Library. The data were used to conduct meta-analysis using Review Manager 5.3 software.

A total of 22 literatures were enrolled after screening. A total of 1 987 patients were studied, including 1 000 in a neuroendoscope group and 987 in a microscope group. In terms of total resection rate, the combined odds ratio using the fixed effect model was 1.62 (95% CI 1.21-2.17, P=0.001); and in terms of postoperative complications, there were no significant differences in cerebrospinal fluid leakage, diabetes insipidus, meningitis, nasal complications between the two groups (all P>0.05). The postoperative hospital stay of the neuroendoscope group was shorter than that of the microscope group (P<0.05), and there was no significant difference in operation time between the two groups (P>0.05).

According to the literature available, the total resection rate of neuroendoscopic transnaso-sphenoidal resection of pituitary adenoma was significantly higher than that of transnasal sphenoidal microsurgery. There was no significant difference between the postoperative complications and the operation time, but neuroendoscopy had some advantages for shortening the hospitalization time after procedure.

chronic subdural hematoma (CSDH) is a common disease in neurosurgery, accounting for about 10% of all kinds of intracranial hematoma, and it occurs in the elderly. Once symptoms of brain compression appear, surgery should be performed^[1]。 Drilling, irrigation and drainage is generally recognized as the first choice for the treatment of CSDH, but the recurrence rate of 3% ~37% is still reported in literature^[2]Among them, the recurrence rate of hematoma after septal CSDH is relatively high. From June 2011 to August 2013, 26 cases of CSDH were treated with soft neuroendoscopy in the Department of Neurosurgery, Beijing Shijitan Hospital affiliated to Capital Medical University, with satisfactory clinical results, which are reported below.

Chiari malformation is a congenital malformation of the craniocervical junction, clinically characterized by hernia of the cerebellar tonsil into the foramen magnum, with or without syringomyelia^[1,2]。 Atlas-occipital decompression surgery to relieve the compression of foramen magnum and cervical spine on cerebellum, brainstem, spinal cord, fourth ventricle and other nerve tissues is the main treatment method^[3]。 From March 2013 to March 2015, six patients with symptomatic Chiari type I malformation were treated in the Department of Neurosurgery of Tianjin Huanhu Hospital. Neuroendoscopy combined with intraoperative ultrasound technique was used for atlantooccipital decompression, and the results were good. The report is as follows.

Compared with craniotomy, stereotactic technique has the advantage of accurate positioning, and neuroendoscopic technique can perform surgical manipulation on the lesion under the condition of direct vision of the lesion area. The characteristics of the two technologies make them quickly popularized and applied in clinical practice. However, the use of the above two techniques independently also has their own limitations. Stereotactic surgery cannot look directly at the puncture channel during the positioning of puncture, and its blindness makes it easy to damage blood vessels during puncture, resulting in bleeding, and the bleeding is difficult to detect and stop^[1]； Neuroendoscopic technique lacks precise positioning, and the brain tissue may be damaged by finding the location of the lesion during operation. In order to overcome the limitations of the two technologies, the Second Department of Neurosurgery of the First Affiliated Hospital of Kunming Medical University began to absorb the experience of many parties since 2009, and after repeated discussion and research, the two technologies were combined into one, and dozens of cases of intracranial micro-lesions were successfully completed. Treatment, truly realizing the minimally invasive concept of neurosurgery. Among them, 7 cases of intracranial cavernous malformation (CM) were treated with this technique, and the curative effect was satisfactory.

To investigate the surgical skills of keyhole approach in the treatment of aneurysms of the ophthalmic segment of internal carotid artery.

The clinical data of 28 patients with aneurysms at the internal carotid-ophthalmic artery segment operated via keyhole approach at the Department of Neurosurgery, the Second Affiliated Hospital of Soochow University from September 2006 to December 2013 were analyzed retrospectively, including 6 large aneurysms and 9 giant aneurysms. Thirteen patients had ruptured aneurysms, 15 had unruptured aneurysms, and 5 accompanied with multiple aneurysms. Twenty-two of them were treated via the supraorbital keyhole approach (2 via contralateral approach), and 6 via the pterional keyhole approach.

Of the 28 ophthalmic artery aneurysms, 27 were clipped, 1 was good in the collateral circulation of posterior communicating artery and was trapped; 5 patients with multiple aneurysms underwent one-stage clipping via the same approach. Because of the huge thrombi in the aneurysms, only removal of the thrombi in 4 aneurysms during the operation, could they be clipped completely; 20 patients were treated with the removal of the anterior clinoid process. Reexamination after procedure, the necks of 2 giant aneurysms had slight residues. One patient had cerebrospinal fluid rhinorrhea after procedure and was repaired via sphenoidal approach; 1 patient lost his ipsilateral sight with preoperative ipsilateral visual light perception; 2 had cerebral infarction after procedure. The other patients were good after procedure.

Under the keyhole approach, the removal of the anterior clinoid process, parent artery remodeling, thrombectomy in aneurysms, multiple clips and strengthening clipping can be performed. The supraorbital keyhole approach is applicable to most of the patients with ophthalmic artery aneurysm, while the patients with pale eyebrows and wide-necked aneurysms pointing to the outside of internal carotid artery, the pterional keyhole approach can be used.

To investigate the effectiveness and safety of endovascular stent angioplasty for the treatment of intracranial posterior circulation artery stenosis via radial the approach.

Sixteen patients with symptomatic intracranial vertebral-basilar artery stenosis failed to medical treatment were treated by stent angioplasty via the radial approach at the Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University from January 2012 to December 2012. The surgical success rate, perioperative complications, and clinical efficacy were observed.

In the 16 patients, 9 Apollo stents and 7 Winspan stents were implanted into the V4 segment of the vertebral artery and basilar artery. One balloon-expandable stent was implanted into a vertebral artery opening. Angiography immediately after procedure, all the residual stenoses were less than <20%, and the technical success rate was 100%. No perioperative complications such as arterial dissection, in-stent thrombosis, and intracranial hemorrhage occurred. The clinical symptoms after procedure were improved significantly compared with before procedure. The postoperative hemodynamics was improved significantly. The vertebral-basilar artery stenosis rate was decreased from 82.3±6.3% before procedure to 5.1±6.0% after procedure. The postoperative National Institutes of Health Stroke Scale (NIHSS) scores of the patients did not increase. The patients were followed up by telephone for 5 to 14 (8.9±2.5) months; the clinical symptoms of 15 patients (93.8%) were improved or disappeared. One patient (6.2%) experienced transient ischemic attack (TIA) in posterior circulation again in hospital. The reexamination found an in-stent restenosis, and he was treated with in-stent balloon dilatation in hospital.

Treatment of symptomatic vertebral-basilar artery stenosis with endovascular stent angioplasty via the radial approach is a safe and effective method.

To investigate the treatment strategies of bifrontal contusions and the related risk factors for progress deterioration.

The clinical data of 61 patients with bifrontal contusions treated from December 2011 to December 2014 were analyzed retrospectively. All patients performed the probe implantion of intraventricular intracranial pressure after admission. Postoperative intracranial pressure and drainage of cerebrospinal fluid were monitored continuously. When the disease progressed and deteriorated, the craniotomy was performed immediately.

The conditions of 38 patients (62%) were not worsening and were treated conservatively; those of 23 patients (38%) were worsening and were treated surgically. There was significant difference in the prognoses between the two groups (P>0.05). The angle between the frontal horns >120°, scattered frontal contusion, frontal hematoma (edema) over bilateral sphenoid ridge line were the independent risk factors for leading to the occurrence of deterioration (P<0.05).

Intracranial pressure monitoring is the basis for the treatment of bifrontal contusions. Strictly controlling the intracranial pressure under the 20 mm Hg by using cerebrospinal fluid drainage and other therapeutic measures is the key to the success of conservative treatment. The angle between the frontal horns >120° can be used as a quantitative indication of craniotomy, at the same time, scattered frontal contusion, frontal hematoma (edema) over bilateral sphenoid ridge line can also be used as the reference indices of craniotomy.

To investigate the methods of effective removal of the middle third parasagittal meningioma in order to improve its clinical efficacy and decrease the postoperative complications.

The tumors were resected with a relatively conservative strategy by using lateral supine and preserved the superior sagittal sinus and draining veins as much as possible. When tumor residues were obvious and progressive during the follow-up period, they were given adjuvant radiation therapy. Finally, the clinical data including surgical effect and postoperative complications were analyzed statistically.

Of the 124 patients, 96 (77.4%) achieved total resection; 28 (22.6%) achieved subtotal resection. They were followed up for 6 to 60 months after procedure, 13 (10.5%) had recurrence, including 9 females (12.2%) and 4 males (9.3%). Nine patients (9.4%) of total resection had recurrence, 4 (14.3%) of total resection had recurrence. There was no significant difference in the recurrence rate between the different genders (P>0.05). There was no significant difference in the recurrence rate between the patients of total resection and those of subtotal resection (P>0.05). After procedure, 120 patients recovered well and returned to work. Two (1.6%) had disability, but they could take care of themselves. Two patients (1.6%) died, one died of pulmonary embolism and the other died of myocardial infarction.

Using lateral supine and microsurgical techniques are conducive to the resection of tumors while protecting the draining veins and cerebral cortices. Preserving the patency of the superior sagittal sinus and draining vein as much as possible may reduce the postoperative mortality and disability. If necessary, using radiotherapy after procedure can also achieve good long-term efficacy.

To investigate the pre-hospital epidemiological data and in-hospital treatment status of the patients with hypertensive cerebral hemorrhage among the different nationalities in Xinjiang.

The medical records of 3 550 Han, Uygur and Kazak patients with hypertensive cerebral hemorrhage who lived in Xinjiang for more than 10 years were sampled from 14 hospitals between January 2010 and August 2012. Their incidence (14 hospitals covered the resident population of the region as a benchmark in the sixth national census 2010), prevalence characteristics, ethnic distribution, and treatment status were analyzed.

Of the 3 550 patients, the Han, Uygur, and Kazak were 2 386, 985, and 179, respectively, and the incidences of intracerebral hemorrhage of the 3 nationalities were 67.6/100 000, 35.1/100 000, and 39.6/100 000, respectively. The proportions of the Han male, Uygur and Kazak female patients were the highest (P<0.01). The proportion of intracranial hemorrhage was the highest among the population ≥60 years old in Han and Uygur, and that of intracranial hemorrhage of Kazak in the 45 to 59 years old was the highest (P<0.01). The lower the level of education, the higher the proportion of patients with intracerebral hemorrhage (P<0.01). The rates of smoking history, drinking history and history of heart disease were the highest in Han, followed by Kazak, and those of the lowest were Uygur (P<0.01). The proportion of the history of hypertension was higher in the 3 nationalities, and there were no significant differences. The overall trend of intracerebral hemorrhage was higher in winter and lower in autumn; Uygur and Kazak were the highest in summer and lowest in spring; and Han was the highest in spring. The incidence of intracerebral hemorrhage was highest at 2 time points (from 7 ∶00 to 12 ∶00 and 13 ∶00 to 18 ∶00) in the 3 nationalities (P<0.01). There were significant differences in GCS scores on admission and GOS scores at discharge among the 3 nationalities (P<0.01). All 3 nationalities were mainly treated with drugs. Surgical methods were mainly soft channel drilling and drainage. The cure rate of Han and Kazak was about 30%, and Uygur was the lowest (11.8%); the proportion of death was highest in Han patients and Uygur was the lowest.

Compared with Uygur and Kazak in Xinjiang, Han had some differences in the incidence of hypertensive intracerebral hemorrhage, age, season, onset time period, treatment modalities, and prognosis

To investigate the differences of clinical efficacy and its reason of cranioplasty using frozen autologous bone and three-dimensional CT titanium mesh repair schemes.

A multicenter controlled study was performed in 216 patients who underwent cranioplasty using frozen autologous bone after decompressive craniectomy because of craniocerebral injury from January 2008 to December 2010, and 139 patients were treated with three-dimensional titanium mesh at the same period. The differences of intraoperative blood loss, duration of surgery, and related complications after procedure, as well as the differences between the short- (within a month after surgery) and long-term (1 month to 3 years after surgery) infections after procedure at different time windows of the two schemes were compared.

There were significantly differences in intraoperative mean blood loss (t=10.205, P=0.000), mean operation time (t=13.957, P=0.000), uncomfortable at the operated area after procedure (χ²=7.565, P=0.006), fear of hot and cold (χ²=167.389, P=0.000), and fear of vibration (χ²=146.654, P=0.000) between the two repair schemes. There were no significantly differences in secondary epilepsy (P=0.563) and depressed deformation at the surgery area (P=0.304) between the two repair schemes. There was no significantly differences in the overall infection rate of the two schemes after procedure between the patients of the early autogenous bone repair group and those of the titanium mesh group (χ²=0.007, P=0.931), however, there was significantly difference in the recent infection rate (χ²=3.860, P=0.049) and long-term infection rate (χ²=3.962, P=0.047) between the two schemes.

The repair time window of the autologous bone group scheme was controlled within 1 to 3 months after craniectomy. The clinical effect was better than the titanium mesh repair scheme, in particular, it has obvious an advantage in reducing the long-term postoperative infection.

To evaluate the correlation between the anterior communicating artery aneurysm and the risk of rupture through measuring and analyzing its geometric parameters.

The anterior communicating artery aneurysms were divided into either a ruptured group or an unruptured group. The maximum tumor size ratio (SR)/diameter of parent artery, flow angle (FA), parent-daughter angle (PDA), volume-to-ostium ratio (VOR), A1/A2 diameter ratio, a ratio of aneurysm volume to bounding sphere volume (AVSV) were measured by computer software, and statistical analysis was performed by using SPSS 19.0 software.

The mean SR, VOR, A1/A2, and AVSV of the ruptured group were higher than those of the unruptured group (P<0.05) and PDA of the rupture group was less than that of the unruptured group (P<0.05); Multivariate analysis results showed that there were no significant differences in SR, FA, PDA, VOR, A1/A2, and AVSV between the 2 groups (P>0.05).

The geometry parameters have the objective significance for the evaluation of the risk of aneurysm rupture, and the bigger the values of SR, VOR, A1/A2, AVSV, the more easily ruptured aneurysm, and the smaller the value of PDA, the more easily ruptured aneurysm.

To investigate the feasibility and clinical efficacy of single pen-door laminoplasly and reconstruction of the posterior structure of spinal canal for the treatment of cervical intradural extramedullary tumors.

From January 2001 to January 2013, 87 patients with cervical intradural extramedullary tumor were treated by using the single open-door laminoplasty, reconstruction of the spinal posterior structure method, and 78 of them were treated with the single open-door setting off lamina, microsurgical resection of intraspinal occupying, lamina and spinous process complex in situ reduction, 9 were treated with single open-door laminoplasty and reconstruction of the spinal canal with mini titanium plate fixation after removal of the tumors.

They were followed up for 12 to 58 months (mean 26.3 months). The numbers of lamina open-door segments were 2 to 5 (mean 2.5). The mean operation time was 92 min (range 62-136 min); the intraoperative mean blood loss was 80 ml (range 50-260 ml). The postoperative clinical symptoms of the patients disappeared completely or mostly. Postoperative X-ray examinations of all cases did not show the signs of spinal instability, CT scan of 63 cases revealed that spinous process-lamina complex of reduction did not have invagination and displacement. MRI of 75 cases showed that their cervical intradural extramedullary tumors did not have recurrence. No spinal canal stenosis, yellow ligament, and dura thickening were observed. The changes of spinal curvature: cervical curvature decreased from preoperative 17.8±8.4° to 16.1±7.8° at 12 months after procedure. There was no significant difference between before procedure and after procedure (P>0.05).

Single open-door laminoplasty for the treatment of cervical intradural extramedullary tumor has satisfactory effect for tumor exposure and resection, at the same time; it saves the continuity of the lamina on one side. After spinous process-lamina complex of reduction, the original anatomical structures of spinal were recovered. It has little impact on the stability of the spine and can avoid the occurrence of spinal deformity after laminectomy.

Intracranial aneurysms are a common disease with an incidence of approximately 2% in adults^[1]Among them, multiple aneurysms account for about 25% to 30%^[2]。 Aneurysm rupture is the most common cause of subarachnoid hemorrhage (SAH), and the mortality and disability rate can be as high as 1/3 after first rupture hemorrhage^[3]。 Although the fatality rate of SAH has decreased with the improvement of medical level, the research on the risk factors affecting aneurysm rupture has been a hot spot in recent years. The risk factors affecting the rupture of multiple intracranial aneurysms are analyzed in this paper as follows.

Frontal and temporal lobe epilepsy is the most common refractory epilepsy in adults. At present, the main surgical treatment methods of frontal and temporal lobe epilepsy are epileptogenic resection and lobectomy. However, these surgical methods often have some complications, such as: brain tissue displacement, subdural effusion, oculomotor nerve paralysis, etc^[1]。 From January 2013 to June 2014, the Department of Neurosurgery of Tianjin Huanhu Hospital treated 7 patients with refractory frontal and temporal lobe epilepsy with prefrontal or anterior temporal lobe dissection, and achieved good therapeutic results, which are reported below.

To investigate the influence of long noncoding RNA HOX transcript antisense RNA (HOTAIR) on human glioma cell metabolism and growth.

The fluorescently labeled small interfering (si-HOTAIR) was used to transfect glioma U87 and U251 cell lines. The real-time polymerase chain reaction (RT-PCR) was used to detect the expression level of HOTAIR in glioma cells. CCK8 test and colony formation assay were used to detect the growth changes of the glioma cells. Seahorse BioScience XF glycilysis stress test kit and XF mitochondrial stress test kit were used to detect the cell aerobic glycolysis and mitochondrial function. Western blot was used to detect glycolysis related enzymes, including the expression levels of glucose-6-phosphate isomerase (GPI), Pyruvate kinase M2 (PKM2), and lactate dehydrogenase A (LDHA).

The transfection efficiency of si-HOTAIR in U87and U251cells observed under a fluorescence microscope was more than 90%. The HOTAIR expression in the cells of the si-HOTAIR group was downregulated significantly compared with the negative control group (P<0.01). The proliferative ability and clonal formation ability of the U87and U251 glioma cells of the si-HOTAIR group were significantly lower that than those of the negative group (P<0.01). After downregulation of HOTAIR, the aerobic glycolysis capacity of glioma cells were diminished, showing reduced based glycolysis level (P<0.05), diminished maximum glycolytic capacity (P<0.01), and decreased remaining amount of glycolysis (P<0.01). The expression levels of GPI, PKM2 and LDHA of the si-HOTAIR group were lower than those of the negative control group (P<0.01). After downregulation of HOTAIR, the mitochondrial function in glioma cells was impaired, showing decreased basal respiration level (U87 cellsP<0.01), decreased mitochondrial coupling efficiency, and diminished residual respiration ability (P<0.05).

Downregulation of HOTAIR expression may impair the glycolytic capacity and mitochondrial function of glioma cells, simultaneously influence the growing ability of glioma cells.

To investigate the 1p/19q deletion status of vascular endothelial cells in anaplastic oligodendroglioma (AO) and to analyze its relationship with survival period.

A total of 30 primary AO specimens with complete follow-up data from Beijing Tiantan Hospital, Capital Medical University were collected between January 2009 and January 2010. There were 14 females and 16 males, and their mean age was 45.9 years (range 23 to 61). Immunofluorescence technique was used to locate vascular endothelial cells. Fluorescence in situ hybridization (FISH) was used to detect the status of 1p/19q deletion. The paired t test was used to count 1p/19q deletion rate of vascular endothelial cells. Survival analysis method was used to assess its relationship with survival period.

The detection signal 1p36 deletion rate of AO vascular endothelial cells was significantly higher than its reference signal 1q25 (t=8.823, P<0.001); the detection signal 19q13 deletion rate was significantly higher than its reference signal 19p13 (t=8.316, P<0.001). The results of survival analysis showed that both the median progression-free survival (PFS) and overall survival (OS) of the patients with 1p/19q co-deleted of vascular endothelial cells were significantly better than those without 1p/19q deletion of vascular endothelial cells (PFS:χ²=16.199, P<0.01; OS:χ²=8.666, P<0.01). The result of Cox regression analysis showed that 1p/19q co-deletion of vascular endothelial cells was an independent prognostic factor (PFS:HR=0.063, 95% CI 0.013-0.313, P=0.001; OS: HR=0.145, 95% CI 0.310-0.678, P=0.014).

AO endothelial cells have a 1p/19q deletion phenomenon. 1p/19q co-deletion of vascular endothelial cells indicates that the prognosis will be good.

To observe the changes in a variety of molecular markers in the differentiation process from glioma stem cells to endothelial cells using live cell fluorescence imaging technique.

Live cell fluorescence imaging technique was used to study the differentiation process of glioma stem cell GSC-1 for dynamic observation of 12 h. The immunofluorescence staining was used to perform endothelial cell surface marker CD34 staining during the three dimensional culture at 0, 2, and 6 h, and the morphological changes of GSC-1 were observed by light microscopy.

Under the three-dimensional culture, GSC-1 cells could form tube-like structures. The number of some cells expressed endothelial cell markers CD34, CD34 positive cells increased with the time of differentiation (P<0.05), while stem marker disappeared gradually. Live cell fluorescence imaging observed that the number of CD34 positive cells increased with the time of induction and differentiation under the same field of vision. The whole process of a single GSC-1 cell transformed from a CD34 negative cell to a CD34 positive cell was observed.

The live cell fluorescence imaging technique detecting the cell differentiation process can get the same result of the traditional immunofluorescence assay, and it is more intuitive and accurate. It can follow up and observe a single cell for a long time.

Romani et al.^[1,2,3]Based on the pterional approach, a modified approach that is simpler and faster than the standard pterional approach has been developed, which they call the "lateral supraorbital approach" (LSO). LSO is more frontal than the pterional approach, which essentially utilizes the skull base space in front of the lateral fissure and on the subfrontal lateral side^[4]。 This method is simple, rapid and less invasive, and can replace the classical pterional approach pioneered and popularized by Professor Yasargil to treat anterior fossa floor, sellar region and suprasellar tumors, anterior circulation aneurysms and other lesions. In order to give full play to the advantages of LSO approach and carry out this approach quickly and well, the Neurosurgery Department of Qilu Hospital of Shandong University introduced the concept of standard operation procedure (SOP), which fully learned from Romani et al^[1,2,3]The characteristics of LSO approach, combined with the skinless wallet cranial opening and closing technology, according to the characteristics of temporal muscle and hairline in Chinese people, and based on the existing domestic conditions, the LSO hemless rapid cranial opening and closing technology has been carried out since 2011, and the SOP of this approach has been preliminarily formulated and practiced (Figure 1), the SOP and advantages of this approach are reported below.

At present, anti-epileptic drugs are still the first choice for epilepsy treatment, but 30% ~40% of patients eventually develop into drug-refractory epilepsy due to unsatisfactory seizure control or unable to tolerate the toxic side effects caused by the combined use of multiple anti-epileptic drugs^[1]。 Although some patients with drug-refractory epilepsy can undergo surgical treatment, the surgical outcome is not completely satisfactory, especially patients with neocortical epilepsy, which not only have poor surgical prognosis, but also often cause permanent neurological damage that is unpredictable before surgery. The presence of up to 30% of patients with drug-refractory epilepsy has prompted medical practitioners to look for new and ideal alternative treatments. At present, vagus nerve stimulation and reactive nerve electrical stimulation have been used in clinical treatment of drug-refractory epilepsy, with an effective rate of about 40% ~50%^[2,3]。 Some breakthroughs have been made in the research of deep brain electrical stimulation, transcranial magnetic stimulation, transcranial direct current stimulation, local drug administration to epileptic foci, photosensitization and other techniques for controlling epilepsy in laboratory or clinical trials^{[4,5,6,7,8,9]}。 In the past few decades, a large number of animal experiments and clinical studies in our laboratory and other research institutions have proved that local hypothermia not only can quickly terminate epileptic seizures, but also has the advantages of reversible effect on cortical function and protective effect on brain tissue, thus showing the broad application prospect of local hypothermia technology in the field of treatment of refractory epilepsy^{[10,11,12,13,14]}。 In this paper, the experimental research and clinical application of local hypothermia in the treatment of epilepsy, the mechanism of hypothermia inhibiting epilepsy, the effect of hypothermia on brain function, its application prospect and challenges are reviewed.

deep brain stimulation (DBS) refers to electrical stimulation of specific parts of the deep brain to achieve the purpose of treating or alleviating diseases or disorders related to the nervous system. DBS has the advantages of good selectivity, clear target, minimally invasive, adjustable and reversible, and has been successfully used in the relief and treatment of Parkinson's disease, dystonia, major depression, alcohol/drug addiction and other diseases^[1,2]。 For different neurological diseases, different deep functional areas of the brain need to be stimulated, and the precise selection of stimulation position and precise implantation of stimulation electrodes directly determine the therapeutic effect of DBS. Stimulation of non-treated areas may cause dysarthria, epilepsy, dyskinesia, cognitive, emotional changes, limb dysfunction and other adverse effects. In addition, with the rapid development of closed-loop DBS technology and the synchronous regulation of multifunctional symptoms such as disease movement and cognition, higher requirements are put forward for the accurate positioning of stimulation electrodes and even contacts and the fine detection of functional areas.

Craniopharyngioma is an embryonic benign tumor, which occurs in the sellar region and often involves important structures such as hypothalamus, pituitary stem and optic chiasm. Surgical resection is the main treatment for craniopharyngioma at present. Postoperative radiotherapy and chemotherapy can improve the clinical symptoms and prognosis of patients. Because the tumor is closely related to the surrounding structures, it is difficult to surgically resect, especially the craniopharyngioma in the third ventricle. The position of the third ventricle is deep and close to important structures such as hypothalamus and Willis ring. Therefore, it is an important task for neurosurgeons to protect the surrounding structures from damage while completely excising the craniopharyngioma in the third ventricle as much as possible. Simple craniopharyngioma in the third ventricle is different from other craniopharyngiomas in the sellar region in origin, clinical manifestation, imaging and surgical methods because of its special location, and at the same time, it needs to meet several conditions such as intact third ventricle floor, obvious suprasellar cistern, normal pituitary stem and sella turcica without obvious abnormalities^[1,2,3]。

indocyanine green (ICG) is a near infrared fluorescent tricarbocyanine green dye with maximum absorption wavelength and maximum fluorescence wavelength of 805 nm and 835 nm, respectively. After ICG is injected intravenously into the human body, it combines with globulin in blood and exists in blood vessels. Under near-infrared light source and fluorescence camera, it can emit fluorescence to develop blood vessels containing ICG, and finally is excreted after liver degradation. The first application of fluorescence imaging in neurosurgery appeared in 1967^[1]。 Since then, with the advent of surgical microscopes displaying indocyanine green video angiography (ICGVA), ICGVA has been widely used in neurosurgery. This article summarizes the current application of ICGVA in neurosurgery, and discusses its advantages and disadvantages.