Volume 31 · Issue 10 · 2015

To investigate the change regulation of the serum procalcitonin (PCT) and procalcitonin clearance (PCTc) in patients with intracranial infection in different outcomes after craniotomy.

A total 32 patients with intracranial infection after neurosurgical operation treated at the Department of Neurosurgery, the First Affiliated Hospital of Xinjiang Medical University from November 2010 to November 2013 were enrolled. They were divided into either a death group (n=8) or a survival group (n=24) according to the results of antibiotic and other therapies. Intracranial infection was detected and PCT was diagnosed within 24 h and at 3, 5, 7, and 9 days after treatment. The serum PCTc was calculated and the Wilcoxon test was used for statistical analysis.

The PCT mass concentration in survival group were the PCT median (range) 0.64 (0.37-0.78), 0.44 (0.34-0.53), 0.22 ( 0.13-0.46), 0.20 (0.95-0.34), and 0.16 (0.14-0.25)ng/ml, respectively for the first time and at the 3, 5, 7, and 9 days of antibiotic treatment, in the death group were 0.46 (0.30-0.93), 0.69 (0.66-0.80), 0.60 (0.46-0.88), 0.96 (0.36-1.08), and 1.06 (0.92-1.52) ng/ml, respectively.There was no significant difference in the first PCT between the two groups. There were significant differences in PCT at 3, 5, 7, and 9 days after treatment(P<0.01). At the 3, 5, and 7 days of treatment, the PCT clearance rates of the survival group were 84.0 (-29.0-123.5)%, 86.7 (-46.9-158.8)%, and 16.13 (11.5-135.3)%, respectively, those of the death group were -26.5 (-44.4--7.0)%, -61.8 (-70.5--29.8)%, and -69.1 (-84.1--38.7)%, respectively.At the 3, 5, and 7 days after treatment, there were significant differences in the PCT clearance rates between the two groups (P<0.01).

The PCT dynamic changes and PCT clearance rate can effectively predict the effectiveness and prognosis of intracranial infection treatment.

Sepsis is a common complication of severe craniocerebral trauma. Both severe craniocerebral trauma and sepsis are common causes of systemic inflammatory response syndrome (SIRS). SIRS caused by both have similar clinical manifestations and are difficult to distinguish. Therefore, the early and effective differentiation of infectious and non-infectious SIRS is important for choosing correct and effective treatment and avoiding the abuse of antibiotics. The value of serum procalcitonin (PCT) in early diagnosis of severe craniocerebral trauma complicated with sepsis was analyzed.

To investigate the effect of perioperative prophylactic administration of antibiotics on post-neurosurgical infection incidence.

It was a retrospective design by using 679 cases of patients who underwent clean neurosurgical operations at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University during Sep 1st to Sep 23 rd in 2011 and the same period in 2010. The incidence of Surgical Site Infection (SSI) were calculated and compared between the two periods. Univariate analysis and logistic regression analysis were applied to reveal SSI-related risk factors.

The SSI incidence was significantly higher during Sep 1st to Sep 23 rd in 2011 than the same period in 2010 (16.5% to 5.0%, P<0.01). And the proportion of prophylactic antibiotic administration was significantly lower during the period in 2011 than in 2010 (36.6% to 80.7%,P<0.01). Prophylactic administration of antibiotics was an independent factor that significantly reduced the SSI incidence (odds ratio, 0.30;P<0.001). Prophylactic administration of antibiotics significantly reduced the SSI incidence by 65.0% (P<0.01) and the cut infection incidence by 81% (P<0.01). In terms of health economics, prophylactic administration of antibiotics shortened median hospital stays by 2 days and decreased median hospitalization cost by 7%.

Perioperative prophylactic administration of antibiotics can reduce post-neurosurgical SSI incidence significantly and independently, and then shorten median hospital stays and decrease median hospitalization cost.

To investigate the experiences in diagnosis and treatment pyogenic ventriculitis caused by gram-negative bacteria (G^-) in severe neurosurgical patients.

Nineteen consecutive patients with pyogenic ventriculitis treated at the Neurosurgical Intensive Care Unit of the Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University from September 2009 to August 2014 were reviewed. Their bacteriological results, clinical treatment, and prognosis were analyzed.

Ventricular drainage of cerebrospinal fluid bacterial smears in all cases were G^-bacteria. Head CT scans confirmed as intraventricular empyema. Eighteen patients were positive in cerebrospinal fluid bacterial culture, 12 of them were Acinetobacter baumannii, 2 were Klebsiella pneumonia, 2 were Serratia marcescens, 1 was Pseudomonas maltophila, and 1 was Escherichia coli. The bacterial culture in one case was negative. The catheters which caused infections were removed and ventricular drainage was conducted in all cases. The patients were treated with intraventricular lavage in combination with intravenous drugs and intraventricular antibiotics according to the conditions. They were followed up for 3 months to 3 years. After treatment for 2 to 8 weeks, 14 patients were cured (74%) and 5 died (26%). In the cured patients, 8 patients underwent ventriculo-peritoneal shunt after the infection being cured in 2 to 6 weeks because of hydrocephalus. No reinfection occurred. Twelve patients came to consciousness, and 2 were in a persistent vegetative state before infection and did not have any improvement.

Suppurative ventriculitis in severe neurosurgical patients is mainly caused by G^-negative bacteria. The mortality is higher. Early diagnosis, especially clarifying pathogens, timely ventricular irrigation, and ventricular drainage in combination with intravenous and intraventricular antibiotic treatment may increase the cure rate and improve the prognosis.

To analyze the incidence, risk factors of intracranial infection after neurosurgical operation and to propose a prediction score scale based on these risk factors.

New prophylactic strategy of antibiotics (timing: 0.5-2 h ahead of neurosurgical procedures; duration: 24 hours for type Ⅰ incision and 48 hours for type Ⅱ incision) was used in 2012, and 2 058 patients from August to October were chosen for analysis. Based on the independent risk factors identified by logistic regression, a score scale was proposed to stratify patients into high-risk or low-risk group for postoperative intracranial infection.

The incidence of intracranial infection for type Ⅰ and type Ⅱ incision was 10.1% (115/1 137) and 11.0% (101/921), respectively. Logistic regression revealed that younger patients, longer operative duration, and lesion in the posterior fossa or the ventricles were independent risk factors for postoperative intracranial infection. Compared with the patients aged 17-40, the ORs (95% CI) of intracranial infection in patients aged 40-60 and ≥60 were 0.546 (0.401 - 0.745) and 0.277 (0.153 - 0.499), respectively. Compared with the lesions in the sellar region, the ORs (95% CI) of intracranial infection for lesion in the supratentorial region, spinal canal, brainstem/cerebellopontine angle/cerebellum, and the ventricle were 3.014 (1.329 - 6.838), 1.977 (0.855-4.571), 4.585 (1.971 - 10.666), and 8.410 (2.924 - 24.195), respectively. Compared with operative duration <4 h, the ORs (95%CI) of intracranial infection for 4-7 h and ≥7 h were 4.555 (2.280 - 9.100) and 8.939 (4.292 - 18.615), respectively. On ROC curve, the cutoff score to predict intracranial infection for type Ⅰ and type Ⅱ incision was -2.2 and -1.9, respectively. For type Ⅰ incision, the frequencies of intracranial infection in low-risk (<-2.2) and high-risk (≥-2.2) groups were 4.4%(30/685) and 18.8%(85/452), respctively. For type Ⅱ incision, the frequencies of intracranial infection in low-risk (<-1.9) and high-risk (≥-1.9) groups were 3.1%(18/588) and 24.9%(83/333), respectively.

Younger age, longer operative duration and lesions in the posterior fossa or the ventricle were independent risk factors for postoperative intracranial infection. The prediction score scale could be effectively used to stratify patients into high-risk or low-risk group for postoperative intracranial infection, which provided the basis for individualized prophylactic strategies of antibiotics.

To investigate the role of the cerebrospinal fluid procalcitonin (PCT) in the identification of intracranial bacterial infection and aseptic meningitis in adults.

A total of 178 patients with the suspected symptom of intracranial bacterial infection at 48 to 72 h after neurosurgical brain tumor surgery at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from October 2013 to March 2014 were analyzed retrospectively. The cerebrospinal fluid routine, biochemical and procalcitonin tests were performed. According to the diagnostic criteria of intracranial infection, they were divided into either a bacterial infection group (n=50) or an aseptic meningitis group (n=128). The cerebrospinal fluid PCT and its changes of the traditional cerebrospinal fluid detection index were compared. The receiver operating characteristic curve (ROC) was used to analyze the values of cerebrospinal fluid PCT for identifying the infection and aseptic meningitis.

Compared with the aseptic meningitis group, the white blood cell count, polynuclear cell ratio, protein content, and PCT content were all increased in the cerebrospinal fluid of bacterial infection, and the blood glucose was reduced. There were significant differences (all P<0.01). There was no significant difference in chloride. The median (range) of cerebrospinal fluid PCT in the bacterial infection group was 0.15 ng/ml (0-3.09 ng/ml), and in the aseptic meningitis group was 0 ng/ml (0-0.46 ng/ml). The ROC results showed that the area under curve of the differential diagnosis of intracranial bacterial infection was 0.746. The diagnostic threshold was 0.075 ng/ml, the sensitivity was 68.0%, specificity was 72.7%, positive predictive value was 49.3%, and negative predictive value was 85.3%. The PCT in cerebrospinal fluid was positively correlated with the leukocyte, proportion of multinucleated cells, and protein (r=0.446, 0.453, and 0.482, respectively, all P<0.01). It was negatively correlated with glucose (r=-0.201, P=0.007).

The detection of PCT in cerebrospinal fluid has an important clinical application value for the diagnosis of intracranial bacterial infection after neurosurgical operation.

From June 12th to 14th, 2015, the 3rd National Pediatric Neurosurgery Academic Conference, sponsored by Chinese Medical Association and jointly organized by Chongqing Medical Association, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine and Children's Hospital affiliated to Chongqing Medical University, was held in Chongqing. Professor Ma Jie of Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine and Professor Qi Songtao of Southern Hospital of Southern Medical University served as the chairmen of the conference, Professor Feng Hua of Southwest Hospital of the Third Military Medical University and Professor Liang Ping of Children's Hospital affiliated to Chongqing Medical University served as the executive chairmen of the conference. At the same time, this conference hosted the 2015 World Pediatric Neurosurgery Continuing Education Course (ISPN Course), the 7th China Pediatric Neurosurgery Forum (CPNF), the 6th Shanghai International Neuroendoscopic Operation Training Course (SINEHOW) and the 2nd Chongqing Young Neurosurgery Physicians Forum.

To investigate the magnetic resonance imaging (MRI) findings of ectopic pituitary adenomas (EPA) and to improve the imaging diagnosis of rare ectopic pituitary adenomas.

The preoperative MRI and clinical data of 6 patients with EPA diagnosed by surgery and pathology admitted to Peking Union Medical College Hospital from January 2000 to June 2014 were analyzed retrospectively.

Of the 6 patients, 4 showed isointense on T1 and T2, 1 showed short T1 and long T2, and 1 showed short T1 and isointense T2. Two patients showed more homogeneous enhancement after the enhanced scan, and the signal was lower than the pituitary tissue, 1 was heterogeneous enhancement, and the enhancement of 3 patients was not obvious. The pituitary size and morphology were normal in 4 cases, and 2 patients were combined with empty sella. The pathology of tumor tissue was consistent with pituitary adenomas, 4 of them were adrenocorticotropic hormone adenomas, 1 was prolactin adenoma, and 1 was thyrotroph adenoma.

When patients have pituitary hormone-related endocrine abnormality, MRI shows occupying lesions outside the area of sella pituitary, especially on the suprasellar region, clear demarcation with intrasellar pituitary gland, and the enhanced signal lower than the normal pituitary tissue, Under the same combined empty sella, the possibility of EPA should be taken into account.

To investigate the safety and efficacy of Lvis stent-assisted embolization of intracranial wide-necked aneurysms.

Twenty-four patients with intracranial wide-neck aneurysm treated with Lvis stent-assisted embolization at the Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University from January to July 2014 were selected. The clinical data, endovascular treatment methods and efficacy of the 24 patients were analyzed retrospectively. The degree of aneurysm embolization was evaluated according to Raymond classification, and its clinical efficacy was evaluated according to the modified Ranking scale (mRS) scores.

The stents of 24 patients with intracranial wide-necked aneurysms were released completely (100%). Raymond grade Ⅰ embolization was 18 cases (75%), Raymond grade Ⅱ embolization was 4 cases (17%), and Raymond grade Ⅲ embolization was 2 cases (8%). One patient had in-stent thrombosis in the process of embolization, and after being treated with tirofiban hydrochloride sodium chloride injection, the thrombosis disappeared. The effective rate of embolization was 92%. After six months of follow-up, 21 patients had good curative effect (the mRS score 0-2), 3 had poor effect (the mRS score 3-6), and the good rate was 88%.

Lvis stent-assisted embolization of intracranial wide-neck aneurysms is safe and feasible, the short-term efficacy is reliable. Because of the short follow-up time, further research is needed to determine the long-term stability of coils and adaptability of stents after embolization.

To investigate the assistant effects of high-field intraoperative magnetic resonance imaging (iMRI)-based neuronavigation system in transnasal-sphenoidal approach for resection of pituitary adenomas.

The pituitary adenomas of 335 patients resected via high-field iMRI-based neuronavigation system assisted transnasal-sphenoidal approach at the Department of Neurosurgery, Tianjin Medical University General Hospital from April 2011 to April 2014 were analyzed retrospectively. The operative effect and application experiences were analyzed.

Of the 185 patients, 58 had residual tumor tissue in the iMRI detection, 40 of them underwent further surgical resection of tumor after updating neuronavigation plan. The initial total resection rate was 68.7% (127/185). Under the assistance of iMRI navigation system, the final total resection rate reached 90.3% (167/185), increasing by 21.6% (40/185). High-field iMRI scan was performed for 1 to 3 times. The time required was 15-20 min/time. The total operative time prolonged 30 to 60 min (mean, 41.30±5.62 min).

In transnasal-sphenoidal approach for resection of pituitary adenomas, using high-field iMRI in combination with neuronavigation technology may provide objective evidence for the guidance of surgical process and real-time judgment of surgical results, and improve the surgical safety and total resection rate of tumors.

To investigate the operation methods and efficacy analysis of paraspinal approach by percutaneous tubular retractor system for microsurgical resection of space-occupying lesions in cervical vertebra canals.

Eighteen patients with space-occupying lesions in cervical spinal canals treated at the Department of Neurosurgery, the Affiliated Union Hospital of Fujian Medical University from November 2011 to February 2014 were analyzed, including 13 patients with schwannoma, 3 with meningioma, 1 with enterogenous cysts, and 1 with simple cyst. Under neurophysiological monitoring, their space-occupying lesions in cervical spinal canals were treated via paraspinal approach by percutaneous tubular retractor system after general anesthesia. The operation time, bleeding volume, and local pain time of postoperative incision were analyzed. The creatine phosphokinase (CPK-MM) levels were recorded at 1 day before surgery, and at 1, 3, and 5 days after surgery. The spinal cord functions were evaluated respectively using McCormick scoring criteria at 1 day before surgery and at 1 day, 5 days and 6 months after surgery. The pain visual analogue scale (VAS) was used to analyze the pain degree of local incision. The cervical CT three-dimensional reconstruction was performed at 1 week after surgery. Cervical MRI scan and enhanced scan were performed at one week before and after procedure, and at 6 months after procedure.

Eighteen patients with intraspinal occupying lesions were totally removed without nerve injury. The postoperative McCormick scores and VAS scores were improved compared with before procedure (P<0.05). The CPK-MM level increased at 1 day after operation and it decreased to the level of before operation at 5 days after procedure. There was no significant difference (P<0.05). MRI scan plus enhanced examination did not reveal occupying residue and recurrence. CT three-dimensional reconstruction showed the range of vertebral lamina fenestration. No injury of articular process and spinal stabilities were observed. No spinal deformity occurred during the follow-up period.

Under neurophysiological monitoring, paraspinal approach by percutaneous tubular retractor system for microsurgical resection of extramedullary occupying lesions in cervical spinal canals has the advantages of less injury, shorter hospital stay, faster recovery, and better postoperative spinal stability.

To investigate the method and clinical effect of microsurgical resection of small and medium-size acoustic neuromas via retrosigmoid approach.

The surgical effect, postoperative quality of life and postoperative nerve function preservation in patients with acoustic neuromas with the maximum diameter of <3 cm treated with microsurgery at the Department of Neurosurgery, Xiangya Hospital Central South University from October 2003 to November 2013 were analyzed retrospectively. The postoperative mean follow-up time was 36.7 months (range, 9-131 months).

Seventy-six patients had total tumor removal, while one had subtotal removal. The intraoperative facial nerves, trigeminal nerves, petrosal veins were preserved anatomically, and anatomic preservation rate of the cochlear nerves was 68%. No patient died during the operation. Two patients had intracranial infection after procedure, 1 had cerebrospinal fluid leakage, and they were cured after symptomatic treatment. All patients returned to work within one year after procedure. The excellent rate of the long-term quality of life assessment (KPS score) was 100%. During the follow-up period, one patient had tumor recurrence, and his tumor was totally resected again. The postoperative facial nerve function was still House-Brackman grade 1. The excellent rate of facial nerve was 96% at the last follow-up. The effective hearing preservation rate was 29%. The symptoms were relieved or disappeared after procedure in 34 patients with preoperative facial numbness and pain.

For the maximum diameter <3 cm of acoustic neuroma, microsurgery can achieve higher total resection rate and neural function retention, and significantly relieve the clinical symptoms of trigeminal nerves. It can be used as a preferred treatment method.

To investigate the treatment of spasticity of lower limbs in cerebral palsy with the selective lumbosacral posterior rhizotomy (SPR).

The clinical data of 1 455 patients with spastic cerebral palsy with lower limbs pasticity treated by SPR were analyzed retrospectively. In addition to relieving the lower limb spasticity after procedure, the long-term follow-up of other accompanying effects were performed.

All 1 455 patients were followed up for 21.8 (mean, 12-44) months. While adding up the efficacy of relieving lower limb spasticity with operation (the total spasm remission rate was 94.8% and the gait function improvement rate was 85.6%) during the follow-up period, the improvement of other concomitant symptoms of patients was observed: the improvement rates of salivation, oral dyskinesia and dysarthria, spasticity of upper limbs, and strabismus were 64.5% (300/465), 39.1% (135/345), 33.3% (240/720), and 33.3% (225/675), respectively.

While in the treatment of spasticity of lower limbs in cerebral palsy, SPR improves the concomitant symptoms, such as salivation, oral dyskinesia and dysarthria, spasticity of upper limbs, and strabismus in different degrees in 33.3-64.5% patients. Its specific mechanism needs to be further studied.

To investigate the clinical features, imaging characteristics, treatment measures, and prognosis of melanocytic tumors of the central nervous system (CNS).

The clinical data of 14 patients with melanocytic tumors of CNS confirmed by surgery and pathology were analyzed retrospectively, and the disease was analyzed according to the literature.

The clinical manifestations of melanocytic tumors of CNS were diverse; the main symptoms were headache, increased intracranial pressure, seizures, and focal neurological deficits.The imaging features were diversified, with 7 of short T1 and short T2 signal, 3 of identical T1 and long T2 signal, and 3 of heterogenous signal among the 13 patients who had the MRI examination.Immunohistochemistry showed HMB45 (+ ) in 14 cases, S-100 (+ ) in 13 cases, and VIM (+ ) in 8 cases.In the initial operations, the total, subtotal and partial removals of the tumors were achieved in 7, 5, and 2 cases, respectively. Four patients were operated again for recurrence of tumors after procedure.The postoperative follow-up time was 2 to 60 months.Eleven patients were followed up, and 7 of them received adjuvant therapy. Nine cases died and 2 cases survived; the median survival time of the died cases was 14 months.

The clinical manifestation of melanocytic tumors of CNS do not have any specificity, and short T1 and short T2 signal on the MRI is the relatively characteristic imaging display. The immunohistochemistry test is help to get the definite diagnosis. The overall malignant degree is high and the prognosis is poor. Operation should be the preferred therapeutic measure. Postoperative adjuvant treatment measures can be taken, such as radiotherapy and chemotherapy.

To investigate the efficacy and prognosis of hemifacial spasm microvascular decompression.

The clinical data of 833 patients with hemifacial spasm treated with microvascular decompression at the Department of Neurosurgery, Cangzhou Central Hospital, Hebei Province from January 2004 to January 2012 were analyzed retrospectively. According to the recovery of the patients after surgery, they were divided into 4 groups: instantly cure, delayed cure, recurrent, and unhealed. The clinical data of 4 groups of patients were analyzed statistically.

Of the 833 patients with hemifacial spasm underwent microvascular decompression, 472 were cured instantly, 302 were cured late; 33 had recurrence; and 26 were unhealed. The difference of the effective rate between 1 year and two years after surgery was minimal. The mean history (98.1±10.4 months) of the delayed cure group was significantly longer than the instantly cure group. There was significant difference between the two groups (P<0.05).

Microvascular decompression is an effective treatment method for hemifacial spasm. One year after microvascular decompression is the more appropriate time limit for identifying the operation effect. The longer medical history may increase the likelihood of delayed cure after procedure.

To investigate the classification methods of various cerebral infarctions after moderate to severe craniocerebral injury and to summarize the experiences.

The patients with moderate to severe craniocerebral injury admitted at Department of Neurosurgery, Affiliated Anqing Hospital of Anhui Medical University from June 2011 to June 2013 were analyzed retrospectively. According to the imaging data, the site of cerebral infarction, as well as the targeted treatment measures taken after cerebral infarction, a variety of cerebral infarctions after moderate to severe brain injury were summarized and classified.

A total of 206 patients with moderate to severe craniocerebral injury were collected and documented, 33 (16%) of them had cerebral infarction and a total of 45 infarct foci were found. The various cerebral infarctions were classified into four types: 21 (47%) territorial cerebral infarctions, 10 (22%) watershed cerebral infarctions, 5 (11%) peripheral vascular cerebral infarctions, and 9 (20%) traumatized peripheral cerebral infarctions.

In the four types of cerebral infarction, their imaging findings, risk factors, and treatment options are different. After moderate to severe craniocerebral injury, the 4-type classifications of cerebral infarction have certain guiding significance for clinical diagnosis, treatment and study of cerebral infarction after trauma.

To investigate the application value of identification of the solitary metastatic tumors and the high-grade neuroepithelial tumors with amide proton transfer (APT) magnetic resonance imaging.

A total of 83 patients with metastatic tumor and high-level neuroepithelial tumor admitted at the Department of Neurosurgery, Zhujiang Hospital, Southern Medical University from March 2013 to March 2014 were enrolled. The patients with metastatic tumor and high-level neuroepithelial tumor newly diagnosed by conventional magnetic resonance imaging performed APT sequential scan. For the 34 patients with metastatic tumor (34 foci) and 49 patients with high-grade neuroepithelial tumors (49 foci) confirmed by surgery, the APT images divided the tumor core areas and two regions of interest of paratumor areas. The amide proton transfer ratio (APTR) was measured and the pseudo-color images were constructed. The APTR differences of the tumor cores and the paratumor areas between the metastatic tumors and the high-level neuroepithelial tumors were compared respectively using two independent sample t tests. Simultaneously, the receiver operating characteristic curve analysis was used to identify the best cut-off values of both.

The pseudo-color images showed that the tumor core signal intensity was similar between the metastatic tumor group and the high-grade neuroepithelial tumor group, but the signal difference of the paratumor area was more obvious. The tumor core area APTRs in the metastatic tumor group and the high-grade neuroepithelial tumor group were (2.92±0.51)% and (3.06±0.56)% respectively. There was no significant difference between the two groups (P=0.233). The peritumoral area APTRs in the metastatic tumor group and the high-grade neuroepithelial tumor group were (1.47±0.23)% and (1.81±0.31)% respectively. There was significant difference between the two groups(P=0.000).

APT imaging combined with conventional sequence, in particular the APTR of quantitative paratumor area, has certain clinical value for the differential diagnosis of the metastatic tumors and the high-grade neuroepithelial tumors.

Acromegaly is a chronic progressive endocrine disease with insidious onset. It is mostly caused by excessive secretion of growth hormone (GH) by pituitary tumors, and is characterized by hypertrophy of limbs and organs. According to the latest literature, the incidence of pituitary adenomas is 78~94/100,000, and acromegaly accounts for 12.5% of them^[1,2]。 Cardiovascular disease is a serious complication in patients with acromegaly, and it is the main cause of death in patients with acromegaly. Almost all patients with acromegaly with a course of more than 10 years will develop cardiovascular lesions, and the latter is the leading cause of death in acromegaly patients. About 80% of untreated acromegaly patients died of various cardiovascular complications before the age of 60. Heart disease caused by acromegaly, except for the involvement of other pathogenic factors, is called acromegaly cardiomyopathy^[3]。 In the 2006 American Heart Association (AHA) classification of cardiomyopathy, acrohypertrophic cardiomyopathy was classified as endocrine cardiomyopathy among secondary cardiomyopathies^[4]。

Pituitary prolactin adenoma is a kind of pituitary adenoma with high prolactin expression and hormone secretion, accounting for about 40% to 45% of adult pituitary functional adenomas, and is more common in female patients aged 20 to 50 years^[1]。 This article will review the diagnosis and treatment of pituitary prolactin adenoma before and after pregnancy.

Cushing's syndrome (CS) refers to a clinical syndrome characterized by hypercortisolemia caused by a variety of causes. Cushing's disease (CD) is the most common cause of CS^[1]Specifically refers to CS caused by excessive secretion of ACTH by adrenocorticotrophic hormone (ACTH) adenomas. The first choice of treatment for CD is transsphenoidal pituitary adenoma resection. At present, the remission rate of primary transsphenoidal approach can reach 65% ~96%, 17% ~35% of patients without remission after operation, and the postoperative recurrence rate is 2% ~20%^[2,3,4,5]。 Compared with the patients cured by the initial transsphenoid approach, the mortality rate of patients with postoperative tumor recurrence is significantly higher, so early detection of CD recurrence after operation and follow-up treatment are particularly critical.

Because of its characteristics of high mortality and short average survival, glioma has been a major problem in the treatment of malignant tumors of central nervous system. Current traditional therapies such as surgery and radiotherapy and chemotherapy have not significantly improved the prognosis of glioma patients^[1]。 In recent years, with the major breakthroughs in molecular biology and tumor immunology, as well as the increasing maturity of genetic engineering technology and cell engineering technology, molecular immunotherapy has made certain progress in the treatment of many malignant tumors. Among them, chimeric antigen receptor modified T cells (CAR-T cells) are the most active direction in the research of tumor immunotherapy at present. A few foreign research institutions have carried out the application of CAR-T cells to treat glioma clinical trials^[2]。 In this paper, the development, research status and prospect of CAR-T cells in immunotherapy of glioma are reviewed.

post-operative central nervous system infection (PCNSI) includes infections caused by bacteria, fungi and viruses, among which bacterial infections are the most common. Often acute onset, critical condition, serious neurological damage. After neurosurgery, due to trauma, edema, bleeding, stress and other reasons (non-infectious factors), meningitis fever, headache, meningeal irritation and other manifestations often occur, and even routine laboratory changes of blood and cerebrospinal fluid occur, which is difficult to distinguish from the clinical manifestations of bacterial meningitis. In addition, due to the use of intraoperative and preoperative prophylactic antibiotics, the positive rate of cerebrospinal fluid bacterial cultures commonly used to diagnose central nervous system infections is generally low. These problems make it difficult to unify the diagnostic criteria of PCNSI at present, which not only makes diagnosis difficult, but also affects the subsequent treatment decisions such as whether or when to start antibiotic treatment. Therefore, how to make a correct diagnosis early and take appropriate treatment measures is especially important for saving patients' lives and their neurological functions. We will summarize the risk factors of PCNSI (this article mainly refers to bacterial infection), the diagnosis of common PCNSI, and the determination of cerebrospinal fluid cytology, etiological indexes and biochemical markers of central nervous system infection after neurosurgery as follows, and propose a stepwise diagnostic scheme for bacterial infection of central nervous system after neurosurgery.

Postoperative infection, bleeding and pain are three major problems that need to be solved in the development of surgery, especially postoperative infection, which seriously threatens the life and health of patients. After the first introduction of aseptic techniques into surgical treatment by Hungarian physician Ignaz Semmelweis in 1847 and the discovery of penicillin by Alexander Fleming in 1928, the postoperative infection rate gradually decreased. However, in recent years, with the emergence of bacterial drug resistance in postoperative infection, nosocomial infection has gradually become prominent, which affects the safety of patients and increases the burden of patients. superbug is a topic of general concern.

At present, the situation of bacterial drug resistance in China is grim, and the resulting nosocomial infection problem is becoming increasingly serious, which is inseparable from the widespread abuse of antibacterial drugs in medical and health institutions. If this status quo is not changed, it will cause serious social harm, and even the treatment crisis of antimicrobial drugs will arise. At the same time, it will also bring a huge economic burden to patients and society^[1]。

A basic principle of functional neurosurgery is to relieve the patient's pain without causing serious complications that are unacceptable to the patient. One of the major problems troubling neurosurgeons who are just trying to perform microvascular decompression (MVD) is the occurrence of severe postoperative complications. Even for doctors with rich experience in MVD surgery, serious complications such as intraoperative petrous vein hemorrhage, brainstem perforating artery dissection, postoperative cerebellar and brainstem hemorrhage infarction can lead to catastrophic consequences, and postoperative facial paralysis, hearing impairment and other cranial nerve-related complications are not uncommon. The probability of posterior fossa decompression due to cerebellopontine angle (CPA) and hematoma of cerebellar hemisphere after MVD is about 0.3% ~2.5%, and about 1/3 of them die eventually; The total mortality rate of MVD was about 0.1% ~1% in addition to postoperative distant hemorrhage, cerebral infarction, hydrocephalus, intracranial infection, perioperative myocardial infarction, pulmonary embolism and other accidents^{[1,2,3,4,5,6]}Therefore, it is extremely important to assess the perioperative risk of MVD, take corresponding measures to improve the safety of MVD surgery and reduce the incidence of postoperative complications.