Volume 31 · Issue 11 · 2015

Hydrocephalus is a frequent and common disease in neurosurgery, which can be primary or secondary to other intracranial diseases. When intracranial tumors and other diseases are complicated with hydrocephalus or are expected to be complicated with hydrocephalus, doctors should consider the treatment strategy of hydrocephalus when formulating the treatment plan. The following introduces the author's experience in the treatment of several secondary hydrocephalus for colleagues' reference.

To investigate the feasibility and its technical methods of keyhole approach for removal of ventricular tumors.

A total of 25 patients with ventricular tumor admitted to the Department of Neurosurgery, the Second Affiliated Hospital of Soochow University from January 2010 to December 2014 were collected. The average tumor size was 38.04 cm³. All the tumors were resected via the keyhole surgical approach. The tumors of 8 patients were located in the lateral ventricles; one of them was operated via the interhemispheric transcallosal approach and 7 were operated via the cortical approach. Seven patients had the third ventricle tumor, 4 of them were resected via the interhemispheric transcallosal approach, and 2 via the supraorbital approach, and 1 via the occipital cortex. Ten patients with the fourth ventricle tumor were resected via the suboccipital midline approach. The surgical approach in 7 patients with lateral ventricle tumor and 5 with the third ventricle tumor were designed under the neuronavigation and were identified by the intraoperative navigation.

Of the 25 patients with intraventricular tumor, 23 were totally removed and 2 were subtotally removed. Before procedure, 9 patients had obvious hydrocephalus. The hydrocephalus of 6 cases disappeared after procedure. One patient was performed ventricular puncture drainage and 1 was performed ventriclar-peritoneal drainage, and another one was performed preoperative ventricular-peritoneal drainage. One patient had residual tumor hemorrhage after procedure and was reoperated for hematoma evacuation and decompressive craniectomy. The consciousness of the patient was clear at discharge with partly aphasia and hemiparalysia. No neurologic morbidity was observed when other patients were discharged.

The position of the ventricular system is deep inside. It is suitable for using keyhole amplification effect to adequately and effectively expose surgical fields. It can effectively decrease intracranial pressure and increase surgical expose space by releasing cerebrospinal fluid through the ventricular system. Most of hydrocephalus can be subsided in patients with preoperative hydrocephalus after postoperative cerebrospinal fluid circulation smooth. There is no need for routine ventricular-peritoneal drainage.

To investigate the clinical features, treatment strategies and follow-up effect of hypothalamic glioma-associated precocious puberty in children.

Seven children with precocious puberty in the hypothalamic glioma cases admitted to the Department of Pediatric Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2009 to December 2013 were selected as the research objects. Their age, gender, lesion types, clinical course, treatment methods, and efficacy were analyzed retrospectively.

There were 3 girls and 4 boys in this group of children, accounting for about 1.75% (7/400) of the all cases during the same time period. Their ages at presentation ranged from 2 to 8 years (mean age 5.1 years). The lesion site was chiasm or hypothalamus. The tumors of patients 1 to 5 and 7 were resected partially, and the tumor of patient 6 was resected subtotally. The pathological results after procedure were 5 cases with WHO grade Ⅰ, 1 with WHO grade Ⅱ, and 1 with WHO grade Ⅲ. The endocrine laboratory results, signs, and Tanner stage were in accordance with the diagnosis criteria of central precocious puberty. The mean follow-up time was 40 months in this group. Four of them were treated with gonadotropin-releasing hormone analogues. It effectively controlled symptoms of precocious puberty in children. The remaining 3 children still have the symptoms of precocious puberty now, because of personal reasons they did not receive treatment.

In addition to hypothalamic hamartomas and germ cell tumors, hypothalamic gliomas in children may also be secondary to the symptoms of precocious puberty. In the process of clinical diagnosis and treatment, enough attention should be paid to. In the postoperative follow-up process, examination should be paid to and be treated accordingly.

To investigate the clinical features, diagnosis, treatment methods, and prognosis of primary intracranial choriocarcinoma in children.

Eight children with primary intracranial choriocarcinoma (7 were confirmed by pathological examination, 1 was confirmed by clinical diagnosis) admitted to the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from May 2002 to January 2015 were analyzed retrospectively. All the 8 children were males, and their mean age was 11. The lesions of 7 children were in the pineal region and 1 in the sellar region. The mean diameter of choriocarcinomas was 3-5 cm. Preoperative examination revealed that the blood and human chorionic gonadotropin (HCG) in blood and cerebrospinal fluid of the 8 children elevated extremely. Of the 8 children, 3 were performed preoperative diagnostic radiotherapy and 1 was performed preoperative stereotactic radiotherapy. Seven children were performed tumor resection via the corpus callosum-interforniceal approach, and 1 was performed radiotherapy and chemotherapy. The follow-up period ranged from 1 to 60 months. The HCG levels and head MRI were reexamined periodically.

Of the 3 children undergoing diagnostic radiotherapy, 2 had tumor apoplexy. One child had tumor apoplexy after undergoing stereotactic radiotherapy before procedure. Of the 7 surgical children, the tumors of 5 children were resected totally and 2 were resected subtotally. Four of the 7 children survived and 3 died at the time of follow-up. One child without having surgical treatment was still alive and did not have tumor recurrence at the time of follow-up.

Primary intracranial choriocarcinoma is a rare pediatric intracranial malignant tumor. The significantly increased HCG and cerebrospinal fluid HCG contribute to the diagnosis. The preoperative radiotherapy may increase the risk of tumor apoplexy. Radiotherapy is not recommended before having the marked effect of the tumor resection or chemotherapy. Operation and combined chemotherapy may achieve better efficacy. For children who are not suitable for operation, chemotherapy can be performed, and additional radiotherapy can be given.

To explore the alternative necessity of perioperative glucocorticoids for patients resection of pituitary adenoma (except adrenocorticotropic hormone adenoma) via sphenoid sinus.

Fifty-two patients with pituitary adenoma operated with transsphenoidal surgery at the Department of Neurosurgery, Huashan Hospital, Fudan University from September 2013 to July 2014 were enrolled. All patients had complete hypothalamic-pituitary-drenal axis (HPA) function, the fasting plasma cortisol level ≥ 251 nmol/L(9.1 μg/dl) as the evaluation criteria at 8 a. m. before procedure. The preoperative, intraoperative glucocorticoids were given to the patients. The variation of plasma cortisol in patients was observed after procedure. The necessity of glucocorticoid replacement was assessed after procedure.

Of the 52 patients, the cortisol of 40 patients reached the peak at the night of surgery. The cortisol of 12 patients reached the peak at 24 h after procedure. Four patients had transient decrease in serum cortisol after procedure, 1 of them was treated with methylprednisolone and cortisone acetate. The cortisol levels of the patients before operation, at the night after operation, and 3 consecutive days after procedure were 412 ± 132, 934 ± 256, 733 ± 376, 471 ± 205, and 457 ± 217 nmol/ L, respectively. Compared with before procedure, there was no significant difference between the night after procedure and 1 day after procedure (P<0.05). There was no significant difference between 2 days and 3 days after procedure (P>0.05). All 52 patients did not have Addison's disease, hypoglycemic coma, hyponatremia coma, cardiovascular failure, and other disease crises.

For the normal HPA function patients with pituitary adenoma before procedure, the perioperative glucocorticoid replacement therapy is not necessary.

To investigate the surgical prognosis in adult patients with intracranial pilocytic astrocytoma (PA) and to analyze the related factors that affect its recurrence.

The treatment outcomes of 28 adult patients with PA reseted at the First Affiliated Hospital of Fujian Medical University from January 2006 to March 2013 were analyzed retrospectively. Among them, 19 had total tumor resection and 9 had partial tumor resection. Five patients received radiotherapy and/or chemotherapy after the first operation or reoperation. The prognoses of the patients were followed up and the possible factors for affecting tumor recurrence were investigated. Kaplan-Meier analysis was used to analyze the postoperative progression-free survival rate of the patients.

Twenty-eight patients were followed up for 8 to 92 months after procedure (mean 41.2 months). There were no deaths during the follow-up period. Kaplan-Meier results showed that the progression free survival at 24 months after initial surgery was 92.7±5.0%. A total of 7 patients had recurrence; the mean recurrence time was 49.5 months (range, 4 to 60 months). In the 7 patients, the tumors of 4 patients were located in the supratentorial region, and 4 needed to be reoperated because of disease progression. The pathological diagnosis of 1 patient was anaplastic astrocytoma after the second operation. The tumors did not recur or enlarge in 5 patients who received radiotherapy and/or chemotherapy. The proportions of recurrence of the total resection and subtotal resection were 1/19 and 6/9 respectively. There was significant difference (P<0.05). There were no significant differences in the proportions of tumor recurrence in patients with different sex, age, tumor location, and cystic, and solid lesions on MRI (P>0.05).

The postoperative prognosis is better in adult patients with intracranial PA. The total resection may be one of the factors for avoiding tumor recurrence. The tumors of patients failed to be totally resected should pay attention to the faster tumor recurrence. The recurrent cases may have malignant transformation, and the postoperative follow-up of these adult patients should be strengthened.

To investigate the efficacy of resection of petroclival meningiomas via modified subtemporal anterior transpetrosal approach.

Twenty-three patients with petroclival meningioma within the internal auditory canal and above the bridge grike resected by using the modified subtemporal anterior transpetrosal approach at the Department of Neurosurgery, the Second Affiliated Hospital of Nanchang University from January 2012 to June 2014 were analyzed retrospectively.

None of the 23 patients died in this group. The tumors of 16 patients were totally resected (Simpson's classification, grade Ⅰ-Ⅱ) and those of 7 patients were subtotally resected (Simpson's classification, grade Ⅳ). They were followed up for 3 to 24 months. The tumor of 1 patient with subtotal resection increased slightly. Of the 20 patients with obvious symptoms before procedure, 13 were improved after procedure. They had transient neurological deficit after procedure, including 1 with oculomotor nerve palsy, 1 with dysphagia, 4 with facial paralysis, 4 with facial numbness, 2 with diplopia, and 2 with contralateral limb movement disorder. The symptoms were not improved significantly during follow-up period, including 1 with oculomotor nerve palsy, 4 with deafness, 2 with facial numbness, and 2 with esotropia.

Resection of petroclival meningiomas within the internal auditory canal and above the bridge grike via subtemporal anterior transpetrosal approach has certain advantages. Although some patients have neurological deficits after procedure, most of them are mild, reversible, and acceptable.

To summarize the clinical features, imaging features and the selection of microscopic surgical approaches and to investigate the factors of affecting postoperative visual acuity recovery of patients.

The clinical data of 44 patients with sellar meningiomas were analyzed retrospectively and the follow-up study was performed. The clinical features, imaging features, and selection of microsurgical approach were summarized. The factors that might affect the recovery of visual acuity in patients after procedure were analyzed respectively with the univariate analysis of non-parametric tests and logistic regression multivariate analysis.

After univariate analysis, the factors of affecting visual acuity are as follows: duration of preoperative visual impairment (P=0.001), degree of preoperative visual impairment (P=0.001), preoperative fundus change (P=0.001), preoperative visual evoked potential amplitude change (P=0.001), tumor base (P=0.006), tumor texture (P=0.002), tumor growth direction (P=0.003), relationship between tumors and optic nerves (P=0.001), optic nerve morphology in surgery (P=0.001), and relationship between tumors and internal carotid artery and its branches (P=0.038). Multivariate logistic regression analysis found that the degree of preoperative visual impairment (P=0.001), preoperative fundus change (P=0.019), preoperative visual evoked potential amplitude change (P=0.009), and relationship between tumors and optic nerves (P=0.012) were the significant factors for affecting postoperative visual acuity recovery.

Sellar meningiomas should be diagnosed and treated early. The degree of preoperative visual impairment, preoperative fundus change, preoperative visual evoked potential amplitude change and relationship between tumors and optic nerves are the key factors for affecting postoperative visual acuity recovery.

Grade I: Total tumor resection, and the dura mater and skull involved in the tumor are removed;

To investigate the clinical features, mechanism and endovascular treatment of anterior temporal artery aneurysm of the posterior cerebral artery.

The clinical data of 6 patients with anterior temporal artery aneurysm treated with endovascular treatment at the Cerebral Vascular Interventional Treatment Center, Henan Provincial People's Hospital, Zhengzhou University from January 2010 to December 2014 were analyzed retrospectively. All 6 patients were accompanied by ipsilateral middle cerebral artery or internal carotid artery occlusion. The diameter of aneurysm was 2.5 to 5.0 mm, 2 of them had subarachnoid hemorrhage, 1 did not have any symptom, and 3 were accompanied by anterior circulation cerebral ischemic symptom.Six patients were treated by endovascular management, 4 cases of unruptured aneurysms were treated by coil embolization and retain its parent artery; 2 case of subarachnoid hemorrhage aneurysm and it's parent artery were embolized by coil or Glubran 2. Aneurysm embolization density, parent artery blood flow and posterior cerebral artery blood flow were observed by postoperative DSA imaging.Patients were followed up for 3 months to 1 year.

The immediate angiography after procedure showed that 4 patients with unruptured aneurysm were embolized densely. The parent arteries of 2 cases were patent, 1 had blood flow retardation, and 1 thrombosis caused parent artery occlusion. No new infarction foci were found after procedure. Four patients were followed up by telephone, and they did not have relevant clinical symptoms. Three patients were followed up with imaging. Their aneurysms were embolized densely without recurrence. The parent artery was patent in 1 case. The blood flow of parent artery was slightly slow in 1 case and 1 had arterial occlusion at 3 months. One patient with subarachnoid hemorrhage died of pulmonary complications after procedure, and the remaining 5 patients recovered well during the follow-up.

Anterior temporal artery aneurysm is a special type of posterior cerebral artery aneurysm. The causes of aneurysm are significantly correlated with hemodynamics. It is easy to confuse it with posterior cerebral artery trunk aneurysm and superior cerebellar artery aneurysm. Endovascular treatment is its safe and effective therapeutic approach.

To investigate the related factors of operative prognosis influencing the focal cortical dysplasiain (FCD) with imaging atypical hippocampal sclerosis (HS) caused epilepsy in patients with operative prognosis.

The clinical data of 24 FCD patients with HS caused epilepsy confirmed by pathology after functional neurosurgical procedure at the Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery from August 2006 to December 2009 were analyzed retrospectively. The patients did not have any manifestations of typical HS on MRI before procedure. According to the follow-up results, Engel grade Ⅰ was a successful treatment group and gradeⅡ-Ⅳ was a non-successful treatment group. The possible factors affecting the prognosis were analyzed.

The postoperative follow-up ranged from 24 to 70 months (mean, 42 months). Among the 17 patients with FCD type I, 15 (15/17) were in the successful treatment group and 2 (2/17) were in the non-successful treatment group; among 7 patients with FCD type Ⅱ, 1 (1/7) was in the successful treatment group and 6 (6/7) were in the non-successful treatment group. There was significant difference (P=0.001). There were no significant differences in the prognoses of the patients between typeⅠA and typeⅠB or typeⅡA and typeⅡB. The proportions of the combined history of febrile seizure in the successful treatment group and the non-successful treatment group were 4/16 and 7/8 respectively, and the proportions of complete removal of the seizure onset zone were 16/16 and 4/8 respectively. There was significant difference (P=0.008, P=0.007). There were no significant differences in gender, age at operation, onset age, course of onset, preoperative seizure frequency, having secondary generalized tonic-clonic seizures or not, operative sides, and revealing foci or not on MRI between two groups (P>0.05).

The operative prognoses of the patients with FCD and imaging atypical HS caused epilepsy are associated with histopathological subtypes, having a history of febrile seizure or not, total resection of seizure onset zone.

To investigate the effectiveness and safety of Onyx embolization in combination with gamma knife surgery for the treatment of intracranial arteriovenous malformations (AVMs).

A total of 86 patients with AVM admitted to the Neurological intervention Center, Beijing Neurosurgery Institute, Capital Medical University and treated with Onyx embolization in combination with gamma knife surgery from April 2004 to September 2011 were analyzed retrospectively. The related complications and clinical prognosis of embolization were counted and analyzed. During the embolization of AVMs, the combined high risk of bleeding (intracranial aneurysms, hemodynamic aneurysms, and AVM-related arteriovenous fistula) were assessed and embolized. According to the risk factors and embolization or not, the intracranial AVMs with high risk factors were divided into either a targeted embolization group or a non-targeted embolization group. The effect of targeted embolization on hemorrhage risk was assessed.

The overall annual hemorrhage rate in patients with AVM was 1.66%, and the ruptured AVM was 2.26%, the unruptured AVM was 1.08%, and the annual mortality rate was 0.74%. One of 16 patients with embolization related complications had permanent neurological dysfunction. Twenty-four of 29 patients complicated with intranidal aneurysm underwent targeted embolization; 4 of 5 patients with hemodynamic aneurysm underwent targeted embolization; and 8 of 9 patients with arteriovenous fistula underwent targeted embolization. Chi square test showed that the hemorrhage complications of the targeted embolization group was significantly lower than that of the non-targeted embolization group (P<0.01).

The targeted embolization in combination with gamma knife surgery may decrease the risk of intracranial AVM hemorrhage, improve clinical prognosis and occur less permanent complications. This method is suitable for the treatment of intracranial AVMs of larger volume and those can not be cured with a single program.

To analyze the clinical features and qualitative diagnosis methods of Cushing's syndrome (CS) in adolescence.

The clinical features and laboratory findings of 50 adolescent patients with CS admitted to the Department of Endocrinology, Peking Union Medical College Hospital from January 1990 to March 2012 were analyzed retrospectively.

The age of medical treatment was 14±4 years. Male︰female=1.00︰1.17. Thirty-six adolescent patients (72%) had CS, and it was the most common cause. The proportions of the typical clinical manifestations, supraclavicular fat pads, moon face, centripetal obesity, and buffalo hump of the adolescent patients were more than 90%. The height of 63% adolescent patients with CS was below the third percentile, but the body mass of 42% adolescent patients was higher than the 75th percentile. Hypertension, osteoporosis, glucose metabolism disorder, and hyperlipidemia were also more common. If the 1.8 μg/dl cut-off point was used, the diagnostic sensitivity of midnight serum cortisol was the highest (100%); followed by the classic low-dose dexamethasone suppression test, 24 h urine free cortisol and overnight low-dose dexamethasone suppression test, their sensitivities were 95%, 88%, and 70%, respectively.

The most common cause is CS in adolescent patients with CS. The clinical manifestations are more typical, including dumpy figure, etc. When the midnight serum cortisol cut-off point is 18.8 μg/dl, its diagnostic sensitivity is the highest.

To investigate the early abnormal functional connectivity of brain default mode network (DMN) and its evaluation for consciousness level after injury in consciousness disorder patients with diffuse axonal injury.

A total of 15 patients with consciousness disorder diagnosed as diffuse axonal injury at Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Command from April 2013 to March 2014 were selected. The resting-state functional magnetic resonance data of the 15 consciousness disorder patients with diffuse axonal injury and 15 healthy volunteers were collected. The independent component analysis was used to extract the DMN ingredient in each subject. The two-sample t-test was performed between the groups in order to obtain the different brain areas, and the correlation analysis of the Glasgow coma scale (GCS) and the coma recovery scale-revised (CRS-R) at 6 months after injury were performed at the different brain areas and the magnetic resonance data were collected on the same day.

The functional connectivity degree of the precuneus/posterior cingulate, bilateral inferior parietal lobule, ventromedial prefrontal cortex, and left temporal lobe in brain DMN in patients with diffuse axonal injury were significantly lower than those of control group (P<0.01). The functional connectivity of the precuneus/posterior cingulated and GCS showed significant power correlation (P<0.05), and it also showed significant power correlation with CRS-R (P<0.01).

The early brain DMN functional connectivity has abnormality in consciousness disorder patients with diffuse axonal injury. The abnormal functional connectivity of the precuneus/posterior cingulate may become an indicator for assessing the degree of consciousness disorder and the prognosis of consciousness disorder.

To investigate the clinical efficacy of the inner dual layer resection for the treatment of spinal meningiomas.

Twenty-five patients who were diagnosed as spinal meningioma and underwent the inner dual layer resection at the Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University from January 2007 to November 2013 were analyzed retrospectively. All the tumors were located in subdural extramedullary space. All patents underwent histopathological examination in order to identify the invasiveness of meningioma to inner dural layer of the pedicle. The feasibility of this technique was analyzed; the incidence of complications such as cerebrospinal fluid fistulas and the tumor recurrence rate were calculated.

The tumors of 25 patients were resected completely in this group. Tumor histopathological examination confirmed spinal meningiomas (WHO grade 1), 13 of the patients were psammomatous type, 10 were meningeal epithelial type, 1 was transitional type, and 1was angiomatous type. The dural HE staining pathological examination in all patients revealed that the inner dual layers in tumor pedicles were free of tumor penetration. The patients did not have any surgery-related complications, such as cerebrospinal fluid fistula and spinal adhesion. The 25 patients were followed up for a mean of 31.2 months. MRI did not find tumor recurrence. The patients with neurological deficits before procedure were improved in varying degrees after procedure.

The operation effect of inner dual layer resection in the treatment of spinal meningiomas is good. It can not only reduce the residual tumor and tumor recurrence, but also decrease cerebrospinal fluid fistula, spinal adhesions, and other postoperative complications. However, the number of cases of the study is small, the follow-up time is short, and it is a retrospective study. therefore, the effect of operation needs to be followed up for a long time.

To investigate the application value of surgical resection of brainstem cavernous hemangiomas in combination with the functional neuronavigation and intraoperative neurophysiological monitoring.

The brainstem cavernous malformations of 17 patients resected at the Department of Neurosurgery, the First Affiliated Hospital of Fujian Medical University from January 2009 to December 2014 were analyzed retrospectively. Neurophysiological monitoring was performed during the operation. Sixteen of them received combined functional neuronavigation. The latest 4 patients also received brainstem nuclei tracings at the base of the fourth ventricle. The impact of intraoperative neurophysiological monitoring and functional neuronavigation on the guiding significance of operation and the operation effect were analyzed.

Seventeen patients in this group successfully conducted somatosensory evoked potentials, motor evoked potentials or brainstem auditory evoked potentials with monitoring of brainstem function; 16 patients successfully reconstructed pyramidal tracts and sensory tracts according to the preoperative diffusion tensor imaging (DTI), and conducted the intraoperative functional neuronavigation; the tracing technique of brain stem nuclei successfully mapped the surface neuromast in 4 cases. The mean follow-up period was 37 months after procedure. The total resection of tumors in 16 cases and subtotal resection of tumor in 1 case were confirmed. At the end of the follow-up period, the KPS scores of 10 patients were improved in compare with before procedure, 6 unchanged and 1 decreased. The postoperative motor and sensory function: 13 patients improved or unchanged at the same period, 2 had new facial paralysis, 1 had oculomotor nerve and abducens paralysis, and 1 had limb numbness.

Preoperative functional neuronavigation can achieve precise and detailed visualization of brainstem white matter fiber bundles, it contributes to assist in the development of operation modes. Intraoperative neurophysiological monitoring can conduct real-time monitoring for brainstem function during operation, and provide the objective basis for function protection and the location of the cranial nerve nuclei at the bottom surface of the fourth ventricle. The combination of both may increase the safety of brainstem cavernous hemangioma surgery.

To investigate the change and its significance of the property of brain network small world in patients with post-concussion syndrome.

A total of 24 patients at 3 months after concussion admitted to the Department of Neurosurgery, the Affiliated Anhui Provincial Hospital, Anhui Medical University from July 2013 to August to 2014 were enrolled. Twenty-one age-, gender- and education-matched volunteers recruited in the corresponding time period were used as a control group. The resting-state functional magnetic resonance imaging (MRI) data of both groups were collected. The functional brain network was constructed using the graph theory analysis. The property of brain network small world (when γ >1, λ≈ 1, and σ= γ/λ >1, the network has the property of small world) and its parameters – the changes of the clustering coefficient (Cp) and the average shortest path length (Lp) of the 2 groups were analyzed.

In the range of sparsity 0.05 to 0.4, both the brain concussion syndrome group and the healthy control group met the property of small world (γ value, 1.871±0.253 vs. 2.178±0.178; λ value, 1.105±0.050 vs. 1.083±0.015; σvalue, 1.654±0.249 vs. 1.942±0.155), but the property of small world changed in patients with brain concussion syndrome compared with the healthy population, and there were significant difference in γ value between the 2 groups (t=3.350, P=0.030). Both the Cp value and Lp value of the brain concussion syndrome group were more than those of the healthy control group (Cp, 0.310±0.022 vs. 0.290±0.026; Lp, 4.721±3.489 vs. 3.743±1.671), however, there was only significant difference in Cp value (P<0.05).

The patients with brain concussion syndrome have the property of small world, but they had the dysfunction of local brain structure, and the whole brain network function does not change.

Endovascular therapy has become one of the main therapeutic methods for intracranial aneurysms, but large and huge intracranial aneurysms are still difficult to treat, and the complexity of operation technique and recurrence are the main problems faced at present^[1]。 In recent years, blood flow guiding devices have been applied in the treatment of large wide-necked intracranial aneurysms with satisfactory therapeutic results^[2]。 Tubridge stent is a domestic blood flow guiding device with independent intellectual property rights, which has the characteristics of low porosity and high metal coverage^[3]。 From March to October 2013, 7 cases of intracranial large and giant wide-neck aneurysms were treated with Tubridge stent in the Department of Neurosurgery of Shenyang Military Region General Hospital, which are reported below.

Hypertensive cerebral hemorrhage refers to non-traumatic hemorrhage in the brain parenchyma. It is a common disease and frequently occurring disease, accounting for 10% to 30% of all strokes. How to improve the quality of life of patients after illness, carry out effective disease assessment and prognosis judgment is an urgent problem for clinicians. Previous studies have found that detection of IL-1 β and IL-6 can be used to judge the prognosis of craniocerebral injury^[1]。 This study will investigate the changes of IL-1 β and IL-6 in plasma and cerebrospinal fluid (CSF) and their application value in the evaluation of cerebral hemorrhage.

Among the 30 patients in this group, 1 case died due to diffuse brain swelling after operation, and 29 cases survived. CT reexamination was performed 1~4 weeks after operation. Among them, 25 patients' ventricles returned to normal, and their symptoms disappeared or improved significantly; The ventricles of 4 patients were reduced, and the symptoms were well controlled. All 29 patients were followed up for 6 months to 2 years, of which: 1 died 6 months after discharge because of the ineffective rescue of other diseases; The survival time of 28 patients was>2 years. Among the surviving patients, 23 cases had complete remission of hydrocephalus symptoms, 4 cases had no obvious remission of symptoms, and 1 case had vegetative survival.

To observe the effect of miR-15b on proliferation and apoptosis of human glioma cell line A172 and to investigate its role in RAS/MEK/ERK1/2 signaling pathway cells.

The synthetic miR-15b mimics transfected the A172 cell line. Methylthiazol tetrazoliu (MTT) assay and flow cytometry were used to assess the effects of miR-15b on A172 cell proliferation and apoptosis. Western blotting assay was used to detect the effect of miR-15b on RAS and its downstream signaling pathways.

After transfecting miR-15b mimics, real-time quantitative PCR was use to detect the △Ct values in the blank control group, the negative control group, the miR-15b mimics group, and they were 15.25±1.12, 15.92±0.98, and 10.58±0.87, respectively, suggesting the expression level of miR-15b in the A172 cells increased significantly. Western blot results showed that miR-15b mimics significantly inhibited the expression levels of RAS, MEK, ERK1/2, and pERK1/2 protein (all P<0.05). The test results of MTT assay showed that relative survival rates of cells were 72.28±6.52%, 61.86±5.79%, and 59.38±5.97%, respectively at 24, 48, and 72 h after the A172 cells being transfected by miR-15b mimics. The cell survival rate of the miR-15b mimics group was decreased significantly compare with the blank control group and the negative group (P<0.05). The cell cycle analysis revealed that the cell G₁/G₀ phase of miR-15b mimics group was 66.84%. The miR-15b mimics induced A172 cell block was at G₁/G₀ phase. The detection of annexin/propidium iodide (Annexin V/PI) double staining showed that the cell apoptosis rates of the blank control group, the negative control group, and the miR-15b mimics group were 2.7±0.83%, 2.5±0.81%, and 18.2±1.58%, respectively. The A172 cell apoptosis rate of the miR-15b mimics group increased significantly compare with the blank control group and the negative control group (P<0.05).

miR-15b can inhibit the proliferation of glioma cells and promote apoptosis. The targeted therapy of miR-15b for RAS/MEK/ERK1/2 signaling pathway is expected to become a new way for the treatment of gliomas.

To develop a rat diffuse axonal injury (DAI) modeling device and to evaluate its molding effect.

A total of 20 adult male SD rats were randomly divided into either a control group (n=5) or a DAI model group (n=15). A rat DAI model was prepared by using a coronal rotation device. The neurological severity scores (NSS) were performed using 6 h, 24 h, and 7 d time points after modeling. HE staining and silver staining were used to observe the morphology changes of brain tissue. Immunohistochemical staining was used to detect the expression of β-amyloid precursor protein (β-APP) in brain tissue after DAI.

Rats showed varying degrees of coma after DAI. They showed no autonomic activities, stinging reflex, and dullness of pupillary light reflex. The coma lasted for about 50 min to 4 h. After awakening, all rats showed reduced activities, unresponsiveness, not eating, and unstable walking. NSS at each time point (6 h, 9.33±0.88, 24 h, 5.67±0.67, and 7 d, 4.67±0.88) was higher than that of the control group (6 h, 1.33±0.67, 24 h, 0±0, and 7d, 0±0) (P<0.05). HE staining showed that the number of cells in the cortex (6 h, 323.33±95.82, 24 h, 294.00±54.98, and 7 d, 277.83±52.26), hippocampus (7 d, 214.50±43.69) and brainstem (6 h, 326.67±102.80; 24 h, 298.33±67.56; 7d, 234.50±18.20) of the DAI model group were significantly reduced compared with that in the cortex (430.33±20.35), hippocampus (327.17±24.34), and brainstem (429.50±81.86) of the control groups (the cell number of brainstem of the DAI 6 h model group [P<0.05], the cell number other DAI model subgroups [P<0.01]), karyopyknosis, and glial cell proliferation were found. In the cortex and around brainstem neurons, a large number of vacuolations and a few bleeding points were observed. The traveling disorders of brainstem nerve fibers were also observed. Silver staining displayed the brainstem axonal string-of-beads axonal ball formation. Immunohistochemical staining showed that the β-APP expression in the cortex (24 h, 9.16±1.32; 7 d, 14.50±2.83), hippocampus (24 h, 10.14±2.56; 7 d, 12.50±1.95), and brainstem (6 h, 6.74±1.33; 24 h, 7.64±1.11; 10.09±1.77) of the DAI model group were significantly higher than those in the cortex (4.02±0.34), hippocampus (4.26±0.70), and brainstem (4.38±0.85) of the control groups (P<0.01), and they increased with the prolonged time of injury after DAI.

This device is able to cause rat brain DAI, and it has the characteristics of simple, controllable, and precise. It can be used in the experimental studies of DAI model in rats.

The incidence rate of chordoma ranged from 0.51 to 8 per 1 million, and the prevalence rate was less than 1/100,000^[1]。 Most of the studies on chordoma are retrospective clinical case reports, with few data from phase II clinical studies and few reports from phase III clinical studies. 10 years ago, most skull base chordomas were considered difficult to remove completely^[2]The total resection rate of chordoma has reached 52% (26/50) recently and 80% (8/10) after 2011^[3]。 In 2013, the European Society for Medical Oncology (ESMO) updated clinical guidelines for the treatment of sarcomas, including chordomas; In addition, under the advocacy and funding of the Chordoma Foundation (CF), more than 40 experts in related fields from the surrounding Atlantic countries reached a consensus and wrote opinions on the diagnosis, classification and treatment of Chordoma for the first time. The evidence level was classified as I ~ V according to the American Public Health Management Grading System of the American Society of Infectious Diseases, and the chordomas in skull base, spine and sacrum were discussed respectively^[1]。 This article intends to interpret the key points of skull base chordoma, and combined with the Expert Consensus on Clinical Application Technology of Skull Base Endoscopy in Chinese Neurosurgery (2014 Edition)^[4]and National Comprehensive Cancer Network (NCCN) 2015 Clinical Practice Guidelines for Bone Tumors (1st Edition)^[5]This discussion aims to help neurosurgeons improve their understanding of skull base chordoma, so as to promote standardized treatment and ultimately benefit patients.

diffuse intrinsic pontine glioma (DIPG) is a type of brainstem glioma. DIPG is characterized by high grade, local invasion and poor prognosis. It occurs in children aged 5~9 years^[1]。 There are about 150 cases a year in the United States and about 30 in the United Kingdom, with the same incidence rates for men and women. DIPG is not uncommon in outpatient clinics in China, but the incidence of DIPG cannot be statistically determined because there are very few people performing surgery in income wards. Brainstem gliomas are classified according to MRI imaging findings into the following growth types: diffuse endophytic, localized, dorsal exophytic and cervical bulbar. Among the four types, DIPG is the most malignant and aggressive, while the last three types are mostly low-grade malignant. This article will briefly review the progress in the diagnosis and treatment of DIPG in recent years.

The incidence of epilepsy after craniocerebral surgery is about 3% ~40%, among which the incidence of supratentorial surgery is 3% ~37%, and the incidence of craniocerebral trauma surgery is 6% ~53%^[1,2]。 Postoperative epileptic seizures may cause intracranial hemorrhage, cerebral edema, etc. However, due to various factors such as allergic reaction of antiepileptic drugs, liver damage, interaction with other drugs, blind use of antiepileptic drugs not only fails to reduce the incidence of epilepsy, but will cause harm to patients^[3,4,5,6]。 Therefore, the rational use of antiepileptic drugs during perioperative period is very important. In this paper, the selection of antiepileptic drugs during perioperative period in neurosurgery is reviewed in combination with the special situation of Chinese pharmaceutical preparations and the recent progress of domestic and foreign research.

Brain metastasis is the most common type of intracranial tumor, and it is also one of the important fatal and disabling factors of advanced malignant tumors^[1]。 10% ~40% of cancer patients will develop intracranial metastatic tumors during their disease development^[1]Its incidence is about 10 times that of primary intracranial tumors^[2]。 The common primary sites of brain metastases are lung (40% ~50%), breast (15% ~20%), skin (5% ~10%) and gastrointestinal tract (4% ~6%)^[3]。 Pathological and biological studies on the occurrence and development of brain metastases are also being carried out in many aspects. This paper reviews the pathological and biological characteristics of brain metastases from the aspects of genes, cell surface molecules, serum markers, brain parenchymal microenvironment and immunohistochemical characteristics related to tumor cells.

senescence marker protein 30 (SMP30) is an anti-aging molecule "discovered" in 1992 with a relative molecular mass of about 30,000, which was accurately measured to be 33,400^[1]。 However, several years later, researchers discovered that SMP30 is the same molecule as regucalcin discovered in 1978. At that time, they only realized that it can regulate intracellular calcium ion concentration and affect the activities of various calcium signaling enzymes^[1,2]。 Moreover, the researchers also found that SMP30 has gluconolactonase activity and is involved in the synthesis of vitamin C in some mammals^[1,3]。 The SMP30 gene is located on the X chromosome in most vertebrates^[1,4], its homologs have been found in at least 14 species and have a high degree of homology, suggesting that it may play some irreplaceable role in the evolutionary course of animal bodies^[1,5,6]。

focal cortical dysplasia (FCD) is a disease caused by neuronal migration disorder or cell proliferation disorder in the cerebral cortex. It is one of the most common causes of refractory epilepsy^[1]。 It is reported in the literature that in epilepsy surgery, FCD accounts for about 40% ~50% of children with epilepsy surgery and about 20% of adults with epilepsy surgery^[2]。 In recent years, with the development of imaging, brain electrophysiology, and pathophysiology, people have gained a deeper understanding of FCD. This article reviews the research progress of FCD and refractory epilepsy.