Volume 31 · Issue 12 · 2015

sponteneoues intracerebral hemorrhage (hereinafter referred to as cerebral hemorrhage) refers to intraparenchymal hemorrhage caused by spontaneous rupture of large, small arteries, veins and capillaries in the cranium in adults caused by non-trauma. According to the cause of the disease, it can be divided into primary and secondary cerebral hemorrhage. Among them, primary cerebral hemorrhage accounts for about 80% ~85% of cerebral hemorrhage, mainly including hypertensive cerebral hemorrhage (about 50% ~70%^[1]), amyloid angiopathy cerebral hemorrhage (CAA, accounting for about 20% ~30%) and unexplained cerebral hemorrhage (accounting for about 10%). Secondary cerebral hemorrhage mainly includes cerebral hemorrhage caused by arteriovenous malformations, aneurysms, cavernous vascular malformations, arteriovenous fistulas, Moyamoya disease (Moyamoya disease), blood diseases or coagulation dysfunction, intracranial tumors, vasculitis, hemorrhagic cerebral infarction, venous sinus thrombosis and adverse drug reactions.

To understand the characteristics of CNS tumor onset and distribution of the population admitted to the departments of neurosurgery in Sichuan province.

All the data of the patients with CNS tumor were directly from 86 medium and large medical institutions in the Sichuan province. They were operated and the primary and secondary CNS tumor cases were diagnosed by pathology from January 2008 to December 2013. The onset of different types of CNS tumors and distribution, as well as the distribution in different genders, ages, and locations were analyzed. The prevalence of CNS tumors in pediatric population and Tibetan people were also analyzed.

A total of 35 496 patients with CNS tumor were diagnosed by surgery and pathology. The numbers in the top four were meningioma (n=10 119, 28.51%), pituitary adenoma (n=5 322, 15.00%), CNS sheath tumor (n=4 887 cases, 13.77%), and glioblastoma (n=4 197, 11.82%). The proportion of male was higher in malignant tumors, such as gliomas and metastases, while the proportion of female was higher in non-malignant tumors, such as meningiomas, schwannomas, and pituitary adenomas. The largest average age of onset was brain metastases (54.5 years, range, 9-85); the youngest average age of onset was 19.3 years (range, 1-91). In neuroepithelial tumors, most of the insular and cerebellar tumors were low-grade gliomas (accounted for 61% and 80% respectively), while most of thalamic and basal ganglia tumors were high-grade gliomas (accounted for 80% and 83% respectively). The proportion of the high-grade and low-grade gliomas in frontal lobes was 6 ∶4. The ratio of high-grade and low-grade gliomas in brain stems was 4 ∶6. The most common tumors in 0-19-year old children and adolescents were pilocytic astrocytoma, cyst, and craniopharyngioma. The occurrence of malignant tumors in Tibetan population was lower than that in the Han population, in particular, the probability of occurrence of high-grade gliomas decreased significantly (P=0.0009).

This study shows the onset and distribution characteristics of CNS tumors in the hospitalized population of the departments of neurosurgery in Sichuan province. To a certain extent, it reflects the characteristics of Chinese people suffering from CNS tumors.

To investigate the efficacy and prognostic analysis of microsurgery treatment of thalamic gliomas.

From December 2011 to January 2015, 57 patients with thalamic gliomas were treated via parietal lobule, corpus callosum, frontal lateral ventricle, and lateral fissure insular approaches, and 47 accepted radiotherapy/chemotherapy after procedure over the same time period. The postoperative symptoms and complications were observed and the overall survival (OS), progression free survival (PFS) were calculated, and the univariate and multivariate prognostic analyses were conducted.

No patient died during the perioperative period in this group. Subtotal resection (>90%) was achieved in 39 cases and partial resection (60%-90%) was achieved in 18 cases. They were clearly diagnosed as gliomas by histopathology. The symptoms were improved in 40 cases, unchanged in 11 cases, and aggravated in 6 cases, did not have complications in 12 cases after procedure. OS of 6, 12, and 24 months were 80.4%, 53.3% and 28.6%, respectively, and PFS of those were 71.4%, 41.3%, and 17.2%, respectively. The median survival time and the median progression-free survival time were 14.0 months (95%CI 13.1-20.7) and 12.0 months (95% CI 9.4-14.6) respectively. Multivariate analysis showed that the pathological types and the treatment modalities were the independent prognostic factors for affecting OS and PFS (P<0.05).

The effect of surgical treatment of thalamic gliomais is better recently. It can effectively relieve symptoms and improve the quality of life of patients. The postoperative adjuvant radiotherapy/chemotherapy may prolong the survival time of patients.

To evaluate the differences of the growth rate of skull base and non-skull base meningiomas.

The follow-up research literature about the growth of meningiomas was retrieved online. The eligible studies were analyzed by using Review Manager (version 5.3) software.

(1) A total of 7 observational cohort studies met the requirements were enrolled, including 361 patients with meningioma without being treated. (2) The Meta analysis results showed that there were significant differences in the absolute growth rate (year), relative growth rate (year), doubling time (months) between the skull base meningiomas and non-skull base meningiomas (WMD=0.42, 95% CI: 0.20-0.64, P=0.000 2; WMD=1.05, 95% CI: 0.82-1.29, P<0.01; WMD= -0.55, 95%CI: -0.77- -0.33, P<0.01).

The available information suggests that the growth rate of skull base meningiomas is less than that of the non-skull base meningiomas.

To evaluate the efficacy of gamma knife radiosurgery for the treatment of central neurocytoma and to discuss the treatment strategies.

Nine patients with central neurocytoma treated with gamma knife radiosurgery were analyzed retrospectively. They were confirmed by surgical pathology. A total of 12 tumor foci were treated. The tumor volume ranged from 0.04 to 14.3 cm³ (mean volume 3.75 cm³). The mean radiation dose of tumor margin was 13.7Gy (range, 11 to 15 Gy). The mean central dose was 26.8 Gy (range, 18 to 33.3 Gy). The follow up was assessed according to the MRI findings before and after gamma knife treatment and long-term quality of life (karnofsky performance scale, KPS).

The mean follow-up time was 46 months. Magnetic resonance imaging showed the tumor reduction in 5 cases, tumor disappearance in 1 case, no change in 1 case, and tumor recurrence in 2 cases. Four patients had 10-point improvement in the KPS score, and 3 did not have any change in the KPS score. The KPS score decreased in 1 case. One patient had intraventricular dissemination and died of tumor recurrence at 42.5 months after gamma knife radiosurgery. The total effective rate of gamma knife treatment was 78%. One patient had enlarged cerebral ventricles and recovered at 6 months after gamma knife radiosurgery. No radiation-related complications occurred.

Residual or recurrent central neurocytoma after gamma knife radiosurgery is safe and effective. In addition to assessing tumor local control, clinical follow-up also needs to pay attention to the problems of possible ventricle changes and tumor dissemination.

To explore the expression of calretinin in adamantinomatous craniopharyngioma and its effect and mechanism in tumor calcification.

The clinical data of 77 patients with adamantinomatous craniopharyngioma were analyzed retrospectively. They were grouped according the degree of tumor calcification before tumor operation. Immunohistochemistry assay and Western blot detection of calretinin were conducted in the specimens of each group. At the same time, after the craniopharyngioma primary cells being cultured, calretinin siRNA transfected cells and the culture medium calcium deposition were compared before and after transfection.

The tumors of 16 patients showed no calcification, 22 patients had mild tumor calcification (29%), 24 showed moderate calcification (31%), and 15 showed severe calcification (20%). Sixty-three specimens were positive for immunohistochemistry. Calretinin and degree of calcification showed positive correlation (r=0.853, P<0.001). The results of Western blot and immunohistochemistry assay were consistent. After the primary cells being transfected into calretinin siRNA, the calcium deposition in the medium was significantly lower than that of the control group.

Calretinin expresses in the mesenchymes of calcified adamantinomatous craniopharyngioma, and its expression is positively correlated with the degree of craniopharyngioma calcification. More research is needed in the mechanisms of calretinin in the calcification of adamantinomatous craniopharyngioma.

To investigate the role of yellow fluorescein-guided technique in the operation of intracranial malignant tumors.

From March 2014 to July 2014, the clinical data of 21 patients with intracranial malignant tumor diagnosed before procedure at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University were analyzed retrospectively. The tumors of 21 patients were resected using the PENTERO 900 fluorescence microscope equipped with YELLOW 560 nm filter during procedure. According to intraoperative fluorescence staining of the tumors, the tumor borders were identified, and the tumors were removed with ultrasound technique.

No contrast agent-related adverse events occurred in 21 patients during procedure. Nineteen patients had fluorescent development during procedure, no yellow fluorescent staining or weak fluorescent staining of tumors in 2 cases was observed. Postoperative pathological diagnosis: 13 patients had glioblastoma, 4 had anaplastic astrocytoma, 2 had anaplastic oligodendroglioma, 1 had glial sarcoma and 1 had metastases complicated with anaplastic astrocytoma.

For intracranial malignant tumors, yellow fluorescence-guided technique is contribute to identifying tumor borders and improves the safety and effectiveness of the operation.

To investigate the management of aneurysm neck tear, the preventive effect of aneurysm clip slippage, and aneurysm rupture with cotton piece-assisted clipping in micro-aneurysm surgery.

From February 2008 to December 2014, the clinical data of 19 patients with 23 micro-aneurysm treated with cotton piece-assisted clipping at the Department of Neurosurgery, the First Affiliated Hospital of Soochow University and the Department of Neurosurgery, Taizhou People's Hospital were analyzed retrospectively. In the operation, 2 aneurysm necks were torn. Taking the parent arteries as the center, the parent arteries were wrapped with the small rectangular pieces of cotton. The remaining 21 aneurysms were all wrapped with cotton pieces, and then the aneurysms were clipped.

Two parent artery ruptures were repaired successfully with the cotton piece-assisted aneurysm clipping, and 21 aneurysms wrapped with cotton pieces were clipped successfully. No aneurysm clips slippage and aneurysm rupture were observed. They were followed up by telephone and clinic visit; the follow-up period was from 2 weeks to 7 years (mean, 30.4 months). In the 18 ruptured aneurysms, 14 patients with Hunt-Hess grade Ⅰ-Ⅲ recovered well, 1 patient recovered well in 4 cases with Hunt-Hess grade Ⅳ-Ⅴ. Because of the short operation time, 3 were still in rehabilitation. There were? no operative deaths.

The cotton piece-assisted clipping plays a key role for the prevention of aneurysm clip slippage, aneurysm rupture, and repair of parent artery rupture in the operation of cotton piece-assisted clipping micro-aneurysms.

To evaluate the effectiveness and safety of carotid artery stenting for the treatment of patients with high-risk carotid stenosis through this study.

From June 2012 to May 2014, the medical data of 59 patients with high-risk carotid stenosis performed carotid artery stenting at the First Affiliated Hospital of Xinjiang Medical University were analyzed retrospectively. The incidence of adverse events and neurological evaluation of the patients were conducted during the follow-up observation at 1 week, day 30, and 1 year after procedure. The preoperative and postoperative differences of the patients were compared.

A total of 59 patients were enrolled. Their average age was 67±8 years old, and 49 of them (83%) are males. The average degree of stenosis of the preoperative carotid angiography was 87±6%. The average degree of stenosis was 9±6% after procedure. There was significant difference (P<0.05). Five patients had adverse events within 1 week after procedure and at day 30 after procedure, including 3 strokes and 2 transient ischemic attacks. One patient died because of cerebral ischemia-reperfusion injury caused intracranial hemorrhage after procedure. They were followed up for 1 year. One patient had major stroke because of cerebral infarction. The preoperative and postoperative neurological evaluation of the other patients were all improved or maintained at the same level (P<0.05).

Carotid artery stenting is a safe and effective treatment for patients with high-risk carotid stenosis.

To assess the accuracy of 320-detector volume CTA (VCTA) in the diagnosis of intracranial aneurysms.

A total of 462 patients suspected with intracranial aneurysm in the Department of Interventional Radiology, the Third Affiliated Hospital of Soochow University from February 2011 to October 2014 were performed 320-detector VCTA and digital subtraction angiographic (DSA) examinations.

In 462 patients, 313 patients with intracranial aneurysm were diagnosed by 3D-DSA and a total of 381 intracranial aneurysms were detected. Ten intracranial aneurysms were missed by non-subtracted VCTA and one aneurysm was misdiagnosed. The sensitivity, specificity, and accuracy of non-subtracted VCTA diagnosed<3 mm intracranial aneurysm were 91.7%, 99.3% and 96.8%, respectively. Two aneurysms were missed by subtracted VCTA and 1 aneurysm was misdiagnosed. The sensitivity, specificity, and accuracy of subtracted VCTA for diagnosis of <3 mm intracranial aneurysms were 97.2%, 99.3%, and 98.6%, respectively. As for the statistical results of the diagnosis of intracranial aneurysms, there were significant differences between the non-subtracted VCTA and subtracted VCTA, and the non-subtracted VCTA and 3D-DSA (allP<0.05); while there was no significant difference between subtracted VCTA and 3D-DSA (P>0.05).

The accuracy of subtracted 320-detector VCTA in the diagnosis of <3 mm intracranial aneurysms is higher. It can be used as the preferred imaging examination for diagnosis of intracranial aneurysms. The non-subtracted 320-detector VCTA relatively easily misses the diagnosis of intracranial aneurysms near the skull.

To investigate relationship between the characteristics of oscillatory activity in the subthalamic nucleus and the akinetic-rigid motor symptoms of Parkinson's disease.

From December 2012 to January 2014, 13 patients with akinetic-rigid type and 14 with mixed type Parkinson's disease admitted to Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University and were analyzed retrospectively. Their target neurons and contralateral limb EMG activities were collected when performing electrode implantation for subthalamic nucleus stimulation. The single cell and power spectrum were used to analyze the characteristics of neuronal oscillatory activity and EMG activity. The correlation analysis was used to investigate the relationship between the neuronal oscillatory activity and limb electromyography. The chi-square test and student's t-test were used to compare the differences between the two groups.

A total of 130 neurons were identified with 23 tracks in the akinetic-rigid type, and 102 neurons were identified with 21 tracks in the mixed type. The proportion of the neurons with β frequency band oscillatory activity of the akinetic-rigid type was significantly higher than that of the mixed type (43.8% vs. 19.6%, P<0.05), while the proportion of the neurons with tremor frequency band oscillatory activity was significantly lower than that of the mixed type (0.8% vs. 26.5%,P<0.05). The β frequency band oscillatory activity of 12% neurons of the akinetic-rigid type was correlated with the limb EMG (P<0.05). The neurons of oscillatory activity (96.0%) are mainly located in dorsal subthalamic nucleus.

The neurons with β frequency band oscillatory activity of the dorsal subthalamic nucleus participate in the pathophysiological activities of the akinetic-rigid type Parkinson's disease. The neurons of oscillatory activity are located in the dorsal subthalamic nucleus. It provides evidence for the selection of effective contacts of the electrode implantation for subthalamic nucleus stimulation.

To observe the feasibility and sensitivity of electrophysiological monitoring of antidromic nerve conduction in the location of trigeminal nerve 2 (V2) or 3 (V3) in semilunar ganglion radiofrequency thermocoagulation for the treatment of trigeminal neuralgia.

From November 2013 to May 2014, a total of 99 patients with typical trigeminal neuralgia (139 branches, the patients with the first branch pain were excluded) treated with the semilunar ganglion radiofrequency thermocoagulation of trigeminal nerve at the Pain Diagnosis and Treatment Center, Beijing Xuanwu Hospital, Capital Medical University were enrolled retrospectively. After the puncture needle entered the foramen ovale under the guidance of CT location, sensory (50 Hz, 0.1 ms) and motor (2 Hz, 1 ms) stimulations were given. According to the complaints of patients, whether the stimulation covered the painful area of trigeminal nerve branches was made clear. The location was accurate and when the stimulation voltage was ≤0.5 V, the position of the puncture needle was correct. Multi-channel electromyograph was used to detect the nerve conduction waveforms of each branch from 0V and the threshold voltage value of the waveforms of the corresponding branches was documented.

The complete remission rate of pain (Visual analog scale ≤3) the next day after operation was 96% (95/99). When the V2 and V3 branches were located, electromyograph recorded obvious nerve conduction waveforms in the corresponding channels in patients with V2 or V3 branch pain. When the sensory stimulation was 50 Hz, the threshold voltage value of V3 branch was 0.07±0.04 V, and V2 branch was 0.10±0.06 V. There was significant difference between both of them (P=0.002). When the motor stimulation was 2 Hz, the threshold voltage value of V3 branch was 0.09±0.04 V, and V2 branch was 0.13±0.07 V. There was significant difference between both of them (P=0.013).

Nerve antidromic conduction monitoring can be used in the location of V2 and V3 branches in the trigeminal nerve semilunar ganglion radiofrequency thermocoagulation, and the V3 branch is more sensitive.

To provide data support and experiences for the management of orbitocranial penetrating injuries by summarizing 20 patients with orbitocranial penetrating injury.

Twenty patients with orbitocranial penetrating injury caused by non-firearm foreign bodies admitted to the Nerve Trauma Center, Huashan Hospital, Fudan University from January 2004 to January 2014 were analyzed retrospectively. The clinical data of the patients included age, sex, Glasgow coma scale (GCS) on admission, time from injury to surgery, foreign body type, surgical approach, type of injury and scope, hospitalization time and visual acuity, as well as major complications affecting prognosis. They were followed up from 3 months to 2 years. The prognosis of patients was assessed by the Glasgow outcome scale (GOS).

There are 18 males and 2 females, their age ranged from 9 to 66 years old(mean 31.7 years). GCS was 15~14 in 19 patients(95%) , 12 in 1 patients (5%). All the injuries were caused by accidents, 11 of them were metallic foreign bodies, 4 were wooden foreign bodies, 3 were bamboo products, and 2 were plastic foreign bodies. CT findings revealed that the orbital entrances of 8 foreign bodies were located at the inner canthi, 8 were located at the lower eyelids, 2 were located at outer canthi, and 2 were located at the upper eyelids. Of the 20 patients, 10 foreign bodies entered from superior orbital fissure into skull. The 8 intracranial entries were located at the great wing of sphenoid, and 2 were located at anterior clinoid process. Five patients were operated via bifrontal transbasal approach and 15 were operated via pterional approach. Five patients complicated with intracranial infection and they eventually recovered and discharged. The GOS grade V was in 18 cases and grade Ⅳwas in 2 cases.

The early detection of intracranial injury and correct surgical treatment will significantly improve the prognosis of the patients with non-firearm orbitocranial penetrating injuries.

Acute lung injury is a common respiratory disease and one of the serious complications of severe traumatic brain injury (STBI)^[1,2]。 Current studies confirm that acute lung injury is an independent risk factor for cerebral hypoxia after STBI^[3]Intracranial hypertension is closely related to the occurrence of acute lung injury after STBI^[4]。 The authors' previous study revealed that the Glasgow Coma Score (GCS) at admission is an independent risk factor for acute lung injury in patients with STBI^[5]。 These studies suggest that acute lung injury may be significantly associated with STBI prognosis. This study retrospectively analyzed a group of patients with STBI to further reveal the relationship between acute lung injury and death during hospitalization in patients with STBI, thus exploring its clinical value.

Cerebral hemorrhage refers to non-traumatic hemorrhage caused by rupture of intraparenchymal blood vessels, accounting for 20% ~30% of all strokes, and the cause of occurrence is mainly related to cerebral vascular lesions^[1]。 High blood pressure is the most common cause. Middle-aged and elderly patients suddenly develop disease during activity or emotional agitation, and quickly develop symptoms of focal neurological deficit, headache, vomiting and other symptoms of intracranial hypertension. CT examination of the head can quickly confirm the diagnosis^[2]。 For the treatment of hypertensive cerebral hemorrhage in China, routine craniotomy, small bone window hematoma removal, stereotactic and CT-guided puncture and drainage of hematoma are often used^[3]。 From August 2014 to June 2015, the Department of Neurosurgery of Beijing Jiangong Hospital applied BrainLab neuronavigation-guided small bone window craniotomy to remove hematoma in 43 patients with hypertensive intracerebral hemorrhage and achieved good results. The report is as follows.

traumatic brain injury (TBI) frequently occurs with coagulation dysfunction^[1,2]This coagulation abnormality leads to prolonged hospital stay and poor prognosis. However, through literature search, there are few studies on the onset time and duration of intermediate TBI coagulation dysfunction. This study was conducted to evaluate the time course (time of onset and duration) of coagulation dysfunction in intermediate TBI and its association with complications and case mortality.

chronic subdural hematoma (CSDH) is a common disease in neurosurgery, and burr hole craniostomy (BHC) is the most widely used surgical method for the treatment of CSDH. Weigel et al.^[1]And Lega et al.^[2]It is agreed that BHC is the best treatment option for "uncomplicated" CSDH. From September 2007 to September 2014, the Department of Neurosurgery of Kaifeng Longhai Brain Hospital selected "Y-shaped double-lumen drainage tube" as the drainage tube, and treated 70 patients with CSDH with satisfactory results. The report is as follows.

To investigate the expression levels of branched-chain amino acid transaminase 1 (BCAT1) and its relationship with glioma proliferation in different levels of glioma.

The glioma specimens of 54 patients resected at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from 2012 to 2013 were collected. Immunohistochemistry assay was used to detect the expression levels of BCAT1 and Ki-67 in 54 patients with glioma. Real-time fluorescence quantitative PCR was used to detect the expression degree of BCAT1 gene.

(1) The expression levels of BCAT1 increased with the elevated pathologic grades (P<0.05). (2) Its expression degree is positively correlated with that of Ki-67 (r=0.825, P<0.01). (3) With the increase of the malignant degree of gliomas, the expression of BCAT1 mRNA increased. There was significant difference in the expression levels between the WHO gradeⅠ (0.5587±0.2038) and grade Ⅱ (1.3499±0.3964) (P<0.01). There was significant difference in the expression levels between the WHO grade Ⅱ and grade Ⅲ (P<0.01). There was significant difference in the expression levels between the WHO grade Ⅲ (2.0004±0.4025) and grade Ⅳ (3.0656±0.4955) (P<0.01).

BCAT1 is positively correlated with the malignant degree of gliomas. The higher the degree of malignancy, the higher the expression level of BCAT1.

To explore the in vitro culture condition of the tumor stem-like cells isolated from rat prolactinoma MMQ cell lines and to observe their characteristics of proliferation, differentiation, and formation of planted tumor.

MMQ cells were cultured with serum-free medium suspension of containing epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF), and the tumor stem cell spheres (briefly cell spheres) were obtained. Clone culture was conducted and its proliferative capacity was observed. Then flow cytometry was used to detect the CD133-positive cell ratio. Western blot was used to detect cell sphere CD133 and nestin expressions. Immunofluorescence technique was used to detect the expressions of cell sphere CD133, nestin, homing cell adhesion molecules (HCAM/CD44), octamer binding transcription factor 4 (OCT4), stem cell antigen 1 (SCA1), as well as their expressions of differentiated cell glial fibrillary acidic protein (GFAP), β-tublinIII, and S100 protein. Twenty-seven female nude mice were randomly divided into 3 groups: a cell sphere planting group, a MMQ cell sphere planting group, and a normal control group ( n=9 in each group). Six weeks after subcutaneous plantation, the tumor volume and serum prolactin (PRL) levels were measured. The sections of tumor tissue were detected by the HE staining and immunohistochemistry.

Under the condition of suspension culture of serum-free medium, only a few cells survived and formed cell spheres. After being blown away, cells could clone and proliferate into cell spheres. The proportion of CD133 positive cells was 1.10±0.17%. CD133, nestin, HCAM/CD44, OCT4, and SCA1 on the cell spheres showed positive expression. After the differentiation of cell spheres, the cells expressed GFAP, β-tublinIII, and S10 protein. The volume of tumor formation in the cell sphere planting group was 1262.2±279.1 mm ^3, and the MMQ cell sphere planting group was 495.9±158.9 mm³ (P<0.05). The serum PRL of the tumor-bearing nude rats in the cell sphere planting group (median,P25, P75) was 36.08 (34.23, 41.42) ng/ml, and the MMQ cell sphere planting group was 21.51 (20.39, 22.98) ng/ml respectively, and they both higher than 0.26 (1.03-0.15) ng/ml in the normal control group (P<0.05). The HE staining of tumor tissue showed the similar characteristics of the rat pituitary adenoma. Immunohistochemical staining showed that the PRL and nerve synaptophysin (Syn) expressions were positive.

In MMQ cell lines of rat pituitary prolactin adenoma, a small amount cells with tumor stem-like cell characteristics exist, and they can be cultured successfully In vitro.

To investigate the effects of microRNA-451 (miRNA-451) on the proliferation and invasion of U87 glioma cell lines in human brains by target calcium-binding protein 39 (CAB39) regulating the expression of hypoxia-inducible factor-1α (HIF-1α).

The U87 glioma cells in human brains were cultured. They were divided into 3 groups: a blank control group, a nonsense sequence group, and a miRNA-451 treatment mimics group (briefly miRNA-451 group). The synthetic oligonucleotide miRNA-451 analogs (miRNA-451 mimics) were transfected to U87 glioma cells. Real-time PCR was used to detect the expression of miRNA-451 after transfection of glioma cells. Western blot was used to detect the expression levels of CAB39, liver kinase B1 (LKB1), and HIF-1α proteins. The flow cytometry was used to detect the changes of cell cycle. The methyl thiazolyl tetrazolium (MTT) colorimetric assay was used to detect cell proliferation ability. Transwell assay was used to detect the changes of cell invasion ability.

The relative expression quantities of miRNA-451 in the blank control group, the nonsense sequence group, and the miRNA-451 group were 13.08±0.48, 12.91±0.66, and 9.94±0.29, respectively; the relative expression quantities of CAB39 were 2.85±0.05, 2.40±0.04, and 0.41±0.02, respectively; the relative expression quantities of LKB1 were 1.05±0.04, 0.95±0.04, and 0.28±0.02, respectively; and the relative expression quantities of HIF-1α were 0.60±0.02, 0.54±0.03, and 0.14±0.05, respectively. There were significant differences (P<0.05). The cell cycle analysis showed that the DNA contents of cell G₀/G₁ phase in the miRNA-451 group were 60.48%, 58.70%, and 75.58%, respectively compared with the blank control and the nonsense sequence group. There were significant differences (P<0.05). The MTT assay showed that the cell growth was significantly inhibited in the miRNA-451 group and the cell proliferation rate was only 41.48% on the 6th day. The Transwell assay showed that the numbers of cells passing through Transwell chambers in the miRNA-451 group were decreased obviously, and. there were only 24. It was lower than 51 and 45 in the blank control group and the nonsense sequence group. There were significant differences (P<0.05).

miRNA-451 regulates the expression of HIF-1α by reducing the expression of target CAB39, and inhibits the proliferation and invasion ability of glioma cells in human brains.

persistent vegetative state (PVS): Loss of any evidence of cognition or ability to express conscious emotional and behavioral responses to external events or stimuli, but with a sleep-wake cycle, complete or partial preservation of autonomic nerve function in the hypothalamus and brainstem. When this cognitive loss persists for more than a period of time, it is called PVS^[1]While the Chinese Society of Neurosurgery identified those with 3 months of unconscious activity and sleep-wake cycles as PVS^[2]。 A significant proportion of patients remain in PVS after severe craniocerebral injury. In recent years, with the development of neuromodulation technology, electrical spinal cord stimulation (SCS) has been applied in clinic, and has obvious effect as a therapeutic method to promote awakening of PVS patients^[3]。 In Kanno et al.^[4]Of the 201 PVS patients treated by SCS, up to 54.2% experienced positive responses such as recovery of consciousness. In 2008, two patients with PVS admitted to the Department of Neurosurgery of Tongmei Group General Hospital in Datong, Shanxi Province were treated with satisfactory results by SCS, which are reported below.

internal carotid artery occlusion (ICAO) is one of the main causes of cerebral ischemic events. An epidemiological study showed that the incidence of symptomatic ICAO in white Americans is 6 per 100,000, resulting in between 15,000 and 20,000 ischemic cerebrovascular events per year in the United States^[1]。 The clinical manifestations of ICAO patients are diverse and may be asymptomatic (often discovered accidentally during physical examination). Symptomatic patients may be manifested as transient ischemic attack (TIA), hemiplegia or even fatal stroke, but the incidence of stroke is relatively low^[2,3,4]。 Disability and mortality rates of ICAO patients were 40%-69% and 16%-55%, respectively^[5,6,7]。 In recent years, some progress has been made in the research of ICAO at home and abroad, which is summarized as follows.

With the continuous development of neurosurgery and intensive care technology, the number of patients in vegetative state (VS) is increasing day by day, and the explanation of VS from the perspective of pathophysiological function is more and more clear. However, a basic problem-the number of VS patients is still unclear.

intraventricular hemorrhage (IVH) usually refers to spontaneous IVH, that is, the rupture of intracranial blood vessels and the rupture of blood into the ventricular system under the action of non-traumatic factors. IVH is a common complication of cerebral hemorrhage and subarachnoid hemorrhage, and the incidence of IVH complicated by cerebral hemorrhage is 42% ~52%^[1]The fatality rate of IVH is 50% ~80%^[2]。 It is reported in the literature that the incidence of IVH in low birth weight premature infants is 15% ~20%, and the mortality rate is 20% ~50%^[3]。 IVH has a high mortality and disability rate, and poor efficacy of medical treatment. Therefore, in recent years, researchers have been exploring more ideal surgical treatment methods.

Primary CNS tumors exhibit great heterogeneity in histology, molecular genetics, and prognosis. WHO classification of central nervous system tumors is mainly based on tumor tissue morphology, occurrence site, age distribution and biological behavior, and the tumors are classified into grade Ⅰ ~ Ⅳ^[1]。 However, relying solely on pathological typing has certain limitations. In recent years, with the application of high-throughput molecular analysis methods, the research progress of molecular genetics of central nervous system tumors has further revealed the mechanism of nerve tumor formation, and provided new ideas for the diagnosis, classification, prognosis and even treatment of nerve tumors.

There are many causes of skull defects, such as craniocerebral trauma, brain tumor, cerebrovascular disease, and congenital diseases, etc., and skull repair is very necessary. First, it can protect brain tissue, restore intracranial and extracranial anatomical structures, achieve the aesthetic outline, and provide support for craniofacial soft tissue; Second, it can relieve the serious psychological burden on patients due to skull defects^[1]。 Although there are many skull repair materials, autologous skull is still unanimously recognized by many experts as the most ideal repair material. Autologous skull repair faces many problems and challenges. This article focuses on the following aspects.

Glioblastoma (GBM) is the most common and most malignant brain tumor. With the development of immunohistochemical technology, the idea that the secondary GBM developed from astrocytoma is a tumor that is essentially different from the primary GBM is finally confirmed by the molecular expression similarity and homology between astrocytoma and secondary GBM^[1]Secondary GBM and primary GBM are two completely different tumors, both from clinical prognosis and from the point of view of molecular pathology and epigenetics. In this article, the molecular pathological manifestations of secondary GBM will be reviewed in combination with recent reviews as follows.