Volume 32 · Issue 01 · 2016

With the start of "brain research programs" and the advent of "precision medicine" era in various countries around the world, how to develop the brain tumor specialty, which plays an important role in neurosurgery, is a problem that experts and scholars engaged in brain oncology have been deeply discussing and paying attention to. In recent years, although the overall level of neurosurgery in China has made great progress, it cannot be ignored that the level of brain tumor surgery and comprehensive treatment in various regions is still very uneven. The national collaborative research network for brain tumors has not yet been established, and the clinical transformation of some new diagnosis and treatment technologies needs to be strengthened urgently. Faced with these problems, how to do brain tumors in China? How to do it? At a time when opportunities and challenges coexist, it is most urgent to change this situation at the national level to "build platforms, collaborative innovation, win-win cooperation and project-driven professional development". As the leader of the brain tumor professional group of the Neurosurgery Branch of Chinese Medical Association, the future clinical diagnosis and treatment of brain tumors and translational medicine research are explained from the following aspects.

To analyze the efficacy of Gamma knife for the treatment of different types of acoustic neuroma.

From April 1997 to June 2013, 123 patients with acoustic neuroma (<3 cm) treated with Gamma knife in Xiangya Hospital, Central South University were enrolled retrospectively. Hasegawa classification: type A 5 cases, type B 38 cases, type C 47 cases, and typed D 33 cases. Different types of tumor growth and complications after treatment were analyzed and the related factors of influencing the effective tumor control rate were investigated.

The follow-up time of 123 patients ranged from 6 to 135 months (median, 41 months). The 5-year effective tumor control rate was 92.1%. The tumor control rate of type D was lower than A+ B+ C types (74.1% and 96.1% respectively; P<0.01). Multivariate Cox model analysis showed that the tumor type was an independent factor for affecting tumor control rate (RR, 12.172, 95% CI 2.584-57.348; P=0.002). In the 123 patients, the incidence of radiation-induced brain edema was 12.2% (n=15), and the type A, B, C, and D were 0%, 2.6% (n=1), 10.6% (n=5), and 27.3% (n=9), respectively. The incidences of type C and D were higher than those of type A and B (P=0.014). The incidence of hydrocephalus was 2.4% (n=3, all type D). Of the patients with complete assessment data, the incidence of facial palsy was 10.8% (n=8), and the type A, B, C, and D were 1/4 (n=1), 8.0% (2/25), 4.2% (1/24), and 19.0% (4/21), respectively. The incidence of rigeminal nerve dysfunction was 29.7% (n=22), and type A, B, C, and D were 0%, 4% (1/25), 37.5% (9/24), and 57.1% (12/21), respectively. The incidences of type C and D were higher than those of type A and B (P=0.001).

The effective control rate of Gamma knife for the treatment of <3 mm acoustic neuroma and the neurological retention rate were closely associated with the tumor typing. The prognoses of type A and B were better, and those of type C and D were poor.

To investigate the pathogenesis and treatment regimen of delayed hyponatremias after transsphenoidal pituitary adenoma surgery.

A total of 422 patients with pituitary adenoma treated at the Department of Neurosurgery, Tianjin Medical University General Hospital and diagnosed by histopathological diagnosis from January 2010 to January 2014 were analyzed retrospectively. The clinical features, laboratory tests and the effects of different treatment options of delayed hyponatremias after pituitary surgery were summarized and analyzed.

After surgery, in 422 patients with pituitary adenoma, 110 had delayed hyponatremia. The pathologic types of nonfunctioning adenomas (29/74, accounting for 39.2%) and adrenocorticotropic hormone adenomas (12/31, accounting for 38.7%) were common. The large pituitary adenomas (macroadenoma 69/246, accounting for 28.0%, giant adenoma 27/73, accounting for 37.0%) and old patients >50 years (68/196, accounting for 34.7%) were prone to delayed hyponatremias ( P<0.05). The patients with hyponatremia usually complicated with adrenal insufficiency. The efficacy was significant with hormone therapy in the correction of hyponatremias.

Delayed hyponatremias are one of the common complications after pituitary adenoma surgery. It can not relieve itself. The appropriate hormone and sodium supplement therapies are the effective treatment methods.

To analyze clinical and pathological features of molecular subtypes of adult medulloblastomas (MB).

A total of 110 adult patients diagnosed as MB by pathology and admitted to the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2007 to January 2015 were enrolled retrospectively. Immunohistochemical staining was used to conduct the molecular typing of samples. The chi-square test was used to analyze the differences in clinical and pathological features of MB molecular subtypes.

In 110 patients, 60 (54.5%) were classic type, 25 (22.7%) were desmoplastic/nodular type MB, 25 (22.7%) were large cell/anaplastic type; 77 (70.0%) were molecular subtype SHH, 10 (9.1%) were WNT, 23 (20.9%) were Group 4 subtype, and no Group 3 subtype. The patients with classic type MB had SHH, WNT, and Group 4 subtype, all accounting for the major proportions of each subtype were 52.0% (40/77), 7/10, and 52.2% (12/23), respectively. There were no significant differences among each group. In patients with large cell/anaplastic MB, SHH, WNT, and Group 4 subtype accounted for 15.6% (12/77), 30% (3/10), and 47.8% (11/23), respectively. There were significant differences (P=0.032). The desmoplastic/nodular type MB of 25 patients was all SHH subtype. There was significant difference in the gender distributions between the SHH subtype (male to female ratio was 2.5 ∶1.0) and the WNT subtype (male to female ratio was 1.0 ∶2.3) (P=0.009). There was significant difference on the distribution of tumor sites between SHH subtype (midline/hemisphere 1.0 ∶1.2) and Group 4 subtype (midline/hemisphere 2.8 ∶1.0) (P=0.017).

Immunohistochemical method may effectively diagnose the MB molecular subtype. The different molecular subtypes have differences in the clinical characteristics and histopathological features.

To investigate the clinical value of preoperative MRI features for predicting hemangiopericytoma (HPC) and angiomatous meningioma.

From January 2005 to December 2014, 12 patients with HPC and 17 with angiomatous meningioma admitted to the Department of Neurosurgery, Nanfang Hospital, Southern Medical University were analyzed retrospectively, and pathological diagnosis was conducted according to the WHO 2007 grading criteria. Preoperative MRI parameters included tumor location, tumor size, tumor shape, T1-weighted imaging, T2-weighted imaging, T1-enhanced imaging, apparent diffusion coefficient (ADC) value, fluid-attenuated inversion recovery (FLAIR) imaging, peritumoral edema, dural tail sign, vascular flow void shadow, subarachnoid space in T2-weighted imaging, and tumor hemorrhage or necrosis. The relationship between the two types of tumor imaging features and clinical pathology were detected by using univariate analysis. Logistic regression model was used to evaluate the relationship between these parameters and HPC.

The results of univariate analysis showed that there were significant differences between age, gender, ADC value, tumor necrosis of two types of tumors and T1-enhanced imaging (P<0.05). Logistic regression model demonstrated that the ADC value was the only independent predictor of HPC (P=0.039, OR: 14.5, 95%CI: 3.7-38.6).

ADC value can be used as a simple and effective tool to identify primary intracranial HPC and angiomatous meningioma. The possibility of HPC in patients with preoperative DWI hypointensity and high ADC coefficient is greater

To investigate gene mutation and clinical features in families with hereditary neurofibromatosis type 2 (NF2).

From January 2011 to December 2014, 37 patients with NF2 from 15 pedigrees treated in Beijing Tiantan Hospital, Capital Medical University were enrolled retrospectively. Thirty-one blood samples and 15 tumor samples (1 case from each pedigree) from patients were obtained; meanwhile, 74 blood samples from healthy controls (24 samples from healthy persons in the pedigrees and 50 samples from healthy persons without kinship) were obtained. Sanger sequencing method was used to sequence the NF2 gene coding region and its adjacent introns. Kaplan-Meier survival curve analysis was used to compare the different types of mutations and the survival period of the patients with different mutations.

Fifteen and 18 NF2 gene mutation types were detected from blood and tumor samples in patients with NF2, including 2 nonsense mutations, 4 missense mutations, 6 frameshift mutations, 1 in-frame deletion mutation, and 5 splice site mutations, 14 of the mutation types had not been reported. No NF2 gene mutations were detected in all the healthy subjects. Kaplan-Meier survival curves showed that the median survival time of the 18 patients in the NF2 gene nonsense/frameshift mutation group was 120.0±20.3 months; that of 11 patients in the missense mutation group was 288.0±91.7 months; and that of mutation site located in the NF2 gene 1-7 exon group of the 14 patients was 120.0±15.3 months; and that of mutation site located in the NF2 gene 8-11 exon group of the 15 patients was 276.0±19.6 months. There were significant differences (P=0.01, P=0.005).

NF2 gene mutation detection is an important method of early diagnosis and screening. The mutation style and sites are the important bases for identifying NF2 disease progression and prognosis.

To investigate the surgical approaches of effective resection of petroclival meningiomas.

Thirty-six patients with petroclival meningioma admitted to the Department of Neurosurgery, Tianjin Huanhu Hospital from January 2009 to January 2014 were enrolled retrospectively. When a major part of the tumor was located in supratentorium, in particular the invasion of the cavernous sinus and broking into the middle cranial fossa, resected it via zygomatic-frontal-temporal approach; when a major part of the tumor was located in posterior fossa or only invasion of Meckel capsule, even a small part of tumor invasion of the cavernous sinus, reseted it via retrosigmoid approach; for patients with huge tumor and invasion of middle or posterior fossa at the same time, the supratentorial and infratentorial tumors were resected by stages in combination with 2 approaches.

The tumors of 21 patients were resected via zygomatic-frontal-temporal approach, those of 12 patients were resected via retrosigmoid approach, and those of 3 patients were resected by stages in combination with 2 approaches. Total, subtotal, near-total, and partial resection of tumors were achieved in 16, 14, 5, and 1 cases, respectively. They were followed up for 6 to 60 months after discharge (mean, 32.0±19.6 months). Thirty-three patients recovered well and 3 recovered poorly. Twelve patients (33.3%) had postoperative complications, including 3 had oculomotor nerve paralysise, and 2 of them recovered; 5 had trochlear nerve dysfunction, 2 had facial numbness, and 1 had tinnitus. They had different degrees of recovery during the follow-up period. One patient had temporal lobe edema, and he was improved after conservative treatment. No cerebrospinal fluid leakage and death case were observed. Four patients had tumor recurrence, 3 had tumor residue, and 4 patients with recurrence were treated with Gamma knife.

Resection of petroclival meningioma via different approaches may achieve a satisfactory effect.

To investigate the advantages and significance of the lateral supraorbital approach in the surgical treatment of anterior cranial fossa meningiomas.

From June 2011 to June 2014, the clinical data of 47 patients resected anterior cranial fossa meningiomas via lateral supraorbital approach at the Department of Neurosurgery, Qilu Hospital of Shandong University were analyzed retrospectively. According to the radiological findings and the symptoms improvement of the nervous system, the reliability of the surgery program before treatment in anterior cranial fossa meningiomas was evaluated.

Forty-five patients had Simpson Ⅰ grade resection and 2 had Simpson Ⅱ grade resection. The pathology showed 46 patients with meningiomas WHO grade Ⅰ and 1 with meningioma WHO grade Ⅱ (atypical meningioma). Four patients had fever after procedure, 5 had hyponatremia, 9 had psychiatric symptoms, 1 had cerebral edema, and 7 had seizures. No incision infection and cerebrospinal fluid rhinorrhea occurred, and none of the patients died. They were followed up for 3 to 36 months after procedure. Imaging examination revealed no recurrence.

The treatment of anterior cranial fossa meningiomas via lateral supraorbital approach has the advantages of complete resection of tumors, less trauma, and fewer complications.

To investigate the effectiveness, tolerability and safety of carboplatin in combination with temozolomide (TMZ) dose-dense regimen for the treatment of recurrent glioblastoma (GBM).

From February 2013 to March 2014, 9 adult patients with recurrent GBM received carboplatin in combination with temozolomide dose-dense regimen at the Department of Radiotherapy, the First Hospital of Jilin University were collected. The specific regimen: carboplatin 350 mg/m² at day 1; TMZ 150 mg·m^-2·d^-1, at day 1-7 and day 15-21, and 28 days were a circle. The follow-up time ranged from 5 to 16 months.

Four cycles of chemotherapy were performed in 7 patients; 5 cycles of chemotherapy were performed in 2 patients. The main toxic reactions were hematological toxic reactions, gastrointestinal reactions, and fatigue. Three patients had grade Ⅰ-Ⅱ of bone marrow suppression; 6 patients had grade Ⅲ-Ⅳ of bone marrow suppression. All patients had mild to moderate gastrointestinal reactions including anorexia and vomiting. All the above adverse reactions were alleviated after symptomatic treatment; none of them had treatment-related deaths. Five patients died of tumor progression. The progression-free survival rate of 6 months was 44% (4/9); the imaging remission rate (PR) was 44% (4/9); the symptom improvement rate was 67% (6/9); and the 1-year survival rate was 22% (2/9).

Carboplatin in combination with TMZ dose-dense regimen for the treatment of recurrent GBM was effective. Most of the patients with 4-5 cycles of chemotherapy could tolerate it. No severe irreversible adverse reactions occurred.

To observe the relationship between the extent of tumor resection and postoperative tumor recurrence or facial nerve function.

A total of 154 patients with coustic neuroma operated by the same surgeon in Tianjin Huanhu Hospital from October 2004 to October 2014 were enrolled retrospectively. All patients were treated via suboccipital retrosigmoid transmeatal approach. The near-total resection strategy was used during operation. Part of the tumors closely adhered to the facial nerves were not removed forcibly. If there was part tumor residue, the internal auditory canal was not drilled open. The relationship between facial nerve function or tumor recurrence and tumor resection degree was analyzed. The patients with recurrent tumor were treated with Gamma knife.

In 154 patients, 1 (0.6%) died during the operation, 124 were followed up, 30 were lost to follow up, and. the follow-up rate was 80.5%. The follow-up time ranged from 8 months to 10 years. In 124 patients, the total resection rate of acoustic neuroma was 19.3% (n=24), the near-total resection rate was 74.2% (n=92), and subtotal resection rate was 6.5% (n=8). The good rate of facial nerve function in 124 patents after procedure was 91.1% (n=113; House-Brackmann grade I to Ⅲ), the total resection group was 79.1% (19/24), the near-total resection group was 94.6% (87/92), the good proportion of the subtotal resection group was 7/8 (χ²=5.72, P=0.048). The recurrence rate was 16.1% (20/124), including 0 in the total resection group, 15.2% in the near-total resection group, the proportion of the subtotal resection was 6/8. There were significant differences (F=19.47, P=0.000). After Gamma knife treatment, the tumor volume increased again in 4 patients (3.2%) during the follow up period. They were reoperated.

After near-total resection of acoustic neuroma, the assisted gamma knife therapy may effectively control the growth of acoustic neuroma, and significantly improve the retention rate of facial nerve function. For the improvement of the quality of life after procedure is a feasible treatment scheme in the facial nerve and some closely tumor-adhered patients.

To analyze the clinical features and treatment of schwannomatosis in central nervous system.

From January 2008 to June 2015, 70 patients (6.7%) with schwannomatosis were screened from 1045 patients with spinal schwannoma treated at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University. They were all treated with surgery. Their clinical features and treatment results were analyzed retrospectively.

Of the 70 patients, 49 were males and 21 were females (P=0.001). The age of first performing spinal operation ranged from 10 to 72 (43.0±4.9) years. Eight patients (11.4%) had a family history. The spinal schwannomas of 18 patients located in cervical vertebra; 6 in the superior thoracic segment (T_1-6); 39 in the inferior thoracic segment (T_7-12); and 58 in the lumbar vertebra. Thirty patients had multiple small cauda equine nodules in spinal canals, 5 complicated with solitary intracranial non-vestibular schwannoma, and 24 (34.3%) complicated with peripheral schwannoma. Fifty-seven patients (81.4%) received a single spinal surgery; 13 (18.6%) underwent multiple spinal canal surgery because of newly developed tumors. They were all non-segmental schwannomatosis. The age of the patients with the first spinal canal surgery was younger than the patients with single surgery (32.9±14.7 years vs. 45.4±14.0 years; P=0.006). The total resection rate was 92.9% (65/70). The postoperative follow-up time ranged from 1 month to 7 years (median, 50 months). Thirty-eight (54.3%) of them fully recovered, 24 (34.3%) improved, 6 (8.6%) were stable, and 2 (2.9%) aggravated.

Spinal canal tumors of schwannomatosis mostly occur in the inferior thoracic segments and within the lumbar tubes. Intracranial tumors are rare. The prognosis of segmental patients or older patients with the first operation is relatively better; part of the patients may need several operations because of the occurrence of new tumors.

To investigate the clinical features, diagnosis and treatment methods of dural arteriovenous fistula at the craniocervical junction.

The clinical data from 13 patients with dural arteriovenous fistula at the craniocervical junction admitted to the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from September 2009 to January 2015 were analyzed retrospectively. All patients were diagnosed after performing encephalon angiography. Ten patients were treated with microsurgery of electric coagulation cutting off fistula via the posterior median suboccipital approach. Three patients were observed and followed up. The follow-up time ranged from 2 months to 5 years.

In the 10 patients treated with surgery, postoperative cerebral angiography showed that the original fistulas, draining veins and aneurysmal changes disappeared in 9 cases, in one case there was partial residue of the fistula, which was completely removed after the secondary microsurgery.9 cases with the onset of subarachnoid hemorrhage had no significant postoperative neurological deficit.The pain in the patient who had trigeminal neuralgia relieved obviously after surgical procedure. During the follow-up period, no recurrence was found in the postoperative patients. Among the 3 patients under observation, one case who was completely paralyzed died of related complications, the remaining 2 cases were lost.

The clinical manifestation of dural arteriovenous fistula in the craniocervical junction do not have specificity, it can be diagnosed by performing encephalon angiography. Currently, microsurgery can generally find fistula and block it, and the efficacy is exact.

To preliminarily discuss the operation strategy in patients with intracranial cavernous hemangioma complicated with venous malformation.

The clinical data and postoperative follow-up results of 13 patients with intracranial cavernous hemangioma complicated with venous malformation operated at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2007 to December 2014 were analyzed retrospectively.

In the 13 patients, intracranial cavernous malformation complicated with venous malformation achieved total resection in 7 patients. They all developed severe cerebral edema after procedure. Four of them were in the supratentorial region, their prognoses were good after strengthening dehydration treatment, and 1 in the supratentorial region died, and 2 left sequelae. The postoperative condition was stable and the prognosis was good in 4 patients whose abnormal expansion of medullary veins were resected, the main drainage veins were retained and in 2 patients whose venous vascular malformations were retained.

In the operation of resection of intracranial cavernous malformation complicated with venous malformation, the resection of abnormally dilated medullary veins and retaining main draining veins at the same time of the total resection of cavernous malformation are more conducive to the rehabilitation of patients.

To investigate the effect of carotid endarterectomy on cardiac function in order to reduce the occurrence of cardiac complications after procedure.

The preoperative cardiac function tests, blood pressure within 24 h after procedure, and changes in heart rate in 50 patients with carotid stenosis treated with carotid endarterectomy at the Department of Neurosurgery, the Fourth Affiliated Hospital of Guangxi Medical University from January 2012 to June 2013 were analyzed retrospectively.

In 50 patients, 7 had a definite history of coronary heart disease. Routine electrocardiogram reported 18 had sinus bradycardia and/or some changes in myocardial ischemia, and echocardiography reported 41 had a mildly reduced left ventricular diastolic function. After procedure, 13 patients had decreased heart rate and blood pressure in different degrees, and 9 had cardiac function problems before procedure. Two of the 13 patients had acute coronary syndrome. They did not have any obvious clinical symptoms during hospitalization. They all improved and discharged from the hospital. One patient had extensive anterior myocardial infarction, and he died after active rescue.

Carotid endarteretomy has a greater impact on cardiac function. Strengthening the preoperative heart function examination, reducing intraoperatie injury of carotid sheath, actively managing the changes of postoperative heart rate, and blood pressure are critical for decreasing the disability and mortality.

To investigate the significance of shunting in carotid endarterectomy by comparing the postoperative stroke rate in patients with carotid endarterectomy between the routine shunting and the selective shunting.

The clinical data of 179 patients received carotid endarterectomy at the Department of Neurosurgery, Shengjing Hospital Affiliated to China Medical University from April 2008 to July 2014 were collected. All the 179 patients were divided into either a routine shunting group or a selective shunting group. The stroke rates at day 30 after procedure were compared between the 2 groups, and the introperative carotid artery occlusion time between the shunting and non-shunting patients in the selective shunting group was compared.

In the selective shunting group, 35%(29/82) patients received shunting, while 64%(7/11) patients with contralateral severe carotid artery stenosis or occlusion conducted shunting. In the selective shunting group, the introperative shunting could significantly shorten the time of intraoperative carotid artery occlusion (P<0.01). There was no significant difference in postoperative stroke rates between the routine shunting group(2%, 2/97) and the selective shunting group(1%, 1/82) (P>0.05).

Shunting should be used to reduce the incidence of postoperative stroke during carotid endarterectomy with contralateral severe stenosis or occlusion.Using selective shunting may decrease the occurrence of perioperative stroke events in carotid endarterectomy and will achieve good surgical effect.

To investigate the clinical efficacy of posterior screw-rod internal fixation and bone graft fusion for the treatment of atlantoaxial dislocation.

Seventeen patients with atlantoaxial dislocation admitted to the Department of Neurosurgery, Zhengzhou Yihe Hospital from June 2014 to December 2014 were analyzed retrospectively. The patients included 8 females and 9 males, aged 21 to 65 years (mean 40 years old). The 17 patients were treated with posterior screw-rod internal fixation and bone graft fusion. All the patients underwent cervical anteroposterior, hyperextended or excessive flexion X-ray examinations, cervical spiral CT scan, three-dimensional reconstruction of the upper cervical spine, and. head and neck joint CTA examination. They were all followed up after procedure.

The follow-up time of the 17 patients in this group was 3 to 18 months (mean 10 months). The screws were in good position on CT reexamination. The diaplasis of atlantoaxial dislocation was satisfactory. All patients had good bon fusion (100%). The neurological symptoms of 1 patient did not have any obvious change compared with before procedure. The clinical symptoms of the remaining 16 patients were improved in different degrees.

Posterior screw-rod internal fixation and bone graft fusion for the treatment of atlantoaxial dislocation may provide an immediate stability of the craniocervical junction, improve the bone graft fusion rate, reduce the complications of long-term cervical external fixation after procedure. It is a safe and effective surgical method.

Primary trigeminal neuralgia is a type of paroxysmal facial pain, and familial cases have been reported rarely. Since the Department of Neurosurgery, General Hospital of Tianjin Medical University began to treat primary trigeminal neuralgia with microvascular decompression in 1999, the author diagnosed and treated a case of familial primary cranial nerve disease in 2013, and investigated a total of 3 cases of primary trigeminal neuralgia in three generations, of which 2 cases were treated with microvascular decompression, with satisfactory clinical results. The review literature is reported as follows.

Anterior communicating artery (ACoA) aneurysms account for about 30% of intracranial aneurysms, while the incidence of distal anterior cerebral artery aneurysms is relatively low, accounting for about 1.5% ~9% of intracranial aneurysms^[1]。 The local anatomy of the aneurysm in this site is complicated, the location is deep, the surgical exposure is difficult, and there are many surgical approaches. At present, the commonly used approaches are pterional approach, subfrontal approach, extra lateral approach, longitudinal fissure approach, frontal-base-longitudinal fissure approach, etc. From January 2012 to March 2015, the Tenth Affiliated Hospital of Guangxi Medical University clipped a total of 11 cases of anterior cerebral artery and ACoA aneurysms through frontal-longitudinal fissure approach. The results are reported below.

There are many types of intracranial tumors, and there are many corresponding treatment methods, among which radiotherapy is an important treatment method. With the gradual deepening of research on radiotherapy for intracranial tumors, many researchers have found that radiotherapy can cause many kinds of radiation damage. These radiation injuries are mainly reflected in the damage to nerve tissue and cerebrovascular system, among which the damage to cerebrovascular system is divided into ischemic damage and hemorrhagic damage^[1]。 Intracranial aneurysms associated with radiotherapy are a rare phenomenon in hemorrhagic lesions^[2]There are few related reports at home and abroad. This article reviewed three patients with intracranial aneurysms due to radiotherapy of intracranial tumors admitted to the neurosurgery department of Tianjin Huanhu Hospital, and analyzed their clinical data and imaging characteristics.

primary non-Hodgkin's lymphoma of bone is a rare bone tumor that occurs in the bone marrow without regional lymph nodes and visceral invasion. Its incidence rate only accounts for 1% ~2% of all malignant lymphomas and 3% ~5% of all lymphomas outside lymph nodes. The most common sites are the long bones of lower limbs and pelvis (50%), long bones of upper limbs (20%), spine, ribs, etc. Cases of skull as the first site are very rare. In 1983, foreign scholars reported the first case of primary non-Hodgkin's lymphoma of the skull. Up to now, no more than 10 cases have been reported with complete case data in China^{[1,2,3,4,5,6,7]}No more than 30 cases were reported in English literature^[8,9]。 A child with primary non-Hodgkin's lymphoma of the skull was admitted to the Department of Neurosurgery of the First Affiliated Hospital of Guangdong Pharmaceutical University on June 23, 2015. The report is as follows.

To investigate the effect of inhibiting connexin 43 (Cx43) expression on the expression of rat glial cell growth factor in prolactinomas.

Forty-eight female rats were randomly assigned to normal, simple estradiol, estradiol+ carbenoxolone, and simple carbenoxolone groups by the completely randomized method (n=12 in each group). A model of rat prolactinoma was induced by estradiol. The normal group did not accept drug treatment; the simple estradiol group was injected estradiol intramuscularly (3 000 mg/kg, once a week, for 13 weeks); 10 weeks after injection of estradiol, the estradiol+ carbenoxolone group injected carbenoxolone via subarachnoid (once a week, for 3 weeks); and the simple carbenoxolone group only injected carbenoxolone for 3 weeks. The changes of body mass of pituitary and histomorphology were observed. Western blot was used to detect the expression levels of Cx43 and glial growth factor (GGF).

The pituitary weights of the normal, simple estradiol, estradiol+ carbenoxolone and simple carbenoxolone groups were 51.0±0.4 mg, 93.3±1.0 mg, 52.7±2.1 mg and 68.5±1.3 mg, respectively. There were significant differences (F=786.73, P<0.01); the relative expression quantities of Cx43 were 8.0±2.2%, 34.7±4.0, .9.3±3.1%, and 15.3 ±3.8%, respectively, and the relative expression quantities of GGF were 17.7±5.2%, 46.9±1.4%, 15.8±3.6%, and 20.0±2.3%, respectively. There were significant differences (F=1051.51. P<0.01;F=806.58, P<0.01). The pituitary histopathological morphology of the estradiol+ carbenoxolone group was close to the normal group and the simple carbenoxolone group.

Inhibition of pituitary Cx43 expression may inhibit the GGF expression, thereby inhibiting the growth of pituitary prolactinomas in rats.

This article reviews and analyzes nearly 2 000 papers involving the surgical treatment of acoustic neuroma, summarizes the contents of literature reports in different eras, and roughly divides the surgical treatment of acoustic neuroma in China into four stages.

Endovascular treatment of intracranial aneurysms has been developed for nearly 30 years. After the appearance of releasable coil, this method has gradually developed and matured, and has become an important method for the treatment of intracranial aneurysms^[1,2,3]。 However, for intracranial microaneurysms (maximum diameter ≤3 mm), endovascular treatment is difficult because of the catheter in place^[4]High intraoperative rupture rate^[5,6,7]And other issues have been controversial. In recent years, with the rapid development of interventional materials such as micro-catheters, micro-guide wires, soft or ultra-soft coils, and the application and popularization of three-dimensional digital subtraction angiogram (3D-DSA), balloon or stent-assisted coil tamponade technology, blood flow guidance devices and other technologies, the endovascular treatment technology has been further improved. Multiple studies have shown that endovascular treatment of microaneurysms is necessary, safe and effective^[8,9,10]。 However, due to the particularity of the treatment of intracranial microaneurysms, existing international studies of intracranial aneurysms such as the International Study of Unruptured Intracranial Aneurysms (ISUIA)^[11]Analysis of Endovascular Treatment of Unruptured Aneurysms (ATENA)^[12]International Aneurysmal Subarachnoid Hemorrhage Test (ISAT)^[13]No special studies on the treatment of microaneurysms have been conducted. At present, endovascular treatment of microaneurysms is mostly single-center, small-sample, retrospective analysis, but lacks the support of prospective, large-sample, controlled studies. Therefore, the endovascular treatment of intracranial microaneurysms is still controversial^[7,10,14,15]。 By summarizing the existing literature at home and abroad, the progress of endovascular treatment of intracranial microaneurysms is reviewed as follows.

Insular gliomas account for about 16% of all gliomas^[1]。 Due to its deep location and complex adjacent structure, insular glioma still has the characteristics of difficult total surgical resection, high incidence of postoperative neurological dysfunction and easy postoperative recurrence. Many scholars at home and abroad advocate total resection of tumor and comprehensive treatment while protecting neurological function to the greatest extent.

Because of the disease, injury and organ dysfunction caused by aging of human tissues and organs, there is a huge gap in clinical tissue and organ replacement therapy^[1,2,3]。 The research of biological artificial organs has always been a hot spot in regenerative medicine research, and has huge clinical application prospect. In order to achieve functional replacement of natural organs, two main end points need to be achieved: generation of the correct component cell types and establishment of a three-dimensional organization structure with physiological characteristics and functions, both of which are highly specific for the corresponding organs^[2,4]。 In recent years, there are multiple research and development strategies that have created a good start in this field, offering theoretical possibilities for transplanting bioartificial organs. At present, the main three strategies include: (1) whole organ decellularization and organ regeneration based on natural extracellular scaffolds that embody organ specificity^[5,6,7]； (2) Different cell types are self-assembled to form specific structures and finally organoids^[8,9,10]； (3) 3D Organ Printing and Directed Implantation of Desired Cell Types Based on Computer-Aided Matrix Scaffold Construction^[11,12,13]。 The research progress is summarized as follows.

High-grade glioma is a kind of malignant tumor with high degree, easy recurrence and poor prognosis. The results of surgery combined with postoperative radiotherapy and chemotherapy are not satisfactory. Bevacizumab, which targets vascular endothelial growth factor (VEGF), has the function of inhibiting blood vessel growth and has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of recurrent high-grade glioma. However, there are still different opinions on whether the combination of bevacizumab and other drugs and therapeutic modalities is effective in the first treatment of high-grade glioma, and whether there are adverse reactions that increase tumor aggressiveness. This article will make a summary on the above problems.

Dystonia is a group of clinical syndromes characterized by constant muscle contraction resulting in twisting, repetitive movements, or abnormal posture^[1]。 It can also be manifested as abnormal activity of muscle involvement in contraction during active movement and not related to the target movement. At present, more and more studies have found that deep brain stimulation (DBS) can achieve good curative effect on dystonia.

Glioma is the most common primary brain tumor in adults, accounting for about 80% of primary brain malignancies^[1]。 In recent years, despite the continuous improvement of surgery, radiotherapy, chemotherapy and other treatments, the prognosis of glioma patients is still very poor^[2,3]。 The median survival of patients with the most aggressive glioblastoma (WHO grade IV) was only 12 to 15 months^[4,5]。 In the past decade or so, short chain non-coding nucleic acids (microRNAs, miRNAs) have received obvious attention. Relevant studies have confirmed that miRNA can bind to the corresponding target mRNA and affect the proliferation, invasion and apoptosis of glioma cells^[5]。 Since Han et al.^[6]After the expression of long non-coding RNA (lncRNA) in glioma and normal brain tissue was confirmed by gene chip for the first time in 2012, the relationship between lncRNA and glioma has gradually gained the attention of researchers. Current studies have shown that lncRNA is closely related to the occurrence, development and differentiation of glioma^[7]。 This article reviews the relationship between lncRNA and glioma.

With the development of transportation, construction, sports and other undertakings in recent years, the incidence of craniocerebral injury is gradually increasing. The patients mainly show that the abnormal increase of intracranial pressure caused by edema, hematoma, etc. leads to brain parenchyma injury and neurological injury^[1]。 The impairment of neurological function directly affects the movement, language, thinking and other functions of patients, among which brain cognitive impairment is the most common, mainly in learning, memory, language, thinking, spirit and emotional function disorders^[2]So that the patient cannot return to normal social life. For the treatment of craniocerebral trauma, especially for patients with severe craniocerebral trauma and cerebral hernia, decompressive craniectomy is often the only surgical treatment^[3]。 Domestic experts have also confirmed through prospective studies of large cases of craniocerebral trauma that large bone flap decompression can fully compensate the volume of cranial cavity, relieve the compression of brain stem caused by cerebral hernia, and effectively protect brain function^[4]。 However, the skull defects caused by decompression also bring a series of complications, especially the cognitive effects, which are also attracting increasing attention^[2]。 The author reviewed the correlation between cognitive impairment of brain after craniocerebral injury and skull defect after decompressive craniocerebral craniectomy.