Volume 32 · Issue 02 · 2016

From 2014 to 2015, endovascular treatment of acute ischemic stroke has undoubtedly become the biggest hot issue in the field of neurointervention. Twenty years ago, the landmark National Institute of Neurology and Stroke (NINDS) study proved that tissue plasminogen activator (tPA) can benefit stroke patients within 3 hours of onset than traditional drug therapy, thus opening a new era of acute stroke treatment^[1]。 How to restore the perfusion of cerebral blood flow as soon as possible is undoubtedly the key to treat acute stroke. The clinical application of the new stent-type thrombectomy device has greatly promoted the endovascular treatment of acute stroke with the advantages of high recanalization rate and low complication rate. However, early clinical studies have not demonstrated that thrombectomy can benefit patients. Based on the lessons learned from the above studies, some research centers have begun to design new studies in order to truly test the role of the latest endovascular therapy techniques in defining patients with acute large vessel occlusion. One of its core elements is the need to clarify the presence of vascular occlusion before randomization, and a strict time limit is set to ensure rapid recanalization of blood vessels. More importantly, the third generation thrombectomy device with relatively high recanalization rate is used. Including the multicenter randomized controlled clinical trial of endovascular treatment of acute ischemic stroke in the Netherlands Endovascular Treatment of Acute Ischemic Stroke (MR CLEAN), the clinical trial of endovascular treatment of small focal stroke with proximal anterior circulation occlusion and emphasis on minimizing the time from CT to recanalization in Canada (ESCAPE), the clinical trial of prolonging the time from acute neurological deficit to intraarterial thrombolysis in Australia (EXTEND-IA), the North American trial of SolitaireTM endovascular mechanical thrombectomy as the primary endovascular treatment for acute ischemic stroke (SWIFT PRIME), and the randomized controlled study of stent thrombectomy and medical treatment within 8 hours in Spain (REVASCAT) have all demonstrated that the clinical outcome of combined endovascular thrombectomy is better than that of optimal drug treatment alone in patients with anterior circulation stroke with internal carotid artery or middle cerebral artery M1 segment involvement and symptoms of corresponding clinical defect^[2,3,4,5]。 It is precisely because of the Class I Grade A evidence provided by the above-mentioned multiple randomized controlled clinical trials (RCT) studies that it is confirmed that the best drug combined with arterial thrombectomy is superior to the best drug alone in patients with acute large vessel occlusion with anterior circulation lesions, making it an important turning point in the treatment of fatal stroke patients. The Guidelines for Endovascular Treatment of Acute Ischemic Stroke in China 2015 have raised the level of evidence-based medicine to Class I Level A evidence.

To investigate the indications and surgical skills of clipping of intracranial aneurysms via contralateral approach.

The clinical data of 13 patients with intracranial aneurysm treated via contralateral approach at the Department of Neurosurgery, the Second Affiliated Hospital of Soochow University from April 2011 to April 2015 were analyzed retrospectively. In 13 patients, 10 had bilateral multiple aneurysm (1 contralateral ophthalmic artery aneurysm, 4 middle cerebral artery aneurysms, 4 posterior communicating artery aneurysms, and 1 anterior cerebral artery A2-A3 aneurysm), 2 had ophthalmic artery aneurysm, and 1 accompanied with arteriovenous fistula (contralateral middle cerebral artery aneurysm). One patient was treated via interhemispheric keyhole approach (ruptured anterior communicating artery aneurysm accompanied with contralateral anterior cerebral artery A2-A3 segment aneurysm), 9 via supraorbital keyhole approach, 2 via pterional keyhole approach, and 1 via frontal small bone window approach (ipsilateral frontal arteriovenous fistula bleeding accompanied with a contralateral middle cerebral artery aneurysm). A CT, CTA, and MRI-based image fusion 3-D model or 3D space entity model would be established when necessary.

Of these 13 contralateral aneurysms, 11 were clipped completely, 1 was clipped incompletely, and 1 did not undergo clipping in contralateral exploration due to the difficulty of clipping. Two patients had ipsilateral olfactory nerve injury during operation; 2 had cerebral ischemia after aneurysm surgery, other patients discharged uneventfully. Glasgow outcome scale (GOS) evaluation: grade Ⅴ 11 cases, grade Ⅳ 1 case, and grade Ⅱ 1 case.

The contralateral approach can take account of the bilateral lesions, the appropriate selection of it can reduce the number of operations. For medial directed ophthalmic artery aneurysms, the contralateral approach can better expose them and reduce surgery-related injury. The olfactory nerve dissection contributes to reduce nerve stretch for contralateral approach and protects the integrity of the olfactory nerve. The 3-D fused image reconstruction model contributes to accurate preoperative design. After mastering the contralateral approach surgical techniques, the keyhole technique can also be used for microinvasive approach. It should be noted that the contralateral approach should improve the occasion and do what is possible.

To explore how to effectively manage the residual or recurrent intracranial aneurysms after embolization.

The treatment methods and clinical efficacy of 36 patients with residual or recurrent intracranial aneurysm after procedure at the Department of Neurosurgery, Tianjin Huanhu Hospital from June 2010 to June 2014 were analyze retrospectively. Among 36 patients, 12 underwent endovascular embolization, 15 underwent surgical clipping directly, and 9 could not be clipped directly were treated by extracranial and intracranial arterial bypass and aneurysm trapping or combined embolization.

The Glasgow outcome scale (GOS) scores of 36 patients after procedure and at discharge showed that 32 (89%) recovered well, 3 (8%) had severe disability, and 1died (3%). They were followed up for an average of 2 years. Thirty-three patients (92%) recovered well, 2 (6%) had disability. During the follow-up period 3 had recurrent aneurysm, 2 of them were retreated by endovascular intervention, and 1 was treated with craniotomy clipping. Cerebrovascular examination revealed that all the grafts were patent.

For residual or recurrent intracranial aneurysms after embolization, the determination of treatment method should be based on the clinical status of patients, aneurysmal characteristics, surgical risk, and possibility of rerupture of aneurysms. The safe and effective personalized treatment can be performed in clinical practice by the methods of craniotomy or endovascular interventional therapy, and it will achieve a satisfactory clinical effect.

To investigate the safety and efficacy of the Willis covered stent system for the treatment of complex internal carotid aneurysms.

Eight patients with complex internal carotid aneurysm treated with Willis covered stent system at the Department of Neurosurgery, Nanfang Hospital, Southern Medical University from November 2013 to May 2015 were analyzed retrospectively. Among them, 3 patients had internal carotid artery blood blister like aneurysms, 2 had paraclinoid segment aneurysms, and 3 had cavernous segment aneurysms (1 traumatic pseudoaneurysm, 1 iatrogenic pseudoaneurysm, and 1 giant aneurysm). According to the intraoperative condition of the paren artery, the guiding catheters were placed as high as possible (near the cavernous segment) to provide adequate support. After the covered stents were implanted.the balloon were inflated to release the stent and the aneurysm were eliminated at the same time.

Eight patients with complex internal carotid aneurysm (8 aneurysms) were implanted 8 covered stents, 7 of them were successfully released in the parent arteries. Angiography immediately after stenting in 5 patients showed that the lesions disappeared completely and the parent arteries were patent; After 1 stent was implanted, 1 patient with recurrent giant aneurysm at the cavernous segment after stent-assisted embolization, a small amount of contrast agent leaked into the aneurysm (endoleak). The stent system in place was difficult in 1 patent with blood blister like aneurysm because of his internal carotid artery tortuosity. Iatrogenic internal carotid cavernous fistula occurred during the operation. Bypass and occlusion of the parent artery was performed after balloon embolization. Other cases did not have operation-related complications. The 8 patients were followed up clinically at 2 to 12 months after procedure. They did not have any neurological deficits. The modified Rankin scale (mRS) scores were 0 in 5 cases, 1 in 2 cases, and 2 in 1 case. Three patients got DSA followed-up again at 6 month after procedure. No recurrence of aneurysms was observed, and their parent arteries were patent without stenosis.

Willis covered stents were safe and effective for the treatment of some complex internal carotid artery aneurysms.

To investigate the strategies and security of endovascular treatment of posterior inferior cerebellar artery (PICA) aneurysms.

The clinical characteristics, endovascular treatment methods, and treatment outcomes of 23 patients with PICA treated at the department of Neurosurgeries, the 455th Hospital of PLA and Changhai Hospital, the Second Military University from May 2006 to December 2014 were analyzed retrospectively. In 14 patients with proximal aneurysm, 3 were treated with stent-assisted coil embolization, 9 were embolized with coils alone, and 2 patients with irregular dissecting aneurysms were treated with coils plus Glubran glue to occlude the parent arteries. The parent arteries of 9 patients with distal aneurysm were occluded with coils or Onyx glue.

Twenty-three patients did not have any operation-related complications. In 14 patients with proximal aneurysm, 12 did not have new neurological dysfunctions after procedure using the method of retaining parent arteries, and 1 had facial numbness and facial paralysis after procedure in the occlusion of the parent arteries in 2 cases. The incidence of complications was 50%. Nine patients with distal aneurysm recovered well after procedure. They were followed up for 13 months. No recurrence of aneurysms was observed.

Endovascular treatment of PICA aneurysms is safe and effective. The choice of treatment methods is associated with the location of aneurysms. For proximal aneurysms, we should try to choose the method of retaining parent arteries.

To investigate the perioperative complications and treatment measures of Solitaire AB stent for embolization of wide-necked cerebral aneurysms.

The clinical and imaging data of 116 patients with wide-necked cerebral aneurysms treated by using Solitaire AB stent-assisted embolization at the Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University from February 2010 to February 2014 were analyzed retrospectively. The perioperative complications were observed. Its causes of occurrence were analyzed and the corresponding treatment measures were investigated.

All stents were successfully implanted in place. The results of immediate DSA examination revealed that 55 of 120 aneurysms were embolized completely. There were 59 residual aneurysm necks, 6 aneurysms were embolized partially. Ten patients had perioperative complications, 3 were intraoperative aneurysm rupture, the bleeding of 2 patients was stopped after emergency packing, and 1 patient died; after having intraparenchymal hemorrhage, 1 patient died of herniation at 5 h after stenting; 4 had thrombotic complications, 3 of them had blood flow recanalization after in-stent thrombolysis, and the efficacy of 1 case was poor and his blood flow was patent after a new Solitaire stent implantation; 2 had stent migration when the stent was not detached during procedure, fortunately, it did not cause significant neurological damage. After procedure, 114 patients were followed up for 3 to 37 months. Twelve patients had aneurysm recurrence and 5 were treated with intervention therapy again.

Solitaire AB stent-assisted coil embolization for the treatment of wide-necked aneurysms is a mature technique, but there are some complications. Therefore, the surgeons need to have good operative skills and rich experience. At the same time, the perioperative management should be strengthened in order to reduce the occurrence of complications and improve the prognosis of patients.

To observe the prognosis-related factors of affecting surgical intervention in patients with poor-grade aneurismal subarachnoid hemorrhage (SAH)

From October 2010 to March 2012, 218 patients with WFNS grade 4-5 from 9 centers received craniotomy, endovascular treatment or external ventricular drainage, and other surgical interventions were enrolled prospectively. The age of patients, WFNS score on admission, Glasgow coma scale (GCS) score, Fisher grade, Classeen grade, having cerebral hernia or not, having stable breathing or not, characteristics of aneurysm, surgical approach, and Glasgow outcome scale (GOS) grade were registered. The related factors influencing the modified Rankin scale (mRS) scores of the patients at 1 year after procedure were analyzed.

The follow-up results at 1 year after discharge showed that 74 patients (33.9%) died, 27 (12.3%) had severe disability or in a? persistent vegetative state, and 117 (53. 7%) recovered well. The good recovery rate in patients with WFNS grade 4 was 68.9% (91/132) and that in patients with WFNS grade 5 was 30.2% (26/86). Univariate analysis showed that that age, herniation, respiratory instability, WFNS grade score on admission, GCS score, Fisher grade, Classeen grade, preoperative GCS score, and GOS score at discharge were the influencing factors of prognosis, while the different surgical modes, timing of surgery, and aneurysm location and size were not the influencing factors of prognosis. Multivariable logistic regression analysis showed that age (OR, 2.54, 95% CI 1.18-5.48; P=0.017) and GOS score at discharge (OR, 0.028, 95% CI 0.004-0.208; P<0.001) were the independent influencing factors of affecting the 1 year prognosis.

For poor-grade aneurysmal SAH, early aggressive surgical intervention can achieve better efficacy. The age of patients and GOS grade at discharge are the main predictive factors of affecting the efficacy at 1 year after procedure.

To investigate the clinical application value of using conventional X-ray fluoroscopy follow-up after interventional treatment of intracranial aneurysms.

From August 2013 to June 2015, all patients with intracranial aneurysm treated with interventional therapy and followed up with digital subtraction angiography (DSA) at the Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Command were analyzed retrospectively. The patients were asked to have both immediately after procedure and reexamination operation position angiograms (all patients took conventional"0°/CRAN 30°"and"LAO 90°/0°"angiograms). A total of 86 patients with 102 aneurysms met the demands. The shadowgraphs of the microcoils were collected: the immediately after procedure"operating position", reexamination"operation position","0°/CRAN 30°", and"LAO 90°/0°"shadowgraphs. The coil shape documented with the corresponding projection angle were compared in the immediately after procedure and follow-up shadowgraphs and determined whether the coil shape changed or not. Whether the aneurysms recurrence or not were identified according to the DSA result of the same case. Kappa test was used to analyze the consistency.

In 102 aneurysms using microcoil embolization, 90 coils did not have any change. DSA examination revealed no relapse. Under X-ray fluoroscopy, the coil shape did not have any change in 3 cases, but DSA revealed aneurysm recurrence. Under X-ray fluoroscopy, the coil shape changed in 9 cases, and DSA did not reveal recurrence. Using Kappa test, both methods were highly consistent (K=0.76, P<0.05).

Observing microcoil shape with X-ray fluoroscopy can well predict whether aneurysms recurrence or not. It has better clinical application value in the follow-up after intracranial aneurysm intervention.

To observe the efficacy and surgical indications of extra-intracranial vascular anastomosis (bypass) in combination with endovascular embolization for the treatment of complex anterior circulation aneurysms.

From January 2011 to June 2014, a total of 16 patients with complex intracranial aneurysm in internal carotid artery system treated with extra-intracranial vascular anastomosis (bypass) combined with delayed intravascular embolization at the Department of Neurosurgery, Guangxi Liuzhou Worker's Hospital were enrolled retrospectively. Their treatment outcomes and surgical indications were analyzed.

In the 16 patients, 1 had grand mal epilepsy and 1 had thalamus infarction on the surgical side after vascular anastomosis (bypass), and other patients did not have any neurological damage. Their clinical follow-up ranged from 12 to 18 months after discharge. The symptoms of the patients with preoperative headache and decreased vision disappeared. The conditions of patients with thalamus infarction were improved. The conditions of other patients were stable. DSA examination at 6 months showed that the anastomotic patency rate was 100%. The internal carotid arteries on the surgical sides still had blood flow passing through in 3 of the patients with aneurysm in the cavernous sinus segment, but the distal flow velocity was significantly slower. The aneurysms were reduced by nearly 1/2. The parent arteries of the remaining patients were occluded and the aneurysms disappeared.

The treatment outcomes of extra-intracranial vascular anastomosis (bypass) in combination with delayed partial endovascular embolism for the aneurysms in complex internal carotid artery system are satisfactory. The incidence of complications and the recurrence rate of aneurysms are low.

To investigate the clinical features and treatment of involving infrasellar craniopharyngioma (CP) of invasion of skull base, sphenoid sinus, nasal sinus, and nasopharynx.

Fourteen patients involving infrasellar CP admitted to Navy General Hospital from August 1988 to December 2014 were enrolled retrospectively. Their clinical features and treatment were analyzed.

In 14 patients, 9 were males and 5 were females. Nine patients were >15 years, accounting for 0.54 % (14/2 582) of all the treated craniopharyngiomas over the same period. Nine patients only involved the infrasellar type, 5 involved both suprasellar and infrasellar types. Four patients had simple solid CP, 8 had simple cystic CP, and 2 had solid cystic CP. The main clinical manifestations were headache, nasal obstruction, visual or visual field, disturbance and hypopituitarism. The tumors of 4 patients were resected with craniotomy (3 were resected subtotally with adjuvant radiation therapy and 1 was resected partially with adjuvant interstitial radiotherapy), 2 underwent tumor resection guided by endoscope via nasal-transsphenoidal approach (1 was resected completely, and 1 was subtotally resected with adjuvant interstitial radiotherapy), 2 underwent resection under the microscope via nasal transsphenoidal approach (1 was resected completely with adjuvant Gamma knife treatment, 1 was resected subtotally with adjuvant interstitial radiotherapy), 5 underwent stereotactic 32P interstitial radiotherapy, and 1 asymptomatic patient accepted clinical observation. The patients were followed up for 9 to 168 months (median, 28 months). The tumors of 2 cases disappeared, the tumor of 10 cases reduced significantly, and 2 cases were stable. The clinical symptoms of 5 cases disappeared and 8 were improved. The asymptomatic observers did not have new symptoms.

The patients with craniopharyngioma involving the infrasellar region are rare. It often involves the skull base, sphenoidal sinus, nasal sinuses and nasopharynx. It is more difficult for complete resection. According to the nature of the lesion and the invasion range, the efficacy of selecting individualized treatment is more satisfactory.

To investigate the correlation of preoperative MRI imaging parameters and pathological grades and prognosis of convexity meningioma and to initially establish the imaging scoring method for predicting of the prognosis and biological behavior of meningiomas.

From January 2003 to December 2006, the preoperative imaging parameters of 246 patients underwent resection of convexity meningioma (Simpson gradeⅠ) at the Department of Neurosurgery, Nanfang Hospital, Southern Medical University were analyzed retrospectively. The preoperative imaging parameters included the signal intensity of diffusion tensor imaging (DTI), T1 enhanced images, subarachnoid layer on T2-weighted images, peritumoral edema on T2-weighted images and tumor shape. The relationship between imaging features of tumors and clinical pathological grades was detected by the univariate analysis. Kaplan-Meier survival analysis and multivariate logistic regression analysis were used to evaluate whether the imaging parameters could predict the occurrence of high-grade meningiomas. According to preoperative imaging parameters, the patients were graded and grouped. Cox regression model was used to analyze the relationship between the imaging scores in patients with convexity meningioma and the overall survival (OS) and progression-free survival (PFS). The credibility of preoperative imaging scores was analyzed by the Kappa coefficient test.

Univariate analysis results indicated that there were significant differences in diffusion tensor imaging (DWI) signal intensity, T1 enhancement images, arachnoid layer on T2 weighted imaging, peritumoral edema on T2-weighted images, and tumor shape in different grades of convexity meningiomas (all P<0.05). Multivariate logistic regression analysis indicated that DWI hyperintensity is the most important independent predictor of high-grade meningiomas (P<0.01,OR, 17, 95% CI 5.8-47.6), others were disruption of arachnoid layer (P<0.01,OR, 14, 95% CI 4.3-42.3), peritumoral edema (P<0.01,OR, 9, 95% CI 3.1-26.8), T1 heterogeneous enhancement (P<0.01,OR, 6.1, 95% CI 2.2-17.1), and tumor shape (P<0.01,OR, 6.1, 95% CI 2.1-17.5). Compared with WHO pathological grades (Ⅰ, Ⅱ, and Ⅲ), the imaging grades (1, 2, and 3) had a certain homogeneity (Kappa value, 0.511, P<0.01). Cox regression model analysis showed that age (P<0.001,OR, 1.039, 95% CI 1.017-0.062), WHO pathological grade (P=0.017, OR, 3.014, 95% CI 1.217-7.465), and preoperative imaging score groups (2-3 group, P<0.01,OR, 6.194, 95% CI 1.956-19.610; 4-5 group, P<0.01,OR, 21.658, 95% CI 5.701-82.273) could be used as the independent predictors of affecting the prognosis of patients.

Preoperative imaging grade has a certain degree of consistency with pathological grade, and can predict the prognosis in patients with convexity meningioma. For patients with pathology indicated WHO grade I, but the imaging score 2-3 may need more close follow-up and more radical resection in case of permission.

To investigate the brain region distribution of phosphatase and tensin homology (PTEN) expression using imaging analysis techniques.

The magnetic resonance images of 143 patients with glioblastoma admitted to the Department of Neurosurgery, Tiantan Hospital, Capital Medical University from May 2011 to March 2013 were collected. The tumor lesion range marker of each patient was conducted respectively and was registered to the standard brain atlas on the MNI coordinate system. The voxel-based quantitative imaging analysis was used to calculate the mean value of PTEN expression level of each voxel, and it displayed on the standard brain atlas through the pseudo-color gradation.

A total of 75 patients were enrolled in a high PTEN expression group and 68 were enrolled in a low PTEN expression group. There were no significant differences in clinical data, such as age, and sex between the 2 groups (P>0.05). Tumors involving the whole-brain map showed that the glioblastomas in this group of patients often occurred in subependymal region on both sides. The brain atlases of the glioblastoma PTEN expression level showed that the PTEN high expression related brain region mainly located in the right frontal lobe, while the PTEN low expression related brain regions mainly located in the right posterior temporal lobe.

Quantitative imaging analysis technique can be used to determine the correlation between PTEN expression and anatomic location in glioblastomas, which provides a new evidence for the process of genetic changes in the process of glioblastoma occurrence.

To investigate the differences of describing tumor size according to the formula calculation and three-dimensional reconstruction methods.

From January 2013 to March 2015, the magnetic resonance images of 90 patients with low-grade glioma treated at the cooperation wards of the Department of Neurosurgeries, Beijing Puren Hospital and Tiantan Hospital, Capital Medical University were collected. The volumes of the tumors were measured by formula calculation and three-dimensional reconstruction methods. Statistical tests were used to compare the differences of tumor volume obtained by different methods.

There was no significant difference in measuring the tumor volume in all cases between the two methods (P=0.158). In 12 patients with a ratio of anteroposterior diameter and transverse diameter >1.2, the tumor volume measured by the formula calculation method was significantly less than that measured by the three-dimensional reconstruction method ( P=0.002). In patients whose tumor volume <60 cm ³ measured by the three-dimensional reconstruction method, the tumor volume measured by the formula calculation method was significantly less than that of the three-dimensional reconstruction method (P<0.001).

The formula calculation method can be used as a primary measurement of tumor volume in clinical practice. However, when the tumor is irregular or its volume is smaller, the tumor volume measured by the formula calculation method may have deviation with the tumor actual volume, then, the three-dimensional reconstruction method should be considered.

To know in detail about the related microanatomy of the far lateral approach.

Stepwise dissection of 10 cadaver heads was performed by bilateral simulating the far lateral approach. Its adjacent relationship and the effect of the important structures on the operative field exposure were investigated.

The suboccipital muscle groups are mainly composed of three layers. The occipital artery (OA) runs deeply into the splenius capitis and is located in the shallow or deep layer of the trachelomastoid. Splenius capitis can be used as an anatomic landmark for searching OA. When OA is out from the digastric groove, the diameter is 2.0±0.2 mm, at the level of the superior nuchal line, the diameter is 1.2±0.3 mm. The vertebral artery (VA) is located in the base of the suboccipital triangle, which is wrapped by the venous plexus. VA often gave off muscular and meningeal branches, before entering the skull, they were 9.5±6.1 mm and 16.0±8.0 mm respectively, and gave off the posterior spinal artery and posteior inferior cerebellar artery. Before bilateral VA convergence 5.7±4.8 mm, they gave off anterior spinal artery. After removing the inner 1/3 of occipital condyle, the operative angle could increase from 43±11.2 degree to 61.0±9.1 degree. There was significant difference (P<0.01). Removing the jugular tubercle, the operative angle could also increase to 68.0±10.2 degree; however, compared with removing occipital condyle, there was no significant difference.

It has important significance for the relationship between familiar with the anatomical layers of suboccipital muscle groups and OA or VA anatomy for the protection of these arteries. Understanding the important anatomic structure and its adjacent relation, such as the occipital condyle, jugular tubercle, hypoglossal canal, lower cranial nerves, VA and its branches contribute to the safe exposure and resection of lesions in the anterolateral lateral medulla oblongata. Removing inner 1/3 of occipital condyle can increase the exposure of the operation area, and removing jugular tubercle can also additionally increase the exposure of operation area.

To systematically evaluate the diagnostic value of cerebrospinal fluid (CSF) lactate for bacterial meningitis after neurosurgical procedure.

The literature about the diagnostic value of cerebrospinal fluid lactate concentration for bacterial meningitis after neurosurgical procedure were retrieved from PubMed, EBSCO, Cochrane Library, and ClinicalTrials database. The retrieval time was from the establishment of the databases to December 2014. A tool for the quality assessment of studies of diagnostic accuracy (QUADAS) was used to evaluate the quality of the included literature. The Meta-DiSc 1.4 and Review Manager 5.3 softwares were used to analyze the included literature; and the Forest plots and receiver operating characteristic curve (ROC) were drawn.

A total of 1 471 articles were retrieved. Five articles with 404 patients were screened out according to the inclusion criteria, in which, there were 4 prospective studies and 1 retrospective study. The Random effect model and statistics showed that the sensitivity of CSF lactate for the diagnosis of bacterial meningitis after neurosurgical procedure was 0.92 (95% CI 0.85-0.96, I²=0.0%; P=0.6699), the specificity was 0.88 (95% CI 0.84-0.92, I²=79.5%; P=0.0006), the positive likelihood ratio was 7.70 (95% CI 3.94-15.05, I²=59.5%, P=0.0428), the negative likelihood ratio was 0.11(95% CI 0.06-0.19, I² =0%; P=0.8504), the diagnostic odds ratio was 83.09 (95% CI 36.83-187.46, I²=1.8%; P=0.3960), and the area under the ROC curve (AUC) was 0.9601(Q^*=0.9046).

Meta-analysis has showed that the cerebrospinal fluid lactate concentration has higher sensitivity and specificity for the diagnosis of bacterial meningitis after neurosurgical procedure. It has better efficacy.

intracranial arachnoid cyst (IAC) is a common benign space-occupying lesion in children, with an incidence rate of about 2.6%^[1]。 The incidence of subdural effusion or hemorrhage caused by trauma or spontaneous rupture of arachnoid cysts is 2.3% ~6.0%^[2,3]Most of them require treatment due to symptoms of intracranial hypertension. This article retrospectively analyzed the clinical data of 15 children with subdural effusion or hemorrhage caused by IAC rupture admitted to the Department of Neurosurgery of Nanjing Children's Hospital affiliated to Nanjing Medical University from September 2009 to April 2014, and explored their etiology, classification, imaging features, treatment methods and prognosis.

Ischemic stroke is one of the major diseases that threaten the health of people in China. It has a high disability rate and mortality rate, and brings a heavy burden to society and families. Stenosis caused by carotid atherosclerosis is one of the important causes of ischemic stroke, and it is a high risk factor of stroke that can be eliminated by surgical intervention. carotid endarterectomy (CEA) is a treatment that prevents stroke due to plaque shedding by removing thickened atherosclerotic plaque in the carotid intima. From January 2014 to June 2015, 40 patients with carotid stenosis were treated with CEA in the Department of Neurosurgery, the Second Hospital of Hebei Medical University, and the surgical results were satisfactory.

To study the therapeutic effect of early using stress-dose hydrocoritsone on critical illness-related corticosteroid insufficiency (CIRCI) after traumatic brain injury (TBI).

The adult male Wistar rats were used to establish a TBI model of hydraulic percussion. The CIRCI rats were screened by the electric stress stimulation at day 1 after injury. The CRICI rats were randomly divided into a CIRCI control group, a low-dose methylprednisolone (MP) treatment group, and a stress-dose hydrocortisone (HC) treatment group. The neurological function scores were measured at day 1, 3, 7, and 14, respectively after injury in order to compare the degree of neurological dysfunction of the 3 groups, and the survival rate of rats in each group at day 14 after injury was observed. Electric stress stimulation was performed after injury at day 7 and 14 respectively. The CIRCI prevalence of the 3 groups of rats was compared. The hypothalamic tissue pathology of the 3 groups was observed after injury at day 3, 7, and 14, respectively. CD31 and Claudin-5 immunofluorescence staining were used to compare the differences of blood-brain barrier endothelial cells in the paraventricular area and the changes of tight junction. Evans blue dye was also used to detect the permeability of blood-brain barrier in that location.

The survival rate of the rats of the stress-dose HC treatment group was significantly higher than that of the CIRCI control group (P=0.046). The neurological function score in rats of the stress-dose HC treatment group after injury at day 7 and 14 was significantly lower than that of the CIRCI control group (P=0.002, P=0.005) and the low-dose MP treatment group (P=0.012, P=0.001), and its prevalence of CIRCI after injury at day 14 was significantly lower than that of the CIRCI control group (P=0.036). Compared with the CIRCI control group, the expression levels of the paraventricular nucleus blood-brain barrier endothelial cell CD31 and tight junction protein Claudin 5 of the stress-dose HC treatment group after injury at day 3 were increased significantly (P=0.013, P=0.000), and permeation amount of Evans blue decreased significantly (P=0.02).

The stress-dose HC can significantly reduce the hypothalamic blood-brain barrier structure and functional damage of the TBI model rats, improve the body's stress level, decrease the occurrence of CIRCI, promote the recovery of neurological function, and thereby increase the survival rate.

To investigate the effect of IKKε in glioma cells on the regulation of E-cadherin expression and cell migration and invasion ability.

The IKKε overexpression vectors and shRNA-IKKε lentivirus were constructed. The TP483 glioma cell lines were transfected by the IKKε overexpression plasmid. The expression level of IKKε in glioma cells was upregulated. The U251 and U138 glioma cell lines were transfected by the shRNA-IKKε lentivirus, IKKε expression level in glioma cells was downregulated. The expression levels of IKKε and E-cadherin in cells were detected by RT-PCR and Western blot. The expression changes of IKKε and E-cadherin after transfecting were observed by using the immunofluorescence assay. The cell migration and invasion abilities were detected by using the scratch test and Transwell assay.

Compared with the non-transfected group (TP483 control group), the expression level of IKKε protein increased (P=0.000), and the expression level of E-cadherin protein decreased (P=0.000) in the transfected IKKε expression plasmid group (TP483 treaed group). In the glioma cells transfected IKKε shRNA(the U251 treated group and the U138 treated group) , the expression level of IKKε protein decreased significantly compared with the non-transfected group (the U251 treated group and the U138 treated group; allP<0.05). At the same time, the expression levels of E-cadherin protein in each treated group were all increased compared with the control group (P<0.05). The scratch repair rate of the TP483 treated group was higher than that of the control group (56.39±0.93% vs. 46.43±1.68%;P=0.035). After transfection of overexpression plasmid for 24 h, the number of TP483 cells passing through the filter membrane increased compared with the control group (55.8±6.0 vs. 24.6±2.3; P=0.000). The scratch repair rates of the U251 and U138 treated groups decreased compared with their respective control groups (the U251 treated group: 50.40±1.09%, the U251 control group: 87.29±11.11%, P=0.043; the U138 treated group: 48.20±1.34%, the U138 control group: 73.15±6.62%, P=0.035); After transfection for 24 h, the number of cells passing through the filter membrane decreased in the U251 and the U138 groups compared with the control group (the U251 treated group: 77.8±6.4, the control group: 124.0±13.4, P=0.000; the U138 treated group: 25.8±4.2, the control group: 54.8±7.1, P=0.000).

The low expression of IKKε can effectively inhibit the invasion and migration of glioma cells, and the high expression of IKKε can enhance their invasion and migration abilities. Its possible mechanism is to influence the invasion and migration abilities of glioma cells through regulating the expression level of E-cadherin.

Anterior choroidal artery aneurysms are aneurysms from the beginning of the anterior choroidal artery to the end of the internal carotid artery, accounting for 2% to 5% of intracranial aneurysms^[1]。 Anterior choroidal artery aneurysm is rare in clinical practice, and its rupture rate is 26.7%, which is significantly lower than that of posterior communicating artery aneurysm^[2]。 Anterior choroidal artery aneurysms mostly occur at the junction of anterior choroidal artery and internal carotid artery, and are often small in size. When they are enlarged, they can replace the anterior choroidal artery, but rarely compress the oculomotor nerve. When they are not ruptured, they mostly have no clinical symptoms. Its rupture can lead to subarachnoid hemorrhage and ventricular hemorrhage, and when the amount of hemorrhage is large, it can lead to cerebral hernia^[1]。

The pituitary stem is an important structure connecting the optic chiasm and the hypothalamus. The clinical manifestations of the lesions in this region are central diabetes insipidus, headache, visual impairment and endocrine symptoms. Common pituitary stem lesions are: thickening and thinning of pituitary stem or absence of pituitary stem. Pituitary stem width greater than 2 to 3 mm is considered pathological thickening^[1]； Absence of pituitary stem and ectopia of posterior pituitary gland are common in pituitary stem occlusion syndrome. The diagnosis and differential diagnosis of diseases related to pituitary stem lesions play a very important role in clinical diagnosis and treatment. This article intends to review the etiology, diagnosis, imaging manifestations, treatment and related research progress of diseases related to pituitary stem lesions.

How to predict the prognosis of craniocerebral injury early is an ancient topic, which has been mentioned in the literature as early as the ancient Egyptian era and Hippocrates era. Among them, Hippocrates has an epigram about the prognosis of craniocerebral injury: "There has never been a disease as complex and changeable as brain injury, which is easily overlooked, and it is desperate because of the serious injury". Since then, doctors have been exploring how to predict the prognosis of craniocerebral injury early. Today, many predictive models of craniocerebral injury have been produced. These models are mathematical models based on clinical studies of large cases, although they are controversial because of their accuracy and ethics^[1]However, some predictive models have been proven by clinical trials of bulk cases to have high discrimination power and accuracy, and can guide clinical practices within specific groups, or even be called "guidelines"^[2,3,4,5]。

Peripheral nerve injury is a common disabling disease in clinic. Among the 1~1.5 new cases/10 million trauma cases in the world every year, peripheral nerve injury accounts for 1.5% ~4.0%. There are 600,000 to 900,000 new cases of peripheral nerve injury in China every year. Compared with the central nervous system, peripheral nerves are simpler in structure and easier to regenerate. However, the degree and speed of peripheral nerve repair are still the difficulties of treatment at present. The extension of regenerative axons after peripheral nerve injury depends on a variety of neurotrophic factors, among which nerve growth factor (NGF) and basic fibroblast growth factor (bFGF) are the most representative. For example, NGF can not only help the regeneration of damaged peripheral nerve axons, but also promote angiogenesis. However, these factors degrade rapidly in vivo, have a short half-life, are very difficult to maintain the therapeutic dose, and exhibit non-specific effects in non-neural tissues. Therefore, how to effectively use the factors in the site of nerve injury and local controlled release is still challenging^[1]。

Intracranial arteriovenous malformation (AVM) is the most common type of vascular malformation in the central nervous system, which is mainly composed of blood supply artery, malformed vascular mass and drainage vein. The arteries in the malformed vascular mass are directly drained to the vein without passing through the capillary bed. AVM is a serious threat to human health. According to statistics, the average annual bleeding rate is 0.5% and the re-bleeding rate is 29%. It is the leading cause of non-traumatic bleeding in young and middle aged people, and 5% to 25% of patients die within 1 year after bleeding, and 25% to 40% of patients have permanent neurological dysfunction^[1]。 However, no satisfactory results have been obtained in the treatment of AVM. The complication rates of surgical resection, radiotherapy and embolization are 29%, 13% and 25%, respectively^[2]Therefore, establishing an experimental model of AVM is of great value for the study of the pathogenesis and treatment strategies of AVM. In this paper, the research progress of various experimental models is reviewed.

In the broad sense, the brain-computer interface technology combines neuroscience, bioinformatics, microelectronics and other multi-disciplinary technologies, and tries to establish a kind of interface between human brain and human brain, human brain and animal brain, human brain and machine, so as to realize the communication between human brain and human brain, animal brain and machine^[1,2,3,4]Thus breaking the limitation of the biological anatomical structure of the human brain and repairing the damage of the brain or brain accessory structures such as limbs and language. This paper summarizes the latest brain-computer interface technology, focusing on the acquisition of characteristic brain signals in brain-computer interface technology and its application in clinical field.