Volume 32 · Issue 03 · 2016

Acoustic neuroma is a benign tumor mainly originating from Schwann cells in the vestibular nerve sheath of the internal auditory tract^[1,2,3], also known as vestibular schwannoma, accounts for 6% to 9% of intracranial tumors and 80% to 90% of cerebellopontine angle tumors^[4,5]。 Because it is located in the internal auditory tract and cerebellopontine angle area, it gradually compresses the surrounding important tissues as the tumor grows, which can cause severe symptoms and even threaten the patient's life, so reasonable treatment strategies need to be adopted.

To explore the changes of neurotransmitter content during long-term, unilateral anterior thalamus stimulation in monkeys with temporal lobe epilepsy.

Eighteen male monkeys were divided into a control group, a sham stimulation group, and a stimulation group (n=6 each group). The anterior thalamic nuclei of the animals in the sham stimulation group and the stimulation group were implanted the deep brain stimulation (DBS) system, and a model of epilepsy was induced by injection of kainic acid in the hippocampus. All the animals in this experiment were extracted by using the microdialysis and high performance liquid chromatography, and the bilateral hippocampal glutamate, γ-aminobutyric acid, and aspartic acid content were measured.

After injection of kainic acid, the aspartic acid and γ-aminobutyric acid content increased significantly in the sham stimulation group ( P<0.05), but the γ-aminobutyric acid content gradually fell to the baseline in the late stage. The glutamic acid content decreased significantly in the acute stage (P<0.05), and increased gradually in the chronic stage. Compared with the sham stimulation group, the long-term anterior thalamic nucleus stimulation significantly decreased the glutamic acid and aspartic acid content (P<0.05), and maintained the γ-aminobutyric acid content until the end of the experiment. The injection of kainic acid in unilateral hippocampus and stimulation of anterior thalamic nucleus did not affect the content of contralateral hippocampus neurotransmitters (P>0.05).

The content of neurotransmitters is mainly affected by the ipsilateral hemisphere. The long-term anterior thalamic nucleus stimulation can cause the content of hippocampus neurotransmitters in epileptic monkey hippocampus changes towards a favorable direction. This may be an important mechanism of anterior thalamic nucleus stimulation in the treatment of epilepsy.

To investigate the effect of progesterone on axonal regeneration and sensory function recovery after brachial plexus injury in rats.

An animal model of brachial plexus injury in rats was induced. Twenty-four rats were randomly divided into 3 groups: a saline group, a progesterone vehicle group, and a progesterone group (n=8 in each group). The rats were administrated continuously for of 2 weeks. Pain, temperature examination, and somatosensory evoked potential (SEP) examination were performed at 3 months after injury. Retrograde tracing method was used to count the number of sensory neurons in dorsal root ganglia. The semi thin and ultrathin sections of spinal nerve roots were used to observe the myelin regeneration and morphology and structure of mitochondria respectively.

Pain test results at 3 months after procedure in rats: The saline group was 4.69±0.76 N, the vehicle group was 4.74±0.74 N, and the progesterone group was 1.50±0.33 N. Compared with 3 groups, the progesterone group recovered significantly. There was significant difference between the saline group and the vehicle group (all P<0.001). Temperature examination results: The saline group was 9.50±3.15 s, the solutive group was 10.08±1.88 s, and the progesterone group was 6.45±1.32 s. The temperature recovery of the progesterone group was stronger than that of the saline group and the vehicle group. There were significant differences (allP<0.05). Somatosensory evoked potential (SEP) showed that the SEP amplitude of the saline group was 2.25±1.97 μV, the vehicle group was 2.36±1.68 μV, and the progesterone group was 5.23±3.40 μV. The SEP amplitude of the progesterone group was higher than that of the saline group and the vehicle group. There were significant differences (allP<0.05). The SEP latency of the saline group was 11.78±0.99 ms, the vehicle group was 11.63±0.83 ms, and the progesterone group was 11.77±1.07 ms. There were no significant differences (P<0.05). The retrograde tracing showed that the numbers of CTB-Alexa555 labeled positive neurons were 223±35, 267±107 and 509±60, respectively in the saline group, vehicle group, and progesterone group. The positive neurons of the progesterone group were more than those of the saline group and vehicle group. There were significant differences (allP<0.05). The semi thin sections showed that the numbers of new myelin sheath in C₇ spinal nerve roots of the 3 groups were 142±64, 168±62, and 102±26, respectively. There were no significant differences among 3 groups (P>0.05). The transmission electron microscope observation of spinal nerve roots showed that the layers of myelin sheaths were blurred, and there was a gap and wormhole-like change among the layers. The mitochondria in axon were swollen and the cristae reduced or disappeared. Microfilaments and microtubules were rare and the structures were not clear. The layers of the myelin sheath were complete and clear in the progesterone group. The mitochondrial structures in axon were complete and clear, the microtubules and microfilaments were clearly visible and arranged in order.

Progesterone can promote axonal regeneration after brachial plexus injury in rats and has a protective effect for the surviving neurons. It may promote sensory function recovery after brachial plexus injury.

To realize the three-dimensional visualization of the subthalamic nucleus and stimulating electrode using CT and MRI in order to provide the basis for electrode location after deep brain stimulation (DBS).

From July 2014 to March 2015, 10 patients with Parkinson's disease performed subthalamic nucleus stimulation at the Department of Neurosurgery, Chinese PLA General Hospital were selected. Using preoperative high-resolution MRI and post-operative MRI or CT images, an effective registration achieved before and after procedure through the nonlinear algorithm. The threshold method was further used to determine the electrode position of the axial images. The straight line fitting method was used for three-dimensional reconstruction of electrode implantation path. The grayscale information of the standard brain atlas was used to separate the subthalamic nucleus and near important nucleus in order to realize three-dimensional visualization of the spatial structure of the subthalamic nucleus, and fused the electrode reconstruction results, obtaining the complete postoperative three-dimensional spatial structure information. Using this algorithm, the postoperative spatial structure of 3 different atlases (BGHAT, ATAG, and Accolla-2014 atlas) realized visualization.

The average root mean square error of 16 reference points in whole brain range was 0.96 mm. It was smaller than a pixel. The reconstruction results were consistent with the head coronal images of the patients. Finally, they were verified by the multispectral data, and were compared and discriminated by a doctor. The results of visualization were consistent and could be used in clinical practice.

Using the preoperative MRI, postoperative CT or MRI images can realize the three-dimensional visualization of the subthalamic nucleus and stimulating electrode, provide intuitive and quantitative information for the postoperative electrode location of DBS, and provide guidance for the postoperative programmed stimulation parameter adjustment, thus it is helpful to improve the efficacy of DBS.

To investigate the value of the characteristics of hypermotor seizures in the localization of epileptogenic zone by studying the clinical symptom characteristics originated from the insular-opercular epilepsy.

From June 2006 to March 2014, the clinical data of 5 patients with intractable epilepsy of hypermotor seizures including history, imaging, scalp electroencephalogram, and intracranial electrode electroencephalography admitted to the Department of Neurosurgery, Tsinghua University Yuquan Hospital were studied retrospectively.

In 5 patients, there was 1 with hypermotor seizures type Ⅰ, 2 with hypermotor type Ⅱ, and 2 with mixed type. Three patients accompanied with bilateral asymmetric rigidity. They were located in the contralateral epileptic foci. Five patients had an aura before seizures, 2 of them had a somatosensory aura on the contralateral side, 1 had palpitations, and 2 had a non-specific aura. The seizures of 2 patients originated from the left hemisphere and 3 from the right hemisphere. Four patients had brain area discharge in the intermittent period. They were located on the ipsilateral epileptic zones. No epileptiform discharges were observed in 1 case. Two patients had generalized ictal onset on the ictal electroencephalogram, the other 3 had unilateral hemisphere or unilateral ictal onset.

Seizures initiated from insular-opercular cortex can show any type in hypermotor seizures. The asymmetric rigidity of specific aura before onset and in hypermotor seizures has the lateralization value. The special facial expression in seizers is more common in hypermotor seizures originated from the insular-opercular cortex.

To investigate the alteration of functional connectivity and its significance in post-concussion syndrome (PCS) patients with memory disorders using resting-state functional magnetic resonance imaging (rs-fMRI).

From September 2014 to April 2015, 28 PCS patients with memory disorders admitted to the Department of Neurosurgery, Anhui Provincial Hospital, Anhui Medical University and 28 health controls (HC) recruited in the same period were studied. The RS-fMRI data were collected and processed. The left and right parahippocampal gyri were used as the regions of interest (ROI) to make functional connectivity with the whole brain and were analyzed in order to obtain the altered brain areas of hippocampal gyrus and whole brain functional connectivity in patients with PCS.

The functional connectivity of the left parahippocampal gyrus and bilateral prefrontal lobe, bilateral temporal lobe, right precuneus, and right precentral gyrus reduced (all P<0.05), and the functional connectivity with the bilateral occipital lobe, bilateral lingual lobe, and left superior parietal lobule enhanced (allP<0.05). The functional connectivity of the right parahippocampal gyrus, right inferior frontal gyrus, bilateral temporal lobe, and bilateral occipital lobe reduced (allP<0.05), and the functional connectivity with the bilateral middle frontal gyrus, left inferior frontal gyrus, right orbital frontal gyrus, left inferior temporal gyrus, left middle occipital lobe, bilateral angular gyrus, right lingual lobe, and left parietal lobule enhanced (allP<0.05).

In resting state, the abnormality of function connectivity of the parahippocampal gyrus in patients with PCS may be one of the reasons for resulting in memory impairment in patients with PCS.

To compare the effect of subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) for the treatment of primary generalized dystonia and to investigate the optimal stimulation target of primary generalized dystonia.

From December 2004 to April 2013, the postoperative motor function improvement of 21 patients with primary generalized dystonia treated with STN-DBS and GPi-DBS at the Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University were analyzed retrospectively. The electrical stimulation was turned on for 1 week before and after procedure respectively, the Burke-Fahn-Marsden dystonia rating scale (BFMDRS) scores were performed at 3, 6, and 12 months. The motor function of the patients was evaluated.

The postoperative motor function of the 21 patients was improved gradually with prolonged stimulation. The average improvement rates at 1 week, 3, 6, and 12 months after procedure were 7.2±3.0%, 32.2±10.1%, 51.9±12.5% and 63.7±14.2%, respectively. The improvement rate >50% was in 17 patients (81.0%) and that ≥80% was in 4 patients (19.0%) at 12 months after procedure. Eleven patients underwent STN electrical stimulation, their BFMDRS scores were 56.86±20.92 and 19.73±7.56 at 12 months before and after procedure. The average improvement rate was 62.4±14.2%; 10 patients who underwent GPi stimulation, their BFMDRS scores were 60.8±19.3 and 20.0±8.4 at 12 months before and after procedure. The average improvement rate was 65.2±14.7%. There was no significant difference in the effect of surgical treatment of different targets ( P>0.05). All the patients did not have any surgical complications and stimulus-related adverse reaction, such as intracranial hemorrhage or infection.

DBS is safe and effective for the treatment of primary generalized dystonia. Both GPi and STN can be used as the surgical targets, and there is no significant difference in the treatment effect.

To investigate the effects of facial injecting botulinum toxin on electrophysiological monitoring indicator lateral spread response (LSR) in patients with hemifacial spasm in microvascular decompression surgery.

Ninety patients with facial spasm underwent microvascular decompression surgery in Guangdong No 2 Provincial People's Hospital from July 2013 to December 2014 were enrolled retrospectively. They were divided into either a botulinum toxin group (n=18) or a non-botulinum toxin group (n=72) according to whether they injected botulinum toxin or not. The effect of botulinum toxin on the changes of intraoperative LSR and the role of LSR changes in prognostic evaluation were observed.

The mean LSR latency of the zygomatic branch in the botulinum toxin group was 11.4±2.1 ms, and in the non-botulinum toxin group was 9.3±1.4 ms. There was significant difference (P<0.05). The LSR latency of the mandibular branch in the botulinum toxin group was 8.9±1.7 ms, and in the non-botulinum toxin group was 8.2±1.4 ms (P>0.05). The LSR amplitude of the zygomatic branch in botulinum toxin group was 116.1±61.1 μV, and in mandibular branch was 116.1±54.5 μV; the zygomatic branch was 125.9±52.1 μV, and the mandibular branch was 125.9±52.1 μV in the non-botulinum toxin group. There was no significant difference between the 2 groups. After implantation of shims, the LSR disappear rates of zygomatic branchs, and mandibular branch were 16/18and 17/18 respectively in the botulinum toxin group; the zygomatic branch disappear rate in the non-botulinum toxin group was 90% (65/72) and that in the mandibular branch was 96% (69/72). There was no significant difference between the 2 groups (P>0.05). The sensitivity of the disappearance of zygomatic branch LSR for prognostic judgment in the botulinum toxin group was 94% (15/16), and in the non-botulinum toxin group was 98% (64/65). There was significant difference (P<0.05). The mandibular branch LSR, and the sensitivities of both zygomatic branch and mandibular branch disappeared simultaneously for prognostic judgment in the botulinum toxin group were 94% (16/17) and 94% (15/16) respectively; and in the non-botulinum toxin group were 92% (64/69) and 96% (59/61) respectively. There was no significant difference between the 2 groups.

Botulinum toxin has influence on intraoperative LSR. It is expressed as the prolonged LSR latency of zygomatic branch. The way of monitoring with mandibular branch or in combination with zygomatic branch LSR may be better than simply monitoring zygomatic branch LSR.

To investigate the application value of stereoelectroencephalography (SEEG) in the preoperative assessment of epilepsy surgery.

The clinical data of 78 patients with drug-refractory epilepsy assessed with SEEG before procedure at the Epilepsy Center, Guangdong 999 Brain Hospital from April 2014 to April 2015 were analyzed retrospectively. The noninvasive assessment was conducted first, and the SEEG electrode placement scheme was designed according to the clinical and imaging data, and then under the guidance of robotized stereotactic assistant (ROSA), the electrode implantation was completed. The SEEG monitoring was conducted in order to complete the resection of epileptogenic zone finally under the guidance of neuronavigation.

Seventy-eight patients completed 81 SEEG electrode implantations (3 patients had additional electrode implantations), including 16 (20.5%) bilateral implantations. A total of 940 SEEG electrodes were implanted and the average number of implanted electrodes was 12.3 per case. Only 1 patient had an epidural hematoma in the electrode region, and other patients did not have the complications, such as serious hemorrhage, infection, cerebrospinal fluid leakage, electrode fraction or displacement. Seventy-six patients successfully completed the resection of epileptogenic zone, and 2 patients failed to undergo surgery. Fifty-nine patients were followed up for 6-18 months. The seizure control for Engel rating grades were grade Ⅰ in 47 cases (79.7%), grade Ⅱ in 2 cases (3.4%), grade Ⅲ in 6 cases (10.2%), and grade Ⅳ in 4 cases (6.8%). In 51 patients with MRI positive, the Engel grade Ⅰ was in 42 cases (82.4%); in 8 patients with MRI negative, the Engel grade Ⅰ was in 5 cases. There was no significant difference in the seizure control rate between the 2 groups (P>0.05).

The surgical treatment of epilepsy under the guidance of SEEG is both safe and effective.

To investigate the occurrence of pituitary adenoma and its clinical features in patients with multiple endocrine neoplasia type 1 (MEN 1).

Clinical features of patients with 92 MEN 1 complicated with pituitary adenoma treated at the Department of Endocrinology, Peking Union Medical College Hospital from January 1985 to December 2014 were analyzed retrospectively.

In 92 patients, 65 (70.7%) with MEN 1 were diagnosed as having pituitary adenoma, including 39 (60.0%) with functional pituitary adenoma, 23 (35.4%) with non-functional pituitary adenoma, and 3 (4.6%) with unknown function of pituitary adenoma. In patients with MEN 1, the ratio of female involvement in pituitary adenomas was 75.9% (41/54) and that of male was 63.0%(24/38). There was no significant difference (P=0.275). The mean onset age of the functional pituitary adenomas was 34.3±11.3 years, and the most common type was prolactinomas (48.7%, 19/39), followed by the mixed pituitary adenomas (25.6%, 10/39), adrenocorticotropic hormone adenomas (15.4%, 6/39), and somatotrophinomas (10.3%, 4/39). In the non-functional pituitary adenomas, the ratio of microadenomas was 60.9% (14/23). It was higher than 34.8% (8/23) of the macroadenomas.

The MEN 1 patients often have pituitary adenomas, so patients with suspected MEN 1 should routinely conduct pituitary dynamic enhanced MRI examinations, and patients with pituitary adenoma should be alert to the possible combination of MEN 1 and should pay attention to screening.

To investigate the clinical features and treatment strategies of pituicytomas in order to provide evidence for the clinical diagnosis and treatment.

The clinical data of the 11 patients with pituicytoma admitted to the cooperative wards of the Departments of Neurosurgery, Beijing Puren Hospital and Beijing Tiantan Hospital, Capital Medical University from April 2010 to April 2015 were analyzed retrospectively, including the clinical presentations, characteristics of imaging, characteristics of endocrinology and pathology, operation and follow-up results.The major clinical manifestations in patients with pituicytoma were visual disturbance, visual obstruction, growth retardation, and endocrine abnormalities. One neoplasm was located at the suprasellar region and 10 at the sellar and suprasellar region. In addition to 1 patient with the increased prolactin and 1 patient with decreased growth hormone in preoperative blood endocrine examination, all other patients did not have endocrine abnormalities. Eleven patients were followed up for 1-55 months (mean 17.5).

All 11 patients were treated with microsurgery, 8 of them were totally resected, and 3 were near-totally resected. MRI reexamination did not reveal tumor recurrence in 10 patients. Their clinical symptoms were relieved or disappeared. Only 1 patient conducted the second procedure because of tumor recurrence.

The clinical manifestations of pituicytomas are mainly compression of optic nerve. The preoperative diagnosis is difficult. The bleeding is easy to control during operation via the frontolateral approach or pterional approach, and can also avoid damage to the adenohypophysis. It is a main method for the treatment of pituicytomas.

To investigate the risk factors for seizures after aneurysmal subarachnoid hemorrhage (aSAH).

From January 2006 to July 2014, the clinical data of 177 patients with aSAH treated by microsurgical clipping at the Department of Neurosurgery, the Third Affiliated Hospital, Sun Yat-sen University were analyzed retrospectively. The data included age, sex, history of hypertension, duration of disturbance of consciousness at the onset, Glasgow Coma Scale (GCS) on admission, Fisher grade, locations of guilty aneurysms, complications (rebleeding, cerebral vasospasm, and hydrocephalus), timing of surgery, and Glasgow Outcome Scale (GOS). The secondary epilepsies after aSAH were divided into early epilepsy (onset within 24 h after subarachnoid hemorrhage) and late epilepsy (onset at 24 h after subarachnoid hemorrhage). The risk factors for early and late seizures in patients with aSAH were analyzed.

In 177 patients with aSAH, 14 had early epilepsy, 16 had late epilepsy, and 3 had both early and late seizures. The history of hypertension might be an influencing factor of the occurrence of early epilepsy (P<0.05). Concurrent hydrocephalus might be an influencing factor of the occurrence of late epilepsy(P<0.05).

The history of hypertension may be associated with secondary early epilepsy after aSAH and hydrocephalus may be associated with late epilepsy.

To investigate the clinical characteristics and surgical treatment method of congenital anterior sacral meningomyelocele in order to reduce surgical complications and improve prognosis by selecting the appropriate surgical approaches and surgical methods.

The clinical data of 4 patients with congenital anterior sacral meningomyelocele treated at the Department of Neurosurgery, Chinese PLA General Hospital from February 2014 to April 2015 were analyzed retrospectively. The clinical manifestations included abdominal pain, numbness of limbs, constipation, urinary urgency, urinary frequency, and other symptoms. The follow-up time ranged from 2 to 12 months (mean 6.5 months).

The postoperative symptoms of the 4 patients had different degrees of improvement compare with the before procedure. The MRI reexamination revealed that the anterior sacral meningocele disappeared. No postoperative cerebrospinal fluid leakage, peritoneal effusion, wound infection, and other complications were found.

The clinical manifestation of congenital anterior sacral meningocele is mainly pelvic organ compression symptom. Microsurgical operation via posterior median approach can achieve good effect. Properly treating fistula and protecting sacral nerve during the operation may avoid the occurrence of postoperative cerebrospinal fluid leakage after procedure.

To study the hemodynamic characteristics of the difference between the trunk aneurysm of posterior communicating artery (PCoA) and the internal carotid artery (ICA)-PCoA aneurysm.

A total of 15 patients with trunk aneurysm of PCoA (11 ruptured aneurysms, 4 unruptured aneurysms, for short PCoA trunk group) treated at the Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University from January 2014 to June 2015 were studied retrospectively. The 15 patients with ICA-PCoA aneurysm with approximately the same size and the same rupture state at the same time were used as a matched control group. A numerical simulation analysis was conducted for individual three-dimensional digital subtraction angiography (DSA) images of the patients using the method of computational fluid dynamics. The differences of hemodynamic parameters of the aneurysms were compared between the 2 groups.

The PCoA trunk aneurysms were in accordance with the blood flow pattern of the lateral aneurysms, and the ICA-PCoA aneurysms were in accordance with the flow blood pattern of the aneurysms at the bifurcations. The hemodynamic parameters in the PCoA trunk group vs. the control group: The wall shear stress (WSS) of the PCoA trunk group and the control group was 0.48±0.08 and 0.63±0.07 respectively. The percentage of the low WSS area (LSA) was 23.20±6.94% and 4.50±2.29% respectively. There were significant differences (P=0.022, P=0.008). The oscillatory shear index (OSI) of the two groups was 0.0233±0.0071 and 0.0158±0.0044 respectively. There was no significant difference (P=0.411). The WSS of the ruptured group (n=22) and the unruptured group (n=8) was 0.45±0.05 and 0.84±0.08 respectively, and LSA was 18.22±5.11% and 1.84±1.76% respectively. There was significant difference (P<0.001,P=0.006). The OSI of the two groups was 0.0234±0.0054 and 0.0091±0.0027 respectively. There was no significant difference (P=0.132).

The low WSS may be one of the reasons for the high risk of PCoA trunk aneurysm rupture.

To investigate the safety and feasibility of the pipeline embolization device (PED) for the treatment of intracranial aneurysms.

Cochrane systematic reviews were used to retrieve relevant literature up to February 2015 through Medline, Embase, Cochrane Database of Systematic Reviews, China national knowledge infrastructure (CNKI), and Web of Science database. The relevant literature was screened according to the inclusion and exclusion criteria. The Reporting of Observational Studies in Epidemiology (STROBE) was used to conduct quality evaluation for the included literature. The data including all the patients studied and the baseline characteristics of intracranial aneurysms, PED postoperative occlusion rate, incidence of safety incidents, corresponding number of patients, and case fatality rate and corresponding number of patients were extracted. Meta-analysis of the occlusion rate was conducted by using the STATA 12.0 software. The chi-square test was used to identify whether there were significant differences between the aneurysm types and the incidence of complications or the mortality rate.

A total of 29 studies and 1 371 patients with 1 562 aneurysms were enrolled. The mean STROBE score of the included literature was 14.9. The mean follow-up time was 6.4 months after PED procedure. The aneurysm occlusion rate was 82.5% (95% CI 78.3-86.8; I²=74.2%), the brain-related morbidity was 8.3% (114/1 371), and the brain-related mortality was 2.0% (27/1 371). The incidence of spontaneous rupture was 1.6% (22/1 371), the incidence of intraparenchymal hemorrhage was 2.1% (29/1 371), and the incidence of ischemic stroke was 4.2% (58/1 371). The brain-related morbidity of giant aneurysms after procedure was higher than that of the small or large aneurysms (χ²=40.42, P<0.05), and the mortality was higher than the small or large aneurysms (χ²=15.32, P<0.05). The incidence of ischemic stroke of posterior circulation aneurysms after procedure was higher than that of the anterior circulation aneurysms (χ²=8.50, P<0.05). The publication bias of occlusion rate was detected with Begg rank correlation method. The adjusted value wasP=0.011.

Generally, the results of meta-analysis support the safety and feasibility of intracranial aneurysms treated with PED. PED has a higher rate of occlusion after procedure. The incidence of serious complications was low. However, giant intracranial aneurysms have higher brain-related morbidity and mortality. The posterior circulation aneurysms have higher risk of ischemic stroke.

To investigate the distribution of species and its change rule of drug resistance of gram-negative bacteria isolated from cerebrospinal fluid in patients after neurosurgical operation from 2006 to 2014.

The distribution of species of cerebrospinal fluid cultured gram-negative bacteria and its drug sensitivity test results of the patients after neurosurgical operation in Beijing Tiantan Hospital, Capital Medical University from January 2006 to December 2014 were collected.

There were a total of 3 220 cerebrospinal fluid cultured positive isolates, including gram-negative bacteria 891 isolates, accounting for 27.7%. After neurosurgical operation, the infected cerebrospinal fluid cultured positive gram-negative bacteria mainly included Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Escherichia coli, etc. The proportion of gram-negative bacteria infection increased from 11% in 2006 to 28% in 2014, and the gram-negative bacteria cultured and isolated from cerebrospinal fluid for the antibiotic sensitivity showed a downward trend.

From January 2006 to December 2014, gram-negative bacterial infection showed an upward trend after neurosurgical procedure. In the detection of drug-resistant bacteria, the efficacy of antibiotics for gram-negative bacteria infection was not optimistic after neurosurgical procedure, because the appearance of pan-drug resistant bacteria, such as Acinetobacter Baumanii and Klebsiella pneumoniae.

To investigate the relationship between the changes of serum inflammatory factors and the postoperative restenosis after carotid endarterectomy.

From January 2010 to May 2015, 80 randomly selected patients with severe carotid stenosis admitted to the Department of Neurosurgery, Dalian Municipal Central Hospital were analyzed retrospectively. Their stenosis degree was 70%-99%. They all received eversion carotid endarterectomy (eCEA). The levels of serum high sensitive C- reactive protein, soluble intercellular adhesion molecule-1, monocyte chemokine-1were monitored at 24 h, 48 h, 72 h, 1, 2, 4, 8, 16 and 32 weeks, respectively before and after procedure, and the surgical side carotid artery ultrasonography was conducted by the professional ultrasound doctors at the same time points. Six patients with postoperative restenosis were divided into group A, and others were divided into group B.

The levels of serum high sensitive C-reactive protein, soluble intercellular adhesion molecule-1, and monocyte chemokine-1 in group A and B after procedure increased significantly compared with those before procedure. There were significant differences (P<0.05). At 4, 8, 16 and 32 weeks after procedure, the above detection indices of group A increased significantly compared with those of group B. There were significantly differences (P<0.01).

Surgery may result in the increased serum inflammatory factors. Restenosis after carotid endarterectomy may begin to occur from the fourth weeks after carotid endarterectomy. The increased level of serum inflammatory factors may be one of the reasons of restenosis.

With the development of subthalamic nucleus (STN) deep brain stimulation (DBS) surgery for the treatment of movement disorders such as Parkinson's disease (PD), essential tremor and dystonia, many patients have benefited from it and greatly improved their quality of life. More and more evidence shows that different partitions of STN have different functions, and stimulating different parts of STN will have different effects. In order to improve the surgical outcome and reduce surgical complications, the anatomical study of STN, especially the study of STN subdivisions and their functions, is particularly important. In this paper, the anatomical research status of STN is reviewed from the perspectives of gross anatomy, fiber connection, functional anatomy and imaging.

microRNA (miRNA) is a kind of endogenous non-coding small molecule RNA with a length of about 19-25 nt^[1]Widely involved in the regulatory activities after gene transcription. Among them, most miRNAs have high sequence conservation, expression timing and tissue specificity. MiRNAs usually target multiple mRNAs and regulate gene expression by inhibiting translation or degrading target mRNAs. Therefore, it determines the functional specificity of the cells and tissues to which it belongs. Mature miRNAs are usually transcribed by RNA polymerase II (RNA-polⅡ) into primary miRNAs (pri-miRNAs) with cap structure (7 mGpppG) and Poly A tail, and then treated by nuclease Drosha-DGCR8 complex into 70-100 nt precursor miRNAs (pre-miRNAs) with stem-loop structure^[2]Transported out of the nucleus with the help of the Exprotin-5 complex, cleaved into double-stranded miRNA by the nucleic acid cleavage enzyme Dicer enzyme in the cytoplasm, and two inhibitory gene expression occurred at the post-transcriptional level: one is double-stranded miRNA unwinding, in which a single strand completely complementary to the target mRNA is bound into an RNA-induced silencing complex (RISC), which is usually bound into the coding region or open reading frame of the mRNA, similar to the action of small interfering RNA (siRNA) to cleave and degrade the target mRNA and inhibit gene expression; The second is a miRNA that is not completely complementary to the target mRNA and usually binds to the 3 '-end untranslated regions (3' UTRs) of the mRNA^[3]and directs the RISC to degrade the target mRNA or repress the translation of the target mRNA according to different degrees of complementarity.

temporal lobe epilepsy (TLE) is a more common type of drug-resistant epilepsy treated by surgery. The main modes of surgical treatment include anterior temporal lobectomy and elective hippocampal amygdalectomy. In 49% to 83% of patients, the seizures were relieved after surgery^[1]。 Because the medial temporal lobe, including hippocampus, entorhinal cortex, parahippocampal gyrus and other structures are the functional areas of memory, the memory of patients after operation decreased significantly^[1]。 Long-term follow-up after surgery revealed that there was a dynamic process of this memory dysfunction^[2]。 Therefore, it is very important to predict the memory impairment caused by surgery before surgery. In recent years, functional magnetic resonance imaging (fMRI) has been actively used in this field. Because of the advantage of this method of non-invasive, there is a trend to replace Wada test^[3,4]。 Notably, there were obvious individual differences in memory function changes after surgery in patients with TLE^[5]And the types of memory dysfunction caused by surgery vary. The author summarizes the related studies in recent years to assess the changes of memory function after TLE, aiming to help clinicians deepen their understanding of TLE and improve the quality of preoperative assessment.

Interleukin-6 (IL-6) has a variety of functions in the body. Studies have shown that the content of IL-6 is increasing in some lesions of malformation of cortical development (MCD)^[1]Moreover, its content increases rapidly during seizures^[2]。 IL-6 may play an important role in the pathogenesis of MCD-induced epilepsy. This article reviews the relationship between IL-6 and IL-6.

Since Jannetta et al.^[1]Since microvascular decompression (MVD) was pioneered in the treatment of idiopathic hemifacial spasm (HFS), primary trigeminal neuralgia (TN), primary glossopharyngeal neuralgia (GN) and other cranial nerve diseases, clinical practice has proved that its curative effect is definite, and it has become the first choice surgical treatment method for related cranial nerve diseases^[1,2,3]。 Although this kind of cranial neurological disease often brings great pain to patients and even seriously affects their life and work, it is all non-fatal diseases. A basic principle of functional neurosurgery is to relieve the patient's pain without causing serious complications that are unacceptable to the patient. Once serious complications after MVD surgery occur, it is often difficult for patients to accept. Therefore, it is an eternal task for neurosurgeons performing MVD surgery to minimize the incidence of severe complications after surgery^[4]。 Postoperative intracranial hemorrhage is one of the most serious complications after MVD, and its incidence is about 1%^[5,6,7,8]It is also the leading cause of death from MVD. This article reviews the general situation, causes, related risk factors, prevention and treatment of intracranial hemorrhage after MVD and recent research progress.

Malignant glioma is the most common malignant tumor in the central nervous system, accounting for 41% ~50% of all intracranial tumors. Its incidence, recurrence and mortality are high, but the cure rate is low^[1]And is therefore one of the most difficult tumors to treat at present. About half of all glioma patients are glioblastoma, with a 1-year survival rate of only 30% and a 5-year survival rate of less than 5%^[2]。 Nowadays, the main treatment method used is surgical resection, but surgery is often difficult to completely remove, and it is prone to recurrence after surgery. Although the combined chemoradiotherapy has achieved some efficacy in the treatment of glioma, the effect is still not good. How to improve the therapeutic effect of glioma is still a big problem in the clinical treatment of glioma.

From February 1 to 4, 2016, the 12th International Neurotrauma Congress, sponsored by the International Neurotrauma Association and co-organized by six academic groups and institutions including J Neurotrauma, was held at the Cape Town International Convention Center in Cape Town, South Africa. Nearly 1,300 delegates from 34 countries around the world registered to attend the conference. World-renowned experts in the field of neurotrauma, including Professor Buki, currently president of the International Neurotrauma Society and director of neurosurgery at Budapest Hospital in Hungary, Professor Unterberg, former president of the International Neurotrauma Society and Professor of Neurosurgery at Heidelberg University in Germany, and Professor Hovda, former president of the International Neurotrauma Society, attended the conference. The delegation of the Neurological Injury Training Committee of Chinese Medical Doctors Association attended the meeting as the only invited academic group in China, with Chairman Liu Baiyun as the head of the delegation, and organized 13 members from all over the country to attend the meeting.