Volume 32 · Issue 04 · 2016

microvascular decompression (MVD) is the first surgical treatment method for the treatment of trigeminal neuralgia (TN), hemifacial spasm (HFS), glossopharyngeal neuralgia (GN) and other cranial nerve diseases. It is considered as one of the most important breakthrough innovative technologies in the history of modern neurological diseases treatment. With the further development of microscopic neurosurgery and the in-depth research on the pathogenesis of cranial nerve diseases, MVD has gradually been used to treat disabling vertigo, refractory tinnitus, essential hypertension and other cranial nerve diseases, and its application is increasingly widespread.

Intracranial arachnoid cyst is a very common benign lesion in children, and its incidence rate accounts for about 1% of intracranial lesions in children, of which 90% are located in the supratentorial and 60% in the middle cranial fossa (also known as lateral fissure arachnoid cyst)^[1,2]。 Because its exact pathogenesis and natural history are not completely clear, there are no guidelines for the treatment of arachnoid cysts. The vast majority of arachnoid cysts are asymptomatic and discovered accidentally, while a few cysts can enlarge progressively, manifesting as headache, cyst rupture and bleeding, subdural effusion, epilepsy, etc. For patients with symptomatic arachnoid cysts, it is recognized that surgical treatment should be given; For asymptomatic patients, whether to give preventive surgery is currently controversial.

There are many types of congenital spina bifida, and there are various subtypes of the same type. Spina bifida depends on the degree of disease, generally, those with spinal canal contents bulge are called dominant or cystic spina bifida, otherwise they are called occult spina bifida^[1,2,3,4]。

After nearly 20 years of clinical practice in China, large bone flap craniotomy has been widely accepted and applied today, from the initial opposition and controversy in academic circles, which fully proves the important position of large bone flap craniotomy (decompression) in the treatment of acute severe craniocerebral trauma. In a recent review of the treatment of traumatic brain injury published in the New England Journal of Medicine, large bone flap surgery was also suggested as the last option for other conservative treatments^[1]。 Although there are still some reports of ineffective large bone flap craniotomy, one of the most influential negative results is Cooper et al.^[2]A multicenter study published in 2011. However, this study does not include patients with mydriasis and fixation, which obviously does not meet the surgical indications for large bone flap craniotomy in China. On the contrary, clinical practice has proved that the application and popularization of this technology has effectively treated thousands of patients with intractable intracranial hypertension who have dilated and fixed pupils after injury every year^{[3,4,5,6,7,8,9,10]}。 Although both theoretical and clinical studies have proved the effectiveness of this operation, due to the regional differences in medical level in China, especially the irregular operation techniques of doctors in primary hospitals, which leads to the deviation of treatment effect, which is also one of the important reasons why some reports of this operation are ineffective. Combined with years of clinical practice and reports at home and abroad, the author introduced the methods of traumatic large bone flap craniotomy^[7,9]。 In 2013, he published the surgical video CD of "bifrontal large bone flap decompression craniotomy" and "one-sided frontotemporal and parietal large bone flap craniotomy"^[11,12]。 After several years of communication, promotion and improvement by the Chinese Medical Physicians Association, this technology has become more and more mature. However, it is still necessary to strengthen the standardization of surgical indications and techniques to improve the overall treatment level of neurosurgeons and traumatologists across the country.

To investigate prognosis and risk factors for children with medulloblastoma.

The clinical data of 92 children with medulloblastoma admitted to the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2003 to January 2007 were analyzed retrospectively. The tumor resection degree, imaging data, pathological type, radiotherapy, chemotherapy or not, and clinical prognosis of the children were investigated and summarized. Kaplan-Meier single factor analysis and Cox multivariate regression analysis were used to conduct statistical analysis for various influencing factors.

Of the 92 children with medulloblastoma, 27 were females and 65 were males. Their age ranged from 3 to 17. The follow-up time ranged from 6 to127 months (median follow-up time 84.0 months). Sixty children had classic medulloblastoma, 24 were desmoplastic type, 1 was large cell type, and 7 were anaplastic type. Nineteen children had tumor spread before procedure, 12 had postoperative residual tumor >1.5 cm ^2, and 6 had both of them. The tumors of 81 children were located in the posterior fossa midline, 53 of them infiltrated the base of the fourth ventricle, and 11 were located in one side of the cerebellar hemisphere or cerebellopontine angle. Regression analysis showed that the large cell/anaplastic histological type and tumor spread were the independent risk factors for affecting the prognosis of the children (P<0.001).

The large cell/anaplastic histological type and tumor spread are the independent risk factors for affecting the prognosis of the children. The prognosis of the children is poor and needs to be treated with different treatment options.

To analyze the incidence of acute postoperative seizures (APOS), risk factors and long-term efficacy after surgery in children and adolescents with drug-refractory frontal lobe epilepsy (FLE).

From January 2009 to September 2011, 51 children and adolescents with drug-refractory FLE (aged ≤21 years) followed up for ≥3 years after resection of frontal lobe epileptic foci resection at the Department of Functional Neurosurgery, Beijing Xuawu Hospital, Capital Medical University were enrolled retrospectively. The risk factors for APOS after procedure and its effect on long-term efficacy were analyzed. Kaplan-Meier survival curves were used to analyze the rate of seizure-free of all patients after procedure.

In 51 patients, 11 (21.6%) had APOS. Compared with the non-APOS group, the surgical sites in the posterior frontal-central region were more likely to have APOS (P=0.020). There were no significant differences in sex, age of onset, age at surgery, course of disease, whether secondary generalized tonic clonic seizures (sGTCS), preoperative MRI having lesions or not, interictal electroencephalogram (EEG) before and after procedure, whether buried intracranial electrode, side of operation, focal cortical dysplasia (FCD) between the 2 groups (P>0.05). All patients were followed up for 36 to 68 months (mean 48.5±10.3). During the follow-up period, none of seizures disappeared in the APOS group, and none of the 21 cases had seizures in the non-APOS group. There was significant difference (P=0.005). The proportion of seizure free in 51 patients at 6 months, 1, 2, 3, and 5 years were 54.9%, 49%, 43.1%, 41.2%, and 41.2%, respectively. Preoperative MRI showed that patients had clear frontal lobe lesions, and the ratio of postoperative 5 years without seizures was 50.0%. It was slightly higher than 33.3% of the patients with normal MRI, however there was no significant difference (P=0.169). Postoperative pathological results were patients with FCD, the ratio of postoperative 5 years seizure-free was 42.9%, and that of the patients with non-FCD was 40.0%. There was no significant difference (P=0.814).

The efficacy of long-term follow-up in FLE children and adolescents with APOS were poor after resection of the frontal lobe epileptic foci. The ratio of seizure free was 41.2% at 5 years after frontal lobectomy.

To investigate the treatment experience of atypical teratoid/rhabdoid tumors (AT/RT) of the central nervous system in infants in order to improve the level of awareness for the disease.

The treatment course of 12 infants with AT/RT diagnosed by pathology and immunohistochemistry at the Department of Neurosurgery, Children's Hospital of Shanghai Fudan University from October 2010 to March 2015 were analyzed retrospectively, and the correlation analysis and the literature review were performed.

In 12 children, AT/RT of 10 were resected completely, and 2 were subtotally resected. Postoperative complications: 2 patients had subdural effusion, 2 had secondary epilepsy, and 1 had mutism. They were all improved after symptomatic treatment. All the children were not treated with adjuvant therapy after procedure, such as radiotherapy and chemotherapy. Two children were lost to follow up after procedure. Nine children were followed up and they all had recurrence, and 1 is still in follow-up. The shortest recurrence time after procedure was 2 months and the longest time was 9 months after procedure. The recurrence time was not more than 1 years. Three of them had recurrence in situ, 6 had cerebrospinal fluid disseminations and intracranial multiple metastases. All the recurrent children were not treated with surgery again.

The clinical incidence of AT/RT is low and the number of cases is less, however, its malignant degree is high and had strong invasion. Although they treated with comprehensive treatment, such as total resection and postoperative chemoradiotherapy, often the treatment effect of infants is poor. Although there are certain characteristics on imaging, it is still hard to differentiate the medulloblastomas with the PNET and other tumors. The final diagnosis should be confirmed by the pathological diagnosis.

To investigate the clinical treatment methods and the use of new materials for cranioplasty in children.

From January 2014 to October 2014, the biomimetic bone (nano-hap/collagen composites) materials developed by the Materials Department of Tsinghua University and used by 11 children with different parts of skull defect treated by the cranioplasty at the Department of Neurosurgery, Yuquan Hospital, Tsinghua University were studied retrospectively after preoperative individualized 3D printing. They were examined again by coming back to the hospital on time after procedure.

The operations of 11 children were completely successful, and their postoperative recovery was good. They were followed up for 1 year. The implanted biomimetic bone materials were well fixed. The measured CT value showed that its material density increased significantly compared with the original values. The head shape of the children developed normally and the incisions healed well. Each neurological function and cognitive function recovered significantly.

Using biomimetic bone materials (nano-hap/collagen composites) to perform the cranioplasty in children may solve the problems of growth and development after skull repair. Its incidence of postoperative complications is far less than other skull repair materials. It is a more reasonable material for repairing skull defects in children.

To investigate the clinical features, imaging findings, treatment and prognosis of posterior fossa epidural hematomas in children.

From August 2010 to April 2015, the clinical data of 35 children with traumatic posterior fossa epidural hematoma admitted to the Department of Neurosurgery, the Affiliated Hospital of Xuzhou Medical College were analyzed retrospectively. Eighteen of them were treated conservatively 8 were treated with skull drilling and drainage. Three of which received urokinase therapy because part of residual hematoma after procedure, and 9 were treated by craniotomy.

In 18 children treated with the conservative treatment, CT revealed that their hematomas were absorbed about 1 month or so after symptom onset. The residual hematomas <5 ml after procedure in 8 children were treated with skull drilling and drainage, and 9 were treated with craniotomy, their hematomas were removed completely after procedure. They were followed up for 4 months to 5 years. All children recovered well, without operation death and disability.

The occurrence of posterior fossa epidural hematomas in children are relatively more common. Most of them are falling and slipping injuries. The lambdoid suture separation fracture and occipital fracture are the main causes of bleeding. Headache, vomiting and disturbance of consciousness are more important for identifying the disease. Hemotomas in acute phase are easy to be liquefied. Drilling skull and drainage are safe and effective for the treatment of liquefied hematomas. The early diagnosis and appropriate treatment of posterior fossa epidural hematomas in children have good prognosis.

Cranial dermoid cyst is a cyst formed by epidermal cells separated along the embryonic closure line. It shows subcutaneous nodules at birth, which increase with age. It mostly occurs at the midline site, and occasionally the cyst can be seen to expand into the cranium in a dumbbell shape^[1,2,3]。 Cranial dermoid cyst in children is relatively rare in clinic, and it is common in children^[4]Clinical diagnosis and surgical treatment are relatively difficult. This article retrospectively analyzed five children with skull dermoid cyst who were admitted to the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University from January 2011 to June 2014 and were confirmed by postoperative pathology. Now, their clinical characteristics and treatment results are summarized and analyzed as follows.

To evaluate the superiority, reliability and clinical application value of monitoring carotid endarterectomy in motor evoked potential (MEP) in combination with somatosensory evoked potential (SEP).

The clinical data of 45 patients with carotid endarterectomy treated at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from December 2011 to June 2013 were analyzed retrospectively. The patients were monitored by the routine SEP and MEP, and the intraoperative changes of SEP and MEP amplitude and latency were analyzed. The differences of the specificity and sensitivity of SEP, MEP and SEP+ MEP monitoring were compared respectively. Whether the combined application of the two methods could improve the specificity of monitoring was evaluated.

In 45 patients, 4 had mild neurological dysfunction after procedure. All patients did not have any severe complications, such as stroke and myocardial infarction. The specificity of the simple MEP monitoring was 78% (32/41), the specificity of the simple SEP was 56% (23/41), and the specificity of SEP+ MEP was 95% (39/41). By pairing chi-square test analysis, there were no significant differences among the specificity of the simple MEP monitoring, the specificity of the simple SEP, and the specificity of SEP+ MEP (P<0.05). The specificity of the combined monitoring was significantly higher than that of the simple monitoring.

The combined monitoring of SEP and MEP for carotid endarterectomy may significantly decrease the judgment of"false positive"in order to accurately help the operator to operate.

To summarize the characteristics of early cortical branch (ECB) aneurysms of the middle cerebral artery (MCA) and to investigate the feasibility, safety, and efficacy of endovascular treatment of aneurysms on this site.

From January 2012 to June 2014, the angiographic data of 146 patients with MCA aneurysm treated with endovascular treatment at the Department of Neurosurgery, Changhai Hospital, the Second Military Medical University were collected. The ECB aneurysms were screened. Their clinical characteristics, cerebral angiographic results, treatment process, and follow-up results were analyzed retrospectively.

A total of 32 patients with 33 ECB aneurysms were screened (including 1 early bilateral branch aneurysm), among them, 21 were early frontal artery aneurysms, 12 were early temporal artery aneurysms, 27 (81.8%) were wide-necked aneurysms. All the treatments of the patients were successfully, including 17 patients treated with coils alone, 3 with balloon-assisted coil embolization, and 13 with stent-assisted coil embolization. The postoperative immediate angiography showed that the aneurysms of 9 patients (27.3%) were packed densely, 4 patients had tumor neck development (12.1%), and 20 had (60.6%) aneurysm body development. One patient (3.1%) had intraoperative aneurysm hemorrhage, and after being treated with hematoma evacuation and decompressive craniectomy, he became better. The imaging follow-up of 21patients (63.6%) ranged from 3 to 14 months (mean 5.7±3.5 months). The aneurysms of 15 patients were embolized completely, 3 had further thrombosis, and 3 had neck recurrence. They were not treated again and were followed up continuously. The clinical follow-up of 31 patients (93.9%) ranged from 10 to 42 months (mean 20.3±8.9). No new nervous system symptoms or aneurysm rebleeding were observed.

The ECB aneurysms are different from bifurcation aneurysms. The aneurysm morphology is complex and the positions are special. Endovascular treatment is technically safe and. feasible

To summarize the safety and efficiency of LVIS stent-assisted coil embolization of small intracranial aneurysms.

From August 2014 to April 2015, 21 patients with small intracranial aneurysm treated with stent-assisted coil embolization at the Department of Intervention Therapy, Henan Provincial People's Hospital of Zhengzhou University were enrolled. The embolization rate of aneurysm, prognosis of patients, complications, and imaging follow-up results were analyzed retrospectively. The utilization skills were summarized.

The surgical success rate of 21 patients was 100%. The aneurysm embolization grades were Raymond gradeⅠin 16 cases (76.2%), Raymond grade Ⅱ in 4 cases (19.0%), and Raymond grade Ⅲ in 1 case (4.8%). The parent arteries were fully retained. One patient had in-stent thrombosis without neurological dysfunction. In the process of stent releasing, the ends of the stents opened poorly in two cases. One was treated with Gateway balloon dilatation, the other was treated with stent expanding after catheter massage, and the stents were expanded well. Eighteen patients were followed up with imaging for 3 to 6 months after procedure. The results were consistent with the image immediately after procedure. No patients had recurrence. Three patients had asymptomatic in-stent stenosis. The modified Rankin scale scores were 0-3 at 6 to 12 months after procedure.

The LVIS stent is safe and effective for the treatment of small intracranial aneurysms. It may be helpful for improving complete embolization rate of aneurysms and decreasing the recurrence risk of aneurysms.

To summarize the preliminary experience of endovascular treatment of irregular and complicated intracranial aneurysms with double microcatheter technique and to investigate the feasibility of its application.

From January 2012 to May 2015, the clinical data of 37 patients with irregular and complicated intracranial aneurysm admitted to the Department of Neurosurgery, Anhui Provincial Hospital were analyzed retrospectively. All 37 patients were treated endovascularly by using double microcatheter technique, 33 of them were treated with double microcatheter technique alone and 4 were treated with stent-assisted double microcatheter technique. Prognosis of patients were evaluated by the Glasgow outcome scale (GOS). The follow-up time after procedure was 6 months.

Immediate angiography after procedure in 37 patients revealed that the aneurysms of 35 patients were densely embolized and 2 were near-totally embolized. All patients recovered well (GOS grade V), no complications and deaths occurred. After 6 months, 24 patients were followed up by DSA, and it revealed that the parent arteries were patent, and no recurrence of aneurysms was found. Thirteen patients were lost to follow-up.

The efficacy of double microcatheter technique for the treatment of irregular and complicated intracranial aneurysms is good and it has feasibility.

To analyze the risk factors for the complications of stent-assisted embolization of acutely ruptured wide-necked intracranial aneurysms.

A total of 56 patients with acutely ruptured aneurysm (58 aneurysms) treated with the stent-assisted embolization at the Department of Neurosurgery, the Fourth Affiliated Hospital of Guangxi Medical University from May 2008 to April 2014 were analyzed retrospectively. Univariate factor analysis and multiple logistic regression analysis were conducted aiming at age, sex, aneurysm characteristics, Hunt-Hess grade, stent type, stent implantation mode, and whether performing lateral ventricular external drainage or not. The influencing factors of procedure-related complications were found.

Nine patients had perioperative complication (16%), including thrombosis in 6 cases (11%) and hemorrhage in 3 cases (5%). The preoperative Hunt-Hess grade (P=0.001), location of aneurysms (P=0.001), type of stent (P=0.012), and stent technology (P=0.009) might be the influencing factors of postoperative complications. Logistic regression analysis indicated that the middle cerebral artery aneurysms (OR, 20.103, 95% CI 3.182-54.365, P=0.012), preoperative Hunt-Hess grade Ⅳ-Ⅴ (OR, 7.230, 95% CI 1.953-22.152, P=0.022), and bailout stent placement (OR, 1.819, 95% CI 1.164-2.065, P=0.048) were the independent risk factors for the complications of stent-assisted embolization in patients with acute intracranial wide-neck aneurysms.

Intracranial aneurysm occurs in the middle cerebral artery, preoperative Hunt-Hess grade Ⅳ-Ⅴ, and patients with acute intracranial wide-neck aneurysm rupture using bailout stent placemen are more prone to complications.

The incidence of intracranial aneurysms is about 2% ~5%^[1]The mortality rate after aneurysm rupture and hemorrhage is about 50%^[2]。 Therefore, aneurysms at risk of rupture should be treated aggressively. However, intervention for unruptured aneurysms is also risky. The fatality rate and disability rate after interventional treatment for unruptured aneurysms are about 1.5% ~2.3% and about 10% ~20%^[3]。 The annual rupture rate of unruptured aneurysms ranged from 0.8% to 2.0%^[4,5]It suggests that most unruptured aneurysms may not rupture for life. In recent years, the analysis of the risk factors of rupture of unruptured aneurysms has become a hot research topic at home and abroad. Therefore, we retrospectively analyzed the clinical data of aneurysm patients who attended the Department of Neurosurgery, First Affiliated Hospital of Kunming Medical University from April 2013 to June 2014, and explored the risk factors of aneurysm rupture.

To evaluate the effectiveness and safety of rituximab combined with high-dose methotrexate, dexamethasone and dexamethasone (R-MAD regimen) for the treatment of patients with primary central nervous system lymphoma (PCNSL).

The clinical data of 35 patients with PCNSL treated at the Department of Hematology, Beijing Tiantan Hospital from January 2010 to June 2015 were analyzed retrospectively. All patients received rituximab (d_0:375 mg/m²), high-dose methotrexate (d_1:3.5g/m²), cytarabine (d_2:0.5-1 g/m²), and dexamethasone (d_1-3:10 mg/d) for chemotherapy. Every 21 days were as a course of treatment, and they were treated for 4-6 courses.

The median follow-up time of 35 patients was 36 (6-66) months, 20 (57.1%) of them achieved complete remission, 13 (37.1%) achieved partial remission, and 2 (5.7%) had progression of disease. The total effective rate was 94.2% (33/35). The median survival time was 38.3 months (95% confidence interval [CI] 19.4-57.2), and the median progression-free survival was 30.0 months (95% CI 9.4-50.6). The adverse reaction of chemotherapy was mainly bone marrow suppression. Twenty-four patients experienced grade 1 to 3 neutropenia and thrombocytopenia in the course of the disease. No grade 4 and above adverse reactions were observed.

R-MAD regimen is both safe and effective in the treatment of primary central nervous system neoplasms.

To investigate the factors and the benefits of different surgical procedures affecting the prognosis of elderly patients with glioblastoma multiforme (GBM).

A total of 103 elderly patients with GBM operated in Nanfang Hospital, Southern Medical University from January 2007 to May 2014 were analyzed retrospectively. The survival analysis and Cox regression analysis were performed for gender, age, onset time, preoperative Karnofsky performance status (KPS) scores, underlying diseases, tumor volume, tumor location, whether dominant hemisphere, degree of resection, adjuvant therapy, time interval for postoperative adjuvant therapy, and immunohistochemical results. Taking KPS as a hierarchical condition, the effect of the degree of resection on the prognosis of the patients with different functional status was analyzed.

The mean overall survival (OS) period of 103 patients was 16.4±0.7 months, and the 2-year survival rate was 7.8%. OS of type Q+ S resection was 20.7±1.2 months, type S resection was 16.7±1.0 months, type T resection was 16.7±1.0 months, and type P resection was 6.8±1.2 months. There were significant difference in OS of different degrees of resection (P<0.01). COX risk models indicated that the prognoses of patients for preoperative KPS score (OR, 0.652, 95% CI 0.435-0.975, P=0.037), PS score (OR, 1.701 , 95% CI 1.048-2.761, P=0.032), no type 2 diabetes (OR, 2.154, 95% CI 1.106-4.198, P=0.024), radical extent of resection (OR, 0.326, 95% CI 0.208-0.511, P<0.0001), and receiving standard radiotherapy and chemotherapy (OR, 0.406, 95% CI 0.245-0.671, P<0.0001) were better. The effect of age (OR, 1.046, 95% CI 0.649-1.684, P=0.809) on OS was minor. The different degrees of surgical resection had influence on the survival prognosis of patients for preoperative KPS >70 (mean OS 19.5±1.4 months) or preoperative KPS ≤70 (mean OS 12.613±0.656 months) ( P<0.01), but there were no significant differences between type Q+ S resection and type T resection in patients with preoperative KPS ≤70 (P=0.062).

Having or without type 2 diabetes, postoperative functional status score, degree of surgical resection, and whether receiving standard radiotherapy and chemotherapy are the independent risk factors for influencing the prognosis of elderly patients with GBM. The postoperative functional status is an important condition to determine whether the elderly patients can benefit from extended resection.

To investigate the effect of abnormal electrical activity and seizure on cognitive function in patients with refractory frontal lobe epilepsy.

From August 2010 to August 2013, the clinical data of 42 patients with frontal lobe epilepsy (Engel classification grade Ⅰ) treated surgically at the Epilepsy Center, Yuquan Hospital, Tsinghua University were analyzed retrospectively. The reasoning ability, language ability, attention function, and executive function of the patients were analyzed, and the influence of the above factors on different cognitive function was investigated in accordance with abnormal electrical activity discharge index, sides, and seizure characteristics.

The Wisconsin Card Sorting Test of 42 patients was affected by the sides of abnormal electrical activity, the scores of the left side, bilateral sides, and multifocal abnormal electrical activities were decreased significantly (all P<0.01). Discharge index and seizure frequency during the waking period were the influencing factors for semantic processing score. When the number of discharges increased (>50%) or the secondary tonic-clonic seizures occurred frequently (>1 time/day), the semantic processing scores were decreased (allP<0.05). The sides of abnormal electrical activity and the secondary tonic-clonic seizures were the influencing factors for the semantic processing scores. When the electrical activity was located on the left side or bilateral sides, and multifoci or secondary tonic-clonic seizures, the speech processing scores of the patients were decreased (allP<0.05). The scores of three-dimensional mental rotation in patients with combined with frequent discharge during sleep (>50%) and secondary tonic-clonic seizures were decreased (allP<0.05).

Discharge index, sides of abnormal electrical activity, seizure frequency, and seizure types during waking and sleeping periods affects cognitive function in different degrees.

To investigate the clinical characteristics and influencing factors of nosocomial infection in patients with severe head-trauma in neurosurgical intensive care unit (NICU).

The clinical data of 372 patients with severe head-trauma admitted in NICU, the Second Affiliated Hospital of Jiaxing University from January 2013 to January 2015 were analyzed retrospectively. Univariate and multivariate logistic regression analyses were used to assess the factors of influencing nosocomial infection of the patients.

In 372 patients with severe head-trauma, 214 ( 57.5%) occurred nosocomial infection. The most of them were in the respiratory tract and urinary system. Gram negative bacteria were the main pathogenic bacteria. Univariate analysis showed that age, Glasgow coma scale (GCS) on admission, craniotomy, tracheal intubation or tracheotomy were associated with nosocomial infection (all P<0.05). Multivariate logistic regression analysis showed that low GCS on admission, duration of coma ≥2 weeks, duration of indwelling urinary catheter ≥2 weeks, duration of indwelling deep vein ≥2 weeks and using sedative drug were the risk factors for the occurrence of nosocomial infection in patients with severe head-trauma in NICU(allP<0.05), while early enteral nutritional support (≥104.5 kJ·kg^-1·d^-1 within a week) was a protective factor for the occurrence of nosocomial infection (P<0.05).

The incidence of nosocomial infection is high in patients with severe head-trauma in NICU. Low GCS on admission, duration of coma ≥2 weeks, duration of indwelling urethral catheter ≥2 weeks, duration of indwelling deep vein ≥2 weeks, using sedative drug in patients with severe craniocerebral injury are prone to nosocomial infection, and early enteral nutrition support may decrease the occurrence of nosocomial infection.

To examine the expression of translocator protein (TSPO) in an intracerebral hemorrhage model in mice.

A intracerebral hemorrhage model in mice was induced by using autologous blood injection. The 28-point neurological deficit scale was used to evaluate neurological deficits of different amount of bleeding in the two group of mice (the mean amount of bleeding was 15 μl and 25 μl respectively) at day 1 after intracerebral hemorrhage, and Western blot was used to detect the expression levels of TSPO in the sham operation group, the amount of bleeding 15 μl group, and the amount of bleeding 25 μl group. Western blot and immunofluorescence staining were used to detect the TSPO expression at 12 h, day 1, 3, and 5 after modeling in mice in the amount of bleeding 25 μl group.

The results of the 28-point neurological deficit scale showed that the neurological defect scores of the 2 groups of intracerebral hemorrhage model mice were significantly higher than the sham operation group (all P<0.05), and the TSPO expression in the amount of bleeding 25 μl group was more significant higher than the amount of bleeding 15 μl group (P<0.05). Within 12 h after modeling, there was no significant difference in the TSPO expression between the amount of bleeding 25 μl group and the sham operation group (P>0.05). The TSPO expression level increased gradually at day 1, 3, and 5 after modeling, and it was higher than the sham operation group (allP<0.05). Immunofluorescence staining results showed that the TSPO expression was not obvious at 12 h after modeling, while it increased gradually at day 1, 3, and 5 after modeling, and they mostly expressed in microglia and astrocytes of the perihematomal brain tissue.

The TSPO expression increases in perihematomal brain tissue after intracerebral hemorrhage in mice. Its expression level is associated with the time after bleeding and bleeding volume, suggesting that it may be associated with the secondary inflammatory response and injury after intracerebral hemorrhage.

Female, 63 years old. He was admitted to the Department of Neurosurgery, General Hospital of Tianjin Medical University on July 7, 2014 for "sudden headache, dizziness and double vision shadows for 2 weeks". He underwent CT angiography (CTA) of the head, and found a huge aneurysm in the clinoid segment of the right internal carotid artery, with the widest diameter of about 30 mm (FIG. 1A)。 First, whole brain angiography was performed under local anesthesia in a Hybrid operating room. Preoperative digital subtraction angiography (DSA) showed a giant aneurysm in the clinoid segment of the right internal carotid artery (FIG. 1B)； The balloon occlusion test (BOT) of the ipsilateral internal carotid artery was also performed. After general anesthesia, routine craniotomy was performed to expose the initial part of the ipsilateral extracranial to intracranial vascular (EC-IC), and the great saphenous vein was selected as the graft vessel. The anastomosis was performed with the external carotid artery and the inferior trunk of the M2 segment of the middle cerebral artery, respectively, and then the aneurysm was isolated. Intraoperative electrophysiological monitoring showed no abnormalities. Another intraoperative DSA examination showed that the bridging vessel was patent, the distal blood supply was sufficient, and the development was good. No aneurysm development was observed (Figure 1C)； The head CTA was re-examined 1 week after surgery and showed that the graft vessels were patent (Figure 1D)。 The patient recovered well after operation and was followed up for 12 months. The carotid artery pulsed well when touched. The B-ultrasound examination of the carotid artery showed that the bypass vessel had smooth blood flow, with an internal diameter of about 5.0 mm and a flow velocity of 0.57m/s (Figure 1E，Figure 1F)。 The patient is currently able to take care of himself, has no neurological deficit, and has a modified Rankin scale score of 0.

Chordoma is a relatively rare low-grade malignant tumor, accounting for 1% to 4% of malignant bone tumors, and its incidence in the population is less than one in a million. The onset age of chordoma patients is about 50 to 60 years old, and the incidence rate is higher in men than in women. The surveillance epidemiology and end results program (SEER) showed that the median overall survival of chordoma patients was 6.29 years^[1]。 The onset sites of primary chordoma include sacrococcygeal region (50%), skull base (35%) and other axial bones (15%)^[2], mainly divided into 3 pathological types, namely: classical type, cartilage type and dedifferentiated type. The main pathological characteristics of chordoma are that a large number of vacuolar structures can be observed in tumor cells under microscope, and the positive expression of S-100 protein, cytokeratin, epithelial membrane antigen and transcription factor T gene (Brachyury) can be detected by immunohistochemical staining^[3,4]。

Moyamoya disease is a cerebrovascular disease characterized by progressive stenosis or occlusion of bilateral internal carotid arteries and initial segments of anterior and middle cerebral arteries, accompanied by abnormal vascular network formation at the base of the skull^[1,2]。 Patients with moyamoya disease may be complicated with aneurysms, and aneurysms tend to form at weak sites of blood vessels such as abnormally dilated collateral pathways^[3]。 This article summarizes the literature at home and abroad, and summarizes the diagnosis and treatment of moyamoya disease with peripheral arterial aneurysm.

persistent vegetative state (PVS) is a state after severe brain damage, that is, the functions of the brain stem and diencephalon are relatively preserved, while the function of the cerebral cortex is lost. Patients exhibit vegetative survival state with only the minimum response-sleep/wake cycle, can open their eyes but are unconscious, and cannot communicate with the surrounding environment or people. 1972, by Jennett and Plum;^[1]The concept of PVS was proposed for the first time. With the progress of clinical research and the development of ethics, in recent years, some European scholars have suggested that unresponsive wakefulness syndrome (UWS) be used to describe this group of people. Because UWS makes patients' families more psychologically acceptable, more in line with ethical requirements, and can make clinical workers hold a more positive attitude and objectively evaluate patients' condition, which may have more positive significance than PVS^[2]。

mitogen-activated protein kinases (MAPK) chain is one of the important pathways in eukaryotic signal transmission network. It is widely distributed in the cytoplasm. It is an important signal transduction system that can transmit extracellular stimulation signals to the nucleus, thus causing cell biological response, and plays a key role in gene expression regulation and cytoplasmic function activities. The MAPK chain includes four basic signal transduction pathways: (1) extracellular regulated protein kinases 1/2 (ERK1/2) pathway, (2) p38 MAPK pathway, (3) c-Jun N-terminal kinases (JNK) (4) big mitogen-activated protein kinase 1 (BMK1 or ERK5) pathway^[1]。 Craniocerebral trauma is caused by mechanical damage caused by external force on the brain, resulting in local brain tissue damage, nerve cell death, and the release of various harmful chemicals, such as stress hormones, inflammatory mediators, free radicals, cytokines, etc., which then initiates a series of complex biological effects of nerve cells, resulting in cerebral ischemia, hypoxia, cerebral edema, neurological deficit and other secondary brain injuries. In recent years, many studies have shown that MAPK pathway is activated after craniocerebral trauma, and is involved in regulating various cellular stress responses after craniocerebral trauma, and is the main signaling pathway of cellular stress and injury response^[2,3]。 This paper briefly summarizes the role of MAPK pathway in the occurrence and development of craniocerebral trauma.

The surgical treatment of cerebrovascular disease has been attracting much attention. The first superficial temporal-middle cerebral artery (STA-MCA) vascular anastomosis was successfully performed by Yarsargil and Donaghy in 1967^[1]。 In the following decades, with the progress of treatment level, the role of cerebrovascular anastomosis in cerebrovascular diseases has attracted more and more attention, but its application value is still controversial. This article summarizes the related cerebrovascular diseases treated by vascular anastomosis, the improvement of anastomosis techniques and materials as follows.