Volume 32 · Issue 05 · 2016

Facial nerve protection has always been an important issue in the surgical treatment of vestibular schwannoma. With the advancement of microsurgical technique, the total resection of vestibular schwannoma has changed from extraordinary to ordinary, and the effective preservation of facial nerve function has gradually become the primary goal of surgical treatment. As the most important nerve structure around vestibular schwannoma, the facial nerve should be accurately assessed for its location, adjacency and morphology before surgery, whether by microsurgery or radiotherapy. Especially for large vestibular schwannoma, it is particularly important to consciously protect the facial nerve structure from damage during surgery^[1,2]。 At present, the anatomical preservation rate of facial nerve in vestibular schwannoma reported by many neurosurgical units at home and abroad has reached more than 90%, but the effective preservation rate of facial nerve function is not ideal. To change this situation, it is difficult to make new breakthroughs only by relying on microsurgery technology. Therefore, how to comprehensively use the existing medical means to further improve the facial nerve function retention rate of vestibular schwannoma is a problem that we should continue to pay attention to.

With the completion of the Human Genome Project, the intergenerational evolution of gene sequencing technology, and the progress of the Cancer Genome Atlas (TCGA) project, the current understanding of tumor-driven mutations is gradually deepening, requiring us to develop more sophisticated, effective, individual patient-specific treatment options. At the beginning of 2015, US President Barack Obama put forward the "Precision Medicine Plan", and the term precision medicine became the hottest keyword in the medical circles of all countries around the world. However, precision medicine is not a brand-new concept, but the integration and superposition of the original plan, giving a new goal. At present, there is no unified definition of its definition. In the field of tumor research, precision medicine mainly refers to the formulation of individualized treatment plans for patients based on personal genome sequencing information. Generally speaking, it is developed from "individualized diagnosis and treatment" combined with a new generation of genome sequencing technology.

To evaluate the quality of RNA samples since the establishment of the brain tumor bank of the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University for 5 years.

The brain tumor samples were collected from the Department of Neurosurgery, Tiantan Hospital, Capital Medical University between 2011 and 2015. Twenty samples were randomly selected each year (a total of 100 samples). The total RNA was extracted from tissues by using Trizol reagent, and the RNA purity, concentration, integrity, and GAPDH and ACTB reference gene expression levels in the samples were detected.

The sample qualification rates of RNA from 2011 to 2015 were 25%, 75%, 85%, 90%, and 100%, respectively. Most of the purity and integrity of the total RNA extracted from the samples in 2011 were poor. RNA had part of the degradation and could not effectively amplify the reference genes GAPDH and ACTB. The Ct value was significantly higher than the mean Ct value of the samples between 2012 and 2015 (P<0.01). The total ratio of A260/A280 of RNA extracted from the samples between 2012 and 2015 reached 1.8 to 2.1, the ratio of A260/A230 could reach more than 2.0, the integrity of RNA in most of the samples was better, and no degradation was observed. Eighty samples could be used to conduct the effective amplification of GAPDH and ACTB genes.

When conducting the experiment study of the RNA levels, using the samples of the storage time within 4 years is recommended, the quality detection of RNA should be conducted before using the tissue samples, and the sample quality should be monitored regularly each year. The quality evaluation should be conducted before leaving the sample bank.

To investigate the clinical application value of neuronavigation multimodal fusing (DTI and BOLD) combining intraoperative electrophysiological monitoring techniques in tumor surgery of brain motor areas.

From October 2014 to January 2015, 20 right-handed patients whose lesions were located near the brain motor areas admitted to the Department of Neurosurgery, Changhai Hospital, the Second Military Medical University were analyzed retrospectively. The patients received preoperative magnetic resonance diffusion tensor imaging (DTI) and blood oxygen level dependent-functional magnetic resonance imaging (BOLD-fMRI) examinations. The original data of white matter fiber tracts and BOLD data were obtained. The neural navigation multimodal fusion DTI, BOLD, anatomical images [brain magnetic resonance venography (MRV), if necessary], and the three-dimensional reconstruction were performed. The microsurgery was performed under the assisted navigation during the operation, and the anterior central gyrus, central sulcus, posterior central gyrus, and subcortical tracts were determined under the neural electrophysiological monitoring.

Of the 20 patients with motor area tumor, the lesions of 17 patients were resected, and 3 were resected subtotally. The intraoperative electrophysiological results were consistent with the preoperative DTI and BOLD reconstructed results. Postoperative pathological results: 9 patients had glioma (low-level 4 and high-level 5) and 11 had meningioma. The postoperative muscle strength of 15 patients did not have any change, 5 had transient hemiparesis. DTI showed that there was no obvious damage to the nerve tracts at 24 h after procedure. After being followed up for 2 weeks to 3 months, the patients were able to take care of themselves.

Neuronavigation multimodal fusing can accurately locate the motor function areas, and combined electrophysiological monitoring can compensate for the errors caused by the drift of the neural navigation. The peripheral adjacent tracks and functional areas were protected real timely during the operation in order to reduce the postoperative neurological dysfunction. The tumors were resected in a maximum degree within the safe range. In addition, the intraoperative electrophysiological monitoring and early postoperative DTI examination can predict the postoperative muscle strength and improve the postoperative quality of life of patients.

To investigate the application value of diffusion tensor imaging (DTI)-based neuronavigation combined with intraoperative neurophysiological monitoring in the adult brainstem glioma surgery.

The clinical data of 39 patients with brainstem glioma admitted to the Department of Neurosurgery, Xiangya Hospital, Central South University from December 2010 to December 2014 were analyzed retrospectively. Among them, 17 used Brainlab neuronavigation combined with intraoperative electrophysiological monitoring techniques (combined group), 22 used traditional imaging techniques and surgery (traditional group). The clinical efficacy of both groups were compared and analyzed.

Compared with the traditional group, the total tumor removal rate of the combined group was improved significantly (94% [16/17] in the combined group vs. 59% [13/22] in the traditional group;P<0.05); the shortened operation time (282.05± 81.37 min in the combined group vs. 337.18± 75.45 min in the traditional group;P<0.05); and the decreased perioperative mortality rate (0% in the combined group vs. 27% in the traditional group,P<0.05). The postoperative Karnofsky performance status (KPS) scores increased significantly (92.35± 13.00 in the combined group vs. 54.54± 41.60 in the traditional group;P<0.05). The progression-free survival time prolonged obviously (20.17± 5.66 months in the combined group vs. 9.63± 4.16 months in the traditional group;P<0.05).

In the treatment of adult brainstem gliomas, neuronavigation combined with intraoperative neurophysiological monitoring can improve the degree of tumor resection, reduce surgical trauma, decrease the postoperative disability and mortality, significantly improve the quality of life after procedure, and prolong the survival time.

To investigate the expression changes of Fascin-1 (FSCN1) protein in pituitary adenomas and to analyze its relationship between clinical features and prognosis.

Tissue microarray was used to construct 10 normal pituitary tissues and 212 pituitary adenomas. The pituitary adenomas were divided into invasive (n=97) and noninvasive pituitary adenomas (n=115) according to whether they were invasive or not. Leica BOND-Ⅲ system was used to detect the expression of FSCN 1 protein. The clinic data of 212 patients with pituitary adenoma were analyzed, and they were followed up by telephone.

The nuclear positive rate of normal pituitaries was 10.0% (1/10); the nuclear positive rate of pituitary adenomas was 34.9% (74/212), and the cytoplasmic positive rate was 20.8% (44/212). The nuclear positive rate of FSCN1 in the invasive group was 54.6% (53/97), that in the non-invasive group was 18.3% (21/115) (χ² = 30.65, P=0.004); the cytoplasmic positive rate of FSCN1 in the invasive group was 37.1% (36/97), and that in the noninvasive group was 6.9% (8/115) (χ² =29.09, P=0.000). In the FSCN1high expression group, the tumor recurrence rate of 67 patients was 22.4% (15/67). In the FSCN1 low expression group, the tumor recurrence rate of 145 patients was 7.6% (11/145) (χ²=9.3310, P=0.002).

The expression level of FSCN1 protein is closely associated with whether pituitary adenoma invasion or not. It is a candidate gene for predicting the pituitary adenoma recurrence.

To construct brain tumors and their surrounding anatomical structures using the multi-modality image data registration and fusion and three dimensional reconstruction method in order to provide guidance for brain tumor surgery.

Ten patients with brain tumor admitted to the Department of Neurosurgery, Yuquan Hospital, Qsinghua University from April 2015 to December 2015 were selected. Head CT and MRI were used to collect the data in patients with brain tumor. NeuroTech software was used to conduct registration and fusion and 3D reconstruction for image data.

The 3D structures of brain tumor, brain tissue, and blood vessel in 10 patients with brain tumor were reconstructed. They clearly revealed the anatomic relationship of tumor size, location, shape, and tumor and surrounding structures. They assisted in the design of the surgical incision and the selection of operative approach and tumor resection.

Using multi-modality medical image fusion technology can visually display the relationship between tumors and blood vessels, brain tissue, skull, and other tissues, provide a large amount of visual information, guide the design of incision of neurosurgery, choose the operative approaches, resect the tumors, and play roles in the aspect of protecting brain function and reducing postoperative complications.

To investigate the efficacy of microsurgery of brain stem solid hemangioblastomas under the techniques of nerve electrophysiological monitoring and temporary occlusion of feeding artery.

The treatment effect of microsurgery in 56 patients with brain stem solid hemangioblastoma treated at the Department of Neurosurgery, West China Hospital, Sichuan University from January 2005 to December 2014 were analyzed retrospectively. Of the 56 patients, 46 were treated via posterior median suboccipital approach, and 10 were treated with microsurgical treatment via extended far-lateral approach. All patients performed temporary occlusion of suspected blood supply artery for assisted tumor resection under the brainstem somatosensory evoked potential and motor evoked potential monitoring.

In 56 patients, the postoperative magnetic resonance examination confirmed that the tumors of 54 patients were resected totally, and 2 were resected neartotally. Two patients who were not resected totally stopped their operation because of electrophysiological monitoring showed significant changes, and accompanied by a significant decrease in heart rate during the introperative separation of tumors. The 56 patients were followed up for a mean of 25 months. During the follow-up period, preoperative neurological dysfunction of 45 patients was improved significantly, 9 patients did not have any improvement compared with before procedure, and 2 developed new neurological deficits. Two patients had tumor recurrence during the follow-up period. One of them the tumor was resected neartotally. The gene detection of the latter was identified as Lindau VonHippel (VHL) disease.

Nerve electrophysiological monitoring and temporary occlusion of blood supply artery may reduce the risk of microsurgical resection of brainstem solid hemangioblastoma, improve the total tumor resection rate, and significantly improve the prognosis of patients.

To summarize the clinical characteristics and surgical treatment strategies of frontal, temporal, and occipital lobe gliomas in non-functional areas.

From January 2009 to January 2013, the clinical data of 89 patients with glioma who had complete data and whose lesions located in frontal, temporal, and occipital lobe non-functional areas treated in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. The corresponding surgical strategies were selected according to preoperative imaging showed the location and size of the tumors and edema degree. The tumor tissues were maximally removed. Routine use of navigation and B-ultrasound localization during the operation, the gliomas were removed by using the yellow fluorescence microscope-assisted resection.

In 89 patients, the lesions of 49 patients were confined to the cortices, 11 were confined to the deep brain ventricles, and 29 invaded the ventricles and cortices at the same time. The lesions of 67 patients were confined to one lobe and 22 invaded a plurality of lobes. The postoperative pathology confirmed that the tumors of 12 patients were WHO grade I, 21 were WHO grade II, 29 were WHO grade III, and 27 were WHO grade IV. The postoperative MRI confirmed that 74 patients (83.1%) had total resection, 11 (12.4%) had subtotal resection, and 2 (2.2%) had near-total resection, and 2 (2.2%) had partial resection. The mean follow-up time after procedure was 30.0+ 3.6 months. The 2-year survival rate of WHO grade Ⅲ was 51.7% and that of WHO grade Ⅳ was 33.3%. Forty-one patients died during the follow-up period, including 21 (77.8%) with WHO grade IV, and their median survival time was 19.4 (11.5-30.2) months; 18 (62.1%) with WHO grade III, and their median survival time was 26.7 (19.7-36.5) months; 2 (9.5%) with WHO grade II, and none of them with WHO grade I died.

Under the guidance of the imaging, the surgical methods and resection range of frontal, temporal, or occipital lobe gliomas are helpful to improve the total resection rate and survival time of the patients..

To evaluate the safety and primary efficacy of BCNU-loaded biodegradable implants for the treatment of recurrent malignant gliomas.

From January 2011 to December 2012, 22 patients with recurrent malignant glioma treated at the Department of Neurosurgery, Sun Yat-sen University Cancer Center and the Department of Neurosurgeries of 5 hospitals in China were analyzed retrospectively. The BCNU-loaded implants were placed into the tumor cavities after surgical resection of gliomas. The adverse reactions of the patients within 28 d after procedure were documented in detail. Its safety was evaluated. The survival time and the efficacy of preliminary drug evaluation after placing the implants in patients were recorded.

A total of 22 patients received local sustained release chemotherapy. The gliomas of 12 patients were totally resected, 8 were subtotally resected, and 2 were partially resected. Three BCNU-loaded biodegradable implants were implanted in 3 cases, 6 were implanted in 3 cases, 8 were implanted in 4 cases, 9 were implanted in 3 cases, 10 were implanted in 3 cases, and 12 were implanted in 6 cases. At day 28 after implantation, 11 patients did not have other treatment, 8 received the chemotherapeutic drugs based on nitrosoureas or temozolomide chemotherapy, and 3 received both radiotherapy and chemotherapy. The most common adverse reaction of the implants was subgaleal effusion (n=9). Other adverse reactions included rash (n=2), thrombocytopenia (n=1), and erythrocytopenia (n=1). The mean follow-up time was 55 months. Twenty of 22 patients died and 2 were still alive up to the last follow-up. The median survival time of the 22 patients was 322 d (95% CI 173-471 d).

The BCNU-loaded biodegradable implants are well tolerated and safe. The agents have a tendency of prolonging the survival time of patients with recurrent malignant glioma. It is worth conducting phase III clinical trial to evaluate the efficacy.

Gliosarcoma is a rare malignant tumor of the central nervous system that was first proposed in 1895 by pathologist Stroebe. According to statistics, the incidence of gliosarcoma is less than 0.5% of all intracranial tumors^[1]。 Gliosarcoma consists of biphasic histology and has been confirmed to have two components: glial and sarcoma^[2]The glial component meets the World Health Organization (WHO) grade IV astrocytoma (glioblastoma multiforme) cytological criteria; The components of sarcoma are usually similar to fibrosarcoma, and sometimes their morphological manifestations are different from those of fibrosarcoma, such as osteosarcoma, chondrosarcoma, angiosarcoma or rhabdomyosarcoma. Due to the low incidence of both primary and secondary gliosarcomas, large sample prospective studies are difficult to conduct, so the current research on gliosarcomas is mainly limited to retrospective studies^[3]。 This study retrospectively analyzed the clinical data of 7 patients with cerebral gliosarcoma admitted to the Cancer Center of Beijing Millennium Monument Hospital affiliated to Capital Medical University from January 2010 to September 2015, which are now reported below and analyzed in combination with the literature.

To investigate whether β oscillatory neuron of subthalamic nucleus (STN) is associated with voluntary movement in Parkinson's disease (PD) and to provide the basis for clinical treatment.

Seventeen patients with PD treated with STN deep brain stimulation (DBS) at the Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University from April 2014 to August 2015 were analyzed retrospectively. The STN cell electrical activities and limb electromyograms on the opposite sides of surgery were collected at the same time using microelectrode and EMG recording techniques during the procedure. The patients were asked to perform 10 s interval of wrist extension movement. The movement was divided into 4 stages according to the movement process: the baseline, before the movement, movement, and after the movement. Single-unit analysis was used to investigate the mean firing rate (MFR) of neurons and the coefficient of variation (CV) of inter-spike intervals. Power spectral analysis was used to investigate the STN oscillatory neuron characteristics. Variance analysis and Bonfferoni test were used to investigate the changes of MFR and CV in different movement stages.

In 119 neurons, 38.7% (46/119) were accompanied by β oscillatory activity; their spectrums were 13-30 Hz (21.0±5.1 Hz). In the 46 neurons, 43.5% (20/46) were associated with movement, 26.1% (12/46) showed the desynchronization associated with movement, and 17.4% (8/46) showed the synchronization associated with movement. There were significant differences in the changes of discharge frequency during the movement compared with the baseline (all P<0.05). In addition, the movement-related neurons were mainly distributed in the middle-upper part of STN.

STN has β oscillatory neurons associated with movement. The changes of discharge frequency may participate in voluntary movement. The neurons associated with movement mainly distribute in dorsal flanking sensorimotor region of STN. It provides the basis for the choice of the best contacts in the DBS treatment of PD.

To investigate the safety and effectiveness of patients with idiopathic intracranial hypertension (IIH) syndrome complicated with cerebral venous sinus stenosis (CVSS) treated with stent angioplasty via jugular vein approach.

Twenty-seven patients with IIH complicated with CVSS treated with stent angioplasty via jugular vein approach at the Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University from July 2013 to September 2015 were analyzed retrospectively. Their clinical efficacy was observed.

The pressure differences at both ends of the stenosis were 14-32 mmHg (mean 18±14 mmHg) in 27 cases before treatment. The stents were successfully implanted in 26 cases. The venous sinus stenosis disappeared after procedure. The pressure difference at both ends of the stenosis was reduced to 0-1 mmHg. The treatment failed in 1 case and he was treated with balloon dilatation, but postoperative stenosis was not improved significantly. No intraoperative and postoperative complications associated with surgery occurred in this group. Twenty-seven patients were followed up for a mean of 9.5 months (3-19 months), 19 did not have any symptoms, and the symptoms of 7 cases were improved. More than a month after stenting, the papilledema of the patients was obviously improved. In addition to the improvement of postoperative visual acuity not obvious in 4 cases, others were improved at 1 month after procedure. Three months after procedure, 16 cases underwent CT venography. After 6 months, 10 patients were examined with DSA. They all showed that the stents were patent and no restenosis occurred.

Stent angioplasty via jugular approach for the treatment of patients with IIH complicated with CVSS may be a safe and effective method.

To investigate the clinical effect of descending hypoglossal branch-facial nerve anastomosis for severe facial paralysis after cerebellopontine angle (CPA) tumor surgery.

From October 2010 to February 2014, 17 patients with severe facial paralysis whose House-Brackmann (H-B) grades were 5-6 or without clear facial nerve anatomical reservation after CPA tumor surgery were treated with the descending hypoglossal branch-facial nerve anastomosis at the Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University. Their clinical efficacy was observed retrospectively.

After neuroanastomosis, no disability and death, no hoarseness, dysphagia and other neurological disorders were observed. In 17 patients, 15 (88.2%) were followed up for 6 to 53 months (mean 25). Facial nerve function H-B grade 2 was in 4 patients, grade 3 in 5 (33.3%), grade 4 in 5 (33.3%), and grade 5 in 1. One patient suffered ipsilateral tongue paralysis completely after procedure. The improvement of facial paralysis was most significant for orbicularis muscles, followed by the orbicularis oculi muscles, and the worst was the improvement of frontal muscles. All the patients benefited from the anastomosis. Although there was no significant improvement for patients with facial paralysis H-B grade 5, the patients felt that the dry eyes, the degree of redness and swelling reduced compare with before procedure.

Descending hypoglossal branch-facial nerve anastomosis can not only improve the facial nerve function in patients with severe facial paralysis in tumors of CPA regions, but also can avoid the influence on the hypoglossal nerve function.

To investigate the etiology, clinical manifestation, imaging features, and treatment methods of brainstem tethering syndrome.

From January 2010 to March 2014, the clinical data of 2 patients with brainstem tethering syndrome admitted to the Department of Neurosurgery, the Second Affiliated Hospital of Zhengzhou University were analyzed retrospectively and the literature was reviewed.

Two patients had meningocele and the history of simple meningoencephalocele resection. The clinical manifestations were central respiratory dysfunction (Ondin's curse), headache, and dizziness, respectively. The imaging results suggested that the brainstem tethering and ventricular dilatation. They were treated with the tethered cutting and ventriculo-peritoneal shunt respectively.

Brainstem tethering syndrome is a rare complication after meningocele surgery. Surgically releasing it and restoring the position of brainstem are the effective means of treatment. Brainstem tethering syndrome often complicates ventricular dilatation, if there is no intracranial hypertension or hydrocephalus signs of normal intracranial pressure, it does not need to be treated with shunt.

At present, China has entered an aging society, and the number of elderly patients with cerebral hemorrhage caused by hypertension has increased significantly. Due to the particularity of physiology and anatomy of this type of patients, as well as whether they take anticoagulants for a long time, and whether they are combined with other underlying diseases, their treatment methods vary from person to person. From January 2012 to June 2015, 186 patients with hypertensive intracerebral hemorrhage were treated in the Department of Neurosurgery of Beijing Yanhua Hospital, including 96 patients (44.6%) over 65 years old. The different treatment methods are reported below.

To investigate the biological function of differentially expressed genes of primary glioblastomas of isocitrate dehydrogenase 1 (IDH1) mutation.

A total of 69 patients with primary glioblastoma from Chinese Glioma Genome Atlas who received surgical resection and then received radiotherapy and alkylating chemotherapy between January 2005 and December 2009 were collected. After the extraction of tissue RNA, the whole genome microarray analysis was performed; after the extraction of tissue DNA, pyrosequencing was performed in order to detect the status of IDH1 gene mutation. The tissue samples were divided into either an IDH1 gene mutation type or an IDH1 wild type according to whether there was a point mutation or not. The RNA expression profile data of the samples were analyzed by using the BRB Array Tools. The differentially expressed genes were obtained between the 2 groups. Omics analysis software OmicsBean was used to conduct the biological function annotation and protein-protein interaction network analysis for differentially expressed genes of mutant wild-type IDH1 in two groups of cases.

In the 2 groups of samples of the IDH1 gene mutation type and the IDH1 wild type, there were significant differences in a total of 525 gene expressions. The 148 genes up-regulated in the expression level in the IDH1 gene mutation type primary glioblastomas mainly reflected the alterations of energy metabolism and protein metabolism after IDH1 mutation (such as tricarboxylic acid cycle and multiple amino acid metabolism), whereas the 377 genes down-regulated in the expression level were mainly involved in the cell adhesion, the interaction of extracellular matrix and receptors and other biological processes.

IDH1 mutation caused the changes in biological processes including energy metabolism, protein metabolism, and the expression levels of some cancer-related genes in gliomas.

To preliminary study the mechanism of artificial synthetic E-selectin inhibiting the proliferation of vascular smooth muscle cells in rats.

Ninety adult male SD rats were randomly divided into 3 groups: a control group, an operation group, and a treatment group (n=30 in each group). The right common carotid artery was made a longitudinal incision and interrupted suture in the operation group and the treatment group, and the control group did not make vascular incision and suture. Artificial synthetic E-selectin and the same amount of saline were injected into the femoral veins of the rats respectively in the treatment group and the operation group after vascular suture. On day 1, 3, 7, and 14 after procedure, ELISA was used to detect the concentrations of serum tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). The vascular tissue at the suture was taken. Western blot and RT-PCR were used to detect the protein level of NF-κB p65 and mRNA expression. Electrophoretic mobility shift assay was used to detect the NF-κB transcriptional activity. Immunohistochemical staining was used to detect the positive cell rate of proliferating cell nuclear antigen (PCNA).

The concentrations of serum TNF-α and IL-6 and the levels of NF-κB p65 protein and mRNA began to increase at day 1 after vascular suture in the operation group and the treatment group. They reached the peak at day 3, and they were still higher than those in the control group at day 7 (P<0.01), and the above indices in the treatment group were lower than those in the operation group over the same period. There were significant differences (P<0.01), and there were no significant differences among the 3 groups at day 14 (P>0.05). The NF-κB transcription activity in the operation group was higher than that in the treatment group at day 3 after suture (P<0.01). The PCNA positive cells began to express at day 3 after vascular suture in the operation group and the treatment group. The expression of PCNA positive cells in the control group was not obvious or no expression. There were significant differences among the 3 groups (P<0.05). They still expressed high at day 7 and 14 (P<0.01), while the expression of PCNA positive cells was lower than that in the treatment group over the same period (P<0.01).

Artificial synthetic E-selectin can inhibit the proliferation of vascular smooth muscle cells by inhibiting NF-κB activity.

To investigate the effects of histone deacetylase 6 (HDAC6) selective inhibitor tubacin on glioma cell proliferation, migration and movement, and apoptosis and its mechanism of action.

The human glioma U251 cell lines were used as the research objects, a blank control group (CON), a temozolomide (TMZ) positive control group, and a tubacin group were set up. MTT assay was used to detect the cell proliferation activity. Transwell experiment was used to detect the cell migration ability. The high content screening (HCS) technology was used to observe the cell trajectory. Flow cytometry and Western blot were used to detect the apoptosis rate and the related apoptosis protein expression. The DCFH-DA fluorescence staining flow cytometry was used to detect the levels of intracellular reactive oxygen species (ROS).

The results of MTT showed that the U251 cell reproductive capacity of the tubacin group was significantly lower than that of the CON group (P<0.05). Compared with the CON group, the cell migration and motility ability was decreased significantly in the tubacin group. There was significant difference (allP<0.05). The results of flow cytometry showed that the apoptosis rate was significantly increased in the tubacin group (P<0.05). The results of Western blot showed that the expression levels of Caspase-3 and Bax were increased significantly in the tubacin group compared with the CON group (allP<0.05), while the expression of Bcl-2 was decreased significantly (P<0.05). The results of ROS assay found that the ROS level increased significantly in U251 cells after the action of tubacin (P<0.05), and this effect of tubacin was dose-dependent.

Tubacin can inhibit glioma cell proliferation, migration, and motility, and promote its apoptosis. Its effect may be produced by inducing the cells to release ROS.

To detect the expression of thioredoxin-interacting protein (TXNIP) and its related apoptosis factors after subarachnoid hemorrhage (SAH) and to investigate the role and its mechanism of TXNIP in early brain injury after SAH.

A rat SAH model was induced by intravascular puncture. A sham operation group, a SAH group, a resveratrol intervention control group, and a resveratrol intervention group were set up. Immunofluorescence staining was used to observe the expression of neuronal TXNIP. The fluorescent TUNEL assay was used to detect cell apoptosis and TXNIP colocalization. Western blot was used to detect the expression changes of TXNIP, p-ASK-1, Caspase-3, Bax, and Bcl-2 at each time point before and after the intervention within 72 h after SAH. TUNEL assay was used to detect the cortical and hippocampal cell apoptosis before and after intervention, and the changes of behavior and brain edema were assessed before and after intervention at the same time.

The results of immunofluorescence staining showed that TXNIP was mainly expressed in neuronal cytoplasm. Fluorescent TUNEL assay found that there was colocalization between TXNIP and subcortical apoptotic cells. Compared with the sham operation group, TXNIP expression increased gradually at 12 h after SAH. The expression at each time point early after hemorrhage was higher than that of the sham operation group (all P<0.05). At the same time, the expression levels of p-ASK-1, Caspase-3, and Bax were increased, and the expression of Bcl-2 was decreased. There were significant differences (allP<0.05). After resveratrol intervention, TXNIP and p-ASK-1, Caspase-3, and Bax were downregulated (allP<0.05). The results of TUNEL assay showed that the apoptotic cells decreased after intervention (P<0.05). Behavioral score and cerebral edema were also improved (allP<0.05).

Early TXNIP expression began to increase after SAH. TXNIP might aggravate early brain damage after SAH through its proapoptotic effect, and resveratrol could improve brain cell death and the prognosis in rats by inhibiting TXNIP. The downregulation of the TXNIP expression might become a new treatment measure at early stage after SAH.

Female, 60 years old. He was admitted to hospital in November 2012 due to "headache for half a month and right limb weakness for 1 week". Physical examination: Conscious, right limb muscle strength grade IV, left limb muscle strength normal. There was no history of seizures. MRI of the skull revealed left occipitoparietal lobe lesions, showing spot nodular enhancement of different sizes, and obvious large edema around it (Figure 1)。 Proposed diagnosis of left occipital space-occupying lesion: astrocytoma or granulomatous inflammatory reaction? Microresection of the left occipital parietal lesion was performed. During the operation, the lesions were yellow granular, slightly hard in texture, with average blood supply and unclear boundaries with surrounding tissues. Postoperative pathology: Chronic inflammatory granuloma, suggesting the possibility of parasitic infection (Figure 2)。 Considering that the patient's hometown is an endemic area of schistosomiasis and has a history of exposure to infested water, the gold serological test and NP30 test of schistosomiasis were positive. 2 courses of treatment with oral praziquantel. After 3 months, CT scan of the head showed that the lesion disappeared and the edema clearly resolved. Final diagnosis: left occipital brain tumor type schistosomiasis. After 3 years of follow-up, the patient was generally in good condition.

Glioma is the most common intracranial tumor. Gliomas classified as grade III and IV by WHO are usually collectively referred to as high-grade gliomas. Grade III glioma is anaplastic glioma, which can be further divided into anaplastic astrocytoma, anaplastic oligodendroglioma and a mixture of the two; Grade IV gliomas were mainly glioblastoma (GBM)^[1]。 At present, the main treatment for patients with high-grade glioma is a combination of surgery, radiotherapy and chemoradiotherapy, but most patients still experience tumor progression or recurrence within a short time after the first treatment. The prognosis of patients with recurrent high-grade glioma is extremely poor. In the case of recurrent GBM, the average survival time of patients is 1 to 4.5 months^[2]。 In recent years, with the rapid development and cross-penetration of oncology, immunology and molecular biology, the research of tumor immunotherapy has made great progress, which brings new hope for the treatment of malignant tumor patients. Among them, immunotherapy has achieved exciting results in the treatment of recurrent high-grade glioma with its unique advantages^[3]。 This article reviews the progress in immunotherapy of recurrent high-grade glioma.

At present, surgical resection is still the first choice for the treatment of glioma, and its purpose is to remove the tumor lesion to the greatest extent, so as to reduce the clinical symptoms of patients and improve the quality of life of patients. At the same time, through surgery to obtain a clear pathological tissue diagnosis, for the next step of radiotherapy and chemotherapy to provide treatment basis. However, traditional craniotomy generally only performs preoperative localization according to the patient's clinical symptoms, signs and imaging examinations. During the operation, the tumor location is judged by anatomical landmarks, approximate location of the lesion, indirect signs of the lesion area, surgical field structure and doctor's experience, and exposed and removed as much as possible. For superficial lesions, it is relatively easy to locate and expose them, while for lesions with smaller volume, deeper location or unclear boundaries, especially gliomas involving functional areas, it is difficult to explore and it is impossible to accurately locate the overall contour of the lesion. Therefore, how to remove the lesions in the greatest range and effectively protect brain function has become an urgent problem to be solved in neurosurgery. At present, with the continuous research and development of emerging auxiliary technologies and wide clinical application, effective total resection of glioma has become possible. In this paper, the application of these new assistive technologies is reviewed.

With the development of medical technology and treatment methods, the survival probability of patients with severe craniocerebral injury has also increased. The prognosis of the state of consciousness plays an important role in the daily care of patients and the evaluation of the effectiveness of various treatments. The prognosis of patients with consciousness disorders is divided into four distinct states: death, vegetative state/unwakefulness syndrome (VS/UWS), minimally conscious state (MCS), and exit minimally conscious state (eMCS). These four different prognostic states can translate into each other, and the treatment options and home care options adopted for these four different prognosis are very different. This article summarizes the mortality, recovery rate and recovery degree of patients with consciousness disorders from the perspective of clinical manifestations.

The incidence rate of intracranial aneurysms is about 5% ~10%, and subarachnoid hemorrhage (SAH) caused by rupture of intracranial aneurysms causes about 60% of disability and mortality^[1,2]。 1937, Dandy^[3]The first surgical clipping of an intracranial aneurysm was performed, after which intracranial aneurysm clipping became the main treatment. In the 1990s, the emergence of electrolytic detachable coils ushered in a new era of intracranial aneurysm treatment^[4]。 Because coil embolization has a higher survival rate and fewer complications than surgical clipping, and with the advent of new technologies and materials such as balloon and stent-assisted embolization technology and 3D biogel-coated coils, it has gradually become the preferred treatment for intracranial aneurysms^[5]。 However, large, huge, wide-necked or fusiform aneurysms still pose great challenges for surgeons. For those giant aneurysms that are difficult to surgically clip, occlusion of the tumor-bearing artery is an earlier endovascular treatment technique, and its effect mostly depends on the patient's tolerance to the occlusion of the tumor-bearing artery. However, delayed cerebral ischemia complications will still occur in 4% to 15% of patients who pass the balloon occlusion test^[6]。 The stent-assisted coil embolization technique remains poor in the treatment of large intracranial aneurysms, and although it can be further improved with overlapping intracranial stents, the effect remains uncertain.

Melanocytic tumors of the central nervous system (CNS) have a low incidence and are classified into primary and metastatic tumors. The clinical symptoms of the disease are not specific, and the tumor is easily misdiagnosed due to the difference of melanin content and combined hemorrhage, its imaging manifestations are diverse. The overall malignant degree of tumor is high, the recurrence is easy after operation, the insensitivity of radiotherapy and chemotherapy, and the treatment effect is poor, which has always been a thorny problem in the field of neurosurgery^[1,2]。 This article reviews the general characteristics, clinical manifestations, pathological and imaging features of CNS melanocytic tumors, especially the latest advances in treatment, in order to improve the understanding of this disease.

Professor Wang Yutian, member of the Standing Committee of the National Committee of the Chinese People's Political Consultative Conference, vice chairman of Hainan Provincial Committee of the Chinese People's Political Consultative Conference, chairman of Hainan Provincial Committee of Jiusan Society, member of World Chinese Neurosurgery Association, editorial board of Chinese Journal of Neurosurgery, vice chairman of Beijing Wang Zhongcheng Medical Foundation, chairman of Neurosurgery Professional Committee of Hainan Medical Association and former president of Hainan People's Hospital, died at 16: 36 on April 17, 2016 at the age of 60 due to ineffective treatment.