Volume 32 · Issue 06 · 2016

Since 2001, The results of The international multicenter randomized clinical trial (RCT) on craniocerebral trauma have been published in The New England Journal of Medicine and The Lancet. These studies included intracranial pressure (ICP) monitoring in patients with craniocerebral trauma^[1]Decompressive craniectomy^[2]Cryogenic technology^[3,4]Ultra-high-dose glucocorticoids^[5]Calcium antagonist^[6]Progesterone,^[7,8]hemostatic agent^[9,10]etc., which has attracted the attention of neurosurgeons all over the world and greatly affected the global clinical treatment methods of craniocerebral trauma. At present, there is no obvious controversy about the RCT results of drug treatment for craniocerebral trauma. However, how should international evidence-based medical evidence such as ICP monitoring technology, decompressive craniectomy and hypothermia technology be interpreted scientifically, objectively and correctly? This article focuses on the interpretation of these evidence-based medical evidence, and uses it as a basis to standardize the clinical treatment strategies of craniocerebral trauma in China.

With the advancement of medical technology, the development of intraoperative imaging and navigation technology, the continuous update of visual magnification lighting equipment and precision surgical instruments, and the further understanding of anatomy and physiology, minimally invasive spinal surgery technology has developed rapidly, and surgeons have been able to complete operations that could only be completed by open surgery in the past through one or more tiny incisions. Minimally invasive spinal surgery can achieve minimally invasive nerve decompression, spinal stabilization and fusion, and correction of spinal deformities.

To investigate the surgical treatment and its efficacy of lipoma type tethered cord syndrome(TCS)in children.

The clinical data of 245 children with lipoma type TCS admitted to the Department of Neurosurgery, Chinese PLA General Hospital from January 2008 to January 2015 were analyzed retrospectively. According to the imaging findings, the 245 children were divided into four types: dorsal type, caudal type, chaotic type, lipo-myelomeningocele type. All the children were treated with microsurgery. Spina bifida neurological scale(SBNS)was used to evaluate the efficacy of surgical treatment. The follow-up time ranged from 6 to 60 months.

The total effective rate of 245 children with lipoma type TCS after procedure was 76.0%. Among all types of TCS, the effect of dorsal type was best, and then followed by caudal type, lipo-myelomeningocele type, and chaotic type. The effect of total resection(near total resection)group was better than the subtotal resection group.

Once the lipoma type TCS is diagnosed, early surgery can prevent or reduce the defecation dysfunction and both lower extremity dysfunction after the growth and development of children. Surgery should strive to total or subtotal resection of lipomas in order to complete release of the spinal cord and cauda equine. The main factors for influencing the operative effect and prognosis were the types of lipomas, timing of operation, preoperative symptoms, complete neurolysis or not, and having retethering or not.

To investigate the clinical classification and microsurgical treatment strategies of spinal dumbbell tumors.

From January 2008 to December 2014, the clinical manifestations and imaging features of 124 patients with intra-and extra-spinal tumors resected by microsurgery at the Department of Neurosurgery, Tianjin Medical University General Hospital were analyzed retrospectively."Four-zone tumor typing method"was established to guide the choice of surgical approaches. Fifty-three patients were treated via the simple posterior midline laminectomy approach, 47 via the semi-laminectomy approach, 11 via the combined anterior and posterior approach, 8 via the lateral cervical approach, and 5 via the far lateral approach, in which 89 patients were treated with stage 1 spinal internal fixation or laminoplasty.

In 124 patients with intra-and extra-spinal tumors, 121 were removed totally, 2 were removed near totally, and 1 was removed partially. Postoperative pathology suggested that 77 patients had neurilemmoma, 15 had neurofibroma, 11 had angiolipoma, 8 had lymphoma, 5 had angioma, 3 had meningioma, 3 had ganglioneuroma, 1 had cavernous hemangioma, and 1 small cell malignant tumor. The main bodies of the cervical tumors were located in the C area in 31 cases, in CB area in 8 cases, in CD area in 13 cases, in CBA area in 6 cases, in CDA area in 3 cases, in CABD area in 1 case, and the thoracic and lumbar tumors were located in C area in 62 cases. No surgical infection, cerebrospinal fluid leakage, and paraplegia patients were observed. They were followed up for 6 months to 3 years after procedure(mean 32.6+ 4.8 months). Postoperative limb motor function and sensory disturbance were improved significantly in 88 cases. There were no significant changes in 6 cases. The patients with new tumor after operation or regional expansion of sensory disturbance were in 3 cases.

The clinical classification of spinal dumbbell tumors has an important guiding significance for the selection of operative approaches. According to the classification of tumors, using the corresponding operation method may conduct tumor stage 1 total resection. Patients with bone destruction or intraoperative resection of small joints should perform spinal fixation simultaneously in order to maintain the stability of spines.

To investigate the change characteristics of diffusion tensor imaging(DTI)parameters value in patients with cervical intraspinal tumor and its relationship with spinal cord function and prognosis.

Twenty-two patients with cervical intraspinal tumor(test group)treated with surgical resection in Department of Neurosurgery, Fuzhou General Hospital of Nanjing Military Command, Fuzhou Clinical Medicine School of the Second Military Medical University between February 2014 and January 2015 were selected. Cervical spinal cord MRI conventional sequences and DTI scans were performed at 3 days before procedure and 1 month after procedure respectively. At the same time, 22 healthy subjects were selected as healthy control(HC)group. The values of fractional anisotropy(FA)and apparent diffusion coefficient(ADC)of each cervical spinal cord level were measured in both groups. The whole cervical spinal cord was divided into 3 areas, the tumor head area, tumor area, and tumor tail area, and the FA and ADC values of the 3 areas were calculated. Differences of FA and ADC between two groups and their relationship with McCormick grading were compared and analyzed.

The FA values of the 3 areas of cervical spinal cord of the test group were significantly lower than those of the HC group(all P<0.05), and the ADC values were significantly higher than those of the HC group(allP<0.05). There were significant differences in FA and ADC values among each area in test group(allP<0.05). The FA values in the tumor area and tumor head area at 1 month after procedure were increased significantly compared with those before procedure(allP<0.05). The improvement rate of spinal cord function in the group of increased FA value in tumor head area after procedure was significantly higher than that of the decreased group(P<0.05). The sensitivity of the change of postoperative FA values for predicting spinal cord function and prognosis in tumor head area was 88%.

The DTI index of cervical cord in patients with cervical intraspinal tumor may change significantly in the whole range of the cervical spinal cord. These changes after procedure may show different degrees of recovery in the different regions of cervical spinal cord, and it is associated with the improvement of cervical spinal cord function. The change of FA value in tumor head area after procedure is a rather sensitive predictor for spinal cord function and prognosis.

To investigate the clinical features, microneurosurgery methods and efficacy of microneurosurgical treatment of neurenteric cyst in high anterior cervical cord.

From March 2011 to August 2015, the clinical data of 12 patients with neurenteric cyst in high anterior cervical cord resected two-partly via posterior cervical approach at the Department of Neurosurgery, Guizhou Provincial People's Hospital were analyzed retrospectively. Their clinical manifestations, MRI features, and surgical efficacy were summarized.

The neurenteric cysts in 12 patients achieved subtotal resection and they were all confirmed by the pathological diagnosis. The neural function recovered well in 12 patients. No complications occurred. In 10 of them the symptoms disappeared completely, and the symptoms were improved significantly in 2 cases. The follow-up time ranged from 6 to 51 months(mean 31.2 months). No recurrence of neurenteric cyst was observed.

Neurenteric cyst in high anterior cervical cord has typical clinical manifestations and MRI characteristics. The disease develops rapidly and should be diagnosed and operated as soon as possible. Reasonable evaluation of surgical difficulty and dividing the cyst resection into two parts may improve the degree of the cyst wall resection and obtain a good prognosis.

Consciousness disorders mainly include vegetative states and microconscious states. In recent years, it has been found that spinal cord stimulation (SCS) can promote awakening in patients with consciousness disorders^[1,2]。 However, the current clinical stimulation parameters, especially the frequency selection, are very different, and the curative effects are different, and they are all based on clinical experience and have no objective basis. Kanno et al.^[3]A summary of 214 patients treated with SCS in a persistent vegetative state with a stimulation frequency of 70 Hz, of which 54% achieved a good clinical improvement. Some studies have also shown that the stimulation frequency of 5 Hz can improve cerebral blood flow in patients with micro-consciousness, cause upper limb muscles to twitch, and contribute to their functional neurological rehabilitation^[4]。 Because the mechanism of action of SCS in the treatment of consciousness disorders is not clear at present, it is impossible to determine the effect of the change of stimulation frequency on brain function clinically.

solitary plasmacytoma is a malignant tumor caused by monoclonal proliferation of plasma cells. It is classified as a subtype of plasma cell tumor in WHO classification, including solitary extramedullary plasmacytoma (SEP) and solitary plasmacytoma of bone (SPB)^[1]。 Solitary plasmacytoma occurring in the spinal canal is extremely rare. The disease has an acute onset and rapid development, with progressive aggravation of symptoms and even paraplegia. Intraspinal solitary plasmacytoma has rarely been reported. This study retrospectively analyzed the clinical data of 5 patients with solitary plasmacytoma in the intraspinal canal admitted to the Department of Neurosurgery of the Third Hospital of Hebei Medical University from June 2002 to December 2014, which are reported below.

Dumbbell-shaped spinal canal tumor is difficult to resect because it involves multiple sites in the spinal canal, intervertebral foramen and outside the spinal canal at the same time^[1,2]。 Eden^[1]According to the characteristics of tumor growth, dumbbell-shaped spinal canal tumors are divided into four types. Among them, Eden 4 dumbbell-shaped spinal canal tumors are mainly originated from the intervertebral foramen and developed outside the spinal canal. The main body of the tumor is located outside the spinal canal but there is no tumor in the spinal canal. retroperitoneal dumbbell lumbar spinal schwannomas (RDLSSs) belong to Eden type 4, and their growth pattern is that the tumor protrudes to the retroperitoneal space through one lumbar intervertebral foramen. It is precisely because the main body of RDLSSs tumor is located in the retroperitoneal space that the traditional posterior median (or paramedian) translaminar approach is not only difficult to resect the tumor, but also traumatic to surgery. In recent years, with the development of endoscopic microinvasive technology, endoscopic resection of spinal canal tumors has been gradually carried out^[3]。 From June 2013 to December 2014, 3 cases of RDLSSs tumors were resected by laparoscopic trans-retroperitoneal anterior approach in the Department of Neurosurgery, Nantong University Affiliated Hospital, and satisfactory results were achieved.

To investigate the effect of long-term mild hypothermia therapy on immune function and its prognostic significance in patients with acute severe brain injury.

From January 2014 to August 2015, 58 patients with severe brain injury admitted to the Intensive Care Unit, the Second Affiliated Hospital of Wenzhou Medical University were collected. They were randomly divided into either a mild hypothermia group(n=32)or a normal temperature group(n=26). Serum immunoglobulin IgA, IgM, IgG content and T cell subsets CD3⁺ , CD4⁺ , CD8⁺ , and CD4⁺ /CD8⁺ levels of both groups were detected on admission at day 1, 3, 5, and 14 after procedure. At the same time, its complications and mortality rate at day 14 were observed.

Compared with before procedure, the postoperative IgA, IgM, and IgG levels were decreased in both groups of patients after procedure. The IgG level of the normal temperature group was decreased significantly at day 14 after procedure(P=0.032); the IgM and IgG levels of the mild hypothermia group were significantly higher than those of the normal temperature group over the same period(P=0.049, P=0.046). Compared with before procedure, CD3⁺ and CD4⁺ were decreased after procedure in both groups, CD3⁺ was decreased significantly at day 3 after procedure in the normal temperature group(P=0.010), and CD4⁺ was decreased significantly at day 5(P=0.037). Compared with before procedure, CD3⁺ and CD4⁺ of the mild hypothermia group were decreased at all time points, but there were no significant differences(all P>0.05). The level of CD8⁺ was increased slightly in both groups after procedure, but compared with before procedure, there was no significant difference(all P>0.05). At day 14 after procedure, the levels of CD4⁺ /CD8⁺ were decreased significantly in the normal temperature group(P=0.002). There was no significant difference in the incidence of common complications between the 2 groups(P>0.05), and the mortality of the normal temperature group at day 14 was significantly higher than that of the mild hypothermia group(P=0.045).

Long-term mild hypothermia therapy stabilized and improved the humoral and cellular immunity in patients with severe craniocerebral injury, reduced the mortality at day 14, and did not have any serious complications.

To investigate the dynamic changes of serum vascular endothelial growth factor(VEGF), angiopoietin-1(Ang-1)and granulocyte colony stimulating factor(G-CSF)in patients with acute traumatic brain injury(TBI)(within 14 days)and their effects on the prognosis.

From December 2014 to May 2015, 54 patients with TBI met the inclusion criteria, completed the follow-up, and admitted to the Department of Neurosurgery, Tianjin Medical University General Hospital and the Department of Neurosurgery, Binhai Hospital, Tianjin Medical University General Hospital were collected. The levels of serum VEGF, Ang-1, and G-CSF were detected at day 1, 4, 7 and 14, respectively after TBI. They were compared with 39 healthy volunteers(control group), their changes were analyzed, and they were divided into either a good outcome group([Extended Glasgow outcome score]GOSE >5)or a poor outcome group(GOSE ≤5)according to GOSE after 6 months follow-up. The effect of the changes of VEGF, Ang-1 and G-CSF in acute phase on TBI was analyzed.

The expression levels of VEGF, Ang-1, and G-CSF in acute TBI showed an increasing trend compare with the healthy control group(all P<0.05). The serum levels of VEGF, Ang-1, and G-CSF at day 1, 4, 7, and 14 of the good outcome group were higher than those of the poor outcome group. There were significant differences in the same time points between the 2 groups(allP<0.05). Multivariable logistic regression analysis indicated that the levels of serum VEGF and G-CSF at day 1, serum VEGF, Ang-1, and G-CSF at day 4, serum VEGF and Ang-1 at day 7(P<0.05)after TBI were the independent risk factors for influencing prognosis.(allP<0.05).

The serum VEGF, Ang-1, and G-CSF have played a positive role in the repair of brain damage in acute phase TBI and the repair of blood-brain barrier. The high expression levels of serum VEGF, Ang-1, and G-CSF are conducive to the prognosis and outcome of the injury. It may become an important marker for determining the prognosis of TBI.

To investigate the risk factors for postoperative secondary hydrocephalus in patients with severe and most severe craniocerebral injury.

The clinical data of 144 patients with severe and most severe craniocerebral injury admitted to the Department of Neurosurgery, General Hospital of Ningxia Medical University from June 2010 to December 2013 were analyzed retrospectively. Univariate analysis was used to examine the relationship between the patients’ age, gender, pre/postoperative Glasgow Coma Scale(GCS), site of injury, pre/postoperative intraventricular hematocele, pre/postoperative aqueduct of midbrain and ambient cisterna structure, postoperative large area cerebral infarction, postoperative intracranial infection, postoperative intracranial pressure, as well as the postoperative lumbar puncture and the secondary hydrocephalus, and multivariate logistic analysis was further conducted to investigate the influencing factors of hydrocephalus after procedure.

The patients with low GCS during the perioperative period(before procedure: P=0.041; after procedure: P=0.039), intraventricular hematocele(before procedure: 0.027; after procedure: 0.039), injury site near skull base(P=0.042), structures of ambient cisterna and aqueduct of midbrain not clear(before procedure: P<0.001; after procedure:P<0.001), postoperative massive cerebral infarction(P=0.031), and postoperative intracranial infection(P=0.027)were the risk factors for secondary hydrocephalus after procedure, and postoperative reduction of intracranial pressure(P=0.001)and early lumbar puncture(P<0.001)were its protective factors. Compared with the patients of the non-lumbar puncture group, postoperative early lumbar puncture could reduce the incidences of acute hydrocephalus(P=0.026)and chronic hydrocephalus(P=0.033)of this kind of craniocerebral injury after the procedure, and there was significant difference in the incidence of hydrocephalus between the patients of both groups.

The patients with severe and most severe craniocerebral injury who have the low GCS during the perioperative period, preoperative and postoperative intraventricular hematocele, injury site near skull base, structures of the ambient cisterna and aqueduct of midbrain unclear, massive cerebral infarction after procedure, and postoperative intracranial infection are prone to hydrocephalus after procedure. While timely and effectively reducing intracranial pressure and releasing the bloody cerebrospinal fluid after procedure may reduce the occurrence of postoperative hydrocephalus.

To investigate the efficacy of different methods for reconstruction of the skull base of open craniocerebral injury combined with the base of anterior cranial fossa fracture.

The data of 46 patients with skull base reconstruction admitted from October 2009 to October 2014 were studied retrospectively. They were divided into either an observation group(n=21)or a control group(n=25)according to the ways of skull base reconstruction. The observation group was repaired with"sandwich"therapy; while the control group only used artificial dura or direct suture of tendon membrane for reconstruction. The complications such as postoperative cerebrospinal fluid leakage, intracranial infection, meningoencephalocele, and reject reaction of both groups were observed.

The patients were followed up for 3 to 36 months(mean 15.8). Of the 21 patients in the observation group, only 1 occurred cerebrospinal fluid leakage. They were cured after treatment. No complications, such as intracranial infection and meningoencephalocele were observed. The incidence of complications was 4.8%(1/21). Of the 25 patient in the control group, 8 occurred cerebrospinal fluid leakage, including 5 cases complicated with intracranial infection. They were cured after treatment. Two patients had meningoencephalocele. The incidence of complications was 40.0%(10/25). There was significant difference in the incidence of complications between the 2 groups(P<0.05).

In the emergency operation for open craniocerebral injury combined with the factures of base of anterior cranial fossa, performing"sandwich"therapy for skull base reconstruction may effectively control the complications, such as intracranial infection and cerebrospinal fluid leakage, and improve the prognosis of patients.

To investigate the treatment effect of continuous lumbar cerebrospinal fluid drainage(CLCFD)on patients with cerebrospinal fluid leakage after severe craniocerebral injury operation.

Fifty-two patients with postoperative cerebrospinal fluid leakage following severe traumatic brain injury admitted to the Intensive Care Unit, Qinghai Provincial People's Hospital from January 2014 to December 2014 were enrolled. According to the different treatment methods, the 52 patients were divided into either a routine lumbar puncture group(n=26)or a CLCFD group(n=26). The differences of the stop time of cerebrospinal fluid leakage, the clinical cure rate within 14 d, and the intracranial infection rate were compared in patients between the 2 groups.

The stop time of cerebrospinal fluid leakage of the CLCFD group and the routine lumbar puncture group was 6.3±1.4 d and 12.2±2.1 d respectively(P<0.001). There was significant difference between the 2 groups. The cure rates of the CLCFD group and the routine lumbar puncture group within 14 d were 92%(24/26)and 77%(20/26)respectively. There was significant difference between the 2 groups(P<0.001). One patient(4%)had intracranial infection in the CLCFD group, and 8(31%)had intracranial infection in the routine lumbar puncture group. The incidence of intracranial infection of the CLCFD group was significantly lower than that of the routine lumbar puncture group(P<0.001).

Using early CLCFD for the treatment of postoperative cerebrospinal fluid leakage following severe traumatic brain injury may shorten the duration of cerebrospinal fluid leakage in patients, improve the clinical cure rate within 14 d, and decrease the incidence of intracranial infection. Its clinical efficacy is significantly superior to releasing cerebrospinal fluid of conventional lumbar puncture.

Traumatic posterior cranial fossa epidural hematoma in children is relatively rare, accounting for 0.1% ~0.3% of craniocerebral trauma and 1.2% ~12.9% of epidural hematoma^[1,2,3]。 The clinical signs and symptoms of traumatic posterior fossa epidural hematoma are associated with the compression of important structures of the posterior fossa, but their manifestations are atypical in the pediatric population, easily missed, and the disease progresses rapidly and can be life-threatening^[3]。 This study retrospectively analyzed the clinical data of 47 children with traumatic posterior fossa epidural hematoma admitted to the Department of Neurosurgery, Yuying Children's Hospital, the Second Affiliated Hospital of Wenzhou Medical University from January 2010 to August 2015, and summarized their clinical characteristics and treatment options.

s To investigate the distribution characteristics of pathogenic bacteria of nosocomial infection and the drug resistance of common pathogenic bacteria in critically ill patients in neurosurgery and to provide the basis for prevention of infection and empirical antimicrobial therapy in critically ill patients in neurosurgery.

From January 2009 to June 2015, the clinical data of critically ill patients who admitted to the Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University after neurosurgery were analyzed retrospectively. The types of bacterial isolates and drug resistance were summarized.

A total of 4 148 bacterial strains were isolated, including Gram-negative bacteria 3 184 strains(76.8%), Gram- positive bacteria 964 strains(23.2%). The proportion of top 6 strains as follows: Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter baumannii, Klebsiella pneumoniae, Steotrophomonas maltophilia, and Escherichia coli. The sources of strains: sputum samples accounted for 84.2%, cerebrospinal fluid accounted for 4%, and others accounted for 11.8%. The resistance rates of Pseudomonas aeruginosa and Acinetobacter Bauman to a variety of antimicrobial agents were high. The resistant rates of Staphylococcus aureus to vancomycin, linezolid, teicoplanin, fusidic acid were <10%.

The bacterial infection is mainly the pulmonary infection in critically ill patients in neurosurgery, followed by intracranial infection. Gram-negative bacteria are the main pathogenic bacteria, and their drug resistance is also higher.

To analyze the morphological and hemodynamic characteristics of unruptured posterior communicating artery aneurysms(PCoA)with oculomotor nerve paralysis.

Seventy patients with unruptured single PCoA aneurysm admitted to the Department of Neural Interventional Radiology, Beijing Tiantan Hospital, Capital Medical University from January 2014 to June 2015 were studied retrospectively. According to their main clinical symptoms, they were divided into 3 groups: asymptomatic group(including mild headache and dizziness), oculomotor nerve palsy group, and other clinical symptom group. The numerical simulation analysis was conducted for the individualized three dimensional DSA images of patients. The differences of shape and hemodynamic parameters in each group were compared.

(1)The mean diameter to neck ratio of the oculomotor nerve palsy group was 1.75±0.46. It was higher than 1.15±0.44 of the asymptomatic group and 1.20±0.42 of the other clinical symptom group. There were significant differences(P<0.01), and there were no significant differences in the side wall/bifurcation type, having daughter blebs or not, maximum diameter, neck width, surface area and volume among the 3 groups(P>0.05).(2)The mean wall shear stress(WSS)in the oculomotor nerve palsy group was 0.48±0.21. It was lower than 0.68±0.24 of the asymptomatic group and 0.82±0.22 of the other clinical symptom group. There was significant difference(P<0.01). The median(quartile range)low WSS area(LSA)percentage in the oculomotor nerve palsy group was 3.77%(1.48%, 27.16%). It was higher than 0.15%(0.00%, 1.07%)of the asymptom group and 0.03%(0.00%, 0.44%)of the other clinical symptom group. There were significant differences(P<0.01). There were no significant differences in oscillatory shear index(OSI)among the 3 groups(P=0.420).

Unruptured PCoA aneurysms with oculomotor nerve palsy have high dome to neck ratio and low WSS. It may be a high-risk type in unruptured PCoA aneurysms.

Chordoid glioma is a rare intracranial tumor with WHO grade II, most of which originate in the third ventricle. This designation was first proposed by Brat et al. in 1998^[1,2]。 This type of tumor is more common in women, with a male-to-female ratio of 1: 2, and is more common in middle-aged people aged 30-60^[3]。 The name of the tumor is derived from its own specific histological manifestations, namely the cord-like arrangement of tumor epithelioid cells under the light microscope and the positive response of glial fibrillary acidic protein (GFAP) in immunohistochemistry^[4,5]。 There are few literature reports about this disease at home and abroad. So far, about 81 cases have been reported internationally, and only a few cases have been reported in China^[6,7]。 This article retrospectively analyzed 4 patients with chordoid glioma admitted to the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University from January 2014 to December 2015, and analyzed and summarized their clinical data, imaging, pathological characteristics, treatment methods and prognosis factors.

The surgical treatment of many neurosurgical diseases requires craniotomy through the frontal base approach. In order to ensure the exposure of the surgical field, the frontal sinus is inevitably opened during the operation. For some patients with developed frontal sinuses, it is even necessary to open the frontal sinus wall in a large area. In order to ensure the integrity of the sinus wall and avoid postoperative cerebrospinal fluid leakage, bone wax is routinely used to reconstruct the frontal sinus wall. Most patients did not have any discomfort after operation, but a few patients may develop frontal sinus and nearby scalp infection and sinus tract formation after operation. From July 2008 to July 2014, 14 patients who underwent frontal craniotomy and intraoperative frontal sinus opening and bone wax closure, and postoperative frontal sinus and scalp infection and sinus tract formation were treated in the Department of Neurosurgery of Henan Provincial People's Hospital. The management experience is introduced as follows.

s To construct CD and VP22-CD genetically engineered vectors and to investigate their killing effects on glioma cells in vitro.

CD and VP22 gene segments were obtain using polymerase chain reaction(PCR). The obtained gene fragments were inserted into pEGFP-N1 vectors using in-fusion gene cloning method. CD and VP22-CD gene engineering vectors were constructed. The constructed gene engineering vectors were transfected into the glioma cells C6 and U87 cells using the liposome transfection method, and the transfection efficiency was observed through in vitro light microscope and fluorescence microscope. The kill rate of glioma cells after transfection was assessed after adding the prodrug 5-fluorocytosine using MTT colorimetric method.

(1)CD gene or VP22-CD fusion gene was inserted into the pEGFP-CD vectors, constructing and obtaining pEGFP-CD and pEGFP-VP22-CD vectors.(2)The pEGFP-CD and pEGFP-VP22-CD vectors were transfected into C6 or U87 glioma cells. The transfection rates were 2.5% and 3.7%, 2% and 4.1%, respectively.(3)Transfection of pEGFP-CD or pEGFP-VP22-CD vectors in the C6 or U87 cells and after adding prodrug 5-fluorocytosine, the survival rates were 30.36±0.63% and 11.75±1.01%, 28.78±3.62% and 18.26±2.27%, respectively. Compared with the transfection of pEGFP-N1 group, there was significant difference(all P<0.05).(4)After adding prodrug 5-fluorocytosine in C6 or U87 cells, There was significant difference between the transfection of pEGFP-VP22-CD group and the transfection of pEGFP-CD group(allP<0.05).

The CD/5-FC system has significant killing effect and bystander effect on the malignant glioma cells in vitro, and shuttle protein VP22 can further promote the killing effect of the system on cells.

To investigate the distribution of the cell cycle alteration and cell migration as well as infiltrating growth process and related genetic changes in each grade and each molecular subtype of gliomas.

A total of 300 glioma specimens(WHO grade Ⅱ-Ⅳ)in Chinese Glioma Genome Atlas(CGGA)were collected. Its tissue RNA and DNA were extract respectively. Sanger sequencing was used to detect the mutation status of PTEN, p53, and TERT promoter. The expression levels of MET and matrix metalloproteinase 9(MMP-9)were derived from whole-genome RNA microarray expression profile. The distribution differences of the mutations of PTEN, p53, TERT promoter and high expression of MET and MMP-9 were compared in each level and each molecular subtypes of glioma.

(1)In WHO grade Ⅱ, Ⅲ and Ⅳ, the mutation frequencies of PTEN were 2.8%(2/72), 5.0%(1/20), and 23.0%(20/87), respectively; the mutation rates of p53 were 28.0%(21/75), 10.0%(2/20), and 20.7%(18/87), respectively; the mutation rates of TERT promoter were 30.2%(26/86), 47.1%(8/17), and 46.8%(29/62), respectively; the incidences of MET high expression were 28.9%(35/121), 33.3%(17/51), and 37.5%(48/128), respectively; and the high expression rates of MMP-9 were 3.3%(4/121), 39.2%(20/51), and 59.4%(76/128), respectively. There were significant differences in each grade of gliomas between the mutation rate of PTEN and the high expression rate of MMP-9(all P<0.01).(2)The mutation rates of PTEN in the proneural type, neural type, classical type and molecular type of mesenchymal glioma were 1.9%(1/52), 12.5%(4/32), 15.0%(3/20), and 20.0%(15/75), respectively; the mutation rates of p53 were 34.0%(18/53), 6.1%(2/33), 40.0%(8/20), and 17.1%(13/76), respectively; the mutation rates of TERT promoter were 37.5%(21/56), 34.5%(10/29), 31.3%(5/16), and 45.1%(23/51), respectively; the MET high expression rates were 25.6%(21/82), 34.5%(19/55), 28.9%(11/38), and 40.0%(38/95), respectively; the MMP-9 high expression rates were 9.8%(8/82), 1.8%(1/55), 44.7%(17/38), and 68.4%(65/95), respectively. There were significant differences in the mutation rates of PTEN and p53, and the MMP-9 high expression rates among each molecular subtype of glioma(allP<0.05).

The mutation rate of PTEN and the high expression rates of MMP-9 were associated with the malignant degree of gliomas. The differences of the mutation rates of PTEN and p53, and the high expression rates of MMP-9 in each molecular subtype of gliomas suggested that they could represent the molecular pathologic features of the specific molecular subtypes of gliomas.

To observe effect of microRNA-218(miR-218)targeting SOX5 on the growth and invasiveness of glioblastoma cells.

U87 glioma cell lines were cultured, and they were divided into a control group, a nonsense sequence group and a miR-218 mimics transfection group. Forty glioma tissue specimens and 35 normal brain tissue samples were selected. The biological information method and the luciferase report system were used to verify that SOX5 was the direct acting target of miR-218. The effect of miR-218 on mRNA and protein expression of SOX5 in U87 cells, glioma tissue and their normal brain tissue were detected by RT-PCR and Western blot. After overexpressing miR-218 in U87 cells, the changes of U87 cell phenotype were detected by using the MTT experiment and Tanswell experiment.

Compared with the control and the nonsense sequence groups, the relative expression quantity of miRNA-218 increased about 42.23 times in the miRNA-218 mimics transfection group. The results of MTT assay showed that the growth of glioma cells was inhibited significantly after overexpreesing miRNA-218. The cell proliferation rate of at day 5 was only 49.2%. The results of Transwell assay showed that the number of cells passing through the Transwell chambers was 13.0±2.1. It was lower than 35.0±2.3 and 32.0±3.1 in the control and the nonsense sequence groups(all P<0.05). The biological information predicted that the SOX5 was one of the target genes of miR-218. UTR contained the binding site of miR-218 in SOX5 3′. The dual luciferase assays indicated that SOX5 was the direct acting target of miR-218. After overexpressing miR-218, RT-PCR and Western blot showed that the expression of SOX5 mRNA and protein in the miR-218 mimics transfection group was significantly lower than that the control and the nonsense sequence groups. There was significant difference(P<0.01). After silencing SOX5, the results of the MTT assay showed that the cell increment rate of the siRNA-SOX5 group at day 5 of cell culture was only 51.0% in the siControl group. The Transwell assay analysis showed that the number of cells passing through Transwell chambers in the siRNA-SOX5 group was 12.0±1.3, and it was lower than 23.0±2.0 in the siControl group(P<0.05).

SOX5 is the target gene of miR-218 and it was negatively regulated by it. miR-218 may play an important role in pathogenesis of glioma through targeting SOX5.

At present, it is believed that chordoma originates from the residual chorda tissue of the embryo, and mostly occurs in the axial bone^[1]。 35% of chordomas were located at the junction of the sphenoid and occipital bones, 55% were located in the sacrococcygeal region, and the remaining 10% were located elsewhere in the spine^[2]。 For skull base chordoma, surgery combined with radiotherapy is generally recommended, but the efficacy is not satisfactory, and the 5-year progression-free survival rate is only 50.8%^[3]with a median survival of 6.29 years^[4]。

Some severe patients, such as spontaneous cerebral hemorrhage, severe craniocerebral injury, septic shock patients, etc., have lower than normal levels of glucocorticoids in the early stage of the disease, so some scholars have put forward the concept of critical illness-related corticosteroid insufficiency (CIRCI)^[1]。 CIRCI is defined as insufficient activity of cellular glucocorticoids, which is difficult to adapt to the needs of severe diseases. It is manifested by insufficient downregulation of pro-inflammatory transcription factors mediated by glucocorticoids and their receptors, which leads to a continuous increase of pro-inflammatory mediators. Therefore, the research of CIRCI is helpful to judge the patient's condition and prognosis, and further guide clinical treatment.

normal pressure hydrocephalus (NPH) was first reported as the first curable form of dementia. It wasn't until 1963 that Hakim and Adams first named the disease NPH. In the first decades, the treatment of cerebrospinal fluid shunt was not favorable due to backward shunt technology, low clinical success rate and frequent complications. In recent years, with the improvement of diagnosis and treatment of NPH, the clinical success rate of cerebrospinal fluid shunt has reached 70% ~90%. The risk assessment data also showed that surgically treated NPH patients had a significantly better prognosis than non-surgically treated NPH patients. NPH patients without surgery survive only a few months or less and have a poor quality of life^[1]。 However, so far, even if a more suitable treatment for NPH is found, only 10% ~20% of NPH patients can receive targeted treatment in time. The main reason is that NPH is difficult to diagnose early and it is difficult to differentiate from other neurodegenerative diseases. In this paper, the recent progress in the diagnosis and treatment of NPH was reviewed in order to provide assistance to the clinical work related to NPH.

In recent years, the nosocomial infection problem of Acinetobacter baumannii has become increasingly prominent, and now it has become the most common iatrogenic infection pathogen together with methicillin-resistant staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. Extremely poor prognosis for intracranial infections caused by multidrug-resistant Acinetobacter baumannii^[1]Thus, it has become an extremely difficult problem in the neurosurgical intensive care unit (NICU). In this paper, the general situation, drug resistance mechanism and prevention and treatment of intracranial infection caused by Acinetobacter baumannii were reviewed in order to provide reference information for clinical work.

The primary cause of compressive optic neuropathy is intracranial space-occupying lesions, and the sellar region is the most common, including pituitary adenoma, craniopharyngioma, meningioma, etc. Space-occupying lesions cause mechanical compression on optic nerve. Many patients are diagnosed in ophthalmology for the first time due to visual loss, visual field defect and optic nerve atrophy in the early stage^[1]。 At present, visual field examination is the "gold standard" for diagnosing visual path lesions, but it is a subjective examination with great variability. Early reports lack consistency, and it is difficult to accurately assess the prognosis of patients' visual function. With the widespread application of optical coherence tomography (OCT) in clinical practice, the related research on patients with compression optic neuropathy has become a hot spot. Compared with visual field examination, OCT has the advantages of rapid, non-contact, non-invasive, high resolution and good repeatability. By measuring the thickness of nerve fibers and the volume of macula, the damage of retina and optic nerve structure can be detected early, and the sensitivity is high; Can quantitatively and objectively evaluate the damage of optic nerve diseases such as compressive optic neuropathy; Moreover, OCT is helpful for the differential diagnosis of diseases, such as compression optic neuropathy and glaucomatous optic neuropathy. Due to early atypical visual field changes, differential diagnosis can be difficult or even misdiagnosed. OCT has certain advantages in differentiating these two diseases. Because OCT can be quantitatively detected, it is helpful to predict the visual function of patients after relieving compression. This article reviews and analyzes the evaluation of optic nerve injury in patients with sellar area occupying space by OCT.

solitary fibrous tumors (SFT) are rare spindle cell tumors. They were originally thought to originate from mesothelial cells in the serous cavity. Kemperer and Robin reported that SFT occurred in the visceral pleura in 1931. Later, it was discovered that it also occurred in a variety of organs and soft tissues other than the serous membrane, such as upper respiratory tract, lung, mediastinum, pericardium, nasal cavity, orbit, parotid gland, liver, kidney, testis and central nervous system^[1,2]。 With the accumulation of clinical cases and the development of pathological diagnosis techniques, the concept that SFT originates from mesenchymal cells has been widely accepted. In 1996, Carneiro et al.^[3]The first case of SFT occurring in the meninges is reported. So far, only about 200 cases of solitary fibrous tumors of the central nervous system (cSFT) have been reported, most of which are individual cases or small cases, and more than 10 cases are rarely reported^[4,5,6,7]。