Volume 32 · Issue 07 · 2016

The surgical treatment of adult low grade supratentorial glioma is a hot topic in the field of neurosurgery at home and abroad. This guideline was developed to establish standardized surgical treatment protocols for low-grade gliomas guided by evidence-based medical evidence. According to the research achievements in related fields in recent years and the revised opinions put forward by experts, it has been improved. This guide contains evidence levels of evidence-based medicine and related recommendation levels, as a more authoritative and instructive technical guide. In order to facilitate readers' understanding and better carry out surgical work, the quality of evidence and strength of recommendation in this guide are based on the standards of evidence grading for evidence-based medicine recognized by the American Association of Neurosurgery (AANS)^[1], this standard was published in a previous series of guidelines. This guideline belongs to clinical practice guidelines, and its goal is to guide the clinical standard treatment, improve the clinical prognosis of patients, and provide support for the establishment of rational and standardized clinical diagnosis and treatment pathways.

craniovertebral junction abnor-malities refer to abnormal pathological changes of the occipital bone, atlas and axial bone, soft tissue and/or nervous system, including occipitalization of the atlas, basilar invagination, basilar impression, cranial settling, atlantoaxial dislocation, flat skull base (platybasia), atlantoaxial developmental malformation, cervical imsegmentation (Klippel-Feil syndrome), Chiari malformation and syringomyelia, etc.^{[1,2,3,4,5,6]}。 Craniocervical junction deformity has a high disability rate and can be life-threatening. The causes of the disease lie in the compression of the cervical medulla oblongata and the instability between the craniocervix, which are influenced by both congenital embryonic development factors and acquired pathophysiological and biomechanical changes. In many cases, multiple deformities coexist at the same time, with various manifestations and complex anatomical variation, which brings difficulties to the diagnosis and treatment of diseases, and has always been a difficult problem in the international spinal neurosurgery community^[7]。

To summarize the efficacy and experiences of high-flow extracranial-intracranial bypass for complex intracranial aneurysms.

From August 2010 to August 2015, the clinical data of 55 patients with intracranial aneurysm treated with high-flow extracranial-intracranial bypasses at the Department of Neurosurgery, Xiangya Hospital, Central South University were analyzed retrospectively. Fifteen patients conducted balloon occlusion test(BOT)before procedure, and 11 of them could not tolerate it. The grafts were the radial artery, the calf or thigh saphenous vein segment; the feeding arteries were common carotid(external))artery, maxillary artery, and superficial temporal artery trunk; the middle cerebral arteries were the blood reception arteries in anterior circulation; the posterior cerebral arteries were the blood reception arteries in posterior circulation.

There were no death in this group of patients. The grafts of all patients were patent at day 1 after procedure. One patient had hemiplegia immediately after surgery. CT scan revealed that a small infarct was in the basal ganglia region. The muscle strength reached grade Ⅲ-Ⅳ at day 8 after surgery. The grafts(saphenous vein of the calf segment)of 2 patients were occluded at day 3 and day 4 without symptoms. The graft(radial artery)of 1 patient was occluded at day 25 after procedure. Forty-three patients were followed up for 6 months to 52 months. The grafts(saphenous veins of the calf segment)of 2 patients were occluded at 6 months after procedure without any symptoms. In 5 patients with the graft occlusion did not conduct BOT.

High-flow extracranial-intracranial bypass for the treatment of complex intracranial aneurysms is effective. All the selected feeding vessels meet the requirements of blood supply. Graft occlusion may occur early or late after surgery. As grafts, both the saphenous vein of the calf segment and radial artery are more prone to occlusion. If they are well compensated, they may not have any clinical symptoms.

s To develop a risk score before microsurgery for poor-grade aneurysmal subarachnoid hemorrhage(aSAH)and to evaluate the score for the accuracy of predicting prognosis.

A total of 119 patients with aSAH(World Federation of Neurosurgical Societies[WFNS]grade 4-5)treated with microsurgery in several medical centers in China from October 2010 to April 2014 were enrolled retrospectively. Preoperative risk scores(0-5 score)were conducted according to their age, WFNS score, having cerebral hernia or not, and having ventricle hematocele or not. They were followed up for 6-28(12.5±3.4)months. The modified Rankin scale(mRS)was used to evaluate the prognosis. The patients were divided into good prognosis(mRS 0-3)and poor prognosis(mRS 4-6). Receiver operating characteristic(ROC)curve was used to evaluate the risk score for the accuracy of predicting prognosis.

Fifty-nine patients(49.6%)had good prognosis, 60(50.4%)had poor prognosis and 37 of them died(31.0%). There were significant prognosis differences in patients with different preoperative risk scores(χ²=42.077, P<0.01). In patients with preoperative score ≤ 1, the incidence of poor prognosis was 21.2%(11/52); preoperative score ≥ 4, the proportion of poor prognosis was 8/9. The higher the preoperative score, the higher the incidence of poor prognosis. The area under the curve of this score predicting poor prognosis was 0.79(95%CI 0.71-0.87, P<0.01). If the preoperative score was 2, it suggested that the sensitivity of poor prognosis was 82%, the specificity was 70%, and the goodness of fit was good(χ²=2.388, P=0.496).

Preoperative risk score is helpful in predicting the prognosis of patients with aSAH who were treated with microsurgery.

To analyze the rebleeding features and possible influencing factors after bypass in patients with hemorrhagic moyamoya disease.

From May 2005 to May 2010, 89 patients with hemorrhagic moyamoya disease operated with bypass surgery in the Fifth Affiliated Hospital of Zhengzhou University were followed up. The end point event was rebleeding. The clinical features in patients with rebleeding were analyzed. Cox regression model was used to analyze the possible influencing factors of rebleeding.

They were followed up for 71.3±10.2 months. In 89 patients, 33(37.1%)had rebleeding. The median age of rebleeding was 48 years old, and the peak age of bleeding was 40-50 years old, accounting for 39.4%(13/33). The median time from having nervous system symptoms to the first bleeding was 13.5(4-21)months. The interval time from the first to the second bleeding was 11.5(7-24)months. There was significant difference(P=0.001). The median modified Rankin scale(mRS)score of the first bleeding was 2(0-5), the second bleeding score was 3(1-5). There was significant difference(P=0.002). Multivariate Cox regression analysis showed that in addition to age(RR, 1.288, 95% CI 0.991-1.672, P=0.058), intracranial collateral vessel formation(RR, 1.271, 95% CI 1.009-3.184), the mRS of the first bleeding was >2( RR, 4.173, 95% CI 1.891-7.544), the time from complete evacuation of intracranial hematoma to bypass >1 month( RR, 2.991, 95% CI 2.670-5.978), anterior choroidal artery dilatation(RR, 3.316, 95% CI 1.135-8.741), posterior communicating artery dilatation(RR, 2.971, 95% CI 1.653-4.465), combined aneurysm(RR, 3.059, 95% CI 1.973-5.065), combined hypertension(RR, 5.587, 95% CI 2.345-10.218)were the independent risk factors for affecting rebleeding(all P<0.05).

The proportion of rebleeding in patients with hemorrhagic moyamoya disease is higher after bypass. The time of rebleeding is shorter, and the conditions become aggravated. The possible risk factors for rebleeding should be prevented and treated as early as possible.

To investigate the experience and prognosis of emergency microsurgery for the treatment of ruptured middle cerebral artery(MCA)aneurysms with intracerebral hematoma.

The case data and follow-up results of 23 patients with ruptured MCA aneurysms with intracerebral hematoma treated with emergency operation at the Department of Neurosurgery, Henan Provincial People's Hospital from January 2009 to May 2014 were analyzed retrospectively.

All 23 patients underwent emergency microsurgery for hematoma evacuation and aneurysm clipping within 24 hours after symptom onset, and 16 were treated with decompressive craniectomy. One patient had serious cerebral edema at day 3 after procedure, and he was treated with decompressive craniectomy once more. CTA revealed that 1 week after procedure, no residual aneurysm was observed. Five patients complicated with cerebral infarction. Two patients were treated with ventriculoperitoneal shunt after procedure because of having communicating hydrocephalus. The patients were followed up for 2-25 months after procedure. The Glasgow outcome scale(GOS)showed that 6 patients had good recovery, 9 could take care of themselves, 4 had severe disability, 2 were in a persistent vegetative state, and 2 died. The good prognosis rate was 65.2%(15/23)and the mortality rate was 8.7%(2/23).

Emergency microsurgery for the treatment of ruptured MCA aneurysms with intracerebral hematoma can achieve satisfactory prognosis.

To investigate the relationship between the maximum height of anterior communicating artery(AComA)aneurysm or the size ratio(SR)of mean diameter of peripheral blood vessels and aneurysm rupture.

The morphological parameters of the aneurysms in 594 patients with AComA aneurysm admitted to the Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University from October 2010 to December 2014 were analyzed retrospectively. There were 529 patients with ruptured AcoA aneurysms and 65 with unruptured AComA aneurysms. The maximum height of aneurysms and the mean diameter of the peripheral vessels were collected respectively, and the relationship between SR and AComA aneurysm rupture in both of them were analyzed at the same time.

Among the 594 patients with AComA aneurysm, the mean value of the maximum height of the aneurysms in the ruptured aneurysms was 4.26±2.19 mm. It was obviously larger than 2.82±2.04 mm of the unruptured aneurysms, and the mean diameter of the peripheral blood vessels of the ruptured aneurysms was 1.91±0.54 mm, it was smaller than the mean diameter of 2.16±0.49 mm in the peripheral blood vessels of the unruptured aneurysms. There was significant difference between both of them(all P<0.001). In the ruptured AComA aneurysms, the mean value of SR was 2.52±2.15, and that of the unruptured aneurysms was 1.38±1.09. There was significant difference between both of them(P<0.001). In addition, all the aneurysms were divided into 2 groups according to the size of the SR values. The rupture rate of aneurysms in the SR >2 group was significantly higher than that in the SR ≤2 group(P<0.001). After the analysis of ROC curve, the area under the curve of the SR ≤2 value of AComA aneurysms was 0.744, and the optimal cut-off value was 1.19.

The size of SR value is significantly associated with the rupture of AComA aneurysms. When determining the treatment options for patients with AComA aneurysm in clinical practice, the SR value can be considered as a reference factor.

To investigate the application value, technical key points and operation experience of intro-neuroendoscopic technique for removing parenchymal hematoma.

From June 2014 to January 2016, the clinical data of 33 patients with parenchymal hemorrhage treated with intro-neuroendoscopic technique at the Department of Emergency, Shenzhen People's Hospital, the Second Clinical Medical College of Jinan University were analyzed retrospectively. There were 24 patients with hypertensive intracerebral hemorrhage, 3 with intracerebral hemorrhage of unknown causes, 4 with traumatic cerebral hemorrhage, and 2 with intracerebral hemorrhage after tumor surgery. All patients were diagnosed with head CT. The mean hematoma volume was 45.22±8.59 cm³. The Glasgow coma score(GCS)scores were 12-5. Hematoma location: 23 patients in the basal ganglion region, 5 in the frontal lobe, 2 in the parietal lobe, and 3 in the occipital lobe. Brain CT scan was performed immediately after procedure in all patients.

In 33 patients, the postoperative hematoma clearance rate of 20 cases was more than 90%, that of 9 cases was 60%-90%, and that of 3 cases was less than 60%. One patient was converted to craniotomy because of intraoperative bleeding. Two patients had intracranial infection after procedure, and the hematomas of 6 cases were drained with the drainage tube injection of urokinase after procedure. The mean length of operative scalp incisions was 3.0 cm(range, 2-4 cm), the diameter of bone hole was 0.8 cm to 1.1 cm, the mean intraoperative blood loss was 50 ml(range, 40 ml-100 ml), and the mean operation time was 65 min(range, 45 min-120 min). The Glasgow outcome scale(GOS)scores: 5 patients recovered well, 16 had mild disability, 12 had severe disability, and none of them died.

Intro-neuroendoscopic technique evacuation of parenchymal hematoma only needs to drill one bone hole for completing the operation. It has the advantages of convenient operation, less injury, faster recovery, and less complications.

To investigate the clinical application value and technical characteristics of pipeline embolization device(PED)for the treatment of intracranial aneurysms.

From December 2014 to December 2015, the clinical data of 20 patients with intracranial aneurysm treated with PED at the Department of Neurosurgeries, Shanghai Punan Hospital of Pudong New District and Donglei Brain Surgeon Group were analyzed retrospectively. Fifteen patients had one aneurysm and 5 had multiple aneurysms. The diameters of 28 aneurysms were 2-33 mm(15.2±9.9 mm). The aneurysm necks of all patients were covered with 1 PED, and 8 of them were treated with the combined aneurysm coil embolization.

The release of PEDs in all 20 patients was completed successfully. The coverage of aneurysm necks was satisfactory. PEDs were found well adhering to the wall. Immediately after surgery, it showed that contrast agents in aneurysm cavities were obviously detained. Three patients had complications of cerebral hemorrhage after procedure, including 1 died and 1 had hemiparesis at discharge. Eight patients were followed up by digital subtraction angiography(DSA)6 months later, 6 were cured completely, the aneurysm of 1 case was nearly completely occluded, and the size of a large aneurysm did not have obvious change. Two patients had asymptomatic anterior cerebral artery stenosis. The head MRI follow-up revealed that the mass effect of the large and giant intracranial aneurysms were significantly relieved or disappeared. The remaining 11 cases had to be followed up.

The efficacy of PED for the treatment of large and giant intracranial aneurysms, tandem multiple small aneurysms and intracranial blood blister-like aneurysms is satisfactory. This device has just begun to be applied in clinical practice in China. The complications and long-term efficacy of the large sample case analysis and research are needed.

To investigate the application and clinical efficacy of endovascular treatment in traumatic intracranial pseudoaneurysms.

The clinical data of 21 patients with traumatic intracranial pseudoaneurysms treated with endovascular treatment at the Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University from December 2006 to June 2015 were analyzed retrospectively. All 21 patients were treated with endovascular treatment, including 3 patients were treated with simple coil embolization, 10 were treated with stent-assisted coil embolization, and 8 were treated with covered stent placement. The follow-up time ranged from 3 to 24 months.

In 21 patients with pseudoaneurysm except 1 died, the remaining 20 were occluded completely, and they were followed up. The modified Rankin scale(mRS)score 0 was in 13 cases and the mRS score 1 was in 7 cases. In 8 patients treated with covered stents, postoperative angiography immediately after procedure suggested that all the aneurysms did not develop. One patient showed distal in-stent stenosis during the reexamination, however, he did not have any symptom. The other 7 patients did not have recurrence and other complications. Of the 3 patients treated with the simple coil embolization, the aneurysms of 2 cases were occluded completely; the aneurysm of 1 case recurred. After being treated with stent-assisted coil embolization, the result was satisfactory. He was reexamined and did not find recrudescence. Of the 10 patients treated with stent-assisted coil embolization, all the embolizations were satisfactory, 1 died of aneurysm rupture after procedure. The remaining 9 cases were followed up and no recurrence was observed.

Endovascular treatment may achieve safe and effective treatment outcomes through a reasonable choice of surgical options for the treatment of traumatic intracranial pseudoaneurysms.

To investigate the safety and short-term effectiveness of using the hybrid operation in the treatment of complex cerebrovascular diseases.

Sixteen patients with complex cerebrovascular diseases treated with hybrid operation at the Department of Neurosurgery, Nanfang Hospital, Southern Medical University from December 2014 to October 2015 were analyzed retrospectively, including 6 patients with acute aneurysmal subarachnoid hemorrhage, 1 with intraoperative embolism bleeding of recurrent aneurysm, 5 with unruptured aneurysm, and 4 with spontaneous intracerebral hemorrhage.Six patients were treated with extra- intracranial arterial bypass and aneurysm exclusion or trapping, 6 with intracranial aneurysm were treated with shaping clipping, 4 with spontaneous intracerebral hemorrhage were treated with hematoma removal and vascular malformation resection. The follow-up time was 3 to 7 months.

In 6 patients treated with extra-intracranial arterial bypass, the intraoperative anastomotic vessels were patent. Six patients treated with aneurysm shaping clipping were clipped completely. Of the 4 patients with vascular malformation, the vascular malformations of 3 cases were resected completely, the vascular malformation of 1 case had a small amount of residual, and a complete resection was achieved after resection again. After procedure, 1 patient gave up treatment because of severe vascular spasm. One patient had a perfusion pressure breakthrough after operation, and he left right upper limb muscle disorder after procedure. Fifteen patients were followed up in clinical practice, they did not have any new neurological disorders, the Glasgow Outcome Scale(GOS)Ⅴ in 8 cases, Ⅳ in 6 cases, and Ⅲ in 1 case. Five patients were followed up with DSA; the aneurysms of 3 cases treated with vascular bypass did not have recurrence, and the parent arteries and anastomosed vessels were patent. The vascular malformation did not have residual in 2 patients with vascular malformation.

The treatment of complicated intracranial vascular diseases with hybrid operation may improve the accuracy of treatment, and it is both safe and effective.

To observe the feasibility and effectiveness of Y-double stent-retriever thrombectomy for terminal acute internal carotid artery T occlusion.

From September 2013 to April 2015, 7 patients with cardioembolism caused distal end occlusion of acute internal carotid artery were treated with double-Y stent-retriever thrombectomy at the Center of Cerebrovascular Diseases, Shanghai Changhai Hospital, the Second Military Medical University. All patients with middle cerebral artery occlusion were treated with the Revive stents.

After thrombectomy, 6 patients(6/7)achieved recanalization successfully. The modified Thrombolysis in Cerebral Infarction(mTICI)grade achieved grade 2 b-3, 5 of them were recanalized completely(mTICI grade 3); 1 was grade 2a. The time from puncture to recanalization was 38-97 min(mean 57.1±21.6 min). One patient had a new thrombosis, 1 had intracranial space-occupying hematoma, and 1 died of pulmonary infection after procedure. No new stroke, transient ischemic attack, death event, and re-occlusion occurred during the 3-month follow-up period.

The use of double stent-retriever thrombectomy technique for the treatment of terminal acute internal carotid artery T occlusion is safe and feasible, and the vascular recanalization rate is higher.

To analyze of the related factors of influencing the epileptic seizure after bilateral cranioplasty and preventive measures.

Fifty-nine patients with craniocerebral trauma treated with bilateral cranioplasty at the Department of Neurosurgery, the 101st Hospital of PLA from January 2008 to December 2014 were analyzed retrospectively. They were divided into either a two-step repair group(n=30)or a bilateral simultaneous repair group(n=29), and the incidence of epilepsy was compared after procedure between the 2 groups. Mantel-Haenszed test was used to further analyze the effects of the size of repair area, the time length of skull defects, the Glasgow coma scale(GCS), and whether performing ventriculoperitoneal shunt simultaneously on the occurrence of epilepsy.

A total of 14 patients(48%)experienced seizures in the bilateral simultaneous repair group and 6(20%)in the two-step repair group. There was significant difference between the two groups(P<0.05). The incidence of epilepsy in patients with preoperative GCS <13 and the repairing area >120 mm² after performing bilateral simultaneous cranioplasty was higher than those with GCS >13 and repairing area <120 mm ², respectively(all P<0.05). There were no significant differences in the time of skull defects and whether simultaneous operation with ventriculoperitoneal shunt or not between the 2 groups(allP>0.05).

For patients whose GCS <13 and/or bilateral skull defect area >120 mm ^2, the two-step cranioplasty reduced the incidence of seizures, and the extension of repair time and simultaneous shunt + repair operation did not increase the risk of epileptic seizures.

Intracranial infection is one of the serious complications after neurosurgery. Timely diagnosis and appropriate treatment can minimize the risk of disability and death. Studies have shown that continued lumbar cerebro-spinal fluid drainage (CLCFD) inflammatory cerebrospinal fluid (CSF) is an effective treatment for postoperative intracranial infection^[1]。 Medtronic EDM system is a special device for lumbar cistern drainage. Its catheter has the characteristics of moderate soft texture, moderate diameter and relatively few postoperative complications. However, its expensive price limits its clinical application. In the past, some scholars used epidural catheter for CLCFD in the treatment of postoperative intracranial infection, and found that there were many adverse reactions such as high incidence of poor drainage (74.5%), easy catheter detachment (48.9%), and easy CSF leakage at the puncture site (31.9%)^[2]。 We treated 23 patients with postoperative intracranial infection with CLCFD with modified epidural catheter connection device, and the efficacy was satisfactory, which is summarized below.

To investigate the differential expression of long no-coding RNA(LncRNA)in human brain arteriovenous malformation(AVM)tissue using an Arraystar-LncRNA chip.

The vascular nidi of 14 patients with AVM used as the specimens of the test group and operated in Beijing Tiantan Hospital, Capital Medical University were selected. The scalp blood vessel or superficial temporal artery segment of the same patient was used as a control specimen. Arraystar-LncRNA chip was used to conduct the expression profile analysis of LncRNA and mRNA. The maximum expression difference of 8 LncRNAs was selected for PCR validation.

After screening and validation, in the 2 8012 detectable LncRNAs, 1 931 were up-regulated for ≥2 times and 450 were up-regulated for ≥4 times compared with the control group; 1 852 were down-regulated for ≥2 times and 719 were down-regulated for ≥4 times. In the 21 780 detectable mRNAs, 1 577 were up-regulated for ≥2 times, 450 were up-regulated for ≥4 times; and 1 699 were down-regulated for ≥2 times and 681 were down-regulated for ≥4 times. The bioinformatics and pathway analyses for mRNAs showed that the differential expression of 8-code mRNAs(FDXR, SYNE2, FCGR3A, NDUFS4, COX5A, OPA1, ETFA, and LPL)were most obvious in comparison of the test group and the control group. These mRNAs were associated with mitochondrial electron respiratory chain function, interaction between cytokines, stress response, lipoprotein lipase, and cytoskeleton associated protein. PCR validation for mRNAs associated with these LncRNAs showed that there were significant differences in the differential expression of 4 LncRNAs(codes ENST00000423394(P=0.03), ENST00000444114(P=0.01), TCONS_00013855(P=0.01), and ENST00000452148(P=0.01).

The occurrence and development mechanism of intracranial AVM may be associated with the mitochondrial NADPH oxidoreductase, lipoprotein lipase, and optic atrophy associated protein-related down-regulation of LncRNA expression.

To investigate the effect of early evaluation of cortical somatosensory evoked potentials(CSEP)and desending neurogenic motor evoked potentials(DNEP)in spinal cord ischemic injury by observing the early change characteristics of CSEP and DNEP of spinal cord ischemia in rabbits.

To establish a rabbit model with different degree of permanent spinal cord ischemic injury through the ligation of different levels of lumbar arteries. The rabbits were divided into 5 groups(ligation of the left renal artery and the different levels of lumbar arteries between arterial bifurcations respectively, including 1 to 5-artery group). After modeling, CSEP and DNEP were continuously recorded for 60 min. After 2 days, the samples of ischemic central area were selected for HE staining. The motor function score Tarlov criteria were used to assess the motor function. The relationship between the amplitude variation of CESP and DNEP and the motor function after ligation were analyzed.

There were statistical significance in the percentages of the CSEP amplitude and preoperative baseline amplitude between the 4- and 5-artery groups compared with before ligation(P<0.05), and there were no statistical differences compared with other groups before ligation(allP>0.05). There were statistical differences in the percentages of the DNEP amplitude and preoperative baseline amplitude among the 3-, 4- and 5 artery groups compared with before ligation(allP<0.05); and there was no statistical significance compared with before ligation in other groups(allP>0.05). Compare with before ligation, there were statistical significances in the motor function 2 days after ligation between the 4- and 5-artery group(allP<0.05), and compare with other groups before ligation, there were no statistical significances(allP>0.05). The amplitude variation of CSEP and DNEP was positively correlated with the motor function 2 days after ligation of blood vessels(r=0.97, P<0.001;r=0.95, P<0.001).

Both CSEP and DNEP can predict the motor function after spinal cord injury. DNEP is more sensitive to spinal cord ischemic injury and is more specific to motor function. It can find ischemic injury in the early spinal cord ischemia.

To investigate the neuroprotective effects of anterior thalamic nuclei(ANT)stimulation on hippocampal neurons in epileptic monkeys.

Eight male rhesus monkeys were randomly assigned to a model control group, a sham-stimulation group, and a stimulation group. A monkey model of temporal lobe epilepsy was induced by injection of kainic acid in the left hippocampus. The seizure frequency was compared in each group. At 6 months after modeling, immunohistochemical method was used to observe the pathological injury and fibrosis in hippocampal tissue. Western blot was used to quantitatively analyze the contents of heat shock protein-70(HSP-70), NeuN, and caspase-3 in hippocampal tissue.

All animals that received the kainic acid injections had seizures. The total number of seizures in the stimulation group was 11.2±2.3 times, compared with 21.0±4.8 times in the sham-stimulation group, it decreased 42.8%(P<0.05). The monthly seizure frequency in stimulation group was 3.7±0.8 times. compared with 7.0±3.7 times in the sham-stimulation group, it deceased 45.7%(P<0.05). The number of surviving neurons in the hippocampi of the animals of the ANT stimulation group[(14.6±3.9)/100 μm²]was significantly higher than that of the sham-stimulation group[(8.4±3.3)/100 μm ²](P<0.05). Compared with the sham-stimulation group, the degree of fibrosis was reduced significantly. The content of HSP-70 in the sham stimulation group was significantly higher than that of the control group(P<0.01), but there was no significant difference between the stimulation groups(P>0.05). The content of NeuN in sham-stimulation group was significantly lower than that in the control group and the stimulation group(P<0.01,P<0.05). The content of Caspase-3 in sham-stimulation group was significantly higher than that in the control group and the stimulation group(P<0.01,P<0.05).

Long-term ANT stimulation may reduce the hippocampal injury and gliosis in temporal lobe epilepsy monkeys. This may be an important mechanism of ANT stimulation for the treatment of temporal lobe epilepsy.

Medulloblastoma is the most common malignant brain tumor in children^[1,2,3]About 85% of medulloblastomas occur in children under the age of 18^[4], and 1 out of every 5 children with brain tumors has medulloblastoma. In recent years, the survival rate of patients with medulloblastoma has improved, but its mortality rate is still high, and even patients with successful treatment often develop neurological and endocrine sequelae. The incidence rate of medulloblastoma is about 0.71/100,000 people. In the United States, 400 to 500 children are sick every year. The peak incidence of this disease is 3 to 6 years old. This disease is very rare in people after the age of 50. There are no reports on the influence of biochemical environment on the incidence of medulloblastoma. However, some genetic diseases can lead to the development of medulloblastoma. About 7% of patients have mutated germ cell genes, and a few medulloblastomas are inherited in families^[5]。

vertebrobasilar dolichoectasia (VBD) refers to the abnormal expansion, lengthening and tortuosity of the vertebral artery or basilar artery caused by abnormal blood vessel wall caused by hereditary or autoimmune diseases, which leads to hemodynamic changes of the vertebrobasilar artery system. It is a rare posterior circulation vascular variation disease. The abnormally located vertebrobasilar artery may cause compression on the adjacent cranial nerves in the limited posterior cranial fossa due to varying degrees of vascular variation^[1,2]The neurovascular compression syndrome (NVCS) caused by NVCS has attracted widespread attention from domestic and foreign scholars due to its pathogenesis, clinical manifestations and special treatment methods^[3]。

Among more than 10 million epilepsy patients in China, about 30% ~35% of patients are drug-refractory epilepsy, and surgical treatment for refractory epilepsy has been widely accepted^[1]。 The efficacy of epilepsy surgery mainly depends on the precise localization of epileptic foci^[2]。 At present, the preoperative evaluation of epilepsy mainly includes symptomatology, imaging and neuroelectrophysiology. Among them, intracranial EEG monitoring plays a decisive role in the determination of surgical protocol^[3,4]。 However, the traditional EEG method was used to guide the localization of epileptic foci, and the operative efficiency was only 34% ~74%^[5]。 With the development of EEG recording technology, EEG activity can now be recorded to>80 Hz. Recent studies have pointed out^[6,7]These high-frequency brain electrical activity may be a potential biological indicator of the source of epilepsy, which can be used to accurately locate the epileptic focus.

cranial neuropathy (CN) mainly includes idiopathic hemifacial spasm (HFS), primary trigeminal neuralgia (TN), primary glossopharyn-geal neuralgia (GN) and other diseases. Clinical studies have shown that blood vessels in the cerebellopontine angle (CPA) region compress the root entry/exit zoon (REZ) of different cranial nerve roots, which can lead to corresponding cranial nerve diseases, namely neurovascular compression (NVC) syndrome. microvascular decompression (MVD) in CPA area is recognized as the first surgical method for the treatment of cranial neurological diseases. familial cranial neurological disease (familial CN, FCN) rare^[1]familial TN (FTN), HFS (familial HFS, FHFS) and GN (familial GN, FGN) are occasionally reported in foreign literatures. FHFS was first seen in 1989 Friedman^[2]FTN was first seen in 1914 in Patrick's report^[3]。 The clinical characteristics, genetic patterns, pathogenesis, treatment methods and efficacy of more than 50 familial CN (FCN) families reported in the literature are reviewed as follows.

Craniopharyngioma is a common congenital epidermal tumor in the cranium, mostly located in the sellar region, growing slowly, often with malignant invasive growth^[1]。 Craniopharyngioma is adjacent to important structures such as hypothalamus, which is difficult to be totally resected, and has a high disability and recurrence rate, which seriously affects the quality of life and survival time of patients^[2]。 The invasive growth of craniopharyngioma is an important reason for the difficulty of total resection during craniopharyngioma surgery. Even in patients with total resection confirmed under microscope and no residual MRI after surgery, there is still a possibility of recurrence^[3]。 Therefore, the aggressiveness of craniopharyngioma has become a hot research topic in recent years. At present, some achievements have been made in molecular biology research on the invasiveness of craniopharyngioma. Based on the current research situation at home and abroad, the related research on invasive growth behavior of craniopharyngioma is reviewed.

Birth defects are a major public health problem faced by China. According to the statistics of the Report on the Prevention and Treatment of Birth Defects in China (2012) released by the former Ministry of Health, the incidence of total birth defects in China is about 5.6% at present, of which nervous system birth defects account for a large proportion. With the strengthening of the prevention and treatment of major birth defects in the 13th Five-Year Plan, a series of nervous system birth defects such as neural tube malformation, craniocervical junction malformation, congenital hydrocephalus and craniosynostosis have begun to arouse new thinking of neurosurgeons.