Volume 32 · Issue 08 · 2016

Neuroendoscopic surgical technique for ventriculocisternal system diseases refers to the use of neuroendoscopic equipment to observe and operate the lesions during the operation of ventriculocisternal system diseases. This technique can be divided into^[1]: (1) Endoscopic surgery: or endoscopic neurosurgery. The surgical instruments are completed through the working channel of the endoscope, and dual instruments can be operated through dual channels at the same time. The disadvantage is that the operation is not flexible. Endoscopic surgery is mainly used for hydrocephalus, arachnoid cysts, intraparenchymal cystic lesions and some intraventricular solid tumors. (2) Extraendoscopic surgery: or endoscopic controlled surgery. The endoscope plays the role of illumination and image acquisition, and the device operates in the working channel outside the endoscope. After the endoscope is fixed with the support arm, it can be operated with both hands to avoid tumor spread and blood entering the cerebrospinal fluid circulation. (3) Combined endoscopic and external surgery: simultaneous endoscopic and external endoscopic operation channels are used for surgery. (4) Endoscopic combined microsurgery: or endoscopic assisted surgery. Major surgical procedures are performed under the microscope, and areas invisible under the microscope are observed and processed endoscopically, discovering important and hidden structures and residual tumors.

Traumatic skull defects in adults (hereinafter referred to as skull defects) are caused by depressed comminuted skull fracture, open craniocerebral injury, severe closed craniocerebral trauma combined with refractory intracranial hypertension and decompressive craniocraniectomy. In patients with large-scale skull defects, local scalp subsidence due to atmospheric pressure may lead to imbalance of intracranial pressure, brain tissue displacement, decreased blood flow in the cerebral hemisphere and disorder of cerebrospinal fluid circulation, resulting in a series of clinical manifestations, mainly including: headache, dizziness, irritability, epilepsy, unexplainable discomfort and various mental disorders^[1,2,3,4]。 Cranioplasty can not only repair skull defects, restore skull appearance and protective function of patients, but also effectively restore normal cerebrospinal fluid dynamics and cerebral cortical blood perfusion, which is beneficial to reduce intracranial complications and help patients to recover neurological function.

To investigate the effect of pituitary adenomas on male sexual function.

The clinical data of 155 male patients with pituitary adenoma admitted to the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2012 to November 2013 were analyzed retrospectively. The effects of the volume of pituitary adenoma, invasiveness, pathologic type, and serum testosterone level of the patients on sexual function in the males were analyzed.

The rate of postoperative sexual function returning to normal in patients with pituitary microadenoma was 100.0%. It was significantly higher than that in patients with large adenoma (32.8%) and giant adenoma (18.6%) (all P<0.01); and whether the tumors were invasive was not associated with postoperative sexual function improvement (P>0.05). The incidence of sexual dysfunction (SD) in patients with prolactinoma before procedure was 92.9%, which was higher than 69.9% in patients with nonfunctional pituitary adenoma (P<0.05). The incidence of SD in patients with prolactinoma after procedure was 85.7%, which was higher than 47.0% in patients with nonfunctional pituitary adenoma(P<0.05). Compared with before procedure, the postoperative improvement of SD was not obvious in patients with functional pituitary adenoma (P>0.05), and the postoperative SD was improved significantly in patients with nonfunctional pituitary adenoma (P<0.01). The postoperative serum testosterone level in patients with pituitary adenoma was significantly correlated with whether SD could be improved or not (P<0.01).

The volume and pathological types of pituitary adenomas are both the factors affecting SD in male patients with pituitary adenoma. The postoperative serum testosterone level can be used to measure the sexual function recovery of patients.

To study the accuracy and related influencing factors for predicting the tumor sides of Cushing’s disease before procedure using the bilateral inferior petrosal sinus sampling (BIPSS) + desmopressin (DDAVP) stimulation test (briefly BIPSS+ DDAVP).

From January 2013 to December 2014, the clinical data of 96 patients with Cushing’s disease admitted to Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences were analyzed retrospectively. BIPSS+ DDAVP was used to predict the sides of Cushing’s disease, and the sex, age, preoperative endocrine indices of the patients, whether having recurrent Cushing’s disease, whether having clear tumor presence on MRI, BIPSS+ DDAVP predicting the number of tumor side positive results, BIPSS+ DDAVP expected tumor sides, and the effect of the actual tumor sides on BIPSS+ DDAVP predicting the accuracy of tumor sides of Cushing’s disease were investigated. Logistic regression was used to establish the related factor model in order to evaluate the predictive validity of the related factors.

The accuracy of preoperative BIPSS+ DDAVP predicting tumor sides of Cushing’s disease was 72%. The results of univariate analysis showed that there was significant difference in the aspect of predicting the number of tumor side positive results and the actual tumor sides between the tumor side predicting correct group and the error group (all P<0.001). The results of logistic regression analysis showed that predicting the number of tumor side positive results (OR, 2.578, 95% CI 1.425-4.664, P=0.002) and the actual tumor sides (OR, 7.548, 95% CI 1.929-29.529, P=0.004) were the independent factors of affecting BIPSS+ DDAVP to predict the accuracy of tumor sides. The more the numbers of positive results of predicting tumor sides were, the accuracy of BIPSS+ DDAVP predicting tumor sides were higher when the actual tumor sides were on the right. According to the number of predicting positive results of the sides, the sensitivity and specificity of predicting tumor sides were 68.8% and 78.9%.

BIPSS+ DDAVP predicting the sides of Cushing’s disease have certain accuracy. It can provide reference for intraoperative exploration.

To investigate the clinical features, diagnosis and treatment strategies of pituitary adenoma with Rathke cyst.

From April 2009 to February 2015, the clinical and imaging features, histopathological features, treatment outcome and prognosis of 12 patients with pituitary adenoma with Rathke cyst admitted to the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University were analyzed retrospectively.

Eleven patients were treated with transsphenoidal approach, One patient was performed with right frontal craniotomy for tumor resection; 8 had total resection, 4 had near total resection; 5 were nonfunctional pituitary adenomas, 3 were prolactin-producing adenomas, 3 were mixed pituitary adenomas, and the other 2 were growth hormone adenoma and gonadotropin secreting adenoma respectively. Eleven patients were followed up for 11-53 months (mean 33.6 months). One patient was lost to follow up. The symptoms of headache and visual impairment of the patients were alleviated. The hormonal level had no apparent abnormality; and none of the patients had recurrence.

The preoperative diagnosis of pituitary adenoma with Rathke cyst is difficult. The transsphenoidal approach for surgical resection is the preferred treatment method. The symptoms of most patients will be relieved or disappeared after procedure.

To investigate the safety and effectiveness of endoscopic endonasal transsphenoidal surgery in old patients with non-functional pituitary adenoma.

From January 2009 to December 2014, the clinical data of 34 patients (≥65 years) with non-functional pituitary adenoma treated with endoscopic endonasal transsphenoidal surgery at the Department of Neurosurgery, Wuxi Second Hospital Affiliated to Nanjing Medical University were analyzed retrospectively. Twelve patients were treated unilaterally by transnasal endoscopic operation and 22 were treated bilaterally by transanal endoscopic surgery.

The tumors of 27 patients (79.4%) were resected totally, 4 (11.8%) were resected near totally, 2 (5.9%) were resected subtotlly, and 1 (2.9%) died. The postoperative visual acuity was improved in 26 cases (92.9%, 26/28) and did not have any change in 2 cases (7.1%, 2/28). Ten patients (29.4%) had postoperative diabetes insipidus, 2 (5.9%) had cerebrospinal fluid rhinorrhea and 2 had new hypopituitarism. Thirty patients were followed up for 3 months to 5 years. Ten patients had hypopituitarism, 1 had anosmia, 1 had sinusitis, and 1 had epistaxis. Of the 6 patients with residual tumor, 2 were treated with radiation therapy after recurrence.

Although the operation risk of the elderly patients with non-functional pituitary adenoma is relatively high, using endoscopic endonasal transsphenoidal surgery is safe and feasible through the strengthening of perioperative multidisciplinary collaboration.

To observe the changes of high signal intensity of the posterior pituitary on magnetic resonance imaging in patients with space occupying lesion in sellar region.

From December 2012 to December 2014, 189 consecutive patients (pituitary adenoma 123, craniopharyngioma 26, Rathke cyst 22, and saddle nodules meningioma 18) with space occupying lesion in the sellar region admitted to Fuzhou General Hospital of Nanjing Military command and confirmed by pathology were enrolled retrospectively. MRI images and pathological analysis were conducted. The occurrence of posterior pituitary bright spot (PPBS) of different lesions and their positions were analyzed.

In 189 patients, 119 (63%) occurred PPBS. The occurrence rate of PPBS in patients with pituitary adenoma was 79.7% (98/123), that of craniopharyngioma was 3.8% (1/26), Rathke's cleft cyst was 9.1% (2/22), and tuberculum sellae meningioma was 100% (18/18). There were significant differences in the occurrence rate of PPBS in patients with different lesions (P<0.01). PPBS could be located inside the sella (n=35), outside the sella (n=48), or inside and outside the sella (n=15) in patients with pituitary adenoma. The PPBSs of the latter three located in the sellae.

There are differences in the occurrence rate and location of PPBS in patients with space occupying lesions in the sellar region. They may be helpful in the identification of different lesions.

To report the cases of angioleiomyoma involving the sellar region and to review and summarize the characteristics of the disease combining with literature.

From June 2011 to June 2015, the clinical data of 2 patients with angioleiomyoma in the sellar region treated and confirmed by pathology in Beijing Tiantan Hospital, Capital Medical University were analyzed retrospectively.

Two patients were diagnosed as pituitary tumor by imaging before procedure. They had excessive bleeding during the operation and the total resection was difficult. The maximum tumor diameter was 3.0 cm in one of them. The tissue biopsy was conducted only with transsphenoidal microscopicsurgery. The patient received postoperative gamma knife therapy and was followed up for 4 years. The tumor had a tendency of sustained shrinkage. The maximum diameter of the tumor was 3.7 cm in 1 case. The tumor was resected partially with transsphenoidal microscopicsurgery. The patient was treated with gamma knife after procedure, and he was lost to follow up. After operation, HE staining showed that there were a lot of blood vessels, smooth muscles, and collagen tissues in the tumor tissues. Immunohistochemistry showed that the expressions of CD34, α-SMA, Ⅷ factor, CD31 and collagen Ⅰ- Ⅲ were positive.

The diagnosis of vascular leiomyomas is difficult before procedure, mainly based on pathology. The operation is difficult. Gamma knife therapy is helpful in controlling the tumors.

To investigate the treatment and prognosis of intracranial anaplastic meningioma.

From January 2008 to July of 2013, the clinical data of 51 patients with intracranial anaplastic meningioma received surgical treatment at the Cooperative Wards, Departments of Neurosurgery, Beijing Electrical Power Hospital and Beijing Tiantan Hospital, Capital Medical University were analyzed retrospectively. Their factors related to prognosis were analyzed.

All 51 patients received surgical treatment. The tumors were confirmed as anaplastic (malignant) meningioma by histopathology. Forty-six of them were followed up, 24 had Simpson grade I resection in the first operation, and a total of 22 had Simpson grade Ⅱ and Ⅲ resection. The postoperative complications were mainly the loss of nerve function on the location of the tumors. In the 46 patients to be followed up, a total of 96 surgeries were performed, 37 had recurrence. The recurrence rate was 80%, and 2-year recurrence rate was 52%. The progression-free survival (PFS) was 2-73 (median 24) months. In the 46 patients to be followed up, 12 patients were in a Simpson grade I resection combined radiotherapy group, 12 were in a Simpson grade I resection without radiotherapy group, 11 were in a Simpson Grade Ⅱ and Ⅲ resection without radiotherapy group. The median PFS in each group were 72, 20, 24, and 13 months, respectively (P=0.001). The recurrence rates were 58%, 92%, 91%, and 91%, respectively.

Anaplastic meningioma is a malignant tumor with high recurrence rate and high mortality. The degrees of surgical resection and postoperative radiotherapy have obvious influence on the prognosis of the tumors. The tumors with Simpson grade I resection and postoperative radiotherapy may significantly prolong PFS, but the decrease of tumor recurrence rate is not obvious. Simpson grade I resection of the tumor should be achieved as far as possible and postoperative radiotherapy is an effective treatment means for anaplastic meningioma.

To investigate the efficacy and safety of using Glubran for preoperative embolization of vascularized meningiomas through superselective branches of internal carotid artery and vertebral artery.

From January 2011 to April 2015, the embolization procedure, complications after embolization, and surgical outcome of 12 patients with vascularized meningiomas through blood supply branches of internal carotid artery or vertebral artery for preoperative Glubran embolization admitted to the Department of Neurosurgery, Zhujiang Hospital, Southern Medical University were analyzed retrospectively.

Twenty patients with meningioma were predominantly fed by the branches of internal carotid artery or vertebral artery, 12 of them were embolized preoperatively with Glubran. The average amount of bleeding during procedure was 972 ml, while the mean operative time was 7.65 h. One patient with embolization related bleeding recovered and was discharged after emergency surgical removal of the tumor and an external ventricular drainage. The average follow-up time of the patients was 8.4 months, and they did not have tumor recurrence. Eight patients were treated with preoperative embolization using the polyvinyl alcohol particles (PVA) alone. The mean amount of bleeding was 1 928 ml, the mean operative time was 10.7 h, and the mean follow-up time was 10.7 h. Two patients had tumor recurrence.

After internal carotid artery or vertebral artery superselection, using Glubran for preoperative embolization may have a good blood flow blocking effect for the intracranial vascularized meningiomas predominantly fed by intracranial arterial branches

To investigate the incidence, prognosis and related factors of ipsilateral hearing impairment after microvascular decompression (MVD) in patients with hemifacial spasm (HFS).

From December 2008 to June 2012, the clinical data of 355 patients with HFS treated with MVD by the same surgeon in Beijing China-Japan Friendship Hospital, National Health and Family Planning Commission were enrolled. The prognosis and influencing factors in patients with hearing impairment after procedure were analyzed retrospectively.

In 355 patients with HFS, 20 patients (5.6%) had ipsilateral hearing impairment after procedure; 15 had hearing loss and stayed awake immediately after surgery, 5 had hearing disability; 14 had hearing loss at 1 week after procedure, and 1 returned to normal. Eight patents were transient hearing impairment; and 12 were permanent hearing impairment, 7 of them had hearing loss and 5 had hearing disability. Nineteen patients were followed up for 3-7 (mean 4.2±1.1) years. Six of 8 patients with mild hearing loss recovered completely, and 2 were improved; of the 6 patients with severe hearing loss, 1 recovered completely, 1 recovered to mild hearing loss; and none of 5 with hearing loss was improved during the follow-up period. There were no statistical significances in age, sex, history length, sides of HFS, symptom severity before procedure, or the types of offending arteries between the hearing impairment group and the non-hearing impairment group (all P>0.05). The ratio of using BAEPs during the operation in the hearing impairment group was 15.0% (3/20), and that of the non-hearing impairment group was 63.6% (213/335). There was significant difference (P=0.014). Pearson correlation analysis showed that hearing impairment was negatively correlated with whether using brainstem auditory evoked potential (BAEP) monitoring during the operation (r= -0.731).

Ipsilateral hearing impairment is a more common complication after HFS MVD, and the prognosis of severe patients is poor. Intraoperative BAEP monitoring is an effective means for reducing this complication.

To investigate the correlation between preoperative imaging features of central meningiomas and surgical cleavage and to comparatively analyze the clinical efficacy of the different surgical cleavages.

From February 2006 to February 2014, the correlation between imaging features and surgical cleavage in 97 patients with center meningioma admitted to the Department of Neurosurgery, People's Hospital of Zhengzhou University were analyzed retrospectively. The relationship between imaging features and surgical cleavage of the tumors were tested by the univariate analysis. Kaplan-Meier survival analysis and multivariate logistic regression analysis were used to assess whether the imaging parameters predicted the surgical cleavage. Cox regression model was used to analyze the relationship between surgical cleavage or overall survival (OS) and progression free survival (PFS).

The result of single factor analysis showed that the relationships between the peritumoral edema and the position of venous sinus, the cortical infiltration and diffusion weighted imaging (DWI) signal intensity and surgical cleavage had obvious relevance (all P<0.05); and tumor size, border, enhancement, calcification, cystic change, dral tail sign, and adjacent bone changes were not associated with surgical cleavage (P>0.05). Multivariate logistic regression analysis showed that cortical infiltration was the most important independent predictor of surgical cleavage on central meningioma (P<0.01), others followed by DWI hyperintensity, parasagittal sinus, and peritumoral edema (P<0.01). The results of Kaplan-Meier analysis show that the median OS and median PFS in patients with the central grade Ⅱ meningioma. Cox regression model analysis showed that the age, WHO pathological grade, and surgical cleavage could be used as the independent predictive factors of influencing prognosis (P<0.05).

The peritumoral edema provided by preoperative imaging, the relationship with the position of venous sinus, cortical infiltration and DWI signal intensity may predict the surgical cleavage of meningioma, and the surgical cleavage is directly associated with the prognosis of patients.

To investigate the clinical application of vertebroplasty in spinal neurosurgery.

From June 2012 to May 2015, the clinical data of 40 patients with spine disease treated by using vertebroplasty (including 35 cases of percutaneous surgery and 5 cases in combination with 2 ways in open spinal surgery) at the Department of Neurosurgery, Nanjing General Hospital of Nanjing Military Command were analyzed retrospectively. The application effect of vertebroplasty in the spine neurosurgery were analyzed and assessed.

A total of 58 vertebrae were injected bone cement in 40 patients of this group. Five vertebrae were treated with combined application of open spinal surgery in 5 patients and the efficacy was good; 53 vertebrae were treated with percutaneous surgery in 35 patients. The leakage of cement occurred in 7 vertebrae in 7 patients. In addition to 1 patient gave up further treatment, others all became well after treatment; 38 patients were followed up for 6 to 36 months (mean 15.4 months), the efficacy of 26 patients with hemangioma and osteoporosis was good. One patient had multiple myeloma. The pain of 6 patients with metastatic carcinoma was relieved. Three patients with metastases, 1 with primary spinal tumor, and 1 with multiple myeloma died of the progress of primary disease 1 year later.

Vertebroplasty has the advantages of simple operation, short learning curve, and curative effect etc. It is best adapted for the elderly, weaker constitution, and other patients who can not be implemented in general anesthesia. It can simultaneously address multiple spinal diseases in the combined application of open spine surgery.

To analyze the MR imaging appearances and relevant clinical characteristics of solitary spinal cord intramedullary germinoma.

Five patients with intramedullary spinal cord germinoma with pretreatment unenhanced and enhanced MR imaging examinations were identified. The MR imaging examinations for each patient were reviewed by 2 neuroradiologists for various imaging characteristics. Relevant clinical data were obtained.

The patients included 4 female and 1 male, ranging in age from 23 to 47 years, with a mean age of 29.6±10.3 years. The disease duration was ranged from 2 months to 19 months with a median of 4 months. Three of them are complicated with other diseases, one case was associated with Klinefelter syndrome, one had sellar germinoma chemotherapy ten years ago without any intracranial recurrence, and another underwent ovarian teratoma surgery 5 years ago without recurrence. Two cases involved cervicothoracic spinal cord, and the other 3 cases thoracolumbar. The longitudinal length of spinal germinomas were 23~66 mm with an average of 40.2±16.4 mm. The tumors showed iso to hypointensity on T1WI, iso to hyperintensity on T2WI. After contrast administration, 2 cases were enhanced homogenously, the other 3 cases were enhanced inhomogenously. The tumor was ill-defined in 4 cases. Tumoral cysts were seen in 3 cases. Peritumoral edema was found in 4 cases. Syringohydromyelia was not found in all cases.

Routine MR imaging demonstrated no specific characteristic of spinal cord germinoma, so correct diagnosis before treatment planning is very difficult, however, the relevant medical history may be helpful for the differential diagnosis.

To search for biological markers closely related to seizure frequency and the location of the epileptic zone by comparing the waveform characteristics of stereo-EEG (SEEG) of two pathological types (type Ⅱa and type Ⅱb) in focal cortical dysplasia (FCD).

Thirty one patients with FCD implanted the stereotactic electrodes at the Functional Neurosurgery, Sanbo Brain Hospital, Capital Medical University from January 2012 to January 2015 were analyzed retrospectively. The differences of the waveform characteristics and the response of cortical electrical stimulation in patients with type Ⅱa and type Ⅱb in the SEEG intermittent period (awaking period), before seizures, seizures period, and after seizures were compared, and the accuracy of the multiple parameter criteria of the combined waveform characteristics in each period and the low voltage fast activities (LVF) for localization of the epileptic zone were compared.

There were no significant differences in SEEG waveform characteristics in each period between the patients with FCD type Ⅱa and FCD type Ⅱb(all P<0.05). The patients with FCD type Ⅱ whose duration of continuous epileptic discharge (CED) was long (P=0.046) and the distribution of discharge was wide (P=0.044) had higher seizure frequencies.

The effect of the pathologic typing of FCD type Ⅱ on the waveform characteristics of four periods during SEEG monitoring and seizure frequencies is not significant. The intermittent period CED may be a biological marker for assessment of the efficacy of FCD type Ⅱ. This index combined with multi-parameter criteria may be more accurate compared with the single application of LVF for the location of epileptogenic zone.

To investigate the prognostic influencing factors in patients with glioblastoma multiforme (GBM) after surgery and adjuvant radiochemotherapy.

From December 2004 to December 2014, the clinical data of 61 patients with GBM operated and treated with postoperative adjuvant radiochemotherapy at the Department of Neurosurgery, Guangzhou General Hospital of Guangzhou Military Command were analyzed retrospectively. The influence of 16 factors on the survival time of the patients were evaluated, including gender, age, lesion site, number of lesions, tumor volume, disease duration, preoperative Karnofsky Performance Scale (KPS) score, operation duration, operative bleeding volume, tumor residual volume, extent of resection, postoperative complications, secondary tumor resection, radiotherapy, chemotherapy, and concurrent radiochemotherapy. Multivariate Cox regression analysis was conducted for the indices of the differences with statistical significance of Kaplan-Meier single factor analysis.

The survival time of 61 patients was 1 to 63 months, and the median survival time was 14.0 months, 1-year, 2-year, and 5-year survival rates were 75.4%, 34.4% and 1.6%, respectively. The univariate analysis of Kaplan-Meier method showed that preoperative KPS score, operation time, residual tumor, total resection, radiotherapy, chemotherapy and concurrent radiochemotherapy were the factors of impacting on the survival time of patients. Multivariate Cox regression analysis showed that preoperative KPS score (OR, 0.302, 95% CI 0.153-0.597, P=0.001), residual tumor volume (OR, 0.225, 95% CI 0.114~0.441, P=0.000) and concurrent radiochemotherapy (OR, 0.275, 95% CI 0.128-0.591, P=0.001) were the independent factors for impacting the prognosis of patients with GBM.

Surgery is still the most important means for the treatment of GBM. The preoperative KPS score is ≥70, the postoperative residual tumor volume is ≤3 cm^3, and postoperative concurrent radiochemotherapy may prolong the survival time of patients.

To investigate the safety and reliability of using the grinding bone function of cut-ultrasound aspiration (CUSA) to conduct internal auditory canal treatment during acoustic neuroma microsurgery.

From January 2014 to June 2015, the clinical data of 33 patients with acoustic neuroma resected via suboccipital retrosigmoid approach at the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were analyzed retrospectively. The posterior superior walls of the internal auditory canals in 21 patients (CUSA group) were ground by using CUSA during the operation, 19 patients treated with the posterior superior walls of internal auditory canal using the grinding drill from May 2012 to October 2013 were selected as a control group (grinding drill group) in the operation at the same time. Electrophysiological monitoring, such as cranial nerve and brainstem auditory evoked potential were performed during the operation. House-Brackmann facial nerve function grading system was used to assess the facial nerve function for all patients within 1 week before and after procedure.

The tumors of 20 cases (95%) in the CUSA group were totally removed. The facial nerves were preserved anatomically in 21 cases (100%), and the practical hearing was preserved in 5 cases (24%). House-Brackmann facial nerve function grade at day 7 after procedure: grade Ⅰ in 5 cases, grade Ⅱ in 8 cases, and grade Ⅲ-Ⅴ in 8 cases. The good reservation rate of facial nerve function was 62% (13/21). In the grinding drill group, the tumors of 17 cases were totally removed (90%), the rate of anatomical preservation of facial nerve was 95% (18/19). House-Brackmann facial nerve function grade: grade Ⅰ in 3 cases, grade Ⅱ in 6 cases, and grade Ⅲ-Ⅴ in 10 in cases, and the good reservation rate of facial nerve function was 47% (9/19). There was significant difference in the good reservation rate of facial nerve function between the 2 groups (P<0.05).

The application of CUSA is safe and effective in treatment of internal auditory canals with acoustic neuroma microsurgery. It is beneficial to the total resection of tumors and the protection of facial nerves.

Intracranial arteriovenous malformation (AVM) is a common congenital vascular disease in the cranium. Treatment methods include surgical resection, endovascular embolization and stereotactic radiotherapy. In recent years, with the advancement of embolization materials and technology, embolization with intravascular ethylene-vinyl alcohol copolymer (Onyx) embolization system has become an important treatment for brain AVM^[1]。 Onyx glue is a non-adhesive embolic material, but during cerebral AVM embolization, because the blood supply arteries are mostly slender and tortuous blood vessels, early severe reflux may occur when injected with Onyx glue, resulting in embolization failure, and may lead to difficulty in extracting microcatheter^[2,3,4,5]。 To solve these two problems encountered in brain AVM embolization with Onyx glue, a variety of solutions have been proposed, such as "pressure cooker technique" (PCT)^[6]"reverse plug and push" technology^[7]"over-the-catheter" technique^[8]"Monorail capture technology "(monorail snare technique)^[9]"pull-push-pull" technology^[10]And using a tip-detachable microcatheter^[11]Etc. The "extubation-injection" technology in this study makes full use of the characteristics of Onyx glue casting mass gradually solidifying from outside to inside with the precipitation of solvent dimethyl sulfoxide when entering the blood. When the casting mass is solidified outside and the core is still in liquid state, the whole casting mass can be compressed, and the polymerization force generated during the solidification process slowly "grasps" the microcatheter, thus ensuring that the casting mass and the microcatheter move synchronously. At this time, the microcatheter is slowly pulled back, resulting in the proximal end of the casting mass being compressed into a dense "plug". While ensuring that the tip of the microcatheter does not move, the Onyx glue is slowly injected with maintaining tension, and the injection is stopped when the embolization is satisfactory or the catheter tip is moved out of the Onyx glue casting mold. The application of "extubation-injection" technique can not only control excessive reflux during intracranial AVM embolization with Onyx glue, increase the success rate of single embolization, but also solve the problem of difficult microcatheter extraction. This technique is reported as follows.

To investigate whether epidermal growth factor (EGF) promoting the proliferation and invasion of glioma U251 cells was involved in the expression of voltage-gated sodium channels (VGSCs) subtype nNav1.5.

The synthesis of nNav1.5 specific siRNA was designed and the liposome transfected U251 cells. The transfection efficiency was tested by Western blot. After treating the cells of the blank group and the transfection group, real-time PCR and Western blot were used to detect the changes of expression level of nNav1.5 mRNA and proteins in each group, and the modified MTT method and Matrigel invasion experiment were used to detect the changes of cellular proliferation and invasion ability in each group.

siRNA were successfully transfected into U251 cells; 100 ng/L EGF significantly upregulated the expression levels of nNav1.5 mRNA and protein in U251 cells (P<0.05), and increased the proliferation and invasion of glioma cells (P<0.05). After the expression of siRNA silenced U251 cells nNav1.5, the ability of 100 ng/L EGF upregulating the nNav1.5 mRNA in U251 cells and protein expression levels was decreased (P<0.05), and the ability of promoting the proliferation and invasion of glioma cells was decreased obviously (P<0.05).

EGF may promote the proliferation and invasion ability of glioma U251 cells by upregulating the expression of nNav1.5.

To investigate the expression of microRNA (miR) -3175 in glioma and its effect on the growth and invasion of glioma.

The expression levels of miR-3175 in 40 human glioma tissues and glioma cell A172 and U87 were detected by quantitative reverse transcription polymerase chain reaction (qRT-PCR). After glioma cells transfection of miR-3175 inhibitor with Lipofectamine 2000, qRT-PCR detected the degree of inhibition of miR-3175. The effects of miR-3175 on glioma cell proliferation, cell cycle, apoptosis, and invasion were detected by MTT assay, flow cytometry assay and Transwell assay, respectively. Western blot was used to analyze the relationship between miR-3175 and apoptosis-related protein p53, Bcl-2, cytochrome C, and Caspase-3.

The expression level of miR-3175 in glioma was increased obviously (compared with the control group P<0.05). The expression level of miR-3175 was decreased significantly after transfection of miR-3175 inhibitors (P<0.05). The miR-3175 inhibitors could effectively inhibit the proliferation and invasion abilities of glioma cells. The proliferation ability of U87 and A172 decreased 23.56±8.06% and 40.33±12.94% respectively; the number of the invasive cells reduced 47.83±4.33% and 45.13±5.03% respectively; at the same time, the MiR-3175 inhibitors could obviously increase the ratio and apoptosis rate of glioma cell G₀/G₁ phase, the ratio of A172 and U87 cell G₀/G₁ phase increased 13.51% and 13.22% respectively; the apoptosis rate increased 8.85±2.51% and 12.31±5.20% respectively. The decreased miR-3175 expression resulted in the abnormal expression of apoptosis related protein p53, Bcl-2, cytochrome C, and Caspase-3 (P<0.05).

The miR-3175 expressed highly in human glioma. The decreased expression level may effectively inhibit the growth and invasion of glioma cells, and promote apoptosis.

The insula lobe is an important structure of the paralimbic system of the brain^[1]。 Insular cortex is an intermediate cortical structure in which old cortex and neocortex are connected. Its formation process undergoes the transition from heterotypic cortex to homotypic cortex^[2,3]。 The insula lobe has abundant neural connections with the whole cerebral cortex and subcortical nucleus, and is a pool area of multiple functions^[4,5]。 The functions of insula mainly include visceral sensory, auxiliary motor, somatosensory, auditory and complex language functions, and coordinate internal and external information from one's own emotional consciousness^[6], plays a balancing role in experiential, emotional, and behavioral activities^[7]。

traumatic brain injury (TBI) is the leading cause of death and disability among young adults worldwide. There are more than 1.7 million new cases of TBI in the United States every year, of which 275,000 require hospitalization and more than 52 000 die^[1]。 China's TBI database shows that the mortality rate of severe TBI patients is 21.8%, and the severe disability rate is 49.9%^[2]。 At present, the diagnosis and prognostic evaluation of TBI mainly rely on the clinical manifestations and imaging examinations of patients. However, the mechanism of TBI injury is intricate, and it is called "the most complex disease of the most complex organ in the human body"^[3]。 Obviously, it is not enough to rely solely on clinical manifestations and imaging examinations. Scholars are dedicated to finding highly specific and sensitive TBI molecular markers, in order to reflect the severity of craniocerebral injury, thus guiding treatment and evaluating prognosis. In this paper, the research progress of TBI-related plasma markers in recent years is reviewed.

Glioma is the most common primary intracranial tumor with the highest fatality rate. Although various comprehensive treatment methods are adopted at present, the prognosis of its patients is still very poor, and the median survival time is only 12~15 months^[1]。 retinoic acid signaling is an important regulatory pathway for cell proliferation, differentiation and apoptosis. The "dual effect" of this pathway in regulating the interchange between division and differentiation of nerve cells is closely related to neural tumors^[2]。 In-depth research on the mechanism of retinoic acid signaling pathway in glioma will be beneficial to the understanding of the molecular mechanism of glioma occurrence, and can also provide new ideas for the treatment of glioma. This article reviews the research progress of retinoic acid signaling pathway in glioma.

Professor Song Jiaren, one of the pioneers of neurosurgery in China, the founder of neurosurgery in Ningxia, the academic leader, and the former president of the Affiliated Hospital of Ningxia Medical College, died at 9: 15 pm on June 20, 2016 in the General Hospital of Ningxia Medical University at the age of 87 due to ineffective treatment.