Volume 32 · Issue 09 · 2016

At present, the commonly used surgical methods for hydrocephalus are divided into catheter shunt surgery and neuroendoscopic surgery, both of which play an important role in the treatment of hydrocephalus. However, catheterization shunt brings many disadvantages due to implants, such as shunt obstruction and improper location, infection, excessive shunt and shunt dependence, etc. Although the manufacturing process of the shunt pipe has been greatly improved at present, and the adjustable pressure shunt pipe and the anti-infection shunt pipe have appeared, the above problems still cannot be completely solved. endoscopic third ventriculostomy (ETV) can avoid shunt implantation and related complications. The surgical method conforms to the physiological characteristics of human cerebrospinal fluid circulation, and the incidence of postoperative complications is relatively low. At present, it is gradually replacing catheter shunt surgery and becoming the first choice for the treatment of obstructive hydrocephalus^[1,2,3,4]。

To investigate the reliability of diagnosing the molecular subtypes of children and adolescents with medulloblastoma (MB) using real-time fluorescence quantitative PCR (RT-qPCR).

Thirty patients with MB diagnosed by pathology and admitted to the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2011 to December 2015 were enrolled retrospectively. RT-qPCR was used to detect the frozen samples of MB. Eleven subgroup-specific protein-coding genes (OTX2, FOXG1B, MYC, DKK1, WIF1, DKK2, MYCN, SFRP1, HHIP, OTX1, and NPR3) were selected. Unsupervised hierarchical cluster analysis and prediction analysis of microarray were conducted according to the differences of gene expression levels, and the heat map and gravity map were drawn. The result of subgroup was validated by immunohistochemical method and expression profile. One-way ANOVA was used analyze the differences of the marker gene expression value among the molecular subtypes. The differences of the clinical factor distribution of the molecular subtypes were analyzed.

Thirty patients with MB were divided into 4 molecular subtypes by using RT-qPCR, including SHH subtype (n=17), WNT subtype (n=4), Group 3 subytype (n=4), and Group 4 subtype (n=5). The results of grouping, immunohistochemical staining and unsupervised clustering analysis were completely consistent. There were significant differences in 11 subgroup-specific protein-coding genes expression among the subgroups (P<0.01 orP<0.05). Among them,SFRP1, MYCN, NPR3, and MYC were the key genes for distinguishing subtypes. There were significant differences in the sex distribution (male: female, 4.7 ∶1.0 and 1 ∶3 respectively) and age at diagnosis (≤3 year: 3-16, 1.0 ∶4.7 and 3 ∶1 respectively) between the SHH subtype and the WNT subtype (all P=0.022).

RT-qPCR may accurately identify the 4 molecular subtypes in children and adolescents with MB.

To conduct clinical molecular diagnosis for Chinese Han nationality children with craniostenosis in order to find the related pathogenic genes.

Five children with craniostenosis admitted to the Department of Neurosurgery, Shanghai Children’s Medical Center of Shanghai Jiao Tong University conducted whole-exome sequencing (WES) on peripheral blood nucleated cell genes using the high-throughput WES between February 2014 and January 2015. The obtained data were used conduct bioinformatic information analysis, and Sanger sequencing was used to validate the gene related mutation found by WES.

The exon 1 of the regulator of epithelial-mesenchymal transition TWIST1 of 2 children had a heterozygous missense mutation respectively: c. 528C>G, p. Ser176Arg和c.487C>T, p.Leu163Phe; the other 3 children had a fibroblast growth factor receptor 2 (FGFR2) gene heterozygous missense mutation respectively. Two of them were located in the exon 7 (c.755C>G, p. Ser252Trp and c. 833G>T, p. Cys278Phe); and 1 was located in the exon 8 (c.1 012G>C, p. Gly338Arg).

With the aid of high-throughput DNA sequencing technology and combined with clinical features, 2 children were diagnosed as Saethre-Chotzen syndrome caused by TWIST1 mutation; 2 were diagnosed as Crouzon syndrome caused by FGFR2 mutation, and 1 was diagnosed as Apert syndrome caused by FGFR2 mutation. Genetic studies contribute to diagnose the children with craniostenosis whose clinical feature is not significant, and provide the basis for the diagnosis of craniostenosis and typing.

To investigate the surgical treatment and its effect in children with hypothalamic hamartoma with epilepsy as the main manifestation in order to provide basis for the treatment of the disease.

The clinical manifestations, operation methods and effects in 20 children with hypothalamic hamartoma with epilepsy as the main manifestation admitted to the Department of Pediatric Surgery, the First Hospital of Peking University from March 2012 to December 2015 were analyzed retrospectively. Seventeen children underwent right frontal craniotomy in stage I. The hypothalamic hamartomas were resected via the transcallosal transseptal interforniceal approach. Two were treated with staging operations combined with interhemispheric translamina terminalis approach and 1 hamartoma posterior to the pituitary stalk was resected via the pterional approach.

The hypothalamic hamartomas of 11 children were resected totally, 6 were resected near totally, and 3 were resected subtotally. Postoperative seizures disappeared in all children. All Engel classification reached grade I. Twelve children experienced transient high fever after procedure, 1 experienced temporary memory deficiency, 3 experienced polyuria, 1 had hypernatremia, 10 had hyponatremia (including 3 hyponatremia convulsions), and 2 had hyperphagia.

For children with hypothalamic hamartoma with epilepsy as the main clinical manifestation, early surgical treatment is safe and effective.

To investigate the clinical features and surgical treatment in children with unicoronal craniosynostosis.

The clinical data of 37 children with unicoronal craniosynostosis admitted to the Department of Neurosurgery, Nanjing Children's Hospital, Nanjing Medical University from January 2005 to December 2015 were analyzed retrospectively. All patients were diagnosed by craniofacial CT scan + three-dimensional reconstruction. The individualized surgical procedures were developed according to the characteristics of skull deformity, degree of deformity, and age of each child. Craniofacial surgery treatment was performed at stage I.

Thirty-seven children with unicoronal craniosy-nostosis were treated by the surgery. The operation effect was good. There were no serious complications. At the time of surgery, 27 children were <1 year old. Their early surgical outcome was more satisfactory. They were followed up for 1 to 10 years after procedure. Their craniofacial contours were reconstructed and brain tissues were fully developed. There were 28 children performed CT + three-dimensional reconstruction again after procedure and the cranial volume measurement was performed. Their statistical results showed that cranial volume of the children increased significantly after procedure ( P<0.05).

The craniofacial CT scan + three-dimensional reconstruction examination has an important significance for the clinical diagnosis, classification of diseases, and postoperative follow-up of craniosynostosis. According to the different characteristics of each child, choosing the individualized operation scheme and early operation, the treatment effect is better.

To observe the clinical efficacy of early external ventricular drainage (EVD) for the treatment of premature and/or low-birth weight neonates with germinal matrix intraventricular hemorrhage (GM-IVH).

A total of 14 children with GM-IVH grade Ⅲ followed up for more than 24 months and admitted to the Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University from January 2013 to February 2014 were enrolled retrospectively. All children were treated with emergent lateral ventricle external drainage for continuous drainage of cerebrospinal fluid after the definite diagnosis. The closed cerebrospinal fluid (CSF) drainage system was applied to prevent secondary intracranial infection.

The mean EVD time of 14 children was 11.9±1.7 d, the volume of CSF drainage was 33.0±12.9 ml/d, and the intraventricular pressure (IVP) was controlled under 50 mmH2O. The intraventricular hemorrhage disappeared in all cases after EVD. The examination at 2 month after the removal of external ventricular drainage in 14 children, the ventricular system continued to expand in 8 cases. Then the ventriculo-peritoneal shunt (VPS) was performed. At 2 months after VPS, the ventricular system was reduced. After EVD, 6 cases were followed up for 24 month, and the ventricular system was reduced. and none of them underwent VPS.

The early treatment of premature/low-birth weight neonates with GM-IVH may help to prevent the occurrence of hydrocephalus after bleeding and reduce the proportion of conducting VPS.

To investigate the risk factors for visual acuity and visual field impairments, and the effect on their prognoses.

The clinical data of 637 patients with pituitary adenoma operated at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2008 to December 2013 were analyzed retrospectively. The patients were followed up at 3 years after procedure. Receiver operating characteristic (ROC) curve was used to obtain the optimal critical value of the risk factors for affecting visual acuity and visual field impairments and postoperative recovery. The round numbers were taken to group.

In 637 patients, 436 (68.4%) experienced visual acuity and visual field impairments, 414 of them had decreased vision, and 292 had visual field defect. Receiver operating characteristic (ROC) curve showed that (1) the suprasellar extension height of tumors <12.5 mm tended to cause less visual acuity and visual field impairments in patients. There was significant difference in whether the preoperative visual acuity and visual field were impaired and the degree of visual impairment between the ≤10 mm group and the >10 mm group (all P<0.01); (2) the suprasellar extension height of the tumors >18.5 mm, the risk of causing permanent visual acuity and visual field impairments increased. There were significant differences in postoperative visual acuity improvement, visual acuity and visual field impairment score (VIS) grades between the suprasellar extension height of tumors ≤20 mm group and the and >20 mm group (P<0.01). There was no significant difference in the improvement of visual field (P>0.05); (3) the patients with the duration of preoperative visual acuity and visual field impairments >13.5 months, the postoperative visual acuity and visual field impairments were more difficult to improve. There was significant difference between the recovery of visual acuity in patients with the duration of the disease >12 months after operation and the VIS grade poor than ≤12 months.

The greater the height of pituitary adenoma extending to the suprasaddle, the higher the probability of visual acuity and visual field impairments. The improvement of visual acuity and visual field after procedure is associated with the height of tumors extending to the suprasaddle and the course of visual acuity and visual field impairments.

To investigate the operation experiences of resection of intraventricular tumors with the neuroendoscopic technique and to evaluate its advantages and disadvantages.

From March 2012 to December 2014, the clinical data of 8 patients with cerebral ventricular tumor resected completely under the neuroendoscopic cavity operation at the Department of Neurosurgery, Nanfang Hospital, Southern Medical University were analyzed retrospectively. The maximal diameter of the cerebral ventricular tumors was 2.1 cm in this group. The clinical manifestations were headache in 4 cases, and dizziness in 1 case. One patient was found after head trauma, 1 was found during the physical examination, and 1 was found hydrocephalus during the prenatal examination. CT and MRI revealed that 8 patients had intraventricular occupying lesions, the tumors of 3 cases were located in the antecornu and 5 were located in the lateral ventricle trigone. All patients used the neuroendoscopic cavity operation technique to remove the tumors.

The intraventricular tumors of 8 patients were resected completely. The pathological examination confirmed that 3 patients had meningiomas and 5 had choroid plexus papilloma. One patient had postoperative intracranial infection, and others did not have any complications. They were followed up for 3-36 months after procedure. No recurrence was found in imaging examination.

The pure neuroendoscopic intraventricular tumor removal has the advantages of less injury, quick recovery, and less complications. It is suitable for resection of small cerebral ventricular tumors

To investigate the roles of multi-voxel proton magnetic resonance spectroscopy for identifying low- and high-grade gliomas.

From January 2015 to December 2015, 53 consecutive patients with brain glioma diagnosed pathologically at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University were enrolled. There were 29 patients in the low-grade group and 24 in the high-grade group. SIEMENS Prisma 3 T magnetic resonance scanner performed conventional magnetic resonance scanning and ¹H-MRS scanning before procedure. The choline (Cho)/N- acetyl aspartate (NAA) of the region of interest at same parts of the side of tumor and contralateral side (unaffected side) was obtained according to the ¹H-MRS results. The ratios of mean values of Cho/NAA and the maximum values in both groups were compared. Receiver operating characteristic (ROC) curve was used to analyze the Cho/NAA value and assess the efficiency of glioma grade.

Compared with contralateral same area of the same group, the mean value of Cho/NAA in the tumor parenchyma areas of the low- and high-grade groups increased significantly. There was significant difference (all P<0.001). Compared with the low-grade group, the maximum ratio, mean value, side of tumor and the ratio of contralateral Cho/NAA mean values of the tumor parenchyma Cho/NAA in the high-grade group were all increased. There were significant differences (allP<0.01). The ROC curve analysis showed that the Cho/NAA maximum ratio of tumor parenchyma, the mean value of Cho/NAA, the ratios of the mean values of the side of tumor and contralateral Cho/NAA for diagnosis of the area under the curve of the different grade gliomas were 0.7938 (the sensitivity and specificity were 54.6% and 92.9% respectively) and 0.7581 (the sensitivity and specificity were 59.1% and 78.6% respectively), and 0.7386 (the sensitivity and specificity were 45.5% and 92.9% respectively).

¹H-MRS detection of Cho/NAA has clinical application value for identifying the low-grade and high-grade gliomas.

To investigate magnetic resonance imaging and pathological features of intracranial hemangiopericytoma in order to improve the understanding of this disease.

From January 2011 to October 2014, the clinical features, imaging findings, intraoperative findings and pathologic features of 12 patients with intracranial hemangiopericytoma confirmed by surgical pathology in Nanfang Hospital, Sounthern Medical University were analyzed retrospectively.

The imaging features of 12 patients: the tumors of all 12 patients were lobulated, 7 had cross-lobe or cross-line growth, 9 showed edema shadow. No hemorrhage and calcification were observed. Necrotic cystic changes were observed in 8 cases, vascular flow voids were observed in 11 cases. Enhanced scan revealed inhomogeneous enhancement in 9 cases. The narrow base connected to the dura in 8 cases. The dural tail signs were observed in 5 cases. The adjacent bone was destructed in 1 case. All patients underwent surgical resection, including 9 invaded the adjacent tissues, 10 were totally resected, and 2 were subtotally resected. Five patients were pathologically diagnosed as intracranial hemanyiopericytoma WHO grade II after procedure, 5 were diagnosed as grade III, and 2 were diagnosed as grade II-III. Immunohistochemical showed that the expressions of CD34 and Vim were positive, and those of EMA, S-100, and GFAP were negative. The Ki-67 positive index increased with the tumor grade.

Intracranial hemangiopericytoma is easily misdiagnosed as meningioma before procedure, however its degree of malignancy is high and the prognosis is poor. Its MRI and pathology have certain characteristics. Analyzing and summarizing its characteristics contribute to the improvement of the accuracy of preoperative diagnosis and provide to help for choosing clinical treatment options.

To investigate the methods and effect of sellar floor reconstruction after resection of pituitary adenoma via neuroendoscopic transsphenoidal approach.

From August 2006 and August 2014, the clinical data of 115 patients with pituitary adenoma admitted to the Department of Neurosurgery, Inner Mongolia People’s Hospital were analyzed retrospectively. All patients underwent resection of pituitary adenoma via single nostril neuroendoscopic transsphenoidal approach. Ninety-seven patients with no obvious cerebrospinal fluid leakage during the operations were treated with artificial dural reconstruction of the sellar floor dura (simple repair). Subcutaneous fat, muscle, fascia, and artificial dura layer repair were used to reconstruct the sellar floor dura in 18 patients with cerebrospinal fluid leakage (complex repair). The follow-up time ranged from 6 to 36 months (mean, 25.5 months).

The pituitary adenomas of 97 patients (84.3%) were resected completely and 18 (15.7%) were resected subtotally. A total of 86 patients completed follow-up and 29 lost to follow up. None of the patients experienced cerebrospinal fluid leakage within the follow-up period.

For patients whose pituitary adenomas were resected via single nostril neuroendoscopic transsphenoidal approach, taking the corresponding sellar floor reconstruction strategy can effectively prevent postoperative cerebrospinal fluid leakage and reduce postoperative complications according to whether occurring cerebrospinal fluid leakage or not during the operations.

To evaluate the efficacy and safety of domestic vagus nerve stimulator for the treatment of pharmaco-resistant epilepsy (PRE) through a prospective, multicenter, randomized, double-blind, parallel controlled trial.

A total of 72 patients with PRE in 5 hospitals were enrolled from August 2014 to December 2014. A domestic vagus nerve stimulator was used to conduct vagus nerve stimulation (VNS). All patients with PRE were divided into either a test group (n=35) or a control group (n=37) according to the principle of central randomization. Two weeks after procedure, the vagus nerve stimulator of the test group was turned on really. The parameters (electric current, pulse width, frequency, duration of stimulation, and time interval) of the stimulus set were optimized; whereas that of the control group was turned on simulatedly. At 4 months after operation, the stimulator was turned on and unblinded. According to the Mchugh classification and the modified Engel classification standards, the effectiveness and safety of using the stimulator to treat PRE were evaluated at 4 and 8 months after procedure in both groups.

At 4 months after procedure, there were 16, 8, 8, 0, and 3 patients, respectively in the McHugh classification grade Ⅰ, Ⅱ, Ⅲ , Ⅳ and Ⅴ test groups, and 9, 3, 16, 0, and 9 patients in the control group, respectively. There were 8, 4, 12, and 11 patients, respectively in the modified Engel classification grade Ⅰ, Ⅱ, Ⅲ , Ⅳ and Ⅴ test groups, and there were 4, 5, 3, and 25 in the control group, respectively. At 4 months after procedure, the seizures in the test groups were improved obviously compared with before procedure. The improvement of the test groups were significantly better than the control group (the improvement rates of seizures were -63.0% and -34.0%, respectively; P=0.006). The symptoms were improved gradually after turning on the stimulator in the control group. At 8 months after procedure, there were 15, 10, 7, 2, and 1 patient, respectively in the Mchugh classification grade Ⅰ, Ⅱ, Ⅲ , Ⅳ, and Ⅴ test groups, and there were 9, 9, 19, 0, and 0 patients in control group, respectively. There were 7, 2, 19, and 9 patients respectively in the modified Engel classification grade Ⅰ, Ⅱ, Ⅲ and Ⅳ test groups, respectively, and there were 4, 2, 12, and 19 patients in the control group, respectively. The efficacy of the control group was gradually similar to the test groups. Compared with the baseline, the efficacy was improved significantly (P<0.001). At 8 months after procedure, the seizure frequency of 33.3% of patients reduced more than 80%, and that of 59.7% of patients reduced more than 50%.

Using domestic vagus nerve stimulators can significantly reduce the seizure frequency in patients with PRE. It has higher effectiveness and safety. It is suitable for the treatment of patients with PRE.

To investigate the operation key points and clinical efficacy of oblique lateral interbody fusion (OLIF) for the treatment of degenerative lumbar disease.

The clinical data of 22 patients with degenerative lumbar disease treated with OLIF at the Department of Neurosurgery, Sichuan Provincial People’s Hospital from December 2014 to October 2015 were analyzed retrospectively. Eight patients were treated with the combined posterior percutaneous pedicle screw fixation, 11 were treated with the combined anterior percutaneous pedicle screw fixation, and 3 did not treated with the screw-rod system fixation. The visual analogue scale (VAS) score, Oswestry disability index (ODI) score, and imaging findings before and after procedure were compared. The clinical efficacy of the surgical method was evaluated. The follow-up time ranged from 3 to 9 months (mean, 6.6 months).

Postoperative VAS score (2.73±0.84) and ODI score (20.97±3.83) were significantly decreased compared with before procedure (VAS score: 7.10±0.97; ODI score: 60.86±6.88; all P<0.05). The average operation time was 92.5±14.8 min, the average blood loss was 78.4±29.6 ml, and the average length of stay was 8.2±2.4 d. Compared with before procedure, the postoperative intervertebral space height was increased (after procedure: 9.12±1.09 mm, before procedure: 5.24±1.07 mm,P<0.001) and the intervertebral foramen area was increased in 22 cases (after procedure: 1.81±0.25 cm², before procedure: 0.83±0.10 cm², P<0.001). None of them had severe complications, such as vascular injury, lumbar plexus nerve injury, ureteral injury and infection.

OLIF is a safe, effective, and minimally invasive surgical method for the treatment of lumbar degenerative disease. Its clinical efficacy is reliable in the near future. It has the advantages of short operation time, less intraoperative blood loss, less trauma, and quick recovery. Strict selection of patients and grasping the technical details are the keys to the success of surgery.

To establish a three-dimensional model of posterior skull fossae in order to help neurosurgeons to master the anatomical characteristics of posterior cranial fossae.

The preparations of 2 adult skull fault specimens were completed by using the freezing milling technique. The calibration, extraction and three-dimensional reconstruction of head serial thin sections were performed by using computers in order to obtain the three-dimensional images of the related structures in the posterior cranial fossae.

A total of 854 coronal sections and 353 horizontal sections associated with posterior fossae were obtained successfully. On the 2 sets of sections, the anatomical structures such as nerves and blood vessels could be tracked dynamically. The morphology of the three-dimensional model of posterior cranial fossae reconstructed was lifelike, including brain stem, cerebellum, vertebral-basilar artery, and cranial nerve Ⅲ~Ⅻ. The three-dimensional model could be rotated arbitrarily, scaled, and splitted randomly.

The three-dimensional model of the posterior cranial fossae can be induced by means of the freezing milling technique and visually display the stereoanatomic relationship of the posterior cranial fossa structure, thereby increasing clinicians understand the anatomical relationship of the region. This model can be used as a teaching courseware, and it can also be used as the basis for the selection of operative approach and the tool for simulating the operation process.

To investigate the cranial fossa skull anatomical landmarks combining CT reconstruction via assisted retrosigmoid sinus approach for craniotomy.

Twenty patients operated via retrosigmoid sinus approach at the Department of Neurosurgery, Nanjing Brain Hospital Affiliated to Nanjing Medical University from December 2014 to May 2014 were enrolled respectively. before operation, 3-D CT reconstruction software was used to reconstruct posterior fossa 3-D skulls of the patients, and a virtual"keyhole" was made on the position of the groove of transverse sinusinner of the inner surface of skull and the sigmoid sinus sulcus transitional position within the lower edge, and then with the aid of the anatomical landmarks such as star points and vertices of digastric groove, the"keyhole" was located, obtaining the distance and angle information, making paper models according to this information. After model disinfection, it is relative to the intraoperative anatomic landmarks, and the"keyhole" was located.

No venous sinus rupture and hemorrhage occurred in 20 patients. The transverse sinus and sigmoid sinus transitional areas within the"keyhole" were exposed clearly in 15 patients; while those were not the same case in 5 patients. They were exposed after the bone was ground or bitten away (4.0±0.3 mm) from the front outer direction. The center distance of star point-"keyhole" was 6.8-21.6 mm (mean 14.0±3.6 mm). The angle between the connecting line of the star point-center and baseline was 4-50° (mean 24±13°).

Using posterior cranial fossa skull surface landmarks combine with the location of 3-D CT bone reconstruction is more accurate. The risk of venous sinus injury is low. It may realize individualized localization of"keyhole" .

moyamoya syndrome (MMS), also known as moyamoya-like disease, refers to cerebrovascular disease caused by more than one underlying disease, in which the terminal end of bilateral or unilateral internal carotid artery (ICA) or the initial segment of middle cerebral artery (MCA) or anterior cerebral artery (ACA) is narrowed or occluded, accompanied by abnormal vascular network formation. Its underlying diseases include: Graves disease, atherosclerosis, systemic lupus erythematosus, etc^[1,2]。 MMS combined with Graves' disease is rare in clinical practice. Since the first case of hyperthyroidism (hyperthyroidism) MMS was reported in 1991, people have gradually discovered that there are potential common pathophysiological mechanisms between the two. This article retrospectively analyzed the clinical data of five patients with MMS complicated with Graves' disease admitted to the Department of Neurosurgery of Aviation General Hospital of China Medical University from January 2011 to July 2015, and now reported as follows.

To study the effect of microRNA-451 (miR-451) on invasion ability of LN229 glioma cells line through the regulation of the expression levels of matrix metalloproteinases (MMP)-2 and MMP-9.

Both in vivo and in vitro experiments there are 3 groups, they were blank control groups, scramble sequence groups, and miR-451 mimics groups, respectively. The synthetic oligonucleotide miR-451 mimics were transfected into LN229 glioma cells in order to upregulate the expression of miR-451. Real-time quantitative PCR assay was used to detect the expression of miR-451 after transfection. Western blot was used to detect the expression levels of MMP-2 and MMP-9 proteins. Transwell assay was used to detect the invasion ability of LN229 glioma cells in each group. A LN229 cell tumor-bearing nude mice model was induced at the same time. Tumor growth curve was drawn, and immunohistochemistry was used to detect the expression levels of MMP-2 and MMP-9 proteins in tumors of each group.

The results of PCR detection suggested that the miR-451 expression was increased significantly in the miR-451 mimics group compared with the blank control group and the scramble sequence group (all P<0.05). The results of Western blot assay showed that the relative expression levels of MMP-2 in the miR-451 mimics group (0.26±0.03) was lower than 0.67±0.03 and 0.65±0.04 respectively in the blank control group and the scramble sequence group (allP<0.05). The relative expression of MMP-9 (0.25±0.02) in the miR-451 mimics group was lower than 0.71±0.04, and 0.73±0.01 in the blank control group and the scramble sequence group (allP<0.05). The results of Transwell assay showed that the number of cells passing through Transwell chamber in the miR-451 mimics group was 41.0±2.9, it was lower than 79.0±2.7 in the blank control group and 73.0±3.4 in the scramble sequence group (allP<0.05). The results of in vivo experiment showed that the tumor volume (697.31±65.25 mm³) in the miR-451 mimics group was less than 1 753.69±76.52 mm³ and 1 532.64±65.31 mm³ in the blank control group and the scramble sequence group (all P<0.05). The results of immunohistochemistry showed that the expression levels of MMP-2 and MMP-9 proteins in tumor tissues of the miR-451 mimics group was significantly lower compared with the blank control group and the scramble sequence group (P<0.05).

miR-451 inhibits the invasive growth ability of LN229 glioma cells by regulating the MMP-2 and MMP-9 expression levels. It may provide a candidate target for potential human glioma gene therapy.

To observe the effect of TUG1 gene silencing on glioma cell growth and apoptosis.

A slow virus vector pLenti6.3-EGFP of carrying shRNA-TUG1 was constructed and then transfected into human glioma U251 cells. The expression levels of TUG1 LncRNA gene in U251 cells were detected by using the real-time fluorescence quantitative PCR. The inhibitory effect of the interference vector on LncRNA TUG1 gene was observed. Flow cytometry and CCK-8 assay were used to observe the effect of interfering TUG1 gene on U251 cell proliferation and apoptosis.

The results of real-time fluorescent quantitative PCR detection showed that as for the relative amount of LncRNA TUG1, there were significant differences among the U251 blank control group (0.40±0.05), the negative control group (1.01±0.12), siRNA-1 (0.09±0.01), siRNA-2 (0.32±0.01), siRNA-3 (0.18±0.04), and siRNA-4 (0.18±0.02) (P<0.05). The siRNA-1 with the best interference effect was selected for subsequent interference experiments. The apoptotic rate of the TUG1 interference group (11.58±0.11%) was higher than that of the blank control group (8.55±0.23%) and the negative control group (9.14±0.17%) (allP<0.05); the cell proliferation capacity of the TUG1 interference group (0.64±0.23) was lower than that of the blank control group (1.07±0.50) and the negative control group (0.94±0.42) (allP<0.05).

TUG1 gene silencing may inhibit the proliferation of U251 glioma cells and promote cell apoptosis.

To evaluate the clinical efficacy of resection of anterior skull base meningiomas via endonasal approach and craniotomy.

Comparison of the randomized and non-randomized controlled trials of resection of anterior skull base meningioma via endonasal approach and craniotomy both at home and abroad were enrolled by retrieving PubMed, Ovid, Cochrane Library, Embase, Wanfang, VIP, Chinese Journal Full-text Database, and manual retrieval. The literature was selected, the data were abstracted, and they were checked crossly by 2 independent reviewers. RevMan 5.3 software was used for statistical analysis.

After screening, 6 articles were enrolled. A total of 182 patients were used as the objects, 68 of them were in the transnasal group and 144 were in the craniotomy group. There was no significant difference in postoperative cerebrospinal fluid leakage between the transnasal group and the craniotomy group (OR=3.16; 95% CI 1.26-7.90; P=0.01). There were no significant differences in the total tumor resection rate, endocrine disorder, infection, recurrence, visual improvement, and visual deterioration between the 2 groups (all P>0.05).

According to the current literature available, the resection of anterior skull base meningiomas via nasal approach could achieve the effect of total resection of craniotomy. Although there were no significant differences in the postoperative visual effects, infection, endocrine disorders and recurrence between the two, the craniotomy has some advantages in the aspect of controlling postoperative cerebrospinal fluid leakage.

A 34-year-old male was found to have a progressive enlarged mass in front of the right ear for more than 2 months. Physical examination: There is a 2cm ×3cm subcutaneous texture in front of the right ear, and there is no redness, swelling and tenderness in the skin. CT examination of the head showed subcutaneous lesions in the right temporal region and space-occupying lesions in the right middle fossa (Figure 1)。 During the operation, the tumor appeared fleshy brown, hard in texture, with calcified tissue inside, adhered to the maxillary joint, invaded and destroyed the bone in the anterior wall of the external auditory canal, the anterior wall of the Eustachian tube, and the inner side of the zygomatic arch, destroyed the temporal bone and protruded into the cranium, invaded the dura mater, and destroyed the bone in the skull base and protruded into the cranium. The boundary between tumor and normal bone is clear, and it is easy to scrape out with a curette. Skull base reconstruction was performed after tumor resection. Pathological examination: The submitted object was dark red tissue with a total volume of about 3cm ×5cm ×7cm, hard in texture and scattered calcification. Microscopically, the tumor was composed of chondroblasts, multinucleated giant cells and chondroid matrix (Figure 1)。 Immunohistochemical results: AE1 (−), AE3 (−), Vim (+), EMA (−), CD163 (+), KP1 (+), 514H12 (+), S-100m (−), NSE (−), CD57 (−), CEA (−), Desmin (−), CD34 (vascular +), Ki-67 (less +), CD45 (−), HMB45 (−), Me1A (−), CAM5.2 (−), CK19 (−), S-100p (+), SMA (+), NF (+), GFAP (−). The diagnosis suggested chondroblastoma. No tumor recurrence was observed after 2 years of follow-up.

Male, 6 years old. He was admitted to hospital in March 2015 due to pain in his right shoulder for 2 months, pain in his right upper limb for 1 month, pain in his neck and head for 20 days, and pain in his left upper limb for 10 days. Physical examination: consciousness was clear, limbs moved freely, muscle strength and muscle tone were normal, and pathological reflexes were not drawn out. There were no abnormalities in the past history, and no similar diseases were found in the family. MRI of the neck showed that the lesion was located at C_4～7Horizontal, extramedullary subdural, ventral side of the spinal cord, compressing the spinal cord backwards, with obvious tumor enhancement and meningeal rat tail sign (Figure 1), considered a benign meningioma. During the operation, it was found that the lesion was located on the ventral side of the spinal cord, firmly attached between the dura mater and the vertebral dissection, and had no boundary with the dura mater. The tumor was gray-white in color, tough and brittle in texture, and the blood supply was abundant. The tumor was totally resected under a microscope (Figure 1)。 Postoperative pathological diagnosis: consistent with rhabdoid meningioma (Figure 2)。 Follow-up by telephone after discharge, loss of contact after 2 months.

Intracranial metastases are the most common intracranial tumors, and the incidence rate is about 10% ~20% of adult cancers^[1]。 Among the primary tumors with brain metastasis, 25% to 30% were lung cancer, 10% to 15% were breast cancer, and 12% to 20% were melanoma^[2]。 Circulating tumor cells of primary tumor can spread through hematogenous, lymphatic tract and direct invasion routes, and metastasize to brain tissue. Most of the metastatic lesions are located in the supratentorial (80%), a few in the cerebellum (15%) and brain stem (5%). The incidence rate corresponds to the volume percentage of each tissue in the brain^[3,4]。 The clinical manifestations of intracranial metastases are not specific, and their diagnosis is mainly based on the symptoms of central nervous system involvement. In the past, due to the insufficient research on intracranial metastases, the treatment was mainly palliative methods, such as the use of glucocorticoids to alleviate peritumoral edema caused by intracranial metastases. In recent years, with the in-depth research on intracranial metastases and the development of imaging medicine, surgery, whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS) and chemotherapy have become the standard treatment for intracranial metastases, but the effect is still not satisfactory, and the overall survival (OS) and quality of life of patients have not been significantly improved. Therefore, targeting and immunotherapy based on oncogenesis and molecular typing have gained increasing attention.

tuberous sclerosis complex (TSC) is a systemic disease characterized by multiple organ tissue defects and hamartomas, which is autosomal dominant and has an incidence of 1/6 000 to 1/10 000^[1]。 The disease-causing genes are TSC1 and TSC2, and mutations in either gene encoding them will lead to dysregulation of nervous system development^[2]。

Epilepsy is one of the most common neurological disorders, affecting about 50 million people worldwide^[1]。 Application of neuroexcitatory blockers to prevent the recurrence of epilepsy is a common treatment for epilepsy. However, approximately 1/3 of the clinical population is not satisfactory for this type of treatment^[2]This may be related to the etiological diversity of epilepsy. Existing studies have shown that gene mutations in receptors, channels and neurotransmitters that regulate nerve excitation can cause epilepsy; Factors that can cause brain damage, such as status epilepticus, trauma, infection, and cancer, can also induce epilepsy^[3]。 Epileptic seizures and status epilepticus can be mediated by immunity, and the International League Against Epilepsy (ILAE) has listed immunity as one of the causes of Epilepsy^[4]。 Gene microarray detection showed that the genes related to the activation of immune response were significantly persistently upregulated during epileptogenesis^[5]。 Studies have shown that removal of neutrophils from animal models can inhibit the occurrence and progression of epilepsy^[6]。 In fact, normal, non-epileptic mice do not have white blood cells in the brain tissue^[7]While white blood cells accumulate in the brain during brain injury and subsequent epileptogenesis. In a mouse epilepsy model, blocking the interaction between leukocytes and blood vessels in brain tissue can prevent the aggregation of leukocytes and thus inhibit the induction and occurrence of epilepsy^[6]。 myeloperoxidase (MPO) is a potential regulator of inflammatory response in leukocytes^[8,9]Participate in the occurrence and development of many diseases. This article reviews the related mechanisms of MPO in epileptogenesis, research progress, some challenges and application prospects.

Intracranial arteriovenous malformations (AVM) are vascular malformations caused by abnormal development of intracranial vessels, consisting of dilated malformed arteries and veins. The main purpose of AVM treatment is to completely remove the malformed vascular mass or occlude the blood flow of the malformed vascular mass, so as to avoid serious complications caused by bleeding of the malformed vascular mass. The main treatment methods include surgical resection, endovascular embolization, radiotherapy and combination therapy. According to the different treatment modes of AVM, various evaluation systems have been established to predict the surgical risk and therapeutic effect. This article summarizes the various evaluation systems of AVM as follows.

Endoplasmic reticulum is an organelle with multiple functions in cells, which can modify, fold and secrete newly synthesized proteins and play an important role in maintaining the homeostasis of the internal environment of cells^[1]。 When external stimuli interfere with protein folding and post-translational modification of the endoplasmic reticulum, lipid and steroid synthesis, gene expression and cell metabolism, and calcium channel conduction pathway, unfolded proteins will accumulate in the endoplasmic reticulum cavity, which can induce endoplasmic reticulum stress (ERS)^[2]。 ERS is generally a self-protection behavior of cells, which can help proteins fold correctly to avoid cell death through the repair of endoplasmic reticulum chaperones; However, if persistent ERS response (ERSR) does not restore cell function, apoptosis will be triggered^[3,4]。 Many factors such as oxygen content, pH and nutrient content of tumor parenchyma can cause ERSR, so cancer cells must have the ability to adapt and prevent excessive stress in the endoplasmic reticulum^[5]。 In recent years, researchers dedicated to tumor-targeted drugs have noticed the role of ERS in affecting glioma cell apoptosis, and have tried to develop new targeted antitumor drugs for the treatment of malignant glioma with this goal^[6,7,8]。 The research progress of ERS in malignant glioma is reviewed as follows.

blunt cerebrovascular injury (BCVI) refers to the pathological injury of different tissues of common carotid artery, intracranial and extracranial internal carotid artery, vertebral artery and other blood vessels caused by trauma, which is prone to secondary stroke and can cause serious neurological dysfunction or even death. In 1872, French doctor Verneuil first discovered carotid artery injury through autopsy. In 1967, Yamada et al. reported clinical cases of carotid artery injury. Subsequently, cases were reported in different neurosurgical centers, mostly traumatic aneurysms and arteriovenous fistulas. With the advancement of neuroimaging technology, increased screening of patients at high risk of BCVI and deeper understanding of such diseases, the incidence of BCVI is on the rise^[1,2]。 For trauma patients, BCVI is a kind of occult injury. Although it is uncommon, if it is not diagnosed and treated in time, it has a high disability rate and fatality rate. This paper reviews the current research progress in epidemiology, pathophysiological mechanism, clinical manifestation, screening strategy and treatment of BCVI, so as to strengthen clinicians' understanding of the diagnosis and treatment of this kind of injury.