Volume 32 · Issue 10 · 2016

Functional neurosurgery is a surgical method to correct the abnormalities of nervous system function, mainly aiming at specific nerve roots, nerve circuits, neuron groups (brain nuclei) and brain networks, aiming at changing pathophysiological processes and reconstructing the normal function of nerve tissue. Functional neurosurgery is an important part of neurosurgery, and it is one of the most rapidly growing, dynamic and promising branches. According to the literature reports, functional neurosurgery and spinal neurosurgery are on the rise compared with all subspecialties of neurosurgery, and the popularity and vigorous development of functional neurosurgery in China in recent years can also be used as evidence^[1]。

microvascular decompression (MVD) is the first surgical treatment for primary trigeminal neuralgia, idiopathic hemifacial spasm, primary glossopharyngeal neuralgia and other functional diseases. In MVD, after the responsible blood vessel that compresses the root entry/exit zoon (REZ) of the corresponding cranial nerve root is separated and pushed apart, an implant is placed between the brainstem and the responsible blood vessel to pad the blood vessel to prevent the vascular reduction from re-compressing the REZ. Over the years, many materials have been used as decompression implants in MVD, so it is necessary to standardize the selection and correct use of their materials.

To investigate the application value of magnetic resonance virtual endoscopy (MRVE) combined with three-dimensional time-of-flight (3D-TOF) and three-dimensional fast imaging employing steady-state acquisition (3D FIESTA) sequence in the microvascular decompression of trigeminal neuralgia.

Seventy-six patients with primary trigeminal neuralgia treated with microvascular decompression (MVD) at the Department of Neurosurgery, Huzhou Central Hospital from August 2012 to April 2015 were enrolled retrospectively. All the causes of disease in the patients were identified during the operations. All patients conducted imaging examinations of 3.0T MRI for 3D-TOF, 3D-FIESTA, and MRVE. The diagnostic and intraoperative values of MRVE combined with 3D-TOF and 3D-FIESTA sequences were evaluated.

In 76 patients, the preoperative 3D-TOF+ 3D-FIESTA sequences diagnosed 63 patients with offending vascular compression. The coincidence rate with the surgery confirmation was 83% and 13 patients (17%) were missed diagnosis; 3D-TOF+ FIESTA+ MRVE sequences diagnosed 72 patients with offending vascular compression, the coincidence rate was 95%, and 4 were missed diagnosis (5%), P=0.04. The patients of diagnostic coincidence of the 2 kinds of sequences were mainly the arteries as offending vessels. The patients of missed diagnosis were mainly in patients with offending vessels as veins, one of the patients with subarachnoid adhesions and thickening was missed diagnosis.

MRVE technique combined with 3D-TOF and 3D-FIESTA sequences may clearly reveal the relationship of three-dimensional space between offending vessels and nerves, and improve the accurate rate for identification of offending vessels.

Sturge-Weber syndrome (SWS), also known as cerebrofacial hemangiomatosis or cerebral trigeminal hemangiomatosis, is a rare and sporadic congenital neurocutaneous syndrome^[1]Caused by GNAQ gene mutation, non-hereditary, with an incidence of 0.02‰ ~0.05‰, manifesting as vascular malformations involving the brain, skin and eyes. Vascular malformations in the brain often cause intractable epilepsy, and different individualized treatment programs are needed according to different conditions. A total of 3 children with epilepsy with Sturge-Weber syndrome were treated in the Department of Neurosurgery, Yuquan Hospital, Tsinghua University from January 2010 to December 2015. The efficacy was satisfactory, and the results are reported as follows.

To investigate the clinical characteristics and surgical efficacy of resection of refractory epilepsy in children and adolescents.

From April 2001 to December 2014, a total of 620 patients with refractory epilepsy (≤18 years old) resected at the Department of Functional Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University were enrolled. The clinical characteristics and surgical outcomes of the surgical treatment in children and adolescents were analyzed retrospectively.

In 620 patients, there was 132 children in a younger group (0-7 years old), 171 in a school-age group (7-12 years old), and 317 in an adolescent group (>12-18 years old). The 169 patients (27.3%) with epileptic focus negative and 451 (72.7%) with epileptic focus positive were located by MRI. A total of 280 patients (45.2%) underwent intracranial electrode long-term monitoring. There were 169 patients with temporal lobe epilepsy (TLE), 415 (66.9%) with extra-temporal lobe epilepsy (ETLE), and 45 (7.3%) with epilepsy caused by hemisphere lesions. There were significant differences in the epileptic types among the different age groups (P=0.002). The proportion of TLE in the adolescent group was the highest (31.5%, 100/317), the ETLE in the school-age group was the highest (73.7%, 126/171), and the proportion of epilepsy caused by the hemisphere lesions was the highest (14.4%, 19/132). After procedure, 620 patients were followed up for a mean of 1.6±1.1 years, 409 (66.0%) were seizure-free. The proportions of seizure-free in the MRI positive group and negative group were 71.2% (321/451) and 52.1% (88/169) respectively. There was significant difference (P=0.000). The proportions of seizure-free in the TLE group, ETLE group, and hemispheric lesion group were 75.0% (123/164), 60.1% (247/411), and 86.7% (39/45), respectively. More serious complications occurred in 14 cases (2.3%, 14/620) after procedure. Pathological examination found that 213 patients (34.4%) had focal cortical dysplasia (FCD), 56 (9.0%) had neoplastic lesions, 31 (5.0%) had nodular sclerosis, and 97 (15.6%) had hippocampal sclerosis (including 39 hippocampal sclerosis with FCD), and 223 (36.0%) had other lesions.

Epileptic focus resection is a safe and effective treatment measure for refractory epilepsy in children and adolescents. The clinical characteristics of the different age groups are different.

To investigate the clinical effect and the risk factors for influencing the surgical prognosis of hemispherectomy for the treatment of intractable epilepsy.

From July 2012 and March 2016, the clinical data of 30 patients with intractable epilepsy treated with hemispherectomy at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University and the Epilepsy Center, Beijing Fengtai Hospital were analyzed retrospectively. Nine patients were treated with anatomical hemispherectomy, 2 with functional hemispheretomy, and 19 with hemispherectomy. Its preoperative clinical characteristics and postoperative seizure control status of the patients were summarized. The related risk factors for influencing the prognosis of seizure were analyzed with chi-square test.

The postoperative mean follow-up time of 30 patients was 19.4±14.8 months. Twenty-six (87%) with postoperative epilepsy achieved seizure free completely. Some patients returned to normal learning and work after procedure, 4 had incomplete remission. The postoperative pathology of anatomical hemispherectomy in 9 patients showed that 7 had encephalomalacia, 1 had Rusmussen encephalitis, and 1 had a large number of subpial capillary hyperplasia (Sturge-Weber syndrome). The hippocampal pathology after hemispherectomy mostly showed atypical changes, 3 of them showed hippocampal sclerosis. There were no significant correlations in sex, age of onset, age of operation, duration of epilepsy, imaging findings, surgical methods, whether contralateral EEG abnormal or not, and surgical prognosis. There was statistical significance between whether clinical seizures were secondary generalized tonic-clonic seizures and prognosis after procedure (P<0.05).

Hemispherectomy is an effective treatment means for patients with intractable epilepsy whose epileptogenic focus involving one side of the cerebral hemisphere. The clinical seizure types had a certain role in prompting for surgical prognosis.

To study the clinical features of idiopathic hemifacial spasm (HFS) after Bell's palsy and the efficacy of microvascular decompression (MVD) of facial nerve root.

From April 2007 to April 2010, 550 patients with HFS were treated by a single operator of the Department of Neurosurgery, China-Japan Friendship Hospital, National Health and Family Planning Commission using MVD, 12 (2.2%) were HFS after Bell's palsy. They were all treated with facial nerve root MVD via retrosigmoid approach. The abnormal muscle response (AMR) was monitored before and during procedures. The postoperative efficacy and complications were assessed during the follow-up.

The AMR wave forms of ipsilateral facial muscles were monitored in 12 cases before procedure. All the 12 patients had clear offending vascular compression during the procedure, 11 had obvious thickening and adhesion of local cerebral cistern. After releasing vascular decompression, the AMR waves disappeared in 11 cases. HFS disappeared immediately in 9 cases after procedure. Those of 2 cases disappeared at 2.5 and 4 months after procedure. The AMR amplitude decreased in 1 case during the operation, but did not disappeared completely. The postoperative symptom was milder than that of preoperative one, however, the symptom still attacked every day. Two patients had mild facial paralysis after procedure and they recovered in about 0.5 months. The patients were followed up for a mean of 67.5 months (range, 51-84). None of them had recrudescence. The total effective ratio was 11/12.

HFS is rare in clinical practice after Bell's palsy. Vascular compression of the facial nerve root exit zoon is the cause of HFS after Bell's palsy. MVD is an effective and safe method to cure the disease. The perioperative facial muscle AMR monitoring is helpful in differential diagnosis and efficacy evaluation.

To investigate the effects of the navigated transcranial magnetic stimulation and functional magnetic resonance imaging in the cortical localization of Chinese language function and to describe the distributions of the essential language functional areas and participating language functional areas at group level and individual level.

Twenty healthy volunteers underwent functional magnetic resonance imaging of brain function by selecting the covert pictures to name task. All participating language functional areas were identified after obtaining the brain activation maps. The picture naming tasks were selected. Under the navigation of the neuronavigation system, the synchronous repetitive transcranial magnetic stimulation was conducted. The essential language functional areas of the participants were identified, and the characteristics of the essential language functional areas and participating language functional areas were analyzed on the group level and individual level.

At the individual level, there was greater difference in the distribution of Chinese language functional areas; at the group level, the range of activation was wider in the participating language functional areas than the essential language functional areas, but the overall distribution trend of the language functional areas was united, including the ventral precentral gyrus of the left dominant hemisphere, classic Broca’s area, and pars opercularis of the right non-dominant hemisphere.

The combined application of transcranial magnetic stimulation and functional magnetic resonance imaging is able to locate the essential language functional areas and participating language functional areas, it can either analyze the language function distribution trend at the group level or precisely plan the language functional areas at the individual level. It contributes to guide surgical treatment of language functional areas.

To investigate the posterior cingulate, adjacent precuneus, and whole-brain functional connectivity and its significance in patients with post-concussion syndrome (PCS) combined with memory disorders using resting-state functional magnetic resonance imaging (rs-fMRI).

From September 2014 to April 2015, 28 PCS patients with memory disorders (test group) admitted to the Department of Neurosurgery, the Affiliated Anhui Provincial Hospital, Anhui Medical University were selected, and at the same time, 28 healthy controls (control group) were recruited. The rs-fMRI data were collected and processed. The right and left posterior cingulates were used as the region of interest (ROI) respectively to make whole-brain functional connectivity calculation and conduct statistical analysis. The changes of the posterior cingulate, precuneus and whole-brain function were derived in patients with PCS.

The bilateral posterior cingulates were ROIs. The data analysis of both groups indicated that posterior cingulate had obvious strong functional connectivity with brain regions, such as medial prefrontal cortex, postmedian cingulate, precuneus, and superior parietal lobule (all P<0.05). The comparative results of both groups show that the left posterior cingulate was used as a ROI, the functional connectivity showed an enhanced state in the left posterior cingulate and bilateral precunues, middle cingulate and right posterior cingulate (allP<0.05); and the functional connectivity showed an decreased state in the bilateral supramarginal gyrus, superior temporal gyrus, Rolandic operculum, and supplementary motor area (allP<0.05). The right posterior cingulate was used as a ROI, it was found that the functional connectivity enhanced brain areas were bilateral precunei, left superior temporal gyrus, and middle frontal gyrus (allP<0.05; and the brain areas with reduced functional connectivity were bilateral supramarginal gyri, superior temporal gyrus, and Rolandic operculum, supplementary motor area, and posterior central gyrus (allP<0.05).

In resting state, the decreased related cortical functional connectivity of posterior cingulate, frontal lobe, temporal lobe, and parietal lobe in patients with PCS may be one of the causes of resulting in memory impairment, and the significantly enhanced functional connectivity with precuneus may be a compensatory effect of memory disorders.

To observe the establishment of postoperative collateral circulation and its types after the combined revascularization for the treatment of patients with moyamoya disease.

From January 2010 to January 2015, 57 patients with moyamoya disease (67 hemispheres) treated with direct vascular reconstruction (superficial temporal artery-middle cerebral artery anastomosis, STA-MCA) combined with indirect vascular reconstruction (encephalo-duro-myo-synangiosis, EDMS) at the Department of Neurosurgery, Brain Hospital Affiliated to Nanjing Medical University were analyzed retrospectively. Head CT or MR perfusion imaging was use to evaluate cerebral blood flow. According to the digital subtraction angiography (DSA) images, the establishment of collateral circulation after procedure (the cerebral hemisphere blood supply range) was evaluated. The blood supply range of revascularization of 2 surgical methods after procedure was compared.

The postoperative follow-up was 6-60 months (mean, 23±12 months). At 6 months after procedure, 60 (89.6%) of 67 hemispheres showed increased cerebral blood flow perfusion on the operated sides. The direct vascular anastomosis was patent in 65 sides (97.0%). DSA showed that the feeding range of neovascularization in patients ≥1/3 of the middle cerebral artery (MCA) blood supply region accounted for 97.0% (65 sides), among them, in patients >2/3 blood supply region accounted for 82.1% (55 sides). The neovascularization was sparse only in 2 sides, and the blood supply range <1/3 MCA blood supply region. At 6 months after procedure, the direct revascularization blood supply range in 19 sides (28.4%) was > the indirect one; and 23 sides (34.3%) were < the indirect revascularization blood supply range; and 25 sides (37.3%) were equal to the indirect revascularization blood supply range. At 6 months after procedure, there was no significant difference in the establishment of collateral circulation between the patients with ischemic and hemorrhagic moyamoya disease.

The effect of the direct revascularization combined with the indirect revascularization for the treatment of revascularization of moyamoya disease is better. The direct revascularization may immediately improve the cerebral perfusion in ischemic area, while the indirect revascularization may provide a more lasting effect of revascularization.

To investigate the clinical effect of multiple-stent after coiling technique for the treatment of the dissecting aneurysm of the vertebral artery.

From September 2011 to September 2015, the clinical data of 43 patients(43 aneurysms) with vertebral dissecting aneurysms admitted to the Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University were analyzed retrospectively. All patients were embolized with the multiple-stent after coiling technique. The follow-up time ranged from 3 to 18 months (mean, 11.6 months).

The postoperative immediate angiography results showed that the aneurysms of 15 patients were completely embolized, those of 22 were mostly embolized, and those of 6 were loosely embolized. No intraoperative aneurysm rupture was observed. The symptoms of patients were improved or stable after procedure. The aneurysms of 12 patients had different degrees of recurrence, 6 of them were treated with endovascular treatment again.

The efficacy of using multiple-stent after coiling technique is good for the treatment of the dissecting aneurysm of the vertebral artery. This method is beneficial to the maximum extent of embolization of the bodies of aneurysms and reduces the reoccurrence of aneurysms.

To investigate the feasibility and safety of the treatment of type III aortic arch right carotid stenosis and bovine type aortic arch left carotid stenosis with stent angioplasty via the right radial approach.

From September 2015 to February 2016, the clinical data of 16 patients with type III aortic arch right carotid stenosis and bovine type aortic arch left carotid stenosis treated with carotid stent angioplasty via the radial approach at the Cerebrovascular Interventional Therapy Center, Henan Provincial People's Hospital were analyzed retrospectively, including operation success rate, cardio-cerebrovascular complications, and radial artery puncture complications. All 16 patients were treated with endovascular treatment via right radial approach. The coaxial technique was used for guiding catheter to the super-select target vessels. From January 2014 to December 2015, 20 patients with type III aortic arch right carotid stenosis and bovine type aortic arch left carotid stenosis treated with carotid stent operation were selected at the same time. The ray irradiation time between the two groups were compared. The follow-up time was 3 months.

The surgical success rate of the 16 patients was 100%. Three patients had decreased blood pressure and heart rate during the operation. None of them had radial artery occlusion or severe cardio-cerebrovascular events. The ray irradiation time (9.94±0.97 min) in patients with carotid artery stenosis stenting via the radial approach was less than those via the femoral artery approach(11.51±1.39 min). There was significant difference (P=0.001).

The success rate of the type III aortic arch right carotid and bovine type aortic arch left carotid stenosis with stent angioplasty via the right radial approach is high, safe and feasible.

To observe the microsurgical anatomy of superficial veins in the brain central gyrus region.

Twenty (40 sides) cadaver head specimens were used, and the arteries and veins were perfused with red or blue latex. Under the microscope, the hand-knob of precentral gyrus was used to locate the central sulcus. The related data of venous constitution near the central sulcus were observed.

In the 40-side specimens, the veins of central gyrus region was mainly composed of precentral veins in 10 sides (25%), was mainly composed of central sulcus veins in 13 sides (32.5%), was mainly composed of central sulcus veins and precentral or postcentral veins in 6 sides (15%), and was composed of thick Trolard's veins in 11 sides (27.5%). Of the 40-side specimens, 29 sides (72.5%) had 29 precentral veins, the diameters were 0.69 cm to 6.96 cm; 32 sides (80.0%) had 35 central sulcus veins, the diameters were 1.38 cm to 5.66 cm; 39 sides (97.5%) had 41 Trolard's veins, the diameters were 0.44 cm to 2.60 cm; 5 sides (12.5%) had 5 postcentral veins, the diameters were 0.74 cm to 2.30 cm. Forty sides (100%) had 43 paracentral veins, they sneaked in the subdural spaces, the ranges were 0.4 cm to 0.9 cm (mean, 0.6 cm±0.3 cm), the return angles were 40.7° to 81.7°.

The variability of the constitution forms of the superficial veins in the cerebral central region is great, the reflux veinous branches are more, the return paths are tortuous, and it is easy to be confused with the adjacent branches of the veins. The angle of the paracentral veins flowing into the superior sagittal sinus or the venous spaces nearby, and the veins in the central gyrus region is large. The sneak distance is short in the subdural space and limits the retractor width of the longitudinal fissure. Although the appearance rate of the Trolard vein is high and sometimes is significantly thick, the veins in the central region still need to be strictly protected.

To investigate the reasonable operation time and operation approaches of the hydrocephalus treatment after decompressive craniectomy and to count its complication characteristics.

From January 2009 to February 2015, the clinical data of 54 patients treated with cranioplasty and ventricular peritoneal (V-P) shunt at the same time (n=21) or different time (n=33) at the Department of Neurosurgery, Shandong Jiaotong Hospital and the Emergency Surgery, Qilu Hospital of Shandong University were analyzed retrospectively. The operation time of both procedures and the operation related complications were analyzed and discussed.

The surgical complication rate was 32% (17/54). The occurrence rates of complications of cranioplasty and V-P shunt groups over the same period were higher than those of the staging operation group (57% vs. 15%; P<0.05). The incidence of postoperative infection of the synchronous operation group was significantly higher than that of the staging operation group (P<0.02). The incidence of postoperative complication in patients with flap bulging was higher than that in patients with flap depression (40% vs. 16%,P<0.05). There were no statistical significance in the effects of successively order, skull defect area, and degree of hydrocephalus on complications of the cranioplasty and V-P shunt between the 2 groups, however, 13 patients did not treated with V-P shunt because of their hydrocephalus were improved significantly after the first cranioplasty.

Because of its lower incidence of complications, the staging cranioplasty and V-P shunt might be more beneficial to the treatment of patients, especially for those with obvious flap bulging. Because the order of 2 procedures did not have any effect on postoperative complications and no need to perform V-P shunt after partial cranioplasty, therefore, it was recommended that patients without flap bulging should conduct cranioplasty first.

The trochlear nerve originates outside the inferior colliculus, is the only cranial nerve connected to the dorsal side of the brainstem, and has the longest path in the cranium. In the lateral area of the tentorial hiatus, the trochlear nerve walks below the tentorial margin and within the tentorial, which is called the tentorial segment trochlear nerve. During surgery in this area, the tentorial trochlear nerve creates an obstacle to exposure and manipulation of the subtentorial region, and is also highly susceptible to surgical injury. According to foreign reports, the injury rate of trochlear nerve is 13% ~28% after operation of meningioma at the free edge of the tentorial hole^[1,2]。 The traditional infratemporal transtentorial approach is to incise the tentorium parallel to the petrous crest located 1 cm behind the point where the trochlear nerve enters the tentorium, but the remaining triangular tentorium portion near the petrous apex will still occlude the exposure of the infratentorial structure. In this paper, the anatomical study of five cadaveric specimens was carried out. By freeing the trochlear nerve in the tentorial segment, the method of tentorial incision was improved, and the scope of tentorial incision was enlarged. Furthermore, the operating space of the infratentorial region, especially the superior and middle segments of the basilar artery and the Meckel cavity of the trigeminal nerve through the infratemporal-tentorial approach was enlarged. At present, there are few relevant literature reports at home and abroad, and the results are reported as follows.

In recent years, the incidence of craniocerebral trauma complicated by central cerebral hernia in the population has shown an increasing trend year by year. Because the patients with craniocerebral trauma complicated by central cerebral hernia are relatively mild in the early stage of the disease, they often do not receive corresponding attention from doctors and delay the treatment, resulting in the gradual aggravation of the disease, thus affecting the prognosis of patients and increasing the fatality and disability rate. In order to explore the diagnosis and treatment of craniocerebral trauma complicated with central cerebral hernia, this article retrospectively analyzed the clinical data of 15 patients with craniocerebral trauma complicated with central cerebral hernia admitted to the Department of Neurosurgery, Wudu District First People's Hospital, Longnan City, Gansu Province from December 2008 to June 2015, and now reported as follows.

Lateral ventricular anterior horn puncture is one of the most basic operation techniques in neurosurgery. In clinical work, there are often defects such as unsuccessful puncture, unsatisfactory position of ventricular end of drainage tube, which affects drainage effect, and brain injury and hemorrhage caused by multiple punctures, which seriously affects the prognosis of patients. Neurosurgery Department of Tianshui First People's Hospital Based on Traditional Location Method^[1]The gradually established virtual plane intersection positioning method can improve the puncture success rate and the satisfaction rate of the ventricular end position of the drainage tube, which is reported as follows.

Internal carotid artery blood blister-like aneurysm (BBA) is an aneurysm that originates from the anterior or anterior inner wall of the proximal superior clinoid segment of the internal carotid artery (ICA) and is not related to the ICA branch. It is named because the tumor wall is mostly wide, thin, visible blood flow, and bright red in appearance, which is "vesicle-like"^[1]。 BBA is rare, accounting for about 0.3% to 1.0% of all intracranial aneurysms and 0.9% to 6.5% of intracranial ICA aneurysms^[2]。 Subarachnoid hemorrhage (SAH) is the clinical manifestation of BBA. Because the tumor wall of BBA is thin and the rebleeding rate is high, active treatment should be taken after definite diagnosis^[3,4]。 Currently, despite the wide variety of treatments for BBA, there is still no optimal treatment^[5]。 The Department of Neurosurgery of the First Affiliated Hospital of Wenzhou Medical University used LVIS stent to treat 2 cases of internal carotid artery BBA, and achieved good results, which are reported below.

To Study the effect of quercetin on the biological characteristics of human glioma U251 cells and to investigate its possible mechanisms.

The U251 cells were cultured in vitro. The effect of quercetin on the proliferation of U251 cells was detected by CCK8 assay. Flow cytometry was used to detect the effect of quercetin on the U251 cell cycle and apoptosis. Scratch test and Transwell test were used to observe the effect of quercetin on metastasis and invasion of U251 cells. Western blot was used to detect the effects of quercetin on protein expression levels of U251 cell Bax, Bcl-2, MMP-9, and MMP-2.

Quercetin could inhibit the proliferation ability in vitro of U251 cells. IC₅₀ at 24 h and 48 h were 113.65 μg/ml and 48.61 μg/ml respectively. Flow cytometry showed that quercetin acting on U251 cells might have some changes, such as the upregulation of peak ratio, the downregulation of G ₀/G₁ phase rate, and upregulation of G₂/M phase rate. The migration and invasion abilities of the U251 cells pretreated by quercetin for 24 h were decreased significantly compared with the control group, and the 20 μg/ml group was lower than the10 μg/ml group ( P<0.05). After the U251 cells being treated with quercetin, the Bax expression level was upregulated, the Bcl-2, MMP-9, and MMP-2 protein expression levels were decreased, and there was significant difference between the 10 μg/ml group and the 20 μg/ml group (P<0.05).

Quercetin has significant cytotoxic effect in vitro on U251 cells. It can induce apoptosis of U251 cells, causing G₂/M phase arrest, decreasing the cell migration and invasion abilities. These effects may be associated with the decrease of Bcl-2/Bax ratio and the downregulation of MMP-9 and MMP-2 protein expression levels.

To investigate the role of myeloperoxidase (MPO) in epileptogenesis and to perform in vivo imaging of MPO noninvasively for localizing the epileptic foci by means of molecular imaging in order to provide the basis for surgical resection of cryptogenic epileptic foci.

A mouse epilepsy model was induced by intraperitoneal injection of pilocarpine. MPO specific inhibitor 4-aminobenzoic acid hydrazide (ABAH) was used to conduct the intervention. The false-induction group, saline treatment group and ABAH treatment group were set up. MPO activity assay was used to detect the MPO activity in the brain of each group. Western blot was used to detect the specific protein products of MPO, and Evans blue staining was used to observe the opening of blood-brain barrier in mice with acute epilepsy. Single photon emission computed tomography (SPECT) system was used to dynamically track the activity changes of MPO in the brains of mice. In vivo autoradiography was used to quantitatively detect the MPO activity in the brains of mice. The hippocampal mossy fiber sprouting was further clarified by Timm staining.

Compared with the false-induction group, the activity of MPO in the brains of epileptic mice was increased significantly (P>0.05). Compared with the saline treatment group, the activity of MPO and the protein products of MPO specific protein in the brains of the mice of the ABAH treatment group were decreased (P=0.016, P=0.016). The results of Evans blue staining showed that the damage of epileptic mouse blood-brain barrier in acute phase reached the peak at 24 h after the onset of epilepsy. SPECT-CT imaging showed that the MPO activity of the saline treatment group in the brains of mice increased significantly compared with the false-induction group (P=0.010); the MPO activity in the brains of mice of the ABAH treatment group was decreased compared with the saline treatment group (P=0.030). In vitro autoradiographic detection results showed that the activity of MPO in the ABAH treatment group was lower than that of the saline treatment group (P<0.05). Compared with the saline treatment group, the hippocampal mossy fiber sprouting in the ABAH treatment group were decreased significantly (P=0.003).

The MPO activity in the brains of mice can be in vivo tracked by the SPECT-CT combining with the specific molecular probes. The MPO in the brain may become a molecular marker of the epilepsy imaging and targeted therapy.

To systemically compare the effect of 3% hypertonic hypertonic saline (HS) and mannitol in reducing the intracranial hypertension.

Cochrane Library, PubMed, Embase, China Biological Medicine Database, CNKI, Wanfang Database, and VIP were retrieved. The related literature about randomized controlled trials of comparing intracranial hypertension with 3% hypertonic saline (HS) and mannitol from the establishment of the databases to January 2016 was collected. RevMan 5.3 software was used to conduct Meta-analyze for each indicator.

Finally, 15 articles met the inclusion criteria were enrolled. A total of 680 patients were included, in which 341 used 3%HS (HS group) and 339 used mannitol (mannitol group). There were no significant differences in the value of intracranial pressure (ICP), ICP decline range, cerebral perfusion pressure (CPP) after intervention, plasma osmotic pressure after intervention, and onset time of drugs between the 2 groups (all P>0.05). There were significant differences in the aspects of reducing the maintenance time of ICP effect(95%CI: 1.01~1.56, Z=9.12, P<0.001), central venous pressure (CVP)(95%CI: 0.48~5.87, Z=2.31, P=0.02), and mean arterial pressure (MAP)(95%CI: 1.48~8.15, Z=2.83, P=0.005) between the HS group and the mannitol group.

Both 3%HS and mannitol may effectively decrease intracranial pressure, however, the effect of 3%HS in reducing intracranial pressure is more durable and may effectively improve CVP and MAP.

In 1898 Ferguson first diverted cerebrospinal fluid from the lumbar subarachnoid space to the abdominal cavity^[1]lumboperitoneal shunt (LPS), with the research and development of shunt materials and the progress of surgical technology, especially the invention and application of LPS special shunt valve, LPS has gradually been accepted by people. Compared with ventricular-peritoneal shunt, LPS has the advantages of no ventricle puncture, short subcutaneous tunnel, less surgical trauma, etc., and has become one of the main surgical methods for treating communicating hydrocephalus in recent years^[2,3]。 Hydrocephalus shunt peritoneal catheterization technique can be divided into traditional abdominal wall incision catheterization and puncture catheterization. Abdominal wall incision usually requires the cooperation of two staff members, and the incision is generally more than 3 cm. If the patient is obese, the incision is longer, and the subcutaneous fat and muscle are separated during the operation, and the operation time is longer. When performing LPS, the patient usually takes the lateral position, which also increases the difficulty of abdominal wall incision to a certain extent^[4]。 Therefore, the author adopted pneumoperitoneum puncture and catheterization technique in LPS, and its efficacy was satisfactory, which is presented as follows.

PatientFemale, 72 years old, right-handed, developed slight tremor in her left upper limb more than 10 years ago. Five years ago, her symptoms involved her right upper limb and head, and she developed severe tremor in her vocalization, unable to finish eating, drinking, dressing and writing on her own. Poor drug efficacy, family history of essential tremor. The Fahn-Tolosa-Marin tremor rating scale (FTM-TRS) was 78 points. A skull CT scan was performed on the day of surgery and the CT and preoperative MRI images were fused on Framelink software. According to the anterior and posterior commissures, the target of the ventromedial nucleus of the thalamus (Vim nucleus) was calculated on the T1 image. The puncture diameter took the middle frontal gyrus cortex of the coronal suture as the entry point. After reaching the target of the Vim nucleus, it went deep about 5 mm to the maximum plane of the red nucleus, that is, the posterior subthalamic area (PSA) located between the subthalamic nucleus and the red nucleus. The patient underwent deep brain stimulation (DBS) on the left side first, and the microelectrode recorded to the target and then went 5 mm deep. There was no obvious discharge under the target (consistent with the characteristics of PSA). Intraoperative micro-damage effect was obvious, and the tremor of the patient's right hand was significantly reduced. Medtronic 3387 electrode was replaced, and the efficacy was tested. Right DBS was performed in the same way. There was no pneumocranium on CT reexamination at 6 days after operation, which was fused with preoperative MRI (Figure 1)。 DBS was turned on 1 month postoperatively, and the last parameters tested were: right electrode: 2-C + (located in the Vim core), 60 μ s, 160 Hz, 2.0 V; Left electrode: 9-C + (at PSA), 60 μ s, 160 Hz, 2.0 V. The left hand tremor disappeared and the right hand, head and voice tremor were alleviated with an FTM-TRS score of 20 and no adverse reactions. Tremor was significantly alleviated with the application of the bilateral lowermost contacts (located in the PSA), but did not stop. Voltages above 2.0 V have not been attempted and synergistimulation has not been attempted.

The pituitary stalk is an important structure connecting the hypothalamus and the pituitary gland^[1]。 A variety of diseases can lead to thickening of the pituitary stem, but it is difficult to clarify the cause due to the non-specific clinical manifestations and the limitation of diagnosis and treatment. This paper summarizes the etiology of thickening of pituitary stem and its progress in diagnosis and treatment.

cavernous malformations (CMs) are cavernous malformations composed of many abnormally thin-walled blood vessels, which can occur in any part of the central nervous system, and their main clinical features are recurrent bleeding and epilepsy^[1]。 Among them, CMs located in the brainstem is difficult to surgically remove because of the deep location of the lesion and adjacent to many important structures, which is a difficult problem in neurosurgery. At present, scholars at home and abroad widely agree that most brainstem CMs can be resected by microsurgery, and the therapeutic effect is positive^[2,3]In this paper, the current situation of surgical treatment of brainstem CMs is reviewed in combination with the reports of relevant literature at home and abroad in recent years.

Intracranial aneurysm is a tumor-like abnormal protrusion of intracranial artery wall caused by various reasons, and its incidence is about 5% ~10%^[1]In which rupture hemorrhage accounts for 70% of subarachnoid hemorrhage, causing a higher residual mortality rate^[2]。 Among them, the rupture of giant aneurysm caused subarachnoid hemorrhage reached 25% ~70%, and the rebleeding rate within one week reached 15%. In recent years, the emergence of blood flow guidance devices represented by PED (pipeline embolization device) has changed the concept of endovascular treatment of intracranial aneurysms, and shifted the conventional packing of tumor sac to reconstruction of blood vessel wall. The research progress of blood flow guidance device in the treatment of intracranial aneurysm is summarized as follows.

Subarachnoid hemorrhage (SAH) caused by ruptured aneurysm has a high mortality and disability rate, and most patients (70%) who survive after SAH develop cerebral artery contraction, i.e. cerebral vasospasm. Most scholars believe that arterial stenosis caused by cerebral vasospasm can lead to cerebral ischemia or even cerebral infarction, so they are committed to alleviating cerebral vasospasm to improve the prognosis of SAH patients^[1]。 However, the efficacy of SAH patients after systemic treatment is not ideal. During treatment, Ca^2＋The blocker nimodipine is used to improve cerebral vasospasm. However, studies have found that although nimodipine is effective for SAH, its effect does not originate from the treatment of cerebral vasospasm^[2]。 In addition, patients with cerebral vasospasm after SAH do not necessarily develop delayed ischemic brain injury, while patients with delayed ischemic brain injury after SAH do not necessarily have cerebral vasospasm, which indicates that cerebral vasospasm after SAH may not be the main cause of poor prognosis in SAH patients^[3]。 A growing number of studies have shown that early brain injury plays an important role in the poor prognosis of SAH^[4]。 Despite the increasing understanding of the mechanism of action of early brain injury in SAH, SAH remains a difficult problem in today's treatment. Perivascular cells are an important component of the blood-brain barrier, and are the only cells with contractile and diastolic functions. They play an important role in the regulation of cerebral microcirculation in pathophysiological processes after SAH. In the past, pericytes were often neglected due to their unclear function and lack of specific markers. The continuous discovery of pericyte marker molecules and the rapid development of experimental technology have greatly promoted the research of pericyte. Mounting evidence shows that cerebral vascular pericytes are associated with a variety of neurological disorders^[5]。 In this paper, the research progress of the role of vascular pericytes in SAH is reviewed.

With the development of social and economic activities, the incidence of spinal cord injury (SCI) is increasing year by year. While SCI brings serious physical and psychological harm to patients, it also causes a huge social burden. Therefore, the research on the correlation of SCI with prevention, treatment and rehabilitation as the main body has become a major topic in the medical field today. In the acute stage of SCI, in order to protect the spinal cord that has not been completely injured, it is necessary to take reasonable and effective neuroprotective measures early after injury, so as to promote the recovery of spinal nerve function to a certain extent. This paper briefly reviews the research progress of SCI drugs in neuroprotection and therapy.