Volume 32 · Issue 11 · 2016

In his speech at the National Conference on Science and Technology Innovation, the Academicians' Conference of the Two Academies of China and the Ninth National Congress of China Association for Science and Technology, * pointed out: "The study of brain connection map is the scientific frontier of cognizing brain function and then exploring the essence of consciousness. This exploration not only has important scientific significance, but also has a guiding role in the prevention and treatment of brain diseases and the development of intelligent technology". The inclusion of brain map research in the strengthening strategic direction of national scientific and technological development has encouraged neuroscience and technology workers, and at the same time, they feel deeply responsible.

intracranial arterial dissection (IAD) refers to a disease in which blood components enter the blood vessel wall through the damaged intima of the intracranial artery for various reasons, resulting in peeling and delamination between the blood vessel walls to form hematoma, or spontaneous hematoma in the intracranial artery wall, resulting in stenosis, occlusion or rupture of blood vessels^[1]。 If a tumor-like protrusion forms, it is called an intracranial dissecting aneurysm (IDA)^[1]。 The specific cause of IAD is currently unknown, and the predisposing factors found in epidemiology include hypertension, oral contraceptives, migraine, history of trauma and recent infection^[2,3]。 Genetic factors are considered to be independent risk factors for the disease^[2]。 IAD is a rare disease, and its incidence in China is unknown. Studies have shown that the incidence of IAD in Asian population is significantly higher than that in European and American population, and the incidence of IAD in posterior circulation (76% ~93%) is higher than that in anterior circulation^[4]。 Although the incidence rate is low, IAD is one of the important causes of stroke in young and middle-aged people, which can cause headache, ischemic symptoms, subarachnoid hemorrhage (SAH) and compressive symptoms^[2,3,5]。 With the continuous progress of medical imaging technology, the detection rate of this disease is increasing year by year^[6]。 However, at present, there is a lack of unified imaging diagnosis and classification standards for this disease both internationally and domestically; Some angiography techniques still lack strong evidence-based medical evidence in the diagnosis and clinical application value of this disease; Clinicians also lack a unified understanding of the imaging features of intracranial dissection lesions. These problems affect the diagnosis and treatment of IAD lesions to some extent.

The World Health Organization (WHO) first published the Histological Classification of central nervous system (CNS) Tumors in 1979. After many revisions in 1993, 2000 and 2006, the fourth edition of the WHO Classification of CNS Tumors "Blue Book" was published in 2007^[1]。 This edition of "Blue Book" mainly classifies and grades tumors according to the histological characteristics under light microscope. The histopathological and clinical diagnostic criteria provided by this edition are still recognized and used by countries all over the world. However, with the development of individualized medicine, molecular pathological diagnosis has been more and more used in clinical practice^[2,3,4]The Chinese Glioma Cooperative Group (CGCG) has incorporated molecular pathology diagnosis into the CNS tumor diagnosis and treatment guidelines and provided a diagnostic process^[5]。 In 2014, the International Society of Neuropathology (ISN) invited 28 senior neuropathologists from 10 countries to hold a meeting on CNS tumor classification and grading in Haarlem, the Netherlands. The meeting reached a consensus that the new version of CNS tumor classification should add molecular pathological diagnosis on the basis of histology, and provided specific diagnostic criteria^[6]。 On this basis, the 2016 WHO meeting updated the fourth edition of the "Blue Book" (2016 CNS WHO), which has important guiding significance for improving the diagnosis and treatment of CNS tumors^[7]。 Combined with the relevant literature recently published in China, the following is interpreted for reference.

To analyze the efficacy of different surgical approach for invasive pituitary adenoma and to raise the rational microsurgical strategy.

We retrospectively analyzed the clinical data of 441 patients with invasive pituitary adenomas at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from July 2012 to June 2015. The clinical manifestation, imaging data, surgical methods, microsurgical skills and prognosis were reviewed. Suprasellar invasive was identified in 310 patients, parasellar invasion was in 293 patients and the sellar floor invasion was in 187 patient. 318 patients underwent transsphenoidal surgery, while 123 patients were treated by craniotomy. In the cases of patients treated by craniotomy, the number of patients undergoing the subfrontal approach, the frontal lateral approach, the frontal temporal approach, the anterior interhemispheric approach and the callosal interforniceal approach was respectively 31, 50, 22, 11 and 9. Univariate analysis and Logistic regression analysis were used to evaluate the influencing factors of surgical approach for invasive pituitary adenoma.

The suprasellar invasion (P<0.001), tumor volume>15 cm³ (P<0.001) were the main factors to choose craniotomy, while the sellar floor invasion (P<0.001) is the main factor to use transsphenoidal approach. The options of subfrontal approach, frontal lateral approach or frontal temporal approach were related to the parasellar invasion (P<0.001) and width of the tumor (P=0.001). The height of the tumor (P<0.001) was associated with the selections of the subfrontal approach, the anterior interhemispheric approach or the callosal interforniceal approach.

The options of the surgical approach of invasive pituitary adenomas should be on the basis of preoperative patient status and imaging findings. Transsphenoidal surgery has unique advantages for excising the tumor which pushes the internal wall of the cavernous sinus - "false tumor invasion" . The frontal lateral approach takes a advantage of the subfrontal approach and the frontal temporal approach to remove the tumor in the cavernous sinus. The options of the anterior interhemispheric approach to remove tumor involving suprasellar space avoid the disconnection syndrome after the operation though the callosal interforniceal approach, and the gross-total resection rate is higher.

To investigate the diagnosis, treatment and prognosis of solitary fibrous tumor/hemangiopericytoma of central nervous system(CNS).

We retrospectively summarized data of 15 patients with solitary fibrous tumor/hemangiopericytoma of CNS who were recruited to the Department of Neurosurgery, China-Japan Union Hospital of Jilin University from December 2010 to June 2016. The patients' pathological diagnoses were reevaluated according to the 2016 WHO classification of CNS tumors.Analysis was conducted regarding the patients' clinical symptoms, imaging characteristics, treatment and outcomes.The clinical manifestations of solitary fibrous tumor/hemangiopericytoma of CNS were diverse mainly with headaches, increased intracranial pressure, seizures, and focal neurological deficits.The solitary fibrous tumor/hemangiopericytoma of CNS usually demonstrates heterogeneous signals and enhanced remarkably on MRI: lobulated shape observed in 12 cases and necrotic or cystic changes in 11 cases. The tumors of 15 cases were resected surgically. Eight patients received postoperative adjuvant radiotherapy. The follow-up time ranged from 2 to 67 months (mean, 21 months).

In the 15 patients, 9 achieved total resection, 4 achieved subtotal resection, and 2 achieved partial resection. Ten patients were followed up, the illness of 7 patients with total resection did not have any progression; in 3 patients without achieving total resection, 2 died of tumor recurrence, 1 has not yet had any clinical progress.

The clinical manifestations of solitary fibrous tumor/hemangiopericytoma of CNS vary greatly.Lobulated shape, necrotic or cystic changes and heterogeneously remarkable enhancement on MRI are its relatively characteristic imaging features. The extent of resection remains the crucial factor influencing the prognosis. The postoperative radiotheraphy should be chosen cautiously based on the extent of resection and pathologic grades.

To explore the method and accuracy of diffuse tensor tractography of facial nerve in the operation of vestibular schwannoma (VS).

We prospectively collected data of 19 patients with vestibular schwannoma who underwent diffuse tensor tractography (DTT) to identify the location and running course of the facial nerve. The seed of ROI was set in the internal auditory meatus and brainstem. The value of FA was set to 0.15. The fibers were considered to represent the facial nerve which connected the internal auditory meatus and brainstem. We intraoperatively evaluated the consistency between tractography and surgerical findings using navigation system、intraoperative facial nerve monitoring and visual inspections byneurosurgeons. Facial nerve function was evaluated at different time postoperatively according to the House-Brackmann (H-B) facial nerve grading system.

The facial nerve of all patients were preserved, most of which were displaced anteroinferiorly.We successfully reconstructed the fibers that represent the facial nerve in 18 cases. In 16 of 18 cases, location of the tractography was entirely consistent with intraoperative findings. In the other two cases of vestibular schwannoma with cyst, the tractography image did not match intraoperative findings. No patient had severe facial paralysis 6 months post surgery. Seventeen patients were graded Ⅰ-Ⅲ according to H-B grade 6 months after the operation.

DTT with intraoperative neuronavigation seems to be a useful tool to identifyfacial nerve in the VS resection and could helpfacilitate facial nerve preservation.

To investigate the relationship between the operation mode and its recurrence rate and the efficacy of the middle/posterior third parasagittal sinus meningioma.

The clinical data of 112 patients with middle/posterior third parasagittal sinus meningioma admitted to the Department of Neurosurgery, Huashan Hospital, Fudan University from January 2003 to December 2013 were analyzed retrospectively. The surgical resection of tumors was performed in all the 112 patients, and their postoperative recurrence and changes of muscle strength before and after operation were followed up. The follow-up time ranged from 2 to 5 years.

Twenty-seven patients underwent Simpson grade Ⅰ resection, the recurrence rate was 0% (0/27); 83 underwent Simpson grade Ⅱ resection, the recurrence rate was 11% (9/83). Two patients had residual tumor in sinus. The recurrence rate of patients with Simpson grade Ⅰ resection was lower than those with Simpson grade Ⅱ resection (P<0.05). In 29 patients with preoperative sagittal sinus occlusion, 25 had ligation of sagittal sinus, burning sagittal sinus wall or left intra-sinus tumors; their muscle strength after procedure was improved compared with that before procedure (P<0.05). The muscle strength of 4 patients with reconstruction of sagittal sinus after procedure were improved compared with before procedure. In 83 patients without occlusion of sagittal sinus before procedure, the muscle strength after procedure of the ligation of sagittal sinus in 6 patients deteriorated compared with that before procedure(P=0.05). The muscle strength after procedure of 77 patients with reconstructing sagittal sinus, burning the wall of sagittal sinus or leaving the intra-sinus tumor was improved compared with that before procedure (P<0.05).

Compared with the patients with the middle/posterior third parasagittal sinus meningioma of the Simpson grade Ⅱ resection, the patients of Simpson grade Ⅰ resection were more difficult to relapse. If the sagittal sinus is completely occluded before procedure, the surgical ligation of sagittal sinus can be performed, and it will not affect the neurological function; if the sagittal sinus is not occluded before procedure, the sagittal sinus should not be ligated. When a tumor is removed, the sagittal sinus and cortical draining vein should be protected so as not to affect the neurological function.

To evaluate the surgical methods and outcomes of parasagittal meningiomas in central gyrus region.

Clinical data regarding 42 parasagittal meningiomas in central gyrus region were analyzed, which were admitted into the First Affiliated Hospital of Zhengzhou University during the time from January of 2007 to January of 2015. Sagittal sinus, rolandic veins, draining veins and peritumoral brain cortices were well protected during surgeries. In case of occlusion of superior sagittal sinus, it was resected together with tumor while draining veins were protected well. Radiosurgery was postoperatively conducted for residual tumors in sagittal sinus or adhered to nearby draining veins.

Among 42 cases of parasagittal meningiomas in central gyrus region, Simpson Ⅰ grade resection was conducted in 7 cases, Ⅱ grade resection in 17 cases, Ⅲ grade in 16 cases, and Ⅳ grade in 2 cases. Motor and sensory deficits, newly developed or worsening, were observed in 14 cases postoperatively, among which 12 cases gradually recovered in 3 months, incomplete limb paralysis remained in 2 cases, and one developed seizure. Morbidity rate was calculated to be 7% with no deaths. Forty-one patients were followed up for 1.3-9.3 years (mean 5.1 years) and the tumor recurrence rate was 12%. Two patients having received Simpson Ⅳ resection reported meningioma recurrence 1-3 year postopertively and a second surgical operation were conducted for them.

Sufficient preoperative imaging evaluation, proper intraoperative dealing with superior sagittal sinus, protection of the rolandic vein、drainage vein、peritumoral brain cortex would ensure and improve the surgical outcomes.

To investigate the clinical characteristics, pathologic manifestation and treatment effect of solitary fibrous tumor (SFT) in central nervous system (CNS) in order to improve the diagnosis and treatment of SFT.

From May 2010 to August 2015, the clinical data of 27 patients with solitary fibrous tumors in central nervous system operated and confirmed by pathology at the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were analyzed retrospectively.

In 27 patients with SFT treated with microsurgery, 21 received total tumor resection, 5 had subtotal resection, and 1 performed biopsy. Twenty-three patients were diagnosed as benign and 4 were diagnosed as malignant with pathological diagnosis. Immunohistochemical examination showed that 21 (78%) were CD34 diffuse positive, 6 (22%) were focal positive, and 21 (78%) were Vimentin positive. All patients were followed up for 38 months. The prognosis of patients with total tumor resection was better; the patients of subtotal resection had in situ recurrence.

The clinical manifestation and imaging examination of SFT in central nervous system are easy to be misdiagnosed. The diagnosis requires pathological and immunohistochemical examinations. Surgical resection is the exact and effective treatment. The prognosis of patients with total resection is good.

Because of its deep location and complex adjacent structures, the choice of surgical approach is crucial to the success or failure of surgery. Typically, the surgical approaches for posterior third ventricle tumors include the subtentorial supracerebellar approach (Crause approach) and the occipital-tentorial approach (Poppen approach). From January 2012 to September 2015, the Department of Neurosurgery of the First Affiliated Hospital of Nanchang University used the transfrontal cortex-ventricle-fornix approach to resect 5 cases of posterior tumors of the third ventricle with the main body located above the anterior tegment of the midbrain, and achieved good clinical results, which are now reported as follows.

There are 7 siblings in a family, including 5 girls and 2 boys. Three of the women had tubercle sellae meningioma (all pathologically confirmed), and the remaining four were subjected to cranial MRI at family follow-up, and no meningioma was found. Three cases of familial tubercle sellae meningioma are reported below.

To investigate the risk factors for rerupture and prognosis of patients in the embolization of ruptured intracranial aneurysms.

From August 2013 to August 2015, the clinical data of 151 patients with ruptured intracranial aneurysm treated with embolization and admitted to the Department of Neurosurgery, the Affiliated Hospital of Southwest Medical University were analyzed retrospectively. Eleven patients (7.3%) had intraprocedural rerupture.

Univariate analysis showed that small aneurysms (P=0.034) and interim operation (P=0.029) had greater risk of intraprocedural rerupture. Multivariate analysis showed that small aneurysms (OR, 5.51, 95% CI 1.12-27.13, P=0.036)and interim operation (OR, 5.03, 95% CI 1.24-20.34, P=0.023) were the independent risk factors for intraprocedural rerupture. After procedure, the patients with intraprocedural rerupture had a higher incidence of symptomatic cerebral vasospasm (45.5% vs. 13.6%, P=0.016), and the incidence of poor prognosis in these patients was significantly higher than those without having intraprocedural rerupture (36.4% vs. 9.3%, P=0.022).

In interventional embolization of ruptured intracranial aneurysms, intraprocedural rerupture is a common surgical complication. It seriously affects the prognosis of the patients. Small aneurysms and interim operation may be associated with the occurrence of intraprocedural rerupture. Intraprocedural rerupture will result in the increased incidence of symptomatic cerebral vasospasm in patients after procedure.

To investigate the operation time in children with tethered cord syndrome and to search for the evidence of the evidence-based medicine of prophylactic surgery in tethered cord syndrome.

The clinical data of 145 children with tethered cord syndrome admitted to the Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University from January 2011 to December 2013 were analyzed retrospectively. The age at presentation was 1 day to 13 years (mean 38.6±3.4 months), 93 of them were males and 52 were females. The follow-up time was 24 months. Their preoperative symptoms were documented according to 4 categories: focal symptoms, bladder and/or rectal symptoms, symptoms of motor function impairment, and other symptoms. The follow-up was conducted by means of questionnaire survey after procedure. At 1, 3, 6, 9, 12, and 24 months after procedure, they came to hospital and a questionnaire survey was conducted by the follow-up specialists. They were documented and divided into excellent (no postoperative symptoms), improvement, no improvement, and aggravation (worse or having new symptoms), respectively according to whether their preoperative and postoperative symptoms were improved or not.

In the preoperative symptoms, 73 patients (50.3%) had focal symptoms, 41 (28.3%) had bladder and/or rectal symptoms, 21 (14.5%) had motor function impairments, and 10 (6.7%) had other symptoms. During the follow-up after procedure, 59.3% (86/145) were excellent, 24.1% (35/145) were effective, 9.7% (14/145) were ineffective, and 6.9%(10/145) were aggravated. The statistical analysis showed that in children with focal symptoms before operation, the postoperative excellent rate was significantly higher than the children having symptoms before procedure (97.3% vs. 20.9%; P<0.05).

Children with tethered cord syndrome should be treated surgically in the presence of the symptoms of nervous system damage. It is recommended to complete the operation before 24 months. The safety of the preventive operation is higher and the clinical effect is satisfactory.

To introduce a new approach through the middle cranial fossa for easy access and safe exposure of the Internal Maxillary Artery (IMA).

Ten specimens were prepared for surgical simulation. After pterional craniotomy and exposing the floor of middle fossa, a two-step drilling was performed. First, a triangular craniectomy was completed anterolateral to the foramen spinosum. By following the middle meningeal artery or deep temporal artery and dividing the lateral pterygoid muscle, the proximal part of IMA was located. Second, a bone slot was drilled in a posterior-to-anterior direction from the anterior aspect of the first craniectomy. Tracing the proximal part, the main trunk of IMA was obtained. The size of the two craniectomies, depth of IMA from the surface of middle fossa, and the length of exposed IMA were measured.

The proposed two-step drilling technique allowed both the IMA's trunk andbranches of the trigeminal nerve to be manipulated safely. In six specimens, IMA ran medially to the pterygoid muscle and in the others ran laterally to it. The total craniectomy measured 27.8±4.2 mm in the anterior-posterior direction, and the posterior portion measured 13.3±1.5 mm in the lateral-medial direction. The depth from middle fossa to IMA (16.8±3.2 mm) was equal to the length of IMA exposed (17.6±3.3 mm).

This new approach provides an efficient and safe method to consistently locate and isolate a segment of IMA.

To investigate the clinical features, endovascular embolization therapy, and treatment outcome of posterior cerebral artery aneurysms.

The clinical features, treatment and prognosis of 17 patients with posterior cerebral artery aneurysms embolized endovascularly at the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2009 to March 2015 were analyzed retrospectively. A total of 18 aneurysms were in 17 cases, 11 (61%) of them were saccular aneurysms, 7 (39%) were fusiform or dissecting aneurysms. Four aneurysms were located in the posterior cerebral artery P1 segment, 1 in P1 and P2 junction zone, 9 in P2 segment, and 4 in P3 segment and beyond. Eight aneurysms were treated with intracapsular coil embolization only, retaining the parent arteries, 6 aneurysms were treated with coil embolization and the parent arteries were occluded at the same time, 1 aneurysm was implanted stents, 1 aneurysm was treated with ballon-assisted embolization, and 2 were not treated.The modified Rankin scale(mRS) was used to evaluate the prognosis. The follow up time ranged from 1 to 5 years.

In the 18 aneurysms, immediate angiography after aneurysm surgery showed that the treated 15 aneurysms were totally embolized. No cerebral ischemia occurred in 6 patients treated with parent artery embolization. One patient with cerebral arteriovenous malformation occurred rebleeding after procedure and left neurological dysfunction after symptomatic treatment, other patients did not have intervention-related complications and the symptom of neurological deficit. In 17 patients with posterior cerebral artery aneurysms, 16 patients completed follow-up and 1 patient lost to follow up.No recurrence in the 14 treated aneurysms have been demonstrated in the DSA reviews during the follow-up period.The mRS 0 was in 12 cases, 1 in 2 cases, 2 in 3 cases.

The posterior cerebral artery aneurysms are often located in P2 segments. Dissecting or fusiform aneurysms are more common than other types. According to the characteristics of aneurysms, the appropriate endovascular embolization scheme can be selected. The treatment process is safe and reliable, and the satisfactory efficacy can be obtained.

To investigate the correlativity between the serum calcium concentration and the hematoma volume in patients with acute intracerebral hemorrhage.

The clinical data of 185 patients with acute intracerebral hemorrhage admitted to the Department of Neurosurgery, Beijing Pinggu Hospital from October 2012 to August 2014 were analyzed retrospectively, including the patients' sex, age, blood pressure on admission (systolic and diastolic blood pressure), blood glucose, platelet count, coagulative function, hematoma location, hematoma volume, serum calcium, serum magnesium, and glutamic-pyruvic transaminase. The factors associated with the amount of hematoma in patients with acute cerebral hemorrhage were investigated. Multiple stepwise linear regression and variance analysis were used for correlation analysis.

Multiple stepwise linear regression analysis showed that both serum calcium and glucose were associated with the hematoma volume in patients with acute cerebral hemorrhage (all P<0.05), and the patients' age, systolic and diastolic blood pressure on admission, serum glutamic-pyruvic transaminase, serum magnesium, prothrombin time, fibrinogen content, international standardization (prothrombin time) ratio, and platelet count were not associated with the hematoma volume in patients with acute cerebral hemorrhage (allP>0.05). The hematoma volume in patients with acute cerebral hemorrhage was negatively correlated with the serum calcium level; it was positively correlated with the blood glucose level.

The serum calcium ion level may reflect the size of hematoma volume in cerebral hemorrhage and the severity of the disease.

To establish a stable and effective schwannoma xenograft model in rats for the study of its clinical treatment.

Fifteen rats were randomly divided into 3 groups according to random number table. RT4 cells and human schwannoma cells were injected into the sheath of sciatic nerve in the model groups, and normal saline was injected into the control group. Function tests of sciatic nerves were performed since the first week after tumor implantation. We observed the tumors during the following 4 weeks, which were identified by pathological examination.

Compared with controls, the space between toes of right hind limbs in model groups was reduced after operation. There was significant difference in the space of right toes between 3 groups 14 days post operation (P< 0.05). There was significant difference between the left and right limbs in model groups 7 days post operation (P< 0.05). Compared with the rats in control groups, the time standing on the pole of rats in the 2 model groups was reduced significantly 7 days after operation (P < 0.05). Rats in the 2 model groups developed tumors within 4 weeks after tumor implantation. Schwannoma were identified in all cases by HE staining. The results of immunohistochemical examination demonstrate that cell membrane and cytoplasm were positive for S-100.

Xenograft schwannoma can be developed in sciatic nerves after tumor implantation.

To investigate the expression change of hippocampal toll-like receptor 4 (TLR4) and proliferation of neural stem cells (NSCs) in mouse model of traumatic brain injury (TBI).

Adult male C57BL/6 mice were randomly divided into "toll-like receptor 4 inhibitor CLI-095" group, solvent group andsham group according to random number table. The TBI mouse model was established using PCI-3000 device. Toll-like receptor 4 inhibitor CLI-095 was administered through intraperitoneal injection in the CLI-095 group and solvent was injected intraperitoneally in solvent and sham groups. NSCs were labeled with thymidine analog 5-Bromo-2-deoxyUridine (BrdU). The expression and distribution of BrdU and MYD88 in hippocampus were assessed by inmmunofluorescence. The expression of MYD88 protein was detected by Western blotting.

MYD88 expression in the mouse hippocampus of the CLI-095 group was decreased following intraperitoneal injection of CLI-095, lower than the solvent group but higher than the sham (P<0.05) in Western Blotting. Numbers of neural cells in the hippocampus increased after intraperitoneal injection of CLI-095 especially NSCs, which increased after intraperitoneal injection of CLI-095. Numbers of NSCs in the solvent groups was higher than the sham group but lower than the CLI-095 group (P<0.05).

Expression of MYD88 in the hippocampus was negatively correlated with to NSC changes. It suggested that inhibition of TLR4 could activate expression of NSCs and increase their proliferation, and thus facilitate repair of injured nerves.

To compare the clinical efficacy of neuroendoscopy and microsurgery for the treatment of hypertensive basal ganglia hemorrhage.

PubMed, Cochrane Library, Embase, VIP, CNKI, CBM and Wanfang database were retrieved. The randomized controlled trials and semi-randomized controlled trials comparing all the basal ganglia hemorrhage treated with neuroendoscopy and microsurgery were searched. The retrieval time was from the establishment of the database to October 31, 2015. After the detected literature being screened, extracted and evaluated, a Meta-analysis was performed using RevMan 5.3 software, and the GRADE system was used to conduct the quality evaluation of evidence.

Finally, A total of 9 trials with 700 patients were enrolled. The results of Meta-analysis showed: (1) in the aspect of safety: compared with the microscope group, the hematoma clearance rate was higher (SMD=0.63, 95% CI 0.30-0.95, P<0.001), operation time was shorter (SMD= -2.66, 95% CI -3.71- -1.60, P<0.001), hospitalization time was shorter (SMD=-0.72, 95% CI -1.01- -0.44, P<0.001), and postoperative complications were less (RR=0.56, 95% CI 0.40-0.77, P<0.001) of the neuroendoscopy group. There were no significant differences in the intraoperative bleeding and hospital cost between the 2 groups (allP<0.05). (2) In the aspect of effectiveness: compared with the microsurgery group, the prognosis was better (RR=1.15, 95% CI 1.03-1.27; P=0.002) and the mortality was lower (RR=0.57, 95% CI 0.22-1.00; P=0.05) in the neuroendoscope group.

Compared with the microsurgery, the prognosis of neuroendoscopy is better, the mortality is lower, the efficacy is better, and the surgical removal rate of the latter is higher, the operation time is shorter, the postoperative complications are less, and the safety is higher. But because of the quality of the original research is lower, the prudent choice and use in clinical practice ARE recommended. More high quality, large sample randomized controlled trials are needed for further argument.

collision tumor refers to two kinds of tumors with different histomorphology appearing at the same site, which is very rare in clinic. Collision tumors that occur in the central nervous system are even rarer clinically. Pituitary adenomas have been reported to coexist with many sellar lesions, with co-existing pituitary adenomas ranging from non-functional to functional, functional pituitary adenomas including growth hormone (GH), prolactin (PRL), adrenocorticotropic hormone (ACTH), and thyrotropin (TSH)^[1,2,3,4]。 Preoperative diagnosis of two different pathological types of tumors in the sella turcica region is very difficult because most tumors have preoperative clinical and imaging findings similar to those of pituitary adenomas, and the final diagnosis of sellar collision tumors depends on histopathological examination. However, the pathogenesis of sellar collision tumor has not been confirmed. The aim of this article is to report the surgical experience of a case of sellar collision tumor and to reveal the origin and pathogenesis of sellar collision tumor through a literature review.

PatientMale, 47 years old. On March 15, 2016, he was admitted to the Department of Neurosurgery of the Second Affiliated Hospital of Zhejiang University School of Medicine with "pituitary adenoma 6 and a half years after operation, blurred vision in both eyes for 1 year and aggravated for more than half a year". The patient had undergone MRI on 29 Sep 2009 due to visual loss and was diagnosed with "pituitary adenoma" (FIG. 1A，FIG. 1B), pituitary hormones are in the normal range, considered as "non-functional pituitary adenoma", transnasal sphenoidal sinus pituitary adenoma resection was performed in our hospital. Postoperatively, it was confirmed by pathology as "pituitary adenoma", and MRI showed that the tumor was subtotal resection (Figure 1C), visual acuity returned to normal, no radiotherapy was performed. MRI showed partial tumor recurrence at 1 year postoperatively (Figure 1D)。 One year ago, blurred vision in both eyes appeared again without obvious trigger, and the symptoms progressively worsened in the past six months, without headache, dizziness, polydipsia, polyuria and other discomfort. MRI at local hospital revealed recurrence of pituitary adenoma. Previous history of neck mass removal.

neurofibromatosis (NF) is a common neurocutaneous syndrome or nevi macular hamartomatosis. The main clinical manifestations are multiple nervous system (central and peripheral) tumors, skin pigmented spots, vascular system and other organ lesions^[1,2]。 Cases of skull dysplasia combined with NF are rarely reported at home and abroad after being admitted to hospital due to trauma. One case was admitted to the Department of Neurosurgery of Qingdao Eighth People's Hospital in May 2016, which is now reported as follows.

Parkinson's disease (PD) is a neurodegenerative disease common in middle-aged and elderly people, with resting tremor, muscle stiffness, bradykinesia and postural balance disorder as the main clinical manifestations. In addition to motor symptoms, most patients often have non-motor symptoms (NMS)^[1]Including sensory disorders, sleep disorders, autonomic dysfunction, neuropsychiatric disorders, cognitive dysfunction, etc. With the progression of the disease, NMS is an important factor in aggravating the motor function impairment, reducing the quality of life and shortening the life expectancy^[2]。 Diverse motor symptoms and NMS indicate heterogeneity in PD^[3]。 According to the onset age of patients, the speed of disease course, different motor symptoms and cognitive characteristics, PD patients can be divided into different subtypes. Typing helps to understand the pathogenesis of different symptoms, predict the course and prognosis of the disease, and provide a basis for the accurate treatment of PD. This article reviews the clinical classification of PD patients and the pathophysiological, biochemical and functional imaging characteristics of different PD subtypes.

With the rapid development of society, the injury factors such as car accident and fall are increasing, and the occurrence of traumatic brain injury (TBI) is increasingly frequent. venous thromboembolic events (VTE), including deep venous thrombosis (DVT) and pulmonary embilism (PE), are serious complications in patients with TBI, resulting in increased disability and mortality. Although low molecular weight heparin can effectively reduce the incidence of VTE, prophylactic anticoagulation will increase the risk of intracranial hemorrhage when patients have TBI, so there is no unified clinical prevention opinion at present. Referring to the relevant literature at home and abroad, the incidence, risk factors and drug prevention strategies of VTE in TBI patients are reviewed as follows.

As an ancient treatment method, hypothermia has been used for many years. Since 1990s, the effect of mild hypothermia on brain protection after craniocerebral injury has gradually attracted attention. However, a series of clinical studies around mild hypothermia suggest that the brain protection effect of mild hypothermia is controversial. With the in-depth research on the change of body temperature of patients in neurological intensive care unit (NICU) and the development of body temperature control technology, the concept of "induced normothermal therapy" has been put forward in recent years, that is, the brain temperature of patients with craniocerebral injury is controlled at 36.5~37 ℃, so as to avoid adverse reactions caused by low temperature and craniocerebral injury caused by high temperature. The author makes a comprehensive review of the history of hypothermia therapy, the physiology of brain thermoregulation, the mechanism of hypothermia on brain protection, the clinical application and controversy of mild hypothermia, and introduces the concept of induction of normothermia therapy.

Gliomas are the most common primary brain tumors, accounting for approximately 28% of all brain tumors^[1], accounting for about 81% of malignant brain tumors^[2]。 Malignant gliomas mainly include anaplastic astrocytoma (WHO grade III) and glioblastoma multiforme (GBM) (WHO grade IV). Among them, the median survival of anaplastic astrocytoma is less than 3 years^[3]； GBM accounts for about 16% of primary brain tumors^[4]With a median survival of 12 to 14 months^[3]。 At present, the standard treatment plan of GBM is to maximize surgical resection combined with radiotherapy and alkylating agent adjuvant chemotherapy on the basis of protecting neurological function to the greatest extent. However, that 5-year survival rate of GBM is still below 10%^[5]The overall median survival was 16 to 19 months^[6]。 Among them, chemotherapy resistance of glioma cells is the key to treatment failure of glioma patients. glioma stem cells (GSC) are clone-derived cells of glioma cells^[7]It is the root cause of glioma resistance to radiotherapy, chemotherapy, progression and recurrence^[8]。 Therefore, the development of new targeted blocking GSC resistance pathways and enhancing chemosensitivity have become the main goals of glioma research.

From August 19th to 22nd, 2016, the "2016 National Neurological Injury Conference and the 5th Tiantan National Neurological Trauma Symposium", sponsored by Beijing Tiantan Hospital affiliated to Capital Medical University and co-organized by six academic groups and units, including World Chinese Neurosurgery Association, was held in Beijing. Nearly 500 representatives from all over the country in the fields of neurosurgery, neurocritical care and trauma surgery attended the conference. About 200 papers were submitted to the conference, including 2 papers from academician forums and 5 comments from specially invited experts, of which 96 papers were exchanged at the conference. Professor Liu Baiyun, Department of Neurosurgery, Beijing Tiantan Hospital affiliated to Capital Medical University, served as the chairman of the conference; Professor Liu Weiming, Department of Neurosurgery, Beijing Tiantan Hospital affiliated to Capital Medical University, served as the executive chairman and presided over the conference.

Sponsored by the Neurosurgery Professional Committee of the Chinese Research Hospital Society and the Neuromedicine Branch of the Chinese Geriatric Society, and undertaken by the Brain Center of the Affiliated Hospital of the Armed Police Logistics College and the Institute of Brain Trauma and Neurological Diseases of the Armed Police Force, the 2016 Neurosurgery Professional Committee of the Chinese Research Hospital Society, the Academic Annual Meeting of the Neuromedicine Branch of the Chinese Geriatric Society and the 13th Neurosurgery Progress Report of the Armed Police Tianjin were held in Tianjin from August 26th to 28th, 2016. More than 500 neurosurgical experts and representatives from more than 20 provinces, municipalities and autonomous regions attended the meeting, and discussed and exchanged views on craniocerebral trauma, cerebrovascular disease, intracranial tumors, functional neurosurgery, pediatric neurosurgery, spinal cord and neurocritical illness, with 38 special reports.