Volume 32 · Issue 12 · 2016

In the history of spinal neurosurgery in the United States, it has been suggested that neurosurgeons should not only perform cervical spine surgery, but also actively perform thoracolumbar spine surgery, which is considered a very visionary suggestion. In 1993, this recommendation was included in the Neurosurgery Residency Program by the American Academy of Neurosurgery (AANS) and the Association of Physicians (CNS)^[1]。 At present, the specialized training of neurosurgery residents in China is in its infancy, and spinal cord and spinal diseases have been included in the training plan. However, the requirements for diseases are questionable, and most of them are limited to traditional intraspinal tumors. Therefore, the active diagnosis and treatment of lumbar degenerative diseases in domestic neurosurgery is also of great significance to the future development of spine subspecialty in neurosurgery.

deep brain stimulation (DBS) is an important method for the treatment of Parkinson's disease (PD). 2012 "Expert Consensus on Deep Brain Electrical Stimulation Therapy for Parkinson's Disease in China" was released^[1,2], standardized the indications and procedures of DBS therapy in my country, and strengthened the cooperation between neurology and neurosurgery. In recent years, great progress has been made in the diagnosis and treatment of PD at home and abroad. In 2015, the International Society of Movement Disorders (MDS) developed new clinical diagnostic standards for PD^[3]China has also formulated the "Diagnostic Criteria for Parkinson's Disease in China (2016 Edition)"^[4]And "Chinese Parkinson's Disease Treatment Guidelines (Third Edition)"^[5]Standardizes the diagnosis and treatment of PD in China.

To discuss the procedures and therapeutic effects of minimally invasive-transforaminal lumbar interbody fusion (MIS-TLIF) via the X-tube retractor for lumbar spinal stenosis(LSS) with degenerative lumbar scoliosis (DLS).

The authors retrospectively reviewed 25 cases of LSS with DLS (grade Ⅱ~Ⅳ according to Lenke-Silva grading standard) who were admitted from January 2012 to January 2016 and treated by MIS-TLIF at Department of Neurosurgery, Xuanwu Hospital, Capital Medical University. Surgical outcomes were evaluated by using the tools including the visual analogue scale (VAS), Oswestry disability index (ODI), short form health survey-36 (SF-36) and imaging examinations. Our follow-up study lasted 6~34 months with an average of 23 months.

Decompression and interbody fusion were performed in 25 patients and 85 levels. All patients were successfully followed-up. Clinical symptoms completely disappeared in 20 cases and significant improvement were achieved in the remaining 5 cases. The interbody fusion rate was 91% with satisfactory placement of screws. No death or severe complications occurred in this study such as neurological function defect, infection and cerebrospinal fluid leakage. There was no failure of internal fixation, pedicle screw or rod breakage, or cage displacement.

MIS-TLIF is an effective procedure for the treatment of LSS with DLS and has the advantages including less injury, less blood loss and low complication rate.

To investigate the clinical features and surgical outcomes of pediatric spinal meningiomas in order to provide evidence for the clinical diagnosis and treatment.

The clinical data of 12 children (≤15 ys) with spinal meningiomas admitted to the Department of Neurosurgery, Beijing Tiantan Hospital from January 2008 to December 2015 were analyzed retrospectively. The lateral position was used for all patients and tumors were resected under microscope by posterior midline approach. Among them, 7 patients underwent laminectomy and the remaining 5 received laminoplasty with titanium fixation. Intraoperative electrophysiological monitoring, including sensation and motor evoked potentials, was applied to avoid neurological function deficits.

Grade Ⅰ and Ⅱ resections by the Simpson criteria were performed in 9 out of 12 cases, and Grade IV resection in the remaining 3 cases. Postoperative remission of symptoms was reported in 8 patients. Grade I meningiomas proved by postoperative pathological examination accounted for 8/12 in this series, and Grade II meningiomas were reported in 4 other cases. During follow-up, tumor recurrence was found in 5 patients and two patients underwent second surgical operation. None of the patients were administered post-operative radiotherapy-or chemotherapy.

Pediatric spinal meningiomas are relatively uncommon and inclined to be associated with neurofibromatosis type 2. The complete resection rate is relatively low for pediatric spinal meningiomas thus the tumors have relatively high possibility of recurrence. Thorough preoperative examinations and sufficient extent of resection would help improve the surgical outcomes.

To evaluate the clinical outcomes and operative techniques of microscopic bilateral decompression for lumbar spinal canal stenosis via the unilateral paramedian approach with tubular retractor system.

A retrospective study was conducted to analyze 35 patients with central lumbar spinal canal stenosis who were admitted to Department of Neurosurgery, Affiliated Union Hospital, Fujian Medical University from November 201l to May 2015. Bilateral spinal canal decompression was performed using microchannel percutaneous system through unilateral paraspinal approach and under intraoperative electroneurophysiological monitoring (IOEM). Data including surgical incision, operation time, blood loss volume and IOEM were analyzed. Creatine kinase(CK-MM) levels were measured 1 day before surgery and l day, 3 day as well as 5 days postoperatively. The Japanese Orthopedic Association (JOA) and Visual Analog Scale (VAS) scores were documented at l day preoperatively, and postoperatively at day 1, day 3, day 5, month 1, month 3, month 6 and month 12 months . Lumbar magnetic resonance imaging, computed tomography (CT), and X-ray scan were conducted preoperatively and at 1 month, 6 month and the last follow-up postoperatively.

The operations were all successfully accomplished with no cases of nerve injury, cerebrospinal fluid leakage (CSFL), postoperative infection or death. The surgical incisions measured 1.5-1.8 cm, the operations lasted 65-110 min, and blood loss volumes were estimated between 8 to 35 ml. The CK-MM level was increased to(461.2±32.6)IU/ml 1 day post-op. with a statistically significant difference compared with pre-op. (P<0.05) and decreased to baseline level at 5 day post-op.(P>0.05). At the 12-month follow-up, the JOA score was elevated from (13.4±3.7) to (28.1±0.8)(P<0.05) and the VAS score decreased from (6.9±1.1) to (0.4±0.5)(P<0.05). Postoperative examination of MRI indicated sufficient nerve decompression.No lumbar spinal instability or scoliosis was observed.

Microscopic bilateral decompression through microelectrode percutaneous approach seems effective for central lumbar spinal canal stenosis with sufficient nerve decompression and less injuries of paraspinal muscles, facet joints, spinous processes and ligaments. This technique offers the advantage of postoperative stability and preserved lumbar mobility.

To evaluate the indications and clinical results of percutaneous transforaminal endoscopic discectomy (PTED) and percutaneous interlaminar endoscopic discectomy (PIED) for the treatment of lumbar disc herniation (LDH).

A total of 126 patients of LDH were retrospectively analyzed, who were admitted to Department of Neurosurgery, Beijing Hospital and Department of Neurosurgery, Xuanwu Hospital, Capital Medical University from April 2014 to June 2015. According to the surgical approach, the patients were divided into the PTED (66 cases) and PIED (60 cases) groups.Pre- and postoperative pain was assessed using the visual analog scale (VAS) and the patient’s functional status was evaluated using the Oswestry disability index (ODI). Various aspects were compared between the two groups that included operation time, times of intraoperative radioactive examinations, length of hospital stay, complications and postoperative recovery.The follow-up time is 3 to 23 months.

In both groups, the patients' mean VAS scores and ODI were significantly decreased compared with data before operation(allP<0.05). There was no significant difference in length of hospital stay, rate of excellent/good outcomes or recurrence between 2 groups(allP>0.05). The operation time(85.6±19.0 min) and frequencies of radiation exposure (28.1±10.3) in the PTED group were significantly higher than in the PIED group(operation time: 59.6±13.0 min, frequency of radiation exposure: 4.9±1.5); while the postoperative bedridden time(4.6±0.9 h) and complication rate (4.5%) in the PTED group were significantly lower than in the PIED group (bedridden time: 9.9±3.7 h, complication rate: 13.3%).

PTED and PIED are generally safe and efficacious in treatment of LDH.Selection of surgical approaches should be based on LDH types and locations.

To explore the surgical techniques and effects of X-tube assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF)in treating lumbar spinal stenosis with spinal instability.

A total of 33 patients with lumbar spinal stenosis with lumbar instability were admitted to Xuanwu Hospital of Capital Medical University from January 2013 to June 2015 and underwent X-tube assisted MIS-TLIF, whose data were retrospectively summarized in this study. The scores of the Japanese Orthopedic Association (JOA), visual analogue scale (VAS) and Oswestry disability index (ODI) were documented before and after operations to assess the treatment effects, and complications were documented as well.The results of lumber fusions were evaluated according to the Suk standard.

Thirty-six lumbar segments of 33 patients were dealt with in this study. One patient underwent revision surgery due to displacement of the lumbar fusion cagecausing compression of the nerve root, and the final outcome was good. One patient developed infection in the surgical site 2 weeks post operation, was treated with immediate debridement and recovered well.The follow-up lasted for an average of 12.8±0.4 months. Compared with preoperative conditions, patients' postoperative JOA scores had significant improvement: (16.8±3.2)vs. (20.7±3.2), while the VAS, (4.4±1.4)vs.(1.6±1.3), and ODI, (15.9±7.2) vs.(37.7±16.0), both decreased significantly(P<0.01). The 12-month follow-up indicated that the fusion rate of vertebrae was good in 28 cases(85%)and acceptable in 5 cases(15%)according to the Suk standard. Lumbar computed tomography showed satisfactory effects of the lumber vertebra fusion.

Lumbar spinal stenosis with instability could be effectively treated by using the MIS-TLIF procedure with X-tube assistance.

To investigate the efficacy of laminectomy decompression under microscope for lumbar spinal stenosis.

A retrospective study was conducted regarding 13 patients with lumbar spinal stenosis who were admitted to Department of Neurosurgery, Xiangya Hospital, Central South University, from April 2015 to April 2016 and underwent unilateral/bilateral laminectomy decompression under microscope.Among the 13 patients of lumbar stenosis, 8 cases involved single segment, 3 invovled 2 segments and 2 involved 3 segments.The segments operated on were L_2~3 in 2 cases, L_3~4 in 5 cases , L_4~5 in 10 cases and L₅-S₁ in 3 cases. The preoperative and postoperative Visual Analogue Scale (VAS) scores were used to evaluate the pain relief. Postoperative follow-up on a regular basis was conducted including examinations of magnetic resonance imaging (MRI), computed tomography (CT) and dynamic spine X-ray.

The operation time in this group was 1.5-5.5 h , the intraoperative blood loss measured 50-400 ml, and postoperative hospital stay was 8-21 d. Back and leg pain in all patients were significantly improved after operation. The postoperative VAS score was 1.38 and decreased from preoperative 4.23. No nerve injury or cerebrospinal fluid leakage due to spinal dura tears was observed in this study. No cardiac or cerebrovascular complications occurred after surgery.Postoper-atively, chest herpes zoster in 1 case and lateral femoral cutaneous neuritis in 1 case were observed. One patient with preoperative bowel and bladder disorders began to recover after opeartion, and restored independent urination 10 days post operation. Varying degrees of ease of lower limb numbness was reported in 9 cases.

Laminectomy decompression under microscope for lumbar spinal stenosis demonstrated advantages including shorter operation time, less intraoperative blood loss and shorter hospitalization length, through which sufficient decompression and good clinical outcomes could be obtained. Further observation is needed to study its long-term effect on the stability of lumbar spine.

To investigate the patterns of clinical manifestations, diagnosis, treatment and surgical outcomes of spinal epidural dumbbell-shaped cavernous hemangiomas.

Between June 2008 and November 2013, a series of 9 patients with symptomatic spinal epidural dumbbell-shaped cavernous hemangiomas were surgically managed in Beijing Tiantan Hospital, in which the diagnoses were pathologically verified. The clinical manifestations, radiographic features, treatment modality and prognosis were retrospectively reviewed. The attention was specially paid to the differential diagnosis for other lesions that mimicking a dumbbell-shaped tumors.

Among the 9 cases, 6 were male and 3 were female.The mean age at presentation was 58±12 years (range 34-79 years) The tumor locations included thoracic levels in 7 cases, cervical levels in 1 case and cervicothoracic junction in 1 case). Except two recurrent cases and one with acute onset, were the others demonstrated chronically progressive features. The initial diagnoses included schwannoma in 6 patients, cavernous hemangiomas in 1 case, meningioma in 1 case and angioma in 1 case.Complete resection was achieved in 7 patients, and partial resection was performed in the other 2 patients .The average volume of intraoperative blood loss measured 400±300 ml, ranging from 100 ml to 1 000 ml. None of the cases developed surgical complications. The follow-up lasted an average of 71±21 months (range 29-94 months), which demonstrated that significant improvement was achieved in 7 out of 9 cases, no significant symptom relief was reported in 1 case, and symptomatic worsening occurred in 1 case. one partially improved, and one worsened during follow-up.

The spinal epidural dumbbell-shaped cavernous hemangioma is relatively uncommon and thus easily misdiagnosed. Microsurgical operations seem to demonstrate relative safety and good outcomes.

To evaluate the clinical results of percutaneous transforaminal endoscopic bilateral decompression (PTED)via unilateral approach for lumbar spinal stenosis (LSSS) caused by lumbar disc herniation (LDH).

From January 2014 to January 2016, 35 cases of LSS caused by LDH were treated with PTED via unilateral approach at Affiliated Hospital of Logistics University of Chinese Armed Police Force, and their data were used for a retrospective analysis. The surgical effect was evaluated using the Macnab score at 3 months post-operation. Visual analogue scale (VAS) and Oswestry disability index(ODI)were used to assess the outcomes at 6 month post-operation.MxLiteView DICOM Viewer software was used to measure the change of spinal canal area before and after operation based on the parameters of axial MRI images.

The mean operation time was (89.1±8.7) min in 35 patients.The preoperative and 6-month postoperative VAS values were (7.9±0.8) and (2.1±0.5) points, respectively, and the ODI were(61.5±3.7) and(21.3±2.1)points, respectively. Both differences were statistically significant (P<0.05). As per the Macnab criteria, 19 patients (54.4%) reported excellent effect, 13 (37.1%) demonstrated good outcome, 2 (5.7%) reported faireffect, and 1 (2.9%) demonstrated poor result.The excellent/good rate reached 91.4%. Compared with the preoperative conditions, the cross sectional areas of spinal canal at the levels of L_3-4, L_4-5 and L₅-S₁were increasedby (35.7±8.5) mm^2, (40.9±4.1) mm² and (42.5±9.1) mm^2, respectively.No postoperative rupture of spinal dura, or injury of nerves, blood vesselsas well as intestines, or infection occurred in this series. The most frequently observed complication was transient paresthesia due to irritation of nerve root.

The procesure of PTED via unilateral approach demonstrate satisfactory short-term effect in the treatment of LSS caused by LDH. Further long-term observations are needed to investigate postoperative stability of lumbar spinal canal, the risk of restenosis, and possibility of re-operation in case of restenosis.

To conduct a preliminary study on the application of multimodal image fusion technology (MIFT) to treatment of lesions within the spinal canal.

From November 2015 to May 2016, a total of 11 patients with lesions within the spinal canal were admitted to Beijing Tsinghua Changgung Hospital for surgical treatment aided by MIFT, and their data were retrospectively analyzed.The O-arm image system was utilized to acquire intraoperative three-dimensional CT images that were subsequently transferred to the navigation system for all patients except 1 casein which preoperative MRI and CT image were fused based on the posterior fossa bone. The image fusion of preoperative CT/MRI and intraoperative CT image was conducted using the Synergy Cranial software, and the reconstructed 3D model of the spine, tumors, vascular structures were employed to guide tumor localization of resection under navigation.

In all 11 patients, lesions were successfully located and completely resected under microscope with the assistance of MIFT.The O-arm scanning and image fusion took about 5-7 min and 7-10 min, respectively.The navigation error was 0.9-5.3 mm with a mean of 1.9±1.0 mm. At the follow-up at 1 month post operations based on the McCormick scale, level Ⅰ was achieved in 9 cases, level Ⅱ in 1 case, and level Ⅳ in 1 case.

The application of MIFT could help locate the segments of spinal column and lesions within the spinal canal.

Chiari malformation, also known as cerebellar subtonsillar hernia, is a congenital developmental malformation characterized by the reduction of the volume of the posterior cranial fossa and the downward entry of the cerebellar tonsil into the spinal canal lumen^[1]Often complicated with syringomyelia and skull base depression, odontoid dislocation, atlanto-occipital fusion and other craniocervical junction deformities. Clinically, Chiari malformation is mainly type Ⅰ, and its clinical manifestations are variable, and there are many surgical methods in the treatment^[2,3,4,5,6]。 If the surgical method is improperly selected, it may lead to difficulty in alleviating or even aggravating the clinical symptoms of patients. From January 2011 to October 2015, 72 patients with Chiari malformation type I were treated with different surgical methods in the Department of Neurosurgery of the First Affiliated Hospital of Anhui Medical University, with satisfactory results. The report is now as follows.

To study the volume changes of gray matter in patients of post-concussion syndrome and discuss its clinical significance using functional magnetic resonance imaging and computer-aided graphics processing technology.

Twenty-three patients diagnosed of post-concussion syndrome following mild traumatic brain injury admitted to Department of Neurosurgery, Anhui Provincial Hospital, Anhui Medical University from April 2015 to January 2016 were recruited as the test group. Twenty-five healthy subjects were recruited as the control group. All subjects underwent regular magnetic resonance scanning and high-resolution 3D-TI weighted examination with the same parameters. We built a brain structure network model, segmented grey and white matters, and analyzed the changes of gray matter volume with the method of voxel-based morphometry, intending to investigate the damaged cortical areas.

Decreased gray matter volumes were found in areas including left inferior frontal gyrus, left inferior temporal gyrus, right gyrus rectus, left operculum insulae and left putamen(all P<0.001), while increased gray matter volumes were not observed.

Changes of gray matter volume were demonstrated in patients with post-concussion syndrome, which may be related to the pathophysiological mechanism of its clinical symptoms.

To investigate the correlation of extent of resection (EOR) as well as residual tumor volume (RTV) and prognosis of new-onset adult supratentorial glioblastoma (GBM).

A retrospective review of 98 adult patients was conducted who were diagnosed with supratentorial GBM and admitted to Department of Neurosurgery, Henan Provincical People's Hospital from January 2010 to December 2013. All patients in this group underwent primary resection of tumors, while some followed by standardized radiotherapy and chemotherapy. Quantitative analysis of pre- and postoperative tumor volumes were conducted, and the Cox proportional hazards regression model was utilized to study the correlation of EOR as well as RTV and the patients' progression-free survival (PFS) and overall survival (OS). The mean period of follow-up was 13.3 (5.9-27.5) months.

All patients were successfully followed up.Among them, 5 (5%) patients were alive at the final follow-up. The OS and PFS were 13.3±4.9 months and 9.5±4.2 months, respectively. The RTV was 2.82±3.61 cm^3, equating to an EOR of 0.91±0.12. Both RTV(P=0.000) and EOR(P=0.000) were statistically significant predictors of survival when controlling for age, Karnofsky performance score (KPS) and adjuvant postoperative therapies. A statistically significant benefit in survival was seen with a RTV no more than 5.5 cm³ or an EOR greater than 0.85. But the relevance of EOR and survival was inexistent when EOR (P=0.880, P=0.665) and RTV(P=0.000, P=0.000)were simultaneously taken in, which suggested that RTV rather than EOR was an independent predictor of survival.

RTV was found to be a significant predictor of survival for patients with new-onset adult supratentorial GBM.

To investigate multiple factors affecting outcomes of the anterior communicating artery (ACoA) aneurysm so as to provide evidence basis for improving its surgical treatment.

The clinical data of 553 patients with ACoA aneurysms were retrospectively studied who were admitted to Department of Neurosurgery, Affiliated Hospital of Qingdao University from January 1997 to October 2015.Therapeutic effect was set as the dependent variable.Univariate analysis and multivariate logistic regression analysis were conducted to examine 10 factors that possibly affected the outcomes and included the patient's age, gender, times of subarachnoid hemorrhage (SAH), characteristics of SAH on Computed Tomography (CT) scans, Hunt-Hess grade, morphological characteristics of aneurysm, surgical timing and approach, presence/absence of intraoperative rupture and postoperative complications.

The six factors including the patient's age , gender, morphological characteristics of aneurysm, timing and approach of surgery , intraoperative rupture did not play a role in affecting the surgical outcomes. The remaining 4 factors affected the patients' outcomes and were times of SAH, CT characteristics of SAH, Hunt-Hess grade and postoperative complications. Furthermore, the times of SAH(OR=3.404, P=0.000, 95%CI: 1.592-7.277), Hunt-Hess grade (OR=11.158, P=0.000, 95%CI: 3.355-37.103) and postoperative complications (OR=15.019, P=0.000, 95%CI: 3.017-61.793) were independent risk factors influencing the outcome.

Times of SAH, Hunt-Hess grade and postoperative complications are independent risk factors affecting the surgical outcomes of ACoA aneurysms.

Isolated temporal horn syndrome is a local obstructive hydrocephalus caused by obstruction of ventriculotemporal horn outflow tract and continuous secretion of cerebrospinal fluid by the choroid plexus of the temporal horn. This syndrome was first reported by Cairns et al. in 1947. So far, less than 30 cases have been reported in the literature^[1,2,3,4]。 This article retrospectively analyzed the clinical data and treatment results of 3 patients with isolated temporal horn syndrome admitted to the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University from 2014 to now.Figure 1)。 The report is below.

To study the abnormal hippocampal structural and functional connectivity in pilocarpine-induced temporal lobe epilepsy (TLE) rats.

Thirty SD rats were randomized into TLE group (n=20) and control group (n=10). Lithium-pilocarpine (LIP) was injected intraperitoneally in rats in the TLE group, and saline instead of pilocarpine was treated in the control group. Six weeks later, rats were received 7.0-tesla T MRI scanning for structural and functional images. The volume of hippocampal gray matter volume and dorsal hippocampus related functional connectivity were compared between the two groups.

Immediately after LIP treatment, 12 rats in the TLE group exhibited status epilepticus. Six weeks later, spontaneous seizures were observed in 10 of the 12 rats in the TLE group were observed spontaneous seizures. The volumes of hippocampal gray matter volumes in the TLE and control groups were 102.51±1.97 mm³ and 85.76±1.62 mm^3, respectively; significant differences wasere noted between the two groups(P<0.05). As compared to controls, the rats in the TLE group revealed decreased dorsal hippocampus related connectivity to the ipsilateral amygdala and the ipsilateral ventral hippocampus(P<0.05), and increased connectivity to the contralateral cortex(P<0.05).

In choronic LIP-TLE rats, hippocampal gray matter structures wereas impaired., and The functional connection in hippocampus-limbic system was diminished, while that in and hippocampus-cortex functional networks was enhancedere also abnormal.

To study the relationship between CUL4B and glioblastoma by inhibiting the expression of CUL4B in U87 and U251 cells.

Three groups were set for in vivo experiments including control group , antisense sequence group (Lv-shCon) and CUL4B group (Lv-shCUL4B); and 2 groups were divided for in vitro experiments including Lv-shCon and Lv-shCUL4B groups. U87 and U251 cells were transduced with shRNA-expressing lentivirus (Lv-shCon or Lv-shCUL4B), respectively. Endogenous expression of CUL4B was detected by quantitative real-time PCR and Western blot. The cell proliferation assay, colony formation assay , Transwell assay and cell cycle analysis were then conducted. Furthermore, U87 and U251 plantation model were set up in nude mice.

The expression levels of CUL4B were significantly reduced in Lv-shCUL4B groups in U87 and U251 cells, in contrast to uninfected(Con) and Lv-shCon groups(all P<0.01). MTT experimental results showed that the growth of Lv-shCUL4B cells was significantly inhibited and U87 and U251 cells decreased by 63.7% and 45.5%, respectively (allP<0.01). The colony formation experiment results demonstrated that the cell colony numbers in U87 cells control group and Lv-shCon group measured an average of 150, while in the Lv-shCUL4B group there were less than 30 colonies.For U251 cells, the control group and Lv-shCon group had an average of 200 cell colonies, and the Lv-shCUL4B group had less than 40 colonies. Compared with the control group and Lv-shCon group, migration ability of Lv-shCUL4B group in U87 and U251 cells decreased significantly(allP<0.05). The cell cycle distribution of U87 and U251 cells was detected by flow cytometry. The results showed that the U251 cells in the G₁ phase accounted for 50.0% in the control group, while the percentages was 52.0% and 82.0% in the Lv-shCon and Lv-shCUL4B groups, respectively. Ten percentage of the U87 cells were 10.0% in phase S in Lv-shCUL4B group, in contrast with 40.0% and 38.0% in blank control and Lv-shCon groups, respectively. Effects of CUL4B knockdown on regulators of cell cycle and migration were detected by Western blot, and the expression levels of Cyclin D1 and MMP-9 were obviously down-regulated, while p16(INK4A) and PTEN were up-regulated in Lv-shCUL4B groups compared with control and Lv-shCon groups(all P<0.01). In vivo experiments demonstrated a reduction of 57.7% and 75.4% of tumor weight in U87 and U251 plantation models of Lv-shCUL4B group compared with Lv-shCon group.

Low expression of CUL4B could inhibit the proliferation of glioblastoma cells. Knockdown of CUL4B might provide a novel therapy for targeted treatment of glioblastoma.

To study the expression of CLDN9 in the oncocytoma subtype of non-functioning pituitary adenomas and the association between CLDN9 and occurrence and invasiveness of oncocytomas.

In this study, we selected 20 cases of oncocytomas (10 invasive and 10 non-invasive tumors) and 3 cases of normal pituitary glands. The CLDN9 expression levels in all pituitary tumors and normal pituitary glands were detected by quantitative polymerase chain reaction (qPCR) and Western blot. The Ki-67 expression levels were observed by immunohistochemistry. Logistic regression analysis was used to examine the correlation between Ki-67 and the invasiveness of oncocytomas.

The expression of CLDN9 in oncocytomas was significantly higher than that in normal pituitary tissue (P<0.01). CLDN9 mRNA and protein expression levels were higher in invasive oncocytomas compared to those in non-invasive oncocytomas (P<0.01). In the oncocytomas with Ki-67 index over 3%, 4 cases were invasive and 3 cases were non-invasive. The Ki-67 was not correlated to oncocytomas invasiveness (P=0.946).

The gene of CLDN9 may play an important role in invasiveness of oncocytomas as a specific biomarker for invasive oncocytomas.

Supratentorial intracranial cavernous malformation (CM) is one of the common intracranial vascular malformations. For superficial non-functional CM lesions with obvious symptoms, surgery is the main treatment, but for CM lesions involving functional areas in the deep supratentorial (especially located in the thalamus and basal ganglia areas), the risk of comorbidity after surgery is higher^[1]The choice of treatment modalities has always puzzled clinicians. In March 2012, the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University operated on a patient with giant cavernous vascular malformation in the basal ganglia and thalamus region with a history of gamma knife treatment and surgical resection, and the curative effect was satisfactory. The report is now as follows.

Angiolipomas of the central nervous system are extremely rare, with about 90% occurring in the spinal canal and only 10% occurring in the cranium, and all of them are reported as individual cases. Histologically, angiolipoma consists of vascular tissue and adipose tissue. In April 2014, a case of angiolipoma involving intrasellar, suprasellar and parasellar was admitted to the Department of Neurosurgery of Weihai Central Hospital, which is now reported as follows.

Pituitary thyrotropinoma is very rare, accounting for about 1% to 2% of pituitary tumors^[1]。 ectopic thyrotropin-secreting pituitary adenoma (ETPA) is rarer and only a case report. Since Cooper reported ETPA in 1996, only seven cases have been reported at home and abroad^{[2,3,4,5,6,7,8]}(Table 1)。 Because it is a rare cause of hyperthyroidism, it is easy to miss the diagnosis and delay the treatment. A patient with ETPA was admitted to the Department of Neurosurgery of Wuxi Second Hospital affiliated to Nanjing Medical University in September 2015. The report is as follows.

hemifacial spasm (HFS), also known as hemifacial twitch, is a benign functional disease in middle-aged and elderly people. The clinical manifestation is paroxysmal involuntary twitching of one facial muscle. The vast majority of patients start with mild unilateral involuntary twitching of orbicularis oculi muscle, which aggravates when emotionally excited and stops after sleep. Most scholars agree that one of the important causes of HFS is the compression of facial nerve by blood vessels. microvascular decompression (MVD) can cure HFS safely and effectively, and has been widely carried out all over the world. This article reviews the surgical evaluation, monitoring and surgical approach of MVD in the treatment of HFS as follows.

Idiopathic hemifacial spasm (HFS), also known as hemifacial twitch or hemifacial spasm, manifests as involuntary, intermittent, painless spastic contraction of muscles in the area of facial nerve distribution on one side of the face. The disease progresses slowly and generally does not improve naturally. It usually starts with the spasm and contraction of the orbicularis oculi muscle, gradually involves the whole half of the face, and the frequency gradually increases, which can eventually lead to the impairment of the visual ability of the affected side. In severe cases, it can involve the neck and shoulder muscles, and excessive fatigue and emotional excitement can induce its aggravation. Foreign epidemiological investigation showed that the incidence rate was 7.4~8.1/1 million, and the ratio of male to female was about 1: 2^[1]。 In the 1960s, Jannetta first proposed the concept of microvascular decompression (MVD) after using surgical microscopy to treat HFS^[2]After decades of development and improvement, it has become the preferred treatment for HFS. In recent years, with the deepening of understanding of the pathogenesis of HFS and the continuous improvement of surgical techniques, the effective rate of MVD surgery has improved to some extent, while the incidence of postoperative ineffectiveness, recurrence and complications has decreased. The hearing impairment of the affected side after MVD is one of the most common serious complications, especially the permanent hearing loss of the affected side after operation, which causes great pain to patients and hinders the further application of MVD to some extent. This article reviews the related situation and prevention and treatment of hearing impairment after HFS MVD in recent years.