Volume 33 · Issue 01 · 2017

The brain is the most complex organ of human body, and it is also an extremely sophisticated and perfect information processing system. Its functional connection and working mechanism are major scientific problems and difficulties that scientists have been trying to solve. Brain science, which aims to clarify the working principles and mechanisms of brain and nervous system, is one of the most rapidly developing branches in life sciences and even all natural sciences. The development of brain science has a huge impetus to the prevention and treatment of brain diseases, the development of information and intelligent industries. Because of this, the European Union, the United States, Japan and other countries have successively released their own brain science research plans. In 2016, China also released "China Brain Project: Brain Science and Brain-like Research"^[1]。 In the brain science research oriented to clinical needs, neurosurgery should actively participate in China's "Brain Project", which will help China make breakthroughs in the research fields of brain cognitive neurological basic principles, brain-like research and the level of diagnosis and treatment of major brain diseases^[2,3]。

Spontaneous intracerebral hemorrhage (SICH) refers to intraparenchymal hemorrhage caused by spontaneous rupture of intracranial large, small arteries, veins and capillaries caused by various causes under non-traumatic conditions. SICH is the most serious type of acute cerebrovascular disease, with acute onset, dangerous condition and high mortality rate. In European and American countries, SICH accounts for about 15% of all strokes; Domestic epidemiological investigation showed that the incidence of SICH accounted for 17.1% ~55.4% of stroke, which was significantly higher than that in foreign countries^[1]。 The occurrence of SICH is caused by the combination of environmental and genetic factors, among which hypertension is the most important cause, accounting for about 50% or more of all SICH. The incidence of SICH caused by hypertension in China is increasing year by year, and it is more frequent and younger. Followed by amyloid angiopathy, accounting for about 15% ~30%; Other causes and unknown causes account for about 10%.

In September 2016, the Brain Trauma Foundation announced the Guidelines for the Treatment of Severe Craniocerebral Trauma (Fourth Edition), which will be published in Neurosurgery^[1], has attracted the attention of academic circles at home and abroad. The new version of the guidelines was published 7 years later than the third edition. With stricter evidence-based medicine standards, 94 new research results were included as evidence, and more accurate treatment recommendations and problem solutions were put forward. There are also changes in views in the new version of the Guide on some controversial issues. Combined with the treatment status and problems of severe craniocerebral injury in China, this paper explains the important issues involved in the fourth edition of the guide, in order to improve the treatment level of craniocerebral injury in China.

To investigate the feasibility and efficacy of purely endoscopic resection of pineal region tumors using infratentorial supracerebellar approach.

A retrospective study of general clinical data and treatment effect was performed for 4 cases of pineal region tumors who underwent pure endoscopic resection using infratentorial supracerebellar approach in Neurosurgery Department at Zhongshan Hospital of Fudan University from August 2014 to December 2015.

Gross total resection was achieved in all 4 cases. Except 1 case of transient diplopia, no surgical complications were observed. The pathological diagnoses included germinoma, anaplastic astrocytoma, pilocytic astrocytoma and mixed germ cell tumor. Postoperative radiotherapy was administered in 2 patients and chemotherapy plus radiotherapy was performed in 1 patient. During the follow-up period (0.5 to 2.0 years), all patients had a normal life without tumor recurrence.

Purely endoscopic resection of pineal region tumors using infratentorial supracerebellar approach seems feasible. It may be considered as an alternative approach for certain pineal region tumors.

To study the feasibility and clinical effectiveness of endoscopic removal of spontaneous supratentorial hematoma assisted by virtual reality (VR) and augmented reality (AR).

A retrospective analysis was conducted with 36 patients with spontaneous supratentorial hematoma who were admitted to the neurosurgery department of PLA General Hospital from September 2014 to October 2015. Based on the hospital picture archiving and communication (PACS) system, three-dimensional visualization of the patients’ hematomas and head outlines were achieved assisted by VR. The technology of AR, used together with imaging fusion application (APP) on android-system cell phones, helped physicians design trajectory to of hematomas. A perforator and transparent sheath were used to set up a working channel for removal of hematomas with endoscopes. Post-operative CT was conducted one day after surgery and volumes of hematomas were calculated with the software of 3D-slicer. The parameters were documented including hematoma evacuation rate, operation time, intraoperative blood loss, preoperative and postoperative (1 week post surgery) scores based on the Glasgow Coma Scale (GCS).

Successful punctures to reach hematomas were achieved with the assistance of VR and AR in call cases. The mean operation time and actual endoscopic operation time were 54.0±9.6 min and 33.0±7.2 min, respectively. The mean amount of blood loss during operation was 80.0±21.5 ml. None of the cases developed postoperative re-bleeding. The average evacuation rate was 95.4%. The mean preoperative GCS score was 6.7±1.6, which was significantly increased to 12.6±1.9 (P<0.01) graded 1 week post surgery.

The technologies of VR based on hospital PACS systems and AR based on cell phone APP could help precisely localize the intracerebral hematomas and select appropriate puncture trajectory. With a working channel established by transparent sheath, the endoscope could help achieve satisfactory removal of hematomas and improve the outcome.

To discuss the surgical strategy and therapeutic effect of neuroendoscopic resection of meningiomas in lateral ventricular trigonum.

A retrospective analysis of 5 cases with meningiomas in lateral ventricular trigonum was conducted, who were diagnosed and underwent operations in Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine from March 2015 to November 2015. All patients underwent preoperative thin-section computed tomography (CT) scans and contrast-enhanced magnetic resonance imaging (MRI). For large intraventricular meningiomas, examinations including computed tomography angiography (CTA), magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) as well as partial vascular interventional embolization were desirable in order to deal with the tumor feeding artery as soon as possible. In the whole process of operation, tumors were resected under the neuroendoscope assisted by neuronavigation, ultrasonic suction system, and a novel brain retractor device.

The meningiomas in lateral ventricular trigonum in all 5 cases were resected completely and were pathologically determined to be fibrous meningiomas. The immunohistochemical analysis showed that Ki-67 index was lower than 1%. The surgical channels were well healed with no brain edema in operation area or ventricle enlargement. Compared with 8 similar patients in other treatment modalities, the mean hospitalization time was significantly shorter [(17.5±4.3) d vs (11.0±2.9) d]. No complications, such as epilepsy, hydrocephalus or visual field defects, were observed postoperatively during the follow-up lasting 6 months to 1 year.

The neuroendoscope combined with neuronavigation, ultrasonic suction system and the novel brain retractor device could help accurately locate deep intracranial tumors, facilitate real-time intraoperative protection of surrounding vessels and functional structures, and achieve maximal safe resection of tumors.

To investigate the effectiveness and prognostic factors of endoscopic third ventriculostomy(ETV) in the treatment of childhood hydrocephalus.

The clinical data of 101 patients with hydrocephalus were retrospectively reviewed, who underwent ETV at Shanghai Children′s Medical Center of Shanghai Jiao Tong University School of Medicine from May 2010 to June 2015.The patient′s ages ranged from l month to 18 years (median age: 29 months). The period of follow-up varied from 6 months to 5 years. The outcomes of ETV and prognostic factors were determined in this study.

Among the 101 patients, a total of 79 patients achieved satisfactory outcomes and the overall success rate(SR) was 78.2%.The specific SRs were determined to be 96.2% (25/26)and 12/14 in hydrocephalus caused by tumors and arachnoidal cysts, respectively, 75.0% (24/32) for aqueductal stenosis, 5/9 for central never system (CNS) infection, 5/8 forhydrocephalus after neonatal hemorrhage, 6/9 for Chiari malformations and 2/3 for communicating hydrocephalus.There was statistically significant difference between SRs associated with different etiologies (P<0.05). The SR of ETV in children less than 2 year old was 67.3% (31/46) and 89.1% (49/55)for children elder than 2 years, and the difference was statistically significant(P=0.007). Among the 4 patients ultimately submittedfor second ETVs, stoma obstruction was confirmed in 3 cases and constructive hydrocephalus with CSF absorption dysfunction was suggested in the 1 remaining case.

ETV seems to be an effective and safe procedure in the treatment of childhood hydrocephalus.The patient's age and etiology of hydrocephalus could be related to the success rate. Anatomical variability, stoma obstruction and CSF absorption dysfunctionmight result in ETV failure, a higher chance of which was observed in children under 2 years old and should be taken with caution.

More than 50% of spontaneous supratentorial cerebral hemorrhage is located in the basal ganglia area, and the disability rate and mortality rate are high^[1]。 Although there are many surgical methods, because of the deep location, the damage to brain tissue is inevitable, and the postoperative complications and prognosis are also different^[2,3]。 Dye et al.^[3]It has been reported that endoscopic removal of hematoma can reduce trauma, but the removal rate of hematoma is not satisfactory. At present, there are few cases of endoscopic clearance of intracerebral hematoma guided by neuronavigation in China. From June 2014 to April 2015, the Department of Neurosurgery, Dong' e County People's Hospital, Liaocheng City, performed endoscopic clearance of hematoma in basal ganglia area under the guidance of neuronavigation combined with brain retractor. The surgical effect was good, which is reported as follows.

To study the clinical effect of superficial temporal artery to middle cerebral artery(STA-MCA) anastomosis combined with encephaloduro-myo-arterio-pericranio-synangiosis (EDMAPS) for moyamoya disease.

This study included a series of 109 patients with moyamoya diseas treated at Aviation General Hospital of China Medical University between May 2011 and January 2015. The patients underwent STA-MCA anastomosis and EDMAPS on 184 hemispheres (unilateral in 34 patients and bilateral in 75 patients)and their symptoms and conditions of vessels were assessed.

CTA studies on 107 patients(182 hemispheres) 1 week postoperation revealed visible direct bypass in 140 (76.9%) hemispheres, and CT perfusion (CTP) studies revealed markedly improved cerebral blood flow in the MCA supply territories (pre- and post-operative cerebral blood flow [CBF]: [25.1±7.8]vs [37.1±11.5] ml·100 mg^-1·min^-1; pre- and post-operative time to peak [TTP]: [12.7±5.4]vs [8.8±3.5] s)(P<0.01). Perioperative complications of brain hemorrhage and infarction occurred in 1 case, respectively. During the follow-up period of 4-50(mean: 33.5±6.4) months, clinical symptoms disappeared in 43 (81.1%) and were significantly improved in the other 10 cases out of 53 patients who had continuous preoperative symptoms. Five of 56 patients with preoperative transient ischemic attack (TIA) had 11 TIA postoperatively. Five of 33 cases with preoperative hemorrhage developed bleeding postoperatively. A total of 105 procedures were performed in 76 patients who underwent CTP study during follow-up (3-18 month post operation) and their CBF and TTP in the corresponding areas of ACA were significantly improved[pre- and post-operative CBF: (20.8±6.5)vs (23.0±8.4) ml·100 mg^-1·min^-1; pre- and post-operative TTP: (8.3±3.8) vs (7.2±3.1) s] (P<0.01). DSA was performed in 81 procedures(46 patients), among which good collateral circulation was observed in 75(92.6%) procedures and collateral vessels developed in the ACA supply areas in 56 (69.1%) procedures.

The procedure of STA-MCA anastomosis and EDMAPS is suggested to be safe and effective in treating moyamoya disease by improving cerebral hemodynamics in both MCA and ACA supply areas.

To investigate the clinical characteristics of hemorrhagic type moyamoya disease and its outcomes after revascularization.

The data of 46 patients with hemorrhagic moyamoya disease, including clinical features and surgical outcomes, were retrospectively reviewed. Among them, 42 cases were treated at Beijing Tiantan Hospital from August 2007 to November 2011. The other 4 cases were managed at the People's Liberation Army (PLA) 174 Hospital from August 2011 to June 2014. In this series of 46 patients, the operation of revascularization was performed in 50 hemispheres. Among them, direct superficial temporal artery to middle cerebral artery (STA-MCA)bypass surgery was conducted in 28 hemispheres, the encephalo-duro-arterio-synangiosis (EDAS) was performed in 10 hemispheres, and 12 hemispheres underwent a combination of STA-MCA bypass surgery and EDAS.

The mean follow-up period was 52.5±6.5 months with a range of 18 ~ 87 months. Among the 19 cases with preoperative neurological deficiency, the symptoms were improved in 11cases, remained unchanged in 6 cases and became worse in 2 cases due to rebleeding. Among the preoperatively asymptomatic 27 cases, good outcomes were observed in 24 cases and rebleeding occurred in the non-surgical hemispheres of the remaining 3 cases. Follow-up CT Perfusion (CTP) and/or SPECT were performed in 25 cases and demonstrated significant improvement of cerebral blood perfusion in 20 cases and no remarkable change in 5 cases. Follow-up (at least 3 months post operation) DSA in the 15 patients who underwent STA-MCA bypass showed complete patency of the anastomosis and diminishing of the moyamoya vessels. In addition, 2 concurrent microaneurysms was found to have disappeared after the direct bypass surgery. Rebleeding developed in 2 (4%) hemispheres (post EDAS) in the surgical group and 3 (7%) hemispheres in the nonsurgical group. There was no statistical difference in the rate of rebleeding rate between the 2 groups(P>0.05).

The surgery of revascularization could improve the symptoms and cerebral perfusion for the patients with hemorrhagic moyamoya disease.

To evaluate the efficacy of versatile fill coils (VFC) as the initial framing coils on embolization of irregular intracranial aneurysms.

A retrospective analysis was conducted in 32 patients with 32 irregular aneurysms and 4 aneurysms of other shapes proved by digital subtraction angiography (DSA) who were admitted to Department of Interventional Neuroradiology, Tangshan Gongren Hospital between January 2015 and December 2015. The 32 irregular aneurysms were embolized using VFC as the initial framing coil and other types of coils were used for embolization of the remaining 4 aneurysms. All patients were followed up 6 months after surgeries.

Immediate postoperative angiographic examinations demonstrated, out of 32 irregular intracranial aneurysms, complete embolization of aneurysms in 28 cases (88%), near-complete embolization in 3 (9%), and partial embolization in 1 (3%). At the follow-up 6 months post operation, complete embolization of aneurysms were found in 26 (81%) cases, near-complete embolization in 5 (16%), and partial embolization in 1 (3%).

VFCs, as the initial framing coils, could facilitate more homogeneous and denser embolization for irregular aneurysms.

To investigate the safety and short-term effect of endovascular treatment for high-risk patients of chronic carotid artery occlusion.

We retrospectively analyzed the data of 12 patients with high-risk chronic carotid artery occlusion who were admitted to First Affiliated Hospital of Xinjiang Medical University from October 2014 to February 2016 and underwent endovascular treatment. National Institute of Health stroke scale(NIHSS)was used to evaluate patients'neuronal functions.Follow-up studies were conducted 1 week, 30 days and 6 months post operations to observe the adverse events. The follow-up time ranged from 4 to 17 months(mean, 13.6 months).

11 patients(11/12) achieved recanalization successfully.The degrees of preoperative and postoperative carotid stenosis in 12 patients was 100% and (22.5±8.9)%, respectively (P<0.05). At 1 week post operation, the adverse event of persistent hypotension occurred in 1 case. Among the 11 patients with successful endovascular treatment, the 6-month postoperative score (3.36±1.56) based on the NIHSS was significantly improved from preoperative level (2.59±1.37) (P<0.05).

Endovascular treatment suggests to be a safe and effective method for high-risk patients of chronic carotid artery occlusion in terms of short- and medium-term effects.

To investigate the prognostic factors in endovascular treatment of ruptured intracranial aneurysms.

The clinical data of 93 cases of ruptured aneurysm treated by endovascular treatment at Department of Neurosurgery, General Hospital of Ningxia Medical University from December 2012 to December 2014 were retrospectively analyzed, including the patients' age, gender, Hunt-Hess grade on admission, Fisher grade on admission, primary hypertension, diabetes, size of aneurysms, location of aneurysms, multiple aneurysms, the time between admission and operation, operation method, extent of embolism, postoperative complication and the level of blood sodium.The patients' outcomes were evaluated adopting the modified Rankin scale Score(mRS) at the time of 18 months post hospital discharge. Possible factors were studied using the univariate analysis, and the factors with statistical significance were further investigated with multivariate variate logistic regression analysis to determine the independent elements.

The follow-up study was successfully conducted for all 93 cases with 68 (73%) demonstrating satisfactory outcomes and the remaining 25 cases (27%) reporting poor outcomes. The univariate analysis indicated that Hunt-Hess grade on admission, Fisher grade, postoperative complications and blood sodium level were significantly correlated with the prognosis(P<0.05). The multiple factors analysis indicated that Hunt-Hess gradeⅢ(OR 14.724, 95%CI 1.520-142.644, P=0.020)、Hunt-HessgradeⅣ(OR 99.350, 95%CI 6.819-1447.563, P=0.001)and postoperative complication(OR 13.420, 95%CI 3.021-59.624, P=0.001) were the independent risk factors affecting the prognosis for endovascular treatment of ruptured intracranial aneurysms.

Hunt-Hess grade on admission and postoperative complications could significantly affect the prognosis of the patients for endovascular treatment of ruptured intracranial aneurysms.

Intracranial aneurysm rupture is the first cause of subarachnoid hemorrhage (SAH). Studies show that the incidence of intracranial aneurysms is 3.6% ~6%^[1]Wherein the fracture rate is 1% to 2%^[1]。 SAH leads to various pathological changes such as cerebral vasospasm, cerebral edema, cerebral infarction and hydrocephalus, and the mortality rate is as high as 25% ~60%. If patients after the first bleeding are not treated in time and correctly, 40% of patients will rebleed within 3 weeks, and the mortality rate of rebleeding is as high as 80%^[2]。 At present, the common practice is to judge the prognosis of patients and whether to undergo surgical treatment according to the Hunt-Hess classification of patients. However, the recent European Stroke Organization management guidelines on aneurysms and SAH recommend that the prognosis on admission of aneurysmal subarachnoid hemorrhage (PAASH grade) should be used to assess the prognosis of aneurysmal SAH (aSAH)^[3]。 In this study, the clinical data of 138 patients with aSAH treated by surgery were retrospectively analyzed to explore the related factors affecting the prognosis of aSAH patients.

To analyze the clinical features, treatment strategies and outcome of ruptured intracranial arachnoid cysts(IACs) with subdural effusions or hematoma in children.

From January 2003 to January 2016, 49 ruptured IACs presented with subdural effusions, subdual and/or intracystic hematoma were retrospectively reviewed at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University. The operative methods including burr hole in 16 cases, craniotomy and fenestration in 5 cases, cysto-peritoneal shunt (CPS) in 20cases, were indicated according to symptomatic presentation or significant radiological criteria. Eight cases were treated conservatively.

The average age of the patients was 7.2±4.7 years, with the dominance of male(78%) and Galassi typeⅡ(53%) middle fossa(94%) IACs. The traumatic history was provided in 26(53%) cases. Raptured IAC were manifested as subdual and/or intracystic hemorrhage in 27(55%) and subdural effusion in 22(45%) patients. After a mean follow-up of 59.1 months in 47 patients, 3 cases disappeared spontaneously, 0 increased in size and all patients have symptomatic improvement. However, 14 of 30 burr hole need reoperation, with craniotomy in 4 and CPS in 10 cases. Shunt dependency occurred in 2 of 19 CPS (11%) and shunt revision was performed in 5(26%) CPS until the utility of programmable valves.

Subdural effusion or hematoma are probably supposed to have an underling IACs in children. Patients with raptured IACs can be treated conservatively in asymptomatic cases. As first procedure, burr hole and subdural drainage should be performed. Craniotomy or CPS should be reserved as the choice for special cases as alternative treatment. Programmable valves may contribute to decrease complications of CPS.

To study the morphology of inferior petrosal sinus and the relationship between the openings of inferior petrosal sinus and the internal jugular veins.

Forty-six patients (78 sides) performed delayed rational venography at the Department of Neurosurgery, the Third Affiliated Hospital of Southern Medical University from April 2015 to January 2016 were enrolled retrospectively, including 32 performed bilateral venography and 14 underwent unilateral venography. The comprehensive lateral venography, three-dimensional rotational venography, and double volume were used for image analysis.

In inferior petrosal sinus of the 78 sides, they were divided into tube-type (35 sides, 45%), plexus-type (10 sides, 13%), hybrid-type (30 sides, 38%), and absent petrosal sinus-type (3 sides, 4%) according to the morphological classification; they were also divided into high-position (the inferior petrosal sinus opening to the upper edge of transverse process of the atlas above the internal jugular veins; 55 sides, 71%), middle-position (the inferior petrosal sinus opening to the upper edge of transverse process of the atlas to the internal jugular vein of the upper edge of the second cervical transverse process; 12 sides, 17%), low-position (the inferior petrosal sinui opening to the upper edge of the second cervical transverse process under the internal jugular vein; 3 sides, 4%), the inferior petrosal sinuus opening to the vertebral venous plexus (5 sides, 6%), and absent inferior petrosal sinus (3 sides, 4%) according to the opening position of inferior petrosal sinus. In 32 patients who underwent bilateral angiography, the morphology of bilateral inferior petrosal sinius and opening positions were completely symmetrical in 3 cases (9%), partly symmetrical in 12 cases (38%), and asymmetrical in 17 cases (53%), asymmetry of the opening in 23 cases(72%).

As for the non-developing rate of inferior petrosal sinius of the delayed rotational venography and three-demensional reconstruction is lower, the morphology of inferior petrosal sinus and their variations to the openings of internal jugular veins are greater.

To explore the values of stereotactic electroencephalography (SEEG) in localization of seizure focus in temporal lobe epilepsy.

From October 2014 to January 2016, 20 epilepsy patients who underwent SEEG for identification of seizure onset zones at the Department of Neurosurgery, China-Japan Friendship Hospital were enrolled. A retrospective analysis was conducted of surgeries and postoperative outcomes.

Twenty patients underwent SEEG surgeries and 135 electrodes were implanted. There was intracranial hemorrhage about 3 ml in one electrode trajectory without any serious symptoms. There is no bleeding or electrode breakage forother electrode implantation. No patient experienced infection or cerebrospinal fluid leakage. The average error is 2.0±0.6 mm. In 14 patients, the seizure onset zones were located at hippocampus, parahippocampus or amygdala. In 6 patients, the seizure onset zones were located at the temporal neocortex. No patient experienced seizures in the follow-up period.

SEEG could help locate the seizure onset zones of temporal lobe epilepsy precisely and explore the epileptic brain networks in temporal lobe epilepsy with relatively low incidence of complications.

To investigate the changes of gene expression after traumatic brain injury (TBI) and the neuroprotective mechanism after TBI.

A cell stretch injury model was induced by using a cell injury controller Ⅱ (CIC Ⅱ). Each parameter was set as pulse time 50 ms and metering valve pressure 0.165 MPa. The gas pulse pressure was 0.021±0.001 MPa. The cell RNAs were extracted by using Trizol reagent in the injury group and the control group, and then the mRNA sequencing was performed. The gene ontology of the differentially expressed genes was analyzed and the ingenuity pathway analysis (IPA) software was used to conduct signaling pathway analysis. The quantitative results were validated by qPCR.

There were 14 310 000 and 15 510 000 reads were obtained respectively in the two samples, and 15 018 genes expressed in the two samples were identified. There were 1 424 differentially expressed genes. Compared to the control group, 1 198 genes were up-regulated and 226 genes were down-regulated in the injury group (P<0.01). Compared with the control group, HIF-1α and ZFP36 expression levels were down-regulated in the injury group and 13 differentially expressed genes after TBI were found and constituted a regulatory network with HIF-1α and ZFP36 as the center. In this network, HIF-1α was regulated by EGLN2 and ZFP36, and interacted with PER1, and regulated the expression of multiple downstream genes at the same time, such as H2AFX, ABCF2, and SLC39A7.

When the injury lasted for 12 hours, HIF-1α at the mRNA level was down regulated by ZFP36, HNRNPD, and EGLN2, respectively, and further regulated the expression of H2AFX, and then prevented the nerve cells from apoptosis, and promoted the repair of nerve cell injury.

To investigate the proliferative activity of vascular smooth muscle cell (VSMC) in the formation of intracranial aneurysm (IA) in spontaneously hypertensive rats (SHR).

A total of 180 adult male rats were randomly divided into 6 groups including the control, 1-, 2-, 3-, 4- and 5-month experiment groups (n = 30 in each group). In the 5 experiment groups, the left common carotid artery and posterior branches of both renal arteries of rats were ligated to establish the rat model of spontaneous hypertensive intracranial aneurysms. The arterial blood pressure of the rats in each group was measured, and intracranial arteries were examined with MRA to observe the formation of IAs in rats. The specimens of aneurysms were obtained and morphological changes of IA were observed by HE staining. The expression of proliferating cell nuclear antigen (PCNA) of IA wall in each group was explored with immunohistochemistry. Apoptosis of IA wall VSMC was detected with the method of TUNEL.The protein levels of α-smooth muscle actin (α-SMA), β-tubulin and osteopontin (OPN) in IA wall were detected by Western blot. The mRNA relative levels of SM22α and hypertension-related gene (HRG-1) were tested with quantitative real-time PCR.

Compared with controls, in experimental groups, the blood pressure of SHR was significantly increased after operation (all P<0.05). Intracranial aneurysms could be observed in 4-month and 5-month experiment groups.The expressions of PCNA were significantly increased, reached the highest levels in the 4-month group, and began to decrease in the 5-month group. The percentage of apoptosis of VSMC of aneurysm wall in the experimental groups was increased significantly.In experimental groups, levels of α-SMA and β-tubulin expression were significantly decreased(allP<0.05). The expression levels of OPN were increased gradually, reached the highest levels in the 4-month group, and began to decrease in the 5-month group. SM22α and HRG-1 mRNA expressions were gradually decreased(allP<0.05).

In the process of IA formation, the aneurysm wall VSMCs demonstrate proliferation activity; and the formation of IA seems to be closely related to the weakening of proliferation activity and number decrease of aneurysmal wall VSMCs.

Internal carotid artery injury is a relatively rare complication of transphenoidal pituitary adenoma surgery, but its consequences can be catastrophic. Two cases of internal carotid artery injury caused by transsphenoidal pituitary adenoma surgery were treated in Qilu Hospital of Shandong University (Qingdao) from March 2015 to January 2016. The reports are as follows.

Acute epidural hematoma is a common intracranial hematoma in neurosurgery, accounting for about 30% of intracranial hematomas. It is extremely rare for the hematoma to dissipate without surgical treatment within 24 h^[1,2,3,4]At present, 13 cases have been reported in domestic and foreign literatures^{[2,5,6,7,8,9,10,11,12,13,14,15]}, including 10 cases abroad. Most scholars believe that the mechanism of its dissipation is due to the existence of skull fracture, and its hematoma penetrates under the scalp through the fracture line and redistributes^{[5,6,7,8,9,10,11,12,13,14,15]}。 The clinical data and treatment effect of a patient with multiple acute epidural hematoma admitted to the Department of Neurosurgery of Qiannan People's Hospital in September 2015 are reported below.

PatientFemale, 76 years old. He was admitted to hospital due to weakness of both lower limbs for 1 year and aggravated for more than 10 days. Physical examination: the muscle strength of both upper limbs was grade V, the muscle strength of left lower limbs was grade I, and the muscle strength of right lower limbs was grade 0. The double Pap sign was not drawn out, and the pain under both costal arches was reduced. MRI suggests T_5～7Epidural space occupying lesions in the vertebral canal at vertebral level (Figure 1)。 Posterior median approach was used for surgery, T_5～7At the level of the vertebral body, a gray-red lesion with soft texture and clear boundaries could be seen in the epidural of the vertebral canal, containing fat, blood vessels and fibrous tissue. There was no obvious adhesion to the dura, and the blood supply was abundant, so it was totally resected. The postoperative pathological diagnosis was angiolipoma (Figure 1)。

With the in-depth study of skull base surgery by endoscopic endonasal approach (EEA) and the continuous improvement of surgical instruments, the technique of skull base surgery in EEA has been continuously improved, the exposure range of skull base has gradually expanded, and the types of lesions that can be resected by endoscopy have gradually increased. Correspondingly, the range of skull base defects caused by surgery increases, and the risk of postoperative cerebrospinal fluid leakage, intracranial infection and encephalocele increases, which become the main factors restricting skull base surgery in EEA. Therefore, the skull base reconstruction technique appears to be crucial. Small-scale skull base defects can be reconstructed with artificial dermis, free tissue flap and other free repair materials, and the success rate is more than 95%^[1,2]。 Endoscopic enlargement of skull base defects caused by transnasal approach has a high incidence of cerebrospinal fluid leakage after reconstruction with free repair materials^[3]More reliable reconstruction techniques are needed. In recent years, the main progress is the application of mucosal flap with vascular pedicle in the nasal cavity for skull base reconstruction, which reduces the incidence of cerebrospinal fluid leakage to less than 5%^[4]。 This article reviews the application of these pedicled mucosal flaps in EEA skull base surgery.

Intracranial aneurysm is a tumor-like protrusion caused by local intracranial vascular abnormalities. It mostly occurs at the bifurcation of intracranial arteries. Due to the lack of smooth muscle cells in the aneurysm wall, it is easy to rupture, resulting in subarachnoid hemorrhage (SAH). The overall mortality rate of aneurysm SAH is about 50%^[1,2]。 According to the epidemiological research on unruptured intracranial aneurysms in China, the incidence rate of intracranial aneurysms in China is about 7%, which is higher than that in other countries in Europe and America^[3]。 However, the etiology of intracranial aneurysm is still unclear. At present, it is believed that intracranial aneurysm is a complex disease that occurs under the combination of congenital genetic factors and acquired environmental factors^[4]。 With the further development of high-throughput whole genome sequencing (WCS), genome association study and whole genome-based gene expression analysis technology, it provides a powerful means for exploring the genetic risk factors and molecular basis of intracranial aneurysm. This article will review the latest research progress of molecular basis and genetics of intracranial aneurysms, in order to provide more recent information for molecular biology and genetics research of intracranial aneurysms.

neurofibromatosis type 2 (NF2) is an autosomal dominant disease with more than 95% of bilateral acoustic schwannomas. As the disease progresses, most NF2 patients will eventually face complete bilateral hearing loss^[1]。 Due to the impaired integrity of the auditory nerve, it is generally difficult for patients to perform hearing reconstruction by cochlear implant (CI). auditory brainstem implant (ABI) can bypass the cochlea and auditory nerve to establish new auditory pathways. It is suitable for deaf patients with impaired auditory nerve integrity or cochlear dysfunction. It is the only way for the vast majority of NF2 patients to reconstruct their hearing^[2]。 This article reviews the application of ABI technique in type 2 neurofibromatosis.

Epilepsy is a disorder of brain function caused by abnormal hypersynchronous discharge of brain cell groups, which can be accompanied by sensory, motor, cognitive, conscious and mental disorders. There are nearly 50 million epileptic patients worldwide, and the prevalence of epilepsy in Mainland China is 3.6‰ ~7.0‰^[1]。 About 1/3 of these epileptic patients cannot be treated with drugs, but need neurosurgical treatment. Studies have shown that neurotransmitter dysregulation, inflammatory response and ion channel dysfunction are all related to the pathogenesis of epilepsy, and the complex pathogenic mechanism leads to the difficulty and complexity of epilepsy treatment^[2]。 This article reviews the role of inflammatory response in the pathogenesis of epilepsy as follows.

Alzheimer's disease (AD) is a progressive neurodegenerative disease with memory impairment as the main manifestation and insidious onset. The disease is also clinically manifested as language impairment, cognitive dysfunction, personality disorder and behavioral changes. The incidence of AD increases approximately exponentially with age. There were about 35.6 million AD patients worldwide in 2010, and it is expected to increase to 115.4 million people in 2050. In 2005, there were about 5.98 million AD patients in China, which will reach 10.2 million in 2020 and 22.5 million by 2040, making it the largest country with AD^[1]。