Volume 33 · Issue 02 · 2017

Pituitary adenomas are common intracranial benign tumors of monoclonal origin of adenopituitary cells, accounting for about 7% of intracranial tumors, and are divided into functional pituitary adenomas and non-functional pituitary adenomas. Except for some specific types of tumors and populations, the treatment of pituitary adenomas is mainly surgical. The main goals of surgical treatment were satisfactory tumor resection, adequate decompression and postoperative endocrine relief. The surgical methods included microscopic craniotomy and neuroendoscopic transnasal sphenoidal sinus surgery^[1]。

To explore the applicability and precision of O-arm combined with real-time navigation technique in spinal fixation.

The clinical data of 31 inpatients with spinal fixation were retrospectively analyzed at Department of Neurosurgery, Beijing Tsinghua ChangGung Hospital from May 2015 to May 2016. Preoperative, intraoperative and postoperative imaging findings were assessed. The patients were divided into occipitocervical fusion group (19 cases) and thoracic-lumbar-sacral spine fixation group (12 cases). The lesion resection was performed under microscope. O-arm combined with real-time navigation was used in spinal fixation. Surgical efficacy in the patients was evaluated by means of operation time, X-ray times, screw positions and complications.

During the occipitocervical fusion group, 112 screws were implanted in the cervical spine, and 57 in occipital bones. Two screws were found to have penetrated bone cortex and were adjacent to vertebral arteries according to intraoperative 3-D image of O-arm. In the thoracic-lumbar-sacral spine fixation group, 72 pedicle screws were implanted, but 2 screws were out of vertebral body and corrected in time. O-arm scan times was 3 per case on average, and the operation time of O-arm and navigation was 20-30 minutes per time. Screw implantation lasted 5-7 minutes per screw in cervical spine, 8-10 minutes in thoracic and 6-8 minutes in lumbar spine.

Through O-arm real-time navigation, the angle and depth of screws could be observed in real during screw implantation, which would greatly improve the implantation accuracy and safety, and, at the same time, reduce the radiation dose and times for the patients.

To explore the effects of minimally invasive nerve root decompression in the treatment of lumbar spinal stenosis.

From January 2008 to December 2014, 208 patients with lumbar spinal stenosis received nerve root decompression under microscope at Department of Neurosurgery, Tianjin Medical University General Hospital. Among them, single-level unilateral decompression was performed in 121 cases, single-level bilateral decompression in 34 cases, multiple-level unilateral decompression in 31 cases and multiple-level bilateral decompression in 22 cases. The Oswestry disability index (ODI) and disc height of upper adjacent segment were documented. The follow-up lasted 2～7 years(mean, 4.1 years).

Out of 208 patients, 182 were successfully followed up and 26 were lost to follow-up. Based on the ODI, significant functional improvement was observed during follow-up at different time points (P<0.05) for patients with single-/multiple-level and unilateral/bilateral lumbar spinal stenosis. Compared with preoperative values, there was no statistical significance in disc height at different time points of follow-up (P>0.05) for patients with L₁/L₂, L₂/L₃, L₃/L₄, L₄/L₅ stenosis.

With limited trauma and fast recovery, microscopic nerve root decompression seems effective for symptom relief of lumbar spinal stenosis and helpful in maintaining spinal biomechanical stability.

To evaluate the efficacy and safety of applying intra-operative computerized tomography (CT) in the analysis of bone removal accuracy in anterior cervical fixation surgeries.

A retrospective study was conducted to analyze 22 patients of cervical spondylosis who were admitted to Department of Neurosurgery, General Hospital of Shenyang Military Region from April 2014 to March 2016 and underwent CT-guided anterior cervical fixation surgery by a single doctor. Seventeen among the patients received anterior cervical discectomy with fusion (ACDF), and the remaining 5 underwent anterior cervical corpectomy with fusion (ACCF). After general anesthesia was induced during surgery, a baseline CT scan was performed. The extent of bone removal was assessed using a 2nd CT scan after bone decompression. If the bone removal was considered inadequate, additional bone was removed and a 3rd CT scan was performed to ensure satisfactory decompression.

The decompression was deemed sufficient in 13 cases after 1st session of bone removal based on intra-operative CT. Insufficient bone decompression was observed in the other 9 cases and further bone removal was performed. In 2 out of the 9 patients a 2nd session of bone decompression was conducted. On average, every patient received CT scan for 2.59 times. The last CT scan proved sufficient bone decompression in all patients. The patients were followed up for 3-7 months after surgery. The average recovery rate based on the Japanese Orthopedic Association (JOA) score was 64% 1 week after surgery, which showed significant improvement after surgery. No cases required re-operation due to insufficient bone decompression. No complications were observed which were related to intra-operative CT scan.

The intra-operative CT scanning could help surgeons monitor the extent of bone decompression and allow immediate remedy in case of inadequate bone removal. In addition, it could enhance the safety and improve outcomes of anterior cervical spine surgeries.

To study the application of intraoperative yellow fluorescence to intramedullary spinal cord ependymoma resection.

The clinical data of 83 in-patients with spinal cord tumors were retrospectively analyzed, who were admitted to Department of Neurosurgery, Beijing Tsinghua Changgung Hospital from December 2014 to December 2015. Among them, the diagnosis of intramedullary spinal cord ependymoma was histologically confirmed in 56 cases (39 men and 17 women), whose mean age was 43.5±4.2 years old (range: 31～65 years). All cases in this study received preoperative MRI scan to demonstrate the location, size and segment of tumors.Fluorescein sodium(3～4 mg/kg) was administered intravenously 30 minutes prior to anesthesia. Tumor resection was performed under alternation between conventional white light and yellow fluorescent light source. At 3 months post operation, MRI scans were conducted for observation of residual tumors, and spinal cord function was evaluated according to the McCormick scale. The mean follow-up period was 3 months.

The rate of gross total resection (GTR)was 100.0% in this series of 56 cases. Among them, 47 cases were significantly stained under fluorescein sodium model (correlated with preoperative MRI enhancement) and received fluorescence-guided tumor resection.The other 9 cases with little staining (including 2 cases with little preoperative MRI enhancement and 4 cases demonstrating uneven MRI enhancement due to tumor apoplexy) underwent resection with conventional white light. Compared with 7-day and 1-month follow-ups, the 3-month postoperative improvement rates of sensory and motor functions were 83.0%(44/53)and 82.4%(42/51), respectively(P<0.01), while the improvement rate of urinary function was 66.7% (P>0.05). Based on the McCormick grading system, 3.6%(2), 55.4%(31), 25.0%(14)and 16.1%(9)of the 56 patients were preoperatively categorized as gradeⅠ, Ⅱ, Ⅲ and Ⅳ, respectively. At 3 months post operation, 7.2%(32), 21.4%(12), 14.3%(8) and 7.1%(4) of the patients were categorized as gradeⅠ, Ⅱ, Ⅲ and Ⅳ, respectively, which demonstrated significant difference compared with preoperative conditions (P<0.01). The patients preoperatively categorized as grade Ⅰ and Ⅱ reported good surgical outcomes, while grade Ⅲ and Ⅳ patients did not. MRI results demonstratedno residual tumors or recurrence 3 months post operation.

Fluorescein sodium could be used for intramedullary ependymoma resection and contribute to complete excision of tumors.

To explore the clinical characteristics and surgical treatment of anterior sacral meningocele (ASM).

A retrospective analysis was conducted for 4 patients with ASM who were admitted to Department of Neurosurgery, Peking University First Hospital from April 2011 to October 2015. The patients included 2 men and 2 women and their ages ranged from 13 to 49 years old. One patient had the comorbidity of tethered cord syndrome, one had uterus bicornis, one had epidermoid cyst, and one had Currarino syndrome. Their main symptoms included lower abdominal mass, pain, constipation and urinary dysfunction. All cases received surgical treatment through median posterior sacral approach. Neuroendosope was applied for assistance in one case. The follow-up lasted for 6～55 months.

All patients received significant symptom improvement postoperatively, and the ASM collapsed remarkably based on MRI examination.

The clinical manifestations of ASM, clinical uncommon, mainly include symptoms due to pelvic organ compression. Surgical operations through median posterior sacral approach seem to be safe and effective for treatment of ASM. Neuroendosope could be useful in observation and protection of the neural structures.

To investigate the clinical effect of using anterior cervical approaches in the treatment of cervical neurogenic tumor of the peripheral nerve from different parts.

A retrospective review of 22 cases of cervical neurogenic tumor of peripheral nerves was performed, who were admitted to Department of Neurosurgery, Beijing Friendship Hospital, Capital Medical University from January 2009 to January 2015.All 22 patients underwent microsurgical operations with anterior approach of sternocleidomastoid muscle in 10 cases, posterior approach of sternocleidomastoid muscle in 4 cases, anterior cervical retropharyngeal approach in 3 cases, trans-oral approach in 2 cases, and supraclavicular approach in 3 cases.

The tumors in all 22 cases were totally resected.No surgical complications such as cerebrospinal fluid leakage were observed except 2 cases which developed hoarseness postoperatively that improved that after neurotrophic treatment. All cases were followed up for 12-84 month with a mean 48.3±18.7 month.Recurrence occurred in 1 case which underwent 2nd operation.

It seems safe and effective to select appropriate approaches corresponding to various tumor locations in the treatment of cervical neurogenic tumors of peripheral nerves.

To investigate the effect of occipital-cervical fusion on craniocervical junction deformity with atlantoaxial instability.

A total of 35 patients with craniocervical junction deformity with atlantoaxial instability were analyzed retrospectively, who underwent occipitocervical fusion at Department of Neurosurgery, the First Affiliated Hospital, Zhengzhou University from January 2013 to December 2015. The patients were followed up for 6-30 months. Before and after operations, the patients received evaluations based on the Japan Orthopedic Association (JOA) score. Atlantoaxial dislocation was assessed by means of the atlantoaxial distance (ADI); the distance between the odontoid and Chamberlain's line(marked as H) was measured to evaluate the vertical displacement; and the cervicomedullary angle (CMA) was used to assess spinal cord compression.

No complications including rupture of vertebral arteriesor nerve injuries occurred during the operations. At 7 days post surgery, the patients' mean scores of JOA, ADI, H and CMA were (11.6±1.6), (2.8±0.6) mm, (3.1±1.5) mm and (152.7±6.2) degrees, respectively. The preoperative corresponding values were (10.8±1.7), (8.2±2.9) mm, (8.1±5.5) mm and (130.1±10.3) degrees. The differences were all statistically significant (P<0.05). Postoperative findings demonstrated that 1 patient (3%) died of extensive brain stem infarction and 1 patient (3%) had undergone a revision operation due to fusion failure at the third month after surgery. The other patients reported good outcomes of bone grafting and internal fixation. The follow-up period was 6～30 months (mean, 14.8±7.8 months). Thirty-two patients reported symptom relief and 2 patients had no remission. The JOA score was (13.2±1.7) points at the last follow-up and statistically significant compared with the preoperative level(P<0.05).

The occipital-cervical fusion seems to be an effective treatment for the craniovertebral junction deformity with atlantoaxial instability.

Intraspinal tumors account for approximately 15% of CNS tumors, while schwannomas account for approximately 25% of intraspinal tumors. Spinal schwannomas are mostly single, and can occur in all segments of the spinal canal. The peak incidence is between 40 and 60 years old, and most of them originate from the dorsal nerve root^[1]。 For the treatment of spinal schwannoma, total laminectomy was the main treatment in the past, but this procedure caused greater damage to the posterior column structure of the spine. Since then, it has gradually developed to apply hemilaminary surgery, and obtained a good prognosis. However, for smaller schwannomas located between laminar segments, surgery (semi-semi-laminar approach) by enlarging the natural space between adjacent laminas can better maintain the stability of the bone structure of the spinal canal and facilitate total resection of the tumor. From January 2010 to June 2015, 18 patients with spinal schwannoma were treated in the Department of Neurosurgery of Jinan Military Region General Hospital, and they were treated with semi-semi-laminar approach, and satisfactory results were achieved, which are reported below.

To investigate the clinical features and treatment strategies based on a single domestic center and network database.

The clinical data of 66 patients with pituitary abscess admitted to Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, from January 1991 to December 2013 were analyzed retrospectively. Clinical data from network database PubMed, Embase, CNKI and Wanfang were selected based on the key words of pituitary abscess and sellar abscess, excluding reports involving less than 10 patients.

A total of 193 patients were enrolled in the study include 92 males and 101 females with an average age of (43.7±3.1) years and an average duration of illness of (37.4±25.0) months. The most common symptoms were headache and dizziness (142 cases, 73.6%), followed by anterior pituitary hypofunction (120 cases, 62.2%), visual disturbance (106 cases, 54.9%), posterior pituitary hypo-function (66 cases, 34.2%) and symptoms related to infection (63 cases, 32.6%). There are 130 cases (67.4%) which showed typical rim enhancement on MRI. In this series, 172 patients (89.1%) were treated with transsphenoidal surgery, 17 patients (8.8%) underwent craniotomy, and the remaining 4 cases (2.1%) were treated with other methods. During the follow-up of (7.2±4.9) years, 8 patients (12.1%) developed recurrence.

The diagnosis of pituitary abscess might be considered for patients with hypopituitarism, diabetes insipidus and rim enhancement on MRI. Proper uses of antibiotics, sufficient drainage through surgery and hormone replacement for hypopituitarism are key factors in treatment of pituitary abscess.

To investigate the causes and risk factors for postoperative mortality after microvascular decompression (MVD).

A total of 12, 339 patients with cranial nerve disorders underwent MVD at Department of Neurosurgery, China-Japan Friendship Hospital between January 2008 and December 2015. Among them, 15 cases died and were retrospectively studied for the causes and possible risk factors. Fifteen parameters were assessed in this study including gender, age, side of illness, duration of illness, medical history (hypertension, diabetes, heart disease, cerebral vascular disease, respiratory disease, comorbidity of at least 2 diseases), ASA (American Society of Anesthesiologists) grade, types of offending vessels, intraoperative decompression difficulty, systolic/diastolic blood pressure fluctuations within 24 h after operation. Univariate analysis and multivariate Logistic regression analysis were conducted to decide the independent risk factors.

The overall mortality was 0.12% (15/12 239) after MVD. The causes of death consisted of complications directly related to surgery (postoperative intracranial hemorrhages in 9 cases and acute intracranial infection in 2 cases) and perioperative complications indirectly related with surgery (acute pulmonary embolism in 2 cases, acute myocardial infarction in 1 case and cerebral infarction in 1 case). Univariate analysis suggested that fluctuations of systolic/diastolic blood pressures within 24 h post operation, history of cerebrovascular disease, history of respiratory disease, more than 2 comorbidities, types of offending vessels, decompression difficulty has association with mortality (all P<0.05). Multivariate Logistic regression analysis demonstrated that history of respiratory disease(OR: 25.487, 95%CI: 1.321-491.714, P=0.032), decompression difficulty(OR: 18.082, 95%CI: 2.867-114.067, P=0.002)and more than 2 comorbiditities(OR: 9.017, 95%CI: 1.363-59.644, P=0.023) remained independent predictors of postoperative death after MVD.

Postoperative deaths after MVD could result from acute myocardial infarction, acute pulmonary embolism, cerebral infarction, intracranial hemorrhage and acute intracranial infection. More than 2 co-morbidities and intraoperative decompression difficulty may increase the risks of postoperative deaths after MVD.

To explore the characteristics and risk factors of headaches associated with Rathke cleft cyst (RCC) and to provide evidence for evaluating the correlation between RCC and headaches preoperatively.

The clinical data of 30 patients, who were admitted to Department of Neurosurgery, the Second Affiliated Hospital of Dalian Medical University from January 2010 to December 2015 and diagnosed with RCC based on postoperative pathological examination, were collected and retrospectively analyzed. The patients were separated into 2 groups: a group of headaches associated with RCC (n=18) and a group of controls (n=12) based on the degrees of headache relief following surgical therapy. Clinical data of the two groups were statistically compared.

RCC-associated headaches were reported in the forehead (13 cases), temporal areas (3 cases) and both areas (2 cases). None of them presented with diffuse headache. Univariate analysis showed that there was no significant difference between the two groups in sex, age, family history, tumor volume and the signal intensity on T2-weighted MRI image (P>0.05). Pituitary dysfunction (P=0.009), hyper-intensity on T1-weighed MRI image (P=0.008), visual deficiency (P=0.024) and the ring-enhancement on MRI (P=0.008) had significant difference between the two groups. By means of multivariate logistic analysis, preoperative pituitary dysfunction (OR=0.069, P=0.046, 95% CI: 0.005-0.905) and ring-enhancement on MRI (OR=12.779, P=0.049, 95% CI: 1.010-161.691) were determined independent risk factors for headache associated with RCC.

Headaches associated with RCC appear to affect the forehead and temporal areas with complex mechanisms. Pituitary dysfunction and ring-enhancement on MRI may have close correlation with headache. Adequate preoperative evaluation could help improve the surgical effect.

To discuss the clinical features and surgical outcome of warfarin-associated intracerebral hemorrhage (WICH).

Sixty-five consecutive patients with WICH were admitted to Department of Neurosurgery, Beijing Anzhen Hospital, Capital Medical University, from January 2005 to May 2016. Their clinical presentation, therapies and outcomes were retrospectively analyzed and discussed with reference to the relevant literatures. Among these patients, 7 cases underwent drilling and drainage, intracranial hematomas were removed by small craniotomy in 50 cases, and both hematoma and bone were removed in the remaining 8 cases.

The average volume of hematomas in 65 patients was (46.8±13.7) ml.The mean dose of warfarin was 1.5-6.0 mg/d and the average dose was(3.5±1.5) mg/d. The medication time was 3-72 with a mean of 27.8±3.4 months. When the intracerebral hemorrhage occurred, the international normalized ratio (INR) was 1.2-5.6 (mean, 2.7±1.2). WICH occurred in 48 (73.8%) patients within the recommended range of anticoagulation (INR: 2.0-3.0). There were no operative complications in the 65 patients. Based on the Glasgow coma scale (GOS), 28 cases (43.1%) were in grade Ⅴ, 15 cases (23.1%) in grade Ⅳ, 8 cases (12.3%) in grade Ⅲ, 5 cases (7.7%) in grade Ⅱ, and 9 cases (13.8%) in grade Ⅰ (13.8%). Nine cases (13.8%) died, among which 4 cases died due to rebleeding and multiple systemic organ failure occurred in the remaining 5 cases.

Appropriate surgical timing and surgical treatment of WICH could help prevent the enlargement of hemotomas, improve the prognosis and reduce its mortality.

To assess the effect of stereotactic puncture and drainage compared with craniotomy in the treatment of patients with hypertensive intracerebral hemorrhage (HICH) in basal ganglia region.

From March 2013 to September 2014, a prospective controlled study was undertaken at the Department of Neurosurgery, the Third Affiliated Hospital of Soochow University. Sixty-eight patients of basal ganglia hemorrhage without brain hernia were enrolled, among which 24 cases underwent trans-frontal stereotactic puncture and drainage (puncture group), and the remaining 44 cases received craniotomy and hematoma removal (craniotomy group). The parameters, including operation time, postoperative complications, 1-month postoperative mortality and 6-month postoperative activities of daily life (ADL), were compared between the two groups.

There was no significant difference in age, gender, hematoma location, hematoma volume, state of consciousness or operation timing between the two groups. Compared with that in craniotomy group, the operation time in puncture group was obviously shortened(42.3±11.3 min vs. 172.2±45.3 min, P<0.01). The overall incidence of postoperative complications in puncture group was lower than that in craniotomy group(16.7% vs. 52.3%, P<0.01), including postoperative local infarction(0% vs. 22.7%, P<0.05), pulmonary infection(16.7% vs. 45.0%, P<0.05) and tracheotomy(4.2% vs. 40.9%, P<0.01). Moreover, the rate of good outcomes at 6-month follow-up assessed with ADL was significantly higher in the puncture than craniotomy group (95.8% vs. 68.2%, P<0.01). There was no obvious difference between the puncture and craniotomy groups in postoperative rebleeding incidence(4.2% vs. 15.9%, P>0.05)and 1-month postoperative mortality (0% vs. 13.6%, P>0.05).

Compared with craniotomy, stereotactic puncture and drainage demonstrate the advantages including relative convenience, minimal invasiveness, safety and good outcome. It could be preferred for the non-hernia patients with HICH in basal ganglia region. Craniotomy might be performed for the rebleeding patients after puncturing who need reoperation.

To explore the brain imaging features of primary central nervous system lymphoma (PCNSL).

A total of 32 patients with histologically confirmed PCNSL in Department of Neurosurgery, Fuzhou General Hospital of Nanjing Military Command form August 2010 to August 2016 were retrospectively analyzed for their CT and MR features.

Fifty lesions were identified in this series of 32 patients including 18 cases (56%) with a single lesion and 14 cases (44%) with multiple lesions.PCNSLs were mostly located in the deep brain areas (76%, 38/50)such as the basal ganglia and corpus callosum, and less commonly shallow brain regions (24%, 12/50). Mild to moderate perilesional edema was seen in 38 out of 50 (76%) cases.On CT images, 44 (88%) lesions were isointense or mildly hyperintense, 6 (12%) lesions presented as mild hypointense, and 11 cases demonstrated significant enhancement with contrast. Most lesions(92%, 46/50)varied from hypointense to isointense on T1-weighted MRI and from isointense to hyperintense on T2-weighted images. Forty-five lesions (90%) presented as hyperintense on DWI.Contrast-enhanced MRI images showed obvious homogenous enhancement with various shapes such as lump-like, crack-like, butterfly-like, satellite-like, fist-like and indentation sign. Pathological studies confirmed 30 cases of diffuse large B-cell lymphoma and 2 cases of T-cell lymphoma.

Certain imagingand pathological features are associated with PCNSL, which would facilitate its diagnosis and differential diagnosis.

Atherosclerosis is the main cause of coronary heart disease and cerebrovascular disease. In patients with coronary atherosclerosis, angina pectoris, myocardial infarction, arrhythmia, and even sudden death can occur if the diameter of the tube is narrowed by more than 75%; Cerebral atherosclerosis can cause cerebral ischemia, cerebral atrophy, or cerebral vascular rupture and hemorrhage. Coronary artery stenosis and carotid artery stenosis can exist simultaneously. According to statistics, about 12% ~17% of patients who plan to undergo coronary artery bypass grafting have carotid artery stenosis>50%; While 66% ~77% of patients with carotid artery stenosis were complicated with coronary heart disease, 28% of them needed coronary artery bypass grafting^[1,2]。 The results showed that coronary artery stenosis and carotid artery stenosis had a significant correlation, and carotid artery stenosis had a tendency to worsen as the degree of coronary artery stenosis progressed^[3]。 Therefore, it is essential to develop a surgical protocol for patients with coronary stenosis combined with carotid stenosis. This article reports the clinical data of 3 patients with coronary artery stenosis combined with carotid artery stenosis admitted to the Department of Cardiac Surgery of the Second Hospital of Hebei Medical University from March 2014 to October 2015, and discusses the treatment experience.

Autologous bone flap has the advantages of satisfactory shape, less immune rejection, low cost and easy acceptance by patients^[1,2], is considered an ideal repair material for skull defects^{[3,4,5,6,7,8,9,10]}。 Bone flap resorption is one of the main complications after autologous cranioplasty, and its incidence varies greatly in the literature reports^{[11,12,13,14,15,16,17,18,19,20]}。 At present, the lack of uniform diagnostic criteria for bone flap resorption after autologous cranioplasty is the main reason for the large difference in the incidence of bone flap resorption reported by various researchers^{[14,15,16,17,18]}。

Brainstem hemorrhage caused by hypertension, sudden onset, dangerous condition, often secondary to multiple complications, resulting in a high mortality rate of patients^[1]。 At present, because of the difficulty and high risk of surgery, conservative treatment is mostly adopted in clinical practice, and it is even considered as a contraindication^[2,3]。 This article retrospectively analyzed the clinical outcomes of 22 patients with severe hypertensive brainstem hemorrhage [Glasgow Coma Score (GCS) ≤8] operated from June 2007 to March 2015 in the Department of Neurosurgery of Suqian People's Hospital of Nanjing Drum Tower Hospital Group, and compared with 24 patients treated conservatively at the same time.

bronchogenic cyst (BC) is a relatively rare congenital disease, which is common in children and mostly occurs in the mediastinum. BC can also occur in gastrointestinal tract, pericardium, sternum, subcutaneous and other parts, so its clinical manifestations are diverse^[1]。 spinal bronchogenic cyst (SBC) occurring in the spinal cord is more rare, only 17 cases have been reported so far^{[2,3,4,5,6,7,8,9,10,11,12,13,14,15]}。 In October 2015, a patient with SBC was admitted to the Department of Neurosurgery of Shanxi Provincial People's Hospital. The pathogenesis and clinical characteristics of SBC were summarized and discussed in combination with previous literature.

Paraganglioma is a neuroendocrine tumor, which occurs in the adrenal medulla, head and neck, retroperitoneal paravertebral areas, etc. Paraganglioma occurring in the spinal canal is rare clinically, and paraganglioma occurring in the cauda equina area is even rarer^[1,2,3,4,5]。 Due to the lack of specific clinical and imaging findings, it is easy to misdiagnose before surgery. In March 2016, the Department of Neurosurgery, the First Affiliated Hospital of Xinjiang Medical University admitted a patient with paraganglioma in the cauda equina region of the spinal canal confirmed by pathological examination. The results of surgical treatment are satisfactory. The MRI characteristics and diagnosis and treatment experience of intraspinal paraganglioma are summarized as follows in combination with literature review.

Adolescents refer to a special group of people aged 15 to 18 years old, whose incidence of intracranial aneurysms is low. Distal intracranial aneurysm mainly refers to a type of aneurysm located at the distal end of the artery away from the Willis ring, the internal carotid artery, the main vertebrobasilar artery, and the main middle cerebral artery. The incidence rate accounts for 2% ~5.5% of intracranial aneurysm^[1,2]。 Among them, juvenile intracranial aneurysms are not located in Willis ring, and are located at the distal end of intracranial artery is extremely rare. There are few relevant literature reports at home and abroad, and occasional case reports^[3]Therefore, its exact incidence has not been reported. From January 2013 to January 2014, two adolescent patients with distal intracranial aneurysm were treated in the Department of Neurosurgery of Ganzhou People's Hospital. The diagnosis and treatment experience is reported as follows.

Case 1 male, 53 years old; Originally from Inner Mongolia, Mongolian. He was admitted to Xing' an League Hospital in Ulanhot on November 7, 2014 due to "pain in the left side of his face for 1 year and aggravated for half a month". One year ago, the patient developed left facial pain without obvious trigger. The pain was paroxysmal electrocautery-like and intolerable. It attacked more than 10 times a day, each time lasting for several seconds to several minutes and then stopped. After oral analgesics, the symptoms were slightly relieved. There were no symptoms such as dizziness, nausea and vomiting, tinnitus, hearing loss and limb twitching. The pain has worsened in the past half month, and the effect of oral carbamazepine and other drugs is not good. Afraid of eating and brushing teeth for fear of pain. When he was young, he had a history of eating pork with cysticercosis, and he always liked to eat lettuce. He had a history of cerebral cysticercosis for 4 years, and his symptoms were relieved after oral medication. Physical examination: clear consciousness, fluent speech, slight reduction of pain in the left side of the face, pain trigger point, normal muscle strength, muscle tone and tendon reflex of limbs, no pathological signs, no meningeal irritation signs. Cerebrospinal fluid pressure at lumbar puncture was 170 mmH₂O, the number of nucleated cells in CSF was 74×10⁶/L, the biochemical test was normal. Cysticercosis antibodies were (+) in both serum and CSF. CT of the head showed multiple cystoid foci and calcification foci in the brain; MRI showed multiple cystic abnormal enhancement foci in the anterior longitudinal fissure cistern, left lateral fissure, left cerebellopontine foot subarachnoid space, and both parietal lobes (FIG. 1A,FIG. 1B,Figure 1C)。 Imaging and medical history diagnosed mixed cerebral cysticercosis and secondary trigeminal neuralgia caused by subarachnoid cerebral cysticercosis. Paratrigeminal cysticercosis removal, trigeminal nerve release and microvascular decompression were given. During the operation, the arachnoid was thickened, the arachnoid was cut open, and the appearance and color of the nerve were normal. The root of the trigeminal nerve formed a noose due to the thickening of the arachnoid and the adhesion of cysticercosis-like substances, and the posterior inferior cerebellar artery was pulled to compress the nerve root, and the cysticercosis-like necrotic substances were removed. Thoroughly release the perineural adhesion, free the trigeminal nerve root, release the nerve entrapment caused by the arachnoid adhesion noose and posterior inferior cerebellar artery, and pad the polyester gasket on the trigeminal nerve root, and the postoperative symptoms disappear. Lumbar puncture was treated 3 times, no infection, cured and discharged. Because cysticercosis was still present in other brain lobes, intestinal worm clearing was administered orally for 10 d. Pathological findings showed that there was a small infiltration of lymphocytes in the degenerated tissue (Figure 1D), considering the degeneration and necrosis of cerebral cysticercosis, the formation of necrosis and arachnoid adhesion to form a noose, pulling the posterior inferior cerebellar artery, and entraping the root of the trigeminal nerve to form trigeminal neuralgia.

Glioma is the most common primary neuroepithelial tumor in the cranium. According to the 2007 WHO classification of central nervous system tumors, grade I and II are low-grade gliomas, and most of adults are grade II gliomas, mainly including astrocytoma, oligodendroglioma and oligodendroastrocytoma^[1]。 Although low-grade glioma grows relatively slowly, it has a tendency to relapse and transform into high-grade glioma, and there is a high clinical disability and mortality rate. Low-grade glioma mainly occurs in young and middle-aged people aged 30-45 years, and their prognosis is quite different. The median survival time is 5-12 years, and it can be extended to about 20 years after effective treatment^[2]。 Therefore, in the treatment strategy, in addition to delaying the tumor growth rate, prolonging progression-free survival and overall survival as much as possible, we should pay more attention to improving the quality of life of patients after treatment. Maximizing safe resection is an important initial treatment for low-grade glioma. On this basis, the adjuvant therapeutic role of radiotherapy has been clearly defined. However, the clinical status of adjuvant chemotherapy is still open to debate, and high-level clinical evidence-based medicine research is urgently needed. This article aims to briefly review the application status and research progress of adjuvant chemotherapy for low-grade glioma.

chordoma is an invasive tumor originating from the residual chordal tissue in the embryonic period. It grows slowly and is low to moderately malignant. The incidence rate is less than 1 in 1 million. It can occur at any age, ranging from 1 to 80 years old, but mainly occurs at 40 to 60 years old. The primary sites of chordoma were mainly in sacrum (50% ~60%), skull base (25% ~35%) and spine (5%)^[1,2]。 Chordoma accounts for 1% to 4% of primary malignant bone tumors, and the overall incidence rate is more in males than in females, about 1.5: 1.0 to 2.0: 1.0. The pathological types of chordoma include classical type, chondroma-like type and undifferentiated type^[2,3,4]。 Chordomas mostly show slightly high density or mixed density shadows on imaging, with bone destruction in the slope, sellar area or other tumor areas, and tumor tissue showing honeycomb changes^[4,5,6,7]。 The treatment of chordoma is mainly surgical resection^[4,8,9]However, incomplete surgical resection, high postoperative disability and recurrence rate, and long-term postoperative complications seriously affect the quality of life of patients, so postoperative adjuvant chemoradiotherapy is necessary^[4,9]。 However, because most tumors are close to some important structures, radiotherapy can control the growth of tumor tissues, but also have irreversible effects on the surrounding normal tissues, and the tumors are insensitive to radiotherapy, so the application of radiotherapy is also limited^[10,11]。 With the deepening of research, the progress of controlling chordoma with drugs has gradually become a new treatment mode. At present, people's understanding of chordoma has entered the molecular field, and it has been found that the occurrence of chordoma is mainly related to gene mutation, which may be the change of multiple genes. At present, the reported chromosome deletion and mutation of chordoma mainly occur in lq36 and 7q33. Chordoma cells can express a variety of genes of interest, mainly including stem-cell factor receptor (C-KIT), platelet-derived growth factor receptors (PDGFR), tyrosine kinase receptors (receptor tyrosine protein kinase, RTKs) and epidermal growth factor receptor (EGFR), etc^[12,13]。 This article reviews the recent types of drugs in the treatment of chordoma and the progress of specific drugs.

Meningioma is one of the most common central nervous system tumors, accounting for about 24% ~30% of primary central nervous system tumors in adults, and the annual incidence rate is about 13/100,000^[1]。 Meningiomas originate from cap-shaped cells of arachnoid granules. According to the classification criteria proposed by the World Health Organization (WHO), meningiomas can be classified into three grades according to histological type: benign (WHO grade I), atypical (WHO grade II) and malignant/anaplastic (WHO grade III), among which grade I meningiomas account for more than 80% of all meningiomas. Histological types of meningiomas are diverse, and multiple histological types can occur in a single meningioma^[2]。 Most meningiomas are benign, and the clinical manifestations are mainly caused by the compression and space-occupying effects of the tumor, such as headache, epilepsy, focal edema, etc. However, skull base meningioma often causes severe symptoms because it is adjacent to important anatomical structures. For example, sellar meningioma can compress the optic nerve and cause visual impairment and visual field defect. Cerebellopontine angle meningioma causing damage to the auditory or facial nerves; Petroclinal meningiomas are located near the brainstem and basilar arteries, which may be life-threatening. Although most meningiomas can be completely removed by surgery and have a good prognosis, there are still great challenges in the treatment of some skull base meningiomas, multiple meningiomas and high-grade meningiomas. Due to the limitation of surgical treatment of meningioma, it is urgent to study new therapies such as molecular targeted therapy^[3,4]。 In recent years, with the continuous progress of molecular biology technology, the academic community has a deeper understanding of the molecular biology mechanism of meningioma pathogenesis. In this paper, the research achievements on the molecular biological mechanism of meningioma in recent years are reviewed as follows.

susceptibility weighted imaging (SWI) is a newly developed magnetic resonance contrast-enhanced imaging technology in recent years, which was first developed by Haacke et al^[1]Invented in 1997, it was initially called "high-resolution blood oxygen level-dependent vein imaging". It was renamed "sensitivity-weighted imaging" in 2004 because it can reflect more information about the magnetic sensitivity of substances^[2]。 In recent years, through the application of high-field magnetic resonance apparatus and the continuous improvement of related technologies, its clinical application scope has been expanded. SWI is mainly used for the display of intracerebral microhemorrhage and microveins^[3,4]In addition to the deficiencies of venulous display in previous images, domestic and foreign studies have gradually paid attention to the application of SWI in intracranial tumors.

Epilepsy is a group of chronic and paroxysmal brain dysfunction caused by excessive abnormal discharge of neuronal cell populations in the central nervous system. At present, about 1% of the world's population is affected by epileptic seizures, among which the prevalence of epilepsy is about 5‰ ~7‰ in foreign countries, and about 0.33% ~0.58% in China^[1]。 Although it can be effectively treated with antiepileptic drugs in the early stage, more than 20% of patients still develop stubborn resistance to drugs and eventually develop refractory epilepsy. In recent years, an emerging technology "optogenetics" has been gradually applied to the treatment of epilepsy. This technology is based on the combination of optics and genetics. By constructing photosensitive protein gene vectors and expressing them in specific neuronal regions, exogenous light irradiation with different wavelengths is used to accurately excite or inhibit neuronal activity^[2]。 Application of optogenetic techniques to epilepsy has made significant achievements recently. Researchers can use this technology to target and regulate specific neuronal regions in epilepsy animal models, and this technology has the advantages of efficient time and space accuracy, and effectively controls the onset of epilepsy^[3]。 However, optogenetic technology still uses virus as vector to construct photosensitive protein gene expression vector. Due to the inherent toxicity, immunogenicity and potential tumorigenicity of viral vectors, there are certain biosafety risks^[4]。 Therefore, it is necessary to develop a novel vector as a targeted delivery tool for photosensitive protein genes. Because of its simple preparation process, excellent photothermal stability and good biocompatibility, nanometer copper sulfide can efficiently penetrate the blood-brain barrier, and targeted enrichment in tumor cells, which has low toxic and side effects on surrounding normal tissue cells^[5]。 In addition, the researchers processed, modified and improved copper sulfide to prepare a novel nanocarrier widely used in biomedical field^[6]。 This paper first summarizes the pathogenesis of epilepsy, at the same time, introduces the research and application of optogenetics and photothermal therapy in the diagnosis and treatment of epilepsy and tumor respectively, and discusses and prospects the nanomaterial copper sulfide as a new carrier combined with photothermal therapy in the treatment of epilepsy.

arachnoid cyst (AC) is formed by the accumulation of cerebrospinal fluid in the intra-and subarachnoid spaces of the cistern or brain fissure. Intracranial AC was first reported by Bright in 1831 and accounts for approximately 1% of intracranial space-occupying lesions^[1,2]。 Children account for about 60% to 90% of patients with AC^[3]It is often found accidentally during cranial imaging examination after brain trauma. With the development of imaging technology, the diagnostic rate of AC has improved. At present, there are still controversies about its pathogenesis and surgical indications. This article summarizes the literature at home and abroad in recent years, and summarizes the pathogenesis, clinical characteristics and treatment modes of AC.