Volume 33 · Issue 03 · 2017

brainstem gliomas (BSG) are a group of gliomas originating in the midbrain, pons and medulla oblongata. Before the 1980s, BSG was considered a group of homogeneous diseases. At that time, the brainstem was still a restricted area for surgery, which resulted in a lack of adequate understanding of the pathological characteristics of BSG. In addition, the tumor itself was insensitive to radiotherapy and chemotherapy, so the overall prognosis of BSG was extremely poor^[1]。 In recent 30 years, with the continuous development of neuroimaging technology, molecular biology and tumor genomics, people have gradually recognized that BSG is a group of highly heterogeneous diseases. First, BSG as a whole has different molecular genetic properties from cerebral hemispheric gliomas; Secondly, in BSG, tumors in different age groups and different sites have different pathogenesis, growth characteristics and prognosis^{[2,3,4,5,6,7,8,9,10,11,12]}。 From the surgical point of view, although the surgical safety and resection degree of BSG have been significantly improved in recent 30 years with the development of microneurosurgical techniques, neuroimaging techniques, neuronavigation techniques and neuroelectrophysiology techniques, the brainstem is still the site with the highest surgical risk in the central nervous system. Moreover, the tumors in different parts and different growth patterns in the brainstem have their own characteristics in the selection of surgical plan, surgical complications and perioperative nursing. The heterogeneity and complexity of BSG itself determine that it needs comprehensive treatment with multidisciplinary involvement. At present, there are no multidisciplinary research and treatment teams around BSG in domestic medical units. In addition, geographical differences in medical technology have led to a still lack of unified understanding of BSG. Therefore, it is necessary to formulate an expert consensus on BSG standardized diagnosis and treatment for the reference and application of medical institutions and medical staff in clinical work.

Since the existence of human activities, trauma has appeared and increased gradually with the development of human society. Among them, the incidence of craniocerebral trauma ranks second only to limb injury, while the mortality rate ranks first. Especially for severe craniocerebral trauma, the mortality rate is still about 30% so far, and almost all surviving patients have different degrees of neurological dysfunction, which brings a heavy burden to society and family. How to reduce the mortality and disability rate of patients with craniocerebral trauma is still an important issue for neurosurgeons^[1,2,3,4]。

To explore the prognosis factors of cranial multicentric gliomas.

A total of 24 cases of cranial multicentric gliomas were retrospectively analyzed who were admitted to Department of Neurosurgery, Beijing Tiantan Hospital , Capital Medical University and underwent surgical operation from February 2013 to February 2016. Postoperatively, 16 cases received radiotherapy and chemotherapy, 2 cases received only radiotherapy, 1 case underwent only radiotherapy and no supplementary therapy was conducted in 5 cases. Kaplan-Meier survival analysis was performed and univariate and multivariate analysis were used to investigate the prognosis factors.

There were totally 51 lesions in the 24 cases, among them 21 patients had 2 lesions and 3 patients had 3 lesions. The largest tumor measured 133.88 cm³ and the smallest was 0.02(P₂₅: 3.15, P₇₅: 25.20)cm³. Among them, 19 cases were high-grade gliomas and 5 cases were low-grade gliomas. Overall survival analysis showed that the survival rate for 1 year was 76.0%, and that for 2 years was 12.0%, and the median survival time was 16.0 months. Univariate analysis revealed that the survival time was correlated with pre-operative Karnofsky performance status (KPS), tumor resection rate and post-operative radiotherapy and chemotherapy.The multivariate analysis indicated that pre-operative KPS(RR=8.526, 95%CI: 1.637-44.404, P=0.011) and post-operative radiotherapy and chemotherapy(RR=0.160, 95%CI: 0.033-0.775, P=0.023) were independently correlated with the prognosis of multicentric gliomas.

Cranial multicentric gliomas seems mainly high-grade gliomas, resection of main lesions and standard radiotherapy and chemotherapy may yield a better prognosis.

To assess the safety and efficacy of intraoperative radiotherapy (IORT) using low energy X-rays in patients with newly diagnosed glioblastoma.

This retrospective study involved 10 patients of newly diagnosed glioblastoma who underwent surgical resection and IORT at Department of Neurosurgery, Beijing Tiantan Puhua Hospital from February 2013 to September 2015. The low energy X-rays equipment we used was INTRABEAM (PRS500, Carl Zeiss) and IORT was administered with the dose of 10 Gy to the applicator surface of applicator(10 Gy/2mm). All patients received the Stupp protocol following operation. We assessed the patients' safety in this group including wound healing deficits, infection, IORT-related cerebral edema requiring surgical intervention and radiation necrosis. The progression-free survival (PFS) and overall survival (OS) were documented. The Kaplan-Meier survival analysis was conducted.

All tumors in this study were supratentorial, among which gross total resection and near total resection were achieved in 8 and 2 cases, respectively. No wound healing deficits or IORT-related cerebral edema requiring surgical intervention occurred in this resection plus IORT group in the early period post operation. One patient suffered from postoperative infection. One patient developed radiation necrosis on follow-up MRI scans. Median PFS and median OS were 9.8 months (95% CI 2.5-17.1 months)and 18.9 months(95% CI 10.4-27.4 months), respectively.

IORT using low energy X-rays with the dose of 10 Gy/2mm seems tolerable for patients of glioblastoma with expectable long-term effects.

To compare the clinical features, therapies and prognosis between intraventricular oligodendroglioma (IVO) and central neurocytoma (CN) so as to raise awareness of these tumors.

This retrospective analysis included 8 cases of IVO and 12 cases of CN admitted to Department of Neurosurgery, Nanfang Hospital, Southern Medical University from January 2011 to December 2015. The clinical data included general information, clinical manifestations, imaging characteristics, pathological findings, treatments and outcomes. Eight cases of IVO underwent resection. 3 cases of IVO received postoperative radiotherapy or chemotherapy. Nine cases of CN underwent resection and among them 7 cases received radiotherapy. The remaining 3 cases of CN received radiotherapy only.Differences in clinical characteristics between IVO and CN were analyzed using independent-samples t test, χ² test, Fisher's exact test or rank-sum test. Differences in prognosis between IVO and CN were analyzed using the Kaplan-Meier product-limit method. The follow-up time ranged from 3 days to 58 months.

Both IVO and CN occurred most commonly in young adults and presented with features of raised intracranial pressure secondary to obstructive hydrocephalus. However, in terms of radiological appearances, they were quite different in location (P=0.007), "scalloping" appearance ( P=0.020), vessels void signal (P=0.020) and ventricular wall invasion (P=0.001). Pathologically, they showed obvious differences in mitotic count (P=0.008), infiltration of parenchyma (P=0.018) and the expression of Olig2 (P<0.001), Syn (P=0.018) and NeuN (P<0.001). In addition, MIB-1 labeling index (P=0.035) and case fatality rate (38% vs. 0%, P=0.021) of IVO were much higher than those of CN, while cumulative survival rate of IVO was much lower than that of CN(60% vs. 100%, P=0.028).

IVO and CN are similar in onset age and clinical presentations but different in imaging manifestations and pathological features. Surgery is the main treatment modality of these tumors. The prognosis of CN seems better than IVO.

To investigate the clinical characteristics of intracranial tuberculoma and its diagnosis and outcomes of surgical treatment.

In this retrospective study, clinical data including manifestations, imaging, laboratory tests and surgical outcomes of 8 adults were analyzed who were consecutively identified with intracranial tuberculoma from August 2013 to April 2016 at Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University.

Among the 8 patients with intracranial tuberculoma, the human immunodeficiency virus (HIV) infection was identified in 4 cases and tuberculosis (TB) involving other systems was found in 3 cases. Out of the 8 patients, lesions were supratentorial in 5 cases and located in posterior fossa of the remaining 3 cases. Seven cases underwent total resection and stereotactic biopsy was performed in 1 case. Pathological acid-fast stain demonstrated positive results and confirmed the diagnosis of tuberculoma. All the patients were regularly treated with anti-tuberculosis drugs. One case died from HIV-related complications 1 year post operation and the rest recovered well.

The clinical characteristics of intracranial tuberculoma vary depending on its location. The supratentorial tuberculoma commonly caused epilepsy and headache and the subtentorial lesion often presented with symptoms related to high intracranial pressure due to hydrocephalus. The diagnosis should be based on a combination of clinical manifestations, imaging features, laboratory examination and anti-tuberculosis efficacy. With strict following of its indications, surgical treatment might be effective.

To construct brain tumors in the central region and their surrounding anatomical structures with the method of multimodal image fusion and BOLD (blood oxygen level dependent)-fMRI and provide surgical guidance.

The CT, MRI and BOLD-fMRI data of 5 patients with brain tumor in the central region were collected, who were admitted to Department of Neurosurgery, Yuquan Hospital, Tsinghua University from April 2015 to November 2015. The patients’ CT and MRI images were fused and 3D-reconstructed using the NeuroTech software. The BOLD-fMRI data was analyzed with the software of IViewbold. Based on the images, the surgical incision and approach were designed and total resection of tumors was performed.

In all 5 cases, the features of their brain tumors in the central region including size, location, shape and spatial relationship with surrounding structures were clearly demonstrated in 3D-reconstructed images. BOLD-fMRI could supply more precise information about the relationship between the tumor and surrounding motor cortex. Postoperatively, increased muscle strength was observed in 1 case, improved language function was reported in 1 case and 1 patient developed epilepsy. The other 2 patients did not develop new symptoms or report deterioration of original symptoms. No residual tumors were shown at postoperative MRI images in this study. Postoperative MRI and BOLD-fMRI examination of 1 patient demonstrated that the central sulcus vein and cortical motor cortex were preserved. The follow-up period lasted 3~11 months with an average of (4.6±3.2) months and no brain tumor recurrence was observed based on MRI reexamination. Improved muscle strengths and language function were observed in 3 cases and 1 case, respectively. The patient with epilepsy demonstrated symptomatic relief.

A combination of multimodal image fusion and BOLD-fMRI could clearly demonstrate the anatomical relationship of brain tumors in the central region to their surrounding structures and motor cortices, which might be useful for design of surgical incision, plan of surgical approach, resection of brain tumors and protection of brain functions.

To analyze the treatment effects of intracranial germ cell tumors (ICGCTs) using microsurgery.

A retrospective study was conducted on the data of 32 cases of ICGCT who were admitted to Yuquan Hospital of Tsinghua University from October 2012 to June 2016. Among them, there were 6 cases of germinoma, 14 cases of mixed ICGCT, 4 cases of mature teratoma, 6 cases of immature teratoma, 1 case of malignant teratoma and 1 case of choriocarcinoma. Preoperative chemotherapy was performed in 4 cases. Postoperatively, 16 cases received chemotherapy, 3 cases underwent local radiotherapy, and 2 cases underwent chemotherapy plus local radiotherapy. The surgical outcomes were followed up.

For the 32 cases, the average follow-up period was (21.8±13.5) months. The gross total resection (GTR) group included 17 cases (53.1%) and the remaining 15 cases (46.9%) did not receive GTR. Out of the 12 patients of tumor recurrence, 3 cases (25.0%) belonged to the GTR group and the other 9 cases (75.0%) were in the non-GTR group. The recurrence rates in the two groups (3/17 vs. 9/15) were significantly different (P<0.05). Pathological results indicated that the " teratoma" components were contained in 22 cases, accounting for 66.8% of all cases in this study and 84.6% of non-germinoma of germ cell tumors (NGGCTs). In 2 cases of tumor recurrence, their pathological results were inconsistent with the original features. No severe surgical complications were observed. By the end of follow-up, 6 patients (18.8%) died, among whom 5 did not receive postoperative chemoradiotherapy and died from tumor recurrence.

Microsurgery seems to be one important approach in treatment of ICGCTs, particularly NGGCTs. Patients might benefit from the GTR of the lesions. Individualized radiation and chemotherapy before and after surgery could help reduce the tumor recurrence.

To investigate the impact of type 2 diabetes mellitus (DM) on prognosis of non-small cell lung cancer with brain metastases.

We retrospectively reviewed the clinical data of 406 patients, who were diagnosed as non-small cell lung cancer with brain metastases and admitted to the departments of brain tumor, radiation therapy, pulmonary medicine and pulmonary surgery at Tianjin University Cancer Institute & Hospital from October 2010 to May 2015. Log-rank analysis and Cox regression model were used to identify prognostic factors of non-small cell lung cancer with brain metastases and the impact of type 2 DM on the overall survival (OS) and progression-free survival (PFS).

Univariate analysis of OS revealed that age, lymph node staging, DM, chemotherapy, Karnofsky performance score had statistical significance (all P<0.05). Univariate analysis of PFS revealed that lymph node staging, DM, chemotherapy had statistical significance (allP<0.05). Multivariate analysis showed that presence of DM (OR, 0.203, 95% CI 0.067-0.618, P=0.005), lymph node staging (OR, 0.573, 95% CI 0.420-0.781, P<0.001) and age (OR, 0.609, 95% CI 0.409-0.907, P=0.015) were considered independent prognostic factors for OS (P<0.05). In addition, DM (OR, 0.317, 95% CI 0.112-0.900, P=0.031), lymph node staging (OR, 0.723, 95% CI 0.556-0.941, P=0.016) and chemotherapy (OR, 0.450, 95% CI 0.253-0.798, P=0.006) were identified as independent prognostic factors for PFS (P<0.05).

It is suggested that a history of type 2 DM might be correlated with increased OS and PFS in patients with NSCLC with brain metastases.

To explore the prognostic value of plasma ACTH in predicting the outcome of patients with Cushing’s disease after operations.

The clinical data of 208 patients with Cushing’s disease treated with neurosurgery at the Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences from January 2012 to December 2014 were analyzed retrospectively, including the patients’age, gender, preoperative MRI findings, tumor size, primary or recurrent condition, as well as perioperative endocrine indicators. The 208 patients with Cushing’s disease were divided into either an early endocrine remission group (briefly early remission group) or a non-remission group according to their postoperative serum cortisol levels. Univariate analysis and multivariate Logistic regression analysis were used to investigate the factors affecting the early postoperative endocrine remission in patients with Cushing's disease. The receiver operating characteristic (ROC) curve was drawn, and the corresponding endocrine indices were analyzed and the accuracy of early postoperative efficacy was identified.

Univariate factor analysis showed that there were statistical differences in preoperative and postoperative ACTH between the early endocrine remission group and the non-remission group (P=0.028, P<0.001). Multivariate Logistic regression analysis showed that the postoperative ACTH was an influencing factor of early remission in patients with Cushing’s disease (OR, 0.955, 95% CI 0.939-0.972, P<0.001). ROC curve analysis showed that the optimal critical value of the prediction of ACTH after procedure was 18.85 pg/ml. The area under the curve was 0.900 (95%CI 0.855-0.945, P<0.001). The sensitivity was 78.5% and the specificity was 88.1%.

The postoperative plasma ACTH is one of the indicators of early efficacy for evaluating Cushing’s disease after procedure. When early morning ACTH is <18.85 pg/ml, it suggests endocrine remission. Its predictive effect on long-term efficacy needs to be confirmed by follow-up.

To investigate the clinical treatment efficacy of intracranial lesion resection in or nearby the functional areas under awake anesthesia combined with multiple technologies.

A retrospective study of 200 cases was conducted who underwent lesion resection in or nearby the functional cortex under awake anesthesia at Department of Neurosurgery, Guangdong 999 Brain Hospital during the period from September 2010 to May 2016. The diffusion tensor imaging (DTI) and blood oxygen level dependent (BOLD) technologies were used preoperatively. Assistance with neuronavigation, electrophysiological monitoring and yellow fluorescence was applied during the operation. In addition, 26 cases of glioblastoma (GBM) were studied who underwent resection without awake anesthesia.

Intraoperative wakening was successful in 196 cases (98.0%) and failed in 4 cases (2.0%). Among the 48 cases of non-neoplastic lesions, the total resection rate was 97.8% (47/48). Among the remaining 152 cases of neoplastic lesions, extended resection and total resection were performed in 136 cases (89.5%). Postoperative follow-up lasted 6~67 months and indicated that 121 (60.5%) cases did not report any functional deficits and language, motion, sensation, cognitive, mental or emotional dysfunctions were observed in 79 (39.5%) cases. The median survival period of 35 GBM patients undergoing resection under awake anesthesia was 21.0 months. The total resection rate of the 35 GBM patients was 71.4% (25/35) and 17.1% (6/36) of the patients developed complications. The survival period of the other 26 GBM patients undergoing resection under general anesthesia was 16 months. The total resection rate of the 26 GBM patients was 42.3% (11/26) and 23.1% (6/26) of the patients had complications. There was statistically significant difference in the total resection rate between the two groups (P=0.042).

Awake anesthesia combined with multiple techniques could be applied to resection of a variety of intracranial lesions located in functional areas and its adjacent zones, which helped improve the total resection rate without increasing the surgical complications.

To explore whether neuronal firing rate and proportion of oscillatory neuronal activity in subthalamic nucleus (STN) is associated with Parkinson's disease (PD) progression.

Twenty-two patients with PD treated with STN deep brain stimulation (DBS) at Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University from March 2015 to March 2016 were analyzed retrospectively. Microelectrode recording was performed in the STN. Single unit analysis including interspike interval (ISI) was used to study neuronal firing rate and patterns. Power spectral analysis was used to evaluate neuronal oscillation.Clinical outcome was assessed using Unified Parkinson's Disease Rating Scales (UPDRS III) pre-and post-surgery. The groups of the early stage and the advanced-stage were defined based on the UPDRS III scores, disease duration and the side of initial symptoms.

Of total 163 neurons identified from 32 STN, there were 66 neurons with mean firing rate of 46.2±13.6 Hz obtained from the patients in the early-stage group whereas 97 neurons with mean firing rate of 59.9±17.1 Hz were obtained from patients in the advanced-stage group. Power spectral analysis showed that there were 27 (40.9%) oscillatory neurons identified from the STN neurons in the early-stage patient group (n=66) whereas 55 (56.7%) oscillatory neurons were identified from the STN neurons in the advanced-stage patient group (n=95). Further analysis found that 29.7% (8/27) β oscillatory neurons were observed in the early stage group whereas 52.7% (29/55) β oscillatory neurons were observed in the advanced stage group. When comparing the mean firing rate and proportion of oscillatory neurons in the STN of early-stage group with that of neurons in the STN of advanced-stage group, it was found that there was a 29. 6% increase STN mean firing rate of neurons (46.2±13.6 Hz vs. 59.9±17.1 Hz, P<0.05) and a 36.8% increase proportion of oscillatory neurons (40.9%vs. 56.7%) between the two groups. In particular, a 77.8% increase proportion of β oscillatory neurons was obtained between the early-stage and advanced-stage groups (29.7% vs.52.8%, P<0.01).

The results strongly suggest that both subthalamic nucleus neuronal firing rate and proportion of β oscillatory neurons increase with PD progression.

To explore the safety and efficacy of single low-profile visualized intraluminal support(LVIS)-assisted coiling of multiple intracranial aneurysms.

Retrospective analysis of clinical data and radiographic data of 19 patients, who underwent one-stage aneurysm embolization of two intracranial aneurysms with single LVIS stent in the period from October 2014 to April 2016 at Department of Neurosurgery, Affiliated Hospital of Southwest Medical University.

Nineteen patients were performed with stent-assisted coiling of multiple aneurysms using single LVIS. The average 11-month follow-up showed that good outcome (mRS: 0~1) was reported in 79% (15/19) of the cases. Mild disability (mRS: 2~3) was observed in 21% (4/19) of the cases. No severe disability or death occurred. Six-month follow-up showed that complete embolization rate was 87% (33/38)assessed using DSA and nearly complete embolization rate was 13% (5/38). A total of 4 aneurysms showed further progressed thrombosis during follow-up, and the incidence of further thrombosis was 57% (4/7)in patients with incomplete embolization. Intraoperative complications occurred in 3 patients which included 1 case of intraoperative rupture, 1 case of transient brain swelling and 1 case of intraoperative stent thrombosis.

Single stent-assisted coiling of multiple intracranial aneurysms using LVIS seemed to demonstrate safety and efficacy. However, the chance of symptomatic stent thrombosis could not be ignored.

At present, the commonly used keyhole procedures include supraorbital keyhole approach, pterional keyhole approach and infratemporal keyhole approach, all of which need to increase the space of brain tissue traction by releasing cerebrospinal fluid. Some patients with cerebral edema and intracranial hypertension have difficulty in releasing cerebrospinal fluid, so ventricular puncture and external drainage are required, but it is often difficult to locate the ventricle during operation. Among the patients who underwent keyhole surgery from March 2013 to February 2016 in the Department of Neurosurgery, Huangdao Campus, Affiliated Hospital of Qingdao University, 19 patients underwent intraoperative ultrasound-guided puncture of the lateral ventricle, and obtained good results, which are reported below.

Arachnoid cyst is a benign space-occupying lesion in the cranium, which is more common in the middle cranial fossa. Arachnoid cyst complicated with chronic subdural hematoma is rare in clinical practice, and few bulk cases are reported in literature. The pathogenesis of this disease is unknown, but external factors such as craniocerebral trauma are important inducers. This study retrospectively analyzed the clinical characteristics and treatment results of 6 patients with arachnoid cyst complicated with chronic subdural hematoma admitted to the Department of Neurosurgery of the First Affiliated Hospital of Guangxi Medical University from October 2007 to November 2015, and combined with domestic and foreign literature reports as follows.

To investigate the enhancement effect of hyperoxia on chemotherapy sensitivity of glioma stem cells in vitro.

The U87 and GL261 glioma stem cells were cultivated by stem cell culture medium, and the expression levels of labeled proteins of tumor stem cells were identified with immunofluorescence staining. The U87 and GL261 glioma stem cells were both treated under high (95%) oxygen and normal (21%) oxygen. The Western Blot and qRT-PCR were applied to detect the expression levels of stem cell labeled proteins, differential proteins and resistant proteins after the treatment. After the pretreatment of U87 and GL261 glioma stem cells under different oxygen concentration, the chemotherapy drug temozolomide (TMZ) was added in the culture medium of each group and IC₅₀ and apoptosis detection was subsequently conducted.

The fluorescence detection results showed that U87 and GL261 glioma stem cells cultured in stem cell medium highly expressed the labeled proteins of tumor stem cells including CD133 as well as Nestin and the drug resistance marker protein MGMT. The expression levels of CD133, Nestin and MGMT were lower after the treatment of hyperoxia in glioma stem cells detected with qRT-PCR and Western-blot (P<0.05), while the differential labeled protein GFAP were much higher (P<0.05). The apoptosis tests showed that the apoptosis value in TMZ-treated high oxygen group was significantly higher than that in the normal oxygen group (P<0.05). Similarly, the IC₅₀ value in the TMZ-treated high oxygen group was significantly lower than that in the normal oxygen group (P<0.05).

High oxygen environment could promote the chemotherapy sensitivity of gliomas by inhibiting the property expression of the glioma stem cells. This study has provided a new theoretical foundation for the glioma treatment using high pressure oxygen combined with chemotherapy which might improve the outcomes.

Intracranial schwannoma, also known as Schwann cell tumor, is most commonly found in the trigeminal and vestibular nerves, while intraparenchymal schwannoma, which is not related to cranial nerves, is very rare clinically^[1]。 The imaging and pathological manifestations of this disease have certain characteristics. Fully understanding and timely and accurate diagnosis are helpful for the formulation of clinical treatment plan and the prognosis of patients. This article retrospectively analyzed the clinical data of two patients with intraparenchymal schwannoma confirmed by pathological and immunohistochemical examination from October 2007 to March 2015 in the Department of Neurosurgery, Jiaxing Second Hospital, Zhejiang Province. Combined with relevant literatures, the mechanism, imaging manifestations, clinical manifestations, pathological characteristics, treatment methods and prognosis of this tumor were discussed.

Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with giant lymphadenopathy, was first reported by Rosai and Dorfman in 1969. RDD is a rare benign histiocytic disease that occurs in children or adolescents, and the proportion of men and women is roughly equal. 43% of RDD occurred outside the lymph nodes^[1]It can occur in almost all organs. The incidence of RDD is high in the peripheral system, and currently known sites include bone, skin, soft tissue, upper respiratory tract, pancreas, salivary glands, eye and orbit, digestive system, mammary gland^{[2,3,4,5,6,7,8]}。 The mean age of patients with intracranial RDD was 40.6 years, accounting for less than 7% of all RDD patients^[9]。 Primary CNS RDD is rare, 6 cases have been reported in the literature so far. The clinical and imaging manifestations of intracranial RDD are mostly similar to meningiomas^[10]。 In October 2015, a case of primary multiple intraparenchymal RDD was admitted to the Department of Neurosurgery of Huashan Hospital affiliated to Fudan University, which is reported in the literature as follows.

Glioma is the most common primary intracranial tumor, with an annual incidence rate of about 4/100,000~5/100,000^[1]。 High-grade glioma has a poor prognosis, with a median overall survival of 14.4 months for glioblastoma^[2]。 With the continuous development of imaging technology, the evaluation criteria of therapeutic response for neurotumors are also constantly updated. In the 1990s, CT began to be used in clinical practice on a large scale. Macdonald et al. proposed a criterion for evaluating the treatment response of high-grade glioma based on CT scan, namely the Macdonald criterion (Table 1)。 This standard uses CT-enhanced lesions and two-dimensional response evaluation standard to measure the size of lesions, which provides an objective basis for the evaluation of tumor treatment response. The Macdonald criteria also refer to the use of corticosteroids in the course of treatment and the neurological status of patients. Because MRI has better resolution than CT, later Macdonald criteria are mostly based on enhanced MRI scans. Since this standard has been applied in clinical practice, it has been widely used in the treatment evaluation of high-grade glioma clinical trials.

glioblastoma (GBM) is the most common primary intracranial malignant tumor in adults^[1]。 In the United States, approximately 10 000 people are newly diagnosed with GBM each year. It is estimated that the incidence of GBM worldwide is approximately 3.5 per 100,000 people. For newly diagnosed patients with GBM, even with aggressive treatment, that is, adjuvant chemotherapy and radiotherapy after surgical resection to the maximum extent, the median survival time of patients is only 12 to 18 months^[2,3]。 Despite first-line drug therapy, nearly all patients experienced tumor recurrence, with an average time to tumor progression of about 6 to 11 months^[4]。 Bevacizumab (BEV) was provisionally approved in the United States for the treatment of recurrent GBM, but the European Food and Drug Agency refused approval due to its lack of controlled trials^[5]。 The most commonly used cytotoxic drugs are alkylating agents such as nitrosoureas [lomustine (CCNU) or carmustine (BCNU)] and methylbenzylhydrazine, or concomitantly temozolomide (TMZ) for the treatment of GBM^[6]。 The chemotherapy response rate was less than 10%, and the progression-free survival (PFS) of 6 months was less than 20%^[7]。 Due to the lack of effective treatment, the overall survival (OS) after recurrence is usually short, rarely exceeding 3 to 5 months^[8]。

Magnetic resonance diffusion tensor imaging (DTI) is an advanced and sophisticated noninvasive magnetic resonance technique developed on the basis of diffusion weighted imaging (DWI) and is a non-invasive method for characterizing microtissue in vivo^[1]。 At present, the application of DTI technology in craniocerebral lesions tends to be mature, and the application research in spinal cord lesions has also become a hot spot. This article reviews the application of DTI in spinal cord tumors.

Holmes tremor (HT) is also known as midbrain tremor, red nucleus tremor, thalamic tremor, and myorhythmic tremor. Tremor caused by midbrain lesions was first reported by Benedikt in 1889^[1], until the first case of HT was described in detail by Holmes in 1904^[2]。 HT is an extrapyramidal disease, mostly caused by brainstem, cerebellum and thalamus lesions, of which thalamus is the most commonly involved part. Its pathogenesis is not clear at present, but it is generally believed that the cerebellum-erythroid-thalamus pathway and the substantia nigra-striatum pathway are damaged. Its etiology includes stroke, tumor, cerebrovascular malformation, craniocerebral trauma, multiple sclerosis and infection, among which stroke is the most common^[3,4]。 HT is rare in clinical practice, and most of the domestic and foreign literatures are retrospective case reports. At present, there is no corresponding treatment guideline. This article reviews the progress of clinical treatment of HT.

Epilepsy is the most common chronic neurological disorder, with about 65 million patients worldwide^[1]。 Epilepsy is an abnormal discharge of brain neurons, which can cause sensory and motor dysfunction of human body, and even change behavior or consciousness, which brings a huge burden to patients and their families. It must be treated in time and effectively. Anti-epileptic drugs are the main means of treating epilepsy, but after a period of standardized drug treatment, about 1/3 of patients still can't be effectively controlled^[2]This type of epilepsy is called medically intractable epilepsy (MIE) and requires surgery or neuromodulation treatment. Since the first case of vagus nerve stimulation (VNS) was performed by Penry and Dean in 1988^[3]Since its successful implementation, invasive Vagus Nerve Stimulation (i-VNS) has been approved by the United States Food and Drug Administration (FDA) in 1994 and 1997. More than 85,000 patients worldwide have undergone the procedure^[4], is an adjuvant treatment approved by the FDA that can be applied to patients with intractable epilepsy ≥12 years old^[5]。 This article summarizes the recent research progress of i-VNS in the treatment of intractable epilepsy as follows.

In 1991, Benabid et al.^[1]After stimulation of the ventral intermediate nucleus of the thalamus by deep brain stimulation (DBS), it was found that tremor was effectively improved in patients with Parkinson's disease (PD). Subsequently Limousin et al.^[2]When the subthalamic nucleus (STN) was used as the stimulation target, in addition to tremor, the symptoms such as stiffness and abnormal movement were well controlled. At present, STN-DBS has gradually replaced damage surgery as one of the common methods for surgical treatment of PD because of its definite, safe and reversible curative effect. Although this technology has been developed for decades, its mechanism of action is still being explored. In recent years, it has been found that the local field potentials (LFPs) recorded by DBS electrode are of great significance in studying the mechanism of action of DBS and the pathophysiological changes of PD. It has the following characteristics: (1) LFPs is correlated with the clinical symptoms of PD patients. (2) During DBS operation, LFPs signal can be directly recorded by DBS electrode. (3) LFPs can continue to collect signals without the interference of DBS electrical stimulation. (4) LFPs signal was regulated by the intensity of electrical stimulation. (5) After implantation of DBS electrode for a period of time, LFPs signal can still be recorded and still controlled by the intensity of electrical stimulation. (6) In PD animal models, the closed-loop stimulation mode with LFPs neuronal discharge and oscillation as feedback signals was superior to the traditional open-loop stimulation mode in improving symptoms^[3]。 This article reviews the association between different frequency bands of LFPs and different symptoms of PD and the preliminary mechanism of DBS in the treatment of PD as follows.