Volume 33 · Issue 05 · 2017

Since the existence of human beings in history, the relationship between disease and human beings has been continuously explored, as well as the impact of medical models on human beings and diseases. From the occurrence and development of diseases to the history of human fighting against diseases, it clearly shows the characteristics of medical models in different eras and the transformation of disease diagnosis and treatment models under their influence.

To analyze the clinical and imaging features, microsurgical strategy and prognosis of brainstem gangliogliomas.

We retrospectively analyzed a cohort of 25 brainstem gangliogliomas treated at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from May 2008 to September 2015. The clinical manifestation, imaging features, microsurgical methods and prognosis were reviewed.

The median age of 25 patients was 22 (range: 5-45) years, median history was 12 (range: 1-384) months and the preoperative Karnofsky Performace Status (KPS) scores ranged from 20 to 100. On the enhanced sagittal MRI, 17 (68%) tumors were characterized by a unique patchy appearance. On the enhanced axial MRI, 11 tumors (44%) demonstrated a"crescent sign". Among all patients, total resection was achieved in 7 cases, near total resection in 5 cases, subtotal resection in 8 cases, partial resection in 4 cases and biopsy in 1 case. No operative death occurred. The follow-up time ranged from 3 to 97 months, with an average follow-up of (50.5 ± 27.7) months. There were 3 cases developing severe postoperative complications and 3 death cases observed during the follow-up. The median PFS of non-infiltrating group (53.0 months) was longer than that of infiltrating group (21.5 months) (P<0.05). Tumor recurrence occurred in 8 cases in a short period of time postoperatively but did not present with symptom aggravation.

Most brainstem gangliogliomas seem to have some unique MRI characteristics. Microsurgical resection might be preferred. Tumors located outside the brainstem could be fully removed, while those infiltrating the brainstem should not be resected with risks. Postoperative short-term tumor recurrence without clinical symptom deterioration could be closely monitored.

To explore the clinical characteristics and microsurgical skills of intramedullary medullocervical ependymomas for increasing the rate of gross total resection (GTR) and decreasing the disabling rate.

A total of 120 patients with medullocervical ependymomas were admitted to Department of Neurosurgery, Changzheng Hospital, the Second Military Medical University of PLA, from January 2001 to November 2016. A retrospective analysis was conducted regarding their clinical manifestations, imaging characteristics, microsurgical manipulations, extent of resection and postoperative follow-up data. In all cases, the tumor resection was performed using posterior suboccipital midline approach.

Among the 120 patients, GTR was achieved in 111 (92.5%) cases and subtotal resection was performed in 9 (7.5%) cases. The maximal tumor size was 25.0×2.0×2.0 cm and affected all cervical levels, and the minimal size of the tumor was 1.0×1.0×0.6 cm. Follow-up was successfully conducted in 106 (95.5%) patients and for 3 to 108 months with an average of (23.0±18.5) months. The patient's sensory and motor functions were relieved or remained unchanged post surgery in 83 (78.3%) cases and aggravated in 22 (20.8%) cases. One (0.9%) death occurred. Four patients (3.8%) were reoperated on due to tumor recurrence. The neurological function was graded based on the McCormick system as 60 (56.6%) cases in grade I, 28 (26.4%) cases in grade II, 16 cases (15.1%) in grade III and 1(0.9%) case in grade IV.

For most intramedullary medullocervical ependymomas, proper surgical strategies and qualified operational skills, combined with imaging and neuroelectrophysiological technologies could be applied to realize the GTR of tumors and preservation of neurological functions.

To explore the microsurgical outcome of medulla hemangioblastomas.

A total of 88 cases of medulla hemangioblastoma underwent microsurgical treatment assisted with intraoperative neurophysiological monitoring at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University between June 2011 and June 2016, whose clinical data and surgical outcomes were retrospectively analyzed.

Among the 88 patients of medulla hemangioblastoma, 38 cases were cyst and solid and the remaining ones were purely solid. Moreover, there were 70 cases with a single lesion and 18 cases with multiple lesions. The Von Hippel-Lindau syndrome was present in 18 (20.5%) patients. All dorsal medullary tumors underwent gross total resection (GTR). Three (3.4%) deaths occurred postoperatively due to pulmonary infection. Temporary pulmonary embolism occurred in one patient. Other complications were also documented including stress-related gastrointestinal bleeding in 3 cases, pneumonia in 24(27.3%) cases, hematoma in 5 cases, deep venous thrombosis (DVT) in 7 cases, cerebrospinal fluid (CSF) leakage in 4 cases and infection of central nervous system in 6 cases. Eighty-one patients were followed up for about 3-60 months. Dizziness, headache, nausea and vomiting were reported in 56 instances, all of which were improved to varying degrees within 6 months. Out of 17 cases with decreased muscle strength prior to operations, 11 recovered and the others remained the same. Among 15 cases who presented with the lower cranial nerve-related symptoms, 9 were improved but the other 6 were not. Tumor recurrence developed in 15(17.0%) patients postoperatively including 2 cases with local recurrence that occurred 4 years and 10 years post GTR, respectively, and underwent the second operation. There were 13 cases developing tumor recurrence in other regions and 10 out of them underwent the second operation. Three (3.4%) patients died during the follow-up.

Satisfactory clinical outcomes could be achieved through microsurgery assisted with intraoperative neurophysiological monitoring.

To analyze the response and toxicity of a modified chemotherapy protocol with carboplatin and vincristine (CV) for pediatric low-grade gliomas (LGGs) in the brain stem.

Ten children with low-grade gliomas (LGGs) in the brain stem were administered the modified CV regimen at Department of Neuro-Oncology, Sanbo Brain Hospital, Capital Medical University from August 2014 to August 2016, and the data were retrospectively reviewed. The conventional CV regimen was modified by changing the carboplatin dose or adding recombinant human endostatin(rhES). Carboplatin was administrated at a dose of 200~300 mg/m² and the vincristine dose was 1.5 mg/m² (maximum dose: 2 mg).

Among the 10 children, 5 patients had objective response (1 had a complete response and 4 had a partial response); 2 got a minor response and 3 kept stable conditions. All patients' illnesses were effectively controlled. The median time for response to chemotherapy was 3 (1.5-8.0) months.The median time for follow-up was 14.5(4-26)months. Objective response was reported in 2 of 3 patients with recurrence. All 3 cases undergoing combination chemotherapy of carboplatin, vincristine and a novel antiangiogenic drug had objective response. Hematologic toxicity was a major side effect. The incidences of severe neutrocytopenia, decreased hemoglobin and thrombocytopenia were 8.8% (23/262), 5.3% (14/262) and 1.5% (5/262), respectively, which could resolve following symptomatic treatment.

A modified CV regimen seems effective for pediatric brain stem LGGs. Increasing carboplatin dose or adding rhES could help with the effect improvement of CV regimen and fast relief of the brain stem dysfunction. Those drug regimens were relatively well tolerated.

To explore the clinical features and prognosis factors of microsurgery treatment of pediatric medullary gliomas.

Clinical data of 18 patients with pediatric medullary gliomas who underwent microsurgical treatment at the Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University from January 2008 to October 2013 were retrospectively analyzed in this study. Regular postoperative follow-up was conducted and the following informations including the patients' symptomatic outcome, tumor recurrence, survival time and cause of death were documented. Prognosis factor analysis of the patient's postoperative survial time was conducted.

Among the 18 patients, gross total resection was achieved in 4 cases, subtotal resection in 9 cases and partial resection in 5 cases. Postoperative pathological findings confirmed the diagnosis of glioma in all cases, which, according to the World Health Organization (WHO) criteria, included a case of grade Ⅰ (pilocytic astrocytoma), 14 cases of grade II (12 astrocytomas and 2 oligodendrogliomas), 2 cases of grade III (anaplastic astrocytomas) and 1 case of grade IV (glioblastoma). The follow-up period was 4-103 months, with a median of (38.2 ± 29.9) months. Six cases died of tumor recurrence. The 1-year and 5-year survival rates were 75.6% and 63.0%, respectively. The mean survival time was (70.4 ± 10.7) months. The pathological grade [RR(95.0% CI)=127.613(2.365-6885.170), P<0.001] and extent of resection [RR(95.0% CI)=12.408(1.361-113.150), P=0.008] were determined to be independent factors affecting the patients' outcomes.

Pediatric medullary gliomas seemed mostly low grade, and the pathological grade and extent of resection might serve as important prognostic factors.

To evaluate the surgical method and resection outcomes of cavernous malformations (CMs) using anterior transpetrosal approach with a preauricular arc incision.

From June 2011 to December 2015, 48 patients with pontine CMs underwent resection using anterior transpetrosal approach with a preauricular arc incision at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, The patients' clinical date and surgical outcomes were retrospectively analyzed.

Among the 48 patients, gross total resection (GTR) was achieved in 44 cases and subtotal resection was performed in the remaining 4 cases. No death occurred in this series. Two patients were reoperated on due to postoperative rebleeding. 48 patients were followed up for a mean of 28.3±8.2 months.All patients with preoperative facial nerve palsy and ocular dyskinesia recovered post surgery, and no new cases of facial nerve palsy were reported. Neurological deficits were improved in 34 patients after operations. Five patients experienced transient aphasia postoperatively. The symptoms of 11 patients remained unchanged following surgery. Three patients' neurological conditions deteriorated after surgery.

The anterior transpetrosal approach with a preauricular incision could provide adequate exposure for the surgical removal of pontine CMs. Resection through anterior lateral part of the brainstem might cause no serious neurological deficits and severe complications such as the facial nerve palsy could be avoided.

Intracranial primary germ cell tumor is the most common germ cell tumor, accounting for about 70% ~80% of intracranial primary germ cell tumor, and mostly occurs in the pineal region, sella turcica region, hypothalamus, basal ganglia and other parts^[1]。 Germ cell tumors occurring in the brainstem are very rare^[2]Because brainstem germ cell tumors lack specific symptoms and signs, preoperative diagnosis is very difficult. Germ cell tumors are extremely sensitive to radiotherapy and chemotherapy, and the purpose of surgery is to take a biopsy to confirm the diagnosis^[3,4]。 There is a rich conduction system in the brainstem, as well as numerous nerve nuclei; The entire brainstem is staggered with a reticular structure, which is "filled" with uneven density of neurons. It is an important plant regulatory center, regulating functions such as cardiac activity, circulation and respiration, and sending impulses to the cerebral cortex to maintain intact consciousness. Based on these characteristics, the brainstem was once considered a restricted area for surgery until 1971, when Lassiter et al.^[5]It is proposed for the first time that brainstem lesions can be treated by surgery. Although various surgery-related adjuvant techniques have greatly improved the success rate of brainstem surgery in recent years, there are still many surgery-related complications. For germ cell tumors at the brainstem site, complications caused by excessive resection can be consciously prevented if the diagnosis can be made accurately before surgery. There are few literature reports of this disease at home and abroad, including 3 cases described in this article. So far, there are 23 cases of germ cell tumor originating from the brain stem site reported in the literature. This article retrospectively analyzed three patients with germ cell tumors originating from the brainstem admitted to the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University from October 2012 to February 2016. Their clinical data, imaging features, pathological manifestations, treatment methods and prognosis are reported as follows.

To evaluate the efficacy and safety of extended endoscopic endonasal approach for resection of craniopharyngiomas.

The clinical data of 32 patients with craniopharyngiomas undergoing extended endoscopic endonasal surgery at Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University between November 2014 and May 2016 were analyzed retrospectively. The visual improvement, extent of resection and surgical complications were evaluated.

The gross total resection (GTR) rate was 69% (22/32), near-total resection (> 95% of tumor removed) was 25% (8/32), and subtotal resection (≥ 80% of tumor removed) was 6% (2/32). Overall, 28 patients presented with visual impairment. In 86% (24 patients) of them, visions were improved or even recovered to normal following surgery. Worsening of the anterior pituitary function was reported in 53% (17 patients) of all, and there were 12 new cases (48% of 25) of postoperative diabetes insipidus. Thirteen (41%) patients had hyposmia and 3 (9%) patients developed severe hypomnesia after surgery. CSF leakage and secondary meningitis occurred in 1 (3%) patient postoperatively. One (3%) patient had brainstem hemorrhage after surgery. The follow-up lasted 4-22 months. No tumor recurrence was identified by MRI examination, and one patient died.

The extended endoscopic endonasal approach for craniopharyngiomas seems generally effective and safe with high GTR rate, which however could also cause damage of hypothalamic-pituitary axis. Thus, continuous attention should be paid to preservation of the endocrine function during surgical management of craniopharyngioma.

To investigate the clinical application value of preoperative facial nerve reconstruction by diffusion tensor imaging (DTI) in operations of acoustic neuroma.

We retrospectively collected 38 cases of patients who underwent operations of acoustic neuroma at Department of Neurosurgery, General Hospital of Tianjin Medical University from September 2013 to September 2015. Prior to operations, each patient underwent 3 T magnetic resonance DTI scanning. The facial nerve fiber tractography was made and the tumor was reconstructed with the software of 3D-Slice. Intraoperative electrophysiological monitoring was conducted to assess the degree of resection and facial nerve injury.

Preoperative DTI reconstruction of the facial nerve was satisfactory in 32 (84.2%) out of 38 cases and clearly revealed the three-dimensional relationship between the facial nerve and the tumor, which was consistent with intraoperative verification. The facial nerve in 6 cases(15.8%)failed to be reconstructed by DTI tracer technique. DTI showed that the facial nerve was located at the ventral anterior inferior part in 10 (31.3%) cases, ventral central part in 16 (50.0%) cases, ventral anterior superior part in 5 (15.6%) cases and lower part of the tumor in 1 (3.1%) case. The facial nerve was anatomical preserved during operation in 36 (94.7%) cases. At 7 days post surgery, the facial nerve function was graded according to the House-Brackmann scale as 10 cases in grade Ⅰ, 20 cases in grade Ⅱ, 3 cases in grade Ⅲ and 5 cases in grade Ⅳ-Ⅴ; and cases with good facial nerve function accounted for 78.9% of all patients.

Preoperative reconstruction of the facial nerve by DTI could be used to guide resection of the acoustic neuroma and reduce the injury of facial nerve to a certain extent.

To investigate the factors related to Department of Neurosurgery, the postoperative recurrence of WHO grade Ⅱ meningiomas.

A total of 84 pathologically confirmed cases of WHO grade Ⅱ meningiomas admitted to the People`s Hospital of Shanxi Province between January 2008 and December 2014 were enrolled in this study. The patients were followed up for possible recurrence and the related factors were studied by using single factor Kaplan-Meier survival analysis and multivariate Cox regression analysis.

The follow-up time for the 84 patients ranged from 24 to 105 months with a median of 72 months (P_25:55, P_75:82). The recurrence-free survival (RFS) range was from 24 to 94 months with a median of 57 months (P_25:48, P_75:75). Recurrence was reported in a total of 30 (35.7%) cases. The single factor Kaplan-Meier survival analysis revealed that the patient's age beyond 57, maximum tumor diameter over 5 cm, partial resection and expression rate of Ki-67 more than 8% were associated with greater rate of recurrence for WHO grade Ⅱ meningiomas(allP<0.05). The recurrence rate of patients who received radiotherapy was 10.0%, while whose didn＇t was 43.8%(P=0.069) The multivariate Cox regression analysis suggested that maximum tumor diameter (RR: 18.936, 95%CI: 2.112-169.773), the patient's age (RR: 0.238, 95%CI: 0.065-0.868), the extent of resection (RR: 3.082, 95%CI: 1.013-8.137) and Ki-67 expression level (RR: 13.377, 95%CI: 2.293-78.045) were independent risk factors related to the tumor recurrence.

The WHO Ⅱ meningiomas demonstrated a relative high tendency for recurrence, which seemed more common in cases of elder patients, large tumor size, incomplete resection and high expression level of Ki-67, and in those instances early radiotherapy and shortening the review cycle might be suggested.

To investigate the treatment strategies and neurological outcomes of spontaneous spinal epidural hematomas (SSEH).

From June 2004 to March 2016, a total of 42 patients with SSEH were admitted to Department of Neurosurgery, Tianjin Medical University General Hospital and were retrospectively reviewed in this study. All patients were divided into the surgery group (24 cases) and conservative treatment group (18 cases). Based on the time interval from inital symptoms to surgery, the patients in surgery group were further separated into <12 h group, 12-24 h group and >24 h group. The neurological functions of patients were assessed by the Japanese Orthopedics Association (JOA) scale and American Spinal Injury Association(ASIA) impairment scale. The JOA scores were used to determine the recovery rate of neurological functions. The follow-up period ranged from 4 to 34 months, with an average of 18±6 months.

There were significant differences in the recovery rate of neurological functions between patients with different ASIA scales either in the surgery group or conservative treatment group (all P<0.05). Significant difference was identified in the neurological function recovery rate between ASIA grade C patients in the surgery group and those in the conservative treatment group (64.1±31.5%vs. 34.1±17.6%, P<0.05). The patients of ASIA grade D in the two groups had no statistical difference (100.0±0.0%vs. 91.9±18.7%, P>0.05). The neurological function recovery rate in <12 h group was (79.8±26.1)% and higher than 12-24 h group (53.9±13.9%) and >24 h group (20.0±21.3%) (bothP<0.05).

For patients graded as ASIA scale A, B, C or those with progressive decline in ASIA scale, early surgical treatment should be recommended. For patients of ASIA scale D, E or those with tendency for neurological function recovery within a short term, conservative treatment might be considered. Patients undergoing operations with higher initial ASIA scale and shorter preoperative interval tend to demonstrate better outcomes. Patients undergoing conservative treatment with higher initial ASIA scale seem more likely to achieve good outcomes.

To investigate the cellular biomarker that is indicative of intracranial pressure (ICP) change post operations of intracranial hemorrhage.

A prospective study was conducted on 52 patients of intracranial hemorrhage who were admitted to the Department of Neurosurgery Tianjin Medical University General Hospital between September 2015 and February 2017. All patients underwent operation and implantation of ICP sensor. Based on the ICP values, the patients were divided into the elevated ICP group (ICP≥20 mmHg, n=20) and the normal ICP group (ICP<20 mmHg,n=32). Peripheral blood was collected from all 52 patients within 24 hours of admission to count the lymphocytes, neutrophils and monocytes. Natural killer (NK) cell counts were analyzed by flow cytometry. The relationship of those cell counts to ICP was studied.

Elevated ICP and normal ICP groups had no significant difference in either the neutrophil or monocyte counts (all P>0.05), while the lymphocyte count in elevated ICP group was higher than that in normal ICP group (P<0.01) and a positive correlation was observed between the increase of ICP and lymphocyte count (R²=0.509, P<0.01). Preoperative NK cell percentage in elevated ICP group was lower than that in normal ICP group (P<0.01). The lymphocyte count of at least 1.655×10⁹/L predicted the maximal ICP over 20 mmHg.

Preoperative lymphocyte count seemed to be correlative with postoperative ICP in patients with intracranial hemorrhage and thus might serve as a cellular biomarker indicative of postoperative ICP.

To explore the efficacy and safety of the neuroendoscopic microsurgical treatment of pituitary adenomas using bilateral endonasal approach with fixed arm.

A total of 57 patients with pituitary adenomas underwent neuroendoscopic microsurgical operations using bilateral endonasal transsphenoid approach with fixed arm at Department of Neurosurgery, the 2nd Affiliated Hospital of Nanjing Medical University from January 2015 to December 2015. Their clinical data were retrospectively analyzed. Extracapsular resection was performed for lesions with pseudocapsules, and the diving technique was applied to improve the rate of gross total resection (GTR).

Among the 57 patients, GTR was achieved in 48(84%) cases, subtotal resection in 7 (12%) cases, and partial resection in 2 (4%). The hormone levels were retested at 12 hours post operations, and the results revealed that the prolactin levels in 28(88%, 28/32) cases and the levels of growth hormone and insulin-like growth factor 1 in 8 (80%, 8/10) cases recovered to normal. Postoperative improvement of vision and visual field occurred in 30 (88%, 30/34) cases. Three patients developed cerebrospinal fluid rhinorrhea 2 weeks to 2 months post operations, which resolved after endoscopic repair of saddle bottom and lumbar cistern drainage. No serious complications such as intracranial infection or rupture of internal carotid artery were observed.

Neuroendoscopic microsurgery using bilateral endonasal approach with fixed arm, combined with pseudocapsule-based extracapsular resection and the diving technology, could be performed to significantly increase the GTR rate of pituitary adenomas and improve the surgical safety.

To investigate the relationship between tumor necrosis factor alpha (TNF-α), vascular endothelial growth factor (VEGF) and endothelin-1 (ET-1) with brain injury secondary to hypertensive intracerebral hemorrhage (HICH).

Fifty-two patients admitted to Department of Pathology, Chengde Central Hospital with HICH (experimental group) were divided into 5 groups based on the time interval between illness onset to operation: ≤6 h group (6 cases), >6-12 h group (15 cases), > 12-24 h group (16 cases), > 24-48 h group (7 cases) and > 48-72 h group (8 cases). The expression of TNF-α, VEGF and ET-1 in the border zone (brain tissues surrounding the hematoma) in the 52 patients and 10 normal controls were detected by real-time quantitative PCR and immunohistochemistry in order to explore the relationship of the factor expression to HICH-induced brain injury.

The expression levels of TNF-α, VEGF and ET-1 mRNA in the ≤ 6 h group , > 6-12 h group, > 12-24 h group, >24-48 h group and > 48-72 h group were significantly higher than those in controls (allP<0.05), and their expression was increased first and then decreased as the illness progresses. The mRNA levels of TNF-α, VEGF and ET-1 in the experimental group were also significantly different when compared between different time points (allP<0.05).

TNF-α, VEGF and ET-1 might be involved in and facilitate HICH-induced brain injury.

Intracranial arachnoid cysts (AC) are a kind of benign lesions related to cerebrospinal fluid in the arachnoid membrane. Most of them are found accidentally by imaging and have no clear clinical symptoms^[1,2]。 After AC combined with subdural hematoma, it often presents with intracranial hypertension and focal neurological symptoms. Clinically, the cases of AC combined with subdural hematoma are relatively rare, its pathogenesis is still unclear, and the treatment method is also controversial. From January 2010 to October 2016, 426 children with AC were diagnosed by imaging examination in the Department of Neurosurgery, Beijing Children's Hospital affiliated to Capital Medical University, of which 5 cases were complicated with subdural hematoma. This study retrospectively analyzed the clinical data, treatment methods and prognosis of these 5 children with AC complicated with subdural hematoma, and analyzed it in combination with relevant literature for clinicians' reference.

neurofibromatosis type 1 (NF1) complicated with pleural meningocele is relatively rare in clinical practice, and other diseases such as brainstem glioma have also been reported^[1]Spinal ependymoma^[2]。 The incidence of NF1 in patients with pleural meningocele is unknown. A few patients see a doctor with dyspnea as the first symptom, and are easily misdiagnosed as thoracic tumor or mediastinal tumor^[3,4]。 From March to June 2016, 3 patients with NF1 complicated with pleural meningocele were treated in the Department of Neurosurgery, Union Hospital affiliated to Fujian Medical University. Now, the surgical treatment of such cases is discussed in combination with relevant literature at home and abroad.

To explore the effect of exosomes derived from glioma stem cells (GSCs) cultured in different oxygen environments carrying miRNAs on the tumor proliferation.

The exosomes derived from U87MG-GSCs cultured under hypoxic(1% O₂) and normoxic(21% O₂) conditions were isolated by differential centrifugation. Exosomes were co-cultured with U87MG glioblastoma cells and human brain microvascular endothelial cells (HBMECs), and cell viabilities were determined using the cell counting kit-8 (CCK-8) assay. The microRNA content of exosomes produced by hypoxic and normoxic U87MG-GSCs were analyzed by Affymetrix microarrays.

The count and diameter of GSC-derived exosomes under hypoxic and normoxic conditions were similar. The average diameter of exosomes was (43.0±20.3)nm (range: 25-65 nm). The U87MG-GSCs under hypoxic and normoxic conditions had in common a total of 152 exosomal miRNAs including 91 miRNAs with up-regulation and 61 miRNAs with down-regulation. Exosomes derived from hypoxic U87MG-GSCs were co-cultured with U87MG and HBMECs, which caused a significant increase in cell viability (all P<0.05).

It is suggested that GSC-derived exosome-mediated miRNA transduction plays an important role in facilitating the proliferation of epithelial and glioma cells. The exosome-involving intercellular signal pathway during tumor proliferation might become a potential treatment target.

atypical teratoid/rhabdoid tumor (AT/RT) is a kidney-like rhabdoid tumor. It is a rare and highly malignant tumor of the central nervous system composed of rhabdoid cells, primitive neuroectodermal cells with interstitial and epithelial components^[1]。 The disease occurs mainly in infants and children, and more than half of the tumors are located in the posterior cranial fossa (especially the cerebellopontine angle). An adult sellar area AT/RT was admitted to the Department of Neurosurgery, Affiliated Hospital of Southwest Medical University in November 2015. A simultaneous search of PubMed and Medline reported a total of 7 such cases from 1985 to 2015 (Table 1)^[2,3,4,5,6], and review its literature.

myeloid sarcoma (MS), also known as extramedullary myeloid tumor, granulocytic sarcoma or chloroma, is a mass that occurs at an anatomical site outside the bone marrow and consists of myeloid blasts with or without signs of maturation^[1,2]。 1988 Davey et al.^[3]To propose the concept of extramedullary medullary tumor, which includes mass-forming granulocytic sarcoma and leukemic extramedullary infiltration. MS can be divided into isolated and leukemic. Among them, leukemic MS can cause extramedullary infiltration in many parts of the body, but it is rare to occur in the spinal canal. A patient with chronic myelogenous leukemia (CML) complicated with MS was admitted to the Department of Neurotumor Surgery of the First Hospital of Jilin University in March 2015. The review literature is reported below.

A patient with oculomotor nerve paralysis was admitted to the Department of Neurosurgery of Jinan Military Region General Hospital, and was diagnosed as oculomotor perineural cyst by pathology. Searching the relevant literature at home and abroad, no similar cases were reported. The diagnosis and treatment results are reported as follows.

Children's brain stem glioma accounts for about 10% ~15% of children's brain tumors^[1]。 Among them, 15% ~20% are low-grade gliomas, showing chronic development process and good chemotherapy sensitivity; The majority of the remaining 80% are mass occupants of diffuse infiltrating pons and are designated as diffuse endophytic pons gliomas (diffuse intrinsic pontine gliomas, DIPG); Non-DIPG high-grade glioma of the brainstem in children has low incidence and poor prognosis. DIPG is the main cause of death in children with brain tumors. The overall survival (OS) is 8 to 11 months, the progression-free suivival (PFS) is 5 to 9 months, and the survival rate is 2 years<10%^[2]The length of the patient's disease course and Karnofsky functional status score correlated with the prognosis of children with DIPG^[3]。 From 1984 to 2005, no survival benefit was found in traditional cytotoxic chemotherapy for DIPG. Since 2005, there have been many new advances in the basic and clinical research of brainstem glioma in children, which has opened a new era for the chemotherapy research of brainstem glioma. This article reviews the clinical chemotherapy, the problems faced by chemotherapy research and the research progress of brainstem glioma in children.

intracranial arterial dolichoectasia (IADE), also known as dilated cerebral arteriopathy, is characterized by the enlargement of at least one intracranial artery in length and diameter, and the affected intracranial artery is dilated and prolonged, sometimes even meandering^[1,2]。 Up to 12% of IADE patients have a history of stroke. The main clinical manifestation of IADE is ischemic stroke, and patients can develop severe neurological deficit symptoms and even die^[1,2]。 To date, no randomized controlled trials of IADE treatment have been reported and, therefore, there is no high-quality clinical evidence available for treatment guidelines. At present, the choice of IADE treatment depends on the patient's clinical presentation and the severity of the disease. Specific methods include blood pressure control, antithrombotic therapy, endovascular therapy, and craniotomy. At present, it is necessary to better assess the incidence of IADE in the general population, establish an epidemiological database of the disease, identify life-threatening complications, and find effective treatments. In this paper, the diagnosis, epidemiology, clinical characteristics, prognosis and treatment of IADE are reviewed.

spinal cord injury (SCI) is a disease with high disability rate and often accompanied by serious complications. Preliminary analysis shows that adolescent SCI is mostly due to traffic accidents and falls from heights; The main causes of young adults' injuries are traffic accidents, falling from height and smash injuries; Traffic accidents and fall injuries are common causes in the elderly. With the development of world economy, the incidence of SCI shows an obvious increasing trend. In developed countries, the annual incidence rate of SCI is 13.3~45.9/1 million. There is no national statistics in China, but there are many local statistics. Among them, the incidence rate of SCI in Beijing in 2002 was 60/1 million^[1]； Statistics from 2004 to 2008 in Tianjin showed that the annual incidence rate of SCI was 23.7/1 million^[2]。 According to a report published by the World Health Organization, the number of SCI occurs worldwide can reach 500,000 every year^[3]。 Therefore, the preparation of SCI animal models is of great significance to study the pathophysiology, neurochemical mechanism and clinical treatment of SCI. Since Allen^[4]The method of heavy objects falling and hitting animal vertebrae has pioneered the preparation of SCI animal models. After continuous improvement and innovation, the types of SCI models have been quite diverse. The author summarizes the current situation of SCI animal models at home and abroad, hoping to provide reference for the development and use of SCI animal models.

A series of far-field evoked potentials, including short incubation period potential (≤10 ms) and medium-long incubation period potential (>10 ms), were recorded in the scalp by stimulating the facial distribution area of the trigeminal nerve and the trigeminal nerve fibers. These evoked potentials belong to a kind of somatosensory evoked potentials. Short incubation period potentials are also known as brainstem trigeminal evoked potentials (BTEPs) or early trigeminal evoked potentials^[1,2]It is a reliable electrophysiological index to evaluate the trigeminal nerve fiber bundle, trigeminal nerve nucleus and its central conduction pathway^[3]。 However, because BTEP is susceptible to myoelectric interference, the puncture of stimulating electrode requires high accuracy, and it needs to be directly punctured into the supraorbital foramen, infraorbital foramen and mental foramen to stimulate the supraorbital nerve, infraorbital nerve and mental nerve. The puncture is difficult, which restricts its clinical research and development. This article summarizes its monitoring methods, origin, application, shortcomings and prospects in trigeminal neuralgia as follows.

Glioma is the most common intracranial malignant tumor. After decades of joint efforts by scholars in related fields, people's understanding of glioma has been continuously improved. The imbalance of glutamate homeostasis and the increase of extracellular glutamate concentration in the central nervous system are one of the important factors involved in the growth and invasion of glioma, which has become the research hotspot in recent years. This article discusses the relationship between glutamate metabolism and glioma and the related therapeutic progress, so as to provide reference information for clinical glioma drug development and clinical treatment.

The myelinated nerve fibers that form myelin structure are essential for the rapid jumping conduction of action potentials. They are formed by the interaction of Schwann cells, axons and basement membranes in the peripheral nervous system, and the whole development process is strictly regulated. Any abnormality in the link may lead to myelination disorder or myelin structure abnormality, thus leading to corresponding peripheral neuropathy. In addition to insulating and protecting nerve axon, myelin sheath can also provide a structural foundation for long-distance nerve impulse jumping conduction, and have a nutritional support effect on nerves, thus promoting damage repair. This article mainly reviews the process of myelin formation of peripheral nerve in vivo, the main components involved in myelin formation and the signal pathways between them, and the research on the establishment of peripheral nerve myelin model.