Volume 33 · Issue 07 · 2017

In the summer of 1956, a group of visionary young scientists gathered together to study and discuss a series of problems related to using machine to simulate intelligence, and put forward the term "artificial intelligence" for the first time, which marked the official birth of this new discipline. artificial intelligence (artificial intelligence) is a new technical science, which is used to simulate, extend and expand human intelligence. Artificial intelligence is a branch of computer science that aims to understand the essence of intelligence and produce a new system of intelligence that can react in ways similar to human intelligence. Artificial intelligence is a subject that studies computer simulation of some human thinking processes and intelligent behaviors (such as learning, reasoning, thinking, planning, etc.). It mainly includes the principle of computer realizing intelligence, making computer similar to human brain intelligence, so that computer can realize higher level application^[1]。 Artificial intelligence involves computer science, psychology, philosophy and linguistics, and its application extends to all disciplines of natural science and social science, and its scope has far exceeded the scope of computer science.

post-traumatic epilepsy (PTE) is a serious complication of craniocerebral trauma, which will aggravate the secondary brain damage and seriously affect the quality of life of patients. It should be paid attention to by clinicians^[1]。 early post-traumatic seizure may be effective for drug prophylaxis, whereas late post-traumatic epilepsy is ineffective^[2]。 Even after early epilepsy prevention, 4% ~53% of patients with craniocerebral trauma still develop late epilepsy^[3]。 status epilepticus is the critical and most severe state of PTE, with a mortality rate of 3% ~33%^[4]。

To investigate the relationship of brain temperature (intra-ventricle, brain parenchyma, or subdural space) to axillary temperature, rectal temperature and bladder temperature in postoperative patients with brain trauma, and to explore the prognosis value of the brain temperature through a multicenter prospective observational study.

A total of 83 patients with brain trauma at 11 hospitals were enrolled to this study from March 2016 to December 2016. The data including patients' brain temperatures, axillary temperatures, rectal temperatures and bladder temperatures were hourly documented postoperatively until withdrawal of monitoring device of brain temperatures. The changes of the values were then further analyzed.

Compared with the axillary temperature, the subdural temperature difference [0.10(-0.40, 0.40)℃] was less than intraventricular temperature difference [0.30(-0.20, 0.90)℃], which was less than parenchymal temperature difference [0.60(0.20, 1.00)℃](bothP<0.05). Compared with rectal temperature and bladder temperature, the subdural temperature difference [-0.20(-0.40, 0.00)℃, -0.10(-0.30, 0.00)℃, respectively] was less than parenchymal temperature difference [0.10(-0.10, 0.20)℃, 0.10(0.00, 0.20)℃, respectively], which was less than intraventricular temperature difference [0.20(0.10, 0.30)℃, 0.20(0.10, 0.30)℃, respectively] (allP<0.05). No matter whether hypothermia treatment was administered, the difference between brain temperature and axillary temperature (ΔT_Br-Ax) was larger than that between brain temperature and rectal temperature (ΔT_Br-Re) and that between brain temperature and bladder temperature (ΔT_Br-Bl) (both P<0.05). When brain temperature was higher than 38 ℃, ΔT_Br-Ax was larger than ΔT _Br-Re , which was larger than ΔT _Br-Bl (both P<0.05). When brain temperature was less than or equal to 38 ℃, ΔT_Br-Ax was larger than ΔT _Br-Bl, which was larger than ΔT _Br-Re (both P<0.05). When the fluctuation of brain temperature within 12 hours post operation was more than 1 ℃, the preoperative Glasgow coma scale (GCS) and the extended Glasgow outcome scale(GOS-E) at discharge were significantly lower compared with those of cases whose brain temperature fluctuation was less than or equal to 1 ℃ (bothP<0.05).

For patients with brain trauma, brain temperature monitoring seems to have a very significant clinical value. When monitoring of brain temperature is not available, the bladder temperature might serve as the best reflection of brain temperature.

To describe the features of spindle waves during intracranial pressure waveform monitoring in patients with traumatic brain injury and to investigate its significance and mechanism.

Clinical data of 50 patients with traumatic brain injury were retrospectively analyzed who were admitted to Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine from March 2016 to December 2016. All 50 patients underwent ventricular puncture and intracranial pressure (ICP) monitoring. Among them, 18 cases showed spindle waves and were assigned to the test group, while the remaining 32 patients in control group did not demonstrate spindle waves. The patient's Glasgow coma scale (GCS) at discharge, length of stay and Glasgow outcome scale(GOS) at 3 months post injury were compared between the 2 groups. Various parameter changes of ICP waveform were analyzed in case of spindle waves.

Compared with control group, the patients with spindle waves tended to have a higher GCS at discharge(12.83±2.04 vs. 10.84±3.77, P<0.05), a larger proportion of good recovery (GOS Ⅳ-Ⅴ)(61%vs. 31%, P<0.05), and a shorter length of stay[(18.4±4.5) dvs. (22.2±7.1) d , P<0.05)]. Furthermore, compared with the parameters before the occurrence of spindle wave, the parameters during the time of spindle wave, including mean ICP, pulse amplitude of ICP, regression of amplitude and pressure coefficient, demonstrated significant improvement (allP<0.05).

The spindle wave in ICP waveform seems to be associated with good outcomes in patients with traumatic brain injury. During the appearance of spindle wave, physiological parameters such as ICP, brain compliance and compensatory capacity showed significant improvement, which may lead to the enhancement of clinical outcomes.

To explore the clinical factors of the brain rebound speed after drainage in patients with chronic subdural hematomas.

The clinical and imaging data of 90 adult patients with chronic subdural hematomas were retrospectively reviewed who were treated at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2015 to December 2016. Those data analyzed included the patient's age, gender, maximal diameter of the hematoma, maximal anteroposterior diameter of the skull, and maximal distance between the brain and the inner edge of the skull. The correlation between clinical factors and the velocity of brain tissue recovery was analyzed.

The postoperative brain rebound speed was significantly higher in the younger age group (<40 years) than in the older age group (>80 years) (P=0.008), and it was significantly higher in patients with small hematomas (<100 mm) than in those cases with larger hematomas (140-150 mm) (P<0.05). In addition, this study suggested a negative correlation between relative brain tissue recovery and the longest diameter of the skull (P=0.027). Gender, the maximal width of initial hematoma, maximal area of initial hematoma were not associated with the postoperative brain rebound speed (all P>0.05).

The brain rebound speed in patients with chronic subdural hematomas seemed to be related to age, the longest diameter of initial hematoma and maximal anteroposterior diameter of the skull.

To evaluate the treatment efficacy and safety of troxerutin and cerebroprotein hydrolysate injection(TCHI) in patients with traumatic brain injury.

A total of 360 patients with traumatic brain injury were admitted to neurosurgery departments at 10 medical centers (mainly led by Beijing Hospital of Health Ministry) and enrolled into this prospective, multi-center, placebo-controlled, clinical trial from June 2013 to July 2014. Through stratified random sampling, patients were randomized into the TCHI (n=240) group and placebo group (n=120). TCHI(40 mg/ml, 2ml/d, iv) or placebo had been intravenously administered for 14 days starting from patient admission. The parameters were compared between the two groups that included Glasgow coma scale (GCS), Glasgow outcome scale (GOS), level of consciousness, language and motor functions, Karnofsky performance status scale (KPS) and incidence rate of adverse events.

The study was successfully conducted in 321 out of the 360 cases, which included 213 patients in the TCHI group and 108 patients in the placebo group. The treatment lasted 14 days in both groups. The GCS in TCHI group (14.1±2.0) was significantly higher than that in placebo group (13.4±2.3) (P=0.007), and the ratio of consciousness in TCHI group was remarkably higher than that in placebo group (81.8% vs. 70.0%) (P=0.036). At the 30-day follow-up, the rate of good outcomes assessed by GOS (82.3% vs. 58.1%), rate of normal verbal functional (86.1% vs 61.9%), rate of normal function in upper/lower limb (88.9%/90.4% vs. 78.1%/81.9%) and KPS score(91.3 vs. 89.1) (P<0.05). No serious adverse effects were noted in either group.

TCHI could be helpful for shortening the coma period and improving the patient's life quality as well as long-term outcome.

To explore the clinical efficacy of bilateral decompressive craniectomy (BDC) in the treatment of severe traumatic brain injury (sTBI).

A total of 193 patients with sTBI underwent treatment at Emergency Neurosurgery Department of Qilu Hospital of Shandong University and Brain Science Research Institute of Shandong University from September 2011 to December 2015. The patients were enrolled in this study and divided into standard unilateral decompressive craniectomy group (UDC group, 106 cases) and bilateral decompressive craniectomy group (BDC group, 87 cases). The clinical effects were retrospectively analyzed in the two groups of patients.

There was no statistically significant difference in sex, age, preoperative GCS score or type of lesion on imaging between the two groups (P>0.05). The highest preoperative ICP in the BDC group and UDC group were 38.9±3.1 mmHg and 38.6±2.5 mmHg, respectively (P>0.05). The ICP in the 2 groups measured immediately post operation were 13.2±3.1 mmHg and 18.3±3.9 mmHg, respectively (P<0.001). The incidence of acute intraoperative encephalocele in the BDC group (3 cases, 3.4%) was significantly lower than that in the UDC group (12 cases, 11.3%) (P=0.042). There was no statistically significant difference in poor incision healing between the two groups (P=0.784). According to the follow-up 1 year after injury, the incidence of hydrocephalus in the BDC group (7 cases, 8.0%) was significantly lower than that in the UDC group (19 cases, 17.9%) (P<0.05). The outcomes of the patients were evaluated by GOS, and it was suggested that the percentage of patients with good outcomes in the BDC group (28 cases, 32.2%) was remarkably higher than that in the UDC group (14 cases, 13.2%) (P<0.01).

For patients with sTBI, BDC could be able to help prevent the acute encephalocele during operation, decrease the ICP dramatically, reduce the incidence of hydrocephalus, and significantly improve the outcome. Therefore, BDC seems to be a simple, effective and feasible treatment for sTBI.

To investigate the characteristics and principles of water and electrolyte disturbance (WED) after traumatic brain injury and to provide evidence for its clinical diagnosis and treatment.

A total of 118 patients with traumatic brain injury were treated at Department of Neurosurgery, Nanfang Hospital, Southern Medical University between June 2015 and June 2016, and their data were analyzed retrospectively. The timing of occurrence of WED was studied. In addition, the associated factors of various types of WED and their relationship to prognoses were explored.

There was no correlation between the degree of traumatic severity and the degree of hyponatremia (P=0.639), while the degree of traumatic severity had significant effects on the degrees of hypernatremia and hypokalemia (both P<0.05). Severe hyponatremia, hypernatremia and hypokalemia normally occurred within the first 1-2 days post injury. Among patients with different injured locations, the degrees of hyponatremia, hypernatremia and hypokalemia revealed statistical difference with each other (allP<0.05). The degrees of hypernatremia and hypokalemia had correlation with the GOS prognosis (bothP<0.05).

After the traumatic brain injury, the severity of WED seems to be closely related to the degree and location of injury in the patient. Severer injury might be linked to increased risk of severe hypernatremia and hypokalemia rather than hyponatremia. Patients with frontal lobe damage and diffuse axonal injury could have a larger chance of developing WED. It is suggested that severe hypernatremia and hypokalemia occur early post injury and are closely related to the patient's prognosis.

To explore the risk factors for second operation on remote site of severe traumatic brain injury patients after craniotomy.

The clinical data of 180 patients with severe traumatic brain injury were analyzed retrospectively who underwent craniotomy from February 2010 to October 2014 at Department of Neurosurgery, the 101 Hospital of PLA, Craniocerebal Injury Cure Center of PLA. Among them, 39(21.7%) patients received a second operation on the remote side. The correlation between multiple factors and second operation on remote site was analyzed, which included sex, trauma site (frontal-temporal, parietal, occipital or multiple), relationship of trauma site to hematoma location (ipsilateral, contralateral or bilateral), fracture on remote site, preoperative pupils (normal, unilateral large or bilateral large), ambient cistern (clear or unclear), midline shift (no, ≤5 mm, >5-10 mm or ≥10 mm), preoperative hypoxia, combined injuries, placement of ventricle drainage and decompressive craniotomy.

It was suggested by multiple logistic regression that the trauma site in frontal-temporal areas with ipsilateral hematoma was the protective factor for re-operation on remote site (OR=0.222, 95% CI: 0.073-0.674, P=0.008), while the occipital trauma with contralateral hematoma (OR=4.647, 95% CI: 1.078-20.033, P=0.039), skull fracture on remote site (OR=3.133, 95% CI: 1.247-7.867, P=0.015) and decompressive craniotomy (OR=5.684, 95% CI: 1.759-18.370, P=0.004) were risk factors associated with second operation on remote site in severe traumatic brain injury patients after craniotomy.

Trauma in the occipital region with contralateral hematoma, skull fracture in distal area and decompressive craniotomy might be related to a larger chance of re-operation on remote site of severe traumatic brain injury patients after craniotomy. Sufficient attention to the patient's conditions are suggested and caution should be warranted.

To explore the clinical application of transcranial doppler ultrasonography (TCD) in severe traumatic brain injury (sTBI)post decompressive craniectomy.

A retrospective study was conducted on 58 patients with sTBI who were admitted to Neurosurgical Intensive Care Unit of Tangdu Hospital, the Fourth Military Medical University From January 2015 to October 2016. All patients underwent hematoma evacuation, decompressive craniectomy and placement of intracerebral pressure (ICP) probe. The parameters of cerebral blood flow including mean velocity (Vmean), end of diastolic (Vedv) and pulsatility index (PI) in sTBI patients were measured by TCD post operation to assess the cerebral blood supply.

The trend of Vmean and Vedv manifested U-shaped mode during the next 7 days, reaching the lowest levels [(72.5±22.6) cm/s and (43.6±19.8) cm/s, respectively] on day 3. There was significant difference in the value of Vmean between day 3 and day 1, 2, 5, 6, 7 (all P<0.05). There was significant difference in the value of Vedv between day 3 and day 1, 2, 6, 7 (allP<0.05). The trend of pulsatility index (PI) and intracranial pressure (ICP) showed parabolic shape during the next 7 days, reaching the highest level [(1.5±0.7) and (17.2±4.5)mmHg, respectively] on day 4. Significant difference was observed in ICP between day 4 and day 1, 2, 3, 6, 7 (P<0.05). The incidence of cerebral hyperemia showed the trend of declining during the next 7 days. There was significant difference in cerebral hyperemia between day 1 and day 5, 6, 7 (allP<0.05). The incidence of cerebral ischemia was up to 36.2% (12/58) on day 4, and it was significantly higher than that on day 1 (P<0.05). The incidence of cerebral vasospasm showed the rising trend and reached the highest level (15.5%) on day 6, which had significant difference compared with the incidences on day 1, 2 and 3 (allP<0.05).

TCD, as a noninvasive, portable, easy-to-use monitoring tool, could help effectively evaluate postoperative changes of cerebral hemodynamics in patients with sTBI.

To study the current status of the nutritional support for patients with severe traumatic brain injury in Zhejiang province.

A total of 219 patients in 24 hospitals in Zhejiang province were enrolled from October 2015 to December 2016 in this study. All the clinical information of these patients after arriving at hospital were recorded, as well as the contents and complications of nutritional support after injury. All patients were followed up , and their Glasgow Outcome Scale were evaluated and recorded.

A majority of patients in this study obtained early nutritional support after the injury, which accounted for 99.06% of all cases on the 7th day post injury. The percentage of enteral nutrition was relatively high. Within 30 days post injury, the average ratio of actual calorie supplementation to the target of calorie supplementation had increased from (42.8±34.1)% to (85.5±27.7)% (P<0.05) . However, the rate of adequate calorie supplementation was as low as 6.2%-29.1%, and the percentage of adequate calorie and protein supplementation was 12.4%-24.3%, which remained relatively unchanged within 30 days post injury (P>0.05). At 6-month follow-up post injury, good outcomes were achieved in 113 cases, poor outcomes occurred in 89 cases, and 17 cases died. Subgroup analysis indicated that patients with inadequate calorie supplementation within 7 days post injury had poorer outcomes at 6-month follow-up compared with patients with adequate calorie supplementation (χ²=8.354, P<0.05). Multiple complications such as nausea and vomiting were observed and related to nutritional support, among them the most common form was hyperglycemia with the incidence rate of 0.5%~13.7%.

Early and diverse nutritional support has been provided for patients with severe traumatic brain injury in Zhejiang province. However, the rate of adequate calorie and protein supplementation seems critically low.

To investigate the feasibility of preservation of the skull flap covered with periosteum in vivo and early cranioplasty in patients with decompressive craniectomy.

Sixty-seven patients underwent autologous cranioplasty using periosteum-covered skull flap preserved subcutaneously after decompressive craniectomy from January 2012 to December 2015 at Neurosurgery Department of Rizhao People's Hospital. Their data were retrospectively reviewed. Cranioplasty was conducted within 4-8 weeks after decompression for all patients. Part of the skull flap tissue was obtained in cranioplasty for identification of the bone activity by pathological examination. At follow-up, all patients received CT scan and 34 patients underwent SPECT to assess the healing and survival of skull flap.

The size of skull flap in the 67 patients with cranioplasty remained the same as that at the time of decompression. Bones were not destructed, focal dead bone was not observed by the pathological examination. The postoperative follow-up lasted 1-2 years and CT scans revealed that the healing rate was 0%, 62.7% (42/67), and (67/67), 100% (53/53) at 1, 6, 12, 24 months after cranioplasty. No skull resorption was reported. Bone survival and good blood supply of the skull flap were demonstrated by SPECT. During the follow-up period, 1 (1.5%) patient had small subcutaneous hematoma, 4 (6.0%) patients developed subcutaneous effusion, and no intracranial or subcutaneous infection was observed.

Biological activities of skull flap in patients with decompressive craniectomy could remain well through subcutaneous preservation with periosteum, which might be useful for facilitating the good outcome of cranioplasty.

To investigate the clinical features, surgical treatment and follow-up results of McCune-Albright syndrome (MAS) presented with pituitary adenoma.

Nine patients with MAS and pituitary adenoma were admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from April 2004 to November 2016 and the data were retrospectively reviewed. Among them, there were 4 males and 5 females. The average age was 42 years old with a range from 31 to 59 years old. Four patients had high level of blood growth hormone (GH), 4 patients had high level of prolactin (PRL) and 1 patient had abnormal level of free thyroxine (FT4). Transnasal resection of the pituitary adenoma was performed in 8 patients (endoscopy surgery in 4 cases, neuronavigation in 2 cases, and microsurgical resection in 4 cases), and craniotomy was conducted in 1 patient. The follow-up lasted 6-151 months. At the follow-up, MRI and CT examinations were performed.

Seven patients received gross total resection, 1 patient had subtotal resection and partial resection was achieved in 1 patient. Postoperatively, 8 patients reported significant improvement on their endocrine function, the GH level remained high in 1 case, and 1 patient developed newly-onset pituitary hypofunction. A total of 6 patients with progressive decrease of visual acuity before surgery had significant improvement postoperatively. During the follow-up, 8 patients' conditions were stable. No tumor recurrence or progression of the fibrous dysplasia were observed. One patient died of heart disease.

The clinical presentation of MAS may vary greatly and lead to misdiagnosis or ignorance. Co-existing pituitary tumor and endocrine dysfunction could exacerbate the patient's conditions. Early diagnosis and effective treatment of abnormal endocrine function, and individualized therapy regimen could help improve the clinical outcomes.

To explore the clinical characteristics, treatment and prognosis of desmoplastic infantile astrocytoma/ganglioglioma(DIA/DIG).

A retrospective analysis was conducted from April 2007 to October 2015 on a total of 6 cases with DIG/DIA who were admitted to Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University. Among them, 4 cases were male and 2 were female, and they were aged 2-19 months. The typical imaging findings included nodular enhancement commonly presenting cystic changes in superficial areas of cerebral hemispheres. The size of tumor was relatively large and could involve multiple lobes, in particular, the frontal and parietal lobes. Pathological examination revealed two-way differentiation of tumor cells to glial cells and neuroepithelium with GFAP (+ ), S-100 (+ ) and Vimentin (+ ), and Ki-67 (+ ) proliferation index was relatively low. Tumor resection was performed in all 6 cases. Postoperative subdural effusion and shunting were conducted in 1 case, and 2 cases underwent postoperative subdural effusion. The follow-up time ranged from 1 to 9 years.

All 6 children with DIA/DIG (grade WHO Ⅰ) underwent total resection of tumors. Among them, 3 cases without undergoing subdural effusion or shunting surgery achieved good outcomes. Except temporary decrease in muscle strength occurring in 1 case, no other neurological disorders or epileptic seizures were reported. Among the 3 cases undergoing subsequent subdural effusion or shunting surgery, 1 case had good outcome, 1 case developed neurologic dysfunction, and 1 case died of infection. No metastasis spread through cerebrospinal fluid or tumor recurrence was observed.

DIG/DIA is a rare kind of intracranial tumor with common onset at less than 2 years old. The tumors are usually large and located in the superficial areas of the frontal and parietal lobes. DIG/DIA could have its unique imaging characteristics and the diagnosis could be established based on its typical pathological presentation. Good outcomes could be achieved through total resection of tumors.

To investigate the characteristics of preictal and ictal stereo-electroencephalography (SEEG) in intractable epilepsy using multifrequency quantity analysis and to provide neuro-electrophysiological evidence for accurate identification of epileptogenic zone.

We retrospectively analyzed the data of 95 intractable epilepsy patients, who underwent preoperative evaluation involving stereo-electroencephalography(SEEG) and subsequent epileptogenic zonectomy between January 2015 and March 2016 at Beijing Tiantan Hospital, Capital Medical University. Preictal and ictal SEEG data of 16 patients, with the sampling rate over 2, 000 Hz, were analyzed using multifrequency quantity method and that patients were followed up for 10.0 ± 2.7 months.

The ictal onset rhythm in those 16 patients covered the frequency bands of 0.2-4.0 Hz and 8-500 Hz. Notably, the quantitative analysis showed that the infraslow activity (0.2-1.0 Hz), fast activity(12-30 Hz) and high-frequency oscillations (80-500 Hz) were more correlated with the seizure onset zone rather than non-seizure onset zone(P<0.001).

The infraslow activity (0.2-1.0 Hz) and high-frequency oscillations (80-500 Hz) in the seizure onset zone seem to demonstrate pronounced increase in preictal period. Broadband frequency analysis of ictal electroencephalography (EEG) could facilitate accurate localization of epileptogenic zone by identifying subtle changes that might be difficult to recognize in conventional analysis.

To analyze the efficacy and safety of linezolid (LZD) on patients suffering from intracranial bacterial infection with suspected resistance to vancomycin, and to provide some references for modifying the clinical strategy in the treatment of the intracranial bacterial infection.

A prospective study was conducted from August 2015 to September 2016, into which a total of 11 inpatients were enrolled who suffered from intracranial bacterial (gram positive cocci as suspected pathogen) infection, responded poorly to vancomycin (≥7 days) and were alternatively treated with LZD ( 600 mg twice daily, i. v.) at the Neurosurgical Intensive Care Unit (NICU) of Tianjin Medical University General Hospital. The treatment efficacy and safety using LZD were evaluated.

Among the 11 cases, 10 were cured and 1 died. Patients were treated with LZD for an average of 22.3±5.3 days. After LZD treatment, 5 cases showed abnormal decreases in multiple parameters of blood routine test, and among them 1 died and the other 4 cases recovered to normal levels after the end of LZD treatment. The median age of the 5 patients with abnormal blood test results was 60 (Q_R: 21.5) years, which was significantly higher than the median age [33 (Q_R: 20)] of patients whose blood examination revealed normal (P=0.017). Persistent abnormalities in blood routine test or other related adverse reactions of LZD was not observed during follow-up.

With close monitoring of blood routine test results, LZD might be used as an alternative to treat intracranial bacterial (gram positive cocci) infection resistant to vancomycin.

To assess the long-term clinical efficacy of bilateral deep brain stimulation (DBS) of the anterior limb of the internal capsule (ALIC) for refractory obsessive-compulsive disorder (OCD).

Four patients with definite diagnosis of refractory OCD underwent bilateral DBS of ALIC at Department of Neurosurgery, Aviation General Hospital of China Medical University during the period from June 2010 to February 2012, and their clinical data were retrospectively analyzed. Symptoms were assessed according to the Yale-Brown obsessive compulsive scale (Y-BOCS), Hamilton depression rating scale (HAMD), Hamilton anxiety rating scale (HAMA), and personal and social performance scale (PSP) before and 6, 12, 36 months after operation. At the same time, all patients underwent PET-CT examination before surgery and 6 months after surgery, and the changes of metabolism in brain nuclei were evaluated.

The 4 patients were followed up for 38-64 months (all beyond 36 months). The improvement rate was 25.0%-100.0% in terms of Y-BOCS score, 25.8%-100.0% in terms of HAMD score, and 27.3%-100.0% in terms of HAMA score. The PSP score indicated that the patients' personal and social functional activities improved significantly. The PET-CT examination suggested that brain structures with low metabolism assessed preoperatively demonstrated improvement with varying degrees at 6 months post surgery. In addition, the patients obtained significant improvement in terms of anxiety, depression and functional activities. None of the patients developed severe surgery-related complications.

Bilateral ALIC-DBS seems to be an effective and safe approach for the treatment of refractory OCD with minimal invasiveness, low rate of complications, benefits in anxiety and depression management and improvement of the patient's life quality.

To investigate the efficacy and safety of one antiplatelet regimen following stent-assisted embolization for intracranial aneurysms.

Clinical data were analyzed retrospectively in 684 patients with intracranial aneurysms who underwent stent-assisted embolization from July 2014 to July 2016 at Wuhan General Hospital of the Chinese Liberation Army. Tirofiban hydrochloride was injected immediately after stent deploying and infused continuously by micro-pump for 24 hours. Dual antiplatelet therapy (aspirin 100 mg/d + clopidogrel 75 mg/d) started on the second day. Postoperatively, the platelet activation function was dynamically monitored by flow cytometry. The dose adjustment criteria of antiplatelet drugs were based on the platelet inhibition status (the positive rate of CD62P after adenosine diphosphate activation was below 20%) and specific postoperative conditions such as hemorrhage or ischemia for 486 cases (passive adjustment group) before June 2015, and those for 198 cases (active adjustment group) after June 2015 were only according to the platelet inhibition status regardless of hemorrhage or ischemia.

Complications were reported in 67 out of 684 (9.8%) cases and included aneurysm rerupture (n=23, 3.4%), hydrocephalus requiring ventriculoperitoneal shunting (n=13, 1.9%), stent thrombosis (n=9, 1.3%), cerebral infarction (n=6, 0.9%), intracranial hemorrhage in remote areas (n=4, 0.6%), plaque shedding (n=2, 0.3%) cases, aneurysm recurrence (n=3, 0.4%) and death (n=26, 3.8%). The medication regimen was adjusted in a total of 221 (32.3%) patients including 147 (30.2%, 147/486) cases in the passive adjustment group and 74 (37.4%, 74/198) cases in the active adjustment group. There was significant difference in the complication rate of hemorrhage between passive and active adjustment groups (9.1% [44/486] vs. 3.5% [7/198], P<0.05). No significant difference was identified in the complication rate of ischemia between the two groups (0.2% [1/462]vs. 1.0% [2/196], P=0.19). Transient ischemic attack occurred in 3 (0.4%) cases during the process of dose reduction of clopidogrel which remitted following the dose increase. No case of resistance to antiplatelet therapy was found.

Antiplatelet therapy regimen guided by platelet activation assay could be useful for preventing thrombosis and hemorrhagic events following stent-assisted embolization for intracranial aneurysms.

hypertension intracerebral hemorrhage (HICH) is a neurological disease with high mortality and disability. There are still great controversies in the surgical indications, timing, approach and technique of neuroendoscopic application in supratentorial HICH^[1]。 This article retrospectively analyzed the clinical data of 128 patients with supratentorial HICH admitted to the Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University from October 2014 to August 2016, and explored the related problems of neuroendoscopic application in this type of patients.

Intracranial and extracranial revascularization is an important method for the treatment of moyamoya disease, which is mainly divided into direct, indirect and combined revascularization. Indirect vascular reconstruction mainly includes encephalo-duro-arterio-synangiosis (EDAS) and temporal muscle patching. Among them, EDAS has achieved good results in the treatment of moyamoya disease in children^[1]However, the clinical efficacy of treating adult moyamoya disease is still controversial^[2]。 In this study, 34 adults (aged ≥18 years) with moyamoya disease who underwent EDAS treatment from January 2012 to July 2016 in the Department of Neurosurgery, Affiliated Hospital of Jining Medical College were followed up and observed, and their clinical efficacy was retrospectively analyzed.

To investigate the therapeutic effect of mixed vaccines which consist allogeneic tumor cells as well as their lysates and syngenic cell lysates in the rat model of glioma.

Mixed vaccines were made which contained allogeneic C6 cells and their lysates and syngenic 9L cell lysates. The 9L/ Fisher 344 glioma model was established in rats which were randomly divided into blank group, 200, 000 treatment group and 300, 000 treatment group. Immunotherapy was initiated at the 1th day after intracranial inoculation of 9 L cells. The survival time of rats was documented. The tumor volume was analyzed on MRI images at the 10 th, 20 th, 30 th, 40 th, 50 th day after 9L cells were injected into the brain, and HE staining and immunohistochemical analysis of invasion changes were conducted at the 20 th day post inoculation.

The survival time in treatment groups was significantly longer than that in blank group (P<0.05). The enhanced MRI showed that the tumor in blank group continued to grow, while tumors in treatment groups grew during the initial phase and then decreased. Analysis of variance was conducted to assess the tumor volume at 20 th day. The tumor volume in blank group [(451.25±9.36)mm³] was significantly greater than that in the 200, 000 treatment group [(122.52±22.30) mm³)] and 300, 000 treatment group [(112.06±17.97)mm³] (P<0.05), and there was no significant difference between those two treatment groups. The tumor cell density in treatment group was lower than that in blank group assessed by HE staining. In the blank group, more positive cells were found within tumor in both Fascin staining and Podoplanin staining compared with the two treatment groups, which had no significant difference (P<0.05).

Mixed vaccines that consist of allogeneic tumor cells as well as their lysates and syngenic cell lysates might be useful in significant prolonging of the rat's survival time and reducing the invasiveness of gliomas.

durai arteriovenous fistulae (DAVF) are the most common intracranial DAVF, which is usually treated by transvenous embolization, and the femoral vein-subpetrosal sinus approach is the first choice^[1,2]。 However, when the opening of the inferior petrosal sinus is unsuccessful, the femoral vein-facial vein-superior ophthalmic vein approach can be selected. This article reports a rare case of facial vein dysplasia and thick superficial temporal vein. Finally, DAVF in cavernous sinus region was successfully embolized through femoral vein-superficial temporal vein-superior ophthalmic vein.

急性缺血性卒中(acute ischemic stroke，AIS)约占卒中发病率的80%，并呈逐年上升的趋势^[1]，具有较高的致残率和致死率。静脉重组组织型纤溶酶原激活剂溶栓是其首要的治疗方法，然而对伴有大血管闭塞的AIS患者，静脉溶栓效果较差^[2,3]。2015年，新英格兰医学杂志连续发表5项随机对照研究(randomized controlled trial，RCT)，包括荷兰血管内治疗急性缺血性卒中的多中心随机临床试验(multicenter randomized clinical trials of endovascular treatment of acute ischemic stroke in the Netherlands，MR CLEAN)^[4]、延长急性神经功能缺损至动脉内溶栓时间的临床试验(extending the time for thrombolysis in emergency neurological deficits-intra-arterial，EXTEND-IA)^[5]、前循环近端闭塞小病灶性卒中的血管内治疗并强调最短化CT至再通时间临床试验(endovascular treatment for small core and anterior circulation proximal occlusion with emphasis on minimizing CT to recanalization times，ESCAPE)^[6]、血管内机械取栓治疗急性缺血性卒中试验(Solitaire with the intention for thrombectomy as primary endovascular treatment，SWIFT PRIME)^[7]、西班牙支架取栓与内科治疗8 h内前循环大血管闭塞随机对照试验(a randomized trial of revascularization with SOLITAIRE FR^®devicevs. best medical therapy in the treatment of acute stroke due to anterior circulation large vessel occlusion presenting within eight-hours of symptom onset，REVASCAT)^[8]，证实血管内治疗能够显著改善伴有大血管闭塞的AIS患者的临床预后。一项针对上述5项研究的荟萃分析——多项血管内治疗卒中试验高效再灌注评价研究(the highly effective reperfusion evaluated in multiple endovascular stroke trials，HERMES)也进一步证实取栓疗法的临床价值^[9]。随后，美国、韩国、加拿大、欧洲等先后更新了各自的AIS救治指南^{[10,11,12,13]}，推荐血管内取栓治疗为大血管闭塞导致的AIS患者的首选治疗方法。我国卒中学会和中华医学会神经病学分会也分别针对这一问题进行了相应的指南修订^[1]。目前，取栓手术已经在我国各级医院广泛开展。然而在临床实践中，由于影响AIS预后的因素众多，导致病例筛选较为困难；各个中心对适应证的选择和技术的不同，也导致了疗效存在较大差异，故虽然相关医学研究报道数量较多，但质量参差不齐。因此，如何快捷准确地筛选合适的取栓患者已成为一个亟待解决的问题。本文综合国内外的最新研究结果，结合中国实际情况将AIS取栓治疗的适应证和禁忌证(第二军医大学附属长海医院将其总结为英文缩写：LAST₂CH₂ANCE)综述如下。

During the rehabilitation process of traumatic brain injury (TBI) patients, patients will face different degrees of functional disorders, such as motor dysfunction, sensory dysfunction, language dysfunction, cognitive dysfunction, emotional disorder, sleep disorder, etc. Among them, the sleep problems of TBI patients are easily neglected. The incidence of sleep disorders in TBI patients is very high, and 30% to 84% of TBI patients will complain of sleep problems to varying degrees^[1,2,3,4]。 With the progression of recovery, the symptoms of sleep disorders in TBI patients will alleviate somewhat, but there is still a significant proportion of TBI patients who have sleep disorders for a long time. Long-term sleep disorders may aggravate the pre-existing symptoms, such as headache, anxiety and depression, impair memory and cognitive function, delay the recovery process, and seriously affect the quality of daily life of patients^[5,6,7,8]。