Volume 33 · Issue 08 · 2017

Intracranial aneurysm is a cerebrovascular disease that seriously threatens human health. Its rupture and hemorrhage occupies the third place in patients with cerebrovascular accidents. The mortality rate after hemorrhage is about 40%, and the mortality rate of re-hemorrhage can be as high as 60% ~70%^[1]。 It is a consensus that ruptured aneurysms must be treated (either endovascular or craniotomy clipping) in order to avoid re-bleeding to the greatest extent. However, for unruptured aneurysms, the treatment is far more complicated than ruptured aneurysms.

To evaluate the safety and efficacy of Tubridge blood flow diverter (FD) in the treatment of large and giant cavernous carotid aneurysms.

The clinical and angiographic data of 27 patients harboring 27 large or giant cavernous carotid aneurysms and treated between November 2010 and December 2014 at Department of Neurosurgery, Clinical Neuroscience Center, Changhai Hospital, Second Military Medical University, were prospectively collected and analyzed. Among them, 16 aneurysms were treated with Tubridge FD combined with coil embolization, while the other 11 were treated with merely Tubridge FDs. Tubridge FDs were employed in all those cases, which were postoperatively followed up in clinics or by telephone to document the patients' symptomatic improvement and imaging results.

A total of 38 Tubridge FDs were successfully implanted for the 27 aneurysms. During the follow-up lasting from 27 to 76 months (mean: 49.8±15.4 months), clinical symptoms were resolved in 15 out of 26 patients, improved in 5, and unchanged in 6. In total, the rate of symptomatic relief was 77% (20/26). Procedure-related morbidity and mortality were both 0. Follow-up angiographies, with a mean follow-up period of 22.8±13.1 (6-48 months), were available in 25 aneurysms. Complete occlusion was observed in 20/25 (80%) aneurysms, further thrombosis was reported in 4/25(16%) cases, and non-symptomatic parent artery occlusion was reported in(1/25, 4%). All stent-associated branches were patent.

It is suggested that Tubridge FD is a safe and effective tool for treatment of large and giant cavernous carotid aneurysms with high resolving rate of compression symptoms.

To evaluate the clinical effects and advantages of Neuroform EZ in constructing Y configured stent in the treatment of wide necked bifurcation aneurysm (WNBA).

Retrospective data was retracted regarding 6 cases of WNBA treated with Neuroform EZ in a Y configuration from October 2016 to March 2017 at Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University. Intraoperative DSA was performed in all cases and immediate results of embolization were assessed based on Raymond scale. Clinical follow-up was conducted at 30 days post surgery based on modified Rankin scale.

The success rate of operation in 6 patients was 100% without surgery-related complications. Intraoperative DSA indicated complete embolization in 6 aneurysms which were classified as grade Ⅰ according to Raymond scale. Postoperative cerebral infarction occurred in 2 cases including 1 reporting symptomatic relief following fluid infusion and heparin anticoagulant therapy before discharge and the other undergoing heparin anticoagulant therapy and developing no neurological deficits at discharge. All patients had the mRS score of 0-1 assessed at the follow-up 30 days post surgery.

Y-configuration double-stent-assisted coiling, using either 2 Neuroform EZ stents or 1 EZ and some other stent, could be important and effective in treatment of WNBA.But the long-term curative effect remains to be further research.

To evaluate the clinical value and outcomes of surgical clipping for large and giant unruptured paraclinoid aneurysms.

A retrospective analysis was conducted on 8 patients (11 aneurysms) who underwent aneurysm clipping assisted with balloon occlusion in hybrid operation theatre at Neurosurgery Department of Xuanwu Hospital, Capital Medical University, from January 2014 to March 2017. All patients were females whose average age was 54.9±5.7 years.

Among 11 aneurysms in this series, a total of 9 aneurysms were treated and included 8 large or giant paraclinoid aneurysms and 1 carotid cave aneurysm. Intraoperative radiography demonstrated that all 9 aneurysms were successfully obliterated, 1 patient developed occlusion of parent artery and 1 had severe stenosis of parent artery. Three patients encountered ischemic events postoperatively. The assessment at discharge indicated a Glasgow Outcome Score (GOS) of 5 in 5 patients, 4 in 1 case and 3 in 2 cases. At the follow-up which was conducted 1.5-39.5 [average: 10.7 (P₂₅: 3.2, P₇₅: 32.3)] months post operation, a GOS of 5 was reported 7 patients and 4 in 1 case. Vision acuity was improved in 7 patients and remained stable in 1 case.

Hybrid surgery seems to be able to facilitate clipping of large and giant unruptured paraclinoid aneurysms, but more studies are needed for exploration of proper interventional devices and methods.

To investigate the safety and efficacy of the LVIS stent-assisted coiling of unruptured intracranial aneurysms.

We retrospectively analyzed 62 patients who underwent LVIS stent-assisted coiling treatment for unruptured intracranial aneurysms at Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, between November 2015 and November 2016. Demographic and clinical factors, including initial clinical presentation, risk factors, location and size of aneurysm, Raymond Classification following initial treatment as well as perioperative complications, were documented. Regular follow-up of the cases was conducted post operation to assess the surgical outcomes.

The 62 patients in this study had a total of 78 unruptured intracranial aneurysms. Among them, 62 aneurysms were treated with single LVIS stent, 6 aneurysms with double LVIS stents, 3 aneurysms with 3 LVIS stents, and 1 aneurysm was treated with Neuroform stent and LVIS stent " Y" -shaped assisted coiling. Raymond Classification following initial treatment indicated that 30 cases (50%) were in class 1, 23 cases (29.5%) in class 2 and 16 cases (20.5%) in class 3. The incidence rate of perioperative complications was 4.8% (3/62). Hemorrhagic event of aneurysmal rupture occurred in 1 patient during coiling who received symptomatic treatment and recovered at discharge. Perforator puncture occurred in 1 case during coiling, and the patient died from secondary in-stent thrombosis formed post procedure. One patient died from nonaneurysmal postprocedural rebleeding. Sixty cases were followed up for 4-13 months with a mean of 7.2±3.1 months. Imaging was followed up in 32 cases with 44 aneurysms. Based on Raymond scale, 31 out of 44 (70.5%) aneurysms belonged to class 1 (complete occlusion). Mild recurrence was reported in 1 (2.3%) case which received continuous clinical observation. Twenty-eight patients with 32 aneurysms were followed up by telephone and recovered well.

Endovascular treatment of unruptured intracranial aneurysms with LVIS stent-assisted coiling is suggested to be safe and effective, and the mid-term follow-up results seems satisfactory.

To explore the efficacy and safety of endovascular embolization of unruptured intracranial aneurysms (UIA).

We retrospectively analyzed the clinical outcomes and complications of 256 patients with UIA who underwent endovascular embolization at Department of Neurosurgery, Zhujiang Hospital, Southern Medical University from January 2011 to December 2016. The clinical prognosis was further evaluated by using modified Rankin Scale (mRS).

In 256 patients (333 aneurysms), the percentage of complete occlusion after endovascular procedures was 88.7% (227/256). Poor clinical outcomes were reported in 24 (9.4%) cases. Surgery-related complications occurred in 9 (3.5%) cases, out of which 3 (1.2%) showed hemorrhage and permanent neurological deficit was observed in 1 case(0.4%) . Associated headaches following endovascular treatment occurred in 86 patients (33.6%), and were more commonly observed in cases undergoing stent assisted embolization of UIA (P=0.04). The mean follow-up time was 18.6±1.5 months and ranged from 3 to 49 months.During the follow-up period, stent stenosis occurred in 6 patients (2.3%), 10 patients (3.9%) developed recurrence of aneurysm, and no case died. Finally, favorable clinical prognosis (mRS<2) was achieved in 95.7% of the patients. Patients with giant aneurysms (diameter over 25 mm) were more likely to achieve poor outcomes (P=0.045), and the diameter of UIA over 10 mm (P=0.004) was correlated with aneurysm recurrence after endovascular treatment.

Endovascular embolization is suggested to be a safe and efficacious way to treat UIA. Proper selection of surgical candidates could be helpful for reducing the risk of bleeding and achieving favorable outcome.

To present preliminary experience and short-term safety and efficacy of pipeline embolization device (PED) for endovascular treatment of unruptured intracranial aneurysms.

A retrospective analysis of clinical data and short-term safety and efficacy was conducted on 42 patients who underwent endovascular treatment with PED at Neurosurgery Department of Xuanwu Hospital, Capital Medical University, from October 2014 to June 2016.

A total of 42 patients with 44 intracranial aneurysms were treated with 49 PEDs during the study period. Retention of contrast agent in the aneurysm cavity was detected by immediate postoperative radiography for 42 aneurysms and contrast agent could still be observed following surgery in 2 other cases. Four patients had procedural complications. A total of 32 aneurysms of 31 patients were followed up for 2-12(mean: 6.6±1.9) months. Majority of the aneurysms (24/32, 75%) showed angiographic evidence of complete obliteration and 6 aneurysms (6/32, 19%) demonstrated angiographic evidence of near complete obliteration.

It is suggested that use of PED may offer a safe and effective strategy for treatment of unruptured intracranial aneurysms. Larger prospective studies are needed to confirm those observations.

To summarize the characteristics of carotid cave aneurysms and to investigate the safety and efficacy of endovascular treatment for this kind of aneurysms.

From November 2013 to November 2016, the clinical data of 22 patients with unruptured carotid cave aneurysms undergoing endovascular treatment, at the Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, were collected. Among them, 3 patients (14%) were male and 19 patients (86%) were female. Their clinical characteristics, outcomes, complications and follow-up results were analyzed retrospectively. Modified Rankin scale (mRS) was used to assess the outcomes and Raymond Scale was used to assess the safety and efficacy of endovascular treatment.

All 22 patients were treated by stent assisted coiling. Raymond 1 was reported in 19 patients (86%) and Raymond 2 was achieved in 3 patients (14%). Thrombosis occurred in the stent in 1 patient during the operation who did not develop any neurological deficits after Tirofiban treatment. Ten patients underwent angiographic follow-up after 1 year and 9 patients achieved Raymond 1. The mRs score was 0 in all patients.

Carotid cave aneurysms seem to be more common in females. Endovascular treatment could be a safe and effective approach for carotid artery aneurysms.

To observe the mid-long term follow-up results of endovascular embolization treatment of intracranial aneurysms and to investigate the factors related to post-operative recurrence.

A total of 69 patients (80 aneurysms) were angiographically followed up by DSA over 18 months who were admitted to Department of Interventional Radiology, Huashan Hospital Affiliated to Fudan University, between June 2006 and August 2015 and enrolled in this retrospective study. All those patients underwent endovascular embolization treatment and studied for clinical prognosis and related factors of the recurrence.

The follow-up period lasted 18-133 months with an average of 39.0±22.6 months. Out of 69 patients, 65 (94.2%) reported good outcomes with modified Rankin scale score < 2. There was no death in this series. Out of 80 aneurysms, 21(26.3%) had recurrence. Univariate analysis demonstrated that the recurrence rate was the highest (83.3%, 5/6) in the giant aneurysm group, the lowest (16.7%, 9/54)in the small aneurysm group, and 35.0%(7/20) in the large aneurysm group. The difference was statistically significant ( P=0.002). Incomplete embolization group had higher recurrence rate than complete embolization group [58.8% (10/17) vs. 17.5% (11/63), P=0.001]. Recurrence rate of wide-necked aneurysms was higher than narrow-necked ones [36.2% (17/47) vs. 12.1%(4/33), P=0.032]. However, the location and treatment approach of aneurysms seemed to have little effect on the recurrence. Multivariate regression analysis suggested that the aneurysm size was the independent risk factor of recurrence (OR=3.828, 95%CI: 1.674-8.754, P<0.001).

The overall clinical effects of endovascular embolization treatment on intracranial aneurysms seem to be satisfactory. The aneurysm size was the independent risk factor of recurrence. The shape of aneurysm neck and extent of embolization may affect the recurrence of aneurysm.

To study the treatment options and prognosis of blood blister-like aneurysms of internal carotid artery.

Clinical Data of 15 people with 16 blood blister-1ike aneurysms confirmed by DSA who were admitted to Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2014 to January 2016 were retrospectively studied. In this series, craniotomy was performed in 2 cases (including 1 aneurysm wrapping and 1 clipping) and stent-assisted coil embolization was applied in the other 15 cases. The outcomes of patients undergoing endovascular treatment were assessed based on the modified Rankin Scale (mRS) 3 months post discharge. The mean follow-up period was 11 months and ranged from 3 to 22 months.

The patient receiving aneurysm wrapping achieved symptomatic improvement and was lost to follow-up after discharge. Postoperative rebleeding occurred in the patient undergoing clipping and resulted in death. Complete embolization was observed in all 13 patients who underwent endovascular treatment. Among the 13 cases, 1 patient died because of postoperative rebleeding and 1 patient developed recurrence at the neck of aneurysm and received a second operation of stent-assisted coil embolization. The mRS assessment for 12 patients at 3 months post discharge indicated 0 in 5 cases, 1 in 6 cases and 4 in 1 case.

Stent-assisted coil embolization for blood blister-like aneurysms of the internal carotid artery could lead to overall satisfactory outcomes with good safety.

To evaluate the indication, safety and clinical effect of stent-assisted embolization in the treatment of unruptured very small intracranial aneurysms.

From January 2013 to September 2016, the clinical data of 25 patients with 25 unruptured very small intracranial aneurysms were retrospectively analyzed who underwent stent-assisted embolization at Department of Interventional Neurology, People's Hospital of Zhengzhou University. The indication and safety were summarized. The mean follow-up period was 9 months (range: 3-24 months) and the clinical effects were evaluated based on modified Rankin Scale (mRS) and self-rating anxiety scale (SAS).

The reasons why endovascular treatment was performed for the very small aneurysms in this group included sentinel headache, multiple aneurysms, irregular aneurysmal shape, enlargement of aneurysms in follow-up period and severe anxiety. The success rate of the operations of the 25 very small aneurysms was 100%. Immediate Raymond Ⅰ grade was observed in 88% (n=22), Ⅱ grade in 8% (n=2) and Ⅲ grade in 4% (n=1). No aneurysm rupture or thrombus formation was found during the procedures. The Raymond Ⅰ grade was up to 94% in 18 cases who were angiographically followed up. During the follow-up period, no bleeding occurred and the mRS score was 0 for all 25 patients. Out of the 5 patients receiving SAS evaluation, 4 were normal and 1 had mild anxiety.

Endovascular embolization seems to be safe and effective for proper candidates with unruptured very small aneurysms. The application of stent could significantly expand the indications and improve the rate of complete embolization.

To assess the clinical factors influencing the growth rate of neurofibromatosis type 2 (NF2)-related vestibular schwannomas (VSs).

The medical records of 66 patients with NF2 treated in Department of Neurosurgery of Beijing Tiantan Hospital from January 2003 to October 2016 were analyzed retrospectively. The tumors were measured by the software of Image J. The tumor growth rate was estimated by linear regression analysis of the changes in VS volumes over time. The clinical characteristics of all patients were documented. The relationship between the tumor growth rate and clinical factors was investigated. Linear regression, Pearson's correlation and t-test were conducted using the SPSS 19.0 statistical package.

The median follow-up duration was 58.8±10.4 months. The average growth rate was 2.6±1.2 cm³/year. The VS growth rate was positively correlated with the initial volume of VS (r=0.97, P<0.01). However, it was negatively correlated with the age at symptom onset (r=-0.41, P<0.01). The VS growth rate in patients who underwent resection of a contralateral VS was slightly higher than that of patients with untreated VSs (P<0.01). The average VS growth rate in patients with spinal tumors was higher than that in those without spinal tumors.

The potential clinical factors influencing the VS growth rate include the age at symptom onset, initial tumor volume, resection of contralateral VS and presence of spinal tumors, which could provide reference for clinical treatment.

To investigate the clinical features and treatment strategies of middle cranial fossa epidermoid cysts and to provide evidences for their clinical diagnosis and treatment.

The clinical data of 13 patients with middle cranial fossa epidermoid cysts, admitted to Neurosurgery Department of Lanzhou University Second Hospital from June 2007 to April 2015, were analyzed retrospectively, which included the clinical presentations, characteristics of imaging and pathology, operations and follow-up results.

Out of 13 patients, 7 patients received complete resection and 6 cases underwent near-complete resection. The postoperative pathological examinations indicated epidermoid cysts in all cases. The 13 patients were followed up for 7-103 months (mean: 40.5±26.1 months). There was no recurrence in 11 cases base on MR examination whose clinical symptoms were relieved or disappeared. Recurrence was suggested by MR in the remaining 2 cases that underwent a second operation and pathological findings revealed inflammatory granuloma in 1 case and recurrence of epidermoid cyst in the other.

Common symptoms of middle cranial fossa epidermoid cysts include neurological dysfunctions in areas innervated by the trigeminal nerve, which has characteristic imaging manifestation. Near-complete resection through interdural approach might be helpful for maximal protection of neurological functions and reduction of the complications commonly associated with traditional operations.

To evaluate the safety and efficacy of using a new guide catheter (Navien) in intracranial endovascular treatment.

We retrospectively reviewed all cases of neuroendovascular treatment during the period between May 2015 and April 2016 in our database at Neurosurgery Department of the First Affiliated Hospital of Nanchang University. A total of 68 cases involving the use of Navien guide catheter were selected. Clinical and imaging data were analyzed including the lesion location, technique for Navien advancement, intraprocedural Navien position and periprocedural complications.

The Navien catheter was used in 68 cases, and the final position of catheter tip was in the petrous intracranial cranial artery (ICA) (45, 66.2%), cavernous ICA (2, 2.9%), vertebral artery V2 (13, 19.1%), V3 (7, 14.7%) and V4 (1, 1.5%). There were no intraoperative hemorrhagic or ischemic complications. Navien-related complication occurred in 1 case of middle cerebral artery aneurysm, in which the endovascular therapy was replaced by surgical clipping because of severe catheter-caused vasospasm.

The Navien guide catheter could be safely placed into intracranial vessels and thus provide safe and stable support for endovascular therapeutic interventions.

To study the anatomy of unilateral frontotemporoparietal structures of the Chinese people and to provide the anatomical basis for approach design in large craniectomy.

Large unilateral frontotemporoparietal decompressive craniectomy were performed on 15 corpse skulls. Through dissection layer by layer, anatomical landmarks were identified and relevant data were documented.

The vertical distance between the distal point of posterior edge of parietal eminence and the external auditory canal was 79.90±4.06 mm. The distance from the midpoint between nasal root and external occipital protuberance to the midpoint of zygomatic arch was 144.60±4.73 mm. The distance between the eyebrow arch and the parietal eminence was 163.50±4.75 mm. Within the bone window, the longest distance between arachnoid granulation in the superior sagittal and midline was 19.62±3.98 mm. The vertical distance between the superior margin of zygomatic arch and the point where the Sylvian vein drains into sphenoparietal sinus was 25.26±3.77 mm.

In order to achieve adequate decompression, the vertical distance from the farthest point of skin incision around parietal eminence to the external auditory canal should not be less than 8 cm, the bone window could be 2 cm from the midline, and the lower margin of the bone could be located at the upper margin of zygomatic arch.

To evaluate the relationship between meningiomas and adjacent large cerebral arteries by multi-slice spiral CT angiography (MSCTA) and its clinical significance in preoperative planning of tumor resection.

A retrospective analysis was conducted on 32 patients with meningiomas who were admitted to the Affiliated Haikou Hospital, Xiangya School of Medicine, Central South University and underwent surgical operations from January 2004 to January 2016. MSCTA was conducted for all patients to evaluate the relationship between the tumors and adjacent (≤ 3 cm) cerebral large arteries. The relationship was categorized into 4 types according to the degree of compression, embedding or erosion, based on which the operational plan for tumor resection was made.

All 32 patients included 3 (9.4%) cases in type Ⅰ, 10 (31.3%) in type Ⅱ, 9 (28.1%) in type Ⅲ and 10 (31.3%) in type Ⅳ (3 in type Ⅳa, 5 in type Ⅳb, and 2 in type Ⅳc). The coincidence rate of MSCTA classification with intraoperative findings was 96.9% (31/32). The tumor resection plan preoperatively made according to the classification was proved to be reasonable during surgery. The Simpson grade Ⅰ resection was performed in 10 (31.3%) cases, Simpson Ⅱ resection in 5 (15.6%) cases, and Simpson Ⅳ resection in 17 (51.1%) cases. The follow-up 6 months post operation did not report any complications related to damages of cerebral large arteries.

MSCTA could be used to accurately assess the relationship between meningiomas and adjacent large cerebral arteries and help with proper treatment of the nearby arteries during tumor resection.

To discuss strategy of microsurgical treatment and efficacy of dumbbell neuroblastoma (NB) with intraspinal extension at cervical, retroperitoneal and pelvic locations.

This retrospective study involved 6 patients with dumbbell NB with intraspinal extension who underwent operation at Department of Neurosurgery, Children's Hospital Affiliated to Capital Institute of Pediatric, from June 2016 to January 2017. It included 3 cases located in pelvic cavity invading spinal canal via anterior sacral foramen, 2 cases in retroperitoneal region invading spinal canal via lumbar intervertebral foramen and 1 case in anterior cervical region invading spinal canal via cervical intervertebral foramen. Resection through single posterior extensive approach was conducted for retroperitoneal dumbbell NB. Posterior and anterior approaches were taken for one- or two-stage resection of tumors in the cervical and pelvic region, respectively. All patients underwent laminotomy and restoration. For the cases with vertebral plate thickness of less than 5 mm and not suitable for fixation by titanium nail and plate, we cut cephalic supraspinous and interspinous ligaments and reserved caudal ligament. The cut ligaments were sutured post tumor resection.

One-stage resection was performed in 2 cases in retroperitoneal region. Among the 3 pelvic cases, 1 underwent one-stage excision and the other 2 cases received two-stage operation. The 1 case with cervical NB underwent two-stage resection of tumor. Postoperative MRI showed subtotal resection in 4 cases in which the residual tumor tissues were mainly located at anterior sacral foramen or intervertebral foramen and total resection in 2 other cases. The follow-up time was from 3 to 10 months. Recurred was reported in 1 case 3 months post operation and no recurrence occurred in the other 5 cases.

Different operative strategies are needed for dumbbell NB with intraspinal extension and varying locations. There tends to be slight amount of residual tumor tissues at bone foramens that dumbbell NB invade.

Sellar diaphragmatic meningioma is adjacent to important structures such as pituitary stem, internal carotid artery, optic nerve and optic chiasm. Patients often have abnormal vision and endocrine function before and after surgery. How to protect optic nerve, internal carotid artery, pituitary stem and reduce later complications is the focus of treatment^[1,2]。 Kinjo et al.^[3]According to different positions, the meningiomas of the saddle diaphragm are divided into three types: A, B and C. Type A: the tumor starts above the saddle diaphragm, and the main body is located in front of the pituitary stem; Type B: The tumor originates above the saddle diaphragm, and the main body is located behind the pituitary stem; Type C: The tumor originates below the saddle diaphragm. Different types of sellary diaphragmatic meningiomas have different surgical approaches^[4,5]。 From January 2008 to June 2016, 11 cases of different types of sellar diaphragmatic meningiomas were resected by microsurgery in the Department of Neurosurgery of Guizhou Provincial People's Hospital. The clinical results were satisfactory, and the retrospective report is as follows.

Cerebral echinococcosis, also known as cerebral hydatidosis, is a kind of intracranial parasitic disease caused by the larvae of Echinococcus tapeworm (Echinococcus), which mostly occurs in northwest of China, especially in Xinjiang^[1]。 According to the type of infected human echinococcus, the disease can be divided into two categories: echinococcosis granulosa and alveolar echinococcosis. The former is also called hydatid cyst, which is more common; The latter are known as "parasitic tumors" because they resemble malignant tumors or multiple intracranial metastases, which are relatively rare^[2]。 Cerebral echinococcosis mostly occurs with intracranial space-occupying symptoms and progresses rapidly. This article retrospectively analyzes the clinical data of 12 patients with cerebral echinococcosis admitted to the Department of Neurosurgery, Friendship Hospital, Ili Kazakh Autonomous Prefecture, Xinjiang from January 2001 to September 2015, and summarizes the following in combination with relevant literature for clinicians' reference.

Large aneurysm of ophthalmic segment of internal carotid artery is an intracranial aneurysm with a diameter of 10~25 mm located between the origin of ophthalmic artery and the origin of posterior communicating artery. Because of its complex surrounding anatomical structure and narrow surgical operation space, it is difficult to directly clip the neck of tumor by surgery, and the mortality and disability rate are high. On May 30, 2016, the Cerebrovascular Disease Center of Beijing Tiantan Hospital affiliated to Capital Medical University treated a patient with large aneurysm of the ophthalmic segment of the internal carotid artery. He was clipped in the compound operating room and achieved good results. The report is as follows.

Freezing gait is one of the typical symptoms of patients with Parkinson's disease, which easily leads to falls and seriously affects the quality of life and social function of patients^[1,2]。 deep brain stimulation (DBS) is currently recognized as an effective method for the treatment of intermediate and advanced Parkinson's disease. High-frequency stimulation of subthalamic nucleus (STN) can effectively control the symptoms of tremor, rigidity and bradykinesia for a long time. Although it can partially improve the midline symptoms such as gait, postural stability and arthria, it may gradually deteriorate 3~5 years after operation^[3,4]。 At present, new targets (such as the pons nucleus) have been targeted^[5]And the study of exploring new stimulus modes. Some studies have found that switching to low-frequency stimulation for Parkinson's disease patients with gait disorders can improve gait, but it can't control other motor symptoms^[6]。 The emergence of variable frequency stimulation provides a new idea for STN-DBS to treat midline symptoms of Parkinson's disease such as gait and posture. In June 2016, the Department of Neurosurgery, Beijing Tiantan Hospital affiliated to Capital Medical University treated a patient with Parkinson's disease with gait freezing with frequency conversion stimulation, and the follow-up effect was good. To investigate the efficacy of variable frequency electrical stimulation STN in the treatment of frozen gait in Parkinson's disease.

Intracranial aneurysm is a pathological dilatation of cerebral vessels, with an incidence of 3% to 5% in adults^[1,2]。 Intracranial aneurysms mainly occur in the age of 40 to 60, the incidence rate of women is higher than that of men, and 20% to 30% of patients have multiple aneurysms^[3]。 With the development of imaging technology, the detection rate of aneurysms is constantly increasing, but the choice of clinical treatment (surgery or endovascular treatment) is still controversial. Once an intracranial aneurysm ruptures, it will lead to subarachnoid hemorrhage (SAH), and up to 35% of them have a poor prognosis^[4]。 This paper focuses on the formation mechanism and clinical prevention management of intracranial aneurysms, and puts forward hypotheses for future clinical and experimental research.

Meningiomas originate from arachnoid epithelial cells and account for about 30% of primary intracranial tumors^[1]。 90% of meningiomas occur supratentorially, and about 90% of meningiomas are WHO grade I, which is more common in women^[2,3]。 Intraventricular meningiomas are relatively rare, accounting for 1% to 3% of all meningiomas and 12% to 20% of all intraventricular tumors^[4]。 According to statistics, 80% of intraventricular meningiomas originate in the lateral ventricle, 15% in the third ventricle, and only 5% in the fourth ventricle^[5]。 Most (70% ~80%) of meningiomas of the lateral ventricle are located in the triangular region. Clinical symptoms of lateral ventricular meningiomas usually appear late, so the tumor volume is large at the time of consultation, and symptoms include headache, visual impairment or visual field defect, seizures, etc. Neurosurgery is an effective treatment for lateral ventricular meningiomas.