Volume 33 · Issue 09 · 2017

microvascular decompression (MVD) of cerebellopontine angle (CPA) is currently the most effective method to completely cure trigeminal neuralgia (TN), glossopharyngeal neuralgia (GN) and hemifacial spasm (HFS). Because of the complex anatomical structure and important neurological function of CPA, redundant or inappropriate operation can easily cause accessory damage to related cranial nerves, cerebellum and brainstem. On the premise of preserving the normal neurological function of patients, whether the responsible blood vessels can be accurately decompressed is largely related to the skills and experience of the surgeon. The application of intraoperative neurophysiological monitoring (IONM) in MVD is beneficial to the protection of intraoperative nerve function and the evaluation of curative effect. At present, with the popularization and application of IONM, the application research level of Chinese scholars in this field is gradually in line with the international standards. How to interpret the significance of IONM signal changes objectively is always worth the attention of the surgical team, and the application mode and value of IONM technology in MVD are also worth further discussion.

Stroke is one of the main diseases that cause human death and disability. Epidemiological survey shows that in 2013, the annual standardized prevalence, morbidity and mortality of stroke in China were 1,114.8/100,000, 246.8/100,000 and 114.8/100,000, respectively^[1]； While the incidence and mortality of stroke in European and American countries are gradually decreasing, the incidence of stroke in China is increasing at a rate of 8.7% per year, which is significantly higher than the overall annual incidence of stroke in the world^[2]。 At present, stroke has become the first cause of death among our nationals. Among new onset patients, ischemic stroke accounted for 70% of the total^[3]The treatment level of acute ischemic stroke (AIS) is related to the health of Chinese residents.

To analyze the epidemiology, pathogenesis, clinical features of adolescent-onset cranial neuropathies (ACN) and to discuss the surgical effects and complications of microvascular decompression (MVD).

We retrospectively analyzed 37 ACN patients (including 34 successfully followed up) who underwent MVD at Department of Neurosurgery, China-Japan Friendship Hospital from March 2001 to October 2016 (ACN group) and compared them with 210 cases of adult cranial neuropathies (CN) which included 188 successfully followed up and were extracted by random sampling method during the same period (adult CN group).

The symptoms of 37 cases in ACN group were unilateral. The average age of onset was 16.7±1.5 years. Compared with the adult CN group, the rate of affecting the right side (56.7% vs. 41.0%), the ratio of arachnoid thickening in cerebellopontine angle (CPA) region (78.4% vs. 25.7%), the rate of narrow posterior fossa (54.0% vs. 28.6%) and incidence of acoustic complications (14.7% vs. 4.3%) were all higher in ACN group, which however demonstrated a lower rate of AICA oppression (24.3% vs. 42.8%). Those differences were statistically significant (all P<0.05). The effective rate was slightly lower in ACN group (94.1%vs. 96.3%) than that in adult CN group (P>0.05).

ACN seems to be rare and more commonly affect the right side. Arachnoid thickening in CPA region and the small volume of posterior cranial fossa may be the pathogenic factors. MVD could be a safe and effective surgical method for ACN in which the operational efficiency is almost the same as that of adult CN, while the incidence of complications in ACN group is suggested to be higher than that in the group of adult CN.

To investigate surgical techniques of microvascular decompression (MVD) for cranial nerve disorders to further improve the efficacy and reduce the complications.

A retrospective study was conducted on 1 576 patients with cranial nerve disorders who underwent MVD and follow-up at Department of Neurosurgery, Affiliated Hospital of Logistics College of PAP, from April 2008 to February 2016. The 613 patients undergoing conventional MVD before December 2013 belonged to traditional surgery group. The remaining 963 patients undergoing MVD with technical modification after December 2013 were classified into modified surgery group. The modifications included employment of neurological electrophysiological monitoring, slinging of the offending vessel, multi-point decompression and et al. The effective rate and complication rate were compared post procedure between the two groups and the statistical data were analyzed.

All 1 576 patients were followed up for 13-73 months with an average of 37.2±11.4 months. For trigeminal neuralgia, the effective rate, recurrence rate and complication rate were 92.66%(265/286), 6.30%(18/286) and 10.84%(31/286), respectively in traditional surgery group, and 96.14%, 2.83% and 5.91%, respectively in modified surgery group. For hemifacial spasm, the effective rate, recurrence rate and complication rate were 94.30%, 7.00% and 11.08%, respectively in traditional surgery group, and were 97.07%, 2.75% and 5.13%, respectively in modified group. The inter-group differences in the parameters above were statistically significant (P<0.05).

MVD is a safe and effective surgical method for the treatment of cranial nerve disorders. The application of intraoperative electrophysiology monitoring, sling retraction of the offending vessel and multi-point decompression could increase the efficacy and reduce the complications of MVD.

To discuss the surgical techniques, outcomes and complications of microvascular decompression (MVD) for treatment of hemifacial spasm (HFS) with offending vessels including the vertebral artery (VA).

A total of 783 patients with HFS undergoing MVD at Department of Neurosurgery, China-Japan Friendship Hospital from January 2010 and February 2012 were retrospectively enrolled into this study. Among them, 125 cases (16.0%) were found to have offending vessels including VA and were classified into VA group. The other 685 cases (84.0%) did not have VA as the offending vessel and belonged to non-VA (NVA) group. The clinical characteristics, surgical techniques, efficacies and complications were analyzed for the two groups.

In the VA group, 120 cases (96.0%) had offending vessels including VA and other arteries. Out of the 120 cases, VA acted as the only main offending vessel or one of the main offending vessels in 11 cases, and as the secondary offending vessel in 109 cases. VA was identified as the only offending vessel in 5 cases (4.0%). Compared with the NVA group, the symptoms in VA group seemed to affect more commonly the left side and male patients (all P<0.05). The mean follow-up time is 51 months(range from 46 to 60 months). In the VA group, the postoperative recurrence rate, delayed curing rate, median delayed curing time and rates of significant ipsilateral hearing loss, immediate postoperative facial paralysis, delayed facial paralysis, injury of posterior group of cranial nerves as well as intracranial bleeding were all higher than those in NVA group, and the differences were statistically significant (allP<0.05). Between the two groups, no difference was identified in the patient's age, duration of illness, effective or non-effective rate of operation (allP>0.05).

It seems uncommon that VA acts as the only major offending vessel, which tends to be the secondary offending vessel and results in compression together with other arteries. The efficacy of MVD in HFS involving offending vessels including VA is suggested to be certain. Compared with the NVA patients, delayed curing is more likely to occur with later remission and higher rate of recurrence in VA patients. Postoperative complications post MVD are more commonly observed in VA patients than in NVA patients.

To explore the classification of different kinds of venous neurovascular conflict (NVC), to present surgical strategies of microvascular decompression (MVD) for the treatment of trigeminal neuralgia (TN) due to venous compression, and to evaluate its clinical outcomes.

A total of 1 456 patients with idiopathic TN underwent MVD at Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, from January 2012 to January 2017, were retrospectively analyzed. Venous compression was identified in 64 cases (4.4%), which were further classified and corresponding surgical strategies were decided.

The intra-operative findings of NVC were described as follows: spatial relationship: riding-compression: 30 cases (46.9%), accompanying compression: 18 cases (28.1%), twining compression: 8 cases (12.5%), penetrating compression: 5 cases (7.8%) and complex compression: 3 cases (4.7%); categories of offending vessels: combination of vein and artery (51 cases, 79.7%), venous compression (13 cases, 20.3%); degrees of compression: simply accompanying (49 cases, 76.6%), with compression dent on nerve root (9 cases, 14.1%), distortion of nerve root (6 cases, 9.4%); compression sites: the cisternal portion (27 cases, 42.2%), trigeminal root entry zone (21 cases, 32.8%), the petrous segment (12 cases, 18.8%), and mixed type (4 cases, 6.3%). The patients were followed up for 3-60 months with an average of 44.3 months. Pain disappeared in 51 patients and the "excellent" rate was 79.7%. The 13 patients without satisfactory pain relief underwent re-operation. Postoperative complications included 8 cases of facial numbness after partial sensory rhizotomy of trigeminal nerve, 1 case of intracranial infection, 1 case of hearing impairment.

Classification of offending veins during MVD would facilitate surgical choice. Sufficient venous decompression could result in good outcomes. For cases in which insufficient decompression could not be achieved, partial sensory rhizotomy of trigeminal nerve root might be taken into consideration.

To analyze the clinical characteristics of familial cranial neuropathy (FCN) and to discuss the outcomes of microvascular decompression (MVD).

Clinical data of 21 patients in 15 pedigrees with FCN and randomly sampled 150 patients (including 126 successfully followed up) with sporadic cranial neuropathy (SCN) were retrospectively analyzed at Department of Neurosurgery, China-Japan Friendship Hospital from January 2011 to September 2016.

Compared with SCN, FCN patients presented earlier ages of onset (38.6±13.5 years vs. 46.8±12.3 years, P<0.05) and a higher proportion of affecting the right side [15/21(71%)vs. 80/150 (53%), P<0.05]. Compared with those in SCN group, the characteristics of MVD in FCN group included a higher rate of narrow posterior fossa identified [43%(9/21)vs. 17%(25/150), P<0.05], a higher proportion of offending vessels not involving vertebral-basilar artery trunk [21/22 (95%)vs. 129/150 (86%), P<0.05], and a higher proportion of single vertebral-basilar artery trunk as offending vessel [1/22 (5%)vs. 0/150 (0%), P<0.05]. However, there was no significant difference in effective rate [91%(20/22)vs. 98%(123/126)] or complication rate [9%(2/22) vs. 7%(9/126)] between the two groups (P>0.05).

FCN seems to be rare and present an earlier age of onset and a higher proportion of affecting the right side. MVD could serve as an effective and safe method of treatment. Cautions should be taken regarding postoperative complications such as dysfunctions of facial or auditory nerve.

To summarize the efficacy and experience of trans-cerebellar-fissure approach and via-venous corridor in microvascular decompression (MVD) of trigeminal neuralgia (TN).

The clinical data, operation videos and outcomes of 420 patients with TN treated between March 2014 and September 2015 at Department of Neurosurgery, Hangzhou First People's Hospital were retrospectively analyzed.

Among all patients, 219 cases (52.1%) had a sufficient exposure of trigeminal nerve after dissection through cerebellar petrosal fissure and lateral venous corridor. An extra opening of medial or intermediate venous corridor was needed for the other 201 cases (47.9%) to fully expose and decompress the fifth cranial nerve. No severe complications including death, disability, petrosal vein injures, hearing disturbance or facial paralysis directly caused by cerebellar retraction occurred. There were 3 (0.7%) patients developing severe facial numbness, 1 patient (0.2%) undergoing reoperation to evacuate cerebellar hematoma and 1 patient (0.2%) reporting permanent hearing loss post surgery by erroneous coagulation of a labyrinth artery. All patients were followed up for 9-30 months with an average of 24.0±8.5 months. At 1 month post operation, the rate of excellent outcomes (T₀+ T₁) was 94.0% (395 cases) and increased to 96.0% (403 cases) after 3 months with the remission of some non-specific symptoms. Pain recurrence was reported in 5.5% (23 cases) of all patients (23 case), and the overall rate of excellent outcomes was 91.0% (382 cases) at the end of follow-up.

Trans-cerebellar-fissure approach and via-venous corridor could be beneficial supplements for conventional approach of MVD in helping provide sufficient exposure of decompression of trigeminal nerve and reduce injuries of the petrous vein, facial and trigeminal nerves.

To investigate the intraoperative threshold change of abnormal muscle response (AMR) and its relationship to clinical outcome in microvascular decompression (MVD) for hemifacial spasm (HFS).

A retrospective analysis was conducted on 67 HFS patients who underwent AMR monitoring during MVD at Neurosurgery Department, General Hospital of Shenyang Military Command, from June 2015 to March 2016. The clinical efficacy was evaluated at two time points: immediately following operation and 1 year post surgery. Threshold change of AMR from pre-decompression to decompression was documented and its relationship to clinical outcomes was analyzed.

The AMR threshold in 67 cases before skin incision was 0.1-19.0 mA (median: 3.6 mA). The AMR disappeared completely in 43 cases after decompression and remained in 24 cases. The threshold of remaining AMR after decompression was 2.2-84.0 mA (median: 18.7 mA). The threshold increased less than 1 time in 9 cases and at least 1 time in 15 cases. All patients were followed up for 1 year and 60 cases (89.6%) were cured and 7 cases (10.4%) were not. Out of 43 cases with disappearance of AMR, 42 (97.7%) were cured which included 40 (93.0%) with immediate remission post surgery. Among the 24 cases whose AMR did not disappear after decompression, 18 (75.0%) were cured including 10 with immediate remission and 8 with delayed effect from 10 day to 11 months (median: 2.5 months) post surgery. Immediate and 1-year postoperative clinical outcomes were significantly different between the group with AMR disappearance and that without AMR disappearance (both P<0.05). In the group with remaining AMR, the curing rate was higher in cases with threshold increase of AMR of at least 1 time compared with that in those with threshold elevation of less than 1 time, which were 14/15 and 4/9, respectively. The difference was statistically significant (P=0.015).

During MVD for HFS, the disappearance of AMR seems to be associated with better outcome and delayed remission is more likely to occur in those without AMR disappearance. The threshold increase of at least 1 time post decompression compared with preoperative (prior to skin incision) level might be related to better clinical outcome.

To explore the pathogenesis, clinical characteristics and surgical treatment of comorbidity of hemifacial spasm (HFS) and glossopharyngeal neuralgia (GN).

Five cases with HFS and GN underwent the keyhole operation of microvascular decompression (MVD) through retrosignoid approach from January 2014 to June 2016 at Neurosurgery Department, China-Japan Friendship Hospital, and were enrolled into this retrospective study. Five cases were followed up through telephone post operation for evaluation of surgical efficacy and complications.

The symptom of HFS completely disappeared in all 5 patients which included immediate relief in 4 cases and delayed remission (2 months post surgery) in 1 case. Neuralgia disappeared in all cases including 4 with immediately effect and 1 with delayed remission (4 days post operation). The follow-up period ranged from 1.0 to 3.5 years with an average of (1.5±0.1) years. During the follow-up period, there was no recurrence or surgical complications reported such as facial paralysis, hearing loss and cerebrospinal fluid leakage.

The comorbidity of HFS and GN is rare, which seems to be mainly caused by vascular compression of entry/exit zone of cranial nerves and could be surgically well treated by MVD.

To investigate the effect of modified method of skull closing in microvascular decompression (MVD) on the incidence of postoperative cerebrospinal fluid (CSF) leakage.

We retrospectively analyzed the clinical data of 257 patients who underwent MVD from August 2013 to October 2016 at Department of Neurosurgery, the Affiliated Hospital of Southwest Medical University. Among them, traditional method of skull closing was used in 151 cases before July 2015 and 106 cases received modified method of skull closing after July 2015. The modifications involved aspects including suturing of dual matter, skull reconstruction and suturing of skin. To study the effect, the incidences of CSF leakage and other complications were compared between the traditional and modified groups.

The surgical effective rates for hemifacial spasm in traditional and modified groups were 91.3%(73/80) and 90.2%(55/61), respectively, and the difference was not statistically significant (P=0.825). The effective rates for trigeminal neuralgia in traditional and modified groups were 85.9%(61/71) and 84.4%(38/45), respectively, and the difference was not statistically significant (P=0.827). The incidences of CSF leakage in traditional and modified groups were 6.6%(10/151) and 0(0/106), respectively, and the difference was statistically significant (P=0.018). The incidence of other complications in traditional group was 10.6%(16/151), which included 6 cases of facial numbness, 2 cases of hearing loss, 2 cases of tinnitus, 5 cases of facial paralysis and 1 cases of intracranial infection. The incidence of other complications in modified group was 9.4%, which included 6 cases of facial numbness, 2 cases of hearing loss and 2 cases of facial paralysis. There was no significant difference in incidence of other complications between two groups (P=0.761). All patients were followed up for 2-23 months, and the median follow-up time was 11 months.

The modified method of skull closing in MVD could help reduce the incidence of postoperative CSF leakage and may be worthy of further promotion.

Microvascular decompression is a classic method for treating trigeminal neuralgia, but it is easy to relapse after operation, with a recurrence rate of 3.0% ~30.0% and an annual recurrence rate of 2.0% ~3.5%. The vast majority of patients relapsed within 2 years after microvascular decompression, and fewer patients relapsed more than 5 years after surgery^[1]。 There are different reports at home and abroad on the causes of postoperative recurrence and the choice of treatment^[2,3,4]However, most of the selected subjects were those with recurrence within 2 years after surgery, and there were few reports of recurrence more than 5 years after surgery. From January 2004 to December 2009, 312 patients with trigeminal neuralgia were treated by microvascular decompression in the Department of Neurosurgery of Wuxi Second Hospital affiliated to Nanjing Medical University. They were followed up for 5 to 10 years for a long time. The clinical data of 11 patients with trigeminal neuralgia who relapsed more than 5 years after operation were analyzed, and the causes and treatment methods of their relapse were discussed.

To study the incidence rate and risk factors of early repolarization syndrome (ERS) in patients with growth hormone-secreting pituitary adenomas.

A total of 103 patients with pituitary growth hormone (GH) adenomas (GH adenoma group) and 99 patients with pituitary nonfunctional adenomas (nonfunctional adenoma group) admitted to Department of Neurosurgery, Pituitary Tumor Center, the First Affiliated Hospital, Sun Yat-sen University, from August 2014 to August 2016 were prospectively enrolled. Comparison was conducted about the difference of left ventricular mass index (LVMI), prevalence of valvular disease, incidence of myocardial ischemia and incidence of ERS between the two groups. The risk factors of ERS in patients with growth hormone-secreting pituitary adenomas were investigated by Logistic regression analysis.

Compared with pituitary nonfunctional adenomas, the growth hormone (GH), insulin-like growth factor-1 (IGF-1), LVMI and ERS were significantly increased in pituitary growth hormone adenomas (all P<0.05), and the incidences of ERS were 35.0% (36/103) and 13.1% (13/99) in pituitary growth hormone adenomas and pituitary nonfunctional adenomas, respectively. The results of Logistic regression analysis showed that LVMI was an independent risk factor for ERS (OR=1.012, 95%CI: 1.003-1.021, P=0.012). The results of the bivariate correlation analysis showed that the duration of disease (r=0.287, P<0.01), serum GH (r=0.310, P<0.01), IGF-1 (r=0.282, P<0.01) and diabetes mellitus (r=0.247, P<0.01) were associated with LVMI. The results of multivariate linear regression analysis demonstrated that the duration of disease and IGF-1 were positive risk factors of LVMI (allP<0.05).

Compared with that in pituitary nonfunctional adenomas, the incidence of ERS is significantly higher in pituitary growth hormone adenomas. Serum GH, IGF-1 and blood glucose demonstrate continuous increase which lead to myocardial hypertrophy and elevated LVMI and may be one of the reasons for increased incidence of ERS.

To study the characteristics, influence factor and clinical value of magnetoencephalography (MEG)in patients of epilepsy associated with Sturge-Weber syndrome.

A retrospective study was conducted at Magnetoencephalography Laboratory of Sanbo Brain Hospital, Capital Medical University. Fourteen patients of epilepsy associated with Sturge-Weber syndrome were enrolled into the study between October 2010 and June 2016. The following data were analyzed including the results of MEG with Long-term video-EEG (scalp) monitoring and preoperative MRI in all patients.

In 8 out of 14 cases, the background activities of MEG were weakened. Epileptiform discharges were detected in 11 cases including 9 cases with epileptogenic zone on ipsilateral side of intracranial lesion (angioma, 6 cases on the right side and 3 cases on the left side) and 2 cases with bilateral epileptogenic zones. Both interictal EEG and MEG detected epileptiform discharges in 9 out of 14 cases. Epileptiform discharges were observed in 2 cases by MEG only and in 1 case by EEG only. Neither MEG or EEG detected any epileptiform discharges in 2 cases.

The interictal results of MEG seem similar to those of EEG in cases of Sturge-Weber syndrome, which mainly include weakening of background activities and epileptiform discharges commonly on ipsilateral side of brain lesion and rarely on both sides or contralateral hemisphere. The magnetic source imaging technology combining MEG and MRI could help localize the epileptogenic zone in Sturge-Weber syndrome.

To study the anatomical structure of cervical 2 nerve root and its surrounding venous plexus at the lateral joint of atlantoaxial joint, and to explore the optimal operation mode of atlantoaxial dislocation and fixation with cervical screws.

Six adult head and neck specimens were perfused. The bilateral C₂ nerve roots and their surrounding venous plexuses were dissected and observed under microscope. Measurement and analysis of related anatomical structures were performed.

Atlantoaxial lateral posterior joint was rich in venous plexus. The medial part of the venous plexus covered the normal dura mater and had a clear membrane boundary. The C₂ nerve root coursed inside the venous plexus from the medial superior side towards lateral inferior direction. The total width of the plexus was 21.1±2.1 mm. The distance from the medial border of the venous plexus to the posterior median line was 5.7±1.3 mm. After sufficient dissection of plexus from the dura mater, the distance was increased to 14.1±1.0 mm. The distance from the middle line of C₂ pedicle to the lateral and median side of venous plexus was 10.7±2.1 mm and 5.9±1.2 mm, respectively. The upper and lower distances between C₂ nerve root and lateral margin of plexus were 6.3±1.3 mm and 2.6±0.6 mm, respectively. Atlantoaxial lateral facet joint was exposed after cleaning of venous plexus and dissection of C₂ nerve root. The height and width of exposed C₁ lateral joint were 6.6±0.3 mm and 13.7±0.5 mm, respectively. The height of exposed superior articular process of C₂ was 4.9±0.3 mm, and the width of C₂ pedicle was 8.2±0.3 mm.

It is of significance in instructing surgical operations to clearly understand the anatomy of C₂ nerve root and its surrounding venous plexus. During implantation of C₁ lateral mass screw and C₂ pedicle screw, the incision along the middle line of C₂ pedicle to dissect the C₂ nerve root could provide maximal exposure and help reduce venous bleeding.

To investigate the effects of transsphenoidal surgery on anterior pituitary function in patients with growth hormone-secreting pituitary adenoma, and to explore the related factors.

A total of 173 patients with acromegaly were enrolled to this study who underwent transsphenoidal surgery from January 2013 to December 2014 at Department of Neurosurgery, Huashan Hospital, Fudan University. Their clinical data were retrospectively analyzed including preoperative and postoperative biochemical tests and the function of anterior pituitary.

The preoperative prevalences of hypoadrenalism, hypothyroidism and male hypogonadism were 15.0% (26/173), 18.5% (32/173) and 60.8% (45/74), respectively. Post-operatively, the newly emerging hypoadrenalism, hypothyroidism and male hypogonadism were 3.2% (4/126), 0.8% (1/121) and 12.5% (3/24), respectively. The recovery rates of hypoadrenalism, hypothyroidism and male hypogonadism were 85.7% (18/21), 92.3% (24/26) and 52.8% (19/36), respectively. Univariate analysis showed that the tumor volume in newly emerging hypoadrenalism group was significantly larger than that in normal group (10.3 cm³vs. 1.3 cm^3,P=0.010). As for male gonadal axis, the disease duration in the newly emerging hypogonadism group was longer than that in normal group (15 vs. 3 years, P=0.039). The percentage of GH remission in the group with improvement of sexual function was higher than that in deterioration group (78.9% vs. 47.1%, P=0.047). By means of multivariate logistic analysis, tumor volume (OR=12.704, P=0.005, 95% CI: 2.115-76.323) was decided to be the main risk factor for postoperative hypopituitarism.

Transsphenoidal surgery could help significantly improve the function of adrenal axis, thyroid axis and male gonadal axis in patients with GH-secreting adenomas, and the incidence of postoperatively anterior hypopituitarism is low. Tumor volume acts as an independent risk factor for postoperative hypopituitarism, and close follow-up and replacement therapy should be taken into consideration when necessary.

To investigate the feasibility and efficiency of stereotactic surgical planning system (SSPS) in neurological surgery.

This study retrospectively analyzed the data of stereotactic surgeries for functional neurological disorders performed at Department of Neurosurgery, the Second Hospital of Shandong University, from March 2008 to January 2013. Stereotactic surgery guided by SSPS started in January 2010 and before that the fame-based MRI images had been used to manually determine the targets for surgery. Since clear MR data were necessary for the operations, the proportions of patients who acquired clear MR data before and after the application of SSPS were compared. The generation time of coordinates of multiple targets assisted by SSPS was compared with that of manual calculation. The number of SSPS-aided stereotactic neurological surgeries was documented in remote pattern.

The ratio of unclear MR images was 12.5%(9/72) without SSPS and 2.0%(3/153) with SSPS. The difference was statistically significant (P=0.003). The generation time of coordinates of multiple targets assisted by SSPS was (8.00±2.75) minutes, which was much shorter than that in manual work (39.98±5.14) minutes (P<0.001). With SSPS, 26 cases received remote surgical planning at SSPS laptop workstation, for which the operations would have been canceled or postponed without SSPS.

With SSPS, the ratio of acquiring unclear MR images and the coordinate generation time of multiple targets could both be reduced, and the operations could be performed in remote pattern, which suggests that SSPS may help improve the feasibility and efficiency of stereotactic neurological surgeries.

To study histological and anatomical features of pia mater, arachnoid mater, dura mater and myelin sheath of lower cranial nerves through jugular foramen.

Nine (18 sides) fetal full-term cadaveric heads (28-36 weeks) were randomly divided into 3 groups and each group included 6 sides. The sagittal, horizontal and coronal plane slices were manufactured containing lower cranial nerves through jugular foramen, which were fixed, dehydrated, wax dipped, embedded, sliced and stained by the Masson method. The starting and ending positions as well as distribution of related pia mater, arachnoid mater, dura mater and myelin sheath were observed under surgical microscope. The meningeal structures underwent three-dimensional reconstruction using the software of Mimics 10.0.

The lower cranial nerves went though jugular foramen, where dura mater, arachnoid mater, pia mater and the transitional zone between central myelin sheath and peripheral myelin sheath were observed. Dura mater included meningeal layer and periosteal layer, formed a dura pocket at jugular foramen and a dura fold above the inner orifice. Arachnoid mater extended to superior ganglia and looked like sleeves which disappeared past ganglia. Pia mater clung to medulla oblongata where nerve roots were and disappeared after that.

The microanatomy of meningeal structures of lower cranial nerves could be visually demonstrated with Mimics 10.0 software, which provides anatomical information for related disorders and operations based on layers and interfaces of meningeal structures.

Pituitary adenomas are the most common space-occupying lesions in the sellar region, accounting for 10% to 15% of intracranial tumors^[1]。 Transnasosphenoidal approach surgery has become the main treatment for pituitary adenomas. Diabetes insipidus is a common complication after pituitary adenoma resection through nasosphenoidal approach, with an incidence of 1% to 67%^[2]。 Uncontrolled diabetes insipidus will lead to hypernatremia and plasma hyperosmolarity, which can lead to dehydration, lethargy, mental abnormalities, and seizures in severe cases. The influencing factors of postoperative diabetes insipidus are still controversial. Understanding the factors associated with diabetes insipidus after pituitary adenoma surgery will help improve perioperative management. This study retrospectively analyzed the clinical data of 65 patients with pituitary adenoma admitted to the Department of Neurosurgery of Fuzhou General Hospital from March 2014 to March 2015 to explore the related factors of diabetes insipidus after transnasosphenoidal approach.

To evaluate the efficacy and safety of flow diverters (FDs) used for intracranial aneurysms.

A systematic search was conducted in PubMed, EBSCO and Web of Science for all accessible articles on FDs between January 2008 and December 2016. Two authors independently graded the quality of the studies and extracted the data. Meta-analysis was performed using the software of Stata.

Fifty-three articles containing 4 458 patients with 4 973 aneurysms were included in the analysis. The overall rate of complete occlusion was 79% (95%CI: 75%-82%). The success rate of FD implantation was 97% (95%CI: 95%-99%). Overall mortality and morbidity were 2% (95%CI: 2%-3%) and 3% (95%CI: 3%-4%), respectively. The rate of intracranial hemorrhage, aneurysm rupture, intraparenchymal hematoma and ischemic stroke were 2% (95%CI: 1%-3%), 1% (95%CI: 0%-1%), 1% (95%CI: 1%-1%) and 4% (95%CI: 3%-5%), respectively. Stenosis of parent artery occurred in 5% (95%CI: 3%-7%) of the patients. The rate of parent artery occlusion was 2% (95%CI: 1%-4%). Subgroup analysis showed that the rates of mortality and morbidity were higher in Silk group (12%, 95%CI: 9%-15%) than those in Pipeline (4%, 95%CI: 3%-6%)and Surpass group(7%, 95%CI: 1%-17%). The rates of morbidity and mortality were higher for large or giant aneurysms.

FDs are suggested to be effective and relatively safe tools for treatment of intracranial aneurysms and, however, the complications should not be neglected.

Animal experiments and clinical studies at home and abroad have confirmed that the ventrolateral coracal end of the medulla oblongata is the center of cardiovascular regulation, and if it is compressed by vascular pulsation, it can cause increased sympathetic nerve excitability and blood pressure^[1,2,3,4]。 For hypertensive patients with hemifacial spasm and other cranial nerve disorders, microvascular decompression (MVD) was performed at the root exit zoon (REZ) of the ventrolateral coracal end of the medulla oblongata. Postoperative blood pressure decrease has been reported^[5]However, reports of MVD for simple refractory hypertension are rare. This article reports a case of simple neurogenic hypertension treated with MVD in the Department of Neurosurgery of Shengli Oilfield Central Hospital in February 2016, and reviews the relevant literature.

Among scalp tumors, scalp hemangioma, melanoma, neurofibroma, basal cell tumor, squamous cell carcinoma and sarcoma are more common, while large B cell lymphoma is rare^[1]。 Scalp non-Hodgkin's lymphoma (NHL) is often neglected due to mild clinical symptoms, slow progression, no early neurological dysfunction, so the missed diagnosis rate is high. The incidence of primary NHL in the scalp is extremely low, and it is difficult to diagnose only based on imaging findings, and it is easy to be misdiagnosed as osteoma and meningioma. This article retrospectively analyzed the clinical data of a patient with primary scalp giant lymphoma with intracranial invasion admitted to the Department of Neurosurgery of the First Affiliated Hospital of Kunming Medical University in June 2016 and conducted a literature review to further improve clinicians' understanding of this disease.

traumatic brain injury (TBI) has become a public health problem worldwide because of its high mortality and disability rate, and refractory intracranial hypertension after TBI is an important cause of poor prognosis and even death. Sedation, intracranial pressure (ICP) monitoring and mild hypothermia therapy are effective ways to monitor and control intracranial hypertension after TBI^[1]。 bispectral index (BIS) is widely used to monitor the depth of anesthesia in surgical patients^[2]。 Some studies have used BIS as a tool to assess the depth of sedation in patients with TBI to guide the use of sedative drugs^[3,4,5]。 The neurosurgical intensive care unit (NICU) of Jiangyin Hospital affiliated to Southeast University School of Medicine treated a patient with intractable intracranial hypertension after TBI in September 2016. After deep sedation, ICP monitoring, mild hypothermia treatment and other measures under BIS monitoring, good results were obtained, which are now reported as follows.

schwannoma (schwannoma) is a benign tumor that originates from the nerve myelin sheath and is one of the most common benign tumors of the nervous system. Schwannoma can occur in cranial nerves and peripheral nerves. At present, the main treatment methods include surgery and stereotactic radiotherapy. Because family hereditary diseases such as neurofibromatosis type 2 (NF2) and schwannomatosis can cause multiple schwannomas, the current treatment methods are not effective^[1]Thus, new treatments are needed. With the deepening of research on the genetics and pathogenesis of schwannoma in recent years, many therapeutic targets have been discovered. At present, a variety of targeted therapeutic drugs have entered the clinical trial stage, providing new treatments for schwannoma. In this paper, the recent research progress in molecular genetics of schwannoma is reviewed.

blood blister-like aneurysm (BBA) originates from the dorsal or anterior wall of the unbranched segment of the internal carotid artery^[1]。 Although cases of BBA located elsewhere in the intracranial circulatory system have been reported in recent years, the classical definition still believes that it originates from the internal carotid artery^[2,3]。 Internal carotid artery BBA is rare in clinic, accounting for 0.9% ~6.5% of internal carotid artery aneurysms, 1.0% of intracranial aneurysms, and 0.5% ~2.0% of all ruptured intracranial aneurysms^[4,5,6]。 Because the cause of formation of internal carotid artery BBA is unknown, the risk of rupture and bleeding is high, and it is difficult to detect by classical imaging methods such as CT angiography (CTA) and digital subtraction angiography (DSA). There is a high false negative rate, and the rate of re-bleeding and recurrence after treatment is high^[1,7]Therefore, its diagnosis and treatment are extremely important. In recent years, due to the improvement of craniotomy and the rapid development of endovascular treatment, there have been some breakthroughs in the treatment of internal carotid artery BBA. This article aims to review the etiology, pathology, clinical characteristics, diagnosis and treatment progress of internal carotid artery BBA.