Volume 33 · Issue 12 · 2017

Although pediatric neurosurgery in China has made great progress in the past two decades^[1]However, with the development of medical science, especially in the field of neuroscience, the development of traditional single-discipline treatment models has been unable to meet the needs of patients. The mode of multi-discipline combination is the general trend of discipline construction in the medical field^[2]。 When a child needs brain surgery, the parents of the child are concerned about whether the lesion can be totally removed, whether the surgery has any impact on limb function and intelligence, whether the body can develop normally, whether it affects marriage or procreation, etc. The above questions are definitely not answered and solved by a single subject of pediatric neurosurgery, which involves pediatrics, pediatric surgery, oncology, endocrinology, neuroelectrophysiology, neuroimaging, brain cognitive function, radiotherapy, chemotherapy, mental health (psychology), rehabilitation medicine, materials science (non-metal implants) and other multidisciplinary systems. These disciplines are complex spider network relationships rather than relationships of parallel lines. This requires a pediatric neurosurgeon not only to master the knowledge and skills of this discipline, but also to understand the disciplines that have a supporting role and influence on pediatric neurosurgery, and to apply them reasonably in clinical medicine.

Lumbar degenerative spinal stenosis refers to the stenosis of the lumbar spinal canal, nerve root canal and intervertebral foramen caused by degenerative causes. This disease is often accompanied by lumbar disc herniation, vertebral hyperplasia, hyperplasia, hypertrophy, calcification or ossification of posterior longitudinal ligament and ligamentum flavum, hypertrophy of synovial sac of facet joints, spondylolisthesis and other pathological changes. Spinal stenosis may entrap and stimulate the spinal cord, nerves and blood vessels, thus causing corresponding clinical symptoms, such as lumbar and leg pain. In severe cases, weakness of both lower limbs, sphincter relaxation, defecation and defecation disorders, etc. may occur, which is called lumbar spinal stenosis. Lumbar spinal stenosis is divided into central stenosis, lateral recess stenosis and nerve root foramen stenosis according to anatomical site.

brain arteriovenous malformation (bAVM) is a congenital disease with an annual incidence rate of 1.12~1.42/100,000 people^[1,2,3,4]。 Cerebral hemorrhage is the most common clinical manifestation of bAVM, with an annual hemorrhage rate of about 2.10% to 4.12%, and about 36% to 68% of patients bleed at the first visit. The risk of rebleeding after initial cerebral hemorrhage increased, from about 9.65% to 15.42% in the first year, and then decreased year by year, and from 1.70% to 3.67% after 5 years^[5,6]。 The annual disability and fatality rates after bAVM hemorrhage were approximately 1.7% and 1.0%, respectively^[7]。 Given the high rebleeding rate of ruptured bAVM, it has been widely recognized that ruptured bAVM needs aggressive treatment, while whether unruptured bAVM needs treatment and the choice of treatment mode are still controversial.

To discuss the effect of microsurgical treatment for children's focal brainstem gliomas with the assistance of neurophysiological monitoring and multimodal neuronavigation technology.

A retrospective analysis was conducted on 42 cases of focal brainstem glioma that were admitted to Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University from January 2012 to December 2016. During surgery, MRI and DTI (diffusion tensor imaging) data were transferred to the neuronavigator for three-dimensional reconstruction. Tumor resection was performed with the assistance of intraoperative neuronavigation and neuroelectrophysiological monitoring. 19 patients underwent radiotherapy and/or chemotherapy following tumor resection.

Among all 42 patients, gross total resection was achieved in 38 (90.5%) cases and partial resection in 4 (9.5%) cases. Major postoperative complications included edema of brain stem (n=3, 7.1%), respiratory disorder (n=1, 2.4%) and injury of posterior cranial nerves (n=4, 9.5%) and were relieved following treatment. There was no perioperative death. The follow-up period varied from 6 to 48 months with an average of 34.0±10.1 months. At the last follow-up study, the average Karnofsky performance score was 90.0±9.2 which was significantly higher (P<0.01) than that before surgery (60.0±16.9). During the follow-up, 4 cases showed tumor progression and included 3 deaths. The total survival rate was 92.9% (39/42).

Microsurgery should be considered for children of focal brainstem gliomas with clear indications. DTI multimodal navigation and intraoperative electrophysiological monitoring could help improve the excision degree of the glioma, reduce surgical trauma and decrease the rates of disability and morality.

To analyze the clinical characteristics and surgical treatment strategy of infradiaphragmatic craniopharyngiomas in children.

A retrospective analysis was conducted on 68 cases of childhood-onset infradiaphragmatic craniopharyngiomas who underwent surgical treatment at Department of Neurosurgery, Nanfang Hospital of Southern Medical University from December 2000 to January 2015. Among them, 19 patients received transsphenoidal surgery, 49 cases underwent craniotomy including 12 through lateral approach and 37 through anterior interhemispheric fissure approach. All patients were clinically followed up post operation. Analysis was conducted to explore the factors affecting the surgical operations, approaches and recurrence of infradiaphragmatic craniopharyngiomas.

Infradiaphragmatic craniopharyngioma was common in childhood-onset craniopharyngiomas and accounted for 41.7%(68/163). Growth retardation and impaired vision were two most common clinical manifestations which accounted for 86.8%(59/68) and 69.1%(47/68), respectively. There were 58.8%(40/68) of the patients who presented pre-operative panhypopituitarism. The follow-up ranged from 18 to 270 months (mean: 71.4±53.4 month), and 13 out of 68 (19.1%) patients showed recurrence during the follow-up, 20 out of 28 (71.4%) non-panhypopituitarism patients presented newly onset deficiency of pituitary hormones. Multiple factors, including the tumor size bigger than 10 cm^3, ratio of suprasellar tumor diameter to intrasellar tumor diameter >2, sagittal maximal tumor diameter greater than 4 cm, tumor with suprasellar complex tumor cysts, were more likely to result in craniotomy (all P<0.05). Tumor resection not along the membrane boundary of intrasellar part and the maximal diameter larger than 2.5 cm were two independent risk factors for recurrence (allP<0.05).

Infradiaphragmatic craniopharyngioma have negative impacts upon the patients’ quality of life. Exposure and removal of the intrasellar part of tumor could reduce the risk of recurrence for either transsphenoidal operation or craniotomy. Anterior interhemispheric fissure approach seems to be helpful for the exposure of intrasellar tumor and superior to the lateral approach.

To discuss individualized surgical scheme for secondary epilepsy in children with temporal lobe gangliogliomas.

A total of 14 children with temporal lobe gangliogliomas received surgical treatment for refractory epilepsy at Epilepsy Center, Yuquan Hospital, Tsinghua University from September 2008 to September 2016 and were enrolled into this study. Their clinical demonstrations, imaging features, electroencephalography (EEG) characteristics and surgical procedures were retrospectively analyzed.

Among those 14 patients, 5 cases received standard anterior temporal lobectomy with amygdalohippocampectomy, 2 cases underwent selective amygdalohippocampectomy, and the other 7 cases received selective resection of temporal structures. All patients were followed up for 1-8 years which demonstrated the outcomes of Engle grade Ⅰ in 12 cases and Engle grade Ⅱ in 2 cases. Gangliogliomas (WHO grade Ⅰ) were confirmed in all cases by pathological examination.

For secondary epilepsy in children with temporal lobe gangliogliomas, good outcomes could be achieved by following individualized surgical scheme based on the tumor locations, symptoms and EEG results.

To explore the clinical effects of laminotomy and titanium plate internal fixation in surgery of children’s space-occupying lesions (SOL) in the vertebral canal.

A retrospective analysis was conducted about 87 patients with SOL in the vertebral canal who underwent laminotomy and titanium plate internal fixation at Neurosurgery Department of Zhengzhou Children's Hospital from January 2010 to January 2013. The patients’ ages ranged from 0.5 to 9.0 years old with an average of 4.7±1.9 years old. The symptoms were assessed according to the modified McCormick grading system and the spine stability was assessed based on the imaging results.

For all 87 patients, laminotomy was performed at 2-7 vertebral segments with an average of 4±2 segments. The operation duration was 60-135 min with an average of 111±15 min. Total resection of lesions was achieved in 77 cases (88.5%) and partial resection in 10 cases (11.5%). No spinal nerve injury related to titanium plate fixation or focal effusion occurred post operation. The patients were followed up for 12-36 months with an average of 26.1±4.9 months and no symptomatic aggravation was reported post operation. Preoperative McCormick grades Ⅰ-Ⅴ were reported in 10, 16, 21, 34 and 6 cases, respectively. Postoperative grades Ⅰ-Ⅴ were decided to be in 44, 29, 7, 5 and 2 cases, respectively. Imaging studies at follow-up showed that the local titanium plates were fixed well without fracture, collapse, displacement, and no stenosis, lateral convexity, posterior convex deformity or spinal instability was reported.

The procedures of laminotomy and titanium plate internal fixation could not only facilitate exposure of lesions, but also help reconstruct anatomical structure of the spinal canal and maintain the spinal stability, which seem to demonstrate simplicity, safety and efficacy.

To discuss our experience and efficacy of modified hemispherotomy for the treatment refractory epilepsy secondary to cerebral hemispheric disorders in children.

From September 2015 to June 2016, a series of 5 patients with intractable epilepsy underwent modified hemispherotomy at Neurosurgery Department of Children’s Hospital of Fudan University and were enrolled into this retrospective study. None of the patients had cerebral hemispheric atrophy or enlarged ventricles. Their ages at surgery ranged from 8 months to 8 years. The left hemisphere was involved in 3 cases and the right in 2.

The operation time was 5-6 h and the amount of blood loss was 100-300 ml (mean: 170±84 ml). Postoperative MRI revealed complete disconnection of the affected hemisphere in all patients. There was no hemorrhage, cerebral infarction, infection or hydrocephalus. Postoperative follow-up lasted 4-13 months and all patients were seizure free. Four patients had reduced the dose of antiepileptic drug (AED) and 1 case stopped AED. All of the 5 patients were able to walk independently without any language impairment. All patients reported slight hemiplegia in the contralateral side. Neuropsychological development remained unchanged compared with preoperative status.

Modified hemispherotomy is suggested to be effective and safe for the treatment of intractable epilepsy related to cerebral hemispheric disorders, particularly in those patients without cerebral hemispheric atrophy or enlarged ventricles. The procedure could help reduce the blood loss during operation and is associated with less surgical difficulty.

To explore the application value of intraoperative neurophysiological monitoring in the surgery of spinal cord untethering.

A total of 35 patients with tethered cord syndrome admitted to Department of Neurosurgery, Yuquan Hospital, Tsinghua University from June 2014 to December 2016 were electrophysiologically monitored in terms of somatosensory evoked potentials (SEP) and electromyogram(EMG) during operation. The Hoffman scale was adopted to evaluate nerve function in all patients. The changes of electrophysiological parameters and the nerve functions were analyzed. The relationship between SEP monitoring results and Hoffman scale was investigated.

Among 35 patients, the cortical potential P40 was recorded in 29 cases. There were continuous bursts of large myoelectric response in 21 patients during operation. All patients underwent nerve root stimulation to identify the cauda equina and filum terminale, the latter were then cut. The follow-up period lasted 6-13 months with an average of 9.4±5.8 months. Significant improvement of neurological function was reported in 8 patients, fair improvement in 18, and no improvement in 9 cases. Comparative analysis showed that in the patients with significant improvement, postoperative amplitude and latency were significant different from preoperative results (both P<0.05). In the patients with fair improvement, the latency rather than amplitude was significantly different (P<0.05) comparing pre- and postoperative data. In the patients with no change, there was no significant difference in the latency or amplitude post operation (bothP>0.05).

Employed in the surgery of spinal cord untethering in children, intraoperative electrophysiological monitoring could effectively help avoid nerve damage, reduce the occurrence of postoperative complications, and improve the clinical outcomes.

To explore the clinical symptoms, treatment strategies and prognoses of occult tethered cord syndrome (OTCS) in children.

Sixteen children with OTCS underwent operations at Neurosurgery Department of Shanxi Children’s Hospital from April 2007 to April 2013 whose data were retrospectively analyzed. The clinical symptoms, radiological examination, urodynamic test, complications and prognoses of those patients were documented. Among all 16 cases, the clinical symptoms included urinary incontinence (n=9), bowel incontinence (2), cutaneous anomaly in the midline of back (9) and low extremity anomaly (4). The preoperative MRI demonstrated that the conus in all patients was in the normal position with a fatty filum terminal. Microsurgery was conducted for all patients with neuroelectrophysiological monitoring. The efficacy of surgical treatment was evaluated by the spina bifida neurological scale (SBNS).

The follow-up of all 16 patients ranged from 12 months to 84 months with an average of 42.0±20.0 months. Among them, 13 had no symptoms or gained improvement of the symptoms, 2 showed no further progression of their symptoms, and 1 patient had symptomatic worsening. The effective rate in the 16 patients with OTCS after surgery was 94% (15/16).

Early surgical intervention could be suggested for children with established diagnosis of OTCS and the outcomes seem to be favorable.

neural tube defects (NTDs) have been considered to be diseases caused by the interaction of genes and the environment. A number of environmental factors have been found to be associated with the pathogenesis of NTDs, especially folic acid deficiency. However, in genetic research, little progress has been made. Whole exon sequencing, as an emerging high-throughput, high-efficiency and relatively low-cost sequencing technology, provides an opportunity for the study of genetic causal factors of various diseases. Exons are the regions where most of the phenotype-related functional variations occur, but their number only accounts for 1% of the total length of the whole genome. The whole exon sequencing method is used to enrich the whole human exon region for sequencing, and to study various variations in disease-related regions, especially single nucleotide polymorphism (SNP), insertion and deletion, with high specificity, high accuracy and timeliness^[1]。 In order to investigate the genetic factors related to the pathogenesis of NTDs in Chinese population, the whole exon deep sequencing of peripheral blood DNA of 16 children with severe NTDs was performed in this study, and further bioinformatics analysis was performed to discover new pathogenic genes.

Epidural hematoma refers to the hematoma formed in the space between the epidural mater and the skull mainly caused by hemorrhage of the dural artery and vein, venous sinus or skull plate barrier^[1]。 Because the dura mater is closely attached to the inner plate of the skull, cases of epidural hematoma in infants and young children are relatively rare^[2]。 From August 2011 to April 2013, 3 infants with epidural hematoma complicated with scalp hematoma and skull fracture were treated in the Department of Neurosurgery of Hebei Children's Hospital. The scalp hematoma puncture resulted in good results, which are reported as follows.

To explore the relationship of cancer stem cell markers to the prognosis of primary astrocytomas and its possible mechanisms.

A total of 130 cases of primary astrocytomas were admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University and underwent surgical operations from January 2012 to January 2016 whose data were retrospectively analyzed. The expressions of cancer stem cell markers CD133, aldehyde dehydrogenase 1A3 (ALDH1A3) and Nestin and IDH1 mutation were obtained through the whole transcriptome sequencing and isocitrate dehydrogenase 1 (IDH1) pyrophosphate sequencing. According to the genes expression levels from high to low, the top 65 cases were defined as high gene expression groups, and the last 65 cases were defined as low expression groups. Among them, patients with both ALDH1A3 and Nestin high expressions were termed as group A (32 cases), ALDH1A3 high expression/Nestin low expression and ALDH1A3 low expression /Nestin high expression were defined as group B (66 cases), and group C (32 cases) consisted of those with ALDH1A3 and Nestin both low expression. The relationship between the expressions of the 3 markers and patients' prognosis and the effect of IDH1 mutation on prognosis in different groups were analyzed.

(1) The median survival time of the patients with ALDH1A3 high and low expression was 432 d and 1 131 d, respectively. The median survival time of Nestin high expression group and Nestin low expression group was 423 d and 1 074 d, respectively. The differences were statistically significant (all P<0.001). The median survival time of the patients with ALDH1A3 high and low expression was 720 d and 965 d, respectively (P=0.273). (2) Group A and B had median survival time of 333 d and 720 d, respectively. Group C showed the best prognosis. More than 50% of the patients survived the last follow-up. The differences were statistically significant (P<0.001). (3) The proportions of IDH1 wild type in group A, B and C were 100.0% (32/32), 75.8% (50/66) and 21.9% (7/32), respectively (P<0.001). The median survival time of IDH1 wild type and mutation type in Group B were 514 d and 1 374 d, respectively (P=0.028). In Group C, patients with IDH1 wild type had a median survival time of 660 d. IDH1 mutation type group had better prognosis and more than 50% of the patients survived the last follow-up (P<0.001).

The expressions of cancer stem cell markers ALDH1A3 and Nestin are related to the prognosis of primary astrocytomas, in which the IDH1 mutation may be involved.

To evaluate the long-term efficacy of deep brain stimulation (DBS) in treatment of medically refractory primary generalized dystonia (PGD) and to compare the effect of stimulation of subthalamic nucleus (STN) with that of globus pallidus internus (GPi) in the treatment of dystonia.

Twenty-one cases of PGD underwent STN-DBS or GPi-DBS at Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University from December 2004 to April 2013 and were enrolled into this study. Among them, 11 patients underwent STN stimulation (STN-DBS group) and the other 10 cases received GPi stimulation (GPi-DBS group). Pre- and postoperative severity of dystonia were assessed by using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS).

The average improvement rates of BFMDRS movement subscale in the 21 cases of PGD were 63.7±14.2 % and 66.5±13.7 % at 1 and 3 years post operation, respectively. Meanwhile, the disability scores were reduced by 43.7±13.8 % and 49.1±12.4 %, respectively. The movement scores in STN-DBS group were 56.9±20.9 prior to surgery and 18.3±6.8 at 3 years post operation, and the average improvement rate was 64.6±15.2 %. Their disability scores were 20.0(11.0) prior to surgery and 8.0(4.0) points at 3 years post operation, and the average improvement rate was 54.5 %(15.0 %). In the GPi-DBS group, the movement scores were 60.8±19.3 before surgery and 18.3±7.9 at 3 years post surgery, and the average improvement rate was 68.6±12.5 %. Their disability scores were 17.5±5.4 before surgery and 8.9±2.5 post surgery, and the average improvement rate was 47.2±12.8 %. There was no statistically significant difference in the improvement rates of BFMDRS movement and disability scores between 2 targets at 1 year and 3 years after surgery (both P>0.05).

The effect of DBS in the treatment of medically refractory seems to be significant and sustained. Our preliminary results suggest that there is no significant difference in the long-term efficacy between stimulation of STN and stimulation of GPi for dystonia.

To evaluate the neurological, neuropsychological and quality of life (QOL) alterations in patients who underwent extended resection of gliomas.

From January 2014 to November 2015, a total of 58 patients with gliomas were admitted to Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University, and were enrolled into this study. Extended resection was performed in all patients. Patients were assessed at 3 time points, i. e. 1 day before surgery (T1), the day of discharge (T2) and 3 months post surgery (T3). National Institutes of Health Stroke Scale (NIHSS) score, Addenbrooke cognitive examination-revised (ACE-R), Hospital Anxiety and Depression (HAD) and neuropsychological test battery (NTB) were used to assess neurological and neuropsychological profiles. QOL was ascertained through the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC-QLQ C30).

At T1 (58 cases), T2 (50 cases) and T3 (46 cases), the patient’s overall QOL score was 67.8 (48.9, 86.7), 66.7 (47.5, 85.9) and 64.8 (41.4, 88.5), respectively. There was no significant difference between different time periods (P>0.05). At T3, 24% (11/46) of the patients showed worsened neurological functions and 28% (13/46) gained neurological improvement compared with pre-operative conditions. According to the neuropsychological test, 65% (13/50) experienced deterioration of neuropsychological functions to varying degrees. However, those functions recovered at T3 for majority of patients.

Extended resection of gliomas does not seem to result in deterioration of QOL of patients. Patients undergoing extended resection might experience deterioration of neurological and neuropsychological functions in the early postoperative period, which could recover to preoperative levels after some time in most cases.

To investigate the clinical values and suggestions for use of domestically developed technology of remote programming for patients with movement disorders.

A total of 56 patients with movement disorders underwent implantation of domestically manufactured devices of deep brain stimulation (DBS) at Department of Neurosurgery, Beijing Tiantan Hospital affiliated to Capital Medical University from February 2016 to October 2017. All patients received remote programing post surgery. The types of remote programing were summarized and the side effects were analyzed.

Among all patients in this study, adjustment of voltage was conducted in 52 cases, authority management in 45, frequency adjustment in 30, pulse width change in 15, battery check in 8, fault detect and handing in 5, contact change in 3, remote startup and shutdown for MRI scan or other reasons in 3 and change of cycling pattern in 2 cases.

Domestically developed technology of remote programming could help resolve some problems for patients with movement disorders, which seems to be correlated with controllable side effects and thus worthy of popularization and application in clinical practice.

To analyze the clinical features of patients suffering from tumefactive demyelina-ting diseases as well as the impacts and efficiency of the administration of glucocorticoids.

A retrospective review was conducted on 7 cases of tumefactive demyelinating diseases that were treated at Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University and Department of Neurosurgery, Beijing Navy General Hospital from January 2007 to April 2017. Among them, 6 underwent brain biopsy and craniotomy was performed in 1. After the surgery, we analyzed and classified the impacts of glucocorticoids on the treatment. All cases were clinically followed up, and the MRI results and symptomatic improvement were analyzed.

Post surgery, the conditions in all 7 diseases did not deteriorate. The CT scan did not show any signs of bleeding or infarct. The average duration of hospitalization was 10-20 days. Pathological study confirmed tumefactive demyelinating diseases in all cases. The follow-up lasted 1-34 months and 6 cases reported significant postoperative improvement in terms of symptoms and MRI results. The other patient’s conditions worsened at about 6 months following surgery. The MRI showed a slight increase in the size of lesion compared with the result at 3 month post operation. That patient was then administered hormone therapy and his conditions were significantly improved.

It is difficult to differentiate the clinical characteristics of tumefactive demyelinating diseases and some intracranial tumors, cerebrovascular disease, cerebral abscess, etc. However, certain characteristic imaging manifestations could the associated with the former and specific examinations of blood and cerebrospinal fluid could facilitate the differential diagnosis. The glucocorticoid therapy might be considerably effective and helpful for early diagnosis.

To discuss microsurgical treatment and outcomes of solid hemangioblastomas in posterior fossa.

This retrospective analysis represented our experience with 21 cases of solid hemangioblastomas in posterior fossa admitted to Neurosurgery Department of Tianjin Huanhu Hospital from January 2008 to October 2016. Among them, 4 patients received endovascular embolization within preoperative 72 hours whose digital subtraction angiography (DSA) results showed the feeding arteries located on the ventral side of tumors.

Gross total resection (GTR) was achieved in 18 patients and subtotal resection (STR) in 3. At the early stage post operation, 2 patients were in the state of coma (1 case died on the ninth day after operation), 1 patient suffered from dyspnea, 5 patients developed caudal cranial nerve palsy, 2 patients developed dysacousis, 1 patient reported facial paralysis and 3 patients developed hydrocephalus. Seventeen patients were followed up for about 3-96 months(average: 43.6±8.7 months). No recurrence was found in 15 patients with GTR. The MRI at 6 months post operation showed tumor growth in 1 patient undergoing STR and no change in 1 patient with multiple solid hemangioblastomas located in the medulla and thoracic spinal canal.

Microsurgical treatment seems to be safe and effective for solid hemangioblastomas in posterior fossa. Intraoperative bleeding could be reduced by preoperative endovascular embolization of tumor feeding artery.

Hypertensive cerebral hemorrhage is a spontaneous cerebrovascular disease caused by the rupture and hemorrhage of small blood vessels in the brain caused by acute increase of blood pressure. It has the characteristics of rapid onset, high morbidity, disability and mortality^[1]It is more common in patients over 50 years old with long-term essential hypertension and atherosclerosis. In recent years, the onset of the disease has become younger. According to the Guidelines for the Diagnosis and Treatment of Spontaneous Intracerebral Hemorrhage in Adults issued by the American Heart Association and the Stroke Association in 2015, craniotomy for hematoma evacuation may be considered for supratentorial lobar hematoma>30 ml and less than 1 cm from the brain surface^[2]But there is no clear diagnosis and treatment guidance for cerebral hemorrhage in the basal ganglia region. Kanaya and Kuroda^[3]The retrospective study found that patients with supratentorial hematoma volume>30 ml and consciousness level between lethargy and light coma can be treated surgically; In patients with intracerebral hematoma>50 ml, surgery cannot change the quality of life of patients compared with conservative treatment. At the same time, Zhao Jizong et al^[4]Preoperative Glasgow Coma Scale (GCS) was reported<In patients with cerebral hemorrhage with 8 scores, the mortality rate at 3 months after surgery was 3.5 times that of patients with GCS ≥8 scores. Therefore, this study retrospectively included 49 patients with hypertensive cerebral hemorrhage with bleeding volume of 30-40 ml and GCS ≥8 scores admitted to the Department of Neurosurgery of the First Affiliated Hospital of Dalian Medical University from January 2013 to June 2015, of whom 23 patients were treated with craniotomy and hematoma evacuation (surgical group) and 26 patients were treated with conservative treatment (conservative group). By comparing the clinical efficacy of the two groups, we hope to provide a reference for the choice of treatment mode for patients with hypertensive cerebral hemorrhage.

To identify the relationship of IL-6R/STAT3 signaling to invasiveness of pituitary null cell adenomas by the study of proteomics.

In this study, specimens were collected from 45 cases of pituitary null cell adenomas which were surgical treated at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University. Normal pituitary tissues were collected from 3 body donors who died from traffic accidents. Different proteins between invasive and non-invasive null cell adenomas were determined by nano liquid chromatography tandem mass spectrometry (nano LC-MS/MS) and quantitative proteomics analysis. The signaling pathway related to invasive of null cell adenomas was identified by bioinformatic analysis. The gene expression levels of the signaling pathway was confirmed by qPCR (quantitative polymerase chain reaction) and immunohistochemistry (IHC) in invasive pituitary tumors and non-invasive null cell adenomas.

A total of 283 differentially expressed proteins (P<0.05) were identified between invasive and non-invasive pituitary null cell adenomas. Among those, 182 and 101 were up-regulated and down-regulated in invasive pituitary null cell adenomas, respectively. The bioinformatic analysis demonstrated that 8 canonical pathways were differentially expressed between normal pituitary glands and pituitary null cell adenomas. IL-6R/STAT3 signaling was related to invasiveness of pituitary null cell adenomas. The IL-6R, JAK2 and STAT3 mRNA expression levels in invasive null cell adenomas (2.2, 2.8 and 4.3, respectively) were significantly higher than those in non-invasive null cell adenomas (1.7, 1.7, 2.9, respectively) based on the results of qPCR (P<0.05). The values of staining intensity of IL-6R, JAK2, STAT3, p-STAT3 and MMP9 (9.2, 8.6, 9.7, 10.5 and 9.8, respectively) were significantly increased in invasive null cell adenomas compared with those in non-invasive null cell adenomas (5.8, 5.3, 5.7, 5.2 and 4.1, respectively) according to the IHC data.

The IL-6R/STAT3 signaling may play an important role in invasive null cell adenomas by enhancement of MMP9 expression.

To investigate the effect of epidermal growth factor (EGF) on the proliferation and invasion of glioma U87 cells and its possible mechanisms.

The siRNA targeting osteopontin (OPN) gene was designed, synthesized and then transfected transiently into U87 cells to downregulate the expression of OPN. Blank control group, EGF group and siRNA+ EGF group were set up. Real-time quantitative PCR (qPCR) and Western blot were used to detect the expressions of OPN in each group of U87 cells. The MTT method and Transwell invasion test were used to detect proliferation and invasion of each group of U87 cells, respectively.

The siRNA was successfully transfected into U87 cells which inhibited the OPN expression by 50.7% (P<0.05). The qPCR and Western blot results showed that the expression levels of OPN were significantly increased in the U87 cells of EGF group and siRNA+ EGF group, in contrast with control group (bothP<0.05). However, the increase of OPN expression in EGF group was more significant. Compared with the EGF group, the expression of OPN in the siRNA+ EGF group was significantly reduced (P<0.05 ). The MTT results showed that the cell growth in EGF group and siRNA+ EGF group was significantly promoted (bothP<0.05). However, the cell proliferation in the siRNA+ EGF group was significantly inhibited compared with that in the EGF group (P<0.05). Compared with the control group, the migrating ability of U87 cells in EGF group and siRNA+ EGF group increased significantly (bothP<0.05), while that in the siRNA+ EGF group decreased significantly compared with the EGF group (P<0.05).

EGF promotes the proliferation and invasion of glioma U87 cells via upregulating the expression of OPN.

Lateral ventriculocentesis is an effective method for the treatment of hydrocephalus and ventricular hemorrhage, which can quickly reduce intracranial hypertension, improve clinical symptoms of patients and promote neurological recovery. However, the conventional method of transfrontal lateral ventricle puncture often has deviations, resulting in the puncture failure to enter the ventricle, resulting in unsuccessful puncture. Therefore, in this study, the coronal plane of transfrontal lateral ventricle puncture was reconstructed in three dimensions after CT imaging of the head, and the angle and depth of puncture were measured on this plane to guide the actual puncture process and improve the accuracy of puncture.

Clinically, spinal cord and spinal lesions often cause corresponding neurological dysfunction. Patients mostly see a doctor for limb sensory or motor disorders, and the diagnosis is easy to confirm by neurological physical examination and imaging findings. However, very few patients with spinal spinal lesions can be complicated by Charcot arthropathy, with joint destruction, which is easily confused with diseases such as primary arthritis. From September 2010 to September 2015, the Department of Neurosurgery of Ganzhou People's Hospital treated two patients with spinal cord disease complicated by Charcott's arthropathy and were misdiagnosed for a long time. After diagnosis and treatment, they improved. The report is as follows.

Subdural effusion is a common disease in pediatric neurosurgery, especially in traumatic craniocerebral injury and intracranial infection. Subdural-peritoneal shunt is the most commonly used surgical procedure for subdural effusion in children^[1,2]Similar to ventriculo-peritoneal shunt, many complications occur in the treatment of subdural effusion or hydrocephalus, with the incidence of intra-abdominal complications ranging from 5% to 30%^[3,4]。 However, the abdominal end of the shunt is displaced into the intestine and prolapsed out of the anus with the intestinal movement is very rare, and its incidence rate<0.1%^[5]。 With the popularization of laparoscopic technology, the surgical procedure assisted by gel laparoscopy is also used in patients with peritoneal shunt and postoperative complications. In November 2015, the Department of Neurosurgery, the Second Affiliated Hospital of Wenzhou Medical University admitted a patient with laparoscopic treatment of children's subdural effusion-peritoneal shunt after shunt displacement into the intestinal canal and transanal prolapse, which is now reported in the literature as follows.

primitive neuroectodermal tumor (PNET) is a rare malignant tumor composed of undifferentiated neuroectodermal cells with the ability to differentiate in multiple directions^[1]。 The clinical incidence is low and can be divided into central and peripheral types according to the origin of tumor cells^[2]。 Peripheral PNET can occur in bone, soft tissue, retroperitoneum, and pleura. The invasion of peripheral PNET into the spinal canal is rare in children. This paper reports a case of posterior mediastinal PNET invading the surrounding tissues and invading the spinal canal causing nerve compression in a child.

The pituitary gland is located in the sella turcica and is divided into adenopituitary gland (anterior lobe) and neuropituitary gland (posterior lobe). The adenopituitary gland differentiates from the Rathke sac of the ectoderm, while the neuropituitary gland is derived from the neuroectoderm at the base of the forebrain. The anterior pituitary gland synthesizes and secretes six hormones: adrenocorticotropic hormone (ACTH), growth hormone (GH), prolactin (PRL), thyrotropic hormone (TSH), luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones act on their respective target glands, regulate the synthesis and secretion of related downstream hormones, thereby controlling the self-stabilization of metabolism, growth and reproduction functions of the body^[1,2]。 The anterior pituitary gland itself is regulated by a variety of factors, including hypothalamus, pituitary cells themselves and negative feedback factors of peripheral target glands. These 3 factors control the life cycle of pituitary cells and the synthesis and secretion of pituitary hormones. Therefore, the occurrence of pituitary adenoma is the result of the combination of three mechanisms: hypothalamus, pituitary cells themselves and negative feedback factors of peripheral target glands.

With the development of interventional materials and imaging techniques, the proportion of patients with intracranial aneurysms undergoing endovascular treatment is increasing year by year. However, complex intracranial aneurysms such as large, wide-necked, fusiform aneurysms are still difficult to achieve complete closure by coil embolization. In recent years, flow diverter (FD) has provided a new way of thinking to solve this problem. The FD is a self-expanding, braided, highly deformable mesh stent with low porosity and high metal coverage. Its mechanism of action is to provide resistance at the neck of the tumor, reduce the blood flow into the intracranial aneurysm, and smoothly merge it into the outflow tract of the tumor-bearing artery, creating a hemodynamic environment conducive to intratumoral thrombosis. Hemodynamics plays an important role in the occurrence, development and rupture of intracranial aneurysms. computational fluid dynamics (CFD) can simulate the best FD placement strategy and evaluate the prognosis of patients before surgery, and provide personalized guidance for the treatment of intracranial aneurysms^[1]。 The research progress of CFD in FD treatment of intracranial aneurysms is summarized as follows.

With the further development of biomedicine, people's understanding of stem cells is getting deeper and deeper. Stem cells are a kind of cells with the characteristics of self-replication, renewal and induction of differentiation. They can transform into a variety of highly differentiated cells in the body, and play an important role in tissue repair, regeneration and replenishment of missing tissues in the body. At present, stem cells have received extensive attention in biomedical research, and their clinical application has been gradually deepened. Masjkur et al.^[1]It was found that stimulating stem cells in the body through nerve and vascular signals can induce blood vessel formation and promote damaged tissue repair. 2016 Bang et al.^[2]Treatment of stroke with mesenchymal stem cells and bone marrow-derived mononuclear cells resulted in improved symptoms. These studies indicate that stem cells have great application prospects in nerve regeneration and tissue repair.