Volume 34 · Issue 06 · 2018

Dystonia is the third leading movement disorder after Parkinson's disease and essential tremor. It has a high disability rate and can seriously affect the quality of life of patients^[1]。 Traditional dystonia is defined as: a syndrome of twisting, repetitive movements, or postural abnormalities caused by involuntary, persistent muscle contractions^[2]。 In recent years, with the deepening of academic understanding of diseases, the definition of dystonia has been updated as: a kind of dyskinesia disease with abnormal repetitive movement and/or abnormal posture caused by involuntary intermittent or persistent muscle contraction; Abnormal repetitive movement and abnormal posture are distorted and patterned, which can be combined with tremor; Voluntary movements can induce or aggravate involuntary movements and abnormal posture, accompanied by activation of "overflow" muscles. Dystonia, as a form of involuntary movement, can also be accompanied by the following characteristics: involuntary movement, action specificity, relief techniques or strategies (sensory tricks or gestes antagonistes), mirror dystonia, zero, overflow or generalization, dystonic tremor. The formulation of its treatment strategy is mainly based on etiological classification and clinical characteristics^[3]。

To discuss the strategy and technique of endoscopic endonasal surgery of recurrent skull base chordomas.

The data of 123 patients with recurrent skull base chordomas were retrospectively studied who underwent surgical treatment between August 2007 and March 2018 at Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University. Recurrent skull base chordomas were classified into 4 types based on the tumor location: total clivus type (n=43) superior-middle clivus type (n=51), middle-inferior clivus type (n=8), and extensive type (n=21). All tumors were resected through EEA (endoscopic endonasal approach).

Among all 123 cases, gross total resection was achieved in 39 (31.7%) cases, near-total resection in 58 (47.2%) and partial resection in 26 (21.1%). Following the surgery, cerebrospinal fluid leakage occurred in 9 cases and secondary surgical repair was performed. Intracranial infection occurred in 3 patients among the 9 cases who received the secondary repair. Among them, 2 patients recovered and 1 died. Postoperative new cranial nerve palsy occurred in 14 cases. Intraoperative internal carotid artery rupture occurred in 3 cases. The rupture in 2 cases was minor and complete hemostasis was achieved during operation. The rupture in 1 case was severe and endovascular covered stent was used for complete hemostasis. No new functional deficits was noted post operation for all 3 cases. Within 6 months post surgery, the improvement rates of hypopsia and visual field defects, diplopia, facial numbness and pain, tinnitus and hearing loss, dysphagia and hoarseness and cough, headache and dizziness, nasal obstruction, and dyskinesia were 47.6% (10/21), 32.3% (10/31), 41.7% (5/12), 30.0% (3/10), 25.0% (4/16), 86.6% (58/67), 100% (9/9) and 66.7% (8/12), respectively.

The resection of recurrent skull base chordomas seems difficult, in which endoscopic endonasal surgery might be more advantageous. Correct surgical strategy and techniques combined with the uses of neuronavigation, neurophysiological monitoring and Doppler ultrasound are the key factors for high-quality operation.

To investigate the complications and risk factors of endoscopic treatment of intraventricular tumors.

A total of 82 cases of intraventricular tumors were enrolled into this study who underwent neuroendoscopic treatment at Neurosurgery Department, Beijing Tiantan Hospital, Capital Medical University from February 2004 to July 2016. All patients received complete follow-up lasting for over 2 years and their postoperative complications were documented. We analyzed the risk factors related to the patients＇ complications.

All 82 patients underwent successful operations. There was no death. Total or subtotal resection was achieved in 64 (78.1%) patients, partial resection in 10 (12.2%) and tumor biopsy in 8 (9.7%). Postoperative complications occurred in 25 (30.5%) patients and included intracranial infection in 17 (20.7%), postoperative intraventricular hemorrhage in 5 (6.1%), subcu-taneous effusion in 2 (2.4%) and neurological impairment in 1 (1.2%). Recurrence was reported in 10 (13.5%) cases 2 years post operation among 74 patients who underwent resection. Logistic regression analysis showed that preoperative hydrocephalus (OR=24.055, 95%CI: 2.910-198.813, P=0.003), hard tumors (OR=28.975, 95%CI: 2.894-290.091, P=0.004) and blood vessel-rich tumors (OR=43.118, 95%CI: 2.134-871.302, P=0.014) were independent risk factors of postoperative complications.

Neuroendoscopic resection of intraventricular tumors is safe and effective. Intracranial infection seems to be the major complication. Preoperative hydrocephalus, hard tumors and blood vessel-rich tumors are independent risk factors for endoscopic treatment of intraventricular tumors.

To explore our surgical experience and clinical outcome of endoscopic extrapseudocapsular resection of pituitary adenoma using bilateral endonasal approach.

A retrospective review of clinical data of 254 patients who were treated for pituitary adenoma by endoscopic surgery using bilateral endonasal approach within the time frame of January 2015-December 2016 at Department of Neurosurgery, First Affiliated Hospital of Nanchang University. The patients who experienced extrapseudocapsular resection were selected for general evaluation of surgical outcome and follow-up results.

A total of 133 cases underwent endoscopic endonasal extrapseudocapsular resection. Among those, 124 (93.2%) cases achieved gross total resection and subtotal resection was achieved in 9 (6.8%) cases. Postoperative improvement of vision and visual field occurred in 61 (84.7%) cases and 42 (73.7%) cases achieved postoperative remission of headache. Among 62 non-functional pituitary adenomas with normal preoperative pituitary function, 42 (67.7%) cases preserved normal pituitary function after operation and the other 20 (32.3%) cases developed partial hypopituitarism. Out of 23 non-functional pituitary adenomas with preoperative partial hypopituitarism, postoperative improvement was reported in 10 (43.5%) cases, persistent hypopituitarism in 10 (43.5%) cases and aggravation in 3 (13.0%) cases. Overall, 44 (91.7%) cases showed biochemical remission in endocrine-active pituitary adenomas after operation. Intraoperative rupture of sellar diaphragm was noted in 52 (39.1%) cases, postoperative CSF (cerebrospinal fluid) leakage in 6 (4.5%) cases, and transient diabetes insipidus (DI) in 27 (20.3%) cases. No death occurred during the follow-up period. Tumor recurrence occurred in 3 (2.4%) cases during the follow-up period lasting for 23.6±7.0 months.

Endoscopic extrapseudocapsular resection of pituitary adenoma using bilateral endonasal approach could achieve high rate of gross total resection and low rate of tumor recurrence, effectively alleviate the patients’ clinical symptoms, increase surgical remission rate in endocrine-active adenomas with less complications.

To explore the role of endoscopic neurosurgery in the diagnosis and treatment of ventriculitis.

A retrospective study was conducted on the clinical data of 21 patients with ventriculitis who underwent neuroendoscopic diagnosis and treatment at 6 medical center including Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University from March 2010 to March 2017. Infection of the ventricular system was divided into Ⅰ-Ⅳ types based on the neuroendoscopic assessment. Neuroendoscopic surgical techniques was applied to incise the intraventricular compartment and reconstruct cerebrospinal fluid circulation, obliterate intraventricular debris and pus and remove artificial implanted materials. Perioperatively intraventricular antibiotics were administered according to the type of infection and the results of bacterial culture. Endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunt was performed for secondary hydrocephalus.

There were 6 cases of type Ⅰ, 7 cases of type Ⅱ, 4 cases of type Ⅲ and 4 cases of type Ⅳ. One (4.8%) died of multiple organ failure. Twenty (95.2%) cases of ventriculitis fully recovered. Among the 16 cases with secondary hydrocephalus, 11 cases underwent ventriculoperitoneal shunt and 5 cases underwent ETV. ETV was ineffective in 1 case and ventriculoperitoneal shunt was then performed for the case. During the follow-up with a median of 25.5 months (5-60 months), there was no recurrence and the surgical effects were satisfactory.

Application of neuroendoscopic techniques seem effective for the diagnosis, assessment and treatment of ventriculitis. In addition, perioperative lavage of the ventricular system with antibiotic saline might be of importance.

To explore the effect and clinical value of neuroendoscopic endonasal transsphenoidal approach for resection of tuberculum sellae meningiomas.

A retrospective analysis was conducted on 15 patient of tuberculum sellae meningiomas who were admitted to Department of Neurosurgery, the First Affiliated Hospital of Shenzhen University from June 2014 to November 2017 and underwent neuroendoscopic endonasal transsphenoidal surgery. We analyzed their clinical data to summarize the clinical effect and operation experience based on literature review. In addition, we discussed the application value of neuroendoscopic endonasal approach in resection of tuberculum sellae meningiomas. All patients were followed up post surgery by assessment of enhanced MRI and visual fields at outpatient department.

Postoperative brain MR showed that gross total resection was achieved in 14 cases and subtotal resection in 1 case without postoperative complications. Postoperative visual acuity returned to normal in 12 patients, no obvious improvement was reported in 2 cases and visual deterioration occurred in 1. The follow-up period in 15 patients lasted for 1-41 months, with an average of 13.3±11.2 months. During the follow-up, mild enhancement in the saddle area was reported in only 1 case (41 months post operation). One case undergoing subtotal resection had reduced tumor size after radiotherapy. The visual fields of all patients remained the same post operation.

Neuroendoscopic endonasal transsphenoidal approach seems relatively safe and effective for resection of tuberculum sellae meningiomas, which could help enhance the rate of gross total resection and reduce the complication rate.

To explore the reliability and superiority of nasoseptal " rescue" flap technique in neuroendoscopic transnasal resection of pituitary adenoma.

A retrospective clinical analysis was conducted about 113 cases of endoscopic transsphenoidal pituitary adenoma resection with the application of nasoseptal " rescue" flap technology in Department of Neurosurgery , Qilu Hospital of Shandong University from January 2016 to March 2017. The reliability and superiority of the technique were evaluated based on the duration of nasal cavity and sphenoid sinus stage, the incidence of post-operative anosmia and cerebrospinal rhinorrhea.

The duration of nasal and sphenoid sinus stage was 15-30 minutes, averaging 24.0±4.5 minutes. There were 27 (23.9%) cases of intraoperative cerebrospinal fluid leakage including 24 cases of low flow cerebrospinal fluid leak and 3 cases of high flow cerebrospinal fluid leak. Twenty-three cases were converted from nasoseptal " rescue" flap to nasal septum flap. The patients were followed up for 3-15 months, averaging 8.0±4.3 months. There were 17 cases(15.0%) of postoperative olfactory decline or disappearance, 1 case(0.9%) of epistaxis and 1 case(0.9%) of cerebrospinal rhinorrhea.

The application of nasoseptal " rescue" flap technique could facilitate sellar floor reconstruction in case of intraoperative rupture of diaphragma sellae. There seems to be no increase of the duration of sphenoid sinus and nasal stage.

To investigate the efficacy of neuroendoscopy combined with neuronavigation in the treatment of hypertensive intracerebral hemorrhage (HICH).

A retrospective analysis was conducted on 96 patients with HICH who underwent treatment at Department of Neurosurgery, the Affiliated Dalian Central Hospital of Dalian Medical University from January 2015 to January 2017. All cases were divided into endoscopic navigation group (n=44) and microscopy group (n=51) based on the treatment method. The endpoints including hematoma clearance rate, intraoperative blood loss, operation time, postoperative hospitalization and hospitalization expenses were analyzed and compared between the 2 groups. The Glasgow outcome scale (GOS) was used for assessment at a 6-month follow-up.

Hematoma clearance rate in endoscopic navigation group was higher than that in microscopy group (91.5±6.0 % vs. 83.7±6.8 %, P<0.001), while intraoperative blood loss(74.1±14.0 mlvs. 224.9±32.6 ml), operation time(69.6±13.7 min vs.128.2±28.4 min), postoperative hospitalization(12.4±2.8 d vs.18.3±2.4 d), and hospitalization expenses(38 600±9 600 yuan vs. 52 300±11 200 yuan) in endoscopic navigation group were significantly lower than those in microscopy group (all P<0.001). At the 6-month follow-up, the score of GOS in endoscopic navigation group was significantly better than that in microscopy group (P=0.029).

Treatment of HICH using neuroendoscopy combined with neuronavigation seems to be featured with less trauma, good efficacy, good prognosis and low costs, which is thus worth being applied and promoted in clinical practice.

To explore the feasibility, safety and efficacy of endovascular reconstructive treatment of large and giant posterior circulation fusiform aneurysms.

A retrospective review was conducted on 22 cases of posterior circulation large and giant fusiform aneurysms who underwent endovascular reconstructive treatment between September 2007 and August 2017 at Neurosurgery Department of Beijing Hospital. Among the 22 cases, stent-assisted coiling was performed in 18 cases and sole stenting was applied in 4. Postoperative follow-up was conducted every 3-6 months at outpatient clinic or by phone. The modified Rankin scale (mRS) was used for outcome assessment. Imaging follow-up was conducted 3-24 months post operation. The outcomes was classified into stable, relieved and recurrent cases.

Technical success rate was 100%. Peri-procedural complications occurred in 2 (9.1%) patients. One died from postoperative hemorrhagic complication and the other developed infarction and recovered well at discharge. A total of 21 patients were clinically followed-up for an average of 42.1±26.3 months (range: 4-105 months) and included 18 (85.7%) cases with good outcomes (mRS score: 0-2) and 3 (14.3%) with poor outcomes (mRS score: 4-6). Among 19 patients with angiographic follow-up of 11.9±6.9 months (range: 3-47 months), 10 patients achieved complete occlusion, 5 reported relief or stable conditions, 3 developed recurrence and 1 had in-stent occlusion.

Reconstructive endovascular treatment seems relatively safe for posterior circulation large and giant fusiform aneurysms with satisfactory mid-term results.

To explore the application of intraprocedural C-arm CT assisted trans-perforator embolization of deep arteriovenous malformations (AVM).

From July 2015 to June 2017 at Neurosurgery Department, Xuanwu Hospital Capital Medical University, a total of 21 cases of hemorrhagic deep AVM were retrospectively reviewed. There were 11 men and 10 women with the average age of 24.3 years old. Among them, 20 lesions were located at the basal ganglia and 1 lesion at the fourth ventricle. Three lesions were classified as Spetzler-Martin grade 4 and 18 lesions were grade 3. All patients were treated with transarterial embolization under general anesthesia. The tip of microcatheter was localized with intraoperative C-arm CT technique when trans-perforator embolization was intended.

Among 21 patients, a total of 49 times of embolization were performed. Twenty-five times of intraoperative C-arm CT scans were used in 37 times of trans-perforator embolization. The tip of microcatheter was positioned 22 times at the safe region and 3 times at the dangerous area. The immediate post-operative angiography revealed complete occlusion or subtotal occlusion in 8 cases, obliteration of hemorrhage-related structures in 11 and partial embolization in 2. Intraoperative ventricular hemorrhage occurred in 2 cases and 1 of them presented with numbness of contralateral extremities post embolization. Twelve cases were followed up by DSA at 4-17 months post embolization. Five lesions which were obliterated completely or subtotally developed no further changes in follow-up angiogram when compared with immediate post-operative results. In 7 lesions which were treated with obliteration of hemorrhage-related structures, the nidus of 1 lesion disappeared completely and that in 6 other lesions had residues without hemorrhage-related structures. The remaining 9 cases were clinically followed up at 6 months post embolization. Recurrent hemorrhage and new-onset neurologic deficits were not found during follow-up period.

The tip of microcatheter could be localized with the assistance of intraoperative C-arm CT technique, which might facilitate more precise trans-perforator embolization for deep AVM.

To investigate the clinical classification, neurosurgical treatment and prognosis of cranio-orbital foreign body injury.

The clinical data of 62 patients with cranio-orbital foreign body injury were retrospectively analyzed who received treatment at Department of Neurosurgery and Cranio-facial Trauma Center, Beijing Tongren Hospital, Capital Medical University between January 2007 and June 2017. According to the positions of residual foreign bodies, all cases were divided into orbit type (type I) and orbital-cranial type (type Ⅱ). Type Ⅱ was further divided into 3 subtypes including the supra-orbital type (type ⅡA), orbital apex type (type ⅡB) and the lateral orbital type (type ⅡC) based on the position where the foreign bodies invaded the cranial cavity. All cases underwent surgical treatment and included 12 cases of trans-orbital surgeries, 8 cases of trans-nasal surgeries, 39 cases of craniotomy and 3 cases of direct removal. After the surgical treatment, all cases were administered anti-inflammatory and neurotrophic drugs.

Among all 62 cases, 20 cases were classified as type Ⅰ and 42 cases as type Ⅱ including 17 cases of type ⅡA, 20 cases of type ⅡB and 5 cases of type ⅡC. Foreign bodies were completely extracted in 59 cases. Thirty-nine cases undergoing craniotomy had no cerebrospinal fluid leak, delayed intracranial hemorrhage or neurologic deficit post operation. Followed up for 2 months to 2 years, type I and ⅡA were associated with better prognosis. Fifteen out of 20 cases (75.0%) of type ⅡB cases reported orbital apex syndrome and 4 out of 5 cases of type ⅡC developed neurological deficits. The visual recovery in remnant cases (88.9%, 24/27) was better than that in vision loss cases (33.3%, 8/24)(χ²=3.81, P<0.01). Fifteen out of 30 cases with eye movement disorder had partial recovery (50.0%). Out of 18 cases of type ⅡB with eye movement disorder, 15 reported orbital apex syndrome. None of the patients had late-onset intracranial or orbital infection following antibiotic treatment.

The classification of cranio-orbital foreign body injury could help make operational plan. Early diagnosis and treatment, removal of foreign bodies as much as possible seem to be useful for the outcome improvement.

To investigate the values of virtual reality(VR) technique in surgical planning of lesions in craniocervical junction.

We retrospectively analyzed 21 cases with craniocervical junction lesions who were admitted to Department of Neurosurgery, Fuxing Hospital Affiliated to Capital Medical University from September 2013 to August 2017. Surgical plans were made in the Dextroscope VR system. Preoperative data including MRI and CT images were transferred into the VR computer for image fusion, reconstruction, withdrawal and surgery simulation for guidance in operation.

VR three-dimensional(3D) images of the 21 cases were successfully achieved, including nerves, vessels, skull and lesions. The anatomical relationship of lesions to the brainstem, cerebellum, arteries, veins and skull was clearly demonstrated. Surgical simulation and surgical planning of VR in the 21 patients were successfully performed. The 3D images obtained from VR were consistent with the real conditions. Total resection was achieved in 19 cases and near-total resection in 2.

Dextroscope VR system could clearly demonstrate and quantify the 3D anatomical relationship of craniocervical junction lesions to their surrounding structures, which is helpful for optimal individualized surgical planning and improvement of surgical effect.

To investigate the clinical features, diagnosis and surgical treatment of fungal infection of the central nervous system.

In this retrospective study, clinical data including manifestations, imaging, surgical procedure and therapeutic effect of 40 patients who were consecutively diagnosed as intracranial fungal infection from February 2011 to October 2016 at Department of Neurosurgery, Beijing Ditan hospital, Capital Medical University were analyzed. All 40 patients were treated with antifungal treatment. Among them, there were 23 cases with high intracranial pressure caused by Cryptococcus neoformans infection, and shunt operation was performed after failure of lowering intracranial pressure by treatment. There were 17 cases with intracranial occupying lesions, 2 of which underwent stereotactic biopsy and 15 underwent craniotomy.

Among the 23 patients with high intracranial pressure caused by Cryptococcus neoformans, 21 cases had AIDS (acquired immunodeficiency syndrome) and the other 2 had immunodeficiency due to other diseases. After operation, symptoms related to high intracranial pressure disappeared in 18 cases and were relieved in 5 without spreading of Cryptococcus neoformans infection. At the 6-month follow-up, the patients＇ original symptoms completely disappeared in 19 cases and were improved in 3. In addition, 1 case died of severe pulmonary infection. Among the 17 cases with intracranial lesions, 16 cases had AIDS and 1 case had secondary fungal infection post operation. Two of them underwent stereotactic biopsy and 15 reported good outcomes after craniotomy. None of them developed significant neurological deficits. One patient died from Pseudomonas aeruginosa infection combined with hydrocephalus.

Fungal infection of the central nervous system fungal mostly occurs in patients with immunodeficiency and is mainly characterized by hydrocephalus or intracranial space occupying lesion. The lesions could be located at the brain parenchyma, skull base and the ventricle system with no specific imaging manifestations. Treatment could be administered by shunting or excision operation and antifungal therapy.

To investigate the diagnostic value of cerebrospinal fluid (CSF) analysis in postoperative intracranial infection.

A retrospective analysis was conducted on 1, 329 patients (with 1, 329 samples of CSF) who were admitted to Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University and underwent elective craniotomy from January 2017 to December 2017. The samples were divided into 2 groups based on the culture results: the infected CSF group (n=176) and the non-infected group (n=1, 153). Comparison was conducted on the glucose level (GLU), protein level (PRO), the counts of total cells and white blood cells (WBC) and the level of lactose (LAC) between the 2 groups.

There were significant differences in GLU, WBC and LAC between CSF infected and non-infected groups (all P<0.001). The diagnostic sensitivity of GLU<2.5 mmol/L for the infection with Gram-negative bacteria was 77.6%, and the specificity was 75.0%. The diagnostic sensitivity of LAC>5.0 mmol/L was 74.1% and the specificity was 74.2%. The sensitivity and specificity of WBC>1, 000×10⁶ cells/L for infection with Gram-negative bacteria were 67.3% and 71.4%, respectively.

The results have suggested the diagnostic values of CSF GLU, WBC and LAC in postoperative intracranial infection. The GLU<2.5 mmol/L, LAC>5.0 mmol/L and WBC>1, 000×10⁶ cells/L might be predictive for intracranial infections with Gram-negative bacteria.

To determine the incidence of postoperative pulmonary complications (PPCs) and to evaluate its relationship to perioperative variables in the elderly patients (≥65 years) undergoing elective craniotomy.

A retrospective analysis was conducted on 299 patients who underwent intracranial tumor resection or intracranial aneurysm clipping from January to December 2016 at Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University. All patients were at least 65 years old. The patients′ data of preoperative, intraoperative and postoperative periods were collected to study the incidence of postoperative pulmonary complications and risk factors of postoperative pulmonary infections.

Postoperative pulmonary infection occurred in 48 (16.1%) patients and 18 (6.0%) patients had respiratory failure. Five patients died and the mortality rate was 1.7%. Fifty (16.7%) patients were diagnosed as lower extremity deep venous thrombosis. Two of them had pulmonary embolism and 1 died. The patients were divided into 2 groups according to whether there was pulmonary infection. There was a statistically significant difference in the duration of hospital stay (P=0.006), hospitalization costs (P=0.007) and lower extremity deep venous thrombosis (P<0.001) between the 2 groups. Predicting factors for postoperative pulmonary infection assessed by multivariate analyses were as follows: the age≥70 years (OR=2.024, 95%CI: 1.079-3.797, P=0.028), chronic lung disease (OR=8.951, 95%CI: 3.649-21.960; P<0.001), intraoperative infusion≥3 000 ml (OR=2.781, 95%CI: 1.451-5.239; P=0.002) and retaining of tracheal catheter after surgery (OR=5.187, 95%CI: 2.510-10.719, P<0.001).

The pulmonary infections are the most common PPCs in the elderly patients undergoing elective craniotomy. Postoperative pulmonary infection could result in prolonged hospitalization and increased hospitalization costs. Risk factors for pulmonary infections may include the age≥70 years, chronic lung disease, intraoperative infusion ≥ 3 000 ml and retaining of tracheal catheter after surgery.

To investigate the safety and efficacy of intraoperative neuroelec-trophysiological monitoring in microsurgery of subtemporal anterior transpetrosal approach to petroclival tumors.

A total of 64 patients with petroclival tumors (meningioma, n=56; trigeminal schwannoma, n=8) underwent surgical treatment with intraoperative neuroelectrophysiological monitoring via subtemporal anterior transpetrosal approach from June 2010 to April 2016 at Department of Neurosurgery, the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital).

Total resection was achieved in 41 (64.1%) cases, subtotal resection in 19 (29.7%) and partial resection in 4 (6.2%) cases. Postoperative complications included neurological dysfunction (18.8%, n=12), temporal lobe hematoma (3.1%, n=2), intracranial infection (4.7%, n=3) and 2 (3.1%) died. Preoperative latencies of brain auditory evoked potential (BAEP) Ⅰ, Ⅲ and Ⅴ waves on affected side[(1.86±0.24) ms, (4.17±0.40) ms, (6.17±0.45) ms, respectively] were longer those of contralateral side [(1.73±0.09) ms, (3.85±0.15) ms, (5.80±0.16) ms, respectively] (all P<0.05). Postoperative latency of BAEP Ⅰ, Ⅲ and Ⅴ waves on affected side [(1.79±0.14) ms, (4.04±0.27) ms, (5.94±0.72) ms, respectively] were shorter than those prior to operation (all P<0.05).

The application of neuroelectrophysiological monitoring in microsurgery of petroclival tumors via subtemporal anterior transpetrosal approach may provide an early detection of cranial nerve dysfunction and better protection of brain stem function.

To investigate the relationship between cerebellar retraction and postoperative hearing loss of microvascular decompression (MVD) for hemifacial spasm (HFS).

The study included 130 patients clinically diagnosed as primary HFS who underwent MVD at Neurosurgery Department of Rui Jin Hospital, Shanghai JiaoTong University School of Medicine from March to September of 2016. The cerebellar retraction (retraction depth and distance) were quantitatively measured on preoperative MRTA (magnetic resonance tomographic angiography). Pre- and postoperative auditory functions were assessed by pure tone average (PTA). Postoperative hearing dysfunction was defined as the postoperative PTA >50 dB combined with a decrease of PTA ≥15 dB compared with preoperative conditions. Correlation of cerebellar retraction with postoperative hearing loss was analyzed by uni- and multivariate statistical methods.

HFS was completely disappeared in 112 (86.2%) patients, spasm of musculus facialis was occasionally appeared in 10 (7.7%) patients, HFS was partly alleviated in 8 (6.1%) patients. Among those 130 cases, 12 (9.2%) patients developed hearing dysfunction post MVD. Univariate analysis showed that the retraction depth in hearing loss group was significantly greater than that in cases without hearing loss (P<0.001), whereas there was no significant difference in gender, age, HFS side or retraction distance between the 2 groups (allP>0.05). Multivariate logistic regression analysis showed that cerebellar retraction depth was significantly associated with the incidence of postoperative hearing loss (P=0.001).

The results have suggested the correlation between cerebellar retraction depth and likelihood of hearing loss following MVD for HFS. In addition, cerebellar retraction depth could be considered as a useful tool for risk prediction of hearing loss post MVD.

To explore the application of augmented reality-assisted three-dimensional(3D) CT in retrosigmoid craniotomy.

Thirty-two patients underwent retrosigmoid craniotomy at Department of Neurosurgery, General Hospital of Ningxia Medical University from August 2016 to February 2017 and were enrolled into this prospective study. 3D reconstruction of CT skull was performed before operation and a simulative burr-hole was placed on the margin of transverse-sigmoid sinus groove junction on the internal view of skull in 3D CT image, which was then saved and transferred to the smartphone. To guide the location of "key hole" , the skull image with simulated drilling points was fused with the actual skull image by augmented reality during the operation.

The treatment outcomes of 32 operations were satisfactory. No damage of venous sinus was reported. The transverse-sigmoid sinus junction was exposed in each key hole.

Simulation of the "key hole" position with preoperative 3D CT and its intraoperative localization with augmented reality could avoid the risk of sinus injury and help identify the individual location of the "key hole" in retrosigmoid craniotomy.

To explore the methods of primary and passage cultures of astrocytes by using serum-free medium.

Cells from cerebral cortices of Wistar rats within 24 h of birth were mechanically dispersed and cultured in serum-free medium. Reaching the confluence of 80%-90%, cells were digested by EDTA (ethylenediaminetetraacetic acid)-trypsin or trypsin, followed by 0.2 mg/ml or 1 mg/ml soybean trypsin inhibitor (SBTI) treatment and centrifugation for 3 min (3 000×g, 4 ℃) to stop digestion, then cells were subcultured with the ratio of 1 ∶2 or 1 ∶3. The cell phenotype was identified by immunofluorescence staining for glial fibrillary acidic protein (GFAP). The cell proliferation was detected by MTT assay.

Under the phase-contrast microscopy, primary cells in serum-free medium were prosperous, showed high refractivity and demonstrated small cell body and nucleus with extensive processes. About 95% of the primary cells were positively stained for GFAP. The passage cells grew and proliferated well in the serum-free medium. The MTT results showed that the cell number in EDTA-trypsin group was higher than that in trypsin group (0.290±0.007 vs. 0.270±0.006, P<0.010). There was no difference in cell count either between 0.2 mg/ml or 1 mg/ml SBTI groups (0.290±0.013vs. 0.290±0.017, P=0.820) or between 1 ∶2 and 1 ∶3 groups (0.340±0.070 vs. 0.320±0.030, P=0.770).

The results showed that we have established the method of primary and passage cultures of rat astrocytes by using serum-free medium, which may provide a new cell model for better evaluation of astrocyte function in vitro without interference of serum.

Cerebral hemorrhage is a common type of stroke^[1,2]。 Surgical methods to remove intracranial hematoma include: craniotomy hematoma evacuation, neuroendoscopic hematoma evacuation, puncture hematoma aspiration and ventricular puncture external drainage^[3,4,5]。 At present, neuroendoscope has been widely used in the field of neurosurgery because of its visual, simple and minimally invasive characteristics. However, the learning curve of neuroendoscopic surgery is longer than that of traditional microsurgery. Therefore, it is particularly important to carry out neuroendoscopic surgical training^[6,7,8,9]。 In this study, the skull model was designed and manufactured by 3D printing technology, and the intracranial hematoma model was prepared by filling with mixed agar and fresh pig blood clot. The model was used to simulate endoscopic and extraendoscopic intracranial hematoma evacuation, and surgical training was carried out for the trainees to test the practicability and simulation degree of the model.

Firearm-induced craniocerebral injury is more common in war period. In China, due to the strict management of firearms, it rarely occurs in peacetime. Once it occurs, its disability rate and death rate are higher^[1]。 In June 2017, a patient with craniocerebral blind tube injury caused by air gun was admitted to the Department of Neurosurgery of the First Affiliated Hospital of Chongqing Medical University. The diagnosis and treatment experience is reported as follows.

Gliomas are the most common primary tumors in the cranium, accounting for more than half of all primary tumors in the cranium. The World Health Organization (WHO) classifies gliomas as grades I to IV. Among them, grade I and II are low-grade glioma, and grade III and IV are high-grade glioma. The standard treatment of glioma is a combination of surgery, radiotherapy and chemotherapy^[1]。 In recent years, the great progress made in glioma surgery is closely related to the development of various adjuvant surgical techniques, one of which is the research and clinical application of 5-aminolevulinic acid (ALA). 5-ALA is a substance ubiquitous in human body, and its fluorescence activity was only discovered in the 1960s. In this paper, the fluorescence characteristics of 5-ALA and its research progress in glioma resection are reviewed.

With the development of emergency and critical care technology, the survival rate of craniocerebral injury and severe ischemic-hypoxic encephalopathy has been greatly improved, and more and more patients have turned from severe coma to disorders of consciousness (DOC)^[1]。 There are more than 100,000 new DOC patients in my country every year, and the annual medical expenditure reaches 30-50 billion yuan, which brings increasingly prominent social, economic and ethical problems.