Volume 34 · Issue 08 · 2018

intracranial dissecting aneurysm (IDA) is a lesion in which pathological dissection occurs between the intima and media or between the media and adventitia of an intracranial artery, resulting in bulging of the artery wall and aneurysm-like dilation^[1]。 IDA can occur in all age groups, but the high incidence period is young and middle age, which is one of the important causes of stroke. IDA occurs in the vertebral artery, followed by the basilar artery and the internal carotid artery. The clinical manifestations of this disease are diverse, which are closely related to the pathological damage pattern and lumen configuration of the diseased blood vessel wall, such as headache, subarachnoid hemorrhage (SAH), cerebral infarction and nerve compression symptoms^[2,3,4]。 The clinical diagnosis of IDA mainly depends on imaging examination. In November 2016, the Neurointerventional Expert Committee of the Neurosurgeon Branch of the Chinese Medical Doctor Association, the Neurointerventional Branch of the Chinese Stroke Society and the Young Physician Committee of the Neurosurgeon Branch of the Chinese Medical Doctor Association jointly organized national renowned experts to write and publish the "Chinese Expert Consensus on Imaging Diagnosis of Intracranial Arterial Dissection". This consensus preliminarily proposes the clinical imaging diagnosis and classification criteria of intracranial artery dissection^[5], providing standardized diagnostic criteria for this disease.

intracranial dissecting aneurysm (IDA) refers to pathological dissection and aneurysm-like dilatation between the intima and media or between the media and adventitia of intracranial arteries. It is the main cause of ischemic and hemorrhagic stroke in young and middle-aged people^[1]。 In the past, the incidence rate of the disease was considered to be low, but in recent years, with the improvement of people's health awareness and the continuous progress of medical imaging technology, the detection rate of the disease has been increasing year by year^[2]At present, it has become one of the more common diseases in neurology, surgery and neuroimaging.

To summarize the clinical outcomes of endovascular treatment of vertebrobasilar large dissecting aneurysms (VBLDAs) and to evaluate the effectiveness of endovascular treatment for VBLDAs.

The clinical data, therapeutic effects and follow-up results of 44 VBLDAs in 41 patients admitted to Department of Neurological Intervention, Beijing Tiantan Hospital, Capital Medical University from January 2010 to May 2016 were analyzed retrospectively to investigate the efficacy of endovascular treatment for VBLDAs.Among 41 VBLDAs patients undergoing endovascular treatment, 18 (43.9%) were treated with stent alone, 18 (43.9%) with stent-assisted coil embolization and 5 (12.2%) with parent artery occlusion.Patients outcome was evaluated by modified Rank Scale (mRS).

Immediate post-operative angiography showed complete occlusion in 9 (22.0%) cases, nearly complete occlusion in 24 (58.5%) and partial occlusion in 8 (19.5%) cases. None of the 41 patients had any complications during the procedures. Four patients had complications post surgery.The follow-up period is 3-60 months(mean: 12.4±11.3 months). The mRS was 0-1 in 30 case, 2-4 in 6 cases, 5-6 in 5 cases.Postoperative follow-up revealed deaths in 5 (12.2% ) patients, recurrence in 4 (9.8%) and no recurrence in 32 (78.0%).

The therapeutic effect of endovascular treatment of VBLDAs does not seem to be satisfactory and the recurrence and mortality rates of VBLDAs patients are relatively high.

To evaluate the prognosis and its predictors after treatment of the unruptured intracranial spontaneous vertebral artery dissecting aneurysms (uis-VADAs) with stent-related reconstructive techniques.

Clinical data of 182 consecutive patients harboring 182 uis-VADAs, which were treated with the stent-related reconstructive techniques at Department of Neurosurgery, Changhai Hospital, Naval Military Medical University(92 cases) and Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University(90 cases) from January 2009 to December 2015, were retrospectively reviewed and analyzed. The prognosis [favorable prognosis, modified Rankin Scale (mRS): 0-2; unfavorable prognosis, mRS: 3-6] and its predictors were evaluated and analyzed.

The postoperative control angiography confirmed complete obliteration or near-complete obliteration in 135 (74.2%) cases and partial obliteration in 47 (25.8%) cases. Four (2.2%) patients suffered from periprocedural complications, which included stent thrombosis in 2 cases and occlusion of the distal posterior inferior cerebellar artery in 1 case with favorable prognosis, and the cerebellar hemisphere and brainstem multiple infarctions in 1 with unfavorable prognosis. Of 182 patients with uis-VADAs, 12 (6.6%) had unfavorable prognosis and included 4 (2.2%) deaths. In contrast, of 178 survivals with the median follow-up of 45 months (range: 12-72 months), 170(93.4%) patients had favorable prognosis. Follow-up angiography was available for 131 (73.6%) cases and reported recurrence in 23(17.6%). The multivariate logistic regression analysis indicated that preoperative cerebral infarction(OR=9.212, 95% CI: 2.154-39.395, P=0.003) and the largest diameter of VADAs (OR=1.112, 95%CI: 1.036-1.194, P=0.003) were predictors of unfavorable prognosis in the reconstructed uis-VADAs.

Patients with stent-related reconstructive treatment for uis-VADAs seem to have favorable prognosis with a low complication rate. The largest diameter of VADAs and preoperative cerebral infarction may be 2 independent predictors of unfavorable prognosis in the reconstructed uis-VADAs.

To investigate the medium and long-term follow-up results of parallel placement of multiple stents and reconstruction technique for treatment of giant vertebrobasilar dissecting aneurysms.

Clinical data of 6 consecutive patients with 6 giant vertebrobasilar dissecting aneurysms admitted to Department of Neurology, Chinese PLA General Hospital from April 2011 to August 2012 were retrospectively reviewed. All patients were diagnosed with vertebrobasilar dissecting aneurysms by DSA whose sizes ranged from 7.9 to 14.0 mm. All patients were treated with parallel placement of multiple stents and reconstruction technique under general anesthesia. Modified Rankin Scale (mRS) was used to evaluate the outcomes.

Six patients were successfully implanted with 21 stents.All patients’signs and symptoms were improved significantly.The follow-up period ranged from 5 to 7 years.All patients underwent DSA reexamination at follow-up, The aneurysmal size was decreased in 3 patients and remained the same in 3 others.Five patients reported permanently improved symptoms. The last follow-up revealved the mRS of 0 in 1 case, 1 in 3 and 2 in 2.

Parallel placement of multiple stents and reconstruction technique for treatment of giant vertebrobasilar dissecting aneurysms could help control the dilatation of aneurysm in the medium and long-term follow-up and thus improve the patient’s clinical symptoms and quality of life.

To investigate the indications, strategies and outcomes of endovascular management of intracranial branch artery dissecting aneurysm (IDA).

From January 2013 to December 2017, 27 consecutive patients with intracranial branch artery IDA who underwent endovascular treatment at Neurosurgery Department of Huashan Hospital Affiliated to Fudan University were reviewed retrospectively. Those cases were treated with simple coiling (n=6), stent-assisted coiling (n=6) or internal trapping technique (n=15). Clinical follow-up was conducted according to modified Rankin scale (mRS) in all patients and angiographic follow-up was performed in 19 cases.

Twenty-seven patients with 27 DAs were enrolled into this study. Thirty-one endovascular procedures were performed including re-embolization of recurrent cases. The rate of successful procedure was 100.0%. Infarctions were revealed post-operatively in 3 cases and included 1 case which was asymptomatic and 2 patients who recovered at discharge with no permanent disability. Post-operative hemorrhage occurred in 1 patient and resulted in death. Among the other 26 patients, clinical follow-up was performed at 3-36 (15.1±13.1) months post treatment. Favorable outcomes were obtained in 26 patients(mRS≤2). Nineteen patients underwent angiographic follow-up which lasted for 3-35 (11.4±9.4) months. Aneurysm recurrence occurred in 2 cases which had been treated with simple coiling technique and underwent re-embolization. Recanalization occurred in 2 occluded parent arteries with no aneurysm recurrence. Chronic occlusion of the parent artery occurred in 3 without neurologic deficits.

To treat intracranial branch artery IDA, simple coiling technique seems to be associated with higher rate of recurrence. Evaluation of collateral anastomosis should be conducted in advance and optimal results could be achieved by remodeling the vascular wall with stent implantation. For DAs with difficulty in remodeling, those involving non-functional arteries or distal DAs, internal trapping with parent artery occlusion could be safe and effective.

To investigate the safety and efficacy of endovascular treatment of dissecting aneurysms of the posterior cerebellar artery (PCA).

We retrospectively analyzed 19 consecutive patients with 19 dissecting aneurysms of PCA who underwent endovascular treatment at Department of Neurosurgery, Tangdu Hospital, Air Force Military Medical University between July 2012 and June 2017. Among those, 9 cases received stent-assisted coiling, 2 cases received double stents implanting and 8 cases received occlusion of parent artery. The post-intervention results were evaluated by Raymond Classification. We followed up all cases after discharge by imaging and telephone. Telephone follow-up results were about the clinical outcome and DSA results were evaluated by Raymond Classification.

All patients in this series were treated successfully. Following initial treatment, there were 11 cases that were graded as class Ⅰ, 5 as class Ⅱ and 3 as class Ⅲ based on Raymond classification. Hemorrhagic event of aneurysmal rupture occurred in 2 cases (1 case with secondary in-stent thrombosis) during treatment and secondary cerebral infarction occurred in 1 case after treatment. All of the 3 cases recovered well at discharge. All cases were followed up for 6-28 months (mean: 13.4±3.1 months). Two patients recovered well based on telephone follow-up. Follow-up imaging results were evaluated by Raymond scale in 17 cases, which reported class Ⅰ in 13 aneurysms, class Ⅱ in 2 aneurysms. The other 2 case with recurrence received second endovascular treatment and had no more recurrence during long-term follow-up.

The endovascular treatment of dissecting aneurysms of PCA at a single center seems satisfactory and the mid-long term follow-up results are favorable. The endovascular treatment of dissecting aneurysms of PCA seems safe and feasible, which still needs to be confirmed by longer follow-up and controlled studies with larger sample size.

To explore the safety and efficacy of intravascular treatment of basilar artery dissecting aneurysms (BDA).

The clinical data and follow-up results of 21 patients with BDA treated at Department of Cerebrovascular Hybrid Surgery, Henan Provincial People's Hospital from January 2009 to June 2014 were retrospectively analyzed to explore the short-term (≤1 year) and long-term (> 3 years) outcome.

Among 21 patients, 7 were treated with stent-only technique and all of them showed partially developed immediately after operation. Fourteen cases were treated with stent-assisted coiling and included 5 with non-development, 4 with partial developed and 5 with neck residual. Complications occurred in 8 (38.1%) cases till the last follow-up. Among them, 5 had complications during perioperative period (2 deaths) and 3 reported complications during follow-up period (1 death). Seven cases were in the stent-assisted coiling group (2 deaths) and 1 was in the stent-only group (death). Hemorrhagic complications occurred in 3 cases and ischemic complications in 5 cases. Postoperative imaging follow-up lasted for 12-62 months with the median of 16 months in 19 cases. Among the 7 patients with stent-only, 4 cases had complete occlusion, 2 reported neck residual and 1 case developed recurrence. Among the 12 patients with stent-assisted coiling, 8 cases showed complete occlusion, 3 cases had neck residual and 1 had recurrence. The clinical follow-up was performed in 19 cases for 22-110 (64.6±19.9) months, and the good outcome [modified Rankin Scale (mRS) ≤2] was achieved till the last follow-up in 17 (81.0%) cases.

Endovascular treatment of BDA seems to have good short-term and long-term efficacy. However, the incidence of complications could be high.

To evaluate the efficacy and safety of overlapping Enterprise and LVIS stents-assisted coiling for the treatment of vertebral dissecting aneurysms.

From January 2015 to June 2017, 22 patients with vertebral dissecting aneurysms were treated with overlapping Enterprise and LVIS stents-assisted coiling therapy at Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University and consecutively enrolled into this study. The clinical data were retrospectively evaluated. The degree of coiling was assessed to determine the efficacy of treatment. The incidence of new or recurrent stroke due to lesioned vessel was used to assess the safety. Patients’ outcomes were evaluated based on modified Rankin Scale (mRS).

Complete occlusion was achieved in 4 (18.2%) patients, nearly occlusion in 7 (31.8%) and partial occlusion in 11 (50.0%). One (4.5%) patient died during peri-procedural period due to re-rupture. The follow-up periods ranged from 4 to 21 months with an average of 9.4±4.8 months. No complications were seen in other patients with mRS of 0. Imaging follow-up was conducted in 10 patients post procedure. Complete occlusion was achieved in 9 patients and parent artery was occluded in 1.

Overlapping Enterprise and LVIS stents-assisted coiling may be an effective and safe therapy for vertebral dissecting aneurysms.

To evaluate the utilization of high-resolution magnetic resonance vessel wall imaging (HR-VWI) in follow-up of vertebrobasilar artery dissecting aneurysms post endovascular treatment.

A retrospective study was conducted on 10 patients with vertebrobasilar artery dissecting aneurysms who underwent endovascular treatment between December 2015 and December 2017 at Department of Neurosurgery, the First Affiliated Hospital of Nanchang University. Among those, 8 cases were treated with stent-assisted coil embolization and 2 with stent embolization. We used DSA、TOF-MRA and HR-VWI at follow-up to identify the arterial stenosis and recurrence of aneurysm.

Intravascular therapy was performed in 10 patients. Immediate postoperative angiography showed complete embolization in 7 cases and partial embolization in 3. There was no postoperative complication reported. The mean follow-up period was 6.8±5.5 months (range: 3-22 months). DSA results showed arteries with stenosis in 2 cases and no stenosis in the remaining 8. There were 6 parent arteries with stenosis and 4 parent arteries without stenosis in TOF-MRA. HR-VWI revealed 3 cases with stenosis and 7 cases without stenosis. There were 3 patients with recurrence in HR-VWI, TOF-MRA and DSA. HR-VWI and DSA were compared to evaluate the artery stenosis, and 2 cases were consistent and 1 case was not. However, there were 2 cases that were consistent and 4 cases that were not consistent by comparing between TOF-MRA and DSA results. The results of DSA, TOF-MRA and HR-VWI were consistent in evaluating the recurrence of dissected aneurysms. Two cases underwent the second endovascular therapy among 3 cases with recurrence and the other 1 case received conservative treatment. DSA and HR-VWI follow-up showed no stenosis or recurrence in the 2 cases.

HR-VWI may have high clinical application value in evaluation of recurrence of vertebrobasilar dissection aneurysms, which could be used as an optional method for follow-up after endovascular treatment of vertebrobasilar dissecting aneurysms.

To investigate the endovascular treatment strategies and short-term efficacy of intracranial vertebral artery dissecting aneurysms based on imaging classification.

This retrospective study included 42 patients with 45 intracranial vertebral artery dissecting aneurysms treated at Neurosurgery Department of Nanfang Hospital, Southern Medical University between January 2008 and March 2017. A new imaging classification system was employed according to the anatomical relationship between the lesion and the posterior inferior cerebellar artery (PICA), in which the lesion located distal to the PICA was defined as type Ⅰ. If the PICA was involved in the lesion segment, it was defined as type Ⅱ (type Ⅱ a: the same side; type Ⅱ b: separated into opposite sides). Type Ⅲ was defined if the lesion was proximal to the PICA. According to clinical symptoms, vertebral artery dominance, and imaging classification, simple stenting (SO), stent-assisted coil embolization (SAC) or parent artery occlusion (PAO) was applied.

Thirteen cases with 14 aneurysms were classified as type Ⅰ, and 4 out of them were treated with SAC, 8 with PAO and 2 with SO. Eighteen cases with 19 aneurysms were classified as type Ⅱ a, and 9 out of them were treated with SAC, 7 with PAO, 3 with SO. Seven cases with 7 aneurysms were classified as type Ⅱ b, and 5 out of them were treated with SAC, 1 with PAO and 1 with SO. Four cases with 5 aneurysms were classified as type Ⅲ, and 4 out of them were treated with SAC and 1 with SO. There were 2 cases of intraoperative rupture and both died. Five (11.9%) cases developed new cerebral infarction within perioperative period. At discharge, grade Ⅴ was reported in 31 cases based on Glasgow outcome scale, grade Ⅳ in 4, grade Ⅱ in 5 and grade Ⅰ in 2 cases. The follow-up period was 3-48 months. There were no new neurological deficits. Twenty-two cases underwent follow-up DSA which reported cure in 20 cases and recurrence in 2.

Based on clinical symptoms, vertebral artery dominance and imaging classification, individualized endovascular treatment strategy seems to be safe and effective in the treatment of vertebral artery dissecting aneurysms.

To investigate the clinical characteristics of intracranial arterial dissection (IAD) and intracranial dissecting aneurysms (IDA) and to evaluate the advantages and disadvantages of various diagnostic and therapeutic methods.

From December 2003 to December 2016, a total of 86 cases of intracranial artery dissection and dissecting aneurysms were treated at Neurosurgery Department, Wuhan General Hospital of PLA. Sixty-five patients were treated with endovascular therapy. Among them, 7 patients were treated with coil embolization, 38 with stent overlapping technique, 18 with stent-assisted coiling and 2 with coil-assisted silk embolization. Twenty-one patients did not undergo surgical treatment. The degree of embolization of each patient was inspected immediately after the endovascular therapy. The patients were followed up to assess mRS (modified Rankin scale) and recurrence through CTA or DSA.

Sixty-five cases were treated successfully with endovascular treatment. The post-procedure DSA demonstrated that 53 cases were totally embolized and the other 12 cases were partially embolized. There were 3 patients developing neurologic deficit and 1 death due to re-bleeding. Among 21 cases undergoing conservative treatment, 5 cases died due to re-bleeding. Sixty-four cases were followed up for 6-12 months with an average of 8.7 months. There were 59 patients with favorable outcome (mRS: 0-1) and 5 patients with unfavorable outcome (mRS: > 2). The follow-up CTA or DSA suggested that 3 cases that were embolized partially with stent-assisted had recurrence with aneurysm enlargement. Reoperations were implemented in those 3 cases with parent artery occlusion in 2 cases and supplementary coiling in the other one.

The IAD and IDA are relatively rare kinds of cerebrovascular diseases with main manifestation of subarachnoid hemorrhage. The occurrence and progression of IAD and IDA are related to multiple factors and endovascular treatment usually leads to favorable outcome. Stent overlapping technique and stent-assisted coiling seem to be the primary endovascular therapies. Occlusion of lesioned vessel or parent artery could be considered as complementary method.

To investigate the prognostic factors in patients with pilocytic astrocytomas.

We retrospectively analyzed the clinical data of 87 patients with pilocytic astrocytomas including 84 undergoing tumor resection and 3 undergoing biopsy at Department of Neurosurgery, Affiliated Brain Hospital of Medical College of Jinan University from January 2005 to August 2011. The significance of prognostic variables in the survival expectancy was evaluated with Kaplan-Meier method and Cox proportional hazard regression model.

The 5-year progression-free survival rate was 70.0%. The 5-year cumulative survival rate was 89.3%. Univariate analysis showed that age (OR=1.1, 95%CI: 1.0-1.1, P=0.001), lesions site (OR=12.2, 95%CI: 1.6-92.8, P=0.016), relapse (OR=14.8, 95%CI: 3.2-67.7, P=0.001) and extent of resection(OR=3.7, 95%CI: 1.2-11.7, P=0.023)were related to patient's prognosis. Multivariate analysis showed that age ≥19 years old (OR=2 296.8, 95%CI: 7.1-742 006.4, P=0.009)and recurrence (OR=14.5, 95%CI: 1.0-203.5, P=0.047) were independent risk factors affecting the overall survival rate of pilocytic astrocytomas.

The overall prognosis of pilocytic astrocytomas seems relative good except for those with age ≥19 years old and/or tumor recurrence.

To investigate the effect of decompression of the optic nerve canal by subdural approach on traumatic optic neuropathy (TON) and the predictive value of DTI.

A total of 52 cases with optic nerve neuropathy which underwent microsurgical depression via transcranial subdural approach were retrospectively analyzed from January 2008 to December 2017 at the Neurosurgical Department of No. 101 Hospital of PLA. Before operation, CT and DTI scans were administered.

The patients were followed up for 3 months after operation. Forty-three patients required the sight recovery to some extent after operations. The effective rate was 82.7% (43/52) and the significant effective rate was 26.9% (14/52). The 43 patients who totally lost their sights had the effective rate of 88.2% (34/43) and the significant effective rate of 27.9% (12/43). Five patients underwent DTI examination. 2 patients whose the optic nerve conduction bundles were not complete the sights did not recover after operation. Another 3 patients whose DIT examination showed the optic nerve conduction beam was intact the postoperative sights were effectively restored.

The decompression of the optic nerve canal by subdural approach seems safe and effective for the patients of TON. The length of duration longer than 72 hours post injury in the TON patients could not exclude the chance of operation. DTI might be the important predictor for the effect of the operation.

To investigate the neurosurgical treatment strategies of the foreign body injury in anterior-middle skull base.

Clinical data of 68 cases with foreign body injuries in anterior-middle skull base admitted to Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University from January 2003 to December 2017 were retrospectively analyzed. The foreign bodies were removed by craniotomy in 39 cases, by endoscopic skull base surgery in 18 cases, and were pulled out directly in 11 cases. Three cases underwent endovascular treatments.

Foreign bodies were completely removed in 65 cases and partially removed in 3 cases. Follow-up period ranged from 3 months to 3 years with the median duration of 7 months. Eye-lid infection occurred in 1 case, transient intracranial infection in 3 cases, cerebrospinal fluid leakage in 2 cases, and intracranial hemorrhage in 2 cases. No death occurred in this group. Of 53 cases with preoperative visual defect, 34 (64.2%) had visual improvement. Of 35 cases with eye movement defect, 19 (54.3%) partially recovered. Five cases with facial numbness had no recovery. Of 3 cases with paralysis, 2 had improvement.

Good outcome and low disability rate and mortality could be achieved by surgical treatment with various strategies designed based on the characteristics and locations of skull base foreign bodies.

To study the feasibility of using carbon nanoparticles to intraoperatively explore the central lymphatic system.

Between December 2016 and July 2017, a series of 7 patients with meningiomas were admitted to Neurosurgery Department at Binzhou Medical University Hospital and enrolled into this retrospective study. Subdural injection of carbon nanoparticles suspension (CNPS) was performed over the tumor area during operation. We observed the epidural dyeing and diffusion of CNPS, collected the images and conducted meningeal pathology examination.

Among 7 cases, 5 cases demonstrated varying extent of CNPS drainage including 3 with drainage into the sagittal sinus, 1 with drainage to cranial base and 1 with drainage into the sagittal sinus and venous dyeing below the tumor entity. HE staining indicated that there was an obvious potential lacuna beside the dyed channel which had little nucleated cells and lacked endothelial cells. There were abundant mast cell-like nucleated cells around the area with dense dyeing of CNPS.

It appears to be feasible to use CNPS to explore the central lymphatic system, which is closely related to various pathophysiological mechanisms and worth further investigating.

Hypertensive cerebral hemorrhage accounts for 10% ~15% of cerebrovascular diseases, and is considered to be the most devastating type of stroke because of its high disability and mortality rate^[1]。 Cerebral infarction after hypertensive cerebral hemorrhage is a serious complication, which can increase the mortality and disability rate of patients. This study retrospectively analyzed the clinical data of 12 patients with cerebral infarction after lateral fissure-insular approach microsurgery for hypertensive hemorrhage in the basal ganglia area from January 2012 to June 2016 in the Department of Neurosurgery of Jinhua Central Hospital.

To investigate the apoptotic mechanism of A172 cells with high-expressed RNA binding motif protein (RBM-5).

Nineteen glioma specimens, gathered from Neurosurgery Department of the First Affiliated Hospital of Chongqing Medical University from August 2015 to June 2017, were retrospectively brought into this research and immunohistochemistry was performed to detect the expression of RBM-5. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to measure the discrepant expression of RBM-5 in A172, U87, U251 and SHG-44 human glioma cells. The lentiviral synthesized in vitro was performed to transfect A172 cell line. Afterwards, the expression of RBM-5 in mRNA level of cells among three groups (namely experimental group, control group and blank group) was evaluated using qRT-PCR. RBM-5, BAX, Bcl-2 and Cleaved-caspase-9 in cells of 3 groups were assessed using Western Blot. Finally, the apoptotic effects of cell lines among 3 groups were investigated using flow cytometry.

Immunohistochemistry demonstrated that RBM-5 in low-grade glioma tissues (WHO Ⅰ-Ⅱ, A values respectively represented 0.021±0.011 and 0.004±0.002) displayed significantly more expression than that in high-grade glioma tissues (WHO Ⅲ-Ⅳ, A values represented 0.000±0.000) (F=7.410, P<0.05). The qRT-PCR results showed that the expression values of RBM-5 in A172, U251, U87 and SHG-44 cells were 0.494±0.186, 1.168±0.775, 2.437±1.281 and 3.547±1.177, respectively, which implied that RBM-5 displayed the least expression in A172 cell line and, on the contrary, the most in SHG-44 cell line (F=6.023, P<0.05). The results of Western Blot verified that RBM-5 (202.854±6.573), BAX (208.000±10.324) and Cleaved-Caspase-9 (112.811±1.684) of A172 cell line with high-expressed RBM-5 represented obviously more expression than those of control group (117.156±0.357, 152.105±2.819 and 62.873±1.313, respectively) and those of blank group (119.283±1.356, 153.159±0.571 and 73.281±4.480, respectively), whereas Bcl-2 (60.420±1.986) represented less expression than that of control group (107.157±2.056) and that of blank group (99.563±3.997). The flow cytometry suggested that the apoptotic percentages of experimental group (20.88%±0.72%) displayed more than that of control group (9.51%±0.57%,P<0.05) and that of blank group(9.49%±0.49%,P<0.05).

High-expressed RBM-5 in A172 glioma cells possibly promotes apoptosis via up-regulating BAX and Cleaved-Capsaed-9 while down-regulating Bcl-2, which might become a new target of clinical therapy.

To analyze the effect and safety of treating intracranial dissecting aneurysm (IDA) by deconstruction and reconstruction in China.

We searched the literatures about interventional treatment of IDA in Pubmed and Wanfang medical ranging from January 2008 to December 2017 and withdrew the data from abstracts in literature. Comparing the effectiveness and safety of deconstruction and reconstruction in treating IDA by using RevMan 5.3, this study counted events consisting of postoperative recurrence, death related to IDA, and other perioperative complications.

A total of 18 articles reported 1 102 cases of IDA including 269 cases with deconstruction and 833 cases with reconstruction. In the deconstruction group, there were 8 (2.97%) cases of recurrence, 5 (1.86%) deaths, 15 (5.58%) cases of other perioperative complications. In the reconstruction group, there were 98 (11.76%) cases of recurrence, 10 (1.20%) cases of death and 16 (1.92%) cases of other perioperative complications, which were summed up to a total of 124 (14.89%) cases. In the fixed effect model, comparison between the 2 groups in dissection recurrence (OR=0.36, 95%CI: 0.20-0.64, I²=12%, P=0.0005) indicated that the risk of recurrence in deconstruction group was lower than that in the reconstruction group. In addition, comparison of the complications except recurrence (OR=2.35, 95%CI: 1.27-4.23, I²=4%, P=0.0006) showed that the risks of mortality, disability and other complications were lower in deconstruction group. Comparing all complications (OR=0.69, 95%CI: 0.45-1.05, I²=37%, P=0.0800) suggested that deconstruction was better than reconstruction in treating IDA.

The effect and safety of deconstruction might be better than those of reconstruction in treating IDA. With the development of materials, the effect of reconstruction would be expected to improve.

As a new auxiliary stent for the treatment of intracranial aneurysms, LVIS stent is a braided, self-expanding nickel-titanium alloy closed-loop stent. It has high metal coverage, and the mesh diameter is only 1 mm, so it can effectively avoid coil protrusion and escape, and is especially suitable for auxiliary embolization of small wide-neck aneurysms^[1]。 Although theoretically, LVIS stents have ideal compliance and adherence, any type of stent may have difficulty in adherence at the arterial turning point. In particular, LVIS stents are braided stents. If the specification selection is biased or the release technique is improper, it may appear poor opening at the arterial turning point, unable to adhere to the wall, and even lead to thromboembolic complications^[2]。 The experience of embolization of aneurysms in the siphon part of internal carotid artery with LVIS stent assisted by coil is reported in 2 cases. The specification selection and release technique of LVIS stent are discussed.

Common sellar tumors include pituitary adenoma, craniopharyngioma, Rathke cyst, etc. Craniopharyngioma is the most common with calcification in imaging^[1]However, a few pituitary adenomas and Rathke cysts may be accompanied by calcification^[2,3]。 Because of the lack of clinical and imaging specific manifestations, preoperative diagnosis is very difficult and easy to be misdiagnosed. This article retrospectively analyzed the clinical data of a patient with calcified pituitary adenoma admitted to the Department of Neurosurgery of the Second Affiliated Hospital of Zhejiang University School of Medicine in April 2017, and summarized and discussed the pathogenesis and clinical characteristics of calcified pituitary adenoma in combination with previous literature.

Turcot syndrome (TS), also known as brain tumor-polyposis syndrome (BTPS), is a rare genetic disease first reported by Turcot in 1959. Its clinical features are familial multiple colon adenomas, colorectal cancer and malignant tumors of central nervous system. At present, 11 relevant reports have been retrieved in China, and more than 150 cases have been reported abroad^[1]。 A patient with Turcot syndrome was treated in the Department of Medical Oncology, Minhang Branch, Fudan University Cancer Hospital, and the report is as follows.

Fungal infections usually occur in patients with severe immunodeficiency^[1], such as human immunodeficiency virus infection^[2,3]Brain abscess after bone marrow transplantation^[4]。 Brain abscess is mostly secondary to Candida infection^{[5,6,7,8,9,10,11,12]}。 A patient with primary brain abscess caused by Candida glabrata was admitted to the Department of Neurosurgery of Sino-Japanese Friendship Hospital of Jilin University. Its peripheral blood IgG, IgM and complement C3 were all lower than normal levels, suggesting abnormal immune system. Such cases are rarely reported. The diagnosis and treatment experience is reported as follows.

Nervous system damage often leads to sensory and/or motor dysfunction, language dysfunction, and even more serious consequences. At the same time, the repair and regeneration ability of the nervous system is limited, the damage repair speed is slow and the repair is incomplete, so the complete recovery rate of nervous system damage is lower than that of other diseases^[1]。 Stem cell transplantation is an important research direction in nerve repair and regeneration. The researchers hope to repair and regenerate nerves by transplanting stem cells, especially neural stem cells (NSCs), into damaged brain tissue and differentiating into functional nerve cells^[2]。 With the establishment and development of various techniques for inducing differentiation, stem cells and NSCs can be obtained from various pathways^[3]。 However, the effect of transplantation therapy is often poor. One of the key links is that few cells of NSCs can migrate to the injured site, differentiate and replace the original nerve structure and function after transplantation^[4]。

Parkinson's dissease (PD) is a dyskinesia characterized by neurodegeneration. The diagnosis of PD mainly depends on motor symptoms such as slow movement, myotonia and tremor^[1]。 The main treatment is dopamine replacement therapy (DRT) based on nigrostriatal dopamine neuronal degeneration. However, with the progress of research, non-motor symptoms (NMS) have gradually been paid attention to. NMS clearly associated with the dopamine pathway include anosmia, rapid eye movement sleep behaviour disorder (RBD), depression, constipation, and the like. Deep brain stimulation (DBS) has been used in PD for more than 30 years, and its efficacy for tremor, rigidity, bradykinesia and other motor symptoms is clear, but the efficacy for NMS is still inconclusive. In recent years, the results of DBS in the treatment of NMS have been gradually reported. By searching the relevant literature in recent years, the current research status of DBS in the treatment of NMS is summarized as follows.