Volume 34 · Issue 09 · 2018

Epilepsy is one of the most common chronic neurological diseases in childhood. Epileptic seizures are extremely harmful to children's nervous system and development, especially drug-refractory epilepsy drug resistant epilepsy (DRE). At present, there are about 10.5 million cases of epilepsy in children worldwide^[1]Many children suffer from epileptic seizures while also suffering from comorbidities such as learning difficulties, mental retardation, developmental delay, mental behavioral disorders and psychosocial diseases, which are more obvious in children with DRE. According to statistics, about 35% of patients have unsatisfactory seizure control, most of them are children, and 25% of these patients are DRE^[2]。 Poor seizure control will have a serious impact on the growth, development and cognition of children, especially infants and young children. Frequent and severe seizures will cause development to stop or even regress, and in severe cases, they will develop into epileptic encephalopathy, which will eventually cause irreversible damage to the nervous system. Therefore, the importance of completely eliminating the attacks caused by DRE in children cannot be overemphasized clinically.

To explore the post-hemispherectomy seizure outcome and its predictors in children with refractory epilepsy.

A total of 76 consecutive children were retrospectively reviewed who underwent hemispherectomy from June 2014 to October 2016 at Pediatric Epilepsy Center, Peking University First Hospital. Eligibility criteria included hemispherotomy, age of less than 14 years and follow-up of more than 12 months post surgery. Seizure outcomes and prognostic predictors were assessed.

The last average follow-up time was 2.1±0.8 (1.0-3.5) years and no cases were lost. At last follow-up, 66 (86.8%) patients were seizure free (Engel Ⅰ) and 10 (13.2%) experienced seizure recurrence with Engel Ⅱ in 1 (1.3%), Engel Ⅲ in 4 (5.3%) and Ⅳ in 5 (6.6%). In Kaplan-Meier survival curve, the estimated seizure-free rate was (95.2±2.8)% at 1 year, (86.3±5.6)% at 2 years and (72.5±8.8)% at 3 years post surgery. The actual seizure-free rate was 86.8% (66/76) at 1 year, 83.7% (41/49) at 2 years and 81.0% (17/21) at 3 years post operation. There was no statistically difference in demographic, types of antiepileptic drugs before surgery, clinical manifestations or side of surgery between the seizure-free group and seizure-recurrence group. In interictal electroencephalogram (EEG), the ipsilateral discharges of the lesion were predominant (63.6%, 42/66) in seizure-free group and the seizure-recurrent group mainly (9/10) showed extensive or bilateral focal discharges. In ictal EEG, the proportion of non-lesional ipsilateral onset in the seizure-free group (16.7%, 11/66) was lower than that in the seizure-recurrent group (5/10). On cerebral MRI, the proportion of contralateral abnormalities was lower in the seizure-free group (19.7%, 13/66) than that in the seizure-recurrent group (5/10). The incidence of acute postoperative seizure (APOS) in seizure-free group (4.5%, 3/66) was lower than that in the seizure-recurrent group (3/10). In multivariate logistic regression analysis, APOS was independent risk factor for prognosis (OR=10.55, 95.0%CI: 1.05-106.45, P=0.046).

The seizure free rate of hemispherectomy in children with intractable epilepsy is about 86.8% in 2 years. APOS may be one of unfavorable predictors in epilepsy surgery.

To investigate the clinical features, evaluation methods and value of resective surgery in children with epilepsy caused by rolandic focal cortical dysplasia (FCD).

Eight patients with epilepsy related to rolandic FCD were admitted to Epileptic Center, Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from May 2015 to June 2017 and enrolled into this retrospective study. All patients underwent head MRI, positron emission tomography (PET)-CT and video-EEG. Three patients underwent stereo-electroencephalography (SEEG) electrode implantation and EEG monitoring lasting for 1-7 days. According to the patient's epileptic symptoms, imaging, and scalp or intracranial EEG results, the epileptogenic zone was identiried and surgical resection was performed. All patients were followed up through outpatient visits or telephone. The Engel scale was used to evaluate the surgical outcome and the limb strength was also assessed.

Among 8 patients, the epileptogenic zone was confined to the central area in 2 and surrounding areas of the central area in the other 6 cases, which included the operculum, secondary motor area, premotor area and insula. Postoperative pathological findings showed FCD type Ⅱ in 7 and FCD type Ⅲd in 1. Image post-processing techniques and SEEG techniques facilitated the determination of epileptogenic zone. The follow-up duration for the 8 patients was 0.3-2.5 years, with the median of 0.6 year. All patients showed epilepsy remission (Engel Ⅰ). At 1 week post surgery, 7 patients had varying degrees of decline in contralateral limb muscle strength and grade 0 was reported in the most severe case. Until the last follow-up, the limb muscle strength of 7 patients improved with varying degrees.

Children with rolandic FCD have complicated epilepsy symptoms. The prognosis could be satisfactory following resection surgery. The muscle strength might decrease during a short term post operation and gradually recover. Early surgical intervention in children with such conditions may provide more benefits.

To explore the value of stereo-electroencephalogram (SEEG) based on multimodal images in the evaluation and treatment of pediatric refractory epilepsy.

A retrospective analysis was conducted on 11 cases who underwent stereotactic intracranial electrode implantation at Department of Neurosurgery, Children′s Hospital of Fudan University from July 2016 to August 2017. The epileptogenic zone was evaluated by analyzing the seizure semiology, electrophysiological studies and neuroimaging. Image processing software SINOPLAN was used for multimodal image fusion, three-dimensional visualization of the cerebral cortex and SEEG electrode implantation. According to the EEG recorded through the stereotactically implanted electrodes, the epileptogenic focus was identified and the resection range was determined to guide the second-stage operation. Engel classification was used to evaluate the outcomes post operation. Meanwhile, the language and neuropsychological development of the children were evaluated.

In 11 patients, 103 electrodes were implanted with an average of 9±2 per patient. The epileptogenic foci were identified and surgical resections were performed in all patients. No bleeding, infection, cerebral infarction or hydrocephalus occurred post operation. The postoperative pathological results showed focal cortical dysplasia (FCD) Ⅱa in 2 cases, FCD Ⅱb in 5, FCD Ⅲa in 1, FCD Ⅲb in 1, FCD Ⅲc in 1 and hippocampal sclerosis in 1. The follow-up time was 6-16 months, with an average of 10.4±2.9 months. Engle Ⅰ was reported in 10 cases and Engle Ⅲ in 1. None of the patients had language dysfunction. One patient with epileptic zone involving paracentral lobule had contralateral lower limb dysfunction and recovered following rehabilitation. The neuropsychological development was improved in 2 patients after surgery(pre-operation: 51 and 55 vs. post-operation: 75 and 81) assessed by Merriam-Webster's intelligence scale.

Multimodal images are beneficial to the identification of epileptogenic foci and could guide implantation of SEEG electrodes which seems safe and efficient under three-dimensional visual condition and thus suitable for children with intractable epilepsy.

To investigate the feasibility, efficacy and safety of intraoperative neurophysiological monitoring (IOM) in epilepsy surgery for children.

A retrospective study was conducted on the clinical data of 83 children with drug-resistant epilepsy who underwent resective surgery and IOM at Children Epilepsy Center, Peking University First Hospital from August 2015 to April 2017. We used the phase reversal technique of somatosensory evoked potential to identify the central sulcus and motor evoked potential (MEP) by direct electrical stimulation of primary motor cortex to map the motor function. MEP was continuously monitored to observe the change of amplitude of compound muscle action potential (CMAP) recorded from various muscles.The seizure outcome was evaluated by Engel classification. The motor function was evaluated by the results of nerve system examination, Peabody motor development scale and video of the patients.

Out of 83 patients, 80 (96.4%) received successful IOM. No seizures or other adverse events were observed during IOM in this series. The range of minimum effective electrical stimulation which can evoke CMAP at muscles was 2-38 mA, with the median of 20 mA. There was a negative correlation between this minimum effective stimulation and age (r=-0.302, P=0.001). The rate of seizure free was 88.8%(71/80) in this study and there was no correlation between ages and sites of surgery(P=0.327, P=0.475). There was no new permanent motor deficit in 76 patients who demonstrated stable CMAP during IOM. On the other hand, 3 out of 4 patients who had irreversible disappearance of CMAP during IOM developed new permanent motor deficits post surgery. There was significant correlation between stable CMAP and good motor outcome (P<0.001).

IOM is safe and can be ued in children’s epilepsy surgery. The electrical stimulation intensity during continuous MEP monitoring in children should be relatively elevated, and there is significant negative correlation between electrical stimulation and age. IOM could reflect the motor function in real time during surgery, and epileptogenic zone could be resected as completely as possible with good protection of motor function at the same time. The patients might have a good outcome as seizure free without new motor deficits.

To explore the values of stereoelectroencephalography (SEEG) in pediatric patients with drug-resistant epilepsy.

The clinical data of 24 pediatric patients with drug-resistant epilepsy in whom SEEG were performed from October 2014 to July 2017 at Department of Neurosurgery, Xuanwu Hospital, Capital Medical University were retrospectively analyzed. Eight patients underwent surgical resection and 15 underwent SEEG-guided radiofrequency- thermocoagulation (RF-TC) with the aim of ablating the epileptogenic zone (EZ). Besides, 1 patient who showed multiple and distant onset zones underwent both resection and SEEG-guided RF-TC. The postoperative outcome was evaluated by Engel classification.

A total of 160 (average: 6.7±2.4, range: 2-13) electrodes were implanted in 24 patients. Postoperative follow-up time was 13±8 months (range: 3-36 months). The outcome of Engel class Ⅰ was reported in 14 patients (resection: 3 cases, RF-TC: 11 cases), class Ⅱ in 7, class Ⅲ in 2 patients and class Ⅳ in 1. No permanent neurological deficit was found.

SEEG in pediatric drug-resistant patients could facilitate the exploration of EZ and its scope to guide the surgical treatment, which might have good outcomes.

To explore the strategy of surgical treatment for children with low-grade tumors associated with epilepsy.

Clinical data of 30 patients with low grade tumors (ages: 1-14 years) were retrospectively reviewed who underwent surgery from January 2011 to June 2016 at Department of Neurosurgery, Guangdong Sanjiu Brain Hospital. Lesions were located in multiple cerebral lobes in 8 cases, in functional zones in 8 and in non-functional zones in 14 cases (including 10 cases with lesions in the medial temporal lobe). The surgical strategy included subtotal resection, gross-total resection and enlarged resection. Postoperative effects were evaluated by Engel classification.

A total of 30 patients underwent surgical treatment. Subtotal resection was achieved in 8 cases, gross-total resection in 5 and enlarged resection in 17 (including 9 cases undergoing anterior temporal lobectomy and 1 case of selective amygdalohippocampectomy). The final pathology suggested that there were 11 cases of ganglioglioma, 8 cases of dysembryoplastic neuroepithelial tumor, 2 cases of pilocytic astrocytoma, 3 cases of oligodendroglioma, 3 cases of pleomorphic xanthoastrocytoma, 1 case of diffuse astrocytoma , 1 case of oligoastrocytoma and 1 case of meningioma. The follow-up duration was 1-6 years, with an average of 3.0±1.6 years. For postoperative recover: 28 cases had an outcome of Engel Class I, 1 patient was in Engel Class Ⅱ and 1 patient was in Class Ⅳ.

For surgical treatment for children with low-grade tumors associated with epilepsy, more attention should be paid to preoperative assessment of the epileptogenic zone. The tumor is not exactly the same as the epileptogenic zone and the strategy of surgical treatment depends on the tumor characteristics as well as whether it is located at temporal lobe or involved in functional areas.

To explore the trend and distribution of spontaneous subarachnoid hemorrhage (SAHs) mortality among the residents with different characteristics from 1999 to 2015 in Tianjin, and to provide basis for prevention and control of SAHs.

SAHs mortality data in 1999-2015 were collected from Tianjin population-based mortality surveillance system maintained by Tianjin Center for Disease Control and Prevention (CDC) and permanent residents’ population data were from Tianjin Municipal Public Security Bureau. Standardized mortality rates were calculated for SAHs and adjusted for age and gender using the year 2000 world standard population. Joinpoint regression and Cochran-Armitage trend were used to determine the statistical significance of differences in mortality trends.

The crude mortality rate of SAHs in Tianjin from 1999 to 2015 was 0.62/100 000 to 1.23/100 000. Adjusted SAHs mortality rate from 1999 to 2009 was 0.56/100 000 to 1.59/100 000, indicating an increased trend (Z=9.88, P<0.001) with an annual percent change (APC) of 10.95%. Adjusted SAHs mortality rate was decreased from 2009 to 2015: 1.59/100 000 to 0.72/100 000 (Z=-6.33, P<0.001) and APC was -10.16%. Those trend changes were similar for male and female residents (P<0.001). The SAHs mortality rate of male (crude: 0.57/100 000-1.22/100 000, standardized: 0.53/100 000-0.75/100 000) was not significantly different with that of female (crude: 0.67/100, 000-1.23/100, 000, standardized: 0.60/100, 000-0.68/100, 000) during the 17 years. SAHs mortality rate increased with age. Adjusted SAHs mortality in urban residents increased from 1999 to 2008 (Z=4.15, P<0.001, APC=6.30%) and decreased in the year from 2008 to 2015 (Z=-5.39, P<0.001, APC=-10.94%). Adjusted SAHs mortality in rural residents increased from 1999 to 2011 (Z=14.79, P<0.001, APC=19.02%) and decreased from 2011 to 2015 (Z=-5.81, P<0.001, APC=-21.22%). The SAHs mortality rate was generally higher in urban residents than in rural residents in 1999-2008, while it was generally higher in rural residents than in urban residents in 2009-2015.

Our results suggest that SAHs mortality in Tianjin increased from 1999 to 2008 and decreased from 2009 to 2015. Compared with urban residents, rural residents had lower SAHs mortality from 1999 to 2008 and higher SAHs mortality in the recent 7 years. Further efforts to reduce SAHs mortality in Tianjin are needed particularly for the people in rural areas.

To review the treatment effect of brain gliomas and to investigate the clinical factors influencing the patients′ outcomes.

A total of 741 patients were enrolled into this retrospective study who underwent their first operation and were diagnosed as primary brain gliomas at Neurosurgery Department of Sun Yat-sen University Cancer Center between January 2000 and December 2016. The patients were treated with various adjuvant therapies after operation. Survival difference between gliomas with varying tumor pathology and treatment methods were evaluated by Kaplan-Meier method with log-rank test. The multivariate Cox regression analysis of the clinical factors related to the patient′s outcome was performed.

A total of 741 patients with follow-up data were reviewed. Tumor total resection and subtotal resection were respectively achieved in 482 (65.0%) and 115 (15.5%) patients. Sixty-four cases were diagnosed as WHO grade Ⅰ glioma, 194 as grade Ⅱ, 191 as grade Ⅲ and 292 as grade Ⅳ. At a median follow-up of 17.0 months (1-188 months), 314 patients were died. The median overall survival (OS) of patients with grade Ⅰ, Ⅱ, Ⅲ, Ⅳ gliomas were not reached (>76.0 months), 123.0 (107.5-139.4) months, 33.0 (25.5-40.5) months and 17.0 (15.3-18.8) months, respectively. The survival was decreased with the increase of pathological grades of gliomas (χ²=138.200, P<0.001). High-grade gliomas (grade Ⅲ and Ⅳ) treated with postoperative radiotherapy and chemotherapy had longer survival [36.0 (29.4-42.6) months] than those undergoing radiotherapy or chemotherapy only [23.0 (16.3-29.7) months,P=0.012] and those without adjuvant treatment [10.0(9.0-11.0) months, P<0.001]. Low-grade gliomas (grade Ⅱ) treated with postoperative radiotherapy or chemotherapy had better prognosis [median OS: not reached (>73.0 months)] than those undergoing surgery only [54.8 (24.9-84.7) months,P=0.004]. In addition, multivariate analysis revealed that age, histology type, extent of tumor resection and postoperative radiotherapy and chemotherapy were independent factors associated with OS of high-grade gliomas (all P<0.05). For low-grade gliomas, Postoperative radiotherapy or chemotherapy could improve the survival of patients with Low-grade gliomas. age, tumor pathology and resection extent of tumor were independent prognostic factors (allP<0.05).

Postoperative radiotherapy and chemotherapy could improve the survival of patients with high-grade gliomas. Age, tumor pathology and resection extent of tumor seem to be major factors related to the clinical outcome of brain gliomas.

To investigate the factors affecting long-term quality of life in patients with craniopharyngiomas following surgical resection.

A retrospective analysis was conducted on the clinical data of 18 patients with primary craniopharyngiomas who underwent surgical resection at Department of Neurosurgery, Fuxing Hospital, Capital Medical University and 61 cases undergoing operations at Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University. Quality of life was assessed based on a short-form health survey (SF-36 version 2) for all patients. The mean value of physical component summary (PCS) and mental component summary (MCS) were calculated according to the results of SF-36 scores accomplished by all 79 patients. The patients whose PCS and MCS were both over 50 were categorized into good group (60 cases); those with either or both scores less than 50 were regarded as fair life quality (19 cases). T test and chi-square test were utilized to identify the factors influencing the quality of life in patients before and after surgery.

In all the 79 cases, gross total resection was achieved in 74 patients, partial resection in 5 patients.The average follow-up time was 6.1 years (range: 4-9 years). Cortisol hormone deficits (P=0.004), thyroid hormone deficits (P=0.010) and obesity (P=0.023) during follow-up significantly affected the outcomes.

The long-term quality of life of patients with craniopharyngiomas following surgical resection seems to be affected by the cortisol hormone deficits, thyroid hormone deficits and obesity. Attention should thus be paid to the protection of hypothalamus structure during surgery.

To assess the reliability and efficacy of microprobe vascular Doppler(MVD) evaluating the patency of anastomotic vessels in patients with unilateral symptomatic carotid artery occlusion(SICAO) undergoing superficial temporal artery to middle cerebral artery bypass surgery(STA-MCA bypass).

Total 50 cases of SICAO patients from July 2012 to May 2016 at Department of Neurosurgery, the First Affiliated Hospital of Soochow University, confirmed by DSA and CT perfusion were treated with STA-MCA bypass surgery. The hemodynamics parameters of M4 segment of middle cerebral artery(MCA) and superficial temporal artery (STA) were evaluated by MVD intraoperation. Postoperative CTP and DSA examinations were performed to evaluate the perfusion of the ischemic area and the patency of anastomotic vessels. Recurrent stroke was recorded 6-12 months after operation and neurological recovery was assessed by modified Rankin scale(mRS).

(1)Intraoperation: MVD revealed the blood flow velocity of MCA M4 segment and the pulsatility index(PI) increased(all P<0.001) and the flow direction of M4 proximal was reversed. The blood flow velocity of STA increased but the PI sharply decreased(allP<0.001) and it appeared "intracranial arterial spectrum" . (2)Seven days after operation: Carotid Doppler ultrasonography (CDU) revealed the diameter and the blood flow volume of STA anterior to the tragus obviously increased (P<0.05). CTP revealed the rCBF of basal ganglia level increased, the rMTT and rTTP decreased and the difference were statistically significant(allP<0.05). (3)Six months after operation: DSA revealed the patency of anastomotic vessels access 96%(48/50). (4)Evaluation of recurrent stroke and neurological function: The postoperative mRS score decreased or unchanged in 96%(48/50)of the patients. No recurrent stroke was found in 48 patients with the patency of anastomotic vessels.

MVD can evaluate hemodynamic changes in STA-MCA bypass surgery in a simple, no-invasive and dynamic way. When STA showing the "Intracranial arterial spectrum" is a reliable index to judge the patency of anastomotic vessels.

To explore the safety and reliability of intracranial electrode implantation based on stereotactic frame.

Sixty patients with refractory epilepsy were retrospectively included from June 2015 to June 2016 in Beijing Tiantan-Fengtai Epilepsy Center. We analyzed relevant indexes which might influence the SEEG (stereo-electroencephalograhy) electrode implantation target deviations and complications related to the implantation. Video-EEG monitoring was conducted after the electrode implantation before operation was performed to remove the seizure focus according to the preoperative evaluation. Outcomes were followed-up.

Sixty patients underwent a total of 474 intracranial electrodes implantation with an average electrode number of 8.0 ± 2.5 and an average application time of 13.5 ± 3.1 min per electrode. The entrance point deviation, target deviation, electrode-skull angle and electrode length in the brain were 0.0-8.3 mm (median: 1.1 mm), 0-12 mm (median: 1.4 mm), 44.0-90.0° (median: 67.5°) and 15-97 mm (median: 43 mm), respectively. The target deviation was positively correlated with the deviation of entry point (r=0.426, P<0.01). The target deviation was negatively correlated with the electrode skull angle (r=-0.247, P<0.01). The target deviation was positively correlated with the length of electrode in the brain (r=0.145, P<0.01). There are totally 6(10%) cases developing complications including small amount of cerebral hematoma in 3(5%), brain abscess in 1(2%) and electrode bending in 2(3%). Fifty-three patients were followed up for 1-2 (1.5±0.5) years post resection surgery. There was 72%(38/53) of the patients achieving seizure free (Engel Ⅰ). Meanwhile, seizures remained in the other 28%(15/53) of the patients (Engel Ⅱ-Ⅳ).

The stereotactic frame-based intracranial electrode implantation technique seems safe and reliable. Combined with postoperative video-EEG analysis, it could be applied for localization of epileptogenic zone.

To investigate the efficacy and safety of minimally invasive posterior lumbar interbody fusion (Mis-PLIF) for treatment of lumbar degenerative diseases (LDD).

This study retrospectively reviewed and included 25 patients diagnosed with LDD and treated at Department of Neurosurgery, Xuanwu Hospital, Capital Medical University from December 2016 through August 2017. With microscope and navigation, we used guidewire to insert cortical bone trajectory (CBT) screw and improved PLIF, which was less invasive. CT and MRI examinations, Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and Japanese Orthopedics Association (JOA) scales were applied at 1 month, 3 months, 6 months and 1 year postoperatively to evaluate the improvement of the patients′ symptoms.

Operation duration was 174-341 (168±73) minutes. Blood loss was 50-600 (242±153) ml. Incision length was 2.5-4.0 (3.0±1.3) cm. Hospitalization stay was 5-12 (7.8±3.9) days. One patient suffered from surgical site infection and recovered with antibiotics administration. Fracture of pars interarticularis in another patient was reported who underwent revision surgery. Mean follow-up period was 7.7±2.7 (6-12 months). CT and MRI showed that the transversal area of spinal canal at the stenotic level (1.21±0.50 cm² postoperatively) and intervertebral height (1.06±0.15 cm postoperatively) were improved compared with preoperative measurement (0.58±0.28 cm² and 0.86±0.20 cm, respectively, P<0.01). VAS (2.7±1.8), ODI (9.3±4.7) and JOA (21.3±4.9) at 6 months postoperatively were significantly better than those assessed preoperatively (5.7±2.0, 21.2±5.6 and 15.2±3.2, respectively,P<0.01).

Mis-PLIF seems to be efficacious and safe for the management of LDD for short term. PLIF with CBT screw internal fixation could be considered for LDD patients who need fusion.

To explore the effect of microvascular decompression (MVD) on blood pressure in the treatment of hypertensive patients with cerebral nerve disorders and the value of preoperative MRI examination for the operation.

From January 2015 to October 2016, 72 hypertensive patients with cerebral nerve disorders were admitted to Department of Neurosurgery, the Affiliated Hospital of Southwest Medical University and enrolled into this retrospective study. We evaluated the relationship between vessels and rostral ventrolateral medulla (RVLM) in the surgical side before operation by 3 dimensional time of flight magnetic resonance angiography (3D-TOF-MRA). Thirty cases underwent MVD of the root exit/entry zone (REZ) of the related cerebral nerves (group A) and the other 42 cases underwent exploration of RVLM or MVD of RVLM in addition to the related cerebral nerves (group B). In group B, 32 cases received MVD of RVLM (group C) and the other 10 cases merely received exploration of RVLM (group D). The positive rate of preoperative MRI examination was compared between two sides. SBP (systolic blood pressure) and DBP (diastolic blood pressure) prior to operation and 12 months after operation were monitored, and the operative efficiency was evaluated.

For preoperative MRI examination, the positive rate on the left and right sides was 87.5% (35/40) and 65.6% (21/32), respectively, which was was significantly higher on the left side than the right (P=0.027). The sensitivity, specificity and accuracy of 3D-TOF-MRA were respectively 85.7% (30/35), 71.4% (5/7) and 83.3% (35/42). The differences between preoperative and postoperative blood pressures were not statistically significant in group A (P_SBP=0.067, P_DBP=0.184), while they were statistically significant in group C (left side: P_SBP<0.01,P_DBP<0.01; right side:P_SBP<0.01,P_DBP<0.01). The differences of △BP (blood pressure change) (P_△SBP=0.425, P_△DBP=0.065) and operative efficiency(P=0.703) between left side and right side were not statistically significant in group C.

MVD seems effective in treatment of neurogenic hypertension, and there is no significant difference in the therapeutic effect between left side and right side. MRI examination could be helpful for the diagnosis of neurogenic hypertension.

To explore and evaluate the clinical outcome of neuroendoscopic treatment assisted with neuronavigation and intraoperative ultrasound for Chiari type Ⅰ malformation.

Between January 2011 to June 2017, 132 patients underwent neuroendoscopic atlantooccipital decompression at Neurosurgery Department of Shanxi Provincial People′s Hospital. During the operations, the surgical fields were lightened by the illuminator of endoscope. All manipulations were conducted with neuronavigation. Intraoperative ultrasound was applied in 34 cases to detect the flowing speed of cerebrospinal fluid (CSF) which determined whether the outer dura was opened. We evaluated the clinic efficacy based on the Tator criteria which was classified into excellent (symptomatic improvement), good (symptomatic stability) and poor (symptomatic worsening).

All 132 patients had follow-up lasting for 6-24 months. There were 92 patients who were determined as excellent in recovery, 36 as stable and 4 as worse. The clinical symptoms were improved in 69.7% (92/132). The clinical symptoms were improved in 65.3% (64/98) of the cases without intraoperative ultrasound and 82.4% (28/34) among those with intraoperative ultrasound, although there was no significant difference (P=0.06). MRI follow-up was conducted in 78 cases with comorbidity of myelosyringosis, which was improved in 41.0% (32/78). There were no cases of scalp hydrops in the occipital area or cerebrospinal fluid leakage post operation. Four cases reported intracranial infection.

Neuroendoscope-assisted atlantooccipital decompression, combined with neurona-vigation, intraoperative ultrasound and dura opening, seems to have satisfactory effect in treatment of Chiari type Ⅰ malformation and low complication rate, which still needs study involving larger number of samples.

To investigate the factors related to postoperative recurrence of malignant meningiomas (WHO grade of Ⅲ).

A total of 24 pathologically confirmed cases of malignant meningiomas admitted to Neurosurgery Department of Affiliated Hospital of Southwest Medical University between January 2002 to December 2015 were enrolled into this respective study. The patients were followed up for possible recurrence and the related factors were studied by using single factor Kaplan-Meier survival analysis and multivariate Cox regression analysis.

Seventeen (71%) of the 24 patients with malignant meningiomas relapsed. The analysis results on recurrent malignant meningiomas showed that age (P=0.009), peritumoral edema (P=0.005), tumor size (P=0.050), invasive type (P=0.011) and extent of surgical resection (P=0.002) had statistical significance in malignant meningioma recurrence. However, by multivariate Cox regression analysis, excluding the invasive type (RR=0.699, 95%CI: 0.184-2.658, P=0.600), peritumoral edema (RR=2.915, 95%CI: 0.881-9.648, P=0.080) and tumor size (RR=1.314, 95%CI: 0.250-6.921, P=0.747), only the age (RR=4.379, 95%CI: 1.125-17.051, P=0.033) and degree of surgical resection (RR=3.442, 95%CI: 1.314-9.016, P=0.012) had statistical significance.

The peritumoral edema degree, tumor invasive type and tumor size of malignant meningiomas may affect the patients′ recurrence. Age and extent of resection seem to be independent factors in determining the recurrence of malignant meningiomas.

To explore the role of neuronavigation combined with intraoperative ultrasound Doppler and neurophysiological monitoring in intracranial lesion surgery.

A total of 34 patients with intracranial lesions who underwent surgical treatment at Neurosurgery Department of the First Affiliated Hospital of Inner Mongolia Medical University from January 2012 to July 2015 were retrospectively reviewed. All operations were guided by neuronavigation combined with intraoperative ultrasonic Doppler localization. Intraoperative resuscitation and intraoperative electrophysiological monitoring were performed in 10 cases with lesions located at functional areas.

In 34 cases, brain shift occurred in 24 cases after intraoperative navigation and the distance was 4-13 (6.7±2.4) mm. For ultrasonic assisted navigation, the lesion localizing accuracy rate was 100%. Intraoperative ultrasonography showed that total resection was achieved in 27 cases, subtotal resection in 5 and partial resection in 2. There were 2 cases of transient unilateral motion dysfunction, 1 case of transient language disorder, 1 case of intracranial infection, 1 case of epileptic seizure and no deaths. Postoperative images showed that the brain damage was mild, the cortex was intact and the extent of lesion resection was consistent with intraoperative ultrasound demonstration. None of the 10 patients with functional area lesions showed postoperative functional impairment.

Neuronavigation combined with intraoperative assistive technology could help precisely localize lesions, protect brain cortex, maximize the removal of lesions and reduce the complications related to the operations.

To analyze the expression and clinical features of ATP binding cassette subfamily C member 3 (ABCC3) in gliomas and to investigate the biological processes and signal pathway involved in glioma cells by ABCC3.

The clinical data and expression information of ABCC3 in 309 glioma patients were collected retrospectively from the CGGA mRNA sequencing data of China. TCGA mRNA sequencing, GSE16011 mRNA micro array datasets and REMBRANDT mRNA datasets were used as validation sets. Kaplan-Meier method and Cox regression analysis were used to investigate the role of ABCC3 in the prognosis of patients. Gene ontology (go) analysis was used to obtain biological processes involved in ABCC3 expression. KEGG pathway analysis was performed to study the signal pathway related to the expression of ABCC3.

The expression of ABCC3 in high-grade gliomas was significantly higher than that in low-grade gliomas [0.232 (0.481), 0.655 (1.420) and 2.260 (2.965) respectively from WHO Ⅱ to Ⅳ, all P<0.01]. The expression of ABCC3 was higher in malignant molecular subtype mesenchymal, IDH1 wild-type and MGMT wild-type gliomas [3.518 (1.988), 2.366 (3.020) and 1.864 (3.036), respectively, allP<0.01]. The cumulative survival rate of patients with high expression of ABCC3 was significantly lower than that of patients with low expression in both LGG and GBM (P<0.05). Moreover, multivariate analysis showed that ABCC3 was an independent marker of glioma in glioma patients (P<0.05).

ABCC3 may be associated with the biological process of glioma such as cell adhesion, inflammatory reaction, hypoxia response, angiogenesis and chemotaxis. ABCC3 has been found to be related to tumor necrosis factor signal pathway, PI3K-AKT and JAK-STAT signal pathway. ABCC3 could promote the development of glioma and thus be used as a prognostic indicator and potential therapeutic target.

The anti-slip stripping airbag controllable flow lumbar puncture and drainage device system (invention patent number: ZL 2015 1 0593810.7) designed by Wuxi Huishan District People's Hospital has the advantages of simple operation, easy catheter placement, prevention of slippage and no tube breakage, and has achieved good clinical efficacy, which is now introduced as follows.

cervical artery dissection (CAD) refers to the flow of blood from the carotid artery through the damaged intima of the artery into the vessel wall, causing the separation of the intima and subintima structures, resulting in vessel stenosis, occlusion or pseudoaneurysm formation. Among the causes of ischemic stroke in young and middle aged, CAD accounts for 10% ~25%^[1]。 Therefore, timely diagnosis of CAD has important clinical significance. Digital subtraction angiography (DSA) is the gold standard for diagnosis of CAD, but vascular lumen imaging techniques including DSA cannot directly display the typical signs of diagnosis of CAD, such as "double lumen sign" and "inner membrane patch". Three-dimensional fast spin echo imaging technology (three-dimensional sampling perfection with application optimized contrasts using different flip angle evolutions, 3D-SPACE) It can effectively display the lumen and wall structure of blood vessels, which has obvious advantages over DSA. In November 2016, the Interventional Department of the First Affiliated Hospital of Zhengzhou University treated a patient with multiple carotid artery dissection and ipsilateral middle cerebral artery tandem occlusion. The diagnosis was confirmed by 3D-SPACE. The specific reports are as follows.

Choriocarcinoma is a malignant gestational trophoblast neoplasia (GTN). It is a treatable gynecological tumor, but nearly 10% of patients have a poor prognosis, especially when metastasis occurs^[1,2]。 Brain is one of the sites of choriocarcinoma metastasis, and about 60% of patients with brain metastasis have secondary intraparenchymal hemorrhage^[3]。 Heze Municipal Hospital admitted a patient with brain metastasis of choriocarcinoma complicated by cerebral hemorrhage in November 2017. The report is as follows.

Chondrosarcoma often occurs in the long bones and pelvis, and its intracranial incidence is less than 10%^[1]。 Intracranial chondrosarcoma is a rare malignant tumor originating from cartilage tissue, accounting for about 0.15% of intracranial tumors. The disease often occurs in the skull base, accounting for about 6% of skull base tumors; The peak incidence was 30-50 years old, and there was no gender difference^[2]。 The clinical manifestations of intracranial chondrosarcoma are not specific, and the most common clinical manifestations in patients with skull base are dizziness and diplopia. Intracranial chondrosarcoma is slow-growing but locally invasive, and can cause fatal complications if it compresses or invades surrounding structures such as the brainstem^[3]。 Distant metastasis of intracranial chondrosarcoma is rare. Although the prognosis of this disease is quite different from that of chordoma, it is difficult to distinguish between the site of occurrence, imaging and histopathological characteristics^[4]。 Common skull base chondrosarcoma is difficult to resect, and it is insensitive to classical radiotherapy. The effective treatment method needs to be further explored^[5]。 This article will review the recent progress in the diagnosis and treatment of intracranial chondrosarcoma.

Cranial nerve root diseases include idiopathic hemifacial spasm, primary trigeminal neuralgia, and primary glossopharyngeal neuralgia. Because the cerebellopontine angle vessels compress different cranial nerve roots into or out of the brainstem area (root entry/exit zoon, REZ), that is, neurovascular compression or aseptic inflammatory reaction adhesion causes local nerve demyelination, and abnormal nerve impulse conduction leads to the syndrome of hyperexcitation and hyperfunction of corresponding cranial nerves. microvascular decompression (MVD) is a safe and effective surgical method for the treatment of cranial nerve root diseases, and has been widely recognized by scholars at home and abroad. Cranial nerve root disease is more common in middle-aged and elderly patients. Because it is often combined with hypertension, atherosclerosis and other diseases, it is easy to lead to long and tortuous intracranial blood vessels and focal arteriosclerosis, which then compresses cranial nerves to produce corresponding clinical symptoms. When the patient is ≤18 years old, it is called juvenile cranial nerve root disease, which is clinically rare and has the same pathogenesis as that of adults, mainly neurovascular compression. However, adolescent patients usually have no underlying diseases such as hypertension and atherosclerosis, so the mechanism leading to neurovascular compression may be different, and there are many differences from adults in surgical strategy, intraoperative findings, postoperative efficacy and complications. This article reviews the recent studies on cranial nerve root diseases in adolescents.

traumatic brain injury (TBI) is a brain tissue injury caused by trauma. It has a high disability rate and mortality rate, and its injury mechanism is complex, involving cell necrosis and apoptosis, inflammatory reaction, glial cell activation, fibrous scar formation, etc. In the past, the treatment methods of TBI mainly included neurotrophic factor therapy and cell replacement therapy, but the clinical effect was not good. The detailed mechanism of pathogenesis of TBI and its repair therapy have become one of the hotspots in neuroscience research in recent years. Studies have found that exosomes derived from marrow mesenchymal stem cells (MSCs) can promote nerve regeneration and repair. Therefore, the application and research progress of exosomes derived from MSCs in the treatment of TBI are reviewed in this paper.