Volume 34 · Issue 11 · 2018

pituitary adenoma occurs from the adenopituitary gland in the anterior lobe of the pituitary gland. It is one of the common intracranial tumors, accounting for about 10% of intracranial tumors. The incidence rate in women is slightly higher than that in men. Traditional pathological classification methods have found that some cases of pituitary adenoma are inconsistent with the clinical process, especially for the diagnosis of so-called chromophobic pituitary adenoma, there are still many problems to be solved, but ultramicropathology classification according to the morphology of hormone particles has its unique features^[1]。 The new World Health Organization (WHO) classification of nervous system tumors adds the characteristics of tumor genes and molecular genetics on the basis of morphology. This classification system is suitable for basic research on pituitary adenoma. In the 2017 version of the endocrine tumor classification, WHO combined specific hormones and transcription factors to classify pituitary adenomas according to cell differentiation lineages, so as to emphasize the source of cell differentiation and make people have a further understanding of the origin of pituitary adenomas^[2]。

To investigate the clinical significance of single-cycle neoadjuvant chemotherapy in the treatment of intracranial secreting germ cell tumor.

From January 2010 to December 2016, 42 patients with intracranial germ cell tumor and elevated serum markers admitted to Department of Neurosurgery, Nanfang Hospital, Southern Medical University were enrolled into this retrospective study. Patients were first treated with one cycle of EP (etoposide and cisplatin) regimen and then divided into two groups according to their chemotherapy outcome. Group I included patients with non-remission or progression after chemotherapy, and then surgery, postoperative chemotherapy and radiotherapy were arranged. Group II included patients with complete remission or partial remission after chemotherapy, and chemotherapy was then continued and followed by radiotherapy.

A total of 42 patients completed the neoadjuvant chemotherapy according to the plan. Among them, improvement or relief was reported in 40 cases and no obvious improvement in 2. Of the 22 patients in the operation group, total tumor resection was performed in 21 cases and subtotal resection in 1. Postoperative pathology revealed that there were 11 cases of mixed tumor, 8 cases of teratoma, 2 cases of choriocarcinoma and 1 case of yolk sac tumor. No patients died or developed disability after treatment. No tumor residues were observed. Group Ⅱ included 20 cases. The serum markers of those patients were within normal limit after treatment and tumor residues were observed in 4 cases. Totally, 34 cases were followed up for 6-72 months with an average of 25.6±4.3 months. There were 2 cases of death and 2 cases of recurrence. The other 30 cases remained stable with normal serum levels of tumor markers.

For intracranial secreted germ cell tumors, single-cycle neoadjuvant chemotherapy can be used for stratification, and the corresponding treatment should be arranged based on this stratification. In conclusion, although single-cycle neoadjuvant improves the safety of operation, the patient's surgical tolerance should be taken into account at the same time.

To investigate the clinical manifestations and surgical treatment of meningiomas in neurofibromatosis type 2 (NF2) patients.

The clinical data of 18 NF2 patients with meningiomas who underwent meningioma resection at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2001 to July 2015 were analyzed retrospectively in this study. Long-term follow-up was performed for those patients.

A total of 18 patients harbored 76 meningiomas. Twenty-one meningiomas in 18 patients were resected. Gross total resection (Simpson gradeⅠ/Ⅱ) was performed in 19 tumors and partial removal (Simpson grade Ⅳ) in 2. Nine tumors were located at the convexity and cerebral falx and the mean diameter was 5.7±1.9 cm (4.0-8.7 cm). Eleven tumors were located at the skull base including foramen magnum (6/11), middle cranial fossa (4/11) and tentorium cerebelli (1/11). The average diameter was 2.7±0.6 cm (1.5-3.7 cm). One tumor was located in the fourth ventricle. The postoperative course of 11 patients was uneventful. Five patients had postoperative infection. The symptoms and neurologic deficits remained in 2 patients. Symptoms were improved in 14 patients at discharge. The results of pathological examination were: 5 for mixed type, 4 for fibrous type, 2 for gravel type, 2 for transitional type, 1 for endothelial type, 1 for hemangioma type, 1 for atypical, 1 for mixture of meningioma and ependymoma, and the other 4 pathological types were unknown. The patients were followed up 11-97 months(median: 42.5 months). The symptoms were alleviated in 15 (83%) patients and stable in 3 (17%). No tumor recurrence or development was observed.

The patients with NF2 seem to be prone to develop multiple meningiomas which can be located at different regions. The main purpose of surgery is to remove the tumor to improve the patient's symptoms and improve the patient's quality of life. Surgical treatment plays an important role in improving the prognosis of patients.

To explore the safety and efficacy of new targeting chemotherapy strategy of glioma stem cells (GSCs) and its preliminary applications.

A total of 12 patients with glioblastoma (GBM) admitted to Department of Neurosurgery, the Second Affiliated Hospital of Soochow University from January 2013 to April 2017 were enrolled into this retrospective study. The patients underwent new chemotherapy if tumor analysis showed ABCG2 (+ ), MGMT methylation (-), or recurrence of GBM after standardized treatment. The temozolomide (TMZ), sodium valproate (VPA) and nicardipine combined drug regimen was implemented for 6 cycles. Evaluation of the efficacy with KPS (Karnofsky performance status scale), Response Evaluation Criteria in Solid Tumors of WHO and lifetime was carried out.

Immunohistochemical examination of tumor tissues in the 12 patients showed that ABCG2 and MGMT were expressed at different levels. Methylation-specific PCR (polymerase chain reaction) results showed that the MGMT methylation was negative in the enrolled patients. Enhanced MR scan was used to evaluate treatment efficacy. Complete remission was achieved in 2 cases, partial remission in 3 cases, stable disease in 2 cases, and progressive disease in 5 cases (including 4 deaths). The average survival time was 18.4±10.9 months. There were no treatment-related serious adverse events. The average KPS post treatment was 51.7±31.6.

The new chemotherapy strategy of TMZ combined with VPA and nicardipine targeting GSCs has certain curative effect on chemo-resistant GBM and those drug regimens could be relatively well tolerated.

To assess the reliability and safety of lateral supraorbital (LSO) approach in the surgical treatment of tuberculum sellae meningiomas (TSMs).

A total of 34 patients underwent operation through LSO approach between June 2013 and June 2017 at Department of Neurosurgery at Qilu Hospital of Shandong University and their clinical data were retrospectively analyzed in this study. All patients underwent surgical resection of the tumor via LSO approach. The extent of resection of the tumor was assessed using the Simpson classification. The effectiveness of the procedure was evaluated based on the patient's postoperative MRI and improvement in neurological symptoms, and the safety of the procedure was assessed based on the occurrence of postoperative complications.

All patients were followed up for 3-36 months with an average of 12±5 months. Of the 34 patients, 30 underwent Simpson Ⅰ-Ⅱ resection and 4 received Simpson Ⅲ resection. Postoperative visual acuity was improved in 23 cases, no change was reported in 8 cases, and visual impairment was worse than preoperative conditions in 3 cases. There were 3 cases of postoperative fever, 3 cases of hyponatremia, 1 case of psychiatric symptoms, 1 case of cerebral edema, and 2 cases of epileptic seizures. In 1 (3%) patient, postoperative imaging findings confirmed recurrence.

LSO approach has multiple advantages including simplified and fast skull opening and closing, clean operative field and small trauma, and it could be used in the effective treatment of TSMs.

To summarize the clinical characteristics, diagnosis and treatment of intracranial chondrosarcomas and to provide the reference for the clinical treatment of intracranial chondrosarcomas.

The clinical data of 17 patients of intracranial chondrosarcoma undergoing surgical operation at Department of Neurosurgery, the First Hospital of China Medical University from June 2007 to December 2016 were retrospectively analyzed. Nine cases underwent postoperative radiotherapy.

Gross total resection of tumor was achieved in 9 cases and subtotal resection in 8. Thirteen cases were pathologically diagnosed as classic chondrosarcoma, 3 as myxoid chondrosarcoma and 1 as mesenchymal chondrosarcoma. Preoperative misdiagnosis rate was 14/17. Postoperative newly developed cranial nerve palsy occurred in 3 cases and cerebrospinal fluid leakage in 2. Intracranial infection occurred in 2 patients and psychiatric disorder in 1. Sixteen patients were followed up for 11-113 months with an average of 55.9±23.1 months. The 2- and 5-year progression-free survival rates were 81.3% and 75.0% respectively. Among the patients with subtotal resection, 5 cases progressed and 2 died.

Intracranial chondrosarcoma is a rare intracranial malignant tumor. Due to lack of specific clinical and imaging features, the preoperative misdiagnosis rate may be high. Surgery should be given priority and patients with total resection could obtain relatively good prognosis.

To evaluate the preliminary application of susceptibility weighted imaging (SWI) in meningiomas.

Fifty meningioma patients, treated at Department of Neurosurgery of Nanjing Brain Hospital Affiliated to Nanjing Medical University between October 2015 and February 2018, were retrospectively enrolled into this study. All cases underwent brain CT, MRI and SWI scans preoperatively, and the minimum intensity projection (mIP) was obtained through processing basic SWI images by software. Compared with MRI and CT, intratumoral microhemorrhage, calcification and drainage vein in meningioma were analyzed in mIP and filtered phase imaging. Pathological examination was carried out after operation. Further comparative analysis was accomplished between microhemorrhagic group and non-microhemorrhagic group in imaging features and pathological indexes.

Among the 50 meningioma patients examined by SWI, 7 (14%) had 24 intratumoral microhemorrhages; 24 (48%) had 47 intratumoral calcifications, including 31 calcifications that were consistent with CT and 16 which were not detected by CT; 16 (32%) clearly showed dominant draining veins originating from the tumor itself, consisting of 11 without peritumoral edema and 5 with peritumoral edema. The patients without peritumoral edema were more likely to form drainage veins than those with peritumoral edema [61%(11/18) vs. 16% (5/32), P=0.001]. All 50 patients were pathologically confirmed to have WHO Grade Ⅰ meningiomas. The edema index (EI), maximum edema width and Ki67 in the microhemorrhagic group were significant higher than those in non-microhemorrhagic group (all P<0.05), while there was no obvious difference between 2 groups in progesterone receptor (P>0.05).

Intratumoral microhemorrhage, microcalcification and drainage vein can be detected by SWI. Intratumoral hemorrhages infrequently occur in WHO Grade Ⅰ meningiomas. Microhemorrhagic meningiomas have higher Ki67 and more serious peritumoral edema than non-hemorrhagic ones. The efferent draining vein from meningioma itself may alleviate the formation of peritumoral edema.

medulloblastoma (MB) is one of the most malignant neuroepithelial tumors in the central nervous system^[1]The typical site of its occurrence is the cerebellar vermis at the midline. Non-midline MB is relatively rare and occurs more in adults than in children^[2]It mostly occurs in the cerebellar hemisphere and is very rare in other parts. This article retrospectively reports the diagnosis and treatment of 4 patients with non-midline MB confirmed by pathology admitted to the Department of Neurosurgery of the First Affiliated Hospital of Chongqing Medical University from January 2014 to January 2017 as follows.

With the continuous development of neuroendoscopic technology, neuroendoscopic transnasal enlargement approach has received more and more attention in skull base surgery. In recent years, neurosurgeons have begun to use this approach to remove craniopharyngiomas^[1]It shows advantages and limitations compared with traditional craniotomy in the therapeutic effect. From February 2013 to October 2017, 21 patients with craniopharyngioma were resected by neuroendoscopic expanded nasal approach in the Department of Neurosurgery of the Second Hospital of Lanzhou University. Combined with relevant literature at home and abroad, the clinical data and diagnosis and treatment experience are retrospectively summarized as follows.

To introduce the operative technique of cyst neck sealing with free-fat graft for sacral Tarlov cyst and to observe its clinical therapeutic effect.

This retrospective study included 59 cases of symptomatic sacral Tarlov cysts treated by cyst neck sealing with free-fat graft from January 2010 to February 2016 at Neurosurgical Department of Army General Hospital of PLA (42 cases), Tsinghua University Yuquan Hospital (14 cases) and Fengning Hospital of Hebei Province (3 cases). The key points of operation were cutting cystic wall, identifying the nerve root and opening of cyst neck within cyst, cutting the cyst neck open and suturing the wound with free-fat graft in it to reconstruct root sheath in order to avoid cerebrospinal fluid leakage and root compression. The pain severity was assessed according to visual analog scale (VAS).

The VAS score was 7.5±1.8 before operation and decreased to 2.7±0.6 and 2.3±0.5 at 6 and 18 months post operation, respectively. The difference was statistically significant (P=0.008). There was no complication relevant to operation. During the 10-18 (average: 15.0±3.7) months after operation, MRI follow-up was conducted. The latest MRI results showed complete obliteration of cysts in 54 cases and a little hydrops ex vacuo in lower place of original cyst cavity in 5 cases without cyst and symptom relapses.

Cyst neck sealing with free-fat graft for treatment of sacral Tarlov cysts is safe and may have better long-term effects.

To investigate the clinical features and surgical outcomes of pediatric intracranial arachnoid cysts (IAC).

A retrospective analysis was conducted on 131 children under 14 years old with IAC admitted to the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from October 2011 to September 2016. Among them, 31 patients were asymptomatic. Initially, 57 patients underwent cystectomy or ostomy, and 13 patients underwent cyst-peritoneal shunt. Four patients underwent drilling and drainage with subdural hematoma or effusion. Follow-up was conducted for 57 cases.

Of the 57 patients who were followed up, the median follow-up duration was 22 (3-48) months. Among them, 16 (28.1%) required surgery and included 14 patients undergoing cystectomy or ostomy and 2 undergoing cyst-peritoneal shunt. In 4 (7.0%) cases, cysts disappeared by themselves. No progression was reported in 26 cases. Slight enlargement was observed in 11 cases. There were 12 (29.3%) cases that were asymptomatic and 29 (70.7%) cases with mild symptoms. For the 90 children undergoing surgical treatment, the median follow-up period was 24 (3-56) months. Among them, there were 33 (36.7%) asymptomatic cases, 47 (52.2%) cases with mild symptoms and 10 (11.1%) cases with obvious symptoms. The size of postoperative cyst was 11.9±6.8 cm^3, which was significantly smaller (P<0.05) than that prior to operation 138.5±26.1 cm³. Of the 71 patients who underwent cystectomy or ostomy, 11 (15.5%) had subdural effusion or hydrocephalus and 8 of whom were no more than 2 years old. Among the 15 patients who underwent cyst-peritoneal shunt, 3 developed shunt-dependent syndrome.

Patients observed during follow-up seem to have a relatively high chance of reoperation. Surgical operation, with satisfactory outcomes, might be the main method for the treatment of symptomatic IAC. Subdural effusion or hydrocephalus (mainly in children of no more than 2 years old) and shunt-dependent syndrome are main surgical complications.

To observe the efficacy of transarterial embolization of carvernous sinus dural arteriovenous fistulas (CSDAVFs) with slender feeding artery by rapid injection of Onyx.

From December 2010 to December 2016, a total of 20 patients with CSDAVFs with slender feeding artery were admitted to the Neurosurgery Department of the First Affiliated Hospital of Soochow University (12 cases), Changhai Hospital of the Second Military Medical University (4 cases) and the Second Affiliated Hospital of Medical College, Zhejiang University (4 cases). Those clinical data were analyzed retrospectively in this study. All underwent transarterial embolization with rapid injection of Onyx.

Twenty-two interventional therapeutic procedures and embolization of feeding arteries were performed in all 20 patients, which involved ascending pharyngeal arteries in 11, middle meningeal arteries in 7, accessory meningeal arteries in 2 and internal maxillary arteries in 2. The mean time of Onyx injection was 5 sec-4 min and the volume of Onyx injected was 0.4-1.5 ml. Postoperative immediate complete embolization was achieved in 8, near-complete embolization in 11 and partial embolization in 1 (with 3 repeats of procedures). Postoperatively, there were 2 cases of ipsilateral facial numbness and 1 case of ipsilateral eyelid ptosis and eye movement disorder occurring after 3 times of arterial embolization. The follow-up period was 2-32 months, with an average of 9.5±2.7 months. In 19 patients with complete embolization and secondary embolization, the clinical symptoms disappeared completely. Among them, 18 cases of conjunctival hyperemia and ocular protrusion disappeared within 2 weeks after operation, and 1 case of heavier conjunctival edema disappeared within 3 weeks after operation. The symptoms of diplopia and vision loss improved within 1 to 3 months after surgery, and there was no recurrence. Twelve patients were followed up by DSA, and 7 patients with complete embolization showed complete occlusion of the fistula and no recurrence.

Transarterial embolization with rapid injection of Onyx may effectively treat CSDAVFs with slender feeding artery with relatively little complications and satisfactory follow-up results.

To analyze the relationship between bi-frontal pneumocephalus (BFP) and acute postoperative agitation following craniotomy.

A total of 365 consecutive adult patients underwent elective craniotomy at Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University from July 2016 to December 2016 and their clinical data were retrospectively analyzed in this study. Sedation-agitation scale (SAS) was used to evaluate the patients 24 hours after the enrollment. Agitation was defined as an SAS score equal to or above 5. Patients were divided into 2 groups according to the presence or absence of BFP in postoperative CT scans within 12 hours post operation: the BFP group (n=83)and non bi-frontal pneumocephalus (NBFP) group (n=282). PSM (propensity score matching) was conducted to reduce confounding bias between the groups. The intergroup analysis was conducted on acute postoperative agitation and other recovery parameters.

Among 365 patients, 45 (12.3%) developed acute postoperative agitation and 83 (22.7%) developed BFP. With PSM, 83 pairs of patients were successfully matched. After matching, compared to NBFP group, the incidence of postoperative agitation was higher (24.1% vs. 3.6%, P<0.001), use of sedation was much more (14.5%vs. 2.4%, P=0.005) and hospital length of stay was longer (10 vs. 8 days, P<0.001).

Brain tumor patients following elective craniotomy with BFP are more likely to develop acute postoperative agitation.

To analyze the level of vascular endothelial growth factor (VEGF) of peripheral blood and cerebrospinal fluid (CSF) in patients with hydrocephalus and to explore the clinical significance of VEGF in evaluating hydrocephalus and its prognosis.

A retrospective study was conducted on 29 children of hydrocephalus (experimental group), including 1 case of mild hydrocephalus, 14 cases of moderate hydrocephalus, and 14 cases of severe hydrocephalus, who received treatment at Neurosurgery Department, Children’s Hospital of Fudan University from March 2015 to December 2016. A total of 24 children with tethered spinal cord treated during the same period were enrolled into this study as well and served as controls. All the children in this series underwent surgical treatment, and the prognosis was evaluated according to the Salmon standard. The Luminex technology was used to measure the levels of VEGF in peripheral blood and CSF collected in all cases, and correlation analysis was further conducted to explore the relationship of VEGF levels to the conditions and prognosis of hydrocephalus.

In the experimental group of hydrocephalus, the VEGF levels in peripheral blood and CSF (132.04±69.85 and 82.72±42.84 pg/ml, respectively) were significantly higher than those in control group (69.20±35.69 and 52.76±45.69 pg/ml, respectively, both P<0.05), and they demosntrated significant correlation (r=0.732, P<0.01). In the experimental group, the blood and CSF VEGF level of cases with severe hydrocephalus (184.07±65.55 and 89.40±28.23 pg/ml, respectively) were significantly higher than those of cases with moderate hydrocephalus (103.38±70.73 and 56.16±28.69 pg/ml, respectively, bothP<0.05). Among the 27 patients with postoperative follow-up, 11(40.7%) cases obtained significantly improvement, 10(37.0%) were moderately improved, 4(14.8%) were slightly better, and 2(7.4%) deteriorated. The single factor variance analysis showed that the content of VEGF in blood and CSF decreased with the improvement of the prognosis of children with hydrocephalus (bothP<0.05).

VEGF content is increased in the blood and CSF of the children with hydrocephalus. Measurement of VEGF level could help evaluate the conditions and prognosis of pediatric hydrocephalus, which serves as an index of laboratory assessment.

To investigate the therapeutic effect of enteral nutrition through naso-gastric tube combined with naso-intestinal tube in patients with severe traumatic brain injury (sTBI).

A total of 104 eligible sTBI patients admitted to Neurosurgery Department of Shanxi Provincial People′s Hospital from January 2011 to December 2015 were enrolled into this retrospective study. According to the ways of enteral nutrition, all 104 patients were divided into naso-gastric tube nutrition group (n=50) and naso-gastric combined with naso-intestinal tube nutrition group (n=54) in order to evaluate their differences in rate of complications related to enteral nutrition (esophageal reflux and aspiration, abdominal distension and diarrhea, upper gastrointestinal bleeding, pulmonary infection and blood sugar disorders), the time duration required for achieving target amount of enteral nutrition, mean hospitalization time and body temperature and mechanical ventilation time at ICU (intensive care unit) between the 2 groups.

The 2 groups were comparable in the patient’s sex, age, causes of trauma, trauma types, Glasgow coma score, surgical treatment and starting time of enteral nutrition (all P>0.05). The rates of esophageal reflux and aspiration (5.6%, 3/54), parenteral nutrition (7.4%, 4/54), blood sugar disorders (9.3%, 5/54) in naso-gastric combined naso-intestinal tube group were significantly lower than those in nasogastric tube group [22.0% (11/50), 28.0% (14/50), 26.0% (13/50), respectively, allP<0.05]. There was no significant difference between 2 groups in rates of abdominal distension and diarrhea, upper gastrointestinal bleeding and pulmonary infection at ICU (allP>0.05). Compared with the patients in the naso-gastric tube nutrition group, the time to nutrition target (84.5±19.0 hvs. 42.0±8.0 h), average mechanical ventilation time (77.2±24.5 h vs. 34.3±21.8 h) and mean treatment time (18.2±4.4 d vs. 14.1±3.8 d) at ICU were significantly shorter in naso-gastric tube combined naso-intestinal tube group. However, there was no significant difference in the mean temperature at ICU between the 2 groups.

The enteral nutrition treatment with naso-gastric combined naso-intestinal tube for sTBI could significantly reduce the rates of esophageal reflux and aspiration, parenteral nutrition and blood sugar disorders and shorten the time required to reach the nutrition target, average mechanical ventilation time and mean treatment time at ICU. It is meaningful to improve the enteral nutrition treatment process for sTBI patients.

Intracranial basal ganglia is the best site of hypertensive cerebral hemorrhage. After hemorrhage, the cortical spinal tract (CST) of the hind limb of the inner capsule is compressed, displaced and damaged, resulting in partial or complete loss of motor function. The presence of hematoma can lead to perihematomal edema (PHE) through physical and chemical pathways. It has been reported in the literature that the degree of PHE occurrence is closely related to the amount and time of hematoma. The occurrence and development of PHE can lead to the deterioration of the disease and further damage of motor fibers^[1,2]。 minimally invasive surgery (MIS) is a mature surgical method in recent years. Through stereotactic insertion of a catheter into the hematoma cavity, the purpose of aspiration and drainage of the hematoma is achieved, and the life of the patient is saved, while secondary brain injury is reduced. With the development of MRI technology, diffusion tensor imaging (DTI) technology can intuitively analyze and judge CST damage. By calculating the fractional anisotropy (FA) value of CST in the basal ganglia region, the integrity and damage of CST were analyzed objectively. At present, there are few reports on the effects of minimally invasive treatment on PHE and CST in patients with basal ganglia hemorrhage. From February 2014 to January 2016, 34 patients with basal ganglia hemorrhage were treated with MIS in the Department of Neurosurgery of Huzhou Central Hospital. The effect of MIS on PHE and CST in patients with basal ganglia hemorrhage was evaluated by DTI, which is reported as follows.

Ventricular hemorrhage is a common type of cerebral hemorrhage disease, accounting for about 45%. Its mortality and disability rate are high, and the cause is mostly hypertension^[1,2]。 Ventricular hemorrhage includes both primary and secondary ventricular hemorrhage. Among them, the clinical manifestations and prognosis of primary ventricular hemorrhage and ventricular hemorrhage secondary to a small amount of cerebral parenchymal hemorrhage are often different from cerebral parenchymal hemorrhage, and the routine treatment with external lateral ventricular drainage still has a high mortality rate^[3,4]。 Neuroendoscope has the advantages of good illumination and multi-angle visual field, and has unique advantages in ventricular hemorrhage surgery. This study included 87 patients with hypertensive ventricular hemorrhage who were treated with neuroendoscopic surgery or external ventricular drainage, respectively, and compared the advantages and disadvantages of the two methods in the treatment of hypertensive ventricular hemorrhage.

To investigate the expression of ribophorin Ⅱ (RPN2) in gliomas and its relationship to clinical features and prognosis.

The clinical data and mRNA-seq data of 309 glioma samples were collected from Chinese Glioma Genome Atlas (CGGA) and the expression of RPN2 was retrospectively analyzed. The 30 glioma samples were collected by Beijing Tiantan Hospital Affiliated to Capital Medical University from 2016 to 2017. RT-qPCR was used to test RPN2 mRNA expression in those samples. TCGA mRNA sequencing and REMBRANDT mRNA array datasets were simultaneously used as validation datasets. The expression pattern of RPN2 in gliomas was analyzed by t-test and ANOVA. The relationship of RPN2 expression to the patient’s overall survival was estimated by Kaplan-Meier method, log-rank test and Cox regression analysis. The DAVID software was used to investigate the RPN2 functions in GO biological processes and KEGG pathways.

In WHO Ⅱ, WHO Ⅲ and WHO Ⅳ gliomas, RPN2 expression was up-regulated along with glioma grade progression (-0.55±0.61、0.05±0.66 and 0.36±1.20, respectively, P<0.0001), which was further confirmed by RT-qPCR experiment. The expression of RPN2 was the lowest in neural subtype and highest in mesenchymal subtype (-0.80±0.56 and 0.68±1.02, respectively,P<0.0001). RPN2 expression in IDH-mutant gliomas was significantly lower than that in IDH-wild gliomas (-0.22±0.77 and 0.22±1.18, respectively,P<0.001). The overall survival of patients with high expression of RPN2 was significantly lower than that of patients with low expression (P<0.0001). Similar results were obtained in both TCGA mRNA-seq and REMBRANDT mRNA microarray datasets. Multi-variate Cox analysis showed that RPN2 expression was an independent predictor of prognosis (P=0.004). RPN2 might be related to the apoptosis, division, proliferation, adhesion and angiogenesis.

The expression of RPN2 seems to be associated with the malignant degree of gliomas and may be a prognostic marker and potential therapeutic target.

To explore the possible inhibiting effect of 3-bromopyruvic acid (3-BrPA) on proliferation of malignant transformed dendritic cells by blocking the pathway of glucose metabolism.

In vitro, co-cultured mice myeloid dendritic cells (DC) with human glioma stem cells (SU3) were used to induce the malignant transformation of DC. Among DC monoclonal for malignant transformation, i. e., glioma stem/progenitor cells induced by malignant transformation of dendritic cells (GSPC-MTDCs), proliferative abilities of SU3, normal DC and GSPC-MTDCs were detected by CCK-8 and flat clone formation assay. Cell invasiveness was detected by Transwell chamber invasion assay. Subcutaneous inoculation of GSPC-MTDCs was performed in 20 non-fluorescent nude mice. At 11 d post inoculation, 10 nude mice with uniform tumorigenesis were divided into intervention group and control group with 5 mice in each group. The intervention group was given 3-BrPA (5 mg·kg^-1·d^-1) intraperitoneal treatment, while the control group was given the same volume of normal saline. After 24 days of intervention, the tumorigenesis was compared between 2 groups.

(1) GSPC-MTDCs had immortalized characteristics. Compared with SU3, the proliferation rate of GSPC-MTDCs was faster and the clone formation rate was significantly higher (38.1±1.9% vs. 30.2±2.7%, P<0.01). Transwell chamber invasion test showed that GSPC-MTDCs had stronger invasive ability than SU3 (1 042±49vs. 782±38, P<0.01). (2) GSPC-MTDCs inoculated into the subcutaneous and caudal veins of non-fluorescent nude mice all formed tumors. At 24 days after 3-BrPA intervention, the tumor masses in the intervention group and the control group were 1.5±0.6 g and 3.3±1.0 g, respectively. The difference was statistically significant (P=0.0107). Pathological observation showed that compared with the intervention group, the control group had more abnormal nuclei, more mitosis, abundant blood vessels, obvious infiltration of inflammatory cells and higher proportion of c-myc positive cells.

Glioma stem cells have the potential to induce malignant transformation of DC cells. 3-BrPA could inhibit the proliferation of GSPC-MTDCs.

Brainstem gliomas usually originate from the pons, followed by the midbrain, medulla oblongata, cerebral foot, and cervical spinal cord; It is further divided into diffuse type, exogenous type, extended ridge type and localized endogenous type. Tectal tumor is a special type of localized brainstem tumor, which has its special clinical manifestations and treatment measures. diffuse intrinsic pontine gliomas (DIPG) are second only to exophytic tumors, which together account for 85% of brainstem tumors. Each of these subtypes has its own unique clinical manifestations, imaging findings, and outcomes. DIPG had poor prognosis, while tectal and longitudinal gliomas had longer survival^[1]。 This article retrospectively analyzes the clinical data of a patient with brainstem glioblastoma who was treated with standardized treatment in the Department of Neurosurgery, Tangdu Hospital, Air Force Medical University in July 2013. At present, the follow-up has ended and is reported as follows.

The primitive trigeminal artery, also known as the persistent trigeminal artery, is an embryonic anastomosis between the internal carotid artery and the basilar artery^[1]It is a rare vascular variation. Rupture of the original trigeminal artery due to traumatic or spontaneous causes can cause a cavernous fistula of the original trigeminal artery. In November 2015, a patient with spontaneous primitive trigeminal cavernous fistula was admitted to the Department of Neurosurgery of Subei People's Hospital of Jiangsu Province, and endovascular treatment was given with good efficacy. The report is now as follows.

Meningioma is a common primary central nervous system tumor in the cranium, accounting for 36.6% of primary central nervous system tumors, and the incidence of meningioma is about 8.3/10 000^[1]。 This disease is mainly benign clinical manifestations, and a few meningiomas show local malignant biological behaviors. Recently, there are more and more studies on meningioma subtypes with related malignant clinical manifestations, but the probability of meningioma metastasis is extremely low, about 1/1 000^[2]Therefore, there are few reports on the metastasis of meningioma at home and abroad. In August 2007, a patient with lung metastasis of meningioma was admitted to the Department of Neurosurgery of Xiangya Hospital of Central South University. The report is as follows.

Chordoma is a rare bone tumor, accounting for about 3% of all bone tumors. It is mostly considered to be the source of residual chordal tissue. It has some characteristics of sarcoma: including relatively low mitotic activity and cell proliferation rate; But has a higher risk of local recurrence and metastasis^[1]。 Therefore, it is often recognized as sarcoma, and the treatment of sarcoma is mostly followed or referred to. The annual incidence rate of chordoma is about 0.51~8/million people, and the prevalence rate of the population is less than 1/10. It can occur at any age, and the peak incidence is 50~70 years old. Chordoma has the characteristics of insidious onset, mostly slow growth, and often has grown for many years before diagnosis. The onset sites are more common in the spine and skull base, and skull base chordoma accounts for 1/3 of all chordomas. Because of its deep location and adjacent to many important neurovascular structures, skull base chordoma makes surgical treatment difficult, and the proportion of in situ recurrence or residual tumor regrowth is high. In addition, 30% ~40% of patients can have dissemination or distant site metastasis, and spinal chordoma is more common (20% ~40%); The proportion of skull base chordoma metastases is relatively low (<10%), dissemination is more common^[2]。 Although some patients with chordoma have a long survival period, more than 50% of them have a poor prognosis due to recurrence or metastasis dissemination^[3]。 In recent years, with the application of many technical means and devices and the in-depth research on the pathogenesis, the treatment of chordoma has made a lot of progress. This article reviews the comprehensive treatment progress of skull base chordoma (hereinafter referred to as chordoma).

Gliomas are the most common primary tumors in the cranium, accounting for approximately 45% of all intracranial tumors. Even with the combination of surgery, radiotherapy and chemotherapy, some patients with glioma still progress rapidly and will relapse in a short time after surgery. How to identify these patients and adopt active treatment to improve their prognosis is an urgent problem^[1,2,3]。 With the development of molecular biology and molecular genetics, people have a deeper understanding of the occurrence and development of glioma^[2,4]。 However, there are temporal and spatial heterogeneity in the process of tumor occurrence and development. Therefore, it is difficult to fully reflect the biological characteristics of tumor by molecular genetic detection based on local tumor tissue^[5]。 Imaging can provide a more comprehensive view of the tumor, and it can also provide dynamic information to help monitor tumor growth, evolution, and treatment response^[6]。 In recent years, with the advancement of imaging extraction and post-processing technology, the research of radiomics in the field of glioma is gradually heating up. It can enable researchers to obtain more objective, quantitative and indistinguishable image features, and then comprehensively describe the morphological differences caused by the genetic changes of tumors^[7,8]It provides a new method for accurate diagnosis and treatment of glioma patients. The author reviews the concept of radiomics, its clinical application in glioma and its challenges.

Cerebral palsy, referred to as cerebral palsy for short, is caused by non-progressive brain injury such as congenital (malformation, intrauterine infection) or acquired (premature birth, low birth weight, asphyxia, hypoxic ischemic encephalopathy, kernel jaundice, trauma, infection) of the immature brain, and its prevalence is about 2‰ ~3.5‰^[1]。 The main manifestations are central motor, postural development disorders and limited activities, with or without sensory, perceptual, cognitive, communication and behavioral disorders, as well as epilepsy and secondary muscle and bone problems, which seriously affect the growth and development of children, make them unable to live independently, and bring a heavy burden to their families and society. Cerebral palsy is divided into spastic type, involuntary movement type, ataxia type and mixed type according to the type of movement disorder; Among them, spastic type is divided into spastic quadriplegia, spastic diplegia and spastic hemiplegia; The involuntary movement types are divided into athetoid and dystonia types. The spastic cerebral palsy is mainly damaged by pyramid system; Involuntary movement type is mainly damaged extrapyramidal system; The ataxia type is mainly cerebellar damage; Mixed type is two or more types of clinical manifestations existing simultaneously, mostly one type of manifestation is the main^[1]。 The diagnosis and treatment of cerebral palsy involves pediatrics (neurology), rehabilitation, neurosurgery, orthopedics and other disciplines. The treatment of all types of cerebral palsy is mainly based on rehabilitation. Long-term and regular rehabilitation training is the most important method for treating cerebral palsy. Neurosurgery is mainly to improve muscle tone, create conditions for rehabilitation treatment or as a supplementary means, and long-term systematic training is still needed after operation. This article mainly reviews the neurosurgical treatment of cerebral palsy.

With the development of emergency and critical care technology, the survival rate of patients with craniocerebral injury has been greatly improved. More and more patients are turning from severe coma to disturbance of consciousness. Disorders of consciousness are a major dilemma in the field of neuroscience and neurosurgery. Disorders of consciousness can be divided into different levels, and distinguishing different levels is challenging, with a 40% misdiagnosis rate if assessed according to behavior. The lack of response to the outside world by patients with consciousness disorders does not necessarily mean that they are unconscious, but how much consciousness and function remain, and to what extent it can be recovered, are urgent questions to be answered.