Volume 34 · Issue 12 · 2018

In recent years, the rapid progress of epilepsy surgery is mainly reflected in the rapid development of stereoscopic electroencephalography technology and image post-processing technology. The reason why the latter has received more and more attention is that magnetic resonance imaging (MRI) negative partial epilepsy is a major challenge in preoperative evaluation. According to statistics, 30% and 25% ~45% of patients with temporal lobe epilepsy and frontal lobe epilepsy are classified as MRI-negative epilepsy, respectively. Cortical developmental malformations are the most common pathological type of childhood epilepsy and the third most common pathological type of adult epilepsy. Similarly, 20% ~30% of cortical developmental malformations are MRI-negative^[1,2,3]。 Medical image post-processing technology can assist in screening intracranial abnormal lesions through computer processing, improve the detection rate of MRI negative epileptogenic lesions, and help to improve the preoperative evaluation efficiency and surgical prognosis of epilepsy surgery.

To elucidate the risk factors and surgical outcome of secondary epilepsy arising from intracranial meningioma.

A retrospective study was conducted on the clinical data of 267 patients with intracranial meningioma admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2015 to December 2015. All those patients underwent surgical operations. The seizure outcome was followed up through outpatient visits or telephone post operation. Univariate analysis and Cox proportional hazards model were applied to identify the predictive factors for epileptic seizures in patients with supratentorial meningioma.

In this series, the incidence of epileptic seizures arising from meningioma was 17.2% (46/267). Univariate analysis demonstrated 4 predictive factors for preoperative epilepsy: tumor location (perirolandic area) (P<0.01), male patients (P=0.01), young people (less than 45 years old) (P<0.01) and hydrocephalus (P<0.01). Two independent predictors were confirmed by multivariate analysis: tumor location (perirolandic area) (HR=2.21, 95%CI: 1.23~3.97, P=0.008) and young people (HR=2.03, 95%CI: 1.11~3.68, P=0.021). A total of 213 patients were successfully followed up for an average duration of 24±13 months. Also, the status seizure free was reported in 80.4% (37/46) of the meningioma patients with preoperative seizures.

Epileptic seizures are common in patients with meningiomas and more likely to be observed in those with tumors located in motor-related areas and young people. Tumor resection could result in favorable seizure outcome.

To investigate the safety and efficacy of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) with three-dimensional lesioning in the treatment of drug-resistant epilepsy.

Forty-eight patients with drug-resistant epilepsy who underwent SEEG-guided RF-TC with three-dimensional ablation at Neurosurgery Department of Xuanwu Hospital Capital Medical University from July 2015 to December 2017 were retrospectively enrolled into this study. There were 22 cases of mesial temporal lobe epilepsy (MTLE), 9 cases of hypothalamic hamartoma, 5 cases of frontal lobe epilepsy, 4 cases of insular lobe epilepsy, 1 case of periventricular nodular heterotopia, 1 case of tuberous sclerosis and 6 cases of multi-focal epilepsy. The clinical efficacy was evaluated based on the Engel grading system and the relevant complications were documented.

The follow-up duration was 5-35 months, with an average of 16.3±7.3 months. The overall outcome was Engel Ⅰ in 23 (47.9%) cases, Engel Ⅱ in 12 (25.0%), Engel Ⅲ in 11 (22.9%) and Engel Ⅳ in 2 (4.2%). There were 71.9% (23/32) of patients who were seizure free at 1 year follow-up. The outcome was better in MTLE and hypothalamic hamartoma epilepsies, with Engel grade Ⅰ ratio of 59.1% (13/22) and 5/9 respectively. Multi-focal epilepsies (Engel grade Ⅲ: 4 out of 6 cases), frontal lobe epilepsies (Engel grade Ⅲ: 1 out of 5), Engel grade Ⅳ: 2 out of 5) had relatively poor curative effect. Transient complications following thermocoagulation occurred in 7 (14.6%) cases and permanent complications in 1 (2.1%).

SEEG-guided RF-TC with three-dimensional lesioning is minimally invasive, safe and effective in the treatment of drug-refractory epilepsy. Compared with other types of epilepsies, MTLE and hypothalamic hamartoma epilepsies have relatively better efficacy and RF-TC can be a complementary treatment for resective surgery.

To investigate the clinical features of surgical-resected glioneuronal tumors associated-epilepsy and to explore the influencing factors of surgical efficacy.

A retrospectively study was conducted on 39 consecutive epilepsy patients with glioneuronal tumors confirmed by postoperative pathology who underwent epileptogenic focus resection at Epilepsy Center of the Second Affiliated Hospital, Zhejiang University School of Medicine from July 2012 to December 2016. Their clinical features and prognostic factors were analyzed (Engel grade Ⅰ: good outcome; grade Ⅱ-Ⅳ: poor outcome).

A total of 39 cases consisted of 28 cases of gangliogliomas and 11 dysembryoplastic neuroepithelial tumors. The average age of onset was 21.5±13.5 years old, and children and young patients (below 35 years old) accounted for 84.6% (33 cases) of all cases. The median duration of course was 2 years. Thirty-one cases presented with refractory epilepsy courses. The tumor location was temporal lobe in 27 cases and frontal lobe in 9. The average follow-up time of 39 patients was 1.9±0.8 years. Among them, Engel grade Ⅰ was reported in 28 (71.8%) cases, grade Ⅱ in 8, grade Ⅲ in 2 and grade Ⅳ in 1. No recurrence was found in brain tumors. Compared with the poor outcome group, the proportion of patients with good outcome was higher in the rate of undergoing intraoperative cortical EEG monitoring (21/28 vs. 4/11), and the difference was statistically significant (P=0.033). Other clinical features, including gender, age of onset, course of disease, operation age, epilepsy type, drug response, tumor location and focal cortical dysplasia, had no correlation with the outcome (all P>0.05).

Glioneuronal tumors associated-epilepsy have a relative higher prevalence in children and young people with common location at temporal lobe and clinical features of refractory course. Surgical resection may lead to good outcome. Intraoperative electrocorticography monitoring could assist in localization of epileptogenic foci and postoperative control of seizures.

To report the clinical characters, surgical treatment and outcomes of patients with cingulate epilepsy (CE).

We retrospectively analyzed the clinical data of 37 CE patients who underwent resective operations at Department of Neurosurgery, the First Affiliated Hospital of PLA General Hospital from January 2003 to October 2016 and performed statistical study of seizure symptoms in different types of CE, surgical approaches and outcomes. In addition, the influencing factors were analyzed for patients who were postoperative seizure free.

The semiology of CE varied. Hypermotor and fear were common symptoms in anterior CE and asymmetrical tonic seizure was more common in middle-posterior CE. However, visual and hallucinatory symptoms were exclusively reported in posterior CE. All 37 patients underwent resected surgery, including 23 cases of pathological focus resection, 11 cases of cerebral lobe and cingulate gyrus (including pathological focus) resection, and 3 cases of epileptogenic zonectomy. Scalp EEG of 12 (32.4%) patients was unable to provide lateralization and localization information for epileptogenic zone. The percentage of postoperative seizure free was 83.8%(31/37) at 1-year follow-up. Univariate analysis showed that MRI results, locations of epileptic foci or pathological lesions in the cingulate gyrus, natures of pathological lesions, and results of scalp EEG were not significantly correlated with seizure-free after surgery(P>0.05). Multivariate logistic regression analysis showed that patients with higher intelligence quotient(IQ) before surgery had better surgical outcomes(OR=15.94, 95%CI: 1.081~234.869, P=0.044).

The semiology of CE vary greatly and the scalp EEG can provide limited information for epileptogenic zone localization. Resective operation is an effective approach in the treatment of CE and high preoperative IQ may be a positive predictor for postoperative seizure-free.

To analyze the clinical manifestation and post-operative seizure outcome in patients with epilepsy originating from posteriolateral temporal cortex.

A retrospective study was conducted on the clinical data of 10 patients with epilepsy originating from posteriolateral temporal cortex who underwent surgical treatment at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from March 2015 to December 2017. Presurgical evaluation data were analyzed in detail. All patients received lesionectomy and seizure outcome was obtained during clinical visit or with telephone.

Ten patients (male: 4) were included in the analysis. The mean age of seizure onset was 14.0±7.6 years old and the mean surgery age was 18.8±6.0 years, with mean disease duration of 5.1±3.3 years. MRI images were positive in all patients. Four patients presented with automatism, including oropharyngeal automatism and bilateral forearm automatism, which was observed in the early phase of seizure. Ictal version (n=6) was another typical seizure semiology and occurred in the early phase of seizure. Ipsilateral version was reported in 4 cases. Two patients had seizures occasionally within one month after surgery and relieved at 3-month follow-up. With the mean follow-up time of 18.6±5.3 months, all patients were seizure free (ILAE level 1).

Ictal version and automatism frequently occur in patients with epilepsy arising from posteriolateral temporal cortex. Thus, epilepsy arising from posteriolateral temporal cortex should be considered according to seizure semiology, electrophysiology and medical imaging information. Lesionectomy appear to be effective in seizure control.

To investigate the effectiveness and safety of stereoelectroencephalography (SEEG) in guiding surgical treatment of temporal-insular type of temporal plus epilepsy (TI-TPE).

A retrospective analysis was conducted on the clinical data of 10 TI-TPE cases confirmed by SEEG from May 2014 to November 2015 at Department of Epilepsy Center, Guangdong Sanjiu Brain Hospital. Those 10 patients accounted for 6.8% of 147 surgical cases of temporal lobe epilepsy treated during the same period. Electrodes were implanted in all cases with the assistance of neurosurgical stereotactic robot. The epileptogenic zone, including the anterior temporal lobe, mesial temporal lobe and epileptic insular cortex, were surgically resected with SEEG guidance. The outcome was assessed to explore the effectiveness of operation.

The number of electrodes implanted in each case was 9-16 (12.4±2.1) on average. Based on the SEEG results, 7 cases were classified as simultaneous type and 3 as independent type. All cases underwent surgical operations. No complication was observed in this series except for 1 who had transient naming aphasia and recovered before discharge. As indicated by clinical follow-up of 18-36 (28±6) months on average, all cases reached Engel class I post operation (9 cases of Ia and 1 of Ic).

SEEG is a significant method for the diagnosis of TI-TPE. For TI-TPE cases, surgical treatment with the guidance of SEEG seems safe and effective.

To investigate the seizure outcome in a case series of patients with periventricular nodular heterotopia related epilepsy treated by stereo-EEG (SEEG)-guided radio-frequency thermocoagulation (RF-TC).

Five patients with periventricular nodular heterotopia related epilepsy admitted to Department of Neurosurgery, Beijing Fengtai Hospital from March 2015 to May 2017 were retrospectively studied. Following video-EEG monitoring, patients underwent SEEG recording for further identification of epileptogenic zone. All patients underwent RF-TC of periventricular nodular heteropia using contiguous contacts of the electrodes employed for recording. The contacts for RF-TC lesions were chosen according to anatomical and electrical criteria. Postoperative follow-up was conducted by outpatient visits or telephone, and the prognosis was assessed by Engel classification.

This cohort included 5 cases and 23 electrodes. No serious complications were observed after operation. During the follow-up of 9-27 months, 4 patients were seizure-free (Engel Ⅰ), and 1 patient did not benefit from RF-TC (Engel Ⅳ). No obvious complications were reported during or after RF-TC in this series.

SEEG-guided RF-TC seems to have important clinical value in epileptogenicity validation and treatment of relatively limited periventricular nodular heterotopia.

To discuss the clinical application value of stereo-electroencephalography (SEEG) guided radiofrequency thermocoagulation (RF-TC) in the treatment of hypothalamic hamartoma (HH) related epilepsy.

A retrospective analysis was conducted on the clinical data of 7 consecutive patients with epilepsy caused by HH who underwent SEEG guided RF-TC at Department of Neurosurgery, Beijing Fengtai Hospital from June 2015 to January 2018. The clinical data included detailed history of illness, semiology, electroencephalography (EEG) and imaging results. Presurgical evaluation suggested that the epileptogenic zone was hypothalamic hamartoma. Then the SEEG electrodes were implanted using stereotactic frame and video EEG monitoring was conducted. Contacts with seizure onset patterns were chosen for ablation through RF-TC. After the ablation, video-EEG monitoring was still carried out. If the epileptic discharge did not disappear, the second RF-TC was carried out until the epileptic discharge disappeared. The postoperative complications were analyzed and post-operative seizure outcome was evaluated based on the Engel outcome classification at follow-up with telephone or clinical visits.

Seven patients were followed up with a duration of 19.6±11.1 months. Among them, 5 were seizure free (EngelⅠ) and 1 achieved 75% decrease (Engel Ⅲ) in seizure frequency. One case had no obvious improvement (Engel Ⅳ). Postoperative complications occurred in 3 patients which included hyperthermia, lethargy, diabetes insipidus, electrolyte disorder and memory decline. All complications were resolved after treatment.

This study has suggested that SEEG guided RF-TC is an effective and safe treatment for seizure control in patients with HH. Complete disconnection between hypothalamus and hamartoma with RF-TC is essential for favorable surgical outcome.

To explore bilateral insular functional connectivity in refractory epilepsy patients using electrical cortical stimulation by stereoelectroencephalography (SEEG) electrodes.

We retrospectively analyzed the clinical data of 4 patients with insular or insular-related drug resistant epilepsy at Epilepsy Center of Yuquan Hospital of Tsinghua University from January 2014 to August 2016. Four patients were implanted with SEEG electrodes in bilateral insular lobes for cortical electrical stimulation. The evoked potential response of each contact was determined by visual analysis and nonparametric test. The evoked potential response was recorded at the contralateral insular lobe electrode on the stimulating side, and the response rate and anatomical distribution were determined.

A total of 28 SEEG electrodes (98 contacts) were implanted into the insular lobe in 4 patients, of which 12 electrodes (47 contacts) were implanted into the left insular lobe. Cortical-cortical evoked potential (CCEP) responses were found between bilateral insular lobes in 4 patients, and homotopic bidirectional CCEP connections were found between bilateral insular lobes. The response rate of contralateral insular CCEP was 39.8%, and the peak latency was 15.5-196.0 ms. There were bi-directional CCEP connections between corresponding bilateral insular gyri.

There are bi-directional functional connections between bilateral insular lobes in patients with insular or insular-related epilepsy, particularly in patients with post-viral encephalitis epilepsy. However, more studies are needed to confirm this result.

To investigate the clinical and imaging features of misdiagnosed cases of skull base chordomas and to improve the rate of correct diagnosis.

A retrospective analysis was conducted on 155 cases of skull base chordomas that were consecutively admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from February 2005 to December 2014. We measured the signal intensity ratio in T2WI and enhanced T1WI sequences (R_T2 and R_EN). The demographics, radiological and pathological features were compared between the misdiagnosed group (n=50) and control group (n=105). Further inter-group comparison and analysis were conducted about the tumor location and common features of misdiagnosed cases.

Among the 50 cases in misdiagnosed group, 19 cases were misdiagnosed as schwannomas, 12 as epidermoid cysts, 8 as meningiomas, 5 as other osseous tumors, 3 as pituitary adenomas and 3 as cavernous malformations. The mean R_T2 and R_EN in misdiagnosed group were 2.49 (0.79) and 0.99 (0.77), respectively, which were not statistical different from those in control group (P>0.05). However, there were significant differences when the tumor location (P<0.001) and extent of bone invasion (P<0.001) were concerned. Multivariate logistic regression showed that tumors in spheno-petrous (SP) (P=0.001) and petrous-occipital (PO) (P=0.008) regions were easily misdiagnosed compared with spheno-clival (SC) type. Exophytic chordoma was significantly easier to be misdiagnosed compared with endophytic type (P<0.001).

Skull base chordomas seem to demonstrate varying imaging features and those located in the lateral skull base and presented in the exophytic status are more prone to be misdiagnosed. The most common mimicking tumors are schwannomas in the lateral skull base and epidermoid cysts in the midline area. Signal intensity ratio on MRI could provide quantitative reference, which needs further research on its value in the diagnosis and differential diagnosis of chordomas.

To study the clinical features, imaging demonstration and treatment outcomes of intracranial extraventricular ependymomas.

A total of 17 patients with intracranial extraventricular ependymoma underwent surgical treatment at Department of Neurosurgery, Renmin Hospital of Wuhan University from March of 2010 to June of 2016 and were enrolled into this retrospective study. Pre-operative MR scan showed single lesion located at supratentorial region in all cases. Those lesions were located in occipital lobe (5 cases), occipitoparietal lobe (2 cases), temporal lobe (3 cases), frontal lobe (4 cases) and parietal lobe (3 cases). Among those, 7 were solid and 10 were cystic lesions. Surgical excision was performed for all lesions. Post-operative follow-up was performed for every patient through telephone and outpatient review.

Of those cases, total resection was achieved in 15 cases, including 10 cases of WHO grade Ⅱ and 5 case of WHO grade Ⅲ, and partial resection in 2 (WHO grade Ⅲ). Intraoperative pathological diagnosis suggested that 10 cases were ependymoma (WHO gradeⅡ) and 7 cases were anaplastic ependymoma (WHO grade Ⅲ). All patients′ clinical symptoms were relieved following surgery. Four cases (grade Ⅲ), including 2 cases undergoing partial resection, received post-operative radiotherapy. The follow-up time of those patient were from 14 to 74 months, with a median of 33.2 months. During the follow-up, no case showed any signs of spinal cord metastasis. Recurrence was reported in 7 cases and 4 of them (grade Ⅲ) received post-operative radiotherapy. Among those, 1 case underwent the second tumor total resection and postoperative radiotherapy, 1 case died 3 months after the second tumor total resection, 2 cases of tumor partial resection rejected the second operation and died after 4 and 6 months, respectively, and the other 3 recurrent cases included 2 (grade Ⅱ) and 1 (grade Ⅲ) undergoing the second tumor total resection without postoperative radiotherapy and 1 (grade Ⅲ) that died of postoperative hemorrhage.

As intracranial extraventricular ependymoma has non-specific clinical and imaging features, accurate pre-operative diagnosis is difficult. Total tumor resection is the primary method of treatment, if it is possible. The choice of resection type and pathological grading could be predictive factors in postoperative evaluation.

To explore the methods and effects of extracranial-intracranial (EC-IC) bypass and aneurysm trapping for the treatment of large and giant paraclinoid aneurysms.

The clinical data of 12 patients with paraclinoid aneurysms were analyzed retrospectively. Those patients were admitted to Department of Neurosurgery, the First Affiliated Hospital of Soochow University between April 2014 and February 2018. There were totally 12 aneurysms in 12 patients, including 8 giant and 4 large aneurysms. There were 1 case of postoperative bleeding of aneurysm embolization and 1 case of thrombotic aneurysms and 1 case of blood blister-like aneurysm. All cases underwent EC-IC high flow bypass and trapping of the aneurysms. The outcomes were evaluated based on the Glasgow Outcome Scale (GOS).

Intraoperative fluorescein angiography and ultrasound suggested bridge vascular patency. The assessment at discharge indicated a GOS of 4-5 (good outcome) in 9 cases and GOS of 2-3 (severe disability) in 3 cases. There was no death. One was lost to follow-up. Eleven patients were followed up for 6-46 months post operation. The GOS of 4-5 (good outcome) was reported in 10 cases and 2 (severe disability) in 1 case. The bridge vascular patency was revealed in 10 cases.

The operation of EC-IC bypass combined with aneurysm trapping seems effective in the treatment of large and giant paraclinoid aneurysms.

To investigate the outcomes in patients with pregnancy complicated with intracranial tumors who underwent comprehensive management.

We retrospectively reviewed the clinical data, anesthesia management and outcome of pregnant women complicated with intracranial tumor admitted to Beijing Tiantan Hospital, Capital Medical University from December 2012 to December 2017 and 19 cases were enrolled into this study. One case was at the first trimester (≤12 weeks), 9 at the second trimester (13-28 weeks) and 9 at the third trimester (>28 weeks). The operation, anesthesia and newborn management for pregnancy with brain tumor is a multidisciplinary teamwork of neurology, neurosurgery, obstetrics and anesthesiology for both mothers and newborns. Twelve cases underwent neurosurgical treatment, among which 6 cases underwent cesarean section followed by brain tumor resection or ventriculostomy (1 case). Among those 6 cases, 2 underwent surgical treatment at the first stage and 4 underwent surgical treatment 5 to 16 days later. Three benign cases carried on pregnancy after tumor resection. Pregnancy was terminated after tumor resection in 3 cases. A total of 7 cases were conservatively treated, among which 3 had the pituitary tumor and were observed till the cesarean section surgery at full term. The other 4 cases with relatively high surgical risks underwent conservative treatment following cesarean section.

There were no anesthetic complications in this series. There were 2 cases of intracranial infection, 2 cases of electrolyte disorder, 1 case of hydrocephalus and 1 case of pneumonia. There was 1 case of in-hospital death in pregnant women. Postoperative follow-up lasted for 8-23 months, with an average of 13.3±3.5 months. There were 3 deaths during the follow-up period. All those 4 cases were patients without resection of tumor. The rest of the patients were in stable condition. There were a total of 16 newborns who were 25-40 weeks of gestation at childbirth. The Apgar scores at birth were 2-10 points, with an average of 8.8±2.2 points. Of those, 15 had good clinical outcomes and 1 died 1 months after birth (28 weeks gestation week).

Individualized perioperative multidisciplinary management for pregnant women complicated with brain tumor might be the optimal approach to secure post-operative outcome of patients and newborns.

To observe the application effect of radiofrequency puncture needle with individualized and on-demand plastic curved needle technique in the treatment of second-branch trigeminal neuralgia by radiofrequency ablation through foramen rotundum with inward opening.

From November 2012 to May 2018, a total of 263 cases of second-branch trigeminal neuralgia were admitted to Department of Anesthesiology, the First Hospital of Jiaxing and underwent foramen rotundum puncture for radiofrequency ablation. All those cases were enrolled into this retrospective analysis. The paranasal sinus model of CT was used to scan the pterygoid fossa with a thickness of 3 mm, and the CT images, including the midpoint of the foramen rotundum tube, the internal and external hole, were selected and the puncture path was designed. The length of the line (puncture depth) and the angle between the straight line and the sagittal plane (the angle of puncture) were measured by using the ruler tool of CT software from the external hole of the foramen rotundum along the lateral wall of the maxillary sinus to the surface of the skin (puncturing point). If the external hole of foramen rotundum demonstrated an inward opening, the angle between the line and the direction of the foramen rotundum tube(the angle of the needle needed to bend) should be measured. The radiofrequency needle was inserted 5 mm into the self-made needle-bender, the corresponding bending angle was pulled out slightly to the side of the needle at the tip of the needle, and the individual radiofrequency needle for the patient was made. Then, puncturing under the guidance of CT followed by designed trajectory. The arc of the needle was turned to the top of the front when the needle reached the external hole of the foramen rotundum. Whereafter, the arc of the needle was turned to the bottom when the needle crossed the external hole. Subsequently, the needle was pushed into the foramen rotundum. Then, electrophysiological test was conducted for radiofrequency treatment.

Of 263 patients undergoing radiofrequency ablation of the second branch of trigeminal nerve, 71 (27.0%) had an inward opening of the external hole of foramen rotundum, which needed the patient's individually designed radiofrequency puncture needle. The average bending angle was 21.3 °±3.6 °(14°-31 °). When using the individual puncture needle, the needle tip could always reach the puncture target. Using 0.1-0.5 mA current could induce obvious muscle tremor or numbness in the region innervated by the second branch of trigeminal nerve in electrophysiological test. Following radiofrequency ablation, the second-branch trigeminal neuralgia disappeared completely. Ipsilateral palate muscosal numbness and the skin numbness involving the side of the nose, upper lip and zygomatic facial region were reported. None of the patients developed numbness involving the first or third branch of trigeminal nerve. A total of 242 patients were followed up for an average of 3.2±0.6 years. The total recurrence rates at 6 months, 1 year, 2 years, 3 years and 4 years were 2.5% (6/242), 7.9% (19/242), 16.1% (39/242), 24.4% (59/242) and 33.9% (82/242), respectively.

CT-guided individually made curved needle technology allows the radiofrequency needle tip to bypass the sphenoid bone which obstructs the outer opening of foramen rotundum and enter the middle of foramen rotundum tube with inward opening, so as to improve the radiofrequency effect and reduce the recurrence rate.

Parasitic diseases of central nervous system are a part of systemic parasitic diseases, which are a special kind of infectious diseases caused by parasites invading the cranium. Ventricular parasitic diseases accounted for 12.0% ~18.0% of cerebral parasitic diseases, and most patients were seen because of hydrocephalus^[1]。 In the past, ventricular-peritoneal shunt was used in the treatment of ventricular parasitic diseases with hydrocephalus, but the rate of tube occlusion was high, and the surgical effect was poor^[2]。 From June 2011 to April 2017, 12 patients with ventricular parasitic disease complicated with hydrocephalus were treated with neuroendoscopy in the Department of Neurosurgery of Guizhou Provincial People's Hospital, and good results were obtained. The retrospective summary report is as follows.

The traditional standard traumatic large bone flap decompression surgery has a wide range of indications, and it is basically used in clinical practice for patients with severe craniocerebral injury. Because its bone flap is large enough and decompression is sufficient, it can remove the hematoma of frontal and temporal lobes at the same time^[1]So it has been widely recognized by neurosurgeons at home and abroad. Jiang Jiyao et al.^[2]A prospective clinical multicenter controlled study showed that standard traumatic large bone flap craniotomy is better than conventional temporoparietal bone flap craniotomy in the treatment of patients with severe cerebral contusion and laceration, cerebral edema and malignant intracranial hypertension. However, in practical application, although patients with frontotemporal craniocerebral injury have different focal points and different injury mechanisms, the decompression of the temporal part is more important than that of the frontal part for the relief of intracranial hypertension^{[1,2,3,4,5,6,7]}。 How to reduce the defect of the forehead skull caused by the removal of the forehead bone flap has clinical significance. At present, many scholars have recognized this problem and tried to improve it^[3,4,5,6,7]。 From January 2007 to December 2017, the Department of Neurosurgery of Xing'an League People's Hospital, on the basis of summarizing the application of standard traumatic large bone flap decompression surgery, explored the method of routinely removing intracranial hematoma and then enlarging the temporal bone flap while retaining the frontal bone flap. A total of 112 patients with craniocerebral injury were treated, and good clinical results were achieved. The retrospective analysis is as follows.

To investigate the expression of long noncoding RNA (LncRNA) small nucleolar host gene 12 (SNHG12) in glioma tissues and its effect on cell proliferation, invasion and migration in gliomas, and to explore underlying mechanisms.

The expression of SNHG12 in glioma tissues of different grades was analyzed within the Chinese Glioma Genome Atlas (CGGA) Database and was verified by quantitative real-time PCR analysis within 27 glioma tissues and 5 normal brain tissues. The specific siRNA targeting SNHG12 was transfected into U251 and U87 glioma cells, and the change of SNHG12 expression was evaluated by qRT-PCR (quantitative reverse transcriptase PCR). Then CCK-8 assay was performed to detect the effect of SNHG12 on proliferation of glioma cells. Transwell assay was conducted to evaluate the migration and invasion efficiency of glioma cells. Pearson correlation analysis was used to detect the genes whose expression was correlated with SNHG12, and Western blot assays were performed to investigate changes of those genes after knockdown of SNHG12.

SNHG12 expression was significantly up-regulated in glioma tissues compared with normal brain tissue (P<0.05), and the expression was lower in low-grade (WHO grade Ⅱ) glioma tissues than high-grade (WHO grade Ⅲ-Ⅳ) glioma tissues (bothP<0.05). Moreover, knockdown of SNHG12 resulted in inhibition of proliferation, invasion and migration in U251 and U87 glioma cells (allP<0.05). Relative analysis within CGGA Database demonstrated that SNHG12 in glioma tissue was positively associated with CDK4, CDK6, Vimentin and MMP-9 (allP<0.05). Besides, those protein expressions were decreased after SNHG12 silencing in glioma cells.

LncRNA SNHG12 is overexpressed in glioma tissues and correlated with the malignant degree of glioma. SNHG12 could enhance the proliferation, invasion and migration of glioma cells through activating related proteins such as CDK4, CDK6, Vimentin and MMP-9. Therefore, SNHG12 may be a novel potential target for glioma therapy.

To investigate the role and potential mechanism of human giant larvae-1 (Hugl-1) in glioma cell migration and invasion.

The GFP (green fluorescent protein) overexpression group (control group) and GFP-Hugl-1 overexpression group (Hugl-1 group) were established using glioma U251 and U87 cells. Digestion assay and attachment assay were used to assess the adhesion ability of cells. Phalloidin was used to detect the cytoskeleton. Glioma cell migration and invasion were examined by using wound healing assay, Transwell assay and gelatin zymography assay. Cellular fractionation, GST-pulldown and Western blot were used to test the effect of Hugl-1 over-expression on subcellular level and activity of RhoA.

(1) Compared with control cells, Hugl-1 over-expressing cells exhibited higher resistance to digestion, faster attachment and less cell aggregation (P<0.05). (2) Compared with control cells, Hugl-1 over-expressing cells showed faster and more pseudopodia formation after serum stimulation. (3) Both U251 and U87 Hugl-1 over-expressing cells showed higher mobility than control cells. Compared with control cells, the migratory cell number in U251 Hugl-1 group was increased by 34%±6% at 24 h post wounding (P<0.05). In addition, the invasive cell number was increased by 30%±7% and 100%±11% in Hugl-1 over-expressing U251 and U87 cells respectively (bothP<0.05). (4) Examined by gelatin zymography assay, over-expression of Hugl-1 promoted the MMP2 activation(P<0.05). (5) Over-expression of Hugl-1 promoted RhoA membrane translocation and activation (P<0.05). (6) Knocking-down of RhoA partially abolished the promotion effect of Hugl-1 on glioma cell migration and invasion(P<0.05).

Hugl-1 promotes the invasion and migration of malignant glioma cells through activation of RhoA.

carotid endarterectomy (CEA) is effective in preventing ischemic stroke and improving blood flow to brain tissue^[1]。 carotid artery stenting (CAS) has been used in the treatment of carotid artery stenosis since 1990s. It has the advantages of less trauma, fast recovery and short time consumption, and is a better alternative treatment for patients with carotid artery stenosis who cannot undergo CEA.

Teratoma is a kind of germ cell tumor, which is mostly located in the lumbar vertebra in the spinal canal, especially in the cone. Cervical spinal cord involvement is rare, cervical spinal cord teratoma is extremely rare, only a small number of reports^{[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16]}(Table 1)。 Intramedullary teratomas involving both the cervical spinal cord and the medulla oblongata are rarely reported at present, so it brings severe challenges to clinical treatment. In October 2017, a case of cervical bulbar intramedullary teratoma was admitted to the Department of Neurosurgery, Peking University Third Hospital. The report is as follows.

Medulloblastoma is the most common malignant invasive tumor in children, accounting for about 25% of childhood brain tumors. It is highly malignant, histologically consistent with the World Health Organization (WHO) central nervous system tumor grade IV, and is easily transmitted through cerebrospinal fluid. At present, due to the lack of objective and effective prognostic evaluation methods and related diagnosis and treatment standards, some children receive over-treatment or under-treatment, resulting in serious complications or poor prognosis^[1,2,3]。 The latest research found that medulloblastoma can be divided into four molecular subtypes according to the different activated signaling pathways, including WNT, SHH, Group 3 and Group 4 subtypes. These four molecular subtypes have significant differences in biological manifestations, clinical characteristics and prognosis^[1,2,3]。 Therefore, there is an urgent need to establish risk classification based on molecular biological characteristics and carry out individualized treatment strategies. Previous studies have combined the molecular typing of medulloblastoma with preoperative metastasis, chromosome imbalance and other factors for risk assessment, in order to improve the survival prediction level of patients with medulloblastoma. At the same time, targeted therapies for different molecular subtypes are also gradually carrying out clinical trials. This paper focuses on the recent advances in molecular biology of medulloblastoma, which have received extensive attention in recent years, and makes a review.

Cerebral palsy, also known as Little disease, refers to a group of syndromes of movement disorders and postural abnormalities caused by non-progressive brain defects or damages in the developing fetus or infants within 1 month after birth, often accompanied by sensory, perceptual, cognitive, communication, behavioral disorders and epilepsy^[1]。 Cerebral palsy can be divided into 6 types according to the type of movement disorder and the paralysis site^[2]: spastic quadriplegia, spastic diplegia, spastic hemiplegia, involuntary movement type, ataxia type and mixed type. Spastic cerebral palsy is the most common subtype, accounting for about 2/3 of all cases. At present, the treatment of spastic cerebral palsy needs multi-disciplinary cooperative intervention, mainly including rehabilitation training, drug treatment and surgery^[3]。 Rehabilitation treatment mainly includes occupational therapy, physical therapy and language training, which occupies a major position in the treatment of cerebral palsy. The primary objective of pharmacological intervention is to reduce spasticity, including oral medication (benzodiazepines, baclofen), botulinum A toxin (BTX-A) and intrathecal baclofen (ITB), indicated for mild to moderate spasticity. Surgical treatment methods include selective posterior rhizotomy (SPR), selective peripheral neurotomy (SPN), carotid artery sheath sympathetic network dissection, bone and muscle tendon orthopedics^[4]。 SPR is currently recognized as a surgical method that can effectively relieve limb spasm^[4,5]。 The damage of the cerebral hemisphere in children with spastic cerebral palsy leads to the decrease of impulses to the intermediate nerve of the spinal cord, the enhancement of the activity of gamma motor neurons, and the abnormal increase of excitability of alpha motor neurons caused by the gamma-loop through the positive feedback mechanism, thus leading to muscle spasm. SPR relieves limb spasm by reducing the excitability of alpha motor neurons and interrupting the positive feedback of distraction reflex^[6]。 SPR has been widely used because of its effectiveness and safety, and the recent research on SPR is reviewed.

cerebral cavernous malformations (CCM) are common intracranial vascular abnormalities, second only to intracranial arteriovenous malformations. CCM is a cavernous vascular mass composed of a single layer of endothelial cells, and there is no nerve tissue between the vascular lacunae. The clinical manifestations are closely related to the lesion site, and the main manifestations are epilepsy and hemorrhage. In the development history of CCM treatment strategies, most of them focused on surgical interventions such as surgical indications, surgical timing and surgical approach selection. After nearly 80 years of development, surgery is effective in treating CCM with repeated bleeding and superficial lesions^[1]。 However, for patients with familial multiple CCM, surgery cannot completely remove all lesions, and its value is limited; In some patients, the tumor is deep or adjacent to important nerve and vascular structures, and the surgical risk is greater. For such patients, non-surgical treatment modalities are of great significance. Unfortunately, the efficacy of radiotherapy in the treatment of CCM is controversial^[2]。 As the understanding of CCM continues to deepen, scholars realize that drug therapy targeting mutant genes and related signaling pathway molecules can help solve this problem, and have actively explored it. This article will review the pathogenesis of CCM and the basic or clinical research progress of its drug therapy in recent years.