Volume 35 · Issue 01 · 2019

In the blink of an eye, 34 years ago, looking back at the extraordinary course of founding, development and maturity of Chinese Journal of Neurosurgery, under the guidance of the pioneering and innovative spirit of the older generation of neurosurgeons represented by Wang Zhongcheng and the trust and support of all neurosurgeons, the magazine has made brilliant achievements and witnessed the development of neurosurgery in China. Based on the rapid development of modern science and technology and the rapid development of neurosurgical technology, the magazine will promote the innovation and development of neurosurgery as the main purpose, strive to build a platform for the promotion of innovative technology, and continuously improve the connotation and quality of the magazine. Looking forward to the future, there are still stars and seas, and Chinese Journal of Neurosurgery will welcome new glory together with Chinese Neurosurgery.

Spasticity is a disturbance of sensory and motor control caused by the damage of upper motor neurons. Physical rehabilitation is the most basic and preferred treatment mode. When severe spasticity hinders the smooth progress of rehabilitation treatment, the importance of surgical treatment is highlighted. Treatment methods include local intramuscular injection of botulinum toxin, selective partial resection of posterior root of spinal nerve, selective partial resection of peripheral nerve, cervical denervation, deep brain electrical stimulation, tendon and bone and joint orthopedic surgery, etc. Individual treatment plan should be implemented according to the patient's condition.

To evaluate the safety and efficiency of deep brain stimulation (DBS) in the treatment of spasmodic torticollis (ST) and to compare the difference between the efficiency of STN (subthalamic nucleus)-DBS and GPi (globus pallidus internus)-DBS.

Fourteen patients underwent DBS from February 2005 to February 2018 at Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University and were retrospectively enrolled into our study. Seven cases were treated with STN-DBS and seven cases with GPi-DBS. The effects of stimulation on cervical dystonia were analyzed based on the Toronto Western Spasmodic Torticollis Scale (TWSTRS). The scores were collected at baseline and the latest follow-up. Related side effects were also documented.

The fourteen patients were followed up for the median of 24 (3-150) months. Eleven out of fourteen patients showed a significant improvement from baseline in TWSTRS (P=0.003). The median improvement rate was 69.6% (46.2%-83.6%). However, there was no significant difference between STN-DBS and GPi-DBS with the improvement rates of 69.8%(46.2%-83.6%) and 68.7%(56.0%-74.0%) respectively (P=1.000). Of all 14 patients, there was 1 case of lead breakage, 4 cases of dyskinesia, 1 case of face tic and 1 case of dysarthria, dysphagia and neck fatigue.

DBS seems to be an effective and safe therapy method of ST. Both STN and GPi are effective targets for the treatment of ST.

To study the complications of lumbosacral selective posterior rhizotomy (SPR) for the treatment of spastic cerebral palsy and to provide the prevention strategies.

We retrospectively reviewed the surgical outcome and postoperative complications of 508 patients with spastic cerebral palsy who underwent SPR surgery at Department of Neurosurgery of Beijing Fengtai Hospital, The First Hospital of Peaking University from March 2003 to November 2016 and were followed up for more than one year. The complications were divided into 2 main categories: perioperative complications (from post operation to discharge) and medium to long-term (follow-up of over 1 year) complications. Incidence, causes, treatment approaches of complications as well as outcomes were analyzed.

A total of 508 patients were included in this cohort. The overall response rate (modified Ashworth spasm scale≤2 grade) was 93.7% (476/508). Perioperative transient complications included lower extremity weakness in 76 (15.0%) cases, abdominal pain in 39 (7.7%), lower extremity sensory deficit in 29 (5.7%), headache related to low intracranial pressure in 18 (3.5%), transient urinary retention in 9 (1.8%), slow incision healing in 5 (1.0%), cerebrospinal fluid leakage in 3 (0.6%), incision infection in 2 (0.4%), and aspiration pneumonia in 2 (0.4%). All patients were followed up for 17-36 months, with an average of 22.5±5.4 months. Medium to long-term complications during follow-up included chronic back pain in 51(10.0%) cases, instability or subluxation of spine in 38 (7.5%), lower extremities dyskinesia in 31 (6.1%), scoliosis in 29 (5.7%), and lower extremity sensory deficit in 25 (4.9%).

The operation of SPR seems to be highly effective for the treatment of spastic cerebral palsy. Perioperative complications are mostly transient and can be resolved within 2 weeks following proper treatment. Medium to long-term complications usually have no significant negative effect on the patient's quality of life.

To investigate the lumbar spine stability in children with spastic cerebral palsy (SCP) following modified selective posterior rhizotomy (SPR).

A total of 90 cases of SCP underwent lumbosacral SPR at Neurosurgery Department of China-Japan Friendship Hospital from January 2012 to December 2017 and were retrospectively enrolled into this study. Paired t-test was used to compare the differences of lordosis angle (Cobb′s method), lumbosacral angle, arch-vertex distance, Cobb’s angle before and after surgery (final follow-up) to observe the occurrence of lumbar spine deformity post operation.

Postoperative follow-up lasted for 6-60 months with an average of 27.0±12.8 months. The average preoperative and postoperative lordosis angles were 36.1°±1.8° and 39.9°±2.6° respectively, which had statistical difference (P=0.029). Pre- and post-operative lumbosacral angles [33.1°±1.4° vs. 33.6°±1.4°], arch-vertex distance (15.6±1.3 mm vs. 17.3±1.2 mm), Cobb’s angle[5.9°±0.9° vs. 7.3°±0.9°]. Those difference were not statistically significant (P>0.05). Of 90 patients, 9 (10.0%) had lumbar deformities before surgery, including 7 cases of scoliosis and 2 cases of lumbar spondylolisthesis. After operation, 24 (26.7%) cases had lumbar spinal deformities, 18 reported scoliosis, and 6 had Ⅰ° lumbar spondylolisthesis. Among the 7 cases with scoliosis before operation, 2 were improved to different degrees after operation and 5 were aggravated.

Little effect on lumbar spine stability is found among children with spastic cerebral palsy in long-term study following SPR.

To investigate the candidate selection, surgical methods, efficacy and complications of selective peripheral neurotomy (SPN) for the treatment of limb spasticity in cerebral palsy.

A total of 119 patients with spastic cerebral palsy admitted to Department of Neurosurgery, Yuquan Hospital, Tsinghua University from January 2016 to June 2017 were enrolled into study. All those patients underwent SPN, which involved 40 upper limbs and 156 lower limbs with 360 nerves operated on. The changes of muscle tension following operation were evaluated by modified Ashworth scale and surface electromyography (sEMG). The changes of upper and lower limb motor function were evaluated by action research arm test (ARAT) and gross motor function measure (GMFM) scales.

The immediate postoperative successful rate with limb spasticity relief was 95.6% (344/360). Moreover, the patients with Ashworth scales of 0, 1, 2, 3 accounted for 60.0% (216/360), 25.6% (92/360), 8.9% (32/360), 1.1% (4/360) respectively. Inefficient treatment accounted for 4.4% (16/360). The rate of sensory disturbance immediately post operation in the innervated region was 10.3% (37/360) and the rate of postoperative muscle strength decline over at least 1 grade was 1.9% (7/360). Sensory disturbance was all relieved within 3 months. All those patients were followed up for 6-24 (17.2±4.9) months. The improvement rate of limb motor function during follow-up was 67.3% (132/196), of which the upper limb improvement rate was 47.5% (19/40) and the lower limb improvement rate was 72.4% (113/156). Recurrence with varying degrees was reported in 32 (8.9%) cases, of which 13 (3.6%) returned to preoperative levels.

The SPN has a significant alleviating effect on the limb spasticity of cerebral palsy. Proper surgical indications and operative methods are keys to improvement of treatment efficacy and reduction of clinical complications.

To evaluate the clinical effects of modified cervical sympathectomy for the treatment of tic disorders (TD) with paroxysmal spasm as the main manifestation and to analyze the feasibility of this method.

A total of 20 patients with TD, admitted to Department of Neurosurgery, China-Japan Friendship Hospital from January 2014 to January 2017, were enrolled into this study. All patients received cervical sympathectomy. The severities of TD symptoms were evaluated respectively by Yale Global Tic Severity Scale (YGTSS) in all patients before operation at 1 month and 12 months post operation.

All patients were followed up for 14-51 months with an average of 25.10±10.25 months. Twenty patients presented 1-month and 12-month postoperative motor tic severity scores of 9.20±3.64 points and 9.25±3.67 points respectively. The 1-month and 12-month postoperative total YGTSS scores were 22.80±15.58 points and 21.65±16.17 points respectively. Compared with preoperative motor tic severity score (19.00±1.17 points) and total YGTSS score (52.90±4.96 points), the 1-month and 12-month postoperative scores showed significant difference (F=68.13, 35.62, respectively, P<0.001). No complications such as hoarseness, choking/coughing while drinking were observed in those 20 patients.

Modified cervical sympathectomy seems to be a feasible and effective method for the treatment of tic disorders with paroxysmal spasm as the main manifestation with relatively few complications or adverse reactions.

To observe the effect of ultrasound-guided injection of botulinum toxin type A (BTX-A) in the treatment of brain-derived lower limb spasticity in adults and the change of integrated electromyogram (iEMG) of surface electromyography (sEMG) following treatment.

A prospective randomized controlled trial was performed in patients with adult brain-derived lower extremity spasticity. From March to December 2017, 40 patients with brain-derived lower limb spasticity were selected from the Department of Rehabilitation Medicine of the Affiliated Hospital of Qingdao University. Forty patients with stroke or cerebral trauma were randomly divided into treatment group and control group. The patients in control group underwent conventional rehabilitation training and those in treatment group were treated with ultrasound-guided injection of botulinum toxin type A in addition to conventional treatment. Before treatment and at 4 weeks post treatment, the scores of modified Ashworth scale (mAS), Fugl-Meyer assessment-lower limb (FMA-lower limb), measurement of step velocity and iEMG were used to evaluate the efficacy in both groups.

(1) mAS: The score in treatment group was 3 (1.75) before treatment and 2 (1.00) at 4 weeks post treatment. The score in control group was 3 (2.00) before treatment and 2 (1.75) at 4 weeks post treatment. (2) FMA score: The score in treatment group was 9.45±2.56 before treatment and 13.20±2.24 at 4 weeks post treatment. The score in control group was 10.05±2.54 before treatment and 11.75±1.65 at 4 weeks post treatment. (3) Pace: step velocity in treatment group was 0.24±0.05 m/s before treatment (0.34±0.07) m/s at 4 weeks post treatment. The pace in control group was 0.24±0.06 m/s before treatment and 0.28±0.07 m/s at 4 weeks post treatment. (4) iEMG: the value of the treatment group was 149.57±15.77 μV before treatment 88.21±13.51 μV at 4 weeks post treatment. The value in control group was 148.38±21.60 μV before treatment 99.47±14.23 μV at 4 weeks post treatment. Compared between 4 weeks post treatment and pre-treatment conditions, there was statistically significant difference in terms of scores of mAS, FMA, step velocity, iEMG both in treatment group and control group (all P<0.05). The improvements in treatment group were significantly greater than those in control group (allP<0.05).

Ultrasound-guided BTX-A injection could further improve muscle spasticity of lower limb and enhance motor. The positioning method seems safe, effective and accurate. The technology of sEMG can be used to objectively assess the change of muscular tension following BTX-A injection and serve as one of the quantitative parameters for evaluation of spasticity improvement.

To study the effectiveness of selective posterior rhizotomy of lumbosacral region for relief of spasticity of lower limbs of cerebral palsy.

A total of 48 patients of spastic cerebral palsy who had undergone SPR at Department of Neurosurgery, The People's Hospital of Liaoning Province from January 2013 to January 2015 were followed-up with limb spasticity, gait and quality of life. The changes of muscle tone were evaluated by the modified Ashworth scale (mAS), the motor function was assessed by the gross motor function classification system (GMFCS), the quality of life was assessed by the activity of daily living(ADL) score, and the salivation condition was assessed by the teacher salivation grading method (TDS).

All patients were followed up for 12-30 months with a mean duration of 18.2±6.5 months. Compared with the preoperative results, mAS scores of the left hips, knees and ankles of the 96 patients at 6 months, 12 months and the last follow-up were lower with statistically significant differences (all P<0.05). GMFCS score(Z=-5.19, P<0.01) and ADL score were significantly improved (F=1.89, all P<0.05), and salivation improvement proportion was 5/15. Postoperative GMFCS grades were negatively correlated with the patient's age (r=-0.44, P=0.009), weight (r=-0.22, P=0.006), and there was no correlation with gender, GMFCS grade before treatment, or number of affected limbs (all P>0.05). Among postoperative complications, the incidence of lower limb sensory disorder and muscle weakness was 7.3%(7/96)and 9.4%(9/96), respectively, both of which were improved during follow-up. Two (4.2%) cases of transient urinary retention and 1 (2.1%) case of dysmenorrhea occurred post operation. The postoperative recurrence rate of spasm was 2.1% (1/48).

Lumbosacral SPR is a safe and effective way to treat spasticity of lower limbs in cerebral palsy patients and improve their quality of life.

To study the efficacy of selective peripheral neurotomy in treating cerebral spasticity in adults.

Sixty-one cerebral spasticity cases in adults treated by selective peripheral neurotomy at Shengli Oilfield Central Hospital from March 2015 to November 2017 were selected. They were analyzed retrospectively in spasticity, muscular tension, gait, quality of life and complication right after operation.

With a period of follow up for 11-26 months (mean duration: 19.5±7.6 months), 5 upper limbs and 68 lower limbs of 73 limbs of 61 patients involved 94 peripheral nerves all experienced notable alleviation of spasticity right after operation, and the alleviation rate in follow-up duration was 91.8%(67/73). The rate of decrease in muscle tension was 100% and it in follow-up duration was 94.5%(69/73). The improvement rate of motor capacities 3 months after operation was 83.6%(51/61), and was 90.2%(55/61)half year after operation. The rate of improvement in upper limb function was 80.0%(4/5)in follow-up duration. A total of 91.8%(56/61)cases had better quality of life by follow-up studying. Postoperative complications like dysaesthesias of limbs were found in 6 cases (8.2%), muscle weakness in 3 cases (4.1%) and recurrence of spasticity in 2 cases (2.7%).

Selective peripheral neurotomy is a safe and effective surgical method in treating cerebral spasticity in adults.

To study the surgical outcome and safety of combined selective peripheral neurotomy (SPN) for treatment of spasticity in lower limbs of cerebral palsy patients.

A total of 109 cerebral palsy patients with lower limb spasticity (218 limbs) were treated with combined SPN on bilateral obturator nerve, tibial nerves and sciatic nerves from March 2007 to March 2017 at Department of Neurosurgery, Linyi Traditional Chinese Medicine Hospital. The modified Asworth scale (mAS) was used for the evaluation of the patients’ spasticity and their movement ability was assessed by the gross motor function classification system (GMFCS).

The mean follow-up period was 73.6±16.7 months (range: 12-132 months). The spasticity was alleviated in 209 (95.9%) lower limbs immediately post surgery, and the rate of alleviation was 90.8% (198 limbs) at the last follow-up. The mAS scores of adductor muscle of hip and ankle metatarsal flexor muscle were 2.66±0.49 and 3.36±0.52 respectively prior to surgery and 1.52±0.46 and 1.57±0.56 respectively at last follow-up. Those differences were statistically significant (P<0.01). At the last follow-up, 95 of 109 (87.2%) had improvement on motor function. There was significant improvement on motor function indicated by elevated GMFCS scales (P<0.05). The sensory disorder of limb was found in 51 (23.4%) lower limbs, decreased muscle strength occurred in 39 (17.9%) lower limbs during hospitalization, and both complications were improved during the follow-up period.

Combined SPN on bilateral obturator nerve, tibial nerves and sciatic nerves was an effective and safe method for the treatment of lower limb spasticity and improvement of lower limb movement in cerebral palsy patients who cannot undergo selective posterior rhizotomy (SPR) due to various reasons or those whose spasticity cannot be completely relieved after SPR.

To investigate the long-term efficacy and complications of modified Foerster-Dandy operation in the treatment of spasmodic torticollis (ST).

A total of 550 cases of ST admitted to Neurosurgery Department of China-Japan Friendship Hospital from April 2005 to April 2013 were retrospectively enrolled into this study. All patients were treated with modified Foerster-Dandy operation, in which occipitocervical posterior median approach was used without opening of occipital squama and foramen magnum. Limited laminectomy, endoscope-assisted bilateral subdural accessory nerve and C₁ spinal nerve root cutting and selective partial cutting of anterior and posterior roots of C_2-4 spinal nerve were conducted. The international Tsui scale was used to evaluate the efficacy post operation. We also analyzed the complications occurring following the operations.

All patients were followed up for 60-156 months, with an average of 117.0±5.5 months. The median improvement rate of spasticity at 6 months, 12 months and the latest follow-up was 73.6% (54.7%, 86.4%), 70.2% (48.8%, 85.1%) and 73.2% (51.1%, 88.5%), respectively. The Tsui score before operation was 17.2 (13.6, 20.6). However, at 6 months, 12 months and the latest follow-up, the Tsui scores were 4.6 (2.2, 7.3), 4.9 (2.6, 8.1) and 4.3 (2.0, 7.5), respectively, which were significantly lower than those prior to operation (all P<0.05). However, 30 (5.5%) cases had neck rotation weakness, 34 (6.2%) reported shoulder shrug weakness, 32 (5.8%) had limited arms abduction, 45 (8.2%) developed long-term neck back pain and numbness, 11 (2.0%) reported neck circumference narrowing, and 62 (11.3%) suffered from dysphagia. Among them, no obvious improvement was achieved in 5 cases with neck rotation weakness and 9 cases with dysphagia. All the other complications were relieved to various degrees during the follow-up period after rehabilitation training. During the follow-up, spasm recurrence to various degrees was reported in 25 (4.5%) cases.

Modified Foerster-Dandy operation is a safe and effective surgical therapy for patients with ST.

To preliminarily evaluate the feasibility and reliability of wearable mixed reality holograms in guiding the intracranial catheter insertion.

A total of 25 consecutive patients undergoing emergent intracranial catheter insertion at Department of Neurosurgery, Xuanwu Hospital, Capital Medical University between July 2017 and January 2018 were prospectively enrolled into Group A (18 external ventricular drain, 6 intracranial hematoma aspiration and 1 brain abscess puncture). Other 25 consecutive patients who underwent the same operation between February 2017 and July 2017 were retrospectively enrolled into Group B (20 external ventricular drain, 4 intracranial hematoma aspiration and 1 brain abscess puncture). According to the planned depth and trajectory orientation, catheter insertion under the three-dimensional holographic guidance of a head-mounted device was applied in Group A. Group B underwent the operation based on the classical localizing method. Total operation time, number of insertions and target deviation distance were compared between the 2 groups.

All patients in Group A achieved holographic guided catheter insertion with an average operation time of 63.2±10.6 min, which was 38.1 ± 12.5 min longer than that in Group B. The mean number of insertions was 1.2 ± 0.2 in Group A and 2.8 ± 0.8 in Group B. The average target deviation in Group A was 4.5 ± 1.7 mm and 13.5 ± 5.9 mm in Group B. Those differences were all statistically significant (P<0.01). None of the patients in Group A had adverse events associated with transcranial puncture catheterization with wearable mixed reality holographic guidance, and 2 (8%) cases of puncture tract hematoma were found after puncture in Group B patients.

This study has preliminarily verified the feasibility and reliability of wearable mixed reality holographic guidance technique for the procedure of intracranial catheter insertion. Further reduction of its operation time is expected.

To further reduce the registration error of ROSA by the application of corrective registration for fiducial osseous marker.

Thirty-four patients, including 33 Parkinson’s disease patients and 1 essential tremor patient, were admitted to Department of Neurosurgery, General Hospital of Shenyang Military Area Command from November 2016 to January 2017 and underwent DBS (deep brain stimulation) operation assisted by ROSA. Each of them was registered by contact with 5-point titanium alloy markers. Each patient received 4 registration plans which were respectively named group A, group B, group C and group D. The virtual probe circles in group A were tangent to the end of the marker image on CT. The virtual probe circles in group B, group C and group D were individually moved by 0.25 mm, 0.50 mm and 0.75 mm to the marker tip along the long axis based on group A. The registration errors in each group were documented and 4 sets of error data were analyzed by variance analysis.

The registration errors in group A ranged from 0.47 mm to 0.77mm, with an average of 0.60±0.08 mm. The registration errors in group B ranged from 0.15 mm to 0.68 mm, with an average of 0.39±0.12 mm. The registration errors in group C ranged from 0.11 mm to 0.39 mm, with an average of 0.27±0.08 mm. The registration errors in group D ranged from 0.22 mm to 0.66 mm, with an average of 0.43±0.10 mm. The population means in the 4 groups were not completely equal by variance analysis (F=68.024, P<0.001). Significant difference was identified in registration errors between any 2 groups except for that between the group B and D. The registration error in group C was the smallest and that in group A was the largest. The registration errors in group B and D were between them.

Registration error decreases when the virtual probe circle is moved by 0.50 mm to the tip of markers along the long axis of markers in the DBS operation assisted by ROSA. The modified registration plan could improve the accuracy of DBS operation.

To explore the sensitivity and specificity of electrocorticography (ECoG) in intraoperative mapping of motor cortices with the event-related potential (ERP) of slow cortical potential resting-state networks.

Thirteen patients with brain lesions near eloquent areas who were admitted to Department of Neurosurgery, Guangzhou General Hospital of Guangzhou Military Command from December 2014 to June 2016 were treated under awake craniotomy. The motor-related cortices were detected by intraoperative direct electrical stimulation. The ECoG were collected from patients in resting state. The ERP of slow cortical potential resting-state networks was analyzed. The sensitivity and specificity of ECoG in mapping of motor cortices were evaluated.

Motor areas were identified by DES in all patients. The ERP of slow cortical potential resting-state networks was significant and regarded as the specific rhythm of motor cortex. When the threshold of ERP of the specific rhythm was chosen as 1.6, this method showed the optimal sensitivity (90.6%) and modest specificity (59.2%) compared with the other threshold.

Data analysis of the ERP of slow cortical potential resting-state networks from ECoG can be used to map motor areas intraoperatively, which is expected as a new adjunct to DES for intraoperative mapping.

To evaluate the efficacy of stereotactic hematoma evacuation surgery for hypertensive cerebral hemorrhage in basal ganglia region.

A retrospective analysis was performed on 65 cases of hypertensive cerebral hemorrhage in the basal ganglia from August 2015 to March 2018 at the Stereotactic and Neurofunctional Center of the 306^th Hospital of PLA. According to different surgical methods, those patients were divided into 2 groups. In the hematoma puncture group, 35 patients underwent hematoma puncture and drainage surgery; in the stereotaxis group, 30 patients underwent stereotactic puncture and catheter drainage surgery assisted by robot Remebot. The baseline conditions, bleeding time, volume of hematoma, preoperative GCS (Glasgow coma scale) score, Barthel score before discharge and at 3 months post operation, and the time of thorough hematoma drainage were compared between the 2 groups.

(1) The time for thorough hematoma drainage in the stereotaxis group was significantly less than that in the hematoma puncture group. There was a significant difference between the 2 groups (Z=3.69, P<0.01). (2) Barthel scores before discharge (89.7±7.2) and at 3 months post operation (94.0±5.7) in stereotaxis group were significantly higher than those in hematoma puncture group (before discharge: 75.3±7.2, 3 months post operation: 76.4±8.2, bothP<0.01).

Stereotactic hematoma evacuation surgery could significantly accelerate the removal time of hematoma in patients with hypertensive intracerebral hemorrhage, quickly relieve the compression of brain tissue by hematoma and promote the recovery of neurological function.

To explore the possibility of using 3D Slicer 3D image reconstruction software to assist in finding small lesions in the brain during operation. In this paper, 8 patients with small intracerebral lesions (maximum diameter ≤3 cm) admitted to the Department of Neurosurgery of Jinan Military Region General Hospital were studied. Preoperatively, 3D Slicer software was used to reconstruct the enhanced magnetic resonance sequence of patients, which showed the lesions and the sulcus and blood vessels on the surrounding brain surface. According to these anatomical structures, the lesions could be quickly located and accurately excised during the operation. The brain surface structure displayed by 3D Slicer image reconstruction software can assist in finding smaller lesions in the brain, which can be an important supplement to preoperative planning.

The clinical data of 515 patients with spontaneous cerebral hemorrhage (sICH) who lived in Shigatse area of Tibet Autonomous Region were retrospectively analyzed to explore the clinical characteristics of sICH in high altitude areas. The results showed that sICH was in accordance with its general pattern of incidence (more males than females, higher incidence in winter and spring, hypertensive cerebral hemorrhage, etc.), but it had the characteristics of advanced average onset age, obvious seasonal trend of onset and high proportion of cerebral lobar hemorrhage.

To identify the role of abnormal metabolism signaling pathways in growth hormone-secreting pituitary adenomas (GH-PAs) based on phosphoproteome profiles.

In this study, twelve GH-PAs specimens were collected from patients who were surgically treated at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from August 2010 to August 2017. Normal pituitary tissues were collected from 3 body donors who died from traffic accidents. The differential phosphoprotein expression patterns involved in GH-PAs were investigated by nano LC-MS/MS in a group of samples. The phosphoprotein expression data were analyzed by bioinformatics. The expression levels of the candidate phosphoproteins were validated by western blot analysis in another group of samples.

A total of 1 213 phosphorylated protein sites corresponding to 667 proteins were significantly different between GH-PAs and healthy pituitary glands (P<0.05, FC≥1.5 or <0.67). Among those phosphorylated sites, 342 exhibited lower levels of phosphorylation in GH-PAs and 871 exhibited lower levels of phosphorylation in GH-PAs. The 1 213 phosphorylated protein sites were mapped to 667 phosphoproteins. The majority of differentially expressed phosphorylated proteins were significantly enriched in glycolysis and the AMPK signaling pathway in GH-PAs by IPA (P<0.05). In glycolysis pathway, 9 of 10 phosphorylated proteins exhibited lower phosphorylation levels in GH-PAs than healthy pituitary glands. The AMPK signaling pathway was demonstrated to be inhibited in GH-PAs by Pathway Activity Analysis. Notably, western blot proved that the level of AMPK(1.75±0.36vs. 1.59±0.75, P=0.663) had no difference and the phosphorylated levels of AMPK (ser496) was significantly lower in GH-PAs than in healthy pituitary glands(1.47±0.58 vs. 0.32±0.16, P=0.016).

Phosphorylation proteomics revealed the abnormal metabolism in GH-PAs. Decreased phosphorylation of the AMPK pathway may be critical for glucose metabolism in GH-PAs.

To assess the efficacy and safety of laminoplasty (LAMP) versus laminectomy (LAMT) in the treatment of intraspinal tumors.

We searched the databases (PubMed, EMbase, the Cochrane Library, CBM, CNKI and Wanfang) to search randomized controlled trials (RCTs) or non-randomized controlled clinical trials (non-RCTs). There was no restriction on publication time. The quality of the included trials was assessed and meta-analysis was conducted by RevMan 5.3 software.

A total of 14 studies (1 RCT and 13 non-RCTs) involving 1 089 patients were included. Meta-analysis results showed that LAMP increased the effective recovery rate [88.3% (128/145) vs. 71.6% (68/95), P=0.002] and reduced the blood loss (SMD=-3.50, 95%CI: -4.84 to -2.16, P<0.01) when compared with LAMT. Meanwhile, the incidences of spinal deformity [6.1% (19/313)vs. 28.9% (153/529), P<0.01], spinal instability [2.5% (7/279)vs. 31.3% (81/259), P<0.01] and cerebrospinal fluid leak [3.0% (10/330)vs. 11.7% (64/548), P<0.01] in LAMP group were lower than those in LAMT group. However, there was no significant difference in total resection rate of tumor [87.1% (183/210)vs. 75.4% (239/317), P=0.21], operation time (SMD=-0.43, 95% CI: -1.01 to 0.14, P=0.14) between the 2 groups. Subgroup analysis showed that age might have an effect on spinal deformity.

LAMP could restore the normal anatomy of spine and reduce the blood loss and postoperative complications, which seems superior to LAMT.

Dural arteriovenous fistula (DAVF) is an abnormal arteriovenous short circuit that occurs on the dura mater and its accessory structures. Among them, the early diagnosis of Cognard type 5 is difficult, and it is manifested as the phenomenon of acute paraplegia in patients with progressive myelopathy who are easily misdiagnosed as myelitis and treated with glucocorticoids. This paper reports two patients with acute quadriplegia caused by Cognard type 5 DAVF treated with glucocorticoids.

The goal of treatment of complex intracranial aneurysms is to reconstruct the vessel wall and correct the hemodynamic disorders. Pipeline dense mesh stent has significant blood flow guidance effect, which can reduce blood flow into the aneurysm cavity, and it is widely used in the treatment of large intracranial aneurysms at present. This paper reports a case of complex intracranial aneurysm treated with Pipeline stent with satisfactory clinical results.

Congenital absence of internal carotid artery is a rare class of cerebrovascular variation, and the mechanism of collateral compensation is still inconclusive. This paper reports a patient with congenital absence of internal carotid artery, collateral circulation established by anastomosis between cavernous sinuses, and intracranial arteriovenous malformation and hemorrhage. After treatment with endovascular embolization, the patient recovered well.

Dystonia is a neurological dyskinesia syndrome characterized by abnormal movement or posture due to uncoordinated contraction of the active and antagonist muscles or excessive contraction. Childhood-onset primary dystonia, also known as idiopathic dystonia, is hereditary, refractory to drugs, and characterized by progressive aggravation of symptoms. Deep brain stimulation has been widely used in the treatment of nervous system dyskinesia such as Parkinson's disease and tremor. In recent years, it has been successfully used in the treatment of adult-onset dystonia. International exploration and research on the application of deep brain electrical stimulation in the treatment of children's dystonia have been carried out, and related clinical treatments in China have also begun. Based on the systematic combing of application cases of deep brain electrical stimulation in the treatment of children's dystonia, the research progress and future problems to be solved of deep brain electrical stimulation in the treatment of children's dystonia are introduced from five aspects: operation timing, target positioning, parameter setting and battery life, treatment effect and related complications.

The concept of neuroendoscopic skull base surgery originates from the transnasal sphenoidal approach to pituitary adenoma surgery. In the past 10 years, with the continuous innovation of endoscopic technology, light source lens and surgical equipment, this field has attracted much attention. At the same time, the indications for the application of neuroendoscopic transnasal approach in skull base surgery are more extensive and independent. This article will focus on the cooperation of neuroendoscopic transnasal approach, the technique of manipulation and hemostasis, and the progress of skull base reconstruction, and its application in different skull base sites and lesions will be reviewed. Finally, the limitations and bottlenecks of this technical approach are also put forward, and the future is looked forward.

At present, cerebrovascular disease has become the first death disease among residents in China. With the development of microsurgery and endovascular therapeutic techniques, the therapeutic effect of these diseases is constantly improving. However, certain cerebrovascular diseases such as complex intracranial aneurysms, intracranial arteriovenous malformations, long-segment stenosis and/or occlusion of intracranial vessels remain less effective in the treatment of a single mode. Compound surgery combines the advantages of endovascular treatment and microsurgery, and greatly improves the therapeutic effect and surgical safety of complex cerebrovascular diseases. This article reviews the application of composite surgical technique in cerebrovascular neurosurgery.

With the development of intracranial stereoencephalography (SEEG), the localization of intracranial epileptogenic foci can be more accurate and direct. SEEG-based radiofrequency thermocoagulation (RF-TC) of epileptogenic foci is a minimally invasive treatment method for destroying epileptogenic foci by local heating of radiofrequency instruments. This therapy has been applied and studied in various types of drug-refractory epilepsy such as hypothalamic hamartoma, ectopic nodules of paraventricular gray matter, focal cortical dysplasia, medial temporal lobe epilepsy, etc. This article reviews the literature on the efficacy and safety of RF-TC in the treatment of different types of drug-refractory epilepsy based on SEEG localization of epileptogenic foci, suggesting that for drug-refractory epilepsy with more localized epileptogenic foci, the efficacy of RF-TC treatment may be close to that of surgical resection, and the safety may be higher.