Volume 35 · Issue 03 · 2019

Glioma refers to tumors originating from glial cells of the brain, and is the most common primary intracranial tumor. The World Health Organization (WHO) classification of central nervous system tumors classifies gliomas into grades Ⅰ ~ Ⅳ, grades Ⅰ and Ⅱ are low-grade gliomas, and grades Ⅲ and Ⅳ are high-grade gliomas. This specification mainly relates to the diagnosis and treatment of high and low grade gliomas derived from astrocytes, oligodendrocytes and ependymal cells.

To explore the clinical characteristics, diagnostic method of epilepsy caused by acquired immunodeficiency syndrome(AIDS)-related encephalopathy and the value of surgical treatment.

A retrospective analysis was conducted on 12 patients with epilepsy caused by AIDS-related encephalopathy admitted to Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University from June 2012 to January 2018. Of the 12 patients, 4 had intracranial lymphoma, 4 had intracranial tuberculoma, 2 had cryptococcal meningitis with intracranial hypertension and 2 had Toxoplasma encephalopathy. Three of them had intracranial multiple occupancies. Ten patients underwent pathological excision and 2 of them with hydrocephalus underwent ventriculo-peritoneal shunt simultaneously. Twelve patients received regular drug therapy and highly active antiretroviral therapy treatment before and after operation.

The symptoms of epilepsy were significantly improved after 6 months to 2 years of follow-up except for 1 case who died of brain edema on the 6th day after operation. Among them, Engel grade Ⅰ was achieved in 7 cases, Engel grade Ⅱ in 3, Engel grade Ⅲ in 1.

The seizure types and pathogenic factors of AIDS-related epilepsy patients are complex and diverse. Comprehensive treatment should be carried out according to clinical manifestations, laboratory examinations, imaging characteristics, electroencephalogram and medical treatment. Under the condition of full preoperative evaluation and mastery of indications, surgery could effectively control AIDS-related epilepsy.

To explore the procedure, efficacy, complications and outcomes of multi-lobe disconnection for children with intractable epilepsy.

The authors conducted a retrospective review of clinical data in children with intractable epilepsy who underwent multi-lobe disconnection at Peking University Pediatric Epilepsy Center between June 2014 and July 2017. Thirty-nine patients who had experienced various kinds of lobe disconnection surgery were collected. Among them, 30 patients underwent temporo-parieto-occipital disconnection, 4 underwent parieto-occipital disconnection, 4 underwent subtotal hemispherotomy and 1 underwent frontoparieto disconnection. One to three antiepileptic drugs were taken after operation. The outcomes were evaluated based on Engel's classification.

In 39 patients, the average surgical time was 4.5±1.0 h and the average blood loss was 214.6±100.3 ml. All patients had been followed up ranging from 6 to 36 months, and the median time was 14 months. During the follow-up, 8 (20.5%) patients had seizure recurrence. Most patients had good seizure outcomes [Engel Ⅰ: 79.5%(31 cases), Engel Ⅱ: 10.2%(4 cases), Engel Ⅲ: 2.6%(1 case), Engel Ⅳ: 7.7%(3 cases)]. Complications were rare. One patient(2.6%) had relapse of herpes simplex virus encephalitis. One patient had weakness on the contralateral side of body immediately post surgery and recovered later. No intracranial infection or hydrocephalus occurred.

Multi-lobe disconnection is common and effective for children, particularly young children, with intractable epilepsy and is characterized by less trauma, less bleeding, shorter operative time.

To explore the accuracy of stereotactic electroencephalograph (SEEG) electrode implantation under neuronavigation in children with refractory epilepsy.

Twenty-one children with refractory epilepsy underwent SEEG electrode implantation for identification of epileptogenic zone at Neurosurgery Department of Shenzhen Children's Hospital from March 2016 to December 2017 and were retrospective enrolled into this study MR surface registration and CT registration with anatomic markers were used for the electrode implantation. The accuracy of electrode implantation was compared between the 2 registration methods. The correlation between the depth of electrode implantation (the distance from cortical entry point to target) and the error of target and the error of entry point was analyzed.

A total of 139 electrodes were implanted in 21 patients. Among them, 56 electrodes were implanted by MR surface registration method, and 83 implanted electrodes were placed by CT anatomical marker registration method. The registration time, registration error, electrode entry error and target error of MR Surface registration group were (37±9) min, (2.3±0.5) mm, (2.7±0.7) mm and (3.1±0.5) mm; those in anatomical marker registration group were (10±4) min, (1.1±0.3) mm, (1.5±0.5) mm, (2.2±0.6) mm respectively. The differences were statistically significant (all P<0.05) in the comparison between the 2 groups. In 139 electrodes, the electrode implantation depth was (4.7±1.7) mm, the entry point error was (2.1±1.3) mm, and the target error was (2.8±1.2) mm. Correlation analysis showed that the depth of electrode implantation was positively correlated with the target error (r=0.57, P=0.034), and there was no correlation with the error of the entry point (r=0.27, P=0.121). None of the patients had complications such as bleeding and infection after electrode implantation. After epileptogenic zonectomy, all patients were followed up for 6 months and included 20 cases as Engel Ⅰ and 1 case as Engel Ⅱ.

In children with refractory epilepsy, the accuracy of SEEG electrode implantation under neuronavigation seems to be relatively high. Compared with MR surface registration method, the registration efficiency and the accuracy of electrode implantation can be improved by using CT anatomical marker registration.

To discuss the microsurgical treatment, outcomes and complications of trigeminal neuralgia (TN) caused by non-arterial compression factors.

A total of 251 patients with complete clinical data of TN undergoing microsurgical treatment at Department of Neurosurgery, China-Japan Friendship Hospital from May 2006 and December 2016 by the same surgeon were retrospectively enrolled into this study. Among them, 36 (14.3%) patients were caused by non-arterial compression factors. Of the 36 patients, 19 (52.8%) were caused by single offending venous compression, of which 12 cases underwent microvascular decompression (MVD), 7 cases over 60 years old underwent selective partial rhizotomy (PR) after MVD; 17 (47.2%) cases had no offending vessels, of which 12 cases underwent radical release of trigeminal nerve root, and the trigeminal nerve root was completely dissected from the brain stem to the Meckel's cave, and 5 cases over 60 years old underwent additional PR. Evaluation of efficacy was based on the Brisman criteria.

Among 19 patients with single venous compression, 11 cases of 12 patients showed immediate effect post MVD, and 1 case did not; all the 7 patients with unsatisfactory decompression undergoing PR showed immediate effect after operation. Among 17 patients without definite offending vessels, 11 cases of 12 patients with completely trigeminal nerve release demonstrated immediate effect after operation, 1 case did not; and 5 cases with additional PR showed immediate effect after operation. The total effective rate was 94.4% (34/36) immediately after operation. Postoperative neurological complications occurred in 3 (8.3%) cases including 1 case of tinnitus, 1 case of diplopia and 1 case of masticatory weakness. Thirty-six patients were followed up from 14 to 142 months, and the average follow-up time was 67.0±9.2 months. The total effective rate was 88.9% (32/36) and the recurrence rate was 5.9% (2/34). The patients with no relief or recurrence obtained improvement after radiofrequency and gamma knife therapy. Three patients with neurological complications recovered after conservative treatment during the follow-up period.

MVD could be performed in patients with single venous compression after complete dissociation of the offending vein. Adhesion around the trigeminal nerve sensory root should be fully released in patients without offending vessels compression. PR of the trigeminal nerve sensory root should be performed in patients over 60 years old. After the treatment of TN with non-arterial compression, the outcome was satisfactory, and there was no increase in operative complications.

To explore application value of epileptogenicity index (EI) in operation of epilepsy post viral encephalitis (VE).

From January 2014 to August 2017, we retrospectively identified 10 patients with epilepsy post VE undergoing surgery at Epilepsy Center of Yuquan Hospital Tsinghua University. All patients underwent comprehensive presurgical evaluation. SEEG (stereo-electroencephalograhy) was necessary in those patients whose noninvasive investigation results did not reveal clear identification of epileptogenic zone (EZ). Habitual seizures were recorded and EI was calculated. We set a cut-off EI value as EI>0.4 (positive). Meanwhile, we superimposed the EI value on the patient's MRI image to better clarify the starting range. Ten patients underwent epileptic focus resection or SEEG-guided radiofrequency thermocoagulation. The outcome was evaluated by using international Engel epilepsy surgery outcome scale after 21 to 43 months of follow-up.

Ten patients were followed up from 21 to 43 months, Engel class Ⅰ was achieved in 3 patients, Engel class Ⅱ in 3, Engel class Ⅲ in 2 and Engel class Ⅳ in 2. The number of electrodes classified as epileptogenic revealed by SEEG was closely correlated with number of EI positive ones (Spearman′s correlation r=0.794, P=0.006). EI analysis was consistent with SEEG visual onset and no completely contradictory results were found. Patients with good surgical outcome(Engel class Ⅰ-Ⅱ) showed a high value restricted to focal area and those with poor surgical outcome(Engel class Ⅲ-Ⅳ)revealed a diffuse EI value which involved widely spread onset.

EI plays an important role in localization of seizure onset of patients with epilepsy after VE and thus could serve as a strong evidence and supplement for SEEG onset. EI could assist in identification of EZ and accurate surgical resection.

To evaluate the effectiveness, safety and influencing factors of Gamma Knife radiosurgery (GKRS) for retreatment of primary trigeminal neuralgia (PTN).

A retrospective analysis was conducted on 28 patients with primary trigeminal neuralgia who underwent secondary GKRS at Head Gamma Knife Treatment Center of the Affiliated Hospital of Inner Mongolia Medical University from January 2004 to December 2016. Pain relief was assessed by the Barrow Neurological Institute(BNI). Analysis was conducted on possible predictive factors including age (<70, ≥70 years), course of disease (≤5, >5years), intervals between two treatments (≤20, >20 months), outcome of the first treatment (recurrent, ineffective), cumulative radiation dose (130-145 Gy, 165-190 Gy) to complete pain relief and complications after the second GKRS.

The median time for pain relief in secondary treatment was 3.0(1.0-4.8) months. The pain relief rate was 96.4%(27/28) and complications occurred in 32.1%(9/28) of the cases. The relapse rate was 3.6%(1/28). Univariate analysis revealed significant differences in cumulative exposure doses for complete remission (P=0.028). Intervals of the two treatments and outcome of the first treatment were closely related to the complications of the secondary GKRS (both P<0.05). Multivariate analysis showed that the interval between two treatments not more than 20 months was an independent risk factor for complications of secondary treatment (OR=0.010, 95%CI: 0.001-0.195, P=0.002).

The efficacy of retreatment of PTN is also worthy of recognition. Dual targets, low cumulative doses irradiating PTN will make it easier for patients to achieve complete remission. If the interval time is more than 1.5 or 2.0 years after the first GKRS, the possibility of complications would be significantly reduced.

To summarize the clinical features of supratentorial subdural hematoma (SDH) following microvascular decompression (MVD).

A retrospective review of 4 937 consecutive patients who underwent MVD at Department of Neurosurgery, China-Japan Friendship Hospital between January 2015 and September 2017 revealed 29 patients with postoperative supratentorial SDH accounting for 5.9‰ of all MVD cases. Among the 29 patients with supratentorial SDH, 21 cases(5.7‰) occurred out of 3 656 patients following MVD for HFS (hemifacial spasm), 8(6.7‰) out of 1 197 patients for TN (trigeminal neuralgia). In addition, there were 84 cases of GN (glossopharyngeal neuralgia) and none of them developed SDH.A retrospective review of clinical features and outcomes of 29 patients with supratentorial SDH.

The 29 patients included 11 males and 18 females. Their age ranged from 19 to 79 years old, with an average of 53.0±15.3 years old. The duration of illness was 0.5-20.0 years, with the median of 5.0 years. In 29 patients, supratentorial SDH occurred ipsilaterally in 16(55.2%) cases, contralaterally in 10(34.5%)cases, and bilaterally in 3(10.3%)cases. Hemorrhagic amount by CT analysis ranged from 2 ml to 15 ml, with the average of 6.5±3.6 ml. Among 28 patients with conservative treatment, 26 displayed complete or obvious absorption of hematomas at discharge and 2 showed hematoma absorption during follow-up. One patient turned into chronic supratentorial SDH and achieved good outcome following single-bore drainage. There was no SDH-related symptoms developed during the 6-month follow-up. Treatment of original illness remained effective in 27 (93.1%) cases.

The incidence of supratentorial SDH after MVD is much lower than other complications of MVD. Furthermore, most patients with conservative treatment seem to have good outcome. Even though, postoperative CT scan is recommended for all MVD patients.

In order to summarize the efficacy and experience of temporoparietal occipital dissection in the treatment of drug-refractory posterior head epilepsy, this study retrospectively analyzed the clinical data of 15 patients with drug-refractory posterior head epilepsy. All patients underwent temporoparietal occipital dissection. The postoperative curative effect was good, and 12 patients with Engel grade I were classified. Except for visual field defects, there were no permanent neurological dysfunctions and no deaths. Temporo-parietal occipital dissection is a safe and effective treatment for multi-lobar drug-refractory epilepsy on one side of the posterior head. The use of intraoperative auxiliary techniques contributes to the smooth operation.

To investigate the feasibility, efficacy and safety of stent-only treatment for unruptured vertebral artery dissecting aneurysm (uVADA).

Clinical data of 36 uVADA patients who received stent-only treatment at Department of Neurosurgery, Huashan Hospital, Fudan University from August 2010 to June 2014 were retrospectively studied. Ten cases were implanted with a single stent and 26 cases with overlapping stents. All cases underwent imaging (DSA, CTA or MRA) and assessment of clinical outcome based on the modified Rankin scale (mRS).

The surgical success rate was 100%. Twenty-nine patients had varying hemodynamic changes immediately after stent(s) implantation. Minor brain stem infarction occurred only in 1 case during the perioperative period, which presented with numbness of contralateral limbs and was confirmed by MRI scan.Thirty-one cases underwent clinical follow-up. Median follow-up of 23 months (range: 12-58 months) in 31 cases showed that aneurysm completely disappeared in 16 patients, improved in 9 patients, and stable in 5 cases. Thirty patients had good outcome with mRS scores between 0-1. Only 1 patient died from subarachnoid hemorrhage (SAH) 2 months later. Lastly, among the patients treated with overlapping stents, 2 had varying degrees of new stenosis discovered in distal or proximal end of the stent and no obvious sign of posterior circulation ischemia was detected.

Stent-only treatment for uVADA might lead to good clinical outcome and few complication.

To explore the hemodynamic features of venous aneurysms in Cognard type Ⅳ dural arteriovenous fistulas (DAVF).

Computational fluid dynamics analysis was conducted in 7 venous aneurysms of 4 patients who received endovascular treatment at Department of Neurosurgery, Beijing Tsinghua Changgung Hospital between July 2017 and December 2017. All 4 patients experienced no intracranial bleeding before intervention.

Average flow velocity was 0.030 (0.002-1.567) m/s in the 7 aneurysms and 0.092 (0.050-2.235) m/s in drainage veins. The difference was not statistically significant (P=0.248). Average pressures in fistula area, venous aneurysm and drainage veins were 7 394.9(6 087.3-7 977.0) Pa, 4 882.2 (3 697.8-7 004.7) Pa and 3 439.1 (3 337.2-5 612.9) Pa, respectively. Median values of average wall shear stress (WSS) were 10.22 (4.07-13.58) Pa in fistula area, 4.11 (0.24-13.95) Pa in venous aneurysms and 7.61 (5.16-12.90) Pa in drainage veins. On the draining system, average pressure in venous aneurysms were higher when compared with drainage veins, but the difference was not significant in statistics (W=39, P=0.072), however, average WSS were significantly lower in venous aneurysms (W=8, P=0.040). For the 2 cases with multiple venous aneurysms, high WSS area was identified in the inflow area of subsequent venous aneurysms.

Preliminary results have indicated that WSS of venous aneurysms is lower compared with drainage veins, and high WSS area is present on drainage veins distal to the venous aneurysm. The relationship between WSS and venous aneurysm rupture requires further validation in future studies.

To investigate morphological and hemodynamic risk factors associated with intraoperative aneurysm rupture (IOR) during clipping to provide evidence for predicting the risk of intraoperative aneurysm rupture.

This study retrospectively reviewed 84 patients who underwent aneurysm clipping at Department of Neurosurgery of Beijing Tiantan Hospital, Capital Medical University from January 2014 to April 2018. This cohort included 28 patients with IOR aneurysms and 56 patients with non-IOR aneurysms. Models were constructed based on presurgical CT angiogram. Morphological parameters were measured and hemodynamic parameters were obtained using computational fluid dynamics. The differences between IOR aneurysms and non-IOR aneurysms were analyzed, and independent risk factors were investigated using multivariate logistic analysis. Receiver operating characteristic (ROC) curve analysis was performed to test the predicting value.

The statistically significant difference was found in length (12.93±8.12 mm vs. 10.43±5.65 mm), aspect ratio (AR) (1.71±0.59 vs. 1.25±0.45), normalized wall shear stress maximum (NWSSM) [0.56 (0.07-1.03) vs. 0.73 (0.21-1.69)], wall shear stress gradient average (14.31±7.19 vs. 11.61±6.52), oscillatory shear index (OSI) [0.006 8 (0.001 1-0.014 4) vs. 0.002 4 (0.000 8-0.007 3)] and low stress area ratio (LSAR)[(0.39 (0.19-0.73) vs. 0.28 (0.12-0.66)](all P<0.05). Multivariate logistic analysis demonstrated AR (OR=3.92, 95%CI: 1.18-12.99, P=0.030), NWSSM (OR=0.44, 95%CI: 0.31-0.63, P=0.001) and OSI (OR=14.84, 95%CI: 11.20-18.90, P=0.001) as independent risk factors for IOR. ROC analysis revealed that the areas under curve of AR, NWSSM and OSI were 0.746, 0.793 and 0.729, respectively (P<0.01).

AR, NWSSM and OSI are independent risk factors for IOR during clipping with good predicting values.

To evaluate the clinical effect of revascularization on the treatment of complex proximal posterior inferior cerebellar artery (PICA) aneurysms.

A retrospective analysis was conducted on 10 cases (accounting for 5.1% of 10/198 cases of PICA aneurysm admitted during the same period) of complex proximal PICA aneurysms (10 aneurysms) who were admitted to Neurosurgical Department of Tianjin Huanhu Hospital from June 2008 to January 2018. According to the morphological characteristics and collateral circulation of aneurysms, various ways of revascularization were undergone. Eight cases underwent occipital artery (OA)-PICA anastomosis + aneurysm trapping; vertebral artery (VA) occlusion + OA-PICA anastomosis was performed in 1 case; aneurysm depression and PICA in situ anastomosis was performed in 1 case. The patency of anastomotic vessels and postoperative complications were observed after operation and the patients' outcomes were evaluated with modified Rankin scale (mRS).

Ten cases successfully underwent the blood flow reconstruction. Intraoperative fluorescein angiography revealed the patency of anastomotic vessels. Two cases developed hoarseness post operation and fully recovered to normal after treatment. One patient developed dyspnea and pulmonary infection 3 days post operation and fully recovered to normal after treatment. Ten cases were followed up effectively. The follow-up period was 3-118 months after operation. No recurrent or ruptured aneurysms were found in the follow-up period. One patient died of cerebral hemorrhage because of hypertension after 12 months. Ventriculoperitoneal drainage was performed in 1 case of hydrocephalus. Nine cases of anastomotic vessels were patent and 1 case showed occlusion. All aneurysms disappeared. The score of mRS was 0 in 8 cases, 1 in 1 and 6 in 1.

Depending on the morphological characteristics and collateral circulation, different revascularization techniques are selected. Revascularization is an effective method for the treatment of complex proximal PICA aneurysms in terms of relief of space-occupying effect and removal of aneurysms.

To determine whether antibiotic prophylaxis (AP) can reduce the rate of postoperative infection of ventriculo-peritoneal (V-P) shunting.

In this study, we retrospectively analyzed the data of 518 patients who underwent V-P shunting at Department of Neurosurgery, Tianjin Huanhu Hospital from January 2011 to December 2016. According to whether prophylactic antibiotics were administered, all cases were divided into AP group (n=297) and non-AP(n-AP) group (n=221). The rate of infection post shunting was calculated in both groups. The effect of AP on the positive rate of cerebrospinal fluid culture was analyzed.

There was no significant difference in the infection rate between AP group [6.7% (20/297)] and n-AP group[4.1% (9/221)] (χ²=1.698, P=0.192). There were 20 cases of postoperative infections in AP group, of which 9 were culture-positive, including 7 cases of staphylococcus epidermidis, 1 case of acinetobacter baumannii and 1 case of klebsiella pneumoniae. There were 9 cases of postoperative infections in n-AP group, of which 8 were culture-positive, including 5 cases of staphylococcus epidermidis, 1 case of staphylococcus aureus, 1 case of enterococcus, and 1 case of pseudomonas aeruginosa. There was significant difference in the positive percentage of bacterial culture between the two groups(P=0.026).

AP seems to be unable to lower the rate of infection post V-P shunting. However, it could reduce the positive rate of bacterial culture.

To explore the risk factors of recurrence of chronic subdural hematoma after drilling and drainage.

Clinical data of 142 patients with chronic subdural hematoma admitted to Department of Neurosurgery, Zhongshan Hospital, Xiamen University from January 2013 to December 2016 were collected and retrospectively analyzed. Univariate (chi-square test) and multivariate (logistic regression test) were used to analyze the risk factors for postoperative recurrence of chronic subdural hematoma.

The postoperative follow-up period of 142 patients was 3 to 24 months. Among them, 21 patients had hematoma after operation and the recurrence rate was 14.8%. Postoperative complications included 4 cases of epilepsy, 2 cases of intracranial infection, 10 cases of subdural effusion, 1 case of intracranial hematoma, and 23 cases of atonic pneumocephalus. Univariate analysis demonstrated that age of onset, anticoagulation, preoperative width of hematoma, preoperative midline shift and postoperative width of subdural space were associated with postoperative recurrence of chronic subdural hematoma (all P<0.05). Multivariate analysis showed that age (OR=20.914, 95%CI: 3.451-126.741), preoperative anticoagulant medication (OR=10.679, 95%CI: 1.873-60.880), preoperative width of hematoma (OR=3.602, 95%CI: 1.029-12.611) and preoperative midline shift (OR=4.613, 95%CI: 1.222-17.418)were significantly associated with postoperative recurrence.

The postoperative recurrence in patients with chronic subdural hematoma is related to multiple factors. Age ≥70 years, preoperative anticoagulation, preoperative width of hematoma ≥20 mm and preoperative midline shift ≥10 mm were independent risk factors for postoperative recurrence of chronic subdural hemotoma.

To compare the behavioral manifestations, electroencephalogram(EEG) monitoring and hippocampal pathological changes in two rat epilepsy models induced by kainic acid (KA) injected into hippocampus and amygdala respectively.

Male adult Sprague-Dawley rats(n=24) were randomly divided into hippocampus model group (n=9), amygdala model group (n=9) and control group (n=6). Two epilepsy models were established by kainic acid (0.6 μg, 1.0 μg/μl) stereotactically injected into hippocampus CA3 region (hippocampus model) or amygdala (amygdala model). The status epilepticus (SE) of rats was observed by behavioral manifestations and EEG monitoring. Following successful modeling, those rats were randomly divided into 3 groups, including 1-day (acute phase), 7-day (latent phase) and 30-day (chronic phase) post SE groups ( n=3 in each group). Rats in the control group were injected with an equal volume of saline in the hippocampal CA3 or amygdala. Immunohistochemistry was used for observing the pathological changes of neuron (NeuN), astrocyte (GFAP) and microglia (Iba1) in the rat hippocampus.

Behavioral and EEG monitoring showed that rats from both models had typical seizure behaviors and EEG characteristics in the acute and chronic phases. However, there were different seize types and onset time between the 2 models in the acute phase. The hippocampus model group had partial seizures at 63.33±4.41 min post KA injection with intermittent generalized tonic-clonic seizures. Multi-phase spikes were recorded in acute phase. Amygdala model group had severe generalized tonic-clonic seizures at 28.67±3.48 min post KA injection, and the main cortical EEG form was sharp wave rhythm. Immunohistochemical staining revealed gradual hippocampal neuron death from acute to chronic phases in both models, which resulted in serious neuronal loss. Meanwhile, the aggravation of astrocyte proliferation and accumulation of microglia occurred in hippocampus in both models. Remarkably, compared with hippocampus model, the amygdala model in chronic phase had more neuronal loss in CA1 region (10.83±1.52 vs. 22.43±5.16, P<0.01) and CA4 region (12.87±2.13vs. 25.81±4.60, P<0.05), more astrocyte proliferation in CA1 region (61.20±7.33vs. 14.65±0.12, P<0.01) and CA4 region (76.73±5.40vs. 43.01±1.35, P<0.01) as well as more widespread accumulation of microglia in CA1 region (13.70±3.88vs. 1.08±0.01, P<0.01).

Our results have indicated that both rat epilepsy models simulated human temporal lobe epilepsy. The differences in the behavior, EEG performances and particularly pathological changes of hippocampus between two models should be taken into consideration in the future study.

One patient with status epilepticus secondary to glioma developed serious complications such as type II respiratory failure, pulmonary infection, rhabdomyolysis with acute renal failure after admission, and recovered after a series of treatments such as anti-epilepsy, anti-infection, mechanical ventilation and continuous renal replacement therapy. The patient was readmitted to the hospital for craniotomy and tumor resection. The pathological findings confirmed glioma, and the patient recovered well after operation.

Partial cerebral vein development can be seen in the arterial phase of cerebral angiography. This phenomenon is called premature venography, which is a rare imaging manifestation and is more common in the process of arterial thrombolysis in patients with acute ischemic stroke. However, it is rare in patients with aneurysmal subarachnoid hemorrhage, and it is rarely reported at home and abroad. This paper reports a patient with aneurysmal subarachnoid hemorrhage treated with coil embolization. Intraoperative angiography showed premature venous imaging combined with hyperperfusion, and the prognosis was good.

Chronic subdural hematoma (CSDH) is a common disease in neurosurgery, especially in the elderly. There are different statements about the cause of recurrence after CSDH. At present, it is believed that the related factors of postoperative recurrence of CSDH can be roughly divided into patient-related factors, imaging factors, surgery-related factors and drug factors. Additionally, there are some uncommon recurrences. This article reviews the findings of some related studies on postoperative recurrence of CSDH.

Endovascular embolization has become the first choice for the treatment of dural arteriovenous fistula. However, for complex arteriovenous fistulas, or lesions involving major venous sinuses, the rate of complete embolization is low. In recent years, with the development of embolization materials, many scholars have proposed balloon-assisted embolization therapy. This article reviews the application of balloon-assisted embolization in dural arteriovenous fistula.

The 2nd Academic Conference of China-Japan Neurosurgery Alliance (the 10th China-Japan Friendship Neurosurgery Conference) was held in Odawara, Japan on November 17-19, 2018. A delegation composed of more than 120 neurosurgical experts, including Chinese Academician Zhou Liangfu, Professor Zhang Liwei (Chinese Chairman) and Professor Zhang Yuqi (Chinese Executive Chairman) attended the meeting; More than 100 representatives of well-known Japanese professors including Tatsuya Kondo, Akira Teramoto (chairman of the Japanese side) and Kawase attended the event. The old, middle and young generations of Chinese and Japanese neurosurgery circles gathered together to share friendship and discuss new technologies and developments.