Volume 35 · Issue 05 · 2019

Chronic disorders of consciousness (DoC) refers to a pathological state of continuous coma for more than 28 days after the onset of the disease. According to the level of consciousness of patients, DoC can be divided into vegetative state (VS) and minimally conscious state (MCS)^[1]。 The pathogenic factors are divided into two categories: trauma and non-trauma. Trauma is the first cause of DoC, and non-trauma factors include hypoxic encephalopathy and stroke^[2]。 The pathogenesis of DoC remains unclear. It is generally considered that intact ascending reticular activation system-thalamic-cortical and cortical-cortical circuits are necessary for the existence of consciousness. The neural circuit composed of the central thalamus, frontal lobe and occipital cortex plays a key role in this network. Severe brain injury affects the regulatory function of this circuit, which can lead to severe and persistent consciousness disorders^[3]。 The survival time of DoC patients is generally 2 to 5 years, the survival time of non-trauma patients is shorter than that of trauma patients, and the survival time of VS patients is shorter than that of MCS patients. The prognosis of patients with trauma and MCS is significantly better than that of non-trauma and VS patients, but some patients with MCS will be stagnant in MCS for a long time^[4]。

To explore the clinical features, diagnosis and therapeutic strategies of pediatric pleomorphic xanthoastrocytoma arising in temporal lobe.

A total of 7 pediatric patients diagnosed as pleomorphic xanthoastrocytoma were treated in Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University between July 2009 and February 2018 and histologically confirmed. All those patients underwent surgical operation. The frontotemporal approach was taken in 6 patients and temporal-occipital approach was used in 1. Their clinical data, imaging features, treatment and outcomes were analyzed retrospectively.

The initial symptom was epileptic seizure in 6 patients. Radiologically, the tumors were completely or mainly solid in 5 patients, and were solid-cystic in 2 patients. The tumors were totally removed in 6 patients, except one with subtotal resection. After operation, radiotherapy was undergone in 1 patient and chemo-radiotherapy in 1. The median follow-up time was 32 months, ranging from 18 to 100 months. One patient was lost to follow-up. The seizures were well controlled and the tumor had no signs of recurrence in this series.

Epileptic seizure seems to be the most common symptom for pediatric pleomorphic xanthoastrocytoma in temporal lobe. Radiologically, the tumors are usually associated with cystic changes. The primary treatment is surgical operation, and total removal is usually correlated with good prognosis.

To explore the predictive value of small current stimulation threshold for the facial nerve outcome after acoustic neuroma surgery.

Ninety-six acoustic neuroma patients underwent tumor resection by a single team at Department of Neurosurgery, Huashan Hospital, Fudan University from January 2013 to April 2015 and were enrolled into a prospective cohort study. We defined the minimal stimulation intensity of facial nerve proximal to the brainstem to induce action potential after tumor total resection as stimulation threshold (ST) and a ST of ≤ 0.05 mA as small current. Facial nerve function was evaluated using House-Brackmann (H-B) scale preoperatively and postoperatively (1, 3, 6, 12 months). By means of binary, ordinal and linear regression analysis, the facial nerve function outcomes in the small current and control (> 0.05 mA) groups were compared.The sensitivity and specificity of the small current prediction facial nerve function were calculated by the four-grid method.

The ST in all 96 cases was 0.01-0.35 mA with an average of 0.06±0.02 mA. Seventy-four patients were included in the small current group and 22 in the control group. While adjusting for the following covariates: ages, tumor size, tumor location, tumor texture, Samii scale and preoperative H-B scale, binary logistic regression analysis showed that the rate of good facial nerve outcome (H-B score of Ⅰ-Ⅱ) in small current group was significantly better than that in control group [43.2%(32/74) vs. 4.5%(1/22) at 1 month; 62.2%(46/74) vs. 31.8%(7/22) at 3 months; 70.3%(52/74) vs. 40.9%(9/22) at 6 months; 81.1%(60/74)vs. 45.5%(10/22) at 12 months; all P<0.05]. Ordinal regression analysis revealed that compared with the control group the facial nerve outcome in small current group shifted toward a better condition at 1, 3, 6, and 12 months postoperatively. A faster recovery rate was found in small current group among patients with H-B score of Ⅳ at 1 month postoperatively (slope: -0.163vs. -0.057, P=0.004). The sensitivity and specificity of small current for predicting facial nerve function 1 year after surgery were 85.7% and 46.2%, respectively.

Small current seems to be a better short-term and long-term predictor of postoperative facial nerve function. For patients with H-B Ⅳ at 1 month post operation, small current could predict faster recovery rate of facial nerve function.

To analyze the clinical and pathological features of malignant peripheral nerve sheath tumors (MPNSTs) located in cerebellopontine angle (CPA).

Eight patients of MPNSTs in CPA region admitted to Department of Neurosurgery of Beijing Tiantan Hospital, Capital Medical University between March 2013 and March 2018 were retrospectively included, and 38 patients with sporadic schwannoma (VS) were enrolled as control. T test and Fisher test were used to compare the differences in clinical factors, imaging findings and pathologic characteristics between MPNST group and control.

This study invlved 8 cases of CPA MPNST (1 male and 7 female). The age of patients with MPNST at diagnosis was 26-60 years (42.1±13.4 years) old. The disease duration with MPNST was 1-18 months (median: 6 months), compared with 3-120 months (median: 24 months) in the control, and the difference was statistically significant (P=0.009). The incidence rates of preoperative hearing loss (8/8 vs. 14 /38, P=0.001), facial nerve dysfunction (3/8 vs. 1/38, P=0.013), cranial hypertension symptoms (4/8 vs. 4/38, P=0.022), the proportion of total tumor resection (4/8 vs. 37/38, P=0.002) and the proportion of facial nerve preservation after surgery (4/8 vs. 38/38, P<0.001) were higher in MPNST patients than in those with sporadic VS, respectively. MPNSTs displayed higher mitotic activity [(38.0 ± 4.2)/10 HPFvs. (1.9 ± 1.0)/10 HPF] and Ki-67 index [(14.2± 8.7) % vs. (1.9 ± 1.0%)] than VS, respectively (both P<0.001). Nuclear positivity of p53 was also higher in MPNST than in VS (4/8vs. 0/38, P<0.001). In addition,NF2 gene mutation was found in 18 of 30 (60.0%) cases of VS, while none of 3 cases of MPNST was detected with NF2 mutation.All of the MPNST patients were followed up for 12-41 months (22.4±7.4 months), recurrence occurred in 4 patients (average recurrence time: 11.8±3.7 months) and 2 cases of MPNST patients died.

MPNSTs in CPA are extremely rare and imaging is difficult to distinguish it from VS. MPNSTs show highly malignant clinical and pathohistological features and histopathology is the main method of diagnosis.

To investigate the clinical characteristics, treatment methods and prognosis of primary meningeal Ewing sarcoma/peripheral primitive neuroectodermal tumors (ES/pPNETs).

The clinical data of 12 patients who had been surgically treated from February 2008 to December 2017 at Department of Neurosurgery, Tongji Hospital, Tongji Medical School, Huazhong University of Science and Technology and in whom immunohistochemical staining results had confirmed the diagnosis of primary meningeal ES/pPNETs were retrospectively analyzed. A fluorescence in situ hybridization (FISH) analysis was performed in 4 cases.Of the 12 patients, 7 were males and 5 were females. The age ranged from 1 to 43 years, and the median age was 14.5 years. The disease duration ranged from 2 days to 7 months (median disease duration: 2 months). Postoperative chemotherapy was performed in 9 cases. Postoperative radiotherapy was performed in 7 cases.

All 12 cases were misdiagnosed by MRI. Immunohistochemistry experiments revealed that 12 cases were positive for CD99. A FISH analysis was performed in 4 cases, and EWS/FLI1 translocation was detected in 3 cases.Gross total resection (GTR) was performed in 6 cases and subtotal resection (STR) in 6. The follow-up period ranged from 2 months to 84 months (median follow-up period: 20 months). One case was lost to follow-up after 24 months. At the last follow-up, local recurrence occurred in 7 cases, and distant metastasis occurred in 3 cases. The number of deaths was 9 and that of survivors was 2. The median survival time (MST) of 11 patients was 20 months. Of the 12 patients, the number of survivors in 1-year and 2-year were 9 and 6, respectively. The number of survivors in 1-year and 2-year were 5 and 4, respectively, in patients with GTR, while they were 4 and 2, respectively, in patients with STR.

Primary meningeal ES/pPNETs mostly occur in children and adolescents, and the misdiagnosed rate seems high. Gross total resection combined with adjuvant radiotherapy and chemotherapy could improve the prognosis of patients. However, the postoperative recurrence rate is high.

To compare different methods of the skull base reconstruction in craniopharyngioma surgery via extended endoscopic endonasal approach (EEEA) and to investigate the advantage and feasibility of in situ bone flap in skull base reconstruction.

Twenty-six cases with craniopharyngiomas who underwent complete osseous skull base reconstruction using in situ bone flap in skull base reconstruction and repair in EEEA were enrolled retrospectively into the experimental group at Department of Neurosurgery, Xijing Hospital, Air Force Medical University from July 2016 to December 2017. Thirty-one cases with craniopharyngiomas who underwent partial osseous skull base reconstruction using fashioned piece of nasoseptal bone or artificial bone matrix from March 2015 to June 2016 were enrolled into the control group. The rates of intracranial infection and lumbar cisterna drainage, time from surgery to out-of-bed activity and hospitalization length were compared between the 2 groups.

Intracranial infection occurred in 2 cases in the control group, whereas no intracranial infection was reported in experimental group. There was no statistically significant difference between the 2 groups (P=0.291). Lumbar cisterna drainage rate in the control group (29.0%, 9/31)was significantly higher than that in the experimental group (3.8%, 1/26, P=0.013). Compared with those in control group, patients in the experimental group were able to get off bed earlier (7.5±1.1 d vs. 12.1±2.4 d, P<0.001). The hospitalization length in the control group was also longer than that in the experimental group (13.5±1.8 dvs. 8.2±0.9 d, P<0.001). There was no delayed cerebrospinal fluid leak or brain hernia during the follow-up period lasting for 3-32 months.

The multilayer repair using duramax, in situ bone flap and vascularized pedicled nasoseptal flap could significantly reduce the incidence of cerebrospinal fluid rhinorrhea and shorten hospitalization length. Skull base reconstruction using in situ bone flap seems to be an effective procedure for EEEA. The clinical efficacy of using the method in EEEA for craniopharyngioma is valid with bright prospects and deserves clinical promotion.

To analyze the characteristics of giant intracranial tumors in infants and to explore their treatment and prognosis.

This study retrospectively enrolled 18 cases of giant intracranial tumors in infants admitted to Neurosurgery Department of Children′s Hospital of Fudan University from January 2014 to December 2017. The clinical characteristics, treatment and prognosis were documented and analyzed. Clinical follow-up and imaging follow-up were applied to evaluate the prognosis. Among the 18 cases, 8 underwent excision of tumor and the other 10 cases refused tumor excision surgery. Ventricular-peritoneal shunt was undergone in 2 patients of them and 1 patient underwent external brain drainage.

Of the 8 patients who underwent tumor resection, gross total resection was achieved in 5 cases, subtotal resection in 2 and biopsy in 1. One patient died from intraoperative hemorrhagic shock. Among the 7 patients with the surgery of tumor excision, 4 developed subdural effusion and 1 patient developed hydrocephalus. The clinical manifestation was improved after symptomatic treatment. Pathology results revealed 3 cases of choroid plexus (including 1 case of atypical choroidal papilloma), 1 case of medulloblastoma, 1 case of primordial embryonic tumor, 1 case of atypical teratoid/rhabdoid tumor and 1 case of nerve epithelial tumor. Five cases in tumor excision group were followed up including 1 patient developing growth retardation and 1 suffering from mild malfunction of nervous system. Eight in the group without tumor excision surgery died within 2 months after discharge and 2 of them were lost to follow-up. The range of follow-up duration was from 2 months to 3.7 years.

Giant intracranial tumors in infants are rare with an overall poor prognosis. To improve the prognosis, the characteristics of tumor, risk of treatment and complications should be taken into consideration to make therapeutic strategy.

To investigate the risk factors that influence the progression-free survival (PFS) in WHO Ⅱ-grade gliomas in adults.

Clinical data obtained from 72 patients with WHO Ⅱ grade gliomas undergoing surgical resection between January 2008 and December 2015 at Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University were analyzed. Immunohistochemistry staining method was employed to detect mutation of isocitrate dehydrogenase 1(IDH1) R132H, α thalassemia/mental retardation syndrome X-linked( ATRX) and the expression of regulator of telomere elongation helicase 1(RTEL1). Survival analysis was estimated by Kaplan-Meier analysis. Cox regression modelling was used for univariate analysis and multivariate analysis.

The results of immunohistochemical staining in 72 patients with gliomas revealed 39 (54.2%) cases of IDH1 R132H mutant positive, 33 (45.8%) cases of negative; 56 (77.8%) cases of ATRX missing mutant negative, 16 (22.2%) cases of positive; 29 (40.3%) cases of RTEL1 positive and 43 (59.7%) cases of negative. The results of survival analysis showed that the cumulative PFS rate of IDH1 R132H negative patients was lower than that of IDH1 R132H positive(P<0.05). There was no statistically significant difference in PFS rate between theATRX positive and negative patients (P>0.05). The cumulative PFS rate ofRTEL1 positive patients was lower than that of RTEL1 negative patients (P<0.05). Univariate and multivariate Cox regression analysis showed that age >40 years (OR=3.618, 95% CI: 1.688-7.753, P=0.001), partial resection (OR=0.204, 95% CI: 0.064-0.656, P=0.008), expression of IDH1 R132H negative (OR=2.867, 95% CI: 1.129-7.282, P=0.027) and RTEL1 positive (OR=0.354, 95% CI: 0.151-0.827, P=0.016) were independent factors influencing PFS of glioma patients, and could be independently used for prognostic judgment of glioma patients.

Age (>40 years), degree of tumor resection (partial resection), expression ofIDH1 R132H (negative) and RTEL1 expression (positive) are independent risk factors affecting the PFS of WHO Ⅱ-grade gliomas.

To investigate the strategy of surgical treatment for anterior clinoid meningiomas and to analyze the influencing factors of efficacy.

A retrospective review was performed on 51 patients with anterior clinoid meningioma who were consecutively admitted to Department of Neurosurgery, the Xiangya Hospital of Central South University from January 2012 to April 2018. All patients underwent tumor resection via the pterional approach or extended pterional approach. The extent of tumor resection was assessed using the Simpson classification. Karnofsky performance status (KPS) scale was used to evaluate the patents′ outcomes.

Among all 51 patients, Simpson Ⅰ-Ⅱ resection was achieved in 41 (80.4%) cases, Ⅲ in 7 (13.7%) and Ⅳ in 3 (5.9%). All 51 patients were followed up. The postoperative follow-up duration was 48.6±28.4 months. Tumor recurrence and progression were identified in 1 case and 4 cases respectively. The KPS at the last visit was 90.3±9.6 and higher than that at discharge (87.0±7.8) and prior to operation (74.3±10.5) (both P<0.01). Univariate analysis indicated that the relationship between tumor and cavernous sinus (P<0.001), the tumor types (P<0.001) and the maximum diameter of tumor (P=0.004) are the risk factors influencing total resection of tumor.

Total resection seems to be easier to be achieved when the tumor has not invaded the cavernous sinus, the maximum diameter of the tumor is less than 2 cm and the Al-Mefty type is Ⅱ or Ⅲ. According to the radiological features of the tumor before surgery, surgical strategies for each patient could be customized, which contribute to maximal tumor resection and preservation of neurological function, thus improving the prognosis of patients.

To explore the application value of intraoperative multi-mode facial nerve monitoring during resection of giant vestibular schwannomas and to provide evidence for further technical and surgical refinements.

A total of 58 patients with giant vestibular schwannomas (tumor diameter≥3 cm) underwent microsurgical resection at Department of Neurosurgery, the First Affiliated Hospital of Xiamen University and were retrospectively analyzed in this study. From December 2016 to January 2018, 28 cases who received multi-mode intraoperative monitoring were set as monitoring group. From March 2013 to November 2016, 30 cases without multi-mode intraoperative monitoring were set as control group. The baseline data (age, sex, size of tumor, cystic-solid quality of tumor, side of tumor), operational duration, surgical resection rate, anatomical and function preservation (evaluated based on House-Brackmann grade) of facial nerves and postoperative complication were compared between the 2 groups.

The operational duration was obviously shorter in monitoring group (413.4±166.1 min) with statistical difference (t=-2.02, P=0.048) compared to that in control group (499.7±159.6 min). Total resection rate in monitoring group was 100.0% (28/28) and that in control group was 93.3% (28/30). Anatomical preservation rate in monitoring group was 100.0% (28/28) while that in control group was 90.0% (27/30). There was no significant difference in total resection rate or anatomical preservation rate between the 2 groups(both P>0.05). Significantly higher function preservation rate of facial nerves was observed in monitoring group than in control group at 1 week (P=0.043) and 3 months (P=0.039) post surgery. The incidence rate of complication was lower (P=0.029) in monitoring group (14.3%) than in control group(40.0%).

Intraoperative multi-mode facial nerve monitoring could help shorten the operation duration, increase the function preservation rate of the facial nerves and reduce the clinical postoperative complications.

To investigate the microsurgical treatment of refractory cerebrospinal fluid (CSF) rhinorrhea after operation of vestibular schwannoma due to the opening of internal auditory canal.

From January 2012 to May 2018, a total of 249 patients with vestibular schwannoma underwent tumor resection at Neurosurgery Department, Xuanwu Hospital of Capital Medical University. There were 8 (3.2%) cases that developed CSF rhinorrhea after operation. Among them, 5 underwent conservative therapy and CSF leakage disappeared and the remaining 3 (1.2%) cases with refractory CSF leakage received second craniotomy for CSF leakage repair on the 3rd, 9 th and 28 th day after tumor resection respectively. Suboccipital retrosigmoid approach (original incision) was used to repair the defect of posterior wall of internal auditory canal. Fresh muscle granules and glue were used to seal the defect of posterior wall of internal auditory canal.

Among the 3 patients who underwent surgical repair operation, CSF leakage disappeared immediately in 2 cases and cured one month later in 1 case. Facial nerve function was not affected after the second operation. The assessment based on House-Brackman classification revealed grade 1 in 2 cases and grade 2 in 1 case at discharge. All the 3 patients developed intracranial infection and recovered after anti-infection therapy.

CSF rhinorrhea after vestibular schwannoma surgery is a relatively common complication. Meticulous sealing of opened air cells in the petrous bone (around the inner auditory canal and mastoid air cells) seems necessary for the prevention and treatment CSF leakage.

To study the imaging features of lymphocytic hypophysitis in order to improve the accuracy of imaging diagnosis of the disease.

Imaging findings of 9 patients with lymphocytic hypophysitis admitted to Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University from January 2010 to December 2016 were retrospectively reviewed. All patients underwent laboratory examinations related to pituitary function. Except for 2 cases of slight increase in prolactin, the levels of other hormones were normal. All patients were examined with pre-contrast and post-contrast T1 weighted MR imaging and non-contrast T2 weighted MR imaging. Six patients received CT scan. Imaging diagnoses were all mistaken as pituitary adenomas.

All cases showed diffuse enlargement of the pituitary, disappearance of neurohypophysis T1WI high signal and enlarged sella. Lesions showed iso-signal on both T1 and T2 weighted image with strong homogeneous or ring-like enhancement. Pituitary stalk was thickened in 5 cases. None of the cavernous sinus was involved in those cases. Lymphocytic hypophysitis was confirmed by pathologic examinations in all 9 patients.

Lymphocytic hypophysitis seems to have characteristic imaging findings. Compared with pituitary adenoma, lymphocytic hypophysitis does not destroy the sellar floor bone with no involvement of the cavernous sinus and it has diffuse pituitary enlargement and basically symmetrical shape. Those imaging findings of lymphocytic hypophysitis may help us improve the accuracy of imaging diagnosis.

To investigate the clinical effect of hybrid operation in the treatment of cerebral and spinal vascular diseases.

A retrospective analysis was made on the clinical data of 15 patients with cerebral and spinal vascular diseases who were admitted to Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University from January 2017 to June 2018. Of the 15 patients, emergency surgery was performed in 7 patients and elective surgery in 8 patients. Five cases of intracranial aneurysms were treated with surgical clipping, in which 4 of them needed clip adjustment during operation, 1 case underwent temporary balloon-assisted parent artery occlusion and 1 case underwent salvage superficial temporal artery (STA)-middle cerebral artery (MCA) low flow bypass; 5 cases of intracranial arteriovenous malformations were treated with partial embolization combined with surgical resection; and the 4 cases of dural arteriovenous fistula and 1 case of intracranial arteriovenous fistula were treated with fistula clamping. The patients' outcomes were assessed based on Glasgow Outcome Scale (GOS).

All hybrid operations were successfully performed. The 5 cases of aneurysms were clipped with no residual neck, and the anastomotic vessel in the patient undergoing STA-MCA salvage bypass was patent. Among the 5 cases of intracranial arteriovenous malformations, 3 cases were resected totally, and 2 cases were found to have residual malformation mass by intraoperative angiography and the operation was continued to achieve complete resection in the end. Only 1 case of residual fistula was detected by intraoperative angiography of the 4 cases of dural arteriovenous fistula and 1 case of cerebral arteriovenous fistula. By adjusting the clip, the fistula was closed completely. The GOS grade of the 15 patients at discharge were: grade Ⅴ in 8 cases, grade Ⅳ in 5 and grade Ⅲ in 2. The patients were followed up for 3 to 18 months. The mean follow-up time was 10.2±3.5 months and their conditions were stable, including 9 cases with GOS grade Ⅴ, 4 cases with GOS grade Ⅳ and 2 cases with GOS grade Ⅲ.

Hybrid surgery is a new mode of surgical treatment for cerebral and spinal vascular diseases, which could improve the accuracy and effect of operation, effectively reduce the incidence of complications, and seems safe and reliable in our initial application.

To investigate the feasibility of intracavity administration of high-dose antibiotics to shorten the course of systemic antibiotic therapy.

A total of 107 patients with bacterial brain abscesses (155 abscesses) who were treated with stereotactic aspiration and intracavity injection of high-dose antibiotic combined with systemic antibiotic therapy(intracavitary treatment group) at Department of Neurosurgery, Chinese PLA General Hospital Sixth Medical Center from January 2005 to June 2018 were enrolled in this study. From January 1995 to December 2004, 51 patients with bacterial brain abscesses who were admitted to Department of Neurosurgery, Chinese PLA General Hospital Sixth Medical Center were treated with traditional stereotactic surgery (traditional treatment group). Clinical characteristics, treatment and prognosis in the 2 groups were compared.

During the follow-up period (mean: 26.2±12.5 months, range: 6-72 months), all the abscesses of the intracavitary treatment group subsided with no recurrence. No adverse effects related to topical use of antibiotics occurred. At the end of follow-up, 78 patients had good outcomes, 21 had mild neurological deficits, 3 had moderate deficits, 1 was in vegetative state, and 4 died of accidents not related to brain abscesses. The course of systemic antibiotic application in the intracavitary treatment group was shorter than that in the traditional treatment group (21.5±2.3 d vs. 36.3±5.2 d, t=25.765, P<0.001). The recurrence rate of abscess was lower (0%vs. 5.9%, χ²=6.057, P=0.014). There was no significant difference in postoperative neurological status between the 2 groups (P>0.05).

Our preliminary results indicated that the local application of antibiotics in brain abscess cavity could reduce the length of time of systemic antibiotic therapy. This treatment could reduce the abscess recurrence rate compared to traditional treatment.

To evaluate the clinical efficacy of neuroendoscopic cisternostomy for the treatment of intracranial arachnoid cysts (IACs) in children.

Thirty-one children in total with IACs who underwent neuroendoscopic cisternostomy from January 2010 to August 2017 at Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University were retrospectively enrolled. All cases were followed up in the aspect of clinical efficacy.

Among 31 children, the improvement rate of clinical symptoms was 91.0% (20/22) in symptomatic patients after operation. The follow-up period ranged from 13 to 36 months, with an average of 21.0±5.6 months. Compared with preoperative data (Mean: 52.5 ml; P₂₅, P₇₅: 31.3 ml, 167.6 ml), the means of shrinkage rates of cyst volume at 3 months (Mean: 27.8 ml; P₂₅, P₇₅: 15.6 ml, 42.3 ml) and 12 months (Mean: 22.5 ml; P₂₅, P₇₅: 13.9 ml, 34.9 ml) post operation were 62.5+ 15.7% and 68.3+ 12.8% respectively with significant statistical differences (all P<0.05). Complications occurred in 7 (22.6%) cases during perioperative period, including fever in 2, subdural effusion in 3 (volume of effusion decreased significantly in 3 months and disappeared in 12 months after operation without obvious symptoms or particular treatment) and subcutaneous effusion in 2 cases. During the follow-up period, only 1 (3.2%) child developed intractable subcutaneous effusion.

Neuroendoscopic cisternostomy for the treatment of IACs in children seems safe and effective.

Carbapenem-resistant Acinetobacter baumannii (CRAB) ventriculitis is a serious complication of external ventricular drainage surgery with high disability and mortality rates. Thirteen patients with CRAB ventriculitis after external ventricular drainage were retrospectively enrolled. Among them, 9 cases were treated with intravenous multi-drug anti-infection combined with intraventricular irrigation plus drug injection regimen, 6 cases were cured, and 3 cases died. Four patients were treated with intravenous anti-infection combined with ventricular drainage and drug injection, and all patients died. The timing of starting treatment with sensitive antibiotics in the cured patients was within 3 days after diagnosis, and the deceased patients were on the 6th or 8th day after diagnosis. It is suggested that early diagnosis and early formulation of multi-drug combined anti-infection regimen, combined with intraventricular irrigation and intraventricular administration can increase the cure rate of CRAB ventriculitis.

To investigate the clinical efficacy of ventriculoscopic surgery in the treatment of cysticercotic hydrocephalus. In this paper, 15 patients with supratentorial ventricular system cysticercosis combined with hydrocephalus were studied in the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University. Preoperative imaging examination confirmed that the ventricles had different degrees of dilatation. During the operation, ventriculoscopy was used to explore the lateral ventricle, third ventricle and midbrain aqueduct in sequence. When the cysticercosis was detected, it was accurately clipped and removed by biopsy forceps. The use of ventriculoscopy in the treatment of cerebral cysticercosis hydrocephalus is less invasive, high efficiency and low complication rate, so it can be the first surgical method of choice.

To study the levels of secreted frizzled related protein 4 (sFRP4) and WNT inhibitory factor 1 (WIF1) in non-functioning pituitary adenomas (NFPAs) and to analyze their association with clinicopathologic features and the possibility as therapeutic targets.

A total of 126 specimens were obtained from Department of Neurosurgery of Beijing Tiantan Hospital, Capital Medical University from January 2012 to December 2016. The tissue microarray was constructed using 6 normal pituitary, Samples 54 invasive NFPAs and 72 non-invasive NFPAs samples. Immunochemistry staining (IHC) was used to measure the protein levels of WIF1 and sFRP4. Real-time PCR (RT-PCR) was detected for the mRNA levels of WIF1 and sFRP4 in GT1-1 cell. Cell proliferation experiment was used for cell viability of GT1-1 cell, and Transwell migration assay was used to measure the invasion ability of GH1-1 cells following decitabine treatment.

H-Scores of sFRP4 and WIF in the invasive group were 134.5±45.3 and 73.7±24.1, and 223.3±47.6 and 133.6±35.7 in the non-invasive group according to the IHC experiment (P<0.05). Univariate analysis showed a significant correlation between tumor recurrence and either sFRP4 (r=-0.383, P=0.025) or WIF1 (r=-0.557, P=0.006). Compared with control GT1-1 cell (equal volume of dimethyl sulfoxide), the cell viability values were 84.5%±7.3%, 74.3%±6.5% and 62.2%±5.8% at 24 h, 48 h and 72 h post decitabine treatment. The trans-membrane positive cells were reduced to 154±42 after decitabine treatment, and those were 436±85 in the control group (P<0.01). The mRNA levels of sFRP4 and WIF1 were gradually increased with time after decitabine treatment (P<0.05).

The sFRP4 and WIF1 levels are closely related to the invasive behavior and recurrence of NFPAs. Decitabine could upregulate sFRP4 and WIF1 levels to inhibit the cell proliferation in GT1-1 cells.

Syphilitic neurological gumoma is clinically rare. A patient with multiple syphilitic granuloma of intracranial and spinal cord was admitted to hospital with the clinical manifestation of spinal cord occupation. Preoperatively, he was misdiagnosed as left insular glioblastoma with cervical and lumbar cord metastasis and underwent surgical treatment.₂~ S₅No obvious tumor lesions were found in the spinal cord, and the serum and cerebrospinal fluid Treponema pallidum specific antibody (TP) and syphilis toluidine red unheated serum test (TRUST) were qualitatively positive after postoperative re-examination. MRI after penicillin treatment showed that the intracranial and spinal cord lesions were significantly reduced, and the patient was diagnosed as syphilitic neurological gumma. The patient recovered after plum removal treatment.

Pituitary stroke is a syndrome in which pituitary adenoma bleeding or infarction causes a sharp increase in the pressure in the sella turcica and causes related clinical symptoms, among which infarcted pituitary adenoma stroke is relatively rare. Acute infarction of pituitary adenoma will seriously squeeze the intercavernous sinus and cavernous sinus, and even affect the blood flow and intra-sinus pressure in the cavernous sinus on the side of non-pituitary gland tissue, resulting in obstruction of venous return of sphenoid sinus mucosa, and then thickening of sphenoid sinus mucosa. At present, the mechanism leading to sphenoid sinus mucosal thickening is still unclear. When pituitary adenoma stroke combined with sphenoid sinus mucosal thickening is found clinically, surgical treatment should be performed as soon as possible. This paper reports a patient with acromegaly, who developed pituitary adenoma infarction during hospitalization, and then found thickening of sphenoid sinus mucosa by imaging, with good postoperative effect.

Multiple intracranial aneurysm (MIA) is a special type of intracranial aneurysm, which refers to the growth of two or more aneurysms in the cranium at the same time. MIA has a high risk of rupture, and the mortality and disability rate of patients after rupture are higher than those of other types of intracranial aneurysms. Clinical treatment is difficult and risky. At present, there are few reports on primary interventional treatment of more than 5 MIA. A patient with seven multiple aneurysms of bilateral internal carotid artery was treated with primary stent-assisted coil embolization, and satisfactory clinical results were obtained.

Pituitary adenoma is more common in intracranial tumors, but pituitary cancer is very rare, accounting for about 0.1% to 0.2% of pituitary tumors, and is only called pituitary cancer when pituitary tumors have discontinuous intracranial spread or systemic metastasis. There are few reports on the exposition, diagnosis and treatment of this disease in the previous literature, and there are many hypotheses on its specific pathogenesis. Through literature review, this paper summarizes the current research status of pituitary cancer in epidemiology, etiology, pathogenesis, clinical manifestations, diagnosis, treatment and prognosis, aiming at improving the understanding and diagnosis and treatment level of this disease.

Fluorescein sodium is widely used in clinical practice, and its application value in glioma surgery is still under study. More and more evidence shows that fluorescein sodium-guided glioma surgery is important for improving the degree of tumor visualization and improving the rate of tumor resection. This article mainly reviews the recent application, timing and dosage of fluorescein sodium in glioma resection and biopsy, and the progress of combined application with other techniques.