Volume 35 · Issue 06 · 2019

To discuss the application value of high-resolution C-arm CT (Dyna micro CT) combined with streak metal artifact removal technology (SMART) in LVIS stent-assisted embolization of intracranial aneurysms.

From October 2016 to June 2018, 48 patients with 52 intracranial wide-neck aneurysms were admitted to Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, underwent LVIS stent-assisted coil embolization. The clinical data and images of those patients were analyzed. Conventional C-arm CT (Dyna CT) and high-resolution C-arm CT (Dyna micro CT) were performed respectively during and after the treatment. The obtained images were processed with conventional reconstruction and SMART. The reconstruction quality was analyzed and compared between different methods. Based on Dyna micro CT combined with SMART as well as operating position angiography, assessment was conducted on the aspects including immediate postoperative extent of stent expansion and aneurysm neck packing density. Complications within 24 hours after procedure were documented and analyzed. The incidences of stent restenosis and aneurysm recurrence were determined based on DSA results at 3-6 months post operation. Clinical outcomes were assessed according to the modified Rankin Scale (mRS).

A total of 52 aneurysm embolization procedures were successfully conducted using 52 LVIS stents. Compared with conventional reconstruction, Dyna micro CT combined with SMART improved visualization of meticulous structures of the stent and reduced the metal artifacts produced by the platinum coils which significantly improved the image quality (P<0.05). Based on the reconstruction results obtained using the methods as above, 5 patients showed insufficient stent expansion which was improved following dilatation with looped micro-guidewire or balloon expansion and attachment. In 9 patients with insufficient embolization of aneurysm neck, the position of the microcatheter head was adjusted and embolization was continued until packing density was sufficient. Within 24 hours post procedure, none of the patients developed acute thrombosis or bleeding complications. Imaging follow-up was conducted for 36 patients at 3-6 months post operation, and only 1 patient showed coil compression indicating recurrence in the area of aneurysm neck. The mRS scores were as follows: 0 in 40 cases, 1 in 4 cases, 2 in 2 cases, 3 in 1 case and 4 in 1 case.

Dyna micro CT combined with SMART can effectively reduce the metal artifacts of stents and coils during intracranial aneurysm embolization, improve image quality, and help guide clinical treatment, thus reducing the incidence of postoperative complications and the recurrence rate of aneurysms.

To explore the clinical application and preliminary experience of Pipeline Flex device (PED Flex) in the treatment of intracranial aneurysms.

The data of 23 patients with 23 intracranial aneurysms treated by Pipeline Flex device at Neurosurgery Department of the First Affiliated Hospital of Xinjiang Medical University from January to November 2018 were retrospectively analyzed. Among them, 4 were ruptured aneurysms and 19 were unruptured aneurysms. There were 20 anterior circulation aneurysms and 3 posterior circulation aneurysms. The size of aneurysm was 7.2-30.2 mm, with an average of 15.7±6.3 mm. There were 19 cases of cystic aneurysm, 2 cases of fusiform aneurysm and 2 cases of dissecting aneurysm. Among all cases, 13 were treated with adjuvant coils.

PED Flex stent was successfully implanted in 21 (91%) cases. The stents adhered well after release and no balloon was used for post-dilatation. PED failed to be placed in 2 cases including 1 with severe distortion of the proximal vessel of the parent artery and the other with intraoperative bleeding resulting in death at 5 days post operation. One patient had obstructive hydrocephalus after operation due to rupture of aneurysm before operation. The remaining patients had no perioperative complications. Six months after operation, 16 patients were followed up by digital subtraction angiography (DSA). All the aneurysms were occluded well without recurrence and the parent artery was unobstructed.

The preliminary results of PED Flex in the treatment of intracranial aneurysms show that the success rate of implantation seems higher and the complications are relatively less. The short-term effect is better and long-term effect needs further follow-up.

To investigate the safety and efficacy of treatment of intracranial complex aneurysms using Pipeline embolization device (PED).

We retrospectively analyzed the clinical data of 48 patients (56 intracranial aneurysms) who were treated with PED at 6 hospitals in Shandong province from January 2015 to October 2016. The average diameter of 56 aneurysms was 10.8±8.6 mm. There were 33 (58.9%) saccular aneurysms, 7 (12.5%) blood blister-like aneurysms, 1 (1.8%) dissecting aneurysm and 15 (26.8%) irregular shaped aneurysms. There were 55 (98.2%) aneurysms located at internal carotid artery and 1 (1.8%) located at vertebral artery. The instant efficacy of embolization was evaluated according to Kamran classification. The efficacy of embolization during the follow-up was assessed by Cekirge classification.

Among all 56 aneurysms, Kamran grade 1 was reported in 13 (23.2%) aneurysms, grade 2 in 20 (35.7%), grade 3 in 11 (19.6%) and grade 4 in 12 (21.4%). The intraparenchymal hemorrhage rate was 6.3% (3 cases) and the mortality rate was 4.2% (2 cases) within 7 days post operation. Thirty-three cases were followed up for 3-16 months post operation. Complete occlusion (Cekirge grade 1) was achieved in 72.5% (29/40), neck filling (Cekirge grade 2) in 12.5% (5/40) and incomplete occlusion with aneurysm filling (Cekirge grade 3) in 15.0% (6/40).

The complication rate seems relatively low in patients with intracranial aneurysms treated with PED and the complete occlusion rate of aneurysms is satisfactory in early and mid-term follow-up.

To investigate the efficacy of various treatment methods in patients with recurrent intracranial aneurysms post embolization.

From January 2015 to November 2017, 35 patients with recurrent intracranial aneurysms were admitted to Department of Neurosurgery, Zhongshan Hospital Affiliated to Xiamen University. Among them, 32 cases had anterior circulation aneurysms and 3 had posterior circulation aneurysms. There were 14 cases undergoing craniotomy (craniotomy group) and 21 cases undergoing interventional embolization (interventional embolization group). The surgical outcome was evaluated by modified Raymond-Roy grade (MRRC). Glasgow outcome scale(GOS) was used to evaluate the outcome of neurologic function. The treatment effect and outcome of neurologic function were compared between the 2 groups.

In the interventional embolization group, MRRC grade Ⅰ was reported in 19 (90.5%) cases and grade Ⅱ in 2 (9.5%). In the craniotomy group, the proportion of patients with grade Ⅰ and grade Ⅱ was 13/14 and 1/14, respectively. There was no significant difference between the 2 groups (P>0.05). Hemiplegic paralysis occurred in one patient in craniotomy group. No postoperative complication was reported in interventional embolization group.The follow-up period was 6 to 24 months, with the median of 14 months. In terms of clinical outcome, the postoperative GOS grade in interventional embolization group was grade Ⅴ accounting for 100% (21/21). In the craniotomy group, the proportion of grade Ⅴ and grade Ⅳ were 13/14 and 1/14, respectively. There was no significant difference between the 2 groups (P>0.05).

For patients with recurrent aneurysms after embolization, both endovascular embolization and microcraniotomy ligation could achieve good outcome of neurologic function.

To investigate the short-term clinical efficacy of clipping and endovascular therapy in the treatment of acute high-grade [WFNS (World Federation of Neurosurgical Societies) grade Ⅳ-Ⅴ] anterior circulation aneurysms.

A total of 162 patients with acute high-grade anterior circulation aneurysms who were admitted to Department of Neurosurgery at Jinhua Municipal Hospital from January 2014 to January 2018 were analyzed retrospectively. Based on the surgical plans, the patients were divided into clipping group (88 cases) and endovascular therapy group (74 cases). The post-operative complications and short-term follow-up were compared between the 2 groups. The efficacy was evaluated by Glasgow outcome scale (GOS). All clinical data were analyzed by Chi-square test、rank sumtest and T-test.

There was no significant difference in the incidence of re-rupture, cerebral vasospasm, cerebral infarction or intracranial infection between the 2 groups (all P>0.05), while the incidence of hydrocephalus was lower in the clipping group (3.4%, 3/88vs. 12.2%, 9/74, P<0.05). The GOS was used to evaluate short-term efficacy. A follow-up of 3-12 months showed that the overall outcome in clipping group was better (56.8%, 50/88vs. 40.5%, 30/74, P<0.05), particularly for WFNS Ⅳ patients (64.4%, 47/73vs. 45.2%, 28/62, P<0.05), while for WFNS Ⅴ patients the outcomes were similar in 2 groups (P>0.05).

For the treatment of acute high-grade anterior circulation aneurysms, surgical clipping may have less complications and better overall short-term outcome.

To compare the clinical effects of aneurysm ligation of ruptured anterior communicating artery through supraorbital keyhole approach and pterional approach.

We performed a retrospective study of 45 cases with anterior communicating artery aneurysms admitted to Department of Neurosurgery, Peace Hospital Affiliated to Changzhi Medical College and 29 cases with anterior communicating artery aneurysms admitted to Department of Neurosurgery, Shanxi Dayi Hospital from January 2013 to June 2018. Among them, 40 cases underwent clipping of aneurysms through pterional approach (pterional approach group) and 34 cases underwent aneurysm clipping via supraorbital keyhole approach (keyhole approach group). Clinical follow-up was performed at 6 months post surgery. The Glasgow Outcome Scale (GOS) was used for outcome assessment: grades Ⅳ-Ⅴ for good outcome, grade Ⅱ-Ⅲ for poor outcome and grade Ⅰ for death. Based on the patient's self-cosmetic satisfaction scores (1-5 points), 1 represented " very dissatisfied" and 5 meant " very satisfied" . The clinical efficacy in the 2 groups of patients was compared.

There was no significant difference in age, gender, Hunt-Hess grade or aneurysm diameter between the 2 groups (all P>0.05). Compared with the pterional approach group, the operation time in the keyhole approach group was shorter (215.0±46.7 minvs. 272.4±50.6 min, P<0.01) and postoperative complication rate was lower [50.0% (17/34)vs. 87.5% (35/40), P<0.05]. At 6 months post surgery, among the 40 patients in the pterional approach group, the outcome was good in 35 cases(87.5%), poor in 3(7.5%) and death in 2(5.0%). Among the 34 patients in the keyhole approach group, the outcome was good in 30 cases(88.2%), poor in 3(8.8%) and death in 1(3.0%). The difference between the 2 groups was not statistically significant (P>0.05). However, the cosmetic satisfaction scores of patients in the keyhole approach group was higher than those in the pterional approach group (4.8±0.6vs. 3.9±1.1, P<0.01).

The keyhole approach is a safe and reliable surgical approach, ruptured anterior communicating artery aneurysm, the supraorbital approach can be partly used to replace the pterional approach.

To investigate the surgical skills and clinical efficacy of microsurgical treatment of paraclinoid aneurysms via Dolenc approach.

The clinical data of 35 patients with paraclinoid aneurysms operated via Dolenc approach at Department of Neurosurgery, Shiyan Taihe Hospital from September 2014 to May 2018 were analyzed retrospectively. The 35 patients had 38 paraclinoid aneurysms, among which 13 were ruptured aneurysms (Hunt-Hess grade Ⅰ-Ⅲ) and 22 were unruptured.All patients underwent operation via pterional approach and paraclinoid aneurysms were exposed via Dolenc approach. In this study, 24 aneurysms were clipped directly and 11 were clipped and shaped. The intraoperative indocyanine green (ICG) angiography was performed to confirm the efficacy.

Satisfactory results were achieved in 35 cases. All aneurysms were completely clipped which were confirmed by CT angiography or digital Subtraction angiography examination. Two patients with giant aneurysms developed cerebral infarction and mild hemiplegia on the contralateral side after surgery, which were improved in 1 following rehabilitation treatment. Three patients developed oculomotor nerve palsy which was improved after 3 months. Three patients with ruptured aneurysms had hydrocephalus within 2 months after operation and recovered following ventriculo-peritoneal shunt. All patients were followed up for a period of 1-43 months, with an average of 19±8 months. The GOS (Glasgow outcome scale) grade was Ⅴ in 29 cases, Ⅳ in 5 and Ⅲ in 1 at discharge.

The removal of anterior clinoid process in extradural space and dissociating distal dural ring via Dolenc approach is favorable for early control of parent artery, may provide a better surgical field for exposing and clipping aneurysms, and thus improve the safety and efficacy of surgical treatment of paraclinoid aneurysms.

216 patients with aneurysmal subarachnoid hemorrhage (aSAH) were retrospectively enrolled. Based on the results of preoperative CT and digital subtraction angiography (DSA), the site of intracranial hemorrhage and the position of responsible aneurysm were judged, and the correspondence between them was compared and analyzed, so as to preliminarily predict the position of responsible aneurysm through the site of hemorrhage.

It is shown that in patients with hemorrhage in the anterior longitudinal fissure pool, the responsible aneurysm is mostly located in the anterior communicating artery or the pericallosal artery; In patients with hemorrhage in the lateral fissure pool, the responsible aneurysm is mostly located in the middle cerebral artery; In patients with extensive suprasellar hemorrhage, the responsible aneurysm is mostly located in the posterior communicating artery; In patients with hemorrhage in the anterior and interpedal cisterns, the responsible aneurysms are mostly located in the basilar artery; In patients with hemorrhage in the prepontinal cistern, interpedal cistern and around the medulla, the responsible aneurysm is mostly located in the vertebral artery. It indicates that there is a close correspondence between the blood accumulation site of aSAH and the position of responsible aneurysm.

To explore the cellular heterogeneity between ¹¹C-methionine (¹¹C-MET) high and low regions in the diffuse intrinsic pontine glioma (DIPG) using ¹¹C-MET-PET/CT guided multiple-target biopsy and transcriptome analysis.

Six DIPG patients admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2017 to December 2017 were included in this prospective study. The ¹¹C-MET-PET/CT image was imported into GE AW4.5 workstation software to measure the maximum methionine uptake value (SUVmax) of the tumor, and the tumor area was divided into methionine high uptake zone, middle uptake zone and low uptake zone. Biopsy was performed on the high and low intake areas of methionine. By sequencing the tissue samples, the differentially expressed genes and hotspot mutations in the high and low methionine regions of 6 patients were compared, and gene ontology (GO) analysis and signal pathway enrichment analysis were performed.

The number of genes up-regulated in the methionine-high uptake area of tumor tissues in 6 patients was 296-1 768, and the expression was down-regulated from 558 to 1 476. The results of detection of common hotspot mutations in methionine high and low uptake areas of 6 patients were as follows: 1 BCOR mutation, 4 H3F3A mutations, 1 PIK3CA mutation, 5 TP53 mutations, and 1 PPM1D mutation (detected only in the ¹¹C-MET low uptake region). GO and signal pathway enrichent analysis showed that compared with the low methionine uptake area of tumor tissue, the genes highly expressed in the high uptake area were mainly involved in tumor proliferation, invasion and neovascularization, while the low expressed genes were mainly involved in immune cell chemotaxis, immune response and biological processes such as the reaction to interferon.

The heterogeneity of cell function is exhibited in the tissues of DIPG. Compared with the lower uptake region of methionine, high uptake region has high expression of tumor malignant biological behavior-related genes and low expression of immunosuppressive and tumor resistance-related genes. ¹¹C-MET-PET/CT could have diagnostic value in distinguishing the biological functions of tumor cells.

To identify independent risk factor(s) in deaths of patients with primary brainstem hemorrhage.

A total of 132 patients with primary brainstem hemorrhage (survival in 88 cases and death in 44 cases) were retrospectively enrolled into this study who were admitted to Department of Neurosurgery, Southwest Hospital, Army Medical University from January 2000 to December 2016. Chi-square test for age, sex, medical history, vital signs at admission or the rank sum test for hematoma volume was performed between the two groups to identify risk factor(s) affecting the survival at 30 days post primary brainstem hemorrhage. Furthermore, multivariate Logistic regression analysis was employed to identify independent risk factors of deaths in patients with primary brainstem hemorrhage.

Univariate regression analysis related to the survival rate within 30 days indicated that risk factors were as follows: age (P=0.017), hypertension (P=0.002), GCS (Glasgow coma scale) score (P<0.001), NIHSS (National Institute of Health Stroke Scale) score (P<0.001), hematoma volume (P<0.001), combined ventricular hemorrhage (P=0.014) and hydrocephalus (P<0.001). The multivariate Logistic regression analysis data showed that GCS score on admission (OR=0.619, 95% CI: 0.414-0.926, P=0.019) was an independent risk factor in patients with primary brainstem hemorrhage.

GCS score on admission is an independent risk factor inducing death in patients with primary brainstem hemorrhage.

To determine the effect of timing of tracheostomy on clinical outcome in neurosurgical patients with infratentorial lesions admitted to the intensive care unit (ICU).

A total of 253 neurosurgical patients with infratentorial lesions, who underwent tracheostomy at Department of Intensive Care Unit (ICU), Beijing Tiantan Hospital from January 2015 to December 2017, were enrolled into this study. Patients were divided into 2 groups based on the timing of tracheostomy. Tracheostomy was performed within 7 days after operation in the early group (group E, n=128), whereas in the late group, it was performed after 7 days post operation (group L, n=125). Total duration of mechanical ventilation (MV), length of stay (LOS) at ICU, hospital LOS, and incidence of ventilator-associated pneumonia (VAP) were compared between the 2 groups.

The total MV duration, ICU and hospital LOS were significantly longer in group L than in group E [M(P₂₅, P₇₅): 7 (3.0, 12.0) d vs. 0 (0, 5.8) d; 19 (15.0, 25.5) d vs. 9 (8.0, 12.0) d, 31 (27.0, 39.5) d vs. 20 (17.0, 24.0) d, respectively, all P<0.001]. The incidence of VAP was higher in group L than in group E [88.0%(110/125)vs. 30.5%(39/128), P<0.01].

Early (within 7 days) tracheostomy could reduce the MV duration, ICU LOS and incidence of VAP in critically ill neurosurgical patients with infratentorial lesions.

To analyze the preoperative personal characteristics of glioma patients and to explore the association of their personal characteristics with clinical factors.

A retrospective analysis was conducted on 85 patients with gliomas (tumor group) who were admitted to Department of Neurosurgery of Affiliated Hospital of Southwest Medical University from February 2016 to December 2018. Minnesota Multiphasic Personality Inventory (MMPI) was used for assessment before surgery. Meanwhile, 41 healthy volunteers who volunteered to undergo the MMPI assessment at Mental Health Center of Affiliated Hospital of Southwest Medical University during the same period were enrolled as controls (healthy control group). The results of MMPI scores were compared between the 2 groups. The relationship between Karnofsky Performance scale(KPS) score, tumor grade, location and side of patients with glioma and MMPI score was further analyzed.

There was no significant difference in age, gender, education level or income between the 2 groups (all P>0.05). Compared with normal control group, the scores of 9 scales of MMPI in tumor group, including Lie (56.0±11.5vs. 50.0±10.0), Validity (53.0±10.6 vs. 41.7±8.8), Hypochondriasis (55.6±11.2 vs. 44.2±8.3), Depression (49.2±9.6 vs. 42.2±10.3), Masculinity-femininity(49.9±9.4 vs. 42.8±14.0), Psychasthenia (51.5±10.0 vs. 40.9±11.5), Schizophrenia (51.2±10.6 vs. 40.2±10.6), Hypomania(51.8±9.1 vs. 47.7±9.4), Social introversion(46.6±8.7 vs. 36.7±13.0), were significant increased (all P<0.05). Meanwhile, compared with normal control group, the score of Correction in tumor group was significant decreased (52.1±13.9vs. 58.8±12.1, P=0.009). The scores of Lie, Correction, Hypochondriasis and Hysteria were significant different statistically between KPS>80 group and KPS≤80 group (P<0.05). The scores of Depression were significantly different between frontotemporal group and non-frontotemporal group (P<0.05). Moreover, the scores of Masculinity-femininity were significantly different between low grade glioma group and high grade glioma group (P<0.05). There was no significant difference in the scores of each scale among right, left and bilateral glioma patients (allP>0.05).

Patients with gliomas usually have some abnormal psychological personality, including evasion, over self-worry, emotional depression, nervousness, anxiety and so on. The KPS scores, tumor grade and location seem to have certain effects on their psychological personal characteristics respectively.

To investigate the treatment effect of subthalamic nucleus deep brain stimulation (STN-DBS) on anxiety level and anxiety components in patients with Parkinson disease (PD).

A retrospective study was conducted on 59 patients with PD who underwent STN-DBS treatment at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from October 2015 to September 2017. Patients were preoperatively evaluated and tracked for more than one year to assess motor symptoms (UPDRS Ⅲ, Unified Parkinson's Disease Rating Scale, Part Ⅲ), quality of life (PDQ-39, 39-item Parkinson's Disease Questionnaire), anxiety (Hamilton Anxiety Scale, HAMA) and anxiety component scores as well as PD drug use. Paired t-test was used to compare the above parameters between pre-operation and post-operation. Pearson correlation analysis was used to explore the relationship between the changes of HAMA and the component scores with other kinds of symptom improvement in PD patients after STN-DBS treatment.

Significantly improved motor symptoms, quality of life and decreased PD-related drug use were observed in PD patients after at least one year of STN-DBS treatment (all P<0.001). The scores of HAMA total, somatic and psychogenic anxiety were also significantly decreased (P<0.001). Moreover, the improvement of HAMA total score and psychogenic anxiety score were positively related to the decrease of PDQ-39 scores (r=0.31, r=0.34, all P<0.05). However, those had no correlation with UPDRS Ⅲ improvement or decreased drug use (allP>0.05). On the other hand, there was no correlation between the improvement of somatic anxiety score and other symptom improvement (allP>0.05).

STN-DBS treatment on PD patients could decrease the anxiety level at follow-up of at least one year. There is positive correlation between improvement of anxiety and quality of life, which is more obvious for psychogenic anxiety.

To study the surgical experience and clinical efficacy of microsurgical treatment on patients with hypertensive basal ganglia hematomas through transsylvian-transinsular approach.

A retrospective analysis was performed on 68 consecutive patients with hypertensive basal ganglia hematomas who underwent surgical treatment at Department of Neurosurgery, Shanxi Dayi Hospital from June 2013 to May 2018. All of them were operated on for hematomas evacuation through transsylvian-transinsular approach.The degree of hematomas evacuation was evaluated by postoperative CT scan results. Glasgow outcome scale (GOS) was used to access the clinical prognosis.

The volume of remaining hematoma was 0-10 ml (median: 3.5±0.5 ml) on CT scan obtained 24 hours postoperatively. In this group, near complete (>90%) evacuation was achieved in 83.8%(57/68), 70-90% in 8.8% (6/68) and less than 70% in 7.4% (5/68). None of the patients had edema or contusion around the surgical corridor. There were rebleeding in 1 (1.5%) case, severe pulmonary infection in 6, intracranial infection in 3, hydrocephalus in 2 and epilepsy in 1. The mortality rate was 4.4% (3/68). There was 42 cases with good function, 18 cases with disability, and 5 cases in vegetative state at 6 months post surgery among 65 surviving patients.

Microsurgery through transsylvian-transinsular approach is one of safe and effective treatments for hypertensive basal ganglia hematomas. Keeping proper dissection plane is crucial to preserve the veins during the sylvian dissection. It could offer a sufficiently wide surgical corridor to evacuate the hematomas.

To investigate the common etiology, clinical manifestations and abnormal hormone levels of anterior pituitary hypofunction (APH).

A retrospective analysis was performed on 140 patients diagnosed with APH at Department of Endocrine & Metabolic Diseases, Fujian Provincial Hospital from January 2013 to January 2017. Basic clinical data were collected to analyze the common causes of APH, main clinical manifestations and laboratory examination results of the patients.

Among all 140 patients, 30 (21.4%) were pituitary adenoma patients, 28 (20.0%) were postoperative pituitary adenoma patients, 18 (12.9%) suffered from pituitary hypofunction caused by craniocerebral radiotherapy, 16 (11.4%) developed pituitary stalk interruption syndrome, and 15 (10.7%) had with Sheehan syndrome. There were 67 (94.4%) cases of growth hormone deficiency (growth hormone function measured in only 71 of 140 subjects), 114 (81.4%) cases of gonadal hormone deficiency, 113 (80.7%) cases of thyroid hormone deficiency and 107 (76.4%) cases of adrenocortical hypofunction. Fatigue in 40 (28.6%) cases and delayed growth in 13 (9.3%) cases were the most common complaints, headache in 11 (7.9%) and visual impairment in 10 (7.1%) were the most common symptoms. In male patients, hormonal abnormalities included growth hormone deficiency (94.6%, 53/56), gonadal hormone deficiency (85.0%, 68/80), thyroid hormone deficiency (81.3%, 65/80), and adrenocortical hormone deficiency (78.8%, 63/80). In femal patients, hormonal abnormalities included growth hormone deficiency (93.3%, 14/15), thyroid hormone deficiency (80.0%, 48/60), gonadal hormone deficiency (76.7%, 46/60), and adrenocortical hormone deficiency (73.3%, 44/60).

The most common reason leading to APH is pituitary adenoma, followed by pituitary adenoma after surgery. The most common complaint is fatigue. The most important hormone abnormalities are? growth hormone and gonadal hormone. There are differences in hormone abnormality caused by APH in different genders.

To investigate the clinical efficacy of small skull window microsurgery for cerebral paragonimiasis in children.

The retrospective study included 25 children with cerebral paragonimiasis who underwent small skull window microsurgery at Department of Pediatric Surgery, Chongqing Three Gorges Central Hospital between January 2015 and February 2018, and all children had intracerebral bleeding at admission and had praziquantel for 4-6 courses after surgery. The surgical treatment effects and outcomes were analyzed and evaluated according to activity of daily living (ADL).

Among 25 cases, there was no operative complications. All the patients recovered well in 3-36 months at follow-up (median: 18 months). According to ADL, the outcomes of 25 cases were graded as follows: level Ⅰ in 24 cases and level Ⅱ in 1. The number and ratio of eosinophils were gradually decreased in blood routine test, and those were at approximately normal levels after 2-3 months of operation. There was no recurrence in this study.

The small skull window microsurgery for children's cerebral paragonimiasis seems to have definite clinical effect and relatively low rates of complications.

The clinical efficacy of 9 patients with acute large vessel occlusive stroke complicated with primary atherosclerotic stenosis treated with the in-stent balloon dilatation technique before Solitaire FR stent release was retrospectively analyzed. Among the 9 cases, 8 cases were classified as Grade 3 and 1 case as Grade 2b with immediate postoperative modified cerebral infarction thrombolysis (mTICI). One patient experienced reocclusion of the responsible vessel 24 h after surgery and died of massive cerebral infarction on the 4th postoperative day. Two patients had asymptomatic intracranial hemorrhage. Three months after surgery, 6 cases had good prognosis [modified Rankin scale (mRS) ≤2 points] and 2 cases had poor prognosis (mRS ≥3 points). Eight patients underwent angiographic examination at 6 months postoperatively, and none of them showed in-stent restenosis.

Electrical stimulation of the vagus nerve (VNS) is effective as an adjuvant method for the treatment of drug-refractory epilepsy (DRE). In recent years, with the increase of the number of surgical patients, postoperative laryngeal adverse reactions such as cough and hoarseness occur from time to time, and very few patients are difficult to tolerate, which affects the further adjustment of parameters and even affects the surgical efficacy. In this study, 13 patients with DRE after VNS were followed up to observe the laryngeal adverse reactions, of which 6 patients underwent laryngoscopy to observe the laryngeal motion pattern.

It was shown that 8 cases had laryngeal adverse reactions after VNS, including 3 cases with cough (1 case with transient shortness of breath) and 7 cases with hoarseness. Only one case changed the adjustment strategy due to laryngeal discomfort, and the rest were transient manifestations. Of the 6 patients who underwent laryngoscopy, 5 presented normal bilateral symmetrical movements of the vocal cords and 1 presented with left vocal cord paralysis.

To study the correlation between the proliferation ability of neural stem cells (NSCs) in hippocampus and the phosphatase and tensin homolog deleted on chromosome 10/protein kinase B/mammalian target of rapamycin (PTEN/Akt/mTOR) signaling pathway after traumatic brain injury (TBI).

A total of 18 rats were randomly divided into sham group (6 rats) and TBI group (12 rats). The TBI model was constructed by the controlled cortical injury (CCI) device. Another 24 rats were randomly divided into TBI+ saline group (12 rats) and TBI+ bisperoxovanadium (BPV) group (12 rats). The rats in TBI+ saline group (12 rats) and TBI+ BPV group were intraperitoneally injected with BPV (total amount was 20 μg/100 g, 4 times, once/4 h) or same amount of saline at 24 h before the construction of TBI. The brain was isolated from rats of at 7 days post TBI, the proliferation ability of NSCs (BrdU/Sox2 double positive cells) and expression of PTEN in hippocampus were measured by immunofluorescence, and Western blot was performed to measure the expression of PTEN and PTEN/Akt/mTOR signaling pathway molecules.

Compared with the sham group, the number of BrdU/Sox2 double positive NSCs was significantly increased (sham: 30.3±2.3, TBI: 113.4±3.9, P<0.01), the expression of PTEN was significantly decreased (sham: 2.13±0.04, TBI: 1.03±0.07,P<0.01), and the expression of PTEN was negatively correlated with the number of BrdU/Sox2 double positive NSCs in TBI group (r=-0.948, P<0.01). Compared with the TBI+ saline group, the number of BrdU/Sox2 double positive NSCs was significantly increased (TBI+ saline: 117.5±6.6, TBI+ BPV: 135.8±7.4,P<0.01), the expression of PTEN was significantly decreased (TBI+ saline: 1.32±0.08, TBI+ BPV: 0.64±0.03,P<0.01), and the phosphorylation ratio of Akt and mTOR was significantly elevated in TBI+ BPV group (ratio of p-mTOR/mTOR, TBI+ saline: 0.93±0.12, TBI+ BPV: 2.15±0.16,P<0.01; ratio of p-Akt/Akt, TBI+ saline: 1.08±0.11, TBI+ BPV: 1.95±0.19,P<0.01).

The proliferation ability of NSCs in hippocampus is elevated after TBI and enhanced by the inhibition of PTEN, which might be correlated with the PTEN/Akt/mTOR signaling pathway.

Dural arteriovenous fistula (DAVF) in the cavernous sinus region is a common disease. At present, the main treatment plan is endovascular therapy, but the effect is not good for some complex lesions. In this case, the patient was converted to composite surgery after attempting arterial approach and conventional venous approach embolization, and the lateral fissure vein was exposed by craniotomy through pterional approach, and the lateral fissure vein was punctured for embolization, and finally the cure was achieved. This method provides a new reference for the treatment of complex DAVF in the cavernous sinus region.

Transcranial direct current stimulation (tDCS) is a kind of neurostimulation therapy that changes neuroplasticity and cortical excitability by direct current stimulation, realizes its neurophysiological effects, and improves various neurological and psychiatric diseases. In the past 10 years, researchers have gradually paid attention to the regulatory and physiological effects of tDCS on brain activity, and explored the mechanism of tDCS stimulating neural networks. This paper will focus on the mechanism of action of tDCS and its research status in neurological diseases, put forward the bottlenecks still existing in this technology, and make a prospect for its future.

Epilepsy is a common disease of the central nervous system, and about one third of patients are ineffective in drug treatment. It is called drug-refractory epilepsy, which is a major difficulty in epilepsy treatment. As a drug efflux transporter, P-glycoprotein can be combined with antiepileptic drugs and excreted, which is regarded as an important cause of drug-refractory epilepsy. In this paper, the relationship between P-glycoprotein and drug-refractory epilepsy will be discussed from the aspects of the structure and function of P-glycoprotein, the substrate and upregulation mechanism of P-glycoprotein, the latest research progress of P-glycoprotein inhibitors and the mechanism of drug-refractory epilepsy.

Cerebral hemorrhage has high mortality and disability rate. Current use of aspirin has been shown to be beneficial in the prevention of myocardial infarction and ischemic stroke, but it also increases the incidence of cerebral hemorrhage. For patients with cerebral hemorrhage who take aspirin orally, the inhibition of platelets by aspirin can be reflected by thromboelastography. An aspirin inhibition rate ≥75% is a high aspirin inhibition rate. Such patients are difficult to stop bleeding during surgery and have a high risk of rebleeding after surgery. However, the surgical treatment of patients with cerebral hemorrhage with high aspirin inhibition rate has been less studied. This article reviews the preoperative examination, preoperative management, operation timing, operation mode and postoperative rebleeding and management of patients with cerebral hemorrhage under high aspirin inhibition rate.