Volume 35 · Issue 07 · 2019

As a kind of chronic ischemic cerebrovascular disease in Asian population, the detection rate of moyamoya disease is increasing year by year in recent years due to the popularization and development of imaging technology. Due to the late start of clinical diagnosis and treatment and basic research of moyamoya disease, there are many confusions and controversies about its etiology, pathophysiology, disease course stage, diagnosis and treatment standards and efficacy evaluation. At present, with the rapid integration of the concept of advanced brain function research and artificial intelligence technology into clinical diseases, it brings new opportunities for the breakthrough of basic research and clinical diagnosis and treatment of moyamoya disease. Based on a variety of advanced brain function evaluations, a standardized evaluation system combined with multi-modal images is gradually taking shape. At the same time, the multi-angle exploration of the disease has contributed to the development of the national multi-center clinical registration study of moyamoya disease, which will provide a big data platform for the construction of new research and diagnosis and treatment models. The artificial intelligence model based on big data will open up a new way for the improvement of clinical diagnosis and treatment of moyamoya disease.

To explore the characteristics and influencing factors of cognitive impairment in adult moyamoya disease (MMD).

A total of 466 adult patients with MMD (case group) admitted to Department of Neurosurgery, Huashan Hospital, Fudan University from June 2013 to December 2017 were retrospectively enrolled. The neuropsychological scale evaluation results were summarized. A matched group of 50 healthy adults were enrolled as the healthy control group. The characteristics of cognitive dysfunction were analyzed. Univariate and multivariate logistic regression were used to analyze the influencing factors of cognitive impairment in patients with MMD.

Overall cognitive function, long-term memory, attention and executive function in the case group were significantly lower than those in the control group (all P<0.05). Influencing factors of cognitive impairment were studied as follows: (1) Mini-mental state examination(MMSE) was used as the grouping standard of cognitive impairment. Univariate analysis results showed that the influencing factors of cognitive impairment included age (P=0.015), years of education (P<0.001), hypertension (P=0.003) and diabetes (P=0.009), while the results of multivariate regression analysis showed that age (OR=1.03, 95% CI: 1.01-1.05, P=0.001), years of education (OR=0.84, 95% CI: 0.80-0.88, P<0.001), and diabetes (OR=2.60, 95% CI: 1.43-4.71, P=0.002) were risk factors of cognitive dysfunction in patients with MMD.(2) Using memory and executive screening(MES) as the grouping standard for cognitive impairment, univariate analysis showed that age (P<0.001), sex(P=0.043), years of education (P<0.001) and hypertension (P=0.001) were the influencing factors of cognitive impairment and the results of multivariate regression analysis showed that age (OR=1.07, 95% CI: 1.05-1.09, P<0.001) and years of education (OR=0.77, 95% CI: 0.72-0.82, P<0.001) were the influencing factors of cognitive dysfunction in patients with MMD. There was no significant difference in various cognitive functions between different MMD types (hemorrhagic and ischemic) (allP>0.05).

According to the single-center experience of Huashan Hospital, Fudan University, cognitive dysfunction in adults with MMD involves specific cognitive domains and is affected by risk factors such as age, years of education and complications, while no significant difference in cognitive function has been found among different disease subtypes.

To investigate the clinical features and surgical outcomes of pediatric patients with familial moyamoya disease (MMD).

The clinical data of 103 pediatric patients with MMD treated at the Fifth Medical Center of PLA General Hospital from August 2004 to June 2018 were analyzed retrospectively, accounting for 9.1% (103/1 138) of the pediatric patients treated during the same period. Among them, 99 cases (183 sides of cerebral hemisphere) underwent encephalo-duro-arterio-synangiosis (EDAS), and 4 cases were treated conservatively. Clinical efficacy and vascular reconstruction effect of patients were evaluated according to the system described by Matsushima. Stroke events were observed during follow-up. Factors affecting postoperative stroke events were analyzed by Cox Regression.

Among the 103 patients, the male to female ratio was 1.0 ∶0.9 (55/48). The median age of onset was 6 years old and the peak age was 5 years old. Ninety-five (92.2%) cases showed ischemic symptoms first and 90.3% (93/103) were affected by first-degree relatives.in which the father-to-child inheritance accounted for 40.9%(38/93), and the proportions of mother-to-child inheritance is 30.1%(28/93) and siblings is 29.0%(27/93).2.9% (3/103) were second-degree relatives and 6.8% (7/103) were third-degree relatives. The Suzuki stage of Ⅳ-Ⅵ accounted for 78.6% (81/103). A total of 46 (44.7%) caes involved posterior cerebral arteries. The follow-up duration of 99 cases undergoing neurosurgical revascularization procedures was 3-137 months with a median of 38 months. There were 87.9% (87/99) of the patients who had good improvement in terms of postoperative symptoms. Cerebral angiography was performed in 53 cases (104 sides). The patients with good grade (A or B) accounted for 87.5% (91/104). Stroke occurred in 7 (7.1%) cases during the follow-up period. Of the 4 cases treated conservatively, 1 case was lost to follow-up and 3 cases did not develop stroke during follow-up. Cox regression analysis showed that age of onset, sex, initial symptom, Suzuki stage, unilateral MMD and posterior cerebral artery involvement were not risk factors for postoperative stroke events(all P>0.05).

The onset age of Chinese pediatric patients with familial MMD is earlier and its presentation is predominantly ischemic. First-degree relatives are more commonly to be affected. The EDAS surgery could effectively relieve the ischemic symptom in pediatric patients.

To investigate the risk factors of epilepsy in moyamoya disease (MMD) patients after cerebral revascularization.

We conducted a retrospective study on 213 patients with moyamoya disease admitted to Department of Neurosurgery, Huashan Hospital, Fudan University from January 2014 to December 2015. A total of 240 sides (hemispheres) of cerebral revascularization were performed, including 25 pediatric patients (29 sides) with indirect revascularization surgery (encepho-duro-myo-synangiosis, EDMS). The remaining 188 patients (211 sides) underwent combined revascularization (EDMS + superficial temporal artery-middle cerebral artery anastomosis). All patients underwent clinical follow-up and postoperative outcome was assessed using modified Rankin Scale (mRS). Univariate and multivariate logistic regression analyses were used to study the clinical risk factors for postoperative seizures in patients with moyamoya disease.

All 213 patients underwent successful cerebral revascularization in 240 sides. The bridge vessels were confirmed unobstructed via digital subtraction angiography (DSA) post operation. Four patients(1.9%) developed new cerebral infarction, 1(0.5%) had cerebral hemorrhage, 19(8.9%) had hyperperfusion syndrome and 28(13.1%) had seizures. Among 213 patients, 198 were successfully followed up for the duration of 2-24 months, with an average of 12.0±5.4 months. Postoperative mRS were 0-2 points in 184 cases, 3-5 points in 9 and 6 points in 5. Univariate analysis showed that the side of moyamoya disease, Suzuki staging, postoperative new cerebral infarction, cerebral hemorrhage and hyperperfusion syndrome were clinical factors affecting postoperative seizures in patients with moyamoya disease (all P<0.05). Further multivariate analysis showed that the moyamoya disease lesion was located on the left side (OR=2.615, 95% CI: 1.004-6.814, P=0.049) and new cerebral infarction occurred after operation (OR=11.565, 95% CI: 1.458-91.741, P=0.021) and hyperperfusion syndrome (OR=7.747, 95% CI: 2.650-22.649, P<0.001) were independent risk factors for postoperative seizures in patients with moyamoya disease.

The new cerebral infarction and hyperperfusion syndrome on the left side and postoperative moyamoya disease are important clinical factors affecting postoperative seizures in patients with moyamoya disease.

To investigate the safety and efficacy of cerebral revascularization combined with craniotomy in the treatment of moyamoya disease with ruptured aneurysm.

Five patients with moyamoya disease or Moyamoya Syndrome complicated with ruptured aneurysms (5 aneurysms) were treated at Department of Neurosurgery, Henan Provincial People's Hospital from June 2016 to March 2018. All patients underwent extracranial and extracranial revascularization combined with craniotomy for aneurysm clipping. Five patients were followed up after operation. The results of follow-up were as follows: digital subtraction angiography (DSA) or perfusion weighted imaging (PWI) was used to evaluate the long-term cerebral revascularization and the effect of aneurysm. The recovery of neurological function was evaluated by modified Rankin scale (mRS) and activities of daily living scale (ADL).

The operations of all 5 patients were successful. Intraoperative fluorescence angiography showed that the intracranial aneurysm did not develop and the bridge vessels were anastomosed unobstructed. No new blood foci were found in 5 patients with CT after operation and there were no complications such as infection, new infarction or bleeding. The follow-up time of 5 patients was 6 to 21 months, with an average of 17.6±1.7 months. DSA showed that the aneurysm did not develop and the bridge vessels were unobstructed in 5 patients at 6 months after operation. During the follow-up period, none of the 5 patients had any new neurological deficit symptoms, and there was no hyperperfusion hemorrhage or large-area cerebral infarction. At the last follow-up, the mRS of 5 patients was 0-3, with an average of 1.4±1.0. The ADL of 5 patients was 55-90, with an average of 76±12 at the last follow-up.

Cerebral revascularization combined with craniotomy seems safe and effective in the treatment of moyamoya disease with ruptured aneurysm.

To investigate the correlation between changes of bypass vascular pressure and curative effect during intracranial and extracranial bypass surgery for moyamoya disease. Thirty-one patients with moyamoya disease treated with superficial temporal artery (STA) -middle cerebral artery bypass grafting combined with cerebral dural artery vascularization were retrospectively enrolled. An invasive pressure sensor was used to detect the pressure of STA and recipient vessels before and after vascular anastomosis. Linear correlation analysis showed a positive correlation between preoperative cerebral blood flow (CBF) and the mean vascular pressure values of recipients before bypass (R²＝0.195，P<0.05), negatively correlated with the modified Rankin scale score (mRS) (R²＝0.059，P<0.05)； There was a positive correlation between the difference of mean blood vessel pressure before and after bypass grafting and the difference of CBF before and after surgery (1 week and 3 months) (R²＝0.569，P<0.05；R²＝0.353，P<0.05), and there was no correlation with postoperative mRS.

To explore the advantages of O-arm-navigated pedicle screw insertion in patients with spinal column and spinal cord tumors.

We retrospectively enrolled 29 patients with spinal tumors who underwent pedicle placement using O-arm-based navigation (Group A, 21 cases) or freehand technique (Group B, 8 cases) at Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University from October 2015 to December 2017. Screw position was judged on the 3D O-arm images and the accuracy of screws placement was evaluated according to the Gertzbein-Robbins scale. The clinical data and neuroimaging data were collected during the follow-up.

Age, sex, body mass index, mean blood loss, length of stay and radiation dose showed no significant difference (all P>0.05) between the 2 groups. The operation time in group A was longer than that in group B (109.7±59.9 minvs. 74.5±19.4 min, P=0.025). A total of 134 screws were inserted in Group A and 117 screws was classified as grade A, 11 as grade B and 6 as grade C. There were 45 screws inserted in group B and 34 screws were classified as grade A, 4 as grade B, 6 as grade C and 1 as grade D. The accuracy of screw inserting was significantly different between the 2 groups (group A: 95.5% and group B: 84.4%, χ²=4.604, P=0.032). No screw-related neurovascular complications occurred.

O-arm-based navigation system could markedly improve the accuracy of screw insertion and thus help reconstruct spinal stability.

To investigate the clinical features, treatment methods and prognosis of primary intraspinal peripheral primitive neuroectodermal tumors (pPNETs).

A retrospective study was performed on 26 patients with primary spinal pPNETs who were surgically treated at Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to February 2018. The dorsal standard midline approach was performed in 25 patients and the remaining 1 case underwent biopsy. Two weeks after the first operation, patients were recommended to undergo chemotherapy and/or radiotherapy depending on the age of the patient and the Karnofsky Performance Status (KPS) scores. Clinical follow-up was performed in all patients. The contents of follow-up included tumor recurrence and metastasis, survival time and cause of death.

Of the 25 patients who underwent surgical treatment, gross total resection was achieved in 14 cases, subtotal resection in 8 and partial resection in 3. Postoperative pathological examination showed that 26 cases were primary intraspinal pPNETs. The follow-up period ranged from 2 months to 86 months. The average follow-up period was 17.0±5.1 months. During the follow-up, 5 patients survived and 16 died. The cause of death was tumor recurrence and/or distant metastasis. The average survival time of 21 patients was 27.3±12.9 months. The overall 1-year, 2-year and 5-year survival rates were 55.3%(11/21), 30.6%(6/21) and 15.3%(3/21), respectively. Of the 13 patients who underwent adjuvant radiotherapy and chemotherapy, the 1-year, 2-year and 5-year survival ratios were 9/13, 7/13 and 3/13, respectively. For 2 patients with adjuvant chemotherapy alone, the 1-year survival was one. The 1-year survival ratio was 1/6 in patients treated without adjuvant therapy.

Primary intraspinal pPNETs have an acute onset, short duration, rapid progression and poor prognosis. Gross total resection of the tumor is the preferred method of treatment. Gross total resection combined with adjuvant radiotherapy and chemotherapy could improve the quality of life and help prolong survival time.

To explore the feasibility and effectiveness of para-split laminotomy in the treatment of lumbar spinal canal tumors.

We retrospectively reviewed the clinical data of 15 patients with lumbar spinal canal tumors who underwent tumor resection following para-split laminotomy at Department of Neurosurgery, Clinical Medical College of Yangzhou University from October 2016 to May 2018. Observation indicators included intraoperative blood loss, surgical duration, tumor resection, tumor pathological results and complications.Neurological functions of the spinal cord evaluated based on JOA (Japanese Orthopedic Association) scoring system. The follow-up situations included tumor recurrence, spinal stability evaluation and bone fusion of laminae.

All lumbar spinal canal tumors were resected completely. The mean blood loss was 95.3±58.2 ml and the mean duration of the surgical procedure was 176.7±35.2 min. In this group, the average preoperative JOA score was 15.5±4.9 and the average postoperative JOA score was 24.0±3.5, which was improved significantly (P<0.01). There were no operative complications occurring. The CT examination showed no pedicle or vertebral fractures. During the follow-up period of 6-18 months (average: 10.8±3.9 months), no tumor recurrence or spinal deformation was found according to the imaging examination. CT examination showed that the split laminae tended to heal in the operative area.

The para-split laminotomy shows minimally invasive damage to the posterior spinal tension band and helps to protect the stability of the spine. It is feasible and effective to apply the para-split laminotomy in the operation of lumbar spinal canal tumors.

To analyze the influencing factors of the survival time of children with diffuse intrinsic pontine glioma (DIPG) and to investigate the treatment strategy for DIPG under current conditions.

Clinical data of 134 DIPG patients under 14 years old who were admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2011 to December 2017 were analyzed retrospectively. The survival time of children undergoing clinical intervention (n=98) was compared with that of children without intervention (n=36). Kaplan-Meier method was used to analyze the difference in survival time between DIPG patients with and without invention. Univariate analysis and multivariate Cox regression model were used to analyze influencing factors of the survival time of DIPG patients.

The median survival time of the patients with and without intervention was 9.3 months and 3.3 months, respectively (P<0.001). Univariate analysis showed that the factors influencing the survival time of children with DIPG included age of onset, course of disease, pathological grade, operation, radiotherapy and chemotherapy (allP<0.05). Multivariate analysis revealed that the pathological grade(RR: 2.095, 95%CI: 1.410-3.113, P<0.001), operation(RR: 0.247, 95%CI: 0.085-0.722, P=0.011), radiotherapy and chemotherapy(RR: 0.429, 95%CI: 0.255-0.720, P=0.001) were influencing factors of the survival time of DIPG patients.

The survival time of children with DIPG seems to be related to multiple factors. Surgical resection combined with radiotherapy and chemotherapy could prolong the survival time of the patients.

To investigate the clinical characteristics and surgical outcomes of AIDS-related primary central nervous system lymphoma (PCNSL).

Clinical data of 17 AIDS-related PCNSL patients admitted to Department of Neurosurgery, Beijing Ditan Hospital Affiliated to Capital Medical University from January 2013 to February 2019 were retrospectively analyzed. Of the 17 patients, 12 underwent tumor biopsy and included 2 patients with obstructive hydrocephalus who underwent ventriculoperitoneal shunt. The remaining 5 patients underwent tumor resection and included 3 patients with cerebral hernia who underwent decompressive craniectomy, 1 patient with foramen magnum hernia who underwent foramen magnum decompression and 2 patients with epilepsy who underwent responsible lesion resection. All patients were followed up by telephone or outpatient service. Survival status was inquired by telephone and cranial MRI Karnofsky performance status(KPS) were reviewed in outpatient service. Kaplan-Meier curve was used to compare the survival time of patients receiving chemotherapy after operation with that of patients without any treatment.

All 17 patients underwent successful operation and all of them were diagnosed as lymphoma by pathology. Postoperative symptoms of patients with obstructive hydrocephalus, cerebral hernia or epilepsy were significantly improved. No treatment was given to 11 patients, and 6 patients received chemotherapy or radiotherapy. The follow-up time of 17 patients was 137.8±7.5 (13-528) days. During the follow-up period, 10 patients died and 7 survived. Among the surviving patients, 3 cases were followed up by imaging showing that the intracranial lesions disappeared or decreased significantly. The KPS scores were 60, 60 and 80 points respectively, which were higher than those before operation (40, 30 and 40 points respectively). By the end of the follow-up period, the survival time of 7 patients was 13-528 days. By Kaplan-Meier curve, the survival time of patients with post-operative chemotherapy was longer than that of patients without any treatment. However, there was no statistical significance (P>0.05).

The clinical features of AIDS-related PCNSL are similar to those of patients with normal immune function. When patients suffer from severe neurological dysfunction even leading to cerebral hernia or frequent epileptic seizures, surgical treatment could improve the quality of life of patients. Meanwhile, postoperative radiotherapy and chemotherapy could prolong the survival time of patients.

To explore the complications and preventive measures of intracranial arteriovenous malformations treated by transvenous approach.

We performed a prospective single-center study among 18 consecutive patients with ruptured intracranial arteriovenous malformations who underwent treatment through transvenous approach and analyzed perioperative complications and preventive measures. All those patients underwent operation at Cerebrovascular Division of Interventional Department, People’s Hospital of Zhengzhou University from November 2016 to May 2018. The modified Rankin scale (mRS) was used to evaluate the prognosis of the patients.

The procedure was technically feasible in 16 of 18 cases. Among the 16 patients, immediate angiographic obliteration was achieved in 14 patients and over 85% volume of nidus was occluded in 2. The remaining 2 cases did not undergo transvenous embolization due to the failure of microcatheter navigation. Perioperative complications were reported in 4 cases. Intraoperative hemorrhage occurred in 2 cases and both were intraventricular hemorrhage. Postoperative hemorrhage occurred in 2 cases and the site of hemorrhage was in the thalamus which broke into the ventricle, splenium of corpus callosum and the fourth ventricle. Eighteen cases were followed up for 1-18 months with a median of 10.5 months. The mRS scores were 2 in 1 case, 1 in 4 and 0 in 13 cases. Angiography imaging was achieved in 10 patients with a median of 4.5(2-9)months post operation. None of the patients had recurrence of the nius during the follow-up period.

Cerebral hemorrhage is the most common complication of transvenous embolization of intracranial arteriovenous malformations. Transvenous embolization of intracranial arteriovenous malformations seems effective if complications could be prevented.

To analyze the factors that influence the prognosis in patients with unruptured anterior communicating artery (ACoA) aneurysm through pterional approach.

We performed a retrospective study of 113 cases with ACoA aneurysms admitted to Department of Neurosurgery, the First Affiliated Hospital of Shanxi Medical University from January 2014 to July 2018. All cases underwent clipping of aneurysms through pterional approach. Clinical follow-up was performed at 6 months post surgery through telephone at outpatient clinics. The Glasgow Outcome Scale (GOS) was used for outcome assessment: grade Ⅳ-Ⅴ for good outcome and grade Ⅰ-Ⅲ for poor outcome. Univariate and multivariate logistic regression were used to analyze the prognostic factors in patients with ACoA aneurysm.

All 113 patients underwent successful operation. During postoperative period, there were 33 cases of cerebral ischemic events, 23 cases of brain contusion, 4 cases of hydrocephalus, 9 cases of intracranial infection and 1 case of lung infection. After symptomatic treatment, the patient's symptoms were relieved. One case died of massive cerebral infarction. There were 112 patients who were followed up. Good outcomes were achieved in 97 (86.6%) patients and poor outcomes in 15 (13.4%) patients. Univariate analysis revealed that age, history of hypertension and Hunt-Hess grade were closely related to the prognosis (allP<0.05). Gender, morphological characteristics of aneurysm, size, timing, approach of surgery and postoperative complications were not related to the prognosis (allP>0.05). Multivariate logistic regression analysis revealed that Hunt-Hess grade (OR=3.470, 95% CI: 1.775-6.782, P<0.001) was the independent risk factor affecting the outcomes of patients.

Hunt-Hess grade seems to be the independent risk factor affecting the outcomes of clipping surgery for unruptured ACoA aneurysm via pterional approach.

To investigate the application value of combined image fusion (diffusion tensor imaging, MRI) neuronavigation, ultrasound, neuroelectrophysiology and yellow fluorescence imaging in the surgery of thalamic glioma. A total of 17 patients were enrolled. Postoperative MRI showed total resection in 8 cases, subtotal resection in 5 cases and partial resection in 4 cases; Surgical-related complications occurred in 2 cases. After 6 months follow-up, 13 patients had improved or no progression in neurological function, 3 had worsened symptoms, and 1 died. Among the 16 surviving patients, 1 patient refused MRI due to critical illness, and the remaining 15 MRI showed that 2 cases had tumor recurrence, and 13 cases had no significant progression.

Craniocervical junction dural arteriovenous fistula (DAVF) belongs to a special type of spinal vascular malformation with low incidence, high surgical risk and poor prognosis. The key to surgical treatment is to clarify the abnormal vascular architecture and accurately judge the fistula location. Seven patients with DAVF at the craniocervical junction were treated by microsurgery. Indocyanine green fluorescence imaging was used to determine the location of fistula and the characteristics of surrounding vascular architecture. The results of intraoperative imaging were consistent with those of preoperative digital subtraction angiography (DSA). All fistulas were occluded during the operation. One case was cured, four improved, one did not improve, and one died of respiratory failure after operation. There were no adverse events associated with indocyanine green drug allergy.

Isolated temporal horn syndrome is a rare postoperative complication of tumor in lateral ventricular triangle. The clinical diagnosis is not complicated, and the diagnosis can be confirmed by CT and/or MRI. Six patients with isolated temporal horn syndrome were treated with individualized surgery, and their clinical symptoms and imaging findings were improved without recurrence. There are few clinical reports of isolated temporal horn syndrome, and the conservative treatment effect is poor. Most of them require individualized surgical intervention, and the prognosis is good, but the survival time of patients depends on the primary disease.

To investigate the effects of circ-ZEB1 on proliferation, invasion and migration of glioma cells.

Real-time quantitative PCR (polymerase chain reaction) was used to detect the expression of circ-ZEB1 in 30 glioma tissues and 8 normal brain tissues(obtained from Department of Neurosurgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University), glioma cell lines (A172 and U251) and normal glial cells (HA1800). A172 and U251 cells were transfected with si-circ-ZEB1 to knock down circ-ZEB1. According to the type of si-circ-ZEB1, it was divided into si-1 group and si-2 group (transfected with si-circ-ZEB1-1, si-circ-ZEB1-2, respectively), and a control group was established (siRNA-NC as negative groups transfected with siRNA-NC). The effect of circ-ZEB1 on the proliferation of glioma cell lines was detected by CCK-8 assay. Scratch assay and Transwell assay were used to observe the effects of circ-ZEB1 on the migration and invasion in glioma cells respectively. CircNet database was used to examine and evaluate of circRNA-miRNA gene regulatory network of circ-ZEB1. The dual luciferase reporter assay was used to validate the interaction of circ-ZEB1/miR-140-3p in the gene regulatory network of circRNA-miRNA.

The expression of circ-ZEB1 was higher in glioma tissues than in normal tissues (12.16±1.31 vs. 6.84±0.56, P=0.001). Circ-ZEB1 was over-expressed in high-grade glioma tissues compared with low-grade gliomas (13.77±3.27 vs. 7.50±1.82, P=0.001). The expression levels of circ-ZEB1 in A172 and U251 were 2.91±0.30 and 3.32±0.20, respectively, compared with HA1800 (both P<0.01). The results of CCK-8 showed that the growth of circ-ZEB1 knockdown group (si-1 group and si-2 group) was significantly inhibited compared with the control group. The proliferation abilities of A172 cells were decreased by 40.0% and 57.1%, respectively (bothP<0.01) and those of U251 cells were decreased by 35.3% and 48.5%, respectively (bothP<0.01). In the scratch test, the migration of circ-ZEB1 knockdown group was significantly inhibited (bothP<0.05). Transwell assay showed that the invasive abilities of glioma cells in si-1 group and si-2 group were lower than those of the control group (bothP<0.01). The gene regulatory networks of circRNA-miRNAs showed that circ-ZEB1 interacted with a variety of miRNAs, which affected the regulation of multiple miRNAs and their downstream proteins. The dual luciferase reporter assay also confirmed the interaction of circ-ZEB1/miR-140-3p in the gene regulatory network of circRNA-miRNA.

Circ-ZEB1 is over-expressed in glioma tissues and cell lines. Down-regulation of circ-ZEB1 could decrease cell proliferation and cell migration in gliomas. The gene regulatory network of circRNA-miRNA suggests that circ-ZEB1 functions by interacting with a variety of miRNAs.

Some complicated anterior communicating artery aneurysms may need two stents to protect bilateral blood vessels effectively due to their anatomical features and hemodynamic factors. The stent can be placed in a variety of ways, the common is the "Y" or "T" type placement, and the "X" type placement is relatively rare, especially the non-crossed Kissing-X placement. This paper reports a case of complex anterior communicating artery aneurysm. Because of the "X" anatomical relationship between the entering artery and the exiting artery, the double-stent Kissing-X implantation technique was used to assist the coil embolization, and good clinical results were achieved.

Infantile melanotic neuroectodermal tumor (MNTI) occurring in the skull is clinically rare. A case of sagittal suture MNTI was retrospectively analyzed, and its clinical manifestations, imaging features and treatment methods were summarized in combination with literature. Total tumor resection was obtained after 2 operations, and no tumor recurrence was seen after 2 years follow-up. For MNTI in the sagittal suture of the skull, total surgical resection of the tumor is an effective treatment.

Good illumination and display magnification of deep brain tissue through surgical display equipment is the basic prerequisite for neurosurgeons to complete microsurgery. The new exoscope display system combines the advantages of surgical microscope and neuroendoscope to make up for their respective shortcomings. It has the advantages of deep depth of field, wide field of view, long focal length, small volume, low cost, high resolution, convenient internal and external scope switching, etc., and provides surgeons with more convenient surgical operation space, comfortable surgical operation posture and high-definition surgical vision. This article will review the development and application of exoscope through literature review and combined with the author's experience.

Intracranial germ cell tumors tend to occur in pineal region, sellar region and basal ganglia region. Its histological types are divided into pure germ cell tumor, teratoma, embryonic carcinoma, endodermal sinus tumor, chorioepithelial carcinoma and mixed germ cell tumor. After traditional radiotherapy and chemotherapy, a series of complications may occur, including secondary tumors, hypopituitarism, diabetes insipidus and sexual dysplasia. Targeted therapy has the advantages of high accuracy and relatively few adverse reactions. This paper analyzes the relationship between intracranial germ cell tumor and c-Kit gene mutation in recent years, and reviews the current status and research progress of intracranial germ cell tumor and c-Kit gene mutation.

The carotid web is a membrane-like structure projecting toward the lumen at the beginning of the carotid sinus or internal carotid artery. Recent studies suggest that it may be a risk factor for ischemic stroke. Therefore, this article aims to review the epidemiology, etiopathology, imaging characteristics, pathogenesis of ischemic stroke and the corresponding therapeutic studies of carotid web.

Closed-loop deep brain stimulation is a new technology developed in recent years based on the concept of brain-computer interface and mainly used in the treatment of Parkinson's disease. On the basis of traditional deep brain electrical stimulation, it monitors and analyzes the patient's own neuroelectrophysiology, such as β wave and other biological markers, and then adjusts the relevant parameters of the pulse generator in real time, finally realizing adaptive neuroregulation. Based on the recent research progress of closed-loop deep brain stimulation, the biological mechanism, working principle and clinical application of closed-loop deep brain stimulation in Parkinson's disease were reviewed in detail, and related thoughts and prospects were put forward.

Hemorrhagic stroke of intracranial benign tumor is different from the slow onset of general benign tumor. Its clinical manifestations and imaging changes are similar to those of acute hemorrhagic cerebrovascular disease, which is easy to be misdiagnosed and affects the treatment. At present, the research on the pathogenesis of hemorrhagic stroke in brain tumors mainly focuses on intracranial malignant tumors, while the discussion on the pathogenesis of hemorrhagic stroke in benign intracranial tumors is still mainly in the stage of clinical speculation, and the research results are inconsistent. This article reviews the recent clinical and basic research progress on the pathogenesis of hemorrhagic stroke caused by benign intracranial tumors.

Ruptured intracranial cerebral arteriovenous malformation is a common cause of intracranial hemorrhage, which is common in young adults. In addition to intracranial hemorrhage, its common symptoms include epilepsy, headache, etc. The main treatment modes are craniotomy, microsurgical resection, endovascular therapy, stereotactic radiotherapy and combination therapy. Based on the 2017 edition of the scientific statement of "Treatment of Intracranial Arteriovenous Malformations", combined with the 2001 edition of the scientific statement of the treatment of intracranial arteriovenous malformations, the 2015 "Treatment Guidelines for Spontaneous Cerebral Hemorrhage" and the latest related literature, this article explains the classification and treatment of ruptured intracranial arteriovenous malformations in detail, and provides a reference for the clinical treatment plan of intracranial arteriovenous malformations.

I was shocked to learn that my best friend, Professor Takakura, had passed away, and I felt very sad in my heart.