Volume 35 · Issue 08 · 2019

Pediatric neurosurgery is an independent discipline with a complete system. In the past forty years, great progress has been made from clinical practice to basic research, especially in the diagnosis and treatment of childhood brain tumors. However, there are still many areas worthy of attention and improvement in pediatric neurosurgery in China, so we should pay attention to the construction and development of pediatric neurosurgery in China, vigorously build the talent echelon of pediatric neurosurgery, attach importance to the development of basic and clinical research, and improve the diagnosis and treatment level of pediatric intracranial diseases, so as to benefit the majority of children.

Traumatic craniocerebral injury is the damage of mechanical force to the various components of the head, which leads to different degrees and types of clinical outcomes. Refined management of craniocerebral injury is one of the ways to improve the prognosis of patients^[1]。 The cranial cavity structure is a close rigid space composed of the skull. Its contents mainly include brain tissue, blood and cerebrospinal fluid. Under normal physiological conditions, there is volume compensation between each part to maintain intracranial pressure and blood supply stability, which is the basic guarantee for maintaining normal brain function state^[2]。 The pathophysiological process of severe craniocerebral trauma includes the dynamic changes of cerebrospinal fluid, and it is closely related to the management of cerebrospinal fluid in many links of clinical management of severe craniocerebral trauma. Based on this, this expert group discussed and wrote this consensus.

To investigate the treatment and prognosis of intracranial ependymoma in children.

The clinical data of 48 children with intracranial ependymoma who were first diagnosed and treated at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from September 2012 to September 2016 were retrospectively analyzed. The tumors were solitary in 48 patients, including under-tentorial tumors in 34 cases and supratentorial tumors in 14 cases. All patients underwent surgical resection, adjuvant radiotherapy and/or chemotherapy, and regular outpatient and telephone follow-up. Kaplan-Meier method was used to analyze the survival rate of patients, and Cox regression analysis was used to explore the influencing factors of survival.

Of the 48 patients, 31 achieved gross total resection at the first operation and 17 received subtotal resection. Postoperative pathological results showed that classical ependymomas (WHO grade Ⅱ) was in 4 cases, anaplastic ependymomas (WHO grade Ⅲ) in 26 cases, and partial anaplastic ependymomas (between WHO grade Ⅱ and Ⅲ) in 18 cases. Postoperative local recurrence occurred in 21 cases, of which 20 cases underwent reoperation. 7 cases developed local recurrence with distant dissemination, of which 4 cases underwent reoperation. Of 48 patients, radiotherapy were performed in 46 cases/times and chemotherapy in 42 patients/times after operation. 2 cases died of hydrocephalus and 14 cases died of recurrence of tumors. The follow-up time of 48 patients ranged from 5 to 68 months, with a median of 34 months. The 3-year progression-free survival rate and overall survival rate were 29.3% and 70.8% respectively. The 3-year overall survival rate of 28 patients with recurrence was 62.1%. Univariate analysis showed that for children with ependymoma, the degree of first surgical excision was a factor affecting progression free survival(P=0.027). The age of diagnosis, the location of the tumors and the degree of last surgical excision might be the influencing factors of overall survival in patients with ependymoma (all P<0.05). Multivariate analysis showed that the degree of resection (RR=3.568, 95%CI: 1.638-7.775, P=0.001) was an independent factor affecting the survival time of patients.

Surgical resection is still the most important treatment for children with ependymoma. The degree of tumor resection is related to survival outcomes.

To explore the clinical outcome and value of prophylactic operation of asymptomatic spinal lipomas in children.

We retrospectively analyzed the clinical data of 168 patients with asymptomatic spinal lipomas who underwent prophylactic operation from April 2001 to June 2015 at Department of Neurosurgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University. Those patients (with an average age of 7 months) aged from 1.5 months to 15 years old were free of preoperative symptoms such as pain, gatism and/or bilateral lower limb dysfunction. Surgical protocols included removal of the lipomas in subcutaneous and extramedullary tissues, complete excision of extraspinal lipomas, subtotal resection of intraspinal fat, detaching of the medullary cones from dura sac and release of the tethered cord.

In 168 patients, complete resection was achieved for the dorsal spinal lipoma(132 patients) and subtotal resection was undertaken for the lateral type and the wrapped lipoma(36 patients). Five cases developed cerebrospinal fluid leakage that caused subcutaneous effusion after surgery, which resolved following multiple punctures and pressure dressing. Six patients had slight gatism. Among them, 5 recovered in 1 month and 1 had no relief of symptoms. In this series, 159 out of 168 cases were successfully followed up for 3-19 years (with an average of 76 months). Long-term postoperative symptoms were observed in 13 patients, with an incidence of 8.2%. Twelve patients of them had spinal cord retethering and 1 had lipoma enlargement.

Prophylactic surgery could lead to favorable outcomes in children with asymptomatic spinal lipomas and help prevent neurologic dysfunction in the future.

To investigate the treatment and prognosis of primary pediatric intracranial nongerminomatous malignant germ cell tumors(NGMGCTs).

A total of 43 children with primary intracranial NGMGCTs who underwent tumor resection at Department of Pediatric Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2006 to March 2019 were enrolled. Only 35 cases received adjuvant chemotherapy and/or radiotherapy.The clinical and imaging follow-up were performed after operation. Kaplan-Meier method and multiple Cox regression analysis were used to analyze influencing factors of overall survival (OS) and progression-free survival (PFS).

Of 34 patients, total resection were achieved in 23 cases (53.5%), subtotal resection in 14 cases (32.6%) and partial resection in 6 cases(13.9%). The median PFS of patients with immmature teratomas, mixed germ cell tumors and yolk sac tumors were 4.86 years, 4.24 years and 0.79 years, respectively(P=0.002). The median OS of patients with immmature teratomas, mixed germ cell tumors and yolk sac tumors were 6.68 years, 5.88 years and 1.03 years, respectively(P<0.001). One patient with choriocarcinoma died of perioperative complication, the other died of postoperative recurrence. Cox regression analysis showed that pathology(HR: 0.26, 95%CI: 0.05-1.28, P=0.010), serum AFP(HR: 0.06, 95%CI: 0.01-0.55, P=0.013) and complete adjuvant therapy(HR: 3.38, 95%CI: 0.99-11.56, P=0.050)are influencing factors of OS in patients with NGMGCTs, while complete adjuvant therapy(HR: 4.72, 95%CI: 1.54-14.47, P=0.007) and pathology(HR: 0.62, 95%CI: 0.19-2.05, P=0.010) was associated with PFS.

For NGMGCTs, the prognosis of immature teratoma and mixed germ cell tumors were the best, followed by yolk sac tumors, while choriocarcinoma was the worst.NGMGCTs patients were treated with surgery and adjuvant chemotherapy and/or radiotherapy.The prognosis of NGMGCTs was associated with pathology.Complete postoperative adjuvant therapy may improve the prognosis of primary pediatric NGMGCTs, while serum AFP>100 ng/ml may predict poor outcome.

To explore the clinical manifestation of children with different QST classification of craniopharyngioma (CP) and its role in prognosis.

We retrospectively analyzed 149 children with CP who underwent surgery at Department of Neurosurgery, Nanfang Hospital of Southern Medical University from December 1998 to December 2015. Of those, 70 (47.0%) children underwent operation through frontal base approach, 46 (30.9%) through pterional approach and 33 (22.1%) through transsphenoidal approach for tumor removal. All patients underwent clinical follow-up after surgery, including MRI review of the sellar region to determine the tumor resection and recurrence, and measurement of relevant indicators to assess the prognosis. All 149 children were classified according to the QST classification criteria, and the differences in clinical characteristics of different types of children were analyzed. Furthermore, multivariate logistic regression analysis was used to determine the clinical factors affecting the prognosis of children.

All children in this series underwent successful operation and 138 (92.6%) out of those had total resection and 11 (7.4%) had subtotal resection. The median follow-up duration of 149 patients was 87 months (range: 11-236 months). Good outcomes were reported in 134 patients and poor outcome in 15. In this study, 91 patients were type Q (Q-group), 14 were type S (S-group) and 44 were type T (T-group) according to the QST classification criteria. There were no significant differences in age, gender, maximum diameter, tumor calcification degree, degree of tumor resection and tumor recurrence between the 3 groups (all P>0.05), while the clinical symptoms, incidence of hydrocephalus, pre- and post-operative pituitary function, operation approach and pathological types were significantly different in patients with different QST classifications among 149 children with CP (allP<0.05). The T-type was more often associated with hydrocephalus, the Q-type was more prone to have abnormal pituitary function, and the S-type was more likely to have vision and visual field damage. Multivariate logistic regression analysis showed that QST classification(OR=5.984, 95%CI: 1.529-23.417, P=0.037) and degree of tumor resection(OR=8.220, 95%CI: 2.158-31.318, P=0.002) were independent prognostic factor in children with CP.

The clinical characteristics of children with different QST classification of craniopharyngioma are different, and QST classification is one of the independent risk factors affecting the prognosis of children with craniopharyngioma.

To investigate the therapeutic effect of low-dose cisplatin combined with etoposide on low-grade glioma in the sellar region of children with diencephalic syndrome.

The clinical characteristics, treatment and outcomes of 4 children with diencephalic syndrome secondary to low-grade glioma in the sellar region were retrospectively analyzed who were admitted to Department of Neurosurgery, Children's Hospital of Fudan University from January 2015 to December 2017. Of 4 cases, 2 were females and 2 were males. The range of age was 6 months to 34 months, with the median age of 16 months. One case with severe hydrocephalus was treated with ventriculoperitoneal shunt surgery. Surgical biopsy or resection was not performed in this series. Low doses of cisplatin (1 mg·kg^-1·d^-1 d0-d2) and etoposide (5 mg·kg^-1·d^-1, d0-d2) were used for 10 cycles of chemotherapy to observe the clinical effect.

All cases successfully completed chemotherapy and no obvious side effects of chemotherapy were reported. Follow-up post chemotherapy lasted for 6 to 20 months (with the median duration of 12 months). The clinical symptoms were better than before and the weight was about 29.3%-50.0% higher than before. The starting time to gain weight was 3 to 12 months after the initiation of chemotherapy (with the median duration of 7 months). There was no progress in the review of cranial MRI saddle area in 2 cases, tumor reduction in 1, substance decrease in 1, disappearance of cisterna ambiens lesion in 1 and disappearance of the fourth ventricular lesion in 1. There was no significant change in hormone level compared with conditions prior to chemotherapy. One case gained weight at 1 year post chemotherapy and presented good clinical performance. Partial resection of tumor was performed. Its final pathological result was pilocytic astrocytoma (WHO Ⅰ) and further radiotherapy was administered.

The chemotherapy regimen of low-dose cisplatin combined with etoposide seems to have a good effect which was to improve the clinical symptoms and postpone the tumor progression of children with diencephalic syndrome secondary to low-grade gliomas in the sellar region.

To analyze the clinical characteristics and surgical outcomes of neurofibromatosis (NF) in children.

A total of 18 NF children who underwent tumor resection and were confirmed by pathological examination at Department of Neurosurgery, Xijing Hospital, Air Force Military Medical University from January 2007 to March 2019 were retrospectively analyzed. Their ages ranged from 3 to 18 years. Among them, 17 cases were NF Ⅰ and 1 was NF Ⅱ. Two cases had positive family history. Clinical manifestations at admission included milky coffee spots in 15 cases, subcutaneous nodules in 14, limb numbness in 4, visual impairment in 4, bone invasion in 2 and lumbar meningocele associated with tethered cord (tumor was identified during lysis and reconstructive operation) in 1. There were 4 cases who suffered from intracranial tumors [parafalx in 1 case, cranio-orbital communication in 2 and bilateral cerebellopontine angles (CPA) in 1] and 4 having intraspinal tumors. For patients with local compression symptoms, progressive enlargement of the tumors, or biopsy purpose, palliative tumor resection was performed and surgical outcomes were followed up.

Among 18 cases, early symptoms disappeared in 10 cases, were relieved in 3, and had no change in visual acuity in 4 (the same as preoperative conditions). Left hearing loss in the child with bilateral CPA tumors became severer than preoperative conditions due to left tumor resection. The follow-up duration was 2 to 143 months with an average of 74±37 months. Follow-up indicated a recurrence in 4 cases in the original surgical area (subcutaneous in 3 and CPA in 1), and a new subcutaneous lesion in 2 cases on body surface (neck in 1 and chest in 1). The 4 patients with intraspinal tumors recovered well without recurrence. Pathological results showed that Ki-67 positive cell index accounted for 1-8%.

Type NF Ⅰ is more common than NF type Ⅱ in children and often combined with multi-system tumors. Subcutaneous and CPA tumors tend to recur even after surgical resection. Palliative surgical decision should be made in order for the patients to maintain a satisfactory life quality.

To explore the relationship between post-circulatory lesions and cerebral infarction in children with ischemic moyamoya disease (MMD).

A total of 44 children with ischemic MMD who were admitted to Department of Neurosurgery, Tianjin Medical University General Hospital from January 2010 to December 2018 were retrospectively enrolled into this study. All of them were divided into cerebral infarction group (15 cases) and non-cerebral infarction group (29 cases) according to whether they had cerebral infarction or not. Three cases were treated with encephalo-myosynangiosis (EMS), 5 cases with superficial temporal artery-middle cerebral artery anastomosis bypass (STA-MCA bypass) and 36 cases with EMS+ STA-MCA. All children were followed up by outpatient visits or telephone and were asked about the improvement of clinical symptoms and whether there were any cerebral infarction events. The outcome was assessed by the modified Rankin scale score (mRS). The clinical efficacy was compared between the 2 groups of children. The clinical factors affecting the children with cerebral infarction were further analyzed by single factor and multiple factor logistic regression.

All 44 patients underwent successful operation. Postoperative complications occurred in 12 cases (27.3%, 12/44). There was no statistically significant difference in the incidence of complications between 2 groups [40.0% (6/15) vs. 28.7% (6/29), P=0.615]. The follow-up duration of 44 cases was 7.2±1.5 months (6-12 months). During the follow-up period, none of the children had cerebral infarction. Among the 44 cases, 35 (79.5%) had good outcomes and 9 (20.5%) had poor outcomes. There was no statistically significant difference in the favorable prognosis rate between the 2 groups [66.7% (10/15) vs. 86.3% (25/29), P=0.130]. Single factor analysis showed that MCA stenosis, PCA (posterior cerebral artery) stenosis and transient ischemic attack before operation were the influencing factors of cerebral infarction in children (all P < 0.05). Further multiple factor analysis showed that PCA stenosis was an independent risk factor for cerebral infarction in children ( OR=5.465, 95% CI: 1.224-24.400, P=0.026).

In children with ischemic MMD, PCA stenosis is an independent risk factors for cerebral infarction, and whether there is cerebral infarction has no significant effect on the prognosis of those children.

To investigate the clinical characteristics and surgical outcomes of dermoid cysts of scalp and skull in children.

From July 2017 to July 2018, 121 children with dermoid cysts were admitted to Department of Neurosurgery, Children's Hospital Affiliated to Nanjing Medical University. The pathological findings showed that they accounted for 50.4% (121/240) of the patients with scalp and skull tumors treated during the same period. Among them, 72.7% (88/121) were less than 3 years old. Among them, 45 cases were located on the scalp and 76 cases had invasion on the skull (superficially compression in 16 cases, partially compression in 37 and full-thickness compression in 23).

There was no significant difference in sex and age distribution between scalp group and skull group (both P>0.05). Among 45 cases of scalp group, 42 (93.3%) cases were located in the skull plate, 3 (6.7%) in the suture, while in 76 cases of skull group, 51 (67.1%) were located in the skull plate and 25 (32.9%) in the suture. The difference was significant (P<0.01). Among 76 cases of skull group, 53 cases had partial invasion on the skull and 23 had penetration of the skull. In 46 (86.8%) cases with partial skull invasion, the lesion was located in the skull plate in 7 (13.2%) cases, 5 (21.7%) cases had the lesion in the skull plate and 18 (78.3%) had the lesion in the skull suture (P<0.01). A total of 121 lesions were completely removed in 121 children. No operative complications occurred. Follow-up for 3 to 15 months showed no recurrence.

Dermoid cyst is a common mass of scalp and skull in children. The incidence of dermoid cyst in young children seems high. The lesions may be confined to the scalp or penetrate various levels of the skull. The lesions located at the suture are more likely to invade and penetrate the skull. Early surgical treatment could achieve good results.

To explore the surgical treatment and outcomes of temporal lobe epilepsy in children.

A retrospective analysis was conducted on 21 children with temporal lobe epilepsy admitted to Department of Neurosurgery, Children's Hospital Affiliated to Capital Institute of Pediatrics from September 2016 to June 2018. Individualized surgical treatment plan was formulated according to the semeiology, imaging and electroneurophysiological findings of the children. Standard anterior temporal lobectomy was undergone in 13 cases, enlarged resection of temporal lobe lesion in 3, selective hippocampal amygdala resection in 2, simple resection of medial temporal lobe lesion in 1, vascular malformation resection in 1, and anterior temporal lobe resection plus frontal lobe nodule resection in 1. All patients were followed up clinically after operation. The follow-up included cranial MRI, electroencephalogram and Engle rating.

All 21 patients underwent successful operation. No serious complications occurred after surgery. The pathological results were mixed neuronal-glial tumor in 14 cases, pleomorphic xanthoastrocytoma in 1, hippocampal sclerosis in 3, focal cortical dysplasia IIb in 1, tuberous sclerosis in 1, and cerebral arteriovenous malformation in 1. The follow-up duration of 21 patients was 18.0±5.9 months (9-30 months). A review of head MRI showed that all tumors were completely resected and no recurrence was seen of the patients with tumor. A review of the EEG showed that there was still a large amount of epileptic discharges in the temporal lobe of 1 patient, and the epileptic discharges of the remaining 20 cases were significantly reduced or disappeared compared with preoperative conditions. Eighteen patients were followed up for more than 12 months. Up to the last follow-up, 17 cases were classified as Engle Ⅰ and 1 as Engle Ⅳ.

Individualized surgical procedures based on comprehensive assessment of the semeiology, imaging and electroneurophysiology of children with temporal lobe epilepsy could lead to good outcomes.

To explore the differences of brain cognitive function and behavior in children with craniopharyngioma during perioperative period.

The clinical data of 19 patients with craniopharyngioma were retrospectively enrolled who underwent craniotomy at Department of Neurosurgery, Tsinghua University Yuquan Hospital from February 2015 to February 2017. The mean age of patients was 9.10±3.53 (6-15) years old. Twelve cases were primary tumors and 7 were recurrent tumors. Craniotomy was conducted for tumor resection in all patients. Fourteen cases were treated through frontal coronal incision approach, 3 through corpus callosum -transparent compartment-dome approach and 2 through small incision of pterional approach. The intelligence test was performed using the fourth edition of the Wechsler Intelligence Test Scale before and after surgery. The Conners Child Behavior Scale (for parents) was used for behavioral testing. The cognitive function and behavioral changes of the brain in 19 children with craniopharyngioma before and 2 weeks after operation were compared.

Among the 19 children with craniopharyngiomas, total tumor resection was achieved in 17 cases and subtotal resection in 2. There was no operative death. The preoperative and postoperative total IQ (intelligence quotient) scores (101.68±18.50 vs. 103.05±15.67), verbal comprehension indexes(98.00±13.51 vs. 101.00±17.07), perceptual reasoning indexes (94.11±12.60 vs. 95.26±15.05), working memory indexes (87.00±14.15 vs. 92.16±19.12), processing speed indexes (92.95±17.17 vs. 95.47±16.91) had no significant difference (all P>0.05). There were no significant differences in behavior scores of the children before and 2 weeks after operation (allP>0.05).

There seems to be no significant decrease in postoperative intelligence and behavioral level in children with craniopharyngioma. It shows that the surgical resection itself would not cause damage to the cognitive function of the child.

To explore the role of diffusion tensor imaging (DTI) in brainstem glioma surgery.

A retrospective analysis was performed on 57 patients with brainstem gliomas who had undertaken surgery from January 2014 to December 2018 at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University. All patients underwent preoperative DTI and tumor resection with the assistance of neuronavigation and electrophysiological monitoring. Radiological and clinical data were collected, including conventional MRI and DTI, corticospinal tract (CST) score, tumor-to-CST distance (TCD), muscle strength and Karnofsky performance status (KPS) before and after surgery. Kruskal-Wallis H test was used to evaluate postoperative motor deficit and KPS of patients with different CST scores. Spearman's correlation was performed to assess the relationship of both CST score and TCD with postoperative motor deficits and KPS, respectively. Multiple linear regression was used to investigate the influence of CST score and TCD on postoperative muscle strength and KPS.

Among the 57 patients, 51 patients had at least one CST compromised. The most common changes of the CST were deviation (30/114, 26.3%) and deformation (30/114, 26.3%). The surgical approaches were adjusted after evaluation of the DTI results in 21 (36.8%) cases. Postoperative muscle strength and KPS were significantly different between different CST score groups (χ²=16.011; χ²=9.576, all P<0.05). Preoperative CST scores were negatively correlated with postoperative muscle strength and KPS (r=-0.362; r=-0.354, both P<0.05) whereas TCD had positive correlation with both postoperative muscle strength and KPS (r=0.305, r=0.339, both P<0.05). CST score could independently influence postoperative muscle strength (t=-2.438, P=0.016). However, CST score could not independently influence postoperative KPS (t=-0.523, P=0.603).

DTI plays an important role in surgical management of brainstem gliomas and could help optimize the surgical strategy and predict postoperative motor deficits.

To discuss about the classification of Chiari Ⅰ malformation based on different CSF (cerebrospinal fluid) flow patterns at the cranial-vertebral junction (CVJ) and to investigate its surgical strategies and outcomes.

A total of 126 patients with Chiari Ⅰ malformation were admitted to Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University from January 2008 to December 2015 and retrospectively enrolled into this study. According to the preoperative findings obtained by using cine phase-contrast MRI (cine PC-MRI) and based on the abnormal CSF flow dynamics at the CVJ, all those patients of Chiari Ⅰ malformation were classified into 3 patterns: type Ⅰ (36 cases), type Ⅱ (48 cases) and type Ⅲ (42 cases). Intraoperative ultrasound to detect cerebrospinal fluid again determined the surgical strategy. In type Ⅰ patients, 34 patients underwent subdural decompression, and the remaining 2 patients underwent subarachnoid decompression due to cerebrospinal fluid obstruction. In type Ⅱ patients, 36 patients underwent subarachnoid decompression and the remaining 12 cases underwent subdural decompression. In type Ⅲ patients, 40 cases underwent subarachnoid decompression, and the remaining 2 cases underwent subdural decompression due to unobstructed cerebrospinal fluid flow. Two weeks after surgery, the patients underwent an imaging review and assessment based on cervical spine modified Japanese Orthopaedic Association (mJOA) score. All patients underwent clinical follow-up. The follow-up included the use of the cervical spine mJOA score to assess the improvement of syringomyelia-related symptoms. The Chicago Chiari Outcome Scale (CCOS) was used to assess postoperative neurological recovery.

All 126 patients had successful surgery. There were no cases of new neurological deficits after operation. Eight cases (6.3%) had fever, and 5 cases (4.0%) had cerebrospinal fluid leakage, which improved after symptomatic treatment. Two weeks after surgery, imaging examination showed that there was no significant improvement in syringomyelia in 2 patients (type Ⅲ, subarachnoid decompression). Further improvement of symptoms was observed after syringomyelia-thoracic shunt. The mJOA score was improved compared with preoperative conditions (12.7±2.0 vs. 10.7±1.6, P<0.01). The follow-up time of 126 patients was 24.8 ± 10.9 months (12 to 96 months). At the last follow-up, the cervial spine mJOA scores of 126 patients were significantly higher than those before surgery (12.8±1.9vs. 10.7±1.6, P<0.01), but there was no significant difference when compared with two weeks after surgery (P=0.48). There was no significant difference in CCOS score compared with 2 weeks post surgery (14.7±1.5 vs. 14.4±1.5, P=0.576).

Chiari malformation type Ⅰ could be classified into 3 subtypes according to cerebrospinal fluid dynamic abnormalities in the cranial-cervical junction area. Type Ⅰ is suitable for subdural decompression and type Ⅲ for subarachnoid decompression. In type Ⅱ, specific decompression methods could be chosen based on intraoperative ultrasound through bone window after craniectomy. The postoperative results seem good.

To investigate the predictive value of preoperative facial nerve F wave in postoperative facial paralysis following acoustic neuroma surgery.

A retrospective analysis was conducted on 37 patients with unilateral cerebellopontine angle acoustic neuroma without facial paralysis admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2016 to January 2017. The latency parameters of facial nerve F wave in healthy and affected sides were measured before operation. Facial nerve function was evaluated based on the House-Brackmann (H-B) grading system at 12 months post surgery. Patients with Grade Ⅲ-Ⅵ were categorized into postoperative facial paralysis group (8 cases) and those with Grade Ⅰ was classified as postoperative non-facial paralysis group (29 cases). The preoperative F wave latency, F-M wave latency, F wave side-to-side difference, and F-M wave side-to-side difference were compared between the 2 groups. The operating characteristic curve (ROC) was plotted and the area under the curve (AUC) was calculated to evaluate the predictive value of F wave of facial nerve before operation in postoperative facial paralysis.

The latency of F wave and F-M wave on the affected side was longer than that on the affected side (both P<0.05). The latencies of F wave and F-M wave on the affected side in the facial paralysis group were longer than that in the non-facial paralysis group (bothP<0.05), and the latencies of F wave and F-M wave side-to-side difference in the facial paralysis group were larger than those in the non-facial paralysis group (bothP<0.05). The preoperative F-wave latency, F-M wave latency, F-wave latency side-to-side difference and F-M wave latency side-to-side difference could be used to predict the H-B grade of facial nerve after operation (AUC: 0.813, 0.920, 0.793 and 0.996, respectively, allP<0.05).

The latency and latency side-to-side difference of F wave and F-M wave of preoperative facial nerve in patients with acoustic neuroma seem to be able to predict the risk of postoperative facial paralysis.

To evaluate the safety and efficacy of LVIS stent in endovascular emblization of unruptured wide-neck intracranial aneurysms.

From November 2014 to October 2017, the consecutive data were collected from 157 patients with 164 unruptured wide-neck intracranial aneurysms admitted to Department of Neurosurgery, People’s Hospital of Zhengzhou University.152 aneurysms were treated with single LVIS-assisted coil embolization and 12 with double LVIS stents. All patients were followed up , including digital subtraction angiography (DSA) and Raymond grading. Survival status was inquired by telephone and improved Rankin scale score (mRS).

Successful placement of the LVIS was obtained in all cases. Immediate Raymond Ⅰembolization was observed in 76.2% (n=125), Raymond Ⅱ embolization in 17.7% (n=29) and Raymond Ⅲembolization in 6.1% (n=10). Postoperative headache occurred in 2 patients, cerebral hemorrhage was confirmed by CT scan, and symptoms improved after medical treatment. Severe neurological complications occurred in 2 patients, but no symptoms improvement after medical treatment. Of the 157 patients, 103 were clinic followed up for (6±4.5) months (3-12 months). There were 105 aneurysms in 103 patients, of which 89 (84.8%) were Raymond I, 13 (12.3%) were Raymond II and 3 (2.9%) were Raymond III. 152 cases were followed up by telephone. The follow-up time was (9±2.2) months (6-12 months). During the follow-up period, 1 case died, and the rest 151 cases had a mRS score of 0 points in 149 cases, 1 point in 1 case and 5 points in 1 case.

LVIS stent assisted coil embolization is a safe procedure for the treatment of unruptured intracranial aneurysms. The immediate and long-term complete embolization results are ideal.

To investigate the role of lateral spread response (LSR) in differentiation of hemifacial spasm caused by Bell's palsy, compression of the nerve by blood vessels, tumors in the brainstem or its surrounding areas.

We retrospectively analyzed 128 patients who had LSR examination at Neuroelectrophysiological Center of Guizhou Provincial People's Hospital from January 2010 to December 2017. The patients were divided into group with hemifacial spasm caused by Bell's palsy (Bell's palsy group,n=37), group with hemifacial spasm due to intracranial blood vessel compression (vascular compression group, n=69) and group with tumors in the brainstem or its surrounding areas (n=22, mild facial spasm in 5 cases) according to surgical confirmation, brain MRI findings and case history. Electromyography, bilateral nerve conduction velocity and LSR examination were performed in all patients.

Decreased conduction velocity of facial nerve was observed in 5 cases in Bell's palsy group. A little denervation potential was seen in 3 cases in this group. No abnormalities were observed in the all examined muscles of the other patients. LSR was induced on the affected side in 37 cases with Bell's palsy and 69 cases with vascular compression. The positive rate was 100.0%. LSR waves were induced on ipsilateral side of the lesion in 10 cases (45.4%, including 5 facial spasm patients) and on both sides in 3 cases among 22 cases in group with tumors in the brainstem and its surrounding areas. The LSR latent periods were 6.4±2.3 ms, 10.6±3.7 ms and 16.4±5.1 ms in Bell's palsy group, vascular compression group and group with tumors in the brainstem and its surrounding areas, respectively(P<0.01).

LSR could be induced in patients with hemifacial spasm by various causes, which could be present in patients with tumors in the brainstem and its surrounding areas having no clinical manifestations of facial spasm. LSR test might help distinguish the etiology of hemifacial spasm and suggest that there may be tumors in the brainstem and its surrounding areas.

This study aimed to analyze the prognosis of patients with giant cavernous sinus cavernous hemangioma (CSH) treated with gamma knife (GKS) fractionation. Fourteen patients with giant CSH with complete follow-up data (median volume of CSH was 56.3 cm) who underwent GKS fractionation treatment at the Gamma Knife Treatment Center of the Fifth Affiliated Hospital of Zhengzhou University from October 2011 to June 2016 were retrospectively enrolled³), and summarized its treatment plan and clinical follow-up data. After GKS fractionation treatment, the tumor volume of 14 patients was significantly reduced, and the symptoms before treatment were significantly improved or disappeared. No treatment-related complications were observed.

To evaluate the correlation between YKL-40 expression and diagnosis and prognosis of gliomas.

The literature on the relationship between YKL-40 expression and the diagnosis and prognosis of glioma patients from database establishment to March 2018 was searched in PubMed/Medline, Web of Science, Cochrane Library, Google Scholar, Wanfang and China Knowledge Network. Two reviewers independently screened, evaluated and extracted the data. Meta-analysis was conducted on the data using RevMan 5.3 software.

A total of 10 articles were included in the analysis and involved 1 002 patients, all of which showed no significant publication bias. Meta-analysis showed that the levels of YKL-40 in blood of patients with different grades of gliomas were higher than those in healthy people (MD=50.48, 95% CI: 28.68-72.29, P<0.001). Further subgroup analysis showed that the patient nationality was the main source of heterogeneity, and the difference in blood YKL-40 concentration in patients with different grades of gliomas had statistical significance (P<0.05). The overall survival of patients in YKL-40 low expression group was longer than that in YKL-40 high expression group (HR=1.44, 95% CI: 0.98-1.30, P<0.001). There was no significant difference in the progression free survival time between the YKL-40 low expression and high expression groups (HR=1.13, 95% CI: 0.98-1.30, P=0.09).

YKL-40 may be a potential molecular marker for the diagnosis of gliomas. The expression of YKL-40 is negatively correlated with the overall survival of glioma patients.

Nasal glioma is an abnormal glial tissue that grows outside the central nervous system. It is a rare congenital developmental abnormality, which is benign and is more common in infants and young children. In May 2018, a child with nasal glioma was treated with percutaneous neuroendoscopic resection in the Department of Neurosurgery, Tangdu Hospital, Air Force Medical University. After 3 months of follow-up, the tumor did not relapse, the incision healed well, and the facial appearance was not significantly affected.

Surgical treatment is the treatment of choice for patients with symptomatic or recurrent chronic subdural hematoma (cSDH), and most patients can be cured. However, in patients with advanced age, brain atrophy, postoperative intracranial pneumatosis, and long-term anticoagulant or antiplatelet aggregation drugs, the probability of postoperative recurrence is still high even after multiple surgical treatments. The Department of Neurosurgery, Affiliated Hospital of Binzhou Medical College, treated a patient with cSDH with recurrence after trauma by coil embolization of middle meningeal artery combined with intracranial hematoma drilling and drainage. CT showed a decrease in hematoma volume and no recurrence 1 month after operation.

With the successful application of vagus nerve stimulation (VNS) in a variety of diseases, its cognitive impact has also been increasingly concerned. Recent studies on refractory epilepsy, Alzheimer's disease and depression have shown that VNS has the effect of maintaining cognitive stability, and even has a certain degree of improvement on different aspects of cognition in some patients. At present, the mechanism of VNS on cognition is still unclear. At present, the research mainly focuses on inflammation, neurotransmitters and the function of brain nuclei, among which the nucleus tractus solitarius, macula coerulea and norepinephrine play an important role.

Patients with glioma are often accompanied by episodic abnormalities (including mood, fatigue, sleep disorders and cognitive impairment, etc.), but their clinical characteristics and related pathogenesis are still unclear. The latest research has found that inflammation may be the main cause of the occurrence and development of behavioral symptoms. The dysregulation of hypothalamic pituitary adrenal axis-inflammatory signal leads to abnormal activation of various inflammatory factors, which is closely related to the occurrence and development of behavioral symptoms in patients. This article reviews the epidemiology of common behavioral symptoms in patients with glioma and the interconnection of hypothalamic pituitary adrenal axis-inflammatory signaling dysregulation and possible regulatory mechanisms.

CRISPR/Cas9 is a novel gene editing technology developed based on the resistance of bacteria and archaea to exogenous phages and nucleic acids. It can realize site-directed modification at the base level of the genome and accurately complete the recognition and editing of exogenous DNA. The system has the characteristics of high efficiency, simple operation and low cytotoxicity, which can provide a new method for the study of related genes of glioma and better service for clinical diagnosis and treatment. In this paper, the molecular mechanism of CRISPR/Cas9 technology and its research progress in glioma are reviewed.