Volume 36 · Issue 02 · 2020

Throughout the development history of brain science, the exploration of brain motor function has always been at the forefront of brain science research. With the progress of brain science, the understanding of the carriers and mechanisms of the generation and conduction of brain motor functions in academic circles is also constantly innovating, such as from cortex to subcortical structure, from simple connection to complex functional network. At present, the application of multimodal brain function localization and protection technology in neurosurgery not only promotes the in-depth understanding of brain motor function, but also helps to gradually break the surgical barrier of motor function area lesions. Looking into the future, comprehensively analyzing the nature of brain motor function network and vigorously developing neurosurgical auxiliary technology will surely open a new chapter for the development of brain motor function research and brain function protection in neurosurgery.

With the emergence and development of new ideas and new technologies, the indications, techniques and treatment strategies of cerebral vascular bypass grafting have also changed significantly. In order to further guide the clinical practice, this article combines the recent advances of cerebral vascular bypass technology in recent years, and makes a multi-center summary of its main techniques and strategies. Among them, it emphasizes the classification, preoperative preparation, intraoperative management, common bypass methods and postoperative management of cerebral vascular bypass surgery, and briefly summarizes the commonly used methods of superficial temporal artery bypass and internal maxillary artery bypass.

To explore the clinical characteristics and prognostic factors of insular glioblastomas.

Clinical data of 44 patients with insular glioblastomas in Chinese Glioma Genome Atlas(CGGA) databases from July 2006 to June 2013 were evaluated. All patients underwent tumor resection. Among them, 27 underwent adjuvant radiochemotherapy and 17 underwent no postoperative adjuvant therapy. Progression-free survival (PFS) and overall survival (OS) of all patients were analyzed by Kaplan-Meier method. Furthermore, multivariate Cox regression analysis was used to investigate the prognostic clinical factors.

In a total of 44 patients, 33 (75.0%) had a history of epileptic seizure, 11 (25.0%) had isocitrate dehydrogenase 1 (IDH1) mutation, 19 (43.2%) had O⁶-methy-lguanine-DNA-methyltransferase (MGMT) methylation, and 42 (95.5%) had tumor enhancement.Based on Yasargil′s classification, there were type 3A in 2 cases, type 3B in 27 cases and type 5A/B in 15 cases. Based on Saito′s classification, there were 2 cases confined to the insular cortex, 9 cases with invasion to the frontal lobe via the anterior circumferential sulcus, 16 cases with invasion to the temporal lobe via the lower circumferential sulcus, and 17 cases with invasion to multiple directions via more than 2 circumferential sulci. Based on Moshe′s classification, there were 35 cases with envelopment or invasion of the lenticulostriate artery, while no invasion was reported in the remaining 9 cases. Based on the putamen classification, there were 38 cases with various degrees of putamen invasion, and the remaining 6 cases had no involvement of the putamen. Kaplan-Meier curve showed that the median PFS of all patients was 278 d and the median OS was 435 d. Multivariate Cox regression analysis showed that tumor volume < median ( HR = 0.390, 95% CI: 0.189-0.802, P=0.011), IDH1 mutation (HR=0.391, 95% CI: 0.175-0.876, P=0.023) and postoperative radiochemotherapy (HR=0.346, 95% CI: 0.162-0.738, P=0.006) were independent protective factors for PFS. However, MGMT methylation (HR=0.371, 95% CI: 0.181-0.758, P=0.007), tumor resection degree ≥90% (HR=0.412, 95% CI: 0.194-0.875, P=0.021) and postoperative radiochemotherapy (HR=0.347, 95% CI: 0.170-0.708, P=0.004) were independent protective factors for OS.

Clinical characteristics of insula glioblastomas include relatively lower incidence, stronger invasiveness, lower total resection ratio and poorer prognosis. Maximum resection and standard postoperative radiochemotherapy may lead to a better outcome.

To investigate language mapping and surgical efficacy of multimodal techniques combined with awake anesthesia for gliomas involving Broca′s area.

A total of 42 patients with gliomas involving Broca′s area underwent surgical resection under awake anesthesia at Department of Neurosurgery, Huashan Hospital, Fudan University from January 2011 to December 2017 and were enrolled into this retrospective study. Language cortical activated areas and subcortical pathways were preoperatively reconstructed for surgical planning with functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) tractography respectively. During the craniotomies, direct electrical stimulation was used to localize language cortical areas and subcortical pathways, and resection of tumor was assisted with intraoperative magnetic resonance image-guided real-time neuronavigation system. According to whether the gliomas invaded ventral premotor cortex (vPMC), the patients were divided into 2 groups. Out of the 42 patients, 24 did not show invasion of vPMC (with merely invasion of posterior inferior frontal gyrus) and 18 did. The language mapping outcomes and surgical efficacy were evaluated and compared.

Intraoperative language mapping was successfully performed in all patients, and in 34 patients (81.0%) at least 1 positive functional site was detected. Three patients (7.1%) experienced focal seizure attack during the mapping process. Gross total resection was achieved in 25 patients, and subtotal resection in 17. Histopathological results indicated 23 cases of World Health Organization (WHO) grade Ⅱ gliomas, 14 cases of grade Ⅲ gliomas and 5 cases of grade Ⅳ gliomas. Sixteen patients (38.1%) experienced short-term language deficits after surgeries, out of whom 12 recovered in 3 months post operation and 4 (9.5%) did not recover. The median follow-up time was 24 months (6-84 months) in 42 patients.Tumour progression was seen in 14 of the 42 patients, and 11 patients died.Compared to the group with tumors that not invaded vPMC, the group with tumors invading vPMC had higher WHO grades(P=0.011) and higher occurrence of short-term language deficits [10/18 vs. 25.0% (6/24), P=0.044] and shorter progress-free survival (28.4±5.2 months vs. 80.7±3.2 months, P<0.001) and overall survival (38.8±5.8 monthsvs. 80.8±3.2 months, P<0.001).

The combination of multimodal techniques and awake anesthesia in the surgical treatment of gliomas involving Broca′s area could help protect the patient′s language function while maximizing the removal of tumors. Among them, tumors with invasion of vPMC may cause a higher rate of short-term speech dysfunction and a worse prognosis than those with merely invasion of posterior inferior frontal gyrus.

To detect the expression of calumenin (CALU) in human brain glioma samples, to explore its effect on the patient′s outcome, and to analyze the related biological functions of the genes co-expressed with CALU.

A retrospective analysis was conducted on CALU sequencing expression and clinical data of 288 glioma patients with positive CALU expression in the mRNAseq_325 database of Chinese Glioma Genome Atlas (CGGA). We analyzed the effects of CALU expression levels on survival in different types of glioma patients. The multivariate Cox regression method was used to determine the relevant factors affecting the survival of glioma patients. Pearson correlation analysis was employed to screen the related genes co-expressed with CALU and their biological functions were explored using the online bioinformatic analysis tools.

Among the 288 patients, the expression of CALU was 4.74±0.68, 5.49±1.12 and 6.17±0.94 in World Health Organization (WHO) grade Ⅱ, Ⅲ, and Ⅳ patients respectively, and 6.13±1.17 and 5.08±0.76 in isocitrate dehydrogenase l (IDH1) wild-type and IDH1 mutant gliomas respectively, and 5.79±0.07 and 4.71±0.07 in gliomas with 1p/19q non-codeletion and 1p/19q co-deletion. The comparative differences in the above indicators were statistically significant (all P<0.01). There was no statistically significant difference in the expression ofCALU between males and females or between primary and recurrent gliomas (both P>0.05). The median survival ofCALU patients with high and low expression levels (144 cases in each) was 13.0(1-132)months and 82.5(2-149)months, respectively, which had statistically significant difference (P<0.01). In patients with WHO grade Ⅱ-Ⅳ gliomas, the high expression ofCALU mainly reduced the survival time of grade Ⅲ and Ⅳ patients (both P<0.01). The multivariate Cox regression analysis showed thatCALU expression was an independent factor influencing the survival of glioma patients (RR=2.193, 95%CI: 1.507-3.192, P<0.01). In the CGGA database, there were 325 genes that were positively correlated withCALU expression. The biological functions of those genes were mainly signal transduction, cell adhesion and cellular metabolism, and were mainly involved in endoplasmic reticulum protein processing, adhesion and cancer pathways.

CALU is significantly related to the malignancy of brain glioma and may serve as an independent prognostic factor in high grade glioma patients, which thus provides a potential therapeutic target in the future research.

To explore the clinical treatment outcomes of the optic pathway glioma in children with diencephalic syndrome.

The clinical data of 8 cases of optic pathway glioma with diencephalic syndrome were analyzed retrospectively who were admitted to Department of Neurosurgery, Beijing Children′s Hospital, Capital Medical University from July 2015 to December 2018. The range of the children′s ages was from 8.0 to 42.2 months. No weight gain was reported in all those patients before the age of 1 year, and they showed a cachexia state of extreme emaciation at admission. The range of children′s preoperative weights was from 5.5 to 11.5 kg. The weight-for-age Z score was lower than -2 in all 8 patients who underwent microsurgical resection of tumor followed by chemotherapy post operation.

Among the 8 cases of optic pathway glioma combined with diencephalic syndrome, subtotal resection was achieved in 7 cases, near-total resection in 1, and there was no death related to operation. Postoperative pathological examination confirmed 2 cases of pilocytic astrocytoma and 6 cases of pilomyxoid astrocytoma. The range of follow-up period of 8 children was from 1 to 18 months, the range of postoperative weight was from 8.0 to 20.0 kg, the weight of all patients increased to various degrees, and some of the patients′ clinical symptoms were alleviated. One patient died after discharge, and chemotherapy was applied to the rest of 7 patients. Residual tumor shrank in 4 patients, progressed in 2 and disseminated in 1.

Subtotal tumor resection in children with optic pathway gliomas and diencephalic syndrome could significantly improve the symptom of emaciation and alleviate some other symptoms. There seems to be great variability in the tumor sensitivity to postoperative chemotherapy.

To explore the effect of direct electrical stimulation in awake craniotomy for glioma resection in the motor area.

We conducted a retrospective analysis of clinical data of 34 patients with gliomas in the motor area who were admitted to Department of Neurosurgery, General Hospital of Southern Theatre Command from March 2015 to July 2017. The tumor was located in the left hemisphere in 16 patients and right hemisphere in 18. The gliomas were in supplementary motor area or premotor cortex in 23 cases, the central area in 9 cases, and supplementary motor area or premotor cortex invading the central area in 2 cases. All patients underwent awake craniotomy under general anesthesia. Neuronavigation and/or intraoperative ultrasound were employed to locate the lesion. Direct electrical stimulation was used for cortical and subcortical mapping of the important eloquent areas. The tumors were removed according to the functional boundary.Neural function and the degree of tumor resection were evaluated after operation.

Of the 34 patients, 24 had a motor response after direct cortical electrical stimulation, 13 had abnormal sensations, and 10 revealed language-related cortices through mapping. For subcortical electrical stimulation, there were 24 cases of motor response, 1 case of abnormal sensation, and 8 cases of language disorders. A total of 30 cases (88.2%) of tumor removal reached functional boundaries, and subcortical electrical stimulation did not identify functional fiber in the remaining 4 (11.8%) cases which were all high-grade gliomas. Within 48 hours post surgery, the head MRI indicated total resection of tumor in 22 cases (64.7%), subtotal resection in 9 (26.5%), and partial resection in 3 (8.8%). The follow-up time of 34 patients was (23.6 ± 8.6) months (11.3-39.3)months.There were 29 cases (85.3%) which showed early postoperative neurofunctional disorders or worsening of pre-existing neurological deficits. Three cases (8.8%) developed late postoperative neurological dysfunction worse than preoperative conditions, of which 1 case was mild, 1 case was moderate and 1 case (2.9%) was severe. Of the 16 patients with preoperative neurological dysfunction or increased intracranial pressure, 13 had improved neurological function in 3 months after surgery, 2 were maintained in preoperative state and 1 had severe neurological deficits.

Functional mapping through direct electrical stimulation and continuous monitoring of the cortical and subcortical white fibers in the motor area during awake craniotomy could maximize the safe resection of glioma in the motor area, the incidence of long-term severe neurological deficits is low, and the quality of life could be improved after surgery.

To investigate the clinical characteristics and treatment regimens of high-grade gliomas in the elderly patients.

A retrospective study including 32 elderly patients with high-grade gliomas was conducted. Those patients were consecutively admitted to Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from April 2012 to August 2017 and enrolled into this study. Clinical characteristics, Karnofsky performance status (KPS), comorbidities (Charlson comorbidity index), tumor pathology classification, treatment regimen and overall patient survival were analyzed. All patients underwent tumor resection or biopsy, followed by concurrent chemoradiotherapy, chemotherapy, or targeted therapy. The Kaplan-Meier method was used to explore the effects of surgical methods, comorbidities and KPS on the overall survival of patients.

The patients enrolled into this study included 21 males and 11 females. Their age ranged from 65 to 79 years old with an average of 71.9±6.9 years old. Among them, there were 22 (68.7%) cases with glioblastoma [World Health Organization (WHO) grade Ⅳ] and 10 (31.3%) cases with WHO grade Ⅲ gliomas. The median KPS score was 78.1 (range: 40-90). The range of assessment results based on Charlson comorbidity index was 4 to 8 with a median of 5.7. Of the 32 patients, 21 patients (65.6%) underwent resection and 11 (34.4%) underwent biopsy. Seven patients underwent standard Stupp regimen after operation, 9 patients received temozolomide adjuvant chemotherapy without radiotherapy, 1 patient received targeted therapy, and 11 patients received no further treatment. Four cases were lost to follow-up. The median survival time of 32 patients was 15.8 months(range: 1.2-73.3 months). Survival analysis showed that surgical methods, preoperative KPS, and Charlson comorbidity index were not factors influencing overall survival of patients (all P>0.05).

Elderly patients with high-grade gliomas are generally in poor health conditions and have multiple comorbidities. Despite having undergone comprehensive treatment, including surgery, radiotherapy and chemotherapy, survival of those patients still seems to be relatively short. Therefore, when deciding treatment regimen, a relatively favorable treatment plan should be selected according to the specific conditions of the patient.

To investigate the role of mTOR signaling pathway in glioma-associated seizures (GAS).

We retrospectively analyzed 12 glioma patients admitted to Department of Neurosurgery, West China Hospital, Sichuan University from January 2016 to June 2016. Among the 12 glioma patients, 9 had glioma GAS and 3 did not. All patients enrolled into this study underwent tumor resection. After surgery, the neuroelectrical activities of tumor tissue, peritumoral tissue and peritumoral normal tissue were documented by patch clamping recording of brain slices to clarify the GAS lesions, followed by Western blotting and immunohistochemical experiments to confirm whether mTOR pathway activation was related to GAS.

Interictal-like discharges (ILDs) were observed in 7 of 12 peritumoral tissues obtained from patients with glioma who had experienced perioperative seizures. Their peak amplitude ranged from 0.300 mV to -0.429 mV and the slope was 1.502 mV/ms. However, their tumor and normal tissue samples didn′t show ILDs. No ILDs were observed in the tumor tissue, peritumoral or normal tissue of 2 patients with GAS and 3 patients without GAS. The results of Western blotting showed that peritumoral expressions of p-mTOR (relative expression value: 1.002) and p-S6K (relative expression value: 0.926) of patients with GAS were significantly higher than those of patients without GAS (relative expression Value: 0.756 and 0.661, both P<0.05), while their mTOR (relative expression value: 1.233vs. 1.178) and S6K expression (relative expression value: 0.925 vs. 0.917) expression levels had no significant difference (both P>0.05). There was no statistical significance in the expression of p-mTOR, mTOR, p-S6K or S6K in the tumor tissues between patients with GAS and those without GAS (allP>0.05). Immunohistochemical staining results showed that p-S6K and p-mTOR stainings were positive in the peritumoral tissues in 8 of 9 patients with GAS, while they were negative in 3 patients without GAS. Both p-S6K and p-mTOR staining were positive in tumor tissues of patients with GAS and patients without GAS.

The mTOR pathway expression in peritumoral issues is associated with GAS, which thus provides a potential target for therapeutics aimed at simultaneously controlling gliomas and seizures.

To evaluate the role of intraoperative ultrasound (IoUS) in the microsurgical treatment of intramedullary ependymoma and astrocytoma of the spinal cord.

A retrospective review was performed on 78 cases of intramedullary ependymoma and 34 cases of intramedullary astrocytoma which were treated microsurgically between January 2010 and May 2018 at Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. All cases of ependymoma or astrocytoma were divided into IoUS group(44 cases of ependymomas, 18 cases of astrocytomas) and control group(34 cases of ependymomas, 16 cases of astrocytomas) according to whether IoUS was employed during operation. All patients were followed up in the clinic or by telephone to assess tumor recurrence and spinal function recovery by radiographic reexamination and Modified McCormick Scale (MMS), which were then compared between IoUS and control group in ependymomas and astrocytomas, respectively. The accuracy of intraoperative ultrasound in evaluating the gross total resection (GTR) rate was also evaluated.

No significant differences were observed in age, sex, presenting symptoms, MMS or spinal cord segment of tumor location between IoUS and control groups in ependymoma or astrocytoma (all P>0.05). Compared with control group in ependymoma, the IoUS group had slightly higher GTR rate [97.7% (43/44)vs. 91.2% (31/34)], slightly higher rate of good outcomes in terms of spinal function [36.4% (16/44) vs. 32.4% (11/34)] and slightly lower incidence of complications [8.8% (3/44) vs. 11.8% (4/34)], which, however, were not significantly different (all P>0.05). For astrocytoma, the IoUS group had significantly higher GTR rate [16/18vs. 9/16, P<0.05] and longer median PFS [84.0 (67.5-100.5) monthsvs. 75.0(52.0-98.0) months, P<0.05] compared with control group. The IoUS group had slightly higher rate of good outcomes in terms of spinal function [3/18vs. 2/16, P>0.05] and slightly lower incidence of complications [0/18vs. 2/16, P>0.05] compared with control group. However, those differences were not significant (P>0.05). Postoperative enhanced MRI was used as the gold standard for verification of GTR. The accuracy rate of IoUS for prediction of GTR was 97.7% (43/44) in ependymoma and 14/16 in astrocytoma.

The intraoperative ultrasound technique could facilitate the real-time and accurate judgement of tumor resection extent, which might have greater application value in the astrocytoma.

To explore the clinical early efficacy of fully visualization foraminoplasty in treatment of lumbar disc herniation with percutaneous spinal endoscope.

A retrospective analysis was conducted on the clinical data of 32 patients who underwent percutaneous spinal endoscopic operation of fully visualization foraminoplasty for lumbar disc herniation at Department of Neurosurgery, Minhang Hospital, Fudan University (18 cases) and Department of Neurosurgery, Zhongshan Hospital, Fudan University (14 cases) from June 2016 to December 2018. Lumbar MRI was reviewed after surgery and visual analog scale (VAS), Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) were employed for outcome evaluation. Outpatient follow-up was conducted for all patients and included the assessment based on VAS, JOA score, ODI and modified MacNab criteria.

All 32 patients successfully underwent the operation. No postoperative infection, spinal canal hematoma or neurological dysfunction occurred. Postoperative review of lumbar spine MRI showed satisfactory excision of nucleus pulposus. Compared with preoperative conditions, 32 patients′ VAS score (2.21±1.18 points vs. 6.25±1.46 points) and ODI [(30.28±7.42)% vs. (68.63±11.04)%] were decreased 2 days after surgery (both P<0.001), and the JOA score (16.66±1.58 pointsvs. 12.43±1.85 points) was increased 2 days after surgery (P<0.001). The follow-up duration of 32 patients was 15±5 months (10-20 months). With the increase of follow-up duration, the VAS score of 32 patients showed a downward trend, the JOA score showed an upward trend, and the ODI showed a downward trend (F=187.43, 72.54, and 564.38, all P <0.001). At 12-month follow-up, the outcomes assessed according to modified MacNab criteria were: excellent in 20 patients, good in 9 patients, fair in 2 patients and poor in 1 patient. The rate of excellent and good outcomes was 90.6 % (29/32).

Percutaneous spinal endoscopic technique of fully visualization foraminoplasty for lumbar disc herniation could improve pain and nerve function, help patients to resume life and work, and has satisfactory short-term outcome. Its long-term therapeutic effect still needs to be further observed.

To investigate the outcome of optic nerve decompression through neuro-endoscopic transethmoidal-sphenoidal approach in the treatment of traumatic optic neuropathy (TON).

The consecutive clinical data of 29 patients (32 sides) with TON who were treated at Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University from December 2013 to February 2018 were retrospectively analyzed. Preoperative visual acuity results were as follows: no light perception (NLP) in 15 sides, light perception in 14 sides, and hand moving in 3 sides. All patients underwent optic nerve decompression through neuroendoscopic transethmoidal-sphenoidal approach assisted with intraoperative neuronavigation. High-resolution skull CT scan was performed before the operation. These aspects were documented including the anatomic landmark observed during operation, visual changes of the patients and operative complications.

The follow-up periods were 5.2±1.1 months (range: 3 to 6 months). Postoperative visual acuity results were as follows: NLP in 10 sides, light perception in 4 sides, hand moving in 4 sides, counting finger in 5 sides, and logMAR≥0.02 in 9 sides. The effective rate of operation was 59.4% (19/32). No surgical complications such as internal carotid artery injury, cerebrospinal fluid rhinorrhea or anosmia occurred.

Optic nerve decompression through transethmoidal-sphenoidal approach seems to be an effective method for the treatment of TON. The anatomic landmarks of the surgical approach are clearly defined, and intraoperative neuronavigation contributes to the safety of operation and reduces the occurrence of complications.

To explore the clinical effect of various surgical operations on the treatment of posterior inferior cerebellar aneurysm.

The clinical data of 36 patients with a total of 36 posterior inferior cerebellar aneurysms admitted to Department of Neurosurgery, Weihai Central Hospital from October 2014 to May 2017 were retrospectively analyzed. Among all 36 patients, 22 underwent transcatheter embolization, 9 underwent aneurysm clipping using craniotomy, and the remaining 5 underwent cerebral artery bypass surgery combined with transcatheter embolization. The treatment outcome was evaluated using Glasgow outcome scale(GOS) at discharge and modified Rankin scale (mRS) at follow-up. Imaging outcome was evaluated by digital subtraction angiography (DSA) or CT angiography (CTA).

Of the 22 patients undergoing transcatheter embolization, 21 were completely embolized. Aneurysms in 8 of the 9 patients were successfully clipped. Successful vascular anastomosis and complete embolization were achieved in 5 patients undergoing cerebral artery bypass surgery combined with transcatheter embolization. Among the 36 patients, 9 cases developed non-newly developed postoperative neurological deficits and 1 died. Thirty-five patients were discharged with GOS grade Ⅴ in 18 cases, Ⅳ in 14 cases and Ⅲ in 3 cases. Thirty-five cases were reexamined by CTA or DSA at 2 weeks post operation, which indicated disappearance of aneurysm. At follow-up of 3 months to 1 year post operation, 3 cases(8.6%) of aneurysm recurrence were reported which had undergone interventional embolization, and the rest of 32 patients had no recurrence. Thirty-five patients were followed up for 1 year. The mRS score was 0-1 in 21 cases, 2 in 8, 3 in 3, 4 in 1 and 5 in 1 case. The rate of good outcome were 85.3% (29/34) and there was 1 patient lost to follow-up.

According to the specific condition, interventional embolization, craniotomy of aneurysm clipping, or cerebral artery bypass surgery combined with transcatheter embolization could be performed to treat the posterior inferior cerebellar aneurysm, which might lead to relatively good clinical outcome with low incidence of aneurysm recurrence.

To summarize the diagnosis and treatment experience of 4 cases of atypical intracranial teratoid/rhabdoid tumor in infants and young children. Among the 4 children, 3 were males and 1 was female; The age ranged from 9 to 34 months. All tumors occupied huge intracranial space, with a maximum diameter>5 cm; Among them, 1 case was located in the left temporal insula of the supratentorial cerebellum, and 3 cases were located in the subtentorial cerebellum. Total tumor resection in 3 cases and biopsy in 1 case were all diagnosed by pathology after operation. The follow-up time of 4 children was 3 to 12 months, and 1 case was treated with chemotherapy after operation. The patient was still alive but the tumor recurred; The remaining 3 cases refused chemotherapy and died 3 to 4 months after operation. Intracranial atypical teratoid/rhabdoid tumors in infants and young children are relatively rare and highly malignant tumors with poor overall prognosis. Surgery and chemotherapy are the main treatment methods.

Rhabdoid meningioma is a rare intracranial tumor with high degree of malignancy, easy recurrence and metastasis, and poor clinical prognosis. Three patients with rhabdoid meningioma were reported. The diagnosis was confirmed by hematoxylin-eosin staining and immunohistochemical staining. One patient died of massive cerebral infarction 1 month after operation, one patient died of pleural effusion 2 years after radiotherapy and/or chemotherapy, and one patient still survived (survival time>25 months after operation). The diagnosis of rhabdoid meningioma needs to be confirmed by combining histopathological features and immunohistochemical staining. Regular postoperative imaging follow-up is necessary. Postoperative adjuvant radiotherapy is recommended for patients whose tumor is not completely removed by surgery.

Posterior inferior cerebellar artery (PICA) aneurysms tend to occur in the bifurcation between vertebral artery and PICA. Because of their deep location and involvement of important structures such as brainstem, the disability and fatality rate of surgery are high. Usually, endovascular therapy is used. However, craniotomy clipping has the advantages of clearing intracranial hematoma, no new space-occupying effect, and no long-term oral anti-platelet aggregation drugs after operation, which has been recognized by many people in the industry. This study retrospectively analyzed the clinical data of 10 patients with PICA proximal aneurysm treated with transocipital distal-lateral approach clipping in the Department of Neurosurgery, Taihe Hospital, Hubei Medical College Affiliated Hospital, Shiyan City from January 2015 to November 2018. Except for one patient who died due to intracranial infection and pulmonary infection, the other 9 patients had a good prognosis.

To investigate the effect of the regenerated facial nerve (FN) with varying degrees on the reconstruction of orbicularis function post facial-hypoglossal side-to-side neurorrhaphy (FN-HN) in the incomplete facial palsy model.

A total of 40 male adult Sprague Dawley rats were divided into 4 groups randomly. All rats were performed with crushed FN injury and FN-HN anastomosis. Three months later, the 4 groups were performed with FN cross section with different ratios at the proximal end to the injured site: no intervention in group A, 1/3 of cross section in group B, 2/3 of cross section in group C and transection in group D. The degree of closure of the affected-side eyelids in rats was assessed using the eye blink score, the muscle active potentials (MAPs) were used to detect the action potential and the area under the curve (AUC) of the rat′s orbicularis oculi muscle on the affected side, the number of positive neurons in the FN and HN nuclei were revealed by retrograde labeling, and the myelinated axons were counted on semi-thin sections of facial nerves and nerve grafts.

For the eye blink scores, the 4 groups showed significant difference during the three months (F=12.47, 11.00, 10.61, 19.13, all P<0.05) and after the cross section (F=29.06, P<0.05). Moreover, the score in group D was lower than that in group A and B(bothP<0.01). One week after the cross-section of FN, all 4 groups showed significant difference in amplitude and AUC of MAPs when we stimulated the proximal end of anastomosis site of facial nerve and the middle of the nerve graft (F=27.56, 11.86, 6.33, 4.65, all P<0.05). In addition, the amplitude and AUC of MAPs in group D were significantly lower than those in group A (bothP<0.05). Among the 4 groups, retrograde labeling indicated significant difference in the number of positive neurons in the FN nucleus (F=6.52, P<0.05), and the neurons in group D were less than those in group A and B (bothP<0.05). The counts of myelinated axons in both FN trunk and nerve graft in the 4 groups were significantly different (F=8.33, 6.35, both P<0.05). In particular, group A had less myelinated axons compared with group C and group D (bothP<0.05).

Preserving structural integrity of facial nerve during FN-HN seems to have positive significance. Retention of at least 2/3 regenerated facial nerve is beneficial for the recovery of the orbicularis oculi muscle.

To explore the pathological mechanism of peripheral nerve decompression in relieving tactile allodynia in diabetic rats.

Healthy adult male Sprague Dawley rats were randomly divided into 5 groups for different interventions: group Ⅰ (healthy control, n=10), group Ⅱ (diabetes model, n=20), group Ⅲ (diabetes model with latex tube placement, n=10), group Ⅳ (diabetes model with latex tube placement and nerve decompression, n=10), group V (diabetes model with latex placement and merely operational area exposure, n=10). The diabetes model was induced by intraperitoneal injection of streptozotocin (STZ). Nerve decompression was performed by removal of latex tube encircling the sciatic nerve at 3 weeks post model establishment. The paw withdrawal threshold was tested 3 days after modeling with the use of "up-down" method. Diabetic rats with tactile allodynia in 4 experimental groups (groups Ⅱ-Ⅳ) were preserved. Morphometric analysis of myelinated and non-myelinated nerve fibers was performed with the use of projection electron microscope. Western blot and immunofluorescence were used to localized and determined the expression of GABA _B receptor protein in spinal dorsal horn.

Three weeks after operation, the incidence of tactile allodynia in STZ-induced rats[55.0%(11/20)] was lower than that in diabetic rats with latex tube placement (groups Ⅲ, Ⅳ and Ⅴ) [86.7%(26/30), χ²=6.254, P=0.012]. The paw withdrawal threshold in group Ⅰ (13.41±1.88 g) was higher than those in groups Ⅱ-Ⅳ (4.06±1.28 g, 3.09±1.43 g, 4.02±1.96 g, 4.15±1.87 g respectively, P<0.05). At 5 weeks post operation, the paw withdrawal threshold in group Ⅳ was higher than those of group Ⅱ, Ⅲ and Ⅴ(allP<0.05). When compared with group Ⅰ, smaller myelinated fibers area and density, as well as higher g-ratio were revealed by electron microscope in each experimental group (allP<0.05). Larger myelinated fiber area and density, as well as lower g-ratio were noted in group Ⅳ when compared with those in group Ⅱ and Ⅴ (allP<0.05). The results of western blot showed that lower expression of GABAB receptor was noted in experimental groups (Ⅱ, Ⅲ, Ⅳ and Ⅴ) when compared with group Ⅰ (allP<0.05), and higher expression of GABA_B receptor in both NF-200⁺ areas and neurons of spinal dorsal horn was noted in group Ⅳ when compared with group V (P<0.05) at 3 weeks post nerve decompression. The results of immunofluorescence showed that lower expression of GABA_B receptor in both NF-200⁺ areas and neurons of spinal dorsal horn was noted in experimental groups (Ⅱ, Ⅲ, Ⅳ and Ⅴ) when compared with group Ⅰ (all P<0.05).

Peripheral nerve decompression can relieve the tactile allodynia of diabetic rats mainly by removing the compression damage of myelinated nerve fibers, lifting the GABA_B receptor downregulation-mediated central sensitivity, thereby relieving the pathological state of elevated spinal excitability.

Low-grade glioma is one of the most epileptogenic brain tumors. Epilepsy, as the most common clinical symptom in patients with low-grade glioma, can lead to cognitive decline and seriously affect the quality of life of patients. The site, histological type and molecular pathological characteristics of glioma are all related to epileptic seizures. The age, type of epilepsy, course of epilepsy, extent of surgical resection and antiepileptic drugs of the patient may also affect epileptic seizures. In addition, epileptic seizures are closely related to patients' prognosis and disease changes. Fully understanding the factors affecting epileptic seizures, better prolonging the survival of glioma patients, reducing epileptic seizures, and improving the quality of life are particularly important in the diagnosis and treatment of patients with low-grade glioma. This article reviews the progress of postoperative seizure and control in adult patients with low-grade glioma.

Alpha thalassemia with mental retardation syndrome X-linked (ATRX) gene is the causative gene of alpha thalassemia with mental retardation syndrome located on the X chromosome, and plays an important role in chromatin remodeling, maintenance of genome and telomere stability. About 30% of glioma patients are presentATRXGene mutation and deletion of the encoded ATRX protein are characteristic molecular changes in World Health Organization (WHO) grade II and III astrocytoma and secondary glioblastoma. In addition,ATRXGene mutations can be used as an indicator to evaluate the prognosis of patients with glioma. ATRX-deleted glioma cells maintain the length of telomeres through telomere replacement prolongation mechanism, and the damage of telomere DNA is serious. Overcoming the damage of telomere DNA may be an important mechanism for the rapid malignant progression of such gliomas. Intervention in telomere DNA damage repair may achieve the effect of targeted therapy.

Brain functional area surgery needs to remove the lesion to the greatest extent on the premise of protecting nerve function, so it is very important to clarify the function of each brain area. Negative motor area or inhibitory motor area is a region of cerebral cortex that has attracted increasing attention in recent years, but its localization, distribution and mechanism are still unclear. The understanding of negative motor response or inhibited motor response can further improve the theory of cortical motor network and provide a reliable basis for individualized surgery of functional area lesions. In this paper, the concept, location, distribution, mechanism, negative motor network and clinical manifestations of negative motor area after resection are reviewed.

As a new biological manufacturing technology, 3D bioprinting has unique advantages in the manufacture of high-resolution biological three-dimensional structures. In the past 10 years, this technology has been widely used in the establishment of organ and disease models. Traditional tumor models in vitro are usually 2D plane culture models, and the cells lack the nourishment of tumor microenvironment, so the experimental results are biased. 3D bioprinting technology has been increasingly used in the research of cancer occurrence, cell proliferation, metastasis and drug response by accurately reshaping the heterogeneity of tumors and the diversity of tumor microenvironment. In this paper, the application progress of 3D bioprinting technology in experimental research of nervous system tumors is reviewed.

Magnetic sensitivity weighted imaging (SWI) is a new magnetic resonance technology that uses the magnetic sensitivity characteristics of substances to image. It is abnormally sensitive to hemoglobin metabolites and calcium, and has been widely used in the clinical diagnosis and treatment of glioma. This review summarizes the role of SWI and intratumoral susceptibility signals in assessing intratumoral calcification, hemorrhage, and neovascularization, glioma grading, differential diagnosis of glioma from other intracranial lesions, and post-treatment monitoring; The role of contrast-enhanced SWI in assessing the size and margins of gliomas is also described. SWI and contrast-enhanced SWI have important clinical significance in qualitative diagnosis, grading diagnosis, differential diagnosis and post-treatment monitoring of glioma.